asked the Attorney-General the average time which elapses between the lodging of a bill of costs for taxation in the High Court and the appointment to tax the bill; whether there is any difference between the time taken in the Queen's Bench and Chancery Divisions, respectively; what time elapses between the actual taxation and the issue of the taxing master's certificate; and what steps he proposes to reduce these periods.

The average time which elapses between lodging a bill of costs for taxation in the High Court and the appointment for a master's taxation is 3½ months, and for a principal clerk's taxation 2¼ months. No distinction is made in the practice of giving appointments in Queen's Bench and Chancery Division cases. The average interval between a taxation and the issue of the master's certificate is about six weeks; this period depends largely on the time taken by solicitors to lodge the completed bills in the Taxing Office.

Because of these delays, which are caused by increased business in the Supreme Court, my noble Friend the Lord Chancellor has recently increased the complement of the Taxing Office very substantially. The Lord Chancellor is most anxious that the delays should be reduced, and he is watching the position closely.

Will the right hon. and learned Gentleman bear in mind that these very long delays are a great hardship to a great many people, bearing in mind that in infants' cases costs cannot be agreed, and in all legal-aid cases costs have to be taxed also? If a period of four to five months is to elapse between the close of a case and the winding up of the case it causes a great deal of hardship and sometimes real injustice.

Can the Attorney-General say whether the increase in the number of taxing masters has had an appreciable effect in the reduction of the arrears—has there been a long enough working of the new arrangement to enable the right hon. and learned Gentleman to say that—and, if not, does he intend to increase further the number of taxing masters?

I do not think that the House will wish me to answer a question like that offhand. They have only been appointed very recently and it is not yet possible to make a statement.

asked the Attorney-General on how many occasions the Royal Commission on Marriage and Divorce has met since the taking of evidence was concluded; and when a report is to be published.

asked the Attorney-General when the report of the Royal Commission on Marriage and Divorce set up by the previous Administration in July, 1951. may be expected.

There have been 37 meetings of the Royal Commission since the last public hearing of evidence. It is hoped that the preparation of the report will be completed by the end of this year.

Is the Attorney-General aware that his answer will be received with some satisfaction? Will he take this opportunity of denying the entirely mischievous statement which appeared in the "News of the World" and elsewhere that the Commission is so divided in its opinion that it is quite in-capable of producing a report; and that the chairman was proposing to ask for the Commission to be dissolved on those grounds?

I am sure that the bon. and learned Member has, by that question, achieved the result which he desires.

asked the Secretary of State for Foreign Affairs how many foreign pilots who served during the last war in the air forces of ex-enemy countries are to be trained in Britain; what countries are concerned; the reason for bringing them to Britain for training; anf if he will give an assurance that no part of their training will fall on public funds.

Her Majesty's Government cannot predict the intentions of private firms in this country to whom it is open to give flying instruction to foreigners who visit the United Kingdom. There is no question of any part of the cost of this training falling on public funds.

But is this not a kind of unilateral nudism which may do a great deal of harm to this country in the event of war? Is it not wrong for the Government to begin to allow this kind of thing? Would it not be better to wait until the world has achieved international disarmament before such things are allowed to happen?

So far as I am aware Her Majesty's Government are not in favour of nudism, whether unilateral or otherwise. Assuming that the hon. and learned Gentleman is referring to the possibility of secret information reaching the pilots, I can tell him that there is no question of any secrets being divulged during the course of flying training.

Would my hon. Friend inform the hon. and learned Member for Aberdeen, North (Mr. Hector Hughes) that if British civil aircraft are to be sold overseas, even to ex-enemy countries, it is frequently necessary to train pilots and crews to fly them?

That is one of the commercial benefits which we hope will accrue from the flying training.

asked the Secretary of State for Foreign Affairs when the former British prisoners of war and civilian internees in Japan may expect to receive a distribution of the proceeds of Japanese assets frozen in ex-enemy and neutral countries; and if he will make a statement.

The International Committee of the Red Cross, which is the body to whom Japan should transfer its assets or their equivalent, in former neutral and ex-enemy territories under Article 16 of the Japanese Peace Treaty, made proposals to the Japanese Government in November, 1953, with a view to the early settlement of this question. This approach has been supported by Her Majesty's Government and the Netherlands, Pakistan and United States Governments. A reply is awaited from the Japanese Government.

It should be noted that the distribution of assets envisaged in the Treaty will include prisoners of war of Japan, but not civilian internees.

asked the Secretary of State for Foreign Affairs whether his attention has been drawn to the statements made by Her Majesty's Minister-designate to Tegucigalpa at a recent official reception given in his honour by the Honduran Chargé d'Affaires in London; and what steps he proposes to take in respect of this appointment.

I have seen the report referred to, and am satisfied that Her Majesty's Minister-designate to Tegucigalpa, who has now left to take up his post, did not use the language attributed to him.

asked the Secretary of State for Foreign Affairs what recent representations have been received from the Greek Government with regard to Cyprus.

asked the Secretary of State for Foreign Affairs what reply Her Majesty's Government have given to recent representations from the Greek Government in regard to Cyprus.

I would refer to the reply which my right hon. Friend the Foreign Secretary gave in answer to a Question on 15th March by the hon. Lady the Member for Holborn and St. Pancras. South (Mrs. Jeger).

Does that mean that further representation has been made by the Greek Government on this matter either to this country or to our allies?

I would ask the right hon. and learned Gentleman to study the answer given by my right hon. Friend. I cannot go beyond it.

Has my right hon. and learned Friend read the leading article which appeared in "The Times" on 1st May, and which was written subsequently to the answer given on an earlier occasion? If so, may I ask whether the attitude of Her Majesty's Government is likely to be modified as a result of that article?

I have no comment to make on that at present.

asked the Secretary of State for Foreign Affairs whether he will give details of the increases in Soviet military strength and that of its satellites, as stated in the communiqué issued after the North Atlantic Treaty Organisation Ministerial meeting on 23rd April.

As the answer to this Question is rather long, I will, with permission, circulate it in the OFFICIAL REPORT.

Can the Minister give the House an indication of the major increases? May I ask him, also, whether we are to have any information about the development of the hydrogen bomb by the Soviet Union, as suggested in a recent publication of theirs, the "Red Star"?

I have no information which I can give to the House at present about the development of the hydrogen bomb in the Soviet Union. As regards conventional weapons and conventional forces, I may say that so far as ground forces are concerned there has been a great increase in the mechanisation with modern equipment of the forces of the Soviet Union. The tank force is up by about 20 per cent, since 1951.

As to the satellites, the number of divisions is almost double the number in 1947. Manpower has gone up from 140,000 to well over one million. The Soviet Union Air Force is steadily replacing piston-engined fighters and light bombers by jets. Nearly 100 per cent, of the Soviet fighter force is now jet aircraft and well over 66 per cent, of the light bombers.

Was not the whole idea of our rearmament programme that we should be able to negotiate from strength in 1954? Do not these figures show that we are not so much better off than we were before we started?

No, Sir. If the hon. Gentleman would like to put a Question about the relative N.A.T.O. strength he would receive what I hope would be an encouraging answer.

asked the Secretary of State for Foreign Affairs if he will make a statement on the proposed staff talks with the United States of America, France and other countries concerning Indo-China.

Existing miltary agencies have been examinng and will, of course, continue to examine jointly the various contingencies with which we may be faced. The five-Power staff agency is one such organisation. I must emphasise that any examinations undertaken are without commitment.

While appreciating the statement of the right hon. and learned Gentleman that no commitments have been made so far, may I ask whether he will give an assurance that there will be no commitment of British troops to Indo-China except in support of an agreement voluntarily agreed by all sides?

I think that is a different proposition altogether. I adhere to the position which was recently announced by the Prime Minister that no political or military commitments have been entered into at all at present.

Does the right hon. and learned Gentleman observe the amusement on his own side of the House when it is suggested that Great Britain should also have some voice in deciding international affairs?

asked the Secretary of State for Foreign Affairs if he will make a statement on the consultations which have taken place regarding the proposed security pact for South-East Asia.

asked the Secretary of State for Foreign Affairs if he will make a further statement about a proposed Pacific security pact.

asked the Prime Minister whether he will make a statement on the plans which are proceeding for the realisation of a South-East Asia security arrangement.

I will with permission answer Questions Nos. 18 and 28, and No. 45, addressed to the Prime Minister, together.

Her Majesty's Government have nothing yet to add to the statement made by my right hon. Friend the Foreign Secretary on 13th April and by the Prime Minister on 27th April.

Is it not a most extraordinary state of affairs that the Minister has made no fewer than three statements to this House saying that no discussions have been going on, and that President Eisenhower said last week that conversations were proceeding and that a security organisation for South-East Asia was in process of formation? Will the Minister tell us exactly what is going on? Will he drop these diplomatic evasions and tell us quite frankly whether any talks, conversations, consultations or discussions are going on about this matter and what is their gist or purport?

The statements to which the hon. Member referred must be considered each in its context. It is clear that the President was referring to informal and exploratory conversations. It is equally clear that on each occasion on which I referred to this matter I was referring to more formal discussion attended by representatives of a number of States.

Is the Minister aware that he stated that no discussions have been arranged, and that the President stated that:

"Most of the free nations of the area and others directly concerned have shown affirmative interest and conversations are actively proceeding… The fact that such an organisation is in the process…"

The right hon. Gentleman is reading.

I am quoting. Mr. Speaker, can I please have your protection from the rowdies opposite? I am quoting from President Eisenhower's statement, which is in flat contradiction to what the Minister said last week. Can we have the truth for a change?

I do not know what the right hon. Gentleman means by his expression, "for a change" The question I was asked was whether in one instance there had been any agreement to hold 10-Power talks. There has been no such agreement to hold 10-Power talks. I was asked whether discussions were taking place to which India, Ceylon and Pakistan had been invited. No such discussions are taking place. As I said before, there have been no arrangements made for formal discussion at which a number of States shall attend. I admit that possibly the words "talks" and "discussions" may be capable of misunderstanding; but if the right hon. Gentleman will be so fair as to see the context in which the statements were made, he will see that upon each occasion it was a reference to something of a formal nature attended by a number of States. I have never disputed that informal or exploratory conversations were going on.

On 5th May the right hon. and learned Gentleman said that no discussions had been arranged. Does the right hon. and learned Gentleman make a distinction between conversations about a specific object and discussions about it?

If the right hon. Gentleman sees the supplementary question to which that was an answer, he will see that it asked whether there were discussions taking place to which India, Ceylon and Pakistan had been invited.

Is it not the job of allies to be in continual consultation as to how they shall meet any eventuality?

Why deny it, then?

Can we take it that what is, in fact, happening is that there are some exploratory discussions and a technical examination of the problems involved by what were described as military aides? May I ask whether the decision to hold the informal discussions and the technical talks was made at the time that Mr. Dulles came to this country, and whether they had been decided upon when the Foreign Secretary made his statement to the House?

It depends what the hon. Gentleman means by discussions. There are not now taking place round a table discussions at which the representatives of 10 countries are taking part. There are conversations going on between one Government and another through the normal channels—for example, between us and the Governments of India, Pakistan and Ceylon.

As it was my supplementary to which the right hon. and learned Gentleman was replying, may I ask whether he was aware that I used the term "discussions" according to the normal diplomatic usage, which is consistent with conversations? May I, therefore, ask him whether the three countries to which I referred in my supplementary are, to his knowledge, considering the possibility of a pact in South-East Asia?

I think that the right hon. and learned Gentleman asked me whether they had been invited to take part in discussions. There are no discussions taking place in which anybody can be invited to take part. What is happening is that there is an exchange of views between Governments. Certainly, exchanges of views have been taking place and will continue to take place between us and the Governments of India, Pakiston and Ceylon. I might add that the interchanges which have already taken place with those three countries have been particularly valuable.

asked the Secretary of State for Foreign Affairs whether he will make a statement regarding the proposed revision of the Nile Waters Agreement. 1929.

The Nile Waters Agreement contains provision for adjustment to take account of developments in Nile conservation. It has become apparent in recent years that the time will soon come when better provision should be made for the Sudan's increasing needs. Her Majesty's Government were, therefore, glad to hear that as a result of conversations last February, agreement was reached between the Egyptian and Sudanese Governments that technical discussions should shortly take place on the sharing of waters which will become available from new works now being planned.

In view of British interests on behalf of Uganda in the Nile Valley, and of Ethiopia's interest in the Nile waters, will those two countries take part in any discussions or negotiations for a treaty to revise the 1929 Agreement in due course?

We certainly would have the right to take part in any revision of a treaty. These, however, are simply technical discussions which are within the framework of the existing Agreement.

In view of the importance of the Nile waters to so many countries, is any agreement anticipated with Abyssinia about Lake Tana?

If the hon. Gentleman will put a Question on the Order Paper on that subject, I will give him an answer.

asked the Secretary of State for Foreign Affairs whether, in view of the vital importance of maintaining Anglo-French understanding, he will give an assurance that Her Majesty's Government will continue the French services of the British Broadcasting Corporation.

Her Majesty's Government are studying the Report of the Drogheda Committee as a whole. I think it would be undesirable to anticipate the results of this study by giving assurances regarding any particular recommendations at this stage.

Will the hon. Gentleman direct his attention to the fact that this is a very critical time so far as our relationship with France is concerned? It is the anniversary of the Entente Cordiale, and it is very important not to restrict any services of this nature, particularly just now.

I can assure the hon. Gentleman that all those considerations will be borne in mind, including the vital importance to us and the free world of preserving Anglo-French understanding.

Is my hon. Friend aware that all through the winter it has been necessary to listen in at 6.30 a.m. in order to hear the French bulletin? Even now, in summer-time, it is necessary to be up at 7.30 a.m. to hear it. It is essential for hon. Members to hear the French bulletin. Does not my hon. Friend think it is rather early for hon. Members who have been detained late in the House the night before to get up to hear the bulletin?

I can only say that the bulletin is directed to French listeners in France rather than to English listeners in this country, however late they may have been kept up the previous night.

Is this not a year of very great importance to Anglo-French friendship, and ought we not to cement our friendship with that great country and not cast eyes to other countries?

I do not know what the hon. Member means about casting eyes to other countries. So far as Her Majesty's Government are concerned, every year is an important year for Anglo-French understanding.

As there are many demands for economy, is it not both obvious and wise that France should be one of the first countries in respect of which economies should be made seeing that France is already so very close to us in commercial, economic and other ways?

In the well-worn phrase, all relevant considerations have been borne in mind.

asked the Secretary of State for Foreign Affairs, in view of the fact that the Soviet Government has now agreed to the removal of the two main obstacles to the conclusion of a European security pact he himself put forward at Berlin, namely, the participation of the Americans, and the existence of the North Atlantic Treaty Organisation, if he will take advantage of the fact that all the Foreign Ministers are now at Geneva to raise the problem again, as a basis for further discussions on European security.

No, Sir. The agenda agreed for this meeting by the four Foreign Ministers at Berlin consists of Korea and Indo-China.

I thank the hon. Gentleman for that reply, but we are fully aware that the agenda is as he said. Might it not be an opportunity, while the Foreign Ministers are together, to give the world an indication of the attitude of this Government to the Soviet Note with regard to the participation of the Americans and the complete compromise on the condition so far as N.A.T.O. is concerned? Realism sometimes is not exactly synonymous with expediency.

I could not begin to understand the last part of the hon. Gentleman's supplementary question, but if he wants to find out the view of Her Majesty's Government and the other N.A.T.O. Governments which agreed to the text, he has only to read Command Paper 9146, laid last week, which gives the answer of Her Majesty's Government to the Soviet Union.

When my right hon. Friend the Member for Ebbw Vale (Mr. Bevan) introduced a rather similar debate a year ago, we on this side were all concerned about the information we had been given just a short time before about the setting up of a special Committee to investigate the financial background of the National Health Service. Many of the anxieties that were expressed at that time are very much still with us in regard to that Committee, but at least it can be said that the Guillebaud Committee is clearly being given the opportunity of time for studying this matter with care and apparently fairly fully, which we welcome. Therefore, some of our anxieties of a year ago need not worry us so much today.

We were anxious then lest that Committee should be used, as other Committees had been used in the past, for making spot interim recommendations that might have a serious detrimental effect on the working of the National Health Service. We feel certain that the more fully the Guillebaud Committee investigates the whole set-up of the National Health Service, the more it will be convinced that true economy in many fields of the Service will demand increased rather than reduced expenditure. We, with others, will await with great interest the report that the Committee will be presenting in due course.

But we would all agree that it would be quite wrong for us in the House of Commons to assume that we have no responsibility for National Health Service expenditure in this interim period before the Guillebaud Committee reports, I make no apology for raising many matters which certainly will be considered by the Guillebaud Committee but the responsibility for which nevertheless falls upon the Minister and, indeed, falls properly upon the House as a whole.

We on this side want to use the debate today not only to raise certain immediate vital issues, on which a good deal of concern has been expressed many times by hon. Members, on both sides, in Questions that have been put to the Minister, we want also to use this opportunity to raise wider questions about the whole future policy with regard to the National Health Service which, we think, it is vital to consider at this time.

I need not emphasise that we on this side are immensely proud of what the National Health Service has achieved. All of us realise what great relief it has brought to thousands of families all over the country. It has relieved a great number of them from very real anxiety. It has brought great new possibilities of treatment. It has unquestionably improved the general standard of hospital provision, although I am rather worried that recently several medical officers of health, in speaking at various congresses in various watering places, have been giving a misleading account of the situation with regard to hospitals.

I am particularly anxious when I see that one very well-known medical officer of health has been saying that no progress whatever has been made in our hospital provision since 1948. We know that that is demonstrably false. We know that throughout the country great advances have been made. While in some cities which were particularly fortunate in the past the same rate of progress may not have been maintained, in order to press forward more rapidly in other areas, it is quite misleading for men in responsible public positions, as many of these medical officers of health have been, to attempt to give the impression to the general public that because they have lost some contact with hospital development themselves, that has meant a complete setback to hospital development as a whole.

This is all the more a matter of anxiety to many of us when we are anxious today to consider ways in which we can secure a more adequate link between hospitals and other services of the local authority. It makes us all the more anxious when particular medical officers of health are making these statements, which are based upon a very narrow appreciation of the situation.

To most of us, certainly on this side and probably on both sides of the Committee, it is vital that we should conceive of the Health Service as whole, as a unity. Even though the Service has been developed administratively with three administrative arms, nevertheless none of our health problems can be solved by any one of those arms alone. We want to emphasise the need for co-operation within all parts of the Service if we are to make effective progress. It must be accepted by everyone that a common responsibility rests not only upon the medical profession, but upon all of us, with regard to the development of this Service.

All of us in this country stand to gain from the National Health Service, whether as individuals we need to make a claim upon it or not. We gain enormously from the general improvement of the standard of health that we seek to ensure. Therefore, it is wrong to argue that this Service —or, indeed, other services—is making us, as it were, dependants of the State. Rather I would urge that this great Service is emphasising our inter-dependence upon one another. It is that aspect of the Service that we want to emphasise as much as we can.

That means that a joint effort is required. If we have a criticism, it may well be that we have failed to make this common purpose as much understood as we need to do. In the medical profession itself there is far too much isolation, both from the world outside and, within the profession, between one section of it and another. So far as the general public is concerned, there is a great lack of knowledge of what is happening in the National Health Service.

Unfortunately, a good deal of what the public learn about the National Health Service comes from rather flamboyant articles about the rare cases that occur within the Service, where something goes wrong. By those accounts many amongst the general public are given a wholly wrong impression of the excellent work and high standard that is maintained generally in our hospitals and elsewhere in the Service. There is, therefore, a very great need for us to attempt to break down in the Service the barriers which at present isolate one section of the profession from another and which also tend to isolate the Service from the general public. I hope to put before the Committee some ideas which may be helpful in trying to meet those problems.

Before turning to that, I want to mention one major issue which, inevitably and very properly is raised year by year in these debates on the Estimates of the National Health Service. I refer to the great anxiety which we feel with regard to the whole financial treatment of this Service. The Minister can quite truly say that his Estimates this year provide for an increased capital allocation to hospitals of some 25 per cent, over the capital allocation last year; but what a miserable total is disguised by that percentage. It means that on the £8 million allocation last year there is an increase of some £2 million.

This increase brings us not wholly but only nearly back to the allocation provided in the Estimates for 1951–52. I do not think that anyone could possibly claim that this very modest increase in total is doing more than partially redressing the severe cuts made a year ago. It goes no way to meet the real needs of the Service. With that, to give him credit, I should imagine that the Minister himself would agree.

There is a serious lack of sufficient capital to embark upon even the modest schemes. We understand that, within the capital allocation, the Minister has been making special provision for mental hospitals and mental deficiency. We were glad to hear that only this weekend he was laying the foundation stone of such a hospital. But that has to come out of this very small increase in capital provision.

Provision for revenue may be regarded as even worse. I do not know what last year's figure amounted to, but the increase over last year is only about 3 per cent. The extra provision in the Estimates—which is all I can go on at the present time—for the general running expenses of the hospitals is some £7½million. The greater part of that must surely be swallowed up by salary and wage increases that have either already been agreed or are about to be agreed and will be current during this period.

The right hon. Gentleman, in answer to a Question which I put to him some little time ago, said that some £6 million was provided in the Estimates as a whole for salary and wage increases that had either been agreed or which it was anticipated would fall upon the Estimates this year. I agree that probably not the whole of that amount will fall upon the hospitals, but a very large part of it certainly will. Therefore, the increase, if increase at all it be, is of a very modest character indeed.

When one looks at the details of the provision for hospitals, one finds that, for example, there is little betterment provided for their repair and maintenance. That is a matter about which, as we all know, there is great anxiety. There comes a point beyond which one cannot further cut down repairs and maintenance except at very serious future capital cost. Many of us believe that that is happening today. Over a series of years we have been putting the screw on this sort of expenditure. If a proper standard of service is to be maintained, that cannot go on, unless one wishes to build up for oneself even higher future costs.

On many occasions I have pressed upon the Minister the urgent need for both capital and maintenance expenditure on such vital work as heating schemes, sanitation and laundry work. Expenditure on a very big scale in that sphere can bring enormous economies in the National Health Service and, apart from its very great importance in the care of the hospital patients, can be of very great value indeed. It is astonishing how many of our most famous London teaching hospitals still work in the most inadequate and out-dated sanitary conditions—conditions which I am sure would be regarded as quite impossible for present-day operation.

The Newcastle Regional Hospital Board, about whose operations I know a good deal, in its report for the year ended 31st March, 1953, made a good deal of comment on this very matter. It has been able to carry out small schemes of concentration of laundry work. It has had a great deal of very valuable advice in this regard. The small schemes it has carried out in relation to two hospital groups in the region have already secured savings, in one hospital group of about £4,500 and in the other of about £10,000 a year. From its experience it is satisfied that in this field in very many cases for £1 of capital expenditure a saving of £1 a year can be obtained. It urges that what is true in the north-east of England is also true of the generality of hospitals throughout the country.

To deny hospitals the opportunity of spending this capital money which can be of such great value is, therefore, just crazy. We must find a way—and I think that the Minister is anxious to do this—to secure the necessary capital grants to carry out this work. It is just as true of heating as it is of laundry work. We all know how many hospitals still have the most out-dated and extravagant heating appliances which are both a nuisance and wasteful in every possible way. The trouble is that today we very often have to wait for a boiler to burst or something of that sort to happen before we can tackle the job of putting in modern equipment. Even then, instead of doing the job properly, we may have to try to patch up.

I suggest that this shows the need for examining in some special way the capital provision for our hospitals. We must be prepared, as we are prepared in general housing provisions, to write off annual depreciation or amortisation of capital expenditure, in the Health Service and to regard it in the same way as we regard it in housing. If that is objectionable to the Treasury, as it may be, can we not at least try to secure some distinction between the types of capital expenditure so as to ensure that expenditure bringing such immediate returns as those which I have mentioned shall be given special and immediate consideration? As I say, I have raised this matter before with the Minister. I think that he is sympathetic towards it, and I hope that he will be able to say something further about it this afternoon.

Owing to the natural development of this country and as a result of factors over which the hospital boards have absolutely no control, there is today probably a need for more hospital beds and more expenditure, and not less. At least, there is a need for the better use of existing beds, and there is a limit to which we can go in this respect. Certainly a great strain is put on hospital staffs.

First, there is the fact of the growth in the general population, and secondly there is the fact of the added population at risk, if I may put it in that way. That is to say, there has been a great increase in the number of old people over retirement age and in the number of children today compared with before the war. I understand that there are over two million more old people and children in our population today, and obviously those are the very people who make the greater call upon our hospitals and, indeed, general medical provisions.

Various small surveys have been made of this matter. I very much hope that the Minister can say that he will be prepared to examine this matter more thoroughly and that there will be an adequate survey of the effect of the change in our population on the requirements of our hospital and other services. Since, because of these natural factors, the demands upon our hospitals must inevitably increase, that makes it all the more necessary to look logically and properly at the total figures of expenditure which are being incurred today.

Another factor which we cannot leave out of account is the serious increase in accidents, both on the road and in the home, which are again occupying a great deal of the work of the average outpatient department in the hospitals today. I learned the other day that, according to an estimate, something like £200 million a year is the cost to the country as a whole of accidents on the road and in the home. A good deal of that cost —I cannot tell how much—must be falling upon the Service as a whole, and a good deal upon the hospitals.

Again, it is utterly illogical to condemn the rising tide of hospital expenditure, as is often done, without regard to these factors with which we all have to deal, whether we like it or not. I think that the continuous pressure upon the hospital management committees and regional hospital boards for economy is beginning to produce a sense of general frustration among the members of those committees themselves. They know perfectly well— no one better—the kind of expenditure that can bring so much vital reward in the form of improved treatment—things that they want to do to improve the standard of provision—and they also know what can be done to produce greater efficiency in the hospital organisation, and economy as well. But they are precluded from doing those very things. Year after year this has happened. It is not just what has happened during the last year. This is piling up upon them, and the sense of frustration is growing.

While mentioning hospital management committees and regional boards, I should like, in view of some comments which the Minister made the other day in answer to a supplementary question, to pay a tribute to hon. Members on both sides of the Committee who have contributed a great deal to hospital management committees and regional boards. Many of them who are well known to us have played a great part in the development of our hospital services both before and since the National Health Service was introduced. One, of whom we are very proud, has been serving as Chairman of the Central Health Services Council since its formation, and he has a very wide experience of the National Health Service. In addition, there are many hon. Members on both sides of the Committee, as well as members of another place, who have contributed a great deal.

I think that it is a little unfortunate that the right hon. Gentleman should have tried to get his little bit of fun out of a supplementary question the other day by suggesting that there had been some political wangling in appointments of that sort, when the names of those concerned bear such a very high reputation throughout the country and, indeed, in some cases abroad as well.

If we are to get on to our management committees and hospital boards people of this calibre, then it seems to me that we must find some way of breaking this sense of frustration—all the more so today when people can see for themselves all manner of other capital expenditure going forward on relative luxuries, and when they know how much they themselves are being cabined, cribbed and confined, and prevented from doing work which they know will inure to the benefit of the country as a whole.

This is not to say that we on these benches do not believe in economy. Of course, we do. We are all fully seized of that and of the need for effective control. What we all want to strive after— and I do not think there is any difference of opinion here—is greater self-regulation in the hospital field as elsewhere. That means, surely, some improvement, if we can achieve it, in our system of costing. Here there have been different proposals put forward by the King Edward Fund and by the Nuffield Trust, and at this very moment the right hon. Gentleman has set up a committee to examine the different proposals and to see what can be worked out from them and what can be applied.

What we clearly need is some way of letting the staff of the department of a hospital know what is happening in relation to the general cost of the hospital, and, even though it may be difficult, if not impossible, to give a really accurate figure that would satisfy the average cost accountant in this field, some sort of rough-and-ready figures would be of immense value and would be helpful within the departments of hospitals themselves. Perhaps the Minister can say something about the committee that he has set up, or it may be that some further time is required before any recommendations can be made. We certainly would be interested to hear as soon as possible. We feel it is important that we should get some self-regulating machinery that will avoid the necessity of as much central control, because it would obviously be a great help to hospital committees throughout the country.

On the question of economy, I come back again to a matter that I have raised on several occasions in the House, the question of the employment and the extent of employment of the part-time specialists in hospitals. We are well aware that provision was made in the Act itself for the employment of part-time specialists. We make no complaint about that and about its continuance, although it raises very difficult issues on many occasions. But what concerns us is the feeling that, in some regions in the country, full-time specialists are being offered the choice of accepting the maximum number of part-time sessions, which cannot but be costly to the hospitals and also tends to cause very great difficulties within the hospitals themselves between full-time and part-time specialists.

There is a further matter; it is not merely a question of expenditure. I think it is a bad thing that full-time specialists at present are, in effect, debarred from domiciliary work. I know that there is no statutory provision to this effect, but in practice general practitioners do not call out full-time specialists for domiciliary work, and yet surely it should be the full-time specialist who, more than any one else, needs the contact outside and should be encouraged to have it.

We ought to bring about a moving around of these specialists in this way. It is a matter of concern that the domiciliary work should have been retained in effect entirely in the hands of part-time specialists. One hears continually accounts of the number of full-time men in the north who are transferring to part-time work. There is also the problem, which we know very well, of the attendance of part-time specialists at the hospitals. Some, we know, are very conscientious indeed; some are not so conscientious, and the hospital staff have to wait on their pleasure in some cases. I suggest that this is a matter of very great concern.

A link with it is the question of pay beds. We are conscious of the fact that we made provision for the maintenance of a certain number of private pay beds in hospitals and also of the fact that the matter has been under consideration, and amenity beds have been developed in many hospitals. But it must be a matter of real concern when we learn, as we do from the answer recently given to a Question put by one of my hon. Friends, that something like one-third of the private pay beds are not being used at the present time. Although I am fully aware of the fact that the total number of pay beds is very small in relation to the total bed provision of a hospital, nevertheless this is a matter which causes an amount of anxiety and worry, far out of proportion perhaps to the number of cases which are involved. I suggest that this is a matter which must be re-examined to see whether we cannot ensure that a higher proportion of these beds which are not being used for paying patients should be made available for the many who want them.

I have said that inevitably, because of the increase of population at risk, the total expenditure on our services tends to rise. There is another reason why our hospital expenditure tends to rise which we should surely welcome, and that is that we are able to treat many diseases which were previously not capable of active treatment, and it becomes more necessary to turn wards which were available for general welfare cases into active treatment units. Each time that is done the cost goes up,

I will take an extreme example. We know that mental hospitals, by and large, have a very low unit cost. There is nothing very much to be proud of in that. The more active treatment we manage to introduce into our mental hospitals, the more that cost will rise—and so it should. I was looking over a large mental hospital near where I live where there has been, as in most mental hospitals, a frightful amount of overcrowding, which still exists; but they have been able to start a certain amount of very progressive new treatment there, and costs are rising nearer to the average cost of the general hospital, which is as it should be. I am sure that in this field, during the next few years, there will be great developments. This will become much more general, and therefore we have to face the fact that it will not mean any reduction in the initial expenditure, but must result in an increase, which we should welcome because of the economies which will shortly be found in several fields in the ordinary general life in the country as a whole.

Surely, no one can say that, if we are able to achieve some improvement in our treatment of a section of mental cases, so that they are able to return home after a relatively short period of time and play some part in the general economy of the country, that is extravagant or wasted expenditure. This expenditure is surely of great importance to the economy as a whole. For all these reasons, there can be no justification for a general charge of extravagance against the National Health Service.

There may be many ways in which some saving can be made, but the general charge of extravagance is one which, we must understand, is quite false. Actually, when we think in terms of our national income and the small proportion of the expenditure on the National Health Service—if anything, a declining proportion—and compare it fairly with the expenditure on health generally in the days before the war, taking into account the change in the make-up of our population, we shall find that the expenditure per head of population has tended to fall rather than to rise.

There are points about the allocation of these funds which I must put. First, we welcome the improvement in the timetable arrangements for estimates which the Minister introduced a year or so ago. With regard to the capital, is it not possible to get the Treasury to agree to an allocation for capital resources at least over a period of some three or four years? I am not suggesting that this can be done over the very large general field of revenue expenditure of hospitals, with all the difficulties involved in that, but I think that with regard to capital expenditure it would be a reasonable proposal, and no doubt the Guillebaud Committee will be making some recommendation about it.

I want to turn to the question of health charges. This is a matter which we have raised from this side of the Committee on many occasions in the past. As we have made clear, we object to the way in which these charges have, in our view, infringed the general principle of a service which is equally available to everyone. I regret the fact that no effective means have been found of checking the detailed effect of these charges upon different sections of the community.

I regret particularly that the social surveys have been stopped which were providing us with some information about those who went to see their doctors and in particular the age composition of those who went. We want that information badly today. I should have thought that the Minister himself would have wanted it. I hope that he is prepared to see what further information can be obtained as to the full effect of these charges. I should have thought that this was the proper time to review the whole of the charging position. We learn that last year assistance of £1 million was paid out in refund of charges. Although I am not suggesting that this outweighs the financial return of the charges being made, it seems an extraordinary thing that so large a figure as that should have to be incurred.

I want to take three examples. First, the prescription charges. Do we really need now to maintain what is nothing more than a niggling tax on the general community? It has been condemned by such great authorities as the B.M.A. and the T.U.C., and when we get a combination of the two agreeing, who can possibly say that there is any case for maintaining those charges?

What is perhaps of greater importance is that we are now achieving a greater effective control over the issue of prescriptions than we had before, partly because of the proposals which were initiated some years ago. On the general question of getting the doctors themselves better informed as to the cost of prescriptions, good work has been done in that direction. I understand that fairly shortly area averages are to be instituted by which doctors can check how expensive their prescriptions have been. In these ways, as well as in drug costing, which the right hon. Gentleman has introduced, we should be able to make valuable progress towards getting really effective control of the amount of our drug bill, which we all want to do. Therefore, the need for any charge, if ever there was one, should now have gone.

I should like to know what progress has been made—and I hope that the Minister will be able to say something about it—on the question of costing. It is a matter which has been referred to by the Public Accounts Committee on more than one occasion, and it is a matter which arouses a great deal of feeling. It seems to me wrong that, where the State itself is paying the bill, the charge in respect of an individual for a certain item of medicine can be almost unlimited. It seems to be fair on the whole that, if the State is to pay the bill in this way, as we believe it should, the State should also have the right of investigation of the make-up of the cost of the articles which it is prepared to supply. I think that the Minister is moving some way towards this in the investigations which he is carrying out now. We shall be glad to hear what progress has been made, and whether some consideration can be given to the wider proposal which I have made.

With regard to dental charges, and especially with regard to charges for treatment, while we welcome the fact that more children are receiving treatment, a good deal of the value of increasing the amount of treatment for children is lost is there is a fall-away in the number of adults receiving treatment. I quite agree that it is very difficult to get any detailed information on this subject. Unless the Minister has made some special arrangements to obtain the figures in this field, a large part of the data is not covered by the ordinary returns, because a good deal of the simple treatment is now being paid for by the patient directly to the dentist, and so we hear nothing about it.

It is now quite commonly being argued by dentists and others that many adults and adolescents who should be persuaded to go to them for a regular checkup on their teeth are no longer going but are waiting until they get a mouthful of trouble, on the natural basis that they have anyhow to pay £1 and might as well get then-money's worth. I believe that that is occurring to a very large extent. If that is true, it is bound to be having a very bad effect upon general health.

Another point which I wish to raise relates to an alteration which was made by the Labour Government and for which I cannot charge the Minister with responsibility. It is the matter of travelling expenses. There is no doubt that this is causing a good deal of difficulty. We always understood that, especially in mining areas, but it is happening elsewhere too. Sometimes patients visiting specialists have to travel a long distance, and on many occasions they have to travel certain distances to attend outpatient departments. It seems wrong that in many of these cases the only way in which they can get a refund of their travelling expenses is by application to the National Assistance Board.

I make no charge against the present Minister on this score; we ourselves accept responsibility for its introduction. We know the abuses which may be possible. The problem is how to avoid abuses and yet deal fairly with the many hard and borderline cases which emerge. If the Minister has any suggestions to put forward, it will be a matter of very great interest to all of us, especially the members of the T.U.C. who have been pressing the subject very strongly.

I have said that it seems to me that if we are to make progress in the development of the National Health Service, we need to have much more effective cooperation within the Service. If we look at any of the major problems, whether they relate to the care of old people, mental illness or the great growing modern problem of cancer, it is surely clear to everyone that no one element of our Health Service can hope to treat it by itself. We must ensure the effective cooperation of all parts of the Service. Indeed, we might well ask whether the preventive part of our Service is getting sufficient attention.

I do not want to exaggerate the effect of dividing the Service into its present three parts. There were previously more than three parts, and so to that extent, what we have at present seems to be a great advance. But it is true that it has had the effect, to some extent anyhow, of holding back some of the co-operation which we might otherwise have had. We must get the medical officer of health, the general practitioner and the hospital specialist working together on the great range of the problems that we face today.

With very great respect to the Central Health Services Advisory Council, I do not believe that co-ordinating committees will get us very far. The danger is that we meet ourselves round the corner, for it is the same group of people, divided into twos, threes, fours or fives, which keeps meeting.

Ideally, we want a single health authority. I was very much struck by an article in the "Municipal Journal" by my right hon. Friend the Member for Ebbw Vale urging that we must now consider the possibility of a single health authority after, and only after, the reform of local government. Large areas of local government would be practicable for hospital planning purposes, but do we need to wait as long as I fear that might be?

I believe that we can make some start on the problem of administrative changes fairly soon. For example, it should be possible within a reasonable period of time to get a linking up to begin with between the health executive councils and the local health authorities. Already we have a good deal of common membership between the two. They cover the same areas.

I know very well the difficulties, which will be more professional than anything else, difficulties between medical officers of health and general practitioners in some cases, but if we could get that combination it would cut out one of the elements of division which we do not want and would enable us to look at part of the problem anyhow rather more sensibly and rather more connectedly.

More important than that is the actual physical contacts which we want to achieve between the doctors themselves and those working under the local health authority, between doctors and the hospital staffs. I certainly believe that group practices can help a good deal. Provision was made in the Danckwerts award to general practitioners for the setting aside of £100,000—a ridiculously small amount —to assist in the development of group practices.

Group practices may constitute merely a working together of anything up to six doctors in one set of premises. The doctors may or may not be partners, but at any rate they are working together from the same premises. Clearly, there is real advantage to be gained from this arrangement. There will be some discussion between doctors, which will be valuable. There will be a better organisation of work to enable the doctors to employ some staff which many doctors on their own cannot afford. There will probably be time available to enable some doctors to do work at some of our hospitals as clinical assistants which they might not be able to arrange on their own. It is a matter of concern that doctors should have direct access to diagnostic facilities in hospitals. Something on those lines has been happening, but we need to encourage it a great deal more.

These are great advantages, but they must be encouraged because we want more use made of them. I want to see a linking together between the general practitioners and those working on the staffs of local health authorities. We do not necessarily want very formal arrange- meats. We want the general practitioner to see more of the health authority staff, more of the medical officer of health and more of the health visitors and district nurses, who are working on the same problem as the general practitioner.

Therefore, I have a suggestion to submit to the Minister. Would it be wise, or possible, to suggest that, where funds are made available for the encouragement of group practices, it should, wherever conceivable, be arranged that there should be some facilities for local health authoity clinics to be held in the same premises or at least that there should be some accommodation for health visitors or district nurses on the same premises? It would not make any very large demand on accommodation and it would in many cases be very simply arranged.

On the other hand, we would also welcome further development of health centres themselves, perhaps on a more modest scale that that of Woodberry Down, which was a vital experiment to carry out, but perhaps more on the lines of the Bristol health centre, where essentially there is obtained a linking up of the general practitioners with the local health authority's staffs.

We cannot afford to wait any longer to get an improvement in general practice. I do not pretend, of course, that the general standard all round of general practice is bad—far from it. The various reports which have been made make it clear that the majority of it is very good, but there is certainly a proportion, possibly a small one but a very serious proportion, which is very bad. We ought to face that fact.

I have been reading, as I am sure many other Members have been, an excellent book by one of our former colleagues in the House, Dr. Stephen Taylor, who has made a most interesting and valuable report which brings out the fact that, from the experience he has gained in going round covering good practices, he estimates that there are something like 10 per cent, of general practices that are really bad—there may be as many as 25 per cent, altogether below standard but 10 per cent, that are really bad, and about which some action really should be taken.

I suggest that the great majority of these bad practices are in industrial areas —we all know that the vast proportion of them are. It is a great tragedy that those doctors are getting the advantage of payments in a way in which they have no right to do. The new award, and the payment to general practice, is based on the assumption of a percentage of expenses of about 38·7. No one will make me believe that in these shocking practices in many of our industrial areas anything like that percentage is being spent on expenses. Therefore, in fact, they are swindling the National Health Service. What is more, they are bringing contumely on the other doctors who maintain, sometimes at great expense to themselves, a good standard of provision generally.

I suggest that we cannot wait any longer before taking action about these bad practices, which are well known. I am sure that the health executive councils know who those concerned are, and I believe that the councils should be encouraged, without waiting any longer, to take action about them. They should now inspect these premises and warn some of the worst offenders at all events that unless some immediate improvement is made they cannot be any longer regarded as practising within the National Health Service. The time has come for really strong action of that kind, and I very much hope that the Minister will consider it.

It is true, unhappily, that many of these bad practices have long lists of patients; it is not a question, unhappily, that the patients are objecting; it may be that they know no better, that they have been used to this very low standard. It is our duty, however, to take action now about such practices and really to raise the standard, because upon this standard of general practice depends the whole of the rest of the working of the Health Service. That is in many cases the only contact which the general public has with the Service. For the sake of our good name in the world, we should do something about it. I apologise for spending so much time on that issue.

It seems to me that we need a new climate of co-operation within the National Health Service. How can we obtain it? I suggest that we must look at the content of medical teaching to some degree; we must have more regard for general practice in the teaching of medicine instead of regarding it as the son of field that the doctor goes into if he cannot go into anything better. The medical student should be encouraged, and I am glad that in some ways he is being encouraged, to regard it in many cases as one of the most important fields for the use of his skill and ability.

We wish to ensure, if we can, that the newly-qualified medical practitioner, having gone out into individual practice, shall retain his contact with his teaching hospital and with hospitals in general. I wish to pay a tribute here to Sir James Spence, whom I know very well, who in the north has done a good deal of valuable work in this field. He has gone out of his way to ensure an informal maintenance of contact with newly-qualified practitioners and has done very well in that way and help to raise the general standard of general practice by encouraging continuous contacts between the hospital and the general practitioner.

I think we can also do something in the sphere of administration. We badly need today a better standard of hospital administration. I make no charge against existing hospital administrators, but they would themselves agree that they would profit by a great deal of further training. Many of them are now taking advantage of some schemes of training that are being provided on a limited scale by the College of Hospital Administrators in collaboration with the King Edward Fund. Can we not regularise that position rather more by conceiving of the linking of the training for hospital administration with one of our existing medical colleges, possibly, for example, with the School of Hygiene? If not that, it ought to be linked, somebody has suggested, with the London School of Economics or social welfare. It needs to be brought within a definite scheme. Everyone who is concerned with this experiment of the College of Hospital Administrators—