§ Mr. Tomlinson
asked the Secretary of State for Social Services if she will make a statement on the financing of the NHS dental and optical services.
§ Mrs. Castle
I have approved for introduction on 1st January 1976 the new scale of dentists 'fees recommended by the Dental Rates Study Group, which gives effect to the new target average net income recommended by the Doctors' and Dentists 'Review Body in April—which the Government have already accepted—and takes account of the substantial increases in dentists' expenses over the 3W last year. Payments on account have, of course, already been made to dentists. Earlier the Government substantially increased opticians' NHS fees to improve their remuneration and to provide for their increased expenses, and have also had to allow increases in the reimbursed prices of lenses and frames. It has, therefore, become necessary to consider what adjustment in charges should be made.
As a party we have always been opposed to the cost-related system of charges introduced by my Conservative predecessor, the right hon. Gentleman the Member for Leeds, North-East (Sir K. Joseph). This system not only leads to an automatic increase in dental charges as costs rise; it also means that in certain cases, such as patients needing extensive dental treatment, the rise in costs acts as a disincentive to treatment. That is why last year the Government decided to freeze dental and optical charges.
This year, although the economic restraints mean that the additional cost of freezing charges yet again would put too great a burden on the funds of the NHS, the Government have decided to move back to the flat-rate basis of charges operated by previous Labour Governments and to introduce other improvements which will reduce the charge on those least able to pay and improve the provision of services under the NHS. I am, therefore, proposing to lay regulations to increase the revenue from both dental and optical charges while improving their incidence. The regulations will take effect on 1st January 1976.
On the dental side I propose that a patient will in future pay
(i) a maximum charge of £3.50 for a course of treatment not including dentures, or the cost of the course of treatment if it is less; (ii) for a denture bearing 1, 2 or 3 teeth £5.40 for a denture bearing 4 to 8 teeth £6 for a denture bearing more than 8 teeth £6.60 (iii) a maximum of £12 for any course of treatment, including the supply of dentures.
This will mean that patients requiring extensive treatment will pay substantially less than at present but the less extensive course of treatment will cost rather more.
Corresponding regulations will be made by my right hon. Friend the Secretary of State for Scotland.4W
On the optical side I have decided to increase the charges for frames so that they will, as under previous Labour Governments, represent the price of each frame as supplied to the optician.
We are also introducing flat-rate charges for spectacle lenses in place of the present cost-related charges which we have strongly criticised because they bear most heavily on patients with the most serious eyesight problems. For single-vision lenses, for which the charges now vary from £1.20 to £3.20 a lens, the new charge will be £2.25 for each lens; for bi-focal lenses, for which the charges now vary from £2.45 to £3.50 a lens, the new charge will be £4.25 or £5 a lense, according to type. This will mean an increase of the order of £2 to £3 a pair for the majority of patients who need relatively simple lenses, but the minority who need the most powerful and expensive lenses will not have much more to pay—indeed, for some there will even be a reduction.
In addition we propose to exempt altogether from these charges the registered blind and partially-sighted, many of whom can be helped by spectacles. This change will, however, have to wait until suitable legislation can be introduced.
I am also proposing a wide range of improvements in the provision for children. First I propose to make the plastic adult type NHS frame available free of charge to children. At present the only frames available to them free are wire or wire-ended frames; and I have no doubt that a good deal of distress is caused to children who feel self-conscious in such frames but whose parents cannot afford what they regard as the more attractive.
Secondly, glass lenses for children whose sight is very poor and in need of powerful correction are often heavy and not necessarily very attractive to the wearer—the so called "pebble" lenses. Plastics single-vision lenses can do exactly the same job without the same disadvantages of weight, and I am proposing that these should become available free to children with poor eyesight. This change and provision of the plastics adult frame for children will be introduced as soon as the necessary adjustments in production can be made, and we shall be discussing 5W these with the industry. I am also proposing to remove the charge made for supplying contact lenses on clinical grounds to children—through the hospital eye service.
I have also been concerned at the failure of the NHS to provide an adequate range of attractive frames for adults which means that large numbers of people, including those on low incomes, have had recourse to privately supplied frames. In fact over 50 per cent. of patients obtaining their lenses under the NHS have had them fitted into new private frames, often at considerable expense. I am convinced that it should be possible to provide a choice of attractive, modern frames at reasonable cost under NHS arrangements and so reduce the amount so many people at present pay for private frames and I am opening negotiations with the industry and the profession in order to secure their co-operation in achieving this.
There has also been widespread and growing concern about the high prices charged for privately supplied spectacle frames and lenses, including contact lenses. My right hon. Friend the Secretary of State for Prices and Consumer Protection has announced today that she has referred these prices to the Price Commission for investigation. I believe that this reference will help to meet this concern.
I should emphasise that many people, in particular those in receipt of supplementary and certain other benefits, and children—and in the case of dental charges, expectant mothers and women who have had a child within the previous 12 months—are automatically exempted from these charges. There are many others who qualify for help with charges on grounds of low income, and I am proposing to introduce a special concession at the same time as the new charges to extend the scope of this help. The margin above supplementary benefit level taken into account in assessing income of people claiming help with charges will be increased from £1.50 to £2.50. This together with the increase from £2 to £4 in the amount of earnings disregarded from 17th November will mean that more people with low incomes will be relieved of the whole or part of the charges.
These changes will have the effect of removing some of the anomalies which 6W exist at present and of making the basis on which these charges are assessed move socially just.
Their net effect will be to provide an additional £16 million from charges for the provision of dental and optical services in Great Britain in a full year.