I think I am entitled to start off what I want to say by a protest, and that is a protest against the absence of the Leader of the Opposition. There is no obligation on the part of the Prime Minister to be here. Anyone who has been present during the Debate – and a very large number of hon. Members opposite have not been – will know by now that, while the Opposition is in need of the sustenance that may be afforded by the Leader of the Opposition, I am in no need of the support of the Prime Minister.
We really have reached the point where we should ask the Opposition to try to prevent the Leader of the Opposition from so grossly misbehaving himself as he does on many occasions. Last week he made a statement, and as usual – it has become so much the practice now that we have noticed it – he was egged on by the Conservative press in blatant, provocative, sensational headlines about extravagance in the Health Service. He came down to the House and said that these Supplementary Estimates are indications of extravagant expenditure and maladministration. He then said, “We will examine them” – having declared the verdict first. If he had used that language after having had the three days’ Debate on the Estimates, there would have been some sense in it. But he told us today that he will consider at the end of the examination whether a Vote of Censure will be moved on us.
If indeed it is the case that this Supplementary Estimate is evidence of gross mismanagement and financial maladministration, then there is no need for the Debate, because the decision has been made by the Opposition. He said it at the very beginning. Whatever the Opposition may do about a Vote of Censure when the three days’ Debate on the Supplementary Estimates is over, I am entitled to ask for a verdict on the Supplementary Estimate tonight. Obviously, after being asked for a Debate, and after being asked for it in so provocative a manner, the House and the country are entitled to receive a verdict as to what is the opinion of the Members of the House upon what has been done. Therefore, I hope that the Opposition, after I have sat down and if I have not convinced them of the error of their ways, will go into the Division Lobby against the Government.
The right hon. Gentleman the Member for the City of London accused me of having miscalculated through incompetence. He was out of the Chamber when the hon. Member for South Hendon accused me of having deliberately provoked a Supplementary Estimate by Machiavellian cleverness in order to put the Opposition to the embarrassment of having to decide whether or not they would vote against it. I am not sure, therefore, whether I am to answer to a charge of duplicity or of ignorance – but I cannot be guilty of both. The trouble with the right hon. Gentleman, may I say with all respect, is that he has generally a most amiable presence, but it is always a foolish spectacle for a weak man to use strong adjectives. It is certainly foolish for him, because it creates a sense of melodramatic anti-climax to wind up so pathetic a speech by the kind of peroration that is usually reserved only for highly dramatic moments.
I say with all sincerity that I regret the atmosphere in which the Debate on this Supplementary Estimate was begun by the Opposition. The House of Commons – and I am not now speaking of any particular part of the House – ought not to allow Supplementary Estimates to go by without examination. That is the duty of the House of Commons. Indeed what I object to is not that a Debate has been requested. What I object to is the utter incompetence of the Opposition in the examination of a Supplementary Estimate and, what is much more serious – and I hope the country will take notice of it – the indifference of the Opposition. The benches opposite have been empty, or almost empty, all the evening. I have here a long list which was taken every quarter of an hour of the attendance of hon. Gentlemen opposite. I have the advantage that my Parliamentary Private Secretary counted the number present. He takes an interest in this matter. These are extracts: Conservative, 19, Liberal, 2, Labour, 72; Conservative, 35, Labour, 57. I regret to say that for a considerable period the Liberal Benches were a complete blank. I am not complaining about the number of Conservative hon. Members present now. I was discussing the numbers present throughout the evening, and I say that, in view of the highly sensational way in which this Debate was launched, the absence of hon. Members of the Opposition this evening is a disgrace to the House of Commons.
It has been difficult to find out from the Opposition what it is that the Minister of Health is accused of, on this Supplementary Estimate. Is it that the Opposition say that they do not mind that the money has been spent, but that there was a miscalculation? Is it the arithmetic that they quarrel about, or the policy? It has been hard to find out what they are complaining about. Are they saying that it would have been all right to have spent this money in this way if it had gone in the original Estimate, or is it that they object to the spending of the money at all? It is very necessary for us to know which of these two positions is being taken up by the Opposition.
If it is that this represents a grave miscalculation, there was no need for this Debate to proceed after what I thought ? and I think most hon. Members will agree ? was the very excellent opening speech of the Parliamentary Secretary. The Parliamentary Secretary broke the Supplementary Estimate into its constituent parts, and showed, one by one, how the additional expenditure arose. There was one part of his speech to which no attention has been given, and that was that, when we put in the Estimate seven months before the money started to be spent, I was still in negotiation with practically all the professions, with the chemists, with the dentists, with the ophthalmic opticians and with the British Medical Association, negotiations with whom had not then ceased. Further, the Spens Committee on specialist remuneration had not reported. All these negotiations were proceeding, but it was necessary, because of the financial procedure of the House of Commons, to put an Estimate in.
How was I to know at that stage what would be the outcome of these negotiations? I want the Committee to recollect this point, because it is a very serious matter. When Ministers, whoever they may be, are in negotiation with sections of the community, it is a very serious matter if a Minister in the middle of those negotiations is subjected to pressure lobbies and log?rolling by the sections concerned. He is engaged, or should be engaged, in defending the public interest against the sectional interest with which he is negotiating.
The hon. Member really should go back to his school days. It is therefore vital, if the public interest is to be properly protected, that he should not disclose his hand. Suppose I put into the Estimates assumptions that could have formed the basis of a negotiation by those professions, I should, immediately have been helpless. If these figures of dental expenditure and if these figures of expenditure on the ophthalmic opticians and the chemists had been put into the Estimates by me, my negotiations would have been hopelessly destroyed from the very beginning. It was absolutely essential not to do so. I think every man who has had any experience of negotiations knows very well that if they could read in the Estimates what I estimated I was going to spend upon those services they would know at once what to ask for and what to expect. It is essential, therefore, that in such circumstances the Minister of the Crown, whoever he might be, whatever party he represents, should be able to – did the right hon. Gentleman say “deceive the House”?
How on earth could I deceive the House when I did not know what the figures were going to be? All I could do was to put in figures based upon the past basis of remuneration. How on earth could I? If I had put in figures based upon a prospective settlement, that itself would have vitiated the negotiations. And these are the people who call themselves competent administrators! The fact is that we had to wait. For instance, there is a Whitley machinery established now, and before the Whitley machinery there is an application from the nurses for an increase in salary. I do not know what may happen to those negotiations. I do say now, however, at this moment, that I do know that a slight increase in nurses’ salaries is essential. I know that. I do not know how much. Therefore, when I put my Estimates in I have to put them in based upon past remuneration and if, in the meantime, in between the Estimate being presented to the House of Commons and the Vote being spent, there is an increase, there must be a Supplementary Estimate unless there is a fall in expenditure in some other place. That is not the consequence of any maladministration. These are the ordinary accompaniments of our constitutional practice for making up our Budget. It is therefore really quite foolish for hon. Members opposite to adopt the line they have adopted and to suggest either that false figures were put into the Estimates or that any miscalculations have occurred. I am astonished at the line some hon. Members have taken.
The fact is that I consider, without I think much immodesty, that the launching of the National Health Service has been one of the greatest pieces of civil administration in the history of all civil Government in peace time, and what shocked me last Thursday was the frivolous irresponsibility of the behaviour of the Opposition, and especially of the Leader of the Opposition in saying what he did, because this hospital administration and health administration is carried on in this country by 11,000 devoted volunteers drawn from all parties in the State. What the Opposition were actually doing was accusing all those bodies of maladministration. The hon. Member for Denbigh, who could not give us factual evidence, charged one hospital with maladministration. I cannot even get the name of the hospital from him. It may be that when I find the name, the majority of the members of the management committee may conceivably be members of the Conservative Party. These bodies responsible for the administration of the Health Service over the last year have given more selfless dedicated service in bringing this great scheme into operation than has ever been known in the history of peace-time government.
What we should have had from the Opposition is some commendation of the work of these men and women, and not, as we have had from them, the suggestion that in nine months already evidence of maladministration and financial irresponsibility has arisen from the administration of the hospital services. I think it is a little hard; indeed, one of the reasons why the Opposition are now running away is because they have already found out that what the Leader of the Opposition said last Thursday is almost as unpopular among Conservatives in the country as it is among Socialists.
Furthermore, the Opposition are in a greater difficulty, because as time goes by it will be necessary for us to evolve inside the administration of the Ministry of Health and inside the whole health service proper principles of administration such as those referred to in what I thought was the most thoughtful speech that came from the Opposition; I refer to the speech of the hon. Member for Chippenham, who put this whole matter in its proper perspective. Nobody suggests that the hospital authorities should be permitted to spend whatever amounts of money they like. The service has got to be in operation at least one year before there are any comparative statistics available to show which particular management committee is not behaving itself properly.
As I understand and envisage the operation of the administration of the hospital system of the future, it will go something like this: we shall have global budgets determined for the regional hospital boards and the management committees of hospitals. Those global budgets will be worked out on principles with which hospital administrators are already quite familiar. Within those global budgets the management committees will have discretion to spend what they wish on this or that item of administration. If they spend more on one, they spend less on another. What would be undesirable would be if no management committee or board of governors could repair a pane of glass without first of all having the consent of the administration, because there bureaucracy would arise.
What we are trying to do is to work out a system of resilient administration with as little bureaucracy as possible, with as much local self-government as possible, and yet at the same time protect the public purse against extravagant administration. I believe we shall do it. In fact, I am convinced we shall do it. We shall show the world how we can centralise financial responsibility and decentralise day-to-day administration in a great service of this sort. I seriously suggest to hon. Members that it is not possible until we have, first of all, at least one year’s experience behind us. That is the main answer to the charges made by hon. Members opposite who are so anxious to denigrate the Health Service.
Let them read the newspapers of the last fortnight or three weeks – the newspapers that support the party opposite. Their leading articles have been full of it. There was the case of the “Evening Standard” tonight. All their newspapers have been full of this misrepresentation, and, therefore, I at once give the hon. Member for Chippenham his reply. That is how we conceive that the hospital administration of the future is going to work. That does not mean, of course, that where a hospital management committee is spending money extravagantly on a particular item and is neglecting its duty to the patients, it will be permitted to keep on with that neglect merely because it is not spending more money than the total. It will still be necessary for the central administration to protect the patient against the misbehaviour of any management committee or regional hospital board.
But what we have to do is to try to prevent the very thing we are charged by hon. Members opposite with having done – having a great bureaucracy. The fact is – it is a fact which other nations of the world cannot understand, and we ought to italicise it here because it is something of which we should be very proud – that the National Health Service is not administered by bureaucratic officials; it is administered, as I have said, by 10,000 or 11,000 volunteers of the various executive committees involved. What has been a source of intense pleasure to me is that I have never had any difficulty at all in getting volunteers. I have always had very many more than I could make proper use of. We need not argue that. It is also common ground, and has been for some time, that the voluntary hospital system was financially failing. Indeed, ever since – the hon. Member should really learn the facts of life before he speaks – I took office in 1945 we have been making grants to voluntary hospitals in order to keep them alive. We had this all out when the Bill was before the House. The amount of money we are finding with which to keep the voluntary hospitals, vastly exceeds all the money in their Endowment Fund. Once again, the hon. Member does not know what he is talking about. If he wishes to have the figures, and if he puts down a Question for that purpose, I will give him the figures, and then on this matter he will be for ever silent.
One of the items of expenditure which has produced this Supplementary Estimate was the increase in the remuneration of student nurses. I was asked by the right hon. Gentleman how many hospital beds would be brought into use by this expenditure. How can I tell? 1 cannot tell until I know what the wastage is going to be, and what is going to be the effect of increased pay on student nurses. 1 cannot tell what is going to be the effect on recruitment in the nursing field of having raised the standard of remuneration of domestic staff. But I want to point out to the Opposition that this is a profession in which we were having great difficulty to recruit girls because of the bad way they had been treated by the Opposition. It is a matter of pleasure that the Parliamentary Secretary has been able to announce that not only have we reversed the tendencies of the last 10 years or so, but in the course of last year we have actually added 6,000 to the number of nursing staff. Of course we are not using all the beds that we have in our institutions, but if this increase had begun earlier these beds would now be occupied by patients. I suggest that the Opposition should organise a little school and take some of their back benchers into that school. I have already informed the hon. Gentleman that there are many more hospital beds in existence today than there were before the war. There are many more beds occupied than before the war, but the need is very much greater now than it was before the war, and that accounts for the fact that some beds are still empty. It is because in London it was the practice to take all the interesting cases into the teaching hospitals and the chronic sick into the L.C.C. hospitals. As the hon. Gentleman wishes to be taught, I will give him another answer. It is this: the teaching hospitals of London have, for reasons obvious to everybody, always been more attractive to nurses and, therefore, it was very much more difficult to get nurses in the local government hospitals. Those two facts combined resulted in what the hon. Gentleman has described, and that is why the committees responsible for reorganising the hospitals have insisted that the teaching hospitals should take their proper proportion of the chronic sick. If there are any more questions, I shall be delighted to answer them.
It was obviously impossible for us to know to what extent spectacles and dental operations would be required. I have been accused of not having made use of the statistical information that was available, but there was no statistical information available. The National Health Insurance statistics have not been of any use since 1939. How did we know what was going to be the demand? But I will point out to hon. Members that, both in this field and in many other fields, whenever we have been able to relieve in any way the burden of suffering of the people of Great Britain, the burden has always proved to have been heavier than we ever thought it would be.
The same thing is true in the housing field; the same is true of pensions. It is an unhappy fact that past conditions concealed a vast amount of inarticulate misery and pain. As these great services come into operation that darkness is now moving into twilight; and before very long will move into the light of day, and we shall see exactly what it is. In so far as these figures represent relief of genuine need, everybody ought to be proud of them; but in so far as a is suggested that they represent abuse, point out where the abuse is. If there is abuse, let us co-operate in getting rid of it. But first identify the abuse, and do not merely make generalisations that smear the whole service.
Although the newspapers and hon. Members’ letters are full of complaints from this or that person about this or that doctor, dentist, optician or hospital, I would remind hon. Members that only malice is news. Remember the vast majority of people who are really satisfied with the service but never mention it at all. This service was not launched in harmonious circumstances. In fact, no medical service in the world has ever been launched in harmonious circumstances. As our example here is followed by other nations – and they will follow it – we shall read of the difficulties that other Ministers of Health will be going through; and I venture to suggest that it may be that even the Conservative Party will have a few fleeting moments of pride about their Ministers of Health, because they will find that those other Ministers of Health might not be able to get this great scheme into operation so easily.
I could, of course, have emerged from this examination perfectly clear of any charges of arithmetical inexactitude. All I need to have done was to have failed as an administrator to have emerged successfully as an arithmetician. And why? Who suspected before 5th July last that in six months, before the end of 1948, these figures would have emerged? Who would have said that we would have in the service many more general practitioners than we ourselves thought would have come in? Who would have suspected that 95 per cent. of the population would have registered with general practitioners by the end of the year? Who would have said that by now even in the most obdurate of all the professions ? I do not want to make too strong a statement – the profession whose ethical standards as a profession are not as high as they might be, the dental profession, we should have got 92 per cent. of the dentists? As these people came into the service, naturally the expenditure went up. But that mounting expenditure was an expression of an administrative success, because if they had not come in I would not have had a deficit: I would have had a surplus, and I would then be praised by the Opposition for being a financial success and a failure as Minister of Health. It is just because all these services expanded so quickly, so harmoniously, and so fruitfully that we find ourselves with this deficit.
Although this financial burden is great, we must nevertheless set off against it the enormous sum of misery we have already alleviated, the general hopes we have already created, and the good health that already starts to flow from what we have done. Why do not right hon. and hon. Gentlemen opposite start ceasing to be so sour? Why is it that as the health of the population goes up, their spirit goes down? The Tory Party used to represent itself as a jocund party. They do not understand now. I will give them a clue: “How jocund did they drive their teams afield.” However, that has all gone now. Pale and miserable lot, instead of welcoming every increase in the health of the nation, the buoyancy of the nation and the vitality of the nation, they groan at it. They hate it because they think it spells electoral defeat.
I have sympathised with hon. Members opposite this evening because they have had a really difficult task. They began by attacking this scheme. Especially in 1947, their hopes were raised because they thought that the economic difficulties into which the country was getting over the balance of payments would result in the jettisoning of the health scheme. Right hon. and hon. Gentlemen opposite have spent most of their time saying how much they approved of the health scheme. I am perfectly entitled to rejoin by saying how much they tried to stop its birth. They always hoped that it would be shipwrecked on the initial difficulties of launching. Indeed, not only did they hope that, but they connived at it.
We have only to go back to 1947 and 1948 to see what the Conservative newspapers were doing and how the Tories were conspiring with some of the most reactionary elements in the medical profession at that time. Mark this, they voted against the Second Reading and they voted against the Third Reading. It is a convention of Parliamentary practice that if one votes against the Bill on Third Reading, one objects to it in principle. One very rarely votes against a Bill on Third Reading if one does not object to the Bill root and branch. That is what hon. Members opposite did. As the scheme has gone on and grown in popularity, they have been trying to forget that dreadful past and they are trying to pretend that they were for it all the time. The Conservative Party has always been in favour of reform in the abstract and against every reform in particular, and exactly the same thing has happened on this occasion.
Later on, when we had negotiations with the dentists and the other professions, we met with hostility. I met with pressure in the House, and every Thursday I was pressed as to why I did not come to an agreement with the dentists and why I did not come to an agreement with the doctors. Instead of supporting Ministers in the negotiations with the professions, the Conservative Party organised itself into a series of pressure lobbies in the Press, pressure lobbies all over the country against every single thing. What they are now saying to the country is, “We were never against it. It is quite true that we voted against it, is quite true that we agitated against it, it is quite true that we plotted against it, but we were really in favour, of it all the time.” They say, “You must not read our intentions from what we have said, because we really mean the opposite of what we are doing.” Therefore, when the Conservative Party tells the country to vote against us, they do not really mean it, they mean that the country should vote for us.
Really hon. Members opposite ought not to have started this Debate. I say that as this great scheme unfolds itself, it will be necessary for anybody who occupies this position to have the support of the House of Commons in seeing to it that the money which is spent upon the health services is spent where it is intended the best good should be done, and that is not upon doctors, That is for the hon. Member for Denbigh, too, because the hon. Member was organising himself into a small pressure lobby for the doctors.
I say it is necessary that the money be not spent upon the most articulate members of the community who might be the chemists, the doctors, the dentists or the ophthalmic opticians, or it might be even the health workers, because each one of these sections is highly organised and is able to bring pressure to bear upon Parliament and upon Ministers. As the hon. Member for Chippenham said, inevitably there is only a limited amount of money to be spent at any time on all our social services. Therefore, I say in all seriousness because this I think we share with the Opposition – if it is spent prodigally in one direction, it is not there for another. I am anxious that the money be not spent on the persons who can organise themselves into loud pressure lobbies, and get their columns in the Press, but on the patients who have to make use of this Service.
I end by saying that I welcome the discussion which has taken place. I believe it has shown the hypocrisy of the Opposition. I believe it has shown the soundness of the Service. The best thing the Opposition can do is to resign its position, or admit it is wrong, or walk into the Lobby and vote against the Estimate.
Source: House of Commons Debates, vol. 461, cols. 1448/61, 17 February 1949.