§ Mr. Michael Meacher (Oldham, West)
I beg to move,That an humble Address be presented to Her Majesty, praying that the National Health Service (Charges for Drugs and Appliances) Amendment Regulations 1984 (S.I., 1984, No. 298), dated 7th March 1984, a copy of which was laid before this House on 8th March, be annulled.
§ Mr. Speaker
With this, it will be convenient to take the following motions:That an humble Address be presented to Her Majesty, praying that the National Health Service (Dental and Optical Charges) Amendment Regulations 1984 (S.I., 1984, No. 299), dated 7th March 1984, a copy of which was laid before this House on 8th March, be annulled.That an humble Address be presented to Her Majesty, praying that the National Health Service (Charges to Overseas Visitors) Amendment Regulations 1984 (Si, 1984, No. 300), dated 7th March 1984, a copy of which was laid before this House on 8th March, be annulled.That an humble Address be presented to Her Majesty, praying that the National Health Service (Charges for Drugs and Appliances) (Scotland) Amendment Regulations 1984 (S.I., 1984, No. 292), dated 6th March 1984, a copy of which was laid before this House on 9th March, be annulled.That an humble Address be presented to Her Majesty, praying that the National Health Service (Dental and Optical Charges) (Scotland) Amendment Regulations 1984 (S.I., 1984, No. 293), dated 6th March 1984, a copy of which was laid before this House on 9th March, be annulled.That an humble Address be presented to Her Majesty, praying that the National Health Service (Charges to Overseas Visitors) (Scotland) Amendment Regulations 1984 (S.I., 1984, No. 295), dated 7th March 1984, a copy of which was laid before this House on 9th March, be annulled.
§ Mr. Meacher
We are praying against the regulations for three fundamental reasons. First and foremost, the Opposition unreservedly condemn the practice of huge increases in Health Service charges, which has been one of the worst hallmarks of the Tory Government. We condemn that practice because its completely undermines one of the guiding principles of the NHS — [Interruption.]
§ Mr. Meacher
We condemn the practice because it completely undermines one of the essential guiding principles of the NHS, which is a service free at the point of use for all, irrespective of income or class. That is one of the foundations of a civilised and caring society. We condemn the practice in this case especially because these increases are far in excess of what is needed simply to keep up with inflation—they are three times greater than the inflation rate. We condemn it with anger when the latest increases have resulted in prescription charges per item escalating eightfold under this Government. We condemn it with contempt when we recall that on 18 April 1979 the Prime Minister told a press conference thatWe have no intention to raise prescription charges.How a party that cheated the electorate by so blatantly misleading it can now, year after year, deliberately force up charges until a mere 20p, which is what it was in 1979, has now become £1.60 per item, defies the imagination, and is surely an act of cynicism that can have few precedents in modern political history.
972 Secondly, we reject the regulations not only because we believe that it is fundamentally wrong to tax the sick but because such a huge increase in charges is bound to act as a deterrent. It is no excuse to say—as I am sure hon. Members will say—that only 30 per cent. are subject to these charges because of the exemption certificate system. The fact remains that next year more than 100 million prescriptions will be dispensed in this country for which the full £1.60 charge per item will be levied. It is not true to say that all of those people are well off and can afford it. It is known that there are at least 1.5 million people in Britain today who are entitled to supplementary benefit but who do not, for one reason or another, claim it. It is those people who are, by definition, poor, as well as the sizeable number of people just above supplementary benefit level who do not claim the means-tested exemption on grounds of low income, who—and they must number about 2 million or more—are potentially the very real victims of the harsh and unnecessary increase in health charges.
It is not just prescription charges that have been pushed up eightfold under this Government. Dental charges have been nearly quadrupled. The cost of more complex dental treatment, which amounted to £30 in 1979, is now being forced up to £110. Is there any hon. Member who seriously doubts that with that level of charges there is a very real possibility that people will be deterred from seeking the treatment that they genuinely need? We on this side assert that this country needs a preventive Health Service with regular check-ups, yet that is surely incompatible with such swingeing charges.
The same is, of course, true of optical charges, with the maximum charge per lens now being pushed up by £1 by the Government to £16.50. Of course, with the privatisation of the optical service, under clause 1 of the Health and Social Security Bill — which we shall be debating next Wednesday—that rise in optical charges will soon be subsumed in the wider private sector price bonanza, as spectacle charges double or even treble for millions of people, especially pensioners. Such people previously benefited from low-cost NHS glasses. Again, can any hon. Member doubt that that will act as a deterrent for millions of people on low incomes who genuinely need glasses?
Those who want evidence of the deterrent effect of the huge rise in prescription charges under this Government need only look at the overall pattern of prescription dispensing during the past decade. Demand rose steadily year by year under Governments of both parties throughout the 1970s. The consistent rise in demand was only checked—as the Government figures show—in the era of rapidly inflated charges under this Government. The logic of that can only be that millions of those who need prescriptions are not applying for them because they cannot afford them. That is another reason why we roundly condemn this latest round of increases in prescription charges.
Thirdly, we condemn this jacking-up of charges for another reason. It is unnecessary. The total extra income raised by the regulations will be about £37 million. If such additional money has to be found within the National Health Service, it would be infinitely preferable to achieve the saving by other means. One alternative would be to accept the Greenfield recommendations on generic prescribing. If six drugs alone — Mogadon Valium, 973 Indesit, Lasix, Aldemit and Indural—were ordered by doctors in their generic or unbranded form, the National Health Service would save about £25 million a year.
Even more strikingly, a report published on 10 January this year by the Royal College of General Practitioners stated that Britain's drug bill could be cut by almost £150 million a year if doctors changed their prescription habits and issued unbranded drugs which, while so much cheaper, were nevertheless efficacious.
However, the Government will do no such thing, because it would cut the profits of the drug companies. Nothing exposes the values of the Government more starkly than that. They would prefer to increase the taxation of the sick than to reduce the profits of the drug companies, which amount to some £250 million a year.
§ The Minister for Health (Mr. Kenneth Clarke)
Perhaps the hon. Gentleman will accept a small correction. The figure of £250 million which he has quoted is the figure for the drug companies' profits before we saved the NHS £100 million through the package of measures which we announced before Christmas.
§ Mr. Meacher
The cut of £100 million referred to future years. When, by means of a parliamentary question, I asked the Minister what in his estimation the drug companies' profits would be, he refused to give me a direct answer. I suspect that the figure of £250 million will not change very much. The overall increase in the drug companies' profits would have been much greater, but it will now remain at about £250 million. The Minister's comment does not invalidate my point.
There are two other options that would have been greatly preferable to raising prescription, optical and dental charges. One of them involves charges for private patients. Can the Minister tell me why pay bed charges for provincial teaching hospitals are being raised by only 6 per cent. and pay bed charges in London teaching hospitals by only 3.5 per cent., when prescription charges are being pushed up by 14 per cent.?
§ Mr. Clarke
I believe that, nationally, the increase in pay bed charges is slightly under 10 per cent. That is in line with the increase in prescription charges. The hon. Gentleman has chosen two of the lower categories. We have discriminated between different classes of hospitals to reflect the different assessment of costs in different types of hospitals.
The hon. Gentleman's point is totally invalid. We have raised pay bed charges by more than many who are interested in private medicine would have wished, because we have tried to follow accurately the increased costs of the NHS.
§ Mr. Meacher
First, the overall increase is about 9 per cent. That is not in line with 14 per cent. The Minister's mathematics cannot be so far awry. Moreover, the 6 per cent. that I quoted is the normal extent to which pay bed charges rise in provincial hospitals. The Government, however, would much prefer to tax the sick than to damage their friends in the private sector by imposing similar increases.
The most important point is that there is no need for an increase in prescription charges. Such charges will raise £37 million and yet, six weeks ago, the Chancellor made a present of 10 times that sum to a tiny number of extremely rich people with invested capital in excess of 974 £100,000 by abolishing the unearned income surcharge. Perhaps it is unfair to ask the Minister to reply to that point, as it is a matter for the Chancellor, but the Minister is a member of the Government that have done that. He is answerable for that demonstration of an appalling set of priorities. Nothing more brutally reveals the callousness of Thatcherism—tax the sick and then give a handout of £360 million to the super rich.
There is already clear evidence that the Government are planning a £2 per item prescription charge for next year. I say that because the latest public expenditure White Paper reveals that, while charges on family practitioner services are being pushed up steeply this year, they are planned to rise twice as fast next year, even without allowing for the loss of income from ophthalmic charges because of the ending of the supply of NHS glasses. That income was estimated by the Government to be about £50 million this year. Will the Minister come clean with the House and admit that, under this Government, the £2 prescription charge is already in the pipeline for next year? I demand that he rejects that assertion if it is untrue.
By constrast to the Government's appalling record on Health Service charges, I should like to make it clear that it is the Opposition's policy not merely to halt the enormous increase in Health Service charges brought about by the Tories but to reduce them and ultimately to phase them out. [HoN. MEMBERS: "Oh."] We shall do it a great deal more quickly than the Secretary of State has increased charges. I can certainly give that assurance The increased charges amount to about £37 million. The charges about which I have given a commitment amount to about £350 million. In our most recent manifesto we gave a commitment to increase Health Service spending by 3 per cent. a year in real terms—that is an extra £500 million a year. On that basis we reject these swingeing increases which are unnecessary, damaging, mean and unjust.
§ The Minister for Health (Mr. Kenneth Clarke)
I thought that, with respect to the hon. Member for Oldham, West (Mr. Meacher), he went through the old routine on this subject with, at times, less than his usual vigour, although he continually tried to go into every subject other than the main one involved in this year's regulations which increase, by a realistic and reasonable amount, prescription and other charges for some services.
The basis of the increases, as the hon. Gentleman knows perfectly well, is that the Government are raising the level of spending on the NHS. We are therefore raising the charges on people who can afford to pay for some parts of the service. The logic of that appears impeccable to me and, I believe, to my right hon. and hon. Friends. There is not much logic in the stance of the hon. Gentleman, who spends most of his time castigating the Government and throwing out wild promises that somehow the Labour party in Government would spend even more than we do on the NHS. He then attacks us the moment we try to make modest increases to this part of the Health Service's income to finance the extra costs.
I did not follow the hon. Gentleman's final and vigorous point about what the Labour party is committed to, but I understood him to say that it is committed to spending another £500 million — to be raised from taxation or borrowing—over and above our increased 975 spending on services and then, I assume, another £344 million to abolish prescription charges. That seems quite absurd.
§ Mr. Meacher
No such argument can be deduced from what I said. I said that we were committed to a 3 per cent. increase in real terms, which on a budget of £15 billion or £16 billion per year is about £500 million. That is more than enough in the first year to remove not just the increases but all prescription, dental and optical charges.
§ Mr. Clarke
The hon. Gentleman said in the election that services would be improved to that extent. That cannot be done if the increased spending is swallowed up by using it all to abolish prescription charges, not to mention all the commitments about manning levels, pay and the rest which the Labour party always makes and which would absorb even more of the illusory money that a Labour Government could not possibly produce to top our record of increased spending on the Health Service. It is that record of increased spending which lies behind the increased charges that we ask the House to approve today.
§ Mr. Clarke
I constantly give the United Kingdom figures. This time I will give the figures for England and Wales. My hon. Friend the Minister with responsibility for health in Scotland can give the figures for Scotland to provide a little variety.
When the Government came to office in 1978–79, in England alone spending was £6.5 billion per year, whereas for 1983–84 it will be almost £13 billion; so spending on the Health Service has increased by about 18 per cent. over and above the general inflation. Spending on the family practitioner services, the family doctor service and the optical and dental services with which we are dealing especially today, also continued to grow; and we intend to increase total expenditure on both next year. On family practitioner services alone we plan to spend more than £240 million more in England in 1984–85 than in 1983–84, making a total of £3,229 million. The increases in charges for which we seek approval today will increase the contribution towards those services by a mere £32 million to a total of £344 million. The background is therefore of increased spending, a small part of which has to be financed by increasing charges on exactly the pattern that the Labour Government introduced and maintained and which I believe that the public accept as a reasonable way to make a modest contribution towards extra resources for patient care in the Health Service.
§ Mr. Meacher
First, the Labour Government did not increase charges sevenfold or eightfold in five years of office. As the Minister continually alleges the same pattern of increased spending, I should make it clear, if he does not know it already, that increased spending in RPI terms gives a vastly inflated picture compared with the increase produced in terms of NHS pay and prices, which is the relevant basis. In those terms, the increase has been about 7.5 per cent. As about 1 per cent. extra is needed to take account of the greater number of elderly people and a further 0.5 per cent. is necessary to take account of the higher costs of medical technology, the Government have so far done little beyond keeping up with extra demand. 976 Moreover, in the coming year, far from any increase in spending, there will be a reduction because the 1 per cent. increase is based on the premise that NHS workers will take a 2 per cent. cut in pay. So let us hear no more about how well the Government have done by the National Health Service.
§ Mr. Clarke
With the greatest respect, the case advanced by the hon. Gentleman is the most blithering nonsense and he frequently repeats it. I talked about increased spending. The way to measure that is to compare the increased output of cash with the general level of inflation. Spending in cash terms has doubled since we came to power, increasing by about 18 per cent. above the rate of inflation. There is no other logical way to define the increased spending and the increased cost to the taxpayer.
All the hon. Gentleman's other qualifications are attempts to go beyond that increased spending and to claim, for reasons based either on increased pay in the Health Service—which I agree has taken up much of the increased spend—or on increased demands that he identified, that we should be spending even more above a real terms increase of 18 per cent. If he claims that that somehow alters the ordinary meaning of the English language and the ordinary cost to the taxpayer of what we mean by increased spending, he is talking nonsense. Unfortunately, he has sold that nonsense to far too many people. Against a background of such increased spending, he organises a debate about so-called cuts in spending, and then, when we try to finance our increased spending by increased charges for those who can afford to pay, he has the temerity to oppose increases that would raise some revenue to contribute towards what we are doing.
The increase in charges represents only a modest proportion of the total expenditure, because the bulk of it comes from the general taxpayer on a basis which we all agree. When we have passed the order, if the House rejects the prayers, about 3.2 per cent. of National Health Service spending will be met by charges. To be fair, I should say that the proportion of spending of family practitioner services will be 10.7 per cent. in 1984–85. However, I shall give some historic comparisons over the long and, I accept, glorious years of the National Health Service of the sort of proportions that Governments of both parties used to raise by charges towards the family practitioner services. In 1953–54, 18 per cent. of family practitioner costs were raised by charges; in 1963–64, it was 15.5 per cent.; in 1973–74 it was 10–8 per cent.; and now it is 10.7 per cent. The proportion remains perfectly reasonable and is a modest and sensible way of contributing towards increased costs.
We do not apologise for raising charges in that way, because we believe that the bulk of the people accept that those who can afford it should make modest contributions towards increased spending on the Health Service. The hon. Member for Oldham, West repeated the old untruth about the Prime Minister's pledge in 1979. He was inaccurate. I quote from the press conference on 18 April 1979, when the Prime Minister, who was then the Leader of the Opposition, said:I doubt very much whether any responsible Government could say that over a period of five years, regardless of what happened to the value of money, they would not put up prescription charges.In 1979 the Prime Minister made two pledges: first, that the Government would not institute charges for stays in 977 hospital and, secondly, that they would not introduce charges for visiting the doctor. The Labour party claimed unfairly in 1979 that we were plotting to do that. She denied that and she kept her promise. She said that she would not give the exact promise which the hon. Gentleman accuses her of giving—that, regardless of what happened, she would not raise prescription charges.
My right hon. Friend repeated a similar pledge during the general election campaign. I quote from a press conference of 24 May 1983, before the June election which we won so convincingly:No responsible Government, no responsible Opposition, no responsible politician could rule out the possibility that prescription charges will rise. So I would'nt dream of ruling it out.We have not broken our promises. We always accepted that charges should contribute, and if we did not, we would deprive the Health Service of that income. Of course, the Labour Government never kept their promise to phase out prescription charges—a promise that the hon. Gentleman coolly repeated tonight. I accept that they did not increase them; they preferred to cut spending on the Health Service in two years, so committed were they to the absurd dogma of freezing prescription charges at the level that they inherited when they came to office.
There is no sensible reason for foregoing income in that way, at the expense of the Health Service, and if the hon. Gentleman ever gets into office and deprives the Health Service of such income it would be a wrong choice of priorities.
As I understand it, the only charge of principle against the charges is that somehow they deprive the poor of medical treatment or deter people from seeking treatment. I make it clear that we are not talking about those on low incomes who cannot afford the services. The pattern of exemptions that we are applying are those applied by the Labour Government in 1968, and, because there are now more elderly people, more people qualify and take advantage of them. Before we get lyrical about the taxing of the sick, let us consider how many of the sick pay these charges and reflect on the fact that the ones who pay are the ones who can afford these modest sums.
Some 72 per cent. of all prescription items are free. Some 45 per cent. of the total eligible courses of dental treatment are given free. Some 35 per cent. of optical transactions are free or partially remitted. The hon. Member for Oldham, West has got carried away about dental examinations, but they are free, as are the sight tests.
§ Mr. Clarke
So far—I am glad, when I can, to agree with the hon. Gentleman.
We are talking about the charges paid by the remaining patients paying the balance of their courses of treatment and the medicines that I have described, and those are people who are judged able to pay by the same criteria that were introduced by a Labour Minister in the Wilson Government of 1968. There is no evidence to claim that anybody is deprived on income grounds of medical treatment that he requires by these charges.
The hon. Member for Oldham, West said that many people are deterred from treatment, because the charges must have a deterrent effect on people wanting medicines and seeking some kind of treatment. There is not a shred of evidence for that claim. There is no evidence that over 978 the years during which this Government have reverted to a sensible policy of increasing charges in line with costs as a contribution to the Health Service, this caused any falling off of treatment. A total of 300 million items were dispensed in 1981, and 315 million in 1983. There were 23,750,000 dental treatment courses in 1973 and 30.5 million in 1983. There has been an increase in the number of people taking advantage of the family practitioner services and an increase in the number of prescriptions dispensed. There is no evidence to support the theory of the deterrent.
§ Mr. Meacher
The right hon. and learned Gentleman quoted a figure of 300 million prescriptions dispensed in 1981. He did not say that in 1978 the figure was 307 million, and it went down in the first three years of the Conservative Government's tenure of office. If it has increased now, it has increased substantially less than it did throughout the 1970s.
As to dental charges, the right hon. and learned Gentleman says that there is no evidence of a deterrent effect. I shall quote from a statement made by the British Dental Association in September 1983. It says:The charts show the proportion of adults still keeping some of their natural teeth who said that they had put off a dental checkup in the past year because of what they might have to pay for treatment. 18 per cent. of women had delayed checkups, compared with 11 per cent. of men, and 17 per cent. of class DE had been put off by cost, against 11 per cent. in class AB … it must surely be a matter for concern that more than one adult in seven is delaying dental treatment because of cost.
§ Mr. Clarke
It is right that there was a dip for a couple of years in the number of prescriptions, when we first came into office. The hon. Gentleman quotes the 1978 figures, but, as he has conceded, they are lower than the 1983 figure. More prescription items were dispensed for our £1.40 than for the 20p. All the savings in principle that the Labour Government made did not mean that more people got medicines—more prescriptions were being dispensed with our increased charges, thereby bringing increased revenue into the Health Service, than there were when the prices were artificially frozen.
I know the BDA's case which is based on not entirely scientific surveys. The BDA is anxious to keep its charges down and to encourage more people to seek preventive treatment. We share that objective. The BDA's case runs in the face of what I have said about the number of dental courses steadily increasing. People's teeth are not steadily becoming worse. The nation's dental health is not deteriorating. More people are taking courses of dental treatment because despite dental charges, people cannot see what is wrong—if they are not on low incomes and exempt — in making a modest contribution to the revenue for a valuable service.
§ Mr. Charles Kennedy (Ross, Cromarty and Skye)
The Minister must be worried that the BDA says one thing about dental care when he says another. Will his Department conduct a survey based upon scientific evidence to find out whether the claims are accurate?
§ Mr. Clarke
We agree with the BDA about the need for a reasonable preventive strategy for dental care. Increasing the number of dental hygienists being trained and experimenting with payment on a per capita basis have been agreed with the BDA and are welcome. I accept that there is, unfortunately, disagreement between us about the effect of charges, but I rely on the scientific evidence of 979 the number of dental courses taken by patients. That is increasing and it does not support wild claims to the effect that the charges have a deterrent effect.
We are going through a ritual through which the Labour party always goes when in opposition but never goes through in government. Labour Ministers have tried to explain why in office they are not able to live up to undertakings such as those given tonight when in Opposition. They tried to get rid of charges in 1965, and in 1968 they had to reintroduce them.
The then Minister for Health, Mr. Kenneth Robinson, said to his own hon. Friends who objected to what he was doing:Given the need for prescription charges, I think that our aim is to ensure that they will operate so as to be socially just has been broadly achieved—though I do not pretend that these charges will be welcomed by those who have to pay them. What charges ever are? But all the indications are that the public understands why we have had to take this step, and accepts it." —[Official Report, 30 May 1968; Vol. 765, c. 2262.]Those were sensible words by the Minister upon which no Labour successor in office has been able to go back. The public know that no responsible future Labour Minister could ever go back upon the present system.
Labour's objections are not only ritual but inconsistent with everything that they say about pushing up spending in the Health Service even further. They are also incredible in the light of Labour's record in office. We do not apologise for the charges. They are in line with costs, with a small additional contribution towards extra spending on the Health Service. I am confident that the House will reject the prayer.
§ Mr. Michael Meadowcroft (Leeds, West)
I agree with the Minister on one matter at least—that this is a ritual. It may be difficult to decide whether charges are a tax on ill health or, if so, whether they are at the right level. Any charge is a tax on ill health because it must be paid by a person in need. The argument between the Front Benches appears to be that it is not a charge on ill health when imposed by a Labour Government but is when imposed by the present Government.
People advocating both arguments should admit that the purpose of charges is essentially to control the use of the Health Service rather than to raise income. The amount of income being raised by the extra charges is infinitesimal compared with the cost of the Health Service as a whole. The amount of extra money that would be brought into the National Health Service by these charges is less than the overspending on the premature retirement calculations for those who retire from the Health Service.
If we are arguing that the money is required to fund the Health Service, I suspect that we are basing the argument on the wrong premise. Indeed, as the hon. Member for Oldham, West (Mr. Meacher) said, one could save far more than the increased income that is coming in through these charges by generic substitution for a mere handful of proprietary drugs. Therefore, if the Government's case is that the income is needed, at least they might go down a different road rather than the same old road of raising the charges for prescriptions or appliances in the Health Service. If we are to impose a charge for prescriptions or 980 for appliances in the Health Service, that is applied, and it is bound to be applied, when people are suffering from ill health and are most vulnerable.
The reliance on global statistics by the Minister has the difficulty that, while it may well show up pleasantly for him and his case to say that so many more millions of prescriptions have been dispensed, many hon. Members have been in receipt of evidence from pharmacists that people are coming to their pharmacies and asking which items on the prescription are more important than others, because they cannot afford to have all the items dispensed. That is anecdotal evidence inevitably compared with the statistics, but it exists. I hope that the Minister in his compassion does not disregard that kind of anecdotal evidence. The people who are coming to pharmacists and asking that question are the people in most need, and not the people who are able to increase their take-up of prescriptions or appliances under the Health Service.
The key problem that no Government have ever resolved is that the National Health Service is a socialised service within a market economy. Nobody has ever found a way, since the 1940s, to cope with the problem of how one inhibits the usage of the Health Service, except by market forces. If that is the case, we have to go some way down a different road. We have to find a way of inhibiting clinical freedom. That is the engine that motors up the increase all the time. One way that was tried was to take the overspending on the family practitioner service out of the hospital budget. The effect of that, particularly in terms of prescribing, was inevitably that the hospital pharmacists would prescribe for shorter periods, thus throwing the extra burden of prescriptions on to the family practitioner service, and it spiralled up the overspending on the family practitioner service.
I draw attention to the paucity of the argument being put forward by the Minister. If the argument is that the extra charges are required to bring increased income into the Health Service, it it alarming that no new idea is coming forward on how to inhibit the immense charge on the Health Service by the usage of drugs which may or may not be required except by increasing charges.
§ Dr. Brian Mawhinney (Peterborough)
I believe that the hon. Gentleman was not present in the House a few weeks ago when the Parliamentary Under-Secretary told the House in an Adjournment debate that the Department had increased the number of assessors who were monitoring general practitioner prescribing habits. Anybody who knows anything about the subject knows that the prescribing habits of GPs are a substantial contribution, although perhaps in a minority of cases only, to the overprescribing of drugs and to the burden on the Health Service. Perhaps the hon. Gentleman would at least acknowledge that the Department is taking steps in this direction which are welcome to many hon. Members, and give the Department encouragement to pursue that line further in the months ahead.
§ Mr. Meadowcroft
I am grateful to the hon. Member, and I willingly accept the point that he makes. I give credit to the fact that that is along the right lines. I am saying that it is strange, if that is being pursued, that the increase in the income from charges being projected by the Government for 1985–86 is over 12 per cent., so that we are bound to have a much higher increase in 1985–86. The Government presumably have no expectation of success in 981 the current subsidies. To go down the same road of increasing charges is bound to have a deleterious effect on the people in the greatest need. It is for those reasons that I find myself unable to support the Government and therefore support the prayer this evening.
§ Mrs. Edwina Currie (Derbyshire, South)
Increases in prescription charges are like increases in rent, mortgages, interest rates or tax—nobody likes or welcomes them. There is never a good time for them. But from time to time, ever since the Labour party introduced prescription charges in 1951, it has been necessary to increase them. It is worth remembering that in all the 36 years of the National Health Service we have only been free of all charges of the kind that we are discussing tonight for approximately the first three years of its life.
I have heard what the hon. Member for Oldham, West (Mr. Meacher) has said. An offer to abolish prescription charges has been repeated by Labour Front Benches from time to time but not carried out other than on the one occasion that my right hon. and learned Friend the Minister for Health mentioned. It would be humbug for the Opposition to suggest that they would throw away the £400 million of income that prescription charges provide.
As for the ritual cries of woe that we have heard tonight, I refer the House to a written answer given by my right hon. and learned Friend on 27 March 1984 in response to a question from the hon. Member for Walsall, North (Mr. Winnick) asking the Secretary of State for Social Services what representations he had received following the recent statement on increased health and prescription charges. The answer was:I have received 29 letters from hon. Members, 46 letters from members of the public and five letters from professional bodies and other organisations about the charges announced on 8 March."—[Official Report, 27 March 1984; Vol. 55, c. 129.]That is hardly a great surge of passion against increased prescription charges. Indeed, if we take into account the probability that most of the 29 letters from hon. Members came from Labour Members, what is so noticeable is the deafening silence from the Labour party about the increase in prescription charges.
The fact is that most people do not pay the charges. Seventy-two per cent. of prescriptions are currently issued free of charge. I want to make three suggestions about the long list of exemptions. Two of them are to add to that list of exemptions and one is to take something off. One addition to the list of exemptions that I should like to see would be people who are terminally ill. That question was raised at the latest Conservative party conference by a woman who had cared for her dying husband. At that august conference it was suggested that those people who are certified by their doctor or consultants as likely not to survive a period of about six months should be entitled, if they wish to be treated at home, to free prescriptions. That was warmly welcomed by the people at that conference. Not many cases would be involved and the money involved would not break the bank. I should like to see that happen.
The second group that I should like to see added I shall not specify. But the list of the chronically sick who are entitled automatically to exemption, which includes people such as diabetics, is now so old-fashioned and out of date that it is about time that it was revised. Many different illnesses, including a number of cancers, can now 982 be successfully treated for a long period, indeed idefinitely—for example, Hodgkins disease and leukaemia are no longer killers. People go home from hospital and as soon as they start to get prescriptions outside the hospital service it costs them a great deal of money. Some 600,000 people last year bought long-term prescription pre-paid assistance. Amongst some of those people are those who are probably finding it difficult and whose doctors and perhaps advisers such as ourselves are finding ways of getting the money through the NHS, for example by sending the patients as outpatients to the hospitals so that the drugs are prescribed through the hospital service where they are free. That is the sort of fiddle that is unnecessary and undesirable and we should examine and revise that list.
Never being one to chuck public money around willy-nilly, I should like to suggest one group of prescriptions that are free and which should perhaps no longer be. You will understand, Mr. Deputy Speaker, that this is a slightly delicate subject. There is only one type of commodity which is free to everyone whether they can afford them or not — contraceptives. I believe that provision was introduced by a Labour Government. It is barmy that if I am being kept alive by drugs for leukaemia or whatever I have to pay for them, but if I want something that will put a sparkle in my eye I can obtain that free, whether I can afford to pay or not.
It is about time that that exemption was removed. I suppose it will be in some newspaper tomorrow that this Tory lady is against free love, and indeed I am. If, by releasing my right hon. and learned Friend the Minister from that obligation, we can thereby find the money to assist people who are chronically sick, that will be a worthwhile step to take.
Most people do not pay anything like the real cost of prescriptions. They pay £1.60 per item, compared with the £4.33 that is the actual cost, of which £3.50 is the drug cost, and the rest goes to the pharmacist.
Most people have not got the foggiest idea what the prescription costs. A pharmacist in my constituency whose pharmacy is in one of the mining villages — where, incidentally, everybody is working — has a lively practice which I would commend to the House. When someone comes into the shop and complains about the cost of the prescription charge he says to them very confidentially, "Would you like me to dispense it privately?" "Oh, yes", is the usual answer, so he disappears into the back of the shop and does his sums and comes out with the bill, and the bill is often as much as £65. Because the fact is that most people have not the faintest idea what the commodities cost that they are so readily taking home. The immediate reaction of his patients is to say they would rather have it under the NHS and they would rather pay the £1.60, and they are very glad to have the opportunity to have the state paying most of it. An interesting aspect of this practice is, however, that it is against the ethical code of the Pharmaceutical Society.
I have two further suggestions to make to my right hon. Friend. The first is this. I believe that pharmacists should be encouraged to tell the public what the drugs and the appliances and the bits and pieces that are on the prescription actually cost. It ought to be common practice. The pharmacists know, because that is how they get paid, 983 and it ought to be possible to pass on that knowledge to the public. I can think of no good reason why that information should be secret.
My second suggestion is this. The aim ought to be to tie the prescription charge in some way to what the prescription actually costs. Currently, it works out at about one third. I would suggest that we officially aim in the medium term to tie it to some proportion—be it one third, or 35 per cent. or 40 per cent.—and then to put a maximum on it, because I may be wrong but I do not think there is a maximum, and a long prescription can be very expensive. If we then said to people that their prescription charge was one third of the cost and that was where it was going to stay that would bring home to people what the NHS does for us.
We do not appreciate the NHS enough in this country. We take it far too much for granted. This is particularly illustrated in the case of dental charges. I refer to this with much feeling because tomorrow afternoon I have to meet my dentist face to face and he has a lovely habit of stuffing my mouth full of instruments and then talking politics for the next half-hour, when I cannot talk back. I am extremely grateful to the Minister, in view of the amount of work that my dear dentist has got to do on me tomorrow, for continuing to have a maximum charge in the NHS, otherwise I think I would be in difficulties.
Forty-five per cent. of all treatments are free, but the routine £14.50 is absolute peanuts compared with the dental treatment we get. If the bill for servicing my car was £14.50, I should feel that I had got off very lightly. Usually the bill for servicing a car in this country is anything up to 10 times that amount. If the cost of decorating a room in my house was only £14.50 I should feel I was doing pretty well, but £14.50—and I checked up this weekend—will buy me two rolls of wallpaper and a pot of paint, which is just about enough to do the smallest room in the house. At £14.50 it is extremely good value and we ought to be saying that dental care is a bargain; let us take full advantage of it, it is cheap at the price.
If the BDA figures prove anything it is that more than 80 per cent. of the people who seek dental care took no notice whatever of the increases in dental charges.
As my right hon. and learned Friend the Minister has shown, the increase in charges in recent years has not kept up with the growth of the National Health Service. Let us consider all the charges—everything that we are looking at tonight. In 1961–62, 5.6 per cent. of all NHS spending came from income from charges. This year it will be 3.2 per cent. — a sharp drop. The wide-ranging list of exemptions ensures that the least able to afford to pay such charges are fully protected. It is only reasonable that those who can well afford to do so should make a contribution to the cost of their care, and so to the overall resources of the National Health Service.
§ 11.6 pm
§ Mr. Willie W. Hamilton (Fife, Central)
During his speech, the Minister referred to the proportion of the total cost of the Health Service paid for by charges. He quoted figures that I found astounding—and which, probably, are inaccurate. I did not have time to take down the figures, but he quoted figures for the 1960s of "teen" per cent. Research note 156 from the Library, which is known to be impartial, truthful and objective states: 984Charges as a proportion of total NHS income have increased in recent years; they were 2.2 per cent. in 1978–9— which was the last full year of the Labour Government—compared to the 3.2 per cent. for the current year. This latter figure is, however, a good deal lower than at some points in the history of the NHS. The Report of the Royal Commission on the National Health Service (Cmnd. 7615, July 1979) includes a table which gives sources of finance for each year from 1949–50 to 1978–79. Charges reached their highest proportion of the total in 1961–2 when they constituted 5.6 per cent. of the total.That was the highest. I do not know where the Minister obtained his figures of "teen" percentage charges. Perhaps he was including charges that the Royal Commission did not include. I should be grateful if he would clarify that point.
§ Mr. Kenneth Clarke
I am sorry if I confused the hon. Gentleman. The figures that he quotes are for the proportion of total spending on the National Health Service. I did quote the figure of 3.2 per cent. that we are expecting next year. He was right in the figures that he quoted. However, it is difficult to make valid comparisons if we go back as far as he did. There have been changes in local government and NHS services in the intervening years.
The single figures relate to the proportion of total NHS cost. The figures I quoted, to which the hon. Gentleman took exception, were the proportion of the cost of the family practitioner services. That is in "teens". That is why there was an apparent discrepancy. I was talking about the proportion of income for that particular part of the Health Service.
§ Mr. Hamilton
I shall be interested to read what the Minister said earlier. The objective of his quotation was to prove that the percentage of the total cost of the NHS now being paid for by charges is very much less, even with the current increases, than it was a few years ago. However, we shall read what he said.
A valid point was made by my hon. Friend the Member for Oldham, West (Mr. Meacher). We are not concerned so much with the charges themselves. I am probably more realistic than my hon. Friend. I have been in this House a long time, and my party has repeatedly claimed that we would remove the charges. However, we have not been able to do so because we have always found that the choice was either to stabilise the charges—not to eliminate them—or to cut the services, or a combination of both. No Government have been able to meet the overriding problem referred to by the hon. Member for Leeds, West (Mr. Meadowcroft)—how to control expenditure in a service where the demand is infinite.
The problem of generic drugs and the enormous and completely indefensible profits of the drug companies are two areas in which massive savings could be achieved. Despite what the Minister and his colleagues have said on previous occasions, they have not met those problems in the way in which they should have been tackled.
Other points that I had intended to make were made by my hon. Friend the Member for Oldham, West. We must consider these charges in the context of the overall budgetary and fiscal policies of the Government. Since 1979, the Conservatives have increasingly placed burdens on the generally lower paid sections of the community—these are part of that process—at the same time as massively increasing tax concessions to the well off, and that is what this debate is all about.
985 The Minister pointedly — I do not blame him —referred to charges for overseas visitors. They have represented the most squalid shambles since the inception of the NHS, with strong undertones of racialism compounded by the gross incompetence of the proposal of the Government of a year or so ago in a scheme introduced to satisfy the raucous skinheads on the Tory Back Benches, against the advice of the Labour party and many other competent outside authorities, including civil servants in the DHSS.
The Minister's estimate in February 1982 of the savings in that connection was £6 million in a full year. In the first six months of the operation of the scheme, the Government got in £374,459. In the first year, the saving will not be £6 million but £1 million—and it may not even be as much as that. It will be interesting to know the exact figure. Sixty-nine health authorities raised no cash. They raised two fingers to the Government, and in doing so they were being polite. Many others raised less than £100. Mid-Essex raised £4, not enought to buy the tea for the people who were doing the job.
What was the Minister's reaction to this monumental fiasco? It was not contrition or repentance and we heard no admission of incompetence. He is a very smooth operator. Tories will never admit to their bungling idiocy. On 16 November 1983 the right hon. Gentleman said:I am concerned by the apparent failure of some health authorities to collect charges from overseas patients … I have asked our officials to make inquiriesMore cost and more time-wasting.I would expect the auditors to question authorities".—[Official Report, 16 November 1983; Vol. 48, c. 500.]That was from a Minister who, if he keeps his nose clean, is a candidate for promotion into the Cabinet. He should take this scheme to the Prime Minister and say, "Look what I have done. I am the greatest." The Minister is too small-minded, too bigoted and too stubborn to admit that he has created a chaotic and expensive shambles. He should summon up the courage to admit that it has been a monstrous disaster, and he should get rid of the whole damned expensive operation.
This discussion is part of a running debate on the Tory onslaught on the welfare state generally. Axes are being sharpened for the purpose, called reviews into pensions, housing and supplementary benefits, benefits for children, young people and the disabled. The Sunday Times was right when it said in an article on 8 April:The aim is to recast the whole 42-year-old system of universal welfare support.There is talk in Government circles about making cuts in payments to school leavers, means testing child benefit and reducing automatic entitlements to welfare benefits and the rest. The regulations are a small part of that overall exercise, and I hope that they are seen in that context.
§ Mr. Roger Sims (Chislehurst)
The debate is basically about whether the NHS is to be completely paid for by the taxpayer and whether some of those who take advantage of the services it offers should make some contribution. How should the contribution be made? Who should make it?
I accept that some hon. Members are opposed in principle to any contribution being made by the users. They can call in aid shades of Aneurin Bevan. As my right hon. and learned Friend the Minister for Health said, the practice of the Labour party when in office differs from its 986 words in opposition. I accept that it is reasonable to make a contribution. In round figures, we are talking of contributions representing 3 per cent. of the cost of the NHS, or just under 11 per cent. of the cost of the family practitioner service. By any standard, that seems to justify my right hon. and learned Friend's expression of a "modest" contribution.
It is not unreasonable to ask users to pay a charge towards the cost of prescriptions, provided that no one is deprived of treatment because he is unable to pay. That proviso is met by the criteria laid down for various exemptions which mean charges are not levelled for 70 per cent. of prescriptions. It is right to include certain chronic conditions in the exemptions, and a case may be made for extending the range. It is right also that a war pensioner, needing a prescription because of his disablement, should not have to pay for that prescription. Those on low incomes and especially those on family income supplement and supplementary benefit should not be expected to pay prescription charges. There are exemptions for all retirement pensioners and children under 16.
The hon. Member for Fife, Central (Mr. Hamilton) referred to stories of recasting the system. I applaud the efforts of my right hon. and learned Friend and his hon. Friends at the Department in reviewing the range of social benefits and the cost of the welfare state. That review is due, and I hope that the process includes the basis on which prescription charges are made. Why should all pensioners be exempt? Is it reasonable that all children under 16 should be exempt from paying prescription charges? Those living entirely on the state retirement pension should, of course, be exempt.
We all know of many people living on other pensions—retired business men, public servants and professional people, some of whom enjoy larger pensions than the wages of those still at work, and do not pay any prescription charges. Would it be unreasonable to suggest that they should contribute? Of course, children in families on small incomes should be exempt, but some parents can, and willingly do, pay for the private education of their children. Many parents can afford expensive holidays. They give their children extremely generous pocket money. Is it really unreasonable to expect them to pay the equivalent of the cost of a pop record or less than two packets of cigarettes or a round of drinks for their children's prescriptions when they are unwell?
It would be perfectly reasonable for us to rethink the whole basis of such charges. I warmly applaud the suggestion of my hon. Friend the Member for Derbyshire, South (Mrs. Currie) that we should rethink how such charges are levied and on whom. Meanwhile, I certainly support the regulations, and I hope that the House will reject the prayer.
§ Mr. Charles Kennedy (Ross, Cromarty and Skye)
It was extremely interesting to listen to the exchanges between the Minister and the hon. Member for Oldham, West (Mr. Meacher). I agreed with one of the Minister's points — that in office, the Labour party has great difficulty in fulfilling the promises that it makes in opposition. I am sure that the Minister and I agree on at least one other point, and that is that the Labour party will not have to face that difficulty in future. Its hypocrisy on this issue is clear. What that party says is damaging to the 987 campaign on the Health Service, which the Minister criticised. Labour Members have a great facility for raising expectations—or at least, they would raise them if they had any political credibility left — and for making outrageous promises, such as that they will spend 3 per cent. per annum in real terms on the NHS, when in reality, even if they ever came to power, their present economic policy would not allow for such expansion. Indeed, the shadow Chancellor of the Exchequer the right hon. Member for Birmingham, Sparkbrook (Mr. Hattersley) believes that the economic policy on which the shadow Secretary of State, the hon. Member for Oldham, West, makes those promises—the policy on which he fought his campaign for the party's deputy leadership last year—is fraudulent and fraught with internal inconsistencies. That is what is so annoying about the moral platitudes that we hear from the official Opposition Front Bench on such matters.
I agree with the Minister and with other sensible hon. Members — including the one Labour Member—who have had the honesty to say that it was not sensible to advocate abolishing NHS charges. Many of us would say that it is impossible to do that, however desirable it is. Indeed, I am sure that all hon. Members would think it desirable to get rid of them, but the revenue that they generate is very necessary.
What the Government have done, however, is quite unacceptable. Although we accept that, unfortunately, the Health Service cannot afford totally to dispense with the income from charges, the current price of treatment—despite the Minister's arguments—must be a disincentive to some of those who should seek medical attention. The British Dental Association has already been mentioned, and I believe it important to put on the record a quotation from a letter that I received from the BDA just a few days ago. It says:The NHS charges issue is a particularly delicate one for us because we run the risk, with very active campaigning, of deterring patients from having checkups so that even more damage is done to dental health. When last month's announcements on dental and prescription charges were made we deliberately left the press to concentrate on the prescription charge increase and played down the dental side of the story. But we are nevertheless very deeply concerned by the Government's dwindling commitment to adult dental services within the NHS and at the consequences which this must have for dental health.If the Minister for Health or the Parliamentary Under-Secretary of State for Scotland with responsibility for health try to dismiss statistics — as was attempted following my intervention—they should at least bring forward some form of independent assessment that proves one way or the other the argument about the level of disincentive caused by such increases in charges.
Therefore, I hope that when the Minister says that there is not a shred of evidence to support that disincentive argument he will be slightly more forthcoming, and that when Labour Members come out with the moral platitudes that they are so fond of, they will remember that by raising people's hopes and encouraging false expectations, they are in a sense doing an even greater disservice to the Health Service than this Government are now doing.
§ Mr. Frank Dobson (Holborn and St. Pancras)
At the risk of falling out with my hon. Friend the Member for 988 Fife, Central (Mr. Hamilton), I should point out, in fairness to the Minister, that it was the right hon. Member for Wanstead and Woodford (Mr. Jenkin) who predicted that £6 million would accrue to the NHS from the introduction of charges for overseas visitors. The right hon. Gentleman is now charging round the country promising that untold millions will be saved through the abolition of the Greater London council and the metropolitan counties. Hon. Members should bear that in mind when they talk about predictions.
I should like finally to nail the lie about what the present Prime Minister said in 1979. On Thursday 23 April 1979 the Daily Mail—that bible of the Conservative party—published what it called "Labour's Dirty Dozen". Lie No. 9, as it was described, was the quotation from the Labour manifesto:There are Tory proposals for higher prescription charges and charges for seeing a doctor or being in hospital".The Daily Mail replied:TRUTH: 'We have no intention of increasing or introducing such charges', says Mrs. Thatcher.That is quite clear. No denial was issued by the innumerable press officers at Tory central office. Indeed, it is believed that the press officers had written the Daily Mail's front page on that day.
What happened next? In comparison with what has already happened under the present Government, an increase of 14 per cent. is modest. In July 1979 charges were increased from 20p to 45p—an increase of 125 per cent. In April 1980 there was a 56 per cent. increase to 70p. Not content with that, in December 1980 the Government increased charges to £1—an increase of 43 per cent. In December 1982 the charge was raised by 30 per cent. to £1.30. In April 1983, in election year, the charges were increasd by only 8 per cent. to £1.40, but the Government are now beginning to revert to form. The charges are now to be raised to £1.60—an increase of 14 per cent.
The Government's excuse is that this is a contribution towards their own extra contribution to the funding of the NHS. Nothing could be further from the truth.
§ Mr. Dobson
No, I do not have time to give way.
This is a contribution not from the Government but from the sick. Whatever blather we may have heard from the Minister tonight about the funding of the NHS, the Government's provision for the NHS is not keeping up with the combined effects of increasing costs in the NHS, the increasing costs of medical technology and the increasing proportion of old people in the community who need to be looked after. If one makes no allowances for the increased proportion of NHS funding represented by these charges, the Government have not even kept up with the rate of inflation, let alone outstripped it.
The Minister said that in the past year the number of prescriptions issued had increased. In fact, under the present Government the total number of prescriptions issued has increased by only 2 per cent. The cost of the drugs dispensed as prescriptions, however, has increased by over 90 per cent. The cost of the drugs dispensed has increased enormously, while the amount of drugs dispensed has remained roughly the same. That is one of the problems that we face. According to the Minister's own figures, the drug industry spent £180 million last year on promoting drug sales to general practitioners and 989 employees of the NHS. That is a disgraceful waste of money and we are now faced with having to raise £37 million through increased charges to help pay for the advertising bills of drug companies.
There is not much point in talking to Conservative Members. The Liberal Members who have spoken have also made it clear that they do not understand our deep feelings on the matter. There is a bitter objection in the Labour movement and the Labour party to any form of charging for prescriptions or appliances. It is at the heart of our tradition and we intend to return to it—
§ It being half-past Eleven o'clock, MR. DEPUTY SPEAKER put the Question, pursuant to Standing Order No. 4 (Prayers against statutory instruments, &c. (negative procedure)).
§ The House divided: Ayes 104, Noes 177.991
|Division No. 255]||[11.30 pm|
|Anderson, Donald||Kaufman, Rt Hon Gerald|
|Archer, Rt Hon Peter||Kennedy, Charles|
|Atkinson, N. (Tottenham)||Kirkwood, Archibald|
|Barnett, Guy||Lamond, James|
|Barron, Kevin||Leighton, Ronald|
|Beggs, Roy||Litherland, Robert|
|Beith, A. J.||Lloyd, Tony (Stretford)|
|Bell, Stuart||Lofthouse, Geoffrey|
|Bennett, A. (Dent'n & Red'sh)||McCartney, Hugh|
|Bermingham, Gerald||McDonald, Dr Oonagh|
|Blair, Anthony||McKelvey, William|
|Boothroyd, Miss Betty||McNamara, Kevin|
|Bray, Dr Jeremy||McTaggart, Robert|
|Brown, Hugh D. (Provan)||Martin, Michael|
|Brown, N. (N'c'tle-u-Tyne E)||Meacher, Michael|
|Brown, R. (N'c'tle-u-Tyne N)||Meadowcroft, Michael|
|Brown, Ron (E'burgh, Leith)||Michie, William|
|Bruce, Malcolm||Mikardo, Ian|
|Caborn, Richard||Millan, Rt Hon Bruce|
|Callaghan, Jim (Heyw'd & M)||Morris, Rt Hon A. (W'shawe)|
|Carlile, Alexander (Montg'y)||Morris, Rt Hon J. (Aberavon)|
|Clark, Dr David (S Shields)||Nellist, David|
|Cocks, Rt Hon M. (Bristol S.)||O'Neill, Martin|
|Cohen, Harry||Park, George|
|Cook, Frank (Stockton North)||Patchett, Terry|
|Craigen, J. M.||Pike, Peter|
|Crowther, Stan||Powell, Raymond (Ogmore)|
|Davies, Ronald (Caerphilly)||Prescott, John|
|Davis, Terry (B'ham, H'ge H'l)||Randall, Stuart|
|Dobson, Frank||Redmond, M.|
|Dormand, Jack||Richardson, Ms Jo|
|Dubs, Alfred||Roberts, Ernest (Hackney N)|
|Dunwoody, Hon Mrs G.||Robertson, George|
|Eadie, Alex||Robinson, G. (Coventry NW)|
|Eastham, Ken||Rooker, J. W.|
|Fatchett, Derek||Ross, Ernest (Dundee W)|
|Field, Frank (Birkenhead)||Silkin, Rt Hon J.|
|Fields, T. (L'pool Broad Gn)||Skinner, Dennis|
|Fisher, Mark||Snape, Peter|
|Foot, Rt Hon Michael||Soley, Clive|
|Forrester, John||Spearing, Nigel|
|Foster, Derek||Stott, Roger|
|Freeson, Rt Hon Reginald||Thomas, Dr R. (Carmarthen)|
|Freud, Clement||Thompson, J. (Wansbeck)|
|Gould, Bryan||Thorne, Stan (Preston)|
|Hamilton, W. W. (Central Fife)||Tinn, James|
|Harman, Ms Harriet||Warden, Gareth (Gower)|
|Haynes, Frank||Wareing, Robert|
|Heffer, Eric S.||Welsh, Michael|
|Hogg, N. (C'nauld & Kilsyth)||Young, David (Bolton SE)|
|Holland, Stuart (Vauxhall)|
|Howells, Geraint||Tellers for the Ayes:|
|Hughes, Simon (Southwark)||Mr. Don Dixon and Mr. Allen McKay.|
|Janner, Hon Greville|
|Adley, Robert||McCrindle, Robert|
|Alexander, Richard||Macfarlane, Neil|
|Amess, David||MacKay, John (Argyll & Bute)|
|Ancram, Michael||Maclean, David John|
|Arnold, Tom||McNair-Wilson, P. (New F'st)|
|Ash by, David||Major, John|
|Aspinwall, Jack||Malins, Humfrey|
|Atkins, Robert (South Ribble)||Maples, John|
|Atkinson, David (B'm'th E)||Marland, Paul|
|Baker, Nicholas (N Dorset)||Marlow, Antony|
|Bellingham, Henry||Mates, Michael|
|Bendall, Vivian||Mather, Carol|
|Benyon, William||Maude, Hon Francis|
|Berry, Sir Anthony||Mellor, David|
|Biffen, Rt Hon John||Merchant, Piers|
|Biggs-Davison, Sir John||Mitchell, David (NW Hants)|
|Blaker, Rt Hon Sir Peter||Moate, Roger|
|Body, Richard||Montgomery, Fergus|
|Boscawen, Hon Robert||Morrison, Hon C. (Devizes)|
|Bowden, Gerald (Dulwich)||Moynihan, Hon C.|
|Boyson, Dr Rhodes||Murphy, Christopher|
|Braine, Sir Bernard||Needham, Richard|
|Brandon-Bravo, Martin||Newton, Tony|
|Bright, Graham||Nicholls, Patrick|
|Brinton, Tim||Norris, Steven|
|Brooke, Hon Peter||Onslow, Cranley|
|Brown, M. (Brigg & Cl'thpes)||Oppenheim, Philip|
|Bruinvels, Peter||Osborn, Sir John|
|Bryan, Sir Paul||Ottaway, Richard|
|Carlisle, John (N Luton)||Page, Richard (Herts SW)|
|Carlisle, Kenneth (Lincoln)||Parris, Matthew|
|Carlisle, Rt Hon M. (W'ton S)||Powell, William (Corby)|
|Carttiss, Michael||Powley, John|
|Chope, Christopher||Prentice, Rt Hon Reg|
|Clark, Dr Michael (Rochford)||Renton, Tim|
|Clarke, Rt Hon K. (Rushcliffe)||Rhodes James, Robert|
|Colvin, Michael||Rhys Williams, Sir Brandon|
|Conway, Derek||Ridley, Rt Hon Nicholas|
|Coombs, Simon||Ridsdale, Sir Julian|
|Cope, John||Roberts, Wyn (Conwy)|
|Couchman, James||Rossi, Sir Hugh|
|Cranborne, Viscount||Rumbold, Mrs Angela|
|Currie, Mrs Edwina||Ryder, Richard|
|Dorrell, Stephen||Sackville, Hon Thomas|
|Dover, Den||Sainsbury, Hon Timothy|
|du Cann, Rt Hon Edward||Sayeed, Jonathan|
|Durant, Tony||Shaw, Sir Michael (Scarb')|
|Dykes, Hugh||Shepherd, Colin (Hereford)|
|Eggar, Tim||Silvester, Fred|
|Fallon, Michael||Sims, Roger|
|Forman, Nigel||Smith, Tim (Beaconsfield)|
|Forth, Eric||Soames, Hon Nicholas|
|Fowler, Rt Hon Norman||Speed, Keith|
|Fox, Marcus||Speller, Tony|
|Franks, Cecil||Spencer, Derek|
|Goodlad, Alastair||Spicer, Jim (W Dorset)|
|Greenway, Harry||Squire, Robin|
|Gregory, Conal||Stanbrook, Ivor|
|Grist, Ian||Steen, Anthony|
|Ground, Patrick||Stern, Michael|
|Grylls, Michael||Stevens, Lewis (Nuneaton)|
|Hampson, Dr Keith||Stevens, Martin (Fulham)|
|Hayward, Robert||Stewart, Andrew (Sherwood)|
|Heddle, John||Stewart, Ian (N Hertf'dshire)|
|Hogg, Hon Douglas (Gr'th'm)||Sumberg, David|
|Holt, Richard||Taylor, John (Solihull)|
|Howard, Michael||Taylor, Teddy (S'end E)|
|Hunter, Andrew||Temple-Morris, Peter|
|Hurd, Rt Hon Douglas||Thomas, Rt Hon Peter|
|Jopling, Rt Hon Michael||Thompson, Donald (Calder V)|
|Key, Robert||Thompson, Patrick (N'ich N)|
|Lamont, Norman||Thorne, Neil (Ilford S)|
|Lawrence, Ivan||Thurnham, Peter|
|Lee, John (Pendle)||Townend, John (Bridlington)|
|Lewis, Sir Kenneth (Stamf'd)||Tracey, Richard|
|Lightbown, David||Twinn, Dr Ian|
|Lilley, Peter||van Straubenzee, Sir W.|
|Lloyd, Ian (Havant)||Viggers, Peter|
|Lloyd, Peter, (Fareham)||Waddington, David|
|Wakeham, Rt Hon John||Whitney, Raymond|
|Walden, George||Winterton, Mrs Ann|
|Walker, Bill (T'side N)||Winterton, Nicholas|
|Walker, Rt Hon P. (W'cester)||Wood, Timothy|
|Wall, Sir Patrick||Woodcock, Michael|
|Waller, Gary||Yeo, Tim|
|Wardle, C. (Bexhill)||Young, Sir George (Acton)|
|Watson, John||Tellers for the Noes:|
|Watts, John||Mr. David Hunt and Mr. Archie Hamilton.|
|Wells, Bowen (Hertford)|
§ Question accordingly negatived.