asked the Minister of Health how many patients are now on the waiting list of Victoria Hospital, Accrington.

One thousand, two hundred and thirteen at 31st December, 1963.

In view of the long waiting list, will the Minister try to ensure that patients are admitted in strict order of medical need and not because they paid for some private consultation?

I must say that I am appalled that the hon. Gentleman repeatedly makes these allegations. Last December he said much the same sort of thing and referred to a particular case. Weeks have passed and not a jot of evidence about that case has reached me, although the hon. Gentleman has admitted that he has it in his possession. I really think it is scandalous, and I hope, as I have stated on a number of occasions, that in fairness to the medical profession he will let me have the details which are in his possession.

Has the Minister seen the correspondence arising from that in the local Press in which a doctor wrote to say that he himself would never wait for admission because he paid and got admission straight away?

I should like to have the name and address and all the details which the hon. Gentleman has quoted in the News of the World on 29th December, and saying that he has information in his possession about a particular constituent. I have asked him on a number of occasions for these details. If he will let me have them I will pursue that allegation, but without the details I cannot do so.

asked the Minister of Health if he will make arrangements to ensure that patients' hospital records remain confidential except in exceptional cases where matters of public interest or criminal matters are involved.

The present arrangements for ensuring confidentiality seem to me to be satisfactory.

While thanking my hon. Friend for chat reply, may I ask whether he will agree that it is very important that communications between doctors and patients should remain as confidential as possible both in the interests of the doctors and of the patients?

Yes, I fully agree with my hon. Friend. He can be assured that hospital authorities will give information from medical records only for sufficient reason and will take care to ensure that the information given to a patient is not medically harmful to him. My hon. Friend may also like to know that hospital authorities have been given guidance about the supply of information about patients engaged in legal proceedings and that this guidance has been agreed with the British Medical Association and the Law Society.

asked the Minister of Health what rules and regulations are now in force regarding the admission of children with mothers as recommended in the Platt Committee Report of 1959.

asked the Minister of Health what further steps he has taken to implement the provisions of the Platt Report on the Welfare of Children in Hospital which relate to the access of mothers to children in hospital and the provision of accommodation in hospital for mother and child.

Hospital authorities were asked to implement this recommendation where possible and the great majority do allow unrestricted visiting. I am continuing to urge the others to do so.

While I am grateful for that reply, will my right hon. Friend continue to urge local authorities, especially in the North-East, to try to implement this very important provision of the Platt Report?

So far as access is concerned, will the right hon. Gentleman bear in mind that this provision has been implemented in certain cases in a restricted way and that there is a great deal more to be done in a large number of hospitals? Will he press the hospi- tals to proceed with both recommendations of the Platt Committee?

As my hon. and gallant Friend and the hon. Gentleman have suggested, I will certainly press on. I think it is worth noting that unrestricted visiting—by which I mean visiting by the parents at any reasonable hour of the day—is now operative in three-quarters of the hospitals in England and Wales. About a year ago the corresponding proportion was about two-thirds. So we are making progress. But we are certainly not satisfied yet.

Can the right hon. Gentleman say how many hospitals at this moment allow the admission of mothers with children under 5?

I am afraid that I could not give that figure without notice. All I can say is that we certainly accept the recommendations of the Platt Committee. As the hon. Gentleman will realise, in some cases, especially in the older hospitals, the circumstances are such that it is very difficult to allow mothers to stay in hospital with their children. But this is something which we wish to encourage whenever possible, and the new building note which gives guidance on the matter, which we shall be issuing shortly, will, I hope, be a great help.

asked the Minister of Health what consultations have taken place between the North West Metropolitan Regional Hospital Board, the Central Middlesex Hospital Management Committee, and general practitioners in Acton on the subject of the re-allocation of maternity beds in the area.

asked the Minister of Health what consultations have taken place with regard to the re-allocation of maternity beds in Ealing between the North-West Metropolitan Regional Hospital Board, the Central Middlesex Hospital Management Committee, the local health authorities and the local medical council; and what views have been expressed by each body.

There were discussions in December between representatives of the regional board, of the hospital management committee and of the general practitioners in the area.

Is the right hon. Gentleman not aware that the Hospital Management Committee of the Central Middlesex Hospital, the general practitioners in the area and the Middlesex County Council Health Committee are all opposed to the scheme put forward by the regional hospital board? In view of this general opposition, will not he require the regional board to modify its scheme to meet at least some of the objections to it?

I do not think I can do that. I have discussed this matter with my hon. Friend, and I have since written to him. I have treated what he has said with great seriousness, but this is part of a general plan. After all, the Middlesex Local Medical Committee, which is representative of all general practitioners in the county, was asked to nominate general practitioners to attend the various area meetings. I should, perhaps, say that the regional hospital board appreciates that the Central Middlesex Hospital is close to the Acton boundary and is considering whether the small residential part of Acton close to the hospital can be served by it. But if there were to be any significant addition to the hospital's area, the trouble would be that it would upset the balance elsewhere.

asked the Minister of Health what progress has been made in the provision of residential accommodation for mentally disturbed children under 17 years of age, and in the provision of psychiatric wards for children requiring treatment for temporary emotional instability; and if he will make a statement.

asked the Minister of Health if he will list the hospitals administered under the National Health Service which provide in-patient psychiatric treatment for young people, giving the number of beds available at each.

Twenty-five in-patient units with 527 beds have been provided for mentally ill and seriously maladjusted children and adolescents. My right hon. Friend has recently advised Hospital Boards to increase this provision as soon as possible. I will circulate the details in the OFFICIAL REPORT.

Can my hon. Friend state what the advice to the boards will cover?

It will cover short and long stay units for children and adolescents who are mentally ill or seriously maladjusted. It takes the form of setting out interim targets for the provision of in-patient accommodation based on current knowledge of needs. As I said, my right hon. Friend has advised hospital boards to increase this provision as soon as possible.

Did I hear correctly that there are only 527 beds in the whole country available for the in-patient treatment of young psychiatric patients? Is this not horrifying? Would the hon. Gentleman confirm that many young people are not being given the in-patient treatment which they require and are either being treated in departments which are meant for adults or having to remain at home although their behaviour may be gravely anti-social and even violent?

This is one field where gross exaggeration of the kind that the hon. Gentleman has just indulged in does not help in the slightest. In the present state of our knowledge, it is difficult to assess with accuracy the extent and character of the total needs. Ways of measuring this are being considered, but this consideration has not delayed the interim guidance to boards about minimum requirements. I will repeat for the benefit of the hon. Gentleman that my right hon. Friend has recently advised hospital boards to increase this provision as soon as possible.

The hon. Gentleman need not get so steamed up about this. Is lie not aware that one of the most seriously under-provided needs in the National Health Service is that of psychotic adolescents? Can be break down his original figures and say how many units and how many beds are devoted to adolescent psychotics?

Without notice, I could not break the figures down. I entirely agree with what the hon. Gentleman has just said, that there is a need here, as my right hon. Friend has recognised. The hon. Gentleman will know that the regional hospital boards are allocated funds and have responsibility for arranging the planning programmes in detail, and these programmes should be flexible enough to allow for the rearrangement of priorities where urgent new needs are brought to light.

Is the hon. Gentleman aware that a constituent of mine complained to me that his son was not being granted treatment in an in-patient department and that when I went to the Orpington Mental Health Association I was told that it was not an isolated case but was universal throughout the country because of shortage of places?

asked the Minister of Health who is to be responsible for the salary of Mr. George Wilkinson, who is employed as chief technician on cancer research at Queen Elizabeth Hospital, Gateshead; on what date a decision on this matter was reached; and to whom this decision was communicated.

I should have thought that it would have been better, if the hon. Gentleman had a specific case in mind in this field, where there is a great deal of anxiety on the part of parents, if he had brought it to my attention. I am always willing, as the House knows, to look into each individual case. All I am saying is that in our present state of knowledge it is impossible to say precisely what the need is, but we are going as rapidly as we can and as resources permit in the direction of making additional provision.

asked the Minister of Health if he will make a statement on the negotiations to transfer Mr. George Wilkinson, of the Special Gynaecological Research Unit, Gateshead, to employment in the National Health Service; what considerations were involved concerning his grading; when the final decision was made regarding the amount of salary and whether he would suffer a reduction; what official information was given concerning the date he would cease to be employed by the Cancer Campaign Organisation; and if it was intended that there should be no break in his service on transfer.

Authority to employ Mr. Wilkinson at the same salary as that paid to him by the British Empire Cancer Campaign was given to the hospital management committee on 12th November, 1963. The Committee were, however, not informed until 6th February that his previous employment had ceased on 31st December; on 7th February he was offered a post in the National Health Service with effect from 1st January. No break in service is intended.

Is my hon. Friend aware that I have photostat copies of correspondence which proves conclusively that the secretary of the board did not, prior to the date which he is now claiming, know that this man's salary from the Cancer Campaign ceased on 31st December? Would he not agree that there has been a lack of communication in the hospital board which could easily have jeopardised the whole of this very valuable service?

The Department gave its authority on 12th November to pay Mr. Wilkinson's salary from hospital funds. I agree with my hon. Friend that there appears subsequently to have been quite a lack of communication. But I am very glad to say that Mr. Wilkinson has been offered a post, which he has accepted, subject to a reservation as to the future. There will, of course, be no break at all in his service.

Has the attention of the hon. Gentleman been drawn to statements in the Press which have been made by Mr. Stanley Way, who is a consultant at Gateshead and head of the cancer research unit, which in the view of many people, certainly in Gateshead, are misleading and quite untrue? Would he not agree that there has been no mismanagement on the part of the local hospital management committee? It did not, in fact, as he stated, receive notice that Mr. Wilkinson had finished with the cancer research unit until 7th February. Therefore, the statements made by Mr. Stanley Way are quite untrue. Will the hon. Gentleman consider the wisdom or otherwise of consultants in the National Health Service making public statements in the Press rather than going to the local machinery and dealing with the matter there? Is it a wise thing for consultants to do?

I think it is true that, until Mr. Way wrote on 6th February, the group secretary had not been informed that the salary from the British Empire Cancer Campaign had ceased on 31st December. I think it is also true that there has been a general misunderstanding all round. I suggest that, as this gentleman has now accepted a post and there has been no break in the continuity of his service, and as there are lessons to be learnt all round, we should leave the matter there.

asked the Minister of Health why the management side of the relevant Whitley Council has found it impracticable to meet the staff side since December last for discussions on the salaries of hospital engineers.

A meeting of the negotiating sub-committee of the Whitley Council took place on 19th February, which was, I understand, the earliest convenient date.

I wonder whether the right hon. Gentleman could tell us a little more about that meeting. Does he realise that his predecessor appointed a study group as far back as January 1961 to go into this problem of the grievance of the hospital engineers and received the report in February 1962? Could we not expect some more definite result or answer than the right hon. Gentleman gave me just now as to how this grievance is being dealt with and when a solution may be expected?

Naturally, I should like to see a solution as soon as possible. I recognise that the matter has been under consideration for a considerable time. But two parties are involved and, as the hon. Gentleman knows, the conduct of the negotiations is a matter for the two sides of the Whitley Council. I do not wish to say anything that would prejudice them in any way, but I am ready at any time to do what I can to help speed up matters, if that is possible. However, difficult and complex points are involved.

As this matter affects my constituency as well, may I ask the right hon. Gentleman whether, if the engineers have lost faith in the Whitley Council procedure, a more expeditious procedure might not be possible?

I am hopeful that these negotiations will make rather better progress than in the past. This is a matter for the Whitley Council, and I am sure that it is best left with the Council. I hope that it will not be too long before a solution is reached. But several problems involved—and I have considered them myself—are very complex indeed. This is not an easy matter. It is not like a simple negotiation concerning salaries alone.

I am encouraged by the right hon. Gentleman's answer, but is he aware that I was equally encouraged in the first quarter of 1962 when I first raised this matter and was told that progress was being made on qualifications and status and that there was only one outstanding issue—the salaries of group engineers? How near is that to the truth at the moment?

I hope that the hon. Gentleman will continue to be encouraged.

asked the Minister of Health if he will invite his Standing Medical Advisory Committee to examine the methods of treating soft tissue lesions carried out at St. Thomas's Hospital under the direction of Dr. Cyriax, with a view to instituting a controlled research study into the effectiveness of this form of treatment.

No, Sir; it is not the Committee's function to advise on the effectiveness of particular forms of medical treatment.

Is there any way in which the right hon. Gentleman can look into this form of treatment of rheumatism or what is called rheumatism and fibrositis? The treatment followed by Dr. Cyriax seems to have been extremely successful. It does not, however, seem to be widely practised in this country. It is, however, more widely used on the Continent—for example, Germany. What can the right hon. Gentleman do to get some detailed assessment of the value of the treatment about which, admittedly, there is some controversy?

As I expect the hon. Gentleman knows, it would be open to Dr. Cyriax to apply for a research grant for a controlled trial from the Clinical Research Board of the Medical Research Council or from some other research organisation, but it is not the function of the Standing Medical Advisory Committee to act as the hon. Gentleman suggests.

Can the right hon. Gentleman say whether, in his view, this is a case still for research or a case of what some would call medical conservatism? If the second, how can it be overcome and a wider knowledge of Dr. Cyriax's method be made known?

I am not sure that I follow the hon. Gentleman, because in his Question he referred to instituting a controlled research study. I was trying to answer that. The treatment of individual patients is the responsibility of the individual medical practitioner concerned.

asked the Minister of Health whether a geriatric consultant has yet been appointed to St. George's Hospital, Hornchurch; how many members of the nursing staff of this hospital have been specially trained in geriatric nursing; what was the corresponding number a year ago; and how many chronic and aged patients are accommodated in this hospital.

Yes, Sir; the present number of nurses trained in geriatric nursing is 38 full-time and 15 part-time, compared with 28 and 19 on 31st March last; on 31st January last the number of chronic and aged patients was 329.

Is the hon. Gentleman aware that everybody will be very glad to hear his reply to the first part of the Question? Can he say whether this appointment is to the group as a whole or to this particular hospital only? If it is to the former, roughly how much of his time will this consultant be expected to devote to the hospital, where there have been so many difficulties, as the hon. Gentleman knows. Secondly, what is the adequate, or the ideal, number of specially trained nurses to cope with this number of aged patients?

With regard to the first part of the supplementary question, this is the number of trained and part-time staff employed at St. George's Hospital itself and not in the group as a whole. I cannot answer the second part of the hon. Gentleman's supplementary question without notice. But, of course, although the nursing staff have increased, more are wanted.

The hon. Gentleman misunderstood my supplementary question. I asked about the first part of his original Answer—"Yes, sir"—which I took be about the appointment of the geriatric consultant. Is this appointment to the group as a whole or to the hospital only?

I cannot answer that at the moment. The consultant is expected to join on 16th March. Perhaps I can write to the hon. Gentleman and clear up that point. This appointment has been needed at the hospital for a long time. I am very glad, as I am sure the hon. Gentleman is, that a geriatrician has now been appointed.

Is my hon. Friend aware that, from personal observation, I can state that the staff at St. George's Hospital is a devoted staff? Is he further aware that the manner of the series of questions over the last 18 months, addressed by the hon. Member for Barking (Mr. Driberg), has not aided recruitment? Is my hon. Friend further aware that the hon. Gentleman has not seen fit to visit the hospital, despite five invitations to do so?^*

I agree with my hon. Friend's opinion of the quality of the staff at the hospital, which I can bear out from my own observations when I visited it.

Mr. Speaker, in view of the personal attack made upon me by the hon. Member for Hornchurch (Mr.

^*[See OFFICIAL REPORT, 26th February, 1964, col.432.]

Order. The Joint Parliamentary Secretary cannot answer about implications in the closing down of Question. Time.

Further, is the Joint Parliamentary Secretary aware that I have not received any invitation to visit this hospital and that, in any case, I do not believe that a layman visiting a hospital at a prearranged time, with everything laid on for that visit, would necessarily know everything that was going on in the hospital?

In fairness to my hon. Friend the Member for Hornchurch (Mr. Lagden), I should point out that the hospital is in his constituency. I understand that he visits it frequently and is aware of the conditions there. He knows, I know, and the hon. Member for Barking (Mr. Driberg) knows, that in the past the conditions at the hospital have been difficult, not because of the quality of the staff but because of the layout of the hospital.

asked the Minister of Health in how many hospital groups where 70 per cent. or more of the maintenance budget is concerned with building work there is no building supervisor, qualified in building, in charge.

I regret that this information is not available.

Should not the information be available? Is it not the situation that there are far too few qualified building supervisors in the hospital ser- vice for them to be able to deal with all the major and minor work which goes on? Will the hon. Gentleman give careful consideration to the pay and promotion prospects of employees of this type to see what he can do to recruit more people?

It is impossible to identify the hospital groups which spend 70 per cent. or more of their maintenance budgets on building work. The number of building supervisors, in whole-time equivalents, was 218 on 30th September, 1962, and the corresponding figure in 1958 was 177. We do not know of any general recruitment difficulties. The question of salaries is, of course, another matter.

asked the Minister of Health if he will list the names of new hospitals built in England and Wales since 1952, and the bed capacity of each.

As the Answer includes a table of figures I will, with permission, circulate it in the OFFICIAL REPORT.

Can the right hon. Gentleman confirm that there are only four new hospitals, representing one every three years, and that the average number of beds in each hospital is about 300, which is half the minimum size for a district general hospital? In this table, do we see the distinction, which none of us on either side of the House has ever appreciated before, between a slightly remodelled hospital and a substantially remodelled hospital and a new hospital?

As a medical man, it is time that the hon. Gentleman directed his attention to the great achievements and great improvements of the hospital service which are in train. If his interest is genuine—[HON. MEMBERS: "Answer."]—I will answer—if the hon. Gentleman's interest is genuine, he should first consider the figures which will appear in HANSARD tomorrow and, secondly, be thoroughly ashamed of his own Labour Government which actually cut the social services in their last year of office.

Can I have an answer to my question? What is the difference between a substantially remodelled hos- pital and a remodelled hospital and between a substantially remodelled hospital and a new hospital? Many hospital authorities and doctors who are genuinely interested in this matter are very anxious that the Minister should make a statement.

I will give an answer. Perhaps I can give an example of a substantially remodelled hospital—St. Luke's, Huddersfield. Work in progress will increase the number of beds from 235 to 400, of which 320 will be in new buildings and 80 in upgraded wards. In addition, there will be ancillary services and a conversion of existing buildings to a new use. It is completely unrealistic not to consider together new hospitals built on virgin sites and those which are substantially remodelled.

As the Prime Minister has said, inaccurately, that a new hospital is being started every nineteen days, does not the right hon. Gentleman think that my hon. Friend is entitled to ask how many hospitals have been completed in the last twelve years? Since it is only one in three years, the right hon. Gentleman should not get quite so hot under the collar.

I thought that we had dealt with this in a debate that we had before Christmas. All I can say is that what the Prime Minister said is true and cannot be controverted, for the reason which I have explained to the hon. Gentleman.

asked the Minister of Health if he will state the number of operations performed in the Ipswich and East Suffolk Hospital during the last known 12 months' period, and the corresponding period 10 years ago.

The number of operations performed was 12,371 in the year ended 31st December, 1963, and 8,572 in the year ended 31st December, 1953.

I thank my hon. Friend for that reply, which shows that there has been a 50 per cent. increase in the number of operations and there are now more surgeons and nurses at the hospital. Is not my hon. Friend rather alarmed that all these operations have to be carried out in two operating theatres, one of which is sub-standard, and that so far his Ministry has done nothing towards making a grant of about £50,000 to put these in good order? Although we know that a new hospital has been promised tome years ahead, this is an urgent matter.

I do not think that my hon. and gallant Friend should jump to the conclusion that we are unable to help. Recent proposals by the regional hospital board for improvements to the operating facilities at this hospital, together with other improvements, are under discussion with the board. In fact, I can tell my hon. and gallant Friend that the board is having discussions today with the hospital management committee and the medical staff at Ipswich to discuss possible schemes costing a moderate amount pending the building of the proposed new hospital.

asked the Minister of Health whether he will require children's hospitals only to use cot restrainers with the permission of the child's parents and, wherever possible, under the supervision of the child's parents and with the attendance of the mother as recommended by the Platt Report on the Welfare of Children in Hospital.

This would not be desirable, as hospital authorities are responsible for the safety of children in hospital, but I am taking advice on whether further guidance can be given on the use of restrainers.

The Minister is to take further advice, but in view of the obviously dangerous and sometimes tragic consequences of the use of this method of restraint, is it not desirable that he should give further and stronger advice to the hospitals concerned? Also, will he consider dealing with the question of mothers being present and the question of the assent of the parents in view of the danger of using these restrainers?

I agree with the hon. Gentleman that these restrainers should be necessary only in exceptional circumstances, and I am considering whether we should give further advice.

I hope that the right hon. Gentleman will bear in mind that it is precisely when hospitals are understaffed that this method of restraint is sometimes used, and that it is precisely where this understaffing exists that the greatest danger occurs. If mothers were admitted with their children, or were present at the time, that would minimise the danger.

Yes, Sir, but, as the hon. Gentleman realises, restrainers are occasionally needed for children suffering from some types of illness to protect them from injuring themselves. I have had no case brought to my attention where restrainers have been used because of a shortage of staff.

asked the Minister of Health what are his long-term plans for maintaining cottage hospitals in rural areas.

These are set out in the Hospital Plan for England and Wales. The primary consideration in any decision concerning a cottage hospital will be to provide the best possible service for the patients.

asked the Minister of Health if he is now in a position to announce his proposals for resolving the deadlock that has arisen regarding the pay claim of clinical psychologists.

A meeting of the Whitley Council has been fixed for tomorrow, when proposals will be considered.

Will the right hon. Gentleman say what proposals? Am I right in thinking that he has himself put forward proposals? Is he aware that this matter has been dragging on for a long time; that the clinical psychologists in the Health Service have salaries which are about 25 per cent. below those paid in the Civil Service and that there is, in consequence, a considerable shortage of clinical psychologists? Is he aware that in some regions as many as 60 per cent. of the established posts for clinical psychologists are vacant?

As the hon. Gentleman may know, the chairman of the management side came to see me to discuss this matter because of difficulties which had arisen and, as a result, proposals will be put to the representatives of the management side at the meeting to take place tomorrow. If there is agreement on the management side, the proposals will be put to the staff side in the ordinary way. The hon. Gentleman will agree that it would be inappropriate for me to reveal the proposals before they have been revealed to the management side or, with the management side's agreement, to the staff side.

In the general interest, will my right hon. Friend circulate in the OFFICIAL REPORT the dates from which all these negotiations have been under review? Is he aware that in many cases the negotiations have gone on far too long owing to delays on the management side and that it would be to the interest of everyone to see what are the circumstances in this case?

If the hon. Lady would like to make a request or put down a Question asking for details of any particular case, I should be glad to consider it.

asked the Minister of Health if he will give the figures of movement of persons away from The Hartlepools in 1960, 1961, 1962, and 1963, respectively.

I regret that the figures are not available.

asked the Minister of Health whether he will take steps to sanction the provision of a motor carriage to accommodate two people where two members of the same family, particularly a man and his wife, are each entitled to a single-seat motor vehicle.

asked the Minister of Health (1) what estimate he has made of the difference in cost of a two-seater car and two single-seater invalid tricycles;

It is contrary to Government practice to disclose contract prices but one small car would cost less than two tricycles.

Is the Minister aware that we are grateful that he is reviewing the matter? It is important. Nobody wants to accuse the right hon. Gentleman of being cruel even if he is trying to be economical. This is a serious matter, and where two invalids are concerned and both are of the same family, they surely ought to be able, even if it costs a little more, to have a two-seater car?

As the hon. Gentleman knows, this is not an easy thing. It has been considered by my predecessors on a number of occasions, but I realise that it is a matter of concern to the whole House and I shall certainly try my best to solve it.

On 26th July, 1963, my constituent about whom I have been writing to the Minister regarding one of these invalid chairs was examined by a consultant at the hospital and the report was sent to the Ministry. I have been asking for weeks for a copy of that report and I have not received one yet, and I should like to ask the Minister, when considering this case, to consider it very deeply indeed, and to look at all aspects of the case, particularly when a man and his wife suffer infirmity of the lower limbs, to which I have referred, and particularly when neither of them can walk. I would ask whether the Minister will consider the total number involved in the country as a whole and, in view of what he has just said in reply to my hon. Friend, whether he would now consider that a case has been made for giving these people a little pleasure. If he does not, it means that these poor people—

Order. I have to remind the House that some element of brevity in supplementary questions is necessary in the general interest.

Yes, Mr. Speaker, but I have two Questions on the Order Paper.

That does not affect the length of the supplementary question. The hon. Gentleman began with a lot of matter which was not interrogatory but merely informative, and then reached a point which I thought was excessive in length.

asked the Minister of Health what gaps stiff exist in' the National Cancer Registration Scheme.

Though improvement continues, registration in some parts of the country is still lower than I would wish, and I am considering what special steps I can take to speed up improvements.

Surely these gaps ought not to exist now. When the right hon. Gentleman's Department held a conference on this subject last year and the difficulties were put forward by the records officers of the regional hospital boards, what steps were taken by his Department to remedy them?

Obviously one difficulty, which I am sure will have occurred to the hon. Gentleman, is that in the very nature of things the number of cases which should be registered but which are not cannot be known and, therefore, deficiencies, in regions cannot be accurately assessed. After that conference had taken place, a working party was set up to consider the present organisation and techniques of regional cancer registries and it is still considering the matter. I agree with the hon. Gentleman that this is an important subject, and I hope that we can do better.

asked the Minister of Health (1) if he will make a statement on his recent discussions on the standards of training and qualifications for public health inspectors;

asked the Minister of Health if he will make a statement on the outcome of his recent discussions with the Public Health Inspectors' Education Board; and what further steps he proposes to take to ensure that there will be sufficient inspectors to cope with the growing need for them in connection with housing and the installation of baths, inside lavatories, and hot water systems.

I cannot yet add to the reply I gave to hon. Members on 9th December.

Does not the hon. Gentleman know that training has recently been discussed by regional centres of the Association of Public Health Inspectors, the Midlands Centre being one example, and that local authorities such as my own, which is short of 13 public health inspectors, have a colossal programme and that it is a great tragedy that they should have these difficulties? Is it not now advisable to introduce a term of training, perhaps a three-year course, as with teachers, including plenty of practical experience and leading to a qualification like the Dip. Tech., thus raising the status of the service and attracting more people to it?

There is undoubtedly a difficulty, as I have told the hon. Lady before. The present position is that the board has asked the local authority associations for information about the numbers of inspectors at present employed by the local authorities and the number expected to be needed in future in order to assess the overall requirements. I understand that replies are still incomplete. The board is responsible for keeping the level of recruitment under review.

Is the hon. Gentleman aware that last week the association agreed to accept less qualified men to assist inspectors, where necessary, on certain types of work? Particularly in view of that, would he be prepared to meet representatives of the association, local authority associations and other Ministries concerned to discuss the whole matter?

I will certainly have the hon. Member's suggestion considered.

Is the hon. Gentleman aware that metropolitan boroughs and other local authorities will find it almost impossible to meet their legal obligations for dealing with overcrowded houses in multiple occupation unless there are many more public health inspectors available for this task, and that unless more of these inspectors or similar people are made available the housing situation in London and other large towns will remain very difficult?

I agree with what the hon. Gentleman has said. I hope that what has been said today will be drawn to the attention of the education board and of the local authority associations.

asked the Minister of Health if he will make a statement on the facts sent to him by the hon. Member for Tynemouth on the high rate of infant mortality in the north-east region; and why the regional hospital board were unable to approve the proposal to convert a private nursing home into a maternity unit for local doctors' patients.

In 1962 the perinatal rate for England and Wales was 31 per 1,000 births. For the Northern standard region it was 34, and for Newcastle-on-Tyne 33. All three rates show a steady decline since 1959, when they were 34, 37 and 39, respectively. I assume the second part of the Question refers to Fernwood House, Newcastle-on-Tyne. The regional board rejected this proposal because of the high cost of acquisition and adaptation, and of the running costs involved.

Is it not correct to say that, in spite of the improvement, there is still a high level of infant mortality on the North-East Coast? As we are tremendously short of hospital beds of all kinds, would not a little more generosity from the Ministry to the regional hospital board help us to overcome some of our difficulties? Will my hon. Friend ask his right hon. Friend to look at this matter in view of the grave anxiety of the Newcastle Regional Hospital Board and of the North-East Coast in general?

The answer to my hon. Friend's first question is "Yes". That is the case. I take note of what she has said and I will ask my right hon. Friend to consider these matters. The attention of all the regional boards has been drawn to the need to encourage local liaison among the hospitals, local health authorities and G.Ps. to ensure the best use of existing resources and to increase maternity service facilities in acceptable ways as soon as possible. My right hon. Friend has made the urgency of the position clear.

Is my hon. Friend aware that this is part of the general anxiety in the country that local facilities should not be abolished wholesale in the new hospital plan so that the local practitioner can remain in close touch with his patient and the great anxiety that the Minister should not lose sight of the value of small cottage hospitals, nursing homes and small hospitals in conjunction with local general practitioner services?

I entirely agree with my hon. Friend. That question is very much in my right hon. Friend's mind; and there is a later Question about it.

asked the Minister of Health what representations have been received from the County Councils Association about the development of a national policy for the fluoridation of water supplies; what reply he has sent; and if he will make a statement.

In November 1962, a deputation from the Association urged the Government to adopt a national policy in favour of fluoridation. In December 1962, local health authorities were informed of my predecessor's readiness to approve the making of arrangements with water undertakings for fluoridation of water supplies as a measure for the prevention of dental decay.

May I ask my right hon. Friend whether he is aware that I am a little puzzled by that reply, because at the moment there does not seem to he any form of national policy to guide the action of water boards? If my right hon. Friend is so sure that the fluoridation of water is so beneficial to public health, and that it has been proved beyond doubt that its application will not have ally cumulative ill effects on anybody, should not he in the public interest insist on all water being treated in this way? If my right hon. Friend does not so insist, does not it mean that he has doubts arising out of the recent comments on research in Canada and more recently at Oxford, that perhaps the long-term effect on some people may not be beneficial?

I looked into this matter most carefully as soon as I went to the Ministry of Health because I realised that it was a matter on which my hon. Friend and others held a view different from mine. I believe that this is a most valuable measure for the reduction of dental disease, but I think it is right that the decison whether or not to arrange with the water undertakings for fluoridation should be left to the local authorities. Indeed, I think I am right in saying that about sixty authorities have passed resolutions in favour of making such arrangements.

May I ask my right hon. Friend whether he is aware that, including Bucks, there are about six counties which draw water in whole or in part from the Backs Water Board, and that, as they cannot agree among themselves as to whether they should introduce this policy, it is impossible for those who wish it to have the water treated in this way, and that it is beneficial to those who do not wish it to be so treated?

I know that my hon. Friend's views are sincerely held. I take a different view from him, but I think it is right that this decision should be left to local authorities and water undertakings.

asked the Minister of Health if he will introduce legislation to establish a special fund out of which those who incur debts, as a result of medical treatment received in foreign countries with which he has no reciprocal agreement, may be compensated.

No, Sir. I do not think that it would be right to use public funds for such a purpose.

May I ask my hon. Friend whether he realises that the Question concerns a constituent of mine, Mrs. Bowen, who when she was in America had an accident and as a result now owes the medical authorities in America 7,900 dollars? Will my hon. Friend ask his right hon. Friend to continue the efforts which I know he is making to get reciprocal arrangements with the United States? Will my right hon. Friend point out to the United States authorities that if the present position continues only rich people will be able to afford to go to the States?

First, may I make it quite plain that it is the policy of the Government to secure reciprocal arrangements wherever possible. The difficulty, of course, is that there are so few countries in the world which have a comprehensive health service similar to our own.

Would my hon. Friend confirm that Foreign Office officials in foreign countries often help our nationals who go into hospitals in those countries with their debts and their passages home, and that if a person is in need they do not press for repayment of the amount involved?

Yes, Sir.

As I know that my hon. Friend would wish to give a satisfactory answer, I should like to take this matter further. I give notice that I shall raise this matter on the Adjournment at the earliest opportunity.

asked the Minister of Health whether he has now begun negotiations with the pharmaceutical industry for the renewal of the Voluntary Price Regulation Agreement; and if he will take into account in the course of such negotiations the views of the Public Accounts Committee as expressed in a number of recent reports.

The first formal meeting was held last week. Negotiations will be completed as soon as possible and will most certainly take into account the views of the Public Accounts Committee.

Is the Minister aware that should he reach a conclusion which we on this side of the House considered unsatisfactory it might be necessary, following a change of Government, to renegotiate this agreement? In the circumstances, would not it be best to extend the existing agreement for twelve months from July, when it expires, so that a new long-term agreement could be negotiated by a new Government of whatever complexion?

I think it right, and I am sure that it would be the wish of the House, that we should proceed on the basis that this Government will be returned with a resounding majority.

asked the Minister of Health what the outcome was of the Paris meetings of officials with regard to the proposals by President de Gaulle for an international cancer research programme; and whether he will make a further statement about the cooperation of this country in that proposal.

I would refer the hon. Member to the reply given by my right hon. Friend the Prime Minister on 14th January to my hon. Friend the Member for Chigwell (Mr. Biggs-Davison); the further meeting to which he referred has been postponed at the request of other Governments until the end of this month.

Will the right hon. Gentleman say whether he is giving the fullest support to the scheme, particularly in view of the fact that it is highly essential that the treatment of cancer should be regarded as an international as well as a national matter? Will he say what information is being available to the team which President de Gaulle has in contemplation with reference to the new developments which have taken place?

I believe that there is a Question on the Order Paper about the new developments, and I imagine that the hon. Gentleman is referring to matters published recently in the newspapers. In answer to a Question on 3rd December my right hon. Friend the Prime Minister said that we are certainly sympathetic to the idea. So far at the meeting in Paris there has been a discussion concerning international co-operation in cancer research on its scientific merits. We must now wait until the next meeting. It was postponed, not at our instigation, but at the instigation of other Governments.

asked the Minister of Health, in view of the concern at the cost of the nation's drug bill, what investigations have been undertaken during the past two years to control the increasing cost without reducing the efficiency of the service, and with what result; what evidence was found for the need of bulk purchasing; and what is being done to introduce this system in all hospitals.

Numerous measures are adopted to promote good prescribing practice. The investigation of the prices of proprietary drugs has continued under the voluntary scheme agreed with the industry, and some price reductions have been negotiated. Most drugs for hospitals are already purchased on either a regional or an area basis. A few are purchased centrally.

In view of the fact that, for a considerable time the Comptroller and Auditor General has been criticising the high cost of drugs, is not it regrettable that after so many warnings he is now able to say that the nation's drug bill has rocketed to £100 million a year; that a major aspect of it is that many hospitals are buying individually and some are being charged five times as much, or more, than others for the same tables? Is not it a scandal that after so long money is being paid unnecessarily to rich drug firms while shillings for prescriptions are being squeezed from the sick poor?

I am afraid that the reasons for the increase in drug costs are more complex than the hon. Gentleman suggests. The introduction of new and more expensive drugs, some making possible more effective treatment, is a very important factor. The present practice is in accordance with the recommendations of the Messer Report, that purchases should not be made centrally unless there was a distinct advantage to be gained.

Does the hon. Gentleman deny that the Comptroller and Auditor General has recently made this complaint? If he has, surely the Minister should deal with the question? Either it is right or wrong.

I do not deny anything. My Department is all the time adopting measures to control expenditure on drugs. I do not think that the suggestion implied in the hon. Gentleman's Question would have any effect on the total cost for the reasons which I have given. The advice tendered to us originally was that purchases should not be made centrally unless there were distinct advantages to be gained and there are purchases centrally when it is necessary to safeguard supplies and quality and where there is a real price advantage.

In view of the unsatisfactory nature of the reply. I wish to give notice that I shall raise this matter on the Adjournment.

asked the Minister of Health if he will give an assurance that he will commence negotiations with chemists about National Health Service remuneration for dispensing before resale price maintenance legislation takes effect; and if he will make a statement.

asked the Minister of Health if he is satisfied that the payments to pharmacists for dispensing medicines under the National Health Service are sufficient to cover their costs and a reasonable profit in respect of the services they provide in this connection; and if he will make a statement.

The final report on a recent inquiry into the expenses incurred by chemists in National Health Service dispensing has just been received and is being discussed with the Chemist Contractors' Committee. Any necessary adjustments in remuneration will be considered as soon as these discussions are complete.

Does my right hon. Friend accept the social necessity of having dispensing chemists widely distributed throughout the community? Will he give an undertaking that he accepts the principle of some review of dispensing remuneration as a result of the abolition of resale price maintenance?

I hope that in this country we shall always have a reasonable distribution of dispensing points. The aim has always been to fix the National Health Service remuneration for chemists, including the profit element, at such a level as to give a fair return for the service involved.

Can the Minister say whether there is any evidence in the Report to which he has referred in support of the assertion by chemists that in order that they may continue dispensing under the National Health Service they should be permitted to make excessive profits on other goods which they sell? Will he agree that if such a situation arises it should be the aim to make an adjustment in the payments made under the National Health Service rather than to allow excessive profits on other commodities?

I am seeing the Chemists Contractors Committee, or rather its representatives, at five o'clock this afternoon to consider this very Report. If the non-National Health Service business of chemists were reduced for any reason, there would probably be a small increase in the proportion of expenses allocated to National Health Service business which would ultimately affect National Health Service remuneration.

Is my right hon. Friend aware that there is no suggestion of excessive profits being made on other items—[HON. MEMBERS: "Oh."]—but that nevertheless there is a crisis developing in my own city as a result of pharmaceutical chemists being unable to maintain themselves on their present rate of earnings? Will he look carefully at this to see that the service is maintained?

I must not repeat myself unduly. I have already said that the aim is to fix the remuneration, including the profit element, at such a level as to give a fair return for the service involved.

Will not my right hon. Friend agree that it would be highly undesirable that drugs and medicines and other medicaments should be sold by all and sundry without adequate control and that chemists and pharmacists are in a particular position with regard to resale price maintenance?

That has been put to me by pharmacists in another connection. It goes much wider than these questions which are concerned with remuneration.