§ The Minister of Health (Mr. Enoch Powell)
With permission, I wish to make a statement.
The net estimates of the National Health Service and the Health Departments for next financial year indicate an increase of 11 per cent. over those for this year. This follows upon an increase of over 8 per cent. this year and 988 over 6 per cent. the year before. The total cost in the current financial year is about £867 million, of which £663 million will be met by the Exchequer.
The Government are determined to continue their policy of developing the Health Service and, in particular, to carry though a long-term programme of modernising our hospitals. These objects would be in danger if the cost of the Service to the Exchequer were allowed to go on increasing at so high a rate. The Government have, therefore, decided that certain steps to reduce the net estimates are necessary.
The cost of a number of items for which charges are made has increased substantially since the charges were last fixed, and it is proposed to adjust them.
The charges for dentures will be increased by amounts ranging from 5s. to 15s. On the other hand, in order to put more emphasis on conservation, the charges for dental treatment will not be raised and children and expectant and nursing mothers will be relieved in future of the present charges for dentures.
The charges for spectacles will be increased by 5s. a pair, with a higher charge for bifocal and multifocal lenses. However, it is proposed that children aged 10 or over shall no longer be charged for spectacle lenses in any type of National Health Service frame.
The maximum charge for amenity beds in hospitals in England and Wales will be doubled from 1st March. [HON. MEMBERS: "Oh."]
The cost of the pharmaceutical services this year will be about £92 million gross, £80 million net. Since the charge for prescriptions was fixed at 1s. an item in 1956, the average cost of an item has increased from 5s. 1½d. to 7s. 4d. The Government are proposing to raise the prescription charge to 2s. per item from 1st March. [HON. MEMBERS: "Shame."] We believe that this measure is necessary, along with others already taken or in hand—[HON. MEMBERS: "Disgraceful."]—to restrain the increase in the cost of the pharmaceutical services.
The Government have decided that from 1st June orange juice, cod liver oil and vitamin tablets under the Welfare Foods Scheme will be sold at prices which cover the cost.
989 The existing arrangements for refund of prescription and other charges will remain in force, and arrangements will be made through the National Assistance Board for the free issue of vitamin supplements.
The Government also propose to increase the National Health Service contribution with effect from the beginning of July next by 1s. a week for the employed man—10d. from the employee and 2d. from the employer—and by the appropriate amounts for other insurance groups. [An HON. MEMBER: "They have never had it so good."] This will increase the yield from the contribution by about £49 million in a full year. My right hon. Friend the Chancellor of the Exchequer will table the necessary Ways and Means Resolution tonight.
A Bill relating to the dental and optical charges will be presented tomorrow. Regulations altering the charges for prescriptions and amenity beds will be laid on Friday, and a new Welfare Foods Order will be made shortly.
All these changes apply to Scotland, except that relating to amenity beds, for which in Scotland the charges are adjusted automatically.
The effect of all the measures which I have announced will be to reduce the net Health Estimates by about £50 million in 1961–62 and about £65 million in a full year. [HON. MEMBERS: "Shame."]
§ Mr. K. Robinson
Is the Minister aware that the comprehensive list of charges which be has just announced represents, in our view, the biggest single assault on the whole principle underlying the National Health Service since it was conceived, and a very serious inroad into the whole Welfare State? [HON. MEMBERS: "Nonsense."] Is he aware that the charges which he has announced are so comprehensive in their nature that he even tried to take credit for the one or two charges which he has not increased? Clearly, the matter is far too big to deal with in question and answer, and we shall have debates on the subject shortly.
However, I should just like to say, at this stage, that we take particular exception to the increase in the National Health Service contribution, which, of course, is a poll tax and falls most heavily on those less able to bear it.
990 As for the prescription charge, does the Minister not recall that a Committee advised him that his Department would probably save money by abolishing the prescription charge altogether? Is he aware that we regard the charging for welfare foods at cost price as being a peculiarly mean step to take?
Finally, the Minister once resigned from office. Does he not think that as the Minister responsible for a great service like the National Health Service he would have done better to return to the back benches rather than agree to these charges?
§ Mr. Powell
On the contrary, I should have been betraying my trust if I had agreed to an increase in the budgetary cost of this Service, for it would inevitably have resulted in the development of the Service itself having to be curtailed or limited if these steps had not been taken. The hon. Gentleman referred to the National Health Service contribution as a poll tax. It falls, of course, to be considered in the context of the whole economic position of the country, of the earnings of those who will pay it and of the tax system as a whole, but the proportion of average earnings which will, in future, be collected by way of the stamp, is not appreciably greater, in the nearest practicable comparison, than it was in 1948.
§ Mr. Turton
Will my right hon. Friend give an assurance that the measures he has announced would not be directed in any way towards reducing the expenditure on the hospital building programme and on the improvements to the National Health Service? Will he bear in mind that when Sir Stafford Cripps imposed a ceiling of £400 million on the Health Service, he did much to retard its development? We do not want that to happen again.
§ Mr. Powell
It is exactly those considerations which the Government have in mind in taking these steps.
§ Miss Herbison
Is the right hon. Gentleman aware that the answer he gave to my hon. Friend the Member for St. Pancras, North (Mr. K. Robinson) proves what all of us felt in the House—and certainly many people in the country—when the right hon. Gentleman was appointed Minister of Health?
991 It seems to us that a Minister of Health should, in the Cabinet, be fighting to ensure that we have a good Health Service. I accuse the Minister of not only doing far from that, but of having incited the Cabinet to put these charges up. Is he not aware that these charges, particularly those for prescriptions, and the increases in the contribution, will fall heaviest on those people who really cannot afford to meet them?
Has he given any thought to those who are just under the National Assistance scale and who are finding it very difficult to pay even 1s. per item? Has he given any thought to the disabled who have to pay for these items? Has he given any thought to the low wage earner, who will have this poll tax put on his earnings?
I hope that the country will show very clearly in the next few days how disappointed and, indeed, how disgusted it is with the Minister and with his Government.
§ Mr. Powell
The hon. Lady referred, in particular, to possible hardship in connection with prescription charges. When my right hon. Friend the Member for Thirsk and Malton (Mr. Turton) announced the last increase in these charges, he offered—and that offer was punctiliously fulfilled—to look at any circumstances of possible hardship, arising out of it, which might be brought to his notice. I renew that offer and pledge now.
As regards what the hon. Lady said in general, I believe that it is recognised in this House, and in the country, that, with the present rate of increase of the cost of the Service to the Exchequer, the alternative is between the measures which I have announced and a limitation of the expansion of the Service. If the House, or the country, has to choose between limiting the expansion of the Service and the measures which I have announced, I have no doubt what the decision will be.
§ Mr. Nabarro
Would not my right hon. Friend agree that the fundamental considerations in this matter price stability and the growth of the national economy? Do not all the measures that he has announced today contribute to that end in the ultimate? Would he not 992 agree that the aggregation of reduction of net cost of this Service, of £50 million this year and £65 million in a full year, represents only 8 per cent. of the total and ought to be judged in that perspective?
§ Mr. Powell
My hon. Friend the Member for Kidderminster (Mr. Nabarro) is quite right in reminding the House that there is an inevitable connection between the national income and what can be deployed upon a particular service, and that it is the duty of those responsible for the respective services to see that the priorities are preserved. By measures of this kind we ensure that the essential and growing elements of the National Health Service can go forward unimpeded.
§ Mr. Harold Davies
Is the right hon. Gentleman aware that many hon. Members, on both sides of the House, whatever they may say, realise that our magnificent Health Service is worse now even than that in Western Germany? Is he further aware that from his side of the House we were told, "Don't let Labour ruin it"? Members opposite have now completely obliterated the purpose of the Health Service.
§ Mr. Powell
I am not prepared to institute a comparison between our National Health Service and the service in any other country, but I can tell the House that the Health Service in this country is steadily providing a better and better service, that over the last five years the number of in-patients treated in hospital has gone up by 10 per cent., that the number of out-patients treated has gone up by 5 per cent., and the number of domiciliary consultations by 30 per cent., and that the most essential elements in the Service—the human material—the nurses and doctors, both inside and outside the hospital service, are steadily increasing in numbers. The Service is steadily and regularly making progress.
Mr. H. Wilson
Since the present Prime Minister introduced the individual prescription charge in 1956, when we were in a financial mess, will the right 993 hon. Gentleman tell us why it is that whenever the Government get into an economic mess it is always the patients and others in greatest need who have to bear the cost? Will he also say, since the main increase in costs has been the profits of the pharmaceutical manufacturers, why he has not taken it out of them instead of out of the patients?
Finally, is he aware that every time these charges have been announced, successive Budgets—usually before elections—have not remitted them, but that, instead, there have been big taxation hand-outs? Will he take it from us that if these measures are to be associated with a hand-out to Surtax payers in the Budget, or with any similar concession, the parry opposite can expect the most bitter—
Is the right hon. Gentleman aware that, if that occurs, then the party opposite can expect the most bitter fight over the Finance Bill that it has ever had? Will he tell us. in view of the posters which we see all over the country, whether this is what the Government mean when they say that "the Conservatives care"?
§ Mr. Powell
I can with confidence leave my right hon. and learned Friend the Chancellor of the Exchequer to answer for his own Budget. The right hon. Gentleman said that these measures were taking it out of the patients, but it would be the patients who would suffer if the development of the National Health Service were held up.
Right hon. and hon. Members opposite have themselves had experience of this. They put a ceiling on the cost of the Service. I want the Service to continue to develop along well-thought-out lines. That is what will be to the benefit of the patients, and that will be the evidence that the Conservative Party cares.
§ Mr. Gaitskell
As the Minister's statement constitutes a major assault on the National Health Service, and as, in our view, it is desirable that it should be debated as a whole, I give notice that we shall immediately table a Motion of censure upon the Government.