HC Deb 09 June 1980 vol 986 cc80-99

'In Schedule 12 of the National Health Service Act 1977, in pararaph 1(1), after subparagraph (a) there shall be inserted— (aa) The supply of any drug, medicine or appliance to a recipient of invalidity benefit ;"'.—[Mr. Hannam.]

Brought up, and read the First time.

Mr. Race

I beg to move, That the clause be read a Second time.

The reason why I am moving the Second Reading of the new clause, which was tabled by the hon. Member for Exeter (Mr. Hannam), is that he has laryngitis. I am sure that we all wish him a speedy recovery from that affliction. I do not know whether I shall make the same speech as he would have done—probably not—but I think that we shall make the same overall points.

The purpose of the new clause is simple—to give free prescriptions and appliances to individuals who are in receipt of invalidity benefit. That is an objective that has been shared by many hon. Members on both sides of the House for many years.

There are a number of reasons that could be advanced for pursuing this policy. The first is that we have a complicated system of exemptions that allows a large number of people not to pay prescription charges, either for drugs or appliances.

This matter was referred to in a written answer on 13 March, in which the Under-Secretary of State for Health and Social Security listed the current exemptions. Hon. Members will know what they are. Primarily, exemptions are given to retirement pensioners—men over 65 and women over 60—expectant mothers and children, individuals suffering from specified medical conditions, such as diabetes, epilepsy and Addison's disease, those who are in receipt of supplementary benefits or family income supplement and individuals whose income is slighty above supplementary benefit level but who could be properly regarded as being among the low paid.

Those are the general exemptions for claiming free prescriptions for drugs and appliances.

As the price of prescriptions increases, the exemptions will become more important. When prescription charges are 20p or 30p an item it is not so damaging to have a narrow range of exemptions, but when prescription charges are £1 an item, as they will be from December, it is different. That is a strong argument for including this substantial group of invalidity beneficiaries within the exemption limits.

Those who qualify for invalidity benefit should be compared with those already exempt from prescription charges. Having paid one's national insurance contribution and received 26 weeks' continuous or linked sickness benefit, one is entitled to the long-term national insurance benefit—invalidity benefit. It is paid to a wide range of people with serious medical conditions who have been unable to work for at least six months. There is also provision to grant invalidity benefit to certain people who have not paid national insurance contributions, but that affects only a small number.

About 600,000 people are in receipt of invalidity benefit at any one time, which is a substantial number. We do not know how many of them would be affected by the new clause. Some of those who would be entitled to free prescriptions under the clause would have been entitled anyway under other exemptions. It is difficult from the Opposition Benches to estimate the number involved, but it would certainly be fewer than 600,000. Perhaps the Minister can give us an indication of the number.

When one compares the categories exempt from prescription charges for specified medical conditions with the groups in receipt of invalidity benefit, it is obvious that there is a great similarity. The medical conditions qualifying for exemption include diabetes, Addison's disease, epilepsy, a continuing physical disability that prevents the patient from leaving his residence except with help from another, and so on. The disabilities were set out in a written answer at column 605 from the Under-Secretary of State on 26 March to my hon. Friend the Member for Barking (Miss Richardson).

Those who are entitled to invalidity benefit are in a similar position, although they do not appear on that list. For example, those who suffer from cancer and chronic heart conditions may be in receipt of long-term invalidity benefit, yet do not qualify under the exemptions. Both those diseases are as serious as many of the conditions specified in the list. No. logical distinction can be drawn between the existing list of exemptions and the other categories that we wish to include.

6.15 pm

There are a number of other reasons why exemption should be granted. In the Social Security (No. 2) Bill the Government dealt a substantial blow to invalidity beneficiaries, those in receipt of industrial injuries benefit and the unemployed by cutting benefits by 5 per cent. in real terms in the November uprating. Their benefit will rise by only 11½ per cent. in November. It is therefore especially appropriate for the House to consider the new clause at this time. It would be of substantial benefit to those invalidity beneficiaries at present not able to claim free prescriptions.

The Government have recognised the difference between invalidity benefit and other benefits cut in clause 1 of the Social Security (No. 2) Bill, when the Secretary of State gave the House a pledge that invalidity benefit would be restored to its real value after a period, given the absence of serious economic constraints. I do not accept that approach as entirely logical, and nor would many of my hon. Friends. However, it shows that, in the Government's own terms, there is a cast-iron case for granting exemption to invalidity beneficiaries.

I wish to make our position clear. In arguing for the new clause we do not go against the Labour Party's position of seeking to entirely abolish prescription charges when next in government. It would be a substantial move in that direction to exempt a large number of the very poorest in our society, who face serious medical and social problems through no fault of their own and who have to pay prescription charges, which have increased dramatically under this Government and are to increase further dramatically.

For those pressing reasons, I hope that the House will agree to the new clause.

Mr. Andrew F. Bennett

I have great pleasure in supporting the new clause. Like my hon. Friend the Member for Wood Green (Mr. Race), I regret that, although the hon. Member for Exeter (Mr. Hannam) is in the Chamber, he cannot give voice to his feelings. It would have been helpful to have views from both sides of the House and I am a little disappointed that the hon. Member has not been able to find one of his hon. Friends to support the new clause.

There is considerable concern about the numbers who face hardship at present and will face even greater hardship because, although they receive invalidity benefit, they are not entitled to free prescriptions.

My first question to the Minister is to ask whether he believes that any one on invalidity benefit is rich or well off. The number of invalidity benefit recipients who have other means must be a tiny proportion of the total. The vast majority have incomes well below two-thirds of average earnings. They are at the income margins and, although they may not qualify for supplementary benefit, their income is only just above the qualifying level.

Such people will find a £1 prescription charge a considerable imposition, particularly when, as so often happens, they are given two or more prescriptions at the same time. The argument that season tickets can solve that problem involves a major misunderstanding. It is the assumption of those with a bit of spare cash in their pocket that one can spend money now in order to save money in the future. For those on low incomes, that is not possible. That problem arises in other schemes, including the fuel saving scheme. My experence of those on low incomes is that they find it difficult to make the initial outlay in order to save in future.

Another problem is that there is no refund if the total cost of the season ticket is not spent. Most people live in hopes that their health will improve and that the number of prescriptions that they need will diminish. That is why they tend to think that it is not worth buying a season ticket.

Others find that their health fluctuates considerably and that sometimes they do not need to spend as much as the cost of a season ticket. Instead of saying that the season ticket is a solution to the problem, the Government should accept the new clause and exempt those in receipt of invalidity benefit.

If the Government insist on making a charge, they should consider offering invalidity benefit recipients a reduced charge that would be likely to add up to no more than the cost of a season ticket—in other words, a season ticket in small instalments. However, that would become administratively complicated, and no doubt the Minister would use that as an excuse for not introducing such a scheme. However, he should accept that the season ticket is an unsatisfactory arrangement.

The list of illnesses raises a number of problems. Many groups are campaigning to get the name of their disability or illness added to the list. That is a rather unfortunate form of campaign. It would be better to lobby, as has been done on the new clause, for help for all those on invalidity benefit, rather than to try to squeeze one more category on to the list of prescribed illnesses.

It is slightly ironic that there are some with diseases on the list who get free prescriptions for all their ailments, even though they are better off, in health and money terms, than those with diseases that are not on the list.

The Minister may say that those just above supplementary benefit level may apply for an exemption under the means test that is provided. Perhaps he can give us some evidence of how many apply in that way, because my impression is that the test is pretty cumbersome and that many people end up paying almost as much as they save after going through the test. It is not satisfactory and if the Government made a broad band of exemptions they could consider how many would be saved having to go through the test.

If about 50 per cent. of those receiving invalidity benefit already get free prescriptions, because they are on supplementary benefit or because of their age or the fact that they have one of the prescribed illnesses, the Government have to consider giving exemptions to only a fairly small number of beneficiaries. A concession would not cost the Government a great deal, but it would be important to the individuals who find it difficult to manage their budgets.

A doctor pointed out to me recently that one of the advantages of knowing that someone is exempted from prescription charges is that he can be prescribed two or three items that improve his comfort without necessarily improving his health greatly. One of the difficulties that doctors experience when they visit someone who is on a low income but who has to pay charges is that they tend to feel that they have to concentrate on the medicines and not prescribe any of the items that could make his care that much easier for him or for those who are looking after him.

I hope that the Minister will consider the case carefully and will give us, not merely sympathy, but an assurance that the Government will take action.

Mr. Alfred Dubs (Battersea, South)

Like my hon. Friend the Member for Wood Green (Mr. Race), I hope that we shall be able to do away with prescription charges before too long. In the meantime, the new clause represents a significant measure of progress for a smallish group who are not able to afford to pay charges.

The concern about prescription charges is that the fact that there is a charge, soon to be £1, means that certain individuals who need medical help are denied the chance to have the sort of medical treatment that their doctor wants to give them.

It is at least an anomaly that not all those receiving invalidity benefit are entitled to free prescriptions. Injustice is a fairer description of the difficulty in which they find themselves. Because some are not exempted—we do not know how many—it has been suggested that a season ticket might be sufficient for them.

However, in addition to the arguments already advanced, there is another reason why a season ticket is unlikely to be satisfactory. By the nature of the illnesses or diseases from which some of those on invalidity benefit suffer, their need for prescriptions will fluctuate. They do not necessarily need a steady flow of medication month in and month out. It is, therefore, difficult for them to calculate whether a season ticket would be a good buy.

For those who are hard up, the calculation about the season ticket is a particularly unfortunate one to have to make. It puts pressure on those who are not so well off or as advantaged as their colleagues. A season ticket can be expensive. It costs £12 and is liable to go up to £16, in line with the increase in prescription charges. It will be interesting to hear whether the Minister expects to be able to keep the price of a season ticket below £16.

There is another reason why those on invalidity benefit are particularly hard hit if they have to pay prescription charges. We know that there are those in all groups who underclaim their entitlement to benefit and that there are some in receipt of invalidity benefit who are reluctant to subject themselves to the means test that is necessary in order to get free prescriptions.

We do not know how many beneficiaries are affected, but we know that many have considerable personal dignity and do not wish to subject themselves to the humiliation of having to be means tested for free prescriptions. I would have thought that for that reason, if he does not accept the other arguments, the Minister should accept the amendment. We are talking about a small group of people to whom injustice is being done. It is right that they should be entitled to free prescriptions.

6.30 pm
Mr. Pavitt

The case has been made so comprehensively that I shall not detain the House for long. I was not surprised to see the name of the hon. Member for Exeter (Mr. Hannam) attached to this new clause. The whole House pays tribute to the hon. Gentleman for his work for the disabled in the all-party group. Hon. Members are aware of his feelings of compassion that lead him to be associated with a new clause of this kind.

The House has heard that the Opposition are not endeavouring in any way to water down Labour Party policy to get rid of all prescription charges. These charges are a tax on the sick that only the sick pay. Our manifesto in 1964 spoke of our intention to abolish health charges. All prescription charges were abolished on 1 February 1965. But that exemption, unfortunately, lasted for only a year. The manifesto was superseded by the Treasury. A year later, on 1 February 1966, the then Minister, Mr. Kenneth Robinson, had to reimpose prescription charges.

One of the many fights that I have lost—I seem to lose more than I win—was as one Back Bencher among many Labour Members at that time, apart from those on the pay roll vote, who tried to avert that decision. When the announcement was made that prescription charges would be re-imposed, the Minister said that the Government would exempt the elderly, children and the chronic sick. In the event, following negotiations with the British Medical Association, it was impossible to designate those who were, or who were not, chronically sick. To the list given by my hon. Friend the Member for Wood Green (Mr. Race) that the Department now has in operation, I can add 34 complaints—such as Parkinson's Disease where medication is required for the rest of the sufferer's life—reckoned by most medical practitioners to rank as chronic sickness.

It is a sin and an iniquity to regard the season ticket as the answer for those on invalidity pension. A person obliged to put up with chronic illness for the rest of his life has to pay £12 or £16 as a poll tax for the privilege of trying to alleviate the symptoms of his pain.

The new clause should commend itself to the whole House. It is a small item of justice. The Labour Party did not say at the last election that it would abolish prescription charges immediately. We said that we would phase them out. The late Dick Crossman said that we should phase out all charges and that prescription charges would be the first to go. One of the most compassionate areas in which phasing out could take place is covered by the new clause. I hope that the Government will accede to the new clause for all the cogent arguments that have been put forward.

Mr. Carter-Jones

I should like to associate myself with the remarks that my hon. Friends made about the hon. Member for Exeter (Mr. Hannam). The hon. Gentleman was not a member of the House when we got through the Alf Morris Act, but he has worked hard and diligently, since coming to the House, to see that it is implemented. We are pleased to see the hon. Gentleman in his place, but we are sorry that the disease prevents him from rising. His complaint is not one of the exemptions. He could have got free medication if he was receiving benefit at that time.

As a broad general rule, those receiving invalidity benefit are very poor. That is a good starting point to adopt over distribution of invalidity benefit. If certain wealthy people, through the passing of this new clause, gained exemptions, I should be happy to see that happen until such time as prescription charges are abolished. The numbers are difficult to calculate. It is stated that, in 1977, 557,000 people were receiving invalidity benefit. Of that figure, 80,000 were exempt from charges on grounds of age or because they received supplementary benefit. It is estimated by Disability Alliance that 37 per cent. of the balance were not exempt on the grounds that they suffered from a prescribed disease. My guess is that this leaves 120,000 people who would benefit. Those people are recognised in society as being extremely poor. Such a move would be extremely valuable to them.

When one considers some of the disabling diseases that are not covered by exemptions, the mind boggles. My hon. Friend the Member for Brent, South (Mr. Pavitt) is correct. I have a small list that I find surprising. It is appalling that sufferers of multiple sclerosis should not be exempt. Spina bifida and severe arthritic conditions are not included in the exemptions. These are conditions that require substantial quantities of medication. I ask the Minister to grant exemption from prescription charges to all in receipt of invalidity benefit. If the Minister says that these people can submit themselves to another means test, I say that he knows that we have argued the case for many years. There are far too many means tests for the disabled. We do not want another.

The Under-Secretary of State for Health and Social Security (Sir George Young)

The House has heard a series of glowing tributes by Opposition Members to my hon. Friend the Member for Exeter (Mr. Hannam). I hope that this will not embarrass him among the Conservatives in Exeter or with the Whip' Office. As many hon. Members have said, my hon. Friend is a hard campaigner for the disabled. It is a campaign that transcends party barriers, and a campaign with which I was happily associated until the last election.

I have enormous sympathy with the object behind the amendment, which is aimed at improving the position of invalidity pensioners. Unhappily, there are some formidable obstacles in the way of conceding this exemption. They are obstacles that the previous Government were unable to overcome, and obstacles that we are unable to overcome.

The receipt of disability or invalidity benefit does not in itself convey automatic exemption from prescription charges, apart from war disablement pensioners who are exempt from charges for medi- cines needed for treating their accepted pensioned disablements. Exemption from prescription charges is based broadly on medical or financial need. Exemption on medical grounds is based on the fact that all those suffering from one of the exempt medical conditions are virtually certain to require prolonged continuous medication. That is not necessarily the case with all invalidity benefit recipients, many of whom, happily, do not require a lot of prescriptions.

Many recipients of disablement and invalidity benefits do qualify for exemption under the present exemption arrangements ; for example, because they are suffering from one of these specified medical conditions or because they are in receipt of supplementary benefit or family income supplement, or because their income falls below a certain level.

The qualifying levels for low income exemption were raised when prescription charges were increased in July 1979, and again on 1 April 1980, thus extending entitlement to more people. The existing exemptions from charges will continue when the prescription charge goes up to £1 on 1 December, and the low income exemptions will be revised on the same date. Prepayment certificates will also be available at favourable rates for those who need frequent prescriptions. I wish to say a word about those in a moment.

From the latest figures available, which date back to 1978, more than 130,000 recipients of invalidity benefit in Great Britain were known to qualify for exemption on age grounds or because they were in receipt of supplementary benefit. Information is not available for any of the other exemption categories. Invalidity benefit recipients totalled approximately 708,000 in 1978 and included those in receipt of the contributory invalidity benefit, the non-contributory invalidity pension and housewives' NCIP. So, basically, the present system gives help to those invalidity pensioners who need constant medical attention because they satisfy the exempt medical conditions, or on grounds of a low income.

The cost of exempting all recipients of invalidity benefit from the 70p charge who are not otherwise exempt would be about £2½ million. If one estimates the cost on the assumption that invalidity benefit recipients required 50 per cent more prescriptions than the average patient, the cost would be about £4 million.

Apart from cost—and this is where we move to the real problem—there are the conflicting claims of the various groups, many of them mentioned in the debate, including people who suffer from serious medical conditions such as cystic fibrosis, glaucoma, chronic bronchitis, emphysema, multiple sclerosis and muscular dystrophy who, in terms of prescription needs and numbers, to my mind seem to have a much stronger case. From the many letters that I have had from hon. Members over the past six months on this subject, I am bound to say that they have pressed this harder than they have the cases of invalidity pensioners. There are many other examples of exemption categories that have been pressed on the Government, including people who retire early, dependent wives of pensioners, and widows.

It is very difficult to deal with invalidity pensioners without considering the conflicting claims of the others. I have a lot of sympathy, for example, for those who suffer from cystic fibrosis. We had an interesting debate some time ago initiated by my hon. Friend the Member for Burton (Mr. Lawrence). If it was the intention to extend it, I should look at some of the medical grounds rather than at a blanket exemption for all invalidity pensioners.

Mr. Ennals

Do I understand, therefore, that the hon. Gentleman is looking at this list of very serious conditions? Is he in negotiation with the medical profession to see whether its members would accept them for inclusion?

Sir G. Young

I shall deal with that later in my remarks.

The real problem that we have to face is that wherever we draw the line there will be hardships and anomolies. I make the point to those hon. Members who have contributed to the debate that they would create more anomalies and hardships by pressing this exemption rather than some of the others.

It might be fairer, through the use of the season ticket, to improve the position of those who need medicine regularly, for whatever reason, relative to those who need medicine on a more casual basis, which happily is the position of most of us. This is one of the roads down which the Government are progressing. A prepayment certificate is worth while currently for anyone who needs more than six items on prescription during a period of four months, and more than 17 items during a period of 12 months. However, as from 1 December this year, when the cost of both certificates and prescriptions will be increased, the increase will be less proportionately for certificate holders than for prescription charges generally. This makes the purchase of a prepayment certificate a more attractive proposition. The new prices of £15 for an annual certificate and £5.50 for one for four months mean that they will be worth while for 15 prescriptions a year rather than 17 prescriptions.

Mr. Pavitt


Sir G. Young

The hon. Member for Brent, South (Mr. Pavitt) shouts "Disgraceful ". His Administration had the opportunity to extend this exemption to this category of patients. They were pressed to do so constantly by hon. Members on both sides of the House. They did not do it. I hope that the hon. Gentleman will address his criticism equally to his right hon. and hon. Friends.

Mr. Pavitt

I have.

Mr. Ennals

The hon. Gentleman has referred to the previous Administration. Since the previous Administration kept prescription charges as low as 20p per prescription, the issue is different from that which he is proposing of 70p now and £1 in December.

Sir G. Young

On the contrary, it would have been far cheaper for the previous Administration to have extended this exemption than it is for the present Administration to do so.

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 the debate. This would increase the cost substantially of any exemption.

6.45 pm

An alternative approach, which has been suggested recently, would be to abolish the list of exempt conditions and rely instead on far more preferential prepayment certificate arrangements. It could be argued that in theory this would be fairer in that prepayment certificates would be available to all and would save money for anyone whose condition required it. On the other hand, it would mean taking away exemption from some of the chronically sick who now enjoy it, and I do not think that that would be the right course to follow at the moment.

I come now to some of the matters raised in the debate. The hon. Member for Stockport, North (Mr. Bennett) asked about the incomes of those on invalidity benefit. It is not a means-tested benefit, so we do not have any realiable information on recipients of invalidity pension. The hon. Gentleman also said that doctors would more readily prescribe more than one item if they knew that a patient was exempt. The doctor has no means of knowing whether the patient is exempt on income grounds unless the patient volunteers the information to the doctor.

Mr. Andrew F. Bennett

Does the hon. Gentleman agree that almost any doctor visiting a patient in his home quickly gains an idea of the financial hardship that exists simply by looking round the house, at the furnishings and at the amount of food available? When treating someone with the sort of illness that we are discussing, it is normal for the doctor to inquire from the patient, or from the person looking after him, whether he is in financial difficulties. It is pretty obvious to him when he prescribes medicines what the family circumstances are.

Sir G. Young

That may be the case when the doctor visits the patient in his or her home, but I do not see how it could possibly be the case when the patient visits the doctor at his surgery. The hon. Gentleman implied that the doctor knew whether a patient was exempt. I am making the point that that is not necessarily so unless the patient volunteers the information.

Mr. Carter-Jones

Does the Minister agree that a doctor would ask whether a person was claiming it and, if he was not, why he was not?

Sir G. Young

That is a question that should more properly be addressed to the medical profession. Some doctors may not want to ask their patients about their incomes. That is a question for the medical profession rather than for a politician to answer.

I want, finally, to play a card which all Ministers keep up their sleeves when in difficulty, which is to say that the amendment is technically deficient. It would exempt only hospital out-patients in receipt of invalidity benefit from payment of prescription charges. I have no doubt that the intention was to effect a general exemption from prescription charges for all people in receipt of invalidity benefits.

Schedule 12 provides in paragraph 1(1): No charge shall be made under section 77(1) … in relation to the supply of drugs, medicines and appliances referred to in paragraph (a) of that subsection". That paragraph (a) limits the exceptions to the supply of drugs, medicines or appliances otherwise than under part II of the 1977 Act. The exceptions do not therefore extend to such supply as part of the pharmaceutical services. These services are dealt with in paragraph (b) of section 77(1) and in paragraph 1(2) of schedule 12, which do not extend the statutory exemptions to the services which the hon. Members have in mind.

Mr. Andrew F. Bennett

I am sure that the Minister would agree that if the House approved this clause he would have the technical expertise to get it right in the other place.

Sir G. Young

I have no doubt that that is the case. If the will of the House was such that it wished to carry the clause, the Government would respond to it.

I have outlined the serious problems facing any Administration seeking to extend the exemption categories. I hope that I have convinced hon. Members that there are more deserving people to qualify for exemption than the specific category of people whose case they have pressed in this debate.

Mr. J. W. Rooker (Birmingham, Perry Barr)

I, too, extend my sympathy to the hon. Member for Exeter (Mr. Hannam). It must be galling for him to have tabled a selected new clause that is supported by the Opposition and not have the chance to move it. Nevertheless, he is here with us and he will have the opportunity to draw the attention of the Government and Ministers—I noticed that a Government Whip sat next to him throughout the debate—to the seriousness of his convictions.

I shall not repeat many of the points that have been made in the debate. The case is clear-cut and precise. It is probably far more precise now because of what has just been said by the Minister about the technical deficiency of the clause.

I wish to make two points that have not been made relating to the income of people in receipt of invalidity benefit. One of my hon. Friends referred to cuts in that benefit being imposed by the Government in the Social Security (No. 2) Bill, which is now in the other place. However one juggles with the figures—and the Minister has said that some people in receipt of invalidity benefit are exempt because of medical conditions or because they receive supplementary benefit—the House knows and the country knows that there are 400,000 people in receipt of invalidity benefit, whose income is less than the personal allowance and less than the tax threshold whose benefit will be cut in November in lieu of taxation.

There is no getting away from that. That cut in benefit will, in some cases, amount to almost £1 a week. They are the people whom we seek to assist with this clause. Even if the clause is technically deficient, I am sure that if the Minister were to accept it, because the deficiency is minor a manuscript amendment would be in order. We would not need to wait for the Government to put the matter right in another place.

The Minister says that the cost of accepting the clause—I presume that he gave us figures based on the clause as drafted—on the basis of the 70p charge would be 12½ million. That is about the sum that the Government will pay to the American bank to secure the services of Mr. MacGregor for the British Steel Corporation, and that demonstrates the scale of the priorities that we see weighed in the balance.

The arguments of Government Ministers about why the previous Government did not increase charges are irrelevant. There was not a lot of pressure from many of the categories mentioned by the Minister when the prescription charge did not increase between 1974 and 1979. The prescription charge of 20p went down catastrophically in real terms because of inflation in those years. As the Minister said, in that situation it would have cost very little to abolish prescription charges. As he knows, that commitment was made by the previous Government in May 1979.

It would have been easy to phase out, or to abolish, Health Service charges on the basis that the prescription charge had not been raised for five years, so it is no good Ministers asking us why we did not do it. The pressure on those whom we are seeking to help with the new clause was not there at that time.

The Government are making matters more complicated by increasing prescription charges with such rapidity, though Ministers say that prepayment certificates can be obtained. In order to keep a check, so that we can advise our constituents where the break-even point might be, we shall all have to carry around calculators and slide rules. People outside the House will not be truly aware of their rights as the system becomes more complex and as it changes more frequently in relation to charges. There has been no commitment that the threshold of £1 for a prescription charge will not be breached.

Mr. Ennals

Does my hon. Friend agree that the administrative costs of this succession of increases, from 20p to 45p, from 45p to 70p and from 70p to £1, will probably be more than the cost of accepting the new clause?

Mr. Rooker

That is likely. It will be interesting to see the figures, because the Minister did not give the House many figures. He admitted that the Government were not sure about the income limits of people on invalidity benefit. He said that 130,000 people were exempt for one reason or another, and that 708,000 were in receipt of the benefit and related benefits. I repeat that we seek to assist those whose benefits are to be cut by the Government under the provisions of another Bill.

This is an all-party new clause. It is significant—and I understand the reasons why the hon. Member for Exeter was unable to speak—that not one Conservative Member has spoken in this debate on behalf of the disabled and those who are at the sharp end of the catastrophic increase in prescription charges. Many times during the debate there have been as many as 20 Conservative Members in the Chamber yet none of them spoke to put a view that would provide an excuse for voting for their own Government. Not one of them spoke on behalf of the disabled who are affected by this clause. When one realises the categories of people who are affected and who will require large numbers of prescriptions and large amount of medication—such as cancer sufferers and those with a serious heart condition—but are not exempt, there is no excuse for the silence of those hon. Members.

We have no hesitation in seeking the will of the House by calling for a Division. As my hon. Friends have pointed out, it is no watering down of the Labour Party commitment, given in the general election and repeated continually from this Dispatch Box, that we shall seek to abolish all health service charges, including prescription charges. That has been made difficult by the Government continually increasing prescription charges, but we must take every opportunity in opposition. Therefore, I ask my hon. Friends to support the new clause.

Question put, That the clause be read a Second time :—

The House divided : Ayes 126, Noes 177.

Division No. 342] AYES [6.57 pm
Abse, Leo Foot, Rt Hon Michael Orme, Rt Hon Stanley
Adams, Allen Foster, Derek Pavitt, Laurie
Allaun, Frank George, Bruce Powell, Raymond (Ogmore)
Alton, David Gilbert, Rt Hon Dr John Prescott, John
Ashton, Joe Ginsburg, David Race, Reg
Atkinson, Norman (H'gey, Tott'ham) Graham, Ted Rees, Rt Hon Merlyn (Leeds South)
Barnett, Guy (Greenwich) Hamilton, James (Bothwell) Roberts, Ernest (Hackney North)
Beith, A. J. Hamilton, W. W. (Central Fife) Robertson, George
Benn, Rt Hon Anthony Wedgwood Harrison, Rt Hon Walter Rodgers, Rt Hon William
Bennett, Andrew (Stockport N) Haynes, Frank Rooker, J. W.
Booth, Rt Hon Albert Healey, Rt Hon Denis Ross, Ernest (Dundee West)
Bottomley, Rt Hon Arthur (M'brough) Heffer, Eric S. Rowlands, Ted
Bray, Dr Jeremy Hogg, Norman (E Dunbartonshire) Sandelson, Neville
Buchan, Norman Holland, Stuart (L'beth, Vauxhall) Sever, John
Callaghan, Jim (Middleton & P) Home Robertson, John Short, Mrs Renée
Campbell-Savours, Dale Homewood, William Silkin, Rt Hon John (Deptford)
Carter-Jones, Lewis Hooley, Frank Silkin, Rt Hon S. C. (Dulwich)
Clark, Dr David (South Shields) Hughes, Robert (Aberdeen North) Silverman, Julius
Cocks, Rt Hon Michael (Bristol S) Jay, Rt Hon Douglas Skinner, Dennis
Cohen, Stanley John, Brynmor Soley, Clive
Cowans, Harry Jones, Rt Hon Alec (Rhondda) Spearing, Nigel
Cox, Tom (Wandsworth, Tooting) Jones, Barry (East Flint) Spriggs, Leslie
Craigen, J. M. (Glasgow, Maryhill) Kilroy-Silk, Robert Stewart, Rt Hon Donald (W Isles)
Crowther, J. S. Kinnock, Neil Stott, Roger
Cryer, Bob Lamborn, Harry Thomas, Dr Roger (Carmarthen)
Cunliffe, Lawrence Lamond, James Thorne, Stan (Preston South)
Cunningham, Dr John (Whitehaven) Lewis, Ron (Carlisle) Tinn, James
Dalyell, Tam Lyon, Alexander (York) Varley, Rt Hon Eric G.
Davis, Terry (B'rm'ham, Stechford) Lyons, Edward (Bradford West) Wainwright, Richard (Colne Valley)
Deakins Eric Mabon, Rt Hon Dr J. Dickson Walker, Rt Hon Harold (Doncaster)
Dean, Joseph (Leeds West) McDonald, Dr Oonagh Welsh, Michael
Dixon, Donald McKay, Allen (Penistone) Whitlock, William
Dobson, Frank McKelvey, William Williams, Rt Hon Alan (Swansea W)
Dormand, Jack McNally, Thomas Wilson, Gordon (Dundee East)
Douglas, Dick McNamara, Kevin Winnick, David
Dubs, Alfred Maxton, John Woodall, Alec
Eastham, Ken Maynard, Miss Joan Woolmer, Kenneth
Ellis, Raymond (NE Derbyshire) Mikardo, Ian Wrigglesworth, Ian
English, Michael Milian, Rt Hon Bruce Young, David (Bolton East)
Ennals, Rt Hon David Mitchell, R. C (Soton, Itchen)
Evans, loan (Aberdare) Morton, George TELLERS FOR THE AYES:
Evans, John (Newton) Moyle, Rt Hon Roland Mr. Donald Coleman and
Field, Frank Oakes, Rt Hon Gordon Mr. Hugh McCartney
Flannery, Martin
Aitken, Jonathan Benyon, Thomas (Abingdon) Body, Richard
Alexander, Richard Benyon, w. (Buckingham) Bottomley, Peter (Woolwich West)
Aspinwall, Jack Berry, Hon Anthony Boyson, Dr Rhodes
Banks, Robert Best, Keith Braine, Sir Bernard
Beaumont-Dark, Anthony Biggs-Davison, John Bright, Graham
Bendall, Vivian Blackburn, John Brinton, Tim
Brooke, Hon Peter Joseph, Rt Hon Sir Keith Powell, Rt Hon J. Enoch (S Down)
Brown, Michael (Brigg & Sc'thorpe) Kaberry, Sir Donald Prentice, Rt Hon Reg
Browne, John (Winchester) Kellett-Bowman, Mrs Elaine Price, David (Eastleigh)
Bryan, Sir Paul Kimball, Marcus Proctor, K. Harvey
Bulmer, Esmond Kitson, Sir Timothy Rathbone, Tim
Cadbury, Jocelyn Knight, Mrs Jill Rees-Davies, W. R.
Carlisle, John (Luton West) Lamont, Norman Renton, Tim
Carlisle, Kenneth (Lincoln) Lang, Ian Rhodes James, Robert
Chapman, Sydney Lawrence, Ivan Rhys Williams, Sir Brandon
Churchill, W. S. Lawson, Nigel Ridley, Hon Nicholas
Clark, Hon Alan (Plymouth, Sutton) Le Marchant, Spencer Roberts, Wyn (Conway)
Clarke, Kenneth (Rushcliffe) Lennox-Boyd, Hon Mark Royle, Sir Anthony
Clegg, Sir Walter Lester, Jim (Beeston) Sainsbury, Hon Timothy
Cockeram, Eric Lloyd, Peter (Fareham) St. John-Stevas, Rt Hon Norman
Colvin, Michael Lyell, Nicholas Scott, Nicholas
Cope, John Macfarlane, Neil Silvester, Fred
Cranborne, Viscount MacGregor, John Sims, Roger
Dean, Paul (North Somerset) McNair-Wilson, Michael (Newbury) Speed, Keith
Dorrell, Stephen McNair-Wilson, Patrick (New Forest) Speller, Tony
Douglas-Hamilton, Lord James McQuarrie, Albert Spicer, Michael (S Worcestershire)
Dover, Denshore Major, John Squire, Robin
Dunn, Robert (Dartford) Marlow, Tony Stanbrook, Ivor
Dykes, Hugh Marten, Neil (Banbury) Stanley, John
Eggar, Timothy Mates, Michael Stevens, Martin
Emery, Peter Mather, Carol Stewart, Ian (Hitchin)
Fairgrieve, Russell Maude, Rt Hon Angus Stewart, John (East Renfrewshire)
Faith, Mrs Sheila Mawby, Ray Stradling Thomas, J.
Fell, Anthony Mawhinney, Dr Brian Taylor, Teddy (Southend East)
Fenner, Mrs Peggy Maxwell-Hyslop, Robin Tebbit, Norman
Fisher, Sir Nigel Mellor, David Temple-Morris, Peter
Fookes, Miss Janet Mills, lain (Meriden) Thorne, Nell (llford South)
Glyn, Dr Alan Mills, Peter (West Devon) Thornton, Malcolm
Gorst, John Mitchell, David (Basingstoke) Townend, John (Bridlington)
Gow, Ian Montgomery, Fergus Trippier, David
Grieve, Percy Moore, John Vaughan, Dr Gerard
Griffiths, Peter (Portsmouth N) Morrison, Hon Charles (Devizes) Viggers, Peter
Grylls, Michael Morrison, Hon Peter (City of Chester) Wakeham, John
Gummer, John Selwyn Murphy, Christopher Waldegrave, Hon William
Hamilton, Michael (Salisbury) Myles, David Walker, Bill (Perth & E Perthshire)
Haselhurst, Alan Neale, Gerrard Wall, Patrick
Hawkins, Paul Needham, Richard Waller, Gary
Hawksley, Warren Nelson, Anthony Ward, John
Heath, Rt Hon Edward Neubert, Michael Warren, Kenneth
Heddle, John Newton, Tony Wells, Bowen (Hert'rd & Stev'nage)
Henderson, Barry Normanton, Tom Wheeler, John
Higgins, Rt Hon Terence L. Onslow, Cranley Wickenden, Keith
Hogg, Hon Douglas (Grantham) Page, John (Harrow, West) Wilkinson, John
Holland, Philip (Carlton) Page, Rt Hon Sir R. Graham Williams, Delwyn (Montgomery)
Hooson, Tom Page, Richard (SW Hertfordshire) Winterton, Nicholas
Hordern, Peter Parris, Matthew Young, Sir George (Acton)
Howell, Ralph (North Norfolk) Patten, Christopher (Bath)
Hunt, David (Wirral) Patten, John (Oxford) TELLERS FOR THE NOES:
Hunt, John (Ravensbourne) Pattie, Geoffrey Mr. Robert Boscawen and
Jenkin, Rt Hon Patrick Pollock, Alexander Mr. David Waddington.
Jopling, Rt Hon Michael

Question accordingly negatived.

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