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Wigley, Dafydd

Williams, Rt Hon Alan (Sw'n W)

Williams, Alan W (Carmarthen)

Wilson, Brian

Wise, Audrey

Worthington, Tony

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Wray, Jimmy

Young, David (Bolton SE)

Tellers for the Noes: Mr. Jim Dowd and Mr. Joe Benton.

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Question accordingly agreed to.

Mr. Deputy Speaker-- forthwith declared the main Question, as amended, to be agreed to.


That this House welcomes the substantial increase in the real level of education spending since 1979; notes that in a tough settlement overall local authorities will still be able to spend more next year than in 1994- 95; looks to them to set sensible priorities; welcomes the substantial improvement in standards of achievement by pupils in recent years, as demonstrated by examination and test results and by school inspection reports; and applauds the Government's education policies which are further driving up education standards, and giving parents more choice and information for the benefit of their children.


Atomic Energy Authority Bill


That, for the purposes of any Act resulting from the Atomic Energy Authority Bill, it is expedient to authorise the imposition of charges to corporation tax by provisions relating to the transfer of property, rights and liabilities of the United Kingdom Atomic Energy Authority in accordance with schemes under the Act.--[ Mr. Page. ]


Mr. Deputy Speaker (Mr. Michael Morris): With permission, I shall put together the motions relating to statutory instruments. Motion made, and Question put forthwith pursuant to Standing Order No. 97(1) (Matter relating exclusively to Scotland),


That the draft Prisoners and Criminal Proceedings (Scotland) Act 1993 (Release of Prisoners etc.) Order 1995, which was laid before this House on 16th February, be approved.

That the draft Prisons (Scotland) Act 1989 (Release of Prisoners etc.) Order 1995, which was laid before this House on 16th February, be approved. -- [Mr. Kirkhope.]

Question agreed to.


Social Security

Motion made, and Question put forthwith pursuant to Standing Order No. 101(5) (Standing Committees on Statutory Instruments, &c.), That the draft Social Security (Incapacity for Work) Miscellaneous Amendments Regulations 1995, which were laid before this House on 2nd March, be approved.-- [Mr. Kirkhope.]

Question agreed to.

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Drugs and Appliances

10.27 pm

Mrs. Margaret Beckett (Derby, South): I beg to move,

That an humble Address be presented to Her Majesty, praying that the National Health Service (Charges for Drugs and Appliances) Amendment Regulations 1995 (S.I., 1995, No. 643), dated 8th March 1995, a copy of which was laid before this House on 9th March, be annulled.

Opposition Members are not here solely to voice our opposition to this savage increase in taxes on the sick; we are here to give Conservative Members a chance to speak for their constituents, and to defeat the proposal. We want to hear from the Government why they are pushing through this increase, this year.

It is clear beyond doubt that, throughout all their years in office, the Government have pursued a policy of milking prescription charges as fully as they dare. Despite what the Daily Mail claimed was a pledge not to increase prescription charges, the process began with a whopping increase of 125 per cent. in the very first months of the Government's life in office. That was followed by a rise of 55 per cent. in 1980.

In fact, since the Conservative Government's election in 1979, in only two years--the boom years of 1988 and 1989--has the increase in the prescription charge been about the same as the rate of inflation. In every other year the charge has risen by massively more than the inflation rate: there was an increase of 25 per cent. in 1984-85--conveniently after the general election--four times more than the then rate of inflation, which had risen by 6.9 per cent. In the following years, increases averaged two to three times the rate of inflation, but since 1992 and the last general election we have again seen increases massively ahead of inflation.

The increase was 10.3 per cent. in 1991-92, when the inflation rate was 1.3 per cent. It was 11.8 per cent. in April 1992-93, when the inflation rate was 2.6 per cent. The regulations would raise prescription charges 10.5 per cent.--three times the current rate of inflation. If the price of bread had increased at the same rate as prescriptions, a loaf would cost £8.08. A pint of milk would cost £3.78. The proposed charges bear no relation to average price rises but bear a close relation to a secretive, undeclared tax on the sick--only on them, and levied only because they are sick. Those spoils--that loot--is being extracted from the sick by overcharging, in half of all cases, for the medicines sold. We know that that is true because the Secretary of State herself admitted that daylight robbery. Answering a question tabled by my hon. Friend the Member for Ipswich (Mr. Cann) last December, the right hon. Lady said that in 55 per cent. of cases the total cost to the NHS of a prescription item was less than the proposed charge of £5.25. Given that charges have increased way ahead of inflation and in many cases are providing a profit for the Treasury, they are not just a tax but a fiscal mugging. It is the kind of criminal offence that Dolly Rawlings, the powerful widow of gangland fame, would utterly deplore. The Dolly Rawlings of the Department of Health, however, is just the kind of mugger who gives crime and taxation such a bad name.

Mr. John Marshall (Hendon, South): No doubt the right hon. Lady read the article in The Economist last

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weekend which suggested that she does not have a policy on health. What would the right hon. Lady do with prescription charges? Would she get rid of them?

Mrs. Beckett: I did not read that article in The Economist . Obviously it would have been a waste of time.

Mr. Marshall: The right hon. Lady should have read it.

Mrs. Beckett: Well, clearly it did not convey much information to the hon. Gentleman, so it seems that it was not worth reading. Our approach to prescription charges has been stated repeatedly in the House. We believe that the whole system of prescription charges should be subject to a thoroughgoing review. The system has huge absurdities. It is crystal clear- -not just from statements made from the Dispatch Box but from the record of past Labour Governments--that we never have and never would use prescription charges as a tax on the sick, in the way that the Government have done since 1979.

The Minister for Health (Mr. Gerald Malone): A Labour Government introduced them.

Mrs. Beckett: That is not true. I know that the Prime Minister made that claim at the Dispatch Box two or three days ago, but the Minister should know better than to believe anything said by his right hon. Friend at Prime Minister's Question Time. A Conservative Government introduced prescription charges--

Mr. Malone indicated assent .

Mrs. Beckett: So the Minister knew that his remark was not true. A Conservative Government introduced prescription charges, not a Labour Government. I hope that we have nailed that lie.

Ministers are quick to argue that the level of charges is unimportant because 80 per cent. of prescriptions are dispensed free. That creates the impression--as I am sure it is intended to do--that only 20 per cent. of people pay, and then only those who can afford to pay. As always when it comes to tax, Ministers are being at least economical with the truth. The latest figures for 1993 show that no fewer than 50 per cent. of the population are liable to pay prescription charges.

It is not true that all vulnerable people are exempt. Ministers list pensioners, children, people on income support, pregnant women and people with certain specific conditions. However, the Library calculates that if one excludes the only two groups who are completely exempt--pensioners and children--85 per cent. of the remaining population are liable to pay. The overwhelming majority of men and women, whatever their income or family circumstances, are liable. People whose incomes are low enough to receive council tax benefit are not thereby exempt. Those in receipt of invalidity benefit--who by definition are long-term sick or disabled--are not exempt. Asthmatics and people suffering from cystic fibrosis are among those with long-term illness who have to pay for their prescribed medication. So do patients with AIDS, motor neurone disease, asthma, multiple sclerosis,

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chronic rheumatoid arthritis, leukaemia, breast cancer, emphysema and renal failure, to name but a few. All are liable to pay prescription charges.

Mr. Malone: Will the right hon. Lady give an undertaking to the House today that she would include them in the list of exemptions if she ever had the opportunity to do so?

Mrs. Beckett: I have already told the hon. Gentleman that we are committed to a thorough review, precisely because of the issue that he raises. There are huge numbers of people, some with diseases only relatively recently identified, but not one of whom has been added to the list. So far as I know, none of them has even been considered by the Government for adding to the list. The Government's policy is clear: huge increases in prescription charges, and no consideration of the addition of any of these groups.

The Minister knows perfectly well that the British Medical Association is calling for the kind of review that we advocate. First, there is a need to reconsider the list of those who are exempt, and the conditions that are included. Secondly, there is a need to look into the question of a person with one condition getting all their prescriptions free. These are serious and important issues which deserve careful consideration by the medical profession. That is what the medical profession wants, and what we would provide. The professsion does not want what the Minister is doing; it opposes it root and branch.

Mr. Malone rose --

Mrs. Beckett: Does the Minister have a serious point to make?

Mr. Malone: Yes.

Mrs. Beckett: That will make a change.

Mr. Malone: I thought from the reaction of the House that my last point to the right hon. Lady was serious. When these matters were last looked at, on 21 March 1968, when a Labour Government were in power, the BMA set down the exemption conditions. Is the right hon. Lady telling the House that the BMA has come to her with a list to add to the exemptions laid down back then? If she is not, this debate is dishonest.

Mrs. Beckett: That is rubbish. Certainly the BMA was involved in the discussion of the list in 1968, but is the Minister suggesting that nothing has changed since then? How many people had AIDS in 1968? How many children had asthma then? What were the charges? What was the treatment available then, and how essential was it to people's well-being?

A huge number of things have changed since 1968, but what has changed most is the prescription charge under the Conservative Government. Under the Labour Government, it did not increase by so much as one penny. Under the Conservatives, it has gone through the roof. And all the time Ministers refuse to look at new kinds of treatment, at new concerns which arise, and at a range of issues which the professionals believe deserve re- examination.

What is more, charges at the level that the regulations propose can be clinically damaging. I do not refer only to those who cannot, because of their incomes, afford to pay all their prescriptions, though they are a growing group. I spoke recently to a GP who explained that he had a patient

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who was acutely depressed, who had just lost her job and who was extremely anxious about her financial position. It was likely that she would need to be on anti-depressants for some time. Because of the woman's financial position, the doctor would have preferred to give her one long-term prescription, but because she was a suicide risk he dared not recommend more than a week's supply. Regular weekly prescriptions at a regular weekly charge are increasing her costs, adding to her anxiety and damaging her chances of a speedy recovery. Another patient, with an eye infection, was given a prescription that she did not collect because she could not afford it. A few days later she returned to her doctor with her eye in a much worse condition. He was so horrified at what had happened that he paid for the drug himself.

The BMA says today that, with each appalling rise in prescription charges, doctors are concerned that more and more patients will be dissuaded from visiting their surgeries at all. All GPs and pharmacists have anecdotal evidence of patients asking which of two or more items on a prescription form are the most important because they cannot afford to pay for more than one at a time.

It is crystal clear that this is a tax, that many more are liable to pay it than Ministers pretend, and that among those are large numbers of people who cannot afford to pay, including many who cannot afford to pay so much precisely because they are long-term or chronically sick. I have little doubt that the Minister of State will claim--as Ministers always claim-- that there is no alternative, especially as next year they expect to raise £310 million from the charge. Almost a third of that could be found instead by abolishing the subsidy on private health insurance, which cost the Revenue £95 million last year. The Government could have held back the £100 million to £120 million that they spent on the legal costs, the logos, the uniforms and the PR that went with the structural changes in their so-called health reforms. There are a number of ways in which they could have economised on the £1.3 billion that is estimated as the overall total costs of the changes.

In other words, the Government are not forced to raise all the money in this way. The sheer scale on which the Government cheat the sick is demonstrated by one simple comparison. If, as the then Mrs. Thatcher indicated in 1979, they had increased prescription charges only in line with inflation, the charge today would be 53p instead of £5.25. In other words, 90 per cent. of the charge that we are debating is down to deliberate Government tax raising.

The Conservatives are the tax-raising party. In these weeks, we are seeing increases in income tax, increases in water charges, increases in prescription charges--every one of them in stark contradiction to the pledges, the promises and the programme that the Government put before the people of Britain. They are dishonest. They are deceitful. They should depart.

10.41 pm

The Minister for Health (Mr. Gerald Malone): I am astonished that the right hon. Member for Derby, South (Mrs. Beckett), who has had a considerable time to reflect on these matters--as has her party over the past 16 years or so, or even longer because it was the Labour party that reintroduced prescription charges in 1968--comes to the House tonight and criticises what the Government are saying, and then simply promises a review. The truth of the

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matter is that she understands, as I think the whole House does, that we have these debates every year, usually in relatively heated circumstances, but nobody from the Opposition Benches is ever able to suggest what should replace the prescription charges that the Government have put in place on a fair basis to increase the amount of money that is spent on health care in this country.

Mr. Nicholas Brown (Newcastle upon Tyne, East): We need a review first.

Mr. Malone: If it takes Labour Members 16 years to work out what the review and the decisions of that review should be, I hope that the whole House will note that the right hon. Lady had not a single substitute to put in place for the benefits that prescription charges provide for the population of this country.

Each year we have to make careful judgments about how the resources of the NHS should best be spent, so that we can continue to provide the highest standard of patient care. As my right hon. Friend the Prime Minister recently reminded the House, surveys of patients show high satisfaction rates with the NHS, and broadly we have a record that I believe that we can be proud of.

Mrs. Beckett: Those are characteristically accurate statistics from the Prime Minister. Of course, what he does not point out is that levels of satisfaction may be slightly higher now than they were two or three years ago, but they are substantially lower than they were 10 years ago, before these reforms.

Mr. Malone: If the right hon. Lady looks at the British social attitudes survey, she will see precisely how satisfaction has increased in recent years, and it is something for which the Government take a great deal of credit. I did not hear many Opposition voices saying that resources are not an important matter. To make the best use of available resources, successive Governments have taken the view that those who can afford it should pay for prescriptions, thereby making an important contribution.

I remind the right hon. Member for Derby, South that it was a Labour Government who in 1949 first took powers to introduce prescription charges. They introduced the first NHS charges in 1951, and a Labour Government abolished them in 1965, only to reintroduce them in 1968.

Mr. D. N. Campbell-Savours (Workington): What do I tell my constituents who come to my surgery and say that they simply cannot afford to pay prescription charges?

Mr. Malone: What I shall say to the hon. Gentleman is that I will now deal with a point that I had intended to deal with later. It is that no pensioner, no child and no student up to the age of 18 pays prescription charges. There is a low-income scheme. Prescription charges are sensible and people who can afford to pay them make a contribution to British health care. What is the policy of the hon. Gentleman's party about replacing prescription charges? I shall be delighted to give way to him.

Mr. Campbell-Savours: I and all my hon. Friends think that we need a total review. That is absolutely right, and we shall have it and have sensible conclusions as a result.

Mr. Malone: The one certainty that I have noticed in my occasional appearances at the Dispatch Box is the

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repeated Opposition cry of, "Let's have a review." There are more reviews in the Opposition than ever appear in the Evening Standard theatre section.

Mr. Hugh Bayley (York): The Minister repeatedly mocks the idea of a review of prescription charges. Is he aware that the Select Committee on Health, which has a majority of Conservative Members, has called for a review? The Committee's recommendation stated: "We therefore recommend that there should be a review of prescription charges and the current exemption categories." In her response to that the Secretary of State for Health promised to examine the potential for change. The Minister's Department has agreed to a review. When will it take place?

Mr. Malone: There is a great deal of difference between what the hon. Gentleman says and what his right hon. Friend the Member for Derby, South said earlier. The right hon. Lady has absolutely no solution to filling the gap that would be left by the loss of the £310 million which contributes to greater patient care. [Interruption.]

Madam Deputy Speaker (Dame Janet Fookes): Order. I cannot hear the Minister. I wish to hear him and I do not want sedentary interruptions from what sounds like overgrown schoolboys.

Mr. Malone: I shall remind the House of what the £310 million would pay for. It would pay for 75,000 hip replacements or 235,000 cataract operations. Where would the right hon. Member for Derby, South find that money if not from those who can afford a modest charge?

I shall now deal with the whole question of the cost of prescriptions. Increases in prescription charges have never been linked to inflation. The Government believe that it is reasonable to ask those who can afford to pay charges to do so. There is no firm evidence that charges deter people from getting the medication that they need.

Mr. Kevin Hughes (Doncaster, North): Will the Minister tell the House what percentage of prescription items cost less than £5?

Mr. Malone: The average cost of a prescription is approximately 55 per cent. of the real cost of the drugs that are provided. That is the important point. That statistic is used because people use a mixture of prescriptions. Over the course of a year, it is right to consider not specific items, but the average cost because that is what the taxpayer is supplementing. It is as clear as it ever has been that prescription charges are good value for money when the cost is averaged out. It is reasonable to ask people who can afford to pay to do so.

As I said to the hon. Member for Doncaster, North (Mr. Hughes) the charge is related not to a particular item but to an average. That is an extremely important point to bear in mind. I am aware of the fact that a number of items cost less than the prescription charge. That is and always has been the case. That was the position when charges were reintroduced by the Labour party in 1968.

The charge is a flat rate. To have something akin to banded charges, or charges directly related to the cost of individual items, would be costly to operate and would not in the least be cost-effective. There are occasions when people are able to buy a prescription item over the counter

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at a cheaper price. They are free to do so. Many people do not know what sort of medication they need until they see the doctor, so it is not surprising that that happens.

Purchase of over-the-counter medicines for the minor ailments which form the bulk of illness is in line with the strategy in "The Health of the Nation". People should take more responsibility for their health, in consultation with their general practitioners and pharmacists. Other items need to be prescribed.

Mr. Alex Carlile (Montgomery): Why will not the Government allow general practitioners to write private prescriptions for items that cost less than £5.25?

Mr. Malone: GPs may do that. Nothing prevents them from issuing private prescriptions. Undoubtedly, they may wish to make a charge on that, or, as the hon. and learned Gentleman well knows, the pharmacist may charge a fee when the drug is dispensed. There is no question about that. There is no reason why that arrangement cannot be entered into.

I turn to exemption and remission arrangements. It is vital that hon. Members recognise what those are. As my right hon. Friend the Secretary of State for Health has often said to the House, we have the most generous exemption arrangements in Europe. More than 80 per cent. of prescription items are dispensed free, compared with 60 per cent. when the Government came to power in 1979. Only 42 per cent. were dispensed free in 1968 when the Labour party were in government and reintroduced charges.

It is important to remind the House about the arrangements. No child, pregnant woman or pensioner has to pay for their prescriptions. People on low incomes, such as income support and family credit, also receive free prescriptions, as do those entitled to full help under the national health service low income scheme. From 1 April, people receiving disability working allowance, who had capital of £8,000 or less when they made their claim, will receive free prescriptions. We are protecting people who are most vulnerable. People with certain chronic medical conditions who need regular or expensive medication also get their prescriptions free, and it is our intention to maintain that position.

We will not reduce an exempt list that has endured since it was first introduced in 1968 by Labour. I know that no change has been made in recent years, but the Government do not intend to extend the list because to do so would benefit only those whose income was above the level of qualifying for help on low income grounds, and an extended list would have to be agreed with the medical profession, which made it clear in 1968 that it would agree only to readily identifiable conditions needing lifelong medication. Nothing has occurred to change that up to now.

Mr. Nicholas Winterton (Macclesfield): My hon. Friend the Minister is delivering a speech that needs to be heeded by all parties. He is presenting some relevant facts and statistics, but is he aware that some Conservative Members believe that a number of lifelong illnesses such as cystic fibrosis merit free prescriptions and being included in the exempt list of illnesses that require considerable medication? In the light of recent experiences and some of the views that have been expressed, would the Government perhaps consider exempting such diseases?

Mr. Malone: My hon. Friend's point highlights the dilemma that faced those who had to reach this conclusion

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in 1968. An agreement that would endure was needed then. It is difficult to include other categories of diseases in the exempt list for the simple reason that it is difficult to get a consensus in the medical profession about the very definitions of the sort of illnesses alluded to by my hon. Friend. The questions that were examined in great depth in 1968 with the British Medical Association resulted in an important list of exemptions that we shall not revise or revisit.

Mr. Eric Illsley (Barnsley, Central): That was 30 years ago.

Mr. Malone: The hon. Gentleman says that it was 30 years ago, but a number of the diseases and problems to which many hon. Members refer were well known in those days. The medical profession at the time considered that they did not fall into the category that required exemption. That is a consensus that the Government do not intend to disturb.

Mr. John Greenway (Ryedale): I have a great deal of sympathy with what my hon. Friend the Minister is saying. The shallowness and hollowness of the Labour party's call for a review is clear in that the party has not a word to say about what it would do. What most annoys my constituents and, I dare say, many of my hon. Friends' constituents, is that some people have to pay an increasing amount but many pay nothing at all. There may not be a review just yet, but will my hon. Friend consider the important problem of the waste of medicines? People who do not pay for them are not being encouraged to use them sensibly. What most annoys those who face the higher charge is that many people pay nothing.

Mr. Malone: I shall respond directly to my hon. Friend's point about the proper use and waste of medicines. We are moving towards original pack dispensing with a more educational form of drug use, which is extremely important. Yes, as my hon. Friend suggested, it is important that when drugs are prescribed and dispensed they are used properly. Moves are being made in the right direction. It is widely recognised that the effectiveness of therapy is often connected with the proper use of drugs over time.

There are many other ways in which fairness is brought to bear in considering prescription charges. For example, prepayment certificates can be of enormous benefit to those who require therapy over time. I am delighted to say that those certificates are available on a basis which allows tremendous and quite dramatic savings to people who require regular prescriptions. On average, those who have a prepayment certificate can save over the period that the certificate is valid some £100 or so if they are on an average dose of drugs.

We have this debate on a regular basis. If the Opposition were providing an alternative to what we do--

Mr. Campbell-Savours: We are.

Mr. Malone: Well, they are offering a review yet again. To the people in Britain who benefit from the additional cash that comes into the health service on a direct basis and receive the additional benefits of all that because of our procedures, the response of the Labour party is hollow. It protests much, but it knows little about

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what to do. It has no alternative to what is being put forward. It promises a review after having looked at this problem for 16 years. It is a hollow promise.

We have fair arrangements which are firmly in place to ensure that those who can afford to contribute towards the cost of drugs that they receive do so and thereby provide benefits for patient care elsewhere in the health service. It is a proper policy. It is the right policy and the House will recognise tonight that the Labour party has no policy.

11.1 pm

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