asked the Secretary of State for Social Services whether he will make a statement about the system of merit awards to consultants.

The distinction awards system was introduced at the outset of the National Health Service, following the recommendations of the Spens Committee. A small professional committee under the Chairmanship of Lord Platt advises the Secretaries of Stale for Scotland and Wales and myself which consultants should receive awards.

I am grateful to the Secretary of State for that information. Can he say anything about the merit award which the consultants at Walsgrave Hospital gave themselves by carrying out private practice illegally? Has he received the report from the Birmingham Regional Hospital Board, and has he any statement to make further to that report?

I think the hon. Gentleman has a Question on the Order Paper on the second part of his supplementary question. It has never been the practice to reveal the names of holders of merit awards.

In view of the widespread dissatisfaction over the system of secret awards, will the right hon. Gentleman carry out a thorough review, together with the other things which he is having considered, with the idea of perhaps making these awards applicable to posts rather than persons?

No, I am not ready to undertake such a review unless much stronger evidence, and the reasons for it, including the views of the professions concerned, in favour of a review is given to me.

asked the Secretary of State for Social Services what advice he gives to local authorities who consult him about the desirability of increased charges to old people for local welfare services in order to save fractions of a new penny on their rates.

I have not been asked for any advice on this point, which is a matter for the local authority to determine.

Does the right hon. Gentleman agree that it should be part of his responsibility to discourage local authorities, like mine in Waltham Forest, from making mean attacks on the living standards of old-age pensioners by, for instance, raising the charges for meals-on-wheels?

The charges made by local authorities for services of this sort are entirely within their discretion within the rules laid down. I am aware of a fractional difference caused by decimal conversion by the local authority concerned—[HON. MEMBERS: "Oh!"]—a matter of 1p a week, a fractional addition, which is entirely a matter for the local authority.

asked the Secretary of State for Social Services in view of the official publication by the United States Food and Drug Administration of a list of products which are useless or dangerous, a copy of which is in his possession, and since many of these products are sold in Great Britain, if he will now issue a similar list as a warning to the public; and if he will introduce legislation restraining manufacturers from marketing such products.

Adequate powers to control the marketing of medicinal products already exist in the Medicines Act. I hope soon to receive the views of the Committee on Safety of Drugs on the list published by the United States Food and Drug Administration.

But is the hon. Gentleman aware that that list has been available for some months, I think in his Department as well as elsewhere, and that it contains not only drugs which are harmful but drugs which are useless and cosmetics which are useless—things, like Colgate's toothpaste, which are widely sold in this country? Does he remember that the thalidomide tragedy did not occur in the United States because they take more care about these things?

The Committee on Safety of Drugs has so far identified 90 of the 369 products listed in the American list, not all of which, as far as we can see, are sold or retailed in this country. I hope that it will be in a position to make a recommendation to us by the end of May.

asked the Secretary of State for Social Services if he will publish in the OFFICIAL REPORT the latest statistics of deaths resulting from the five most lethal diseases.

Yes, Sir.

The hon. Gentleman has not been very helpful. Is he aware that there is a feeling in the country, which is documented in various ways, that the disease of alcoholism is rapidly mounting to the top in the league of lethal diseases? Will he consider doing something about this matter, particularly as the Government have introduced legislation to sell State pubs?

I can anticipate the view which the hon. Gentleman will presently get of the list by telling him that alcoholism is not in the list of the first five killers. We do, however, take an extremely serious view of the health hazard of alcoholism, and the hon. Gentleman will recall that my right hon. Friend has made special financial provisions to pursue remedies in this direction.

asked the Secretary of State for Social Services when he next proposes to increase family allowances.

I have nothing to add to my right hon. Friend's reply to similar Questions on 2nd November, 1970.—[Vol. 805, c. 269–70.]

Instead of hiding behind his right hon. Friend's unsatisfactory reply, why does not the Minister frankly admit that the Conservative electoral promise of adequate family allowances has been broken and that the mystical £8 million spent on family income supplements by his right hon. Friend is peanuts compared with the millions of £s distributed to surtax payers? Will he give a straight answer to a straight question? Are the Government going to increase family allowances, or not?

On the contrary, the Govment have made a good start by introducing the family income supplement scheme and by announcing in the Budget substantial increases in child tax allowances. Neither of these rules out further changes in family allowances.

asked the Secretary of State for Social Services what plans he has to reduce the number of persons dependent on supplementary benefits.

Our proposals for the reconstruction of the national insurance scheme will he announced in due course.

Will the Minister accept that all the Government's policy initiatives so far have been essentially short-term and tactical reactions, and that what is needed for the future is a radical and major shift from means-tested awards, which nobody wants or likes, to benefit as of right in each category of social need? Will he also confirm that in increasing, as his policies will, the present 4 million who are subject to supplementary benefit he is consolidating two nations divided between stigma on one side and self-respect on the other?

If the hon. Gentleman is saying that we are bringing speedy help to those most in need, we gladly plead guilty. In the long term, the intention is that the national insurance scheme plus occupational schemes over and above that, in which people are encouraged to save for their retirement, will progressively over the years reduce the number of people who have to rely on supplementary benefit.

asked the Secretary of State for Social Services what is the average supplementary benefit paid to retirement pensioners to cover extra heating that, because of age or illness, they may require.

I regret that this information is not available. The basic scale-rate covers normal heating needs. All supplementary pensioners receive the long-term addition of 50p a week which provides a margin for such things as extra heating. It is when this addition is insufficient to meet special heating needs that the Supplementary Benefits Commission allows extra benefit specifically for this purpose.

While I thank the hon. Gentleman for that reply, is not it a fact that even when supplementary benefits are paid they are invariably totally inadequate to meet the extra heating costs that many elderly people face? The hon. Gentleman must know, as most hon. Members on both sides of the House do, many constituents who have to turn off their heating because they cannot afford to pay for it. Will not the hon. Gentleman, as a matter of urgency, ask his Department to look at this state of affairs again in the coming months so that a substantial increase can be made before the winter months commence?

The extra allowances for special needs have been improved recently, and, as the hon. Gentleman will know, the supplementary benefits rates are going up in September.

asked the Secretary of State for Social Services what plans he now has for further increases in prescription charges or for charging the patient a proportion of the cost of a drug.

asked the Secretary of State for Social Services if he intends to introduce a cost-related system for prescriptions under the National Health Service.

asked the Secretary of State for Social Services what representations he has received from the Pharmaceutical Society and/or other interested organisations concerning the introduction of cost-related prescription charges; and if he will make a statement.

asked the Secretary of State for Social Services if he is now in a position to make a statement arising from representations made to him by the pharmaceutical industry arising out of proposed changes in prescription charges.

Preliminary proposals have been put to the medical and pharmaceutical professions as a basis for discussion, and I propose to discuss with their representatives the objections which they see. The pharmaceutical industry has been assured that I will inform it of any firm proposals which emerge.

Will the right hon. Gentleman in his discussions bear in mind that the professional bodies of the doctors and the pharmacists have strongly and publicly expressed their opposition to cost-related charges, in view of the fact that such charges would mean that the amount a person had to pay would depend on the nature of his illness and might affect the doctor's prescription.

It is because I want to understand fully their objections that I am seeking meetings with both professions.

Under the cost-related system the chemist must assess the price of the prescription before he dispenses it. Has the Minister considered the ethical question that will arise if a patient is short of money? When the patient is told what the charge will be he will ask the chemist which part of the prescription he ought to take. Thus an ethical question will arise between the medical profession and the chemist who dispenses the prescription.

The House will be aware that all those who suffer from pressure of finance should be relieved by the exemptions provided by the Government, but it is because I want to hear the chemists that I have sought a meeting with them.

Does not independent examination show that the administrative costs of introducing the new system would wipe out any savings? If the Minister will not take back his iniquitous proposals on the basis of ethics or principle, will he take them back on the grounds of efficiency?

No, Sir. The net saving of £15 million which my right hon. Friend the Chancellor of the Exchequer estimated is a saving after allowing for costs.

Will the right hon. Gentleman tell us whether he will consult his right hon. Friend the Secretary of State for Scotland? Although there is a split of departmental responsibility, the right hon. Gentleman must know that Scottish pharmacists are indignant at this proposal and have said that it will eventually mean many people not being able to get the medicines they need because they will not be able to pay for them.

My right hon. Friends the Secretaries of State for Scotland and Wales and I will study the objections together very carefully.

Is the right hon. Gentleman aware that there are working people who, because of the increased prescription charges, are not taking up their prescriptions, and that what was described by my hon. Friend the Member for Birmingham, Ladywood (Mrs. Doris Fisher) is already happening? Is it not an absolute disgrace that working people should be put in this position by the policy of the Government?

If the hon. Gentleman knows of such cases, I hope he will advise the people concerned of the immunities available and the help available by means of prepayment certificates.

I ask the right hon. Gentleman seriously to reconsider this scheme. He will know that those who are suffering, for example, from chronic mental illness may face additional charges of as much as £1 to 30s. a week. He will also know that doctors are concerned about the "blunderbuss" principle—that is to say, putting several medicines together into one—and about the cost of a prescription for what might be described as black market, low-quality medicines. In the interests of the National Health Service I ask him to take back what seems to be an utterly destructive and misconceived scheme.

I must explain to the House that the scheme which my right hon. Friend and I propose to discuss with the professions is parallel with schemes already in operation in such countries as Sweden. It is not identical but it is parallel. The hon. Lady is quite wrong to talk of people having to pay £1 or more a week. A prepayment certificate limits the cost of all drugs that may be prescribed to 1p a day, and for that figure any citizen can get complete exemption from all future drug charges.

asked the Secretary of State for Social Services why the total cost of National Health Service prescriptions has more than doubled in the last 10 years.

Factors include the changed value of money; an increase in the number of prescriptions; and changes in the pattern of treatment involving the use of more effective and more costly drugs.

Is the right hon. Gentleman aware that we are still spending only 8 per cent. of our total budget on our general practitioner service, whereas we are spending 12 per cent. on pharmaceutical products? Is he also aware that for every eight general practitioners there is one commercial traveller from drug firms calling upon them? Is he further aware that each time the Government have put a charge on prescriptions, in 1956, 1961 and 1966, the drugs bill has risen? Last time it rose by £7 million. Will the right hon. Gentleman undertake a complete overhaul of his voluntary price regulation?

No, Sir. The country has benefited from the increased range and effectiveness of drugs, and this has contributed enormously to the relief of suffering.

Does my right hon. Friend agree that a great deal of medicine is wasted and that we are a nation whose bedroom and bathroom cupboards bulge with half-used bottles of medicine? Would not it be a good idea if people were encouraged more to use the medicine that they are prescribed?

Yes, Sir. I agree with each of those propositions. But what a Government should do about it defeats me.

In view of the escalation in drug prices, will the right hon. Gentleman discuss with the medical profession the advantage of prescribing national formulary drugs, which are often just as effective as proprietary ones and a good deal cheaper?

I do not accept that the price of drugs in real terms has moved faster than the price of other commodities; on the contrary. As for the hon. Lady's suggestion, that should be addressed to her own profession as much as to the Government. Certainly I shall consider whether anything more can be done.

asked the Secretary of State for Social Services if, in view of the shortage of facilities within the National Health Service for carrying out terminations of pregnancy, indicated by the recent case dealt with by the General Medical Council, he will take steps to provide additional facilities within the National Health Service in cities such as Birmingham, Sheffield and Liverpool, where women are not being given the same advantages as women in those parts of the country providing a better service.

I am aware that there are regional differences in the number of abortions performed under the National Health Service, and I expect that the inquiry I announced on 23rd February will consider the reasons for them. These differences are not necessarily associated with a lack of facilities.—[Vol. 812, c. 313–18.]

Does not the number of women living in these regional hospital board areas who have to go out of their regions to get the service which is provided for them by Act of Parliament lead the right hon. Gentleman to conclude that these women are compelled to go into the private sector—about which there has been complaint recently—and to pay about £150 for the abortion to be carried out? Is there not a danger that we shall be back where we were before the Act was introduced, in that many women will be compelled to seek illegal terminations simply because they cannot get the facilities under the National Health Service? Will the Minister look at this again?

The decision whether to recommend or carry out an abortion in a particular case is a matter for the professional judgment of the doctor concerned, and is not necessarily related to facilities. All these questions will be within the remit of Mrs. Justice Lane's Committee, the membership of which I hope to announce shortly.

Is my right hon. Friend aware that the Registrar-General's statistical review, published last Thursday, indicated that hundreds more abortions were carried out in Birmingham than in any other city of comparable size? Will he take no notice whatever of the request of the hon. Member for Wolverhampton, North-East (Mrs. Renée Short) as far as Birmingham is concerned?

My hon. Friend's supplementary question shows that this is a complicated matter with deep implications. That is why I look forward to the review by Mrs. Justice Lane's Committee.

asked the Secretary of State for Social Services what he estimates will be the total public expenditure for the benefit of disabled people in 1972–73, compared with 1969–70, taking into account the further proposals in his statement on 31st March.

No comprehensive figures are available, but the expenditure in 1972–73 on social security invalidity pensions and allowances, attendance allowance, war and industrial disablement pensions and allowances is estimated at £378 mil- lion. The comparable expenditure in 1969–70 was £271 million.

Is it not a fact that these encouraging figures reflect among other things, the first steps which the Government have taken to help disabled people? Can my hon. Friend confirm that before long the Government will disclose more of their plans, particularly in the light of the desperate needs revealed by the Survey of the Disabled, published today?

I am grateful to my hon. Friend. The answer to both supplementary questions is "Yes".

While welcoming the increased assistance for disabled persons, may I ask the hon. Gentleman to cast his mind back to certain questions, which I put to him and which he answered in some detail in February and March last, regarding the number of disabled people not receiving help from various local authorities? Is not today's report a further indication of the amount of help still required? No matter how much the hon. Gentleman has announced today, are we not still only tinkering with the problem?

Yes, Sir. This is a joint effort, on the part of the central Government, local government and voluntary bodies, which is going to be necessary in order to deal with what in the past has been a big gap in our social service arrangements.

asked the Secretary of State for Social Services when he expects to receive the report of his working party on homelessness in London.

I cannot yet say.

Can the hon. Gentleman assure us that the working party will analyse the housing market in London? Does not he agree that, whatever the merits or demerits of competition in other activities, greater competition for housing in London will only increase the number of homeless, particularly among lower-paid workers with families?

The working party has wide terms of reference. I assure the hon. Gentleman that it is proceeding with its work as quickly as possible. It had its first meeting on 11th March, and has already met six times.

Is the hon. Gentleman aware that the problem of homelessness in London is approaching disastrous dimensions? Will he bear in mind, for example, that the number of homeless persons in the borough of Lambeth who had to be given temporary accommodation went up from 1,001 in 1967 to 1,213 in 1970? If further evidence is required of the urgency of the problem, those figures alone should ginger up the Government into taking speedy action.

There is no complacency on the Government's part. There is a serious problem here, and it is being tackled both by my right hon. Friend and my right hon. Friend the Secretary of State for the Environment, who is primarily responsible here.

asked the Secretary of State for Social Services what was the total cost to public funds of payments of supplementary benefit to strikers and their dependants during the first four months of 1971; and what estimate he has made of the change in that total resulting from the Social Security Bill.

The provisional figures to 20th April show payments of about £3¾ million to strikers' dependants and about £3,500 to strikers themselves. Tiding-over payments after return to work totalled approximately £450,000. Had the Social Security Bill been in force this total of roughly £4¼ million would have been reduced by about £1 million; this figure would have been considerably larger—perhaps £2¼ million—if strike pay or tax refunds had been available in the postal dispute.

I am grateful to my right hon. Friend for that reply. Does it not show that even if the Bill had been in operation during this period the total level of this form of strike subsidy would have been running at about 30 times or more the level for the whole year in any year prior to the passage of the Ministry of Social Security Act, 1966? Does this not suggest that there is a case for reverting to the element of dis- cretion which was previously enjoyed by the National Assistance Board, set up by the Attlee Government, and by my right hon. Friend's Department?

I think we should try the system proposed by the Government in the new Bill. I have made it plain that the Government will have to keep the position under review.

I wonder how many times the right hon. Gentleman is going to answer the same question from the hon. Member for South Angus (Mr. Bruce-Gardyne)—

It is not the same.

with a slight variation. Does not the Secretary of State feel that, in introducing the Social Security Bill, the Government now intend to intervene directly on one side in an industrial dispute? Does he think this is going to help industrial relations?

All the Government are doing is removing an abuse of Parliament's intention, expressed in the Ministry of Social Security Act, 1966.

asked the Secretary of State for Social Services whether he will delay the implementation of his proposals relating to reduced benefits for strikers and their families until proportionate income tax increases for the managers and directors of companies whose employees go on strike have been imposed.

No, Sir.

The right hon. Gentleman has suggested that what is happening is an abuse. Is not he aware that all the examinations which have been made of strike causation have suggested that in at least half the cases the immediate cause is delinquent action on the part of managements? Is he not, as my hon. Friend the Member for Salford, West (Mr. Orme) said, making it clear that the Government are for management even when management is wrong, and against the striker even when the striker is right?

The hon. Gentleman will not draw me into questions outside my departmental responsibility. All we are doing with the Social Security Bill is carrying out the intention of Parliament, as I have just explained.

asked the Secretary of State for Social Services who are now the members of the National Insurance Advisory Committee; and what interests they represent.

Members of the National Insurance Advisory Committee are not appointed as representatives. Of the chairman and eight members, however, four are required to be appointed after consulting certain organisations. I will, if I may, circulate the names and the organisations consulted, in the OFFICIAL REPORT.

Would my right hon. Friend ensure in future that the Advisory Committee includes someone who is an expert on modern methods of handling data, including electronic data processing?

I would not like to give that commitment because my Department disposes of ample advice on that subject and the National Insurance Advisory Committee itself relates more to the substance of the insurance scheme.

asked the Secretary of State for Social Services whether he is now able to state his policy towards an earnings-related pension scheme.

asked the Secretary of State for Social Services what further progress has been made since 1st April in the Government's consideration of the reconstruction of the national insurance scheme, particularly as regards the earnings rule for retirement pensioners.

I would refer the hon. Members to my right hon. Friend's reply to the hon. Member for Fife, West (Mr. William Hamilton) on 27th April.—[Vol. 816, c. 73.]

What is the delay?

There is no delay. The Government are pressing ahead with great speed with their plans, and they will be announced substantially earlier than was the case with the scheme of the hon. Gentleman's right hon. Friend.

Is the hon. Gentleman aware that letters I receive from my constituents urge upon me that the recent relaxation of the earnings rule on retirement pensions is tinkering with the problem, which can only be effectively solved by the abolition of the earnings rule? Can he assure us that the review announced by his right hon. Friend will include the abolition of the earnings rule for pensioners?

I must ask the hon. Gentleman to await the review. I am sorry he feels that an increase of no less than £2 in the earnings rule is mere tinkering with the problem. It is a substantial increase.

Can my hon. Friend assure us that the plans will include clear provision for the protection of pension rights on change of employment?

I am glad to assure my hon. Friend of that. The Government are as keen on this matter as he is.

Will not the hon. Gentleman go a stage further and assure the House that there will be transferability of pension rights, which has been the objective of all Governments?

We should like to see that done where it is possible. At present it is probably not possible to go further in legislation than to provide for preservation, but also to ensure that no bars are put in the way of transferability where that can be effected.

asked the Secretary of State for Social Services what is the average weekly cost of keeping a patient in Walsgrave Hospital, Coventry; and what is the national average.

In 1969–70 the average cost per in-patient week for Walsgrave General Hospital (Phase II) was £76·21. The national average for all hospitals similarly classified as "acute" and with more than 100 beds was £55·70. Figures for 1970–71 are not yet available. The General Hospital, with 614 acute beds, did not open until 18th May, 1969, and the average number of beds available in 1969–70 was only 396. The in-patient costs in that year are not, therefore, representative of the comparative position expected when the hospital has been working to full capacity for 12 months.

Mr. Speaker, am I entitled to draw the conclusion from the length of that answer that the Minister is on the defensive?

All that the hon. Gentleman is entitled to do is to ask a supplementary question.

I regarded that as my supplementary question. In view of the fact that it is out of order, I shall move on to my next one. Is the Minister as committed as his predecessors were to the concept of great new district hospitals, or will he reverse the trend of creating size for the sake of size and closing down or running down other hospitals in the area to pay for it?

It all depends what the hon. Gentleman means by "great". We believe that there is a future for local hospitals, especially in association with the needs of general practitioners.

In view of the alarming cost of full-time medical care in hospitals, will my hon. Friend consider schemes for helping institutions, particularly in the private sector, which give after-care facilities?

That is a general question. If my hon. Friend cares to pose a specific request, we shall consider it sympathetically.

asked the Secretary of State for Social Services what consultation he has had with the Central Council for the Disabled concerning the implementation of the Chronically Sick and Disabled Persons Act; what action he is taking; and if he will make a statement.

My right hon. Friend is in touch with the Council with a view to arranging an early meeting.

Does the hon. Gentleman agree that the long awaited report published today by the Office of Population Censuses and Surveys contains some really shocking findings emphasising the need for urgent further consultation with the Central Council about the implementation of the Act? Will his right hon. Friend be making a statement in this House today or tomorrow about the report, and can he say when the report is likely to be debated?

The report is being studied. We shall hope to discuss it with the Central Council when its representatives come to see us. There is a great deal of material in it which needs full appraisal and digestion.

asked the Secretary of State for Social Services what representations he has received from the Royal College of Nurses about circular HM71(12) relating to charges for residential accommodation; and if he will make a statement.

None, Sir.

Is my hon. Friend aware that the circular has aroused considerable anger among nurses because of the unevenness of residential charges to nurses and medical staff? A senior nurse earning £2,880 is charged £485, whereas a consultant who may be earning more than £12,000 a year is charged only £420, and, when his accommodation does not come up to a general standard, he may be given an abatement. Are not these considerable discrepancies? Cannot my hon. Friend think of some means by which we can get more evenness into the accommodation charges for nurses and doctors?

It is very difficult to make meaningful comparisons between the charges made to doctors and nurses, having regard to the differences between their terms and conditions of service.

Will the hon. Gentleman bear in mind that, even if he has received no representations, there is strong feeling about this among nurses and that they feel that what they were given with one hand in the form of an increase in pay has been taken away with the other?

I think the hon. Lady knows that the Royal College of Nursing is represented on the Nurses and Midwives' Whitley Council which has full responsibility for considering the appropriate charges.

asked the Secretary of State for Social Services what consideration he has given to the European Economic Community's draft directives on the harmonisation and mutual acceptability of qualifications for the health professions between member countries; what estimate he has made as to whether such directives would be acceptable to the United Kingdom; and what effect he estimates such harmonisation and mutual acceptability of qualifications would have on the potential supply of doctors for the National Health Service if accepted by the United Kingdom upon entry into the European Economic Community.

We are considering with the appropriate registering bodies and professional associations the possible implications for the health professions in this country, if we join the Community, of the directives in accordance with the drafts so far published. It is too soon to make a full assessment, but no substantial change in the supply of doctors for the National Health Service seems likely.

I thank my hon. Friend for that answer and for the consideration which, clearly, he has given to the matter. Will he accept that if we can get terms and conditions for members of our medical profession comparable with those of European countries, it is possible that the mutual acceptability of quafications may lead to a valuable source of additional medical personnel in this country, bearing in mind the time which must elapse before we can have an adequate supply of doctors trained here?

I accept the broad outline contained in my hon. Friend's suggestion. However, the language barrier will still represent a severe impediment to any cross-movement.

Is the hon. Gentleman aware that the failure rates in comparable examinations was 6 per cent. in Great Britain compared with 71 per cent. in Italy? If we have harmonisation, there is the possibility of consultants on this side who at the moment are nine-elevenths engaged in the Health Service spending a great deal of time performing operations on the Continent, to the detriment of the manpower position in our hospitals.

I take note of that, but I think we should get closer to the Community before pondering these imponderables.

asked the Secretary of State for Social Services if he has reached a conclusion about the disposal of vacant hospital sites in Keighley of Morton Banks, Victoria and St. Johns.

Yes, Sir. My right hon. Friend intends to offer the major parts of these properties for sale by public auction as soon as arrangements currently in hand are completed.

I hope these arrangements will be made quickly, because the property in the land is deteriorating meanwhile, and the three hospitals have to be guarded at night from vandals and thieves at a cost of £350 a week, which could be better spent on the National Health Service.

I have noted my hon. Friend's comment carefully. We shall pursue these sales as expeditiously as possible.

asked the Secretary of State for Social Services if he can now make a detailed statement on his plans to increase the number of beds at the Royal Northern Hospital, Holloway, N.19.

The North-West Metropolitan Regional Hospital Board proposes to convert accommodation no longer required for radiotherapy to provide 18 additional beds for surgical cases. The work will start as soon as possible and should be completed in about six months.

Does the hon. Gentleman appreciate that there are more than 1,000 people on the list of the Royal Northern Hospital waiting for operations to be carried out? Some have been waiting for as long as three years. His answer will be cold comfort to those people in Islington waiting for operations to be carried out.

The regional board is under no illusion about the pressure on beds, and it is willing to consider any proposals for bed availability which the management committee may submit.

asked the Secretary of State for Social Services wheher his attention has been called to a recent case in which an unqualified man was permitted to act as a doctor at Long Grove Hospital; and whether he will order a full inquiry into the circumstances.

I have only recently become aware of all the details of this case and am making urgent inquiries to see what further guidance I might give to hospital authorities.

Is my right hon. Friend aware of the great concern locally that patients can be treated in a State hospital by a man who is not a doctor? Will he give careful consideration to the proposals put forward by the chairman of the local management committee as to a system under which doctors from overseas will be able to identify themselves as such?

Yes, certainly; but my right hon. Friend may not fully realise that the imposter used forged documents identifying him as a genuine doctor whose name appeared in the medical directory. I am having to study the implications very carefully.

Will the right hon. Gentleman nevertheless bear in mind that without immigrant doctors our National Health Service could not survive? Apart from this particular case, it is essential that people coming to this country should have their qualifications carefully checked, particularly with regard to forgery.

I do not think that either my right hon. Friend or anybody in the neighbourhood was making any point about immigrant doctors as such. The point is that this man was not a doctor.

asked the Secretary of State for Social Services what steps he intends to take to ensure that suitable hospital accommodation is found for the mentally unstable girl, about whom the hon. Member for Don Valley wrote to him on 28th April, 1971.

I am making inquiries to determine the most suitable accommodation for this girl and will write to the hon. Member when these are completed.

Is the Minister aware that this situation discloses a rather lamentable lapse in the arrangements made under the National Health Service to deal with cases of this kind? Is he aware that this girl of 14 years of age, who is capable of extreme physical violence, was asked to be returned to her home because the staff at the hospital were not prepared to take care of her and there was no suitable institution available? The medical people at the hospital made extensive inquiries throughout the country and suitable accommodation could not be found for her, so they asked for her to be returned to her home, an ordinary council house, where she could not be looked after and where she would have been a disruptive influence in the domestic circle.

This is a tragic and complicated personal case, and I should prefer to pursue it with the hon. Gentleman in correspondence.

asked the Secretary of State for Social Services whether he will now announce the appointment of a health ombudsman.

I have nothing further to add at present to my reply to the hon. Member on 2nd February.—[Vol. 810, c. 309.]

Is the right hon. Gentleman aware that there is growing concern throughout the country about the lack of an effective complaints procedure where there have been abuses in the National Health Service? Is he also aware that even the medical profession is coming round to the view that there ought to be an ombudsman for the National Health Service?

The issues are nevertheless fairly complex, and I want to discuss them with the representatives of the medical profession before finally making up my mind.

Will the right hon. Gentleman at least give the House some hope that he will favourably view the appointment of an ombudsman? As the Farleigh Hospital inquiry strongly recommended an ombudsman and there are now extremely disturbing revelations coming out about another mental sub-normality hospital, will he at least consider other safeguards for patients who are unable to protect themselves?

I shall certainly give full weight to the Farleigh recommendation, but I must hear arguments on the other side as well before coming to a final conclusion.

asked the Secretary of State for Social Services what has been the net redistributive effect to a married man with three children earning £20 a week as a result of the extra social service benefits and extra National Insurance contributions he has so far announced.

From 21st September such a man will pay no more than 3p a week extra in national insurance contributions when working. In return he will receive an extra £2·50 a week in flat-rate benefit for himself and his dependants if he falls sick or becomes unemployed or, alternatively, up to £6·80 more if he becomes chronically sick. Also, considerably higher benefits will be payable to him and his wife when he retires, or to his widow in the event of his death. This takes no account of the extra 97p a week he will gain with effect from 6th April as a result of the recent income tax changes. Assuming he pays a fairly typical rent, he and his dependants are already entitled to free prescriptions and dental and optical treatment, and his children are entitled to free welfare milk and school meals.

Despite this list of exceptional circumstances, will the right hon. Gentleman nevertheless confirm that even this low-paid £20 a week man with three children, because he is excluded from the family income supplement scheme and, therefore, ineligible for the passport system, will, net of price rises since June, 1970, and net of the Government's proposed rent increases, make a net loss from the Government's total fiscal and welfare policies whilst the man paid at 20 times that level will make a huge net gain of over £2,000 a year?

No. The hon. Gentleman chose the figure, and at that figure there are considerable net advantages to the particular family; and, of course, earnings have gone up since last June, as we all know.

asked the Prime Minister when he will next take the Chair at the National Economic Development Council.

rose—

On a point of order. Mr. Speaker. May I draw your attention to the fact that a week ago the hon. Member for Ashton-under-Lyne (Mr. Sheldon) asked my right hon. Friend a virtually identical Question in the following terms:

"when he next intends to take the chair"—

[Interruption.]

Order. I think it would be better, if possible, for the hon. Member to raise this point at the end of Question Time.

I am aware that it is possible for me to do so, Mr. Speaker, but when the House is confronted with an abuse of this kind I think it is right to raise the matter during Question Time.

:Order. I do not think the hon. Gentleman is on a point of order at all. This Question has been passed by the Table. It must be put.

Further to that point of order. I wish to ask how it is that the Table now seems to be passing identical Questions at intervals which are so close together that there can scarcely be any reasonable supposition that new matter arises which could lead my right hon. Friend to give a different answer.

I shall consider that matter and rule upon it at a future date, if necessary. The Prime Minister.

I have nothing to add to the answer I gave to an identical Question from the same hon. Gentleman last Tuesday.—[Vol. 816, c. 228–30.]

But is the Prime Minister aware that he gave no answer on that occasion? When the Prime Minister sees the N.E.D.C., will he take up with it his constant refusal to give details of the maximum figure of unemployment which he is prepared to accept? Is this refusal the result of some doubt which he may have about the nature of the connection between unemployment and inflation, which he confidently asserts on many occasions, or is it because he is not sure at what point in time the Government's nerve will break?

The hon. Gentleman does me wrong. I replied to his Question a week ago saying:

"I have nothing to add to the reply which I gave on 20th April to a similar Question from the hon. Member from Heywood and Royton (Mr. Barnett)."—[OFFICIAL REPORT, 27th April, 1971; Vol. 816, c. 228.]

The point about the N.E.D.C. is that the three parties to the Council settle their own agenda and discuss subjects which they think are important at the moment. Tomorrow, when they meet, they will be discussing monetary policy and action taken to combat inflation in other countries. This will allow discussion about unemployment and the means of bringing it down.

asked the Prime Minister if he will place in the Library a copy of the public speech which he made at Cardiff on Saturday, 3rd April, on Government policy.

asked the Prime Minister if he will place a copy of his public speech at Cardiff on Saturday, 3rd April, 1971, concerning Government policy, in the Library.

asked the Prime Minister if he will place in the Library a copy of his public speech in Cardiff on 3rd April on Economic policy.

I did so on 6th April.

Does the right hon. Gentleman recall that in that speech he referred to the Budget as allowing people to earn more and to keep more of what they earned? Was he referring to the unemployed, or even to the worker on £30 to £35 a week? Is it not the case that a worker like that, if one takes into account all the so-called tax concessions and all the charges which the Government have inflicted and will inflict in the next few months, will be considerably worse off than he was before the Budget?

In that speech I was, I should have thought, stating a fact—that the reductions in taxation give people greater freedom in their expenditure. If the hon. Gentleman wants to deal with any particular case, I will gladly send him the overall accounting for it.

Does the right hon. Gentleman recall that passage in the speech in which he referred to restraining price increases by nationalised industries? Will he not concede that determining a nationalised industry's price policy is tantamount to determining its investment policy? Will he now take full responsibility for the confusion which has arisen in relation to the British Steel Corporation's future investment policy?

No, Sir; I do not accept the hon. Gentleman's conclusion. There are a number of actions which a nationalised industry, as any other firm, can take if it cannot increase its prices. The pressure on the private sector is always there, and it is pressure to greater efficiency and greater and better utilisation of manpower—

Why?

Because it operates in a competitive climate. If the hon. Gentleman does not realise that, he had better go to Scotland and see.

As for steel, the British Steel Corporation is still dealing with its investment programmes, and the Government are awaiting its final proposals. But hon. Gentlemen opposite have asked me constantly to carry out what we said we would do at the General Election, which was to intervene where we thought a nationalised industry was unjustifiably putting up its prices. That is precisely what we have done with the British Steel Corporation—at a stroke.

Reverting to unemployment, since there must be a level beyond which even this Government are prepared to prevent it rising even further, is the righ hon. Gentleman's persistent refusal to give us such a level due to the fact that he prefers the fear of uncertainty, in the hope that it will depress wage claims?

No, Sir. My right hon. Friend the Chancellor of the Exchequer explained that he had taken measures in his Budget to hold back the rise in unemployment, and he has explained constantly what the reasons are for the increase in unemployment.

Would my right hon. Friend place 290 copies of his speech in the Library so that every hon. Member of the Opposition can read and study it with profit?

It was well reported in the Press, but if any of those hon. Gentlemen had taken the trouble to make the usual inquiries in the Library they would have been told that the speech was there weeks ago.

Did I understand the Prime Minister to say, in answer to my hon. Friend the Member for Clackmannan and East Stirlingshire (Mr. Douglas), that, in his view, all private firms are operating in a competitive market, and that, therefore, there is no need for any further action to restrain their prices?

They are certainly operating in a competitive market, and, where they are not, it is possible for the Government to take—[Interruption.] They are operating generally in a competitive market, and if hon. Members were to study the figures of consumer expenditure over the past quarter they would see what is happening in a competitive market. Moreover, if there are examples of cases in which competition is not being maintained, the matter can be dealt with by the Monopolies Commission.

Does the Prime Minister recognise that he has been completely misinformed about the situation in the steel industry, that it is not the case that the Government are waiting for the investment programme from the Steel Corporation but that the Corporation is, unfortunately, having to wait for the decisions of the Government? Does he understand that the Steel Corporation has to compete with Japanese steel and that, if the Government go on holding up the investment programme, it will not be able to compete?

I realise also that it will not compete if it follows the hon. Gentleman's advice of pushing up prices far further than British industry can cope with.

Would the right hon. Gentleman now take the trouble to find out the real facts about the situation of the Steel Corporation? Would he come to the House next week and state whether it is not the case, as I have said, that the Corporation is awaiting the Government's decisions on this matter? Does he think it right that the Corporation should have the power to go ahead with its £3,000 million investment programme? Does he think that interference with its prices will assist the Corporation in carrying out that essential investment programme? Or is it the case that this Government do not give a fig for the steel industry?

What I do know is that the interference with those prices will give the whole of British industry a better opportunity of competing in world markets. What I also know is that no one has done more than the hon. Member for Ebbw Vale (Mr. Michael Foot) to incite both wage increases and price rises against the national interest.

rose—

No!

Order. Dr. Gilbert, next Question.

asked the Prime Minister what representations he has received from the public that he set up a department with exclusive jurisdiction over the affairs of the banking industry.

None, Sir.

Is the Prime Minister aware that the paragons of competition that he has been talking about—the banks—have four distinguishing characteristics in common—first, that they indulge in misleading advertising, since they do not give their true interest rates; second, that they are notorious for their collusive practices; third, that no fewer than 91 of them do not publish full and honest accounts, according to a Parliamentary Answer given to me yesterday; and, fourth, that they are a repository for those Tory Cabinet Ministers whose incompetence he can no longer bear? Now—

Order. I think that that is enough to be going on with.

The hon. Gentleman has given me no question to answer. But if he wishes to refer to what is commonly called the cartel within a section of the banking industry, it was his right hon. Friend the Member for Birmingham, Stechford (Mr. Jenkins) who, when Chan- cellor of the Exchequer, refused to change the arrangements. It is this Government which are now examining them afresh.

asked the Prime Minister when he next plans to seek an official meeting with President Yahya Khan.

I met President Yahya Khan in Islamabad in January. There are at present no plans for a further meeting, but I have since kept in touch with the President through diplomatic channels. In addition, I had a meeting a week ago with Mr. Arshad Husain, the President's special envoy.

Does the right hon. Gentleman accept that if a country is involved with another country's affairs, either by supplying arms or by supplying aid, that gives that country the right to speak up when events happen as they did in Pakistan? Is the Prime Minister prepared to say to President Yahya Khan that Britain will not enter into any new aid commitments for Pakistan so long as East Bengal is held down by military oppression?

There are two aspects to this very difficult question. I would agree with the hon. Gentleman that it is right that we should use all our influence in these circumstances to secure what the President himself has publicly said is his objective, and that is a political solution to the difficulties confronting Pakistan. But the hon. Gentleman will recall, on further reflection, that British policy on aid has on the whole been to proceed regardless of certain political aspects of a country's national life. I would not, on this occasion, like to say that that is a principle which should immediately be overthrown.

In view of what my right hon. Friend has said about aid, is he aware that there are now over 1 million refugees from East Pakistan in West Bengal, Tripura and Assam, and that the Indian authorities are encountering increasing difficulty in providing food, shelter and medical supplies? Is there any step he can take to speed international relief to deal with what appears to be an increasingly tragic situation?

There are, alas, many hundreds of thousands of refugees in West Bengal. The last figure we were given was 600,000 but it may well now be more. We understood that the numbers were increasing at the rate of about 20,000 a day. As to the specific point raised by my hon. Friend, we are in contact with the private charitable organisations which are arranging the transport of relief supplies to West Bengal to help the refugees from East Pakistan. Our understanding is that they are hoping to get the first flight-loads away in two days' time.

In view of the many allegations of very brutal repression in East Bengal, has the right hon. Gentleman pressed upon the Pakistan President or the Government the desirability of introducing observers into that country to see whether these grave allegations are correct, and, if they are, to exercise a restraining influence?

The right hon. Gentleman will not expect me to reveal the contents of confidential exchanges that we have had. I would agree with him that where there are allegations and misrepresentations of a situation the healthiest way of dealing with it is to have observers, under an international organisation or from certain countries or from the Press, who can see the situation for themselves.

While I am sure the House is grateful to my right hon. Friend for the action that he has taken, may I ask him whether there is any chance of getting international relief organisations to operate in East Pakistan? Up till now, although many are waiting to go, none has been allowed to get in. This is a very urgent matter, and I wonder whether my right hon. Friend can tell us anything about the talks that he is having with the Pakistan Government on this point?

I know that the international relief organisations are in many cases prepared to help in this very difficult situation. We are in contact with those organisations which have approached us in this country. I hope that in the course of the next 48 hours they will be able to render help. There have also been talks with the international organisations, but I cannot at this moment give my right hon. Friend any firm details as to when it will be possible for them to render assistance.

In view of this serious situation, would the Prime Minister agree that it might be time to use the medium of the Commonwealth or perhaps a group of Commonwealth Prime Ministers to make a joint approach? Would it not also have the advantage of avoiding any further sharpening of the disagreement between India and Pakistan?

If I thought there was any reasonable prospect at all of that being a helpful move I would not hesitate for one moment to take it, but the hon. Gentleman and the House will realise that certain frictions exist between Commonwealth countries over this problem and I am not sure that it would be helpful at this moment to bring them together about it.

Do not some of the questions asked by hon. Gentlemen opposite on this question reveal the impression that some of them have not got used to the idea that Britain is no longer the imperial Power in the Indo-Pakistan sub-continent?

I agree with my hon. Friend that we have to respect the territorial integrity of Pakistan and its sovereignty as a State. I have always made absolutely plain to the President of Pakistan that this is the position of the British Government. At the same time, there is deep feeling in this country and the House about the problems which exist. This was shown in the different situation which arose when part of East Pakistan was hit by the hurricane and there was an upsurge of voluntary effort which amazed the world, as I know from my own contacts. There is similarly today a very deep feeling about the situation. I think it is quite natural that many in this country and the House would want to help.

Is it not a cause of some concern that many of the weapons that have been used in East Bengal were provided for very different purposes by members of CENTO, including this country?

It is always a difficult circumstance when there is internal strife in a country which is a member of an alliance. On the other hand, many of the weapons which the Pakistan Government had at their disposal were secured from sources quite other than CENTO and the British Government.