HC Deb 20 April 1950 vol 474 cc456-62

9.59 p.m.

Mr. Linstead (Putney)

I beg to move, That an humble Address be presented to His Majesty, praying that the Regulations, dated 16th December, 1949, entitled the National Health Service (General Medical and Pharmaceutical Services) Amendment (No. 2) Regutions, 1949 (S.I., 1949, No. 2341), a copy of which was laid before this House on 16th December, 1949, in the last Parliament, be annulled. The first thing I have to do tonight is to express my apologies to the Parliamentary Secretary that having put this Prayer on the Order Paper, I was not in my place when it was called. I have already expressed my regret to him personally, and I shall repeat it tonight. The excuse, which I hope appeals to him, was that at that time I was engaged in the business of some of his own Ministry's hospitals, and I must plead that in extenuation.

In these Regulations I wish particularly to draw attention to two paragraphs only. One paragraph is No. 16 on the fourth page, which deals with the advertising of the Pharmaceutical Services, and the other one on page three, No. 11, dealing with a new system of prescribing under the National Health Act. Both these new Regulations involve matters of principle, and that must be my justification for bringing them to the attention of the House, and for asking, as I shall, for one or two assurances from the Parliamentary Secretary.

In dealing with the new method of prescribing medicines, which Regulation 11 provides, I would just outline what it does. It permits in an institution a doctor who is responsible for the medical care of the inmates of the institution, to write prescriptions for stocks of drugs and medicines instead of writing prescriptions for individual patients. That represents a very substantial departure from the principle of the National Health Service. The Section under which these regulations are made is a Section which in two places makes provision for personal medical services.

The first point I want to make is that a provision whereby bulk medicines are prescribed to institutions to be kept in store in those institutions until somebody there requires them, is a complete departure from the principle of a medical service. I believe the intention has been to meet a complaint which is quite understandable from boarding schools and places of that kind, where there is a sanatorium, where it has been customary to keep stocks of medicines and where in the strict method of the National Health Service it might be wasteful for a doctor to prescribe a series of individual bottles of medicine when there is an epidemic or where there is a group of patients in the sanatorium all suffering from the same illness.

That would be quite understandable, and if the Regulations were merely to provide for that contingency it might be described as providing for personal medical service, but the Regulations deliberately do not do that. They say that every time a school doctor or doctor attending a National Assistance institution writes one of these bulk prescriptions, he has to enter the name of the school or institution and the number of persons residing therein for whose treatment he is responsible. In other words, it is not merely a bottle of medicine or a number of tablets to be divided amongst a number of patients but a new departure of building up of stocks in a sanatorium or the sick room of an institution.

The second point is: Why choose one type of institution for preferential treatment? Take all the factories which have medical officers, nurses and provisions for the health of the employees. Why should factory proprietors be expected to pay for the medicines which they provide whereas the governors of a boarding school should be given free medicines to stock in their medicine cupboards? if the new method of bulk prescribing, with the bulk treatment by nurses and matrons which it involves, is to be permitted to one or two institutions, it should be extended to all those other places—factories are an obvious example—where National Service patients are receiving medical treatment.

Another point on which I invite the Parliamentary Secretary's answer relates to the provision at the end of the regulations dealing with advertising of the pharmaceutical services in chemists' shops. Advertising by doctors and dentists is controlled by their professional bodies, and is largely prohibited. I should have thought that it would have been the desire of the Minister of Health to extend a similar prohibition to the optical and pharmaceutical services and that the last thing he would want would be one person providing the National Health Service in competition with another person, with the implications that one was providing a better service than the other, and that the Minister was providing a different service of a different quality in different places.

The Minister settled a standard form of notice which the optician might display and he said, in effect: "That is what you may have in your consulting room, and the patient will then know that there is an optician. That is all that he needs to know." In connection with the pharmaceutical service he has gone far beyond that, and has permitted competitive advertising among different chemists. He has done that by ignoring the advice given to him by the professional body responsible for the discipline of chemists and he has acted against the views held in his own Department until 18 months ago.

At the end of these regulations is a definition of "advertising" which includes: Advertising in newspapers, by circular letters, loud speakers, by placards, streamers, or signs, and by films or slides. Then he provides certain restrictive words any of which may be used according to the interpretation of the regulations by any of the methods I have described. Instead of providing, as in the case of opticians, one standard form which all could accept, he has permitted, and, indeed, encouraged, all those people to indulge in the use of restrictive words by any of those prescribed meanings. He is doing that in spite of the fact that his own Department in March, 1948, in a letter which I have here, expressed this opinion: As regards the question of advertising the pharmaceutical service under the National Health Service Act, we would regard this also a wholly professional matter which we should not attempt to deal with by regulation. I am certain that it was unwise on the part of the Minister to depart from that opinion. I am sure that if he had left it to the professional body, as he left it in the case of the dentists and the doctors, to prescribe the methods of advertising he would have been on much firmer ground. It has been laid down by the Pharmaceutical Society that advertisements to the public should not refer to dispensing services provided that this does not apply to the use of the description "dispensing chemist" or to the exhibition of a notice at any premises stating that dispensing is carried on there.

Instead of contenting himself by relying on the professional disciplinary body, he has now instituted his own professional standards, which include provision for all those methods of advertising to which I have referred, and I am sure that in doing so he has cheapened his own service. It is a matter of very great regret that he should have put himself into competition with the standards laid down by the professional body. I believe that the professional body will still insist upon applying its own standards irrespective of the slacker standards which the Minister may be prepared to see.

I very much hope that the Parliamentary Secretary will be able to say that if there is abuse of either of the matters of which I have spoken the Minister will be prepared to look at them again. I believe that a matter of principle is involved in both cases and that it might not prove to be satisfactory to leave the situation as it is left by the Regulations.

Sir Hugh Lucas-Tooth (Hendon, South)

I beg formally to second the Motion.

10.14 p.m.

The Parliamentary Secretary to the Ministry of Health (Mr. Blenkinsop)

We appreciate the manner in which this subject has been raised and the interest of the hon. Member for Putney (Mr. Linstead) in the points which he has mentioned. Also, I accept the apology which he graciously made to the House.

I shall first take the point which he raised on the subject of bulk prescribing. It is obviously true that, in general, the practitioner should prescribe individually for each patient, and, as he rightly said, that has been the principle on which the Service has been founded; but in practice we have found, as the result of experience that there are certain exceptional cases where this is very difficult to apply and where it seems to us to be wasteful of both the doctor's time and that of the patient—which we consider to be of some importance—as well as wasteful of medicine bottles and medicines. We must always be prepared to consider the practical issues involved in these cases.

We could take the case of the boarding school or some institution such as Dr. Barnardo's Homes, where one doctor is responsible for many of those in the institution, and where there may be some comparatively mild infection amongst many of those for whom the doctor is providing a service. It has been found in practice that the doctor has been expected under the existing regulations to make out a separate prescription form for each of the patients suffering exactly the same ailment. That is rather stupid, particularly when it may amount to quite a number of pupils in schools or institutions.

We say that there we must have some simpler form which will save the time of the doctor and, indeed, save medicine bottles. I have no doubt that on several occasions doctors have got round the Regulation by making out a prescription possibly for a much larger quantity for one pupil. We think it far better to deal with the matter by amending the Regulation although we appreciate that there are problems involved, and we shall keep an eye upon the operation of this Regulation and shall, of course, be perfectly willing to reconsider it if it does not work out satisfactorily.

Mr. Linstead

The Parliamentary Secretary is really answering a rather different point. I would not have been so critical of what is provided if it were merely providing in one bottle medicine for a number of people who are ill. That is not what the Regulation is designed to do. It provides that one writes on the prescription not the number of people who are ill, but the total number of people in the institution. Therefore, the main object of the Regulation is not to deal with sick people who are ill but to provide for 600 people; otherwise, why make that requirement? It is directed not at the epidemic but at accumulating stocks of medicine in the institution.

Mr. Blenkinsop

That can cover both cases. In this Regulation we have asked for the number of people in an institution in order to qualify for this provision. We have also provided that the doctor must have more than a certain number in that institution on his list before this can operate, otherwise it might bring it down almost to the size of a family.

Mr. Linstead

Could the hon. Gentleman explain why the Regulation requires on the prescription the total number of people in the institution?

Mr. Blenkinsop

We ask for the number of people in the institution in order to prove that the doctor concerned has the requisite number on his list, and so that we have some confirmation of that on the bottle.

Mr. Linstead

I feel that the Parliamentary Secretary is not on too strong ground there.

Mr. Blenkinsop

This is a perfectly reasonable suggestion and it has been referred to us by quite a number of doctors, as well as by institutions. It seems to us that it is fair to make a trial of a Regulation of this kind. It is always possible for us to amend it if we find that there is any abuse of it.

The hon. Member asked, if we found this procedure suitable in these particular cases, why not extend it to factories and other centres of that kind? Surely, the answer is that we are dealing there with a very different type of situation. When we speak about schools and other residential institutions, the doctor is the regular doctor who is providing care to those patients, whereas in the factory we are thinking only of special attention for first-aid or emergency. The worker in the factory is still on the list of his own doctor near his home and we have no desire in any way to break that relationship. In fact, we have always insisted that it should be maintained

The hon. Member also raised the question of advertising by chemists and he asked why my right hon. Friend had altered the existing regulations. The present position, as I think is known, is that advertising can be undertaken solely in the windows of chemists' premises and within the approved wording. There are three points of view in the profession, and it is not quite fair to say that the profession are unanimous about this matter. That, to some extent, is our difficulty.

There is the view of some chemists who suggest that the present position should be retained. Others go to the opposite extreme and say that there should be completely free opportunity of advertising. There is a further group which takes a middle course in suggesting that a restricted form of advertising should be permitted in approved wording, but that chemists should be allowed, not only to advertise their participation in those approved words in the windows of their shops, but also to do it in the Press and in other specified ways.

We felt that it was fair, in view of the representations that have been made to us and the differing points of view that are taken up, that we should follow this middle course. Again, we will of course keep under review these changes which we are making, and if there appears to be any general abuse of the Regulations, or if any undesirable practices appear to be developing, then clearly we shall be perfectly willing to review them and to make such amending Regulations as may be necessary. I hope that in view of this..the hon. Member will be prepared to withdraw his Motion.

Mr. Linstead

I am grateful to the Parliamentary Secretary for what he has said, and in view of his assurances I beg to ask leave to withdraw the Motion.

Motion, by leave, withdrawn.