HL Deb 08 November 1988 vol 501 cc541-50

1 Clause II, page 12, line 1, leave out subsection (7)

The Commons disagreed to this amendment for the following reason:

2 Because it alters the financial arrangements made by the Commons: and the Commons do not offer any further reason, trusting that this reason mar he deemed sufficient.

Lord Belstead

My Lords, I beg to move that the House do not insist on their Amendment No. 1 to which the Commons have disagreed for the reason numbered 2.

I first say a word about the reason given by another place for disagreeing with Amendment No. I, which was passed by your Lordships in July—an amendment which effectively prohibited charging for dental examinations. Of course your Lordships' House had every right to pass that amendment and thereby to ask another place to think again on this matter. As a result this issue has been debated twice in the House of Commons and when Members of another place did so last week they were able to take full account of the views expressed in your Lordships' House. On both occasions Members in another place decided that it was right to proceed with the proposal to charge for dental examinations and in sending the amendment back they have simply given their financial privilege as the reason for their disagreement.

Where the Commons offer such a reason for disagreeing to a Lords amendment then this House does not insist upon it. As Erskine May puts it: "This hint of privilege is generally accepted by the Lords, and the amendment is not insisted upon". There are, as your Lordships will be aware, a number of conventions and practices which, along with the statutory provisions of the Parliament Acts, regulate the position of this House in relation to the House of Commons. And respect for Commons financial privilege, so far as Lords amendment are concerned, is one of those conventions which your Lordships I am sure would not want lightly to put aside. I believe that it really would not be appropriate for your Lordships' House to depart from what has undoubtedly been its practice in the past, and that we should not now insist on this amendment.

However, if your Lordships will bear with me for just a moment or two more, I think it would be right for me to say a word about the Government case for introducing charges for dental examinations. The proposal in the Bill is National Health Service dental examinations should be put on the same basis as all other dental treatment. People who are not exempt—and there are a lot who are—would pay 75 per cent. of the cost, which would work out at just over £3 for an examination. I really do not believe that this will act as a deterrent, provided of course that there are fair exemptions. I give an assurance that the same people who are now exempt from paying any charges for treatment will be exempt from an examination charge also. That means that all children under the age of 16, together with 17 and 18 year-olds and students under 19, will be exempt, as will be people on income support, those on family credit, and expectant and nursing mothers. Some 38 per cent. of the population—21 million people—will get dental examinations as well as treatment completely free.

A week ago the Government announced over £2 billion extra money for the National Health Service next year. That is the largest increase hat the service has ever had. But, as your Lordships know well—there are many experts in this House—the sophistication of medical treatment becomes mercifully greater and greater and the demands on the health service are ever increasing. For that reason we have promised to aim to increase the level of spending by £600 million over the next two years on items which we believe are of the most immediate concern for patient care. At the end of last year the White Paper on primary health care identified areas where more spending would do most good, but it said that we would need to release some resources for this purpose by making charges for dental examinations and eye tests. The fact is that the first of these, the matter we are discussing now, would release some £49 million and the second would release £85 million, making £135 million in all.

That is a very large sum of money, which could, and we hope will, be used to develop medical services, some of which would go back to dentistry improvements for which the profession has been pressing for many years. I am therefore saying that, if today we were to insist on the Lords amendment, we should be forcing the state to offer free dental examinations to everyone, however well off, instead of redirecting those resources to the development of family doctor and dental and also eye services. This would involve a large sum of money being reallocated and financial privilege has been invoked by another place in disagreeing with your Lordships' amendment. To insist on our amendment would be wholly in breach of the conventions between the two Houses and I therefore ask your Lordships not to insist on this first amendment. I beg to move.

Moved, That the House do not insist on their Amendment No. 1 to which the Commons have disagreed for the reason numbered 2.—(Lord Belstead.)

Lord Ennals

My Lords, I do not intend to follow the Leader of the House in debating the funding of the National Health Service, but I want to say, before we move on from this issue, that we on these Benches greatly regret both the decision that was taken in another place and the decision that was forced upon it by Her Majesty's Government. So far as we are concerned, the principles underlying free dental examination and free sight testing are the same.

We should have liked to have an opportunity of expressing our views on this subject of dental care, but a ruling has been made and we shall not seek to challenge it. However, I should like to make one request. If those of us on all sides of the House who oppose charges for sight tests are successful this evening—and since the principles of both free tests are the same—are the Government prepared to think again about their decision on dental charges? The two go together and I hope that the Government will hold themselves free to review the dental charges issue if this House is successful in what it has set out to do later this afternoon.

Baroness Gardner of Parkes

My Lords, I speak with great regret at the position we face today over the amendment, because it was my amendment that was passed by this House in July. The whole dental profession looks on this as a very retrogressive move. In that splendid opening speech made by the Leader of the House, the one misleading phrase suggested that we would be forced to offer free dental examinations. That is the present situation. It is not a case of being forced to offer free examinations: they exist now and this provision takes them away.

Dentistry is the success story of the NHS and because of that we seem to be being punished for looking after people too well rather than too badly. I do not accept the Secretary of State's view that dental and eye examinations are not a form of screening and that anything detected in the form of disease is as a result of the skill of the professional person. I still view the examination as a screening process.

Even if this House accepts the Commons rejection of its amendment—as I understand it will—it is only an enabling position. The Government are not obliged to charge for national health treatment. The are merely enabled to do so, but until now they have not had the right. I ask the Government to investigate the possibility of oral cancer screening where the patient could present himself and not be charged. There is a parallel situation whereby if one is bleeding orally and one goes to a dentist, he is allowed to suture the haemorrhage without any charge whatsoever. There are only 14,000 cases a year—approximately one per dentist. The detection rate of oral cancer is not high but the degree of genuine concern on the part of patients is high. Perhaps the Secretary of State can consider that possibility.

If the charges are to be introduced, it is important to simplify Form AG I, a copy of which I am holding. It contains 17 pages and must be completed if one requires any financial assistance for examination or treatment. The number of letters I have received during the past week makes clear people's reluctance to undertake the marathon task of completing 17 pages of questions to discover whether they can have a free prison visit, glasses or a dental examination. The form appears to cover everything and the answer, when it is received, likewise covers everything.

It would also be good for the Government to consider the position of older pensioners. I refer to the recent statements made by the Chancellor of the Exchequer when he said that they are the very people whom he would like to target. All the charges will be introduced by regulation. If, when the regulation is laid, provision is made to exempt people born before 1919 everyone aged 70 or over will be covered. It is quite clear from the correspondence that I have received that those people are in most distress. They receive the smallest pensions prior to SERPS. Pride is important to them and they are managing with great difficulty on little money.

I accept the fact that we are bound by the ruling from the House of Commons and that we cannot debate the issue fully today. I have made those few comments in the hope that the Secretary of State will read them and consider ways of improving the situation, particularly for the disadvantaged.

3 p.m.

Lord Diamond

My Lords, I was in total support of the noble Baroness when the amendment first came before your Lordships' House, and I still hold that view. However, that is not the issue that we are now discussing. I wish to ask the Leader of the House whether he has sufficiently protected the rights of your Lordships' House in what he has said.

It must be obvious to all noble Lords that this is not a matter of national or local taxation. It is a matter of charges the nature of which, three centuries ago, honourable Members of another place who passed the resolution asserting their privileges could not have contemplated. In other words, we are dealing with territory which was unknown at that time and we must have regard to the way in which these matters have developed.

In that connection it must be equally obvious to all noble Lords that should we take the view that Commons privilege applies to any issue which is directly or indirectly connected with finance, there will be little left to discuss on any day. A case can always be made that something or other has a direct or an indirect effect on finance. Therefore there must be an area between what is and what is not clearly a matter of financial privilege. Without hesitation I accept that the other place— in effect, Mr. Speaker, as advised by his advisers—is the guardian of financial privilege. I accept that without hesitation.

Equally, what our Leader says and what the House decides can also be interpreted as guardianship of the privileges of this place. It is that with which I am concerned. I hope that I may not be regarded as unduly troubling the House if for the sake of accuracy I read out what is stated in Erskine May about the area with which we are dealing at the moment.Erskine May states: On some occasions, however, when the Commons have rejected amendments on the ground of privilege"— that is today's circumstance— and have indicated the fact in their formal statement of reasons, the Lords have not insisted on the amendments— I imagine that that is today's circumstance— but have asserted, by a resolution, that they made no admission in respect of any deduction which might he drawn from the reasons offered by the Commons, and did not consent that these reasons should thereafter be drawn into a precedent". It is most important for the maintenance of your Lordships' privileges—not an increase in them but their maintenance—that what we are doing this afternoon and why we are doing it should be made absolutely clear. I should have been happier had the Leader of the House added a form of words for which there is precedent to make that position more acceptable to many of your Lordships.

Lord Simon of Glaisdale

My Lords, the Parliament Act begins by defining, explaining and introducing the mechanism of a Money Bill. It goes on to show that your Lordships have a limited right of amendment and, unless the other place accepts it, can delay such a Bill for only a month. The Act then deals with other Bills which your Lordships have the right to delay for a year. Section 6 of the 1911 Act, which remains unamended, states that nothing therein before shall be taken as qualifying or modifying any existing privileges of the House of Commons. That provision was assented to by your Lordships in passing the Parliament Act in 1911.

The question which was raised by the noble Lord, Lord Diamond, relates to that issue; namely, what is the extent of the pre-existing privileges in financial matters of the House of Commons? That is really quite easy to answer because in practically every Bill that comes before this House your Lordships insert what is called the privilege amendment which is then removed b). the House of Commons. It is in common form and the one 1 shall read is from a Bill passed very recently by your Lordships—last week, I think, or possibly the week before; namely, the copyright Bill. It begins: Nothing in this Act shall impose any charge on the people or on public funds or vary the amount of incidence or otherwise alter any such". I should have apologised before attempting to read—your Lordships will accept from appearances that I can disclaim the necessity of declaring my interest in the subject under discussion—but I believe I have read enough. Those words make it quite clear that your Lordships concede and the other place accepts the concession that your Lordships will not interfere in any way with charges on public funds.

It is not merely a question of constitutional propriety. There are powerful practical reasons. The other place has most elaborate machinery for dealing with expenditure and raising funds. The House goes into a Committee of Ways and Means in order to decide how the funds shall be raised. It goes into a Committee of Supply to decide how the funds shall be laid out and the Estimates are voted upon. The House decides in great detail how the money shall be laid out and it is not open to a government department to switch from one head of Vote to another. It passes a Consolidated Fund Bill, and that is certified as a Money Bill. As we know from experience in the past two or three days, your Lordships pass it through all its stages; there is then an Appropriation Act which is dealt with in the same way. Above all, at the end of that, there is the Public Accounts Committee that the other place enjoys.

I emphasise the privileges of the other place because I am all against any derogation from the privileges which your Lordships are entitled to enjoy under the Parliament Act. In two respects which I need not go into now, your Lordships do not exercise the full powers. However, in view of what I have read out—and I believe it answers the question of the noble Lord, Lord Diamond—it is essential that your Lordships should respect, in every way, variation as well as outright protection in dealing with the raising and expenditure of public funds.

3.15 p.m.

Lord Colwyn

My Lords, I have to admit that I had intended to put down an amendment insisting on our amendments. However, it was made quite clear to me by the Public Bill Office that that would not be in order.

Perhaps I may bring the discussion back to dental charges. These are, after all, what we are debating. All health care professionals are united in opposing charges for dental examinations and sight tests within the National Health Service. There is not a shadow of doubt that we have won the argument against both proposals. The votes in another place were very close and the arguments very similar. The sums of money for the patients are also much the same.

Most important is a common principle which goes well beyond optics and dentistry. We are entering a new era of health care, promoting positive health instead of merely responding to damage and disease. Millions of people in this country suffer unnecessarily because they are not being directed towards health promotion. Access to advice is the foundation.

The Government's proposed charges will put that whole approach at risk. I share the concern of Members of the other place who dc not feel that satisfactory answers have been given to their questions. Why are dentistry and optics different? If these charges are acceptable, why have charges not been introduced for other screening techniques and even for visits to general medical practitioners? Where do the preventive policies of the Government's White Paper on primary health care then stand?

The Government have tried to put priorities on parts of the body. But all parts of our body contribute to the quality of our lives and need to be looked after. My own view is that both Houses have paid too much attention to the occasional lives which are saved following a dental examination or sight test and not enough to the sheer misery and inconvenience of tooth loss or poor sight. If we have problems with our mouths or eyes, our lives are less satisfactory. The great majority of us function less effectively without regular maintenance of our mouths. I am prepared to defend free dental examinations for dental reasons and in the interests of dental health as an integral part of general health. The extreme health problems which dental examinations sometimes reveal are a bonus, not the real argument.

I cannot challenge the Commons reason this afternoon. I would however ask the Minister, even at this late stage—if there is a change of heart by the Government on sight tests either in response to the Motion in the name of my noble friend Lord Cullen or to the amendment in the name of the noble Lord, Lord Ennals—to undertake to have the position of dental examination charges reconsidered. Dental examinations involve the much smaller potential revenue loss of about £50 million out of the £150 million projected revenue of the two charges together. In the case of pensioner exemptions, the cost in lost dental examination charge revenue would be a mere £5 million. This Bill is only an enabling measure. A power to charge for dental examinations does not have to be used or can be used selectively.

I have been especially disheartened by one argument of health Ministers in defence of these charges; namely, that they may be waived as dentists and opticians seek to protect their livelihoods. Although that directly contradicts the other argument that the charges will have no effect on patient demand, perhaps the Minister can confirm that arrangements will be made to ensure the continued availability of National Health dentistry in areas where the inevitable fluctuation of demand and low patient attendance will force many practitioners to reconsider the basis of their contracts with the health service in order to protect their incomes.

Finally, I should like to know whether the Government have an implementation date for dental examination charges. A date sometime before Christmas has been rumoured. If that is so, I should be grateful for the Minister's assurance that all NHS patient information leaflets and posters will first be amended and that dentists will be given adequate warning of the introduction of the new charges.

I am sorry that the other place has invoked its financial privilege and has denied us the chance to test the opinion of the House on these charges. I look forward to the debate on optical charges with great interest.

Viscount Tonypandy

My Lords, I hope, as we approach a decision, that the House will hesitate long and hard before it throws back in the face of another place the claim it has held for centuries; namely, the claim about controlling expenditure.

I do not wish to give the House a lecture about the powers of Mr. Speaker. However, it was in 1376 that the first Speaker was elected, and within four years the other place had demanded of the Monarch the right to control expenditure. To my mind there are two principles at stake today. The question of costs is one. At this very moment, however, the issue before the House is Mr. Speaker's ruling and whether the question of privilege claimed by another place is to be rejected by this House. This is a non-elected Chamber.

Noble Lords

No one is arguing that.

Viscount Tonypandy

My Lords, some have been arguing to that effect. We have just heard a noble Lord do that.

Noble Lords

No.

Viscount Tonypandy

My Lords, in that case perhaps I may say to the noble Lord that I am very pleased that this House is acknowledging the rights and privileges of the House of Commons, which is the elected Chamber in our Parliament.

Lord Glenamara

My Lords, before the Leader of the House replies, can he explain how there can be financial privilege today if there was not financial privilege when we discussed the subject a few weeks ago? What will the public make of a Parliament in which one House is forbidden to discuss a subject which it could discuss two or three weeks ago?

Lord Belstead

My Lords, before I come to that point, I first of all thank my noble friends Lady Gardner and Lord Colwyn for taking part in this debate because there is one aspect which is symptomatic of your Lordships' House; that is, the expert knowledge and a consistency of attitude to subjects which we consider are matters of principle. I respect both my noble friends for the line that they have taken even though 1 am in the position of not agreeing with them.

However, I can be helpful to my noble friend Lady Gardner in two ways. First, my noble friend put her finger on the fact that the forms, which are called AG 17s, certainly need looking at. In fact, my noble friend put that point with some force to me, together with some officials from my right honourable friend's department. Outside the Chamber we certainly agreed that my noble friend has a point and we are now following up that aspect.

The second point is that my noble friend is absolutely right to have pointed to the fact that although those on retirement pensions in this country have been doing better and better in recent years—and let us be thankful for that and proud of it—there are people on retirement pensions who still need to have their needs considered very closely. My noble friend absolutely rightly, if I may say so, drew attention to those who were on retirement pensions without having taken an occupational pension and before the introduction of what is known as SERPS.

I have no difficulty in giving my noble friend an undertaking which I know my right honourable friends the Chancellor of the Exchequer and the Secretary of State for Social Services will endorse. They are looking at precisely those people in the community.

Perhaps I may say to my noble friend Lord Colwyn that the intention, if your Lordships agree with this Motion, would be to bring in these charges next year. Again, I have taken on board what my noble friend said about the need for publicity and I have little doubt that my noble friend is right. Where I part company with my noble friend is on the dentists' contract. I have to say that as the charge for checkups will not, we believe, involve demand we do not think that it will affect the contract. However, I should like to look at what my noble friend said and, if necessary, write to him later.

I now quickly deal with the points put to me with considerable expertise from some parts of the House on the constitutional position. I come first to the point made by the noble Lord, Lord Diamond. In effect, the noble Lord said that he regretted that I had drawn attention to the constitutional position in the way that I had. I should like to make absolutely clear that I would be the first among your Lordships to defend the right of your Lordships' House to ask another place to think again—and, if necessary, again—when we believe it should be done.

It is worth bearing in mind that on this Bill, out of the 54 amendments we sent to another place 50 were accepted without query. Noble Lords who appear restive will know that, in what has been an extremely long Session, we have had many Bills through this House where we have sent a mass of amendments to another place and it has agreed with the vast majority of them. However, when the noble Lord, Lord Diamond, says that he questions the rightness of the Commons message—

Lord Diamond

My Lords, I cannot allow that to be said. I never suggested that at all. I said two or three times that I accept without hesitation—I used the words "without hesitation"—the right of the other place to do what it has done. If I am pressed, I am criticising the Leader of the House for his lack of protection of the privileges of this House. He could have done so by using a form of words, for which there are precedents in the plural, during the course of his speech which would not have affected our voting at all, and which would not have affected the privileges of another place, but made clear that we are not agreeing to reduce the privileges of your Lordships' House.

Lord Belstead

My Lords, let me take that point absolutely head on.Erskine May makes perfectly clear on page 849 that when there is a hint of privilege, including the hint of privilege where the financial arrangements made by the Commons are involved, then the House of Lords does not insist on its amendment. That is precisely the message which your Lordships' House has received from another place.

I suggest that the noble Lord should glance at the Marshalled List. He will see that for Amendment No. 2 the Commons disagree to the amendment because it alters the financial arrangement made by the Commons. I do not believe the majority of your Lordships' House would consider that as the Leader of this House I was serving your Lordships well if I advised your Lordships to disagree with such an amendment which would have a severe bearing on the comity between the two Houses.

Finally, I was grateful to the noble and learned Lord, Lord Simon of Glaisdale, and the noble Viscount, Lord Tonypandy, for what they said. I also answer the noble Lord, Lord Ennals. The noble Lord, if he will forgive me for saying so, asked an extraordinary question. He asked what the Government would do on this amendment if the noble Lord was to succeed in beating the Government on the next amendment. I do not think that either of those things will happen, and I now ask your Lordships not to insist on this amendment.

Viscount Mountgarret

My Lords, before my noble friend sits down, will he answer the question put by the noble Lord opposite on why the matter of privilege on this issue has been raised at this late stage? It might have been of help to your Lordships' House to know that this matter was possibly subject to privilege.

Lord Belstead

My Lords, privilege is a matter for another place. How we respond to privilege is a matter for this House. I have attempted to advise your Lordships, and I now again recommend to your Lordships that we do not insist on this, amendment.

On Question, Motion agreed to.

3.30 p.m.