asked the Minister of Health what proposals he has for extending the fluoridation of water supplies where these are deficient in fluorine content.

asked the Minister of Health what is his present policy with regard to extending the fluoridation of water supplies.

Since the benefits and safety of the fluoridation of water supplies were established beyond doubt, my policy has been to urge local health authorities to arrange for its introduction and to assist them in implementing their proposals. The need for further action is constantly under review.

Is my right hon. Friend aware that the Answer which he gave to a Question which I put to him on this subject last week does not reveal a satisfactory result to this policy of guiding local authorities? Would he now give urgent consideration to doing something much more strenuous, knowing that he will have the support, probably of the majority of hon. Members but certainly of hon. Members on this side of the House?

I am aware that in certain areas the wishes of the majority of local health authorities in favour of fluoridation are being frustrated by one or two who are opposed and who receive their water from the same supplier. Clearly this is a situation to which I must give consideration.

Is it not the case that fluoridation is now a routine public health measure in the United States and most advanced countries? Would my right hon. Friend bear in mind that many big advances in medical science, including vaccination and antiseptic surgery, have been the object of irrational opposition and that it is his positive duty to ensure that fluoridation takes place in this country on an extensive scale in the interests of our children and future generations?

I certainly agree with what my hon. Friend says about the benefits of fluoridation. It is true that the United States and certain other countries are more advanced than we are in this matter. I hope to have fairly shortly the results of dental studies in the United Kingdom after 10 years of fluoridation. These will, I believe, give further proof of the value of this measure. I hope that their publication will overcome any remaining doubts on the part of local authorities.

What does the phrase "constantly under review" actually mean in this context?

Precisely what it says.

asked the Minister of Health when he proposes to introduce legislation to ban cigarette coupons.

As my hon. Friend knows, the timing of legislation is not for me.

I suppose that I must say, "In thanking my right hon. Friend for that reply", but is he aware that his reply is not satisfactory? Does he realise that a number of us on this side of the House do not see the banning of cigarette coupons as the answer to this most complex problem of discouraging people from smoking? While we think that this is a very useful measure in indicating the Government's intentions towards cigarette smoking, can my right hon. Friend give an assurance that the whole programme will be prosecuted with greater vigour than appears to be the case at the moment?

When I discussed the possibility of a voluntary ban with the industry, I offered it a reasonable, indeed a generous, period for the winding up of existing schemes. Since the Government have announced their decision and the industry is on notice, I regard the winding up period as now running. Therefore, the timing of legislation is not perhaps as vital as it might otherwise have been.

What evidence has the Minister that the giving of coupons by cigarette manufacturers increases the consumption of cigarettes?

We had a considerable exchange at Question Time on a recent Monday on this matter, and I expressed my view that the giving of gifts—more gifts and better gifts the more cigarettes one smoked—prima facie suggested that it was an encouragement to smoke more.

asked the Minister of Health if, in view of the critical national shortage of doctors, he will discuss with the British Medical Association and other interested parties the possibility of reducing the load on doctors by training a grade of assistant doctor to undertake routine medical work.

No, sir. We must await the report of the Royal Commission on Medical Education, which is expected early next year.

Has any work study analysis been carried out on the work load on the general practitioner from the point of view of seeing whether part of his routine work could be passed on to other qualified people such as health visitors?

A number of studies have been made, and we are also helping doctors to make better use of their time, for example by assisting general practitioners to employ ancillary help.

asked the Minister of Health (1) if he will now state the approximate date by which he expects to receive the finalised report of the survey into the problems involved in the rehabilitation of crude spirit drinkers;

I have recently received advice on the organisation of facilities for the treatment of alcoholism, but it recognises that medical treatment offers little prospect of success unless voluntarily accepted. Such treatment is available for persons living in Tower Hamlets.

I cannot understand what the Minister is referring to when he speaks of such treatment being available in my borough, unless he is referring to members of the Simon community which is a voluntary but ineffectual body. Is he aware what delay in this matter means in my constituency? Is he aware that a near-violent confrontation took place between tenants and members of this community a short time ago? Does he not realise that if Government agencies do not do something in this matter, vigilante action by the people themselves is a possibility for which he will have to bear responsibility?

On the question of treatment, facilities are available at St. Clements Hospital where there is a five-bed unit for alcoholics. I have deliberately limited my reply to the area of my own responsibility, which is that of treatment. My hon. Friend will recall that there was a petition from Tower Hamlets on the more general problem which was received last July by my hon. Friend the Minister of State, Home Office.

asked the Minister of Health if he will arrange for persons suffering from haemophilia to receive grants to enable them to make suitable adaptations to their own cars.

Eligible disabled persons, including those suffering from haemophilia, are entitled under existing flies to a cash grant towards the cost of converting their own car to hand control.

This very small group of people, who have not been provided for in a long time, will be most grateful to the Minister for that statement.

Will the Minister give serious consideration to the suggestion that haemophiliacs and others should be issued with adapted cars if they are themselves willing to pay the difference in co between the car and the invalid tricycle which they have already?

I have answered Questions before about the eligibility of haemophiliacs for motor cars rather than for invalid tricycles but, without any commitment, I am prepared to look at the matter again.

DOCTORS PROVIDING FULL GENERAL MEDICAL SERVICES IN ENGLAND AND WALES AT 1ST OCTOBER, 1966*
Age-group (years)			Under 30	30 to 34	35 to 39	40 to 44	45 to 49	50 to 54	55 to 59	60 to 64	65 and over
Percentage	…	…	3·3	10·6	15·0	17·7	14·3	13·8	10·1	8·2	7·0
*This is the latest date for which these figures are available.

asked the Minister of Health what is the proportion of general practitioners in England and Wales in each of the following age groups, 25 to 30 years, 30 to 35 years, 35 to 40 years, 40 to 45 years, 45 to 50 years, 50 to 55 years, 55 to 60 years, 60 to 65 years and over 65 years.

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

Would not my right hon. Friend agree that the figures indicate a serious danger of a grave shortage of doctors in this important sphere of the Health Service? Will he assure the public and the House that everything possible is being done to overcome this potential shortage?

Yes, but I would not accept what my hon. Friend said because I think he will see when he studies the table that there have been no great changes in the age structure in recent years, apart from the decrease in the proportion of those under 30. This is partly due to the welcome tendency for doctors over the years to undertake vocational training before they enter general practice. We are steadily increasing the intake to medical schools.

What result, if any, has come from counter brain drain activities in the United States to relieve the shortage of doctors? Is it true that a number of doctors who have been asked to return have found it difficult to obtain employment in the specialities in which they operate?

There is a later Question to be answered on this subject. The hon. Member will be glad to know that already 50 doctors have accepted appointments in this country and provisional arrangements are being made to bring them back here.

asked the Minister of Health if he has now assessed the reports of his Social Science Research Unit and of the local medical officer of health in regard to the Rotherham experimental health checks; and what advice he is giving to local health authorities who are considering offering similar periodic screening facilitiis for certain types of illness.

I am awaiting these reports. Authorities considering this kind of action are advised first to discuss their proposal with my medical officers, who can explain the problems involved.

Is my right hon. Friend aware that the public response to these schemes has been most enthusiastic and almost overwhelming, and that a number of medical officers of health are raring to go on with similar schemes if they get an enthusiastic response from the Department? Would he look at this with some urgency and try to get his reports collected as soon as possible?

As I have said before in this House, I am most interested in what is being done in Rotherham and elsewhere, but I am not satisfied on present evidence that this method of detecting disease should be recommended to local authorities generally. I have still to receive the report of the Rotherham Medical Officer of Health. The report of the Social Science Research Unit will, we hope, be completed very shortly.

asked the Minister of Health why a small child, Nigel Haywood, who died shortly afterwards when recently taken to Loughborough General Hospital suffering from acute poisoning, was given no treatment nor first aid but referred to his private doctor; and if he will make a statement.

As my hon. Friend knows the Sheffield Regional Hospital Board has appointed a committee of inquiry into this case and hope to receive its report early in the New Year.

Will my right hon. Friend bear in mind that as this tragic incident happened several months ago it is absolutely incomprehensible to the people of Loughborough that there should be such a long delay in publishing the results of the inquiry?

I am glad to have this opportunity of explaining. The child died on 23rd-24th September. The hospital board appointed a committee of inquiry on 11th October. I understand it is making good progress. It has to interview a doctor who is absent abroad but is expected to return in January. The committee hopes to complete the report and present it to the board before the end of January.

asked the Minister of Health if he will take steps to place the salary rates of psychiatric social workers on an equivalent basis with those of other workers in the social services.

This is primarily a matter for the negotiating bodies concerned, who take into account the relevant work and responsibilities of the several groups of workers in the social services.

But would the Minister, who is, after all, not unconnected with the results of the inquiry, not recognise that social workers do an important and arduous and very difficult job, and psychiatric workers as much as any of them, and that there ought to be parity in their payment?

Interdepartmental discussion is proceeding on co-ordination, training, recruitment and deployment of social workers generally, but remuneration is a matter for the negotiating bodies which deal with the different services and they need to have regard to the levels of work and responsibility as well as levels of qualification. The matter is under consideration.

Would my right hon. Friend not agree that psychiatric social workers give exceptionally valuable services and provide continuing care for psychiatric patients not only in hospitals but also in their own homes, and that therefore their wage and salary claims deserve very sympathetic consideration?

I agree that they are a most valuable body of workers in the health and welfare services but, as my hon. Friend knows, remuneration is a matter for the appropriate Whitley Council in the Service.

asked the Minister of Health whether, in view of the increases in the charges for dental laboratory services, he will now take steps to increase the remuneration of dentists.

No, Sir. No general increase in charges by dental laboratories have recently been brought to my attention.

Is the Minister not aware that not only the cost of materials for work done generally in dental laboratories but also the effects of Selective Employment Tax have contributed to greatly increased charges in those laboratories? Will he please look at the facts again?

They have been looked at. The level of dentists' fees has been fixed so as to allow for any rising trend in practice expenses and still to provide dentists, on average, with the target net income of £3,325 which was recommended by the independent review body. It is expected that this target will be achieved.

asked the Minister of Health what additional funds a-e to be made available to maintain the hospital building programme, in view of rising costs as a result of devaluation.

asked the Minister of Health what additional funds are to be made available to maintain the local authority health and welfare capital programmes, in view of rising costs as a result of devaluation.

asked the Minister of Health (1) what additional funds are to be made available to maintain the hospital building programme in the Sheffield Regional Hospital Board area, in view of rising costs as a result of devaluation;

asked the Minister of Health what estimate he has made of the additional cost that will be incurred by the National Health Service and his Department as a result of devaluation.

asked the Minister of Health (1) what additional funds are to be made available to maintain the hospital building programme in the Liverpool Regional Hospital Board area in view of rising costs as a result of devaluation;

The effect of devaluation on Government expenditure is still under consideration and it is too early to make a statement.

But is the Minister aware that even on his own admission the rate of increase of hospital building expressed as a percentage of gross investment is not rising as fast as it did? Is he prepared to give an undertaking to the House at this stage that devaluation will not cause the proportion of total of gross fixed investment to rise even more slowly—the proportion devoted to hospital building?

I do not accept the premises of the hon. Gentleman's supplementary question. If he would like to put a Question down I shall be very glad to answer it.

On the local authority side, does the Minister recollect that there has already been a cut—last year—of £3 million on capital programmes, and that unless more money is made available his plans for the local authority services will fall even further behind his original plans?

It is not expected that devaluation will result in costs of the local authorities' capital programmes rising by all that much, or, indeed, very rapidly.

Will the Minister give a categorical assurance that rising costs will not cause any delay in the establishment of the university hospital in Nottingham, a project which is eagerly awaited there?

I understand the hon. Gentleman's concern, but he will understand that I cannot give a categorical assurance while the matter is under consideration.

Does the Minister expect that the cost of drug imports, now running at £15 million a year, will go up and up, and if so by how much? Does the right hon. Gentleman expect that foreign-owned drug companies which now control two-thirds of the drug industry in this country, will change their pricing policies? Does he appreciate that devaluation makes the brain drain of doctors and nurses even more attractive?

I have no idea how the pharmaceutical industry will react to the effects of devaluation, but, no doubt, this will emerge in due course.

Will the right hon. Gentleman undertake that there will be no reduction in the capital programme in Liverpool without consultation with the regional hospital board and the Liverpool United Hospitals' Board?

I can only give the hon. Gentleman the assurance that the allocation to regional boards will be conducted in future with the same scrupulous fairness as it has in the past.

Would my right hon. Friend not agree that when previous Conservative administrations were faced with financial crises they consistently slowed down hospital building programmes and cut social services?

That, I think, is a fact, and my hon. Friend will remember that on the two previous occasions when there had to be a cutback in Government expenditure the hospital building programme remained unscathed.

In view of the suggestions in the national Press over the weekend that there may be cuts in ex- penditure on the Health Service, will my right hon. Friend assure the House that he will resist any efforts to reduce expenditure not only on the hospital building programme but on the Health Service as a whole?

I take note of what my hon. Friend says.

The right hon. Gentleman has not given any figures. Does he accept that the only way to honour the Prime Minister's pledge that there will be no cut in the Health Service and the health and welfare services following devaluation is by making an actual increase in the expenditure on these services?

What my right hon. Friend the Prime Minister said was that the hospital building programme would not figure in the cuts in civil expenditure which he announced.

asked the Minister of Health if he will take steps to raise the educational content and standards of play groups to those of nursery schools.

Local health authorities have already been given guidance on the educational aspects of private day care, and my right hon. Friend and my right hon. Friend the Secretary of State for Education and Science are considering what further advice is needed.

I thank my hon. Friend for his reply, but would he bear in mind that the persistence with which some of us pursue this matter is due to the fact that owing to the inadequate provision of nursery schools more and more under-fives now come under his Ministry, and that the same attention should be given to the educational standards of play groups as is given to the number of lavatories and the hygienic conditions of the groups?

Although I should like to examine those assumptions a little more closely, may I inform my hon. Friend that there were two circulars issued in 1965 giving advice to local authorities about ways of meeting the training needs of people in charge of children. There have been two recent publications, which I should be happy to send to my hon. Friend, entitled "Not Yet Five", and Play with a Purpose ", both issued by Her Majesty's Stationery Office. I take her point about the educational requirements of this category of child.

The hon. Gentleman referred to the co-operation of his right hon. Friend the Secretary of State for Education and Science. Is he aware that there have been cases where local authorities seeking to make site provision for nursery schools next door to primary schools have had loan sanction refused? In view of the delay inevitably involved in providing nursery schools, will he see that better facilities for the education and looking after of children in these ways are made available at day nurseries and play centres?

Yes, Sir. These things must take their place in the queue, taking into 2.ccount the resources available. However, there are not many people who need to be convinced of the need to cater for this group of children. The hon. Gentleman will bear in mind that this Government have taken many steps and secured much information with a view to the planning of this form of educational facility.

asked the Minister of Health what steps he intends to take to ensure that all outside interested bodies and organisations have an opportunity of making their views known in connection with the inquiry into the structure and administration of the National Health Service.

In my statement of 6th November—[Vol. 753, c. 643–646.]—I give assurances of full consultation in die course with all interested parties and indicated that I would publish a Green Paper embodying my own tentative views as a basis for this consultation and for public discussion.

Are we to understand from that that the Green Paper will be published prior to consultation and that those bodies who are concerned because they have not been consulted in the course of its preparation will be consulted afterwards?

Yes, that is so.

asked the Minister of Health if he will conduct a public inquiry into the needs of and provision for the pre-school child.

I would refer my hon. Friend to my reply to her Question on 23rd October.—[Vol. 751, c. 1336–7.]

While bearing in mind that my right hon. Friend has already proposed Amendments to the Nursery and Childminders Act which will help to tighten up some of the existing loopholes, will he bear in mind and comment upon the fact that, if his proposals are successful, the number of places providing child-minding facilities will be reduced and that, until a public inquiry is held to discover the number required, it will be impossible to legislate for this group of people?

That is a very important point. There was a great deal of information in the Yudkin Report which will enable us to assess the problem as it develops.

Is the Minister aware that this is much more than a question of numbers, and that it is clear that the social, emotional and other needs of the pre-school child are not sufficiently catered for and perhaps not sufficiently realised? Therefore, in my view and, I hope, that of the Minister, the Yudkin Report, supported by numerous child welfare societies, has made out an overwhelming case for a Government inquiry.

I am not certain that further inquiries are necessary. We have a volume of information at our disposal. One interesting point is that, within the Department, we are reviewing urgently the research already carried out into the effects of the separation of children from their mothers during the working day. It is not so much a lack of information as the need for still further co-ordination of the eventual effort.

asked the Minister of Health how many babies were born in hospital in South Bedfordshire in 1960, 1963, and 1966; what proportion of the total numbers born this represents; and what steps are being taken to increase maternity provision in the area.

I regret that figures for South Bedfordshire alone are not available. I have now written to the hon. Member about the increased maternity provision proposed.

Have any investigations been carried out in this area into whether the proportion of admissions could be considerably increased if the time spent in hospital after childbirth was marginally reduced?

That is a question for clinical assessment about which I should not like to express a view. However, the contract for the additional maternity beds which it is proposed to have in operation at the end of 1970 or the beginning of 1971 is going out almost forthwith.

asked the Minister of Health when reconstruction of the Macclesfield Hospital will be started; and when is the expected completion date.

I cannot add to the reply given to the hon. Member on 4th July last year.

Is the Parliamentary Secretary aware that that reply was a long time ago? Does he recall that in the past three years I have repeatedly pointed out that Macclesfield Hospital was built 130 years ago? What is going to be done about it? Is this another broken Labour promise?

I do not think that this is a question of a broken Labour promise, although I must say that had there been earlier consideration during the time of the administration supported by the hon. and gallant Member, the present position might not have been as bad as it is. The

asked the Minister of Health (1) whether he will now make a statement on the hospital facilities available in Shrewsbury, following the representations made to him by the hon. Member for Shrewsbury;

The present facilities are inadequate, with correspondingly long waiting lists. The remedy lies in the new district general hospital now being built.

I will circulate figures in relation to waiting lists in the OFFICIAL REPORT.

Does not the Minister agree that the waiting lists for the service in this area are among the worst in the country? In those circumstances, does he not realise that it is wholly inadequate for him to put forward proposals, as he has done, going as far ahead as 1971? Does he not realise that a great deal more urgency is needed?

I have said that the waiting lists are undesirably long. We are taking every action that we can within our resources. Arrangements are being made for the admission of patients to the R.A.F. Hospital at Cosford to help alleviate the situation. There has been a marked reduction in the total number on the surgical waiting lists. But I agree with the hon. Member that the position is unsatisfactory, and it will be reviewed the whole time. It is accepted as a bad case.

asked the Minister of Health if he is aware that patients have to wait between four and 10 weeks to obtain a new appointment to attend outpatient clinics at hospitals under the control of the South-East Kent Hospital Management Committee; and what steps h is taking to remedy this delay.

In 49 out of a total of 67 out-patient clinics, the waiting period for non-urgent cases is less than four weeks. At only one clinic is it 10 weeks. Urgent cases receive priority. The regional board has taken steps designed to spread the non-urgent load between clinics.

Is the Minister satisfied with this situation? Is it better or worse than in the rest of the country? May we have the Minister's assurance that no cuts due to the economic situation will make this situation worse?

There is a Question later on the Order Paper about that aspect of the matter. One of the troubles in this area is that there has been a build-up of waiting lists because there has been a tendency for references to be made to specific consultants. If the load is more equally shared—and we are taking steps to get that done—the position may be alleviated.

asked the Minister of Health if the decision of the Manchester Regional Hospital Board to limit current nurse recruitment in order to reduce expenditure is in accordance with Government policy.

Regional hospital boards determine their own priorities to contain expenditure within approved estimates.

Is the Minister aware that the circular recently issued by the Manchester Regional Hospital Board suggests that nurse recruitment is now to be limited to a figure below that which was previously considered to be necessary? Does he not agree that this is the very last field in which economies should be made?

The hon. Member will be glad to know that since April, 1964, the Manchester Regional Hospital Board has increased its nursing staff in the region by very nearly a quarter. I understand that the hospitals in greatest need of additional nursing staff will be the least affected by these limitations, and psychiatric hospitals are not affected at all.

Will the Minister have a realistic revision of establishments for nurses in hospitals which often do not give a true indication of the shortages which exist?

I entirely agree with my hon. Friend. Over a long period we have considered whether it is possible to lay down national standards, as it were, for establishments. The trouble is that hospitals vary so much in their nature and the work which they do that this is proving extremely difficult.

Surely the right hon. Gentleman ought not to shunt off his responsibility to the regional hospital board? Does he not recognise that the restriction on hospital nursing staff to 90 per cent. of the optimum establishment is causing serious difficulties in hospitals? Is it not right that the public should be aware that the problem is not a shortage of recruits but a shortage of finance coming from the Treasury?

That is not necessarily the answer in every part of the country. The Board is not seeking to reduce its expenditure but to limit the increase to a level which it can contain within its approved estimates. There is nothing new in that. It happened during the time of the right hon. Gentlemen opposite.

asked the Minister of Health what steps he is taking to expedite the setting up of treatment centres for drug addicts; and whether special funds will be granted to regional hospital boards for this purpose.

Additional facilities for the treatment of heroin addiction are being set up as quickly as possible, mainly in the London area, and my Department is in close touch with the hospital authorities. The cost is not expected to be very large in relation to the funds available to regional hospital boards and I do not contemplate that special financial arrangements will be necessary. Consideration is given to any case of difficulty.

Will it not take a long time before the whole country is covered by these treatment centres? If extra funds are not to be provided, will not other facilities have to be cut? Can the Minister say whether in the meantime general practitioners will be able to continue to prescribe for drug addicts?

Yes, Sir. On many occasions I have made it clear to the House that the ban on general practitioners prescribing will not be operative until we are satisfied that sufficient treatment facilities exist in the hospital service. But outside London there is no evidence that the current demand for treatment is not being met. This is very largely a London problem.

Is the Minister aware that facilities in the London area for the treatment of drug addicts are woefully inadequate? Will he say what they are and what they are likely to be within the next few weeks?

I do not accept that they are woefully inadequate. I have said that we have not yet completed the total of facilities which we want to be available for the time when the new arrangements come into operation. At the end of October there were about 70 patients receiving in-patient treatment and 180 receiving out-patient treatment for heroin addiction in some 40 hospitals.

Can the Minister explain why he will not name the hospitals where he is setting up treatment centres for drug addicts? Until we know the names it is almost impossible to assess the progress which is being made.

I do not agree that it is impossible to assess the progress being made. I have given the numbers. The reason why we do not give the names of the hospitals is that it is unwise to release names if we are to prevent addicts rushing to a number of hospitals in succession, but generally practitioners in the London area have been told where treatment is available.

Will my right hon. Friend give an assurance that in the setting up of treatment centres, particularly out-patient treatment centres, adequate care will be given to providing social welfare staff as otherwise these centres will be almost valueless?

I would not say that they will be almost valueless, but I agree with the implication of the question that proper social welfare assistance is very important indeed.

asked the Minister of Health (1) how many male and female patients aged 20 years and over were admitted to mental illness hospitals and units, including teaching hospitals, during 1966 and what was the rate for each sex per 100,000 of the population for the same age group;

I will circulate the figures in the OFFICIAL REPORT.

I am grateful to my hon. Friend for that reply. Will he state what steps he is taking to improve mental health in communities where the rate is far in excess of the national average? Also will he say something about the need for improved community care, because of the great increase in discharges?

I think the figures will indicate the general improvement in care that is being provided, as evidenced by the fact that there has been a steady decline over the past few years in the total hospital population covering mental illness 2nd the patients for this type of

asked the Minister of Health what is his estimate of the total sum paid to hospital doctors in addition to remuneration in respect of travel expenses and grants for conferences, study leave, &c., at home and overseas, expenses allowances, fees for domiciliary visits and any other fringe benefits.

The total sum paid out annually in respect of domiciliary visits is in the region of £2 million, but I regret that information for an estimate under the other headings is not available.

Is my right hon. Friend aware that in October of 60 doctors in one region given permission to attend conferences, including New York, Kuwait and Rome, 49 were consultants and only 3 were registrars? As it would seem that consultants can be spared from their work more easily than registrars, should we not pay registrars more than we pay consultants?

I think there is a fallacy in my hon. Friend's logic. He may like to know that the new arrangements for study leave enable doctors in training grades to have up to 30 days paid leave each year for fully approved courses. Senior staff may have up to 30 days in three-year periods.

asked the Minister of Health what is his policy regarding the employment of trained staff in dialysis departments in National Health Service hospitals; whether salary scales have been fixed; which negotiating machinery applies and whether it is administered by the matron or by the hospital secretary; and if he will make a statement.

The departments are staffed by doctors, nurses and supporting technical and ancillary staff. The salaries of nurses are those negotiated by the Nurses and Midwives Whitley Council and I have determined salaries for the technical and ancillary staffs not at present covered by Whitley agreements. The staff attached to these units work under medical direction.

Is my right hon. Friend aware that there is an area of uncertainty over the responsibility of qualified nursing staff concerned with these duties? Will he look at this in view of the heavy work and responsibilities which these staff are carrying.

I should be glad to look at any problem raised by my hon. Friend.

With reference to technical staff, will the Minister bear in mind that this work involves very considerable hazards to health and that it has resulted in a number of disasters? Will he bear this in mind when establishing the pay of these technical staff as against that of other technical staff?

Yes, I am aware of that, and I think these considerations have been borne in mind in fixing these salaries.

asked the Minister of Health whether general administrative costs within a hospital are included in assessing charges for private beds in hospitals.

Yes, Sir.

Is the Minister aware that pay beds in many hospitals are pricing themselves out of the market? Would it not be better for them to carry the overheads of their department rather than the very high overheads of the whole hospital which accrue to the Health Service as a whole?

The current method of calculating charges for pay beds is based on the Regulations of 1953 which were introduced when the right hon. Member for Enfield, West (Mr. Iain Macleod) was Minister.

Would not my right hon. Friend agree that further aid to pay beds would mean that people who can afford to pay for these things would be, to a degree, subsidised by the general taxpayer? Would he not agree that the ideal solution to all this would be to raise the status of National Health Service hospitals so that pay beds became a thing of the past and cash would have no further consideration in the treatment of sickness?

I have said that I am very anxious indeed to raise standards in the National Health Service so that no one would wish to be treated privately, but in answering this Question I was referring to current methods of calculating prices. My hon. Friend will know that new methods are proposed in the Health Services and Public Health Bill which is now before the House.

When there is such a great shortage in the hospitals because money is not being found to pay for nurses, is it not crazy to follow a policy of closing down wards of private beds which, if established, would help the whole situation?

I think the hon. Member misunderstands the position. The reduction in the number of pay beds which took place as a result of my review means that the beds released are now available for non-paying patients.

When does the Minister expect his new proposal for assessing charges on a national basis to be in operation?

Certainly not until the Bill is on the Statute Book.

asked the Minister of Health what proposals he has for a maternity unit at the Whitchurch General Hospital, in view of the widespread local support for such a unit.

None, Sir. Provision for Whitchurch is made in the new maternity unit at Copthorne Hospital, Shrewsbury.

Does not the hon. Gentleman recall that earlier in Question Time today he confessed that hospital conditions in the Shrewsbury district were inadequate? Is he aware that over 6,000 people have petitioned for such a hospital and that the Answer he has given will encourage the belief that hospital planners, whether in Birmingham or London, show a woeful indifference to local needs popularly expressed?

I believe there is a great deal to be done in educating the public into a general understanding that we cannot with justification prevent patients from getting the best technical treatment. This technical treatment can be provided only within the concept of the district general hospital. That is why I have given the reply I gave. It is quite wrong to say the regional board is insensitive to local demand. It is a questiton not only of highly sophisticated equipment but also of the provision of trained staff.

asked the Minister of Health what is the deficiency of basic grade pharmacists in the hospital service in the North-West Metropolitan Region; and what action he is taking to recruit more pharmacists.

asked the Minister of Health what action he will take to increase the number of pharmacists employed in the national hospital service.

There is a shortage a number of areas including the North-West Metropolitan Region. To improve recruitment the salaries of hospital pharmacists were substantially increased earlier this year and ways of improving the career structure are being studied urgently.

Can the right hon. Gentleman give me the figure for the North-West Metropolitan Region, which is what I asked for? Can he say whether it is of the order of 80 per cent., because, if it is, that is a very serious deficiency indeed which seems to indicate further action beyond that taken earlier this year?

There are no fixed standards by reference to which they can be precisely measured. I agree it is serious in the North-West Metropolitan Region but at the last staffing inquiry over the whole country a shortfall of those in post on estimated requirements was 22 per cent. in terms of whole-time equivalents. The last staffing report showed an increase in staff in post—a small increase—from 1,405 to 1,444 in the year ended 30th September, 1966.

Does the Minister appreciate that during last year the number of pharmacists, who are basic to the hospital services throughout the country, has fallen by almost 50 per cent.? Will he press on with a new career structure as a matter of urgency?

We are taking whatever steps we can and I think we ought to see how the recruitment position goes following the recent considerable increase in salaries.

asked the Minister of Health what proportion of the supervisors and assistant supervisors in hospi- tal schools for the mentally handicapped and mentally subnormal have the appropriate National Association for Mental Health qualification or other recognised qualification.

About 21 per cent.

Is not this proportion of trained staff in the hospital schools substantially below the proportion of trained staff in the junior training centres? Will the right hon. Gentleman bring the conditions of service in the hospital schools, particularly those relating to holidays, into line with the staff in the junior training centres?

I take note of that suggestion. Arrangements were made in September 1966 to enable suitable hospital staff to be seconded on full pay to courses leading to qualifications. So far, we have had 28 applications for secondment, all of which have been approved.

asked the Minister of Health whether he is aware of a recent death resulting from the system adopted for identifying blood for transfusions at Queen Victoria Nursing Institute, Wolverhampton; and what steps he is taking to prevent any further failures to identify bottled blood at this hospital.

I am aware of this tragic incident. Blood for transfusion at this hospital is labelled in accordance with the uniform hospital system for distinguishing the blood group and I have no evidence of need for change in the system. The hospital management committee is considering what action is needed locally to prevent a repetition.

Can the Minister say whether it is intended to hold an inquiry into this case? Is he aware that while he may be satisfied with the system a lot of people are not? Two people of the same name were in the hospital and the wrong blood was given to a lady who subsequently died? Is he aware that this has caused a great deal of alarm? I would be grateful if he would have an inquiry into the whole business?

The system is perfectly all right. There were errors committed, the hospital management committee has arranged for the paints brought out at the inquest to be studied by its nursing committee and the group medical advisory committee. I understand that questions of negligence are likely to be raised in civil proceedings against the hospital, and in those circumstances the House and the hon. Gentleman will perhaps forgive me for not elaborating.

asked the Lord President of the Council whether he has authorised special sales of wines, spirits or tobacco, in bulk, by the catering department.

I have been asked to reply.

The Chairman of the Catering Sub-Committee on 27th July notified the Committee that wines and spirits would be available at special prices. These have been offered to Members, staff and the Press, and priced on the advice of the Manager in consultation with the shippers. Tobacco is not being sold at a special price.

Is the hon. Gentleman aware that there will be considerable resentment if it is found that these attractive offers are made not from existing stocks of the House of Commons but that the House is simply being used as an agency for an outside wine merchant?

I am not aware of any resentment. On the contrary, the offer has been well received and is proving very successful.

asked the Lord President of the Council what stocks of wine are held for the purpose of the special offer of wines and spirits; and what was the cost of these stocks.

I have been asked to reply.

We do not hold stocks for this purpose. The wine merchants operating the cellar stocking system took our old stock away and, in producing the special offer list for Members, have augmented these and enlarged the wine list by adding some of their own stocks.

Is the hon. Gentleman saying that the House of Commons is being used as a mail order agency for an outside wine merchant which is a subsidiary of a very large group of brewers?

I am not saying that at all. All that has happened is that the Catering Sub-Committee, looking for revenue in order to ensure that the charge on public funds is reduced, has continued the practice of providing Members, the staff and the Press with an opportunity of acquiring wines for purchase at Christmas time. As I have said to the hon. Gentleman, this is proving both popular and successful.

Can the hon. Gentleman explain how the Catering Sub-Committee can enter into this sort of arrangement in an organisation which does not pay rates and which is not in equal competition with people outside? Does he not realise that this is very unfair trading?

We have entered into this arrangement by authority vested in the Catering Sub-Committee of the House. I believe that it is in the interests of the House that it be continued.

On a point of order, Mr. Speaker. In view of the unsatisfactory nature of those replies, I beg to give notice that I shall seek to raise this matter on the Adjournment at the earliest opportunity.

asked the Lord President of the Council what progress has been made in considering the suggestion that the dining facilities at the Palace of Westminster should be available to the general public when Parliament is in recess.

I have been asked to reply.

Active consideration is being given to this problem. Positive steps have been already taken to enable this service to be provided, if the Services Committee approves it. It is hoped to make a further statement as soon as possible.

Can my hon. Friend say whether a decision will be taken in time to provide this facility for the next Summer Recess, and can he give the House an assurance that the decision will be taken by elected Members and not by any official of the House?

To answer the first part of my hon. Friend's supplementary Question, the decision can and will be taken in time for the Summer Recess, subject to the technical facilities being available. In answer to the second part, of course, the decision will be taken by the House and by no one else.

In addition, will the hon. Gentleman bear in mind the possibility of additional revenue being gained by providing refreshments for members of the public on Saturdays?

We will certainly look into that as a further suggestion for improving the revenue and for making available the resources of this House to the staff, Members and their guests and visitors.

asked the Lord President of the Council whether, since the Catering Department is now out of the red, he will now arrange for a general increase in the wages of the staff.

I have been asked to reply.

No. An all-round increase of 10 per cent. was awarded recently.

Does the hon. Member recall that the former policy was that so long as the prices were kept low there should not be any substantial increase in wages which would not be appropriate. Now that prices have soared, is there any reason why there should be a restriction on a further reasonable increase in wages for our staff?

There is no restriction on a further wage increase for our staff. As the hon. and learned Gentleman will recollect, the House has generally expressed its desire that the servants of the House be paid commensurate with the remarkable efforts that they are putting in. However, having just received an award of 10 per cent., it would be a little premature to talk about any additional awards. Furthermore, as I expect the House will note when the first report of the Catering Sub-Committee is published, it appears that we are breaking even, and we expect to be making a profit next year. I believe that we must stick to what my right hon. Friend the Chancellor of the Exchequer has asked, namely, that we pay bonuses only after they have been earned and not before.

asked the Lord President of the Council whether lie is aware of the deterioration of the quality of food in the Members' Tea Room; and whether he will give an assurance that future expenditure will be used to maintain food standards rather than on furniture and decoration.

I have been asked to reply.

I have no knowledge that the food has deteriorated in the Members' Tea Room. Since the installation of the new equipment, I understand that it has considerably improved.

Is the hon. Gentleman aware, just as an example, that now it is not possible to get any decent plain biscuits—only nasty cheap sugary ones, like the Prime Minister's Questions and Answers?

I would not wish to engage in any polemics with the hon. Lady. If she has any complaints about the biscuits, perhaps she would put in a recommendation and the Manager will look at it.

asked the Lord President of the Council when he expects to be able to install an automatic telephone exchange for the Palace of Westminster, following the report of the Postmaster-General.

It is hoped that the report from my right hon. Friend the Postmaster-General will be available shortly. At this stage there is nothing I can add to the Answer I gave my lion. Friend on 24th July.

Does my right hon. Friend not agree that it is false economy not to modernise this place? The present switchboard is not only grossly unfair to the operators using it, but it is grossly inefficient and a great burden on Members of Parliament, preventing them from doing their job properly.

I think everybody here realises that we should modernise the switchboard. We ought to modernise it after we have received the report from the Postmaster-General.

asked the Lord President of the Council when he proposes to move to appoint a Select Committee on Economic and Financial Affairs.

I explained my proposals for Select Committees this Session on 14th November, but I will certainly bear this possibility in mind.

Does my hon. Friend feel, following the economic events of the last few weeks, that there is or is not a special urgency attaching to this type of Select Committee dealing with a most critical phase of policy-making in the House?

I do not think that we ought to appoint Select or Specialist Committees in terms of current difficulties. There has always been a strong case for committees of this kind, and that case has been strengthened by what has been happening recently.

asked the Lord President of the Council whether he will move for the establishment of an ad hoc Specialist Committee to examine the social costs involved in the Government's fuel policy.

As I said to my hon. Friend the Member for Stoke-on-Trent, Central (Mr. Cant), I explained my proposals for Select Committees this Session on 14th November. This particular aspect of fuel policy has been, and is being, taken into account.

Would not my right hon. Friend agree that if we are to have the sort of effective virile committee system which he believes in, they ought to be able to take up particularly urgent topics of public concern, as well as looking at other issues, and that this one, because of the interest that it arouses in mining constituencies in particular, would be a very good candidate for an ad hoc Specialist Committee?