§ 4 p.m.
§ Baroness Trumpington
My Lords, with the leave of the House, I should like to read a Statement being made by my right honourable friend the Minister for Health in another place. The Statement is as follows:
§ "The 1985 Public Expenditure White Paper (Cmnd. 9702) included plans to increase spending on the NHS overall by £ I billion in England during 1986–87. Family Practitioner Services' expenditure continues to increase to meet service pressures, demographic and social changes, advances in treatment of all kinds including drugs. The Government have provided for an increase of £250 million in England in 1986–87. All but a small part of this will be met from taxation and national insurance. The remainder will come from increased revenue from charges to patients. The proportion of the cost of the NHS met through charges is expected to fall slightly in 1986–87 to 3.02 per cent.
§ "There will be no change in dental and optical charges. The prescription charge will rise from £2.00 to £2.20. The four-monthly and annual season ticket fees will increase in the same proportion, to £12.00 and £33.50 respectively.
§ "The existing range of exemptions from charges will continue, including the present exemptions from the prescription charge for those suffering from certain specified conditions.
§ "I am today laying the necessary regulations before the House so that these changes will come into effect at the beginning of April. My right honourable friends the Secretaries of State for Scotland and Northern Ireland will be taking the equivalent steps. A note providing full details of the changes is available in the Vote Office."
§ My Lords, that concludes the Statement.
§ Lord Ennals
My Lords, I am most grateful to the noble Baroness for reading the Statement made in another place. The only thing that I welcome is the fact that there are to be no further increases in charges for dental and optical services. The damage has already been done there and any further action would virtually take dentistry and optical services out of the National Health Service altogether. To add more would make it rather like a bald man having a haircut!
I should like to ask the noble Baroness a number of questions. Is she aware that since her Government came to power prescription charges have increased eleven-fold—from 20p when we left office to the £2.20 she has now announced? Secondly, can she say what possible justification there can be for increasing charges by twice the rate of inflation, unless it is a prophecy that we are to have a higher rate of inflation? I ask that question because last year's increase of 40p was a 25 per cent. increase on the previous year. Can she tell the House how she and her right honourable friend can justify such a substantial increase?
415 Thirdly, is the noble Baroness aware that the level of charges—before she made her announcement, and even more so now—will in many cases exceed the cost of the prescriptions? Fourthly, does the noble Baroness accept the view of the British Medical Association that, even before the increase announced today, the level of charges acts as a deterrent to some non-exempt patients? She must understand that although a substantial proportion of prescriptions are exempt, many of those people who are not exempt are not just sick, but poor as well.
The increasing burden of prescription charges, which now bears no relationship to the cost of prescriptions and the rate of inflation, is a further erosion of the basic principle of the National Health Service—that the cost of sickness is borne by the nation as a whole rather than falling on those who have the misfortune to be sick.
I suppose that the Government will add this extra tax on the sick to the amount that they claim they are spending on the National Health Service. As the Statement relates entirely to the family practitioner services, can the noble Baroness yet tell the House when the Green Paper on primary health services will be published? This is the ninth time of asking.
§ Lord Kilmarnock
My Lords, we on these Benches would also like to thank the noble Baroness for repeating the Statement. We welcome the fact that there will be no move on dental charges. The last uprating was sufficient to constitute a serious deterrent to the use of dental services. There has been some evidence that the present level of charges has been detrimental to preventive dental treatment. We think that that decision is right. For the residue of the optical service, which applies only to children and supplementary benefit beneficiaries, it seems also right that charges should be frozen. We agree with the noble Lord, Lord Ennals, on both those points.
It must be recognised that, given the rising demand on the National Health Service, prescription charges could not at present be removed. But one must bear in mind that those charges have risen by 1,100 per cent. since 1979. The noble Lord, Lord Ennals, said elevenfold. I am giving the figures in percentage terms. We firmly believe that the charges should not be increased by more than the retail price index. We cannot, therefore, welcome the 10 per cent. hike. Among other things, it merely encourages bulk prescribing, which is wasteful.
This increase also raises the question of the success of the Government's limited list measures which were supposed to save £75 million. Recently, £45 million has been mentioned as a more realistic figure. Can the noble Baroness say whether this larger than justified increase in prescription charges is designed merely to plug that gap? It seems wrong that the average patient should be made to pay for the Government's miscalculation. Finally, on the question of exemption for certain specified conditions, can the noble Baroness remind the House what they now are and whether they include anti-cancer drugs? I associate myself with the remarks of the noble Lord, Lord Ennals, about the famous missing Green Paper.
§ Baroness Trumpington
My Lords, the noble Lord, Lord Ennals, will remember that it was his Government who introduced charges in 1968. We have maintained that innovation. The first question that he and the noble Lord, Lord Kilmarnock, asked concerned the increase being higher than the rate of general inflation. The 10 per cent. rise is exactly in line with the rising cost of medicines. It is higher than general inflation by about 5 per cent. because better and often more expensive medicines are becoming available or more widely prescribed.
A question was asked about some drugs being cheaper than others. A small proportion of prescribed items can be bought without a prescription at a price less than the prescription charge. We have no objection to the pharmacist concerned pointing that out to the patient. Whether he does so or not is entirely a matter for him. If he does, and the patient buys the item, the prescription is not dispensed. If the prescription is dispensed, the charge is payable unless the patient is exempt. Many drugs, as the noble Lord will be aware, are more expensive. It is a swings and roundabouts situation.
With regard to the increased charges acting as a deterrent, all the present exemptions remain, as was said in the Statement, and the proportion of prescriptions paid for by the flat rate charge is expected to fall to less than 20 per cent. next year. The increased numbers entitled to exemption have over the years caused a fairly consistent fall in the number of chargeable prescriptions. There is no evidence to show that the charge has deterred patients from seeking medical treatment.
Both noble Lords asked me about the publication of the Green Paper. I can tell them both "shortly". I was asked whether the increase in prescription charges was designed to plug the gap in savings from the limited list. We are on course for the original savings of £75 million. Either you want more resources put into national health or you do not. We do.
§ Lord Ennals
My Lords, may I follow up what the noble Baroness has said. Of course we want to see more money paid for the National Health Service, but not at the expense of the sick; namely, the patients. While thanking her for the information she gave to the House, may I ask her one or two other questions. First, how much money will be raised by what she has announced today? Secondly, can she refresh her own mind about the history that she told me about? In the period of the last Labour Government, from 1974 to 1979, there was no increase at all in prescription charges. We inherited prescriptions at 20p and they were 20p when the Conservative Government took over. They are now £2.20, so we ought to get the record straight.
§ Baroness Trumpington
My Lords, in answer to the noble Lord's further questions, I referred previously to the cost of medicines having increased and this increase is to match that cost. The revenue to be raised will be 10 million. There is no change in the categories of people who are entitled to free prescriptions. Currently, over 70 per cent. of all prescription items are issued free of charge, and nearly 6 per cent. go to holders of pre-payment certificates; in other words, season tickets.