asked the Secretary of State for Social Services when he will now institute an inquiry into the increase in the cost of unemployment benefit in the last few years.

The increased cost of unemployment benefit is a reflection of higher rates of benefit and a higher level of unemployment. I have no reason to think that other factors account for more than a fraction of the increase, but if there are any aspects on which the hon. Member feels that inquiry is called for I should be glad to consider them.

Has the Minister considered the desirability of tightening the administration of the payment of unemployment benefits, made on his behalf at employment exchanges, on the same lines as the tightening introduced by the previous Minister of Social Security for the payment of supplementary benefits to unemployed by officers of his Department?

Officers of the Department of Employment and Productivity exercise a great deal of vigilance. Each exchange has an officer especially responsible for this, and there is a team of investigators, as I have previously told the hon. Gentleman. He will be interested to know that last year there were more than 700 successful prosecutions for unemployment benefit fraud compared with about 550 in the previous year.

Will not my hon. Friend agree that the number of people involved in fraud is very tiny compared with the number genuinely receiving unemployment benefit? Is it not dangerous to develop the hon. Gentleman's argument in view of what used to happen in prewar years?

I entirely agree with my hon. Friend. It is a small proportion. In a total of about 500,000 unemployed, of course some individuals will seek to exploit the scheme, but they are a small minority.

asked the Secretary of State for Social Services what is the estimated cost in working man-hours lost for mental illness to the nation for the years 1966, 1967, 1968, and to the latest available date in 1969.

asked the Secretary of State for Social Services what is the cost in sickness benefit paid to the mentally ill and the days of incapacity this reflected for the years 1966, 1967, 1968, and to the latest available date in 1969.

I have information only about sickness which is notified for the purpose of claims under the National Insurance Acts and about the cost of benefit paid in the period June 1965 to June 1966. The estimated cost of sickness benefit for incapacity attributed to psychoneuroses and psychoses was about £24 million for 28 million days. In the period June 1966 to June 1967, the latest for which figures are available, the corresponding figures were about £25 million for 29 million days.

Is not 28 million days about four or five times as many as the days lost through strikes? Will my right hon. Friend try to concentrate the attention of the public on the problems of mental health in the same way as it has been drawn to the problems of strikes?

It certainly is true that sickness benefit, including this aspect of sickness, is much more significant numerically than the number of days lost by strikes. We are doing a great deal to concentrate the attention of the public on the problems of mental illness and mental disease as well as the facilities that are available for treatment and care.

Despite the increase, will my hon. Friend discuss with the Department of Employment and Productivity the great success that we have had in the last three years in industrial therapy compared with occupational therapy with a view to making sure that we can employ more people who are mentally ill in the community instead of paying them sickness benefit for days off?

There are increasing facilities for those suffering from this disadvantage to have forms of protected employment. I will certainly have further discussions with the Department of Employment and Productivity to see whether we can go further. But I should point out that the increase to which I referred in my Answer is very marginal and is in line with the general increase in sickness benefit.

Can the hon. Gentleman say what proportion of the man hours lost was due to depression and what investigation his Department is making in the more extended use of anti-depressant drugs to reduce the period which people are away sick with this illness?

With respect, that is a different question. Perhaps the hon. Gentleman will put down a Question on that matter.

asked the Secretary of State for Social Services what estimate he has made of social security payments that have been made during the current year to official and unofficial strikers, respectively, and to those rendered unemployed by strike action; and if he will make a statement.

Strikers are not entitled to unemployment benefit, nor to supplementary benefit for their own requirements. In the 12 months to 31st May of this year, approximately £390,000 has been paid in supplementary benefit for the dependants of persons involved in official and unofficial strikes. The statistics kept do not distinguish between official and unofficial strikes; nor are figures available for unemployment benefit and supplementary benefit paid to persons not themselves on strike but unemployed as a result of strike action.

Has the hon. Gentleman's attention been drawn to the speech by Mr. Ted Varley, the President of the National and Local Government Officers Association, in which he argued that social benefits should be withheld from wildcat strikers? Do not the views of this senior member of a respected trade union deserve very careful consideration by the Department?

That suggestion would impose greater hardship on the wives and children of strikers than was imposed even in the days of the old Poor Law. There is another issue also. In the case of the recent Leyland dispute, for example, a rough calculation suggests that the men lost upwards of £800,000 in wages and supplementary benefit payments totalled about £52,000. It would take a very great deal of overtime at the end of the dispute to make up for that shortfall.

Was not the Leyland dispute an official trade union dispute in which dispute benefit was paid by the union concerned? Can my hon. Friend say what proportion the £390,000 represents of the total payments of supplementary benefit?

I am sorry that I cannot give the exact figures. It was, however, pointed out by the Donovan Report that it appeared that during the period 1962 to 1966 only about 8 per cent. of workers involved in stoppages lasting more than two weeks received supplementary benefit. Even in prolonged strikes lasting several weeks, the proportion of strikers claiming supplementary benefit is seldom more than 35 per cent.

asked the Secretary of State for Social Services what proposals 'he has to improve the pensions of those people who elect to continue working until after their 70th birthday.

People who work and contribute during the five years following minimum pension age earn increments to the retirement pension they eventually receive. These were last increased in October, 1967, and the Government have no plans to make further improvements at present.

Would my hon. Friend not agree that the rewards for someone who wishes to work these five years and forgo the pension during that period are completely inadequate in the present pension structure?

No, Sir. There has been little connection between the timing of the new increase in benefit rates and the increase in increment rates. The two coincided only in 1951 and 1967. In 1959 the increment increase was made independently of other benefit changes.

Does the hon. Gentleman recollect that selective employment tax is being increased by 28 per cent. today? Would not the best incentive for the over-seventies be to ensure that they do not have to pay it, or that their employers do not?

That is a question not for me but for my right hon. Friend the Chancellor of the Exchequer.

asked the Secretary of State for Social Services whether he will set an upper limit to the total amount of the Exchequer contributions to the National Insurance Fund in his proposals to reform national superannuation and social security.

No, Sir.

So there is to be no upper limit to the amount which the taxpayer has to pay into National Insurance? Now that the Ministry has put the contribution on a graduated basis, what is the justification for keeping the taxation element in this system at all?

There will be no upper limit set, but the intention is, in the up-rating Bill at present in Committee, to retain the Exchequer contribution at roughly the same proportion as it has been for a number of years. Equally, the intention in the new long-term scheme for national superannuation is to keep the proportion roughly the same—at 18 per cent.—as part of the contribution towards the redistributive element within the new scheme.

Would my hon. Friend not agree that there is a strong case for not decreasing but increasing the amount of contribution?

One would not want to increase it too high, because this is, after all, a contributory scheme. It is important that the contributory element should be maintained so that there is some relationship between the benefit which people receive and the contributions which they have paid.

asked the Secretary of State for Social Services if he will take steps to prevent a reduction in the proportion of employed people contracted out of the State graduated pension schemes following Her Majesty's Government's decision no longer to adhere to the existing basis for relating benefits to contributions for those contracted in.

No, Sir. Employers, in consultation with their employees, will continue to have a free choice in this matter.

So the Minister does not mind if the contracted out section declines dramatically?

It is, as I said, entirely for the employers to decide. There is no evidence that there will be any substantial increase either in the contracted out element or in the number of those who remain contracted in.

Is it the objective of the Department, then, to increase the number of persons contracted out, to reduce it, or to keep it exactly the same as under the Boyd-Carpenter scheme?

The intention is that there should be opportunities for occupational pension schemes to maintain their position and to expand, but, at the same time, we want properly to protect the finances of the State scheme.

asked the Secretary of State for Social Services if he has considered the case submitted to him by the hon. Member for South Bedfordshire concerning a pension reduced by 6d., due to the introduction of reduced bus fares in Luton; and if he will take steps to prevent pension reductions of this type.

The reduction of retirement pension starts when earnings reach a level which is not wholly compatible with retirement, and in assessing earnings the independent statutory authorities which determine these questions can only take into account actual expenses. This pensioner and his wife are no worse off and can still gain from the concessionary fares other than when travelling to and from work. The income from pension and earnings of a retired married couple can amount to £13 16s. before the pension is affected, a figure which will rise to £15 12s. in November.

Does my hon. Friend not appreciate that this type of absurdity creates an unnecessary Scrooge-like impression of social security? Would he and the Government agree that there is here, perhaps, a case for some rigid minima and more flexible maxima in the payment of social security benefits?

No, Sir. As I said, the statutory authorities can take into account only the actual expenses involved. My hon. Friend will know that the new arrangements in the Bill now before Parliament will raise the level of earnings at which the rule begins to operate from £6 10s. to £7 10s. The pensioner who is the subject of this Question will then be outside the scope of the rule.

asked the Secretary of State for Social Services if he will take steps to enable men to draw Social Security benefit for themselves and their families when they have to stay off work due to the illness of the wife; what is the estimated cost of such a provision; and if he will make a statement.

Where there is no alternative to the man's staying at home, supplementary benefit can be paid to meet the requirements both of himself and his family. The estimated yearly cost of such payments is of the order of £¾ million.

Although we are aware that the man will obtain a supplementary benefit, is it not time either that the sickness of the wife should be accounted as ordinary sickness in these terms or, much more progressively, that the rôle of housewife should be recognised in social security contribution terms, and that she should therefore be given a proper status as a worker in society?

No, Sir. That would mean a complete change in the national insurance scheme. My hon. Friend will know that National Insurance benefits are to compensate for earnings lost through incapacity for work, unemployment or old age. Provision for other contingencies such as the one he mentioned is made through the supplementary benefits scheme.

Is the hon. Gentleman aware that there are well-documented cases of doctors giving sickness notes to husbands when their wives are sick to enable them to draw sickness benefit while staying at home to look after the children?

If the hon. Gentleman would draw our attention to these cases, we should certainly look into them for him.

asked the Secretary of State for Social Services if he will take steps to ensure that oral contraceptives issued by the Family Planning Association are provided only under qualified medical supervision.

Rule 31(2) of the Poisons (No. 2) Rules 1968 already provides that oral contraceptives must not be supplied from a family planning clinic except on and in accordance with a prescription given by a duly qualified medical practitioner.

Is the Secretary of State aware that at some clinics the Family Planning Association, for the work of which in general I have the utmost respect, issues oral contraceptives to women returning for a second six months' supply without the women having been seen or examined by a doctor? In view of the potential danger of some of these drugs, will he take steps to investigate this situation?

What the hon. Gentleman has said is news to me. I was aware that from time to time they were issued by non-medical members of the team, but I gathered that that was mainly because some women could not afford to pay for them all at one go and came back for some afterwards. I do not believe that they are issued other than under strict medical directive, as is prescribed. However, if the hon. Gentleman has any evidence to the contrary, I hope he will bring it to me.

Can my right hon. Friend say why non-oral contraceptive devices are free of charge whereas teeth and spectacles have to be paid for?

I suspect that that question is rather different from that which I have just answered.

asked the Secretary of State for Social Services how many of the private nursing homes relicensed at the end of April for the termination of pregnancy operation for two months only have now been reexamined and found to be up to standard and given a new licence accordingly.

Approval of the Lang-ham Street Clinic; The Avenue Clinic, St. John's Wood; St. Mary's Nursing Home, Hendon; and the Old Court Clinic, Ealing, has been renewed until 27th April, 1970. Approval of the West Hampstead (Private) Clinic and the Heywood Clinic, Stanmore, has been given for six and two months respectively. Further approval will depend on satisfactory completion of structural work now in progress at these two establishments.

Presumably, my right hon. Friend is satisfied that all the homes that have now been approved are up to standard and capable of meeting an obvious need. Will he bear in mind that many of the rumours of charter flights from abroad and the pressure from abroad on these facilities are propaganda being used by opponents of the Act who want to press him and the House into taking certain action? Nevertheless, will he keep a close eye on all these establishments and, if he feels that there are any abuses, take a tough line with those responsible?

I have taken an extremely tough line. I must make it clear to my hon. Friend that my job is to see that the establishments are properly kept and that I am not concerned with what a doctor does inside an establishment, which is not my responsibility. I realise that these establishments are not always normal nursing homes and that especially strict conditions must be imposed when large numbers of operations occur in a single place.

Is it not a little optimistic of the Secretary of State to think that those who are operating rackets will give accurate replies to his letter? In the circumstances of great public alarm and high public controversy, would not the best solution be for the Minister to appoint an impartial committee representing all points of view to investigate what is going on?

It is a lot to suggest, when asking about a particular fact, that the responsible people running the nursing homes will tell me lies. It is important to observe that the operating doctors are required by the Act to notify each case in detail to my medical officers. I have watched this carefully, and it would be extremely serious if they did not notify in detail. So it would be wrong to assume that if they all denied that it was true it was not merely an exaggerated story. As for the idea that we need further investigation, I do not think that that is true. We really need a sense of proportion, and people should not write and publish with enormous emphasis stories based upon such a small amount of fact as I thought these stories were.

Will my right hon. Friend assure the House that he will resist all attempts to amend the existing legislation along the lines suggested by the hon. Member for Chelmsford (Mr. St. John-Stevas), because, clearly, the facts have not yet been established, other than the scaremongering which has appeared in the Press?

The legislative intentions of the hon. Gentleman he will perhaps disclose to me later, and we shall judge them on their merits. However, it would be most unwise to amend the Act yet. I have no reason to believe that the Act is not working well throughout the Health Service. There are minor difficulties which can be remedied. In a very small segment of the private sector concentrated in London, over which I have no control, things are taking place of which I do not approve and neither does the medical profession. But they do not prove that the Act needs amending.

Will the right hon. Gentleman remind hon. Members that those who use extravagant phrases like London being "the abortion capital of the world" cannot be surprised if some foreigners then take them at their word?

That is a fair point. If things are taking place inside these homes which conflict with the spirit of the law, it is not for me to deal with the doctor's conscience. It is for the doctor himself and for the medical profession's own disciplinary authorities. This is a very small group of doctors. It would be extremely grave if such a small group were to discredit what I think is a considerable reform.

asked the Secretary of State for Social Services if he has now made an assessment, in the light of the representations submitted to him, of the need for increased facilities under the National Health Service for the termination of pregnancies under the Abortion Act; and what action he intends to take to meet this need.

It is still too soon to form an assessment of the adequacy or otherwise of National Health Service facilities. I am continuing to watch the position.

Will my right hon. Friend bear in mind, in view of the large number of case notes which I sent him recently, that it is clear that in some parts of the country gynaecologists within the National Health Service are not carrying out their duties under the Act and are abusing the conscience Clause of that Act?

Nonsense.

It is not nonsense if a woman dies because she has not been examined by a consultant gynaecologist. As 27 homes for unmarried mothers have been closed down recently, will my right hon. Friend consider using some of them as units for carrying out terminations of pregnancies in these certain areas, so that at least the advantages of the Act can be given to all women who are in need of them?

I would not wholly agree with the first part of my hon. Friend's question. The Act made it clear that we rely on the conscience of the doctor. We knew that there would be a wide variety of conscience between one doctor and another. That was an inevitable drawback of an Act of this kind, and I do not blame doctors whose consciences differ from my own. But doctors who interpret their conscience in such a way as virtually to refuse the operation in almost any circumstances merely drive women to go to the private segment in London, and that does not do anyone any good.

Does not the hon. Lady's original Question—but not her supplementary question—pinpoint the problem? Is not a basic feature of the problem that many women who in the past had abortions in deplorably dangerous conditions now have abortions perfectly legally? As this was the foreseeable result and purpose of the Act, why did not the Government provide for an expansion of the gynaecological services in the National Health Service? Why leave the emphasis on the private clinics?

I would remind the hon. Gentleman that if we had done so at an even pace over the whole country the result would be a great deal of empty space in Birmingham and Liverpool. These are the areas where there has been no substantial increase because of the views of the doctors. We had to wait to see what happened. Nor do I believe that there is much evidence in the Health Service of undue pressure. The pressure is all within the small private sector which already takes 40 per cent., against 60 per cent. for the Health Service.

Does not my right hon. Friend agree that the way to relieve pressure from the private sector is by expanding facilities within the Health Service. As he said, Birmingham is an example of a place where there is this lack of Health Service facilities. What is his view on the setting up of the proposed abortion clinic in Birmingham?

I am prepared to consider that. That was the second point made by my hon. Friend the Member for Wolverhampton, North-East (Mrs. Renée Short) about whether we should ourselves establish small abortion clinics in these disused buildings. I am reluctant to do that. That is why I think that we had better wait to see how it is going, because we hope to even it out between the various regions. But it would have been no good increasing accommodation in Birmingham. The problem as between Birmingham and Newcastle is the interpretation of the Act by the rival consultants.

Would it not help the right hon. Gentleman, and, indeed, all those who are interested and anxious about the Act, if he were to set up an independent committee to which all doctors and all those interested in the matter could put their points of view? Does the right hon. Gentleman think that he is in a position to wait and then say he cannot do this and cannot do that because he has not got the evidence? Lots of people would be willing to help him put these matters straight.

Each of us has to weigh the time for a new investigation. There have been endless investigations in the past. Now action has been taken and the Bill has become an Act of Parliament. I want to give that Act reasonable time to settle down before more investigation is carried out. I think it really would be unwise to importune for further investigation, because that is not required at present.

asked the Secretary of State for Social Services in view of the fact that environmental conditions influence mental breakdowns, in particular relapses, what plans he has for special resources to be applied to the depressed areas.

asked the Secretary of State for Social Services if he will seek to provide special financial help for those areas with greatly above average incidence of mental illness.

As my hon. Friends know, rate support grant is distributed by reference to factors which reflect the needs and resources of different areas. In addition, grants can now be made to local authorities under the urban programme towards approved expenditure in urban areas of special social needs.

Recent figures show that East London has a higher national average of mental sickness. Has my right hon. Friend considered certain studies in other distressed areas in large cities like Liverpool, Manchester, Birmingham and Glasgow?

Yes. A lot of research and investigation is going on. I should again point out that the urban programme gives us power to concentrate on black spots.

Does the right hon. Gentleman recollect that on 27th March he said that there would be a reallocation of resources for mental health services? Can he say what results have been achieved?

I said that it was not only for mental health but mainly for long-stay hospitals and hospitals for the mentally subnormal. I am meeting the regional hospital board chairmen. I gave them until their July meeting. I said that I would meet them then and see what they had achieved in this period. That meeting will take place in the near future.

asked the Secretary of State for Social Services if he will take steps to encourage hospital management committees to admit the Press to their meetings.

I am considering how public relations in the hospital service can be further improved. Clearly, access to meetings is one of the best means. I must, however, leave this to the discretion of the hospital management committees as they sometimes have to discuss matters concerning individual patients and staff which ought not to be made public.

I thank my right hon. Friend for the tone of his reply. But does he accept that in many cases hospital management committees could admit the Press to a lot more of their meetings than they obviously plan to do at the moment? Will he, therefore, make further inquiries to improve the position with the object of having the public more involved in these vital community decisions?

Yes. I am certainly prepared to consider this. One thing I am already actively discussing—not with the hospital management committees direct—with the regional hospital boards is the meetings of hospital management committees at a time when a different kind of public can attend, both as members and as the general public, which seems almost as important.

Is the right hon. Gentleman aware that hospital management committees do not take important decisions? This Question ought really to have referred to the regional hospital boards, which are extremely poor in their Press relations. What steps will the right hon. Gentleman take, on the lines of his recent statement, to make sure that the regional hospital boards give proper information to members of the public and the staff of the hospitals?

I think that both are important. The hospital management committee is much more concerned with the problem of the individual patient, and that is not unimportant to the public. As for capital investment and balance and closures, this comes at the higher level, and public relations are equally important. I have not advised that merely appointing hundreds of public relations officers would do the job. We need people on those boards who really feel that keeping in contact with the grass roots of the community is important, which is not so in all cases today.

asked the Secretary of State for Social Services what increased expenditure he is proposing for 1969–70 on research into the causes and treatment of mental illnesses.

My Department's programme for 1969–70 is still under consideration, but the expenditure this year on research projects already approved into mental illness, mental subnormality and addiction amounts to about £120,000. In addition, £100,000 is being contributed towards the cost of experimental forms of service. These amounts are respectively about one-third and one-sixth higher than in 1968–69.

As half the beds in hospitals are occupied by the mentally ill, despite the efforts of the Mental Health Research Fund and other voluntary organisations, does the right hon. Gentleman agree that these sums, direct or through the Medical Research Council, are inadequate to meet the problem?

It is true that in this area we need more research and, I should add, more concentration of medical talent. We shall not get the research unless it is thought that these are areas where ambitious and vigorous men can make good as doctors. I am trying to combine making them attractive to medical superintendents, on the one side, and doing research on the other. Research has to extend into community services, because I want to stop institutionalisation and get people out of hospitals, not into them.

asked the Secretary of State for Social Services what plans there now are for the provision of special facilities for the treatment of psychopathic patients; whether he is satisfied with this provision; and if he will make a statement.

asked the Secretary of State for Social Services by what means the growing problem of the psychopathic patient is being dealt with; what steps are being taken to improve the facilities available for the treatment of such patients; and if he will give details of the facilities to deal with this.

The term "psychopathic" covers a wide range of behaviour disorders, some of which may respond to medical treatment or to social training. There are differences of opinion among psychiatrists on methods of treatment, and, indeed, on whether any treatment is effective. Special facilities on a substantial scale can be developed only as medical knowledge increases. Regional hospital boards have been asked to try different approaches to treatment.

Is the right hon. Gentleman aware that that reply is inadequate in the extreme? Is he satisfied that the pressures recently applied, particularly for psychopaths who have received a prison sentence and are not receiving sufficient care, are being considered in a sympathetic light?

I think it is important for the hon. Lady to realise that what I said was true. If I had given a much more euphoric reply, I should not have been reflecting the truth. The truth is that these patients are in a way the most difficult. They are the ones left over when all other treatments have failed. It is no good my saying that we know the way to handle them. What I said, quite rightly, was that we cannot invest large sums of money for further treatment until research justifies the development of this treatment.

Will the right hon. Gentleman consider the possible usefulness of a study into whether nursery school education would be of service in trying to moderate, or even cure, psychopathic behaviour? There may be some usefulness in the maxim of catching a psychopath early enough. I have had evidence of this in my constituency. Will the right hon. Gentleman look at this problem seriously?

There is a good deal of evidence on this. One of the few bits of firm evidence is that psychopathic abnormality often relates to very early happenings in a child's life. To that extent I agree with the hon. Lady.

asked the Secretary of State for Social Services how many special units there now are for the treatment of adolescents with psychiatric problems; whether he is satisfied with this provision; and if he will make a statement.

asked the Secretary of State for Social Services if he will make a statement on his plans to improve adolescent psychiatric facilities.

There are fourteen special units in England. About 30 more are planned, of which five are due to open in the next 12 months. Guidance was given to hospital authorities in 1964 about the provision of such units, and boards are fully aware of their advantages.

Does the right hon. Gentleman recall that his predecessor, the Minister of Health, told the hon. Member for Newport (Mr. Roy Hughes) over a year ago that there were thirteen such units? His answer implies that only one has been opened in the last year. As the right hon. Gentleman has said that 30 to 35 more are required, is he satisfied with this rate of progress, and what steps is he taking to speed things up?

I am not satisfied with the rate of progress, because I regard the treatment of adolescents with psychiatric problems as tremendously important. We have 30 units planned, of which five are due to open in the next 12 months, which I think might improve the average.

Does my right hon. Friend agree that it is most unsatisfactory for young adolescents with these problems to be mixed up with older folk, often with different problems? Can he give us any idea of the progress being made? Can he give us the percentages at the moment of all the adolescent people with psychiatric problems, of those in special units, and of those in general units?

I could if my hon. Friend were to put down a Question. I have not the information here, but I can give the extent of the provision. The 14 existing units provide only 290 beds. Those due to open in the next 12 months will give us another 110. Those planned will give us another 600. But I must warn the House that these are relatively small figures compared with the total demand.

Would the right hon. Gentleman agree that the shortage of inpatient facilities for psychiatrically disturbed adolescents is probably one of the greatest weaknesses of the whole of the psychiatric services? As this is always going to be a low priority in each regional board area because the numbers are small, will he consider grouping together the regional boards so that at least in various groups of regional hospital boards such facilities will be provided?

I should like to think about that before replying. I should not think that the grouping of boards was the answer, but I shall consider it.

asked the Secretary of State for Social Services how many patients were admitted to mental illness hospitals in 1958–59 and 1968–69; respectively; how many new outpatients and day patients were seen; how many in-patients there were and what proportion was compulsorily detained; what was the average length of stay of those discharged; and if he will make a statement.

I will, with permission, circulate the figures in the OFFICIAL REPORT. These figures reflect changes in methods of treatment. They include patients treated in psychiatric departments of general hospitals. Instead of long-term in-patient care, hospitals are increasingly providing shorter periods of active treatment to in-patients, and making greater use of out-patient and day-patient treatment.

Does the right Gentleman agree that that probably shows that although more individuals have gone into hospital they have been got out rather more quickly than in the past? Does not that show the need for increased research?

No doubt we ought to have more research, but I am more concerned with getting the facilities right, and I am sure that the right thing is to move to facilities in acute district hospitals and to reduce long-stay patients. We can claim that the figure dropped from 103,000 at the end of 1958 to 79,000 at the end of 1968. That was a substantial decrease, but readmissions increased in that time from 44,000 to 83,000. So there we have the good with the bad. If we reduce the long-stay, we increase the risk of people coming back. I still think that it is better to come back and then go home again, rather than be there for life.

asked the Secretary of State for Social Services how many patients categorised as being treated as drug addicts were patients in all types of hospitals on 1st January, 1969, 1st January, 1964, 1st January, 1960, and 1st January, 1958; and what were the number of new out-patient attendances of people categorised as drug addicts during these same years.

On 31st December, 1963, there were 97 patients in mental illness hospitals and units with a primary diagnosis of drug addiction. On 31st December, 1967, there were 78 heroin addicts as in-patients and 104 on 31st December, 1968. 391 heroin addicts attended clinics as new out-patients in the six months July to December, 1967, and 1,999 in the year 1968.

Are not these figures alarming as showing the rate of growth of addiction over these years? Is the hon. Gentleman satisfied that the facilities provided in the new out-patient centres are adequate to cope with the problem? What plans has he, apart from extending the scope of these outpatient departments, to deal with the amphetamines, which are a serious and growing problem?

As the hon. Member knows, the particular problem of amphetamine addiction is being considered by the advisory committee. As we are now beginning to obtain quite a lot of information about the pattern of addiction, I propose, Mr. Speaker, with your permission and that of the House, to publish in the OFFICIAL REPORT a small resumé of information in which we think that the House might be interested.

Does that include information about the cases of people who started on so-called soft drugs and moved on to hard drugs? This is the point which is of considerable interest to us.

I am not certain that our information is yet firm enough to publish in Parliamentary form, but I take the point made by my hon. Friend. It is a most important matter, and I shall consider his question today and see what we can provided in due course.

asked the Secretary of State for Social Services what is the estimated expenditure on dental health education for the current year.

The primary responsibility for dental health education lies with local authorities, and no information about their expenditure is available centrally. The Health Education Council's approved estimates provide for expenditure of £7,600 on dental health education in 1969–70.

In view of the fact that we are currently spending about £100 million on the dental service, is not that a woefully inadequate allocation? Will not the hon. Gentleman agree that the more money spent on dental health education now, the more we shall help minimise the cost of the National Health Service in the years to come?

That may be true, and I agree with much of what the hon. Gentleman says. Perhaps he will lend his authority and influence to encouraging local authorities to adopt the general principle of fluoridation to encourage better health in the teeth of young children.

asked the Secretary of State for Social Services if he will define his policy regarding the provision of dental facilities in health centres.

We are anxious that the necessary facilities should be available for dentists who wish to practise at health centres.

Would the hon. Gentleman at least agree that it would be better not to sanction the provision of dental facilities at health centres at public expense in those areas where, clearly, there is already an adequate supply of ordinary dental practitioners?

It is up to the dental practitioner engaged in the public service, if he thinks that he might do his work more efficiently from a health centre for the greater convenience of his patients, to make use of such facilities as there are in the health centre. I am talking of services under the National Health Service.

asked the Secretary of State for Social Services what steps he is taking to increase facilities for the domiciliary care of geriatric patients.

Domiciliary care for elderly people is the responsibility of local health and welfare authorities, who are aware of the needs. All the relevant services have expanded substantially in recent years.

Since my right hon. Friend a moment ago said that he was anxious to get people out of hospitals rather than into them, would it not be better if the Government were to apply their energies towards that end more vigorously than seems apparent from that reply?

We have by no means reached perfection in the matter. But in home nursing, home help, health visiting, meals, chiropody and the provision of certain nursing equipment, there have been substantial improvements in recent years.

Can the hon. Gentleman tell us what progress has been made with schemes for building flats for old people in the grounds of former cottage hospitals now falling into disuse, so that domiciliary care can be combined with the medical and nursing care available at those hospitals?

This has received the attention of an advisory committee established by my right hon. Friend. We are urgently examining standards, and the financial provision which those standards might imply.

Can the hon. Gentleman give the House any information about the extent to which the new powers in the Health Services and Public Health Act are being used by local authorities, particularly with regard to the provision of laundry facilities for people living at home?

No date of operation of the Act has been decided so far as those provisions are concerned.

asked the Secretary of State for Social Services if he will make a statement on his plans to improve the geriatric services.

The plans of hospital authorities envisage an increase of bed numbers in areas of local shortage and to meet the needs of an expanding population. Primary objectives are more efficient assessment, greater emphasis on rehabilitation and on out-patient and day patient treatment, and improved conditions for those who must remain in hospital as long-stay patients.

Now that the stigma of mental health treatment has been largely removed, would not my right hon. Friend agree that the extreme ends of the service, such as the adolescents, to whom he referred a short while ago, and, indeed, the geriatric service, are perhaps the most vulnerable? Will he, therefore, ensure that his resources are directed to these two vulnerable sectors?

I would add that the aim once again must be to see the fewest number of people in hospital, and for only a short time rather than long stay, and then to go for out-patient services and day hospitals for what is, I think, the greatest way of raising the self-esteem and the morale of these people.

Can the right hon. Gentleman say to what extent his reconsideration of the rôle of the small hospitals is valid in this context?

I have now received a most interesting report on the future of the district hospital and the relation between the big hospital and the small hospital, and I hope in due course to be able to make a statement to the House on it. It is a complicated question. Certainly, the arguments are not all on the side of the big hospital.

Is my right hon. Friend aware that there is a new geriatric unit at Luton and Dunstable Hospital with 80 beds which has been awaiting opening for some weeks because of a shortage of cleaners? Will he consider what advice can be given at ministerial level on this serious matter?

I would advise my hon. Friend to put down a separate Question.

asked the Secretary of State for Social Services, in view of the varying amounts of money spent by local authorities on community care services, whether he will set up an operational research programme to evaluate in depth those services provided.

My Department already supports a substantial programme of operational research in the health and welfare services.

Would my hon. Friend agree that there is not much sign locally of co-ordination between neighbouring units in this matter? Is he satisfied with the amount of coverage given to operational research in the sector of which he is speaking, because I fear that there is not much of it coming out locally?

The total cost of projects sponsored by my Department and currently in progress concerned with the evaluation of local authority community care is approximately £390,000. Of this total, £160,000 is for studies of services for the mentally ill and subnormal. If my hon. Friend has a particular area in which he thinks that there is a shortcoming of services within the expenditure which I have mentioned, perhaps he will let me know.

Is the Under-Secretary aware that these services can be effectively provided only if there is proper co-ordination? Is he aware that some local authorities are reorganising their personal social services in a manner which conflicts with the recommendations of the Seebohm Report? When will the Secretary of State be in a position to make a statement on this matter?

My right hon. Friend is well aware of that activity by certain local authorities. We are considering the matter.

asked the Secretary of State for Social Services what estimate he has made of the appropriate ratio of mental welfare officers per thousand population.

The ratio of mental welfare officers needed depends on many factors which vary from one area to another.

Does the hon. Gentleman think that that reply answers the Question adequately? There are a number of reasons for concern in certain areas about the supply of mental welfare officers. Is the hon. Gentleman aware that that concern exists?

I think it is a glimpse of the obvious to say that there is a variation in local demand. A ratio per thousand population in present-day conditions does not seem to be useful for comparative purposes, though local health authorities plan to provide an average of 0·05 mental health social workers per thousand population in 1975.

I wonder whether my hon. Friend would, nevertheless, take us into his confidence about what he thinks is the right ratio. My hon. Friend indicated that there were local variations, but is not there also a policy within the Ministry to go beyond that? This is a creative thing, and not simply the rubber stamping of the activities of individual organisations.

We shall listen to what local authorities have to say in the light of their experience. We think that the target I gave is a reasonable one, but we should like to watch events in this matter.

asked the Secretary of State for Social Services what number of out-patients per psychiatrist he estimates to be the maximum for effective treatment; and how far the present out-patient services meet this need.

Methods vary and no fixed ratio is appropriate: there is no serious overall shortage of psychiatrists though more are needed in some areas.

Does my hon. Friend consider that there are sufficient in the Birmingham area? Is he aware that I have had evidence that many psychiatrists in the Birmingham area seem to be very much overloaded with work in the outpatient department?

That is probably quite true in the Birmingham area. In other areas there seems to be some under-occupation. I should, however, add that at the end of September, 1968, there were 938 consultant psychiatrists and 442 registrars of mental illness and child psychiatry.

asked the Secretary of State for Social Services whether, in view of the fact that 40 per cent. of deaths from coronary attacks take place within the first hour, he will take steps to encourage the provision of mobile coronary care units in all major towns and cities.

I would refer the hon. Member to my reply to the hon. Member for Birmingham, Edgbaston (Mrs. Knight) of 2nd December.—[Vol. 774. c. 240.]

Is the Under-Secretary aware that a significant number of lives could be saved annually in our large towns and cities if expert help and equipment could reach the victims of coronary attack within a few minutes? As this disease is, unhappily, on the increase, should we not be a little more sophisticated in the way we try to tackle it?

That point of view is, to some extent, confirmed by experiences in the Belfast experiment. The programme initiated by my Department will now go on for up to two years. We can then assess the value of these trials. The procedures are, of course, very expensive in terms of medical manpower, and there are other calls on the available manpower. I quite agree, however, with the hon. Member that it is a matter which needs to be carefully followed and that some results, if not all, are very interesting.

asked the Secretary of State for Social Services whether he will issue instructions that medical examinations required by the adoption regulations should be obtainable under the National Health Service.

General practitioners in the National Health Service are not permitted under their terms of service to make a charge for the medical examination of patients on their lists, but they are required to provide without charge only a limited range of medical certificates. A charge can be made for certificates required in connection with adoption. I am making further inquiries, and I will write to my hon. Friend.

I thank my hon. Friend for that reply. Is he aware that under the adoption regulations a number of medical examinations have to be held—at least three and sometimes five—and that it is the current practice in many parts of the country to charge at least £3 3s. each for these examinations?

Yes, Sir; I was aware of that. The British Medical Association recommends to its members a scale of fees for private certificates, but, as I said, I am making further inquiries.

asked the Secretary of State for Social Services (1) if he is satisfied with the efficacy of the fixed combination drugs albamycin T, cremostrep, ivax, orastrep, penicillin v sulpha, as used in the National Health Service; and what consultations he is having with the British pharmaceutical industry and the British Medical Association in regard to their manufacture and use;

The withdrawal of these products on grounds of safety has not been recommended by the Committee on Safety of Drugs. The Joint Committee on the Classification of Proprietary Preparations, one of whose major concerns is relative efficacy, has, however, classified four of them as products whose use it regards as open to question and will be considering the fifth shortly. My right hon. Friend has no further consultations in mind.

I thank my hon. Friend for that reply. Is he aware that I was not complaining about the safety of the drugs, but suggesting that this was a most inefficient, expensive and wasteful method of treatment? Could he put in the OFFICIAL REPORT the names of the four drugs to which he referred?

Yes, Sir.

asked the Secretary of State for Social Services (1) whether he will make a statement on the future administrative structure of the National Health Service in the light of the recommendations of the Royal Commission of Local Government;

I have as yet nothing to add to my reply to the hon. Member for Northants, South (Mr. Arthur Jones) on 16th June.—[Vol. 785, c. 19.]

Does the right hon. Gentleman not realise that he is giving the impression of having very little policy by realising his plans in such a piecemeal fashion? Can he not now give some date when he will be able to tell us his conclusions on the new Green Paper on the Seebohm Report and on the relations of the two to the Royal Commission's Report?

The hon. Gentleman will appreciate that the Government—this is a Government decision—cannot come to any conclusion on any of those matters until there has been consultation with a large number of authorities. The consultations are just starting. I would not be unhopeful, however, that in the autumn the first preliminary statement could be made.

In the light of this answer, would the right hon. Gentleman explain why local authorities are already being put under pressure to let the Government have their views of the Royal Commission's Report by October.

For the precise reason that if there is to be a preliminary statement of Government policy in the autumn, it is vital to have the preliminary views of the local authorities by October.

Will my right hon. Friend assure the House that in these consultations he will incline towards putting the Health Service under democratic control and not solely under the control of the medical profession?

I think that I should be most unwise if I were tempted to indicate my personal inclinations in the matter.

asked the Secretary of State for Social Services what is the local health expenditure on the mentally ill and on the mentally subnormal.

The net revenue expenditure of local health authorities in England and Wales on mental health services in the year 1967–68 was £21·9 million; for the year 1968–69 it was estimated by local authorities that it would be £25·4 million. These figures include rather over £2 million each year as the apportioned element of general administration cost. In addition, loan sanctions for capital works totalling about £6 million were granted during the year 1967–68, and about £6·1 million during the year 1968–69.

Is my hon. Friend satisfied that that is an adequate proportion of local resources to devote to this important subject?

I think that we are getting near some acceptability in this proportion. In the last five years the revenue expenditure has doubled from about £12½million in 1964–65. Total Revenue expenditure over the last five years amounted to over £93 million compared with about £35 million in the previous five years.