NATIONAL HEALTH SERVICE (DRUGS AND APPLIANCES) (Hansard, 13 November 1968)

§ Dr. M. P. Winstanley (Cheadle)
I beg to move, That an humble Address be presented to her Majesty, praying that the National Health Service (Charges for Drugs and Appliances) (Amendment) Regulations 1968 (S.I., 1968, No. 1588), dated 3rd October 1968, a copy of which was laid before this House on 15th October, in the last session of Parliament, be annulled. My aim is to provide an opportunity for these Regulations to be explained and debated. They have not yet been fully explained. When the House was considering the Lords Amendments to the Health Services and Public Health Act, 1968, on 10th July, the right hon. Gentleman the then Minister of Health was asked when the Regulations would be fully explained and opportunity given for a debate. Replying to the hon. Member for Penistone (Mr. Mendelson), he said that they would be made and would be open to debate.
My right hon. and hon. Friends and I have no wish to delay the introduction of this scheme, which will alleviate hardship in certain cases and is being looked forward to by certain people. But, in saying that, I want it clearly understood that my attitude in principle remains unchanged. I still take the view that it is possible for our people, with proper administration and organisation, to establish a fully comprehensive, efficient and humane Health Service.

§ Mr. Speaker
Order. The hon. Gentleman is straying out of order. These Regulations are quite narrow and he must talk about them.

§ Dr. Winstanley
The Regulations are designed to fulfil the pledge given by the right hon. Gentleman the Prime Minister in announcing the introduction of the scheme when, on 16th January, 1968, the Government embarked upon the folly of reintroducing prescription charges. The Prime Minister said: The Government have…decided…with the utmost reluctance to reintroduce a system of charges for prescriptions issued under the National Health Service, at the rate of 2s. 6d. per item. He went on to say that there would be various exemptions, adding: Those we have in mind are the elderly"—

§ Mr. Speaker
Order. With great respect to the hon. Gentleman—I appreciate entirely his point of view—we are talking about specific Regulations which provide for prepayment for charges under the National Health Service.

§ Dr. Winstanley
With great respect, Mr. Speaker, surely the purpose of the Regulations is to give effect to an undertaking which the Prime Minister gave and which I am about to read. That undertaking is surely related to the Regulations, because this is what the Regulations are for. Perhaps if I read the quotation I may then know whether I am still in order. The Prime Minister said: Those we have in mind are the elderly, over 65, children up to 15, expectant and nursing mothers and the chronic sick."—[OFFICIAL REPORT, 16th January, 1968; Vol. 756, c. 1587.] That, of course, has been the whole difficulty. How does one define the chronic sick? The Government have been constantly questioned about it. I have here page after page, taken from the OFFICIAL REPORT, of questions put to the right hon. Gentleman the then Minister of Health asking for his definition of the chronic sick and suggesting that the Government have not fulfilled their undertaking. Indeed, all they have done so far until these Regulations is to attempt to exempt persons suffering from a list of illnesses categorised in previous Regulations. It is a limited list and certainly does not cover all the chronic illnesses. This is why the Government have been pressed to fulfil the Prime Minister's undertaking to do something about the chronic sick.
The definition of chronic sickness in the previous Regulations was limited. Doctors were unwilling to act as adjudicators and discriminate between one patient and another, and say that one was worthy of exemption while the other was not. The responsibility was, therefore, left with the Government.
When the previous Minister of Health introduced the previous Regulations, he said with disarming frankness that they might look a little complicated. These Regulations also look a little complicated, and perhaps the hon. Gentleman will explain them. They require those who are chronically sick to define themselves. People are asked to guess how 541 ill they are going to be, how many prescriptions they might need, how many items there might have to be on the prescription, and whether their illness will last for six months or a year. On the basis of whatever conclusions they arrive at, they will opt for a season ticket for six months or for a year. The introduction of complicated arrangements of that kind proves the total impossibility of making satisfactory, by elaborate exemptions and regulations, something which is not satisfactory in itself.
I recognise that this is an attempt to help the chronic sick, but how wise an attempt is it? What has a patient to do? How does he arrive at his decision? He has to consider how long his illness will last. His doctor will not advise him about that. There are many instances in which a doctor will not wish to say to his patient, "Look, if I were you I should-buy a season ticket, because you will not get better for some months". That is not the kind of thing a doctor would wish to say to his patient.
A patient will have to decide whether he wants a season ticket for six months or a year. He will have to decide how many prescriptions he is likely to need. It must be remembered, of course, that a person can be chronically sick without requiring prescriptions. His illness may not need medical treatment. It may need physiotherapy, or perhaps an operation. He may have to decide whether to remain at home, or to go into hospital. Once he goes into hospital, not only does he get his drugs free, but he gets his food and laundry free, too. In a sense that reveals the inequity of these Regulations. The patient has to consider how many items he wants on the prescription. This is an important matter, and I hope that before the debate ends we shall hear from the hon. Gentleman some details about how the scheme is working out.
I warned the Government on a previous occasion—and I do so again now and I suggest that this is relevant to the debate—that one effect of the scheme has been to encourage poly-pharmacy and blunderbuss prescribing. In other words, it has encouraged doctors to combine two or three items in one, instead of prescribing two or three items.
I have here a copy of the modified prescription form which a patient must 542 complete and make his option. A few minutes ago I did an exercise on the cost of treating someone who regarded himself as chronically sick, and wished to take advantage of the Regulations. I decided to prescribe iron and vitamins for his anaemia. Three items mean that the patient has to pay 7s. 6d. The cost to the Government is very small, because these are cheap items. I then decided to prescribe a drug which is now on the market, and which combines the three different ingredients I had prescribed before. The patient now pays 2s. 6d. for the new drug, but the Government pay rather more than three times what would have been the cost of the three items had I prescribed them. I hope that the hon. Gentleman is following my argument.
We have had the arithmetic spelled out. A season ticket costs 30s. for six months, and £2 15s. for a year. He has to do the sum. He has to ask himself, "How much is this a week? How many prescriptions am I likely to have? Is it worth it or not?"

§ Dr, John Dunwoody (Falmouth and Camborne)
On the point that the hon. Member has just made, does not he also agree that poly-pharmacy of this sort—the putting together of a number of prescriptions into one drug—is often very bad medicine?

§ Dr. Winstanley
I agree. That is the kind of point that the Government must bear in mind. Their actions have consequences more grave and far-reaching than they originally thought.
We are considering people who, because they are ill and likely to remain ill, are unlikely to be earning large amounts. They are most likely to have difficulty in meeting their financial obligations. My hon. Friend the Member for Orpington (Mr. Lubbock) has given me details of a case concerning a couple who come within the age group—over 15 and under 65—and whose only income is sick pay. Because the National Health Insurance pay does not count as supplementary pension there is no exemption under other Regulations. The husband is chronically sick. He had a stroke, and now suffers from hemiplegia—an illness which requires regular treatment. He also has to have treatment for other conditions. His wife is also sick.
543 He has to decide, "Shall I apply for one of these exemptions for myself and my wife?" The cost is £5 10s.—and he is a person with no money. It is like saying to him, "Do not pay 5s. for the prescription; pay £5 10s." or like saying to somebody at a station booking office who asks, "May I have a single ticket to so-and-so?" and then on being told the cost, says, "Oh, I cannot afford that", "Very well, buy a season ticket." I would have thought that that system would not please people like those to whom I have just referred.
Before the debate concludes I hope that the hon. Member will let us know how people are to be informed of their rights and how they are to make application. Is it direct to executive councils, or is there some easier method? What steps is the hon. Gentleman taking to inform them of the new arrangements? Will he let us know the results of the calculations which must have been made? How many people does he think will take advantage of this option? What is likely to be its effect upon the total saving which the Government announced would be made as a result of the whole scheme? How many people, and how much money, does this represent? What calculations has his Department made as to the cost of implementing this scheme, in terms of the new aspects which come under these regulations? We know that the Ministry has had to make certain payments to pharmacists to compensate them for the additional work they have had to do in carrying out a very complicated scheme.
I want to know what has been the effect, so far, on the cost of prescriptions, per item. Is it having any effect on doctors' prescribing habits? What are its effects in terms of the frequency of prescribing?—because to avoid the difficulties outlined in the Regulations doctors are now tending to prescribe large amounts so as to save their patients visiting them too often, and this means that certain patients are not being seen as often as they might.
At the outset of this matter, back in January, the Prime Minister made a calculation of the saving involved. Subsequently, it was said by the Minister of Health and others that there was no reason to vary that prediction, because 544 things were working out as envisaged. But we heard from the hon. Member only last week that 51 per cent. of persons are exempt.

§ Mr. Speaker
Order. With all the good will in the world, I cannot allow the hon. Member to drift into a debate on prescription charges. He knows what is in the Regulations.

§ Dr. Winstanley
Nevertheless, Mr. Speaker, I am sure that you will agree that I am in order in saying that under these Regulations the scheme will have a profound effect upon the calculations which the Government originally made. One would like to know the results.

§ Mr. John Cronin (Loughborough)
The scheme is a matter of repugnance to many of us on both sides, and it will cause hardship and suffering to many people in the cause of our economic stability. The vital question is whether it will produce the saving of about £20 million which has been suggested.

§ Mr. Speaker
Order. The hon. Gentleman's question is linked to prescription charges. We are discussing whether some sort of prepayment arrangement should be made for certain patients.

§ Dr. Winstanley
I have said enough to make clear my view of the whole scheme of which the Regulations are a part, and to make clear—

§ Mr. Speaker
Order. The hon. Gentleman's view of the whole scheme is out of order in this debate.

§ Dr. Winstanley
I think that Mr. Speaker would prefer me to conclude, which I am trying to do, so that other hon. Members may speak.

§ Mr. Leadbitter
The hon. Gentleman has underlined what we all feel about the season ticket, which is ridiculous. But there is a matter which he may have overlooked. From his own considerable experience, could he tell us about the consequences for people with limited incomes? If they cannot forecast the length of their sickness, and thus make a judgment, there are some who possibly could do so but are so poor that they might not be able to afford a season ticket. 545 Therefore, is not the consequence of this kind of legislation to get at the people that really matter, but who would then have to fall back on the prescription charges?

§ Mr. Speaker
Order. Interventions should not be speeches. Many hon. Members wish to speak.

§ Dr. Winstanley
I am grateful for the hon. Gentleman's question, because it is true that the Regulations are designed to help, but, as he suggests, the people who are most in need of help are the very people who will be least able to take advantage of them. People who are hard up prefer to pay bit by bit and not in a lump sum. Perhaps the Minister will comment on the important question whether they could pay weekly rather than in a lump sum, provided that they undertook to opt for the full season ticket.
These complicated Regulations are further evidence that one cannot make the scheme really satisfactory, though I accept that they are an attempt to do so. I look forward with interest to the Minister's explanation, in the light of which we shall have to decide our attitude to the Regulations.

§ Mr. Michael Foot (Ebbw Vale)
Since all my hon. Friends present wish to speak, I shall try to confine my remarks to a very few sentences, but I wish to tell the Government exactly what some of us think about the necessity they apparently feel to introduce the Regulations.
The hon. Member for Cheadle (Dr. Winstanley) has done an important service to the House by praying against the Regulations so that we may debate them. I agree with his suggestion—although I think that we should await what my hon. Friend the Minister says—that it would be foolish for us to vote against them, because they will at any rate mitigate the present situation and, on those grounds, it would be foolish for us to oppose them.
However, the Government should be in no doubt about what we feel about the necessity for this debate. It is a most miserable affair that such a debate should have to be staged under a Labour 546 Government, in view of the specific undertakings we have given not to put the country and ourselves in the need to introduce any such Regulations.
Moreover, it might be thought, and it may be argued, that these Regulations are, in part, a fulfilment of the pledge which was given by the Prime Minister, and we are entitled to argue whether that is the case. Certainly, we do not regard them as a fulfilment. Indeed, when the Cabinet decided to introduce prescription charges, they were under the illusion that it would be possible to exempt all the chronic sick from the payment, and the introduction of these Regulations is the proof that this is not so.
The original decision to reimpose prescription charges was taken by the Cabinet on false pretences, on the assumption that it would be possible to do that. Instead of that, we have the Regulations and the addition of fresh forms which people have to fill in so as to get proper medical assistance.
This is one of the most objectionable features of the whole system—the ever-increasing burden of forms which is imposed on poor people if they are to get their rights. Poor people have to make all the calculations made by the hon. Member for Cheadle. Rich men have tax experts to make their calculations and to go through the forms, but poor people have to go through such forms as these, which are difficult enough for us to understand, to find out whether they will get their rights. They may seek advice from a doctor but, as the hon. Member illustrated, the doctor will not be able to give them accurate advice.
This is certainly a palliative to a very unhappy situation—something which should never have needed to be introduced at all. I hope that the Government will be under no illusion. When we pass the Regulations we shall wish to return at a very early date to a full debate on the whole question of prescription charges. We shall wish to debate how speedily we can get rid of these Regulations, along with the whole of this apparatus, which is a defiance of our election pledges, a defiance of the decisions of our party conference and a defiance of the principles for which this party has stood in the establishment of a National Health Service.
547 The beauty of the Health Service—and that is not too strong a word—was that poor people, sick people, could get their rights without having to go through the indignity of sending in forms or through the anxiety of wondering whether they would get their rights and whether they would get their prescriptions. The beauty of that system is being eroded by one form of means test after another, by one form after another imposed on the poor people of this country.
Some of us will not rest until we have removed prescription charges and restored the Health Service to the principles on the basis of which it was originally established. I hope that the Government will be under no illusion about this matter. I hope that they will not assume, when we allow these Regulations to go through, that we shall let the matter rest there. We shall seek at the earliest possible opportunity to debate the whole issue.

§ Mr. Eric Lubbock (Orpington)
I could not agree more with the hon. Member for Ebbw Vale (Mr. Michael Foot). I wish that I had his eloquence to tell the House of my disgust and of the repugnance which I feel at having to agree to passing these Regulations, which I shall do with the greatest reluctance, because I, too, am opposed to the whole scheme. I will not test your patience, Mr. Speaker, by discussing the prescription charges themselves—

§ Mr. Speaker
Order. The hon. Member knows that he would be out of order if he did so.

§ Mr. Lubbock
I realise that, Mr. Speaker.
I intervene to underline what was said by my hon. Friend the Member for Cheadle (Dr. Winstanley) about a constituent of mine who is in particular difficulty and who has written to me about the implementation of this scheme. The Minister of State, the Department of Health and Security, who is sitting on the Front Bench, has done his best to reply with the very poor brief with which he has been provided. He knows that this constituent has, unfortunately, been invalided out of the Post Office and prematurely retired on account of coron- 548 ary thrombosis and hemiplegia. It is probable that he will never be able to work again. But he does his best to overcome the difficulties. He is a most remarkable man. In his retirement he has taken up printing as a hobby, which he does with one arm. He finds it very difficult to get about, and he has to use a stick, but he overcomes all these difficulties, for he is a man of immense courage.
My constituent came to me and said, "I notice these Regulations are to be introduced and the Government will ask me to spend £2 15s. on a season ticket which will entitle me to prescriptions for a whole year, but my wife also is a semi-invalid and she cannot work either, and she needs prescriptions very frequently. I have no doubt that the cost in total will be more than £2 15s. divided by 52, but where shall I get this money from? I am living on sickness benefit which amounts to £7 6s. a week, plus a very small pension from the Post Office." He also had a minute amount of savings, but I do not know the amount.

§ Mr. Speaker
Order. I am following the hon. Member closely, but this seems to be an argument against prescription charges. He must link it with these Regulations.

§ Mr. Lubbock
With very great respect, Mr. Speaker, I am explaining how impossible it is for a person in the position of my constituent, who has only a very small amount coming in every week, suddenly to fork out £2 15s. for himself and £2 15s. for his wife, making a total of £5 10s., all in one lump sum. If you compare it with the sickness benefit he is receiving, £7 6s., plus a small Post Office pension, you will understand, I think, that it is quite impossible.
The Minister is giving us a scheme which will benefit the very rich, who are quite able to fork out this amount for themselves and their wives, and there is no difficulty for them at all. As I understand, anyone who thinks that he will be advantaged by paying out £5 10s. for himself and for his wife can do so at his own option and does not have to obtain the approval of a doctor. The patient himself is to be asked how many prescriptions he thinks he will require 549 in the next six months or a year—a ludricrous position to be put in.
What is more important from my point of view is that the scheme will benefit only rich people who are able to produce this amount in one lump sum, but it will not benefit my constituent, who cannot do so. Every penny he has coming into his household is needed to be spent on food, electricity, various bills which come in periodically. Of course, the expenses of a person who is a paraplegic and who has a coronary condition, and whose wife is not at all well, either, are bound to be higher than those of a married couple in a state of perfect health. That is unavoidable.
Therefore, I am telling the Minister that my constituent will not be able to take advantage of the scheme, and I regret it, as he regrets it, because, no doubt, over a period of six months or a year, he might derive some benefit, but he cannot afford to. It is because he might, that I am not inclined to vote against the Regulations. I am just pointing out to the Minister these facts, and I hope he realises, and that the House will realise, too, that what he is doing is to offer a nice present to rich people who are ill and can well afford £2 15s. for their prescriptions, but he is doing nothing for the people who are dependent on sickness benefit and who are just above supplementary benefit level and who are the people who most require help.

§ Mr. Will Griffiths (Manchester, Exchange)
This is, in a way, one of the most absurd sets of Regulations that the House has had to consider for a very long time. Let us consider the origin.
The Government, in a curious way, got themselves into a mess, because they have a guilt complex about the whole policy they have embarked upon. Once they decided to impose a charge they then sought to ease their conscience and to assure their supporters by pointing out the width of the exemptions, and so right from the beginning, as my hon. Friend the Member for Ebbw Vale (Mr. Michael Foot) said, the Government declared that it was their intention above all to relieve the chronic sick. Such was their incompetence, and the haste with which they introduced this abominable principle, that they did not look at the possibility of 550 the definition of the chronic sick. So they come along to the House tonight with Regulations which are not designed to help the chonic sick as such.
The absurdity of the situation arising from the Regulations is that they constitute, in effect, an insurance policy for any member of the community. Anybody who wishes can, at the moment the Regulations become effective, apply to the executive council, as I understand, for an exemption certificate. That means that someone who thinks that he may be afflicted, for example, with bronchitis in a bad winter may have a gamble and, if he has the money, apply for an exemption certificate. On the other hand, someone who is genuinely chronically sick may, at the very moment when he needs an exemption certificate, not be in a position, for obvious financial reasons, to benefit under the terms of the Regulations.
The Regulations represent, in a way, a hypochondriacs' charter. A person who, on the assumption that he might be afflicted with, say, bronchitis, in a bad winter, pays 30s. for a six-month exemption certificate, may, at the end of the fourth or fifth month of a mild winter, say, "I have paid the 30s. for an exemption certificate which ends in another month or so. At least, I will go along and have a chat with the doctor." In effect, this exemption certificate will be a gross embarrassment to the medical profession, because in the circumstances I have instanced these people will race to the surgeries in the last month before the certificate expires. It is a great piece of nonsense.
The only time the House of Commons had an opportunity to debate the policy on which the Government have embarked we had a Division. I looked up the figures, and found that the Government then managed to scrape together 129 votes. But I also found that when one left out Ministers, Whips and Parliamentary Private Secretaries, the Government managed to get from the party on this side only 35 votes. On the other hand, in the other Lobby, 52 members of this party registered their discontent. The rest stayed away. So much for the situation in which the Government have got themselves—

§ Mr. Speaker
Order. It is not the general policy that we are debating, as 551 the hon. Gentleman knows, but this particular policy. He must get back into order.

§ Mr. Griffiths
I very much appreciate your guidance, Mr. Speaker. I shall not stray further. I think that I have said all that I need to say.
The position is absurd. I am very sorry that the right hon. Gentleman the former Minister of Health, who did such excellent work during the years when he occupied that office, and who is widely respected in all branches of the medical profession, will, lamentably, be remembered by so many members of the public and by members of the party of which he has been an adornment as the man who, at the end of his career as Minister of Health, was obliged by the stupidity of the Government to impose once again, this tax on the sick.

§ Mr. Speaker
Order. The only question that can be discussed is whether these Regulations be annulled.

§ Mr. Paul Dean (Somerset, North)
I believe that the Minister of State is making his first appearance in a health debate, and I should like to wish him well in his new office. He is certainly going in at the deep end in having to deal with a debate of this character for his first appearance.
I realise from what you have said, Mr. Speaker, that this is a very narrow debate, and as there are many hon. Members who wish to speak I shall restrict myself to some brief remarks, and to some questions on the right hon. Gentleman's Regulations.
We on this side—

§ Mr. Lubbock
Who is "we"?

§ Mr. Dean
It is an extraordinary sight to see so many members of the Liberal Party present at any one time. What they are complaining about when they get the chance of making speeches on this subject, I do not know.
We accept this season ticket concept—[Interruption.]—not because we like it—[Interruption.]

§ Mr. Speaker
Order. The hon. Member for Orpington (Mr. Lubbock) really must control himself. He has spoken; he must let other hon. Members speak.

§ Mr. Dean
We accept this season ticket concept, not because we think it a good scheme, but because it is an improvement on the present arrangements for the chronic sick. The exemption categories are arbitrary, unfair, and they have bred a feeling of injustice in many whose sickness is long-term and whose life depends on regular prescriptions, but who, at present, bear the full weight of prescription charges. Many of these people are more severely handicapped than those already exempt. These Regulations are an attempt to deal with this feeling of injustice.
We all appreciate the difficulties the Government have in trying to define the chronic sick and to give a definition which would win acceptance by the medical profession. I hope that the Minister will be able to give an assurance that this is not the Government's last word and that the fact that they have introduced this season ticket concept does not mean that they will not try to extend the categories of exemption for the chronic sick.

§ Mr. Speaker
Order. We cannot discuss, on these Regulations, other Regulations which the Government might introduce some other time.

§ Mr. Dean
I am sorry. I shall try to keep within the limits laid down for this debate.
As the hon. Member for Cheadle (Dr. Winstanley) rightly said, the season ticket puts responsibility on the patient to decide where the advantage lies. That will not be an easy decision. For someone who is already sick to have to decide whether it is worth paying in advance 30s. for six months or 55s. for 12 months is not an easy matter. He has to try to assess whether he will need more than 12 items in six months, which is the break-even point.

§ Mr. Edward Milne (Blyth)
Not only is that a difficult decision, but it is difficult for many in areas which many of us represent to find any of this money.

§ Mr. Dean
I thank the hon. Member; I am coming to the question of hardship.
553 It is a difficult decision for those who can find the money to assess whether they will need more than 12 items in six months. Not only have they to try to decide that, but also what their state of sickness will be over a comparatively long period. There is also the question of the number of items which will be included in a prescription. They will certainly need the help and advice of their doctors and a great deal of information and publicity as to their rights and how to assess where their advantage lies. I hope that when he replies the Minister will give a clear indication on these points and will say what publicity arrangements the Government will make and what advice people may expect from their doctors or other sources in trying to make a very difficult decision.
I wish to ask about what may be a very difficult grey area which this season ticket concept will open. That is the area concerning those who may be eligible under this scheme, but also eligible under Category D of the exemption arrangements. There is a real possibility that there will be this grey area. I hope that the Minister will be able to assure us that patients and doctors will receive guidance on this, because there is a very narrow definition between Category D of the exemption arrangements, on which I cannot enlarge tonight, and the season ticket concept.
I hope, too, that the Minister will tell us something about the cost. This will be a complicated scheme to administer. What will it cost to put into operation, and what is the likely cost of the scheme itself?
Finally, I am not clear from reading these Regulations how the refund arrangements will work for those who require refunds. There are arrangements for the refund of dental and other charges to those who would suffer hardship if they had to bear the full cost. There are also arrangements covering those who are on supplementary benefit. What about people who cannot afford to put down the 30s. as a lump sum? What are the refund arrangements, and how will they apply?

§ Mr. Laurence Pavitt (Willesden, West)
This Prayer finds the House at its most impotent, because, as the hon. Member 554 for Cheadle (Dr. Winstanley) said, the Prayer was laid before Parliament on 15th October, it came into operation on 17th October, and has been operating since 1st November; so we are 13 days too late to do anything. Most of us have a feeling of frustration in that, whatever we say about the Regulations, except to guide the Minister in his interpretation of them there is little we can do.
The Regulations are not only a hypochondriac's charter, but a printer's paradise. On 10th June we printed 160 million prescription forms at a cost of £35,000. Now, because of the Regulations, we print another 210 million forms at a cost of £55,000. These are increasing charges; it means, as the previous Minister of Health said, that the whole idea of prescription charges was a nonsense. This becomes an additional part of the nonsense. We are grateful to the hon. Member for Cheadle for pointing out that clinically, medically and economically it is still a nonsense.
Why were not general practitioners instructed to send back the forms which are now obsolete for pulping? Why were they instructed to burn them? One hundred and sixty million forms are quite a lot. There is a supply of at least five weeks of these forms unused. General practitioners have written to me claiming that they literally have thousands. That Regulations create an additional ridiculous and unnecessary waste.
As my hon. Friends have said, this is an attempt to redeem a promise. We had hoped to exempt the chronic sick. The hon. Member for Somerset, North (Mr. Dean) asked the Government to go further, but it is impossible in these Regulations. It is also impossible because the doctors refuse to go further than four categories. Therefore, only these Regulations can give any kind of additional exemption.
How will this scheme be operated? The newly-printed forms are much more clear. There are only five little blocks to tick in one place and two little rings to tick somewhere else—all in quite small print. There are now 290 million prescriptions per year. How many inspectors will there need to be, because anybody who wishes to claim that he has an exemption certification under the Regulations need only 555 put a tick in square 4 and he then gets his prescription free of charge. There must be an inspection scheme. How many more civil servants shall we have to check these things?
Will these new arrangements be adapted for use in the machines now being developed for the printing of stamps covering prescription charges? All hospitals are now installing machines into which one can put half-a-crown and get a stamp out to cover the prescription charge. Will there be stamp machines for 30s. at the executive council offices? It is difficult to ascertain the details of how the scheme will work and make any sense, in spite of the Government's honest endeavour to ameliorate the lot of the chronic sick.
The hon. Member for Somerset, North spoke about marginal cases and the "grey areas". This is an important matter. There will be a problem here for people who are in need of constant medication but who are also in the bracket lying between the 30s. season ticket and entitlement to have their money back under one of the qualifying categories.
One of the points missed by the Government in this matter is that, when a person is chronically sick, his problem is not just one of prescription charges. There is the whole range of impact on the family of such illness, especially if he is the wage earner. Inevitably, there are all kinds of extra expenses which one cannot note down on a form or cover by ticking square 1, 2 or 3. In my view, with those added burdens, a sum of 30s. for six months is far too much.
Although a lesser sum may be involved—some chronic sick may save as much as £5 over the original scheme—there remains another objection. What will be the situation if the Government are able to introduce graduated contributions for their pensions schemes? Is it possible that these Regulations will be irrelevant? We could adhere to the principle that those who are healthy pay for those who are sick, and, therefore, in stead of relying entirely on taxation, we could have a graduated contribution to pay for the Health Service, which would not be the iniquitous poll tax such as we have now—

§ Mr. Speaker
Order. Many hon. Members wish to speak in the debate. We cannot, however, discuss graduated pensions proposals which may or may not be brought in by the Government.

§ Mr. Pavitt
I am grateful to you, Mr. Speaker. It is just that I could see a possible way by which the Regulations would be irrelevant, if there were some other means of avoiding the season ticket scheme now proposed—

§ Mr. Speaker
Order. There may be many ways in which the Regulations could be irrelevant, but we are discussing the Regulations as they now stand.

§ Mr. Pavitt
I bow to your Ruling, Sir.
May we be told how the scheme affects those patients who are having medication in hospital? I am a member of a regional hospital board which is at present investigating the doubling of the amount spent on prescriptions at a certain hospital in August as compared with July as a result of prescription charges coming in on 10th July. I want to know whether the new scheme will make any difference to the total amount of medication. If one no longer needs a prescription in terms of half-a-crown a time, but in terms of a 30s. season ticket, it may be possible to reduce the quantities of medicines which will be given by doctors.
My hon. Friend the Member for Ebbw Vale (Mr. Michael Foot) spoke for all of us when he told the Government that this is another of the warnings to them after the unanimous vote at our Labour Party conference against the whole concept of a season ticket and the other aspects of this matter. I assure my right hon. and hon. Friends on the Front Bench that we shall pursue this case with all the tenacity at our command until we restore the basic principle on which we all went to the polls at the last election and on which the National Health Service was built.

§ Mr. Jeremy Thorpe (Devon, North)
It has become apparent that when the hon. Member for Somerset, North (Mr. Dean) claims to speak on behalf—to use his words—of the whole of this side, the truth is that, apart from, perhaps, the statutory Whip and one or two backbench Tories who drift in and out, the Tory Front Bench agree in this matter 557 with the Labour Front Bench, and the hon. Gentleman no more represents those who sit behind him than, I suspect, the Minister will when he rises to reply.
I have two questions to put to the Government. We are here considering a suggested exemption which is designed to take some of the sting out of the murder of the free Health Service, which itself is a wider matter which would be out of order in the present debate. I am delighted that there has been this opportunity, albeit after the Statutory Instrument took effect, for these matters to be debated. We note who express interest in these matters and feel deeply concerned, and who are conspicuous by their absence.
The suggestion is that there should be a 30s. six-month season ticket and a 55s. 12-month season ticket, and the first question is on what basis the figures were worked out. Were they thought to be what the chronic sick could afford, or to be the appropriate figure for those who will need more than 12 or 22 prescriptions? I understand that the attendances at doctors' surgeries average five a year, and, assuming that each results in one 2s. 6d. prescription charge, that would mean a personal bill of 12s. 6d. Do the Government suggest that people have to be five times as sick as ordinary citizens in arriving at their charge for season tickets? Was it thought that these figures were roughly what people could afford to pay for their sickness? That is the new development which we face. Or were they regarded as representing the amount of drugs their state of sickness would probably call for?
Second, under the previous Statutory Instrument, No. 759, those who receive supplementary pension or supplementary allowance are exempt from the charges. What is to be the position of a person who does not receive a supplementary benefit but finds extreme difficulty in meeting the charges, and has not sufficient liquid cash to meet the six months' or 12 months' charge? What will be the attitude of the Ministry in interpreting the Regulations? If people find that they cannot qualify for a supplementary benefit, but cannot afford the season ticket for six or 12 months, will they be able to qualify for a supplementary benefit to meet the charge? If they will, how will they be able to satisfy 558 the officials in the Social Security office within whose discretion is the award or refusal of a supplementary benefit?
Will it be because a citizen says that in his view he would not be able to raise 30s. or £2 15s. to buy a season ticket? Will that be sufficient proof for him to be assisted by the Ministry or will he have to get a doctor's certificate? If so, what advice will be given to the doctor on recommending that in those circumstances a supplementary benefit should be awarded?
I hope that the Government will be able to give us some guidance on those two matters, because at present the whole philosophy behind the Statutory Instrument, as I see it, is that if one is going to be really sick, and cannot afford the 2s. 6d. prescription charge each time, one must find a really big lump sum. That seems very strange economics, but no doubt the Minister will be able to explain.

§ Dr. John Dunwoody (Falmouth and Camborne)
It saddens me to give even a guarded welcome to a measure that means that yet again those who use the National Health Service will have to pay charges. But we must welcome any measure that mitigates the worst consequences of the reintroduction of prescription charges. I think that as Members we are all alive to those consequences, because we must all have received letters from our constituents. I am also alive to them because I have been doing some work in a doctor's surgery for the past few weeks.
With the Regulations, we once again find underlined the basic impossibility of defining those who should be exempted. We cannot define the chronic sick effectively and fairly, and doctors rightly will not sit in judgment on their patients. All we could do with the previous Regulations was to introduce a few very limited categories. This was obviously unsatisfactory, so new Regulations have to come before us.
We are introducing a quite extraordinary new principle. It is to be the patients themselves who decide whether they should obtain relief. It will be the patient who will decide this in a way that is unrelated to his medical condition or to his financial means. This seems 559 to me to be a rather strange precedent that we are introducing.
I would also like to underline the difficulty which faces the doctor even in advising patients that they should consider applying for this degree of relief, because with many diseases it simply is not possible to tell the patient that he will require so many prescriptions over the next 12 months that the payment of 55s. will save him a lot of money. The doctor cannot say that to somebody when, in the next breath, he holds out hope that recovery is around the corner and that there are real prospects, although in his heart he may know that the chances are rather small. I therefore ask my hon. Friend to watch the working of the scheme in the practical sense and to watch it carefully in the early months to see whether it gives rise to the sort of difficulties that I think it will cause in doctors' surgeries.
I should like to know from my hon. Friend whether thought has been given to the possibility of patients in certain circumstances obtaining rebates of fees which they have paid. For example, a patient might pay 55s. to cover him for a 12-month period, but within a month or so his condition could change, with the result that he comes within one of the complete exemption categories, perhaps as a result of being confined to home. Will such a patient be able to obtain a rebate? What will happen when a patient dies a week or two after having paid 55s. for 12 months? Will his or her next of kin be able to obtain a rebate?
Why are the figures set at 30s. and 55s.? Why should the patient have to pay it all in one lump sum? If I live in Kensington or Westminster and want to park my car outside my house, I can pay bit by bit, day by day, by separate stamps. Why cannot a patient suffering from chronic illness do that?
One small part of the Regulations extends the exemption for war disabled, and this I welcome, but will the Minister look seriously at the position of the fully industrially disabled, people with conditions like pneumoconiosis, for example?
I shall not speak longer—I know that many of my hon. Friends wish to contribute to the debate—but I ask my hon. Friend to take every measure he can to let the patients know that if they have 560 more than one prescription a fortnight, they will save money by using the scheme. Will he send notices to every doctor's surgery, but will he still realise that the very complexity of the Regulations is one of the strongest arguments against the whole basic conception of prescription charges?

§ Mr. Eric S. Heffer (Liverpool, Walton)
My hon. Friend the Member for Falmouth and Camborne (Dr. John Dunwoody) said that the Regulations would not be related to the financial means of a patient. I agree with everything he said except that, because I think that they will be very much related to the financial means of a patient.
Let me give an example. I had at my "surgery" last Saturday a constituent who has Parkinson's disease, who is steadily getting worse and who is not on the list of chronic sick. Obviously, he is not working and he cannot afford 30s. or £2 15s. He cannot afford 30d. That is the reality of it.
Let us face the position as it will apply to that patient. If he had the money, in that sense he would benefit as a result of the Regulations. If he does not have the money, it is a real problem for the patient. The Regulations are not only a hypochondriac's charter. To some extent they are a rich man's charter.
This is a debate that we ought never to have had. The Regulations should never have been laid before the House. They are one more example of the almost incredible situation into which the Government have got themselves. I am longing for the day when I can get up in a debate and wholeheartedly support the legislation proposed by the Government, but this is not such an occasion. I shall not, of course, vote against these Regulations, for reasons which have been explained by my hon. Friend the Member for Ebbw Vale (Mr. Michael Foot). A limited degree of help will be given, but nevertheless this is totally unnecessary and very bad legislation, in that, although it helps to a limited degree, it does not help those who ought to be helped and who ought never to be placed in such a position.
I underline the incredible situation by referring to the speech of my hon. Friend the Member for Falmouth and 561 Camborne. He said that those who die will not get a rebate, but their relatives might claim one. To talk about rebates is absurd; the answer is quite simple. It is about time the Government dropped the whole scheme and returned to the basic principles of this party on which we fought the General Election.

§ Mr. Speaker
It may or may not be, but not in this debate. Mr. Edward Milne.

§ Mr. Edward Milne (Blyth)
This wide-ranging debate has concentrated on two main points. Some hon. Members have spoken of the mitigation of the hardship of prescription charges which is introduced by the Regulations. Surely the direct criticism of the scheme is that it in no way eliminates the anxieties and difficulties of those who fall sick. There are people who do not have the opportunity of choosing to pay the season ticket charge since their income and ability to pay do not allow them to have a choice.
Last week the secretary of my constituency Labour Party spent four hours in a chemist's shop examining the situation of the people who were calling for prescriptions, and this examination underlined the point made earlier that the complexity of forms makes it extremely difficult for people to decide whether or not to take advantage of this
Rather than discuss these Regulations, I should prefer to hear from the Minister of State precisely what will be done for the person who may not be able to find the initial sum needed for the season ticket, but who may be able to pay by instalments. Not that I like the idea, but if we seek mitigation these matters have to be discussed.
On going over my correspondence with people who were affected by the prescription charges, I found that in no instance since prescription charges were introduced would these Regulations in any way have helped those concerned, since, by reason of their income they would not have been entitled to a season ticket. They cannot put the wherewithal down to secure a season ticket. The Government are again introducing into the health services the position in which those most in need of assistance are the least able to afford it.
562 It has been said that it is important for as many hon. Members as possible to take part in the debate and the main points have already been put. We are grateful to the hon. Member for Cheadle (Dr. Winstanley) for initiating the debate and for his speech, made from his expert knowledge. I hope that my hon. Friend the Minister of State will make this into a real debate and will not stick too closely to his brief but will deal with the matters raised by hon. Members.

§ Mr. David Steel (Roxburgh, Selkirk and Peebles)
I want to underline a point made by the hon. Member for Blyth (Mr. Milne) which has not been explored in the debate to any great extent. This is the effect of the Regulations on chemists' shops. I represent the kind of constituency where the chemist's shop is in a small community and is not just a place for the storing and handing over of drugs but is almost a social centre. The chemist is able to give information about the effect of the Regulations and the other steps the Government have taken with as much accuracy if not more than the doctors.
From the evidence I have received, these Regulations will place an additional burden on the chemists in giving their advice on the different categories of exemptions, the season tickets and the forms. But the saddest commentary on the Government's policy is that I have heard quite independently from the chemists that there are people in their localities who were receiving prescriptions to which they were entitled but now, with the reintroduction of charges, are no longer getting them.

§ Mr. Stanley Orme (Salford, West)
I support the Motion so ably moved by the hon. Member for Cheadle (Dr. Winstanley) and supported by his hon. Friends and by my hon. Friends. It is significant that there has been no complete support for the Government with the exception of the support of the Opposition Front Bench, and I do not think right hon. Gentlemen opposite have a creditable record in this matter.

§ Mr. Dean
The hon. Gentleman must not misrepresent what I said. I stated that we have grave reservations about the drawing up of this scheme but that it is better than the present arrangements for 563 exemptions, which give no provision for the type of people we are discussing.

§ Mr. Orme
I will leave the House to judge. Basically, however much this scheme is an attempt at alleviation, there is now a tax on sickness. We were once told that the scheme would be popular with the electorate. We have learnt differently. I have had people coming to see me who are, as it were, on the limit of the scheme, who are sick but not retired, as, for instance, women over 60 who are still working, some of them widows with dependants. When I have explained how the season tickets will work, they have said, "We cannot afford it. It will be a basic tax on our earnings." While this scheme is an attempt to alleviate the situation, the more it attempts to do it the more complicated the problems become. The whole matter is ridden with contradictions. If this is not a case against selectivity, I do not know what is.
In consequence, although on this occasion we will not vote against the alleviation which some people will be able to claim, nevertheless my hon. Friends and I will vote when the opportunity arises.
I have two further points to make. The first concerns our constituents. My hon. Friend the Member for Ebbw Vale (Mr. Michael Foot) said that it was difficult enough for us to understand these problems. People will have to apply to offices for this season ticket. What arrangements will be made to make them easily accessible to those who want information? How will they get it, and where do they apply?
Secondly, these new forms, which are clearer, are still not clear enough; they are still complicated. Looking at paragraph 2, concerning Regulation 4, do I take it that there will only be one type of form in the doctor's surgery, or two? This paragraph can be read two ways. I should like an answer on that point.
This is not a very happy occasion. We do not feel very pleased at having to do this, but we feel that we must make it clear to the Government that the sooner they remedy the mistake that they made the better it will be for all.

§ Mr. Dudley Smith (Warwick and Leamington)
Normally I find myself poles apart from hon. Gentlemen opposite, par- 564 ticularly those who have spoken tonight. However, I must confess that I have a great deal of sympathy with many of the views that they have expressed.
I believe that there is every case for prescription charges in the present economic circumstances. On the other hand, there is no case whatever for the feeble attempt to deal with the chronic sick problem which the Government have brought forward in these Regulations.
I suppose that I should declare a technical interest, because I am connected with the pharmaceutical industry. However, that has no relevance to the debate tonight.
Anyone who comes within an ace of being permanently or chronically sick ought to obtain automatic exemption. There should be no question of any charge being made on them. If the medical profession has to err, it should err on the side of humanity.

§ Mr. Will Griffiths
I agree about the need to widen the exemptions, but how can we possibly define the chronic sick if the doctors refuse to do so? I agree that they are right to refuse, but in what other way can we define the chronic sick?

§ Mr. Smith
I disagree with the hon. Gentleman. No one is better qualified to judge than the medical profession.

§ Mr. Win Griffiths
But the doctors will not do it.

§ Mr. Smith
I know that they will not, but they should. If the responsibility has to lie with somebody, it should lie with the medical profession, not with the Secretary of State. Most medical practitioners are capable of deciding who should come within the category of being permanently or regularly sick, and those people should gain the exemption.
It is a nonsense to bring forward Regulations which, as one hon. Member said, will in fact encourage hypochondriacs and will introduce an element of gambling on the part of many people who will say, "I will pay the 30s. in the hope that I may benefit in the long run as a result of the charges which will be levied against me." Other hon. Members have said that to many people 30s. is a lot of money.
565 One thing which has impressed me in the last few months is the genuine anxiety expressed by many people, who I think come within the category of chronic sick, about the present state of affairs in not being granted exemption. They will still be worried about having to complete a complicated form, and, indeed, will worry whether they will be charged further in due course. I think that the Government ought to have second thoughts about this. Granted that they should impose prescription charges in the present economic situation, they should apply the most liberal principles in doing so. I am sure that those who are genuinely sick, and are regularly sick, should be granted the exemption which is their due. Nobody ever asks to be ill. Many pathetic cases come to the notice of hon. Members and the medical profession. Surely these people are entitled to some form of humanity? I think that tonight the Government are singularly lacking in humanity.
I shall not vote against the Regulations, nor will my hon. Friends. The Liberal Party is here in strength. I have never before seen five of its Members present. If they like to vote on this issue, that is a matter for them, but I shall not vote against these Regulations, because they are an improvement on the present position albeit a very poor improvement. I agree with hon. Gentlemen opposite, that the Government ought to abolish this altogether and make sure that those who are entitled to it get permanent exemption.

§ The Minister of State, Department of Health and Social Security (Mr. David Ennals)
The hon. Member for Warwick and Leamington (Mr. Dudley Smith) was in the House for a long time while the party opposite was in power. There were no exemptions then, and it is rather hypocritical for the hon. Gentleman to say that we ought to be more generous.
I welcome the initiation of this debate by the hon. Member for Cheadle (Dr. Winstanley), partly because it gives me the opportunity of explaining something about the prepayment certificate, and of adding to the publicity which has been given to it so that the information will be available to those who want to use it. 566 We are most anxious that these facilities should be known to everyone to whom they can apply. It is for this reason that there has been an extensive advertising campaign, and leaflets are now being prepared which will be widely available. They will be available in doctor's surgeries, and in post offices, and we shall continue by every means to make the scheme widely known.
I am glad that hon. Members on both sides are not going to press the matter to a Division. If these Regulations were annulled, we would be deprived of the opportunity of relieving a considerable number of people who are not otherwise exempted from paying prescription charges of a financial burden when they are sick. We are all aware of our constituency problems. I know of several people who need four, five, or even six prescriptions, and who, but for the newly introduced season ticket, would be paying 10s., 12s. 6d. or even more a week. It is essential that we find a means of relieving these people of paying heavily for essential health requirements, and I think that we should be grateful to my right hon. Friend the former Minister of Health for having devised a system, to which these Regulations give effect, which involves patients in an outlay of less than 1s. 6d. a week. This will be a tremendous advantage to them.

§ Mr. Ennals
I have only a short time in which to reply. I shall give way later. I want to deal with many of the questions which have been put to me.
As many of my hon. Friends have said, the Government would have preferred not to reintroduce prescription charges. I do not think anyone could have envied my right hon. Friend's task when he introduced them, but can any hon. Member imagine that we could be forging ahead with the hospital building programme—

§ Mr. Leadbitter
On a point of order. All night Mr. Speaker has kept hon. Members to the Regulations. We do not want to hear about the hospitals. Get on with the Regulations.

§ Mr. Ennals
I shall respect Mr. Speaker's Ruling.
567 Having recognised that there had to be some savings, quite clearly we would have preferred—[Interruption.]—If my hon. Friends want me to answer the points which have been raised, they must let me get on.
Having accepted the necessity for this the Government would have preferred to be able totally to exempt the chronic sick. The hon. Member for Cheadle said that a promise had been made by the Prime Minister. What the Prime Minister said in his statement was not an undertaking to exempt the chronic sick; he said that the Minister would open negotiations with the medical profession with a view to introducing a system of exemptions. As is known, there were genuine difficulties and, as my right hon. Friend explained in the debate in May, doctors were unwilling to differentiate between individual patients because they feared that this would harm the doctor-patient relationship.
As a result of lengthy discussions with the doctors' representatives the limited list of medical conditions specified in the Regulations was drawn up, the intention being that sufferers from them would be entitled to exemption. This list was the maximum on which agreement was possible. But we must recognise—and many of my hon. Friends seem not to have done so—that the exemptions are already extremely wide. There is no need for payment by children under the age of 15 or people over the age of 65, those with an executive council exemption certificate issued to expectant and nursing mothers—

§ Mr. Lubbock
On a point of order. Several times when other hon. Members were speaking Mr. Speaker pulled them up and said that they were not entitled to discuss previous Regulations or prescription charges. The hon. Member must come back to these Regulations.

§ Mr. Deputy Speaker (Mr. Harry Gourlay)
I fully appreciate the point made by Mr. Speaker in his Rulings. I am watching the Minister very carefully.

§ Mr. Ennals
I am grateful to you, Mr. Deputy Speaker. It is essential that we should explain why we are introducing these Regulations.
568 We already have a wide range of exemptions. In the first six weeks of the introduction of the charge, 49 per cent. of those obtaining prescriptions were exempted from payment. Subsequently another 2 per cent. gained repayments, so exempting altogether 51 per cent. But this still left a number of people needing frequent prescriptions who were not exempted, especially the chronic sick, about which so much concern has been expressed. It is fair to say that a high proportion of the chronic sick are over 65 and are already included in existing exemptions.
We had to look for another means of identifying those who would need prescriptions and for whom it would have been unfair to pay the total charges. If the doctors could not identify them, the only other group who could do so were the patients themselves. Most patients suffering from a chronic condition will know only too well how frequently they need prescriptions. A person came to me in my constituency and listed six items that he needed every week. He knows precisely what he needs.
There will be a tremendous saving from this scheme. One hon. Member mentioned that there would be a saving of £5, but in many cases there will be more saving that £5. Without this prepayment system those constantly on medicaments of one sort or another would have to bear a very heavy burden.

§ Mr. John P. Mackintosh (Berwick and East Lothian)
Will my hon. Friend make clear now or at some point exactly how much money the Government will save as a result of this scheme, or the cost of its administration?

§ Mr. Ennals
The cost of administration both of this prepayment scheme and also of other exemptions to which reference has been made have been taken into consideration in the saving of roughly £25 million that we expect to make in a full year. There have been certain additional costs. The whole system of exemptions of one sort and another, including the prepayment system, will cost roughly £1 million, of which part is accounted for by publicity to initiate the scheme, so that people can understand how to proceed.
569 I want now to answer some further questions about how they do proceed. Anyone who considers it worth while may apply to the National Health Service executive council for one of these certificates. There is no list of those who may apply: anyone who thinks that it would be an advantage may do so. There are two certificates—one valid for six months, costing 30s. and one for 12 months, costing 55s. It would therefore be worth while for any patient to buy either one of these if he would not be eligible for exemption or refund and if he required more than 12 items to be prescribed over six months. He would thus limit his expenditure for prescriptions to an average of less than 1s. 3d. a week. The 12 months' certificate will suit especially people with a long-term chronic condition. Those with chronic bronchitis may, perhaps because it occurs at a particular time of year, want a six months' certificate rather than a 12 months' one.
But the doctor of course will give advice. He will help the patient to decide according to the nature of his condition. The certificates will be issued very quickly, and once he has received his certificate, all that the holder has to do to secure exemption from prescription charges is to complete the declaration on the rear of the prescription form. We have introduced, from 1st November, a new form which is much simpler than the old. There was roughly four or five weeks' stock of the old form, but there have undoubtedly been criticisms of its complexity, and many people will welcome the fact that the new form is much clearer. The Regulations require that, after 30th November, chemists will refuse to dispense prescriptions on the old forms, partly to prevent their fraudulent use.
My hon. Friend the Member for Falmouth (Dr. John Dunwoody) mentioned another part of the Regulations, which provides for the issue of exemption certificates to Service disablement pensioners in respect of treatment of disablement attributable to service between the two wars. This puts them in the same position as those whose disablement occurred during either war and makes it easier for them.
570 My hon. Friend also asked about the industrially disabled. I will look into this to see whether anything can be done and will write to or discuss the matter with my hon. Friend.

§ Mr. Ennals
I only have two minutes left. A number of questions have been put and it is only right that I should try to answer them.
I was asked how many people this would apply to. This is very difficult to estimate. There are probably hundreds of thousands for whom this would be an advantage. It is still too early to make an estimate. One would not expect everyone to apply immediately, but often only when their particular health condition led them to do so.
I ask my hon. Friends to recognise that this has been a genuine attempt to deal with the problem of the chronic sick and that of identification and to satisfy our anxiety to see that the cost of ill health was not substantial. As to the very poor, the exemptions apply to up to roughly 50 per cent. of those requiring prescriptions, including all those on supplementary benefit, and to many at an income level higher than that rendering them eligible for supplementary benefit who, because of prescription charges, need extra assistance.
I hope that my hon. Friends will recognise the genuineness of this attempt and will do everything they can to publicise it so that much-needed relief can be provided for those who, before the Regulations were introduced, did not secure exemption.

§ Mr. Deputy Speaker
The Question is—

§ Dr. Winstanley
If I may have leave to speak again—that is, if, as the mover of the Motion, I need the leave of the House—I would say that, despite the fact that many of the questions have not been answered and that many of the answers have not changed our view on the situation, we have no wish to hold up these Regulations. I therefore beg to ask leave to withdraw the Motion.