Prescription Charges

Oral Answers to Questions — Ministry of Health – in the House of Commons at 12:00 am on 20th March 1961.

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Photo of Mr Albert Oram Mr Albert Oram , East Ham South 12:00 am, 20th March 1961

asked the Minister of Health what consultations he has had with professional organisations of chemists about the procedure to be followed in respect of items prescribed under the National Health Service for which the ordinary retail price is less than 2s.; and if he will make a statement.

Photo of Mr Enoch Powell Mr Enoch Powell , Wolverhampton South West

I am in touch with the Chemist Contractors Committee, as indicated in my reply to the hon. Member on 6th March.

Photo of Mr Albert Oram Mr Albert Oram , East Ham South

Will the Minister bear in mind that it is important not only that the chemists should know the procedure in such cases, but that the patient should know when the retail price of the item prescribed is less than 2s.? Will the Minister take this into account in the discussions which will take place?

Photo of Mr Enoch Powell Mr Enoch Powell , Wolverhampton South West

Certainly. The hon. Member's Questions have been useful in drawing attention to this fact.

Photo of Mr Kenneth Robinson Mr Kenneth Robinson , St Pancras North

Does not the Minister think that the procedure which he has suggested will certainly involve the chemist in a good deal of extra work and, in particular, in a lot of on-the-spot costings which hitherto he has not had to do?

Photo of Mr Enoch Powell Mr Enoch Powell , Wolverhampton South West

I do not think that there will be any practical difficulty for the chemist in knowing whether an item when sold retail over the counter would have cost appreciably less than 2s.

Photo of Mr Richard Kelley Mr Richard Kelley , Don Valley

asked the Minister of Health (1) what is the cost of the ingredients of a week's treatment with aspirin compound tablets;

(2) what is the cost of the ingredients of a week's treatment with dexamphetamine tablets.

Photo of Mr Stephen Swingler Mr Stephen Swingler , Newcastle-under-Lyme

asked the Minister of Health (1) what is the cost of the ingredients of a week's treatment with gentian violet paint;

(2) what is the cost of the ingredients of a week's treatment with penicillin eye ointment.

Photo of Mr William Wilkins Mr William Wilkins , Bristol South

asked the Minister of Health (1) what is the cost of the ingredients of a week's treatment with sulphacetamide ointment;

(2) what is the cost of the ingredients of a week's treatment with thyroid, ½ grain.

Photo of Mr Edward Milne Mr Edward Milne , Blyth

asked the Minister of Health (1) what is the cost of the ingredients of a week's treatment with phenobarbitone, ½ grain;

(2) what is the cost of the ingredients of a week's treatment with ephedrine, ½ grain.

Photo of Mr William Owen Mr William Owen , Morpeth

asked the Minister of Health what is the cost of the ingredients of a week's treatment with vitamin B1 compound.

Photo of Mr Gerald Reynolds Mr Gerald Reynolds , Islington North

asked the Minister of Health what is the cost of the ingredients of a week's treatment with Lanoxin tablets.

Photo of Mr Norman Dodds Mr Norman Dodds , Erith and Crayford

asked the Minister of Health what is the cost of the ingredients of a week's treatment with magnesium trisilicate powder.

Photo of Mr Reginald Prentice Mr Reginald Prentice , East Ham North

asked the Minister of Health (1) what is the cost of the ingredients of a week's treatment with gelusil tablets;

(2) what is the cost of the ingredients of a week's treatment with amytal tablets.

Photo of Sir Leslie Plummer Sir Leslie Plummer , Deptford

asked the Minister of Health (1) what is the cost of the ingredients of a week's treatment with sodium bicarbonate compound;

(2) what is the cost of the ingredients of a week's treatment with white liniment.

Photo of Mr Cyril Bence Mr Cyril Bence , Dunbartonshire East

asked the Minister of Health (1) what is the cost of the ingredients of a week's treatment with magnesium hydroxide mixture;

(2) what is the cost of the ingredients of a week's treatment with fergon tablets.

Photo of Mr Archibald Manuel Mr Archibald Manuel , Central Ayrshire

asked the Minister of Health what is the cost of the ingredients of a week's treatment with Disprin tablets.

Photo of Mr Charles Loughlin Mr Charles Loughlin , Gloucestershire West

asked the Minister of Health (1) what is the cost of the ingredients of a week's treatment with turpentine liniment;

(2) what is the cost of the ingredients of a week's treatment with Soneryl tablets.

Photo of Mr William Warbey Mr William Warbey , Ashfield

asked the Minister of Health what is the cost of the ingredients of a week's treatment with mercury eye ointment.

Photo of Mr Enoch Powell Mr Enoch Powell , Wolverhampton South West

I will, with permission, answer Questions 22 to 25 and 28 to 31 and 33 to 35 and 37 to 46 together.

Photo of Mr Gerald Reynolds Mr Gerald Reynolds , Islington North

On a point of order. The Minister asks the permission of the House to answer all these Questions together, but they do all refer to different types of prescription, and unless he is going to use a catalogue I do not see how this can be done. As far as I am concerned, I am not willing to give permission.

Photo of Sir Harry Hylton-Foster Sir Harry Hylton-Foster , Cities of London and Westminster

As far as the words "with permission" are concerned, the House will remember that I ruled in accordance with my predecessor's Ruling that they are a polite expression and do not involve any power to refuse. As for the rest of the point of order, it must be right, I think, first of all to hear what the proposed Answer is.

Photo of Mr Norman Dodds Mr Norman Dodds , Erith and Crayford

Further to that point of order, will you explain, Mr. Speaker, why words are used which are purely polite and mean nothing at all? It seems nonsensical to use these words if we cannot refuse permission.

Photo of Sir Harry Hylton-Foster Sir Harry Hylton-Foster , Cities of London and Westminster

Such is the practice of the House. I would be changing the Rulings of my predecessor if I ruled otherwise.

Photo of Mr William Wilkins Mr William Wilkins , Bristol South

Further to that point of order, do I understand that the Minister omitted to include Question No. 28 in that catalogue?

Photo of Mr Enoch Powell Mr Enoch Powell , Wolverhampton South West

No, not 27.

The amount used in a week's treatment, and therefore the cost, will vary from case to case.

Several Hon. Members:

rose——

Photo of Mr Stephen Swingler Mr Stephen Swingler , Newcastle-under-Lyme

Is not this an abuse of the rules of the House? The Minister has answered a whole number of Questions, all of which deal with individual items and ask for them to be costed, and we have asked the Minister to give information. He then lumps them together and abuses the procedure by saying that it is impossible to give the information. Is that not an abuse of the rules of the House?

Photo of Sir Harry Hylton-Foster Sir Harry Hylton-Foster , Cities of London and Westminster

No. I am not able to say that anything that has happened so far is out of order or an abuse.

Photo of Mr Stephen Swingler Mr Stephen Swingler , Newcastle-under-Lyme

May I ask a supplementary question?

Photo of Sir Harry Hylton-Foster Sir Harry Hylton-Foster , Cities of London and Westminster

When the hon. Member's turn comes, otherwise I shall be getting out of order and forget.

Photo of Mr Norman Dodds Mr Norman Dodds , Erith and Crayford

On a point of order. I put it to you, Mr. Speaker, that in Question No. 35 I ask what is the cost of a particular item for a week. You said that we should wait until we heard the Answer given by the Minister, but I have not got the details I have asked for. Is it not patent, from the way in which the Minister has blatantly answered all these Questions, that this is an abuse of the rules of this House, and can we not have your protection in a matter like this? He quite clearly has abused the House.

Photo of Sir Harry Hylton-Foster Sir Harry Hylton-Foster , Cities of London and Westminster

I think the hon. Member did not hear me. I said that there was no question of abuse or anything out of order. I have so ruled. I call Mr. Swingler.

Photo of Mr Stephen Swingler Mr Stephen Swingler , Newcastle-under-Lyme

With reference to Questions Nos. 24 and 25, bearing in mind that the Minister has held his office for only a short time, is he not aware that they represent a perfectly normal prescription for a week's treatment, and would he not therefore kindly make further inquiries in the profession, when they will be able to tell him roughly the quantity which is involved, so that he may possibly give me the costing?

Photo of Mr Enoch Powell Mr Enoch Powell , Wolverhampton South West

Not as I am advised. May I say that there is no wish on my part to withhold any information from the House which it is within my power to give. My difficulty is that the Questions do not specify an amount which it was practicable for me to cost, but I am available to give any information which I can to hon. Members.

Photo of Mr William Wilkins Mr William Wilkins , Bristol South

The reply which the Minister has just given is completely unsatisfactory from this point of view.

He says that he is unable to give an answer because he was not made aware of the amount to cost, but in Question No. 28 he will find that I am asking what is the cost of the ingredients of a week's treatment with sulphacetamide ointment, which is an eye ointment which would be prescribed. What one gets under the National Health Service is a small tube which is valued at 1s. 3d., which may last for three to five weeks, so it ought to be possible for the Minister to tell us that it would be roughly about 3d.

Photo of Mr Enoch Powell Mr Enoch Powell , Wolverhampton South West

I am sorry, but my difficulty is that the expression "cost of a week's treatment" has no meaning sufficiently ascertainable for me to carry out the costing.

Photo of Mr Edward Milne Mr Edward Milne , Blyth

Will the Minister tell us whether the prices of the items mentioned in Questions Nos. 30 and 31 fall below 2s., and if that is so and as in view of his earlier reply he seems to be so badly briefed on the subject, what hope is there of concluding successful negotiations with the profession to secure ending this anomaly of over-charging which has arisen and ought to be removed, and which has taken place within the last three weeks?

Photo of Mr Enoch Powell Mr Enoch Powell , Wolverhampton South West

Questions Nos. 30 and 31, no more than the other Questions, specify any ascertainable quantity.

Photo of Mr Edward Milne Mr Edward Milne , Blyth

A week's supply.

Photo of Mr Enoch Powell Mr Enoch Powell , Wolverhampton South West

Exactly, but it is not an ascertainable quantity. But, as I say, I shall be glad, in any way I can, to be at the service of hon. Members to supply the prices of specific amounts of ingredients.

Photo of Mr Edward Milne Mr Edward Milne , Blyth

In view of the unsatisfactory nature of that reply——

Hon. Members:

No.

Photo of Sir Beresford Craddock Sir Beresford Craddock , Spelthorne

The hon. Member has done it now.

Hon. Members:

No.

Photo of Mr William Owen Mr William Owen , Morpeth

Would the Minister be good enough to tell the House whether it is possible for his Department to ascertain from the doctor who prescribes a week's treatment the amount which is involved in terms of cash, and, on the basis of that information, would he not be willing to compare it in terms of what is now the recognised prescription charge?

Photo of Mr Enoch Powell Mr Enoch Powell , Wolverhampton South West

The difficulty is that doctors, quite rightly, perscribe different quantities for a week, or any other period.

Photo of Mr Gerald Reynolds Mr Gerald Reynolds , Islington North

Is the Minister not aware that the various prescriptions mentioned here are the normal quantities prescribed by doctors and that they would cost less than 2s.? Is he not further aware that his predecessors have advised doctors in the past not to prescribe for more than one week? Would he, therefore, have a look at some of the prescriptions mentioned here and advise the doctors, where the dosages are small, that they may in those circumstances, where it is necessary, prescribe for more than one week so that the patient may avoid having to pay 2s. per week and so keep the prescription charge at about the 2s. mark?

Photo of Mr Enoch Powell Mr Enoch Powell , Wolverhampton South West

I am sure the hon. Member is aware that where there is a foreseeable need for continuing treatment doctors are not merely free but are advised to prescribe for that longer period, and that results in the saving of the dispensing fee.

Photo of Mr Norman Dodds Mr Norman Dodds , Erith and Crayford

It is well known that a week's treatment with the powder mentioned in Question No. 35 is ordinary. Is the Minister not aware of this? If he is aware of it, why is it not possible to give the costing? Is he aware that I am getting complaints from constituents that they are prescribed the minimum and that 2s. is the minimum charge, and that people are feeling very dissatisfied about matters like this? Will he help us with these questions?

Photo of Mr Enoch Powell Mr Enoch Powell , Wolverhampton South West

My advice is contrary to what the hon. Member says about the standard meaning of a week's treatment, but if he will specify the quantities of these substances I will gladly cost them.

Photo of Mr William Wilkins Mr William Wilkins , Bristol South

Did the Minister answer Question No. 29 in the replies he gave?

Photo of Sir Leslie Plummer Sir Leslie Plummer , Deptford

Referring to Questions Nos. 39 and 40, may I ask whether it is not possible for the Minister to have a random sample taken by his Department of what has been the average cost over the last convenient period of prescriptions such as I have mentioned? Could he not then tell the House exactly how much they cost?

Photo of Mr Enoch Powell Mr Enoch Powell , Wolverhampton South West

That is a different question. If the hon. Member puts it down I will see whether it is possible to get an answer to it.

Photo of Mr Archibald Manuel Mr Archibald Manuel , Central Ayrshire

Is the Minister aware that the basis of nearly all these Questions, and especially of Question No. 43, is that the cost is much less than 2s.? Is he further aware that when a patient receives a prescription from a doctor he wants to follow it up and go to the chemist to obtain what the doctor prescribes, but that it is not always easy for the patient to read the prescription. Is he aware that there is often a miscarriage of justice in that it would be dangerous to prescribe certain medicines for a period of more than a week? As prescriptions in these cases are limited to a week, would the right hon. Gentleman not agree that he should think more about this problem, because patients are constantly going to the chemist not knowing what has been prescribed and as a result are being over-charged?

Photo of Mr Enoch Powell Mr Enoch Powell , Wolverhampton South West

As to items of which the retail cost over the counter is substantially less than 2s., I refer the hon. Member to my Answer to Question No. 10. I am sure that he will appreciate that even where the ingredient cost is much lower than 2s. the retail cost of the item as dispensed and made up over the counter would not normally be less than 2s.

Photo of Mr Kenneth Robinson Mr Kenneth Robinson , St Pancras North

Would the right hon. Gentleman not admit that the normal week's treatment of all these preparations costs substantially less than 2s.? Does not that at least bring to question the reply which the right hon. Gentleman gave to my hon. Friend the Member for East Ham, South (Mr. Oram) last week when he said that the number of such prescriptions would be very small? Is the right hon. Gentleman not aware that the list contained in these Questions is nothing like an exhaustive list? Will not he think again about this business of 2s. per item?

Photo of Mr Enoch Powell Mr Enoch Powell , Wolverhampton South West

These Questions refer to ingredient cost and we are now talking about retail cost across the counter, which includes dispensing fees and other items, and that is a very different question.

Photo of Sir Barnett Stross Sir Barnett Stross , Stoke-on-Trent Central

Would the right hon. Gentleman consider the position of the doctor in country areas who does his own dispensing, as many of them do? Do the Minister's answers mean that when he offers a drug to a patient for treatment the doctor must weigh up in his own mind and make a calculation not only of the cost of that drug, as for example 7 or 14 tablets of amytal, but also what he is to receive for prescribing? Has he to add all these up before he is able to say to the patient, "I think that it will be 1s. 9d. Do not pay me 2s."?

Photo of Mr Enoch Powell Mr Enoch Powell , Wolverhampton South West

That is an entirely different question. These Questions ask about the cost of ingredients.

Photo of Mr William Wilkins Mr William Wilkins , Bristol South

May I ask, as a supplementary Question to Question No. 29, whether it is not astonishing that with all the advice that he has available to him the Minister is unable to give an answer to a Question referring to ingredients in regard to which I understand it would be the common practice for that amount to be supplied? If the right hon. Gentleman is unable to give information about this, will he ascertain that my information is correct that the cost of the ingredients—not the retail price—is under 1d. for a week's treatment of 21 tablets?

Photo of Mr Enoch Powell Mr Enoch Powell , Wolverhampton South West

The advice available to me is that the meaning of "a week's treatment" is so variable, even in this context that no useful assessment can be attached to it?

Photo of Mr Charles Hale Mr Charles Hale , Oldham West

Could not the Minister reply to Question Nos. 1 to 47 by saying that all these matters are under constant review, every avenue is being explored, all relevant facts are being taken into consideration, and the collective wisdom of Her Majesty's advisers is being applied to all these Question in the teeth of the fluctuating wind of economic change?

Photo of Mr Enoch Powell Mr Enoch Powell , Wolverhampton South West

That is a very interesting suggestion. The difficulty from my point of view is that it would involve using a number of phrases which I desire not to include in my answers to this House.