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Mr. Malone: The relevant fact is whether the hon. Gentleman can say how many of that 14 per cent. were exempt and how many were due to incur charges. If he cannot do that, he is making a totally irrelevant point.
I refer to the evidence that we received from the Royal Pharmaceutical Society of Great Britain. Its president, Mr. Nicholas Wood, said:
"Sometimes patients do say, `I have not got enough money with me. There are three items on the prescription. Which one shall I take?' It is very unfortunate and it puts a pharmacist into a difficult position."
There is evidence from the professionals that people are unable to get the drugs that they need because of the charge. It is not good enough for the Government blindly to dismiss it and to say, "It does not matter. We shall carry on putting up the charge, not just by the rate of inflation, but by three times the rate of inflation." There is evidence that patients are not getting the treatment prescribed to them by their doctors and the Government should act on that evidence.
Mr. Bayley: Intuition suggests that people who have to pay are less likely to cash in their prescriptions, but there is evidence from the British Medical Journal and the Royal Pharmaceutical Society of Great Britain and there was the evidence to the Committee from the British Medical Association. It is extraordinary that when the evidence is brought to the attention of the Secretary of State in our report, the Government neither respond to the evidence nor do they tell the House that they are investigating it.
The Minister won a few laughs from his side by deriding Labour's policy of conducting a thorough review of prescription charges, but in their response to the Select Committee report the Government said that they were conducting a review. Who is undertaking that review, and when will the report be produced? If the Minister cannot
Column 1147tell us the answer, I imagine that the Select Committee will want to know why the response to its report was made in such terms. There is a contradiction between what the Minister has told the House today and what the Secretary of State told the Committee in response to our report.
My right hon. Friend the Member for Derby, South (Mrs. Beckett) asked the Minister directly what proportion of prescriptions cost less than £5.25. He could not give a figure. Instead, he gave an answer to a question that had not been asked. The Select Committee's evidence revealed, however, that 52 per cent. of items prescribed--the majority--cost less than the old, lower prescription charge, and the current estimate is in excess of 60 per cent.
"over 50 per cent. of prescription items will have a total cost to the NHS of more than . . . £5.25".
It follows that just under 50 per cent. will cost less than £5.25.
The Select Committee--which, like all Select Committees, has a Conservative majority--said in its report:
"We consider it unreasonable that any patient should have to pay the full cost of prescription charges in respect of items the actual cost of which is less than the prescription charge."
That is what a Committee with a Conservative majority is saying to the Minister. How does he respond to his hon. Friends' proposal? Our Committee- -whose majority reflects the composition of the House--has called for a review of prescription charges and exemptions. The Minister asks what such a review should cover. I will make some suggestions. Under the regulations, the cost of an annual prepayment certificate--an annual prescription season ticket--will rise to £74.80. Why do not the Government, in a review, consider a system whereby people could pay in instalments?
People who are, by definition, on low incomes--otherwise they would not want a prepayment form--but not quite on income support level which would make them exempt from charges will find it difficult to pay nearly £75. That is a benefit that the Government could have introduced if they were keen to ensure that patients received the medicines that their GPs prescribe. The Minister could also examine the low-income exemption categories: why is someone receiving unemployment benefit not exempt? My right hon. Friend the Member for Derby, South gave other examples.
Hon. Members on both sides of the House have pointed out that there are exemptions for some chronic diseases, such as epilepsy and diabetes, but not for others, such as chronic asthma, cystic fibrosis and hypertension. Those anomalies need to be resolved: given that certain people need regular prescriptions throughout their lives, it is plainly wrong for some to be exempted while others are not.
Column 1148Mr. Malone: I wonder whether the hon. Gentleman cleared that shopping list with his Front Bench. It is clear that Opposition Members can come out with shopping lists that their Front Bench refuses to acknowledge.
Mr. Bayley: The Minister would find it outrageous if, as a member of a Select Committee, I went running to my Front Bench to ask permission to include something in the Committee's report. Every one of the suggestions on my list was the Committee's suggestion, backed by every one of its Conservative members. They were the authors of that revolutionary shopping list--that drug-inspired psychedelic madness that the Minister derides.
Just for good measure, I will add a suggestion of my own which was not included in the Select Committee's list--although it was suggested in evidence from the British Medical Association: someone who has a repeat prescription should not have to pay a repeat prescription charge. We heard earlier about a patient whose drugs for depression were prescribed at weekly intervals, for her own good. If the Government do nothing else, surely they can agree to drugs being prescribed in smaller amounts--which would be less wasteful and cost the NHS less money--without penalising the patient by imposing a further prescription charge since the charge is a tax.
Mr. Malone indicated dissent .
"is in the nature of a tax."
"Patients are not making a payment for the drug that they receive. They are making a contribution to the NHS."
The charge is a general contribution to the cost of the NHS. The Minister argued tonight that that is the purpose of the prescription charge. It is a Tory tax which has gone through the roof. If it had increased in line with inflation since 1979, the prescription charge would be 53p instead of a proposed £5.25. That is the mega inflation of a mega Tory tax.
Lady Olga Maitland (Sutton and Cheam): The right hon. Member for Derby, South (Mrs. Beckett) did patients no favours with her speech. She was terrorising them with her emotive language and dangerous, misleading and scaremongering statements. A patient at home listening to the debate could only be deeply alarmed.
The proposed 50p increase in prescription charges is equivalent to two first-class stamps, two sliced loaves or not even a pint of beer. We must keep a sense of proportion. Every person in the land knows that health is a priority in their family budget. If charges are as burdensome as the right hon. Member for Derby, South and her supporters claim, why is not my surgery packed with complaining patients? Instead, people tell me about the excellent NHS treatment they have received. They tell me how quickly they received treatment, and how quickly they recovered, returned home and got back to work and to help their families.
That is the good news from the national health service. Labour chokes on admitting that we do have good news. The good news has come because we have managed to
Column 1149eliminate waste; we have packaged our resources to ensure that the maximum amount of money is available for patient care. The £310 million to be raised by the charge will go to the front-line patients, who will benefit by it.
Let us examine the sort of treatments that could be on offer as a result. There could be more than 75,000 hip replacements. Or there could be more than 50,000 coronary artery bypass operations--
Lady Olga Maitland: I am saying that the money raised by the prescription charges will pay for all this treatment--and for 200,000 cataract removals besides. Surely any patient queuing up for these treatments would be delighted to get them. How can the Labour party seek to deny them those treatments?
The Labour party talks about a review. What good is a review to my patients? None at all: it will not speed up treatment. More, I suspect that the review will just be another device to bring about delay and upheaval. In the end it will mean fewer resources for patients.
It might help patients to learn a bit of history, too. Charges are a long- standing feature of the NHS. I remind the Labour party that the Attlee Government, on coming to power, decided to introduce prescription charges. In 1949, Labour, not the Conservatives, made that decision. Mr. Attlee announced it himself, and the Opposition can read that in Hansard of 24 October 1949.
Finally the charges were introduced in 1952, but then, Labour had already introduced charges for dentures and spectacles in 1951. And charges for dental treatment were introduced in 1952. Labour abolished prescription charges in 1965, only to reintroduce them in 1968. That shows how much hypocritical cant we have heard from the Labour party today.
It would also benefit those outside this place to go over some comparisons with other countries in the European Union. In many other EU countries, charging for treatment is much more widespread. The fact is that we have the most generous health service of all. Spain and Britain are the only EU countries to exempt pensioners from prescription charges. In Germany, pensioners have to make a contribution from their pensions into a sickness fund. In France, pensioners are expected to pay towards hospital charges; and in Belgium, pensioners pay up to 25 per cent. of doctors' consultation fees. Do the Opposition agree that pensioners in this country are infinitely better off?
In other countries, too, pensioners are expected to make a financial contribution. Many people in the Irish Republic have to pay charges for doctors' consultations and in-patient stays. In Italy, there are daily charges for the first 10 days' stay as a hospital in-patient, although
Column 1150pensioners are exempt. In Luxembourg there are daily charges for hospital in-patient stays. There are charges for doctors' consultations in Portugal.
Lady Olga Maitland: One thing that is for sure is that the Conservative party and the Conservative Government respect our responsibilities in caring for the sick, the frail and the weak. We give them our priorities. We spend more money on the health service than the Labour party has ever dreamt of. It is salutary to bear in mind the fact that we spend £100 million a day on our health service. That is good news. As far as I am concerned, patients' health is safe in Conservative Governments' hands. It would be wrecked and undermined by the Labour party.
Mr. Nicholas Brown (Newcastle upon Tyne, East): I do not want to be accused by the hon. Member for Sutton and Cheam (Lady Olga Maitland) of suppressing good news. The good news that is before the House today is the Government's proposition that prescription charges should rise at three times the rate of inflation. We are debating the Labour party's prayer against that proposition--a prayer that I urge my right hon. and hon. Friends to support.
The Minister opened the debate by whingeing about its timing. The timing of our prayer is directly consequent on the timing of his announcement. Is the Minister proud of what he is doing? Indeed, are Conservative health Ministers ever proud of increasing prescription charges? The evidence seems to suggest that they are not. These announcements have been repeatedly sneaked out. The House will recall that the latest increase was announced on a Wednesday. On the Monday, there was a debate on health care, in which it could have been announced. On the Tuesday, there was a debate on health care, in which it could have been announced. But no, it was a written answer, put out proudly in the name of the Secretary of State--no, slipped out in the name of the Minister of State, when there was an important announcement on Northern Ireland at the same time.
Indeed, only a week before, my hon. Friend the Member for Doncaster, North (Mr. Hughes) had asked the Minister of State whether he had any plans to increase prescription charges. The Minister replied: "Any announcement will be made at the appropriate time."--[ Official Report , 14 February 1995; Vol. 254, c. 637. ]
So it is a bit rich of him to whinge about the timing now. It is par for the course. In 1994, the 50p increase came out in a written answer. In 1993, Madam Speaker had cause to rebuke the Secretary of State and the then Minister of State for abusing the pursuant device to sneak out a supplementary written reply. In 1992, the 35p increase was sneaked out during a high-profile dispute about employment figures.
In other words, the evidence is perfectly clear that the Government are not proud of what they are doing. If they are not proud of what they are doing, the Labour party is saying that it is not unreasonable for them to pause and think again, to review what they are doing. As my hon. Friend the Member for York (Mr. Bayley) has perfectly
Column 1151correctly pointed out, prescription charges have risen from 20p in 1978 to £5.25 from April 1995--a tenfold increase in real terms. If the charges had increased in line with inflation, they would now stand at 53p. The issue that the House must consider is why prescription charges are getting these regular, steady increases, dramatically ahead of the rate of inflation. Why single out prescription charges?
A number of hon. Members have drawn comparisons. Indeed, the right hon. Member for Sutton and Cheam treated us to a shopping list. I know that several of my hon. Friends were rather hoping to persuade her to get our shopping in at those prices. She referred to equivalents. In 1978, the prescription charge was equivalent to the price of half a pint of beer. It is now equivalent to more than three pints of beer. In 1978, the charge was less than half the price of a packet of cigarettes. It is now around twice the price of a packet of cigarettes. Why is the relative price of prescription charges rising against the price of beer and cigarettes? What are the Government trying to say to the British people in the relative judgments that they are making on these matters?
The Minister said that there was no evidence to show that price affected consumption--in other words, affected the number of prescriptions. That is not so, as his own Department could tell him--if it dared, or if he asked it. The figures that his Department has issued show that the average number of charged prescription items per person in 1978 was 5.5 per year. In 1993 there were 2.2 items per year.
The Institute for Fiscal Studies looked at prescription charges in a report published in 1990 and concluded that the entire fall in the increase in charge prescriptions could be accounted for by the increase in the real level of the prescription charge. That evidence runs counter to the Minister's statement. There was similar research by the York centre for health economics which estimates that the prescription charge increases have halved the demand for prescriptions among those who are not exempt. People are not taking the medicines that they should take because of price, although they are being advised by clinicians to take them. That must be wrong and it is false economy.
Precisely the same reasoning applies to national health service eye tests. There is a compelling case for free tests for those over the age of 65. That case was made in the debate and the principles that underpin it are the same as those that apply to prescription charges.
The Government claim that more people get free prescriptions under them than they did under Labour. But that is not because the Government's prescription exemptions are any more generous: they have not changed at all. It is because more people are now living in real poverty, more are unemployed and there are more elderly people, although I cannot blame the Government for that. Increased costs are deterring those who have to pay. [Interruption.] I say to the hon. Member for Lancaster (Dame E. Kellett-Bowman), who screeches at me, that the Government should take demographic factors into account. That is why we say that these matters should be reviewed. Some 50 per cent. of the population are liable to pay for their prescriptions and they are being excessively picked on. Those people are being picked on well beyond the degree to which the Government pick on any other item for which they charge.
Column 1152The Minister will ask what Labour should do. It is perfectly clear that we shall vote against this impost, and we shall do so now. 11.56 pm
Mr. Malone: If our strategy had been to try to slip the increase out by sleight of hand at dead of night, doing it by way of a parliamentary question and my appearance on the Jimmy Young show to justify the Government's policy, which I was pleased to do, and having a debate about these matters after the right hon. Member for Derby, South (Mrs. Beckett) prayed against the regulations, it would have failed.
The hon. Member for Newcastle upon Tyne, East (Mr. Brown) has come up with no policy at all. He suggests a review and that is it. It being one and a half hours after the commencement of proceedings on the motion, Mr. Deputy Speaker-- put the Question, pursuant to Order [24 March].
The House divided: Ayes 238, Noes 281.
Division No. 121] [11.57 pm
Column 1152Abbott, Ms Diane
Adams, Mrs Irene
Ainsworth, Robert (Cov'try NE)
Anderson, Ms Janet (Ros'dale)
Banks, Tony (Newham NW)
Beckett, Rt Hon Margaret
Beith, Rt Hon A J
Benn, Rt Hon Tony
Bennett, Andrew F
Blair, Rt Hon Tony
Bray, Dr Jeremy
Brown, N (N'c'tle upon Tyne E)
Campbell, Mrs Anne (C'bridge)
Campbell, Menzies (Fife NE)
Campbell-Savours, D N
Carlile, Alexander (Montgomery)
Clark, Dr David (South Shields)
Cook, Frank (Stockton N)