“take any reasonable steps to”

secure that various precautions are taken, rather than simply if they do not secure that they are taken, as the Bill currently proposes. That is just common sense. The owner could have done everything possible to ensure that the skip was “properly lighted”, for example, but someone could come along in the middle of the night when they are fast asleep and vandalise the lighting. The local authority could then impose a fine, even though the skip had been perfectly well lit. I do not see how the owner could have been expected to do more. If amendment 14 is not accepted, however, that person could find themselves in the ludicrous situation of having to pay a penalty. That cannot be right. It flies in the face of common sense.

I appreciate that my hon. Friend the Member for Harrow East is a sensible, moderate chap, and he personally would apply all these rules with the proper discretion

10 July 2013 : Column 502

and common sense, but we cannot pass legislation that is reliant on people doing that. If we do so, we will end up with perversities in the law. We need to avoid that. It seems perfectly sensible to ask people to take “reasonable steps” to do things. That should be sufficient. We cannot ask them to do things that are, in essence, beyond their control. That is the problem with the Bill as it stands at the moment. I hope that my hon. Friend the Member for Christchurch will find a way to divide the House on amendment 14 if it is not accepted by the promoters, because it represents a common-sense approach.

I see amendment 16 as a natural consequence of amendment 14. As I understand it, if amendment 14 were accepted, the whole issue of clause 9(8) would become redundant. I therefore hope that, if amendment 14 were accepted, amendment 16 would be accepted as well. I hope that my hon. Friend the Member for Christchurch will concentrate his fire on amendment 14, because it is a sensible proposal that would improve the Bill.

My hon. Friend the Member for Harrow East suggested that amendment 14 would water down the Bill, but it would not. In clause 9(6), the promoters of the Bill are trying to deal with the issues that my hon. Friend the Member for Christchurch and I have raised. Paragraph (d) states that people may appeal against a penalty charge if, for example, the contravention

“was due to the act or default of another person and…he took all precautions and exercised all due diligence to avoid the contravention by himself of another person under his control.”

There, the promoters are trying to do exactly what my hon. Friend the Member for Christchurch is seeking to do in amendment 14. Having tried to deal with these anomalies, however, they muddy the waters with clause 9(8), which introduces yet another condition to make it difficult for the owner to achieve what is required. The amendment would not water down the Bill, as my hon. Friend the Member for Harrow East suggests; it would make clear the purpose of the legislation. In my opinion, it clarifies the Bill.

I would hope that the scenario I have given—of somebody who properly lights a skip, goes to bed with it properly lit and finds it vandalised in the middle of the night—would persuade my hon. Friend the Member for Harrow East that the person should not be prosecuted. I hope he would accept that; I am sure he does, because he is a reasonable man. The legislation as it stands would not necessarily prevent that person from being prosecuted; the only thing that would do so is amendment 14, tabled by my hon. Friend the Member for Christchurch. Because my hon. Friend the Member for Harrow East and I agree that such a person should not be prosecuted, I hope that he will follow through the logic of that position and accept amendment 14, which will deliver what both he and I think should be the case.

Mr Chope: I am grateful to my hon. Friend for his support of my amendment. Does he accept that exactly what he is asking for is in a sense reflected in clause 9(3)(b)(iv), which provides that

“the skip is removed as soon as practicable after it has been filled”?

It does not say that it should be removed as soon as it has been filled, but as soon as is practicable. That has been accepted by the promoters, but not extended to other provisions.

10 July 2013 : Column 503

Philip Davies: My hon. Friend makes a very good point. His amendment goes with the flow of the legislation rather than against it, and I think this is a genuine improvement.

On amendment 15, I agree with my hon. Friend the Member for Harrow East. Making the provisions for London much more onerous than in other parts of the country would be unfair. The only thing I will say—and here I hope my hon. Friend will forgive me if I tease him somewhat—is that his point about not providing different rules for London than obtain in other parts of the country is the argument that we have been making in respect of virtually every other part of this particular Bill. He has refused to accept that particular logic with all the other provisions, so it seems to me ironic that he was prepared to pull that argument out of the hat when it suited him, when he has denied it in respect of lots of other amendments on this legislation. I hope he will forgive me for teasing him in that way.

On the final three amendments—amendments 17, 18 and 19—I thought my hon. Friend for Christchurch made a very good point in his usual engaging and amusing way in saying that if a skip is causing a particular problem in a local community, it is surely the wrong solution to immobilise it and keep it there unnecessarily for even longer. I am not entirely sure that my hon. Friend the Member for Harrow East answered that point to my satisfaction, because there is an unerring logic to what my hon. Friend the Member for Christchurch was saying. It may well be that there are occasions when immobilisation is the best solution, although my hon. Friend the Member for Christchurch and I cannot think of them. I am prepared on that basis to give my hon. Friend the Member for Harrow East a rather dubious benefit of the doubt.

I do not want to extend my remarks any further, but I reiterate my hope that if the opportunity allows it, my hon. Friend the Member for Christchurch will seek to press his amendment 14, which is the strongest of his amendments and the one that would improve this legislation without doubt.

Mr Nuttall: If I may, I will start where my hon. Friend the Member for Shipley (Philip Davies) left off, and work in reverse order through this set of amendments, presented so ably a short while ago by my hon. Friend the Member for Christchurch (Mr Chope). I am grateful, as ever, for the clarification of what might be termed the case for the defence, so ably made by my hon. Friend the Member for Harrow East (Bob Blackman).

Starting with amendments 17, 18 and 19, I entirely agree that it is somewhat bizarre that the solution to a problem skip is to immobilise it, but I was persuaded by what my hon. Friend the Member for Harrow East had to say on the matter. To be perfectly honest, I have never seen one of these devices, and I can only imagine what they must look like. I understand that they both immobilise and light up the skip at the same time, which seems an eminently sensible idea for dealing with a problem skip. I have always thought that even empty skips are particularly difficult to move, so I would not think that they needed much help to be immobilised, although I am prepared to accept that that may well be a solution in some cases.

I turn to the other easy one—amendment 11, which has sensibly been accepted by my hon. Friend the Member for Harrow East and the promoters. That

10 July 2013 : Column 504

demonstrates the sense and worth of the work done by my hon. Friend the Member for Christchurch in going through the Bill in some detail and tabling the amendments. The promoters have accepted that the correct period is 14 rather than three working days.

I turn to the slightly more contentious amendments. I looked at amendment 10 and thought it was merely a clarification. There would be no point in criminalising someone or causing them to commit an offence if the information was patently obvious from looking at the side of the skip, in accordance with clause 9. Apparently, the promoters think otherwise. Personally, I would support amendment 10.

We now move neatly into the debate about decriminalisation. We are not really decriminalising these things, just moving the responsibility for taking action from one authority, the police, to another authority, the local authority. The net result is the same. Anyone reading language such as “commits an offence” would think, “Crikey! They mean a criminal offence.” Apparently, however, the measure represents decriminalisation. I humbly suggest that if clause 8 had read, “A person on whom a requirement is imposed under this section shall be liable to a civil penalty,” that would have been more appropriate if the intention was to decriminalise.

I entirely agree with what my hon. Friend the Member for Shipley said about amendment 14. It is entirely right that when it comes to the liability of someone who has committed a skip offence, to use some shorthand—[Interruption.] Not a skipping offence, but a builder’s skip offence. When it comes to such a person’s liability, the inclusion of the words

“take any reasonable steps to”

is entirely sensible. Although it might look as though one of those specific offences was being committed, there could be a whole host of reasons why a person ought not to be held liable.

The issue of criminalisation is important when considering the question of proof. If the offences are to remain criminal, the burden of proof is “beyond all reasonable doubt”. However, if they are to be dealt with according to a civil burden of proof, “the balance of probabilities” applies—it could be 51:49. There is a whole host of difference between liability in criminal and civil cases. The matter needs to be nailed down. We need to be absolutely clear about whether we are decriminalising this. Is it going to be a criminal offence, or is it going to be a civil offence and is it going to be dealt with under the civil law? That will affect the burden of proof required of those who seek to enforce these requirements.

9.45 pm

Let me make it clear that I entirely agree that these are sensible laws to have. I remember a case from some years ago—the 1980s—when I was acting for someone who ran into a skip that was not lit. That does happen, and it is a serious matter. As my hon. Friend the Member for Christchurch said, some of these amendments seek to strengthen the Bill, as, indeed, does amendment 15. I, too, found it somewhat ironic to hear an argument that we have often deployed, which is that the law in London should not be different from the law in the rest of the United Kingdom.

10 July 2013 : Column 505

On amendment 15, I think it is sensible to have something other than just a telephone number or the address, because there is a danger that many skip operators will opt to have an address that might be a PO box or the registered office of a limited company which turns out to be a huge office block in London with hundreds of other offices, and which is in fact the office of an accountant or a lawyer, and not the place of work of the skip owner. I therefore think amendment 15 is entirely sensible. Although I appreciate what my hon. Friend the Member for Harrow East said, it may well be an idea for a private Member’s Bill to at some point bring in on a national basis the requirement that all skips should bear the name, address and telephone number, so that if there is a problem, the person who is responsible for putting the skip there can easily be found.

On amendment 16 and the question of effectively making the accused, whether of a criminal offence or a civil liability, guilty unless they prove themselves innocent, I again entirely agree with my hon. Friend the Member for Shipley that if amendment 14 were accepted, to give them a “get out of jail free card”—if one can describe it as that—by saying that if they had taken reasonable steps, they would not be liable, would negate this rather draconian step of saying, “Look, once we’ve served you with this notice, it is your responsibility to come up with some other person who is more guilty than you are.” It seems a very strange way of setting up a legal system, and it seems to me to be entirely alien to all the principles of English law. I can well see that at some future point there may be many a legal case fought over clause 9(8), as people say, “How can it be fair that I have been picked on? I have got nothing to do with this, yet I have been victimised and made to pay this penalty.”

Mr Chope: Does my hon. Friend agree that one of the big problems is that local authorities have already demonstrated through the use of decriminalised penalty notices that they can be over-zealous and keen to get the maximum amount of revenue irrespective of the justice of a situation, which is why we hear all these stories of traffic wardens hiding and then creeping up on unsuspecting motorists so that they can get extra penalty points imposed and extra fines for themselves and their local authority?

Mr Nuttall: My hon. Friend makes a good point, as that is one reason why one is slightly sceptical about this sort of clause. Just this day I received a letter from a constituent raising exactly that point about the behaviour of traffic enforcement officers in Bury; it detailed how they have been served with a penalty notice in circumstances where it would have been easy to deal with the matter in another way if more common sense had been applied. That would have avoided having to give a local resident a penalty notice. Such examples make me want to agree with my hon. Friend’s proposition that people will be suspicious that this provision is there to make it easy for the local authority officer to find somebody. It does not matter who they find on this basis; they can give the notice to almost anybody and they will be able to say, “We have done what we can. It is now your problem. If you weren’t responsible, it is now your responsibility to find somebody who was.” I humbly submit that that is clearly not the right way for things to be done. It should be the responsibility of the responsible officer of the local authority to find out who is responsible, rather

10 July 2013 : Column 506

than expecting a person on whom a notice has been served to identify that other person for the purposes of determining who has committed the offence.

If I were to enter this little competition of saying which amendment I would press, I would opt for amendment 14, as it is entirely reasonable that where someone has taken reasonable steps to avoid committing an offence, they should not be held liable under this part of the Bill. With that, I will wait to hear what others have to say.

Mr Chope: In summing up an excellent debate, may I thank my hon. Friend the Members for Bury North (Mr Nuttall), for Shipley (Philip Davies) and for Harrow East (Bob Blackman) for their contributions? If the Minister had contributed, the debate would have been even better, as indeed it would have been had the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) spoken—they demonstrated unusual self-restraint on these important issues, particularly on the issue of “national versus local”.

As my hon. Friend the Member for Shipley said, the promoters of the Bill are now saying that it would be unreasonable potentially to impose on operators from outside London a requirement to put their name, telephone number and address on a skip, given that the legislation that applies outside London requires only the telephone number or the address. Clearly, there is an inconsistency between the approach of the promoters to those of us who argue that we should have national legislation on these issues rather than localised legislation.

Mr Nuttall: I appreciate that my hon. Friend is summing up, but are we not talking about the same case that was made earlier in respect of amendment 20 and gated roads?

Mr Chope: Exactly the same point applies in relation to gated roads, which is why it is a pity that we have not heard from the two Front-Bench spokespeople on where they think the balance should be between individual local authorities, or groups of local authorities, legislating in this area and a responsibility for the Government to try to introduce a national regime.

My hon. Friend the Member for Harrow East has gone through each of the amendments seriatim and tried—

Stephen Pound (Ealing North) (Lab): Seriatim!

Mr Chope: I am delighted that the hon. Gentleman is joining in with the debate, albeit from a sedentary position, because he has been referred to already in dispatches, as he might know. We had been hoping to hear from him on immobilisation devices, but he has now put on record his enthusiasm for the word “seriatim”.

Let me take the amendments one by one for the benefit of the hon. Member for Ealing North (Stephen Pound). My hon. Friend the Member for Harrow East said that he did not think that amendment 10 would be appropriate because of the conflict between the national and local legislation. This is an opportunity for London to lead the field so that others can follow. It would be sensible, taking amendments 15 and 10 together, to require that in London skips should have the name, address and telephone number of the owner clearly and

10 July 2013 : Column 507

indelibly marked on them. I am disappointed that the promoters are not interested in accepting those amendments but I am delighted that amendment 11 is to be accepted.

On amendments 12 and 13, I am grateful to my hon. Friend for drawing to our attention that there is a proposal to increase fourfold the maximum fine levels on the standard scales. I think that would have quite a significant impact on the cost of living of the criminal classes. It would also put into a negative position all those provisions where the maximum fine is level 3—£1,000, which is reasonable—

9.57 pm

Three hours having elapsed since the start of proceedings, thebusiness was interrupted (Order, 3 July).

Bill to be further considered on Tuesday 16 July.

Business without Debate

Hertfordshire County Council (Filming on Highways) Bill [Lords]

Bill to be read a Second time on Tuesday 16 July.

Delegated Legislation

Motion made, and Question put forthwith (Standing Order No. 118(6)),

Constitutional Law

That the draft Natural Resources Body for Wales (Consequential Provision) Order 2013, which was laid before this House on 3 June, be approved.—(Mark Lancaster.)

Question agreed to.

Motion made, and Question put forthwith (Standing Order No. 118(6)),


That the draft Renewable Heat Incentive Scheme (Amendment) (No. 2) Regulations 2013, which were laid before this House on 10 June, be approved.—(Mark Lancaster.)

Question agreed to.

Motion made, and Question put forthwith (Standing Order No. 118(6)),

Judicial Appointments and Discipline

That the draft Judicial Appointments Commission Regulations 2013, which were laid before this House on 20 June, be approved.—(Mark Lancaster.)

10 July 2013 : Column 508

Question agreed to.

Motion made, and Question put forthwith (Standing Order No. 118(6)),

Judicial Appointments and Discipline

That the draft Judicial Appointments Regulations 2013, which were laid before this House on 20 June, be approved.—(Mark Lancaster.)

Question agreed to.

Motion made, and Question put forthwith (Standing Order No. 118(6)),

Supreme Court of the United Kingdom

That the draft Supreme Court (Judicial Appointments) Regulations 2013, which were laid before this House on 20 June, be approved.—(Mark Lancaster.)

Question agreed to.

Motion made, and Question put forthwith (Standing Order No. 118(6)),

Terms and Conditions of Employment

That the draft Unfair Dismissal (Variation of the Limit of Compensatory Award) Order 2013, which was laid before this House on 10 June, be approved.—(Mark Lancaster.)

The Deputy Speaker’s opinion as to the decision of the Question being challenged, the Division was deferred until Wednesday 17 July (Standing Order. No. 41A).

Draft Deregulation Bill (JOint committee)


That this House concurs with the Lords Message of 4 July 2013, that it is expedient that a Joint Committee of Lords and Commons be appointed to consider the draft Deregulation Bill presented to both Houses on 1 July 2013 (Cm 8642).

That a Select Committee of six Members be appointed to join with the Committee appointed by the Lords to consider the draft Deregulation Bill (Cm 8642).

That the Committee should report by 16 December 2013.

That the Committee shall have power:

(1) to send for persons, papers and records;

(2) to sit notwithstanding any adjournment of the House;

(3) to report from time to time;

(4) to appoint specialist advisers; and

(5) to adjourn from place to place within the United Kingdom.

That Andrew Bridgen, James Duddridge, John Hemming, Kelvin Hopkins, Ian Lavery and Priti Patel be members of the Committee.—(Mark Lancaster.)

10 July 2013 : Column 509

Prescription Charges (Long-term Conditions)

Motion made, and Question proposed, That this House do now adjourn.—(Mark Lancaster.)

9.59 pm

Sir Bob Russell (Colchester) (LD): We should rejoice at the wonderful advances in medical science, particularly in the last half-century, which have enhanced the quality of life of people with serious health conditions, and we should give thanks to those whose research made those advances possible. Some people’s lives have been extended, or even saved. The invaluable research work goes on. I pay tribute to those involved; they deserve our gratitude. In the case of cystic fibrosis, I should mention the Cystic Fibrosis Trust, pioneering researchers at places such as the Royal Brompton hospital, and patients and their families, past and present, without whose endurance the present survival rates would never have been achieved.

It is not that long ago that for some conditions, such as cystic fibrosis, life expectancy was so low that few lived beyond their teens. Today, living into the 40s is the average, and that will improve still further; of that I am sure. Although there have been advances in helping those with serious health conditions, to the point that today people are better placed than at any time in history, the reality is that the rules, regulations and bureaucracy of prescription charge exemptions are stuck in a time warp, taking us back to nearly half a century ago. It is astonishing that while we have witnessed medical advances and breakthroughs on a large scale, achieved by those driving forward the boundaries of medical research, successive Governments, wedded to the bureaucracy of the 1960s, have not moved forward an inch when it comes to helping people with serious health conditions to pay for prescriptions. People are forced to pay, in many instances to stay alive, and in every instance to sustain a quality of life that is seriously compromised if the right level of medication is not taken.

I am grateful to the Prescription Charges Coalition, which comprises 27 organisations, including the Cystic Fibrosis Trust, with which I have had an association for 16 years, and Asthma UK, the British Heart Foundation, Crohn’s and Colitis UK, the National Rheumatoid Arthritis Society, Parkinson’s UK, Rethink Mental Illness, the Royal Pharmaceutical Society, the Terence Higgins Trust and the Multiple Sclerosis Society. They cover a wide range of serious conditions, and they are united in calling on the Government to put right an anomaly. I am confident that those who, 45 years ago, drew up the list of exemptions would today, because of medical advances, include on the list those conditions represented by the Prescription Charges Coalition.

Yesterday morning, the associate parliamentary health group held a seminar in the Jubilee Room entitled “Public health killers: tackling obesity, smoking and alcohol abuse”. Why does the national health service treat those who are guilty of abusing their body better, in financial terms, than those to whom mother nature has given serious health conditions? We should contrast what the Prescription Charges Coalition is calling for—free prescriptions for those who need them to live—with the £5 billion spent every year on health problems associated with being overweight or obese, or the £2.7 billion per

10 July 2013 : Column 510

annum cost to the NHS because of alcohol misuse. Alcohol-related admissions to hospital, according to Department of Health statistics, are rising at a rate of around 11% a year. Smoking is the biggest killer, accounting for nearly 80,000 preventable deaths in England in 2011. What I do not have a figure for, but it must cost the NHS billions of pounds, is dealing with the consequences of people taking illegal drugs.

Given that enormous cost to the public purse as a result of self-inflicted lifestyle choices, I call on the Government to look fairly on those with health conditions whose lifestyle choices are restricted. The cost of what I am seeking is modest in comparison with the huge sums that I have listed for self-inflicted body abuse.

I am pleased that this evening I can raise a serious issue, which I also highlighted in the last parliamentary Session through early-day motion 1, signed by 41 hon. Members, namely the terrible unfairness faced by those with cystic fibrosis who have to pay prescription charges. That also applies to those with other conditions embraced by members of the Prescription Charges Coalition, who I know will understand why, in the limited time available, I will concentrate my remarks on CF; however, my case for CF applies equally to the other conditions.

As I am sure the Minister will be aware, the criteria that determine eligibility for exemption from prescription charges for those with certain medical conditions were laid down in 1968. The only slight amendment was the welcome addition in 2009 of cancer. In 1968, someone with cystic fibrosis was unlikely to live until adulthood. I am pleased to say that, 45 years on, life expectancy is 41-plus. However, the condition continues to claim the lives of younger adults, teenagers and even children. For the 10,000 people in the UK with cystic fibrosis—contrast that relatively low figure with the 945,000 alcohol-related admissions to hospitals each year: 10,000 versus 945,000—their condition is such that they are especially prone to infection and may eventually require a lung transplant.

I therefore support the call made last Friday by the hon. Member for Sheffield South East (Mr Betts), who wants the law changed in respect of organ donations so that there should be presumed consent. This follows the welcome announcement last week by the Welsh Assembly of a move towards presumed organ donation consent significantly to increase the number of organs for transplant. We should do the same in England.

Those with cystic fibrosis have a great deal to contend with throughout their lives and, on reaching adulthood, they face the additional burden of having to pay prescription charges to stay alive unless—this would be laughable if it was not so serious—they have insulin-dependent diabetes, which gives them an exemption from paying. It is such nonsense, you could not make it up.

Tonight’s debate is about the striking inequality and the significant impact that prescription charges are having on people in England who have a range of long-term conditions, but not those living in Wales, Scotland and Northern Ireland. In support of the Prescription Charges Coalition, I call for a fairer system of exemptions. It is a matter of considerable concern that many people with long-term conditions are not collecting or taking their medicines effectively because of the cost, as is all too clearly illustrated in the Prescription Charges Coalition’s recent report, “Paying the Price”.

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Many MPs will be aware of reports of constituents struggling to afford their prescriptions and the impossible choices they have had to make between paying for food, clothing, housing and other bills or their prescription medication. Austerity has added to the problems. People with long-term conditions are not “all in this together”, as the Chancellor would have us believe. For many, it means splitting tablets in half, missing doses or substituting cheaper but less effective alternatives to eke out medication until pay day. Inevitably, individual health suffers and there are numerous knock-on effects. The Prescription Charges Coalition’s survey found, very worryingly, that more than one third of those who pay for each prescription had not collected at least one item because of the cost. Indeed, the Royal Pharmaceutical Society reports that pharmacists are often asked, “Which of these prescriptions can I do without?”

I am advised that the majority of those who reported that they were not taking their medicine as prescribed said that their health had got worse as a result, with additional treatment then being required. Emergency admission to hospital was the dramatic and costly consequence in 10% of cases. For example, one respondent said: “I ended up being hospitalised for two weeks because I missed five days of medication.” Another stated: “I could not afford the prescribed medication, went without, and ended up having panic attacks and losing my job.”

The implications of this are extensive, not only for the individual’s quality of life and long-term health outcomes, but with regard to the impact on their families, on their ability to remain in employment and independent of state support, and also, of course, on the NHS. At a breakfast briefing this morning I was surprised to be told that this is not a matter for consideration by the Care Quality Commission. This suggests a lack of joined-up thinking on the health needs of our country. The stress and anxiety caused by worrying about how to afford prescription costs can exacerbate a condition and the ability to manage it effectively. Individuals also report cutting back on food or utility bills to afford medicines and that could also clearly have an impact on their health.

Those with long-term conditions do not choose to be ill. They face a daily routine of various types of medication and physiotherapy to maintain any quality of life. The Department of Health is aware of the survey by the Prescription Charges Coalition, so I hope that the Minister will tonight confirm that she is personally aware that more than half of those who reported not taking their medicine as prescribed cited cost as the reason. Perhaps she can explain why there is discrimination against those with long-term conditions who live in England. Why cannot they get the same deal as those living in Wales, Scotland and Northern Ireland?

I suggest to the Minister that one way of helping immediately would be to scrap the 28-day prescribing limit for those with stable, long-term conditions on regular maintenance medication. Having to make monthly trips to the doctor and pharmacist for repeat prescriptions is a further and unnecessary inconvenience that means extra cost and additional distress, particularly when errors occur with prescriptions. Patients might need

10 July 2013 : Column 512

to take time off work, depending on surgery opening hours. Scrapping the limit would also ease pressure on doctors.

In the past, the category of person I am referring to could have a three-month supply, which is cheaper and more convenient for those who require medication. I hope that the new clinical commissioning groups will consider carefully the need for individual prescribing for optimal treatment plans and avoid the rigid 28-day limit. Please may we have central guidance from the Department of Health?

The Secretary of State stated last year that those with long-term conditions and older people with multiple long-term conditions are among his key priorities. In that context, it is important to remember that it is not necessarily older people who have long-term conditions. A number of long-term conditions, such as cystic fibrosis, start from birth, while others, such as Crohn’s disease, rheumatoid arthritis and multiple sclerosis, are commonly diagnosed in the teens and twenties. Those conditions have their most devastating impact just as young people are becoming adults and are attempting to complete their education, entering relationships, learning to balance their budgets and forming their career and life path.

In addition to all the usual challenges that poses, those young people have to face the additional pressure of a lifelong illness that will have a considerable social, emotional, functional and economic impact on their daily lives. A significant aspect for many will be the requirement to pay for their medicine until retirement. Is that fair? I refer to my earlier observation about the billions of pounds the NHS spends treating those whose approach to life has damaged their health. I repeat: is that fair? The prescription prepayment certificate and the NHS low-income scheme are obviously better than nothing, but they are like using a sticking plaster on a gaping wound.

Seven years ago the Health Committee produced a report on NHS charges that concluded:

“The system of health charges in England is a mess.”

It still is. The Committee also observed:

“The system of medical exemptions to the Prescription Charge is particularly confusing.”

It still is.

I challenge the Minister on why the recommendations set out in the prescription charges review, undertaken at the behest of the previous Government by Professor Sir Ian Gilmore when he was president of the Royal College of Physicians, have not been implemented. They would greatly assist those with long-term conditions. His eminently sensible, measured and practical approach would be likely to have all manner of positive effects. Removing this aspect of health inequality, this barrier to getting and keeping well, would facilitate effective self-management, reducing unnecessary pressure on health professionals’ time and hospital A and E departments. It would also help people stay in work and off benefits and improve their long-term health conditions.

There is no excuse for an inequality that stretches back more than 40 years. The Prescription Charges Coalition, the Health Committee report and Professor Gilmore’s recommendations provide ample justification for this injustice to be put right. I urge the Minister to state tonight that this will happen.

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10.14 pm

The Parliamentary Under-Secretary of State for Health (Anna Soubry): I congratulate my—I have to say—hon. Friend the Member for Colchester (Sir Bob Russell) on securing the debate, although I do not think that he made much of a friendly speech, and I have no doubt that he will not be much impressed by my response. He rightly brings the subject before the House, as is his right, and so he should. However, I think that we have to be completely realistic and honest about the situation in which we find ourselves. The simple truth is that if we extended the exemptions to all long-term conditions it would cost a considerable amount of money, and, in the words of a member of the previous Government, there is no money. I am very proud of the fact that the coalition has been able to secure the NHS budget at a time when we have had to take tough decisions and cut other budgets. We have not only maintained the NHS budget; by 2015 we will have seen a rise in the amount of money going into the NHS under the tenure of this Government. I am very proud of that.

My hon. Friend asked whether it is right and fair that all these long-term conditions do not receive free prescriptions. He then drew a contrast with people who, in his words, have “self-inflicted lifestyle choices”, referring to those who have drug addition, alcohol addiction, obesity problems and so on. I would challenge him on that. I do not take the view that it would be right in any way, shape or form to make such suggestions about people who are having their prescriptions paid for because of their income status but have those afflictions. I can assure him that addiction is not some lifestyle choice. Many people who are addicts are born addicts; it is a disease that needs treatment, and those who are unfortunate enough to suffer from it need our support. I am sure that he is not suggesting that we should take money away from those unfortunate people in order to give it to those who are, I accept, equally in need.

Sir Bob Russell: I regret that the Minister is drawing an inference that I did not intend in any way. I was merely making a comparison in saying that some people have been dealt unfairly with by mother nature in having to pay to stay alive, whereas others who we are told can be treated are, for whatever reason, getting free treatment.

Anna Soubry: I am pleased that my hon. Friend has made that point, because some people, I can assure him, would have made such an interpretation. I am pleased that we have set the record straight.

In fact, the current system does provide support for people who need it the most. In 2011, for example, about 94% of all prescription items were dispensed free of charge at the point of dispensing. It is estimated that about 60% of people in England are exempt from charges. A wide range of exemptions exist to help the most vulnerable, those requiring prescriptions the most and those most in need of support. People aged 60 and over, women who are pregnant or are in the 12-month period following childbirth, those on income support, those with pension credit, those on income-based jobseeker’s allowance, those on income-related employment and support allowance, and those in receipt of a variety of tax credits all rightly receive free prescriptions.

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As we have heard, people who use prescriptions frequently can buy a prescription prepayment certificate that allows anyone to obtain all the prescriptions they need for the equivalent of £2 per week. The cost of the annual prescription prepayment certificate has been frozen at £104 for the past four years, and the cost of the three-monthly certificate has been frozen at £29.10 for two years. There are options whereby people can pay by direct debit. I concede that the system is not perfect, but it is very good.

My hon. Friend asked, properly, why we have this system in England whereas in Wales, Scotland and Northern Ireland prescriptions are free. I am sure that he knows the answer: health is a devolved matter. It is for those in the Scottish Parliament, the Welsh Assembly and the Northern Ireland Assembly to decide how they will spend their budget. The simple truth is that making prescriptions free for all in those countries has taken money away from other areas of their health budget. We have decided to spend our allocation of money in a different way, and rightly so, especially when we consider that the prepayment certificate of £104 a year is eminently fair for people who are unfortunate enough to have the long-term conditions that my hon. Friend identified and described. It is important to put forward that argument as well.

As it happens, I suffer from a long-term condition—asthma—and have the benefit of an excellent GP. I am sure that that will not win me any extra favours with my hon. Friend—although I am sure he will be grateful for my comments—but I, like most of us, have an outstanding GP who has made sure that my medication is at such a level that I do not now need a prepayment certificate, because we are managing my condition.

I am not suggesting that one should always be alert to the financial cost of issuing prescriptions, but I think it is right and fair to say that many general practitioners are aware of it. Increasingly, prescribing GPs—in other words, all GPs—are taking on the huge responsibility of bearing in mind the cost to the national health service of the prescriptions they issue their patients.

I pay tribute to the Prescription Charges Coalition, which has worked with officials in my Department to help raise awareness of the help available to patients with the cost of their prescriptions, particularly the prescription prepayment certificate. The awareness-raising work with the PCC has already had encouraging results. Purchases of certificates in the first quarter of this year were 13% higher—about 50,000 extra—than in the same period in 2012, when this work began. We continue to work with the PCC to consider how we might build further on that awareness-raising activity.

My hon. Friend asked a number of questions and I hope I will be able to answer them all. If not, the usual rules will apply and my officials will, of course, write to him. Since 1968 the only condition that has been added to the list is cancer in September 2008, as announced by the then Prime Minister. I pay tribute to the work of Sir Ian Gilmore. The Health Committee has produced a report and answers have been provided, but I think it is fair to say that this is all about cost. I accept that things have changed a lot since the late 1960s, but the simple reality is that if we extended free prescriptions to all long-term conditions it would cost an incredible amount of money, and I am afraid to say that that is money that we simply do not have.

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It would be very difficult to consider particular conditions in isolation and to somehow choose one. My hon. Friend has advanced the case of cystic fibrosis and one can understand why: nobody chooses to have cystic fibrosis; it is a thoroughly unpleasant condition.

Sir Bob Russell: I did say that I was using cystic fibrosis as an example of various long-term conditions. All I ask is that the Minister and her officials look at the recommendations of Professor Sir Ian Gilmore, because at least that would give some encouragement to people with long-term conditions that the Government were looking at their situation seriously.

Anna Soubry: That is a valid point, well made, but the Government’s attitude is that it would not be right in the current situation to look at just one particular condition in isolation, because others would argue, with vigour—and rightly so—that their condition was as valid of an exemption as any other.

My hon. Friend asked why the Government have not introduced more flexible prescribing patterns and moved away from the 28-day prescribing policy. The responsibility for prescribing, including repeat prescriptions and the duration of prescriptions, rests with GPs and other doctors who have the expertise and who rightly take clinical responsibility for that particular aspect of a patient’s care. Doctors can prescribe flexibly and take decisions about prescribing patterns on the basis of a patient’s need. Ultimately the decision must be left to the doctor, but guidance has been issued by the National Prescribing Centre about prescription terms, encouraging prescribers to be receptive to the needs of patients and to use appropriate prescribing patterns.

My hon. Friend asked about the lack of relevant data on the costs and consequences of the current prescription charging system. At the moment, some £450 million is raised each year by charging people for their prescriptions, which is equivalent to about 13,500 qualified nurses or 3,500 hospital consultants per year. One can see the power of that money from prescription charging, but given the lack of relevant data, more research is needed

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to inform policy. It is important that we make best use of the available evidence and identify gaps in knowledge. We would, of course, welcome input from groups such as the Prescription Charges Coalition about any evidence it is aware of or studies that may have been undertaken in that area. That would help inform any research proposals that the Department of Health might consider in its assessment of research priorities. I hope that may be of interest and comfort to my hon. Friend.

As I have said, the Government report that 90% of prescription items are dispensed without charge, but up to three quarters of those of working age with long-term conditions are believed to pay for their prescriptions. Current exemptions provide valuable help for those on the lowest incomes. They must always be our priority because they simply do not have the means to pay for a large number of prescriptions.

Older people generally have the greatest need for medicine, and I am sure that my hon. Friend will have visited a pharmacy and seen, as I did in my constituency, the amount of medication that is often required for older people, which can be quite astronomical in size and complexity. Many older people have good, long, happy and healthy lives because of the abundance of medicines they receive, and that is one reason why we have an exemption for older people.

Although people with long-term conditions will continue to pay for their prescriptions, the prescription prepayment certificate ensures that they can pay at considerably reduced cost. By repeatedly freezing the price of a prescription prepayment certificate and introducing a direct debit payment option to spread the cost of a 12-month certificate, we ensure that those certificates are accessible to those who need multiple prescriptions.

I am happy to take an intervention, but I hope I have explained the Government’s current policy. It is right and proper for this issue to be raised, but at the moment the simple truth is—it gives no one any pleasure to say this—we simply do not have the money to do all that my hon. Friend urges on me.

Question put and agreed to.

10.27 pm

House adjourned.

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Deferred Division

Financial Services and Markets

That the draft Alternative Investment Fund Managers Regulations 2013, which were laid before this House on 10 June, be approved.

The House divided:

Ayes 273, Noes 27.

Division No. 54]


Adams, Nigel

Aldous, Peter

Amess, Mr David

Andrew, Stuart

Arbuthnot, rh Mr James

Baker, Steve

Baldry, Sir Tony

Baldwin, Harriett

Barclay, Stephen

Barwell, Gavin

Bellingham, Mr Henry

Benyon, Richard

Beresford, Sir Paul

Berry, Jake

Bingham, Andrew

Blackwood, Nicola

Boles, Nick

Bone, Mr Peter

Bottomley, Sir Peter

Bradley, Karen

Brady, Mr Graham

Brake, rh Tom

Bray, Angie

Bridgen, Andrew

Brokenshire, James

Brooke, Annette

Browne, Mr Jeremy

Bruce, Fiona

Bruce, rh Sir Malcolm

Buckland, Mr Robert

Burns, Conor

Burns, rh Mr Simon

Burt, Alistair

Burt, Lorely

Cable, rh Vince

Cameron, rh Mr David

Campbell, Mr Gregory

Campbell, rh Sir Menzies

Carmichael, rh Mr Alistair

Carmichael, Neil

Chishti, Rehman

Clappison, Mr James

Clark, rh Greg

Clarke, rh Mr Kenneth

Clwyd, rh Ann

Coffey, Dr Thérèse

Collins, Damian

Colvile, Oliver

Crabb, Stephen

Crockart, Mike

Crouch, Tracey

Davey, rh Mr Edward

Davies, David T. C.


Davies, Glyn

Davies, Philip

Davis, rh Mr David

Dinenage, Caroline

Djanogly, Mr Jonathan

Dodds, rh Mr Nigel

Doyle-Price, Jackie

Duncan, rh Mr Alan

Duncan Smith, rh Mr Iain

Dunne, Mr Philip

Edwards, Jonathan

Ellis, Michael

Ellison, Jane

Ellwood, Mr Tobias

Elphicke, Charlie

Eustice, George

Evennett, Mr David

Fabricant, Michael

Fallon, rh Michael

Farron, Tim

Field, Mark

Foster, rh Mr Don

Freeman, George

Freer, Mike

Gale, Sir Roger

Garnier, Sir Edward

Garnier, Mark

Gauke, Mr David

George, Andrew

Gibb, Mr Nick

Gillan, rh Mrs Cheryl

Glen, John

Goodwill, Mr Robert

Grant, Mrs Helen

Gray, Mr James

Green, rh Damian

Griffiths, Andrew

Gummer, Ben

Gyimah, Mr Sam

Hague, rh Mr William

Halfon, Robert

Hames, Duncan

Hammond, rh Mr Philip

Hammond, Stephen

Hancock, Matthew

Hands, Greg

Harper, Mr Mark

Harrington, Richard

Harris, Rebecca

Hart, Simon

Haselhurst, rh Sir Alan

Hayes, rh Mr John

Heald, Oliver

Heath, Mr David

Heaton-Harris, Chris

Hemming, John

Hendry, Charles

Herbert, rh Nick

Hinds, Damian

Hoban, Mr Mark

Hollingbery, George

Hosie, Stewart

Howarth, Sir Gerald

Howell, John

Hughes, rh Simon

Hunt, rh Mr Jeremy

Hunter, Mark

Huppert, Dr Julian

Hurd, Mr Nick

James, Margot

Johnson, Joseph

Jones, Andrew

Jones, rh Mr David

Jones, Mr Marcus

Kawczynski, Daniel

Kelly, Chris

Kennedy, rh Mr Charles

Kirby, Simon

Knight, rh Mr Greg

Kwarteng, Kwasi

Laing, Mrs Eleanor

Lamb, Norman

Lancaster, Mark

Lansley, rh Mr Andrew

Latham, Pauline

Laws, rh Mr David

Leadsom, Andrea

Lee, Jessica

Lee, Dr Phillip

Leech, Mr John

Lefroy, Jeremy

Lewis, Brandon

Lewis, Dr Julian

Liddell-Grainger, Mr Ian

Lilley, rh Mr Peter

Lloyd, Stephen

Lord, Jonathan

Lucas, Caroline

Luff, Peter

Lumley, Karen

Macleod, Mary

MacNeil, Mr Angus Brendan

Main, Mrs Anne

Maude, rh Mr Francis

Maynard, Paul

McCartney, Karl

McCrea, Dr William

McIntosh, Miss Anne

McLoughlin, rh Mr Patrick

McPartland, Stephen

McVey, Esther

Menzies, Mark

Metcalfe, Stephen

Miller, rh Maria

Milton, Anne

Moore, rh Michael

Mordaunt, Penny

Morgan, Nicky

Morris, James

Mosley, Stephen

Mowat, David

Mulholland, Greg

Mundell, rh David

Murray, Sheryll

Neill, Robert

Newton, Sarah

Nokes, Caroline

Norman, Jesse

Offord, Dr Matthew

Ollerenshaw, Eric

Ottaway, Richard

Paice, rh Sir James

Parish, Neil

Patel, Priti

Paterson, rh Mr Owen

Pawsey, Mark

Penning, Mike

Penrose, John

Phillips, Stephen

Pincher, Christopher

Poulter, Dr Daniel

Prisk, Mr Mark

Pritchard, Mark

Pugh, John

Raab, Mr Dominic

Randall, rh Mr John

Rees-Mogg, Jacob

Reid, Mr Alan

Rifkind, rh Sir Malcolm

Robertson, Angus

Robertson, rh Hugh

Robertson, Mr Laurence

Rogerson, Dan

Rudd, Amber

Russell, Sir Bob

Rutley, David

Sanders, Mr Adrian

Sandys, Laura

Scott, Mr Lee

Selous, Andrew

Shannon, Jim

Shapps, rh Grant

Sharma, Alok

Shelbrooke, Alec

Simmonds, Mark

Simpson, David

Simpson, Mr Keith

Skidmore, Chris

Smith, Miss Chloe

Smith, Henry

Smith, Julian

Smith, Sir Robert

Spelman, rh Mrs Caroline

Spencer, Mr Mark

Stephenson, Andrew

Stewart, Bob

Stewart, Iain

Streeter, Mr Gary

Stride, Mel

Stunell, rh Sir Andrew

Sturdy, Julian

Swinson, Jo

Swire, rh Mr Hugo

Syms, Mr Robert

Tapsell, rh Sir Peter

Teather, Sarah

Thornton, Mike

Thurso, John

Tomlinson, Justin

Tredinnick, David

Truss, Elizabeth

Turner, Mr Andrew

Tyrie, Mr Andrew

Uppal, Paul

Vara, Mr Shailesh

Villiers, rh Mrs Theresa

Walker, Mr Robin

Wallace, Mr Ben

Walter, Mr Robert

Watkinson, Dame Angela

Weir, Mr Mike

Wharton, James

Wheeler, Heather

White, Chris

Whittingdale, Mr John

Wiggin, Bill

Willetts, rh Mr David

Williams, Hywel

Williams, Mr Mark

Williams, Roger

Williams, Stephen

Williamson, Gavin

Willott, Jenny

Wilson, Mr Rob

Wilson, Sammy

Wishart, Pete

Wright, Jeremy

Wright, Simon

Young, rh Sir George

Zahawi, Nadhim


Beckett, rh Margaret

Cash, Mr William

Corbyn, Jeremy

Davidson, Mr Ian

Drax, Richard

Durkan, Mark

Flynn, Paul

Henderson, Gordon

Hermon, Lady

Hollobone, Mr Philip

Hood, Mr Jim

Howarth, rh Mr George

Jackson, Mr Stewart

Jenkin, Mr Bernard

Long, Naomi

McDonagh, Siobhain

McGovern, Jim

McKechin, Ann

Mills, Nigel

Nuttall, Mr David

Reckless, Mark

Ritchie, Ms Margaret

Shepherd, Sir Richard

Skinner, Mr Dennis

Walker, Mr Charles

Walley, Joan

Whittaker, Craig

Question accordingly agreed to.

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