asked the Minister of Health if he will make a statement on the future of the Adela Shaw Orthopaedic Hospital, Kirbymoorside.

This is being considered by the Leeds Regional Hospital Board, which is consulting local interests. I have not yet received any formal proposal.

Is the Minister aware that the procedure laid down in circular 1958 has been disregarded in this case in that the Board has reached a decision, communicated it to the staff of the hospital and held a Press conference, at which it described the closure as inevitable, before local interests were consulted and before a local inquiry was held? What action does the Minister intend to take to put this right?

This is not my information. I am informed that local consultations are now proceeding and that the Board has not yet decided what proposals to put forward. I understand that the right hon. Gentleman has arranged to meet the Board at an early date. I should not like to make any further statement until I have a proposal from the Board.

Is the right hon. Gentleman aware that this hospital draws patients from a very wide area, much of which is very isolated, particularly in winter, and that, therefore, it is necessary to take into account the real needs of the locality before any decision is taken?

The hon. Gentleman knows that all decisions to close hospitals are made by me, and one of the factors I always take into account is the adequacy of alternative arrangements.

asked the Minister of Health whether, in view of the exceptional nature of the heart transplant operation at the National Heart Hospital on 3rd May, he will make a calculation of its cost.

To calculate the full cost would involve making a number of arguable assumptions and then expending a disproportionate amount of time and effort.

Is my right hon. Friend aware that many hon. Members want to send good wishes for the complete recovery of the patient concerned? Does my right hon. Friend think it appropriate that the large sums involved in experimental advanced surgery of this kind— and about £20,000 is the figure I have seen—should come from the National Health Service budget? Will he consider asking Parliament for a special budget for research work of this kind?

Research funds come from a number of different sources under existing arrangements. While paying tribute to the outstanding achievements of the hospital team which performed the operation, it would be well not to forget the great contribution which the hospital service can make to the relief of human suffering by means of simpler and more routine procedures. I understand that the patient's improvement, following his relapse yesterday, has been maintained, but his condition still gives cause for concern.

In view of what the Minister has said, will he reassure the House that in counting the cost of these operations he is also counting the diversionary effect on more conventional treatment?

Yes, certainly.

In addition to considering the cost and the whole question of priorities in the medical sphere in a matter of this kind, we ought to be considering further the question of the decision about the point at which death takes place and the question surrounding the giving of consent relating to operations of this kind. Does the Minister agree that it is time we debated the whole matter?

The question of a debate is not for me, although I would welcome expressions of view from the House and from other quarters. The conference which I called has been reconvened and has reconsidered this matter. I shall be making a further statement to the House in due course.

asked the Minister of Health why the hon. Member for Richmond, Surrey, was informed by him by letter dated 14th May that there was no immediate prospect of the reopening of the casualty department of the Royal Hospital, Richmond, in view of the letter of the same date from the Chairman of the South-West Regional Hospital Board, informing the hon. Member that the department was reopened on 13th May; and if he will institute an immediate inquiry into this misunderstanding between his department and the Board.

I would refer the hon. Member to my right hon. Friend's letter of 22nd May.

Will the hon. Gentleman now give a firm assurance that the casualty department of the Royal Hospital, Richmond, will remain open?

As the hon. Gentleman probably remembers, during an Adjournment debate on the Friday preceding the Whitsun Recess I undertook to pursue inquiries with the regional board concerned about the future of this Department. This I shall carry out, and write to the hon. Gentleman when I have established the facts.

asked the Minister of Health if he is aware that certain imported plastic surgical instrumentation is less thoroughly sterilised than comparable British products necessarily sold at a higher price; what steps he is taking to ascertain whether this equipment is sterile; when he will announce an official definition of the word sterile; and if, meanwhile, he will ensure that none of the imported products will be bought for the National Health Service.

The sterility of these products can only be ascertained with certainty by inspection of manufacturing conditions and methods; the system of control by inspection and other means is being extended; there is no doubt about the definition of the word sterile; hospital authorities are warned when my Department has reason to believe that an item of medical equipment may be hazardous.

Does my hon. Friend agree that it is also extremely important to seek to define standards of packaging, and is he aware that shoddily packaged products identical with those that he told me in a letter would be rejected are now being bought by the Army and shipped all over the world to British military hospitals?

I shall certainly look into that matter in collaboration with my right hon. Friend in the Ministry of Defence, and when I have ascertained the facts so far as they affect my Department I shall write to my hon. Friend.

asked the Minister of Health what is the ratio between the number of doctors, nurses and hospital beds available and total population in the Sheffield Region; and how this ratio compares with that in other regions.

With permission, I will circulate the figures in the OFFICIAL REPORT.

Is it not true that our region is relatively poorly provided for? Is not this a sad reflection on the previous Administration? Will my hon. Friend ensure that in future this region receives both capital and continuing financial payments to enable the Health Service to be really effective?

My hon. Friend is right. This is an inheritance with which we have had to deal. The deficiency of hospital beds and other facilities in many parts of the region was one of the principal factors taken into account in preparing the hospital building programme for the region. This programme is now well under way, and no doubt my hon. Friend knows of the new district general hospitals being built at Doncaster, Boston and Barnsley.

asked the Minister of Health what is the average waiting time in Great Britain for admission to hospital for cataract operations, varicose vein operations, tonsilectomy, adenoidectomy, for pay bed patients and National Health patients, respectively; and what further steps are being taken to step up the proportion of National Health beds as compared with pay beds.

In 1966 in England and Wales the median waiting time for hospital admission of National Health Service patients was about 11 weeks for cataract, 12½ weeks for varicose veins and 15 weeks for tonsils and adenoids operations; comparable information about private patients is not available. My right hon. Friend has no plans for a further general review of pay beds at present.

Would not my hon. Friend agree, however, that this idea of having first-class and second-class patients from the point of view of waiting time is completely alien to the ideology of the type of Health Service which most hon. Members on this side of the House want to build up? Would he agree that ultimately—in the long term if not in the short term—his aim must be to abolish pay beds?

The general intention of the review on this subject was quite adequately discussed earlier. As regards the local position, which may be of particular interest to my hon. Friend, he will know that there has recently been a small adjustment because of new circumstances and evidence which came to the attention of my right hon. Friend.

Would the hon. Gentleman explain the difference between the median waiting time which he gave in his Answer and the average waiting time for which his hon. Friend asked?

The median waiting time is the time waited by the middle case in a group listed in order of the amount of time waited. A large proportion of the cases occur around this point. The median time is not affected by a patient having a long waiting time, and the use of this formula gives more accurate information to the House.

asked the Minister of Health whether he is aware that many social workers in training are unable to have the experience of a student placement in a psychiatric hospital for lack of a senior psychiatric social worker to teach them; and if he will therefore take steps to increase the number of such senior workers.

Yes, Sir; my right hon. Friend has told hospital authorities of the need and asked them to examine ways of extending training facilities.

We are grateful for that Answer as the existing salary structure operates to the disadvantage of hospital social workers and has hitherto been responsible for a drift of social workers from hospitals to local health authorities. The hon. Gentleman's statement will be very much welcomed.

I am much obliged.

asked the Minister of Health whether, in view of the fact that hospitals to be built at Bury St. Edmunds and Frimley are very similar in concept to the proposal put forward two years ago by the Brighton consultants for a new hospital at Stanmer Park, the concept of which he rejected, he will now reconsider the application of the Stanmer Park concept in deciding future hospital developments.

No, Sir. I cannot accept the premise on which the hon. Member's Question is based.

Is the Minister aware that an official spokesman of his Ministry told the Brighton Evening Argus that the concepts were similar? Does he agree that the constructional features in these two new hospitals are very similar to those put forward by the Brighton consultants, and will he go a step further and adopt the ideas of the Brighton consultants for the fast throughput in acute hospital beds which is also an essential part of their scheme?

No, Sir. I have already said that I am not prepared to do so. My view is quite clear that these concepts are very different. I will examine what the spokesman is alleged to have said to the Brighton Evening Argus.

asked the Minister of Health what increased expenditure he is proposing for 1968-69 on research into the causes and treatment of mental illnesses.

Expenditure by my Department on research into various aspects of mental illness and mental sub-normality will be about £54,000 in 1968–69, compared with £33,000 in 1967–68.

As about half the beds in this country are occupied by people suffering from mental illness, will the right hon. Gentleman, in this Mental Health Week, do something to increase the effort, both financial and otherwise, put into research?

As the hon. Gentleman knows, the main agencies for the support of research are the universities and the Medical Research Council for which my right hon. Friend the Secretary of State for Education and Science is responsible. I have no doubt that my right hon. Friend will take note of what the hon. Gentleman has said.

Without denying the value of this kind of research, may I ask my right hon. Friend to give priority to ensuring that local health authorities have a sufficient number of local health workers to visit mental cases on a domiciliary basis?

I think that we need both.

As only 8 per cent. of the Medical Research Council's budget is devoted to research into mental illness and mental subnormality, and as, as my hon. Friend said, 50 per cent. of the hospital beds are occupied by patients who are mentally ill, does not the right hon. Gentleman agree that there ought to be a marked improvement or a full explanation given to the public so that this situation is acceptable to them?

I must ask the hon. Gentleman to address questions about the Medical Research Council to my right hon. Friend who is the responsible Minister.

asked the Minister of Health why it is taking eight years for the Joint Committee of his Standing Medical Advisory Committee and his Advisory Committee on the Health and Welfare of Handicapped Persons to report on the implementation of the recommendation of the Cohen Report on medical and welfare service for epileptics.

The recommendations of the Committee on the Medical Care of Epileptics were commended to hospital authorities when its Report was published in 1956. This followed appropriate advice to local authorities in 1953. The Joint Sub-Committee of the Standing Medical Advisory Committee was set up in 1967 to review the nature and scope of the services currently provided and to advise on their future development. Its report cannot be expected yet.

Can my right hon. Friend say why it took from 1956 until he took office to report what happened as a result of this Report, and, as this question of epilepsy deals with mental health, will he take the opportunity to welcome Mental Health Week and the excellent work being done by the National Association?

I warmly welcome Mental Health Week with which I have been associated in past incarnations. I do not think that my hon. Friend would expect me to comment on the sins of omission of previous Governments.

asked the Minister of Health by what means the patient will be able to appeal against a refusal to grant exemption from prescription charges.

There is no formal right of appeal; but any representations made to my Department or to that of my right hon. Friend the Minister of Social Security against a refusal to issue an exemption certificate will be carefully considered.

Does not my right hon. Friend agree that many people have had great difficulty in reading, and more so in understanding, the advertisements about exemptions, and that the absence of a more formal means of appeal will leave many patients with a sense of grievance in the months ahead?

I hope not. I think my hon. Friend will recognise that executive councils are not exercising any discretion. They are dealing with medically supported facts in issuing exemption certificates. I do not think that this is an appropriate situation for any formal right of appeal, but I am prepared to investigate any representations which might be made to me.

Does not the right hon. Gentleman think that he will put his officers in a difficult position? As interested parties, they are going to be judge and jury in the cases concerned, are they not?

No, Sir. I do not think that that is the case. I think it more likely that there might be representations on grounds of financial hardship, which is a matter for my right hon. Friend the Minister of Social Security, who is well accustomed to this sort of problem.

Will my right hon. Friend take a special look at the problem of appeals in relation to the hospital service? Only yesterday there was considerable confusion, and there is a need for further advice, especially to newly employed people, to cope with this problem.

If my hon. Friend gives me any evidence, I shall certainly consider whether further advice to hospital authorities is necessary.

In view of the grievance which the reimposition of prescription charges will cause, can the right hon. Gentleman say how much money will be saved by their reimposition? Could not cuts have been made in other Government expenditure in place of these?

I do not recall the hon. Gentleman being present in the House when we debated the matter just before the House rose for the Whitsun Recess. It was dealt with at some length then. The saving will be about £25 million a year.

asked the Minister of Health what steps he proposes to take to improve facilities for obtaining medicines prescribed by doctors in rural areas.

Executive councils are responsible for securing the provision of adequate pharmaceutical services in their areas and for dealing with any local difficulties which may arise. I am not aware of any need for general action.

Is my right hon. Friend aware that with the growing number of old people and the progressive decline in rural transport services it is becoming more and more difficult for old people to get to chemists' shops to get prescriptions made up? Will he ask local executive councils to look at the whole problem again?

I think that executive councils keep this matter continuously under review. The difficulties in remote areas are often eased by informal arrangements, or, where these are not appropriate, by schemes organised with safeguards and with the advice of the Pharmaceutical Society for the collection of prescriptions and the delivery of medicines.

In considering the difficulty of dealing with prescriptions, may I ask the right hon. Gentleman not to forget the problem of people in remote country areas buying household remedies? Will he give an assurance that the general sale list to meet these needs will, from the start, be made as wide as possible?

I hardly think that that arises out of this Question, but I think that I gave the hon. Gentleman similar assurances during the Committee stage of the Medicines Bill.

Is my right hon. Friend aware that in important urban areas such as Stoke-on-Trent there are pharmaceutical deserts in which people do not have access to chemists' shops? Will my right hon. Friend consult the executive councils to try to set up a chain of pharmaceutical prescription collection points, because the pharmaceutical authorities are favourably disposed towards that suggestion?

If my hon. Friend has a particular area in mind and would like to send me details, I will certainly look into it, but I should remind the House that I have no power to require a pharmacist to practice in a particular place.

asked the Minister of Health if he will state when he intends to introduce legislation to ban cigarette coupons.

I cannot say at present.

Would my right hon. Friend at least confirm that he will be introducing legislation in the near future, without giving us any definite date? Would he go a little further, in view of the fact that over 30,000 people will die of lung cancer in this country this year, and start now a much bigger public health and educational campaign to try to get people off cigarette smoking?

On the question of the campaign against cigarette smoking, the newly-constituted Health Education Council will be dealing with this matter in due course. As to the time of the legislation, my hon. Friend knows that it is not for me to decide. The statement which I made on 23rd October last stands.

While it is obviously important and invaluable for the Ministry to put over all the information it can by way of publicity to people warning them of the dangers of unnecessary smoking, may I ask what is the point of trying to ban their smoking if they so wish, since they can die in any way they wish?

I have a responsibility to the House and the country for the promotion of health as well as the cure of disease.

You might as well ban everything.

Would my right hon. Friend see that any proposed Bill along these lines is put in the dustiest pigeon-hole in his Ministry and allowed to remain there?

Would the right hon. Gentleman resist the temptation to interfere with the marketing methods used by the firms concerned of a product which is freely on sale?

asked the Minister of Health whether he will make a detailed statement on the National Board for Prices and Incomes' Report No. 60 on the Pay of Nurses and Midwives in the National Health Service.

asked the Minister of Health whether he will now make a detailed statement on Report No. 60 of the National Board for Prices and Incomes on the Pay of Nurses and Midwives in the National Health Service.

I would refer the hon. Members to my reply on 28th March to my hon. Friend the Member for Fife, West (Mr. William Hamilton).—[Vol. 761, c. 335–6.] So far the Whitley Council has reached agreement on a number of recommendations including the four per cent. increase, effective from 1st October, 1967, in salaries and board and lodging charges, the psychiatric and geriatric leads, effective from 1st April, 1968, and the extension of overtime payments in psychiatric hospitals, effective from 1st October, 1968.

In that reply, the right hon. Gentleman said that he would be having discussions with the nurses and midwives concerning the recommendations about training and management. Have those discussions yet taken place?

No, Sir, they have not taken place, but they will take place shortly.

But is the right hon. Gentleman aware that there is a considerable feeling of unfairness among student and pupil nurses living in, because, at the end of May, they were required to pay increased charges for board and lodging which they have already had and paid for over the previous eight months?

Board and lodging charges, which are still heavily subsidised, have always been linked with the pay of student and pupil nurses, and it was a clear recommendation of the Prices and Incomes Board that the two increases should be operative simultaneously.

Would my right hon. Friend undertake to look very carefully at this proposition, especially where there are gross and unfair anomalies in the Board's Report? Is it not the case, for instance, that a three-year trained staff nurse at the maximum will get less than a two-year trained senior enrolled nurse? Is this not a gross reflection on the nursing profession?

These matters will be considered in detail by the Whitley Council and it would not be appropriate for me to comment on them while these negotiations are in progress.

Would my right hon. Friend not think it appropriate at this time to advise the Whitley Council that overtime payments should now be made to all nurses, no matter what sort of hospital they work in?

It is not for me to advise the Whitley Council. The Council is considering the recommendation of the Board which, with the agreement of the Government and the profession, considered the whole matter of nurses' pay.

Surely it is within the Minister's competence to express an opinion about differentials. Can he assure us that he has taken the point of the narrowing of the differential, partly due to overtime, between the highest-paid auxiliaries at the lower end of the scale and the lowest-paid matrons at the top end of the scale? Would he not consider the effect of this on recruitment, on people staying in the profession and on incentives for those seeking higher positions, particularly tutorial positions?

I have had no representations on this matter yet, but I will consider the point which the hon. Gentleman raises.

asked the Minister of Health whether any nurses will receive less payment as a result of the review of the National Board for Prices and Incomes on the pay of nurses.

The Board's recommendations on pay are still under negotiation in the Nurses and Midwives Whitley Council. None of the agreements so far reached could result in a nurse receiving less payment.

Is it not rather strange to find, in a Report stressing the need to attract more part-time staff, that nurses who work only on Sunday or do night duty on fewer than five nights a week will, so far as I can see, actually receive less? If that is so, will the right hon. Gentleman iron out that kind of anomaly?

This point is still under discussion, and, although a considerable extension of the arrangements for special duty payments is recommended—at considerable cost, I may say, to the Exchequer—the present rates would be reduced for many nurses. This matter is being discussed by the Whitley Council, which is seeking further advice from the Prices and Incomes Board.

Will the right hon. Gentleman assure us that no nurses will receive less pay under the new arrangements?

It would be wrong for me to give any assurance at this stage while the matter is not only under discussion at the Whitley Council but has gone back to the Prices and Incomes Board.

asked the Minister of Health whether he will make a detailed statement on the Review Body on Doctors' and Dentists' Remuneration 9th Report, Command Paper No. 3600.

asked the Minister of Health whether he will make a detailed statement on the Review Body on Doctors' and Dentists' Remuneration 9th Report Command Paper No. 3600.

Discussions are in progress with the medical profession on matters left for negotiation with them but implementation of the Review Body's recommendations for doctors and hospital dentists must await the professions' decisions on these recommendations. It has been agreed that the recommendation that the target net income of general dental practitioners should remain unchanged does not at present require revision of the scale of fees.

But does the right hon. Gentleman not think, in view of the amount which is spent on training and the increasing amount which it is proposed that the Commission should spend, that an increase in doctors' remuneration is required if medical practitioners are to be retained in this country and he does not in future face the necessity of sending missions to the United States to try to get them to come back?

All these points were considered by the Review Body on the evidence submitted by the profession, and it made its Report. That Report is still under discussion, as I said, with the profession.

asked the Minister of Health whether he will now make a statement on the Report of the Royal Commission on Medical Education.

I have nothing yet to add to my reply of 23rd April to my hon. Friend the Member for Willesden. West (Mr. Pavitt).—[Vol. 763, c. 22.]

Does not the Minister appreciate, while one understands the necessity for consultation, that, in the interim, the whole system of medical education is in the melting pot, right across the board? Does he not feel that that lends urgency to a decision by him?

Yes, Sir, and I can assure the hon. Gentleman that, as my right hon. Friend the Prime Minister promised on 4th April, the Government are now examining the recommendations in the Report most urgently.

asked the Minister of Health how many full-time training centres are now approved by the Training Council for Teachers of the Mentally Handicapped; and how many this represents for adult training centres and junior training centres.

There are 17 full-time courses approved by the Training Council now in operation and the number will increase in September to 22, of which seven will be for staff of adult centres and 15 for staff of junior centres.

I am not sure about the hon. Gentleman's answer—[An HON. MEMBER: "It is not in your brief."]—At least I write my own. He implied that he was talking about how many courses were approved by the Training Council. I asked how many training centres are approved. May I take it that the answer is the same in both cases?

On a point of order. Are we witnessing an innovation in constitutional practice, in that the hon. Member for Farnham (Mr. Maurice Macmillan) is reading from a carefully prepared brief? If this is so, are these briefs prepared by the Civil Service?

That is an interesting point, but not exactly a point of order.

I should like to answer the hon. Gentleman's question qualitatively. In most cases the terms are synonymous, but not absolutely so. There is a new possibility of recruiting more people for this sort of work in the shape of the new course being established at the Ewell Technical College, a part-time two-year course for older women wishing to take up the teaching of mentally handicapped children, and this will start shortly.

asked the Minister of Health how many teachers employed in training centres for the mentally handicapped are qualified.

At 30th September, 1967, 1,020 supervisors and assistant supervisors in local authority training centres were qualified to teach the mentally handicapped.

Would the hon. Gentleman agree that the new methods of training are yielding very encouraging results and does not this suggest that a higher priority should be given to qualified teachers?

The figures for staff who are now undergoing courses and are securing appointments show a quite reasonable improvement, but we have a lot of leeway to make up.

asked the Minister of Health whether he has considered the evidence as to the number of old people not getting the services they need, put forward by the Officer of Health Economics, details of which have been sent to him; what conclusion he has reached; and what action he proposes to take.

The research reported in this useful publication is well known both to my Department and to the authorities responsible for providing services. Development of existing services will continue, and the authorities' powers will be greatly augmented by Clause 45 of the Health Services and Public Health Bill at present before Parliament.

Would the hon. Gentleman agree that nearly three-quarters of a million people over the age of 65 who are in need of, for example, chiropody services, are not receiving them and that the demand for the home help service is more than twice the rate of supply? Will he seek to extend these services which are so important to old people?

If the hon. Gentleman examines the proceedings in Committee on the Clause to which I have referred he will see that the matter was adequately discussed, and we think that it will increase flexibility in the provision of the care and various services which he mentioned. These points were discussed and examined to the general satisfaction of that Committee, but perhaps we can look at the matter again.

Would the Parliamentary Secretary agree that many elderly people occupying expensive and scarce hospital beds could be more effectively and more happily cared for in sheltered accommodation with proper domiciliary services? Will he place the emphasis of his policy on short-stay geriatric units coupled with adequate domiciliary services?

That is the emphasis which we are at present placing, but we believe that the increased general facilities about which I spoke when answering his hon. Friend the Member for Surbiton (Mr. Fisher) cover the point he has made, in addition to the more general question.

asked the Minister of Health, in view of the large number of inoculations and immunisations required by children which are spread over a long period, if he will recommend to local health authorities that they adopt a standard official form of record card to be given to parents to enable them to check that inoculations are given at the right time.

Many local health authorities already issue record cards for this purpose, and this was one of the points brought to the notice of medical officers of health by my right hon. Friend's Chief Medical Officer in a recent letter aimed at improving acceptance rates.

I appreciate that, but does not the Parliamentary Secretary think that as the number of inoculations and immunisations increases, so it would be advantageous to standardise the form to ensure that it is the same throughout the country?

This would be desirable but not entirely practicable since local practice and usage is not identical in all areas. My right hon. Friend is commending a new schedule which will go a long way to meet what the hon. Gentleman is suggesting.

Would my hon. Friend realise that this is a matter of particular importance to patients in remote parts of Scotland and in country districts? Will he, in making any beneficial changes, bear this in mind?

I will always take note of anything mentioned by my hon. and learned Friend, but this matter would be more appropriately raised with my right hon. Friend the Secretary of State for Scotland.

asked the Minister of Health what steps he is taking to increase facilities for the domiciliary care of geriatric patients.

Local authorities plan substantial development of their domiciliary health and welfare services for the elderly and others and the powers envisaged in Clause 45 of the Health Services and Public Health Bill should assist this. The increasing association of local authority nurses and health visitors with family doctors should improve the domiciliary services available to all, including the elderly. Day hospital and outpatient geriatric provision is also being expanded.

Would not my hon. Friend agree that, as his general policy is to decrease the number of old people's beds in hospitals and not to increase them, a great burden will rest on general practitioners and local authority services?

Yes, Sir. While this is so, it is not necessarily undesirable. The intentions behind Clause 45, to which I have referred this afternoon, include using facilities outside hospitals which may in many cases be more desirable and satisfactory to the people concerned. This is a more flexible attitude which my right hon. Friend has adopted and which we think will serve the public well.

Would the hon. Gentleman consider the suggestion, put to him several times, of the appointment of a new officer to local health authorities —an old person's officer—to be responsible for the integration of all these services which are coming from so many different sources?

I will look at this matter and discuss it with my right hon. Friend.

asked the Minister of Health what steps he is taking to encourage doctors to remain in this country rather than leaving to work permanently abroad.

A number of important improvements in the working conditions of hospital doctors were agreed last year and further proposals have been made with a view to improving career planning and prospects of junior doctors. As regards general practice, I would refer my hon. Friend to my reply to my hon. Friend the Member for Newark (Mr. Bishop) on 5th February.—[Vol. 758, c. 13–14.] My aim is to improve still further, in consultation with representatives of the profession, working conditions throughout the National Health Service as the best means of encouraging doctors to remain in this country.

Would not my right hon. Friend agree that the emigration of at least 500 doctors a year is extremely serious? Has he implemented the suggestions made to him by the group of doctors who recently visited America to interview other doctors who had emigrated there?

Yes, Sir. I have certainly considered that report and I agree that emigration is a serious problem. However, it is not a new problem and nor is it one confined to this country. The best statistics I have available suggest that, on average, in the three years ending September, 1965—the latest date for which figures are available—the annual net loss of British doctors was about 370.

Is the Minister aware that the hand-out his Ministry issued on Friday, 5th January, indicated that the main reasons for doctors leaving the country were medical, that is, the conditions of work, and the main reasons for their return were non-medical, that is, considerations about children's education and so on? Therefore, when considering net figures such as those he has just quoted, will he bear in mind that what is bringing the doctors back is not necessarily the conditions of the National Health Service, although that may be what is sending them out in the first place?

We are steadily improving conditions in the National Health Service. As I said in my reply, it is our aim to make further progress in this direction.

Will my right hon. Friend look at the position of the junior partners in general practice partnerships, as the conditions of service and the partnership agreements they have signed are sometimes the reasons why they emigrate?

This may well be the case, but my hon. Friend knows that the question of partnership agreements freely entered into between doctors is not a matter for me.

Is the Minister aware that a number of doctors are writing to their Members of Parliament saying that they wish to emigrate, because they feel that they are losing the art of medicine in this country and are becoming form-fillers and not healers?

I think that there were always a small minority of doctors who wrote in this strain.

asked the Minister of Health if mental health education is to be part of the responsibility of the newly-formed Health Education Council.

The Council's remit extends to mental health education.

In view of the Minister's statement, which I welcome, would not it be helpful to have on the Council one person clearly identifiable as having a primary interest in mental health?

I think that there is more than one member of the Council who has had experience of this work, and there is an additional member who I know has experience whose appointment takes place in a month or two.

asked the Minister of Health how many local authorities run home employment schemes; and how many mentally and physically disabled people are assisted in this way.

Paid home employment is provided for 798 blind people by local authorities under schemes for home workers. No other statistical information is available.

Why cannot this scheme be extended to the psychiatric patients? Does the Minister realise that that would have an immense therapeutic value? Will he see that local authorities extend it to this group?

Yes, Sir, but we must bear in mind that a slight difficulty develops sooner or later over social security benefits to which such patients are entitled. Therefore, we must watch the position rather carefully. There is no objection to this sort of incentive being provided.

asked the Minister of Health if he is yet in a position to issue guidance to local authorities on the principles which should govern incentive payments to trainees in adult training centres for the mentally handicapped.

Guidance was issued last October.

Can the Minister say what the response to the guidance has been from the local authorities? Is he satisfied that it is working correctly?

It is a little early to read any particular lesson into the guidance that was given, but as regards incentive payments for mentally handicapped patients in training centres, we are under the impression that there are grounds for optimism. We must watch the position over supplementary benefits rather carefully, as I said in reply to an earlier Question.

asked the Prime Minister whether the public speech made by the Lord President of the Council on 10th May at Aynho about the freedom of the Press represents the policy of Her Majesty's Government.

The published portion of my right hon. Friend's speech to the Banbury Constituency Labour Party—and it is this which I imagine the hon. and learned Member has in mind—did not deal with matters of Government policy, Sir.

Is it really true that the Prime Minister has suffered from the Press " an orgy of abject and uncritical adulation", as the Lord President said? What does the Wonder Boy say?

asked the Prime Minister when he will make an official visit to Czechoslovakia.

I have no present plans for such a visit, Sir.

Will my right hon. Friend bear in mind that the Conservative Government once betrayed Czechoslovakia in the same way as the Opposition would now betray the people of Rhodesia? Will he seek to make amends by considering what economic assistance can be given to Czechoslovakia to maintain conditions in which there can be further progress towards freedom? In particular, will he consider releasing a certain amount of gold to that country?

I do not think that it would be right for me to comment on what is currently happening internally in Czechoslovakia, but two of my right hon. Friends have recently visited Czechoslovakia and one discussed in some detail the possibility of improving trade arrangements with Czechoslovakia. I think that trade rather than economic assistance is what would be appropriate.

Arising from the supplementary question, will the Prime Minister tell the House how a previous Conservative Government could have saved Czechoslovakia from its fate when the Labour Opposition refused to vote any arms at all and were against conscription?

It all seems a long time ago, but I do not believe that many Conservatives today defend their then Government's record in 1938.

asked the Prime Minister if he will now make further efforts to negotiate a settlement of the Rhodesian question.

asked the Prime Minister if he will make a further statement on Rhodesia in the light of the Whiley Report and the United Nations resolution.

asked the Prime Minister what further action is proposed through the United Nations Organisation to end the illegal régime in Rhodesia; and if he will make a statement.

Our policy regarding a settlement in Rhodesia remains as described by my right hon. Friend the Commonwealth Secretary and myself during the debate on Rhodesia on 27th March. On the question of action through the United Nations I would refer hon. Members to the Answers given by my right hon. Friend the Commonwealth Secretary to Questions on 30th May.— [Vol. 761, c. 1662; Vol. 761, c. 1545; Vol. 765, c. 2135.]

Lest the House may be tempted to conclude from that reply that the right hon. Gentleman enjoys his rôle as the eye in the centre of the typhoon, will he state unequivocally—I know that that is "difficult for him—if he is prepared to resume negotiations with Mr. Smith forthwith?

The position is exactly as stated in the debate and several times in Answers to Questions since. We have said that we are prepared to consider any possibility arising out of a willingness to implement the six principles. There has so far been little evidence of any willingness to accept the six principles, and in the most recent public statement there was a flat denial of their acceptability to Rhodesia.

If the Prime Minister will not talk to the Rhodesians, is his policy now to wait until sanctions have caused the Africans to revolt? Can the right hon. Gentleman say whether his Ministers have had any talks with African leaders who organise the freedom fighters-cum-terrorists?

I see that the hon. Gentleman is very faithfully reporting a speech by Mr. Smith during the Recess. The position is that, appropriately, Commonwealth Office Ministers have had talks with African nationalist organisations in this country and in Lusaka. We do not accept the illegal proscription or detention of Africans carried out by the hon. Gentleman's friends, and it is perfectly appropriate that the Government who have the ultimate responsibility for deciding the fate of Rhodesia in a Parliamentary sense should have talks with representatives of the majority as well as the minority in Rhodesia.

Can my right hon. Friend say approximately how many countries have initiated action to implement the Security Council Resolution? Will he confirm that right hon. and hon. Members opposite who for months have been declaring that sanctions must be ineffective are likely shortly to find their doubts on that score set at rest?

I have not had an up-to-date list of the number of countries that have already taken legislative or executive action, but certainly a number of countries quoted by hon. Members opposite as permitting trade with Rhodesia have already taken action. With regard to my hon. Friend's second question, I do not think that there will be any doubt that sanctions are having a considerable effect and that there is great anxiety in Rhodesia about them. No one in the House would want to see sanctions last for a day longer than necessary. As I said to Mr. Smith on H.M.S. " Tiger ", we could have started to unwind sanctions in December, 1966, if he had accepted the terms then proposed to him, which the Conservatives supported him in rejecting.

Is the Prime Minister aware that we on this bench welcome the steps which have just been announced by Her Majesty's Government in order to negotiate the right kind of settlement?

Yes, Sir. Of course, this is a question of the right kind of settlement. Everyone wants to see a settlement there but that settlement must be in accordance with the principles laid down by the previous Government in this country and accepted by Her Majesty's present Government. These are the principles which the whole House has maintained and if any hon. Members in any part of the House are prepared to rat on those principles, we are not.

Although it is possible that the Monday Club is right and that the unanimous view of the Security Council is wrong, is it not a fact that the Rho-desian Front has rejected the Whaley Report and has come down on the side of permanent white supremacy? Does not this show the futility of further negotiations with Ian Smith? In what way is the United Nations proposing to make sure that the new sanctions are effective?

I do not think that any hon. Member has suggested that the Whaley Report was consistent with the six principles, but, whereas Mr. Smith showed some desire to accept it, it is clear that pressure from the Right caused him to move into the even more intransigent position which was set out in his interview with the Sunday Telegraph some weeks ago.

Will the Prime Minister give a clear answer to the question put to him earlier? Is he or is he not prepared to resume talks with Mr. Smith now with a view to making a further effort to find out whether it is possible to reach a settlement?

I would refer the right hon. Gentleman to our debate in March, his absence from which we all regret and understand, when I stated the position clearly. I have repeated that position many times since. If we get clear evidence of acceptance of the six principles from those who have the power to talk in Rhodesia, we will be prepared to talk, but every attempt made so far has led either to the rejection of the six principles or, when progress was being made, to a scurrying away under pressure from the Right wing. In any case, we cannot deal with the racialists in Rhodesia.

Despite what has been said on the Opposition benches about the ineffectiveness of sanctions, has my right hon. Friend noted the reports from Rhodesia about increasing pressure by business interests on the Smith régime? Would not he agree that, until this kind of pressure for a more realistic attitude by the régime begins to show results, it would be premature to consider further approaches to Rhodesia?

It is not so much a question of a more realistic attitude by the régime but of a more broadly-based Government such as we proposed to Mr. Smith in the talks on H.M.S. "Tiger" and which at that time he was prepared to contemplate. There is no doubt, from the pressures and very gloomy statements both by the tobacco industry and by the organised chambers of commerce and industry, that sanctions are having a very serious effect. We all regret that they have had to go on so long and that there has been no response by those responsible to the kind of offers made so frequently in accordance with the six principles.

asked the Prime Minister whether the speech of the Minister of Technology at Llandudno on 25th May, recommending changes in the Parliamentary system, with a view to preventing a breakdown of law and order, represents the policy of Her Majesty's Government.

asked the Prime Minister whether the public speech by the Minister of Technology at Llandudno on 25 th May on the use of referenda represents the policy of Her Majesty's Government.

I would refer hon. Members to the Answer I gave on 29th May to a Question by the hon. Member for Moray and Nairn (Mr. G. Campbell). [Vol. 765, c. 241–2.]

If the Prime Minister shares the view of the Minister of Technology that Parliament is getting out of touch with the country, has he considered the idea of holding a Genera] Election?

I do not in any way share the view that Parliament is out of touch with the country. I heard the noteworthy broadcast the day after my right hon. Friend's speech in which my right hon. Friend and the right hon. Gentleman expressed their personal views on these matters. I thought that the truth lay somewhere between the two.

Would not the Prime Minister be wise to accept the Minister of Technology's advice and hold a referendum on whether or not we should withdraw our application to join the Common Market and so avoid the discontent which the Minister of Technology envisaged would engulf the nation in bloodshed?

I do not think that there is any question of bloodshed arising from the decision to apply to join the Common Market, which was accepted by such a large majority in the House. I do not recall that my right hon. Friend suggested a referendum on the matter which is so dear to the right hon. Gentleman's heart, but I think that most right hon. and hon. Members would regret the idea of government by referendum.

Would my right hon. Friend agree that there is great danger in having a referendum, which might quickly become a plebiscite? Recognising this, and also accepting that a gap may be widening between public and Parliament, may I ask him to look into the possibility of creating a system whereby it is possible for members of the public to record their opinions and make those opinions collectively accessible to Parliament?

I am not sure that my hon. Friend always fully responds to these judgments when they are made by members of the general public, but I think that the real issue, as the House recognises, is that every Government of whatever party must sometimes take, over a fairly lengthy period, measures unpopular but necessary. If each of these measures or each tax proposal had to be submitted to an immediate referendum, there would be no Government and no taxation.

asked the Prime Minister if he will place in the Library a copy of his public speech to the Church Assembly in Scotland on human rights on Sunday, 26th May.

asked the Prime Minister if he will place in the Library a copy of his public address to the Church Assembly in Scotland on Saturday, 25th May.

I have already done so, Sir.

My own researches confirm my right hon. Friend's answer and I thank him for his action. Will he confirm that, with a few rather bad exceptions, the civilised world is moving towards a consensus about the proper treatment of minorities and that, if the Race Relations Bill reaches the Statute Book substantially in its present form, we shall shortly be in a position to ratify the United Nations Convention on Racial Discrimination?

My speech referred to the Race Relations Bill but in a non-political and non-party sense appropriate to a gathering of that kind. Indeed, I went so far as to quote what had been said by certain right hon. Members opposite on the question. I agree that some of the deep disappointments there have been in other countries, and the attempt, which appalled so many of us recently, to whip up racial hatred in this country, are exceptions to the decent views of the people of this country and of most other countries where we have seen these manifestations as well.

What is the Prime Minister doing about the improvement of race relations in Nigeria?

If the hon. Gentleman is referring to the extremely difficult situation following the breakdown of the talks which we tried so hard to get established in Kampala, my right hon. Friend will be answering a Question, I understand, at the end of Question Time on the whole situation in relation to Nigeria.

asked the Prime Minister if he will invite the President of Tunisia to visit the United Kingdom to discuss matters of mutual concern.

I have no present plans to discuss matters of mutual concern with President Bourguiba but he would of course always be a most welcome visitor to the United Kingdom.

Has my right hon. Friend seen the constructive and statesmanlike proposals put forward by President Bourguiba recently for a solution of the Middle East situation? What initiative are Her Majesty's Government using to take steps towards the solution of the increasingly dangerous situation in the Middle East?

While some form of United Nations force might have a place in any arrangements for putting the Security Council Resolution of 22nd November into effect—and this was envisaged, as he explained at the time, by my right hon. Friend the Member for Belper (Mr. George Brown) when he was Foreign Secretary—it would be inappropriate for me at this moment to comment when Mr. Jarring is pursuing his very difficult talks in New York. We must leave implementation matters until those talks make further progress.

asked the Prime Minister if he is aware of the disproportionately small number of women appointed by him to serve on public committees, councils and boards, and of the valuable services rendered by women in the Civil Service and in other spheres; and what plans he has made to correct this disproportion in future appointments.

The Government are well aware of the contribution women can and do make in so many spheres; as to public appointments, these are made solely on the basis of suitability for the post concerned, and very many women have accordingly been appointed.

In view of the success of those already appointed, and indeed those elected to this House, will the Prime Minister appoint more so as to establish equality between the sexes in the various spheres of public service?

The real way, of course, to establish and honour the principle of equality is to appoint the best person for the job regardless of whether that person is a man or a woman. If one starts arguing that we have to appoint more women just because they are women that is a denial of equality in itself.

Is the Prime Minister aware that on regional economic planning councils women are conspicuous by their absence? In view of his expressed opinion, will he correct this omission?