National Health Service

HC Deb 08 April 1987 vol 114 cc401-17 10.31 pm

Mr. Frank Dobson (Holborn and St. Pancras)

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 1987 (S.I., 1987, No. 368), dated 9th March 1987, a copy of which was laid before this House on 11th March, be annulled.

Mr. Speaker

I understand that it will be convenient for the House to discuss also the following motions: That an humble Address be presented to Her Majesty, praying that the National Health Service (Charges to Overseas Visitors) Amendment Regulations 1987 (S.I., 1987, No. 371), dated 10th March 1987, 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 (General Medical and Pharmaceutical Services) Amendment (No. 2) Regulations 1987 (S.1., 1987, No. 401), dated 11 th March 1987, a copy of which was laid before this House on 11 th 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 1987 (S.I., 1987, No. 367), dated 4th March 1987, a copy of which was laid before this House on 11 th March, be annulled. That an humble Address be presented to Her Majesty, praying that the National Health Service (General Medical and Pharmaceutical Services) (Scotland) Amendment Regulations 1987 (S.I., 1987, No. 385), dated 9th March 1987, a copy of which was laid before this House on 11 th March, be annulled. That an humble Address be presented to Her Majesty, praying that the National Health Service (General Medical and Pharmaceutical Services) (Scotland) Amendment (No. 2) Regulations 1987 (S.I., 1987, No. 386), dated 9th March 1987, 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) (Scotland) Regulations 1987 (S.I., 1987, No. 387), dated 9th March 1987, a copy of which was laid before this House on 11 th March, be annulled.

Mr. Dobson

These days a lot of attention is being paid in the House to the next general election, although in view of the recent polls the Prime Minister may have missed the 7 May boat and the general election could be as many as 14 months away. But first, I should like to draw attention to the general election of 1979.

Mr. James Couchman (Gillingham)

Boring.

Mr. Dobson

The hon. Gentleman says, "Boring." I should like to draw attention to the basis on which the Tory party fought that general election.

On the Thursday before the 1979 general election the Daily Mail, which has always been a favourite gutter rag of the Tory party, obliged its Tory friends by running a major headline which read, "Labour's dirty dozen". It said that the Labour party was putting about 12 lies and it would give the Tory answers. Lie No. 9 was said to be: There are Tory proposals for higher prescription charges … Truth: 'We have no intention of increasing … such charges', says Mrs. Thatcher".

Mr. Patrick Nicholls (Teignbridge)

That is an old lie. In the course of this nonsence, will the hon. Gentleman tell us what the Prime Minister actually said on 18 April 1979? She said at a press conference: I doubt very much whether any responsible Government could say that over a period of five years, regardless of what happened to the value of money, they would not put up prescription charges.

Mr. Dobson

The Daily Mail article was published a week before the general election.

Mr. Nicholls

So was this.

Mr. Dobson

The Tories were in opposition and the Prime Minister was quoted. This is in quotation marks in the Daily Mail. She never sought for one moment to deny what was stated in quotation marks on the front page of the Daily Mail that Thursday.

Mr. Nicholls

Will the hon. Gentleman give way on that point?

Mr. Dobson

I certainly will not.

What is more, the right hon. Lady then rewarded the editor of the Daily Mail with a knighthood. Either he was lying and she gave him a knighthood, or he was telling the truth and she gave him a knighthood. She probably has ceased to distinguish between the two.

When that promise was made on the front of the Daily Mail, the prescription charge was just 20p. The Tories won the general election and, before the year was out, that charge which was not going to be increased had been increased twice to a total of 70p — a 350 per cent. increase in a year.

Mr. Tony Marlow (Northampton, North)

Will the hon. Gentleman give way?

Mr. Dobson

No, I shall not give way. There is not enough time.

There have been seven more increases since those initial two increases, taking us to the present proposition of a total of 240p—an increase of 1,200 per cent. That rate of increase even exceeds the rate of increase in the value of British Telecom multiple share purchases by Tory Members.

The Labour party is opposed in principle and in practice to these charges. No other party is so opposed. With the benefit of the document which reads Conservative Research Department Brief on the English and Scottish National Health Service charges", which was prepared for this debate, under the "general points to make" given in the advice to Tory Members we find the following: The Conservative party has always maintained that those who can afford to should make a fair contribution to the costs of the NHS. The fairest tax is income tax. People who can afford to pay income tax can contribute to the costs of the National Health Service in that way.

Mr. Nicholls

Will the hon. Gentleman give way on that point?

Mr. Dobson

No, I certainly will not.

The SDP, which could be described as the spiritual home of prescription charges, remains in favour of them. I understand that the Doctor has told the other David that the Liberal party is in favour of prescription charges. Therefore, the Labour party remains the only party opposed to these charges.

Mr. Simon Hughes (Southwark and Bermondsey)

Will the hon. Gentleman tell us for the record why in the original Bill the Labour party provided that there should be a facility for charging and why the Labour Government in the 1960s, having abolished prescription charges, reintroduced them?

Mr. Dobson

In my view, they brought them back under pressure from people in the City who had no intention —[Interruption.] I may look as though I am getting on a bit, but no one can accuse me of being in the House as long ago as 1966. In my view, that decision was wrong and the increase should never have been introduced in the first place. My hon. Friend the Member for Walsall, North (Mr. Winnick), who was present then, was one of those who voted against the introduction, and all credit to him.

We believe that the implementation of these charges proves to be a deterrent to people seeking treatment.

Mr. Nicholls

Will the hon. Gentleman give way on that point?

Mr. Dobson

No, I shall not. I shall develop my own arguments. [Interruption.] I am normally very willing to give way, but as the Government, who organise the business of the House, have organised it in such a way that a debate of an hour and a half has already been reduced to an hour by the previous debate running over, I do not think that it is reasonable to be expected to give way.

Other people share our concern about the impact of prescription charges on poorer people. The British Medical Association says that the charges have reached a level that deters people from seeking medical treatment.

It says: Any extension of the present exemptions"— which has been suggested as a way round the problem by some people— is likely to introduce further anomalies and raise disproportionately the burden on those paying the charges" It describes the present list of exemptions for the chronically sick as incomplete, illogical and open to attack —and the members of the British Medical Association are masters of understatement.

In Stockport recently, I visited the Shaw Heath health centre. A general practitioner there told me that he now asks his poorer patients if they are exempt from charges. If they say, "Yes, we are exempt from charges", he prescribes all the drugs that they need. If they say that they are not exempt, he either omits the second or third most important item—if it is a multiple-item prescription—or puts all the items on the prescriptions and tells the patients which are the most important items so that if they cannot afford all of them they will know which they can best do without. The other doctors present— and, to the best of my knowledge, not a single one, including that doctor, is either a member or a supporter of the Labour party—said that they did the same.

Figures from the prescription checking bureau, which are available to Ministers, confirm that that is so, with as many as 100,000 items a year on multiple-item prescription forms not being bought.

A further development is that doctors whose social consciences exceed that of the present Government —and, God knows, that must include most of the medical profession — are increasingly prescribing more than a 30-day supply of drugs for people on repeat prescriptions to keep down the costs. In the spring of 1986, the proportion of 30 days-plus supplies had reached no less a level than 16.5 per cent. of prescriptions. That response by doctors is at the same time both humane and disturbing: most people agree that supplies prescribed should be kept to a minimum, because access to large numbers of drugs and long supplies are potentially dangerous both to the patients and to other people living with or helping them. All those are the consequences of the grasping policies of the present Governent.

No doubt the Minister will switch on his Norm-speak auto-pilot and repeat all the stuff about three quarters of the public not paying for their prescriptions — [Interruption.] Oh, it is true. He will go on to suggest that the remaining quarter who pay for the 80 million prescriptions that are paid for are flush with money— perhaps not the sort of people who could afford to make multiple applications for privatised shares in public assets, but people for whom paying, say £7.20 for a three-item prescription will not be a strain. But of course not everyone is a QC specialising in company law.

Let me advise Ministers — and any hon. Member proposing to support them in the Lobby tonight — to look at the official leaflet entitled "NHS Prescriptions: How to Get them Free". Tory Members will no doubt be able to call on the services of their accountants or lawyers if they find it difficult to understand—and I suggest that they may find it difficult to understand. The section on low incomes reads as follows: What counts as a low income depends on how many people there are in your family and how much money you've got left after you've paid essential outgoings and taken account of certain allowances. You can work this out for yourself (all these amounts are each week)". It then lists rent or mortgage rates life insurance premiums HP payments for essential household goods fares to and from work of you and your partner trade union subs"— they have not noticed that yet cost of care of a child or other dependant while you are at work £4 of your earnings £4 of your partner's earnings if you are a lone parent, half your earnings between £4and £20". When we have done all that it says: Take this total away from the money you have coming in each week and see how much you have left. Now see whether it's worth claiming free prescriptions. It's worth claiming if, for example, you're single, not a householder, and don't have much more than about … £33 left each week, or if you're a couple and don't have much more than about £53 left each week … or if you're a couple with two children, one aged under five … and don't have much more than about £75 left each week.

Mr. Tony Favell (Stockport)

Will the hon. Gentleman give way?

Mr. Dobson

I shall finish this point, and then I will decide whether to give way.

Ministers should consider the finances of those who have just a little more than that left at the end of each week and who therefore do not qualify for free prescriptions. Using the family expenditure survey that is provided by the Government, a couple—after the deductions I have mentioned—with £56 or £58 left to them at the end of each week will spend more than £45 a week of that on fuel, light, food, clothing and footwear alone, leaving them with £11 or £13 a week. Out of that, they have to pay for everything else that I have not already listed: for soap, washing-up liquid, matches, shoe polish, phone calls, stamps. That leaves them with less than a fiver. They will be unable to save up for a holiday, yet they will have to pay for prescriptions. At the end of the week they will not have enough money left to pay for a three-item prescription.

Mr. Favell

rose——

Mr. Dobson

I shall not burden the House by giving other examples. Many people who are not well off are having to pay for prescriptions and are deterred from seeking medical treatment because they have to pay. That is borne out by the prescription checking bureau figures, by the British Medical Association representations and by the representations that are made by doctors to Members of Parliament. If I had to choose between all those bits of evidence and something from a Minister in this Government, I know where I believe the truth lies.

I do not intend to refer tonight to dental charges other than to welcome the news that they are not to be increased.

Mr. Favell

Will the hon. Gentleman give way?

Mr. Dobson

I believe that the hon. Gentleman is a parliamentary private secretary and that it is traditional for parliamentary private secretaries to keep their traps shut.

Mr. Favell

rose——

Mr. Dobson

Regulations are also before us tonight that will increase the charges for overseas visitors who fall sick when they are here.

Mr. Favell

On a point of order, Mr. Deputy Speaker. The hon. Member for Holborn and St. Pancras (Mr. Dobson) mentioned my constituency and made certain allegations about a health centre in the constituency. In those circumstances, is it not usual to allow an intervention?

Mr. Deputy Speaker (Mr. Ernest Armstrong)

The hon. Gentleman knows that it is entirely up to the hon. Member who is addressing the House whether he gives way.

Mr. Nicholls

Further to that point of order, Mr. Deputy Speaker.

Mr. Deputy Speaker

It can hardly be further to a point of order that was not a point of order.

Mr. Nicholls

It is a new point of order, Mr. Deputy Speaker. Is it in order for a Front Bench Opposition spokesman in the middle of a speech to yell over the Dispatch Box, "Keep your trap shut?" So far as that is a call to order, should it not be a matter for the Chair?

Mr. Deputy Speaker

I think that such matters are best left to the Chair. As I understand it, it was part of the hon. Gentleman's speech.

Mr. Dobson

I always try to raise the tone wherever I go.

Certain people have always put it around that it is possible to come to Britain deliberately to obtain free medical care. It was never free on the NHS. The Government introduced charges for people who fell sick while they were here. There were many people, including some Conservative Members, in 1981 and 1982, when the matter was debated, who felt that it would be damaging to our international reputation to introduce charges for such people.

Nevertheless, the charges were introduced with effect from October 1982 on the assumption that they would bring in the princely sum of £6 million a year. The Government sold our reputation for a mess of pottage. The charges have scarcely raised £6 million in gross takings since their introduction. The Government have consistently refused to give any estimate of the cost of collecting the charges. Nor have they made any estimate of the cost of establishing the charging system, which has had to be set up in each of the 214 health authorities and boards in England, Wales and Scotland.

The Opposition regard the charges as shabby. They are an affront to the principles on which the NHS was established.

The Minister for Health (Mr. Tony Newton)

The hon. Gentleman made it absolutely clear that, in his view at least, prescription charges ought to be abolished. Will he make it plain whether the next Labour Government, if such should ever be returned, would enable people to come here for free treatment under the NHS?

Mr. Dobson

The Minister——

Mr. Nicholls

Answer.

Mr. Dobson

I am happy to answer. The Minister said that people would be able to come here for free treatment. People were never entitled to come here with the intention of receiving free treatment. The Minister should not try to give that myth another run.

Mr. Newton

Does that mean that, in addition to every other control on immigration, visitors must be asked whether there is any possibility of their needing medical treatment while they are in Britain?

Mr. Dobson

The hon. Gentleman ought to know that many visitors are already asked that question on arrival. We think that it is wrong that that question, and many others like it, should be asked. It was never lawful for someone to come here seeking free treatment under the NHS, and we do not propose to change that.

Prescription charges are damaging to our health care system. They are damaging to people who are not very well off and who do not benefit from existing exemptions. It is the Labour party's policy, on being returned to office, to reduce them substantially immediately and to phase them out in the lifetime of one Parliament.

10.54 pm

The Minister for Health (Mr. Tony Newton)

I had thought that it would be for the convenience of the House if I were to wind up the debate because I imagined that at least one or two other hon. Members would wish to take part in the debate, but as it seems to be the wish of the House, and certainly of the Opposition, that I should speak now, I shall do so. However, I shall not make many of the remarks that I had intended to make in outlining what these various regulations will do. The hon. Member for Holborn and St. Pancras (Mr. Dobson) paid scant regard to a large part of the subject matter of tonight's debate and strayed in various ways. Although he gave us a good deal of entertainment, he hardly raised the level of debate on these serious issues.

In the light of the history of this matter, in terms both of the record of the last Labour Government and some of the suggestions about the remarks of my right hon. Friend the Prime Minister during the election campaign in 1979, I found some of the hon. Gentleman's earlier remarks extraordinary, and they were convincingly and effectively disposed of by my hon. Friend the Member for Teignbridge (Mr. Nicholls).

The great point on which the hon. Member appeared to be clear early in his speech, and about which I understood him to make a ringing declaration, was that prescription charges would disappear in a puff of wind if and when he and his hon. Friends got into office. Although it sounded like that at the beginning, it did not sound like that at the end. By the end, one got the clear impression that these were promises to be made before an election, only to be run away from after it.

Dr. John Marek (Wrexham)

The hon. Gentleman can talk!.

Mr. Newton

Not only can I talk, but I intend to talk. What is more, I intend to ask one or two questions of the hon. Member for Holborn and St. Pancras. It is all very well for him to come here and say that he knew that a Labour Government abolished these charges in 1965, only to reintroduce them in 1968, and when challenged say that had he been here he might have voted against that being done because he thought it was wrong.

Mr. Dobson

That is a loose paraphrase.

Mr. Newton

It is not all that loose.

At any rate, we now know that the hon. Gentleman thinks that the Labour Government's of 1964 to 1970 were wrong on at least that matter. The rest of us could probably think of many other matters on which they were wrong. What I want to know from the hon. Gentleman is what gives him any conceivable grounds for believing, in the light of the record of that Government, and of the intervening Labour Government, that any future Labour Government would get anything any more right.

Mr. Dobson

The problem was caused by the City.

Mr. Newton

The hon. Gentleman thinks that City gents were responsible for the failure.

Mr. Dobson

There are no gents in the City.

Mr. Newton

It was chaps in the City, or, for all I know, gnomes in the City. I wonder.

The hon. Gentleman said that he was too young to have been here in 1968, and I shall not speculate about that. However, I know that he has been in politics for long enough to know that it was not the people in the City who caused the problems for the Labour Governments of 1964 to 1970. The people in the City ran out of their capacity to finance a profligate Labour Government, who had to turn to the international bankers. We had the International Monetary Fund here.

Mr. Frank Haynes (Ashfield)

This Government have broken their promises.

Mr. Newton

I can deal with the hon. Member for Ashfield (Mr. Haynes) as well if need be.

The memory of the hon. Member for Holborn and St. Pancras does not embrace the fact that the following Labour Government were also involved with the IMF. That Labour Government got it all wrong as well, and on that occasion the casualty — more significantly than anything that we are talking about tonight—was the whole National Health Service and above all the hospital building programme. With such a track record in the 1960s, and another in the 1970s, on what does the hon. Member for Holborn and St. Pancras base the pathetic belief that any future Labour Government would do any better?

Mr. Michael Stern (Bristol, North-West)

I can offer a possible solution to the dilemma that my hon. Friend has just posed. He will recollect that one of the principles to which the hon. Member for Holborn and St. Pancras (Mr. Dobson) referred — the basic principle of the Health Service, to which he wanted to return — was that the Health Service would eventually wither away. Could a future Labour Government be proposing a return to the basic principles of the Health Service by claiming that they will deal with prescription charges by allowing the Health Service to wither, as they did when last in government and as they had done previously?

Mr. Newton

My hon. Friend is very likely right. I do not say that a future Labour Government would intend the Health Service to wither, but the consequence of their policies in the past has been to wither the service and it is only by dint of considerable effort and, above all. additional investment by this Government that the hospital building programme is now recovering from the effects of the previous Labour Government. Against that background, I find it incredibly stupid — apart from anything else—that the hon. Member for Holborn and St. Pancras should come here tonight and say that he is willing to give up about £150 million of revenue for the Health Service, which I believe is raised reasonably, which is certainly making a very useful contribution to other aspects of the Health Service and which no Government in their right mind would throw away in the manner suggested by the hon. Gentleman, at one blow, or gradually as he suggested at the end of his speech.

I shall not speak for much longer, as I believe that other hon. Members wish to contribute to the debate.

If I understood the other arm of the policy adumbrated by the hon. Member for Holborn and St. Pancras, it was that he would abolish prescription charges at some stage and fund that substantial sum of money by increasing income tax. Has he considered what that would mean for pensioners, who are currently exempt from prescription charges, but who are certainly not exempt from income tax? Has he tried that line on the pensioners? Has he—

Mr. Vivian Bendall (Ilford, North)

Does my hon. Friend know how much that would cost the taxpayer? If not, would he let me know later?

Mr. Newton

It would cost about £150 million. That is the income from prescription charges. The hon. Member for Holborn and St. Pancras has said that he will add that to income tax.

Having commented on the main points raised by the hon. Member for Holborn and St. Pancras, I want to make another point, on which I pressed the hon. Gentleman in interventions during his speech. However clear the House may feel that the hon. Gentleman's position is on prescription charges — and I, at least, thought that he shifted his position from the beginning to the end of his speech—we need to have a clear understanding of what a Labour Government's attitude would be to those who come to this country as visitors and are treated under the Health Service. We need to know whether that would be free.

The Government's position on that matter is absolutely clear, and has been throughout. We think that it is reasonable that people coming as visitors to this country should be expected to cover the costs of the medical treatment that they receive here, in the same way as citizens of this country who have to visit the United States, for example, are expected to insure within the terms of the health service operating in that country, and have appropriate cover for most other countries in the world.

I have no doubt that the overwhelming majority of the British public believe that that is common sense. They would regard it as something of scandal if nothing had been done about people coming to this country, often—although this is difficult to check specifically—with the intention of receiving free treatment on the Health Service. That prospect is obviously re-opened by the implied policy stated by the hon. Member for Holborn and St. Pancras tonight.

Mr. Haynes

rose——

Mr. Newton

The hon. Member for Ashfield is great at diversionary tactics. Let me just——

Mr. Haynes

Do not dodge the issue.

Mr. Newton

I would not want to dodge the hon. Gentleman, nor would I want to tempt him into making more of his flattering remarks about my hon. Friend the Member for Derbyshire, South (Mrs. Currie), the Parliamentary Under-Secretary of State for Health and Social Security, which have kept her in the newspapers heavily for the best part of six weeks.

Mr. Haynes

The Minister is jealous.

Mr. Newton

I am not looking to the hon. Gentleman to describe me as attractive or pretty. I shall leave him to continue his dialogue with my hon. Friend the Under-Secretary of State.

I shall return to the serious issue from which the hon. Member for Ashfield was trying, understandably, to divert the House. The debate should not be allowed to end this evening without a much clearer-cut statement from the hon. Member for Holborn and St. Pancras on his party's policy on charging those from overseas who come to Britain to receive treatment on the National Health Service, or to need treatment on it while they are here for another reason. Whether the cost is £6 million or any other sum, there is a point of principle, and certainly of common sense, that needs to be established. We are entitled to a clearer answer than anything that we have heard so far from the hon. Member for Holborn and St. Pancras.

With the leave of the House, I shall happily comment upon any of the other contributions that are made in the debate. For the moment, I shall rest my case.

11.7 pm

Mr. Simon Hughes (Southwark and Bermondsey)

I shall vote against the Government measures that are before us. I have done so on previous occasions when charges have been increased by more than the rate of inflation since the Government have come to power.

Although there are difficulties, I do not take the unrealistic line that the Labour party propounds. There is no doubt that the rate of increase in the charges since 1979 has been substantially above the rate of inflation. There was an increase of 125 per cent. within the first year alone of the Government coming to office. If the basic prescription charge had been raised in line with inflation since 1979, the charge would now be about 37p. If the charge had been raised in line with inflation from the time that the moderating charge was introduced in the early 1950s, it would be about £1. Unfortunately, the Government have not been consistent. Indeed, this year's increases were such that the Daily Telegraph on the day after the Minister's announcement, described them as "higher than expected". That appeared on the front page in the leading article.

The second unfairness about the increase in the charges in that there is a 9 per cent. increase in the basis prescription charge while the amenity beds charge is increased by only 8.3 per cent. over two years. and private out-patients' charges have been increased by only 6.1 per cent. this year. There should be a consistency in the increase in the changes

There is an unfairness in treatment between the NHS generally and the private sector. There is also the issue of uncollected charges. To impose charges that amount to the rate of inflation and then to fail to collect them leads to a double disadvantage. I hope that we shall hear sooner rather than later about what the Minister intends to do about uncollected charges. I believe that he owes me a letter on that issue. I ask him also to justify the lower than 9 per cent. charge that has been imposed on the private sector.

Mr. Dobson

The Minister does not owe the hon. Member as much as the private patients owe the NHS.

Mr. Hughes

I have made the point: there is a lot of uncollected money, not least in Camberwell health authority area, part of which I represent.

The view of the Liberal party has never been that prescription charges should be abolished. Indeed, right from the beginning the Labour Government provided for charges in the legislation by which the Health Service was set up. The moderating fee was introduced early in the life of the National Health Service. I have always believed that a fee is proper because people need to be reminded that they are getting things which cost the public sector money. After all, 75 per cent of people are exempt. In general terms that covers the most vulnerable groups.

The Minister should answer one further valid point that has been made. The British Medical Association and other professional bodies make the point consistently that the level of charges now is a deterrent to some people having prescriptions. That is clear evidence that the substantial increase since 1979 is unjustified. I accept that there should be charges but when charges start to deter, that is tilting the charging balance too far in the wrong direction.

It is also ludicrous that some prescriptions, if obtained through the NHS, will cost £2.40 if these regulations are accepted, when their real cost is substantially less. I appreciate that nothing can be done about this before we vote tonight on the regulations. but the Minister should look into the matter. Some commonly used and easily obtainable drugs are available for, say, 50p. In such cases people should not have to pay the substantial amount of £2.40. Of course, there is always an averaging job to do, but, as I understand it, 32 per cent. of prescriptions issued cost in real terms less than the £2.40 charge.

There is no reason why people coming to Britain should not be required to pay. I have a clear view on that. As the Minister rightly said, when we travel abroad we have to insure ourselves and make proper contingency plans. People should not come to Britain with the presumption or expectation that they will be treated free.

Mr. Nicholls

The hon. Gentleman is making a serious contribution to the debate. As I understand it, he says that he agrees with the principle of charges being made. In a sense he could not deny that, because that point was made by Lord Grimond when the Labour party introduced prescription charges. If the hon. Gentleman wishes to introduce the criterion of charges at a level which will not deter people from getting prescriptions, what evidence can he produce to the House that the present level of charge is deterring people who would otherwise take up prescriptions?

Mr. Hughes

There is a factual answer to the hon. Gentleman's perfectly proper question. The number of prescriptions issued has gone down. There are several reasons. General practitioners and dispensers can testify to one reason, about which there has been much survey evidence—that the level of charge has a deterrent effect.

The argument about prescription charges is always how one balances the books for the Health Service. The Health Service benefits from charges.

The Minister may have seen in New Society last September an article headed : Should drugs be free? The Labour party last week promised to abolish prescription charges. Jeremy Laurance asks if this is a sensible priority. The article ended : Removing the charges risks stimulating demand, and putting an extra financial burden on an already stretched NHS. My colleagues and I cannot say that we will abolish prescription charges, much though we would like to do so in an ideal world. Something else in the Health Service would suffer if that were done. There will be prescription charges, but at no stage will they be increased by us by more than the irate of inflation, as far as one can possibly help or predict that. However, I am unwilling to compromise other areas of health care when the majority of the vulnerable are exempt. Certainly, a few people still suffer when they should not, and exemptions should be extended. However, in general terms, the criticism is not that there are prescription charges but that under this Government those charges have increased much more than they need have done, and have done so with unfair consequences.

11.15 pm

Mr. Tony Marlow (Northampton, North)

There is something deeply disagreeable these days about the nature of the Labour party. Because Labour Members have lost the political argument, they seem to concentrate on personal attack. There is grave disgrace as far as their party is concerned at the moment. Where they are still involved in the political argument, they seek not to illuminate but to misrepresent.

Who would have thought from the behaviour of those few Labour Members who are here this evening that on one occasion during this debate — a deeply important debate, so we are led to believe by the Labour party— there were only three Labour Members present? That, too is a disgrace. Who would have thought that during the lifetime of this caring Government there has been an increase of one quarter in expenditure on the Health Service? For every £4 that was spent when this caring Government came to power, £5 is now spent on the needs of the unhealthy and of the people who we in this country, and in this Government, want to take care of? Who would have thought from the weasel words of Opposition Members that three quarters of prescription charges do not need to be paid and that three quarters of prescriptions are paid for by the taxpayer, and quite rightly so, as well? Who would have thought that the most disadvantaged in society do not have to pay prescription charges? Who would have thought that all men over 65, women over 60, children under 16 and mothers do not have to pay prescription charges? The chronically sick do not have to pay prescription charges. Season tickets are available for those who want them to pay for their prescription charges.

Opposition Members do not care. They do not want to inform; they want to misinform. When there is rationalisation in the Health Service, when old, inefficient and inadequate resources are put on one side and the money saved from those resources is put into new hospitals, new buildings and new operating theatres, we do not hear anything from Opposition Members. All they seek to do is to misrepresent. All they seek to do, for their own grubby political ends, is to lower people's faith and to undermine their trust in the National Health Service for their dirty, grubby, deep, unpleasant, sanctimonious ends.

Out of the £1.8 billion that prescriptions cost this country, a mere £145 million is raised through prescription charges. That money is spent in the Health Service. That money is spent on providing free syringes for people who did not have them before, for diabetics. This is another side of the caring Government. What is the Labour party going to do? It will not get into power, but what would it do if it did get into power? Would it provide those free syringes? If it did, where would it get the money from? About £145 million is spent on care in the Health Service as a result of prescription charges being paid only by those who can afford to pay them.

Mr. Dobson

The hon. Gentleman is on page three now.

Mr. Marlow

Mr. Deputy Speaker, for 27 minutes of this debate, that giggling idiot on the Labour Front Bench——

Mr. Deputy Speaker

Order. The hon. Gentleman is not helping the debate. He should withdraw that remark.

Mr. Marlow

I withdraw that remark, Mr. Deputy Speaker. The hon. Member for Holborn and St. Pancras (Mr. Dobson) spent 40 per cent. of the debate addressing the House with weasel words and reading from his text word by word, yet he is accusing me of reading when I have no notes before me.

Labour Members have no policies or facts. All they seek to do is to disrupt, to undermine and to lower people's faith in the Health Service that the Government are rightly giving to the country.

11.20 pm

Mr. Michael Foot (Blaenau Gwent)

I am glad that my hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) has reaffirmed from the Front Bench that the next Labour Government will proceed to reduce, and eventually to abolish, prescription charges. [Interruption.] I cannot understand why there should be such maniacal screeches from the Conservative Benches.

My time goes back further than that of my hon Friend and I am not sure what stage of development he had reached in 1966——

Mr. Dobson

Innocence.

Mr. Foot

Yes, innocence and I am glad to see that my hon. Friend retains a large proportion of that innocence even now. I remember vividly how the Conservative party did everything possible to oppose the introduction of a free National Health Service. Tory Members voted against it on Second Reading and again on Third Reading, which was a further confirmation of their opposition to the principle of the service. One of the elements that they particulary hated was the idea that the service should be free to the patient. Because of the Socialist idea to provide the service on the basis of need, not money, and other practical reasons, the service was introduced in the first place. That was undoubtedly why Conservatives at that time were so bitterly opposed to it.

I know that we cannot necessarily restore the NHS all in one go, although it would not be impossible. I understand that the cost would be £360 million, and in the Budget the Government could easily have raised £360 million from people who have been drawing £360 million in tax reliefs ever since 1979. They could easily contribute that sum, partly to restore the principle of a free Health Service, and partly to restore some parts of the Health Service——

Mr. Nicholls

Will the right hon. Gentleman give way?

Mr. Foot

No, I shall not give way. Because of the way in which the Government have mismanaged the arrangement for this debate there is hardly a minute left, so I shall not give way to the hon. Gentleman. Moreover, I am not at all sure that the hon. Gentleman is in a fit condition to be given way to.

Mr. Nicholls

On a point of order, Mr. Deputy Speaker. I am sure that your hearing is at least as good as mine. I do not know what the right hon. Gentleman had in mind by making a slur like that. On reflection he may feel that he should not only withdraw it but give me a chance to intervene.

Mr. Deputy Speaker

Order. What the right hon. Gentleman was saying was not clear to me.

Mr. Foot

I am glad that the Labour party is now recommitted to the restoration of a free NHS. [HoN. MEMBERS: "Withdraw."] I hope——

Mr. Nicholls

Will the right hon. Gentleman give way?

Mr. Foot

I hope that the——

Mr. Nicholls

On a point of order, Mr. Deputy Speaker. I understood that the right hon. Gentleman was getting to his feet to withdraw the imputation that I was incapable of making an intervention. Will he withdraw it, or not?

Mr. Deputy Speaker

Order. The right hon. Gentleman did not make any specific allegation about the hon. Gentleman. [HON. MEMBERS: "He did."] The right hon. Gentleman did not feel that the hon. Gentleman was making the right interjection.

Mr. Foot

I did not hear you make any request to me to withdraw my comment, Mr. Deputy Speaker. I certainly do not think that I have said anything that requires to be withdrawn.

Mr. Deputy Speaker

Knowing the right hon. Gentleman, I am sure that if he had made any allegations that the hon. Gentleman was in some sort of condition, he would withdraw it.

Mr. Marlow

On a point of order, Mr. Deputy Speaker.

Mr. Foot

If I had thought for a moment that the hon. Gentleman——

Mr. Marlow

On a point of order, Mr. Deputy Speaker.

Mr. Deputy Speaker

Order. The right hon. Gentleman is addressing me.

Mr. Foot

rose

Mr. Marlow

On a point of order, Mr. Deputy Speaker.

Mr. Deputy Speaker

Order. I had called Mr. Foot. He was going to make some explanation to me.

Mr. Foot

I do not think that I made any reflection on the hon. Member for Teignbridge (Mr. Nicholls) that required any withdrawal. If he thinks that any withdrawal is necessary, he must have an even thinner skin that I thought. When I depart from any parliamentary procedure and I am asked to withdraw by any occupant of the Chair I obey, but no such requirement has been made.

Mr. Patrick Thompson (Norwich, North)

rose——

Mr. Michael Stern (Bristol, North-West)

rose——

Mr. Foot

I am glad that my hon. Friends have given a commitment to the restoration of a free National Health Service——

Mr. Thompson

On a point of order, Mr. Deputy Speaker. The right hon. Member for Blaenau Gwent (Mr. Foot) said that my hon. Friend the Member for Teignbridge (Mr. Nicholls) was not in a fit state to make his speech or intervention. He has not withdrawn that.

Mr. Deputy Speaker

As I understood it, the right hon. Gentleman may have meant that the hon. Gentleman was over-excited — [Interruption.] Order. I am anxious to help the House. I did not sense a personal attack.

Mr. Foot

Mr. Deputy Speaker, I think that you are right. I was following your instructions——

Mr. Stern

Further to that point of order, Mr. Deputy Speaker. I naturally accept your hearing of what was said by the right hon. Gentleman. However, I think that we are entitled to some consideration. I was in the direct path of the remarks of the right hon. Member for Blaenau Gwent (Mr. Foot) and it seemed to many Conservative Members that there was a clear implication in what he said. One would hate to think that the right hon. Gentleman was using his seniority in the House to get away with something that many hon. Members would not be allowed to get away with.

Mr. Foot

Anyone who listened to what I said could see how justified it was.

Mr. Nicholls

On a point of order, Mr. Deputy Speaker. That is the second time that the right hon. Gentleman has suggested that I am not in a fit state to speak in the House. Your must have heard that.

Mr. Deputy Speaker

Order. I did not hear the right hon. Gentleman say that any hon. Member was not in a fit state.

Mr. Foot

The hon. Gentleman should study Hansard tomorrow and look at the facts of the matter.

I am sorry that more time was not provided by the Government for the debate. I am sorry also that some Conservative Members thought it advisable to take up time with bogus points of order to stop the debate proceeding.

It is right that we should make clear to the country that one of our objectives is to re-establish a free National Health Service. We know that it will cost something. I should like to see it extended to the restoration of a proper dental service, the restoration of a proper optical service and the restoration of the ideals that prevailed when the service was introduced, which was why the Conservatives tried to prevent its being brought into being. That is the kind of service that we want to see re-established. The sooner we start that task, the sooner we shall be able to carry it through to completion.

At the beginning of his speech the Minister for Health pretended that the Prime Minister had not sought to mislead the public on whether the Government intended to introduce prescription charges. The Prime Minister said that she had no intention of introducing prescription charges, yet we are discussing those increases. No hon. Member could make that excuse and think that he would get away with it.

11.29 pm

Mr. Tam Dalyell (Linlithgow)

I want to ask the Minister one factual question which concerns dental charges. My evidence, frankly, is only anecdotal, but it seems to many of us that decisions are made not necessarily on the clinical judgments of dentists, but on their assumptions, right or otherwise, about a patient's ability to pay. As the hon. Member for Southwark and Bermondsey (Mr. Hughes) said, there is a deterrent here. I simply ask, in the time available, whether the Department recognises that there is a problem.

Mr. Newton

I am in some difficulty because there are no proposed changes in dental charges in the regulations.

Let me tell the right hon. Member for Blaenau Gwent (Mr. Foot) that the ideals of the National Health Service, on his analysis, lasted for only about three years because the then Labour Government introduced charges in 1951——

It being half-past Eleven o'clock, Mr. DEPUTY SPEAKER put the Question pursuant to Standing Order No. 15 (Prayers against statutory instruments, &c. (negative procedure)).

Question put :—

The House divided: Ayes 67, Noes 142.

Division No. 142]	[11.30 pm
AYES
Adams, Allen (Paisley N)	Campbell-Savours, Dale
Alton, David	Canavan, Dennis
Ashdown, Paddy	Carlile, Alexander (Montg'y)
Atkinson, N. (Tottenham)	Clark, Dr David (S Shields)
Beckett, Mrs Margaret	Clwyd, Mrs Ann
Beith, A. J.	Cocks, Rt Hon M. (Bristol S)
Benn, Rt Hon Tony	Cook, Frank (Stockton North)
Bennett, A. (Dent'n & Red'sh)	Corbyn, Jeremy
Bermingham, Gerald	Cunliffe, Lawrence
Boyes, Roland	Dalyell, Tam
Callaghan, Jim (Heyw'd & M)	Davis, Terry (B'ham, H'ge H'l)

Deakins, Eric	McWilliam, John
Dixon, Donald	Madden, Max
Dobson, Frank	Marek, Dr John
Dormand, Jack	Marshall, David (Shettleston)
Dubs, Alfred	Millan, Rt Hon Bruce
Eastham, Ken	Nellist, David
Fatchett, Derek	O'Neill, Martin
Fields, T. (L'pool Broad Gn)	Pike, Peter
Flannery, Martin	Powell, Raymond (Ogmore)
Foot, Rt Hon Michael	Raynsford, Nick
Foster, Derek	Robinson, G. (Coventry NW)
Golding, Mrs Llin	Shields, Mrs Elizabeth
Hamilton, James (M'well N)	Skinner, Dennis
Haynes, Frank	Smith, Rt Hon J. (M'ds E)
Hogg, N. (C'nauld & Kilsyth)	Tinn, James
Hughes, Sean (Knowsley S)	Wardell, Gareth (Gower)
Hughes, Simon (Southwark)	Wareing, Robert
John, Brynmor	Welsh, Michael
Kennedy, Charles	Winnick, David
Leadbitter, Ted	Young, David (Bolton SE)
Lewis, Terence (Worsley)
Livsey, Richard	Tellers for the Ayes:
McDonald, Dr Oonagh	Mr. Allen McKay and Mr. Chris Smith.
MacKenzie, Rt Hon Gregor
McNamara, Kevin

NOES
Alexander, Richard	Hirst, Michael
Amess, David	Holt, Richard
Arnold, Tom	Jackson, Robert
Ashby, David	King, Rt Hon Tom
Atkins, Robert (South Ribble)	Knox, David
Atkinson, David (B'm'th E)	Latham, Michael
Baker, Nicholas (Dorset N)	Lightbown, David
Baldry, Tony	Lloyd, Sir Ian (Havant)
Batiste, Spencer	Lloyd, Peter (Fareham)
Beaumont-Dark, Anthony	Luce, Rt Hon Richard
Bellingham, Henry	McCrindle, Robert
Bendall, Vivian	Maclean, David John
Benyon, William	McNair-Wilson, M. (N'bury)
Biggs-Davison, Sir John	McQuarrie, Albert
Blackburn, John	Major, John
Blaker, Rt Hon Sir Peter	Malins, Humfrey
Bonsor, Sir Nicholas	Malone, Gerald
Boscawen, Hon Robert	Marlow, Antony
Bottomley, Peter	Mather, Sir Carol
Bottomley, Mrs Virginia	Maxwell-Hyslop, Robin
Bowden, Gerald (Dulwich)	Mayhew, Sir Patrick
Brandon-Bravo, Martin	Merchant, Piers
Brinton, Tim	Meyer, Sir Anthony
Brooke, Hon Peter	Miller, Hal (B'grove)
Brown, M. (Brigg & Cl'thpes)	Mills, Iain (Meriden)
Browne, John	Mitchell, David (Hants NW)
Bryan, Sir Paul	Moate, Roger
Burt, Alistair	Morrison, Hon C. (Devizes)
Butterfill, John	Moynihan, Hon C.
Carlisle, John (Luton N)	Nelson, Anthony
Carlisle, Rt Hon M. (W'ton S)	Neubert, Michael
Chapman, Sydney	Newton, Tony
Clarke, Rt Hon K. (Rushcliffe)	Nicholls, Patrick
Colvin, Michael	Norris, Steven
Conway, Derek	Oppenheim, Phillip
Coombs, Simon	Ottaway, Richard
Cope, John	Page, Richard (Herts SW)
Couchman, James	Peacock, Mrs Elizabeth
Cranborne, Viscount	Powell, William (Corby)
Currie, Mrs Edwina	Powley, John
Dorrell, Stephen	Price, Sir David
Douglas-Hamilton, Lord J.	Raffan, Keith
Durant, Tony	Raison, Rt Hon Timothy
Eyre, Sir Reginald	Rhodes James, Robert
Fallon, Michael	Rhys Williams, Sir Brandon
Favell, Anthony	Ridley, Rt Hon Nicholas
Forsyth, Michael (Stirling)	Robinson, Mark (N'port W)
Garel-Jones, Tristan	Rowe, Andrew
Harris, David	Ryder, Richard
Harvey, Robert	Sackville, Hon Thomas
Hayward, Robert	Sainsbury, Hon Timothy
Heathcoat-Amory, David	Scott, Nicholas
Heddle, John	Shaw, Sir Michael (Scarb')

Shelton, William (Streatham)	Waddington, Rt Hon David
Shepherd, Colin (Hereford)	Wakeham, Rt Hon John
Silvester, Fred	Walden, George
Smith, Tim (Beaconsfield)	Waller, Gary
Speller. Tony	Wardle, C. (Bexhill)
Spencer, Derek	Warren, Kenneth
Spicer, Jim (Dorset W)	Watts, John
Squire, Robin	Wells, Bowen (Hertford)
Stanbrook, Ivor	Wells, Sir John (Maidstone)
Stanley, Rt Hon John	Wheeler, John
Stern, Michael	Whitfield, John
Stevens, Lewis (Nuneaton)	Wiggin, Jerry
Stewart, Andrew (Sherwood)	Winterton, Mrs Ann
Taylor, Teddy (S'end E)	Winterton, Nicholas
Temple-Morris, Peter	Wood, Timothy
Terlezki, Stefan	Woodcock, Michael
Thomas, Rt Hon Peter
Thompson, Patrick (N'ich N)	Tellers for the Noes:
Thornton, Malcolm	Mr. Mark Lennox-Boyd and Mr. Francis Maude.
Townend, John (Bridlington)

Question accordingly negatived.