asked the Minister of Health what proposals he has for setting up nursery clinics for mentally handicapped children under five years of age.

The provision of community care for these children is the responsibility of local health authorities.

Does the right hon. Gentleman appreciate that different local authorities and different county councils have different standards? Would it not be advisable for him to give some direction about his attitude towards this important matter?

No, Sir; it is not customary for Ministers to give directions to local authorities. I think that the hon. Gentleman is concerned about the situation in East Kent. My officers will shortly be approaching those of the Kent County Council to consider the needs of that area.

asked the Minister of Health if he will take further steps to develop post-graduate educational opportunities for family doctors.

Post-graduate educational opportunities for family doctors have expanded rapidly in recent years and encouragement for further expansion is being continuously given.

While I welcome my right hon. Friend's Answer, may I ask whether he will give special consideration to the difficult problems that are often faced by rural family doctors in this regard, doctors often isolated not only geographically but professionally?

Yes, Sir, but I think that my hon. Friend will be encouraged to know that the number of attendances by family doctors at post-graduate educational activities held under these arrangements in England and Wales have roughly trebled over the last five years.

asked the Minister of Health whether he will introduce legislation which will enable him to do more for the disabled driver.

My right hon. Friend hopes to introduce legislation in the present Session.

Will the hon. Gentleman's right hon. Friend bear in mind when framing that legislation that it would be a great help to many people who are now entitled to three-wheelers if they were able to receive instead a credit of equal value which they could put towards the purchase of an ordinary car?

Any further charge on public funds is a matter for serious consideration, but the powers which my right hon. Friend hopes to obtain will be with a view to examining what further provision can be made.

When that legislation is being framed, will the Minister bear in mind the desirability of making two-seater vehicles available to crippled mothers where the father is no longer in the family because otherwise she can never go out of doors with her child, which must affect the mental development of the child?

That is a very important point, and it will be taken into account.

asked the Minister of Health if he will make a statement about the visit of the Principal Medical Officer of his Department and the interviewing team which visited the United State of America and Canada for the purpose of interesting British doctors in returning to medical work in this country.

The team has just concluded its interviews with some 140 British doctors now working in North America who would like to return to this country and these doctors are being advised on their prospects of obtaining reentry to medicine here. I expect to receive the team's report shortly.

I congratulate my right hon. Friend on the success of his initiative. Can he do anything about the adverse publicity given to the hospital service which has encouraged doctors to emigrate, especially the speech made by my hon. Friend the Member for Pembroke (Mr. Donnelly) who was irresponsible, ill-informed and from an hon. Member who has not attended his party's health group since 1959?

I have no control over the publicity but I may add that in this instance perhaps I wish I had.

Order. Supplementary questions must be about Ministerial responsibility.

asked the Minister of Health whether, in view of the continued failure of manufacturers to reach agreement on curtailing cigarette advertising, he will take the steps necessary to limit promotion of their sales.

asked the Minister of Health what conversations he has had with cigarette manufacturers concerning advertising, and with what result.

asked the Minister of Health what measures he has in mind to limit promotion of cigarette sales, in view of the failure to achieve voluntary agreement on reducing cigarette advertising.

I would refer the hon. Members to my reply on 23rd October to my hon. Friend the Member for Falmouth and Camborne (Dr. John Dunwoody).—[Vol. 751, c. 1328–9.]

Is my right hon. Friend aware that his reply last Tuesday was very helpful? Could he say now when we might expect legislative action to curb the menace of cigarette advertising in view of the fact that 30,000 persons died last year in Great Britain of lung cancer induced by cigarette smoking?

My Chief Medical Officer estimated deaths last year caused by cigarette smoking at more than 50,000. I cannot give any indication of the timing of legislation.

What success has the restriction of advertising of cigarettes on television, which has been in operation for two years, had on the sale of cigarettes?

It is difficult to quantify these matters. The number of smokers in the adult population fell significantly but unfortunately last year rose again.

Will the right hon. Gentleman make representations to the Chancellor of the Exchequer to encourage people to switch from cigarettes to cigars or pipe tobacco, which would be much more effective in reducing cigarette smoking than a ban on advertising?

I note the hon. Gentleman's suggestion.

Is it not the case that every published statistic shows that total consumption of cigarettes is not so much affected by coupon gift schemes or advertising but by price? Is not the right hon. Gentleman's proposal going to result in coupon cigarettes being reduced by 2d. or 2½d. in price? If this results in increased consumption, will not his action have proved somewhat parodoxical?

This is a matter for the manufacturers but it is impossible to produce evidence to show that coupon gift schemes do not encourage smoking and do not encourage people who do smoke to smoke greater quantities.

asked the Minister of Health what surveys have been conducted by his Department on the effect of free gift coupons on cigarette consumption.

asked the Minister of Health what evidence he has regarding the numbers of cigarettes smoked by consumers of brands promoted with gift coupons and those sold without gift coupons.

I am aware of both published and unpublished evidence about smoking of coupon and non-coupon brands, but no survey has been conducted directly by my Department on this point.

Before my right hon. Friend brings in legislation against coupon gift schemes, will he consider having a survey, because otherwise this looks like spoil-sport discrimination against one group of cigarette smokers? Is he to have consultations with the Chancellor of the Exchequer about reducing the duty on cigars and tobacco?

I have already explained that that latter matter is for my right hon. Friend the Chancellor of the Exchequer. I can assure my hon. Friend that this is not spoil-sport legislation. We are here dealing with what has been legitimately described as a lethal product, and the responsible Minister could not sit back and watch the unfettered promotion of such a product.

If, as the right hon. Gentleman admits, there is not a shred of evidence that people who smoke these particular cigarettes smoke more than others, and as the evidence of the researches which I have seen is the other way round, what is the reason for this move other than pointless and objectionable interference with the freedom of choice by the individual?

Perhaps the hon. Gentleman has seen the evidence from the Imperial Tobacco Company, which I, too, have seen. I do not accept those findings. The hon. Gentleman may be interested to know that other manufacturers have given other figures which lead to other conclusions which have not yet been published.

Will my right hon. Friend recognise that the evidence which has come from market research suggests that cigarette coupons are a useful marketing instrument for moving confirmed smokers from one brand to another, but that developing a market among young people, which is what my right hon. Friend is trying to prevent, is a function of price?

It is very difficult to find evidence to support my hon. Friend's contention.

Does the right hon. Gentleman admit that he is proposing to introduce this legislation when he cannot back it with any statistical evidence whatever? If there is evidence, why cannot we have it and why cannot it be published?

I have already told the noble Lord and other hon. Members that there are studies which produce different conclusions. This is a matter in which common sense ought to prevail and the offer of larger gifts for more cigarettes smoked is self-evidently an inducement to smoke more.

As smoking in this country is still perfectly lawful, what right does the Minister think he has to dictate how cigarettes should be sold?

There is no question of my dictating how cigarettes should be sold. The hon. Gentleman knows that I had discussions, lasting very nearly two years, with the industry in order to reach a voluntary agreement about the limitation of promotion. There was no unwillingness on the part of industry to take these discussions very seriously. But the industry could not agree because of the conflict of commercial interests. That produced a deadlock which, in the circumstances, could not be left where it was.

Is it not a fact that the consumption of cigarettes increased last year and deaths from lung cancer now occur at the rate of one every quarter of an hour?

That is perfectly true.

asked the Minister of Health why he has decided to seek to ban the inclusion of gift coupons in packets of cigarettes.

Coupon gift schemes are part of general cigarette sales promotion which the Government have decided to curb as a whole in the interests of health.

Has not the Minister already admitted he has made no study of this in his Department and that the only thing on which he has to go for legislation is a hunch? Can we expect Government legislation of a compulsory diet sheet to deal with the thousands who die from over-eating every year?

There is a great deal more than a hunch in this. I can only repeat that when there are more than 50,000 deaths every year from cigarette smoking which could have been prevented, the Government have to take action in the interests of public health.

asked the Minister of Health what is the annual cost of the campaign by his Department to diminish cigarette smoking and what measure of success is achieved.

About £92,000 in 1966–67. This does not take account of the amount spent by local health and education authorities, by whom the campaign is largely conducted. It is not possible to measure the success achieved.

Would the right hon. Gentleman recognise that the only effec- tive and ubiquitous method of warning all cigarette smokers of the dangers is to print the warning on the cigarette packet itself, which would represent no extra cost to the Ministry or to the manufacturer because the packet is printed overall, anyway?

This method has been adopted in the United States. I am not sure that it has been wholly successful. But I can assure the hon. Gentleman that surveys carried out by the Government Social Survey show that nearly everyone is now aware of the health risks of smoking. Unfortunately, not all smokers relate the health risks to themselves.

asked the Minister of Health what proposals he has for supplying small cars to haemophilic drivers instead of invalid tricycles.

My right hon. Friend has no proposals for extending the provision of cars to any further category of the disabled, at present.

We have been told that there is to be a great step forward in these matters. Can the hon. Gentleman indicate how big a step forward is to be taken about these tricycles? Is he aware that I have a constituent who has had 39 injections of plasma at a cost of £30 a time—£1,000 a year—for knocks received while driving an invalid tricycle? Can such invalids have four-wheeled cars?

As I said in answer to a previous Question, we are proposing to introduce legislation during this Session. The use made of the powers must depend on the resources available, but there are many cases, not just that which the hon. Gentleman has mentioned, which will deserve consideration when we are in an economic position to give help.

Why is not the policy altered so as to permit invalids to get four-wheeled cars if they are prepared to make a contribution towards the cost? I have a constituent who is most anxious to get a four-wheeled car which would be beneficial to himself and his family and who is prepared to pay part of the cost. Why should not the regulations be altered to permit that?

We must await the legislation, when that sort of case will be considered.

asked the Minister of Health what steps he is taking to attract more general practitioners to the West Midlands.

Special allowances of £400 a year are now payable to general practitioners providing full medical services in the areas of greatest shortage, a number of which are in the West Midlands. Initial practice allowances are also available to doctors starting to practise in such areas. My Department has recently further publicised these arrangements.

I am much obliged for the information contained in that reply and I am sure that it will encourage my constituents who are concerned about the low doctor-patient ratio. Does my hon. Friend not think that it would be a good idea for the General Medical Council to be asked to look at its regulations controlling the ability to practise of doctors coming from certain countries abroad?

That is not quite the Question on the Order Paper. My hon. Friend will know that there has been a certain amount of comment recently about a particular case which I have reason to suppose is at any rate being considered. I will send my hon. Friend a copy of the publicity which we issued recently bringing to the attention of doctors and the medical schools the new allowances which are available.

Has the Minister considered that one way of increasing the supply of doctors in the West Midlands would be by making it more easy for them to carry on private practice where there is a demand and increasing the supply of pay beds where there is a demand?

Except in a few lucky countries there is a worldwide shortage of doctors. This Government stand for giving medical help to people who really need it.

asked the Minister of Health what improvements he proposes to make to the system of medical examination of immigrants and follow-up by medical officers of health.

Immigrants coming here with Ministry of Labour vouchers are examined at the ports and their destination addresses are obtained so that there can be a follow-up by local medical officers of health. At present those dependants who have a statutory right of admission are not subject to medical examination and their destination addresses cannot always be obtained.

Is the hon. Gentleman aware that many local health authorities are very anxious and dissatisfied about this state of affairs? Is there any reason why the same precautions should not be taken in the interests of dependants as are taken in the interest of others, because many of these immigrants have notifiable diseases which are not checked?

I know that there has been concern, but the hon. Member will recollect the White Paper on immigration from the Commonwealth, which envisages legislation to make all dependants subject to examination and to having to report to a medical officer of health. This, of course, needs legislation.

asked the Minister of Health what were the total sums of Government money spent on research into alcohol and drug dependence during the last three years.

Expenditure on such research is not identifiable because it was combined with other fundamental biomedical research or with treatment.

Has the right hon. Gentleman reason to think that what we are spending on research into this subject is far too little at the moment?

There are areas where we need to do further research, but I believe the right hon. Gentleman knows that, following the recommendation of the Brain Committee, an addiction research centre was established this year at the Maudsley Hospital at a capital cost of £26,000 and an expected running cost of about £15,000.

asked the Minister of Health what action he proposes to take to initiate Government-sponsored research into alcohol and drug addiction in the light of the Report of the Office of Health Economics, a copy of which is in his possession.

The Government have already initiated research into drug dependence and will continue to examine the need for further research.

Does not the right hon. Gentleman think that in the light of this Report by the Office of Health Economics there is substantial evidence of an urgent need to advise on what needs to be spent on this sort of research and considerably to increase the sum now allowed by the Treasury?

I do not think that finance is an important limiting factor here. I understand that the Medical Research Council will shortly bring together a number of research workers with expert knowledge of drug dependence to discuss the possibility of identifying areas in which further research would be both useful and feasible.

asked the Minister of Health when he expects to complete his inquiries into the allegations of cruelty to old people contained in the book "Sans Everything".

The committees of inquiry were appointed by the hospital boards. They are not yet able to say when they will be ready to report.

Is the reported dismissal of the male nurses at St. Barnabas Hospital, Bodmin, over the weekend connected with these inquiries? If it is, does the Minister think it wise that piecemeal disciplinary action of this kind should take place before he and the House have had an opportunity of seeing the reports as a whole?

No, Sir, the case in question was one of two nurses who had been suspended from duty because of allegations of ill-treatment of patients. This had nothing whatever to do with the book "Sans Everything". I think the suspensions took place before the publication of the book.

While expressing sincere tribute to the kindness of the vast number of nurses in long-stay units, may I ask if there is not a case for establishing an inspectorate similar to the schools inspectorate for long-stay and geriatric hospitals where it is difficult for patients to register complaints?

This suggestion has been considered from time to time and usually rejected on grounds of impracticability. I am, of course, extremely concerned that any cases of ill-treatment of such patients, if these exist, shall be revealed and any tendencies of this kind stamped out. I think the present arrangement for ad hoc inquiries is probably more effective than a standing inspectorate of the kind which the noble Lord suggests.

Is it the intention of the Minister to make public the results of these inquiries eventually in order that justice may be done to the vast and overwhelming number of people who are not guilty of any offence?

Yes, Sir. As my right hon. Friend the then Minister without Portfolio told the House, the findings and recommendations of the committees of inquiry will be published in due course.

asked the Minister of Health what is the estimated percentage of total health services privately financed; and what proposals he has to encourage private medical provision.

Information for such an estimate is not available. I have no proposals to encourage private medical provision.

But in view of the Chancellor of the Exchequer's indicated restraints on public expenditure, would it not be sensible to encourage the private provision of medical services if we as a country are to devote anything like an adequate share of our total resources to health?

I do not know what the hon. Gentleman regards as "adequate", but expenditure on the health and welfare services in the United Kingdom amounted to just over 4·6 per cent. of the gross national product in 1966 compared with about 3·7 per cent. when the Conservative Party was in power in 1956.

Would not my right hon. Friend agree that the encouragement of private practice would lead to two standards of treatment, one for those who could pay and another for those who could not and that it would be an erosion of the principle of the Service that it should be free to everybody in time of need?

Yes. That is why I said that I have no proposals to encourage private medical provision.

The right hon. Gentleman kindly gave the proportion of the gross national product spent on the National Health Service in 1956. Perhaps he could give the figure for 1964.

Not without notice. [HON. MEMBERS: "Oh."] It seemed to me reasonable to take a period of 10 years, during which the percentage has gone up from 3·7 to 4·6.

asked the Minister of Health when he expects to conclude his discussion of the Sainsbury Report with the pharmaceutical industry; and if he will make a statement.

It is too early to say; I would refer the hon. Member to my reply of 23rd October to my hon. Friend the Member for Falmouth and Camborne (Dr. Dunwoody).—[Vol. 751, c. 1326–8.]

Is the right hon. Gentleman aware that the Sainsbury Report is, in many respects, a highly controversial document? Therefore, could he assure the House that he will proceed with wisdom rather than speed in his consultations? Would he indicate whether he thinks that the consultations will be of such a time scale that he will be able to introduce legislation during this Session?

There are certain recommendations in the Report which relate to the White Paper on medicines published during the Recess, and in order to be able to produce the legislation promised in the Gracious Speech I am undertaking urgent consultations on those aspects with the industry and other interested parties. As for the other matters, consultation will start roughly at the end of this month. It may take some time.

Before legislation following the Sainsbury Report is introduced, will the House have an opportunity to debate the whole matter?

As the hon. Gentleman knows, the question of a debate is not for me, but I would personally welcome one.

asked the Minister of Health what action he is proposing to take to improve the arrangements for handling complaints involving the National Health Service, in view of the anxiety expressed by the Council of Tribunals in its annual Report.

I shall send a copy of the Report to all executive councils. As the Report indicates, the features criticised by the Council in a particular case were fully discussed by my Department with the executive council concerned. General advice on procedure has been issued and I have no reason to believe that such features are characteristic of the handling of complaints generally.

I am glad to hear that general advice has been issued. Does not the right hon. Gentleman feel that there is fairly general concern that complaints can be made only to the management committee, or to the regional hospital board, or to the Ministry, all of whom are, in a way, judges in their own case? Would he consider establishing some kind of independent appeal system?

The hon. Gentleman has slightly misunderstood the Council of Tribunals' Report. The Report referred to service committees of the executive council where there is a procedure laid down by regulation which I come into only on appeal. As for complaints against hospitals, the complaint procedure has been reorganised while I have been in office, and I think that, on the whole, it is working fairly satisfactorily.

Would my right hon. Friend reconsider his original recommendation that the scope of regional hospital boards and other hospitals should be excluded from the province of the Parliamentary Commissioner, especially in view of the widespread feeling on both sides of the House that this should be done?

I would remind my hon. Friend that it was the decision of this House that it should not.

asked the Minister of Health if he will take steps to make it a condition of entry to Great Britain for all visitors that they take out an insurance policy against illness during their visit.

No, Sir.

Is my hon. Friend aware that there are considerable abuses of the Health Service and that the premium for covering what is suggested in the Question would, in most cases, be less than £1?

We have no evidence that there is considerable abuse. If the suggestion in the Question were adopted, it would involve a very complicated system of discrimination against everybody using the National Health Service, and it would involve a comprehensive system of registration for the whole population.

asked the Minister of Health what advice he has given to Friends of Hospitals and other organisations proposing to raise money for the purchase of kidney machines.

I would refer the hon. Member to the last paragraph of my statement in the House on 8th February this year. I welcome and appreciate this practical expression of concern by Leagues of Friends and others; in order that their gifts may be used to best effect I would only ask that the hospital authority should be consulted before fundraising begins.—[Vol. 740, c. 1559–64.]

Is not the real problem the provision of specialised trained staff, and if so, is it not impossible for Friends of Hospitals to proceed with ideas of this kind unless there is an assurance from the hospital that staff are available?

Yes, Sir; certainly the limiting factor to faster progress is the problem of training sufficient staff. We want to make sure that a fund is not raised for a purpose which is not capable of being implemented because the hospital in question is unsuitable for various reasons for such a unit.

Notwithstanding his reply, will not my right hon. Friend advise regional hospital boards to have fuller discussions when organisations raise such funds as these to ensure that the money is at least put to good use and that they are not just given the brush-off?

I would certainly hope that in no circumstances would any body of this kind be given the brush-off. As far as I know, the sort of discussions mentioned by my hon. Friend have taken place in most cases.

asked the Minister of Health whether he will make a statement about the availability of kidney machines under the National Health Service.

There are adequate facilities for the treatment of acute renal failure. I made a statement in the House on 8th February about the treatment of chronic renal failure. Since then the number of patients being treated under the National Health Service has more than doubled, and at 1st October was 238. Of these, 36 were being treated in their own homes compared with 7 in May.—[Vol. 740, c. 1559–64.]

Was the Minister informed of the desire of public-spirited constituents of mine to raise funds for kidney machines? Can the Minister say whether anyone is at present being denied treatment for want of finance?

I have explained on a number of occasions that at present finance is not a limiting factor in this matter. I am aware of a number of fundraising efforts. Offhand, I could not say anything about the particular details of the efforts in the hon. Gentleman's constituency, but I shall look into the matter.

asked the Minister of Health which hopitals have treatment centres for drug addiction.

I would refer the hon. Member to the reply I gave on 3rd July to my hon. Friend the Member for Wolverhampton, North-East (Mrs. Renée Short).—[Vol. 749, c. 1238–9.]

If I recollect that reply correctly, what the right hon. Gentleman said at the time was that there were 10 hospitals in London providing in-patient treatment and 13 providing out-patient treatment. I do not think that he gave the names of the hospitals at that time. Is there a reason for not giving the names?

Yes, Sir. I have explained to the House why I think it undesirable to give the names of the hospitals publicly at present. General practitioners are being advised of the services as they become available, but we think that until the regulations come in altering the prescribing arrangements for doctors it is better not to publish the names of the hospitals.

asked the Minister of Health if he will arrange for discussion with representatives of the nursing profession in the National Health Service to ascertain the views of nurses on the proposed replacement of their uniforms with a drill overall.

I know of no such proposal. The group of hospital officers, including nurses, which has been studying nurses' uniforms is expected to report this month. Before decisions are taken the statutory nursing bodies, nursing staff organisations and hospital authorities will be consulted.

Is my hon. Friend aware that, in the London region at least, nurses who are changing into this new overall regard it as inefficient and that it has caused disenchantment, disillusionment and disappointment? They regard it as an unimaginative garment and inefficient. Is he aware that the nurses are opposed to it?

My hon. Friend has apparently been talking to a different sort of nurse from that I have been talking to. While it is true that a type of uniform that he has mentioned has been tried out at two hospitals and in one group of hospitals, no decision has yet been taken.

asked the Minister of Health whether he will make a statement on the policy of the National Health Service on the resuscitation of elderly patients.

asked the Minister of Health what is his policy on the resuscitation of elderly patients.

Yes, Sir. The professional advice which I sought as a matter of urgency is that no patient should be excluded from consideration for resuscitation by reason of age or of diagnostic classification alone, without regard to all the individual circumstances. Any form of general instruction is wholly unacceptable. In each individual case, the decision to attempt resuscitation must remain the responsibility of the doctor immediately in charge of the patient.

While I express appreciation for the right hon. Gentleman's statement, which will do something to allay the very real anxiety amongst the public on this question, could not some further positive direction be given that it is the duty of the profession to resuscitate patients unless there are very strong indications to the contrary?

I think that there has been some anxiety but I also think that there has been a good deal of misunderstanding about the matter. I am advised that only a very small number of hospital patients are affected by cardiac arrest—which is what we are talking about—in circumstances in which it would be possible to take measures which could be effective in reversing the process of restarting the heart.

Will my right hon. Friend convey this information to the B.B.C.? Is he aware that the publicity given to its inquiry into a hospital at Neasden in my constituency has given unnecessary anxiety to many senior citizens in my constituency and has crucified Dr. Twining McMath who is one of the finest physicians we have had?

I think we have kept in touch with the B.B.C. about the progress of this matter.

asked the Minister of Health whether he is aware that his proposal to halve the number of pay beds available in Solihull Hospital has caused concern to the people of Solihull and the medical profession; and if he will reconsider this proposal.

I have in fact authorised four pay beds at this hospital, instead of the six authorised previously.

Why has the right hon. Gentleman cut down the number which is recommended by the regional hospital board? Does not he appreciate that the demand for pay beds in Solihull is such that three-quarters of the patients in Edgbaston Nursing Home come from Solihull? Will he reconsider the proposal?

No, Sir. Occupancy of the six pay beds by paying patients in 1965 and 1966 averaged only 35 per cent. The occupancy of National Health Service beds in this hospital averaged 90 per cent. and there was a long waiting list.

asked the Minister of Health how many pay beds are available in hospitals in England and Wales on 1st November, 1966, how many are now available and how many it is anticipated will be available on 1st January next; and if he will make a statement with regard to his policy in this matter.

asked the Minister of Health if he has completed his review of pay beds; and if he will make a statement.

I regret that the numbers of pay beds available on a given day are not know centrally. I have however, completed my review of pay beds, which was designed to avoid wastage of beds and make better use of them for National Health Service patients. I have informed hospital boards of my decisions. The number of pay beds before the review was 5,764. The number now authorised is 4,379 which should meet the present demand for such beds.

Does not the right hon. Gentleman agree that this drastic reduction has been carried out against the opposition of the medical profession? Is it part of a concerted policy against pay beds in hospitals? Does he realise that, if he continues to conduct this campaign against private medicine, he will drive yet more doctors out of the country?

I have made it clear to the medical profession throughout, and I have kept it informed of the purpose and progress of the review, that the object is not to withdraw facilities for private practice but to bring about a situation in which pressure on pay beds more nearly equals the pressure on nonpaying beds.

Is my right hon. Friend aware that his reply means that the use of very much more single bed accommodation is now being determined by medical and social reasons rather than by pure commercial ones? Can he assure the House that this tendency will continue in the years ahead?

I hope and believe that that will be the case and it represents my policy on the matter.

Does not the right hon. Gentleman agree that, if he were to reduce the price of pay beds instead of increasing it as he has done, more people would be anxious to use those beds? Instead, they are in the millionaire class.

The weekly cost of pay beds is determined by Statutory Instrument in accordance with formulae introduced by my predecessors form the party opposite.

Is my right hon. Friend aware that he is to be congratulated on his statement, especially since we have a waiting list of about 500,000 people for hospital beds? Will he look again to see whether he could not reduce the number of pay beds still further?

This has been a very long operation and has been carefully carried out. We had better see how we proceed from now on.

Does not the right hon. Gentleman agree that it is a stupid and farcical philosophy that people can go into shops to get what they want or obtain services they want while it is a crime in the Government's view to pay for medical services?

It is not a question of it being a crime in the Government's view but there is not the same limitation on shops and services that there is on medical services.

In view of the unsatisfactory nature of the reply, I beg to give notice that I shall seek to raise this matter on the Adjournment at the earliest opportunity.

asked the Minister of Health what advice he has recently given to regional hospital boards about the purchase of equipment in the exercise of their responsibilities under the National Health Service Acts.

My Department's advice covers a considerable range of components and supplies, and much of it is published. If my hon. Friend will let me know what type of equipment he has in mind I will gladly provide him with more detailed information.

Is my hon. Friend aware that the Liverpool Regional Hospital Board was contemplating the purchase of a futuristic X-ray table despite discouragement by the Ministry's technical advisers? On a more general question, will he now indicate what financial penalties might be imposed on a regional hospital board which decided to press ahead with such an order despite discouragement?

It would be a mistake to give an answer to a specific case like that; I should like to examine it. A number of publications are issued by my Department giving complete advice to purchasing authorities about the obtaining of equipment.

What consultations does the hon. Gentleman's Ministry hold with the Ministry of Technology about the standardisation of equipment ordered by the National Health Service and the limitation on different varieties of equipment so as to reduce the purchasing cost of equipment -to the Service?

A Committee, the Hunt Committee, has studied this important subject. On the basis of its report the form of supply organisation considered desirable will be notified to the purchasing authorities.

asked the Minister of Health if he will make a statement about delays in fitting limbs to patients at the limb-fitting centre, Queen Mary's Hospital, Roehampton.

Continuing attention to the appointments system has reduced waiting-time at the centre, particularly in the early morning and in the afternoon.

It was not the waiting time I asked the hon. Gentleman about, but delays in getting limbs fitted after they have been made. It is the limb-fitters who are holding the process up.

The industrial dispute was concluded in July and arrears of work have now been caught up with. The general position relating to the disparity of time, mentioned by the hon. Member, appears to be not unacceptable, but a new limb-fitting centre is planned for Stanmore to serve North London. This should draw work away from Roehampton.

asked the Minister of Health whether he is satisfied with the arrangements in teaching hospitals for obtaining the co-operation of patients in connection with the teaching of students; and if he will make a statement.

I would refer the hon. Member to my reply to my hon. Friend the Member for Harrow, East (Mr. Roebuck) on 23rd October.—[Vol. 751, c. 352–3.]

Does the right hon. Gentleman realise that this Question, like the last one, arose from very great public anxiety because of remarks of Lord Platt? Does he not think that further inquiries are necessary in view of the great experience of the noble Lord?

I am not aware of any teaching hospital which makes treatment conditional on the patient consenting to co-operate in teaching. I would deprecate any attempt to coerce any patients to take part in teaching and I have made my views known to all teaching hospitals.

asked the Minister of Health how many beds in National Health Service hospitals are closed; and what are the reasons for their not being used.

During 1966, of the beds allocated for use, approximately 8,500 at any one time were closed. The main reasons were redecoration, quarantine or illness of staff.

Not only illness of staff but shortage of staff also. Is it not a rather mistaken policy that hospitals, which could recruit more nurses and which have beds and wards closed because of shortage of nurses, are forbidden to recruit up to their optimum establishment?

There is no question of hospitals being forbidden to recruit. Hospitals, as the noble Lord knows, have to keep within a budget. I can assure him that there are more nurses of every grade in the hospitals today than there were ever before, and certainly substantially more than when his party was in power.

asked the Minister of Health, what further information is required from the South Western Regional Hospital Board regarding the sale of land and the building of housing units at Frenchay Hospital, Bristol; what steps are being taken to hasten the decision in his Department; and when a decision can be expected.

Information is awaited about the layout and density of the buildings to be erected by the local authority and an estimate of the cost of those to be purchased by the regional hospital board. Any decision by my Department must await this information.

May I draw the attention of my hon. Friend to this scheme, particularly as this unique scheme would be of great value to those who work in hospitals whether as medical, administrative or ancillary staffs? It would be no cost to the hospital but it would be a useful adjunct to hospital facilities in the area.

Yes, Sir. Some of the delay which has occurred has arisen through a change in local authority boundaries. The scheme was originally proposed by Bristol Corporation, but now it will be under the Chipping Sodbury Rural District Council.

asked the Minister of Health what steps have been taken to relieve pressure upon the Department of Gynaecology at Frenchay Hospital, Bristol; what is the present waiting list; and whether this has increased or decreased compared with figures for 1st July, 1967.

On the first part of the Question, I cannot add to my reply of 3rd July, to my hon. Friend. The waiting list has decreased from 731 on 1st July to 718.—[Vol. 749, c. 159–60.]

I thank my hon. Friend for that reply. May I draw his attention to another speciality in the hospital with a staggeringly large increase in the number of people waiting for treatment in it? It needs urgent action to be taken by his Department. May I ask what he will do about it?

I think that my hon. Friend is referring to the specialty in plastic surgery. This is a matter for concern, and I shall be writing to my hon. Friend.

asked the Minister of Health what progress he has made with the review of the educational facilities for children in hospital schools; and if he will make a statement.

These children's needs are under constant review.

While not thanking my hon. Friend, was not an undertaking given 18 months ago that a review would take place? In view of the urgent needs of these children, would my hon. Friend ensure that a proper review takes place rather than this constant thing which seems to be ignored?

In fact, it is proposed to institute a special and wider review, including children of two and over with an I.Q. of less than 50–55. It will be carried out by local education authorities with the help of sub-normality hospitals. My right hon. Friends the Minister of Health and the Secretary of State for Education and Science hope to consult local authority associations and regional hospital boards about a draft circular to be issued shortly.

asked the Minister of Heath what steps he is taking to ensure that a hospital bed will be available in future for a case such as a lady of 89 with a fracture of the second lumbar vertebra, as set out in a letter to him from the constituent of the hon. Member for Rye, Mrs. Tanner, of Wart-ling Vicarage, Boreham Street, Hailsham, on 13th October, 1967.

I will write fully to the hon. Member when the regional board's investigations into this complaint are complete.

Will not the hon. Gentleman admit that this is an excellent example of the type of case on which representations are continually being made to the Ministry? Would he not further agree that for a lady aged 89 having a broken spine to be left 12 days in a vicarage before getting into hospital, where she died 15 days later, does not widely commend his administration to the public?

It also reflects the failure of the party opposite to provide more beds. The hon. Member will, no doubt, be pleased to know that the regional hospital board in question expects to provide an additional 24 geriatric beds at All Saints Hospital, Eastbourne, early next year, and that a major hospital development at Eastbourne is included in the board's capital programme for the period after 1969–70.

asked the Minister of Health on what date the building of the new hospital at Derriford, Plymouth, will start to be constructed; and on what date it is anticipated it will be completed.

Construction of Phase I of Derriford district general hospital is planned to start in April, 1970, and finish in December, 1974.

In thanking the Minister for that reply, may I ask whether he can state the number of beds which will be provided? Does he realise that there is an enormous waiting list of up to two years for cold surgical operations?

Phase I will contain 300 beds, an accident and emergency department and associated services. Further phases to follow after 1975–76 will increase the size of the hospital to a total of 900 beds.

asked the Minister of Health, in view of the shortage of staff in the Radiodiagnostic Department of Freedom Fields and other hospitals in Plymouth, what action he is taking to remedy the situation.

The regional board has authorised additional radiographer posts, and efforts to fill these and other vacancies are continuing.

Does the hon. Gentleman consider that the salary is adequate for these people? There is great difficulty in getting them in the West Country. Next time there is a shortage, should the hospital board inform general practitioners that they cannot send patients to the hospital?

I do not think that salary rates are the most serious factor. Perhaps the hon. Lady will be comforted by the fact that, according to our information, the position should improve in December, when it may be possible to recruit students from the Plymouth School of Radiography if the existing vacancies have not been filled by that time.

asked the Lord President of the Council what proportion of the 7½ per cent. surcharge on Refreshment Department charges will be distributed to the staff as gratuity.

The question of the way in which this surcharge is to be allocated was under negotiation at the end of the last Session.

Surely this is grossly unfair to our staff. First, they are given a 10 per cent. award, then we are informed that they cannot receive tips. Now we are told that there is a surcharge, and one would normally assume that the 71 per cent. would go entirely to the staff. My information is to the contrary. When will we know exactly what amount goes to the staff?

I am aware of the feelings of the hon. Gentleman and, to some extent, I sympathise with them. I am in some difficulty, because the Services Committee has not yet been reappointed and the negotiations are not completed. That is why I gave a deliberately prevaricating answer which I hope the hon. Gentleman will accept as providing the best chance of our looking into his point.

How can my right hon. Friend justify a 7½ per cent. compulsory tip on every meal we eat when the menu card says "no tipping"?

I am not an expert in these matters, but I would guess that the surcharge was a substitute for the tip.

asked the Lord President of the Council if instructions will be given to the Refreshment Department in future not to purchase beer from brewers who make contributions to political party funds.

No, Sir.

Will not my right hon. Friend recognise that when he drinks a Double Diamond, he is doing a great service to Conservative Party funds, and—

Order. Even commercials must be brief.

Will my right hon. Friend seek to make available alternative beers, the names of which I will be glad to give him—for example, Watney's, Younger's or Fuller's?

It was not my impression that the Question was about the drinking of specific beers. I do not believe that the quality of a beer is directly related to the political affiliations of the brewer.

Is the right hon. Gentleman aware that if this principle were extended, we would not be able to buy foodstuffs from the co-operative societies?

That was one of the thoughts at the back of my mind.