HL Deb 17 November 1949 vol 165 cc794-802

5.28 p.m.

Order of the Day, for the House to be put into Committee read.

Moved, That the House do now resolve itself into Committee.—(Lord Shepherd.)

On Question, Motion agreed to.

House in Committee accordingly:

[The LORD HOLDEN in the Chair]

Clauses 1 to 6 agreed to.

Clause 7 [Removal of hardships]:

LORD MILNE had given notice of two Amendments in subsection (6) (relating to the composition of the arbitration committee) the effort of which was to place the name of the Association of Certified and Corporate Accountants above that of the Institute of Chartered Accountants in Ireland. The noble Lord said: The first Amendment is submitted at the instance of the representative committee. I put it forward as a drafting Amendment. I do not think it is necessary for me to say anything upon it. I beg to move.

Amendment moved— Page 11, leave out line 17.—(Lord Milne.)

LORD SHEPHERD

There has been an opportunity of consulting with the Association of Certified and Corporate Accountants on this matter, and as a result I am in a position to accept this Amendment. On Question, Amendment agreed to.

LORD MILNE

I beg to move the next Amendment which stands in my name; it is consequential.

Amendment moved— Page 11, line 18, at end, insert ("The Institute of Chartered Accountants in Ireland").(Lord Milne.)

LORD SHEPHERD

We accept this Amendment also.

On Question, Amendment agreed to.

Clause 7, as amended, agreed to.

Clauses 8 to 14, agreed to.

LORD SHEPHERD moved, after Clause 14 to insert the following new clause:

Additional functions of Medical Practices Committee .Regulations made under section thirty-four of the Act of 1946 and regulations made under section thirty-five of the Act of 1947 may confer or impose on the Medical Practices Committee or, as the case may be, the Scottish Medical, Practices Committee such additional functions in relation to arrangements for the provision of general medical services as may be prescribed.

The noble Lord said: The purpose of this new clause is to add to the authority of the Medical Practices Committee. The functions of the Medical Practices Committee are at present limited technically to granting applications by doctors not yet on a medical list, for inclusion in that list. It is regarded as important that the Committee should have authority to look at all applicants for appointments. As a case in point, when a doctor on the list desires to appoint an assistant and the executive council for his area refuse the appointment the doctor should be able to appeal to the Medical Practices Committee, who may hear and determine the case. That is an illustration of the kind of extra authority which it is proposed to give to the Committee. This will also be applied to Scotland by the necessary reference to the Act of 1947. I beg to move.

Amendment moved— After Clause 14, insert the said new clause.—(Lord Shepherd.)

LORD LLEWELLIN

I believe that this new clause meets a point made by the British Medical Association and that it has been agreed between that body and the Minister. But I would like the noble Lord to see whether there ought not also to be consequential Amendments to Sections 33 and 34 of the original Act. Those who advise the British Medical Association are not satisfied on this point. Section 33 expressly directs that regulations shall be made requiring executive councils and not the Medical Practices Committee to arrange for the provision of personal medical services. Perhaps there ought to be some amendment to include the Medical Practices Committee in those regulations. I am told that Section 34 may require amendment in the same way, because as it stands it limits the functions which devolve on the Medical Practices Com- mittee. I do not expect to have an answer during Committee stage, but I shall be obliged if the noble Lord and his advisers will look into this point before the next stage to see whether there ought not to be these consequential amendments.

LCRD SHEPHERD

I shall be glad to respond to the noble Lord's suggestion, and will get in touch with him almost immediately.

On Question, Amendment agreed to.

LORD SHEPHERD moved, after Clause 14 to insert the following new clause:

Recovery of charges in respect of pharmaceutical services

"Section thirty-eight of the Act of 1946 and section forty of the Act of 1947 (which provide for the making of arrangements for pharmaceutical services) shall be amended by the addition at the end of each of those sections of the following subsection:— '(3) Regulations may provide for the making and recovery, in such manner as may be prescribed, of such charges, in respect of such pharmaceutical services, as may be prescribed, and may provide for the remission or repayment of the charges in the case of such persons as may be prescribed.'

The noble Lord said: This clause gives the necessary statutory authority for the proposal already announced by the Prime Minister in another place to make a charge for prescriptions under the National Health Service. The clause is drafted in general terms because the exact nature of the arrangements to be made has not yet been settled. But, as your Lordships know, the Prime Minister has already announced that the charge will in any case not exceed one shilling and that old-gage pensioners will be relieved of the charge. In addition, the Minister of Pensions has explained that war pensioners will continue to receive free treatment for their pensioned disabilities. No further particulars can be given at this stage. The object of the proposal lying behind the Amendment is twofold: it is to act as a deterrent to excessive or unnecessary resort to doctors and chemists, and to reduce expenditure. Eventually, it may be possible to tackle these problems on other lines. The Central and Scottish Health Services Councils have set up a Joint Committee to advise whether it is desirable and practicable to restrict or discourage the prescribing by doctors in the National Health Service of medicines of doubtful value or of unethical character, and of unnecessarily expensive brands of standard drugs.

The Joint Committee consists of members suggested by the Standing Medical and Pharmaceutical Advisory Committees of England and Wales, the Scottish Medical, Pharmaceutical and General Practitioner Services Advisory Committees, the three Royal Colleges, the Scottish Royal Medical Corporations, the British Medical Association, the British Pharmacopœia Commission and the Society of Apothecaries. It is too early to say yet what may be found possible on these lines, but it is conceivable that general acceptance of a list of drugs of recognised value, with the corollary that a doctor would be expected to justify the prescribing of any not so recognised or of unnecessarily expensive brands of recognised drugs, will in the long run be the better way of handling the problem. The clause will be applied to Scotland by the necessary reference to the Act of 1947. I have only one word to add: the clause is so drafted that it is of a permissive character, and will enable the Minister to vary conditions governing these practices. I beg to move.

Amendment moved— After Clause 14 insert the said new clause.—(Lord Shepherd.)

LORD LLEWELLIN

I am glad that, consequent on a remark T made on the Second Reading of the Bill, the Minister of Pensions has so quickly ensured that disabled ex-Service men will not have these charges placed upon them. Previously the only persons exempt were the old-age pensioners. I think that provision will give general satisfaction. I frankly admit that I do not understand one sentence of the noble Lord's words. I have not the faintest idea of what an "unethical" medicine is. Perhaps the noble Lord will be good enough to tell us what that means. The new clause is a wide one. It gives general power to the Minister to make regulations to make charges. It would be premature to say much about them, but we shall have to watch what these regulations do when they come out. I do not know whether the line of one shilling per prescription originally adopted by the Government will work in practice. I am told that 70 per cent. of the prescriptions which are made under the National Health Service are not handled by the pricing bureau, and that if we are to have a charge of one shilling for every prescription it will require a much larger staff in the pricing bureau than there is at the present time, unless the intention is to make an average adjustment, as apparently has been done so far under the Health Acts.

I would like to know from the noble Lord whether the price is to be per prescription or per item on the prescription. I am tell that a number of prescriptions given by doctors include—as one would expect—more than one item. A further mint I would like to make is that, in addition to the old-age pensioners and ex-Service people, some provision should be made so that people who regularly have to take a drug such as insulin, do not Lave to obtain a fresh prescription each time, and thereby have to pay for each issue of a drug which they must have. I am sure that is not a matter with which the Minister wants to deal when he is 'trying to get rid of abuses under the provisions of this Act. As I say, we shall have to wait and see what the regulations are, and all we can do at the moment is to allow the Minister to have the power to make them.

LORD HAWKE

I should like to ask the noble Lord whether he could tell me something which I might have looked up for myself if I had Known he intended to raise this particular issue. Can he say when the financial effect of this scheme will come into operation? The Prime Minister announced various cuts the other day, some of which were to take effect within the present financial year, and others in the next. I do not remember whether this was to appear before April 1, or after. I would also like to ask the noble Lord whether he can be tempted to give some forecast as to when, in practice, the charge will be imposed.

LORD SHEPHERD

As the noble Lord, Lord Llewellin suggested, the time for discussion of many of these details will arise when the regulations come before Parliament. Your Lordships will note that the clause we are now discussing merely gives the Minister power to prescribe the regulations. I hope that those regulations will see the light of day before long. Of course, there will have to be consultations about them. Not only will the question of prescribing be reviewed by the Committee, the membership of which I recited, but I understand that there will also be consultation with the professional organisations about the details of the scheme for the recovery of charges. Therefore, many of the points which are giving rise to disquiet in certain quarters will undoubtedly be considered by the Minister before the regulations are drafted. I hope that when they come before us they will be full enough to enable your Lordships to reach a decision without being anxious about the results. The noble Lord, Lord Llewellin, put a poser to me which I find it difficult to answer. The interpretation I will hand to him is not of my own making; it is given to me in the form of a suggestion—namely, that unethical treatment by the supply of drugs appears to be something that stimulates the emotions. Perhaps your Lordships will allow me to leave it at that. As to the noble Lord's statement that 70 per cent. of the prescriptions are not handled by the pricing bureau I can tell him that an attempt is being made to secure a system which, under a fairly inexpensive administration, will give us the results that we require. I can assure the noble Lord that the point he raised about the repetition of prescriptions for a given complaint will receive consideration. I cannot now give a definite reply to the noble Lord, Lord Hawke, but perhaps I shall be able to do so when the regulations are brought before Parliament.

LORD HAWKE

The noble Lord probably cannot answer my second point, as to the date when the charge will begin to be imposed. But I have no doubt that he can give me a reply to the point as to whether the Prime Minister calculated the saving in this financial year or in the next.

LORD SHEPHERD

A certain amount of it will be in this year, but we shall get the full fruits in a full year.

On Question, Amendment, agreed to.

5.47 p.m.

LORD SHEPHERD moved, after Clause 14 to insert the following new clause:

Recovery of charges from persons resident outside Great Britain

"—(1)The powers of the Minister to make regulations under the Act of 1946 shall, notwithstanding anything in section one of that Act, include power to make regulations providing for the making and recovery, in such manner as may be prescribed, of such charges, in respect of such services provided under the Act of 1946, as may be prescribed, being services provided in respect of such persons not ordinarily resident in Great Britain as may be prescribed; and such regulations may provide that the charges are only to be made in such cases as may be determined in accordance with the regulations.

(2) This section shall apply to Scotland with the substitution for the reference to the Minister of a reference to the Secretary of State and for the reference to the Act of 1946 of a reference to the Act of 1947."

The noble Lord said: This clause gives power to make regulations for the making and recovery of charges for any use which may be made of the National Health Service by persons not ordinarily resident in this country. It is certainly not the intention to exclude all foreign visitors from having any of the benefits of the Health Service while they are in this country. Reasonable use of our Health Services by those who fall ill when visiting this country is, in the Minister's view. a part of hospitality; but abuse by people who perhaps come here mainly to take advantage of a free service, for which we had to foot the Bill, is quite another matter. This clause is meant as a power to check abuse. The Minister said in another place on October 19 that people should not be able to come from abroad for the purpose of exploiting the National Health Service, and that he proposed to take power to frame regulations "where it may be practicable to do so" to prevent such abuse. Any regulations which may be made will not debar any person in this country from using the National Health Service, but may require him to pay a charge for so doing. Subsection (1) of the new clause provides that the regulations made under the clause shall specify to what services the charges will apply, and what the charges are to be. The regulations will also lay down to what classes of person not ordinarily resident in Great Britain the charges will apply. Owing to the difficulty which will doubtless be met in framing regulations which will not prove too rigid in their application to individual cases it is provided that the charges shall be made only in cases where the Minister so determines. I am afraid that no further particulars are available at the present time. I beg to move.

Amendment moved— After Clause 14, insert the said new clause.—(Lord Shepherd.)

LORD LLEWELLIN

Naturally the noble Lord, who has followed the course of this 13i1l in another place, will expect me to welcome this clause. It is a clause that imposes on the Minister the responsibility for making regulations to recover from overseas visitors a charge for the use of the Health Services. I would like to quote from what Mr. Bevan said in another place when speaking about an Amendment on almost identical lines. He said: In other words, the clause would impose on the Minister the responsibility for making regulations to recover from overseas visitors a charge for the use of the Health Service. I say at once that that is absolutely and utterly impracticable. However, here it is, and we are very glad that on second thoughts the Minister has come to this conclusion. Your Lordships will remember that when this Bill originally came before us I said that it was a happy occasion because it was through promises of which the Bill represented the fulfilment that the original Health Service was able to come into operation at the proper time. That was three and a half years after suggestions on similar lines had been made in your Lordships' House during our discussions on the principal Act. I congratulate the Government most heartily that this time our suggestions have been adopted within three and a half weeks, and I thank them for it.

On Question, Amendment agreed to.

Clause 15 [Superannuation of officers of certain hospitals]:

On Question, Whether Clause 15 shall stand part of the Bill?

LORD LLEWELLIN

There is one point I would make on Clause 15, but not to criticise it in any way, because I am not sure that it can be altered. There is a snag which will have to be appreciated by any hospital management before availing itself of the facilities under this clause. Under this clause the employers would have round their necks an unknown and unlimited liability in the matter of a deficiency contribution to the Minister's superannuation account. This is always a difficulty, as those of your Lordships who have gone into superannuation questions know. It has happened under the Local Authority (Superannuation) Acts and from time to time they have to make good out of the rates the deficiency in the pension funds shown on valuation. I do not know that this difficulty can be remedied, but it is a point to which I think it is proper to draw attention, because that will be the effect if any of these bodies comes in under the provisions of Clause 15.

LORD SHEPHERD

I have made an inquiry about that, and I find that if there is an actuarial deficiency in the scheme of any particular hospital, then the payments into the fund for that hospital may be increased. But it would not he a question of making good a deficiency over the general body of hospitals. I had no previous notice of the point, and perhaps I may have a talk with the noble Lord about it.

LORD LLEWELLEN

I am much obliged.

Clause 15 agreed to.

Remaining Clauses and Schedule agreed to.

House resumed.