§ 9. Mr. Benceasked the Minister of Pensions and National Insurance what steps he is taking to protect insured persons on sickness benefit from having to submit to a means test before being enabled to recover National Health Service prescription charges incurred by them during their period on sickness benefit.
§ 19. Mr. Sydney Irvingasked the Minister of Pensions and National Insurance whether persons on sickness benefit require to make application to the National Assistance Board and submit to a means test before obtaining any refund of National Health Service prescription charges which they may have been obliged to pay.
§ The Minister of Pensions and National Insurance (Mr. John Boyd-Carpenter)A person whose sickness benefit is supplemented by National Assistance can obtain a refund at the post office without further formality, on production of the chemist's receipt and his supplementary order book. Others who want help can apply to the National Assistance Board under the arrangements fully described by my right hon. Friend the Minister of Health on 8th February.
§ Mr. BenceIs the right hon. Gentleman aware that in country areas, particularly in Scotland where vast distances have to be covered, this means considerable inconvenience to men on sickness benefit? Will he look into the matter again and see if this is necessary in country areas where men often have to travel for miles to the National Assistance Board or miles to the dispensing chemist's shop, and this may be a very expensive item?
§ Mr. Boyd-CarpenterOf course, the Board will follow up any case in which difficulty arises, but, as the hon. Member knows, this is not a new procedure. It has been followed for a good many years in respect of existing prescription charges, and I have no reason to believe that it will cause any general difficulty.
§ 10. Mr. Manuelasked the Minister of Pensions and National Insurance what was the number and amount of National Health Service prescription charges refunded by the National Assistance Board in Ayrshire to persons not in receipt of National Assistance supple. mentation during each of the past four years.
§ Miss Hornsby-SmithIn general, such information can be given for particular localities only for the past two years, as it is derived in part from accounting records which have been destroyed for earlier periods. It is estimated that during (959 and 1960, in an area approximating to Ayrshire, the National Assistance Board refunded, in respect of persons not already receiving a regular weekly National Assistance grant, total amounts of, respectively, £70 representing 1,400 prescription items and £60 representing 1,200.
§ Mr. ManuelIs the right hon. Lady aware that the County of Ayr is comprised of many small villages and that many people in them strongly object to having to ask for this refund because that fact soon becomes everybody's business? Could she try to inculcate in her right hon. Friend some more humane method whereby poor people receiving National Assistance might be able to recoup the prescription charge without the matter being publicised as it is at present?
§ Miss Hornsby-SmithI think the hon. Member does scant justice to the great care and sympathy shown by the National Assistance Board. Indeed, in the supplementary question he referred—
§ Mr. ManuelThat is not the point I was making.
§ Miss Hornsby-Smith—to those receiving National Assistance, whereas his main Question refers to those not normally in receipt of National Assistance.
§ Mr. ManuelMay I ask—
§ Mr. SpeakerNo. I was too indulgent to the hon. Member in allowing his other question. I did not call him again.
11. Mr. Milianasked the Minister of Pensions and National Insurance what proportion of applications to the 10 National Assistance Board for refund of National Health Service prescription charges over each of the past three years was granted; and what proportion was refused.
§ Mr. Boyd-CarpenterIt is not possible to answer this Question in precisely the form in which it is asked, but I can state that in 1958 the total amount refunded by the National Assistance Board was £972,000 representing over 19 million prescription items; in 1959, £1,003,000 representing over 20 million; and, in 1960, £1,066,000 also representing over 20 million. The numbers of applications rejected in these years were, respectively, about 3,000, 2,000 and 1,500.
§ 15. Mr. Gourlayasked the Minister of Pensions and National Insurance at what level of weekly personal income a woman living alone may expect the National Assistance Board to refund a National Health Service prescription charge she has paid.
§ 16. Mr. Cliffeasked the Minister of Pensions and National Insurance at what level of weekly personal income a married man without children may expect the National Assistance Board to refund a National Health Service prescription charge paid by him in respect either of himself or of his wife.
§ 17. Mr. Rossasked the Minister of Pensions and National Insurance what is the minimum weekly income for a man, wife and two children that will qualify for refund by the National Assistance Board of National Health Service prescription charges paid by that family.
§ 12. Mrs. Cullenasked the Minister of Pensions and National Insurance what is the minimum weekly income for a man, wife and four children that will qualify for refund by the National Assistance Board of any National Health Service prescription charges paid by that family.
§ Mr. Boyd-CarpenterI am afraid it is not possible to give the figures asked for in these Questions, since a number of factors, such as rent, rates, age of children and special needs, which under the National Assistance (Determination of Need) Regulations the Board is required to take into account, are not stated and may vary from case to case.
§ Mr. GourlayIs the Minister aware that his Answer is completely unsatisfactory? Will he therefore reconsider the position so that people may know what their entitlement is for reclaiming refund of these prescription charges?
§ Mr. Boyd-CarpenterI take it from the hon. Gentleman's supplementary question that he does not fully appreciate how National Assistance works and is administered, and that to relieve need and prevent hardship it is, for example, necessary to take into account the extent of the rent and rates paid, the special, seeds of the person concerned, and a number of other factors. Therefore, it simply is not possible, unless those factors can also be predicated, to answer this kind of question.
§ Mr. HoughtonDoes the Minister realise the difficulties which will be imposed on many people at the marginal point between National Assistance and no National Assistance, and the good deal of unnecessary traipsing round the National Assistance Board and correspondence and visits by National Assistance Board officers that will be necessary to determine these cases? Can he not get some simplified method of a plain declaration—some simple information as to the qualifying standards—and allow that to stand as the basis for refund of contributions?
§ Mr. Boyd-CarpenterThe information, of course, is available in National Assistance Board leaflets which set out very clearly what are the bases on which there is a qualification for National Assistance generally under the Determination of Need Regulations. One can only simplify it in the way suggested in the Question at the price of inflicting hardship and injustice on, for example, people whose rents are above the average.
§ Mr. RossSurely the Minister appreciates that if the Government are to avoid hardship in these cases of people who are not in receipt of National Assistance they need somehow or other to get across to them some sort of sample information such as we have asked for in the Question; otherwise people will adopt the attitude of: "Why should we bother? We do not know whether it is worth our while." Whether the Government like it or not—and obviously they do not like it from their statements—hardship will be caused.
§ Mr. Boyd-CarpenterI do not reject the idea of sample information. Indeed, the hon. Gentleman will recall that my right hon. Friend the Minister of Health gave some the other night. The trouble is that these Questions as framed would not elicit such information.
§ Sir A. V. HarveyWould it not be possible where National Assistance is drawn for recipients to be given a leaflet with their money at the Post Office?
§ Mr. Boyd-CarpenterAs my hon. and gallant Friend will appreciate, the problem to which these Questions relate is in the case of people not drawing regular Assistance. I think that there is no reason to believe that any difficulty at all arises in the class of case to which he refers.
§ Mr. LawsonIs it not the case that what the Minister is saying is that no one will be able to obtain these rebates unless he or she first goes to the National Assistance Board? There is no other way in which it can be done. What we are asking is that there be some sense of the humiliation many people feel will be inflicted on them by this move. We are asking whether they be given advice as to what their position is without their first going to the National Assistance Board.
§ Mr. Boyd-CarpenterThere is, as the hon. Gentleman knows, no need in the literal sense to go to the National Assistance Board. It is perfectly possible to get in touch with the Board, as many people will in this case, through the post. The hon. Gentleman should also, I think, appreciate that this is a system which has been operating for quite a number of years in respect of the existing prescription charges.
§ 18. Mr. Cooperasked the Minister of Pensions and National Insurance if he will state the conditions which have to be satisfied to enable a person not currently in receipt of National Assistance to claim a refund of prescription and other charges.
§ Mr. Boyd-CarpenterApart from war pensioners who, whatever their resources, can obtain a refund in respect of medicines, etc. prescribed for their accepted war disabilities, a person to be eligible for refund of prescription charges has to satisfy the Board that after paying the 13 charge or any part of it he would be left with insufficient resources to maintain himself and his dependants on the standards laid down by the National Assistance Regulations.
§ Mr. CooperRemembering the great importance of this subject, and in view of what has been said to the House, will my right hon. Friend give serious consideration to the method of publicising these conditions, because I am certain that there are hundreds of thousands of people who are unaware that they can get these refunds?
§ Mr. Boyd-CarpenterI am at the moment considering with the National Assistance Board how best to make sure that there is complete understanding of where entitlement arises.
§ Mr. G. ThomasIs it not perfectly clear from the Minister's reply that to get a refund applicants will have to reveal the most personal details about their income and expenditure, and that to get back the 2s., or whatever they spend, they will have to submit to the full process of the means test?
§ Mr. Boyd-CarpenterThe hon. Gentleman knows very well that the National Assistance Board's handling of these matters, based on a good many years' experience, is calculated to cause the least embarrassment and difficulty.
§ Mr. John HallIs it not clear from the Answer to this and previous Questions that there is a great deal of confusion and no little anxiety about the way this will operate? Would it not be much easier, and indeed much fairer, if all those below a certain level of income were exempt from paying prescription charges? No doubt that could be done by the P.A.Y.E. code.
§ Mr. Boyd-CarpenterThat question goes far beyond my responsibility in replying for the National Assistance Board, and is, I think, a matter for my right hon. Friend.
§ Mr. StracheyCould not the Minister tell us whether it will not cost more than 2s. to make the means test on these applicants? Is it not therefore a very cumbrous system?
§ Mr. Boyd-CarpenterWhat is important is that hardship should be prevented.
§ 20. Mr. Smallasked the Minister of Pensions and National Insurance how many applications to the National Assistance Board in Glasgow over each of the past three years for refund of National Health Service prescription charges were refused.
§ Miss Hornsby-SmithIn an area approximating to the City of Glasgow, 64, 37 and 28, respectively.
§ 21. Mr. Lawsonasked the Minister of Pensions and National Insurance what is the customary number of weeks for which an insured person is expected to be on sickness benefit before being considered by the National Assistance Board as qualifying for refund of National Health Service prescription charges.
§ Mr. Boyd-CarpenterThere is no such customary period.
§ Mr. LawsonIs the Minister aware that a person on unemployment benefit has to be unemployed for three or four weeks before he has any chance of getting National Assistance? Is the same idea—whether or not by regulation—in operation, or might it be in operation, in respect of the prescription charges?
§ Mr. Boyd-CarpenterWhile not accepting the statement of the position made by the hon. Gentleman in respect of unemployment benefit, it is the fact that there is no such restriction of any kind in respect of prescription charge refunds. Indeed, as the hon. Gentleman may be aware, under the provisions of the National Health Service Acts, 1951 and 1952, these refunds can be made even to people in full work, who are otherwise statutorily debarred from National Assistance.
§ 22. Mr. Lawsonasked the Minister of Pensions and National Insurance how many applications to the National Assistance Board in Lanarkshire over each of the past three years for refund of National Health Service prescription charges were refused.
§ Miss Hornsby-SmithIn an area approximating Lanarkshire, 22, 23, and 13, respectively.
§ Mr. LawsonDoes this not indicate how many people other than those on National Assistance dare apply for the 15 refund of those prescription charges? This is clear evidence of the feeling of humiliation many people have when they make application. The evidence here is that people not on National Assistance are almost not applying at all.
§ Miss Hornsby-SmithOn the contrary, amongst those who applied not being on National Assistance there were in the last two years refunds in respect of about 3,200 and 1,400 prescription items.
§ 23. Mr. Reynoldsasked the Minister of Pensions and National Insurance if he will publish a White Paper showing the assessment scales and disregards operated by the National Assistance Board in deciding upon applications for refund of National Health Service prescription charges made by persons not currently on National Assistance supplementation.
§ Mr. Boyd-CarpenterNo, Sir. The scales and disregards are set out in the National Assistance (Determination of Need) Regulations and the Disregard of Assets Order, 1959, and in the leaflets published by the Board.
§ Mr. ReynoldsDoes not the Minister realise that he has named three separate items, one of which was in the plural, namely, leaflets? Would it not be a good idea to simplify the matter—it has not been simplified by his answers, or lack of them, this afternoon—by publishing one document dealing with the whole procedure and all the disregards?
§ Mr. Boyd-CarpenterAs I said in reply to my hon. Friend the Member for Ilford, South (Mr. Cooper), I am considering with the Board whether any improvement in publicity arrangements is possible. From the point of view of making the provisions clearly known to people eligible for the refund, a White Paper is almost the worst expedient.
§ Mrs. BraddockWhile the Minister is considering the question of publicity, will he consider the position of those who cannot pay for the prescription at all? A prescription may be given to a person upon the very day before he draws his pension. Under what circumstances does the Assistance Board pay for prescriptions before they are purchased?
§ Mr. Boyd-CarpenterThere are arrangements for doing that in cases of 16 need. However, before answering fully on the precise nature of the arrangements, I should be grateful if the hon. Lady will table a Question.
§ 28. Mr. Hector Hughesasked the Minister of Pensions and National Insurance how many applications to the National Assistance Board in Aberdeen over each of the past three years for refund of National Health Service prescription charges were refused.
§ Miss Hornsby-SmithIn an area approximating to the City of Aberdeen, eight, five and three, respectively.
§ Mr. HughesWill the right hon. Lady state what the reasons were in each case and what alternative provision was made for the unfortunate people to whom refund was refused?
§ Miss Hornsby-SmithI cannot tell the hon. and learned Gentleman without notice, but he is assuming that they were necessarily within the National Assistance standards.
§ 30. Dr. Dickson Mabonasked the Minister of Pensions and National Insurance what number of applications to the National Assistance Board in Paisley, Greenock, and the county area of Renfrewshire over each of the past four years for refund of National Health Service prescription charges was refused.
§ Miss Hornsby-SmithIn Renfrewshire, which includes Paisley and Greenock, 14, 9, 12 and 8, respectively.
§ Dr. MabonDoes the Parliamentary Secretary realise that some doctors in the area know of cases where the National Assistance Regulations, either in the past or as at present, do not take account of the chronicity of the illness from which a person is suffering? That is an added argument for suggesting that some consideration should be given to this element in phrasing the instructions to the National Assistance Board.
§ Miss Hornsby-SmithThe Board is concerned with the level of income. These questions have shown that there have been very few refusals, and a not inconsiderable number in all these years of people who have drawn prescription charges whilst not normally on National Assistance.
§ 31. Dr. Mabonasked the Minister of Pensions and National Insurance what were the numbers and amounts of National Health Service prescript ion charges refunded by the National Assistance Board in Paisley, Greenock and Renfrewshire to persons not in receipt of National Assistance supplementation during each of the past four years.
§ Miss Hornsby-SmithAs I have already explained, figures can be given only for 1959 and 1960. They are, for the whole county of Renfrewshire, including the two burghs named, respectively, £70 and £90 representing 1,400 and 1,800 prescription items.
§ Dr. MahonWill the Parliamentary Secretary be kind enough to inform her right hon. Friend the Minister of Pensions and National Insurance or her right hon. Friend the Minister of Health that a tremendous burden of administration is being handed over to the National Assistance Board in these areas, which already carry a heavy burden by virtue of the high and deep-seated unemployment there? Will not she consider arguing the case for making a register of the chronic sick, which would exempt people automatically without recourse to National Assistance investigation?
§ Miss Hornsby-SmithI will certainly bear in mind what the hon. Member has said and pass it on to my right hon. Friend.
§ 32. Dame Irene Wardasked the Minister of Pensions and National Insurance what arrangements the National Assistance Board has made to refund the new prescription charges for those living on limited pensions, whether public or private, and on interest on savings and to what extent an assumed rent allowance will also be included in the disregards.
§ Mr. Boyd-CarpenterOn the general question as to the basis on which these refunds are and will continue to be made, I would refer my hon. Friend to my reply to my hon. Friend the Member for Ilford, South (Mr. Cooper). Rent or comparable outgoings and the normal disregards are of course allowed for by the Board's officer in making his assessment.
§ Dame Irene WardArising out of the examples given by my right hon. Friend 18 the Minister of Health in the last debate, am I right in assuming that people not paying Income Tax on their basic income, their earnings being too low to attract Income Tax, would in the main be permitted to have their prescription charges refunded?
§ Mr. Boyd-CarpenterI should not like to tax my mathematical ingenuity by making, whilst standing at the Dispatch Box, an equalisation or balance between the Inland Revenue law and the National Assistance scales.
§ Mr. SwinglerWhy is it not possible for the Minister to state a figure of net income after payment of rent and rates below which it will be automatic for people to get refunds?
§ Mr. Boyd-CarpenterEven rent and rates do not resolve the matter. In cases where there are children the Assistance scales vary considerably in accordance with their ages. That affects the calculation. There is also the element of special needs. I can certainly give examples, but they would be based on, say, half a dozen assumptions over and above those included in any Question on the Order Paper today.
§ Dame Irene WardWill not my right hon. Friend agree that there is very great anxiety about all these matters among all sections of the community? Is he considering any scheme for altering the pattern which may help those people above the National Assistance level who come into the category of small fixed incomes?
§ Mr. Boyd-CarpenterI am replying on these matters today on behalf of the National Assistance Board. If I understand my hon. Friend aright, what she says seems to be within the responsibility of my right hon. Friend the Minister of Health.
§ Mr. ChetwyndIn view of the onerous burden put upon applicants and the officers of the National Assistance Board in establishing need in these cases, would it not be much better now to scrap the whole lot? Will not the administrative charges by far outweigh the saving the Treasury hopes to make?
§ Mr. Boyd-CarpenterAs the administrative costs must be practically the same whether the refund is 1s. or 2s., the effect 19 of the change must be to reduce the proportion of the costs of administration to the total refunded.
§ Mr. JayDo not all the Minister's answers show that the whole arrangement is extremely complicated and will be very difficult for ordinary people to understand in practice?
§ Mr. Boyd-CarpenterThe right hon. Gentleman may say that, but ordinary people have succeeded in understanding it in practice for many years past.
§ 34. Mr. Prenticeasked the Minister of Pensions and National Insurance how many refunds of National Health Service prescription charges have been made by the National Assistance Board in East Ham during each of the last three years.
§ Miss Hornsby-SmithIt is not possible to give figures of the number of refunds made in particular localities, as complete records are not kept by locality for the refunds made at Post Offices, which are the very great majority.
§ Mr. PrenticeWithout figures of this kind, how can the Government possibly claim that they are taking effective measures to avoid hardship resulting from the Health Service charges, or is it that the situation is simply that Conservatives do not care?
§ Miss Hornsby-SmithThe hon. Member is making a false assumption. Anyone already receiving National Assistance gets back the charges automatically. It would be a sheer bureaucratic waste of time and money to sort out repayments which were automatically made to those applying to the Post Office— [HON. MEMBERS: "To whom?"] —to beneficiaries already receiving National Assistance and who draw that assistance through the Post Office. On showing their current National Assistance book, they will automatically draw back the prescription charges and they will be paid at the Post Office on showing their books.
§ Mr. PrenticeWill not the hon. Lady agree that every hon. Member is entitled to know how this matter affects his constituents? Otherwise, how are hon. Members on the hon. Lady's side to be able to judge whether this is good legislation?
§ Miss Hornsby-SmithSome 12 million prescription receipts are put through the Post Office by people who are currently on National Assistance. Hon. Members have been suggesting that the procedure should be simplified, and this is the simplest method—the production of a receipt so that one can obtain a refund when one is on National Assistance.