NATIONAL HEALTH SERVICE (CHARGES)

HC Deb 30 May 1968 vol 765 cc2263-307

9.20 p.m.

Dr. M. P. Winstanley (Cheadle)

It is not long since I spoke in the Second Reading debate on the Health Services and Public Health Bill. On that occasion I concluded by saying that I hoped that no hon. Member on this side of the House would seize that opportunity of raising the red herring of prescription charges. I recollect that the right hon. Gentleman the Minister of Health nodded in warm agreement. I little thought that this subject would be raised not from this side but from the benches opposite.

The speeches we have heard so far have shown the utter impossibility of making satisfactory by a series of Regulations and exemptions provisions which, by their nature, are not satisfactory in themselves. When referring to the Regulations, the right hon. Gentleman said with extraordinary frankness that they might look a little complicated. He went on to explain the vast number of exemptions which would be made and he hinted that there would be further exemptions and even different degrees of exemption. I have not considered his recent statement as carefully as I might, but I gather that we are to have virtually a series of graduated prescription charges for a series of graduated illnesses.

We have listened to speeches about tuberculosis and pneumoconiosis. I assure the House that if one tries to get sense into something of this kind by defining medical conditions in this sort of way and by segregating them—by saying that this condition is worthy of being exempted while that condition is not quite worthy of exemption and will be only half exempted—one will find oneself in a lot of difficulty.

The Secretary of State for Wales (Mr. George Thomas)

Is the hon. Gentleman making nothing of the fact that old-age pensioners and the categories to which my right hon. Friend referred are indeed exempted?

Dr. Winstanley

I accept that. I am sure that the right hon. Gentleman will, equally, agree that there are many people who are deserving of exemption in addition to old-age pensioners. The Minister of Health accepted that. I am glad that old-age pensioners have been included and I wish that a more realistic age limit for women, at 60, would be introduced because that would be more rational, but I want to concentrate upon why this exercise is being undertaken at all. Clearly it is not designed to raise money. It has been made clear that the kind of money that will be raised is not the kind of money that will make any difference. It will not raise money for the Health Service. If that were the purpose of the exercise one might consider it in a different light. It is designed, one gathers, to in some way reduce pressure on demand at home by seeing that a few people, those who need prescriptions, have less to spend at home.

Consider the possible effects of this. I have said many times that there is a possible argument for introducing a charge for the use of the service. I do not agree with this argument, but it is at least tenable. It seems, however, that if one is to introduce a charge for the use of the Service, it is utterly illogical to pick on something almost accidental like the need for prescription or the number of items on it. If one must make a contribution, why not base it on the use one makes of the Service? A prescription charge makes no assessment of that kind. The patient who goes to the doctor for advice perhaps takes half an hour of the doctor's time but does not necessarily have to have a prescription.

If he merely needs advice, he will pay nothing at all. A person who goes to the doctor may have to have medicines, tablets, or ointments and may need a prescription with two or three items on it and yet take only two minutes of the doctor's time. That patient will pay 7s. 6d. A patient with pneumonia at home may have to pay up to —1 for prescriptions whereas a patient with pneumonia in hospital not only gets his prescriptions free but gets his food free, his laundry free and everything else free.

It is utterly illogical. Why should there be a bigger charge if there are more items? If a person's illness is one of those unfortunate kinds of illness which needs the prescription of different kinds of tablets rather than one single one, why should he be charged double or treble? If we look at it from that point of view, it is illogical.

I would not say that I would support charges of any kind but if we have to make charges, for goodness' sake let us do it logically—charge for the use of the service, or something of that kind.

It may be argued, and it will be argued by some, that the introduction of charges will have some beneficial effect on people's use of the service and make their use of the service more economical. I have practised before the National Health Service began, before 5th July, 1948, in the days when there were white slips for the panel patient, pink for a patient in receipt of National Assistance, none for people paying for their dependants. I was in a position to judge its effects on people requiring all sorts of treatment, and how they took it. Did they use the service uneconomically because they got it for nothing? Similarly, when the health service prescription charges were introduced I was in a position to judge how it affected me as a doctor prescribing and how it affected my colleagues and the pharmacists and how it affected patients.

Let us consider the patients. There is a general feeling that somehow many people who use the health service ought to be discouraged. I accept that there are people who waste the resources of the National Health Service. These, on the whole, are inadequate people who probably need support and go to the doctor with the slightest problem. They are people who need to be assisted, they are people inadequate in many ways; they need education, instruction or support, but their waste of the service would not be discouraged by charges. If there were charges they would still go to the doctor, even if they could not pay.

Mr. Molloy

The hon. Member is talking of the genuinely inadequate, but would he not agree that those who try to cash in on the inadequacy of some people who use the service in this way are themselves inadequate?

Dr. Winstanley

Let us deal with the matters before us rather than with polemics of that kind. I am sorry that I cannot follow the hon. Gentleman.

Next comes the hypochondriac who wastes her doctor's time. My experience is that the hypochondriac is often a person with a social conscience and feels a little bit reluctant about taking up the doctor's time when it is free to him or her, but introduce charges and she thinks it is cheap at half the price and the tendency is for that person to use the service even more.

What is the effect on the doctor? The doctor immediately tries to save money for his patient by making out prescriptions for larger amounts. I did it. My colleagues did it, and my colleagues will do it again. The pharmacist will make up a blunderbuss preparation and instead of there being three different substances or three kinds of tablets the pharmaceutical industry will roll the three tablets into one for one charge. This had an undesirable effect on the drug industry because it encouraged poly-pharmacy, the production of mixed preparations of this kind designed purely to escape this tax.

I come next to the effect on pharmacists. People went to pharmacists with prescriptions which the pharmacist had every reason to believe to be necessary, for antibiotics and so on, and said that they did not have the money. The pharmacist issued the prescription and sometimes got the money and sometimes did not. There were others who took in prescriptions which it was clear from their nature had been issued for something important, but which had not been presented for several days after the issue. In other words, people delayed receiving treatment purely for economic reasons.

I have gone on long enough and several hon. Members wish to speak. [HON. MEMBERS: "Go on; it is very good."] I believe that it is perfectly possible for us to provide an efficient, humane and fully comprehensive Health Service entirely without the use of charges. Perhaps we shall have to make some modifications and perhaps we shall have to make better use of some of our present resources, but we can do that and it is not necessary to introduce charges as any kind of penalty, and if they are not as a penalty, they are not for anything.

I assure the right hon. Gentleman that this is a Tory policy. I am not here to campaign for the return of the Tories, but if we are to have Tory policies, one can make out a good case for having Tories to carry them out—at least they have had plenty of practice. The prescription charge scheme which they introduced was at least realistic, and sensible and one could see what it was. It was honest and straightforward and, although I did not agree with it, I thought that it was at least understandable. This scheme is a mess, and I hope that the Prayer succeeds.

9.33 p.m.

Dr. M. S. Miller (Glasgow, Kelvingrove)

It is a formidable task to speak in the debate after the hon. Member for Cheadle (Dr. Winstanley). It seems that I am often accorded the honour of following him, and on most occasions I find myself almost completely in agreement with him. This evening, I agree with his principle, but some of the points he made require a heart-to-heart discussion with him.

It is easy to pass off people who frequent doctors' surgeries as inadequate, and they probably are, but their inadequacy costs the country a great deal of money.

Dr. Shirley Summerskill (Halifax)

Oh!

Dr. Miller

One can make all kinds of expressions of horror, but that is the case. I should have preferred these Regulations not to have been made. When the idea was first put forward, I thought that it should not be considered, because the amount of money involved was paltry and not worth the effort. Regretfully, I have concluded that we have to do a considerable reshaping, not only of the policy of the National Health Service, but also the policy of the social services generally. I regret, however, that this debate on prescription charges takes place in isolation.

The Health Service needs more and not less money to be spent on it. That is something which we must all recognise. Although last year about —1,500 million was spent on the Service, it was not enough. But it is interesting to note that the Beveridge Committee of 1944 estimated the annual cost of the Health Service to be —170 million. It said that, as it gradually improved the health of the nation, its benefits would offset the increasing costs. As it transpired, the cost of the Service in 1952 was —400 million. By 1960 it had risen to —726 million. The cost now is about —1,500 million a year. Yet I say that more money must be spent on it. The question is: from where is the money to come?

Mr. Speaker

Order. A lot of hon. Members wish to speak. The hon. Gentleman must address himself to the Regulations.

Dr. Miller

I am sorry, Mr. Speaker. I thought that I was putting forward a case for imposing prescription charges which would raise a certain amount of money, but indicating that it was only part of the problem. I will bow to your Ruling, Mr. Speaker.

The Service requires the expenditure of another —200 or —250 million. It is true that my right hon. Friend is asking for only —25 million to be raised. It is not a tremendous sum. The main point which concerns me is not that the Service should be absolutely free at the time of use but that it should provide the best facilities and the best medical treatment possible. Our Health Service does not provide the best medical treatment.

I wish to draw attention to the expenditure of some countries. In Sweden, for example, only one-third of general Government expenditure—

Mr. Speaker

Order. With respect, we are not debating the National Health Service in general. We are praying against or for Regulations which introduce certain prescription charges. The hon. Gentleman must link his remarks to the Regulations.

Dr. Miller

I am sorry, Mr. Speaker. I again bow to your Ruling.

As my hon. Friends have indicated, I feel that it should not be necessary to apply these Regulations, but as we are faced with difficulties and despite the fact that the amount which it is estimated will be raised by prescription charges, —25 million, is relatively small, I must support the Government this evening.

9.38 p.m.

Mr. Maurice Macmillan (Farnham)

The hon. Member for Glasgow, Kelvin-grove (Dr. Miller) has pointed to the Minister's dilemma, but I hope that he will forgive me if I do not take up his argument. I wish to intervene as briefly as possible, as many hon. Members wish to speak.

I had some criticisms of detail of the Regulations and exemptions and of the mechanism and administration of the Regulations, but most of them have been made by hon. Members on both sides of the House. Unlike the Minister's hon. Friends, I am not so strongly against them in principle, but I criticise him not only for a lack of consistency with his own past, which might be an unfortunate necessity, but for the Jack of consistency which he showed in his remarks.

The right hon. Gentleman said that the only reason for bringing in the charges was a regrettable necessity, thereby implying that there was an exceptional reason in the present situation for doing so. He went on to admit that a regrettable necessity of this kind has been facing successive Governments, both Socialist and Conservative. I will try to show why we on this side of the House do not share the view of his hon. Friends. At least we have a tribute from the Liberal Party that, whatever the fault of our systems, they were realistic, truthful, honest and efficient. I agree with the hon. Member for Cheadle (Dr. Winstanley) that this is not a characteristic of this form of Regulation.

In our view this is a matter primarily not of principle, but of priority, and this is why we are more consistent than the Minister. It is only by accepting this and by accepting implications that go further than prescription charges that one can get better value for money and make the Health Service more effective in action.

The hon. Member for Willesden (Mr. Pavitt), in a very telling speech, set out an extremely logical and defensible point of view. I do not agree altogether with his premise or his argument, but I take his point. He is setting out a consistent policy. Until recently, I thought that the Minister more or less shared that view. As a Tory, I welcome his late conversion and that of some at least of the hon. Gentlemen opposite.

We remember that the present Prime Minister resigned over the issue of false teeth and spectacles, and the Minister himself has been adamant about the damage which would be caused to the Health Service by the imposition of charges. We on this side say that we would prefer him to have come to his new conclusions earlier so that he could have saved more money than he will save now.

I admit that any Minister of Health is facing a genuine dilemma and, contrary to what the Minister suggested to the House this evening, in our view it is a permanent dilemma which faces the Minister of Health and has faced him from the start of the Health Service. I am inclined to take the view of the hon. Member for Kelvingrove that what concerns us is not so much to see that the Health Service is free in every aspect at point of use as to see that it is effective.

As the Minister said, the Tory Government were faced with this dilemma in 1956. The late Mr. Gaitskell faced it in his Budget speech in 1951 and found it necessary to impose charges on the Health Service. According to the New Statesman of 24th March, 1961, the right hon. Gentleman the present Prime Minister, 10 years later in March 1961, said: The first task on the Health Service will be to recreate the free service established by Aneurin Bevan. The repeal of the charges is likely to cost —45 million a year, but this is not all. Year by year the pace is becoming stronger for taking the Health Service and its contribution under the general Exchequer system. We have now reached a different point, and the Minister has implied that, for some reason, this is no longer possible. But he is deluding himself if he assumes that it will ever be possible under his Government, because we are coming near the limit to which taxation can be increased to finance the Health Ser-vice—

Mr. Winnick

Rubbish.

Mr. Macmillan

The hon. Member does not agree. In their booklet, "Socialism and Affluence", which was published in May last year, Professors Titmuss, Abel Smith and Townsend took the view that taxation can be increased and that the risk to economic growth is not significant. On the other hand, in May, 1967, the present Chancellor of the Exchequer said that we cannot be indifferent to the disincentive effect which very high taxation on earned income might have—

Mr. Speaker

Order. The hon. Gentleman must not broaden the canvas. We are discussing a Prayer. He must keep to it.

Mr. Macmillan

If hon. Gentlemen opposite will allow me to develop my argument, I think that it will be seen to be in order.

The Chancellor was arguing that the need for economic growth cannot be avoided and that, only by economic growth, can social progress and social expenditure be financed. The Lord President of the Council, too—

Mr. Speaker

Order. The hon. Gentleman must take note of what Mr. Speaker says. Debate on a Prayer is limited to the Prayer. We cannot discuss the whole theory of economics and taxation.

Mr. Macmillan

I bow to your Ruling, Mr. Speaker. I was seeking merely to show that neither economic growth nor high taxation is in itself enough to provide an adequate and expanding Health Service. I would agree with the hon. Gentleman—

Mr. Speaker

Order. The hon. Gentleman must take note of what I have said. We are discussing a Prayer against a Statutory Instrument.

Mr. Winnick

The hon. Gentleman should join the hon. Member for Tyne-mouth (Dame Irene Ward).

Mr. Macmillan

I will turn, then, to some of the regulations and exemptions. First, there are a number of exempted people categorised by who they are. We must press the Under-Secretary of State to tell us why women have been exempted only after the age of 65. Surely the logic of any exemption by age is a drop in income on retirement, in which event the position of women should be based entirely on their retirement.

I am not certain of the logic of exempting parents from paying prescription charges for all their children of any age. It seems to me that the age of 15 is arbitrary and needs further explanation.

Then there has been no mention of the position of hospital patients who are co-operating in various forms of experiments with hospitals and require prescriptions. At the moment, there is no method for exempting them from paying prescription charges when they have their prescriptions filled by outside chemists.

The second group of people set out in the regulations is the category known as the chronic sick. Obviously, the grave disadvantage of any regulation of this type is the extremely difficult task of definition. The Minister has taken two bites at this cherry. He has set out to define the chronic sick first by the nature of the disease and, second, by the degree of disability.

I do not think I need add to the questions which have been asked as to why various diseases have or have not been included in the Minister's list. We should have a little further explanation as to how what the hon. Member for Willesden, West called the graduated prescription charge will work in practice. I emphasise one public health aspect which is foolish for many reasons, including that of the discouraging tuberculosis patients from taking necessary drugs at a stage when we are so near total elimination of this disease. I am also not sure of the logic about heart patients.

The other definition which the Minister gave was those whose disability is sufficient to prevent them leaving home unaided. The Under-Secretary, when replying to the debate, might give us more idea of the principles involved in this, because it seems that the Minister is actively discouraging those who may require a considerable degree of medication in order to be able to go on working and who are perfectly well and able to leave home by themselves provided they continue the treatment. Some forms of mental patient should be included in this.

I hope that the hon. Gentleman will be able to reassure us on some of the matters about costs raised by my hon. Friend the Member for Maldon (Mr. Brian Harrison), who has great knowledge of hospital administration. The running costs, according to the Minister, were, I think, set out at —250,000. He was not specific about the initial cost or the future cost when he will bring the more permanent scheme into operation.

I hope that we can be reassured that this will not inhibit in any way the ideas that the Minister may be bringing forward as to plans based on various Reports, such as the Seebohm Report and the Green Paper. This is a piecemeal approach to the problem of Health Service finance. I think that the House would like to be reassured that this piecemeal approach will not inhibit future action.

I hope that the Minister can provide a little more justification for a scheme which seems to have all the disadvantages of which a Tory scheme could be accused, but none of the elements of simplicity or efficiency and of a plan which the Minister must have produced with great reluctance knowing in his heart that he is as much against it in principle as those of his hon. Friends who keep attacking it in practice.

9.54 p.m.

Dr. John Dunwoody (Falmouth and Camborne)

I shall not pursue the points raised in the rather wide-ranging speech of the hon. Member for Farnham (Mr. Maurice Macmillan), but I find the crocodile tears which have been shed by hon. Members opposite about prescription charges come ill from a party which fought the last General Election precisely on the introduction of prescription charges again.

I rise tonight more in sorrow than in anger, in sorrow that it should ever have become necessary to argue in this House of Commons about prescription charges with my friends and political colleagues. This sorrow is all the more strongly felt because our record as a Government has been so very good in the National Health Service during the last thre and a half years, in which we have seen dramatic changes, a considerable increase in investment in the Service, schemes for hospital building getting off the ground, new hospitals being built and a new general practitioner pay structure; and when all the resignations which were in the hands of the Minister not so long ago have been forgotten.

I believe that my right hon. Friend the present Minister is outstanding and excellent. I say this having worked in the Health Service under a large number of Ministers of Health of the party opposite. But to tax the sick, which is what we are talking about tonight, is, and always will be, socially unjust. The present scheme is financially questionable, and prescription charges are medically damaging and potentially dangerous. The whole exercise in which we are engaging is politically inept.

I turn first to my political objections to the Regulations. The National Health Service is not a sacred cow to me. It is a practical example of what Socialism is all about; it is an example of Socialism at work in the community. The basic principle of the Service is that we pay for our medical treatment when we are fit, when we are working, when we can afford to pay, and do not pay for it when we are off work, when we are sick, when we are retired.

It is illuminating to remind ourselves of what we said in our party Health Service document, "Members One of Another" issued just before the 1964 General Election. We said: Labour has always stood for the principle that the National Health Service should be paid for by all of us when we are well, and should be available without charge to all of us when we need its help. That is just as true today as it was then. The document continues: Moreover the charges "— It is referring to the prescription charges then in force under a Conservative Government— are the thin end of a dangerous wedge, and already some Conservatives are advocating an extension of charges as a way of ' disciplining' the public and relieving the taxpayer. We reaffirm the pledge, repeatedly given, that, in order to restore a free Health Service we shall abolish all charges… That pledge was important and meaningful. It was one of the reasons why we won the 1964 General Election. We won it by a very small majority, and every part of our manifesto was of great significance. After we had won the election we kept the promise and in February, 1965, abolished prescription charges. I was then in general practice and could see the consequences of doing this. It provided considerable help to certain sections of the community for whom the Health Service is vital. We must be concerned that we are doing more than failing to keep a political promise; we are breaking a pledge that we have already fulfilled.

I have certain objections to the economic arguments for the reintroduc-tion of the charges. The only real argument put forward for the charges in the debate is that it is economically necessary to introduce them. Figures of £50 million have been quoted several times as the revenue from charges, if we have only the sort of exemptions the Conservatives had, or £25 million with the widely-based exemptions proposed in these and subsequent Regulations.

I question these figures because of some Answers to Questions I have put to the Minister in recent months. He has told me that in the last convenient 12-month period up to March, 1967, if we had had a charge of 2s. 6d. on every prescription issued we should have raised £34 million, not the £50 million that has been quoted. But we know from past experience that when charges are introduced the number of prescriptions falls. The total value does not, because all the doctors hand out larger quantities. One can imagine that the fall would be perhaps 10 per cent., bringing the figure down to £30 million.

The Minister said today, and we have heard this before in answer to Questions, that perhaps about 45 per cent, of the community will be exempted from charges, but we are also told that this 45 per cent, of the community will make up only about 50 per cent, of surgery attendances and prescription issues. I cannot accept this figure. I hope that when my hon. Friend answers the debate he will give some justification for this oft-repeated claim.

I have spoken to a number of general practitioners. I asked them to keep records of the people attending their surgeries. In very case those who are to be exempted comprised two-thirds or more of the patients. If two-thirds are to be exempted, the figure of £30 million comes down to about £10 million. One can add another 10 per cent, or so for Scotland. But the figure is less than some which have been quoted.

In the Budget it was necessary to raise taxation by £900 million. By putting a few pence on cigarettes and tobacco, the Chancellor raised £30 million; by an increase of a few pence on spirits and wines he raised £15 million; the betting and gaming duty increase was £30 million. Here, however, we are talking in terms of a figure of £10 million or £11 million. If we had put a penny on the price of a pint of beer we would have got nearly £40 million extra revenue. Surely there should have been higher priorities for additional revenue.

I fall back on my experience as a family doctor. I know that, when we had the charges before, a small proportion of patients as a direct result were denied medical treatment. The number is not large, although it is fairly regular and comprises constant attenders at the surgeries. They are, in particular, people with low incomes, others who are not particularly adequate and people who are not perhaps problem families but who are bordering on being such. They would often come to me for a prescription on Tuesday and keep it until Friday, when their money came in. Sometimes they would take the prescription to the chemist and ask him to pick out which was the most important item so that they would have to pay only one charge. This sort of thing is one of the serious social and medical consequences of prescription charges.

Another aspect I am unhappy about is that the charges fall particularly heavily on certain parts of the country, particularly in those areas where the average income is low. The part of the country I represent has the lowest average wage of any county in England, which means that the charges will be a greater burden on the people there than on those in the prosperous areas of the Midlands and the South-East. The charges will fall particularly heavily on those parts of the country like colliery areas and South Wales, where the incidence of illness is much higher than elsewhere. If we believe in regional policies, we should also take these considerations into account.

I come now to the medical objections. First, there is the overriding medical judgment that it is to me repugnant to be taxing the sick, but I want to look at some of the exemptions proposed and to be critical in certain cases. There is the exemption of youngsters under 15. Why under 15? Why does it not apply to those in full-time education? Why not exempt the 16 or 17 year old who is still at school and not earning?

There is to be exemption for those over 65 years of age, but what about the women pensioners between the ages of 60 and 65? These are a group who are regular attenders at surgery and who often need medical treatment at an early stage. The war disabled are to be exempted. That is obviously right. But what about the industrially disabled and the other disabled? Some of them will slip through.

There are endless anomalies to be found in any system of exemptions, however comprehensive it may appear to be. The bulk of chronic illnesses will not be covered. It may be that the season ticket system will do something to help, but many people in the country are very worried about this measure, and justifiably so. I have here a letter representative of many I have received from people in my area. The man asks what his position is to be and says: I suffer from bronchial asthma and have just resumed work after being home for 6 months … I have only worked four months since April of last year. I have to see my doctor at fortnightly intervals, and after seeing him today he informed me that he cannot see where I can be exempt. I am now taking four different tablets … two different medicines when required and also using inhalers. All these drugs have been prescribed by the consulting physician…. If I have to pay for these, it is going to cost me quite a lot of money … I am a family man with three children and am employed by British Rail … I could I suppose, if I have to pay these charges, be as well off in money matters not working at all". This is the position in which many people will be put. It may be that we shall be able to help some of them by going through the procedure of getting supplementary benefit for them and thus giving them some relief. But it will be complex and difficult and many of them will not be helped. These are people who are suffering from bronchitis, asthma, emphysema, arthritis and psychiatric conditions. The psychiatric cases concern me particularly.

I have received a letter from a consultant psychiatrist who is very concerned about this matter. He brings up the question of schizophrenic patients. One of the most dramatic developments of the last 20 or 30 years has been our ability to treat and control schizophrenics with modern drugs. Many of these patients are not particularly co-operative and will use any excuse to avoid getting their tablets and continuing their treatment. This consultant psychiatrist writes: As I am sure you will appreciate, these patients often have little or no insight into their condition and into the necessity for their taking medication…. Many of them … often hold down poorly paid jobs. If they have to pay something for their medication or, indeed, submit to what may seem to us an uncomplicated procedure, my fear is that their disinclination to bother with taking drugs could cause a number of relapses and could well increase the number of admissions and thereby raise N.H.S. costs rather than reduce them … This is a widespread fear among psychiatrists. It is a fear which is strongly held by many people working in mental health.

Another group of patients who will not be given the sort of relief which they should have are those with malignant diseases. In this country, 100,000 people or more die from cancer every year. Many of them are aged under 65. Many of them are not the sort of people to whom one can say, "You will be chronic-ally sick now". One has to try to buoy them up and keep them going. Sometimes one cannot tell them the truth. They will not be able to get exemption even when all the new schemes are in operation because too often the doctor has to pretend that this is a temporary illness and they will be on their feet next week. This is a large and unfortunately increasing group of patients who will not be helped.

I welcome the fact that there will be additional exemptions in months ahead as a result of later Regulations, but I appeal to my right hon. Friend to try to introduce them as soon as possible because there will be many anomalies from 10th June if these Regulations are passed. Millions of pounds will be spent by people who subsequently will be exempted when the latest scheme for exemption is introduced. It is urgent that the latest scheme for relief should be introduced fairly soon.

It is no good blaming the doctors if we have not been able to devise a satisfactory scheme, because it is not the doctors' job to decide who will and who will not pay tax. Governments have the job of deciding taxation policy. The doctor's job is to get the patient fit and well. If the doctors had not done what they have done they would have run a real risk of damaging the doctor-patient relationship, which will be damaged to a certain extent by the introduction of charges.

This is a sad day. This is a serious blow to the National Health Service, but not a fatal one. Most of those who go into the Lobby in support of prescription charges will know in their hearts that they are wrong. The real supporters of charges are the people on the outside who are not here tonight. We may lose tonight, but this fight will go on until we again have a Health Service freely available to all in their time of need.

10.4 p.m.

Mr. T. L. Iremonger (Ilford, North)

The Minister said that the Undersecretary of State for Scotland would be winding up the debate and would deal with points which might have been raised after he had sat down. I hope that the hon. Gentleman will not confine himself to Scotland, but will answer in respect of other general points. Would the hon. Gentleman amplify what the Minister said about psychiatric patients coming in under the season ticket system which is being introduced in legislation now on its way through Parliament.

Will the Minister explain whether this means patients suffering from schizophrenia? There are two of the largest and finest hospitals which treat patients under the Mental Health Act in my constituency. I have had a letter from the the assistant physician superintendent of one which I ought to bring to the Minister's attention. He asks me whether it would be possible to ensure that, if prescription charges are introduced, patients suffering from schizophrenic illness may be included amongst the exempted classes. He also says: There are a very large number of such patients who are able to remain reasonably well so long as they have their maintenance treatment. But it is very often difficult to persuade such patients that they continue treatment and I foresee that if they have to pay 5s. to 7s. 6d., or more, each time they go to the doctor to get a repeat prescription, they will be even less likely to continue maintenance than they are at present and many more will need to be readmitted to hospital. These readmissions into mental hospitals will be of a class of patient which, at the moment, it is possible to keep outside much more than it has been in the past, a class of patient which accounts for a very high proportion of beds in hospitals that treat mental illness and a high proportion of the total number of beds in the National Health Service as a whole.

The acting physician superintendent goes on: Maintenance treatment of this kind needs to go on for years … and t seems to me that they should qualify just as much as epileptics requiring continuous anti-convulsant therapy, or people suffering from endocrine disorders That seems to be a very powerful and important case and I hope that it will be convenient, on these Regulations, for some reassurance to be given to the House.

In general, I should not wish to ingratiate myself with hon. Gentlemen opposite. Seeing them ranged there in all their strength and passion it would be cowardly of me not to say bluntly that I am in favour of prescription charges. I have no doubt that in the eyes of hon. Gentlemen opposite I am wrong. Having sat here as long as I have tonight, and having sat on the other side of the House on earlier occasions, I can say that I understand pretty well what hon. Gentlemen opposite feel. I see the force of their case, but I think that they are wrong.

I disagree also with the hon. Member for Cheadle (Dr. Winstanley) who, in a very moving and telling speech—he said that if we are to introduce prescription charges we should do it the way the Tories did; that is better. My hon. Friend the Member for Farnham (Mr. Maurice Macmillan), who spoke from our Front Bench, said the same. He thought that our way was better. I do not think so. I think that the Minister's way is better. I am his only friend here tonight [HON. MEMBERS: "Oh."] It is about the only encouragement that the right hon. Gentleman has been given tonight. I am sorry to give him such devastating embarrassment as to be his only supporter.

Although I know that he is not in favour of prescription charges, I am. What is more, I think that if we are to do this, we should do it in his way. I do not see why we should not have prescription charges, and then make exemptions in the way being made in these Regulations and also in the season ticket method we hope to have shortly. The merit of doing it in this way is that one can try to make the exemptions with some precision, try to get it right and get the best medical advice about the exemptions which are most necessary. I think that is the sense of paragraph 7 of the Regulations. I am sorry that it does not include schizophrenic patients, but I hope that other provisions will be made for them and I ask for an assurance of that.

10.15 p.m.

Dr. David Owen (Plymouth, Sutton)

This is a sad day for hon. Members on this side of the House, and I do not take part in the debate with any relish. In many ways it would have been better if, on my pairing day, I had taken up my pair and ignored the challenge which we face.

I do not take the speeches of hon. Gentlemen opposite very seriously. Their views on the Health Service are known to us all. They would like to see a large and expanding private sector. They would like to see, and at one time openly supported, free medicines for people in the private sector.

We on this side of the House have to face seriously the problem of what is happening to the Health Service. I have listened with great care to the speeches of my hon. Friends. I agree with the arguments advanced by those who are opposed to these Regulations. I found very little with which to disagree in the speech of my hon. Friend the Member for Falmouth and Camborne (Dr. John Dunwoody), but I disagree with his conclusion.

I hope that those of my hon. Friends who spend a lot of time like myself urging high rates of public expenditure, and trying to get something done about poverty, will respect my feelings. I speak as one who spends some time on the finance committee of a large hospital group. I cannot disguise what an appalling lesson this has been to someone who has worked in the Health Service, signed prescriptions, signed people up for expensive treatment, and also worked for short periods in general practice.

I am appalled at the challenge of financial stringencies which the Health Service is facing. We must recognise the problem. We cannot judge this issue without first looking at the Health Service as it is. It is under-capitalised, and underfinanced in comparison even with the American system. In 1962 they spent 5.5 per cent. of their gross national product on their health service, while we spent only 4 per cent. on ours. Theirs is largely a privately-financed health service.

We have to take into account also the fact that during the last four years this Government have increased the amount put into the Health Service by 45 per cent. We are now spending 4.85 per cent. of our gross national product on health, and this is a higher percentage than ever before. That is the background to the debate.

We have to remember, too, the courageous decisions which the Government set out in January in their expenditure review and in the Budget. During the National Plan period we have maintained the 4.25 per cent. growth in public expenditure which was envisaged on the basis of a 4 per cent. growth rate in the economy. We have, therefore, maintained faith with our principles. We have maintained high rates of public expenditure and in consequence people are now asked to take a 1 per cent. cut in their collective living standards. We on this side of the House know how unpopular that is, and how difficult it will be to carry out.

We cannot consider these prescription charges without looking at the January decisions which racked us, namely, not to raise the school-leaving age, to raise charges for school meals, school milk—

Mr. Speaker

Order. We must look at these Regulations.

Dr. Owen

I respectfully agree with you, Mr. Speaker, but we cannot, in all honesty, look at them in isolation. It is said that the £25 million which it is intended to save on prescription charges is not much money. In the circumstances in which we find ourselves, I think that it is a lot of money, and it is no good some of my hon. Friends saying that it is not.

We have to put ourselves in the Minister's place. He was told, rightly or wrongly—and, in view of the cuts which were made in other areas like education, I think rightly—that he had to make savings in the National Health Service in the first year of £29 million, and £31 million in the next year. He therefore looked at the Health Service. I put myself in the Minister's position and I cannot but come to the same conclusion, that he faced a direct choice in getting a saving in this year of either cutting the hospital building programme or raising prescription charges. Faced with that choice, however regrettable and whatever the objections to the prescription charges, all of which I respect, I think that he was right.

Of course prescription charges are a tax on sickness. I would not deny that. I fought elections on that slogan and I stand by it, but inadequate provision in the Health Service is equally a tax on sickness. We cannot go on asking people to accept a free Health Service which does not make adequate provision. One and a half million people have opted out of the Health Service and are now covered by private insurance. This number is increasing and, if it does much more there will be two standards. I believe in a universal, comprehensive Health Service. That is why we must inject much more money into it and the extra amount which has been put in is a tribute to the Government in relation to our financial position.

I accept all the objections to prescription charges, and I have some detailed points on the Regulations. I am shattered that it has not been possible, for instance, to make an accommodation for chronic schizophrenics, who are groups of patients on "maintenance therapy" as much as any other categories, and who must be covered by the scheme which my right hon. Friend hopes to introduce, loosely called the "season ticket" scheme.

We have the right to ask for one pledge. This scheme will throw up many anomalies. These exemptions have never been introduced before. This is a quite different prescription charges scheme from the previous one and it would be intolerable if it were administered with Treasury officials breathing down the Minister's neck and saying that the £25 million saving had to be sustained at all costs. Over the next year, he may have to revise these Regulations considerably and he should not be afraid of doing so.

He is asking my hon. Friends and many in the country to take something which goes right against everything which they have ever wanted. We must accept that this is very hard to take for many of our loyal party supporters, but what we must get across is a much more rational attitude to charging in the Health Service. I believe that it would be possible to introduce a system of charging which is not a tax on sickness, and in that sense I find prescription charges much harder to take. The Minister should look at a system of charging for the food of those in hospital, which could raise exactly the same amount—[HON. MEMBERS: "Oh."] —my hon. Friends may not like that, but it is not a tax on sickness and could raise money. Where else will this saving come from?

Mrs. Anne Kerr (Rochester and Chatham)

Would my hon. Friend not accept that there is possibly an absolutely different method of running our national finances than the one which the present Government are adopting? Would he not therefore accept that it is unnecessary to tax sickness and also that one cannot charge people who are already sick when they are in hospital?

Dr. Owen

My hon. Friend must try to follow the argument. Of course I accept those criticisms, but they must be viewed against the background of a Budget which has taken out over £900 million in general taxation. This is the situation. We must remember too that 75 per cent. of those interviewed in a recent public opinion poll said that they would accept prescription charges, provided that there was exemption for lower paid workers. This may not be entirely representative, but at least it shows that there is a widespread acceptance in the country of the principle of charging within the National Health Service. I appreciate that this is objectionable to a great many of my hon. Friends. I respect their views, but they must consider the alternatives.

We have made cuts totalling £5 million in the community health services and I believe that these cuts are far worse in their effect on the old than prescription charges, from which most of them are exempt. By stopping health centre building and services for old people—one can think of simple things like chiropody and other services provided by many local authorities—great hardship will be caused, and this must be faced.

I appreciate that many of my hon. Friends will find what I have said difficult to accept. I have said it because somebody on these benches had to make these remarks and I believe that the Govern- ment have made the right choice. We are facing the fact that the Health Service must have more money. Under this Government we have rightly maintained high rates of public expenditure and, in the circumstances, I believe that we have made the right decision. We have made a massive shift in resources to correct public squalor, one of the main reasons why we were elected in 1964. It is all very well for hon. Members to say that, I am just being loyal to the Government —[Interruption]—but my experience is that loyalty to this Government does not carry much reward. It is much easier not to offend people and while I respect the differing views which have been expressed—

Dr. Summerskill

On a point of order. When an hon. Gentleman opposite was making comments which were totally irrelevant to the Regulations he was called to order. Should not the same be done to my hon. Friend?

Mr. Speaker

I am grateful to the hon. Lady for assisting Mr. Speaker in his duties. Dr. Owen.

Dr. Owen

This has been a difficult speech for me to make and I hope that my hon. Friends will accept that I have made it with sincerity, just as I am sure that others have been sincere in the views that they have expressed.

10.28 p.m.

Mr. Tim Fortescue (Liverpool, Garston)

I was grateful to the hon. Member for Plymouth, Sutton (Dr. David Owen) for reminding the House that the Conservative Party fought the last election on the basis of restoring prescription charges. Had he not mentioned that fact, I would have done so. The hon. Gentleman made a powerful speech and I agreed with almost every word of it. However, as many hon. Members still hope to take part in the debate, I will not comment on many of the points he made.

I have been trying to understand the basis on which the Minister has made exemptions to these charges. In Regulation 7(1) there are six categories of exemptions—two on the ground of age, under 15 and over 65; three on the ground of conditions, pregnancy, chronic sickness and war disablement; and one on the ground of need, which speaks for itself.

Nobody will quarrel with the exemption on the ground of need, but in respect of the three on the ground of condition—I admit that nobody will quarrel with the war disablement exemption— why have the Government not included industrial injury disablement as well? 1 should like to see that exemption made.

Hon. Members with more knowledge than I have spoken at length on the need to extend the chronic sickness exemptions. The Minister explained that he has not been able to do this because the doctors do not agree. This is a difficult point to accept because one must ask who is running the country, the doctors or the Government?

As for the exemption for pregnancy, one cannot argue against pregnant women being exempted, but is it necessary for them to remain exempt for one year after the birth of the child? I suggest that this is not in line with modern medical thinking, although I stand to be corrected. I have seen many young women a year after their babies have been born and some of them have been pregnant again and looking well.

Dr. Winstanley

If such a woman is looking well and is well, she would not need a prescription.

Mr. Fortescue

Under the Regulations she is exempted for a year after the baby is bora. She is, therefore, exempt whatever the condition of her health and the exemption is not solely in respect of the aftermath of the pregnancy. The fourth exemption is on the ground of age. There has been extensive comment on the exemption of those over 65. Why is it over 65 when the pensionable age for women is 60? This is something which must be put right very soon.

There is, finally, the exemption for children under 15. With this I disagree almost entirely. How can exempting all children under the age of 15 be justified? Many hon. Members, many of those in the Chamber tonight, have children under the age of 15. How can they happily see their children getting their prescriptions free when the ailing wife of a man earning £10 or £12 a week has to pay for her prescriptions? How in all conscience can they allow that? How can that be in any way in accordance with Socialist theory, or that of the House of Commons? While giving the Minister my general support for these prescriptions charges, I beg him to look again at these categories, because hardly any are satisfactory from the point of view of logic or compassion.

10.31 p.m.

Mr. Arthur Blenkinsop (South Shields)

I completely accept the sincerity of my hon. Friend the Member for Plymouth, Sutton (Dr. David Owen) and I hope that he will equally accept the sincerity of many of us who believe that we are concerned with a major principle. As one who played some part in earlier debates on this subject and who was involved with some of those whom we no longer have with us, particularly Nye Bevan, in the development of the National Health Service, I must say something on this subject, if only briefly.

I cannot comprehend the attitude of the hon. Member for Cheadle (Dr. Winstanley), that if we are to have charges, we should have them in the vicious form in which they were introduced by the Tories. I deeply wish that we were not to have charges, but, if we are, I prefer to exempt as many categories as possible to the system which we had before of paying charges and reclaiming them, a system which was both appallingly wasteful administratively and a way of imposing hardships and difficulties on individuals. The more we can widen the categories for exemption, the more pleased I am, and the more ridiculous becomes the scheme, because the more the scope of exemptions is widened, the smaller is the revenue and the greater the worthlessness of this proposal.

To me and to many of my hon. Friends this is putting us back where we started. Many of us regard this proposal as leading almost inevitably to the position taken up by the right hon. Member for Wolverhampton, South-West (Mr. Powell)—I hope that I have got the right part of Wolverhampton; I should not like to offend my hon. Friend the Member for Wolverhampton, North-East (Mrs. Renée Short). Consistently over the years, the right hon. Member for Wolverhampton, South-West and the right hon. Member for Enfield, West (Mr. Iain Macleod) have made a case for the introduction of charges throughout the various public services.

On the contrary, many of us hold the view, equally strongly, that it is vital to our concept of the development of social services that they should be free at the time of need, especially when we are concerned with services vital to the whole community, when they are services in which the element of choice is not involved. This is not a matter of choice; it is a matter of necessity for the community; these are services for the community. Therefore, anything which imposes a charge at this level is a danger. It has been the hope of many of us that services of this character should not be diminished but should be greatly increased in proportion and that the level of commercial operations in our community should be to that extent diminished This is the way in which we saw the new approach to our society developing.

What has been so important to many people is that the principle has been in sharp conflict with our commercial society—and this is something which young people are beginning to recognise more fully at the present time. Therefore, there is danger if we give up this principle, above all in a service so vital to the whole community as the National Health Service. It is on this principle that I take issue with the Regulations and it is because of this that I welcome the new extension of exemptions which we can achieve, because that takes us nearer to the principle to which I am attached.

That is why I would certainly not support the attitude of the hon. Member for Cheadle. I am in difficulty this evening because I recognise that anything that harms in any way the position of the Government I support is helpful to hon. Members opposite. I know perfectly well that their alternative is to bring in the whole range of charges, to bring the National Health Service to the market place, which is precisely where they believe it and other services belong. I do not believe that it belongs in the market place and for that reason I cannot support my right hon. Friends tonight.

10.38 p.m.

Mr. Eldon Griffiths (Bury St. Edmunds)

I have listened to the last seven speeches and have heard the two speeches by medical practitioners, both of which impressed me very much. The speech by the hon. Member for Cheadle (Dr. Winstanley) pulverised the Government's case. The speech by the hon. Member for Falmouth and Camborne (Dr. John Dunwoody) similarly demonstrated that the Order is an administrative dog's breakfast.

I make it clear that I am in favour of prescription charges. I support them on principle because I think they are good for the National Health Service, good for the doctors and good for the country. I am sure that hon. Members opposite would prefer hon. Members on this side to say openly and honestly where we stand and I recognise that they stand in precisely the opposite corner.

But the matter before us is the Regulations. I have read them carefully. I do not see how they are going to work with justice. They are creating anomalies. They will bring to hon. Members large numbers of complaints from constituents—"He is getting free medicine and I am not." We are going to have to bombard the right hon. Gentleman with requests for explanations of why inequities and anomalies have been put upon our constituents.

I am in favour of prescription charges but I could not possibly vote in favour of these Regulations. Indeed, unless the Minister is able to produce in his reply something more convincing, my instinct will be to vote against the Regulations.

10.40 p.m.

Mr. Will Griffiths (Manchester, Exchange)

The hon. Member for Bury St. Edmunds (Mr. Eldon Griffiths) has been forthright and frank. He reinforced what my hon. Friend the Member for South Shields (Mr. Blenkinsop) said, that there have been hon. Members opposite who for years have frankly said, as the hon. Gentleman did tonight, that they believe in a Health Service with charges. I remember that many years ago a former Minister of Health, the right hon. Member for Enfield, West (Mr. Iain Macleod) said quite clearly that he believed in charges in the National Health Service, not only for financial reasons but on social and ethical grounds.

That has never been the position of hon. Members on this side of the House. It was infinitely tragic to see my right hon. Friend the Minister, who has acted with great distinction in his Department and been a most eloquent advocate of a free National Health Service, making a Tory speech at the dictates of my right hon. Friend the Chancellor of the Exchequer.

My hon. Friend the Member for Plymouth, Sutton (Dr. David Owen) talks, as other Members may, about being loyal to the Government. But what about being loyal to one's electorate? I imagine that every Member on this side of the House, possibly even the Minister himself, boasted to the electorate in March, 1966, of having carried out one important pledge made in 1964—the pledge to abolish prescription charges. I suppose that it did not do my hon. Friend the Member for Sutton any harm either, along with the rest of us.

We are debating Regulations which give expression to an aspect of Government policy on Government expenditure enunciated last January. There has been nothing more depressing for me in the past few months than to hear my colleagues who are Ministers in the Social Security Departments saying, "Well, we all had to have a whip round; we all had to make a contribution." This is what we have heard repeatedly. It is the ultimate abdication of collective responsibility. This is more depressing than the individual items, because it challenges the validity of assumptions we have all held, namely, that politics is about social priorities.

We have our honestly expressed differences on this. I was in the House when the Labour Party was convulsed on a previous occasion over prescription charges. I had the privilege of being Parliamentary Private Secretary to Aneurin Bevan, and I was one of those who supported him and my right hon. Friend the present Prime Minister when they resigned from the Government in 1951.

Nowadays I hear the Prime Minister talking about sacred cows. If I interpret the phrase correctly, I should have thought that we want the Government almost to recognise some sacred cows, and to preserve them. A free National Health Service has become a principle of Labour Party thinking. I am not prepared to discuss whether or not people can afford to pay prescription charges. I shall not get involved in that, because it is a Tory argument. The argument was settled for this party a long time ago.

Why has the decision been made to impose the charges now? I should have thought that many of my hon. Friends could collectively advance to the Government a series of alternatives which would enable us to escape from the agony we face tonight, even though perhaps they have not quite the academic distinction of some members of the Cabinet. The present Cabinet probably contains more people of academic distinction than any for many years—it is stuffed with economists. I have been a Member of the House at times when the economists have led us, to put it mildly, on the wrong path.

The Minister advanced the argument, "What would you do?" Since he has ventured into this field and asked that, I should like to ask him what criteria were laid down for him when he was coming to these decisions. What have these charges on poor and sick people and people in pain to do with import substitution, export expansion and the saving of foreign exchange? Nearly all the political commentators seemed to suggest at the end of last year that the economy would collapse at once unless we imposed Health Service charges. Mr. Ian Trethowan made that case in The Times.

I wonder whether my colleagues who were Members in 1951 or who have read about what happened then remember the charges being imposed and the reasons advanced for them. This was the year in which the Labour Government were persuaded to embark on a sudden expansion of their defence programme. The great year of decision was to be 1954. In 1951 we embarked on a hastily conceived expanded defence programme. The budgetary consequences of that rearmament programme were expressed in the form of the first charges on the National Health Service in 1951. The political consequences were the resignations from the Labour Government of the present Prime Minister, Mr. Bevan and Mr. John Freeman. Our party was riven by dissent. A year later the Conservative Party returned to power, and one of the first things that Sir Winston Churchill told the House was that those of us who had argued against the Health Service charges in 1951 because the economic policy was wrong—the "Bevanites", as they called us in those days—were right, but added, characteristically, "but for the wrong reasons."

Many of my hon. Friends have cast doubt on the financial savings which the Government expect to make by imposing prescription charges. My hon. Friend the Member for Falmouth and Camborne made a very persuasive case. When we consider these very complicated Regulations—and here I agree with the hon. Member for Bury St. Edmunds—we realise the intolerable burden which the Government are placing on patients, pharmacists and doctors. They are passing the buck all right.

I have looked at the prescription form. It is an extraordinarily complicated document and is rather difficult to read simply because of the size of the print. This constitutes a barrier to obtaining exemptions. Note of us could hardly look at the form without seizing on some apparent absurdity or anomaly. My hon. Friends and hon. Members opposite have given examples. Let me give three. I understand that there is no appeal machinery. If the Regulations are passed, why cannot the Supplementary Benefits Appeals Tribunal deal with appeals under Regulation 7(1)(f)? If exemption is refused, will people be given a written statement showing how far above the income limit they are? There has been much talk about the list of chronic diseases. The hon. Lady the Member for Plymouth, Devonport (Dame Joan Vickers) said that in some instances it might be extremely unwise if a patient knew from what he was suffering.

I do not understand all the categories of illness, but I know what myasthenia gravis means, because it has some connection with my own profession. The other week I again saw a young lady who was suffering from this muscular disease. It is a wasting disease which affects the involuntary muscles, breathing, and so on. This young woman, who wanted to be a professional dancer, came to see me. Because my suspicions were aroused, I referred her elsewhere and she was found to be suffering from this disease. Her medical advisers and others sustained her over many years, enabling her to carry out her ambition to be a dancer. She is an intelligent girl. It is just conceivable that if she now goes for drugs and is exempted as suffering from this disease—and I doubt whether she knows what she is suffering from—she may go to a library, discover what it means, and thus shatter all her hopes and expectations for the future.

This is another example of the anomalies that arise in Regulations of this kind once one departs from a fundamental principle. Those who think that this is a departure will continue to fight the Minister and his colleagues. The Government have put this matter on the agenda of every trade union conference this year, when they could have been thinking about other things. As they have taken the initiative, we should take up the challenge and fight them in every way that we can.

10.53 p.m.

Mr. William Molloy (Ealing, North)

I think that most of us on this side of the House would readily acknowledge that the fundamentals of our arguments were submitted in the very able and moving speech of my hon. Friend the Member for Willesden, West (Mr. Pavitt). He paid a well deserved tribute to my hon. Friend the Minister of Health. It was a sad occasion for us tonight to listen to a sad voice being compelled to make a Tory speech from the Front Bench of the Labour Government. It was upsetting to the Minister and it was distressing to many of us on this side of the House.

One of the golden threads of democratic Socialism has been to see the world enjoy a world national health service. Many of us sincerely believe—I certainly do—that if it had not been for the interruption of the 13 years of the party opposite we would not only have had a first-class National Health Service in this country, but it would have been of such proportions that possibly many other parts of the world would have attempted to emulate us. Many on this side were sad and disheartened that the Labour Party lost the General Election of 1951, if only for that reason. Therefore, perhaps my right hon. Friend and many of his colleagues on the Front Bench will try to understand the anguish and bitterness that many of us feel in making the speeches we have been compelled to make against the Government on this issue.

These Regulations are not merely distasteful; they are repugnant. We have to ask: was this a decision of the British Cabinet, or was it forced on them to influence someone outside? Might it be that at this late hour my right hon. Friend will create Parliamentary history by withdrawing this Order? Might I encourage him, by announcing that Mr. Cecil King has been found out and has had to give up his job. He is now redundant. This might be some encouragement to my right hon. Friend not to take any notice of others who have given him such bad advice.

The main arguments we have had have been about problems in the economy. There have been problems in the economy. What is clearly distasteful to us is that in trying to resolve the problems in the economy the Government have quite rightly looked to see who shall make the big contributions. We think that bigger contributions to assist the economy ought to come from the City, from big business, and from those who are hale and hearty. The last thing that we should try to do is to get money from those who are sick. The paradox is that if, by some remarkable chance, in the next couple of years the people of this country are astonishingly healthy, the economy will be in a more dreadful state than it has ever been. That is the logic of these Regulations. We are concerned about whether this is the thin end of the wedge. We are concerned about where the process will end. Will we get to the position of having to say that the economy is held together by an abdominal belt? That will be about as daft a situation as one can imagine.

Hon. Gentlemen have, naturally, criticised these Regulations. They say that they will not work efficiently, and that they will not produce enough money. All their arguments about the social services are based on money. The hallmark of a true Conservative is that he knows the price of everything but the value of nothing, and that has been demonstrated this evening. I regret that that argument is now being advanced from our Front Bench.

The argument that the economic situation demands the introduction of these charges is phoney. My hon. Friend the Member for Plymouth, Sutton (Dr. Owen) put forward a suggestion which I wish Mr. Speaker had allowed us to pursue. My hon. Friend wanted the debate to be widened so that he could suggest other means of saving money. If the debate had been widened, I am sure that many of my hon. Friends would have suggested many sound suggestions about how the Government could save much more than this miserly sum and leave the Health Service alone.

We have listened to all the arguments about collecting this money. We have heard all the gruesome stories about how difficult it will be to define who is chronically sick. Will this saving really assist our economy? Aneurin Bevan used to argue that the Health Service made money by preventing people becoming seriously ill. He was, of course, talking about important people—coal miners, steel workers, transport workers, and so on.

At one time it was estimated that by reducing the incidence of bronchitis in those industries the advantage to the economy was three times the cost of the Health Service in any one year. If people have to pay a few shillings for the first and second occasions on which they need prescriptions, they will try to avoid having to visit a doctor. What worries us is this horrible phrase about having to struggle not to visit a doctor until it is really necessary, because we know that people will put off their visits until it is too late for simple remedial action to be taken, and they will then suffer long periods of illness. The result will not only be deleterious to the individual, but, if the person concerned is one of the workers to whom I referred earlier, the loss in economic terms will far outweigh the saving envisaged by these proposals.

Many of my hon. Friends and I think that the manner in which this debate has been treated—it might have been worse if there had not been a protest—was not consonant with Parliamentary procedure or with the importance that such a debate should be accorded. We would have been prepared to debate this matter all through the day—and all through the night, to use a Welsh phrase. We wish that my right hon. Friend had responded to my request. He has a wonderful opportunity to weigh up the arguments and make Parliamentary history by agreeing that the Regulations should be annulled.

We ask the Government not to commit a crime which we expect the Tory Party to commit. The Tory Party has always loathed the National Health Service, but it was never politically expedient for the Tories to say so. The shameful thing about these Regulations is that they will destroy much of what the Labour Party has believed in in its fight to build up a great National Health Service. They will cause dissension and unhappiness within the ranks of the Labour Party. Most important of all, they will put a burden on those who can least afford to pay.

In a dark, gloomy and miserable world the National Health Service, with its free comprehensiveness, has been the only beacon of sanity to which mankind could turn. I know that the idea of a free National Health Service to alleviate suffering is a joke to the hon. Member for Bury St. Edmunds (Mr. Eldon Griffiths). I hope that there will be enough of us here tonight to ensure that these Regulations are annulled. We will not merely be annulling a Statutory Instrument and preventing the imposition of prescription charges. We will be giving encouragement to everybody who wants to see sanity placed again on the agenda and money spent all over the world on health, food, and all the decent things of life. This is what we mean when we say that we want the Regulations annulled so that decency and sanity can take their place high on the agenda of the affairs of mankind.

11.3 p.m.

Mr. John Cronin (Loughborough)

I am grateful to my hon. Friend the Member for Ealing, North (Mr. Molloy) for shortening his speech so that I can make a few remarks before the Undersecretary of State for Scotland speaks. I am sorry that my few remarks will have to be rather critical of my right hon. Friend the Minister of Health and his proposed prescription charges. The Minister said that he had no alternative except to make this cut in National Health Service expenditure of the choice available. This is not the argument. There was no need for any cut in the Service at all. If the Minister had resolutely declined to accept any cut and had offered to resign rather than accept a cut, the Government would not have dared to introduce these prescription charges.

These Regulations are socially unjust, economically irrelevant, and an act of grave political unwisdom. There was never any need to make this form of cut. Several forms of taxation could have been employed which would have raised much more than the amount which will be saved by this cut. An increase of 1d. in the tax on a pint of beer, or a small increase in the betting tax, would have obviated the need for this invidious and undesirable cut.

The Minister was rather coy about saying what the saving will be which justifies this political behaviour, this abandoning of Socialist principles. The Prime Minister said in January that the figure would be about £25 million, but he did not then know what the exemptions would be. Even if it is £25 million, will this relatively small sum, equivalent to about 2½ per cent. of our current and capital account balance of payments deficit last year, be worth the suffering and abandonment of principle involved? Will it really bring a gleam into the eyes of the gnomes of Zurich?

The Minister must be aware that, economically, it will not be helpful, even from his limited point of view, because much of the saving will be offset by bulk prescribing by doctors. People will also indulge in self-medication. This will result in the same amount of money being spent on Pharmaceuticals and diverted from exports.

This order is a gross social injustice. Many hon. Members have pointed out that it is totally unfair to tax the sick.

This charge will particularly affect low wage-earners, agricultural employees and others who receive perhaps £15 a week. Such a man with a wife and family might spend £1 or more a week in prescription charges if several of his children are ill. [HON. MEMBERS: "They are exempt."] My remarks apply to older members of his family. This is a particularly harsh form of discriminatory taxation. My hon. Friends have taken pride in opposing taxes which bear harshly on those who are least able to afford them. When we were in opposition we opposed all proposed Purchase Tax and other increases which hit the less well off. Now we are introducing what is, in effect, a poll tax on an unfortunate section of the community, the sick, at the time when they most need our sympathy and help.

This imposition is unwise politically. The Government have repeatedly performed acts which have alienated Labour supporters. This is one of the gravest. Whatever the result of tonight's vote, this policy is opposed by the majority of my hon. Friends, and the same can be said with even more force about active Labour supporters outside. We are doing ourselves great political harm for a narrow, limited and doubtful economic objective.

Most of my hon. Friends will not accept this situation. We will continue to fight it and press for these charges to be withdrawn. Although the damage has been done and the image of the party has been besmirched, the majority of us will continue to oppose these prescription charges. We will ensure that ultimately justice is done to the sick.

11.9 p.m.

The Under-Secretary of State for Scotland (Mr. Bruce Millan)

I naturally understand the feelings that some of my hon. Friends have expressed, and many of their criticisms. With many of them I have a good deal of sympathy, as has my right hon. Friend, which will be clear from his remarks. None of my hon. Friends and no Member of the Government has looked forward to this debate or took the decision to reimpose prescription charges except with the strongest feelings of regret. We have to place this decision in the context of the economic situation in which it was taken.

I do not think that this is precisely the time to argue all the facts of the economic situation, but it is generally accepted in all parts of the House that the Government in January had very many unpleasant decisions to take, but decisions which were absolutely essential if we were to put our economy on its feet. My right hon. Friend has pointed out that in those circumstances it was inevitably necessary that certain reductions should be made, not in the absolute limits of social service expenditure but in the increases which it had otherwise been intended should take place.

Despite what my hon. Friends have said this evening, it is unrealistic to expect that when reductions were being made elsewhere that the Health Sendee could be completely excluded from consideration. [HON. MEMBERS: "Why not? "] The decision that had to be made was to reduce the expenditure in a way that we felt would be least damaging to the fabric of the National Health Service as a whole.

This naturally involves questions of priority, and I ask my hon. Friends to believe that, despite some of the facile assumptions some of them have made this evening, it is quite necessary in this kind of situation to have some regard to priorities, and therefore the kind of statement that was made, for example, by my hon. Friend the Member for Plymouth (Dr. David Owen), very accurately described the kind of considerations which the Government had to have in mind.

There was, for example, the possibility of a decision to cut the hospital building programme, or one might have taken some other decision within the National Health Service to make other reductions in its expenditure. But all such reductions were very much more unpleasant than our decision to reimpose the prescription charges.

Mr. Pavitt

Can I assure my hon. Friend that all the factors he has mention have been taken into consideration by the North-West Metropolitan Regional Hospital Board, of which I am a member?

Mr. Millan

Then I am surprised that my hon. Friends should have reached the decision they took, because a cut in the hospital building programme and hospital expansion generally of the same amount as is to be produced by the re-imposition of the prescription charges would very seriously damage the Health Service at the present time.

It is also worth pointing out, because my hon. Friend the Member for Willes-den, West (Mr. Pavitt) made the point, that while in any situation one has a choice between reducing expenditure or increasing taxation, in my right hon. Friend's Budget there have been very substantial increases in taxation. It seems to me to be slightly overlooking some of the important facts of the situation to suggest that the Government did not take into account the possibility of taxation increases when, in the Budget a month or so ago, we had these very substantial increases in taxation.

In that situation, regrettable as it may appear to my hon. Friends, as it is to members of the Government, the decision was reached that reimposition of prescription charges was the least damaging step that could be taken in respect of the National Health Service. For those of my hon. Friends who look on this in absolute terms, and are not willing even to discuss whether in any such situation prescription charges might be levied, the rest of what I have to say will be rather irrelevant to the major consideration. I wish to address the rest of my remarks to those who take a more realistic view of the choices before the Government in January.

Having decided to reimpose prescription charges, the main consideration in the detailed study which the Government gave to this subject was the avoidance of hardship. In this respect, I want to draw some distinctions between this scheme and that which was imposed and carried on by right hon. Gentlemen opposite. One of the major objections to the previous Government's scheme was that it involved a system of refunds. In other words, the patients had to pay the charge and then go through a rather elaborate procedure for getting the money back. We decided that the system which we introduced would be based on exemptions rather than refunds.

It has, therefore, taken us rather longer to work out the details of the scheme, but we think that that delay in the introduction of the scheme is worth while, because it has enabled us to lay down in these Regulations not refund provisions, although these may be necessary for a minority of cases, but exemption provisions for the vast majority to whom we wish to give special attention. These are the people who are to be exempt on grounds of age, under 15 or over 65, the chronic sick, the war disabled, those on supplementary benefit and also, of course, those who are not on supplementary benefit but who are among the lowest income earners.

It is an indication of the difference between this scheme and the scheme of the previous Government that under their scheme refunds were just over 10 per cent. of the total number of prescriptions, whereas under this scheme 50 per cent. of prescriptions will not bear the charge, representing categories of exempt patients running at about 42, or 43, or 44 per cent. In these circumstances, it is extraordinary that the hon. Member for Cheadle (Dr. Winstanley), for example, should have said that he preferred the Tory scheme. The Tory scheme provided refunds for about 10 per cent. of prescriptions, whereas the present scheme will provide for exemptions for about 50 per cent. of prescriptions.

Dr. Winstanley

I never suggested that I preferred the Tory scheme. I said that it was more honest and more straightforward and more intelligible. I said that I was opposed to charges. I did not say that I preferred that scheme; I said merely that it was more honest.

Mr. Millan

It is still an extraordinary comment if the hon. Gentleman does not believe in charges.

Some of my hon. Friends rightly asked—and I can understand their feelings—what the effect of the scheme would be on the attitude of patients towards going to the doctor, particularly patients in poorer circumstances. We know from experience that, particularly in the early period of the reimposition of charges, the number of prescriptions goes down appreciably, but that reduction is strictly temporary. However, obviously, one would not want any scheme to have the effect that people who needed medication would be prevented from going, or made reluctant to go, to their doctors. But my hon. Friends who have made that point completely overlook the range of exemptions involved in the scheme.

For example, they cover the lower-paid workers, who are able to apply to the Ministry of Social Security for a refund, in the same way as those on supplementary benefit. Therefore, I do not believe that there would be large numbers of people, particularly in view of these exemption categories, who will be prevented from going to doctors or who will be reluctant to go to their doctors because of the introduction of prescription charges. I do not believe that that happened in the past to the extent that some may have believed, and I am sure that it will not happen under the scheme we are discussing.

Mr. Lomas

Would my hon. Fnend stop being an apologist for Tory policies? He should have some regard for our concept of a Health Service free for all at the time of need. May I inform him that 1 had intended tonight to abstain. In view of his comments and the speech of the Minister of Health, I intend to vote against the Government.

Mr. Millan

That is no doubt very regrettable, but hon. Members must listen to some of these facts about the Regulations and perhaps not approach this matter with the closed mind that some of my hon. Friends have demonstrated this evening.

Mr. Andrew Faulds (Smethwick)

You are going to lose some more votes.

Mr. Millan

One of the characteristics of the closed mind is an inability to listen to arguments with which one does not agree. This has been demonstrated on more than one occasion tonight.

There have been a number of criticisms about the complexity of the Regulations. But they inevitably must be complex if we are to provide for these categories of exemption. Most of the arguments we have heard tonight, far from asking for further simplification of the Regulations—for example, the argument for extending the categories of exemption—are arguments for making the Regulations even more complex. But the Regulations inevitably must be complex when we are trying to provide for this wide variety of exemptions which I have described. But I do not think that that vitiates the calculations of the savings we have announced on the re-introduction of charges.

I could not understand the remark of my hon. Friend the Member for Willes-den, West that the Government had been coy about quoting the savings. The figure was announced at £25 million in the original announcement in January, and the savings are calculated now at the same figure.

May I say something about the age limits. There is no magic about the age limit of 15. It would have been perfectly possible and arguable to fix another age limit, perhaps 14 or 16, for children. But the age chosen seems to me to represent the exemption of very large numbers of children, which is surely what my hon. Friends want.

A similar situation exists concerning a number of other categories. It was asked, for example, why the industrially disabled should not be covered in the exemption categories. One could perhaps draw a different line, but many industrially disabled people do not require prescriptions to any greater extent than many other people. There is no particular relationship between industrial disablement and the number of prescriptions. In any case, the industrially disabled, as with a number of other categories which have been mentioned, will gain advantage from the single payment scheme which is coming later this year.

My right hon. Friend explained what considerations the Government had in mind in denning the categories of chronic sick. He told of the discussions we have had with the medical profession, and the doctors' understandable reluctance to be concerned in a definition of chronic sick that would mean making judgments which, medically speaking, are very difficult and might have involved them in invidious comparisons between one patient and another.

Therefore, the list in the Regulations at present defining the chronic sick is inevitably restricted, that is a list of conditions which can be defined with some precision. There are a number of other illnesses and conditions which it is arguable should be included in the definitions, such as tuberculosis, schizophrenia and other forms of psychiatric illness, pneumoconiosis and silicosis. A number of others were also mentioned in the debate.

The difficulties of which my right hon. Friend spoke apply in one measure or another to all the conditions mentioned. Relevant here is the single payment scheme—the season ticket system, to use rather an unfortunate term—which my right hon. Friend announced would be introduced later this year when we have the statutory power to do so under a new Clause in the Health Services and Public Health Bill. All the categories mentioned can take advantage of the single payment scheme, about which there seems to have been some misunderstanding. More than one hon. Member asked whether all illnesses would be eligible for the single payment or season ticket system. There is no eligibility. Any patient will be able to apply for the season ticket once the scheme is introduced. Therefore, most of the marginal difficulties which my hon. Friends have mentioned tonight will be taken care of in the scheme.

Dame Joan Vickers

Will the hon. Gentleman say something about the different age of 60 and 65? This is very important.

Mr. Millan

There is no evidence that women between the ages of 60 and 65 require more prescriptions than men of the same age. There is no particular magic age of 60 or 65 for women.

Mrs. Lena Jeger (Holborn and St. Pancras, South)

Has my hon. Friend noticed that the time is going on?

Mr. Millan

Yes, I have noticed that. I was about to say that I have taken up some of the detailed points made tonight. But the basic decision that must be made, at least on this side of the House, is whether in the circumstances we faced in January our action was right. The details of the scheme are very important, but it is on that basic decision that we shall be voting this evening.

Mr. Pavitt

I beg to move, That the Question be now put.

Mr. Deputy Speaker (Mr. Sydney Irving)

I cannot accept that Motion.

Mr. Millan

I was about to say that I have explained the background and the necessity for the decision. It was regrettable but one which we felt was necessary in the circumstances, and I ask the House to support us.

Question put.

The House divided: Ayes 52, Noes 129.

Division No. 207.]	AYES	[11.30 p.m.
Allaun, Frank (Salford, E.)	Gregory. Arnold	Park, Trevor
Atkinson, Norman (Tottenham)	Criffiihs, Will (Exchange)	Parkyn, Brian (Bedford)
Barnett, Joel	Hughes, Emrys (Ayrshire, S.)	Perry, George H. (Nottingham, S.)
Bidweli, Sydney	Jeger,Mrs.Lena(H'b'n&St.P'cras,S.)	Roberts, Gwilym (Bedfordshire, S.)
Booth, Albert	Jenkins, Hugh (Putney)	Rowlands, E. (Cardiff, N.)
Brown, Hugh D. (G'gow, Provan)	Johnston, Russett (Inverness)	Ryan, John
Butler, Herbert (Hackney, C.)	Kerr, Mrs. Anne (R'ter &Chatham)	Sheldon, Robert
Cronin, John	Kerr, Russell (Fettham)	Short,Mrs.Renée (W'hampton,N.E.
Dickens, James	Lee, John (Reading)	Swain, Thomas
Dobson, Ray	Lestor, Miss Joan	Thorpe, Rt. Hn. Jeremy
Driberg, Tom	Lomas, Kenneth	Whitaker, Ben
Dunwoody, Dr. John (F'th & C'b'e)	Lubbock, Eric	Wirmick, David
Ellis, John	Mendelson, J. J.	Winstanley Dr. M. P.
Evans, Cwynfor (C'marthen)	Mikardo, Ian	Yates Victor
Faulds, Andrew	Molloy, William	mt
Fletcher, Ted (Darlington)	Newens, Stan	TELLERS FOR THE AYES:
Foot, Rt. Hn. Sir Dingle (Ipswich)	Norwood, Christopher	Mr. Laurence Pavitt and
Foot, Michael (Ebbw Vale)	Orbach, Maurice	Mr. Frank Hooley.
Galpem, Sir Myer	Orme, Stanley
NOES
Albu, Austen	Harrison, Walter (Wakefield)	Parker, John (Dagenham)
Anderson, Donald	Hart, Rt. Hn. Judith	Peart, Rt. Hn. Fred
Archer, Peter	Hazell, Bert	Pentland, Norman
Armstrong, Ernest	Healey, Rt. Hn. Denis	Perry, Ernest G. (Battertea, S.)
Benn, Rt. Hn. Anthony Wedgwood	Hilton, W. S.	Prentice, Rt. Hn. R. E.
Bishop, E. S.	Houghton, Rt. Hn. Douglas	Rees, Merlyn
Blackburn, F.	Howell, Denis (Small Heath)	Reynolds, G. W.
Boyden, James	Howie, W.	Richard, Ivor
Braddock, Mrs. E. M.	Hughes, Rt. Hn. Cledwyn (Anglesey)	Roberts, Goronwy (Caernarvon)
Bray, Dr. Jeremy	Irvine, Sir Arthur (Edge Hill)	Robinson,Rt.Hn.Kenneth(St.P'c'as)
Broughton, Dr. A. D. D.	Janner, Sir Barnett	Robinson, W. O. J. (Walth'stow, E.)
Brown, Rt. Hn. George (Belper)	Jenkins, Rt. Hn. Roy (Stechford)	Rodgers, William (Stockton)
Brown,Bob(N'c'tle-upon-Tyne,W.)	Johnson, James (K'ston-on-Hull W.)	Roebuck, Roy
Brown, R. W. (Shoreditch & F'bury)	Jones,Rt.Hn.Sir Elwyn(W.Ham,S.)	Ross, Rt. Hn. William
Buchan, Norman	Judd, Frank	Shore, Rt. Hn. Peter (Stepney)
Callaghan, Rt. Hn. James	Lawson, George	Short,Rt.Hn.Edward(N'c'tle-u-Tyne)
Carmichael, Neil	Ledger, Ron	Silkin, Rt. Hn. John (Deptford)
Castle, Rt. Hn. Barbara	Lee, Rt. Hn. Frederick (Newton)	Silkin, Hn. S. c. (Dulwich)
Chapman, Donald	Lever, Harold (Cheetham)	Skeffington, Arthur
Concannon, J. D.	Loughlin, Charles	Slater, Joseph
Crosland, Rt. Hn. Anthony	Lyon, Alexander W. (York)	Small, William
Crossman, Rt. Hn. Richard	McCann, John	Snow, Julian
Dalyell, Tarn	MacColl, James	Stewart, Rt. Hn. Michael
Davidson, Arthur (Accrington)	Mackie, John	Stonehouse, John
Davies, Dr. Ernest (stretford)	Mallalieu,J.P.W.(Hudder&field,E.)	Swingler, Stephen
Davies, Harold (Leek)	Marsh, Rt. Hn. Richard	Taverne, Dick
Davies, Ifor (Gower)	Mason, Rt. Hn. Roy	Thomas,Rt.Hn.George(Cardiff,W.)
Dell, Edmund	Mellish, Rt. Hn. Robert	Thomson, Rt. Hn. George
Diamond, Rt. Hn. John	Millan, Bruce	Tinn, James
Dunnett, Jack	Mitchell, R. C. (S'th'pton, Test)	Urwin, T. W.
Dunwoody, Mrs. Gwyneth (Exeter)	Moonman, Eric	Varley, Eric G.
Ennals, David	Morgan, Elystan (Cardiganshire)	Walker, Harold (Doncaster)
Evans, loan L. (B'rm'h'm, Yardley)	Morris, Charles R. (Openshaw)	Wallace, George
Fitch, Alan (Wigan)	Morris, John (Aberavon)	Wellbeloved, James
Foley, Maurice	Moyle, Roland	White, Mrs. Eirene
Forrester, John	Murray, Albert	Whitlock, William
Fowler, Gerry	Noel-Baker, Rt.Hn.Philip(Derby,S.)	Williams, Alan (Swansea, W.)
Freeson, Reginald	Oakes, Gordon	Williams, Alan Lee (Hornchurch)
Gray, Dr. Hugh (Yarmouth)	Ogden, Eric	Williams, Mrs. Shirley (Hitchin)
Greenwood, Rt. Hn. Anthony	O'Malley, Brian	Wilson, Rt. Hn. Harold (Huyton)
Grey, Charles (Durham)	Oram, Albert E.
Griffiths, Rt. Hn. James (Llanelly)	Oswald, Thomas	TELLERS FOR THE NOES:
Gunter, Rt. Hn. R. J.	Owen, Dr. David (Plymouth, S'tn)	Mr. Neil McBride and
Hamling, William	Pannell, Rt. Hn. Charles	Mr. Joseph Harper.
Hannan, William