Prescription Charges

HC Deb 03 April 1990 vol 170 cc1151-71 10.14 pm

Mr. Robin Cook (Livingston)

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 1990 (S.I., 1990, No. 537), dated 8th March 1990, a copy of which was laid before this House on 9th March, be annulled.

This will be a short debate, as it is based on a prayer and must finish by 11.30 pm. Indeed, it will be so short that the House will remember that I have made speeches longer than this whole debate. In opening the debate, I shall confine myself to the central proposal— [Interruption.]

Madam Deputy Speaker (Miss Betty Boothroyd)

Order. The House is attempting to hear the hon. Member for Livingston (Mr. Cook), who is moving the prayer.

Mr. Cook

You disappoint me, Madam Deputy Speaker. I had hoped that I had stimulated unusual interest in my speech.

As 1 was saying, I shall confine myself to the central proposal of the regulation, which is that, if the regulation is carried by the House, it will increase prescription charges by 9 per cent.—in a year in which the Government have based the funding of the National Health Service on the assumption that inflation will be 5 per cent. If the regulation is carried, prescription charges will be £3.05. That figure is so large that Conservative Members may have difficulty remembering what it was when they took office. To assist them, I remind them that in 1979, when they inherited office from the last Labour Government, prescription charges were 20p. My hon. Friends will have no similar difficulty in recalling what the Daily Mail said in that year, when we warned that the Conservatives might double prescription charges—it called the warning "another Labour lie".

I must confess to my hon. Friends that the Daily Mail had a point, as we had failed to warn the nation of the full shock in store for patients in the NHS. If the latest increase is put in place, prescription charges will be 1,425 per cent. higher than when Labour left office.

Mr. Andrew Rowe (Mid-Kent)

Will the hon. Gentleman remind me, as I have forgotten, what proportion of National Health Service patients pay prescription charges?

Mr. Cook

One quarter of those who claim prescriptions pay the prescription charge. If the hon. Gentleman will allow me, I will deal with that point at some length in the course of my remarks. I very much hope that I shall have his attention when I come to that aspect. If that is a factor in the hon. Gentleman's thinking, we may be able to persuade him with reason to join us in the Lobby.

To put the increase in perspective, in 1979 one could get three prescriptions for the price of one packet of cigarettes. After this regulation is in place, one will need to club together the price of almost two packets of cigarettes to pay for one prescription. That relative price movement provides an awkward footnote to the Government's health strategy.

It would be bad enough if the new prescription charge merely covered the cost of the drugs that it purchased, but we have arrived at the stage when prescription charges will exceed the cost of a large number of the prescriptions that they pay for.

Mr. John Marshall (Hendon, South)

Will the hon. Gentleman give way?

Mr. Cook

I will give way, but as we have to conclude by 11.30, this had better be the last time.

Mr. Marshall

The hon. Gentleman is taking us down memory lane. Will he confirm that the Labour party promised in 1974 to get rid of prescription charges but did not do so?

Mr. Cook

I fully admit that the last Labour Government had their failings. If the hon. Gentleman's concern is that we failed to get rid of prescription charges, I happily offer him a compromise: we shall withdraw any commitment to getting rid of prescription charges if he will join us in the Lobby to vote for a prescription charge of 20p as opposed to the Government's proposal for a charge of £3.05. To complain that the last Labour Government left charges at 20p hardly seems a logical or rational argument for increasing the charges to £3.05.

To return to the point that I was about to make, arising from a highly contemporary parliamentary answer, the Minister of State admitted only last month that one third of all prescriptions dispensed have a drug content costing less than the face value of the prescription charge. They are the more common drugs, amounting to more than a third of the total number of prescriptions. Forty-five million prescriptions are being dispensed every year on a prescription charge which renders a profit to the Secretary of State. The National Pharmaceutical Association has furnished me with a full page listing common drugs which can be bought over the counter at a cheaper price than they can be obtained on prescription. Is that what Conservative Members want to achieve? Is it part of their strategy of commercialising health care to encourage patients to dose themselves rather than to seek a prescription on qualified medical advice?

Over the years, as we have debated the matter, I have become familiar with the defence that the hon. Member for Mid-Kent (Mr. Rowe) has already advanced. It is that the exemption from prescription charges is so wide that there is no real problem. The reason why the proportion of people who are exempt from prescription charges is so high is that the majority of prescriptions are for pensioners and children, who are automatically exempt. The majority of prescriptions to adults under the age of retirement are not exempt.

For example, people with chronic illnesses, who represent a large number of those who require prescriptions, are not exempt. They may have conditions which require repeated prescriptions, and those repeated prescriptions may well be expensive, but such people have no automatic exemption. There is no exemption for people who suffer from cystic fibrosis, asthma, Parkinson's disease, multiple sclerosis or schizophrenia.

Each of those diseases has been brought to the attention of the Government by organisations representing people who suffer from them and the people who care for those who suffer from them. Repeatedly over the years the Government have refused to widen the exemption to cover them. All the conditions that I have mentioned automatically and unavoidably lower the sufferer's capacity to earn. They all require medication—perhaps two or three prescriptions a week—but there is no exemption for sufferers from them unless they pass the income test.

That brings me to the income test as the basis for exemption. A feature of the Government with which my hon. Friends will be familiar is that means tests keep getting meaner. I am indebted to my hon. Friend the Member for Burnley (Mr. Pike) for winkling out of the Minister of State the fact that the number of people eligible for free prescriptions on grounds of income fell by half a million last year. That is the result of the changes made in April 1988. Changes were made to the income test for free prescriptions without any statement to Parliament or debate in the House. As a result of the changes, only 3.4 million adults in Britain, out of the whole population under retirement age, qualify for free prescriptions on the grounds of low income. The rest have to pay, unless they fall into one of the other small exempt categories.

One group of people who have increasingly become liable to pay the full prescription charge are those in receipt of invalidity benefits. Since the changes in 1988, many of those people found that they lost the exemption that they had on the grounds of low income, not because their income rose in real terms but because the threshold fell in real terms. The problem for them is that, once they are carried £1 over the income threshold, they lose all their exemption. By definition, if someone is on invalidity benefit, the chances are that they require regular prescriptions—perhaps two or three a week. But even if they require two or three prescriptions a week, the moment they go £1 over the income limit they are expected to find £9 to pay the face value of the prescription. That is a serious reduction in the standard of living for a household living on perhaps £70 or £80 per week.

I have seen the correspondence between one such person on invalidity benefit and the Minister's office. The correspondent wrote complaining that, following the change in the income test, he had not been able to afford five prescriptions that he had needed in the previous month because he could not spare the necessary £14 out of his tight budget. The reply from the Minister of State's office—I exempt the present Minister of State from blame, as the letter came from her predecessor's office—was masterly in its incomprehension of what life is like on a hand-to-mouth existence in which one has to count every penny. The reply, if you please, advised the correspondent that it would be cheaper for him to make a bulk purchase by buying a season ticket for the prescriptions. As the correspondent pointed out in his letter to me in rather blunter terms than I can share with the House, if he could not budget to find £14 to pay for the prescription charges how did the Minister imagine that he would find £40 to buy the annual certificate in the first place?

Every week, pharmacists are confronted with patients who have been given three prescriptions and ask the pharmacist to advise them which ones they really need because they cannot afford all three. I find it curious that Conservative Members keep denying that charges have that effect. After all, every Conservative Member believes in market forces—it is a condition of membership of the modern Conservative party. They know that market forces work by the price signal, so it is an article of faith that if prices go up, demand must go down. That is certainly what has happened with eye tests.

This week marks the end of the first year since charges were introduced for eye tests. Every survey—there have been many—concludes that charges have been accompanied by a 30 per cent. drop in eye tests—3.5 million fewer eye tests have been performed, so 3.5 million people have been put off by the new price signal of a tenner a test.

Mr. David Winnick (Walsall, North)

That is damaging to health.

Mr. Cook

The Secretary of the Association of Optometrists shares my hon. Friend's belief as he observed on Monday, that 200,000 people have been missed who might have serious eye conditions which would have been detected if they had come forward for a test, as they would have done last year. He said: I think it is inevitable that people will go blind as a result of charging.

The deterrent that we have seen in the case of charges for eye tests can also be witnessed in the case of prescription charges. The Government's own figures show that prescriptions that are not exempt, those prescriptions for which there is a charge, fell from 107 million in 1979—I have already reminded the House that the charge then was 20p—to 70 million in 1988. That is a reduction of about a third. That drop is all the more remarkable given that, in the same period, those prescriptions which are exempt continued to rise.

The York Centre for Health Economics has made the reasonable estimate that, if prescriptions for which people have to pay had continued to increase at the same trend growth rate as those which are exempt, the number of prescriptions for which people are currently paying would be double the current level. In other words, half the demand for prescriptions has been suppressed by the current level of prescription charges.

Ironically, in the very month in which the Government have announced the latest increase, the Institute for Fiscal Studies released a study which concluded: The entire fall in the number of charged prescriptions could be accounted for by the increase in the real level of the prescription charge"— an entire fall of one third in real terms.

The Institute for Fiscal Studies is not alone in its judgment. The latest increase has been condemned by the Royal Pharmaceutical Society, the National Pharmaceutical Association and the British Medical Association—the very organisations which speak for pharmacists and for general practitioners. They are the people who see the effect of prescription charges on their patients. They know that it is a tax on the sick and they find it repugnant that the people who are most sick have to pay most. There can be no justification for the latest increase.

The House began its proceedings after Question Time today with a ministerial statement on capping local authority poll taxes. I invite the House to conclude the day's work by joining me in the Lobby to cap the Government's own poll tax.

10.30 pm

Mr. John Marshall (Hendon, South)

Whenever the House talks about prescription charges, we have a debate that is little better than a charade, because it is full of cant from Opposition Members. If we consider the history of prescription charges in this country, we must remember that a Labour Government first took upon themselves the power to impose prescription charges. We must remember that in 1964 Lord Wilson won the election on the promise that he would get rid of prescription charges. He did for three years, but then Lord Jenkins reintroduced them in 1968. In 1974, Lord Wilson was at it again; he promised to get rid of prescription charges.

It is no use the hon. Member for Livingston (Mr. Cook) saying that prescription charges were merely 20p at the end of his term of office. The integrity of election promises is at issue. It is surely wrong and cynical—

Mr. Cook

I am delighted at the hon. Gentleman's observation about the integrity of election pledges. May I invite him to consider two issues to which he must address his mind in the context of this debate? First, will he show my hon. Friends and me where, in the Conservative manifesto in 1987, there was a commitment to introduce charges for eye tests or dental examinations? Will he cast light on how it was that before—[Interruption.] The hon. Gentleman may seek guidance, but he will not find a reference in the manifesto.

Secondly, will the hon. Gentleman cast light on how it was that the Conservative party could assure the country in 1979 that it had no intention of doubling prescription charges when it increased them fifteenfold?

Mr. Marshall

We made a commitment in 1979 to improve the quality of the Health Service, which is what we have done. Those prescription charges are part of that improvement. Those who vote against prescription charges tonight are voting against an income for the Health Service of more than £200 million.

Dame Jill Knight (Birmingham, Edgbaston)

I wonder whether my hon. Friend noted with the same interest as I did the fact that, in all the remarks of the hon. Member for Livingston tonight, not once did he say what cuts he would impose on the Health Service to meet the drugs bill.

Mr. Marshall

My hon. Friend is right. The choice facing the country is simply whether we want—

Mr. Jeremy Corbyn (Islington, North)

rose—

Mr. Marshall

I have given way twice, and I am trying to answer my hon. Friend. When I have done so, I shall give way to the hon. Gentleman.

The choice facing the country is simple: do we want a better Health Service for those who are ill or do we want free drugs for people who can afford to pay for them? The Labour party must say how many nurses it would get rid of, how many fewer hip replacements and how many fewer heart transplants there would be if its views were to prevail.

Mr. Corbyn

I shall take the hon. Gentleman back to 1979. Will he tell us exactly what the pledge was in that Conservative election campaign? I seem to remember very well that there was a pledge not to increase prescription charges. That has clearly been broken. The argument then was just as valid as it is today: by increasing prescription charges, one increases the cost for those who can least afford it because they are ill at the time.

Mr. Marshall

I well remember 1979 because that was when the hon. Member for Islington, North (Mr. Corbyn) was causing chaos throughout north London by persuading refuse collectors not to collect refuse, indulging in a series of strikes and disrupting education in the London borough of Haringey, where schools were closed for several weeks.

As for the hon. Gentleman's talk of an alleged election promise, no promise was made in 1979 not to increase prescription charges. A specific promise was made in 1974, however, which the Labour party refused to honour. It is perhaps significant that we have not heard from the Labour party tonight what its policy is. Is it the policy of the 1989 Labour party conference, which was to get rid of prescription charges, or is it a fact that its latest policy review fails to mention the subject at all? I suspect that Labour Members have realised that no one will believe any promises they make in respect of prescription charges.

Mr. Robin Cook

rose—

Mr. Marshall

I have given way three times.

Mr. Cook

If the hon. Gentleman will ask these questions, he must expect them to be answered. The answer is perfectly straightforward. Our commitment, as a first priority, is to abolish the charge for eye tests, and that will go; secondly, we will abolish the charge for dental examinations, and that will go; then we will make what progress we can within resources in reducing the prescription charge. There will certainly be no increase. If there is no increase, it will mean that the prescription charge will decline with inflation. Of course, under the next Labour Government, inflation will be so low that that will not be satisfactory, so I assure my hon. Friends that I shall seek to make real cuts in the value of the prescription charge.

Mr. Marshall

That has been a valuable little exercise: we have managed to smoke out from the Labour party spokesman on health the fact that a future Labour Government would retain prescription charges. The commitment to reduce them is so "pie in the sky" that we know it will not happen. To be told that a future Labour Government will reduce the rate of inflation, when under the previous one inflation increased within 12 months to 25 per cent. and the average rate of inflation was twice the rate under this Government, is pure "pie in the sky" economics.

There are widespread exemptions for these charges, and we should look at them in relation to the total drugs bill. We have been told that they are going up by 8.9 per cent. in the current year. What we were not told by the hon. Member for Livingston was that the drugs bill is estimated to go up by 13 per cent. this year, so that prescription charges will be meeting a smaller percentage of the total drugs bill.

We should also look at the size of the drugs bill, which in the current financial year will be £2.4 billion. I should have thought that a system of charges raising less than 10 per cent. of the total drugs bill is not at all unreasonable. The charges are not paid by the needy, as the hon. Member for Islington, North (Mr. Corbyn) said, because there are widespread exemptions covering a very large number of people.

I believe that the charges are reasonable. I believe that the opposition to them is full of cant and humbug and pays no attention to what the Labour Government did.

10.37 pm

Mr. Charles Kennedy (Ross, Cromarty and Skye)

I am not going to follow the hon. Member for Hendon, South (Mr. Marshall), particularly on his line of argument, although I would say that perhaps the best—or perhaps not the best but the most worrying—thing that could be said about his speech is that he actually sounds as if he believes it. It strikes me that we have had a recurrence of debates at about this hour of the evening, when Ministers from the Department of Health or the Department of Social Security are frequently lambasted from their own Back Benches on a variety of issues, but when there will be one loner, one loyalist, who will stand up and read the brief, either from Smith square or the Whips Office.

I wonder, when the hon. Member speaks, how it is that the Whips allocate these things. It must be on a "short straw" basis, the choice of who has to make the speech defending a policy which, to judge by the expressions on the faces of other hon. Members on the Government Benches, particularly those interested in health issues, is fairly indefensible. I suspect that, within the parliamentary Conservative party, it works rather like a reverse example of how one loses a driving licence—by accumulating points over time. The more of this kind of speech one makes, the more one accumulates points; one does not lose one's licence at the end—one is given a knighthood for services to the state. So I wish the hon. Gentleman well in his endeavours.

Let us just deal with the reality of this. One thing struck me when this year's increase in prescription charge was announced. It is a worrying fact, which reflects the longevity of the Government and, alongside that longevity, the extent to which the public have become much less interested over the years in increases in these charges. For slightly more than a decade, we have become used to way-above-the-odds increases in prescription charges that, even compared with when I entered the House in 1983, are no longer as big and as dramatic a story in the media—[AN HON. MEMBER: "They should be."] They certainly should, but they are not. That is a sad reflection of an almost weary acceptance among reporters. They feel that it is the same old story again of the Government putting up prescription charges above the level of inflation, even though inflation is well beyond what was anticipated in the current financial year.

In addition, that group in society who are most dependent upon prescriptions—the categories referred to by the hon. Member for Livingston (Mr. Cook)—are all too often the same strata of strained financial cross-sections who have the weakest voice, not only on prescription charges but on housing and social security policies. Therefore, we are right to debate these matters on each and every occasion they arise, so that we can give voice to the reality that we hear in our constituency surgeries. I cannot believe that Conservative Members do not hear it also, because they certainly appear to be hearing all the complaints about the poll tax. They have somewhat selective hearing when it comes to social security issues in general and health policies in particular.

The hon. Member for Livingston also referred to eye test charges and the deregulation in that category of the Health Service, with the resultant serious problems. During the past few months, my party, through a questionnaire, has polled the opinions of almost 2,000 opticians throughout England, Wales and Scotland. The results have been in line with what the professional associations have found—that there has been about a 30 per cent. drop in the number of people seeking eye tests. Almost as high a number—28 per cent.—of opticians feel that there is a question mark against their financial liability if the changes introduced last year are not reversed.

We now have a contrast. A year ago, when Lords amendments were debated on the Floor of the House, the Government majority was slashed to single figures or at least the low teens. They sought to overcome the amendments on dental and optical tests imposed in another place. I took the trouble to read the Hansard of the exchanges during that debate, including the remarks of the Minister and the Secretary of State. They offered the same assurances that they are now offering on prescription charges—that they would not have a detrimental effect, that there would be sufficient exemptions, that it was scaremongering by the Opposition, that there was no need to upset people, and so on.

The evidence since then is overwhelming and disastrous. First, the changes make nonsense of public health preventive medicine policy. Secondly, they must raise legitimate anxieties about public safety. With a 30 per cent. drop in eye tests, how many people are now behind the wheel of a vehicle on our roads who, had they had an eye test during the past 12 months, would be wearing glasses and would therefore be safer drivers? They also make nonsense of transport policy and public safety on our highways, which should be an arm of government into which the Department of Health has an input.

Thirdly, the Government are carrying out a survey of opticians and are due to publish the results in May. Surprise, surprise, I have been looking at some of the detailed comments that the professional associations have made, and we should take with a pinch of salt any findings in the Government's collection of statistics that apparently give the lie to the most recent surveys. I say that because the questions are loaded. They are loaded to avoid the public's giving the kind of answers that would give an accurate reflection of this attitude to eye tests.

I will give one example. One of the questions asked is: "Have you had an eye test since Christmas?" They do not say since the beginning of the year, or in the last three months. MORI has been asked to advise on the efficacy of using the word "Christmas" and it says, as an organisation of experienced opinion pollsters, that that is a deliberately vague term in that it stretches the bounderies of recollection back as far as November, and that it does not line up with the kind of dates over which the Government have been promising that they would be able to give accurate figures.

Secondly, the pollsters ask the public not if they had to pay but what kind of eye test they had. They say: "Did you have a National Health Service eye test, or did you pay for an eye test?" Again, they are trying to confuse the public by the questions they are asking.

I sent the Secretary of State a copy of the questions which we circulated throughout Britain, and a copy of the responses. I think he will find that they are far more accurate and honest. Given that the results produced from nearly 2,000 opticians approached directly are completely in line with the figures discovered as a result of the professional bodies carrying out their surveys, if the Government figures are far removed from those, it is because their supposed survey has been rigged.

In comparison with what we were assured over dental and optical charges 12 months ago and the disastrous downturn since, one can have no confidence whatsover in the Goverment's latest hike in prescription charges, because any assurances that they can offer are likely to prove too low, not least when we hear the kind of assurances drafted from Smith square for Back Benchers which immediately preceded my own contribution.

10.47 pm

Mr. Roger Sims (Chiselhurst)

This debate, as the hon.

Member for Ross, Cromarty and Skye (Mr. Kennedy) implied, is an annual event that takes on something of a ritual quality, not least with the Pavlovian response from Members on the Opposition Front Bench. These are entirely predictable, although certainly more enjoyable from the lips of the hon. Member for Livingston (Mr. Cook) than from some of his predecessors.

I assure the hon. Member for Ross, Cromarty and Skye that I am not a pressed man but very much a volunteer, as I hope my hon. Friend the Member for Sheffield, Hallam (Mr. Patnick) can confirm. Indeed, I am no party hack on this or any other issue.

Mr. Kennedy

Having served on a number of Committees with the hon. Gentleman, I would never accuse him of that. I think that is why he tends to stand further way from the Treasury Bench.

Mr. Sims

I am grateful for that compliment from the hon. Gentleman, as no doubt the hon. Member for Livingston is for the one that I just paid him.

As the subject has been mentioned, I remind the House that I believe that it was wrong for the Government to impose charges for eye tests and teeth checks, and spoke and voted accordingly. I believe that the evidence that we have already heard in the debate this evening, when it has had more time to emerge, will prove the case, but time will tell.

Having established my position on that, I am bound to say that I think it entirely reasonable that those who can afford to do so should make a contribution towards the cost of prescriptions. After all, more than half the population are within the exempt categories and only one quarter of prescriptions are charged for. We are talking of £3 or so per item, although with the use of the so-called season ticket facility the average cost reduces. However, I sometimes wonder whether people are as aware of this facility as they should be and whether it might usefully be given more publicity.

I was interested that the hon. Member for Livingston made a comparison with the cost of a couple of packets of cigarettes. Is it unreasonable to expect people to pay for a prescription what they pay for a couple of packets of cigarettes or a round of drinks in the pub, although they probably pay a good deal more for a round of drinks?

Another comparison might be with the items on a normal shopping list at the chemist. People expect to pay £2 or £3 for cough mixture, aspirins, sticking plasters and many other items to be found in the average bathroom cabinet. Is it unreasonable to ask people who can afford it to pay £3 for a prescription?

If Opposition Members are really against it, they must answer the questions posed by my hon. Friend the Member for Hendon, South (Mr. Marshall). The Department estimates that this increase we are discussing will provide the NHS with £13 million. What alternative method of raising money for the NHS do Opposition Members have? Should it come from increased taxes? Or would they prefer cuts to be made in NHS expenditure to protect those with means from having to pay a little more for their prescriptions? If that is their view, it is a curious socialist philosophy.

Were Labour Members to follow through their party conference policy and abolish prescription charges, they would have to find about £170 million, if my calculations are right. There would have to be huge NHS cuts to find that sort of money. The Government proposal is reasonable and reflects the higher cost of pharmaceutical services in the NHS.

10.52 pm

Mr. David Hinchliffe (Wakefield)

We must discover the real reason why, yet again, the Government wish to increase prescription charges. After all, the Conservatives have increased them every year snce they came to power in 1979.

Conservative Members have offered only one reason for the increase—that of raising money for the NHS. Compared with the overall NHS budget, the extra cash that this increase would raise—£13 million—is chickenfeed.

The Government have had huge sums at their disposal, but have invested them otherwise than in the NHS In a recent short debate on the Consolidated Fund Bill, I pointed out that the Conservatives had raised about £50 billion through selling public assets—the family silver—and a further £83 billion from North sea oil. No previous Government have had such enormous resources at their disposal from which to make a larger contribution to the NHS. Yet today we are discussing a mere —13 million, which will penalise the poor and the sick. It is disgraceful.

I believe that there are other reasons why the Government wish to increase prescription charges. They may wish, for example, to establish financial disincentives so that people will think twice before obtaining the drugs that they require. Is that the reason why the Government are bringing forward increased charges?

My hon. Friend the Member for Livingston (Mr. Cook) mentioned the report by York university, which is well worth studying. A number of points raised by that report give us cause for concern. We are worried about the implications of increased prescription charges, because the York report said that increasing prescription charges may … be reducing as opposed to enhancing the use of primary care resources. The Government must be aware of that problem. They are affecting the way in which general practitioners operate, and the way that primary care can assist the patient.

The Government must also be aware of the huge reduction in the take-up rate for prescription since charges were introduced. Some 107 million were cashed in 1979. The figure was down to 70 million by 1988. We should all be concerned about the implications of that for the patients involved. be valued and will be used rather than flushed down the toilet or the drain? Do the Government feel that if something is paid for it is more valued? I have been waiting to hear the Government's justification from the Government benches for another huge increase in prescription charges, but frankly no reason has been given.

The real reasons relate to the Government's wider political objectives for the National Health Service. The Under-Secretary of State for Health knows my view of the scenario because he heard it last week and the week before. He heard it in the Standing Committee on the National Health Service and Community Care Bill. He understands my view of the Government's actions. I feel that I need to repeat it again and again because I genuinely believe that the Government's policies are part of an overall plan to transform the National Health Service into something quite different.

The Government have made a deliberate attempt to undermine public confidence in the National Health Service during their time in office—for example, by the way in which they have continued to underfund the service. Year in and year out since 1982, the National Association of Health Authorities report has indicated massive underfunding of the Health Service.

The Government have deliberately provoked industrial disputes within the National Health Service. The nurses' dispute and the ambulance crews' dispute were inflamed deliberately by the Government and in particular by the Front Bench and the Secretary of State for Health. The Government have attempted to try to convince people that we can no longer afford a state National Health Service and that we need to consider alternatives to the service that we have been fortunate enough to have since the 1940s.

Those Government policies are part of an overall plan to prepare for something very different. The Government have deliberately attempted to create a public expectation that one now has to pay for the health care which has been freely available in this country since the inception of the National Health Service. What other justification can there be for the provisions in the Health and Medicines Act 1988 for eyesight checks that the hon. Member for Chislehurst (Mr. Sims) mentioned?

My hon. Friend the Member for Livingston cited some appalling figures tonight—3.5 million fewer eye sight checks have occurred as a result of the charge. That number of people would otherwise have gone for those checks. What other justification can there be for charges for dental checks? Charges for hospital parking will be a disincentive for people to attend hospital or to visit relatives in hospital. What other justification can there be for the huge jump in prescription charges?

The measure relates to wider issues than just another huge increase in prescription charges. I was fortunate to have been born shortly after the inception of the National Health Service, so I never knew about doctors' bills—but I have read about them and I have been told about them. It is fitting that my right hon. Friend the Member for Blaenau Gwent (Mr. Foot) is here tonight as I have read the volumes that he wrote about Nye Bevan and learnt from those and from other publications about the reality before the inception of National Health Service.

In the past week, the reality of the situation that we may face has been brought home to me. One of my constituents is facing a bill for £6,000 for private health treatment which she cannot afford to pay. The medical insurance company which she thought would cover those expenses has told her, "Sorry, but because of a technicality you are not covered" and she is being sued for £6,000. That sort of thing should have gone out of the window in 1948, on the introduction of the National Health Service.

The real reason behind this measure is the Tory policy of turning the Health Service into a commercialised, pay-as-you-go, American-style health care system. Anyone who believes in the NHS should today and in any future debate vote solidly against the Government in defence of the Health Service of this country.

11 pm

Mr. Anthony Coombs (Wyre Forest)

I agree with the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) about how remarkably little coverage there has been of this measure in the national press. In the Library, I failed to find one mention of it in any national English newspaper. Unlike the hon. Gentleman, I do not think that that is the result of apathy, but that newspaper commentators and the majority of the public accept that there is nothing wrong in asking people who can afford to pay prescription charges to make some contribution— albeit not an economical contribution—and so provide the Health Service with substantial additional revenue at a time when the drugs budget is rising rapidly.

It is easy to caricature prescription fees as a charge on the sick, as was said by the hon. Member for Leeds, West (Mr. Battle), and to claim that they deter people from seeking proper medical treatment. That may be good political hyperbole, but the majority of the public reject it as totally divorced from reality.

The reality is that the Opposition recognise the strength of the argument for prescription charges. Although Labour abolished charges in 1965, they reintroduced them three years later, at a 25 per cent. higher level. In 1974, Labour promised to abolish prescription charges but failed to do so during their subsequent four years in government. Last year, Labour's national conference voted to abolish charges, but the shadow Chief Secretary to the Treasury must be concerned that prescription charges raise £212 million—the equivalent of budgets for six or seven health authorities of reasonable size. The total amount raised by all Health Service charges, many of which Labour introduced after the war, is £1,020 million annually, which even Opposition Members, in their saner moments, would regard as a significant contribution to NHS funding.

Most people accept that it is a sensible, progressive and sane proposition that people who are able to contribute to prescription costs, and have sufficient income, should do so. The charges involved can hardly be regarded as regressive. Of a total of 335 million prescriptions, no fewer than 260 million are provided free of charge. The number of prescriptions per person has risen by about one tenth since 1977, the amount spent on the drugs budget per se has risen from £550 million in 1979 to £2.4 billion, and the drugs budget is rising significantly faster than increases in charges.

Despite that background, the exemptions that the Government have allowed, which account for a higher proportion of the total drugs budget, have increased over the past 10 years. In addition to children under 16, all pensioners, people on income support or family credit, expectant mothers and mothers who have had a child within the previous 12 months, in 1982 the Conservative Government allowed a further extension to include mothers who have had the appalling experience of having a stillborn child within the previous 12 months, between 1983 and 1985 they made further exemptions for medical conditions, and in 1988—a fact that has not been mentioned by the Opposition or by my hon. Friends—they extended exemption to students under 19 who are in full-time education.

It is scarcely surprising that, with 55 per cent. of the population and a far greater proportion of those needing prescriptions being exempt, the changes are met with understanding and, indeed, a deafening silence by the newspapers which might be expected to oppose them.

The hon. Member for Livingston (Mr. Cook) mentioned the Institute of Fiscal Studies and an article in its February magazine. It is not surprising that research shows that the increase in charges of some five times in real terms over the past 10 years has not resulted in any decrease in the number of prescriptions. Indeed, between 1979 and 1987 the number rose by 11 per cent. The hon. Gentleman said that the Institute of Fiscal Studies showed that the number of paid prescriptions declined from 107 million to 70 million between 1979 and 1988 and that this showed that the increase in prescription charges had reduced the number of people who were prepared to pay for prescriptions. That may be a significant determinant. Indeed, the Institute of Fiscal Studies argued that.

The Institute of Fiscal Studies also argued that many people who would no longer pay for prescriptions realised, as a result of prescription charges going up, that they had a statutory right to free prescriptions and, far from stopping taking out prescriptions, more of them went to their doctors to get the free prescriptions to which they were entitled. Instead of increased charges leading to a decline in the total number of prescriptions given out by doctors, they had the opposite effect.

The Institute of Fiscal Studies has showed that increasing prescription charges can have a beneficial effect on take-up and on preventive health care. The hon. Member for Livingston was not prepared to elaborate on that when he discussed the report. For that reason and the other reasons that I have outlined, I shall support the regulations and oppose the Opposition prayer.

11.9 pm

Mr. Ian McCartney (Makerfield)

Earlier today we debated the poll tax capping legislation. My local authority will be capped for increasing its expenditure by 6 per cent.; after 11 years of Conservative government, we now find ourselves debating a 1,000 per cent. increase in prescription charges. As my hon. Friend the Member for Burnley (Mr. Pike) pointed out to me earlier, this, too, is a kind of poll tax. Conservative Members have provided no more than a tissue of excuses for the attempt to privatise medical care and introduce market forces that underlies the Government's proposals.

Mr. Peter L. Pike (Burnley)

Like the poll tax, this tax on health will affect most seriously those whose housing and working conditions are worst: their health will suffer most.

Mr. McCartney

My hon. Friend is absolutely right. The introduction of charges will cause the cronically ill to ask doctors to delete items from multiple prescriptions, or to abandon their prescriptions altogether.

Opposition Members have said a good deal about the general implications of the proposals; I refer specifically to the problems of women who cannot afford to pay multiple prescription charges. I am currently dealing with the case of a constituent of my late colleague Allan Roberts, who was the Member for Bootle. Because she could not afford the three-part hormone replacement therapy package, a growth of hair now covers her face and she lives almost as a hermit. She was recently sent to a consultant dermatologist in Liverpool, who has written to me that the case is one of the worst that she has seen. Because of cuts, however, she cannot begin to treat the patient for nine to 12 months, although the patient is deemed to he in the emergency category. She has advised the patient that, if she is prepared to pay, treatment can begin at the same hospital 24 hours after an appointment has been made.

I have already written to the Minister about the case, so I shall not go into detail now, but it illustrates graphically the disincentive that multiple prescription charges will introduce: people will be discouraged from either embarking on or continuing treatment.

Conservative Members have simply parroted their speeches. I think that the hon. Member for Hendon, South (Mr. Marshall) must have left his speech on his seat, and the hon. Member for Wyre Forest (Mr. Coombs) must have picked it up and read out pages 3, 4 and 5. Perhaps another hon. Member will read the concluding passages. The hon. Member for Hendon, South spoke of raising resources for the National Health Service, but he did not mention the Government's proposal to provide £40 million in tax relief for private medical insurance in the current financial year. I trust that one of the first steps that the Labour Government will take will be to remove that relief, and pump the money back into the NHS, so that people need not pay prescription charges.

Mr. John Marshall

Will the hon. Gentleman give way?

Mr. McCartney

The hon. Gentleman has had ample opportunity to put his case. He has been out of the Chamber since then—for medicinal purposes., I understand.

The issue at stake is this: how can we establish preventive medicine within the confines of the NHS and ensure that multiple prescriptions are effective for preventive and treatment purposes? The Minister owes it to the House to explain clearly why the Government have failed on the 15 occasions when prescription charges have been raised to do anything to protect those who require multiple prescriptions. That affects women in the main and there is growing evidence that the lives of many women who go without hormone replacement treatment become an abject misery. Far more expensive hospital treatment may be needed later in their lives, whereas, if the treatment had been carried out through the prescription service, much of the pain would have been relieved and much of the expense of in-hospital treatment would not have been incurred by the National Health Service.

These dangerous increases run even against the Government's concept of value for money. The proposals are not value for money for the National Health Service in terms of their long-term effect on people's health. I know that the Minister is desperate to speak tonight to explain why it is in the interests of the nation's health once again to increase prescription charges.

Why, when the Select Committee on Social Services is in the process of analysing in detail the effect on uptake of the introduction of eye test charges, are the Government attempting to influence public opinion to their way of thinking? All the evidence so far suggests that there has been a substantial and growing decline in the number of people using the service. In some areas, the drop is not 30 per cent. or 40 per cent., but 60 per cent. and above. Most of them are areas of social deprivation and high unemployment, with a high incidence of child deaths and a high mortality rate. Yet the Government, with their warped way of seeking to influence public opinion, are trying to suggest that the charges are not having the effect that the evidence before the Select Committee suggests.

I hope that the Minister will make two promises tonight: first, to put all the independent evidence from the current investigations about eye tests before the Select Committee so that we can check and verify it, and, secondly, to amend the regulations next year, if not this year, to allow some relief for people, especially women going through hormone treatment, who must have multiple prescriptions.

11.17 pm

The Parliamentary Under-Secretary of State for Health (Mr. Roger Freeman)

The House owes a debt of gratitude to my hon. Friends the Members for Birmingham, Edgbaston (Dame J. Knight) and for Hendon, South (Mr. Marshall). They have performed a valuable function in drawing out of the hon. Member for Livingston (Mr. Cook) a commitment—a Front-Bench commitment, I assume—that a Labour Government would freeze the prescription charge in monetary terms. He gave that commitment clearly. In the coming year, they would remove £13 million from the National Health Service. Freezing the charge is an irrational way of targeting resources on those who most need assistance and a very inefficient way in which to proceed.

The House would have expected a more reasoned argument from the hon. Gentleman, perhaps indicating certain categories of those receiving prescriptions on whom he wished to concentrate resources. Instead, we had an argument based more on political symbolism than reality. It is convenient for an Opposition Front-Bench spokesman to spend money by forgoing increases in charges without, as my hon. Friend the Member for Hendon, South so clearly put it, explaining precisely where the resources were to come from.

That adds a further £13 million to the cost of the hon. Gentleman's two previous commitments—to end compulsory competitive tendering, which will lose the NHS £100 million, and to end, in view of the Labour party's evident hostility to them, private practice and income generation, losing another £100 million to the NHS.

Mr. Sims

Can my hon. Friend reconcile the apparent commitment to freeze prescription charges with the commitment of the Labour party conference to abolish them altogether?

Mr. Freeman

I am grateful to my hon. Friend. I was taking the words of the hon. Member for Livingston at face value as a Front Bench commitment, but my hon. Friend is right to draw attention to the Labour party's commitment, which would lose the Health Service about £180 million—the revenue from charges, which contribute about 8 per cent. of the total cost of the drugs budget.

Mr. Tom Clarke (Monklands, West)

The Minister paid glowing tribute to his hon. Friend the Member for Hendon, South (Mr. Marshall). Given that he referred to a drugs budget increase of 13 per cent., how can the Minister justify an element for inflation of a mere 5 per cent.?

Mr. Freeman

I was coming to that very point. It is reasonable to increase prescription charges from 1 April 1990 by 25p, from £2.80 to £3.05. The 8.9 per cent. increase cited by the hon. Member for Livingston compares with the 10 per cent. increase in resources going into the NHS in the coming year—amounting to about £30 billion in the United Kingdom.

The hon. Member for Livingston referred to the rate of increase in the total drugs bill during the past few years. Certainly, the average monetary increase has been about 13 per cent. We believe that those who can afford to pay should contribute, by way of an increase in the charges, a reasonable proportion of the cost of the drugs bill, bearing in mind that increase. Our proposals for indicative drug budgeting are intended not to reduce the real cost of the drugs budget but to bring some moderating downward pressure on the rate of its growth.

We understand that the real cost of drugs must increase each year, to pay for new techniques in the NHS and for an aging population, so the drugs bill is rising at 13 per cent. in monetary terms; set against that, the increase of just under 9 per cent. in prescription charges is reasonable. I have already said that only 8 per cent. of the total cost of our drugs budget is recovered by way of charges. That total was £2.2 billion in 1988–89, and it is forecast to rise further in the coming year.

The proportion of the average cost of drugs prescribed that prescription charges recover is also relatively modest. For prescriptions for which there is a charge, the charge covers only 36 per cent. of the average cost of the prescription. The hon. Member for Livingston selectively referred to drug costs, but I am taking the total cost of the prescription, which rightly includes all the other costs of preparation and dispensing. The plain fact is that charges amount to only one third of the total cost of prescriptions.

As my hon. Friend the Member for Chislehurst (Mr. Sims) said, the increased resources available to the NHS in the coming year are of the order of £12 million to £13 million. The hon. Member for Wakefield (Mr. Hinchliffe) called that chickenfeed, following the hon. Member for Livingston, who said that he would forgo that increase. I invite the House to consider what £13 million amounts to per district health authority— [Interruption.]—including that of the hon. Member for Crewe and Nantwich (Mrs. Dunwoody). It amounts to some £65,000 in the coming year alone. That is the increase that would be forgone. It is equal to five qualified nurses for every district health authority. I put it to the hon. Member for Wakefield that those sums are not chickenfeed.

Mr. Hinchliffe

I should be grateful if the Minister would put my comments into their full context. I said that the money was chickenfeed in the context of the overall NHS budget. I am sure that the Minister would agree with that.

Mr. Freeman

The hon. Gentleman is ducking the issue. The total sum of £13 million, just under 9 per cent. in the coming year—I shall come on to deal with waivers of prescription charges which make the system fair—and £65,000 on average per health authority, which is equal to five qualified nurses, are real numbers which make a real difference.

We have a generous system of waivers for prescription charges. The hon. Member for Livingston rightly said that some 75 per cent. of all items dispensed are free. The exempt categories include those on low incomes, pensioners, children under the age of 16, students under the age of 19, and expectant and nursing mothers. It is a generous range of exemptions, amounting to three quarters of all prescriptions.

Mr. Tom Clarke

So why bother with the rest?

Mr. Freeman

We bother about the £180 million collected from the other 25 per cent. because it is a significant sum for the National Health Service. It is ploughed back into patient care and it is contributed by those who can afford to make the payment. By waiving those charges—as an act of political symbolism, I suspect—the hon. Gentleman would lose the NHS real funds of £180 million, which is equivalent to £1 million per district health authority.

Mr. Robin Cook

The Minister lays heavy stress on the revenue to the NHS from the charges. If that is the sole argument that he can adduce in defence of the increase, where does his argument stop? If raising revenue for the NHS is the only concern, why not introduce charges for seeing a GP? Why stop at prescription charges? We must surely grasp the fact that we are debating the fundamental principle that people should pay for the NHS not at the moment when they are sick, but when they are well.

Mr. Freeman

The hon. Gentleman carefully did not subscribe to the view of his party that prescription charges should be abolished. He carefully said from the Front Bench that in his judgment the charge should remain at £3.05 and not be increased further. I will give way to the hon. Gentleman if he wishes to correct me.

Mr. Cook

The Minister is creating a problem for a future Labour Government. Every time the Government increase the prescription charge, they increase the cost of abolishing it, as the Minister well understands. I said that in the first instance there would be no further increase in real terms and that we would seek to reduce the prescription charge as resources permitted. [Laughter.] I do not see what hon. Members find funny about that. We have made an explicit commitment that the first priority will be to abolish the charge for eye tests. The second will be to abolish the charge for dental examinations. The third will be to make what progress we can to reduce the prescription charge. If the Minister is worried about the cost of that, he should join us in the Lobby today and vote against his increase, which will merely increase the cost of abolition.

Mr. Freeman

The hon. Gentleman is changing his tune—[HON. MEMBERS: "No."] He has clearly redefined the commitment from the Labour Front Bench. He is now saying from the Front Bench that the Labour party would not increase the prescription in real terms. Perhaps he will clarify the position.

Mr. Cook

If the Minister is in any doubt, I am glad to repeat the commitment. We shall not increase the prescription charge and we shall seek real reductions in it. I would also like to achieve cash reductions.

Mr. Freeman

We strongly believe that the proposals are fair, reasonable and prudent. I invite the House to throw out the prayer and support the regulations.

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)).

The House divided: Ayes 197, Noes 278.

Division No. 158]	[11.29 pm
AYES
Abbott, Ms Diane	Doran, Frank
Adams, Allen (Paisley N)	Dunnachie, Jimmy
Allen, Graham	Dunwoody, Hon Mrs Gwyneth
Archer, Rt Hon Peter	Eadie, Alexander
Armstrong, Hilary	Evans, John (St Helens N)
Ashton, Joe	Ewing, Harry (Falkirk E)
Banks, Tony (Newham NW)	Ewing, Mrs Margaret (Moray)
Barnes, Harry (Derbyshire NE)	Fatchett, Derek
Barron, Kevin	Field, Frank (Birkenhead)
Battle, John	Fields, Terry (L'pool B G'n)
Beckett, Margaret	Fisher, Mark
Beggs, Roy	Flannery, Martin
Beith, A. J.	Foot, Rt Hon Michael
Bell, Stuart	Foster, Derek
Benn, Rt Hon Tony	Foulkes, George
Bennett, A. F. (D'nt'n & R'dish)	Fraser, John
Bermingham, Gerald	Fyfe, Maria
Bidwell, Sydney	Garrett, John (Norwich South)
Blair, Tony	Gilbert, Rt Hon Dr John
Blunkett, David	Godman, Dr Norman A.
Boateng, Paul	Golding, Mrs Llin
Boyes, Roland	Gordon, Mildred
Bradley, Keith	Gould, Bryan
Bray, Dr Jeremy	Griffiths, Nigel (Edinburgh 5)
Brown, Gordon (D'mline E)	Griffiths, Win (Bridgend)
Brown, Nicholas (Newcastle E)	Grocott, Bruce
Brown, Ron (Edinburgh Leith)	Hardy, Peter
Bruce, Malcolm (Gordon)	Harman, Ms Harriet
Buchan, Norman	Healey, Rt Hon Denis
Buckley, George J.	Henderson, Doug
Callaghan, Jim	Hinchliffe, David
Campbell, Menzies (Fife NE)	Hoey, Ms Kate (Vauxhall)
Campbell, Ron (Blyth Valley)	Hogg, N. (C'nauld & Kilsyth)
Campbell-Savours, D. N.	Home Robertson, John
Canavan, Dennis	Hood, Jimmy
Clark, Dr David (S Shields)	Howarth, George (Knowsley N)
Clarke, Tom (Monklands W)	Howells, Geraint
Clay, Bob	Howells, Dr. Kim (Pontypridd)
Clelland, David	Hoyle, Doug
Clwyd, Mrs Ann	Hughes, John (Coventry NE)
Cohen, Harry	Hughes, Robert (Aberdeen N)
Cook, Frank (Stockton N)	Hughes, Roy (Newport E)
Cook, Robin (Livingston)	Ingram, Adam
Corbett, Robin	Johnston, Sir Russell
Corbyn, Jeremy	Jones, Barry (Alyn & Deeside)
Cousins, Jim	Jones, Martyn (Clwyd S W)
Crowther, Stan	Kaufman, Rt Hon Gerald
Cryer, Bob	Kennedy, Charles
Cummings, John	Kilfedder, James
Cunliffe, Lawrence	Kirkwood, Archy
Dalyell, Tam	Lambie, David
Darling, Alistair	Lamond, James
Davies, Rt Hon Denzil (Llanelli)	Leighton, Ron
Davies, Ron (Caerphilly)	Litherland, Robert
Davis, Terry (B'ham Hodge H'l)	Livingstone, Ken
Dixon, Don	Livsey, Richard
Dobson, Frank	Lofthouse, Geoffrey

Loyden, Eddie	Rooker, Jeff
McAllion, John	Ross, Ernie (Dundee W)
McAvoy, Thomas	Ross,William (Londonderry E)
McCartney, Ian	Rowlands, Ted
McKay, Allen (Barnsley West)	Ruddock, Joan
McKelvey, William	Sedgemore, Brian
McLeish, Henry	Sheldon, Rt Hon Robert
McNamara, Kevin	Short, Clare
Madden, Max	Skinner, Dennis
Marek, Dr John	Smith, Andrew (Oxford E)
Marshall, Jim (Leicester S)	Smith, C. (Isl'ton & F'bury)
Martin, Michael J. (Springburn)	Smith, Rt Hon J. (Monk'ds E)
Martlew, Eric	Smith, J. P. (Vale of Glam)
Maxton, John	Snape, Peter
Meacher, Michael	Soley, Clive
Meale, Alan	Spearing, Nigel
Michael, Alun	Steel, Rt Hon Sir David
Michie, Bill (Sheffield Heeley)	Steinberg, Gerry
Michie, Mrs Ray (Arg'l & Bute)	Strang, Gavin
Moonie, Dr Lewis	Straw, Jack
Morgan, Rhodri	Taylor, Mrs Ann (Dewsbury)
Morley, Elliot	Taylor, Matthew (Truro)
Morris, Rt Hon A. (W'shawe)	Thompson, Jack (Wansbeck)
Morris, Rt Hon J. (Aberavon)	Turner, Dennis
Mowlam, Marjorie	Vaz, Keith
Mullin, Chris	Walker, A. Cecil (Belfasr N)
Murphy, Paul	Walley, Joan
Nellist, Dave	Wareing, Robert N.
O'Brien, William	Watson, Mike (Glasgow, C)
O'Neill, Martin	Welsh, Michael (Doncaster N)
Orme, Rt Hon Stanley	Wigley, Dafydd
Patchett, Terry	Williams, Rt Hon Alan
Pendry, Tom	Williams, Alan W.(Carm'then)
Pike, Peter L.	Wilson, Brian
Powell, Ray (Ogmore)	Winnick, David
Prescott, John	Wise, Mrs Audrey
Primarolo, Dawn	Worthington, Tony
Quin, Ms Joyce	Wray, Jimmy
Radice, Giles	Young, David (Bolton SE)
Randall, Stuart
Redmond, Martin	Tellers for the Ayes:
Rees, Rt Hon Merlyn	Mr. Frank Hayes and
Reid, Dr John	Mr. Ken Eastham.
Richardson, Jo
NOES
Adley, Robert	Buck, Sir Antony
Aitken, Jonathan	Budgen, Nicholas
Alexander, Richard	Burns, Simon
Alison, Rt Hon Michael	Burt, Alistair
Allason, Rupert	Butler, Chris
Amess, David	Butterfill, John
Amos, Alan	Carlisle, John, (Luton N)
Arbuthnot, James	Carrington, Matthew
Arnold, Jacques (Gravesham)	Carttiss, Michael
Arnold, Tom (Hazel Grove)	Chapman, Sydney
Ashby, David	Chope, Christopher
Baker, Nicholas (Dorset N)	Clark, Hon Alan (Plym'th S'n)
Baldry, Tony	Clark, Dr Michael (Rochford)
Banks, Robert (Harrogate)	Clark, Sir W. (Croydon S)
Batiste, Spencer	Clarke, Rt Hon K. (Rushcliffe)
Beaumont-Dark, Anthony	Conway, Derek
Bellingham, Henry	Coombs, Anthony (Wyre F'rest)
Bendall, Vivian	Coombs, Simon (SWindon)
Bevan, David Gilroy	Cope, Rt Hon John
Biffen, Rt Hon John	Cran, James
Blaker, Rt Hon Sir Peter	Currie, Mrs Edwina
Body, Sir Richard	Curry, David
Bonsor, Sir Nicholas	Davies, Q. (Stamf'd & Spald'g)
Boscawen, Hon Robert	Davis, David (Boothferry)
Boswell, Tim	Day, Stephen
Bowden, A (Brighton K'pto'n)	Dorrell, Stephen
Bowden, Gerald (Dulwich)	Douglas-Hamilton, Lord James
Bowls, John	Dover, Den
Braine, Rt Hon Sir Bernard	Durant, Tony
Brandon-Bravo, Martin	Eggar, Tim
Brazier, Julian	Emery, Sir Peter
Bright, Graham	Evans, David (Welwyn Hatf'd)
Brown, Michael (Brigg & Cl't's)	Evennett, David
Bruce, Ian (Dorset South)	Fenner, Dame Peggy

Field, Barry (Isle of Wight)	Leigh, edward (Gainsbor'gh)
Fishburn, John Dudley	Lennox-Boyd, Hon Mark
Fookes, Dame Janet	Lester, Jim (Broxtowe)
Forman, Nigel	Lightbown, David
Forsyth, Michael (Stirling)	Lilley, Peter
Forth, Eric	Lloyd, Sir Ian (Havant)
Fox, Sir Marcus	Lloyd, Peter (Fareham)
Freeman, Roger	Luce, Rt Hon Richard
French, Douglas	Macfarlane, Sir Neil
Fry, Peter	MacGregor, Rt Hon John
Gale, Roger	Mackay, Andrew (E Berkshire)
Gardiner, George	Maclean, David
Garel-Jones, Tristan	McNair-Wilson, Sir Michael
Gill, Christopher	McNair-Wilson, Sir Patrick
Gilmour, Rt Hon Sir Ian	Madel, David
Glyn, Dr Sir Alan	Malins, Humfrey
Goodlad, Alastair	Mans, Keith
Goodson-Wickes, Dr Charles	Marland, Paul
Gorman, Mrs Teresa	Marlow, Tony
Gow, Ian	Marshall, John (Hendon S)
Grant, Sir Anthony (CambsSW)	Martin, David (Portsmouth S)
Greenway, Harry (Ealing N)	Maude, Hon Francis
Greenway, John (Ryedale)	Maxwell-Hyslop, Robin
Gregory, Conal	Mayhew, Rt Hon Sir, Patrick
Griffiths, Sir Eldon (Bury St E')	Mellor, David
Griffiths, Peter (Portsmouth N)	Meyer, Sir Anthony
Grist, Ian	Miller, Sir Hal
Ground, Patrick	Mills, Iain
Grylls, Michael	Mitchell, Andrew (Gedling)
Gummer, Rt Hon John Selwyn	Mitchell, Sir David
Hague, William	Montgomery, Sir Fergus
Hamilton, Hon Archie (Epsom)	Moore, Rt Hon John
Hamilton, Neil (Tatton)	Morris, M (N'hampton S)
Hampson, Dr Keith	Morrison, Rt Hon P (Chester)
Hanley, Jeremy	Moss, Malcolm
Hannam, John	Moynihan, Hon Colin
Hargreaves, A. (B'ham H'll Gr')	Neale, Gerrard
Hargreaves, Ken (Hyndburn)	Neubert, Michael
Harris, David	Nicholls, Patrick
Haselhurst, Alan	Nicholson, David (Taunton)
Hawkins, Christopher	Norris, Steve
Hayes, Jerry	Onslow, Rt Hon Cranley
Heathcoat-Amory, David	Oppenheim, Phillip
Hicks, Mrs Maureen (Wolv' NE)	Parkinson, Rt Hon Cecil
Higgins, Rt Hon Terence L.	Patnick, Irvine
Hill, James	Patten, Rt Hon Chris (Bath)
Hind, Kenneth	Patten, Rt Hon John
Hogg, Hon Douglas (Gr'th'm)	Peacock, Mrs Elizabeth
Holt, Richard	Porter, Barry (Wirral S)
Hordern, Sir Peter	Porter, David (Waveney)
Howarth, Alan (Strat'd-on-A)	Portillo, Michael
Howarth, G. (Cannock & B'wd)	Price, Sir, David
Howe, Rt Hon Sir Geoffrey	Raffan, Keith
Howell, Rt Hon David (G'dford)	Raison, Rt Hon Timothy
Hughes, Robert G. (Harrow W)	Redwood, John
Hunt, David (Wirral W)	Renton, Rt Hon Tim
Hunt, Sir John (Ravensbourne)	Rhodes James, Robert
Hunter, Andrew	Ridley, Rt Hon Nicholas
Irvine, Michael	Rifkind, Rt Hon Malcolm
Irving, Sir Charles	Roberts, Wyn (Conwy).
Jack, Michael	Roe, Mrs Marion
Jackson, Robert	Rost, Peter
Janman, Tim	Rowe, Andrew
Jessel, Toby	Rumbold, Mrs Angela
Johnson Smith, Sir Geoffrey	Ryder, Richard
Jones, Gwilym (Cardiff N)	Sackville, Hon Tom
Jones, Robert B (Harts W)	Sainsbury, Hon Tim
Jopling, Rt Hon Michael	Shaw, David (Dover)
Key, Robert	Shaw, Sir Giles (Pudsey)
King, Roger (B'ham N'thfield)	Shaw, Sir Michael (Scarb')
King, Rt Hon Tom (Bridgwater)	Shephard, Mrs G. (Norfolk SW)
Kirkhope, Timothy	Shersby, Michael
Knapman, Roger	Sims, Roger
Knight, Greg (Derby North)	Smith, Tim (Beaconsfield)
Knight, Dame Jill (Edgbaston)	Soames, Hon Nicholas
Knox, David	Speller, Tony
Lang, Ian	Spicer, Sir Jim (Dorset W)
Latham, Michael	Spicer, Michael (S Worcs)
Lawrence, Ivan	Squire, Robin
Lee, John (Pendle)	Stanbrook, Ivor

Stanley, Rt Hon Sir John	Viggers, Peter
Steen, Anthony	Wakeham, Rt Hon John
Stern, Michael	Waldegrave, Rt Hon William
Stevens, Lewis	Walker, Bill (T'Side North)
Stewart, Allan (Eastwood)	Waller, Gary
Stewart, Andy (Sherwood)	ward, John
Stewart, Rt Hon Ian (Herts N)	Wardle, Charles (Bexhill)
Stokes, Sir John	Warren, Kenneth
Stradling Thomas, Sir John	Watts, John
Sumberg, David	Wells, bowen
Summerson, Hugo	Wheeler, Sir John
Tapsell, Sir Peter	Whitney, Ray
Taylor, Ian (Esher)	Widdecombe, Ann
Taylor, Teddy (S'end E)	Wiggin, Jerry
Tebbit, Rt Hon Norman	Wilshire, David
Temple-Morris, Peter	Winterton, Mrs Ann
Thompson, D. (Calder Valley)	Winterton, Nicholas
Thompson, Patrick (Norwich N)	Wolfson, Mark
Thornton, Malcolm	Wood, Timothy
Thurnham, Peter	Woodcock, Dr. Mike
Townend, John (Bridlington)	Yeo, Tim
Townsend, Cyril D. (B'heath)	Young, Sir George (Acton)
Tredinnick, David
Trippier, David	Tellers for the Noes:
Trotter, Neville	Mr. Kenneth Carlisle and
Twinn, Dr Ian	Mr. John M. Taylor

Question accordingly negatived.