asked the Minister of Health, in view of the fact that an artificial kidney machine for home use is now in production, what arrangements he will make for these machines to be available at key hospitals for training in self-use.

The provision of suitable equipment is only one of the problems associated with home dialysis. All of them are being evaluated in pilot studies, pending the results of which it would be unwise to encourage the extension of home treatment.

Does the Minister realise that there are quite a number of cases in which the smaller machine, which if of comparatively small cost, can be used? Will he look into the matter with the object of ensuring that the knowledge of this machine is held in the right places?

This machine is being evaluated, but the problems include the need for completely reliable and safe equipment, the need to train the patient and a relative in the operation of the equipment, the psychological stresses which may occur in the patient and his family and a number of others. They are being considered by my Department.

asked the Minister of Health what new proposals he now has to enable married women doctors to return to work in view of the recent survey which indicates that many wish to do so, providing that suitable arrangements are made for those with young children.

I would refer my hon. Friend to my reply to my hon. Friend the Member for Harrow, East (Mr. Roebuck) on 23rd June.

I thank my right hon. Friend for the interest which he is obviously taking in this problem. Would he not agree that the provisions for married women to return to the hospital service and many other jobs and professions are inadequate, particularly for women with young children? Will he therefore press on with this work and undertake to have discussions with my right hon. Friend the Secretary of State for Education and Science to see if more can be done in this respect?

I am anxious to do anything I can to encourage married women doctors to return to work in the National Health Service, and particularly in hospitals. We understand that about one half of married women doctors already work full time, that about one-third work part time and that about one-fifth are not working. It is this one-fifth we are anxious to see back in the Service.

Is it not a fact that the survey revealed that at least 1,000 women doctors who were not working professionally would like to do so and that another 1,000 who were working only part time would like to do more work? In view of the acute shortage of doctors, would the right hon. Gentleman say what positive steps he is taking to make use of these hard-earned and much-needed skills?

I enumerated in my Answer to my hon. Friend the Member for Harrow, East (Mr. Roebuck) a number of the steps which I am taking in this matter. The hon. Gentleman may be interested to know that only about one-quarter of those who are not working gave the lack of suitable work as their sole reason for not working. To answer the other point raised by my hon. Friend, certainly the hospitals can provide for the children of staff where they consider this to be worth while, and that might help married women doctors with children.

Would my right hon. Friend pay particular attention to the problem of maintaining the superannuation rights of married women doctors who have had service in the National Health Service, since I understand that at present they must work for one week every 12 months to maintain these rights?

I think that my hon. Friend is right when he says that they are required to work for a short period every 12 months to preserve their rights. I am certainly prepared to look into this matter.

asked the Minister of Health how many local authorities have extended their family planning advice as a result of his recent circular urging them to do so.

This information is not yet available, but I propose to call for reports in due course.

Will my right hon. Friend bear in mind that large numbers of women wish to choose the kind of contraceptive method which they wish to use? Will he instruct local authority clinics to make it possible for women to choose a particular method without reference to either their husbands or to the requirements of the Medical Defence Union?

I do not think that it is for me to instruct the local authority clinics in the way they make their arrangements. I sent the circular out as recently as 17th February and I have it in mind to call for reports by about next September. Perhaps my hon. Friend will put down a Question after I have received those reports.

asked the Minister of Health if he will give guidance to general practitioners on the interpretation of their terms of service with regard to refusals to give family planning advice or to issue National Health Service prescriptions for the contraceptive pill when there is a medical need for family planning.

I think it is better to leave it to general practitioners to decide what advice and treatment to give in the light of their obligation under their terms of service to provide all proper and necessary treatment for their patients.

Will the right hon. Gentleman state clearly whether or not a National Health Service doctor who refuses to issue a prescription for the pill on conscientious grounds would or would not be regarded as in breach of his terms of service? Further, would the right hon. Gentleman arrange for the patients of such doctors to be able to receive these prescriptions from other National Health Service doctors without having to transfer from their own doctor's list?

No, Sir; I am sure that such doctor would not be in breach of his terms of service. But a doctor who does not wish to prescribe these contraceptives or appliances may himself refer the patient to another doctor or a clinic, and any patient who is dissatisfied with her doctor's general attitude towards family planning is free to transfer herself to another doctor.

Would not the right hon. Gentlman consider requesting doctors to provide the names and addresses of other doctors who are willing to give such advice if they themselves refuse it on grounds of conscience or bias, or is it not possible that they should automatically hand to the patient the address of the nearest family planning clinic?

I am not sure that it would be appropriate for me to do this. I should have thought that any woman going to a doctor for this advice and failing to get it would know how she could get it from another doctor or a family planning clinic. I will consider what has been said, but I think that these things are best left to the profession itself.

asked the Minister of Health if he is aware that drug addiction is largely a secret addiction; and what steps he is taking to ensure that the members of the advisory committee which he is about to appoint are neither addicts nor partial to the addiction.

Members of this Committee will be carefully chosen after appropriate consultations.

Really! Does not my right hon. Friend realise that unless he publicly demonstrates that the members of this committee are free from this secret vice, their work will be ludicrous, futile and held up to public ridicule? What steps is my right hon. Friend taking in this case to investigate their possible addiction to this secret vice?

If my hon. and learned Friend is right—that it is a secret vice—then it would be difficult to give him the proof for which he asks. However, neither my right hon. Friend the Home Secretary nor I have any reason to suppose that in this country so high a degree of secrecy as he suggests attaches to drug addiction.

Can my right hon. Friend give the reasons for the extremely long delay that occurred in appointing the members of this important advisory committee in view of the social and medical problems involved in drug addiction?

I assure my hon. Friend that the reasons were solely concerned with the necessity to engage in proper and full consultations. As I told the House, I am aware of the urgency of this matter and I hope to make a statement before the House rises for the Summer Recess.

asked the Minister of Health if he is satisfied that general practitioners possess the necessary experience to detect efficiently deafness among children; and what action he is taking to ensure that all children who suffer in this way are identified as early as possible.

A general practitioner suspecting deafness would normally refer the child to an audiology clinic for full investigation. The importance of early detection and diagnosis of deafness in young children was emphasised in circulars sent to all local health and education authorities in 1961 and in March this year.

Is my right hon. Friend aware that the period of training of specialised teachers of deaf children is much longer than that received by general practitioners? Is he aware that experience in the King's Lynn area shows that the incidence of deafness may be far greater than suspected, and will he consult his right hon. Friend the Secretary of State for Education and Science on setting up a proper sample survey throughout the country to assess the need?

I will consider anything that my hon. Friend suggests. I agree that most general practitioners probably do not feel that they have had enough experience themselves in this field to make the final diagnosis, and that treatment, including the provision of any necessary hearing aid, is a matter for the specialist in otology.

asked the Minister of Health whether he will now arrange for dentists to be provided with disposable needles and syringes through the National Health Service.

I am considering, and will be discussing with representatives of the dental profession, whether this is the best means of meeting the need for sterility of equipment used in dental practice.

In the meantime, will the Minister bear in mind that it is really an absurd anomaly for doctors to be able to get their needles and syringes through the National Health Service while dentists cannot? Will he please try to put an end to this absurd anomaly?

It is not an absurd anomaly. After all, the position obtained in both professions until very recently—certainly until after this Government took office—and I do not want to make any changes until I have finished the consultations I am having with the profession about the rather wider question of sterility, which includes this.

Is the Minister saying that expenditure on all this sort of equipment, which will make for a better dental service, is not included in the practice expenses element laid down in the new dental regulations which are being laid before Parliament? If he is saying that, can he give an assurance that this is a matter that he will certainly discuss with the profession at the very earliest possible opportunity?

No, Sir. I am not saying anything of the kind. The precise opposite is the case. The cost of the syringes is part of the practice expenses which are remunerated in full to the profession as a whole.

asked the Minister of Health if he will review the instructions given to ambulance authorities regarding the collection of emergency cases which do not arise from accidents but from illness in circumstances where a casualty's doctor is not available to certify the course of the illness.

My right hon. Friend has given no instructions on this matter, which is primarily one for ambulance authorities themselves; but he proposes to ask all authorities to review their present practice in such cases.

Is my hon. Friend aware of a very sad case in my constituency, where an ambulance was sent for by a patient who was too ill by the time it arrived to be able to give the name of the doctor and the ambulance men then refused to take him away to hospital because they had no proper authority to do so? While not blaming the ambulance men, may I ask whether my hon. Friend would agree that this is a rather ridiculous situation, and that it should be possible in other situations besides road accidents for people to be taken to hospital without a doctor's certificate?

I am afraid that I am not in a position to comment entirely on the incident to which my hon. Friend refers, of which I have prior knowledge, but I think that we should recognise that where someone has a sudden illness at home it is necessary to get a doctor to the patient, because even the very act of removing the patient may have serious consequences. As I have indicated in my reply, my right hon. Friend is endeavouring to see that there are clear and precise instructions to ambulance controls so that every possible assistance can be given to patients and relatives.

Would not my hon. Friend agree that, whatever the circumstances involved in the case at Reading, the general level of help, first-aid and emergency treatment offered by ambulance men is often of the very highest order; and that there should be no question of any reflection on their integrity or ability?

I can assure my hon. Friend that I have no intention of reflecting on anyone, as to their ability or otherwise. I have admiration, as has my hon. Friend, for the ambulance staffs.

asked the Minister of Health how the fees now received by ophthalmic opticians under the National Health Service compare with those received by them when the Service was introduced in 1948, both in monetary and in real value.

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

While I am grateful to the Minister for that reply, may I ask him whether he considers that the rise in remuneration has been commensurate with the rise in the cost of living and the rise in remuneration of other branches of the medical profession?

asked the Minister of Health whether he will improve pay and conditions of service for

As my hon. Friend no doubt knows, the level of fees is a matter for the Optical Whitley Council. An inquiry into the level of practice expenses is being carried out at this moment as a preliminary to reviewing the fees.

Is it not a fact that in real terms ophthalmic opticians are receiving smaller fees than they did in 1948? Is not one of the consequences of this that the National Health Service content of the ophthalmic service is being subsidised by private fees received by ophthalmic opticians?

I think it is a fact that in real terms the fees are lower, for reasons which are well known to my hon. Friend and to the House. However, perhaps I might tell my hon. Friend that the response of opticians to the inquiry which I mentioned in a previous supplementary answer has been very disappointing. This perhaps suggests that not all opticians regard a revision of fees as a matter of urgency.

The pay and conditions of service of these staff are matters for the various negotiating bodies for local authority and hospital staffs.

Would the Minister, whose long-term interest in the mentally handicapped is widely recognised, agree that there is a special case here for priority in view of the success achieved in the last few years in bringing a number of these mentally and physically handicapped people into useful employment?

This category is broken down into three or four. Some of these persons are working in hospitals and some in other fields. I understand that there has been a substantial increase over the last 12 months. At the present time consideration is being given to a scheme for other workers. While one could argue that this might be a special case, the matter is under consideration anyway.

Does the hon. Gentleman agree that some of the most worth-while and most dramatic advances are being made in this field at the present time; and, because of the humanitarian and economic value of the work, is it not essential to do everything we can to attract people of the highest calibre into the profession? Will the hon. Gentleman look at the matter very carefully?

I agree with the hon. Lady on all counts. Some wonderful work is being done. We should certainly like to attract, so far as is humanly possible, all the staff that we require in this field.

asked the Minister of Health what annual sum is represented by 50 per cent. of the proceeds of a shilling charge for each National Health Service prescription.

In England and Wales, at present levels of prescribing, just over £6½ million.

Can the right hon. Gentleman say whether his Parliamentary Secretary on his visit to my constituency and the King George Hospital there the other day made any assessment of the need for extra beds in the hospital, and how much they were likely to cost?

I have not discussed this problem with my hon. Friend, but if the hon. Gentleman requires an answer perhaps he will put that Question on the Order Paper rather than the one which he has done.

asked the Minister of Health whether he will reconsider his previous decisions and provide suitably converted small cars for disabled drivers instead of the single-seater vehicles at present provided.

I would refer my hon. Friend to my reply to the hon. Members for Liverpool, Garston (Mr. Fortescue) and Suttton and Cheam (Mr. Sharples) on 27th June.

Is my hon. Friend aware that many of us on both sides of the House were hoping for a change and will maintain that attitude? Bearing in mind my hon. Friend's Written Answer to me on 29th June, it would appear that the annual average cost of this change would be a mere £5 million a year for the first eight years and that this would completely transform and enhance the usefulness of these vehicles to the disabled.

My hon. Friend will recollect that, in previous Answers, I have clearly indicated that a review is taking place and that we are as concerned about relieving distress and suffering as anyone else in the House. I also pointed out that it would be done as quickly as possible.

Would it not be better nationally to aim at replacing all these single-seater vehicles with mini-cars?

That may well be so and, indeed, this question is part of the review taking place. While I would not make promises about this, the House should recognise that, if we took such a course, there would be a substantially increased number of applications and that it would cost a lot of money.

My hon. Friend has said that the cost would be relatively small. If hon. Members on both sides are in favour, if my hon. Friend is in favour and if the cost is relatively small, what is holding it up?

The simple answer is that the cost is not relatively small.

asked the Minister of Health if he is satisfied that all Commonwealth and other immigrants undergo efficient health checks on arrival in Great Britain; and if he will make a statement.

Certain categories of immigrants are not medically examined on entry to this country, particularly entitled dependants from the Commonwealth who cannot be required to submit themselves for medical examination; but with these exceptions, all Commonwealth citizens and aliens coming here for settlement are normally referred for examination by a medical inspector.

Does not the right hon. Gentleman appreciate that many local medical officers have shown their concern and think that all immigrants should undergo a check in view of the fact that fatal diseases have been imported in this way?

I am sure that the hon. Gentleman would not want to exaggerate the hazard. I assure him that I shall continue to do all I can to improve health safeguards within the limits of my powers. But, as I have explained, there is no power to require dependants to submit themselves for examination.

Would it not be better for all concerned if more effective arrangements could be made for medical examination of these people at the point of embarkation rather than leaving it until they arrive here.

Discussions are in progress with this objective in view.

Does not my right hon. Friend agree that most of the incidence of diseases such as T.B. arises in the immigrant population after arrival here? Does not this point to the fact that they need better health care than they have been able to obtain in their countries of origin?

Yes, Sir. My hon. Friend makes an important point in relation to this question.

asked the Minister of Health what procedure is followed to remove a patient's name from his general practitioner's list when the patient leaves the United Kingdom permanently.

Information about emigrants is collected from various sources including those emigrating. On the basis of this information doctors are notified by executive councils of the removal of the names.

May I take it from that reply that there is no set procedure, that it is purely haphazard and that the names of a large number of people who left years ago are still on doctors' lists at considerable cost to the Exchequer?

I do not think that it is a large number. Under the old pool system there was no cost to the Exchequer. The hon. Gentleman might be interested to know that, in 1965, the names of 202,000 persons leaving the country were removed from doctors' lists. I am seeing whether we can do even more to ensure that information gets to the executive councils.

asked the Minister of Health how frequently doctors' registers of patients are checked to ensure that they do not contain the names of patients who have removed and to ensure accuracy of payment; and if he will make a statement.

The principal method for maintaining accuracy of doctors' lists is the system for notification of changes used by executive councils in conjunction with the National Health Service Central Register, which is designed to avoid duplicate entries as far as possible.

Does the right hon. Gentleman realise that there are many duplicate entries? Can he give an estimate of how many people are on the registers of more than one doctor and what that is costing the country?

There has always been what is called a degree of inflation of lists. At the moment the total of lists is 101·36 per cent. of the population. Under the pool system, this did not cost the taxpayer or the Exchequer one penny. Because of the new system which has been introduced with the new general practitioners' contract, it is all the more necessary that we reduce this inflation as much as possible. But the fact was known to the Review Body when it advised on remuneration.

asked the Minister of Health what steps he will take to ensure that young children are not denied the benefits which derive from fluoridation.

The primary responsibility for securing the benefits of fluoridation for young children and others rests with the local health authorities, but I am doing all I can to encourage and help them.

Does not my right hon. Friend agree that, since many local authorities have deep-seated and, in their view, well-founded objections to the principle of fluoridation of public water supplies, it is time that the Ministry took another look at this vexed question? In particular, can he give an assurance that alternative methods will be explored to see that young children are not denied a very valuable preventive against dental caries?

These matters have been, and are still being, considered but on present advice I am satisfied there is no other method which is as safe and effective as the fluoridation of water.

Will my right hon. Friend assure the House that he will use no method to impose on local authorities this system of poisoning water against which so many of them have declared their objection?

I am happy to say that many more have declared their support.

asked the Minister of Health what facilities exist within the Portsmouth area for the treatment of chronic kidney disease; and how many people in the area are known to be in need of such treatment.

In addition to the ordinary medical services already available in the area, a renal unit for the investigation and treatment of kidney diseases was opened at Priorsdean Hospital, Portsmouth, in October, 1965, serving the Wessex Hospital Region as a whole. The Wessex Board also intends to build a unit at Priorsdean Hospital specifically for the treatment of chronic renal failure by intermittent dialysis. There is no reliable means of assessing how many people in the area are suffering from chronic kidney disease, nor what proportion of them would benefit from intermittent dialysis.

While welcoming this news about future policy for the Portsmouth area, may I ask my right hon. Friend whether he is aware that there is concern in the area about the speed with which the new unit can be introduced? There seems to be a difference of opinion between the local board and the Ministry.

If my hon. Friend likes to write to me or put down a Question, I will be glad to look into the possibility of such difficulties and see whether they might be removed.

asked the Minister of Health (1) what his plans are for the research team responsible for the production in recent years of the patient-operated selector mechanism at Stoke Mandeville to carry on their research;

My right hon. Friend is arranging to supply this mechanism to suitable patients under the National Health Service. He is ready to consider any proposals for further research in this field.

Is the hon. Gentleman aware that this nine-man team—whose product, for which there is considerable export demand, has virtually enabled useless bodies to become taxpayers—which leads the world in medical engineering, had to leave Stoke Mandeville last week because the grant from the Polio Research Fund has come to an end? What aid can the hon. Gentleman give the team, which is now financing itself?

When the hon. Gentleman looks at my reply tomorrow, he will find that we are ready to consider any proposal for further research. The leader of the learn has already been invited by officials of my Department to put forward proposals which will merit support from research funds under our control.

Is the hon. Gentleman aware that although one in three of the permanently disabled now in hospital could leave and go home, due in part to the developments mentioned by my hon. Friend, thus reducing pressure on hospital resources, they are unable to do so because of the absence of adequate help in the home? Does not that reinforce the argument, advanced from these benches last week, for a constant attendance allowance? Can the hon. Gentleman ask his right hon. Friend to discuss this matter with the Chancellor of the Exchequer?

If the hon. Gentleman wants an answer on those other issues, he must put down a Question. We have entered into a contract with the team mentioned in reply to the hon. Member for Liverpool, Wavertree (Mr. Tilney) for the production and maintenance of a number of units. We have offered to meet the team to discuss what research assistance we can give. I do not know what more we can do.

On a point of order. As the leader of the team was unaware last Friday night of what the hon. Gentleman has just said, I give notice that I shall raise the matter on the Adjournment at the earliest possible moment.

Notice must be given in the conventional way.

asked the Minister of Health whether, in assessing training grants for student radiographers, he will consider making special provision for those who of necessity live away from home.

No, Sir. It has been policy to provide schools in a large number of areas so that radiographers can train and work near their homes.

Is my hon. Friend aware that some student radiographers still cannot live at home and that there is considerable resentment among them that they are financially worse off than those living in the towns and great conurbations?

We have about 100 radiography schools. While I appreciate that there may be isolated examples of difficulty, the alternative to the present flat-rate grant would be grants similar to the university grants and based on parental contribution, so that even if we made this change it might not prove as advantageous as my hon. Friend believes.

asked the Minister of Health what plans he has to start clinics in Norwich for the taking of cervical smears.

Discussions are taking place between the medical officer of health, the regional hospital board and the local medical committee about the extension of the present service. The Norfolk and Norwich Hospital hopes to be able to provide a full service within the next two months.

Is my hon. Friend aware that that Answer will give substantial satisfaction and that we hope that his plans are successful?

asked the Minister of Health if he will estimate when there will be available sufficient technicians trained in the reading of cervical smears to support an adequate programme of clinics in Norwich and in Norfolk.

A screening service is already available at King's Lynn and sufficient technicians are expected to be available within the next two months to provide a similar service at Norwich.

Is my hon. Friend aware that that Answer does not relate to clinics in Norfolk where there is some feeling of concern about this matter, as private companies are now able to maintain services like this for their staff?

I am sorry, but I did not hear that. Will my hon. Friend repeat what he said?

Is my hon. Friend aware that his Answer related to Norwich, but that I am now concerned about Norfolk and that there is some concern in the county as a whole about the provision of these technicians? I have had letters about this matter. There is concern particularly as private companies seem able to maintain these services for their employees.

I agree that some private companies are able to maintain these services for their employees. The best thing I can do is to look into the whole matter and write to my hon. Friend.

asked the Minister of Health what action he has taken resulting from the letter from the Chartered Society of Physiotherapists on the subject of the Selective Employment Tax.

My right hon. Friend has sent the hon. Lady a copy of his reply.

Is that reply satisfactory? Is the hon. Gentleman win-his battle for the physiotherapists and the Royal College of Nursing with the Chancellor of the Exchequer? I should like to know now so that I can put the proper supplementary question.

Not knowing what the proper supplementary question which the hon. Lady wants to ask is, I cannot give the right supplementary answer.

asked the Minister of Health what arrangements are being made to ensure the refunding to general medical practitioners of any taxation liable to be paid under the Selective Employment Tax.

As regards ancillary staff in respect of whom direct payments are to be made under the National Health Service, and trainee assistants, refund will be made as part of the payments for the staff concerned. As regards other staff employed for National Health Service purposes, the cost of the tax will be taken into account in future reviews of remuneration.

asked the Minister of Health what progress has been made in the application of incentive bonus schemes to building workers employed in the hospital service; and if he will make a statement.

asked the Minister of Health what recent developments there have been in the application of incentive bonus schemes to building workers employed in the hospital service; how long these schemes have been in preparation; and if he will make a statement.

asked the Minister of Health what progress has been made in the application of incentive bonus schemes to building workers employed in the hospital service; and if he will make a statement.

asked the Minister of Health what action has been taken in the application of incentive bonus schemes to building workers employed in the hospital service; how long such schemes have been under preparation; and if he will make a statement.

asked the Minister of Health what progress has now been made in introducing incentive bonus schemes for building workers in the hospital service; how long these schemes have been in preparation; and if he will make a statement.

asked the Minister of Health what progress has been made in the application of incentive bonus schemes to building operatives employed in the hospital service; and if he will make a statement.

The experimental scheme in the Royal Buckinghamshire Hospital Group came fully into operation in March. In February my right hon. Friend arranged for management consultants to carry out preparatory work to see whether two further experimental schemes could be introduced and this work is in progress.

Is my hon. Friend aware that there is considerable concern among building trade operatives on this matter?

We, too, would like to see progress at the earliest possible date. I can assure my hon. Friend that we are looking at this matter on the basis of trying to get the introduction of the right kind of scheme in the right places so that we can make progress.

Is my hon. Friend aware of the extensive delay in negotiations in the hospital service? Is he further aware of the extensive dissimilarity in wages earned in this section of employment between maintenance workers employed by hospital boards and those brought in by contractors? Will he try to speed up the introduction of incentive schemes to resolve this inequality?

I appreciate what my hon. Friend says, but he ought to be quite clear that there are some difficulties in introducing in hospitals the type of work study schemes which apply in other buildings. I can assure him that we are doing what we can to get the picture quite clear and to introduce such schemes where they are viable.

Is my hon. Friend aware that the delay in introducing incentive schemes of this kind is severely testing the loyalty of workers who could play an important rôle in the modernisation and building of our hospitals? Will he do something to speed up the introduction of these schemes.

There are a number of problems peculiar to hospitals and my hon. Friend will have to accept this. I keep having to repeat that we are conscious of this problem, that we want the highest productivity and that bonus schemes may give this to us, but we do not want to rush ahead with these proposals unless we feel that we shall get the right results.

Is my hon. Friend aware that the first item of correspondence on the negotiations dates from 1957? Is he aware that negotiations have dragged on under two Conservative Administrations and two Labour Administrations. Does he realise that the tolerance shown by these workers in these circumstances is deserving of public tribute?

I am always paying public tributes to people who work in the Health Service, but my hon. Friend must accept that I can accept responsibility only for the period of time during which my right hon. Friend has been in office. We have not delayed to the extent suggested in the supplementary question.

Is my hon. Friend aware that it appears that the prices and incomes policy is running at two levels in the Health Service? Why is there speed in one type of settlement in the Health Service, possibly justified, but not on the manual workers' side? Is he aware that it is only the loyalty of these workers to the Health Service which has prevented a serious strike in this industry?

I appreciate the loyalty of the workers in the Health Service. If my hon. Friend wants an answer to the main part of his question, he must put a Question down.

Is my hon. Friend aware that, while difficult, it is not impossible to institute bonus schemes for maintenance workers? Is he aware that this is now being done by all local authorities and surely, on the basis of what my hon. Friends have said, he must agree that it is high time that some positive and quick action was taken in this matter?

Of course it is not impossible. We have been in consultation with the trade unions about this matter, and, as I indicated in my original reply, we have appointed consultants to try to resolve the problem.

On a point of order [Interruption.]

Order. I understand that the hon. Member wishes to raise a point of order, but he must not wave papers at the Chair.

On a point of order. Is it not unusual, Mr. Speaker, for my right hon. Friend the Minister not to reply when so many hon. Members on this side of the House are interested in the question concerning the incomes policy? Should not the Minister answer the question?

That is not a point of order for the Chair. The hon. Gentleman should, if he wishes, raise that matter at the end of Question Time. He should know that by now.

asked the Minister of Health when the first and second phases of the new hospital at Macclesfield will be started; and what is the date of completion.

The Hospital Building Programme (Cmnd. 3000) includes these phases of the new hospital at Macclesfield in the first list of schemes at present expected to start after 1969–70. Construction is likely to take two to three years for the first phase and three to four years for the second.

Is the Parliamentary Secretary aware that the postponement of at least three years has caused extreme dismay in Macclesfield and district? In looking at this matter, will he reconsider the whole problem, taking into account the fact that the Congleton War Memorial Hospital, which is of quite modern design, should be put on a permanent basis with the delayed new hospital at Macclesfield?

The regional hospital board is aware of the situation in Macclesfield and will take all these matters into account in defining its plans. These plans are fluid and flexible. If the occasion arose, or needs occurred which were greater than in other parts of the region, the plans could be changed.

In view of the unsatisfactory nature of the Parliamentary Secretary's reply, I beg to give notice that I will endeavour to raise this matter on the Adjournment at the earliest possible opportunity.

asked the Minister of Health (1) what detailed plans he has for new maternity accommodation in Redditch, in view of the enlarged size of the town; (2) what detailed plans he has for new hospital accommodation in Redditch, in view of the enlarged size of the town.

Detailed plans for the new hospital at Redditch, which will include new maternity accommodation, will be drawn up nearer the time when building is to start.

Is the Parliamentary Secretary aware that that Answer is highly unsatisfactory and that I understand that it will be something like 12 years before this hospital is in full use? Since for such a long time Redditch has been short of hospital accommodation, may I ask whether the hon. Gentleman considers that 32 beds are adequate for a town of this size? Does he not realise that in this area we are badly in need of maternity accommodation?

I appreciate that the hon. Gentleman wishes to do what he can to get hospital facilities for his constituents. I understand his indignation. However, he must recognise that arrangements are made to treat the Redditch population in this instance in other hospitals in the area. This is arranged by the regional hospital board, which has the task of assessing priorities.

In view of the highly unsatisfactory reply given by the Parliamentary Secretary, I beg to give notice that I will raise this matter on the Adjournment as soon as possible.

asked the Minister of Health what is the percentage of babies born in hospitals and the average period of application necessary to obtain a maternity bed in hospitals in the London area.

asked the Minister of Health what percentage of births take place in hospitals in the Greater London area; and how long is the average waiting period for a maternity bed.

For the first quarter of 1965, which is the latest period for which information is available, it is estimated that of babies born to mothers normally resident in Greater London, 78 per cent. were born in hospitals, including private nursing homes. The information asked for in the last part of the Question is not available.

As the birth rate is rising and as, therefore, the position is likely to get worse rather than better—and as I have been informed that in the London area only about 60 per cent. of mothers can obtain maternity beds—does the Parliamentary Secretary genuinely feel that this matter is being given a high enough priority in the Health Service?

I think the information which the hon. Gentleman has about the position in the Greater London area is slightly erroneous. We have given the figures for the whole of Greater London and the figure of 78 per cent. is, as the hon. Gentleman knows, much higher than that for many other regions. It is very difficult to say that this is inadequate, comparing it with the percentage in other regions.

Is my hon. Friend aware of the difficulties in Redbridge of obtaining maternity beds, and will he make the provision of maternity beds there a matter of urgency?

On the same basis of calculation, the position in Redbridge is virtually equivalent to that which exists in the rest of the country. I do not think, therefore, that I could give any promises to make improvements there.

Would my hon. Friend consider, if it does not already happen, extending to hospitals outside the inner London area the principle of the catchment area for maternity purposes, which has been so successfully introduced and implemented in the last few years?

I will consider the point my hon. Friend makes.

asked the Minister of Health what proportion of British hospitals has facilities for restarting the heart; and what proposals he has for increasing this equipment.

Many acute hospitals already have these facilities and the requirements for a more comprehensive service are at present being considered by my Standing Medical Advisory Committee.

As I am told that this equipment might save hundreds, perhaps thousands of lives every year, may I ask the right hon. Gentleman to do his very best to install it in as many hospitals as possible as quickly as possible? Can he indicate what the limiting factor is in going ahead with the programme?

It is not really so much a question of additional equipment as of organising the service in such a way as to make the best use of medical and nursing skills and equipment. I am treating it as a matter of urgency.

asked the Minister of Health what information he has about plans to build or use existing buildings for private consulting rooms within National Health Service hospitals; and what is his policy towards such schemes.

I am not aware of any proposals to provide private consulting rooms or any other accommodation within National Health Service hospitals exclusively for use for private out-patients, and I would not approve such proposals.

While I welcome my right hon. Friend's reply, I notice that he mentioned the word "exclusively". Is he aware that there would be particular anxiety on the part of many hon. Members on this side of the House were any private consultations to take place at National Health Service hospitals?

This has always been the case. Private out-patients who are treated in National Health Service hospitals generally make use of the normal out-patient accommodation at times when it is not being used for non-paying patients. This was agreed to at the outset of the National Health Service.

Will the right hon. Gentleman bear in mind that what is really needed is more surgical beds to deal with the results that are found in these consulting rooms, and will he do something urgently to deal with the chronic cases that are found in South Devon and West Devon, and overcome this acute problem there?

If the hon. Member has any particular problem in his area, perhaps he will put down a Question on the Order Paper.

asked the Minister of Health whether any hospital accommodation is currently being built by industrialised building methods; and whether he will encourage experiments with such methods by hospital boards.

Most current schemes use such methods, though to varying extents. As examples, seven major contractors are using their systems for maternity units. A system developed by the Oxford Hospital Board is being adopted overseas as well as here. My Department's development projects at Kingston, Walton and Greenwich are wholly industrialised. I welcome experimentation and have issued a great deal of technical guidance on this subject to hospital boards.

Can the Minister hold out any hope that these methods will reduce the tremendous length of time it now takes from the planning to the completion of major modern hospitals?

Yes, Sir. I have hopes that these methods will reduce the time taken in planning and construction—perhaps to a rather greater extent than they will reduce the cost.

Will my right hon. Friend inform us to what extent the information gained by this research and development is made available, or will be made available, to local health and welfare authorities for building projects they are planning?

I am not sure that techniques of hospital building by industrialised methods are necessarily appropriate to the type of much simpler building in which local health and welfare authorities are engaged.

asked the Minister of Health what improvements have been made in accommodation and modern equipment at Leeholme Hospital in Easington.

In the period 1960–65 an X-ray department and nurse training accommodation were provided; improvements were made in the outpatients department; the hospital kitchens were modernised; and a new major X-ray set installed.

Is my right hon. Friend aware that I recently brought this matter to his attention? What has happened since? Is he aware that I am getting a little annoyed about the delay in effecting what possible improvements can be brought about in this place? Does my right hon. Friend understand that he cannot ask these geriatric patients to live in such squalid conditions? Will he instruct the regional hospital board to take action immediately, or else?

I am sure that the regional hospital board does not need instructions from me in this matter. Perhaps I can reassure my right hon. Friend by stating that there is no prospect of closing the hospital for at least 10 years, and probably 20 years or more, and, therefore, further expenditure on the hospital will undoubtedly be necessary, and this is accepted by the regional hospital board.

asked the Minister of Health when he will publish a circular to local authorities and hospital authorities on the planning, designing and siting of health centres.

As soon as the necessary consultations have been completed.

While thanking my right hon. Friend for that reply, might I express the hope that it will not be long before the circular is issued? Will he bear in mind in preparing the circular that it is important to establish genuine health centres? Will he bear in mind that there are some local authorities now preparing schemes which name them health centres but they are no more than surgery suites for local general practitioners attached to local health authority clinics? Will my right hon. Friend also bear in mind that there are sites attached to hospitals in certain localities which could well be used to bring the three wings of the National Health Service together under that circular?

I can assure my hon. Friend that I will take both of his points into account before the circular is finalised.

asked the Minister of Health if he will seek to amend the Human Tissue Act, 1961, in line with proposals agreed at a recent Ciba conference on Ethics in Medical Progress, details of which have been sent to him, so as to facilitate further progress in transplantation surgery.

I have not received details of the proceedings of this conference, but am aware of one proposal which was discussed. This I am examining.

Will my right hon. Friend bear in mind that this is a matter of considerable concern to surgeons engaged in this field, particularly in the case of kidney transplants from cadavers, where the operation has to be undertaken very quickly. and surgeons feel that they are considerably handicapped by the present Act?

Yes, Sir; I have heard of the discussions. I do not know to what extent the proposal was endorsed by the conference, nor do I know whether it would command wider acceptance. These are delicate matters which I think need further study.

asked the Minister of Health what proportion of hospital beds is occupied by patients suffering from schizophrenia; what proportion of these patients are readmissions; what advice he has had from the Medical Research Council about the theory that the cause of schizophrenia is biochemical and that the cure is treatment by half-gramme doses of niacin; and what approaches he is making to drug manufacturers to encourage them to make niacin tablets available in this country in the requisite strength, as they are in Canada and the United States of America.

13·5 per cent. at the end of 1964; 70 per cent. of admissions for schizophrenia that year were readmissions; none; none.

Would the right hon. Gentleman give further thought to this matter and realise what an enormous impact this new discovery may have on the whole requirements of the National Health Service? Could he ask the Council to look into this and hold consultations with the drug manufacturers?

I am aware that there have been experiments by Hoffer and Osmond in the use of niacin, but I am advised that their results are unproved. I can assure the hon. Gentleman that the drug is available under the National Health Service, and I know of no difficulty about the strength of the tablet.

Would not my right hon. Friend agree that to put down the Question is irresponsible, that to suggest that there is a readily available cure for schizophrenia is not true and that the Question can only raise false hopes in the minds of close relatives of those who are suffering from this tragic disease?

I am sure that that was not the hon. Gentleman's motive. But these sort of conclusions are too readily adopted, I am afraid, by people who read claims in the Press and elsewhere on behalf of new drugs.

Is the right hon. Gentleman aware that my hon. Friend has touched upon a matter of very great importance? Bearing in mind that about half our hospital beds are occupied by mental patients and that about one-third of these are schizophrenics, and bearing also in mind that the Medical Research Council is devoting only about 10 per cent. of its budget to research in psychiatry, does the right hon. Gentleman think that this is adequate?

I seem to recall calling the attention of one of my predecssors to this matter many years ago when the proportion of the budget was very much smaller than it is today. But I can tell the hon. Gentleman that the Medical Research Council considers that the theory of a biochemical causation for some forms of schizophrenia offers a promising line of investigation, but there is no substantial evidence that niacin cures schizophrenia.

asked the Minister of Health what reply he has sent to the Cleethorpes Borough Council's request for a new hospital to serve the people of North Lincolnshire; in view of the fact that this area will grow rapidly because of the off-shore findings of gas and oil, if he will give urgent priority to this hospital; and if he will make a statement.

I have sent the hon. Member a copy of my Department's reply to this request. It is for the Sheffield Regional Hospital Board to judge the priority which should be attached to this scheme. I know that they have in mind the prospective increase in population in North Lincolnshire.

While recognising that the hon. Gentleman cannot meet every demand in the country straight away, may I ask him to bear in mind that this area will be the gateway to Europe and will develop immensely? Will he, therefore, get a hospital built there quickly? Will he use his influence to get his former colleague to cross the Floor of the House and join us?

I appreciate the need of the Grimsby area, because the Grimsby Hospital is scheduled to cater for Cleethorpes and already deserves some degree of priority. But it must await completion of some of the schemes which the Sheffield Regional Hospital Board has in hand. We shall watch the position carefully. As the hon. Gentleman will appreciate, my right hon. Friend the Member for Grimsby (Mr. Crosland) has already been in touch with me.

asked the Minister of Health what representations were received concerning the installation of bed lifts at Baguley Hospital, Manchester; what consultations took place with the hospital's medical staff on this matter; and if he will make a statement.

Only those forwarded to me by my hon. Friend. The medical advisory committee, and the Baguley Hospital House Committee on which the medical staff are represented, were consulted and their views considered, and there was a special meeting between members and officers of the regional hospital board and the hospital management committee on 13th December, 1965, at which members of the medical staff expressed their views on the proposal.

Was not inconvenience, not to say pain, caused to seriously ill patients by the choice of stretcher lifts instead of bed lifts? Is my right hon. Friend fully satisfied that there was sufficient consultation with the senior medical staff?

Yes, Sir. I am satisfied that there was sufficient consultation. I accept that bed lifts would have been preferable and so does the regional hospital board. It was a matter of whether the hospital could afford to wait until bed lifts could be provided, and on balance it was thought that stretcher lifts immediately was the preferable alternative.