asked the Minister of Health if he will make a statement on his progress in finding a definition of the chronic sick for the purposes of exemption from prescription charges.

asked the Minister of Health what exemptions he has arranged from the need for paying prescription charges from 1st April.

asked the Minister of Health if he will make a statement on the consultations he has had with interested bodies on exemptions from prescription charges; and what decision has been reached.

asked the Minister of Health whether, when prescription charges are reintroduced, in the interests of simplicity of administration, he will consider using two types of pre- scription form, one type being for free prescriptions and the other involving payment.

asked the Minister of Health what estimates he has made of the size of that section of the population who, though qualifying for exemption from prescription charges on income grounds, will have to claim refunds on account of the fact that they cannot be satisfactorily identified.

asked the Minister of Health whether he will give an assurance that arrangements for the exemption of certain groups from any prescription charge will start simultaneously with the introduction of a 2s. 6d. per item prescription charge.

asked the Minister of Health what progress he is making in his discussions about administrative arrangements for the prescription charge; and if he will ensure that those people who are to be protected from the charge will not be made to pay the charge and then have to reclaim it, but that they will be exempted from payment of the charge in the first place.

asked the Minister of Health when he will announce his complete scheme of exemptions from prescription charges.

asked the Minister of Health what have been the results of his discussions with the medical profession on securing suitable arrangements for exemptions from paying prescription charges.

asked the Minister of Health what results have been achieved in discussions with the medical profession over defining grounds of exemption from the payment of prescription charges when they are reintroduced.

I have little to add as yet to the statement made by my right hon. Friend the Prime Minister on 16th January. Discussions with the medical profession are proceeding and I hope soon to start discussions with the other interests concerned. I shall inform the House about the outcome of these consultations in due course.—[Vol. 756, c. 1587.]

In the meantime, pending the subsequent statement which he hopes to make, can the right hon. Gentleman give an undertaking that, whatever mechanism of selective exemption is applied by the Government, it will be one which will minimise the burden placed upon the general practitioners?

That is certainly one of the objectives in these discussions.

Is my right hon. Friend alive to the fact that we are about six weeks away from the proposed date for the introduction of the scheme? Does he not think that the indignity of personal sickness is not lightly to be added to by the indignity of placing people in categories? Would he talk to his colleagues in the Cabinet who know much less about human problems than he does, and tell them of the feelings of so many of us on this side of the House?

I do not think that there is any indignity in seeking to exempt from these charges those upon whom they might bear oppressively.

Is it not the case that if there was a proper scheme for exemptions the amount of saving would be much smaller than was announced earlier? Is the Minister aware, although I know that he is not personally to be blamed for this, of the very deep feelings inside the Labour movement to any such charge being brought in?

Of course I know that a number of people have deep feelings and I well understand that. As to the estimated savings, these were the best estimates we could make and nothing that has transpired since vitiates them.

Would the Minister agree that whatever mechanism is eventually adopted, it should be based on exemption rather than repayment, because our experience of previous prescription charges shows that such a system is completely inefficient?

This was the purpose of seeking to arrange an exemption scheme. It will be backed by a refund scheme for those who may suffer personal hardship and would not come within the exempted categories.

Would my right hon. Friend not agree that the whole business of refunds and of trying to persuade people to claim them is the wrong sort of selectivity because it is essentially divisive? Are prescription charges really worth all the administration and political trouble that they will cause?

I am considering with my right hon. Friends the Secretary of State for Scotland and the Minister of Social Security measures to ensure that the groups that will be entitled to have charges remitted or refunded are fully aware of the arrangements which will apply to them.

Is not the Minister saying that some people whom he wishes to exempt will have to pay charges because he has not finished his homework?

No, Sir, that is not what I said at all. What I said was that we were maintaining the arrangements that obtained when the hon. Gentleman's party was in power, and introduced these prescription charges, for relieving people on grounds of personal hardship, quite apart from other categories of persons who will be exempt altogether from paying the charge.

Does my right hon. Friend appreciate that very real hardship was caused last time there were prescription charges, when people had to pay in the first place and then claim the refunds? Is he aware that they found this very difficult, because they could not afford the money in the first place? Can he try to find a way round this problem?

Yes, I am aware of this and that is why we are attempting to introduce a scheme wholly different from the scheme that we got rid of three years ago.

Is the Minister not now persuaded that it is administratively impossible to produce an equitable scheme of exemption?

No, Sir.

In any exemption scheme, would the right hon. Gentleman bear in mind that the greatest hardship falls on people who have to have more than one prescription at a time? The person who has to have one prescription is not very hardly dealt with.

That point will certainly be borne in mind.

The right hon. Gentleman has misunderstood my hon. Friend's question. Is it the Government's intention to introduce prescription charges before the machinery for exempting the elderly and chronic sick is in operation?

That was not, as I understood it, what the hon. Gentleman asked. My right hon. Friend the Prime Minister has already stated that regulations bringing the charges into operation will be made in the spring simultaneously with the reintroduction of the arrangements for refunding charges. Whether exemptions can be introduced simultaneously with the reintroduction of the charges will depend on how soon the arrangements can be worked out and brought into operation, but it is my hope that they can be.

Would my right hon. Friend assure the House that prescription charges will not be introduced until a fair and comprehensive system of exemption for the chronic sick has been evolved?

My last supplementary reply dealt with that point.

Would my right hon. Friend have a look at all the anomalies surrounding exemption and ensure that any scheme introduced does not have more anomalies than exemptions?

I will try to devise the fairest possible scheme.

asked the Minister of Health what action he proposes to take to make the need to apply for registration under the Abortion Act more widely known by the proprietors of private nursing homes in the provinces.

I would refer my hon. Friend to my right hon. Friend's reply to her Question on 11th December, 1967.—[Vol. 756, c. 9.]

Is my hon. Friend aware that that does not answer the Question at all? It is clear from that reply that no advertisements have been inserted in the provincial Press. Is my hon. Friend further aware that there are some counties in Britain which have no registered nursing homes for this purpose? Would he ensure that the advertisements are now inserted in the provincial Press where some result can be expected?

I will consider that, but, meantime, my hon. Friend may take comfort from the fact that 110 applications have been received from England and Wales, 65 sets of forms have been returned completed, and 48 approvals have been given. No applications have been received from Wolverhampton, although four have been received from the Birmingham area.

asked the Minister of Health how many doctors who left Great Britain to work in the United States of America are now expected to return in 1968 as the result of his Department's efforts; and if he will make a statement.

Of the 100 or so doctors interviewed recently in North America who evidently wished to return home, I expect that a least 50 will succeed in doing so this year and a substantial proportion of these will come from the United States. My Department, which is doing what it can to help doctors overseas to overcome the handicap they suffer in obtaining posts from a long distance, regularly receives enquiries from those thinking of returning, but I cannot say how many of these will return in 1968.

I thank my right hon. Friend for the efforts which he has made and for the results which are obviously forthcoming. Will he continue to press on these lines and also publicise to doctors who may be on the verge of thinking of going to the United States the fact that it is not Eldorado?

The report of the interviewing board was published in the medical Press, and, I think, by and large, it bore out what my hon. Friend has just said.

Can the Minister give any information about the type of work or positions to which doctors are returning compared with salaries and conditions in the United States and what they were doing before they went there?

No, I do not think so, because there is a variety of posts to which they have returned. But it would be true to say that, in general, as we all know, salaries are considerably higher in the United States. There happen to be other attractions in working in the National Health Service in Britain.

As the figures given by my right hon. Friend apply, I assume, to Great Britain, can he say how many return to Scotland?

Not without notice.

Is there any estimate of the number of doctors leaving this country, and can the right hon. Gentleman say what percentage of that figure those who have returned represent?

The best estimate which we have of the number of doctors on average who emigrate each year is 300. All that we are dealing with in this Question is an exercise which I mounted in North America. I am having at least a trickle of letters from doctors in Australia who are similarly anxious to return home.

asked the Minister of Health what information he has as to the number of people suffering from brucellosis; and whether he will make it a notifiable disease.

I would refer the hon. Member to my right hon. Friend's reply on 2nd February to the hon. Member for North Angus and Mearns (Mr. BuchananSmith).—[Vol. 757, c.428.]

Will the hon. Gentleman consult his right hon. Friend and ask him to approach the Minister of Agriculture about this, as cases are occurring in my constituency?

Yes, Sir though I should say that notification of brucellosis would be unlikely to be of practical value in tracing a source of infection because of the length of time elapsing between infection and confirmed diagnosis.

Will the hon. Gentleman look at this again, because this disease is much more frequent in the community than is generally appreciated? Will he look again at the question of notification and at the question of designating it as an industrial disease for farmers and farm workers, and will he take steps to stop the sale of raw milk, from which most of the disease originates?

I do not think that the question of designation is one for my Department, but I will take note of what my hon. Friend says. I may say that the Circular issued by my right hon. Friend in 1966 had the result of bringing about a greater awareness of the disease, and current figures of cases may have been inflated because of the greater awareness.

asked the Minister of Health if he will initiate a research project to discover why only about one quarter of drivers eligible for invalid tricycles actually apply for them.

asked the Minister of Health whether he is aware that the majority of disabled persons entitled to invalid tricycles do not apply for them; whether he is satisfied with the adequacy of the machines; and if he will make a statement.

The total number of disabled people who might be entitled to invalid tricycles and who do not apply for them is not known and I do not think that a research project would be appropriate. I am satisfied that the vehicles are well designed for their purpose.

Is it not rather curious that the Ministry should not know how many people are entitled to them but do not have them? Is the hon. Gentleman aware that three-quarters of the people entitled do not apply? Will he look at this again and do something about it?

I do not know that three-quarters of the people entitled do not apply. That sounds like conjecture. If the hon. Gentleman has any evidence, I shall be glad to know about it. Eligibility depends, naturally, on medical examination of the applicant. We have no reason to suppose that these vehicles are not suitable for the many and varied types of disablement with which we have to cope.

Is it true that the Department does not buy a slightly better vehicle at a similar price in order to keep down demand?

That is quite untrue.

If the hon. Gentleman does not know this basic information, on what can he base the new proposals before Parliament about invalid tricycles?

The new proposals incorporated in the Bill now under discussion in Committee are merely powers to provide additional categories of vehicles when resources permit.

If my hon. Friend cannot assure us authoritatively that a large number of people do not apply for these vehicles, is one not led to assume that there is something in the claim that many people are deterred because of the unsuitability of the vehicles?

All vehicles, whether disabled persons' vehicles or ordinary cars, are capable of improvement. That is self-evident. As to the lack of evidence of people who might apply and who are entitled, in fact many people do not want to draw attention to their disabilities by applying for vehicles. We are anxious to help on three-wheeled vehicles where we can.

The hon. Gentleman has said that, in his view, the design is satisfactory. Is he implying by that that a new design has come out recently, because the vast majority of designs available today are quite disgraceful?

I would not agree that they are disgraceful. I do not know whether the hon,. Gentleman has had experience of them. We have tried them out. Of course, they can be improved, and so can any car. They are being improved, and there are designs for future production.

asked the Minister of Health what effect cuts in local authority spending will have on the provision of training centres for the mentally handicapped.

The building of training centres will continue, though at a rather slower rate than previously planned.

Is my hon. Friend aware that there is a near-desperate shortage of places, particularly for mentally handicapped children? Will he ask local authorities to give this part of the service even greater priority, in spite of restrictions on spending?

It is very much in the hands of local authorities to decide their projects and priorities. My hon. Friend will be pleased to know that the new adult training centre at Arnold will now go ahead and capital will be made available for it. Likewise, the first phase of the extensions and improvements at Digby Avenue Training Centre will be authorised shortly.

Can the Parliamentary Secretary tell the House what, if any, will be the effect on this programme of the transfer of the responsibility which may take place from the Ministry of Health to the Secretary of State for Education, bearing in mind that we are concerned with the mental rather than the physical age of the children involved? Can he give any date when it is likely to happen?

No, Sir. Nothing has yet been announced. Decisions have yet to be made.

Will my hon. Friend consider sending a circular to local authorities drawing attention to the chronic lack of investment in these centres over many years and deprecating any cutting off of investment in this sphere?

I think that has already been done. There is a great pent up demand for this sort of accommodation. When my right hon. Friend receives the replies from the local authorities about the priority for building projects for which he has asked, he will take into consideration local excess demand.

asked the Minister of Health what estimate he has made of the increased numbers of civil servants which will be required in his Department on the basis that the recommendations of the Sainsbury Committee are implemented.

asked the Minister of Health whether he can make an estimate of the number of additional civil servants and their total salaries which would be required by his Department in order to implement the recommendations of the Sainsbury Committee.

Until the Government have reached conclusions on the Committee's recommendations, there would be little purpose in making such an estimate.

Is the right hon. Gentleman aware that the independent member on this Committee, Lord Sainsbury, is apparently reported to have joined an extreme Left-wing group to pressurise that this report should be fully implemented? This is somewhat unusual for an independent chairman. Will he point out to the noble Lord that there is a restriction on increasing the numbers of civil servants and this must mean that not all the recommendations in the Report will be implemented?

I do not know what on earth the hon. Gentleman means by his initial remarks about the chairman of the Committee. I think that he would be most unlikely to join an extreme Left-wing group. Certainly we are all aware of the Government's policy to restrain the growth of civil servants as a whole, but the Committee made the point in its Report that the cost of additional staff required should be measured against its conclusion that the National Health Service drug bill had been inflated by excessive prices over the last three years.

As the Committee also acknowledge that its proposals would entail a whole new division in the Ministry of Health, surely it is relevant for the House to know what this figure is likely to be to assess whether the saving is likely to be worth the cost of collecting it?

If it is desirable to give this information in due course when the Government have reached conclusions, I will give it.

Will my right hon. Friend give an undertaking that he will not be discouraged from implementing the recommendations of the Sainsbury Report by any such considerations as are contained in these Questions?

I am never discouraged by hon. Gentlemen opposite.

asked the Minister of Health what is the precise amount referred to in the Report of the Sainsbury Committee by which the National Health Service has been overcharged by the pharmaceutical industry over a period of three years.

The Committee's statement was:

"The figures suggest that the cost to the National Health Service has been inflated by excessive prices to the extent of several millions of pounds over this period of three years."

How many millions is "several"? Surely the right hon. Gentleman must know the answer to this, because the Committee's whole case against the industry is based on it. Surely the House is entitled to know the answer to enable us to assess the value of the Report, especially as one of the major companies was criticised and the charge made against it has since been shown to be disingenuous, to put it mildly.

No, Sir. I do not think that the Committee is obliged to put a gloss on its Report to satisfy the hon. Gentleman. I can only repeat what the Committee said, and I do not think it is true to say that the Committee mounted a case against the industry. I would have thought that it was a very fair Report.

Is my right hon. Friend aware that many of the reports are leading many Members to believe that somebody is on a big fiddle in this industry? Is it not about time that my right hon. Friend considered a much greater degree of public control and ownership of this industry?

As my hon. Friend knows, this aspect of the problem was specifically considered by the Sainsbury Committee and it produced a clear negative report on this issue.

Is the right hon. Gentleman aware that it has been privately estimated that savings from implementing the Sainsbury recommendations might amount to about£2 million a year? Would he agree that the savings under the voluntary price regulation scheme have been of the nature of£4½. million a year?

I do not know who made that estimate. I wonder whether it was made by some members of the pharmaceutical industry itself. I can only say that some of my hon. Friends estimate that figure at more than£25 million. I would not like to say where, in that wide bracket, the true figure is likely to fall.

asked the Minister of Health what proposals he has to encourage the activities of private welfare organisations such as the British United Provident Association and the Hospital Savings Association in the light of the restraints on public expenditure expected to arise from the post-devaluation economic situation.

None, Sir.

Would not the right hon. Gentleman agree that the private sector makes a most welcome contribution to the total of our national resources which are devoted to health, and would not he further agree that that most welcome contribution is even more to be desired in the economic situation of post-devaluation?

I remind the hon. Gentleman that medical manpower is limited and that if private patients claim disproportionately more of it there will be less of it for National Health Service patients.

Will the right hon. Gentleman at least accept that the recent cuts in health and welfare expenditure highlight the importance of getting additional money into health through voluntary health insurance?

No, Sir. I do not think that that follows at all.

asked the Minister of Health what rehabilitation courses have been organised for hard drug addicts following successful withdrawal treatment.

Methods of rehabilitation vary with the needs of individual patients and there is no standard formula which might serve as a basis for arranging special courses for heroin addicts; but I have recently issued guidance on the range of services and facilities which may be needed for their rehabilitation and after-care.

Will my right hon. Friend look at the kind of case work in rehabilitation which has been carried out at the Chelsea Addiction Centre, and will he ensure that when he arranges courses for rehabilitation in the future they are sufficiently long and are held far away from urban centres?

Experience so far, both in this country and abroad, indicates that only a small proportion of heroin addicts who complete withdrawal treatment are willing to continue with longer-term rehabilitation. Nevertheless, I agree that it is a matter to which we have to turn our attention. I do not think that special courses are indicated at the moment.

I thank the right hon. Gentleman for acceding to our request and publishing the names of the hospitals giving in-patient and out-patient treatment. Surely he ought now to be in a position to announce his proposals for the after-care service, in particular, perhaps, the provision of hostels for those withdrawing from drug addiction in our main cities?

I published the list of hospitals when I deemed that it was proper to do so. The hon. Gentleman's hon. Friends asked for it much earlier, and I resisted their blandishments. I have issued a circular on the question of rehabilitation, which no doubt the hon. Gentleman has seen.

asked the Minister of Health whether he will initiate studies of the problems, other than technical problems, involved in organ transplant operations.

asked the Minister of Health whether he will make a statement on his policy in relation to heart transplant and similar operations for transference of organs.

asked the Minister of Health whether he will set up a panel, composed of medical and lay persons, in order to study and advise upon the problems of transplantation of human hearts and of animal hearts into human beings; and if he will make a statement.

My right hon. Friend the Secretary of State for Scotland and I are shortly convening a conference to discuss problems connected with organ transplant operations.

Would my right hon. Friend accept my congratulations on taking this decision? We recognise that he understands the enormous ethical, practical and administrative problems which will be involved if organ transplants, particularly those involving the heart, were to be extended rapidly throughout the world? Does he propose to publish a White Paper following the conference?

The conference will be private, but I will consider whether a statement should be made afterwards. I am grateful to my hon. Friend for his remarks. He will be glad to know that Sir Hector MacLennan, President of the Royal Society of Medicine, has agreed to take the chair.

May I ask the right hon. Gentleman who will be invited to the conference? Meanwhile, does he have any plan to ensure that in National Health Service hospitals the donors of hearts or other vital organs are in fact dead before any excision operation is carried out?

The second part of the hon. Gentleman's supplementary question is self-evident and self-answering. Invitations have been sent to leading members of the medical and nursing professions, lawyers, representative of the churches, lay men and women.

Has the Minister's attention been drawn to the forecast that within a decade pigs' hearts will be successfully transplanted into human beings? Bearing in mind that there may be partial brain transfers in future, will the right hon. Gentleman ensure that the whole matter is considered by the conference and that there is a very strong lay representation as well as medical representation on it?

There will be a strong lay representation. I do not think that this conference alone could encompass the range of study which the hon. and learned Gentleman wants, but I agree that developments in medicine at present and in the foreseeable future require the most careful study on non-medical as well as purely medical grounds.

asked the Minister of Health what is the number of consultancy posts in psychiatric hospitals occupied by senior hospital medical officers with allowances, lacking a consultancy grading, in Scotland, and in England and Wales, respectively.

There are 25 in this specialty in England and Wales, and none, I understand, in Scotland.

Would the right hon. Gentleman tell me why this odd anomaly should exist between Scotland and England and Wales? Why are they not all paid the rate for the job?

I cannot say why it happens that there is none in Scotland. But these allowances were introduced in 1959 as an interim measure while the hospital medical staff structure was under review. The closing date for applications was 1965.

asked the Minister of Health what is the length of time a senior hospital medical officer has to spend in consultancy posts in a mental hospital before obtaining the grading of a consultant; and how many senior hospital medical officers with allowances are in consultancy posts without the grading of a consultant who obtained their appointments prior to 1947 by open competition.

There is no qualifying period: doctors achieve consultant grading by obtaining a consultant post in open competition after appropriate training and experience. The information requested in the second part of the Question is not centrally available.

Does not the Minister realise that there are only 25 senior medical officers in the country who are in consultancy posts without consultancy grading? I know of one who has been in the post for over 20 years and is still not getting the rate for the job.

As part of the review of the medical staffing structure, senior hospital medical officers with allowances were eligible for a special review conducted by professional committees. Full weight was given to experience as distinct from formal qualifications in this review.

asked the Minister of Health whether he will take action in the light of the report of his department's fact-finding board to ensure that National Health Service appointment committees will no longer insist on an applicant for a job attending for an interview where the applicant is a United Kingdom citizen employed in the United States of America at the time of his application.

This is a matter for appointment committees to decide. They are unlikely to insist on interviewing an applicant from overseas except for permanent appointment at consultant level.

In view of the urgency of the brain drain problem, would my right hon. Friend use his influence along the lines that there should be more joy in the National Health Service over one emigrant who repenteth than 99 who are saved?

My hon. Friend may be interested to know that a number of British doctors overseas come here for interview at their own expense, but to remove any such deterrent in the case of doctors recommended by my interview board in North America as suitable for appointment hospital boards have been authorised to meet their travel expenses.

asked the Minister of Health whether, in view of the necessity of improving the balance of trade, he will circularise all architects and engineers drawing up plans for building hospitals instructing them to ensure that wherever possible indigenous materials are used for the construction of such buildings and the use of imported materials reduced to a minimum; and whether there are existing instructions to architects and engineers in this connection and of what nature.

asked the Minister of Health if he will instruct all architects and engineers to support British manufacturers wherever possible in the hospital building and modernisation programmes and at the same time to be prepared to use imported technical products if these are cheaper or technically superior so that hospital equipment is as efficient as possible.

It is the current policy for home-produced materials to be used in the hospital building programme whenever they are available of suitable quality at competitive prices, and no further instructions to this effect are necessary.

Would the Minister agree that, during this period of emergency, with very inflated imports, the time has arrived to look at this again to see what savings can be made in the huge timber imports of£200 million a year? Would he like some examples sent him from the building trade of the wrongful use of imported materials?

I am always glad to have any information with which the hon. Gentleman cares to furnish me. The arrangements in my Department accord with general Government purchasing policy, and that includes observance of our international obligations, especially Article 14 of the E.F.T.A. Convention.

Is the Minister aware that the British Tile Manufacturers' Council, in which I have no interest to declare, claims that there are very competitive British ceramic tiles on the market which, nevertheless do not get a fair crack of the whip from his Department? Would he care to look into a specific example if I send it to him?

I will be glad to look at any specific case which the hon. Gentleman cares to send me. Devaluation provides an added incentive to contractors to use British-produced materials. I am sure that everyone in the building industry is aware of this and will do everything possible in that direction. However, there is a limit to the substitution which can be achieved, and there is great difficulty in the case of timber, which was mentioned by the hon. Member for Twickenham (Mr. Gresham Cooke).

In addition to trying to get substitutes for imports, can my right hon. Friend indicate how far his Department has gone in urging upon architects the need for greater standardisation in design, which in itself would result in a great saving in hospital building?

I agree with my hon. Friend, and my Department has taken a forceful lead in impressing on hospital authorities the importance of standardisation of design. We are accelerating the pace all the time.

asked the Minister of Health what steps he is taking to reduce the numbers of patients on waiting lists at hospital in-patient departments.

Advice to this end has been given to hospital authorities under several heads, and waiting lists are regularly reviewed.

While thanking my hon. Friend for his reply, as the waiting lists have increased by 50,000 over the past few years, will he redouble his efforts and do his utmost to keep the lists reduced?

Yes, Sir. This is our present policy. I should say that the waiting lists have been inflated in recent years by the introduction of new services. Cytology screening and the uncovering of latent demand have been two factors which have tended to increase the waiting lists.

Is the hon. Gentleman aware that, according to a study carried out last year by the Office of Health Economics, there are wide variations in the length of stay in hospitals for the same condition? One example given covers cases of tonsillectomy and adenoid operations where, in one group of hospitals, the stays varied between one and six days. Will the hon. Gentleman see what can be done to achieve uniformity between hospital groups so as to secure the optimum treatment for patients?

I do not think that the hon. Gentleman would like to undergo an operation according to some set of rules. There must be clinical judgment in these matters.

asked the Minister of Health what action he is taking to increase the number of staffed beds in the hospital service.

My right hon. Friend's policy is to make fuller and better use of the beds in the service rather than to increase their total number.

Will my hon. Friend look at this again, because the fact that the number of these beds has fallen by 4,000 over the past three years is very disturbing? Surely this should have the greatest priority in the hospital service?

Again, these figures tend to be distorted somewhat by the fact that treatment for certain conditions such as chest disease, involving tuberculosis, and mental illness has resulted in a big reduction in the demand for beds. These factors have to be taken into consideration when judging the availability of beds.

Can the hon. Gentleman say how many beds are closed due to the lack of staff?

Relatively very few. In point of fact, the staff availability is now greater overall than ever before.

asked the Minister of Health what sum was authorised for capital expenditure by the Sheffield Regional Hospital Board in 1967–68; and what was the comparable figure for the year 1963–64.

£8·81 million in 1967–68 and£3·53 million in 1963–64.

While appreciating that the spending on new hospital building in the East Midlands has more than doubled under a Labour Government, may I ask whether my hon. Friend would agree that the East Midlands is one of the poorest areas in the country concerning the ratio of hospital beds to population? Will he continue to bear our needs in mind?

Yes, Sir.

asked the Minister of Health whether he is aware of the shortage of geriatric beds in the Rugby area; what steps he is taking to remedy this shortage; and if he will make a statement.

I am not aware of any such shortage. The regional hospital board will take account of probable future increase in demand in planning the expansion of hopital services for Rugby.

asked the Minister of Health what is the estimated loss of revenue to the National Health Service following the recent reduction in the number of pay beds.

I would refer the hon. Member to my reply to the hon. Member for Twickenham (Mr. Gresham Cooke) on 30th January.—[Vol. 757, c. 262–3.]

Is the Minister aware that that told us nothing? Why is he being so coy about these figures'? Would he care to comment on the estimate that his recent decision on pay beds means a loss of about£2 million a year to the Exchequer? If this is so, how much longer is Socialist prejudice against the private patient going to stand in the way of urgently needed finance for the National Health Service?

I should be delighted to comment, and I will try to do so with restraint. It is nonsense. The reduced number of pay beds should still be sufficient to meet the current level of demand. Assuming it does not decrease, there should be no change in the revenue on account of the reduction in numbers.

Will my right hon. Friend bear in mind that while there is great demand and people are queueing to get into hospital, some people feel astonishment that pay beds continue to exist at all?

Will the Minister give an absolute assurance that he has no intention of denying people the right to spend money on health if they so wish?

I have always said that I do not propose to eliminate the facilities for private practice in National Health Service hospitals, but I do not intend to see them prejudice the facilities for nonpaying patients.

Will my right hon. Friend bear in mind that any loss which may occur through reduction in the total number of pay beds could be offset by increasing the charges for those remaining?

I think that is a self-evident fact.

asked the Minister of Health what steps he is taking to discourage tonsillectomy in the light of recent evidence, details of which have been sent to him, that such operations are often unnecessary.

asked the Minister of Health if he is aware that a large and increasing number of doctors and consultants are of the opinion that a substantial proportion of the 150,000 tonsil operations performed per year on children in National Health Service hospitals at a cost of£3 million annually with occasional fatal results are unnecessary; and if he will set up an inquiry or a research team to investigate the matter.

I am aware that some doctors think that tonsillectomy is often performed on children without sufficient reason, but it is not my function to advise doctors on the exercise of their clinical judgment.

Will the Minister agree that it is a disturbing fact that 30 per cent. of the children who now go into hospital go in for tonsillectomy which many experts regard as unwise and unnecessary? Will he try to do more to dissuade both doctors and parents from indulging in this expensive fad which is monopolising valuable Health Service facilities which could be more usefully employed in the ear, nose and throat sphere?

I would not want to go further than to say that there is a division of opinion within the medical profession on this matter. It is not for me to tell doctors the operations that they should perform. However, I shall be guided by any findings which the Medical Research Council may produce as a result of the reference of the research aspect to it.

While strongly in favour of the Minister not interfering with the clinical judgments of members of the medical profession, may I ask him to bear in mind that a recent survey in Australia showed that 40 per cent. of children who had tonsillectomy had no symptoms long before they reach the tonsillectomy stage? If there is such a proportion approaching that figure in this country, it is his duty to protect these unfortunate children from dangerous and unnecessary experiences.

My hon. Friend, who is a distinguished member of the medical profession, is asking me to protect people against the medical profession. As I said before, I would not want to go further than to say that there are differences of view, but I think it is a matter that probably needs to be looked into.

Is the Minister aware that costs of hospitalisation for the removal of tonsils is running at£6 million and not£3 million, as mentioned in Question No. 27? Will he seriously look into the variations in the length of stay for the operation between different regional boards, which are not explicable on any clinical ground?

They are explicable according to the judgment of the individual surgeon. Some surgeons are happy to discharge children the second day after the operation. Others insist on keeping them in, and think it is only safe to do so, for six days. I can assure the hon. Gentleman that my information about the cost coincides with that of my hon. Friend. I understand that it is£3 million a year.

asked the Minister of Health if he will now indicate why a small child, Nigel Haywood, who died shortly afterwards, when taken to Loughborough General Hospital in September 1967 suffering from acute poisoning was given no treatment or first aid but referred to his private doctor; and if he will make a statement.

The Sheffield Regional Hospital Board expects to receive this week the report of the Committee of Inquiry which it appointed to look into this case, and will consider it as quickly as possible.

Can my right hon. Friend say why there has been this extraordinary delay, in view of the fact that this tragic incident happened in September last?

The Committee was not able to interview one witness until 30th January of this year, because he had been abroad. The Committee is now completing the Report.