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.