asked the Minister of Health what plans exist for the building of a new hospital in Newcastle-upon-Tyne; and what is the expected date of commencement and completion of any such proposed building.

The building of a new hospital has been agreed in principle and outline proposals are now under discussion. No firm starting date can yet be given.

Would my right hon. Friend bear in mind that for some years there have been dire shortages in beds and staff in this region and that the completion of a new hospital for the area is a vital part of the plan to overcome the problem?

Future development of hospital services in Newcastle generally is one of the matters being discussed as part of the current review of the hospital programme.

Would the right hon. Gentleman discuss with the regional board the need for a day hospital and psycho-geriatric unit within the existing general hospital in Newcastle?

I have no doubt that this also will form part of the discussions which are now taking place in connection with the programme.

While welcoming the news the right hon. Gentleman has given, may I ask him to bear in mind that quite a lot of requests have been made following questions by my hon. Friend the Member for Newcastle-upon-Tyne, North (Mr. R. W. Elliott) and that on every occasion we have received indications of the shortages but never any money to get on with the work? What we want to do is to get on with the work—now.

The regional board has more money than it had under the previous Government, and I have no doubt that the remarks of the hon. Lady and her hon. Friends will not go unnoticed by the board.

asked the Minister of Health if he will instruct the regional hospital boards to reduce the interval between tests in the cervical screening service from five years to three years; and if he will also issue instructions to reduce the age at which tests commence from 35 years to 21 years.

The frequency and age range adopted were recommended by my medical advisers as a practical basis for a start to routine screening. Boards have been advised to plan laboratory facilities on this basis. Study of these matters is continuing and I am keeping them under review.

I realise the difficulty the right hon. Gentleman is in in providing these facilities so quickly, but may I ask him to look at an article in the Lancet of 29th January, by the Medical Officer of Health for Derby, from which he will see that in the 10 months to 31st October, 1965, of the positive tests taken at Derby no less than 65 per cent. were of women under the age of 35 and 15 per cent. were under the age of 25? Would he consider having tests started at the age of 21 and not 35?

I do not think that those findings conform with the general experience. We take the view that these tests should start where the need is greatest. I am told that the risk of cervical cancer increases considerably after the age of 35, but we shall extend the age range as facilities extend. In the meantime, younger women who wish to have the tests will not be turned away.

Will the right hon. Gentleman recall that in Orpington we have testing every three years from the age of 25 onwards and that this decision was made with his approval? Will he at least consider lowering the age to 25 if not to 21?

I propose continuing as we have started, but, as I say, my mind is not closed to extending the age range as soon as we have sufficient facilities.

asked the Minister of Health what progress is being made in establishing adequate facilities in Essex, especially South-East Essex, for the early detection of cervical cancer.

There has been good progress towards the establishment of a cervical cancer screening service in Essex. Diagnostic facilities for women with symptoms are fully available and screening of women without symptoms should have started in all areas by the spring. In South-East Essex a service for women without symptoms has already started and is to be expanded.

I appreciate what the hon. Gentleman has said, but as the difficulty here as elsewhere in the country seems to be a shortage of technicians for the initial screening, will the hon. Gentleman kindly inquire into whether the facilities for training in our hospitals are adequate—I have reason to believe they are not—and whether the conditions of pay and service for attracting these technicians are adequate, and will he ask his right hon. Friend to look into the admirable Brighton cancer project to see whether that example can be followed elsewhere in the country?

My right hon. Friend is studying the Brighton project, but—and I think that the hon. Gentleman appreciates this—one of the drawbacks to the full extension of this service, though not in recent months, has been the whole issue of training sufficient personnel. We think that there has now been real progress in the enrolment and training of the personnel, and while we are not supremely optimistic, we think that we are making the right kind of progress.

asked the Minister of Health what facilities are available in the Birmingham region for cervical cancer tests; and what factors are delaying full facilities for the screening of women of 35 years of age or over.

Diagnostic facilities are available in the region for all women with symptoms. There is a partial service for screening other women in over two-thirds of the region. The main impediments to a full service are lack of laboratory space and of technicians trained in cytology; both are being remedied as fast as possible.

Is the Minister aware that in my constituency the Standing Conference of Women's Organisations is expressing considerable anxiety about this matter, especially since many patients seeking this test have been advised to come back in six months? Will he press on very fast with the development of electronic scanning devices?

We are aware that deficiencies exist in this service in this region. My right hon. Friend has urged the board to push on with the service as fast as possible. As for the last part of the right hon. Member's supplementary Question, I am not too sure that this could be done at present.

asked the Minister of Health whether he will state Her Majesty's Government's present policy in regard to the provision of cervical tests for cancer for women; and what advice he has given to hospital boards and local authority health committees in regard to this matter.

Our aim is to make routine screening available to all women at risk, starting with those aged 35 or over, at five-yearly intervals. Hospital authorities have been asked to expand facilities for cytology in hospital laboratories to support this service. Sufficient trained laboratory staff are now becoming available to allow routine screening to start in most areas and I am preparing further detailed guidance for all health service authorities on the organisation and development of a full-scale service.

While thanking the Minister for that reply, may I ask him to consider the problem in relation to women under the age of 35? A small committee, of which I am chairman, has discovered that 80 per cent. of the women found to have positive symptoms are under the age of 30.

I referred to this matter in answer to an earlier supplementary question. I will look at this evidence, but all the indications which I have received from my medical advisers suggest that the risk rises steeply from the age of 35. Although the hospital returns for December are not yet complete, those available suggest a 25 per cent. increase at least over the June rate of 51,000 women tested per month.

Is the right hon. Gentleman aware that many women have to wait months before they can obtain appointments for tests in a hospital and that this delay is sometimes literally a matter of life and death? Can he do anything further to improve the position in this very important respect?

There should be no delay for women with symptoms, which is the category suggested by the phrase "a matter of life and death". I accept that the development of the service is not uniform over the entire country but we are doing our very best to bring up the more laggard areas at any rate to the average as quickly as possible.

asked the Minister of Health what progress hospital management committees have made with the implementation of his circular on improving the effectiveness of the hospital service for the mentally subnormal; and whether he will make a statement, with particular reference to research within the hospital.

The full implementation of this recent circular will take time, and it is too early to assess progress.

Is the Minister aware of the opinion that relatively too much is being spent on administration and not enough on research? What plans does the Minister have for the improvement of junior training centres which, despite devoted staff, are inadequate in my part of Essex?

In general, the development of junior training centres is proceeding at a very satisfactory pace. In reply to the first part of his supplementary question, I assure the hon. Member that over 300 research projects concerned with sub-normality were initiated or completed in hospitals during the five-year period to 1964 and that the majority of these were in hospitals for the subnormal.

As the greatest drawback to an improvement in caring for the mentally subnormal is, as is shown in my local hospital, the lack of nurses, both male and female, will the Minister look carefully at the scales of pay for nurses in this type of nursing?

As the hon. Member knows, there has recently been a substantial improvement in nurses' pay, and there is a differential in favour of psychiatric nurses which has been maintained.

In the light of the case of the boy Tommy Coyne, reported in the papers this morning, will the Minister look urgently and carefully at the treatment of the young mentally subnormal?

Yes, Sir. The boy in question is not subnormal, but is a psychiatrically ill patient. Perhaps I may take this opportunity of saying that I am having a full investigation made but that a preliminary study of the facts suggests a very different picture from that presented in the Sunday newspaper concerned.

asked the Minister of Health whether, in view of the inconvenience caused to hospitals in having to seek recourse to the courts for permission to use blood where objections are raised, he will give authority to hospitals to make use of plasma without such procedures.

Hospital authorities have in fact been advised not to resort to the courts in such cases but to rely on the clinical judgment of the consultants concerned after full discussion with the parents.

Do not some hospitals feel that there is not sufficient ground for so doing? Will he draw to the attention of hospitals the fact that they are entitled to use blood when their clinical judgment determines?

I will see if any further guidance is needed, but I am advised that if he obtained the written supporting opinion of a colleague that a patient's life was in danger, and an acknowledgment from the parents that they refused consent, despite their having been given an explanation of the danger, a doctor would run little risk in a court of law if he acted with due professional competence and in accordance with his own professional conscience.

asked the Minister of Health if he is satisfied with the present allowance for food per patient in mental hospitals; and if he will make a statement.

asked the Minister of Health how often he reviews the allowance for food per patient per week at mental hospitals.

The amount spent on food at hospitals is decided by the hospital management committees. My Department is carrying out a study of food in psychiatric hospitals and I hope shortly to give advice which will help management committees in making these decisions.

Bearing in mind the fact that what that amounts to is 37s. 6d. per patient per week, on average, and that this has to include provision for special diets, when prescribed—which is about one-third of that prescribed in ordinary hospitals—and that patients who have left mental hospitals are loth to complain, should not the Minister institute an inquiry as soon as possible?

I do not accept the hon. Member's figures. On average, the cost per person per week in mental illness hospitals in 1964–65 was 25s. 2d., and the cost in acute hospitals was 33s. 3d. Some disparity is to be expected because of the extra quantities of milk and some other foods which are required for physically ill people and the greater number of elderly patients in psychiatric hospitals. I am not satisfied that these considerations fully justify the present disparity.

Can my right hon. Friend say whether there is any justification for treating mental patients as "untouchables" or second-class citizens by giving them a lower food allowance than is given in ordinary hospitals?

There is no reason whatever for treating psychiatric patients as "untouchables"—nor do I think that they are so treated today. I have given the reason for the difference between the cost of feeding the two types of patient. I should not like to foreshadow the results of the study I am having undertaken, which is not quite complete.

asked the Minister of Health if he will authorise the early construction of a new maternity hospital in Leicester.

asked the Minister of Health whether he is aware of the concern felt over the condition and inadequacy of the Bond Street Maternity Hospital, Leicester, which have progressively worsened for years; and if he will expedite the erection of a new maternity hospital in that area.

I am aware of the poor conditions in which the work of the Leicester Royal Infirmary Maternity Hospital is at present carried on. The Sheffield Regional Hospital Board will provide a new maternity unit for this hospital and hope that planning will be completed in time for building to start towards the end of next year.

Is the right hon. Gentleman aware that at probably no other maternity hospital in this country do the staff and patients have such conditions? Will he give the House an assurance that this projected construction date will not be delayed by any threatened governmental economies?

No, Sir. Before the building can start the hospital board has to obtain my approval to the final cost limit of the scheme, and then has to prepare working drawings and bills of quantities, and then it goes out to tender. I hope that as soon as it is ready to start it will be able to do so.

Is my right hon. Friend aware that there is considerable concern at the delay which has been caused in regard to the erection of the new building and the development of existing buildings over many years, and under the last Government in particular? Does he realise that this ought to be one of his first priorities? We must remedy the defects which have cropped up under the last Government.

I recognise this as an urgent need.

In view of the unsatisfactory nature of the Minister's reply, I beg to give notice that I shall seek to raise the matter on the Adjournment.

asked the Minister of Health if he will take special measures to obtain a definition of the estimated population of the area served by the West Kent Hospital, in view of the fact that this area is short of beds of all types and in order to enable comparison with other areas.

The hospital service for the central Kent area is provided by a number of hospitals jointly and one particular hospital in the group cannot be said to serve a defined population.

Is the Parliamentary Secretary aware that the hospitals at Tunbridge Wells, Ashford and Canterbury were rebuilt between the wars, that they have traditionally had space to spare and have provided beds for my constituents hitherto, but that with the growth of population in the South-East they now say that they are unwilling to provide beds for my constituents, whereas the West Kent General Hospital at Maid-stone has remained more or less static in its bedding? Will he take urgent steps to consider the problem and remedy it?

There has been a recent completion of facilities at the West Kent General Hospital. The original Answer pointed out that we cannot define populations in relation to one hospital. It so happens that if we took all the hospitals in this area we should find that the number of beds was in excess of that which is considered normal. We are not saying that full facilities are available, but we think that the regional hospital board has looked at the problem.

Is the right hon. Gentleman aware that this is a basic failure to forecast the needs of the very big increases in population which will come in this region? Will he ask his right hon. Friend to have another look at the potential needs in the South-East, in terms of the hospital building programme?

We are inquiring into the whole business of the projection of populations.

asked the Minister of Health what is the average length of time a patient has to wait for a doctor's recommendation before gaining admission to a hospital for an operation.

The time varies so much according to the operation that an average figure would have little meaning. Urgent cases are admitted without delay.

Is the right hon. Gentleman aware that in Leicestershire the time is increasing year by year and that a constituent of mine has had to wait as long as six years for admission to hospital and, during the whole of that time, has had a bag packed and has been taking tablets to relieve the pain?

I will gladly look into any cases of which the hon. Gentleman tells me, but, in the country as a whole, a sample in-patient inquiry in 1961 indicated that, for non-urgent surgery, the median waiting time varied between about five and 12 weeks according to the type of operation required, and the strict average, that is, the mean waiting time, is between 9 and 21 weeks.

Is my right hon. Friend aware that private patients going into pay beds get in very much more quickly and that the length of queues for ordinary patients is sometimes far too long? This could possibly mean that an operation will not be as successful as it might have been.

To the extent that my hon. Friend's first allegation is true, this. I hope, will be remedied to some extent by the review of pay beds which I have asked hospital boards to undertake.

Is the Minister aware that the waiting lists are increasing the whole time and that there is much resentment in some places at the fact that, if patients offer to pay to go into hospital, they can jump the queue, leaving people who are very much more ill and need an operation more quickly well behind in the list? What steps is he taking to deal with this?

As the House knows, this is something which I am very keen to contain, to reduce and to eliminate if I can. These are the purposes of the review of pay beds which is currently proceeding.

Is the Minister aware that the figures he was quoting from are four years old? Would it not be a good idea for him to have another inquiry to bring himself up to date and know the extent of this problem, which is very serious in many parts of the country?

I should like to have a very much deeper analysis of waiting lists, because I do not think that they represent an altogether accurate estimate of the number of people who need to go into hospital. We need some more up-to-date statistics, but I quoted the latest we have.

Is the Minister aware that we understood that pay beds were always made available to people, whether they could pay or not, in cases of urgency? If this is so, will not the Minister say that he thoroughly approves of pay beds where they are not urgently needed for people who cannot afford to pay?

I regret to say that it is not true that they are always used for patients who are non-paying if they are not occupied by paying patients. The advice which has always been tendered by my Department to hospital authorities is that this should be so, but this, in itself, is not an argument for pay beds.

asked the Minister of Health whether he is aware of the need for hospital accommodation at Kirkby Stephen; and why this development was not included in his 10-year plan.

My right hon. Friend has not yet completed his review, nor published a plan, but the Newcastle Regional Hospital Board at present considers that other needs in the region have greater priority.

Is the Minister aware of the great local dissatisfaction over the delay in this matter? Is he aware that visiting in this area of Carlisle involves a round trip of about 80 miles? Will the Minister consider receiving a deputation from interested people from this area?

The regional hospital board keeps its hospital building programme constantly under review. I assure the hon. Member that it is bearing in mind the needs of Kirkby Stephen. I intend to write more fully to the hon. Member on the whole problem. If, after he has received my letter, he feels that he ought to bring a deputation to see me, I will gladly see it.

asked the Minister of Health what investment expenditure took place on hospitals in the East and West Ridings of Yorkshire in 1963–64; and how this compares with the total for the United Kingdom expressed as a percentage.

A total of £6,636,000. This is 11·8 per cent of the expenditure in England and Wales.

Is my right hon. Friend aware that hospital investment in the East and West Ridings is in line with the population there and that this information will be received with great satisfaction? Is he further aware, however, that there are many health hazards peculiar to Yorkshire of a climatic and industrial nature? Will he bear these in mind in future consideration of the hospital investment programme.

We have all these considerations in mind. The population of the East and West Ridings is only 9 per cent. of that of England and Wales and in percentage terms they are getting more than their share.

asked the Minister of Health what were the total numbers waiting for beds at the two general hospitals in Leicester in December, 1964, and December, 1965, respectively.

The numbers were 4,893 and 6,158.

What plans has the right hon. Gentleman for alleviating this rapidly deteriorating situation? Does he not agree in the circumstances that it is a very great mistake that in the Government's five-year plan a decreasing amount, proportionately, of the gross national product is being spent on hospitals?

What is required in Leicester is more operating theatres rather than more beds. A scheme to provide two new theatres at the Leicester General Hospital is planned to start this April. Further developments have been proposed and are under consideration in my review of the Hospital Plan.

asked the Minister of Health if he will now take steps to extend the prohibition of advertisements for cigarettes to the Press, poster-hoardings and other advertising media, in view of the dangers to health, including lung cancer, of cigarette smoking, and in view of the intention of many advertisements to extend the habit, particularly among young people.

I have nothing to add at present to the reply I gave on 29th November to my hon. Friend the Member for Renfrew, West (Mr. Buchan).

Would my right hon. Friend say what significance we should attach to the emphasis he put on the words "at present"? Is he not aware that it is quite illogical to ban cigarette advertising from one medium but to allow it on the others? If it is dangerous, it is dangerous, and we should take steps to deal with it on all media. Has he had any consultations with the Press Council—

Order. Hon. Members must put questions briefly.

I am not sure whether my views of logic are exactly those of my hon. Friend, but I would inform him that we have under review a study of matters connected with smoking and health, including advertising in media other than television. These are complex issues on which I am not in a position to make a statement.

Can the right hon. Gentleman say when he is likely to be able to make a statement on this?

I would not like to guess at that.

asked the Minister of Health what progress is being made to ensure that all immigrants to this country have a medical examination in their countries of origin or at their port of entry.

Commonwealth immigrants with labour vouchers and others coming to settle are already examined at the port of entry and arrangements are in train for their examination in the country of origin. Entitled Commonwealth dependants are under present powers exempt from medical examination, but voluntary examination is being encouraged. Aliens are already liable to be referred for medical examination at the port of entry.

Would not my right hon. Friend agree that perhaps the compulsory medical examination of all immigrants would not only be a necessary public health measure but would relieve the overworked doctors in the areas where immigrants settle?

Under existing legislation this is not possible.

Would not the Minister agree that it would be much more satisfactory if these examinations could be arranged in the countries of origin, but that some of those countries are very short of medical staff? If cases of this kind arise, would the Ministry of Health be able to organise teams to help with the examinations in the countries of origin?

Arrangements are under discussion with the Commonwealth countries, concerned.

asked the Minister of Health what progress is being made in providing cars as opposed to tricycles for disabled drivers.

asked the Minister of Health whether he will seek powers to make a grant equivalent to the value of a single-seater invalid car to a disabled National Health Service patient who is entitled to a single-seater invalid car but who wishes instead to buy a motor car with special controls so as to enable her to go out of the house with her children.

My right hon. Friend does not propose to make any changes until he has completed his review of all our provisions of vehicles for the disabled.

Can the hon. Gentleman say when that review, for which we have been waiting quite a long time, will be completed? As the Government have said that this whole matter is a question of the relative priority of money resources, does it not seem a little unfair that people who can afford, for example, to pay prescription charges should not do so, because if they did the money there from would provide many cars?

We really have not been a long time waiting for the review. We have got nicely through the additional provisions made by the previous Administration and we hope to get the review completed sometime this year. That is as far as I can go. As to prescription charges, the extent of the services which it is suggested could be provided by prescription charges, ranging from the TSR2 to almost everything else, is amazing.

On what grounds does the Minister resist the proposal for making a cash grant equivalent to the cost of a vehicle? It would not cost his Department a penny more than is being spent at present, and it would bring great happiness to a number of crippled mothers who can never go outdoors with their children.

The hon. Gentleman will appreciate that we want to examine the whole field. The question of making cash grants of this kind involves an enormous number of technical difficulties. In any event, we do not make cash grants. The question of ownership would also arise. I ask the hon. Member to examine the implications of the question.

Will my hon. Friend give an assurance that he will not delay this matter for 13 years, as the last Government did?

The only assurance I want to give the House is that both my hon. Friend and I have the greatest possible sympathy with the category of patients for whom appeals have been made, and we will do our utmost to solve some of the problems.

I hope that the Minister appreciates that his Answer is very unsatisfactory to a great number of hon. Members. From his personal knowledge of the cases which come before his Ministry, does he not appreciate the great amount of hardship that is caused to families by this provision and that it would not cost the Ministry a penny more to introduce this proposal? Cannot the hon. Gentleman speed up his review to make this possible?

I cannot accept the hon. Member's statement that it would not cost a lot of money. It would cost some money. I assure the House that we are very sympathetic and are doing whatever we possibly can to resolve these problems.

asked the Minister of Health what action he proposes to take in respect of the advertising and sale of caffeine tablets, details of which have been sent to him by the hon. Member for Swindon, in view of the possibility of the public being misled and of the health hazard involved in heavy dosage.

The power to institute proceedings in respect of misleading drug advertisements rests with the local food and drugs authorities under the Food and Drugs Act, 1955, and not with my right hon. Friend. I am advised that caffeine in tablets, though more concentrated, is pharmacologically no more active than in tea or coffee. Heavy dosage causes unpleasant effects which would discourage abuse.

I understand my hon. Friend to say that this medicine is both ineffective and potentially dangerous. Is he aware that it is also expensive and that the advertisements are quite abominable? Will he do something to stir up the local authorities to prosecute these unscrupulous manufacturers?

I would not like my hon. Friend to put words into my mouth. It is not quite as straightforward a matter as he suggests, but we are looking into the problem.

asked the Minister of Health if he will state for each of the three years ended 31st December, 1965, the cost to the National Health Service of the drug tetracycline, specifying this expenditure in terms of supplies from patentees or licensees and the supplies from other sources.

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

asked the Minister of Health if he will state in respect of supplies of tetracycline to the National Health Service why he has not continued to invoke Section 46 of the Patent Act in respect of patentees and licensees in view of the fact that these patentees and licensees are supplying the drugs at approximately £45 per 1,000 tablets as compared with contractors to the Ministry of Health, who were supplying it at £4 per 1,000.

The patentee and the principal licensee offered to negotiate the prices to be charged for tetra cycline to hospitals concurrently with price negotiations under the voluntary price regulation scheme for supplies to the pharmaceutical service. Negotiations are proceeding.

Would it not be possible for the drug manufacturers to offer their products at lower prices if they did not spend as much as £9 million on sales promotion?

The question of sales promotion is under consideration by the Sainsbury Committee. The negotiations take into account the cost of tetracycline to the National Health Service as a whole and I hope that this will lead to a satisfactory overall saving to the Exchequer.

asked the Minister of Health what representations have been made to him that some effective and beneficial methods of preserving teeth are not available under the National Health Service because the present method of payment of general dental practitioners makes such work unremunerative; and if he will make a statement.

None, Sir. I understand that a small minority of dentists are refusing to accept patients requiring certain types of treatment but the patient's remedy is to apply to another dentist.

Would not the Minister agree that many of the recent advances in dental technology are being denied to National Health Service patients because the cost of treatment makes it unremunerative for dentists to undertake it at the present scale of fees? Does not this require some action by the Minister?

No, Sir; I would not accept the premise on which the hon. Member bases his supplementary question. To a very limited extent, there have been complaints about the fees for crowns, inlays and certain other treatments, but the question of relativity of fees for different types of treatment is currently under review between the profession and my Department in the Dental Rates Study Group.

asked the Minister of Health (1) what steps he is taking to improve the supply of tubes for the Resomax 300,000-volt X-Ray therapy machine; and if he will make a statement;

Six Resomax units are temporarily out of action. We have already taken steps to replace two by alternative equipment and to have a replacement tube fitted to a third unit. The manufacturers are making every effort to speed the production of tubes for the remaining units.

In thanking my hon. Friend for that reply, may I ask him to consider that the only manufacturers of these tubes have a complete monopoly and that not only have they increased the price, but they have not promised very speedy action? Will my hon. Friend investigate the whole position?

We appreciate that there has been some difficulty in manufacture. This is because there has been a change from one manufacturer to another. I am not too sure what would be the correct answer concerning the alleged monopoly, but we hope that production will improve in May. The manufacturers have assured us that this will be the case.

asked the Minister of Health how soon he intends to publish the Report of the working party on Ambulance Training and Equipment; and why there has been so much delay in the publication of this Report.

asked the Minister of Health when the Report of the committee on training of ambulance personnel and the equipping of ambulances will be available.

Part I of the Report, dealing with training, will be published next month, but the working party has not yet completed its work on equipment. There has been no avoidable delay.

Could my hon. Friend say whether it is now broadly accepted that ambulance men are entitled to the same treatment and recognition as are received by other life-saving services?

I am not too sure precisely what my hon. Friend has in mind here. If he means recognition of their organisation to make representations on wages and conditions, that is a question for the Whitley Council.

asked the Minister of Health in view of the facts that people under-estimate the seriousness of their illness and that they do not visit their doctor regularly, if he will take steps to ensure that the public make use of the health services as much as they should in their own interest.

I have no reason to believe that people generally fail to make use, as required, of the advice and treatment available to them under the National Health Service. I hope no one who is ill will hesitate to make proper use of these services.

Has my right hon. Friend noted a recent survey which suggests that for every person who exploits doctors there are at least a dozen who fail to visit a doctor when they should? If my right hon. Friend has not seen this survey, will he accept a copy of it if I send it to him?

I shall be glad to receive any evidence which my hon. Friend cares to send me. Statistics indicate that people in this country consult their general practitioners on average about five times a year. This does not of itself suggest an under-use of the Service, but there is no doubt that some people who should see their doctors, for one reason or another refrain from doing so.

Has the right hon. Gentleman no information to give the House which would enable us to establish objectively whether people go too much, or too little, or just right?

I think that it would be very difficult to establish that objectively, but I have sought from the profession itself evidence about workload and it has singularly little statistical evidence to offer on this.

asked the Minister of Health when he expects to receive a report from the Doctors' Review Body.

I cannot yet say when the Review Body is likely to report to the Prime Minister.

Is the right hon. Gentleman aware that there is great discontent and unrest amongst doctors in the National Health Service, and is he really seized of the urgency to do something about this very quickly?

If I am not, I do not know who should be. The Review Body is very well aware of this, and it is hoped that the Report will be made in time for decisions to be reached, particularly on a new system of remuneration for general practitioners, before 1st April.

Can the Minister say whether the Review Body's decision will be final?

I do not think that the Government can commit themselves to the Report until they have seen it.

asked the Minister of Health what action he is taking to stimulate recruiting of doctors for the National Health Service.

There is no shortage of suitable applicants for places at medical schools. As regards expansion of medical schools I would refer the hon. Member to my reply to my hon. Friend the Member for Fife, West (Mr. William Hamilton) on 26th January.

Is the Minister aware that the National Plan looks forward to no improvement in the situation during the next five years? Is the right hon. Gentleman also aware that the information which he gave me in answer to a Question last week displays that there is an increasingly deteriorating position in the National Health Service, and what is he doing to put it right?

I think that the hon. Gentleman is slightly confused. His reference to the National Plan was in the context of general practice, when we said—and this is a realistic estimate—that we could not see any substantial increase in the number of general practitioners over the plan period; but in my reply to the Question to which I referred I announced that work would start in 1966–67 and the following year to increase the entry of students by 250, and this would bring the annual entry to more than 2,500; and that is what we are doing about it.

asked the Minister of Health what representations he has had from local authorities about payment for ambulance services; and if he will take steps to transfer the cost to regional, hospital boards.

My right hon. Friend has received representations from Birmingham Corporation that the cost of the service should be borne by regional hospital boards. He is studying the arguments for and against a change, which would require legislation, in the responsibility for providing ambulance services and will bear these representations in mind.

Does my hon. Friend realise that, while the city council operates the ambulance service, it has no say in the use of it? Would not this be better paid for from the Health Estimates, rather than from local rates?

We appreciate that what my hon. Friend says is true, but this whole matter is now being reviewed in the light of representations from Birmingham and elsewhere, and from other organisations. I assure my hon. Friend that the representations which have been made by Birmingham will be taken into consideration in that review.

asked the Minister of Health what research he has authorised into the value of zirconium as a preventive to dental decay in children's teeth; and if he will make a statement on the results of the experiments.

None, Sir. No scientific report on the American research has yet been received and I have no evidence which would justify me in asking for research to be carried out in this country.

Is not my right hon. Friend aware that statistics have been published, and researches at the University of Indiana show that zirconium prevents decay not only of juvenile teeth, but also of adult teeth? If that be the case, would not it be rather difficult for my right hon. Friend to defend the system of compulsory mass medication to attain the same end?

Perhaps I can tell my hon. Friend that reports in the American and British Press were exaggerated, and were unauthorised by the research workers concerned. Until at least preliminary results are available, I have no evidence on which to judge the potentialities of the suggested method.

asked the Minister of Health if he is aware that in certain areas decisions against the fluoridation of water supplies are being taken; and if he will give an undertaking that he will take steps to ensure that children in these areas will not be allowed to suffer unnecessary damage to their dental health through any fluoride deficiency in their water supplies being allowed to continue.

I am hopeful that those local health authorities which have not yet resolved in favour of fluoridation will soon recognise it as an effective and completely safe means of preventing dental decay; but the responsibility for action to promote the dental health of children in their areas is theirs.

Does the right hon. Gentleman realise that this has brought forth all the cranks in Christendom, and that he has a responsibility beyond that which is stated, which is to see that the dental health of the nation does not suffer because of the ridiculous utterances of this bunch of cranks?

I would not altogether dissent from the general sentiments which the hon. Gentleman has expressed. I welcome the support which many hon. Members are giving in persuading the public to accept fluoridation, but I think that at this stage at any rate, persuasion and voluntary local action are the right way to proceed.

What steps is the Minister taking to re-educate reactionary councillors in the local authorities who have rejected fluoridation?

Reactionary Members.

All steps of a persuasive nature.

Is not the word "fluoride" a disguise for the medical term "sodium fluoride", which is a well-known poison and cannot be good for anybody?

My hon. Friend's supplementary question is not untypical of the propaganda with which local authorities are being deluged.

asked the Minister of Health what further progress has been made concerning his discussions with the medical profession on the recommendations of the Brain Committee on Drug Addiction; and whether he will make a statement.

The discussions referred to in my reply to the hon. Member on 31st January are continuing but I am not yet able to make a further statement.

As the Brain Committee reported over two months ago and this is an urgent matter, could the Minister give some indication of when the discussions will be completed? Will he, in the meantime, bear in mind two suggestions, first, that the proposed central authority should keep a record of sources from which notified addicts get their supplies, and second, that all prescriptions containing heroin should be sent to the authority immediately after dispensing?

The first of the two suggestions would be taken care of if the recommendations were fully implemented. I should like to look at the second. I am pressing on as quickly as possible with the discussions on the examination of outstanding points with my right hon. Friends the Home Secretary and the Secretary of State for Scotland with a view to the introduction of the necessary legislation as soon as Parliamentary time permits.

asked the Minister of Health whether he has completed his review of family planning services; and when he will make a statement.

Yes, Sir. I propose to issue a circular of guidance to local health authorities later this week.

Will the Minister acknowledge that the interest which is now so extensive throughout the country reflects a rapidly-changing situation in this respect, a situation which would change more rapidly if the promise of contraceptive tablets for use by men is carried to fruition, as seems likely? Will the House have an opportunity of discussing this statement shortly?

It is not for me to say whether the House will be in a position to discuss the statement. Without wishing to anticipate the details of the circular before it is in the hands of local authorities, I will tell my hon. Friend that it will remind them of the importance of family planning advice and treatment and will encourage them to make use of their existing powers to the fullest possible extent.

asked the Minister of Health if he is satisfied with the existing facilities for publicising the importance of the early diagnosis and treatment of cancer; and if he will make a statement.

asked the Minister of Health, in view of the importance of early treatment of cancer, what further steps he now proposes to take to educate the public about the symptoms and nature of this disease.

I share the view that more education is needed to promote a truer understanding of cancer and of the importance of early detection. A number of local health authorities already undertake cancer health education, and I shall continue to seek ways to develop it in co-operation with them and other bodies, including the new Health Education Council when it is set up.

While thanking my right hon. Friend for his Answer, I should like to add that I believe that the time is now opportune for a massive publicity campaign in this direction carried out quickly and forcibly. Would he not agree with that sentiment?

I am in favour of further education in this respect and I am sure that it is one of the things which the new Health Education Council will take very seriously as soon as it is in being.

Would not one of the ways of improving education in this respect be for the Minister to authorise the expenditure of a much larger sum of money? Could he say how much is currently being spent in the cancer campaign on educational work? Would he not agree that, when we are spending about £100 million on free prescriptions and school meals, it might be a more sensible priority to divert some of the money into this important work?

The Health Education Council will have its own budget. I cannot say, without notice, how much is currently being spent. It might be difficult to give an estimate because a great deal is spent by voluntary bodies.

asked the Minister of Health whether he will state Her Majesty's Government's policy in regard to the employment of qualified auxiliaries in place of or in addition to the trained and registered professional chiropodists in National Health Service clinics.

With certain exceptions specified in the 1964 regulations any person employed in the capacity of chiropodist in the National Health Service must be State registered. The employment of persons in other capacities in connection with the care of the feet is a matter for employing authorities.

Will the right hon. Gentleman look into this matter? Several local authorities are proposing to employ what they call "qualified" people. We had a very difficult time in getting professions supplementary to medicine to agree to come into the Act and it would be very detrimental to the profession and to the people in general if there were not compliance with the Act.

Local authorities have been advised that regulations do not prevent the employment of persons to carry out simple foot hygiene, especially for old people, of a kind which any active person might do for himself. But there is no recognised qualification or grade of auxiliary chiropodist.

asked the Minister of Health if he is aware that drugs, which to children are often mistaken for sweets, are in wide circulation; and if he will consult manufacturers with a view to introducing legislation on standardisation of colour and shape.

Some drugs look like sweets and some sweets look like drugs. In his review of medicines legislation my right hon. Friend is considering the need for powers to facilitate the identification of medicines by colour or shape or for example the tablets or capsules in which they are made up. But legislation in itself cannot be fully effective against accidents. The best safeguard is to keep all drugs out of the reach of children.

Is my hon. Friend aware that in recent months there has been at least one fatality and several cases of serious illness because of this mistake being made by young children? Does he not agree that some measures should be taken because the possible saving of human life is of paramount importance and should take precedence over every other consideration?

Obviously the saving of human life is of paramount importance but this is a question of how we can overcome the possibility of children eating drugs which may be harmful to them, and we consider that the only way in which this can possibly be done is by parents accepting their responsibility to see that drugs are not placed in such a position that children can get hold of them.

asked the Minister of Health whether the National Health Service is fully staffed with midwives; and whether part-time retired midwives are required and recruited to support the hospital and domiciliary services.

Some hospitals and local health authorities need more mid-wives. The number employed part-time by hospitals has risen by 70 per cent. in the last five years, but separate figures for part-time domiciliary midwives are not available. I expect that the midwifery service, like nursing, will become increasingly dependent on part-time staff.

May I ask the right hon. Gentleman why in answer to Questions last week he put midwives at a disadvantage compared with State-registered nurses? Are they not both required to have skills? Why denigrate the midwives by reducing their allowances when training as midwives after having become State registered?

I did not denigrate midwives either directly or by implication in what I said last week. All I said was that if they are to work as midwives, then hospitals are allowed to second them for training without their having to be put on the normal training allowances.

asked the Minister of Health whether he will make a statement on the present outbreak of influenza.

Outbreaks of influenza have been reported from many parts of England and Wales since the middle of January, principally in the northern half of the country. Illness among schoolchildren has been a conspicuous feature, but a substantial number of adults has also been involved. Illnesses have generally been mild, lasting only a few days, but serious illnesses have occurred, particularly among the old. Over the country as a whole there is no evidence yet that the outbreak has begun to decline.

While thanking the Minister for that reply, may I ask whether he is satisfied that the medical service has been able to stand up to the demands made upon it by the outbreak as he has described it?

Yes, Sir—I think that in general that is so.

asked the Minister of Health what discussions he has had with the professional bodies on the need for a longer period of obstetric training in the general training at medical colleges; and if he will make a statement.

None, Sir. The content of the medical curriculum is a matter for the individual medical school, subject to the statutory responsibilities of the General Medical Council.

Is the hon. Gentleman aware of the report which I sent to his right hon. Friend some time ago, and the reply by the Minister to the effect that, if I liked, he would send it on to the Royal Commission which is at present looking into medical education? Why, then, is the Parliamentary Secretary taking an entirely different view from that of the Minister?

I am not taking an entirely different view. The hon. Lady's letter referred to people attending refresher courses in obstetrics and also to clinical attachments. There is one of these at Chelmsford. The Royal Commission on Medical Education will, within its tems of reference, be considering the general content of medical education and I think that the hon. Lady will, on reflection, agree that it is not for my right hon. Friend to determine the content of medical education.

Has the hon. Gentleman anything to say about setting up a postgraduate centre for general practice obstetricians?

Not without notice.

asked the Chancellor of the Duchy of Lancaster if he will make a statement on his proposal to raise the rents of farms administered by his Department in the Whitewell and Bow-land districts of Yorkshire; and what percentage of the existing rents the increase will represent.

No, Sir, not while my proposals to the tenants concerned are under negotiation. If the hon. Gentleman has any particular case or cases he would like to discuss with me, I am at his disposal.

Can the Minister confirm that some of the increases in rent which he is proposing amount to 30 per cent. of 33 per cent.? Does not he consider that these are very great increases, especially in view of the Government's prices and incomes policy? Can he tell me whether he has discussed these proposed increases in farm rents—some of which will rise from £600 to over £800—with the Minister of Agriculture, so that he can take them into account when fixing prices in the forthcoming Price Review?

That is not the only test that I have to apply in determining a fair rent. In 1949 Duchy farm rents were roughly at the same level, in money terms—not real terms—as in 1870. Since then they have risen, on average, by about 3 per cent. per annum. But I am quite ready to discuss with the hon. Gentleman any specific cases, if he will see me.

asked the Chancellor of the Duchy of Lancaster if, before the increase in rents are imposed on farms administered by the Duchy of Lancaster in the Whitewell and Bowland area of Yorkshire, he will submit such proposed increases to the National Board for Prices and Incomes.

No, Sir.

Why not?

Answer.

The hon. Member asked me whether I would. I said, "No, Sir".

Why not?

Does not the right hon. Gentleman's Answer make absolute nonsense of what his right hon. Friend the Minister of Agriculture has said in the last few weeks about rent control on farms? Will the right hon. Gentleman talk to the Minister of Agriculture and try to get some sense into him?

Answer.

Order. I understood that the Minister was not answering.