Drugs and Appliances

HC Deb 29 March 1995 vol 257 cc1130-55 10.27 pm

Mrs. Margaret Beckett (Derby, South)

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 1995 (S.I., 1995, No. 643), dated 8th March 1995, a copy of which was laid before this House on 9th March, be annulled. Opposition Members are not here solely to voice our opposition to this savage increase in taxes on the sick; we are here to give Conservative Members a chance to speak for their constituents, and to defeat the proposal. We want to hear from the Government why they are pushing through this increase, this year.

It is clear beyond doubt that, throughout all their years in office, the Government have pursued a policy of milking prescription charges as fully as they dare. Despite what the Daily Mail claimed was a pledge not to increase prescription charges, the process began with a whopping increase of 125 per cent. in the very first months of the Governments life in office. That was followed by a rise of 55 per cent. in 1980.

In fact, since the Conservative Governments election in 1979, in only two years—the boom years of 1988 and 1989—has the increase in the prescription charge been about the same as the rate of inflation. In every other year the charge has risen by massively more than the inflation rate: there was an increase of 25 per cent. in 1984–85—conveniently after the general election—four times more than the then rate of inflation, which had risen by 6.9 per cent. In the following years, increases averaged two to three times the rate of inflation, but since 1992 and the last general election we have again seen increases massively ahead of inflation.

The increase was 10.3 per cent. in 1991–92, when the inflation rate was 1.3 per cent. It was 11.8 per cent. in April 1992–93, when the inflation rate was 2.6 per cent. The regulations would raise prescription charges 10.5 per cent.—three times the current rate of inflation. If the price of bread had increased at the same rate as prescriptions, a loaf would cost £8.08. A pint of milk would cost £3.78. The proposed charges bear no relation to average price rises but bear a close relation to a secretive, undeclared tax on the sick—only on them, and levied only because they are sick.

Those spoils—that loot—is being extracted from the sick by overcharging, in half of all cases, for the medicines sold. We know that that is true because the Secretary of State herself admitted that daylight robbery. Answering a question tabled by my hon. Friend the Member for Ipswich (Mr. Cann) last December, the right hon. Lady said that in 55 per cent. of cases the total cost to the NHS of a prescription item was less than the proposed charge of £5.25.

Given that charges have increased way ahead of inflation and in many cases are providing a profit for the Treasury, they are not just a tax but a fiscal mugging. It is the kind of criminal offence that Dolly Rawlings, the powerful widow of gangland fame, would utterly deplore. The Dolly Rawlings of the Department of Health, however, is just the kind of mugger who gives crime and taxation such a bad name.

Mr. John Marshall (Hendon, South)

No doubt the right hon. Lady read the article in The Economist last weekend which suggested that she does not have a policy on health. What would the right hon. Lady do with prescription charges? Would she get rid of them?

Mrs. Beckett

I did not read that article in The Economist. Obviously it would have been a waste of time.

Mr. Marshall

The right hon. Lady should have read it.

Mrs. Beckett

Well, clearly it did not convey much information to the hon. Gentleman, so it seems that it was not worth reading. Our approach to prescription charges has been stated repeatedly in the House. We believe that the whole system of prescription charges should be subject to a thoroughgoing review. The system has huge absurdities. It is crystal clear—not just from statements made from the Dispatch Box but from the record of past Labour Governments—that we never have and never would use prescription charges as a tax on the sick, in the way that the Government have done since 1979.

The Minister for Health (Mr. Gerald Malone)

A Labour Government introduced them.

Mrs. Beckett

That is not true. I know that the Prime Minister made that claim at the Dispatch Box two or three days ago, but the Minister should know better than to believe anything said by his right hon. Friend at Prime Ministers Question Time. A Conservative Government introduced prescription charges—

Mr. Malone

indicated assent.

Mrs. Beckett

So the Minister knew that his remark was not true. A Conservative Government introduced prescription charges, not a Labour Government. I hope that we have nailed that lie.

Ministers are quick to argue that the level of charges is unimportant because 80 per cent. of prescriptions are dispensed free. That creates the impression—as I am sure it is intended to do—that only 20 per cent. of people pay, and then only those who can afford to pay. As always when it comes to tax, Ministers are being at least economical with the truth. The latest figures for 1993 show that no fewer than 50 per cent. of the population are liable to pay prescription charges.

It is not true that all vulnerable people are exempt. Ministers list pensioners, children, people on income support, pregnant women and people with certain specific conditions. However, the Library calculates that if one excludes the only two groups who are completely exempt—pensioners and children—85 per cent. of the remaining population are liable to pay. The overwhelming majority of men and women, whatever their income or family circumstances, are liable. People whose incomes are low enough to receive council tax benefit are not thereby exempt. Those in receipt of invalidity benefit—who by definition are long-term sick or disabled—are not exempt. Asthmatics and people suffering from cystic fibrosis are among those with long-term illness who have to pay for their prescribed medication. So do patients with AIDS, motor neurone disease, asthma, multiple sclerosis, chronic rheumatoid arthritis, leukaemia, breast cancer, emphysema and renal failure, to name but a few. All are liable to pay prescription charges.

Mr. Malone

Will the right hon. Lady give an undertaking to the House today that she would include them in the list of exemptions if she ever had the opportunity to do so?

Mrs. Beckett

I have already told the hon. Gentleman that we are committed to a thorough review, precisely because of the issue that he raises. There are huge numbers of people, some with diseases only relatively recently identified, but not one of whom has been added to the list. So far as I know, none of them has even been considered by the Government for adding to the list. The Governments policy is clear: huge increases in prescription charges, and no consideration of the addition of any of these groups.

The Minister knows perfectly well that the British Medical Association is calling for the kind of review that we advocate. First, there is a need to reconsider the list of those who are exempt, and the conditions that are included. Secondly, there is a need to look into the question of a person with one condition getting all their prescriptions free. These are serious and important issues which deserve careful consideration by the medical profession. That is what the medical profession wants, and what we would provide. The professsion does not want what the Minister is doing; it opposes it root and branch.

Mr. Malone

rose—

Mrs. Beckett

Does the Minister have a serious point to make?

Mr. Malone

Yes.

Mrs. Beckett

That will make a change.

Mr. Malone

I thought from the reaction of the House that my last point to the right hon. Lady was serious. When these matters were last looked at, on 21 March 1968, when a Labour Government were in power, the BMA set down the exemption conditions. Is the right hon. Lady telling the House that the BMA has come to her with a list to add to the exemptions laid down back then? If she is not, this debate is dishonest.

Mrs. Beckett

That is rubbish. Certainly the BMA was involved in the discussion of the list in 1968, but is the Minister suggesting that nothing has changed since then? How many people had AIDS in 1968? How many children had asthma then? What were the charges? What was the treatment available then, and how essential was it to peoples well-being?

A huge number of things have changed since 1968, but what has changed most is the prescription charge under the Conservative Government. Under the Labour Government, it did not increase by so much as one penny. Under the Conservatives, it has gone through the roof. And all the time Ministers refuse to look at new kinds of treatment, at new concerns which arise, and at a range of issues which the professionals believe deserve re-examination.

What is more, charges at the level that the regulations propose can be clinically damaging. I do not refer only to those who cannot, because of their incomes, afford to pay all their prescriptions, though they are a growing group. I spoke recently to a GP who explained that he had a patient who was acutely depressed, who had just lost her job and who was extremely anxious about her financial position. It was likely that she would need to be on anti-depressants for some time. Because of the womans financial position, the doctor would have preferred to give her one long-term prescription, but because she was a suicide risk he dared not recommend more than a weeks supply. Regular weekly prescriptions at a regular weekly charge are increasing her costs, adding to her anxiety and damaging her chances of a speedy recovery.

Another patient, with an eye infection, was given a prescription that she did not collect because she could not afford it. A few days later she returned to her doctor with her eye in a much worse condition. He was so horrified at what had happened that he paid for the drug himself.

The BMA says today that, with each appalling rise in prescription charges, doctors are concerned that more and more patients will be dissuaded from visiting their surgeries at all. All GPs and pharmacists have anecdotal evidence of patients asking which of two or more items on a prescription form are the most important because they cannot afford to pay for more than one at a time.

It is crystal clear that this is a tax, that many more are liable to pay it than Ministers pretend, and that among those are large numbers of people who cannot afford to pay, including many who cannot afford to pay so much precisely because they are long-term or chronically sick. I have little doubt that the Minister of State will claim—as Ministers always claim—that there is no alternative, especially as next year they expect to raise £310 million from the charge. Almost a third of that could be found instead by abolishing the subsidy on private health insurance, which cost the Revenue £95 million last year. The Government could have held back the £100 million to £120 million that they spent on the legal costs, the logos, the uniforms and the PR that went with the structural changes in their so-called health reforms. There are a number of ways in which they could have economised on the £1.3 billion that is estimated as the overall total costs of the changes.

In other words, the Government are not forced to raise all the money in this way. The sheer scale on which the Government cheat the sick is demonstrated by one simple comparison. If, as the then Mrs. Thatcher indicated in 1979, they had increased prescription charges only in line with inflation, the charge today would be 53p instead of £5.25. In other words, 90 per cent. of the charge that we are debating is down to deliberate Government tax raising.

The Conservatives are the tax-raising party. In these weeks, we are seeing increases in income tax, increases in water charges, increases in prescription charges—every one of them in stark contradiction to the pledges, the promises and the programme that the Government put before the people of Britain. They are dishonest. They are deceitful. They should depart.

10.41 pm

The Minister for Health (Mr. Gerald Malone)

I am astonished that the right hon. Member for Derby, South (Mrs. Beckett), who has had a considerable time to reflect on these matters—as has her party over the past 16 years or so, or even longer because it was the Labour party that reintroduced prescription charges in 1968—comes to the House tonight and criticises what the Government are saying, and then simply promises a review. The truth of the matter is that she understands, as I think the whole House does, that we have these debates every year, usually in relatively heated circumstances, but nobody from the Opposition Benches is ever able to suggest what should replace the prescription charges that the Government have put in place on a fair basis to increase the amount of money that is spent on health care in this country.

Mr. Nicholas Brown (Newcastle upon Tyne, East)

We need a review first.

Mr. Malone

If it takes Labour Members 16 years to work out what the review and the decisions of that review should be, I hope that the whole House will note that the right hon. Lady had not a single substitute to put in place for the benefits that prescription charges provide for the population of this country.

Each year we have to make careful judgments about how the resources of the NHS should best be spent, so that we can continue to provide the highest standard of patient care. As my right hon. Friend the Prime Minister recently reminded the House, surveys of patients show high satisfaction rates with the NHS, and broadly we have a record that I believe that we can be proud of.

Mrs. Beckett

Those are characteristically accurate statistics from the Prime Minister. Of course, what he does not point out is that levels of satisfaction may be slightly higher now than they were two or three years ago, but they are substantially lower than they were 10 years ago, before these reforms.

Mr. Malone

If the right hon. Lady looks at the British social attitudes survey, she will see precisely how satisfaction has increased in recent years, and it is something for which the Government take a great deal of credit. I did not hear many Opposition voices saying that resources are not an important matter. To make the best use of available resources, successive Governments have taken the view that those who can afford it should pay for prescriptions, thereby making an important contribution.

I remind the right hon. Member for Derby, South that it was a Labour Government who in 1949 first took powers to introduce prescription charges. They introduced the first NHS charges in 1951, and a Labour Government abolished them in 1965, only to reintroduce them in 1968.

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

What do I tell my constituents who come to my surgery and say that they simply cannot afford to pay prescription charges?

Mr. Malone

What I shall say to the hon. Gentleman is that I will now deal with a point that I had intended to deal with later. It is that no pensioner, no child and no student up to the age of 18 pays prescription charges. There is a low-income scheme. Prescription charges are sensible and people who can afford to pay them make a contribution to British health care. What is the policy of the hon. Gentleman's party about replacing prescription charges? I shall be delighted to give way to him.

Mr. Campbell-Savours

I and all my hon. Friends think that we need a total review. That is absolutely right, and we shall have it and have sensible conclusions as a result.

Mr. Malone

The one certainty that I have noticed in my occasional appearances at the Dispatch Box is the repeated Opposition cry of, Lets have a review. There are more reviews in the Opposition than ever appear in the Evening Standard theatre section.

Mr. Hugh Bayley (York)

The Minister repeatedly mocks the idea of a review of prescription charges. Is he aware that the Select Committee on Health, which has a majority of Conservative Members, has called for a review? The Committees recommendation stated: We therefore recommend that there should be a review of prescription charges and the current exemption categories. In her response to that the Secretary of State for Health promised to examine the potential for change. The Ministers Department has agreed to a review. When will it take place?

Mr. Malone

There is a great deal of difference between what the hon. Gentleman says and what his right hon. Friend the Member for Derby, South said earlier. The right hon. Lady has absolutely no solution to filling the gap that would be left by the loss of the £310 million which contributes to greater patient care. [Interruption.]

Madam Deputy Speaker (Dame Janet Fookes)

Order. I cannot hear the Minister. I wish to hear him and I do not want sedentary interruptions from what sounds like overgrown schoolboys.

Mr. Malone

I shall remind the House of what the £310 million would pay for. It would pay for 75,000 hip replacements or 235,000 cataract operations. Where would the right hon. Member for Derby, South find that money if not from those who can afford a modest charge?

I shall now deal with the whole question of the cost of prescriptions. Increases in prescription charges have never been linked to inflation. The Government believe that it is reasonable to ask those who can afford to pay charges to do so. There is no firm evidence that charges deter people from getting the medication that they need.

Mr. Kevin Hughes (Doncaster, North)

Will the Minister tell the House what percentage of prescription items cost less than £5?

Mr. Malone

The average cost of a prescription is approximately 55 per cent. of the real cost of the drugs that are provided. That is the important point. That statistic is used because people use a mixture of prescriptions. Over the course of a year, it is right to consider not specific items, but the average cost because that is what the taxpayer is supplementing. It is as clear as it ever has been that prescription charges are good value for money when the cost is averaged out. It is reasonable to ask people who can afford to pay to do so.

As I said to the hon. Member for Doncaster, North (Mr. Hughes) the charge is related not to a particular item but to an average. That is an extremely important point to bear in mind. I am aware of the fact that a number of items cost less than the prescription charge. That is and always has been the case. That was the position when charges were reintroduced by the Labour party in 1968.

The charge is a flat rate. To have something akin to banded charges, or charges directly related to the cost of individual items, would be costly to operate and would not in the least be cost-effective. There are occasions when people are able to buy a prescription item over the counter at a cheaper price. They are free to do so. Many people do not know what sort of medication they need until they see the doctor, so it is not surprising that that happens.

Purchase of over-the-counter medicines for the minor ailments which form the bulk of illness is in line with the strategy in The Health of the Nation. People should take more responsibility for their health, in consultation with their general practitioners and pharmacists. Other items need to be prescribed.

Mr. Alex Carlile (Montgomery)

Why will not the Government allow general practitioners to write private prescriptions for items that cost less than £5.25?

Mr. Malone

GPs may do that. Nothing prevents them from issuing private prescriptions. Undoubtedly, they may wish to make a charge on that, or, as the hon. and learned Gentleman well knows, the pharmacist may charge a fee when the drug is dispensed. There is no question about that. There is no reason why that arrangement cannot be entered into.

I turn to exemption and remission arrangements. It is vital that hon. Members recognise what those are. As my right hon. Friend the Secretary of State for Health has often said to the House, we have the most generous exemption arrangements in Europe. More than 80 per cent. of prescription items are dispensed free, compared with 60 per cent. when the Government came to power in 1979. Only 42 per cent. were dispensed free in 1968 when the Labour party were in government and reintroduced charges.

It is important to remind the House about the arrangements. No child, pregnant woman or pensioner has to pay for their prescriptions. People on low incomes, such as income support and family credit, also receive free prescriptions, as do those entitled to full help under the national health service low income scheme. From 1 April, people receiving disability working allowance, who had capital of £8,000 or less when they made their claim, will receive free prescriptions. We are protecting people who are most vulnerable. People with certain chronic medical conditions who need regular or expensive medication also get their prescriptions free, and it is our intention to maintain that position.

We will not reduce an exempt list that has endured since it was first introduced in 1968 by Labour. I know that no change has been made in recent years, but the Government do not intend to extend the list because to do so would benefit only those whose income was above the level of qualifying for help on low income grounds, and an extended list would have to be agreed with the medical profession, which made it clear in 1968 that it would agree only to readily identifiable conditions needing lifelong medication. Nothing has occurred to change that up to now.

Mr. Nicholas Winterton (Macclesfield)

My hon. Friend the Minister is delivering a speech that needs to be heeded by all parties. He is presenting some relevant facts and statistics, but is he aware that some Conservative Members believe that a number of lifelong illnesses such as cystic fibrosis merit free prescriptions and being included in the exempt list of illnesses that require considerable medication? In the light of recent experiences and some of the views that have been expressed, would the Government perhaps consider exempting such diseases?

Mr. Malone

My hon. Friends point highlights the dilemma that faced those who had to reach this conclusion in 1968. An agreement that would endure was needed then. It is difficult to include other categories of diseases in the exempt list for the simple reason that it is difficult to get a consensus in the medical profession about the very definitions of the sort of illnesses alluded to by my hon. Friend. The questions that were examined in great depth in 1968 with the British Medical Association resulted in an important list of exemptions that we shall not revise or revisit.

Mr. Eric Illsley (Barnsley, Central)

That was 30 years ago.

Mr. Malone

The hon. Gentleman says that it was 30 years ago, but a number of the diseases and problems to which many hon. Members refer were well known in those days. The medical profession at the time considered that they did not fall into the category that required exemption. That is a consensus that the Government do not intend to disturb.

Mr. John Greenway (Ryedale)

I have a great deal of sympathy with what my hon. Friend the Minister is saying. The shallowness and hollowness of the Labour party's call for a review is clear in that the party has not a word to say about what it would do. What most annoys my constituents and, I dare say, many of my hon. Friends constituents, is that some people have to pay an increasing amount but many pay nothing at all. There may not be a review just yet, but will my hon. Friend consider the important problem of the waste of medicines? People who do not pay for them are not being encouraged to use them sensibly. What most annoys those who face the higher charge is that many people pay nothing.

Mr. Malone

I shall respond directly to my hon. Friends point about the proper use and waste of medicines. We are moving towards original pack dispensing with a more educational form of drug use, which is extremely important. Yes, as my hon. Friend suggested, it is important that when drugs are prescribed and dispensed they are used properly. Moves are being made in the right direction. It is widely recognised that the effectiveness of therapy is often connected with the proper use of drugs over time.

There are many other ways in which fairness is brought to bear in considering prescription charges. For example, prepayment certificates can be of enormous benefit to those who require therapy over time. I am delighted to say that those certificates are available on a basis which allows tremendous and quite dramatic savings to people who require regular prescriptions. On average, those who have a prepayment certificate can save over the period that the certificate is valid some £100 or so if they are on an average dose of drugs.

We have this debate on a regular basis. If the Opposition were providing an alternative to what we do—

Mr. Campbell-Savours

We are.

Mr. Malone

Well, they are offering a review yet again. To the people in Britain who benefit from the additional cash that comes into the health service on a direct basis and receive the additional benefits of all that because of our procedures, the response of the Labour party is hollow. It protests much, but it knows little about what to do. It has no alternative to what is being put forward. It promises a review after having looked at this problem for 16 years. It is a hollow promise.

We have fair arrangements which are firmly in place to ensure that those who can afford to contribute towards the cost of drugs that they receive do so and thereby provide benefits for patient care elsewhere in the health service. It is a proper policy. It is the right policy and the House will recognise tonight that the Labour party has no policy.

11.1 pm

Mr. Alex Carlile (Montgomery)

We have heard the word review bandied about a lot tonight in what I suppose may be regarded as the late-night revue on prescription charges. On one hand, we were reminded that the Secretary of State has said that she will keep prescription charges under review. On the other, we have heard that the Labour party is going to have a review of the whole system of prescription charges.

The Government have raised prescription charges way beyond inflation on the basis of the excuse that the charges have never had anything to do with inflation. That is arguing from a position of least advantage against the least advantaged, and the Minister knows it very well.

The Labour party says that it does not yet know what it will do about prescription charges. It would have been helpful—I agree with the Minister to this extent—if the right hon. Member for Derby, South (Mrs. Beckett) had been able to tell us, for example, that she thought that prescription charges should not be raised. It would have been helpful if, for example, she had said what I believe to be the case—it has been my party's policy for a considerable time—that taxes on tobacco could be higher.

If one applied a hypothecated system of taxation to the national health service, the money that could be raised by increasing tobacco taxes could be applied to keeping prescription charges down to a reasonable level, not more than they are now. The many elderly people who now have to pay for eye tests could be spared. Many who are reaching the stage at which they have to change their spectacles frequently could be excused from paying for eye tests.

Mr. Campbell-Savours

Will the hon. and learned Gentleman give way?

Mr. Carlile

No I shall not.

Mr. Campbell-Savours

Come on.

Mr. Carlile

I shall give way—possibly—in a moment. I do not want to speak for a long time. In reality, the Government have converted prescription charges into a health tax. Prescription charges were never concealed—

Sir Norman Fowler (Sutton Coldfield)

The Liberals would not lower charges.

Mr. Carlile

The right hon. Gentleman is interrupting from a sedentary position rather more energetically than we are used to from him. A late night away from the family I see. He and the Minister know very well that prescription charges were not introduced as a tax. They were introduced as a way in which to obtain a small contribution to offset the cost of the national health service.

It is very important that the Government should now be honest about the whole basis on which prescription charges are levied. Is the Minister saying that the charges are intended to offset the cost of prescriptions, or that they are a way of raising money for the Government coffers—that they represent simply a general contribution to the Governments tax collection system?

Mr. Campbell-Savours

Will the hon. and learned Gentleman tell me by how much he thinks that the price of a packet of 20 cigarettes should rise?

Mr. Carlile

As the hon. Gentleman well knows, my party has said that the tax on a packet of cigarettes should rise by at least double the rate of inflation each year.

Mr. Nicholas Winterton

Why?

Mr. Carlile

The hon. Gentleman intervenes from a sedentary position.

Mr. Winterton

Will the hon. and learned Gentleman give way?

Mr. Carlile

No, I heard what the hon. Gentleman asked. The answer to his question is: because smoking is extremely unhealthy and costs the national health service an immense sum, and because those who, possibly like the hon. Gentleman, enjoy their pipe or cigar—perhaps he enjoys a King Edward cigar—would be prepared to pay the extra money rather than give up.

Mr. Winterton

Will the hon. and learned Gentleman give way?

Mr. Carlile

No I shall not, because this is a short debate and we should concentrate on prescription charges.

The Minister should tell the House the basis upon which the Government levy prescription charges. Are they a tax or merely a modest subvention?

Mr. Malone

rose—

Mr. Carlile

I shall give way to the Minister if he will answer the question.

Mr. Malone

A prescription charge is a modest subvention; it is certainly not a tax. The charges represent a very small proportion of the health service budget, and are levied on those who can afford to pay. They are a contribution to health care, in addition to the record sums that the Government are already spending on the health service.

Mr. Carlile

The Minister has deliberately failed to answer the specific question. However, he has made it clear that in his view the charges are a tax on health, not a subvention on prescriptions. They represent a way of trying to get many people who cannot afford to do so to pay an extra impost to line the Governments coffers so that they can cut taxes at a later stage.

The Minister knows that his claim to rely on opinion polls and reviews of public attitudes towards the health service is not based on a single question about public satisfaction or otherwise with prescription charges. I challenge the Government to ask the public whether they approve of a prescription charge of £5.25. Of course they would not dare to ask that question, because they know what the answer would be.

The Government spend a lot of time complaining about scroungers. Yet, incomprehensibly, this tax is aimed at the very people whom the Government believe might, in a mad moment, vote for them. It is a tax on taxpayers. We know that many people are exempt from prescription charges, but how do the Government justify to the parents of the children who are exempt, the children of the pensioners who are exempt, and the carers who pay their taxes, a prescription charge increase at three times the rate of inflation?

How do the Government justify to doctors and pharmacists the fact that they must act as tax collectors for the Government? That is what happens with prescription charges. How do the Government justify their ignorance, and especially the Ministers ignorance, of what happens in doctors surgeries? Does he really believe that if ones general practitioner says, If I could give you a private prescription you could have the drug for £3 not £5, he or she is entitled to write a private prescription? That is not what GPs think that they are entitled to do. If the Minister approves of the practice he should say so tonight, because many GPs believe that they can not do that. Indeed, I was so advised today by those who represent the doctors. It is an important point, and I challenge the Minister to tell us whether that is the case. I am willing to give way to the Minister, as it is a simple question. Can GPs give their patients an NHS prescription for part of the drugs which they are prescribing and, on the same occasion—

Mr. Malone

indicated dissent.

Mr. Carlile

The Minister is now changing his mind and revealing his true ignorance. Earlier, he was suggesting that that was the case. Now, I understand him to be saying that the Government refuse to allow doctors to enable their patients to save money by giving private prescriptions on individual items costing less than £5.25. If that is the situation, why will the Minister not change that regulation and allow doctors to serve their patients with the best health care and also to assist in their economic interests when prescribing drugs?

Mr. Nicholas Brown

The position is that the British Medical Association wants the word shall in the GP contract to be changed to the word may to give GPs some discretion. In other words, it wants the Minister to review the situation.

Mr. Carlile

I am grateful to the hon. Gentleman. I received the same briefing from the BMA, which made the situation clear. The Minister should have known that, and should not have tried to cloud the issue when he intervened. He has been a Minister for long enough, and as such he has been energetic enough, to know the answer to a simple question such as that by now. It is simply a fraud on the public. The Government are using as the innocent tools of their fraud the hard-working GPs and pharmacists who are hard-pressed seeing patients every day.

Dame Elaine Kellett-Bowman (Lancaster)

I was under the impression that extremely skilled pharmacists can advise patients to have something that is not on their prescriptions if they think that it would help patients.

Mr. Carlile

The hon. Lady is right—pharmacists do that all the time—but she is missing the point. There are many drugs which pharmacists cannot sell across the counter, and that raises my next point. Surely the time has come when we must have a close look at the system which operates in France, where it is possible to buy far more drugs across the counter. There is no evidence that health in France has been significantly damaged by that. For example, why should not some antibiotics be available across the counter? That is one example of the many drugs which might fall into that category.

These new regulations impose a tax on the public.

Mr. Malone

rose—

Mr. Carlile

If the Minister wants to intervene, I shall of course allow him to do so. But will he now tell the House whether he is prepared to review the regulations so that GPs may give private prescriptions for drugs costing less than £5.25 at the same time as prescribing drugs which cost more than £5.25?

Mr. Malone

The hon. and learned Gentleman knows that GPs may well give such a prescription for a drug, but somebody who goes to have that drug dispensed may find that there is a charge for doing so. There is a balance in every case, as the hon. and learned Gentleman well knows.

The point of my intervention is that the hon. and learned Gentleman is suggesting that prescription charges are a tax. I put to him the question that I put to the right hon. Member for Derby, South (Mrs. Beckett), who failed to address it. I have listened to the hon. and learned Gentleman's speech with care. How would his party replace that £310 million? Would he get rid of prescription charges? What pledges will he give to the House tonight on the subject?

Mr. Carlile

The Minister should have been listening earlier. Did he not see his hon. Friend, the smoker from Macclesfield, getting excited about the Liberal Democrats policy on the issue?

Mr. Nicholas Winterton

On a point of order, Madam Deputy Speaker. The hon. and learned Member for Montgomery (Mr. Carlile) is telling the House an untruth. I do not smoke and I never have smoked. I was telling the House that the tobacco tax brings the Exchequer about £9 billion a year and that the cost to the health service is about £1 billion a year. Will the hon. and learned Gentleman apologise for his allegation?

Madam Deputy Speaker

That is a point of information.

Mr. Carlile

I shall certainly withdraw. I must say that the hon. Member for Macclesfield (Mr. Winterton) misled me by his enthusiasm into the belief that he must occasionally have a quiet weed somewhere near Black Rods car park.

The Minister has intervened three or four times but has failed to answer a basic question. Why do the Government allow patients to be ripped off by having to pay more for the cost of drugs because they have an NHS prescription? That is not fair and the regulations are not fair. The Government have an unfair attitude. They know that the regulations are hitting some extremely poor families.

11.15 pm

Mr. John Marshall (Hendon, South)

On these occasions we hear ritualistic speeches. None was more ritualistic than the praise of France by the hon. and learned Member for Montgomery (Mr. Carlile). He told us that France was wonderful but chose not to tell the House that in France, unlike in the United Kingdom, not all pensioners are exempt from prescription charges. He might have told the House that in France pensioners have to pay boarding charges when they go into hospital. That is the society that the hon. and learned Gentleman was praising.

Dame Elaine Kellett-Bowman

Does my hon. Friend agree that it would be dangerous to adopt the policy proposed by the hon. and learned Member for Montgomery (Mr. Carlile) and dispense antibiotics over the counter? Chemists do not have the medical records of their customers and they should not dispense antibiotics. Their customers would build up an immunity to antibiotics, and they would then be of no use to them.

Mr. Marshall

My hon. Friend is right. If someone does not have access to the medical records of the patient, it would be wrong of him or her to prescribe antibiotics across the counter.

On these occasions we hear a great deal of synthetic indignation from the Labour party. The sincerity of the right hon. Member for Derby, South (Mrs. Beckett) can be judged from the fact that last year she was an even more prominent member of the Labour party. Did she decide to table a prayer against an increase of 11.8 per cent. in prescription charges? That was a slightly higher increase in percentage terms than this years.

The right hon. Lady did not table such a prayer. Why is she so angry this year when she was so silent last year? Is she trying to hide the fact that she has no policy on health? The right hon. Lady is no longer in her place. I do not know where she is. Perhaps she has gone to read The Economist of last Friday, which contained an article headed Labours health policy: Improvising. It is suggested that the Labour party lacks a coherent strategy on health. It added that the Labour shadow health spokesmen were like a group of frightened rabbits.

Mr. Nicholas Brown

Will the hon. Gentleman give way to a frightened bunny rabbit?

Mr. Marshall

Yes.

Mr. Brown

That is very good of him.

I enjoy The Economist. It is a good magazine until it writes about something of which I have knowledge.

Mr. Marshall

I do not know whether the hon. Gentleman was the member of the Opposition Front-Bench team who is reputed to have said, If we are ahead without a policy, why do we need one?

We have heard this evening a great pledge by the Labour party that, if it wins the election, it will have a thoroughgoing review. So at the next election we shall hear the slogan, Vote Labour for more Royal Commissions. Vote Labour for more reviews.

On one occasion, the Labour party was accused of offering the British people a menu without prices. On this occasion, it will be a menu without products and without prices, and both will be filled in after the election. What a load of stuff and nonsense.

Mr. Bayley

Does the hon. Gentleman agree that VAT on fuel was rather like a menu without prices or items on it?

Dame Elaine Kellett-Bowman

What has that got to do with this?

Madam Deputy Speaker

Order. There are too many seated comments, and very few of them seem to have any value whatever.

Mr. Marshall

That did seem to be one of the less relevant comments that we have heard this evening.

Let us consider the history of prescription charges. Some Members in the House remember the 1964 general election campaign, during which the Labour party said that it would abolish prescription charges. It did, but it did not promise at that election that it would reintroduce them at a higher level than it had inherited, so that, by the time of the 1970 general election, prescription charges were two and sixpence per item instead of the two bob per form that prevailed in 1964. By the end of the first Wilson Government, prescription charges were greater than when he came into office in 1964.

The right hon. Member for Derby, South fought the 1974 general election. She should read the 1974 Labour general election manifesto. It said: Revise and expand the NATIONAL HEALTH SERVICE. Promise No. 1: abolish prescription charges. What happened? Labour did not abolish prescription charges. Perhaps that is why, at the most recent general election, the Labour party did not even mention prescription charges. It did not say whether it would abolish them, reduce them or have a thoroughgoing review. In the document Health 2000 there was no mention of them either. [Interruption.]

Madam Deputy Speaker

Order. I am extremely tired of these rather stupid sedentary interventions. I am making a special note of those who engage in them. The next time that they want to catch my eye to make a speech, they may find that I am rather blind.

Mr. Marshall

Madam Deputy Speaker, it would be very difficult to be blind to some hon. Members in the House, but I am sure that we wish you good luck in your attempts to do so.

We have to remember, as my hon. Friend the Minister said, that prescription charges cover no more than 10 per cent. of the total drugs budget. He reminded us that the revenue from prescription charges would pay for 75,000 hip replacement operations and that 80 per cent. of prescriptions are exempt. He might have told us, if he had been trying to make partisan points, that the level of exemptions for prescription charges in Britain is much more generous than that in other countries of the European Union. He might have said, for example—

Mr. Illsley

I am sorry to interrupt the hon. Gentleman, but he skipped from the 1974 general election to the 1992 general election. He said that in 1974, the Labour party committed itself to abolishing prescription charges. Will he tell us what the charges were in 1974, or indeed in 1979, when a Labour Government committed themselves to abolishing those charges? Was it not something of the order of 20p? If those charges had been increased at the rate of inflation, we would be talking now of abolishing a charge of 53p rather than £5.25.

Mr. Marshall

I should like to thank the hon. Gentleman for reminding the House that the rate of inflation in recent years has been very low—very much lower than it was under the most recent Labour Government. The hon. Gentleman admits that the Labour party made a promise in 1974; he admits that it did not keep that promise.

Mr. Kevin Hughes

What did Mrs. Thatcher say in 1979?

Mr. Marshall

The right hon. Lady Baroness Thatcher said in 1979 that she would improve the quality of the health service, and that is what has happened. She promised that more people would be treated; more people are being treated. She promised that waiting lists would decrease; they are decreasing. We kept our promises, and the money from prescription charges has helped to improve the quality of service given to the people of the country. The Labour party should welcome that fact.

Mr. Jimmy Wray (Glasgow, Provan)

The hon. Gentleman said that people are being treated much better by the national health service. A 70-year-old constituent of mine was recently taken to hospital at 3 am with a heart complaint. He was sent home alone in a taxi at 6 am and taken back to hospital at 8 am where he died at 10 am. That is the kind of service that has been provided since the trusts have taken over. It is a greyhound service and we could fill Hampden park in Scotland with the people who have been sent home and have then returned to hospital.

Mr. Marshall

My sister worked for the NHS in Scotland for many years, and the case to which the hon. Member for Glasgow, Provan (Mr. Wray) refers is not typical of the NHS in Scotland or England. It is an insult to the devoted people who work for the NHS to point out the mistakes that occur when the majority of those who are treated by the NHS welcome the treatment that they receive.

I conducted a survey in my constituency in which we asked the questions: have you recently been treated by the NHS and, if so, were you satisfied with that treatment? Those who had received treatment, almost to a man and to a woman, said that they were satisfied with it.

Mr. Thomas Graham (Renfrew, West and Inverclyde)

I am most grateful to the hon. Gentleman for giving way. He referred to the situation in Scotland. Does he know that the Royal Alexander trust hospital recently charged a 12-year-old American who was suffering from a sore stomach £800 for a 36-hour visit to that hospital? Yet the private hospital up the road would have charged £237. Is that not a case of privatisation through the back door? In the end, the people will suffer. Prescription prices are rising so high that, at the end of the day, people will have to treat themselves, as they will not be able to get into trust hospitals.

Mr. Marshall

I think that our remarks are ranging far wider than the scope of the debate. The hon. Gentleman referred to an American who was treated in a Scottish hospital. The charges that that parent paid to the hospital are a fraction of what he would have paid if his child had fallen ill in the United States of America.

Labour Members should tell us—they will not do so in this debate or, I suspect, in any other debates before the election—whether they intend to increase spending on the national health service. If they intend to abolish or restrict prescription charges, how would they pay for the net impact of that loss of income? Would not the Labour partys vendetta against private medicine put a great strain upon the health service?

Madam Deputy Speaker

Order. The hon. Gentleman is now ranging rather wider than the subject matter of the debate tonight. His remarks must relate to prescription charges.

Mr. Marshall

What impact would the Labour party's policy—which I understand that the hon. Member for Wakefield (Mr. Hinchliffe) unveiled to a surprised audience in the City recently—of imposing value added tax on private health care have upon the health service, the cost of drugs and therefore the cost of prescriptions? That would clearly restrict the number of people who use private health care and it would force more people into the prescription net.

Mr. Nicholas Brown

That is not our policy, and we could not pursue it, even if some Labour Members wanted to, as the hon. Member for Hendon, South (Mr. Marshall) knows very well.

Mr. Marshall

It seems that, when the frightened rabbits go to the City and find that a thoroughgoing review is not enough, they make up policy on the hoof and they get it wrong. It is no wonder that Labour Members are like frightened rabbits.

Finally, we would like to know whether a national minimum wage would do anything other than hurt the health service because many of those who work for it—

Madam Deputy Speaker

The hon. Member for Hendon, South (Mr. Marshall) tries my patience. He must return to the subject of prescription charges or sit down.

Mr. Marshall

I will return briefly to the subject of prescription charges to say that they provide £310 million of income for the national health service. They allow the provision of extra services and the exemptions in this country are more generous than in any other European Union country.

11.29 pm

Mr. Hugh Bayley (York)

It is a shame that the pharmaceutical industry has not yet developed a pill for bunkum and hogwash because it would have been in order this evening, given the myths peddled by Conservative Members. Both the hon. Member for Hendon, South (Mr. Marshall) and the Minister came out with the myth that the most generous prescription scheme in Europe is ours in the United Kingdom.

When the Select Committee on Health was taking evidence on the NHS drugs budget we were told at paragraph 882 of the report: Holland does not have a prescription charge. Who was the source of that subversive nugget of information? It was none other than the then Minister for Health.

In an intervention earlier, the hon. and learned Member for Montgomery (Mr. Carlile) asked the Minister why a GP cannot prescribe privately items which cost less than £5.25, the cost of a prescription, and the Minister replied that a GP can do that.

In paragraph 216 of our report we made the following recommendation to the Government: We recommend that the Government introduce a system whereby the pharmacist may dispense an item privately if the cost of the product prescribed is less than the NHS prescription charge. The Government response was: The Government notes the Committees views and will examine the potential for change.. They are still examining the potential for change and they have not yet pronounced. It is part of a review that the Government are currently conducting.

The Minister said that there was no evidence whatever that high prescription charges deter people from getting the drugs that they need and which are prescribed by doctors. I urge the Minister to look at the British Medical Journal of 2 October 1993, which reports that 14 per cent. of prescriptions are not dispensed. They are given to patients and the patients do not cash them in. Surely that is evidence that, having been given a prescription by their doctor, patients are deterred from taking it to a pharmacy and getting it dispensed. The Minister should answer those questions.

Mr. Malone

The relevant fact is whether the hon. Gentleman can say how many of that 14 per cent. were exempt and how many were due to incur charges. If he cannot do that, he is making a totally irrelevant point.

Mr. Bayley

It is not a totally irrelevant point; it is a point which we put to many people who gave evidence to the Select Committee.

I refer to the evidence that we received from the Royal Pharmaceutical Society of Great Britain. Its president, Mr. Nicholas Wood, said: Sometimes patients do say, I have not got enough money with me. There are three items on the prescription. Which one shall I take? It is very unfortunate and it puts a pharmacist into a difficult position. There is evidence from the professionals that people are unable to get the drugs that they need because of the charge. It is not good enough for the Government blindly to dismiss it and to say, It does not matter. We shall carry on putting up the charge, not just by the rate of inflation, but by three times the rate of inflation. There is evidence that patients are not getting the treatment prescribed to them by their doctors and the Government should act on that evidence.

Mr. Illsley

Has the Select Committee come across any reason why anyone should not cash in a prescription, other than the threat of the cost?

Mr. Bayley

Intuition suggests that people who have to pay are less likely to cash in their prescriptions, but there is evidence from the British Medical Journal and the Royal Pharmaceutical Society of Great Britain and there was the evidence to the Committee from the British Medical Association. It is extraordinary that when the evidence is brought to the attention of the Secretary of State in our report, the Government neither respond to the evidence nor do they tell the House that they are investigating it.

The Minister won a few laughs from his side by deriding Labours policy of conducting a thorough review of prescription charges, but in their response to the Select Committee report the Government said that they were conducting a review. Who is undertaking that review, and when will the report be produced? If the Minister cannot tell us the answer, I imagine that the Select Committee will want to know why the response to its report was made in such terms. There is a contradiction between what the Minister has told the House today and what the Secretary of State told the Committee in response to our report.

My right hon. Friend the Member for Derby, South (Mrs. Beckett) asked the Minister directly what proportion of prescriptions cost less than £5.25. He could not give a figure. Instead, he gave an answer to a question that had not been asked. The Select Committees evidence revealed, however, that 52 per cent. of items prescribed—the majority—cost less than the old, lower prescription charge, and the current estimate is in excess of 60 per cent.

Mr. Gordon Prentice (Pendle)

In a letter that I received from the Minister today, he estimates that over 50 per cent. of prescription items will have a total cost to the NHS of more than … £5.25 It follows that just under 50 per cent. will cost less than £5.25.

Mr. Bayley

I thank my hon. Friend for bringing me up to date. That is a substantial number.

The Select Committee—which, like all Select Committees, has a Conservative majority—said in its report: We consider it unreasonable that any patient should have to pay the full cost of prescription charges in respect of items the actual cost of which is less than the prescription charge. That is what a Committee with a Conservative majority is saying to the Minister. How does he respond to his hon. Friends proposal?

Our Committee—whose majority reflects the composition of the House—has called for a review of prescription charges and exemptions. The Minister asks what such a review should cover. I will make some suggestions. Under the regulations, the cost of an annual prepayment certificate—an annual prescription season ticket—will rise to £74.80. Why do not the Government, in a review, consider a system whereby people could pay in instalments?

People who are, by definition, on low incomes—otherwise they would not want a prepayment form—but not quite on income support level which would make them exempt from charges will find it difficult to pay nearly £75. That is a benefit that the Government could have introduced if they were keen to ensure that patients received the medicines that their GPs prescribe. The Minister could also examine the low-income exemption categories: why is someone receiving unemployment benefit not exempt? My right hon. Friend the Member for Derby, South gave other examples.

Hon. Members on both sides of the House have pointed out that there are exemptions for some chronic diseases, such as epilepsy and diabetes, but not for others, such as chronic asthma, cystic fibrosis and hypertension. Those anomalies need to be resolved: given that certain people need regular prescriptions throughout their lives, it is plainly wrong for some to be exempted while others are not.

Mr. Malone

I wonder whether the hon. Gentleman cleared that shopping list with his Front Bench. It is clear that Opposition Members can come out with shopping lists that their Front Bench refuses to acknowledge.

Mr. Bayley

The Minister would find it outrageous if, as a member of a Select Committee, I went running to my Front Bench to ask permission to include something in the Committees report. Every one of the suggestions on my list was the Committees suggestion, backed by every one of its Conservative members. They were the authors of that revolutionary shopping list—that drug-inspired psychedelic madness that the Minister derides.

Just for good measure, I will add a suggestion of my own which was not included in the Select Committees list—although it was suggested in evidence from the British Medical Association: someone who has a repeat prescription should not have to pay a repeat prescription charge. We heard earlier about a patient whose drugs for depression were prescribed at weekly intervals, for her own good. If the Government do nothing else, surely they can agree to drugs being prescribed in smaller amounts—which would be less wasteful and cost the NHS less money—without penalising the patient by imposing a further prescription charge since the charge is a tax.

Mr. Malone

indicated dissent.

Mr. Bayley

The Minister may shake his head at my use of the word tax, but when his predecessor gave evidence to the Select Committee he acknowledged that the prescription charge is in the nature of a tax. He explained: Patients are not making a payment for the drug that they receive. They are making a contribution to the NHS. The charge is a general contribution to the cost of the NHS. The Minister argued tonight that that is the purpose of the prescription charge. It is a Tory tax which has gone through the roof. If it had increased in line with inflation since 1979, the prescription charge would be 53p instead of a proposed £5.25. That is the mega inflation of a mega Tory tax.

11.41 pm

Lady Olga Maitland (Sutton and Cheam)

The right hon. Member for Derby, South (Mrs. Beckett) did patients no favours with her speech. She was terrorising them with her emotive language and dangerous, misleading and scaremongering statements. A patient at home listening to the debate could only be deeply alarmed.

The proposed 50p increase in prescription charges is equivalent to two first-class stamps, two sliced loaves or not even a pint of beer. We must keep a sense of proportion. Every person in the land knows that health is a priority in their family budget. If charges are as burdensome as the right hon. Member for Derby, South and her supporters claim, why is not my surgery packed with complaining patients? Instead, people tell me about the excellent NHS treatment they have received. They tell me how quickly they received treatment, and how quickly they recovered, returned home and got back to work and to help their families.

That is the good news from the national health service. Labour chokes on admitting that we do have good news. The good news has come because we have managed to eliminate waste; we have packaged our resources to ensure that the maximum amount of money is available for patient care. The £310 million to be raised by the charge will go to the front-line patients, who will benefit by it.

Let us examine the sort of treatments that could be on offer as a result. There could be more than 75,000 hip replacements. Or there could be more than 50,000 coronary artery bypass operations—

Mr. Deputy Speaker (Mr. Geoffrey Lofthouse)

Order. The hon. Lady is straying rather far from prescription charges.

Lady Olga Maitland

With respect, Mr. Deputy Speaker, I am not. [HON. MEMBERS: Oh!] I am saying that prescription charges—

Mr. Deputy Speaker

Order. The Chair cannot hear what the hon. Lady is saying.

Lady Olga Maitland

I am saying that the money raised by the prescription charges will pay for all this treatment—and for 200,000 cataract removals besides. Surely any patient queuing up for these treatments would be delighted to get them. How can the Labour party seek to deny them those treatments?

The Labour party talks about a review. What good is a review to my patients? None at all: it will not speed up treatment. More, I suspect that the review will just be another device to bring about delay and upheaval. In the end it will mean fewer resources for patients.

It might help patients to learn a bit of history, too. Charges are a long-standing feature of the NHS. I remind the Labour party that the Attlee Government, on coming to power, decided to introduce prescription charges. In 1949, Labour, not the Conservatives, made that decision. Mr. Attlee announced it himself, and the Opposition can read that in Hansard of 24 October 1949.

Finally the charges were introduced in 1952, but then, Labour had already introduced charges for dentures and spectacles in 1951. And charges for dental treatment were introduced in 1952. Labour abolished prescription charges in 1965, only to reintroduce them in 1968. That shows how much hypocritical cant we have heard from the Labour party today.

It would also benefit those outside this place to go over some comparisons with other countries in the European Union. In many other EU countries, charging for treatment is much more widespread. The fact is that we have the most generous health service of all. Spain and Britain are the only EU countries to exempt pensioners from prescription charges. In Germany, pensioners have to make a contribution from their pensions into a sickness fund. In France, pensioners are expected to pay towards hospital charges; and in Belgium, pensioners pay up to 25 per cent. of doctors consultation fees. Do the Opposition agree that pensioners in this country are infinitely better off?

In other countries, too, pensioners are expected to make a financial contribution. Many people in the Irish Republic have to pay charges for doctors consultations and in-patient stays. In Italy, there are daily charges for the first 10 days stay as a hospital in-patient, although pensioners are exempt. In Luxembourg there are daily charges for hospital in-patient stays. There are charges for doctors consultations in Portugal.

Mr. Peter Mandelson (Hartlepool)

She is reading out a central office brief.

Mr. Deputy Speaker

Order. The House must quieten down.

Lady Olga Maitland

One thing that is for sure is that the Conservative party and the Conservative Government respect our responsibilities in caring for the sick, the frail and the weak. We give them our priorities. We spend more money on the health service than the Labour party has ever dreamt of. It is salutary to bear in mind the fact that we spend £100 million a day on our health service. That is good news. As far as I am concerned, patients health is safe in Conservative Governments hands. It would be wrecked and undermined by the Labour party.

11.49 pm

Mr. Nicholas Brown (Newcastle upon Tyne, East)

I do not want to be accused by the hon. Member for Sutton and Cheam (Lady Olga Maitland) of suppressing good news. The good news that is before the House today is the Governments proposition that prescription charges should rise at three times the rate of inflation. We are debating the Labour party's prayer against that proposition—a prayer that I urge my right hon. and hon. Friends to support.

The Minister opened the debate by whingeing about its timing. The timing of our prayer is directly consequent on the timing of his announcement. Is the Minister proud of what he is doing? Indeed, are Conservative health Ministers ever proud of increasing prescription charges? The evidence seems to suggest that they are not. These announcements have been repeatedly sneaked out. The House will recall that the latest increase was announced on a Wednesday. On the Monday, there was a debate on health care, in which it could have been announced. On the Tuesday, there was a debate on health care, in which it could have been announced. But no, it was a written answer, put out proudly in the name of the Secretary of State—no, slipped out in the name of the Minister of State, when there was an important announcement on Northern Ireland at the same time.

Indeed, only a week before, my hon. Friend the Member for Doncaster, North (Mr. Hughes) had asked the Minister of State whether he had any plans to increase prescription charges. The Minister replied: Any announcement will be made at the appropriate time.— [Official Report, 14 February 1995; Vol. 254, c. 637.] So it is a bit rich of him to whinge about the timing now. It is par for the course. In 1994, the 50p increase came out in a written answer. In 1993, Madam Speaker had cause to rebuke the Secretary of State and the then Minister of State for abusing the pursuant device to sneak out a supplementary written reply. In 1992, the 35p increase was sneaked out during a high-profile dispute about employment figures.

In other words, the evidence is perfectly clear that the Government are not proud of what they are doing. If they are not proud of what they are doing, the Labour party is saying that it is not unreasonable for them to pause and think again, to review what they are doing. As my hon. Friend the Member for York (Mr. Bayley) has perfectly correctly pointed out, prescription charges have risen from 20p in 1978 to £5.25 from April 1995—a tenfold increase in real terms. If the charges had increased in line with inflation, they would now stand at 53p. The issue that the House must consider is why prescription charges are getting these regular, steady increases, dramatically ahead of the rate of inflation. Why single out prescription charges?

A number of hon. Members have drawn comparisons. Indeed, the right hon. Member for Sutton and Cheam treated us to a shopping list. I know that several of my hon. Friends were rather hoping to persuade her to get our shopping in at those prices. She referred to equivalents. In 1978, the prescription charge was equivalent to the price of half a pint of beer. It is now equivalent to more than three pints of beer. In 1978, the charge was less than half the price of a packet of cigarettes. It is now around twice the price of a packet of cigarettes. Why is the relative price of prescription charges rising against the price of beer and cigarettes? What are the Government trying to say to the British people in the relative judgments that they are making on these matters?

The Minister said that there was no evidence to show that price affected consumption—in other words, affected the number of prescriptions. That is not so, as his own Department could tell him—if it dared, or if he asked it. The figures that his Department has issued show that the average number of charged prescription items per person in 1978 was 5.5 per year. In 1993 there were 2.2 items per year.

The Institute for Fiscal Studies looked at prescription charges in a report published in 1990 and concluded that the entire fall in the increase in charge prescriptions could be accounted for by the increase in the real level of the prescription charge. That evidence runs counter to the Ministers statement. There was similar research by the York centre for health economics which estimates that the prescription charge increases have halved the demand for prescriptions among those who are not exempt. People are not taking the medicines that they should take because of price, although they are being advised by clinicians to take them. That must be wrong and it is false economy.

Precisely the same reasoning applies to national health service eye tests. There is a compelling case for free tests for those over the age of 65. That case was made in the debate and the principles that underpin it are the same as those that apply to prescription charges.

The Government claim that more people get free prescriptions under them than they did under Labour. But that is not because the Governments prescription exemptions are any more generous: they have not changed at all. It is because more people are now living in real poverty, more are unemployed and there are more elderly people, although I cannot blame the Government for that. Increased costs are deterring those who have to pay. [Interruption.] I say to the hon. Member for Lancaster (Dame E. Kellett-Bowman), who screeches at me, that the Government should take demographic factors into account. That is why we say that these matters should be reviewed.

Some 50 per cent. of the population are liable to pay for their prescriptions and they are being excessively picked on. Those people are being picked on well beyond the degree to which the Government pick on any other item for which they charge.

The Minister will ask what Labour should do. It is perfectly clear that we shall vote against this impost, and we shall do so now.

11.56 pm

Mr. Malone

If our strategy had been to try to slip the increase out by sleight of hand at dead of night, doing it by way of a parliamentary question and my appearance on the Jimmy Young show to justify the Governments policy, which I was pleased to do, and having a debate about these matters after the right hon. Member for Derby, South (Mrs. Beckett) prayed against the regulations, it would have failed.

The hon. Member for Newcastle upon Tyne, East (Mr. Brown) has come up with no policy at all. He suggests a review and that is it.

It being one and a half hours after the commencement of proceedings on the motion, MR. DEPUTY SPEAKER put the Question, pursuant to Order [24 March].

The House divided: Ayes 238, Noes 281.

Division No. 121]	[11.57 pm
AYES
Abbott, Ms Diane	Corston, Jean
Adams, Mrs Irene	Cox, Tom
Ainger, Nick	Cummings, John
Ainsworth, Robert (Cov'try NE)	Cunliffe, Lawrence
Allen, Graham	Cunningham, Jim (Covy SE)
Alton, David	Cunningham, Rt Hon Dr John
Anderson, Ms Janet (Ros'dale)	Dalyell, Tam
Armstrong, Hilary	Darling, Alistair
Ashton, Joe	Davidson, Ian
Austin-Walker, John	Davies, Bryan (Oldham C'tral)
Banks, Tony (Newham NW)	Davies, Rt Hon Denzil (Llanelli)
Barnes, Harry	Davies, Ron (Caerphilly)
Barron, Kevin	Davis, Terry (B'ham, H'dge H'I)
Bayley, Hugh	Denham, John
Beckett, Rt Hon Margaret	Dewar, Donald
Beith, Rt Hon A J	Dixon, Don
Bell, Stuart	Dobson, Frank
Benn, Rt Hon Tony	Donohoe, Brian H
Bennett, Andrew F	Dowd, Jim
Bermingham, Gerald	Dunnachie, Jimmy
Berry, Roger	Dunwoody, Mrs Gwyneth
Betts, Clive	Eagle, Ms Angela
Blair, Rt Hon Tony	Eastham, Ken
Blunkett, David	Enright, Derek
Boateng, Paul	Etherington, Bill
Bradley, Keith	Evans, John (St Helens N)
Bray, Dr Jeremy	Ewing, Mrs Margaret
Brown, N (N'c'tle upon Tyne E)	Fatchett, Derek
Burden, Richard	Field, Frank (Birkenhead)
Byers, Stephen	Fisher, Mark
Caborn, Richard	Flynn, Paul
Callaghan, Jim	Foster, Rt Hon Derek
Campbell, Mrs Anne (C'bridge)	Foulkes, George
Campbell, Menzies (Fife NE)	Fraser, John
Campbell-Savours, D N	Fyfe, Maria
Canavan, Dennis	Galloway, George
Cann, Jamie	Gapes, Mike
Carlile, Alexander (Montgomery)	Gerrard, Neil
Chidgey, David	Gilbert, Rt Hon Dr John
Church, Judith	Godman, Dr Norman A
Clapham, Michael	Godsiff, Roger
Clark, Dr David (South Shields)	Graham, Thomas
Clelland, David	Grant, Bernie (Tottenham)
Coffey, Ann	Griffiths, Nigel (Edinburgh S)
Cohen, Harry	Griffiths, Win (Bridgend)
Cook, Frank (Stockton N)	Grocott, Bruce
Corbett, Robin	Gunnell, John
Corbyn, Jeremy	Hain, Peter

Hall, Mike	Morgan, Rhodri
Hanson, David	Morley, Elliot
Harman, Ms Harriet	Morris, Estate (B'ham Yardley)
Henderson, Doug	Mowlam, Marjorie
Heppell, John	Mudie, George
Hill, Keith (Streatham)	Mullin, Chris
Hinchliffe, David	Murphy, Paul
Hodge, Margaret	Oakes, Rt Hon Gordon
Hoey, Kate	O'Brien, Mike (N Wkshire)
Hogg, Norman (Cumbernauld)	O'Brien, William (Normanton)
Home Robertson, John	Olner, Bill
Hood, Jimmy	Orme, Rt Hon Stanley
Hoon, Geoffrey	Pearson, Ian
Howarth, George (Knowsley North)	Pickthall, Colin
Howells, Dr. Kim (Pontypridd)	Pike, Peter L
Hoyle, Doug	Pope, Greg
Hughes, Kevin (Doncaster N)	Prentice, Gordon (Pendle)
Hughes, Robert (Aberdeen N)	Prescott, Rt Hon John
Hughes, Roy (Newport E)	Primarolo, Dawn
Hughes, Simon (Southwark)	Purchase, Ken
Hutton, John	Quin, Ms Joyce
Illsley, Eric	Randall, Stuart
Ingram, Adam	Raynsford, Nick
Jackson, Helen (Shef'ld, H)	Redmond, Martin
Jones, Barry (Alyn and D'side)	Reid, Dr John
Jones, Ieuan Wyn (Ynys Mon)	Rendel, David
Jones, Jon Owen (Cardiff C)	Robertson, George (Hamilton)
Jones, Lynne (B'ham S O)	Roche, Mrs Barbara
Jones, Martyn (Clwyd, SW)	Rogers, Allan
Jones, Nigel (Cheltenham)	Rooker, Jeff
Jowell, Tessa	Rooney, Terry
Keen, Alan	Ross, Ernie (Dundee W)
Kennedy, Jane (Lpool Brdgn)	Ruddock, Joan
Khabra, Piara S	Sedgemore, Brian
Kilfoyle, Peter	Sheerman, Barry
Kirkwood, Archy	Shore, Rt Hon Peter
Lestor, Joan (Eccles)	Short, Clare
Lewis, Terry	Simpson, Alan
Liddell, Mrs Helen	Skinner, Dennis
Litherland, Robert	Smith, Andrew (Oxford E)
Livingstone, Ken	Smith, Llew (Blaenau Gwent)
Lloyd, Tony (Stretford)	Snape, Peter
Llwyd, Elfyn	Soley, Clive
Loyden, Eddie	Spearing, Nigel
Lynne, Ms Liz	Spellar, John
McAllion, John	Stevenson, George
McAvoy, Thomas	Stott, Roger
McCartney, Ian	Strang, Dr. Gavin
Macdonald, Calum	Straw, Jack
McFall, John	Sutcliffe, Gerry
McKelvey, William	Thompson, Jack (Wansbeck)
Mackinlay, Andrew	Timms, Stephen
McLeish, Henry	Tipping, Paddy
McMaster, Gordon	Touhig, Don
McNamara, Kevin	Turner, Dennis
MacShane, Denis	Tyler, Paul
McWilliam, John	Vaz, Keith
Madden, Max	Walker, Rt Hon Sir Harold
Maddock, Diana	Wallace, James
Mahon, Alice	Wardell, Gareth (Gower)
Mandelson, Peter	Wareing, Robert N
Marek, Dr John	Wicks, Malcolm
Marshall, Jim (Leicester, S)	Wigley, Dafydd
Martin, Michael J (Springburn)	Williams, Rt Hon Alan (Swn W)
Martlew, Eric	Williams, Alan W (Carmarthen)
Maxton, John	Wilson, Brian
Meacher, Michael	Wise, Audrey
Meale, Alan	Wray, Jimmy
Michael, Alun	Young, David (Bolton SE)
Michie, Bill (Sheffield Heeley)
Milburn, Alan	Tellers for the Ayes:
Miller, Andrew	Mr. Joe Benton and
Moonie, Dr Lewis	Mr. Eric Clarke.

NOES
Ainsworth, Peter (East Surrey)	Evans, David (Welwyn Hatfield)
Alexander, Richard	Evans, Jonathan (Brecon)
Alison, Rt Hon Michael (Selby)	Evans, Nigel (Ribble Valley)
Allason, Rupert (Torbay)	Evans, Roger (Monmouth)
Amess, David	Evennett, David
Arbuthnot, James	Faber, David
Arnold, Jacques (Gravesham)	Fabricant, Michael
Arnold, Sir Thomas (Hazel Grv)	Fenner, Dame Peggy
Ashby, David	Field, Barry (Isle of Wight)
Atkins, Robert	Fishburn, Dudley
Atkinson, David (Bourmouth E)	Forman, Nigel
Atkinson, Peter (Hexham)	Forsyth, Rt Hon Michael (Stirling)
Baker, Rt Hon Kenneth (Mole V)	Forth, Eric
Baker, Nicholas (North Dorset)	Fowler, Rt Hon Sir Norman
Banks, Matthew (Southport)	Fox, Dr Liam (Woodspring)
Bates, Michael	Fox, Sir Marcus (Shipley)
Batiste, Spencer	Freeman, Rt Hon Roger
Bellingham, Henry	French, Douglas
Bendall, Vivian	Fry, Sir Peter
Beresford, Sir Paul	Gale, Roger
Bonsor, Sir Nicholas	Gallie, Phil
Booth, Hartley	Gardiner, Sir George
Boswell, Tim	Gillan, Cheryl
Bottomley, Peter (Eltham)	Goodlad, Rt Hon Alastair
Bottomley, Rt Hon Virginia	Goodson-Wickes, Dr Charles
Bowden, Sir Andrew	Gorst, Sir John
Bowis, John	Grant, Sir A (SW Cambs)
Boyson, Rt Hon Sir Rhodes	Greenway, Harry (Ealing N)
Brandreth, Gyles	Greenway, John (Ryedale)
Brazier, Julian	Griffiths, Peter (Portsmouth, N)
Bright, Sir Graham	Gummer, Rt Hon John Selwyn
Brooke, Rt Hon Peter	Hague, William
Brown, M (Brigg & Cl'thorpes)	Hamilton, Rt Hon Sir Archibald
Browning, Mrs Angela	Hamilton, Neil (Tatton)
Bruce, Ian (Dorset)	Hampson, Dr Keith
Budgen, Nicholas	Hanley, Rt Hon Jeremy
Burns, Simon	Hannam, Sir John
Burt, Alistair	Harris, David
Butcher, John	Haselhurst, Alan
Butler, Peter	Hawkins, Nick
Carlisle, John (Luton North)	Hawksley, Warren
Carlisle, Sir Kenneth (Lincoln)	Hayes, Jerry
Cash, William	Heald, Oliver
Channon, Rt Hon Paul	Heathcoat-Amory, David
Churchill, Mr	Hendry, Charles
Clappison, James	Hicks, Robert
Clark, Dr Michael (Rochford)	Higgins, Rt Hon Sir Terence
Clarke, Rt Hon Kenneth (Ru'clif)	Hill, James (Southampton Test)
Clifton-Brown, Geoffrey	Hogg, Rt Hon Douglas (G'tham)
Coe, Sebastian	Horam, John
Colvin, Michael	Hordern, Rt Hon Sir Peter
Congdon, David	Howard, Rt Hon Michael
Conway, Derek	Howarth, Alan (Strat'rd-on-A)
Coombs, Anthony (Wyre For'st)	Howell, Rt Hon David (G'dford)
Coombs, Simon (Swindon)	Hughes, Robert G (Harrow W)
Cope, Rt Hon Sir John	Hunt, Rt Hon David (Wirral W)
Couchman, James	Hunt, Sir John (Ravensbourne)
Cran, James	Hunter, Andrew
Currie, Mrs Edwina (S D'by'ire)	Hurd, Rt Hon Douglas
Curry, David (Skipton & Ripon)	Jack, Michael
Davies, Quentin (Stamford)	Jackson, Robert (Wantage)
Davis, David (Boothferry)	Jenkin, Bernard
Day, Stephen	Jessel, Toby
Devlin, Tim	Jones, Gwilym (Cardiff N)
Dicks, Terry	Jones, Robert B (W Hertfdshr)
Douglas-Hamilton, Lord James	Jopling, Rt Hon Michael
Dover, Den	Kellett-Bowman, Dame Elaine
Duncan, Alan	Key, Robert
Duncan-Smith, Iain	Kilfoyle, Peter
Dunn, Bob	King, Rt Hon Tom
Durant, Sir Anthony	Knapman, Roger
Dykes, Hugh	Knight, Mrs Angela (Erewash)
Eggar, Rt Hon Tim	Knight, Greg (Derby N)
Elletson, Harold	Knox, Sir David
Emery, Rt Hon Sir Peter	Kynoch, George (Kincardine)

Lait, Mrs Jacqui	Shaw, David (Dover)
Lang, Rt Hon Ian	Shaw, Sir Giles (Pudsey)
Lawrence, Sir Ivan	Shephard, Rt Hon Gillian
Legg, Barry	Shersby, Michael
Leigh, Edward	Sims, Roger
Lennox-Boyd, Sir Mark	Skeet, Sir Trevor
Lester, Jim (Broxtowe)	Smith, Sir Dudley (Warwick)
Lidington, David	Smith, Tim (Beaconsfield)
Lilley, Rt Hon Peter	Soames, Nicholas
Luff, Peter	Spencer, Sir Derek
MacGregor, Rt Hon John	Spicer, Sir James (W Dorset)
MacKay, Andrew	Spicer, Michael (S Worcs)
Maclean, David	Spink, Dr Robert
McLoughlin, Patrick	Spring, Richard
McNair-Wilson, Sir Patrick	Sproat, Iain
Madel, Sir David	Squire, Robin (Hornchurch)
Maitland, Lady Olga	Stanley, Rt Hon Sir John
Malone, Gerald	Steen, Anthony
Mans, Keith	Stephen, Michael
Marland, Paul	Stern, Michael
Marlow, Tony	Stewart, Allan
Marshall, John (Hendon S)	Streeter, Gary
Martin, David (Portsmouth S)	Sumberg, David
Mates, Michael	Sykes, John
Mawhinney, Rt Hon Dr Brian	Tapsell, Sir Peter
Mellor, Rt Hon David	Taylor, Ian (Esher)
Merchant, Piers	Taylor, John M (Solihull)
Mills, Iain	Temple-Morris, Peter
Mitchell, Andrew (Gedling)	Thomason, Roy
Mitchell, Sir David (NW Hants)	Thompson, Sir Donald (C'er V)
Moate, Sir Roger	Thompson, Patrick (Norwich N)
Monro, Sir Hector	Thurnham, Peter
Montgomery, Sir Fergus	Townend John (Bridlington)
Nelson, Anthony	Townsend, Cyril D (Bexl'yh'th)
Neubert, Sir Michael	Tracey, Richard
Newton, Rt Hon Tony	Tredinnick, David
Nicholls, Patrick	Trend, Michael
Nicholson, David (Taunton)	Trotter, Neville
Nicholson, Emma (Devon West)	Twinn, Dr Ian
Norris, Steve	Vaughan, Sir Gerard
Onslow, Rt Hon Sir Cranley	Viggers, Peter
	Waldegrave, Rt Hon William
Oppenheim, Phillip	Walden, George
Ottaway, Richard	Walker, Bill (N Tayside)
Page, Richard	Waller, Gary
Paice, James	Ward, John
Patnick, Sir Irvine	Wardle, Charles (Bexhill)
Patten, Rt Hon John	Waterson, Nigel
Peacock, Mrs Elizabeth	Watts, John
Pickles, Eric	Wells, Bowen
Porter, Barry (Wirral S)	Wheeler, Rt Hon Sir John
Powell, William (Corby)	Whitney, Ray
Rathbone, Tim	Whittingdale, John
Redwood, Rt Hon John	Widdecombe, Ann
Renton, Rt Hon Tim	Wiggin, Sir Jerry
Richards, Rod	Wilkinson, John
Rifkind, Rt Hon Malcolm	Willetts, David
Robathan, Andrew	Wilshire, David
Roberts, Rt Hon Sir Wyn	Winterton, Mrs Ann (Congleton)
Robertson, Raymond (Ab'd'n S)	Winterton, Nicholas (Macc'fld)
Robinson, Mark (Somerton)	Wolfson, Mark
Roe, Mrs Marion (Broxbourne)	Wood, Timothy
Rowe, Andrew (Mid Kent)	Yeo, Tim
Rumbold, Rt Hon Dame Angela	Young, Rt Hon Sir George
Ryder, Rt Hon Richard
Sackville, Tom	Tellers for the Noes:
Sainsbury, Rt Hon Sir Timothy	Mr. Sydney Chapman and
Scott, Rt Hon Sir Nicholas	Mr. Timothy Kirkhope.

Question accordingly negatived.