Clause 7. — (Removal of Hardships.)

Part of Orders of the Day — National Health Service (Amendment) Bill – in the House of Commons at 12:00 am on 9th December 1949.

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Photo of Dr Santo Jeger Dr Santo Jeger , St Pancras South East 12:00 am, 9th December 1949

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.

11.30 a.m.

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—