NATIONAL HEALTH SERVICE (CHARGES FOR APPLIANCES)

HC Deb 21 July 1969 vol 787 cc1369-401

10.1 p.m.

Mr. Laurence Pavitt (Willesden, West)

I beg to move, That an humble Address be presented to Her Majesty, praying that the National Health Service (Charges for Appliances) Regulations 1959 (S.I., 1969, No. 906), dated 3rd July 1969, a copy of which was laid before this House on 8th July, be annulled. This debate arises from a proposal to raise charges for teeth and spectacles, and many of us are in a very difficult position. I am encouraged, however, by the very powerful speech made on 9th February, 1961, by one of the most honoured and respected Members who sits for one of the South Coast constituencies, who, in his concluding remarks on that occasion, said: I am glad that our party will fight these charges solidly on every possible Parliamentary occasion."—[OFFICIAL REPORT, 9th February, 1961; Vol. 634, c. 723.] I am following that advice in fighting the increase in charges on this occasion.

When one looks at what was said on and after the announcement of increased charges on 1st February, 1961, it is rather like reading the roll call of my present Front Bench colleagues and members of the Cabinet. I would remind the House that, discussing the raising of the cost of teeth and spectacles, my right hon. Friend the Prime Minister asked whether the then Minister of Health can … tell us why it is that whenever the Government get into an economic mess it is always the patients and others in greatest need who have to bear the cost? Will he also say, since the main increase in costs has been the profits of the pharmaceutical manufacturers, why he has not taken it out of them instead of out of the patients? He was followed by the then Leader of the Opposition, the late Hugh Gaitskell, who said: As the Minister's statement constitutes a major assault on the National Health Service, and as, in our view, it is desirable that it should be debated as a whole, I give notice that we shall immediately table a Motion of censure upon the Government."—[OFFICIAL REPORT, 1st February, 1961; Vol. 633, c. 992–1.] The amount of money involved is extremely small. It is rather like a speck on the moon. In a full year it will be £3.5 million, and that represents only one-fifth of one per cent. of the total amount spent by the National Health Service. In relation to all public expenditure this year, it is only one-fiftieth. I therefore submit that it is absolute poppycock to protest that this Prayer raises any question at all of the Government's credibility, or any question that a Government defeat should be a matter of major importance leading to a General Election. Nevertheless, although the amount is small—like the two men on the moon in the early hours of today—it is a small step which could lead to an infinite number of changes, and it is precisely for that reason that so many of us are this evening seeking to persuade the Government to reverse their decision.

My right hon. Friend the Member for Sowerby (Mr. Houghton) recently told us that it is not sufficient to say "Let's Go With Labour": we also have to say in which direction. It is because I am passionately concerned, both intellectually and emotionally, with the direction in which the National Health Service is going that I feel bound to fight the Order. I accept that I have no monopoly of concern, and I sincerely believe that my right hon. Friends the Secretary of State and the Patronage Secretary share my concern keenly. Nevertheless, it is right that arguments should take place and that points of view should be put forward—

Mr. Tom Driberg (Barking)

And voted on.

Mr. Pavitt

No debate in this House has ever been charged with so much mutual understanding. The way in which conversations have gone on with the Leader of the House, the Secretary of State, the Chairman of the Parliamentary Labour Party and the Chief Whip have indicated that there is no misunderstanding on this. There is a genuine difference of opinion.

When the Opposition on two occasions tried to make out that the problem was not what was being done but the way in which this was done, the debates which followed showed that this was not the case. The matter was a question of the actual policy of my right hon. Friend. I accept that the Secretary of State stood in the same position in 1951 as I do now, and said precisely the same as the backbenchers and I are seeking to say tonight; so did the Prime Minister. I submit to my right hon. Friend in all humility in the same way that I am aware that he understands my position and that of my hon. Friends who support me and I can assure him that no hon. Member is more aware of the heavy responsibilities and decisions which the person responsible for the National Health Service has to carry.

Therefore in praying against these Regulations tonight I do so with some understanding, but I think it imperative to uphold my party's record for the last 18 years. This was a Labour party policy on which we fought election after election, Labour party policy accepted in the constituencies and reaffirmed only as recently as the last Labour Party annual conference. It was stated by the then Shadow Minister of Health, Hilary Marquand, on 1st May, 1952, on behalf of the Attlee Government: when we are returned to power we shall take steps, as soon as Parliamentary opportunity permits, to bring all these charges—charges for drugs, medicines, appliances, dentures, dental treatment and spectacles—to an end."—[OFFICIAL REPORT, 1st May 1952; Vol. 499, c. 1776.] That is the pledge I am seeking to honour in the debate this evening.

The 1964 party manifesto said that we aim to restore as rapidly as possible a free health service. The 1966 manifesto confirmed Government declared policy. The then Minister of Health reaffirmed Government policy on many occasions. On 16th November, 1964, in reply to a Question by the right hon. and learned Member for Hertfordshire, East (Sir D. Walker-Smith), the former Minister of Health said: The Labour Party said during the Election that it was our intention to restore completely a free national Health Service as rapidly as possible."—[OFFICIAL REPORT, 16th November, 1964; vol. 702, c. 27.] On 17th December, 1964, he said: There will remain the charges for dental treatment and appliances and those for spectacles. It is our aim to abolish these charges also."—[OFFICIAL REPORT, 17th December. 1964; vol. 704, c. 581.] On 31st May, 1965, the hon. Member for Croydon, North-East (Mr. Weatherill) asked the Minister of Health: in view of the need to end the present uncertainty in the dental profession and among members of the public generally about the abolition of dental charges, if he will state whether he intends to introduce legislation on the subject next Session. The Minister replied: I cannot say when I shall be able to introduce legislation, and I hope no patient will delay seeking dental treatment which he needs."—[OFFICIAL REPORT, 31st May, 1965; vol. 713, c. 1167.] I have many more quotations reaffirming the intention.

The argument has been used that because it is a peripheral matter for the Health Service the general public accept the increase in charges for teeth and spectacles. I am not quarrelling with that diagnosis, for those who are healthy are always in the majority. Those who do not need artificial teeth and spectacles are in the majority. The job of this House is not to follow national opinion polls, but to lead public opinion. At the last Labour Party conference, on a show of hands it was unanimously decided that prescription charges and teeth and spectacles charges of this nature should be abolished, and that is the voice that the Government should listen to when preparing to lay Orders of this kind.

Mr. Eric Heffer (Liverpool, Walton)

The Motion was carried unanimously.

Mr. Pavitt

At the coming party conference there will be 21 Motions submitted by constituency Labour Parties expressing this opinion, and I have had 63 letters from constituency Labour Parties and Co-operative Parties, ranging from Scotland to the West Country and from Wales to East Anglia on the subject.

Mr. Stanley Orme (Salford, West)

Does not my hon. Friend agree that at last year's Labour Party conference out of over 2,000 delegates not one hand was raised against the point he is now making?

Mr. Pavitt

This is quite right and the point of the argument. In the area of controversy I doubt very much whether my party, because it is a live, active and virile party, will ever find itself swamped in the Sea of Tranquillity, and especially in matters concerned with the Health Service. We shall always be arguing about them and debating them, and rightly so.

It is right that we should pay heed to some other opinions in addition to the type my hon. Friend has just mentioned. Tom Parker, Secretary to the National League of the Blind and Disabled, speaking on behalf of 130,000 registered blind, says this in a letter to me: Many thousands of registered blind people have a low degree of visual acuity … many of them need periodic changes of lens to compensate for changing eye condition. These increased charges may deter some of them from visiting the optician as frequently as they should", with disastrous consequences. The Association of Optical Practitioners also stresses the deterrent effect of increased charges on the whole range of the work that it does. The Socialist Medical Association Ophthalmic Group and the Socialist Medical Association Dental Group point to a number of other problems that arise.

Many of us fought for years to try to stop children at school being called "Four Eyes" because they had the misfortune to wear spectacles. One of the great things that the National Health Service has done has been to make the wearing of glasses, even by children, socially acceptable. We were able to avoid children being second-class citizens with steel rims; after the age of 10 we were able to give them the kind of glasses which made them comparable and which had some cosmetic effect.

The Regulations put the clock back in that regard, because the evidence I have is that not only children of 10 upwards but children from seven to 10 find themselves in the situation that, if their parents cannot afford to have the kind of frames that most of us are wearing in the House, there tend to become established two classes of children—those that have posh frames and those that have the N.H.S. second-class frames. My party never intended this when it brought forward these Regulations.

I accept the fact that these are small minorities out of a population of 53 million, but I am certain that it was never the intention of my Government to tax the blind or to harass or make life difficult for children while still at school.

As to the economic necessity of these charges, I repeat what I have said in the House recently. We must ask the question—can the nation afford it? I quote the leader in The Guardian of a few days ago on this subject: What exactly is meant by the claim that we cannot afford a 'free' health service or 'free" spectacles and teeth?

Mr. Speaker

We are not debating a free Health Service. We are debating certain increased charges.

Hon. Members

Oh.

Mr. Pavitt

rose—

Mr. Speaker

Order. Noise does not affect Mr. Speaker.

Mr. John Mendelson (Penistone)

On a point or order. Surely a leading article in a national newspaper written on this particular occasion referring to these Regulations must be quotable in this debate?

Mr. Speaker

Order. What leading articles in newspapers do has nothing to do with the order of the House. We are debating certain increases in certain charges.

Mr. Pavitt

I bow to your Ruling, Sir, and cannot quote the very persuasive articles arguing why the increases in teeth and spectacles brought about in these Regulations should not go through; nor can I follow through the other ways in which my right hon. Friend would have an alternative to these Regulations which were included in The Guardian leader. I submit to my right hon. Friend that, apart from what The Guardian has said, there are other alternatives, if he wishes to raise this amount, to raising it on teeth and spectacles. I will not, because I fear that I might be treading on the edges of order, outline a whole list of ways in which it would be possible for my right hon. Friend to avoid laying these Regulations by doing other things in, other places.

If we accept the principle that these things should be free at time of need, my right hon. Friend might well ask—why pray against the increased charges for teeth and spectacles when there are so many areas in which we do accept that there ought to be charges for health and welfare? There is the question of home helps and the way in which we care for the aged. This party has always stood for a complete acceptance of community responsibility so far as it can. At one time it even talked of housing as a social service. I submit, therefore, that if, in the provision of teeth and spectacles, we reach a certain area in the extension of this principle, it is wrong to go backwards to cede territory which we have already gained, merely because we have not been able to gain all the territory that we would have liked in other spheres.

This is not just party dogma. I am fighting for a whole philosophy of the Health Service in realistic, practical grounds, arising from knowledge of the matter and not just from slogans and generalisations. It has been accepted by all of us that the prevention of illness is far better than the cure. Prevention of blindness is far better than providing a white stick. These Regulations act as a deterrent to regular examinations which can have a profound effect upon maintaining the health of the individual.

Consider the way in which a brain tumour can be spotted, the early diagnosis of diabetes, early pathological changes which can be detected if a person has his eyes regularly examined. The whole balance of vision and septic sinuses. All of these conditions may arise and not be treated in time because a person does not change his glasses at the right time. Then my right hon. Friend has to find a lot of money and hospital beds to cure things which could have been prevented.

In the same way, with the increase in the charges for dentures, consider the rapid spread of periodontological diseases, the whole question of the way in which the health of the mouth affects the health of the individual, bones and gums, tumours and cysts, even cancer of the mouth. All these things, which can be prevented by early diagnosis are hit by these Regulations. Above all, there is a general deterioration of health because people who wear dentures do not go regularly enough to get changes. If people went at two-yearly intervals for an examination, the National Health Service would be saved as much as we are trying to make by these Regulations, by preventing further deterioration.

I submit that good eyes and good teeth are part of the positive concept of health—not just a question of absence of illness. This is a question of the way in which we deal with the whole body. We do not regard the National Health Ser- vice as a means of providing spare parts, rather like somebody mending a carburettor or seeing if his tyres are right. The concept of the Health Service is one of the greatest concepts which this House has put into legislation to deal with health as a whole. Health of mind and body are integrated. It is because this proposal is a step in the opposite direction that we oppose these Regulations tonight.

The fact that the Regulations have been laid is a breach of principle that teeth and spectacles should be provided free in time of need. My right hon. Friend the Member for Sowerby once said that the trouble with this party is that we have too many good principles and cannot live up to them all at the same time. That may be right, but the Lord help us if we do not at least try to live up to our principles to the best of our ability. It is important for the Labour Party to get back to the basic concept in relation to Health Service charges and those include teeth and spectacles. I urge the Government to make a clear and unequivocal statement before or at the annual party conference. This must inevitably be, on this matter as on other matters, a statement of Government policy and not just the sincere views which the Secretary of State of one Department may hold. He must carry the whole of the Government with him.

Because of the importance of this matter, I can only speak for myself; I cannot make up the minds of the 140 of my hon. Friends who supported the initial Motion that I placed before the House on this subject. They must exercise their persuasive influence to the best of their ability in the manner they think fit, as I am doing. I fully accept the consequences of my own action, and I expect none of my hon. Friends to vote in either Lobby solely to shield either me or my Government from the consequences of a vote on this Prayer. However, I believe that a solid vote would be a good insurance lest right hon. and hon. Members opposite should manage to gain power. I am certain that, at that time, it would be necessary for us to reaffirm that we did not want these charges and that there was a large body of opinion in the House which did not wish to see the process continue.

I have to keep faith with that handful of stalwarts, old and young, who have given a life time to see their principles applied, even if not yet universally, in their lifetime, at least for the sick and suffering, the halt, the blind, the lame and the deaf. So I shall vote. I have to keep faith with myself.

Mr. Speaker

It has been suggested to me that we take the two Prayers together, the second being as follows: That an humble Address be presented to Her Majesty praying that the National Health Service (Charges for Appliances) (Scotland) Regulations 1969 (S.I., 1969, No. 918) dated 7th July 1969, a copy of which was laid before this House on 8th July, be annulled. I remind the House that this debate will finish at half-past 11. I know that many hon. Members wish to speak. Reasonably brief speeches will help.

10.21 p.m.

Dr. M. P. Winstanley (Cheadle)

The whole House should be grateful to the hon. Member for Willesden (Mr. Pavitt) for giving us this third bite at a rather unpalatable cherry, and, more than that, for giving not only an opportunity to hon. Members on both sides to advance arguments against charges for the third time but, more important, an opportunity to the Government Front Bench spokesman to give an answer to those arguments for the first time.

We had no kind of argument in the previous debates on this subject. In May, 1968, when the Minister of State replied, we received no answer at all to the detailed arguments advanced about charges generally. At the second bite at the cherry in November, 1968, the Under-Secretary of State for Scotland replied to the debate but we had no real answer from him. Then, a fortnight ago, when we had a Motion of censure, the Secretary of State, although he gave an answer, perhaps, to certain charges of another kind which had been levelled, gave no answer on the particular matter of these health charges.

I shall not detain the House for long. I had an opportunity to express my views fully on previous occasions. I wish that it were in order merely to give the column numbers so that hon. Members could look at them again. The belief which my hon. and right hon. Friends and I on this bench hold with regard to the financing of the Health Service has been made clear over and over again. We believe that it should be perfectly possible, with proper organisation and administration, and provided that one avoids extravagance, duplication and overlapping, to provide an efficient effective, comprehensive and humane Health Service—I see the Minister nodding and muttering that he has heard it before. So he has, but he did not answer it. I am saying that it is perfectly possible to provide an entirely free service without the need for charges—

Mr. Speaker

Order. We cannot discuss the Health Service generally on this Motion. We are discussing whether certain charges should be increased.

Dr. Winstanley

The answer to that question, Mr. Speaker, is what we are waiting for. We have been waiting for a long time to know the purpose of these charges. Are they to finance the Health Service or are they to do something else of which we have not been told? It may be said that these increased charges for teeth and spectacles are needed merely to raise money for State funds. The raising of £3½ million by this method makes perfectly clear that that cannot be the whole purpose. It cannot be the purpose behind the Government's doing something for which they could not get a single vote at the Labour Party conference last year. If they are now doing something for which they could not get a single vote, they must have a good reason and it cannot be merely that we cannot do without the £3½ million which these charges will raise.

Second, they may say that the purpose of this increase is to make some attack on purchasing power at home. I am prepared to accept the arguments for reducing or curtailing purchasing power, but if that is done, it must surely be on a general basis and not merely to curtail the purchasing power of the dentureless or the myopic or some very limited group like this. Why pick on these two groups to bear an increase at this moment?

I cannot think what the increase is for, and I hope that enough time will be left for the Secretary of State to say what it is for, because we have not heard; we did not hear in the two previous debates about prescription charges and we have not heard about these charges.

If one cannot see an obvious reason—I cannot, at the moment—one must ask. what are the possible ill-effects. There will definitely be ill-effects from these increases. I have argued that there will be ill-effects from prescription charges but the ill-effects of these increases could be even greater. It has been argued, for example, about prescription charges that the justification was that this could encourage people to make more economic use of the service, that it could discourage extravagant and frivolous use of the Health Service. But people do not wear spectacles for frivolous purposes: they wear them because they cannot see. People do not wear false teeth for extravagant reasons: they wear them because they cannot eat.

So one cannot argue that the effect—the right hon. Gentleman is looking sceptical, but, over and over again in our discussions on these matters, the defence which has been advanced by some, mainly on this side, for introducing charges is that the presence of a charge would act as a disincentive to those who might otherwise use the service frivolously or extravagantly, that it would encourage people to realise its real value. I do not believe that that argument will operate in regard to these charges.

Both teeth and spectacles are things which people can do without. They are not like drugs urgently required for some serious illness, which they cannot do without. People can understand them and can make a judgment of their own. On many occasions, both in industrial medicine and in general practice, I have seen people doing without spectacles or teeth because of the existing charges. I have often had the responsibility of persuading people in industry to get spectacles because they cannot see properly to do a job. I have had to take them off a certain job, perhaps crane driving, and put them on another, perhaps sweeping up, until they had their spectacles. The argument has been, "I cannot afford my spectacles yet; I will get them later". That kind of postponement is likely to occur more frequently with teeth and spectacles than it is with drugs.

Much illness which is blamed on other causes—digestive ailments and so on—is due to bad teeth. Doctors have constant difficulty in persuading people to have their teeth attended to, because people say. "I cannot afford it yet: I will get my teeth done after my holidays." Whatever reason the right hon. Gentleman may have concealed so far, he may have some reason for these charges, but if he does not have one, the charges will have ill-effects.

It seems that for a purpose, for which we have had no reason yet, purely to produce some limited amount of money for State funds or purely to make a marginal and minimal attack on purchasing power at home, the Government intend, quite arbitrarily and unnecessarily, to introduce new Regulations which will cause some suffering, considerable inconvenience and possibly will have marginal effects on production by discouraging people from doing sensible things, and they will have no good effect at all.

I thank the hon. Member for Willesden, West, not for providing me with an opportunity to speak, but for enabling the Secretary of State to tell us what on earth this extraordinary decision is about.

10.30 p.m.

Mr. Alex Eadie (Midlothian)

It is not my intention to follow my hon. Friend the Member for Willesden, West (Mr. Pavitt), who has advanced an iron-clad case for the Government having another change of mind. I think that I speak on behalf of my hon. Friends when I say that I do not enter this debate with relish but with a great deal of sadness that my Government should introduce increased charges for teeth and spectacles and back them up with financial and budgetary reasons which remain to us completely unconvincing.

I am aware of the argument which will probably be put—that we are not breaching a principle since charges are already levelled on teeth and spectacles, but I should point out that many of us who have been described as "stone age" Socialists believe that the debate gives us an opportunity of discussing the principle of the National Health Service. I do not delude myself into thinking that the service in relation to spectacles and teeth can be free since it has to be paid for somehow. As the miners used to say, everything has to come off the point of the pick. But I believe that it should be free at the time of use and that it is for the Government and Parliament to arrange the finances of the nation to ensure that this is so.

To tax the unfortunates who use the National Health Service is almost impossible to defend but I shall be grateful to hear my right hon. Friend's defence. To many of us, this proposal coming on top of increased prescription charges is the thin end of the wedge and the Government must be told that enough is enough. We are told that these increases must be made because of financial considerations. It is even suggested that people feel they are paying enough.

We should not be ashamed to tell people that we are keeping our parents and our grandparents alive longer and that payment has to be made for that success. In the past three winters, fewer older people have died. The increase in the number of retirement pensions has been about 200,000 a year since 1964 and at the end of 1968 they totalled nearly seven million.

I have here the Report for 1968 on the Health and Welfare Services in Scotland, Command 4012. It is a report of which the Government should be proud. My right hon. Friend the Secretary of State for Scotland and his team at the Scottish Office, probably the best team we have ever had there, should be proud of it. It is the most powerful testimony that could be produced in favour of the N.H.S. and should be compulsory reading for the "knockers" of the service. From a host of information I draw attention to paragraph 1.9 on page 4, which reacts: Increases in the number of cases with strabismus (squint), cataract and glaucoma all contribute to the overall increase in cases discharged from ophthalmological units. Because of better diagnostic services, more people are getting treatment and spectacles admittedly are only part of it. An increase has been recorded in this respect. Are the Government happy about the extra revenue which they may receive from this source?

I remember working in the pits as a young man. I benefited from the wisdom of the older miners, many of whom were well read. I recall saying to one miner on the eve of his retirement that he would be able to enjoy reading in his retirement—I knew his love of books. He said that he would have liked to have been able to do so, but that his eyes were "gone" for that purpose.

I tell that so that it will be understood that my hon. Friends and I will not be placated by the statement that retirement pensioners will not have to pay the increases. People need spectacles before they reach that age and not after, and anything that discourages the use of spectacles by those who need them is wrong. The argument about spectacles applies to dentures.

My right hon. Friend has a terrific responsibility on his shoulders tonight. He must think about his reply carefully. I do not try to threaten when I say that his reply will determine how many of us will go into the Division Lobby against the Government.

10.37 p.m.

Mr. Will Griffiths (Manchester, Exchange)

I was in the House of Commons on 24th April, 1951, for the Second Reading of the National Health Service Bill. A few minutes before the Minister moved the Second Reading, there was a resignation speech from the present Prime Minister, and it is relevant to our discussions this evening. He was criticising the imposition of charges and, among other things, he said: But it carries with it, in a time of rising prices, the danger—I should have said the certainty—of further erosion of the social services as year succeeds year. The principle of the free health service has been breached, and I dread to think how that breach might be widened in future yea rs."—[OFFICIAL REPORT, 24th April, 1951: Vol. 487, c. 229.] He could say that again.

He was supported by the present Secretary of State who was also in opposition to the Bill and who, on Third Reading, said: This is openly a money-raising Bill and not an extravagance-curbing Bill … that is a charge designed to make as much money as possible in the easiest possible way out of the most vulnerable section of the Health Service."—[OFFICIAL REPORT, 7th May, 1951; Vol. 487, c. 1689–90.] What the House has to consider tonight is why the Minister has done this. What is it all about?

It is a tangled story. We have heard various justifications. It has been said at one stage that savings had to be made for mental health and at another—for comprehensive schools. I believe that the truth is that suddenly the Treasury tumbled to the fact that contributions by patients were no longer the proportion of the total that they had been for many years.

For example, in 1961–62 the total cost of the general dental services was £56 million; payment by patients was £11 million. In 1968–69 the total cost of the general dental services had risen to £76 million and the payment by patients to £14 million. In 1961–62 the total cost of the ophthalmic service was £15 million, payments by patients £7 million. In 1968–69 the total cost of the ophthalmic service had risen to £23 million, and the payment by patients to £8 million. So the patient is paying proportionately less of the total than he was eight or nine years ago.

Why did the Minister do it? He must have known the feelings of the party of which he has been an adornment for so long. I know he was at the annual conference which was referred to by my hon. Friend the Member for Willesden, West (Mr. Pavitt). In a free, democratic society it is madness for him not to take account of the feelings of his Parliamentary colleagues and of the people in the party to which he belongs.

Is the expenditure on these services grossly excessive? There is no joy to the Opposition in this situation. I pay tribute to the Government in that their expenditure on the National Health Service since 1964 is the highest ever in financial terms and as a percentage of the national income. The lowest figure since 1948, expressed as a percentage of the national income, to be spent on the National Health Service was in 1954, when right hon. Gentlemen opposite were responsible. Expenditure increased gradually until 1957, and reached the highest ever, over 5 per cent. of the national income, in 1967.

Expenditure on the ophthalmic service as a percentage of the total National Health Service expenditure has been declining year by year. In 1950 it was 5.2 per cent. of total National Health Service expenditure; in 1967 it had declined to 1.4 per cent. The dental service figure of 9.9 per cent. in 1950 had declined to 5 per cent. in 1967.

Neither of these two services where the Minister has submitted to Treasury advice can be charged with consuming a disproportionate amount of the money available to the National Health Service as a whole. It will not be good enough for the Minister to ask, as did his pre- decessor, "Would you rather have hospital building or this?" That is a nonstarter, because the proportion is less.

Dr. Winstanley

Will the hon. Gentleman make it clear that the adult dental patient was already paying a substantial part of the cost of his dental treatment?

Mr. Griffiths

I quite agree; I am grateful to the hon. Gentleman for reminding me of that. May I declare my interest? I worked, when I have had the opportunity, for many years as an ophthalmic optician. I have done this partly as an insurance policy against the vagaries of the Boundary Commission, partly against the vagaries of the electorate, and partly—and this is sometimes more to the forefront of my mind—against the performance of the National Executive of the Labour Party. Based on this experience I will turn to what I regard as some possible consequences of the increase in optical charges.

I work in a busy working-class practice, and there is no doubt that these increased charges will be a deterrent. What flows from that? It is true that the examination of the patient is free; that is to say, the practitioner is paid, but the patient does not have to pay. The patient thinks, however, that it is just possible that he will have to have a pair of spectacles, and the increased charges will make him think twice about going.

That means—I do not exaggerate—that there is the possibility of a number of patients, by their non-attendance at the clinics or in the practitioners' consulting rooms, not having a potentially serious disease detected at an early and vital stage. These cases occur, and it is a matter with which hon. Members should be concerned. Then there is the diminution of visual efficiency, with all its domestic and industrial dangers.

Nobody knows better than the Secretary of State, because he was with us when we argued this before, that the effect of these charges will be that many millions of our fellow countrymen are put in a worse position than they ever were before the introduction of the National Health Service Act in 1948, because under the old National Insurance Acts there was always a proportion of people who got free appliances as a so-called additional benefit. That, also, we ought to note.

Then there is the whole business of the Labour Party and the Labour Government attempting, when they have a bad conscience, as they did over prescription charges—to their credit, in a way—to minimise the effect. So they extend the area of exemption, in a way trying to show their guilt, but they want to say, "Well, we are compassionate." They are not as ruthless as right hon. and hon. Members opposite, who would not bother about these exemptions. When one tries, however, to draw the line somewhere or to embark on the path of exemptions, one gets into an awful mess.

I say this to my right hon. Friend about the whole business of selectivity. Whatever he does to try to ameliorate the consequences of these increased charges, he will, as always in selectivity, make it worse for the poorest and the less well educated, because it is upon them that the burden of interpreting the form, with its small print, bears the most heavily.

The whole show is really not worth it. My right hon. Friend has not heard the last of this in the House of Commons tonight. We shall go on arguing about this. I enjoin my right hon. Friend to look again at what he said in years gone by with, I thought, blazing sincerity. Let him return to that path and not be suborned by the Treasury for a trivia.

10.48 p.m.

Mr. Maurice Macmillan (Farnham)

As has been said, this is the second occasion on which these increases in charges have been debated. The first was an occasion when the Opposition expressed their disapproval of the Secretary of State's contortions and the damage done to the National Health Service by the prolonged pretence that he would stick to his principles and his reluctance, in face of pressure from behind, openly to abandon them.

This debate is to enable the hon. Member for Willesden, West (Mr. Pavitt), whose sincerity I once more acknowledge, to express his disapproval and that of his hon. Friends without having to agree with the Tory Party. [Interruption.] I hope that I may be allowed to intervene in what looks like a private debate.

Hon. Members

It is nothing to do with you.

Mr. Speaker

Order. This is not a private debate.

Mr. Archie Manuel (Central Ayrshire)

We consider that it is.

Mr. Speaker

Order. Mr. Macmillan.

Mr. Macmillan

I bow to your Ruling, Mr. Speaker. This is a matter which concerns people other than hon. Members sitting below the Gangway opposite. I intervene for two reasons only, and, as I said, very briefly.

The first is to make it clear that we are not voting this evening; and second, because, as the hon. Member for Cheadle (Dr. Winstanley) said, we have not yet heard from the Under-Secretary of State, the Minister of State or the Secretary of State any attempt to relate these particular increases in charges to the whole question of charges generally, and the method and extent of their application in the Health Service, as they see it on the Government Front Bench.

We know that this chopping and changing, this vacillation, and pretence, that the cost of the National Health Service is very dear, is not so much the reason for introducing these charges for a few hundred thousand pounds only, but their general attitude, because, as the hon. Member for Manchester, Exchange (Mr. Will Griffiths) said, this Government have never had the courage of even losing their convictions. The prescription charges were delayed. Had they been kept on they would have provided £75 million extra. By introducing these increases the Secretary of State seems at last to have made up his mind.

In answer to the hon. Lady the Member for Halifax (Dr. Summerskill) on 5th May—I must apologise to the House for going back so far as that, but I am unable to find any precise statement any later from the Governmeht—the Secretary of State said: I am sure that we all do hope that in due course all charges could be abolished, but I should be deceiving my hon. Friend and the House if I suggested to her that I thought a total remission of all charges had a priority as high as looking after a number of very urgent areas of the Service—including, for instance, hospitals for the subnormal."—[OFFICIAL REPORT, 5th May, 1969; Vol. 783, c. 47.] This, as far as I can see, means that these charges and increases are necessary as long as there is a serious shortage of money within the National Health Service in the eyes of the Secretary of State and the Government. In other words, this is, so to speak, a short-term requirement which is going to be indefinitely extended.

The position of the Tory Party has always been very clear. We have always believed and still believe that charges have an important part to play, together with taxation, together with the insurance contribution, in financing the National Health Service, and that is why we shall not vote against the increases today. But we shall not vote for them. For two reasons. First, it is no business of ours to help this Government get their business through. Secondly, because if we were to vote for these increases in charges we should be voting for a policy of vacillation and expediency, and for charges without any consideration for the longer-term problems.

Some hon. Gentlemen asked, why did we not tell the electorate? But we did. In 1966 it was part of our election manifesto that we would reintroduce charges. We did say that—in great contrast to the party opposite, who introduced charges for prescriptions, and now these increases, when it was part of their election manifesto that they would do no such thing.

Mrs. Anne Kerr (Rochester and Chatham)

Will the hon. Gentleman give way?

Mr. Macmillan

I wish to be brief. In the last year of the Tory Party's administering the Health Service charges amounted to a total of 5.7 per cent. of the current Government spending on the National Health Service. If they had stayed that way they would have raised another £155.5 million in the five years since. What proportion, after these increases, do the Government aim the charges should make of the total Health Service financing? Will the Secretary of State tell us that? Will he confirm or deny that the charges are here to stay for as long as the National Health Service requires more money? Will he confirm or deny that as long as they are here, he will adjust them upwards, as he has hinted, to meet rising prices? Will he confirm or deny that the upward adjustment from time to time will apply to teeth and spectacles?

Mr. Speaker

Order. We cannot discuss on these Regulations further upward adjustments.

Mr. Macmillan

In due course in this debate the Secretary of State will be very grateful for your Ruling, Mr. Speaker.

In our previous debates, he said, I shall have ample time for the substance of this debate when we come to the Regulations."—[OFFICIAL REPORT, 7th July, 1969; Vol. 786, c. 1083.] He has ample time. I hope that he will use it clearly and honestly and to the satisfaction of the House as a whole.

10.57 p.m.

Mr. W. A. Wilkins (Bristol, South)

I hope that my right hon Friend will listen to the voice of his hon. Friends rather than the voice of the Front Bench speaker from the Opposition, the hon. Member for Farnham (Mr. Maurice Macmillan).

I require only a couple of minutes to state my views on this Prayer because all my hon. Friends know quite well where I stand and have stood ever since the introduction of the National Health Service. I am opposed to the Regulations and any others which may be tabled imposing prescription charges, not so much because I do not trust my hon. Friends when they say that they will take off the charges again at the earliest opportunity as because of my great fear of what will happen if the Conservative Party ever come to power again. About 20 years ago I told the then Minister of Health, the late Aneurin Bevan, that the proposal for a Bill to enable prescription charges to be made and then a new Clause on the subject in the Act dealing with National Health Service was making a present to the Conservative Party, but I did not then think that my hon. Friends would accept that present for themselves and utilise it for themselves.

This being my last Parliament, I hope that this will be the last occasion on which I shall have to raise my voice in protest against the actions of my own Front Bench. My right hon. Friend is courting disaster if he goes on with this proposal—disaster within the party in the House and disaster among those who support us in the country. We have spoken with great pride about this Service. My rooted objection to the charges is that it is unfair to those people who pay for these services through their National Health Insurance contributions for them again to be charged at the time that they use the service. It is a National Health Insurance scheme and it should cover all needs of national health—teeth, spectacles and anything else.

My last reason for objection to the Regulations—and I shall vote against them—is that I refuse to double-cross myself, I refuse to double-cross my constituents and I refuse to double-cross the party. It is only a few years ago that the right hon. Member for Wolverhampton, South-West (Mr. Powell), then Minister of Health—my hon. Friend the Member for Manchester, Exchange (Mr. Will Griffiths) will recall it very well—introduced a Bill to increase the charges for spectacles and teeth. Our commission—we carried it out very well, I think—was to oppose that as ruthlessly as we could. I did that then, and I do not intend to go back on it. What is good for a party when it is in opposition should be equally good for it when it is the Government. I hope that either my right hon. Friend will have second thoughts or that we shall register our protest yet again, and I hope for the last time, in the Lobby.

11.0 p.m.

Mr. Archie Manuel (Central Ayrshire)

I, too, want to register my strong protest, as I have done on other occasions, both at party meetings and on the Floor of the House. This is one of those sad occasions on which events have forced themselves upon us because of mistaken views—I will not call them "principles"—and Cabinet decisions. It is a sad occasion because it belies all the beliefs held by the very best people in the Labour Party. I spent 15 years in local government and was Public Health Convenor for Ayr County. In those days we were propagating on behalf of the Labour Party the idea that when we got to power we would introduce a free Health Service. We did that.

These Regulations impose more charges on a sector of the Service which in the beginning provided free teeth and spectacles. Do not those who require spectacles from the time they are at school suffer a big enough hardship already compared with the healthier section who go through life not needing spectacles until their later years? Why should my right hon. Friends support something which will injure this group of people in this way?

I hope that all of us on this side, although some will vote for the Regulations and some will vote against, will recognise that what is being done by these Regulations is deplorable. Every hon. Member on this side during election campaigns repeatedly praised the concept of the free Health Service. Every one of them won votes by so doing. Some of them were returned simply because they praised the concept of a free Health Service. In view of that, these Regulations do something which is abominable; and I shall certainly vote against them.

11.3 p.m.

Dr. John Dunwoody (Falmouth and Camborne)

It is sad and depressing that this evening we are yet again discussing the question of increased Health Service charges. It is right, though, that we should debate and discuss these matters—not just the narrow issue before us, but the question of charges as a whole, because it is impossible for most of us to separate increased charges for spectacles and dentures from the whole question of Health Service charges—charges for the user of the Service at the time of need.

I put my name to the Prayer partly because I thought that we should continue the debate, partly because thought that we should have an opportunity to express our views, and particularly because I wanted to give the Government the opportunity to make a statement about their position on the whole question of Health Service charges. I believe that for the last year or so we have been drifting on this issue into more and more troubled waters. I want to see where we are going. Of course these charges are not the same as prescription charges.

We are discussing the raising of the existing charges by a total of some £3.5 million. Those increases will not fall, as do prescription charges, almost exclusively on those who are ill and, perhaps, out of work, but there are a number of very real reasons for objecting to them.

The first reason is the probable consequences, which have already been outlined from both sides, of making the increased charge for dentures. The second reason is the suggestion that seems insidiously to be coming in that there should be a direct relationhip between the cost of the service being provided and the charge being paid by the patient. That is even more repugnant. The third reason is that the sum involved is so very small—just a drop in the ocean. Are there not other means by which this sum of £3½ million can be raised? The fourth reason is the principle of charging. I object to that as well as to the practice, because when working as a general practitioner, before coming to the House, I have seen the result of these charges.

I cannot support any Regulations in favour of charges or their increase. I look forward to the time when we will have a Health Service which is really free. I know that we charge for some things now and that it will be a long time before we can provide them free, but I look forward to the time when home helps will be provided free for those who need them for social and medical reasons. I look forward to the time when we shall not have to worry about amenity bed charges because the standards in our hospitals will be such that there will be enough single and double bedded rooms to ensure that people will not be obliged to pay amenity bed charges.

But now is the time at least for my right hon. Friend to assert the temporary nature of these increases and of the charges we have on prescriptions. The time has come to re-examine quite urgently the whole question of the charges, because there is a lot of false thinking on the subject. I ask my right hon. Friend seriously to consider the question of anomalies. Some grave anomalies arise, for instance, because we are trying to make the best of a bad job by exempting pensioners from payment of prescription charges yet we are increasing the charges for their dentures and spectacles unless the pensioners concerned are on supplementary benefit.

Finally, we should remind my right hon. Friend and his colleagues that many of us feel very strongly that the basic principle of the National Health Service is that it should be free at the time of use. These Regulations take away from that basic principle. Our aim and our object must be to work for a move towards a National Health Service that is free at the time of use.

11.8 p.m.

The Secretary of State for Social Services (Mr. Richard Crossman)

In answering this debate, I must pay a tribute to the Opposition for the courtesy of their presence, and the distinguished way in which the hon. Gentleman the Member for Farnham (Mr. Maurice Macmillan) explained why discretion on this occasion was the better part of valour in the Division Lobbies. Apart from saying that, I intend to confine my remarks to this side of the Chamber, because this is where the serious debate has occurred.

I divide my speech into two parts: the first dealing with the detailed points raised on the Regulations increasing the charges for spectacle lenses and dentures; the second considering the increases in relation to charges in general and the idea of the free National Health Service, because I am well aware that a number of hon. Members expect this of the Government, and have a right to expect it.

Before going into the details, I want to deal with an impression which several hon. Members seem to have about the Regulations, and which was expressly mentioned by my hon. Friend the Member for Willesden, West (Mr. Pavitt). It is that even though this Statutory Instrument is directly concerned only with £3½ million, which is insignificant in relation to total Health Service expenditure, nevertheless it is significant, despite its insignificance, because it is, as I think the hon. Member for Midlothian (Mr. Eadie) put it, the thin edge of the wedge.

My hon. Friend the Member for Willesden, West said that it was a small step which could lead to an infinite number of changes which could later alter the whole direction of the National Health Service and undermine its whole philosophy. Someone suggested that it provided evidence of the Government's conversion to the principle of the use of charges for financing the Service. All these impressions are without any foundation whatever. [An HON. MEMBER: "Why?"] I will explain why and use my time to tell the House if hon. Members will listen.

There is no justification for this view. My hon. Friend the Member for Manchester, Exchange (Mr. Will Griffiths) was completely accurate in his description. So also was my hon. Friend the Member for Falmouth and Camborne (Dr. John Dunwoody). This is an increase in charge which is an adjustment of charge to cost and follows naturally on the increase in the charge for pay and amenity beds which was made earlier this year and the 50 per cent. increase in the maximum charge for dental treatment which was made last year against which the Prayer was withdrawn without a Division. There was no indication of a change. This was simply an increase of that particular kind. I was grateful to my hon. Friend the Member for Falmouth and Camborne for making that clear.

I will deal with the detailed points first. My hon. Friend the Member for Manchester, Exchange, who I usually think is fair and well-informed, was not quite fair about the arrangements for exemption from these charges. The arrangements are very fair indeed and have been working for some years. Taking first the charges in connection with children, I should have thought they have worked well and they are certainly a great deal more generous than in the case of prescription charges. I remind hon. Members that both for dentures and for spectacles we exempt not merely children up to the age of 15 but all children under 16 and, beyond that, all those who are receiving full-time school education, with dental treatment up to 21. Anyone who would suffer hardship through paying the charges can secure a refund, and there is a voucher scheme the effect of which is that anyone who cannot afford to pay and then obtain a refund can be exempted altogether; that is—[Interruption.] Hon. Members have asked about the detail of the charges and I must deal with the questions in order.

Mrs. Anne Kerr

Will my right hon. Friend give way?

Mr. Crossman

I have many questions to answer—

Mrs. Kerr

A free Health Service—

Mr. Speaker

Order. If the right hon. Gentleman does not give way, the hon. Lady must resume her seat.

Mr. Crossman

I think my hon. Friend the Member for Rochester and Chatham (Mrs. Anne Kerr) is a little unreasonable. I have to deal with a great many points. About half the speeches dealt in detail with what hon. Members thought wrong with the charges. I will deal with the principle second.

I had one complaint which I take very seriously. It was a letter from the children's officer of Oxfordshire County Council. In the letter, which I received today, she pointed out that one of the problems about exemptions from the charges and the voucher scheme is the failure of people to realise their rights. [Interruption.] It is important that note should be taken of this. I hope that my hon. Friends will help in making people realise—my hon. Friend the Member for Holborn and St. Pancras, South (Mrs. Lena Jeger) shakes her head. She is not interested in this?

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

I am interested only in the Labour Party, for which I have worked all my life to support, standing by its election pledge.

Mr. Crossman

There was no election pledge, I remind my hon. Friend, about the charge for teeth and spectacles, it was on prescriptions only. [Interruption.]

Mr. Speaker

Order. I must protect the right hon. Gentleman. [HON. MEMBERS: "Why?"] Order. I must protect the right hon. Gentleman from his hon. Friends.

Mr. Crossman

With great respect, I am embarrassed by any protection you give me, Mr. Speaker. I would much rather get on without your protection.

My hon. Friend the Member for Manchester, Exchange, suggested that the increased charges would deter patients from securing glasses and dentures which they should have. There is a good deal of evidence about this and, on the basis of experience when the charges were last increased in 1961, I frankly believe that my hon. Friend exaggerated what is likely to happen—[Interruption.] On that occasion the increase in the charges for spectacles was followed by a temporary dip in the number of glasses provided under the Health Service, but it was a small dip and a short-lived one. Indeed, by 1964 the number of glasses provided was greater than in 1960.

Experience with dentures was much the same, though here interpretation of the figures is complicated by the increasing emphasis which has, for the last 20 years, been laid on conservation treatment. The effect of this is that dentists are spending more time on fillings and less on extractions and the provision of dentures. Even so, the number of dentures supplied changed very little in 1961 and the immediately succeeding years and I see no reason to suppose that the increased charges had any significant effect on demand. I do not think that the effect of the present increases is likely to be any greater than in 1961 and I do not, in general, expect people to be deterred from securing spectacles or dentures which they should have.

That concludes my remarks about the details of the charges. I will now present the increased charges for teeth and spectacles against the background of the Government's views about the part which charges can and should play in financing the Health Service. First, I will define—I may reach agreement with my hon. Friends on this—[An HON. MEMBER: "I doubt it."]—the principle on which the Health Service is based. It is that it should be paid for by the healthy and be free to the sick. More precisely, people should pay when they are at work and earning rather than when they are sick and not earning.

Before the Health Service began people often had to pay the doctor's bill when they were sick, resulting in anxiety and hardship. One may ask—we asked it and debated it in the debate on the financing of the Health Service on a day recently provided by the Opposition—if the healthy are to pay, why not rely on the insurance principle? The answer is clear. It is that a service which covers everybody, not only insured workers but every citizen, and which is paid for by the healthy is only possible if it is financed mainly through taxation. There is a rôle for contributions as well, and a minor rôle, at best, for charges—[Interruption.]—which, I have pointed out, cover about 5 per cent. of the cost.

This brings me back to the principle. Since 1948 the principle has been applied flexibly and humanely. We must remember, if we are discussing the principle, that from the start there have always been charges in the Health Service and that nobody objected to them.

Mrs. Lena Jeger

Rubbish.

Hon. Members

Be honest.

Mr. Crossman

As I was saying—[Interruption].

Several Hon. Members

rose—

Mr. Speaker

Order.

Mr. Crossman

The charges for pay beds and amenity beds, for example, have been there since 1948 and no one has objected. In the local authority services also there have been a number of charges, some of them permissive and some mandatory. The charges for home helps, day nurseries and nursing equipment are examples of permissive charges made by local authorities in the Health Service. The local authority has power to levy them, but is not mandated to do so.

On the other hand, the charge for a place in an old people's home is mandatory. The local authority is not permitted to provide this service free. Either one pays or part of one's supplementary benefit is taken. I do not want tonight to discuss the merit of local authority charges, which seem to me to be based on no very clear principle.

Our concern is with the Health Service charges, in particular with those on teeth and spectacles, but it is noteworthy that the charge which has aroused most opposition is not that on teeth and spectacles, but on prescriptions, precisely because it is that which is in breach of the general principle I have just discussed.

The Government therefore took the abolition of prescription charges as their first priority when they came to power and the abolition of charges for teeth and spectacles was regarded, quite rightly in my view, as a matter of less urgency, and was left over until economic circumstances were more favourable.

I come to devaluation. The Prime Minister made perfectly clear that prescription charges were being reintroduced with great reluctance and my predecessor explained that he regarded prescription charges as a lesser evil than a cut in the hospital building programme. I share his view that the abolition of charges for teeth and spectacles was less urgent than abolition of prescription charges.

Mr. Driberg

Does my right hon. Friend recall the name of a person called Aneurin Bevan, whose friend he once pretended to be? Would he have dared to address this thin pragmatical argument to that great man?

Hon. Members

Hear, hear.

Mr. Crossman

We had many arguments about things and we each expressed many things to each other.

What has happened since 1968? While the new arrangements for exemptions from prescription charges were being worked out, my hon. Friend the Member for Willesden, West had a discussion with my right hon. Friend the Prime Minister. Following that talk, my right hon. Friend wrote to my hon. Friend to give a considered expression of the Government view—and it was a collective view—which dealt with the questions raised by my hon. Friend the Member for Falmouth and Camborne. My right hon. Friend said: It would be wrong for you to assume that these charges reluctantly introduced to meet a serious economic situation, carry the implication of a permanent change of the Government's policy or of its approach to health service financing. When the economic situation improves sufficiently for substantial extra sums (beyond normal annual growth) to be made available to the National Health Service they would, of course, be allocated according to the priorities determined by the Minister and the Government at that time. Clearly, however, any Labour Government will take proper cognisance of the party's declaration and priorities. My hon. Friend asked me whether there had been any changes in that policy since the letter, and whether anything has happened to undermine our determination to get back to a free Health Service. Had anything happened to change the view that prescription charges should go first and those on teeth and spectacles later?

There have been no changes. Rather the reverse, for when my right hon. Friend's letter was written we did not know that because of the objections from the medical profession, we were not going to be able to exempt the chronic sick from prescription charges to the extent we had hoped.

Hon. Members

We told you so.

Mr. Crossman

Nor the difficulties the exemption arrangements would make.

I certainly do not underrate the £25 million a year which it would cost to abolish prescription charges, but the experience of the last two years has not led me to regard the reintroduction of prescription charges as representing, in my right hon. Friend's words: a permanent change of the Government's policy or of its approach to health service financing. It is in this perspective that the House should look at the Regulations, knowing that it does not affect the. Government's attitude to prescription charges one iota.

I believe that to dispense with the charges for dental and optical services must rate a good deal lower priority than getting rid of prescription charges. A person who needs dental or optical services is not normally ill in the usual sense of the word—

Mrs. Anne Kerr

He just cannot see.

Mr. Crossman

—nor in most cases is he prevented by his condition from going to work. We have made special provision through exemption arrangement for priority classes which have worked for years extremely well. That perhaps is partly why these particular charges have been accepted by the public with comparatively little resentment.

Dr. Winstanley

Will the right hon. Gentleman take his glasses off?

Mr. Crossman

Moreover, their yield of £25 million a year, which we felt we could not spare when we abolished prescription charges years ago, we certainly cannot afford to give up today.

Let me, therefore, sum up as temperately as I can the case that I am putting to the House. [Interruption.]

Mr. Speaker

Order. Noise and interruption are not argument.

Mr. Crossman

There is no justification whatsoever for the allegation that the decision to bring back the level of these charges into relation with cost has any effect on the Government's attitude to charges in principle. That remains the same as when the Prime Minister wrote his letter to my hon. Friend in March of last year. In fact, this increase is consequential on the 50 per cent. increase in dentistry charges introduced last year without a Division on the Order.

Secondly, as members of the Government, we share the objection to charges which violate the essential principle that the healthy who can work should pay for the Health Service and the sick who cannot should not. That is why we were so reluctant to reintroduce prescription charges after devaluation. That is why the Prime Minister gave the assurances he did to my hon. Friend.

Finally, in judging these priorities, the abolition of the charges on teeth and spectacles does not and should not rank nearly as high as the abolition of prescription charges.

It is against this background that I ask the House to approve tonight Regulations which sanction not a new charge or the restoration of an old charge but quite simply the modification of an existing

charge so as to bring it into proper relation with costs.

Mr. Douglas Jay (Battersea, North)

Does my right hon. Friend appreciate that if he cannot advance any better arguments than that, he will induce quite a number of hon. Members to abstain from voting in the Division who might otherwise have supported the Government if any rational arguments had been advanced?

Question put, That an humble Address be prescented to Her Majesty, praying that the National Health Service (Charges for Appliances) Regulations 1969 (S.I., 1969, No. 906), dated 3rd July 1969, a copy of which was laid before this House on 8th July, be annulled.

The House divided: Ayes 59, Noes 199.

Division No. 340.]	AYES	[11.29 p.m.
Allaun, Frank (Salford, E.)	Gregory, Arnold	Newens, Stan
Alldritt, Walter	Griffiths, Eddie (Brightside)	Norwood, Christopher
Ashton, Joe (Bassetlaw)	Griffiths, Will (Exchange)	Orbach, Maurice
Atkins, Ronald (Preston, N.)	Grimond, Rt. Hn. J.	Orme, Stanley
Atkinson, Norman (Tottenham)	Heffer, Eric S.	Park, Trevor
Beaney, Alan	Hooley, Frank	Parkyn, Brian (Bedford)
Bidwell, Sydney	Jeger, Mrs. Lena (H'b'n&St.P'cras,S.)	Perry, George H. (Nottingham, S.)
Booth, Albert	Jenkins, Hugh (Putney)	Roberts, Gwilym (Bedfordshire, S.)
Butler, Herbert (Hackney, C.)	Kerr, Mrs. Anne (R'ter & Chatham)	Rowlands, E.
Carter-Jones, Lewis	Kerr, Dr. David (W'worth, Central)	Ryan, John
Delargy, Hugh	Kerr, Russell (Feltham)	Shaw, Arnold (Ilford, S.)
Dickens, James	Lee, John (Reading)	Silverman, Julius
Dobson, Ray	Lewis, Arthur (W. Ham, N.)	Steel, David (Roxburgh)
Driberg, Tom	Lubbock, Eric	Thorpe, Rt. Hn. Jeremy
Dunn, James A.	Mackenzie, Alasdair(Ross&Crom'ty)	Wilkins, W. A.
Dunwoody, Dr. John (F'th & C'b'e)	Mahon, Peter (Preston, S.)	Winstanley, Dr. M. P.
Ellis, John	Mahon, Simon (Bootle)	Woof, Robert
Fletcher, Ted (Darlington)	Manuel, Archie
Foot, Rt. Hn. Sir Dingle (Ipswich)	Mendelson, John	TELLERS FOR THE AYES:
Foot, Michael (Ebbw Vale)	Mikardo, Ian	Mr. Laurence Pavitt and
Garrett, W. E.	Molloy, William	Mr. Ted Leadbitter
NOES
Abse, Leo	Crawshaw, Richard	Fowler, Gerry
Albu, Austen	Cronin, John	Fraser, John (Norwood)
Anderson, Donald	Crosland, Rt. Hn. Anthony	Freeson, Reginald
Bacon, Rt. Hn. Alice	Crossman, Rt. Hn. Richard	Ginsburg, David
Bagier, Gordon A. T.	Dalyell, Tam	Gordon Walker, Rt. Hn. P. C.
Bence, Cyril	Davidson, Arthur (Accrington)	Gray, Dr. Hugh (Yarmouth)
Benn, Rt. Hn. Anthony Wedgwood	Davies, Ednyted Hudson (Conway)	Grey, Charles (Durham)
Binns, John	Davies, G. Elfed (Rhondda, E.)	Gunter, Rt. Hn. R. J.
Bishop, E. S.	Davies, Dr. Ernest (Stretford)	Harming, William
Blackburn, F.	Davies, Rt. Hn. Harold (Leek)	Hannan, William
Boardman, H. (Leigh)	Davies, Ifor (Gower)	Harrison, Walter (Wakefield)
Boston, Terence	de Freitas, Rt. Hn. Sir Geoffrey	Hart, Rt. Hn. Judith
Bottomley, Rt. Hn. Arthur	Dell, Edmund	Haseldine, Norman
Boyden, James	Dewar, Donald	Hatterslev, Roy
Bradley, Tom	Diamond, Rt. Hn. John	Hazell, Bert
Bray, Dr. Jeremy	Dunnett, Jack	Healey, Rt. Hn. Denis
Brooks, Edwin	Dunwoody, Mrs. Gwyneth (Exeter)	Hilton, W. S.
Broughton, Sir Alfred	Edwards, William (Merioneth)	Houghton, Rt. Hn. Douglas
Brown, Bob(N'c'tle-upon-Tyne, W.)	Ennals, David	Howarth, Harry (Wellingborough)
Brown, R. W. (Shoreditch & F'bury)	Ensor, David	Howarth, Robert (Bolton, E.)
Buchan, Norman	Evans, Albert (Islington, S.W.)	Howell, Denis (Small Heath)
Callaghan, Rt. Hn. James	Evans, loan L. (Birm'h'm, Yardley)	Howie, W.
Cant, R. B.	Fernyhough, E.	Hoy, Rt. Hn. James
Carmichael, Neil	Finch, Harold	Hughes, Rt. Hn. Cledwyn (Anglesey)
Castle, Rt. Hn. Barbara	Fitch, Alan (Wigan)	Hughes, Hector (Aberdeen, N.)
Coleman, Donald	Fletcher,Rt.Hn.SirEric (Islington,E.)	Irvine, Sir Arthur (Edge Hill)
Concannon, J. D.	Foley, Maurice	Jackson, Colin (B'h'se & Spenb'gh)
Conlan, Bernard	Ford, Ben	Janner, Sir Barnett
	Forrester, John	Jeger, George (Goole)
Jenkins, Rt. Hn. Roy (Stechford)	Morgan, Elystan (Cardiganshire)	Skeffington, Arthur
Johnson, Carol (Lewisham, S.)	Morris, Alfred (Wythenshawe)	Slater, Joseph
Johnson, James (K'ston-on-Hull, W.)	Morris, Charles R. (Openshaw)	Small, William
Jones, Dan (Burnley)	Morris, John (Aberavon)	Snow, Julian
Jones, Rt. Hn. Sir Elwyn(W. Ham, S.)	Moyle, Roland	Stewart, Rt. Hn, Michael
Jones, J. Idwal (Wrexham)	Mulley, Rt. Hn. Frederick	Stonehouse, Rt. Hn. John
Jones, T. Alec (Rhondda, West)	Murray, Albert	Strauss, Rt. Hn. G. R.
Kenyon, Clifford	Neal, Harold	Symonds, J. B.
Lawson, George	Oakes, Gordon	Taverne, Dick
Ledger, Ron	O'Malley, Brian	Thomas, Rt. Hn, George
Lee, Rt. Hn. Frederick (Newton)	Oram, Albert E.	Thomson, Rt. Hn. George
Lever, Rt. Hn. Harold (Cheetham)	Oswald, Thomas	Thornton, Ernest
Lipton, Marcus	Owen, Dr. David (Plymouth, S'tn)	Tinn, James
Loughlin, Charles	Page, Derek (King's Lynn)	Tomney, Frank
Luard, Evan	Pannell, Rt. Hn. Charles	Urwin, T. W.
Lyon, Alexander W. (York)	Pearson, Arthur (Pontypridd)	Varley, Eric G.
Mabon, Or. J. Dickson	Peart, Rt. Hn. Fred	Wainwright, Edwin (Dearne Valley)
McBride, Neil	Pentland, Norman	Walden, Brian (All Saints)
McCann, John	Perry, Ernest G. (Battersea, S.)	Walker, Harold (Doncaster)
MacColl, James	Prentice, Rt. Hn. Reg	Wallace, George
MacDermot, Niall	Price, Christopher (Perry Barr)	Watkins, David (Consett)
McGuire, Michael	Price, Thomas (Westhoughton)	Weitzman, David
Mackenzie Gregor (Rutherglen)	Probert, Arthur	Wellbeloved, James
Mackie, John	Randall, Harry	Wells, William (Walsall, N.)
Mackintosh, John P.	Rankin, John	White, Mrs. Eirene
Maclennan, Robert	Rees, Merlyn	Whitlock, William
McMillan, Tom (Glasgow, C.)	Rhodes, Geoffrey	Williams, Alan (Swansea, W.)
McNamara, J. Kevin	Richard, Ivor	Williams, Alan Lee (Hornchurch)
Mallalieu, E. L. (Brigg)	Roberts, Albert (Normanton)	Williams, Clifford (Abertillery)
Mallalieu,J.P.W.(Huddersfield,E.)	Robinson, Rt.Hn.Kenneth(St.P'c'as)	Williams, Mrs. Shirley (Hitchin)
Marks, Kenneth	Rodgers, William (Stockton)	Willis, Rt. Hn. George
Marquand, David	Roebuck, Roy	Wilson, Rt. Hn. Harold (Huyton)
Marsh, Rt. Hn. Richard	Rogers, George (Kensington, N.)	Wilson, William (Coventry, S.)
Mason, Rt. Hn. Roy	Rose, Paul	Woodburn, Rt. Hn. A.
Mellish, Rt. Hn. Robert	Ross, Rt. Hn. William	Wyatt, Woodrow
Millan, Bruce	Shore, Rt. Hn. Peter (Stepney)
Miller, Dr. M. S.	Short, Rt.Hn. Edward (N'c'tle-u-Tyne)	TELLERS FOR THE NOES:
Mitchell, R. C. (S'th'pton, Test)	Silkin, Rt. Hn. John (Deptford)	Mr. Joseph Harper and
Moonman, Eric	Silkin, Hn. S. C, (Dulwich)	Mr. Ernest Armstrong