§ 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 1985 (S.I., 1985, No. 326), dated 5th March 1985, a copy of which was laid before this House on 11th March, be annulled.
§ Mr. SpeakerIt will be for the convenience of the House also to discuss the following motions:
That an humble Address be presented to Her Majesty, praying that the National Health Service (Dental Charges—Variation) Regulations 1985 (S.I., 1985, No. 352), dated 7th March 1985, a copy of which was laid before this House on 11th 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 1985 (S.I., 1985, No. 353), dated 7th March 1985, a copy of which was laid before this House on 11th March, be annulled.That an humble Address be presented to Her Majesty, praying that the National Health Service (Increase of Dental Charges) (Scotland) Regulations 1985 (S.I., 1985, No. 354), dated 7th March 1985, a copy of which was laid before this House on 11th March, be annulled.That an humble Address be presented to Her Majesty, praying that the National Health Service (Charges to Overseas Visitors) Amendment Regulations 1985 (S.I., 1985, No. 371), dated 11th March 1985, a copy of which was laid before this House on 11th March, be annulled.
§ Mr. MeacherBefore I come to the substance of this matter, I wish to register a strong protest at the manner in which the motions have been handled by the Government. They know that it is an issue of acute public interest and that the £2 prescription charge is an exceedingly unpopular move, so they are trying to smuggle through the orders at a time of maximum distraction by the Budget debate as late at night as possible.
I can give Ministers the assurance that they may control the business management of the House and manipulate it to their purpose, but they will not and cannot stop this issue from being raised on every platform throughout the country as an election issue. It may be that at the next election it is a £3 prescription charge.
We reject these orders first and foremost because, in conjunction with other Government policies now being unveiled, they represent — if they have not already reached this point — a final, decisive break with the principle so valued by the people of this country of an NHS free at the point of service for all who need it, irrespective of income, class, age and gender.
That principle is being smashed this year by a combination of a £2 prescription charge—which is no longer marginal but which is a real, onerous and damaging tax on the sick—a limited list which will, for the first time for thousands of people previously protected in exempt categories, mean that they will pay through the nose for the drugs they need, and a general practitioner voucher scheme now being examined by the DHSS— however much the Secretary of State may ignore it—that will privatise general practice in this country on the American pattern.
I warn the Government that all three measures are bitterly resented by the people of this country who want none of Reagan's health care here and have no intention 152 of returning to poor law medicine when money, vouchers and means tests — not medical needs — determined treatment. We object to the orders—
§ Mr. Tony Baldry (Banbury)Did not the Labour Government introduce prescription charges in legislation immediately after the last war?
§ Mr. MeacherPrescription charges in 1951, when the Labour Government left office, were a minuscule fraction of what they are today. The majority of people in this country would like to return to that level of charge rather then the current £2.
We object to the orders because a 10–fold increase in prescription charges is as harsh and vindictive a symbol of six years of Thatcherite Government as is the trebling of unemployment. It cannot be justified by the actual rise in the cost of drugs. The great majority of drugs prescribed have not shown excessive cost increases, and some have actually become cheaper per unit to the NHS since the mid–1970s. Increased prescription charges cannot be justified in terms of there being no alternative sources of income within the health budget, which the Secretary of State likes to pretend is the excuse.
I shall mention one other single item. How can the Secretary of State—Mr. 1,000 per cent., as we should no doubt dub him—explain putting up charges 10–fold for poor people as well as the better off when his Department this year will still hand out £135 million in tax relief, paid for by the same taxpayers, for the promotional expenses of the drugs companies when, under this Government, they have already had a guaranteed rate of profit of up to 21 per cent.? How can that possibly be justified? I will give way to the Secretary of State if he wishes to answer that question.
This huge prescription charge hype—which this year is five times the annual rate of inflation — can be justified only by the Government's obsession with markets and privatisation and their craven determination to undermine the principles of a National Health Service built on Socialist lines and designed to override the inequalities and injustices of market forces.
But even the Government have gone over the top this time because, according to a parliamentary answer on 16 November 1984, a half of all prescriptions dispensed have a net ingredient cost of below £2. That must mean that millions of people will be forced this year to pay more for their prescriptions than it costs the NHS to dispense them. Patients are being forced to subsidise the NHS in exactly the same way as council tenants are being forced to subsidise the rates through their rents continually being hyped up under the Conservatives. The same principle is being operated, pushing up charges to the point where there is forced distribution from the poor to the better off.
§ Mr. Tim Eggar (Enfield, North)As the cost of prescription charges makes the same contribution to the NHS budget as it did in 1968, when the then Labour Government reintroduced prescription charges, will the hon. Gentleman confirm that the criticism that he is levelling at the present Government would have been levelled by him at that Labour Government in 1968?
§ Mr. MeacherThe hon. Gentleman's figures are not quite correct — [Interruption.] — but I object to prescription and other charges forming anything like the proportion of total NHS expenditure that they will this 153 year, and that is the case whatever the Government in power. I wish to be in a Government who will wind down, rather than push up, prescription charges as a proportion of NHS revenue.
§ Mr. Charles Kennedy (Ross, Cromarty and Skye)If the hon. Gentleman were now the Secretary of State, given the present economic conditions, at what level would he fix prescription charges?
§ Mr. MeacherI would want them to be much lower than £2. It will be one of the priorities of our manifesto to reduce prescription charges to well below that level. I give that assurance to the people of Britain, though no doubt, by the time of the next election, the charge will not be £2. Indeed, perhaps the Secretary of State would care to say what the charge will be in 1987–88, it having increased 10 times in six years. By that time a prescription will cost between £3 and £4.
§ Mr. Tim Yeo (Suffolk, South)rose—
§ Mr. MeacherI will not give way. This is a short debate and I hope that the hon. Gentleman has an opportunity to take part.
The Secretary of State's justification for the increase when he made his statement on 11 March was that extra revenue for the NHS had to come from somewhere. That was his only excuse. There was no alternative, he claimed,but to increase charges. He said:
If we want to see more resources going to the health service, charges must make a contribution to that growth."—[Official Report, 11 March 1985; Vol. 75, c. 22.]I am glad that the Secretary of State nods his assent. Of course, that statement is untrue. The Government have said that the increase in revenue from all the increased NHS charges this year will be £40 million. A week ago the Chancellor of the Exchequer handed out, predominantly to the rich and better off, £155 million through further concessions in drawing the teeth of capital gains tax and a further £50 million from the abolition of development land tax. I shall give another example of where alternative revenue could come from if only the Government had half a mind to look elsewhere. Ten days ago The Times carried this story on its front page:
It has been estimated that defence contractors made a windfall excess profit of up to £360 million between 1980 and last year because the old 20 per cent. profit rate had been set too high by an independent review board and because the Government had refused to make a unilateral reduction in the rate.That means that the Government are ready to insist on screwing an extra £40 million out of sick patients but decline to take back from defence contractors a sum that is nine times that figure in excess profits clawed out of the Ministry of Defence by some of the most lucrative contracts in the country.
§ Mr. Jerry Hayes (Harlow)rose—
§ Mr. MeacherNo, I shall not give way. The hon. Gentleman must seek to make his own speech. If the Government want an example of alternative revenue from within the NHS, the Minister should look no further than his own recent audit of private medicine abuses. I am glad that the Minister nods. His Department audited only one sixth of the district health authorities in England and Wales. It found corruption in private practice that was cheating the NHS of about £10 million a year. If he were now to audit — I should like to know why he is not 154 doing this — the other five sixths of the health authorities, he could save far more for the NHS by making defrauding consultants, rather than sick patients, pay.
The principle of a comprehensive dental service that is free for all has virtually collapsed. Charges have escalated so far over the past six years that after 1 April patients will be obliged to pay an average contribution of about 60 per cent. of the full cost of their dental fees. The damaging features of the latest round of swingeing increases in dental charges and the real risk that they will deter people from seeking treatment and that their manner is such that they offer a price incentive to removing teeth rather than dentists seeking to preserve natural teeth, and that is not desirable.
How much better it would be if instead of there being a tax on dental health the Government attacked the causes of dental disease and not treatment. The Government are already taxing cigarettes and alcohol heavily and surely they should now be taxing sugar. That would be a far better alternative to this attack on dental health.
These huge increases in NHS charges are wrong, unpopular and unnecessary. There are far better ways of raising the money if the Government really need it.
§ Mr. MeacherNo, I shall not give way. These increases are a harsh and damaging tax on the sick. They will hit hardest some of the poorest and most vulnerable in our society. We reject them; we shall vote against them; we shall campaign against them and in the end we shall repeal them.
§ The Minister for Health (Mr. Kenneth Clarke)Five sets of regulations are being taken together. They have one point in common—they all raise revenue for the NHS. We make no apologies for raising revenue for patient services in the NHS. The hon. Member for Oldham, West (Mr. Meacher), in trying to explain his position got himself into total confusion about from where he would or would not raise revenue and his attitude towards the NHS.
The hon. Member for Oldham, West began with a ringing declaration on behalf of the National Health Service, committing himself and his party to a free service that was free at the point of delivering treatment, and so on. We would all subscribe to his declaration. He went on, however, to remind us of some of his actions in the House during the past few weeks. He was, once more, against a selective list of drugs. He said that he would deprive the Health Service of £75 million of savings which can be devoted to patient care. The hon. Gentleman is against the charges that are raised in these regulations. He is therefore, against another £70 million of revenue being raised for the Health Service, which it can spend on developing these services. His only suggestion for compensating the Health Service for this loss of income, which would undoubtedly lead to cuts in services, was to introduce taxes on food with a tax on sugar.
We are putting forward the proposals for one reason only—because we support the NHS and think that it is legitimate to carry on raising extra revenue for patient services so long as the revenue is raised from those who can afford to make a reasonable contribution.
§ Mrs. Jill Knight (Birmingham, Edgbaston)Did my right hon. and learned Friend notice that the hon. Member 155 for Oldham, West (Mr. Meacher) said that he believed in this service being free for all, irrespective of income? Would that mean that a considerable number of extremely wealthy people who are well able to pay for what they need would be able to get free dental health services?
§ Mr. ClarkeIt would mean that. The hon. Member for Oldham, West was totally irrational from the beginning to the end of his speech, as the Labour party has been irrational in its approach to a charging policy in the Health Service ever since it introduced charges in 1951. Since then, from time to time, the Labour party has promised to abolish those charges. The Labour Government abolished charges once, and then reintroduced them. The Labour Government froze the level of charges but did not abolish them the last time they were in power. It is unfortunate that we have go through this annual ritual as Labour spokesmen try to produce something that could be called a credible policy.
We make no apologies for raising revenue in this way, because we believe that we are raising only a modest contribution towards treatment from those who can afford to pay. Of course, many of them may not want to pay. Many of us do not like to pay for services that might otherwise be free. We have been concerned to ensure that no one in need is denied necessary treatment on financial grounds.
All of the pleas of the hon. Member for Oldham, West about the burden on the poor or the deterrents to treatment founder on the fact that we maintain the wide-ranging arrangement for exemption and remission which we inherited from the Labour Government when they instated the present pattern of charges. The result is that 72 per cent. of prescription items are dispensed free with a further 6 per cent. going to the holders of prepayment certificates. We are talking about the 22 per cent. of prescriptions paid for by those who can afford to make a modest contribution.
§ Mr. Tony Favell (Stockport)My right hon. and learned Friend has raised an important point. During the debate on the Budget, we heard from the Opposition nothing but bleatings that those who can afford to pay should pay. Now we hear the opposite—those who can afford to pay should not pay. How on earth can my right hon. and learned Friend explain this?
§ Mr. ClarkeI agree. It is axiomatic that the votes that the Opposition will cast tonight will mainly benefit people above the incomes level of those who at the moment are entitled to exemption. The Opposition are about to cast a vote on behalf of the better off, against the NHS depriving the Health Service of revenue and putting £2 a time into the pockets of those who do not qualify for exemption.
Because the charges that we raise are from a comparatively small proportion of the population, they make only a modest contribution to the funding of the Health Service. That revenue will account for only 3.2 per cent. of total Health Service spending in the 1985–86 financial year. My hon. Friend was right when he said that in the last year of the Wilson Government, in 1969–70, the then Labour Government raised 3.5 per cent of the income of the Health Service from charges, and relied more on charges than we do.
§ Mr. MeacherWhy bother?
§ Mr. ClarkeThe modest percentage that we are talking about will amount to £460 million worth of the income of the National Health Service, and that is the scale of the sum that the hon. Gentleman would sweep away if it remains his policy, which was quite obscure, that somehow a Labour Government will give that income altogether.
§ Mr. MeacherBefore the right hon. and learned Gentleman seeks to make capital out of the intervention of his hon. Friend the Member for Stockport (Mr. Favell), let me quote from the Central Statistical Office series "National Income and Expenditure 1983" which states that in 1968–69 the proportion of NHS revenue coming from charges was 3.1 per cent. According to the same series, in 1982–83, the figure was 6.2 per cent. — exactly double.
§ Mr. ClarkeI was talking about the last year of that Labour Government — 1969–70—when the figure was 3.5 per cent. That was a higher proportion than the 3.2 per cent. for which our charges will account.
§ Mr. MeacherThat is right—3.5 per cent. Only half of what it is now.
§ Mr. ClarkeI am amazed that we agree on a figure. I am used to Meacherite figures from documents. If the hon. Gentleman looks at the right year, he will find that the proportion was higher.
§ Mr. Robert C. Brown (Newcastle upon Tyne, North)I accept that it was a regrettable step years ago when the right hon. Member for Glasgow, Hillhead (Mr. Jenkins) —now a Social Democrat—who was our Chancellor of the Exchequer, introduced prescription charges. However, the Minister is now defending the Prime Minister, who said that the Government had no intention of increasing prescription charges. We are now in the £2 ball game, but prescriptions charges were 10p when the right hon. Lady made that statement. Is the Minister aware that two elderly constituents of mine, who came to see me at the weekend, will have to pay for prescriptions for a drug that they have been taking for 35 years?
§ Mr. Deputy Speaker (Mr. Harold Walker)Order. Interventions should be brief.
§ Mr. ClarkeI am sure that there were tears in the hon. Gentleman's eyes as he walked through the Division Lobby to support the reintroduction of prescription charges in 1968–69, and that he was even more distressed when he voted again to put them up the following year, and even more distressed when he failed to vote for their abolition at any time when the Labour party got back into power. The fact is that we are now relying on them to a lesser extent than the Government of whom he was a supporter, if not a member, in the late 1970s.
Let me tell the hon. Gentleman exactly what my right hon. Friend the Prime Minister said at a press conference on 24 May 1983 during the general election campaign. She said:
No responsible Government, no responsible Opposition, no responsible politician could rule out the possibility that prescription charges will rise. So I wouldn't dream of ruling it out.My right hon. Friend has never at any stage pledged us to the abolition of prescription charges, and she would not dream of doing so now.I should like to deal with the meat of the regulations. I shall not spend time reminding the Opposition—they 157 do not like to be reminded—that the Government are spending more on the NHS than ever before, and certainly far more than the last Labour Government or any Labour Government. Our spending is now double in cash terms what it was when we took office. It is 20 per cent. more in real terms, over and above the movement in prices, than was spent by the Labour Government. Therefore, in putting forward the charges, we are merely supporting a policy of increased spending on patient services in the NHS, and that is the only basis on which they are put forward. Increasing the basic charge from £1.60 to £2 will bring in an extra £19 million, from those who can afford it, to help offset the cost of the drugs bill, which now stands at £1.5 billion a year.
The hon. Member for Oldham, West compared the £2 prescription charge with the cost of some of the prescriptions that are dispensed. Of course, a flat rate charge, which is not related to the cost of prescriptions, will mean that the charge is rather more than the cost of some prescriptions and less than the cost of others. That has always been the case. The average prescription will cost about £4.50 next year, so we are imposing a charge that represents well under half of the average total cost of a prescription item. As I have said, 72 per cent. of prescriptions are dispensed free in any event, and we are not changing the exemption arrangements.
The cost of the prepayment certificates has also increased — four monthly ones from £8.50 to £11 and annual ones from £24 to £30.50. They are excellent value for those who think that they will require frequent prescriptions but are not exempt. They help to meet the problems that can arise for those who need frequent medication.
We have made a small concession, the need for which was impressed on us by hon. Members on both sides of the House. If, in future, someone takes out a season ticket — the prepayments certificate — but finds within one month that he is exempt, or if, unfortunately, the patient dies, the cost of the ticket will be reimbursed. It is not a big change, but it shows that we continue to try to be sensitive to the problems that arise for some people when paying prescription charges.
The hon. Member for Oldham, West said that the new charges would have a deterrent effect on people seeking drugs. He and his predecessors have said that every year as we have steadily taken prescription charges back to a reasonable level. That assertion does not square with experience or the facts in any year. The number of prescription items dispensed has increased from 300 million in 1979 to an estimated 320 million in 1984, and I do not expect it to drop in 1985 after these increases. There are fluctuations, but there is no deterrent effect because the charges are imposed only on those who can afford to pay.
I tried to follow what the hon. Member for Oldham, West said when he attempted to put together an argument suggesting that certain types of treatment are now more financially advantageous. I find it hard to take seriously anything that the hon. Gentleman says on this subject. When he last discussed this matter he claimed that more than 90 per cent. of people have to pay the maximum charge when they visit the dentist. In 1983–84, about 85,000 courses of treatment attracted the maximum charge out of a total of more than 30 million. That represents less than 0.3 per cent. The hon. Gentleman's statistics on dental charges are more unreliable than his usual 158 Meacherite statistics. Perhaps he was referring to the routine treatment maximum which we raised from £14.50—
§ Mr. MeacherYes.
§ Mr. ClarkeHe is wrong there, because more than 9 million courses of treatment consist of treatment for which no charge can be levied. That is 30 per cent. of the total. Of the remainder, 46 per cent. are provided free. That means that about 60 per cent. of people pay nothing when they visit the dentist.
Of the remaining courses, for which people pay, about half attract a charge of less than £14.50. There will be no increase in that charge, because such patients are already paying the full cost. The regulations therefore relate to about 20 per cent. only of all visits to the dentist. That is the proportion affected by the changes in the regulations. The increases in many of the charges are modest. The main change is in the charge for routine treatment, such as fillings, scaling, X-rays, extractions, and periodontal and endodontic treatment, where the total cost of the treatment is more than £14.50. I shall describe the effect of the only significant change that we are making after I have given way.
§ Mr. Norman Buchan (Paisley, South)The right hon. and learned Gentleman mentioned one third of 1 per cent., over 60 per cent. free and only 20 per cent. paying, but why in heaven's name is anything being charged? It sounds as though it would he much cheaper if it were all free.
§ Mr. ClarkeThe hon. Gentleman successfully identifies the dilemma which faces the Opposition. We are raising a perfectly worthwhile sum, which will be spent by those who provide the services of the NHS, but only from a comparatively small section of the population who can afford to make the payments. That is why the Opposition's obsession with how we are persecuting the poor and driving down the level of treatment is consistently contradicted by the facts of what happens each year after we make the changes.
The main change is to routine treatments which cost more than £14.50. I agree that the change being made is a little complicated, but it is a step towards a fairer system of charging for patients who pay. We are raising to £17 the level to which patients must pay the full cost of their treatment. Patients will pay 100 per cent. of the cost up to £17, unless they are exempt. Above that level, patients will now pay 40 per cent. of the extra cost. That means that instead of a sharp cut-off at £17, the charge will be related to the cost of the treatment. That is the only significant change in dental charges. It moves a step towards a fairer system. The increases produced will be modest, and in two thirds of the cases affected by the change the increase will be less than £10.
Hon. Members argue that increases in charges deter people from visiting the dentist. That is contradicted by all experience. Nevertheless the Opposition repeat that claim year in, year out. The number of courses of dental treatment has continued to increase from 28.5 million in 1979 to 32.6 million last year. After the increases last year, which the Opposition vigorously opposed the increase in the total number of treatments appears to have been about 1.6 per cent. The deterrent effect of which Opposition Members talk is not borne out in practice; nor will it be next year.
§ Mrs. Renée Short (Wolverhampton, North-East)According to figures issued by the British Dental Association, the cost of having a back tooth root filled will increase to about £36. Under the scheme, if a patient has some exemptions, it can cost £25. Does the Minister not see that the difference between the high cost of having one tooth filled and the cost of having it extracted, which is just more than £3, will not improve dental care for patients who cannot afford to pay the filling charges? They would prefer to have their teeth pulled out.
§ Mr. ClarkeThe change will produce a larger than average increase in the cost of certain routine treatments for which we are moving towards getting charges more closely related to the actual cost of the treatment received. That is fairer between patients. The comparison that the hon. Lady makes has always been the case. The system of dental charges always made it much cheaper to have teeth extracted but, as she knows, in modern dental practice people do not opt to have a tooth extracted if it can be saved. Experience shows that they are increasingly prepared to pay a modest charge to have a tooth saved. Those who cannot afford it and who would be driven by financial extremes to have a tooth extracted which could be saved are protected by the low income exemptions. All who are adversely affected financially have a free choice, because they are exempt from charges.
Finally, I shall deal with overseas visitors' charges, of which less has been made this year. We have raised their charges in line with the new charges for private patients. The hon. Member for Oldham, West wisely did not complain about the level of the increase, because he no doubt approves of the fact that we have increased the charges of private patients in the NHS by about 14 per cent., although the actual rate varies according to the type of hospital.
For the first time, we have improved on the system that we inherited from the previous Labour Government in yet another way, by taking into account capital costs and administrative costs in setting these charges. The overseas visitors charges must match that. I hope that no hon. Member will claim that the overseas visitors charges are discriminatory and racialist; they replace more discriminatory provisions that existed before, and they raise income from visitors who come from countries which charge British patients who visit those countries. We had only six complaints about the system in 1983, and we investigated them all. We are raising about £2 million each year from those charges, which is a worthwhile contribution to the service.
§ Mr. Max Madden (Bradford, West)The Minister said that the charges raise £2 million. Can he tell us what the net profit from those charges is?
§ Mr. ClarkeWe always thought that the administrative costs would be insignificant. Although it is obviously not a net income of £2 million, it is undoubtedly a substantial income to the service. The problems that were allegedly going to occur on the administrative front have not occurred in practice, so far as we are aware.
We are raising the charges, plus the private patients charges, to a reasonable level which we believe can be withstood by patients without deterring anyone from treatment. The effect is that we contribute to our increased 160 spending on the National Health Service. We maintain the exemption arrangements to ensure that the increases do not adversely affect the poor.
We have this debate annually. It is probably as well that it is taken late at night to spare the embarrassment of Labour Members, whose protestations become stranger each year. I hope that by the time we end the debate tonight, the hon. Member for Oldham, West will be a little clearer about the Labour party's policy this year, what the charges would be if the Labour party were in power, and what they might be if it returned to power, the hon. Gentleman said that the Labour party would wind down the charges raised by the service. He would wind down £460 million worth of income to the service if he did so. He may believe that he could take credit for that, just as he may believe that he could take credit for the fact that the Labour Government did not abolish or increase charges, but froze them for their entire period of office. We increased them 10 times because we inherited them at such an artificially low level.
When the Labour Government came to office, they were completely uncertain about what to do, but their decision was foolish and irresponsible. It was a bad decision, taken for politically expedient reasons at the expense of the National Health Service. Did they believe that the NHS did not need the money? It did, if one considers how little they spent on the service compared with what we are spending on it now. Did they believe that the Health Service needed a little money, but not much more, when they maintained the level of charges? Of course, they did not. They were impaled on the horns of a ludicrous political commitment which they knew they could not afford, but to which they clung at the expense of the Health Service. As a result, they deprived it of revenue.
We believe that we should collect all the income that we can reasonably expect to be collected by the National Health Service for the National Health Service. We shall be rigorous in collecting it from private practice. We deplore abuses and lax financial control, and we have taken steps to prevent them. The hon. Member for Oldham, West draws on what we are doing to collect income from private practice to augment his speech. We collect income from private practice, from dental charges, from prescription charges, from overseas visitors and from road traffic accident charges, because we believe that the system is reasonably fair. It exempts the poor and those who cannot pay, and it raises money for an extremely good service that can put it to the benefit of patients.
A vote against the regulations is a vote against the service, unless and until the Labour party can explain from where on earth it will get the money to maintain patient care.
§ Mr. Willie W. Hamilton (Fife, Central)We are used to the repetitious speeches of the Minister for Health on the Health Service, but the fact is that the people of the country do not believe that the Government are doing other than decimating the Health Service. I have said before in the House—and I repeat—that the evidence is there for everyone to see.
Tonight, we are debating three further stages in the dismantling of, and the attack on, the fundamental principles on which the Health Service is based. First, the optical services will be dismantled in a few days' time. 161 The right hon. and learned Gentleman did not mention that, and it may not be strictly relevant to the debate, but only children under 16, students under 19 and those on supplementary benefit, family income supplement, or other low incomes, will, from 1 April, be eligible for NHS glasses. Everybody else will be paying for their glasses, but through the private system of profiteering—or, as the Government call it, competition. If anybody believes that that will lead to reduced prices, he had better think again. They will have a rude shock when they go to pay for their glasses.
Secondly, GPs will no longer be able to prescribe certain drugs on the NHS. We have already been round this course. Only a limited number of generic drugs will be available to treat certain conditions. Some of the drugs will be available over the counter, but elderly people, children and low income families now exempt from NHS prescription charges will have to pay. The latest figure for the Government's estimate of the savings from this is £75 million. I doubt whether that will be achieved.
The main attack is the health charges that we are discussing. After six years of Tory government, in which they say that the nation has progressed, we have had growth and they are on course with their successful economic policies, they have succeeded for the first time in British history in giving us the £2 gallon of petrol and the £2 per item Health Service prescription charge. That is the measure of their success. They may say that they are doing this because they believe that, where possible, people should pay for the service that they get, as that is the gist of the Government's argument not only in health but in other sectors.
The Government always come up with the claim that 70 per cent. are exempt from charges. However, there are always a certain number of people just on the margin, who are just below entitlement for welfare benefits. They will suffer more than somewhat from the imposition of these charges. It is no good the Minister saying, as he did when my hon. Friend the Member for Oldham, West (Mr. Meacher) tackled him about dental charges that mean that it will be cheaper to have a tooth extracted than filled, that that has always been the case. That is not a justification for an extension of the practice. The right hon. and learned Gentleman knows as well as I do that there are already crooked dentists who are extracting and making fortunes. I have the figures, which have been given to me by the Minister and the Scottish Office, in parliamentary answers. This is only a minority, but some dentists make £200,000 gross and more because they are extracting teeth rather than filling them.
Although the British Dental Association has made representations to the Department of Health and Social Security asking the Department to remedy, alter, change or modify the system by which dentist are paid, which is the incentive for engaging is such malpractices, for one reason or another the right hon. and learned Gentleman has not moved to attempt to alter, modify or change that system. If the right hon. and learned Gentleman is looking for savings, there may be minimum savings by this means, but since he does not turn up his nose at saving a million or two in certain other ways, why does he not do so here?
The Opposition have asked questions many times in the House, as I did when I was on the Public Accounts Committee, about the extortionate profits that are made by the drugs companies. If the Government want to make real savings in the National Health Service the right hon. and 162 learned Gentleman ought to be much more ruthless about the drugs companies. I believe that he would like to be. He wants any savings that are made to be transferred to patient care. I believe that far greater savings could be obtained by tackling the drugs companies much more ruthlessly than the Government have done hitherto. Those savings would be far more dramatic than any savings that could be achieved by means of the regulations. I believe the right hon. and learned Gentleman knows that very well. Much more evidence is needed of the Government's determination to move in that direction. Regulations of this kind, which hit those who can ill afford to bear the burden, would not then have to be laid year after year.
If such regulations are considered in the context of the Chancellor's speech only a short time ago — about a low-wage economy and an increase in National Health Service charges—one sees that those on low incomes are continuously bearing all these burdens while people earning £20,000 and more have benefited from Budgets ever since 1979. Such regulations penalise those on low incomes. We are arguing about the basic injustice and unwisdom of it.
I do not know what a future Labour Government would do, but we agreed that the National Health Service is under-funded. Given the likely economic position of this country in three years' time, it will be very difficult to find additional revenue with which to finance the National Health Service. The Labour party set up the NHS in the face of fierce Tory opposition. We are determined as soon as possible to return to the fundamental principles upon which the NHS was based. This Government are willingly, deliberately, eagerly, moving away from that basic principle by imposing heavier and heavier charges and are seeking to excuse themselves by saying that the savings will be transferred to patient care.
I do not know by what method this House could control the direct transfer of such savings to patient care. There is no means by which the House could find that out. This is a smokescreen and the Minister knows that it is a smokescreen. We shall have no hesitation about going into the Lobby tonight to oppose these charges, because we know very will that it is not the end of a story that will continue to be extremely squalid until this Government come to an end.
§ Mrs. Edwina Currie (Derbyshire, South)Once again we have had a collection of ritual words from Labour Members. It was particularly interesting to hear the hon. Member for Oldham, West (Mr. Meacher), because this time he made a right mess of it, did he not? He started off by saying that he would abolish charges for all. We would all like to abolish charges for everybody. It would be nice to have a free NHS. But it is worth remembering that national average earnings are approaching £200 a week and that would only benefit the best off in our society, including many hon. Members, who can perfectly well afford to pay for those aspects of their care for which the Government are charging them.
Then the hon. Gentleman said that we should tax sugar. Does he realise in just how many thousands of foodstuffs that people eat every day of the week sugar is found? It is found in bread, biscuits, soup, every kind of preservative and canned fruits, not just in food that is sweet. Sugar is a major preservative. I am not held back by any payment from the British Sugar Corporation. It is 163 in every item that we eat. Therefore, the hon. Gentleman is saying that he would be pleased to see us taxing food. He would be pleased to see us taxing the food that is particularly eaten by people who cannot afford a range of choice. We are against taxing food. We have said clearly that we are against any kind of VAT extension on food. He would like to tax food; clear note should be taken of that.
Thirdly, the hon. Gentleman has a major problem because he tried hard to have a go at the Government's spending on the NHS. Yet the Government's funding of the NHS in real terms and in money terms, their results, the number of patients treated, the ways in which they are treated, the general health of our society and all the other improvements that we have seen since 1979, show that the hon. Gentleman has a real problem on his hands. Therefore, I do not blame him for making a mess of the opposition to the Government on these issues.
Nobody likes charging for prescriptions. It would be nice to have a free NHS. As long as three quarters of the prescriptions go free, we cannot argue that the charges prevent abuse. I am on record as saying in the House this time last year and previously that the wrong people get free prescriptions. It is wrong that every woman in the country from the wealthiest to the poorest should receive free contraceptives when people dying of cancer have to pay for their prescriptions, whether they have pre-payment certificates or not. Once again, I urge my right hon. and learned Friend to put that anomaly right.
As long as the charge bears no direct relation to the cost, we are not telling people what their treatment costs. We have begun to put that right with dental charges, and I urge the Government to see whether we can make the cost of prescriptions relate to the cost of the drugs so that we can tell people that their drugs are expensive and that they will be charged a proportion of their cost, perhaps with a limit, so that they will begin to understand exactly what it costs to treat them.
The charges irritate people and they put some people off, but on the dental side there is no evidence that they put a lot of people off. The number of people receiving dental treatment is well up and we can take the charges in our stride. We must have the charges, because they raise £500 million a year. Without them, the NHS would be in trouble. That is a perfectly adequate reason for having them.
The attitude of Labour Members is opposition for the sake of it, When it comes to the NHS it is sheer humbug. They would not abolish the charges. They would "reduce them below £2". How generous. For how long? Where would they find the rest of the money to make up the income thereby lost to the NHS? They did it once and they brought them back immediately. Harold Wilson, now the noble Lord Wilson of Rievaulx, resigned from the Government in 1951 when charges were introduced and he abolished them when he became Prime Minister in 1965. He then reintroduced them, within a matter of months, in 1968. He was an Oxford graduate who read politics, philosophy and economics, as did many other hon. Members, and if he could not manage without prescription charges, we can be pretty sure that nobody could. I am sure that the hon. Member for Oldham, West could not. The 164 Opposition tried twice to have free prescriptions and they failed twice. They reintroduced those charges twice and they would do the same again.
The Opposition would create even more problems for the NHS, given half the chance, because they would abolish pay beds altogether. When I was responsible for the Queen Elizabeth hospital in Birmingham, which had a budget of about £15 million, £1 million of that was raised by the charges that we made for our pay beds. It was the Labour Government of the 1960s, under the then Secretary of State, Barbara Castle, who did their best to drive pay beds out of the NHS, and almost succeeded. But in reality they only drove private patients away from the NHS into private hospitals, and consequently the NHS lost a great deal of income that we are not likely to get back. We only lost income and the opportunity to treat our people in the way that they deserved.
To deny the NHS — as the Opposition would — the sum of £500 million, or something very close to that this year, would be to deny many people the opportunities for treatment that they now have. If we abolished charges, or even reduced them in the way that has been suggested, waiting lists would be increased, research would be diminished and capital programmes would be destroyed just as they were last time this was tried. The worst off among our people would lose the most.
The Opposition's approach to the whole NHS, and particularly to NHS charges, is one of empty oratory. I am glad to support the Government.
§ Mr. Charles Kennedy (Ross, Cromarty and Skye)The hon. Member for Derbyshire, South (Mrs. Currie) suggested that one genuine way out of this annual ritual over the increasing of prescription charges might be to relate the prescription charge to the cost or value of the drug. That might be one solution, but it does not commend itself to me, and I do not imagine that it would commend itself to other hon. Members either. We would then be making people pay according to the severity of their illnesses or according to how unlucky they had been in contracting a specific illness. Therefore, although I do not question the hon. Lady's motives in making that suggestion, I do not think it would commend itself to a Government.
The Minister's speech and that of the hon. Member for Oldham, West (Mr. Meacher) showed that statistics can be used to prove anything. The Minister has performed as one would expect a slick QC to perform, particularly in his deployment of the argument over the NHS drugs bill. In the past few weeks hon. Members have been told that the limited list is necessary and essential because we must reduce the number of prescriptions, and some of the excessive and unnecessary prescribing that goes on. But when it is pointed out that proposals for dental charges and increasing prescription charges may have a deterrent effect, he denies it and says that prescribing is increasing and that that is to be greatly welcomed. He uses the same piece of information to prove one argument one week and another, quite contradictory, argument the next week. I shall be interested to hear the Minister's response to that.
We have also heard that we could tackle the cause of dental problems by taxing sugar. The hon. Member for Derbyshire, South referred to the number of products containing sugar. To be fair, however, to the hon. Member for Oldham, West, I think that he was speaking 165 specifically about the 2 lb household bag of sugar. But that suggestion might commend itself if the Government guaranteed that the revenue raised would be pumped into preventive medicine, and into putting more emphasis on preventive education. That might be a plus factor for that suggestion, but I by no means endorse the suggestion as it stands.
§ Mrs. CurrieDoes the hon. Gentleman realise that he is suggesting that it is perfectly all right to feed our children on convenience foods, but that he will tax good home baking?
§ Mr. KennedyWith great respect, I think that the part of the country that I come from has more distinguished home baking—I think that even the Under-Secretary of State for Scotland who is responsible for health will agree with me about this—than most other areas. That is not a sensible interpretation of the remark.
We oppose the charges, but not because we deny that charges are a fundamental part of health finance. We do not deny that charges have to be increased. The Government should come clean and operate an annual uprating in line with the inflation rate. That is where we part company with Labour spokesmen. I do not know what price the Labour party would put on prescription charges if it were in power, but we favour increasing prescription charges automatically in line with inflation each year. That is fair.
Of course we should like to move towards scrapping prescription charges and towards reducing the burden which they impose, but we must be honest and realistic. We cannot abolish them because of their contribution to funding the Health Service.
§ Mr. Gerald Malone (Aberdeen, South)From what base would the Alliance calculate prescription charges? If the base is similar to that proposed tonight, will the hon. Gentleman and his hon. Friends support the Government? If not, what is his base?
§ Mr. KennedyThe base is 1979 when the Conservatives came to power and started the round of changes. That is a straightforward answer.
Let us not forget why the Government propose such a massive increase. It is not just that charges were frozen by the last Labour Government, but because the Secretary of State announced that he would save £100 million through the limited list. It was an inadequate list and now the still rosy and optimistic estimate is that £75 million will be saved by that means. A large part of the difference is accounted for by the charges announced in haste before the Budget and shortly after the revised limited list was agreed. That is neither a consistent nor fair way in which to decide NHS prescriptions.
The Minister said that increased dental charges did not appear to deter people from seeking dental treatment. The Government are well known for their faith in market forces. They must see the logic of continuing to increase charges. Ministers tell all Departments that if they do not make themselves commercially attractive customers will not place orders. If the Minister continues to place such a burden through dental charges the service will cease to be attractive, or attainable, and the take-up, which he claims is increasing, will begin to subside.
The optical services have almost been moved out of the NHS. Our worry is that if we proceed with such levels of 166 uprating — which are dictated more by short-term responses to Treasury demands than by a consistent policy for ploughing growing resources into the Health Service — we shall do immense damage. With my right hon. and hon. Friends I shall be joining the Labour Opposition in the Lobby to oppose the proposals.
§ Mr. Richard Hickmet (Glanford and Scunthorpe)It is somewhat extraordinary that the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) should say that the Social Democratic party is in favour of prescription charges and will maintain them, yet, when asked at what level prescription charges will be maintained, he says at the 1979 level, plus the retail price index. That is a novel and extraordinary statement. If and when the disastrous day occurs when his party has power, how will he get back to the figures that he mentioned?
Prescription charges are designed to produce £500 million income for the NHS — about one third of the drugs bill. The debate has been about the cost of providing the drugs, the savings to be made and the increased income from raising charges. Therefore, it is legitimate to examine precisely towards what the costs, if we pass these regulations, patients in the limited categories affected will have to pay £2.
In my ignorance and innocence, I thought that we were talking about the costs of manufacture, research and development. But of the £12,069 million 1982 drugs bill, an astounding £182 million was accounted for by sales promotion, distribution and information. It is legitimate to ask how much of the £2 proposed charge will service promotional costs. In 1982, sales promotion accounted for £130 million. That is a quite unacceptable figure if we expect patients to pay £2 for their prescriptions. Of that £130 million, £60 million was spent on representatives. With respect to my right hon. and learned Friend the Minister for Health, according to a parliamentary answer last month he is unable to provide information about how representatives operating within the pharmaceutical price regulation scheme are paid or remunerated. If we expect people to pay £2 towards prescription costs, it must be legitimate to ask how that figure is made up. It is £60 million on representatives, £32 million on advertising, £17 million on literature and £12 million on information items, such as data sheets, material for medical symposia, and samples. Although the promotional costs have been reduced from 10 per cent. of the 1985 drugs bill to 9 per cent., they will still amount to £135 million.
I wish to make it clear that I believe that it is necessary to find the funds for which the Minister is asking to contribute towards those costs. However, it is not satisfactory that companies operating within the pharmaceutical price regulation scheme should get away with those expenses. If we are examining the charges to patients, we must similarly examine the costs of the drugs being supplied. Inasmuch as the cost of the drugs will be represented next year by £135 million of sales promotion — or 9 per cent. — and if we take into account distribution costs on which £60 million was spent in 1982 —and my right hon. and learned Friend does not have information on how that figure was made up—£200 million of the cost of the 1982 drugs bill of £1,300 million is represented by sales promotion, information items and distribution costs.
167 If we must increase prescription charges to £2 — regrettably, I accept that the increase is necessary—the time has come for the pharmaceutical price regulation scheme to be examined carefully. When I asked the Secretary of State how the items to which I referred were examined and what control existed, I was told in a parliamentary answer that the matter was controlled by an ad hoc formula. May we be told what sort of formula controls expenditure of £200 million? Whatever the formula, it cannot be satisfactory if it is conducted by an ad hoc method.
It is unacceptable that the NHS should have to pay for sales promotion, distribution and information amounting to almost 15 per cent. of the drugs bill, while at the same time we expect patients to pay £2 towards the cost of their prescriptions. There must be a cheaper way to disseminate information to doctors.
I shall support my right hon. and learned Friend tonight, but I urge him to accept that the time has come for a detailed examination of the PPRS, its operation and its cost to the NHS. It is a thoroughly bogus argument to say that research, development and investment in this country will be cut unless we take action of this nature, when such alarmingly high sums are spent to persuade gullible doctors to prescribe the most expensive drugs on the market.
On the subject of doctors and charges to private patients in NHS hospitals, is my right hon. and learned Friend satisfied that all such charges are being levied, that consultants are passing on information to the relevant authorities so that charges can be collected when patients are treated privately in hospital and that waiting lists are not kept artificially long as a result of pressure on consultants to perform private work? The time has come for a thorough review of the manner in which drugs in the NHS are costed.
§ Mr. Harry Ewing (Falkirk, East)The hon. Member for Glanford and Scunthorpe (Mr. Hickmet) expressed the fears, worries and doubts of hon. Members on both sides of the House about the advertising and distribution costs of the drug companies in relation to the NHS.
More important, he expressed the deep concern that is felt by many members of the public, for it is becoming obvious that a reason for the size of the drugs bill is the extent of the figures that the hon. Gentleman presented and the points made by my hon. Friend the Member for Fife, Central (Mr. Hamilton).
When Conservatives ask Opposition Members, whatever their party, what they would do to reduce prescription charges—at a time when the Government are increasing them to £2—they are insulting the sick. Whatever way the issue is considered, the increased charges are an extra tax on the sick. Any Government who would impose value added tax on the intimation of a death in the press are capable of imposing the tax that we are debating.
I shall explain to the hon. Member for Derbyshire, South (Mrs. Currie), the Minister and anyone else who wants to listen why prescription charges need not have risen on this occasion and previously since 1979 when the Government came to power and the prescription charge was 20p. We all remember how Hoffman La Roche had 168 to return millions of pounds to the NHS because it had been bleeding the service dry through overcharging it for the drugs that it was supplying. We remember vividly that millions of pounds had to be returned to the NHS because it was discovered that Hoffman La Roche — I suspect that other drug companies have been involved as well— were supplying a service and making—
§ Mr. Willie W. HamiltonExtortionate profits.
§ Mr. EwingAs my hon. Friend says, the company was making extortionate profits at the expense of the NHS and, directly, of sick people. There is undoubtedly widespread abuse of NHS facilities by private practice. The hon. Member for Glanford and Scunthorpe (Mr. Hickmet) referred to £159 million when talking about the advertising of products. If that sum were added to the money that Hoffman La Roche returned to the NHS and to the sums that would become available by clamping down on the widespread abuse of NHS facilities by those engaged in private practice, we would be able to fund this increase and every other one that the Government have imposed since coming into power in 1979.
We do not need lectures from Conservative Members on the difficulties of reducing prescription charges.
§ Mr. MaloneIt is important that this issue is clarified. To what level does the hon. Gentleman think that the charges should be reduced? At least the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) was patently honest on this score. By my calculations, he was saying that his party would introduce charges of about 35p that would be based on the rate of inflation. Is that a figure that the hon. Member for Falkirk, East (Mr. Ewing) would accept? If not, what figure would he consider reasonable?
§ Mr. EwingThe hon. Gentleman is not a lawyer cross-examining a witness now. It is for the Government to defend the £2 prescription charge, which is a tax on the sick. I invite the hon. Member for Aberdeen, South (Mr. Malone) to defend this tax on the sick at Aberdeen over the weekend. If he had listened slightly more carefully —he usually listens quite carefully—to my remarks, he would be aware that I explained that if the Government were to clamp down on the widespread abuse of NHS facilities by private practice, a significant contribution would be made to the move to reduce prescription charges.
The Government commissioned audits of health authorities in England and Wales, but we have not reached that stage in Scotland because of the complacency of the Under-Secretary of State for Scotland who is responsible for these matters. However, we shall come to that. There is evidence of abuse in Scotland as well, including one outstanding case that the Government refuse to do anything about. There is widespread abuse within the NHS as a result of private practice using NHS facilities. Nearly £200 million is spent—that sum has been mentioned by the hon. Member for Glanford and Scunthorpe — on advertising and distribution costs.
If the sums that I have mentioned had been brought together, it would not have been necessary to increase the charges. The 35p rate that the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) has talked about in using the formula laid down by the SDP causes me to have a funny feeling that it was thought out on the spur of the moment by the hon. Gentleman. Of course, that is typical of the SDP, the party of instant policy makers. I suspect 169 that the policy was framed at about five minutes to midnight. I have a funny feeling also that the SDP will live to regret the pronouncement of policy by the hon. Gentleman. We shall come to that in another debate.
Since 1979, there has been no need to increase prescription charges.
§ Mr. Jeremy Corbyn (Islington, North)Does my hon. Friend agree that one solution to the problems of NHS finances and the way in which prescription charges have increased would be to have a democratic, publicly owned and controlled drug industry? The NHS would not then be like a beggar at the doors of these multinational companies.
§ Mr. Deputy SpeakerOrder. That may be, but it is outside the scope of the measure before the House.
§ Mr. EwingI am grateful to you, Mr. Deputy Speaker.
Figures published by the Government — the hon. Member for Derbyshire, South will be especially interested in them — show that 40 per cent. of prescriptions do not cost £2 an item, yet the Government still impose a charge of £2 an item on the person who is prescribed the medicine. That can only be described as a tax on sickness. The hon. Member for Derbyshire, South said that 70 per cent. of prescriptions were free. That may have been true before the restrictive drug list was introduced. It is certain that that 70 per cent. figure does not now stand examination. Four out of every five of the more than 1,800 items removed from the list of drugs available on prescription from the NHS were prescribed for people who did not pay for their medicine. These drugs are no longer available to doctors to prescribe on the NHS, and those four out of five people will have to buy their medicine across the counter.
I imagine that the percentage of prescriptions that are free is much lower than 70 per cent. Only time will tell whether the hon. Member for Derbyshire, South, who shakes her head in disagreement, is correct or whether I am correct in asserting that, because of the restrictive list, we have prevented many people from obtaining free medicine.
§ Mrs. CurrieThe hon. Gentleman said that the £2 prescription charge is in some cases more than the cost of the item. That may well be true with regard to the cost of the drugs, but as one with an interest in this subject, in the sense that my family are retail pharamacists, I put it to the hon. Gentleman that somewhere along the line some one has to pay the pharmacist as well. A dispensing fee is involved.
§ Mr. EwingI have an interest in this matter as well, because many of my constituents are patients. My interest is only with my constituents, who are patients, and that is why I am arguing their case so forcefully.
I am the first to concede that one of the major improvements in health has been in the dental health of young children and teenagers. It is always a source of great pride to me when I look at young people with excellent teeth, because over the years it has been made relatively easy for them to pursue a course of dental treatment, either from an orthodontist or a dental practitioner. These charges will deter people, especially youngsters—there is no point in the Under-Secretary of State shaking his head — from going to dentists to obtain the treatment that will maintain the improvement in dental health which I am proud we have achieved.
§ Mr. Michael Shersby (Uxbridge)Is the hon. Gentleman aware that 50 per cent. of children under the age of 12 in England are now caries-free, and that that is a result of better nutrition, better dental health and the use of fluoride? Therefore, there is no question of them being deterred.
§ Mr. EwingI do not want to digress into the argument about proper eating habits and all that is associated with it. I caution Government supporters about venturing into that debate, because it was the present Government who deliberately sank the report on proper eating habits at the request of the companies that were feeding money into the Tory party funds, the sales of which would have been affected if the proper eating habits report had been adopted by the Government. Therefore, that is not an advisable argument for Tory Members to follow. There is no doubt that as a result of the increase in the charges, dental health will suffer.
The quicker the Government tackle the problem of the dentist's contract, the better they will be able to come to grips with the abuses in dental practice. Ministers know the flaws and defects in that contract. They know that it is easy for a dentist to reduce his NHS output, and because he is on a net target income, he is paid the same net target income for doing less NHS work. Then he increases his private practice, which leads, as my hon. Friend the Member for Fife, Central said, to dentists earning £200,000 a year. Dentists deliberately reduce their NHS output, and while obtaining the same net target income from the NHS, increase private practice output and thus earn those massive sums. Ministers must have the will to tackle that problem.
The effect of the prescription charges will be devastating on patients. I do not know for the life of me how any right hon. or hon. Member can come to the House and seek to defend these substantial increases: this tax on the sick. The Government's unpopularity is now beginning to manifest itself. On Thursday last week the Secretary of State for Scotland had the ignominy of losing a regional seat in his constituency that has been a Tory seat for nearly 80 years. That is only the beginning. It will go on and on until the Government are removed from office and a Labour Government are returned to power, committed as we are to give a free and decent Health Service to the people.
§ Mr. Michael Shersby (Uxbridge)The proposal by the hon. Member for Oldham, West (Mr. Meacher) to impose a tax on sugar as a means of ameliorating prescription charges is quite extraordinary. In making my speech, as always, I declare that I have an outside interest in the sugar industry. Therefore, I am interested to hear the hon. Gentleman attack constituents of his hon. Friends the Members for Greenock and Port Glasgow (Dr. Godman) and for Newham, South (Mr. Spearing) and apparently attempt to reverse the Labour party's policy by imposing a tax on sugar, which, if it were ever to be approved, would affect the price of every other food product on supermarket shelves. The hon. Gentleman is trying to turn the clock back to the days of Disraeli, who abolished the sugar tax.
Therefore, I hope that the hon. Gentleman will do his homework and that in future he will pay attention to the report of the panel that reported recently on diet and 171 cardiovascular disease, and made no recommendation for a reduction in sugar consumption. Therefore, his arguments are not well founded. They are merely parroting the cries for yet another tax burden on people who can ill afford to pay. The hon. Gentleman should think again before he talks about such taxation.
I should like to refer to the pharmaceutical industry and pick up the remarks of the hon. Member for Fife, Central (Mr. Hamilton), who was a member of the Public Accounts Committee. I am a member of that Committee at present. I remind the hon. Gentleman that the work that he and his colleagues set in hand when he was a member of that Committee, in using the pharmaceutical price regulations scheme to reduce the profit margin on pharmaceutical products, has been carried on by the present Committee. Profit margins on drugs are today even lower than they were when the hon. Gentleman was a member of that Committee.
The remedies thrown out by the Opposition today in their desperation to justify their extraordinary policies do not wash, and the hon. Member for Oldham, West had better do better in future debates.
It being one and a half hours after the commencement of proceedings on the motion, MR. DEPUTY SPEAKER put the Question, pursuant to Standing Order No. 3 (Exempted Business).
§ The House divided: Ayes 179, Noes 268.
174| Division No.166] | [12.15 pm |
| AYES | |
| Adams, Allen (Paisley N) | Corbyn, Jeremy |
| Alton, David | Cowans, Harry |
| Archer, Rt Hon Peter | Cox, Thomas (Tooting) |
| Ashley, Rt Hon Jack | Craigen, J. M. |
| Ashton, Joe | Crowther, Stan |
| Atkinson, N. (Tottenham) | Cunliffe, Lawrence |
| Bagier, Gordon A. T. | Cunningham, Dr John |
| Banks, Tony (Newham NW) | Davies, Rt Hon Denzil (L'lli) |
| Barnett, Guy | Davies, Ronald (Caerphilly) |
| Barron, Kevin | Davis, Terry (B'ham, H'ge H'l) |
| Beckett, Mrs Margaret | Deakins, Eric |
| Beith, A. J. | Dewar, Donald |
| Bell, Stuart | Dixon, Donald |
| Benn, Tony | Dobson, Frank |
| Bennett, A. (Dent'n & Red'sh) | Dormand, Jack |
| Bermingham, Gerald | Dubs, Alfred |
| Bidwell, Sydney | Duffy. A. E. P. |
| Blair, Anthony | Dunwoody, Hon Mrs G. |
| Boyes, Roland | Eadie, Alex |
| Bray, Dr Jeremy | Eastham, Ken |
| Brown, Gordon (D'f'mline E) | Evans, John (St. Helens N) |
| Brown, Hugh D. (Provan) | Ewing, Harry |
| Brown, N. (N'c'tle-u-Tyne E) | Fatchett, Derek |
| Brown, R. (N'c'tle-u-Tyne N) | Field, Frank (Birkenhead) |
| Brown, Ron (E'burgh, Leith) | Fields, T. (L'pool Broad Gn) |
| Bruce, Malcolm | Fisher, Mark |
| Buchan, Norman | Flannery, Martin |
| Caborn, Richard | Foot, Rt Hon Michael |
| Callaghan, Jim (Heyw'd & M) | Forrester, John |
| Campbell-Savours, Dale | Foster, Derek |
| Canavan, Dennis | Fraser, J. (Norwood) |
| Carlile, Alexander (Montg'y) | Freeson, Rt Hon Reginald |
| Cartwright, John | Garrett, W. E. |
| Clark, Dr David (S Shields) | Golding, John |
| Clarke, Thomas | Hamilton, James (M'well N) |
| Clay, Robert | Hamilton, W. W. (Central Fife) |
| Clwyd, Mrs Ann | Hancock, Mr. Michael |
| Cocks, Rt Hon M. (Bristol S.) | Harrison, Rt Hon Walter |
| Cohen, Harry | Hart, Rt Hon Dame Judith |
| Coleman, Donald | Healey, Rt Hon Denis |
| Concannon, Rt Hon J. D. | Hogg, N. (C'nauld & Kilsyth) |
| Conlan, Bernard | Holland, Stuart (Vauxhall) |
| Home Robertson, John | Parry, Robert |
| Hoyle, Douglas | Patchett, Terry |
| Hughes, Robert (Aberdeen N) | Pendry, Tom |
| Hughes, Roy (Newport East) | Penhaligon, David |
| Hughes, Sean (Knowsley S) | Pike, Peter |
| Hughes, Simon (Southwark) | Powell, Raymond (Ogmore) |
| Janner, Hon Greville | Radice, Giles |
| John, Brynmor | Redmond, M. |
| Johnston, Russell | Rees, Rt Hon M. (Leeds S) |
| Jones, Barry (Alyn & Deeside) | Richardson, Ms Jo |
| Kaufman, Rt Hon Gerald | Roberts, Allan (Bootle) |
| Kennedy, Charles | Roberts, Ernest (Hackney N) |
| Kilroy-Silk, Robert | Robinson, P. (Belfast E) |
| Kirkwood, Archy | Rogers, Allan |
| Lamond, James | Ross, Stephen (Isle of Wight) |
| Leadbitter, Ted | Rowlands, Ted |
| Leighton, Ronald | Ryman, John |
| Lewis, Ron (Carlisle) | Sheerman, Barry |
| Lewis, Terence (Worsley) | Sheldon, Rt Hon R. |
| Litherland, Robert | Shore, Rt Hon Peter |
| Lloyd, Tony (Stretford) | Short, Mrs R.(W'hampt'n NE) |
| Loyden, Edward | Silkin, Rt Hon J. |
| McCartney, Hugh | Skinner, Dennis |
| McCrea, Rev William | Smith, C.(Isl'ton S & F'bury) |
| McDonald, Dr Oonagh | Smith, Cyril (Rochdale) |
| McNamara, Kevin | Smith, Rt Hon J. (M'kl'ds E) |
| McTaggart, Robert | Soley, Clive |
| McWilliam, John | Spearing, Nigel |
| Madden, Max | Steel, Rt Hon David |
| Marek, Dr John | Stewart, Rt Hon D. (W Isles) |
| Marshall, David (Shettleston) | Stott, Roger |
| Martin, Michael | Straw, Jack |
| Maxton, John | Thomas, Dr R. (Carmarthen) |
| Maynard, Miss Joan | Thorne, Stan (Preston) |
| Meacher, Michael | Tinn, James |
| Meadowcroft, Michael | Wallace, James |
| Michie, William | Wardell, Gareth (Gower) |
| Mikardo, Ian | Wareing, Robert |
| Millan, Rt Hon Bruce | Weetch, Ken |
| Miller, Dr M. S. (E Kilbride) | Williams, Rt Hon A. |
| Morris, Rt Hon A. (W'shawe) | Wilson, Gordon |
| Morris, Rt Hon J. (Aberavon) | Winnick, David |
| Nellist, David | Woodall, Alec |
| Oakes, Rt Hon Gordon | Wrigglesworth, Ian |
| O'Brien, William | Young, David (Bolton SE) |
| O'Neill, Martin | |
| Orme, Rt Hon Stanley | Tellers for the Ayes: |
| Owen, Rt Hon Dr David | Mr. Frank Haynes and |
| Paisley, Rev Ian | Mr. Allen McKay. |
| Park, George | |
| NOES | |
| Aitken, Jonathan | Boyson, Dr Rhodes |
| Amess, David | Brandon-Bravo, Martin |
| Ancram, Michael | Bright, Graham |
| Arnold, Tom | Brinton, Tim |
| Ashby, David | Brooke, Hon Peter |
| Aspinwall, Jack | Brown, M. (Brigg & Cl'thpes) |
| Atkins, Robert (South Ribble) | Browne, John |
| Atkinson, David (B'm'th E) | Bruinvels, Peter |
| Baker, Rt Hon K. (Mole Vall'y) | Bryan, Sir Paul |
| Baker, Nicholas (N Dorset) | Buck, Sir Antony |
| Baldry, Tony | Budgen, Nick |
| Banks, Robert (Harrogate) | Bulmer, Esmond |
| Batiste, Spencer | Burt, Alistair |
| Beaumont-Dark, Anthony | Butcher, John |
| Bellingham, Henry | Butler, Hon Adam |
| Bendall, Vivian | Butterfill, John |
| Benyon, William | Carlisle, John (N Luton) |
| Best, Keith | Carlisle, Kenneth (Lincoln) |
| Bevan, David Gilroy | Carlisle, Rt Hon M. (W'ton S) |
| Biggs-Davison, Sir John | Cash, William |
| Blackburn, John | Chalker, Mrs Lynda |
| Blaker, Rt Hon Sir Peter | Channon, Rt Hon Paul |
| Bonsor, Sir Nicholas | Chapman, Sydney |
| Boscawen, Hon Robert | Chope, Christopher |
| Bottomley, Peter | Clark, Hon A. (Plym'th S'n) |
| Bottomley, Mrs Virginia | Clark, Dr Michael (Rochford) |
| Bowden, A. (Brighton K'to'n) | Clark, Sir W. (Croydon S) |
| Bowden, Gerald (Dulwich) | Clarke, Rt Hon K. (Rushcliffe) |
| Clegg, Sir Walter | Haselhurst, Alan |
| Cockeram, Eric | Hawkins, C. (High Peak) |
| Colvin, Michael | Hawkins, Sir Paul (SW N'folk) |
| Coombs, Simon | Hawksley, Warren |
| Cope, John | Hayes, J. |
| Couchman, James | Hayward, Robert |
| Currie, Mrs Edwina | Heathcoat-Amory, David |
| Dickens, Geoffrey | Heddle, John |
| Dicks, Terry | Henderson, Barry |
| Dorrell, Stephen | Hickmet, Richard |
| Douglas-Hamilton, Lord J. | Hicks, Robert |
| Dover, Den | Hind, Kenneth |
| du Cann, Rt Hon Sir Edward | Hirst, Michael |
| Dunn, Robert | Hogg, Hon Douglas (Gr'th'm) |
| Durant, Tony | Holt, Richard |
| Dykes, Hugh | Hordern, Peter |
| Edwards, Rt Hon N. (P'broke) | Howard, Michael |
| Eggar, Tim | Howarth, Alan (Stratf'd-on-A) |
| Emery, Sir Peter | Howarth, Gerald (Cannock) |
| Evennett, David | Howell, Rt Hon D, (G'ldford) |
| Eyre, Sir Reginald | Howell, Ralph (N Norfolk) |
| Fallon, Michael | Hunt, David (Wirral) |
| Farr, Sir John | Hunt, John (Ravensbourne) |
| Favell, Anthony | Hunter, Andrew |
| Fenner, Mrs Peggy | Jessel, Toby |
| Finsberg, Sir Geoffrey | Johnson Smith, Sir Geoffrey |
| Forman, Nigel | Jones, Gwilym (Cardiff N) |
| Forsyth, Michael (Stirling) | Jones, Robert (W Herts) |
| Forth, Eric | Kellett-Bowman, Mrs Elaine |
| Fowler, Rt Hon Norman | Kershaw, Sir Anthony |
| Fox, Marcus | Key, Robert |
| Franks, Cecil | King, Roger (B'ham N'field) |
| Fraser, Peter (Angus East) | Knight, Gregory (Derby N) |
| Fry, Peter | Knight, Mrs Jill (Edgbaston) |
| Gale, Roger | Knox, David |
| Galley, Roy | Lang, Ian |
| Gardiner, George (Reigate) | Latham, Michael |
| Gardner, Sir Edward (Fylde) | Lawler, Geoffrey |
| Goodhart, Sir Philip | Lawrence, Ivan |
| Goodlad, Alastair | Lee, John (Pendle) |
| Gow, Ian | Lennox-Boyd, Hon Mark |
| Grant, Sir Anthony | Lester, Jim |
| Gregory, Conal | Lewis, Sir Kenneth (Stamf'd) |
| Griffiths, E. (B'y St Edm'ds) | Lilley, Peter |
| Griffiths, Peter (Portsm'th N) | Lloyd, Ian (Havant) |
| Ground, Patrick | Lord, Michael |
| Grylls, Michael | Luce, Richard |
| Gummer, John Selwyn | Lyell, Nicholas |
| Hamilton, Hon A. (Epsom) | McCrindle, Robert |
| Hamilton, Neil (Tatton) | McCurley, Mrs Anna |
| Hampson, Dr Keith | Macfarlane, Neil |
| Hanley, Jeremy | MacKay, Andrew (Berkshire) |
| Hannam, John | MacKay, John (Argyll & Bute) |
| Hargreaves, Kenneth | Maclean, David John |
| Harris, David | McNair-Wilson, P. (New F'st) |
| Harvey, Robert | McQuarrie, Albert |
| Madel, David | Renton, Tim |
| Major, John | Rhodes James, Robert |
| Malins, Humfrey | Ridley, Rt Hon Nicholas |
| Malone, Gerald | Ridsdale, Sir Julian |
| Maples, John | Rifkind, Malcolm |
| Marland, Paul | Roberts, Wyn (Conwy) |
| Marlow, Antony | Roe, Mrs Marion |
| Mather, Carol | Sainsbury, Hon Timothy |
| Maude, Hon Francis | St. John-Stevas, Rt Hon N. |
| Mawhinney, Dr Brian | Shaw, Giles (Pudsey) |
| Mayhew, Sir Patrick | Shaw, Sir Michael (Scarb') |
| Mellor, David | Shepherd, Colin (Hereford) |
| Merchant, Piers | Shepherd, Richard (Aldridge) |
| Meyer, Sir Anthony | Shersby, Michael |
| Miller, Hal (B'grove) | Silvester, Fred |
| Mills, Iain (Meriden) | Sims, Roger |
| Mills, Sir Peter (West Devon) | Skeet, T. H. H. |
| Mitchell, David (NW Hants) | Smith, Sir Dudley (Warwick) |
| Moate, Roger | Spencer, Derek |
| Montgomery, Sir Fergus | Stevens, Lewis (Nuneaton) |
| Morris, M. (N'hampton, S) | Stevens, Martin (Fulham) |
| Morrison, Hon P. (Chester) | Stewart, Allan (Eastwood) |
| Moynihan, Hon C. | Stewart, Andrew (Sherwood) |
| Mudd, David | Stokes, John |
| Murphy, Christopher | Tebbit, Rt Hon Norman |
| Neale, Gerrard | Terlezki, Stefan |
| Needham, Richard | Thomas, Rt Hon Peter |
| Nelson, Anthony | Thompson, Donald (Calder V) |
| Neubert, Michael | Thompson, Patrick (N'ich N) |
| Newton, Tony | Thurnham, Peter |
| Nicholls, Patrick | Townsend, Cyril D. (B'heath) |
| Normanton, Tom | Trotter, Neville |
| Norris, Steven | Twinn, Dr Ian |
| Onslow, Cranley | Vaughan, Sir Gerard |
| Oppenheim, Phillip | Viggers, Peter |
| Osborn, Sir John | Waldegrave, Hon William |
| Ottaway, Richard | Walden, George |
| Page, Richard (Herts SW) | Wall, Sir Patrick |
| Parris, Matthew | Waller, Gary |
| Patten, Christopher (Bath) | Wardle, C. (Bexhill) |
| Patten, J. (Oxf W & Abdgn) | Warren, Kenneth |
| Pattie, Geoffrey | Watson, John |
| Pawsey, James | Wells, Bowen (Hertford) |
| Percival, Rt Hon Sir Ian | Wheeler, John |
| Pollock, Alexander | Whitney, Raymond |
| Portillo, Michael | Wilkinson, John |
| Powell, William (Corby) | Wolfson, Mark |
| Powley, John | Young, Sir George (Acton) |
| Proctor, K. Harvey | |
| Raffan, Keith | Tellers for the Noes: |
| Raison, Rt Hon Timothy | Mr. Peter Lloyd and |
| Rathbone, Tim | Mr. Tristan Garel-Jones. |
§ Question accordingly negatived.