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Mr. Alex Carlile (Montgomery): We have heard the word review bandied about a lot tonight in what I suppose may be regarded as the late-night revue on prescription charges. On one hand, we were reminded that the Secretary of State has said that she will keep prescription charges under review. On the other, we have heard that the Labour party is going to have a review of the whole system of prescription charges.

The Government have raised prescription charges way beyond inflation on the basis of the excuse that the charges have never had anything to do with inflation. That is arguing from a position of least advantage against the least advantaged, and the Minister knows it very well.

The Labour party says that it does not yet know what it will do about prescription charges. It would have been helpful--I agree with the Minister to this extent--if the right hon. Member for Derby, South (Mrs. Beckett) had been able to tell us, for example, that she thought that prescription charges should not be raised. It would have been helpful if, for example, she had said what I believe to be the case--it has been my party's policy for a considerable time--that taxes on tobacco could be higher.

If one applied a hypothecated system of taxation to the national health service, the money that could be raised by increasing tobacco taxes could be applied to keeping prescription charges down to a reasonable level, not more than they are now. The many elderly people who now have to pay for eye tests could be spared. Many who are reaching the stage at which they have to change their spectacles frequently could be excused from paying for eye tests.

Mr. Campbell-Savours: Will the hon. and learned Gentleman give way?

Mr. Carlile: No I shall not.

Mr. Campbell-Savours: Come on.

Mr. Carlile: I shall give way--possibly--in a moment. I do not want to speak for a long time. In reality, the Government have converted prescription charges into a health tax. Prescription charges were never concealed--

Sir Norman Fowler (Sutton Coldfield): The Liberals would not lower charges.

Mr. Carlile: The right hon. Gentleman is interrupting from a sedentary position rather more energetically than we are used to from him. A late night away from the family I see. He and the Minister know very well that prescription charges were not introduced as a tax. They were introduced as a way in which to obtain a small contribution to offset the cost of the national health service.


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It is very important that the Government should now be honest about the whole basis on which prescription charges are levied. Is the Minister saying that the charges are intended to offset the cost of prescriptions, or that they are a way of raising money for the Government coffers--that they represent simply a general contribution to the Government's tax collection system?

Mr. Campbell-Savours: Will the hon. and learned Gentleman tell me by how much he thinks that the price of a packet of 20 cigarettes should rise?

Mr. Carlile: As the hon. Gentleman well knows, my party has said that the tax on a packet of cigarettes should rise by at least double the rate of inflation each year.

Mr. Nicholas Winterton: Why?

Mr. Carlile: The hon. Gentleman intervenes from a sedentary position.

Mr. Winterton: Will the hon. and learned Gentleman give way?

Mr. Carlile: No, I heard what the hon. Gentleman asked. The answer to his question is: because smoking is extremely unhealthy and costs the national health service an immense sum, and because those who, possibly like the hon. Gentleman, enjoy their pipe or cigar--perhaps he enjoys a King Edward cigar--would be prepared to pay the extra money rather than give up.

Mr. Winterton: Will the hon. and learned Gentleman give way?

Mr. Carlile: No I shall not, because this is a short debate and we should concentrate on prescription charges.

The Minister should tell the House the basis upon which the Government levy prescription charges. Are they a tax or merely a modest subvention?

Mr. Malone rose --

Mr. Carlile: I shall give way to the Minister if he will answer the question.

Mr. Malone: A prescription charge is a modest subvention; it is certainly not a tax. The charges represent a very small proportion of the health service budget, and are levied on those who can afford to pay. They are a contribution to health care, in addition to the record sums that the Government are already spending on the health service.

Mr. Carlile: The Minister has deliberately failed to answer the specific question. However, he has made it clear that in his view the charges are a tax on health, not a subvention on prescriptions. They represent a way of trying to get many people who cannot afford to do so to pay an extra impost to line the Government's coffers so that they can cut taxes at a later stage.

The Minister knows that his claim to rely on opinion polls and reviews of public attitudes towards the health service is not based on a single question about public satisfaction or otherwise with prescription charges. I challenge the Government to ask the public whether they approve of a prescription charge of £5.25. Of course they would not dare to ask that question, because they know what the answer would be.


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The Government spend a lot of time complaining about scroungers. Yet, incomprehensibly, this tax is aimed at the very people whom the Government believe might, in a mad moment, vote for them. It is a tax on taxpayers. We know that many people are exempt from prescription charges, but how do the Government justify to the parents of the children who are exempt, the children of the pensioners who are exempt, and the carers who pay their taxes, a prescription charge increase at three times the rate of inflation?

How do the Government justify to doctors and pharmacists the fact that they must act as tax collectors for the Government? That is what happens with prescription charges. How do the Government justify their ignorance, and especially the Minister's ignorance, of what happens in doctors' surgeries? Does he really believe that if one's general practitioner says, "If I could give you a private prescription you could have the drug for £3 not £5," he or she is entitled to write a private prescription? That is not what GPs think that they are entitled to do. If the Minister approves of the practice he should say so tonight, because many GPs believe that they cannot do that. Indeed, I was so advised today by those who represent the doctors. It is an important point, and I challenge the Minister to tell us whether that is the case. I am willing to give way to the Minister, as it is a simple question. Can GPs give their patients an NHS prescription for part of the drugs which they are prescribing and, on the same occasion- -

Mr. Malone indicated dissent .

Mr. Carlile: The Minister is now changing his mind and revealing his true ignorance. Earlier, he was suggesting that that was the case. Now, I understand him to be saying that the Government refuse to allow doctors to enable their patients to save money by giving private prescriptions on individual items costing less than £5.25. If that is the situation, why will the Minister not change that regulation and allow doctors to serve their patients with the best health care and also to assist in their economic interests when prescribing drugs?

Mr. Nicholas Brown: The position is that the British Medical Association wants the word "shall" in the GP contract to be changed to the word "may" to give GPs some discretion. In other words, it wants the Minister to review the situation.

Mr. Carlile: I am grateful to the hon. Gentleman. I received the same briefing from the BMA, which made the situation clear. The Minister should have known that, and should not have tried to cloud the issue when he intervened. He has been a Minister for long enough, and as such he has been energetic enough, to know the answer to a simple question such as that by now. It is simply a fraud on the public. The Government are using as the innocent tools of their fraud the hard-working GPs and pharmacists who are hard-pressed seeing patients every day.

Dame Elaine Kellett-Bowman (Lancaster): I was under the impression that extremely skilled pharmacists can advise patients to have something that is not on their prescriptions if they think that it would help patients.

Mr. Carlile: The hon. Lady is right--pharmacists do that all the time--but she is missing the point. There are many drugs which pharmacists cannot sell across the counter, and that raises my next point. Surely the time has come when we must have a close look at the system which


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operates in France, where it is possible to buy far more drugs across the counter. There is no evidence that health in France has been significantly damaged by that. For example, why should not some antibiotics be available across the counter? That is one example of the many drugs which might fall into that category.

These new regulations impose a tax on the public.

Mr. Malone rose --

Mr. Carlile: If the Minister wants to intervene, I shall of course allow him to do so. But will he now tell the House whether he is prepared to review the regulations so that GPs may give private prescriptions for drugs costing less than £5.25 at the same time as prescribing drugs which cost more than £5.25?

Mr. Malone: The hon. and learned Gentleman knows that GPs may well give such a prescription for a drug, but somebody who goes to have that drug dispensed may find that there is a charge for doing so. There is a balance in every case, as the hon. and learned Gentleman well knows.

The point of my intervention is that the hon. and learned Gentleman is suggesting that prescription charges are a tax. I put to him the question that I put to the right hon. Member for Derby, South (Mrs. Beckett), who failed to address it. I have listened to the hon. and learned Gentleman's speech with care. How would his party replace that £310 million? Would he get rid of prescription charges? What pledges will he give to the House tonight on the subject?

Mr. Carlile: The Minister should have been listening earlier. Did he not see his hon. Friend, the smoker from Macclesfield, getting excited about the Liberal Democrats' policy on the issue?

Mr. Nicholas Winterton: On a point of order, Madam Deputy Speaker. The hon. and learned Member for Montgomery (Mr. Carlile) is telling the House an untruth. I do not smoke and I never have smoked. I was telling the House that the tobacco tax brings the Exchequer about £9 billion a year and that the cost to the health service is about £1 billion a year. Will the hon. and learned Gentleman apologise for his allegation?

Madam Deputy Speaker: That is a point of information.

Mr. Carlile: I shall certainly withdraw. I must say that the hon. Member for Macclesfield (Mr. Winterton) misled me by his enthusiasm into the belief that he must occasionally have a quiet weed somewhere near Black Rod's car park.

The Minister has intervened three or four times but has failed to answer a basic question. Why do the Government allow patients to be ripped off by having to pay more for the cost of drugs because they have an NHS prescription? That is not fair and the regulations are not fair. The Government have an unfair attitude. They know that the regulations are hitting some extremely poor families.

11.15 pm

Mr. John Marshall (Hendon, South): On these occasions we hear ritualistic speeches. None was more ritualistic than the praise of France by the hon. and learned Member for Montgomery (Mr. Carlile). He told us that


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France was wonderful but chose not to tell the House that in France, unlike in the United Kingdom, not all pensioners are exempt from prescription charges. He might have told the House that in France pensioners have to pay boarding charges when they go into hospital. That is the society that the hon. and learned Gentleman was praising.

Dame Elaine Kellett-Bowman: Does my hon. Friend agree that it would be dangerous to adopt the policy proposed by the hon. and learned Member for Montgomery (Mr. Carlile) and dispense antibiotics over the counter? Chemists do not have the medical records of their customers and they should not dispense antibiotics. Their customers would build up an immunity to antibiotics, and they would then be of no use to them.

Mr. Marshall: My hon. Friend is right. If someone does not have access to the medical records of the patient, it would be wrong of him or her to prescribe antibiotics across the counter.

On these occasions we hear a great deal of synthetic indignation from the Labour party. The sincerity of the right hon. Member for Derby, South (Mrs. Beckett) can be judged from the fact that last year she was an even more prominent member of the Labour party. Did she decide to table a prayer against an increase of 11.8 per cent. in prescription charges? That was a slightly higher increase in percentage terms than this year's.

The right hon. Lady did not table such a prayer. Why is she so angry this year when she was so silent last year? Is she trying to hide the fact that she has no policy on health? The right hon. Lady is no longer in her place. I do not know where she is. Perhaps she has gone to read The Economist of last Friday, which contained an article headed "Labour's health policy: Improvising". It is suggested that the Labour party lacks "a coherent strategy" on health. It added that the Labour shadow health spokesmen were like a group of "frightened rabbits".

Mr. Nicholas Brown: Will the hon. Gentleman give way to a frightened bunny rabbit?

Mr. Marshall: Yes.

Mr. Brown: That is very good of him.

I enjoy The Economist . It is a good magazine until it writes about something of which I have knowledge.

Mr. Marshall: I do not know whether the hon. Gentleman was the member of the Opposition Front-Bench team who is reputed to have said, "If we are ahead without a policy, why do we need one?"

We have heard this evening a great pledge by the Labour party that, if it wins the election, it will have a thoroughgoing review. So at the next election we shall hear the slogan, "Vote Labour for more Royal Commissions. Vote Labour for more reviews."

On one occasion, the Labour party was accused of offering the British people a menu without prices. On this occasion, it will be a menu without products and without prices, and both will be filled in after the election. What a load of stuff and nonsense.

Mr. Bayley: Does the hon. Gentleman agree that VAT on fuel was rather like a menu without prices or items on it?


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Dame Elaine Kellett-Bowman: What has that got to do with this?

Madam Deputy Speaker: Order. There are too many seated comments, and very few of them seem to have any value whatever.

Mr. Marshall: That did seem to be one of the less relevant comments that we have heard this evening.

Let us consider the history of prescription charges. Some Members in the House remember the 1964 general election campaign, during which the Labour party said that it would abolish prescription charges. It did, but it did not promise at that election that it would reintroduce them at a higher level than it had inherited, so that, by the time of the 1970 general election, prescription charges were two and sixpence per item instead of the two bob per form that prevailed in 1964. By the end of the first Wilson Government, prescription charges were greater than when he came into office in 1964.

The right hon. Member for Derby, South fought the 1974 general election. She should read the 1974 Labour general election manifesto. It said:

"Revise and expand the NATIONAL HEALTH SERVICE".

Promise No. 1: "abolish prescription charges". What happened? Labour did not abolish prescription charges. Perhaps that is why, at the most recent general election, the Labour party did not even mention prescription charges. It did not say whether it would abolish them, reduce them or have a thoroughgoing review. In the document "Health 2000" there was no mention of them either. [Interruption.]

Madam Deputy Speaker: Order. I am extremely tired of these rather stupid sedentary interventions. I am making a special note of those who engage in them. The next time that they want to catch my eye to make a speech, they may find that I am rather blind.

Mr. Marshall: Madam Deputy Speaker, it would be very difficult to be blind to some hon. Members in the House, but I am sure that we wish you good luck in your attempts to do so.

We have to remember, as my hon. Friend the Minister said, that prescription charges cover no more than 10 per cent. of the total drugs budget. He reminded us that the revenue from prescription charges would pay for 75,000 hip replacement operations and that 80 per cent. of prescriptions are exempt. He might have told us, if he had been trying to make partisan points, that the level of exemptions for prescription charges in Britain is much more generous than that in other countries of the European Union. He might have said, for example--

Mr. Illsley: I am sorry to interrupt the hon. Gentleman, but he skipped from the 1974 general election to the 1992 general election. He said that in 1974, the Labour party committed itself to abolishing prescription charges. Will he tell us what the charges were in 1974, or indeed in 1979, when a Labour Government committed themselves to abolishing those charges? Was it not something of the order of 20p? If those charges had been increased at the rate of inflation, we would be talking now of abolishing a charge of 53p rather than £5.25.

Mr. Marshall: I should like to thank the hon. Gentleman for reminding the House that the rate of inflation in recent years has been very low--very much


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lower than it was under the most recent Labour Government. The hon. Gentleman admits that the Labour party made a promise in 1974; he admits that it did not keep that promise.

Mr. Kevin Hughes: What did Mrs. Thatcher say in 1979?

Mr. Marshall: The right hon. Lady Baroness Thatcher said in 1979 that she would improve the quality of the health service, and that is what has happened. She promised that more people would be treated; more people are being treated. She promised that waiting lists would decrease; they are decreasing. We kept our promises, and the money from prescription charges has helped to improve the quality of service given to the people of the country. The Labour party should welcome that fact.

Mr. Jimmy Wray (Glasgow, Provan): The hon. Gentleman said that people are being treated much better by the national health service. A 70- year-old constituent of mine was recently taken to hospital at 3 am with a heart complaint. He was sent home alone in a taxi at 6 am and taken back to hospital at 8 am where he died at 10 am. That is the kind of service that has been provided since the trusts have taken over. It is a greyhound service and we could fill Hampden park in Scotland with the people who have been sent home and have then returned to hospital.

Mr. Marshall: My sister worked for the NHS in Scotland for many years, and the case to which the hon. Member for Glasgow, Provan (Mr. Wray) refers is not typical of the NHS in Scotland or England. It is an insult to the devoted people who work for the NHS to point out the mistakes that occur when the majority of those who are treated by the NHS welcome the treatment that they receive.

I conducted a survey in my constituency in which we asked the questions: have you recently been treated by the NHS and, if so, were you satisfied with that treatment? Those who had received treatment, almost to a man and to a woman, said that they were satisfied with it.

Mr. Thomas Graham (Renfrew, West and Inverclyde): I am most grateful to the hon. Gentleman for giving way. He referred to the situation in Scotland. Does he know that the Royal Alexander trust hospital recently charged a 12-year-old American who was suffering from a sore stomach £800 for a 36-hour visit to that hospital? Yet the private hospital up the road would have charged £237. Is that not a case of privatisation through the back door? In the end, the people will suffer. Prescription prices are rising so high that, at the end of the day, people will have to treat themselves, as they will not be able to get into trust hospitals.

Mr. Marshall: I think that our remarks are ranging far wider than the scope of the debate. The hon. Gentleman referred to an American who was treated in a Scottish hospital. The charges that that parent paid to the hospital are a fraction of what he would have paid if his child had fallen ill in the United States of America.

Labour Members should tell us--they will not do so in this debate or, I suspect, in any other debates before the election--whether they intend to increase spending on the national health service. If they intend to abolish or restrict prescription charges, how would they pay for the net


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impact of that loss of income? Would not the Labour party's vendetta against private medicine put a great strain upon the health service?

Madam Deputy Speaker: Order. The hon. Gentleman is now ranging rather wider than the subject matter of the debate tonight. His remarks must relate to prescription charges.

Mr. Marshall: What impact would the Labour party's policy--which I understand that the hon. Member for Wakefield (Mr. Hinchliffe) unveiled to a surprised audience in the City recently--of imposing value added tax on private health care have upon the health service, the cost of drugs and therefore the cost of prescriptions? That would clearly restrict the number of people who use private health care and it would force more people into the prescription net.

Mr. Nicholas Brown: That is not our policy, and we could not pursue it, even if some Labour Members wanted to, as the hon. Member for Hendon, South (Mr. Marshall) knows very well.

Mr. Marshall: It seems that, when the frightened rabbits go to the City and find that a thoroughgoing review is not enough, they make up policy on the hoof and they get it wrong. It is no wonder that Labour Members are like frightened rabbits.

Finally, we would like to know whether a national minimum wage would do anything other than hurt the health service because many of those who work for it--

Madam Deputy Speaker: The hon. Member for Hendon, South (Mr. Marshall) tries my patience. He must return to the subject of prescription charges or sit down.

Mr. Marshall: I will return briefly to the subject of prescription charges to say that they provide £310 million of income for the national health service. They allow the provision of extra services and the exemptions in this country are more generous than in any other European Union country.

11.29 pm

Mr. Hugh Bayley (York): It is a shame that the pharmaceutical industry has not yet developed a pill for bunkum and hogwash because it would have been in order this evening, given the myths peddled by Conservative Members. Both the hon. Member for Hendon, South (Mr. Marshall) and the Minister came out with the myth that the most generous prescription scheme in Europe is ours in the United Kingdom.

When the Select Committee on Health was taking evidence on the NHS drugs budget we were told at paragraph 882 of the report:

"Holland does not have a prescription charge".

Who was the source of that subversive nugget of information? It was none other than the then Minister for Health.

In an intervention earlier, the hon. and learned Member for Montgomery (Mr. Carlile) asked the Minister why a GP cannot prescribe privately items which cost less than £5.25, the cost of a prescription, and the Minister replied that a GP can do that.


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In paragraph 216 of our report we made the following recommendation to the Government:

"We recommend that the Government introduce a system whereby the pharmacist may dispense an item privately if the cost of the product prescribed is less than the NHS prescription charge."

The Government response was:

"The Government notes the Committee's views and will examine the potential for change.".

They are still examining the potential for change and they have not yet pronounced. It is part of a review that the Government are currently conducting.

The Minister said that there was no evidence whatever that high prescription charges deter people from getting the drugs that they need and which are prescribed by doctors. I urge the Minister to look at the British Medical Journal of 2 October 1993, which reports that 14 per cent. of prescriptions are not dispensed. They are given to patients and the patients do not cash them in. Surely that is evidence that, having been given a prescription by their doctor, patients are deterred from taking it to a pharmacy and getting it dispensed. The Minister should answer those questions.


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