asked the Minister of Health what proposals he has to implement the recommendation of the Cohen Committee on the Medical Care of the Epileptic.

I have reviewed developments since the Cohen Committee"s Report. Though the diagnostic and treatment facilities for epileptics have been developed, more needs to be done, and I propose to seek advice on what fresh guidance to further their active treatment and rehabilitation might be issued to hospital and local authorities.

In thanking my right hon. Friend for his very helpful reply, may I draw his attention to the fact that one of the greatest areas of concern is the school leaver who is labelled an epileptic? Would he consult his right hon. colleagues the Minister of Labour and the Secretary of State for Education and Science to consider ways and means of improving the employability and other opportunities of these young people?

I will gladly do that. The point is that hospital provision for epilepsy has largely been developed as part of the general out-patient and inpatient services, and not through the separate facilities which the Cohen Committee recommended. I am not altogether happy about the position, and it is partly on that account that I propose to seek advice.

Is the Minister aware that one of the anxieties of the Committee was that areas existed where advice on the special problems relating to the epileptic was not available? Has there been any advance since the Committee reported in late 1950?

I would want notice of that particular point, but it is certainly one of the matters I am taking into account in the review I am having made.

asked the Minister of Health how long cars adapted for disabled persons are retained before they are replaced.

Normally eight years, but the period varies according to the condition of the car.

Will the right hon. Gentleman bear in mind that I have one or two cases in my constituency where it appears to me that cars are being carried on to a life really beyond the practical limit? Will he see whether it is economically desirable, apart from the inconvenience to the users, that cars should go on for almost eight years, irrespective of mileage? I do not think that it is necessarily economic.

There is nothing rigid about it. The hon. Gentleman will recognise that one car can be on the road for three years and in terms of mileage do twice as much as a car that is on the road for six years. Normally we expect eight years. If the hon. Gentleman has any particular problem and writes to me, I will certainly do what I can about it.

asked the Minister of Health if he will now seek to supply suitably adapted production motor cars instead of the present invalid vehicles to the disabled who qualify.

asked the Minister of Health who qualify for the Ministry"s two-seater car; and if he will make a statement about the future issue of invalid cars.

asked the Minister of Health when he will complete his investigations into the question of the provision of vehicles for disabled persons; and whether he will now provide cars for those at present using Ministry tricycles.

asked the Minister of Health when he expects that the extensions announced last July will have been fully implemented; and how soon after that he will announce his new policy on the question of vehicles for disabled drivers.

Four-seater motor cars are supplied to certain severely disabled war pensioners and to married couples where both partners are eligible for invalid tricycles or where one is eligible and the other is blind. I have no proposals at present for extending the supply of motor cars but I have undertaken to review the whole question of the provision of transport for the disabled when the recent improvements have been fully implemented. This will be in about a year"s time; I cannot forecast how long the review will take.

While thanking my right hon. Friend for that reply, may I ask him whether he is aware that his undertaking to review the whole position will be welcomed and very well received by those who may benefit? Is he also aware that many of these vehicles which are at present supplied are rather dangerous as well as unattractive? Will he push his review as quickly as possible?

I am grateful for the first part of my hon. Friend"s supplementary question, but I really cannot accept the latter part in which he suggested that invalid tricycles are dangerous. They have been specially designed for the disabled driver and, if reasonably well driven and maintained, they are reliable machines.

Will my right hon. Friend consider the promise made by the previous Administration some years ago that they were prepared to consider the case which I put to my right hon. Friend, and about which they did nothing? Will my right hon. Friend at least give a firm undertaking that something will be done in the period to which he has referred today?

I have only undertaken to review the whole position of transport for the disabled. There is no doubt that the provision of motorcars in place of tricycles would involve a very considerable additional call on the resources available for the National Health Service as a whole, and we will have to balance this against other claims on those resources.

Is the right hon. Gentleman aware that some of us find this answer rather disappointing? In this review, will the right hon. Gentleman bear in mind the desirability of providing two-seater vehicles for mothers who are crippled where there is no father in the family? Unless such vehicles are made available, it means that the child can never go out with his parent. Not only is this incredibly sad, but it impedes the mental development of the child. Will the right hon. Genleman bear this in mind in his review?

I will certainly bear it in mind but, as the hon. Gentleman knows, it has been considered many times by the previous Government. The provision of passenger-carrying vehicles under the National Health Service would in any event require legislation.

asked the Minister of Health what progress he has made in the choice of a two-seater invalid car, and if he will have a look at the maintenance arrangements generally, and in particular, those obtaining in the constituency of the honourable Member for St. Helens.

On the first part of the Question I would refer my hon. Friend to my right hon. Friend"s reply on 15th February, to the right hon. Member for Monmouth (Mr. Thorneycroft). My right hon. Friend has looked at the maintenance arrangements in St. Helens and elsewhere and these appear to be working satisfactorily.

When looking at the proposed new models for invalids, will my hon. Friend bear in mind that a heater should be installed because of the special conditions arising from the health of these people? Will he also take into consideration my opinion about whether proper service is being given in St. Helens to those invalid carriages which need maintaining?

If I may deal with the last part of the supplementary question first, about 50 patients have powered tricycles in the St. Helen"s area and are catered for by approved repairers at Liverpool, Warrington, Southport and Birkenhead. We have had no complaints at all from the locality about the failure of the service. With regard to heaters, my hon. Friend will be very pleased to know that we have just approved a type of heater for these vehicles, and we hope to get them installed very quickly.

In regard to the provision of cars for invalids, will my hon. Friend be prepared to examine the possibility of allowing people who qualify for an invalid carriage to use for this purpose the garage which they formerly used with their tricycle?

We have had a look at the provision of cars, but this question is confined to maintenance, with perhaps a heater added. This is rather different.

asked the Minister of Health if he is aware of concern among those interested in the welfare of the elderly at the proliferation of voluntary organisations at national level concerned with such matters; and if he will take steps to co-ordinate their activities.

I am not aware that this matter is giving concern, but I am always ready to give these organisations any help they may wish in coordinating their work.

I thank the right hon. Gentleman. Would he not agree that the existence of the National Old People"s Welfare Council, perhaps the best established today, the National Corporation for the Care of Old People, the National Benevolent Fund for the Aged, and now the National Trust for the Welfare of the Elderly, is a proliferation which requires some measure of co-ordination? Would he undertake to pay heed to any representations which might be made to him on the subject?

I will certainly consider any representations, but I understand that all the major bodies are in touch with each other and, in various ways, with my Department, which I believe willingly gives any help it can.

Would my right hon. Friend agree that it was initially arranged at the establishment of the National Health Service that these bodies might be controlled and, if possible, reduced? Is it not the case that they have been tending to increase?

I understand that one or two bodies have been set up recently, but I have had no representations in favour of amalgamations such as was indicated in the hon. Gentleman"s supplementary question.

This question deals with the co-ordination of the care of the elderly. Will the Minister take this opportunity to express his repugnance at the co-ordinated activities of hon. Gentlemen last week in deliberating filibustering—[Interruption.]

Order. How progress is supposed to be made in Questions if we do things like this I do not know.

Reverting to the original Question, would not the Minister be the first to agree that, of the bodies named, at any rate the first two or three have entirely different functions which do not overlap, as he knows full well, and there is no risk of conflict or collision?

This is certainly true of the National Corporation for the Care of Old People, the National Old People"s Welfare Council, and the Women"s Voluntary Service. They all have separate functions.

In any co-ordination which may be done, will the Minister take care not to undermine the wonderful work being done by the Red Cross and the W.V.S. in caring for elderly people?

I certainly would not wish to undermine their work. Nor have I undertaken to do any co-ordination.

asked the Minister of Health what representations he has received from the National Association of Registration Officers; what reply he has sent; and if he will make a statement.

asked the Minister of Health what representations he has received from the National Association of Registration Officers concerning the need for the establishment of arbitration and disputes machinery in order to secure an adequate level of remuneration for registration officers.

Representatives of the Association discussed with me, four days ago, the matters raised in their petition presented to the House by the hon. Member for Leeds, North-West (Sir D. Kaberry); and I am now considering what they said. They are aware that registration officers have the same access to arbitration on disputes as local government officers.

Would my right hon. Friend agree that these officers have been extremely patient in waiting for this meeting and have not made the type of protest that other people with whom he has been negotiating have made recently? Therefore, would he do his best to make a decision on their representations as soon as he possibly can?

I will certainly consider what they have to say as quickly as possible. I do not think I have kept them waiting unduly. They came to see my predecessor as well.

asked the Minister of Health what steps he is taking to educate the public in the health risks of purchasing bargain tins of canned meat.

None, Sir. I am not aware of any risk associated with bargains as such.

Would the Minister agree with Professor Semple, Medical Officer of Health for Liverpool, that, however good official arrangements are, critical public opinion is important? Would he encourage local authorities to make this fact known to the public?

As the right hon. Gentleman knows, it is an offence to sell unfit food for human consumption, whatever the price may be. Local authorities have powers to seize or detain food for sale if they think it is unfit for human consumption. I certainly encourage them to act on those powers.

asked the Minister of Health whether he will review payment of ambulance charges under the National Health Service.

asked the Minister of Health whether he will make provision for ambulance charges to be covered under the National Health Service in those cases where a doctor considers it necessary for a patient to be moved from one private house to another.

It is for each local health authority to decide whether provision of free ambulance transport for a particular journey falls within its duty under Section 27 of the National Health Service Act, 1946. A journey from one private house to another may or may not form part of their duty according to circumstances.

Will the Parliamentary Secretary consider sending a directive to local authorities suggesting that where a doctor certifies that it is important for the patient to be moved from a house where there is no one to attend to that patient to a house where there is a relative, payment should be made under the National Health Service?

We expect local health authorities to place the needs of the patient first. This is the paramount consideration, and we would hope that in all cases where it is necessary from a medical point of view to transfer patients from one house to another, local authorities will do the job in the interests of the patient.

Will the Parliamentary Secretary tell us why, in the case of the use of helicopters as ambulances in the South-West, the local authority is enabled to charge for this service? Is not this an operation which the Air Force could carry out as a training job and help the community at the same time?

I think the hon. Gentleman is flying a bit high on this Question. If he puts a Question down I will give him an Answer.

asked the Minister of Health what evidence he has received of an increase or decrease in demand for prescriptions since 1st February, 1965.

asked the Minister of Health what evidence he has received on the increased demand for prescriptions following the abolition of prescription charges.

asked the Minister of Health if he will publish statistics of the changes in demand for prescriptions following the abolition of prescription charges.

It will be some time before it is possible to assess the effect of abolishing prescription charges; preliminary information suggests that the number of prescriptions dispensed in February of this year, compared with the same month in the last six years, was probably higher than in four of those years and lower than in the other two.

Would my right hon. Friend not agree that, in view of that reply, it can be shown that in the winter months there usually is an increased demand for prescriptions depending on the severity of the winter and that the assumption on the part of hon. Members opposite that there would be an increase in demand even before the charge was taken off was quite unjustified?

I would certainly agree that there is nothing whatever in the provisional figures which have reached me so far to suggest that there have been any of the abuses by patients so confidently forecast from the benches opposite.

Does not the information given by the right hon. Gentleman prove conclusively that talk during the election that thousands of people were being kept away by what was called a "tax on the sick" was absolute rubbish?

As far as I know, nobody talked, and certainly I never talked, about thousands and thousands of people being kept away, but to the extent that people who were kept away have now been able to get prescriptions I am sure that all of us on both sides of the House will be pleased. In any event, we expected some increase. There is an indication of some increase, but there is no indication of any large increase or abuse.

There may have been some slight increase, but would my right hon. Friend agree when all the information is to hand to provide some evidence on those cases and to analyse any increase which has taken place in respect of type of patient and even type of doctor responsible for giving the prescriptions?

I will gladly give such information as I can to the House, but I doubt whether it would be possible to break down the figures in quite the way that my hon. Friend would like.

Is the right hon. Gentleman aware that in yesterday"s Sunday Express a general practitioner in Chatham said that he gave out 255 prescriptions instead of the normal 60 on the first day of the removal of the charge and that he and many other doctors reckon that they are now being blackmailed by their patients?

Rubbish.

I saw the report in the Sunday Express and I gave it the attention which I thought it deserved.

Is my right hon. Friend aware that the pattern of prescription charges, the economic difficulties of the Government and the pressure by general practitioners on pay are all leading to a situation where a school of thought is growing in favour of having a two-way system of not only free National Health Service at the time of the service but also for some form of payment? In the negotiations with the general practitioners, will my right hon. Friend resist any attempt to dilute the idea of a free at-the-time service to sick people?

I am glad to inform my hon. Friend that there is no indication that this is what the doctors wish to discuss in their charter for general practice.

Will the right hon. Gentleman accept from me that Croydon doctors have found that the number of prescriptions have gone up by an average of 20 per cent. since the charge was taken off? Will he look into this?

Certainly, I will, but Croydon, as in some other matters, must be atypical, because there is no indication of anything like a 20 percent. increase.

asked the Minister of Health if he will introduce legislation to compel dependants of voucher holders and returning residents, at present exempted under the Commonwealth Immigrants Act, to undergo medical examination on landing.

asked the Minister of Health if he is satisfied with the health regulations governing immigrants from Commonwealth countries; and whether he intends to enforce stricter control.

I am sending the hon. Members particulars of new arrangements that were introduced earlier this year. I intend to study their effect before deciding whether further measures are needed.

While appreciating the improvement in the arrangements, may I ask the right hon. Gentleman whether he is aware that the British Medical Association still consider that there is a gap in respect of dependants? Will the right hon Gentleman bear in mind that dependants, whom none of us would wish to exclude, would actually benefit from such a medical examination?

I should like to see how present arrangements are working out, because to require the medical examination of dependants would involve legislation. The right hon. Gentleman might like to know that in the first six weeks since X-ray apparatus has been established at London Airport, out of 150 X-ray examinations three active and two non-active cases of tuberculosis were discovered.

Would the right hon. Gentleman also bear in mind in his further consideration of this matter that there is strong medical evidence, which I believe has been put by the B.M.A., to the effect that healthy immigrants have been the cause of propagating disease when they have come to this country?

I am not sure that I know the evidence to which the right hon. and learned Gentleman refers, but I shall be glad to consider anything that he likes to put before me.

Is the right hon. Gentleman aware that many people feel that it would be more efficient to establish a health test in the country of origin rather than at the port of entry? If the right hon. Gentleman agrees, will it be possible for him to approve and equip medical health teams to go out to the key countries in the Commonwealth?

As the hon. Member knows, there is a mission going shortly to Commonwealth countries and it will be within their competence to discuss the possibility of such things. As at present advised, I do not think that it would be a very practical solution, but my mind is not closed on it.

asked the Minister of Health if he is satisfied with the research facilities on infant mortality in the north-east of England; and if he will make a statement.

The incidence of infant mortality in all regions of England and Wales is being studied by the Registrar-General. Local studies, both publicly and privately sponsored, are also in progress, including a special community research project at Newcastle. We welcome all efforts to add to existing knowledge in this field.

Is the hon. Gentleman aware that the Princess Mary Maternity Hospital, Newcastle, is 100 years old and that its research facilities are very inadequate? Is he aware that in consequence there is considerable concern that there is not a maternity hospital planned in the next ten years in the teaching group of the North-East centred upon Newcastle-on-Tyne? Will he look at this question?

Hear hear.

I can appreciate the hon. Lady the Member for Tynmouth (Dame Irene Ward) saying "Hear hear", but we have been concerned with this for little longer than six months. We are examining it. As I indicated in my Answer, the Registrar-General is studying the causes of infant deaths in 1964 by region and according to social class, age of mothers and various other factors. We can only examine the matter as far as we possibly can. I think that we are doing what we can about it.

In view of the very disquieting figures about deaths which his right hon. Friend gave to my hon. Friend the Member for Cheadle (Mr. Shepherd), will the hon. Gentleman undertake to take this matter very seriously indeed, and try and make as quick progress as possible?

I do not know what the right hon. Gentleman means when he asks that we should take it seriously indeed. I wonder why he did not take it so seriously in the period when he was in the Government. The Registrar-General is carrying out studies in Birmingham, Bristol, and Gloucester and one is being carried out by the Welsh Board. We are taking the matter seriously and we shall be getting information. Once we have got it we will act upon it.

What does the hon. Gentleman mean by "social class"?

Obviously it is a question of social class, but if the hon. and learned Gentleman wants a different word let us talk about social strata.

Will the hon. Gentleman explain what "social strata" means?

asked the Minister of Health if he will reconsider the pool system of payment for general practitioners and bring forward proposals for developing a salaried service through the establishment of health centres by local authorities and hospital departments.

asked the Minister of Health if he will now make a statement on arrangements for family doctors" pay and expenses.

asked the Minister of Health if he will take steps to set up health centres under the National Health Service.

I expect all these matters, apart from the level of remuneration, to come into the discussions with the profession which I am to begin shortly.

I thank my right hon. Friend for that answer, but will he bear in mind that the policy of establishing a network of health centres throughout the country remains as vital as ever in the field of preventive medicine and that such a system would probably provide the most effective way of satisfying the demands laid down in the recently published B.M.A. charter? Will he consider issuing a circular to local authorities as soon as possible after these consultations with a view once again to encouraging the establishment of health centres throughout the country and the necessary consultations at local level between local health and welfare authorities and the general practitioner services?

I assure my hon. Friend that I intend that the discussions I have with the profession should cover practice premises and the use of health centres. He may be interested to know that, although only 21 new health centres have so far been set up, interest has been growing recently and I know at the moment of about 50 projects under consideration or actually in progress.

When does the right hon. Gentleman expect these discussions with the profession actually to start, and has he any idea how long they will take? Further, would the outcome then have to be referred to the Review Body on the remuneration aspect?

I should not like to speculate on how long they will take. It is expected that when the terms of a new contract have been agreed, it will then be put to the Review Body for pricing. I am to have a preliminary meeting with the leaders of the profession tomorrow.

Will my right hon. Friend give special attention to the last part of Question No. 42 and review the possibility not only of extending health centres by local health authorities under Section 21 but the possibility of incorporating the hospital service and the hospital management committees themselves into the extension of local health centres?

I am prepared to discuss arty method of providing practice premises, and I should not rule this one out.

Mr. Braine, Question No. 43.

On a point of order, Mr. Speaker. I understood that my right hon. Friend was answering my Question No. 77 at the same time.

With respect, I do not think that the hon. Gentleman was here when I made a pronouncement the other day about late-number Questions.

On a point of order, Mr. Speaker. In your consideration of Questions, will you take under review the number of hon. Members who have not been present today when they have been called to ask their Questions? It is exceedingly unfair.

I am not sure about that. I say nothing about it now because I should like to think about the implications of what the hon. Gentleman says.

asked the Minister of Health what further steps he is taking to expedite the provision of nationwide facilities for the routine cancer screening of women.

Good progress is being made. About 39,000 women a month are now being tested, mainly in hospital clinics, and the number will increase as more staff are trained. There are already about 200 pathologists and 150 medical laboratory technicians trained in cytology and more are undergoing training or awaiting places on the courses. Of the hospital laboratories handling this work about a quarter expect to be able to support a routine screening service some time this year.

The whole House will be very pleased to hear about what progress has been made, but is the Minister aware that about 3,500 women die every year from cancer of the cervix and the uterus, and is he further aware that many women are at risk below 35, the age at which it is proposed that screening should begin? Will he not agree, in view of the tragic toll and the obvious urgent priority here, that facilities for earlier screening, certainly for those women who apply for it, ought to be provided, and, if this means a greater allocation of resources, could he not persuade his colleagues to make them available?

As the hon. Gentleman knows as well as most people in the House, we regard this as a most important priority. I think that a good start has been made. At the end of last year, tests were running at an annual rate of 470,000, which is encouraging. There is some risk to women under 35 years of age, but my advisers say that this is the best minimum age at which to start routine screening. We must make a limited start, but, when we get the facilities going, we can extend them to younger women.

Although the House will be grateful to my right hon. Friend for the advances in the service which he has been able to announce, is he aware that there is a greater preoccupation with this matter among women now arising largely from the publicity which has been given to the statistics involved and many women are beginning to worry greatly because of this publicity? Will my right hon. Friend take it that any further resources which he can make available for this project will be much appreciated?

I can well understand that the very considerable publicity which has been given to the service, which I personally welcome very much, may have given rise to additional anxiety on the part of some women who are in the group at risk, but I can assure my hon. Friend that we are really pressing ahead as fast as we can. The special courses for pathologists and technicians are now running at five centres and all regional boards are sending people for training there. When those who have been trained go back to their own base, they themselves can embark on training in their own local hospitals.

While I appreciate what has been done, may I ask the right hon. Gentleman to bear in mind that I have recently had a case of a woman constituent of mine who is barely 35 and had all the symptoms of cervical cancer and was told by a London teaching hospital that it would take four or five weeks before she could be screened? Will he bear in mind the tremendous agony of mind in such a case, and do all that he can to press on with his plans?

I will certainly bear that in mind. I do not like commenting on a particular case without notice, but I should have thought that it would have been possible somewhere in London for the woman to have got an earlier smear test analysis, particularly if she showed symptoms.

Is the right hon. Gentleman aware that a far more extensive service is being provided at Orpington Hospital than is available under the National Health Service? Is he aware that not only is the service being extended to a lower age but screening will be once in three years instead of five years? Will he say that he welcomes this initiative? Also, what steps is the Ministry taking with regard to research into the electronic scanning of slides so that the number of people who need to be trained for this purpose can be kept to the minimum and the service can be introduced more rapidly?

We are looking very carefully into various methods of examining slides, into biochemical as well as electronic scanning, but I am advised that it will be some years before we shall know whether these methods are reliable or not. I certainly welcome the initiative in the hon. Gentleman"s constituency, about which he came to tell me.

As the right hon. Gentleman accepts that there is very widespread concern about the matter, is he still maintaining the position that he is not prepared to increase the number of training facilities which are available for cytologists? Would he perhaps look again into the number of training places available with a view to the possibility of increasing them?

I have looked at them, and so far as I am aware they should be quite sufficient to do the job that we want to do in a reasonable time. We have also got, as I have told the hon. Gentleman, 200 pathologists and 150 technicians trained, and 29 pathologists and 74 technicians are at the moment undergoing training in the special centres. There have been many more nominated for future courses.

asked the Minister of Health what steps he is taking to assist rural practitioners, the number of whose patients is below the average, and who live in areas that require travelling time above the average.

Special payments are already available in suitable circumstances.

Is the Minister aware that in many parts of rural Suffolk a doctor may have to travel up to 10 or 12 miles, taking perhaps 40 minutes, to see a single patient? Is he aware that group practice is particularly difficult to arrange in rural areas, and that there is very strong feeling that rural practitioners are having an even more unfair deal than many of their urban colleagues?

There are difficulties here, but I do not think that the hon. Gentleman"s view would be shared by those urban colleagues. However, I must tell him that the rural practice payments scheme was revised as recently as July, 1963, and further revised a year later, in order to give greater benefits to the type of practices that he has described. The fund now totals £1½ million and is shared by some 5,000 doctors. I agree that group practice is not so easy to establish in rural areas, but there are doctors who have found it possible.

asked the Minister of Health what proposals he has for the future of charges for dental treatment.

I would refer the hon. Member to my statement in the House on 17th December.

Is the right hon. Gentleman aware that a number of patients who ought to be having dental treatment are having it delayed in the mistaken belief that they will shortly get it free? Is he aware that I have letters from dentists in my constituency who are extremely worried that the treatment will be more complicated? Will he do something to make patients realise that they will not get the treatment free in future?

I am very anxious indeed that dentists should not find themselves short of patients either now or when the removal of charges becomes imminent. Nothing that I have said should lead anybody to delay having dental treatment if he needs it now. He should realise that he may allow serious dental decay to develop if he does not take the opportunity of going to his dentist when he needs to do so. I will certainly see whether there are any further assurances that I need to give in order to prevent this happening.

asked the Minister of Health whether, in view of the fact that the cancellation of prescription charges will deprive chemists of part payment at the time of dispensing, he will take steps to institute a monthly payment on account pending final pricing and settlement.

No, Sir; chemists in the National Health Service have a standing payment on account and payment in full for prescriptions dispensed during February will be made in the next 2 or 3 weeks.

Is not the effect of the present system that the chemist gives the Government about three months" credit for one month"s work rolling forward, and that this can bear hardly on small chemists because it involves providing extra working capital because wholesalers will not give more than about six weeks" credit, whereas the Government require about three months? Will the right hon. Gentleman look into the matter, because it bears hardly on some rural chemists?

I have had some representations on this matter. I told the chemists that on the present evidence I was not able to agree to the increase in the standing charge which they sought, but I have told them that if they have evidence of serious financial hardship in a substantial number of individual cases I shall be prepared to consider with them whether there are any temporary measures which might be brought to bear to deal with them.

Does the right hon. Gentleman think it satisfactory that this very considerable financial change for chemists should have been dictated by wholly different considerations? The change made a considerable difference to the chemists, but the considerations which led to it really had nothing to do with their paying more or less?

I suppose that one might regard it as fortuitous that the chemists got the 2s. over the counter when the prescription charges were first introduced and increased. In any event they have recently received very large back payments, totalling some £8 million, for dispensing in 1962 and 1963 and the first nine months of 1964.

asked the Minister of Health what steps he is taking to improve the quality and remuneration of hospital administrators.

The National Staff Committee for the Hospital Service is considering a number of measures, regional staff committees are being set up, and arrangements are being made for the recruitment this year of 46 administrative trainees under the existing arrangements. The Administrative and Clerical Staffs Whitley Council is considering a claim for substantial increases in salaries.

Will the right hon. Gentleman do all he can to raise this standard rapidly, since the hospital is about the only large-scale undertaking which no one appears to be running, and it is very difficult for administrative staffs with relatively low salaries to be able to have any real influence amongst consultants who earn three, four, five and ten times the amount that the staffs earn?

I would not accept all that the hon. Gentleman says. Indeed, there is at the moment a very substantial claim before the Whitley Council for administrative staffs. But I do expect great things from the National Staff Committee which, although it was set up last July, only really got going when its principal officer took up post in January this year.

asked the Minister of Health whether he intends to increase the number of hospitals to be built in the 1964–74 programme.

asked the Minister of Health what are his proposals regarding the number of hospitals to be built in the 1964–74 programme.

Until hospital boards have reviewed their programmes and I have in due course considered their revised proposals, I cannot speculate on the number of hospitals likely to be built.

Is the Minister aware that in his original statement on this subject he asked the hospital boards to consider this in view of the resources which were available? Does he intend the resources to be greater than were originally estimated or less than were originally estimated?

I am planning for the rate of expenditure on hospital building to increase over the period, but what resources are provided for hospital building are and must be related to the overall resources of the nation as a whole. The hon. Gentleman must realise that.

Can the Minister now say when his review will be complete and when he will be able to make a statement?

Not yet.

When my right hon. Friend is giving further consideration to the matter of an increase in the number of hospitals, will he recall that I have frequently pointed to the need for a hospital in the area which I represent? Would he give that consideration?

This Question is in general terms. If my right hon. Friend has a question about a particular hospital, I hope he will be kind enough to table it.

As the date for starting Cheadle General Hospital has now regrettably been put back, are we to take it that the hospital programme under the present Administration will be slower than under the previous Administration?

No. It will certainly be faster, because, thanks to the £5 million extra we have got for the coming financial year, we shall be able to start all those programmes which are ready to start.

asked the Minister of Health whether he will establish a day hospital in the Clacton area to deal with geriatric cases.

; Since there is no geriatric hospital department in Clacton, day hospital provision there would not be appropriate.

As such a successful geriatric day hospital has been established in the Cambridge area, could the Parliamentary Secretary say why it is not possible to establish a geriatric day hospital in the Clacton area, where the number of elderly is much greater?

I am advised that it would not be in the best interests of the patients to have a day hospital divorced from a hospital geriatric department with consultant cover. There is reasonable provision in Clacton for the care of aged people. We consider that at this stage, pending the building of the new hospital, it would not be in the best interests of the patients.

Will the Parliamentary Secretary keep an open mind on this problem?

My mind is always open.

asked the Minister of Health whether he will ensure that sufficient finance is made available to the South-West Regional Hospital Board having regard to the need to expand the hospital facilities in that area.

asked the Minister of Health whether he is satisfied that the amount of special extra capital allocated to the South Western Regional Hospital Board will ensure that the West Country gets a fair and adequate share of new hospitals and hospital improvements; and if he will make a statement.

asked the Minister of Health whether he is satisfied that the allocation of money to the South-West makes adequate provision in view of the wide spread of the population; and if he will make a statement.

I am satisfied that within the resources available the South Western Region gets its fair share. The special needs of each region are taken into account in determining capital and revenue allocations. The special extra capital allocation to hospital boards for 1965–66 of £5 million has been distributed in a way that enables a start to be made by this and other boards on schemes ready and scheduled to start in that year.

I thank the right hon. Gentleman for that reply. He will be aware that I am particularly interested in an out-patient department of the Princess Elizabeth Orthopaedic Hospital in Exeter. Can he give me an assurance that the start of this department will not be delayed?

I understand that the South Western Regional Hospital Board hopes to start the new out-patient department at the Princess Elizabeth in November of this year.

Will the Minister do his best to ensure that there is at least enough of the allocation available for improvements to the Bridgwater Hospital, which has been making a very valuable contribution for a long time, and is still doing so, to the area around it as well as to Bridgwater itself?

I understand that, subject to the outcome of the review, it is unlikely that rebuilding of the Mary Stanley Maternity Home at Bridgwater will be possible for some years, but the board has in hand plans for interim improvements to the outpatient and other facilities at Bridgwater Hospital.

Can the Minister say whether phase 3 of the new hospital being built at Truro will be started within the coming financial year with the new funds he is to allocate to the South Western Region?

I cannot answer the hon. Gentleman without notice on that point.

Has my right hon. Friend taken note of the sudden and passionate yearning displayed by hon. Members opposite for improved hospital services, about which they were pretty dumb until last October?

I welcome their enthusiasm. I am only sorry that it was not greater when they were in office.

Will the Minister bear in mind how important it is to keep the small cottage hospitals going until the bigger hospitals are built? Will he ensure that they have the necessary supplies and finance to carry on?

This is always taken into account when any proposal to close a cottage hospital or small hospital comes before me.

asked the Minister of Health what steps he is taking to reduce the waiting list of surgical patients in the South-west in view of the long time many patients have to wait.

This problem was brought to the attention of my right hon. Friend during his recent visit to the South Western Region. Both the Regional Hospital Board and the Board of Governors of the United Bristol Hospitals are planning further major schemes which should relieve pressure.

Will the Parliamentary Secretary bear in mind the very real need for a new hospital in North Devon, and that we are not overstating our case? The staff are frustrated and there is a long waiting list of patients for surgical treatment. Can the hon. Gentleman now tell us whether the South Western Board is able to revise its building programme?

The South Western Board is considering the building programme. So far as North Devon is concerned, the board has plans for releasing certain space in the North Devon Infirmary for a few additional beds and another operating theatre. This should improve the situation. We appreciate the problem. My right hon. Friend realises it in consequence of his visit, and I can assure the hon. Gentleman that we are now giving it every consideration.

Can the hon. Gentleman say what plans the hospital board has for the other parts of Devon and Cornwall and the rest of the region, and can he say how much of the £5 million extra will be spent there?

Not without notice.

Does my hon. Friend appreciate that, generally speaking, those who can afford it can jump the queue and obtain a surgical operation at short notice?

That is a slightly different matter from the Question on the Order Paper.

It is still important.

asked the Minister of Health to what extent he will increase the approved annual capital building programme of the Eastern Regional Hospital Board, in order to ensure that hospital and other health services match the needs of the increased population in Ipswich and other towns in the Eastern Region which will result from the expansion plans announced by Her Majesty"s Government.

The hospital building programme is under review. I cannot say, at this stage, what variation, if any, in the distribution of resources may be made to take account of population changes.

That review will undoubtedly include the factor of expansion, will it not? Bearing in mind that there is no establishment of any regional advisory board and so on because the South-East Study is being reconsidered, could the Parliamentary Secretary say what is the machinery at the moment for discussing and arguing about the necessary capital allocation in these circumstances?

The situation is that the regional hospital boards will be pro- vided with projected population changes and we shall expect them to allocate the resources in accordance with any population changes that may take place.

asked the Minister of Health, if he will ask hospital boards to draw to the attention of their medical staffs the fact that they are entitled to issue panel medical certificates in their out-patient departments, thus frequently obviating for the patient the necessity of making a further medical visit, this time to his general practitioner.

This has already been done.

While thanking my hon. Friend for that reply, may I ask him whether he is aware that, in spite of the fact that he said that this is being done, many hospital doctors do not carry out the instructions which have been given to them or, at least, they do not avail themselves of the right which they have? This constitutes a considerable inconvenience both to the patients and to the doctors.

My hon. Friend can take it from me that we have drawn the attention of hospital management committees to this matter. There is some difficulty in Scotland, and I understand that the matter is now being discussed with my right hon. Friend the Secretary of State for Scotland. I hope he will soon get as good a situation in Scotland as we now have in England and Wales.

In view of the addendum to the previous reply, are we to take it that this has not yet been carried out in Scotland?

I gather that some discussion is taking place in Scotland.

asked the Minister of Health if he is aware of the low degree of priority given to maternity hospitals in the north-east of England in the new hospital building programme; and what action he will take.

No, Sir. The Newcastle Regional Hospital Board"s programme includes five maternity schemes now in progress and four more at present planned to start in the next five years, all in the North-East.

Does the hon. Gentleman realise that the research which has been going on during the past few years —it was mentioned in reply to Question No. 38—indicates that in some areas there is a higher birth-wastage rate than in others? Does not the evidence suggest that maternity hospital facilities in the north-east of England should be increased?

I do not know precisely what the hon. Gentleman means by "birth-wastage rate". If he means that mortality in relation to live births is higher in some regions, I agree. As regards the North-East, we hope to increase the number of maternity beds from the present 1,080 to 1,685 as soon as we possibly can.

Will my hon. Friend ensure that there is no unnecessary delay in authorising this expenditure? The Newcastle Regional Hospital Board pressed the previous Administration for years to make up the scarcity of beds. Is my hon. Friend aware that there has been a lot of talk about a new general hospital and further extensions to mental and other hospitals for very many years, and will he now ensure that real progress is made as speedily as possible?

As my right hon. Friend said in his statement on 8th February, he is now reviewing the hospital programme. The question of getting the priorities right is one of the matters which we shall take into account.

Does the hon. Gentleman recollect that last year a substantially greater proportion of the beds in the hospital programme was allocated for the maternity service, and, in fact, 600 extra maternity beds were provided? Will he give an assurance that this trend towards a greater proportion will be continued in the next two years?

We are not going to give any assurances in advance of the review. It would be silly to do so. Although the noble Lord may be satisfied with the increase in maternity beds last year. his hon. Friend the Member for Newcastle-upon-Tyne, North (Mr. R. W. Elliott) is not.

I am not either.

To ask the Minister of Health what considerations he took into account when deciding to replace the present chairman of the Welsh Hospital Board.

Mr. Donald Box.

On a point of order, Mr. Speaker. Apparently, the hon. Member for Cardiff, North (Mr. Box) is not here to ask his Question. Can you tell the House whether there was any indication given by the hon. Gentleman that he would not be here? Is it not most undesirable for a Question to be put on the Order Paper designed for the purpose of attacking the newly appointed chairman of the Welsh Hospital Board and then for the hon. Gentleman not to be present in the House to put it?

The hon. Member is, alas, under no obligation to tell us whether or not he would be here. I should not like to institute any arrangement of that kind—my desk would really be terribly loaded today—nor do I think it necessarily follows, with respect, that the Question constitutes what the hon. Gentleman says it does. But I must not get into the realms of argument.

asked the Minister of Health what steps he is taking to ensure that youthful sufferers from multiple sclerosis, poliomyelitis, spasticity, rheumatoid arthritis and arteriosclerosis are accommodated in other than chronic wards.

Regional boards have been asked to group the younger chronic sick in special wards as far as possible. My Department is at present engaged on a study of the needs of the younger chronic sick patients in hospital. When the results of this study are available, we shall consider what further guidance might be given.

I am very grateful for that helpful and constructive answer, but will my hon. Friend bear in mind that, in matters of this sort, quite small adjustments in the distribution of accommodation can give rise to considerable relief to sufferers?

We appreciate that even small adjustments can give relief, but my hon. and learned Friend will accept that, very often, it is a question of putting younger patients close to their homes so that parents and friends can visit rather than putting them a long distance from home and imposing an onerous burden on relatives.

asked the Minister of Health how many reports he has received from hospital governing bodies, management committees or individual expert sources, to the effect that operating theatres in particular hospitals are unsafe or dangerous for surgery.

Dangerous conditions are dealt with by Hospital Authorities as soon as they are identified, and formal reports would not be made to me unless advice or help is needed. Seven such reports have been made over the past year or so and steps have been taken to close, reconstruct or otherwise render safe the theatres involved.

Is the right hon. Gentleman aware that there has been a great deal of public disquiet recently about reports that some operating theatres are unsafe? Does not he feel that this matter should be given first priority by the Ministry in the reorganisation of hospitals?

A great deal is being done to modernise and, indeed, to renew operating theatres. I hope that the hon. Gentleman will not suggest that, in all circumstances, where operating theatres are out of date, the conditions for patients in them are dangerous. That is not the case. As I said in the House on another occasion, 400 new theatres have been built since the National Health Service started and over 100 are under construction. I regard this matter as one of priority, and we are pressing ahead as fast as resources permit.

How many complaints were made in the five years before the right hon. Gentleman took office?

I cannot answer without notice.

Is it not the case that many of these operating theatres now described as unsafe are not really as unsafe as all that? Is it not a fact that all they require in such cases is some extra care taken over sterilisation procedures?

A great deal of extra care has to be taken in out-of-date operating theatres by medical and nursing staff. The fact that they do take such great care is shown by the very high safety record which our operating theatres generally enjoy.

Will the right hon. Gentleman undertake to make unsafe buildings as safe as possible for patients and as tolerable as possible for surgeons without waiting for complete rebuilding schemes which might not take place for many years? Will he replace individual sterilisation by theatre supply units as is done in America?

Yes. We want very urgently to get rid of the boiler or steam kettle type of sterilisation. The hospital authorities were advised over two years ago that the sooner they got rid of this sort of sterilisation the better, since we know that it is not completely effective.

Is my right hon. Friend aware that, even when the hospital theatre is completely rebuilt under the advice of the consultants present, mistakes can still happen? Will he make sure that the best advice is given by the hospital building unit in cases of rebuilding going on at present?

A circular is in draft and will shortly be sent to hospital authorities concerning the whole question of operating theatre procedure with special relation to safety factors. I hope that this will help the hospital authorities in planning new theatres.