§ 7.37 p.m.
§ Mr. Kenneth Robinson (St. Pancras, North)
1 beg to move,That an humble Address be presented to Her Majesty, praying that the National Health Service (Charges for Drugs and Appliances) Regulations. 1961 (S.I., 1961, No. 182), dated 1st February 1961, a copy of which was laid before this House on 3rd February, be annulled.I think it would be for the convenience of the House if you would agree, Mr. Speaker, that this Prayer and the Prayer against the Scottish Regulations be discussed together.
§ Mr. Speaker
Yes, if the House really understands the consequences of that. It is quite agreeable to me if that is the common desire, but owing to difficulties which have arisen in the past I step delicately about making such suggestions myself. The time axe will fall and the Question will have to be put separately.
§ Mr. Robinson
I understand that, and we would prefer it that way. We have tabled these two Prayers against the Statutory Instruments increasing the prescription charges in respect of the general medical and pharmaceutical services under the National Health Service, which leaves for discussion on another occasion the charges on prescriptions issued under the hospital services and also the increase in charges on amenity beds.
This is now about the fifth round in the Parliamentary battle which was quite consciously and deliberately provoked a fortnight ago by the Minister of Health. There will be many more rounds to come as the subsequent Orders are discussed and as the two Bills now before the House pass through their various stages.
1842 The earlier rounds of the battle have already served more than one purpose. They have certainly served to alert the public to what is happening to the National Health Service at the hands of the Government and the Minister and to warn them of the demands which will be made upon them in terms of cash in the next few weeks and months. Our earlier debates have also served to expose the utter flimsiness of the Government's excuses for the Measures they are bringing in and the total failure of the right hon. Gentleman and his right hon. Friends to justify them. One further advantage is that yesterday we had an admission from two Treasury Ministers that the cost of the National Health Service today in terms of the national income was no greater than it was ten years ago. That is also a step forward, because that is what we have been saying persistently since this series of debates began.
Yesterday, we also had another piece of evidence in the form of the Vote on Account. The Vote on Account shows quite clearly that for next year there will be a decrease of £31 million in the net Estimates for the National Health Service for England and Scotland—from £631 in the current year to just a fraction over £600 for 1961 62—
§ The Minister of Health (Mr. Enoch Powell)
That is not, of course, comparing original Estimate with original Estimate.
§ Mr. Robinson
I understood that it was a fair comparison. Presumably the right hon. Gentleman is indicating that the figure for the current year includes the Supplementary Estimate for the doctors' pay
§ Mr. Robinson
All the Supplementaries, of which that was the greatest by a large margin.
However, I believe that it is now abundantly clear that the whole set of proposals put forward by the right hon. Gentleman is no more or no less than a calculated redistribution of the cost of the Service and a shift of the financial burden from the backs of the well-to-do to the backs of the poor and the sick.
These Regulations deal with prescription charges, and I want to remind the 1843 Minister that his predecessor set up the Hinchliffe Committee to advise him on the cost of prescribing. That Committee reported in 1959, and stated its views on prescription charges repeatedly and very clearly. Paragraph 288 of the Report states:We consider that the present charge "?that is, the 1s. charge:is a tax which stimulates avoiding action and is resented by patients and doctors as a tax on illness.In paragraph 289, the Report says:We conclude … that, besides stimulating the wrong incentives, the charge … has proved disappointing financially.The Committee went on to make constructive suggestions. It suggested that the medical profession should be invited for a trial period to co-operate in the voluntary limitation of quantities of drugs to be prescribed, and that, if this trial were successful, the Minister should seriously consider the abolition of the 1 s. prescription charge. The right hon. Gentleman's predecessor, the right hon. and learned Member for Hertfordshire, East (Sir D. Walker-Smith), issued that invitation to the medical profession, and I understand that it was accepted by the profession and a trial period of two years was undertaken. I remind the House that the whole purpose of this recommendation of the Hinchliffe Committee was that it should lead to the oblition of the charge.
Without waiting for any success or failure, the present Minister simply doubles the charge, and I should like to make one further quotation from the Hinchliffe Report, because it is a very important document. It states in paragraph 12 (lviii):If any change in the basis of the prescription charge is contemplated in the future, it should not be put into effect without an attempt to assess in advance its probable effects by means of a special inquiry through a body such as the Social Survey.I should be very interested to hear from the right hon. Gentleman whether any such inquiry has been embarked on. I think that it is perfectly clear that no inquiry has even been considered, and that the Minister has gone blindly ahead in the teeth of all the evidence.
The Minister's proposals generally have produced a pretty violent reaction among the public, and they have had a 1844 distinctly chilly reception in the Press, even in those sections of the Press that normally support the Government and the Conservative Party. But to the prescription charges there has been almost universal hostility, perhaps most marked of all amongst the doctors themselves.
On the day that the Minister made his deplorable statement, the British Medical Association said, through a spokesman:The prescription charge is a financial barrier between the patients and the treatment they require.There was an editorial, in considerably more trenchant terms, in the Lancet, which said:The prescription charge is especially objectionable because for the ailing this is liable to be a severe recurrent toll on low incomes. Moreover as a weapon against the mounting cost of the pharmaceutical service, such a charge is not only blunt but wrongly aimed. If indeed the drug bill is too high the Minister should turn not to the patient … but to the prescriber and possibly to the manufacturer.I shall return to that last point in a moment. The Lancet sums up the right hon. Gentleman's proposals for increased charges by describing them as damaging and retrogressive ".
I have had a very large number of letters—I will not weary the House by quoting from them—from doctors and chemists, from innumerable old-age pensioners and the like. One letter was signed by 15 doctors from places as far apart as Kent and Edinburgh, condemning the Minister in the roundest terms. It is a fact that the Minister is flouting the advice he is receiving and has received from every quarter. He thinks that he knows best. I understand that it has been said of him that once he has written out a political prescription he will claim that he is right even though the patient dies,
The Minister now knows the doctors' views. He should know that they are strongly held views and views that he ignores at his peril, because here the right hon. Gentleman is in the doctors' hands. He needs the doctors as the instruments of his policy. I should like him to recall what happened when the prescription charge was last increased when the right hon. Gentleman the Member for Thirsk and Malton (Mr. Turton) increased it from 1s. per prescription form to 1s. per item in December, 1956. The 1845 average cost of a prescription went up from 4s. 11½d. to 5s. 10½d. in one year; an increase of almost 20 per cent. in a year, and one that represented two and a half times the previous average annual rate of increase—and the number of prescriptions fell slightly.
There is little doubt about the reason for the increase in the cost of the prescription then. It resulted from doctors prescribing larger quantities in order to protect their patients from the worst effect of the charges. This situation was examined very closely in a survey carried out by two economists at Manchester University—Dr. Martin and Mrs. Williams. Referring to this increase in the cost of the prescription, they said:It appears that about 40 per cent. of this increase was due to doctors prescribing in larger quantities. The strength of this reaction was such as to increase the net total prescription bill by just over El+ million instead of reducing it by £4f millionwhich was what the then Minister of Health expected to be the result of his prescription charge increase. That situation will be repeated, and it will be repeated on a more massive scale.
I ask the House to reflect on what used to happen before the National Health Service came into existence. A wife of an insured person who was not herself on the panel, if she were ill, would have to go to the doctor as a private patient and, in very many industrial and other areas of England, it was normal in such circumstances for such a patient to have a consultation and a bottle of medicine from the doctor for 2s. 6d. Today, with the National Health Service, which in theory covers everyone in the land, this same woman, if she has a prescription —the average is 1.5 items on a prescription—will pay 3s., and that is 3s. in a nominally free Service as opposed to the 2s. 6d. she used to pay as a private patient for a bottle of medicine and a consultation. This is the point to which the Service has been dragged down by successive introductions of charges by successive Ministers of Health.
I wish to draw attention to a special category of doctors, the dispensing doctors. They are the men who do their own dispensing, and they are the ones who resent these charges more than anybody except, perhaps, the patients themselves. The procedure is that the dispensing doctor, when he gives his patient 1846 the medicine, is required to charge the prescription charge and to receive cash for each item. He will then give a receipt, afterwards handing over the cash to the local executive council. Dispensing doctors are, in fact, tax collectors for the Government, and they find it an extremely distasteful as well as a time-consuming job.
The patient thinks that the doctor pockets the "bob". It will be a florin in a few weeks when the Regulations come into force. The patient feels that he is paying the doctor for his medicine, and this unconscious or subconscious misunderstanding, of course, plays havoc with the doctor-patient relationship which ought to be the proper basis for treatment.
What will the Minister do if the dispensing doctors in their perfectly just anger all decide to refuse to collect the 2s. charges? Will he discipline thousands of them, each one separately? He would do well to ponder the situation and not under-estimate the feelings of these doctors. Would it not be wiser to have second thoughts about the increased prescription charge and withdraw the Regulation altogether?
Of course, the Minister will tell us again about the measures which the Government are taking to relieve hardship. I take first the straightforward case of the patient in regular receipt of National Assistance. However simple the arrangements are made by the Minister or by his right hon. Friend the Minister of Pensions and National Insurance for refunds for this type of patient, it is still a very tiresome business for many of them, particularly the olden ones. It is a matter of waiting, first, perhaps, for half an hour in the doctor's surgery, then waiting up to half an hour at the chemist's to have the prescription made up, then queueing in the post office to get the refund on the prescription, quite apart from the business and, perhaps, even the cost of travelling from one place to the other.
Is there no simpler method if we are to have these charges at all? Is it not possible to institute some sort of coloured prescription form or an endorsement of some kind which the doctor could put on? After all, the doctor knows his patients. He knows that the man carrying a National Assistance book is the man whose name 1847 is written in the book. It would be a good enough safeguard against fraud, which is always the thing which seems to worry Government Departments in situations like this. These are only suggestions, and there must be others. I ask the Minister to simplify the procedure.
The real trouble arises not with those on regular National Assistance but with the people on the hardship line who are not in receipt of National Assistance. They have to go to the local National Assistance Board office which in a rural area may be miles away. They will know—if they know anything about the arrangements at all—that when they get there they will be subjected to a means test. Many of them, perhaps most of them, will never even attempt it. The Minister must face this fact. After all, if we go on past experience, according to the figures which I obtained from the Ministry of Pensions and National Insurance, the number of people who actually receive refunds on hardship grounds represents one quarter of 1 per cent. Does the Minister really say that this is a true measure of what hardship there is, apart from people regularly in receipt of National Assistance—a quarter of 1 per cent. of all patients? Of course, the fact is that people are just not going to the National Assistance Board.
It has been said again and again in the House that the greatest sufferers of all will be the chronic sick, especially those on the borderline of National Assistance. Their prescription cost will be 4s., 6s., 8s. or even more than that. The Minister will say that special arrangements are in contemplation for these people, but all that sort of thing was said last time and, when it came to the point, it did not amount to a row of beans. It was always found to be administratively difficult or impossible to make up packs. I think that only two were made up. Now, the Minister says that he will encourage doctors to prescribe for two or three months ahead. It is not always possible to do this, and these assurances, I guarantee, will be blown away on the wind just as the previous ones were.
There have been references to the various categories of chronic sick, the diabetics and the others. The case of the epileptic has not, I think, been discussed so far in these debates. Very 1848 many epileptics are in regular employment but, because of their medical condition, most of them are obliged to take jobs at wages well below the national average. Many of them, because they want a feeling of independence, are content to earn a wage very little more than the weekly income they could receive from National Insurance. To depress their wage still further by the extra Is. on contributions and by further prescription charges for essential drugs is not only harsh but foolish because it may well as a last straw discourage some of these people from trying to carry on in employment at all.
I am told that it is quite common for an epileptic to need three different types of tablet at once, and the doctors are constantly changing the proportions of one or the other so that there is really no point and no advantage in prescribing for months ahead. The whole situation is always fluid. Moreover, I am told that it is frequently dangerous to prescribe large quantities of some of the drugs. Will the Minister think about these cases and see whether some sort of comprehensive charge could be worked out for epileptics and, indeed, for other types of chronic sick?
Will the Minister go further and examine the possibility of drawing up a register of chronic sick, area by area, in co-operation with the general practitioners and, perhaps, the hospitals, the people on which would automatically be exempt from the prescription charges? If the will were there to do it and if the Minister were not so much more concerned about gathering in the money, surely these things ought to be possible.
I now come to the question of drug prices. As I said in the debate on the censure Motion, if the Minister really felt that he needed savings, particularly savings in the drug bill, why did not he look a little more closely at the drug prices and the profit margins? The manufacturers were mentioned in the Lancet editorial which I quoted, but they were only saying in guarded terms what nearly every newspaper in the country is saying quite openly today, what the Public Accounts Committee said and what countless doctors and pharmacists are saying. We on this side are not claiming that the drug bill is too high, certainly not that it is more than the nation can afford. We 1849 recognise that there has been a steady stream of new and effective drugs, many of them expensive, particularly antibiotics and tranquillising drugs, which have been effecting more and more cures and getting more and more people back to work and back into the community. We welcome that.
We certainly do not say that all drug manufacturers are exploiting the National Health Service. We recognise that there are many reputable British firms and some foreign firms which are quite content to work on a reasonable margin of profit, but there are some, especially among those American firms with subsidiaries in this country, which emphatically are not so content. Whenever a question is asked about the cost of drugs, the manufacturers or their spokesmen always pray in aid the research costs. Of course, these are very considerable for many firms. I fully recognise that. We know that a great deal of research has to go into producing one successful new drug. We know that firms have to get back those costs on the small minority of successful drugs. But we cannot discover the facts of the matter. If facts are suppressed with the consistency that these facts are suppressed, then we cannot help having suspicions at least. These firms are very cagey about their. production costs and research and development costs and particularly about their promotional costs and profit margins.
I think that it can be shown unquestionably that the prices of some products of which the United States subsidiaries in this country have a monopoly are exorbitant. Take the case of a well-known antibiotic which the Minister will know is widely used in the National Health Service and which is manufactured by one of these British subsidiaries of a United States firm. It is a drug for which the Minister pays a negotiated price for the National Health Service of £64 per thousand tablets. I should like to ask him why the same drug from the same manufacturer sells in France and Holland at £28 per thousand tablets, substantially less than half the price that the right hon. Gentleman is paying. The same drug imported from those countries can be bought at £37 10s., and that includes a substantial import duty.
1850 When a native British firm produced a virtually identical antibiotic drug and placed it on the market at a price much lower than £64, I ask the right hon. Gentleman why it was that not a single order was executed at that price and why the price suddenly and smartly jumped up to £64.
§ Mr. Robinson
The manufacturer of the drug which I mentioned to the right hon. Gentleman is the firm of Pfizer.
More and more proprietary drugs are being supplied within the National Health Service. The figure is now well over 50 per cent. I believe that the proportion of proprietary drugs which are of American origin is also increasing. What we want to know is whether we are getting value for the money which we are spending on these proprietary drugs. We believe that many of these prices are inflated, and I am sure that one of the inflationary factors in the price is the cost of promotion.
Undoubtedly the United States firms have been forcing the pace in promotional expenses all along the line. The pressure on doctors and pharmacists is so great that even reputable English companies which do not want to do this sort of thing are simply forced to follow suit in order to survive. It is impossible to obtain the exact figures, but there is one American firm which is estimated to have 600 representatives calling on doctors at a cost of about £750.000 a year. It has also been stated, and as far as I know not contradicted, that there are over 2,200 representatives of drug manufacturers going round the country. That is one for every ten doctors.
Doctors are being bombarded with advertisement literature and free samples. One doctor estimated—I think that this appeared last Sunday in one of the newspapers—that he had received £100 worth of samples in five weeks. The literature which the doctors receive is not entirely medical in content. I have here a glossy magazine, also produced by an American company, which contains articles on Capri, space travel and port wine.
§ Dr. Barnett Stross (Stoke-on-Trent, Central)
If the figure of 2,200 is correct, does not that mean that in salaries and 1851 expenses about £3 million a year is being spent on this one item, representation, alone?
§ Mr. Robinson
On the previous calculation, I should have said that it was in excess of £2 million and may be substantially more. We can only guess because nobody knows exactly, and great care is taken to ensure that nobody knows.
I do not wish to go into detail about the gifts in kind which are received, about the "phoney" conferences on the Continent, with lavish hospitality and entertainment, the free larygascopes for every G.P. in the country, golf balls, lunches and gramophone records. The fact is that the cost of all these things goes on to the price of the product. This is done because it is very big business.
About £56 million worth of proprietary drugs were sold last year through the National Health Service. Is there no room for economy here? How much longer is the National Health Service to be held up to ransom? Why does not the Minister get a bit tough with these big pharmaceutical manufacturers instead of picking the pockets of the patients? It would not be difficult. He has the tools in his hands. He has the Patents Act, the Restrictive Trade Practices Act, and, above all, there is the fact that he is by far the largest purchaser of these drugs. If he wished, he could practically make his own terms.
If these measures fail, there are still others open to him. I will not embarrass him further by reminding him of what his hon. Friend the Member for Torrington (Mr. P. Browne) said. What we must have at least is a full independent public inquiry into the facts about the drug industry, drug costs and prices.
I have here a letter which I received, out of the blue, from a chemist who is quite unknown to me. He finished his letter with this passage:To do as Mr. Enoch Powell has done, to reduce the chances of effective treatment, is the action of a callous individual who is out of touch with the circumstances in which ordinary elderly people live, or rather exist. In a large number of cases they will not go to the doctor at all, and in many more cases they will not be able to pay such a sum of money as is often required to ensure really effective treatment.And yet these are the people that the Minister is going for, and not the drug manufacturers.
1852 The Regulations against which we are praying tonight, perhaps more than any other of the Minister's lamentable proposals, will lead to real hardship and suffering. There will be more self-medication, with all its attendant dangers. The health of the nation can only worsen as a result. Some old people will suffer where, but for these Measures, they might have been relieved, and a few old people will die just a little sooner than they need. It is because these things will happen that we seek to annul the Regulations and we ask the House to support the Motion.
§ 8.11 p.m.
§ The Secretary of State for Scotland (Mr. John Maclay)
The hon. Member for St. Pancras, North (Mr. K. Robinson) has made a moving speech and has worried us who have listened to him by his stories of the things that, he said, will happen to these people for whom, of course, we all have the greatest sympathy. I would pay much more attention to the hon. Member if, as I said the other night, exactly the same things had not been said many years ago when these charges were first introduced. I do not believe that the hon. Member can bring any proof that those evil consequences have come. It really is not good enough to draw up a picture of the people whom we all want to help—the hon. Member knows very well that we want to help them, too, and that we are doing everything we can—and then to say that certain things will happen without being able to produce a vestige of proof.
I shall not, however, pursue that line because there are some facts which I wish to put before the House and I do not want to take too much of the time of this debate. We are not concerned tonight to debate the principle of what is happening. That principle, I repeat, was established in 1949. If hon. Members opposite have changed their minds since then, I would remind them that it is a good deal easier to make that kind of decision, if they really have changed their minds, when in Opposition than when they are responsible as the Government of the country.
The charge has existed in one form or another since 1952, for eight years, and I can find no evidence that it has made any difference to the working of the Health Service, either in the hospitals 1853 or in the general medical service. This debate is about whether it is right in any circumstances, or in the particular circumstances which now exist, to increase the charge in the way that the Government have done.
We can agree at least on the essential facts about what National Health Service prescriptions cost. It is worth repeating these figures; they have been mentioned several times at intervals. The cost of the pharmaceutical service of Great Britain has been increasing year by year from £35 million in 1949–50 to an estimated gross cost for 1960–61 of £92 million. The average cost of a prescription increased from 3s. 1 d. in 1949 to 5s. ld. in 1956 and 7s. 4d. in 1960. [Interruption.] An hon. Member says "Salaries". There are many components in the figure. What I am stating is the facts of the increase in the bill. That is what we are establishing tonight.
I agree that part of the increased cost is due to the change in money values. I agree that the overall bill has gone up to some extent simply because there are more people in the country than there were in 1949, and there is an increasing proportion of old people. A large part of the increase is, however, an increase in real terms in the cost of the drugs actually prescribed. That is not necessarily something to regret. These new, more complex and expensive drugs represent a considerable advance in treatment. They bring benefit to the community as a whole. They enable patients to be treated at home instead of in hospital and they shorten illness, both at home and in hospital. The Government fully recognise this.
It remains a principle of the Health Service, as it always has been, that the individual patient should get all the drugs that he needs for proper treatment. It is, however, quite clear that if we have a bill which is rising for the various reasons which I have given, we must watch that it does not get out of proportion to what is possible consistent with all our other obligations. At the same time, the Government—
§ Dr. Stross
I shall not do that. I should like to ask the Secretary of State a simple question. Since 1949–50, the gross cost of drugs has doubled. The gross cost of the Service has also doubled and the gross cost of the hospitals has at least doubled. Why select one particular part of the Service for a charge and when will there be charges on all the other parts?
§ Mr. Maclay
The hon. Member is going into a hypothetical question. The general point is quite clear. If we have a series of social services and all of them continue to increase in relation to the whole, sooner or later we shall be in trouble. Some social services have gone ahead very fast in the proportion they have taken of the whole. That cannot be allowed to continue unrestricted.
Let me deal with the measures that we have already taken to secure economy in drugs. We have the duty to ensure that the pharmaceutical service is run efficiently and economically and that the country gets full value for its money. I must make clear what we have already done to this end. We have instituted, both in England and Wales and in Scotland, as the hon. Member for St. Pancras, North said comprehensive inquiries into prescribing practice and we have had the reports of the Hinchliffe Committee and of the Douglas Committee in Scotland. In Scotland practically all the recommendations of the Douglas Committee on the family doctor service have been given effect. I should like to acknowledge the co-operation that we have had from the medical profession in doing this.
We are now giving the doctors as much information as we effectively can to help them to prescribe efficiently and economically. Apart from the British National Formulary—which, for the benefit of the uninitiated, is produced jointly by the medical and pharmaceutical professions —and also "Prescribers Notes" and a new comprehensive "Prescribers Handbook", both produced by the Health Departments, we send the doctors statistics which show the cost of their own prescribing compared with that of their colleagues. More effective steps are being taken to secure prompt and regular investigation of doctors' prescribing where at first sight, the costs seem to be unduly high. Similar measures are.
1855 I know, being taken by my right hon. Friend the Minister of Health in England and Wales.
We have also arranged between us for a new journal to be produced by outside experts which will give the doctors objective evaluations of new drugs. The first issue will be coming out in about six weeks' time. It sounded from the speech of the hon. Member for St. Pancras, North, in opening the debate, as if we were doing nothing about that side of the work. We are doing a great deal.
I come now to the prices which the manufacturers charge for drugs. We have recently concluded with the industry a new voluntary price regulation scheme governing the cost of proprietaries, which now account for about 85 per cent. of the cost of all drugs. As my right hon. Friend told the House last week, this new scheme has opened the means of very effective negotiation with the industry which is being vigorously pursued. We are conscious of the strength of the position of the Government, to which the hon. Member for St. Pancras, North referred.
In fairness, however, and particularly in view of some of the hon. Member's remarks, I must say that the Health Service and the people of the country owe a great deal to the progress which the drug industry has made in developing new and more effective treatment agents. The hon. Member made a lot of fun, if one can call it that, about advertising practices. I know very well that advertising can be argued about for a long time, but it should be remembered that the whole object of that advertising in the long run is to increase volume and thereby to reduce the ultimate costs. It cannot be done in any other way. If costs are to come down, the volume is necessary; and, of course, the advertising is designed to that end. I do not say that all the advertising is right, but I ask hon. Members to keep that in perspective.
§ Mr. K. Robinson
Surely the hon. Member does not want to go on record as at any rate appearing to condone the methods of advertising I have described and which he knows perfectly well take place.
§ Mr. Maclay
I have tried to say that I do not consider all methods of advertising proper or right, or the kind I would 1856 like to indulge in myself if I were able to, but it is not right to condemn out of hand all advertising, even intensive advertising, although there may be some methods which we do not like.
Having set all those measures in train we were faced with a situation which my right hon. Friend described last week, of very large additions to the Health Estimates which we felt should be made if the Service was to develop as it should. The money had to be found. It is easy to say that it should be found by additional direct taxation but all Governments recognise that there must be a limit to the burden of direct taxation. No responsible Government can take direct taxation to the point at which it begins to have an adverse effect on the whole economy of the country and the prosperity upon which, among other things, the yield of taxation ultimately depends. Hon. Members opposite know that they were faced with exactly the same problem when they were in power. We, therefore, decided that a part of the increased cost of prescriptions should be met by increasing the prescription charge. We had to make a decision of some kind like this and even if it is a brave decision or an unpopular decision we believe it is the right one in order to maintain progress in a service we are determined to maintain throughout. It is wrong to suggest that this represents an attack on the Service.
In the opening speech this evening the hon. Member for St. Pancras, North did not touch on the emasculation of the Service or "knocking it to bits." I cannot remember all the phrases that have been used but they included "undermining" and others. The phrase was used that it was a calculated shift of the method of getting money. It does not really add up. My right hon. Friend gave the House last week a very impressive account of the many ways in which this Service has developed in the years since we came into power and if I had been in order I would very much have liked to tell the House precisely what has happened about the development of the Service in Scotland. I dare not do it on this Order.
May I turn now to the arrangements to avoid hardship. We are being told that these charges will cause hardship, particularly to patients with chronic illness. The hon. Member for St. Pancras, 1857 North developed that at some length, and I hope the House will forgive me if I reply to that in a little detail. We realise that the incidence of these charges will vary, and it is most important to get this into perspective.
I should like to bring to the attention of the House some figures which have a very strong bearing on this problem. They are not official figures, but they are taken from an article in the British Medical Journal in November last year written by three Scottish family doctors practising in partnership whose prescription costs had been criticised by the local medical committee for being too high. In the course of the article, which gives their reasons for the costs which were being criticised, they included an analysis of those patients who required drugs over a period—what they called maintenance therapy.
In a period of three months there were 850 such patients who got on an average four prescriptions each—that is, they paid on the present basis 4s. each in a period of three months and on the new basis they will pay 8s., or 8d. per week. Within the 850 patients there were 77 chronic rheumatic patients and they got on the average three prescriptions each. There were 51 bronchitis patients who averaged six prescriptions each, 16 diabetics who averaged four each and 15 cardiac cases, who averaged seven each. These are averages and hon. Members will realise that some individual patients would get fewer prescriptions and some more.
With this reservation, however, the figures—which have been very difficult to get up to now—suggest that the number of prescriptions and the cost for the individual patient, even the chronic patient, is not as high as it might have seemed from some of the speeches that have been made on this subject. I repeat that these are not my figures. They are the doctors' own figures and they were doctors whose prescribing costs were on the high side. These are facts which are very well worth studying.
As regards the number of patients in this sample who were receiving treatment for more than one illness, there were, out of a list of 4,316 patients of the whole practice, 111 suffering from two chronic conditions, 14 suffering from three chronic conditions and three suf- 1858 fering from four chronic conditions. It is worth getting these figures into perspective because, listening to the speeches we have heard, one would imagine that the chronic sick were in need of prescriptions with the utmost regularity. They need them regularly but not with the utmost regularity. I agree that this is a sample from a big practice but it is a sample and I commend it for study.
We have always recognised that because of the circumstances of a particular patient, or because of a series of illnesses in the same family, a prescription charge, which can be readily paid by the vast majority, may be liable to produce hardship. We know that. I would repeat again the undertaking which my right hon. Friend gave last week to examine any case of potential hardship which may be brought to our notice. We have had a good deal of discussion with the doctors to try to devise what are called "multiple packs" to avoid a series of items for what is essentially one treatment. There are eleven such packs in use, and not two as the hon. Member said. So far it has not been possible to go further.
The doctors already know that where a patient will require the same drug over a considerable period they can prescribe the whole quantity required at the outset and so avoid repeated prescriptions. I realise the danger of that, but it is a necessary thing as well. That can be done only where the drug will remain effective when stored in the patient's house. If hon. Members have any further suggestions on these lines to put forward my right hon. Friend and I will consider them very carefully.
We wish it to be as widely known as possible that those patients who do find difficulty in meeting the charges should not hesitate to apply for a refund. This is something to which they have a right if they are in need by the standards which the National Assistance Board applies. The arrangements applied by the National Assistance Board have been made as simple as possible. The hon. Member touched on them and I think I should give them in a little more detail because it is extremely important that they should be realised.
A person already receiving assistance has simply to ask the chemist for a 1859 receipt when paying the charge and to take the receipt to the post office or, if he is an unemployed person, to the employment exchange. The charge is then automatically refunded when his weekly allowance is paid, or he can get the refund before his normal pay day if he prefers. If, exceptionally, he has no money to pay the chemist, he can get it in advance by applying at the Board's local office.
The Board also considers the marginal case of the person not already receiving assistance. It has to apply its normal standards of assistance, but it does this in a broad and flexible way and in a spirit of humanity, as anybody who has had any contact with the National Assistance Board knows.
To have their cases considered, people in this position—that is those not already receiving assistance—can get a combined receipt and application form from the chemist and they either take it or post it to the Board's office. If they call personally, the application will be dealt with there and then. If they post the form, an officer will visit the applicant at his home within the next few days and make a payment if one is needed. [HON. MEMBERS: "Oh."] Hon. Members ought not to interrupt because they make it more difficult to get over to the public what is the position.
I also ask hon. Members not to say what I have had thrown at me outside the House, namely, that this is National Assistance. It is the gravest disservice that any hon. Member can render to the people whom we all want to help to decry National Assistance. It is theirs as of right, just as are family allowances or anything else.
The arrangements for applying by post should get over any risk of serious inconvenience to people living in remote rural areas, particularly the elderly or sick who cannot get about and see to their own affairs themselves. It may be said that the patient must still get out to the post office. But the patient will almost invariably be relying on someone else—a friend, a relative or perhaps a neighbour—for services such as shopping and collecting any weekly pension or benefit. This friend will usually be able 1860 to send off the combined receipt and application form when getting a prescription dispensed.
If someone who is chronically sick requires a prescription regularly or frequently, the National Assistance Board's officer will be able to give him a form and a franked envelope on the first occasion, if he is found to be in need of assistance, which will save him trouble on the later occasion. We also provide a poster for exhibition in chemists' shops indicating that advice on how to apply to the National Assistance Board for a refund of prescription charges will be given on request. It is very important that these provisions should be known. We all know that in any system there are always people who are on the margin and we must make certain that they are provided for, and this we are doing our best to do.
§ Mr. Norman Dodds (Erith and Crayford)
Will the right hon. Gentleman say something about bus fares in scattered rural areas?
§ Mr. Maclay
I have given details of the sources of help and I do not believe that anyone can say with justifiable conviction that these added charges will damage, far less wreck, the Health Service or the health of individuals. With the steadily rising level of earnings throughout the country, the added charge should not present a problem to the vast majority, and the means are there to help those in need.
I repeat that hon. Members opposite have no monopoly of human feelings. We are concerned with the health of the nation. We are concerned with the wellbeing of individuals and we are concerned about the progressive development of social services to which all parties have made their contribution. This is made clear from our record of the last nine years and is understood and appreciated by the nation as a whole.
§ 8.34 p.m.
§ Mrs. E. M. Braddock (Liverpool, Exchange)
I have listened to the best part of this debate and our recent debates and this subject, and what I have not heard I have read. I think that the explanations which have been offered for 1861 the additional charges on people who require medicines are about the weakest that I have ever heard.
Speaking from considerable experience, I believe that these new charges will undermine the new Mental Health Act, because that Act is designed as far as possible either to keep people who suffer from mental illnesses out of hospital, or to bring them out of hospital as soon as possible back into the community so that the incidence of mental illness will not be quite so pinpointed as it has been under the old Act.
From my knowledge of my own area, and that gained by talking to organisations throughout the country, I am certain that these additional payments for drugs and medicines necessary for people suffering from mental illness will drive far more of them into hospital than they will keep out. Consequently, that means higher costs, because the cost per patient week in hospital is rising all the time. It should be the intention of the Ministry to keep people in the community, if possible, by seeing that they are regularly and easily, and without worry, supplied with the medicines they require in order to keep them out of hospital altogether.
During these last few weeks I have listened to all sorts of explanations from the Government. I am not interested in how much more the Health Service is costing. The country is wealthy enough to pay. There are enough wealthy people and industries to pay very much more than the increases in the Health Service costs. We talk of increased costs and charges, but let us also look at the amount of wealth made in take-over bids since the Government took control in 1951. There is any amount of money available there to cover the small increases in the cost of the Health Service.
The Minister of Health grins. He has no heart. He was put where he is to do the job that he is doing, because no one else was prepared to do it. I do not think that I am incorrect when I say that his predecessor, the right hon. and learned Member for Hertfordshire, East (Sir D. Walker-Smith), was not prepared to do this, so the right hon. Member for Wolverhampton, South-West (Mr. Powell) was brought in to do it.
Those of us who have known the right hon. Gentleman since he came into this 1862 House in 1950 know the line in economics which he takes. He hates the prospect of the ordinary persons having the opportunity to get a little more. He would rather charge people who cannot afford to pay than make these charges on those who have the wealth. The right hon. Gentleman screws his face up now. It is difficult for him to understand, except when he is standing at that Dispatch Box, talking in terms of millions of pounds and explaining why these charges are necessary. The ordinary people do not understand all the arguments put not only from that side of the House, but from this side as well. All they understand is that it will cost them more to be ill, though they have only a small amount of money.
The right hon. Gentleman will be a murderer if any person in my constituency dies because he is not able to purchase drugs and medicine, which the doctor says he needs, because he cannot afford to pay for them. That is how the right hon. Gentleman and the Government stand over this position. This is brutal—
Mr. Deputy - Speaker (Major Sir William Anstruther - Gray)
I am reluctant to interrupt the hon. Lady, but I would advise the House, if I may, that I saw quite a number of hon. Members rise to speak when I called the hon. Lady. We are much restricted in time, and the only hope of getting in most hon. Members who want to contribute to the debate is to keep as strictly as can be to the Motion.
§ Mrs. Braddock
That is an amazing statement for you to make, Mr. Deputy-Speaker. I am not challenging it, but this is the first time that I have attempted to speak in these debates, although I have been present throughout them. Surely I am entitled to make my case against the increased charges in the way in which I think fit, and not in the way which someone else thinks fit.
I have a big responsibility for my constituency in Liverpool, where we are desperately trying to reduce the number of mentally sick going into hospital. These people have to have a regular supply of medicines and drugs, and if they cannot pay for them their doctors automatically admit them to hospital where they can get them. Yet the cost 1863 of a patient in hospital is £20 or £30 a week, even in an ordinary hospital.
I said that I was not concerned with the cost of the Service. Anyone who works when he is well, whoever he is and whatever his job, is entitled, when he is ill, to receive the best services that the country can afford, and to do so without cost to himself. We know that the Tory Party does not like the Health Service. If it did, it would not interfere with its organisation. If hon. Members opposite were interested in the Health Service, then, instead of increasing charges, they would be setting about improving the industrial health organisation and ensuring that everything was available to keep people at work instead of being off work sick for days at a time.
I do not object to the Government studying the problem of increased costs, but let them not always consider those costs on the basis of trying to recover them from those people least likely to be able to bear the burden. Let them study administration and the cost of drugs, and so on, where they would save very much more than they will get from this increase in prescription charges.
In my constituency, there are many people whose incomes are just above the maximum for the National Assistance Board to return their prescription charges to them. The Secretary of State for Scotland told us that this expenditure could be met through the Assistance Board, but the Government do not seem to realise that when people are sick they want less and not more worry. The fact that they have to go through all this process to obtain a refund of their prescription charge is a worry to them.
I think that I heard the right hon. Gentleman say that if people could not afford to pay their prescription charges they should get the amount paid before they bought their medicine. That is new to me. I have never heard of such a case and I have always understood that the person goes to the chemist and pays for the prescription and then, if necessary, obtains a refund from the Assistance Board. I have never met a case when a person has been able to go to the Assistance Board with his prescription saying that he could not afford to pay for it and applying for money to meet its cost.
1864 People on National Assistance have to pay out of their weekly National Assistance payments the amounts charged for their prescriptions, which they can then reclaim from the Post Office. They do not get it before they have to pay out, and I am certain that the increase will create many more difficulties. Living in Liverpool, and knowing the conditions there for the length of time that I have done, I am certain of one thing. I loathe anyone who makes it necessary to have a means test before people can obtain the things which they ought to have of right. I hate the means test, and so do the people in Liverpool, because they have lived through it. To continue in this affluent society with the Tory Party always in the position of enforcing a means test on people on the lower standards. makes me sick.
I agree that these people deserve what they are getting because of what they did in the last General Election, and what I should like to see is all those people who supported hon. Members opposite having to pay the increase on their prescriptions and those who did not support them being able to be taken out of it altogether.
I know that there will be difficulties. I know that people will have to go short, that it will make it difficult for the doctors and for the liaison between the hospital service, the general practitioners and the health authorities in establishing the sort of Health Service we want to establish under the new mental health arrangements. It will be much more difficult, and we shall not be able to persuade people whom we think ought to be at home in receipt of attention for mental illness to go to the doctor, when they know that it will cost them so much more to obtain their prescriptions.
I know about the cost of prescriptions, the cost of which is based upon the cost of the drugs which people have to have, and my hon. Friend the Member for St. Pancras, North (Mr. K. Robinson) has already asked the Government to look into the question of the cost of drugs. How much is it costing the Government to obtain for patients the drugs they require? If the Government would start at that end, instead of at the bottom, I am quite sure that they could save more than the amount represented 1865 by the increased charge they are putting on prescriptions.
You have reminded me, Mr. Deputy-Speaker, that many other hon. Members want to speak, and I should like to finish by reading extracts from two letters which I have received which show that there will be very great difficulty about this increased cost. I happen to be a vice-president of the British Diabetic Association, because my mother happened to be a diabetic and needed a lot of attention and a lot of drugs, though, thank goodness, she did not have to go through a means test to obtain them. I became associated with this organisation because I know the very great hardship and difficulty which people who suffer from diabetes have to meet when they have to have continual supplies of drugs, insulin and tablets.
I have received the following letter, dated 12th February from the secretary of the Liverpool district branch of the British Diabetic Association:The proposed increase in the prescription costs of the National Health Service is going to be a great burden to many diabetics, who through no fault of their own have to have continuous prescriptions of three or four items in order to live. I know that doctors were given permission to prescribe up to three months' treatment when the charge was raised to a shilling per item. Many patients can take advantage of this, but there are many for whom it is not wise that such a large amount of drugs should be available. These are the people for whom I am most concerned.I understand that what is known as a comprehensive prescription is available for new diabetics. This consists of a supply of all the items necessary to a diabetic, such as insulin, or tablets, syringe, needles, cotton wool, surgical spirit and urine testing reagents. If this service could be extended to cover all subsequent prescriptions it would do much to mitigate the hardship which will certainly be caused by the 2s. per item charge. May I ask for your support?That society is trying to deal with a very difficult illness, from which many people suffer. People who have it go to work and make the best of it. Whether they want to or not, they have to have regular prescriptions.
I should like to quote from another letter from a woman living in Liverpool, who says:As you are aware, we do not visit the doctor just for a few pills. We have to go, while life lasts, for our regular supply of insulin, needles, cotton wool, surgical spirit, etc., and at 2s. per item it is going to be 1866 expensive. The promised diabetic pack is never heard of these days.That is from a diabetic who says that she will be in difficulty because of the increased costs. Other chronically ill persons will be in a similar position.
This charge will cause people great difficulties, and I shall agitate throughout the country whenever I can against a Government which are prepared to undermine the Health Service as originally intended and to place the burden upon those who are least able to bear it, namely, those who suffer chronic sickness and the old people—people who cannot get about as others can. In a country which can produce so much, and which is supposed to have an affluent society, I shall never agree that people who need medical attention should be charged for the drugs, surgical appliances and other things they require. These things should be at their disposal completely free of cost right from the beginning of their illnesses. They are living in a country which has plenty of money at its disposal, and which should be using that money to see that our Health Service is completely free and available for all those who need it.
§ 8.53 p.m.
§ Mr. Edward Gardner (Billericay)
The hon. Member for Liverpool, Exchange (Mrs. Braddock) feels very dissatisfied with the new prescription charges, as one would expect. Anybody who has been in the House for many hours during the last few days and nights will have gained the impression, from the speeches of hon. Members opposite, that some sort of wild flame of indignation is spreading through the country, [HoN. MEMBERS: "That is true. That is what I thought would be said. The new town of Basildon is in my constituency. I assure the House that many people there thoroughly, sincerely, and heartily disagree with the views expressed by the hon. Member for Liverpool, Exchange about the Minister of Health. The hon. Lady said that my right hon. Friend had no heart. Because of these prescription charges, and because of the efficient way in which he proposes to run the Health Service and improve it to fulfil its destiny, he is able to produce plans for building hospitals.
Mr. Deputy Speaker
I interrupted the hon. Member for Liverpool, Exchange (Mrs. Braddock) because I thought that I should keep the debate as closely as possible to this Prayer on the prescription charges. I hope that the hon. Member will try to make his speech accordingly.
§ Mr. Gardner
I do not want to take this matter too wide, Mr. Deputy-Speaker. I was trying to answer the point made by the hon. Member for Liverpool, Exchange.
I want to deal with the cost of drugs. It is disturbing to know that the £74 million we spent on drugs last year was about double the sum we spent on drugs in 1949–50.
§ Mr, Laurence Pavitt (Willesden, West)
As the hon. and learned Gentleman is dealing with the cost of drugs, will he at the same time deal with the decline in the percentage of referals to hospitals by general practitioners as a result of using drugs and giving treatment at home in comparison with the cost of hospitalisation?
§ Mr. Gardner
I do not want to be misunderstood. I am making this point about the increase in the cost of drugs because there is a secondary point which I want to emphasise. In 1949–50 the cost of the ingredients was 3.5 per cent. of the total cost of the Health Service. This year the cost of the ingredients is likely to be about 6.5 per cent. This is an alarming figure, and one has to ask oneself whether we are becoming a nation of drug addicts and medicine men.
One of the serious problems to be considered is whether doctors are over-prescribing. Are steps being taken to see that good husbandry is being exercised in medicine?
The other aspect which ought to be considered is the pharmaceutical industry. This industry has a great deal to be proud of. It produces life-saving and wonderful drugs, and there are millions of people who owe their lives to this industry. I agree that we ought to criticise the industry when it deserves criticism, but we ought not to overlook the wonderful work it does. In addition, one must remember that the export record of this industry is one of the most successful of any industry in the country.
1868 It exports £40 million worth of goods, which is about the same amount as it sells to the National Health Service; and through its association it entered, last December, into a voluntary agreement with the Ministry of Health about drug prices. The amount of money spent annually on research runs into millions of pound.
Having said that, one must ask whether the pharmaceutical industry is responsible for unnecessary costs for drugs. It would appear that the amount of evidence available at present is inconclusive—[HON. MEMBERS: "No."] That was the finding in the second Report of the Committee of Public Accounts.
§ Mr. Gardner
The hon. Member says "nonsense", so perhaps I may be allowed to quote from the Report. In paragraph 18 it states:The evidence adduced before Your Committee was insufficient to enable them to give an assurance to Parliament that prices charged to the Health Service were no more than fair and reasonable.It goes on to say of the information about the prices charged:This information, while indicating high profits, is inconclusive.All I am asking is that in the interests of the National Health Service and of this industry, with its fine record, there Should be an attempt made to get better evidence so that we may come to a reliable conclusion.
It is true that in the United States recently Senator Kefauver, sitting with the American Senate and the Trust Monopoly Sub-Committee, came to the conclusion, after a review of all the evidence available, that the high prices of drugs in the United States was caused by what he called inflated profits. I say with sincerity that I do not believe that that state of affairs necessarily obtains in this country. The curious and perhaps the promising feature of the industry here, so far as it has been investigated, is that the prices charged would appear to be fair and reasonable. I say that because in February of 1959, as hon. Members will remember, the Minister of Health investigated the prices being charged by the insulin manufacturers. After investigating the costs and profits 1869 the Ministry came to the conclusion that they were fair and reasonable.
The hon. Member for St. Pancras, North (Mr. K. Robinson) asked my right hon. Friend whether he was satisfied that we are getting value for money from the drug manufacturing industry. I think it is in the interests of the National Health Service that we should know the answer to that question. Only today I was sent through the post a pile of advertising matter. I find that some of this advertising is excellent and most beautiful, but I cannot avoid the impression that there are many advertising pamphlets and other means of advertising in which are elements of wasteful expenditure.
One could not help feeling that if a doctor's clinical judgment were to be affected by two of the advertisements I saw, which in quality rose little above that of a detergent advertisement, it would be wrong. If his judgment were not being affected, obviously it would be a waste of money, All I ask—and I should have thought it in the interest of the pharmaceutical industry as much as the interest of anyone else—is that the Minister should consider making inquiries into this side of the drug bill to see if in fact there is any foundation for the suggestions made from time to time that an unnecessarily large amount is being spent on advertising drugs.
§ 9.7 p.m.
§ Mr. Llewelyn Williams (Abertillery)
The hon. and learned Member for Billericay (Mr. Gardner), in his opening sentences, informed the House that he was not aware of any deep disturbance in his constituency about the matters we are discussing this evening and matters kindred to them. I beg leave to doubt that assertion very much. In over ten years in this House I can truthfully testify that, not even excepting Suez, I have never known such an eloquent angriness surging in the hearts of the people I seek to represent as there is over this question.
My hon. Friend the Member for St. Pancras, North (Mr. K. Robinson) referred to the almost universal repudiation in the national Press—and this goes for the local Press, too— of these prescription charges and increases. It may well be that the Conservative Government, 1870 entrenched as they are with their 100 majority in the House, are able to ignore even the newspapers which normally support them and their policies, but I wish to underline what has been said by my hon. Friend that not even the Conservative Government can afford to ignore the universal repudiation expressed by the doctors.
The British Medical Association, which by no stretch of the imagination can be considered as supporting the political outlook and philosophy of the Labour Party, immediately came out in vigorous protest against these proposed increases, particularly in regard to prescriptions.
My own family doctor is a Scot, like you, Mr. Deputy-Speaker. Unlike some of my Scottish colleagues, he is quiet and restrained. [Laughter.] Perhaps I may be more diplomatic and put it the other way round: he is not as eloquent and loquacious as my Scottish hon. Friends. He could hardly contain himself in a conversation about what he regarded as this iniquitous business.
I would not use the phraseology employed by my hon. Friend the Member for St. Pancras, North in describing the Minister of Health. Perhaps the Minister and I have certain affinities which are not present in the case of my hon. Friend and the Minister. I do not regard the Minister as a callous man. However, I say to him deliberately that I am frightened of him. I am frightened of his intellectual rigidity, his intellectual inflexibility, and his inability sometimes to approach some of the great problems which will confront his Ministry in the future, as they have confronted it in recent weeks, with that elasticity and imagination which are more necessary in the Ministry of Health than in any other Ministry.
What worries my hon. Friends and me is that this will not be the end. I am trying to think ahead. Where will the axe fall next? There have been three Conservative Governments since 1951. The first Conservative Government had a majority of about 16. The second Conservative Government were a little more confident; their majority had increased to 50 or 60. This Conservative Government have a majority of over 100.
Little by little, in a piecemeal fashion, never by one fell blow, attacks are being 1871 made on the Service. In the first instance, it was 1s. on the prescription sheet. When the Conservative Government felt more confident, they increased it to Is. per item on each prescription sheet. They also increased contributions. Now much wider destructive influences are bearing upon the Service. In the first place, it was a chiselling away. In the second place, it was a mallet. Now the hatchets are out, and we are very disturbed. I wonder if it is possible, even at this late stage, to convince hon. Members opposite that their tampering with the Service will have repercussions the gravity of which may be beyond their comprehension.
I do not suppose that the Minister thought it fit to consult the trade unions, but he could have done so. It is doubtful if he consulted the doctors. During our debates in the last few days one thing has struck me very forcibly. It is the seeming inability of hon. Members opposite to understand why we feel so deeply about these issues. Let me disabuse them now of any idea they may have that ours is a synthetic indignation, brought about by such adventitious considerations as to whether or not we are a united party on some other issue. If they cannot realise that they are deeply concerned about this matter I am afraid there is a very rude and sharp awakening ahead of them.
In some matters my approach may sometimes be different from that of my colleagues, perhaps because of my vocation before coming to this House. I have always been prepared to make a distinction between Conservatives and Conservative thinking. I would suggest, without offence, that Conservative thinking, among other things, is very often an admixture of cynicism, patronage and enlightenment. Sometimes one element obtrudes itself more than others.
I do not deny that there are some very fine things to be put to the credit of the Conservative Party, and I am happy to be able to declare my honest view that there are Conservative hon. Members who are greater than their own political thinking, and they must feel—
I hope that the hon. Gentleman will keep as closely as he can to the Prayer which is under discussion.
§ Mr. Williams
With respect, Mr. Deputy-Speaker, what I sought to say was that there must be a tremendous amount of uneasiness in the minds of some hon. Members opposite about this 2s. prescription charge.
By the same token, I am prepared to admit—and I do not like saying this—that there is also a distinction to be drawn between Socialist thinking and Socialists. Our Socialist thinking is an admixture of idealism—I suppose that some hon. Members opposite would call it misguided idealism—genuine human sympathy, and economic understanding of issues. Some of us on this side may sometimes fall short of the demands of that idealistic thinking, but it is on an issue like this one of the Health Service that we see the basic difference between the two types of political thinking.
Let me put the matter in a much closer and more human perspective. Tonight, I think of four and a half million old-age pensioners. More than a million of those are recipients of National Assistance benefits or supplementations and the 2s. charge will not fall on them at all. I have heard it said from this side—and it has never yet been contradicted from that side—that we have today about a quarter of a million people who, by the most stringent tests, would be entitled to National Assistance supplementation but who, for different reasons—maybe pride, maybe ignorance, but for some reason—do not receive those benefits.
I mention ignorance, Mr. Speaker, because a few months ago I made a study of loneliness in this country—we are not always as imaginative as we might be about that social and human problem. In 1951—and I am sure that the figure is much larger now, because it had been increasing at an alarming rate in the twenty years before that—over one million people lived alone. Not all these people were old, of course— the majority were women—but my own personal exprerience convinced me that there were thousands of old people who even now did not know what was available for them in the Welfare State. This cost will fall very heavily on thousands of people in that category.
People earning low wages will be harshly hit. I am not indulging in hyperbole or exaggeration. I will give a simple 1873 illustration of what 1 mean. On a day since the Minister announced the charges in the House—and a very black day it was —one of my constituents visited me in my home. I shall not enlarge unduly on the simple interview which took place, but it was a very sad interview. He was an old man, over 80 years of age, and this was the cause of his concern. His wife's sight is growing worse and worse, and she is to see an eye specialist to find out whether she has now reached that percentage of blindness which will entitle her to have the increased blind person's pension.
This man, I know him well, is no scrounger. He is no parasite. He is as good a type of man as one will find in our whole community. He has led a fine life. He has been a church officer for many years. He was by no means one of the "What-can-I-get-out-of-it?" types. I asked him what his worry was. He is on National Assistance. His reply was, "If she gets the increased pension because of her blindness, with these new charges—and both of us are in indifferent health—we may find that we lose our National Assistance benefit "and will be worse off than before.
I was able to assure him, as the Minister and the right hon. Member for Thirsk and Malton (Mr. Turton) have assured the House, that hardship cases of that kind will be considered. But the whole point of my reference to that example is to put this question directly to the Minister. Does he think in February, 1961, that a person of that type should have to deliberate in his mind in that sort of dilemma? Is this the best we can offer people who have lived as they have lived? I know that man and, although I think he is not of my political persuasion, I know that he has been sadly disappointed in the Conservative Party and the Government's record on this issue.
I come now to another example which takes me back some years. I hope the House will be indulgent as I recount it. I was called to the death-bed of a man I had known for many years. He was slightly pneumoconiotic, slightly diabetic, and he was dying in the agony of angina and hypertension. He died a few hours after the little conversation I had with him. He had a very wry, almost grim, sardonic sense of humour. He said to me, "This is a nice kettle of fish. With 1874 all this terrible pain, the doctors are changing the prescription two or three times a day. If this illness goes on for a long time "—the Conservative Government had just introduced the ls. per item—" it will cost a pretty penny ".
It so happened that his financial worries were completely unnecessary. I knew that he had children who would easily see to all that side of things. But then he said—and, knowing him well, I knew that it came from his heart—" It seems unjust that at the very time a man is ill, the very time when he cannot fend for himself, he has to meet these increased charges. Whatever you do in Parliament, fight for justice and fight against injustice ". That story is literally and absolutely true, because that man was my own father. I would not be in this place had he not left me, as a legacy, a determination to fight injustice.
I honestly and sincerely believe that for a Minister to come to this House and to impose charges on sick people cannot be justified in any way. Goodness knows, illness is not a luxury. It is bad enough when one is ill, but for the Minister to say, "I want this increased charge from you" is going too far.
I hope that I have conveyed to the House, not only my own personal feelings, but the feelings of every hon. Gentleman on this side. The best way that you, Sir, could have conducted this series of debates would have been to allow every one of the 257 Labour Members of Parliament to speak for four minutes on what they believe to be the wickedness of this matter. Surely that would have convinced the Government.
Before I entered the Chamber I read once again, as I am sure all of us have read many scores of times. the font, the original inspiration, of all health services. I hardly need say where I found that original inspiration. For those who do not know their Bible, it will be found in Luke, Chapter 10. I know that the Minister of Health is a religious man and that he will know the context of this quotation:… and when he saw him, he had compassion on him, And went to him, and bound up his wounds, pouring in oil and wine, and set him on his own beast, and brought him to an inn, and took care of him. And on the morrow when he departed, he took out two pence, and gave them to the host, and said 1875 unto him, Take care of him; and whatsoever thou spendest more, when I come again I will repay thee.The Minister's attitude seems to be, "We will pay two pence, but then he will have to have a means test. If his expenses come to more than two pence, he will have to pay a contribution ". That attitude is not worthy of a great Minister of Health.
§ 9.29 p.m.
§ Sir Hugh Linstead (Putney)
We have all been much moved by the speech of the hon. Member for Abertillery (Mr. Ll. Williams). It would be quite impossible to attempt to join issue in any way with him after such a speech, but perhaps one evening I shall have the opportunity of having a private conversation with him.
There is one word to which I think the hon. Gentleman will respond and that is the word "charity". I ask him, out of his charity, to believe that there may be some hon. Members on this side of the House who feel very deeply that the only way to preserve what is great and good in the National Health Service is to underpin it with some new finance. [HON. MEMBERS: "Undermine it."] I am not addressing myself to those hon. Members who are mocking. I am addressing myself to the hon. Gentleman, whom I know and respect greatly. I ask him out of his charity to believe that there may be a few hon. Members here who feel very deeply about the need for maintaining this service.
§ Mrs. Harriet Slater (Stoke-on-Trent, North)
On a point of order. Is it in order for an hon. Gentleman to assume and to say that hon. Members who disagree violently with him on this issue are mocking?
§ Mr. Speaker
I do not think that it involves a point of order. It is not necessarily insulting or un-parliamentary. It may be an accurate or inaccurate description of the hon. Member's impression.
§ Sir H. Linstead
If the word is offensive, I withdraw it immediately.
The point which I wanted to put to the House arises from the fact that in another capacity outside this House I am secretary of the Pharmaceutical Society of Great Britain, and in the last 1876 few weeks I have had from pharmacists in various parts of the country letters stating why they believe that these increased prescription charges are a mistake. Pharmacists do not receive personal benefit from these charges. They have only the thankless and, sometimes, the painful task of collecting them for my right hon. Friend. Nevertheless, they and those doctors who in country districts supply medicines, are the people who come into direct contact with the public at the time when payments for prescriptions have to be made. Their views are important and should be taken into account in assessing the effect of these charges.
The summary of the opinions that have come to me can be put briefly as follows. It is clear that many believe that some of these charges will create hardship for deserving patients. They believe that some prescribers, in an endeavour to help patients, are likely to go to such expedients as prescribing one item for two members of a family. They say that there may be cases where a prescriber will omit a desirable item under pressure from the patient, who may want to limit the number of charges he has to pay. There is no doubt that one effect of the charges will be to increase the quantities and, possibly to increase wastage.
It is said that another effect will be to encourage self-medication, because a new habit will tend to develop when the patient pays the first 2s. of the cost of the medicine. Then, there is the general criticism that it involves the prescriber and the patient in a sort of conspiracy to defeat the charges. It is a little difficult to put it precisely, but it is both an undesirable element in the Service and a barrier to a proper doctor-patient relationship. Those are the sort of criticisms that have come to me from the people who have to handle these problems daily, and they are worth passing on.
As I have said earlier in this series of debates, my personal fear about hardship is not that there will be hardship at the National Assistance Board end of the scale, nor with, it may be, as many as 80 per cent. of the population. There is, however, that fringe group of people who will be above even the extended 1877 Assistance Board level and who will not be able readily to find the 2s., the 4s., or the 6s.
Those, I think, are the group of people to whom some more consideration may have to be given. We may find by experience, that such an element of hardship does not exist. I hope that my right hon. Friend, after the charges have run for three or four months, will make some positive inquiries through his regional medical officers, and inspectors under the Pharmacy Act, to find out from the doctors and pharmacists whether or not the shoe really is pinching. If he finds, as a result of inquiries of that kind, that this present arrangements for the payment or advancing the charges are not working satisfactorily, I hope that he will have another look at them. I want to take the argument about these charges a little further.
§ Mr. A. Woodburn (Clackmannan and East Stirlingshire)
Has the hon. Gentleman's informant given him any idea as to the maximum any one family might be called upon to pay under the new charges? There may be several members of a family needing prescriptions. How much does the hon. Gentleman think should be the maximum sum such families should incur?
§ Sir H. Linstead
Anybody's guess would be as good as mine. I would not attempt to make such an estimate.
The point which I want the House to consider is one made by the hon. Member for Abertillery, when he asked, "Where is this to end"? I would prefer to put the question in another form. What about the future of the pharmaceutical service and of the drug bill? So far as I can see it, the cost of drugs will inevitably rise, not because of any original sin on the part of manufacturers but simply because new and modern drugs inevitably are more complicated to make, to test and put on the market.
We are bound to find—and my right hon. Friend must be quite conscious of this—that the drug bill, with every possible economy, will continue to rise. The Hinchliffe Committee drew attention to the fact that the increasing cost of drugs is not a British matter alone. It is to be seen in many foreign countries and under industrial conditions different from those in this country.
1878 What can be done to prevent this steadily increasing cost of modern drugs once again putting the Health Service into jeopardy? There is no doubt that the person to whom my right hon. Friend will have to turn is the prescriber. He is, among all the welter of forces acting in this field, the person who has in his hand control over the drug bill. We have heard already from my right hon. Friend the Secretary of State for Scotland some of the steps that are being taken to educate the prescriber in his responsibilities. I think that the few figures I have here will illustrate that it is needed.
If one takes the cost per person of prescribing under the National Health Service in a year one finds that it varies between one part of the country and another. For example, in Wigan, it costs 53s. a year to provide drugs to a Health Service patient. In Wakefield, it is 52s., in Middlesbrough, 30s., and, in Bootle, 30s. a year. Here is a question which demands investigation. Why are there these very substantial differences between one part of the country and another? In Caernarvonshire, the figure is 55s., and in Northamptonshire, 23s.
As to the cost of each prescription, in West Hartlepool it is now 8s. on average, in West Ham it is 5s. 5d., in Cornwall it is 7s. 11d. and in Holland, Lincolnshire, it is 5s. 6d. Obviously, there is a prescribing habit among doctors in different parts of the country which may or may not be related to the illnesses in that part of the country. It may be just a habit that has grown up among the doctors there. It is possible that if the reasons for these prescribing habits could be found, and if the knowledge so gained were spread among the doctors, the high-cost areas, without any loss of efficiency to the Service, could be brought down to the level of the low-cost areas.
The Hinchliffe Report emphasised the need for training and education in prescribing. I hope that my right hon. Friend will be able to give some indication of what he is doing to attack that problem and see whether he can keep the medical student, the young houseman in the hospital and the general practitioner in touch with modern prescribing methods by some other means than through the representatives of the manufacturing houses, so that they can 1879 more competently co-operate in keeping the cost of the Service reasonable.
The Hinchliffe Committee says:We are satisfied that there is a clement need for systematic post-graduate instruction of general practitioners in pharmacology and therapeutics. Innumerable new drugs are produced and the average doctor is unable to judge the validity of the claims made on their behalf by the manufacturers' representatives.Here is a challenge to my right hon. Friend—
§ Mr. Wilfred Proudfoot (Cleveland)
I have a constituent who is a doctor who seems to be surcharged because his prescribing expenses are greater than anyone else's in the district, but he also claims that for putting patients in hospital, which is also very expensive, his figure is the lowest of the lot.
§ Sir H. Linstead
No doctor is necessarily surcharged when he over-prescribes. He is invited to explain to his colleagues how it is that his prescribing is so much more generous than his neighbours'. If he can satisfy his colleagues, that is the end of the matter. The conclusion need not be so gloomy as is suggested.
In my view, it is the prescriber who holds the key to economy in this section of the Health Service. As long as the principle that the prescriber is to be free to prescribe whatever he believes his patient needs is safeguarded, his knowledge and his judgment are the main things that my right hon. Friend has to rely on. The patient can do very little to control prescribing. It is for that reason that I very much regret that he should have to pay for increased costs over which he has virtually no control at all.
§ 9.45 p.m.
§ Mr. Maurice Edelman (Coventry, North)
When I was listening to the Secretary of State for Scotland—who has now left the Chamber—I had the illusion, perhaps due to the all-night sitting, that I was listening to the cold clicking of an electrical computer as he did the arithmetic of these charges, rather than to the voice of a Member of this House, so devoid was his speech of the humanity one might have expected on a matter of this kind.
We are not dealing with a simple matter of arithmetic but with grievous 1880 burdens being imposed on millions of people by the Regulations we are now discussing. Every Member, certainly every one on this side of the House, is well aware of the hardship which these Regulations will bring.
I want to give an illustration because, in doing so, I can put before the House the tragedy so many people will endure as a result of the Regulations. I had a letter from a constituent who wrote as follows:My mother is an old-age pensioner and a chronic invalid. We look after her at home. She has a small capital besides her pension of £2 10s. per week, just enough to preclude her from receiving National Assistance benefit. She therefore has to pay her own prescription charges. She has regular prescriptions—five one week and two the next, i.e., 7s. a fortnight, plus two irregular ones. If these charges are doubled, you can see the cost involved. As she has suffered a paralysing stroke, the prescriptions are absolutely necessary.This old lady is confined to bed, paralysed and incontinent, and suffers from bedsores. I see that the Minister of Health winces. I am sure that when he is confronted with the consequences of these Regulations, when he sees them illustrated with pain and suffering, and brought home to him in this way, when even he, who has already expressed in his juvenile poems his detestation of the old and the sick, will realise the burden—
§ Mr. Charles Loughlin (Gloucestershire, West)
Did not the Minister once write a poem asking for the escape of madness, but is he not now almost in it?
§ Mr. Edelman
I do not want to delay by talking about the Minister's poetry. I merely want to point out that, in dealing with this grave problem, he is tackling it from the wrong end.
Instead of demanding of the pharmaceutical industry that it should lower its prices, he has put the onus on the sick and has turned a blind eye to the system by which the pharmaceutical companies —this has certainly been established in America and is, I hope to show, equally well established here—get together in concert in order to keep prices high and make the vast and growing profits which occasionally appear before the public. In fact, the National Health Service has been milked by these drug companies, both British and American, as if it were some great placid cow whose object was 1881 to nourish profits instead of to sustain the health of the nation.
I will not repeat what has been said about the remarkable rise in the cost of proprietary drugs since 1949. The cost was then £34 million and has risen, in 1961, to about £92 million. The average cost of prescriptions has risen from 3s. 1 d. in 1949 to 7s. 4d. in 1960.
From time to time the Government have very properly shown concern at this alarming and apparently irresistible rise in the cost of drugs. They first appointed the Cohen Committee, which produced the voluntary price agreement, but that did not work. However well intentioned, the voluntary price agreement was completely unsuccessful in preventing prices from rising. After that came the Hinchliffe Committee, and that was equally ineffective in holding down the prices which the pharmaceutical companies were charging.
But certain things appeared from those Reports which were enough to cause alarm to everyone concerned. One of the most sinister symptoms detected by the Hinchliffe Committee was that the average level of profits of 43 major companies whose costs were analysed by the Committee was far above the level of industrial profits throughout the country.
In addition, we have had the incursion of the American drug companies into the National Health Service scene, an incursion which was certainly not made in the interests of philanthropy but was based entirely on commercial considerations, an incursion which has yielded highly profitable results to those companies.
There are 17 American-controlled companies in this country making drugs which are available on prescription only-We have to ask ourselves whether the shareholders of those American companies are growing fat on money made from the sick and ailing in this country. I hope that the House will bear with me while I offer it certain figures which I consider of great significance.
Hon. Members will have seen on the tape that a company called the Cyanamid Company of Great Britain has decided that it is substantially to lower the prices of its products. Indeed, the announcement said that Cyanamid will reduce prices by 12 per cent. from 27th February.
1882 This company is the manufacturer of what are known as broad spectrum antibiotics —antibiotics which have proved of the greatest value in the treatment of certain forms of infectious disease.
This announcement coming on the eve of tonight's debate is something which hon. Members might want to welcome without further analysis, but what is the history of the British subsidiary of Cyanamid? When the Health Service was introduced, the company was paying nothing to its American parent company, but in 1960 it had repatriated to America £1,400,000 profit from the National Health Service, from that captive customer.
I offer another figure to show how these American companies are milking the Health Service. In 1948, the Cyanamid Company made a trading profit of £45,000, but in 1960 that figure had risen to £3 million. In the circumstances, it is easy to see how that company can make the gesture of reducing prices by about 12 per cent.
§ Colonel Sir Tufton Beamish (Lewes)
In order to present a fair picture, I am sure that the hon. Member for Coventry, North (Mr. Edelman) will want to say how much Cyanamid has spent on research in the last twelve months. I do not keep the figure in my head, but it is probably about 15 million dollars.
§ Mr. Edelman
I naturally defer to the hon. and gallant Member's knowledge of the British and American pharmaceutical industries because, if I am not mistaken, he has commercial connections with an American pharmaceutical company and, consequently, his testimony has a considerable value in this matter.
§ Mr. Robert Edwards (Bilston)
Does not my hon. Friend the Member for Coventry, North (Mr. Edelman) agree that that investment in research was made in America and that most American research into medicine and chemistry takes place at the universities and is financed by grants?
§ Mr. Edelman
I agree, and I hope to touch on that subject in a moment.
I want rapidly to give some further illustrations so that the House will be aware of the vast profits made from what the Kefauver Committee called "the fantastic profiteering" which is going on 1883 not only in America by some American pharmaceutical companies but by their British subsidiaries here as well, profits which are made out of what I have justly called the captive customer of the Health Service.
There is another American firm, Eli Lilly & Company, owned by a parent company in Minneapolis, which has raised its net profit from £100,000 and last year increased that figure to £944,000 in this country. There is another company, with which hon. Members may be familiar, Merck, Sharpe and Dohme, which in 1948 in this country made a profit of £44,000. Last year, its profit had risen to nearly £1½ million, and that profit was made out of the National Health Service. The American Parent company, Merck & Co., Inc., drew a record £800,000 from the profits made in this country.
Finally, I turn to the company which has already been mentioned—the Pfizer Company, which started in Britain as recently as 1953. Its first trading profit was £12,000, but by 1957 its profits had gone up to £1½ million. The sick, the humble, the poor, the people who are deprived, the people who are living in the conditions I mentioned in the letter from my constituent, are being asked to pay these extra shillings which are being demanded, or indeed extorted from them, in order to maintain prices which yield these fantastic profits and maintain the vast sums which are distributed to shareholders in Britain and America.
These are very serious matters, and when we are considering what has been done by the well-intentioned Cohen Committee, and the equally well-intentioned Hinchliffe Committee, what we have seen in effect is that American business men, and indeed British businesses concerned with the pharmaceutical industry, have always been one jump ahead of the well-intentioned doctors and scientists who constituted those committees. We all know that a voluntary price regulation scheme suggested by the Cohen Committee was expected to yield in three years a saving of £750,000 on an annual expenditure of £20 million, but we have had nothing like that. All we have had is a saving of £412,000 on an annual expenditure of £28 million 'between 1957 and 1960.
1884 As to research, which is constantly thrown up in order to show what is being done by the drug companies, those engaged in research offer to society the great advantages of their knowledge, while some of the shareholders may have never seen the drugs in their lives, and the scientists, the doctors and people in the industry derive very little benefit from the drug discoveries.
I should like to turn now to one case which I raised myself in this House some time ago. Some hon. Gentlemen may recall that I spoke about a drug called Inverscine, which is extensively used in the treatment of hypertension. It is a drug of proved value, and I said in a debate some time ago that the manufacturers of that drug were obtaining from it a profit of close upon 1,000 per cent. The Minister, in the traditional debating manner when a statement of that kind is made, said something like "Prove it."At that time I had not got the information about the cost, but I now have the cost of this particular drug, which conclusively proves that the profit made by the manufacturers out of the National Health Service is something like 1,000 per cent. Since that time I am able to report that that profit has been reduced. Today it is only 500 per cent. This illustration, concerning a drug which is used for widespread disease and which is demanded by sufferers by hypertension, shows how the National Health Service is being exploited by the drug companies.
The Service requires, as its counterpart, a nationalised pharmaceutical industry. I cannot believe that ill-health should be the business of anyone. I cannot believe that it is right that the people who utilise the work of the scientists, doctors and research workers—the wonderful work which has greatly benefited mankind—should group themselves together and engage in these rings, and the sort of activity which has been so roundly condemned in America by the anti-trust laws and the Supreme Court. I cannot believe that we can tolerate those practices in this country. The hon. and gallant Member for Lewes (Sir T. Beamish) smiles. I am sure he knows that in the United States companies supplying the Salk vaccine were indicted for forming a ring combining to keep up prices which held the Americans up to ransom. They were 1885 indicted, and later, as the House may recall, some were condemned for their activities.
I would ask the Minister one question: would he say whether there has been a diversity of bids in respect of the supply of vaccine—Salk or otherwise—for inoculation against poliomyelitis? Will he say whether there has been competition, or whether, as I suspect, arrangements have been made by the companies concerned to make identical bids for this vast business of selling vaccines for inoculations against poliomyelitis?
I want to give one example from my own experience. At the time of the polio epidemic in Coventry a few years ago I went to France to see if I could obtain some of the excellent anti-polio vaccine manufactured by the Pasteur Institute. Officials of the French Ministry of Health agreed to send to Britain 50,000 inoculations of vaccine at a time when the polio epidemic was raging. I have no means of knowing whether the inquiries which the British Ministry of Health instituted at that time were pursued, or whether, at a subsequent stage, any attempt was made to obtain bids from the Pasteur Institute for the supply of vaccine to this country.
I think I have said enough to indicate that it is clear that the whole pharmaceutical industry is a mystery involved in an enigma. 1 endorse the statement of my hon. Friend the Member for St. Pancras, North (Mr. K. Robinson) that the time is ripe for a public inquiry into the pharmaceutical industry, in order to see how the moneys of the National Health Service are being spent. Our charge against the Minister is that these prescription charges are not necessary. If the Minister were the good administrator he claims to be his first attack would be upon the drug companies, in order to bring down the profits of which I have spoken. If he did that he would easily be able to raise the revenue required to pay for the prescription costs.
One of the worst side-effects of the Regulations before the House is that they will result in increased self-medication. Once more we can say that it will be the pharmaceutical industry which will benefit from the Minister's activities—the sellers of proprietary medicines who sell 1886 their goods for self-medication through the Press and commercial television. They will be the ones who will benefit. They will strengthen their appeal to the poor and the sick who perhaps cannot afford to pay 2s. but will not be willing to go to the National Assistance Board and who will be all the more eager to have some nostrum, advertised in the Press and on television, by which they can promptly dismiss their ills when they cannot afford a protracted course for their illness. The man in the white coat on the television screen waving magic bottles will be the huckster translated into modern terms. With their quack implementations and the mumbo-jumbo of their incantations the witch doctors of commercial television will reap a rich harvest from the seeds of injustice which the Government have sown.
In praying against these Regulations we are praying that Britain should not again be divided into the two nations of the doctored and self-medicated. I believe that we should not revert to the time when some people were too poor to enjoy good health. The purpose of the National Health Service, after all, was to ensure that health became the birthright of all. We will do everything in our power to prevent the vicious attack by the Government on what should be a sacred principle.
§ 10.6 p.m.
The Earl of Dalkeith (Edinburgh, North)
In the short contribution I propose to make to this extremely interesting debate, I shall concentrate on the problem of the Is. increase in the prescription charge rather than go into the question of the merits or demerits of the principle of having prescription charges. As we know, the principle of the charge was introduced by the Labour Government in 1949, when the then Prime Minister, Lord Attlee, said that it was:… to reduce excessive and, in some cases, unnecessary resort to doctors and chemists… "—[OFFICIAL REPORT, 24th October, 1949; Vol. 468, c. 1019.]I do not think we need go further into that at the moment.
This is the first time in the course of my short period in the House—I have been here for nine months—that I have had apprehensions about action being taken by the Government. I am apprehensive about the exemptions and concessions inasmuch as they relate to 1887 people who might suffer hardship because of these increased charges.
While I welcome the provision of safeguards to protect people against hardship in theory, I am a little uneasy about the effective methods of administering these theoretical ideas in practice. I am also a little doubtful whether they go far enough and whether they cover enough people.
As regards the greater proportion of the people who are earning reasonably good wages—in fact, very good wages in many cases—I believe that they are getting a good bargain by paying 2s. for a prescription which, on the average, is worth 8s. That is a good bargain about which I do not think anybody who can afford to pay can complain. What is more, they are today getting better drugs and better medicines which cost more.
That is just one of the many economic reasons why there is justification for keeping some of the prescription charges. I know that hon. Members on both sides agree that one cannot measure this simply in terms of £ s. d. It must be measured in terms of human compassion and human sympathy. The biggest mistake which hon. Gentlemen opposite continue to make is to think that they have a monopoly in human warmth and human sympathy. If someone is stuck in a snowdrift and a St. Bernard dog comes to the rescue, it is not much comfort to that person if the animal is breathing down the back of his neck and perhaps licking him. There has to be the brandy as well. In other words, we need the administrative ability of the Government to be able to carry out this work in a humane way. It is because of this human angle that I feel many of us are concerned about the possible effect of these charges, and we are particularly anxious about the border-line cases which are difficult to define
In the last few days I have been making searching inquiries, and I must admit they have greatly dispelled the fears which I entertained previously. I would like to ask my right hon. Friend for some assurances in respect of four categories. Can he assure us that the poorer members of the community will not be deterred from taking preventative action in the early stages of illness because of these higher charges? Secondly, can he help to explain the 1888 provision of a refund for borderline cases of hardship, particularly in respect of elderly people who are outside the scope of National Assistance, and will he give the assurance that they be treated liberally and sympathetically by the National Assistance inspectors who will investigate their case? A great deal will depend on individual National Assistance inspectors and officers, who I know have a fine record of service.
Thirdly, I should like an assurance that if the refund procedure proves too complicated for the elderly and ill they will not go without the refund and thus become hardship cases, nor will they be allowed to go without medicine, to the detriment of their health. May I also ask for an assurance that if the exemptions turn out to be not working as we would hope and hardship results, there will be an examination of the whole system?
My fourth request for an assurance refers to the chronic sick. There are a great many perishable drugs and medicines which cannot be prescribed in large quantities. I hope therefore that my right hon. Friend will keep a careful watch on the cases of the chronic sick and take action as he sees fit to avoid hardship arising. The present concessions, though generous, may not be sufficient.
One other category to which I wish to refer are the old people living on fixed incomes who are just outside the scope of National Assistance. These people, I submit, in the last ten or fifteen years, in relation to the rest of the population, have been getting gradually poorer. [An HON. MEMBER: "Since the Tories came in."] I said, in relation to the rest of the population. In spite of recent pensions increases and the admirable efforts of the Government to restrain inflation, in relation to their neighbours their standards of living are not increasing as quickly.
Sometimes some of these people have to supplement small fixed incomes by spending their capital. Many of them are faced with the predicament that if they live another five years or so they will be all right because the money will last, but if they live longer than that they will have to apply for National Assistance. I am anxious that as a result of having to pay a higher charge, if they are not already covered by the 1889 present scheme of refunds, this may hasten they day when they are forced into claiming National Assistance. That would cause a great deal of unhappiness and the nation would derive no benefit as a result. I particularly ask my right hon. Friend to keep the case of these people in mind.
I know that my right hon. Friend has already said that he will look out for any cases brought to his attention. I agree that it is still too soon to see whether these hardship cases will actually turn out to be such cases as we fear they may be. This is an important group in our community and we must recognise it. Because very often they are decent independent-minded people who have always believed that they should look after themselves, they are practically allergic to claiming anything in the way of refunds if they feel that by so doing they would be begging. One of the greatest disservices one can do is to discourage people from claiming what they can justly claim by encouraging them to believe that they would be begging.
It is a pity that there are many people —I have met some myself—who will not claim National Assistance out of a sense of pride. That is something we must recognise. At the same time we should bear in mind whether it is a good or a bad thing that we should be encouraging people perhaps to adopt a begging attitude as a result of asking them to claim back these various charges. I confess it is very difficult to find another practical way of deciding who should and who should not pay these charges. The purpose of this discussion has been whether the charge should be Is. or 2s. I think there is every justification for nine-tenths of the population paying the increased charge of 2s. and for there to be safeguards for those who may become cases of hardship. We should look after them and see to it that they do not become cases of hardship. We should see that we do not leave them too late.
My right hon. Friend has already made provisions which cover most of the cases I have mentioned. I ask him to give us the assurances and safeguards which I have mentioned for these particular cases which could become cases of hardship. I ask him if he can see to it that they are not only written in terms of theory, but also actively and effectively practised. Although I know 1890 the system at present envisaged seems rather complicated, I would ask if he can review the system which has been suggested if it is proved to be necessary.
The 2s. prescription charge is part of what is the best National Health Service in the world. My right hon. Friend the Minister deserves to be most heartily congratulated on his plans for making it a more efficient and better Health Service still. if he is able to give me the assurances which I hope he can and will give me tonight, I shall have every confidence in supporting the Government in the Division Lobby.
§ 10.20 p.m.
§ Mr. James H. Hoy (Edinburgh, Leith)
I was interested to hear what the noble Lord the Member for Edinburgh, North (The Earl of Dalkeith) said. His apologia was not unexpected, because last week he abstained from voting in one of the Divisions in connection with the new charges. He tried to salve his conscience tonight by asking questions which the Minister cannot answer. How can the Minister know whether or not someone will go to the National Assistance Board? It is humbug to suggest that he will know.
The noble Lord's attitude is rather like the attitude of the hon. Member for Putney (Sir H. Linstead), who is the secretary of the Pharmaceutical Society. He said that he had received representations from chemists all over the country who had expressed grave doubts about the wisdom of imposing the charges. I have no doubt that the hon. Member for Putney, like the noble Lord, will go into the Lobby tonight to impose these charges at the Government's behest. We want no more nonsense of that kind.
§ Mr. Hoy
No, I will not give way so soon.
We are discussing two Health Service Acts tonight. One applies to England and Wales. The other applies to Scotland. If the noble Lord had been present when the Secretary of State for Scotland spoke he would have received his answer, because the right hon. Gentleman said that the Government will take every precaution to let people know how they 1891 can get the 2s. back. The Government will put handbills in the window to advise people how to do this.
The Earl of Dalkeith
The Division on which I abstained the other night concerned a different subject. A different principle was involved. I had justification for abstaining. I acted according to the dictates of my conscience.
§ Mr. Hoy
He made another one tonight. The great division which exists between the two major political parties was exemplified when it became clear that the right hon. Gentleman, who has never had this remission and does not know what these little troubles are, was unable to appreciate what the charges can mean to certain families. The noble Lord made the same error. When he spoke of the charge increasing from ls. to 2s., he seemed to believe that there is only one item on all prescription sheets. A prescription sheet which previously cost ls. or 2s. may now well cost 8s. or 10s., because each item will cost 2s. The country should understand that. The same mistake was made by the hon. Member for Holborn and St. Pancras, South (Mr. G. Johnson Smith), who spoke on television a few days ago of the prescription charge rising from is. to 2s. as if that was the end of the story. He ignored the fact that the prescription sheet may now cost 8s. or 10s.
Now, drug charges. I do not accept the analysis of the secretary of the Pharmaceutical Society that because a prescription in one part of the country costs 5s. 10d. but costs 7s. 11d. in another part of the country it necessarily means that the 7s. 11d. prescription is the most expensive and unnecessarily expensive prescription. That is nonsense. He spoke of an analysis being undertaken by the Ministry of Health.
1892 The Minister of Health knows that analyses have already been made. Making the charge for each item 2s. may save a great deal in rising charges.
Drug charges is not a new subject in the House. I was surprised when the Minister of Health intimated, when introducing the new charges, that as a kind of offset to them he would initiate an inquiry into the cost of proprietary drugs. He spoke as if that was something new. If anyone knows anything about the subject, it is the right hon. Gentleman, because he and I were members of the Public Accounts Committee. He knows that this was inquired into many years ago.
Let me remind the House of the Report of the Public Accounts Committee for as far back as 1953. The Committee reported that 'argent inquiries were being adopted, and as a result of our inquiries in that year we reported that the Public Accounts Committee felt bound to express regret at the long delay in dealing with this subject. They were disappointed that negotiations had so far been concluded for only two out of 8,000 proprietaries. That was the Report, unanimously approved by the Public Accounts Committee of which the right hon. Gentleman was a member —and that was seven or eight years ago.
It is also interesting to recall that the right hon. Gentleman himself put a Parliamentary Question to the Department about the cost of these things. He wanted to know the value of these prescriptions, and he was told by what is now his own Department that 10 per cent. of the prescriptions had no therapeutic value at all. That was the reply he got, so we do not need him to tell us, seven years later, that this is something that should be inquired into. In addition, his Ministry was saying that investigations were still proceeding.
When I interjected in the debate yesterday I mentioned certain figures that had been reduced in 1957. I have to correct that, and say that it was 1955. I am not impressed by the firm that today has announced a decrease in its charge for proprietary medicines, because in 1955 the Comptroller and Auditor-General reported, and it was confirmed by the Ministry, that the Ministry had approached only three 1893 firms that were supplying these proprietaries to the Health Service. As soon as those firms were told that it was thought that they were charging too much, they reduced their charges to such an extent that, as was stated in the Public Accounts Committee Report for 1955, a saving of no less than £850,000 a year was effected. It is equally obvious that had that approach not been made, those firms would have gone on wrenching money out of the Service.
I am not, therefore, impressed when this firm—in view of the challenges made against it, and knowing full well that this discussion is now taking place —now announces a reduction of 12 per cent. in its charges. If that action does anything, it proves the suspicion of the Public Accounts Committee that it was high time there was a real, high-powered inquiry into the way in which the Service was being robbed by these firms.
The right hon. Gentleman knows it to be perfectly true that we have always had the greatest difficulty of getting information from some of these firms. 1 defy any hon. Member, on either side of the House, who has served on the Public Accounts Committee to deny that there is always the greatest difficulty in getting information from them. I have come to the conclusion that that is because they have something to hide. It is as a result of all this sort of thing that so much expense is incurred.
Instead of the right hon. Gentleman and the Secretary of State for Scotland imposing these increased charges on a section of the community least able to bear them, they would be far better employed in inquiring into the extortionate profits of these firms. If that had been done, it would not have been necessary to impose these increases on the old-age pensioners, the sick and the disabled, and it would have saved themselves and the noble Lord the embarrassment of going into the Lobby tonight.
I have never believed anything other than that people cannot buy health in that sense. Health is one of the greatest assets that we have. If the Health Service has done nothing else, it has provided many people with good health that they otherwise would not have enjoyed. As a consequence, they have been able to make their contribution to the national 1894 economy. Do not let us forget that contribution. That should go on the credit side of the balance sheet when the Secretary of State for Scotland and the Minister are so busy making these little entries on the debit side about prescription charges. They should remember what the Health Service has achieved. If we have never had it so good, surely the nation should be able to afford the very best Health Service for every man. woman and child in the community.
I believe these Regulations to be an attack on that Service. The right hon. Gentleman and those who are associated with him do not believe in a National Health Service. I do not believe that they regard the social services in the same light as we do. We believe that they are an essential part of a decent and humane society, and it is because we believe that that we shall go into the Lobby tonight against there impositions.
§ 10.32 p m.
§ Colonel Sir Tufton Beamish (Lewes)
I wish to declare that I have a direct interest in the pharmaceutical industry, because I am on the board of the British subsidiary of an American firm. Because I am in that position, I know the facts.
§ Sir T. Beamish
I know all the facts. I am sorry that I have only two or three minutes in which to speak. Anyone who knows the first thing about industry is aware that it is absurd to relate profit to nominal capital. Yet that is what even the Comptroller and Auditor General did.
§ Mr. Woodburn
On a point of order, Mr. Deputy-Speaker. Is it in order for a debate in this House to be used as a means of putting before Parliament information that ought to be put before the Public Accounts Committee?
§ Sir T. Beamish
If people wish to be fair to a firm whose profits they are criticising they should take into account the research that is carried out by that firm.
I did not wish to rise to defend American firms that have been attacked: my speech was intended to be quite different, but it is a fact that in America last year more than 150 million dollars—the figure is from memory; in fact, it is more than that amount—was spent on research. That is a fact which nobody on the opposite benches has mentioned, because they did not wish to be fair. I believe that the American pharmaceutical companies have invested in this country more than they have so far taken out.
§ Sir T. Beamish
It is not rubbish. I have looked at some figures and I shall be glad to show them to the hon. Gentleman.
It is perfectly true that the drug bill has gone up year by year, and it will continue to rise, but if one wishes to be fair one should mention that it has borne a constant relationship to the total cost of the National Health Service—between 9 per cent. and 10 per cent. every year in the last ten years. That is a fact.
1896 Throughout the last ten years, furthermore, the cost of the pharmaceutical services has remained constant at between 0.38 per cent. and 0.40 per cent. of the national income.
That has not been mentioned by any hon. Member opposite, nor has anyone opposite mentioned that the Board of Trade wholesale price index for pharmaceutical preparations rose by only 1.4 per cent. in the five years 1954–59, whereas during the same five years the index rose by eight times as much for all manufactured products. That is something of which the industry ought to be proud, not something for which it should be abused. If the cost of prescribed drugs were really excessive in this country per head of the population, it would be high here in comparison with other countries. So far as I can ascertain from considerable research, it may be the lowest in the world, and it is certainly one of the lowest.
I have promised to sit down at twenty-five minutes to eleven, in little more than ten seconds from now. I am sorry that I have no time to give the House more of the facts. It is very unfair to present such a partial and fictional picture as hon. Members opposite have done. I believe that, on the whole, the pharmaceutical industry has done a very fine job for this country which, translated into terms of human happiness and the improvement of health, is impossible to assess. It is a great pity that we should have to listen to this worn-out old gramophone record being played over month after month by the Opposition.
§ 10.36 p.m.
§ Mr. Thomas Fraser (Hamilton)
Even if the House were to accept every word of what the hon. and gallant Member for Lewes (Sir T. Beamish) has said—and it certainly does not—even though it could be convinced that there is no drug company in this country or no drug company supplying drugs to the National Health Service which is making a profit which would be regarded by any hon. Member as excessive, it would still he no argument whatever for increasing the prescription charges to the sick. I pinched myself several times during the debate this evening, because I could see hon. Members being lulled into the belief that the drug bill had reached a certain figure and it could not go beyond that, and therefore, if we could not take the money out of the drug firms, we had to take it out of the patients. Surely, the Minister will not claim that that is the position.
I want to make abundantly clear that we believe that not only should the prescription not be doubled but that it should be removed altogether forthwith. We believe that the Regulations before us will bring death in their wake. We believe that fellow citizens of ours will die as a direct consequence of the House passing these Regulations. We all know that one of the results will be that the chronic sick, now rendered curable by some of the new drugs, will remain in their conditions of chronic illness because they will not go to the doctor, because they will not take advantage of the Health Service. We know that persons who might otherwise be relieved of suffering will not be relieved because they will not go to the doctor.
§ Mr. Fraser
We have been told by innumerable independent committees. We have been told it by the B.M.A. and by articles in the Lancet. We have been told even by the Hinchliffe Committee. We have been told it by the hon. MemPutney (Sir H. Linstead) during the debate today. These things happen to be true, and if it is the fact that some of our fellow citizens are going to die as a direct consequence of passing these 1898 Regulations, then surely we have a right to pause and consider whether we should pass them.
A lot has been said about the drug firms. I have just spoken about the drug firms not being allowed to influence whether or not we should impose the prescription charge. In all the debates that we have had about what has sometimes been described by my hon. Friends as the drug racket it has always been asserted by hon. Members opposite that there was no room at all for reductions. It is the Left in politics in this country that has carried out this campaign.
§ Mr. Fraser
I am saying it now.
A week last Sunday, Reynolds newspaper called attention to the firm of Cyanamid, pointing out that its profits had soared by more than £2 million in the last four years and demanding that there should be a reduction in the very heavy price which the Health Service would have to pay for the products of this very prosperous firm. Of course, nobody on the benches opposite would have admitted that the firm could make any reduction, but, as my hon. Friend the Member for Coventry, North (Mr. Edelman) intimated, even while we were having our discussions this evening a report appeared on the tape stating that the firm had reduced its prices by 12 per cent. If all the drug firms were to cut their prices by 12 per cent. to should get all the money needed to produce the sum which the Minister is going to get by the imposition of these charges.
This happens to be true. It is surely desirable, therefore, that, together with discontinuing all these charges for prescriptions, the Minister should look at what is happening in the drug industry. If he has not the time to do so himself—I sure he has not— let him take note of the advice given by the Public Accounts Committee, a Select Committee of this House. Let him have an independent inquiry made into what is happening in the drug industry in this country, and let him find whether the justification offered by some of his hon. Friends for the prices exists.
It seems to us that the increasing number of our fellow citizens who will 1899 undertake self-medication and who will refrain from going to the doctor is a terribly serious matter. They will certainly refrain from going to the doctor. I personally know some who will, not very many but some. We have had these Reports to which I have referred. People are being given great encouragement in the process of "doing it yourself" by commercial television, by some terribly expensive advertisements by drug firms, very largely paid for by the Chancellor.
This again happens to be true. I ask the Minister who is said to be a very considerate man—I do not know him personally—to have another look at this matter.
§ Mr. Fraser
There is no reason from this experience to believe that the increase in the charges will in any case effect any reduction in the cost of the drug bill. Our experience up to now, since the charge was imposed first of all in 1952 and since it was increased to Is. per item in December, 1956, is that it did not result in the reduction of the drug bill for the nation as a whole. In each case it had the result that the drug bill went up because of the tremendous waste. Is it not a tragedy that we should be imposing unnecessary hardship upon millions of people in this country and at the same time not bringing any relief whatsoever to the Exchequer—which was the whole point of the exercise in the first place? I believe that the total cost of the drug bill was bound to rise, and to rise pretty steeply. We have all of us read of the cost of these new drugs, these antibiotics, these lifesavers.
We know that many of these newer drugs have not only relieved very great suffering but have enabled people who were chronically sick and who appeared to be totally incapacitated and unable to undertake employment for the rest of their lives to be sufficiently restored to fitness as to go back to work. It is difficult to measure the value of that to society. Let us not, therefore, look at what the drug bill was ten years ago and say we must increase the prescription charge to the patient.
1900 The Secretary of State said that there was tonight no discussion about principle, that that was all decided in 1949. He is quite wrong. It was not all decided in 1949. The charges were first imposed in 1952. Hon. Members talked about the charge being double what it was to begin with. It is not being made double what it was to begin with. It was Is. per person; then it was Is. per item; now it is 2s. per item. The Secretary of State said that this was a brave decision.
§ Mr. Fraser
This was a brave decision, he said, because there had been an increase in the cost of the total drug bill because of the coming in of these antibiotics, these more expensive medicines. The Secretary of State seemed to think that that was a justification for putting the prescription charge of 2s. on the patient who gets a Is. 3d. cough bottle. Many of these items cost substantially less than 2s.: substantially less. The Secretary of State says this is a brave decision which throws no real burden on the chronically sick—because he had worked it all out, as though he were the Minister of Health, as though he were an expert in these figures. He worked it all out and said the average cost to the patient, the chronically sick, would be 8d. a week or so at the present time.
§ Mr. Maclay
There was a sample taken, and I was very careful to explain exactly what that sample was.
§ Mr. Fraser
Yes, he quoted this sample, and he gave that figure, that the cost of drugs to those people in the sample was 8d. a week. All these were chronically sick people. He said this would not cause them any hardship. Would it cost the Surtax payer any hardship if he carried it in taxation? What does this increase represent to the average Surtax payer?
§ Mr. Fraser
So small, it is hardly calculable. But the Secretary of State said that because we have the chronic sick this was a brave decision by the Government—
§ Mr. Fraser
—in this society at this time when we have never had it so good.
He said a lot about the arrangements made by the National Assistance Board. It is disgraceful that the Secretary of State, or any other Minister, should stand at the Box and say that there is no reason why a poor person, or an old-age pensioner, when going into the chemist's shop should not get a receipt or, having got a receipt, go along to the post office, or get some other member of the family to get the receipt from the chemist and go along to the post office on behalf of the old-age pensioner. Why should we impose all this loss of dignity on the older people in the community? Why should they have to say, in the chemist's shop, "I am on National Assistance. Can I have a receipt?" Why should we impose this indignity on those old people?
In the course of yesterday's debate, we once again had reference to the contribution to the Service by the insured worker, and quotations from the Beveridge Report. I should like to quote a passage from the Beveridge Report and go on to show that, on the basis of that Report, the Government can hardly justify what they did yesterday and what they are doing today. At paragraph 437, dealing with the contribution of 10d. towards the National Health Service—which, incidentally, as a result of yesterday's Bill, will become 3s. 4d. per man—the Beveridge Report said:It is proposed accordingly that, in the contributions suggested as part of the Plan for Social Security, there shall be included a payment in virtue of which every citizen will be able to obtain whatever treatment his case requires, at home or in an institution, medical, dental or subsidiary, without a treatment charge.As I said in the debate a week ago, that was what we got for the 10d, over the years from 1911. It was not always 10d., but from 1911 we got our free prescriptions because we made a contribution to that limited Health Service in our National Health contribution. The Minister of Health and the Secretary of State—the Government, in fact—have said that the insured worker who got his prescriptions free from 1911 onwards because he made that contribution must now pay., not the contribution of 10d., but a contribution of 3s. 4d.
Even when the 10d. becomes 3s. 4d. over the period of only a few years—because the party opposite was the first 1902 to step up the new insurance contribution, and it has stepped it up so steeply that in a few years the 10d. contribution has now become 3s. 4d.—the same insured worker whom the Beveridge Committee assumed would continue to receive his treatment free because that contribution was being made, has now to pay 2s. for every item on the prescription. There is no doubt that many of those in employment and paying these contributions out of low wages must still have regular medical treatment and regular prescriptions, and a good many of them have prescriptions with three or four items on them every week. Those people will not only pay another 10d. a week on their insurance contribution, but another 6s. or 8s.—or, if the right hon. Gentleman wants to be precise about it, another 3s. or 4s. a week—for the medicines they get across the chemist's counter.
Some people will certainly be put off by these charges. They will not be the wealthy people. They will not be people who are asking for tax concessions at present. They are not the people who might be entitled to have six months in the sun to do them good. They are the poor people for whom we in Parliament have a duty to stand up, the people for whom we should care. If the Conservatives really cared, they would not proceed with these Regulations. I hope very much that hon. Members opposite who have uttered criticisms of these prescription charges will have the courage of their convictions and will come into the Lobby with my hon. and right hon. Friends.
§ 10.55 p.m.
§ The Minister of Health (Mr. Enoch Powell)
I am sure that it would be true to say that every speech in this debate, from whatever point of view it has been uttered, has been inspired by concern for the well-being of the National Health Service. In particular there has been considerable expression of anxiety about the gross cost within the Health Service of the pharmaceutical service.
Before I come almost immediately to the Regulations themselves, I should like to say straight away that the Government do not regard these Regulations as in any sense a substitute for action to ensure that we get value for money for the gross cost of the pharmaceutical service. In ensuring that we do so, and I have taken the expression of my hon. 1903 Friend the Member for Billericay (Mr. Gardner), there are two aspects both of which have to be looked at the same time. One concerns the prices of drugs, and the other the prescribing of drugs.
As for prices, the new voluntary price regulation scheme which was negotiated at the end of last year not only was in itself a substantial improvement over its predecessor but it opened the way to continuing negotiations, some of the first fruits of which have been reductions in the cost of some Cyanamid drugs which have been mentioned several times in the debate, and with that process the Government intend steadily to continue.
On the prescribing side, I entirely agree with the authoritative analysis of my hon. Friend the Member for Putney (Sir H. Linstead). Undoubtedly if there is a key in this matter the key lies in the hands of the prescribing doctor, and it is the duty of the Government to do all that lies in their power to help him, within his complete professional discretion, to achieve good and economical prescribing. One means is the production of the new Prescribers' Journal which is designed to attain that purpose. So by a balanced operation upon prices and upon prescribing we shall progressively, I believe, make sure that we are getting full value for the money that we spend on the pharmaceutical service.
§ Mr. A. E. Cooper (Ilford, South)
Would my right hon. Friend bear in mind that the Ministry of Aviation has a technical costs organisation which is very effective? Would he consider introducing some similar organisation in respect of the pharmaceutical service?
§ Mr. Powell
Certainly my Department seeks and uses expert costing advice in these matters.
In no way are the Regulations which are before the House an alternative to or substitute for the action about which I have just been speaking. The result of the Regulations will be to raise by way of increased prescription charges the sum of £11½ million in the next financial year and £12½ million in a full year. It is, I think, apposite to remind the House of what the Guillebaud Report, which has many times been quoted in our debates in these last few days, had to say about the prescription charge. The Guillebaud Committee was speaking, of 1904 course, about the prescription charges in 1956. It said:… we have no reason to think that the charge hinders the proper use of the Service by at least the great majority of its potential users …I shall come in a moment to consider the position of the small minority who are, by implication, referred to in that expression, but let me for a moment take these words:… we have no reason to think that the charge hinders the proper use of the Service by at least the great majority of its potential users …
§ Mr. K. Robinson
Will the right hon. Gentleman make it clear that the Report was referring to the 1s. per form prescription charge? As there are now on average 1.5 prescriptions per form, the charge is now to be three times the charge referred to by the Guillebaud Committee.
§ Mr. Powell
I specifically said that, and I am bound to point out that the whole of our experience since then, which includes the period of the increase of the charge to 1s. per item in 1956, bears out the conclusions of the Guillebaud Report.
In the first place, according to the best advice which is available to me, there is no evidence which tends to show that either the 1952 or the 1956 prescription charges have had any unfavourable effect upon the country's health.
§ Mr. Powell
It is a very material point. Secondly, if it is alleged that these charges have been a barrier and have prevented people obtaining the prescriptions they should have obtained, how comes it that the number of prescriptions dispensed in the year coming to a close is greater than the number dispensed in the last year before the 1956 charge, and in the last year before the 1952 change, bearing in mind the fact that undoubtedly following the 1956 charge there was, as there was intended to be, an increase in prescribing for longer periods for the chronic sick and a corresponding reduction in the number of prescriptions?
Of course, this is not a surprising experience, because this period of nine years from 1952 to 1961 has witnessed an increase in purchasing power throughout the whole community.
1905 Whether we test it upon, for example, National Insurance benefits or upon earnings, we find that there has been an enormous increase over those years in the purchasing power of the community of something like 70 per cent. or 80 per cent., to say nothing of the increase since 1949, when Parliament first thought it right to pass the legislation under which these Regulations are being made.
I turn at once from this general picture —which no one really doubts—of a prescription charge which is no barrier to the use of the Service by the great majority—I use the Guillebaud Committee's own description—to consider the tiny minority to whom it may be a barrier. It is right that concern about that minority should have been expressed from both sides of the House, and not least from this side of the House, in the debate tonight.
How stands it with that tiny minority? They are, of course, catered for, as the House knows, in one of two ways. There are those in receipt of regular National Assistance—and I pause there for a moment to point out that the area covered by National Assistance, the scope of National Assistance, is today far greater than it was in 1952. In real terms there has been an increase of something like 40 per cent. in the value of the National Assistance standards. Those who can automatically recover the charges because they are in regular receipt of National Assistance are higher up, in a higher band of society, than was the case in 1952.
I now come to the other element of provision for the minority, which concerns those who are not in regular receipt of National Assistance. There the contribution made through the Board is dictated by two considerations. First, these payments can be made to people in employment, and the special arrangements have to take account of that fact, and, secondly, the need here being met is essentially of an occasional and not a constantly recurring nature: these are sums which fall from time to time upon the budgets of the persons or families concerned. It is on that basis that the arrangements for the assessment of their need—which I mentioned in the House last week and which I propose to mention again—are based.
In these cases, before the Board applies its scales it allows expenses in connection 1906 with employment, such as fares to and from work, superannuation contributions and trade union subscriptions, and it also allows such items as mortgage repayments hire-purchase payments and insurance premiums and, finally, up to 40s; of net earnings is disregarded.
It will be easier for the House to grasp the scope of these arrangements—and it is a wide scope—if I put before it some concrete instances of persons or families who would qualify for the refund of prescription charges under them. I will first take examples of people who are earning and then examples of people who are retired. From 1st April a man with a wife and three dependent children, paying a rent of 10s. or more—[Interruption]—ten shillings or more; that is, paying a rent as low as 10s., and who has, apart from family allowances, net earnings as high as £8 15s. a week, after allowing for fares to work, insurances and all the other disregards and allowances which I have mentioned would be able to get his prescription charge refunded.
Let me take another example. A man with the same family would be likely to qualify, even though he earned about £10 a week net, if he had a rent of about 25s. a week and some hire-purchase commitments. Finally, a man with higher commitments still might qualify even though his earnings were higher than the figures I have given. The House will probably appreciate from those examples that there is ample scope in the second leg of the arrangements for ensuring that not even a minority is held back from getting the benefits of the National Health Service by this charge.
§ Mr. T. Fraser
Does the Minister appreciate that last week I quoted a speech of his in which he said that these people would just not go to the National Assistance Board?
§ Mr. Powell
I am now taking up the challenge of what I said in 1951, because I regard arrangements such as these as amply fulfilling the conditions I had in mind when I made the speech in 1951, which was quoted by the hon. Member.
Now let me come to the example of a retired person. Let us take a pensioner drawing from 1st April the new retirement pension of 57s. 6d. Let us suppose that that person also has a superannuation payment of 35s. a week, a small 1907 superannuation payment, but a typical instance of a pensioner who is outside the normal scope of the National Assistance Board.
In such a case, if there were a rent of about 2'4s. a week—not at all an unlikely eventuality—he would qualify for refund of prescription charges, and it is interesting to note that in such a case the income concerned approximates closely to that which attracts the age exemption for Income Tax purposes.
Not only are these arrangements wide in their scope, but the method for securing them is simple. I have here the receipt form which can be obtained at the chemist when the drug—or drugs—is purchased. All that a person in the second category about which I have been talking has to do is to fill in his name and address on the back of this form, and either take it, or post it, to the National Assistance Board, in which case the applicability of a payment will be determined by the Board.
My right hon. Friend the Secretary of State for Scotland reminded the House that, where cash is not available, it can be obtained in advance upon the prescription form itself.
§ Mr. Powell
Many hon. Members, in particular my hon. Friend the Member for Tynemouth (Dame Irene Ward) in an earlier debate, have emphasised the importance of these arrangements being as widely known as possible. I think that the House would wish to know the arrangements which the Government propose to make to ensure that, as far as is humanly possible, the availability of refund in these circumstances is known to all whom it may concern.
The detailed information which has already been sent to doctors and chemists will be revised and re-issued. As regards the general public, posters with full details will be sent to all chemists and family doctors, and they will be able to give patients or customers details of the procedure for obtaining refunds. The National Old People's Welfare Council will give the information to its 1,600 local councils in its next bulletin. The local managers of the National Assistance Board will make it 1908 their duty to communicate these arrangements not only to the local old peoples' organisations, but to all the many local organisations with whom they are in contact as part of their duty. Finally, the National Assistance Board is already in touch with the Citizens' Advice Bureau with a view to circulating to all its branches details of how to obtain this refund.
§ Dr. J. Dickson Mabon (Greenock)
This does not meet the argument about the chronic sick who are above those levels which I do not consider are levels of anything more than poorness itself. I put a suggestion to the right hon. Gentleman. Why cannot a certificate be issued to a person who is chronically sick which will exempt him from all charges?
§ Mrs. Braddock
The right hon. Gentleman mentioned refunds. Does that mean that a person has to pay for the prescription before there is any possibility of getting a refund?
§ Mr. Powell
As I have already explained, where the cash is not available it can be obtained in advance upon the prescription form; that is, not waiting for the receipt from the chemist, but on the prescription form.
Coming to the point made by the hon. Member for Greenock (Dr. Dickson Mabon), the difficulty about that kind of exemption is the extreme one of finding a definition of the term "chronic sick" which would be both appropriate and fair as between one person and another. The Government believe that this is a matter which must be left to the discretion of the family doctor, knowing the circumstances, so that he can decide the maximum period for which to prescribe—and he is encouraged to do so.
§ Mr. Powell
I am sorry, but I must get on. I promise that I will correspond with the hon. Gentleman on the subject. My mind is quite open to any practical improvements which it may be thought can be made.
§ Mr. Powell
Over and above all that I have told the House about these exemptions, there is the pledge of my predecessor, which the Secretary of State for Scotland and I have repeated, to 1909 examine specific cases where hardship may arise, and, in reply to my hon. Friend the Member for Putney, I feel that the implementation of our pledge will best ensure that, as time goes on, the working of these arrangements would be constantly under review.
I have not mentioned, but I should mention, that where war disability is concerned, there is no question but that the charges will be automatically refunded. That is the position where the charge relates to war disability.
With such safeguards which have already under the past arrangements resulted in refunds being available to the extent of 8 or 9 pea. cent. of the total of prescription charges, and with the experience of the working of the prescription charges system over the last ten years, and with the background of increasing prosperity and well-being during those ten years, it would be hard indeed to assert that it is more important to keep the charge at a shilling than to apply the £12 million or £13 million which this new charge will yield to some other part of the National Health Service.
In the coming year, the gross cost—that is, the real cost, the full cost—of the Service will rise by £79 million, from £807 million to £886 million. Of that increase of £79 million, some £50 million has been made possible by the measures which we have been debating in these recent days, and of which this £12 million or £13 million is an integral part. That is the decision which the House is taking tonight namely, whether it wishes to apply £12 million or £13 million in this way.
I think that the House should be reminded of the general view of the charges and their place in the service which was taken by the Guillebaud Committee.
§ Mr. Powell
I am quoting from paragraph 571.We do not believe that the country will be in a position to provide a fully comprehensive health service, which is adequate for all desirable needs, in the foreseeable future. The Government's problem is how to make the best possible use of the available resources and to decide which are the most urgent priorities to be met as and when more resources become available. The question of the priority to be given to the reduction of charges must, therefore, depend on the relative importance 1910 attached to other outstanding needs in the Health Service as a whole, as well as on the financial resources at the disposal of the Government for all purposes ".That statement of the Guillebaud Committee, which is really self-evident, and the issue which I have put before the House tonight, that we are deciding whether it is better to keep the prescription charge as it is at present or to spend another £12½ million upon the development of the Service, is no new discovery.
§ Mr. Powell
I will convince the hon. Gentleman that it is the real choice before I conclude. Let me quote the following words:It was absolutely necessary to obtain money from charges upon some other parts of the Health Service so that we could maintain the essentials. The charges that we now propose are estimated to yield us £13 million in this year. With the aid of that revenue we plan to spend £15 million more on hospitals this year than was estimated for last year… Thus, in the next financial year we shall, despite the ceiling of £400 million, have £12 million more available to meet essential needs … than we have this year."—[OFFICIAL REPORT, 24th April, 1951; Vol. 487, c. 238.]That was said by the right hon. Member for Middlesbrough, East (Mr. Marquand). Let there be no misunderstanding. It is this question of priorities which the House is deciding tonight.
Here is another quotation:Let us look at the actual facts. It is not the National Health Service that would be making a charge to the patient. It is the National Health Service that would be saying to the patient: ' Where a doctor has given you a prescription that costs more than a shilling, the National Health Service will pay the cost above a shilling, but up to the shilling you will pay.' We could quite as easily restrict the new service in another direction." —[OFFICIAL REPORT, 9th December, 1949; Vol. 470, c. 2261.]That was said by the late Aneurin Bevan in 1949.
§ Mr. Powell
I will give the hon. Lady the Member for Cannock (Miss Lee) an opportunity to intervene later.
I was going to refer to the speech which the hon. Lady made last week, which was heard, if I may respectfully say so, with the attention which she always commands. She touched the House by a description of a personal 1911 experience which emphasised the continuing deficiencies, gaps and lacks in an important part of the National Health Service. I want to ask the hon. Lady a question in a moment. She said in her speech:… we might at this moment have the pleasure of perfecting our Health Service. Instead, we are engaged in this squalid debate about raising prescription charges from Is. to 2s…"—[OFFICIAL REPORT, 8th February, 1961; Vol. 634, c. 480.]I should like to ask the hon. Lady which she considers to be more important—to keep the prescription charge at its present level or to have f12 million or £13 million additional available for applying, for example, to the part of the National Health Service where she drew attention to the deficiency.
§ Miss Jennie Lee (Cannock)
The Minister is putting an entirely false point, and it is an insult to the productive capacity and common sense of this country to say that we have not the resources to meet both those needs. May I also ask him to consult the appendix to "In Place of Fear," where he will discover what he must already know, that, even before the Labour Government left office, in the Ministry of Health plans were being made to deal with profits in the pharmaceutical section and others that had been ten years wasted. The fact that one or two of my hon. Friends on this side of the House had not an entirely clear vision is no justification for the right hon. Gentleman's total blindness.
§ Mr. Powell
I knew that the hon. Lady would take one or other of the escape routes which hon. Members opposite throughout these debates have allowed themselves, because they are not carrying responsibility. The two escape routes are, first, to say that there would not be this dilemma if the national income were larger.
§ Miss Lee
The Minister has misunderstood me. I believe that with wiser Government the national income could have been larger; but, taking the national income as it has been in the last ten years, I think it is quite disgraceful that a higher priority should not be given to the subjects we are discussing.
§ Mr. Powell
The hon. Lady went out through the other door, not the one I 1912 supposed. The other door is to say that it is quite easy, because we could allocate more from general revenue.
§ Mr. Powell
Yes—one or other of those escape routes has been provided for themselves by hon. Members to escape from what is the real dilemma and the real choice before the House. [HON. MEMBERS: "No."] Very well. I will make the utmost concession which mile one wishes to ask from me. I will assume any increase which hon. Members please in the national income in the present year—[AN HON. MEMBER' "What about next year?"]—or next year, if hon. Members like it. I will assume also that my right hon. and learned Friend the Chancellor of the Exchequer has allowed me for my Estimates this year any demand which I care to make out of tax revenue. So strong is the force of the argument that the dilemma still confronts the House. Am I to keep the charges at their present level—?
§ Mr. Powell
We have it at last. Hon. Members opposite believe that it is more important to keep the present level of charges which are not withholding the benefits of the Service from anyone rather than have another £12 million or £13 million for expenditure on essential purposes.
The Opposition have never realised that neither the National Health Service nor the society in which it exists stands still. They are both living, changing things reaching out to new aims as people are able to meet old needs for themselves.
A remarkable contribution, though a brief one, was made to our debates earlier last week by my hon. Friend the Member for Plymouth, Sutton (Mr. I. Fraser). He set out to perfection, I thought, the true difference—and there is, of course, a fundamental difference here—between the two sides of the House. [HON. MEMBERS: "Yes."] Yes, there is indeed. My hon. Friend said thatthere is no ideal pattern for the National Health Service laid up in heaven …We have got to find a pattern for the National Health Service which will not only suit it but which will work. It has to suit the dynamic and increasingly prosperous society at all levels. Why I am poles apart from hon. Members opposite is that I do not 1913 believe that their ideal pattern for the Health Service would either suit or work."—[OFFICIAL REPORT, 9th February, 1961: Vol. 634, c. 737.]When, in a moment or two, the House divides, the Division will be between a party for which time stood still in 1951, a party which is still looking back to the society that the rest of the country has left behind and in the other Lobby a party which is looking forward to a
§ continuing development of the National Health Service as of the other social services and which is confident that it will receive the understanding and support of the nation in fulfilling its duties.
§ Quesion put:—
§ The House divided: Ayes 220, Noes 285.1917
|Division No. 57.||AYES||11.30. p.m|
|Abse, Leo||Hart, Mrs. Judith||Oswald, Thomas|
|Ainsley, William||Hayman, F. H.||Owen, Will|
|Allaun, Frank (Salford, E.)||Hewitson, Capt. M.||Padley, W. E.|
|Allen, Scholefield (Crewe)||Hill, J. (Midlothian)||Paget, R. T.|
|Awbery, Stan||Hilton, A. V.||Pannell, Charles (Leeds, W.)|
|Bacon, Miss Alice||Holman, Percy||Pargiter, G. A.|
|Beaney, Alan||Holt, Arthur||Parker, John (Dagenham)|
|Bellenger, Rt. Hon. F. J.||Houghton, Douglas||Parkin, B. T. (Paddington, N.)|
|Bence, Cyril (Dunbartonshire, E.)||Hoy, James H.||Pavitt, Laurence|
|Blackburn, F.||Hughes, Cledwyn (Anglesey)||Pearson, Arthur (Pontypridd)|
|Blyton, William||Hughes, Emrys (S. Ayrshire)||Peart, Frederick|
|Boardman, H.||Hughes, Hector (Aberdeen, N.)||Pentland, Norman|
|Bowden, Herbert W. (Leics, S.W.)||Hunter, A. E.||Plummer, Sir Leslie|
|Bowen, Roderic (Cardigan)||Hynd, H. (Accrington)||Popplewell, Ernest|
|Bowies. Frank||Hynd, John (Attercliffe)||Prentice, R. E.|
|Braddock, Mrs. E. M.||Irvine, A. J. (Edge Hill)||Price, J. T. (westhoughton)|
|Brockway, A. Fenner||Irving, Sydney (Dartford)||Probert, Arthur|
|Broughton, Dr. A. D. D.||Janner, Sir Barnett||Proctor, W. T.|
|Brown, Alan (Tottenham)||Jay, Rt. Hon. Douglas||Pursey, Cmdr. Harry|
|Brown, Rt. Hon. George (Belper)||Jeger, George||Randall, Harry|
|Butler, Herbert (Hackney, C.)||Jenkins, Roy (Stechford)||Rankin, John|
|Butler, Mrs. Joyce (Wood Green)||Johnson, Carol (Lewisham, S.)||Redhead, E. C.|
|Callaghan, James||Jones, Rt. Hn. A. Creech (Wakefield)||Reid, William|
|Castle, Mrs. Barbara||Jones, Dan (Burnley)||Reynolds, G. W.|
|Chetwynd, George||Jones, Elwyn (West Ham, S.)||Rhodes, H.|
|Collick, Percy||Jones, J. Idwal (Wrexham)||Roberts, Albert (Normanton)|
|Corbet, Mrs. Freda||Jones, T. W. (Merloneth)||Roberts, Goronwy (Caernarvon)|
|Craddock, George (Bradford, S.)||Kelley, Richard||Robinson, Kenneth (St. Pancras, N.)|
|Crosland, Anthony||Kenyon, Clifford||Rogers, G. H. R. (Kensington, N.)|
|Cullen, Mrs. Alice||King, Dr. Horace||Ross, William|
|Darling, George||Lawson, George||Shepherd, William|
|Davies, Harold (Leek)||Ledger, Ron||Short, Edward|
|Davies, Ifor (Gower)||Lee, Frederick (Newton)||Silverman, Julius (Aston)|
|Davies, S. O. (Merthyr)||Lee, Miss Jennie (Cannock)||Skeffington, Arthur|
|Deer, George||Lever, Harold (Cheetham)||Slater, Mrs. Harriet (Stoke, N.)|
|de Freitas, Geoffrey||Lever, L. M. (Ardwlck)||Slater, Joseph (Sedgefieid)|
|Delargy, Hugh||Lewis, Arthur (West Ham, N.)||Small, William|
|Dempsey, James||Lipton, Marcus||Smith, Ellis (Stoke, S.)|
|Diamond, John||Loughlin, Charles||Snow, Julian|
|Dodds, Norman||Mabon, Dr. J. Dickson||Sorensen, R. W.|
|Donnelly, Desmond||McCann, John||Soskice, Rt. Hon. Sir Frank|
|Driberg, Tom||MacColl, James||Spriggs, Leslie|
|Ede, Rt. Hon. C.||McInnes, James||Steele, Thomas|
|Edelman, Maurice||McKay, John (Wallsend)||Stewart, Michael (Fulham)|
|Edwards, Rt. Hon. Ness (Caerphilly)||Mackie, John||Stones, William|
|Edwards, Robert (Bilston)||McLeavy, Frank||Strachey, Rt. Hon. John|
|Edwards, Walter (Stepney)||MacMillan, Malcolm (Western Isles)||Strauss, Rt. Hn. C. R. (Vauxhall)|
|Fernyhough, E.||Mallalieu, E. L. (Brigg)||Stross,Dr.Barnett(Stoke.on-Trent.C.)|
|Finch, Harold||Malialieu. J.P.W.(Huddersfield,E.)||Swain, Thomas|
|Fitch, Alan||Manuel, A. C.||Swingler, Stephen|
|Fletcher, Eric||mama, Charles||Sylvester, George|
|Foot, Dingle (Ipswich)||Marquand, Rt. Hon. H. A.||Symonds, J. B.|
|Foot, Michael (Ebbw Vale)||Marsh, Richard||Taylor, Bernard (Mansfield)|
|Forman, J. C.||Mason, Roy||Taylor, John (West Lothian)|
|Fraser, Thomas (Hamilton)||Mayhew, Christopher||Thompson, Dr. Alan (Dunfermline)|
|Gaitskell, Rt. Hon. Hugh||Mellish, R.J.||Thomson, G. M. (Dundee, E.)|
|Galpern, Sir Myer||Mendelson, J. J.||Thornton, Ernest|
|George,LadyMeganLloyd(Cirm'rth'n)||Millan, Bruce||Timmons, John|
|Ginsburg, David||Milne, Edward J.||Tomney, Frank|
|Gooch, E. G.||Mitchlson, G. R.||Ungoed-Thomas, Sir Lynn|
|Gordon Walker, Rt. Hon. P. C.||Molson, Rt. Hon. Hugh||Wade, Donald|
|Gourley, Harry||Moody, A. S.||Wainwright, Edwin|
|Greenwood, Anthony||Morris, John||Warhey, William|
|Grey, Charles||Moyle, Arthur||Weitzman, David|
|Griffiths, Rt. Hon. James (Llanelly)||Mulley, Frederick||Wells, William (Walsall, N.)|
|Griffiths, W. (Exchange)||Neal, Harold||White, Mrs. Eirene|
|Grimond, J.||Noel-Baker, Francis (Swindon)||Whitlock, William|
|Hall, Rt. Hon. Glenvil (Colne Valley)||Oliver, G. H.||Wilcock, Group Capt. C. A. B|
|Hamilton, William (West Fife)||Oram, A. E.||Wilkins, W. A.|
|Hannan, William||Willey, Frederick|
|Williams, D. J. (Neath)||Wilson, Rt. Hon. Harold (Huyton)||Yates, Victor (Ladywood)|
|Williams, LI. (Abertillery)||Winterbottom, R. E.||Zilliacus, K.|
|Williams, W. R. (Openshaw)||Woodburn, Rt. Hon. A.||TELLERS FOR THE AYES:|
|Willis, E. C. (Edinburgh, E.)||Woof, Robert||Mr. Howell and Mr. Cronin.|
|Agnew, Sir Peter||Fraser, Ian (Plymouth, Sutton)||Low, Rt. Hon. Sir Toby|
|Aitken, W. T.||Freeth, Denzil||Lucas, Sir Jocelyn|
|Allan, Robert (Paddington, S.)||Galbraith, Hon. T. G. D.||Lucas-Tooth, Sir Hugh|
|Ashton, Sir Hubert||Gammons, Lady||McAdden, Stephen|
|Atkins, Humphrey||Gardner, Edward||MacArthur, Ian|
|Barber, Anthony||George, J. C. (Pollok)||McLaren, Martin|
|Barter, John||Gibson-Watt, David||McLaughlin, Mrs. Patricia|
|Batsford, Brian||Glover, Sir Douglas||Maclay, Rt. Hon. John|
|Beamish, Col. Sir Tufton||Glyn, Dr. Alan (Clapham)||Maclean,SirFitzroy(Bute&N.Ayrs.)|
|Bennett, Dr. Reginald (Gos & Fhm)||Glyn, Sir Richard (Dorset, N.)||McLean, Neil (Inverness)|
|Berkeley, Humphry||Goodhart, Philip||Macleod, Rt. Hn. lain (Enfield, W.)|
|Biggs-Davison, John||Gower, Raymond||MacLeod, John (Ross & Cromarty)|
|Birch, Rt. Hon. Nigel||Grant-Ferris, Wg Cdr. R.||Macmillan,Rt.Hn.Harold(Bromley)|
|Bishop, F. P.||Green, Alan||Macmillan, Maurice (Halifax)|
|Black, Sir Cyril||Grosvenor, Lt.-Col. R. G.||Maddan, Martin|
|Bossom, Clive||Gurden, Harold||Maitland, Sir John|
|Bourne-Arton, A.||Hamilton, Michael (Wellingborough)||Manningham-Buller, Rt. Hn. Sir R.|
|Box, Donald||Harris, Frederic (Croydon, N.W.)||Markham, Major Sir Frank|
|Boyd-Carpenter, Rt. Hon. John||Harris, Reader (Heston)||Marten, Neil|
|Boyle, Sir Edward||Harrison, Brian (Maldon)||Mathew, Robert (Honiton)|
|Braine, Bernard||Harvey, Sir Arthur Vere (Macclesf'd)||Matthews, Gordon (Meriden)|
|Brewis, John||Harvey, John (Walthamstow, E.)||Maxwell-Hyslop, R. J.|
|Bromley-Davenport,Lt.-Col.SirWalter||Harvie Anderson, Miss||Maydon, Lt.-Cmdr. S. L. C.|
|Brooke, Rt. Hon. Henry||Hastings, Stephen||Mills, Stratton|
|Brooman-White, R.||Hay, John||Montgomery, Fergus|
|Browne, Percy (Torrington)||Heald, fit. Hon. Sir Lionel||More, Jasper (Ludlow)|
|Bryan, Paul||Heath, Rt. Hon. Edward||Morrison, John|
|Bullard, Denys||Henderson, John (Cathcart)||Mott-Radclyffe, Sir Charles|
|Bullus, Wing Commander Eric||Hendry, Forbes||Nabarro, Gerald|
|Burden, F. A.||Hicks Beach, Maj. W.||Neave, Airey|
|Butler,Rt.Hn.R.A.(Saffron Walden)||Hiley, Joseph||Nicholls, Sir Harmar|
|Campbell, Sir David (Belfast, S.)||Hill, Dr. Rt. Hon. Charles (Luton)||Nicholson, Sir Godfrey|
|Campbell, Gordon (Moray & Nairn)||Hill, Mrs. Eveline (Wythenshawe)||Noble, Michael|
|Carr, Compton (Barons Court)||Hill, J. E. B. (S. Norfolk)||Nugent, Sir Richard|
|Carr, Robert (Mitcham)||Hinchingbrooke, Viscount||Oakshott, Sir Hendrie|
|Channon, H. P. G.||Hirst, Geoffrey||Orr-Ewing, C. Ian|
|Chataway, Christopher||Hobson, John||Osborn, John (Hallam)|
|Clark, Henry (Antrim, N.)||Hocking, Philip N.||Osborne, Cyril (Louth)|
|Clark, William (Nottingham, S.)||Holland, Philip||Page, John (Harrow, West)|
|Clarke, Brig. Terence (Portsmth, W.)||Hollingworth, John||Partridge, E.|
|Cleaver, Leonard||Hope, Rt. Hon. Lord John||Pearson, Frank (Clitheroe)|
|Cole, Norman||Hopkins, Alan||Peel, John|
|Cooper, A. E.||Hornby, R. P.||Percival, Ian|
|Cordeaux, Lt.-Col. J. K.||Hornsby-Smith, Rt. Hon. Patricia||Peyton, John|
|Cordle, John||Howard, Hon. C. R. (St. Ives)||Pike, Miss Mervyn|
|Corfield, F. V.||Hughes Hallett, Vice-Admiral John||Pilkington, Sir Richard|
|Costain, A. P.||Hughes-Young, Michael||Pitman, I. J.|
|Coulson, J. M.||Hulbert, Sir Norman||Pitt, Miss Edith|
|Courtney, Cdr. Anthony||Hurd, Sir Anthony||pott, Percivall|
|Craddock, Sir Beresford||Hutchison, Michael Clark||Powell, Rt. Hon. J. Enoch|
|Critchley, Julian||Iremonger, T. L.||Price, David (Eastleigh)|
|Crosthwaite-Eyre, Col. O. E.||Irvine, Bryant Godman (Rye)||Price, H. A. (Lewisham, W.)|
|Crowder, F. P.||Jackson, John||Prior, J. M. L.|
|Cunningham, Knox||Jennings, J. C.||Prior-Palmer, Brig. Sir Otho|
|Curran, Charles||Johnson, Dr. Donald (Carlisle)||Profumo, Rt. Hon. John|
|Currie, G. B. H.||Johnson, Eric (Blackley)||Proudfoot, Wilfred|
|Dalkeith, Earl of||Johnson Smith, Geoffrey||Quennell, Miss J. M.|
|Dance, James||Jones, Rt. Hn. Aubrey (Hall Green)||Ramsden, James|
|d'Avigdor-Goldsmid, Sir Henry||Joseph, Sir Keith||Rawilnson, Peter|
|Deedes, W. F.||Kerans, Cdr. J. S.||Redmayne, Rt. Hon. Martin|
|de Ferranti, Basil||Kerby, Capt. Henry||Rees, Hugh|
|Digby, Simon Wingfield||Kerr, Sir Hamilton||Renton, David|
|Donaldson, Cmdr. C. E. M.||Kershaw, Anthony||Ridley, Hon. Nicholas|
|Doughty, Charles||Kimball, Marcus||Ridsdale, Julian|
|Drayson, G. B.||Kirk, Peter||Rippon, Geoffrey|
|du Cann, Edward||Kitson, Timothy||Robson Brown, Sir William|
|Eccles, Rt. Hon. Sir David||Lagden, Godfrey||Rodgers, John (Sevenoaks)|
|Eden, John||Lambton, Viscount||Roots, William|
|Elliot. Capt. Walter (Carshalton)||Lancaster, Col. C. G.||Ropner, Col. Sir Leonard|
|Elliott,R.W.(N'wc'stle-upon-Tyne,N.)||Leather, E. H. C.||Royle, Anthony (Richmond, Surrey)|
|Emery, Peter||Leavey, J. A.||Russell, Ronald|
|Emmet, Hon. Mrs. Evelyn||Legge-Bourke, Sir Harry||Sandys, Rt. Hon. Duncan|
|Errington, Sir Eric||Lewis, Kenneth (Rutland)||Scott-Hopkins, James|
|Erroll, Rt. Hon. F. J.||Lilley, F. J. P.||Sharples, Richard|
|Farey-Jones, F. W.||Lindsay, Martin||Shaw, M.|
|Farr, John||Litchfield, Capt. John||Silverman, Sydney (Nelson)|
|Finlay, Graeme||Lloyd, Rt. Hon. Selwyn (Wirral)||Simon, Rt. Hon. Sir Jocelyn|
|Fisher, Nigel||Longbottom, Charles||Skeet, T. H. H.|
|Fletcher-Cooke, Charles||Loveys, Walter H.|
|Smithers, Peter||Thomas, Leslie (Canterbury)||Webster, David|
|Smyth, Brig. Sir John (Norwood)||Thomas, Peter (Conway)||Wells, John (Maidstone)|
|Speir, Rupert||Thompson, Richard (Croydon, S.)||Whitelaw, William|
|Stanley, Hon. Richard||Thornton-Kemsley, Sir Colin||Williams, Dudley (Exeter)|
|Stevens, Geoffrey||Tilney, John (Wavertree)||Williams, Paul (Sunderland, S.)|
|Steward, Harold (Stockport, S.)||Turner, Colin||Wills, Sir Gerald (Bridgwater)|
|Stodart, J. A.||Turton, Rt. Hon. R. H.||Wilson, Geoffrey (Truro)|
|Storey, Sir Samuel||Tweedsmuir, Lady||Wise, A. R.|
|Studholme, Sir Henry||van Straubenzee, W. R.||Wolrige-Gordon, Patrick|
|Summers, Sir Spencer (Aylesbury)||Vane, W. M. F.||Wood, Rt. Hon. Richard|
|Sumner, Donald (Orpington)||Vaughan-Morgan, Sir John||Woodnutt, Mark|
|Tapsell, Peter||Vickers, Miss Joan||Woollam, John|
|Taylor, Sir Charles (Eastbourne)||Vosper, Rt. Hon. Dennis||Worsley, Marcus|
|Taylor, Edwin (Bolton, E.)||Wakefield, Sir Wavell (St. M'lebone)|
|Taylor, W. J. (Bradford, N.)||Wall, Patrick||TELLERS FOR THE NOES:|
|Teeling, William||Ward, Dame Irene||Mr. E. Wakefield and|
|Temple, John M.||Watkinson, Rt. Hon. Harold||Colonel J. H. Harrison.|
|Thatcher, Mrs. Margaret||Watts, James|