asked the Minister of Health whether he will issue instructions that venereal disease be compulsorily reportable.

No, Sir. I am sure that this would hinder progress rather than help it.

Is my hon. Friend aware that there are many diseases sexually transmitted which do not come under the legal definition of venereal disease? In view of the fairly large and substantial increase amongst young persons, surely the Minister will reconsider his attitude?

No, Sir. I agree with my hon. and gallant Friend that the increase in certain diseases since 1954 is a matter of serious concern, but compulsory notification of venereal disease would be of little use, unless treatment of the patient, notification of his consorts and examination and treatment of the consorts were also made compulsory. Only in the most exceptional circumstances would such extensive compulsion be acceptable in this country, even if it were likely to be effective.

asked the Minister of Health what steps he is taking to ensure that no chiropodist at present paid out of public funds is prevented by reason of not being registered, from continuing to work until sufficient registered chiropodists are available.

The Regulations which my right hon. Friend laid before the House on 29th June do not prevent chiropodists who are not qualified for registration from continuing in posts where they are properly employed.

Can my hon. Friend confirm that these Regulations will cover the case of the two ladies about whom I have written to him, who are working as chiropodists in Keighley and doing much valuable work?

Yes, Sir. I know my hon. Friend has been concerned about this. I can confirm that the new Regulations do not affect the employment of these two ladies. Therefore, their employment is in fact protected.

Is the Joint Parliamentary Secretary aware that some local authorities have been employing chiropodists who are neither registered nor qualified? Is it a fact that the new Regulations will at any rate make this practice no longer possible as to new entrants to the Service?

Yes; I understand that that is the position as regards new entrants to the Service. The new Regulations also make registration a requirement for employment in local authority welfare services and services provided by voluntary organisations as agents for local health and welfare authorities only for persons appointed after 29th June, 1964. In all other cases of existing employment the position is safeguarded.

Will the hon. Gentleman watch this matter very closely, because it is essential that a qualified person, or someone who thoroughly understands the job, should be responsible for dealing with people's feet, especially the feet of old people? So much depends upon the right treatment. There are all kinds of voluntary organisations employing people who have merely taken a postal course and are not qualified at all.

I entirely agree with the hon. Lady. The whole purpose of these Regulations is to ensure that proper standards are employed. My hon. Friend in raising this question was concerned with people who have been providing good service over a number of years to a local authority, and we were anxious in this particular case—I am sure that the House will feel that this is right—to ensure that their employment continued.

asked the Minister of Health whether he will now amend the regulations so as to allow the carrying of a passenger in such invalid tricycles as have room for them.

asked the Minister of Health if he will now give approval for the provision of cars for the industrial-disabled paraplegics.

asked the Minister of Health if he will make a further statement about the provision of two-seater cars for civilian disabled persons in lieu of invalid tricycles in special circumstances.

I am advised that the carriage of a passenger in an invalid tricycle would be dangerous. I hope very soon to have completed a review of the whole question of invalid vehicles.

Can my right hon. Friend give an indication of when he will have completed this review and, in particular, whether he will make a statement before the House rises for the Summer Recess? Is he aware that many people feel that these invalid tricycles could be used by two people, particularly for married couples who are both incapacitated, and that this would be of immense value?

In answer to the second part of my hon. Friend's supplementary question, of course I see the great social advantage of being able to carry a passenger in an invalid tricycle, but I am told that accidents have occurred when a passenger has been carried and that in some cases this has seemed to have been the result of the vehicle having become unstable.

I welcome the Minister's statement about his intention to make an announcement before we rise for the Recess. Is he aware that hon. Members who represent constituencies where the incidence of disablement resulting from industrial injuries, particularly mining disablement, is high are sick and tired of this proscrastination on the part of the Government? Does the right hon. Gentleman not agree that the continued treatment of the industrially disabled—the cruel discrimination that takes place between those who have been injured through industrial accidents and are severely disabled and those who receive their injuries in another way—requires action on the part of the Government?

I can assure the hon. Gentleman that there is no question of procrastination here. I am trying to reach the best conclusion I can. As to his remarks about discrimination, with due respect to the hon. Member, if I were to do as he suggests in his Question—and I have, of course, given serious thought to his suggestion—that would be discrimination in favour of industrially disabled paraplegics over other people who are equally disabled and for whom provision is made within the National Health Service; and I do not think that that would be right.

Do not the difficulties mentioned by the right hon. Gentleman apply to all disabled people, and is it not illogical that the war disabled should have two-seater cars while the industrially disabled should not?

That matter has been considered on many occasions by the House and, as the hon. Gentleman knows, it has generally been the view of the House that some preference should be given to war pensioners.

Does not the Minister realise that by refusing to agree that there has been procrastination over this matter he is refusing to accept that my hon. Friends and I have for years been urging that something should be done but have received no action from the Ministry? If that is not procrastination, what is?

asked the Minister of Health what arrangements are being made to secure that facilities for training the staff of training centres for the mentally sub-normal are available in Middlesex after 1st April, 1965.

The county council is arranging for training for the staff of junior training centres to be carried on by the Chiswick Polytechnic, whose first course will start in September.

Can my hon. Friend say precisely what arrangements are in hand for the new London boroughs in the Middlesex area to carry on this valuable training for the staff of the junior training centres when they take over next April? Can he also say what arrangements there may be for providing courses for the staff of the adult training centres?

The course at Chiswick Polytechnic will be open to students from any authority. I understand that a number of places for the first course will be reserved for Middlesex students. On the specific Question asked by my hon. Friend, we expect that the nine London boroughs in the Middlesex area will agree to sponsor these students after April 1965. In addition to courses for staff for adult training centres, the National Association for Mental Health also provides four full-time courses for teachers of mentally handicapped children, for which students are accepted from all over the United Kingdom and overseas.

asked the Minister of Health what special features have characterised the services for the mentally disordered provided in recent years by Middlesex County Council.

Two particularly noteworthy features are the development of industrial training for mentally subnormal adults including units within ordinary factories, and a small residential hostel for patients discharged from mental hospital which is run by the residents themselves and was the first such hostel to be opened anywhere in the country.

Would the Joint Parliamentary Secretary not agree that Middlesex County Council has an outstanding record in mental health services, and can he give an assurance that the new London boroughs, when they take over from the Middlesex County Council next April, will continue and develop these services?

Yes, Sir, and I entirely agree with my hon. Friend. [HON. MEMBERS: "Oh."] Hon. Members opposite have no need to say "Oh" because I have always believed in giving credit where it is due. Just as my own county council has a splendid record in the welfare sector, so it is true to say that Middlesex County Council has an excellent record in the provision of mental health services.

asked the Minister of Health if he will prepare legislation to make the provision of free washing facilities compulsory in public conveniences and in toilets in railway stations, work places, restaurants, public houses, places of entertainment, hotels and houses in multiple occupation.

There are already detailed requirements about washing facilities in most of the places mentioned by the hon. Member. They vary according to the particular type of place, and I do not think that general legislation would be appropriate.

Does the Minister remember that at the time of the typhoid epidemic in Aberdeen, which is an unusually clean town, it was said that one-third of the public conveniences were without washing facilities? Are these facilities not as important for health as factory legislation is for safeguarding against accident? Will the right hon. Gentleman at least consult with his right hon. Friends the Minister of Transport and the Minister of Housing and Local Government to see that in their Departments insistence is placed on washing facilities being provided?

I expect that the hon. Gentleman will already know that local authorities may provide washing facilities in public conveniences and that they are not obliged to charge for them, although I appreciate that some do. My right hon. Friend the Minister of Housing and Local Government, in replying to a Question asked by the hon. Member for Lanark (Mrs. Hart) on 9th June, undertook to consider issuing a circular to local authorities about the provision of free washing facilities in public conveniences.

Why does not the Minister of Health consider that general legislation on this subject would be appropriate? Is it not desirable, from a health point of view—and in view of the experience of happenings like the Aberdeen typhoid epidemic—that washing facilities of this type should be provided universally? Is it not advisable, if their provision cannot be obtained by other means, that it should be done by general legislation?

The reason why I do not think that general legislation would be appropriate is because requirements differ, for example as to the persons for whom the facilities should be provided. [HON. MEMBERS: "Shame."] I refer to workpeople, residents or the general public. That is why there are regulations relating to each of the types of establishment referred to in the Question. It is better to deal with it in this way, although I am not saying that it may not be necessary to improve and extend the regulations; but general legislation would not be the best way of achieving what the hon. Gentleman and I both have in mind.

Does not the Minister appreciate that the events of recent months have suggested that our standards of food cleanliness are really not as high as they should be? Does he not think that perhaps the time has come for a general review of food hygiene regulations in order to see whether or not they should be rather more stringent and rather more stringently applied than at present?

The hon. Gentleman knows, because I have announced it in the House, that I am reviewing the regulations concerning hygiene in markets and certain other places. As I understand it, it would in any event have been necessary, as a result of that review—and the regulations are now with the local authorities concerned for comment—to consider amendments to the general regulations. In doing that, of course, I am quite willing to—and, indeed, I have already decided that we should—take into account the events of recent months, and if there is anything we can learn, or any improvements we ought to make, we shall make them.

asked the Minister of Health if he will introduce legislation to restrict the sales of all medicines, including proprietary brands of medicinal products, to pharmacists only.

The current review of medicines legislation has not so far suggested that so comprehensive a restriction would be in the public interest.

May I thank my right hon. Friend for that Answer? Is he not aware that there must always be a qualified pharmacist at all times on the premises of any dispensing pharmacy even if he is selling only aspirins or cough mixture, whereas at the same time a supermarket can employ a nonqualified teen-age assistant to sell the same articles? Is he furthermore aware that when customers go into a supermarket for aspirins or something of that kind it may not necessarily be the article they want? The qualified pharmacist can offer guidance whereas the unqualified assistant cannot always do so.

I see the point made by my hon. Friend. One of the matters being considered in the review is whether the existing restrictions on the sale or supply of medicine need extending at all, but, as far as I understand, the Pharmaceutical Society itself is not pressing for a complete monopoly.

asked the Minister of Health what provision is being made in Cardiff for accommodating elderly people who need residential care.

Cardiff County Borough Council provides 427 places in 12 homes. Thirty-five places are provided by voluntary organisations acting as agents of the authority. The authority has two new homes with 83 places under construction and a further nine with 362 places are planned by 1974.

Is my hon. Friend aware that his reply will be widely welcomed in Cardiff, but can he tell me how much of this accommodation will be provided from former public assistance institutions?

I am very glad to tell my hon. Friend that the answer to that is "None". Cardiff County Borough Council has the best record in Wales in the construction of purpose-built homes. I am very glad to say that the council vacated its last former public assistance accommodation early in 1961. Again I should like to pay tribute to a progressive authority.

Is the hon. Gentleman aware that his tribute to the Labour Council of Cardiff will be very deeply appreciated, and used? Despite the splendid record of the local authority, can the hon. Gentleman say how long it will be before we can eliminate the waiting list of those who desire residential care?

I seem to detect a partisan note creeping into the hon. Member's observations. In this particular field we see no distinction. There are first-rate authorities throughout the country, some under Socialist administration and some under Conservative administration. The important thing is that in recent years resources have become increasingly available from the Government in order to allow the expansion of local authority services. As for the latter point in the supplementary question, I notice that this subject is very near to the hon. Member's heart and that he has secured the Adjournment debate tonight. I suggest that we pursue the argument there.

On a point of order. I am raising an entirely different matter tonight. Would you care, Mr. Speaker, to give me an opportunity to follow up the supplementary question.

Not now.

asked the Minister of Health why he disregarded the researches, of which he was informed, of Dr. Ionel Rapaport into the relationship between the concentration of fluoride in the water supply and the proportion of mongol births.

I would refer my hon. Friend to the Answer my hon. Friend gave to my hon. and gallant Friend the Member for Arundel and Shoreham (Captain Kerby) on 24th June. I am sending him a copy of my chief medical officer's circular letter mentioned in it.

Whilst I am not aware of the content of the letter, may I ask whether it is not rather odd that the Ministry, especially as in detailed evidence in Circular 105, disregards completely the overwhelming evidence in favour of the fact that an increase in mongol births is directly associated with an increase in fluoride in water and that an amount up to one part per million recommended by the Ministry is sufficient in itself apparently to have some effect? Although the number of such births is comparatively small, is it not entirely wrong that a local authority should be encouraged to put fluoride in the water supply even if one mother only is affected thereby?

I disagree entirely with what my hon. Friend has said. I have considered this matter carefully, and the advice I have been given is that there is no basis whatever for any suggestion that fluoride might even cause one mother to give birth to one mongol child. The defects in the report of the work of Dr. Rapaport are fully explained in the document which I am sending to my hon. Friend.

Is it or is it not a fact that Dr. Rapaport's statistical evidence and conclusions are not accepted by any reputable authority, and that to the best knowledge and belief of my right hon. Friend no harm has come to anybody by drinking water containing up to one part per million of fluoride, whether artificially or naturally present?

There is certainly no evidence whatsoever of any harmful effect from water with a fluoride content of the level which is adopted in fluoridation. A carefully planned investigation by Dr. Berry, in this country, in which virtually all mongols were traced and control areas were included, shows that there is no connection between the concentration of fluoride in water supply and the proportion of mongol births.

Would the right hon. Gentleman not agree that it would be absurd if he were to recommend local authorities to add Epsom Salts to all our drinking water because some people suffer from constipation? Does he not realise that the parallel with the addition of fluoride is exact? Surely all of us do not need to drink fluoridated water just because it is of use to some children.

I do not agree with the hon. Member. Epsom Salts may be appropriate in his case, but I do not need it.

asked the Minister of Health whether, in view of the recent pronouncement of the East Anglian Regional Hospital Board on the subject of the provision of additional maternity beds at Lowestoft, he is in a position to give a firm date for the new maternity ward to be provided at Great Yarmouth with its consequent improvement to the position at Lowestoft Hospital.

Not yet, by the Board is treating it as a matter of urgency.

Will my hon. Friend do everything he can in his Department to help the Board get on with this project quickly? It is very badly required. Is my hon. Friend aware of the very serious position on the East Coast at the moment in regard to maternity beds?

Yes, Sir. Both my right hon. Friend and I are well aware of the local concern in my hon. Friend's constituency and next door in Great Yarmouth. The project will be a major one and time is needed for the planning work before the Board can commit itself to a date.

asked the Minister of Health what machinery he has for encouraging improved methods of use of resources by hospitals.

This year £145,000 is being provided for research into hospital management. Suggestions for improvements in efficiency are made in a variety of ways, and my right hon. Friend has the advice of an Advisory Committee for Management Efficiency. At the present time 155 work study officers are employed in the hospital service.

Can my hon. Friend say to what extent regional hospital boards and hospital management committees have been advised that they may employ specialist consultancy services externally to their hospitals for payment out of revenue allocation, whether the sum of £145,000 to which he referred is additional to normal revenue allocations, and whether the additional money is being provided for local clinical research?

I can assure my hon. Friend that my right hon. Friend is prepared to consider any such proposals put to him by regional hospital boards. The sum of £145,000 is in addition to the money being provided by hospital authorities from their normal revenue allocations. My right hon. Friend is also providing £445,000 this year for local clinical research.

When the Joint Parliamentary Secretary says that additional money is being provided to give hospitals a chance to use their resources to better advantage, could it be that they will use some of it to deal with the matters outlined in Questions 69 and 70; namely, to see that ambulances are available for patients who really need them?

That seems to be an entirely different question and I think that we must wait until we reach the Questions to which the hon. Gentleman refers.

asked the Minister of Health what was the number of new hospitals built in the County of Durham since January 1952.

None, but over £5½ million has been spent on improvements to hospitals in the county. Site work on a new district general hospital at North Tees has also begun, and work on substantially remodelled hospitals at Shotley Bridge and Darlington is in progress.

Is the Minister aware that since 1952—during the course of 12 years—we have had six Conservative Ministers of Health, none of whom has been able to produce a hospital in the County of Durham? Is he also aware that his predecessor, in reply to a Question I put about the need for a hospital in the new town of Peterlee, a town with a rapidly-growing population and a very clamant need for hospital accommodation, informed me that a hospital was being extended in Stockton, 20 miles away? Is that position regarded as satisfactory?

I have pointed out that already £5½ million have been spent on improvements to the hospitals in the county. The North Tees General Hospital will be a completely new hospital and, as I said, the Shotley Bridge Hospital and the Darlington General Hospital will be substantially remodelled, and major schemes are now in progress at both. It is planned that the West Hartlepool General Hospital, the Sunderland General Hospital, the South Shields General Hospital, the Queen Elizabeth Hospital, Gateshead, and Bishop Auckland General Hospital will all be substantially remodelled, and major schemes for all are planned to start in the next five years.

All those extensions are remote from the area with which I am primarily concerned, which has a rapidly-growing population, as I have said. It is at the very centre of a still prosperous mining industry, where, unfortunately, many accidents occur. Is not this a bad situation? Does not the right hon. Gentleman think that even in the limited time at his disposal he might be able to initiate something?

There is no difference between hon. Members on the two sides of the Chamber as to the size of the hospital programme. The question at issue is really one of priorities, and I should have thought from what I have seen of what is being done in the area that we had the priorities right. I must say to the right hon. Gentleman that last year the Labour Party scoffed when we said that we would start one new or substantially remodelled hospital every 19 days—but we did it. And this year we shall start one every ten days.

Is my right hon. Friend aware that our hospital services on the North-East Coast were, for a variety of reasons, very behindhand after the war, and that when the capital allocation was made at the time of the establishment of the National Health Act, no additional capital allocations were made to the North-East Coast, and it was left to the Conservative Government to put up the capital allocation, which those concerned there were glad to receive?

I am very grateful to my hon. Friend for having made that point which, I am bound to say, had not occurred to me.

asked the Minister of Health what provision is being made for a regional centre in the Newcastle-upon-Tyne area, for the treatment of burns.

A burns unit of 40 beds is already in existence at the Hospital for Sick Children, Newcastle. Plastic surgery units which also deal with burns are in existence at the Newcastle General Hospital and the Royal Victoria Infirmary. Further provision will be made in the plans for the main Newcastle hospitals.

But is my hon. Friend aware that badly-burnt patients need to be cubicle-ised, and that there is at the moment only one burn cubicle available at the plastic unit at Newcastle? Can he say what other plans there are for units to deal with badly-burnt patients in the North?

It is not envisaged that there will be a single burns centre for each large region. The Standing Medical Advisory Committee recommendation was that certain accident centres which would normally be provided at most district general hospitals should be designated as burns centres. The answer to the second part of my hon. Friend's supplementary question is that the regional boards also plan to provide burns centres at Middlesbrough and Carlisle, and possibly at Sunderland.

asked the Minister of Health what progress has been made in the provision of improved casualty facilities at the Croydon General Hospital; and if he will make a statement.

The regional board has now approved a scheme to provide an additional treatment cubicle, improvements to the waiting space and entrance, new partitions to the cubicles, complete redecoration of the department, and additional equipment.

While thanking my hon. Friend for that helpful reply, may I ask whether he can say anything about the staffing services for this hospital? Would he, in conjunction with the regional hospital board, provide for a rather more efficient service for casualties, particularly at weekends, than we have been able to have in the past?

I cannot, without notice, say anything about the staffing position. I am told that the board is satisfied that major changes are not practicable; and that its intention is still to move the casualty department to the Mayday Hospital, elsewhere in Croydon. Perhaps I should say that the improvements I mentioned should be completed by September of this year.

asked the Minister of Health how many houses owned by the hospital authorities do not conform to the standards now prescribed for a local authority house.

Such standards relate to the construction of new local authority houses. The construction of hospital houses matches these standards.

The Joint Parliamentary Secretary knows that there are a good many hospital houses that are not really satisfactory, and should be brought up to date. Will he do something about this by circularising the boards to see that standards are more in conformity with modern trends?

My right hon. Friend has already done something about it. For existing hospitals, he has asked boards to conform within a reasonable time with the standards set out in the Housing Act.

asked the Minister of Health how many hospital wards are at present standing empty; and for what reasons.

I regret that this information is not available. Wards can be temporarily out of use for a variety of reasons, including redecoration, quarantine, and staff illness.

Can they not also be out of use because there are not enough nurses available or money available sometimes to open new wards—because the scheme is postponed for money reasons? Does he not think that it would be a good idea to call for returns about vacant wards, so that the public may know what is going on in the hospital service?

The hon. Gentleman is not only behind in this respect as he was before, but completely wrong. Hospital nursing and midwifery staffs are now at record levels. The point is that statistics by wards have never been collected, for the obvious reason that there can be many kinds and sizes of wards. I should have thought that the hon. Gentleman would have been aware that hospital statistical returns all give a total number of staffed beds available, irrespective of actual use. The information that the hon. Member requests could be obtained only by special census, and neither my right hon. Friend nor I consider that the work involved would justify it.

Is it not the fact that the official returns to the Department used to include in the figure for staffed beds the beds that were unavailable through lack of staff, and that this figure is no longer given? If so, why?

If I heard him aright, the hon. Gentleman has referred to beds, in which case he is quite correct, but the question refers to wards—[Interruption.] No, the hon. Gentlemen is on a perfectly fair point, but it is a different point. The hon. Member for Bishop Auckland (Mr. Boyden) referred to a statistic that would be utterly and completely worthless.

On a point of order. The Parliamentary Secretary has accused me of not being up to date. May I say that, in all fairness, he should recollect that I raised this Question three years ago?

I do not observe a point of order.

asked the Minister of Health what planning and what consultations have begun to ensure that the new town of Redditch will have adequate hospital facilities; and whether he will make a statement.

The regional hospital board has already been in touch with the newly appointed chairman of the new town corporation and it has been agreed that the provision of hospital services for this area will be discussed as soon as the corporation is ready to do so.

Can my right hon. Friend give me any information on when these discussions are likely to take place? Can he also give a positive assurance that the movement of population within my constituency will be taken into account when hospital planning for the future is thought about?

Yes, Sir. I understand that discussions will be arranged as soon as the key staff of the new corporation have been appointed. The chairman was officially appointed only on 1st June. I assure my hon. Friend that the regional hospital board has taken note of the information so far available about the projected movement of population into Redditch and will keep the hospital development plans for this and the surrounding areas constantly under review.

If this new town can get a new hospital, why cannot I?

Answer.

I am sorely tempted to do so.

asked the Minister of Health what steps he is taking to increase the number of hospital amenity beds.

This is a matter initially for hospital authorities, but I am always willing to consider their proposals.

Would my right hon. Friend not agree that there are a number of patients whose recovery would be hastened if they were able to obtain an amenity bed? Would he not also agree that because of the tremendous shortage of these beds, such patients are often forced to obtain private beds at considerable cost? Will not he do something to make an increasing number of amenity beds available, especially in the big teaching hospitals?

The present practice, which I think is right, is to provide amenity beds to meet the demand where this is possible without detriment to the number of beds in single rooms or small wards which are normally required by patients on medical grounds. Wards in new hospitals planned in accordance with the Hospital Building Notes will have an adequate provision of single rooms and small wards to permit the designation of amenity beds.

asked the Minister of Health what was the ratio of admissions from outside the area of the Gateshead and District Hospital Management Committee to the total figure of admissions to the Dunston Hill Hospital during 1963; and to what extent the figure of outside admissions was taken into account when assessing the bed requirements of the Gateshead Group and its effect upon the problem of accommodation for geriatrics.

Thirty-seven per cent. Future bed requirements are based on the expected needs of the area to be served, and not on current admissions to individual hospitals.

Is the Parliamentary Secretary aware that during the last 12 months in the Gateshead group of hospitals the waiting lists have swollen by one-third and waiting periods are something like 2 to 12 months and more? In any case, this does not take account of the time spent in waiting to see the consultant. Would the hon. Gentleman not agree that the admissions from outside the Gateshead Group are aggravating the situation? Can he tell me what action is being taken to bring about a decrease in the waiting lists?

There are really two points here. The first is that at Dunston Hill war pensioners have a first call on the service and it is also a regional neurosurgical rehabilitation unit. Some beds are used for gynaecological and ortho- paedic cases from the adjacent South Shields Hospital Management Committee. It is thus serving a larger area. On the second point relating to waiting lists, I should like notice of the question. May I look into the matter and write to the hon. Gentleman?

asked the Minister of Health what is the policy of Her Majesty's Government concerning the establishment of a grade of senior enrolled nurse.

My right hon. Friend is taking steps to establish this new grade which we regard as an important advance. My right hon. Friend the Secretary of State is taking similar action in Scotland.

Is the hon. Gentleman aware that when the Minister made the announcement to the State-enrolled nurses on 21st April many of them expected action in the near future? Could the hon. Gentleman give some indication of when this grade will be created? Could he also say what will be the qualifications for entry into the senior grade?

I cannot give a date at the moment. Before a date can be announced, advice has to be sent to hospital authorities. A memorandum is being sent shortly asking them to revise establishments with the object of designating suitable posts in wards and departments. I can understand the impatience of the hon. Gentleman to get things moving, but I am sure there will be a general welcome to this further recognition of the place of enrolled nurses in the hospital service and the new opportunity for promotion which it will give.

Can the hon. Gentle-man answer my question about the qualifications for the senior grade?

I should like notice of that question.

asked the Minister of Health how many hospitals have so far applied the 42-hour week to all nursing staff.

My right hon. Friend has asked for progress reports at six-monthly intervals. The first will be available in November.

Can the hon. Gentleman give no indication at all at the moment of whether the target date for the 84-hour fortnight will be met by 1st January, 1966?

We have asked hospital authorities to complete by 1st January, 1966, the implementation of the reduction in working hours. We hope that they will achieve this, or will make every effort to do so. I cannot give any more information on that point at the moment.

Would the hon. Gentleman see that in the current negotiations the 72,000 nurses in training receive a fair deal in their wages this time? Is he aware that many of them are receiving only £2 15s. a week after they have paid for their board? Will he also bear in mind that they will not be satisfied with the 3½ per cent. recently awarded to the clerical staff in accordance with the Government's guiding light, because that would mean only 4s. a week extra for them?

I always bear in mind anything that the hon. Gentleman puts to me. Of course, this is a matter for the Whitley Council, and I have no doubt that the consideration which he has been advancing will be advanced by the appropriate side.

asked the Minister of Health if he will insist, in negotiating renewal of the Voluntary Price Regulation Scheme, upon full disclosure by individual pharmaceutical manufacturers of such research and manufacturing costs, profit margins, and sales promotion expenditure as may be required by his Department; and if he will take steps to ensure that any new agreement has a maximum duration of three years, subject to six months' notice.

I hope that a new scheme will be agreed at a meeting which is taking place today, and I have noted the hon. Gentleman's points.

Would the right hon. Gentleman not agree that, in the absence of the kind of information referred to in the first part of the Question, he will be negotiating prices of individual drugs with one hand tied behind his back—if that is possible? Would he not also agree that his hand in these negotiations on the agreement ought to have been strengthened by the assurance, which I now repeat, that in the event of a change of Government we would not necessarily feel bound by an agreement which we did not consider adequately safeguarded the taxpayers' interests?

In reply to the first part of the supplementary question, compulsory powers for obtaining information are contained in the Emergency Laws (Repeal) Act, 1959, and are continued in the Emergency Laws (Re-enactments and Repeals) Bill which has just received its Third Reading. The Act provides, in general terms, for the undertakings concerned with medical supplies to furnish such informaton as may be prescribed.

Is the right hon. Gentleman aware that if he does not investigate the difference between basic research and development research he may unconsciously be subscribing to claims for original discovery which bear no relationship to the facts because of the limited amount of basic research in this country? Is he further aware that he will be well advised to investigate the sources of income of the Association of the British Pharmaceutical Industry wherein he may discover that there are unnecessarily suspicious sorts of contribution?

I think, with respect, that the powers which the Minister of Health will be taking in the Emergency Laws (Re-enactments and Repeals) Bill, which has received its Third Reading, will be adequate to achieve what we all desire.

asked the Minister of Health whether the chimney of the University Hospital of Wales is of the height and shape originally designed; whether it was included in the scale model as exhibited; and whether he will take steps to reduce annoyance to nearby residents by replacing it with a more attractive design.

Yes, Sir; as is normal, the detailed design work was undertaken after the model was prepared; the design is intended to minimise any risk of nuisance from grit or fumes.

Is my hon. Friend aware that, while we welcome the construction of this hospital in Cardiff, it is understood that this chimney has been increased in height by some 25 ft.? It is something of an eyesore and a monstrosity, causing a great deal of annoyance to residents over a considerable area. Will my hon. Friend not see whether something cannot be done by redesigning or repainting, or doing something, to reduce the great pain which is caused to a number of people over a wide area in my constituency?

The appearance of the chimney, or for that matter any chimney, is bound to be a matter on which there will be differing views. I can assure my hon. Friend that the greatest care has been taken in designing the chimney to minimise the possibility of grit or fumes being a nuisance or harmful to health. I should have thought that a nuisance of that kind would have given infinitely more pain to my hon. Friend's constituents.

Is the hon. Gentleman aware that as a constituent of the hon. Member for Cardiff, North (Mr. Box), albeit unwillingly, I can assure him that the hon. Gentleman has interpreted the feelings of people in Cardiff about this horrible, ugly, annoying chimney, which is, I believe, quite unnecessary in view of modern design? Will the hon. Gentleman ask the hospital authority to look again at this chimney, which is getting on the nerves of us all? Is he aware that wherever we go in Cardiff we see this chimney?

All I can say is that the height and the position of this chimney on the site were determined only after tests of the model of the hospital had been carried out at the National Physical Laboratory at Teddington. [Interruption.] The scientific tests, to which I imagine the hon. Member for Cardiff, West (Mr. G. Thomas) would attach some importance, were carried out at the National Physical Laboratory at Teddington. I will certainly consider whether it is possible to have a look at this point again, but I do not want to leave the House with the impression that the most careful thought has not already been given to this chimney in order to ensure that it does not pollute the atmosphere.

asked the Minister of Health what was the total amount of the decrease in the financial content of the hospital building programme 1963 to 1974 shown by the latest revision, as compared with the programme previously agreed for the North-West Metropolitan Regional Hospital Board; what schemes have now been excluded until the period 1970 to 1974; and what schemes were originally included in the period up to 1972–73, but are now deferred beyond 1974.

The financial content of the hospital building programme for this region has not been decreased, as implied in the hon. Member's Question. On the contrary, this year's revision shows an increase for the region of £8 million compared with what was originally proposed. As I have already explained, with changes in priorities, involving the development of new projects in the national programme and the bringing forward and the enlargement of others, it has been necessary, despite an increased hospital programme in real terms, to defer some schemes. I will, with permission, circulate in the OFFICIAL REPORT details of those schemes suggested as likely to start within the original ten-year programme but now beyond it and expected to start before the end of the ten-year programme of the revised plan. I will also circulate in the OFFICIAL REPORT details of the schemes referred to in the last part of the Question.

How can the Minister reconcile the figures which he has given with the figures from last year's revision, £66·5 million being reduced in this year's revision to £48·5 million, which, according to my reckoning, is a cut of £18 million in the financial content? Can the right hon. Gentleman say how it is that a number of the deferred schemes which are for out-dated and antiquated hospitals, which we had expected, before the plan presented by the right hon. Member for Wolverhampton, South-West (Mr. Powell), would be started by 1966, are now to deferred until after 1975? Does the Conservative Party mean by a 10-year plan a 10-year deferment of things which were to happen earlier?

If the hon. Gentleman looks at the Answer which I have given, he will agree that my figure of an increase of £8 million as between the two programmes is correct. As regards his second point, all I can say is that it was made abundantly clear by my right hon. Friend the Member for Wolverhampton, South-West when he introduced the Hospital Plan, and it is, in fact, specified in the plan itself, that the estimates made in the preparation of the plan were tentative and might have to be modified considerably when the detailed schedules of accommodation came to be prepared. It was never intended to be a rigid plan, and I do not doubt that in the future, as in the past, there will be further modifications as priorities change. This is inevitable. What is important is that this is an expanding plan, a plan which is growing significantly not only in money terms but in real terms.

asked the Minister of Health what is the total reduction in expenditure on the South-West of England Regional Hospital Board's hospital building programme for 1963–64 revealed by the latest revision; what schemes have now been excluded until the period 1970–74; and what schemes originally included in the period up to 1972–73 have now been deferred beyond 1974.

asked the Minister of Health what is the total amount of the decrease in the financial content of the hospital building programme, 1963 to 1974, shown by the latest revision, as compared with the programme previously agreed for the South-Western Regional Hospital Board; which schemes in the programme have now been postponed until the period 1970 to 1974; and which of the schemes originally planned to be commenced or completed prior to those dates have now been deferred beyond 1974.

The financial content of the hospital building programme for this region has not been decreased, as implied in the hon. Members' Questions. On the contrary, this year's revision shows an increase for the region of £11 million compared with what was originally proposed.

Will the Minister look again at the replies which he gave me last Wednesday to questions about Redruth, Tehidy and Budock Hospitals and take into account that these hospitals are likely to be needed for as far ahead as can be seen? Will he ask the regional hospital board to take this into account when making plans for the future?

I am sure that the regional hospital board, as I shall, will always take into account what the hon. Gentleman suggests, but I must point out that, even though this is a programme which is expanding considerably in real terms, it is necessary to look at the priorities.

Having regard to the Minister's reply to me in the debate on 11th June, which is reported in Col. 718 of HANSARD of that date, and in the light of his statement now that the programme has been expanded by £11 million—which, I presume, is to be over the next ten years—will the right hon. Gentleman consider publishing in HANSARD, in furtherance of the reply which he gave to me, information about where in the various regions the 20 new or substantially remodelled hospitals referred to in the Conservative Party's statement are to come? The right hon. Gentleman spoke of more than 19, so I presume that there are to be 20 new hospitals this year.

I am always ready to provide what information I can. If the hon. Gentleman will put down a Question, I shall do my best to oblige him. The point is that, while we all regret that, from time to time, certain projects have to be deferred, with changes in priorities, what really matters is the overall financial content of the programme. It is relevant to bear in mind in this connection, particularly from the point of view of hon. Members opposite, that the "shadow" Chancellor, the hon. Member for Cardiff, South-East (Mr. Callaghan), has made perfectly clear that the present hospital programme, as he put it,

"could not be exceeded by any party with any degree of responsibility."—[OFFICIAL REPORT, 11th March, 1964; Vol. 691, c. 477.]

Will my right hon. Friend confirm that the hospital programme is a rolling programme so that at any time during the next ten years, if priorities vary or medical needs vary, it will be possible to alter it?

That is so. That is the whole purpose of having annual revisions.

In view of the vast number of major schemes which were included in last year's ten-year programme but which have been excluded from this year's ten-year programme, how can the Minister talk about a plan expanding in real terms? If he is interested in dishonesty, will he consider withdrawing that remark?

Certainly not. The plan is expanding in real terms, as the hon. Gentleman knows only too well. We spent more last year than we spent in the previous year, we are spending more this year, and we shall spend more next year. The overall plan for the next ten years involves an increase in real terms of no less than £160 million as compared with the finance which was assumed in the original plan. Of course, priorities change. The hon. Gentleman talks about the dishonesty of this year's revision. He knows very well that in this year's revision there are pages of new schemes which are brought into the plan for the first time. This very year we are starting projects which will provide enough maternity beds for an additional 45,000 confinements a year. If the hon. Gentleman considers that a larger programme—[HON. MEMBERS: "Speech."]—is irresponsible, and he objects to the deferments which I have announced and of which he knows, let him tell the House frankly which of the new schemes he would cut out.

rose—

We must get on.

On a point of order, Mr. Speaker. In view of the length and tenor of that last answer, which was a speech, not an answer, will you consider whether, in equity, we were entitled to a reply from this side?

I shall consider all those things, but, at the moment, let us have another Question.

asked the Minister of Health whether he will request the regional hospital board to provide a lift at the Budock Hospital, near Falmouth.

I understand that the regional hospital board is considering the provision of a lift at Budock Hospital.

Will the Minister take it that everyone in my constituency will be delighted at that Answer, since this is a long-stay geriatric hospital and there is at present not even a lift to the first floor, a deficiency which prevents some of the patients being taken on car outings by friends of the hospital?

asked the Minister of Health what scale of remuneration is being offered to qualified physiotherapists living in Hull and district in order to induce them to undertake part-time work in their profession; and how this compares with the scale of remuneration offered to induce qualified teachers to do part-time work.

The Whitley Council rates are £1 10s. a session for the basic grade but where more than four sessions a week are worked payment is based on the full-time salary scale. I understand that there are no prescribed scales for part-time teachers but that the local education authority makes payments in proportion to the Burnham salaries to which they would be entitled as full-time teachers.

While thanking my hon. Friend for that reply, may I ask him whether he will agree that, in view of the failure of the level of remuneration to attract physiotherapists to part-time work in Hull, very serious consideration must be given to whether the scale is adequate and whether sufficient recognition is given to qualification and experience?

I know the difficulties in Hull, and I have been in communication with my hon. Friend on the subject. I think that he knows that the Whitley scales are applied nationally. There are no inducement payments, but I understand that an arbitration award on the salaries of physiotherapists is awaited. The staff side claims closer relativity with the pay of teachers.