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Lord Renton: My Lords, I do not have a point to make which will affect the National Health Service, but I have a drafting point to make which I make with some
seriousness. I make it because there are too many occasions in this Bill and in other Bills in which, although primary legislation deals with most of the matter, nevertheless power is given to make regulations which in this particular case--I shall draw attention to the detail in a moment--seems a quite unnecessary power.On the third page of the amendment on the Marshalled List--on page 9--under the heading "Penalties" new Section 122B is proposed to the 1977 Act. The proposed new Section 122B states:
- "Regulations may provide that, where a person fails to pay--
- (a) any amount recoverable from him under section 122(1) above ...
- (b) any amount recoverable from him under section 122A",
There are other examples to come--I shall not bore your Lordships with the earlier examples. Some are in the Bill and some are in the amendments. I picked this out as a very obvious example of a clause in which the whole of the law could be perfectly well stated in the primary legislation without the need to amplify it by regulations.
7 p.m.
Baroness Carnegy of Lour: My Lords, the noble Lord's strictures will, I am sure, be heard by the Government. I wish to ask a simple, practical question. I am one of those people who has occasionally to get some medicament or other with a prescription, and I sign a form to say that I am a pensioner. You can tell by looking at me that I am a pensioner. I know the chemist, who probably knows the year in which I was born and a good deal more about me than I would like to think. Many people are not like that. I was surprised when the Minister said that very few people dodge payment in this way. It is an enormous temptation and the Government are absolutely right to do something about it. I have often wondered why there was not a sanction.
I should like to know how the system will work. To begin with, how will people know that it has come into being? How will they know what it will cost them if they get it wrong? Will it be set out in enormous letters on every counter? Will the pharmacist be obliged to tell the customer that this is the case? It is only right that it should be very obvious indeed and well publicised. How will the penalty, if there is one, be paid? Will it be paid over the counter to the pharmacist? Who will issue the penalty? Who will receive the payment? Where will it
go? These matters may be mentioned in the amendment but I have had great difficulty in discovering exactly how it will work.Will the pharmacist be obliged to tell the customer that an item can be bought more cheaply over the counter than £5.80 if there is the ordinary exemption? I am not sure whether the pharmacist is obliged to do that at the moment. I think not. For example, if one is prescribed Aspirin, one can buy 100 Aspirin, I think, for 90p. But it would cost £5.80 if one bought it on prescription. If one takes an Aspirin a day, as many of us do, will the pharmacist be obliged to tell one about that? That question is linked. I hope that I am not being dim about this, but I should like to know the answers.
Baroness Fookes: My Lords, I am as anxious as anyone to avoid fraud. It has always seemed to me that, with prescriptions, it is extraordinarily easy to be fraudulent if one so chooses. I am interested in detection. It does not matter how great is the scale of charges or how fearsome it all looks; if there is to be no means of finding out easily whether people are defrauding the NHS, all these penalties will be of no use. Perhaps the Minister could expand a little more on that point.
Lord Brougham and Vaux: My Lords, like my noble friend, I, too, do not want fraud to appear. I mentioned to the noble Baroness, Lady Jay, when she was in the shoes of the noble Baroness, Lady Hayman, that I used to have a pre-payment prescription form which lasted for a year. One paid one's money up front and then one would get one's prescription for a year. At the end of the year I never received a reminder that that pre-payment prescription form had expired. Occasionally, when one keeps it in one's wallet, for example, one cannot see the date on the form properly. If we want to stop fraud, why do not the people who issue these pre-payment forms send out a reminder to people that their form has run out of date and that they have to renew it?
Lord Clement-Jones: My Lords, I rise briefly to say that I share some of the reservations about the amount of practical detail that the Minister has made available. I certainly believe in the spirit of the amendment. It is quite clear that this is something which probably should have been on the statute book some years ago. I thank the Minister for his very clear exposition when he moved the amendment and I hope that he will give some more practical details. As I understand it, we are creating a new criminal offence. It is of significance that we are doing so. The mechanics of how notices are to be issued, by whom and in what circumstances are clearly important. The noble Lord, Lord Renton, made an interesting point about the drafting. It seems to me that the primary legislation contains all that is required. I do not understand why there is reference to regulations. It is belt, braces and suspenders--the whole shooting match
really--which is interesting in a piece of legislation. But generally we on these Benches welcome the amendment.
Baroness Masham of Ilton: My Lords, I wish to ask a very brief question. This change should be made clear to patients. But as so many people have language difficulties, will it be made clear in different languages?
Earl Howe: My Lords, I wish to ask the Minister a very brief question following on from what the noble Lord, Lord Clement-Jones, said. Are we talking about a new criminal offence or about a set of administrative penalties? That is what I understood us to be talking about.
Lord Hunt of Kings Heath: My Lords, this has been an extremely interesting debate. I shall attempt to answer the points that have been raised. I have not been in your Lordships' House very long but I know that when the noble Lord, Lord Renton, rises to question a piece of legislation your Lordships pay that matter full attention. In relation to the specific point that the noble Lord raised, I am advised that the regulations contained in the clause to which he referred were to allow administrative procedures for sending out and collecting the penalty notice. They are to give flexibility to, for example, changing the time limit for sending the notice in the light of experience. They are also for setting the different times for different services; for instance, contrasting between a general medical prescription and dental services. Nonetheless, I shall take back the more general point that the noble Lord raised.
I have been asked a number of questions about the extent of false claims. It was right for me to say that the vast majority of NHS patients are honest. However, the estimate that I originally gave in relation to the potential loss of £150 million was based on an investigation by the Prescription Pricing Authority's fraud investigation unit. It undertook a check over a two-month period and in that period estimated that false claims amounted to 7 per cent. As noble Lords can see, that is quite a high percentage and it is essential that we deal with it.
In relation to what is to be done about it, it is important to say that the position arising from these amendments is but one step in a number of actions that are being taken. The Prescription Pricing Authority's fraud investigation unit will institute more checks in the future. In addition we are introducing dispensing checks in pharmacies in the future and those will provide for the simple verification of claims to exemption within the pharmacy. The pharmacist or a dispensing doctor will ask the patient claiming exemption from the prescription charge if they have supporting evidence for exemption. If the patient does not have the evidence available the pharmacist will mark the prescription form to show no evidence. This will allow subsequent checks of exemption claims by the Prescription Pricing Authority's fraud investigation unit.
In ensuring that through these measures we reduce the degree of evasion in the National Health Service, it is important that we make it abundantly clear to users of the service that we shall introduce this new system. It is
intended that an advertising campaign to target prescription evasion will be instituted for a four-week period from the middle of March. Leaflets will be available to the public in pharmacies and surgeries. We will also be advertising in national magazines and women's magazines. I take on board the point made by the noble Baroness, Lady Masham, concerning the need to ensure that the leaflets are in a number of languages. It is something that I will take back to the Department of Health.
The noble Baroness, Lady Carnegy, asked whether pharmacists should be obliged to tell patients with prescriptions that they can buy cheaper medicines over the counter for less than £5.80. I do not have an answer for her at this stage and I hope she will allow me to write to her on that point. In relation to the question of prepayment certificates, health authorities often issue reminders when they expire, but they are not obliged to do so. I very much take the point and we would encourage the issue of reminders by health authorities; but the responsibility to renew a prepayment certificate is clearly that of the holder.
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