HC Deb 30 April 1968 vol 763 cc973-8
2. Dr. David Kerr

asked the Minister of Health what provision he is planning for the exemption from paying prescription charges of patients suffering from chronic schizophrenia and other psychoses.

13. Mr. Fisher

asked the Minister of Health whether those suffering from cancer will be exempt from prescription charges.

30. Mr. Moonman

asked the Minister of Health to what extent his definition of the chronic sick for the purpose of reimbursing prescription charges will include the psychiatric patients whose health depends upon long-term, possibly permanent medication and who, without medicine would soon become chronic sick.

31. Mr. Pavitt

asked the Minister of Health why he has not designated as a chronic sick person exempt from prescription charges one who has suffered from a coronary thrombosis.

Mr. K. Robinson

For the reasons explained in my reply to my hon. Friend the Member for Birmingham, Ladywood (Mr. Victor Yates) on 21st March, it is not possible to include these conditions as such within the definition of chronic sickness for exemption purposes. Patients suffering from them may qualify for exemption otherwise than as chronic sick or because they are also suffering from one of the specific conditions listed in my earlier reply.—[Vol. 761, c. 143–5.]

Dr. Kerr

Is my right hon. Friend aware that we want to be kind to him but find it very difficult when he gives replies like that? Is he not aware that the condition of chronic schizophrenia occurs considerably more frequently in the community and that if such people are to be kept fit to remain in the community they must take their drugs? Will he accept that the imposition of a charge for this treatment is an added disincentive to them to take the treatment they need in order to remain viable human beings?

Mr. Robinson

I explained in my earlier Answer to my hon. Friend the Member for Ladywood that we had found it necessary to define objectively categories in which are to be found patients certain to need continuous medication for long periods, and which admit of no discretion as to identification of individuals. This was the result of the attitude of the medical profession, which I fully understand, for otherwise doctors would have been put in an impossible position vis-á-vis their patients in exercising discretion as to which individual was or was not chronically sick.

Mr. Fisher

Does not the Minister agree that cancer really is a chronic disease, the most serious of all chronic diseases, and that many people go home for quite long periods between operations, during which time they must have strong analgesics and other drugs? Therefore, they should be included in the list of exemptions?

Mr. Robinson

Different considerations arise with cancer patients. Of course, this matter was discussed with the medical profession. I had to provide the best answer I could within the limitations understandably laid down by the doctors, without whose co-operation no definition of chronically sick is possible.

Mr. Moonman

As the success rate in these mental cases is likely to be affected by the uncertainty in the provision of drugs, will my right hon. Friend reconsider his decision so that some assistance may be given on this the most grave of the implications associated with the prescription charges?

Mr. Robinson

I do not believe that the imposition of this charge will have any serious disincentive effect on schizophrenic patients taking their medication.

Mr. Pavitt

Will my right hon. Friend withdraw the claim that he is giving exemption to the chronic sick, since it is quite obvious that in the four cases we have discussed he has not? Will he bear in mind that although he has adhered to what the doctors want, he has landed a good deal of trouble on the pharmacists?

Mr. Robinson

I do not think that the latter part of my hon. Friend's supplementary question arises from the Question on the Order Paper. Perhaps I should remind the House of what my right hon. Friend the Prime Minister said on 16th January. He said that I would enter into discussions with the medical profession with a view to introducing as soon as possible a system of exemptions. This is what I have done. I have produced the best system the circumstances permit.

Lord Balniel

What arrangements is the Minister making for the exemption of the chronically sick from the payment of a prescription charge where in the opinion of a doctor it is undesirable, as it is in many of these cases, that the patient should know that he is suffering from chronic illness?

Mr. Robinson

The certificate the doctor signs goes direct from his surgery to the executive council. The patient will have to make an application, but he will not know what the doctor signs.

Mr. Roy Hughes

Does not my right hon. Friend feel that it would be better not to introduce prescription charges at all? Instead, he is drawing up a list of exemptions which could become exhaustive.

Mr. Robinson

No, Sir. The general arguments for the introduction of prescription charges have been discussed in the House and will no doubt be discussed again when the regulations are introduced.

Dr. John Dunwoody

Does my right hon. Friend agree that in many cases of chronic illness such as schizophrenia or cancer it is against the patient's interests that he should know that he has a chronic illness? For this reason no system of exemptions will operate fairly with chronic illnesses of this kind.

Mr. Robinson

That merely illustrates one of the difficulties, but I thought that it was the wish of the House that we should go as far as possible in relieving those who are chronically sick from the effects of the introduction of charges. As I also explained in my earlier reply to my hon. Friend the Member for Ladywood, I recognised that this necessarily limited categorisation would leave others who require numerous prescriptions, and expressed the hope that in due course I should be able to help them by enabling them to obtain an exemption card on the payment of a fee representing the cost of perhaps two prescriptions a month.

Dr. Kerr

In view of the unsatisfactory nature of the reply, I propose to raise the matter on the Adjournment as soon as possible.

10. Mrs. Knight

asked the Minister of Health how many people he now estimates will be eligible for exemption from prescription charges.

Mr. K. Robinson

Some 20 million in England and Wales.

Mrs. Knight

Could the Minister give us the benefit of the estimate, which he must have made, as to the cost of the exemption machinery?

Mr. Robinson

I do not think that that arises out of this Question.

Sir C. Osborne

How much will the Exchequer save now under the latest estimates, allowing for these exemptions, by the imposition of prescription charges generally?

Mr. Robinson

I have no reason to believe that the saving in a full year will be substantially different from the original estimates.

Mr. Molloy

Would my right hon. Friend not agree that with the vast complications arising from the declaration of the intention to introduce prescription charges, allied to the intention to exclude the chronic sick, the best thing would be to abolish the first intention?

Mr. Robinson

I would not accept my hon. Friend's premises.

Lord Balniel

Does the Minister of Health still agree with the Minister of Health, who in July, 1967, said that the reintroduction of prescription charges would damage the Health Service irreparably?

Mr. Robinson

The Minister of Health on that occasion was referring to a wholly different system of prescription charges in which no attempt whatever had been made to exempt, not only the chronic sick, but also the other hardship classes who are being quite clearly and categorically exempted now.

Mr. Manuel

Is my right hon. Friend aware that the number that ought to be eligible for exemption has been drastically pruned because of his inability to reach agreement with the doctors regarding the chronic sick?

Mr. Robinson

No, Sir. When we began discussing the question of chronic sick with the doctors no estimate could be made about the numbers involved, so I cannot accept my hon. Friend's statement that there has been any drastic reduction. If he has followed the answers that my right hon. Friend the Minister of Social Security has given he will see that a very considerable number which was previously in the refund category has been added to the exemption category by the arrangements which she will be able to make.

12. Mr. Dean

asked the Minister of Health when prescription charges will be introduced.

64. Mr. Cronin

asked the Minister of Health when he now proposes that prescription charges will be introduced.

Mr. K. Robinson

On 10th June.

Mr. Dean

The right hon. Gentleman is referring to what he calls the interim arrangements. When does he intend to introduce permanent arrangements for prescription charges?

Mr. Robinson

Not yet, but as soon as possible.

Mr. Cronin

While I deplore the imposition of these charges, will my right hon. Friend give some consideration to taking other measures to reduce the general public's psychological dependence on pills and medicines which are so often prescribed unnecessarily, and thereby have finance available to improve the hospital service, which greatly needs improving?

Mr. Robinson

I naturally do everything open to a Minister of Health to reduce over-prescribing, but perhaps to the extent that my hon. Friend's charges are substantiated the remedy lies in the hands of his own profession.