§ Mr. Roland Moyle (Lewisham, East)I beg to move, That an humble Address be presented to Her Majesty. praying that the National Health Service (Charges for Drugs and Appliances) Regulations 1980 (S.I., 1980, No. 1503), dated 10 October 1980, a copy of which was laid before this House on 27 October, in the last Session of Parliament, be annulled.
I place on record the intense annoyance that we feel that the charges came into operation yesterday and that we are debating the order nearly 48 hours later. That is not good enough. It underlines the increasing contempt of the House of Commons by the Government and it reinforces our opinion of the attitudes of the Secretary of State for the Environment and the Chancellor of the Exchequer in recent weeks. We do not expect this to happen again.
There is a growing difference between the attitude of the Government and that of the Opposition to National Health Service policy. Government Members say that they intend to move towards a system under which the health care received by an individual is based upon what he can afford to pay through an insurance system. Regular increases in prescription charges are a preparation for a system under which people receive the health care that they can afford rather than the care that they need.
Government and Opposition policies on prescription charges are diverging sharply. Prescription charges were fixed at 20p per item in 1971 by the right hon. Member for Leeds, North-East (Sir K. Joseph). We fought the 1974 election on phasing out prescription charges. Between 1974 and 1979, no increase in prescription charges took place. Inflation was allowed to erode their value substantially. Consequently, we fought the 1979 election on the basis that we would abolish the charges if we were returned to office.
It is worth recalling that a bare 18 months ago prescription charges were 20p per item. They are now five times that amount. That is almost equal to the size and speed of the oil price increases in the 1974–75 period. There are consequences. We are indebted to the Office of Health Economics for the figures that it has provided for the debate. It is not exactly affiliated to the Labour Party. It is one of the many pharmaceutical organisations that are united in their total opposition to the increase in charges. It is interesting to note that in 1978 the number of prescriptions dispensed was 378 million. Following the first year of Conservative Government policy on prescription charges, the figure for 1979 had fallen to 372 million. That is a difference of 6 million prescriptions. I believe that there is a Government estimate that, following upon this latest increase, there will be a further decline of 12 million prescriptions in the ensuing 12 months. The Minister for Health is shaking his head. He will have the chance to explain his view. The evidence that we have to hand shows a sharp decline in prescriptions as a result of the charges.
§ The Minister for Health (Dr. Gerard Vaughan)The right hon. Gentleman has been reading the Pharmaceutical Journal of 22 November, which forecast a reduction of 12 million prescriptions.
§ Mr. MoyleThat is true, but the Pharmaceutical Society of Great Britain attributes the forecast to the Government.
219 Who are the people who are no longer obtaining prescriptions because of the increased charges? It is not an across-the-board reduction but a reduction concentrated entirely on those who have to pay for prescriptions. As the charge rises, the proportion of people able to enjoy free prescriptions is rising rapidly. In March 1980, 66 per cent. of prescriptions avoided charges. In August 1980, the figure had risen to 70 per cent. It is those who have to pay for their prescriptions who are ceasing to obtain them through the National Health Service. That leads to unqualified prescribing, which has its own dangers. It may lead to inadequate treatment, which eventually may be halted only by hospital treatment at a cost of £300 a week. That is false economics.
The Royal Commission on the National Health Service supports our attitude. It took not a moralistic attitude towards prescription charges but a practical attitude. On page 342 it of its report, it states:
Indeed, we feel that, particularly with the irrational structure of charges we now have, there is a good case for their gradual but complete extinction, and we so recommend.That was the most recent and thorough examination of the Health Service by a group of outside experts. They totally reject the policy on which the Government have embarked.Charges do not reduce frivolous use of the Health Service. All use of the Health Service, especially medicines, is based on the advice of the medical profession. People who are not advised by their doctors to take medicines are in no position to obtain any part of the vast range of medicines that are available. Those who are urged by their doctors to take medicines are under considerable pressure to obtain the medicines and take them. There is no lay market available to be stimulated by a price reduction or damped down by a price increase.
If there is frivolous use of the Health Service, it is based entirely on the medical profession's advice, and, therefore, incentives and disincentives should be directed towards doctors. Admittedly, that is a difficult problem, which has challenged the capacities of successive Secretaries of State and has not been solved. It is sloppy thinking to try to control that by applying prescription charges to patients who are in the hands of the medical profession either for primary care or for hospital treatment.
There are practical arguments, but the Opposition's argument is a moral one. We believe that it is wrong to deny health care by fixing a price tag to medicines. Medicines and the whole of the National Health Service should be provided out of taxation, which is levied according to means, and should be free at the time of usage. That is the battle that we are striving to win. Sometimes we do not achieve our objectives, but that is the main objective.
Prescription charges have nothing to do with economics. The Pharmaceutical Society of Great Britain and its negotiating committee say bluntly that they are a tax on medicines. If they are a tax, they are a doubly regressive tax. They are regressive because they are a poll tax in the same way as national insurance employee contributions, which are the same whether one is rich or poor. Whether one is rich or poor, except for those on supplementary benefit, one pays the same amount for prescriptions, which was increased to £1 yesterday.
220 Prescription charges are a regressive tax not only in that sense, because they are levied when someone is ill and possibly out of work. He or she may possibly be on a falling income. The figures tabled by the Office of Health Economics confirm that this tax is having a deleterious effect. About 6 million prescriptions that should have been taken from the NHS as a result of advice given by doctors are not being taken. By this time next year, the number may increase to 17 million or 18 million. That is because there is a tax of £1 on each item prescribed by the doctor. That can be extremely costly.
The Government defend themselves by referring to those receiving social security benefits and low income groups who are exempt from prescription charges. What about the income groups immediately above supplementary benefit level? They often have serious economic problems and find that they can make ends meet only by doing without medicines that their doctor advises them to take.
It is particularly bad that the policy should be applied now, because the nation is entering a slump. As incomes are declining, charges are rocketing. There has been a 500 per cent. increase in 18 months. There is a public sector wages policy of a 6 per cent. cash limit that the Government are trying to impose. However, even in this one recent step there has been a 30 per cent. increase in the cost of medicines. If the Government want to get themselves into difficulties with their wages policy, that is up to them. The Opposition are here to ensure, as far as we can, that no one is denied access to medical care when it is needed.
I have one or two questions and a suggestion to put to the Minister. First, a rumour is being carried by the pharmaceutical press — it believes in it — that the Government are thinking of withdrawing the exemption from the prescription tax for those on the State retirement pension. Is that true? We ask for a categorical statement from the Government on that.
Secondly, in the light of the substantial increase in prescription charges, are the Government to open discussions with the medical profession to increase the number of chronic ailments that are exempt from prescription charges? Such action is long overdue. The list is short. There are many chronic ailments that are outside the scope of the existing list. I appeal to the medical profession to co-operate with the Government if they go ahead with that. That is a palliative only. The best thing would be for the Government to get away entirely from the policy that they are following.
Thirdly, with a prescription charge of £1 per item it may be that a doctor prescribes several items, each of which has to be paid for. The patient will have to pay several pounds to get his basket of prescriptions. If the patient tells the doctor that he cannot afford that basket of prescriptions, the doctor may be able to tell him that he can leave out one item. However, the patient may not discover that the £1 per item will be levied until he sees the pharmacist. Should the pharmacist tell him to go back to his doctor or advise him which of the prescriptions should be dropped, so that the total can be brought within the price that the patient can afford? The DHSS, the BMA and the Pharmaceutical Society of Great Britain should get together to try to work out a code of practice to advise pharmacists on their conduct in such a situation, which will become increasingly frequent.
221 I saw in The Times yesterday that the Prime Minister was comparing the state of the nation with
the rough ride of the patient A ho is ill and taking medicine who for a time is suffering from the illness and the medicine.An increasing number of her electorate in Finchley would very much like to have the chance to suffer from both the illness and the medicine. Such people are decreasing in number. They are put off by what is, in effect, a prescription tax, designed not for any economic purpose but purely to raise taxes while pretending not to do so.In the meantime, the right hon. Lady is supposed to be preparing us for a brave new world and is dishing out medicine of a sort. What she is doing — and these prescription charges are part of the package—is doing the nation with, an economic thalidomide in preparation a for that brave new world. There will be no compensation for the warped victims of the consequences of the policy.
The Secretary of State is an ex-Treasury Minister. He has had long experience at the Treasury. He should know more than mw t that the proper people to raise revenue are the Board of Inland Revenue or the Board of Customs and Excise. Will the Minister convey to the Secretary of State for Social Services that it is high time that he went back to his old Department and told those there that he is not a tax collector? They are, and they had better relieve him
§ Mr. Paul Dean (Somerset, North)The right hon. Member for Lewisham. East (Mr. Moyle) has repeated his party's pledge to abolish prescription charges. How quickly the right hon. Gentleman forgets his past. Who first introduced prescription charges? It was a Labour Government. Who kept those charges year after year? It was a Labour Government.
§ Mr. Stanley Orme (Salford, West)We did not increase them.
§ Mr. DeanThe right hon. Gentleman had better be rather careful about his interventions. He cannot deny that a Labour Government first introduced prescription charges. Equally, he cannot deny that when he was a Minister his Administration kept prescription and other charges. How quickly right hon. Gentlemen forget their past.
No one likes putting up charges for anything, but both Labour and Conservative Governments have found charges essential in maintaining the fabric of the National Health Service, They have found them in practice to be an important source of revenue.
The right hon. Member for Lewisham, East said that prescription charges have nothing to do with economics. If so, why did vie Labour Government not abolish charges during the long years when they were in Government? This prayer tonight is wholly bogus. The Labour Parry's record in the past shows that very clearly.
It is important to take into account not only the fact that Labour and Conservative Governments have found this to be an important source of revenue but that substantial exemptions exist. My hon. Friend the Minister for Health will no doubt be able to confirm, when he replies, that about 70 per cent. of prescriptions are exempt from the charges. In other words, it is only those who can reasonably be expected to afford the charges who pay them.
The exemptions are clear from the regulations that we are debating. They include all people under the age of 16. 222 They include men over the age of 65 and women over the age of 60. They include expectant mothers and mothers with children under the age of one year. Exemptions are available for a number of medical conditions which are listed in regulation 7. There are exemptions for those who have certificates for accepted disablement. There are exemptions for all members of a family in receipt of family income supplement. There are exemptions for all those who are in receipt of supplementary pensions or allowances. The Government, in other words, have identified all the vulnerable groups and have ensured that they will get their prescriptions entirely free.
I hope that my hon. Friend, when he replies, will he able to scotch the rumour to which the right hon. Gentleman referred and that he will be able to assure the House that the exemptions that I have read out are a correct interpretation of the position.
§ Mr. Lewis Carter-Jones (Eccles)Does the hon. Gentleman agree that some of the exemptions which are missing are very worrying? For example, multiple sclerosis is not included. If the diseases which ought to be included were included, would there not be a case for saying that the economic savings are counter-productive and that to find out who is to be exempted costs more than the saving on prescriptions?
§ Mr. DeanI share the hope of the hon. Gentleman that it will be possible to increase the number of medical conditions that can be exempted from the prescription charges. My hon. Friend may be able to say more about that in his reply.
My point is that the main vulnerable groups in our community are already exempted from the charges. I understood that the £1 payment that is proposed will represent about one-third of the average cost. Therefore, the Government's proposition does not seem to be unreasonable. But, clearly, the higher the prescription charge becomes, the greater the number of prescriptions which may cost less than the £1 charge. I hope that if a significant number of prescriptions cost less than £1, it will be possible for my hon. Friend to make arrangements so that the people concerned—possibly by means of private arrangements with the pharmacists—will be able to pay the cost of the prescription rather than the cost-plus whatever is the difference between the cost and £1.
It seems that we are being asked to agree to a reasonable contribution from those who can afford to pay towards maintaining the National Health Service. That is directly related to the announcement that was made by my right hon. and learned Friend the Chancellor of the Exchequer last week. The one service that was exempted from the 2 per cent. cut in public expenditure was the National Health Service. One of the reasons why the Government have been able to maintain the real value of expenditure on the National Health Service is that this increase in prescription charges will bring about an additional modest contribution. That is right, and I am delighted that the Government have been able to make that exception for the National Health Service. It is right because demand continues to increase.
We all know from our constituency correspondence that there are still many people awaiting operations and anxiously awaiting treatment of various sorts. These regulations make a modest contribution towards reducing 223 the waiting lists. [HON. MEMBERS: No."] I congratulate the Government on the reductions in the waiting lists that have already taken place since they took office.
Do the Opposition really want to increase the waiting lists again? Do they really want to deny these additional resources to the National Health Service? If they had any sense of reality and any regard to their past, they would be ashamed of this prayer to annul the regulations. If they persist in voting for the prayer, I shall have no hesitation in voting for the regulations and in voting for more money for the National Health Service.
§ Mr. David Ennals (Norwich, North)The speech of the hon. Member for Somerset, North (Mr. Dean) was below his normal standard. He said that no Government wanted to increase prescription charges. Let us look at what happened. The Government of which I was proud to be a member inherited prescription charges of 20p, and they remained at 20p for nearly six years. This Government have increased prescription charges three times—first to 40p, then to 70p and then to £1, an increase of 500 per cent. —in the last 18 months. The hon. Gentleman said that the Government do not want to increase the charges, but they are certainly prepared to do things that they do not want to do. They are also prepared to do things that during the election campaign the Prime Minister suggested that they would not do. [HON. MEMBERS: "That is right."]
During the election campaign, I told the Prime Minister that in my view the Conservatives would increase prescription charges. The right hon. Lady, then the Leader of the Opposition, said that she had no plans to do so. Those were weasel words of the worst order. Perhaps she had no plans to increase prescription charges, but the Secretary of State — whose absence from the Front Bench is surprising on an issue such as this—had plans to do so. He had one plan to put up the charge to 40p, another plan to put it up to 70p and a third plan to put it up to £1. In addition, the higher charges have made their contribution — modest though it is — to pushing up inflation, which the Government say they are trying to reduce.
The Government decided on these courses of action for two perfectly clear reasons. The first was to make the sick pay for their illness. We on the Labour Benches believe that it is morally wrong to do that. If more money must be raised for the Health Service, it should be raised from everyone—from the taxpayers—and not simply from those who suffer the inconvenience of being sick. As my hon. Friend the Member for Eccles (Mr. Carter-Jones) pointed out, many people are outside the exemptions.
The second reason was to deter people from taking medicines that they need. My right hon. Friend the Member for Lewisham, East (Mr. Moyle) has quoted from the Office of Health Economics to show that even before the £1 charge people were not taking prescriptions given to them by their doctors. I have been asking my GP and my local chemists about the reaction. Already they are faced with the difficulty of the patient who has four prescriptions, cannot afford to pay for all of them and asks which is the most important. That is no decision for a 224 chemist to take. That is why the pharmacists strongly oppose the Government's action, as do the doctors and the Office of Health Economics.
The hon. Member for Somerset, North pointed out that nearly 70 per cent. of patients are exempt. They number about 35 million, but about 20 million have to pay the new charge. The selection of many of the exempt categories is highly arbitrary. For instance, diabetics and epileptics do not pay, but anyone suffering the inconvenience of being a schizophrenic must pay. There is no logic in the system. Perhaps it did not matter when the charge was 20p, but it makes a lot of difference now that it is five times that amount.
With the charge at £1, the absurdity arises that, unless the Minister gives the reassurance sought by the hon. Member for Somerset, North, patients will pay more for some prescriptions than the items would cost if purchased. A whole list of medical items—pain-killers, laxatives and pills for cardiovascular conditions, for example—would cost the patient less over the counter than if they were prescribed by the doctor. Panadol is an example. Twenty-four tablets of the pain-killer cost 39p from a chemist or supermarket, but from yesterday a non-exempt patient acquiring them with a prescription will have to pay 61p more.
I submit that the Government have taken a shameful decision. I fear that this is just another step in introducing not only higher but more charges. It is a way of moving the burden of paying for the Health Service on to the sick and away from the generality of taxpayers. We are strongly opposed to that principle, and I hope that my right hon. and hon. Friends will vote against it in great strength.
§ Mr. R. A. McCrindle (Brentwood and Ongar)Before turning my attention to the details of the prayer, I should like to clear my mind on the differences between the two sides of the House on this matter.
I listened with care to the right hon. Member for Lewisham, East (Mr. Moyle), a former Minister for Health, particularly when he said that there were growing differences between the Government and the Opposition on this matter. I cast my mind back to the time when the right hon. Gentleman had responsibility to decide—no doubt, in consultation with Cabinet colleagues—whether prescription charges should be phased out or increased. For reasons that he has tried to explain, they were neither phased out nor increased.
The great burden of the right hon. Gentleman's complaint seems to be that prescription charges are now being increased in what he would no doubt describe as a fairly dramatic way. I cannot square that with what he then said about there being a moral objection. If the Opposition are putting forward a moral objection, surely it is a question not that the charge was 20p when they were in office and its being £1 when we are in office but that under a Labour Government there should not have been the slightest suggestion of there being a prescription charge at all. Yet, looking at the history of this matter, we find that the Labour Government not only kept a prescription charge in being but actually introduced it in the first place.
It is proper for us to have differences about prescription charges, but it is going too far to suggest that the difference is based on a moral objection. Whatever else it may be, it clearly cannot be a moral objection, unless the right hon. Gentleman and his right hon. Friend the Member for 225 Norwich, North (Mr. Ennals), the former Secretary of State for Social Services, are now admitting that they failed to remove not only a financial irritant which caused financial difficulty to many people but a matter to which they took a strong moral objection. If they are saying that they failed when in office to take any steps to remove something to which they have a moral objection, they owe more explanation to the House than has so far been forthcoming.
§ Mr. MoyleThe whole gravamen of my speech was that we failed finally to eliminate the prescription charge, but we got it so reduced that we fought the 1979 election on a pledge that if we were returned to office we would abolish it. We fought the 1974 election on the principle that we would phase out the charge, and we did phase it out as a result of inflation.
§ Mr. McCrindleThat is such an eloquent illustration of just where the Opposition stand on this matter that no words of mine could possibly advance the argument put forward by the right hon. Gentleman.
§ Mr. McCrindleI shall tell the right hon. Gentleman if he will give me time.
I think that it is legitimate to probe the real reasons behind the Opposition's prayer to annul the regulations. The right hon. Member for Lewisham, East said that his real objection to the Government increasing the prescription charge to £1 was that it is another move towards an insurance-based system. I appreciate the opposition by Labour Members to what is broadly called an insurance-based system, yet at least two of our fellow members of the EEC have thriving health provision on the basis of what could be called an insurance-based system. I refer to France and Germany. When I recall that in Germany at least there is a Social Democrat Government, I cannot see why the Opposition continue to be so totally opposed to any exploration along those lines.
Thirdly, the Opposition say that prescription charges should have nothing to do with the price of the medicine prescribed. I do not accept that that is so. Accepting that inflation has been with us during the period of office of our Predecessors and that it is still with us today, there is a very strong argument, unless the objection is one of principle, for keeping the prescription charge in some relationship to the actual cost of prescription.
My simple point is that either the Opposition are opposed to prescription charges in principle and, therefore, they have a moral objection—in which case they stand condemned by their own record during the period they were in office—or they are objecting to the size of the charge. I do not believe that they can have it both ways. The House has not yet been treated to a real examination of how the Opposition believe they can take a high moral position on something that they failed to touch during five years of Labour Government.
§ Mr. Ted Leadbitter (Hartlepool)The hon. Member's speech will no doubt be widely reported in his constituency, so, as he objects to Opposition Members describing the rise as dramatic, will he say categorically first how he would describe it; secondly, whether he categorically supports the £1 charge; and, thirdly, when his Government are apparently boasting that inflation is falling, how he substantiates a 500 per cent. increase in the charge?
§ Mr. McCrindleI am happy, first, to reassure the hon. Member that all my speeches are widely reported in my constituency.
Secondly, I believe that the level of the prescription charge at £1 in 1980, in relation to the cost of the average prescription, is not out of relationship in any greater fashion than 20p was out of relationship when that charge was introduced in 1971. If we are to have a system under which there is to be a contribution from the person requiring a prescription, it is nonsense to keep the contribution at such a level as to have no meaning in relation to the true cost of the prescription.
I shall deal during the next few minutes with some of the other points about which I have been asked, but I wanted to intervene because I find it quite remarkable that no one has yet mentioned—with the possible exception of my hon. Friend the Member for Somerset, North (Mr. Dean)—that under the very considerable cutbacks in Government expenditure which have had to be introduced the NHS has survived virtually unscathed. I believe that that can be justified only if there is to be a contribution from the user of the NHS. Charges are needed. The charge that we are discussing is not extortionate in all the circumstances.
The choice seems to be between contributing and allowing the NHS to run down. So ready are Opposition Members to remind us of the services which are being adversely affected by cutbacks in expenditure that they have failed so far to pay tribute to the fact that, amid all the difficulties, under the present Government expenditure on the NHS is being virtually maintained.
In all the circumstances, I believe that very little hardship will be created by the increase to £1 for the prescription charge. I can no more graphically describe what I mean than by reminding the House that in asking a person to pay £1 for a prescription we are asking him to pay no more than the equivalent of 1½ pints of beer or 30 cigarettes.
§ 11 pm
§ Mr. A. J. Beith (Berwick-upon-Tweed)If Conservative Members do not understand the hardship generated by the £1 prescription charge, they do not understand what it is like to live on incomes which come just above the family income supplement level and to go to a chemist with a prescription with two or three items on it at £1 each and be expected to pay £3 on every visit—and there may be quite frequent visits during a series of illnesses going through several adult members of a family. If hon. Members do not appreciate the hardship involved, they are living in a dream world.
I remind the Government first that they are going quite explicitly against an election pledge, as the right hon. Member for Norwich, North (Mr. Ennals) pointed out. It was not just the Prime Minister who made the pledge. The present Paymaster General said that a Labour Party leaflet had suggested that the Tories planned to increase prescription charges by 300 per cent. It was slightly inaccurate; it is 400 per cent. The Paymaster General commented:
This is a direct lie.Government supporters are now prepared to vote in defence of the breaking of yet another election pledge—this time the pledge that that kind of increase would not occur.227 When many people get to a chemist with a prescription which he points out, once he has deciphered the doctor's handwriting, has not one but several items on it, they will ask "Cannot you give me just one of these? Surely I do not have to have them all. Cannot you give me something over the counter which does not cost as much?" There may be items prescribed by the doctor which cost less than the prescription fee, and a helpful pharmacist will tell the patient "You do not need this on prescription. I can give you this for less than that. Throw away the prescription, and I will give it to you now." But in many other cases patients will be saying "Please give me something which does not cost as much as this."
It has happened to me. I have had pharmacists say to me "Do not hand in a prescription for that. You can get it for less than the prescription charge." Such a pharmacist is being helpful to the patient in doing that. Obviously, it is helpful to do that.
§ Mr. EnnalsDoes not the hon. Gentleman agree that in most cases that would not happen? This is taking away the rightful income of a pharmacist, who is entitled to be paid for the prescription written by the doctor, so that the burden is really placed upon him.
§ Mr. BeithThat is right. The pharmacist is doing a service to his customer and a disservice to himself in giving that advice. But I am even more worried about the position of a pharmacist who is asked by a customer "Please give me something that costs less than this lot. Surely there is something which you can give me over the counter which does not cost as much."
Another difficulty which will arise is that doctors will be put under pressure to prescribe larger quantities of drugs for which repeat prescriptions are needed, and that may be wasteful if they are not used and, even worse, may be dangerous. Larger quantities of pain-killing drugs and other materials will be left around, when previously it has been the practice of many doctors to prescribe in smaller quantities so that dangerous amounts are not left in the house. We all know the dangers involved from abuse of materials of this kind.
A great many dangers arise from both the pharmacist and the doctor trying to help a patient out of the difficulty which arises from having to pay £3 or £4 to redeem even one prescription.
For this enormous increase, we are getting no benefit in terms of new categories of exemption or, indeed, new inclusions on the list of items which can be prescribed. I have written to the Minister frequently, on the basis of my experience, about the problems of diabetics. I remind him that there are desperate pleas coining to him for certain items to be capable of being prescribed on the National Health Service. One example concerns disposable syringes. Has the Minister ever tried using a glass syringe with one hand to inject a small child because he needs the other hand to restrain the child? It is nearly impossible. As a result, many people buy disposable syringes which are not, available on prescription because that is the only way they can administer injections to small children. There are many pleas to the Minister for blood sugar monitoring strips to be available on prescription. That could save the NHS quite a bit of money if it kept diabetic patients out of hospital. But there are no inclusions on the list as a return for the heavy increase in the price of prescriptions.
228 Is the Minister doing anything else to reduce the overall cost of prescriptions, such as placing more emphasis on generic prescribing or encouraging pharmacists to supply the cheapest available version of a prescribed drug? There are many ways in which Ministers could try to keep down the costs of prescribing. The last thing they should be doing is to tell the patient who has already been advised that he needs a particular medicine that he will not be able to afford it. That is what high prescription charges mean.
One might have been able to understand the Government's position a little more readily if they had returned to the system of a charge per prescription instead of a charge per item. They have given us the worst of all worlds by providing no new exemptions, no new inclusions on the list of materials that can be prescribed and no benefit in terms of development of prescribing policy in return for a high increase in charges.
I strongly object to prescription charges as a means of financing the Health Service. I object even more strongly to this kind of ludicrous increase and the hardship that it will bring.
§ 11.6 pm
§ Mr. Alfred Dubs (Battersea, South)To get the record straight, it should be made clear that the National Health Service has suffered in real terms under this Government. VAT has been imposed on NHS expenditure, and the way in which cash limits are being applied in a period of high inflation means that in real terms the money available to the NHS is getting less and less.
I should like to get the record straight on another point. The prescription charge was raised on 1 April 1971 by a Tory Government. It stayed at that level until it was raised last year. By any standard, that means that in real terms the charge was becoming smaller and smaller. Therefore, the burden on the sick was reducing each year, and it is not true that the Labour Government had the same attitude as the present Conservative Government have.
The hon. Member for Somerset, North (Mr. Dean) was mistaken to suggest that the increase in prescription charges would make a difference to waiting lists or to NHS resources. Every hon. Member is well aware that the reason for the increase is to get the public sector borrowing requirement right or to bring sterling M3 to the right level. It has nothing to do with making the NHS operate better or with giving more resources to the NHS. There will not be one extra bed provided as a result of the additional income that will come from the heavy increase that is being imposed on sick people. Nothing we have heard tonight in any way justifies a fivefold increase in the charges.
It is clear that despite the exemptions the increase will hurt people—for example, those who are just above the exemption limit. There are many in that category. Some hon. Members will ask "What about the season ticket, the prepayment certificate?" That is being increased to £15, which is a hefty charge to impose on people who have been told that a season ticket is an easier way to cope with the burden of prescription charges.
Several hon. Members have referred to the comparison between the cost of some prescriptions and the price charged over the chemist's counter. Some general practitioners may well tell a patient "I shall not give you a prescription. Go down to the chemist and buy what is needed, and you will be OK." But some doctors fear that 229 this will reduce the authority of what they are suggesting the patient should have, and they may not want to do it, apart from whether chemists will want to do so.
Where the cost of the product is less than the £1 prescription charge, the chemist should be under pressure from the Minister to sell it over the counter rather than go through the cumbersome and bureaucratic procedure which is costly to the patient and to the taxpayer.
If the Government were serious about the costs of pharmaceuticals, they could take another tack. They could examine the extent to which general practitioners prescribe more expensive items than are necessary. There must be some reason why the drug companies put so much advertising effort into persuading general practitioners to prescribe new drugs when often they are only minutely different from drugs which are cheaper.
Some years ago, a research scientist at a university told me that he thought he had made a breakthrough in a drug for a disease. He was reluctant to publicise it because he was afraid that the drug companies would seize upon it. He could not make the idea available without the pharmaceutical companies making an enormous profit. My friend wanted to ensure that the people would derive the benefit. That is not possible. Most of the important breakthroughs in developing new drugs are made not by the drug companies but by the universities and other research institutions.
The drug companies concentrate on making only marginal improvements so that they can make a slight difference to a drug's name and advertise it. The Minister for Health shakes his head, but I should be surprised if he could provide evidence to back his opinion. If he is really serious about saving costs, he should do something about excessively expensive prescribing by general practitioners. Cheaper alternative drugs exist which are just as effective for many diseases. That is a better path than putting the burden on the sick who cannot afford the extra heavy cost which the hon. Gentleman is imposing.
§ The Minister for Health (Dr. Gerard Vaughan)We are discussing an important subject and I have followed the debate closely. The right hon. Members for Lewisham, East (Mr. Moyle) and Norwich, North (Mr. Ennals) sounded like replays of rather tired and much overplayed records. When in Opposition, Labour right hon. and hon. Members always say that prescriptions will be reduced or abolished. However, in Government they always do the opposite. That is on record. [HON. MEMBERS: "Nonsense."] It is in history.
The decision to raise the prescription charge to £1 was announced in the Chancellor of the Exchequer's Budget speech last March. I could not help noting, when the right hon. Member for Lewisham, East complained about short notice, that the application for the debate was made only on 20 November. The application was supported by only six signatures. That is not many for a debate of such importance.
It is well known that the Government's general policy on Health Service charges is that in suitable cases people who want to contribute towards health care and the cost of the National Health Service should be able to do so. At present, the average cost of a prescription item is £3.12. As my hon. Friend the Member for Somerset, North (Mr. Dean) said, a charge of £1 is less than one-third of the cost. The money raised by prescription charges contributes 230 directly to financing the Health Service. A £1 prescription will contribute savings to the National Health Service of £5 million in 1980–81 and about £30 million a year from 1981–82 onwards.
My hon. Friend the Member for Somerset, North pointed out the advantages of that in terms of patient care. I am surprised that Opposition Members did not look more concerned when he also pointed out that after five years in which waiting lists had risen every year we now have a steady fall every three months. The current waiting lists are more than 90,000 less than they were a year ago. With the increase in charges, we have not reduced the range of exemptions but have widened them slightly. I shall return to that point later.
The right hon. Member for Lewisham, East said that the increased charge would result in 12 million fewer prescriptions in a year. I do not believe that it will be anything like that. Supposing that there is a reduction in the number of prescriptions, surely that is no bad thing provided that all who need real treatment can obtain it. We cannot on the one hand say that too many—
§ Dr. Shirley Summerskill (Halifax)The Minister admits that the number of prescriptions has fallen by 6 million since charges were increased. Is he saying that previously doctors were prescribing unnecessarily? Is he saying that since the charge was imposed many people have not received necessary drugs?
§ Dr. VaughanI am surprised that the hon. Lady should ask such a question.
§ Mr. Michael Morris (Northampton, South)Will my hon. Friend remind the House that the figure of 12 million for the reduction in prescriptions sits on the memory of the right hon. Member for Lewisham, East (Mr. Moyle), because that was the fall that took place in 1968 when the right hon. Gentleman's party reintroduced prescription charges?
§ Dr. VaughanI am grateful to my hon. Friend for his remarks. I am surprised that the hon. Member for Halifax (Dr. Summerskill) should make the point that she did. She well knows the difficulties at times between doctors and patients when patients ask for prescriptions. I do not think we can say that too many people are taking too many medicines and then complain if there is some reduction in unnecessary prescribing. Personally, I welcome the increased interest by the public in how drugs are used and in economies of drug-taking. In 1978 there were 307 million prescriptions, last year there were 304.6 million and this year we expect about 303 million.
§ Mr. MoyleIf the Minister admits, as he has come close to doing, that doctors are prescribing unnecessarily, why does he not apply the disincentive to the doctor and not to the patient?
§ Dr. VaughanA working group from the medical profession is examining that point.
My hon. Friend the Member for Somerset, North made clear the importance of exemptions. I shall not repeat the list of exemptions that he gave, but in addition there are the low income groups — the families in receipt of supplementary benefit or family income supplement and others with low incomes. It will please the hon. Member for Berwick-upon-Tweed (Mr. Beith) to hear that there has been a slight change. After allowing for special expenses on mortgages and hire purchase, we have increased the 231 additional weekly allowance from £1.70 to £2.50. This modest increase will increase the number who are eligible. The exemptions amount to 64 per cent. of prescriptions. If we add the 5 per cent. who take up season tickets, the total is about 70 per cent.
The right hon. Member for Lewisham, East asked whether we are considering withdrawing the exemption arrangements for pensioners. That rumour is totally and completely untrue. It is mischievous and malicious, and I hope that it does not cause too much anxiety to pensioners.
§ Mr. Ennals rose—
§ Dr. VaughanThe right hon. Gentleman asked whether we are discussing with the medical profession any extension of the medical category exemption. I realise that there is great anxiety on both sides of the House about the number of medical conditions that are included. On 9 June, my hon. Friend the Under-Secretary of State said:
We have continued to think about the representations made on this matter, and we have decided reluctantly at this stage not to approach again the General Medical Services Committee in an attempt to have another look at the exempt medical conditions. Any approach to the medical profession would have to include a large number of conditions such as those mentioned in that debate. This would increase the cost substantially of any exemption."—[Official Report, 9 June 1980; Vol. 986, c. 92.]It is with reluctance that I have to tell the right hon. Gentleman that we are not contemplating discussions at this stage.The hon. Member for Battersea, South (Mr. Dubs) made some interesting comments, although some of them were misguided and misinformed. He spoke of the problems between doctors prescribing and pharmacists making up the prescriptions. An important element is the multiple prescription or season ticket. The cost of such tickets has been increased from £12 to £15 for a year or from £4.50 to £5.50 for four months. We have not, as was done in the past, raised the cost of the season ticket in proportion to the change in the prescription charge. We have set a limit. It is a very good buy for anyone who needs more than 15 items a year. We place great importance on the arrangement. It seems to be a fair way of limiting the burden of expenditure on certain patients for the cost of medicines.
We have been ascertaining what we can do to bring the knowledge of the availability of season tickets to as many people as possible. From 10 November we ran a campaign in the national daily and Sunday newspapers—
§ Mr. EnnalsHow much did it cost?
§ Dr. VaughanThe cost was £39,000. I recorded a radio interview on exemptions for release by the COI. We have prepared a special poster for post offices, community health councils, family practitioner committees and doctors' surgeries. We have a further poster setting out the details of season tickets and the rights of their holders.
I know that the House will feel that we have the needs of patients in mind. I hope it will agree that we are doing what is necessary to bring the information on exemptions and season tickets to as many members of the public as possible. However, I was astonished—perhaps I should not have been—to hear yet again the same old remarks from the Opposition in attacking the Government for increasing or continuing charges. It is on the record, 232 despite what the right hon. Member for Lewisham, East has said, that when in Opposition Labour Members always say that the next Labour Government will abolish or reduce charges. Then, when they are in Government, they do exactly the opposite.
§ Mr. MoyleThe hon. Gentleman is mistaken. During the whole period of office of the Labour Government between 1974 and 1979, prescription charges fell substantially in cost. We did not put them up. We reduced them.
§ Dr. VaughanIt is an extraordinary remark to say that charges were reduced because of inflation. I do not see how the right hon. Gentleman can say that charges were kept steady when, in Opposition, his party said that they would be abolished. I have the quotation here. I do not see how the right hon. Gentleman can clear the record by such remarks.
§ Mr. EnnalsWhat is the Minister's answer to the point that a firm assurance was given by the present Prime Minister during the general election campaign to the effect that the Tory Party would not do what it is now doing?
§ Dr. VaughanThe right hon. Member knows perfectly well that that is not how the pledge was given. Opposition Members know that it is not a matter of practising what they preach; it is a matter of preaching one thing in Opposition and doing something quite different in Government.
My hon. Friend the Member for Somerset, North reminded the House, and Labour Members did not like it, that in 1949 it was a Labour Government who passed the Act allowing charges to be made. They introduced charges. That cannot be lived down. What my hon. Friend did not mention was that it was the then Labour Government in 1951 who, for the first time, imposed charges for dentures and spectacles. There is no denying that. In 1964, Labour said that charges would go as rapidly as possible. When Labour left office in 1970, what was the situation? Not only had charges not been abolished, as the Labour Party had said, but the charges were higher—considerably higher than when Labour took over.
We have the ironic situation that the Labour Government have repeatedly done exactly the opposite to what they said they would do when in Opposition. When the Labour Party is out of office, out come the pledges. In office, they are forgotten. In 1973 the pledge was to phase out charges and in 1974 it was to abolish them—a distinct hardening of approach. In Government, the pledges are broken and the charges retained. The right hon. Member for Lewisham, East should be frank with the House and admit that a completely free service is not only undesirable but unrealistic and is not in keeping with any sensible system of priorities in the National Health Service.
I was astonished to see the same old weary note from the right hon. Member for Salford, West (Mr. Orme). When talking about the Royal Commission report, he said:
To meet this requirement of the report, charges would have to be phased out by a future Labour Government, and that is our policy goal. I make that very clear. This recommendation is central to the Royal Commission report, and the Labour Party believes that it is crucial to the future of the National Health Service."—[Official Report, 23 January 1980; Vol. 977, c. 473.]What hollow words those are when one looks at the record and sees what the Labour Party does in office.233 I had not intended to end on that note, but I was provoked by right hon. Members opposite. I hope that the House will recognise these demands, which come over and over again, for the reduction and abolition of charges for what they are—sheer political humbug.
§ It being half-past Eleven o'clock, Mr. DEPUTY SPEAKER put the Question, pursuant to Standing Order No. 4 (Prayers against statutory instruments, &c. (negative procedure)):—
§ The House divided: Ayes 229, Noes 280.
| AYES | |
| Division No. 6] | [11.30 pm |
| Abse, Leo | Evans, John (Newton) |
| Adams, Allen | Ewing, Harry |
| Allaun, Frank | Faulds, Andrew |
| Alton, David | Field, Frank |
| Anderson, Donald | Fitch, Alan |
| Archer, Rt Hon Peter | Fitt, Gerard |
| Armstrong, Rt Hon Ernest | Flannery, Martin |
| Ashley, Rt Hon Jack | Fletcher, Ted (Darlington) |
| Ashton, Joe | Foot, Rt Hon Michael |
| Atkinson, N.(H'gey,) | Ford, Ben |
| Bagier, Gordon AT. | Foster, Derek |
| Barnett, Guy (Greenwich) | Foulkes, George |
| Barnett, Rt Hon Joel (H'wd) | Fraser, J. (Lamb'th, N'w'd) |
| Beith, A. J. | Freeson, Rt Hon Reginald |
| Benn, Rt Hon A. Wedgwood | Garrett, John (Norwich S) |
| Bennett, Andrew(St'kp't N) | Gilbert, Rt Hon Dr John |
| Bidwell, Sydney | Ginsburg, David |
| Boothroyd, Miss Betty | Golding, John |
| Bradley, Tom | Gourlay, Harry |
| Bray, Dr Jeremy | Graham, Ted |
| Brown, Hugh D. (Provan) | Grant, George (Morpeth) |
| Brown, R. C. (N'castle W) | Grant, John (Islington C) |
| Brown, Ron (E'burgh, Leith) | Hamilton, James (Bothwell) |
| Buchan, Norman | Harrison, Rt Hon Walter |
| Callaghan, Jim (Midd't'n & P) | Hart, Rt Hon Dame Judith |
| Campbell, Ian | Hattersley, Rt Hon Roy |
| Canavan, Dennis | Haynes, Frank |
| Cant, R. B. | Healey, Rt Hon Denis |
| Carmichael, Neil | Heffer, Eric S. |
| Carter-Jones, Lewis | Hogg, N. (E Dunb't'nshire) |
| Cartwright, John | Home Robertson, John |
| Clark, Dr David (S Shields) | Homewood, William |
| Cocks, Rt Hon M (B'stol S) | Hooley, Frank |
| Cohen, Stanley | Horam, John |
| Coleman, Donald | Howell, Rt Hon D. (G'ldf'd) |
| Conlan, Bernard | Howells, Geraint |
| Cook, Robin F. | Huckfielcl, Les |
| Cowans, Marry | Hughes, Mark (Durham) |
| Craigen, J. M. | Hughes, Robert (Aberdeen N) |
| Crowther, J. S. | Hughes, Roy (Newport) |
| Cryer, Bob | Janner, Hon Greville |
| Cunliffe, Lawrence | John, Brynmor |
| Cunningham, G. (Islington S) | Johnson, James (Hull West) |
| Dalyell, Tam | Johnson, Walter (Derby S) |
| Davidson, Arthur | Johnston, Russell (Inverness) |
| Davies, Rt Hon Denzil (L'lli) | Jones, Rt Hon Alec (Rh'dda) |
| Davies, Ifor (Gower) | Jones, Barry (East Flint) |
| Davis, Clinton (Hackney C) | Jones, Dan (Burnley) |
| Davis, T. (B'ham, Stechf'd) | Kaufman, Rt Hon Gerald |
| Deakins, Eric | Kerr, Russell |
| Dean, Joseph (Leeds West) | Kilroy-Silk, Robert |
| Dempsey, lames | Lambie, David |
| Dewar, Donald | Lamborn, Harry |
| Dixon, Donald | Leadbitter, Ted |
| Dobson, Frank | Leighton, Ronald |
| Dormand, Jack | Lestor, Miss Joan |
| Douglas, Dick | Litherland, Robert |
| Dubs, Alfred | Lofthouse, Geoffrey |
| Duffy, A. E. P. | Lyon, Alexander (York) |
| Dunnett, Jack | Lyons, Edward (Bradf'd W) |
| Dunwoody, Hon Mrs G. | Mabon, Rt Hon Dr J. Dickson |
| Eadie, Alex | McDonald, Dr Oonagh |
| Eastham, Ken | McElhone, Frank |
| Ellis, R. (NE D'bysn're) | McKay, Allen (Penistone) |
| English, Michael | McKelvey, William |
| Ennals, Rt Hon David | MacKenzie, Rt Hon Gregor |
| Evans, loan (Aberdare) | Maclennan, Robert |
| McNally, Thomas | Sheerman, Barry |
| McTaggart, Robert | Sheldon, Rt Hon R. |
| McWilliam, John | Shore, Rt Hon Peter |
| Marks, Kenneth | Short, Mrs Renee |
| Marshall, Dr Edmund (Goole) | Silkin, Rt Hon J. (Deptford) |
| Marshall, Jim (Leicester S) | Silkin, Rt Hon S. C. (Dulwich) |
| Martin, M(G'gow S'burn) | Silverman, Julius |
| Mason, Rt Hon Roy | Smith, Rt Hon J. (N Lanark) |
| Maxton, John | Snape, Peter |
| Maynard, Miss Joan | Soley, Clive |
| Meacher, Michael | Spearing, Nigel |
| Mellish, Rt Hon Robert | Spriggs, Leslie |
| Mikardo, Ian | Stallard, A. W. |
| Millan, Rt Hon Bruce | Stewart, Rt Hon D. (W Isles) |
| Mitchell, R. C. (Soton Itchen) | Stoddart, David |
| Morris, Rt Hon A. (W'shawe) | Stott, Roger |
| Morris, Rt Hon C. (O'shaw) | Straw, Jack |
| Morris, Rt Hon J. (Aberavon) | Summerskill, Hon Dr Shirley |
| Moyle, Rt Hon Roland | Taylor, Mrs Ann (Bolton W) |
| Newens, Stanley | Thomas, Jeffrey (Abertillery) |
| Oakes, Rt Hon Gordon | Thomas, Mike (Newcastle E) |
| O'Halloran, Michael | Thomas, Dr H.(Carmarthen) |
| O'Neill, Martin | Thorne, Stan (Preston South) |
| Orme, Rt Hon Stanley | Tilley, John |
| Owen, Rt Hon Dr David | Tinn, James |
| Paisley, Rev Ian | Torney, Tom |
| Palmer, Arthur | Varley, Rt Hon Eric G. |
| Park, George | Wainwright, E.(Dearne V) |
| Parker, John | Walker, Rt Hon H.(D'caster) |
| Parry, Robert | Watkins, David |
| Pendry, Tom | Weetch, Ken |
| Powell, Raymond (Ogmore) | Wellbeloved, James |
| Race, Reg | Welsh, Michael |
| Radice, Giles | White, Frank R. |
| Rees, Rt Hon M (Leeds S) | White, J. (G'gow Pollok) |
| Richardson, Jo | Whitehead, Phillip |
| Roberts, Albert (Normanton) | Whitlock, William |
| Roberts, Allan (Bootle) | Willey, Rt Hon Frederick |
| Roberts, Ernest (Hackney N) | Williams, Rt Hon A. (S'sea W) |
| Roberts, Gwilym (Cannock) | Wilson, Gordon (Dundee E) |
| Robertson, George | Wilson, William (C'try SE) |
| Robinson, G. (Coventry NW) | Winnick, David |
| Rodgers, Rt Hon William | Woodall, Alec |
| Rooker, J. W. | Woolmer, Kenneth |
| Roper, John | Wrigglesworth, Ian |
| Ross, Ernest (Dundee West) | Young, David (Bolton E) |
| Ross, Stephen (Isle of Wight) | Tellers for the Ayes: |
| Rowlands, Ted | Mr. George Morton and |
| Sandelson, Neville | Mr. Austin Mitchell. |
| NOES | |
| Adley, Robert | Bryan, Sir Paul |
| Alexander, Richard | Buchanan-Smith, Hon Alick |
| Ancram, Michael | Buck, Antony |
| Arnold, Tom | Budgen, Nick |
| Baker, Kenneth(St.M'bone) | Bulmer, Esmond |
| Baker, Nicholas (N Dorset) | Burden, Sir Frederick |
| Beaumont-Dark, Anthony | Butcher, John |
| Bell, Sir Ronald | Cadbury, Jocelyn |
| Bendall, Vivian | Carlisle, John (Luton West) |
| Benyon, Thomas (A'don) | Carlisle, Kenneth (Lincoln) |
| Benyon, W. (Buckingham) | Carlisle, Rt Hon M. (R'c'n ) |
| Best, Keith | Chalker, Mrs. Lynda |
| Bevan, David Gilroy | Channon, Rt. Hon. Paul |
| Blackburn, John | Chapman, Sydney |
| Blaker, Peter | Churchill, W. S. |
| Body, Richard | Clark, Hon A. (Plym'th, S'n) |
| Bonsor, Sir Nicholas | Clark, Sir W. (Croydon S) |
| Boscawen, Hon Robert | Clarke, Kenneth (Rushcliffe) |
| Bottomley, Rt Hon A.(M'b'ro) | Clegg, Sir Walter |
| Bowden, Andrew | Cockeram, Eric |
| Braine, Sir Bernard | Colvin, Michael |
| Bright, Graham | Cope, John |
| Brinton, Tim | Cormack, Patrick |
| Brocklebank-Fowler, C. | Corrie, John |
| Brooke, Hon Peter | Costain, Sir Albert |
| Brotherton, Michael | Cranborne, Viscount |
| Brown, M.(Brigg and Scun) | Critchley, Julian |
| Browne, John (Winchester) | Crouch, David |
| Bruce-Gardyne, John | Dean, Paul (North Somerset) |
| Dickens, Geoffrey | Lewis, Kenneth (Rutland) |
| Douglas-Hamilton, Lord J. | Loveridge, John |
| Dover, Denshore | Luce, Richard |
| du Cann, Rt Hon Edward | McCrindle, Robert |
| Dunn, James A. | Macfarlane, Neil |
| Durant, Tony | MacGregor, John |
| Eden, Rt Hon Sir John | MacKay, John (Argyll) |
| Edwards, Rt Hon N. (P'broke) | Macmillan, Rt Hon M. |
| Eggar, Tim | McNair-Wilson, M. (N'bury) |
| Elliott, Sir William | McNair-Wilson, P. (New F'st) |
| Eyre, Reginald | McQuarrie, Albert |
| Fairbairn, Nicholas | Madel, David |
| Fairgrieve, Russell | Major, John |
| Faith, Mrs Sheila | Marland, Paul |
| Farr, John | Marlow, Tony |
| Fenner, Mrs Peggy | Marshall Michael (Arundel) |
| Finsberg, Geoffrey | Marten, Neil (Banbury) |
| Fisher, Sir Nigel | Mates, Michael |
| Fletcher, A. (Ed'nb'gh N) | Mather, Carol |
| Fookes, Miss Janet | Maude, Rt Hon Angus |
| Forman, Nigel | Mawby, Ray |
| Fowler, Rt Hon Norman | Maxwell-Hyslop, Robin |
| Fox, Marcus | Mayhew, Patrick |
| Fraser, Rt Hon Sir Hugh | Mellor, David |
| Fraser, Peter (South Angus) | Meyer, Sir Anthony |
| Fry, Peter | Miller, Hal (B'grove) |
| Gardiner, George (Reigate) | Mills, Iain (Meriden) |
| Gardner, Edward (S Fylde) | Mills, Peter (West Devon) |
| Garel-Jones, Tristan | Miscampbell, Norman |
| Gilmour, Rt Hon Sir Ian | Mitchell, David (Basingstoke) |
| Goodhew, Victor | Moate, Roger |
| Goodlad, Alastair | Monro, Hector |
| Gow, Ian | Montgomery, Fergus |
| Gower, Sir Raymond | Morris, M. (N'hampton S) |
| Gray, Hamish | Morrison, Hon C. (Devizes) |
| Greenway, Harry | Morrison, Hon P. (Chester) |
| Griffiths, E.(B'y St. Edm'ds) | Mudd, David |
| Griffiths, Peter Portsm'th N) | Myles, David |
| Grist, Ian | Neale, Gerrard |
| Grylls, Michael | Needham, Richard |
| Gummer, John Selwyn | Nelson, Anthony |
| Hamilton, Hon A. | Neubert, Michael |
| Hamilton, Michael (Salisbury) | Newton, Tony |
| Hampson, Dr Keith | Nott, Rt Hon John |
| Hannam, John | Oppenheim, Rt Hon Mrs S. |
| Haselhurst, Alan | Page, Rt Hon Sir G. (Crosby) |
| Hastings, Stephen | Page, Richard (SW Herts) |
| Havers, Rt Hon Sir Michael | Parris, Matthew |
| Hawksley, Warren | Patten, Christopher (Bath) |
| Hayhoe, Barney | Patten, John (Oxford) |
| Heddle, John | Pawsey, James |
| Henderson, Barry | Percival, Sir Ian |
| Heseltine, Rt Hon Michael | Peyton, Rt Hon John |
| Hicks, Robert | Pink, R. Bonner |
| Higgins, Rt Hon Terence L. | Pollock, Alexander |
| Hogg, Hon Douglas (Gr'th'm) | Porter, Barry |
| Holland, Philip (Carlton) | Prentice, Rt Hon Reg |
| Hooson, Tom | Price, Sir David (Eastleigh) |
| Hordern, Peter | Prior, Rt Hon James |
| Howell, Rt Hon D. (G'ldf'd) | Proctor, K. Harvey |
| Howell, Ralph (N Norfolk) | Pym, Rt Hon Francis |
| Hunt, David (Wirral) | Raison, Timothy |
| Hunt, John (Ravensbourne) | Rathbone, Tim |
| Hurd, Hon Douglas | Rees, Peter (Dover and Deal) |
| Irving, Charles (Cheltenham) | Rees-Davies, W. R. |
| Jenkin, Rt Hon Patrick | Renton, Tim |
| Johnson, James (Hull West) | Rhodes James, Robert |
| Jopling, Rt Hon Michael | Rhys Williams, Sir Brandon |
| Kaberry, Sir Donald | Ridley, Hon Nicholas |
| Kimball, Marcus | Ridsdale, Julian |
| King, Rt Hon Tom | Rifkind, Malcolm |
| Knox, David | Rippon, Rt Hon Geoffrey |
| Lamont, Norman | Roberts, M. (Cardiff NW) |
| Lang, Ian | Roberts, Wyn (Conway) |
| Latham, Michael | Rossi, Hugh |
| Lawrence, Ivan | Rost, Peter |
| Lawson, Nigel | Royle, Sir Anthony |
| Lee, John | Sainsbury, Hon Timothy |
| Lennox-Boyd, Hon Mark | St. John-Stevas, Rt Hon N. |
| Lester Jim (Beeston) | Scott, Nicholas |
| Shaw, Michael (Scarborough) | Trippier, David |
| Shelton, William (Streatham) | Trotter, Neville |
| Shepherd, Colin (Hereford) | van Straubenzee, W. R. |
| Shepherd, Richard | Vaughan, Dr Gerard |
| Silvester, Fred | Viggers, Peter |
| Sims, Roger | Waddington, David |
| Skeet, T. H. H. | Wakeham, John |
| Speed, Keith | Waldegrave, Hon William |
| Speller, Tony | Walker, Rt Hon P.(W'cester) |
| Spence, John | Walker, B. (Perth) |
| Spicer, Jim (West Dorset) | Walker-Smith, Rt Hon Sir D. |
| Spicer, Michael (S Worcs) | Wall, Patrick |
| Sproat, Ian | Waller, Gary |
| Squire, Robin | Walters, Dennis |
| Stanbrook, Ivor | Ward, John |
| Stanley, John | Warren, Kenneth |
| Steen, Anthony | Watson, John |
| Stevens, Martin | Wells, John (Maidstone) |
| Stewart, Ian (Hitchin) | Wells, Bowen |
| Stewart, J.(E Renfrewshire) | Wheeler, John |
| Stokes, John | Whitelaw, Rt Hon William |
| Stradling Thomas, J. | Whitney, Raymond |
| Tapsell, Peter | Wickenden, Keith |
| Taylor, Robert (Croydon NW) | Wiggin, Jerry |
| Taylor, Teddy (S'end E) | Williams, D. (Montgomery) |
| Temple-Morris, Peter | Winterton, Nicholas |
| Thatcher, Rt Hon Mrs M. | Wolfson, Mark |
| Thomas, Rt Hon Peter | Young, Sir George (Acton) |
| Thompson, Donald | Younger, Rt Hon George |
| Thorne, Neil (Ilford South) | |
| Thornton, Malcolm | Tellers for the Noes: |
| Townend, John (Bridlington) | Mr. Spencer Le Marchant and |
| Townsend, Cyril D, (B'heath) | Mr. Anthony Berry |
§ Question accordingly negatived.