HL Deb 21 July 1977 vol 386 cc416-20

3.16 p.m.

Baroness YOUNG

My Lords, I beg leave to ask the Question which stands in my name on the Order Paper.

The Question was as follows:

To ask Her Majesty's Government why those suffering from multiple sclerosis are excluded from the groups of persons entitled to an exemption from, or a refund of, prescription charges.


My Lords, the list of medical conditions which qualify for automatic exemption from prescription charges was the maximum on which agreement was possible with representatives of the medical profession. However, sufferers from multiple sclerosis who are housebound can claim exemption as having continuing physical disability which prevents them from leaving their residences except with the help of another person. The noble Baroness will know that exemption is also available on grounds of age or income; and, where exemption cannot be claimed, the prepayment certificate is available for those who need frequent prescriptions.

Baroness YOUNG

My Lords, in thanking the noble Lord for that full reply, may T ask him whether it would be possible for reconsideration to be given to the question of the exclusion of those suffering from multiple sclerosis from the list of illnesses for which an exemption can be claimed? Secondly, does he not think that, in the case of people who suffer from multiple sclerosis but who are just sufficiently able to leave their house, it is very hard that they are not eligible for this help in the way that other sufferers are eligible?


My Lords, I have some sympathy with the point of view which the noble Baroness puts forward. Our difficulty is that when the arrangements for exemption of those with specified medical conditions were discussed with the British Medical Association in 1968, the profession made it perfectly clear that they could agree to exemption only for readily identifiable medical conditions which called automatically for continuous long-term medication. That was in 1968. The list of exempt specified medical conditions has been periodically reviewed by all Governments since that date in consultation with the medical profession, and it was last discussed with the British Medical Association in 1976, but I regret to say that it was not possible to agree to any extension. I do not think I can take it beyond that, but that is the position.


My Lords, does the noble Lord recollect that this provision was originally made to fulfil a commitment made by the then Prime Minister to exempt the chronic sick? Does he agree that, far from exempting the chronic sick, it merely exempts a group of people suffering from any one of a small number of chronic ailments, most of which, with the exception of diabetes, are very rare? In these circumstances, does the noble Lord not think that it is high time we reviewed this list again, particularly with a view to considering multiple sclerosis but also certain psychiatric and circulatory disorders which require long-term continuous medication?


My Lords, I thought I had made it clear that a succession of Governments had, since 1968, tried to get this extended with the BMA and have not succeeded. The reason why this is so is only part of what the noble Lord has said. The profession's representatives are unwilling that doctors should have to make discretionary judgments about individual patients seeking exemption. They did not feel that they could accept responsibility for identifying, for the purpose of exemption, conditions other than those specified. A succession of Governments have tried to get this reviewed since 1968.


My Lords, is the Minister aware that this raises a very serious issue? If successive Governments have taken the view that this is a medical condition which ought to qualify the sufferer for exemption, it is not satisfactory that the BMA should tell the Government or this House that it cannot be done. We do not accept that when other trade unions try to impose their will. At least, we say that we do not. Many in this House do not see why we should treat doctors differently. Should not this Government, backed by Parliament, tell the BMA, "Sorry, but Parliament has decided that this is a case for exemption from the requirements"?


My Lords, the questions that have been raised in this House this afternoon can do nothing but good. I will see that they are conveyed to my right honourable friend in the hope that he may feel able to do something about the matter.

Baroness VICKERS

My Lords, can the noble Lord say how many cases of this disease exist? Does he realise that this is a very long-term disease and that it will be very desirable if some help can be given to the sufferers because this is a disease of which very little is known and for which there appears to be no cure? Will the noble Lord look into this to see the number involved and to push for action in the future?


My Lords, I cannot give the numbers off-hand without notice. I would remind the noble Baroness that sufferers from multiple sclerosis can claim exemption if their physical disability makes them house-bound. That helps only a small number and I take your Lordships' view about the need for this to be more widely applied.


My Lords, has not the Department its panel of expert medical advisers? Cannot they be guided by the advice of their own panel instead of by the advice of the BMA?


My Lords, I think that I am treading on thin ice here. I will take note of my noble friend's observations.


My Lords, although I have great sympathy with anyone who is suffering from this horrible disease, did not the noble Baroness, Lady Vickers, put her finger on the spot, perhaps unwittingly, when she said that there is no cure. Am I not right in thinking that if a cure or a powerful drug which could cause amelioration of the symptoms were to be discovered tomorrow it would be put immediately on to the list?


My Lords, the crucial phrase in the present agreement is "continuous long-term medication". It may be necessary to look at that in the light of what has transpired here this afternoon.


My Lords, does the noble Lord not think that it is terrible to make people choose between declaring themselves house-bound or having their medication free?


My Lords, they cannot declare themselves housebound. That has to be established as a medical fact.


My Lords, can my noble friend tell us what is the position about diabetics? They are, mainly, not house-bound. Do they get free prescriptions?


My Lords, they do. I was at some pains not to list all those who are entitled to exemption—largely because some of the words I cannot pronounce.