§ The Secretary of State for Social Services (Mr. Richard Crossman)With your permission, Mr. Speaker, and that of the House, I should like to make a statement on charges for lenses and dentures.
I propose shortly to lay before the House regulations increasing by about 25 per cent. the charges payable by patients in England and Wales for dentures and spectacle lenses supplied under the National Health Service. Similar increases will be made in Scotland.
These increases, which are broadly in line with movements in cost since the charges were last adjusted in 1961, will help to keep total public expenditure within the limits set out in the White 43 Paper "Public Expenditure 1968–1969 to 1970–1971"—Cmnd. 3936.
The present arrangements for exemptions and refunds will continue.
§ Mr. Maurice MacmillanPerhaps the right hon. Gentleman will be good enough to satisfy the curiosity of the whole House by telling us just how near the Prime Minister got to reacting to this statement of increased charges in the same way as he reacted to the original imposition of charges.
I should like to ask the right hon. Gentleman four questions. First, what relation do the new charges, compared with the original charges, bear to the total cost? Perhaps, in this context, he will say something about the charges for frames. Second, can he assure the House that the arrangements for and nature of priority classes remain unchanged? Third, can he tell the House whether he expects this increase in charges to produce the same sort of switch of more treatment in priority classes that the original imposition achieved? Fourth, in view of his denial on 14th April of any increase in charges, will he tell the House when he intends next to increase prescription charges?
§ Mr. CrossmanAnswering the last question first, I must point out that the statement I then made in answer to a supplementary question was that I was not introducing further charges or increases in prescription charges. Those were the two precise statements I made.
On the question of priority, the priority classes remain completely unchanged in this arrangement.
The hon. Gentleman asked about the relation between the cost of the charges as compared with their first introduction. I would want notice of that question, but I did compare the charge with 1961, the last time the charges were introduced. Dentures will, after this change, be just under 50 per cent.: they were just over 50 per cent. then.
On average, lenses will be just a little over cost, as they were in 1961, and also, I think I am right, in 1951. So the proportion has been maintained. Indeed, the purpose of the increase is to maintain that proportion.
§ Mr. Michael FootSince many of us will be very deeply shocked by these proposals, will the Secretary of State say how much money it is estimated these charges will bring in for the Health Service? Will he take into account the fact that many of us feel that, if these charges are imposed because of a ceiling on the Health Service, that ceiling should be altered rather than that we should impose fresh charge on people who need these special facilities?
§ Mr. CrossmanThe amount we estimate in a full year is £3.5 million, and in the current year the amount will be just over £1.7 million.
My hon. Friend asked whether this change meant that there was a ceiling on the Health Service. The answer is "No". The Service has had a fairly steady increase over a period, but we have to seek in the Service, as everywhere else, the most economical management. In my view, although my hon. Friend may differ, this method of saving £3.5 million is far less damaging than would be cutting back one of the increases in the Service to which we are committed. I have no doubt that this was a lesser evil.
§ Mr. PardoeWill the right hon. Gentleman confirm that the charge for a denture will be £6 10s. when the new charges come in? Will he say how this accords with the principle that illness ought not to be financially penalised? Does he recognise that this is a very heavy poll tax on low income families and particularly old-age pensioners? Will he re-emphasise for those concerned exactly how they can get it back in supplementary benefit?
§ Mr. CrossmanThe exemptions and refunds which were there before are not, of course, affected by this increase, nor, indeed, is the principle about which he asked, whether one could get back charges for dentures and spectacles. We had the charges before; the only question is at what level should the charges be maintained in view of costs.
In reply to the hon. Member's first question, about the actual price, I think that his calculation is slightly wrong. The increase is from £5 to £6 5s., not £6 10s.
§ Mr. Will GriffithsIs my right hon. Friend aware that the dismaying statement he has made will be energetically fought inside and outside the House of 45 Commons in the weeks and months to follow? May I remind my right hon. Friend that tomorrow will be the anniversary of an occasion when he made a speech in this House opposing the first imposition of the charges. He then described them as a money-raising—
§ Mr. SpeakerOrder. No matter how tempting, there can be no quotations in supplementary questions.
§ Mr. Crossman rose—
§ Mr. Griffiths rose—
§ Mr. SpeakerThe hon. Member must complete his question without quotation. Mr. Will Griffiths.
§ Mr. GriffithsMay I therefore recommend my right hon. Friend to have a look at what he said then and to say how he can possibly equate what he is doing today with the unexceptionable sentiment he uttered on that occasion?
§ Mr. CrossmanI am not sure to which occasion my hon. Friend has referred—[HON. MEMBERS: "Oh."] I should have thought that this was not in the debate on the introduction of prescription charges but in a debate, if it occurred, on this particular question of dentures and spectacles, which have always been distinguished from prescription charges.
I have no doubt that hon. Members behind me who feel strongly will fight against this proposal. There is one thing to be remembered, however, about these charges. Although my hon. Friends may feel passionately, there is no evidence that the general public are as fiercely opposed to them.
§ Lord BalnielCan the right hon. Gentleman explain why as recently as 14th April he quite categorically said that he did not expect further charges to be imposed on the Health Service? Was that not as tricky as announcing increased National Insurance benefits and not at the same time announcing how they would be paid for?
§ Mr. CrossmanThe noble Lord will observe the question I was answering. I was asked a question about further examples of selectivity. It was clear that I was being asked whether we would extend the principle of charges beyond the present level of prescription charges 46 and teeth and spectacles. I said, "No", and that is correct.
§ Dr. John DunwoodyMay I assure my right hon. Friend that the suggestion that deficiencies in the Health Service can be met only by increases in these charges is repugnant to many of us on this side of the House and that his suggestion that there should be an automatic relationship between the level of charges and the cost of the services concerned seems to be introducing a new principle into the whole question of charges? Will he assure the House dogmatically that this principle will not be applied to prescription charges?
§ Mr. CrossmanThe point I made is that in the case of these particular charges for dentures and spectacles a rough relation between cost and charge has been maintained on the three occasions—or the two occasions—when we have had to change them. We sought in the change to make the relation so in those cases. This does not apply to prescription charges, because each must be judged on merits in application.
§ Sir H. Legge-BourkeIs this latest announcement one of a series to follow the Budget Statement until eventually the whole picture is filled in for all the necessities of life which are now to be taxed? Will the right hon Gentleman also say on what logic he selects for this treatment only those who are short-sighted or long-sighted, or who have difficulty with their teeth? What about the other faculties? Why are those not brought into the same bracket?
§ Mr. CrossmanIn answer to my hon. Friend the Member for Falmouth and Camborne (Dr. John Dunwoody), it is not a question of expansion of the service being only possible, but how one uses money most wisely and avoids what otherwise would be necessary, a slowing-down of the process we want to achieve owing to the weight of the cost. If I am asked about teeth and spectacles, charges have been imposed for these from time to time and the charges have to be adjusted. There is no issue of a new principle there.
§ Dr. SummerskillMay I remind my right hon. Friend of Labour's election pledge? [HON. MEMBERS: "Hear, hear."] It was to abolish all charges. 47 [HON. MEMBERS: "Hear, hear."] Why should the edentulous and the myopic be expected to correct our balance of payments?
§ Mr. CrossmanI am grateful to my hon. Friend for reminding me of that quotation from the election manifesto. I am sure that we all do hope that in due course all charges could be abolished, but I should be deceiving.[Interruption.]
§ Mr. SpeakerOrder. Too much noise does not help.
§ Mr. CrossmanI 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.
§ Mr. PavittDoes this mean and financially irrelevant decision mean that the Government have finally repudiated the pledge, which I am not permitted to quote but which will be found in the OFFICIAL REPORT for May, 1952, col. 1776, when Hilary Marquand on behalf of the Attlee leadership specifically pledged that charges including those for dentures and spectacles would be removed? Does this statement repudiate the unanimous decision of the Labour Party conference last year that these charges should be removed?
§ Mr. CrossmanI have nothing to add to the answer I gave to the previous question. The answer is, "No", there is no final repudiation.
§ Sir M. Stoddart-ScottThe right hon. Gentleman stated that this will cost £3½ million. Does he realise that his predecessor told us when the prescription charges were put up that they would cost £27 million and they cost almost £50 million? Does the right hon. Gentleman think that this estimate will be equally accurate?
§ Mr. CrossmanI should like notice of that question. I do not recall my predecessor anticipating the cost, but the yield. I do not think that the estimate was far out and I think that this estimate will be as correct.
§ Mr. LomasIs my right hon. Friend aware that his statement will be 48 described as naive, stupid, or courageous in the local elections this week, and that I regard it as naive and stupid? It is in direct violation of every principle of the Labour Party when we said that we would have a Health Service free of charge in time of need.
§ Mr. CrossmanI cannot think that an increase to a charge introduced many years ago could be a violation of a principle. This is an extension of a practice and that is somewhat different.
§ Mr. WyattIs my right hon. Friend aware that, despite the little local criticism he has run into this afternoon, the great majority of the public—
§ Mr. SpeakerOrder. If so, there is too much noise from the minority at the moment.
§ Mr. WyattIs my right hon. Friend aware that the great majority of the public will regard his new charges as a realistic approach to financing the Health Service, which everybody knows is far too short of money; and that everybody also knows that the general public are not willing to accept further increases in general taxation to pay for it, but would much rather have increases in charges of this kind?
§ Mr. CrossmanI hope that the general public will take the view, which my hon. Friend claims that it will, in the narrow term of these charges. However, if he were to imply that these charges indicate a view by me that a wide extension of charges is preferable to taxation, this is absolutely untrue, because in my view charges are matters of limited utility at the best and the public must face the fact that the major cost of the Health Service will in future always have to be borne by taxation.
§ Sir D. Walker-SmithWhen the right hon. Gentleman refers to the matter having been settled in principle, does he refer to 1951 Act, which the present Prime Minister and the right hon. Gentleman himself said was fundamentally in contradiction to their own personal and political principles? When he speaks of the level of charges, will he identify to the House the opportunities, whether by way of vote on Statutory Instruments or 49 otherwise, that hon. Gentlemen behind him will have of expressing the opposition by vote as well as by voice which they evidently have?
§ Mr. CrossmanWhen the regulations art laid there will be the normal debate and it will be ended in the usual method in this House. The right hon. and learned Gentleman's question about principles is the kind of interesting historical question on which I think two or three opinions could be held reasonably.
§ Several Hon. Members rose.
§ Mr. SpeakerOrder.
§ Mr. OrmeOn a point of order. I raise this point of order, Mr. Speaker, because on 14th April in this House, in answer to a supplementary question, in c. 771, my right hon. Friend said—
§ Mr. SpeakerThe hon. Gentleman should give the sense of the quotation.
§ Mr. Orme—that there would be no increase in Health Service charges. These are Health Service charges.
We ask you, Sir, to protect us in this matter. The obvious contradiction between my right hon. Friend's statement today and what he said on 14th April should be corrected. Could you, Mr. Speaker, call on my right hon. Friend to correct this?
§ Mr. CrossmanI wish, Sir, that you had allowed my hon. Friend to make the quotation, because this matter can be discussed only in terms of the actual words which I used. I answered two supplementary questions on that occasion—one about whether I believed that we would extend the system of charging in the Health Service further. I said, "No." The second was specifically about an increase in prescription charges. I said, "No" to that. I was not asked about charges other than prescription charging.
§ Several Hon. Members rose—
§ Mr. SpeakerOrder. I hope that right hon. and hon. Members will not attempt to pursue the debate by dint of points of order.
§ Mi. PowellOn a point of order. I understood you, Mr. Speaker, when an hon. Member raised with you just now a point which was raised as a point of 50 order, to object to his quoting from something previously said in the House. Is it out of order, in raising a point of order, to quote what is reported to have been said? If so, it is difficult to understand how many genuine points of order could properly be raised with you.
§ Mr. SpeakerI have always understood that the rule about supplementary questions applies to points of order in the same way. I admit that it puts the Minister in an advantage, because he can give the actual quotation.