Health Benefits (Hansard, 14 January 1992)

§ Mrs. Alice Mahon (Halifax)
I beg to move, That leave be given to bring in a Bill to extend exemption from prescription charges to, and to make further provision for, persons in receipt of certain categories of benefit; to exempt from prescription charges the chronically ill and those over 60; and to exempt those over 60 from certain dental and optical charges. If passed by the House, the Bill will reform fairly and effectively the forgotten area of the health benefits system. The present system is unwieldy, unnecessarily complex, inconsistent and over-bureaucratic. [Interruption.]

§ Mr. Speaker
Order. Will hon. Members please leave the Chamber quietly if they are not remaining for this ten-minute motion?

§ Mrs. Mahon
At present, health benefits are available to people who are eligible because they are exempt or who must claim on low-income grounds. The benefits are free prescriptions, optical and dental charges and help with fares to hospitals.
In its report "Health Warning", the National Association of Citizens Advice Bureaux highlighted deficiencies in the scheme in four respects. The first concerned simplicity. The rules are inconsistent because, for example, pensioners are automatically exempt from prescription charges but will qualify for help with other charges only if they have low incomes. Other people on incomes marginally above income support levels may get some help towards dental and optical charges but no help towards prescription charges.
The second deficiency concerned adequacy. The scheme aims to cover the cost of health charges so that the poorer sections of the community are not prevented from receiving health care by the cost. In practice, however, the scheme does not meet its objectives. Many thousands are deterred from claiming because of the complexity of the scheme, so many people go without vital treatment. There is also considerable evidence that even people entitled to, for instance, free glasses, must still contribute significant amounts to the cost, because the value of the benefit has not kept up with the cost of glasses.
The system has also failed on grounds of accessibility. NACAB's evidence shows that the scheme is about as accessible as Fort Knox. The relevant form is 20 pages long and contains more than 50 questions, and the 1 million people a year who labour to fill it in often fail to do so or are helped by relatives and friends; 100,000 go to the citizens advice bureaux for help. Even so, about 35 per cent. of those people—361,000—have their forms returned to them because they filled them in incorrectly. When I challenged the Secretary of State for Health to fill in the form, he not surprisingly refused. There is no comparison between this form and the one on which people claim for mortgage interest relief.
NACAB's fourth point is that the present scheme is deficient on grounds of equity. Anomalies cause confusion and anger among claimants. Often people entitled to free dental treatment find that they must contribute towards the cost of glasses, and the scheme cries out for reform. My Bill will effect just that. At a stroke, the need for 300 staff in the health benefit unit could end and they could be redeployed to improve other parts of the service.
815 This Bill proposes that health benefits be available free to all receiving means-tested benefits—for instance, the disabled working allowance benefit, due to begin in April 1992, could lead to claimants who take it up moving from income support to that benefit and thus losing the right to free prescriptions. That would cause considerable hardship.
My Bill proposes that people in receipt of this benefit and in receipt of poll tax benefit, invaliditity benefit, long-term sickness benefit, the severe disablement allowance, and mobility and attendance allowances should be exempt from prescription charges. Moreover, anyone categorised by his GP as chronically sick should be covered, as the list of prescribed illnesses is outdated.
People requiring regular medication would also be exempt from prescription charges. That would cover people with cystic fibrosis, inflammatory bowel disease, asthma, multiple sclerosis, cancer and a host of other long-term illnesses.
My Bill also seeks to right the serious and indefensible wrong brought about by the abolition of free eye and dental tests; and free prescriptions would be available to all over the age of 60. The Minister for Health sought to defend the indefensible when she wrote in a recent letter to The Guardian about the abolition of the tests. Her letter brought forth a torrent of rebukes from people far more expert than she—and far more caring.
Mr. Ian Hunter, Secretary General of the Association of Optometrists, wrote in reply to the Minister's letter: To restart national health service eye examinations for the over 60s would now cost about £25 million but the cost for not doing so will be two or three times as much because eye disease will remain undetected until treatment is less effective and more expensive. The real social costs of blindness for some have also regrettably to be added. I can only add that the abolition of free eye tests is the worst false economy imaginable, and could only be contemplated by such a short-sighted Government.
The present scheme's inadequacies are best highlighted by a constituent, Mr. Russell, who wrote to me on the advice of his local DSS office, which also thinks that the system is unfair. Mr. Russell lost out when he received a 6p rise which put him above the income support level. He lost entitlement to free prescriptions; he also had to pay £24 for 816 dental treatment, and he can no longer claim his hospital fares unless they cost more than £8.50. He concluded his letter: The 6p rise I received means I am approximately £2.50 a week worse off. Surely this can't be right. I agree with Mr. Russell.
Patients with mental illness are particularly vulnerable. My Bill would exempt many of them from prescription charges.
Charges have gone up 17 times under the Government. There has been a 600 per cent. increase, from 20p to £3.40, since 1979. They have created an intolerable burden on people on low incomes. Many people now go without the necessary treatment because they cannot afford prescriptions.
Even the Government have recognised the need for reform, although the review which they commissioned in 1990, which has yet to report, appears to have been an excuse for inaction. When it reports, it will address only the administration of the scheme and not the real solution, which would be to scrap the low income scheme and replace it with one based on exemptions.
The present scheme is bureaucratic, inconsistent and complex. We need in its place a scheme which is simple, fair and effective, one which people can understand and which delivers help for those who need it most. The scheme must be based on exemptions. My Bill would provide for that.