Family Practitioner Services

HC Deb 10 March 1986 vol 93 cc669-76 3.36 pm

The Minister for Health (Mr. Barney Hayhoe)

With permission, Mr. Speaker, I should like to make a statement on charges in the NHS family practitioner services from 1 April 1986.

The 1985 public expenditure White Paper included plans to increase spending on the NHS overall by £1 billion in England during 1986–87. Family practitioner services' expenditure continues to increase to meet service pressures, demographic and social changes, and advances in treatment of all kinds, including drugs. The Government have provided for an increase of £250 million in England in 1986–87. All but a small part of this will be met from taxation and national insurance. The remainder will come from increased revenue from charges to patients. The proportion of the cost of the NHS met through charges is expected to fall slightly in 1986–87 to 3–02 per cent.

There will be no change in dental and optical charges. The prescription charge will rise from £2.00 to £2.20. The four-monthly and annual season ticket fees will increase in the same proportion, to £12 and £33.50 respectively.

The existing range of exemptions from charges will continue, including the present exemptions from the prescription charge for those suffering from certain specified conditions.

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. and learned Friend the Secretary of State for Scotland and my right hon. Friend the Secretary of State for Northern Ireland will be taking the equivalent steps. A note providing full details of the changes is available in the Vote Office.

Mr. Frank Dobson (Holborn and St. Pancras)

That appears to be the shortest statement ever made on prescription charges. I can assume only that the principle of least said soonest mended has been applied.

Will the Minister confirm that the increase in prescription charges is more than twice the rate of inflation, and that it is an increase of 1,000 per cent—in other words, an elevenfold increase—since 1979, when the right hon. Member for Finchley (Mrs. Thatcher) told the country, via the front page of the Daily Mail, under the heading, "Twelve Labour Lies":

We have no intention of increasing or introducing prescription charges. Can the Minister tell us of any other commodity or service that has witnessed such an increase during that period? If not, why have the Government singled out health for the lowest possible priority? Does the right hon. Gentleman accept the BMA's view that the present level of prescription charges deters poorer people who are not exempt from them? When does he intend to announce the outcome of the review of exemptions from prescription charges for those suffering from certain specified conditions, which he has been promising for some time?

We welcome the decision not to increase dental charges again, but does the Minister accept that the dental charges introduced last year are doing severe damage to the dental care of poorer people? Does he accept the British Dental Association's survey, which showed that, not unexpectedly, poorer people are put off most by last year's increase? Does he accept the evidence quoted by the British Dental Association that the new charges introduced last year have increased the cost of routine treatment payable by the patient by no less than 39 per cent.—eight times the rate of inflation?

Does the Minister accept that the Government have abolished the supply of NHS glasses, introduced prohibitive charges for dental treatment and are now deterring many people from getting prescriptions? Will he remind himself that there have been distinguished people in his office of Minister for Health who have made their reputations by caring more about the health of the nation than about being popular with the Treasury?

Mr. Hayhoe

The hon. Gentleman's description of what has happened is a travesty of the reality. The 10 per cent. increase is exactly in line with the rise in costs of medicines. It is more than the rise in the retail price index because better and often more expensive medicines are being prescribed and patients are benefiting accordingly. I should remind the hon. Gentleman that 75 per cent. of prescriptions are exempt from charges anyway and that 5 per cent. are met by season tickets.

My right hon. Friend the Prime Minister has made it perfectly clear that no responsible Government could ever promise not to increase prescription charges. The important matter—although I recognise that importance and reality are not matters which concern the hon. Gentleman and his hon. Friends—is that the exemptions remain.

On the question of certain specified conditions, the hon. Gentleman clearly did not listen to the statement or read the advance copy which was sent to him. The hon. Gentleman seems to be unable to criticise dental charges this year and has had to refer to what happened last year, which perhaps shows the depth and strength of his criticisms.

Mr. Robert McCrindle (Brentwood and Ongar)

Is it not a fact that year after year the same people are subject to exemption? While for the most part that is correct, has the time not arrived when some review of those exemptions might well be undertaken to see whether, for example, the better-off retired who are capable of paying prescription charges should not be exempted, which might lead to a lower increase for the rest of us?

Mr. Hayhoe

As I made clear in my statement, I have no plans to change the existing range of exemptions, which will continue, nor to change the present exemptions from the prescription charge for those suffering from certain specified conditions, but I have noted what my hon. Friend said.

Mr. Gregor MacKenzie (Glasgow, Rutherglen)

Is the Minister aware that while we heard him specifically relate his monetary charges to England, he made no reference to charges and increases in Scotland? Are we to expect a specific statement about that from the Secretary of State for Scotland on another occasion? I assure the right hon. Gentleman that Scottish Members of Parliament take exception, first, to his acting in this way, and, secondly, to the increases.

Mr. Hayhoe

We are following the precedents which have been established on many occasions for the announcement of such increases. As I said in my statement, my right hon. and learned Friend the Secretary of State for Scotland will make arrangements for the necessary regulations to be laid before the House.

Mr. Patrick Cormack (Staffordshire, South)

Will my right hon. Friend give thought to the manner in which exemptions and season tickets are publicised? Will he spend a little money on a good graphic designer, because many people are not aware that they are entitled to a season ticket or exemption?

Mr. Hayhoe

I am grateful for my hon. Friend's constructive comments. I reiterate that pensioners, children under 16, expectant and nursing mothers, those in receipt of supplementary benefit or family income supplement, and those on low incomes are entitled to exemptions, and, as I have said, these account for three out of four of prescriptions.

Mr. Michael Meadowcroft (Leeds, West)

Is the Minister aware that his reason for putting up prescription charges by more than double the rate of inflation runs wholly counter to his expressed policy in introducing the restricted list and shows the failure of that policy? Could we not expect to have increases that are lower than the rate of inflation when the Government are supposed to be saving through the restricted list? Does not the Government's method of trying to limit access to much-needed medicines through the size of one's purse, which method they have presumably rejected for dental charges because they have not put them up, show that they accept that increased costs have a deterrent effect on people seeking treatment? Why will the Government not accept the same conclusion on prescriptions?

Mr. Hayhoe

There is no evidence to suggest that there is a deterrent effect. The hon. Gentleman has it wrong about the limited list. It was introduced by my predecessor, who said that he hoped it would bring a saving of £75 million in a full year. I am advised that it is on target to achieve that saving. The increase that I have announced today will bring in about £7 million, about one tenth of the amount that is being saved as a result of the restricted list. When I say saved, I mean saved on the drugs bill, thus making the funds available for patient care in other sectors. Of that there is no doubt.

Mr. David Sumberg (Bury, South)

Will my right hon. Friend remind the House that nearly three quarters of all prescriptions are issued free, will he confirm that that will continue, and will he also remind the House that, as a result of the exemptions, the poorest in our community continue to pay no charge for the products that they use?

Mr. Hayhoe

My hon. Friend is right. It is worth underlining that in view of the rather specious opposition that we are getting from Labour and Alliance Members. Three quarters of the population pay no prescription charges, and that means that the poorest within our community are wholly and fully protected by these arrangements.

Mr. Willie W. Hamilton (Fife, Central)

Will the Minister re-emphasise that it is £2.20 per item, not per prescription, which means that the great majority of people who are not exempt will pay £6.60 for three items on a prescription, and that that will be a considerable hardship for people on low incomes who are above supplementary benefit level? Does he not recognise the danger of that situation, in that people will tend to go to the chemist and prescribe their own medicines, or get them prescribed for them by the chemist?

Mr. Hayhoe

The hon. Gentleman is wrong in saying that the majority of people who go to a chemist with more than one item on a prescription will pay in the way that he specified. The majority of people, as I have said on three or four occasions, are exempt—75 per cent. are exempt. I confirm that what he said about the number of items on a prescription is correct.

Mr. Robin Maxwell-Hyslop (Tiverton)

My right hon. Friend has referred to people on what he has termed low incomes who are entitled to reimbursement—not to free prescriptions. How do people in this category who are not in receipt of a specific pension recognise themselves as being entitled to reimbursement?

Mr. Hayhoe

There is an NHS leaflet available which gives that information. I shall gladly send a copy to the hon. Gentleman. It is freely available, and I am surprised that he has not seen it.

Mr. Kevin Barron (Rother Valley)

In answering my hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) the Minister said that parts of my hon. Friend's speech were a travesty of the truth. Does the Minister agree that it was a travesty for the then Leader of the official Opposition to make promises to the nation that there would be no increase in prescription charges and then, within seven years, to increase those charges by 1,000 per cent.?

Mr. Hayhoe

The tragedy at the moment is that the Opposition have pledged to remove all the charges, which would amount to about £500 million a year, but they do not say, in this area or in any other, where the extra money is to come from. The Opposition are very quick to say that they will spend money, but they will not say where the resources will come from.

Dr. Michael Clark (Rochford)

Will my right hon. Friend say whether the expected revenue from these higher charges in 1986–87 will be a greater or smaller percentage of the total NHS drug charges than the present charges in the current financial year?

Mr. Hayhoe

There will be a slight reduction, and overall, taking NHS spending as a whole, there is a small reduction in the percentage of the total NHS costs now being met by charges.

Mr. Harry Ewing (Falkirk, East)

Is it not a disgraceful use of figures for the Minister to justify a 10 per cent. increase in prescription charges by saying that the cost of drugs and medicines has risen by 10 per cent , bearing in mind that when the Opposition argue for increased spending on the NHS, the Government use the Treasury inflationary figure of 5 per cent.? The figures put forward by the Minister are not only disgraceful but are an additional tax burden on sickness, for which the people will not readily forgive the Tory Prime Minister and her Government.

Mr. Hayhoe

I reject the hon. Gentleman's emotive comments. I made the comment about the relationship with the rising costs of medicines because that is factually correct. As the hon. Gentleman knows, I regularly supply figures to the House, and particularly to the hon. Member for Holborn and St. Pancras (Mr. Dobson), based both on the retail price index and on NHS prices and pay.

Mr. Tony Baldry (Banbury)

Did my right hon. Friend see a report last week from the British Medical Association, which said that doctors felt that many of the shortfalls in the NHS could be met by cutting out waste in the NHS? Will my right hon. Friend have discussions with the BMA on how essential savings can be made in the durgs bill, not least by cutting out over-prescribing?

Mr. Hayhoe

I am glad to say that one of the first, if not the first, official engagement that I had as Minister for Health was to attend a conference with leading representatives of the medical profession and the pharmaceutical industry about prescribing. My information is that, following the introduction of the limited list last year and the great publicity that was given to these matters, more responsible prescribing is now taking place more widely in the NHS.

Dr. Roger Thomas (Carmarthen)

Is the Minister not using a twin-headed coin? He blames today's rise on the fact that doctors are prescribing more expensive medications, yet the Minister's predecessor made sure that many cheap but effective remedies are not available. For example, simple antacids are now replaced by acid blocking drugs costing ten times as much as the antacids.

Mr. Hayhoe

If the hon. Gentleman is seeking to rerun the arguments about the selective list, he must recognise that the changes were made as a result of decisions taken by a distinguished and authoritative group of medical and pharmaceutical experts. These changes, as I said a moment ago, are achieving a £75 million a year saving in the drugs bill, and these extra resources are being used for patient care in other areas.

Mr. Charles Kennedy (Ross, Cromarty and Skye)

Does the Minister accept that, although the exclusion of dental and optical charges is much needed and very welcome, his defence of increasing prescription charges by twice the rate of the retail price index needs to be further explained? On previous occasions the Minister has refuted my argument by saying at the Dispatch Box that the accurate measure of inflation in the National Health Service is the retail price index, rather than the internal National Health Service rate. However, he has defended this statement by using the internal National Health Service rate of increased drugs charges to justify this increase. Does that indicate a change in Department of Health and Social Security or Treasury policy, and if not, why not?

Mr. Hayhoe

It indicates that either the hon. Gentleman is seeking to misrepresent what I have said, or that he has misunderstood it.

Mr. Richard Hickmet (Glanford and Scunthorpe)

Does my right hon. Friend agree that the Opposition's reaction of outrage is synthetic and bogus, that it is motivated, as usual, by political objectives, that the Government are committed to providing free drugs for pensioners, children, and pregnant women and nursing mothers and that in those circumstances the Government's policy is entirely to be applauded?

Mr. Hayhoe

I think that my hon. Friend has put it in a nutshell.

Mr. David Winnick (Walsall, North)

Is the Minister for Health aware that there is nothing phoney in the Opposition's condemnation of the 1,000 per cent. increase in prescription charges since this Government took office? The Minister always refers to the number of exemptions from prescription charges, but will he confirm that a large number of families, by no means high income earners, are not exempt? Therefore, this further increase in prescription charges is a tax on the sick. The Minister should therefore be thoroughly ashamed of himself for having come to the House to justify yet another increase.

Mr. Hayhoe

I do not accept that argument for one moment. The reality is that the percentage of the total cost of the National Health Service that is being met by charges is within tenths of a percentage point of what it was during the last full year of the previous Labour Government.

Mr. Peter Bruinvels (Leicester, East)

Although I regret these increases, which will affect 25 per cent. of sick people, will my right hon. Friend confirm that only 5 per cent. of sick people claim a season ticket? Should not my right hon. Friend encourage all surgeries to make leaflets available to patients informing them of their entitlement? Perhaps Saatchi and Saatchi ought to be used to publicise this fact. If one fell ill, one would be able to apply there and then for a season ticket. That is the way to keep down prices.

Mr. Hayhoe

Of course I am glad to recommend the wider use of season tickets by those who need a steady supply of medicine. However, that does not apply, happily, to a substantial number of our fellow citizens. The increase from £2 to £2.20 that I have announced, together with the widespread exemptions, will not place a heavy additional burden upon those in the community who will have to pay the increased charge.

Several Hon. Members

rose—

Mr. Speaker

Order. I shall call the three hon. Members who have been rising, but may I ask them to put brief questions. I call the hon. Member for Workington (Mr. Campbell-Savours).

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

Why should 15 million people have to pay an increase that is twice the rate of inflation? Is there not an irony in the fact that the Minister stood at the Dispatch Box as a Treasury Minister only a year or two years ago and asked for the indexation of capital gains tax and capital transfer tax at a rate that was equal to the rate of inflation? Is it not obvious that, although the Minister wants to secure justice, in his view, for those who are paying taxation on very large incomes and very large tranches of wealth, he does not want equally to protect those who are not in such a privileged position?

Mr. Hayhoe

If I were to take the hon. Gentleman's figure of 15 million people who are to pay, in total, over the year an additional £7 million, it would mean that in fact those people were paying 1p a week more.

Mr. John Ryman (Blyth Valley)

The Minister said, quite wrongly, that there is no evidence that increased prescription charges deter patients from asking for prescriptions. There is an abundance of evidence in northeast England about that. Will the Minister have a word with the chairman of the northern regional health authority? He would show the Minister his annual report, which cites specific examples. Will the Minister also have a look at the enormous profits that are made by pharmaceutical firms from supplying drugs to the National Health Service?

Mr. Hayhoe

I am prepared to consider any evidence on the first issue which the hon. Gentleman gives to me. Secondly, I am glad to have his implicit support for the measures taken by my predecesser, which much reduced the moneys flowing to the pharmaceutical companies. As I think is well known, discussions and negotiations between the Government and the pharmaceutical companies are continuing. I hope that a satisfactory agreement to all concerned will result.

Mr. John Home Robertson (East Lothian)

The Minister is claiming much credit for the exempted patients, but will he say a little more about the consequences of the exempted drugs being taken out of the NHS? What does he say to those of my constituents who are still complaining to me that they cannot obtain on the NHS the drugs that they need? I have made representations on this issue to the Minister at the Scottish Office with responsibility for the Health Service, and the results have not been satisfactory.

Mr. Hayhoe

These matters are considered by a highly authoritative specialist and expert committee. It is right and proper that my right hon. Friend and I take the advice of that important and distinguished committee and not seek to double guess it on matters on which its competence is widely understood and recognised.

Mr. Dobson

The Minister sought to justify the 20p increase in prescription charges on the ground that it was in line with the increase in the cost of drugs. Will he confirm that in 1979 patients used to meet 10 per cent. of the drugs bill and that the implementation of the proposition that is before us will mean that they will meet about half of it?

To return to something which I raised earlier and which the Minister appears to have misunderstood, when does he expect to be able to announce the result of the review of the categories of person who suffer from certain specific conditions which are currently exempted? When does he expect that review to be completed?

Finally, when the Daily Mail reported the Prime Minister as having said in 1979, We have no intention of increasing prescription charges, was the Daily Mail lying, or was the right hon. Lady lying?

Mr. Hayhoe

The hon. Gentleman referred to certain specified conditions. As I made clear in my statement, this follows a review of all these matters. I would not be making such a statement without having reviewed carefully every item in it. I have no plans to change the present exemptions from the prescription charge for those suffering from certain specified conditions. As I have said, my right hon. Friend the Prime Minister has made it abundantly clear that no responsible Government could ever promise not to increase prescription charges. The important feature is that the exemptions remain. However the hon. Gentleman seeks to obscure the realities of the present condition, the mere existence of that wide range of exemptions will make his efforts null and void.

Mr. Speaker

I hope that the hon. Member for Holborn and St. Pancras (Mr. Dobson) was not accusing the Prime Minister of lying.

Mr. Dobson

I would not wish to do so, Mr. Speaker, but the right hon. Lady was reported in the Daily Mail as having said—

Mr. Speaker

Order. I ask the hon. Gentleman to withdraw that allegation.

Mr. Dobson

I shall have to say, Mr. Speaker, that the Daily Mail was lying.