asked the Secretary of State for Social Services if he is aware that many workers laid off by industrial disputes or other causes work two or three days a week but have to pay the full National Insurance contribution for that week; and if he will take steps to introduce proportional contributions for cases in which only proportions of the normal working week are worked.

It would be impracticable to vary the present flat-rate contributions according to the proportion of the week worked; but under our proposals for a new scheme of national superannuation and social insurance the contributions of employees will move with their earnings.

Does my hon. Friend accept that as benefits are paid on a proportional basis it would be equally just if contributions were paid proportionately? Because of the increased use of machinery, would not the added burden on administration be minimal?

This applies to the new scheme when it is introduced. To introduce it now, at a time when we are using National Insurance cards and stamps, would mean having four or five times as many stamps, and would add tremendously to the problems of administration both of the Post Office and of employers.

asked the Secretary of State for Social Services what are the latest figures available for the percentage of gross salary a man earning £10, £20, £40, £100, and £1,000 a week pays in National Insurance contributions; and whether he will take steps to introduce a non-contributory National Insurance scheme.

The figures are: 7·33 per cent., 5·54 per cent., 2·91 per cent., 1.16 per cent. and 0·116 per cent. respectively if paying graduated contributions; if contracted-out from the graduated pension scheme, 8·04 per cent., 4·25 per cent., 2·25 per cent., 0·9 per cent. and 0·09 per cent. respectively. These percentages exclude the contribution to the National Health Service. As regards the second part of the Question, the answer is "No, Sir".

Does my hon. Friend accept that those figures prove without doubt that the present contributory scheme puts a heavy burden on the lower-paid worker? Does not my hon. Friend believe that as we are considering a social security system which is designed to last for 20 years or more, that system should be based on a non-contributory basis?

There are two parts to that question. First, the flat-rate system imposes a proportionately heavier burden upon lower-paid workers. This is one of the main reasons why we are introducing a new earnings related system. Secondly, when my hon. Friend suggests that we should base National Insurance on a non-contributory, and therefore presumably on a taxation system, I must say "No". This would add, at the present rate, 6s. 9d. on the standard rate of Income Tax, and I do not think that it is a proposal which the Chancellor of the Exchequer would welcome at the present time.

In order to present a proper balance to the House on this matter, would not it be appropriate to quote the figures after taxation, as direct taxation runs up today to 18s. 3d. in the £ on top marginal rates, which is both extortionate and exorbitant?

If the hon. Gentleman wants to put down a Question on that he is at liberty to do so.

asked the Secretary of State for Social Services what was the total amount paid out to the families of men engaged in industrial disputes in the form of supplementary benefits over the latest year for which full figures are available.

asked the Secretary of State for Social Services whether he will state the amount paid in supplementary benefits to the families of persons taking part in official and unofficial industrial disputes, respectively, during the past 12 months.

In 1968 payments totalling £333,722 were made for the dependants of men involved in trade disputes.

Has the hon. Gentleman noticed that this annual rate of subsidy from the taxpayer to strikes regularly described by the Prime Minister as "sabotaging the economy" has risen seven-fold since this Government came to power? What do the probation officers from our international creditors have to say about this when they inspect the books from time to time?

I have no knowledge, without notice, of the last point in that question, but, if payments were not made to the dependants of the strikers, the hon. Gentleman must realise that great hardship would be imposed upon wives and children.

Will not all this be rather academic when the Government have rushed through their legislation on the subject?

If the hon. and gallant Gentleman would put down a Question to that effect, I should be glad to reply.

asked the Secretary of State for Social Services whether he has studied the results of recent research into the effect of noise on health; and what action he proposes to take.

I know of no recent reports of research into the effect of noise on health generally, but we have recently received a report on research into the effects of industrial noise on hearing. It has been referred to the Industrial Injuries Advisory Council for consideration and advice and also to my right hon. Friend the Secretary of State for Employment and Productivity.

Would my hon. Friend agree that it is better to avoid injury to health than to compensate for it afterwards? Would he seize the opportunity, while this is being considered, to invite his colleagues from other Departments to consider methods by which injury to health can be reduced rather than the people concerned being compensated afterwards?

I will bring those points to the attention of my right hon. Friends.

Would the hon. Gentleman see that some research is done into the effects of noise, particularly on those living in the vicinity of airports, which is becoming a growing menace to health?

That is quite a different question. The right hon. Gentleman can put down a Question to the appropriate Minister.

Might I pursue the question raised by the right hon. Member for Reigate (Sir J. Vaughan-Morgan)? With respect, this is not a question for another Ministry. If there is a health hazard because of aircraft noise to those living in the vicinity of airports, that seems to me very much within my hon. Friend's portfolio. Does he not think that it is high time that rather more vigorous steps were taken to make those of his hon. Friends who are responsible for the number of aircraft going into London Airport more aware of the dangers to health of continuous noise?

The research to which I referred is, of course, Government-sponsored, undertaken by the Medical Research Council and the National Physical Laboratory of the Ministry of Technology. It is very serious and fundamental research into the problems of noise in industry. We are considering this very seriously, but the terms of reference do not include the effect of noise at a distance from an airport.

asked the Secretary of State for Social Services what allowance he will make in settling the terms for contracting out of the proposed state graduated pension scheme for the fact that payments by employees into private schemes are accepted as a deduction from income for tax purposes but those to the state scheme are not under present arrangements.

I would ask the hon. Member to await the results of our current study of the detailed arrangements for contracting out under the new scheme.

Is it not obvious that the Government have got themselves into a thorough muddle over this? Would it not be better to admit that social insurance and Income Tax are simply different aspects of the same cash relationship between the individual and the State, and by so doing cut the Gordian knot?

That, of course, would mean providing an entirely new scheme, which would imply, I suppose, in the first place, abjuring the rights to a return on their contributions which millions of contributors have received, and this we do not intend to do.

But surely the right hon. Gentleman will accept that the impact of Income Tax and the impact of contribution on the family must be considered together. Does he realise that his proposals immensely increase the disincentive effect of the total? What will he do about that?

That, again, is somewhat different to the Question, and I replied to the part which was asked. If one tried to take into account the advantage gained by occupational schemes through the Income Tax concession, one would have to observe that some gain it and some do not. For instance, in the case of all non-contributory schemes the gain is nil.

asked the Secretary of State for Social Services whether he will take steps to make it obligatory for contracted-out pension schemes to give beneficiaries increases dependent on the general level of prices.

I would refer the hon. Member to the reply I gave the hon. Member for Kensington, South (Sir B. Rhys Williams) on 3rd March.—[Vol. 779, c. 17.]

Will the right hon. Gentleman make it obligatory that the benefits under contracted-out schemes shall rise along with general increases in wages and salaries?

I thought that I had dealt with that in my original Answer.

asked the Secretary of State for Social Services how much revenue he estimates will be lost from the proposed State pension scheme for each one quarter of a million contracted out.

The answer depends primarily on the level of abatement of the contributions for contracted-out employees. This has still to be worked out.

Can the right hon. Gentleman say when, if contracting out continues at the present rate, the scheme will come into deficit?

If we have the same number of people as we have at present, when the scheme would come into deficit would depend on the terms on which they were contracted out, which have not yet been agreed.

Will the right hon. Gentleman indicate what are his objectives in this respect? How many people would he like to see contracted out of the scheme?

This is a difficult question to answer because it depends on the balance of advantage. I want a scheme which is fair to those contracted in and to those contracted out. I suppose my aim would be to get contracting out on about the same level as now.

asked the Secretary of State for Social Services how many homes for unmarried mothers were closed during 1968; and how many are likely to close during 1969 and 1970.

Exact figures are not available but my information is that about 25 homes closed during 1968, including some maternity homes which closed in recognition of the fact that it is desirable for unmarried mothers to be confined in hospital.

Does not my hon. Friend think it a rather extraordinary situation that homes of this kind can be closed at a time when the illegitimate birth rate is increasing, particularly among girls still at school? Does he not think he should investigate the matter to see whether local authorities are making proper use of the facilities that they already have?

Most of the facilities that exist, though responsibility lies on local authorities, are provided by voluntary organisations—normally religious organisations. It should be noted that the number of applications for accommodation has fallen to the point where in some cases it is not economic for a home to continue in being. It is true that an increased number of those requiring maternity treatment now naturally go to maternity hospitals rather than to private institutions.

asked the Secretary of State for Social Services what is the number of clerical grade officers and senior officers employed by the executive council covering the Southall constituency to check claimed exemptions from medical prescription charges; what was the num- ber of prescriptions checked between September 1968 and January 1969; what was the number of patients found not to have been entitled to exemption; and what was the total of the charge recovered from those patients.

asked the Secretary of State for Social Services how many clerical grade officers and senior officers are employed by or engaged within the Stockport Executive Council to check entitlement to exemption from prescription charges; what is the estimated annual cost, the number of prescriptions checked in the year ended December 1968 and the number of patients found not to be entitled to exemption; and what was the total of the charge recovered from these patients.

asked the Secretary of State for Social Services what is the number of clerical grade officers and senior officers employed by the Nottinghamshire Executive Council to check entitlement to prescription charge exemptions; what is their estimated annual cost; what was the number of prescriptions checked between September 1968 and January 1969; what was the number of patients found not to be entitled to exemption; and what was the total of the charge recovered from these patients.

asked the Secretary of State for Social Services what is the number of clerical grade officers and senior officers employed by the Sheffield Executive Council to check entitlement to exemption from prescription charges; what is their estimated annual cost; what was the number of prescriptions checked between September 1968 and January 1969; what was the number of patients found not to have been entitled to exemption; and what was the total charge recovered from those patients.

asked the Secretary of State for Social Services what is the number of clerical grade officers and senior officers employed by the Manchester Executive Council to check the entitlement to exemptions from prescription charges; what is their estimated annual cost; what was the number of prescriptions checked between September 1968 and the nearest convenient date; what was the number of patients found not to be entitled to exemption; and what were the total charges recovered from these patients.

asked the Secretary of State for Social Services what is the number of clerical grade officers and senior officers employed by the Huddersfield Executive Council to check the entitlement to exemption from prescription charges; what is their estimated annual cost; what was the number of prescriptions checked between September 1968 and January 1969; what was the number of patients found not to have been entitled to exemption; and what was the total charge recovered from those patients.

asked the Secretary of State for Social Services what is the number of clerical grade officers and senior officers employed by the St. Helens Health Executive Council to check the entitlement to exemption from prescription charges; what is their estimated annual cost; what was the number of prescriptions checked between September 1968 and January 1969; what was the number of patients found not to have been entitled to exemption; and what was the total of the charge recovered from those patients.

asked the Secretary of State for Social Services what is the number of clerical grade officers and senior officers employed by the Birmingham Executive Council to check the entitlement to exemption from prescription charges; what is their estimated annual cost; what was the number of prescriptions checked between September 1968 and January 1969; what was the number of patients found not to be entitled to exemption; and what was the total of the charge recovered from those patients.

asked the Secretary of State for Social Services what is the number of clerical grade officers and senior officers employed by the Sunderland Executive Council to check the entitlement to exemption from prescription charges; what is their estimated annual cost; what was the number of prescriptions checked between September 1968 and January 1969; what was the number of patients found not to have been entitled to exemption; and what was the total of the charge recovered from those patients.

asked the Secretary of State for Social Services what is the number of clerical grade officers and senior officers employed by the Executive Council for the city of Sheffield to check the entitlement to exemption from prescription charges; what is their estimated annual cost; what was the number of prescriptions checked between September 1968 and January 1969; what was the number of patients found not to have been entitled to exemption; and what was the total of the charge recovered from these patients.

asked the Secretary of State for Social Services what is the number of clerical grade officers and senior officers employed in the Northern Region and Hartlepool, respectively, to check the entitlement to exemption from prescription charges; what is the estimated annual cost; what was the number of prescriptions checked between September 1968 and January 1969; what was the number of patients found not to have been entitled to exemption; and what was the total charge recovered from those patients.

As a number of figures are involved, I will, with permission, circulate a tabular statement in the OFFICIAL REPORT

I look forward eagerly to seeing those figures. Is it not a fact that the return to prescription charges generally undermines our Socialist ideas? Should we not get rid of this taxation on the sick as soon as we possibly can, so as to get back the favour of our supporters in the country?

I should have thought that that was a somewhat different question from the question which my hon. Friend asked me, which was about the cost of the staff employed. I can help him by saying that I estimate that the cost of staff averages less than ¼d. for each exempted prescription, or about ¼d. for each prescription charge of 2s. 6d. I hope that my hon. Friend will take that as a general reply.

Would my right hon. Friend agree, though, since he knows the figures and we at the moment do not, that they will show that this exercise in the principle of individual selectivity in the social services is not useful in terms of money or manpower? Will he in future resist this individual selectivity principle which is so urgently demanded by hon. Members opposite?

If my hon. Friend is asking me whether I expect further charges to be imposed on the Health Service, the answer is "No."

Although we do not know these figures yet, my right hon. Friend will be aware that we have the advantage of having seen the figures for the London area. In the light of an Answer to my hon. Friend the Member for Willesden, West (Mr. Pavitt), would my right hon. Friend not agree that money would be better spent on extending the exemptions among the chronic sick or, indeed, exempting secondary school children over 15? Would he read again his speeches from the 1950s on?

If my hon. Friend is referring to the figures for Willesden or London, I suggest that he waits and considers the figures for the rest of the country, because I think there is no evidence that increases in the total wages bill exceed expectations.

Is my right hon. Friend not aware that we should not have given him permission to answer all these Questions together because we are not in possession of the facts? But would he say how this accords with the speeches and statements made by himself, the Prime Minister and the Minister of Health at the time on this subject? Is it worth the candle to do this for 2s. 6d?

I think the Question that my hon. Friend asked was about the cost of the clerical grade officers and I am not sure that that has very much to do with speeches about prescription charges. What he is asking me is whether the administrative burden is financially heavy, and all I can say is that in that way the imposition of these charges has not had an effect other than that anticipated.

Would my right hon. Friend bear in mind that the administrative cost set out in the Answer which we have not had the benefit of seeing is only a part of the total social cost? Would he remember that the burden which is imposed, not only on the admini- strative workers but upon chemists and others, is considerable?

Yes, indeed. Of course, administration and the financial cost of the staff is only one part of the burden of prescription charges. It is also worth noticing that nearly half the population are exempted from them.

Has the right hon. Gentleman seen a speech made by one of his Ministerial colleagues over Easter who stated that charges in the National Health Service would have to go up? Are prescription charges going up? If so, what effect will that have on administrative costs?

That is a slightly different question. If the hon. Gentleman wants to put it down, I will answer it.

Would my right hon. Friend say whether the total number of prescriptions issued by doctors has increased since the imposition of charges? If it has fallen, would he attribute that to the imposition of charges?

My hon. Friend should put down a Question on that matter. It is a difficult question to answer because I should have to have an estimate of the effect of the prescription charge. I should seek to do so if I had a precise question to answer.

Did not the right hon. Gentleman in a supplementary answer say that no more charges would be introduced? Therefore, is not my hon. Friend's question absolutely germane? Is there any intention to increase prescription charges?

The answer is "No".

When we see these figures, will they be taken into account with all the other administrative charges that lie both in the hospital service and in the local executive councils? When added together will they be charged against the amount coming in as income from prescription charges or hidden in other accounts to give us a false answer? Does not this make the whole thing irrelevant?

My hon. Friend is very learned in these matters. I am not sure that I can answer that question very easily. Perhaps he will put down in a precise form what he is asking about prescription charges.

asked the Secretary of State for Social Services if he is satisfied with the operation in general of the Abortion Act in relation to the facilities afforded by the medical profession to women seeking terminations of pregnancy; what action he plans to take to enable the National Health Service to meet its obligations to women patients in this respect; and if he will make a statement.

I am by no means satisfied so far as private practice under the Act is concerned. I have recently reviewed the question of the standards required in approved establishments, and have asked for additional information before granting my approval or re-approval which is needed to enable any such establishment to continue in use after 27th April. It is too early to reach conclusions about the adequacy of National Health Service hospital facilities, but I am watching the situation closely.

Will my right hon. Friend continue to watch this very carefully with regard to the National Health Service? Is he aware that some consultant gynaecologists are issuing blanket refusals to take any terminations at all, even though they may be referred and recommended by two or even three medical colleagues? Does my right hon. Friend not think it is high time that women were freed of the tyranny of a certain section of the medical profession in this regard, and will he see what can be done to ensure that the law is in effect carried out?

I agree that my hon. Friend has pointed out an extreme danger which may occur in certain cases.

It does.

If my hon. Friend will send me details I shall be grateful. But I should point out that the danger I mentioned is at the moment a far graver one.

Arising out of the hon. Lady's supplementary question, may I ask the right hon. Gentleman to bear in mind that a lot of the medical profession think that the Measure was placed on the Statute Book without sufficient safeguard in it and without the medical profession as such being able adequately and properly to express its views?

I am as aware as the hon. Lady of what happened during the course of the Bill. The Amendments to the Bill did not satisfy even everybody in this House about the safeguards. However, the question that I was asked was about how the Act is working. There is no doubt that the way that the Act is working, in particular in the private sector, is giving grave alarm even to those who were keen supporters of it.

Is my right hon. Friend aware that those of us who supported the principle of the Act will nevertheless welcome his recent strictures and actions? Does he also agree that there is undoubtedly a financial racket being worked in this sphere, and will he consider carrying out an investigation into this aspect of a very shady and unsatisfactory situation?

I entirely share my hon. Friend's feelings. I am having a most careful investigation made about all aspects of what is going on, but I have to limit my activities to what I am legally entitled to do. This is what I referred to in my original answer.

As the Question specifically refers to the general operation of the Statute, may I ask the right hon. Gentleman to have regard to the large number of foreign women alleged to be entering this country—

Rubbish.

—to take advantage of the liberality of our reformed abortion laws? Will he take steps to investigate cesser of that abuse?

I am keeping this aspect under careful review. It is some- thing that applies solely to the private sector, and, of that, one sector in London. However, I am looking at the matter very carefully, indeed. I would remind the hon. Member that the figure represents a tiny proportion of the total number of operations performed.

I ignore the exaggerations of the hon. Member for Worcestershire, South (Sir G. Nabarro). Nevertheless, will my right hon. Friend discuss with the B.M.A. the problem that arises when people from abroad who are not entitled to an abortion operation can go to a local practitioner and, by reason of a private fee, get a referral to hospital? Will my right hon. Friend discuss that angle with the doctors concerned?

That is one of the subjects I want to discuss with the B.M.A. As I say, I am gravely concerned about aspects of the working of the Act, but it is too early yet to draw general conclusions.

asked the Secretary of State for Social Services whether, as a result of the regular reviews of all new claims for supplementary benefit from unemployed persons under 45 years of age, made in the light of his predecessor's Answer to the hon. Member for Horncastle on 25th July 1968, he can now state what proportion of such applicants are not genuinely seeking work.

No, Sir. The arrangements to which the hon. Member refers are not designed to provide any such figure, but to encourage people who are fit and for whom jobs are available to find suitable work as quickly as possible.

The Minister refuses to answer my Question, though I see no reason why the information should be kept secret, but would he not agree that the scheme introduced by the previous Minister has been well worth while? In view of the fact that in the financial year that has just ended the cost of unemployment benefit will have approached the staggering figure of £200 million, does he not agree that some such scheme is urgently necessary in employment exchanges as well?

I did not refuse to answer the hon. Gentleman's Question. The figures for which he asked are not available, as I said, but I agree that the steps taken by my right hon. Friend have proved successful. I can give the hon. Gentleman some figures. Two steps were taken with regard to fit, unemployed persons under the age of 45. First, in areas where jobs are available, single, unskilled men are told at the outset that their allowance will be limited to four weeks. That step applies to about 2,000 cases a week. Secondly, in other cases the allowance is reviewed after it has been running for three months. The claimant may then be told that he can continue for only a further four weeks. This step applies to about 200 cases a week.

Does not the Minister of State recognise that there is very wide public concern over this matter? Will he not be a little more communicative to the House and say exactly what is being done?

I am being extremely communicative to the House. I have just given information about the precise steps taken by my right hon. Friend. It was because there was concern that a minority of people were taking advantage of the provisions that my right hon. Friend acted in this way. I am now demonstrating to the House by means of a great deal of information that the steps my right hon. Friend decided then to take have proved very worth while.

Is it not clear to my hon. Friend that people receive a greater amount of income precisely because the present Government are much more concerned about unemployment than ever any Tory Government were?

Oh.

I agree. By a number of steps we have taken, including the short-term graduated system, we have shown that we are concerned not only with the unemployed but with all those who are facing difficulties, whose needs are being met not only by National Insurance but by supplementary benefits.

asked the Secretary of State for Social Services when he plans to amend Regulation 27 of the National Health Service (General Medical and Pharmaceutical Services) Regulations, 1966, so that the present one mile rule covering dispensing by doctors is replaced by an arrangement more convenient to patients.

As my hon. Friend the Minister of State indicated in the debate on the Consolidation Fund (No. 2) Bill on 25th March, I expect very shortly to announce a decision.—[Vol. 780, c. 1450–3.]

I thank the right hon. Gentleman for his reply. Will he do everything possible to speed things up? It is a long time since the Government announced their policy in regard to this demarcation dispute between two honourable professions, both of which would welcome a decision as soon as possible.

I appreciate that the delay has been unfortunate, but it is the result of new Ministers coming in. It has taken some time to learn both sides of the dispute, and I can tell the hon. Gentleman that it is not an easy decision to take.

asked the Secretary of State for Social Services whether he will publish in the OFFICIAL REPORT a list of those diseases which, on the basis of data on cause of death, show a statistically significant regional variation in their incidence throughout England and Wales; and if he will make a statement.

Yes, Sir. Detailed figures for England and Wales are published in the Registrar-General's Decennial Supplement, 1961, Area Mortality Tables and Life Tables.

Will not my hon. Friend agree that geographical correlations can be of great value in isolating previously unsuspected possible causes of disease, as was done in the relationship between dental caries and fluoride? Will he indicate whether there is any evidence to show the relationship between radiation levels and the varying forms of cancer in this country?

I should want notice of the second half of my hon. Friend's supplementary question. Apart from the figures in the Supplement, I have additional figures which indicate that there is a very wide range of different causes of mortality—geographical, environmental, industrial, social and economic. The material my hon. Friend will receive provides a good deal of food for thought.

Has the Minister of State seen the interesting reports on the relationship between hard and soft water and coronary disease, and will he encourage extra research into this aspect? Is not this subject rather more important than the fluoridation of water supplies?

I would not agree with the second half of the hon. Gentleman's supplementary question, but I will look at the subject to which he refers.

asked the Secretary of State for Social Services whether he will make a statement on the scope and purpose of clinical trials he is conducting or proposes to conduct in co-operation with doctors.

Clinical trials sponsored by my Department are for the purpose of providing information which will be of use in defining policy or leading to better use of resources. Trials are currently being undertaken, for example, in acute myocardial infarction, where home treatment is being compared with intensive hospital care; in the treatment of varicose veins, where injection compression sclerotherapy in out-patients is being compared with straightforward surgical techniques; and in other situations where particular developments, such as new monitoring equipment or sterile environments, are being evaluated in clinical situations.

I am obliged to the right hon. Gentleman for that information. Can he help to deal with a confusion which has arisen with regard to the term "clinical trial"? Is he aware that following the Medicines Act this is often regarded as a trial of new medicines? Will he take steps to ensure that the term is used rather more specifically than appears to be the case at present?

I am grateful to the hon. Gentleman for his expression of thanks and will bear his point in mind.

asked the Secretary of State for Social Services how many women's organisations in Scotland have made representations to him about the White Paper on National Superannuation and National Insurance; and what reply he has sent.

None, Sir.

I am surprised at my right hon. Friend's reply. What steps has he taken to acquaint women of the advantages which would accrue to them from this scheme? What single facet does he think gives them advantage in this scheme?

I hate to say it, but my Answer referred only to Scotland. I have received quite a number of replies and suggestions from England. As to the way in which we seek to help women to understand the scheme, we have a popular version of the White Paper which summarises admirably precisely what women get under the women's charter of the scheme. This White Paper is being increasingly read.

asked the Secretary of State for Social Services what progress has been made in his consideration of a change in the earnings rule for the wife of a disabled man.

I have at present nothing to add to the Answer I gave to the hon. Member for Harborough (Mr. Farr) on 3rd March.—[Vol. 779, c. 28–9.]

Is it not very wrong that once the earnings of a disabled man's wife go above £2 16s. she loses the whole of those earnings? Something should be done about this at once, especially in these days of high cost of living and inflation.

The rule reflects the view that it would be unfair and uneconomical to pay a married man on his contributions a substantial increase for a wife who was financially self-supporting. A wife who earns more than the amount of the dependency allowance ceases to be a dependant. This is the principle. As I said in my Answer to the hon. Member for Harborough, the question of the levels is now being examined and a statement will be made in the comparatively near future.

Is it not of great importance to the psychological health of the wife of a disabled person that she should be encouraged to go out to work and not discouraged? Is not the abolition of this earnings rule, which cannot cost a great deal of money, a very high priority in the reconstruction of social security?

The noble Lord is presumably referring to the disabled man. We have also to look at the unemployed man and the sick man, who are equally affected. It is not fair to pick on one section of the community without considering the others. This is a point which is well recognised in the new scheme which we shall be introducing, and as far as the levels are concerned, a statement will be made later.

asked the Secretary of State for Social Services how much his Department is spending on giving aid to research into industrial diseases; and if he will list the amount spent in each category.

Expenditure on research under Section 71 of the National Insurance (Industrial Injuries) Act during the last financial year amounted to £14,120. I will circulate in the OFFICIAL REPORT the detailed table asked for.

Is my hon. Friend aware that far too many working people are crippled by pneumoconiosis? Does he agree that if the effect of this terrible disease could be minimised the work force would be not only more comfortable but better able to assist in building the country's productive wealth?

A study of pneumoconiosis is already being undertaken by the Industrial Injuries Advisory Council. I agree that this is an important subject for research, but a great deal of work has already been done on the subject.

As many more days are lost through illness and injury sustained at work than are lost through strikes, is my hon. Friend satisfied with the amount his Department is spending on this? It seems a disappointingly small figure. Can he assure us that no worth-while projects of research are being held up through lack of funds?

The figure for one year does not give a very fair impression because, although there are three researches which the figure I gave in part covers, one of the researches—for instance, that on industrial noise and hearing—was a very much larger research and much more of the cost was carried in earlier years. If new proposals are put forward as a basis for research, I assure my hon. Friend that my right hon. Friend will look at them very carefully. We are already substantially expanding the field of research in both parts of the new Department for which my right hon. Friend is responsible.

asked the Secretary of State for Social Services, how many hotels and restaurants were inspected in 1968; and how many prosecutions were initiated for breaches of food and hygiene regulations.

The local authorities are responsible for both inspection and prosecution. The information requested is not recorded centrally.

Does not my hon. Friend agree that there are far too many hotels and restaurants in which the standards of hygiene leave far too much to be desired? Is he aware that the Medical Officer of Health for Brighton, speaking in the "World at One" programme this morning, indicated that there are many of these establishments in Brighton and other seaside resorts? Will he take vigorous action to bring these establishments to heel and see that they observe the regulations?

As I told my hon. Friend, the responsibility is primarily one for local authorities, but I agree that in some cases—I am not going to specify—the standard is much below what one would expect and which we and visitors to this country are entitled to expect. I hope that what has been said in the House today will be brought to the attention of local authorities which have this responsibility.

The hon. Gentleman said that he is not prepared to specify any areas, but would he at least clear London of this charge?

No, I certainly would not. I myself have experience certainly in restaurants and cafés where I consider the standard is well below what the British public and visitors from abroad are entitled to expect.

asked the Secretary of State for Social Services if he will introduce amending legislation to the National Health Service Act, 1952 to remove the exemption from the payment of prescription charges from those persons suffering from venereal disease.

No, Sir.

Is my right hon. Friend aware that, while I recognise that the treatment of venereal disease is a social necessity, many of my constituents are asking—in fact, they have written to me—why people who contract venereal disease "through pleasure" should be exempt from payment, while persons who contract arthritis as a result of work should have to pay? This has made nonsense of the system of prescription charges.

The explanation is that we are signatories of the Brussels Agreement of 1924 under which we are obliged to provide free treatment for venereal disease.

asked the Secretary of State for Social Services what part of the supplementary benefit scale rates, in shillings and pence, is calculated as a margin for amenities, that is to say, a cash income to be spent in accordance with the individual's needs and preferences.

The whole of a supplementary benefit payment is a cash income which the individual can spend in accordance with his own needs and preferences. It is not possible to analyse this into component parts since people's spending habits vary widely. Since 1964 benefit rates have improved by 19 per cent. in real terms so that all beneficiaries have an increased margin of spending power to use as they please.

Does my hon. Friend mean, from what he has just said, that this sum is variable in accordance with different people's tastes and preferences? If so, is it not difficult for the local officers to calculate it—and if my hon. Friend cannot estimate the components of the total rate, how can he arrive at the total?

The Supplementary Benefits Commission is concerned about increasing the margin of spending power so that people themselves can decide how they wish to spend their supplementary benefit.

asked the Secretary of State for Social Services if he is aware that the hon. Member for Barking has had no substantive reply to a letter from a constituent, forwarded to the Department on 12th September 1968, concerning payment of unemployment benefit to occupational pensioners, and has received interim replies, the first dated 6th November 1968, stating that this matter was to be studied urgently, the second dated 10th March 1969, stating that no decision would be taken for some time; and if he will expedite a decision.

As my letter of 10th March to my hon. Friend explained, it would be premature to come to any decision in advance of the report of the National Insurance Advisory Committee on the draft regulations. The Committee is aware of the widespread interest in this matter, on which it has received a great deal of evidence which it is now considering.

Complicated though this matter, no doubt, is, can my hon. Friend say why it has taken the Committee so long to report to his Department? Does he realise that meanwhile a number of these occupational pensioners are waiting with considerable anxiety knowing that they have paid National Insurance contributions all their working lives?

I am aware of the concern on the matter, but, as my hon. Friend said, it is a complicated and difficult problem. The National Insurance Advisory Committee has had considerable evidence submitted to it, and representations have been made by the trade unions and other bodies. It will report as soon as it possibly can.

asked the Secretary of State for Social Services if he will introduce legislation to safeguard the rights of patients in teaching hospitals; and if he will make a statement.

I strongly deprecate attempts to coerce patients to take part in teaching, more particularly since they contradict the clear assurance given to my hon. Friend by my predecessor when she moved new Clause 3 of Health Services and Public Health Bill. In view of recent disturbing evidence, I have gone into this question afresh and I can now give my hon. Friend an assurance that no teaching hospital makes treatment conditional on the patient consenting to participate in teaching.

While thanking my hon. Friend for that reply, may I ask him whether he can make it clear that the assurance that he has just given does ensure that hospitals will not in future confine their services to patients who agree to co-operate in medical education, and that what he has just said supersedes the recent cases which have been reported to him where teaching hospitals have made treatment conditional on patients co-operating in teaching?

I should like to put the matter in this way. I was not satisfied by the replies given to an investigating gentleman called Mr. Armstrong from three teaching hospitals, which seemed to imply something which did not accord with my predecessor's assurance. However, I went into it. In fact, the practice of none of these hospitals was to exclude anybody. So the situation was satisfactory. But I must admit that an impression was given by certain of the secretaries that a patient would not be encouraged to go if he was not prepared to accept the teaching.

While entirely agreeing with all that the right hon. Gentleman has said, may I ask him to make it quite clear that teaching cannot continue in teaching hospitals unless people are willing to be used as clinical material and that the overwhelming majority of patients in teaching hospitals are willing and glad to co-operate?

I might add that my replies have applied mainly to the London hospitals where the problem arose. I entirely agree with the right hon. Gentleman. Teaching hospitals obviously assume that the great majority of patients will not object. Indeed, they do not object. Some of them positively enjoy being important and interesting persons in the hospital. Nevertheless, we must preserve the right of the minority to object. The point of my answers was that what my predecessor said remains as clearly categoric as he said it.

Does the right hon. Gentleman agree that the position of child patients in this matter must be particularly safeguarded? Will he undertake that no child is used for teaching purposes in a hospital without the permission of its parents?

I think I am right in saying that the assurance applies to the parents of a minor in the same way as it applies to the parents themselves.

asked the Secretary of State for Social Services if he is satisfied with the operation of the casualty departments of non-teaching hospitals in England and Wales; and if he will make a statement.

I am satisfied that the concentration of services into designated accident and emergency departments is enabling hospital boards to provide a more effective service in the interests of patients.

Is the right hon. Gentleman aware that some small hospitals are more deficient in their casualty departments than in any other department? Should not this be given full priority in any rethinking that is going on in the National Health Service?

I am aware that there may be accidents where it appears to be almost to the advantage of the patient to be taken to a nearby small hospital than to a larger one. Nevertheless, in general it is clear that the modern kind of accident and emergency department is far better able to deal with grave accidents than the smaller hospital. After all, accidents cannot be diagnosed on the spot on the road. Therefore, it is important to get the patient to a place where he can be dealt with adequately.

asked the Secretary of State for Social Services how many circulars dealing with family planning have been sent to hospitals in the past 25 years; and what analysis he has undertaken of their results.

Circulars issued to local authorities in 1966 and 1967 were brought to the attention of hospital authorities, which were asked to co-operate with local health authorities in the introduction of a comprehensive service. The circulars did not call for reports from hospital authorities.

Will not my right hon. Friend agree that in this respect there is great scope for the hospitals? Will he indicate whether fresh legislation is needed to give hospitals the same rôle as that now performed by local authorities, or does he envisage the work at present committed to local authorities being subsumed by the hospitals in the light of the forthcoming report on the tripartite structure?

I do not think I would accept the second part of my hon. Friend's supplementary question at all. I have always assumed that local authorities were the right people to run this advisory service, and that what was done by the hospitals was only secondary, and done in relation to those who went to the hospitals. In any reorganised service, I take it that it would be not the hospitals but the services outside the hospitals that would still do the work.

Is my right hon. Friend aware that many of us are very concerned about the lack of progress among local authorities in taking this job seriously so as to cater for all the women who need the service? What progress is being made?

I share my hon. Friend's concern. It is very unfortunate that this new service was launched at a time of increasing financial stringency. Some local authorities seem much too inclined to regard the small sum they give to this work as being the first thing to dock when things are difficult, which is something I greatly deprecate.

Would not my right hon. Friend point out to local authorities that it is much cheaper—if we must look at this question from the economic point of view—to spend a few hundred pounds on family planning services for all women, married or unmarried, in a local authority area than to spend the money needed after the baby has been born on the various services that the child and the mother may need? Does he not also agree that maternity hospitals are very productive places where this kind of advice could be given? Does he know how many maternity hospitals are giving family planning advice?

I can see that the idea could be launched in the maternity hospitals. I rather agree with the first part of my hon. Friend's supplementary question, but I should like to put it that I should like this country to be known primarily for its family planning and only secondarily for abortion.

asked the Secretary of State for Social Services what revenue was received in 1967 and in 1968 from insurance companies in payment to National Health Service hospitals for treatment to patients injured in road accidents.

Hospital income in England and Wales from fees and charges under the Road Traffic Act, 1960, was £583,000 in 1966–67 and £611,000 in 1967–68.

Is not the principle of making charges within the Health Service where an insurance scheme stands behind the patient a sound one? Will the Minister of State consider the possibility of extending insurance schemes of this sort to areas other than those involving motor accidents?

No; I will deal only with the Question that has been tabled. It was a right decision which was taken. Section 5 of the Public Expenditure and Receipts Act, 1968 empowered the Secretary of State to vary the sums specified in the 1960 Act. Since then there has been a regulation which has substantially increased the fees involved. The estimated income for 1969–70 will be over £1 million from this source.

Will my hon. Friend resist any question of helping to develop private insurance schemes with a view to adding to the income of the National Health Service, since the inevitable consequence would be a first and second class service?

I agree with my hon. Friend's forecast of the outcome and have said this in the House on a number of occasions. However, that aspect does not arise from the Question.

Is the Minister of State satisfied that payments by insurance companies go anywhere near as far as they could and should towards paying the cost?

Although there has been an increase which will be reflected in the figures for 1969–70, the cost to the hospital service of in-patient and out-patient treatment attributable to road accidents is about £10 million a year.

Following on the supplementary question asked by my right hon. Friend the Member for Reigate (Sir J. Vaughan-Morgan), does not the Minister of State agree that there is a case for saying that motor insurance should cover a much higher proportion of the cost of the casualty service than it does at present?

As a result of the order which was introduced increasing the fees for emergency treatment from 12s. 6d. to 25s., the maximum charge for out-patient treatment from £5 to £20, and the maximum charge for in-patient treatment from £50 to £200, there has been a substantial increase, which in most cases is borne by the insurance companies.

On a point of order, Mr. Deputy Speaker. In view of the widespread interest in this matter, I should like to give notice that I shall try to raise this subject on the Adjournment.

asked the Secretary of State for Social Services how many transplant operations have taken place in hospitals in the United Kingdom for each of the last three years; and what was the percentage of success.

Separate statistics for this kind of operation are not collected at present. Some centres have published their results with kidney transplants, but it is too soon to appraise the effectiveness of transplant operations.

I share the widespread admiration of the skills shown by those who engage in transplant operations, but does not the Secretary of State detect a certain sense of unease among the general public about them? Should not the House have the opportunity of debating the moral, ethical and legal implications, and, indeed, the financial priorities within the Health Service of these operations?

As a result of the enterprise of one private Member, we have already had discussions on this question on two occasions. I now have a committee which is looking into the legal position and will advise me. I am hoping to put legislation before the House, if possible.

Will the Secretary of State bear in mind that it was exceedingly difficult to make progress on the Private Member's Bill which I was privileged to sponsor on two occasions due to the lack of statistics on cadaver kidney transplants, which account for more than 90 per cent. of the organ transplants carried out in Britain, excluding cornea, during the last five years? Could not the right hon. Gentleman initiate the collection of appropriate statistics in this important field?

On receiving this Question I looked into the matter. Central statistics would not be very meaningful at present because of the very limited number of operations. However, we have a fairly complete oversight of the whole matter. Directly statistics are meaningful we will collect them.

asked the Secretary of State for Social Services what is the average waiting period for a child in need of tonsillectomy; and what proposals he has for reducing the average such waiting period.

Statistics for children only are not available. The latest information for all patients is that the average waiting time for tonsils and adenoids operations was 22 weeks. The steadily expanding hospital building programme and the more effective use of resources will I hope reduce all waiting times.

Will my right hon. Friend investigate the position in view of the concern which is felt about children not having this operation when the medical people concerned are advised that it is essential that it be performed as quickly as possible?

I will certainly look into any local case which my hon. Friend has in mind. We in the West Midlands have certainly had difficulties on this subject recently. The whole question of tonsillectomy is still a very controversial one within the medical profession. I hope to get some help from the Medical Research Council in the not too distant future.

asked the Secretary of State for Social Services what steps he is now taking to encourage the increasing employment of fully-trained married women nurses on a part-time basis in the National Health Service hospitals.

Advice has been given to hospital authorities on recruitment, reception, welfare and refresher training; the number employed is steadily increasing and I do not think that additional action on our part is required at present.

Has my hon. Friend investigated the practice in certain teaching hospitals in London where part-time nursing is defined as one or two hours less than full-time employment? Is he aware that this is discouraging some married women from taking part in nursing when they are urgently needed in the service?

There are several different definitions according to the needs of the hospitals concerned. We have specially asked the hospitals, in making their plans, to try to make use of the opportunity for service of people who are prepared to do part-time work. In fact, the figures of increase are encouraging. In 1964 there were 29,000; in 1966 the number had risen to 39,000, and in 1968 there were over 44,000 part-time workers in National Health Service hospitals.

Will the hon. Gentleman bear in mind that there are many other questions concerning nursing which require answering? Would he ask his right hon. Friend whether he will be ready tomorrow to answer the Question that I have put on the Order Paper about the nursing profession in general and their grievances?

I think it is possible that my right hon. Friend has heard what the right hon. Lady has just said.

Is my hon. Friend aware that current Press publicity on deductions in respect of meals from nurses' salaries will have a seriously adverse effect on recruitment?

That is an entirely different question which I certainly cannot answer now.

As we already employ consultants on three-hour sessions, on three-quarters allowance time, would my hon. Friend consider a similar kind of scheme for nurses?

I will have a look further at ways in which the hospital service can make use of the varying degrees of time that can be made available by people who are prepared to work part-time. As I have said, it needs to fit in with the requirements of hospitals, but hospitals equally must make their arrangements to fit in with the willingness of people who come forward at the times when we want them to come forward.

Is the hon. Gentleman aware that one of the disadvantages of closing the smaller hospitals and concentrating the service entirely on the very large ones will be that we shall lose the services of many women who can work part-time as long as the hospitals are near their homes?