§ Mrs. Gwyneth Dunwoody (Crewe)
I beg to move:That an humble Address be presented to Her Majesty, praying that the National Health Service (Dental and Optical Charges) Amendment Regulations 1982 (S.I., 1982, No. 284), dated 3rd March 1982, a copy of which was laid before this House on 10th March, be annulled.There is nothing worse than having one's promises recorded, particularly in the Official Report, if one does not intend to stick to them. The Government, when they came to office, made great play of their commitment to the principles of the National Health Service. Their election address stated:In our National Health Service standards are falling; there is a crisis of morale; too often patients' needs do not come first".That is fine. The House of Commons is, therefore, obliged not simply to look at what the Government say but also at how they behave. The two sets of charges covered by the regulations we are debating have one thing in common. Both are positive deterrents to the patient who seeks specialist help. Both are totally opposed not only by patients but by the professional organisations which wall be most concerned with their administration.
In the case of dental charges, the British Dental Association has spoken of the anger of its members at the Government's failure to honour an undertaking given by the Minister for Health on 31 March 1981 that charges would risein line with costs" (Official Report, 31 March 1981; Vol 2, c. 135).and no more.
The BDA points out that when Ministers took office, charges were a maximum £5 for routine treatment with a £30 maximum for all treatment. Those charges are now to be respectively £13 and £90, an increase of nearly treble the original charges in three years. This comes from a Government who actually stated during the election that it was a great lie to suggest that they would increase National Health Service charges. What is more, the proposed increase will exceed the estimated percentage increase in costs by 21 per cent. The real effect of the charges is therefore to impose a straight tax on those seeking dental treatment—a tax, moreover, that will raise £27 million more than the cost to the National Health Service.
The dental review body set up in 1980 by the right hon. Member for Wanstead and Woodford (Mr. Jenkin) when he was Secretary of State for Social Services published its findings in a report entitled "Towards Better Dental Health: Guidelines for the Future". It stated that dentistry in the NHS should aim at providing the opportunity for everyone to retain a healthy functional dentition for life and that the level of charges to patients should be set as low as possible because of their deterrent effect. That recommendation has been totally ignored by Ministers. even though, on another occasion in this House, when speaking of dental therapists, the Minister, concurring in the shameful closure of the New Cross school of dental therapists, prayed the report in aid on every possible occasion. It would seem that Ministers are not only exceedingly selective in the advice they accept from the review body but that they do not hesitate to ignore its findings completely when they choose.
195 The truth is that the proportion of gross costs recovered from the patient through dental charges has been steadily rising. In 1978–79, the proportion was 19.8 per cent. In 1980–81, it had risen to 22 per cent. What is more, the charges for routine treatment have consistently increased by a greater amount than the increase in costs. The absurd situation has now been reached where over half the adults having treatment are in effect paying the whole costs.
The patient who visits the dentist regularly and who has his teeth scaled and polished, has some radiographs and perhaps a filling, will be paying in future the whole cost of the treatment. In addition, the patient who is more likely to be deterred from regular check-ups by the increase in charges to a £90 maximum is also more likely to refuse conservative treatment—I use the phrase in the medical sense—when he does go to the dentist and is therefore much more likely to opt for extractions. It is apt that conservative dental treatment in this case should mean that all a patient does is lose his teeth. We shall soon be back to the situation where dental health is a luxury for a few and not the accepted norm for the many.
In talking on previous occasions of the excess of dental therapists available in the country, the Under-Secretary of State said that dental health was so much improved in the population as a whole that we did not require the same numbers of trained personnel. How long will that situation exist once the new charges come into operation on 1 April? The charges have now been increased four times from £5 to £9 for routine treatment while the maximum charges have gone from £30 to £90.
If this was not enough, the categories of those eligible for treatment have been changed. One of the groups that most concerns me consists of those young people who are not students and who are now excluded from free treatment. They are also the young people who are likely to suffer most from the increased charges for those aged between 18 and 20. Many of these young people are involved in youth opportunities schemes or work experience. Yet they do not qualify for treatment under the existing exemptions. In my constituency, there have been horrifying cases of people who have gone back to removing their own teeth because they are not eligible for very expensive treatment—a return to the early nineteenth century under an eighteenth century Government. These are hardly the most affluent of our young. The decision to exclude them is unnecessarily punitive.
The Minister should look again at the whole question. Even if he cannot do anything else, he should get up tonight and say that he intends to change the terms of the regulations in respect of those who fall within this group so that they will in future be covered by the exemptions.
I come now to the other half of the regulations. The changes in respect of optical charges are even more complex. Not only are the increases themselves absolutely swingeing but the new structure will also be far more difficult to administer. For example, the charges for single vision lenses will now range from £3.70 to £9.25 per lens compared with £2.90 and £3.35 at present. Whereas there were previously two scales of charges, there will now be 15. What is more, there will be additional charges for prisms and tints even when these are prescribed by the practitioner as a result of his examination of the patient.
This means that the Government are determined to penalise those patients whose need is the greatest. The 196 more visually handicapped—those who need to wear high prescription lenses—will suffer the most under the increases. These are very often the elderly who are least likely to be able to afford the higher charges. It is not right automatically to assume that they will all be entitled, or that they will even be eligible, to claim supplementary benefit. They may be post-operative cataract patients who will require two pairs of National Health Service spectacles. In future, they will be openly penalised by the savage increase in prices. Inevitably, many patients will be deterred from seeking help. Once they realise that NHS spectacles will be considerably dearer they will understand that the whole purpose of these changes is to make it more, not less difficult for people to receive specialist help.
The impact of these regulations on the health of the nation will be wholly damaging. The increase in charges is a deliberate attempt to move further away from a National Health Service free at the time of use to one in which charges are used as a positive deterrent to the patient. The regulations are opposed by many community health councils on behalf of patients and it is noticeable that the professions concerned are completely opposed to what is contained in them. They will discourage dental and optical treatment by imposing the burden of monetary barriers between the patient and the practitioner and they are a practical demonstration of the small, narrow-minded approach of the present Government to health. The Government resent the existence of the National Health Service and they are doing their best, by bringing in as many additional charges as possible, to deter patients from going for any kind of specialist help.
Not only are the regulations deliberate in intent, they are an open breach of faith by the Government, even by their own very peculiar standards. They have said that they will increase charges only in line with costs. Yet these charges are way above true costs and are a straight and damaging tax on health care.
§ Mrs. Dunwoody
As my hon. Friend says—let the sick pay. That has been the basis of Conservative thought for a very long time and that thought is enshrined in the regulations.
The Royal Commission on the Health Service made it clear that any charges are likely to act as a deterrent to the patient who wishes to seek help. When we return to office, it will be our aim to abolish all theses charges at the earliest possible moment. We wish the NHS restored to what it should be—a protection for the sick in time of need and, a fully comprehensive service free at the point of use and open to all. It should be and it must be an object of pride for all our people. In opposing the regulations the Labour Party has the interests of the people of Great Britain at heart.
§ The Under-Secretary of State for Health and Social Security (Mr. Geoffrey Finsberg)
Last week we read in the press of an alleged altercation between the hon. Member for Crewe (Mrs. Dunwoody) and the right hon. Member for Bristol, South-East (Mr. Benn) about who was entitled to make Health Service policy on behalf of the Opposition. Having heard the hon. Lady, I can say that there is not a jot of difference between them. They are talking sheer rubbish and I shall attempt to explain that to 197 the House in some detail. We have already listened to an immense amount of ill-informed and ill-intentioned comment about the possible effects of the regulations. Therefore, I shall try to put the record straight and to set the proposed increases in perspective.
First, in spite of what the hon. Member for Crewe said ad nauseam, the increases have to be seen in the context of total NHS spending. The Government, contrary to every word spoken by the hon. Lady, have maintained planned expenditure on the National Health Service as a whole, and that is a significant achievement.
Up to 1982–83 it is planned to increase in real terms by 6 per cent. To help finance this protection for health expenditure, existing charges to people using the family practitioner services have had to be increased. It is just not possible, given the need to contain public expenditure, to plan for growth without making some offsetting savings.
The second point that seems to me to have been wholly lost sight of by the Opposition is that we are not proposing to reduce the total amount spent on either the general dental services or the general optical services. Total spending this year on the general dental services will have been about £490 million and it is expected to rise to some £530 million in 1982–83—an increase that includes real growth of 2½ per cent. As for expenditure on the general optical services, this is expected to be £141 million in 1981–82 and to rise to £166 million in 1982–83—a real growth of 2 per cent. So much for the charge about cuts.
Much has been made of alleged assurances that charges would increase in line with costs, and no more.
§ Mr. Finsberg
I said "alleged", if the hon. Lady will be patient.
Certainly the 1981 public expenditure White Paper made it clear that the Government intended to raise charges annually in line with costs, but this was not intended to preclude a real terms increase as well, should this prove necessary. The latest review of the Government's public expenditure plans concluded that additional charges revenue would be required to offset growth in expenditure on the family practitioner services.
This accounts for an extra £27 million from dental charges—about the only fact that the hon. Lady got right—and an extra £6 million from optical charges. We think it is right that those who can afford to do so should make a greater contribution to the cost of services in this way.
§ Mr Pavitt
I am following the hon. Gentleman carefully. Will he explain how it is that, with the increased income, the closing of dental therapist schools, the rationalisation of dental medical teaching and the cuts that have taken place in the various parts of the country—for example, in Leicester, there are no NHS dentists available—there will be increased expenditure?
§ Mr. Finsberg
It is because we rely on factual information, not on information in newspapers. If the hon. Gentleman would care to write to me and substantiate what he said about there being no NHS dentists in Leicester, I should be grateful. That is a claim I should like to go into.
We think it right that those who can afford to do so should make a greater contribution. What are the only realistic alternatives? They would have to be cuts in services or increases in taxation, neither of which are 198 acceptable to us. Even with the increases proposed, the Exchequer—the mythical Exchequer that is the taxpayer—will still be meeting 70 per cent—nearly threequarters—of the cost of both the general dental services and the general ophthalmic services.
We have also heard claims about the deterrent effect of charges, particularly dental charges. While increases in charges may lead to short-term fluctuations in the number of people going to the dentist, there is no evidence of a long-term deterrent effect. The number of courses of treatment has increased steadily since the Government took office—from 28.3 million in 1978–79 to 30 million in 1980–81—and it continues to rise.
Within these increases there has been no reduction in the proportion of courses of treatment provided to paying patients. Moreover, there are wide-ranging provisions for exemption from charges—all children, pregnant and nursing mothers and students under 19—and for help for those on low incomes. If the hon. Member for Crewe had bothered to read the regulations, she would know that there has not been a single alteration in the exemption categories this year. That took up four minutes of her speech, but she was wholly wrong.
All families receiving supplementary benefit and family income supplement are automatically entitled to free treatment. Others on low incomes may have nothing to pay or pay only part of the charge, depending on their circumstances. Some 43 per cent. of the courses of dental treatment that attract a fee are, in fact, provided completely free.
There is still no charge for check-ups, stopping bleeding, repairs to dentures or calling out a dentist in an emergency. Given this protection for the more vulnerable groups, the Government do not believe that people will put their dental health at risk because of increased charges. There is no such evidence from courses of treatment.
§ Mr Robert Hicks (Bodmin)
I acknowledge that there are fluctuations in the relationship between costs and the standard of dental care. Will my hon. Friend assure the House that if there is any long-term decline in the requirements from our dental service, he will look at the figures and the costs again?
§ Mr. Finsberg
I shall be delighted to do that, but we are not prepared to give assurances when there is no evidence to back them. Any sensible Government—and that is what I believe we are—would consider the hard facts that emerge.
A recently published survey of adult dental health is interesting in this context. It found that fear of the dentist's chair was the main reason for patients putting off treatment rather than cost, and this was particularly so among people who said that they went to the dentist only for an occasional checkup or when having trouble. The best way to combat this is to encourage children from a young age to visit the dentist regularly so that they get over their fear and become regular attendees. Since treatment for the under-18s is free, there can be no question of charges being an obstacle to such health education among the young.
I turn now to the specific provisions of the regulations On dental charges, the proposal is that from 1 April the maximum charge for a routine course of treatment should increase from £9 to £13, and the maximum for any course of treatment involving the more expensive items from £60 199 to £90. The estimated total yield from charges in 1982–83 will be £151 million, as against £118 million this year. We should be quite clear that the £13 and £90 figures are, as I have said, maximum charges. Many people will pay less, and certain items, such as check-ups—which are, of course, given to almost everybody—are and remain free. The average percentage cost of treatment met by patients will be 30 per cent. and the average for paying patients still only 45 per cent.
Having heard all the tarradiddle from the hon. Member for Crewe, let us look at what the Labour Government did, after she had ceased to adorn it, having gone to the claret territory of Europe. Several Opposition Members present supported the Government at that time. In 1977, the Labour Government increased the overall maximum charge from £12 to £30—an increase of 150 per cent. compared with our 50 per cent.—and on synthetic resin dentures—those mainly used by the elderly—the charge went up from £12 to £20—and increase of over 50 per cent. compared with our proposed increase of 6 per cent. I do not remember Labour Members voting against that. Yet, today, because they can happily promise things in Opposition, they think that they will get some kudos from opposing these regulations. The proportion of the dental service covered by patients' charges will still be 28.5 per cent. after this year.
A new feature of the charges proposals is that, instead of a flat-rate charge for all crowns—whatever they cost—there should be a two-tier charge. Given the need to increase charges, we wanted to do this in the fairest way possible. In the past, patients getting crowns with a high gold content enjoyed a high subsidy by comparison with many other items of treatment, and we did not think that we could justify that any longer.
We have, therefore, set two levels of charge for crowns, depending on the materials used. If a patient has an expensive gold crown, the charge will be higher than for the all-porcelain variety. This is the same principle as is already applied to dentures where there is a higher charge for metal than for plastic dentures.
This will be about 60 per cent. of the cost. For example, the charges for plastic dentures are to be increased by only small amounts because they were already at about this level, whereas expensive crowns were charged at only about 20 per cent. to 30 per cent. of cost. Therefore, they will go up more.
Generally, we have tried, where possible, within the present structure of charges, to move towards a more equal charge-cost ratio for the different categories of non-routine treatment. On 21 July 1969, when charges were going up, the late Richard Crossman said:This is an increase in charge which is an adjustment of charge to cost" —[Official Report, 21 July 1969; Vol. 787, c. 1393.]That is what we are doing. We are increasing the charges to fit in with the increased cost of the service. Moreover, no one howled down Richard Crossman for his breach of Socialism.
§ Mr Finsberg
Alas, I was not here at the time. That is not the point. No one howled him down for a breach of Socialism, and in the Division Labour Members found it necessary to support their own Government.
§ Mr. Finsberg
I shall give way in a moment. If my memory is correct, the vote went in favour of Mr. Richard Crossman. I merely add that I could not have put it better than he did. I do not always agree with what he said, but that happens to be a convenient and useful way of agreeing with him.
§ Mr Arthur Lewis
As one who was here at that time I can confirm what my hon. Friend the Member for Brent, South (Mr. Pavitt) said. There was a Division, and we voted against the proposal. I was here at the initiation of the scheme. I was here when the late Aneurin Bevan resigned, as did my right hon. Friend the Member for Huyton (Sir H. Wilson) and others, because they refused to have any charges—even temporarily—put on the Health Service scheme. We are now in 1982, and they are still temporary. We still oppose them, as we did from the beginning.
§ Mr Finsberg
I am delighted to confirm what the hon. Member for Newham, North-West (Mr. Lewis), with his long experience in the House, said. It may explain why he has never adorned the Front Bench. He is an honourable person, and I say that with genuine admiration for him. The fact remains that Richard Crossman and the bulk of the Labour Party went along with what I said.
I want to take up another of the comments of the hon. Member for Crewe. In her speech, she quoted from col. 136 of Hansard of 31 March last year. Clearly, she quoted from a brief that had been given to her, but she had not read, understood or checked it. The page of Hansard is headed—and it is accurate, as Hansard always is under the direction of Mr. Speaker—"Prescription Charges". Nowhere is there a word about any charge other than prescription charges. I have signed about 300 letters to hon. Members pointing out that the information supplied to them by a very august body was inaccurate. On 31 March there was no reference to dental charges. If the hon. Lady had read Hansard and looked at the extract, she would have seen that the hon. Member for Fife, Central (Mr. Hamilton) asked a supplementary question:Does the Minister agree that he invokes a new principle in tying a charge to the rate of inflation? Will he give an assurance that no other Health Service charges will be linked to the rate of inflation?That was the only part that departed from prescription charges. My hon. Friend the then Minister for Health replied:No."—[Official Report, 31 March 1981; Vol. 2, c. 136.]That is the only place at which there might have been a reference to the matter, and it was clearly denied on the spot.
§ Mr Terry Davis (Birmingham, Stechford)
In view of what the Minister has just said, may I ask him to reconcile his clear and unequivocal statement that there is no reference in Hansard of 31 March 1981 to dental charges with what appears in columns 254–55?
§ Mr. Finsberg
I was referring to col. 136 of Hansard for 31 March—prescription charges. That was the question in the references that we all had from many authorities, particularly the British Dental Association.
§ Mr. Davis
The Minister unequivocally said that there was no reference on 31 March. In fact, there was a debate on 31 March 1981. I have just referred him to columns 254–55. How does he reconcile the unequivocal statements made at that time by the Minister for Health with the Government's policy today?
§ Mr. Finsberg
I will look at that point. I was referring to what the hon. Member for Crewe said. I was not concerned with extra supplementary material.
§ Mr. Finsberg
I shall give way in a moment. As the hon. Gentleman knows, all the quotations up to now have related to Question Time that day. I was replying to the hon. Lady's reference in that connection.
§ Mr. Finsberg
I checked Hansard, as I always do, for the relevant pieces. I am sure that the hon. Gentleman appreciates that when a subject is raised at Question Time and letters have been dealt with on that basis, other matters that suddenly emerge may or may not be relevant. I was not discussing those matters. I was resting my case solely on what has been said so far and which the hon. Member for Crewe repeated.
The hon. Member for Crewe also made heart-rending references to exemptions that no longer existed. I have shown that those references were equally inaccurate.
The proposals on optical charges will result in the minimum charge for a lens rising from £2.90 to £3.70. The maximum charge will go up from £8.30 to £15. The estimated total yield from charges in 1982–83 will be £50 million, compared with £35 million this year.
Before we have too much synthetic anger from the Opposition, I should remind the House that, even after the increases, the percentage of the cost raised by optical charges will be only 30 per cent. as opposed to 34.8 per cent. in 1977–78 and 52 per cent. in 1972–73.
When the Opposition attack the Government, it is useful to refute their claims with facts. We were told that the Government are determined to break up the NHS, but let us consider my pair of NHS spectacles, which were re-prescribed for me a month ago. They cost me £14.77. After 1 April they will cost £.17.27—an increase of £2.50, or 16 per cent. They are among the cheapest NHS glasses, and I am delighted to pay tribute to my superb optical specialist and to the NHS, as most of us do.
§ Mr Mike Thomas (Newcastle upon Tyne, East)
I hesitate to raise this matter, but I wonder whether the hon. Gentleman feels that his speedy move to purchase new glasses could be condemned outside the House as insider dealing?
§ Mr. Finsberg
That may be so, but when one is getting a series of headaches, one goes to an optician for a checkup, which is free. The result was that I was prescribed new glasses.
The main features of our proposals are an increase in the number of band charges from five to 30 and the introduction of additional charges for prisms and tints where prescribed. Those features have resulted from making charges more closely reflect the varying costs of different types of lenses to the NHS.
202 The five-band system operates unfairly in some ways, because the subsidies given on each type of lens are spread unevenly. To a large extent, the restructured charges proposed for 1 April will spread the subsidies more evenly. We have taken care of the needs of those with the poorest sight, who require the most expensive lenses. We have adopted a £15 maximum charge for a lens, so that the greatest subsidies will be given on the most expensive lenses. That measure of protection, together with the remission arrangements for those in greatest need, will mean that no one requiring the strongest lenses need be deterred.
I hope that I have shown that there is no question of the proposed increases in charges leading to a dismantling of NHS dentistry or optical services. The facts are as I have set them out.
§ Mr Jim Craigen (Glasgow, Maryhill)
As a Scotsman, I am naturally impressed by the Minister's frugality, but I am not sure whether the example of his own spectacle costs should be translated to those not fortunate enough to be earning the hon. Gentleman's salary. Those on or just below average earnings will get the rough end of the stick.
§ Mr Andrew F. Bennett (Stockport, North)
They are a lot better than the wages of many of our constituents.
§ Mr Finsberg
We will not go into that at the moment. There is a wide range of exemptions and assistance, and many people will be able to get assistance with the purchase of spectacles. We have made no change in that area.
§ Mr Arthur Lewis
Considerable publicity has been given in recent months and years to allegations that there are many monopolistic rackets in the supply of lenses and that one can buy lenses almost anywhere in the world for about one-third of the price paid by our NHS and its customers.
Will the Minister look into those allegations to find out whether the NHS and the public are being rooked? If there is over-charging, we ought to put a stop to it. I do not expect the hon. Gentleman to give an answer now, but perhaps he will make a statement later.
§ Mr Finsberg
I can help the hon. Gentleman. We hope to have later this year the results of an investigation into those matters which is being carried out by the Office of Fair Trading. I am sure that if the hon. Gentleman has any evidence on the subject, the OFT will be pleased to receive it.
We believe that the vast majority of people are prepared to contribute to the cost of the services that they receive and understand that charges have to rise in the present economic climate. We have protected the position of the less well off. They will continue to be protected by the extensive arrangements for exemptions and help with charges.
Few can sustain an objection in principle to charges where appropriate. The Opposition certainly cannot do so, in the light of their record in Government of increasing charges year after year. Few can justifiably attack the new charges as excessive and many must see the logic and 203 equity of the new charges, which continue to protect the weak. I hope that the House will consign the prayer to the dustbin.
§ 6.7 pm
§ Mr. David Ennals (Norwich, North)
I crave the House's indulgence, because I spent the morning at the dentist's and not only will I have difficulty in making myself comprehensible, because of a swollen jaw, but I am in considerable pain. I felt strongly enough to speak in the debate, but I shall not speak at length.
Nothing that the Minister said undermined the strength of the case made by my hon. Friend the Member for Crewe (Mrs. Dunwoody). The hon. Gentleman's accusations against my hon. Friend were grossly unfair. He accused my hon. Friend of not having briefed herself, but it became clear after the intervention of my hon. Friend the Member for Birmingham, Stechford (Mr. Davis), that the Minister had not briefed himself. He had read what it suited him to read and he quoted what it suited him to quote. That is not what we expect from a Minister, but I fear that it is what we have to expect from a Minister of the present Government.
What the Government are intending to do, if we do not win the vote, is damnable and grossly against the interests of the National Health dental service. If we look at the increases in 1979, 1980, 1981 and 1982, the Minister cannot deny that dental charges will have almost trebled since his Government came to power. If he denies that, let him get up and say so. We have the figures and they speak for themselves.
When the Labour Government lost power, a routine treatment cost £5. It went up to £7, £8, £9 and it is now proposed that it should go up to £13. When the Labour Government lost power a course of treatment cost—admittedly at the maximum—£30. It went up to £36, £54, £60 and it is now proposed that it should be increased to £90. For the hon. Gentleman to say, in his concluding remarks, that no one can say that those charges are excessive, means that he does not understand the value of money.
For some strange reason the Minister seems to be conducting an aggressive war against the British Dental Association. The British Dental Association says:Charges are already an obstacle to necessary dental care for many adult patients.The British Dental Association goes on to say:Social security arrangements for patients with low incomes do not help most working families.The fact that there are a large number of exemptions does not affect what happens to average middle-aged working people who have to go to the dentist if they are to ensure that they have good dental health.
The Minister's charge that somehow or other the British Dental Association is putting out facts, figures and conclusions that are misleading or incorrect, is an extraordinary attack upon dentists. They understand dental health better than I do, and better than the Minister does, although, perhaps, not better than the hon. Member for Belper (Mrs. Faith). If he can say what motive the British Dental Association has for the conclusions that it has reached concerning the effect upon the dental health of our people, I would like to hear him.
§ Mr Geoffrey Finsberg
I sympathise with the right hon. Gentleman and his swollen jaw. He is going through what I went through four weeks ago.
I have not attacked the BDA at all. All I have tried to do is to point out that it has sent inaccurate briefings about Question Time on 31 March—no more and no less. I am setting the facts right.
§ Mr Ennals
The hon. Gentleman, referring to one of my hon. Friends, said:The hon. Gentleman is using information sent to him by the BDA, which is totally misplaced. It relates only to prescription charges."—[Official Report, 9 March 1982; Vol. 19, c. 710.]I want to go on to look at what the White Paper, Cmnd. 8175, "The Government's Public Expenditure Plans 1981–82 to 1983–84," said at page 117, paragraph 15:Charges in all services will increase annually in line with costs".The Minister's reply to that was that it did not say that charges would not rise above costs. If there ever was a wriggle, that is it. Anyone who read the statement would understand that it was Government policy to raise charges in line with costs. If they meant to raise them three times as high as costs, or twice as high as costs, they should have said so. If that was too difficult they should have said that prices would rise at least in line with costs or sometimes more, according to the Department's conclusions. However, as it stands that statement is clear and any trying to get away from it is, as I said, sheer wriggling.
When he comes to reply, will the Minister say how the 44 per cent. increase for routine treatments, and 50 per cent. for other types of treatment, can possibly be justified? Does he deny that it runs contrary to previously declared policy? Does he deny that the new charges will act as an even more substantial deterrent to proper dental care? The statement that I have quoted from the BDA related to the position before the imposition of the extra charges that these regulations are about and which we are praying against.
What sort of motive does the Minister think the BDA has? He knows as well as I do from my experience as Secretary of State, that dentists' incomes are not affected by the cost of each form of treatment. I have had long discussions with the BDA, although it does not always agree with me. Never, throughout the period of the Labour Government, nor through that of the present Conservative Government, has the BDA taken a position other than to say that to put up charges would deter people on modest incomes. I am not talking about those who are exempt; I am talking about ordinary working people on modest incomes. The BDA has always been against excessive increases, from whatever Government they may have come. The Minister has seriously maligned the BDA by speaking as he has done today.
The whole motive of the Government is to undermine the National Health dental service in order to push patients into the private sector. The higher the costs imposed by the Government, the more people are likely to want to have private treatment and the less we will have of a real National Health dental service, or for that matter, a real National Health optical service. I hope that that is not the Government's intention. I hope that they will say what their policy is, because that will be the result of constantly raising charges year by year way above the level of inflation. It will do great damage to the dental health of 205 our people. That is an indictment that sits squarely upon the shoulders of the Ministers now occupying the Department of Health and Social Security.
§ Mr. Mike Thomas (Newcastle upon Tyne, East)
First, I should make clear that the Social Democratic Party would have supported a move of charges in line with costs had that been the issue before us today. I am sorry that the Department of Health has brought before us these quite disproportionate increases. I agree with the right hon. Member for Norwich, North (Mr. Ennals) that they cannot be justified, particularly in the present difficult economic circumstances. I suspect that the increases, which are simply too large, are just another DHSS sacrificial offering to the god of the PSBR. I suspect that there is not much more logic behind them.
I share the Minister's view that it is hypocritical in the extreme for the Labour Party to come to the House and say that it would wish to abolish all such charges. We know perfectly well that that is the Labour Party promising in Opposition what it did not carry out in Government and what it would not carry out if it were in Government tomorrow. [Interruption.] I opposed it at the time, as the hon. Member for Crewe (Mrs. Dunwoody) may know. The Labour Party is promising something that it will not carry out and that it did not carry out when it had ample opportunity to do so. Therefore, we should not pay too much attention to what Labour Members say.
I wonder what is different about teeth and eyes. I have never understood why we should be prejudiced about financing a decent level of provision to keep people's teeth in order, to maintain their capacity to eat and masticate properly and to keep people's eyes in order. The prejudice probably dates from a Victorian perception that spectacles and false teeth were cosmetic rather than essential. Perhaps we should review why that distinction is drawn and why we have introduced and sustained charges, particularly for dental and ophthalmic services. However, if the Government had sought an increase in line with costs, we would have been inclined not to oppose it.
Despite the assurances given by Ministers, I am worried that ophthalmic and dental services are developing not into a two-tier system but into a one-and-a-half tier system. In the second tier, many people fall just outside the exemption limits and the proposed charges will act as a substantial deterrent to treatment. Ministers should take that point more seriously. The British Dental Association has no axe to grind. Its members' incomes do not depend on how many people attend for treatment. Nevertheless, it claims that there is a problem.
I am inclined to believe my observations when the statistics seem to produce nonsense. We know that dentists in inner urban areas—such as the area that includes my constituency—say that as a result of increased charges, there has been a diminution in the use of services. They expect there to be a further diminution. In other parts of the country people may be well-off and all the courses of treatment that the Minister mentioned may be being taken up. However, dentists have told me that in the inner urban areas fewer people, particularly on the lower income scale, use dental services.
§ Mr Clement Freud (Isle of Ely)
Does not my hon. Friend accept that there has not only been a diminution, but—in view of the increase in the number of people and the number of teeth—an alarming diminution?
§ Mr. Thomas
I suspect that that is so. No doubt Ministers give us the figures for treatment in good faith, but those figures do not tell the whole story. I hope that the Minister will give an assurance that the Government will reconsider the figures carefully. I should like to know the situation, particularly in our inner urban and poor areas. The hon. Member for Brent, South (Mr. Pavitt) is no longer in the Chamber, but he referred to Leicester. I agree that in many parts of the country dentists are unwilling to take on new NHS patients. In that way, we shall develop a one-and-a-half-tier system of dental care. In principle, the same applies to ophthalmic services, although the problem is not quite so severe.
I am told by student dental officers that the removal of the exemption for students aged between 19 and 21 has resulted in many students failing to look after their teeth properly after their first year—at the age of 18 or 19—at university or college. That problem should be considered. It is vital that we should not build in such inhibitions. Given the present level of student grants, no one could argue that students are a wealthy group who do not need special care and attention.
We would have been prepared to support a more modest increase, but in the circumstances, we shall vote in favour of the prayer.
§ Mr. Andrew F. Bennett (Stockport, North)
To say the least, the remarks of the hon. Member for Newcastle upon Tyne, East (Mr. Thomas) were illogical. He suggested that the Social Democratic Party would have agreed to the Government sticking to the level of inflation, but said that, as they had asked for a little extra, the SDP would oppose the prayer. However, the hon. Gentleman did not outline the basis on which the charges are fixed. If the charges are fixed on a logical basis, the hon. Gentleman's position might be tenable. However, charges have always been fixed by the amount that the Treasury thought that it could get away with without a major row. There is no logic to that, and that is one of the major disadvantages.
§ Mr. Bennett
I firmly believe that charges should be abolished. It is unfortunate that, over the years, Labour Governments have not abolished them. There is logic in having no charges and logic in a full cost charge, but little logic in a position in between the two. I regret that the Labour Party has fallen, like the hon. Gentleman, for expediency and for what the Treasury thinks that it can get away with. That results in the worst of all worlds.
Most people greatly value the National Health Service, but they do not know how much it costs. By imposing charges in this way we shall continue to mislead them by allowing them to think that the NHS is much cheaper than it is. When asked to pay for dental or ophthalmic treatment, most people think that they are meeting most of the cost. They do not realise how little of the cost they meet. Therefore, they do not know the value of the service. That is unfortunate. It would be much better to tell people how much things cost.
I am not suggesting that there should be charges. It is important to have a free service, but when people ai e prescribed drugs and receive glasses or dental treatment, 207 we should tell them what it costs so that they know the benefit of a free NHS. There is virtue in that. The present system misleads and devalues the NHS by making people feel that it is much cheaper than it is.
I hope that the Minister will tell us whether he is certain that 100 per cent. of those entitled to exemptions actually receive them. I doubt whether they do. That is one of the worrying facets of the Government's strategy. They say that people are entitled to benefits and exemptions, but I wonder how many receive them. Many of those entitled to social security benefits do not receive them. The take-up rate is not high enough. The Government's case seems to rest on the argument that everyone in need receives an exemption. If so, they should tell the House that there is a 100 per cent. take-up of the right to exemption. I doubt whether the Minister can give the figures, and I am sure that he cannot give an assurance of a 100 per cent. take-up.
Many of those on low incomes have to pay the charges and then claim a refund. As they tend not to have cheques or bankers' cards, they have to pay in cash. Many of them have not got the money. That is a major problem. Often, it is not the charge that matters for those on low incomes, but what they think it will be. When in work and on relatively high incomes, they may have gone for dental treatment, but when they are in reduced circumstances they do not go to the dentist because they think that there will be a high charge. They are frightened of the cost. They are not aware of the charges that would apply to them and do not realise that they would be exempt from them. Therefore, they are put off not by the cost, but by what they perceive the cost to be.
Sometimes debates such as this do a disservice to the public, because they give the impression that there are charges. We do not hammer home sufficiently the number of those who will not have to pay. We leave some people with the impression that they will not be able to afford the treatment.
It is the fear of the cost that puts some people off applying. Others are put off because, when they apply for treatment, they find that it costs them money in the short term—when they do not have it—if not in the long term.
Will the Minister assure us that the charges do not have any distorting effect on the treatment? I suspect that some dentists take the charges into account. I am told repeatedly that when people go for a check-up, the dentist always manages to find something to do. Often it is a minor filling, a replacement of a filling or a piece of work involving a charge. Time and again constituents ask me "Was that really justified?" One cannot tell unless one is a dentist and has examined the patient's mouth beforehand. After the treatment has been carried out, one cannot be certain whether the dentist, instead of giving a free check-up, found it convenient to carry out dental work to enable him to make a charge, which affected the amount charged to the patient and the amount of remuneration received by him.
I could say much the same about opticians. We know that the test is free, but there is a suspicion that sometimes the optician recoups more by suggesting that, because there is a minor change in a patient's eyesight, he should have new lenses or spectacles. It worries me that the 208 charges have a distorting effect on professional judgments. I wonder whether as much treatment would take place if the charges were not imposed.
It would be far better not to increase the charges, but to work towards abolishing them and stressing to people the real value of the National Health Service.
§ Mr. Clement Freud (Isle of Ely)
I am concerned about the regulations that are before us. My right hon. and hon. Friends will support the humble Address because we feel—I hope that the whole House feels—that the Beveridge concept of 1946 was right. We shall continue to oppose any diminution of that concept. Like my colleague from the Social Democratic Party, the hon. Member for Newcastle-upon-Tyne, East (Mr. Thomas), I am concerned that different parts of the body are being, as it were, privatised. It is absolutely wrong not to feel that dental care is anything but a part of general medical care.
The idea that we should spend more money having our teeth looked after than our ears is one that I do not accept. We are discussing increases in the cost of the Health Service which are totally unconnected with inflation. We are discussing the introduction of new levels of charges that will involve in administration many who would be better occupied in providing health care. The number of charges in the optical and dental areas will lead to the employment of bureaucrats and the money that will be paid to them should be spent on the care of people.
The Minister said that this is not a deliberate step in the long-term removal of certain facets from the National Health Service. I hope that he is right. It would be a tragedy if parts of the body were left, as the Scots would say, outwith the Health Service. It would also be a false economy because when a financial disincentive to look after oneself is created and promises are made by the Government that when one reaches a certain financial situation medical benefits will again be forthcoming, people will suffer from a dental or optical debility and wait until they qualify for supplementary benefit; then the cost of putting the problem right will be much higher than it would have been. There will be no saving in real terms.
I am frightened that we shall create a huge middle class, a class beneath the rich, who can pay and not mind paying, and above the poor who get it for nothing. The middle class will have to weigh the physical malady against the financial deprivation. There is little doubt that no one is happy with what is going on, especially dentists. In a letter to the British Dental Journal, which is not a publication that I read very often, but is pertinent to the case, one David Masorella writes:Madam"—that is presumably the editor—Just how are we, as general dental practitioners, expected to be able to fulfil our ethical and moral obligations to the general public in pursuit of our professional duties, when the proposed increases in dental charges are brought into effect? Only too clearly, are we held in high regard by this Government, not for our skills as dental surgeons, but rather in our capacity as unpaid civil servants in the alarming disguise of tax collectors.I hope that the Minister has seen that letter. We spoke on the very same subject a few weeks ago when we were discussing health charges for overseas visitors. Here is another instance of those with professional skills being used as tax collectors for the Government when their time and assistance would be much better spent in helping people.
209 I move to the opticians' monopoly. It is a monopoly in the private sector and while it pertains it is doubly wrong to make National Health people pay more for their spectacles. The hon. Member for Newham, North-West (Mr. Lewis), who is no longer in his place, said in an intervention that in certain countries it is possible to buy glasses very much more cheaply than in the United Kingdom. The hon. Gentleman talked about one third of the cost here. I think that everybody knows that there are bucket shops throughout the world where it is possible to buy glasses over the counter. In Hong Kong for example, one can buy glasses for about 75p. In another place my hon. and noble Friend Lord Winstanley said:It does nobody any harm to be wearing the wrong glasses"—
Mr. Deputy Speaker (Mr. Bryant Godman Irvine)
Order. Is the hon. Gentleman quoting from the current Session?
§ Mr. Freud
That is a very good question, Mr. Deputy Speaker. To fulfil the demands of order I shall merely say that my hon. and noble Friend Lord Winstanley said at some time in another place that it has never done anybody any harm to wear the wrong glasses. He claimed that the only harm could be a secondary one because as a result of not being able to see very well someone might be run over or find himself in some similar situation which would do no good to his health. I am sure that my hon. and noble Friend put it more eloquently than that.
The Government seem to be perpetuating the opticians' cartel and supporting it in the same way in which they support the tobacco manufacturers. While that continues there is every reason for them to limit the increases in National Health charges on glasses.
I hope that the Government will make a clear statement to the effect that dental and optical charges will remain an integral part of the NHS. I accept that the Government's exemption document was prize-winning for its clarity. I hope that they will give the House an assurance that they will also try to win a prize for the efficiency with which it is distributed. It simply is not enough to have a good document. It is also essential that that document should be available to all those who need it.
§ Mrs. Sheila Faith (Belper)
Although I am not a practising dentist, I understand the concern of hon. Members that there is to be a large increase in dental charges. I acknowledge that in future, adults will pay half the costs of the service. However, one must bear in mind that we live in a time of economic recession and that all services must bear some of the difficult cuts. For example, education has had to take its share of cuts, whereas the Health Service, on the whole, has been protected. The cost of the Health Service has become a heavier and heavier burden on the economy because of all the new technology and scientific findings—heart and kidney transplants and new medical research. They all place a heavy burden on the economy.
Therefore, we can understand that the money must come from somewhere. After all, if the Government increased the money given even further, they would have to borrow it and, of course, that would lay a heavy charge on industry. Otherwise, the Government would have to tax more, which would be very unpopular and stunt initiative. 210 Another course would be to print money, which would be inflationary. The Government said that their prime intention was to bring down inflation.
Nevertheless, I am happy to bear in mind that dental health is improving and that there has been a marked decrease in caries and periodontal disease. The Government are not taking advantage of the situation. We all look forward to the time when the dental surgeon will become more of a dental physician and able to use his skills and training in that direction. There is nothing to stop him using his skills in that way now, because regular dental examinations are still free of charge. That is an important point.
Therefore, I assume that the same number of people will come forward for treatment. When patients come forward, I suggest that dentists note the people who do not continue treatment, because of the new charges. That aspect should be monitored closely. Dentists could perhaps inform the Minister of that. He might reconsider his decision in the light of their findings. I asked the Minister, during Question Time, whether the money being spent on dental services as a whole was being reduced. He assured me that the cost of dental services was rising by 2 per cent. this year.
§ Mrs. Faith
Because of better standards of oral hygiene and dental health education, and as many areas have fluoridation, fewer people need dental care today. That aspect of dentistry is cost-effective and must be pursued. As dental examinations are still free of charge, there is no reason why this should not continue. Therefore, I shall vote with the Government this evening.
§ Mr. Laurie Pavitt (Brent, South)
The hon. Member for Belper (Mrs. Faith) said that the Health Service had been protected. The area health authority in my constituency has faced a £750,000 cut. The largest regional health authority in Britain—North-West Thames—this year had a 0.03 per cent. increase on the whole of its provision. This will be a swingeing cut in the amount of money available for all sectors of the Health Service.
The hon. Lady said that there was a diminution in the need for dental care. A fascinating reason for that is that children use fluoride toothpaste and do not spit it out. A recent survey of a dental hospital showed that that factor has been at work. The hon. Lady also knows, as a previous community dental officer, that when it comes to choosing a career in dentistry, the dental officers caring for small kids are at the bottom of the heap. Therefore, the proportion of dental officers available for children in the ILEA area, for example is so fantastic that the amount of service one can give is not what I am sure the hon. Lady would wish.
What is morally wrong about this increased dental charge? First, in her election campaign, the Prime Minister made a categoric statement about what would happen to the NHS. That statement concerned all Health Service charges; prescriptions, dental health and welfare 211 foods. She stated she had no plans to raise charges on them. As we have seen since 1979, there have been massive increases in all those sectors.
The charges are morally wrong because we have a comprehensive Health Service paid for, to roughly 84 per cent., out of taxation. Everybody has already paid, and therefore, is covered for dental and eye service. They pay day in and day out. Every time they receive a PAYE statement, they see that they have paid for a dental and optical service. The only people who pay twice are those in need. When charges are imposed in the Health Service, the people who constantly pay for prescriptions are those with coronary thrombosis, on TNT for the rest of their lives. It can be seen from writings of the late Richard Crossman or Barbara Castle's diary that my opposition to NHS charges has been recognised as my King Charles' head within my party. I am a loyal member of the Labour Party yet when I divided the House in the 1960s on this issue it was the largest vote against my own Government. Therefore, I concede we have had problems and the Labour Party's history is full of the results of this division.
On dental service, I cannot understand why the Government have thrown overboard the whole idea of consultation with the people most concerned. The British Dental Association made representations and put notices on walls in dental surgeries, protesting against the iniquity of the size of these charges and their consequences. Nevertheless, the Government brushed those representations aside. The Association of Optical Practitioners mounted a formidable case as to why this move is bad in terms of prevention of blindness and the way that one should care for the eyesight of the community. However, that has also been brushed aside.
I do not blame the Minister when he claims credit for increased treatment because I am afraid that all Health Ministers, of both parties, are inclined to consider health as if it were some productive statistic in industry or commerce. There is no pride in the fact that more people need dental treatment, that we need to treat more cases in hospital, or that more people need to wear glasses. The pride should be about the prevention of such things. I am waiting for a Minister of either party to come to the House and say he is pleased to report that we do not need all those hospital beds or glasses because we have solved the problem of prevention rather than cure.
I had the privilege of serving for three years on the Medical Research Council. I took a keen interest on prevention concerning dental health. It is amazing that politicians have not listened to the technical facts. In 20 years there could be no more denal caries, toothache, oral disease or periodontology. We already know the answers and they do exist.
I chaired a working party on this subject and was pleased that, after three or four years' struggle, my party, at its annual conference, accepted our recommendations as Labour Party policy. I shall look forward to the time when my hon. Friend the Member for Crewe (Mrs. Dunwoody) is in Government and will carry out that policy. We shall not solve all dental problems in the first five years, but there would be steps forward and a planned elimination achieved in two decades.
I challenge the Minister about the cuts. There has been an emphasis on treatment. The New Cross dental therapy school is being closed. The Minister and I have 212 corresponded on that matter. I put forward some propositions about the Department's way of thinking on dental education. It is a nonsense that we have put dental hygienists, dental therapists and medical students studying dentistry into separate categories. If the Minister had a new policy, of combined operations, he would not need to put so many burdens upon the poor patient at the other end of the scale.
I am sure that the Minister will have read all the material that has been produced and the letters written by the British Dental Journal. Therefore, I shall turn to the optical side. One of the paradoxes of the actions of the Government is the way in which their practice differs so much from their preaching. They have a laudable maxim that if one spends money on the National Health Service, one should spend it on the people engaged with patients and not on cumbersome administration. Yet every act that they take increases the amount of administration that is required.
There has been an increase from five optical charges to 30 charges. Why did the Minister reject the compromise put to him by the Association of Optical Practitioners, which would have brought down that number to 18? Why was that not dealt with? I hope that the Minister will deal with that matter when he replies.
I shall examine the administration of the 30 new charges. In a letter from the Association of Optical Practitioners it is stated that because of the 30 new charges(i) practitioners will have to spend much more time with patients explaining the new arrangements(ii) practice administrative costs will increase considerably, and many of these costs will fall to be included in the NHS fee negotiations(iii) an increase in NHS administrative costs, through Family Practitioner Committees, is inevitable as a great deal more checking of opticians' claims will be necessary.Either opticians will have a blank cheque to do what they want, or they will have to be monitored. If 30 separate charges have to be monitored any income that the DHSS will receive will be offset against the amount of paperwork, time, and administrators that will be necessary.
Finally, the letter states:(iv) it will now be virtually impossible for opticians to tell a patient what their NHS charges will be (as between £7–40 and £30–00) until an examination has been completed and their prescription determined.It is almost as if bureaucracy runs wild when the Government seek to make such changes. The spin-offs of increased costs never seem to be considered. The problem in the dental service is that a person is not informed whether he will receive treatment on the NHS or will have to pay privately. I quoted a case in the Midlands, where there are only two dentists who are prepared to give NHS service. All the other dentists give only private service.
Both Labour and Conservative-, Governments have made mistakes about dental provision. The biggest mistake was in the National Health Service Act 1946 when dentists were put on piece work, so that the more holes they filled and the more china and lead they put into people's mouths, the more they were paid. That was a basic mistake. We should have had a list on which there was a family dentist, as is the case with the general practitioner. Children should be taken to the same dentist time after time so that he can take an interest in them and to care for the family.
Opticians must explain and deal with what is necessary for their patients. I plead a personal case. My hon. Friend 213 the Member for Crewe has already talked about cataracts. I am pleased to say that as well as my two false ears, I have a false eye. I have had an intra-ocular implant, which means that I do not have to wear a contact lens, but I must change my glasses every six months.
Therefore, the more difficulty the patient is in, under the regulations, the more he will pay. The person who has perfect sight pays nothing. That stands the principle of the National Health Service—that the healthly pay for the sick—on its head. I hope that the Labour Party will have full support in the Lobby in an attempt to pray against these iniquitous proposals.
§ Mr. Terry Davis (Birmingham, Stechford)
The debate has been remarkable, at least for one thing—a statement by the hon. Member for Newcastle upon Tyne, East (Mr. Thomas) about the policy of the Social Democratic Party on dental and optical charges. He said that the policy of his party was for charges to be increased in line with costs. Therefore, I presume that he accepts the increases that have taken place under the present Government and is only concerned that the charges should increase in line with costs in future. He does not object to the increase that has already taken place in the maximum charge for routine dental treatment from £5 to £9, which is to be further increased on this occasion, and the increase that has already taken place in the maximum charge for other dental treatment from £30 to £60, which is a doubling of the charge. However, I do not think that that was what he said to the electors in Newcastle at the time of the general election.
My hon. Friend the Member for Stockport, North (Mr. Bennett) asked the Minister a most important question about exemptions. A year ago, my hon. Friend made the same point to the Minister's predecessor, the hon. Member for Reading, South (Dr. Vaughan), who replied that he would look into the way in which the information about exemption from charges for dental treatment was provided. When the Minister for Health replies, I hope that he will tell us what has happened about that promise, because I have not noticed any change in the Government's practices regarding the information that is available to inform people about their rights on exemptions.
The hon. Member for Belper (Mrs. Faith) said that adults would now pay half the cost of dental treatment. As it stands, I believe that her statement is misleading. The Minister will correct me if I have misunderstood the way in which the charges operate, but I think that they mean that half the adult population will pay the full cost of their treatment and therefore pay half the total cost of treatment. I have been advised by dentists that the increased charges will mean that many adults will pay more than the cost of their own treatment through the NHS. The Minister is shaking his head. We have already had a testimony from the Under-Secretary of State and my right hon. Friend the Member for Norwich, North (Mr. Ennals) about their recent visits to the dentist. I, too, have recently visited the dentist. While I was helpless, I was lobbied most effectively about the increases in dental charges. I was assured that it would be in the interests of those who are fortunate enough to have as good dental health as I enjoy to pay privately rather than to go through the NHS because we would pay more than the cost of the treatment that we received from the NHS. I think I am therefore right in 214 saying that half the adult population will pay the full cost of their treatment, and that the hon. Member for Belper may have misled the public when she referred to adults paying only half the cost.
I turn now to the speech of the Under-Secretary of Slate who began with a sneer at my hon. Friend the Member for Crewe (Mrs. Dunwoody). He claimed that the figure she had quoted of £27 million, as the difference between the increase in charges and the increase in costs, was the only fact she had quoted correctly during her speech. The Minister should be the last Member to point the ringer at other hon. Members and to claim that they have made mistakes of fact in their speeches.
The Minister, who has not been very long in the Department of Health and Social Security, has already made two mistakes in only six months when talking about dental charges in the House. The first occasion was when he replied to a question that I put to the Secretary of State about the increase in costs. On 7 December the hon. Gentleman replied that the estimated increase in the cost of dental treatment was 16 per cent. Two weeks later, he had to record his apology in the Official Reportand express his regret that he had given the wrong figure because the increase was not 16 per cent., but only 7 per cent.
The Minister made another mistake during Question Time three weeks ago. My hon. Friend the Member for Newcastle upon Tyne, West (Mr. Brown) asked the Minister how he reconciled the promise not to raise charges faster than the increase in costs when this rise would bring in £27 million more than the rise in costs. My hon. Friend went on to ask whether it was a mark of Tory inefficiency that the Government had increased dental charges four times in 34 months compared with one increase in three and a half years when the Labour Government were in office. The Minister replied that it was not a sign of inefficiency on the part of the Government. That is a matter of opinion. He then went on to say that my hon. Friend was using information, sent to him by the British Dental Association, which was totally misplaced and related only to prescription charges. He said that there was no reference to dental charges. Yet, only three weeks earlier, the hon. Gentleman had answered another question in the House confirming that the difference between the yield from dental charges and the increase in costs was expected to be £27 million.
The hon. Gentleman seems to have a vendetta against the British Dental Association. More important, he seems to be continually making mistakes in the House in dealing with this matter.
This evening the Minister said that he would set the record straight. He then went on to allege that the Labour Party, when in office, had increased charges "year after year". That was his phrase. That is not correct. The Labour Government did not increase dental charges or charges for opthalmic services year after year. There were, indeed, increases during the period of the Labour Government, but they did not take place "year after year".
The Minister then went on to accept—
§ The Minister for Health (Mr. Kenneth Clarke)
Could it be that, because they failed to raise them year after year, they had to increase them by 150 per cent. in one go in 1977?
§ Mr. Mike Thomas
I wonder what the hon. Gentleman considers more reprehensible: the rather minor, nitpicking errors of the Minister—no doubt made in good faith and in the heat of the speech—or, with deliberate intent, to tell the electorate that the Labour Party proposes to carry out a policy vis-a-vis dental and ophthalmic charges when it knows perfectly well that, when it comes to office, it will not do so?
§ Mr. Davis
The hon. Member for Newcastle upon Tyne, East suffers from a number of psychological problems. First, of course, he is embarrassed about his own record during the last Labour Government. Wriggle as he may, he cannot escape that. Secondly, he must be embarrassed by the contents of his last election address. He did me the courtesy of sending me a copy at the time of the general election. I am not sure why, but he did. I remember reading it very carefully. I recall no pledge to the electors of Newcastle upon Tyne, East that the hon. Gentleman wanted to increase these charges in line with costs. I accept that the hon. Gentleman has changed his party. It seems to me that he has probably changed his opinions as well.
The Minister accepted that the proportion of the cost borne by the patient would be increased by these new charges. He said that this would "still" be 28 per cent. That, too, is a slightly misleading statement, because it suggests that it is 28 per cent. at present. Of course it is not. The proportion is 23.9 per cent., and it will be increased to 28.5 per cent.—an increase of nearly 5 per cent. in the proportion to be borne by the patient. In 1978–79, the proportion of the cost of dental treatment borne by the patient was less than 20 per cent., so the proportion has increased by nearly half under this Government. That is not an increase in line with the increase in costs. It is a very real increase in the proportion of the cost borne by the patient.
The Minister also claimed that it had been alleged that charges would rise only in line with costs. He poured scorn on this allegation and referred to the expenditure plans published a year ago. The House will remember that the Government, in their expenditure plans, published a year ago, said:Planned expenditure to 1983–84 reflects the expected changes in demand for general medical, dental, ophthalmic and pharmaceutical services. Charges in all services will increase annually in line with costs.They then went on to discuss prescription charges. It was clear that the Government were saying that dental and ophthalmic charges would increase annually in line with costs up to 1983–84.
That is not what is taking place today. Ministers cannot wriggle out of it. In a debate on 31 March 1981, the Minister for Health said:We are increasing the charges to fit in with the increased cost of the Service. As we announced in the public expenditure White Paper, if necessary these will now be increased annually as the costs vary within the Service.Later, he said:We take the view that charges should keep pace with the rising costs of providing these services. That was spelt out in the recent White Paper on public expenditure".—[Official Report, 31 March 1981; Vol. 2, c. 254.]216 It is clear that the policy of the Government a year ago was that dental charges would increase annually in line with costs. There was no suggestion at that time that there might also be a real increase in dental charges—an increase in excess of the increase in costs—if the Government then decided that it was necessary. This change has come with the Minister's arrival at the Department of Health and Social Security.
The Minister also said that there is no evidence that cost has any effect on the number of people seeking treatment. He may be correct in saying that there is no statistical evidence. The British Dental Association believes that cost does affect the number of people who seek treatment, but that is an opinion. It is an important opinion, however, because it comes from the dentists themselves, and they, after all, are in a position to form a subjective but imporant opinion.
However, some evidence does exist because, as my hon. Friend the Member for Crewe pointed out, last year the Government published the report of the Dental Strategy Review Group entitled "Towards Better Dental Health—Guidelines for the Future". In paragraph 4.8 of this report, produced by a group which was established by the Government to advise them on dental service policy, we read:There can be no doubt that any charge to patients will deter some from seeking the treatment they need. The level of charges should therefore be set as low as possible.That is the opinion of the Dental Strategy Review Group. The Government were quick enough to pick up the suggestion in the report that the New Cross school for dental therapists should be closed, but they have totally ignored that recommendation.
Indeed, the Under-Secretary of State has changed his opinion, because, as recently as December 1981, in a written answer he said that the available data did not support the contention that patients were putting off treatment for whatever reason. Later he said that there was no evidence that patients were putting off treatment because of the level of dental charges. On being pressed by the hon. Member for Brentwood and Ongar (Mr. McCrindle), he said:The available figures show that there has been a steady increase in the number of courses of dental treatment provided since this Government took office, which suggests that patients are continuing to look after their dental health."—[Official Report, 1 February 1982; Vol. 17, c. 60.]The hon. Gentleman made similar statements to several of my hon. Friends in March. However, he qualified them because he was then telling the House that increases in chargesmay lead to short-term fluctuations in the numbers of people coming forward for National Health Service dental health treatment, but there is no evidence that demand for dental care is sensitive to charges increases in the long run."—[Official Report, 9 March 1982; Vol. 19, c. 389.]There may not be any statistical evidence, but there is certainly an informed opinion from the British Dental Association and a most informed opinion from the Dental Strategy Review Group.
The Government are trying to defend the indefensible this evening. The Opposition will vote for this prayer and against the increases.
§ The Minister for Health (Mr. Kenneth Clarke)
We all appreciate that any increase in National Health Service charges will be unpopular. When the Labour Government 217 raised charges they were unpopular, and if we have a Labour Government in the future who raise charges they will also be unpopular. If we ever have the Social Democratic-Liberal alliance in Government, no doubt if it increases the charges it will be unpopular.
Given the fact that we know that there is bound to be some resistance to any increase in charges for this or other health services, it is understandable that we should give some expression to the outside concern and the lobbying from bodies such as the British Dental Association. However, we do the practice of politics no good if opposition to such charges is turned into a ritual exchange of party political views, especially—I agree with the hon. Member for Newcastle upon Tyne, East (Mr. Thomas)—if Labour Front Bench spokesmen repeat claims that their party will abolish the charges for dental and optical services, when we know perfectly well that they did not think of doing so when in Government and we know that they would have no opportunity to forgo the large sums of money obtained from charges in the future. It is cynical in the extreme to make such statements, which are quite irresponsible for a party that is still the official Opposition.
I know that the hon. Member for Brent, South (Mr. Pavitt) has an honourable record and has always voted against prescription charges. His right hon. Friend the Member for Norwich, North (Mr. Ennals) and his hon. Friend the Member for Crewe (Mrs. Dunwoody) have been in the Division Lobbies against him in the past when he has voted against Labour Government increases.
§ Mr. Pavitt
I wish to deal with the Minister's point about the phasing out of charges, which the 1974 Labour Government wished to carry out. In fact, Barbara Castle did precisely that and we lost £3 million because she made an immediate change in the prescription charges one of the first acts of that Government.
§ Mr. Clarke
The hon. Gentleman's memory of the history of the Labour Government is clearer than mine on that matter. He said that the 1974 Government pledged to phase out the charges. As I shall show, in 1977 the Labour Government made a massive increase in dental and optical charges which dwarfs the increase about which Labour Members express such indignation today.
We must accept the continued existence of charges for optical and dental charges whatever party is in power, because those charges contribute a substantial sum towards the provision and expansion of NHS services generally. There is no way in which a Government can dispose of them in the foreseeable future.
We had a slightly ritual debate and, while becoming extremely excited, one or two Labour Members went beyond criticising the charges and began to suggest that we wished to change the National Health Service, to drive people into private practice and to pave the way for the end of dental and optical services in the National Health Service. The hon. Member for Isle of Ely (Mr. Freud), being a liberal and sensitive man, was concerned about that and wished me to reaffirm that optical and dental services will remain within the NHS. I am happy to do so.
The Government are completely committed to the retention of dental and optical services in the Health Service. We are following the practice of raising some modest charges from the proportion of the population that can pay for its treatment, because it contributes towards the resources of the National Health Service. Our only 218 motive is to provide more funds for the expansion of the Health Service and for the increased expenditure on general dental and optical services, which has been a pattern of the Government's health policy.
At one stage the right hon. Member for Norwich, North suggested that the Government might be raising charges to the extent that they would drive people into the private sector. I am glad to say that, even after the increases, NHS charges for that section of the population not exempt will be far below private sector charges. The maximum National Health Service charge for a full set of plastic dentures will still be only £35 whereas, according to figures published by a group of dentists in Barnet in March 1981, even then the private charge would have been about £150. We retain our full commitment to dental and optical services in the National Health Service, and the only sensible debate should be about the level of charges that some patients should contribute towards the National Health Service.
The hon. Members for Newcastle upon Tyne, East end Isle of Ely both asked, sensibly, why we have such charges for eyes and teeth as opposed to other parts of the body. There is no logical answer to that, but there is a historical one. The policy cannot be changed without forgoing large sums of money that we wish to divert into health services.
The only person that I could find who attempted to explain why dental and optical services were charged on that basis was a Secretary of State in the Labour Government who raised the charges in July 1969. The late Richard Crossman, with his usual recklessness, attempted to persuade a dissatisfied House that a logical distinction could be drawn. I shall not rely upon it because he was interrupted by some angry Members while he tried to give his explanation. He stated:A person who needs dental or optical services is not normally ill in the usual sense of the word … nor in most cases is he prevented by his condition from going to work. We have made special provision through exemption arrangements for priority classes which have worked for years extremely well. That perhaps is partly why these particular charges have been accepted by the public with comparatively little resentment."—[Official Report,21 July 1969; Vol. 787, c. 1398.]Despite the then Labour Government's attempt to justify the increases in those terms, it is best regarded as a historical anomaly. The key point is that the charges raise a substantial sum of money, without excessive public reaction, that can then be diverted—it will be diverted by this Government—into the expansion of the National Health Service.
I hope that I have shown that we reject the allegation that it is a Government plot to undermine the National Health Service. Our motives for bringing forward the charges are simply to make a contribution to the increased spending in real terms upon the National Health Service that the Government have maintained. As my hon. Friend the Under-Secretary of State made clear when opening the debate, whatever else is said about the Government's record, it is no good making wild assertions about the cults in care or declining standards of health. By next year, under this Government, NHS spending on all services will have increased in real terms by about 6 per cent.
Today we are concerned about dental and optical services. I am delighted to say that the Government are devoting more resources to both. Expenditure on general dental services will rise from £490 million in 1981–82 to an estimated £530 million in 1982–83. That will be a real growth of about 2.5 per cent. in resources for the general 219 dental services. I was asked how far that works its way through into treatment for the patient. We were caught in a new version of Morton's fork by the hon. Member for Brent, South. He suggested that the statistics showing increased dental treatment meant that the nation was getting unhealthier and he thought it was sad that the nation needed extra treatment. If we reach the stage of reducing dental treatment he will say that we are cutting the Health Service. He cannot have it both ways.
My hon. Friend the Member for Belper (Mrs. Faith) is, I think, the only qualified dentist in the House and therefore knows more than any of us about these matters. She said that the general standard of dental health has been improving. There has been a steady increase in the number of cases of dental treatment provided. In the last year the number of treatments went up from 28.3 million to 30 million and the trend is a continuing increase.
As to whether or not charges appear to have a deterrent effect on treatment, it may be that any charges have a deterrent effect on a few people, but the underlying trend is that more people are taking dental treatment at a time when the charges are going up. Coming to the point made by the hon. Member for Stockport, North (Mr. Bennett), we exempt a substantial proportion of the population; 43 per cent. of all courses of dental treatment are provided completely free by the National Health Service. Of course, all check-ups and other routine matters are provided free as well.
§ Mr. Mike Thomas
The point that concerns me is not the trend of increased treatments, increased spending and all the rest of it. All that I am prepared to accept and welcome. What concerns me is that certain groups are suffering. I mentioned two—those earning relatively low wages and living in inner cities, and students. Those groups are the exception to the rule. The assurance I want from the Minister is that the Government will consider whether there are identifiable groups being discouraged from seeking treatment and whether they will try to do something about it.
§ Mr. Clarke
In regard to students, a change in exemptions was made last year. This year we are making no changes in exemptions. I am not aware of any evidence that that has led to a decline in student dental care. If the hon. Member has evidence or if we have access to such evidence, we will examine it.
I agree that there is a problem in regard to the take-up of exemptions for dental charges. We all agree that a substantial part of the population should be exempt. Some people automatically get their treatment free; others can qualify for exemption. The hon. Member for Stockport, North asked about the exemptions which are given and referred to a prize-winning leaflet produced by the Department of Health and Social Security on exemption from charges for National Health Service dental treatment. I was asked to say what the Government are doing to make that leaflet widely available so that those who are entitled to assistance with charges may know.
We are publishing a revised leaflet on dental treatment, what it costs, and how to get it free. It will be issued shortly. It will be widely available in dentists' waiting rooms, social security offices, main post offices, community health councils, family practitioner committee offices and citizens' advice bureaux. Dentists will also 220 receive a poster for display in their waiting rooms. We will see how well that works. I hope that illustrates that we are maintaining the existing categories of exemption and that we want to ensure so far as possible that people who need assistance with the charges get it.
§ Mr. Clarke
I do not believe we have that information. I have no ready access to it. If it can be discovered, I shall write to the hon. Gentleman. As I said, we can make the publicity arrangements to ensure that the information on exemptions is widely available.
I was asked by the hon. Member for Bodmin (Mr. Hicks) what would happen if at some stage we raised the charges to a point where they began to have a deterrent effect on treatment. If it turned out that we had made a misjudgment, we would be happy to look at the evidence of a decrease in the number of dental treatments and the risk to dental health. All the evidence about previous increases in charges under this Government is that they have had no effect on treatments. The number of treatments has increased. We are still able to increase resources to the dental services. For the time being, therefore, and in regard to these regulations, we can put fears of that kind at rest.
§ Mr. Clarke
It might be a significant drop in the number of dental treatments, a reversal of recent trends, a lack of take-up of dental services, or other evidence by way of surveys of dental health. I do not want to particularise the kind of evidence we would consider. I mean evidence.
With respect to the case that is being mounted against the Government today, although it is understandable that all dentists prefer the charges to be as low as possible, almost all of it is anecdotal and most of it can be rebutted by such evidence as we have because the number of people getting dental treatment is increasing.
I do not want to spend so much time on the optical services because there has not been so much concern expressed about them in the debate. Before getting too excited about the opthalmic services, the House ought to appreciate that the background is that increased use is being made of the general ophthalmic services and that the resources going to them are increasing. Spending on general optical services will go up from £141 million in 1981–82 to £166 million in 1982–83. That means that the Government are increasing resources to the general optical services by 2 per cent. in the coming year.
On the pattern of usage, the number of sight tests has increased since 1980–81 and the number of dispensings has also gone up slightly. The number of sight tests has gone up from 8.3 million to 8.4 million and the increase in dispensings has been from 4.8 million to 4.9 million. Both of those are substantially higher than the 1979 figures when we came into power.
I was asked about the number of charges that we have introduced. The hon. Member for Crewe and others were critical of the range of charges. This is merely a justifiable attempt to relate the charges to the actual cost of the service. The hon. Member for Brent, South says that that means that those with the worst sight problems are most 221 vulnerable to the charges, but I must point out that we have protected those with serious sight problems by putting maxima on the various charges. The maximum charge will be £15 for a lens. Therefore, those with the worst problems with their sight will get the greatest subsidy, if they are from that section of the population that has to make a contribution towards its optical services.
That is the background—increased resources for dental services, increased resources for the optical services, and more people making use of both of them. We hope that there will be a welcome improvement in the dental and optical health of the nation. It is all very well to say that charging more is unpopular, but there has to be some kind of contribution from the taxpayer if we are to sustain improved services.
I intimated that I would not go into the various political arguments which have unnecessarily been drawn into the debate. Obviously I have to answer the allegations that we have gone back on what we said. The Prime Minister's guarantee, which was given at the last general election and which was referred to by the hon. Member for Brent, South, was that there would be no new health charges. That was when we were facing the allegation that we were about to introduce payments for hospitals and payments for the Health Service. That was the canard that was shot down then. We have introduced no new forms of health charge. We do not intend to do so.
Reference was made to various statements by my hon. Friend the Member for Reading, South (Dr. Vaughan), my predecessor. I have scanned not only the pages of Hansard which we knew about from the British Dental Association but the additional pages to which the hon. Member for Birmingham, Stechford (Mr. Davis) was referring. I have found no reference featuring the terms which he kept using that my hon. Friend the Member for Reading, South committed us not to increase charges beyond cost. He said that the policy was to raise the charges in line with cost. At no stage, so far as I can see, did he give any indication that we would not go beyond that. It requires special reading of both the public expenditure White Paper and Hansard to discover that.
When it comes to quotations, I am surrounded by Hansards and if I wanted to play this game I could go back into what Labour right hon. and hon. Members have said and done about optical and dental charges. In 1977—I think it must have been before the right hon. Member for Norwich, North became Secretary of State or he would not have had the temerity to take part in this debate as he did—the Opposition dealt with dental charges by increasing the overall maximum charge from £12 to £30, an increase of over 150 per cent., compared with our 44 per cent. about which they are so indignant today. The charge on synthetic resin dentures increased from £12 to £20—an increase of more than 50 per cent. compared with our proposed increase of 6 per cent. The practice of distinguishing between various forms of dental care was also introduced by the Opposition. Evidence of vast raisings of charges by successive Labour Governments can be found.
I examined the 1969 record, when the hon. Members for Brent, South and Newham, North-West (Mr. Lewis) were in the middle of a small Labour revolt against the decision to increase charges. What did I find when I scanned the interesting Division lists? The hon. Member for Crewe, who led for the Opposition today, and the right hon. Member for Norwich, North, who was once 222 Secretary of State and who also supported the attack on the Government today, both voted for increased charges on that occasion—against the hon. Member for Brent, South with whom they are cynical enough to align themselves today.
§ Mr. Clarke
My maths is always fallible. The word "over" may turn out to be superfluous, but the calculation of 150 per cent. is certainly defensible. That contrasts strikingly with the 44 per cent. that someone whose maths is better than mine has calculated the Government's increase to be.
I shall not play politics any further, or I shall be guilty of the behaviour of which I have accused others. I merely say to those who insist that we can forgo the charges or any part of them this year that they must face the problem that the forgoing of revenue to the NHS involves. The only purpose of our increases is to acquire more money to maintain the growth that we are achieving in the NHS. To talk of abolishing charges means that the official Opposition are talking about getting rid of £151 million worth of dental charges and £50 million worth of optical charges next year. We cannot be attacked for cuts that we are not making in the NHS if the Opposition intend to forgo £200 million of revenue for the NHS as one of their first acts if they are returned to Government. The extra money that we are raising by the regulations is £33 million from dental charges and £15 million from optical charges. They are not enormous sums, despite the general economic climate, but when the Government's record of maintaining and improving services is so good the House cannot begrudge a modest contribution to those improvements coming from raising the cost of services as we propose.
What the Government are doing will not be popular, but it is necessary. To vote for the Opposition motion would therefore be the height of irresponsibility and optimism.
§ Question put:—
§ The House divided: Ayes 220, Noes 262.225
|Division No. 111]||[7.32 pm|
|Abse, Leo||Clark, Dr David (S Shields)|
|Allaun, Frank||Cocks, Rt Hon M. (B'stol S)|
|Alton, David||Coleman, Donald|
|Anderson, Donald||Concannon, Rt Hon J. D.|
|Archer, Rt Hon Peter||Cook, Robin F.|
|Ashley, Rt Hon Jack||Cowans, Harry|
|Atkinson, N.(H'gey,)||Cox, T. (W'dsw'th, Toot'g)|
|Bagier, GordonA.T.||Craigen, J. M. (G'gow, M'hill)|
|Barnett, Guy (Greenwich)||Crowther, Stan|
|Barnett, Rt Hon Joel (H'wd)||Cryer, Bob|
|Beith, A. J.||Cunningham, G.(Islington S)|
|Bennett, Andrew(St'kp'tN)||Dalyell, Tam|
|Booth, Rt Hon Albert||Davidson, Arthur|
|Boothroyd, Miss Betty||Davies, Ifor (Gower)|
|Bottomley, Rt HonA.(M'b'ro,)||Davis, Clinton (HackneyC)|
|Bradley, Tom||Davis, Terry (B'ham, Stechf'd)|
|Bray, Dr Jeremy||Deakins, Eric|
|Brown, Hugh D. (Provan)||Dean, Joseph (Leeds West)|
|Brown, R. C. (N'castle W)||Dewar, Donald|
|Brown, Ronald W. (H'ckn'yS)||Dixon, Donald|
|Brown, Ron (E'burgh, Leith)||Dobson, Frank|
|Buchan, Norman||Dormand, Jack|
|Callaghan, Jim (Midd't'n& P)||Douglas, Dick|
|Campbell, Ian||Dubs, Alfred|
|Canavan, Dennis||Duffy, A. E, P.|
|Carmichael, Neil||Dunlop, John|
|Cartwright, John||Dunn, James A.|
|Dunwoody, Hon Mrs G.||Mason, Rt Hon Roy|
|Eadie, Alex||Maxton, John|
|Eastham, Ken||Maynard, MissJoan|
|Edwards, R. (W'hampt'n S E)||Meacher, Michael|
|Ellis, H.(NED'bysh're)||Mellish, Rt Hon Robert|
|English, Michael||Mikardo, Ian|
|Ennals, Rt Hon David||Millan, Rt Hon Bruce|
|Evans, Ioan (Aberdare)||Miller, Dr M.S. (EKilbride)|
|Evans, John (Newton)||Mitchell, Austin (Grimsby)|
|Faulds, Andrew||Mitchell, R.C. (Soton Itchen)|
|Field, Frank||Morris, Rt Hon A. (W'shawe)|
|Fitch, Alan||Morris, Rt Hon C. (O'shaw)|
|Fitt, Gerard||Morris, Rt Hon J. (Aberavon)|
|Fletcher, Ted (Darlington)||Newens, Stanley|
|Foot, Rt Hon Michael||Oakes, Rt Hon Gordon|
|Ford, Ben||O'Halloran, Michael|
|Forrester, John||O'Neill, Martin|
|Foster, Derek||Palmer, Arthur|
|Foulkes, George||Park, George|
|Fraser, J. (Lamb'th, N'w'd)||Parker, john|
|Freeson, Rt Hon Reginald||Parry, Robert|
|Freud, Clement||Pavitt, Laurie|
|Garrett, John (Norwich S)||Pendry, Tom|
|Garrett, W. E. (Wallsend)||Penhaligon, David|
|George, Bruce||Powell, Raymond (Ogmore)|
|Gilbert, Rt Hon Dr John||Prescott, John|
|Ginsburg, David||Radice, Giles|
|Golding, John||Rees, Rt Hon M (Leeds S)|
|Graham, Ted||Richardson, Jo|
|Grant, George(Morpeth,)||Roberts, Albert(Normanton)|
|Grant, John (Islington C)||Roberts, Allan(Bootle)|
|Hamilton, James(Bothwell)||Roberts, Gwilym(Cannock)|
|Hamilton, W.W. (C'tral Fife)||Robertson, George|
|Harrison, Rt Hon Walter||Robinson, G. (Coventry NW)|
|Hart, Rt Hon Dame Judith||Rooker, J.W.|
|Hattersley, Rt Hon Roy||Roper John|
|Haynes, Frank||Ross, Ernest (Dundee West)|
|Healey, Rt Hon Denis||Rowlands Ted|
|Heffer, Eric S.||Ryman, John|
|Hogg, N. (EDunb't'nshire)||Sandelson, Neville|
|Holland, S. (L 'b 'th, Vauxh 'll)||Sever, John|
|Home Robertson, John||Sheerman, Barry|
|Homewood, William||Sheldon, Rt Hon R.|
|Hooley, Frank||Shore, Rt Hon Peter|
|Howell, Rt Hon D.||Short, Mrs Renée|
|Howells, Geraint||Silkin, Rt Hon J. (Deptford)|
|Hughes, Mark(Durham,)||Silkin, Rt Hon S. C. (Dulwich)|
|Hughes, Robert (Aberdeen N)||Silverman, Julius|
|Janner, Hon Greville||Skinner, Dennis|
|Jay, Rt Hon Douglas||Smyth, Rev. W. M. (Belfast S)|
|Jenkins, Rt Hon Roy (Hillhead)||Soley, Clive|
|Jones, Rt Hon Alec (Rh'dda)||Spearing, Nigel|
|Jones, Barry (EastFlint)||Spriggs, Leslie|
|Kaufman, Rt Hon Gerald||Stallard, A.W.|
|Kerr, Russell||Steel, Rt Hon David|
|Kilfedder, James A.||Stewart, Rt Hon D.(W Isles)|
|Kilroy-Silk, Robert||Stoddart, David|
|Lamborn, Harry||Stott, Roger|
|Lamond, James||Strang, Gavin|
|Leighton, Ronald||Straw, Jack|
|Lestor, MissJoan||Summerskill, Hon Dr Shirley|
|Lewis, Arthur (N'ham NW)||Taylor, Mrs Ann (Bolton W)|
|Lewis, Ron (Carlisle)||Thomas, Mike (Newcastle E)|
|Lofthouse, Geoffrey||Thomas, Dr R. (Carmarthen)|
|Lyons, Edward (Bradf'dW)||Thorne, Stan (PrestonSouth)|
|Mabon, Rt Hon Dr J. Dickson||Tilley, John|
|McCartney, Hugh||Tinn, James|
|McDonald, Dr Oonagh||Torney, Tom|
|McElhone, Frank||Varley, Rt Hon Eric G.|
|McGuire, Michael (Ince)||Wainwright,E. (Dearne V)|
|McKay, Allen (Penistone)||Wainwright, R.(Colne V)|
|McKelvey, William||Walker, Rt Hon H.(D'caster)|
|MacKenzie, Rt Hon Gregor||Watkins, David|
|McNamara, Kevin||Wellbeloved, James|
|McTaggart, Robert||Welsh, Michael|
|Magee, Bryan||White, Frank R.|
|Marshall, D(G'gowS'ton)||White, J. (G'gowPollok)|
|Marshall, Dr Edmund (Goole)||Willey, Rt Hon Frederick|
|Marshall, Jim (LeicesterS)||Williams, Rt Hon A.(S'sea W)|
|Martin, M (G'gowS'burn)||Williams, Rt Hon Mrs (Crosby)|
|Wilson, Gordon (Dundee E)||Wright, Sheila|
|Wilson, Rt Hon Sir H. (H'ton)|
|Wilson, William (C'trySE)||Tellers for the Ayes:|
|Winnick, David||Mr. George Morton and Mr. Lawrence Cunliffe.|
|Adley, Robert||Fell, Sir Anthony|
|Alexander, Richard||Fenner, Mrs Peggy|
|Alison, Rt Hon Michael||Finsberg, Geoffrey|
|Ancram, Michael||Fisher, Sir Nigel|
|Arnold, Tom||Fletcher, A. (Ed'nb'ghN)|
|Aspinwall, Jack||Fletcher-Cooke, Sir Charles|
|Atkins, Rt Hon H. (S'thorne)||Fookes, Miss Janet|
|Atkins, Robert(Preston N)||Forman, Nigel|
|Baker, Kenneth(St.M'bone,)||Fowler, Rt Hon Norman|
|Banks, Robert||Fox, Marcus|
|Beaumont-Dark, Anthony||Fraser, Rt Hon Sir Hugh|
|Bendall, Vivian||Fraser, Peter (SouthAngus)|
|Benyon, W. (Buckingham)||Fry, Peter|
|Berry, Hon Anthony||Gardiner, George(Reigate,)|
|Best, Keith||Glyn, Dr Alan|
|Bevan, David Gilroy||Goodhew, Sir Victor|
|Biffen, Rt Hon John||Goodlad, Alastair|
|Blackburn, John||Gow, Ian|
|Blaker, Peter||Grant, Anthony (Harrow C)|
|Body, Richard||Gray, Hamish|
|Bonsor, Sir Nicholas||Grieve, Percy|
|Boscawen, Hon Robert||Griffiths, E.(B'ySt.Edm'ds)|
|Boyson, Dr Rhodes||Griffiths, PeterPortsm 'thN)|
|Braine, Sir Bernard||Grist, Ian|
|Bright, Graham||Grylls, Michael|
|Brittan, Rt.Hon.Leon||Gummer, John Selwyn|
|Brooke, Hon Peter||Hamilton, Hon A.|
|Brotherton, Michael||Hamilton, Michael(Salisbury)|
|Brown, Michael(Brigg & Sc'n,)||Hampson, Dr Keith|
|Browne, John(Winchester)||Hannam john|
|Bruce-Gardyne, John||Haselhurst, Alan|
|Bryan, Sir Paul||Havers, Rt Hon Sir Michael|
|Buchanan-Smith, Rt. Hon. A.||Hawksley, Warren|
|Buck, Antony||Hayhoe, Barney|
|Budgen, Nick||Heddle, John|
|Bulmer, Esmond||Henderson, Barry|
|Burden, Sir Frederick||Heseltine, Rt Hon Michael|
|Butcher, John||Hicks, Robert|
|Cadbury, Jocelyn||Higgins, Rt Hon Terence L.|
|Carlisle John (Luton West,)||Hill, James|
|Carlisle, Kenneth (Lincoln)||Hogg, Hon Douglas(Gr'th'm,)|
|Carlisle, Rt Hon M. (R'c'n)||Holland, Philip(Carlton)|
|Chalker, Mrs. Lynda||Hooson, Tom|
|Channon, Rt. Hon. Paul||Hordern, Peter|
|Chapman, Sydney||Howe, Rt Hon Sir Geoffrey|
|Clark, Hon A. (Plym'th, S'n)||Howell, Ralph(N Norfolk)|
|Clark, Sir W. (Croydon S)||Hunt, John(Ravensbourne)|
|Clarke, Kenneth(Rushcliffe)||Irving, Charles(Cheltenham)|
|Cockeram, Eric||Jessel, Toby|
|Colvin, Michael||Johnson Smith, Geoffrey|
|Cope, John||Jopling, Rt Hon Michael|
|Corrie, John||Joseph, Rt Hon Sir Keith|
|Costain, Sir Albert||Kaberry, Sir Donald|
|Cranborne, Viscount||Kellett-Bowman, Mrs Elaine|
|Critchley, Julian||Kershaw, Sir Anthony|
|Crouch, David||Kimball, Sir Marcus|
|Dean, Paul(North Somerset)||King, Rt Hon Tom|
|Dorrell, Stephen||Lamont, Norman|
|Douglas-Hamilton, Lord J.||Lang, Ian|
|Dover, Denshore||Latham, Michael|
|Dunn, Robert(Dartford)||Lawrence, Ivan|
|Durant, Tony||Lawson, Rt Hon Nigel|
|Dykes, Hugh||Lee, John|
|Eden, Rt Hon Sir John||Lennox-Boyd, Hon Mark|
|Edwards, Rt Hon N. (P'broke)||Lester, Jim (Beeston)|
|Eggar, Tim||Lewis, Kenneth(Rutland)|
|Elliott, Sir William||Lloyd, Peter (Fareham)|
|Emery, Sir Peter||Loveridge, John|
|Eyre, Reginald||Luce, Richard|
|Fairbairn, Nicholas||Lyell, Nicholas|
|Fairgrieve, Sir Russell||Macfarlane, Neil|
|Faith, Mrs Sheila||MacGregor, John|
|Farr, John||MacKay, John (Argyll)|
|Macmillan, Rt Hon M.||St. John-Stevas, Rt Hon N.|
|McNair-Wilson, M. (N'burry)||Shaw, Michael(Scarborough)|
|McNair-Wilson, P.(NewF'st)||Shelton, William(Streahtam)|
|McQuarrie, Albert||Shepherd, Colin(Hereford)|
|Marland, Paul||Shepherd, Richard|
|Marshall, Michael(Arundel)||Sims, Roger|
|Mates, Michael||Skeet, T. H. H.|
|Mather, Carol||Smith, Dudley|
|Maude, Rt Hon Sir Angus||Speller, Tony|
|Mawby, Ray||Spence, John|
|Mawhinney, Dr Brian||Spicer, Jim (WestDorset)|
|Maxwell-Hyslop, Robin||Spicer, Michael (S Worcs)|
|Mayhew, Patrick||Sproat, Iain|
|Mellor, David||Squire, Robin|
|Meyer, Sir Anthony||Stainton, Keith|
|Miller, Hal(B'grove)||Stanbrook, Ivor|
|Mills, Iain(Meriden)||Stanley, John|
|Mills, Peter (WestDevon)||Steen, Anthony|
|Miscampbeil, Norman||Stevens, Martin|
|Moate, Roger||Stewart, A. (ERenfrewshire)|
|Monro, Sir Hector||Stewart, Ian (Hitchin)|
|Montgomery, Fergus||Stokes, John|
|Moore, John||Stradling Thomas, J.|
|Morrison, Hon C. (Devizes)||Tapsell, Peter|
|Morrison, Hon P. (Chester)||Taylor, Teddy (S'endE)|
|Murphy, Christopher||Tebbit, Rt Hon Norman|
|Myles, David||Temple-Morris, Peter|
|Neale, Gerrard||Thomas, Rt Hon Peter|
|Neubert, Michael||Thorne, Neil(IlfordSouth)|
|Newton, Tony||Thornton, Malcolm|
|Normanton, Tom||Townend, John (Bridlington)|
|Onslow, Cranley||Townsend, Cyril D, (B'heath)|
|Osborn, John||Trippier, David|
|Page, John (Harrow, West)||van Straubenzee, Sir W.|
|Page, Richard (SWHerts)||Vaughan, Dr Gerard|
|Parkinson, Rt Hon Cecil||Viggers, Peter|
|Parris, Matthew||Waddington, David|
|Patten, Christopher(Bath)||Wakeham, John|
|Pattie, Geoffrey||Walker, B. (Perth)|
|Pawsey, James||Walker-Smith, Rt Hon Sir D.|
|Percival, Sir Ian||Waller, Gary|
|Peyton, Rt Hon John||Walters, Dennis|
|Pink, R. Bonner||Ward, John|
|Pollock, Alexander||Warren, Kenneth|
|Porter, Barry||Watson, John|
|Prentice, Rt Hon Reg||Wells, Bowen|
|Proctor, K. Harvey||Wells, John (Maidstone)|
|Raison, Rt Hon Timothy||Wheeler, John|
|Rathbone, Tim||Whitelaw, Rt Hon William|
|Renton, Tim||Whitney, Raymond|
|Rhodes James, Robert||Wickenden, Keith|
|Ridley, Hon Nicholas||Wilkinson, John|
|Ridsdale, Sir Julian||Winterton, Nicholas|
|Rifkind, Malcolm||Wolfson, Mark|
|Rippon, Rt Hon Geoffrey||Young, Sir George(Acton)|
|Roberts, M. (Cardiff NW)||Younger, Rt Hon George|
|Rost, Peter||Tellers for the Noes:|
|Royle, Sir Anthony||Mr. David Hunt and Mr. Tristan Garel-Jones.|
|Sainsbury, Hon Timothy|
§ Question accordingly negatived