laid upon the Table:

Mr Chairman, just before the adjournment of the debate yesterday I was saying that I thought it was up to us in future to come forward with proposals which would ensure the maximum delegation of power to local authorities so that local communities could govern themselves in an independent way.

Mr Chairman, it will most certainly be possible to draw up a long list of matters which could be devolved to local communities. In the time at our disposal, however, we cannot consider everything. What we must realise, though, is that local government today is anything but autonomous.

Mr Chairman, I want to refer briefly to two minor matters which are at present, in my opinion, causing friction. In this respect I want to refer in particular to the Cape. I want to ask the hon the Minister to forgive me for raising a provincial matter here. The matter I want to deal with is the collection of rates.

The Cape Provincial Ordinance provides that a ratepayer whose rates are outstanding on the final date is issued with a summons not later than 30 June of the year in question. If the city or town treasurer concerned were to omit to issue summons to such a ratepayer before 30 June of the year in question, he must submit the reasons for such omission to the Administrator of the Cape, clearly motivating why the ratepayer concerned was not issued with a summons. In order to prevent having to make this explanation, treasurers in the Cape are very punctilious in regard to this provision in the ordinance in question, and ratepayers in the Cape are diligently issued with a summons.

What is the result? The ratepayer is issued with a summons, and if he cannot pay at once, judgement can be obtained against him. When that has happened the property in question can be sold.

I have seldom seen such a property actually being sold. Ultimately the ratepayer pays the outstanding rates, the only difference being that a tremendous amount in costs has now been added. Now the ratepayer not only has his rates to pay, but also the costs in connection with the summons and the judgement, and in addition he has to pay the attorneys’ collection fees, plus interest on the outstanding amount.

This has become a frequent occurrence recently in Port Elizabeth in particular, where there is tremendous unemployment. Under these circumstances, where people are having a hard time of it and find it almost impossible to pay their rates, they are burdened with additional costs as a result of summonses, judgements and collection fees. The only organisation that scores, is the attorney of the town or city council concerned.

What makes this occurrence even worse, is the interest which is charged on arrear rates. From time to time the interest rates which may be charged by town and city councils in the Cape on arrear rates are laid down by the Executive Committee of the Cape Provincial Council. Unfortunately a very long period of time elapses before interest rates are revised. At present the bank rate is approximately 14%. The ratepayers of Port Elizabeth—and I assume in the rest of the Cape Province as well—are at present paying 23% on arrear rates. That is approximately 9% above the bank rate.

What is the good of the SA Reserve Bank trying to force down interest rates to make more money available to the man in the street if semi-State institutions are still charging these tremendously high interest rates? However, the town or city councils can do nothing about the situation.

My request to the hon the Minister is that the power of issuing summons for arrear rates be delegated to the treasurer of the town or city council concerned, who must be held accountable by his town or city council. This person knows the local conditions. He knows the ratepayers in his area. He is also answerable to his town or city council. I know municipal treasurers in the Cape to be extremely responsible people.

Another request I want to make to the hon the Minister is that such a treasurer should be given the right to determine interest rates on arrear rates himself, according to a formula laid down by the hon the Minister, possibly 2% or 3% above the bank rate. When interest rates fluctuate these percentages can then be adjusted rapidly and without any disruption. I know the hon the Minister will try to help us here in the Cape Province by using his influence, although he does not, as yet, have the jurisdiction.

Furthermore I just want to ask whether, in these days of rationalisation and economy measures, it is still necessary for the approximately 80 000 municipal voters of a city like Cape Town to be represented on the city council by 34 elected representatives. Is it also necessary for the 45 000 municipal voters of Port Elizabeth to be represented by 26 elected representatives? Now that the Provincial Council has been abolished, every hon member in this Committee represents approximately 18 000 voters in his constituency, compared with 2 400 voters per council member in these two cities. In East London the position is even worse. My experience in the Cape has been that, particularly in the larger cities, matters usually tend to revolve around a small group of council members only.

While we are considering uniform municipal electoral legislation, is it not possible to investigate the possibility of electing only one representative in cases where the ward system exists, instead of two persons per ward? I believe that smaller councils will function better than large, clumsy councils. In future we will have to ensure that only the best local people become members of the town and city councils. To make this possible these people will have to be paid adequate allowances to make this profitable to them. If we reduce the size of all the councils, major savings can be affected by means of which the smaller councils can then be properly remunerated, something which we will have to do in any case, whether the councils are reduced in size or not.

In conclusion I should like to make an appeal to the Cape municipalities to give thorough consideration to the institution of executive committees with, if possible, a fulltime chairman. I think it is imperative that elected representatives be brought closer to the real administration of local community matters.

Mr Chairman, in the dying moments of this debate I just want to refer briefly to the sales promotion campaign of the State during the past few years. I want to refer to the way in which it affects all race groups, but in particular to how it affects the group for whom the hon the Minister of Local Government, Housing and Works in the House of Assembly is responsible.

When this scheme was introduced the State had two basic objectives. Firstly the State wanted in that way to encourage and establish individual home-ownership. Secondly the State wanted to ensure a return flow of money to the State enable it to finance new housing. I honestly think we can tell one another today that the scheme has not succeeded to the extent to which we hoped it would. I think we can admit this to one another today because there is still time to do something about it.

The latest information indicates that approximately 70 000 units out of a possible reserve of between 500 000 and 600 000 units have been sold. I am referring to all race groups. Initially there was a variety of incentives for prospective buyers. I can remember a 30% discount for cash and 5% for occupation. There were a few other elements which I need not repeat for the purposes of my argument.

What was of decisive importance was the way in which these units were revalued for selling purposes. The current formula is the original building costs of that unit plus the present replacement costs, which is then divided by two. Calculations indicate that the replacement costs of a unit built in 1960, say, at present amounts to seven times that cost. This causes the valuation of available units to be hopelessly and unattractively high.

By allowing the emphasis to be placed primarily on the return flow of capital we have in my opinion impaired the ideal of individual home-ownership. The result was that the houses were not sold, at least not to the extent which we expected. Consequently the return flow of capital which we needed so urgently did not take place.

Therefore we shall have to give serious consideration to making ownership rather than the return flow of funds the priority. We can only succeed in doing that if we drastically revise the formula according to which the revaluation is made, and in that way also reduce the market prices of those units as drastically.

It may also be necessary for one to take a look at the incentives, but that is a side-issue.

It may be argued that if we were to reduce prices in this way, it would be immoral towards the 70 thousand people who have up to now already bought houses. I think this is a valid argument, and for that reason we ought to make the same concession to existing owners. In the case of a cash buyer it would entail our having to make a cash repayment; in the case of a loan it would simply mean a ledger adjustment. Because the hon the Minister understands this situation so exceptionally well, I want to make an earnest request to him to try, through the channels at his disposal, to obtain Cabinet approval for the National Housing Commission, and afterwards his own commission, to have authority to make such ex gratia repayments. Naturally we will have to obtain parliamentary authorisation for this, but I do not think there can be any problems in this connection because the administrations of the two other Houses, as well as the Department of Development Aid, are struggling with the same problem.

We must address this problem more urgently than ever before, so that the flow of funds, which seems to me has almost dried up, can once again become a stream with which we will be able to finance new housing.

Mr Chairman, the hon Chief Whip of Parliament has raised some important matters regarding home-ownership about which we are all very concerned, and I look forward to the hon the Minister’s reply to his representations.

I want to start by saying that the hon the Minister made a statement which was reported in the Cape Times of 17 January 1986 and which put him on record as saying the following:

I ask the hon the Minister whether he still intends to table this legislation during this session.

Referring to the various laws which the hon the Minister apparently wishes to revise and change, I want to summarise our representations with regard to some of these laws. I want to start with the Rent Control Act and ask the hon the Minister to take four steps.

Firstly, the tenants living in the 29 000 flats and the 26 000 houses presently controlled under the Rent Control Act must be protected.

Secondly, I want to appeal to the hon the Minister not to squeeze out the protected tenants—that is those people occupying these flats and houses between October 1949 and June 1966—by maintaining the income limits of R800 per month for a family and R450 per month for a single person, but rather to raise them to R1 300 and R700 per month respectively. This can be done immediately because all the hon the Minister needs is a proclamation, not a law.

Thirdly, I appeal to the hon the Minister to enact an urgent amendment to section 28(4) of the Rent Control Act so that people are not given six months’ notice to vacate premises on the grounds that the owner wishes to repair and renovate the building, only to find that the building is renovated and is then converted to sectional title or put to other use.

Fourthly, I appeal to the hon the Minister not to negate the Rent Control Act by too readily granting exemptions from control of the Act in respect of blocks of flats. I do believe the figure of 63 in the past 12 months is far too high.

As far as housing is concerned, I urge the hon the Minister to take two steps. Firstly, regarding the limit of R40 000 under the home-ownership scheme for first-time home owners, I appeal to the hon the Minister to reverse the principle so that it is not the person who earns the highest salary who receives the highest subsidy but rather the one who earns the lowest salary. That is a reversal of the principle applied at present.

Secondly, I appeal to the hon the Minister to raise the limit of R40 000 to, say R50 000, after he has reversed the abovementioned principle.

Furthermore, I hope the hon the Minister will press the hon the Minister of Finance to agree, firstly, to raise the limit on the exemption of transfer duty from the present limit of R30 000 to R40 000 for all home purchases so that those people can take transfer of their homes. Secondly, he should urge the hon the Minister of Finance to see to it that the instalments paid to building societies by all home owners living in their own homes are made deductible for tax purposes. I urge the hon the Minister to do that.

The hon the Minister also referred to the slum clearance. This is a question of urban renewal. Urban renewal is necessary. There are cities like Johannesburg which are 100 years old, and we find that many suburbs are decayed and require slum clearance. It is very often necessary to effect complete urban renewal in certain areas.

The philosophy of urban renewal is one of the chequer-board system or domino method. The theory behind it is that one takes people out of an area for slum clearance, moves them to another area, renews the old area, and then brings the people back again. I have had the benefit of studying the position both in the USA and in the UK, and I have found that that system works in theory only. The people never actually get back to the area where they lived originally. This is wrong. We should try to preserve the areas where the people live as far as we can. It just does not work. It is an essential philosophy as far as the elderly people living in those areas are concerned that they should have security in life which involves being used to the environment in which they live. They are used to the post office, library, the museum and the general area in which they live; and furthermore, that they live in an area where they see young children and where they are part of the community and where they remain part of that community.

There are two quick methods that I can refer to in this regard. The first is the core method used in the United States where the centre is removed from an apartment building. Bathrooms are then built on one side and kitchens on the other and the entire building is renewed in seven days.

The other method to which I should like to refer in closing, is the turnkey method. Here a utility or other company, in consultation with a local authority, provides the local authority with a complete housing scheme, such as a block of flats for example. It finances the scheme and builds it on land made available by the local authority. It then turns the key over to the local authority, having completed the building which the local authority may then take steps to have occupied.

Now that we have come to the end of this debate, I should like to say in conclusion that we cannot associate ourselves with the philosophy of own affairs. We would like to see these matters dealt with within the framework of general affairs. However, within the constraints of the present own affairs system, we would urge the hon the Minister to provide homes for people and for the care of the aged as soon as possible.

Mr Chairman, the hon member for Algoa made very interesting proposals to the hon the Minister today in respect of local government development in the Cape, and we can also support many of the proposals the hon the Minister made.

Yesterday the hon member for Kroonstad tried to get tough with the CP here. After all, they call him the rising star of the Free State. [Interjections.] Yesterday we asked the hon the Minister very politely to spell out to us what decisions had been taken in respect of local government in South Africa. I told the hon the Minister that we hoped that he was not, as Minister, going to become a mere follower of the hon the Minister of Constitutional Development and Planning. We hope that he will act in his own right in the interests of the White local authorities in South Africa.

The hon the Minister of Local Government, Housing and Works participated twice in the debate on his Vote. While he was speaking every hon member of the CP asked him questions about the local government system, because we were keen to debate his replies. So far, however, the hon the Minister has not adopted a single standpoint in this connection.

Nor is it only us who are in the dark about these things. Just listen to what the hon member for Kroonstad had to say:

The hon member said that great confusion existed in the country. It is true! Great confusion also exists in this Committee because the Government does not want to indicate to us precisely what is going to be done. The hon member for Kroonstad went further:

Now I want to ask the hon the Minister …

Mr Chairman, may I put a question to the hon member?

No, I am sorry, I only have six minutes at my disposal; I do not have time to reply to any questions. [Interjections.]

I now want to ask the hon the Minister, if he does not want to listen to us, please to listen to the hon member for Kroonstad, and clarify these matter for us today.

It came to our attention that in these times of great unrest in and around our local authorities or municipalities, only 150 of the 476 local authorities have acquired an A certificate for civil defence. In these dangerous times this is an alarmingly low figure.

Today I want to make an appeal to the hon the Minister of Local Government, Housing and Works—he is responsible for White local authorities—to urge those authorities on and make it possible for them to achieve full preparedness, not a low percentage of preparedness, and that he will go out of his way to bring about preparedness in respect of civil defence among the White local authorities. [Interjections.]

Civil defence falls under the multiracial regional services councils that are about to be established. It falls under them. This important task, in regard to which such an alarmingly low figure applies, is being taken away from the provinces and placed under this multiracial form of local government. In the cases where the hon the Minister has White local authorities under his jurisdiction, I want to ask him today to give very urgent attention to this matter.

When White local authorities are going to be in charge of White group areas, the same thing is going to happen in those areas which is now happening in Johannesburg, viz that thousands of Black people, Coloureds and Indians will move into White group areas. This must be stopped, and the hon the Minister must enable the White local authorities to help prevent the crowding out of Whites from their own living space.

In the report of the hon the Minister he also referred to an investigation having been instituted into the drafting of a uniform municipal electoral Act—an electoral Act which is a general affairs, and electoral Act which dictates to so-called own local authorities how their elections should take place. Under the present system which is disappearing and which is being destroyed by the hon the Minister of Constitutional Development and Planning, the provinces did at least have the right to decide about franchise qualifications and when local government elections could take place. We find that the Transvaal at present has a franchise that is different to the one in the Cape.

What is happening now? The NP talks so easily about self-determination and a uniform electoral system is being crammed down everyone’s throat. The hon the Minister himself may not decide when the local governments which had been placed under his jurisdiction may hold a general election. The hon the Minister of Constitutional Development and Planning will decide when elections may take place—that hon Minister who has violated democracy so easily by deferring municipal elections until 1988 for example.

It has been asked whether Kuruman is prepared. In this regard we are quite prepared to ensure that Kuruman obtains a full CP town council next time in order to look after the interests of the White voters of that town.

The last time you lost!

No, the last time we won. [Interjections.] At the last election in Kuruman the CP won. However the National Party newspapers did not kick up a fuss about it as they did the previous time—14 days after we left the National Party. [Interjections.] The Conservative Party won the last election in Kuruman convincingly. We shall do the same in future. [Interjections.]

Mr Chairman, we have come to the end of a long but also interesting debate, for which I sincerely want to thank all hon members who have participated. In particular I also want to mention today that for me and for my department it has been an enriching experience to have shared the ideas and the positive proposals raised by various hon members. I should like to assure hon members that I shall join the department in examining each and every proposal that has been made and that I shall also, at some future date, give a suitable response.

Before I come to two particular matters— those of rent control and local government matters—I want to say a few words to the Director-General of the Administration: House of Assembly, Mr André Cornelissen, who becomes Transvaal Provincial Secretary on 1 July of this year. I should personally like to extend a sincere word of thanks to him—on behalf of my department too—for the outstanding co-operation, loyalty and friendship we have had from him and also for his hard work since the inception of the Administration: House of Assembly. I should like to wish him and his wife everything of the best. I have nothing but the utmost appreciation for him as a person and as an official.

Hear, hear!

Mr Chairman, unfortunately the hon member for Witbank is not present in the House today. He has tendered his apologies for his unavoidable absence. In his speech he asked me to consider appointing a commission of inquiry into housing for the handicapped. Let me just say that I have referred this matter to the Development and Housing Board for further attention.

The hon member for Losberg also asked for the Development and Housing Board to convene at least four times a year. Let me tell him that it will indeed be doing so. In fact, it has respectfully been requested that this board convene interim meetings to give attention to the comprehensive terms of reference with which it has been entrusted.

In the course of my speech I shall also come back to most of the subjects raised by the hon member for Hillbrow this afternoon.

In my reply I shall also be dealing with certain matters touched upon by the hon member for Kuruman. [Interjections.]

I want to thank the hon Chief Whip of Parliament for the speech he made. It was a very interesting speech. In principle I am in favour of the simplification of conditions of sale. The promotion of home-ownership is also a very high priority in this department, and I should like to tell the hon Chief Whip that I shall consider the matter and give him suitable feedback in due course. I should like to thank the hon member for his outstanding contribution.

†The first issue I should like to deal with, Sir, is a very sensitive and complex one. It concerns rent control, and I say it is a complex issue because the interests of the landlords and those of the lessees are diametrically opposed to one another while the Rent Control Act endeavours to strike a balance between these opposing interests. It is also a matter of particular public interest.

I dealt with the matter last year during the discussion of this Vote, as the hon members for Hillbrow and Cape Town Gardens have indeed indicated. During this debate the hon members for Bellville, Hillbrow and Cape Town Gardens, in particular, raised this issue. The hon member for Cape Town Gardens also put a question to me on this matter in the House earlier this session.

I wish to say that I have also had discussions with, inter alia, the South African Property Owners’ Association—Sapoa—and the United Municipal Executive on proposed legislation. I have received comments from Sapoa, but I am still awaiting a reply from the United Municipal Executive.

The proposals also entail aspects involving the devolution of functions to local authorities. It stands to reason, therefore, that it would be difficult to proceed with this legislation, inter alia, on these considerations without the blessing of organised local government in this regard.

The hon member for Hillbrow has this afternoon referred to particular aspects which I have indicated would be included in the proposed legislation. The Commission of Inquiry into Housing Matters recommended in 1977 that rent control be phased out in accordance with a fixed programme, and the Government approved the recommendation but stipulated that those lessees who would normally qualify for assistance in terms of the Housing Act should be excluded from the phasing out programme as long as they conformed to the income qualifications and as long as they occupied the dwelling unit concerned.

By means of proclamations issued in terms of the Rent Control Act of 1976—on 6 April 1978, 26 April 1979 and 23 May 1980—the date of application of rent control was pushed back step by step to the extent that rent control is at present only applicable to dwelling units occupied before 21 October 1949, and to other dwelling units in the case of which the present lessee of the unit occupied it on the date on which the proclamation concerned was issued and appliable, provided that that lessee complied and is still complying with the qualifying requirements as to income. The term “protected lessees” was coined for these tenants.

The Select Committee on Rent Control recommended in its third report in 1984 that dwellings which had been occupied for the first time prior to 21 October 1949 should also be exempted from rent control but that continued rent protection be afforded to existing lessees whose monthly income did not exceed an amount to be determined by the Minister. It was also recommended that for the purpose of the determination of the monthly rental of a lessee who laid claim to rent control protection all sources of his income as well as half of the income of his wife and children residing with him be taken into consideration. A further recommendation was aimed at affording rent control protection to a lessee of 70 years of age or older as long as the lessee occupied the dwelling in question.

It is also of interest to note that the following hon members of this House served on the Select Committee on Rent Control viz Messrs J P I Blanché, C W Eglin, A F Fouché, P J S Olivier, A G Thompson, J H van der Merwe, A T van der Walt, A B Widman and Dr M H Veldman.

After due consideration and discussions, and in the light of the recommendations of the select committee, it is my intention to exempt all the dwellings which are still subject to rent control, with the exception of those dwellings which are occupied by protected lessees and lessees who are 70 years of age or older.

In terms of section 51(g) of the Rent Control Act the provisions of the Act are not applicable to any dwelling, garage or parking space exempted from rent control by the Minister by notice in the Gazette unconditionally or on such conditions as he may determine. The Minister may be similar notice amend or withdraw the said notice of exemption at any time. If section 51(g) is used, the recommendations of the Select Committee on Rent Control which called for the exemption of dwellings occupied for the first time prior to 21 October 1949 can be accomplished without amending the Rent Control Act, while rent control protection for those lessees who qualify for such protection can continue.

Although it is not possible to determine how many dwellings were occupied for the first time prior to 21 October 1949 full details can be obtained from the rent boards in respect of dwellings for which rent determinations have been made.

*I do not want to take up the committee’s time with the methods to be adopted in regard to the exemption with a view to phasing out. It will involve drawing up a list containing the property description of all dwellings in regard to which rent determinations have been made and the names of the tenants within the specific areas of jurisdiction of these boards. The tenants of dwellings or buildings will be notified by registered mail that exemption is being considered. The notice will also contain particulars of age and income limits. It will then be pointed out to the tenant that if he qualifies for protection on the grounds of income or age, he should furnish proof of his age or income to the landlord and the Rent Board within a specific period. If such a sworn statement or certificate is not received before the target date he will be thought not to qualify for protection.

By this envisaged method of phasing out, which after approval by the Minister embodies the furnishing of particulars of the individual’s premises and the exemption notice, a more accurate method will be adopted than that adopted in the past in regard to this phasing-out process, specifically as far as informing those involved is concerned, and that is an important point.

Consideration should also be given to methods of cushioning the increase of rent when it comes to tenants who will no longer have the benefit of rent control protection, for example by stipulating that for the first two years the rents for exempted premises will only increase by a certain annual amount.

†The hon members for Hillbrow and Cape Town Gardens made specific proposals regarding the increase of the income limits. I will give their proposals due consideration.

*In regard to the phasing-out date that we should like to commence with, I want to refer to the answer I gave the hon member for Cape Town Gardens to a question he put earlier this year. At the time I informed the hon member that the increase in the present income limit qualifying a person for rent protection, was the subject of an intensive investigation by the inter-departmental committee. The income limit is also related to the whole question of rent control provisions and therefore also to the possibility of phasing out rent control. The chairman of the inter-departmental committee has informed me that by the end of June they expect to be in a position to submit proposals on possible new income limits. At that stage we shall consider continuing with the steps I have announced.

Once the decision about the income limits had been taken, exemptions will be considered, with specific conditions laid down for exemption, for example the income limit, the age limit, rent increase limits for the first two years, exemption to come into force after three calender months from the date of the decision concerning exemption and also that only lawful tenants can lay claim to continued protection. Interim applications for exemption from rent control will not be considered where tenants are subject to rent protection.

This could lead to a limiting of the functions of Rent Boards and future rationalisation will therefore be necessary.

I want to issue a serious warning, and that is that I shall not hesitate to place premises under rent control once more if exploitation takes place or steps are taken to have protected tenants vacate premises with a view to getting rid of rent control.

†I should like to turn now to the alleged abuse of section 28 of the Rent Control Act. It so happens that during 1985 it came to my notice that a number of lessors of rent-controlled dwellings were giving notice to lessees to vacate the premises in terms of section 28(4) of the Rent Control Act for the purpose, inter alia, of rebuilding and repairs, while sometimes the motive was presumably to get rid of the lessees in order to promote sales of dwellings under sectional title and block shares schemes.

This practice which in some cases resulted in the vacation of their dwellings by less affluent lessees without being aware of or availing themselves of the protection which the Act provides in this regard, was also identified by the Select Committee on Rent Control, as the hon member for Hillbrow has also indicated this afternoon. As is well known the committee recommended that the Act should also be amended in this regard to provide that a notice to vacate premises may not be given to a lessee unless a court order has been obtained beforehand to the effect that the premises concerned are reasonably required for the purpose of any reconstruction or rebuilding scheme, repairs, restoration or conversion for which the vacation of the premises is essential.

On a court order?

Yes. In the circumstances I deemed it necessary—I am referring to some of the things that happened last year—to issue a Press statement on 1 July 1985 in which it was pointed out to lessees of rent controlled residential premises that courts had to be satisfied that premises were reasonably required to be vacated for the purpose, inter alia of rebuilding and repair before an eviction order could be granted. I do not have time to deal fully with the Press statement which I issued at the time, but I also indicated that as the Act required lessors to provide the rent board concerned with copies of notices to vacate served on lessees of rent controlled premises the Department of Local Government, Housing and Works would forthwith be actively identifying cases where the relative legal provision was being abused and whereby lessees of rent controlled premises were unlawfully induced to vacate premises, and that the necessary action would be taken in this regard. I also called on lessees of rent controlled premises who upon receipt of notices to vacate were in doubt as to their rights, to bring the matter immediately to the notice of the regional representative of my department in the area concerned. We also issued a circular to all the regional representatives.

I may add that our experience over the past year has been that complaints of lessees resulting from section 28(4) notices have declined drastically. We can ascribe this to various factors such as my statement, the economic climate, a possible decline in the popularity of sectional title schemes and an increase in the incidence of vacant residential units. It is therefore my contention that at this stage the situation does not justify an amendment of the Rent Control Act in this respect, and the department is convinced that the necessary control can be exercised by means of administrative measures. An amendment will, however, be considered if necessary.

*It is, of course, not possible or desirable to prohibit reconstruction or repairs, since these activities are essential and contribute to urban renewal. I should like to express the hope that the proposed steps will serve to protect those who need protection, to facilitate the restful and secure tenancy of a large number of aged citizens of the country and to inspire the private sector and developers to again establish rental accommodation facilities and make them available.

Mr Chairman, may I ask the hon the Minister a question?

My time is limited, Sir, and I still have to deal with local government. If there is any time left, I shall come back to the hon member.

*I should like to thank hon members who participated in the debate, and specifically for contributions in connection with local government. I should like to thank the hon members for Welkom, Newcastle, Algoa and Kroonstad sincerely for their fine contributions on the various facets of local government. It is also a pleasure for me to give attention to the requests that were made. This afternoon the hon member for Algoa made a request, as did other hon members. If there is time available, I would be glad to go into this in more detail.

In my reply this afternoon I shall also deal with various matters raised by hon members. The hon members for Umbilo, Kuruman, Brakpan, Pietersburg, Hillbrow, Greytown and the hon member for Sasolburg—whom I do not see here—all referred to local government matters.

†Firstly, in replying to the hon member for Hillbrow, I shall also be replying to other hon members who raised issues concerning the regional services councils, their functions and the devolution of power.

The hon member for Hillbrow sees regional services councils as a threat to primary local authorities in two specific respects, namely their finances and their functions. Of course, my department is not responsible for the establishment of RSCs or their operations. As was announced last Tuesday by the hon the Minister of Constitutional Development and Planning, the control of the RSCs will rest with the new provincial system as it involves the control over a general affairs body handling general affairs functions, as clearly indicated in the definitions contained in the Act.

My department and I are, however, closely and intimately involved in the RSC Act and its operations in the sense that concurrence with all the major aspects in the establishment and the operation of RSCs is required, such as the region for which it is established, the functions to be allocated to the RSC, the appointment of the chairman, the settling of disputes, the transfer of assets and personnel and the promulgation of regulations. Therefore my replies to the questions raised by the hon member for Hillbrow will also apply to questions raised by other hon members, especially as my department is in fact in favour of the establishment of RSCs, as I also indicated last year during the debate on the Bill in this House. I think the establishment of these bodies will in fact be to the benefit of primary local authorities. I also encouraged the acceptance of the Act, and I would like to refer hon members to the speech I made as far as my department and its activities and administration are affected by this Act.

The most common misconception regarding the establishment of RSCs is that all the functions mentioned in the schedule to the RSCs Act shall be functions of the RSCs. This is not the case as these functions are mentioned as potential functions. Furthermore, the functions to be transferred or allocated to an RSC are to be decided upon upon its establishment and subsequently. It is very clear from the Act that the RSC will only handle general affairs functions, if hon members will care to refer to the definitions contained in the Act.

*That also answers the hon member for Kuruman’s question. The functions mentioned in the schedule are functions that can be declared functions of the RSCs by adopting the procedure outlined in section 3. Section 3(d) of the Regional Services Councils Act provides that the functions mentioned in schedule 2, or even a portion of the functions mentioned there, could be entrusted to the RSCs. What is more, in section 3(d) mention is only made of regional functions which are restricted, in the definition, to those functions mentioned in schedule 2 which are general affairs.

As far as electricity and water supplies are concerned, in schedule 2 mention is only made, of course, of the bulk supply of water and the bulk supply of electricity. This naturally means the provision of these services to a local authority body and not to bulk consumers.

The hon member for Kuruman also alleged that no functions would be dealt with by the RSCs which were not already being dealt with by local authorities. Here we already have an example of the bulk services, furnished by bodies other than local authorities, which ought to become a function of the RSCs.

†Another example is planning. At the moment we have planning within a local authority area, which is in most cases an own affair in terms of item 5 of Schedule 1 of the Constitution Act. Concerning this aspect of planning, I want to confirm my view that local authorities should have more final control in this regard than is the case at present, and that unnecessary control should be abolished. In this regard, most of the provincial administrations have affected some changes or are in the process of doing so to vest most of the control in this regard in the primary local authority.

Concerning planning in the region, I want to draw the attention of hon members to the fact that it was announced last week by the hon the Minister of Constitutional Development and Planning that there could be no sound reason why most of the executive functions involved in the administration of the Physical Planning Act could not devolve upon the second tier and even further down where they are closer to the community level. I am of the opinion that some of these aspects can be dealt with by regional services councils. These functions are at present at the central Government level and have not been dealt with by local government in the past.

I also agree with the hon member for Hill-brow that a local authority can only provide the necessary services if it has the necessary finances. This is one of the reasons why devolution cannot be brought about overnight. There must be the closest liaison with local government in these processes.

I also share the hon member’s concern in regard to the financial viability of primary local authorities. However, I must point out that it was not only the Driessen Commission that recommended additional income— some, but not all, of which was realised—but also the Croeser Committee.

The new sources of income mentioned in the Regional Services Councils Act, namely the regional services levy and the regional establishment levy, are in fact additional sources of income to finance expenditure at the local government level. The creation of infrastructure is surely the best example of this. The financing of infrastructure for the poorer communities is presently a reality at the local government level, and I am sure the hon member for Hillbrow will agree that Johannesburg is a very good example of this. This burden on the primary local authority will definitely be alleviated when a regional services council is established. This will mean that the primary local authority will have a reduced financial responsibility in respect of matters regarded as general affairs in a particular region, as this responsibility will be limited to the primary local authority’s contribution in respect of the new sources of income. This will of course not mean—and I think this is very important—a reduced responsibility regarding its expertise and experience which is available to that community and which is sometimes of greater importance than merely the financial aspect. I therefore regard the establishment of regional services councils as being in the interests of primary local authorities both financially, as the sources of income will in fact be additional sources, and also with regard to their functions, as primary local authorities will now have a say in matters affecting them which they did not have before.

It will also be a valuable instrument in making it possible to devolve functions to the primary local authority as the necessary expertise can be found in the regional services council, whereas particularly a smaller community does not have it readily available. The more economic use of scarce resources can also be to the financial benefit of local authorities. The establishment of regional services councils makes possible the distribution of the financial burden in respect of improvements which are of a regional nature—the hon member for Hillbrow, among others, referred to the question of access roads.

I should like to thank the hon member for Hillbrow who I feel made a valuable contribution to this debate. I think his long career in local government has served him well, and I think we heard the evidence of that in his speech. I should like to say, however, that the hon member will also concede that the concept of regional services councils is not as unacceptable to local government practitioners as I think he tried to make out. My advice is that both Johannesburg and Cape Town have already formally indicated their willingness to administer the new sources of income on behalf of the regional services councils which are to be established in their particular regions.

*In connection with the other questions put by hon members, including the hon member for Kuruman, I should like to say that it is probably clear from the answer I have just furnished that I also advocate the continued existence of a strong system of primary local authorities with a greater say in their own functions. And one must not only look at the functions that local authorities have at present. Some of the other hon members also referred to that.

My intention—and that of my department—is that in future local authorities should have more extensive powers in regard to other own affairs functions, and the relevant negotiations have already been initiated with organised local authorities.

As far as unnecessary control measures are concerned, the UME has also been requested to provide me with particulars of measures which it regards as unnecessary with a view to possibly enabling me, even when the functions are taken over, to eliminate some of them. So there is already a process of negotiation underway.

There is another question to which several hon members referred. In respect of the transfer of powers in regard to the own affairs component, from the administrators to the own affairs Ministers, as far as local authorities are concerned, the ideal is to have this take place at the second tier together with the implementation of the new dispensation. Ordinances are at present still being introduced, during the last session of the provincial councils, to make this possible.

The project team of the Commission for Administration is engaged in the identification of own affairs functions, and already a large degree of finality has been reached in that regard. The investigation is taking place in consultation with my department. It is therefore the intention to have the political decision-making powers in regard to this own affairs component, as mentioned previously, transferred on 1 July of this year. Administrative services will then probably be transferred as quickly as possible after that date. Negotiations in that connection are also taking place.

In regard to matters of fundamental importance to the Administration: House of Assembly, I am satisfied that measures already contained in legislation, together with mutual arrangements already made with the provinces for the protection of such matters in primary local authorities as own affairs institutions, are to all intents and purposes adequate.

The hon member also referred to the phasing out of divisional councils. In this connection I should like to refer him to the speech that the hon the Minister of Constitutional Development and Planning made here in the House of Assembly on 12 May of this year.

To draw a comparison between the present authority exercised by the provinces over local authorities and the authority of the own affairs administrations is, in fact, not all that easy. The provinces will retain control of general affairs at local authority level, whilst the own affairs administrations will obtain full control of own affairs. When negotiations in this connection have been rounded off, I am convinced of the fact that the content of the control of own affairs administrations over local authorities will be sufficient to ensure self-determination at local authority level. That is, in fact, the point of departure of this side of the Committee.

There are a few remaining matters to which I would like to refer on a later occasion. The hon member for Pietersburg, for example, spoke more than once. He was, for the most part, concerned about the question of free trading areas. As the hon members knows, that is a matter which is administered by the Department of Constitutional Development and Planning. I just want to say that in my view it is very clear, from the legal provisions, that every institution or person is free to submit an application in a specific area. A body such as a local authority, which is responsible for the development of its area, ought to take the initiative, in my opinion, when it comes to investigating this matter and submitting the necessary applications.

The hon member for Pietersburg also expatiated on the question of the franchise in such an area. It goes without saying that property owners in such a free trading area will pay taxes to the local authority in whose area the property is situated. It is, however, set out clearly in sections 2 and 3 of the Local Government Bodies Franchise Act that this does not mean that in the area of a White local authority the franchise will be given to members of the other population groups and vice versa. Even when a vote is cast on behalf of a corporate body that does, in fact, have the franchise, the vote must be cast by someone of the same population group as that over which the local authority has control, as provided for in subsection 3(e) of the Act.

I want to make a friendly request to the hon member for Pietersburg to familiarise himself with the contents of this legislation because, with all due respect, there was no indication in his speech that he had even looked at the Act.

Mr Chairman, may I put a question to the hon the Minister?

No, at the urging of the Whips, I now have to round off my speech. I am sorry, but I cannot answer any questions now. Further clarity can be obtained in the Third Reading debate.

I have thanked hon members for the speeches they made. Unfortunately at this stage I cannot get round to the other notes I have prepared on the speeches made by other hon members.

In conclusion I want to express my thanks, and that of my department, for the liaison taking place in regard to local government. In particular I should like to express my appreciation to the hon the Minister of Constitutional Development and Planning and his department, and also to my hon colleagues in the other Ministers’ Councils, the Administrators and the MECs involved in local government affairs, for the co-operation and liaison that my department and I have had from them, particularly in regard to local government affairs. Liaison with organised local government, with bodies such as the United Municipal Executive, the provincial municipal associations, municipal institutes and local authorities were also conducted in a positive spirit throughout.

I have every confidence in the functionaries, councillors and officials of local government institutions. I see the establishment of the regional services councils as a positive development at this level of government, a development that will lead to better co-operation between communities in the interests of the future of our country.

That is why I am saying that we should not make politics of the establishment of regional services councils. They should much rather be seen as bodies which take decisions at that level of government which is closest to people, which affect the interests of people in a regional context and which solve problems. Success at local government level is essential for bringing about stability and peace, and in this context I have every confidence in our local authorities.

Let me conclude by thanking all hon members for their contributions to the debate.

Vote agreed to.

Vote No 1—“Health Services and Welfare”:

Mr Chairman, it is not only appropriate but also my pleasant duty on behalf of my department to take leave of the Director General of the Administration: House of Assembly, who is leaving our administration soon. All I can say to him is: May he be richly blessed, and may his labours be rewarded.

I should also, because it is a heart-felt need, like to thank my chief executive director, Dr Slabbert and his staff, who are also present here this afternoon, very sincerely for their hard work during a year of tension. We had to build up a department virtually from scratch and I have great appreciation for the loyalty and the dedication with which these gentlemen performed their task. Naturally I should also like to convey my thanks to my private secretary and his personal staff, who supported us so tirelessly during the past year.

This is the first opportunity I have, in my new capacity, to participate in a budget debate of this nature. That is why I think it is appropriate that I emphasise certain activities of the department and also present to hon members the policy in respect of certain aspects of our activities.

Firstly I want to turn to the privatisation of health services. According to Schedule 1 of the Constitution the registration and control of private hospitals is a function of the Department of Health Services and Welfare. The department therefore deals with applications for the establishment and registration of private hospitals and detached operation theatre units. At present 72 private hospitals and 69 detached theatre units have been registered by the department. In these 72 private hospitals, there are 8 389 beds and 273 theatres. In 1985, 943 125 patients were admitted for a total of 1,88 million patient-days. One of the deficiencies in these hospitals is that only 82 intensive care and 26 high degree of care beds are available. That is 1,3% of the total number of beds, and I trust that this position will be rectified soon.

In the 69 detached operating theatre units there are 94 theatres. In 1985, 121 183 patients were admitted and 120 172 procedures carried out in these units.

†Governmental budgetary support for health in many countries is faltering and in some cases actually declining in real terms. This is the result of countries struggling to exercise fiscal restraint in the face of poor economic performance and burgeoning debt. In many countries there is a real fear that escalating costs will threaten to erode the health gains of the past.

At present the Republic of South Africa’s expenditure on health care is approximately 5,5% of the gross domestic product. The public sector’s expenditure on health is 60% of the total health care expenditure.

While these current figures may seem modest, the potential for even more rapid expansion in the next two decades is substantial. Factors leading to an increased demand for and therefore cost of health care, that we are facing at present, are the following: Population increases, increased life expectancy, urbanisation and improved education. It is also true that as per capita income rises, health spending rises faster as a matter of course. Where incomes have reached levels equivalent to those in developed countries, health care can become a troublesome giant. For example, over 10% of the gross domestic product in the USA is spent on health care. With the pressing needs for increased expenditure on education, housing, water supplies, social infrastructure, job creation etc in South Africa, we must accept that the financial resources available for health care will remain limited in the foreseeable future.

One of the major shortcomings of our present policy is that we are financing health care to a significant extent from public revenue sources—from taxes. Unless we are prepared to increase taxes even further, alternative approaches to the financing of health care should be identified and executed. One of the alternative approaches is of course privatisation of health care.

*One of the national objectives, as expressed in the Constitution, reads as follows:

Although the Government has committed itself to a policy of privatisation, it also realises that health services are a very sensitive area. It would be fatal to attempt the privatisation of health services overhastily and without proper forward planning. In my department, which is responsible for the provision of health services to Whites, we adopt the following approach. In the first place private institutions are being allowed, and even encouraged while the public sector is maintaining its present involvement. In the second place the department will only expand its involvement if a clear need for it exists, and if the private sector is not prepared or is unable to meet the needs concerned. In the third place, attention is also being given to the joint use of facilities and transfer of facilities from the public to the private sector. In this connection I could mention that I have already held provisional talks with the private welfare organisation, during which a pilot project for the sharing of facilities was tentatively decided upon.

We are all aware of the fact that beds are at present standing empty in some of our hospitals. The possibility is at present being examined of making unutilised capacity available to this private organisation, by means of this pilot project, for the care of infirm aged. The joint use of the kitchen, the laundry, even the dispensary could be advantageous for the public as well as the private sector. If this project succeeds we will be solving two of our major problems, viz that of unutilised hospital beds and that of a shortage of accommodation for infirm aged.

I wish to close my argument on this aspect with a warning. Privatisation may never be permitted to harm the service. Before the privatisation of a service can be considered, there are two questions which must be answered. The first question is whether the private sector will render an equivalent service on a long-term basis. The second question is whether the private sector, if it is in fact prepared to render the service, will do so on conditions which are acceptable to the community.

You see therefore, Mr Chairman, that our point of departure is very clear. The State and the private sector are not in competition with one another. The State and the private sector must supplement one another. The construction of a private hospital is not detrimental to the State. It is beneficial to the health services in the Republic of South Africa.

†I should like to refer now to the question of care of the aged. The total welfare budget—that is programme 4—amounts to R657,280 million. Care of the aged receives 67,5% of the total amount. It being such an important facet of the department’s function, I would like to elaborate on this.

It is an undisputed fact that the aged population continues to increase. The declared policy of the Department of Health Services and Welfare of the Administration: House of Assembly is based on the philosophy that the aged should be an active and integral part of our community for as long as possible. The services to the aged cover three main areas, namely services to the aged in the community; special housing projects; and institutional care.

The first covers a wide field, ranging from preparation for retirement to medical and social services. The loneliness of old age can be a major problem and must be actively prevented. Here the community can and should play an important role. An example of this is the 75 community service centres which together care for 20 821 aged people and which the department subsidises. It is estimated that an amount of R4,737 million will be paid out in respect of subsidies for these service centres for the 1986-87 financial year.

Housing projects especially for the aged are planned in conjunction with the Department of Local Government, Housing and Works. Since the inception of this scheme in 1971, 361 projects accommodating 21 884 aged persons were approved.

I mentioned institutional care of the aged as the third type of service. In 1950 there were but 27 State-supported homes. These homes accommodated 1 500 people. Today there are 395 such homes catering for 27 309 elderly people, 21 715 of them in the sub-economic group. In addition, there are 104 private homes which care for 5 062 aged people. The department itself runs four homes caring for 360 infirm, aged and handicapped people. The firm Smith, Mitchell and Company, also runs four old age homes for the State, caring for 518 aged and handicapped people. A total of 33 187 people are thus being cared for in homes for the aged. This represents almost 8% of the aged population, making South Africa’s aged population in institutions one of the highest in the world—even including welfare states such as Holland! One is therefore compelled to draw the conclusion that too much stress has been placed on institutional care of the aged. The time has definitely come for consideration to be given to ways and means of keeping the aged in the community for a longer period of time. There is ample evidence that older people prefer other alternatives to that of entering an institution.

Whilst it is accepted that the majority of elderly people entering institutions do so because of major infirmities, there are certain factors that increase the chances of their being institutionalised. These factors are: A lack of social support systems and services in the community; a lack of adequate transport facilities; and the relatively inconvenient location of local resources such as medical and hospital facilities, stores, businesses and so on. These factors seriously hamper independent living.

Personal security is an essential requirement for the satisfactory use of one’s community. We read almost daily in the local newspapers of old people being attacked, robbed and murdered. In a survey in the USA, crime was mentioned most often as the respondent’s major personal concern.

For many home-owners their home is their major asset. Unfortunately, in many cases their income is insufficient to allow proper and needed maintenance, repairs and alterations to be done. At present the department is considering some form of financial aid for senior citizens who wish to alter their homes, thereby increasing their security and suitability for elderly people.

I ask now: Is it not time for communities to become more involved in the provision of housing for the aged? Church and welfare organisations should consider buying large houses in the community in which eight to ten senior citizens can be housed. These senior citizens operate as a family performing the necessary domestic chores themselves, share the expenditure, do their own shopping, and so forth. They thus remain independent in the community.

*The impression is sometimes created that this department is insensitive to the financial problems at present being experienced by welfare organisations. Here I am referring specifically to the subsidies we pay our welfare organisations. The department understands fully that welfare organisations find it difficult to render their services in the oppressive economic situation in which the country finds itself. Unfortunately the department does not have an unlimited supply of money at its disposal for the subsidisation of welfare services, and consequently it is not always possible to pay realistic subsidies.

Up to now the department has been able to make regular annual adjustments to subsidies to compensate in that way for the cost increases to which organisations are subjected. For example subsidies are adjusted annually as follows: There is a 3% adjustment to make provision for normal salary increments of personnel in the employ of organisations. When the salaries of public servants are increased, as was the case with effect from 1 April 1986, the salary component of the organisations is adjusted by a corresponding percentage.

The other expenditure of organisations is adjusted by a percentage as approved by the Treasury to compensate for the rise in the consumer price index.

When the approved number of inmates of subsidised institutions increase during the year, subsidies are automatically adjusted.

The department is also continually trying to effect improvements to subsidy schemes out of moneys appropriated in areas where the biggest problems are being experienced. Thus it was possible, besides the abovementioned adjustments, to effect the following improvements as from 1 October 1985: The income limit as applicable to subsidised homes for the aged and homes for the handicapped was raised from R300 per inmate per month to R450 per inmate per month, which amounted to an additional expenditure of R8 million per annum.

The subsidies payable to service centres for the aged were doubled from R200 per inmate per annum to R400 per inmate per annum, which amounted to an additional sum of R1,5 million per annum.

The subsidies payable to sheltered employment for the disabled was virtually tripled from R350 per worker per annum to R900 per worker per annum, which came to an additional amount of R500 000 per annum.

With the latter two adjustments an effort is being made to stimulate community services.

I should like to give the assurance that the improvement of existing subsidies is constantly being examined by this department, and when money is available such improvements will be effected.

1986 is the Year of the Disabled. Once again the approach is that the disabled person forms an integral part of the community and should not simply be removed from the community. One of the basic requirements is that buildings must be accessible, particularly for paraplegics. Is it not time we thought of making the Parliamentary buildings accessible to people in wheelchairs? Fortunately I can announce that I have already discussed this matter with Mr Speaker, and that he has already taken steps to make this building as well accessible to people in wheelchairs. [Interjections.]

I ask hon members to allow me to quote a paragraph from the annual report which was presented to me by the Chief Executive Director, because I think the philosophy and dedication of this department and its officials is summed up very succinctly here:

It is especially in geriatric care where community involvement comes to the fore in, for example, the transport of the elderly to clinics, the valued visit of a younger person to an older sick person in the neighbourhood, or the making of a telephone call to a doctor for the ill elderly person.

Mr Chairman, firstly I want to apologise for the fact that my colleague the hon member for Parktown is not present. He is overseas at present and I am sure he is doing good work for South Africa there.

†Mr Chairman, I should also like to request the privilege of the half-hour.

The hon the Minister of Health Services and Welfare who has just taken over does not necessarily need to be treated with the same kidgloves with which the hon the Minister of National Health and Population Development has to be treated. Although he was until recently only a Deputy Minister or, as we say in a friendly way in Afrikaans, “’n kortbroek-minister,” he is also a “lang-broek-kortbroek-minister” as he is a fairly experienced Minister and he has been through a few political battles in his life, not least with our party. [Interjections.]

There are a number of issues which the hon the Minister raised in his speech which I will deal with in the course of mine. He touched upon the aspect of our resources being applied to the aged. He pointed out that in terms of the White aged in this country they are actually better cared for than the aged in a country like Holland which is generally regarded as having the best treatment of aged people in the world. In a society like ours where the age profile is changing and where there is a higher proportion of older people one has to look very carefully at how our resources are being applied in that situation. I am sure that the hon the Minister is right when he says that old people should rather be cared for within the community and, if necessary, looked after by district nurses.

I also believe it is important that the resources which are applied in caring for the aged should be kindly applied but that they should also be in proportion to the needs of the country as a whole.

To talk about health own affairs is, in one and the same breath, a farce and a scandal. I do not believe that any conscientious doctor or nurse can justify or support a statutory racially discriminatory health service on ethical grounds. The hon the Minister should really be ashamed of having said in regard to the importance of care of our fellow-men:

How can any person seriously committed to health in a society only apparently be allowed to be interested in the health of one group which is arbitrarily determined on a racial basis? Germs, sickness and hygiene do not observe the racially discriminatory barriers which this Government imposes on South Africa.

Such an approach also causes a scandalous waste of resources. Our whole health system is geared to providing a First World and not a Second World health service. As a result, only about 6% of our health expenditure is on preventative or primary care—depending on how one defines that term—and 94% is on curative care. This is widely recognised as a thoroughly undesirable way of spending public resources on health.

Whites cannot expect to retain their apartheid privileges with public money. They are going to have to accept non-racial hospitalisation, but that does not necessarily mean there will be a lowering of standards. If we open our half-empty hospitals to all those people who can afford them or who can be brought into them, the difference will be that they will also be able to enjoy the standards of those hospitals, acquire a vested interest in them and help uplift them.

There are highly competent Indian doctors working at many of the so-called White hospitals in Natal. One of the most important heart surgeons doing bypass operations at Wentworth Hospital is an Indian. The people there are also concerned about maintaining high standards.

I would like to give a few examples of underutilised White hospitals. The hon member for Carletonville referred yesterday to a hospital in Ventersdorp which is standing empty and unused. The Karl Bremer Hospital in Bellville was built some 30 years ago and is half empty, as is the J G Strijdom Hospital in Johannesburg which was built about 20 years ago. The Pretoria West Hospital is also half empty, and the Johannesburg General Hospital is severely underutilised.

This is happening because Whites are rich and do not want to go into State hospitals. They prefer private medical care because their doctors recommend it and because their medical aid schemes will pay the bills.

I cannot believe that the hon the Minister is seriously considering using all those empty wards for geriatric purposes. Surely the solution is to release hospitals like the ones I mentioned into the private sector. They should be leased or sold.

There are also at least four or five private hospitals rising like mushrooms in the Bellville area.

Are you opposed to private hospitals?

No, I am not against them at all.

Listen to what he is saying!

Why don’t you sell Karl Bremer?

People pay for treatment there. I object to the fact that the State, for racial reasons, holds on to half-empty hospitals. The three hospitals I mentioned cost us at least R20 million per year which could be used to provide decent primary health care in areas where it is really needed. My suggestion is that they should become private hospitals so that Indians, Blacks and Coloureds, who are increasingly becoming members of medical aid schemes can also pay for their own medication. Let them use these hospitals as well. Why should the State provide hospital services for rich people whether Black, Indian, White or Coloured? This problem exists particularly in our White communities which have the most wealth at present.

I would like to cite a further example of what can happen at a fairly typical South African hospital. The Estcourt Provincial Hospital serves Blacks, Whites, Indians and Coloureds. The White section is one-third utilised and has been so since the day the hospital was opened 15 years ago. The White nurses’ quarters are hardly used at all. In fact, single teachers and all sorts of other people who are connected with Government departments stay there—something which was not originally intended—and they are still not full. The Black section is full. Indian patients on medical aid schemes asked to use one or two of the wards in the White hospital, but were refused. So, what happened? A new ward was built to deal with these patients. However, there is no money to run the ward and so the ward stands empty. The Indians who want the advantages of more private treatment, or whatever those advantages are, travel to Pietermaritzburg to the Northdale Hospital to get their treatment there. This whole situation is disgraceful.

It is crazy!

It is the direct fault of apartheid. I cannot believe that sick people can object to being in a mixed race ward when all the patients there are ill, when they observe the rules of the hospital and when they can afford to pay to make use of those facilities. [Interjections.]

[Inaudible.]

Estcourt was the example. However, Estcourt is an example of something which I think happens in many of our small towns. We are still waiting for a reply from the hon the Minister and his senior colleague who deals with general affairs as to how that kind of hospital is going to be administered. [Interjections.] Our problem is that that hospital, if this new policy is going to be applied, will presumably have three or four administrators. Who is going to pay for the coal which is to be used for the boiler? There are any number of such questions. I believe we are going to have very serious problems in this regard. [Interjections.]

I also want to raise another matter with the hon the Minister. In this debate I suspect—I am not sure, but I have a suspicion—that the dangers to health of smoking will be raised, and I must say immediately that I support campaigns which warn that smoking is a danger and which try to limit the effects of smoking. However, there is another and far more serious threat which costs tens of millions of rand, which does immeasurable harm and which destroys and disrupts tens of thousands of lives and families in our country. Yesterday I read that bottle stores are going to be allowed to stay open till ten o’clock in the evening, or that is Fedhasa’s belief. Now, can this hon the Minister and, indeed, any decent citizen—I am excluding the indecent ones—sit idly by while alcohol sales and the availability and promotion of alcohol are given almost unbridled licence to expand, to advertise and to promote these socially destructive products? We have seen this over the past few years with the marketing of flavoured wine etc.

More than 60% of all cases at our hospital out-patient departments have alcohol-related causes. I am sure the hon the Minister knows that. If he goes to the out-patient departments at Groote Schuur Hospital, King Edward VIII Hospital or the Johannesburg General Hospital, he will discover that at least 60% of all cases which are brought into out-patient departments have alcohol-related causes. Our mental hospitals have thousands of people whose brains have been addled by alcohol and dagga abuse. Our industrial schools, our child welfare and our family guidance and social welfare groups all work with the sad results of alcohol abuse. The majority of motorcar accidents have alcohol as a contributing factor.

I do not believe that this hon Minister is doing his job if he does not act to stop the activities of the promoters of increased alcohol consumption. Alcohol, despite its dependence-producing qualities, is socially acceptable as a drug. I accept that. It is a socially acceptable drug. To try to stop its use, as is done with other drugs, will be as unenforceable as making adultery a crime and as ineffective as the attempts to stop dagga consumption in the Black community in particular. Prohibition is no solution. However, surely the hon the Minister can, in the interest of the health of the people of South Africa, endeavour to stop the promotion of the consumption of liquor.

Once again I want to support the campaign against smoking. I believe, however, that alcoholism is much more costly in social terms—let alone individual lives—to our society. This hon Minister ought to do everything possible to ensure that the use of alcohol is not promoted. Where it is available, it is a person’s free choice whether to use it or not, but I do not believe it is in the interests of South Africa that people should be encouraged to consume more and more alcohol. If cigarette packets carry a health ban and the advertising of cigarettes is restricted or banned, how much more desirable is it not to ban the promotion and advertising of alcoholic dependence-producing substances? This hon Minister owes it to the health of the nation to take this action.

The third matter I want to deal with briefly concerns statistics which are not available in this hon Minister’s department’s report but in that of the hon the Minister of National Health and Population Development. I want particularly to refer to the statistics on abortion which I believe are extremely helpful. The information supplied in terms of section 7(3) is the most valuable but also somewhat disturbing. It is valuable because it gives reliable statistics, because those who are attempting to have the law amended to allow for de facto abortion on request, use wild and unsubstantiated and unsubstantiable figures, usually round figures, to support their case. This set of statistics sets out clearly how many women come to our hospitals for care after a miscarriage. The definition of “miscarriage” in this case of course includes both a natural miscarriage as well as one which may be the result of an induced abortion in what are sometimes termed “backstreet clinics”.

The disturbing aspect of these figures is that there were just over 7 000 White women who were treated and 32 500 women in total. I believe this figure should cause concern to our health authorities. However, it seems to me that the Act is achieving its objective of limiting abortions. In the spirit of Mother Theresa of Calcutta the Act regards our unborn babies as a precious heritage for our people to care for. In that attitude I am sure it has the support of the overwhelming majority of all our people. However, it is vital that the situation be monitored and that fertile women and men should have access at affordable cost and in convenient locations to safe family planning resources.

I also want to draw the hon the Minister’s attention to the fact that section 3(l)(b) is the section being most widely used for obtaining legal abortions. It is precisely that section which it was anticipated would be used most often for obtaining legal abortions.

It is my hope that the hon member for Parktown will be back tomorrow to participate in the debate. Let me hasten to add that views on abortion in our party are, of course, a matter of free conscience, although, clearly, the law is still the law.

Mr Chairman, at the beginning of his speech the hon member for Pietermaritzburg North referred to a fledgling Minister (kortbroek-minister). I think he realised very soon, however, that this was no fledgling Minister but, as he was speaking of fledgling Ministers, I began wondering about the “kortbroek” doctors who are speakers in this debate now! [Interjections.]

The matters raised by the hon member are all debatable; we agree on some and I am convinced the hon the Minister will furnish him with a good reply.

I consider it a privilege to participate in the debate on the Health Services and Welfare Vote. The own affairs health group of the NP has found it a very great privilege to have been able to work with the hon the Minister since the inception of this Ministry. We find an exceptional attitude of co-operation in the hon the Minister and, when I am looking for conviction regarding an exceptional interest in the health and welfare of the population group we represent in the House of Assembly, I find that conviction in the hon the Minister who is interested in this par excellence. The executive and the group found it a pleasant experience to have been able to co-operate with the hon the Minister over the past year and in this regard I take pleasure in referring to the frank way in which the hon the Minister discussed matters as well as his sympathetic ear and understanding when an hon member came to discuss problems with him.

We also wish to refer to arrangements the hon the Minister made for a tour for the group which we found very illuminating and important. We take pleasure in expressing our thanks to the hon the Minister for that pleasant co-operation and for the exceptionally capable way in which he manages his portfolio. I have no doubt that the hon the Minister as the political head of the Department of Health and Welfare will expand this own affairs department maximally for the benefit of the White population group.

At the same time we also wish to express our hearty thanks to Doctor Slabber and his department for their dedication, friendliness and hearty co-operation. Our grateful thanks too for the clear synopsis in the annual report. This is written in a language anyone can read and I recall the late Dr Nak van der Merwe’s saying that when drawing up an Act, one should do it in such a way that everyone could comprehend it. It is the case in this report too as everyone can read and understand it and it is very useful.

It is Government policy to expand Administration: Own Affairs vigorously through the various departments involved and Health and Welfare will not be left behind either in the prescribed sphere; it is actually one of the most important spheres. If a people is physically and mentally healthy— this is the departmental responsibility—and if there is prosperity in the economy as well as in the sphere of welfare, other problems of national import can be attacked energetically.

In section 14(1) of the Constitution own affairs of a group are defined as—

Schedule 1 of the Constitution contains a list of matters identified as own affairs of each population group. Two of the identified areas are social welfare and health matters. All welfare matters, including social pensions, which relate to a specific population group, are own affairs of the group in question. The Schedule explicitly mentions those health matters which, if they relate only to a specific population group, are own affairs. They are hospitals, clinics and similar or related institutions; medical services at schools and to indigent persons; health and nutritional guidance and also the registration of private hospitals to which the hon the Minister referred in his speech.

Mr Chairman, may I put a question to the hon member?

No, my time is limited.

As is the case in any department or other institution, the Department of Health Services and Welfare also experienced growing pains and especially the pains of its establishment. No one could possibly be so naive as to think that after only a year and a half since its establishment everything would already be proceeding smoothly. It is certainly an interesting and exciting challenge to place the operation of the department on a firm footing especially as a new phase is being entered in the light of changes taking place on the second tier of government. This will definitely affect the aspect of health. Unprecedented challenges posed by the new concept of own affairs administration caused the management and personnel of the department to devise a distinctive strategy to be able to carry out the responsibility entrusted to them in terms of the Constitution.

The department had to find its feet at a time when difficulties were being experienced in the economic sphere. Consequently it also had to make sacrifices under the limitation on State expenditure and felt the influence of this. This compelled the department to evaluate its priorities and to organise the most economic application of the funds voted.

The department furnishes service across a broad spectrum in the field of health services. Its functions cover a very wide area under the leadership of the Chief Directorate: Health Services and include the Directorates: Medical Services; Mental Health Services and Dental Services and the Section: Nursing Services. Each of these services fills a particular niche in the family and their value should never be underestimated. I think one should always be careful to see all the divisions in the department in the right perspective regarding the service they furnish to the public. My comment arises specifically from what the hon member for Pietermaritzburg North said. Lately there has been much talk about privatisation—to which the hon the Minister also referred— and privatisation in the sphere of health services as well. To my mind the State cannot continue supplying all services indefinitely— and that goes for health services too.

Nevertheless I am equally convinced that the State bears a great responsibility for providing certain health services to an exceptional degree. This is the case especially if we consider that health services and welfare are so inextricably bound—as regards the care of the aged in particular. On this head I am thinking for instance of district surgeon services, outpatients and hospitalisation. In conjunction with these goes welfare work.

We can definitely not reject the idea of privatisation; it will certainly have to receive attention, particularly in the case of hospitalisation and the supply of medicine. It remains important to me that health services always stay within the reach of the consumer whatever may happen in future.

This brings me to medical aid schemes. Because of the high cost of medicines it is very important today that medical schemes be extended and used in such a way that their members derive the maximum protection and benefit. From information I have obtained, there are approximately 200 or more medical aid schemes at present with about 1,5 million members. In total approximately 4,5 million people are covered by medical funds. I am very pleased that in the region of 85% of the Whites in South Africa already belong to medical funds.

Order! I regret to inform the hon member that his time has expired.

Mr Chairman, I rise merely to afford the hon member the opportunity of completing his speech.

Mr Chairman, I thank the hon member for his thoughtfulness.

I said it was pleasing that in the region of 85% of the Whites of South Africa belonged to medical funds. Members should be warned, however, to use their benefits judiciously otherwise it will merely give rise to premiums ultimately becoming so high that it will be impossible for the ordinary man with a low or average salary to find the premiums. I consider it very important that this be brought to the attention of every member of a medical scheme so that the benefits may be applied very judiciously because, if medical schemes run into trouble, we shall experience very great problems with health services in future.

The second arm of the function of the department is welfare. This is an especially important aspect in the care of the aged and indigent in particular. According to statistics in the annual report of the department, in 1985 the old age pension benefited 143 090 people representing 67% of total expenditure on social pensions and allowances. They received R284 845 566 million. War veterans’ pensions comprised 6,5% of this and they received R27 295 000 million while social pensions in the amount of R57 887 000 or 14% of the Vote were paid. Almost 5% of social pensions went to the blind and they received almost R1,5 million. In addition, 12% of social pensions were spent on maintenance, family care and foster-parents’ grants; these amounted to R52 100 000, giving us a total of R423,5 million.

In addition to direct social pensions, there are 378 subsidised institutions caring for 25 667 of the aged. Their current expenses were subsidised in the amount of R55 million.

Welfare services comprise welfare promotion, care of the aged, care of the disabled, child and family care services, combating of alcohol and drug dependence, emergency relief and an enormous number of institutions, social welfare and research, receiving vast amounts of money from the Treasury.

The appropriation for health services and welfare amounts to R716 643 000 for the financial year of which R657 million is to be spent on welfare promotion. As health services and hospitals increasingly become departmental responsibility in future, the amount will probably be changed and increased appreciably in total.

Hon members on this side of the Committee will discuss the various aspects of health and welfare further and I should like to refer to a few other matters.

It is a fact that all applications for social pensions do not succeed and for different reasons. Hon members are aware that in the past it was customary to send a stereotyped letter with a cross and a square to applicants by means of which the result of the application was made known. Almost 7 600 applications are known to be turned down annually. The hon the Minister has decided that in future a neat personal letter will be written to each applicant. This will cause additional expense but I am convinced that it will give rise to great appreciation and better understanding; I believe it is fine. The hon the Minister’s thoughtful decision deserves very high praise and he has our grateful thanks for it.

A further matter I should like to discuss is capital investment in welfare housing to which reference has already been made in this debate. Over the past five years R164 million was spent on welfare housing of which R135 million went on providing homes for the aged. We have a tendency in South Africa always to want to erect the most beautiful and luxurious buildings whereas on the other hand we simply demolish sound but slightly older buildings in no time. Recently the hon the Minister took the Health Study Group on a tour of welfare institutions in the Western Cape; I have actually already referred to this. What an experience it was to see how two old hotel buildings in Kalk Bay had been converted into private homes for the debilitated aged and other disabled people by the Smith & Mitchell organisation. The entire project is absolutely functional. The institutions can provide nearly all the medical needs of the inhabitants, in proof of which I may say that we have information that approximately five people from the total number of 234 patients are sent to provincial hospitals for treatment every month. We find effective accommodation there—at low cost to boot. In addition we have evidence that the Smith & Mitchell organisation built a hospital with 200 beds elsewhere in the country for the amount of R2,5 million.

Should we not examine the exploitation of the State by building contractors who succeed in getting away with vast amounts of money through abnormally high tenders? I believe we should concentrate less on the luxurious and do more regarding functional accommodation.

A further matter to which the hon the Minister attaches great weight is the possible better utilisation of existing buildings, especially multistoreyed hospitals and vacant nurses’ homes. The hon the Minister has already referred to them. They can be very effectively converted and arranged as accommodation and places of care for the debilitated aged. I am aware that the sickbay in almost every home for the aged in the country is so full that numbers of debilitated people cannot be admitted. Instead of erecting further buildings for this purpose, it should first be established whether there is no existing accommodation in the town concerned which could be effectively converted to supply existing needs.

My argument is therefore that we should concentrate on the better utilisation of existing facilities instead of erecting new and expensive buildings. There are numerous debilitated and neglected old people who could be accommodated in this way. Health care and welfare services in our country make heavy calls on the Treasury so in future we should lay more stress on preventative in preference to curative medicine.

Of great import—and I close on this note—is that we should always realise that access to unlimited, free health services remains a privilege and should never be a right.

Mr Chairman, I should like to request the privilege of the second half-hour.

Mr Chairman, permit me in opening to congratulate the hon member for Middelburg on his election as chairman of this new study group of his party. I equally wish to congratulate the hon the Minister who, as the hon member remarked, was handling the discussion of this Vote in the House for the first time. I am saying this because this department deals especially with the interests of the health and welfare of the White part of the population.

Bravo, Willie! That was well done!

Sir, I shall refer to the hon the Minister of Transport Affairs later as well. [Interjections.] I also want to take the opportunity of congratulating Dr Slabber, the Director-General of Health Services and Welfare, most heartily on the beautiful annual report he tabled here.

In terms of Schedule 1 of the Constitution, which defines the so-called area of own affairs, hospitals and clinics are specially designated as own affairs “but subject to any general law in relation to such matters”—as item 4 of Schedule 1 of the Constitution runs. It appears to me that it is precisely the interpretation of this which is giving the Government a headache in the control of provincial hospitals, municipal clinics and so on. That is why the hon the Minister has not so far been able to reply to our questions on this. Yesterday, for instance, when a question was put in connection with this, we heard that the matter was before a Cabinet committee at the moment for a final decision.

This causes great uncertainty among the staff of provincial hospitals so I want to appeal sincerely to the Government not to leave these people in the dark much longer. One can deduce from the annual report of the department that this very matter forms part of the establishment and growing pains which are being experienced in the ranks of the department itself.

Personal health services should in any case always be an own affair. It is also compatible with the ethnic policy of this side of the Committee that every people should chiefly assume the responsibility for the care of its own members.

In consequence of this, we welcome the fact that training facilities such as those at Medunsa have to be instituted to train doctors for the Black people of Southern Africa as well. Everyone conversant with general practice will be aware how important it is to know and consider the language, culture, traditions, religious observances and factors creating fear, uncertainty and tension in one’s patient in the proper treating of each case. An intimate and personal matter such as health care can therefore be best served by a healer who knows and understands the language, background and spiritual composition of his patient—a healer who can fathom the finer nuances of the psyche of one of his fellows as no one else can.

This also applies regarding nursing services in particular but also paramedical and other auxiliary services for which this hon Minister has to assume responsibility. This scientific fact cannot be overemphasised. Scientific evidence of this truth actually comes from that university—Medunsa. I wish to refer to an article which appeared in the magazine Huisartspraktyk in April. This is the official organ of the South African Academy of Family Practice. Dr T Germont of the Department of Family Practice reports in this article on a conference recently held in Finland on the concept of a so-called “whole person medicine” which one may perhaps translate into Afrikaans as “globale gesondheidsorg”. I should like to present two quotations from the article to hon members. This medical practitioner first says:

The article continued:

The article continued:

To me this underlines the enormous importance of a people-orientated health system at least at the personal level which should exist between doctor and patient and patient and nurse.

I now wish to ask the hon the Minister if this is also his standpoint and that of his department. Is it therefore his standpoint that there should be own hospitals and own nursing staff for the various population groups?

I shall explain why I am putting this question. In the chapter “Mental Health” of the annual report of the Department of National Health and Population Development there is mention of private hospitals and also other hospitals which have been transferred to the Administration: House of Assembly. Under the title “Mental Health Education” in Chapter 4 there is mention of an amount of R100 000 which was received for example by the SA National Council for Mental Health. I have a circular from the National Council for Mental Health in my hand and will quote a paragraph from it to register my protest because these people are also conducting politics. I shall read the following from their newsletter of January 1986:

The SA National Council for Mental Health therefore actively works to bring about racial integration in this particular sphere. I think we have the right to protest at this. From our side we should like to keep politics out of this department in particular but I want to ask whether what is contained in this newsletter is in accordance with current Government policy.

This immediately brings one to the entire question of the privatisation of health services to which the hon the Minister also referred. Many rumours are in circulation that the Government is considering transferring far more of the current health services from the public to the private sector. It is said that even provincial hospitals are involved. Of course, certain services have been privatised for some time; think of some geriatic services for instance, psychiatric services and rehabilitation centres, sheltered employment and so on. The Parliamentary health services and welfare groups recently had the privilege of visiting some of these institutions as the hon member for Middelburg mentioned. I also wish to thank the hon the Minister from our side for the privilege of being included in such a tour; it was illuminating and very educational.

It was obvious that in cases demanding particularly intensive care such as seriously disabled patients with serious physical and mental handicaps for instance and demanding special care it remained the State which had to step in and provide that care. It is only logical that the less profitable services such as the care of the underprivileged and the training of doctors and nurses should remain State responsibility.

If one examines in addition the astronomic cost of private hospitalisation, the State should think twice before hospital services are privatised on a large scale. I wish to refer to what the hon the Minister said and appeal to him to do this with great caution. In his speech the hon the Minister said the conditions on which these services would be furnished by the private sector would be examined. I want to warn the hon the Minister that, once these services are entirely in the hands of the private sector, I do not know how the State will still be able to set certain conditions on the cost of hospitalisation. Consequently I want to issue a word of warning on this.

Regarded from a strategic point of view, it is definitely not desirable either that its most important component should ultimately be placed entirely in the hands of private initiative in spite of problems experienced in offering the required standard and number of health services to an increasing population.

One need only look at the cost of hospitalisation in a highly privatised country like the USA in comparison with that in South Africa. Even under current conditions patients in this country have problems in fulfilling their obligations, especially in the type of hospital already transferred to the Administration: House of Assembly. A case came to my notice of someone admitted to a psychiatric hospital of this kind. He was admitted for three months suffering from reactive depression. It is true that these cases sometimes demand prolonged therapy. The patient is a public servant earning R598 a month after deductions, with 33 years’ service in the Public Service. His hospital bill now runs to R3 721. How on earth is such a person to pay such an account on such earnings? I wish to ask the hon the Minister whether the State cannot possibly assist such cases. A situation like this is sufficient to plunge such a poor patient back into his condition of depression.

According to my judgment it will also come about that provincial hospitals will fall under the Administration: House of Assembly because we see statistics concerning certain provincial hospitals already reflected in the annual report. I therefore want to draw the hon the Minister’s attention to a certain matter in good time. There are a few categories of illness—including inter alia children with cystic fibrosis—which occur quite seldom. It is a fact that the parents of such children for instance could obtain the medication through provincial hospitals in the Cape Province up to 1 April but this has now fallen away. As the hon the Minister is aware, this genetic communicable disease requires prolonged treatment and may cost the parents of such children anything from R200 to R600 per month because many medical funds exclude benefits for these unfortunate cases of illness. I should like to ask how the hon the Minister feels about reintroducing this benefit; it should occasion no serious burden to State finances.

I further wish to raise a few aspects on social pensions. As from 1 October there is to be a meagre increase of 10% in the social pensions of Whites. In view of an inflation rate of approximately 20% and an increase materialising only in October, this situation becomes untenable to these people. It is difficult to convince our pensioners that in spite of modern computer services it was technically impossible to cause their increase to coincide with all the other increases which became operative on 1 April. If, for example, it was possible for the hon the Minister of Transport Affairs to give his pensioners an increase on 1 April, I really wish to appeal on behalf of our old people that this be considered in future as well.

If we examine the appropriation for disability pensions, we see the hon the Minister has budgeted R57 million for the current financial year and R71,5 million for the next. If we compare this with the appropriation of the House of Representatives, the Minister concerned there has appropriated R95,9 million for disability pensions. If we take the demographic facts of these two population groups into account, I wish to ask the hon the Minister how this is possible. How can he explain it? Surely there must be an explanation for this. Is there possibly a difference in norms of disability between the two different population groups? I should like to hear the hon the Minister’s opinion on this matter.

This hon Minister and his department still have to find their feet amidst the growing pains of its introduction as the annual report said. I wish to express the hope that they will ultimately do so to the advantage of the Whites in South Africa.

Mr Chairman, the hon member for Pietersburg initially told us we had difficulties in interpreting the Constitution. I shall have more to say about this later but I do not think we have any difficulty with this although we do have problems in the practical implementation of those matters concerning and related to own affairs.

You have many problems with …

The hon member for Barberton should really not interfere where health is concerned. [Interjections.] All he knows about medicine is that he has a doctor for a bedfellow. He had better keep to that. [Interjections.]

I shall refer to the question of practical implementation again later. We are prepared to do our share in this regard in the search for the necessary solutions.

Why are there growing pains? It is because matters developed as they did—with the approval of the hon member for Pietersburg as well. Over all the years he occupied NP benches and provision had to be made for Black people’s health services, he never expressed any reservations from his side on the development of a Black section next to a White hospital. At the time he did not oppose the provision of those services.

That has been the case over the years.

Now the hon member is using the case of Medunsa as a good example. Obviously it is splendid if medical facilities can develop in this way but in practice we have to deal with hospitals for various colour groups on one site and that is the matter we are addressing at present.

All mixed up!

Act 110 of 1983 was debated in this Chamber and passed with a two-thirds majority. That also includes the Schedule which is written in very clear language. The fact is that the debate surrounding this matter has been concluded and we have no desire, concealed plan or intention to amend the Constitution in this respect—at least not at present. In discussing own affairs today—in this debate we are discussing health as an own affair—we are not talking about yesterday. Yesterday is gone and we are speaking about today, tomorrow and afterwards.

As I have already said, we did not expect the switch to the new department to be easy. We also expected the attendant pains, as is certainly the case. We shall encounter considerably more of these bottlenecks in future but with officials of the quality we have in the department we are able to counter those problems. My grateful thanks go to all those involved in the transfer mechanism and devising the planning for this, from the Commission for Administration to the most junior official, for the great deal of work they did in this regard and are still doing.

I said it would sometimes be difficult to give substance in practice to the Government’s standpoints of principle as contained in the Constitution and also very clearly set out in the Schedule. Ordinary people have to do this, people with their own ideas and views. Many of them also have their own quirks and whims and everyone thinks he is right. We have to find our way through this to the right answer at the right time. There are even differences of opinion on the legal interpretation of the Constitution.

This is understandable because there are radical differences in this regard even in political circles. On the one hand there are people who say we are reaffirming apartheid and on the other the group which says we are introducing total integration.

Let us revert to the legal interpretation. There are those who consider that if there is even one person of colour in a traditional White institution, it should be classified as a general affair. They therefore judge purely and literally on a legal-technical basis. They have every right to do so and it will not be the first time that a provision in an Act has been interpreted differently. We have numerous examples of this. There are others who read it and understand the clear language. They also read what is contained in the Constitution and are well aware what section 14 comprises; they also read the Schedule and section 16 and therefore know what an own affair is.

I wish to argue that the system of medical care which we regard as the best and wish to expand should be directed at the need of the population groups we wish to serve. If one views the needs of the various groups and communities and analyses them accurately, it is very clear that in applying differentiation we can create an own administration for better service across the entire health spectrum of prevention, cure and rehabilitation.

Let us examine the truth of my statement that communities definitely differ in their needs. There is no time to go into this in detail but I wish to mention a few points. I want to use the case of the Whites as an example. The Whites are a group imbued with very strong community awareness which has benefited from their being of Western culture and almost completely self-sufficient in the sphere of health. This is a very important point. The White knows that pure water, effective sanitation, the removal of refuse and so on are worth more than all the antibiotics available. There is an everincreasing geriatric problem among Whites. As the hon member for Pietersburg pointed out, more genetic problems occur among Whites. I need not tell hon members what problems we encounter regarding nutrition and metabolic diseases manifested in specific illnesses which are limited more to the White group. This means that, if one wishes to address these problems as they deserve, one should do so in that context.

In the same way one can look at the Indians and the Coloureds. Hon members know what problems we are faced with in consequence of the exceptionally high population increase among the Coloureds. For socioeconomic reasons those people are also more exposed to tuberculosis. It is also true that their group awareness is not as strong and that problems of child neglect, alcoholism and so on are great.

It emerges clearly from these few thoughts that needs differ greatly. I believe an own administration within the community context will have better success in acting effectively and furnishing a satisfactory service. Who is better aware of the needs of the Whites regarding medical affairs than the responsible hon Minister sitting with us here? Who is better aware of the needs of the Coloureds than Minister April? Minister April stated it very clearly when discussions were conducted with him on health and welfare matters that he first had to be given the opportunity of addressing the greatest problem in this regard which was the welfare of his people. In other words this is a specific community-orientated effort which we cannot control in the structures we wish to develop to address these matters. That is why I believe the person best able to negotiate will be the one who has a good case and directs it to his hon Minister.

In previous debates there was frequent reference to the matter of fragmentation and the disastrous results it would supposedly of necessity have. In previous debates—I am referring in particular to the debate on the private member’s motion of the hon member for Yeoville—the hon member for Yeoville said inter alia that what arose from the policy of own and general affairs was not practical, that it was “politically unacceptable” and “costly”. He went further and said, “It was always bad, but now it is sophisticated.” I agree with him on the last statement; never have health services been as badly fragmented in any country as in the RSA. Consequently it was a bad system and it is misrepresentation to want to contend that the old system was so wonderful and unfragmented. Let us examine what we were dealing with and I wish to cite only a few examples.

I have been informed that at least 16 institutions had to negotiate with the Treasury annually for funds for health and welfare. Is that not fragmentation? There were four hospital services departments, four tender boards and four code lists from which to work. There were four computer systems to each department and, if those computer systems could have been linked, it would not have been so bad. As a result of totally different computer systems, however, it was not even possible to link them. Does that not represent fragmentation? [Time expired.]

Mr Chairman, the hon member for Rustenburg has touched on a variety of matters, some of which I will return to in the course of my speech.

I want to start with a matter on which the hon the Minister was notably reticent this afternoon, and to which the hon member for Rustenburg referred at the start of his speech. I am referring to the practical application of the Schedule to the Constitution Act insofar as health services are concerned. The hon member for Rustenburg himself made the particular statement that there were problems in the practical implementation of this Schedule.

We are faced with a strange situation. There are Ministers without portfolio in some governments, including our Government, but here we have a Minister with a portfolio, but without a job! He has a few bits and pieces of jobs, but his main job as Minister of Health Services and Welfare was to involve the take-over of White hospitalisation. That is still in the hands of the provinces. He is the Minister of Health Services and Welfare, but the biggest portion of the Health Vote is not included in his portfolio. He has welfare services, yes, and infectious diseases and mental health as well as the care of the disabled etc. We have heard a lot of statistics from the hon the Minister concerning the number of beds and the number of bed days and the number of patients who were treated. I assume those were only White patients.

That was in private hospitals. If the hon member had listened correctly, he would have heard that! [Interjections.]

If the hon the Minister would only speak up one would have some idea of what he was talking about! I am going to deal with private hospitals later, too.

However, I want to ask the hon the Minister what is going to happen when, or if, he is entrusted with the hospitals that are now run by the provinces. Apart from building a new administrative empire—that he will have no problem with because we know this Government’s propensity for building new administrative empires—what is he going to do? He will have no problem building his administrative empire. He will have ample help in that, and ample precedent. When or if he takes over, he is not going to run it with the small number of people who administered it for the provinces, because that will lead to the diminution of his status. That means that he has to build up a new administrative machine—an empire to control. The advance guards are already there in some cases. I hear that they are letting it be known that they are ready for the big take-over. They are also letting it be known that there will be changes made and that people will be shown how hospitals should be run when they take over.

I want to ask the hon the Minister some specific questions as to how he is going to handle the hospitals I know best in my province of Natal. There is one of which I have been a member of the hospital board for 20 or more years, namely Addington Hospital. Addington Hospital caters for Whites and Coloureds. It has a Coloured children’s section. It has specialist units, such as a renal and a cardiac unit, which are open to people of all races. Here we have a hospital, therefore, which because the majority of patients are White, I assume will be classified as an “own affairs” White hospital. Many of the doctors are not White, however. There are Coloured and Indian doctors as well as White doctors. However, it will be a White hospital.

What is going to happen to the administration of the Coloured wards—the Coloured maternity ward and out-patients department? Will there be a different administration there? Is that going to fall under the House of Representatives, because that falls under the category of own affairs: health of the House of Representatives?

The new hospital in Pietermaritzburg is multiracial in that it is open to all races. However, there are two other hospitals there. One deals mainly with Coloured patients and the other mainly with Indian patients, but they are administered by the province as one unit. The visiting specialists who serve those hospitals, serve them both. The hospitals share their services. They have built up a reputation and they attract eager young registrars who want to work in that atmosphere and receive training from these specialist doctors who have long experience and who are highly honoured. Outside Pietermaritzburg and Durban, however, all the other hospitals that are controlled by the province of Natal, with the exception of the Black kwaZulu hospitals such as those at Edendale and Ngwelizane outside Empangeni, are multiracial. They all cater for every race group in their area. They have White, Coloured, Indian and Black patients.

What is the hon the Minister going to do? Is he going to take the “jaws of life” and start dissecting those hospitals, saying that certain wards are to be administered by the House of Delegates and so on, or is he simply going to say that it will be dealt with one an agency basis? On what basis does one decide who will administer the hospital and act as an agent for the others? Will it be the group that has the most patients or the group that has the most doctors or the group that has the medical superintendent? If it falls to the group with the most patients, then in most cases it will not be under the auspices of this hon Minister.

Do you not have a contribution to make?

I do have a contribution to make. [Interjections.] The contribution I am making is supported by the Medical Association of South Africa.

You have made that speech before. [Interjections.]

Yes, I made part of it. It is supported by various other organisations such as a Professor of Maternal and Child Health Care of Natal, the Medical Association, Natal Coastal Branch as well as the Midlands Branch, etc and this is the view of everyone who works with these hospitals. We have gone on for month after month in uncertainty and there is great concern about it there. There is great concern among the people who are employed there. People are saying: “Well, I do not know whether I am going to stay. I am getting out.” I want to tell the hon the Minister that it is time he realised that this sort of “scrambled egg” situation where we are providing services for all races through the same institutions cannot be unscrambled. It cannot be split up and dealt with by three different administrations. The more he does that, the more his administrative empire is going to expand.

The hon member for Pietermaritzburg North simply keeps on shouting: “Apartheid! Apartheid!” I am talking about the practical problems of administration in a situation …

Of apartheid!

Yes, of own affairs, which we accept. We accept in principle that intimate affairs affecting a community should, as far as possible, be dealt with by that community. [Interjections.] The PFP does not accept this principle, in the same way as it does not believe that South Africa should defend itself against ANC terrorists. [Interjections.] We believe in group rights and in group responsibilities. [Time expired.]

Mr Chairman, probably the most important standpoint adopted by the hon member for Durban Point was that they supported the principle of own affairs. I shall not enlarge on the questions he put as the hon the Minister announced that the matters to which he referred were being investigated by a Cabinet Committee at present.

I should like to express a few thoughts on money and welfare organisations. It is true that money must be one of the matters providing welfare organisations with most headaches. It is also definitely one of the subjects on which most profound utterances have been heard. It has been said, for instance, that one’s possession of money does not necessarily ensure one true happiness. Someone added that it was nevertheless worthwhile to find this out for oneself. [Interjections.]

Most welfare organisations nowadays are engaged in a battle to balance their books. P T Barnum once said:

The ability of welfare organisations to function within the limits of a budget and simultaneously to proceed with the extension of services creates a serious bottleneck nowadays. There are also welfare organisations which are hard-pressed at present merely to maintain existing services so it is logical for these institutions to turn to the Government for solutions to these problems.

I think it is also necessary for us to put the opposing standpoint which is that money is not the answer to all problems. The problem of the financing of welfare services demands a totally new approach today, especially concerning the nature of aid programmes furnished as well as the way in which welfare services are undertaken and organised within a specific organisation but also within more extensive community groups. Greater co-operation and co-ordination are required. Rationalisation has become essential within organisations as well as in broader communities.

It is true that these concepts elicit resistance among welfare organisations. They create uncertainty on how these matters will affect their identity. I have sufficient confidence in the leaders’ ability, talents and good intentions to be able to address this problem with expertise and efficiency in the fields of service in which they are active. It has become necessary, however, that they discuss this subject with Government.

I wish to present this case to the hon the Minister this afternoon and say it has become necessary for the Government to take the lead. Consequently I should like to discuss the question of a new norm in the subsidisation of welfare services. I want to stress the seriousness of this matter very strongly. Welfare organisations have been requesting that this matter receive attention for years; over the years their requests have been received sympathetically by the Government and investigated as well. Nevertheless not one of the welfare organisations could succeed in coming up with meaningful, constructive proposals providing any direction so this matter has progressed slowly over the years.

There are institutions which mistakenly think that a new norm will mean more money and larger subsidies for them. This is obviously a misconception. Over the past five years payments to welfare organisations have risen from R32 million to R134 million and all these welfare organisations are requesting more money in spite of this escalation averaging 32% per annum. It appears to be a bottomless pit which can simply never be filled. Consequently we require replanning here in order to achieve an improved application of existing funds. This will demand great co-operation from all organisations because the essence of the aid programme should be revised.

A committee composed of representatives from all the large organisations in the country struggled for two years with a possible new approach in the subsidisation of welfare services. I wish to request the hon the Minister to accord this matter the highest priority. It is clear that it is no mean undertaking; it will demand original thought but I also believe that we can arrive at meaningful answers.

I am also prompted to mention this as aspects of it have already been indicated by means of investigations into this subject. Here I am referring to an investigation by an MA student, Miss Engelbrecht, at the University of Port Elizabeth, who found that a reasonable percentage of the subjects in a random test she conducted had been unable to achieve scholastic success. Consequently the nature of the aid programme has to be adapted to the abilities of the people who are to use it. I therefore retain the view that cheaper programmes are certainly possible for certain groups of people. This will mean that welfare organisations will have to do the necessary surveys together with the Government so that social needs may also be researched according to their incidence on a regional basis.

At present we have structures at our disposal—here I am referring to regional welfare councils—which could be used for this very purpose. I think it would require expert teams with the ability to realise practical objectives to be placed at the disposal of these structures.

I should also like to appeal for greater participation and responsibilities for these regional welfare councils in allocating money made available to them according to priorities and at local level to welfare institutions for special welfare programmes. This should result in welfare organisations planning new undertakings more thoroughly, compiling more incisive reasons for new programmes and the possibility of greater co-ordination at local level.

I think this also opens the way to a re-evaluation of existing programmes which may result in the reallocation of funds for programmes which could be modified. This would also require the approach, however, that specific basic services be identified which should be subsidised by more than 75%. I am referring to basic services which have to continue in order to ensure permanence in a certain programme.

In conclusion, I wish to refer to one more case and thank the hon the Minister for announcing that the revision of subsidies would be examined on a continuous basis. Nevertheless I wish to bring the matter to his attention that, in subsidising a post for a social worker, the maximum amount according to the current formula is reached between the seventh and eighth notches. Subsequently the subsidisation becomes static even if the social worker progresses to the top notch. This also results in the real subsidy ultimately received for such a post amounting to 59% in contrast with the intended 75%. This causes a welfare organisation to have large operating deficits and funds it has to find somewhere.

There is another matter I should like to request the hon the Minister to attend to. There ought to be a regulation or provision as regards advance payments made to welfare organisations on approved posts which fall vacant that this money which is paid as soon as the post falls vacant be placed in a provident fund to ensure that operating shortfalls do not arise later when the payment has to be made.

Mr Chairman, in closing, I think we should express our appreciation for the enthusiasm with which the hon the Minister applies himself to this very great and important matter as well as the zeal he exhibits whenever we approach him on it.

Mr Chairman, it is not often that one female debater follows another in this House. I am pleased therefore to have the opportunity of following the hon member in this debate this afternoon, although the subject which I intend to cover is not the same as the one discussed by her. I hope I will be able to encourage her—persuade, I think, would be a better word—at some stage in her career to see fit to support the cause which I am about to espouse. I say this, Sir, because I have been espousing this cause for many years. The present hon Minister who was Deputy Minister of Health and Welfare—I am sorry the hon the Minister of National Health and Population Development is not here today to hear what I have to say—and of course the hon the Minister’s predecessor who is sitting in his front bench now, should already know what I am alluding to.

Abortion!

What else?

Yes, abortion! Well done! Good guess! I am not talking now about abortion per se but about the law applying to abortion in this country which, I believe, needs review. I say this because, Sir, this law has been on the Statute Book now since 1975—eleven years—and that is a long period in which to consider whether or not a law which has great social consequences is working properly, whether it needs to be amended and whether there are deleterious side effects to the law as it stands.

I have asked in previous years that a commission of inquiry be appointed to investigate this legislation. I have asked for an independent commission of inquiry, headed by a judge and having on it people of both sexes, unlike the commission which recommended the legislation which was passed in this House in 1975. That commission did not have a single woman sitting on it—either when it was a select committee of Parliament—and there were then two female members of Parliament—or when it was converted into a commission of inquiry. I would hope that the commission which I ask for will not only be headed by a judge but will also have women sitting on it who are properly qualified and who will have in their ranks representatives of the medical profession, the nursing profession, the social workers profession, and of course representatives of women’s organisations, and—I presume this goes without saying—that they will be people of all races. There is no point in having just Whites sitting on that commission, as happened previously. Not only were they all male then, but they were also all White.

Sir, I cannot see any objection to the appointment of such a commission, neither can my friend the hon member for Pietermaritzburg North who disagrees with me on the principle of abortion but who nevertheless agrees with me that we should have a commission of inquiry to review the situation. He would then be able to put his point of view to the commission, and I would be able to put my point of view to them. I believe that would be a logical and a very sensible thing to do. Like the hon member, I want to stress that in the PFP we have always considered this not to be a party political issue. As everybody in this House knows, the subject of abortion is a very heated one in practically every country in the world, and in many countries it is considered on a non-party political basis. Indeed, in 1975, when the then Bill was introduced, members of the old United Party also debated the Bill on non-party political lines.

Now, Sir, some of the figures used by the hon member for Pietermaritzburg North are figures I want to use too, although possibly from a different angle. The annual report tells us that there were 32 500 operations for removal of residues of pregnancies during the period 1 November 1984 to 31 October 1985. The hon member for Pietermaritzburg North thinks this is evidence that the Act is working properly. I read it to be evidence to the contrary. I believe many members of the medical profession—and those who do not agree with this are indeed in the minority— will agree that the majority of the operations for the removal of the residues of pregnancies are operations which have been necessitated because of self-induced abortions or because the unfortunate victim has gone to a backstreet abortionist who has in fact inflicted very great harm upon the body of that person.

I think this is evidence that the Act is not working properly. I do not believe these are normal miscarriages we are talking about. We are in the main talking about induced abortions, either self-induced or induced by a backstreet abortionist. This, of course, is but the tip of the iceberg, because if this is the number of women who end up in hospital, there must be thousands more—I will not quote any figure because we do not really know the exact figure—who do not end up in hospital and who manage to recover. What damage is done to them, however, by way of permanent infertility, for instance, has yet to be ascertained.

Are you in favour of abortion on demand?

No, not on demand; on request, and that is rather different. In the end, it has to be the doctor who will decide whether he will perform this operation or not. I believe that like many other countries in the Western World this is the direction which South Africa should consider taking, namely, liberalising our abortion laws.

I am going to give two or three specific examples of cases where I feel this should be done. First of all, abortion should be legalised for girls under the age of 16 who fall pregnant. I want to know how many fathers of daughters—young daughters—among the hon members sitting in this Committee today would countenance their daughter’s continuing with a pregnancy conceived when the girl is under 16 years of age—a schoolgirl, in a gymslip, pregnant! [Interjections.] It is my bet that they would put her on a ’plane and send her overseas for an abortion as quickly as possible. That is what I believe a lot of people do who can afford abortions. Unfortunately, it is always the people who cannot afford this luxury who end up with the unwanted child or at the backstreet abortionist.

I want to tell the Committee, since many hon members were not here in those days, that in 1973 the Bill that came back from the select committee contained a clause which allowed abortion for girls under the age of 16 on the same basis as abortion is allowed in the present Act for pregnancies as a result of rape or incest, that is, legal abortions. The first Bill that came back from the select committee also allowed girls under the age of 16 to have legal abortions. That clause disappeared however, when the select committee became a commission and the commission returned a Bill in 1975 for this House to consider. I moved an amendment at the time. My colleagues in the Progressive Party supported that amendment, and so did some of the members of the United Party. We lost, however; and so girls under the age of 16 are not permitted to have a legal abortion unless their cases fall under one of the other provisos, which are very difficult indeed to meet, as far as legal abortions are concerned.

The other case, of course, is that of a woman who has attempted to have sterilisation—which is legal—or can show that she has attempted contraception. In cases of failed contraception and failed sterilisation, I believe a much more liberal attitude towards abortion should be considered by this Committee.

Thirdly, there is the case of the woman over 40 or the woman who has a large family, and the woman who is a single parent— of whom there are very many in this country—who simply cannot cope. The woman who is a single parent is the wage-earner, and if she falls pregnant and does not wish to have the child, she should be allowed to have an abortion. The unwanted child does not lead an easy life—as all of us in this country who know something about battered babies will bear testimony.

I think we ought to start having a more modern outlook on these issues. I hope nobody is going to tell me I do not understand the mores of South Africa, as I was told year after year when I begged for the repeal of section 16 of the Immorality Act and the Prohibition of Mixed Marriages Act. I was told year after year that I did not understand the mores of South Africa.

You have convinced the Nats so far. [Interjections.]

Now that legislation has been repealed. I hope there are hon members of this Committee who are sufficiently, shall I say, emancipated in their outlook to consider this whole question of abortion so that we can at least have a review of the situation in order to see what is happening. After all, if hon members go to any of the hospitals in this country like Baragwanath Hospital or King Edward Hospital in Durban, they will find that a great deal of time and money is spent on treating cases of self-induced abortion or abortions that have been the heinous work of backstreet abortionists.

What about the religious argument?

I am not suggesting that abortion be made compulsory. That is my answer to the religious argument. [Time expired.]

Mr Chairman, I have the greatest sympathy with women who suffer because of unwanted pregnancies whether they be young girls or otherwise. I have seen many of those cases in my own practice for more than 20 years. However, I do not think the answer lies in unduly liberalising those laws. I will make an agreement with the hon member. The moment she has succeeded in convincing all the hon members of the PFP and converting them to her opinion I will welcome her with open arms and we will take the matter further. [Interjections.]

*There is an anecdote going around concerning ex-Minister Ben Schoeman at the time that he was the Leader of the House and a senior Minister. One weekend one of the younger Ministers spoke out of turn and made certain allegations Minister Schoeman did not like. As he is still alive, I shall not mention the young Minister’s name but I wish to add immediately that it was not the hon the Minister of Foreign Affairs. The following Monday Minister Schoeman called him in and asked him what on earth he had said that weekend. He replied that he had only given his personal opinion, upon which Minister Schoeman said he was a Minister and therefore no longer had a personal opinion.

I now wish to make the somewhat debatable assumption that, as I am not a Minister, I am still entitled to a personal opinion. [Interjections.]

I have a few comments today on the privatisation of medical services and more particularly of private hospitals. As this is actually not a party-political affair, I wish to express my personal opinion on some matters.

Remember what happened to Pik.

I think I shall talk to the hon member for Houghton again because there are certainly cases in which people would perhaps have been better off if they were not in this Committee. [Interjections.]

The first point of personal opinion I wish to make concerns the role the medical practitioner and paramedics in the private sector should and can play in the privatisation process. Last week we participated in a debate on agriculture and the farmers were in full cry—the hon the Minister and all the other farmers. They spoke on farmers and farmers’ interests.

What interests do farmers have in co-operatives and what role do they play in them? In South Africa the situation unfortunately exists that as soon as a doctor becomes involved in medical services—here I am referring to the private sector, to private interests and inter alia to making money—it suddenly becomes unethical and terribly evil. I want to say that I do not agree with that view at all, knowing full well my standpoint is controversial and all my hon colleagues do not agree with me.

I want to refer hon members to the so-called Dan de Villiers Report of years ago. That report found that when medical practitioners were involved at private hospitals, when they therefore served as directors or were shareholders, those hospitals were operated better, more cheaply and humanely. Do hon members know what the recommendation of that commission was? It recommended that doctors should not be involved in this.

The subject then arose that private hospitals should be phased out. The hon the Minister of Communications and the hon the Minister of Health Services and Welfare will recall that they were involved in this and also the late Dr Nak van der Merwe, the chairman of our study group at the time. The point I made then will also be remembered.

I now want to make yet another slightly debatable assumption. If something happened a little more than 10 years ago, I think one may gradually start talking about it again. I am referring to something which occurred a little more than 10 years ago. At the time I adopted the standpoint in the study group that the story of the phasing out of private hospitals was utter nonsense. I must say the hon the Minister of Communications gave me sterling support on that occasion. He comes from the Cape and they had a better policy than those in the Transvaal.

I want to state that doctors should actually be more involved. I have read papers and listened to discussions of the private sector on the subject of private hospitals. I have seen them come up with fine economic principles which are right and proper. They say there should be more open competition and a patient should have the right to go to a hospital where he can receive the best and cheapest treatment. These are sound financial and economic principles but my standpoint is that, as soon as one removes the medical practitioner and the nurse from the matter, one decreases the humane factor which is then no longer present there. I feel that is precisely where we should be involved—I am involved in this—to retain the humane factor among other aspects.

There are many more reasons for this. I think there is no reason why a doctor as a citizen of the country should not have the same right to compete in the financial sphere.

I want to touch upon another matter and request the State to be so good as to adopt the attitude in the privatisation process that the smaller entrepreneur and smaller hospitals, perhaps in country districts, be protected and advanced to some degree. If there has to be a monopoly, we have said it should preferably be a State monopoly. We should not create monopolies in this sphere as well. We have to protect the smaller entrepreneur.

I want to state as a fact that the private sector is capable of furnishing the same or a better service at a lower cost per unit. The hon member for Middelburg also referred to this in mentioning Smith, Mitchell and others. This is simply a fact. I do not have the time to cite many examples but I wish to refer to one.

†The Harrow Centre outside London was founded by a group of doctors who were contracted out of the National Health Scheme. They supply full general practitioner care—the so-called GPC—to their patients at a cost that is well below that of the NHS.

*I could mention many other examples to the Committee. I want to state that the private sector could furnish a better service at a lower cost.

We have to remove the enormous bluff existing at the moment from the situation. A patient goes to a provincial hospital and pays R100 a day for instance. At a private hospital he pays R200 a day for example. He then says he has paid twice as much at the private hospital than at the provincial hospital but this is not true. It has cost the provincial hospital R300 or R400 of State money which comes from our pockets so there is a bluff or an illusion.

I do not want to involve the hon the Minister of Transport Affairs in this but certain services such as dispensary services for Railway personnel are also a bluff. Railway patients supposedly receive cheap treatment and cheap medicine but who pays for this? How does this work? I think we should take the illusion out of this matter. We are going to have difficulty in selling private hospitals to people if we do not expose this bluff now.

We save R20 million!

The hon the Minister does not save that money—it is taken out of our pockets. [Interjections.] I am a good Nationalist and a good party supporter and I said I would sometimes express my personal opinion today but I do not wish to cross swords with that hon Minister.

Mr Chairman, I want a turn to speak! I want to trounce him! [Interjections.]

The hon the Minister of Health Services and Welfare stated a point of principle in his opening speech and I think he summarised it beautifully. If I took it down correctly, he said the basic approach was a simple one, that of a smaller role for the State and a greater role for private initiative which in its turn would lead to a smaller Government sector, lower taxation and higher employment. I agree with that entirely; I think the hon the Minister gave us a fine summary.

If we are not to expose the bluff, however, and a man therefore has to pay more at a private hospital without paying less tax, we are going to be in trouble. We shall then cripple our people if they have to pay more at a private hospital while we continue milking them for taxes as we are doing at present. Our policy will not succeed in such a case.

I concede that the hon the Minister said he would not extend the involvement—this is stated in my own words—unless he were compelled to it by the private sector and so on. Yet I am a little concerned because the hon the Minister also stated that the State would retain its involvement. I think it would be more desirable for the State to scale down its involvement than to retain it.

I now wish to summarise my standpoint. We should scale down and reduce State involvement. We should remove the illusion from existing so-called cheap medical services. The private sector has to be able to furnish these more cheaply. Finally, we should market it correctly otherwise this affair will boomerang again like the salaries of Members of Parliament.

Mr Chairman, I do not wish to quarrel with the doctors about their opinions on health services but I want to tell the hon member Dr Venter I agree with her that money will become very scarce. Welfare services for which payment has to be made have recently been providing us with many problems.

The greatest act in welfare must surely be to help a person and to inspire him to help himself and so experience the joy of achieving something for himself. We can definitely contribute greatly there.

I want to tell the hon member for Houghton that this party is absolutely opposed to abortion; it is against our Christian principles and we will never support it.

Did you hear that, Helen?

[Inaudible.]

The most precious possession one could ever desire is one’s health. It cannot be purchased with money or treasure; it is a wonderful gift which only God the Creator can bestow on one. As the gift of health is so important to a person, one should look after it and protect it will all one’s resources.

Many people lose this treasure in consequence of negligence and dependence on harmful habits which not only erode physical health but also that of the mind. A sound body supports a sound mind and vice versa. If the mind is sound, the body will probably be also attempt to adapt accordingly.

Other people lose their health through factors beyond their control and still others are broken reeds at birth.

Mental and physical health is the core of every person’s being. It determines his point of view and also his extrovert actions; his views and conduct determine how he will react to outside influences and other people; it also determines his behaviour and lifestyle.

This is why the medical world with all its various branches fulfils an extremely important role, not only in the life of every individual but also in community life to the furthest corners of the earth.

I wish to make an exception and illustrate one of the pillars on which the medical world rests—nursing. Because nursing was purely a religious action for many centuries, it developed with Christianity and later even took place on an organised basis on world battlefields.

The first school for nursing was established in 1860 by Florence Nightingale because she felt nursing should become a profession and therefore conducted on an organised basis through well-planned courses and instruction.

In consequence, nursing is the same throughout the world because the needs of all sick people and of all health services are the same throughout the world. The distress and needs of sick people are of such a nature that they demand charity, discipline and knowledge. This knowledge can only be acquired by means of very good, thorough training. That is why the nurse of today is a well-trained person. There are three essentials for nursing. Professional nursing was established under the threefold influence of religion, military requirements of the time and science. It is a discipline with divergent demands.

One can also understand why the profession of nursing is carried on chiefly by women. Precisely because she is a woman, a nurse is suited to this profession as she possesses all the characteristics par excellence so essential to bring to nursing the success that the career deserves. Her pleasant smile and white uniform give life and significance to long hospital corridors, wards, operating theatres, medicinal smells, disinfectants and, last but not least, theatres. This is very important. Her image exudes confidence so that the child feels secure, the sick person feels relief from pain at her hands and the aged permits himself to be cared for and nursed. She provides comfort and support to relatives of a patient who is seriously ill or deceased. They also expect it from her.

She is the one who copes with the care of the unborn baby until he gives his first cry. She looks after him throughout his life until at the end she closes his eyes as a final service to him.

I wish to remark, however, that a nurse’s day holds a great deal of hard work. There are difficult incidents and problem cases but she is sometimes also a part of the joy and delight at a new life or the recovery of a patient. We do not even mention her tired body and aching feet as she reaches the end of her daily work. She often has to suppress her own heartache and domestic problems and merely proceed with her duty until she may find a moment to set aside for her own heartache or sorrow. Such a time may not occur while she is on duty because her attention and loyalty are demanded elsewhere.

A nurse not only fulfils an important role at a hospital. One need only think of all the nurses in the consulting rooms of doctors, dentists, psychologists and institutions supplying health services such as municipalities, etc. We should very much like to pay tribute here to nurses and acknowledge that they could never be paid in rands and cents for the great work they do.

This brings me to a further group which may not have had training but learned through practical experience and sometimes hard lessons—yet they are indispensable. We find one in every home in the country— the voluntary, unpaid nurse. She gives life, sustains that life and prepares it as well. As a childminder she has to kiss away tears and apply ointment to stubbed toes.

In many cases it is the servant. [Interjections.]

She is the comforter and the homemaker to husband and children; the dietician who has to provide nutritious food and the laundress supplying clean, hygienic clothes and bedding for every family. She also has to see to Father’s aching feet, his breaking back, his rheumatism and sometimes his fads and fancies as well. She has to be sympathetic. She is also the comforter when disappointments strike her family; she is the quiet participant in all their successes as well. She is the one who knows that the shortest road to heaven to entrust her family to a loving Keeper is just any place where she may fall to her knees at any time with any request.

Mr Chairman, it is a pleasure to follow on after the hon member for Germiston District, more generally and affectionately known to us as Tant Bessie. But I do just want to tell her that we do not entirely support her views on abortion in the sense that we are not totally opposed to it. There surely are certain circumstances—we have entrenched this in the legislation—under which we think that abortion should in fact be allowed. We also want to tell her that we share her feeling and praise for the nursing profession. We on this side of the Committee have also said so in the past.

I just want to tell the hon member for Houghton that she should ask the hon member for Pietermaritzburg North, who sits behind her, whether he shares her views on these liberal abortion laws. He can tell her in private whether he shares her opinion.

Today I want to return to a matter which I have raised in the House before, and this concerns a group of Whites who, medically speaking, I want to describe as being in a “grey world”. They are the people who fall just outside the means test limit and therefore do not qualify for social pensions. They are the people who receive a few rand out of pension funds or incomes which fall just above the means test limit which excludes them from receiving social pensions.

Social pensioners can visit either the provincial hospitals, or the district surgeon or clinics if they live too far away from provincial hospitals. In contrast to this the people who at present receive R120 to R220 per month and who receive their pensions out of a private fund, are in a worse position, particularly if they live far away from provincial hospitals. These people are dependent on private transport to get to hospitals for medical treatment, and it is precisely here that problems arise.

Financially some of those elderly people are simply not in a position to hire a taxi at R20 or R30, for example, to take them to the hospitals. The problem becomes even greater if one bears in mind that they still have to return to their homes.

A practical example of this is to be found in both towns in my constituency, Orkney and Stilfontein, where there is a reasonable number of older inhabitants. Financially they are simply not in a position to hire taxis to take them to the provincial hospital in Klerksdorp. Such a trip would cost R15 or R20. They cannot consult private practitioners either, because the cost of the consultation plus the medication is just simply financially beyond their reach. They do not have the wherewithal to do so.

The result is that they do not always receive the medical treatment they need. They then simply try to cure themselves and overcome their problems by taking a few pills, and this sometimes has tragic results.

Allow me immediately to express my thanks to those who offer wonderful assistance to these people, I am referring to certain individuals and voluntary organisations. These people do succeed in taking a number of the older residents to the hospitals and clinics, but their ability to do so is also restricted.

Now hon members may ask me what the solution is. First of all we always say we are very sorry for older people in that situation but that we unfortunately can do nothing further because they are not registered social pensioners. We say we have tremendous empathy with them, but that is where it ends. I am afraid that it just is not satisfactory any more to say that we feel sorry for them and that we pity them and that we understand their problems. That alone does not solve our problems.

I therefore want to call upon the hon the Minister today to initiate an urgent investigation into the possibility of allowing all people—that is women older than 60 and men older than 65, which is the age at which they qualify for social pensions—to visit the local district surgeon and/or the local clinic in areas where there is no provincial hospital in the town. We could very easily use their identity documents to determine their age.

Before we gasp at the terrible burden we would cause to fall upon the State’s shoulders, we should rather analyse the matter a little further. First of all, it will be found that not all women older than 60 and not all men older than 65 will now suddenly go to the clinics or the district surgeon. I say this because there is an ever-increasing number of people who, as ongoing members of medical funds have their own private cover. We may as well admit that these people would much rather make use of their own doctors than go to the district surgeon or the municipal clinics, because of the time they have to spend waiting at those places.

I once again refer to my own constituency. By far the most pensioners are ongoing members of the medical aids of the mines, and they have only the best medical services available to them. They would therefore not use such benefits. This also applies to many other towns.

But let us now look at the financial implications if we were in fact to take such an approach in the future. Every person who falls just above the means test limit for social pensions, can, where there is a provincial hospital go to that hospital, and apart from the examination also obtain medication for a standard fee. There is no reason why we cannot give the same benefits to those who live far from provincial hospitals. As I have said there are not many of them.

We should at least also not be so insensitive to say that such people’s children or friends should take them to provincial hospitals. We after all know that it is practically impossible for someone to leave early in the morning and then still to wait for a few hours with the elderly people at such a hospital. It is simply practically impossible.

Why could we not then ask the district surgeon or the clinic sister to charge the same fee as the hospital? Then there would be no cost to the State as such as far as the payment is concerned. Besides, it would not be the district surgeon who would have to do it. It would be the receptionist, seeing as virtually all the district surgeons in the rural areas have a part-time private practice where there are receptionists.

The older person could obtain a consultation as well as medication at the same cost there, even if that has to take place on an agreed basis with local pharmacists. The pharmacists can, for example, send the State an invoice for the cost price of the medicine. The pensioners could then pay in a certain percentage of the amount, if necessary. I think we are just shying away from the little bit of additional administrative workload that would accompany this.

In my opinion an urgent investigation into this “grey” medical area is essential, particularly because it would not cost the State much, and above all because we have a duty to try and help these elderly people. They are not asking us to make these medical services available to them free of charge. They only ask for the same kind of treatment as is received by those who are close to provincial hospitals. We cannot leave the responsibility in the hands of private individuals and organisations any longer. Our elderly people are too valuable to us and we owe them too much for what they, as younger citizens, did for us.

It would cost us taxpayers a very small additional amount to make these services available. I personally feel that taking into account the small amount of money and the number of people involved, we certainly could have an investigation carried out into this problem and this bottleneck.

Mr Chairman, I should like to support the plea of the hon member for Stilfontein regarding those pensioners who fall just outside the limits of social pensions and benefits. I am thinking particularly of those civil pensioners who fall into that category because I know that they have a particular problem in this regard.

I should like to turn away from social pensions, however, and consider the whole matter of social welfare policy. In his introduction today the hon the Minister indicated that his department operated under section 14(1) of the Constitution Act, which defines certain matters as own affairs. I should like to focus on the social welfare policy as an own affair and to refer to the document from which I quoted the other day during the debate on the National Health Vote, namely the report of an investigation into the present welfare policy of the Republic of South Africa.

As I indicated then, and as the hon the Minister insisted on explaining to me again, it is a draft document. I am well aware of that. I asked this hon Minister by way of a question whether the report had been submitted to his department for comment and his reply was “yes”. I also asked whether his department had commented on the separate organisations for the various race groups proposed in the report. The hon the Minister’s reply was:

I want to quote particularly from page 9 of the report which concerns voluntary welfare organisations:

I do not know who sets that policy—

The point I am trying to put across to the hon the Minister is that there is a very great distinction between what the Constitution obliges his department to do and what voluntary welfare organisations may do. They are like chalk and cheese. There is no stipulation in the Constitution to the effect that welfare organisations must be racially separate; neither is there any provision in the Constitution which determines that teacher organisations of educational bodies outside the State sector must be separate. I want to make this point very clearly because it affects the hon the Minister’s and his department’s handling of volunteer welfare organisations.

It also links up with the point made a little earlier by the hon member for Pietersburg regarding organisations which feel that they constitute and should constitute non-racial organisations. They have the perfect right to do so. There is nothing in the Constitution to prevent them from forming such organisations. The organisations of such volunteer welfare bodies is supported by the Social Workers’ Association of South Africa which is also a non-racial body and which rejects all the aspects of this report which are based on separate population group representation.

Therefore, I believe it is very important that, as far as social welfare is concerned, we should separate in our minds the legal obligations of Act 110 of 1983, the Constitution, and what a volunteer organisation may do. I trust that the hon the Minister will draw this distinction quite clearly.

I should like now to turn to the aspect of child care under social welfare. I want to pose certain questions to the hon the Minister. I should like to know from the hon the Minister what has happened to the Child Care Act, No 74 of 1983 because, as far as I have been able to gather, Act 33 of 1960, the preceding Act, is still in force. No regulations have been promulgated under the new Child Care Act, and this impinges very greatly on the issue on which I should now like to focus, namely that of places of safety.

A year ago, in the debate on this Vote, I pointed out that we had certain problems regarding the place of safety in Pinetown. The hon the Minister and I had been corresponding on the matter. He responded to me indicating that certain changes had been made. I am pleased to say that they were good changes. However, I do not think they have actually solved all the problems.

In reply to a question I put to the hon the Minister, he said on 17 May 1985 (Hansard, col 5745):

The hon the Minister will know which three groups these are—

I accept the goodwill and perhaps the good intentions of the hon the Minister but I want to warn that the question of places of safety and children in care in institutions of the State is a minefield. It is a minefield politically but, far more important, it is a minefield because it impinges on the conscience of our nation. I should just like to quote some examples in this regard. I quote from the Sunday Star of 18 August last year: “The place of safety was a cross between a prison and a poorhouse”. It is a fairly scathing article of the conditions found.

I quote this merely as an indication of what this minefield could be. Rapport also poses penetrating questions under the heading: “Suid-Afrika se verwerpte kinders”. [Interjections.]

You can never trust Rapport. [Interjections.]

I acknowledge that this was particularly referring to “nywer-heidskole”.

[Inaudible.]

Hold on; I want to pursue the point further, because I have not attacked the hon the Minister. I have said that he has made improvements in places of safety. All I am trying to say is that institutions of the State in which children find themselves are minefields—schools of industry and other places of safety.

The reason why I have mentioned the Child Care Act, 74 of 1983 is because it proposed certain things should be done regarding both places of safety and schools of industry—as did the Children’s Act, 33 of 1960, which also handles places of safety and schools of industry.

I have a particular problem and it may be because I do not know the long history of why we should divide places of safety and reform schools from schools of industry. What I am trying to say is that there are aspects which the hon the Minister needs to look at very carefully, and I trust, regarding the kinds of things he indicated in his speech to me last year, such as a lack of money in order to carry out certain things, will change. I hope he gets that money because he needs it urgently.

I also want to refer to his reply to me on 25 February, regarding the recommendations of the De Meyer Committee of Enquiry into Certain Aspects of Child Care. It is interesting that the report also refers to these recommendations in a section which deals with a conference on comprehensive social welfare services. On page 23 the report emphasises the recommendations of the De Meyer Committee of Enquiry into Certain Aspects of Child Care relating to the department’s places of safety. When we examine those recommendations—and this is what I was asking the hon the Minister earlier this year—we find that there are a number of them which have not been implemented. I do not think it is for want of trying; I must make that quite clear. I do not think it is for want of trying, but what we have earnestly then got to direct, not to this hon the Minister but to the hon the Minister of Finance is a request that he has to make money available. I cannot overemphasise the dynamite that these places represent if they are not effectively controlled.

Here I acknowledge to the hon the Minister of Health Services and Welfare that his colleague, the hon the Minister of Education and Culture, had this explosive situation last year in the schools of industry and he reacted almost immediately. He set up the Van Loggerenberg-Nel Committee. It investigated the situation and it made certain recommendations, and I am glad to see that according to the Gazette of 9 May certain of those recommendations have been implemented—certain schools have been closed, girls have been shifted and so forth. Therefore, what I am saying is if the hon the Minister is going to hold up the recommendations of the De Meyer committee of inquiry as good recommendations—and I believe they are—then he must implement them. He must really get on with implementing them.

Similarly, I think the whole question of schools of industry, probation services— which I want to mention as well—and places of safety needs to be examined by the hon the Minister and his colleague, the hon the Minister of Education and Culture, because I do not believe it is doing child care in South Africa any good at all to divide these services between two Ministers. I think we do need to look at this, particularly as areas of the hon the Minister of Education and Culture’s responsibility for children who are disabled will in fact be going to the provincial services. It appears only logical to me that that is exactly the time when the hon the Minister of Health Services and Welfare should take over schools of industry and matters like that.

Order! I regret to inform the hon member that his time has expired.

Mr Chairman, I merely rise to give the hon member an opportunity to complete his speech.

The hon member may proceed.

I thank the hon Whip for that, Mr Chairman.

I should like to turn to crèches and the hon the Minister’s responsibility for the registration of crèches. There are, as mentioned in the report, 1 108 registered crèches, and there are 66 578 children in those crèches. There is considerable debate on the whole question of the registration of those crèches and on the devolved function at second-and third-tier government for the registration of those crèches. As the hon the Minister is no doubt aware, there are bylaws at local authority level regarding crèches and other places which undertake the care of the children. I think this is another area where the hon the Minister has to explain to us how he is going to take over the second-tier functions of the recognition of the by-laws of local authorities concerning crèches.

I want to add to that, however. The registration of crèches and the requirements for such registration are physical needs, namely space, health norms, and the like. I believe there is a need for this hon Minister and his department to consult the Department of Education and Culture once again to look at the educative functions of pre-school institutions. I think this area needs to be examined very critically.

I turn now to social workers. I would like to support the plea of the hon member Dr Venter regarding the salaries of social workers. It seems to me fairly scandalous that we can, on the one hand, provide full funding in respect of pre-primary teachers—the department pays the teachers’ salaries in full even if they do not pay for anything else in the school—while salaries of social workers are calculated on a rather extraordinary formula. The length of the salary scale is averaged, a bonus is added, and the result is multiplied by 75%. So the social workers in fact receive three quarters of an average. As the hon member Dr Venter pointed out, it does not help the social workers to improve their qualifications or to do better in their work because the organisation is still going to get that average salary. I do believe that this is another instance where money from the State—here the hon member Dr Venter and I differ—is like dung, like manure: One spreads it around and then things grow.

It does not smell! [Interjections.]

So we need to be very careful regarding the salaries of social workers.

Related to this issue—it is not directly the responsibility of this hon Minister but it does have something to do with those of his hon colleagues who are in the Cabinet, particularly those concerned with health and welfare matters—is the whole question of racially disparate subsidies. I cannot believe that any single hon member of this NP Government can stand up and justify the payment of subsidies on a racially devisive basis. Look at grants to foster homes, for example. How the payment can be R120 for a White child that has been fostered, R85 for a Coloured child that has been fostered, and R48 for a Black child that has been fostered I fail to understand this because what it actually means is that the Government is putting a price on the life of the child. That is absolute nonsense and should be one of the first things that this Government must pay attention to.

I turn now to a problem relating to the whole question of the custody of children and child abduction. The hon the Minister and his department may wish to give this issue attention at greater length, but it relates to a problem we see fairly frequently in the press, namely, the problem of parents who become divorced or separated and then one of them takes his or her child or children and flees to another country. This question of child abduction is a complicated one. I have taken it up with the Department of Foreign Affairs, and they have indicated to me that they will pass it on to the hon the Minister’s department.

I should, however, like to refer to The Hague Convention on Civil Aspects of International Child Abduction. The British Parliament agreed to this in terms of the Child Abduction and Custody Act, 1985. I think this hon Minister and his hon colleagues should look at this question. I do believe that South Africa could agree to this international convention. This is, after all, an extremely emotive issue, and a great deal of anguish is suffered by the parent who does enjoy custody at the hands of the parent who does not enjoy custody and who flees to another country with the child. [Interjections.]

The hon the Minister has made mention of the Year of the Disabled. I should like to do so too. I am also very pleased that he has made mention of the fact that he has addressed Mr Speaker on the subject of having Parliament made accessible to, for example, people in wheelchairs. What I should like to ask this hon Minister is whether he has made any comment to his colleagues in the Cabinet on the building regulations which appeared in September 1985 as Norms and Standards for Accessibility to Buildings for Disabled Persons. The problem I have, Sir, is that the Government is great at having this Year of the Disabled, and yet those building regulations are not made compulsory. They are optional. People need not put those building regulations into effect in order to provide accessibility. If at least we could get the Government to agree that in future all Government buildings would be made accessible—in other words that the Government would adhere to those building regulations— it would be a step in the right direction.

I come now to the final issue to which I want to address myself. I am pleased to see the hon the Minister increased his spending on social relief, as he needed to do, from R30 000 the year before last to R2,3 million last year. I am delighted because I do believe it is necessary. I do, however, merely want to pose a difficulty that has arisen. Someone who is destitute, who has nothing except the house that happens to be his fixed asset, and who applies for social relief, is turned down. He cannot receive social relief. I believe this is a problem which needs to be addressed because there is no way in the current market situation in which anybody can dispose of a house and get the money immediately. These people need to be considered.

Mr Chairman, the hon member for Pinetown will pardon me if I do not react to his speech. Nor do I wish to be drawn into the debate on the question of whether health services should be a general or an own affair. I would rather leave it in the capable hands of the hon the Minister.

It is true that care for the aged is a matter which is receiving intensive attention in all Western countries. The Government’s programme with respect to care for the aged is approached as follows. In the first place it includes services in the community, special accommodation and institutional care. For the infirm aged the only solution at present is considered to be institutional care. Because of the astronomical costs involved in institutional care, and because it is a traumatic experience for the individual, there is a move away from long-term institutional care. The shift in emphasis now tends to be towards regular evaluation and rehabilitation. Doctors acknowledge the lack of sufficient numbers of trained geriatic practitioners, and at the moment there is in the medical field an increasing awareness of contraindications owing to the increasing use that is being made of unsuitable medications which are still being freely prescribed for use by aged. It is recommended by experts that as few medications as possible—especially tranquillisers—be administered to the aged.

There is still a need for the establishment of evaluation units for the aged at provincial hospitals, as well as at satellite clinics with evaluation teams to operate in the rural areas. Effective evaluation brings about immediate, purposeful and successful treatment and is therefore cost-effective. At present it is being recommended that only exceptionally infirm aged ought to be allowed admission to existing homes. The approach is therefore still aimed at rehabilitation. In future serious thought will have to be given to the care of exceptionally infirm aged in long-term care wards as extensions of provincial hospitals, and some members have already referred to that. This provision will bring about that medical practitioners will experience a wider and more intensive involvement, and will consequently be able to promote the aims of the gerontological association. Therefore it is imperative that we display a new approach to this matter, and that we plan according to the changing requirements of our time.

The architect is the point of departure as far as accommodation is concerned. Consideration will have to be given to accessibility, supporting facilities and the location of houses and recreational facilities. Planning will have to apply up to the 90th year and not merely the 65th year. With healthy eating habits, a healthy way of life and good mental health these people should be able to live comfortably and self-sufficiently within their respective communities. We shall have to expand this approach. We shall have to change the attitude of the community towards the aged and their place in the community for socio-economic reasons and also because of the human dignity of the individual. In this regard we should keep to the biblical maximum of:

The aged, a father or a mother, are precious luxuries. The English authoress Angela Finckle said that one should never cut down on luxuries. I wish to state that the aged of South Africa are luxuries that which ought to be cared for as such. [Interjections.]

The hon the Minister is well acquainted with the representations which have been made to him recently, in which other colleagues of mine and I were involved. Today I should like to make the statement that the State simply does not have the necessary financial and other means to maintain care for the aged in the RSA on a healthy and satisfactory level. That is why it is now imperative for the private sector to accept joint responsibility for the care of our aged. In this regard I associate myself with other hon members, including the hon member for Middelburg, the chairman of the group.

There are a few obstacles which stand in the way of this goal. In order to illustrate this to hon members I wish to inform them about the problems that we are struggling with in practice. In Port Elizabeth there is a group of private developers who are prepared to build 900 dwelling units from their own funds, which would provide accommodation for 900 to 1 300 aged. It would be an economic shot in the arm of approximately R27 million for our city. It would also mean more than 450 new job opportunities.

The developers are prepared to do this and would make their money through the sale or letting of those 900 units. The sale price is estimated to be approximately R29 500 to R30 000 per unit. The project would therefore meet a wide range of needs. Furthermore the developers are prepared to grant the necessary land to the organisation which will deal with the administration. The one obstacle is, however, the construction and maintenance of the institution for the care of infirm aged. In order to do this, the following must take place:

Firstly a church society or similar institution will have to apply in full, according to the necessary provisions. The hon the Minister knows that in this case it is the Full Gospel Church of God.

Secondly the Department of Health Services and Welfare must then consider the application since it has to provide the funds for maintenance.

In the third place a loan must be obtained from the State. In this case it amounts to slightly more than R2 million. In the normal course of events the Municipality of Port Elizabeth guarantees the amount and registers a bond in its favour on the property. The party making the application, repays the loan over the usual period. In this case it will consist of an institution and 24 units providing 76 aged people with accommodation.

What is happening now, is that the project cannot be approved since similar welfare projects have already been approved in Port Elizabeth. Because I have little time at my disposal I shall not refer to this matter any further, but the hon the Minister knows of five or six enterprises whose applications have already been approved.

I completely understand the problem of the hon the Minister and the reason why he cannot approve the application of the Full Gospel Church. The problem is what will the hon the Minister tell the other societies or enterprises that have already received permission and approval. I fully understand his problem.

I am also very grateful to be able to say that the hon the Minister also understands my problem completely. My problem is that I want that plus-minus R30 million development for my city. I wish to see job opportunities created and above all the elderly people there to be provided with reasonable accommodation. There is a great need for and shortage of such accommodation in Port Elizabeth. It would be a tragic day for South Africa in general and Port Elizabeth in particular if the authorities allow projects such as this which offer a solution to this tremendous problem in future, to miscarry as a result of competition and rivalry between church groups and organisations.

I therefore wish to make an urgent appeal to the hon the Minister if possible to convene the parties involved without delay and make a suitable arrangement in order to bring this extremely important project for Port Elizabeth and our aged into existence. Furthermore I wish to ask the hon the Minister please to approve the project in principle in order to ensure that the entrepreneurs do not lose interest and take the capital out of our city. Most of the methods and procedures which were acceptable and adequate in the past are simply not practical any more.

In conclusion I should like to turn to a matter which is of deep concern to me and discuss it with the hon the Minister. I am referring to the Aurora Centre for handicapped children which is situated at No 3 Seventh Avenue, Newton Park. The centre was established in 1978 and follows a programme similar to that of a kindergarten, but it is adapted to the individual requirements of each child. The centre accepts handicapped children with an IQ lower than 30, which is not suitable for admission to other centres. The largest percentage of the children at the centre are handicapped by a moderate to a severe degree of mental retardation, while many others are physically handicapped.

Despite their physical and mental limitations these children thrive on love, warmth and a feeling of security. They need every possible opportunity to discover and get to know their world in order to develop their personalities and potential to the full. These children deserve a special place in our lives. I have presented a complete memorandum on the Aurora Centre to the various hon Ministers, including the hon the Minister of Health Services and Welfare.

Finally I should merely like to emphasise a point and ask the hon the Minister whether he cannot help us with it. The subsidy that is being paid, amounts to R3 per day per child for untrainable children up to the age of 18 years. If the care centre provides transport for the children it amounts to an additional R1 per child per day. This is completely inadequate and I should like to ask for additional assistance in this regard. The subsidy is paid according to a quota system which means that not all the handicapped children can be subsidised in a particular centre.

For the construction of housing for the seriously mentally retarded a State loan is granted which is repayable at an interest rate of 1%. For the construction of sheltered workshops for persons with IQ’s above 30 the project as a whole is subsidised by 95%. I would very much like to request that in the case of donations, they be deducted from income tax. [Time expired.]

Mr Chairman, I gladly follow on the hon member for Newton Park. I believe that the matters which he advocated have reached the ear of the hon the Minister.

This afternoon a few things were said in the debate to which I wish to reply. In the first place the hon member for Durban Point referred to the hon the Minister and said he did not think the hon the Minister had very much to do. Immediately afterwards he said that a large empire was going to be built up by the hon the Minister when the provincial councils disappeared. One cannot help wondering which complaint was valid.

The words which struck me the most were in fact those of the hon member for Pietersburg. He made a plea for each group to be allowed to deal with its own health services. I should now like to know from him whether he has the same view about sanitary services. Must each population group in each city or town take care of its own sanitary services and sweep its own streets? [Interjections.] These are interesting matters which one would like to take a look at and discuss with the hon members of the right wing. [Interjections.] One would also like to ask them whether they support that view as far as private hospitals are concerned. [Interjections.] Would they accept a Coloured male nurse or nurse in a private hospital? [Interjections.] It does not seem to me as if the hon member is going to reply to that.

That was the reaction one received from that hon member. There was also reaction from the hon member for Germiston District. She referred eloquently to the white uniform and the noble person who serves in that uniform. I agree with her on that score.

Mr Chairman, is it the hon member’s party’s standpoint that there ought to be racially mixed hospitals?

The party’s standpoint! [Interjections.]

I asked the hon member a question and now he replies with another question.

Of course!

That is a genuine question, but yours is just speculation.

I wish to debate with him the question of whether he accepts such people when they are doing nursing work. All of us on this side accept them, because nursing is a noble profession. My next question deals with the same subject. Will he accept them in private hospitals?

[Inaudible.]

Will you accept them in a State hospital?

The hon member for Pietersburg will not accept them, but if such a person is dressed in a factory worker’s clothes, the hon member accepts him as part of the community life in which he has existed all these years.

[Inaudible.]

He also accepted them in that way while he was sitting on this side of the Committee. These are the interesting things which one noticed in this debate. I wanted to single out a few of these matters …

You are skating on thin ice!

… because one must debate them, for at election time those hon members always say something else.

You are a bunch of stealthy reformers!

The things which the hon member has just raised, are exactly the kind of things one hears.

I wish to congratulate the hon the Minister on the progress his department has made in establishing itself as a substantial own affairs department. Health and welfare services are unfortunately one of those aspects of a society’s structure to which few people give much attention these days. Only when they need these services do most people realise the all-embracing role which these services play in our nation’s life and survival.

Because it is an own affair, the communities are going to find to an increasing extent that they are dependent on their own resources for many of these services, and that they must be presented as cost-effectively as possible. The hon member Dr Venter also referred to this fact. Because increasing demands are going to be made on the Treasury by each own affairs department we are going to have to take the lead in presenting these services more effectively. That is why I am convinced that the local authorities will have to play an even greater role in this regard.

Over the years the Whites have become selfreliant in this field. I shall explain in a moment what I mean by “selfreliant”. In each White community there are a handful of people serving their fellowman. They develop into huge country-wide organisations. The churches, service clubs, women’s organisations and even some cultural organisations have relieved the State and the authorities of a great burden by offering welfare and health services in our community life.

Because we shall also have to expand such organisations amongst our other population groups, I am of the opinion that local authorities will have to be persuaded to play a greater role as coordinators in this regard. Therefore I wish to propose certain steps to the hon the Minister which in my opinion should be considered at this early stage.

Firstly I believe that land must be identified for future welfare uses. The State and local authorities posses large tracts of land in many towns and cities throughout our country. Every Ministers’ Council should at this stage identify such land and utilise it for retirement villages for the aged, homes for child welfare or homes for the infirm aged.

We should also see to it that local authorities identify those land uses in a sensible manner. A home for the infirm aged must for example not be kilometres away from a hospital, a doctor’s consulting rooms, pharmacies or transport terminals. If possible we should reserve the area around hospitals, where doctors or specialists’ consulting rooms can be built and where blood transfusion services can be accommodated. Even a home for nursing staff can be built there. By planning in this manner, we can provide the most effective service at the lowest cost.

We should also persuade doctors to practise outside the business centres because their patients occupy parking places for long periods of time in business centres to the disadvantage of businessmen, overburdening the traffic department and annoying other motorists who have to drive around looking for parking spots in order to do their shopping.

We must take a look at the practices and patterns which have developed amongst the Whites, and see whether they are still the best practices for the times in which we are living. If that is not the case, we must not allow them to survive amongst other groups. In many cases welfare services and funds are provided by the compassionate public, and therefore we must take another look at how those services and funds are being utilised. Often we waste such money and services without being aware of it.

Since the Rotarians and the Round Table organisations will provide an old age home or a home for infirm aged with a minibus, we tend to build that home on the outskirts of the town rather than near the hospitals. We do not think about how much it will cost us to transport patients to hospitals daily for years on end. That is why I say that local authorities must begin to play a greater role. Every cent which the man in the street collects for welfare services, should in future be utilised as effectively as possible. We as Whites must take the lead in this, because the wrong example we set will be followed by others.

Over many years the White community has acquired a great deal of experience of the rendering of welfare services. The hon member Dr Venter referred to that. We must convey that knowledge and experience as quickly as possible to our fellow South Africans, because if we want to share prosperity in this country, we shall have to carry each other’s joy and sorrow. The people on the right of the political spectrum will realise that even in Morgenzon they will not be able to escape this truth. [Interjections.] Larger amounts are going to be demanded from the tax fund for the welfare and health services of other groups. Since there is already a great backlog, this will be justified.

Health services and welfare on the respective levels are going to require more and more initiative on the part of the local community. Therefore I should like to make the timeous request that the White community look into ways in which the available manpower as well as the funds can best be utilised. A further reason … [Time expired.]

Mr Chairman, the years are creeping up on me and when I glance around this House and I see your own grey hairs and those of the hon Minister of Transport Affairs …

I am young!

… of the hon the Chief Whip of the Official Opposition and the hon members for Pinetown and Rosettenville as well as quite a few others, I think that the time has come for us to begin talking about taking care of our aged.

Hear, hear!

Especially Helen.

When the present generation of aged were children, the aged still formed an important part of the three generation family with grandfather, grandmother, mother and father and children. It was quite a general phenomenon that the grandfather and grandmother lived with their children and grandchildren under one roof.

Sorry, I did not hear what you were saying.

Mr Chairman, unfortunately I have forgotten to include the hon member for Houghton in this age group.

He said you were growing old gracefully.

He is a big fat chauvinist person. [Interjections.]

Order!

Not only did they live there, but they occupied an important position in family life. They had duties and responsibilities and they were treated with respect. Great value was attached to their experience of life and the grandchildren looked up to them because of their tales of bygone days and certain skills which they displayed. As the elders of the community they took the lead especially in matters of religion, but often in other spheres as well. We remember those days.

The rapid economic and technological changes of the past few decades have brought about a great change in this regard. A small minority still live with their children. The elderly prefer to avoid living with their children and grandchildren because so often they feel they are just in their children’s way.

Times have changed to such an extent that their experience of life no longer has much value in the modern era. Their opinions and value judgements no longer carry much weight because they were formed in circumstances which belong to an entirely different era. They live in a world dominated by science and technology which are the creations of the younger generation. They have, in other words, no longer the bonds of authority with their families and the community as elderly persons had in earlier years.

This compels the elderly person and the community to which they belong to make a reappraisal of the elderly person’s place in the community as well as his needs and capabilities. The rapid and constant change in the economic, technological and social structures compel us from time to time to reconsider possible course adjustments which have to be made with respect to our services to the aged. The question can now be put: Which factors cause us to take a new look at the aged and the phenomenon of age?

There is the number of aged as part of our population. Over the last 20 years the number of people who are 65 years and over has increased by 63% the world over. According to a UN estimate there were an estimated 260 million people in this age category in the world in 1980. This comprised 5,8% of the world’s total population. It is expected that the number of aged will increase to approximately 400 million people by the year 2000. These millions of aged will then comprise 6,4% of the total world population. Although still a minority group, the number of aged seen numerically, is a factor which must be thoroughly reckoned with.

As far as South Africa is concerned, it can be determined from the available sources that in 1936 the Whites of 65 years and older comprised 4,9% of the total population, and these 4,9% represented about 99 000 people. In 1980 this percentage rose to 8%, or 367 785 people. It is calculated that by the year 2000 there will be more than 500 000 elderly persons in South Africa.

The significance of the aging of the population as reflected in the statistics I have just quoted, must on the one hand be sought in the real and in the potential social and economic value of the aged person; not only for his immediate community, but also for the country as a whole. On the other hand it must also be sought in the happiness and joie de vivre and fulfilment which the elderly person should experience in the third phase of life.

The phenomenon does occur that in the normal approach to the problem of the aged it is often referred to as if becoming old is a pathological phenomenon which constitutes a danger to the community and for which a remedy or a solution must be found. This image which is still occasionally being projected of aged, may have its origins in the realisation by the community that it has a responsibility to care for the aged. It may also be that the erroneous image that we have is one of a person in his last years, who bears the scars of illness and degeneration, and who can no longer look after himself; to say nothing of rendering a service to others. By regarding the elderly person as a problem, we are doing him an injustice.

The elderly person is not a problem; on the contrary he is an asset and must be seen and utilised as such. The third phase of life is a period full of challenges and expectations, a period in which talents and abilities can be applied to the advantage of the aged person himself, his fellow man and his community, a period in which the pleasures and the responsibilities of life can be enjoyed with a glad heart and blithe spirit.

One task that we must set ourselves, is to convey this image of the aged to the community in plain language. The community must realise that there is a phenomenal economic and social potential hidden in the aged, and that it must be used in their own and in the country’s interest. In this regard striking examples have been given by various service centres for the aged, which exist in our country. They are institutions through which the aged can jointly render an indispensable contribution. For the elderly person it offers an opportunity to participate in his own care, and for the community one of having an active share in the care of its aged.

Service centres can provide the aged with many facilities. One merely needs to think about meals which can be provided in turns by the various organisations in the community with the help of active elderly persons. Health clinic services can be undertaken mainly by volunteers with the help of the aged. There are probably many non-working nurses in every community who can make their services available to such a service. It is possible by means of such a service to provide nurses who can see to the needs of the bedridden aged in their own homes. There are people who can nurse and wash, who can turn them in their beds in general offer the essential clinical nursing aid assistance.

There are library services that can to a large extent be provided by the aged themselves. There are social recreation facilities, choirs for example which can be established and trained and which can perform to the benefit of the aged. [Time expired.]

Mr Chairman, it is a pleasure to follow on after the hon member for Swellendam. I want to associate myself completely with the sentiments he expressed on the aged. I shall still further expand on this, and I therefore hope he will not hold it against me if I do not react further to his speech.

It is a fact that the care of the aged is a matter of great concern to everyone of us in this committee, because this has to do with the people in our community who, in their productive years, also gave of their best to the community and society to pave the way so that we can make our country a finer one in every field today.

It is a fact that the responsibility for the care of the aged lies with the family members and children in the first instance, and then with the community and the Department of Welfare. Children have also been given an instruction. We can look at the Scriptures where the following is written in I Timothy 5 verse 4:

But it is also a fact that economic circumstances, the standard of living and perhaps carelessness and self-indulgence has taken them out of the parental sphere of influence. Particularly in the rural areas, as a result of better education, children have left in search of job opportunities, and the parent has remained in the country. Proverbially speaking, one could say: “Out of sight, out of mind”. And so the care of the aged has increasingly become the responsibility of the community.

The care of the aged cannot be maintained by the State, the church or the community alone, but only by co-ordinated teamwork.

I agree that so much more could be done by the community to give the aged a constant feeling of self-worth, and to show that an interest is being taken in them. The hon member for Swellendam referred to the fact that the aged still have a contribution to make in the economic sphere. I have seen ladies in old age homes who at 70 and 80 years of age could still do the most beautiful, delicate needlework. Those people sense that they are still of some value to the community and appreciate it when their services are still made use of. [Interjections.]

It is actually quite simple to provide a service to the aged. It could be done in town, or in old age homes themselves as an out-of-town farmer, for example, one could offer to give someone a lift to the shops, to the bank or to church. Those elderly people have an incredible appreciation for such gestures. We can never do enough to maintain this good attitude.

It is true that the State makes a tremendous contribution in this context. One greatly appreciates it. The fact that the department, for example, subsidises 395 old age homes with more than 27 000 residents, is proof of this. These homes are managed by various service organisations, such as the ACVV, and other women’s organisations and utility companies.

Due to an increasing life expectancy as a result of better medication and the better care of our aged, the number of inhabitants in these homes is increasing. South Africa is one of the Western countries that does the most in providing housing for the aged. This is something to be proud of, something to be grateful for. This once again shows that there is also State recognition for these people who in their active years made a contribution to the community.

One asks oneself what the reasons are for the aged to go to old age homes. I want to touch on just a few reasons. Today, for example, there is the high cost of wages for domestic servants and gardeners, the high cost of building maintenance, furnishings, appliances and so forth. There is also the rising cost of living, rising flat or house rents and the increasing cost of personal care and medication. Elderly people also fear that if they were to grow feeble there would not be room for them in an old age home. That is why they want to go to an old age home at an earlier stage.

There is also the fear of loneliness when they lose their marriage partner, and the fear of being transferred to a strange centre. Safety and care during the night is also one of the big worrying questions for the aged so that when night comes they pray for the sun to rise again.

There is a saying that one cannot transplant an old tree. And so I want to argue today that it should be granted to the aged to spend their last years in the surroundings and community in which they grew up, and to which they made their contribution. [Interjections.]

The aged fall into three categories: Firstly, there are the economically viable aged who are still self-supporting and are also in a financially sound position; secondly, the sub-economic, as well as the economic aged who are still healthy but for whom provision is made in old-age homes; and thirdly the enfeebled aged. The new policy is that more must be done for the enfeebled cases. New planning should have less and less bearing on the healthy sub-economic and economic class. According to this more provision should be made for the enfeebled cases.

In my constituency if one were to take these cases out of the home, it would no longer be possible to be run the old-age homes economically. In contrast, if the two categories were added together, there would still be enough aged to make such an old age home economically justifiable.

Hence my plea that we continually bear in mind that, as I have said, the aged in the district rural areas have a fear of being transferred to a new environment and that keeping them in the rural areas creates the job opportunities to which I have referred, with the concomitant purchasing power.

Old age homes are struggling today to obtain the necessary care and nursing staff in the rural areas, and that is why the question also arises when it comes to service centres, whether the trained staff will always be available to the service centre, a system which has my wholehearted support. Today I want to ask that we in the distant rural areas should not close the door entirely to the healthy cases—economic as well as sub-economic. We should allow them to decide in their own time whether they want to be admitted to the old age home, or whether they still want to stay in the community.

When someone goes to an old age home, they vacate a house. I know of numerous houses that have made available to the younger generation after the aged have been admitted to old age homes. In this area it also saves money because it is not necessary to build additional housing. The elderly people would otherwise remain in their houses until the day they die. On behalf of those of us who live in distant areas, far from medical centres and so forth, I would like to plead that a new look is taken at our situation in the rural areas.

Another point I want to touch on, which links up with this, concerns the aged in the rural areas who have to travel long distances to present themselves as out-patients for medical attention at hospitals. They have to be there early in the morning. They are elderly and unhealthy, and then they still have to wait for hours to receive the necessary care. Perhaps they arrive by train or get a lift to the hospitals and then they have no one to take them around. These people feel deserted and lonely and the city is frightening to them as it is.

I want to plead for special provision to be made for our aged from distant areas, so that they can wait in a waiting room and special attention can be given to them and they, like us, can go to a doctor by prior appointment so that they know whether they are being treated at 11h00 or 11h30. Even if there were a delay then, it would at least not mean they are sitting there from the morning to the afternoon, until the cows come home. [Time expired.]

Mr Chairman, the hon member for Beaufort West spoke about people who live far away, and I want to congratulate him on giving the committee such a precise description of their distress. [Interjections.]

I shall return to this topic in a moment, but I now want to get down to the people who are not far away. In connection with this I want to refer to the South Rand Hospital in my constituency, the future of which I have discussed with the hon the Minister. It could possibly be used for the enfeebled aged—the people who live in little rooms in the city. I find more and more that we who are well-off, should take more care of the people who are less well-off. If we really want our community to develop, we should look after those who cannot manage.

The importance of community development was impressed upon me after I got 10 social workers to determine the needs existing in Glenesk, over in my constituency. As secretary of the Christmas Fund of Die Transvaler I want to thank the CMR sincerely for their assistance with this project analysis. Glenesk is a scheme in the south of Johannesburg which is squeezed into the confines of the industrial area there and is situated virtually in Eloff Street extension. The people there have very few facilities. In 1939, when the Afrikaner was still very poor, this housing scheme with its red brick houses and simple building design was started. The situation there is such that there are no schools in that area, also no medical services, no cinemas, no swimming baths, no church or shop. They do not even have a butchery or a greengrocer. Those people naturally do not have strong group ties. The inhabitants themselves isolate each other in that area. It is a place where the average income of the inhabitants is R266. According to the survey that was done, only 13% of the people there receive a salary, while 48% receive grants.

As far as the question of transport there is concerned—and this shows that we should see to all the various aspects—88% of the people are dependent on municipal transport. Only 12% have their own transport. This own transport, however, also includes walking and the use of bicycles. Only 35% of those people are members of complete families, while single parents—all women— amount to 65% of the inhabitants. This is precisely the matter I was also discussing yesterday. Of the inhabitants of that area, 61% are elderly people between 60 and 69 years old. Elderly people live there for an average of 3 years before they either move or die.

In my constituency, apart from the many elderly people and the families to which I referred, there is of course also the Johanna Raath Home. Of the families in that area, 3% did not know of the existence of the existence of the Johanna Raath Home. They also did not know that there were special little houses for the aged. Of the organisations who do welfare work there, 52% are registered. Only 11% of those people play some kind of a sport or another. There is no library there, although 35% of people said that they were interested in a library. 17% of the people indicated that they would very much like to have a women’s club. 16% indicated that they would very much like a needlework club. 13% indicated that they would very much like a cookery club and those who felt a need for Bible Study represented 13% of the inhabitants. The children attend 23 separate schools.

Hon members can therefore realise what the conditions are like there. There are also 18 separate religious groups and churches in the approximately 9 bordering suburbs. All those people have to go there. All these things therefore indicate the total lack of a feeling of common destiny amongst the people in that area.

Moving away completely from the community I have held up as an example here to hon members, I just want to show the House photographs which I took myself. I have about 24 photographs which very clearly depict the conditions in which the elderly have to live in this area. Here is a photograph of elderly people in one of the blocks of flats there. We see what these flats look like, particularly when it rains. The roof is full of holes and the residents even have to catch the water in buckets while they themselves are huddling under umbrellas—and in their own flats too!

Now this is how the people who rent flats are being exploited by some agents. Hon members will be amazed. These are elderly people, who cannot obtain accommodation elsewhere. We clearly see how they are being exploited there. I think this is a matter we should see to. All these photographs have been to the hon the Minister of Local Government, Housing and Works. He looked at them. I must point out that the estate agents involved constantly insist on rent increases.

Now where is this?

This is in Rosettenville—in my constituency. This is the kind of conditions that make it necessary for us to do something drastic.

I just want to return briefly to what is being done in Johannesburg. This is possibly the idea which we should follow. The Johannesburg City Council—I referred to it the other day as well—bought the Casa Mia hotel and is providing elderly people with the refuge. There is a waiting list of 219 names of people who would like to go and live there.

This is of course what we need, Mr Chairman. We shall have to start giving more thought to establishing utility companies to assist with this. The State cannot manage all these tasks. We shall of course also have to try to increase our communities’ involvement in these utility companies. Our affluent communities and business undertakings will have to help, in co-operation with the State, to bring about a real change in these circumstances.

In the short space of time still left to me, I should like to refer briefly to the question of the rural areas. It is really the rural areas that I want to discuss this evening. In connection with this I should like to say a few things about the empty accommodation available in the rural areas. I have here with me a long list of vacant accommodation which is available. The vacant accommodation in the rural areas is a matter which simply causes concern at the moment. We shall eventually have to do something to utilise vacant accommodation in the rural areas, particularly for the purpose of housing the aged.

The hon member for Swellendam had a lot to say earlier on about us old grey heads. Let me tell him that we are not really so terribly old. His calculations are completely off the mark. [Interjections.] One of my sons has a little four-year-old daughter and my daughter had her first baby last week. [Interjections.] I am therefore much younger than the hon member for Swellendam, Mr Chairman. Let me assure him that his calculation is entirely incorrect. In his area around Swellendam, there are 20 houses standing empty. He should rather see to it himself that those 20 houses are filled.

Mr Chairman, I want to tell hon members about the hotel at Draghoender station. That was the place where the snooker championships used to take place. That hotel is now standing empty and could very well be used for the aged. Do hon members know why we have to pay so much there? A long time ago the transport drivers said that the railway line should pass the town two to three kilometres away, because they when all is said and done still wanted to transport the goods from the station to the town. That then is the cause of many rural stations eventually having to be closed down today, due to the distance of the stations. Now we have Kleinbegin, Putsonderwater and all those other small stations, which should all be interconnected. Can hon members realise what it is like having a well without water, when one has to make a small start? [Interjections.]

That is the hon the Minister of Transport’s fault.

No, he is a fine person. It is rather the fault of the old transport riders, such as the United Party members. They were in power in those days. [Interjections.] It was not the Nationalists. That was still in those primitive times, when we still wrecked meetings. [Interjections.]

When you blew up the railway lines. [Interjections.]

No, let me admit this today. I was never a member of either the Ossewabrandwag or the Stormjaers. [Interjections.]

Cheers, Sporie!

I never belonged to them. Never! I believed that we would eventually come into power constitutionally by way of the NP. [Time expired.]

Mr Chairman, the hon member for Draghoender … I beg your pardon! … the hon member for Rosettenville made out a case here for the utilisation of the South Rand hospital as a place in which we could accommodate elderly persons in need of care. This hospital does have 234 beds, but at the moment it is still being administered by the Transvaal Provincial Administration. Nevertheless it is one of the hospitals we could consider using for the accommodation of the inform aged. [Interjections.]

The hon member also raised the matter of a certain community in Johannesburg. We saw the hon member’s pictures and illustrations, and it is truly tragic to see the degree of exploitation that is taking place there. I intend to issue instructions to my department to investigate that situation from a welfare point of view, and to see whether there is something we can do about it.

Unfortunately I cannot, at this stage, reply to all the hon members who participated in the debate. I just wish to express my thanks to those hon members who have participated in the debate so far. Hon members will have to be patient with me because there are certain of these speeches to which I wish to react, but in respect of which the information is not immediately available. In my last turn to speak tomorrow afternoon, I shall react to those speeches to which I do not react this evening.

I also want to thank the hon member for Middelburg sincerely for his kind words, and also for his congratulations. For me it is a pleasant group to work with, and I, too, can speak only with praise of the way in which this group is performing its task.

As I said in my introductory speech, it is true that the State has certain responsibilities. Its responsibilities extends from the fate of our subeconomic group to the fate of our elderly persons in particular, and I am now emphasising the fate of the infirm aged. We are now faced with the situation—I do not like calling it a problem—and the hon the Minister of Transport Affairs is faced with the same situation that everyone wants to utilise the services which are profitable, but no one wants to utilise the difficult services from which one does not make any money. Both of us are therefore in the same boat. However, I do not have a train I can board to travel away from my difficulties, while he fortunately does.

I am very pleased that the hon member was also so kind as to refer to the letters we now send out to every person whose pension application has not succeeded. We feel that we enhance his human dignity in that way. To have to go to the magistrate to apply for a pension is already a traumatic experience for any person, and in this way we are trying to ensure that he retains his self-respect and human dignity.

He also referred to the medical schemes, and I may just tell him that these are discussed at length in the Browne Report which, we hope, will be tabled soon …

When?

… and in which quite a number of changes in respect of the administration of medical schemes are being proposed.

I also want to thank the hon member for Pietersburg for his congratulations, and for his speech, which in general was constructive. Unfortunately I cannot approve of everything he said, because there were certain things I did not agree with. In his favour I want to say that he expressed the philosophy behind these own affairs departments very well. That is precisely the way the NP feels about them. [Interjections.] It proves that the few years he was a member of the NP did him a lot of good. [Interjections.]

He asked whether there should be own hospitals, and I think there must, in the nature of things, be own hospitals. The hon member will understand though—this also applies to other hon members who asked the same question—that, as I said yesterday in this Committee, I am not able at this stage to give hon members a detailed reply. In fact, I am not in a position to give any reply. All I can tell the hon member is what is stated in the Constitution, and he quoted that himself.

The hon member also asked me for the assurance that we would only utilise White nurses and male nurses for White patients. I must candidly admit that that is impossible, and that we cannot comply with that demand. Politics has nothing to do with it. In this connection I wish to mention one example only. There is a rehabilitation centre at Cullinan. There we treat extremely disabled children—babies and children who are mentally handicapped. Do hon members realise that we have to employ two nurses for each child in that institution because they need attention every minute of the day? I put it to the hon member that we make use of Coloured as well as Black nurses there. They do their work with the greatest dedication imaginable. [Interjections.) I do not want to make a political issue of this situation.

It is political. [Interjections.]

I am glad to hear the hon member for Kuruman asserting that Black people never helped to look after his children.

No, they did not.

I accept that. The hon member must not think that I was attacking him. He must not try to put me off my stroke. The fact of the matter is that there are few White families in this country—and I am saying this without fear of contradiction—whose children were not at some stage or another looked after by Black or Coloured nursemaids.

As long as it is master and servant!

That hon member has the whole day tomorrow to get a turn to speak; he must not try to interrupt me now.

Then you must talk sense!

Is what I have just said wrong?

Yes, of course! What it amounts to is master and servant!

What? [Interjections.]

Order! The hon the Minister may proceed.

That hon member has just returned from Italy, and now that I come to look at him it seems to me he has jet lag. [Interjections.]

There are few White families who do not make use of Black or Coloured nursemaids to look after their children. I would not be surprised if the hon member for Parktown was looked after by one of them. [Interjections.] I am talking about the hon member at the back there, who has so much to say for himself.

You must just stop talking nonsense! [Interjections.]

Order! I insist that hon members give the hon Minister an opportunity to make his speech now.

As I said in my introductory speech, the State is fully prepared to accept its obligations and responsibilities— and now I am still speaking to the hon member for Pietermaritzburg—towards those patients for whom it has to accept responsibility. There are subeconomic people and those who, owing to circumstances beyond their control, cannot afford to look after themselves, and whom other people are not looking after either. However, there is one thing we must not forget in this country. It is not a welfare State. The private sector has just as much a responsibility as the State does when it comes to the provision of medical and welfare services.

We shall guard against this becoming excessive. The kind of case which the hon member for Pietersburg mentioned, of a public servant with a small salary who found himself in big trouble, is the best way of involving the community in the fate of that person. The State can help and make treatment for that person possible, but the State cannot compensate for every case in which heavy medical expenses are involved. To my mind that is an ideal case in which the community can participate. It happened in the case of young children who had to go to America for liver transplants, and so on. Those families would not have been able to afford it if the community had not also discharged its obligation. One has only praise for that community.

What I am now saying I also want to say to the hon member for Durban Point. He is very deeply concerned about the question of pension increases, which usually are only made with effect from 1 October. The hon member for Pietersburg referred to this.

I was only going to talk about that tomorrow!

Now the hon member need not talk about it any more, and he can save himself a turn to speak, because I am going to communicate some very good news to him now. [Interjections.]

In the past there were very sound reasons for this payment only occurring with effect from 1 October. With the process of computerisation it now appears possible for us, and we are now investigating the possibility of making this increased payment effective as from 1 May of every year. [Interjections.] This announcement is usually made in the Budget Speech, which is usually delivered during or late in March. The computers have to be programmed, and there are all kinds of formalities which first have to be disposed of. That is why it is not possible for us to do so with effect from 1 April. We are, however, exploring the possibility.

The hon member must understand that if we were to do so with effect from 1 May, as is the case this year, the monthly increases will be considerably less, although they will extend over a longer period. After all, we cannot make them effective for longer than 12 months.

I want to ask the hon the Minister whether it is not true that when the increases come into operation on 1 October, they extend over a year? If they therefore begin on 1 May, it is still a year, and it is therefore not necessary to reduce them.

The monthly amount will decrease, but the annual amount will remain precisely the same. The hon the Minister of Finance approved an amount of money which enabled us to introduce an increase of R18 per month with effect from 1 October. If we began to make the increased payments earlier in the financial year, for example on 1 April, we would only be able to make provision for R9 per month. Does the hon member understand that?

And the bonus?

The hon member must not refer to the bonus only now! This year the bonus was added into the increase. This year there is no bonus, owing to circumstances with which the hon member is well acquainted.

The hon member for Rustenburg spoke with great responsibility about the entire question of the provisions of the Constitution as far as own and general affairs are concerned.

Well done, Veltie!

The critics of general and own affairs systems forget one basic thing. It is perfectly true that medicine knows no colour bar, but certain diseases do in fact recognise dividing lines based on colour. We find it here in the Cape Peninsula, for example, where there is at present a tuberculosis epidemic. After all it goes without saying that the hon the Minister of Health Services and Welfare in the House of Representatives will allocate a far higher priority to the combating of tuberculosis than I would, because it is not applicable to the White population community.

There are scientific grounds for this division, and it applies virtually to the whole world. In Belgium, for example, one is dealing with Whites, but among the Walloons and the Flemings health is an own affair. Consequently I do not think it is as strange and ludicrous as the hon member for Park-town is trying to imply.

It is ridiculous and repugnant!

That hon member ought to know there are certain diseases which occur to a greater extent among certain race groups only. Is that right or wrong? [Interjections.]

Among the Whites as well! [Interjections.]

Well done, Dr Morrie! Eat him up! [Interjections.]

Eat him up? I shall never do that! I would rather spit him out! [Interjections.]

†The hon member for Durban Point misconstrued the speech of the hon member for Rustenburg. The division of services between the provinces and the own affairs departments has nothing to do with experiencing difficulties with the Constitution. We are simply experiencing certain practical difficulties at this moment.

That is what I said.

That is not how I understood the hon member, but I would like to put the record straight in any event. There are certain practical problems which make the implementation of this division very difficult.

Fine.

In all friendliness, I have to mention that there is something about the hon member that I cannot understand. Having accepted the principle of own and general affairs, he went on to put forward his hypothesis of how the division would take place. His whole speech was an exercise in futility and utterly hypothetical, because he put forward a hypothesis and then proceeded to shoot it down. We cannot argue along those lines, because nobody in this House knows how this division is going to take place and which hospitals are going to be given to which department.

Not even Chris!

The hon member Dr Venter is a doctor in the field she discussed, and she also made it clearly apparent that she is an expert as far as this matter is concerned. She referred in particular to the problems welfare organisations are having with their finances. Once again she put a question she has asked before, and I want to repeat it here. Are there not too many welfare organisations, that have to rely for their finances on the same sources as those on which many other organisations rely? Is there not a duplication of services? Cannot we rationalise welfare organisations in order to deal with this cost aspect? I would be the last one to say which welfare organisations are redundant or are a duplication of others, but I think this is a matter which these welfare organisations will have to give serious consideration to themselves so that they can establish to what extent their functions are being duplicated and to what extent rationalisation can take place.

Furthermore I want to make an appeal to welfare organisations, particularly those involved in institutional projects, such as children’s homes and homes for the aged, to begin to promote managerial expertise among the people managing those institutions. I have already suggested to certain of these organisations that the management, or the people involved in the management of institutions, should receive in-service managerial training. Managerial expertise should improve in an effort to curb expenses, because we find that the major losses of many of these organisations occur in their kitchens. What happens in the kitchens of these institutions will have to be watched very carefully. [Interjections.]

†The hon member for Houghton came up with her perennial speech about the abortion law, and the only thing I can tell her is that it does not fall under my department. [Interjections.] The hon the Minister of National Health and Population Development stated very clearly that …

Do not pass the buck.

Am I passing the buck? [Interjections.] The hon member knows very well that this falls under general affairs …

Does a woman have a general baby, or does she have her own baby? [Interjections.]

Order! There are too many interjections.

The position is that the hon the Minister of National Health and Population Development said in a statement which he issued a couple of days ago, that the Government is not considering appointing a commission of inquiry into the abortion law because the existing abortion law reflects the policy of the Government. I stand by that, and I have nothing to add to that.

All your policies are abortions!

The hon member Dr Vilonel referred to private hospitals. I just want to tell him that we draw no distinction between small and large entrepreneurs in the allocation of licences, but owing to the major costs involved in the building of hospitals, many small entrepreneurs find it very difficult to finance private hospitals. The hon member also referred to the fact that he, as an MP, was entitled to a personal opinion and drew my attention to the fact that when he and I were still MPs, in our young days, I also adhered to the standpoint that a medical practitioner should not be allowed to own shares in a private hospital. I just want to tell him it is strange how one’s opinions change when one occupies the responsible position I occupy at present. One eventually comes to see matters from a completely different angle. [Interjections.] In any event, I am of the opinion that the question of shareholding by doctors in private hospitals is an ethical matter, which most certainly is not the responsibility of my department, but that of the Medical and Dental Council.

In this stage I just want to reply to the speech made by the hon member for Pine-town.

†I just want to refer to a couple of points that he made. One such point concerns the subsidisation of social workers’ posts. It is true to say that at present the State pays subsidies to welfare organisations per social worker post at the rate of 75% of the mean of the salary. What must not be lost sight of, however, is that in addition to this subsidy the State also pays a subsidy for the administration costs in respect of these social worker posts. It is agreed, however, that the present system had to be reviewed, and this was done. It is therefore now the approved policy of the State to move away from the subsidisation of the social worker posts and administration costs, and to subsidise welfare organisations for approved services rendered by them. This new approved policy can, however, only be implemented once the necessary funds become available.

As far as places of safety are concerned, the department is at present implementing various facets of the report of the De Meyer Commission. It is an ongoing process, particularly concerning the staff of places of safety. These recommendations have been implemented almost in their entirety. The quality of staff has been improved substantially. Professionals such as clinical psychologists and occupational therapists are now contributing to an enhanced quality of service for the children. Major improvements in the physical facilities are under way in order to upgrade the accommodation to an extent which will bring these facilities up to an acceptable level. Members of the department served on the committee of inquiry, and provision is being made for ongoing liaison between this department and the Department of National Health and Population Development.

I also wish to inform the hon member that the State does assist people in need of social relief even if they do own a home or a farm.

Tell the magistrates that! They are turning people down.

The hon member should bring those cases to my attention and I will see to it that the situation is corrected.

During the past financial year we gave financial assistance to the tune of over R2 million to the unemployed. Financial assistance to farmers in drought-stricken areas amounted to R974 000, and emergency social relief R915 000.

The hon member also referred to the international convention dealing with the custody and the abduction of children. The department is in favour of international co-operation in this regard. All positive aspects emanating from such conventions will be duly pursued.

I make no secret of the fact that we do encourage the establishment of separate welfare organisations. Those organisations that are multiracial are subsidised by us to the extent to which they render services to members of the White population.

*I want to refer to the speech of one other hon member, namely the hon member for Newton Park. He made a plea here for a local matter. The hon member is aware that I am very sympathetically disposed towards this matter, but that there are certain very sensitive aspects associated with the matter in Port Elizabeth. I am not prepared to discuss this matter with him across the floor of this House. He is very welcome to come and see me in my office, and then we can discuss this matter again. However there is a certain sequence according to which these things must be done. That is why we have those bodies there. One of the basic requirements is that the regional welfare board must give a specific project an annual priority rating. These are the people who are able to assess the local priorities. It would be very unwise of me to ignore the recommendations of that board, which I appointed to provide me with advice. However, the hon member is very welcome to come and discuss this matter with me in my office.

Because there was no time for it during the Second Reading debate, there are certain matters to which I now wish to refer. The information was not at my disposal at that specific stage, and for that reason I should just like to refer to certain speeches which were made during that Second Reading debate in order to place certain facts and statistics on record. Firstly I want to refer to a speech made by the hon member for Park-town.

During the Second Reading debate the hon member for Parktown concentrated on welfare, and raised the following specific points. He said there was a new welfare policy in South Africa. He spoke about the privatisation of welfare services, the financial efficiency of welfare organisations and the cultural contents of welfare services. I should like to discuss these items with him across the floor of this House.

Do you still remember, Marius? [Interjections.]

No, he does not even remember. The so-called new welfare policy to which he referred is a document compiled by a working group under the chairmanship of an official of the Department of Constitutional Development and Planning. This document was drawn up by officials who had accepted the political situation as a given reality, and paid attention only to the implementation of welfare services within the existing constitutional structure. What is stated in that document in respect of separate regional welfare boards and welfare committees is merely a confirmation of a situation which has existed since the introduction of the National Welfare Act in 1978, and which fits in with the constitutional structures. I can see nothing wrong in this. It is the actual position. It is the legal position and no speech in the world will enable that hon member to change the situation. The so-called new welfare policy to which he referred …

Own affairs!

What is new about that? [Interjections.]

Order! There is a tendency among hon members of this Committee to regard the hon the Minister’s reply to the arguments advanced by them as an open invitation to comment in turn on what the hon the Minister is saying. I am not going to allow that. The hon the Minister may proceed.

The so-called new welfare policy was referred to the Department of National Health and Population Development in order to obtain comment on it from the respective interested parties and organisations. Basically the document is a working document for discussion purposes and cannot at this stage be regarded as a proposal for an amended welfare policy. The idea is to get the entire welfare community involved in reviewing the present welfare policy. I wish that hon member would do me the courtesy of listening to me. [Interjections.]

I am listening!

I just want to tell that hon member that this debate has taken place in a very good spirit this afternoon, and that he should not disturb the atmosphere now because he has just returned from Italy. [Interjections.]

†No, I am not taking any notice of the hon the Chief Whip of the Official Opposition. I am talking to the hon member for Parktown. I shall sit down and I shall not reply to him if that is what he wants.

*Only after the desired comment has been received will attention be given to the formulation of an amended welfare policy. At this stage no opinion can be expressed about a document, while it is not yet official policy.

The hon member also spoke about the privatisation of welfare services. The purpose of privatisation is to reduce the responsibility of the State in respect of welfare services, and attendant upon that to enhance community involvement in welfare needs. An important aspect of the privatisation of welfare services is the development of employees’ assistance programmes, by means of which employers in the private sector are given a share in welfare services and the prevention of social problems among their employees. The issue is not which population group is involved. In the South African setup it is in any event the case that almost all organisations have employees from more than one population group. The crux of the matter is that it is in the employer’s own interests to look after his employees properly.

Productivity is increased if the work-force is happy, not only in the work situation, but also in the community. Employers who have already introduced such programmes can testify to their cost-effectiveness. The Department of Health Services and Welfare is involved on executive level in promoting and implementing such programmes in the private sector. This is done by means of its community work, by means of which the business and industrial sectors are provided with advice and encouraged to put these programmes into operation.

†He also referred to the financial shortcomings of welfare organisations, as did the hon member Dr Venter. The statement that welfare organisations should be run on sound business principles is, of course, sincerely endorsed. Welfare organisations collect funds from the public and are also subsidised by the State. Much attention has been given and continues to be given to pointing out the benefits of the rationalisation of services, and ensuring that overlapping does not occur. I also referred to this in a previous reply to hon members.

We cannot afford to waste manpower, finances or resources. That is why the department has stressed the necessity of certain principles being adopted by all concerned in the rendering of welfare services. The first principle is that of co-operation between the State and private enterprise in order to meet the needs of the public.

Closely allied to this, is the principle of regulation. When the public contributes to the activities of private welfare bodies, it has the right to be assured that these moneys are spent properly. At the same time, the public is also entitled to be assured that the funds are being used for the purpose for which money has been asked. Welfare organisations are thus accountable to the public both with regard to the way in which they use the funds and with regard to the results which have been obtained. Much work is being done at present to ensure that welfare organisations apply sound business and managerial principles. I also referred to this aspect previously. Only in this way can welfare needs be met adequately.

Let us look now at the cultural content of welfare services. Social welfare services are concerned with individuals, families and communities. They address people’s basic needs such as the provision of food, accommodation and clothing. They also address very intimate, personal situations and conditions such as marriage, parent/child relationships and social norms. The cultural traditions, customs, norms and role models with which a person grows up determine to a large extent his lifestyle, attitude, values and expectations. This is a fact which cannot be ignored and which is evidenced in literature throughout the world. Attention is being given to the specific welfare needs of different cultural or ethnic groups which exist …

Order! Although there is no specific hon member who is conversing too loudly there is such a general conversation in progress among the hon members of the Government party in particular that I can hardly hear the hon the Minister. This must stop at once. The hon the Minister may proceed.

Sir, I cannot speak any louder! [Interjections.]

Social workers in particular need to work within the specific cultural context of their clients with understanding, not only concerning the methods they employ but also with regard to the type of welfare services which are established to meet the people’s needs.

An article in the British Journal of Social Work covering some dominant perspectives in literature relating to multiracial social work in the United Kingdom stresses the importance of recognising both the existence and the legitimacy of ethnic interests, whatever they may be. In the same article it is stated that the major task faced by social workers is the creation of services which were appropriate to the needs of the clients. In other words, welfare services must be ethnically sensitive, not merely as regards language and certain cultural differences but also as regards the total psycho-socio-cultural context of the client.

I also wish to refer, for the record, to the speech made by the hon member for Yeoville.

Mr Chairman, can the hon the Minister give his views on the report’s recommendation that privatisation should make it possible for the State to have no financial or other responsibilities for certain welfare services.

To which document is the hon member referring?

From the report of the investigation.

Mr Chairman, I have already said that that report is merely a working document. [Interjections.]

It is a draft. I am asking for the hon the Minister’s views.

I certainly cannot see that the State can wash its hands of welfare work in any manner whatsoever. There are certain responsibilities the State has to accept.

The hon member for Yeoville, during his speech at Second Reading, made the statement “… that we in these benches are certainly not satisfied with regard to the position of the pensioners to whom the hon the Minister referred or of the position of the war veterans …”

Mr Chairman, on a point of order, may the hon the Minister refer to a constituency that does not exist as far as we know? [Interjections.]

Order! I heard the hon the Minister referring to the hon member for Yeoville.

The hon the Minister said “Yewville”. [Interjections.]

Order! The hon the Minister may proceed.

How petty and frivolous can that hon Chief Whip really become! He is a disgrace to himself! [Interjections.]

“I believe”—this is what the hon member for Yeoville or “Yewville” said—“that they are becoming forgotten men in this country, except by those of us who have reason not to forget them. South Africa should also certainly not forget them”. The hon member stated that World War II veterans are becoming forgotten men in this country. I suspect that he was making a plea for the abolition of the means test for this group. According to my information …

No, that the allowance has not been increased. That is the objection.

Just listen to my argument. Mr Chairman, this hon member can speak the whole day. I do not mind at all.

According to my information 211 193 White soldiers enlisted. A total of 8 772 died on the battlefield and 202 421 were demobilised. At present 12 120 war veterans are already receiving a war veterans’ pension. If the means test for this group is abolished the maximum amount of R195 per month will be payable to all those veterans. This may therefore entail an additional expenditure of R445,3 million annually. Although I agree with the hon member that we must not forget these people, I am sure he will accept the fact that the funds are not available at present.

Mr Chairman, will the hon the Minister confirm that when the R10 war veteran’s allowance was added to the war veteran’s pension it was then more than 10% of the pension and it has remained at R10 until 1981 and then R15 until now. That is the complaint, not the means test. It is that that war veteran’s allowance has remained the same for some fifteen years and then again unchanged until now.

Mr Chairman, as I do not have the statistics at my disposal at the moment I cannot reply to the hon member adequately.

Mr Chairman, may I put a question to the hon the Minister in connection with military pensions? Does the hon the Minister agree with the principle that in respect of military pensions differential pensions are paid out depending on academic qualifications?

Mr Chairman, I just want to emphasise that hon members should please draw a distinction between military pensions and war veterans’ pensions. The one is a social pension and the other involves a contributory pension fund from which benefits are drawn. Therefore I cannot furnish an adequate reply to the hon member’s question.

Mr Chairman, the hon the Minister has replied to a number of hon members in this debate and in regard to other debates as well. Insofar as the hon member for Parktown is concerned, I am quite sure he will address the hon the Minister tomorrow when he speaks. I merely want to express my sympathy to the hon the Minister in having a department which is very much in suspense in waiting for the committee of the Commission for Administration to decide what the future will be of hospitals once the provincial councils are dissolved.

The subject matter of my speech tonight includes references to hospitals in the sense that if the hon the Minister would give me his co-operation I am sure we would be able to reduce the number of patients who attend those hospitals, while at the same time reducing the expenses relating to their treatment, and also of course administration costs.

The Standing Committee on Private Members’ Bills, at a meeting held on Tuesday, 25 March 1986, considered the Smoking Control Bill introduced by me. That Bill, as hon members will recall, contains four important provisions. The first of those provisions is that every cigarette packet shall contain details concerning the average nicotine and tar content of cigarettes, both of which substances are most dangerous to one’s health. The second provision stipulates that within one year of the legislation becoming operative every cigarette packet shall bear a warning in both English and Afrikaans stating that smoking is dangerous to one’s health. This warning should be printed conspicuously and legibly and should contrast clearly with the lay-out and colour of the packet.

Thirdly, Mr Chairman, the Bill provides that within one year of the legislation coming into operation all advertisements for cigarettes and tobacco products shall include the nicotine and tar content, as well as the warning to which I have just referred. The penalty for failure to comply with this stipulation is a fine of R10 000 or imprisonment for five years or both such fine and such imprisonment. Fourthly, Mr Chairman, the Bill provides that cigarettes or tobacco products shall not be sold to children under the age of 16 years. The penalty for failure to comply with this provision is a fine of R100 or imprisonment for six months.

As hon members will appreciate, the Bill does not attempt to stop anyone from smoking. It does, however, give the hon the Minister the right to prohibit or regulate the advertising of cigarettes and tobacco products in certain public places.

The fact that cigarette smoking is detrimental to one’s health, and even fatal in certain cases, is scientifically based. In this regard I call as my witness none other than the Medical Research Council of South Africa. The MRC, in a statement on smoking and health issued recently, says, and I quote:

What makes matters worse, Mr Chairman, is that passive or non-smokers are also subjected to the same dangers as active smokers. In relation to this I quote again from the same statement by the MRC, as follows:

A study was carried out in Japan by a certain dr Hirayama, who examined 91 450 non-smoking women in whom lung cancer had been diagnosed over a period of fourteen years. That study showed that the wives of men who smoked had a higher risk of dying. Furthermore, the incidence of bronchitis in children was higher in the homes of parents who smoked. This is also proved in another study carried out by a person called Weiss.

Bringing the message home from a man who lives quite near to where we are now—a man living in Bellville—I should like to quote from a letter he wrote me quite unsolicited. It is dated 3 February 1985, and in it he complains about smoking on aircraft. He also refers to correspondence between himself and the hon the Minister of Transport Affairs, from whom, as he states, he had little joy. I share this man’s sentiments when he demands that the hon the Minister of Transport Affairs forbid smoking on aircraft completely, so preventing endangering the health and well-being of all passengers who travel by air. [Interjections.]

We have to live with you, so you will just have to live with us!

Who on earth wants to live with you, Vause? [Interjections.]

Mr Chairman, I quote the final paragraph from this person’s letter, as follows:

The man lives in Bellville, as I have said.

The Standing Committee on Private Members’ Bills was aware of the statement made by the hon the Minister of National Health and Population Development that from October …

Mr Chairman, may I ask the hon member a question?

No, I do not have the time.

As I was saying, the standing committee was aware of the statement made by the hon the Minister of National Health and Population Development that from October the tobacco companies would print—on a voluntary basis—on cigarette cartons: “Smoking is a health risk.” This is not good enough. There is no control. We can see how they did this. I have here in my hand the cigarettes of my colleague, the hon Chief Whip. [Interjections.] One cannot even read the printed warning. When, however, one looks at the American pack one can see, printed in gold, very clearly and legibly:

It is important to note that the standing committee decided to send a deputation to the hon the Minister. The deputation was to consist of myself, the hon member for Roodepoort, the hon member for Toekomsrus in the House of Representatives, and the hon member for Mariannhill in the House of Delegates. I accordingly wrote a letter to the hon the Minister of National Health and Population Development. The letter reads:

To this day the hon the Minister has not even acknowledged my letter or replied to it, and of course the hon the Minister has not given us an appointment.

This is where the hon the Minister of Health Services and Welfare comes into it.

Mr Chairman, on a point of order: The hon member is now referring to the hon the Minister for National Health and Population Development. This is an own affairs Vote. He cannot discuss that matter here. [Interjections.]

Order! I am listening attentively to the hon member for Hillbrow. The hon member may proceed.

I say again, this is where this hon Minister comes into it. For the sake of the health of the South African nation, I want to appeal to this hon Minister. Firstly, I appeal to him to prevail upon the hon the Minister of National Health and Population Development to give us an appointment as soon as possible. Secondly, I appeal to this hon Minister to accompany our deputation to see the hon the Minister of National Health and Population Development. [Interjections.] In addition, I call upon this hon Minister to mount a campaign throughout his department, starting with his own officials and their staff, and to warn them, in a formal circular or publication, of the dangers of smoking. Furthermore, I appeal to him to have a warning placed in every office occupied by him or members of his staff, and in fact the offices of every other department. The warning can take the form of a red and white no-smoking sign such as the one I am holding up to hon members now. Furthermore, I appeal to the hon the Minister to prohibit smoking in all the offices of his department and certainly in all hospitals, mental homes, homes for the aged and other homes under his control. Moreover, I call upon the hon the Minister to instruct all his senior staff to actively campaign against smoking and to encourage their staff to stop smoking. He should also ensure that programmes are provided to assist those people who want to stop smoking but experience difficulty in doing so.

This policy should also be applied to all nursing staff, medical services staff, research workers, social workers, staff of the old age homes, welfare workers and staff of mental institutions.

If I can get the co-operation of this hon Minister, we can find a way to get the message across to the people of South Africa. Perhaps then other State departments will follow suit.

Mr Chairman, I have known the hon member who has just taken his seat for the past 25 years. During those 25 years, he has changed his political party four times and I see they are again adapting the policy of the party he belongs to now. The fact remains, however, he simply does not like people to smoke and he makes use of every opportunity to warn them against doing so. It is coincidental that I am speaking after him tonight. I have no choice but to second his suggestions tonight. [Interjections.]

We are discussing the Health Services and Welfare Vote tonight and I want to tell hon members that effective health and welfare services in any community contribute to the happiness of the community to a great extent. Since health services and welfare are an own affair, I should like to wish the hon the Minister and his department every success and say I believe Health and Welfare will do well as an own affair, as will the hon the Minister and the extremely capable and loyal officials who assist him.

In a reply tonight the hon the Minister referred to earlier speakers who had spoken about hospital beds. I do not want to repeat what I said in the debate about the vote of the Department of National Health and Population Development, but I do want to make one remark. In view of the low occupation of hospital beds throughout our country, I want to ask the hon the Minister to support my request that the many empty beds be placed at the disposal of our infirm aged. There are many children who are prepared to take care of their parents when they have become infirm. They want to go on holiday at least once a year, however, and I think in such cases hospitals can be more lenient to assist them.

I want to make a single remark about homes for the aged. I should like to submit the idea to the hon the Minister that we should really move away from the large homes for the aged in future. It is impossible to find a welfare organisation which is prepared to accept responsibility for the larger homes. I think we must consider smaller units in various residential areas, in which a flat can be furnished for an older couple to live in in safety. This also applies to our children’s homes.

The percentage of aged people living in institutions in South Africa is the highest in the world. I really do not think that is to our credit. I wonder how many parents of wealthy children are living in residential units subsidised by the State. Should we not consider that on occasion? I made inquiries at a home for the aged in my own constituency and found that the problem of those people—the infirm aged in particular—was that they were lonely and did not feel secure where they had lived previously. It is not imperative that they be put in such homes, however. I think the private sector can play a very important part in assisting us in this respect. When we look at our children’s homes, I wonder how many of those children who are reported as being in need of care and who end up in Government-subsidised homes, are really in need of care. We must consider these matters.

When we look at the extent of welfare services in South Africa, I should like to agree with the hon the Minister tonight that we must pay serious attention to rationalisation. I want to emphasise very clearly tonight that duplication definitely occurs. I shall come to that later in my speech because I want to make a specific recommendation in this connection.

In view of the new constitutional development, and since we are involved in the devolution of authority, which is being devolved to the third tier of Government, I want to say tonight the time has come for us to devolve welfare services as well to the level of local government. An anomaly exists already. If one looks at the Black Local Authorities Act, Act 102 of 1982, one will see welfare services are the responsibility of the local authorities. I want to motivate my standpoint in respect of this matter. I should like to use Johannesburg as an example. Johannesburg is not the only example, since I can also mention Pretoria, Krugersdorp, Randfontein and my own local authority. They have all rendered welfare services for years. Johannesburg had a municipal social welfare department from 1939 to 1959. It was later called the Johannesburg City Social Welfare Department. It initiated and managed certain services as a service to the residents of Johannesburg.

In 1959 a commission of inquiry was appointed with Prof Piet Hoek as its Chairman. At that stage I differed from Prof Hoek and his committee. The recommendation of the Hoek Commission was that welfare was not the responsibility of local government. I differed from Prof Hoek and his committee at the time and I still differ from their point of view.

I therefore want to make a plea tonight that we devolve welfare work to the level of local government. Even before the Hoek Commission came into being, the Du Plessis Commission had indicated in 1954-55 that local authorities must render services in the interests of the local community as a whole and that these should be called community services.

When we look at the present situation, we see there have been drastic changes since 1959. Today’s health services and the progress in the sphere of medical science have contributed to our people’s becoming older and older. When one keeps that in mind, along with the process of urbanisation, the demand for the care of our senior citizens and aged will increase. The Government will not be able to meet this demand alone; we shall have to devolve those services to the local government level.

Welfare organisations find it difficult financially to keep up with the constant demand for their services. I shall return to that later. The fact that more and more women are entering the labour market, leaves a great gap in the number of people who are prepared to do voluntary service. To make matters worse, the amount received from bodies in donations is much smaller because of the high inflation rate and the recession prevailing in the country at present. There are even welfare organisations which are struggling to keep head above water.

In looking at the role of the local authorities, one sees they are very closely involved in the needs of the residents on a daily basis. In many cases local authorities are in the ideal position to fulfil the needs of their people relatively quickly. In this way, for example, a local authority is responsible for the administration of housing schemes, including units for senior citizens who are still self-supporting. Some of them may have lived in the particular unit for senior citizens for years, and now they have to seek other accommodation which will admit infirm aged people. [Time expired.]

Mr Chairman, I listened attentively to the hon member for Witbank. I merely want to point out that the Pretoria City Council, for example, renders a certain degree of welfare services as far as the provision for flats for the aged is concerned. This is a problem I do not want to discuss now, however, because I should like to draw the attention of the hon the Minister to another matter.

I want to associate myself with the hon member for Pinetown and ask the hon the Minister what has happened to the new Child Care Act, No 74 of 1983. I understood there were problems with the regulations. This Act has been on the Statute Book for three years without the regulations having been drawn up. Otherwise there is a problem in compiling three sets of regulations for own affairs from one piece of general legislation.

I am not putting this question because I want to have the Act applied. I dealt with the legislation on behalf of the CP in 1983, and had a number of problems concerning it. I proposed certain amendments, which the hon the Minister did not want to accept at the time. I still believe that if this Act were to be implemented, it would have to be revised very quickly because it has a number of deficiencies.

In my opinion the main issue is the educational aspect that is involved. It looks as though the Department of Education and Culture is also waiting for these regulations as far as schools of industry and reform schools are concerned. They must take certain steps in this connection. With reference to the policy we accept, viz that we must try to keep our aged in the community for as long as possible, I merely want to make a statement with reference to children. In my opinion this policy applies to children to an even greater extent. That is why I am pleased that the annual report mentions the fact that 6,47% fewer children were found to be in need of care, and that this was thanks to the preventive services which were rendered by welfare organisations and social workers.

Incidentally, I want to compliment the department on their excellent annual report.

What about the hon the Minister?

I believe that if those welfare organisations had the staff to render even more and better services, the picture would be even brighter and we would be even more successful in having fewer children committed to children’s homes, away from their parental homes.

In considering the matter, it is clear that the department has to subsidise the building of children’s homes, because they are already subsidising the equipment, the running costs and the maintenance involved, as well as the salaries of staff members. I want to suggest to the hon the Minister, that instead of pushing so much money into the institution itself, it would be better to give some of this money—the hon the Minister can insist that the hon the Minister of Finance give us more money for this—to our welfare organisations so that they can appoint more staff, can render a larger and more extensive field of preventive services and perhaps can succeed in keeping even more of our children, who would have been committed to children’s homes on the basis of needing care, out of these homes. In this way we can try to keep as many children as possible in their parental homes, which are their natural place.

In most cases a child in need of care will be placed back in the parental home under the supervision of a probation officer or a welfare worker. Perhaps we can make an effort by means of reconstruction work to keep the family unit together as long as possible.

I want to make a plea tonight for us to apply this policy to our children as well, and to try to provide money so that the welfare organisations can render preventive services to keep our children in the family circle as long as possible. I think this is imperative for the education and development of the child as a whole.

Pursuant to this, I should like to draw the hon the Minister’s attention to a matter in connection with care of the aged. Although we agree that one wants to keep one’s aged in the community as long as possible, we have a problem with the two categories of people that exist in respect of occupation. The aged person in the first group has bought his own house and still owns that dwelling when he retires. The other group consists of people who have to rent their homes.

I speak from experience. There are a number of old age homes in my own constituency which have a great many names on their waiting lists. These people are constantly approaching me to help get them admitted to the old age homes. The great problem of the aged people who approach me is that the money they have—whether it is savings or a pension—is too little to satisfy the demands of life. The cost of living is increasing, everything is expensive and the inflation rate is high. Those who still own a house, have to pay taxes on it. The water and electricity accounts are very high and there are numerous other expenses.

The financial pressure on these people forces them out of their own homes or the homes they rent, since rent has increased as well. As a result they have to leave the community and go to an old age home.

I have a question to put to the hon the Minister in this connection. Subsidies for the building of old age homes cost the department a great deal of money. They have to subsidise equipment and professional staff. Can we not try to prevent this? I understand that many of these aged people are supplied with meals and already receive medical services and many other services from the community, but the cash which has to pay for the rent of the house, the tax, the water and the electricity, is lacking. Instead of subsidising more money for the building of more new institutions, can we not rather subsidise the rent, tax, water and electricity of these aged people in some way or another? In this way we can remain faithful to our policy that the aged must stay in the community as long as possible. Those people must be subsidised and kept in their communities rather than be forced to leave their homes or rented homes to go to an institution, where we have to pay a great deal to support them in any case because of financial pressure.

There is another matter which I want to bring to the hon the Minister’s attention. It concerns the population development plan to which reference is made on page 25 of the annual report. I see the hon the Minister is very true to his Vote and is wearing a beautiful “White” flower in his lapel. I want to congratulate him on that. [Interjections.] As far as participation in the population development programme is concerned, I should like to quote from the annual report. The paragraph I regard as being important reads as follows:

The next sentence is very important:

I want to extend this emphasis on the difference that exists to another matter. That is the statement made in the debate about the Department of National Health and Population Development that this development programme determines that every woman in the country must have 2,1 children and that we must try to reach that point at a certain future date. I merely want to say that we must take these differences between population groups, referred to in the annual report into very thorough consideration in this connection. Suppose there are two million White women and each has two children; that means there are four million people. If there are 10 million Black women, however, and each has two children, there are 20 million Blacks. I think that is completely out of proportion and that is why I am advocating a different ratio for the Whites. [Time expired.]

Mr Chairman, the hon member for Koedoespoort referred to the high taxes and high tariffs in towns and cities. The hon member’s party opposes the regional services councils and they have every right to do so, but I should like … [Interjections.] The hon member must be patient. I am convinced that we shall be able to render services on a regional basis when the regional services councils are established. This should definitely contribute to a decrease in taxes and tariffs for the people in our cities and towns.

I referred to the home for the infirm aged. Homes for the infirm aged are administered by welfare and charity organisations. This accommodation is usually very scarce and difficult to get. In many cases it is also extremely expensive. I can give hon members the example of a case in my own constituency in which people pay up to R750 per month for such accommodation. If one looks at the services they receive for this, it is truly a great pity that we cannot render that service to our people.

It is logical, therefore, that a local authority should be able to get permission to build its own units for infirm citizens and to manage them together with a housing scheme for senior citizens. A local authority has professional officials in its service full-time to render very good and consistent service. I mention that as a motivation for my argument.

I should like to refer to Pretoria. The hon the Minister referred to duplication tonight. If I may use Pretoria as an example, I want to illustrate this matter to hon members. The city council of Pretoria controls 1 599 residential units which are situated in housing schemes in various sections of the city. A housing supervisor has been appointed for each group of residential units over which she has direct control with a view to its maintenance. To be appointed to this post, she also has to have a BA degree in Social Work or an equivalent qualification. Bearing in mind that the residents of these housing units are poorer members of the community and as a result have specific financial, social and even physical problems, and because a housing supervisor of this kind has to have exceptional insight and knowledge to meet the requirements of this control function, one can understand that most of the tenants begin to look up to the housing supervisor in due course and in the process discuss all kinds of personal problems with her in the expectation that she will guide them in overcoming the particular problems. The housing supervisor therefore becomes involuntarily involved in these people’s problems and, without contravening the director of local government’s regulations, she tries to assist the tenants. The nature of the guidance she has to give covers all possibilities. The problems which require the attention of the separate welfare organisations are brought to their attention for further action by liaison with such organisations. There is a person who has the necessary knowledge and experience and who can render the welfare services just as well.

In looking at the extent of welfare services, I should like to refer tonight to the subsidies paid by the Government to two welfare organisations which have rendered excellent service to our community through the years. The Suid-Afrikaanse Vrouefederasie is one of the welfare organisations I want to refer to. During the 1984-85 financial year, the SA Vrouefederasie received an amount of R5 346 944 from the Government for the service they render. This amount is not even half of the total amount spent on welfare services. I mention this just to acquaint hon members with the extent of welfare services in South Africa.

I am also going to refer to the ACVV which spent a total amount of R13 763 480 during the 1984-85 financial year. The total amount received from the Government in subsidies was R6 252 641. This organisation collected a further R1,6 million to render service to our people.

I would be neglecting my duty if I did not also refer to the centre near Parliament, which the ACVV put into service a week or two ago. We must look at the scope of the service rendered under that scheme which cost R5,5 million. There is a crèche for 160 children, a home for the aged containing 79 beds and 29 beds for the infirm aged. The first protective residence for single women who are physically or mentally handicapped, or psychologically disturbed, has been established here too. These people have set a fine example and I think we should take cognisance with great thanks and appreciation of the great work done by our welfare organisations.

I want to make a serious plea to the hon the Minister tonight to consider devolving welfare work to the local level. In my opinion decentralised welfare services have the following advantages: In the first place there is participation by and involvement of the residents of the town. Decision-making takes place more quickly. Decision-making is effective, since local authorities are closer to the problem. The people live together in one community and have to contend with each of these cases within the community day after day. Original ideas are initiated and adaptable and flexible systems are provided.

In South Africa, the central authority should be responsible for determining administrative policy and standards, as well as control and part financing. When decentralising of the welfare function to local authorities is considered in South Africa, the possibilities of regional welfare boards and the welfare committees can be analysed. A welfare committee could be introduced in a local authority, for example, and a representative from the local authority and the various voluntary organisations could serve on it.

Such a welfare committee can be responsible for determining needs, for establishing and maintaining child care, welfare and care of the aged, as well as for combating and treating alcoholism. I think of drug addiction too. We need only think of the time it takes at present for the department to determine needs when provision has to be made for a home for the aged or the infirm aged. The hon the Minister of Local Government and Housing ordered a survey of the extent of the accommodation we needed for our welfare cases in our country. In view of this believe and am convinced that this should be done by every local authority so that the community itself will determine the need in order to render that service to all its people.

Unfortunately time does not permit me to elaborate, but if we look at the practice in many other countries in the world—countries such as England, the USA, Switzerland and Sweden—we find that welfare services in all those countries are rendered by the local authorities. That is why I appeal seriously to the hon the Minister to devolve welfare work in South Africa to the third tier of Government with the phasing out of the provincial councils and the establishment of the regional services councils so that an effective welfare service can be rendered by the community for its own people.

Mr Chairman, I intend to deal tomorrow with the subject of pensions and welfare which the hon the Minister and other hon members have dealt with. This evening I should like to deal with one other major aspect of health services but first—and I am not going to be diverted, tempted or taunted by interjections—I shall deal with one or two unrelated matters.

Natal is to get a new teaching hospital. I do not know whether this falls under the hon the Minister or whether it is a general affair. This is the problem we have. I am not going to repeat myself but I think I have proved my point regarding the impossibility of separating these services. Who should I talk to in order to find out what the other teaching hospitals have? They do not fall under the Minister of National Health and Population Development. I have tried asking him. I want to find out how many teaching beds there are in the various teaching hospitals. Can this hon Minister tell me? No, he cannot tell me. This is the problem I have. [Interjections.]

I can find out for the hon member.

Well, I wish the hon the Minister could because I cannot find out. I cannot ask the hon the Minister this question because these hospitals fall under all four provinces. I cannot ask the hon the Minister of National Health and Population Development because he says it is not his concern, and so I hope the hon the Minister can find out for me. Natal has been limited to 800 beds for its new hospital. Other hospitals have 1 600 to 2 400 beds. Natal will need far more than those 800 beds. This is a matter of great concern. What is the use of spending all that money when the hospital will then be too small for the purpose required? [Interjections.]

The other matter I want to raise has to do with ambulance services. I assume that that service will be taken over from the provinces by the own affairs department. I want to know how this is going to work. Are the ambulances now going to be run separately for the various groups or are they going to serve all people who need medical treatment and who have to be transported to hospital? I want to appeal to the hon the Minister, for heaven’s sake, that we must not go back to the “oerwoud” days when one had to lie in the street when one was knocked down until an ambulance for one’s own race group arrived. I hope the hon the Minister will give an assurance that ambulance services will transport whoever needs to be transported.

I should also like the hon the Minister to react, if he would, to the AA report on some of the alleged shocking conditions in ambulance services.

That is only in the Free State!

No, only Natal has a clean sheet. There were complaints about all the other provinces. [Interjections.]

I come now to the issue of privatisation to which the hon the Minister referred. One thinks back almost with nostalgia to the good old family doctor. Some of us are lucky enough still to have family doctors. They were the most fantastic people and are still the most fantastic people for those who still have family doctors. I think back to the number of times when one was young and did not have a medical aid scheme that one just ’phoned the doctor and he suggested treatment for one’s kids over the telephone.

We are moving away from that wonderful situation where the family doctor was a friend who visited one and whom one visited in return, and with whom one was on Christian name terms. Doctors are moving more and more into fields of specialisation today. More often than not their hours are now from 8h00 to 17h00, or the like—they decide upon them. When one needs a doctor in the evening, and one does not have one’s own doctor, one battles to find somebody who is prepared to come out at night. I am sure the hon member for Parktown … [Interjections.]

I am listening very carefully!

The hon member for Park-town knows I am right. [Interjections.] He starts early in the morning, makes his pile during the day and then comes to work in Parliament again. [Interjections.] He is not one of the lazy ones but I bet he would not go out if a stranger ’phoned him and said his child was choking to death with whooping cough! [Interjections.] Well, then, I give him full marks!

He is the one doctor I know who would! [Interjections.]

Yes, I hear the hon member for Bezuidenhout say he is the only doctor who would go out on such a case at night. Fortunately, there are still doctors, like that hon member, who remember and honour the Hippocratic oath.

I say privatisation is a misnomer. It implies private enterprise which implies open competition. However, there is in fact no open competition because medicine operates in a closed shop. Both the doctor and the pharmacist today have a closed shop. For years they have had to do certain training, they belong to an association and they are limited by law. It is not free enterprise. Doctors do not compete with one another. As far as medical aid associations are concerned, if they are contracted in, their fees are fixed.

There is no more contracting in or out.

All right, but there was. The fact remains that there is no free, open competition for the ordinary man and certainly not for the private hospitals. [Interjections.] Most of the doctors today have their consulting rooms at or near a particular hospital and the doctor determines which hospital one goes to. What is happening is that the cost of private hospitals and the inability of provincial hospitals because of the shortage of money to provide the wards and staff for admission of private patients are pushing up the cost of medicine to such an extent that I believe we are going to find more and more medical aid schemes collapsing, like Medico with which we had the trouble here in the Cape last week. [Interjections.]

I am shocked to find that there is no fidelity fund, there is no protection at all. The patient will have to pay the doctor and, if he cannot, the doctor will lose out; if he can, the patient will lose out, unless they can save the situation by each member of the scheme paying a double month’s contribution. What it proves, however, is that the cost of medicine—even with a medical aid fund—is getting beyond the reach of a vast sector of working people.

We are finding that the contribution to the medical aid fund is becoming too high for many workers to afford. It is up around R80 or R90 per month and a man who is earning something like R400, R500 or R600 per month, or a working mother with children cannot afford it. The protection which the hon the Minister is seeking of the private sector and medical aid funds supplementing State health services is rapidly becoming a dream.

If the war between Masa and the pharmacists and pharmaceutical manufacturers continues and if costs go on escalating, ultimately one will have the position where public demand will force a system of medical socialism onto South Africa.

[Inaudible.]

Exactly. If medicine goes beyond the ability of people to pay for it, then they will turn to the State and force it into socialism. It is vital that the doctors, the medical profession and the associated professions take care that they do not become the catalyst or the cause of forcing people into demanding a system which I would hate to see in South Africa. [Time expired.]

Mr Chairman, the hon member for Durban Point will understand if I do not react to what he said. I believe the hon the Minister and his department will supply the necessary answers.

I should like to return to a matter we broached last year, viz care of the aged as it affects my constituency. I want to talk about the care of the infirm aged in particular tonight. I think we all realise that this is a growing problem. When we look at the background of this whole matter, it is true that our population is becoming older and older. By the year 2010 the number of Whites above the age of 60 will equal the number of Whites under the age of 60. There are projections that the number of people above the age of 80 will increase by 70% during the next 25 years.

This brings one involuntarily to the infirm aged. There are many new schools of thought concerning this subject. The hon member for Koedoespoort referred to a few of them tonight, but when one considers the new schools of thought in respect of care of the aged and the infirm aged that have developed during the past few years, they tend to advocate fewer and fewer old age homes, perhaps more smaller kinds of old age homes, such as dwellings which have been converted for that purpose. We think of service centres, for example, which will be able to function from such smaller old age homes.

There was talk about granny flats a few years ago. Perhaps the hon member for Rissik would like to live in such a flat. [Interjections.] I must admit I never really liked this concept of granny flats for the simple reason that one is creating a capital expense which will be of value to one only for a few years. Such a flat can be of value to one as ordinary care for one’s parents or close family. The moment those parents become infirm, however, one creates loneliness for those aged and a servitude on the children which is almost unbearable.

The new idea is to adapt hospitals or a few floors or certain sections of the hospital for the infirm aged. It is a good idea, especially in the case of hospitals which are empty or partly empty and can be used for that purpose. Nevertheless I want to issue a warning that although there are arguments for this idea, there are also arguments against it.

Grant me the opportunity to mention a few arguments against it. I hasten to add that this does not mean I am opposed to the principle. The problem I have with this idea, is that it can be a very expensive enterprise. Inevitably a hospital is an expensive enterprise, which is going to become more and more expensive in future. I also want to say that the other school of thought, viz privatisation, is becoming more and more expensive as well; to such an extent—other hon members have referred to this—that it can become impossibly expensive for the middle and lower income groups.

Another problem I have with the hospital as a place of care for the infirm aged, is that such places normally have restricted visiting hours. Hon members know that when one has an infirm aged person in one’s family circle or circle of friends, one cannot adhere only to the particular visiting hours applicable at a hospital.

If the infirm aged person who is lying there knows one on a personal level, one gets the idea that one must be careful of the idea that can arise that such an infirm aged person is being taken from the community to hospital to die.

If a floor or a section of a hospital is made available—hon members will forgive me if I direct the attention to my constituency, but we have two old age homes there which are not very close to hospitals—and if we were to include these or use them as a unit for the care of our infirm aged, we must guard against making these old people feel that they are a nuisance within the hospital organisation. We must rather make them feel that they are exceptional, that the community still wants to take care of them and that they have not been sent there to die. This means that we must counter this idea the old people have.

A number of our hon members are a bit older, but none of us have really reached that stage yet. I want to tell hon members I had to help my own parents through that stage, and the fear in those people’s minds is that they are being moved out to go and die. They feel that their every day will consist only of their bottles of pills, their Bibles and their children’s visits to them.

I want to ask hon members to ensure that we never plant that idea in the minds of old people if we want to apply these ideas in practice. If we apply these practices, let us do so for everyone, regardless of the people’s incomes. Let us also impress upon them that they will receive the best care for 24 hours of the day. Then it will be meaningful.

I now want to plead that where existing old age homes have sickbays, we must not get carried away with this new idea. We must do the one thing and not neglect to do the other. In cases where hospitals are not available for that purpose, we must develop our sickbays. I believe, if we can create a balance between the idea of caring for the infirm aged in hospitals and the idea of developing existing sickbays in old age homes, it will be to the advantage of our whole community. I make a plea for this to be done, for the sake of my own constituency, but also for the sake of those to whom we owe so many thanks in our own lives.

Mr Chairman, it is a pleasure to speak after the hon member for Wellington since he is someone who knows what he is talking about. We have a number of hon members here who are getting old and are going to need care at some time or another. An old man in particular is a wretched creature. [Interjections.] He cannot look after himself.

So many representations were made to the hon the Minister today, and now I have one as well. Just to soften him up a bit, I want to convey my sincere thanks to him for the work he and his department do. I also want to tell him it is wonderful what a flower can do to a man who is not very handsome. [Interjections.]

Hon members must not waste my time by laughing. I do not want to run out of time again.

According to the results of the 1980 population census, 75 000 Whites of all age groups in the Republic can be regarded as handicapped people. This represents 1,65% of the total population or 16,5 in every thousand. Although handicapped people make up a small percentage of the total population, this group of people does consist of a great number of individuals and the community has a responsibility to assure them of a dignified way of life. They may not be neglected; on the contrary, the opposite should apply. The potential of each one must be developed.

The question of whether a handicapped person should be cared for at home or in an institution can be debated for a long time. Nearly all Western countries accept that institutional care and treatment should be regarded as a last resort as far as possible, and restricted to the most essential cases.

The main idea is that the handicapped should be assisted to take up their places in normal community life as far as possible.

The responsibility in respect of the handicapped is shared by various bodies. There is the Department of Manpower by means of its sheltered employment scheme, for example; the Department of Education and Culture in the Administration: House of Assembly, which takes care of all trainable children; the Department of Health Services and Welfare which is responsible for White children and adults with an IQ of 30 and lower, who are regarded as untrainable and ineducable.

In respect of those aged 16 and older, with an IQ of between 30 and 70, and regarded as trainable—they are also the responsibility of this department—a specific policy is followed and that is a policy of co-operation with welfare institutions. This amounts to the welfare institution’s initiating and running the care institution and/or the protective place of work, while the department subsidises the services by means of two separate subsidy schemes.

The payment of disability pensions to the handicapped is a further important contribution of the department in respect of care of the handicapped.

The expenses of social workers employed by welfare organisations which are involved with handicapped people, are also subsidised. At present there are 54 institutions with 2 800 residents, and 14 places of sheltered employment with 624 employees who are subsidised by the department.

We must accept that there will always be people for whom care in an institution is the appropriate solution. I am referring to handicapped people who are not capable of holding their own in society and need constant supervision and care.

According to the population census of 1980 there are 4 090 White blind people in South Africa. The loss of the blind person’s sight does not necessarily affect his other abilities and qualities. It is imperative, therefore, that his other abilities be developed and the open labour market be accessible to him.

A growing number of visually handicapped people do have additional handicaps and chronic illnesses. These multiply handicapped blind people still have a productivity potential, but because of the combination of their handicaps they are unacceptable to the open labour market. Their only refuge is a protective working environment and residential care. The staff who have to supervise the work and welfare of the multiply handicapped blind in their places of work and residences, have no specialised or professional knowledge of dealing with these multiply handicapped blind people.

The main source of these candidates is the Pionierskool vir Gesiggestremdes in Worcester where multiply handicapped blind children’s problems are dealt with by a professional team consisting of the following professions: Psychology, occupational therapy, physiotherapy and mobility and activity training. These specialists, in co-operation with residential and training staff, ensure that the quality of life of the multiply handicapped children is increased to the highest possible level.

An average school career of 15 years costs R150 000 per child, viz R10 000 per child per year. The Government contributes R100 000 to this. These speciality services fall away completely, however, when these children are transferred to the workshops and homes for the blind. As a result the quality of life deteriorates within a short period of time. This has an extremely negative effect on the workshop population as a whole, resulting in general decline in productivity. This leads to a variety of behavioural deviations such as alcohol abuse and sexual offences, which in turn cause an undesired population growth of handicapped people. Only constant understanding, interest and therapy by the abovementioned specialists can salvage this very oppressive situation.

The service to multiply handicapped blind people was begun in 1976 by a management body of the Institute for the Blind. At that stage the Church’s contribution to the care of these people was R36 000 and that of the Government was R12 000. At the end of 1985, the Church’s contribution was R71 000 as against the Government’s R85 000. The Church’s contribution during the past 10 years was R500 000 as against the R300 000 of the Government. Apart from the financial contribution made by the Church, with this service the management ensures that despite staff shortages, multiply handicapped blind people are utilised as productively as possible to try to prevent a growing burden on the Government.

The building of an institution for 100 multiply handicapped people has been approved, and we hope this will materialise shortly. As in foreign countries, the problem in South Africa is enormous.

I now come to the question of the deaf. The deaf person finds that he is constantly moving between two worlds. He has to adapt to and function within the subculture of the deaf, but at the same time he must be able to make a livelihood in a normal environment. The deaf person is constantly exposed to prejudice. Since he has no visible handicap, the community is less sympathetic towards him.

The hon the Minister visited Worcester. I am pleading for the creation of professional posts with the financial support of the Government. I know that is a mouthful and that everyone is asking the hon the Minister for money these days. I hope I opened the Minister’s heart by praising the flower, however, since the need is very great.

Mr Chairman, I rise merely to react very briefly to an appeal for the liberalisation of the South African abortion legislation directed here tonight by the hon member for Houghton to the hon the Minister. I wish to associate myself with the appreciation expressed by the hon member for Germiston District for the standpoint of the Government, the hon the Minister and the hon the Minister of National Health and Population Development that they were not in favour of that.

This matter is also assuming substance in public debate and we on this side wish to adopt a very clear standpoint on it. Our standpoint is that human life should be protected and respected from the moment of conception.

I should like to quote from SA Huisarts-praktyk of March 1986 on this subject. The article was written by a young medical practitioner of Pretoria, Dr C W M J de Muelenaere and, coming from a doctor, his message carries so much more weight. He writes as follows under the title “Die Ou Testament oor abortus provocatus—’n persoonlike ontdekkingstog” :

The article continues:

This young doctor quotes three very impressive passages from the Old Testament. The first is from Psalm 71, verse 6:

The following is from Psalm 139, verses 13-16:

The third quotation is from Jeremiah 1, verse 5:

The doctor continues:

That also represents the standpoint of this side of the Committee. It remains our duty to protect the lives of those unborn fellow South Africans out there right from the beginning to the end.

In terms of section 3(b) of the Abortion and Sterilisation Act, abortion is permitted “where the continued pregnancy constitutes a serious threat to the mental health of the woman concerned”. We believe that it is possible for this provision to give rise to unborn children still being the victims of abortion. If one looks at the statistics, especially on the various population groups, we have reason for concern about this.

I have put our standpoint which I believe is also that of the hon the Minister. I hope the Government will never comply with demands for abortion on demand.

Mr Chairman, I take pleasure in following the hon member for Pietersburg. He referred to a very sensitive and emotional subject and I believe the hon the Minister will reply to him on it so I shall not comment on it myself. I should like to speak on two important matters which I believe are close to the heart of every member in this Committee because they affect us all very closely and they are children’s homes and the disabled.

At the moment there are 78 children’s homes in South Africa which are subsidised by the department and have 7 831 inhabitants. The total amount appropriated for this is R18,432 million; the monthly subsidy per child is R247 plus an increase of 13,9% which now becomes operative. The increase is therefore R33,67 and brings the total monthly subsidy to R281,22 per child.

Five of these 78 children’s homes are in the Free State; they are responsible for the care of almost 1 000 children. One of the best-known and currently probably one of the largest children’s homes, the Charlott Theron Children’s Home, where there are 280 children at present, is in Bethlehem in my constituency and has furnished an excellent service to all the children of our country since 1903. The important fact is that according to estimates approximately 30% of the total amount of R1,6 million which is being appropriated is provided by the children’s home itself from money received by way of interest on investments, donations, the letting of property and contributions from the Church. In spite of this and in spite of large savings effected on expenditure, it is estimated that, in consequence of the enormous increase in costs, there will be a deficit in excess of R300 000 at the end of this year. This will have to be supplemented from reserves.

Adjustments and increases in subsidies were only 4% last year and 13,9% this year as I have already said. This gives an average of 8,8% whereas the inflation rate reached levels of above 20% at one stage. Meanwhile the need for care in children’s homes continues increasing as a result of current economic conditions as well as other circumstances. I am providing hon members with this information to enable them to understand the need clearly—not only of the children’s home at Bethlehem but also that of all other children’s homes in our country. On the other hand, I do not believe that the solution lies merely in the increase of subsidies but far rather in the adjustment of the subsidy to the quality of service furnished at these children’s homes. There are numerous children’s homes, of which the Charlotte Theron is only one, which already have single units comprising ten children each at the most in order to create a more homely atmosphere but where the maintenance and management are obviously far more expensive in being able to furnish this specialised service and such a children’s home also has to have a multidisciplinary team of personnel at its disposal. I therefore wish to suggest and appeal to the hon the Minister that, as in the case of homes for the aged, children’s homes should also be graded in different categories and the subsidy per child then adjusted accordingly. This action would not only cause us to succeed in ensuring the continued existence of our children’s homes but I am convinced that the quality of the care of the children would improve considerably. I believe I am speaking on behalf of the administrators of all children’s homes in our country.

Secondly, I should like to talk about the disabled. On the occasion of the conferring of degrees at the University of Stellenbosch on 12 December 1985, the State President said the following:

The State President further stated that the Cabinet decided on 20 November last year to declare 1986 the National Year of the Disabled. On that occasion the State President also announced that an additional amount of R10 million would be made available for special accommodation, means of aid and so on as a sign of the State President and Cabinet’s sincerity in declaring 1986 as the Year of the Disabled. We are very grateful that this year has been designated in this way but perhaps it is long overdue as 1980 was the World Year of the Disabled. As the disabled are not only the responsibility of the State, this year will contribute to each of us—every privileged, normal person—becoming more involved in the care of our disabled.

In the short time at my disposal it is difficult to give hon members a comprehensive survey of the disabled in our country but I should like to give the following information in brief. The hon member for Worcester has already referred to it.

According to the 1980 census there were 16 766 mentally retarded—that is people with an IQ below 70—among Whites of all age groups. This represents 3,7 in every 1 000 of the population. For the purpose of my argument I should like to divide the retarded into two groups—those qualifying for compulsory education in the age group 6 to 18 and the adult group above 18—because separate departments are responsible for the care of these people. I should also first like to confine myself to the Free State and secondly perhaps more specifically to my constituency on our contribution to the Year of the Disabled.

The disabled of school age are the responsibility of the Department of Education and Culture and I think fine progress has been made in the case of these children over the past number of years. In 1981 a national plan was launched under which the Free State—and probably the other provinces as well—was divided into two regions with growth points in Bloemfontein and Welkom. The Vryburger centre for the disabled which was established at Bethlehem at the beginning of 1980 with a pupil count of only seven, which rose to more than 80 within a year, was closed at the end of March this year and the children transferred to Welkom where we believe they will receive the necessary specialised attention.

As regards the adult disabled, at present there are 52 homes for the care of 2 942 physically disabled and mentally retarded people. I believe enormous leeway exists regarding these disabled people, especially the mentally retarded. I also believe that the parents of the disabled are particularly concerned about the mentally retarded child above school age.

There are only 24 aftercare centres accommodating 1 583 people for the mentally retarded. There is only one of these in the Free State—the Free State Aftercare Centre in Bloemfontein. There are 140 active and 40 passive disabled persons at this centre and more than 140 names on the waiting list. I am mentioning this merely to indicate the enormous need there is for such centres in the Free State.

There is also an enormous shortage of trained personnel. According to information I have obtained, more than 50% of the personnel at all these institutions do not even have standard 8 training.

I have already said the Vryburger centre in Bethlehem has been closed but the Bethlehem community wishes to be involved in the care of our disabled. At present we are working for the institution of an after care centre. We have 13 hectares of land for this purpose and a splendid fund exceeding R30 000 has already been accumulated by the Bethlehem community which wishes to contribute in this way by creating an aftercare centre during the current Year of the Disabled.

That is why I appeal to the hon the Minister and his department to approve in principle the establishment of such a centre in Bethlehem so that it may be carried out when adequate finance is available. [Time expired.]

Mr Chairman, as in the case of cricket, it often happens that the Whips give men who make a strong stand a turn to talk late in the evening!

When I participated in this debate earlier today, I quoted from the hon the Minister’s introductory speech to the discussion of this Vote. I regard what he said as a very strong and positive way of stating Government policy. I think it is worthwhile repeating that quotation; this then from the hon the Minister’s introductory speech:

That is a mouthful and we definitely have to carry it out because I said we would have problems if we did not. If we continue allowing people to pay the same taxes and have them pay even higher medical charges, we are taking more milk from that cow which does not have an extra teat. If one knows one’s anatomy, one knows there is not an extra teat from which to milk taxes or whatever.

During the dinner hour I examined a few very interesting papers which I have at hand.

†One of them is a paper delivered on 1 May 1986 in Johannesburg at the Privatisation Conference of the Greater Soweto Chamber of Commerce and Industries and the Free Market Foundation of Southern Africa. It was delivered on 1 May 1986 by Dr E de la H Hertzog, the managing director of a private hospital group. He said, among other things—and it conforms with what I said earlier today—that inevitably the Government’s expenditure would increase on medicine—there is no doubt about that— and that medical costs in South Africa would inevitably rise a lot. He said further that the Government could only reduce its financial obligation in three ways, firstly, by increased efficiency, of which the effect will not be dramatic because high quality health care remains very expensive to provide; secondly, by the lowering of standards, which of course, is unpopular and also not acceptable; and thirdly, by the shifting of patients to the private sector, which is a logical alternative.

He then goes on to say something of great importance, which I would like to quote from the paper:

*That is precisely the problem I put. I further referred to this bluff, this idea which patients have that they receive cheap treatment at provincial hospitals. At a lecture a little earlier, on 18 March this year, the same gentleman made this interesting observation at the annual congress of the Representative Association of Medical Schemes:

[Interjections.] He quoted figures from official statistics. These are important figures because the actual day-patient costs at a Government hospital are very difficult to determine; in fact, I think no one knows what they actually amount to. Who pays for furniture, for instance, and for pens, paper and repairs? The cost of these are not added to those daily costs; depreciation and all related factors are not added. The figures supplied regarding day-patient costs are therefore not a true reflection; costs are really much higher.

The official figure for day-patient costs supplied for the Johannesburg General Hospital is R185.

Mr Chairman, on a point of order: Is the hon member for Newton Park permitted to sit reading a newspaper in the Committee?

Order! No, no hon member may sit and read a newspaper in the Committee. The hon member Dr Vilonel may proceed.

In the Orange Free State the cost per patient per day at the Universitas Hospital is R330,59; it is R160,90 a day at the Bethlehem hospital for Whites but I say that costs are actually much higher.

As regards income and expenditure of medical health services in the Cape Province, in 1982 the income was R24,7 million whereas expenditure amounted to R434 million. In 1983 income was R36,8 million and expenditure R532 million!

The hon member for Durban Point was mistaken on the point I now wish to put. He said people received cheap treatment at provincial hospitals—I am damned if that is true. We, the taxpayers and private patients, pay an enormous proportion of it. If a patient pays R50 and it actually costs R350 to keep him there, who pays the balance of R300? The taxpayer has to pay it. The hon member is under an illusion, a bluff, and we shall run into trouble if we are unable to carry out the policy as the hon the Minister put it. That is why I said we should give people the correct information and, what is more, prepare them correctly.

Time is catching up on me and I therefore wish to appeal for incisive discussions—I think we are approaching that point—between the private sector and the State on privatisation in the hospital sphere as well. The private sector and the State often do not use the same terminology. The private sector cannot draw up a series of ordinances or regulations; they require the actual facts to be able to take steps.

There is another matter I wish to touch upon briefly and that is the role medical practitioners and paramedics can play and which they actually play as regards the promotion of human relations in intergroup relations. In the first case I wish to pay tribute to the medics, nurses and paramedics for the enormous task they accomplish in our country—not only in the medical sphere …

Mr Chairman, on a point of order: Is the hon the Minister of Transport Affairs permitted to read a newspaper while the debate is in progress?

Order! I do not see the hon the Minister of Transport Affairs reading a newspaper. The hon member Dr Vilonel may proceed. [Interjections.]

I wish to pay tribute to the medics for the enormous task they furnish our country day and night, seven days a week, 30 days a month, 12 months a year, year in and year out. They not only provide a medical service to alleviate pain and suffering; they also play an important part in human relations. The task carried out by a doctor and a nurse—the hon member for Germiston District also referred to this— is so noble that it enables them to promote good human relations in a fine way.

I wish to draw the attention of the Committee to what the Chairman of the Federal Council of the Medical Association of South Africa said about discrimination in medical treatment. I am quoting from an article in the SA Medical Journal of 9 November 1985:

I think that even the hon member for Pietersburg who is a member of the Medical Association like all doctors would agree with what Dr Le Roex says:

I wish to state the point that they actually do this.

I want to relate an anecdote to the Committee briefly. I said earlier today that it was a debatable statement but, if something had happened 10 years before, one could reveal it. About 10 years ago I was involved in Mozambique in what I shall call certain exercises. On one occasion I saw an athletically built Black woman in a uniform with a gun. I had never seen anything like that before and wanted to take a photograph of her. As a typical female, she was quite willing to have the photograph taken but, as I was taking it, I was arrested by Frelimo. While my friend and I were waiting for the commandant in the office, I made very sure that they learnt I was a doctor. Before long I had examined the second in command, diagnosed his illness and told him what to do about it. By the time the commandant turned up, the atmosphere was of such a nature that we were held for hardly two or three hours before being released again. Ultimately I accompanied the commandant to the bush where I saw how Frelimo was trying to teach Black soldiers, whom they had previously taught to kill nearly all White people, no longer to do so.

I wish to make the point that I was treated well because I am a medical man and, because medical practitioners lend themselves to striving for a policy of no discrimination, they can make an enormous contribution to human relations; they do so, in fact. [Time expired.]

Mr Chairman, I shall not respond to the hon member Dr Vilonel and his arrest.

Earlier this evening the hon member for Pinetown referred to problems surrounding places of safety and to the recommendations of the De Meyer Report. It would perhaps have been fairer if the hon member had devoted more attention to the recommendations which have already been carried out by the department. The hon member devoted considerable attention to matters he considered required further attention but, if he had gone into this thoroughly, he would have had to admit that the department deserved considerable praise for matters which had received attention such as the appointment of expert staff at most places of safety, which is a great expense.

One of the matters we are too inclined to ignore is the responsibility of communities in upgrading facilities and services at places of safety. One of the characteristics of this problem is the phenomenon among certain communities that people show no interest whatsoever in these children in need of care. [Interjections.] I think it necessary that interest should also be shown from the side of the community and that the upgrading programme should have community support.

I wish to revert to a matter I touched upon earlier this evening which is the revision of standards in subsidising welfare services. One of the matters to which I referred was the importance of examining the nature of aid programmes in particular. As an example, I should like to discuss two possible aid programmes to substantiate that it is possible to furnish effective programmes on less money.

I am referring for instance to the parent guidance action of the South African Women’s Federation in the Transvaal. This programme, which has been operative for the past 20 years and is chiefly offered in the Transvaal is a preventative development-orientated programme furnishing mothers and parents with guidance. This programme reaches 3 000 mothers a month on average and the costs involved amount to approximately R37 000. That was the 1984 amount but it must be considerably more now.

If we consider the expenditure attached to this programme and compare it with the amount of money spent on the care of needy families—in which eight social workers in Pretoria have to attend to approximately 1 000 families at a cost of some hundreds of thousands of rands—there is no comparison between the expenditure in the two programmes. It is also possible to indicate that results obtained from the preventative development programme are of more use or at least make a definite contribution to the community.

The aim of this programme is not to concentrate so much on problematical aspects in the educational situation so the focus is not chiefly on problems but on educational objectives. Attention is paid to what parents should know and the abilities they should acquire to be effective parents. The entire programme is organised by one expert with the assistance of a number of trained people who furnish their services gratis and volunarily. This makes it possible to carry out meaningful action throughout the community.

The following programme I wish to cite as an example is the involvement of volunteers n the care of needy families. I have just reefred to the treatment of such families. Most of these families have been receiving attention for as long as 20 to 30 years. When an analysis is done of the actual practical problematical aspect of these families, it becomes clear that the social worker runs up against certain practical problems in the aid programme such as limited mental capacities. People do not always have the capacity to be able to make the best use of this highly defined, clinical therapeutic aid programme. Consequently a number of these families are dentified as such when we are reasonably sure that there are limited capabilities for progress and bringing about change. These families are then allocated to a number of volunteers who are recruited from the comnunity and trained as auxiliary assistants to he social worker. They then keep an eye over a group of these families under the upervision of one social worker.

The results of this treatment are usually encouraging as it has been found that these lients find greater rapport with the voluneer. The fact that the social worker repesents the structure of authority and the lient sometimes fears that this social worker nay cause statutory interference in his way of life, is an impediment to much closer involvement. Against this, the volunteer has a very spontaneous and informal type of approach to this client. The type of contact which takes place makes it possible to render assistance even in these cases where this was not actually expected at the inception of the programme. At the launching of the programme it was hoped chiefly to institute a supporting service to clients or families in the community because, after a number of years of active involvement by expert personnel, we were sure that they would not progress. It was felt, however, that they could not be left to their own devices and we had to see to it that there were people who would care for them. The costs attached to such a preventative development-orientated programme are fare less, for instance, than the expensive clinical therapeutical programme in which social workers have to be involved in a one-to-one situation in the treatment of these cases.

A further programme I can also cite as an example of precisely what can be carried out with a low-cost structure is the foster-care programme in which a number of foster-parents, in conjunction with social workers, are involved in group sessions in which the entire problematical aspect concerning the care of the foster-child is discussed with these parents. Parents are then given the opportunity of discussing all their uncertainties on the foster-care situation in a group situation with the social worker. This eliminates the expensive work situation of one-to-one cases.

Possibilities are unlimited and I should very much like to make a strong appeal that in revising subsidies we make particular provision for the subsidisation of such programmes. Of all the programmes to which I have referred, not one has so far fully qualified for subsidisation. The parent guidance programme, for instance, has been entirely carried financially by this organisation. I therefore consider it necessary—and should like to put it very strongly to the hon the Minister—that this kind of aid programme is the very type of case which should qualify for subsidies because we reach very many more people through this, because we carry it out in a cheaper way and because the results of these programmes have convinced me that we would progress much farther with them than with expensive clinical there-apeutic programmes. [Time expired.]

Chairman directed to report progress and asked leave to sit again.

Mr Chairman, since the members have behaved themselves so well, I move:

Agreed to.