asked the Secretary of State for Social Services whether he will include representatives of the hospital doctors, including junior hospital doctors, in his consultations with the profession on the Zuckerman Report on Hospital Scientific and Technical Services.

Yes, Sir.

I thank the Minister for that Answer. I am grateful for the time that it will give us to debate these proposals. But has there been any change of heart, feeling or emphasis within the Ministry about the possible time, rate or plans for implementing or producing any further publications as a result of public discussion?

There has been no change of heart or policy since I made the announcement to the House a few weeks ago. We are now in the process of consulting a wide range of organisations within the profession, including hospital doctors and others, and so soon as we have their advice we will be in a position to decide on policy.

asked the Secretary of State for Social Services whether he will now state his plans for overcoming the shortage of operating theatre nurses.

I have nothing to add at present to the answer I gave to the hon. Member for Farnham (Mr. Maurice Macmillan) on the 18th November.—[Vol. 773, c. 211.]

Does the hon. Gentleman recollect that that is an exact carbon copy of his Answer to a similar Question on 2nd December? Does he realise that about three-quarters of the theatre nurses are on call outside their duty hours, when they are supposed to be resting? Is not this an intolerable situation, in view of the strain and responsibility involved in current operations?

Yes, but the hon. Member will recall that in my earlier Answer to his hon. Friend I said that this matter was being examined by the appropriate committee. I can now say that the report should be available about mid-1969. That is not so very far ahead. I would add that we fully take into account the fact that the work load has increased as a result of improvements in treatment and operations. We must take that fact into account, along with the fact that we now have more nurses in post than ever before.

Will my hon. Friend assure the House that Commonwealth immigrants Who enter this country for other employment and become qualified to take such nursing posts will have no impediment put in their way, nothwith-standing the recent speech by the Leader of the Opposition this weekend requiring certification authority for a change of employment? Will he give an assurance that people will not be hounded in this way?

I can give an unqualified assurance on that point. It should be remembered that many of these immigrant nurses who have now achieved improved qualifications in this country were brought here under the auspices—in terms of the Ministry concerned—of the right hon. Member for Wolverhampton, South-West (Mr. Powell).

asked the Secretary of State for Social Services what plans he has to assist hospitals fill medical and nursing staff posts which are vacant owing to lack of money to pay salaries.

It is for hospital authorities to decide priorities for expenditure within the resources available to them.

Does the Minister recall that when this Question was last asked on 2nd December the House was told that the Secretary of State was giving this problem his urgent attention? Does he agree that vacancies are still not being filled for nurses and doctors, because there is not sufficient money to pay their salaries?

I am afraid that we do not keep a special record of vacancies which may be due to lack of finance within a particular hospital authority, or which may be due to the non-availability of nurses or medical staff. But there are some such cases and, as I said in my original reply, this is, of course, the responsibility of the hospital authorities, but we are doing a good deal to help in this respect. After all, there was an increase in pay for nurses in January this year and we are also doing as much as we can to relieve nurses of some of their responsibilities, which would enable them to make fuller use of their time.

Will my hon. Friend confirm that, in hospital budgeting, this sector is the most crucial of all the financing that we do? Second, would he call for a further review of the establishment of hospitals, since many of these vacancies appear because many of the establishments are not realistic?

I will look into the last part of that question. On the first part, my hon. Friend is absolutely right.

asked the Secretary of State for Social Services what plans he has for extending facilities for treatment of alcoholics.

Hospital boards plan to provide four new special units for this purpose and to increase the size of one existing unit; others are under consideration.

In view of the estimates that there are between ¼ million and ½million people suffering from alcoholism and that the cost to industry in lost man-hours is over £40 million a year, may I ask whether the Secretary of State is absolutely satisfied that the facilities for treatment are adequate and, indeed, that his Department is taking this whole problem sufficiently seriously?

I think that the increases now proposed in the hospital boards indicate the seriousness with which we are taking it One would never say that one was satisfied with the attention being given to a major evil of this kind.

Would not the right hon. Gentleman confirm that it is a fact that less spirits are being consumed today because of the exorbitant taxes inflicted by this Government?

That is a different question.

asked the Secretary of State for Social Services if he is aware of the need for the enlargement of the casualty department at the Stockport Infirmary; and what action he is taking to remedy the situation.

Yes, Sir; work to enlarge and improve the department will begin as soon as planning is completed.

While thanking my hon. Friend for his reply, may I ask him to expedite this work in co-operation with the regional hospital board, as this is the only casualty department in the City of Stockport?

Yes, Sir. The current estimate of the cost of the works to be provided is about £73,000, and the delay has been occasioned by the need to find alternative out-patient accommodation at Stepping Hill hospital. Until that is provided, one could not go on with the planning of the new accommodation.

asked the Secretary of State for Social Services whether he will publish the comments which he has received on the Green Paper on the Structure of the Health Service.

Not at this stage.

Will the right hon. Gentleman tell the House when he intends to publish any comments that he has received on the Green Paper? If this is to be a public debate, surely it would be better if it were conducted in public so that all sides of the argument were known to all who may take part in it?

I think that is very reasonable. I have so far received 280 comments, many of them extremely long. The difficulty is that people were not told when they sent them in that they were for publication. I have no objection to any of the interested bodies publishing on their own, but I will consider later whether anything further needs publishing.

asked the Secretary of State for Social Services how many people have had their supplementary benefit allowance curtailed as a result of the more rigorous checks on young people applying for social security benefits announced on 25th July, 1968.

Between 1,800 and 1,900 decisions to issue a short-term allowance from the outset of a claim are made each week. In addition, about 200 claimants who have already received allowances for three months have the period of any further payment limited to four weeks.

Will the Minister confirm that the physically and psychologically unfit are not being harshly treated under this new policy? Does the Minister agree that for a young, fit, single man without family responsibilities, supplementary benefits should be curtailed not merely if there is suitable employment in his locality, but if such employment is available at any distance up to, say, 100 miles?

Taking the second point first, that is indeed part of the policy which is being applied.

When looking into this problem, will my right hon. Friend consider the position of a person sent to work at another place where train services are being cancelled or abolished altogether, making it almost impossible for him to work at a distance of up to 100 miles, as suggested by the hon. Member for Liverpool, Garston (Mr. Fortescue)?

If my hon. Friend can draw my attention to any such case I will go into it. Certainly the availability of travel facilities should be taken into account in all these cases.

asked the Secretary of State for Social Services by how much prices have increased since pensions were last increased.

7·3 per cent. measured by the Index of Retail Prices.

As prices have been rising more rapidly in recent weeks, may I ask whether the Government can hold out any hope of improving on the rather gloomy forecast of the Prime Minister a year ago when he implied that the earliest time for the next increase in pensions would be autumn this year?

The hon. Gentleman will no doubt have in mind that during the period when this rise took place the supplementary benefit scales have been raised. I am referring to the period since pensions were last raised in October, 1967. This is a factor which will be taken into account in the next review during the next 12 months.

asked the Secretary of State for Social Services what is the loss in value in real terms of the National Insurance retirement pension since it was last increased.

asked the Secretary of State for Social Services what has been the reduction in the purchasing power of the £4 10s. pension since it was fixed at that weekly rate.

Measured by the Index of Retail Prices, the purchasing power of the retirement pension which has been considerably improved since this Government look office has, since its last increase in 1967, diminished by rather less than 7 per cent.

How is that Answer to be reconciled with the Prime Minister's promise that the most vulnerable sections of the community would be safeguarded against the effects of devaluation?

It depends upon the periods at which the reviews take place. The Prime Minister made that promise, and I would stress that the present level of the pension is still considerably above the level, in terms of its real value, in October, 1964. This change in the cost of living will be taken into account when the next review takes place.

Has not the hon. Gentleman read the report of the Cost of Living Advisory Committee, which shows that the basic prices paid by pensioners were increasing faster than the average rise in the cost of living index? Bearing in mind that on the right hon. Gentleman's own figures there has been a fall of 6s., was it on a different basis from the pensioners' budget, on the figures given in this report?

The hon. Gentleman will know that a further report is coming out on this subject. My hon. Friend the Under-Secretary for Employment and Productivity has promised to bring this out, and we: shall take this into account in assessing what shall be done about pensions in the next review.

Does not my right hon. Friend agree that nearly all the claims for increased wages today are based on the fact that the cost of living—and particularly the cost of food—is continually rising? As these claims are accepted in many cases, why are pensions not increased in order to meet what is accepted as the continuing rise in the price of food?

This factor will be taken into account. It depends at what periods the pensions are reviewed. They will be reviewed again shortly. In spite of the fact that their real value today is higher than it was four years ago, they will be reviewed and this rise in the cost of living will be taken into account.

The right hon. Gentleman seems complacent. In considering the burden of rising costs on pensioners will he also take into account the fact that in the first four years of this Government the real value of pensions has been increased by 14 per cent. whereas in the last four years of the former Conservative Government the real purchasing power of the pension was increased by 19 per cent.? Could elderly people have expected this deterioration in their interests from the speeches delivered by the Government spokesman at the last election?

I should make it plain that the increase of 14 per cent. is an increase in real value of the pension as left by the Tory Administration. That is the position about which we are talking. Nothing that I have said is complacent. The real value of the pension is higher. Though we recognise that the cost of living has been rising, we cannot deal with this matter from month to month. We shall deal with it in the next review.

asked the Secretary of State for Social Services what is the current actuarial value of the National Insurance pension for someone who had paid contributions for 20 years, excluding the Exchequer subsidy.

This depends on various assumptions, including the interest rate assumed, and, in the case of pension for a married couple, on the age of the wife. Assuming, for example, a rate of interest of 5 per cent. the contributions paid for retirement pension over the last 20 years by a man and his employer might provide a weekly pension of £2 3s. 0d. for a single man aged 65 and £1 14s. 0d. for a married couple where the man is 65 and his wife is 60.

On what basis of equity does the Government continue to refuse to pay to people over 80 the difference between the actuarial value of the pension and the current level of benefits? Will the Minister undertake to support my hon. Friend the Member for Farnham (Mr. Maurice Macmillan) when he introduces a Bill to remedy this situation?

I am not sure whether I understand the hon. Gentleman aright. The basic point is that this is a contributory scheme, and the Fund is based on contributions from employers and employees, with a supplement from the Exchequer. Those who have not been in the contributory scheme cannot draw a contributory pension. That is precisely why we have established the supplementary benefits system—in order that those people shall be entitled to something from the Supplementary Benefits Commission.

asked the Secretary of State for Social Services whether he will now extend the provision of cervical cancer smear tests for women under 35 years of age.

I have nothing to add to my reply of 2nd December to the hon. Member.—[Vol. 774, c. 1031–1032.]

Does the Minister realise that I am attempting to clear up some ambiguity? Will not he say clearly whether the reason is a shortage of money or too many people taking advantage of the existing facilities?

The point is that the priority, in terms of danger, is for those who are over the age of 35. I can point out that, where laboratory facilities permit, there is no refusal in respect of those under the age of 35. Many younger women are already being screened at hospital ante-natal and post-natal clinics and local authority clinics, but the greatest danger is for those over the age of 35. We are doing everything we can to encourage people in that age range to come forward for screening.

Can my hon. Friend say what percentage of women aged over 35 were tested last year? Does not he agree that the first priority must be to increase the acceptability of this test to the women who are most at risk?

I agree. The question of acceptability is an extremely important one. We welcome the work being done by women's organisations and, interestingly enough, now, by trade unionists, to make the importance of this known to people of this age range. During the six months ended 30th June, 1968, no fewer than 703,000 women were tested, which was an increase of 12 per cent. over the previous six months. I cannot give a breakdown of the figures, as to how many were over 35 and how many under that age.

If facilities are being under-used for people over 35, who must have priority, could not the Minister, meanwhile, do something about their use for women under 35 who, by the time they are convinced, may be over 35? Could not fuller use be made of the available facilities in that way?

It is true that some facilities are being under-used. The important thing is to impress upon women over 35, for whom there is the greatest danger, that they should not hesitate to come forward. It is much more important to do that than to make some change in respect of tests for those under 35 years of age.

Is it not equally important to extend the facilities for the detection of cancer of the breast? Will my hon. Friend take steps to do this as well?

I will look into the point raised by my hon. Friend.

asked the Secretary of State for Social Services, in view of the evidence in Command Paper No. 3569, paragraph 358, of the annual needs of the United States of America for between 2,000 and 3,000 doctors from outside and the developing emigration to the United States of America of young doctors qualified in the United Kingdom medical schools, what steps he proposes to take to attract more of them to stay here either by reorganisation of the National Health Service or by improvements in their pay and conditions of service.

asked the Secretary of State for Social Services what plans he has to improve the recruitment of doctors into the Hospital Service and to lessen its dependence on immigrant doctors.

A number of important improvements in the working conditions of hospital doctors were agreed in 1967 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 the hon. Members to the reply given by the former Minister of Health to my hon. Friend the Member for Newark (Mr. Bishop) on 5th February last.—[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.

But does the right hon. Gentleman not realise that the proposals in his Green Paper, by making the Hospital Service more bureaucratic, tend to make it less attractive?

My Green Paper, which is an independent Paper, produced by my predecessor, is a basis for discussion: the hon. Member would be wrong to assume that it will remain as a basis for action.

Would the right hon. Gentleman not agree that an effective way to improve the pay and equipment of doctors would be to give every possible encouragement, particularly by such things as tax incentives, to private health and hospital schemes?

No, Sir. I should have thought that that was a very dubious idea. It would not necessarily be true that, if we stimulated the private sector of medicine, we should improve the salaries in the service.

But if my right hon. Friend is successful in this recruitment, how does he propose to improve the salaries of these doctors, since a previous Answer indicated that establishments can- not be filled at the moment because the regional boards cannot pay the doctors?

My hon. Friend will appreciate that the subject of doctors' remuneration is a very different question from the one that I was asked.

asked the Secretary of State for Social Services in view of the conclusions of the Royal Commission, Command Paper No. 3569, regarding the reliance of the National Health Service on reinforcements of doctors from overseas and the need to reduce such reliance, what steps he proposes to take.

asked the Secretary of State for Social Services what steps he intends to take to reduce the number of doctors coming from overseas, in view of the Royal Commission's Report on medical education.

I am in sympathy with the Royal Commission's comments on this subject and am taking them into account in reviewing future needs both for overseas and for British doctors.

I welcome that reply, but would the right hon. Gentleman consider it to be in the interests of this country, as well as of the developing countries, to ensure that, when medical reinforcements come in from outside, they are on the basis of being trainees or students, rather than on work vouchers, which carry with them the right of permanent settlement?

I am not prepared to go as far as that, and I repeat that I am in entire sympathy with the Royal Commission's comments. I think that they have pointed to what could be a danger to the long-term recruitment of doctors in this country. If the hon. Gentleman will put down another question later, I hope to be able to give him a more concrete answer.

Is my right hon. Friend aware that senior consultants, with their merit awards, all oppose dilution, that is, the appointment of more consultants, yet they are quite happy to allow dilution at the lower end of the hospital and medical service? Does he not think that it is absolutely immoral that we should take trained doctors from underdeveloped countries—people in whom they have invested a large share of their national resources—when we should be training more doctors here and helping them to train doctors?

We are training more doctors here and there is emigration from this country to other countries, as well as immigration to this country from others. I do not think all movement of doctors is bad, but we do regard the emigration to the United States, as my hon. Friend knows, as something which we should be actively trying to reduce. Equally, we are considering carefully and critically the dependence on doctors from the Commonwealth, both from our own point of view and from that of the Commonwealth countries themselves.

In view of the obvious importance of these matters and all other matters which are the subject of the Todd Committee's Report, does the right hon. Gentleman intend to publish a statement about the Report?

It could not be done in a single statement but would require a series of statements. A number of the matters concerned are not the responsibilities of my Department but those of the Department of Education and Science. However, I am hoping in the relatively near future to make a statement about medical manpower and the Todd recommendations.

asked the Secretary of State for Social Services what is the average length of service in Great Britain after completion of training of foreign doctors who have trained in this country.

This information is not at present readily available but studies are in progress with a view to obtaining more data about doctors born overseas and working in this country, including their length of stay.

May we have an assurance that we will be given this information as soon as possible? Is the hon. Gentleman aware of the tremendous shortage of doctors in certain industrial areas? What are the Government planning to do to try to get people who train in this country to stay on and work in the National Health Service on completion of their training?

This has in part been dealt with by my right hon. Friend in his previous Answer. It is true that, in some parts of the country, there is a shortage of doctors. Executive councils are doing what they can and the degree of shortage is not nearly as much as it was some years ago. I can give the hon. Gentleman the assurance for which he asks. The data concerning the actual movements in and out of doctors is not nearly as good as we should like, and this is why we are urgently looking at means of improving our statistics.

Will my hon. Friend accept from me that there are many young hospital doctors, English and overseas, working up to 120 hours a week, working day, night and the next day, without going to bed at all, and that therefore if it were not for these doctors from overseas, our wives and families would not receive the attention that they might need?

This is absolutely true. As to the extent to which junior hospital doctors are working, my hon. Friend is right. When he refers to the dependence that we have on doctors who come from other parts of the world, especially from the Commonwealth, I agree that it would be extremely difficult for us to maintain our hospital services were it not for those who have trained in other countries and have come to give their services here in Britain.

Is it not a fact that the egress of doctors from this country is larger than the intake of doctors from overseas and that it is not a matter of conditions of service, as the Minister said, but largely of the lack of pecuniary rewards and the invidious comparison with the United States, where a trained doctor can earn 40,000 or 50,000 dollars a year?

The question of pecuniary rewards is not one that I can answer at present. I doubt whether the hon. Member is right concerning the flow of doctors leaving this country compared with those coming in, but I cannot give him a precise answer. Our statistics do not show whether doctors leaving this country were trained in Britain or overseas.

asked the Secretary of State for Social Services what further plans he has for extending facilities for treatment of drug addicts.

asked the Secretary of State for Social Services whether he will make a statement on progress made in the setting up of treatment centres for drug addicts.

asked the Secretary of State for Social Services what further proposals he has to extend facilities for the treatment of drug addicts.

I would refer to the replies given on 24th October last to my hon. Friend the Member for Halifax (Dr. Summerskill) and on 2nd December to my hon. Friend the Member for Wolverhampton, North-East (Mrs. Renée Short) which still apply generally. The number of heroin addicts attending outpatient clinics at the end of November was 919 in London and 228 elsewhere, and the number receiving in-patient treatment 68 in the London area and 39 elsewhere,—[Vol. 770, c. 378–9. [Vol. 774, c. 235.]

Is not the Minister aware of the great concern which has been felt about the treatment of drug addicts? Has his attention been drawn to an article in the Sunday Times in which a supervisor at one of these centres said, "This is supposed to be a treatment centre but it is becoming a prescription centre"? This is a matter which is causing great concern to many people. What do the Government intend to do about it?

I rather share those views. I was at a centre the other day at which much the same answer was given. We are still studying the problem. We have to face the fact that there is not yet a complete answer or knowledge how to tackle the problem. Much of the work at the centres must be analysis and research before they can provide a cure. It would be wrong for the public to be given the idea that there was a simple, easy answer to the problem. We are still studying it.

But surely the Minister should not be merely studing the question. He should be remedying the scandalous situation which was revealed in the Sunday Times article. Does he need compulsory powers to make treatment effective?

I should like to think carefully about the implications of the last part of that question. I could not answer it off the cuff. It was not put on the Order Paper. The implications of the first part of the question seem not wholly fair in view of what I and my hon. Friends have seen in the work of these centres.

While accepting what my right hon. Friend said about our not knowing all the answers, may I ask whether he does not nevertheless think, in view of the increase in the number of drug addicts, particularly among young people, that it is regrettable that such an established unit as the Cane Hill Unit, which was doing excellent treatment for some addicts, has been closed down, thus reducing the number of beds available for those who are willing to take inpatient treatment?

I do not think that the problem is that there are not enough places in the centres for those who wish to go to them. All my evidence is that the centres are not fully used.

Has my right hon. Friend seen recent Press reports about addiction to the amphetamines? Does he not agree that this poses a very serious problem and will he consider further restricting the availability of this group of drugs?

That is a totally different question. I suggest that my hon. Friend puts down a separate Question about it.

asked the Secretary of State for Social Services if he will set up an inquiry into the effect on mental health and general health of extended listening to loud pop music; and if he will make a statement.

asked the Secretary of State for Social Services if he will set up an inquiry into the effects on the health of young people of extended listening to pop music.

The answer is, No, Sir.

Is my right hon. Friend aware that there is great concern about continuous pop music not only among lay people but also among youth officers and others—concern not only about the short-term physical and mental effects but also about possible long-term mental factors associated with it? There is concern that in continuous pop music there may be a new and much more deadly opium for the masses.

I remind my hon. Friend that when Karl Marx coined the phrase he coined it metaphorically and not clinically.

Does the Minister agree that in this dull and dreary life which the Government have organised for us, pop music can only be good for the health and for the morale of our young people and that it is better for them to indulge in pop than to indulge in drugs, disorders, sit-ins and the rest?

I must take the question seriously. There is no evidence whatever that this music has any serious medical effect.

Would it not be better if my right hon. Friend considered an investigation of the kind suggested into some of the speeches in this place?

Will the right hon. Gentleman remember that he was young once and that youth likes noise and pop?

asked the Secretary of State for Social Services how many projects in the health and welfare capital building programme have been deferred; and what is the value of the projects.

I assume the Question refers to deferments following the announcement in January, 1968, that the planned rate of growth in local authority expenditure would be reduced in Great Britain as a whole by an average of £5 million a year for the period 1968–69–1970–71. It is not possible to identify projects deferred as a result of this reduction.

Does the hon. Member not agree that, deplorable as all cuts of this nature must be, to some extent they are an inevitable consequence of the failure of the wealth of the nation to increase under the Labour Government and of the increase in the uncom-petitiveness of the British economy under the Labour Government? Will he tell us what discussions representatives of his Department have had with representatives of the International Monetary Fund on its capital spending programmes in view of their inspection of the books at regular intervals?

The last part of the question is not for me. The hon. Member is talking absolute nonsense in the first part of his question. There has been a slow-down in the planned rate of expansion but there is still expansion, and this is so in health and welfare, about which he asked. Even for the year in question, though there has been a slowdown in the granting of loan sanctions, £2·9 million more were granted in 1967–68 than in the previous year on these projects.

How does the Minister explain the fact that the White Paper on Public Expenditure shows clearly a reduction of £29 million in health and welfare expenditure in this year and of £31 million for next year? Surely he must know something about the sort of project which will suffer under these cuts?

There has been a range of projects in health and welfare and other local government activities in which proposals which have been put forward have not been immediately accepted. It is essential that in local government as well as elsewhere there should be a moderation of the sustained, very rapid rise in expenditure, but there is still a rise, as I said in my Answer.

asked the Secretary of State for Social Services, whether, in view of the inadequacy of existing servicing facilities in the Bromley and South-East London areas, he will now grant official recognition to Messrs. Beaven Brothers of New Cross as approved repairers for invalid vehicles.

My Department has received no complaints about the servicing of invalid vehicles in these areas, but the approved repairer facilities there are being reviewed and Messrs. Beaven Brothers' application will be taken fully into account.

While I am grateful for that glimmer of hope, may I ask the Minister please to bear in mind that although he may not have received any complaints, I have received many expressions of dissatisfaction in my constituency from disabled drivers within Bromley and district about the existing servicing facilities? They are also full of praise for Beaven Brothers, who at the moment are able to carry out only minor and emergency repairs. They would like to see full recognition for this garage, which I believe will be well justified.

I understand that the hon. Member has a constituency interest to advance. If he will let me have details of specific cases of dissatisfaction with present arrangements, I will look into the matter.

asked the Secretary of State for Social Services what are the latest available figures for the number of people receiving unemployment benefit.

On 4th November, 1968, some 294,000 people were receiving unemployment benefit.

How do those rather startling figures square with the Labour Party's election pledges to maintain and safeguard full employment in this country?

The hon. Member must have misheard the figures which I gave. I said that 294,000 people were receiving unemployment benefit. The Labour Party's pledges about unemployment benefit will be fulfilled.

Is the Minister aware that a substantial number of those persons in receipt of unemployment benefit are also in receipt of termination grants paid under redundancy payments scheme? Is he satisfied that this double payment of benefit is the best use of scarce resources? Will he consider a possible link between redundancy payments and mobility and retraining?

If the noble Lord would like us to look into that and will put down a Question about it, we will certainly look into it for him.

asked the Secretary of State for Social Services what is the additional amount of money he will raise by putting National Insurance contributions on a graduated basis.

I must ask the hon. Gentleman to await the publication tomorrow of the White Paper on the new earnings-related pension scheme.

Would the Secretary of State explain the point of raising National Insurance contributions by putting them on a graduated basis if the money is dissipated again by giving graduated benefits? Is he not giving most money to those with the least need? Will he give an undertaking that if more money is to be available for spending he will give it to the disabled, the over-80s, and children in poverty, and not to people who are already the best-off in society?

The only assurance I can give the House today is that, when the House debates the White Paper, as it will no doubt wish to do, I will explain the reasons.

asked the Secretary of State for Social Services whether he will now make a statement on the Government's plans for a comprehensive wage-related system of social security.

asked the Secretary of State for Social Services if he will now make a statement on the Government's new plan for social security.

The White Paper containing proposals for a new earnings-related pension scheme will be published tomorrow. In order to make the proposals readily available to the public, a summary version of the White Paper priced Is. will be published simultaneously.

Is my right hon. Friend aware that many of us wish to congratulate him on the completion of this mammoth preparatory task? In view of the great deal of public interest in this matter, may I ask how soon it will be before the Government introduce legislation?

Legislation will certainly not be introduced before next Session, but I hope early next Session. As for my hon. Friend's congratulations, I advise him—though I am delighted to find him so enthusiastic—to wait until he has seen which parts he likes better than others.

Would my right hon. Friend comment on the detailed versions of some of his plans which have already appeared in the Press? Would he agree that the present tendency for so many matters to be announced or reported in the Press before being formally announced should, if possible, be prevented?

I believe that when my hon. Friend reads the White Paper he will be struck more by the contrast which it shows between the comprehensive position and the bits and pieces which have dribbled into the Press in the last four years.

Can the Minister say to what extent the White Paper will vary from what we have already read in the Press?

I must leave the hon. and gallant Member in nervous anticipation of publication.

asked the Secretary of State for Social Services what is the current annual amount of employers' contributions to the National Insurance schemes.

Employers are paying National Insurance contributions, including contributions for industrial injuries, at the rate of about £1,025 million a year.

This is an extremely large sum of money. Would the right hon. Gentleman explain what em- ployers get in exchange? Does the whole of this money get spent on dealing with needs which arise directly out of employment?

This money is invested in a comprehensive social security scheme on behalf of the whole nation and, therefore, benefits the entire population. The arguments for this will once again be set out in the improved scheme which will be presented by my right hon. Friend tomorrow.

Is my right hon. Friend aware that many Labour hon. Members feel that the contribution made by employers is not large enough and should be increased? Would he agree that employers get, in return, a very good service indeed from workers in industry?

I must ask my hon. Friend to wait 24 hours and to consider the propositions which will be put forward tomorrow by my right hon. Friend.

asked the Secretary of State for Social Services if he will conduct a survey to ascertain to what extent, if any, the current levels of social security benefits exceed earnings from employment in lower wage occupations.

We expect to get some information about this from the inquiry now being planned into the circumstances of families.

While in no way questioning the present level of social security benefits, may I ask the right hon. Gentleman if he is aware that, in many low-wage rural occupations, there is a widespread belief that it barely pays to work? In these circumstances, will he make representations to his Cabinet colleagues about the utter folly of referring farm workers' wages to the National Board for Prices and Incomes?

The last point of the hon. Gentleman's supplementary question seems to be somewhat remote from the first.

Having carried out the original survey into the circumstances of families in 1966, is it not possible to carry out a limited piece of research annually to obtain a quick check on the current position? Could not this be done at a limited cost and so avoid the need for a major survey every few years?

There is a great deal in what my hon. Friend says. In fact, I have been disappointed with how much things are now out of date compared with the 1966 survey. I am trying to make sure that what we are now doing lays the basis for a regular report, which is what we really need.

asked the Secretary of State for Social Services what is his time-scale for making the new prototype P5 invalid tricycle available to disabled drivers; and what additional cost per vehicle he estimates to be involved in making this a two-seater vehicle with storage for an invalid chair.

asked the Secretary of State for Social Services what progress is being made in the development of the P5 prototype two-seater invalid car; and if he will make a statement.

asked the Secretary of State for Social Services what new categories of disabled drivers will receive four-wheel vehicles.

asked the Secretary of State for Social Services (1) if he will list the first three categories of disabled drivers which are to receive four-wheel vehicles in the next extension of this facility;

asked the Secretary of State for Social Services if he will draw up categories of the totally disabled with the object of gradually granting concessions similar to those for which they would be eligible if they were less severely disabled, including financial assistance towards the cost of private transport.

The 1969 three-wheeler will have greatly improved suspension and a new three-wheeler with a bigger engine and automatic transmission will be introduced in 1970. These important improvements will considerably increase the cost of providing vehicles for the disabled. Although the actual fitting of a second seat in a new three-wheeler which did not need to carry a wheelchair would not be difficult or costly, the consequences of permission to carry a passenger would be costly and my right hon. Friend is unable to provide further additional funds for this service at the present time at the expense of other National Health Service developments. For the same reason, the conditions applying to the issue of cars are not being changed. The timing and nature of any future changes cannot yet be forecast, but when available resources permit an extension of the service my right hon. Friend will consider the needs of all suitable groups.

Is my right hon. Friend aware that disabled people generally will welcome the news that this three-wheeler will be introduced at a reasonably early stage? Will he accept, however, that there will be considerable disappointment at the fact that there are not to be facilities for carrying passengers? Will he bear in mind that loneliness—including when driving—is a real problem to the disabled and will he, therefore, look at the matter again?

This is a matter which is deserving of the sympathy of hon. Members in all parts of the House. In fact, we are reviewing our future provision most carefully. It must be understood that the arrangements aim to provide a degree of personal mobility. This is expensive enough and the cost of this is increasing yearly. We do more for our disabled people in this respect than does any other country in the world.

Concerning Question No. 28—I do not see how this Question has a direct connection with the others being answered by the Minister—does not my hon. Friend consider it curious to make a distinction between the civilian partially disabled and the civilian totally disabled to the disadvantage of the totally disabled when no such distinction is made in respect of the war disabled? Will he think further about this distinction?

The association of my hon. Friend's Question with the other Questions arises because of the same regrettable fact that there is an economic factor here which we find difficult to cope with at the moment. The totally disabled war pensioner who cannot drive can have one of our vehicles or an allowance towards the cost of running his own and is thus in a more favourable position than the National Health Service patient. This is in line with policies that have been adhered to by all parties for a long time. One day, perhaps, we might have an expression of view by the House about the present views of hon. Members on this subject. The House must face the fact that to make the practice general as between war disabled and other disabled people would be a very expensive exercise indeed.

Would the Minister explain why there is no other category for the four-wheel disablement vehicle?

When further resources become available, the desirability of making improvements for those who are already entitled to vehicles will have to be considered together with the claims of those who do not at present qualify for any such help. This is the problem. We may extend the use of four-wheeled vehicles but, on present form, it would be to the detriment of many categories of people who marginally are not at present entitled to three-wheeled vehicles.

Does the Minister's somewhat disappointing reply—he will agree that it is disappointing—mean that the new P5 three-wheeler is not to be a two-seater simply because it would be more convenient and, because it would be more convenient, more people would want it?

There is no technical difficulty involved in making the P5 a two-seater. Where the difficulty arises is in then finding space in it for a wheelchair. The hon. Gentleman, whose work in this respect, together with the work of many of my hon. Friends, is well known, will appreciate that there is no unanimity of opinion outside the House on this matter. Indeed, it would be helpful if he could use his influence to see that there is a clearer definition of the disabled people's views on this matter. I can find no uniformity on this issue at present and, as I explained, it is a question of developing as resources become available.

When my hon. Friend is looking into this matter, will he take into account the anomalies which arise? Will he examine, for example, the position of those disabled through respiratory complaints who are entitled to a three-wheeled chair only if they are going to a place of employment? Is he aware that often the difficulty for these people is that they are too ill to have an occupation?

This is one of the factors which we shall be taking into consideration as the situation develops. I do not wish to conceal our great difficulty in meeting the demand that is coming from disabled people who are only marginally not entitled to some sort of vehicle.

asked the Secretary of State for Social Services the market value of the securities held by the National Insurance Reserve Fund and the National Insurance Fund, respectively, at the end of 1968, with comparable figures at the end of 1964.

The market value of the securities held by the National Insurance Reserve Fund and the National Insurance Fund, respectively, at the 31st December, 1968, were £704 million and £88 million. Comparable figures for 31st December, 1964, were £874 million and £188 million.

In the light of those figures, can the Minister clear up the question of whether the £200 million which was supposed to have been transferred from the Reserve Fund to the Fund was £200 million at market value or £200 million nominal?

£200 million at market value, of which £50 million was transferred in December, 1968.

Does the Minister recollect that we were informed that this transfer of £200 million from the National Health Reserve Fund was to meet special payments during the winter—for example, increases in sickness or unemployment benefit? If no such payments have to be made, will it be returned to the Reserve Fund?

I said that we would have to see how the situation worked out. The transfer is not for the purpose of any special payment. When the Motion was presented, I said that the transfer was being made because the National Insurance Fund had become low, as had been occurring over a long period of time.

asked the Secretary of State for Social Services what were the annual deficits on the working of the National Insurance Fund for the years 1964–65, 1965–66, 1966–67, respectively; and what he estimates will be the outturn in 1968–69 after making allowance for the transfer to the Fund of £200 million from the National Insurance Reserve Fund.

There was a deficit of £21 million in 1964–65, a surplus of £25 million in 1965–66 and a deficit of £13 million in 1966–67. It is estimated that if transfers from the National Insurance Reserve Fund are left out of account, the deficit in 1968–69 will be something over £60 million, depending on the level of sickness during this winter.

Do those figures mean that the fall in the value of the securities held by the two Funds, which the right hon. Gentleman announced in his previous Answer, is mainly due to a falling off in the value of the securities in which the Fund is held?

As, I think, the right hon. Gentleman will know, that is a trend which, unfortunately, has been occurring over a long time, with fluctuations over a period of 20 years. During the last four years when the right hon. Gentleman was Minister, I think that there was a fall in the value of these securities of about 11 per cent.

asked the Secretary of State for Social Services whether adequate supplies of flu vaccine are now available; and if he will make a statement.

asked the Secretary of State for Social Services if he will make a further statement on the manufacture and distribution of the A2 influenza vaccine.

1,070,000 doses of Hong Kong influenza vaccine have now been distributed. Supply is still not meeting demand but increasing quantities are going to retail chemists to meet doctors' prescriptions.

While I fully appreciate that the epidemic has not really occurred, may I ask the hon. Gentleman at least to say what steps he is taking to make sure that those with responsibility for maintaining essential services are given the vaccine? Is he aware that some general practitioners still cannot get a supply?

The Government are not responsible for either manufacturing or distributing vaccine, and I do not expect that the hon. Member would propose that we should be. Recognising, however, that there would be a demand and that there might be a shortage, we took the advice of our experts and decided that there should be certain priorities who should, if possible, have the vaccine first. This advice was made known and I had discussions with the manufacturers and distributors. They gave their ready cooperation in seeing that bulk supplies went mainly to hospitals and local authorities, and much more of the sup-lies have now gone to retail chemists to meet doctors' prescriptions. But the supply is, of course, still not meeting all demands.

I hope that there will not be undue optimism because of a few days of mild weather. In the criteria that my hon. Friend wants to establish, will the bronchitic and asthmatic have first claim? If so, how does this square up with the fact that members of the staff of the House of Commons got their "jabs" this morning but, apparently, not one Member of Parliament?

The priorities that were suggested by the Joint Committee still apply. This is the first information I have had about jabs being given this morning. Mr. Speaker, and not the Government, is responsible for the administration of the House of Commons. I will make inquiry about the point raised by the hon. Member.

In view of what the hon. Gentleman has said, may I ask whether he is aware that most of the hospitals that I have contacted, both in London and in the North of England, do not have supplies even for their very ill patients? Were any financial commitments required from hospitals before vaccine was delivered to them? Will the hon. Gentleman accept that the whole distribution has not been very effectively or efficiently done?

As to the question of payment, there is no difference from any other system of ordering prescriptions and drug supplies. I certainly do not accept the point made by the hon. Lady. I do not know when she made her inquiries—

Last week.

or at what hospitals, but my inquiries have led me to the impression that almost all hospitals have now received their requirements. There is still insufficient to meet some prescriptions by doctors, but in the matter of distribution my impression is that although we have, of course, no means of insisting how a doctor prescribes—it would be quite wrong for us to do so—the vast proportion, I would say 95 per cent. of that which has become available, has gone to the priority groups.

As we understand that this vaccine is a preventive measure, can my hon. Friend tell us on what basis it is being distributed? He has referred to doctors' prescriptions. Does that mean that only those who are attending doctors for other illnesses are getting injections, or are block injections being given, as was referred to a moment ago?

I have occasionally heard reports of block injections. Most of my inquiries have shown that the vaccine was either the pre-Hong Kong variety or was ordered in October before the Government's intervention to bring about the voluntary distribution system. The supplies which are now available are, of course, to meet doctors' prescriptions and are available through the chemists.

Could the hon. Gentleman restore the balance a little and inform us about ordinary 'flu? Am I right in assuming that the relationship of that vaccine to Hong Kong 'flu is the same as the relationship of the previous vaccine to ordinary influenza and that it is still possible for people to get a non-Hong Kong virus, with which the vaccine has no effect, and that it is just as dangerous for bronchitic and asthmatic patients?

I would not say that it necessarily had no effect. It is too early to say. Certainly, it is a vaccine which is designed to deal with this particular type of virus. As has been recognised and said in the House, the incidence so far has been very mild and some of the scaremongering statements that were made have so far proved to be absolutely untrue. We cannot be certain. It is interesting to note that new sickness benefit claims last week showed a reduction compared with 12 months ago.

asked the Secretary of State for Social Services whether he has now completed his study of a social security scheme to aid those who are disabled from any cause whatsoever; and if he will make a statement.

asked the Secretary of State for Social Services whether, in preparing the Government's plans for reshaping the system of social security, he will give special attention to the position of disabled people; and if he will now make a statement.

We cannot complete our plans until we have the information which is lacking at present of the numbers, needs and financial circumstances of severely disabled people. This we shall be getting from the current Government survey. Meanwhile, I would ask hon. Members to await the Government's White Paper which is being published tomorrow and which will set out the kind of provision we have in mind.

Since the Government pledged themselves to produce a scheme as long ago as 1964 and rejected the very helpful Bill of my hon. Friend the Member for Moray and Nairn (Mr. Gordon Campbell), which the Minister himself opposed, are not the Government behaving with extraordinary callousness to the plight of 150,000 citizens who are not within this insurance scheme, who have no help of any kind and who are disabled?

No, I would not say that. It was an unfair question with unfair imputations. What the Government are doing is to have the first adequate survey made of the problem of disablement. It is no good the hon. Member giving figures. No one knows the numbers, the degree of disablement or the extent of the problem. What we have said is that we cannot pass Bills to deal with a problem before we have studied it adequately.

Can the right hon. Gentleman tell us, roughly, in what month of this year he hopes to publish the results of the survey?

I am hopeful of having it published in the summer. I hope to get some access to it for use in the Department a month or two earlier. It is a major report, which will take a few weeks to publish.

Can the Minister say, since the Opposition are continually asking the Government to cut down on all forms of expenditure, including social security, whether, if any of these schemes they are pressing for are put into operation, the Opposition will not complain that the Government are again wasting money? Have they given him any assurance?

It is not the kind of assurance we would expect from the opposite side of the House. I agree with my hon. Friend that any suggestion for a brand new insurance scheme covering all disabled people, grading them and giving them cash benefits would be an enormously expensive addition to our social security system.