Dental and Optical Charges

HC Deb 14 April 1983 vol 40 cc1029-42 10.13 pm

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 and Remission of Charges) Amendment Regulations 1983 (S.I., 1983, No. 309), dated 3rd March 1983, a copy of which was laid before this House on 11th March, be annulled.

Mr. Speaker

It might be in the interests of the House to debate with this the next motion: That an humble Address be presented to Her Majesty, praying that the National Health Service (Dental and Optical Charges and Remission of Charges) (Scotland) Amendment Regulations 1983 (S.I., 1983, No. 335), dated 4th March 1983, a copy of which was laid before this House on 11th March, be annulled.

Mrs. Dunwoody

One of our new annual entertainments provided by kind members of the Conservative Government is a discussion of the way in which charges for receiving dental and optical treatment are to be hyped. As we are told that 1983 is being seriously considered as an election year, the increase is not as large as last year's considerable price rise. However, 1983 has stretched the system of charging just about as far as it will go.

We find it sufficiently important to pray against the regulations because this is the fifth time that the Government have raised charges for dental treatment and the third time that they have raised the charges for optical treatment. For a Government who came into office saying that it was not their intention to increase charges and that it was a wicked Socialist lie that there would be a change in prescription or other NHS charges, theirs is a disgraceful performance.

The Government are not really concerned with maintaining any proper dental care or the provision of optical services. They are concerned with a simple change. They want to make it impossible for there to be a unified system that provides a National Health Service. They want to increase charges so much to those who are not exempted that there will be virtually no difference between the price charged for private treatment and that for NHS treatment. They are coming close to that wish.

To be sure of causing as much trouble as possible, the Government have complicated the system. Last year not only were there increases in charges for optical treatment but the numbers of charges were changed from five to 24. We are told that the changes are simply an annual rise in line with the rate of inflation. That is manifestly untrue. Last year's rise was way above the inflation rate. Also, the rise in charges has put up the amount of money being gained from that source. The income from charges has risen from £25.4 million to £53.6 million— a rise of 110.8 per cent., or 39.2 per cent. above the increase in the retail prices index. That hardly keeps in touch with either inflation or the change in prices. The Government are intent on deflating and undermining dental services.

In 1981 the Government's expenditure plans gave a commitment that they would not raise dental charges faster than costs. They have consistently broken that promise. The British Dental Association has calculated that charges as a percentage of total dental costs have changed in the following manner: in 1978–79 they were 21.3 per cent.; in 1979–80 they were 22.9 per cent.; in 1980–81 they were 22 per cent.; in 1981–82 they were 24.1 per cent.; and this year they will be 27 per cent. Each year that the charges increase, they also become a higher percentage of the overall costs.

What happened under the Labour Government? They increased charges in April 1977 to a maximum of £5 for routine work and £30 for specialist work. This Government's fifth rise means that routine work will cost £13.50 and specialist work £95. Those are increases of 170 and 216 per cent. respectively. That is increasingly indefensible. Conservatives at every level ask why I come to the House and make such a fuss. They say that the charges are no great hardship and that anybody who needs an exemption can have one. They say that anyone with a reasonable explanation or reasonable case will be exempted from charges, and that the only people who will have to pay the increased rates are those who should be prepared to pay for a proper percentage of their dental care.

All this is part of a consistent political attitude towards the NHS. It is not just that the Government see the provision of services as an unnecessary expenditure. They really think that if they change the way in which the dental and optical services operate they will discourage many people from applying for dental care, but the country cannot afford that. There is already growing evidence, not only among schoolchildren, but among ordinary families, that the increase in charges is having a direct deterrent effect upon those who want to use either the dental or optical service.

For instance, let us look at what is happening about charging for crowns in dental treatment. The Government decided to split the charge for crowns into charging for high and low-cost treatment. That this will almost inevitably mean that when the dentist offers treatment to his patients they will opt for the cheapest and not necessarily the best form of crown does not seem to worry the Government. The charges will be considerable. In 1981 the charge for a crown was £20. In 1982 the change came and the charge was £24 for a cheap crown and £48 for an expensive alloy crown. This year it will be £26 for a cheap crown and £50 for an expensive alloy crown. This attack by various means of charging for dental treatment is being repeated across the various special services.

In case it is thought that it is exaggerated to say that this demonstrates a particular attitude rather than economic management of proper charging, we have only to look at two specific instances which the British Dental Association has raised with the Government this year. It pointed out that it already treats vast numbers of students on the exemption basis, mainly because they apply under the provisions for low income. The association then asked whether, as there were so few students who did not qualify under the existing arrangements, it would not be far simpler, admininstratively much more effective, and in the final analysis much more efficient, to exempt more students. The Government's reply was, simply, no. They said that if they gave a special provision of this kind, everybody would expect the same treatment. Old-age pensioners and other sections of the community would ask to be exempted if the scheme for students went ahead.

Secondly, there is a special form that enables patients to get dental treatment for the second time without being means-tested again. This is an even more interesting example of the way in which the Government regard dental treatment. The BDA said that, as a service to their patients, many of whom are being deterred from seeking treatment, it would be a good idea if they were able to place in their waiting rooms copies of the form, which would enable the patients to apply easily. The Government, who are so efficient at management, said that they did not have sufficient money available to print the necessary forms. What they meant was that it was not their intention, under any circumstances, to make it easier for patients to receive proper dental care.

What is happening to dental charges is happening to optical charges. I may be seeing unnecessary difficulties, but it seems to me that a Government who have accepted an Office of Fair Trading report on opticians, but have not defended the need to have proper skilled and professional care and have even suggested that they are seriously examining the report—of course suggesting that they should open optical provision to private enterprise and make it more competitive — will not be above using optical charges as a means of deterring people from seeking proper eye care.

We passed the Opticians Act 1958 because of the generations of people who had been subjected to the sort of eye care that consisted of going into a large general store, buying a pair of magnifiers and on a self-select procedure plonking them on their noses and saying that that was the only kind of optical care that they required. We found that offensive then, and we find it now both inefficient and unacceptable.

The Government have made no attempt to bring that report to the House, refute it or discuss it, or even to discuss the implications of the changes that would result if the OFT report were accepted. Instead, they have changed the optical charges again. The minimum charge for a single lens will increase by 8.1 per cent., to £4. For bifocals, the maximum charge has risen by 6 per cent. The maximum charge for prisms has risen by 19.1 per cent., which is £2.80. All these charges will inevitably encourage the day when there is no difference between the NHS provision and private provision. That is, of course, the reason for these orders.

The changes in charges for elastic stockings, wigs and fabric supports, all of which are regarded as of less importance than the items that the House discusses, are subject to the Government's consistent ploy since they came to office, which is to use a new system of increasing charges annually—not, as they have said, in line with costs, but last year way above costs, and this year possibly above costs—to remove specialist services from the NHS. They hope that this ploy will result before long in fewer and fewer people regarding the NHS and its specialist professionals as the automatic right of every person in this country. We are reaching the stage where those who receive treatment are virtually paying the private rate for that treatment. That is not only retrograde, but unacceptable.

We have the right to pray against these regulations tonight, not because they are simple economic changes that can be defended in the light of calculations of the rate of inflation and changes in the retail prices index, but because they are all part of a consistent pattern which, in the final analysis, will remove from ordinary families the health care that is their right. For many years dental services developed to the point at which children's teeth are now far better than they were 20 years ago, but those standards in dental services and general eye care will not continue to be the norm if we destroy the charging service of the NHS, as proposed in these regulations.

If we were not in what the Prime Minister sees as an election year, the amounts by which the sums are to be increased would be even larger. It has happened before, and if the Government are returned to office it will undoubtedly happen again, not because it can be defended or because it improves dental or optical care or makes better provision for those who need other NHS support, but because of the simple, almost bigoted commitment of Conservative Members to an increase in private dental care and private health care. They do not regard the basic rights of primary care as their concern.

We shall vote against there regulations, not becuase the changes are dramatic, as they were last year, but because they are fundamentally wrong, because they seek to destroy the dental and optical services, and because, in the final analysis, they hand back even more to those colleagues of the Government in private health care who regard it as a matter of importance to earn money from patients.

10.30 pm

The Under-Secretary of State for Health and Social Security (Mr. Geoffrey Finsberg)

I listened with rising incredulity, as I imagine did most hon. Members, to the farrago of nonsense from the hon. Member for Crewe (Mrs. Dunwoody).

Mr. Clement Freud (Isle of Ely)

On a point of order, Mr. Deputy Speaker. Is it not very unkind of the Minister to say beastly things about the hon. Member for Crewe (Mrs. Dunwoody) while her mother is in the Gallery?

Mr. Deputy Speaker (Mr. Bernard Weatherill)

It is completely out of order to comment on the presence of anybody in the Gallery. The hon. Gentleman should know that.

Mr. Finsberg

I shall reserve my remarks for those galleries to which the hon. Member for Isle of Ely (Mr. Freud) plays so often for another occasion.

I can only imagine that the hon. Member for Crewe has conned her hon. Friends into wasting the time of the House until 11.30 pm on a Thursday night. There is nothing at all in the arguments that she has produced. I remind the House that the increases are in line with rising costs. I should perhaps mention that the two sets of regulations, one for Scotland and the other for England and Wales, are identical and my observations will apply to both.

It is clear from a study of all the figures that are available to the House that an increase of less than 4 per cent. is the maximum for routine dental charges and for lenses. I should have thought that that is a perfectly reasonable figure to put to the House. We shall continue to increase the total spending on the National Health Service, as we have done since we came to power. I remind the House that dental expenditure in England is up this year by £30 million to over £560 million and that optical expenditure is up by £15 million to £165 million. I also remind the House, because it would not have understood this from what the hon. Lady tried to say, that over 70 per cent. of the general dental and optical service charges are made out of taxation, not charges. National Health Service expenditure in England is up from £6.5 billion in 1978–79 to almost £13 billion in 1983–84. Even allowing for inflation, that shows a real growth of 7.5 per cent. If that is measured against the retail price index it rises to 17 per cent. None of the figures that I have given to the House substantiate in any way any of the hon. Lady's statements which attempted to suggest that the Government had a grudge or a bias against dental and optical services.

I remind the House that an enormously wide range of free treatments remain. Children under 16, young people under 19 and still in full-time education, expectant mothers and many more qualify for free dental treatment, and children under 16, children under 19 in full-time education, and, again, many more, are eligible for free NHS glasses. Both those services are available to families on family income supplement and supplementary benefit. I suggest again that that shows that the Government believe that the services should be provided for those people most in need.

The hon. Lady said in the debate on 30 March 1982, referring to last year's increases: 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. The House will note that there has been no protest from the professional organisations this year, because they recognise the common sense of what we have done. The hon. Lady continued: they will discourage dental and optical treatment".—[Official Report, 30 March 1982; Vol. 21, c. 196.] I do not know how she works that out, so I had better continue my lesson in elementary mathematics for her.

For the quarters March to December 1980 the annual total of courses of dental treatment was 30.07 million. In 1981 it was 30.50 million—an increase of just under 500,000. In 1982 —the year of the great deterrent to treatment, according to the hon. Lady—it rose from 30.5 million to 31.47 million, an increase of 3.2 per cent. over the previous year. Those are the only figures on which we can operate. That increase of 3.2 per cent. compares with an increase of 1.4 per cent. in the previous year, so in the year of the swingeing increases to which the hon. Lady constantly refers, the increase in courses of treatment more than doubled. Those figures entirely disprove the hon. Lady's argument. Moreover, in 1980 there were 8.79 million optical tests, compared with 8.93 million in 1981 and 9.19 million in 1982.

Mr. Peter Hardy (Rother Valley)

The Minister seems excessively smug about the 31 million courses of dental treatment, but that means that only about half the population actually saw a dentist last year. Does he regard that as a matter for complacency and satisfaction?

Mr. Finsberg

If the hon. Member for the Rother Valley (Mr. Hardy), for whom I have great respect, had listened to the burden of my argument he would have realised that my point was that the charges had not deterred people from going for treatment. I shall deal in a moment with his point about the total number of people who actually go to a dentist.

Frankly, the House has heard humbug from the hon. Lady today. In the debate last year, she also said this: When we return to office, it will be our aim to abolish all these charges at the earliest possible moment." — [Official Report, 30 March 1982; Vol. 21, c. 196.] She certainly did not repeat that today. Has she now dropped that proposal, or has she been forced to drop it as she has been forced to drop so many others?

Mrs. Dunwoody

I keep making the mistake of taking the Minister seriously. A document that he can buy for 90p from the Labour party contains not only new hope for the people of Britain but a firm commitment to a real increase of 3 per cent. for the National Health Service and a very plain commitment on the phasing-out of all charges. If he will do us the elementary honour of reading that, he will see that the commitment is clearly spelt out.

Mr. Finsberg

It was noticeable that the hon. Lady did not repeat that commitment, but, of course, I am prepared to re-read her horror comic. The only point about that horror comic is that Labour has held office for many years since 1945. I can recall an ex-Prime Minister resigning from a departmental office because of charges. Every opportunity that the Labour party has had to remove charges has not been taken. I shall remind the hon. Lady of them so that she knows: he value that people put on her pledges to remove charges. The Labour party has never done so—and never will—because the economic facts of life have hit it as they hit the Chancellor of the Exchequer in the previous Government who came scuttling back from Heathrow to borrow money from the IMF and to increase NHS charges more than any charges since the second world war.

Mrs. Dunwoody

That is untrue.

Mr. Finsberg

The hon. Lady says that that is untrue. I remind the House that, as a result of the incease of April 1977, the maximum charge for a single course of treatment increased by 150 per cent.—the highest increase since the second world war. That happened under a Government that kept saying that they would reduce and abolish charges. The Labour Government of 1969 increased charges by 25 per cent. The Labour Government of 1976 increased them by 20 per cent. and the Labour Government of 1977 increased them by 150 per cent. It is perfectly clear that what the hon. Lady repeats time and again is meaningless.

Mrs. Dunwoody

Will the hon. gentleman be kind enough to tell us what charges were when we left office and what they are now?

Mr. Finsberg

According to the latest figures, the overall maximum charge in 1979 was £36 and it is now £95. The hon. Lady never likes setting that against the increase in total expenditure in real terms on the NHS and the fact that in spite of all of these charges, the number of courses of treatment increase all the time.

The emphasis that we have tried to place on charges this year is that of prevention. That is why we have increased the routine course of treatment by only 50p, or 3.8 per cent. I notice that the hon. Lady did not mention some of the reductions in charges for glasses. We have carefully considered the needs of patients in that regard. Since 1979, the cheapest single vision lens has decreased by 19 per cent. in real terms. The hon. Lady did not say anything about that. The cost of the cheapest bifocal lens has increased by 2 per cent. in real terms since 1979.

One thing is clear for any hon. Member who reads what the hon. Lady said in 1981 or 1982—she never learns. Moreover, she never listens and, if she listens, she never understands. A prescription in Britain is usually taken with water. The Labour prescription has been exposed as sheer codswallop. It should be taken neither with water nor with a pinch of salt. It is a prescription which will be taken at the nation's peril if it is foolish enough to open the bottle when it has already read what happens when that bottle is uncorked. The price increases in the two regulations will be seen, by sensible people, to be reasonable. The professional organisations do not regard them as unreasonable. I strongly hope that the House will reject the Opposition's prayers.

10.43 pm

Mr. Clement Freud (Isle of Ely)

This is an annual event to which no one much looks forward. We seem to gather here for an exchange of figures that are bandied around to the advantage of the incumbents of whichever Bench they come from. In one of his first speeches as Minister of Health, the hon. and learned Gentleman described this as highly discriminatory. It is. I had much sympathy with the hon. Member for Crewe (Mrs. Dunwoody) when she said that this is fundamentally wrong. It is fundamentally wrong to treat some parts of the body differently from others. It is astonishing that, if there is something wrong with one's eye, one pays through the nose for treatment, but, if there is something wrong with one's nose, the treatment is free. However, when we reach the teeth or gums, we start to pay again.

I accept the Minister's statement that the increases are not draconian—they seem to be reasonable—but the concept is wrong. It means that some parts of the body cost more to maintain than other parts. I hope that the Government will recognise that fact. Successive Governments have charged for this disparate maintenance, and I hope that, when Governments recognise how fundamentally wrong the concept is, they will at least peg those prices in absolute terms.

The Minister said that a wide range of people receive free treatment, which is correct, but, as I have said before, the charges are very hard on students. Those in full-time education up to the age of 19 are not charged, but the student who is unleashed for three years of tertiary education is often the person least able to afford dental and optical care. If any concession is to be made, I hope that the Minister will consider that class of person above others.

10.46 pm

Mr. Bill Walker (Perth and East Perthshire)

It is staggering to hear the suggestion of the hon. Member for Crewe (Mrs. Dunwoody) that those who can afford to pay should not, and that we should not look after those who cannot afford to pay for treatment. It is a complete contradiction of the policies advocated by the right hon. Member for Stepney and Poplar (Mr. Shore), who said that a Labour Government will tax those in the income bracket who can afford to pay tax, and that they will reduce tax for those who earn below a certain level. Is that not what happens with National Health Service treatment? Those who can afford to pay are required to pay, and those who cannot—there is no problem in determining who they are—are not required to pay.

If a student belongs to a family who can afford to pay for any treatment he may require, that family should contribute towards the payment. In that respect, I am talking about my family. I should be prepared to pay if it would help others who are less well off and who cannot afford to pay. That is what a caring society is about. Those who can pay, should, and those who cannot pay should receive.

I was also staggered by the record, as repeated by my hon. Friend the Minister, of Labour Governments. It shows clearly that, when the Labour party is in office, it never lives up to the promises that it made when not in office. That is true not only for health care but in every other area. When the Labour party is out of office, its members always make a story sound convincing, but when they are in office the product never lives up to the sales pitch. The hon. Lady talked about the income from charges, but that must be reflected in the number of customers. Any shopkeeper could tell the hon. Lady that if the number of customers increases, income is bound to increase.

One must add to that the inflationary element that has existed in Britain for so long, but at the end of the day we must return to constant money prices, or true money. If we examine the real growth in expenditure on the National Health Service under this Government, we can see the hollowness of the charge made by the hon. Lady that, with these regulations, the Government are trying to destroy the National Health Service for the majority of people. That cannot possibly be true when 70 per cent. or more people receive treatment at the taxpayer's expense.

This evening shows clearly how hollow and shallow the Labour party's promises and attitudes are. When they have no case they bluff and bluster, but they convince no one. These reasonable increases will be seen for what they are and they will be respected by the professions because they understand them.

10.50 pm

Mr. Peter Hardy (Rother Valley)

The hon. Member for Perth and East Perthshire (Mr. Walker) said that the increases were reasonable. They are not as steep as in earlier years, but I cannot accept that they are reasonable, because far too few people seek the treatment that common sense suggests they need.

It is not good enough for the Government to be smugly satisfied that 30 million people are having courses of dental treatment, when the population is nearer 60 million. It may be more than last year, but that may be because there are more people on supplementary benefit who are entitled to free treatment. Of course, under this Government they have the leisure to take advantage of the treatment provided by dentists. It is one of the few advantages which, they may have secured over the past few years.

The Minister suggested that last year's adverse criticism had not been repeated in 1983. People can see no point in protesting to the present heartless Administration. They recognise that the time for a different protest is approaching which may allow the Labour party to win its ninth general election.

The Minister said that Labour Governments had been in office for many years. The history of the Labour movement shows that we have won nine elections, but for about 11 or 12 years only have a Labour Government had a majority and effective power. In one of those years the National Health Service was created. Many of the things that have happened over the past three years have eaten away at the spirit and intention of the National Health Service, which is to seek to provide a decent standard of health in our community. The Government should consider the fact that last year 25 million people who should have visited the dentist did not do so.

The Government commit themselves to supporting the National Health Service, but they did remarkably little to implement the recommendations of the Black report.

I believe that the charges and experience over the past three years, rather than those of the past 12 months, suggests that there is a grim reality in the Government's approach to the National Health Service. They offer shabby treatment to the vast majority of the people.

The Government say that they are increasing aid to many people. More people in my region are public beneficiaries now than three years ago. In the Yorkshire and Humberside region, for example, three times as many people are dependent upon state allowances as in 1979. The Government might reasonably say that they are poor people and that they will help them. However, in addition to the fact that there are now three times as many people below the poverty level receiving supplementary benefit, in most parts of the country the number approaching that level has increased.

I am surprised that a Scottish Member should dissent from that view. I could understand that from hon. Members representing comfortable seats south of Potters Bar, but in the industrial areas, which are blighted by Government policies, there are hundreds and thousands of people who cannot afford to go to the dentist and the optician.

Mr. Bill Walker

That is not true.

Mr. Hardy

It is true.

Mr. Geoffrey Finsberg

Rubbish.

Mr. Hardy

In that case, will the Minister tell us when there will be 55 million or 60 million courses of treatment or visits to the dentist in a year?

Mr. Finsberg

The hon. Gentleman commented on the fact that the only Scottish Member here is my hon. Friend the Member for Perth and East Perthshire (Mr. Walker). The Opposition prayed against the regulations, but there is not a Scottish Opposition Member present. The point that the hon. Gentleman makes can be achieved if he is prepared to dragoon people into going to the dentist. No one is prepared to do that. The Health Education Council work that is being done in schools is successfully increasing the numbers year on year. The hon. Gentleman cannot dispute that.

Mr. Hardy

I spent a considerable part of my life as a schoolmaster, when I sought to encourage people to visit their optician and dentist regularly. Until the Labour Government did something about promoting the training and appointment of dentists, we did not have enough dentists to go round in the industrial areas of the north. Now, under the present Administration, there will be unemployed dentists as well as doctors.

Mr. Frank Haynes (Ashfield)

We have them now.

Mr. Hardy

We may have them now, but I hope that we can still appoint a few more in my area. I should like the Government to take steps to encourage people to go to the dentist and the optician. The Minister knows well that the charges are a real deterrent.

Mr. Finsberg

They are not.

Mr. Hardy

Yes, they are. I can justify that statement by referring to conversations that I have had in my constituency. I met some people in their early 60s and late 50s. Many of them were on much lower levels of real income than they enjoyed before 1979. They told me that there was no advantage in going to the dentist or the optician today and that they might as well wait until they are 65, when they will not have the same economic struggle to meet the bill.

The Minister has a duty to guard the nation's health. It is not good enough that people in late middle age should defer seeing the dentist or the optician, because at their time of life it might be highly appropriate for them to make regular visits. I know my constituency better than anyone else in the House. There must be many other constituencies like it that contain people who are so depressed, disturbed or anxious about money that they are saving more or avoiding spending anything, even on essentials such as these.

That is one of the consequences of the Government's approach. It is on a par with their neglect of the Black report. It is on a par with the treatment that areas such as mine have received, when we have seen our unemployment treble, our industries laid waste and our services threatened. I suggest that the DHSS should look again at the consequences of its policies, particularly pernicious ones such as this, and their effect on the industrial areas of the north of England.

10.57 pm

Mr. Frank Haynes (Ashfield)

The Minister suggested that my hon. Friend the Member for Crewe (Mrs. Dunwoody) had not listened and does not listen. I make it clear to him that I listen. I listen to the Minister regularly when he is at the Dispatch Box. As my hon. Friend the Member for Rother Valley (Mr. Hardy) said, the Minister has been smug in some of his comments. I do not think that the Minister knows what the problem is all about. He sits for a constituency in the rich south.

I have had a letter from the Department informing me that the Minister is to visit my consituency next week. Bearing in mind what he has said tonight about there being no real problems in optical services and dentistry, I shall arrange something for him, if he likes, for when he comes up to the constituency. Perhaps the Minister will say that he is too busy. He is even too busy to meet the chairman of the community health council in central Nottinghamshire.

Mr. Finsberg

The hon. Gentleman must get his facts right. I was asked today if I would meet the chairman. I said yes the moment I was asked. I know the hon. Gentleman's constituency. I worked for two years down the pits in his constituency. I know it well. I said clearly that in the charging system there were no problems. I do not deny that people have sight problems and dental problems. I said that the number of courses was rising year on year. I am coming to the hon. Gentleman's constituency. I shall be glad to see him as well and have a discussion with him if he wishes. No one has ever found me unwilling to meet people and have a discussion.

Mr. Haynes

Mr. Deputy Speaker, I do not want you to ask me to leave the Chamber or to rule me out of order. The Minister has brought into the argument the fact that he worked in the pits for two years. I remember him, but he does not remember me. He is nodding now. He had two years in the pits, but I had 30-odd years. Whether we talk about eyes or teeth or heavy industries such as coal mining we have real problems.

The Government are clearing the way in optical services for the big store in the High Street. We know what went through the House not long ago in regard to going to Woolworths. The professional people in the service do not like it. It drives people away from having tests. They will be able to go into Woolworths and pick up a pair of glasses which may not suit them for reading or whatever they want to do. A proper service should be provided; that means having tests. The effect of the regulations will be to drive people away from the service.

The Minister has quoted figures. The next figures for the number of eye tests will be lower. What sort of argument will the Minister put up then? The Government are cashing in on people's disabilities. That is how they work, not just by putting through these regulations but in everything else. All the Government care about is putting up prices. In 1979 there was great talk about the two shopping bags and the prices people had to pay for the necessities of life. Tonight we are talking about necessities for certain individuals. Some people may need glasses because of accidents down the pits. For donkey's years I have seen people having to get specialist treatment for injuries received in the pits.

The Government are putting up the charges again. That will continue while this lot are in office. I support what my hon. Friend the Member for Crewe said. Enough is enough. The increases must stop. People cannot keep paying in this way. When they pay these charges, they have to give up something else.

I recall the earlier comment of the Minister about people being able to afford the charges, because the increase is minimal. The Minister will be able to afford the charges if he wants to use the service, but we are talking about the people we represent. I am talking notabout those who qualify for a grant or for free treatment but about the people who are near the line but still have to pay, people in the very low income group who are only just over the line. The Government are not helping those people.

The hon. Member for Perth and East Perthshire (Mr. Walker) talked about caring for people. The Conservatives constantly say theirs is a party that cares for the people.

Mr. Bill Walker

It is.

Mr. Haynes

They are off again, nodding their heads at what I am saying.

Mr. Walker

I am sure the hon. Gentleman has noted that I care enough — as do my hon. Friends the Members for Edinburgh, South (Mr. Ancram) and for Galloway (Mr. Lang), who are the only other Scots in the Chamber — about the fact that we are debating the National Health Service in Scotland to be here. There are no Scottish Members on the Opposition Benches. We care. Opposition Members do not care.

Mr. Haynes

I cannot speak for my Scottish hon. Friends. Perhaps my Scottish colleagues have much to do in the north in preparation for a general election. We hear Conservative Members claim that they represent a caring party—

Mr. Michael Ancram (Edinburgh, South)

We care enough to be here.

Mr. Haynes

I remember the action of Conservative Members when the proposition was put to the House that there should be an easement on VAT for the voluntary organisations. They trooped into the Government Lobby to oppose the measure. That is an example of their caring approach. I am talking about voluntary organisations that work within the NHS, and there are many in my constituency. I have been lobbied by them about the VAT problem.

The attitude of Conservative Members to imposing charges on those with a disability shows how much they care. I hope that we shall be able to defeat the Government tonight, although I doubt very much whether that will be the outcome of the Division. We were able to defeat them a few nights ago and I hope that we shall be able to do so again in preparation for the election. When the next Labour Government take office, they will right the wrongs that the Government have done in giving the people a raw deal over the past four years.

11.7 pm

Mr. Edwin Wainwright (Dearne Valley)

In this debate our concern must lie with those who are unfortunately disabled. Of course, there are many who can afford various charges, and the National Health Service does not matter very much to them. We now have 3.5 million unemployed officially, and there is hidden unemployment amounting to another one million. Some of the unemployed may happen to be just above supplementary benefit level and they will find it difficult to obtain what amount to basic requirements.

The Government seem all the time to want to take from the poorer section of the community—

Mr. Ancram

That is not so.

Mr. Wainwright

Then what are the Government playing at? They have sought by every avenue to take substance away from the poorer section of society and to find means of not giving those within it their fair share of the country's wealth. I am wondering what will happen to the Montague hospital in my constituency. Are the Government seeking to obtain more money by increasing dental and optical charges with a view to building up the hospital? Are they saying "We must look after patients no matter what is wrong with them; we must ensure that we cater for them"?

I do not think that that is the Government's approach. Conservative Members are more professional than most Labour Members. The more professional Conservative members get, the more the caring attitude that they claim goes out of the window. They do not seem to realise what the ordinary individual has to put up with. Hon. Members should consider what it means to make anyone have to pay extra for something vital in order to live a normal life. It is easy not to realise—unless one is unable to obtain spectacles or to pay for the dentist—what it means to be short of such vital things. The hon. member for Perth and East Perthshire (Mr. Walker) shakes his head. He will probably get up and say that he cares just as much as us about those people, but it is not true. However, I hope that he says that, because if he does, he will have to show a little more compassion when opposing our prayer, whether he does so because of his party's diktat or because that is his judgment.

It is time that Conservative members realised that sections of our community are suffering much more than they ever thought that they would do. Some of them even voted for the Tory party, because they expected a gradual increase in the standard of living and that there would be greater benefits. They were promised that.

Mr. Bill Walker

There has been a gradual increase.

Mr. Wainwright

There has not, because a graph would show that there is a vast difference between the top 10 per cent. and the lowest 20 per cent. in this country, and that is the result of the Tory party's efforts. It is time that Conservative Members gave a little more thought to the unfortunate. The Government should be making every effort to create more wealth at all levels of industry, and should not take money from the poor, as they are doing.

Mr. Ancram

Does the hon. Gentleman agree, in the absence of his Scottish colleages, that his arguments do not, obviously, apply to Scotland?

Mr. Wainwright

If the Scottish people were to decide today on the Government whom they wanted, the Tories would not stand a chance. Some hon. Members may have gone home to canvass. They may have decided to see what stand our caring and wonderful Conservative Members take tonight, despite the fact that they profess to be so concerned about workingclass people. When people read about what has happened tonight they will rise up with even greater strength and determination in order to destroy the Conservative party at the next general election.

I hope that the Government will realise that they should govern all the people. They should care more about the lower section of society, and less about the upper section. I find that in 99 cases out of 100 what the Government do is of more help to those with wealth, and pinches those poor, unfortunate people, who need and deserve a far better life than they are being given today. It might do Conservative Members good to live at the standard of some of our unfortunate people. We pride ourselves on the fact that ours is a wealthy nation. It is for some, but not for the poor, unfortunate people on the lower rungs of society.

Question put:—

The House divided: Ayes 51, Noes 110.

Division No. 115]	[11.15 pm
AYES
Allaun, Frank	Dubs, Alfred
Archer, Rt Hon Peter	Dunwoody, Hon Mrs G.
Atkinson, H.(H'gey,)	Eastham, Ken
Bagier, Gordon A.T.	Evans, John (Newton)
Beith, A. J.	Foster, Derek
Callaghan, Jim (Midd't'n & P)	Freud, Clement
Cocks, Rt Hon M. (B'stol S)	George, Bruce
Cowans, Harry	Hardy, Peter
Cunningham, Dr J. (W'h'n)	Harrison, Rt Hon Walter
Davis, Clinton (Hackney C)	Haynes, Frank
Davis, Terry (B'ham, Stechf'd)	Holland, S. (L'b'th, Vauxh'll)
Deakins, Eric	Home Robertson, John
Dean, Joseph (Leeds West)	Homewood, William
Dormand, Jack	Horam, John

Hughes, Simon (Bermondsey)	Skinner, Dennis
Jenkins, Rt Hon Roy (Hillh'd)	Soley, Clive
Kaufman, Rt Hon Gerald	Spearing, Nigel
Litherland, Robert	Spellar, John Francis (B'ham)
Lyons, Edward (Bradf'd W)	Wainwright, Edwin
McCartney, Hugh	Welsh, Michael
McKay, Allen (Penistone)	Wigley, Dafydd
Millan, Rt Hon Bruce	Williams, Rt Hon Mrs (Crosby)
Mitchell, R. C. (Soton Itchen)	Winnick, David
O'Brien, Oswald (Darlington)
Parry, Robert	Tellers for the Ayes:
Powell, Raymond (Ogmore)	Mr. Lawrence Cunliffe and
Prescott, John	Mr. George Morton.
Robinson, G. (Coventry NW)
NOES
Alison, Rt Hon Michael	Marlow, Antony
Ancram, Michael	Mather, Carol
Aspinwall, Jack	Maude, Rt Hon Sir Angus
Atkinson, David (B'm'th,E)	Mawhinney, Dr Brian
Beaumont-Dark, Anthony	Maxwell-Hyslop, Robin
Berry, Hon Anthony	Mellor, David
Biggs-Davison, Sir John	Meyer, Sir Anthony
Blackburn, John	Miller, Hal (B'grove)
Boscawen, Hon Robert	Mills, Iain (Meriden)
Bright, Graham	Moate, Roger
Brinton, Tim	Nelson, Anthony
Brooke, Hon Peter	Neubert, Michael
Brown, Michael (Brigg & Sc'n)	Newton, Tony
Bruce-Gardyne, John	Page, Richard (SW Herts)
Buchanan-Smith, Rt. Hon. A.	Parris, Matthew
Buck, Antony	Patten, Christopher (Bath)
Carlisle, Rt Hon M. (R'c'n)	Pawsey, James
Chapman, Sydney	Percival, Sir Ian
Clark, Hon A. (Plym'th, S'n)	Prentice, Rt Hon Reg
Clarke, Kenneth (Rushcliffe)	Proctor, K. Harvey
Cope, John	Renton, Tim
Cranborne, Viscount	Rhodes James, Robert
Dorrell, Stephen	Rossi, Hugh
Dover, Denshore	Sainsbury, Hon Timothy
Dunn, Robert (Dartford)	Shaw, Giles (Pudsey)
Dykes, Hugh	Shelton, William (Streatham)
Eden, Rt Hon Sir John	Shepherd, Colin (Hereford)
Fairgrieve, Sir Russell	Shepherd, Richard
Faith, Mrs Sheila	Shersby, Michael
Farr, John	Sims, Roger
Finsberg, Geoffrey	Skeet, T. H. H.
Fox, Marcus	Speller, Tony
Goodlad, Alastair	Spicer, Jim (West Dorset)
Greenway, Harry	Stanbrook, Ivor
Griffiths, Peter (Portsm'th N)	Steen, Anthony
Gummer, John Selwyn	Stevens, Martin
Hampson, Dr Keith	Stradling Thomas, J.
Haselhurst, Alan	Taylor, Teddy (S'end E)
Hawkins, Sir Paul	Thompson, Donald
Hawksley, Warren	Thorne, Neil (Ilford South)
Heddle, John	Trippier, David
Hicks, Robert	Waddington, David
Hogg, Hon Douglas (Gr'th'm)	Waldegrave, Hon William
Hunt, John (Ravensbourne)	Warren, Kenneth
Jopling, Rt Hon Michael	Watson, John
Kershaw, Sir Anthony	Wells, Bowen
Kitson, Sir Timothy	Wells, John (Maidstone)
Lang, Ian	Wheeler, John
Lawrence, Ivan	Wickenden, Keith
Lester, Jim (Beeston)	Wilkinson, John
Lyell, Nicholas	Winterton, Nicholas
McCrindle, Robert	Wolfson, Mark
Macfarlane, Neil	Young, Sir George (Acton)
MacGregor, John
MacKay, John (Argyll)	Tellers for the Noes:
McNair-Wilson, M. (N'bury)	Mr. Archie Hamilton and
Major, John	Mr. Tristan Garel-Jones.

Question accordingly negatived.