I beg to move, "That this House doth agree with the Lords in the said Amendment."
This, and the following Amendment to line 18—at end insert "The Institute of Chartered Accountants in Ireland"—are both drafting Amendments which simply make certain changes in the order in which the accountants societies appear in the list in Subsection (6).
In page 15, line 15, at end insert new Clause "A"—(Additional functions of Medical Practices Committee).
Regulations made under section thirty-four of the Act of 1946 and regulations made under section thirty-five of the Act of 1947 may confer or impose on the Medical Practices Committee or, as the case may be, the Scottish Medical Practices Committee such additional functions in relation to arrangements for the provision of general medical services as may be prescribed.
In page 15, line 15, after the Amendment last inserted, insert new Clause "B"—(Recovery of charges in respect of pharmaceutical services).
Section thirty-eight of the Act of 1946 and section forty of the Act of 1947 (which provide for the making of arrangements for pharmaceutical services) shall be amended by the addition at the end of each of those sections of the following subsection:—
'(3) Regulations may provide for the making and recovery, in such manner as may be prescribed, of such charges, in respect of such pharmaceutical services, as may be prescribed, and may provide for the remission or repayment of the charges in the case of such persons as may be prescribed.'
On a point of Order. I trust that it will be possible because naturally we accepted the assurance of the Minister that it was a drafting Amendment, not wishing to delay proceedings, but the Amendment to insert a new Clause "A" is far from drafting—not that we intend to oppose it—and it would be for the convenience of the House and the record, if some explanation were permitted.
I believe that is correct. I did not notice that there were two Amendments which were drafting. Actually the hon. Member for Queen's University of Belfast (Professor Savory) spoke to the second Amendment when we were discussing the first. I hope we have that right now.
In page 15, line 15, at end insert new Clause "A"—(Additional functions of Medical Practices Committee).
A. Regulations made under section thirty-four of the Act of 1946 and regulations made under section thirty-five of the Act of 1947 may confer or impose on the Medical Practices Committee or, as the case may be, the Scottish Medical Practices Committee such additional functions in relation to arrangements for the provision of general medical services as may be prescribed.
I beg to move, "That this House doth agree with the Lords in the said Amendment."
This is merely to enable the Minister to make regulations adding to the functions of the Medical Practices Committee. Those functions, as already set out, in relation to the distribution of doctors are at present limited by statute to granting applications by doctors not already on the medical list for inclusion in that specific list. This has resulted in some practical difficulties. For example, where several doctors may apply to fill a vacancy, it might be held that the Medical Practices Committee are only strictly concerned with applications which come from outside the area in which the vacancy occurs, whereas obviously it is desirable, and has indeed been the practice, for the Medical Practices Committee to consider applications from wherever they may come, and make their decision upon the qualities of the applicants.
There are one or two other cases where experience has shown that an extension of functions might be desirable. For example, in England and Wales the view is taken that a doctor whose application to employ an assistant is refused by the executive council, as it might properly be, should have the right of appeal; and it seems to us that the Medical Practices Committee should have the power of determining such appeals. These matters have had the full consideration of the medical profession and I can give the assurance that any other similar widening of the powers and functions of the Medical Practices Committee would receive the consideration of the medical profession before any changes in regulations were proposed.
We on this side are in complete agreement with the Amendment, which we think is a useful addition to the Bill. We understand from the Parliamentary Secretary that there are three specific purposes for which these additional powers for the Minister to make regulations are required. I think that before we pass from the Lords Amendment we should have some statement from the Government that it is not intended to use its rather wide wording to take additional powers for the Medical Practices Committee without, at any rate, giving Parliament some opportunity of considering what those powers might be. The wording of the Lords Amendment is a little wide and it may be that powers could be given to take care of the sort—
I understand the right hon. Gentleman to say that there will be regulations, which will require to be laid and which will, therefore, give an opportunity to Parliament to consider any specific powers. In those circumstances, we on this side welcome the Amendment.
In page 15, line 15, after the Amendment last inserted, insert new Clause "B"—(Recovery of charges in respect of pharmaceutical services).
B. Section thirty-eight of the Act of 1946 and section forty of the Act of 1947 (which provide for the making of arrangements for pharmaceutical services) shall be amended by
the addition at the end of each of those sections of the following subsection:—
(3) Regulations may provide for the making and recovery in such manner as may be prescribed, of such charges, in respect of such pharmaceutical services, as may be prescribed, and may provide for the remission or repayment of the charges in the case of such persons as may be prescribed.
I beg to move, "That this House doth agree with the Lords in. the said Amendment."
The Lords Amendment is designed to give the necessary statutory authority for the proposal announced by my right hon. Friend the Prime Minister to make a charge for prescriptions under the National Health Service. The proposed new Clause is drafted widely because the exact nature of the arrangements has not yet been settled; discussions are proceeding.
It has, of course, already been announced that the charge will not exceed one shilling and that old age pensioners will be relieved of the charge, as will ex-Service men who are war pensioners, who will continue to receive free treatment for their war disabilities. Beyond that, I cannot say further than that we have under consideration the many representations which have been made by Members of the House and others as to the detailed working of the scheme, which is under consideration.
In another place the suggestion was made that there has been over-prescribing by doctors. On that point I should say that already there is a joint committee of the Central and Scottish Health Services councils to advise whether it is desirable and practicable to restrict in any way the prescribing by doctors of medicines of doubtful value and of unnecessarily expensive brands of standard drugs. We shall not, of course, be in a position to make any statement about this until any recommendations have been made.
This, of course, is an Amendment of more substance, but we ought to be able to dispose of it in a relatively short time, because, as the Minister has said on a previous Amendment, it is merely giving him power to lay regulations. These eventually will be laid, and on that occasion the House will have an opportunity of considering the actual proposal instead of, as now, merely the principle involved. We would not, of course, oppose this Amendment. We did not divide against the Bill on Second Reading and we do not propose to divide against this and the succeeding Amendment, which in our view give the necessary latitude to the Minister.
At the same time, it would not be desirable to pass without a certain amount of comment, the proposal which is now being made. It is a proposal which admittedly will place some 19 million people in a worse position than they have been in since July, 1948, and a considerable number of people in a worse position than they have been in since 1912, when the new schemes allowed insured persons to obtain their prescriptions without this charge.
I understand from the hon. Gentleman that it is £10 million. If the Minister speaks further on this matter perhaps he would inform us whether that figure is still intended. Secondly, on a matter of very great importance, when may we expect the regulations to be laid? The Parliamentary Secretary said that discussions were taking place, but the Prime Minister made the introduction of these reforms a matter of urgency and suggested that they would all need to come into operation at a very early date. Parliament is now about to prorogue. Will the regulations be laid during the Prorogation of Parliament? That is to say, will the regulations be current before Parliament meets again? It is a matter of great importance, because these regulations have the force of law as soon as they are laid and Parliament will need to take the earliest possible opportunity of debating them thereafter.
Furthermore, will the sums which it is intended to raise by this procedure obviate any suggestion or necessity of a Supplementary Estimate for the Ministry? It will be remembered that last year Supplementary Estimates for a considerable sum were laid. [Laughter.] Indeed, it is a very germane question, because the Prime Minister laid much emphasis upon the great undesirability of increasing expenditure and, indeed, upon the necessity for reducing expenditure. It is very important to know whether these sums which are to be raised are actually to reduce expenditure, or merely to diminish an increasing expenditure which has already been determined
It is true, as the Parliamentary Secretary has said, that these matters are still being worked out, but we are all—I am sure, the Minister more than anyone—under a bombardment of questions as to what the line is likely to be. I wonder whether, for the convenience of the country, the Minister could give us any further information upon that this morning. Certain hard cases can be met; the Parliamentary Secretary mentioned old age pensioners and ex-Service men who are war pensioners. Is there any intention to extend further the category of hard cases, of which every one of us has had many examples brought to our notice?
A very important point, which the Minister, I think, must by now have determined, is whether the charge is to be based on each prescription or on each prescription form. As the Minister knows, often on a prescription form there may be a number of prescriptions. As far as I have been able to ascertain the average number of prescriptions on each prescription form is 1.5, that is to say, three prescriptions on two forms. It is very desirable to know whether the prescription form, or the prescription is to be charged.
When the Minister says that a sum not exceeding one shilling is to be charged is it intended that it shall be on a flat rate, or a graded rate? The Parliamentary Secretary will realise the importance of that. Obviously, some prescriptions are very expensive, but a great number are inexpensive and it is on those inexpensive prescriptions that the pricing machinery is just now in great difficulty. I agree with the Minister when he says that he shudders to think of the flood of medicines the British public are pouring down their throats and I am delighted to think that he does not accept an increase in prescriptions as indicating an improvement in the health of the country, but it is the large number of small prescriptions which is causing the difficulty with the chemists. If they are to be priced on a graded figure that difficulty will be increased, but, if the increase is to be on the small prescriptions, it may well be that a proportionately large charge is to be exacted. I should have thought that the Minister would be able to give a general lead by this time on these matters because, although the regulations will state them in detail, the ordinary public are, of course, extremely interested and anxious to gain what information they can from our discussions this morning.
If the Minister could give us information on those matters it would be of very great use and importance, particularly on the point of when he expects the regulations to be made and when they are to be available in draft, as I suppose they will be sent out in draft first for our consideration. I trust the Minister will agree that we are approaching the matter this morning, as it should be approached, on a businesslike basis and, as those concerned with the practical working of the scheme, anxious to see that it works economically and as efficiently as such a great scheme would be expected to work.
I think the House will agree that, on the whole, I have been extremely friendly to the National Health Service, but, this morning, I want to ask the Minister very seriously indeed if he will give further consideration to the suggestion that there should be a charge for prescriptions. I would go further and say that the more I have looked at this, the more I have come to the conclusion that the Lords Amendment should be rejected, for two reasons. One, I do not think it is going to work; and, two, I do not believe it is right to deal with a matter of this sort entirely by regulations.
I know the very great difficulties in putting too much into an Act of Parliament, but I think this House should have clearly in mind the categories and classes of people to whom this is going to apply and that ought to be in the Act, because regulations cannot be amended and this House has a responsibility to discharge to its fellow citizens. We ought to know, in some form which we can consider and amend, exactly to whom and to which classes this particular type of charge is to relate. As the right hon. and gallant Member for the Scottish Universities (Lieut.-Colonel Elliot) said, this is the first time for 36 years that the insured workers have been called upon to pay something for their prescriptions. It was never part of the Liberal health insurance scheme. We ought to be extremely careful about giving to any Government, or to any Minister, powers to make regulations which can only be challenged in toto and which cannot be examined in detail, because it is the details which will matter to the people of the country.
It has been mentioned that categories we must consider very carefully are the unemployed and those on sickness benefit. This House should not give the Minister any powers to deal with those categories without knowing the actual way in which he proposes to deal with them. What about the actual difficulties of this scheme when rural practitioners dispense their own medicines? Are we not creating more administrative difficulties, more bureaucracy and more administration? We ought to know that before we give the Minister such powers. What about those who require continuous treatment, like diabetics? Is this to be a continuous charge of 50s., or 60s., a year to some people? If it is, I am not standing for it and I want the proposals laid before the House in a form in which they can be amended in detail.
I say quite frankly that I do not think the scheme will work. If the charge is too high it will cause serious injustice and will be too high for some people, but if the charge is too low it will not remove the abuses, or so-called abuses, of the system. I believe this Lords Amendment should be withdrawn and a serious attempt made to deal with the heavy burden laid on the medical system of the country at present. We should not give the Minister the powers he is seeking now, because the House would be irresponsible to do so.
As one of the few medical Members of this House who is still attempting to follow his profession regularly, I am grateful for the opportunity of saying a word or two on this matter. I could not agree more with the hon. Member for North Dorset (Mr. Byers). Of course the right hon. and gallant Member for the Scottish Universities (Lieut.-Colonel Elliot) followed the line that was expected of him; this is a move in his direction and, therefore, he welcomed it.
I very much regret that the Government have found it necessary to introduce the idea of charging for prescriptions. I regard it as a completely retrograde step. When the National Health Service was introduced we all regarded it as a great move-forward. We were removing the barriers between the classes and opening the results of research and advance in medical treatment to everyone in our population. To that end we encouraged everybody to become health conscious; we raised the value of early diagnosis and said that if people considered that they had small ailments they should seek consultations, because small ailments, if untreated, often lead to very serious diseases.
Now we are told that this is being introduced as a deterrent. Whom are we to deter from obtaining medical treatment, or medicine, which it is considered they need? Is it really suggested that people are going to wait very long hours in doctors' surgeries when they know they will get something very trivial in the way of treatment and that it is a small prescription which will not even come under the eye of the pricing department? We know that most people have not time to do so and will not wait long hours in surgeries if they are to receive a trivial kind of treatment and if their complaints are of a trivial nature. But, since we have told them that small complaints often lead to serious diseases, we cannot blame them when they take that to heart. When they go into a doctor's surgery they do not know whether they are to have an expensive medicament, or a cheap prescription, because they do not know what is the matter with them, and often the doctor does not know, but has to give them an expectorant or a waiting treatment. The patient certainly does not know.
We have already had reference to people who may not be intermittent patients but who need continuous treatment, people with all sorts of diseases such as rheumatism, chronic bronchitis, heart complaints, disturbed blood pressure, poor-operative conditions, and diabetes. Is it really suggested that these people, or many of them—we do not know what categories will be exempted—should have to pay for their medicines over a comparatively long period? They are the kind of persons who get into financial difficulties. It is true that there is a National Insurance Scheme which provides those entitled to it with 26s. per week plus something for their dependants. Surely, it is not suggested that that is so magnificent a sum that it can be spread over all sorts of extra expenses which a sick person is liable to incur and that, in addition, he should be able to pay for his medicines which he has hitherto not been asked to do?
I am afraid that we shall deter the wrong people from going to the doctor for treatment. The right hon. and gallant Gentleman the Member for the Scottish Universities referred to the number of prescriptions which may be included on a prescription form. I believe that there is printed on the back of the form an instruction to doctors that they must not include more than two prescriptions on the form. The average is less than that, it is 1.5. One can easily imagine an ailment for which a doctor may have to prescribe four or five different items. For example, I have seen Members of this House wearing dressings which indicated that they had boils. The treatment of boils may require four, five or even six different items to be prescribed at one time if the treatment is to be adequate and successful. If a man with a boil who walks into a doctor's surgery is to be asked, either there or at the shop of the chemist to whom he takes the prescription to be dispensed, to pay five or six shillings for treatment it seems to me that that will be a little excessive.
We have heard only in a general way what the Government propose to do. We have had no details; we have not had the regulations. I feel very much as does the hon. Member for North Dorset, that we ought to have an opportunity to see the regulations and, if possible, to amend them. I might not be so much opposed to this step as a general principle if there were adequate provisions for exemptions and for amending the regulations at the time when they are made. Without seeing how the proposal is to work, I think that as a general principle it is bad and I do not think that the House ought to agree to it.
The Minister of Health recently made a speech in which he talked about cascades of medicines being poured down people's throats. We all know that a good deal of unnecessary medicine is being prescribed and consumed, but the Minister knows as well as I do that medicines are given not only for their physical effect but also for their psychological effect. We all know that a medicine is often given to a patient to act purely as a mental poultice. We cannot expect by one speech, not even a speech uttered with the eloquence of my right hon. Friend, to alter the mental make-up of the whole world and the kind of faith which the world has been brought up to have in medical advisers.
There is a great tradition of the supernatural about it—witchcraft, love potions, all sorts of things—which is to be found in a very extensive literature extending from the Bible to Shakespeare and going beyond in both directions. I repeat that one speech by my right hon. Friend will not wipe out all that, however true what he says may be. People go to doctors either because they are ill or because they have perfectly natural fears about their health. These fears may be justified or unjustified. It is not always possible for a doctor to eliminate or alleviate those fears by words. He has to do something more, and it may be that part of what he has to do is to supply a prescription. Many of these very cheap prescriptions which have been referred to so contemptuously or eloquently are necessarily of a very cheap character. I dare say that my right hon. Friend knows the word by which they are known in the medical profession. If he does not I will present him with it. They are known as placebos, which I need not explain simply means "I will please you."
It has been said that for the first time since 1911 insured workers will, under these regulations, have to pay for prescriptions. That is a very serious matter. I do not think that the worker who has been accustomed almost for generations to get his medical treatment free of charge should now be asked to pay for it. It is a backward and retrograde step. I am sure that it is not one by which my right hon. Friend would care to be remembered in history. It is foreign to his temperament and inclinations, and I am sure that if he will look at the matter again he will realise it is also contrary to necessity.
We are told that old age pensioners might be exempted, but what is an old age pensioner? Is it someone who has retired on retirement pension or is it someone who is working beyond retirement age and drawing wages? We know that people have been urged to stay at work because there are many industries which are short of workers. Such people will receive higher retirement pensions later when they stop working. Are they to be exempted or are they to be expected to pay for their prescriptions although they will be older than many old age pensioners?
Who is to carry out the necessary detective work to ascertain whether they are entitled or not to be exempted? Is the chemist to ask for proof? I do not think the doctor will agree to do so or that he will be asked to do so. Everyone will agree that the doctor already has sufficient to do. The chemist may have to be asked to ensure that the people who bring the prescriptions to him supply the proof that they are entitled to exemption. I do not think the chemist will feel that he should have to do such detective work either, that he should be required to ask people to produce their birth certificate or to show whether they are working or drawing the old age pension. The proposal seems to me to involve more practical difficulties in all sorts of directions than is justified by the amount which the Government hope to get from it.
The Minister has had resolutions and representations from all sorts of quarters about the iniquity of this proposal. Curiously enough he has had representations made to him both by the British Medical Association, who passed a resolution, and by the Socialist Medical Association. I do not think that these two bodies have ever been in agreement on any subject before, but they are very definitely in agreement on this one. I do not know whether my right hon. Friend considers this to be an unholy alliance but it is certainly very interesting that two bodies of doctors who disagree so much on so many vital questions connected with the National Health Service should agree so fundamentally on this question.
Another criticism I wish to make is in reference to the fact that there is a good deal of scope in the proposal for evasion. Again I speak subject to the regulations; I have not seen them and I do not know how they are to work. I could, however, show the Minister many ways in which both doctors and patients could evade this charge. They could get a very large bottle of medicine full to the brim and expect it to last over a long period. If there were no change in the condition of the patient that would be satisfactory, but there are not many cases where there is no change in the condition of a patient from one week to the next, or one fortnight to the next. So a very great deal of waste would be involved in a procedure of that sort.
I suppose that a patient could get a prescription for himself or herself, and get one for an old age pensioner, who might be the father or mother. All the prescriptions would be put on one form. There would be no check on that kind of thing at all if anyone wished to perpetrate that kind of evasion. What is to prevent a mother who has three children of approximately the same age all suffering from the same kind of complaint—let us suppose all three children had whooping-cough for example—getting one large bottle of medicine which would suffice for all three of the children, who are going to have the same treatment in any case? That is another kind of evasion, and I could go on multiplying instances of this kind almost ad infinitum.
There is one rather more serious aspect, and that is that a good deal of medical research in the past has been done by general practitioners. I think it fair to say that a multiplicity of remedies for any given illness is a measure of the failure hitherto of research in that particular illness. Any attempt to limit the work of general practitioners to drugs which are on a standardised list, and to prevent them from trying out unestab-lished drugs which have not yet received the impress of the British Pharmacopoeia or the Medical Research Council, will have a bad effect. It will suppress original work and prevent medical practitioners from taking a real interest in a very absorbing and vital side of their profession. We do not want to stop original work, or to prevent medical discoveries or the trying out of new preparations. It would be a calamity indeed if the suggestions made by the Parliamentary Secretary were taken seriously and adopted—
Do I now understand my hon. Friend to say that if a committee consisting of responsible members of the medical profession say that a certain ingredient sold under a more expensive title is exactly the same as another ingredient sold under a less expensive title, we ought to adopt the idiosyncrasy of a general practitioner and pay the inflated price?
I did not say that at all. I agree that when there are two preparations, one of which costs less than another, that, other things being equal, one should use the cheaper one. That is self-evident. But we did not get that kind of idea from what was said by the Parliamentary Secretary. What was being suggested was—
I hope that my hon. Friend will not pursue this matter because it might very well prejudice discussions now going on. If my hon. Friend is now proceeding to say that in no circumstances whatsoever can we have an official list of drugs provided by a responsible authoritative committee, I am sure he is going much further than my hon. Friends around him would wish him to go.
On a point of Order. Is it in Order for the House to be asked by the Minister not to discuss a matter brought before the House by the Government because it will prejudice discussion elsewhere? If that is the position, this discussion had better be adjourned for a few months, or else the House ought to be allowed to discuss the matter.
I referred to this matter only because it was mentioned in passing by the Parliamentary Secretary. I am prepared to accept what the Minister has said and not pursue it any further. I would point out again that we are discussing a general principle on which we have no details or regulations and it is a little difficult to limit one's field.
I have had very considerable experience in the last 25 years as a general practitioner, and I have had something to do with treating persons under the new Service. In my experience, there has been very little abuse of the Service. I do not find people coming to the surgery for nothing. I do not find that they abuse the Service, or that they make excessive demands. I find that the Service is working very well indeed. There are only a few individuals who, from the point of view of the doctor, are a nuisance.
It is very interesting that when one discusses this matter with a patient, one finds that every patient says, "Of course, doctor, I think there ought to be a charge, but I do not think that the charge ought to be made to me. I think that all those people who are waiting in your surgery and who keep me waiting many hours are probably abusing the Service; but I am not abusing it. I have come for a perfectly good and valid reason." When everyone says that, one realises it is possible to support a proposal of this kind for the wrong reasons; and every person is convinced that he himself is not the person making an excessive demand upon the facilities provided for him.
When all the various possible exemptions are considered—people who are receiving unemployment benefit; people suffering from various kinds of chronic illness; people who are war pensioners; people who are entitled to draw their old age pensions, whether they do or not; people incapacitated for a long period and in financial difficulties—when each one of those various exemptions is considered, plus exemptions we have already been told about, one comes to the conclusion that there would be very little of the £10 million expected which would still await collection.
One is told again of the disorganisation caused to chemists and doctors. There is also the mental disturbance and possible physical deterioration that would be caused to patients, because if we prevent or deter people from going to the doctor's surgery we shall encourage self-medication and the purchase from chemists' shops of patent medicines. I am sure that if this proposal goes through, the vendors of patent medicines will find their sales going up by leaps and bounds, and I think that would be a very harmful result indeed. For all those reasons, I hope that the Amendment will not be proceeded with.
As no doubt many hon. Members know, I am the Secretary of the Pharmaceutical Society and I welcome the opportunity this morning of being able to inform the House of what I have been able to gather of the views that chemists have on the proposals which the Minister is making. I would say, generally, in relation to the last two speeches to which we have listened, that if one looks at the Health Service as a whole, one is bound to realise that it needs an enormous amount of money. I would not condemn out of hand a proposal which meant that, in order to be able to afford a little more money for the hospitals, let us say—which are in need of money—the Minister is exploring the possibility of, shall we call it, "pay as you use" in relation to some other part of the Service. I would far rather that was explored than that cuts should be made in the hospital service, or the rebuilding of hospitals held up simply because enough overall finance was not available.
I would not go so far as the hon. Member for Northern Dorset (Mr. Byers), and condemn this proposal out of hand. He said he was satisfied that it would not work. My trouble is that I do not know whether it will work or not, because, with all respect to the Minister, I do not yet know what his scheme is. It is only fair to the House that we should not be asked to go too far with our approval of this scheme without knowing in rather more detail just how he proposes to carry it out. The Parliamentary Secretary said that consultations or discussions were already proceeding. I am fairly confident that the chemists have not been brought into the discussions if. in fact, they have extended outside the Ministry. I hope that the Minister will be able to say that he proposes at an early date to bring the chemists into the discussions. They are the people, as far as one can see, who will have to operate this scheme. They have taken on an enormous amount of additional work and they are entitled to know just where they stand. They certainly do not know at present
When one considers the enormous increase in the cost of medicines under the Health Service and when one realises how unequal is the incidence of prescribing the cost of medicines as between one part of the country and another, then one concludes that the Minister is justified in setting on foot inquiries which may lead to payments by the patients. For example, the original estimates for the pharmaceutical service were £6 million. They went up to £13 million, and now the estimates are £20 million. On figures of this sort, the Minister is entitled to examine the circumstances to see whether there is not something which can be saved to the Exchequer out of this large expense.
I want to put a few questions to the Minister mainly in an endeavour to outline the problem to him in case he may not have seen all the aspects of it, and also in an endeavour to discover what he has in mind as to the actual working of this charge. One or two hon. Members have already asked the question, "Is it to be a charge on each prescription or on each form?" That, I think, is fundamental. Surely the Minister must have had some advice on that subject during the rather long time which has elapsed since the Prime Minister first made his announcement. The hon. Member for South-East St. Pancras (Dr. Jeger) mentioned the case of the prescription written for more than one patient. There are any number of prescriptions of this type written by doctors. I had one shown to me the other day for two items. The second item had two doses attached to it. I caused the chemist to make an inquiry and he discovered that the first item was for the mother and the second was for two children. Does a prescription of that kind rank as one or does it rank as three?
That is not an isolated example picked out because it happens to be an obvious anomaly. I am sure that there are hundreds of thousands of such prescriptions written in cases of family sickness. As the Minister may know, discussions are going on whereby what are called group prescriptions can be written if there is an epidemic in a school. Instead of writing 60 individual prescriptions a school doctor may be able to write one prescription for 60 patients. Is that to rank for a charge of 1s. or 60s.? Until questions of this sort are settled, it is impossible to judge this scheme fairly.
An important point is whether there is Jo be a flat rate charge or a charge graduated according to the value of the medicine. My view is that there must be a flat rate charge. It would be impossible, when the pricing officers cannot cope with the normal pricing of prescriptions at present, to attempt to make any sort of assessment according to the value of the medicine. The most they can do is to count the forms. I doubt very much whether they are equipped now to count the number of prescriptions on the forms.
It seems to me to be relevant to ask, since members of the public who go to a general practitioner are to be charged this amount, what of members of the public who go as out-patients to hospitals? Where should we draw the line between the two? The last thing we want to do is to move the flow of patients from the general practitioner into the out-patient departments of hospitals. There is also the problem of the rural doctor who enters into a special type of contract. He is paid a per capita fee for his patients and he provides the medicine in addition to the diagnosis and so on. There is no prescription in those cases. Is a 1s. charge to be paid by the patient and, if so, how is it to be paid and what is the guarantee that in due course it will be paid to the Treasury?
Then there is the very difficult question of exemptions. We already know about the old-age pensioners and the war pensioners. I think I have seen somewhere a reference to the exemption of diabetics who, in order to make life at all tolerable, have to go possibly weekly for their prescription for insulin. If diabetics are to be exempted, what about epileptics who have to go regularly for prescriptions, and what about the chronic sick, who very often are the people who can least afford to pay at regular intervals the sum of 1s., or whatever it may be, for bronchitis mixture or whatever it is they need? Has the Minister any criterion for exemptions?
Finally, how is the calculation to be done? If it is to be a straightforward payment of 1s. when the medicine is handed over the counter, possibly the system may work. Is it intended that for each form which the chemist sends in to the pricing office he will be paid 1s. less, on the assumption that he has already collected 1s.? That could be done, but if anything more elaborate than that is required, and particularly if as the hon. Member for South-East St. Pancras suggested, the chemist is to assess whether or not a person is entitled to exemption, then it seems to me we will have such a complicated scheme of accounting required of the chemists that the whole plan will be unworkable. In that case the chemists would be asked to undertake a job which is far beyond their capacity.
The Minister may say that all these matters are really details and that it is in order to get these details worked out that he is now conducting discussions. He may say that when the regulations emerge we shall know the answers to these questions; but there are some instances in which the details are the essence of the scheme. This is such a scheme. Although I am not opposed to the general principle of the pay-as-you-use system adapted to the National Health Service, I do not see why it should be restricted to the pharmaceutical service. If it is justified in principle, it is justified for the dental, the ophthalmic and the other benefits. However the matter is worked, the details are of the essence of the scheme. Until we hear the details, we are bound to suspend judgment and to say that the Minister has not made out his case. If there is a Division, unless the Minister can help us on this matter, I should feel inclined to refrain from voting one way or the other.
I should like to make a humble but very sincere protest against the principle involved in this new Clause. I have always looked upon the National Health Service Act as perhaps the best piece of legislation carried out by the present Government. It is based on that great Socialist principle—to each according to his need. When the scheme first came into operation, there were many old people who did not appreciate the profundity of that great principle. They inquired whether, if they had never paid insurance contributions, they had any right to take advantage of it. Are we going to replace that great Socialist principle "Each according to his need" by "Each according to his shilling "?
I have discussed the question of abuse with very many doctors, both before and after the proposal to charge for medicine was put forward. I found that perhaps a little more than half of the doctors with whom I have discussed the matter agreed that there was some abuse. With a new service, people like to try it out, and there may have been some abuse. But, when I have tried to analyse the replies of the doctors who said there was abuse and those who said there was none, I found that, without exception, the doctors who agreed that there was any considerable abuse were the doctors who were opposed to the scheme from the start, who did not want a universal Health Service but who wanted the well-to-do to be compelled to pay for it directly. Undoubtedly, there may have been some abuse in the past. There always will be neurotic people who go to the doctor more often than they need, but I would like to ask the Minister whether he supposes that these neurotic people will be deterred by a shilling, and be robbed of the enjoyment of bad health, and, perhaps, the chief interest in their lives? I suggest that one of the people who will be deterred will be the poor mother with young children, who is over-burdened in any case and who is perfectly ready, unfortunately too ready, with all her preoccupations, to take advantage of any excuse for not bringing her children to the doctor at the earliest possible moment.
I suggest to the Minister that, so far from these proposals reducing the "cascades of medicine" of which he has talked, they may even increase them. Doctors generally are very concerned about the interests of their patients. They are ready to do anything that is reasonable and possible to serve these interests, and I think a doctor may very reasonably say, "This is a poor patient, who may feel the shilling, and I should be wiser to give him medicine for a month rather than for a fortnight." May not this, in some cases, result in more medicine being ordered, rather than less?
I have felt, and many have felt, that a great advantage of a free and universal service was that the doctors should get hold of illness earlier than they otherwise would do, for it is true to say, in medicinal treatment perhaps more than anything else, that the stitch in time saves nine. This has always been true, but it is infinitely truer today since so many bacteriocidal new drugs have been introduced.
Let us take the case of a child with ear-ache. The doctor orders penicillin, sulphonamide or one of these drugs, and the trouble clears up rapidly. If the child is not taken to the doctor at once, he would probably get a perforated drum, and that perforation might become permanent for life, or mastoid disease might develop. We do want to get the cases early. The same thing applies to cancer. Where it can be recognised early, the results of treatment of cancer are astound-ingly good. What the profession wants to know are the early symptoms of the disease so that we can get the condition under treatment before it becomes so obvious that it can be a real inconvenience to the patient. I had hoped particularly that this great service would help the whole profession to recognise disease earlier, and I look upon this proposal to put any obstacle in the way of the earliest possible appeal to the doctor as entirely retrograde.
The Minister interrupted my hon. Friend and very rightly pointed out that not a few doctors are inclined to order proprietary medicines when perhaps a cheaper medicine, identical in character but with a different name, would do just as well. I am certain that this is true. The public do not understand how busy the drug houses are in sending round their travellers to doctors. They give liberal samples, and the doctors try these proprietary medicines on one or two of their patients; if they succeed, they go on ordering them, although there is an equivalent in the British Pharmacopoeia which can be prescribed at a quarter of the price. I suggest to the Minister that if he would get busy giving the doctors lists of equivalent drugs and asking them to supply them to their patients, he would save the necessary money and also the good name of this great scheme, as the author of which he will go down to history.
I am opposed to this new Clause, because it discriminates in favour of the well-to-do against the poor. The hon. Member for Putney (Mr. Linstead) said that he did not know what the scheme was, and he therefore found difficulty in joining issue with the Government. The scheme is very simple. It consists of an order from the Treasury to the Minister to save £10 million. I venture to suggest that the excuse why this cut has been rendered necessary—the unnecessary resort to doctors and chemists—does not hold water, and, indeed, cannot bear investigation.
When the Prime Minister, on 24th October, announced this cut and gave the excuse which I have just repeated, he spoke before the Chancellor of the Exchequer, but the way in which the Chancellor put it on 26th October was quite different. When one looks at the speech of the Chancellor, it must become quite clear to the most innocent Member of the House that the reason for this cut—and the sole reason for it, whatever the ostensible excuse may be—is that, in the view of the Government, a contribution of some £10 million had to be made to the general scheme of cuts. Let me quote one or two short sentences from the speech of the Chancellor of the Exchequer to establish this point. The right hon. and learned Gentleman said:
We have … decided that short of slashing some major social service, which we do not propose to do, our economies must consist of a large number of relatively small items.
He then itemised these various things, referred to a group of measures which he defined as "further measures," and went on to say:
The further measures required to bring the total savings to the figure we think necessary were given and explained by the Prime Minister but for convenience I will repeat them now without further explanation: the charge for prescriptions under the National Health Service yielding £10 million economies.
Later on he said:
In the nature of things it is not possible to be precise about the date by which these savings will be in full operation."—[OFFICIAL REPORT, 26th October, 1949; Vol. 468, c. 1343–6.]
Therefore, whatever may have been in the mind of the Prime Minister, certainly in the mind of the right hon. and
learned Gentleman who is primarily responsible for the national finances there was only one issue, and that was: "How can I save money at the expense of the ordinary person? By proposing a charge of 1s. on prescriptions."
One can take this argument and examine the excuses put forward by the Chancellor for the other cuts which were discussed on 26th October, because they bring into better and clearer perspective the reason for the cut involving this proposed charge for prescriptions. For example, I submit that the excuse put forward for imposing a charge on prescriptions was a type of excuse not available to the Government in relation to the other cuts. Had it been available they would gladly have seized upon it. For instance, in cutting the housing programme from 200,000 this year to 175,000 next year, they could not very well say that local authorities were abusing the housing programme and that too many people were unnecessarily demanding houses. There could be no excuse of that sort. Then, again, on the education cuts they could not say that there was abuse—
I am much obliged to you, Mr. Speaker, for stopping me if I was going too wide of the Debate. As I said a moment or so ago, I was trying to bring the excuse given for this cut into what I submit is its true perspective, but I will not pursue that, having regard to what you have said.
If the intention of the Government was, as it appears to have been, to save £10 million, one immediately asks oneself this question: "Before putting this extra burden upon the backs of the working class"—who, after all, comprise the greater part of our population—" did it not occur to the Minister of Health to see whether he could save money by taking some of the profits away from the manufacturers of pharmaceutical products and the manufacturers of chemical products?" It might well be that had he been as diligent in his attempts to cut profits as he is in putting a shilling on the bottle, he might have avoided taking that latter course. Again, had he had a word with some of his colleagues in the Cabinet it may be that instead of slashing £10 million off the Health Service more could have been taken from the Armed Forces, so that not only could this cut have been halved but perhaps the cuts in other social services co'uld have been reduced.
Assuming for the moment that there is some validity in the argument that this cut was not purely a financial one but, as the Prime Minister said, was rendered necessary because of unnecessary resort to doctors and chemists, what is the position? As we have heard from the hon. Member for Barking (Mr. Hastings), who is very experienced in medical matters, the imposition of the 1s. charge will not deter hypochondriacs, who will want their pleasure out of their misery at any price. I do not think there can be any doubt about that. As has been pointed out, it will lead to more difficulties in the early diagnosis of disease. It means, for example, that if a child has a persistent cough, the mother, knowing that she may have to pay 1s. for a prescription, will not take the child to the doctor, yet that child might be suffering from the early stages of tuberculosis, or some disease which could be cured if the mother took the child to the doctor at an early stage.
Certainly the 1s. charge will mean financial hardship to many people. In my constituency there are many workers, on the railways, in cement factories, in oil refineries and elsewhere, who are living barely above the subsistence level, and to their families 1s. is a substantial sum. Those are the very families who are usually most in need of medical attention because of their low level of living. It therefore seems to me that this 1s. charge does not discriminate between those who really need the service and those who abuse it—if there are many who abuse it. As I said at the beginning of my speech, this charge discriminates in favour of the well-to-do against the poor. In the case of those unfortunate people who suffer from chronic diseases such as diabetes, stomach troubles, and pernicious anaemia, it may be that in one or two cases special provision may be made, but, by and large, this proposed charge which we are considering today must necessarily cause very great hardship to chronic patients.
I ask the Government seriously to consider their attitude to this proposal. We must all appreciate that it is quite contrary to our Socialist traditions; and we must surely all appreciate that it is really contrary to the direct promises we gave in the 1945 Election, or at all events the implications contained in our programme. I venture to say that it is not merely sufficient to oppose this proposal with words alone. I hope there will be some hon. Gentlemen whose convictions will take them into the Division Lobby against this proposal, because this is not a small matter. This is a great matter affecting large sections of the population. Indeed, it seems a great pity that when we are debating a matter of this importance there should be only nine hon. Members on the Opposition benches and fewer than 30 on this side of the House. That is a tragic commentary upon what appears to be the complete lack of democratic interest shown by many hon. Members in something which is of fundamental importance to our people.
I know that if a Division takes place—as I hope it will—it will result once again in the Government having their own way on these cuts. But that will not be the final decision. This will have to be fought out outside the House, and the general public will have to make its decision felt at a not very distant time. I attach great importance to this, and I know that when I vote against this proposal I shall be supported in my action at the General Election, when I shall fight on this very issue in my constituency as an Independent Labour candidate. I am sure that my action today will then be greeted in a practical way, and will result in my coming back to this House in the next Parliament.
It may perhaps be for the convenience of the House if I speak at this stage, because the speeches—and I make no complaint about it—have tended to repeat themselves. Hon. Members are, of course, speaking under difficulties. They are. difficulties that are inherent in the proposal to take powers to do something, when what is intended to be done is not in fact before the House. This is always the case in every Statute where it is found necessary to take power to make regulations of a detailed character. Everybody. I think, who has experience of this matter will agree that we have found it almost impossible to escape that necessity.
I know that the hon. Member for Northern Dorset (Mr. Byers) has expressed, as I have done on many occasions when sitting on the back benches, deep distrust of conferring on a Minister the power to make regulations which would not be subject to amendment. In the course of this Parliament, we have altered that procedure in one or two instances in order that there might be an instrument of discussion rather less restrictive than merely a discussion on a Prayer to annul a regulation. Therefore, I sympathise wholeheartedly. with those who say: "Here we are giving this power blindly, and we do not know how it is going to be used."
I have been asked a number of questions as to how I propose to use this power. I say frankly that if I could give the answer there is no excuse for my not having had the regulation ready. I do not myself yet know all the answers. Before this can be made into a practical scheme, it will have to be discussed with representatives of chemists and doctors to see how it is to be worked out.
The proposal to have a charge up to 1s. creates no administrative difficulty at all. The administrative difficulties arise out of the necessity of exemption. I am not myself displeased that we have had this discussion this morning. I am not displeased that hon. Members have been brought up against the administrative" difficulties of carrying out principles which many people have so gliby proposed.
We have had, in the course of the last year, a large number of allegedly erudite letters written by professional men and journalists in the daily newspapers advocating charges of various kinds on the National Health Service and pointing out how large sums of money could be saved if these charges were made. All the time they have assumed that there is an economy in transferring, a charge from the State to the individual. That in itself is not an economy at all. I am not suggesting that it is. It is not an economy merely to transfer a charge; a proper economy is a more efficient way of giving the service. I have read some of these letters and communications with a good deal of quiet pleasure because I knew that the time would come when the legislature would be faced with the working out of some of these principles.
The same problem arises on the next Amendment, although in that case it will be rather easier when we are asked to distinguish between foreigners and our own nationals. We have had that argument raised, and the newspapers supporting the Opposition have been carrying headlines for almost 15 months on this particular matter. When we come to make a distinction and go from the easy realm of abstract principle' to that of practical discriminations, all kinds of administrative problems arise. I can quite see that, in some instances, the cost of administration would exceed the economy, so I am not at variance with a good deal of what has been said this morning.
I want to answer the charge that this proposal was only made in consequence of a demand for economy. If that were the case, how do hon. Members whp have made that charge explain that these are powers only to deal with the pharmaceutical services? If indeed the Government wanted to take power to make a charge to the citizens for use of the Health Service, then we would have general power for making a charge. We have not done that. What we have done is to say that we want to take power to make a charge in respect of the pharmaceutical service alone. Why have we done that? This is a complete answer to the hon. Member for Thurrock (Mr. Solley). It is because our experience has gone to show that it was this very vital part of the service in which the general practitioner was most involved and where the greatest load had fallen, and that the service was inclined in some respect not to give the standard of service we wanted from it. It is quite incorrect to say that it was the purely financial aspect of this matter that weighed most with me when I accepted this tentative proposal. In fact the exaggeration we have had pis morning—
I am bound to say that my hon. Friend is an innocent Parliamentarian if he imagines for a single moment that any Minister is going to stand at this Box and give a detailed description of the internal communications that take place between the members of the Cabinet and himself; he really is more than ingenuous. There is a principle of collective Cabinet responsibility.
What I am saying is that on the face of it the proposal does not bear out the sinister interpretation placed upon it by the hon. Member for Thurrock, because we are in fact confining the power to make regulations to withholding free sales up to a certain amount—not to impose a charge. This is not a power to impose a charge. This is to restrict the free service on the pharmaceutical side up to 1s.
Let us look at the actual facts. It is not the National Health Service that would be making a charge to the patient. It is the National Health Service that would be saying to the patient: "Where a doctor has given you a prescription that costs more than a shilling, the National Health Service will pay the cost above a shilling, but up to the shilling you will pay." We could quite as easily restrict the new service in another direction.
Nor it is true to say, as the right hon. and gallant Member for the Scottish Universities (Lieut.-Colonel Elliot) said, that we are putting the National Health Service contributor in a worse position than he has been in since the beginning of the National Health Service Act. That is not true. What is actually happening at the present time is that the National Health Service is giving him a far wider range of services than he had under the National Health Insurance Act; therefore, even if this were imposed, what would be left to the National Health contributor would be a far wider range of service than was ever available before.
What is true is that in certain cases where the National Insurance contributor is having his bottle of medicine free, he will now have to pay up to 1s. for it. All the rest of the service which he gets is infinitely more valuable than that "bob," and he will have a far greater service than before. If he had to choose between the two, ask him which he would prefer.
That is not in dispute. The only suggestion I made was that, whereas under the Liberal scheme we could keep the medicine free, under this scheme up to a 1s. will have to be paid. I grant that the scheme is an improvement, but the Minister cannot get away from that point.
It is the right hon. Gentleman who is saying, as a result of his action, that a person must choose between the two, and if he is given the choice he will obviously choose the scheme that is now operating.
Therefore, it is a false argument to say that he is worse off. The argument was an attempt to show that the National Health Insurance contributor was in a worse position than before 5th July last year. All I am saying is that what will happen in this case will be a slight withdrawal.
I do not want to intervene in this interesting discussion between the right hon. Gentleman and his opponent. I merely wish to say that we do not accept the arguments of the right hon. Gentleman, and I do not think he will find they will be generally accepted.
I think the right hon. and gallant Gentleman will find that the ordinary housewife has a little more common sense than he attributes to her. The housewife and the ordinary citizen will know whether they are better off under the National Health Service without our attempting to advise them.
We shall see.
We have had the experience, as I said earlier, that it is on this particular side of the service that the greatest burden has fallen. In those circumstances, we had to ask how that burden could be mitigated, and we came to the conclusion that if we could in some way reduce the queues at the surgeries and the unnecessary expenditure at the chemists' shops, it would be a good thing.
It is not correct to say it is only on the side of bottled medicine that some of the abuse has taken place—it is aspirins, bandages and so forth, costing less than a 1s., which in a large number of cases could have been purchased by the patient without having to call on the general practitioner, or without making a second call on a doctor for a prescription. That is where the abuse arises. It is no use my hon. Friends telling me that this is not the case, because this proposal has not, in fact, been received with much indignation, as it is generally accepted that there is an awareness of the abuse which has been taking place.
Does my right hon. Friend not agree that there has been an abuse on both sides, both by the patient and by the doctor? If so, why should the corrective methods be only on the patient's side.
If my hon. Friend can tell me how to visit it on the doctor, I will gladly consider the position, but we must presume, until it is proved to the contrary, that it is not in the interests of the patient to have too many prescriptions. We cannot go beyond that at the moment. We do know, however, on the purely subjective side, that this proposal would have met with far greater indignation had there not been this awareness of abuse. We thought, therefore, it would give rise to easement on the general practitioner's side in the early stages of this scheme. I am not suggesting that this ought to be a permanent feature of the National Health Service.
My hon. Friends need not be apprehensive about this matter, because I am as deeply concerned with maintaining the Socialist approach to this service as any one on this side of the House. Therefore, as far as I am concerned, this is put forward only for the purpose of a temporary easement, if it be practicable, and there will then be a residual financial advantage, the extent of which no one knows, because we do not yet know what the exemptions will be. What is practically certain is that the figure of £10 million was based on the assumption that there would be no exemptions, and that any exemptions will reduce that amount, although to what extent no one knows at the moment. All I can say is that the House will have an opportunity of discussing the regulations before they are put into effect.
It is impossible to have the regulations in a form in which Amendments can be made. I want the House to be quite clear about this. These are not the only regulations which are made under a Statute. A whole series of regulations concerning the assistance board have been made, and there is no reason why these regulations should be in a different position from those regulations which are infinitely more important. I see no reason why we should have an extra-Parliamentary procedure for what amounts to a very small aspect indeed of the whole administration.
A lot of exaggeration has gone on that is not revealed in comparison with the figures involved. We are speaking here of a service involving £340 million a year, of which this figure of £10 million is but a small proportion. We must keep our sense of proportion, because we shall then see that what we are considering is not a considerable retreat from the position we have taken up, but merely a mitigation of the burden which has fallen on the general practitioner service at the present time.
No, Sir. They will be regulations requiring the negative Resolution procedure, but that does not affect the situation seriously because I will so arrange the dates that before the regulations are put in operation, an opportunity will be given to the House for a Prayer, so that as far as Parliamentary procedure allows we shall refer the matter back to the House of Commons before any incidence falls on the citizens of the country.
There is already some evidence, as a consequence of the publicity which has been given to this aspect of the service, of a reduction in some cases of the burden on the general practitioners. There is a growing consciousness that people ought not to abuse the service in any particular. I am convinced that, as the service develops, there will be a growing sense of responsibility, and that discipline of this sort will not eventually be necessary in the service as a whole. I hope, therefore, that with those assurances and those explanations the House will permit me to have the powers for which I am now asking.
Before the right hon. Gentleman sits down, may I ask him a question? If what he hopes really comes about; if this suggestion has already resulted in an improvement in the situation and a reduction in the abuses, and. if that means that when he is considering the result in saving it may possibly be unnecessary for him to introduce these regulations, would he give consideration to that?
Certainly; I am giving consideration to it. As I have said, I am not anxious to burden myself with a complicated administrative machine if I can achieve the same results by other means.
There can be nobody, in any section of the House, who is quite happy about the Amendment with which we have to deal. I do not propose to say much about the general proposition put forward by the hon. Member for Northern Dorset (Mr. Byers). I agree with him generally, and I know that many hon. Members in all parts of the House agree, about the disadvantage of dealing with some of these vital matters by regulation, but that subject is more germane to the general provisions of the principal Act and I do not think we can very usefully discuss it at any length this morning.
Let me say at once that, though I have differed on most political questions from the hon. Member for Barking (Mr. Hastings), when he talks on a subject on which he speaks with experience—as he does in this case—I always listen to him, as I do to many of his medical colleagues, with the greatest attention and respect. I did so in Committee when the principal Act was going through. Perhaps it is not inappropriate that I should make a few remarks today because I number a great many medical men among my constituents.
The most questionable and astounding thing which the Minister said in his speech was his statement that this was a tentative proposal. I cannot imagine why he says this is a tentative proposal. Quotations have already been made from the speeches made by the Prime Minister and the Chancellor of the Exchequer when this matter was first mentioned. In those speeches it was announced as a matter of Cabinet decision and Cabinet policy; the matter is by no means tentative.
I quite agree, but I do not think that that is in favour of the Minister: I think that is in favour of the criticisms which are being offered this morning. A very definite decision was announced by the Prime Minister and the Chancellor of the Exchequer and we now know that exemptions were already contemplated at that time. I suggest to the House—and this cannot be very controversial—that a good deal must have been known about what was contemplated, by the Prime Minister and the Chancellor of the Exchequer at the time they put this proposal forward and named a figure, and. if that is the case. I cannot imagine why the right hon. Gentleman cannot give us more particulars this morning.
I quite agree that an opportunity for debate may arise when the regulations are made, but I should have thought that that very detailed statement of policy by two of the right hon. Gentleman's colleagues did entitle this House to expect that, when we were asked to deal with this Amendment, some particulars of how it was going to work would be put before us. The fact that there is difficulty in any possible scheme has been stated in various quarters of the House, and not least by the two medical gentlemen who have given to the House this morning the benefit of their experience.
The right hon. Gentleman said it was false to say that insured persons were placed in a worse position than before, but surely that is wrong. Some people may, indeed, be placed in a better position as a result of the Act, but some may be placed in a worse position; for a great number of years insured persons have been enabled to obtain their medicine without paying for it. I sometimes think that when hon. Members and right hon. Members opposite say, about various things, "It must never happen again," they should think of their own reforms in the law now suggested and consider that, for many years at any rate, "It did not happen before."
The workability of these proposals depends a great deal on the answer to the numerous questions which have been put from both sides of the House and to which we have had no answer whatever from the right hon. Gentleman. I do not know why the House should not be treated to rather more information. I agree entirely with what was said by one hon. Member, and indeed with what was implicit in the speech of the right hon. Gentleman himself, that it is far better that economy should be exercised than that the Health Service itself should be endangered and, in so far as this Amendment is intended to check abuses, I cannot think that in any part of the House there would be an objection to it. We are, however, entitled to know how it is proposed to carry out the proposals.
I cannot think that the right hon. Gentleman's colleagues can have been so irresponsible as to give an estimate of the saving that this would involve—and the Minister now tells us that they had in mind the fact that exemptions would be made—unless there were some particulars known and decided by the Cabinet, even in October, of what would be contained in these regulations. If there is any such decision, it has been kept entirely dark. The House has no idea whatsoever what these regulations will contain and I do not believe that that is the way in which this House should have been treated. Some detailed questions were put by my right hon. and gallant Friend the Member for the Scottish Universities (Lieut.-Colonel Elliot). Some of those questions have been repeated, I think, by the hon. Member for Barking and some, I think, by the hon. Member for South-East St. Pancras (Dr. Jeger). I cannot think why we should not have an answer to them. It is very difficult to judge the proposals in complete ignorance of what the regulations are to be. I think the Government are in this dilemma: either they have some idea, in which case they ought to have told us, or they have no idea, in which case the speeches of the colleagues of the right hon. Gentleman were irresponsible.
Perhaps I may say a few words on the subject for, as I listened to the Minister, at the time he almost seemed to say that he was actually giving the people £10 million instead of taking it away from them. I recall what people so often say if a lawyer makes a speech like that. They say, "He is only a clever lawyer." If a layman makes a speech like that they say, "What a success he would have made at the Bar." I do not suppose the right hon. Gentleman would like me to say that he would have made a success at the Bar, and, having listened to his speech, quite frankly I do not think he would. I think he would have been a failure, because it was altogether too un-plausible for anything. He went into an elaborate argument with the Libera] Party, which has now left the Chamber, and one or two other Members about whether the position was better than before. Really if a solicitor's clerk had to face that question on a summons he would know better. Of course, it is far better than it was before July, 1948. It is far better than it was when the Liberals first introduced it, although we must be historically fair and say that in 1911 the Liberals did a magnificent job within the limits of that time. The point is—and no lawyer, not even an unscrupulous one, could get away from it—that it is worse by approximately £10 million, which is to come out of the pockets of people who need doctoring, than it was before the cut was imposed.
The next thing in which I thought the right hon. Gentleman was really too ingenious for anything was in dissociating the whole of this Amendment almost entirely from any notion that there has been a financial crisis or a devaluation or a cut. I cannot understand, on that footing, how it was that the Prime Minister announced this. I should have thought that it ought to have been the Minister of Health, because, as far as I can gather, it has got nothing to do with saving money. It is only a coincidence that these medical abuses were, according to the right hon. Gentleman, discovered about the same time that we had one of the crises of the capitalist system. I do not think anybody will believe the right hon. Gentleman on that point. I do not believe that anybody will agree that the whole or main motive for this serious inroad on medical treatment in the country—on which I am not going to dilate be-cause others who know far more about it than I do, have spoken and have spoken very well—was a question of abuses. I do not think anybody would have heard of these cuts of the right hon. Gentleman, if it had not been for the financial motive.
Of course, having now to defend it, the right hon. Gentleman discovers that there are quite substantial abuses. I do not agree. It would have been astonishing if somewhere, here and there, somebody, having for years never got anything for nothing, had not tried to get some- thing for nothing. It is my own limited experience—and I gather that medical experience is much the same—that any abuse has been absolutely negligible and that the real benefit of people having the possibility of getting early treatment, saving many times £10 million in the long run, apart from human health and happiness, immensely outweighs any sort or kind of abuse. If there had been any serious abuse, surely anyone so vigilant as the right hon. Gentleman would have introduced this Amendment long before there was a crisis.
I want to say a word in defence of the right hon. Gentleman, if he does not mind, and even if he does mind, on the question of the power to pass regulations. I think I go perhaps further than most Members on this side of the House not merely in accepting the necessity for legislation by regulation, but in not believing that there is any real abuse or danger in it. I also do not mind the fact that we are asked to give the regulating power here, although what the Minister really wants to do with that power is not at present more than half-baked. I understand the difficulties, and I make no complaint whatever, but I do assert that this particular Amendment should be resisted on the question of principle. However much or however little use the Minister wants to make of this regulating power, it is a blunt question of principle of whether we should go back on this very important item in the great reforms in medical treatment for the working classes, by imposing a very serious barrier on their proper treatment. It is of that principle I propose to speak. The difficulties of regulating powers and so on have not much to do with that.
I was a little amused to discover that the Minister objected to the phrase "making a charge." He said "Oh, no, it is not making a charge at all. We are practically giving the people something. We are letting them off everything on the cost of prescriptions except for one shilling" In those circumstances, I hope the Minister will vote against the Amendment, because I have discovered in the Amendment the sinister words:
Regulations may provide for the making and recovery …, of … charges.
The main criticism of the Government's proposal has been on what the details may prove to be when the regulations are in due course put before the House. I think it would be proper if we withheld our criticisms, which can only be of a hypothetical nature, until we see the regulations. But there is still quite a lot to be said about the general principle involved in this proposed new Clause. For my part, I fully accept the Minister's statement that this Clause was not introduced solely as one of the so-called cuts. Indeed, I think it is true to say that we on this side of the House, long before the cuts, had drawn the right hon. Gentleman's attention to the fact that there were abuses going on, and had suggested to the best of our ability that it was time he looked into them with a view to taking some kind of action both in this connection and in certain other connections, which it would now be out of Order to mention, related to the Health Service.
I think it is relevant here to refer to the precise passage of the Prime Minister's statement made in the House on 24th October last, in which this particular proposal was first announced.
If it is true that this Amendment is mainly to deal with the question of abuse, does the hon. Member agree that the exemptions which are to be made should receive his support, and if so is it not also true that the only abuses are by the younger people and not by old people or pensioners?
The hon. Member is doing exactly what it is impossible for anyone in this House to do this morning—to discuss an entirely hypothetical scheme. We have no idea at all what the Government intend to do, and until we see their proposals how can we possibly criticise them one way or the other? The question here is whether or not we are going to give the Government power by regulation to do something in this connection. It is important, therefore, to see what is the general purpose which is intended.
While speaking of this matter I think it is right to tell the hon. Member that even though I agree that the sole purpose for introducing this measure is not to effect an economy, I entirely disagree with his statement that it is not the main purpose. If it had not been necessary to make economies we should never have been discussing this Amendment this morning.
I quite agree with the hon. Member. In fact, he and I are members of the Estimates Committee and are very well acquainted with the Report in question. I conceded that point in my opening remarks.
The real reason for the introduction of this proposed new Clause is the announcement which was made by the Prime Minister on 24th October last. He said:
The total of these items still falls well short of what we consider necessary. We therefore intend to take certain further measures. We propose to make a charge of not more than 1s. for each prescription under the National Health Service. The purpose is to reduce excessive and, in some cases, unnecessary resort to doctors and chemists, of which there is evidence which has for some time troubled my right hon. Friends the Minister of Health and the Secretary of State for Scotland The resultant saving will contribute about £10 million, although this is not the primary purpose of the charge. Arrangements will be made to relieve old age pensioners of this charge for prescriptions."—[OFFICIAL REPORT, 24th October, 1949; Vol. 468, c. 1021.]
If I read those words in the way I think they were read by everyone who heard them in this House and read them in the country, the effect is that the actual saving intended is to be £10 million or thereabouts, and that is after taking into account the amount lost through the proposed exemptions. If those words do not mean that, I can only say that they were dishonest words intended to mislead this House; and I do not believe they were.
The Prime Minister used the words "approximately £10 million." We do not know, neither does anybody else, and it can only be known retrospectively, how much the exemption of old age pensioners would reduce the amount of £10 million. That is because nobody knows until after they have done it how much these people use the pharmaceutical services.
I quite appreciate that the precise estimate of the amount could not possibly be calculated to within £100,000 or so, but the effect of the statement of the Prime Minister is that, after taking into account such estimate as we can make of the losses through the exemptions, the sum to be saved will be' of the order of £10 million, and that is exactly what has been denied by the right hon. Gentleman from that Box this morning. The only deduction I can make is that the right hon. Gentleman is now trying—I do not put this offensively—to wriggle out of a commitment which was forced upon the Government at the time of the cuts earlier this year.
Does the hon. Gentleman deny that my right hon. Friend the Prime Minister on two occasions in that short passage said that the purpose of the charge was to reduce abuse? Does he further deny that he would like to see exemptions, or would he wish to see all the exemptions abolished in order to get the full £10 million?
I have rarely seen the right hon. Gentleman let loose two red herrings at the same time. Of course not. I do not deny either. The point I am making is that the Prime Minister assured the country that there would be a cut of about £10 million on the services, and now the right hon. Gentleman this morning has put a completely different picture before the House. The words he used in the course of his speech have shown quite clearly that he is no supporter of the Prime Minister in his policy of retrenchment.
The hon. Member is up to his usual game of smiling and smiling and remaining a villain still. What we will want to know from him, and what he does not give us, is the answer to this question: does he wish to co-operate with me in making reasonable exemptions, or does he wish to keep to the strict letter of £10 million?
I have rarely found the right hon. Gentleman in so great a difficulty that he has to invite the services of the Opposition, and of myself in particular, in order to help him out. That is the position he is in. The point is that we are dealing with a proposal to make a saving of £10 million.
On a point of Order, Sir, we are doing no such thing, and in my respectful submission the hon. Member has been out of Order in three parts of his speech. Cuts are not really in question, and Mr. Speaker said so. All that is before the House this morning is the question of power conferred upon the Minister of Health to make regulations which may do what the Amendment says may be done.
Mr. Deputy-Speaker, I will immediately resume my seat when you call me to Order, but I do not think it is for the right hon. Gentleman to attempt to divert attention from the real issue before the House by attempting to put points of Order in this way. The fact of the matter is that when we asked the right hon. Gentleman what is intended by this new Clause, he said quite candidly, because he had no other course to take, "I do not know the answer." That is not a satisfactory position for the House to find itself in when debating whether or not to add such a Clause as this to the Bill.
Then the right hon. Gentleman—speaking, according to his own view, entirely out of Order—rebutted altogether the suggestion that this Clause had anything to do with the cuts, and spoke of the proposal as a temporary easement for the general practitioner, and went on to add in parenthesis "If it becomes practicable." In other words, it appears that the right hon. Gentleman is doubtful whether this Clause will ever become effective. That is the most extraordinary position for the House to find itself in. We believe that the kind of policy indicated by this Clause is the right kind of policy to pursue at the present juncture of our financial affairs and having regard to the needs of the health scheme, but we are in great difficulty in knowing what is the proper attitude to the right hon. Gentleman when he comes forward with proposals about which he says quite candidly that he does not know the answers.
This is a somewhat dishonest procedure being followed by the Government. We started with a firm promise that this proposal would save the country a sum of £10 million. It then appeared that this sum would not become fully effective immediately but must await first, legislation and then regulations. It is
quite clear, however, that the Government still intended the country to believe that the saving would be made reasonably early. I think, Mr. Deputy-Speaker, that I am in Order in quoting the statement of a responsible Minister in another place. Lord Shepherd was asked specifically at what date it was intended to bring in these cuts, and he stated:
A certain amount of it will be in this year, but we shall get the full fruits in a full year.
It would be interesting to know what the right hon. Gentleman understands by "the full fruits." having regard to his statement this morning, but, letting that pass for the moment, it is clear that when this Clause was being discussed in another place it was fully intended that there should be some substantial saving during the current financial year. I press the Govrenment to make a much more specific statement about when they intend to introduce what is proposed under this Clause. If we get no more than we have had today so far, it will be open for the Opposition to say that here is a case where the Government are paying nothing but lip service to the cuts and, because they know they will be unpopular, they are deliberately putting them off until after the General Election.
When we come to decide how to vote on this proposal, the advice I would give to any of my hon. Friends who sought it would be that we ought to support the Clause because the principle involved is the right one, and because the details, when they come to be laid before the House, can be debated. The right hon. Gentleman has given a guarantee that he will lay the proposals before the House before they become effective. Our rights in that respect, therefore, are reserved. In these circumstances I shall support the Motion and I only hope that the policy will be made effective at a reasonably early date.
I hardly think that the speech which we have just heard calls for any reply. To my mind, by far the most important part of the Minister's statement was his hint that this proposed charge may be only temporary. He also stated that the announcement of the charge has already had some effect in reducing the number of prescriptions. If this tendency has, in fact, already begun to show itself, why not defer the charge for a while longer? If the suggested charge can have the effect of steadily inducing a reduction in the number of prescriptions, not only will it save the whole of its administrative costs, but after a period of a few months it may actually save an even larger amount than the £10 million which is envisaged. If the present number of 187 million prescriptions per year could be reduced, allowing for all seasonal variations, by a matter of, say, 15 per cent. within the next six months—and, if this process is continuous, possibly a reduction of 30 per cent. may show itself at the end of 12 months—surely all the need for the imposition of this charge will have vanished.
I ask the Minister especially to bear in mind that what we are up against is not so much an abuse of the facilities granted under the Bill. What it sets out to do in many cases is to change the habits of hundreds of thousands of people who depend to some extent, either psychologically or medicinally, upon the benefit of having a bottle of medicine. I ask him, therefore, if it is not at all possible to delay in the inception of this charge a little while longer.
It may be quite conceivable that my right hon. Friend's successor—the devil whom as yet we do not know—should be given a full chance to reconsider the whole matter. I feel that after a lapse of time we shall find a drop in the prescription rate from the present figure of 187 million to somewhere in the neighbourhood of 150 million, or even 120 million, so that the whole need for this charge of 1s. a bottle, or whatever else the final decision may be, may be totally unnecessary. I ask the Minister to defer the inception of the charge until he has full time to consider its implications; and perhaps within the very near future the time may come when he may be able to justify to the country that it is no longer necessary.
The Minister today seeks to justify the Lords Amendment on the ground that there has been abuse. In fact, on 24th November he was asked a Question in reply to which he said:
There is evidence of unnecessary resort to doctors and chemists which the proposed charge is intended to reduce."—[OFFICIAL REPORT. 24th November, 1949; Vol. 470, c. 505.]
I therefore asked him a Question yesterday, which was answered in writing:
whether he will publish evidence in his possession disclosing unnecessary resorting to doctors and chemists.
The Parliamentary Secretary answered:
No."—[OFFICIAL REPORT, 8th December, 1949; Vol. 470, c. 174.]
It would be very useful if the House could have such evidence in some form or other, for the Minister is basing the main case precisely on this point. In fact, he has attempted, as the hon. and learned Member for North Hammersmith (Mr. Pritt) has shown, to dissociate himself from the origin of the statement which gave rise to the Amendment—namely, that made by the Prime Minister on 24th October, which was directly in relation to the proposed economy cuts, and the similar statement which followed from the Chancellor of the Exchequer. Therefore, if the Minister is attempting to dissociate himself in that respect, ought not the House to have evidence?
We have this morning heard several medical Members of the House, one of whom, as many of us know, is in actual practice as a general practitioner; he practises in a working-class area in Shore-ditch and, I believe, has another practice also. The hon. Member said that he has no evidence of this abuse. Another hon. Gentleman who spoke is a man with very long experience in the medical profession and one whom we all respect. He, similarly, made the very important statement that all the doctors he has questioned on this matter—he holds a position in the Socialist Medical Association—
Of all the doctors he has questioned about this, the hon. Member finds that more than half say that there is abuse. He went on to add that most of those who say there is abuse, are of the kind who have constantly objected to the Act in any case. That is the kind of evidence we have had. Another medical member also has spoken, and although he produced no evidence he has nevertheless pleaded against the immediate introduction of the Amendment. The House is justified therefore, in seeking evidence to show that abuse exists. In fact, there is no one who can give the evidence.
I have read that report. Anyone who reads it must ask this question: Who is giving the evidence? If the doctor gives the evidence, he is casting a slur on himself. The patient cannot give the evidence, for either the patient seriously believes that he needs the medicament or he is abusing and certainly will not give evidence to that effect. Even in those cases, as the hon. Member for Barking (Mr. Hastings) said, he is more likely than not to be a neurotic and does not even know that he is abusing in that sense. Therefore, from whom are we to get this evidence? In fact, there is no evidence which any court or any inquiry could really accept.
What the Minister must admit is that, granted there would be cases of abuse—as the hon. Member for Barking said, this is likely—he is making the innocent suffer for the guilty. No exemptions which he can possibly introduce and which he mentioned in his speech can be such that the innocent do not pay for the guilty. The Minister can only exempt certain categories either of obvious serious illness or of certain classes towards which there is special sympathy, such as the old folk, ex-Service men and so on. The right hon. Gentleman went on to say that recently there has been evidence to show that there has been less demand as a result of the announcement. That may be so, but he is not suggesting that this lesser demand arises from the fact that the abusers are no longer abusing; it may be that the lesser demand arises because of the kinds of cases referred to by the hon. Members for South-East St. Pancras (Dr. Jeger) and Barking, who speak with experience—namely, that people who require to go to doctors are refraining from doing so and that, therefore, this is merely leading up to much more serious illness later.
This would assume, as the language of the hon. and learned Member for North Hammersmith (Mr. Pritt) would assume, that the charge is imposed now. The charge is not imposed now.
No, the Minister was trying to show that there was some abuse and made the point, which the House will accept, as no doubt he has the figures about it, that there is evidence to show that there was a less demand in the last few weeks, which he believes is related to the announcement of the Prime Minister a few months ago. I think he will agree that that was the tenor of his argument.
Really we are having a great deal of repetition of the same arguments this morning. I said that in consequence of the publicity given to this matter, not only of the announcement in the House of Commons but by Press interviews and what not, there has been a marked fall in certain areas in the demands on the chemists and general practitioners. It cannot be as a consequence of the imposition of a charge, because no charge has been made.
Evidently the Minister did not hear me, as that is exactly what I said. I said that arising from the statement of the Prime Minister and the Chancellor's statement in October and the publicity, there has been less demand and I accept that there has been less demand. But has the Minister got proof, and is he satisfied, that this lesser demand arises from the fact that the abusers have stopped abusing, or may it come from the fact that some people are hesitant now in going to doctors because they are afraid they may land themselves into some kind of prescription which may later on incur a charge and the public are not sure when it may be made? We have not had a hint of the time.
I was a member of the Standing Committee which discussed this matter three years ago. We were all very pleased with most of the points in the Bill. One of the points the Minister made on the Second Reading on 30th April, 1946, was:
it has been the firm conclusion of all parties that money ought not to be permitted to stand in the way of obtaining an efficient Health Service.
A few lines later he said:
It is cardinal to a proper health organisation that a person ought not to be financially deterred from seeking medical assistance at the earliest possible stage."—[OFFICIAL REPORT. 30th April, 1946; Vol. 422, c. 43.]
That was the particular point to which the hon. Member for Barking referred several times in the course of his very
important speech this morning, that no patient should be deterred because of incurring a financial charge, but now the Minister proposes that the patient should incur this charge. It is clear that there is widespread opposition, for what the Minister said in April, 1946, was true—that was the view of all parties and all enlightened persons; and now this charge, however small it may be in relation to the overall expenditure of more than £300 million on health, is a step away from the principle that he laid down rightly and wisely three and a half years ago. It is, therefore, no surprise now to see a united front between the British Medical Association and the Socialist Medical Association. It is no surprise because that was the principle to which everyone agreed.
This morning the Minister showed his attitude when he replied to one half of the Debate in the course of which he appeared to be so conciliatory. I feel hon. Members should not accept so easily what the Minister said, however much he may intend, or would like to intend, that the proposed charge should be a temporary charge. The hon. Member for Preston (Dr. Segal) made reference to this. I believe the Minister would like it to be a temporary charge and I believe frankly, that the Government would like it to be a temporary charge, but as other circumstances are pushing the Government in certain directions, this may not only become more than a temporary charge, but other charges may yet be introduced.
I ask the Minister to note particularly what the hon. Member for Putney (Mr. Linstead) said this morning when he almost anticipated this as a precedent for other charges. In fact, that is the line which many of the Tories have been plugging for a long time. While the Minister rightly said that in this Amendment he is confined to pharmaceutical matters, there will be pressure from the other side of the House and by economic circumstances for this to be extended.
The reason, in fact, is not abuse, whatever evidence the Minister may have of that and whatever evidence the Estimates Committee may have presented on that. The main reason is that which was given by the Chancellor and the Prime Minister—an economic one. In this connection, several hon. Members have asked Questions of the Minister in the last few weeks about taking steps in connection with the drug industry and reducing the charges for medicaments. May I draw his attention to some of the profits that are made, because if we are to discuss the question in all its aspects of whether there is need for this Amendment to be introduced and whether the money can be. saved in some other way than by imposing burdens on patients, these are matters which we cannot overlook.
I have a list of about a dozen cases, but I will give only two or three in order not to burden the House unduly. The names are popular household names. Glaxo Laboratories who, among other things, produce penicillin, made a profit in 1948 of £1,641,000 and a net profit of £660,000. In 1949 it was £2,605,000 and a net profit of £930,000. As the directors are very good, patriotic citizens, this firm obeyed the requests of the Chancellor of the Exchequer and did not increase their dividends. In 1948 they distributed 125 per cent. and so they confined them in 1949 to 125 per cent. If there was a case for saving expenditure, then the Government could save expenditure if they sought to cut down the prices these firms are charging, for these profits show there is plenty of scope for their prices to be cut.
I am glad Sir that you think that is a very good case, and I rest myself on it. Let me give an example of price fixing. The Minister said that there is a Committee dealing with this matter, and we hope to hear more about it. I will give an example of price fixing and the way in which the racket works. Here is the case of "Dexadrine"—
Further to that point of Order, if it was a point of Order, may I point out that I am trying to show that this Amendment, which seeks to give the Minister power to impose a charge, on patients, seeks to do so on more than one ground—not only the ground of abuse, but the economic ground. I have made some points on the question of abuse and am trying to show that even on the economic ground there are other ways of saving the money than this, and I hope to show that there is no need for the Minister to make this charge. If I may proceed, Mr. Deputy-Speaker—
Thank you very much. Let me give this example. "Dexadrine," which I understand is a very useful drug, was first introduced by Menley and James under the trade mark "Dexadrine" at 126s. per thousand. The same tablets were shortly afterwards marketed under their scientific name by Ward Blenkinsop—no relation, I trust, of the Parliamentary Secretary to the Ministry of Health—at 31s. per thousand. Within the last few weeks, according to my information, Boots have marketed the same preparation at 8s. 6d. per thousand—one-fifteenth of their original price.
I will give an example in connection with price fixing to show what could have been done in this sphere if the Minister had put his foot down, as he could have done four years ago, thus saving plenty of money for the Exchequer. Procaine-penicillin, a very important drug, was first sold on the market in this country by I.C. (Pharmaceuticals) at 44s.' a phial. A few weeks later it was sold by Glaxo Laboratories at 32s. As a result of negotiations between the firms interested and Allen & Hanburys, the price was ultimately fixed at 36s. There is an example of what under capitalism would be called useful competition, one firm undercutting another, followed however by a combination of the competitors, a cartel, who decided on a figure of 36s.—4s. above the price of the most efficient manufacturer.
If the Chancellor wishes to save money, and the Minister of Health, in asking the House to agree to this Lords Amendment today, acknowledges that part of the reason for the Lords Amendment is the economic position, there is plenty of scope on the part of the Exchequer for cutting down expenditure. These are some of the grounds which I seek to place before the House. I hope that on these grounds, in addition to the very good points put forward earlier, the Minister will not press this Lords Amendment; otherwise I trust that many hon. Members will vote against it.
There has been a little confusion in this matter on the part of the Minister and other people who have spoken on this subject. I can see the necessity for regulations in respect of one of the two cases that have been mentioned. Because of that I shall support the Minister's request in this matter but I would ask the Minister himself to be quite clear about the reason for these regulations because the reason will obviously dictate the content of the regulations. The first reason given was the necessity for economy. It has been debated a little this morning that that fact is not the case at the present time, but the fact remains that that was the first reason given for the necessity to introduce regulations. That is borne out by the fact that if economy is needed in this service then exemptions from the measures to be taken should be given to certain classes of people—those least able to bear any charge which might have to be made as a result of the regulations.
I do not disagree with that argument; I think it is perfectly valid and acceptable. But we now have another reason given for the necessity for regulations. That reason was given as abuse. If we are to deal with abuse it will have to be dealt with in regulations in a manner different from that which would be adopted if we were dealing with the matter from point of view of economy. I think that the Minister thoroughly realises that. I wish briefly to postulate those two points to him. Regulations are necessary for either one or the other of these reasons, and if regulations are necessary, and I am accepting the fact that they are, the regulations will obviously differ in accordance with which is the reason for the regulations being drawn up.
I ask the Minister to recognise this factor when he is drawing up his regulations because abuse is not particularised in any one class or age of people, whether middle-class people or old people, but if regulations are drawn up for reasons for economy exemptions will obviously be necessary on the grounds which the Minister indicated. I hope that he will bear that point in mind because one of his strong points in this matter is his logic.
|Division No. 301.]||AYES||[1.37 p.m.|
|Adams, Richard (Balham)||Chetwynd, G. R||Hynd, J. B. (Attercliffe)|
|Albu, A. H.||Collindridge, F.||Irving, W. J. (Tottenham, N.)|
|Allen, Scholefield (Crewe)||Cove, W. G||Isaacs, Rt. Hon. G. A.|
|Austin, H. Lewis||Daines, P.||Jenkins, R. H.|
|Ayrton Gould, Mrs. B||Davies, Haydn (St. Pancras, S.W.)||Jones, Rt. Hon. A. C. (Shipley)|
|Baldwin, A. E.||de Freitas, Geoffrey||Jones, D. T. (Hartlepool)|
|Balfour, A.||Dobbie, W.||Jones, Elwyn (Plaistow)|
|Bechervaise, A. E.||Ede, Rt. Hon. J. C||Keeling, E. H.|
|Bellenger, Rt. Hon. F J||Edwards, John (Blackburn)||Key, Rt. Hon. C. W.|
|Bennett, Sir P.||Elliot, Lieut.-Col. Rt. Hon. Walter||King, E. M.|
|Beswick, F.||Erroll, F. J.||Kinghorn, Sqn.-Ldr. E.|
|Bevan, Rt. Hon. A. (Ebbw Vale)||Evans, Albert (Islington, W.)||Kirby, B. V.|
|Bing, G. H. C.||Follick, M.||Law, Rt. Hon. R. K.|
|Binns, J.||Foster, J. G. (Northwich)||Lee, Miss J. (Cannock)|
|Blenkinsop, A.||Freeman, J. (Watford)||Lindgren, G. S.|
|Bottomley, A. G.||Gaitskell, Rt. Hon. H. T. N.||Lipton, Lt.-Col. M.|
|Bowden, H. W.||Ganley, Mrs. C. S.||Lucas-Tooth, Sir H.|
|Braddock, T. (Mitcham)||Greenwood, Rt, Hon. A. (Wakefield)||McAdam, W.|
|Bramall, E. A.||Griffiths, Rt. Hon. J. (Llanelly)||McCorquodale, Rt. Hon. M. S|
|Broughton, Dr. A. D. D||Guy, W. H||MacDonald, Sir M. (Inverness)|
|Bruce, Maj. D. W. T.||Hall, Rt. Hon. Glenvil||Macdonald, Sir P. (I. of Wight)|
|Burden, T. W.||Hewitson, Capt. M.||McEntee, V. La T.|
|Callaghan, James||Hobson, C. [...].||McGhee, H. G.|
|Carson, E.||Holman, P.||McKay, J. (Wallsend)|
|Channon, H.||Hudson, J. H. (Ealing, W.)||Mackeson, Brig. H. R.|
|Chater, D.||Hynd, H. (Hackney, C.)||Manning, Mrs. L. (Epping)|
|Marquand, Rt. Hon. H. A.||Robinson, Kenneth (St. Pancras, N.)||Symonds, A. L.|
|Mayhew, C. P.||Rogers, G. H. R.||Thomas, John R. (Dover)|
|Mikardo, Ian||Ross, Sir R. D. (Londonderry)||Tiffany, S.|
|Mitchison, G R||Royle, C.||Tomlinson, Rt. Hon. G.|
|Morley, R.||Savory, Prof. D. L.||Vernon, Maj. W. F.|
|Nally, W.||Segal, Dr. S.||Viant, S. P.|
|Nichol, Mrs. M. E. (Bradford, N.)||Shawcross, Rt. Hon. Sir H. (St. Helens)||Wakefield, Sir W. W.|
|Nicholls, H. R. (Stratford)||Silkin, Rt. Hon. L.||Wallace, H. W. (Walthamstow, E.)|
|Noel-Baker, Capt. F. E. (Brentford)||Skeffington-Lodge, T. C||Weitzman, D.|
|Noel-Baker, Rt. Hon. P J. (Derby)||Skinnard, F. W.||Wheatley, Colonel M. J. (Dorset, E.)|
|Noel-Buxton, Lady||Smith, C. (Colchester)||Whiteley, Rt. Hon. W.|
|Paget, R. T||Smith, H. N. (Nottingham, S.)||Willey, F. T. (Sunderland)|
|Palmer, A. M. F.||Smithers, Sir W.||Willey, O. G. (Cleveland)|
|Pannell, T. C.||Snow, J. W.||Williams, D. J. (Neath)|
|Pargiter, G. A.||Sorensen, R. W.||Williams, W. R. (Heston)|
|Parker, J.||Sparks, J. A.||Winterton, Rt. Hon. Earl|
|Parkin, B. T.||Steele, T.||Woodburn, Rt. Hon. A.|
|Proctor, W. T.||Stewart, Michael (Fulham, E.)||Woods, G. S.|
|Ranger, J.||Stubbs, A. E.|
|Rees-Williams, D. R.||Summerskill, Rt. Hon. Edith||TELLERS FOR THE AYES:|
|Reid, T. (Swindon)||Sutcliffe, H.||Mr. Pearson and Mr. G. Wallace.|
|Ayles, W. H.||Granville, E. (Eye)||Roberts, W. (Cumberland, N.)|
|Byers, Frank||Hutchinson, H. L. (Rusholme)|
|Davies, Rt. Hn. Clement (Montgomery)||Pritt, D. N.||TELLERS FOR THE NOES:|
|George, Lady M. Lloyd (Anglesey)||Reed, Sir S. (Aylesbury)||Mr. Piratin and Mr. Solley.|
Question put, and agreed to.
In page 11, line 15, after the Amendment last inserted, insert new Clause "C"(Recovery of charges from persons resident outside Great Britain).
C.—(1) The powers of the Minister to make regulations under the Act of 1946 shall, notwithstanding anything in section one of that Act, include power to make regulations providing for the making and recovery, in such manner as may be prescribed, of such charges, in respect of such services provided under the Act of 1946, as may be prescribed, being services provided in respect of such persons not ordinarily resident in Great Britain as may be prescribed; and such regulations may provide that the charges are only to be made in such cases as may be determined in accordance with the regulations.
(2) This section shall apply to Scotland with the substitution for the reference to the Minister of a reference to the Secretary of State and for the reference to the Act of 1946 of a reference to the Act of 1947.
I beg to move, "That this House doth agree with the Lords in the said Amendment."
This Amendment carries out the undertaking given on the Report stage of the discussions on this Bill, in that it gives power to my right hon. Friend to make regulations for the making and recovery of charges for any use which may be made of the National Health Service by persons not ordinarily resident in Great Britain. I should make it quite clear that my right hon. Friend, as he mentioned at the time when this was considered on the Report stage, has no intention of any general and wholesale exclusion of foreign visitors from the benefits of the scheme in any regulations that he might lay before the House. Rather he would seek to try to secure the ending of any abuses by any persons who might conceivably come to this country especially and entirely for the purpose of securing free treatment of one kind or anpther. But we have always made it clear that in fact there is very little evidence of abuses of this sort, and that the statements about it which have been given a good deal of publicity, when we have examined them, have had very little basis at all.
Subsection (1) of this Clause provides that regulations made under the Clause shall specify to what services the charges will apply and what the charges are to be. The regulations also will lay down to what class of persons not ordinarily resident in Great Britain the charges will apply. Again we do not want this necessarily to apply to everyone. Owing to the difficulties which undoubtedly will be met in framing the regulations, and so that they will not prove too rigid in their application, it is provided that the charges shall be made only in cases where the Minister so determines.
With those provisos we seek power to make regulations that will check any abuses there may be, but at the same time we are most anxious to avoid regulations which will cause a great deal of concern and difficulty throughout the Service, both to those normally resident and those who we feel have the natural rights of hospitality and reasonable treatment and service should they fall ill when they come to this country.
This Amendment, like the others, follows a familiar course. First the Opposition bring forward certain suggestions. Then the Government say they are impossible. Then the supporters of the Government, rashly believing that the Government mean what they say, deliver a number of sentimental speeches on the subject. Later on the Government say that the thing will be done, and introduce regulations. It is also true to say that the Minister has followed common form—
The right hon. and gallant Gentleman said that the Government introduced regulations. We are only seeking the power, as he will agree, to make regulations. As we have said already, this is a very complicated matter, and it will take some time to make the regulations.
That is the sign of grace. I take it that when the cat is away the mice will play, and therefore the Parliamentary Secretary adheres to the pledge. It is, of course, true to say that this was moved by the Opposition, and it was only after pressure from the Opposition that the suggestion by the Minister that he might think over it was made. It was made so late that it did not come in until after the hon. Member for Hornchurch (Mr. Bing) had made an eloquent speech quoting Scripture, and suggesting that the Opposition was proposing to repeal the Parable of the Good Samaritan. The hon. Member for Hornchurch, with great tact, is not in his place—
I think again that the Parliamentary Secretary is not completely accurate. We gave the Minister power to make regulations just as he is taking here. He has the power to make regulations and charges on anybody and in any amount, the only criterion being, "not ordinarily resident in Great Britain." That in fact was the criterion which we applied. Naturally we are glad to see this sign of grace. We are glad to have it admitted at last by the Minister that there was a case in the representations put forward. I trust that the Press will also be gratified to find the Minister apologising, although a little tardily, and admitting that the case put forward in the Press has a certain amount of basis. Naturally, the Minister minimises the basis of it. The Minister sufficiently admits the case to ask King, Lords and Commons to give him power to deal with this abuse and I trust very much that it will obviate the necessity in which the Minister, and indeed the Government, were placed before that, when the determination whether people were coming into this country for the purpose of seeking medical advice or not was left to the immigration officer to decide. I think that that was the crowning absurdity and I am glad to find that that absurdity is to be erased from our administration. Of course, we welcome the new Clause.
The right hon. and gallant Gentleman the Member for the Scottish Universities (Lieut.-Colonel Elliot) seems to claim for himself and his party credit for this Amendment. I listened attentively to the speech of the right hon. and gallant Gentleman when he moved a somewhat similar Amendment on the Report stage of this Bill, and I have recently refreshed my memory by reading the OFFICIAL REPORT of that Debate. In that speech he admitted that my right hon. Friend the Minister of Health had previously arranged for immigration officers to turn back aliens who were coming to this country to secure the benefit of the free Health Service. As he has said, my right hon. Friend in that Debate stated that it was his intention to bring to the notice of another place this matter which was causing him concern so that a suitable Amendment could be framed. The right hon. and gallant Gentleman really should not claim credit for this. My right hon. Friend was ahead of him all the time, as is invariably the case.
The hon. Member really must at least get the clock right. He will see that the Minister spoke long after the Amendment had been moved and seconded from this side of the House and we took exception—I have taken it again today—to the fantastic way in which the matter was previously being dealt with—namely, that an immigration officer was asked to decide upon clinical data.
The fact that the Minister had taken action by requesting the immigration officers to watch this matter shows that he had not overlooked it. If it is any consolation to the right hon. and gallant Gentleman I will say that the Amendment which he moved, his eloquence in doing so and the entertaining exchange of words which occurred between him and my right hon. Friend, spread further interest in this matter in this House and in the country.
As I read this Amendment, it appears to me that it would allow a Minister of Health to make charges on all foreigners using our Health Service. I hope that no future Minister of Health will make such a regulation. The present Minister of Health is unlikely to do so. He said in this House that a reasonable use of the service by those who fall ill when visiting this country is a part of hospitality.
Of course I realise that the words "persons resident outside Great Britain" include people of British nationality. These regulations will necessarily be complicated. It was my hope that some special allowances might be made for people of British nationality.
I was at a meeting a few months ago where there was a discussion on this subject. We listened to arguments for and against the policy. After a while a young woman at the back of the hall said that she was a visitor to the United Kingdom from the United States of America. She said that she had had no illness in her life and that her health was then good, but she added, "If I am taken ill whilst away from home, it is good to know that someone will look after me." She felt the comfort of being among good Samaritans. I think that she is only one of thousands of foreigners to carry back to their own lands grateful memories of our generosity. The use of the Health Service by foreigners has not cost the country a great deal of money. The price has been small for the amount of international good will and friendship which has been created. I hope that we shall continue to give free medical attention in those bona fide cases of illness which occur among foreigners visiting this country. Surely, it is our desire to set an example to the world in courtesy and in international ethics.
Abuses by people who come deliberately to the United Kingdom to take advantage of a free service present another matter. That practice must be checked. Quite apart from economic reasons which certainly cannot be ignored, on principle we must not allow such conduct.
When regulations are made to stop abuses by foreigners, I hope that care will be exercised not to discourage people from other countries coming here for medical and surgical treatment if they are prepared to pay for it. If they are willing to pay the costs of private wards in hospitals, drugs, dressings and doctors' fees, no impediment should be placed in their way.
People from many countries go to Switzerland for sanatorium treatment. We hear of people going to the United States of America for difficult and delicate brain operations. In this country we have hospitals of fame, physicians and surgeons of international repute, and we have a new, efficient and improving Health Service. I think that we should encourage rather than debar from our country foreigners seeking treatment, provided they cause us no financial loss.
To summarise my views, I place foreign patients in three categories. First, there are those who are taken ill whilst with us. They should be allowed, if they so wish, to have free medical attention. Secondly, there are those who come to grasp something for nothing. They must be stopped. Thirdly, there are those who come for medical attention and are ready to pay for it. They should be welcomed. When regulations are drafted, I hope that each of the three categories I have mentioned will receive just regard.