asked the Minister of Health what study he has made of the petition signed by 810,000 old-age pensioners and others which was presented to the House of Commons by the hon. Member for Blackburn on 13th March calling for the abolition of all prescription charges; and what action he intends to take upon it.

I have nothing to add to my reply to the hon. Members for Wood Green (Mrs. Butler) and for Leicester, North-West (Sir B. Janner) on 11th December.

Does the Minister intend to ignore this powerful plea? Does not he know that Members of Parliament are receiving fresh evidence every week of the personal hardships and the medical harm caused by these prescription charges, and will he not try to retrieve at least some part of the Government's tattered reputation by abolishing them?

As I said in the Answer to which I have referred, I am watching the position; but I find no ground for altering the charges or for believing that the money yielded is not better employed in the National Health Service otherwise than by reducing the charges.

What evidence does the Minister need to convince him that the charges are causing real hardship and are acting as a deterrent to treatment? Is he quite impervious to argument in this matter?

There is no ground for thinking that they are acting as a deterrent to treatment. There are no figures or trends which suggest that at all.

Is the Minister aware that the 800,000 old-age pensioners who signed this petition are wondering exactly what is done when petitions of this sort are signed? They have heard nothing about it. There has been very little reference to it. Does the Minister realise that very many of those who signed the petition are asking whether it is any use making representations to a democratic body and then not hearing anything about it?

asked the Minister of Health what recent action he has taken, and what further steps he proposes to take, to deal with the health problems associated with cigarette smoking, and in particular to discourage young persons from acquiring the smoking habit.

asked the Minister of Health what action he has taken to date following the report of the Royal College of Physicians on the dangers of cigarette smoking; and what expenditure he has incurred as a result.

Initial guidance has been given to local health authorities, the first batch of publicity material has been issued to them, and further issues are in preparation. The expenditure involved so far will be about £25,000.

That is all very well as far as it goes, but it does not go very far. When will the Minister be in a position to tell the House what is being done about the important recommendations, notably those suggesting a control of cigarette advertising, particularly that directed to young persons, and what does the Minister intend to do about the establishment of anti-smoking clinics within the Health Service?

I am considering the practicability of establishing some antismoking clinics experimentally. On the general question, I must refer to the reply of my right hon. Friend the Home Secretary on 1st May.

I thank the Minister for adopting the novel but welcome practice of notifying me in advance that my Question would be answered with an earlier Question. When compared with the £800 million which the Government derive from tobacco taxation and the millions of £s spent by tobacco advertisers on increasing the sale of their wares, do not the efforts of the Government to date seem puny and inconclusive?

There is no direct relationship between the two sets of values which the hon. Gentleman has mentioned. I am sure that it is unwise to move faster in this matter than really useful and effective publicity material can be produced.

asked the Minister of Health how many new drugs have been prescribed to National Health Service patients before adequate clinical trials have taken place in the last three years; how many of such drugs have been withdrawn; and what steps he is taking to protect patients in this matter.

It is not for my right hon. Friend to judge when adequate clinical trials of drugs have taken place. It is the doctor's responsibility to decide whether he is justified in prescribing a particular drug for a particular patient.

Is the hon. Lady aware of the concern expressed by Lord Cohen at a recent seminar and the statement by Professor Graham Wilson that, in the last year, more than half the drugs which had been issued had not been correctly clinically tested? Further, is she aware of the position in regard to the drug thalidomide which has been used for three years but has had harmful effects upon pregnant women? Is it not the Minister's duty to protect the patients in this respect?

I am aware of the symposium which was held and of the comments which were made. The drug to which the hon. Gentleman refers is the subject of a later Question, and I shall not anticipate the Answer. In fact, the British pharmaceutical industry and the medical profession both maintain a very high sense of responsibility in this matter.

Does not the hon. Lady think that there ought to be some control by the Ministry and clinical testing of drugs before they are put on the market with the high-pressure salesmanship and intensive advertising which goes on? Are the patients to go on suffering because doctors just have not the time or are not supplied with knowledge of whether certain drugs are clinically safe or not?

This is not the responsibility of the Minister of Health. It is the responsibility of the drug manufacturers and the doctors, and I have no reason to believe that the information is not available.

But is not a doctor able to prescribe only that which he is permitted to prescribe and which is paid for under the National Health Service? How can the hon. Lady shelve responsibility in this way, in view of the fact that these statements have been made by very responsible people, professors of pharmacology, and that of 56 drugs tested by Professor Wilson only 25 were found to have been adequately tested by clinical means?

It still is not the responsibility of the Minister of Health to tell the doctors which drugs they shall prescribe. It is the responsibility of the Minister to see that a service is available to patients.

asked the Minister of Health if he will establish a central body independent of the drug industry and responsible to him charged with the duty of approving all drugs to be prescribed to National Health Service patients.

I have no powers to do this.

Is not this totally unsatisfactory? If the responsibility rests on the doctor, is it not possible to ensure that he has in his possession clear unbiassed opinions telling him the qualities of drugs and what the side-effects are likely to be? Is it not inherent in the booklet prepared by the manufacturers that they must be able to be selective in the information they give? Should not the prescriber be in full possession of all the facts? I recognise that the pharmacological and drug houses have a high measure of responsibility and in the main are responsible, but in cases where there is doubt ought not the prescriber to have that knowledge put into his hands and should not a central body be responsible for that decision?

The National Health Service Acts quite rightly, in my opinion, gave me no powers to limit the drugs that a doctor may prescribe, but the Cohen Committee, that considers new preparations, and indicates those of no proved therapeutic value, and the grounds for doing so, may include the fact that adequate clinical trials have not been carried out.

My right hon. Friend will be aware that in his Department a working party has been dealing with this type of problem for about two years. Is he able to say whether he has yet received a report from that working party and, if so, whether it makes any recommendations on the subject matter of this question?

Not without notice.

asked the Minister of Health whether he will give wide publicity to the dangers to pregnant women of the drug called thalidomide to ensure that people who have supplies of this drug in their home will destroy them.

My right hon. Friend and the Secretary of State for Scotland are taking steps to give warning through the Press and otherwise of the risk of taking hypnotics in circumstances for which they have not been prescribed.

While thanking my hon. Friend for that reply, may I ask whether she is aware that at the same time there is a drug marketed in this country known as Distaval which has ghastly effects? Does she not agree that the widest publicity should be given to what this drug can do—the ghastly effect it can have on unborn children? While I realise, from an Answer to a previous Question, that this is not her responsibility, would not my hon. Friend agree that before any new drugs are put on the market the widest possible investigation should be made of any adverse effects they might have?

I think that we should all have in mind the necessity of not worrying pregnant women unduly. Nevertheless, this particular drug has been withdrawn and the medical profession has been warned by manufacturers and by articles in the medical Press. We in the Department are prepared to add to that very quickly by issuing a Press statement and by writing to general practitioners, medical officers of health and to hospitals asking them to warn women patients of the dangers which they might incur during the pregnant stage if they use drugs which are not specifically prescribed at that time.

Will my hon. Friend also bear in mind the fact that this drug is available to women who are not pregnant? They may have some in their medicine chests at home and if they have discovered them to be effective as tranquilisers they might take them again when they are pregnant. I want all of this drug destroyed in people's homes.

That is why I put particular emphasis on women not using drugs prescribed for a condition other than that for which they were prescribed.

Is the hon. Lady aware that this drug was available for three years before this kind of information was available? We do not wish to worry pregnant ladies unduly, but it should be stressed that it should be the Minister's responsibility to see that protection is given.

That is really a separate question, but, in fact, the drug had extensive tests, in Germany first and then in this country. The side-effects which showed later could not possibly have been foreseen.

asked the Minister of Health to what extent there has been increased prescribing by doctors of standard drugs from the British National Formulary in preference to identical pro- prietary brands; and what is the estimated saving to the Exchequer in a full year.

It is still too early to judge.

Will the hon. Lady consider some way of helping doctors to write out their prescriptions when prescribing drugs from the British National Formulary? The branded description is often much more simple than the chemical one. Would not the provision of a rubber stamp which impressed the words "British National Formulary", Which doctors could stamp on their prescriptions, assist them?

I will consider that point. At first blush, it does not seem to me to be very practicable. I may also add that the Cohen Committee recently approved lists of proprietary preparations and branded preparations whose active therapeutic constituents are identical or differ only in physical form. My right hon. Friend is considering at the moment how the information in these lists can be presented.

I appreciate that it may be too early to estimate annual savings, but can the hon. Lady say whether the returns coming into her Department show any marked improvement since the new policy was adopted?

Our experience is still not really sufficient to give any indication. It will mean considerable analysis of all the returns over a twelve-month period.

asked the Minister of Health if he will now state how his negotiations with firms in the pharmaceutical industry under the voluntary price regulation scheme are progressing.

Most prices have now been reviewed and a number of substantial reductions in the prices of patented drugs have been agreed. Negotiations continue.

I thank my right hon. Friend for that Answer. Can he tell the House how much this element of the National Health Service is now costing? Last July he said that it was costing £100 million a year, Secondly, is he satisfied that the patient is getting the maximum benefit from these drugs? Thirdly, in view of certain earlier Questions this afternoon, will he again confirm that all those in genuine need can get a refund of the prescription charge?

I cannot, offhand, give my hon. Friend the total cost of the pharmaceutical service on an annual basis at this moment, but reductions in the prices made since the new scheme came into effect total about £4 million a year. I can assure him that none of these reductions in price has operated to the disadvantage of any paient; in fact, the contrary is probably the case.

asked the Minister of Health, why he has requested local executive councils to secure less publicity for doctors guilty of a breach of their terms of service.

I have not done so.

Has not the right hon. Gentleman issued a circular reminding local executive councils that names and other means of identification must never be given? Is he not trying to give more protection to guilty doctors, because there is no law that makes it illegal for the Press to publish names? Would it not be better to provide more protection for the public and less protection for the guilty doctors, some of whom have appeared five or six times before local executive councils?

The hon. Gentleman, by using the word "reminding", has put the matter in the right light. There has been no change in this respect.

Is the right hon. Gentleman aware that his statement has given rise to certain misgivings? What we are concerned about is that doctors and dentists who are guilty of serious professional negligence should have their cases reported by the right hon. Gentleman to the General Medical Council and General Dental Council. Can he assure the House that he is doing that and can he say how many cases have been reported during the last twelve months?

I can give that assurance and I have informed the House to that effect. I cannot give the exact number, but it is a very considerable proportion of the total number of cases.

asked the Minister of Health if, in view of the social and economic disabilities suffered by the children of those who have been certified insane, he will take steps to provide for the formal annulment of such certification when it is found to have been based on an erroneous diagnosis.

No, Sir.

Is the right hon. Gentleman suggesting that—rare though undoubtedly they must be—mistakes in diagnosis have never occurred? If they do, is it not grossly unjust to the person concerned and to his children because of the disabilities which must be known to the right hon. Gentleman—the jobs for which there are questionnaires asking whether there is a family history of mental illness, and that kind of thing?

As the hon. Gentleman knows, the Royal Commission on Mental Health looked into this matter, but it did not recommend that there should be a statutory procedure for annulment.

That is not what I asked. I asked the right hon. Gentleman if he was aware that there were these disabilities, and if he cannot take some action to remedy what I admit must be a very rare kind of error?

As I explained, there is no statutory procedure for this purpose, but I have no reason to think that the circumstances to which the hon. Member refers are arising or cannot be dealt with and met in other ways. If he has any particular case in mind, I should be very happy to consider it.

asked the Minister of Health when the hon. Member for Barking may expect a reply to his letter of 22nd January concerning the provision of a motor invalid chair for Mr. Thomas Tuck, of 4 Roycraft Avenue, Barking.

There is no trace of any such letter or of any application from Mr. Tuck having been received.

Is the hon. Lady aware that that is really a very feeble Answer, since we have been on to her Department by telephone repeatedly asking when we should get a reply, and since we gave all the particulars again about ten days ago?

That is not my information. I know that contact has been established with the hon. Gentleman's private secretary. I understand that there is no trace of any acknowledgement. A copy of the letter was promised to us but it has not yet been received. I shall be happy to do something if I can have the information.

asked the Minister of Health whether he will end the practice by which doctors are asked by executive councils to write false prescriptions in order to discover whether pharmacists are defrauding the National Health Service.

I assume the hon. Member refers to the scheme for test prescriptions. No, Sir.

Is the hon. Lady aware that many doctors regard it as unprofessional that they should have to act as private detectives or, indeed, almost as agents provocateurs for the Ministry? Would she give serious consideration to whether there is not some more honourable method of testing the capacity of pharmacists to make up prescriptions?

I do not think it is necessary to consider changing the system. It has served since before 1948 under the old Health Insurance Scheme. In general it has the support of the medical and pharmaceutical professions. Its prime purpose is to protect the patient. The hon. Member may like to know that there is in effect a conscience clause and that if a doctor does not want to write test prescriptions the executive council is empowered to take that point into account.

Since there is no testing scheme for doctors dispensing or for hospitals dispensing, why should there be a testing scheme only for the retail chemist?

This is a test in the same way as test purchases are sometimes made under the Food and Drugs Act. As I say, it has a long history and its intention is to protect the patient.

asked the Minister of Health what immediate improvements he intends to make in the maternity service in Greater London.

I would refer the hon. Lady to my reply to her on 13th November. In addition, about 100 further beds will be provided in the next few months.

Is the hon. Lady aware that because of the shortage of beds in the Greater London area last year more than 3,000 mothers had to make use of the emergency hospital beds service, and that while mothers were trying to find places in hospitals a number of babies were born in ambulances and others in most unsatisfactory home conditions? Is the hon. Lady aware that tinkering with the problem will not end what has become a major scandal in the Greater London area and that it needs drastic action taken at once? One hundred beds will go nowhere to meet the shortage.

I am aware of the figures which the hon. Lady has quoted. In fact, London is exceptional. The greatest pressures are there. More people come to London. There is a greater floating population. More unmarried mothers come to London. There are more births in hospitals in London; in the L.C.C. area between 80 per cent. and 85 per cent. of the births take place in hospital, which is well above what was recommended by the Cranbrook Report. The immediate need is for 100 beds. That, taken with the better selection, will, we believe, relieve the position.

asked the Minister of Health, if, in view of the high rate of induced abortion among married women and the large numbers of unwanted children coming into public care, he will urge local health authorities to inform mothers, through the medium of health visitors and by any other means, of the availability of family planning services.

No, Sir.

Is it not a ridiculous position that even where family planning clinics already exist in local authority premises, it is forbidden to advertise them or publicise them in any way? Is it not time that the Minister ceased to be intimidated by a religious minority from adopting a rational policy to what is a most valuable and necessary health service?

I am not intimidated by anybody and I do not accept that the existence of these facilities and their availability is not well known, or that doctors, where they consider pregnancy to be undesirable on medical grounds, do not refer their patients for the necessary advice.

asked the Minister of Health what representation he has received from the profession with regard to his proposals for distributing the £500,000 per year set aside for the payment of merit awards to general practitioners.

The profession have not yet reached a decision on the Joint Working Party's proposals.

Is my right hon. Friend aware, however, that there are distinct antagonistic reactions starting again to this proposal? Does he not agree that this is a unique instance of a profession being offered money and not wanting it? Does not this situation appeal to his economic frame of mind? Alternatively, perhaps he could give the money to the nurses.

These arrangements require the agreement of the profession before they can be brought into effect, but I think that it would be wrong for me to comment while the profession is considering them.

asked the Minister of Health what representations he has received from Bolton Corporation concerning the inadequacy of arrangements for co-ordinating those health services for which the corporation are responsible with those which are the responsibility of the Manchester Regional Hospital Board.

A resolution urging automatic representation of local health authorities on hospital management committees.

Is the Parliamentary Secretary aware that the local health authority is most concerned about the day-to-day co-ordination between its health services and those provided by the hospitals? It feels that it should know about the deliberations of the hospital management committee since it is the largest local health authority in the area. Is the hon. Lady aware that there is widespread dissatisfaction at present over the composition of a lot of hospital management committees and will she look into this whole matter and, perhaps, have a Departmental inquiry to see how this dissatisfaction can be removed? This is a matter of great irritation and embarrassment to many of the excellent people at present serving on these committees?

It would need legislation to amend the existing pattern, but under the National Health Service Act, regional hospital boards are required to consult local authorities, among other bodies, and I think that this is the right way to do it. We choose people because of the contribution that they can make and not because of the specific interests which they represent. The hon. Gentleman will know that in his own area, two Bolton councillors are, in fact, members of the hospital management committee, although their names were not suggested by the council. The medical officer of health is also a member of the hospital management committee.

But the local health authority has repeatedly sent nominations which have constantly been turned down over a number of years.

Not turned down. It is impossible to make room for all the people suggested to the regional boards. I emphasise that this is the responsibility of the regional board and not of my right hon. Friend. Wherever someone can be appointed who can bring practical knowledge to the work of the hospital management committee, that is taken into account.

asked the Minister of Health whether butter imported from France, Argentina and South Africa is subject to hygienic conditions comparable with those for imports from Commonwealth countries.

Yes: importation is subject to the same conditions under the Imported Food Regulations.

I am grateful to my hon. Friend for that reply. Will she continue to see that these hygiene regulations are stringently applied to all countries which import butter to this country?

Yes, Sir.

asked the Minister of Health whether his attention has been drawn to the report of the Health Committee of the Derbyshire County Council, a copy of which has been sent to him, about the rapid decline in the consumption of welfare foods since the price increase of June last, and the Committee's concern about the future health of mothers and children if this decline continues; and what steps he will take to arrest this fall in consumption.

My right hon. Friend is aware of the Report, but consumption in Derbyshire increased in the last quarter.

If the consumption increased in the last quarter there would not be much purpose in the Health Committee's commenting on the fall in the consumption of these welfare foods. Obviously the Health Committee has taken into account more than one quarter.

I am aware of the representations. It is true that there was a marked decline with the changes in the price of these foods, but it has taken an upward trend in the last quarter, which is a factor to be recognised. Other than that, the same answer still applies—that mothers are obtaining the necessary vitamins for their children from other sources.

But where can they get these cheaper than they can obtain them from the Health Committee, or from local authorities generally? Are mothers prepared to pay more money when they can get these foods for less?

Very frequently. I am glad that the hon. Member has made my favourite point, that these things are very good value.

In order to put the matter into perspective, will the hon. Lady tell the House what is the percentage current consumption in Derbyshire compared with the consumption before the subsidy was eliminated?

No, Sir—not without notice.

asked the Minister of Health how many trained nurses and student nurses were employed in the Queen's Park Hospital, Blackburn, on 31st December, 1949, and 31st December, 1961, respectively.

In December, 1949, 76 and 64, and in December, 1961, 77 and 72, respectively.

Is the hon. Lady aware that twice as many patients were admitted to this hospital in 1961 as were admitted in 1949 and that twice as many operations were performed? Do not the figures which she has just given show that the productivity of the nurses, whether trained or in training, has doubled during this period, and on this ground alone is there not an overwhelming case that they should be offered more than the miserly increase of 2½ per cent.?

The hon. Lady has not stated that the number of beds has fallen. The total number of nurses has increased, but the number of beds has dropped. It is true that there has been a greater turnover in those beds, but, on the subject of pay, I think that she should await the debate later this afternoon.

asked the Minister of Health whether he has now received the report of the inquiry into the management of the Rubery Hill Hospital in Birmingham; and what action he proposes to take.

No, Sir.

Can the right hon. Gentleman say when this report is expected and when it will be published? Is the right hon. Gentleman aware that many of us, after careful thought, have very grave reservations about the use of a public inquiry in cases like this, since it may do great harm to the traditions of voluntary public service in this country if a man can be invited by the Minister to perform voluntary work, can do it in a distinguished manner for many years and then find himself subject to the sort of public inquiry which involves him in personal costs of many thousands of pounds?

The hon. Gentleman asked me whether I had received the report. I have not yet received it. Until I do, which is not a matter within my control, it would obviously be improper for me to comment.

Is the right hon. Gentleman aware that this whole affair raises very grave issues indeed of public policy and that when the report is received and published and the right hon. Gentleman announces a decision we shall wish to debate it?

asked the Minister of Health what part of the total costs incurred by Mr. D. Rhydderch in defending himself at the recent inquiry into the direction of the Rubery Hill Hospital is being met from public funds.

Two hundred and fifty pounds and the cost of a transcript of evidence has been promised, without prejudice to further consideration.

Since the total costs to Mr. Rhydderch personally seem likely to be about £3,000, can the Minister give a firm assurance that he will reconsider the figure of £250? Since he would not answer this question before, may I ask it again: does not he realise the grave implications for the traditions of public voluntary service if a Minister, appointing a—

Order. It is not in order to ask a question to which an answer has been refused

The Minister did not refuse to answer. He simply did not answer at all.

He did not give an answer, which, from my point of view, makes the hon. Member's repetition of the question on this day out of order.

May I ask the first question again? Is it not clear that this figure of £250 is so low and the implications of it for the traditions of public voluntary service so great that it should be reconsidered?

The solicitors have been told that it is open to them to make representations at any time for an increase in the amount.

asked the Minister of Health, what are the ratios between the current maximum salaries of a ward sister, a staff nurse and a State enrolled nurse as compared with those on 1st February, 1949; and what are the equivalent figures allowing for the change in the value of the £.

As the answer contains a number of figures, I will, with permission, circulate them in the OFFICIAL REPORT.

Is the hon. Lady aware that during this period the wages of women over 18 years of age have doubled, and that I am sure that the figures which will be given in the OFFICIAL REPORT will show that nurses have been left behind in the increase in the standard of living achieved by their contemporaries? Is the hon. Lady further aware that this indicates that they have been grossly unfairly treated in the rejection of their wage claim?

The hon. Gentleman will find when he is able to study the figures in the OFFICIAL REPORT that they show that increases in pay to nurses have more than kept pace with changes in the value of the £. However, I am sure that he will wish to amplify his points in the debate later today if he catches your eye, Mr. Speaker.

asked the Minister of Health how many representations he has received since 13th March, 1962, either directly or through Members of Parliament, regarding the remuneration and working conditions of nurses and midwives; and whether Her Majesty's Government will advise the setting up of a Royal Commission to consider these matters with instructions to report with all possible dispatch.

Between five and six hundred to the end of April. The answer to the second part of the Question is "No, Sir."

Does the right hon. Gentleman appreciate the extent of public concern in this matter? Is there any reason why the Government should not, in the case of nurses, follow the precedent set in the case of the police?

I think that this and other matters will be dealt with in the debate on this subject which is to take place later today.

asked the Minister of Health why the hospital management committee at South Ockenden refused to allow a deputation of nurses to meat the hon. Member for Thurrock at the hospital premises.

Because they considered a meeting of the kind proposed would be more suitably held elsewhere.

This is a rather surprising answer. Is it the right hon. Gentleman's policy to prevent Members of Parliament from meeting their constituents in their constituencies in hospital without his permission? Where better to meet the nurses than in the place where they work, in the spacious accommodation which exists? In particular, will he say whether he approves of this decision taken by the hospital management committee? There are three supplementary questions, and I should like to have three answers.

I think that the decision is entirely within the powers and duties of the hospital management committee. I am sure that all hospital management committees—it would certainly be my wish—will welcome Members of Parliament on to their premises and welcome opportunities for Members of Parliament to meet the nurses and other staff as they go about their work. But, as the hon. Member knows, the meeting envisaged was for a specific purpose connected with wage negotiations and the hospital management committee thought it better that that meeting should take place elsewhere.

Does not the right hon. Gentleman appreciate that nurses are in a difficult position since many of them live in and it is, therefore, difficult for them to meet their Members of Parliament elsewhere. Will he not give some sort of advice to all regional hospital boards instructing them not to perpetuate this rather stupid obstruction of Members of Parliament?

I do not think that any particular advice on this is needed, and I think that the hospital management committees behave very sensibly in this matter.

Is it true that some hospital matrons have told the nurses under their control not to write to their local Members of Parliament?

That is another question and it cannot be within my knowledge.

Why should a hospital management committee think it inadvisable for me to meat the nurses on the premises to talk about their pay conditions, since pay has nothing whatever to do with hospital management committees?

That seems to me to be a very good reason.

asked the Minister of Health whether Her Majesty's Government will advise the setting up of a Royal Commission to consider the recruitment, remuneration and working conditions of nurses and midwives.

No, Sir.

Has the Minister not received any representations from the nurses themselves? Does he not know that the Nursing Association is strongly in favour of such a Commission being appointed?

There is a debate on this whole question later today.

I am asking if the right hon. Gentleman is aware of the Nursing Association's desire for this Commission?

asked the Minister of Health what would be the estimated sum involved in granting an all-round 20 per cent. increase to all trained nurses within the National Health Service.

Nineteen million pounds a year in Great Britain, including local health authority services.

Since that represents less than one quarter of the concession to be given to Surtax papers this year, will the right hon. Gentleman do something to take some of the heat and violence out of the debate which we will be having later by announcing now that he proposes to grant such an increase?

I would refer the hon. Gentleman to the debate which is to follow.

asked the Minister of Health to what extent matters of discipline and regulations affecting the nursing and other staffs of hospitals, in particular the wearing of uniform outside hospital precincts, are left to matrons or to the hospital boards or committees; and whether any general advice on such matters has been given to the regional hospital boards.

These are matters for the hospital authorities. My right hon. Friend has issued no general advice.

Does the hon. Lady appreciate that in most hospitals nurses are allowed to go out into the main thoroughfares in their uniforms on certain occasions and to attend various public events on other occasions when they are not permitted to wear their uniforms? In these circumstances, would not some kind of general advice bring about a code of disciplinary treatment so that nurses may know where they stand and prevent the absurd incident which happened quite recently?

I do not think that advice is needed on this relatively unimportant point. However, I must correct the hon. Gentleman on the main point which he raised. The common practice is for nurses when off duty not to wear their ward uniforms, or at least their aprons and caps, because of the risk of carrying infection back to the hospitals.

Is not the hon. Lady aware that the mix-up in this matter has caused great concern? Some hospital matrons have agreed that, if they desire, nurses should go to meetings in their uniforms. The point about infection being carried back to the hospital is completely fallacious. Nurses go all over the place in their uniforms for certain purposes. When a request is made to management committees, no direction is given. Management committees make their own decisions by taking a vote in some instances. Will the hon. Lady ask the Minister whether some general direction can be given so that nurses and matrons know where they stand?

I see no need to lay down general standards of discipline. Responsibility in this matter must rest with the hospital management committee concerned.

Does not the hon. Lady agree that it is not so much the wearing of uniform in such a case that is of concern as the fact that a large number of people believe that a great deal of the present shortage of nurses is due to the nonsensical Victorian discipline which is being applied to them?

There have been tremendous changes in standards of discipline in the hospital world since I first became associated with it. By and large, the discipline which is applied today is reasonable.

On a point of order. Owing to the unsatisfactory nature of the reply, I beg to give notice that I shall raise this matter at the earliest opportunity.

asked the Minister of Health what is the number of unqualified staff doing ward duties at the Rain-hill Hospital, St. Helens; and if he will make a statement about staff problems affecting this hospital.

One hundred and seventy-four whole-time and 172 part-time nursing assistants and 76 students at 31st March, 1962. Some overtime is being worked by unqualified staff, but otherwise my right hon. Friend is not aware of any special staffing problems.

Is the hon. Lady aware that the Minister's instruction to the management committee that time shall be taken off later in respect of overtime worked is having unfavourable effects amongst qualified nursing staff, and that it is in the best interests of the staff that overtime should be authorised and a straight payment given for it? Will the hon. Lady consider that suggestion?

Overtime has not been worked by qualified staff since July, 1961. Some, but not all, of the unqualified staff work overtime, but I take it that the point is that all ought to be paid for it. As I have said before, conditions of service are different for qualified and unqualified staff, and it is part of the conditions of the latter that they are eligible for overtime pay where overtime is worked.

asked the Minister of Health how many psychiatric social workers are on the staff of Rampton Hospital.

One.

Does the Minister think that this is the right staffing to deal with the conditions? Is the right hon. Gentleman relying on occupational therapists who have not got the proper qualifications? Will he not do something to increase the number and to increase the training facilities as well as to improve the salary and conditions under which they work, so that we have a proper representation of physiotherapists at Rampton?

The Question refers to psychiatric social workers. I have approved a second post which will hp filled as soon as possible. The numbers of trained psychiatric social workers in post are going up annually at a considerable rate.

Is the right hon. Gentleman aware that since before Christmas to the middle of March there was not a psychiatric social worker employed at Rampton at all? How can he possibly deal with these unhappy creatures under conditions like these?

I do not dispute the importance of these specialised workers. It is a very selective employment and the training is important. Their numbers are steadily and rapidly increasing.

asked the Minister of Health if, in view of the widespread anxiety caused to hospital employees by the publication of his hospital redundancy plans, he will hold discussions with the relevant trade unions to secure an agreed scheme.

I have nothing to add to the statement of my hon. Friend the Parliamentary Secretary on the Adjournment on 3rd May.

Surely, during that debate, the Parliamentary Secretary gave the impression that there was very little between the Ministry and the trade unions. If so, why cannot the Minister bridge the gap in order to make for better relationships in the service?

Because the matters in addition to those already covered, which the staff interests would wish to see met, seem to me to be outside the scope and to go beyond the purpose of the redundancy arrangements.

Is the right hon. Gentleman aware that the Parliamentary Secretary's reply on that occasion was quite unsatisfactory? Since we both agree that the redundancy arrangements are not likely to be extensive, does not the right hon. Gentleman think that the best thing he could do would be to withdraw the circular about redundancy, and re-negotiate it and come to an agreed settlement with the staff representatives?

No, Sir. I think that these arrangements very fairly meet the case of the relatively very few cases of redundancy that there will be.

asked the Minister of Health what instructions or guidance he has given to hospital authorities regarding the provision of emergency electricity supply.

An emergency supply in operating theatres is recommended in Building Bulletin No. 1. Advice on emergency arrangements for other parts of hospitals is given as necessary when building schemes are examined. My right hon. Friend is considering whether any advice is necessary in relation to existing hospitals.

While these recommendations may be in Bulletin No. 1, is the hon. Lady aware that on 26th March there was a forty-minute power failure in London when it was discovered that the London Hospital, one of the biggest teaching hospitals in the country, had no emergency power supplies at all? Is it not criminally negligent that a large general hospital in London was unable to treat its patients because of a breakdown in the power supply?

I am not aware of that particular incident, but we are considering this at the moment, and have already taken steps to see what can be done to review the arrangements at hospitals. That, together with the advice given in the budding notes, will, I hope, solve the situation for the future.

asked the Minister of Health if he will state approximately the number waiting for adenoid and tonsil operations in England and Wales, the average waiting time before admission to hospital for these operations and the average waiting time last year.

I regret this information is not available.

That Answer is a bit disappointing. Does not the Minister know that in some areas children are having to wait up to three years for this operation unless their parents can pay privately, in which case it is done immediately? In this period, their ear drums can be permanently damaged through infection. What emergency steps does the Minister intend to take in this matter?

Emergency cases in which there is real urgency are dealt with at once, but there may be particular reasons for delay in other cases. Sometimes a patient's name is put on the waiting list so that he can be put under observation. It does not necessarily end in an operation. Sometimes operations are deferred because of the time of year—for instance, during the poliomyelitis season.

There is a tremendously long delay in many cases even in getting a consultation so that it can be ascertained whether an operation is needed. As I say, during this period, a child's ear drums may be permanently damaged.

If there are such instances, it is for the general practitioner to impress on the hospital authority the urgency of dealing with the patient whom he wishes to be examined.

Is not the sort of answer which we have had this afternoon really appalling? Must children go on suffering and, perhaps, suffer permanent damage before the Minister considers putting forward an emergency scheme to deal with them? It is not merely one isolated person who needs emergency attention. Many people are having to wait for emergency attention. Will the hon. Lady consider this problem on a national scale and do something about it?

There have been increases in ear, nose and throat sessions in many hospitals. It is extraordinarily difficult to answer sweeping assertions that everything is wrong. Everything is not wrong. A great deal which is good is being done. My right hon. Friend is issuing guidance to hospital authorities to ensure that waiting lists are reviewed. Meantime, I repeat that any case of emergency in which an immediate operation is necessitated is given priority.

Should it not be emphasised that the presence of many names on waiting lists is due to the fact that people do not wish to take up the opportunity given to them to have an operation at the time that they are offered one by the hospital authorities since, for some reason or other, it is inconvenient for them to have it at the time offered? Therefore, these waiting lists do not give a wholly factual or true picture of the situation.

That is certainly a factor in inflated waiting lists and is one of the reasons why my right hon. Friend has asked that they should be reviewed.

asked the Minister of Health if plans for reorganisation and regrouping in the North-East Metropolitan Hospital Board region have now been completed; what new buildings will be constructed; what will be the cost; if the nursing staff is to be increased or reduced in consequence of the reorganisation; what financial economies will be effected; what buildings will cease to be used for hospital purposes; and what are the anticipated stages in the implementation of the whole scheme.

My right hon. Friend has approved three proposals for amalgamating hospital management committees and I understand the board may be making further proposals later. The changes are administrative and will not affect nursing staff. I cannot yet estimate the economies. On the rest of the Question I would refer the hon. Member to Command 1604.

First, does the hon. Lady appreciate that, although they may not affect the nursing staff directly, administrative economies should lead to some reduction in nursing staffs? Secondly, will she answer my question about whether she agrees that the widest possible publicity is required regarding developments in this part of Essex so that the staff and public and, indeed, the administrative staff may be aware of what is to happen?

I cannot believe that administrative changes will have any repercussions on nursing staff. The hospitals will continue to exist, but two of them will probably be managed by one committee instead of two separate committees. In answer to the hon. Member's point about publicity, the White Paper issued in January had a very wide coverage in the national Press and is still being dealt with at local level.

asked the Minister of Health to what extent he is including adequate canteen facilities in his present hospital building programme.

These are included in new buildings as appropriate to meet the needs of out-patients, visitors and staff.

I am grateful to my hon. Friend for that Answer. Can she assure me that this very important side of the hospital service is given adequate attention in all the expansion of the important hospital programme which her right hon. Friend advertises?

Yes. This does have specific mention in the building notes which we have issued for the guidance of hospitals.

asked the Minister of Labour if he is aware that bank employees who leave the employment of one of the joint stock banks are precluded by agreements between the joint stock banks from obtaining employment in another bank; and whether he will introduce legislation to make this practice illegal.

I am informed that no such agreements exist. I will certainly consider any evidence to the contrary which my hon. Friend can give me.

Is my right hon. Friend aware that it is practically impossible for an individual to transfer from one bank to another, or to be reinstated in a bank which he has left voluntarily? If I produce evidence to this effect, will he talk to the banks about this highly undesirable restrictive practice?

As I have just told my hon. Friend, I shall be very pleased to consider any evidence that he can bring forward on this point.

Is not this situation another illustration of the rather feudal position that exists in the banking world, in which the only bona fide trade union is not recognised by any of the banks? Does not this situation call for some positive action on the Minister's part, such as that suggested by his hon. Friend?

It would be wiser to get hold of the facts rather than indulge in generalisations.

asked the Minister of Labour whether he will act to the advantage of the nation by taking earlier initiatives in intervening in industrial disputes; and whether he will make a statement.

It is my policy to take the initiative as soon as I think this will be to the advantage of the nation and parties concerned. The time at which I can intervene most effectively, however, depends on the circumstances of the particular dispute and the attitudes of the parties. Premature intervention can often make the situation worse.

I recognise the vital importance of my right hon. Friend's last sentence, but may I ask whether he would agree that many disputes, especially in the shipbuilding industry, could be helped or even solved by an earlier intervention of the Ministry of Labour? Will he instruct his local officers to take an earlier initiative in many of these disputes?

I rather suspect that my hon. Friend has a particular dispute in mind. He should know that for the past two weeks my local officers have been trying to find a basis upon which to bring the two parties together. They will continue to give all the assistance they can.

asked the Minister of Labour what expansion of Government re-training and resettlement schemes would be required in order to qualify for maximum grants for the European Economic Community Social Fund under Articles 123 to 127 of the Rome Treaty in the event of Britain's accession to the European Economic Community.

The payment of grants from the Fund depends on satisfaction of several conditions and its administration is the responsibility of the Commission. It is impracticable to forecast what grants might be payable to us if we join the Community.

Does not my right hon. Friend feel that his Department should even now be considering the ways in which this may work, so that if we do join we can take as full advantage of the Social Fund as, for example, Germany?

I certainly do not disagree with what my right hon. Friend has said.

Does not the Minister feel that in view of his experience of the past week it would be a very good idea if he put Mr. Frank Cousins in full charge of all the negotiations about the Common Market?

The hon. Member is very modest; I should have thought that he would put himself in this position.

asked the Minister of Labour what was the reason for the rise in industrial accidents during 1961; what steps are being taken by his Department to deal with this situation; and if he will make a statement.

In 1961 reported accidents increased by 2,251 or about 1 per cent. as compared with 1960. The figures so far available show that the rise can be entirely attributed to a further increase in accidents in the construction industry. This industry is now making special efforts to cut down the number of accidents. The complete picture of what has happened can be obtained only after a careful study of accident rates which are now being calculated and which will be published in the Annual Report of the Chief Inspector of Factories in September. It is, however, clear that as in previous years most accidents were caused by human failings and carelessness. The most important contribution which can be made to accident prevention is better safety organisation throughout industry. As the hon. Member knows, I have taken up with a number of industries, including the construction industry, the need for a review of their arrangements and I propose to press on with this campaign.

Is the Minister aware that I am sure that we all wish him well in the talks which he is having on these matters and we appreciate what he says about the human factor? Would he not agree, however, that it is a terribly serious situation that in the third year running the number of industrial casualties has gone up? Would not the right hon. Gentleman consider what has been constantly urged upon him by this side of the House and take one important step by making a drastic increase in the Factory Inspectorate so that there can be a much more frequent rate of inspections in dangerous industries?

As the hon. Member knows, I have increased the number of inspectors. I know that he and every hon. Member share our concern about this appalling rate of accidents which industry and everybody connected with it must go flat out to try and correct.

Is the right hon. Gentleman aware that if he takes the best firms where there is a really efficient organisation of this type the accident rate is far and away below the average? Would the right hon. Gentleman advertise the methods used in very good firms so that the bad firms can take advantage of them?

The hon. Gentleman is perfectly right. I am trying to make available to those industries with less good records information about what can be done by those industries which are taking the matter seriously.