Diabetics (Needles) and NHS Charges (Hansard, 3 March 1987)

§ The Minister for Health (Mr. Tony Newton)
With permission, Mr. Speaker, I should like to make a statement about the supply of disposable syringes to diabetics and NHS charges from 1 April 1987.
There are in this country an estimated 1 million people who suffer from diabetes, of whom up to 200,000 require regular injections of insulin to maintain the stability of their condition. While some receive disposable syringes through the hospital service, the majority receive only reusable syringes and needles, which is all that is available from their general practitioners on prescription.
As the House is aware, this situation has been widely perceived as unsatisfactory. We have received many representations from hon. Members, the British Diabetic Association and others about the disadvantages of the reusable equipment, and the greater comfort and convenience of disposables. This has been particularly strongly argued in respect of children.
I am pleased to be able to tell the House today that the Government have decided to make disposable insulin syringes and needles available on general practitioner prescription. Since diabetics are among the groups who are exempt from all prescription charges, this supply will, of course, be free. Discussions with the manufacturers to make the necessary arrangements, in particular to ensure an adequate supply at an appropriate price, will start immediately. Our aim will be to introduce the new supply at the earliest possible moment. The estimated cost may well approach £10 million in a full year.
As I am sure the House would think right, we have linked our consideration of this matter with that of the appropriate level of prescription and other charges for the forthcoming year.
First, taking account of the existing wide range of exemptions from prescription charges, which will continue to mean that some 75 per cent. of all prescriptions—including all those for pensioners—are free, we propose to increase the charges broadly in line with the cost of the service, balanced, however, to improve still further the value-for-money offered by the "season ticket" arrangements. The item charge will rise by 20p to £2.40, the four-monthly pre-payment certificate by 50p to £12.50, and the annual pre-payment certificate by £1.50 to £35. Full details are available in the Vote Office, and the necessary regulations will be laid shortly with a view to their taking effect on 1 April. Equivalent steps will be taken by my right hon. and learned Friend the Secretary of State for Scotland and my right hon. Friend the Secretary of State for Northern Ireland. We estimate that these increases will produce of the order of £10 million in 1987–88.
Secondly, there will be no change in dental charges. They will therefore remain on the basis set in April 1985.
Thirdly, on charges for private patients, the House will be aware that, in response to recommendations from the Public Accounts Committee about the structure and level of these charges, regulations were laid last month to allow health authorities in England and Wales from 1 April either to determine their own charges to recover costs or to adopt the model charges of a central reference list. I have today placed in the Vote Office details of these model charges. For amenity beds, they are 8.3 per cent. higher 750 than the current charge, set two years ago. For private out-patients, they are 6.1 per cent. higher than that set last year. For private in-patients, the increase is larger at 17.6 per cent., to reflect not only increased costs but the PAC recommendations and the fact that private in-patients have shorter lengths of stay than NHS patients.
Fourthly, charges for overseas visitors in England and Wales will be increased in line with the central reference lists for private patients. Regulations to specify these new charges from 1 April will be laid shortly. Charges for private patients and overseas visitors in Scotland will also be announced shortly.
The context of the measures which I have announced today is an overall increase of expenditure on the NHS in England of over £1 billion in the coming year. Alongside the development of cancer screening services announced last week by my right hon. Friend the Secretary of State, I believe that the House will endorse the sensible ordering of priorities that now enables us to develop our services for diabetics, too.

§ Mr. Frank Dobson (Holborn and St. Pancras)
I welcome without reservation the announcement that the Government have decided to provide free disposable syringes and needles for diabetics, as called for by my right hon. Friend the Leader of the Opposition. The Opposition always welcome the Government's conversion to the principle of providing national health services on prescription free of charge. Will the Government agree to make blood glucose test drips available free to diabetics, so that diabetics can carry out tests on themselves necessary for the proper control of their condition?
The need for the Government to be converted to the free provision of national health services is demonstrated by the Minister's suggestion that the free disposable syringes for diabetics are to be paid for by a £10 million increase in prescription charges. That is insulting to diabetics and to those who have to pay the higher charges. This is an increase up to £2.40 from the 20p which prevailed in 1979 when, as reported in that model of accuracy, the Daily Mail, when reporting matters to do with the Conservative party, we were told that the Prime Minister—then the Leader of the Opposition—had said : We have no intention of increasing prescription charges.
The increase is disgraceful. As the Minister knows, doctors believe that people are putting off treatment. Some doctors are resorting to the unfortunate practice of giving prescriptions covering a lengthier period so as to reduce cost. That is a reasonable thing for the doctors to do, but it is dangerous to have those drugs about. The Opposition welcome the decision not to increase dental charges and assume that the Government accepted our recommendations that the 1985 increase in charges discouraged people from seeking necessary treatment.
As to charges for private patients, the Government have got into the ridiculous position whereby, since 1979, there has been a substantial increase in the number of pay beds in NHS hospitals but fewer patients are being treated in them. The Government are now failing to recover the costs of those patients. Health authorities are now faced with the ludicrous dilemma of increasing charges and losing patients or cutting charges and losing more money. The Government have not yet resolved that dilemma.
We regarded charges for overseas visitors as a squalid measure when they were introduced. We were told that 751 those charges would raise £6 million a year. I doubt whether they have yet raised £6 million in all the time that they have been in operation. Those charges have only damaged this country's reputation as a hospitable place for people to visit.

§ Mr. Newton
To take those points in reverse order, I believe that most hon. Members will regard charges for overseas patients as entirely sensible and justified. Those charges have raised about £6 million—albeit less than we originally hoped—which would not otherwise have been available to the Health Service. The hon. Gentleman has persistently failed to recognise that point. As to private patients, the Government are concerned to respond to the Public Accounts Committee and to ensure that costs are recovered on a better basis than in the past. That is the basis of the proposals.
On dental charges, there is no evidence to support the propositions put forward by the hon. Gentleman. The number of courses of dental treatment has continued to rise. We seek to check prescribing for long periods through the normal operation of the administration of prescriptions and their control. Lastly, the cost of blood-testing insulin strips would be roughly the same as the cost of supplying needles which I announced today. Although that is something we would like to do in due course, we have come to the conclusion that the supply of needles should be given priority at this point. The hon. Gentleman's whole response was typical of the Opposition, who relentlessly promise everything and will never face up to the need to pay.

§ Sir Peter Hordern (Horsham)
I congratulate my hon. Friend on his announcement about disposable needles, which will do more for those who suffer from diabetes than almost any other action apart from the supply of blood-testing insulin strips, which he also mentioned. This campaign has been continuing for a long time. The Minister's announcement is all the more welcome news for that and demonstrates beyond doubt that the Government listen and do what is right for those who suffer most.

§ Mr. Newton
I am grateful to my hon. Friend and I pay tribute to his efforts to bring about the decision which I have announced today.

§ Mr. Simon Hughes (Southwark and Bermondsey)
I welcome the announcement about disposable syringes for diabetics. The Minister will accept that, not least among the campaigners for that change over a long time, both to his Department and to the Prime Minister, has been my hon. Friend the Member for Berwick-upon-Tweed (Mr. Beith).
Does the Minister not accept that the increase in prescription charges of over 200 per cent. since 1979 is bound to mean that some people are deterred from going for a prescription when they need one? Does he not accept that last year the estimate was that by putting up the charge there would be a £30 million loss because of over-prescribing to compensate and that there may well be a similar loss to the Health Service this year?
In relation to private patients, in addition to this change, which is less than the increase in prescription charges, are the Government satisfied that the so far unrecovered money will be recovered? Is he aware that in the health authority in Camberwell. in my area, the figure 752 was about £83,000 in the last full year and over £100,000 in unpaid private patients' fees in the regional health centre?

§ Mr. Newton
It is my growing experience in this Department that there are few policies that can he undertaken without problems but the income we have gained from prescription charges has been more than matched by the improvements in various services which have been made possible.
As to private patient charges, the aim is that costs are properly and fairly recovered. That has not been done effectively in the past and we are now seeking to change that.

§ Mrs. Elizabeth Peacock (Batley and Spen)
I welcome my hon. Friend's statement. There are many diabetics in my constituency who will welcome this measure greatly, including the parents of a three-year-old boy, whom I recently wrote about, and a young lad who will now find it much easier to continue in his normal daily employment with disposable syringes rather than having to bother with the ones that have to be sterilised.

§ Mr. Newton
It is the children that I am particularly pleased about. I am glad to have been able to do something to respond to my hon. Friend's efforts in this field.

§ Dr. M. S. Miller (East Kilbride)
May I extend to the Minister a welcome for his decision on the supply of disposable syringes. It would have been ludicrous not to supply diabetics with disposable syringes when drug addicts are to be treated to that so-called privilege. May I impress upon the Minister the necessity of these disposable syringes being disposed of and not used again. In today's context it is essential that there be no contamination and that patients should be given a clear indication that the disposability of the syringes and needles is absolute, and that they cannot be used again.
In connection with the increase in prescription charges, many people are exempt but a number of people are still put to the very considerable expense of paying more and more. Would it not be better for the Government to consider methods of decreasing rather than increasing the prescription charges?

§ Mr. Newton
On the second point, it is precisely to assist with that possible problem, which I recognise, that the hon. Member will find that the increase in the season tickets is only about half, in percentage terms, the increase in the per item charge. We think that is a sensible approach. As to disposable needles, we shall be giving further consideration to whether extra steps need to be taken to safeguard their disposal.

§ Mr. Graham Bright (Luton South)
May I ask my hon. Friend to accept grateful thanks from every diabetic and certainly from the parents of young children and young people in general for his announcement? May I ask that this measure be introduced as soon as possible and that, where young people and children are concerned, clear instructions are given about disposal, because otherwise there might be other problems? With that in mind I welcome the Minister's statement.

§ Mr. Newton
The answer to the latter question is yes The answer to the former question is yes, as soon as possible, but we are talking about tens of millions of syringes and needles and we need to be sure that the supply is available.

§ Mr. Laurie Pavitt (Brent South)
While the Minister claims 75 per cent. exemptions, has he also read the report of the Pharmaceutical Society, which shows that one in two of every FP10 is paid for? With regard to the increase in the season ticket, is it not appalling that people who are chronically sick with angina or Parkinson's disease—young people—may be paying this extra burden for the rest of their lives? Young women who have had mastectomies and chemotherapy are paying £2.40 every three weeks or £35 a year. Is this not really the height of meanness?
On overseas charges, is the Minister aware that, although he takes the credit for income, he does not take the debit for extra administrative costs that every hospital's in-patient and out-patient departments must bear? This has a racist impact. Those who are questioned the most are the ones with a different skin pigmentation.

§ Mr. Newton
I am sure that the hon. Gentleman knows—he has studied the matter carefully — that we have issued guidance to health authorities which is designed to avoid the problem upon which he has touched and to keep administration to a minimum. On prescription charges, I should not at this stage wish to hold out hope of reopening the exempt list. It is precisely for reasons of the type upon which the hon. Gentleman has touched that I have taken steps to keep down the increase in season ticket prices.

§ Dr. John G. Blackburn (Dudley, West)
Will my hon. Friend accept the warm and generous appreciation that has been expressed by all hon. Members on behalf of diabetic patients? In addition, will he seriously consider the provision of blood glucose treatment and the provision of Nova pens, which are most important in treating diabetics, bearing in mind the tremendous savings to the Health Service by not having such people in hospital? Will he accept that his statement will be greeted with acclamation?

§ Mr. Newton
I am afraid that I cannot give my hon. Friend an immediate yes to either of his specific questions, but we shall certainly keep his points under sympathetic review.

§ Mr. Geoffrey Lofthouse (Pontefract and Castleford)
Is the Minister aware that his statement will be most welcome, certainly throughout my constituency and in Dr. White's clinic in my area? Has he considered that the costing is only for syringes that will be disposed of immediately after they have been used? Has he also taken into consideration the saving that will be made by non-disposal of syringes?

§ Mr. Newton
I have certainly heard it argued that the cost will turn out to be lower because some people will use syringes more than once. The hon. Gentleman will understand that I do not wish to base a Government policy proposal on the assumption that people will use syringes more often than originally intended.

§ Mr. Geoffrey Dickens (Littleborough and Saddleworth)
The Minister will know from the dozens of letters that I have sent him from diabetics and their children that we welcome such a compassionate move by Her Majesty's Government. We recognise that prescription charges have gone up, but my hon. Friend has announced that 75 per cent. of all drafted prescriptions do not need to be paid for. That is an important element.

§ Mr. Newton
I am suitably grateful to my hon. Friend, and likewise pay tribute to his efforts on behalf of his constituents in this matter.

§ Mr. Gareth Wardell (Gower)
I am pleased also to associate myself with what other hon. Members have said in welcoming the Minister's announcement. None-the-less, it is a pity that the announcement was not made at the same time as the announcement about free disposable syringes for drug addicts. On 3 November, the Under-Secretary of State wrote to Sir John Nabarro of the British Diabetic Association, stating that there were strong arguments for making blood monitoring equipment available on prescription. This afternoon, the Minister said that the priority must be disposable syringes. Will he give hon. Members some idea of how long it will be before the other important matter will be put right?

§ Mr. Newton
I cannot give a definite commitment as to time. I have made it clear that the Government are aware of the point and will continue to keep it in mind.

§ Mr. Robert Atkins (South Ribble)
I declare an interest as a parent of a child who is a diabetic, and has been for about eight years. On her behalf and on behalf of many other children and adults who suffer from the disease, I inform the Minister that we are grateful for the way in which he has listened and heard representations from many hon. Member. Does he agree that it makes nonsense of the continuing cries from various parts of the country that the Government do not care? The Minister's statement demonstrates to all concerned that we care, that we listen to representations and that we act.

§ Mr. Newton
I entirely agree with my hon. Friend. Frankly, not the least of my pleasures this afternoon is to know that I have helped to serve a cause in which he is greatly interested.

§ Mr. Ernie Ross (Dundee, West)
Does the Minister accept that the decision was absolutely necessary because of the furore caused by the fact that drug addicts were to be issued with free syringes, whereas those who were born with an illness over which they have no control were prejudiced? Does he accept also that it is nonsensical to talk about giving massive tax handouts when such an announcement is likely to bring support from all hon. Members? Will he discuss with his right hon. Friend the Chancellor of the Exchequer a better use of resources rather than giving tax handouts?

§ Mr. Newton
My right hon. Friend the Chancellor of the Exchequer has readily agreed to large increases in resources going to the Health Service over a number of years. I am grateful to him for that. Of course I am aware of the connection that has been made in the argument, but this measure stands on its own merits and could rightly have been done, and has been done, in its own right.

§ Sir Hector Monro (Dumfries)
I thank my hon. Friend and the Scottish Office Ministers for urgently reconsidering a matter that many hon. Members have raised. Does he understand that many diabetics will appreciate the decision that has been made?

§ Mr. Newton
I am happy to pass on my hon. Friend's remarks to the Under-Secretary of State for Scotland, who is sitting close by me. I know that he will be grateful.

§ Mr. A. J. Beith (Berwick-upon-Tweed)
In warmly thanking the Minister for his decision may I associate with 755 those thanks the Under-Secretary of State for Health and Social Security — the hon. Member for Derbyshire, South (Mrs. Currie)—who replied to my Adjournment debate on this issue and added her efforts? I assure the Minister that costs could be substantially lower than he now supposes if admissions to hospital are fewer because better control is exercised through the more accurate plastic syringe. I ask him to be a little clearer about how quickly he hopes to get the measure into operation.

§ Mr. Newton
No one will be more pleased than I if the cost proves to be lower. It will make it much easier for us to do some of the other things that people have mentioned. On timing, I do not think that, at the moment, I should like to go beyond early summer. We shall urgently discuss the matter with manufacturers, but there is no point in saying that something will happen until we can say that supplies are available. I am glad to associate my hon. Friend the Under-Secretary of State, who I am sure deserves thanks on this occasion, as on all occasions.

§ Mr. Andrew Rowe (Mid-Kent)
Given the cynical propensity of the Opposition to misrepresent everything that the Government do, will my hon. Friend assure the House that, when he puts out publicity about new prescription charges, he will reiterate the many categories of people who do not have to pay?

§ Mr. Newton
I certainly have no intention whatever of hiding our light under a bushel.

§ Mr. Nicholas Winterton (Macclesfield)
I thought, Mr. Speaker, that I would have to strip off like the Tamils at Heathrow to be noticed. [Interruption.] The Minister is considered by Conservative Members and by millions of other people to be one of the most caring — [Interruption.]

§ Mr. Speaker
Order.

§ Mr. Winterton
rose—[Interruption.]

§ Mr. Speaker
Order. Mr. Winterton.

§ Mr. Winterton
I am sorry, Mr. Speaker, if you find it difficult to hear me. I was saying that my hon. Friend is considered by his colleagues and by millions of other people as perhaps one of the most honest, courageous and caring Ministers. His decision to provide free disposable syringes and needles to diabetics is warmly to be welcomed, although such a move is only just, bearing in mind that we provide free replacement needles to drug addicts. Diabetics deserve consideration and sympathy more than drug addicts do. Will he highlight to the people of—[Interruption]—

§ Mr. Speaker
Order. The hon. Member might as well get it right.

§ Mr. Winterton
I apologise, Sir. Because of the polemics from the Opposition, will he highlight to the people of this country the fact that 75 per cent. of all prescriptions are provided free and, therefore, that the benefit of a free prescription system is available for all who need it?

§ Mr. Newton
I am grateful to my hon. Friend for re-emphasising that important point. As for the earlier part of his question, I am tempted to ask whether I can now quit while I am ahead.

§ Mr. Derek Conway (Shrewsbury and Atcham)
I hope that my hon. Friend will accept that the Shropshire 756 diabetic association will greatly welcome his statement this afternoon, along with the 60 colleagues who very generously signed my early-day motion. Is it not the case that the more efficiency that my hon. Friend and his colleagues can introduce into the National Health Service the sooner the day will come when we shall also have a similar encouraging and welcome statement on testing strips?

§ Mr. Newton
I very much hope that the forecast will prove to be true, and I should like to pay tribute again to my hon. Friend, of whose early-day motion we have been very conscious.

§ Mr. Eric Forth (Mid-Worcestershire)
Along with so many other hon. Members, I welcome my hon. Friend's announcement about needles for diabetics, particularly since their condition is not brought on by anything that they have done.
In that light, will my hon. Friend reconsider his decision to give free syringes and needles to drug addicts who impose their own condition on themselves? Will he talk to the Minister of State, Home Office, who is attempting to reduce drug addiction, compare notes with him and ask himself what his Department is doing and whether it ties in with what the Home Office is trying to do?

§ Mr. Newton
My hon. Friend will probably have heard me resisting the straightforward parallel that was implied in an earlier question. I shall say only this about pilot schemes for needle exchange in relation to drug abuse: intravenous drug abuse and the sharing of needles is one of the main ways in which AIDS can be spread into the heterosexual population, and it is vital that the Government should do everything possible to reduce that risk.

§ Mr. Harry Greenway (Ealing, North)
As some of my constituents have had to pay £10 a month for needles for diabetic usage, I warmly welcome what my hon. Friend has said. Will dentists be paid a fee for examining people when no treatment is required? In order to obtain a fee, I believe that in some cases fillings and other treatment is given unnecessarily.

§ Mr. Newton
Having announced no increase in dental charges, I think that I ought to confess that I have not focused on that point very much this afternoon, but I undertake to look at my hon. Friend's point.

§ Mr. Patrick Thompson (Norwich, North)
I join the many hon. Members on both sides of the House in warmly welcoming the Minister's announcement about free disposable syringes. I have received very many representations from diabetics and their relatives and friends in Norwich. Obviously they will welcome wholeheartedly this announcement. Also I join hon. Members on both sides of the House in asking my hon. Friend to think again as soon as possible about blood glucose testing strips and their inclusion on the prescription list.

§ Mr. Newton
I am grateful to my hon. Friend. I note what he said in the latter part of his question.