The Lords had agreed to the amendment made by the Commons: In page 4, line 7, leave out from 'and' to second 'for' in line 8 and insert
'it is hereby declared that the power conferred by section 1(1) of the National Health Service Act 1952 to provide for the making and recovery of charges includes power to provide for the making and recovery of charges'.
§ with the following amendment—
§ In line 4, leave out 'includes' and insert 'does not include'.
§ 10.15 p.m.
§ The Secretary of State for Social Services (Sir Keith Joseph)
I beg to move, 174 That this House doth disagree with the Lords in the said amendment to the Commons amendment.
The Lords have disagreed to the following amendments made by the Commons: In Schedule 4, page 63, line 13, at end insert—'22A. At the end of section 38(3) of that Act (which relates to charges for pharmaceutical services) there shall be inserted the words"; and it is hereby declared that regulations under this subsection may include provision in respect of charges for the supply of such substances and appliances as are mentioned in section 4 of the National Health Service Reorganisation Act 1973In page 69, line 37, at end insert—'(2) In section 1(2)(c) of that Act (which provides that no charge is to be made under that section for the supply of an appliance for a young person) after the word "appliance", there shall be inserted the words", otherwise than in pursuance of section 4 of the National Health Service Reorganisation Act 1973."'for the following reason: because disagreement to them is consequential on the Lords Amendment to the Commons Amendment in page 4, line 7.
In respect of these two amendments I shall be moving, Mr. Deputy Speaker, "That this House doth insist upon its amendment to which the Lords have disagreed."
As you have said, Mr. Deputy Speaker, a question of privilege arises and the House will wish to bear that in mind. The effect of making the Lords amendment and of not making the Commons amendments with which the Lords disagree would be to remove the power to charge for contraceptive substances and appliances from the Bill. It would thus reverse the decision of the House, reflected in our amendments to the Bill, that family planning supplies should be treated as other drugs and appliances under the National Health Service—namely, subject to prescription charges. Under the Bill as amended family planning services would become a normal part of the National Health Service and subject to the normal charges and the normal exemptions.
That decision was reached by this House after full discussion in Committee and on Report after consideration of revised Government proposals, which, as 175 the House will recall, went a great deal further than we envisaged when the Bill was first introduced in another place.
We have, in the light of the Lords message, reviewed our decision. However, we remain of the view that it was right and that the proposals in the message from the Lords are open to strong objection. I shall lay before the House the argument against the Lords amendments.
First, they would involve additional expenditure. The sum involved of £3 million is not astronomical but it is not insignificant. There are many other priorities. Even when the general cause is good we cannot adopt every matter irrespective of what it might achieve and irrespective of its cost.
Secondly, the Lords amendments would create a serious anomaly between drugs and appliances prescribed for contraceptive purposes and all other drugs and appliances prescribed under the National Health Service. It is true that vaccinations and general public health services are usually free but preventive drugs and medicines are not as such free under the National Health Service. Drugs subject to normal prescription charges include medicines which are intended to prevent conditions developing or recurring as well as those intended to cure and relieve.
I turn now to the crucial issue. The arguments which I have already mentioned against the Lords amendments might not prevail in our minds if it were the case that to eliminate the 20p charge would serve the purpose which we all share. Of course, all extremes of argument on both sides of the House wish to reduce unwanted pregnancies, illegitimacies, and abortions. That is common ground. The House generally agrees with the moves that the Government have already made which will expand the tax-borne cost of advice and supplies for the next few years from the £1 million a year which we found on taking office to about £30 million. That will be likely to reduce but not eliminate unwanted pregnancies, illegitimacies and abortions.
The question is whether the 20p charge will stand in the way of a still larger reduction. That is the crux of the argument to which hon. Members must address their minds tonight. Those in 176 the Lords urging a totally free service assume that the charge will stand in the way of a greater reduction. I believe that that is a delusion and that the facts are much more complex. First, there will be group exemption. There will be automatic exemption for those on supplementary benefit, those on family income supplement and those who have had a baby in the previous year.
Secondly, we shall encourage the Health Education Council and the new area health board authorities to give much increased publicity to the services which will be available under the National Health Service. Much of the increased take-up in the free zones stems from increased publicity. Those who take the trouble to go to clinics will not be deterred by the 20p charge—20p at most once a month for a few months while a woman and her medical adviser are seeking the contraceptive supply most clinically apt for her, and thereafter 20p two or three times a year. Those who are or can be motivated to avoid pregnancy will use the service if we put supplies on prescription at 20p. The 20p will make no difference to those who are or who can be motivated to avoid pregnancy.
Those who ate not so motivated—and these are the people most in our minds—who are casual or are overwhelmed will not use the service even if it is free. It will not be the 20p which will deter them. This second group, the casual and the overwhelmed, cannot be reached by free supplies but only by domiciliary persuasion. That we intend to increase sharply. There is no question whatsoever of charging the casual and the overwhelmed for domiciliary supplies. We intend to make administrative arrangements for waiving charges in such cases.
These arrangements will have to be used tactfully but will cover all the existing domiciliary cases and those who are so defined in future or are felt by the professional workers used by area health authorities to be in need of this sort of help. There will also be powers to widen the provision for exemption by amending regulations if this proves desirable or practicable.
§ Mr. Leo Abse (Pontypool)
The right hon. Gentleman is indicating these new administrative arrangements. In view of 177 the large number of people who at present and in the past have had domiciliary visits and have been transferred to clinics, is he suggesting that the people who will be going to the clinics, having been so directed or encouraged from domiciliary visits, will have to pay a prescription charge—yea or nay?
§ Sir K. Joseph
Nay, while they are still considered to be in need of the service which I have described in shorthand as domiciliary. That is, by sustained persuasion. Once they are considered to be self-motivating, they will not need to be treated any differently from anybody else. [Laughter.] I beg to the House not to dispose of this argument. While the professional workers concerned judge that such people need persuasion, whether by domiciliary visit or in the clinic, they will be exempted as they are now.
We have considered whether there is any alternative proposal that we should recommend in the place of the Lords amendment. A possible variant which has been suggested, for example, by my hon. Friend the Member for Norwich, South (Dr. Stuttaford) of free supplies in particular areas is open to equal or greater objection. It is surely wrong in a national service that a person's ability to obtain free supplies should depend on the past decisions of a local authority which has ceased to carry responsibility for the service. I must emphasise that what we are discussing is not a requirement to make particular charges but a power to do so by regulation. The power is flexible, as shown in Clause 55(4).
§ Dr. Tom Stuttaford (Norwich, South)
Did my right hon. Friend suggest that the social workers in the clinics will have to carry out a means test of motivation as well as a cash need?
§ Sir K. Joseph
My hon. Friend may or may not be aware that there is at the moment a domiciliary service which normally involves totally free supplies. That domiciliary service is needed only by a very small proportion of the population. The individuals are identified by co-operation between a number of social services—some probation officers, health visitors, midwives, social workers, district nurses and clinic nurses. This is happening now in different parts of the country. It is the Government's intention that it 178 should spread throughout the country to those people who are considered to need the encouragement and who are not self-motivating. Therefore, my answer to my hon. Friend is "Yes".
I was pointing out that the power under the Bill is flexible. This power enables us to provide, if necessary, for exceptions to be made in particular cases or classes of case. If, therefore, further experience should show that our present proposals should be looked at again, the power is already in the Bill to modify these proposals. Indeed, there would be power by regulation to abolish charges for contraceptive supplies if this turned out to be the right social priority and if evidence showed that our judgment was wrong. The Lords amendment which the other House ask us to agree gives no such flexibility.
I return to the heart of the issue. The Bill provides that contraceptive supplies should be treated like any other medical supplies on prescription, with automatic exemption for those on supplementary benefit or on family income supplement, or who have had a baby in the previous year.
It would just not be understood by large numbers of the public if we went further than that. I say with full deliberation that there is no case for going further. Totally free supplies will not, just because they are free, reach the casual and the overwhelmed. We intend to reach them by much-expanded domiciliary services offering supplies which will be free in their case. It is the Government's view that the right thing to do is to stand by the judgment which this House has made.
I shall, with permission, seek an opportunity to answer any new points which are made by hon. Members.
§ Mr. John Silkin (Deptford)
When the subject of family planning was discussed on previous occasions in the House or in Standing Committee, the debates were wide-ranging. We had to consider en bloc a number of amendments, including the question whether there should be a family planning service at all. For my part, I have always regarded this latter question as a matter of moral decision which hon. Members must make in their own way, and for that reason I recommended to my right hon. and hon. Friends 179 a free vote on our side. I still regret that the Government did not follow that example.
Tonight, however, the House has only one question to consider—whether family planning, which will now be on the National Health Service in any event, should be provided free or by prescription and therefore subject to prescription charges. In my view, there arc three major reasons why the Government ought to have thought again about their opposition to the Lords amendment.
First, I do not think that the Secretary of State has fully taken into account the attitude of general practitioners. When we were in Committee, negotiations had started with the general practitioners to obtain their view of a GP-based service. As I understand it, the negotiations still continue. But if I interpret the views of the British Medical Association correctly, they are that the question of family planning should not be regarded as an obligation for the doctor. The BMA regards this as an additional service, and one which should be paid for.
In that event, what happens to the £3 million which the Secretary of State told us he would save if there was not a free service? The right hon. Gentleman's arithmetic, no doubt, is far better than mine, but if only half the GPs in the country operate the service and charge £1 a visit, which does not seem to me to be excessive these days, the total cost will be well over three times his £3 million. Perhaps he could check those figures. He has the time.
§ 10.30 p.m.
§ Secondly, the BMA does not consider that the supply of appliances should be made generally available to men through their family doctor. They should, it thinks, be available only to women, so that the basis is not a comprehensive universal service for family planning. Thirdly, it also takes the view, perfectly understandably, that the doctor should be able to refer a patient to another doctor if his personal views are inimical to family planning. I understand that, but it means that there is a tremendous gap in the comprehensiveness of the service. The three arguments that the BMA has in mind clearly demonstrate that the 180 service will not be universal, that administratively it will be inefficient, costly and irregular. These irregularities will be constantly open to public criticism, and rightly so.
§ The second major disagreement that we have is on the question of the prescription charges. We contend that the use of prescription charges for family planning is a totally unjustifiable extension of the prescription charge base. The Secretary of State tried to make the point that it was on common ground with those items that are subject to prescription charge. The House must know that I am against prescription charges of any sort but that I fully accept the reality of the situation that prescription charges will continue during what is left of the lifetime of this Government. [Interruption.] We plan to abolish them. [Interruption.] Hon. Members will just have to wait and see.
§ Nevertheless, because the reality is that prescription charges are here to stay during the lifetime of this Government my right hon. and hon. Friends and I contend that the levying of prescription charges on family planning appliances is totally out of context with other prescription charges. It is always possible to judge the validity of a rule by its exemptions. Here the exemptions include children under 15, elderly persons over 65 and expectant mothers, which shows that this is not an area which has much common ground with prescription charges. As my hon. Friend the Member for Willesden, West (Mr. Pavitt) has said, common ground exists in the area of preventive medicine, and the Secretary of State did not give that fact due weight. To that extent it can be compared with immunisation, vaccination, X-ray and other such services which remain free.
§ For these reasons we are grateful for the opportunity to re-examine the problem. Experience has shown that where free family planning services already exist an increasing number of persons is using the facilities. Nor does that offend the general view of the people of this country, as the Secretary of State seemed to think. A National Opinion Poll in December 1972 showed that 64 per cent. of people asked—and the figure was 79 per cent. for men and women under the age of 45—were in favour of free family planning.181
§ The Secretary of State has certainly moved a good deal between February 1971 and today. I now ask him to catch up with the rest of the public because they are in favour of free family planning. Therefore, in giving them such a service we shall not only be in accord with their view but shall be in accord with common sense. For those reasons I call on my hon. and right hon. Friends to agree with the Lords in the said amendment.
§ Mr. J. Selwyn Gummer (Lewisham, West)
I believe that we ought not to hide from ourselves the enormous steps which have already been taken towards comprehensive family planning arrangements. The real question before us is the specific one of whether we would extend the number of people who would be likely to use family planning if it were a free service rather than if it were on prescription charge. That is the narrow point at issue.
But even in discussing that point, it should not be omitted that the Bill in general has done more in this matter in a very short space of time than has been done at any time before, and my right hon. Friend ought to take proper pride in that fact. But having said that, we have to ask ourselves whether, if we agreed to the Lords amendment, we would reach that group of the population we are all concerned should have the opportunity and, indeed, the encouragement, to use family planning, which it does not do at the moment.
What we really ought to be doing is spending as much money as possible on the domiciliary service and on the monitoring of the service to see whether it should in future be extended or changed. We should not be spending the money on free family planning for two reasons.
First, no evidence has been adduced that even a free service would reach precisely that group of the population which, rightly, the right hon. Gentleman the Member for Deptford (Mr. John Silkin) and we all wish to reach. All we have had is a general statement which, in effect, is that anything free is likely to reach more people than something which is not free. The question is whether it is not more sensible to spend this money in another direction. I do not believe that a case has been made 182 out that the £3 million can be usefully spent in providing a free service. There is, indeed, considerable argument that the people believe that it should not be.
It is all very well for the right hon. Gentleman to quote a public opinion poll, but I suggest that if a person is asked whether he would prefer something to be free, he will say that he would prefer to have it free. The purpose of this House is to decide not whether it would be eminently desirable to make a whole range of things free, but whether, given the resources, this is the right way to spend them. It is this House which has to make the decision, and no one else, because it is this House's responsibility to decide the way in which we spend the money raised in taxes. In this case, we have to decide whether the money would be better spent on the domiciliary service or some other parts of the National Health Service, or whether we should be more concerned, for no really provable benefit to make the family planning service free.
The second point, which is incontrovertible, is that the argument of the right hon. Gentleman that this service is not like anything else provided under the NHS does not stand up. The right hon. Gentleman is right to say that we should not ask people to pay for life-giving drugs or medicines necessary to keep them alive—although I remind him that the Labour Government reintroduced prescription charges—but most people would agree that it is rather odd to turn round and say that all people should get family planning service free. Surely it is reasonable to say that people should pay for that if they can afford it, just as they do for anything else.
§ Mr. R. J. Maxwell-Hyslop (Tiverton)
Is my hon. Friend under the impression that the Secretary of State has offered to spend another £3 million on the domiciliary service? I have not heard any such offer.
§ Mr. Gummer
I am under the impression that the Secretary of State has stated clearly that if it is necessary to extend the domiciliary service in order to reach the people we wish to reach, he will have, under the Bill, the means whereby, through regulations, that can be done.
§ Sir K. Joseph
Perhaps I should point out that estimates that have been given include a great increase in the domiciliary service, including free supplies for that service.
§ Mr. Gummer
If we are concerned to reach that section of the population pointed out by the right hon. Member for Deptford it does not help to make the service free. It means that we are saying to the people that because it happens to be a trendy thing to do we will do this rather than consider the real issue which is how do we help these people directly. The domiciliary service is a much better way of doing this. if at the end of the first year we find it does not work effectively we ought to extend the domiciliary service rather than make the social services pay for this.
§ Mr. Laurie Pavitt (Willesden, West)
This is a short debate and I do not have time to demolish the arguments of the hon. Member for Lewisham, West (Mr. Selwyn Gummer). If he has time will he please spare an hour and come to my constituency and I will give him all the proof he wants that his argument is a lot of nonsense?
I want to direct the Secretary of State's mind to the possibility, even at the eleventh hour, of accepting some of the extremely important arguments advanced in another place. There is a deal of administrative nonsense involved here. The right hon. Gentleman is creating a NHS reorganisation Bill based on efficiency. Yet in this part of the Bill he has created enormous administrative bureacracy. This £3 million will be lost in it. Another 15 million EC10 forms will have to be printed and distributed. All of the exemptions will have to be checked to make sure that they apply to those who are exempt. All this adds to the weight of work.
The general practitioners and the pharmacists will want more money. The reorganisation of the NHS chemists and the contract chemists will involve more work. There is also the effect of voluntary workers. At the moment there are 1,500 and the right hon. Gentleman hopes for 2,000. People are prepared to volunteer for a good social purpose but are not prepared to volunteer to work as tax collectors. If they have to put 20p stamps on prescription forms or find some way 184 of getting round it there will be the same problem as we had with the prescription charges.
This makes a nonsense of the GP service and distorts the delivery of care by the imposition of charges. Already condoms will not be supplied by doctors. We are supposed to be going into action by 1st April, but the way in which negotiations are going means that the work load on GPs will vary widely. Some will be on the obstetric list some will be FP doctors, others will not. There will be difficulty in sorting out doctors and patients and there will be competition between doctors in terms of capitation fees.
In health centres and in group practice there will be a need for more ancillary workers and this will cost hard cash. After the present salary negotiations with the Review Body and the SMSC there will be very little cash saving.
Unusually for the right hon. Gentleman this is very narrow and shallow thinking. He has not gone into this in depth, realising the comprehensive nature of his responsibilities to the Health Service. For the sake of a doctrinaire approach on a small matter he is distorting the rest of the Health Service. I remind him that he is responsible for social services as well as health. For every £1 saved in prescription charges he will spend at least £20 on all the other problems that will arise.
This is the first time a charge has been made on the prevention of social problems. Just as he would not think of putting a charge on the work of probation officers, on work for the welfare of the elderly, the provision of geriatric wards, psychiatric social workers, assisting the mental and physically handicapped and the disabled surely for the sake of 20p it is nonsense to erect this huge machinery. The right hon. Gentleman is erecting an unnecessary barrier between the doctor and those who require human understanding.
In my area of Middlesex doctors have panels ranging from 2,500 to 4,000 people, and doctors are to be expected to take on this extra responsibility. I plead with the right hon. Gentleman, even at this late stage, to cut out this nonsense and to accept the matter as their Lordships have given it to us.
§ 10.45 p.m.
§ Mr. Ronald Bell (Buckinghamshire, South)
On the Report stage of this Bill in this House some of us made clear our position on the clause which sought to confer these powers to subsidise the use of contraceptive appliances. But, as the right hon. Member for Deptford (Mr. John Silk in) pointed out, that is no longer the question before the House. The clause is in the Bill, but the provision applies to unmarried as well as to married people. This must regulate one's attitude to the Lords amendment.
It was my view on the wider issue—as it is my view on the narrower issue—that considerations of money are not responsible for any appreciable part of the proportion of unwarranted or illegitimate pregnancies. I do not believe that lack of money ever stands between people and the contraceptives they want to use. [An HON. MEMBER: "How do you know?"] It could be argued that old-age pensioners might find it a burdensome expense, but unwanted pregnancies do not characteristically occur among old-age pensioners. Therefore, I think we can discuss that consideration from our minds.
If it be true that the prescription charge of 20p will not come between any person of child-bearing age or child-procreating competence and the acquisition of contraceptives, then the narrower question which is before us tonight, as the Lords have left the Bill, should be decided as a moral issue.
There have been those who have argued that the provision by the State of totally free contraceptives to all who come in for open-handed largesse will have no impact on people's moral attitudes. They are entitled to their view, but I do not accept it—indeed I find it impossible to accept. We cannot make this distinction. If the Lords amendment were passed, many people would consider that the State had given respectability, and even its blessing, to promiscuity—[HON. MEMBERS: "Oh."] We cannot separate the two things. One cannot make promiscuity easier and at the same time argue that one is not encouraging it.
§ Mr. Robert Hughes (Aberdeen, North)rose—186
§ Mr. Ronald Bell
This is to be a short debate and I am afraid I cannot give way. I want to be brief. As I was saying, one cannot separate the consequences from the state of mind in which people enter upon courses of conduct. I feel that the House tonight should insist on the Bill as it left this House and reject their Lordships' amendment.
§ Mrs. Renée Short (Wolverhampton, North-East)
The Secretary of State misled the House, and I think that he did so deliberately when he said that the public—[HON. MEMBERS: "Order."] I ask hon. Members to wait to hear what I am about to say—
§ Mr. Speaker
Order. I think that the suggestion of deliberately misleading the House is not parliamentary.
§ Mrs. Short
Very well. I withdraw the word "deliberately". But the right hon. Gentleman still misled the House when he said that the public outside did not want us to go any further than he was prepared to go. The right hon. Gentleman is deliberately ignoring the expressed view of the public in public opinion polls which have been conducted. Before the Lords Amendment was carried in the other place, they showed that something like 64 per cent. of the general public were in favour of a free comprehensive family planning service. Something like 64 per cent. of those Conservatives who were asked also supported it, as well as 70 per cent. of Labour supporters. I believe that something like 62 per cent. of the Liberals who were asked also supported it. So it goes right across the board and shows that a majority of the supporters of all parties support the introduction of a free family planning service.
The right hon. Gentleman also chose to ignore the experience of those local authorities which have introduced completely free family planning services in their areas. On Report, my hon. Friend the Member for Aberdeen, North (Mr. Robert Hughes) spoke of the results in Aberdeen, of which the right hon. Gentleman is aware, quite apart from the results in many of the London boroughs, in Birmingham and in other areas, all of which show a very large increase in the 187 take-up of family planning advice when the service is given completely free.
I should have thought that that experience would encourage the right hon. Gentleman to go just a little further than apparently he is prepared to and to say that the £3 million, which is a very small proportion of the total spent on the National Health Service, would be money well spent. Past experience in a large number of local authority areas shows that if the service is provided, some of those women who are most in need avail themselves of it. After all, it is those women with whom we are concerned. I hope therefore that the right hon. Gentleman will think again.
Let me ask the right hon. Gentleman also to think of the consequences of not doing this. These are all arguments which were rehearsed in the various stages of the Medical Termination of Pregnancy Bill. But the recent figures which show the cost of keeping a child in care, for example, are very considerable. To keep a child in care now costs almost as much as it does to keep a prisoner in prison—more than £1,000 a year. In 1971, 90,000 children were taken into care. Of those, 5,000 were under two years of age, 600 were abandoned or lost, 3,000 were illegitimate and were taken into care because their mothers were unable to provide for and to cope with them, and a further 25,000 were taken into care because of the incapacity of their parents together or their guardians. This represents an enormous well of misery and unhappiness among women, among mothers who have had children they cannot cope with and, last but not least, among those children.
I ask the House to think of the children who are abandoned at six months, a year, two months or two years and who are thrust into foster homes and into local authority care, with many people looking after them during their developing years. The Secretary of State should be concerned about what happens to those unwanted children when they become adolescents. I will not develop it, but it is a situation for which we should have great regard.
It so happens that most of the methods of contraception which require medical supervision are those used by women. If 188 men are too lazy, too ignorant or too bloody-minded to take precautions themselves, the onus falls on the women. I put it to the Secretary of State that what he said about people not using the service if it is free is disproved when one looks not only at the local authority situation where this has been done but at the large numbers of working-class women who are not in a position to pay for contraceptives. They cannot afford it. Many women have to operate on a very tight family budget. The right hon. Gentleman knows perfectly well that many families do not claim family income supplement. He is concerned about that, and nods agreement. He knows the facts.
§ Mr. Martin Maddan (Hove)
§ Mrs. Short
One of the right hon. Gentleman's less enlightened hon. Friends says "Nonsense"
§ Mr. Maddan
I am grateful to the hon. Lady for giving way. She is trying to show that there is a great ground swell of opinion, fact or statistics in favour of her case. Would she care to comment on the fact that the amendment in another place was carried by the votes of the life peers, who are very much older than we in this House are—[AN HON. MEMBER: "TOO long".]—
§ Mrs. Shortrose—
§ Mr. Maddan
The hon. Lady will have to sit down.
§ Mrs. Short
On a point of order—
§ Mr. Speaker
Order. Interventions must be of reasonable length.
§ Mr. Maddan
My intervention is very reasonable in length, Mr. Speaker. I only wish to ask the hon. Lady whether she would care to comment—
§ Mr. Speaker
Order. The hon. Gentleman is not entitled to make a speech.
§ Mrs. Shortrose—
§ Mr. Maddan
On a point of order, Mr. Speaker. I have always understood that if an hon. Member gives way he or she will at least allow a point of challenge to be developed. Therefore, I wish to say to the hon. Lady—
§ Mr. Speaker
Order. An intervention is not an opportunity to develop a point. An intervention is to put a short, sharp point, which the hon. Gentleman has not done.
§ Mr. Maddanrose—
§ Mr. Speaker
Order. If the hon. Gentleman has a short, simple point to put to the hon. Lady, I will let him do it—if it is short and simple.
§ Mr. Maddan
I will put my short and simple point—[Interruption.]—I will put my short and simple point—[Interruption.]—I will put my short and simple point—
§ Mr. Speaker
Order. It does not become any shorter and any simpler if the hon. Gentleman repeats himself three times.
§ Mr. Maddan
If the House would allow me to make my point, it would be short and simple. I must rely on your protection, Mr. Speaker, to allow me to do that.
My point is simply this: does not the hon. Lady acknowledge that her cause is years out of date, and that the amendment was carried in another place by the life peers, who are all of a different generation from that of hon. Members of this House?
§ Mrs. Short
The only comment I make about that little interlude is that it persuades me that retrospective legislation has many advantages.
The Secretary of State must be aware that many women are hard pressed and find it difficult to pay for this service, and will not do so if the charge is maintained. Many unmarried women who are working and living on low earnings will also find things difficult. I therefore ask the Secretary of State, bearing in mind that this is something that will affect women very much more in future, to reconsider his advice to the House. I hope that those right hon. and hon. Gentlemen opposite who had the courage of their convictions when almost 70 of them signed the motion on the Notice Paper will think of that effect and vote with us in the Lobby tonight.
§ 11.0 p.m.
§ Mr. Geoffrey Finsberg (Hampstead)
The last remark of the hon. Lady the 190 Member for Wolverhampton, North-East (Mrs. Renée Short) might have been more to the point on the last occasion when we debated this subject if she had had the support of her right hon. and hon. Friends, so perhaps we can draw a veil over that.
My right hon. Friend talked about the extra cost of £3 million. I remind the House that the approximate cost of providing a full free service is between £6 and £7 per head of those using the service. It costs something in excess of £1,000 per annum to keep an unwanted child in care, and about £300 per annum to take a child into a nursery school during the time that the parent is working.
§ Sir K. Joseph
I hope that my hon. Friend will not make the fashionable assumption, which I have tried to argue against, that a charge will necessarily affect those who have illegitimate children, abortions or unwanted pregnancies. My hon. Friend has that link to establish before he can make the argument that he is trying to put forward.
§ Mr. Finsberg
I made a similar point last time, and my right hon. Friend did not give me that rejoinder. I was merely pointing out that even if one wants to leave aside ethical, moral and health considerations there is still the cost-benefit consideration that one cannot overlook. That was the only point that I was making. My right hon. Friend has treated the subject with deep sincerity, but I hope he will acknowledge that those who cannot go with him have deep and sincere convictions, too.
My hon. Friend the Member for Lewisham, West (Mr. Selwyn Gummer) wondered whether the service reached the right people. I should be delighted to take him to Camden and show him that it does. My hon. Friend does not require to go to Aberdeen to find out.
I gave the House certain statistics on 13th June, and perhaps I may now give some up-to-date ones. In the calendar year 1972, in the London borough of Camden, there were 2,791 requests from general practitioners for family planning supplies. In the first 23 weeks of 1973, there have been 2,257 requests from general practitioners in that area for family planning requisites.
191 The reason why I ask my right hon. Friend to think again on this is that he was being a little unfair in the argument that he developed when he put this matter to the House tonight. About 10 million people now living in local authority areas are able to get the benefit of fully free family planning services. These have been voted to them by their elected local authority representatives of both parties, and I cannot accept that just because the House is being asked to reorganise the Health Service, and because local authorities are to disappear, that right, which was voted to them by both parties in 33 local authorities, should disappear, too. It is illogical, to me. I have spent 25 years in local government, but this is not how I ever thought the Conservative Party looked at local government. The Labour Party also has had many failures in its attitude to local government. When local government is dealt with by Parliament Members on both sides protest that they like local government, but then they find reasons for saying, "Not on this occasion; it had better fall into the Civil Service plan". To this extent Governments of all parties have failed.
I hoped that my right hon. Friend would have found it possible to say, "I recognise there is deep feeling on this matter". On the last occasion the House considered it there were three votes. One was for a fully free service. I forget for the moment what the second was, but the third was for the service to be retained for all those local authorities which had the service. The House took a decision by an odd majority, because a large number of people were not here. Now we have been given an opportunity by the House of Lords to think again, and we ought to think again.
I am speaking only for myself, not for my hon. Friends, many of whom signed the motion to which the hon. Lady referred, and many of whom voted in the same Lobby as I on that last occasion, but if my right hon. Friend can say, "I understand the position; I will make certain that at least those local authorities which have a fully free service may continue with it when they become part, or parts, of area health authorities next year", then I will not vote against my right hon. Friend tonight.
192 However, if he is unable to give me that assurance, then I fear that I must vote against him. I will vote in support of the Upper House which on this occasion, as on many other occasions, has shown itself to be more closely in tune with the moral feelings people have and the worries people have.
§ Mr. Leo Abse (Pontypool)
As one heard the hon. and learned Member for Buckinghamshire, South (Mr. Ronald Bell) adumbrate once again his opposition one was aware that that battle was fought on the Family Planning Bill. Hon. Members of all parties realised that they were not then primarily concerned with the conduct of unmarried parents; all were concerned primarily with the children and with the illegitimate.
The Secretary of State, as he began to speak, laid down that it was the view, and, he rightly said, the view of the whole House, that we were all concerned to see if we could reduce the numbers of the illegitimate and the numbers of abortions. Rightly then, as in his intervention, he stressed the error of the simplistic view that the giving of family planning devices and appliances will automatically and necessarily reduce illegitimacy or abortions. He rightly stressed that nobody can make that assumption and rightly criticised those who make, without evidence, that assumption. That is true, but, just as we must not take those simplistic views or attitudes to prove our case, we must expect him, too, not to take such a stand, and I return to what he emphasised when he opened this debate.
The right hon. Gentleman is concerned with reaching out to that section of the population who by their behaviour are helping to perpetuate the cycle of deprivation which he is constantly stressing has in some form got to be broken. He presented the argument that the way to do it is by domiciliary visits. He has unfortunately got himself into the position that, having done more than any Minister since Kenneth Robinson in the way of family planning, he is reacting to pressure. He is in the curious position that although he is spending millions—yea, tens of millions—and has given considerable assistance to many who could well afford to buy their own family planning appliances—he has not reached to 193 that very area which all of us are concerned about, and that is, those who have to be motivated to family planning if we are to succeed in breaking the cycle of deprivation. He has fallen back entirely on the argument that the only way to reach these people is through domiciliary visits. He knows that there is a vast grey area of people who could and would be reached if the service were free, and who will not be reached unless the service is totally free.
Is it not true that, after all the work that the Minister has done in advertising, only half the families estimated to be eligible for family income supplement are claiming it?
§ Sir K. Joseph
The Secretary of State agrees with me.
That means either that the remainder were not in touch with the referral agencies, like health visitors or social workers, or that the agencies failed to make it clear to them that they could claim the benefit. Family income supplement carries exemption from prescription charges, but that cannot be any good to those women who are theoretically eligible if they do not receive FIS. If they are not in touch with the referral agencies, they are unlikely to be included in the domiciliary family planning programme. When the right hon. Gentleman stresses the domiciliary programme alone, he is leaving out probably half of those who should be reached.
Although it would be absurd for anyone to be didactic, there is the more suggestive evidence that, since some local authorities have been giving a totally free service, precisely those women who feel the burden and have so little to spare are taking advantage of it. For example, when Lambeth began such a service, 14 per cent. of those who applied were women with three or more children. I find it impossible not to believe that that group had not been deterred, at least in part, by charges for contraception. Apparently the doctors, midwives and health visitors had not referred those women to the Lambeth clinic.
The Secretary of State should not deceive himself: domiciliary visits alone are not enough. The only possible way of reaching these people is by "overkill".
194 Having gone so far and given so much to people who could afford to pay, we are spending millions in the wrong direction and ignoring the area of greatest need. The right hon. Gentleman is being impaled by his own bureaucrats. He did not think out beforehand the strategy for reaching this area. As the pressures have built up, the Department has responded, but it has not been able to alter its basic strategy so as to help those who, as the Secretary of State's past speeches have demonstrated, need help above everybody.
I hope that the House will vote in such a way as to save us from this bureaucratic attitude—not in any partisan spirit or spirit of condemnation. There are hon. Members on this side of the House who in my judgment should be ashamed that they were not present on the former occasion. They can claim no kudos from that. But the time has now come to talk not in terms of party spirit but in the thought that if we take the wrong decision, perhaps tens of thousands of children will be born who will perpetuate the social problems that we seek to avoid.
I hope that the House will rise to the occasion.
§ 11.15 p.m.
§ Dr. Anthony Trafford (The Wrekin)
When we last debated this subject I voted in support of my right hon. Friend, and I have listened with interest to learn what case the Opposition would present in trying to persuade us to change our minds. With great clarity the right hon. Gentleman the Member for Deptford (Mr. John Silkin) presented three points: the medical or doctors' objections; the question of the proven existence of the local authority services, and the question of prescription charges. Although, as I say, he presented those points with great clarity the fact is that, first, there are a large number of contradictions in the doctors' attitude. For example, we often hear a lot about the total care of the patient which the local practitioner reserves quite properly to himself. But now we hear from the right lion. Gentleman that this is something they would wish to dispense with.
Then there is the implication that there is something peculiarly special about the administration of these drugs and, in 195 particular, the drugs referred to rather than any others. We are told that a humane and difficult task has to be performed in six minutes, or whatever the time is, but essentially there is no difference in the prescription of these drugs from that of a dozen others, and these drugs are quite frequently used for purposes other than those of contraception. Many drugs are far more difficult to use than these are. Therefore, again, there is something of a contradiction in the medical objections.
Particularly with regard to male appliances I have a slight suspicion, and I hope that the House will forgive me if I am a little cynical, that doctors like other people in the professions and elsewhere, may be making out a bit of a special case here. They know very well that from time to time there are reviews of their responsibilities and the payment for them, and they are perhaps putting it on a bit. There is nothing easier than to fill in the EC10—putting in the number of the particular contraceptive. It may take six minutes to assess the capabilities of a certain person, but one certainly does not need six or seven years of medical training to decide that sort of thing.
Again, there is enormous substance in the arguments of the right hon. Gentleman with regard to the proven value of existing local government services. These are based on figures, and one hears at once loud cries of "Aberdeen," "Camden" or elsewhere. With regard to figures, there is an enormous difficulty in separating cause and effect. It is very difficult to distinguish the concentration, the drive and the enthusiasm in Aberdeen or Camden from the actual benefits of the free service. In what is called a controlled trial one would have to distinguish in some way the effect of all that generosity and enthusiasm—and perhaps of a particular attitude in some part of the country—from the mere provision of free contraceptives. This has not been proven, and it is very difficult to do that.
I hasten to add that that does not mean that the figures which the hon. Member for Wolverhampton, North-East (Mrs. Renée Short) was quoting were necessarily wrong, but it would suggest that they are not necessarily right, and that she may be—as her right hon. Friend 196 the Member for Deptford may be—drawing more conclusions from those figures than they justify.
Finally, the third argument of the right hon. Gentleman was on the question of prescription charges. I happen to disagree with my right hon. Friend the Secretary of State about the values and the ways in which prescription charges should be imposed. There are better ways of dealing with an ever-escalating drug bill than prescription charges. However, by and large, my views have not prevailed. I shall leave that argument aside.
As these prescription charges exist, I shall be asked, as will others, to prescribe on the same basis, digitalis and minovlar. In all conscience, I cannot see how these two can be equated. It would be wrong to exaggerate too much and to refer to one as a fun drug and the other as a lifesaving drug, but the fact is that they are different in both quality and substance. I cannot see, so long as the present situation exists, with prescription charges, that it would be morally right for me to say that those which are inessential shall be free and those which are vital shall be charged for.
§ Dr. Stuttaford
Will my hon. Friend give way?
§ Dr. Trafford
No. I am trying to be exceedingly brief.
§ Dr. Trafford
I apologise to my hon. Friend, but I will not give way.
Although I accept the sincerity of the case put forward by the right hon. Member for Deptford, and by some of his hon. Friends and some of my hon. Friends, even on those three bases, particularly on the last one, I should be wrong to do other than support my right hon. Friend tonight.
§ Mr. Eric Ogden (Liverpool, West Derby)
In less time than any of the previous speakers I wish to make three brief points. I am not interfering in the dispute between the two sections of the medical community. Obviously that is represented in the House as it is outside it.
First, my right hon. Friend the Member for Deptford (Mr. John Silkin) 197 reminded the House that we have had a free vote until now. It was right that we should have had that. It is unfortunate that we have had to change that, but a two-line Whip is not that strong.
The Secretary of State will recall the circumstances in Committee that enabled the Government to carry their amendment. I have some responsibility for that, which I am not shirking. But tonight the right hon. Gentleman referred to the fact that the free service would be available to "the casual and the overwhelmed." Other words that he might have used could have been "the irresponsible" and "those who are not responsible for one reason or another."
The right hon. Gentleman has my voting record. It seems that for the sake of this sum of money the right hon. Gentleman is getting into tremendous administrative difficulty. The whole purpose of the argument is that it will not be worth it for what he will save or not save.
If there is a moral reason that a painkilling drug has to be on prescription and paid for and a drug for another purpose should be free, certainly that can be countered by the argument, in the Secretary of State's words, that those who are responsible and accept their responsibilities will have to pay, and those who may be casual or overwhelmed—I would accept the overwhelmed having it free—the casual, in the right hon. Gentleman's terms, through the domiciliary services, are to have the service free. There is complete opposition between the right hon. Gentleman's words and those of his hon. Friends.
Why should the responsible pay when the deliberately irresponsible are getting it free? In those circumstances, however is one to persuade the deliberately irresponsible to accept responsibility? The right hon. Gentleman is getting into tremendous administrative difficulty for no particular reason.
§ Mr. Anthony Fell (Yarmouth)
First, I apologise to my right hon. Friend the Secretary of State for being absent at the beginning of the debate when he was speaking.
It would be as presumptuous of me were I not to credit those who believe passionately and with absolute sincerity 198 that all family planning appliances, and so on, should be free to everyone, as it would be wrong for them not to credit people who believe that what the House of Lords did is wrong and that there should be some brake upon the increase of permissiveness. My hon. and learned Friend the Member for Buckinghamshire, South (Mr. Ronald Bell) referred to the morality of this matter. In the last 25 years this country has seen the most extraordinary changes take place. They are changes that many people have helped to bring about—and one respects their views—and which have left thousands, indeed millions, of people in a state of turmoil as to the direction in which the country is heading.
The hon. Member for Pontypool (Mr. Abse), whom I supported once on such matters, feels passionately about these things. He spoke—and it was a sad thing to say—of the hundreds and perhaps thousands of children who will be born if there are no free contraceptives. He was, I believe, talking about Lambeth, where I live. I do not know whether the hon. Gentleman lives in Lambeth; it does not really matter whether he does or not.
§ Mr. Fell
By Kennington Cross. Does that help the hon. Gentleman? Come down there any day with me. Parts of Lambeth are crowded with young children, some of them from very poor families. Pick out the children who ought never to have been born. This is what has to be faced by those who have brought in all these aids to permissiveness. Why is it not possible for people to face the facts? Are hon. Members afraid to face them? Are they afraid of admitting that there are people who have moral standards that are different from those of other people?
§ Mr. Nicholas Winterton (Macclesfield)
I am sure that my hon. Friend abhors abortion as much as I do. Many abortions regrettably take place in this country. Would my hon. Friend not agree that if this sum of £3 million were granted for the provision of free contraceptives and saved but a handful of abortions it would be money well spent?
§ Mr. Fell
It is difficult for me to answer my hon. Friend. I can see perfectly well what he is getting at, but it is difficult to answer him because I believe, with my hon. and learned Friend the Member for Buckinghamshire, South that we are taking another step along the road to greater immorality and less regard for the moral values of life. The hon. Member for Roxburgh, Selkirk and Peebles (Mr. David Steel) may wag his head, but obviously he has permissive views. [Interruption] I apologise if the hon. Gentleman has not got permissive views. There are millions of people in this country who do not hold the permissive views that have been pushed down our throats by Governments ever since the end of the war.
Those people must be heard, and anything that my right hon. Friend does to fight against the growth of the permissive society is a help to at least that part of the nation which has some regard for the moral values of our people.
§ 11.30 p.m.
§ Rear-Admiral Morgan-Giles (Winchester)
Obviously, there are strong arguments on both sides of this subject, but I wonder whether those who advocating free issue ad lib have considered one practical point. [HON. MEMBERS: "What about the Navy?"] I was about to say that I had some small practical experience, since, quite rightly, the Navy makes the issue free. The question I put to those who are advocating free issue ad lib is whether, under their scheme, there is anything to prevent a man's going to his doctor seven days a week—[Laughter.] Perhaps not everybody would be virile enough to make use of supplies on such a scale, as has been pointed out by my hon. Friend the Member for The Wrekin (Dr. Trafford), with his medical knowledge.
But, seriously, what is to prevent people taking abroad suitcases full of what my right hon. Friend the Secretary of State delicately calls substances and appliances, and selling them in huge quantities to pay for their very cheerful holidays!
§ Mr. James A. Dunn (Liverpool, Kirk-dale)
I find it difficult to follow that argument. I want to bring the discussion back to a serious level. If I may say so with respect, I do not think that the intervention by the hon. and gallant 200 Member for Winchester (Rear-Admiral Morgan-Giles) has helped one iota in resolving the dilemma facing us tonight.
This argument has gone across the Floor on many occasions. The culmination has now been reached by the message from the Lords, and it is up to each of us to decide how we shall vote, according to our own view. I thought that my right hon. Friend the Member for Deptford (Mr. John Silkin), replying to the Secretary of State, made a telling point. I remember the time during the Labour Government when I found myself in grave difficulty, opposing the imposition of prescription charges. If there was a contradiction for me then, I plead guilty to the same fault now, because, having voted in those days against the Government in their wish to reimpose prescription charges, tonight I am turning tail and saying that I believe that the argument has not been established by my right hon. Friend that we should support the Lords amendment.
In all honesty, I believe that the prescription charge for contraception should be retained, bearing in mind the qualifications laid down by the Secretary of State. If I were asked to choose priorities for the spending of money to mitigate prescription charges, this would be the last on my list.
I feel that my right hon. and hon. Friends should hear from me because on another occasion I made a declaration. I should add that it has caused me vexation since I made it. I have constantly thought about it, and I have come to this conclusion. I took office with the Opposition as a Whip, and that imposed certain responsibilities and discipline upon me. I would find it extremely difficult, even at this point, to disobey that trust which was vested in me. At the same time, I cannot go along with what my right hon. Friend and other hon. Friends would wish me to do. I respect their point of view. I have known that they have campaigned for a long time on the issues that are before us tonight.
I ought to tell the House in honesty that I have never been against contraception. If, as was suggested by one hon. Member, the embracing of a free and comprehensive contraception service within the National Health Service would 201 stop abortions, I would embrace it tomorrow. But we were told this before about abortion. We were told that once it was made possible, the figures would go down. Unfortunately, there has been a reversal.
§ Mrs. Renée Short
We were never told that.
§ Mr. Dunn
With respect, I was not addressing my remarks to my hon. Friend. We all know her point of view. Perhaps she will do me the courtesy of listening to mine.
§ Mrs. Short
Do not misrepresent us.
§ Mr. Dunn
I would not misrepresent my hon. Friend, because she does not need me to represent or misrepresent her. She is quite capable of dealing with her own subject.
There is a dilemma before us tonight. Many of us believe that the issue is a quite clear and simple one. My right hon. Friend put it this way, and other hon. Friends have understood the dilemma facing many of us on this side of the House. My right hon. Friend says that the abolition of prescription charges for contraception should have priority. I will have none of that, and this evening I do not intend to support either one argument or the other.
Had there been a free vote, there might have been a different cast to the debate. I must say to the Secretary of State and his colleagues that I would have preferred a free vote on this matter, as was done on the first occasion. It might have been to his advantage had that been done. It might have left for me at least—and there might be many others—a difficulty that did not have to be surmounted. Indeed, it is probable that there would have been more sincerity at the end of the day, because on his side of the House on a moral issue the Secretary of State has a three-line Whip which I do not believe should ever be imposed on a question such as this and one of such importance.
§ Mr. Norman Tebbit (Epping)
The whole House will have felt very deeply with the hon. Member for Liverpool, Kirkdale (Mr. Dunn). What he has said emphasises what this debate tonight has been about as opposed to earlier debates. Tonight's debate is undoubtedly 202 about the fact that my right hon. Friend has moved 80 per cent—[An HON. MEMBER: "Ninety per cent."]—90 per cent. of the way he has been asked to go by those who will now vote against the Government tonight.
We all know the argument. In essence, if it were true, it is that the cost of 20p means that people get involved in unwanted pregnancies. My goodness, if that were true there would be no unwanted pregnancies among the middle and upper classes. Sad to say, there are.
The practicality, however, is that there are those on this side of the House, and some on the Opposition side, and many outside, whatever the opinion polls say, who would be deeply affronted if this House went any further than it has already made up its mind to go and if it did so merely because a group of what I think are best described as trendy, backstreet—not backwoods—peers have instructed us to do.
Let us say again what we said before, because this House is the master, as Labour Members would have reminded us had their Lordships decided to axe the provision instead of increase it.
§ Sir K. Joseph
With the leave of the House, I should like to welcome the support of a number of hon. Members, some of whom feel that the Government have already gone too far. I include my hon. Friend the Member for Lewisham, West (Mr. Selwyn Gummer), my hon. and learned Friend the Member for Buckinghamshire, South (Mr. Ronald Bell), my hon. Friends the Members for Yarmouth (Mr. Fell) and Epping (Mr. Tebbit). I pay tribute also to the hon. Member for Liverpool, Kirkdale (Mr. Dunn) for his authentic views.
The costs of all the factors in the Government's policy—including the general practitioners' services, free supplies for the domiciliary services, and the administration—have, of course, been included in the estimate given to the House. I assure the hon. Member for Willesden, West (Mr. Pavitt), whose sincerity is not in question, that no bureaucracy is involved in this policy. The clinics already charge. They will act under the National Health Service, and I hope that large numbers of volunteers will continue to serve, but 203 I can confirm that no extra process will be involved.
The principal issue tonight remains as it did before—between those who believe that the 20p will stand between some women and contraception and those who do not. The hon. Members for Wolverhampton, North-East (Mrs. Renée Short) and Pontypool (Mr. Abse), and my hon. Friend the Member for Hampstead (Mr. Geoffrey Finsberg), all in differing degrees, prayed in aid common sense, common experience or the free zones that 32 local authorities are now running. There is no doubt that the free services have attracted large extra demand. That is because in practically all cases they have used a great deal of extra publicity and because, above all, the alternative to going to these clinics is to buy the contraceptives commercially not at 20p, 40p or 60p a year, but at £4, £6 or £8 a year, as is now the commercial charge.
My hon. Friend the Member for The Wrekin (Dr. Trafford) rightly said that the local authority free zones are not experiments with proper control arrangements. There is no evidence from them that merely because the supply is free it will reach those who are in all of our minds. The House must bear in mind that we are to provide supplies at 20p for everyone, with free supplies for those who are identified as being without motivation and therefore in need of encouragement. But the maximum anyone would have to pay would be 20p and this seems to me totally to invalidate the argument that my hon. Friend the Member for Hampstead feels so strongly about—that the local authority free zones are a pattern that we should follow.
The hon. Member for Pontypool argued that there are not just two groups—the motivated and the non-motivated—but a third "grey" group of people who are neither. One of our biggest intentions, however, is so to expand what I call, for shorthand, the domiciliary services that the professional workers involved—through clinics, through hospitals, through those GPs who are willing to co-operate, and through social workers, health visitors, district nurses and the probation service—will identify, so far as is practicable, those who are not motivated, and thus will reach, we hope, not 204 in every case but in most cases, those who need our help.
The hon. Member for Liverpool, West Derby (Mr. Ogden), in a brief intervention, asked how we could possibly justify helping with subsidies those who did not need help, and giving supplies at no cost to those who do not ask for help. We do not need to reach out far for justification. To help the non-motivated to protect against pregnancies they do not want is in their interests and is in the public interest and that is why we have every justification for what we are doing.
I turn finally to the arguments of the right hon. Member for Deptford (Mr. John Silkin) which, had they been valid, would have been formidable. I think that my hon. Friend the Member for The Wrekin dealt effectively with most of them.
§ 11.45 p.m.
§ The right hon. Gentleman said that we were getting into a muddle with the general practitioners—that they had rejected the chance to co-operate in a contraceptive service, and that we would fail because in our plans we had depended on them and they would not be working with us. That would be to misrepresent the position.
§ Mr. John Silkin
It would be to misrepresent it—but I did not say it.
§ Sir K. Joseph
I think that the general purport of the right hon. Gentleman's argument was that I had counted excessively on their co-operation and had under-estimated what their co-operation would cost. In our estimates we have taken into account what we think the cost will be of a general practitioner service. We are discussing with the GPs the pattern they may be willing to fall in with. We have assumed such a charge.
The fact is that large numbers of GPs offer contraceptive advice no one forces them to do so if they do not wish it—to their patients in their surgeries, and that large numbers co-operate voluntarily—though for pay—in family planning clinics. We expect both these habits to continue.
I must ask the House to face reality. Both the House of Lords and those in this House who argue for a free service 205 are asking the Government to suppose, quite wrongly, that a free service will achieve a larger fall in unwanted pregnancies, illegitimacies and abortions than a service on prescription charges. These assumptions are wrong. The casual and the overwhelmed will not use the service whether it is free or at 20p. They will not in any case, be charged. We shall reach to them and seek to persuade them, through clinics and domiciliary services,
§ to use the service which, for them, will be free. I hope the House will stick to the decision which, on the merits, we have twice reached.
§ Question put, That this House doth disagree with the Lords in the said amendment to the Commons amendment:—
§ The House divided: Ayes 247, Noes 220.209
|Division No. 181.]||AYES||[11.48 p.m.|
|Adley, Robert||Farr, John||Lane, David|
|Alison, Michael (Barkston Ash)||Fell, Anthony||Langford-Holt, Sir John|
|Allason, James (Hemel Hempstead)||Fenner, Mrs. Peggy||Lewis, Kenneth (Rutland)|
|Amery, Rt. Hn. Julian||Fisher, Nigel (Surbiton)||Lloyd, Ian (P'tsm'th, Langstone)|
|Archer, Jeffrey (Louth)||Fletcher-Cooke, Charles||Luce, R. N.|
|Astor, John||Fookes, Miss Janet||MacArthur, Ian|
|Atkins, Humphrey||Fortescue, Tim||McCrindle, R. A.|
|Baker, Kenneth (St. Marylebone)||Foster, Sir John||McLaren, Martin|
|Baker, W. H. K. (Banff)||Fowler, Norman||Macmillan, Rt. Hn. Maurice (Farnham)|
|Barber, Rt. Hn. Anthony||Fox, Marcus||McNair-Wilson Michael|
|Batsford, Brian||Galbraith, Hn. T. G. D.||McNair-Wilson, Patrick (New Forest)|
|Bell, Ronald||Gardner, Edward||Maddan, Martin|
|Bennett, Dr. Reginald (Gosport)||Gibson-Watt, David||Madel, David|
|Benyon, W.||Gilmour, Ian (Norfolk, C.)||Mahon, Simon (Bootie)|
|Berry, Hn. Anthony||Gilmour, Sir John (Fife, E.)||Marples, Rt. Hn. Ernest|
|Biffen, John||Glyn, Dr. Alan||Marten, Neil|
|Biggs-Davison, John||Godber, Rt. Hn. J. B.||Mather, Carol|
|Blaker, Peter||Goodhart, Philip||Maudling, Rt. Hn. Reginald|
|Boardman, Tom (Leicester, S.W.)||Gorst, John||Mawby, Ray|
|Body, Richard||Gower, Raymond||Meyer, Sir Anthony|
|Boscawen, Hn. Robert||Grant, Anthony (Harrow, C.)||Mills, Peter (Torrington)|
|Bossom, Sir Clive||Gray, Hamish||Miscampbell, Norman|
|Braine, Sir Bernard||Green, Alan||Mitchell, Lt.-Col. C. (Aberdeenshire, W)|
|Bray, Ronald||Griffiths, Eldon (Bury St. Edmunds)||Mitchell, David (Basingstoke)|
|Brinton, Sir Tatton||Grylls, Michael||Moate, Roger|
|Brocklebank-Fowler, Christopher||Gummer, J. Selwyn||Money, Ernie|
|Brown, Sir Edward (Bath)||Gurden, Harold||Monks, Mrs. Connie|
|Bruce-Gardyne, J.||Hall, Miss Joan (Keighley)||Monro, Hector|
|Bryan, Sir Paul||Hall, Sir John (Wycombe)||Montgomery, Fergus|
|Buchanan-Smith, Alick (Angus, N & M)||Halt-Davis, A. G. F.||More, Jasper|
|Buck, Antony||Hamilton, Michael (Salisbury)||Morgan, Geraint (Denbigh)|
|Bullus, Sir Eric||Harrison, Brian (Maldon)||Morgan-Giles, Rear-Adm.|
|Butler, Adam (Bosworth)||Harrison, Col. Sir Harwood (Eye)||Mudd, David|
|Campbell, Rt. Hn. G.(Moray & Nairn)||Haselhurst, Alan||Murton, Oscar|
|Carlisle, Mark||Havers, Sir Michael||Nabarro, Sir Gerald|
|Carr, Rt. Hn. Robert||Hawkins, Paul||Neave, Airey|
|Channon, Paul||Hayhoe, Barney||Nicholls, Sir Harmer|
|Chapman, Sydney||Heath, Rt. Hn. Edward||Noble, Rt. Hn. Michael|
|Chataway, Rt. Hn. Christopher||Heseltine, Michael||Nott, John|
|Chichester-Clark, R.||Higgins, Terence L.||Onslow, Cranley|
|Churchill, W. S.||Holland, Philip||Oppenhelm, Mrs. Sally|
|Clark, William (Surrey, E.)||Holt, Miss Mary||Osborn, John|
|Clarke, Kenneth (Rushcliffe)||Hordern, Peter||Owen, Idris (Stockport, N.)|
|Cockeram, Eric||Hornsby-Smith, Rt. Hn. Dame Patricia||Page, Rt. Hn. Graham (Crosby)|
|Cohen, Stanley||Howe, Rt. Hn. Sir Geoffrey||Parkinson, Cecil|
|Cooper, A. E.||Howell, David (Guildford)||Percival, Ian|
|Cordle, John||Howell, Ralph (Norfolk, N.)||Peyton, Rt. Hn, John|
|Cormack, Patrick||Hutchison, Michael Clark||Pike, Miss Mervyn|
|Costain, A. P.||Irvine, Bryant Godman (Rye)||Pink, R. Bonner|
|Critchley, Julian||James, David||Powell, Rt. Hn. J. Enoch|
|Crouch, David||Jenkin, Rt. Hn. P. (W'st'd & W'df'd)||Price, David (Eastleigh)|
|Davies, Rt. Hn. John (Knutsford)||Johnson Smith, G. (E. Grinstead)||Prior, Rt. Hn. J. M. L.|
|d'Avigdor-Goldsmid, Sir Henry||Jones, Arthur (Northants, S.)||Proudfoot, Wilfred|
|d'Avigdor-Goldsmid, Maj.-Gen.Jack||Jopling, Michael||Pym, Rt. Hn. Francis|
|Dean, Paul||Joseph, Rt. Hn. Sir Keith||Raison, Timothy|
|Deedes, Rt. Hn. W. F.||Kaberry, Sir Donald||Ramsden, Rt. Hn. James|
|Dixon, Piers||Kellett-Bowman, Mrs. Elaine||Rawlinson, Rt. Hn. Sir Peter|
|Drayson, G. B.||Kershaw, Anthony||Redmond, Robert|
|du Cann, Rt. Hn. Edward||King, Evelyn (Dorset, S.)||Rees, Peter (Dover)|
|Dykes, Hugh||King, Tom (Bridgwater)||Rees-Davies, W. R.|
|Eden, Rt. Hn. Sir John||Kinsey, J. R.||Ridley, Hn. Nicholas|
|Edwards, Nicholas (Pembroke)||Kitson, Timothy||Ridsdale, Julian|
|Elliot, Capt. Walter (Carshalton)||Knight, Mrs. Jill||Rippon, Rt. Hn. Geoffrey|
|Emery, Peter||Knox, David||Roberts, Michael (Cardiff, N.)|
|Eyre, Reginald||Lamont, Norman||Roberts, Wyn (Conway)|
|Rost, Peter||Tapsell, Peter||Welder, David (Clitheroe)|
|Russell, Sir Ronald||Taylor, Sir Charles (Eastbourne)||Wall, Patrick|
|St. John-Stevas, Norman||Taylor, Edward M. (G'gow, Cathcart)||Walters, Dennis|
|Scott, Nicholas||Taylor, Frank (Moss Side)||Ward, Dame Irene|
|Shaw, Michael (Scth'gh & Whitby)||Taylor, Robert (Croydon, N.W.)||Wells, John (Maidstone)|
|Shelton, William (Clapham)||Tebbit, Norman||White, Roger (Gravesend)|
|Shersby, Michael||Temple, John M.||Whitelaw, Rt. Hn. William|
|Simeons, Charles||Thatcher, Rt. Hn. Mrs. Margaret||Wiggin, Jerry|
|Skeet, T. H. H.||Thomas, John Stradling (Monmouth)||Wilkinson, John|
|Smith, Dudley (W'wick & L'mington)||Thomas, Rt. Hn. Peter (Hendon, S.)||Wolrige-Gordon, Patrick|
|Soref, Harold||Thompson, Sir Richard (Croydon, S.)||Wood, Rt. Hn. Richard|
|Speed, Keith||Tilney, John||Woodnult, Mark|
|Spence, John||Trafford, Dr. Anthony||Worsley, Marcus|
|Sproat, Iain||Trew, Peter||Wylie, Rt. Hn. N. R.|
|Stainton, Keith||Tugendhat, Christopher||Younger, Hn. George|
|Stanbrook, Ivor||Turton, Rt. Hn. Sir Robin||TELLERS FOR THE AYES:|
|Stewart-Smith, Geoffrey (Belper)||Vaughan, Dr. Gerard||Mr. Bernard Weatherill and|
|Stokes, John||Waddington, David||Mr. Walter Clegg.|
|Abse, Leo||Finsberg, Geoffrey (Hampstead)||Maclennan, Robert|
|Allaun, Frank (Salford, E.)||Fisher, Mrs. Doris (B'ham, Ladywood)||McMillan, Tom (Glasgow, C.)|
|Archer, Peter (Rowley Regis)||Fitch, Alan (Wigan)||McNamara, J. Kevin|
|Ashton, Joe||Fletcher, Ted (Darlington)||Mallalieu, J. P. W. (Huddersfield, E.)|
|Atkinson, Norman||Foot, Michael||Marks, Kenneth|
|Bagler, Gordon A. T.||Forrester, John||Marquand, David|
|Barnett, Guy (Greenwich)||Fraser, John (Norwood)||Marsden, F.|
|Barnett, Joel (Heywood and Royton)||Freeson, Reginald||Marshall, Dr. Edmund|
|Baxter, William||Garrett, W. E.||Mason, Rt. Hn. Roy|
|Benn, Rt. Hn. Anthony Wedgwood||Gilbert, Dr. John||Maxwell-Hyslop, R. J.|
|Bennett, James (Glasgow, Bridgeton)||Ginsburg, David (Dewsbury)||Mayhew, Christopher|
|Bidwell, Sydney||Gourley, Harry||Meacher, Michael|
|Bishop, E. S.||Grant, George (Morpeth)||Mellish, Rt. Hn. Robert|
|Blenkinsop, Arthur||Grant, John D. (Islington, E.)||Mikardo, Ian|
|Booth, Albert||Griffiths, Eddie (Brightside)||Miller, Dr. M. S.|
|Boothroyd, Miss B. (West Brom.)||Grimond, Rt. Hn. J.||Milne, Edward|
|Bowden, Andrew||Hamilton, William (Fife, W.)||Mitchell, R. C. (S'hampton, Itchen)|
|Bradley, Tom||Hamling, William||Molloy, William|
|Brown, Robert C. (N'c'tle-u-Tyne, W.)||Hardy, Peter||Morgan, Elysian (Cardiganshire)|
|Brown, Hugh D. (G'gow, Proven)||Harrison, Walter (Wakefield)||Morris, Alfred (Wythenshawe)|
|Brown, Ronald (Shoreditch & F'bury)||Hart, Rt. Hn. Judith||Morris, Charles R. (Openshaw)|
|Buchan, Norman||Hattersley, Roy||Morris, Rt. Hn. John (Aberavon)|
|Butler, Mrs. Joyce (Wood Green)||Hatton, F.||Morrison, Charles|
|Callaghan, Rt. Hn. James||Healey, Rt. Hn. Denis||Moyle, Roland|
|Cant, R. B.||Heifer, Eric S.||Mulley, Rt. Hn. Frederick|
|Carmichael, Nell||Hooson, Emlyn||Murray, Ronald King|
|Carter, Ray (Birmingh'm, Northfield)||Horam, John||Oakes, Gordon|
|Carter-Jones, Lewis (Eccles)||Hornby, Richard||Oram, Bert|
|Castle, Rt. Hn. Barbara||Houghton, Rt. Hn. Douglas||Orme, Stanley|
|Clark, David (Colne Valley)||Huckfield, Leslie||Oswald, Thomas|
|Cocks, Michael (Bristol, S.)||Hughes, Rt. Hn. Cledwyn (Anglesey)||Owen, Dr. David (Plymouth, Sutton)|
|Coleman, Donald||Hughes, Robert (Aberdeen, N.)||Padley, Walter|
|Concannon, J. D.||Hughes, Roy (Newport)||Palmer, Arthur|
|Conlan, Bernard||Janner, Greville||Pannell, Rt. Hn. Charles|
|Coombs, Derek||Jeger, Mrs. Lena||Pardoe, John|
|Cox, Thomas (Wandsworth, C.)||Jenkins, Rt. Hn. Roy (Stechford)||Parker, John (Dagenham)|
|Crawahaw, Richard||Jessel, Toby||Parry, Robert (Liverpool, Exchange)|
|Cronin, John||John, Brynmor||Pavitt, Laurie|
|Crossman, Rt. Hn. Richard||Johnson, James (K'ston-on-Hull, W.)||Perry, Ernest G.|
|Cunningham, G. (Islington, S.W.)||Johnson, Walter (Derby, S.)||Prentice, Rt. Hn. Reg|
|Cunningham, D. J. A. (Whitehaven)||Jones, Barry (Flint, E.)||Prescott, John|
|Dalyell, Tam||Jones, Rt. Hn. Sir Elwyn (W. Ham, S.)||Price, William (Rugby)|
|Davidson, Arthur||Jones, Gwynoro (Carmarthen)||Probers, Arthur|
|Davies, Denzil (Llanelly)||Jones, T. Alec (Rhondda, W.)||Quennell, Miss J. M.|
|Davies, Ifor (Gower)||Kelley, Richard||Radice, Giles|
|Davis, Clinton (Hackney, C.)||Kerr, Russell||Reed, D. (Sedgefield)|
|Davis, Terry (Bromsgrove)||Kinnock, Nell||Reed, Laurance (Bolton, E.)|
|Deakins, Eric||Lamble, David||Rees, Merlyn (Leeds, S.)|
|de Freitas, Rt. Hn. Sir Geoffrey||Lamborn, Harry||Richard, Ivor|
|Dell, Rt. Hn. Edmund||Lamond, James||Roderick, Caerwyn E.(Brc'n & R'dnor)|
|Dormand, J. D.||Latham, Arthur||Rodgers, William (Stockton-on-Tees)|
|Douglas, Dick (Stirlingshire, E.)||Lawson, George||Ross, Rt. Hn. William (Kilmarnock)|
|Douglas-Mann, Bruce||Lestor, Miss Joan||Rowlands, Ted|
|Driberg, Tom||Lipton, Marcus||Sandelson, Neville|
|Dunnett, Jack||Lomas, Kenneth||Sheldon, Robert (Ashton-under-Lyne)|
|Edelman, Maurice||Lyon, Alexander W. (York)||Shore, Rt. Hn. Peter (Stepney)|
|Edwards, Robert (Bliston)||Lyons, Edward (Bradford, E.)||Short, Rt. Hn. Edward (N'c'tle-u-Tyne)|
|Edwards, William (Merioneth)||Mabon, Dr. J. Dickson||Short, Mrs. Renée (W'hampton, N. E.)|
|Ellis, Tom||McCartney, Hugh||Silkin, Rt. Hn. John (Deptford)|
|English, Michael||Machin, George||Silkin, Hn. S. C. (Dulwich)|
|Ewing, Harry||Mackenzie, Gregor||Sillars, James|
|Fernyhough, Rt. Hn. E.||Mackintosh, John P.||Silverman, Jullus|
|Sinclair, Sir George||Swain, Thomas||Wallace, George|
|Skinner, Dennis||Thomas, Rt. Hn. George (Cardiff, W.)||Watkins, David|
|Smith, John (Lanarkshire, N.)||Thomas, Jeffrey (Abertillery)||Weitzman, David|
|Spearing, Nigel||Thorpe, Rt. Hn. Jeremy||Whitehead, Philip|
|Spriggs, Leslie||Tinn, James||Whitlock, William|
|Stallard, A. W.||Tope, Graham||Williams, Alan (Swansea, W.)|
|Steel, David||Torney, Tom||Williams, W. T. (Warrington)|
|Stoddart, David (Swindon)||Tuck, Raphael||Wilson, Alexander (Hamilton)|
|Stott, Roger (Westhoughton)||Varley, Eric G.||Wilson, William (Coventry, S.)|
|Strang, Gavin||Wainwright, Edwin||TELLERS FOR THE NOES:|
|Strauss, Rt. Hn. G. R.||Walden, Brian (B'm'ham, All Saints)||Mr. Joseph Harper and|
|Stuttaford, Dr. Tom||Walker, Harold (Doncaster)||Mr. John Golding.|
|Summerskill, Hn. Dr. Shirley|
§ Question accordingly agreed to.