HC Deb 11 March 1985 vol 75 cc21-32 3.33 pm
The Secretary of State for Social Services (Mr. Norman Fowler)

With permission, Mr. Speaker, I shall make a statement on charges to be applied within the Health Service in the coming year.

In the next financial year the Health Service plans to spend an extra £800 million, bringing total spending up to some £17½ billion. That is an increase of over 20 per cent. in real terms since this Government came to power. In England alone the Health Service will be spending an extra £670 million next year. The great bulk of that extra spending will be paid for from taxation and national insurance, but, as the Government's detailed spending plans made clear, the Government believe that there should be some increase in the contribution from direct charges.

From prescription charges we are seeking an extra £19 million of income to help offset the cost of the drugs bill, which now stands at £1½ billion a year. Because of the exemptions policy, almost three-quarters of prescriptions are dispensed free of charge. This means that the retired, those on low incomes including those on supplementary benefit and family income supplement, children, expectant and nursing mothers and people suffering from certain conditions do not pay any charges. In addition, more than one in five of the prescriptions which are paid for are covered by prepayment certificates. It has been suggested recently that we should narrow the range of exemptions rather than seek other ways of reducing the drugs bill. The Government believe that it is right to protect those in need from the impact of charges, and we do not, therefore, intend to make any change in the categories which are exempt from prescription charges. However, we believe that those who can afford it should make a larger contribution. We have therefore decided to raise the basic prescription charge to £2. Even so, the charge will cover well under half the cost of the average prescription, which is now about £4.50.

There will also be equivalent increases in the cost of the prepayment certificates.

For dental treatment, there are again wide exemptions from charges. The existing range of exemptions—for children, those on low incomes and expectant and nursing mothers—will continue. These exemptions account for almost one half of all chargeable courses of treatment. Dental examinations will continue to be free of charge for all. The charges for specific treatments—crowns, inlays, bridges and dentures—will increase by between 6 and 10 per cent. The maximum charge for any single course of treatment will increase by just 4½ per cent. We have decided to change the structure of charges for routine treatment such as fillings and extractions and to relate the charge more closely to the cost of treatment. In future, patients will pay the full cost of routine treatment up to a maximum of £17—rather than £14.50 as at present—but they will also pay two-fifths of any cost above that level.

In the hospital service, we intend to increase the charges for private patients and overseas visitors so that the charges meet the full cost of the services provided, including all overheads, some of which have not been fully allowed for in the past. This will mean an average increase of just over 14 per cent., although there will be variations for different types of charge and hospital. These charges will now make a total contribution of more than £60 million a year to health authorities' budgets.

I am today laying the necessary regulations before the House so that these changes will come into effect at the beginning of April. My right hon. Friends the Secretaries of State for Scotland and for Northern Ireland will be taking the equivalent steps. A note providing full details of the changes is available in the Vote Office.

The result will be that the Health Service remains predominantly funded by general taxation — which accounts for some 86 per cent. of expenditure. A further 11 per cent. is derived from national insurance contributions. After the changes that I have announced today, charges will account for only some 3.2 per cent. of total Health Service spending.

The net effect of the changes that the Government are making to all health charges this April will be to increase total income from charges by some £40 million next year. This will be a contribution towards the extra £670 million of health service spending that we are planning for next year. If we want to see more resources going to the health service, charges must make a contribution to that growth, provided that exemptions policy protects those who cannot afford to pay.

Mr. Michael Meacher (Oldham, West)

Is the Secretary of State aware that his announcement of a tenfold increase in prescription charges since 1979, like the trebling of unemployment, is the hallmark of the disaster of six years of Thatcherite Government? On 25 April 1979 the present Prime Minister, then Leader of the Opposition, said: We have no intention of increasing prescription charges. After this series of huge prescription charge increases every year since 1979, the Secretary of State should apologise for the deceitful and weasel words of the Prime Minister six years ago.

Is the right hon. Gentleman aware that this latest huge increase, at five times the current rate of inflation, is paralleled by an equally big reduction in the tax component of NHS funding since 1979, so that wider the Conservatives the sick are having to pay more for their medicines to pave the way for even bigger tax handouts to the rich in budget after Tory budget?

How does the Secretary of State justify this deliberate financial penalty on the sick, five times greater than is warranted by inflation, when the great majority of drugs prescribed have not shown excessive cost increases and when some have actually become cheaper per unit to the NHS since the mid-1970s? How can the right hon. Gentleman justify imposing a charge of £2 per item when the Parliamentary Under-Secretary of State stated in a written answer in November last that nearly 41 per cent. of prescriptions written by GPs had a net ingredient cost of less than £1.50."—[Official Report, 16 November 1984; Vol. 67, c. 386.] Is it not a fact that many people will in future be paying more for their prescription than the cost to the NHS? Will the right hon. Gentleman confirm that that will apply to no fewer than 170 million prescriptions dispensed in the coming year? Will he acknowledge that a substantial number of those who will be paying over and above the market cost of the drugs that they receive will be in nonexempt, low income households, and only slightly above the supplementary benefit poverty line?

As for the increase in dental charges, is the Secretary of State aware that the maximum charges—which are what more than 90 per cent. of people have to pay when they go to the dentist—have now reached a level at which the principle of a general dental service readily available to all in need is in real danger of collapsing? Does he realise that the damage inflicted by these further huge price increases will be most severe among the worst off and worst educated, who already have the poorest dental health?

The one innovation in the right hon. Gentleman's statement — the two-tier structure of dental charges which he is now proposing — will be administratively more costly and more difficult to operate. A similar scheme introduced in 1971 had to be abandoned in 1976 because of administrative complexity.

Is the right hon. Gentleman aware that, instead of charging ordinary people who are sick £2 for a prescription, he could raise the extra £40 million revenue, and more, he says he needs by stopping the haemorrhage of funds from the NHS as a result of the widespread abuses of private medicine, as revealed by his audit reports? If he will not do that—because the Government are too soft on private medicine — he could make the necessary savings out of the swingeing tax cuts to the rich which the Chancellor is no doubt planning to hand out yet again in a week's time.

These huge increases in prescription and other charges for the sixth year running under Tory rule are unjust, and discriminatory, and represent a vicious attack on some of the poorest and most vulnerable people in society. Even at this stage we call on the Government to withdraw them.

Mr. Fowler

The hon. Gentleman really must make up his mind about what he wants. Does he want more resources for the National Health Service, or does he want cuts in the service? That is what the question comes down to. If he wants more resources for the service, they must be found and paid for, and the only options are tax, national insurance or charges. Tax and national insurance are already providing 97 per cent. of the cost of the NHS. It is totally hypocritical for the hon. Gentleman to call for more spending on health but to condemn every means of raising the money.

When the right hon. Gentleman talks about the impact on the public, he must recognise that almost three quarters of prescriptions are prescribed free. Almost half of dental courses are free. The hon. Gentleman referred to my right hon. Friend the Prime Minister and quoted what she had said at the general election. My right hon. Friend said that it was important that exemptions remain. The exemptions will remain. He referred also to the proportion of NHS costs that are raised by prescription charges. Charges now raise 3.2 per cent. of NHS costs, compared with 3.5 per cent. during 1969–1970 when the previous Labour Government were in power.

It is ludicrous that the hon. Member should talk as he does about dental services. About 70 per cent. of the cost of the service is provided by the taxpayer and only 30 per cent. from charges. He commented about private patients, but he knows that I sent in the statutory auditors to examine the raising of income. I am determined to raise income and ensure that there is no abuse. However, the hon. Gentleman would abolish pay beds and, with that, £60 million of income for the Health Service.

Mrs. Jill Knight (Birmingham, Edgbaston)

Will my right hon. Friend bear in mind that it is not altogether satisfactory for Members to read in the weekend press that a statement is to be made the following Monday? I ask my right hon. Friend to stress, and stress again, that the poorest and most needy are protected all the way along the line and that even those who are neither poor nor needy will still pay only £2 for a prescription which is worth £4.50, which is a bargain in anyone's language. The true danger and threat to the Health Service will be posed by a Government who will not allow it to be financially viable.

Mr. Fowler

I agree with everything that my hon. Friend has said. About 72 per cent. do not pay prescription charges, and another 6 per cent. have prepayment certificates. That means that only about 20 per cent. pay full prescription charges. About half of dental courses are provided free. The exemption policy——

Mr. Neil Kinnock (Islwyn)

Come to my surgery.

Mr. Fowler

The right hon. Gentleman the Leader of the Opposition is commenting from a sedentary position. I am describing a policy which has been pursued by previous Labour Governments as well as by this Government. If he does not know that, he knows even less than we thought he did.

Mr. Michael Meadowcroft (Leeds, West)

Why has the Secretary of State chosen this time to introduce a substantial increase in charges when he aims by an order to be laid next Monday, to increase income by £75 million by means of the limited list proposals? Does he realise that many pharmacists are being asked regularly by clients which of the prescribed items is the most important because they cannot afford to pay for them all?

Mr. Fowler

In 1985–86 we shall be spending £17.5 billion on the Health Service. I am being pressed constantly by the hon. Gentleman and by Labour Members to spend more and to provide even more resources. We shall provide £800 million more for the Health Service next year, and the issue is how the money is to be raised. I am saying—it is as well that the Labour party listens to this as well—that charges must make a contribution.

Mr. Roger Sims (Chislehurst)

Is my right hon. Friend aware that many people will feel that this charge of £2 for prescriptions imposed on those who can well afford to pay it is not an unreasonable figure when compared with the cost of a packet of cigarettes, a pint of beer or a cinema seat? Is my right hon. Friend aware also that the list of chronic conditions which enjoy exemption is relatively limited and that some people feel that it should be widened? Will he be open to representations on that matter?

Mr. Fowler

I shall certainly examine that matter again. I have looked at it in the past, and I know that there are strong views about it. My hon. Friend is right to point to the exemptions policy, which means that those who are unable to afford the prescription charges are protected from their impact.

Mr. Kevin Barron (Rother Valley)

When this matter was discussed in Cabinet and it was argued that £19 million should be obtained from increasing prescription charges by a colossal amount—an increase which is five times the general level of inflation—did the right hon. Gentleman tell the Prime Minister and other Cabinet Members that the increase was tiny compared with the amount spent on Trident — [HON. MEMBERS: "Oh!"] Government Members are dropping their heads. Perhaps they would drop a lot more if Trident were ever used. Did the right hon. Gentleman tell the Cabinet that the amount that the Health Service needs is a tiny proportion of the amount that has been spent on Trident? Did the right hon. Gentleman put to the Secretary of State for Defence that argument for sanity and good health, instead of destruction?

Mr. Fowler

I want more resources to be devoted to the Health Service, and that is what the Government are providing. I believe that charges must make a contribution to those increased resources.

Mr. Roy Galley (Halifax)

My right hon. Friend will no doubt be aware that many sensible people will welcome the fact that those who can afford to pay a contribution will now be increasing revenues for vital health services, such as more kidney dialysis. Will my right hon. Friend confirm my interpretation of the figures that the total full-year effect will be an increase in revenue of £100 million? Will he clarify the position of prescription season ticket holders who, while they are still eligble for a season ticket, become able to claim free prescriptions?

Mr. Fowler

There have been complaints, and I hope that I can help, so that refunds can be made available. The £39 million to £40 million of revenue which is to be raised is a net figure. The overall figure is not £100 million, but £74 million.

Mr. Derek Foster (Bishop Auckland)

Why does the Secretary of State not come clean to the House and admit that he has had to impose this swingeing tax on the sick because he has been a pushover in the Cabinet? Is it not an insult to the country to make this announcement today when, in a few days, the Chancellor will announce that he is stuffing pounds into the pockets of those who do not need the money?

Mr. Fowler

It would be an insult to the country if the Government were cutting back on resources to the Health Service. The hon. Gentleman has to make up his mind. If he wants cuts in the Health Service, let him say so. I shall make my stand on seeking to increase resources to the Health Service by adopting a reasonable charging policy.

Sir Raymond Gower (Vale of Glamorgan)

Will my right hon. Friend reconsider, in the context of these changes, anomalies which bear harshly on many people? As he knows, long-term bulk prescriptions are available to people with certain chronic ailments. Yet, inconsistently, such prescriptions are withheld from other persons who have serious long-term chronic illnesses.

Mr Fowler

I shall take another look at that matter. As I said earlier to my hon. Friend the Member for Birmingham, Edgbaston (Mrs. Knight), 72 per cent. of prescriptions are free. The percentage is rather less for dental services. We are moving from a position where about three quarters of prescriptions are at present free.

Mr. Willie W. Hamilton (Fife, Central)

Is the Secretary of State aware that, despite what he says about the Government's expenditure on the Health Service as a whole, everyone can see that the Health Service is falling apart because of a lack of resources, and that therefore young children and old people are dying day by day? The right hon. Gentleman says that there will be a saving by this exercise of about £40 million. He asks where we shall find the resources if we do not have this measure. Is it: not the case that the Government's official figures show that this year the Government are spending £552 million on defence in the Falkland Islands, to defend 1,200 people, 8,000 miles away? Do not tell the Opposition or anyone else that we are short of resources to save life when, we are spending that amount of money to kill people.

Mr. Fowler

We are spending that sort of money to defend people, not to kill them. I am prepared for the public to decide that point. Next year we shall spend £17½ billion on the Health Service—£800 million more than this year.

Mr. Hamilton

Do not give us that.

Mr. Fowler

The hon. Gentleman can work it out for himself. It represents a real increase in resources of 20 per cent. When the hon. Gentleman talks about £500 million, he must remember that the hon. Member for Oldham, West (Mr. Meacher), by his promise to abolish all charges in the Health Service, will remove £500 million of income which would go to the Health Service.

Mr. Robin Maxwell-Hyslop (Tiverton)

Will my right hon. Friend confirm that, however little importance Opposition Members attach to the sacrifice made by our defences forces, those in receipt of war disablement pensions will continue to be included among the exemptions from prescription charges?

Mr. Fowler

Yes, they are exempt for their accepted disabilities. That will continue.

Mr. Max Madden (Bradford, West)

Is not the truth of the matter that the Secretary of State has come here today to turn the tax screw again on the sick because he has lost the battle with the Treasury? Why did the Secretary of State not make up his mind to tell the Chancellor of the Exchequer that he was not prepared to increase prescription or other charges until the Chancellor had recovered some of the thousands of millions of pounds a year that he is losing through the City slickers avoiding and fiddling their taxes and otherwise depriving the Revenue of the money which the Secretary of State has to make up from the sick and others who can ill afford to make up that money?

Mr. Fowler

I did not put that case because I think that it is silly and indefensible.

Sir Kenneth Lewis (Stamford and Spalding)

Does my right hon. Friend agree that the problem with the increase in charges for drugs and dental supplies is that they must be imposed on too narrow a base? Have not Governments of both parties made a mistake by restricting the private sector in the National Health Service because if it had been expanded it would have brought in more money for the Health Service?

Mr. Fowler

I have some sympathy with what my hon. Friend says, but the Opposition intend to abolish all that. If they do, it will mean that they will turn their back on over £60 million of income coming to the National Health Service. That is why I say to the Labour party that if it wants to expand the Health Service it will have to explain where the money will come from.

Mr. Nigel Spearing (Newham, South)

The Minister mentioned a gain of £40 million. Can he tell the House upon what basis that was calculated? Is it on the current prescribing, or is it on the basis of the so-called new lengthy list that he wishes to introduce? How do he and the Cabinet reconcile a five-times increase in the cost of medicine with the precepts of St. Francis of Assisi?

Mr. Fowler

On the first point, the figure is based on an estimate of what prescribing habits will be and what prescriptions will take place. On the second point, we believe that this system is fair and just, and so, I am sure, will the hon. Gentleman when he has had time to consider it.

Mrs. Elaine Kellett-Bowman (Lancaster)

Does my right hon. Friend accept that my constituents are not so much worried by the rise in prescription charges as by the fact that some drugs on which they rely will no longer be obtainable? For example, elderly arthritics who in the past have taken soluble distalgesics will no longer be able to obtain them. They will have to take Paracetamal combined with Dextropropoxyphene. Will he put soluble distalgesics back on the list, or help the drug companies find a cheaper alternative?

Mr. Fowler

The two ingredients that my hon. Friend has named are the ingredients of distalgesic, and they will be available under the limited list proposals.

Dr. John Marek (Wrexham)

Does the Secretary of State accept that, notwithstanding the exemptions from prescription charges, some families will find it difficult to pay £2 for a prescription? If he accepts that, and is personally responsible for it, what estimate has he or his Department made of the number of deaths that will occur each year as a result of the extra charges? In the long run, some people will not be able to pay the £2 charges.

Mr. Fowler

I repeat that three quarters of the prescriptions are free, and the exempted groups include pensioners, children under 16, expectant and nursing mothers, people on supplementary benefit, people on family income supplement and people with low incomes. Therefore, I do not believe that the exemptions policy can remotely be criticised for not being wide enough.

Mr. Richard Tracey (Surbiton)

I am sure that my right hon. Friend was as concerned as I was to hear a doctor in a radio interview this morning saying that apparently pharmacists are advising patients on best buys, rather than doctors doing it. Are doctors not supplied with a list of prices of the same medicines so that they can do their bit to save money for the National Health Service?

Mr. Fowler

That information is provided for them.

The other point made incorrectly in the same interview this morning was that prepayment certificates—season tickets—were not available as well. That is a sensible way for someone who expects to have a number of prescriptions over a period to make an economical choice in that area.

Mr. James Lamond (Oldham, Central and Royton)

Has the Secretary of State's Department made any estimate of the drop in the number of prescriptions that will be issued following the price increase? If there is a drop, will that not show that the price will have risen to a level which even those who are not exempt cannot afford for each item? Can the Secretary of State tell us of any other necessary item of everyday use which has increased tenfold in the time that the Government have been in office?

Mr. Fowler

The answer to the hon. Gentleman's last point is that it is a matter of the proportion of NHS income, and I am seeking to maintain the 3 per cent. proportion.

The hon. Gentleman's first point is an interesting one, but it does not sustain his case. In 1979, 300 million prescriptions were dispensed. By 1983 the number had increased to 315 million, and today it is estimated at 320 million, so the number of prescriptions has increased, not reduced.

Several Hon. Members


Mr. Speaker

Order. I have to bear in mind that after questions on the statement there is to be an important Opposition Day debate. I shall endeavour to call all those hon. Members who are standing, provided that they keep their questions brief.

Mr. Richard Hickmet (Glanford and Scunthorpe)

Is my right hon. Friend satisfied with the manner in which consultants use the facilities for private health care within the NHS? In particular, what steps are taken by him or his Department to ensure that NHS waiting lists are not artifically long, or longer than they would be were facilities not available to consultants to carry out private health care within the NHS?

Mr. Fowler

As I have already made clear, I asked my statutory auditors to investigate the position in 37 health authorities. The result was that my right hon. and learned Friend the Minister for Health wrote to all authorities drawing their attention to the findings in the report. They have now been asked to report back to me on what action they are taking. They were given full permission—that is why my hon. Friend has the information—to make the reports available in public session of the health authorities. Therefore, we are taking all possible action to ensure that no money is being wasted in this area.

Mr. Robert Litherland (Manchester, Central)

Is the Minister aware that a recent area health authority report in Manchester described that city as having one of the highest short-life expectancies in the United Kingdom? Is he also aware that the number of children dying before they are one year old is one of the highest in the United Kingdom? Does he not think that the new prescription charges will lead to a worsening of the position and that that should be on his conscience, because he is making it a luxury to be ill?

Mr. Fowler

The hon. Gentleman has made rather better than I have the case for more resources to go to the National Health Service, and that is the purpose of the charging policy.

Mr. Timothy Wood (Stevenage)

Will my right hon. Friend comment again on the amount that is contributed to the NHS by way of charges? Will he further comment on how the NHS might be affected if such charges were not contributed to the overall Health Service provision.

Mr. Fowler

At present in England, out of a total budget of £14½ billion, about £460 million comes from charges. If the Labour party had its way, we would simply turn our back on that £460 million. That is the policy of the Labour party, and it has never——

Mr. Kinnock


Mr. Fowler

I am glad to hear that the Leader of the Opposition is now reversing the policy. Perhaps he will have a word with his hon. Friend the Member for Oldham, West (Mr. Meacher). It is the first time that we have had any light from the Opposition on its exact policy in this area. Up to now we had understood—the Leader of the Opposition appears to be correcting the position—that the policy was that all charges should be abolished.

Mr. Robin Corbett (Birmingham, Erdington)

Can the Secretary of State assure the House that, under the proposed charge of £2 per item, no one will be paying more than the proper cost of an item? How does the right hon. Gentleman square his announcement with the statement of his right hon. Friend the Prime Minister in April 1979, when she made an absolute promise that prescription charges would not go up?

Mr. Fowler

The Prime Minister did not make a pledge at that time——

Mr. Corbett

It is here in the Daily Mail.

Mr. Fowler

I am delighted to see my neighbour from Birmingham quoting the Daily Mail. If the Daily Mail said what the hon. Gentleman claims, it is an inaccurate report. [HON. MEMBERS: "Oh."] Even the Daily Mail makes mistakes at times. [Interruption.] "Labour's Dirty Dozen". It hardly seems to be the right quotation. The £2 prescription charge will cover only 44 per cent. of the cost of the average prescription, which is about £4.50.

Mr. Tim Eggar (Enfield, North)

How does the 3.2 per cent. of NHS expenditure to be covered by charges, as a result of my right hon. Friend's announcement today, compare with the situation in 1968, when the Labour Government reintroduced prescription charges?

Mr. Fowler

It is almost precisely the same. In 1968–69, 3.1 per cent. was provided by charges under the Labour party's policy. In 1969–70, that figure rose to 3.5 per cent., so the Labour Government were ahead of this Government in what they were asking for in charges.

Mr. George Foulkes (Carrick, Cumnock and Doon Valley)

Quite apart from the other areas of spending that could be cut instead of imposing the new charge, why does the Secretary of State prefer to raise the money through a scheme which is expensive to administer and takes money from those who are unlucky enough to be ill, rather than raising it through general taxation? If he followed that method, the cost of administration would already be covered, and those who had to pay would include those of us who are lucky enough to be well.

Mr. Fowler

Under the present charging system, those who are most in need of help do not pay and the charges fall on those who can afford to pay. Two of the groups helped over prescription charges are those on family income supplement, and retirement pensioners, who would be adversely affected if the charges were to be transferred to the tax bill.

Mrs. Edwina Currie (Derbyshire, South)

Does my right hon. Friend agree that the reactions of most people in this country to the £2 per item prescription charge will be, "Ouch"? Does he agree also that most people have not the faintest idea of the cost of the drugs being prescribed to them? Is not the time now here when we should adopt a system of prescription charges which relates much more closely to the cost of the drugs and the service being provided—35 or 40 per cent. of the scrip? It would be much the same as for dentistry. In that way we could be assured that people appreciated what they were getting.

Mr. Fowler

We can look at that, but the £2 prescription charge, with the exemptions, is a better way than the proportionate type of prescription charge which we have looked at in the past.

Mrs. Ann Clwyd (Cynon Valley)

May I remind the Secretary of State that in 1979, after his Government came to office, the Royal Commission on the National Health Service, of which I was a member, recommended abolishing prescription charges altogether? The right hon. Gentleman has completely ignored that recommendation. Secondly, why has the right hon. Gentleman ignored the recent statistics, which show that rises in dental treatment charges are already affecting the quality of treatment, and that dentists who previously used clinical judgment in prescribing treatment now have to prescribe it according to the amount of money that the patients have to pay for it? Finally, may I say that the right hon. Gentleman made a misleading statement this afternoon——

Mr. Speaker

Order. The hon. Lady has asked two questions. She must now put her third one briefly.

Mrs. Clwyd

Yes. Thank you, Mr. Speaker. Is the Minister aware that he made a misleading statement, in that he said that expectant mothers do not pay any charge? That is not true. If a woman becomes pregnant after she has started her treatment, she pays for that treatment. Surely the right hon. Gentleman should put that anomaly right instead of raising charges.

Mr. Fowler

I shall look at that anomaly.

It is all very well for the Royal Commission on the National Health Service to say that it wants prescription charges to be abolished, but it must explain how that would be financed and paid for. There is no evidence of any lasting effect on demand for dentistry. Courses of treatment have risen from 24 million in 1973–74 to 27 million in 1979, and to almost 31 million now. Between 1979 and today there has been an increase of 2,000 dentists.

Mr. Toby Jessel (Twickenham)

Will my right hon. Friend confirm that roughly half the medicine prescribed under the National Health Service is not consumed and that, as everyone knows, people have bathroom cupboards chock-a-block with half-empty bottles of medicine? Does my right hon. Friend accept that some people need drugs, that many people who receive drugs do not need them, and that the health of the nation at large would be much improved if people took more sleep, more exercise and less tobacco?

Mr. Fowler

That all sounds rather good advice.

Mr. Robert Parry (Liverpool, Riverside)

Is not the prescription charge a cruel tax on ill health? Those who are just over the poverty line and who suffer from ill health could have more pain and suffering and might even die prematurely. As the right hon. Gentleman supports this increase and this heartless Government, he should do us all a favour and resign.

Mr. Fowler

I prefer to make more resources available to the Health Service, and that is what I shall continue to do.

Mr. Tim Yeo (Suffolk, South)

As the poorest section of the community does not pay prescription charges anyway, the only effect of holding down charges, as advocated by the Opposition, would be to increase the effective subsidy paid on each subscription to better-off people. As that would reduce the resources available for those in real need, does my right hon. Friend agree that in that respect the hon. Member for Oldham, West (Mr. Meacher) is acting like Robin Hood in reverse—robbing the poor to increase subsidies for the rich?

Mr. Fowler

My hon. Friend is right. What became clear during the exchange between the Leader of the Opposition and the hon. Member for Oldham, West, the Opposition social services spokesman, is that the Opposition do not have the first idea of what their health policy actually is.

Mr. Allan Rogers (Rhondda)

The Secretary of State and his hon. Friends constantly reiterate the amount of money to be raised, but it will be so small that his action will be interpreted, particularly in Wales, as mean, spiteful and malicious. As a Welsh Member, I deplore the fact that the Secretary of State for Wales is not here for the statement. I suggest to the Secretary of State for Social Services that the reason why so many prescriptions are free is that many people are living in dire poverty.

Mr. Fowler

I shall put the hon. Gentleman's first point in reverse. He takes a grand view of £40 million. If I had come to the House and said that I was proposing to cut Health Service expenditure by £40 million, I am sure that the hon. Gentleman would have been the first to condemn that as a monstrous policy.

Mr. Peter Bruinvels (Leicester, East)

I accept that prescription charges must be raised to a more realistic level, but does my right hon. Friend agree that the time is now ripe to promote the prepayment scheme, because many people will still get their prescriptions free as before, so it is important that the service that is available to others is as wide and detailed as possible?

Mr. Fowler

I agree with my hon. Friend. We shall certainly do so.

Mr. Dennis Skinner (Bolsover)

Is Mr. 1,000 per cent. aware that only he can compete with the Prime Minister in vindictiveness against the disabled and those least able to bear it? As for the exemptions, what good will they do to Ben Gibson in my constituency, who is crippled with emphysema and who has to go into hospital three times a year? When he manages to get his breath and ring me, he says, "Can you get me a prescription for that nebuliser, Dennis?", and I write to the Secretary of State, and he says no. Is he saying no again?

Mr. Fowler

I do not know the case, and I shall not make a flip reply to a case that I have not seen. I shall look at it and give a full reply.

Mr. D. N. Campbell-Savours (Workington)

Why did the Secretary of State avoid having these increases announced in the Budget next week, at the same time as the reductions in capital gains tax, capital transfer tax and tax on the higher paid generally are announced? That is what will be done in the Budget next week. Could the real reason be that he knew that the British people would see the transparent nature of the Government's economic policy, which is to transfer from the poor directly to the rich?

Mr. Fowler

It is much simpler than that. We followed the precedent of last year. It is almost precisely to the day that we announced the increase in charges last year.

Mr. Frank Dobson (Holborn and St. Pancras)

Even as a member of a Tory Government who has seen prescription charges rise faster than the pound has come down, will the Secretary of State tell us of any further commodity or service which, since 1979, has seen a tenfold increase? Not even the £2 gallon of petrol compares with that. Will the right hon. Gentleman confirm that when the Government came to office the sick paid only 10 per cent. of the drugs bill, whereas he now expects them to pay nearly half? Further, how can the right hon. Gentleman justify his statement that the hospital services benefit from a profit of £60 million from private patients and overseas visitors when his own statement says that they have not been meeting the full cost up to now, which is why he is increasing the charges? I come back to the point that my hon. Friend the Member for Birmingham, Erdington (Mr. Corbett) and other hon. Members have raised. What can the right hon. Gentleman do to explain the Prime Minister's statement, recorded in the Daily Mail: We have no intention of increasing or introducing prescription charges."? If the Prime Minister did not agree, why did she not issue a denial? She did not do so. She gave David English a knighthood for his pack of lies.

Mr. Fowler

The matter to which the hon. Gentleman referred in his concluding comments has been raised unsuccessfully by the Leader of the Opposition with the Prime Minister. The fact of the matter is that the Prime Minister said that no responsible Government could ever promise not to increase prescription charges. The important thing is that the exemptions remain.

I repeat what I said previously about the scale of the charges. The charges today are raising about 3.2 per cent. of NHS costs, which is rather less than at the end of the 1960s, when the Labour party was in power. With regard to the pay bed contribution, I assure the hon. Gentleman that I shall want to ensure that we get the maximum income from pay beds, but that does not remotely square with his policy of simply abolishing pay beds and that income as well.