§ Lords Amendment No. 5, in page 23, line 41, at end insert new Clause "A":
§ ments for wide categories of patients to be exempted. Of those categories, the most difficult to exempt is the chronic sick, where finding a satisfactory definition presents both practical and theoretical problems. On the one hand, we have wished to do everything possible to help a class of patient who, because of the number of prescriptions they are liable to need, are clearly at risk of suffering hardship if they have to pay prescription charges. On the other hand, we have necessarily had regard to the understandable reluctance of doctors to accept responsibility for exercising discretion in the identification of those who are to be regarded as chronic sick.
695§ The help of doctors is, of course, essential in defining the chronic sick for the purpose of exemption. As a result of lengthy discussions with doctors' representatives it was decided that the best course would be to try, with their help, to define objectively categories which are certain to need continuous medication for long periods and which admit of no discretion as to the identification of individuals. The result was the list of diseases and conditions specified in the Regulations. This list was, I repeat, the maximum on which it was possible to secure agreement.
§ There is, however, one class of patient which does not benefit; people between 15 and 64 not receiving Ministry of Social Security pensions or allowances who, through not suffering from any of the conditions listed, nevertheless require, over a period, an exceptional number of prescriptions. Some examples are patients who suffer from prolonged bronchitis in the winter and arthritic and psychiatric patients whose condition calls for regular medication.
§ These diseases cannot be included in the list of exemptions because they embrace a very wide range of conditions, varying according to the severity and stage of development in each case, so that discrimination between individuals would require invidious discretionary judgments. Where, however, such patients need regular medication, the Government wish to help them if they can. It is proposed, therefore, that arrangements should be made enabling any patient to obtain an exemption certificate which would be valid for a fixed period on payment of a suitable fee. Such people will thus be relieved of the excess burden which their special need for medication would otherwise impose. At the same time, we can avoid the problems of further defining chronic sickness.
§ The existing powers under which charges can be levied for prescriptions are not wide enough to allow exemption certificates to be made available on payment, and that is why it has been necessary for the Government to introduce the new Clause. I cannot at present forecast the contents of the Regulations. We have still to work out finally the mechanics of the scheme, but I have already indicated my general ideas to the House, and 696 perhaps the main arrangement might be an exemption for six months in return for a single payment of 30s.
§ In connection with the timetable, I cannot add to what I said in the debate on 30th May; that I hope that we shall be able to have the scheme working by the winter. We will, of course, need to arrange for publicity to be given to the scheme when it is about to start. Given that there is no prospect of securing agreement to a widening of the definition of the chronic sick, I am satisfied that a single-payment exemption is a device which will go a long way towards mitigating any residual hardship which will not be caught up by the very wide exemption arrangements already in operation.
§ Mr. J. J. Mendelson (Penistone)What opportunity will the House have to take another look at the matter when my right hon. Friend has filled in the details?
§ Dr. John Dunwoody (Falmouth and Camborne)I will not delay the House unnecessarily at this late hour, but this is an extremely important new Clause about which several matters should be raised.
This is a well-intentioned proposal which will go some way towards alleviating the harsher effects of the introduction of prescription charges.
As my right hon. Friend said, it will help the chronic sick in many categories, such as those with recurring winter illnesses, bronchitis, heart trouble, arthritis, as well as psychiatric patients. Inevitably anomalies will arise and injustices will occur. I fear that the sense of grievance which is already felt will spread among patients as a result of the half-crown prescription charge. Most of us are already receiving letters from patients expressing a sense of grievance about the charge.
Many difficulties will present themselves to doctors and patients in carrying out the "season ticket" procedure. This procedure will still place the doctor in a nearly impossible position when he feels, for medical reasons, that it is not possible for him to let a patient know that he is chronically ill; for 697 example, when it is not possible to tell a patient who is suffering from a malignant disease that he has an illness which will last for many months. One may try to suggest that it is a temporary illness. In these circumstances patients will not be able to obtain exemption for the payment of a fee.
The same is true of many other conditions, including psychiatric patients. It is probably equally true of the cases of multiple sclerosis that will occur all too tragically among young people who are still at work. These are the inevitable consequences of the introduction of prescription charges, and whatever method of exemption we have we will still find ourselves facing these difficulties.
My right hon. Friend says that probably in most cases there will be a lump sum payment of 30s. for six months' exemption, and I presume there will be a comparable figure for longer or shorter periods. I find it difficult to accept the reasons given for the necessity of having such a payment. It seems yet again to negate the basic principles behind the National Health Services, and that once again we are taxing the sick. We are, perhaps, not taxing them as much as we would if there were a charge of 2s. 6d. for every prescription, but we are still taxing the sick—the chronic sick. It will have to be paid, for example, by people who are disabled but who yet manage to get from their homes to work, and people who are suffering from pneumoconiosis and have had to give up higher paid for lower paid employment.
One has to ask: why must anything be paid? When these charges were initially suggested, we were told that as soon as possible a system of exemptions would be arranged for particular categories, and that those categories would include the chronic sick. I cannot understand why a charge must be made. Is it to be a deterrent to the patient? Does it mean that we cannot trust the doctors?
§ Mr. SpeakerOrder. We cannot discuss on this particular Lords Amendment the question of prescription charges and exemptions in general.
§ Dr. DunwoodyI am sorry if I have strayed beyond the allowable limits, Mr. Speaker. My point is that the 30s. charge seems to be unnecessary. It will be a deterrent, and as a means of raising 698 revenue it will raise only a paltry sum. Here we have another example of a dangerous wedge which, if driven, could give rise to other charges being made in other areas. While I accept the Clause, I ask my right hon. Friend to review its operation after a short period, because the time must come when we can abandon these changes once and for all and avoid taxing ill-health—
§ Mr. SpeakerOrder. I would not question the hon. Member's right to say what he wants to say, but he cannot say it on this Amendment.
§ Dr. DunwoodyI hope that as soon as possible my right hon. Friend will take the opportunity to review the present means of providing exemptions for those who require them.
§ Mr. MendelsonThis is one of the important powers that the Minister is taking in implementing the policy of re-imposing prescription charges, so he had to argue that it is part and parcel of his general scheme, an important factor in making the scheme acceptable to him and to the Government, and an important factor in strengthening the Government's case for recommending the scheme to the House. I am opposed to any rushing of a debate such as this whatever may be the time. If this House of Commons does not take proper time for the discussion of the consequences of re-imposition of prescription charges it is not doing its work—
§ Mr. SpeakerOrder. Time has nothing to do with it: order has everything to do with it. We are now discussing a particular Clause.
§ Mr. MendelsonYes, Mr. Speaker, and with great respect I am deliberately introducing my contribution as I have done because there have been tendencies by the Executive in introducing this subject at this late hour to produce a hurried debate. I wish to record my protest against introducing it at this late hour. A matter of this importance should come on for debate early in the afternoon, so that it may be properly reported in the early editions of the newspapers to those affected. It is the business managers in the House who make these decisions. We back benchers have no power over them. It is therefore deliberately and advisedly that I introduce my remarks in this way.
699 During the debate on the main question on the reimposition of prescription charges, the Government pointed out that the great difference between what they were doing and what had been suggested hitherto was the exemptions. Their case for what they are doing hinges upon the provisions for exemption. We are now told by the Minister that it has not been possible to reach agreement, as he desired, on categories of exemptions. This is a failure of the Government to implement their original pledge that this will be a reimposition of charges which provides such exemptions that we can be certain that nobody who ought to receive his prescriptions free will not so receive them. After what the Minister said tonight, we have no such assurance. Those who voted for the original reimposition of charges ought to think again. Therefore, this is a debate of fundamental importance.
12.15 a.m.
At the time that the main question was debated it was said that not so many people had yet written to hon. Members.
§ Mr. SpeakerOrder. I know the hon. Gentleman's keen interest in this, but we are not debating the main question. The hon. Gentleman must find some other day for debating the main question. We are debating a Clause which another place put into the Bill.
§ Mr. MendelsonWhilst another place was putting this Clause into the Bill hon. Members were apprehensive as to what the nature of the Clause would be. It is not possible to separate the two. Now letters are beginninig to roll in—I have received some; other hon. members have received some—directly relevant to the Clause. Those who write to us are saying things such as—I quote from memory—"My husband has been ill for many years. He used to work in a dust-producing industry. I am told by my family doctor that my husband cannot be included in any of the exemption categories". I submit, Mr. Speaker, that that is directly relevant to the Clause, because the people that my right hon. Friend is talking about as coming under the Clause are the kind of people who are now writing to hon. Members in the terms that I have just quoted.
It is noticeable that, although the benches opposite were nearly full a few 700 minutes ago when the pharmaceutical industry was being debated and money was involved, they are now nearly empty. It is the task of hon. Members on this side, who genuinely represent those affected by this provision, to speak up on this occasion.
I turn to the essential details of the Clause. If a number of categories which we were given to understand that the Minister was striving to have included are not to be included, it is clear that progressively more and more people who are ill, and who have been ill for many years, will be forced to make these payments. I come from an area which has a number of dust-producing industries. It is well understood in the House that the incidence of certain types of social legislation falls far more heavily upon certain parts of the country than it does upon other parts of the country.
Many of the debates which have been held in the House about the establishment of new, accepted industrial diseases within the category of industrial diseases have turned upon the incidence in different parts of the country of industries that produce a lot of dust. Areas which contain mining, foundry works and other heavy dust-producing industry are directly represented. I represent one of those areas.
The illness of pneumoconiosis has already been mentioned. I am certain that there will be many more letters like the one I have already cited, and I know for certain, too, that there will be a larger number of people in the industrial areas—
§ Mr. SpeakerOrder. With respect, I am not without sympathy for the view which the hon. Gentleman would wish to express, but we are not discussing the burden of prescription charges on the community. We are discussing a Clause which, as the hon. Gentleman will find if he reads it, has to do with certificates of exemption.
§ Mr. MendelsonI leave that point, Mr. Speaker. I have made my main point. I appreciate your difficulty as regards the general theme, and I have no wish to go out of order. I pass now from the question of the differing incidence in different parts of the country.
A sum as large as 30s. may well be less than that represented by a number 701 of prescriptions which a patient may need over six months. But what matters is the burden of such a sum of money for the people of whom I have spoken. Many in the category I have described have been ill for years. Either they have had a low income all their lives or they were at one time on a higher income, when they were doing a different job, and have had a low income for some time now. They come in what we usually call in debates the lower income groups. It is no light matter for them to have to pay out 30s., as it might be for others with higher incomes. This is the essential point of the debate which we had when the reimposition of prescription charges was proposed, and it is directly relevant to the present debate on the Clause. People with lower incomes will be harder hit by this provision than others.
If the Government are now saying that, regrettably, other categories for exemption could not be agreed and they are, therefore, offering this new Clause to the House as a solution to the problem, I predict that my right hon. Friend will find that it will not be regarded as an acceptable solution. He ought, therefore, to try to add to the categories for exemption. He must not think, because at this late hour there are comparatively few Members present, that he will not hear from many more as the scheme develops and as the incidence of its imposition comes fully home to many of our constituents. People are not yet aware of what it will mean to them, but they will become aware and will then make their voices heard.
§ Mr. PavittI shall make my speech as succinct as I can, Mr. Speaker, but, as you and the House know, I feel passionately on the whole question of this provision, which is part of a totality of policy with which I am not in accord.
The scheme of the Clause and the system of exemptions by certificate are a complete nonsense. It is altogether cumbersome, and I hope that, as a result of this debate, the country will realise, perhaps for the first time, that there is no such thing as an exemption for the chronic sick. Only a few people—four categories in medical terms—can be exempted. People in the other 60 or 70 categories of chronic sick—people like the one whose letter was quoted by my 702 hon. Friend the Member for Penistone (Mr. Mendelson) and people like those who have written to me, and many of whose letters I am sending on to my right hon. Friend—will feel that they have been cheated. They were under the impression that, as they were chronic sick, they would be exempt, but they will now find that they are not.
The Clause will give but little amelioration of their situation. I hope that it will now be made clear to the country that the chronic sick are not exempt, but there is only a season ticket, so to speak, which will afford them some reduction. In any event, the season ticket will be self-defeating. For one illness, a short illness of a fortnight's duration, one may need more than 12 items of medicine. But if people feel that they are likely to need more than that amount of medicines in the following six months, they can opt under the Clause to take out a season ticket.
But human nature being what it is, this is the hypochondriac's charter. People who fancy that they are likely to be ill can apply for 30s. worth of medicines, and have the right to have as many medicines as they like for that sum. Instead of bringing down the drugs bill, the Clause will have the ultimate result of causing the consumption of more medicines and wasting more of doctors' time. Having paid their 30s. for a complete six months, people will reckon that whether they want aspirin or anything else they are entitled to have it as they have already paid.
The reason for the Clause, as my right hon. Friend has said, is that he could not get the doctors to play. This meant that the whole burden of operating prescription charges rests on the pharmacists, and therefore they are to be given £450,000 more this year and £500,000 more next year to operate the scheme. This is nonsense, because the object is to help the country in its economic difficulties and not to pay another £500,000 to pharmacists, and therefore the Clause does not help.
When shall we have an opportunity to debate the Order? The Clause only gives my right hon. Friend the right to lay it. It is likely that the House will rise for the Summer Recess before 21 days left in this Session have elapsed and time will be short even if an Order is 703 laid tomorrow. The House will no doubt approve the Clause because it is ameliorative. Bad as it is, it is better than nothing. In the event of the Order not expiring before the House rises for the recess, do we get the introduction of the season ticket scheme during the recess? Shall we have to debate it at ten o'clock on the last day before the House rises? I am sure that hon. Members will wish to have a further debate.
What will the cost of the season ticket scheme be? At one time my right hon. Friend estimated it at £800,000. Has he confirmed that estimate?
§ Mr. K. RobinsonWith the leave of the House I shall gladly answer my hon. Friend's two questions. I cannot tell him anything about cost because this depends on the administrative arrangements we make. The figure he quoted was for a much more elaborate scheme covering the whole of prescription charges. As to the timing of laying the 704 Order, I cannot go further than I went in opening. We still hope to get the system into operation by the winter, but if it were necessary to lay an Order before the end of the long recess the 40 days for a Prayer would not begin to operate until the House resumed, so there would be plenty of opportunity for the House to put down a Prayer against the Order. The timing of that debate is not a matter for me but for my right hon. Friend the Leader of the House.
§ Question put and agreed to. [Special Entry.]
§ Remaining Lords Amendments agreed to.