Clause 6.—(MEDICAL REQUIREMENTS ETC.) (Hansard, 13 June 1966)

§ Mr. Braine
This Clause touches on a matter of considerable importance and principle which require an explanation from the Minister. It would appear that the provision is merely a continuance of the present charges for dental and ophthal- 1142 mic services—spectacles and surgical appliances; boots, supports and elastic hosiery. Presumably, too, it means that such charges do not apply to hospital inpatients, patients in receipt of National Assistance and war pensions in respect of their accepted war disabilities. But what about other persons who are not able to afford the charges?
Under the present arrangements such people may apply to the National Assistance Board for a grant towards these charges. In such cases the Board is empowered to waive its rule of not assisting people who are in full employment. Will this still be the position? I am bound to say—and I say this more in sorrow than in anger—that the Government's attitude to the question of charges is bewildering in the extreme. The provision in the Clause is in complete conflict with what the party opposite has promised the electorate. I recall that as recently as 1961 the present Prime Minister advocated not only the abolition of Health Service charges but of National Health Service contributions as well. Indeed, he wrote in the New Statesman on 24th March, 1961: The first task in the Health Service will be to recreate the free service established by Aneurin Bevan.…Year by year the case is becoming stronger for taking the Health Service and its contributions under the General Exchequer system". Indeed, such a proposal was advanced in the Labour Party's manifesto for the 1964 election. In that document the party opposite stated: Our aim is to restore as rapidly as possible a completely free Health Service. When one remembers that the Government's National Plan shows that income from National Health Service charges is actually expected to be higher than it is today, can we assume from this Clause that the Government have finally decided to abandon the idea of a completely free Health Service?
The matter is of such importance and relevance that the Committee is entitled to be told the answer. As these charges are to remain—and we must assume that the Government are legislating for some time ahead—the Committee is entitled to know whether the Minister is satisfied that the present system of recovery of charges is working satisfactorily. I ask this for a specific reason. I can remember, when I was at the Ministry of 1143 Health and sitting on that side of the House, how critical hon. Members opposite were when they were in opposition. Is the Joint Parliamentary Secretary satisfied that there will be no undue delay or difficulty in regard to refunds to those people whom this Bill is designed to help and who need the various services or appliances which I have mentioned?
There is a further point. I have found, and I imagine that this has been the experience of other hon. Members, that it is not generally known that persons whose income is slightly above National Assistance scales can apply to the National Assistance Board for reimbursement of National Health Service charges—if not in whole, then certainly in part. I put this question to the National Assistance Board officers whom I know and with whom I worked for many years, and they told me that they are astonished that, despite all the publicity which has been given by successive Governments and by the National Assistance Board, this fact is still not widely known. Will this arrangement continue? Despite the provisions laid down in the Clause, will it be possible for people who get the supplementary allowance to receive a quick and full reimbursement of National Health Service charges?
I should also like to know whether the new Minister will arrange to make this more generally known. I am sure from what the right hon. Lady said earlier that this would be her intention, but I am giving her the opportunity to make it absolutely clear.

§ The Joint Parliamentary Secretary to the Ministry of Pensions and National Insurance (Mr. Harold Davies)
I am grateful to the hon. Member for Essex, South-East (Mr. Braine) for raising the point, but I do not want to delay the Committee. Let us get rid of the party piece. We were asked the rhetorical question whether it is our intention to abandon the free Health Service. We have before us today what marks the completion of a further stage of the Government's review of our social services. The Bill will provide a better deal for the poorest people in the community, the old and the sick.
That is what we are dealing with, so what in the name—I must keep in order 1144 —of the Lord has the free Health Service to do with this? It has nothing to do with this Clause. To discuss it is completely out of order, with due respect to you, Sir Beresford. Let us come to the point. [HON. MEMBERS: "Hear, hear."] It was necessary to point out the irrelevance of the opening gambit in order for me now to come to the master move at the centre of the board.

§ Mr. Davies
Let me finish the sentence first, please, and I shall give way, because the hon. Gentleman is always courteous. I wanted to make this point, because it was not fair to introduce that question when the hon. Member had put forward quite important issues that were worthy of answer. Now I shall sit down.

§ Mr. Braine
I am grateful to the hon. Gentleman. He should not deliver these strictures, because it is quite clear from the provision that for some considerable time to come the Government are requiring these charges to be levied, and I made the point, which I think is valid and which I hope the Joint Parliamentary Secretary will answer, that under the National Plan the Government evidently expect the revenue from such charges to rise. I am sure that under the Labour Government people will not get so sick and incapacitated that many more will require these appliances and services. It follows that the Government have abandoned the idea that charges for these appliances and services can be waived for the whole population.

§ Mr. Davies
With respect, the argument has nothing to do with the case that we are discussing, which is whether the Clause shall stand part of the Bill. The Clause merely refers to medical requirements and to the National Health Service charges. The Clause ensures, first, that benefit is not awarded twice. It is not awarded to meet requirements which may be met without charge by the National Health Service. That is a piece of common sense.
Secondly, provision is made to enable benefit to be paid to meet requirements for which charges still remain under the National Health Service. Irrespective of anything else, hon. Members on both sides of the Committee know that certain 1145 charges remain. We are concerned with he chronic sick, the ill and others in that category. In that case the Bill does not exclude help for surgical, optical or dental requirements from the definitions, or, in other words, from help.
In 1965 the Board made certain grants in respect of assistance for National Health Service charges other than for prescriptions and surgical appliances. In respect of 448,000 pairs of spectacles we paid out £991,000, and for dentures and dental treatment given in 148,000 cases we paid out £563,000. We have already told the Committee that nobody will be worse off.
Subsection (1) describes the appliances and services for which benefit can be granted. I was surprised to hear the references made to conditions under which war pensioners and others are living. The treatment of war pensioners under the Royal Warrant system is such that nobody needs to worry about them. I give that as an answer to the hon. Member's point.

§ Mr. Braine
I did not mention war pensioners. I did not have them in mind. I had very much in mind those persons who are above National Assistance rates, but only just, and who have the right to claim reimbursement from the National Assistance Board. I want to know whether these people, who are not necessarily eligible for additional benefit under the Bill, will continue to have that right.

§ Mr. Davies
Yes, they will. There is the same flexibility with the Commission as existed before. We shall be dealing with this question later in a little more detail.
Subsection (2) provides that the amount of benefit paid will be whatever is appropriate. This will be for the Commission to determine, having regard to the claimant's resources and ordinary requirements, and the amount of the charge. Secondly, it may be paid to or on behalf of the person receiving treatment. In other words, it enables payments to be made either to the claimant or direct to the dentist or optician. Neither side of the Committee wishes to deceive itself. It is obvious from the spirit in which these debates have been conducted that both sides wish, within 1146 the limits of available finance, to do the best we can for those covered by the Bill. I have now answered directly the questions put so courteously by the hon. Member for Essex, South-East.