§ Order for Second Reading read.4.47 pm
§ The Secretary of State for Social Services (Mr. Norman Fowler)
I beg to move, That the Bill be now read a Second time.
The Bill has three themes. First, it is about improving the rights of the public. Clause 1 deals with the important area of optical services and opens up the market for the sale of glasses; while a further example of the same theme occurs in clause 13 where the Bill tackles the wholly indefensible position of what is called "franking" which results in manifest loss for the members of some private occupational pension schemes. The second theme deals with the improvement of health provision and in particular the change in the status and construction of family practitioner committees. While the third theme contained in the second part of the Bill concerns changes in the social security law — of which probably the most important change is the new severe disablement allowance, which will replace the non-contributory invalidity pension and in particular the much criticised housewives' duties test. I would like to deal with these three parts in turn.
On optical services, the Bill follows a report by the Director General of Fair Trading on opticians and competition, which was published at the beginning of this year. The report took 12 months to complete by the Office of Fair Trading and in that time evidence was taken from a wide range of interests, including the opticians themselves. It should be emphasised that the report itself followed earlier studies such as the 1976 report of the Prices Commission.
The Office of Fair Trading report recalls that the opticians' monopoly is relatively new. It was introduced by the 1958 Opticians Act which in itself was a private Member's Bill for the registration of opticians, introduced by the late Sir Ronald Russell. As first presented the Bill sought to protect the title of optician and did not seek to prevent unregistered opticians from practising. But two new clauses were added during the Committee stage of the Bill which prevented the testing of sight and the sale of optical appliances by unregistered people. That monopoly position has continued to this day. In its report the OFT distinguished between the professional functions carried out by opticians, such as sight testing, and the much more commercial undertaking of selling glasses. On the sale of glasses, the Office of Fair Trading was under no doubt that the present position operates against the interests of the consumer in this country and in particular it criticised the restrictions that there were on advertising.
Basically the present position is that virtually the only advertising that is allowed is on spectacle frames displayed in the windows of the optician's own premises. The optician cannot advertise in the press; he cannot advertise on television or radio; he cannot advertise on prices or on the speed of service; and he cannot even advertise when he is open. The best information that we have is that the restrictions on advertising in the United Kingdom are greater than any other west European country, with the possible exception of Ireland.
295 Not surprisingly, the Office of Fair Trading came to the conclusion that from the point of view of the consumer —and that, after all, is the acid test—these restrictions on advertising were totally unsatisfactory. In a powerful passage on page 141 of its report it says that the rules of publicity effectively deny consumers information on available opticians in their locality; the range and prices of available products; the services that are offered by opticians in terms of opening hours and the speed of dispensing. Consumers, it says, are therefore denied the knowledge on which to make an informed choice of an optician. This lack of knowledge on the part of the consumers has the effect of increasing the ability of opticians tofix prices without regard to the prices of other opticians and thereby to recover their overheads while operating below capacity".
In other words the OFT found that restrictions on advertising led to a lack of information for the consumer and wide variations in prices for similar glasses. That was shown graphically in one survey that was carried out in London where the same prescription was taken to 58 opticians. The prices offered by those opticians ranged between £44 and £103. It seems to me that that kind of example presents an unanswerable case for more information being made available to the public. It may be justifiable for one optician to charge more for the same work than another, but where that acts against the public interest is when the public are denied most reasonable means of finding out what the relative prices are and choosing for themselves. It was, therefore, not surprising that the principal conclusion of the Office of Fair Trading wasthat the advertising restrictions result in prices being significantly higher and efficiency significantly lower than they otherwise would be".It was this position that the Government were required to face. I know that there are those opticians who believe that it would have been more sensible for the profession itself to make proposals to lift the restrictions on advertising. I must say, however, that it had every chance and every opportunity to do just that. Earlier this year the General Optical Council made proposals on advertising which scarcely took the position forward at all. At a meeting that I and the Minister for Health had with the professions six weeks ago, again it was quite clear that there was no support for change. The choice for the Government then was whether simply to leave the position as it was, with all the drawbacks that that position had for the consumer, or to make proposals for change. As the Bill shows, we have decided to make changes which we believe will serve the consumer best.
The Government seek in this Bill to distinguish between the important professional role that opticians clearly have and the essentially commercial role of selling glasses. As far as the professional role is concerned, only registered opticians and doctors will be able to test eyes, to dispense to children or to dispense and sell contact lenses. We believe that those restrictions are reasonable, and we also believe that the access to a free sight test is important in detecting serious eye disease.
However, as for selling spectacles, we believe that many of the restrictions that at present apply to opticians can be lifted. At present, the rules governing advertising are proposed by the General Optical Council, which is composed of members of various optical bodies, who are in the majority, as well as medical and lay members. These 296 rules are subject to the approval of the Privy Council. But the only power that the Privy Council has is either to accept or to reject the proposals. It does not have the power to amend and, in effect, make new rules. We therefore intend to take power whereby the Privy Council car. amend the rules on advertising, while at the same time recognising that a distinction should be made between the professional function of sight testing and the commercial function of selling glasses.
§ Mr. Jim Craigen (Glasgow, Maryhill)
I should like clarification Government thinking on this matter. I noted what the right hon. Gentleman said about eye testing by practitioners, but am I to take it that spectacles sold over the counter as easily as sunglasses?
§ Mr. Fowler
No. That could not happen under the proposals that I shall come to later. The glasses will have to be sold against a recent prescription whereas if the hon. Gentleman goes to buy a pair of sunglasses that is not the situation.
We then come to the essentially more controversial question whether non-opticians should be allowed to compete subject to certain conditions. This again was considered by the Office of Fair Trading. It found that there were likely to be unregistered sellers who would be prepared to come into the market, and it recognised that there was a case for having no restrictions at all on the dispensing of spectacles to adults. However, it reported that, if Ministers felt that the potential health risks outweighed the competition benefits, they could consider the alternative of derestricting dispensing but providing by legislation that spectacles may only be sold against a prescription issued in, say, the previous two or three years—the point that the hon. Gentleman was raising. Such a system, it said, would be likely to reduce the competition benefits, but would eliminate the health risks. It is basically that middle way that the Government have chosen.
Under the Bill, non-opticians will be prevented from supplying children or fitting contact lenses. It is also our intention to make regulations under which non-opticians will be able to sell only against a recent prescription that we would define as a prescription issued in the previous two years. In addition, we intend to consult on other conditions that a non-optician seller might be required to meet. I should be entirely clear about this: I do not want to reinstate a new and cumbersome licensing system which simply replicates what we have at the moment. It should be remembered that the vast majority of prescriptions in this country — this is unlike the position in many other countries — are made up not on the optician's own premises, but by special prescription houses where the staff involved do not have to be, and mostly are not, registered opticians.
§ Mr. Michael Meadowcroft (Leeds, West)
Would not the Secretary of State accept that even in that case it is a registered optician who is taking responsibility for the delivery of those lenses, however they are made up?
§ Mr. Fowler
Yes, he is certainly taking responsibility for that and, as I have made clear also, we shall want to consider what conditions a non-optician seller may be required to meet so that he will be able to take a similar responsibility.
Necessarily, those changes take us on to the next stage of considering the the general ophthalmic service. At 297 present, the service provides free sight tests and free glasses for exempt groups, such as children and low-income families, and that provision will continue. I should point out that when, as we expect, prices in the new deregulated market come down sufficiently, the Government would see great advantage in also allowing the exempt groups the right to choose more widely and either reimburse them or provide them with some kind of money voucher. This would have advantages both for the customer and the Department of Health. It is not at once obvious that a Government Department is best equipped to carry out the cosmetic role of designing spectacle frames, and perhaps that is one reason why there has been only one updating of NHS glasses since the early 1950s.
The change will also mean that NHS glasses will not in future be provided for the non-exempt groups. At present, we spend as taxpayers almost £20 million a year in supporting all those who choose to buy NHS glasses, including those who choose to put NHS lenses into private frames. In effect, this means that anyone who chooses NHS spectacles or NHS lenses in private frames gets an average subsidy of £5 from the taxpayer. In the vast majority of cases I cannot believe that that subsidy is justified. On the other hand, it has been argued that those with the very poorest sight need complicated and more expensive lenses, and I am certainly prepared to consider the evidence on that to see whether they can have continued access to NHS glasses.
§ Mr. Ernie Roberts (Hackney, North and Stoke Newington)
Is not the exemption of children under the Bill an evidence of the serious results that can arise if eyesight is not treated correctly, and is that not just as important for old people as for children?
§ Mr. Fowler
If the hon. Gentleman reads the report of the Office of Fair Trading and takes account of professional opinion, he will find that he is certainly right in what he says about children. That is why we have made these provisions, not only in terms of dispensing for children but in terms of stating to whom and where children should go. As for adults, the report makes it clear that even when the average person is prescribed and dispensed a wrong pair of glasses, that will not cause damage to the adult's eyesight. and that is an important point to remember.
§ Mr. Sydney Chapman (Chipping Barnet)
We are now discussing a crucial point. The Minister will be aware that opticians, although perhaps with a vested interest, fundamentally disagree with paragraph 14.13 of the OFT report, which says, in effect, that inaccurate spectacles —not cause permanent damage to the eyes, but only a minor discomforture. Is my hon. Friend relying just on that paragraph in the report or has the Department gone into the matter in greater detail? Is he aware that health care is the crucial matter in this context? Is he further aware that hon. Members in all parts of the House would feel happier if they knew that the Government had made further investigations into the matter?
§ Mr. Fowler
We have gone into that. My hon. Friend will have seen from the paragraph in the report to which he referred that in evidence to the OFT only one person from the professional bodies sought to challenge the 298 conclusion of the OFT in the matter. However, it is also the view of the medical advice that is available to my Department.
Let us be clear that the only revolutionary principle involved in these proposals is that basically we are saying that the service generally should be organised with the interests of the consumer first. Certainly there is nothing new in the principle of paying for spectacles, and it would be ironic if the hon. Member for Oldham, West (Mr. Meacher) were to argue that this marks the end of the NHS as we know it.
§ Mr. Fowler
I shall come to precisely that point.
As Opposition Members know full well, the principle of charging for optical services was introduced by a Labour Government in 1951, when the then Minister for Health, Mr. Hilary Marquand, said that the Bill—the one that he was then introducing—had been described in some quarters as an attack on the NHS or as the first step in dismantling the service. We have heard that phrase before.
Mr. Marquand went on to say that he was tempted to voice the indignation that he felt about that, and pointed out that the then Government were putting forward plans to expand the hospital and general practitioner services. Mr. Marquand hoped that those who were critical would realise that their criticism was ill-founded.
I do not think that I could improve on that defence, for that is exactly the position today. [Interruption.] The House should be in no doubt about our objectives. Obviously we shall listen to the arguments that are adduced, but our objectives are to give better value for money, to promote competition and to remove from the state a function that it cannot do well and has not done well in the past and, above all, to promote a better service for the consumer.
§ Mr. Archy Kirkwood (Roxburgh and Berwickshire)
How will the changes affect families on supplementary benefit?
§ Mr. Fowler
Those on supplementary benefit will be part of the exempt group who will continue to have NHS glasses supplied to them.
Consumer protection is also the aim of clause 13 of the Bill, which is taken together with schedule 5. That abolishes the practice known as franking in contracted-out occupational pension schemes. Although the working of schedule 5 may appear formidably complicated, it is important and is accurately summed up by its title, "Protection of pensions".
At present, one of the terms on which an occupational pension scheme can be contracted out from the state arrangements is that it should provide a guaranteed minimum pension at the end of the day. If an employee leaves a scheme that guaranteed minimum pension must be increased by the scheme each year until state pension age. But injustice can arise—this was pointed out by the Occupational Pensions Board — where the individual leaves his scheme when he has an entitlement that is well above the guaranteed minimum pension.
He may, for example, have been a member of the scheme for several years prior to 1978, when the new system came into operation. Extraordinarily, under the 299 law as it stands—under the 1975 legislation—there is nothing to prevent a scheme revaluing the guaranteed minimum pension by using the extra pension rights which the individual had already accrued. In other words, the guaranteed minimum pension is certainly revalued, but only at the cost of reducing the remainder, leaving the same amount of total pension payable to the individual.
No one knows how widespread that practice is, although some believe that it is very widespread inside the pension industry. Equally, however, virtually no one now seeks to justify the practice, which clearly operates against the interests of the pension scheme member. Accordingly, the Government believe that action must be taken on this, and that is the reason for that clause. It is a further example of our intent to improve the whole area of occupational pensions and in particular the rights of early leavers, which have all too often been ignored in the past.
The second theme of the Bill is the improvement of health provision and, in particular, better primary care. Clause 2 and schedule 2 will make important changes to the status, accountability and structure of the family practitioner services.
I do not think there can be any argument about the overall objective. For most people the family practitioner services are the main contact with the Health Service—perhaps the only contact. The vast majority of all health complaints are treated by the family doctor or one of the other health complaints are treated by the family doctor or one of the other members of the primary health care team —for example, the health visitor, the midwife or the district nurse. It is the family doctor who normally refers a patient to specialist hospital treatment and it is the primary health care team which provides the continuing support on returning home.
Since 1979 it has been one of the Government's priorities to develop and improve primary health care services. Since we came to office the number of general medical practitioners in England and Wales has grown by more than 1.500. The number of community nurses is also up by 4,500. Last year there were over 200 million consultations with family doctors and 7.6 million patients were visited by home nurses and health visitors. We recently underlined that commitment when I announced to the House that we were making available additional funds during the next three years to tackle the problems of providing primary health care in our inner cities.
But what is equally clear is that we have failed to develop the right machinery to manage, administer and make accountable the family practitioner services. The present structure makes the committees accountable to me for the arrangements they make for the provision of services but dependent on the district health authority for their staff, accommodation and equipment. It was hoped that this shared responsibility would lead to better joint planning.
§ Mr. Robert N. Wareing (Liverpool, West Derby)
Did I hear the right hon. Gentleman aright when he talked about improving primary care in the inner cities? Will he talk to his right hon. Friend the Secretary of State for the Environment, who has recently announced slashing cuts in the rate support grant to local authorities such as Liverpool? Does that mean that Liverpool will receive some compensation so that its primary health care facilities can come up to the standard in other parts of the country?
§ Mr. Fowler
I was reminding the hon. Gentleman—I am sure that in his normal, fair way he will need no reminding—that the Government have made £9 million available during the next three years specifically for the problems of family health care in the inner cities.
§ Mr. Fowler
The hon. Gentleman says "peanuts". We judge the hon. Gentleman on his performance in government, and he has much to be modest about.
It was hoped that the structure of shared responsibility would lead to better joint planning but it has failed to achieve that in many places and has hindered the strong thrust towards better community health care — the original objective of the whole policy. Very few would argue that nothing should be done. The changes that I now propose are directed towards better management and more positive direction of the family practitioner services, including better planning and better collaboration with other local services.
At present the system of dual control makes for considerable difficulties. Lines of authority are complicated and this affects the execution of policy. Under the new arrangements we shall have a single line of authority between family practitioner committees and the Secretaries of State. FPCs will become employing authorities in their own right, they will be responsible for all their own services, and they will be answerable for their own management costs. I believe that this will improve not only accountability but administrative efficiency—both by giving FPCs the incentive and challenge of sole responsibility and by enabling Ministers to hold them to account and require them to promote measures to increase cost-effectiveness.
Because of these changes the new FPCs will be stronger bodies than the old. They will be specialist committees that will be able to concentrate on primary health care. We want them to develop the planning side of their role in a way that a few have pioneered — for example, by producing detailed plans, in consultation with the local medical committee, for the development of family doctor services in their areas.
Part II of the Bill deals with social security matters—
§ Mr. Dennis Skinner (Bolsover)
Do I understand that the Government who came to power talking about cleaning out all the quangos will get rid of the representatives on the family practitioner committees and set up quangos throughout the country?
§ Mr. Fowler
No. The hon. Gentleman has slightly, but I am sure genuinely, misunderstood the aim of the proposals. It is proposed that the committees should be responsible in their own areas. At the moment they have dual accountability. We have rationalised the position so that we can have—
§ Mr. Fowler
I do not think that the hon. Gentleman, when arguing about control and accountability, can argue that new quangos have suddenly and mysteriously been created. That betrays a total ignorance about primary health care.
§ Mr. Tim Rathbone (Lewes)
Will the new structure have injected into it a greater level of comparability so that general practitioners can assess their own efficiency in treating their own patients?
§ Mr. Fowler
That is one matter to be considered. We want the family practitioners to contribute to the planning of local health services, and that can be done in several ways. They can provide information about family practitioner services, which will help them formulate policies, and they can encourage the development of primary health care in ways which will help to secure the creation of properly integrated health care services in the district. I think that the proposal of my hon. Friend is sensible and useful.
Part II of the Bill deals with social security matters. Clause 4 provides for the introduction of a new cash benefit for disabled people — severe disablement allowance. This benefit will replace the non-contributory invalidity pension, which is currently payable to those who do not have the necessary contribution record to qualify for contributory sickness or invalidity benefits. The present position is that non-contributory invalidity pension, while available to men and single women who have been incapable of work for more than 28 weeks, has been available to married women only if they are also incapable of performing their normal household duties.
Since it was introduced in 1977, this household duties test has been a source of controversy and discontent both on grounds of discrimination and because of the way in which the test operates. In 1980 the then national insurance advisory committee recommended that the test should be reviewed and that consideration should be given to finding a more acceptable alternative. The results of that review, which were carried out by officials of my Department, was published at the beginning of this month by the Minister who has responsibility for the disabled.
The review concludes that the household duties test is unsatisfactory both in concept and in operation, and the Government endorse that view. I do not think that there will be any disagreement in the House about that. We have, however, made it clear on a number of occasions that simply abolishing the test and allowing married women to claim NCIP on the same basis as men and single women is not a viable option. It would cost some £275 million a year— [Interruption.] I am not trying to disguise anything. It would cost £275 million a year, and money on that scale is not available. Even if it were, we are not convinced that spending it in that fashion would be the most effective way of improving the lot of the disabled as a whole. We needed to find a solution that was both fair and affordable, and one that would concentrate resources where they were most needed. I believe that the proposals in the Bill achieve that aim.
§ Mr. Alfred Morris (Manchester, Wythenshawe)
Will the right hon. Gentleman make it clear that 16,000 disabled married women who now receive HNCIP will not qualify for the severe disablement allowance?
§ Mr. Fowler
I shall come to those who gain and those who lose in a moment. I am sure that the right hon. Gentleman will concede that we are increasing —[Interruption.] The right hon. Gentleman may shake his head, but he actually introduced the household duties system.
§ Mr. Morris
I am not shaking my head. I ask the right hon. Gentleman to make it pikestaff plain to the House and to the country that 16,000 disabled married women who qualify for HNCIP would not qualify for the severe disablement allowance.
§ Mr. Fowler
The right hon. Gentleman must allow me to answer his point before he asks another—especially when he was wrong in the first place.
Those people in receipt of payment will continue to be paid. The right hon. Gentleman is talking about future losers under the scheme, and I shall come to that point in a moment.
§ Mr. Brynmor John (Pontypridd)
Did not the thought that they might have to spend £275 million on the allowance for married women cause the Government to break their promise to the House about consultation once the report was published?
§ Mr. Fowler
The report was published at the beginning of the month and it is available for the information of the House. It will be used in debates on the Bill.
§ Mr. John
On 13 July 1982 the then Minister for Social Security said:We intend to publish the results of the review and then to invite consultation."—[Official Report, 13 July 1982; Vol. 27, c. 841.]Does the right hon. Gentleman think that introducing the Bill on 1 December, having its First Reading on 2 December and publishing it on 5 December is adequate consultation?
§ Mr. Fowler
When we have the opportunity to introduce such legislation we should take it, and that is precisely what we have done.
The new severe diasablement allowance will be available equally to men and women regardless of marital status. Poople who become incapable of work on or before their 20th birthday will qualify on that basis. Those who become incapable later in life will qualify if they are also at least 80 per cent. disabled. That will be assessed by the same loss of faculty test that currently applies in the industrial injuries and war pension schemes. That again is a system that is widely accepted as an objective measure of disability.
We hope to introduce the new SDA in November 1984. We estimate that in the first year of full operation about 20,000 more people will qualify over and above the existing recipients of NCIP and HNCIP who will transfer automatically to SDA. Thus, in the short term the additional costs will be about £20 million a year. It is fair to add that in the longer term, since some people who would have qualified for the present benefits may not qualify for the new one, those figures may be expected to be somewhat lower. I make no secret of that.
The new benefit represents an important improvement in the level of provision for disabled people on several counts. First, it will result in an increase in the number of people eligible for benefit.
§ Mr. Fowler
I have just given the figure, which is 20,000. It means that with increased take-up of attendance and mobility allowances, the real value of social security help for the long-term sick and disabled has risen by nearly 30 per cent. since the Government first took office. I am, therfore, disinclined to be lectured by the Opposition on that point.
303 Secondly, we are ending the controversial household duties test and introducing a benefit that is sex equal and that will be payable on more objective and well-tested criteria.
Among the other proposals on social security, there are changes to the dependency provisions of the social security scheme. We have already provided under the EC directive on equal treatment for a woman with invalidity benefit to receive a dependency addition for her husband. The directive does not extend to increases of retirement pension, but we have decided that to withdraw a dependency increase from a woman invalidity pensioner who retires and becomes entitled to retirement pension would cause unacceptable hardship. Clause 5 provides that such a woman would continue to receive a dependency increase. That is a wholly beneficial proposal and will cost an additional £500,000 a year.
Clause 6, taken with schedule 4, relates to dependency additions in respect of children. The House will know that the lower rate child additions now available with the short-term benefits — notably unemployment and sickness benefit—have been gradually reduced over recent years as child benefit has increased. We have never made any secret of our objective to move child support for those not at work because of a short-term contingency wholly to child benefit. The addition now stands at 15p a week for each child and it is our intention to phase out the additions completely at the next general uprating of benefits.
§ Mr. Meacher
If the abolition of the child dependency additions for the unemployed is dependent on improvements in child benefit, how can the right hon. Gentleman justify that when child benefit stands today at only 10p above its real level in 1979, while the child dependency additions have been reduced by £1.70 per child since then?
§ Mr. Fowler
We have been seeking to transfer gradually and step by step from child dependency additions to child benefit—
§ Mr. Fowler
The answer is that child benefit stands at an all-time record real figure.
We have also been looking at the position of child dependency additions for long-term beneficiaries — notably retirement and invalidity pensioners. We think that it is unreasonable to view the child of a couple, who both normally work, as automatically dependent on whichever of them happens to become a national insurance beneficiary. A person who remains at work and earns a wage becomes the major breadwinner of the family and it seems appropriate that a child dependency increase should not be payable if those earnings are substantial. We propose, therefore, that where the partner's earnings are more than £80 a week, the first child's dependency addition should be withdrawn. Above that level of income, dependency additions for each further child will be withdrawn for each extra £10 of earnings. For example, a family with three children will not lose all of the dependency additions unless the earnings are more than £100 per week. Only the child dependency allowance is affected by this and not the child benefit itself.
There are several other clauses in the Bill, but I hope that the House feels that I have dealt with the most important provisions. We shall deal with any issues that arise on the outstanding clauses at the end of the debate.
304 Perhaps I should add that clause 9 broadens the basis for membership of the new social security appeal tribunals, which were created under the Health and Social Services and Social Security Adjudications Act 1983. That will be familiar territory to hon. Members.
The Bill encompasses a range of subjects. I make no apology for that, although it clearly makes it difficult to provide a neat summary of all its proposals. Basically, the Bill aims to provide better health care for the public. It improves the position of the disabled. Above all, the Bill is concerned with securing a better deal for the public. Most of the attention will no doubt be focused on the provisions in clause 1 concerning optical services, opticians and the sale of glasses. That reform is important and will be widely welcomed by the public. It epitomises the Government's policy, which is to put the interests of the user of the service first rather than those of the provider. It is on that basis that I ask the House to support the Bill.
§ Mr. Michael Meacher (Oldham, West)
This is a mean, nasty, spiteful and authoritarian Bill from an increasingly mean, nasty, spiteful and authoritarian Government. I shall spell out exactly why I have used those words. It is also a miscellaneous rag-bag of a Bill that artificially combines wholly unconnected issues.
However, there is one common thread running through all the unrelated elements. It is a theme that the Conservative party has pursued single-mindedly and relentlessly since it came to office. I refer to the piece by piece mutilation of the welfare state. Because of the welfare state's principled protection of the poor and disadvantaged, it has manifestly earned the undying hostility of the Prime Minister and her other Right-wing zealots. In this Bill, they have excelled themselves.
The Secretary of State may laugh, but he has succeeded in yoking together in one Bill the mangling of the general ophthalmic service, an authoritarian centralisation in the structure of the NHS which is unprecedented, even for this Government, a massive cutback in disability benefits—when what we need is a big expansion—and, perhaps most iniquitous of all, the virtual destruction of the principle of benefit as a right for the sick and unemployed, which has always hitherto been the cornerstone of a society freed from the shackles of a Poor Law mentality. It is that Poor Law ethos and attachment to punitive means testing — to which the Government have already shown themselves so studiously committed—that they are now so nastily reinforcing in this little Bill.
I shall begin with the Bill's assault on the ophthalmic service.
§ Mr. Campbell-Savours
The Government will make savings as a result of the Bill and the miscellaneous measures that have been introduced. Will my hon. Friend tell the House where the money saved is to go and what it will be spent on? Is it not true that the Government can guarantee that in next year. s Budget there will be a corresponding reduction in the amount of capital transfer tax paid by the better off in society, because the money being saved today will fund such reductions for a very small percentage of the population?
§ Mr. Meacher
My hon. Friend is absolutely correct. That is the prime purpose of the Bill. The Bill is not about 305 health; it is purportedly about social security. However, it is concerned not with social security but with a redistribution from the poor to the rich. The £275 million that is to be saved by the changes in the introduction of the severe disablement allowance will certainly—and the House can rely on this — find its way into the next Budget and into further tax handouts to the well off. That is the whole purpose of this Government's mangling of social security and the welfare state.
As the Bill is such a panjandrum of unconnected elements and is four Bills in one, I hope that my right hon. Friend the Member for Manchester, Wythenshawe (Mr. Morris) and my hon. Friend the Member for Birkenhead (Mr. Field) will be able to catch your eye, Mr. Deputy Speaker, so that they can state the Opposition's case on the disability and social security aspects of this rag-bag compound of measures.
Clause 1 is a classic example of Right-wing Tory dogma in dismembering part of the NHS into its basic services only, while privatising as much as possible of the profitable elements in order to open up new markets for the Tory party's big business friends. The Secretary of State may laugh. Perhaps he does not mind that 3 million people will be deprived of the opportunity of low-cost spectacles of a quality that is properly controlled to British standards. It is no matter to him, because he only sniggers. However, those on small occupational pensions will be particularly hard hit, as the elderly are most likely to need complicated lenses, the prices of which will almost certainly triple under the new arrangements.
It is no matter to the Secretary of State, as he sits there smiling, that NHS frames, by being restricted to the poor, will become stigmatising as a badge of poverty for adults. The poor will become easily identifiable as such. That may not affect Ministers, but it will certainly affect millions of people. It is no matter to the right hon. Gentleman that the proposed free market traders in spectacles will be neither qualified nor accountable to the professional bodies, and that the public will therefore have no protection against prescriptions that are not properly made up.
§ Mr. Geoffrey Dickens (Littleborough and Saddleworth)
Is the hon. Gentleman aware that frames are leaving a factory not many miles from his constituency at £5.75 a time and being sold in opticians' shops at between £50 and £60 each? How can he justify that?
§ Mr. Meacher
I am surprised that the hon. Gentleman should make a point against a political interest that I had assumed he would support. There is certainly a huge markup, but the benefit is not going to the consumer.
The Bill is a classic demonstration of the Tory principle of redistribution from the poor to the rich on both the consumer and retail sides. The Secretary of State did not seem to understand the key point that the better-off will gain from the reduction in the price of private glasses. It is they who will gain as a result of the Bill, while millions of poorer families—and it will be millions of them, as under this Bill the NHS market is being reduced from 50 per cent. to about 10 per cent.—will be forced to pay a very big increase on the present average NHS price of £12.
Equally, on the retail side, the loss of dispensing work and the introduction of cut-price advertising by large corporations and multiples in main shopping areas will damage the small dispenser. So much for Tory concern 306 about the small business man. It will undoubtedly lead to a contraction of the service in rural and semi-rural communities. Again, the poor will be the main sufferers.
The most serious consequence of the Government's obsessive drive towards increased commercialism is that it will steadily diminish the crucial eye care aspect of the service.
§ Mr. Meacher
The Secretary of State seems to assume that dispensing is not a skill, when it certainly is. Shop assistants not trained as dispensing opticians will have neither the skill nor the facilities to centre spectacles correctly or to check that the lens prescription has been correctly made up. The result for the public will be eye strain and headaches at best. At worst it will be the inability to see clearly so that they are at risk in their work, a hazard on the road or otherwise may injure themselves unnecessarily.
If the Secretary of State thinks that that does not matter much compared with the benefits of letting American multinationals into the so-called optical market, where will it all end? Will the next step be to allow supermarket assistants to dispense drugs or to fit dentures on the basis of a prescription made up by a dental surgeon? The Government have clearly yet to learn that a high quality primary eye care service is incompatible with market place practices.
§ The Minister for Health (Mr. Kenneth Clarke)
The hon. Gentleman attacks the entire measure as an assault on the poor, ignoring the fact that they will continue to receive free spectacles. Will he explain how a pensioner on a modest income, wishing to discover whether there is a choice of which he or she could take advantage, will be assisted by the Opposition's refusal to contemplate price advertising or any other easing of the present monopoly which, as my hon. Friend the Member for Littleborough and Saddleworth (Mr. Dickens) pointed out, drives prices up excessively for everyone?
§ Mr. Meacher
If the Minister is really concerned to ensure that poorer families obtain low cost spectacles, it would be better to extend the exempt groups arrangement than to implement the proposal in the Bill which will certainly double or treble spectacle prices. Millions of families now paying an average of £12 will pay £25 or £30 or more under the arrangements proposed in the Bill.
§ Mr. Fowler
The hon. Gentleman seems to oppose all our proposals for the optical service. Does that mean that he utterly rejects all the views of the Director General of Fair Trading on opticians and competition? If so, the public should know that.
§ Mr. Meacher
The Office of Fair Trading proposals offered alternative arrangements for the provision of spectacles to controlled standards and at modest prices. It certainly did not recommend the abandonment of low cost spectacles. There is an alternative which does not involve forcing millions of poorer families to pay twice or three times as much for their spectacles. The Secretary of State is clearly more interested in privatisation than in providing better spectacles for those millions of families and it is wrong of him to try to imply otherwise.
§ Mr. Fowler
The hon. Gentleman has not answered my question. He seems not even to have read the OFT report. The fundamental criticism in the report was that 307 restrictions on advertising led to unfairness for the consumer. Does the hon. Gentleman, in his defence of the status quo, also defend those restrictions on advertising?
§ Mr. Meacher
I am not defending the status quo. I believe that cheaper spectacle frames should be made available to many families who are now forced to pay extremely high prices. In this context, the Secretary of State should remember that it was the Government's failure to pay back the £90 million owed to the opticians which forced them to increase prices in the first three yearsof the Tory Administration to higher levels than would otherwise have been necessary. In the past year, prices fell from about £54 to about £51, although I agree that that is still too high. Nevertheless, prices are coming down.
There was an alternative to the Government's proposal for complete privatisation of the service. Under the Government's proposal, millions of elderly people who need expensive spectacles will have to pay £35 to £40 or more. Indeed, the Sunday Telegraph suggested that elderly people now paying £35 for complicated lenses will have to pay £81 in future as a result of the Government's proposal. Is that what the Secretary of State recommends and desires?
§ Mr. Fowler
The principal conclusion of the OFT report was that advertising restrictions resulted in significantly higher prices and significantly lower efficiency than would otherwise be the case. Does the hon. Gentleman agree or disagree with that?
§ Mr. Meacher
We have expressed no opposition to opticians providing more information about their prices locally, but we object to massive advertising by big companies in supermarkets and multiples which will undoubtedly drive many small opticians out of business. Is that the Secretary of State's intention? Does he believe that that is right? That will undoubtedly be the effect of the completely free basis for advertising that he recommends.
Equally retrograde and wrong-headed is the proposal in clause 2 to establish family practitioner committees as health authorities in their own right. It flies in the face of all Health Service planning in recent years to integrate hospital and primary health care. It is also the exact opposite of the system recommended by the Royal Commission on the National Health Service, and, more recently, by the Acheson report which referred tothe advantage in responsibility for a whole range of services in a given area being discharged by a single authority. Only then would it be possible for the barriers between different parts of the Health Service to be removed and for the current restraints and inflexibilities in the use of Health Service resources to bze overcome.The Secretary of State turned his back on that recommendation but gave no reasons for doing so.
Another seriously disturbing aspect is the proposal in schedule 2 that the Secretary of State should appoint not just the chairmen but all 30 members of all the family practitioner committees — a total of more than 3,000 personal appointments by the Secretary of State. If that is not a quango, I do not know what is. At present, family practitioner committees elect their own chairmen, and the membership is appointed locally. One must ask what is the reason for the monstrous increase in Government patronage.
§ Mr. Meacher
No doubt my hon. Friend's expression will pass into the English language.
One would have thought that it was enough for the Secretary of State to have sacked all non-compliant chairmen of regional and district health authorities—or failed to renew their appointments, which amounts to the same thing, as there was no question of incompetence. The Secretary of State has stuffed those bodies with his own placements and he is now going for broke.
Perhaps the reason for that—the Secretary of State did not give one, and it is not stated in the Bill—is that the Government, having shied away from cash limiting family practitioner services following the Binder Hamlyn exercise, on which the Government are still sitting, are now looking for a back door route to the same end. I suspect that that is the motive. Perhaps it is also intended that once family practitioner committees have been given their independence, they will seek and undoubtedly be granted an extension of their powers.
Indeed, I am told that there are leading elements in the DHSS who favour family practitioner committees becoming primary care authorities with control over all primary health care activities. The Opposition believe that such a development would be disastrous, even on the basis of the present 50 per cent. professional membership of family practitioner committees. Nevertheless, perhaps that line of thought explains why the Secretary of State has arrogated to himself the momentously anti-democratic power to secure a conveniently compliant lapdog role for those bodies. He could then steamroll through more cuts in primary care services.
§ Mr. Skinner
Does my hon. Friend agree that while the Government are parroting on about democracy in the trade unions and votes for this and ballots for that, we now have an operation, which my hon. Friend has exposed, providing 3,000 Government—appointed positions? We already know that company directors pay substantial amounts of money to get a knighthood or a peerage. It is apparent that the positions that are to be created are for the benefit of directors of some of the 35,000 failed companies —for example, the Prime Minister's son, who has not made it to the top.
§ Mr. Meacher
So far from being cheap, my hon. Friend always puts his finger right on the point. There is a disgraceful incompatibility between forcing trade unions into being democratic when they are already democratic structures and the Secretary of State taking the power to appoint people to 3,000 new positions. That is a disgrace.
There is another pointer in the same direction. Clause 3 seems to pave the way to honoraria being paid to family practitioner committee chairmen on the lines of payments which are now made to chairmen of regional and district health authorities. I am sure that the Secretary of State will not deny that the role of chairman of family practitioner committees, as presently constituted, is in no way comparable in terms of difficulty or time with that of health authority chairmen. Does that move not therefore betoken an enhanced role for family practitioner committees? If so, and if they are to be controlled by the Secretary of State through unalloyed patronage, are we not witnessing, first with Griffiths and secondly with the Bill, a comprehensive centralisation of power being imposed on the NHS? That utterly overturns the objectives of the 309 Government's White Paper "Patients First" and inaugurates yet another massive upheaval of the Health Service which is reminiscent of earlier Tory reorganisations in 1974 and 1982. That is a source of less than uninhibited pleasure. If the Government have any such intention, I warn the Secretary of State of our unmitigated opposition to any such anti-democratisation of the NHS.
§ Dr. Brian Mawhinney (Peterborough)
I have listened closely to what the hon. Gentleman has said. Will he help me to understand one point which I do not find clear? He was a member of a Government who cash limited the hospital sector of the Health Service, but he has given us the impression today that he would like there to be no limits on expenditure on primary health care. Why does he support a cash limit in the acute sector while not being prepared to countenance any restriction of spending in the chronic sector?
§ Mr. Meacher
The hon. Gentleman has a background which deserves attention from the House. Perhaps he will say how he takes that view when the Binder Hamlyn report is finally brought before the House. At the general election, the Labour party made it clear that, far from cash limiting the hospital or acute sector, it believed in an overall expansion of spending on the NHS of 3 per cent. each year over and above the level of inflation.
§ Mr. Meacher
It is a limit, but it is vastly different from and better than the 3 per cent. below inflation target that the Secretary of State is imposing for next year. I hope that we shall have an opportunity to debate that issue.
This is not really a Health Service Bill at all. It was extensively previewed as one which had a few social security clauses thrown in. It is easy to see why. Examination of the social security clauses reveals that it is an even nastier Bill. The Opposition unreservedly welcome the abolition of the household duties test, but that is about as far as the welcome can go.
The severe disablement allowance represents yet another pernicious exercise by the Government in the redistribution of poverty. They are giving a little to some people with one hand and taking away a great deal more from other people with the other. The central snag with the new proposal is that, although people who currently receive non-contributary invalidity pension and HNCIP will be transferred to the new allowance, in future, people who have become disabled after the age of 20 and would have been eligible for NCIP or HNCIP will qualify only for severe disablement allowance if they are 80 per cent. disabled. There can therefore be no doubt that a substantial number of men and single women might fail to qualify although they are still incapable of work.
§ Mr. Dafydd Wigley (Caernarfon)
The hon. Gentleman is right to underline that point. Does he agree that the results of the change will be much the same as what now happens with mobility allowance whereby, if there are two people with identical complaints, one will get benefit and the other will not? Does he agree that we should be tending to go towards an integrated and coherent disability benefit rather than a piecemeal approach, which is merely a backward step?
§ Mr. Meacher
The hon. Gentleman has foreseen clearly what I was about to say. I strongly agree with what he said. The impact of the much more stringent conditions of entitlement for severe disablement allowance than for NCIP will be sharpest for married women. Almost all of the 240,000 women who are currently excluded from claiming NCIP by the household duties test will also fail to qualify for the new payments, such is the extent of the restriction. That much is clear from the DHSS estimate that 20,000 extra people will be able to claim severe disablement allowance from November 1985, and that that figure will eventually level out to an extra 5,000 beneficiaries. The main conclusion, therefore, and the Opposition's main complaint, is that the new conditions of entitlement will exclude just as many disabled people from benefit as did the old household duties test.
Far from moving towards a comprehensive disability pension scheme, such as the hon. Member for Caernarfon (Mr. Wigley) mentioned—and that is undoubtedly what is needed—the Bill replaces discrimination on grounds of sex and marital status with discrimination on grounds of age. If people who are disabled early in life are to have a non-means tested incapacity benefit, they will have to claim severe disablement allowance before reaching the age of 20. In effect, they must write themselves off. If they do not do that, they will have to undergo an 80 per cent. disability test even though they might have been disabled from birth. That cannot be right.
§ The Under-Secretary of State for Health and Social Security (Mr. Tony Newton)
That is not right.
§ Mr. Meacher
When I say, "That cannot be right," I am saying that it is correct, but it is wrong to impose such restrictions.
§ Mr. Newton
The hon. Gentleman is not correct because we are not imposing such a restriction. If somebody can show that he was disabled before the age of 20, he will be able to claim the benefit on that basis.
§ Mr. Meacher
That is a loophole that needs exploitation, but how many people get through that loophole, given the way that the NHS operates? That is a small concession.
§ Mr. Newton
The hon. Gentleman must already be aware that people can claim the mobility allowance if they can show, up to the age of 66, that they were sufficiently disabled before the age of 65. I do not have the numbers who do this, but it is a well-established provision. If that system works for this benefit, I do not see why it cannot work for the other.
§ Mr. Meacher
There is also the other type of problem —that if they seek to get work after the age of 20 they are also disqualified. It cuts both ways.
§ Mr. Meacher
The other objection is more fundamental. The Government have illogically, but deliberately, mixed up in the severe disablement allowance scheme two entirely different concepts—an incapacity for work test and a loss of faculty test. The Government have done that not in a way that would give them credit, but because they were forced to abolish the household duties test by the EC directive 7/79, requiring equal treatment in social security matters for men and 311 women. That comes into force in January 1985. That is the reason why we have this in the Bill. The Government are bowing reluctantly to this legal pressure. As the Secretary of State made clear, they have taken three and a half years to respond to their national insurance advisory committee report in the middle of 1980. However, the Government were still determined that abolition should not involve them in any significant extra expense. That is the principle underlying the Bill. The 80 per cent. loss of faculty test was tacked on, thus cruelly withdrawing from hundreds of thousands of women the prospect of benefits that the EC had opened up.
That is a major reason why I call this a mean, nasty, spiteful little Bill, but the chief contestant for that title must be clause 6. That provides for the abolition of child dependency additions paid out with short-term benefits. As the Secretary of State said, it is only 15p at the moment, but we are now seeing the culmination of a long-term Tory policy to reduce the real value of financial support for the children of the unemployed or sick.
The facts are clear. As a result of changing the basis on which the child additions were uprated in 1980, total child support — that is, child addition plus child benefit — received by an unemployed claimant has been steadily reduced until it is now £1.70 less than it would have been under the rules left by the Labour Government in 1979.
The Government seek to justify this by saying in their press release:It has been the policy of successive Governments to make provision in these short-term cases, through the child benefit scheme.What an almighty and breathtaking deceit to say that this was the policy of "successive Governments". Child benefit is worth precisely 10p more in real terms than it was in 1979—the first time in the history of this Government that it has been worth more. The Secretary of State has still not answered the question of how a 10p a week improvement in child benefit can compensate for a £1.70 a week cut in total child support. We want an answer to that question. If the Secretary of State is prepared to give it now, I shall be glad to give way.
The truth is that the Government's action has been condemned by their own social security advisory committee, which, in its first annual report, stated that the "objective"— that is, to replace the child dependency additions—is a sound one only if there is no loss of income in real terms to families dependent on contributed benefit.How do the Government justify this £1.70 a week reduction, except as just another mean cut?
There seems to be no limit to the Government's viciousness towards the unemployed. There are now nearly 4 million people deprived of work through no fault of their own. What do the Government do? First, they abolish the earnings-related supplement, tax unemployment benefit and reduce the uprating of unemployment benefit below the rate of inflation, and now the child additions are being phased out. What a mean, callous set of priorities, at a time when the Stock Exchange is riding at an all-time high, capital taxes for the high-paid are at their lowest since the war, and misery for the unemployed is accompanied, Budget after Tory Budget, by massive tax handouts to the rich.
As if all this were not enough, there is one last innovatory nastiness in the Bill, which, in the long-term, will be the most damaging of all. Even for those entitled 312 to long-term benefits—not the unemployed or the sick--child additions will no longer be granted to the beneficiary responsible for the care of the child. Instead, under the Bill, entitlement will depend on whether a spouse or a cohabitee is earning below a certain level—£80 in the case of a one-child family and £10 more for each further child. The significance of this seemingly innocuous clause is great. It represents the introduction of a means test to ration the payment of a national insurance benefit. Et represents perhaps the most serious and disturbing breach yet of the fundamental national insurance principle of contributory benefits to which entitlement therefore exists as a right.
The Bill is a further major step along the road down which the Government are dragging the country, from the welfare state to a means-test state. It is a direction to which we are adamantly and unyieldingly opposed. The nation is also overwhelmingly opposed to this constant sniping at benefits, this constant victimisation of the unemployed, this constant undermining and eroding of the structure of the welfare state. The Opposition and the nation are committed to the civilised protection and decencies of a welfare state and a National Health Service, which they unquestionably cherish. I appeal to my right hon. and hon. Friends, and to others who share our ideals, to reject the Bill for the mean, petty, spiteful authoritarian measure that it is
§ 6.8 pm
§ Mr. Gwilym Jones (Cardiff, North)
I am grateful to you, Mr. Deputy Speaker, for calling me at this time and giving me my first opportunity to address the House. Naturally, I wish to start by making reference to my predecessors. I use that word in the plural because before the general election parts of my constituency were represented by my hon. Friends the Members for Vale of Glamorgan (Sir R. Gower), for Monmouth (Mr. Stradling Thomas) and for Cardiff, Central (Mr. Grist). I need riot say too much about those hon. Friends, as the evidence of the regard in which they are held by their electorate both present and past is shown by their continued presence in the House.
However, the greater part of my constituency was represented by the late Michael Roberts, who tragically died immediately after speaking at the Dispatch Box in reply to a Welsh debate. I have learnt early that he was held in high regard in the House, as I already well knew that he was held in high regard outside, throughout Wales and particularly in Cardiff, North-West. His untimely death was a sad loss, when he had contributed so much and was set to contribute so much more.
My constituency consists of attractive residential suburbs and farming countryside, being the northern third of the capital city of Wales. It includes, among other things, the University Hospital of Wales, the Wales and the Marches headquarters of British Telecom, the South of Wales electricity board and a large complex of Government buildings in which is located Inland Revenue PD1, which handles the affairs of hon. Members. I would also mention the presence of Amersham International—a very successful company, which recently announced the creation of yet another 200 new jobs. Its success for itself and its employees is a testament to the Government's policies.
My constituency is a forward-looking area. It has good communications, with two rivers, three railway lines, the 313 Eastern Avenue and the M4. Despite pessimistic references to the Severn bridge, these communications will facilitate the continued recovery of my constituency and of south Wales.
Coming to the Bill, I wish to refer to the provisions that deal with the sale of glasses, as I am concerned that we must not move forward too rapidly in our reform, and we must give proper regard to the best features of the present arrangements.
I start from the premise that monopolies are not usually a good thing—whether they involve opticians, as in our debate today, or solicitors, as in our debate last Friday. The complaints against opticians are usually, first, that there is a monopoly, and second, that their charges are too high. We would do well to remember that the present arrangements were brought about by an Act of Parliament. In answer to the first complaint, it is self-evident that there is a monopoly. The second criticism is not necessarily self-evident.
The report of the Office of Fair Trading says that opticians' profits have not been excessive. The opticians' professional body tells us that opticians' charges in this country are among the lowest, if not the lowest, in the European Economic Community. Nevertheless, that does not preclude us from wanting even lower charges, if that were possible. In replacing a monopoly, we must consider all the people who are involved—those who purchase glasses and those who sell glasses, and we must try to be fair to all.
Perhaps we should bear in mind another comment in the report of the Office of Fair Trading, that the private practice of the work of opticians has subsidised the work that they have done for the National Health Service. The report also says that the Department of Health and Social Security recently paid about £80 million by way of refunds or back payments for underpaid fees to opticians.
Our first concern should be with the competence of the people who may now be able to sell glasses under the new reformed regime. The basic competence is that they are able to read the prescription for the glasses. That implies, at the very least, a certain technical ability, which presumably will have to be demonstrated by an appropriate qualification. However, there needs to be more than a technical competence. I suggest that a professional approach, akin to the present system, would be needed.
There is a natural and understandable tendency to make the maximum profit out of any transaction. It follows, thererfore, that a commercial retailer of glasses would want to minimise his overheads and the amount of capital invested in stock, and go for maximum sales to achieve maximum profits. It may be possible to devise a limited range of standard lenses, and the salesmanship of commercial glasses retailers might persuade the intending purchaser to accept the nearest standard lenses, instead of the lenses that were actually prescribed. That would not be right. In trying to guard against people ending up with glasses that are not as prescribed, we must be concerned whether it happens by accident or by design. Although such lenses might be cheaper to the customer, and perhaps the retailer would make a bigger profit, they would not be what was paid for, and would not be value for money.
We all want the public to be better informed generally, and better informed in this respect. However, here we are talking about comparatively simple information, which 314 would be transmitted through advertising. It would not involve the public's ability to judge whether they had bought the best pair of glasses available, and it would certainly not involve the public's ability to judge whether they had bought the glasses that had been prescribed.
It will be necessary to ensure that the glasses are supplied against a recent prescription — in fact, a prescription that is not more than two years old. Presumably, some procedure will be necessary to ensure compliance with the condition that the glasses will be supplied against a prescription that is not more than two years old. Without such a procedure, forms of self-testing could evolve. That would not be evolution. It would be a retrograde step if one could purchase glasses over the counter, whether in Woolworths, Tesco or Sainsbury. Glasses might be purchased by the self-tester because he feels that they are nearest to the best available or, worse, that they have the most attractive frames.
Then there is the matter of after-sales services. In its simplest form, it could involve a complaint that something needs tightening in the glasses—that a screw is loose and needs to be tightened. At present, minor work of this nature is done at little or no cost—usually at no cost—by opticians. At the other end of the scale, under the heading of an after-sales service, there is the person who complains about his glasses but it transpires that the passage of time has encompassed a deterioration in eyesight that requires medical attention, notification to the person's general practitioner. It could be a treatable condition that a trained optician could detect and refer to the general practitioner. I cannot see that happening in the case of a person returning for after-sales service to a commercial glasses retailer. I stress that the Office of Fair Trading refers to British ophthalmic opticians as being among the most highly trained for the detection of symptoms of abnormality and disease.
Surely, in contemplating the reform of sale of glasses, it would appear that people who purhase glasses need greater protection than that which is available through the Sale of Goods Act. There must be a monitoring supervisory process for the new regime, and it will involve some cost, which presumably will have to be met by a levy on the retailers of glasses.
There may be another alternative. As the Secretary of State said, perhaps we should concentrate on the unsatisfactory restrictions on advertising, even though that might mean that we make progress slowly. I appreciate what the Secretary of State said about the unsatisfactory proposals from the General Optical Council and the difficulty of trying to amend the present rules. At least if we tried to move towards taking away the unsatisfactory restrictions on advertising, including the advertising of prices, that would be a major step towards achieving progress. Possibly we ought to move carefully and evaluate what we are doing.
A recent consumer survey revealed a wide range in the prices of glasses. That means that competition is widespread among opticians and that is to the benefit of purchasers of glasses.
We must bear in mind the interests of all involved. Wearers of glasses could be tempted to purchase cheap glasses. The elderly and the not so well-off might be tempted to purchase for price reasons alone and not take into account the many other factors. Many if not all sections of the community could be vulnerable to price-based offers.
315 Surely opticians are entitled to expect our consideration when we contemplate reforming their monopoly. They could be entitled to expect that whoever will now be able to sell glasses should have an appropriate technical expertise comparable with theirs and a professional competence appropriate to the sale of glasses. If we were able to achieve that, opticians would have no grounds on which to complain about the withdrawal of their monopoly.
I welcome the principles of greater competition and more informed choice in the Bill and, it is to be hoped, lower charges. However, we must be fair to all involved and, above all, we must seek value for money for the wearers.
§ Mr. Alfred Morris (Manchester, Wythenshawe)
The hon. Member for Cardiff, North (Mr. Jones) made an interesting and, indeed, stimulating maiden speech. It is often said that first utterances in this House should eschew controversy. I am happy to say that the hon. Gentleman's speech was not entirely non-controversial. I shall not myself deal with the points that he made, but I congratulate him on having made his maiden speech and hope that we shall hear frequently from him in the future. Moreover, I hope that the hon. Gentleman will never be afraid of controversy, which is, after all, what this House is very often all about. It is a legislative assembly, not a mutual admiration society.
My hon. Friend the Member for Oldham, West (Mr. Meacher) said that today we are debating four Bills masquerading as one. As the House will appreciate, my principal interest, as a former Minister and now as Opposition spokesman, is in the proposals that affect the incomes of disabled people and, in particular, the proposal in clause 4 for a severe disablement allowance to replace the non-contributory invalidity pension—NCIP—and the housewives' non-contributory invalidity pension — HNCIP.
Following careful analysis of that proposal, the Disability Alliance, speaking for more than 80 organisations of and for disabled people, has described it asa mean and shabby measure.It regards the new all-or-nothing 80 per cent. test of disability as "harsh and inhuman" and condemns the Government for their "shameful" treatment of people with disabilities.
Leaders of the Spastics Society, the Disablement Income Group, MENCAP and the Multiple Sclerosis Society, among other organisations, were "astounded" when they saw the Government's proposal, while the legal and parliamentary committee of the Royal Association for Disability and Rehabilitation was wholly convinced that, if introduced.the new benefit would prove a disaster.They are just some of the angry comments made to me about clause 4 of the Bill. The Minister had better understand, from the outset, that opposition to what he is proposing is both fierce and widespread. In fact, I challenge him here and now to name any authentic spokesperson for disabled people who has welcomed his proposal. I shall be happy to resume my seat, and give way to him, if he can quote even one representative of disabled people in support of clause 4 of the Bill.
316 The famous review by DHSS officials of the household duties test for HNCIP—which has been well described as Whitehall's equivalent of "The Mousetrap" — took well over three years to complete. The slim and superficial report of the review—the words "slim and superficial" are the Royal Association's, not mine — was finally made public in response to a planted parliamentary question on 1 December.
In the course of the review, no evidence was requested from either disabled people or their organisations, and the Minister must now explain why his Department so completely ignored them. This shocking absence of consultation is shown very clearly in the conclusions of the review and, as the Royal Association states bitterly in its response to the report,the whole process appears to have been one of number crunching in which the numbers themselves are highly dubious".The Royal Association goes on:We also deplore the decision to publish a Bill at the same time as the review. Ministers have consistently given the impression that there would be adequate time for debate both in and outside Parliament on the review. The rush straight into legislation indicates that the Government want as little light as possible to be shed on their sleight of hand.This is a most serious charge against a Government who repeatedly promised consultation with disabled people and their organisations on the outcome of the review of the household duties test.
Let me remind the House of the promise that was given by the hon. Member for Hornsey and Wood Green (Sir H. Rossi), then Minister of State, Department of Health and Social Security, on 13 July 1982. I quote from the excellent brief prepared for this debate by the Library of the House of Commons:Replying to a parliamentary question on 13 July 1982, Mr. Rossi, the then Minister for Social Security, said that the Government intended to publish the results of th DHSS review of the household duties test 'and then to invite consultation'.The hon. Member was repeating equally firm ministerial promises made earlier by, among others, the hon. Member for Wallasey (Mrs. Chalker) who, speaking as a DHSS Minister, stated twice within a single speech in July 1981 that the report would be debated and—"if wished" — voted upon by the House. The hon. Lady must now also profoundly regret having stated, in the same speech, that the DHSS's review of the household duties test was being pursued "most urgently" when in fact its outcome was not to be published until almost two and a half years later.
The hon. Lady like the hon. Member for Hornsey arid Wood Green, can hardly now be surprised by the angry comments by disabled people and their organisations about the Government's total failure to consult them and the dishonouring of the clear promise that there would be a debate on the outcome of the DHSS's review in advance of legislation. Their embittered reaction is the natural one of people who feel not only cheated and insulted but also betrayed. The hon. Member for Wallasey, more than any Member on the Conservative Benches, knows what painstaking arrangements were made by the last Labour Government to consult disabled people and their organisations about every aspect and detail of our proposal to introduce what became the first-ever cash benefit specifically for disabled housewives.
We first announced our intention in a House of Commons paper on 13 September 1974, which said: 317Housewives in this context are essentially married women who do not have paid work and whose normal job is in the home.Our proposal was aimed, as we made repeatedly clear, at helping the housewife whose disability was such that she had never been able to take paid work outside the home or to do household work.
There was an unprecedented degree of consultation about the new benefit we proposed. First and foremost, we worked closely with representatives of the disablement income group, sharing our thoughts with them as we went along and obtaining their views about principle and detail in return. We held linked discussions with representatives of the all-party disablement group in the House, again in an atmosphere of openness and trust. We also met representatives of the blind to look more closely at the particular problems of the blind housewife. Finally, we arranged a pilot exercise in consultation with DIG and, with particular help from the hon. Member for Wallasey, actually to try out with a number of disabled housewives and doctors the sort of questions we would need to incorporate in the final medical report and the claim form.
As the then Minister for the Disabled, I made my officials available for consultation with the all-party disablement group that was quite different in character and extent from anything that had been attempted by any previous Government. I know this will be readily confirmed by, among others, my right hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley), my hon. Friends the Members for Eccles (Mr. Carter-Jones) and for Cynon Valley (Mr. Evans) and the hon. Members for Exeter (Mr. Hannam), for Eastleigh (Sir D. Price) and for Wallasey.
They were all most helpful in consulting me about the principle and detail of HNCIP and I thank especially the hon. Member for Wallasey for her help in pre-testing the arrangements we were to make when the new benefit was introduced by the Labour Government.
The reward for our having consulted so widely was that our estimate that the benefit would go to about 40,000 disabled married women was very nearly correct. By July 1978, within a year of its introduction, we had made 43,000 awards. Of course, we entirely understood the desire of many that the new benefit should go to more people. As we made clear at the time, however, the problem was one of resources. From the moment HNCIP was introduced there was increasing pressure to dispense with the household duties test, whatever the cost. Yet to have done so could have brought in some 300,000 beneficiaries instead of the 40,000 for whom we had been allowed to budget in accord with the intended scope of the benefit when it was announced.
To have obtained the money needed to introduce any kind of HNCIP at all was in itself no mean achievement. Here I readily acknowledge the help I had from fellow campaigners in the House. They exerted just the right pressure—I speak as a former Minister who welcomed pressure to do more—and did so both at the right time and in the right place.
As I explained to the House on 7 November 1978, after reversing a decision the previous September by a tribunal of national insurance commissioners that could have more 318 than doubled expenditure on HNCIP, the money was just not available to me to go further at that time than our stated intention when the new benefit was first proposed.
Nevertheless, we agreed that the question of widening entitlement to HNCIP should be referred to the national insurance advisory committee for consideration. This was done on 30 November 1978 and, when NIAC reported, following the change of Government, it became our policy to abolish the household duties test.
§ Mr. Newton
I am left almost flabbergasted by the last few minutes in which we have had — I hope that the right hon. Gentleman will accept this—a lecture about the virtues of consultation, the result of which, in the right hon. Gentleman's experience, was to produce a benefit which has been universally condemned ever since. We are now getting a historical survey which omits entirely the fact that on 8 September 1978 the household duties test was greatly widened and virtually eliminated by a tribunal of commissioners but that on 12 September 1978 the Government published urgent regulations which put back the interpretation to where they wanted it to save the money and which came into effect on 13 September 1978. Those regulations were not then referred to NIAC until November after a major public outcry.
§ Mr. Morris
I have made it very clear that the money was not available to me or my colleagues who were DHSS Ministers to widen the scope of HNCIP in the way decided by the national insurance commissioners. [Interruption.] The Minister now whispers that the money is not available to him and his colleagues to widen the benefit they now propose. What I did was to make it repeatedly clear that we were always battling with the Treasury for more resources. Anyone who doubts whether our pledge to abolish the test would have been honoured should look at the range of new help made available to disabled people by the last Labour Government.
We not only honoured every pledge that was given in 1974, but indeed went further than the terms of our manifesto commitments in the advances we made. We introduced four new cash benefits for disabled people and their families between 1974 and 1979. Our expenditure on cash benefits alone more than trebled, from £474 million in 1974 to £1,584 million in 1979. We also more than trebled our expenditure on services for the disabled. Among 150 other advances, we introduced the pneumoconiosis compensation scheme and made industrial disablement benefit payable to the victims of byssinosis. We made occupational deafness an industrial injury and extended the attendance allowance to kidney patients dialysing at home. We extended the terms of reference of the Rowntree Trust family fund to include all severely disabled children without exception and gave substantial help to the thalidomide children. We introduced the vaccine damage payments scheme and financially supported the crossroads care attendance scheme.
We zero-rated VAT on aids and appliances for disabled people and also on aids and equipment donated to hospitals for the purpose of treatment or research. We made the new behind-the-ear hearing aid available to 1 million hearing-impaired people and set up the Institute of Hearing Research. We increased the blind persons' tax allowance, extended the "orange badge scheme" to include the blind and made capital grants for pilot residential units for young 319 people who are both deaf and blind. We backed the Rating (Disabled Persons) Act 1978 and substantially increased special housing provision for disabled people. We widened the application of important provisions of the Chronically Sick and Disabled Persons Act and extended the Act as a whole to Northern Ireland.
§ Mr. Speaker
Order. I am reluctant to stop the right hon. Gentleman but he must relate his speech to the Bill and not to what has happened in the past.
§ Mr. Morris
The issue is that of resources and whether Labour Governments honour their pledges. We exceeded the commitments we gave. Those are just some—
§ Mr. Morris
I am sorry, Mr. Speaker, but our problem today is that the debate is on four Bills which have been pressed into one.
I gave only a random selection of the advances made by the Labour Government between 1974 and 1979 and did so as our credentials for criticising in this debate a Government whose policies are condemned not only as "mean and shabby" but even as "harsh and inhuman" by the organisations of disabled people.
I was told in a parliamentary answer last Friday that as many as 16,000 married or cohabiting women who are currently in receipt of HNCIP would not satisfy the conditions for severe disablement allowance set out in the Bill. This is a staggering figure which no doubt explains why DIG has said it can now be argued that it would be better to retain the household duties test.
It is totally clear from the replies that I have had to recent parliamentary questions that, in the future, far fewer disabled married women will satisfy the conditions for the severe disablement allowance than would qualify for help if the household duties test were to continue. This is a grave indictment of the Minister and wholly justifies the extent of the criticism levelled against him.
§ Mr. Morris
The hon. and learned Gentleman will have the opportunity of reading the reply that I received last Friday. It made it clear that 16,000 disabled married women who receive HNCIP under the present arrangements would not qualify for the severe disablement allowance.
If and when the Bill becomes law, there will be women with a preserved right—
§ Mr. Newton
I accept that there are losers as well as winners in the long term, but I want to make it clear, not least for the benefit of those outside the House, that anyone who is receiving these benefits will receive the new severe disablement allowance so long as he continues to pass the incapacity for work test.
§ Mr. Morris
I should not have let the hon. Gentleman intervene. It is already clear to the entire House that married women who are in receipt of HNCIP have a preserved right to the new benefit. My point is that, if and when the Bill becomes law, there will be women with a preserved right to benefit, having qualified for HNCIP, who are far less incapacitated than other women in their localities who will be refused the severe disablement allowance. Yet this is the Government that promised—I quote their manifesto commitment—to provide 320a coherent system of cash benefits to meet the costs of disability, so that more disabled people can support themselves and live normal lives.The proposals in the Bill complicate the social security system and run totally counter to that commitment.
The Government also promised to "single out" disabled people for special help, whereas many disabled married women who would have qualified for HNCIP but will not satisfy the conditions for the severe disablement allowance, will feel that in truth they have been singled out for special hardship and unmerited injustice.
I am very concerned, as are many of my hon. Friends, that the Government have been unable to answer many of the parliamentary questions I have put to them about the proposed new benefit. In particular, they have no clear information to offer about the disabled people who will be disadvantaged by the changing rules.
Two categories of people aged 20-plus will be affected. They will be people who become incapable of work but are unable to satisfy either the first or second contribution conditions. The first category will include anyone pursuing higher education and the vast army of the never-employed. The second will comprise people, mainly married women, who have worked and satisfied the first condition but have fallen out of the system while caring for children.
In the parliamentary questions I tabled for answer last Friday, I sought information from the Minister specifically about the people of each age band from 16 to 30 who satisfied the first condition. I asked also for information about people of all ages who failed to satisfy one or both conditions. For until we know the number of non-contributors, we cannot fully assess the effect of clause 4. To both questions, the Minister replied that the figures I was seeking could be obtained only at disproportionate cost.
I asked a related question, about how many current NCIP recipients—men and single women—would not satisfy the 80 per cent. test. There was no information available to the Minister. From somewhere or other the Under-Secretary of State has produced an estimate that 5,000 men, 3,000 single women and 4,000 married women over the age of 20 will claim the benefit successfully, once the severe disablement allowance has been phased in. Yet in reply to my hon. Friend the Member for Pontypridd (Mr. John), the Minister said, on the same day, that only a small proportion of men and women become incapable of work after the age of 20. How does he reconcile his reply to me with the one he gave to my hon. Friend?
There are two more questions that I must put to the Minister. First, will claims from people of any age be accepted under subsection (2) if they can prove incapacity before the age of 20, and what evidence will be acceptable? Secondly, will the Minister ask his officials to produce figures on the number of men, single women and married women who will have to endure the 80 per cent. test, which were the figures I sought by parliamentary question last Friday?
I must also draw attention to another parliamentary reply which shows that, in the course of a year, only 160 people received awards of 80 per cent. or more as a result of industrial accidents and a mere 50 as a result of industrial diseases. Most incapacity is, of course, caused 321 by disease. Yet this is the experience on which medical boards are now to be asked to decide the benefits of many thousands of people.
The assessment procedure, with its all-or-nothing disablement cut-off, will cause deep and widespread resentment. More people will be subjected to the 80 per cent. disablement test than were affected by the household duties test and we ought now to be told by how much assessment costs will be increased.
We should be told also why the Government are ignoring the social security advisory committee's findings in favour of the introduction of a new partial incapacity benefit for disabled people who do some work but whose capacity to earn is affected by their disabilities. The present sick-or-fit and all-or-nothing system is now manifestly unjust and the Minister ought to let us know today if he is prepared to consider amendments to the Bill that will give effect to one or other of the alternative schemes proposed by the SSAC for a partial incapacity benefit.
The Government are saving £60 million this year at the expense of long-term sick and disabled people who have to live on invalidity benefit. That is the cost of their 5 per cent. cut in the real value of invalidity benefit. In the Bill, the Government are proposing further hardship for invalidity pensioners by the back-door means testing of national insurance benefits. For a sick or disabled claimant with three children, there could be a loss of £22.80 per week because of what is proposed about child dependency additions. That is a scandalous new assault on some of the most vulnerable people in this country by a Government who, in a single day, gave £1,500 million in tax cuts to the richest 5 per cent. of taxpayers. By their priorities ye shall know them.
The Secretary of State must know that the Bill has had the worst reception among informed critics since Peter O'Toole's "Macbeth". In that case, so it was said, the production was so bad that the only people who went to see it did so to see just how bad it was. That would be no witticism in the case of this Bill, yet the Minister speaks of it as a masterpiece and of his audience as a failure.
I say emphatically that the Bill does not deserve a Second Reading and venture to hope that even some hon. Members opposite will weigh very carefully the criticisms of disabled people and their organisations before voting in the Lobbies tonight.
§ Dr. Brian Mawhinney (Peterborough)
It gives me great pleasure to be the first Conservative colleague to compliment my hon. Friend the Member for Cardiff, North (Mr. Jones) on his maiden speech. Conservative Members and, I believe, Opposition Members, will warmly welcome the tribute that he paid to his predecessor, Mr. Michael Roberts, who was held in high esteem in all parts of the House. I hope that my hon. Friend will note that heads are nodding in agreement in all quarters.
The House was impressed by the thought and care that my hon. Friend put into his articulate speech. It is frequently said as a matter of course that the House will look forward to the future contributions of a Member who has just made his maiden speech, but I can assure my hon. Friend that we shall do so with genuine pleasure.
322 I shall comment briefly on the two speeches that we have heard from the Opposition Benches. I believe that I have heard every speech made by the hon. Member for Oldham, West (Mr. Meacher) since he assumed his new responsibilities. I have an advantage over the rest of the House in that the hon. Gentleman gave an exclusive story to my local paper in Peterborough on his views on health matters. I hope that he will not take it amiss if I say that the impression generated by his means of communication reminds me of the speaker's notes which advise: "At this point argument weak — shout louder." The hon. Gentleman has a legitimate political viewpoint and a legitimate contribution to make, and I do not doubt his sincerity. However, it is difficult to get at what he is trying to say through all his rhetoric, and the rhetoric diminishes the strength of his arguments. That was especially true this afternoon.
The right hon. Member for Manchester, Wythenshawe (Mr. Morris) made an interesting speech. I suspect that my colleagues would agree that by protesting so much about his record, the right hon. Gentleman simply demonstrated to the House the inadequacy of what he was advancing. That became increasingly clear in the course of his speech. It is strange and unacceptable to be told that the Labour Government were limited by the Treasury, but that a Conservative Government, when the Labour party is safely in opposition and likely to remain so for some considerable time, are to be denigrated because—
§ Mr. Alfred Morris
I made it pikestaff plain that between 1974 and 1979 the Labour Government more than trebled their spending on cash benefits for the disabled. I also made it clear that we trebled our spending on services for the disabled. It is also fair to point out that our increase in spending far outstripped the increase in inflation. Our record deserves to be much more widely acknowledged.
§ Dr. Mawhinney
We can infer from that intervention that the right hon. Gentleman feels under-appreciated. He has certainly given the House a chance this afternoon to appreciate both the Labour Government's record and the discontinuities in his argument.
I support the measured proposals on the optical service. Those involved in the service, and a few of my hon. Friends, have reservations. I respect their views. In particular, I respect the views of my hon. Friend the Member for Birmingham, Edgbaston (Mrs. Knight), as does the whole House. She has considerable knowledge of these matters. If she catches your eye later in the debate, Mr. Speaker, I expect that she may express her reservations.
Having listened to the debate this afternoon, and bearing in mind that clause 1 is only one clause in a long Bill, I hope that those with reservations will reconsider any intentions that they may have to vote against the Government this evening. I also applaud the work that is manifest in the provisions for aid to the severely disabled, which has been the subject of much discussion.
I should like to congratulate the Government on recognising the need in the primary care sector. I welcome the statutory structure which is to be provided for the family practitioner committees. Primary care by the family practitioner is among the most important aspects of medical care. As my right hon. Friend the Secretary of State has said, it is frequently the first and the only contact that our constituents have with the medical profession and 323 the National Health Service. I know that he would join me in welcoming the improved professionalism of general medical practitioners. Courses have been laid on in medical schools such as the one in which I teach, and there is provision for training general practitioners after graduation. Such provisions, combined with the vocational dedication of doctors, have improved the services available to patients. No one listening to this debate should conclude that the work of general practitioners is not recognised and appreciated in all parts of the House.
The Bill is an important step in giving primary health care a statutory framework similar to that in the hospital sector. I did not intervene lightly in the speech of the hon. Member for Oldham, West. The issue deserves to be considered coolly and dispassionately. We have an arrangement at the moment which is supported by both parties. It is agreed that there is a limit—we are not this evening debating where it should be set—on the amount of resources available for the hospital sector. At present there is no such limit for primary health care. Perhaps the House should not involve itself in logic, but in logic—never mind politics—there is no reason for assuming that it is permissible to have a cash limit in the acute sector while the primary health care sector is totally open-ended. There is no structure applying constraints or restraints or, at the very least, seeking better value for money in that sector, although hon. Members on both sides of the House accept that the amount of money available is limited and that the savings will be applied to patient care.
§ Dr. Mawhinney
I prefer not to give way.
I understood from the speech of the hon. Member for Oldham, West that he would not wish to see any restriction at all. I am sorry if I have misrepresented him. No doubt, in summing up, his hon. Friend will clarify what was meant.
There is a case for applying some structure of constraint in order to maximise value for money and to improve patient care, which is what, ultimately, the family practitioner committees are supposed to be about. Some Opposition Members may tell me that I am seeking to withhold necessary treatment from those who need it. That is not what I am saying. Personal experience, and conversations with medically qualified colleagues, have persuaded me that there is room for improvement in the service that is delivered.
§ Mr. Meadowcroft
In the light of what the hon. Gentleman has said about the limitations on budget, does not the present system, under which overspending on drugs by the FPCs is to be clawed back from the hospitals' drug bills, contradict the case that the hon. Gentleman has put forward?
§ Dr. Mawhinney
Until we have a statutory structure for family practitioner committees, as envisaged in the Bill, there will always be tension between primary care and the hospital sector. It is in the interests of the National Health Service as a whole to have some form of structure for primary care.
I have two general questions for the Minister, First, the Secretary of State referred to the family practitioner committees as employing authorities. We should be told 324 how far their authority will extend. He said that they would become involved in work practices. How far will that extend? I may wish to go further than many other hon. Members in order to ensure that the structure has a high degree of accountability.
I do not fear the direct link between FPCs and the Secretary of State. One of the problems of the Health Service is that management and authority has been too diffuse over the past few years. There has not been sufficient accountability. Secondly, we have suffered, not just in the use of scarce resources, but in the application of treatments to patients.
I should like to raise with the Minister the subject of the amount of money that goes to general practitioners. He will remember that he gave me a written answer on 31 October which said:the average gross income of general medical practitioners was about £34,700 (this excludes payments for the supply of drugs). Nearly 10 per cent. of that gross income was derived from the fees".—[Official Report, 31 October 1983; Vol. 46, c. 296]It might be thought that when one goes to see one's general practitioner at night or calls him out at night that is part of the service under the National Health Service. In fact, the cost to the Exchequer in 1982–83 was just over £8 million in extra fees. One might think that obtaining vaccination or immunisation from a GP was part of his NHS service, but it is not, to the tune of over £11 million a year. One might have thought that going to a GP for contraceptive services was what he should be all about, but it is not, to the tune of an extra £18 million a year. One might have thought that going to the GP for the provision of maternity medical services was part of the service, but it is not, to the tune of almost an extra £30 million a year. For the year 1982–83 those extra fees totalled nearly £80 million. In the fullness of time, would it be possible for family practitioner committees to study that extra expenditure for what are often thought to be NHS facilities to see whether that money might be spent in other ways?
How pleased Conservative Members were to hear the Minister's statement last week that he will be encouraging GPs to become more involved in generic prescribing. That is plainly something that he and my right hon. Friend agree is important. It is accepted by Conservative Members and, I believe, the whole House, as an important contribution to the better use of resources. Simple encouragement might not be enough. I hope that the new FPCs will at least have the right to consider whether they should eventually start auditing GP prescribing habits.
I had an interesting conversation a few weeks ago with a medical consultant at the hospital in which I work. He said, "Brian, of course, you do not understand GPs. Many of them prescribe a drug in order to end a consultation. They cannot get a patient out of their office unless they can have a piece of paper." I replied that I thought that those days were coming to a close because the nation could not afford it.
I do not blame GPs. We are all responsible because we have all created a climate in which patients have been led to believe that they only have to go to their doctor to obtain a drug and all will be well. Those who know anything about health know that that is not true in many cases. In many cases people will get better even if they do not go to their GP.
My second question is about the relationship of these new FPCs with the DHAs in the areas in which they operate. I know that my hon. Friend shares my view that 325 there are benefits to be derived, as my right hon. Friend said, from close co-ordination and co-operation between the two bodies. I welcome the fact the DHAs will be able to nominate up to four people to serve on a FPC. However, in some areas, the four DHA nominees will not be sufficient to allow one nominee from each DHA that is covered. I hope that my right hon. Friend the Secretary of State will consider that point when he is appointing the seven other members, as he is entitled, under schedule 2.
There is no doubt that it is in the best interests of the NHS that we should make the best use of resources by integrating, as far as possible, general practitioner surgeries, community health clinics and outpatient departments. People tend to use them interchangeablAy more than in the past. They will be under different authorities. I hope that the chairmen of DHAs and FPCs can be led to understand that maximum benefits in patient care will be achieved by close co-operation between them. I hope that my right hon. Friend will accept that point. He has been an advocate of greater flexibility to maximise resources within the NHS. It is something that he needs to bear in mind as the FPCs develop.
I welcome clauses 2 and 3. They are a step in the right direction. It may be that they will eventually lead to the full integration of the services as proposed by Acheson. I commend my right hon. and hon. Friends.
§ 7.7 pm
§ Mr. Michael Meadowcroft (Leeds, West)
I join other hon. Members in commending the hon. Member for Cardiff, North (Mr. Jones) on his maiden speech. The hon. Gentleman has the benefit of being a Welsh countryman combined with long experience on local government which probably assisted the fluency that he displayed. I have no doubt that the House will welcome his future contributions.
As has been said, the Bill is essentially a composite of a number of items that do not hang together. A number of points that could be made about individual items might be better made in Committee. I am conscious that a number of hon. Members wish to take part in the debate, so I shall not deal with all the points.
The first half of the Bill contains a number of separate items, two of which are controversial. The first is the removal of the closed shop in the dispensing of optical prescriptions. I do not have any objection to that in principle, provided that there are adequate safeguards to protect those who will go to dispensers for prescriptions which could considerably affect them in their daily lives. I shall deal with the safeguards later.
The second point relates to the family practitioner committees. I listened carefully to what the hon. Member for Peterborough (Dr. Mawhinney) said. It does not follow that separating part of the Health Service will achieve the control over its expenditure that the hon. Gentleman fondly wishes. It is possible to argue the opposite—that containing it under the umbrella of the services which are constrained will provide the best example of the case that he wishes to put to the House. The experience of many hon. Members of the family practitioner committees is not, I believe, such as to encourage one to think that as separate entities they will suddenly start behaving themselves and be less self-defending organisations. I accept that general practice is a success story in virtually 326 every aspect. However, if that is the case, surely it would be wrong to hinder the application of that success story by moving the service further towards isolation.
The second part of the Bill, in so far as there is any consistent pattern with regard to social security, has a pattern that I and my colleagues reject, although certain clauses, such as the abolition of franking, we support. The trend of the proposals appears to be detrimental to the concept of a family — a concept that the Government profess to support. We shall vote against Second Reading tonight for certain specific reasons to which I shall come.
The safeguards in the Bill against unqualified optical dispensing are inadequate. It has been suggested that opticians have been cross-subsidising the low income they receive for their diagnostic work by charging higher markups on their dispensing work. If so, an examination should be undertaken to see whether they need an increase in the fees that they receive for that part of the work that will remain their monopoly. It is no part of my argument to suggest that that kind of cross-subsidy should continue.
The Secretary of State expressed some doubt as to whether the two-year period that he was suggesting for the validity of a prescription was adequate. He suggested it might even be three years.
§ Mr. Meadowcroft
I am grateful for the right hon. Gentleman's comment. When he made his statement he indicated that he might even be prepared to consider an even narrower gap than two years.
§ Mr. Roy Beggs (Antrim, East)
Does the hon. Gentleman agree that there have been instances in the past when qualified opticians have been able to identify medical conditions in patients during eye-testing, and that for too long a period to be remitted in prescribing could endanger the health of patients?
§ Mr. Meadowcroft
Indeed, yes. Evidence has been presented to me and no doubt to other hon. Members, suggesting that that is so. The Secretary of State seemed to get himself into difficulty by failing to suggest some way to guarantee the qualifications of those who are dispensing—presumably with the aim of covering the point that the hon. Gentleman raised. Indeed, I hope that at some point the Secretary of State will detail what he means by "adequate safeguards". I do not see how one can protect people against witting or unwitting negligence that might lead to detrimental effect without some method of registration. Without registration in some form there is no way of preventing a person from practising as a dispensing optician. Indeed, if one wants to protect people financially against the results of bad dispensing, I suspect that registration is essential. It is not merely that the wrong spectacles may or may not cause harm to people's sight — I accept the evidence that they may not — but the effect of incorrect prescribing resulting in disastrous consequences for an individual in his work place or behind the wheel of a vehicle.
The second argument against supporting the Bill is the crucial one that it removes National Health Service optical provision from all but the young and the poor. It is reprehensible to create two classes of people and two types of provision entitlement. It is a substantial division because about one third of the population would have the right to National Health Service provision and two thirds 327 would be deprived of that right. A division on that scale would create a very unhealthy precedent. It harks back almost to the days when one could identify poor children by those appalling National Health Service glasses so clearly identifiable in our schools.
If the Government are right that the Bill will so help in bringing down prices that the National Health Service provision is not needed, then why not keep it, because the provision will wither on the bough? If that argument is not correct, then it must be kept so that adequate provision exists for people in future. The problems of mentally handicapped people and the necessity to make provision for them must also be considered as they will not be covered by the exemptions in the Bill.
I come now to the acknowledged problems of pharmacists in specific areas and the necessity to subsidise them. If we go too far in excluding National Health Service prescribing, it will be necessary also to subsidise the optical service in some of the sparser areas of the country.
The Bill removes the subsidy available through the National Health Service for the supply of unusual or complex lenses, with the exception of the one subsidy that will remain within the National Health Service provision generally. It is interesting that the Secretary of State in opening the debate introduced the new point that he was prepared to consider the prospect of some assistance where the lenses subsidised under the National Health Service were substantially more expensive than they would otherwise be. The National Health Service charges for all but what are described as the average NHS reading lenses are in excess of the price charged to the patient. The difference varies from some £4 up to £19. If it is right in principle, as the right hon. Gentleman suggests, to subsidise those at the higher end of the scale, it should surely he accepted in principle that where the cost would be higher than the National Health Service provision the right to subsidy should remain. If this is not so, it is simply penalising those with more serious eyesight problems than those who are able to pay. That would surely be unacceptable.
I do not accept that it will be beneficial to separate the family practitioner committees from the general Health Service administration and accountability. The points raised by the hon. Member for Peterborough dealt with the problem of clinical freedom as opposed to accountability within the National Health Service administration. If he wishes to pursue that argument, it will have to be considered by the House when examining the available resources and the expectation of people for health services. I should have thought that was the wrong direction in which to go. It seems somehow to separate one part of the Health Service for direct administration through appointees of the Minister. Considerable dangers exist in having the power of appointment conferred upon one individual in that way.
§ Mr. Kenneth Clarke
Perhaps I can assist the hon. Gentleman. He seems to fear that the family practitioner committees will be made directly accountable by my right hon. Friend because my right hon. Friend will appoint the members. The hon. Gentleman appears to be suggesting that they should be made subordinate to the health 328 authorities. Has the hon. Gentleman forgotten that my right hon. Friend appoints all the members of the regional health authorities and all the district health authority chairmen?
§ Mr. Meadowcroft
I was shocked by being regarded as a member of the Labour party. It is the direct control by the Minister that causes the difficulty. In the DHAs there is at least some indirect representation from local authorities, but even that is taken away. There is also the bizarre situation regarding schedule 2 and the place of a dispensing optician to be appointed by the Minister.
§ Dr. Mawhinney
The hon. Gentleman will have noticed, however, that in schedule 2, 23 of the 30 members to be appointed, while they are technically appointed by the Secretary of State, are in fact nominated by the various professional and vested interests — [Interruption.] I should not say "vested interests". I was thinking of professional and local authority members who are nominated locally by those groups. While it may be technically right to claim that they are all appointed, will the hon. Gentleman at least acknowledge that 23 of the 30 will have been generated by the people most involved at local level?
§ Mr. Meadowcroft
My experience of indirect appointment, or indirect election, of people to bodies is that one can still select people who are in sympathy with one's viewpoint. If that viewpoint is as dogmatic as is often the case with Conservative Members, clearly it is not a satisfactory safeguard. Apart from that, I noted what the hon. Gentleman said about people having a vested interest.
I come now to the social. security implications. We welcome the abolition of the household duties test, as that removes the sexist element from social security provision. In that sense we welcome the merging of the noncontributory invalidity pension and the housewives noncontributory invalidity pension into one benefit. Again, however—this is another reason for opposing the Bill—this move has its attendant acts of meanness.
Although we welcome the simple test of "incapability for work" for those under 20, the 80 per cent. disablement test is worrying. It could lead to the most ludicrous anomalies. People who had previously claimed severe disablement allowance and tried to hold down a job and failed—probably for more than the eight-week linkage that is normally taken—might be refused the allowance because they were then over 20. Further, people who failed to claim until they were over 20, but who otherwise would have been eligible, would suffer from the same drawback. It is not sufficient to say that those who can demonstrate that they were disabled before the age of 20 had that opportunity open to them. That is a hard test to apply, despite what the Minister said about mobility allowances in other circumstances. The Government admit that some who would have been eligible under the old rules will be ineligible under the new proposals. It would appear from the financial memorandum that this will save only about £15 million a year. In the whole context of spending, it is a petty meanness that will hit the poorest and most disadvantaged.
As regards the child dependency additions, in principle, again, we support subsuming the short-term benefit under the child benefit, thereby simplifying and unifying one part of the rather Byzantine social security system. However, we object strongly to the fact that this apparent 329 simplification is being used as an excuse for cuts. Child benefit has increased by only 5p or 10p in real terms since the Tories took office, and that through only the most recent uprating. Before that the record was very different. In the corresponding period, the short-term benefit dropped from £1.07 to 15p. If the Bill is passed, simple arithmetic makes it clear that this will represent a severe cut in child support. To have maintained its real 1979 value, total support should have been about £9.20.
It is no use the Secretary of State saying that child benefit is at an all-time record when, taking it as a whole, the actual sum will be much less than it should have been under the principle that the Minister was trying to enunciate. The changes in long-term benefit are even worse because they are wrong in both concept and execution.
We oppose the idea behind these changes because they introduce an earnings rule in respect of what amounts to a national insurance benefit. Universality—the original Beveridge principle—is one that we still surport. These changes will give a vicious new depth to the poverty trap. One-child families, with one wage-earner parent in receipt of a long-term benefit, will find their income docked by £7.60 per week should that parent's wage increase from £79.99 to £80.01. That fact comes out clearly from the proposals in the Bill.
Although this change removes certain sexist elements from the regulations, in that women will have the same rights as men to claim the benefit—a move that is to be welcomed—it will still place women at a disadvantage, de facto if not de jure, because women claimants are most likely to be penalised by a means test applied to a spouse's earnings. These changes, according to the financial memorandum, will save £4 million a year for the short-term benefits and £18 million for the long-term benefits. I should have thought that sum was hardly worth while given the anguish that will be caused to the poorest in the community.
We thoroughly oppose the retrograde provisions for occupational pensions. It is remarkable that a party which in its 1979 manifesto said that it would abolish the earnings rule for pensioners, which it reiterated in its 1983 manifesto, should now make the earnings rule worse, which is precisely what the provisions relating to occupational pensions will do. Apart from being misguided, they are illogical, for the rule will apply to national insurance benefits but not, thankfully, to unemployment or housing benefit.
The composite Bill before us must be carefully weighed. I have made it clear that some of its provisions are to be supported. However, on balance its defects greatly outweigh its benefits and therefore it does not warrant our support at this stage.
§ Mrs. Jill Knight (Birmingham, Edgbaston)
I begin by declaring my interest in that part of the Bill that deals with optical appliances. I have for more than 35 years been married to an ophthalmic optician, but I must make it clear that he has no possible pecuniary interest in the Bill as his job is mainly connected with fitting patients for contact lenses, and that is exempted under the Bill.
The last 35 years have taught me much about opticians and I strongly resent the accusations that have been flung 330 about in recent months to the effect that opticians are money-grubbing opportunists who consistently make fortunes by overpricing frames. There are many things to be said in favour of opticians, and tonight I intend to say them.
It should be understood that for years successive Governments have deliberately underpaid opticians for their professional job of testing eyes and have told them that they must make their money from selling frames. Opthalmic opticians have a long training—at least four years and sometimes more; my husband had five years — and they know so much about eyes that they frequently spot the first signs of diabetes, heart disease, cancer and glaucoma.
Successive Governments have said, "We will not pay you adequately. You must get your recompense by supplying frames." That has always been a scandal, one that I have raised twice in the House. Now we are presented with a Bill that says that it is wrong even to do that. What, then are opticians to do? Practices must pay overheads, telephones, post, light, heating, cleaners, rent and rates, receptionists and so on.
I was distressed that in a statement made by the Minister on 28 November it was said that the "customer" should have the right to lower prices. I found it sad and significant as I listened to him today that he constantly referred to people who needed glasses as "customers." I refer to them as patients, because they need some correction in their eyes, and that is a health matter.
In any event, if "customers should have the right to lower prices", I hope that the Minister will agree that opthalmic opticians, dispensing opticians and others have a right at least to cover the overheads of running their practices. If the Bill is passed, the Government will have to pay far more to those doing eye tests, or else there will not be anybody left to do them. Both ophthalmic and dispensing opticians lose money on every NHS frame that they supply. On average, 36 per cent. of all frames supplied by a practice would be NHS frames. Since the introduction a few months ago of the short-lived women's new fashion frame, the figure has increased to about 40 to 50 per cent. in some practices. Every NHS frame dispensed is one on which opticians lose money.
Opticians also lose money heavily on domiciliary visits. My husband has said that he regards such visits as a social service. He tests the eyes of persons who are bedridden and unable to visit his practice and it costs him money. Many opticians provide such a service. The House should realise the type of service that many opticians provide without a word.
In December 1982, after five years of negotiations through the Whitley council — a body that does not make snap conclusions—the Government were told that they should have paid the opticians more. The Whitley council examined all expenses connected with running a practice. To the expenses that I have mentioned, we must add the time that is taken to test patients' eyes. The council concluded, after five years of careful study, that the opticians were owed £90 million in back pay from January 1978 to December 1982. A similar exercise by the Whitley council for earlier years came to the same conclusion, that opticians were underpaid. It also recommended substantial payments.
Something rather shocking has occurred as a result of the recent Whitley council report. A total of £6 million has been withheld from the opticians by the Government 331 because they claim that the opticians have made unintended profits during that period. In spite of the questions from every professional grouping of those connected with supplying glasses — such as on what grounds do the Government consider that the £6 million should be withheld, what proof is there that money was made by unintended profits, how was the £6 million calculated, which opticians benefited and received the money?—every attempt to elucidate answers has been met with absolute silence. The truth is that there is not one jot, tittle or shred of evidence that that £6 million is owed or was ever owed by the opticians to the Government. However, the Government still hang on to the money. If anyone other than the Government did that, it would be illegal.
Far from being the villains of the piece, opticians have not been treated fairly since 1951 when the then Socialist Government changed the rules and imposed charges. It is interesting to examine the sums of money paid to opticians then. In 1948 the dispensing fee for a pair of spectacles was 25s. If that sum was rounded up and inflation taken into account, the fee today would be £25. Instead, the dispensing fee is, on average, £7. In 1948 the examination fee was 15s. If that was rounded up and inflation taken into account, the fee today would be £15 — but it is £8. Before 1982, it was £4.50.
One might ask, how did the opticians manage? They managed because they did what the Government told them to do and sold frames. Some may have charged too much and profiteered. There are bad apples in every barrel. A view widely held outside the House is that not every hon. Member is always as honourable as he should be on every occasion. It would be wrong to paint the whole profession of opticians as villians. The overwhelming majority perform an excellent job and can hold their heads high in an ungrateful world.
The current charge of £8 for an eye test means that opticians must derive the lion's share of their income from selling frames. The dispensing fee will disappear except for the young, those receiving supplementary benefit and pensioners. About 40 per cent. of NHS dispensing will disappear. There will be no NHS glasses. I am worried about that because it will be a serious drawback to many people who, until now, have had their eye needs catered for by having NHS frames at a good price.
There are three categories of opticians — the ophthalmic medical practitioner, the ophthalmic optician and the dispensing optician, and the Bill affects each group differently. The ophthalmic medical practitioners and the ophthalmic opticians will still be used—or will they? The Secretary of State said on 28 November, and again this evening, that the Government will allow sales of ready-made spectacles, but sales by unregistered sellers will be against a recent prescription not more than two years old. I am delighted to hear what my right hon. Friend says, but that provision is not in the Bill, which allows this or any future Government to exempt ready-made spectacles from the definition of "optical appliances". it allows the exemption of spectacle lenses of certain strengths. Virtually anything can be done regarding spectacles except allowing unregistered sellers to fix contact lenses or to dispense for children.
We are dealing with an enabling Bill, and statutory instruments will be required. That will be dealt with in Committee, and we shall all long to be away in 10 minutes 332 when we should be dealing with these crucial points. That it is just not good enough. Such an important matter should be written firmly into the Bill.
My right hon. Friend must understand that leaving good eye care to the mercy of ignorance is wrong. What will happen to the Bill if the noble Lord Rugby was able to move the statutory instrument? God save and help the opticians then.
§ Mr. Fowler
If my hon. Friend examines clause 1(3A) at the top of page 2 of the Bill, she will realise that an order must be made which would be debated by the House. There is no question of my seeking to set down conditions that cannot be debated. Clearly they can be debated and approved or disapproved.
§ Mrs. Knight
Perhaps the preceeding paragraphs of my speech may be regarded as a probing amendment. I am delighted to hear what my right hon. Friend says. These issues are important and I and others outside the House believe that they should have been written into the Bill. Providing my right hon. Friend alters the 13ill, the ophthalmic optician may survive, even if his income is severely reduced.
But the dispensing optician sees his entire future at risk. The provisions of the Bill imply that he is an unnecessary adjunct—dispensers can be dispensed with. Members of the public will be able to get their glasses anywhere—the greengrocers, the butchers, the supermarket, at a street market or even from a man with a battered suitcase on the pavement in Oxford street. One may have to vie for his attention with a passing police constable, but he will be able to provide spectacles. The garage where I buy my petrol sells a wide variety of garden furniture, ice cream, cheap watches and Christmas wrapping paper. If the Bill is enacted, there can be no reason why the man who sells me petrol should not also sell me spectacles.
The Government do not appear to understand that expertise is required to dispense glasses. Anyone can read a prescription after a few hours coaching. I beg my right hon. Friend to understand the problems. Reading a prescription is only half the story. Because someone can read a prescription does not mean that he can automatically dispense glasses. Some ophthalmic medical practitioners are already declaring that they will virtually refuse to prescribe. They will not bother to test eyes unless they can tell patients where to go to have their prescriptions filled. All their training, expertise and care in the testing of eyes will amount to nothing if the glasses are not properly fitted.
My right hon. Friend wears spectacles. I ask him to lift them up and move them about a bit to discover whether he is capable of seeing if they are not properly fitted. Many different points must be taken into consideration if a frame is to be fitted properly. Even if someone has the best prescription in the world, if it is not properly fitted he will not be able to see properly.
What will happen if the glasses are badly fitted? What will happen if the patient cannot see properly? To whom will he go? Will he return to the man with a suitcase in Oxford street, or to the man in the garage—or will he return to the optician who gave him the prescription? It is likely that he will return to the optician and say, "You have given me the wrong prescription. I cannot see properly." That is what worries the ophthalmic medical practitioners.
How will my right hon. Friend judge whether a prescription is recent? After all, spectacles themselves 333 have been used to indicate a prescription. I shall take off my glasses. I am now holding a prescription in my hand. It is a recent prescription. Do I take these glasses to just anyone and say, "This is my prescription; please can I have another pair?"?
How can we know that my right hon. Friend's intentions will be carried out—
§ Mr. Dickens
Does my hon. Friend accept that lenses, whether National Health or private, are made by highly specialised companies, and that their tolerances are beyond the dreams of years ago? If a prescription is correct the lenses, wherever they are sold in a frame, and by whomsoever they are sold, will be accurate.
§ Mrs. Knight
But that is exactly my point. The prescription is handed over to the seller, who will produce the lenses and the frames and sell them to what my right hon. Friend is pleased to call a customer. Britain has the highest quality lenses in the world by Government decree. That will not be the position if the Bill becomes law.
My right hon. Friend must understand that the trained man who tests eyes will not produce the lenses. The Government are opening up the business of providing spectacles to every bucket shop in town. How can we be sure that the prescription is recent? Who will monitor that, who will pay for it and who will ensure that the prescription is new?
How did my right hon. Friend decide on a limit of two years for a prescription? The present Act limits the validity of prescription to one year, and it will be dangerous to change that. Some patients with certain conditions need a change of prescription every six months. My right hon. Friend does not need to take only my word for that; he can ask doctors. Two years is a nonsense.
Why dispense with a prescribing system that has worked well for 35 years? I find it appalling that the Government have allowed themselves to be railroaded by ignorant persons—some in another place—who take the view that expert eye care should be sacrificed on the altar of cheapness. We all know that some articles can be obtained more cheaply than others, but the price for good products holds firm. Someone might buy a cheap pair of spectacles, but he must not kid himself that they will be as good as a more expensive pair. That is why the present regulations came into being.
The Government say that it is a person's responsibility to ensure that he has the right glasses. I suggest that they try to say that to the person who has failed to ensure that he has obtained the best glasses for his needs. If his vision is distorted, he could run over a child in the street. Let the Government try telling the accident victim that it was the person's responsibility to ensure he had the right glasses.
My right hon. Friend wisely made reference to the Opticians Bill, the second reading of which took place on 6 December 1957. He said a great deal about that Bill, but he did not say why it was introduced. The sponsor of the Bill, Mr., later Sir, Ronald Russell, said:The objects of the Bill are … to promote a high standard of professional education and conduct among opticians and … to protect the public".Another hon. Member said, "The quacks flourish." This part of the Bill is a quacks' charter. An ex-Minister of Health said that the Bill would besafeguarding the rights of the citizen."— [Official Report, 6 December 1957; Vol. 579, c. 827, 855.]334 Today, we are throwing all that away, and I am not happy about it.
I want to deal briefly with the critics who have said that glasses are cheaper abroad. There is no way that that can be said about NHS frames, which must be the best bargains in the world. They are supplied at cost. No one is making any profits from them. We could go from here to Timbuktu and back, but nowhere in the world will we find a better bargain than a NHS pair of spectacles. Anyone can have NHS spectacles and NHS frames.
§ Mr. Tam Dalyell (Linlithgow)
The hon. Lady has made her best speech in 18 years. How does she intend to vote tonight?
§ Mrs. Knight
If the hon. Gentleman will possess his soul in patience, he will find out.
All NHS spectacles will stop, except for children and supplementary benefit recipients. The critics must take testing into account. Eyes are tested free in Britain, and we should be jolly grateful for that. Free eye tests are not available elsewhere. As the former Price Commission said, it is impossible to compare a $12 pair of ready-made glasses with the price of British private spectacles dispensed through a prescription, with the quality guaranteed of both the prescription and the lenses. The Price Commission said:You are not comparing like with like.We should not forget that the Office of Fair Trading report says that opticians in Britain are not making inflated profits. The former Price Commission said the same thing. Yet ill-informed people—some with a vested interest in the business of marketing frames purely for profit —have fostered the view, and persuaded my right hon. Friend, that our professional system is somehow unacceptable. Yet every independent body set up to examine the question dispassionately has concluded that opticians are not guilty of profiteering.
The average cost of spectacles in the United Kingdom is among the lowest in Europe, as the Common Market has recently discovered. The only other country in Europe where glasses are as cheap as they are in Britain is Holland —everywhere else they are more expensive. None of the glasses from Hong Kong or the United States have any quality guaranteed. Some of them have bubbles in the glass and some have frames with screws that fall out. That is very worrying.
On 28 November 1983, my right hon. Friend the Secretary of State said:people who currently buy NHS glasses will in the future be able to obtain a wider selection of non-NHS glasses at reasonable prices."— [Official Report, 28 November 1983; Vol. 49, c. 438.]Really? That certainly will not be true for those who need particularly strong lenses. At present such lenses call for a greater Goverment subsidy, so they are not very expensive for those who need them. However, that subsidy is to go. That worries me, because it is often the elderly and the poor who need stronger lenses.
No one will be able to obtain cheaper glasses than those currently available on the NHS. Why should my right hon. Friend say that they will be able to obtain them? Is advertising the magic touchstone? Broadly, I support advertising and am all for it, but we are not selling soap powder or furniture polish. We are talking about a service that will harm health unless it is carried out properly. I am 335 against advertising spectacles, because it will destroy public awareness of the importance of professional care for the eyes.
I pray in aid the British Medical Association. I am sure that my right hon. Friend the Secretary of State will have received a paper that I got this morning. The BMA's considered opinion is:Since spectacles are a product with a significant health element, we do not feel that it is appropriate for the public to be unduly influenced in their purchase by advertising.That is the BMA's view, and it is also my view.
§ Mr. Fowler
My hon. Friend fairly warned me that she would oppose me, and she is not doing a bad job of it. However, the principal conclusion of the Office of Fair Trading was that the advertising restrictions at present resulted in prices being significantly higher, and in efficiency being significantly lower than would otherwise be the case. Does my hon. Friend support that?
§ Mrs. Knight
I do not support what the Office of Fair Trading said about advertising. I am supporting the BMA, because it is more knowledgeable on this point.
I frequently go to the United States of America, and am appalled by the way in which glasses are advertised there. I remember that the neon lights on the other side of the street flashed on and off all night, destroying my sleep. I shall never forget that they said:Go visit Abie Brown for the cheapest spex in town.That appalls me. If the Government want to advertise spectacles, perhaps they should also return to advertising false teeth. When I was a child, huge pairs of false teeth were advertised. Will there be advertisements on the hoardings saying, "Dr. Giles, the best man for piles," or, "Green Lawn private hospital gives you the prettiest appendix scar"?
It would, indeed, be a retrograde step to revert to such advertising. It is also highly debatable whether advertising would increase business for those who do not advertise. Certain professional people, such as ophthalmic medical practitioners or ophthalmic opticians, will not advertise. The most professional people involved will not advertise, and nobody will make them do so. Advertising will be left to the cheap and less expert end of the market.
There is not an endless market. Sales of spectacles will not be increased by advertising, and that is particularly true for ophthalmic opticians. The bucket shop end of the market will advertise, while the responsible end will not. I warn the Government that if all the ophthalmic optician has to live on is the fee currently paid for testing a person's eyes—without also providing glasses—he will go out of business. He will not advertise. I can well imagine that those who have had their eyes tested will be attracted by the advertising to go to some cheaper firm.
No ophthalmic optician will be able to keep open his doors if he is not allowed to cover his overheads. Many small firms as well as those in rural areas will go under because they cannot afford to advertise. We shall have the problem of the pharmacists all over again.
It is very strange that one of the arguments used for the Bill is that it will introduce competition into the supply of glasses. This afternoon my right hon. Friend the Secretary of State said that the Office of Fair Trading had found that a pair of glasses could be obtained for, if I recall correctly, £40 from one optician and £102 from another optician. Which? magazine and others have pointed out that glasses can be bought more cheaply if the person shops around. 336 But surely that means that there is competition already. I am not sure that the report of the Office of Fair Trading compared like with like, and it is impossible to put the price of glasses in an advertisement, as it will vary so much. The case that my right hon. Friend made impeccably this afternoon for competition illustrated how much competition already exists. George Orwell, thou shouldest be living at this hour! What can my right hon. Friend's observations mean other than that competition already flourishes? One is quite free to shop around.
§ Mr. Kenneth Clarke
It is only her eloquence that is carrying my hon. Friend away. In fairness to the report of the Office of Fair Trading, a comparison was made between exactly the same glasses and exactly the same prescription for, in effect, the same patient. I am waiting to hear my hon. Friend explain why the optician who is competing and who can provide glasses at £40 should not be allowed to advertise in the local newspapers and elsewhere, so that people can exercise their choice and go to the cheap shop while still expecting the same service.
§ Mrs. Knight
There should not be advertising for health matters. It is obvious to everyone that the same sort of house is a jolly sight cheaper in the north than in London. However, my right hon. Friend the Secretary of State and my hon. and learned Friend the Minister will not get off the hook quite so easily. They, and the report of the Office of Fair Trading, have admitted that there is already ample competition. Thus, competition already flourishes, and one is free to shop around. If the Government have drafted clause 1 and schedule 1 in order to introduce competition, we can all go home, because there is competition in abundance. However, it is competition with a built-in safeguard. The Government propose to bring in something that we already have and to jettison something that we shall always need. That worries me. At present, there are guaranteed safeguards for good eye care, but they would be a casualty of the Bill.
A great deal of nonsense is spoken about a monopoly. If I fly in an aeroplane, I want the pilot to have passed some flying exams. What a shocking thing to want! A monopoly! Just think, only people who have passed exams are allowed to fly aeroplanes! Shocking! If I needed my appendix taken out, I should want the operation to be done by a doctor who had passed a few exams. Pilots and doctors have monopolies over the services that they provide. Long may that continue! If, after having my appendix out, I want medicine, I shall want to go to a pharmacist who knows how to dispense a prescription. Similarly, I want an expert to test my eyes and I need an expert to fit my glasses.
The Secretary of State says that no one but a qualified optician will be able to sell glasses to children and families on low incomes. If that is put another way, my right lion. Friend is saying that only those two groups need expert eye care, and that the rest do not need it. It is only children and the elderly or very poor who need first-class glasses. The rest can go wherever they like. Of course it is vital that children should have excellent glasses, but is it not also crucial that those who drive cars, cranes and trains or who deal with dangerous factory machinery should also have expert eye care? Why single out the young and poor as the only ones to receive top eye care? Unless lenses prescribed by the profession are made up by experts they will not meet the required standard and accidents will be caused.
337 If one loses a leg, a hand or an arm, medical technicians can now produce workable replacements. We can obtain dentures if we lose our teeth, and wigs if we lose our hair. One can even get a new heart or a new kidney. But one can never get new eyes. Sight is one of the most precious of all God's gifts. We should prize it and guard it. Nothing in the Bill will actually rob us of sight, but it will certainly downgrade eye care in Britain—an area in which until now we have led the world. Bad glasses may not cause harm to eyes, but badly dispensed and fitted glasses will certainly prevent people from seeing as well as they should. There will be eye strain, discomfort, headaches and accidents.
This part of the Bill is a thoroughly bad and retrograde step. I shall vote against it.
§ Mr. Deputy Speaker (Mr. Paul Dean)
Order. In more than three hours of debate there have been only seven speeches. A number of hon. Members are seeking to catch my eye. Unless we improve the productivity rate, I fear that some will be disappointed.
§ 8.1 pm
§ Mr. Brynmor John (Pontypridd)
As the first stakhanovite, I wish to concentrate on two of the social security aspects of the Bill—the new severe disablement allowance and the child dependency allowance. I shall deal with them under two headings—what is proposed and how it came to be proposed.
My right hon. Friend the Member for Manchester, Wythenshawe (Mr. Morris) gave a comprehensive review of the disablement allowance. I shall not repeat what he said, but I take issue with the Government's press statement introducing the new 80 per cent. loss of faculty test. Three and a half years after the Government began their review they proposed the 80 per cent. loss of faculty test, which they had not floated to anyone, on the basis that it substituted a test of which the Department already had long experience and on which there was no history of public disquiet or concern.
We are dealing here with industrial injuries and I can well imagine that the civil servant who wrote that press statement had never been near a coal mining or slate quarrying area in his life. Anyone who thinks that the assessment of pneumoconiosis has always been without public disquiet is utterly ignorant of the facts of that disease. There has been profound disquiet. Lest the relevance of this escape anyone, I remind the Under-Secretary of State that he provided me with the statistic that pneumoconiosis was the second largest industrial disease/accident requiring to be assessed. The largest single group, 80 per cent., comprised traumas—that is, accidents causing amputation or injury.
The same pattern is not repeated, however, for the illnesses compensated by the non-contributory invalidity pension. The Minister's answer to me on 16 December, as yet unpublished in the Official Report, stated that diseases of the genus arthritis and rheumatism accounted for 35.5 per cent. of such pensioners, diseases of the nervous system and sense organs, which clearly include multiple sclerosis, accounted for 26.6 per cent. and diseases of the circulatory system for 15.6 per cent. The pattern is entirely different. In industrial injuries, doctors 338 generally have to assess the effects of trauma. The 80 per cent. loss of faculty test is completely untried in relation to illness. We cannot predict how the tribunals will consider nervous illness. The whole basis on which the Minister commends the 80 per cent. test — its well-known characteristics and blameless past — is thus entirely false on both grounds.
Secondly, the present system is not universally popular. In addition to the pneumoconiosis experience, I refer to a book entitled "The Meaning of Disability" in which Mildred Blaxten produced a survey of disabled people of working age. On loss of faculty tests, she concluded:The survey subjects were unanimous in finding this system ludicrous.So much for the provenance of the scheme now being put in place of the household duties test. I should make it clear that I am delighted that the household duties test is being done away with, but I greatly fear that the new system will prove no easier, and possibly a great deal more difficult, to administer in practice than that which it replaces.
The non-discrimination requirements of the 1978 European directive are clearly the real reason for this measure, but the Government have looked for the cheapest, most grudging way to scrape by. The Under-Secretary of State shakes his head. He is good at doing that, but we have crossed swords before. As almost all men and single women are covered by the contributory system, very few of them will lose under the new scheme and the 80 per cent. test, but between 235,000 and 240,000 married women will be denied benefit under the new scheme. As it is a breach of article 4 of the convention to discriminate on grounds of sex either directly or indirectly, I believe that the fact that a huge number of married women and a minuscule number of men and single women will be adversely affected will mean that the Government will be in breach of that article. Indeed, I strongly suspect that that may be the only way to force the Government to face reality and to introduce a scheme of which the whole House can be proud.
Thirdly, the age of 20 has been chosen arbitrarily. The age of majority may be set at the arbitrary right figure of 18 or the arbitrary wrong figure of 21, but no evidence is produced to support the choice of the age of 20 in the context of the Bill. I hope that the Minister will deal with this when he winds up. The Government and everyone else are trying to encourage disabled people to experiment with work, but the Bill will penalise people aged 20 and over because if they try work for more than eight weeks after their 20th birthday they will lose their automatic right to benefit based on the fact that the disability was contracted before the age of 20 and they will then become subject to the 80 per cent. test. I hope that the Government will be flexible on that.
I also hope that they will be willing to make concessions with regard to full-time students. We are trying to encourage more disabled people to become students but they are hardly likely to experiment in work or in full-time education if the result of such action is to be taken outside the under-20-year-old rule, if I may so call it. Just as it is possible to pay NICP to students under 19 years of age in full-time education, I hope that the Government will be able to find a way in which to pay people over the age of 20 in full-time education the new disablement allowance.
What the Bill does pales into insignificance compared to the way in which the Government have presented it. It 339 has been a long time coming. The Government have given many replies to questions that have been asked during the long and anxious inquiries. The hon. Member for Hornsey and Wood Green (Sir H. Rossi) mentioned bringing the matter before the House as soon as the review was completed. In a letter to the Spastics Society the Secretary of State said:We are pressing on with the review in the full awareness that those who have made representations about the household duties test are impatient for results but I cannot at present give a date for its completion. When it is we will, as promised report to Parliament.That was in March 1982. In July 1982, the hon. Member for Hornsey and Wood Green said:We intend to publish the results of the review and then to invite consultation."—[Official Report, 13 July 1982; Vol. 27, c. 841.]The review was published on 1 December 1983. The Bill received its formal First Reading on 2 December 1983 and was published the following Monday, 5 December 1983. Some consultation that was. The Government have hurried it through to avoid consultation.
Why, after three and a half years, is there such a rush? Why do the Government no longer feel that they need to consult anyone or that they can benefit from consultations? The only conclusion that we can reach is that the Bill represents the weakest and cheapest scheme that will formally comply with the appropriate European directive. I hope that even in its present lame and limp form the Bill will be found to be in breach of article 4 so that we shall have to re-examine it and arrive at measures of which we can be proud rather than those of which we should be wildly ashamed.
It is a bitter irony that in the week leading up to a holiday which is supposed to be all about children we are debating the formal end of the Government's legal responsibility to pay additional child support to people whose only income is either short-term insurance or social security benefits or long-term benefits. As my hon. Friend the Member for Oldham, West (Mr. Meacher) said, people receiving short-term benefits have suffered a cut from £1.70 to 15p. That represents a cut in money terms as well as in real terms. Child support has fallen by 19 per cent. since 1979. The Government say that everyone agrees that the solution lies with child benefit. There are two approaches, however. We favour raising child benefit to the extent that people's standards of living would not be damaged if the child dependency allowance were removed. However, the Government insist on reducing the child dependency allowance until it is at the same level as child benefit. That is a quite different concept. The Government should be clear about their doing the very reverse of what most people, especially the child poverty lobby, want.
It is no accident that the hon. Member for Eltham (Mr. Bottomley), after an early taste of the debate, has been absent for a long time. I suspect that he is being chased by his past and is having to run hard to keep ahead of it.
§ Mr. John
That is not a cheap comment. We have suffered lecture after lecture from the hon. Member for Eltham about how he will rebel next time if the Government do not behave themselves. Of course, he 340 never has rebelled. The Under-Secretary of State has been conspicuously absent from debates on this subject until his most recent elevation—
§ Mr. Dickens
On a point of order, Mr. Deputy Speaker. The hon. Gentleman's remark is unfortunate because my hon. Friend the Minister has been stationed on behalf of the nation in Northern Ireland and therefore could not be present in the House. The hon. Gentleman was unfair to my hon. Friend and I beseech you, Mr. Deputy Speaker to ask him to withdraw his remarks.
§ Mr. Deputy Speaker
That is a point of information which the hon. Gentleman has got on the record, rather than a point of order for me.
§ Mr. John
I do not dispute that the Minister has done another job. I said that because he has not attended enough debates on the subject he is not yet qualified to criticise my criticism of the hon. Member for Eltham. Some of us who have sat through many social security debates know the hon. Gentleman's performance and record.
The motivation with regard to long-term benefit seems to be confined to the European directive. No doubt the Minister will confirm that. The Government have acted in a grudging and parsimonious way. On Second Reading of the Social Security Bill in 1979 the Secretary of State said:The second stage under which married women will be able to claim for children, irrespective of the husband's earnings".—[0fficial Report, 20 December 1979; Vol. 976, c. 914.]
In Committee on the same Bill on 2 December, the Minister of State, Department of Transport—who was then in the Department of Social Security—said much the same thing. Now that we have the Bill we discover that what the Secretary of State said is not correct. A woman can claim for her children irrespective of her husband's earnings just as long as he is earning £80 a week. This is one of the few examples of the insurance principle being breached. The Government are introducing a means test on benefits into the national insurance principle. The Government cannot expect us to be enthusiastic about that, nor can they expect us to acquit them of misleading the House when those pledges were given. I believe that the Ministers who gave those assurances did so in good faith but whoever decided on the content of this Bill broke faith with the House and with those pledges. The result of the change is that people in receipt of long-term benefit will suffer a loss of 11.7 per cent. in real terms in the child dependency allowance.
The Government's record is frightening. Belief in the great advances in social security about which they have trumpeted today rely on our not reading the financial memorandum, which shows that the Government are saving £20.5 million a year. The Bill will result in not very well-off people losing even more. That has been the Government's consistent record. The Under-Secretary of State for Health and Social Security looks puzzled but if he examines page iv of the memorandum and does the necessary addition and substraction he will discover that what I have said is correct.
My hon. Friend the Member for Oldham, West was right. The Government have not yet risked a frontal attack on the welfare state. Rather. like a pack of curs, they have 341 tried to weaken it by yelping at its heels until it is too weak to fight back. The Government's claim that the welfare state and the Health Service are safe in their hands carries about as much conviction as a protestation about the digestion of diners at a Borgia table.
§ Mr. Christopher Hawkins (High Peak)
I have no links with the optical industry. My hon. and learned Friend the Minister for Health asked my hon. Friend the Member for Birmingham, Edgbaston (Mrs. Knight) whether we should prevent opticians who made glasses £40 cheaper than somebody else from advertising that fact. None of us would want to stop them from doing so, and I should be happy for us to allow that, but that is not the same as a Bill that seeks to let untrained, unskilled people dispense glasses.
Sooner or later every hon. Member faces the problem of a Bill, or part of a Bill, that he does not like being introduced by his party. For me, that has come sooner rather than later and, sadly, it comes at a time when I should much rather be congratulating my hon. and learned Friend on the reforms that he announced yesterday in the system of deputising services for doctors. Those reforms are bold, far-reaching and necessary. I welcome them, but I am not happy about the proposals for opticians in clause 1
To call the dispensing industry a monopoly is laughable. A monopoly means an industry dominated by one firm, from the word "mono", rather as British Rail has a monopoly of rail. There are hundreds and thousands of opticians. By any standard definition, that is not a monopoly, but almost the complete opposite. We should not say that nurses have a monopoly because they are the only ones who nurse, or that garages are a monopoly because they are the only ones that sell petrol. Are we really to say that any trade, profession or job that requires standards and training is a monopoly even if there are thousands of people in the industry competing with each other, just because there is some restriction on entry based on qualifications or skill? It is ludicrous to describe that as a monopoly.
My reservations about the Bill are threefold. First, as a result of it, giant supermarkets will get huge discounts on a limited range of glasses and will wipe out small retailers, as has happened in so many other retail trades. This will give us less choice, not more, and less opportunity to have repairs done.
Secondly, clause 1 assumes that, as other hon. Members have mentioned, dispensers need no skill, but I reject that assumption. Under the clause, anyone will be able to dispense glasses. People should be able to dispense glasses only if they use properly trained staff in this specialised medical subject. Proper opticians use British standard lenses. After the Bill, inferior lenses, some of which are already available, will be used.
What worries me as much as anything is that there will be no one to check that the lenses are made to prescription. There is a belief that because someone has prescribed a particular lens, and the prescription has gone to the lens manufacturer, it will necessarily come back as the lens in the prescription. I have twice, by going to opticians with the proper testing equipment, discovered that the lenses that I was wearing were not the lenses on my prescription. 342 There is no provision in the Bill to ensure that those who dispense will have both the proper checking equipment that is available and the trained staff to operate it. All retailers who are dispensing should have checking equipment and the correct staff to operate it.
Thirdly, I am sad to say that I greatly dislike the labelling of the exempt group by the glasses that they wear. With my party loyalty intact, like my admiration for the reforms announced yesterday, I shall none the less oppose the Bill.
§ Mr. Ernie Roberts (Hackney, North and Stoke Newington)
The Secretary of State becomes fouler and fouler in his privatisation schemes for the Health Service. The Tory Government, not satisfied with the murderous attacks that they have made on hospital services, are now determined to make the public pay through their eyes by making them pay more for eye care. About 3 million people will be deprived through the operation of the Bill. Those who suffer most will be people, such as those whom I represent, who are already beaten down into poverty by the Government.
Let me give the House the opinion of an optician who, writing on behalf of ophthalmic opticians in Hackney, reminds me:I wrote to you once before when the threat to the NHS General Ophthalmic Service was the breaching of the 'servicefree-at-time-of-need' principle, ie when the government was trying to bring in a charge for Examinations. The threat now is more like the total destruction of the Ophthalmic section of the NHS and this is not an exaggeration … The figures for 1982 for the whole of the UK show 5 million pairs of NHS lenses dispensed, of which 9 per cent. were children, 27 per cent. DHSS remits and the remaining 64 per cent. ordinary NHS supply. It is, of course, the last that would lose.
In areas such as Hackney, that 64 per cent. is more like 72 per cent. People in areas such as Hackney will be the hardest-hit group.
All in all, it turns the clock back to the 1930s and what starts with optics will doubtless become the pattern for dentistry, pharmacy and possibly even medicine.
The lady's view on advertising is thatit is unlikely to bring prices down in the long run as someone has to pay for it. Those of us that work for ourselves (and in spite of continual talk of monopoly most of us do) could not stand up to big money either indigenous or from the Americans and could easily be driven out of business by the permitting of advertising...
Why should the Minister talk about giving people supplying spectacles training in reading a prescription when we already have some thousands of Dispensing Opticians properly trained and registered and the public has the protection of the NHS and the General Optical Council?
On the other hand, the Financial Times made the point that those who buy NHS spectacles will be paying more while those who buy privately will pay less. Again, the better-off will benefit. The Sunday Telegraph says that pensioners with small occupational pensions will be the hardest hit, for they will have to pay up to £50 more for their high-powered bifocal lenses.
The changes in the Bill are opposed, as has already been said, by the ophthalmic group of the British Medical Association. They are also opposed by the Association of Optical Practitioners, which says that in its opinion the effect will beto withdraw, from April 1985, NHS optical dispensing services from at least 3.2 million people (64 per cent.) who are currently using those services annually; to withdraw from these people, many of whom will be pensioners or others on low or fixed incomes who do not qualify for financial help — the State 343 subsidy; the State control over the price and quality of NHS spectacle frames and lenses; the 12 months limitation on the presentation of a prescription for dispensing; the inbuilt complaints procedure".Those are the views of the members of the Association of Optical Practitioners.
The Prime Minister, who received the best and most urgent treatment for her eye trouble—she is a wealthy women — is denying to the poor of Hackney and elsewhere the same right to receive the best possible eye care. The right hon. Lady is driving them back to the 1930s, which I remember, when people went to Woolworth or to a secondhand shop to buy a pair of glasses. The people of Britain have a right to the best possible eye care that can be provided and in this country it is excellent. That is what we must defend.
§ Mr. Geoffrey Dickens (Littleborough and Saddleworth)
I shall confine my remarks to clause 1 and schedule 1, ending the opticians' monopoly on the supply of glasses, ending the supply of National Health Service glasses to people other than schoolchildren and the poor, and increasing the freedom of suppliers of glasses to advertise.
Before I come to the main thrust of my speech, I should like to congratulate my hon. Friend the Member for Cardiff, North (Mr. Jones) who made his maiden speech earlier. It was a very good maiden speech, and I am sure that Cardiff, North has produced a good parliamentarian who will be very useful on the Tory Benches.
I am disappointed that the hon. Member for Oldham, West (Mr. Meacher) is not in the Chamber. Therefore, I shall fight fair and resist the almost irresistible temptation of launching into the attack. His speech was spiced with words like "vicious" and "mean", and on occasion he introduced a couple of "mangles". He failed, in my opinion, to win the intellectual argument. In fact, the best speech from the Opposition came from my hon. Friend the Member for Birmingham, Edgbaston (Mrs. Knight). I did not agree with what she said, but she made a good contribution. Long may we have hon. Members on the Conservative Benches—I like to think that I am one of them—who are prepared to speak plainly, whether they agree or disagree with the Government. On this occasion, the Front Bench will be delighted to know that I am on its side. I know that it likes to have me on its side.
The Prime Minister has said many times from the Dispatch Box that if we are to be successful in business we must produce the products that people want. We have to produce quality goods, at competitive prices and delivered on time. The last two elements are involved in clause 1—competitive prices and delivery times. The consumers' interest is paramount. It is imperative that we make provision for high street competition, and end the monopoly on the dispensing and selling of glasses.
How can consumers possibly get value for money? They must be allowed to shop around. We have to introduce a high street war so that people sharpen their prices. We have wonderful food shops in this country because of the fierce competition.
The General Optical Council at present allows no advertising of the prices of glasses. Nor does it allow advertising of the speed of service. In other words, if people want spectacles, as many do, just before their holidays, it is nice to find an advertisement saying, "We will give you a 24-hour service".
344 There are two quite separate functions. On the one hand, we have sight testing, which should be completely separated—as it is in the Bill—from the other function of selling glasses. Sight tesing is done by qualified opticians or doctors who will produce the sight prescription—that is safeguard number one—and it has to be a recent prescription. If I am selected as a member of the Standing Committee considering the Bill, I might be persuaded to try to push the Government into a one-year, instead of a two-year prescription. I give the Government that warning, in case they would rather not have me on the Committee.
There is a danger in many cases—in this monopoly it is a fact — that many opticians are simply setting themselves up as glorified doctors. In fact, they are highly skilled commerical business men, marketing expensive glasses. I apologise to my hon. Friend the Member for Edgbaston, whose husband was an optician.. as she declared, although he dispensed contact lenses. Not all opticians are the same, but some of the large chains are beginning to act in that way. We have to protect the consumers and our constituents.
I ask hon. Members to follow me into a large optician's shop. Their eyes are tested with sophisticated and fascinating equipment. They are told that they either need glasses or replacement glasses. They step outside into the plush shop and are confronted with hundreds of frames. Vanity being what it is, they want to get a frame that makes them look good. There are no prices on the frames. They sit in front of a mirror, and glasses are slipped over their noses. Finally, out of all the hundreds of frames, they find something to suit them. Then they start to talk about the price. They are a captive market. That is why we must be very careful
I know a factory — I mentioned it in an earlier intervention when you were not in the Chair, Mr. Deputy Speaker, so you will be interested in this -- which produces glasses at a cost of £5.75. The factory manager told me that he had seen the same frames in a shop selling at between £50 and £60. I am talking about the frames, not about the lenses. That is a scandalous mark-up, and that is what the Bill seeks to prevent.
Glasses for children, and contact lenses, can be sold only by qualified opticians and doctors under the Bill. That is safeguard number two. However, it gives the opticians a real market advantage. If all the children come to a particular shop where they are well suited on price and in other ways, it can be habit-forming, and the shop has a captive customer. I believe that that includes children up to 16, but if they are in full-time education it can be up to 19. That is a good safeguard, and it gives quite an advantage to the qualified opticians. They get the children when they are young, and if they give them the right price and the right service they will have them for ever after.
Concern has been expressed about the suitability of shops, general stores, and so on, for selling glasses. People are not stupid. I watch the Secretary of State peering through his glasses at the shadow Secretary of State, who is peering back through his glasses. They can see each other, and they can see their notes, as we know from the colourful introduction to the debate. When people are given a prescription and go to a shop, they are not idiots. They are not going to walk out of the shop under a car. They will look at a board, and all the rest. We are not going back to the old days when the old soul used to go up to the counter at Woolworths, where there was a 345 mass of glasses and she tried on pairs until she thought that she could see reasonably well. We are not going back to those days. We are talking about a recent prescription that people take with them to get their glasses. Nowadays we have sophisticated specialised companies which produce lenses to very high tolerances. It is a different world. If one has a prescription and a general store has a stock of lenses one can rely on the accuracy of that prescription. The optician will continue to do his job, although perhaps the Government will have to find more money for testing to compensate for money saved in other directions.
§ Mr. Christopher Hawkins
If one could rely on manufactured lenses always being supplied precisely as prescribed, opticians would not have checking equipment or trained staff for checking the lenses and my optician would not have twice discovered that my lenses were not made to his prescription. My hon. Friend is not making a fair point.
British standard lenses are used by almost all opticians, but once the greengrocer or anyone else can set up as a dispensing optician some inferior lenses will come from abroad which no one will check because they will not have the equipment or the staff.
§ Mr. Dickens
My hon. Friend does a disservice to our Front Bench and Ministry officials by talking about greengrocers or garages being able to dispense glasses. That is ridiculous. It has been made clear that people involved in the dispensing of glasses will be trained before being given the responsibility. We are not going back to the dark ages. My hon. Friend simply frightens people by making such statements.
§ Mr. Christopher Hawkins
I withdraw my reference to greengrocers. It is a phrase that has become standard and means untrained people. Of course, I do not really mean greengrocers. However, the Bill contains no provision for using trained staff to check lenses, to check whether the optical centre is opposite the eye, that a person's face is symmetrical or whether the eyes are exactly the same distance from the nose. Dispensing opticians check those factors.
§ Mr. Dickens
I am sure that the people involved will quickly become experienced with the minimum of training. It is one thing to be an optician capable of conducting eye tests and fitting contact lenses, for which the curvature of the eye is critical, and another to fit a pair of glasses on a person's nose. The stores will have separate departments and use the same measuring devices, and the operation will be conducted in a responsible way. The resultant competition will be to the advantage of the consumer. The Bill provides an opportunity for everyone, including constituents, to purchase glasses at a more sensible price.
§ Rev. Martin Smyth (Belfast, South)
I regret that I cannot share the enthusiasm of the hon. Member for Littleborough and Saddleworth (Mr. Dickens) in supporting the Bill. I recognise the case for competition and for advertising wares. In Northern Ireland and elsewhere it seems that there is a shortage of opticians. Perhaps people looking for work could find a place in that profession. I criticise not the suggestion that opticians 346 should be able to advertise, but what flows from that. The hon. Member for Littleborough and Saddleworth said that the Bill was not an attempt to return to the old days and that we can trust those involved.
I pay tribute to the hon. Member for Cardiff, North (Mr. Jones) who made his maiden speech today. I also represent a capital city in one of the regions. The hon. Member for Cardiff, North displayed gifts and talents which will be useful to the House. He said that people would be tempted to purchase cheap glasses. He was nearer the mark than the hon. Member for Littleborough and Saddleworth and more aware of human frailty. By opening the doors as suggested, people might be tempted to take the easy way if they can buy glasses cheaper at the corner shop or on the high street.
I am not convinced by the argument about the mark-up on the manufacturer's price, because the same can apply to dispensing opticians. Any type of glasses can be dispensed because people are not aware of what goes on.
As I listened to the arguments, I drafted notes about how the Bill would affect Northern Ireland. Whether the Government intend it or not, the Bill represents a further serious erosion of the National Health Service. It means that at least 60 per cent. of the Northern Ireland population will be denied the right to NHS spectacles. That seems to be on a par with what is happening in the rest of the United Kingdom.
Some people say that the poor and children are provided for. I submit that a large number of the people who will be excluded from NHS optical dispensing will be pensioners or others on low or fixed incomes who do not qualify for state financial help. A growing number in that category are being caught by the poverty trap.
We are talking about patients, not customers. A significant number will require high power or multifocal lenses. It is not a simple question of providing contact lenses. A wide range of lenses exist for normal frames. The people who are subsidised by the state and need glasses because of their condition will be deprived of that aid. They will have to pay the full cost. In other words, despite the claims that the Bill will reduce charges, many people will pay more, not less, for their spectacles after April 1985.
The hon. Member for Birmingham, Edgbaston (Mrs. Knight) proved to be a valiant champion of the opticians, especially when she castigated those who seek to prune their activities. The hon. Lady certainly left the Minister with questions to answer.
A substantial proportion of an optician's university training is devoted to accuracy in dispensing. It is not possible to envisage that the present high standard will be maintained by unqualified personnel. Badly dispensed lenses can cause double vision, distortion and visual discomfort with a subsequent reaction not only to the individual but perhaps to the community at large. It seems to be impossible, from the evidence presented in today's debate, for the Government to ensure that spectacles are made only to a recent prescription. The power of a person's existing lenses is not measured, so new spectacles will not be made up to this prescription.
I am concerned, as I am sure many other hon. Members are, that the use of cheap, sub-standard lenses and frames could become widespread due to insufficient monitoring. How would the public who use unregistered persons be protected against the supply of incorrect spectacles by unscrupulous traders? If anyone suggests that there are no 347 such people, he is not living in the real world. For 35 years there have been price and quality controls by the DHSS and strict control over 80 per cent. of all ophthalmic lenses supplied by opticians. That protection, as I understand it, is to be removed from April 1985 from 60 per cent. of those supplied.
I regret to see that the Under-Secretary of State, the hon. Member for Oxford, West and Abingdon (Mr. Patten), has left the Front Bench. I was happy to see him there, because I realised there was no Minister from Northern Ireland on the Front Bench, and the hon. Gentleman has some knowledge of the position there. He would know that the change in Government plans will provide direct competition to optical firms in the Province and optical firms elsewhere. It is important that we do not confront our own work people and suppliers with unfair competition through imported goods which could be subsidised by other bodies. That aspect may not have been fully covered during the debate.
I was puzzled about why the Bill was presented in this form because, like other hon. Members, I have been waiting for the period of discussion and consultation. It may have something to do with the coming together of the Government and trade unions. The hon. Member for Leeds, West (Mr. Meadowcroft) perhaps gave the game away because he talked about a composite Bill. I thought that this might be the Government's attempt to lean over to meet the composite motion of which the unions are fond. It has not helped in the presentation of the case.
I do not believe that the Bill has gone down the road that I and many other hon. Members would have liked the Government to take in the care of the handicapped and disabled in our society. While I welcome the removal of the household duties test, ultimately many will be caught in the trap again. Reference was made to those under 20. The Minister said that the way it worked for mobility allowance would be a guarantee that it would work all right in this new form. I am sure that right hon. and hon. Members have already discovered that the mobility allowance is full of traps. Those who do not deal with medical problems, even on tribunals, or those who handle them in a different way quite often come to decisions which have jeopardised people with severe handicaps who want to live lives as normal as possible. They do not get financial support because of the rulings that have to be made. I submit that the Bill is in that pattern.
I was interested to hear the comments of the hon. Member for Peterborough (Dr. Mawhinney) who spoke about the family practitioner committees. He paid a gracious tribute to general practitioners. Many hon. Members would pay tribute to the high standards throughout our medical profession. Having said that, the Minister spoke yesterday on deputising and the new consultancy procedures. Apparently, a person who phones for an appointment cannot be sure whether anyone will be available to write out the death certificate a week later. This is where the "contactor bureau" comes into play. We must be fair and say that there is room for improvement in the method of general practitioner work. In that context, I would welcome a tightening up of family practitioner committees.
The biggest room in the world is room for improvement. I hope that, as the Bill goes into Committee, the Government will move towards improving it.
§ Mr. Alistair Burt (Bury, North)
I should like to inform the House first of my own background and interest in health matters and hence in this Bill. My father is a general practitioner in Bury and is chairman of the local family practitioner committee. I have grown up in an atmosphere in which health care has been important and where consideration of the position at the sharp end—the scalpel end, certainly at the patient end—has been most important. The local health authority has an enviable record of care, concern and efficiency. It is an authority that proves that those three need not always be at odds.
I wish to speak not on the family practitioner committee part of the Bill but, like many other hon. Members, on the clauses on opticians. I had the pleasure yesterday at his invitation of visiting the premises and workshop of a local optician and discussing the Bill with him and a colleague on behalf of his colleagues in the town.
Before I go on to that I should like to say a few words about the general principle of liberalisation in economics. On that general principle and in the area of health care, I would tentatively offer the Government a basic principle which I am sure the country would welcome if it were put forward strongly by the Government as a reason for their actions. I do not believe that the country at large is composed of devout followers and understanders of economists, whether Adam Smith, Keynes, Friedman or whoever. Economics tends to matter to people rather less as words on a printed page than as an end result in terms of service or effect on the pocket.
I doubt whether the country would be enamoured of an approach which looks at monopoly of any type in a doctrinaire way as though it is in itself bad and must therefore be done away with. Much more acceptable, I believe, is an approach which looks at the service provided first and foremost and then at the way in which it is provided. If it is provided by a monopoly, the Government should approach it in this way: "Are we going to improve the standard of care or, at the very least, leave it as it is by liberalisation? At the same time, will it also produce the side effects of lower costs to the consumer?" If a measure passes that test, all well and good. Much though theorists may like to judge measures from other standpoints, the test that I have described is the one that the people will apply ultimately. They will test the service and not the economic dogma that lies behind it.
There is not a simple distinction between the professional job of prescribing and the commercial job of supplying spectacles. The dispensing and fitting stage is most important and the one that causes my constituents the most worry.
At present the responsibility for the eventual fitting of spectacles falls to the qualified optician. It is the optician who makes the prescription, which may be simple in specifying low-power lenses or complex in involving bifocals or heavier high-power lenses. Once the prescription passes from the optician's hands, he wants to know that it is in the hands of a qualified, responsible and thoroughly professional person. Technicians have a full and proper training, which may vary from three to five years. They work exclusively in the important area of making up opticians' prescriptions. Therefore, the dispensing optician has behind him a person with professional training when glasses are fitted.
349 It is vital, for example, that glasses are centred accurately and that the pupillary centre corresponds with the centre of the lens. If it does not, the glasses, at best, may fit poorly and lead to headaches and discomfort. In that event, the patient will not be able to see properly. At worst, the patient may suffer continually from bad headaches and the eyes may be damaged.
The Secretary of State has voiced his understanding of the problems and suggested a willingness to accept representations and to receive amendments. However, he expressed hostility to any licensing or registering system. I ask my right hon. Friend urgently to consider some safeguards to prevent the dispensing of optical prescriptions in an unacceptable manner in unacceptable conditions solely because there may be a reduction in the price of spectacles. If spectacles do not fit properly, money will be wasted in any event. I ask my right hon. Friend ultimately to reconsider his opposition to a licensing system.
It has been amply demonstrated throughout the debate that the possible lack of safeguards is causing the most concern. We cannot suddenly take away from the public a system of health care that has been built up over a number of years and quickly opt for something of which we know little. There must be a system of safeguards to work in with the present system of health care.
If things go wrong, where will the patient go for redress? At present, if anything is wrong with his spectacles or the lenses, he can go to the family practitioner committee but in future, will he have to rely for protection solely upon cumbersome consumer legislation? I am assured by my optician constituents that although certain states in the United States of America have liberal systems of spectacle provision and dispensing, Europe generaly does not. Europe generally has a system with safeguards of a sort that are not proposed in the Bill. We must proceed carefully and listen intently when my hon. and learned Friend the Minister for Health replies to learn whether any safeguards are to be introduced infuture.
I urge my right hon. Friend the Secretary of State most seriously to reconsider his earlier decision to reject a licensing and registration system. Something of that sort must be introduced. Concern about dispensing is clouding, despite what my hon. Friend the hon. Member for Birmingham, Edgbaston (Mrs. Knight) said, the general approval for the removal of advertising restrictions. The proposed reforms might on their own produce the effect that the Government must want, which is the maintenance of the standard of health care at a reduced price for the patient. The removal of advertising restrictions could produce what the Government want, and it is possible, despite what my hon. Friend said, to have competition with safeguards. It is not necessarily true to say that advertising within health service provision is unacceptable. I think that there can be advertising between opticians—
§ Mr. Burt
Yes, and solicitors. The advertising must give the assurance that behind the comparison of cost and supply there is a professional background to ensure that the product that is being supplied is safe and that those who 350 provide the service are also safe. I believe that it is possible to have the competition that the Bill envisages with safeguards which, at present, are not in the Bill.
I do not think that generally the British people swallow the arguments of Opposition Members about the Health Service. More cant, hypocrisy and rubbish are still uttered by them on that topic than anything else. The Opposition have a disgraceful record on nurses' pay, strikes in the Health Service, cuts in capital spending on hospitals and health spending generally, and more rubbish comes from them on the Health Service than on anything else. I am afraid that the usual over-the-top Front Bench speech did not contribute anything constructive to the debate.
We must guard our own ground well. We must ensure that the charge that health care is less important to us then economic dogma does not stick. It must not stick, for it is not true.
The opticians give this country a good service, and their concerns about optical care in the future should be listened to very keenly. I hope that the Minister will take note of the anxiety expressed by opticians, and that it will be possible for safeguards to be introduced into the Bill. The concerns about dispensing, in particular, require an answer tonight.
§ 9.6 pm
§ Mr. Robert N. Wareing (Liverpool, West Derby)
Much has been said about the rundown of optical services. In Liverpool, and in my constituency, there is so much poverty and unemployment that more and more people will be encouraged to run to Woolworth, John Lewis, Tesco and Fine Fare in order to buy cheap glasses. The Government will correct me if I am wrong, but I do not believe that there is anything to prevent any retailer from producing some adaptation of sunglasses which will be brought by poor people who cannot afford the high price which glasses will reach—particularly bifocals, which are necessary for many people—if the Bill becomes law.
A few weeks ago, the Government organised opposition to a Bill that I introduced on the severe disability allowance. One of their arguments was that there was not enough time to study the Bill. In a parliamentary answer, the Minister made the point that half the objections that he had received to the Bill had reached him before it had been published.
However, in the case of the severe disablement allowance, the report on the household duties test was delivered on 1 December and on the self-same day the Government decided their policy. They decided to deny 16,000 people the right to benefit. They did not consult the organisations of the disabled, which have nevertheless stated their views. The Disablement Income Group, for example, has stated:Fewer disabled married women will qualify for the allowance in future than would have qualified had the household duties test continued.The Government have introduced an irrelevant test. Some people who are 20 per cent. disabled are less able to work than some who are over 80 per cent. disabled. The test is irrelevant, and fewer disabled married women will qualify under the legislation. The new proposal will discriminate against everyone whose national insurance contributions do not entitle them to a contributory invalidity pension. The Government ought to remember 351 that. I hope that if the Bill reaches Committee stage, there will be enough opposition in Committee to ensure that something is done about some of the proposals.
There is no correlation between the degree of disability and incapacity for work. In its comments on the Bill, the National Consumer Council has stated:SDA combines two criteria of incapacity for work and loss of faculties in a way which seems illogical. If the DHSS wish to compensate for costs of disability there is no need to place a restriction on the benefit in terms of capability of work. The joining up of the two concepts is simply a device to ration the benefit.That is the crux of the argument. This is a device by the Government to respond to the wishes of the Chancellor. Every piece of legislation that comes before us shows more clearly that the Treasury has become a super-Department. The Secretaries of State for Social Services, for the Environment and for Education are all minions at the disposal of the Chancellor.
As a result of the decision which no doubt will be taken tonight, because of the three-line Whip, disabled people — [Interruption.] At least they admit that there is a Whip. There was also a Whip a few weeks ago. The disabled will respond in the same way as they responded to the decision taken then. They will be implacably opposed to the legislation, and will fight it. We shall lead the fight until the household duties test is done away with, without the need for such inimical legislation.
§ Mr. Frank Dobson (Holborn and St. Pancras)
My first duty is to congratulate the hon. Member for Cardiff, North (Mr. Jones) on his first speech. I always feel embarrassed doing that, because it is not so long ago that I made my first speech. He made an admirable speech, if only because it caused two signs of pain on his Front Bench. When he mentioned Amersham International, the Chancellor of the Exchequer's ghost turned in its grave. The hon. Member defended optical services in a way that was clearly offensive to the Secretary of State and the Minister. I hope that the hon. Member continues in that fine tradition.
When we consider this hotch-potch of a Bill we must remember that it is not an isolated measure; it is part of the Government's overall strategy. Their long-term strategy is to strengthen the rich and powerful sections of our society at the expense of the poor and the weak. As they made clear in their 1979 election manifesto, the Tories are tilting the balance of advantage further towards the employers. The main method used by the Government is the deliberate increase in unemployment. This policy directly deprives the unemployed of any power and impoverishes them and their families. Just as important, it makes many others in work frightened to press for better pay because it creates a buyer's market for jobs.
As Beveridge recognised, the buyer's market for jobs was the major source of impoverishment and the principal obstacle to the creation of a fairer society. No survey of the effects of the Government's policy on health, social services and social security should ignore the crucial fact that unemployment, poverty, inequality and health are inextricably linked. In the short term, the Government's policy is to ensure that the burden of coping with the world recession and the Government's economic incompetence should fall upon the shoulders of those least able to bear it—the old, the poor, the disabled and the sick—the 352 people whom the DHSS was established to protect. That protective role has been abandoned under this Government.
Time was when even Tory Ministers took a pride in defending their departmental functions and fightirg for a budget to meet their needs. That is no longer so. Now, promotion for Tory Ministers depends upon a craven willingness to sacrifice departmental services to the Chancellor of the Exchequer's crude butchery and the Prime Minister's spiteful whims. I will give one example of that change. Harold Macmillan made his reputation by building a record number of houses. The Secretary of State for Defence was promoted to his present task for building the fewest houses in modern times. It is necessary in those circumstances to study the record and character of the Ministers introducing this measure.
Long hours on successive Transport Bills gave me the opportunity to observe the deadly duo of the hon. and learned Member for Rushcliffe (Mr. Clarke) and the right hon. Member for Sutton Coldfield (Mr. Fowler). Whenever people have met them, there comes the eternal question, "Why is the one with glasses Secretary of State and the fresh-faced lawyer his junior? Why not vice-versa? Should not the monkey swap places with the organ grinder?" I have no answer to that question; it, ies in the deeper recesses of the Prime Minister's mind.
Every time a Cabinet reshuffle is mooted the name of the hon. and learned Member for Rushcliffe is on every tongue, save that of the Prime Minister. Indeed, there are times when I suspect that the sole object of ministerial changes is to show that Cabinet status is beyond our Ken. Instead, he is stuck with being one of a pair, like the ugly sisters, Jekyll and Hyde, the pit and pendulum, tonsils and adenoids or, more appropriately, Burke and Hare, the notorious body snatchers.
I have to admit that as a pair they are effective. The hon. and learned Member for Rushcliffe puts a bad case well and the right hon. Member for Sutton Coldfield issues a slick press statement—no trendy gimmick is beneath him. When he was Secretary of State for Transport he said he wanted to do a Freddie Laker on the buses, and, to give credit where it is due, he did, because over 40 million fewer rural passenger miles were covered in the year that followed his Transport Act. Villagers up and down the country waved goodbye to their last bus.
Now these master minds have set about the nation's health, but their task has over-taxed even their skills. At Question Time last week they even argued that the gross domestic product had gone up since they got in. But no phoney figures, no creative accountancy, no satistical sleight of hand can cover up their attack on the National Health Service. All over the county hospitals are closing, wards are empty and promised projects have been shelved.
The people of London are told that their hospital provision must be cut so that other areas can catch up. The Trent region is supposed to be the major beneficiary, but anyone who goes there, as [did a fortnight ago, will find that it is the same story there. Hospitals are threatened with closure, wards are empty and projects are held hack. In Nottingham, which serves the Minister's own Rushcliffe constituency, the university hospital is built, but wards have never been brought into use, not because nobody needs them—there are nearly 11,000 people on hospital waiting lists in Nottingham—but because the Minister 353 will not find the money, and even a plastic surgery unit for children has had to be postponed. All over the country the story is the same.
§ Mr. Christopher Hawkins
The Trent area happens to be in my constituency and, for the record, it has been given extra staff in the hon. Member's so-called "cuts" and has a £25 million new hospital opening in Chesterfield next year, for which extra staff are being provided so that it will be opened.
§ Mr. Dobson
There are certainly bits of the country where new hospitals are opening, but there are other parts of the country where others are closing and there are even more where they are being kept empty. All over the country the story is the same, yet Ministers seem not to have noticed because, safe in their comfortable offices, they proclaim paper triumphs and ignore the facts in the field. In short, they behave like first world war generals. In one way they are even worse than those generals because at least the generals used to pay tribute to their troops. Not so the modern Tory. Scarcely a day goes by but one or other of them says that the National Health Service is inefficient or, wasteful or could do with fewer staff.
When a former bankrupt who apparently advises the Prime Minister got space in Rupert Murdock's Times to vilify those who work in the health Service, we looked in vain to health Ministers to defend their staff from such attacks. But loyalty to people who do the work has never been a Tory trait. They never tell the truth about our National Health Service. For all its faults, it is the cheapest and most efficient in the developed world. Instead, they set out to hamper and maim it. If anybody from the National Health Service criticises them, Ministers dismiss their critics as representing a "vested interest". By this definition life-long dedication to Health Service patients counts as a vested interest. Instead, Ministers promote the interests of cheapjack outfits that claim they can do the laundry or cleaning better and cheaper than the present staff. The only way those private firms could do that is by lowering standards and paying wages even lower than the present poverty level wages paid to National Health Service and ancillary staff.
§ Dr. Mawhinney
On a point of order, Mr. Speaker. Earlier in the debate your predecessor in the Chair encouraged hon. Members on both sides to speak shortly and to the point, because a number of hon. Members would not otherwise have an opportunity to speak. The hon. Member for Holborn and St. Pancras (Mr. Dobson) has spoken for nine of his 25 minutes without tangentially approaching the Bill. Do you have the power, Mr. Speaker, to ask him to sit down so that hon. Members who wish to talk about the Bill may have an opportunity to do so?
§ Mr. Speaker
Unfortunately I do not have power to ask any hon. Member to sit down. I think that the hon. Member for Holborn and St. Pancras (Mr. Dobson) was about to deal with the provisions of the Bill.
§ Mr. Dobson
We needed a little context in which to consider the Bill. Ministers are promoting private companies, not least because the Benches behind them are thick—thick with hon. Members with a direct financial interest.
354 When we consider the proposals in the Bill about glasses, it is as well to remember what happens now. If one wants new or replacement glasses, one goes to a qualified optician for a sight test, for which the optician gets an £8 fee, and one then buys the glasses from that optician or another one. The Government propose to change that by letting any Tom, Dick or Harry sell glasses. Even more important, they propose to abolish the sale of NHS glasses, both frames and lenses.
When introducing the Bill, the Secretary of State justified his proposals largely on the strength of the report from the Office of Fair Trading. However, the House should know that the OFT did not contemplate for one moment getting rid of NHS glasses for sale, and the National Consumer Council's support for the measure has been withdrawn as a result of that change.
At present, 80 per cent. of people who use glasses get NHS glasses and nearly 40 per cent. get NHS frames. In other words, given a free choice most people opt for the NHS goods because they are cheap and the quality is guaranteed. Indeed, during the past four years even the number and proportion of adults getting NHS frames has increased. The problem, said the Secretary of State, was the overpricing of some private frames. His solution is to get rid of the cheapest glasses on the market, those provided by the NHS. With logic like that, no wonder he loses arguments in Cabinet.
Children and the poor will still be able to get glasses on the NHS, at least for the time being. However, they will be the only people who can get them. As other hon. Members have pointed out, NHS glasses will soon become an obvious badge of poverty. In any case, many poor people, including two thirds of pensioners, are not entitled to free glasses. This move is a direct and deliberate attack on the NHS, a move away from a health care service to a commercial rip-off. Before long, the provision of NHS glasses, even to children and the poor, will also be abolished. Instead, vouchers will be issued which they will take to Woolworths to be handed over in front of the prying eyes of other shoppers as yet another humiliating public indication of their poverty.
What of the people who do not get free glasses but who get a sight test and a prescription and then want to buy their glasses? At present they get the prescription read, interpreted and made up by experts, people who know about eyes and lenses, who can fit a frame and who have had training. That offers massive consumer protection. That is especially important with glasses, not just because they affect the eyesight and eyes but because lay people cannot judge what they are getting except in terms of the appearance of the frames. Often it is only afterwards that discomfort or blurred vision shows up.
It should be remembered, therefore, that cost is not the only thing by which to judge. Yet the only consumer protection that the Secretary of State proposes is under the Sale of Goods Act. When he made his original statement to the House he promised that any further protection for the consumer would be included in the Bill. As none is included, presumably he believes that none is required.
Let us take a practical approach and consider what will happen. After a sight test, people will be able to go to any shop selling glasses. I do not wish to insult everybody who works in shops. Most are helpful. However, many are not and some are scarcely fit to sell cans of paint or Christmas 355 cards. In goes the patient complete with prescription—hands it over to the shop assistant. Then what? Here is a genuine prescription which I will read out:Right eye—9.0 dioptre sphere— 1.25 dioptre cyclinder with an axis of 110 degrees with a prism of 1 prism dioptre base down.
Left eye + 6.25 dioptre sphere, + 1.5 dioptre cyclinder with an axis of 60 degrees—interpupilary distance 66 millimetres.
Will a shop without trained staff be able to cope with that? Could an untrained person make sure that such a prescription is properly made up and fitted? The 66 mm. mentioned is the distance between the pupils of each eye. How will they measure that—with the measure that they use for inside leg measurements or will they just guess?
Let us charitably assume that the Minister of State, who is a university-educated barrister, is intelligent and helpful. Could he cope? I have here a prescription given to me following a sight test that I had yesterday. It is a simple prescription, and it says:Right eye +0.5 dioptre cylinder with an axis of 180 degrees. Left eye +0.5 dioptre sphere, +0.5 dioptre cylinder with an axis of 10 degrees.Does the Minister know what that means? I shall pass the prescription to him so that he can examine it. Could he make up some glasses for me? Perhaps his right hon. and hon. Friends who know so much about this could help him. Perhaps he will ask his officials to advise.
After all, if we extend the principle that anyone who can read can dispense glasses, some people may even conclude that anyone who can read a Civil Service brief could be a Minister. There is no knowing where the process of deskilling will end. It is no use the Minister saying that this is unfair. After all, he is the one who claims to know more about dispensing glasses than the whole of the optical profession and also, for that matter, practically everyone who has spoken from the Government Benches today.
More seriously, does the Minister not accept that a skill in dispensing helps protect the public? What is more, does he not accept that if prescriptions are required, few, if any, pairs of ready-made glasses will ever be sold and such glasses are the only ones cheaper than NHS glasses? At present, NHS frames cost between £2.05 and £13.05. NHS single vision lenses range from £4 to £8.85 and bifocal lenses from £9.20 to £15.50. In 1982, on the other hand, the average price of a pair of old-fashioned style, private, single-vision glasses was £43 and £57 for private bifocals. So someone whose eyesight is deteriorating and who needs more high-powered lenses or bifocals can expect under the new system that new lenses will cost at least £25 more than they must pay for them at present. So much for the cuts in price for most people.
Perhaps in winding up the ever-talented Minister will come up with a case that he has found in economic history where prices fell as a result of the cheapest top-quality goods being taken off the market. But I must warn him that if he does he will confound the theoretical basis of the market economy preached by every right-wing economist from Adam Smith to Milton Friedman, so he had better not do so, or the Prime Minister will demote him this time.
What about the proposal to permit advertising? Whatever other effects that will have, it will give an advantage to the few large opticians and the multiple stores that do not currently sell glasses, to the disadvantage of the small firms. That means that, yet again, the Tory Government will have put small firms out of business— 356 especially those that serve the country areas that the Government claim to cherish. They will suffer like the rural buses, post offices and pharmacies.
Sight testing and eye examination are still vital parts of our National Health Service. If a small optician's shop loses its dispensing trade, it will need to charge higher fees for sight testing or be driven out of business. That sight testing service will be less accessible, and many people's eyesight will suffer.
In short, the Government's proposals on glasses will reduce choice, abandon consumer protection, put up the price of glasses for most people and threaten the small optician's business, especially in rural areas -- and all because the Minister, as he reveals when he speaks privately to journalists, thinks of glasses as jewellery or fashion accessories. It may be that the dream world in which he lives is inhabited solely by Dame Edna Everage and Elton John, but in the real world his flippant ideas will damage a vital part of our health care system.
The next part of the Bill deals with family practitioner committees. Under the Joseph reforms of 1973, those were linked with area health authorities for administrative purposes as part of the effort to integrate the three parts of the National Health Service — hospitals, community health services and family practitioner services.
Having been a member of a family practitioner committee, I shall avoid making exaggerated claims about the degree of integration that has been achieved--in my experience it was small, and still less in the planning of primary care. But that does not mean that we should stop trying to achieve more, as was recommended by the Royal Commission on the National. Health Service.
Planning the nature and distribution of health provision in a geographical area does not make much sense if the service on which most people rely is not included. We believe, therefore, that the family practitioner services should become the responsibility of district health authorities. We must, however, recognise the concern of family practitioners about that idea. They fear that full integration would result in the hospitals—especially the teaching hospitals — gobbling up part of the funds presently allocated to family practitioners. They have seen what has happened to some community health services, and they do not want it to happen to them.
As a result, many family practitioners support the Government's proposal to move in quite the opposite direction by separating family practitioner committees from the district health authorities altogether. I believe that they are wrong. Changes within districts to give proper priority to care in the community will be required anyway, and Labour will give that a high priority. Some doctors appear to think that if they report directly to the DHSS they will somehow obtain more resources. Their idea is that getting closer to the source of funds will get them more funds—like standing nearer to the person who is doling out the treacle. I suspect that events will show that getting closer to the present incumbents at the DHSS may prove to be more like pressing closer and yet closer to a circular saw — a nerve-racking process leading to serious and possibly disastrous cuts.
That aside, we should ask what are the Government's priorities for primary care. Is it really their view that the most pressing need is the administrative separation of FPCs? I suggest that a massive investment in the Acheson proposals to strengthen primary care in the inner cities is a higher priority. The £9 million over four years promised 357 by the Secretary of State is a flea bite and an insult to those working to improve primary care. Ministers might also have paid more attention to legitimate criticisms of the effectiveness of FPCs in protecting patients. Perhaps the Government could even turn their attention to the cost of drugs dispensed by general practitioners.
Of course, there is another reason for the Government giving high priority to separating FPCs from the district health authorities. In future they propose that Ministers should appoint all the members of the FPCs. Local authority and district health authority nominees will now have to be appointed by the Secretary of State. That is yet another example of the Government taking more and more powers to interfere in local functions.
We must still ask why the Government are becoming so blatant in abandoning the old relationship between central and local government and undermining the independence and integrity of every public body. The answer is that a diffusing of power in a plural society makes it difficult for them to carry out their overall strategy of promoting the interests of the rich and powerful at the expense of the poor and weak. Most public services were established to provide for the worst-off the services that the free market would never provide. As such, those services are an affront to this Government and that is why they are being cut.
Labour's NHS was based on two lines in Labour's election manifesto for 1945. Those two lines were:the best health services should be available for all. Money must no longer be the passport to the best treatment".For all its faults, our NHS is, after the monarchy, the most popular institution in this country. Over the past 35 years it has proved itself superior in practice, principle and morality to anything that the Tories have to offer. As our people recognise more and more the threat to the NHS, so they cherish it more and more. They are resisting the Tory efforts to smash the NHS. Our people recognise the inherent soundness of the Socialist principles on which it was founded, and in good time they will call for them to be extended to the rest of our society.
§ The Minister for Health (Mr. Kenneth Clarke)
I was tempted by the opening words of the hon. Member for Holborn and St. Pancras (Mr. Dobson) to follow him into the byways along which he travelled before turning to the subject of the Bill. He reminded me of the prolonged and entertaining debates on bus de-licensing held at an earlier stage in the Government's career. To some extent, his remarks were relevant to our deregulating proposals for opticians. I well remember the hon. Gentleman passionately defending the licensing system in its every form, and deriding our suggestion that de-regulating express bus services might produce an improvement in services to the public. I invite him to go to any bus station and to look at the prices that the National Bus express service offers to those—mostly the less well off in our society—who wish to use it. He should look back and consider just how wrong he was then to defend a vested interest against our deregulating changes.
I am even more tempted to engage the hon. Gentleman in a debate about hospitals in my constituency. I understand that he recently took part in a march past my constituency surgery. At least, he addressed those who 358 took part. A mass rally was organised by the Rushcliffe and Nottingham Labour parties which comprised about 75 people. They marched past and went to listen to the hon. Gentleman. If he had attracted more people, he might have found out more about the health services in the Nottingham region. The unopened beds in the university hospital were a legacy of the Labour Government, who planned the building of a giant hospital, but failed to allow for the revenue with which to open it. The beds are now filling up rapidly and there is an agreement with the health authority to open almost all of the remaining beds in the next two years. The position is a vast improvement on that left by the Labour Government.
I thought that the hon. Member for Holborn and St. Pancras spent so long on other subjects—and the same must be true of the hon. Member for Oldham, West (Mr. Meacher)—because he had not read or studied parts of the Bill. However, he eventually gave his reasons for opposing the part of the Bill that refers to the opticians' monopoly. The hon. Gentleman put his reservations—as did the hon. Member for Oldham, West — far less cogently than did my hon. Friend the Member for Cardiff, North (Mr. Jones). My hon. Friend chose this debate in which to make his maiden speech. Of course, most Ministers would wish that newly elected Conservative Members did not make their maiden speeches on Bills about which they had the greatest reservations. However, it was obviously a sign of my hon. Friend's independence and characteristic of his approach that he should speak on a subject to which he has devoted considerable thought. He asked some very cogent questions, to which I shall attempt to give some answers, and we look forward to hearing from him again.
With sincere respect, may I say that my hon. Friend the Member for Birmingham, Edgbaston (Mrs. Knight) made one of the best speeches that I have ever heard her make in the Chamber on one of the poorest cases. She frankly and fairly admitted that she was married to an optician. However, I think that it was loyalty to that profession, in which she has many friends, that led her to put its case so strongly. Of course we have not entered the debate lightly, and we are not—contrary to the claims—casting aside the public interest. However, we have reached the considered view that the present rules are badly in need of amendment, because they do not serve the public interest. Too many of them are a legacy of the past and serve only professional interests.
My introduction to the subject was rather curious. When I took up my present job I inherited discussions that had been going on for a long time about the possible introduction of a new NHS ladies' frame. The result was the introduction of a frame which, as I recently told a group of opticians, might be called the Kenneth Clarke memorial ladies' frame. I am told that it is selling fairly well, although it reminds one of the kind of spectacles that typists wore about 10 years ago if they were getting into the prime of life behind their typewriters.
The fault in the process was that I and my officials were presented with a rack of different frames which might be added to the NHS range and had to make a choice surrounded by people talking about the impact that it might have on their profession, their trade or their income from other parts of the service. I concluded that it was farcical for a Minister to be involved in gazing at racks of frames and trying to choose a Government approved type to be made available to ladies. I was not at all surprised to learn 359 that it had taken from the early 1950s until 1983 for the NHS to introduce a new frame. That experience led to the serious question of what on earth was the purpose in modern circumstances of having a state approved frame at a regulated price introduced in that way.
My other introduction was reading the report of the Office of Fair Trading, which was devoted to the consumer interest, and considering its arguments about advertising and competition. When we put the report to the General Optical Council and the optical professions, there was no response at all —despite the cogent evidence given for the findings—except to defend the status quo. That in turn led us to question the present professional rules.
Everyone seems to have declared an interest today. I belong to a profession which could in the past have been described as one of the most restrictive — the legal profession. Nevertheless, I am proud to belong to an independent profession and I defend the role of professions independent of Government in disciplining themselves and maintaining their own standards for the good of the public. As my hon. Friend the Member for Bury, North (Mr. Burt) pointed out, however, the public interest is the right test. The only purpose of professional rules governing groups of people admitted to a profession by qualification, as opticians are, is to protect the public against quacks. The sole purpose of the rules is to ensure that the standards delivered are those that the public expect in a serious area in which people may suffer real harm if the standards are not observed.
The purpose of professional rules should never be the benefit of the profession itself — that is, to restrict competition, to keep up its income or to protect a monopoly that is not itself justified. The Bar used to have some extremely curious rules. If one took a case off one's circuit one had to have a junior with one. There had to be two counsel whenever there was a silk on the case. In the quarter sessions at which I first practised, prosecution briefs for pleas of guilty cases were shared out two at a time to every member of the mess through what was known as the soup system. One had to pay a fee to another circuit if one took a case off circuit, and so on. All those rules existed in my time and all were abolished, although in every case abolition was resisted by some members of the profession who produced convoluted arguments claiming that the practices were in the public interest when clearly they were not.
Every profession should have its rules questioned occasionally, retaining only those which protect the public and sweeping away restrictive practices, of which professions may be just as guilty as trade unions or any other group with a common purpose.
§ Mrs. Knight
I hope that my hon. and learned Friend has noted that not only the opticians' associations but the British Medical Association has now come out against this part of the Bill.
§ Mr. Clarke
I heard what my hon. Friend said about the BMA's reservations about the advertising of professional services. I accept that certain aspects of professional services are not susceptible to advertising. The hypothetical example of a doctor advertising that he is the best for a particular complaint is not a practice that anyone is contemplating. Similarly, we are not contemplating allowing advertising for sight testing—the professional part of the service which ophthalmic 360 opticians provide. We shall not allow people to vie with each other about skills which the public have no means of judging. Advertising would not help that.
The restrictions on advertising which we propose to give the Privy Council power to modify go far beyond that. At the moment, there is no advertising which allows any comparison of prices to be made. There is no advertising which allows an optician to say what hours he will be open. There is no way in which a new optician who is opening a practice can let the public know, through the local press or on the radio, that he is opening. I invite my hon. Friend the Member for Edgbaston and others who expressed reservations to address themselves to the totally restrictive rules which the General Optical Council proposes and which we want to give powers to the Privy Council to amend in view of the wealth of evidence in the Office of Fair Trading report. How it can be sustained that flat restrictions on any form of price advertising for services do not drive up prices and restrict competition I do not understand.
The more substantial reservations of my hon. Friend the Member for Edgbaston and others extended to the dispensing of glasses in some cases by non-opticians to adult patients. That is a more difficult consideration as we are effectively saying that the professional qualifications which at the moment apply to the sale of lenses, frames and any other type of optical appliance ought not to be restricted and that the monopoly should be weakened.
I return to the test which I apply and which my hon. Friend the Member for Bury, North said that we should apply to protect the health of patients and the public. A sight test is a health service. We are saying that in every case there should be a sight test which is carried out only by an ophthalmic optician or a doctor and that nobody should dispense glasses unless there has been a recent sight test on the basis of which a qualified professional person has given a prescription.
We have also said that the dispensing of glasses to children from a prescription should always be done by a qualified optician and that the dispensing of contact lenses should always be carried out by an optician. That is a list of circumstances in which we have identified the possibility of a health risk when the public could be harmed by provision of the wrong service. In those cases the retention of professional standards is essential to the public. However, the overwhelming majority of evidence suggests that, outside those circumstances, no damage can be done to the eyesight of an adult if there is an error in the dispensing of glasses.
If any adult buys a pair of glasses, puts them on, finds that he cannot see properly and does not realise that an error has been made and point out that error to the dispenser, I should be extremely surprised. There can be no damage to an adult if that happens. We are saying that adults should be free to choose whether to go to a dispensing optician—they are the only people who will be able to advertise themselves as opticians, as their title is protected--or to go to someone else who seems able to offer a decent service on the basis of being able to read a recent prescription and dispense glasses to the customer's satisfaction. The customer might want to compare prices before doing that.
If we wish, we can insist that the lenses are up to British standards. We can also consider standards for frames and examine the conditions that are imposed on those who sell. however, I do not believe that we should set up a new registration or licensing system and create a new 361 monopoly. I simply do not believe that it is necessary, once someone has had a recent sight test and therefore a prescription, to insist that dispensing to adults can be carried out only by a registered optician.
The hon. Member for Holborn and St. Pancras went on about every Tom, Dick and Harry selling spectacles and people buying them out of suitcases in the street. The fact remains that if somebody wants to, he can try to buy a suit in a television repair shop. There are all sorts of silly things that people can do. Adults who have a recent prescription are sensible enough to make their own choice about where to go to have their glsses made up. Most members of the public will not think that a large reputable store offering a good service should be excluded from such activity.
§ Mr. Meadowcroft
If one takes a prescription to a chemist, one does not know whether the drugs have been made up in the right fashion until one has taken them and seen the consequences. Is not the parallel that one can take a prescription to a registered practitioner, in which case, why does not the Minister accept that opticians should be registered in the same way as chemists?
§ Mr. Clarke
If a chemist, or a non-chemist, supplied a badly prescribed drug one could die, have serious side effects or suffer from ill health. If an adult goes into a non-optician and the prescription is not properly made up, he will not suffer any ill health. [Hon. Members: "Oh!"] Bland assertions in the face of all the medical evidence by those who interrupt are wrong. The overwhelming evidence is that no harm can result and one can tell, when one puts on the glasses, whether they are the same quality as before.
Those who defend this monopoly, and they do it with vigour, are trying to preserve for opticians a stronger monopoly than that which is available for doctors. We do not give doctors an absolute monopoly for all kinds of treatment. We do not purge the osteopaths and the chiropractors and the people to whom we allow adults to go with their symptoms. Certain things are reserved to a registered medical practitioner where there is a health risk. But the opticians have a more absolute monopoly on selling their goods than doctors have in giving advice on ill health and treatment.
The absolute right that opticians are protecting is not a professional service. They are the only people who can sell frames of any kind. Even the most expensive fashion frames, as worn by Dame Edna Everage and Elton John, can legally be sold only by registered dispensing opticians. There is no open competition. My hon Friend the Member for Littleborough and Saddleworth (Mr. Dickens) described the sort of healthy competition that he would wish to see. He hit the nail on the head, and will have the support of many members of the public.
The hon. Member for Holborn and St. Pancras went back to his familiar theme that somehow we were damaging the NHS, and I refute that. We are getting the Government and the NHS out of the business of providing types of frames and glasses. We are protecting children and those on low incomes by providing them with free glasses and lenses for the foreseeable future, until such time as the market moves in the direction in which we think that it will, when there will be no need to exclude 362 them from the same choice as the rest of the public, and they will be reimbursed up to a set limit and able to choose as well.
The only change is that the better-off will pay more towards their glasses in the short term, but will gain the advantages of lower prices that competition will bring. Every subsidy to the general public for each pair of NHS glasses bought is at the moment about £5 a pair. In 81 per cent. of the cases, the subsidy is under £2 a pair and in 90 per cent. it is under £10 a pair. On average, glasses are bought about once every two years and those who pay more than that cover the small proportion of people who face any significant risk of increased payments. That will not be a significant feature.
We are keeping in the NHS what should be kept there —free sight tests for everyone, regardless of need. That is the major health element that the NHS provides. We are keeping a free service for those who may need it, such as children, although many children already wear non-NHS frames, and a free service for the exempt groups. There have always been exempt groups because there have always been charges for everyone else — charges introduced by a past Labour Government.
Those who are expressing worries are mainly concerned, as my hon. Friend the Member for Edgbaston conceded, with the effect on opticians. The effect on opticians of this move will be the same as the effect on bus operators of what we did before. Some will become more prosperous, some less. Some practices will grow and some will fail. I do not accept what my hon. Friend the Member for High Peak (Mr. Hawkins) said—that only the big opticians will prosper. Those who prosper will be those who provide a good service for their customers both in price and quality. That is how it should be, and that is what we propose.
I want to say a brief word about the later parts of the Bill. First, I want to mention the family practitioner committees. We debated the subject in the last Parliament. This provision was excluded at the time of the general election, because the Labour party was then opposed to it.
Everyone agrees that the present arrangements for family practitioner committees are a nonsense. Everyone wanted to change the present arrangements, some in the direction of making the FPCs sub-committees of the district health authorities, others giving them the independent status that we have always preferred. We prefer the independent status, because we believe that the importance of primary health care within the NHS justifies putting it in the hands of specialist committees who will concentrate on that aspect of care alone. In that way, it will not run the risk of being subordinated to the interests of the much larger hospital service and all the lobbies within that service.
The Opposition chose to turn the whole debate into an argument about our power of appointment. At one stage, the hon. Member for Oldham, West (Mr. Meacher) agreed with a proposition from his hon. Friend the Member for Bolsover (Mr. Skinner) that we would appoint people to the family practitioner committees as a compensation for failing to get knighthoods. They would not be such attractive appointments. Moreover, the appointments will be made from the names that are put forward by the professions, local authorities, health authorities and other bodies which my right hon. Friend will be obliged to consult. The Opposition want to prevent us making from appointments in that way, and want the committees to be 363 subordinate to the health authorities—the regional health authorities, in particular—all of whose members we already appoint. So that is not a significant point.
The more substantial points were raised by my hon. Friend the Member for Peterborough (Dr. Mawhinney), in his thoughtful speech. He knows far more about primary care than most hon. Members know. May I give him the assurance that in making them employing authorities we are talking about their administrative staff and those whom they directly employ. We are not intending to alter the independent contractor status of the professions. I accept everything that my hon. Friend says about the need to encourage closer collaboration with the district health authorities. It is a danger that we have to face and avoid. If more than four district health authorities coincide in an FPC, we take powers either to enlarge the FPC or to use the seven members who can be nominated by the Secretary of State. In particular, we have set up a joint working group between the health authorities and the FPCs to advise us on how we can improve collaboration between the different parts of the service. That group will report early next year. We shall issue guidelines following that. We shall put the new FPCs on the joint consultative committees, get them involved in joint planning with health authorities and local authorities, and try to make them effective and responsive bodies that will play their part in a properly co-ordinated service.
Incidentally, we also intend to open up the proceedings of the FPCs to the same access by community health councils that those councils now have on behalf of consumers into the activities of district health authorities.
Finally, I want to mention the severe disablement allowance, which was the subject of a number of speeches. An extraordinary debate has been conducted against it, with an attack mounted on it by many people who are interested in the disabled, making it sound as though it were a retrograde step. In fact, it makes two worthwhile improvements to the present system. Everyone has had to acknowledge that they are improvements and a step in the right direction. The first improvement is that we are ending the discrimination against married women that was implicit in the household duties test, and we are doing that in a way that brings 20,000 more people into benefit, at an additional cost of £20 million, compared with the present situation. Disappointment we understand, and we must always expect worthwhile claims to be made for those who see other directions in which we might eventually go, but to say that those improvements are so disappointing that they must be opposed is quite extraordinary. It is particularly extraordinary when it comes from the right hon. Member for Manchester, Wythenshawe (Mr. Morris), who made the third Opposition Front Bench speech. After all, he was the one who introduced the household duties test, accurately described by the hon. Member for Leeds, West (Mr. Meadowcroft) as sexist.
§ Mr. Speaker
Order. I must ask the right hon. Member for Manchester, Wythenshawe (Mr. Morris) to sit down.
§ Mr. Clarke
The household duties test—the right hon. Member does not wish to be reminded -- was introduced by him. It has—
§ Mr. Clarke
The household duties test, which could perhaps be described as the Morris test, is now to be abolished amidst general satisfaction. There will be more gainers than losers as a result of the change.
§ Mr. Clarke
The right hon. Gentleman was responsible, and it is humbug for him to oppose: a desirable, limited new benefit as if it were some kind of setback for the disabled and not a desirable feature of a very desirable Bill.
§ Question put, That the Bill be now read a Second time:—
§ The House divided: Ayes 298, Noes 188.367
|Division No. 112]||[10 pm|
|Adley, Robert||Blaker, Rt Hon Sir Peter|
|Aitken, Jonathan||Body, Richard|
|Alexander, Richard||Bonsor, Sir Nicholas|
|Alison, Rt Hon Michael||Boscawen, Hon Robert|
|Amery, Rt Hon Julian||Bowden, A. (Brighton K'to'n)|
|Amess, David||Boyson, Dr Rhodes|
|Ancram, Michael||Braine, Sir Bernard|
|Arnold, Tom||Brandon-Bravo, Martin|
|Ashby, David||Bright, Graham|
|Aspinwall, Jack||Brinton, Tim|
|Atkins, Rt Hon Sir H.||Brittan, Rt Hon Leon|
|Atkins, Robert (South Ribble)||Brooke, Hon Peter|
|Atkinson, David (B'm'th E)]||Brown, M. (Brigg & Cl'thpes)|
|Baker, Nicholas (N Dorset)||Browne, John|
|Baldry, Anthony||Bruinvels, Peter|
|Banks, Robert (Harrogate)||Bryan, Sir Paul|
|Beaumont-Dark, Anthony||Buchanan-Smith, Rt Hon A.|
|Beggs, Roy||Buck, Sir Antony|
|Bellingham, Henry||Budgen, Nick|
|Berry, Sir Anthony||Bulmer, Esmond|
|Best, Keith||Burt, Alistair|
|Bevan, David Gilroy||Butcher, John|
|Biffen, Rt Hon John||Butler, Hon Adam|
|Biggs-Davison, Sir John||Butterfill, John|
|Carlisle, John (N Luton)||Jones, Gwilym (Cardiff N)|
|Carlisle, Kenneth (Lincoln)||Kershaw, Sir Anthony|
|Carttiss, Michael||King, Rt Hon Tom|
|Chalker, Mrs Lynda||Knight, Gregory (Derby N)|
|Channon, Rt Hon Paul||Knowles, Michael|
|Chapman, Sydney||Knox, David|
|Chope, Christopher||Lamont, Norman|
|Clark, Hon A. (Plym'th S'n)||Lang, Ian|
|Clark, Dr Michael (Rochford)||Lawrence, Ivan|
|Clark, Sir W. (Croydon S)||Lee, John (Pendle)|
|Clarke Kenneth (Rushcliffe)||Lester, Jim|
|Clegg, Sir Walter||Lewis, Sir Kenneth (Stamf'd)|
|Cockeram, Eric||Lightbown, David|
|Colvin, Michael||Lloyd, Ian (Havant)|
|Conway, Derek||Lloyd, Peter, (Fareham)|
|Coombs, Simon||Lord, Michael|
|Cope, John||Lyell, Nicholas|
|Corrie, John||McCrindle, Robert|
|Couchman, James||McCurley, Mrs Anna|
|Critchley, Julian||Macfarlane, Neil|
|Crouch, David||MacGregor, John|
|Currie, Mrs Edwina||MacKay, Andrew (Berkshire)|
|Dickens, Geoffrey||MacKay, John (Argyll & Bute)|
|Dicks, T.||Maclean, David John.|
|Dorrell, Stephen||Macmillan, Rt Hon M.|
|Douglas-Hamilton, Lord J.||McNair-Wilson, M. (N'bury)|
|Dover, Denshore||McQuarrie, Albert|
|Dunn, Robert||Madel, David|
|Durant, Tony||Major, John|
|Dykes, Hugh||Malins, Humfrey|
|Edwards, Rt Hon N. (P'broke)||Malone, Gerald|
|Eggar, Tim||Marshall, Michael (Arundel)|
|Emery, Sir Peter||Mates, Michael|
|Evennett, David||Mather, Carol|
|Eyre, Reginald||Maude, Francis|
|Fallon, Michael||Mawhinney, Dr Brian|
|Farr, John||Maxwell-Hyslop, Robin|
|Favell, Anthony||Mayhew, Sir Patrick|
|Finsberg, Geoffrey||Merchant, Piers|
|Fletcher, Alexander||Meyer, Sir Anthony|
|Fookes, Miss Janet||Miller, Hal (B'grove)|
|Forth, Eric||Mills, lain (Meriden)|
|Fowler, Rt Hon Norman||Mills, Sir Peter (West Devon)|
|Fox, Marcus||Mitchell, David (NW Hants)|
|Fraser, Rt Hon Sir Hugh||Moate, Roger|
|Fraser, Peter (Angus East)||Molyneaux, Rt Hon James|
|Fry, Peter||Monro, Sir Hector|
|Gardner, Sir Edward (Fylde)||Montgomery, Fergus|
|Garel-Jones, Tristan||Moore, John|
|Glyn, Dr Alan||Morrison, Hon P. (Chester)|
|Goodlad, Alastair||Moynihan, Hon C.|
|Gower, Sir Raymond||Mudd, David|
|Grant, Sir Anthony||Murphy, Christopher|
|Greenway, Harry||Nelson, Anthony|
|Griffiths, E. (B'y St Edm'ds)||Neubert, Michael|
|Grist, Ian||Newton, Tony|
|Grylls, Michael||Nicholls, Patrick|
|Gummer, John Selwyn||Nicholson, J.|
|Hamilton, Hon A. (Epsom)||Normanton, Tom|
|Hamilton, Neil (Tatton)||Norris, Steven|
|Hampson, Dr Keith||Onslow, Cranley|
|Harris, David||Oppenheim, Philip|
|Hayes, J.||Osborn, Sir John|
|Hayward, Robert||Ottaway, Richard|
|Heddle, John||Page, John (Harrow W)|
|Henderson, Barry||Page, Richard (Herts SW)|
|Heseltine, Rt Hon Michael||Parris, Matthew|
|Hicks, Robert||Patten, John (Oxford)|
|Hogg, Hon Douglas (Gr'th'm)||Pattie, Geoffrey|
|Holland, Sir Philip (Gedling)||Pawsey, James|
|Holt, Richard||Peacock, Mrs Elizabeth|
|Hooson, Tom||Percival, Rt Hon Sir Ian|
|Hordern, Peter||Pollock, Alexander|
|Howard, Michael||Porter, Barry|
|Howarth, Gerald (Cannock)||Powell, Rt Hon J. E. (S Down)|
|Howell, Rt Hon D. (G'Idford)||Powell, William (Corby)|
|Hunter, Andrew||Powley, John|
|Jenkin, Rt Hon Patrick||Prentice, Rt Hon Reg|
|Jessel, Toby||Price, Sir David|
|Johnson-Smith, Sir Geoffrey||Proctor, K. Harvey|
|Raffan, Keith||Tebbit, Rt Hon Norman|
|Raison, Rt Hon Timothy||Temple-Morris, Peter|
|Rees, Rt Hon Peter (Dover)||Terlezki, Stefan|
|Renton, Tim||Thatcher, Rt Hon Mrs M.|
|Rhodes James, Robert||Thomas, Rt Hon Peter|
|Ridsdale, Sir Julian||Thompson, Donald (Calder V)|
|Rifkind, Malcolm||Thompson, Patrick (N'ich N)|
|Roberts, Wyn (Conwy)||Thorne, Neil (Ilford S)|
|Roe, Mrs Marion||Thornton, Malcolm|
|Ross, Wm. (Londonderry)||Thurnham, Peter|
|Rossi, Sir Hugh||Townsend, Cyril D. (B'heath)|
|Rowe, Andrew||Tracey, Richard|
|Rumbold, Mrs Angela||Trippier, David|
|Ryder, Richard||Twinn, Dr Ian|
|Sackville, Hon Thomas||van Straubenzee, Sir W.|
|Sayeed, Jonathan||Vaughan, Dr Gerard|
|Shaw, Giles (Pudsey)||Viggers, Peter|
|Shaw, Sir Michael (Scarb')||Waddington, David|
|Shelton, William (Streatham)||Wakeham, Rt Hon John|
|Shepherd, Colin (Hereford)||Waldegrave, Hon William|
|Shepherd, Richard (Aldridge)||Walden, George|
|Shersby, Michael||Walker, Cecil (Belfast N)|
|Silvester, Fred||Waller, Gary|
|Sims, Roger||Ward, John|
|Skeet, T. H. H.||Wardle, C. (Bexhill)|
|Smith, Tim (Beaconsfield)||Warren, Kenneth|
|Smyth, Rev W. M. (Belfast S)||Watson, John|
|Speed, Keith||Watts, John|
|Speller, Tony||Wells, Bowen (Hertford)|
|Spence, John||Wells, John (Maidstone)|
|Spencer, D.||Wheeler, John|
|Spicer, Jim (W Dorset)||Whitfield, John|
|Spicer, Michael (S Worcs)||Whitney, Raymond|
|Squire, Robin||Wiggin, Jerry|
|Stanbrook, Ivor||Wilkinson, John|
|Steen, Anthony||Winterton, Mrs Ann|
|Stern, Michael||Winterton, Nicholas|
|Stevens, Lewis (Nuneaton)||Wolfson, Mark|
|Stevens, Martin (Fulham)||Wood, Timothy|
|Stewart, Allan (Eastwood)||Woodcock, Michael|
|Stewart, Andrew (Sherwood)||Yeo, Tim|
|Stewart, Ian (N Hertf'dshire)||Young, Sir George (Acton)|
|Stokes, John||Younger, Rt Hon George|
|Stradling Thomas, J.|
|Tapsell, Peter||Tellers for the Ayes:|
|Taylor, Rt Hon John David||Mr. David Hunt and|
|Taylor, Teddy (S'end E)||Mr. Tim Sainsbury.|
|Adams, Allen (Paisley N)||Clay, Robert|
|Anderson, Donald||Cocks, Rt Hon M. (Bristol S.)|
|Archer, Rt Hon Peter||Cohen, Harry|
|Ashdown, Paddy||Coleman, Donald|
|Ashton, Joe||Concannon, Rt Hon J. D.|
|Atkinson, N. (Tottenham)||Conlan, Bernard|
|Bagier, Gordon A. T.||Cook, Frank (Stockton North)|
|Banks, Tony (Newham NW)||Cook, Robin F. (Livingston)|
|Barnett, Guy||Corbett, Robin|
|Barron, Kevin||Corbyn, Jeremy|
|Beckett, Mrs Margaret||Cowans, Harry|
|Beith, A. J.||Craigen, J. M.|
|Bell, Stuart||Cunliffe, Lawrence|
|Bennett, A. (Dent'n & Red'sh)||Cunningham, Dr John|
|Bidwell, Sydney||Dalyell, Tam|
|Blair, Anthony||Davies, Rt Hon Denzil (L'lli)|
|Boyes, Roland||Davies, Ronald (Caerphilly)|
|Bray, Dr Jeremy||Davis, Terry (B'ham, H'ge H'!)|
|Brown, Gordon (D'f'mline E)||Deakins, Eric|
|Brown, Hugh D. (Provan)||Dixon, Donald|
|Brown, N. (N'c'tle-u-Tyne E)||Dobson, Frank|
|Bruce, Malcolm||Dormand, Jack|
|Callaghan, Rt Hon J.||Douglas, Dick|
|Callaghan, Jim (Heyw'd & M)||Dubs, Alfred|
|Campbell, Ian||Duffy, A. E. P.|
|Campbell-Savours, Dale||Dunwoody, Hon Mrs G.|
|Canavan, Dennis||Eadie, Alex|
|Carter-Jones, Lewis||Eastham, Ken|
|Cartwright, John||Edwards, R. (W'hampt'n SE)|
|Clark, Dr David (S Shields)||Evans, loan (Cynon Valley)|
|Clarke, Thomas||Evans, John (St. Helens N)|
|Fatchett, Derek||Mikardo, Ian|
|Faulds, Andrew||Milian, Rt Hon Bruce|
|Field, Frank (Birkenhead)||Miller, Dr M. S. (E Kilbride)|
|Fields, T. (L'pool Broad Gn)||Mitchell, Austin (G't Grimsby)|
|Fisher, Mark||Morris, Rt Hon A. (W'shawe)|
|Flannery, Martin||Nellist, David|
|Foot, Rt Hon Michael||O'Brien, William|
|Forrester, John||O'Neill, Martin|
|Foster, Derek||Orme, Rt Hon Stanley|
|Foulkes, George||Paisley, Rev Ian|
|Fraser, J. (Norwood)||Park, George|
|Freeson, Rt Hon Reginald||Parry, Robert|
|Freud, Clement||Patchett, Terry|
|George, Bruce||Pavitt, Laurie|
|Godman, Dr Norman||Pendry, Tom|
|Golding, John||Pike, Peter|
|Hamilton, James (M'well N)||Powell, Raymond (Ogmore)|
|Hamilton, W. W. (Central Fife)||Prescott, John|
|Hardy, Peter||Radice, Giles|
|Harman, Ms Harriet||Randall, Stuart|
|Harrison, Rt Hon Walter||Redmond, M.|
|Hart, Rt Hon Dame Judith||Rees, Rt Hon M. (Leeds S)|
|Hattersley, Rt Hon Roy||Richardson, Ms Jo|
|Hawkins, C. (High Peak)||Roberts, Ernest (Hackney N)|
|Haynes, Frank||Robertson, George|
|Heffer, Eric S.||Robinson, G. (Coventry NW)|
|Hogg, N. (C'nauld & Kilsyth)||Rooker, J. W.|
|Holland, Stuart (Vauxhall)||Ross, Ernest (Dundee W)|
|Howells, Geraint||Rowlands, Ted|
|Hoyle, Douglas||Ryman, John|
|Hughes, Mark (Durham)||Sedgemore, Brian|
|Hughes, Robert (Aberdeen N)||Sheerman, Barry|
|Hughes, Roy (Newport East)||Sheldon, Rt Hon R.|
|Hughes, Simon (Southwark)||Shore, Rt Hon Peter|
|John, Brynmor||Short, Mrs R.(W'hampt'n NE)|
|Jones, Barry (Alyn & Deeside)||Silkin, Rt Hon J.|
|Kaufman, Rt Hon Gerald||Skinner, Dennis|
|Kennedy, Charles||Smith, C.(1sl'ton S & F'bury)|
|Kilroy-Silk, Robert||Smith, Rt Hon J. (M'kl'ds E)|
|Kirkwood, Archibald||Snape, Peter|
|Knight, Mrs Jill (Edgbaston)||Soley, Clive|
|Lamond, James||Spearing, Nigel|
|Leadbitter, Ted||Stewart, Rt Hon D. (W isles)|
|Leighton, Ronald||Stott, Roger|
|Lewis, Ron (Carlisle)||Strang, Gavin|
|Lewis, Terence (Worsley)||Straw, Jack|
|Litherland, Robert||Thomas, Dr R. (Carmarthen)|
|Lloyd, Tony (Stretford)||Thompson, J. (Wansbeck)|
|Lofthouse, Geoffrey||Thorne, Stan (Preston)|
|Loyden, Edward||Tinn, James|
|McCartney, Hugh||Torney, Tom|
|McDonald, Dr Oonagh||Wardell, Gareth (Gower)|
|McKelvey, William||Wareing, Robert|
|McNamara, Kevin||Weetch, Ken|
|McTaggart, Robert||White, James|
|McWilliam, John||Wigley, Dafydd|
|Madden, Max||Williams, Rt Hon A.|
|Marek, Dr John||Wilson, Gordon|
|Martin, Michael||Winnick, David|
|Mason, Rt Hon Roy||Woodall, Alec|
|Maxton, John||Young, David (Bolton SE)|
|Maynard, Miss Joan|
|Meacher, Michael||Tellers for the Noes:|
|Meadowcroft, Michael||Mr. Allen McKay and|
|Michie, William||Mr. John Home Robertson.|
§ Question accordingly agreed to.
§ Bill read a Second time.
§ Bill committed to a Standing Committee pursuant to Standing Order No. 42 (Committal of Bills).