This has not been a very good day for me; firstly, in view of the result of the voting on the Sexual Offences Bill and, secondly, because I have been balloting for the Adjournment of the House on this subject for weeks, my turn has come at a rather inappropriate time. It was only last Wednesday that the House debated the National Health Service, and various references were made then to the abolition of prescription charges. I shall not weary the House by repeating what was said then, but I should like to put forward one new aspect on the abolition of prescription charges.
I must give some of the background to the abolition of these charges. When the present Government took office they proclaimed to the world that financially Britain was in desperate straits. They blamed this, as they blamed everything, on Tory misrule, and they told us that immediate steps had to be taken to protect the £ sterling. Bank Rate was put up but, in spite of this, a great many foreign exchange speculators were still sellers of sterling because they were shaken by the Government's panic measures and by ill-considered statements by the Chancellor and other Ministers.
It was against this background that the Government decided to abolish prescription charges. Fortunately for the country, the wise men of the Bank of England came to the Government's rescue. They conducted negotiations with international bankers and brought some sanity into the situation which had been created mainly by the present Government. They arranged an extension of credit and further credits through international banking channels.
I have almost come to the end. The wise men of the Bank of England arranged the further credits which have given this country a breathing space in which to get our financial matters in order. What has been the effect of the abolition of prescription charges?
I have not even started on my arguments yet. I have only a short time and, if the hon. Gentleman would allow me to pursue my argument, he will perhaps have two or three minutes before the Minister replies.
In the first place, the effect of abolishing prescription charges was that medicine chests throughout the land have become overstocked with half-empty bottles of pills and potions causing a waste of medicine and drugs. I wish to use only two quotations to reinforce my argument. One was used in last Wednesday's debate by the right hon. Gentleman the Member for Bridlington (Mr. Wood) in quoting Lord Attlee, who said that we had:
…to reduce excessive and, in some cases, unnecessary resort to doctors and chemists, of which there is evidence…."—[OFFICIAL REPORT, 24th October 1949; Vol. 468, c. 1019.]
The other quotation is the well-known one of the late Nye Bevan who referred to a "ceaseless cascade of medicine pouring down British throats". Half the medicine chests in the country are now overstocked with half-empty bottles of pills and potions. This is a complete and utter waste.
Secondly, the cost of abolition to the country will probably amount to £50 million a year. Perhaps the Minister will tell me if my figure is wrong, but it is estimated by fairly reliable sources that this year £50 million of borrowed money will be given away when we are supposed to be in the middle of a financial crisis.
What do you imagine, Mr. Speaker, the international bankers think about this? Make no mistake, the effect of giving away this £50 million has not gone unnoticed by those in Zurich. They certainly have taken note of this distribution of largesse. They must think we have gone crazy. With one hand the Government tighten our belts and put on a squeeze, and with the other they give away money which is not really theirs and which they have had to borrow or arrange credits for.
It takes a big man to admit a mistake. I hope that even now the Minister, for whom I have a very healthy respect, will admit his error of judgment, in spite of the fact that I know that during the last election he canvassed support for the abolition of prescription charges. In order to prevent a further waste of money and materials, and to show the world that we really mean to overcome this financial crisis, real, as I think, or unreal, and to set an example, I hope that he will reimpose the prescription charges, which I think were wrongly abolished.
The hon. Member for Eastbourne (Sir C. Taylor) feels that our economy is so sick that we need to continue a tax on sick people. But he has not made out his case. To try to satisfy international bankers by putting on the old, young and sick a 2s. charge for every prescription is surely the last way in which a country with a heritage like ours should be prepared to act, however dire the economic circumstances.
The hon. Gentleman said that the Minister had made a mistake with his figures, because it was anticipated that the cost of abolishing prescription charges would be about £25 million whereas it seems to be about £38 million, possibly a little higher. The charge was imposed by a previous Minister to raise £12½ million. The Minister might well consider why, in four years, a charge estimated at £12½ million has escalated to this extent. If the hon. Gentleman is anxious to save the nation money, he might look at the drug bill in its constituent parts. More than £10 million is spent on advertising and the sending of glossy literature to doctors who do not need it. There are other ways of bringing about economies in the National Health Service.
The hon. Gentleman has not made out a sufficiently strong case for my right hon. Friend to note. If we did what he suggests, we should return to the situation in which people who, before they go to the doctor, are worried not only about their illness and symptoms but about the mounting cost of the charge which they may have to pay when they take their prescription to the chemist.
The medical profession was absolutely constant in its view of the matter until we came to power and the charges were abolished. All of the medical organisations were opposed to prescription charges. They were vehemently opposed to them particularly in 1961, when they were raised. The Medical Practitioners' Union, the B.M.A. and the Socialist Medical Association and other people connected with health matters were opposed to these charges. I hope not only that my right hon. Friend will resist any request to reimpose prescription charges but that he will consider the much smaller matter of the abolition of the charge made on mothers for orange juice and cod liver oil. This would be another step in ensuring that there was no barrier between people unfortunate enough to be sick and the treatment which they require.
When I asked the hon. Member for Eastbourne (Sir C. Taylor) to give way, my purpose was to recall a saying by a distinguished predecessor of my right hon. Friend, the late Aneurin Bevan, who said that a society should be judged by the manner in which it treated those who were most in need. Judged by that test, the present Government have done extremely well during the time they have been in office.
I found little in the speech of the hon. Member for Eastbourne that could be regarded as either fair or reasonable comment on my right hon. Friend's decision to abolish prescription charges or on the way in which my right hon. Friend has conducted the general affairs of his Department over the past 16 months. Moreover, I felt that the hon. Member was at least in danger of using an Adjournment debate to make a general party political attack upon the Government. I hope that we shall see fewer examples of this, because the purpose of an Adjournment debate will be degraded if it becomes an occasion merely for a general attack on this or that party.
I understand that there is a large volume of support among qualified people in the medical profession for the ending of prescription charges. I read, for example, in a recent issue of the Lancet the strongly stated view that the decision to end prescription charges was a very wise decision of the present Government.
Perhaps I may conclude my brief intervention by assuring my right hon. Friend the Minister that the decision to end prescription charges was widely welcomed in my constituency, where it is taken to be a measure of my right hon. Friend's humanity and of his standing as Minister of Health.
The hon. Member for Eastbourne (Sir C. Taylor) has raised a subject which, as he acknowledged, the House debated the day before yesterday. On that occasion, by some unaccountable mischance, he failed to catch Mr. Speaker's eye. The ground that he has covered is,, therefore, somewhat familiar, and I apologise to the House if my remarks should happen to follow rather the same course as my contribution to our last discussion.
The facts, as the right hon. Member for Leeds, North-East (Sir K. Joseph) fairly summarised on Wednesday evening, are that over a number of years the Labour Party made solemn pledges that we should abolish the prescription charges and that—I acknowledge this—the financial effect has been somewhat larger than we anticipated, but, to use the right hon. Gentleman's words, I have not felt financial cramp as a result.
We gave our pledge because we believe that a tax—which was what these charges were—which fell upon the sick and at the time of sickness was in principle wrong. If it is argued that the charges were also a deterrent to the use of the Service, as the hon. Member argued, we point out that it is a deterrent which discriminated unfairly against those least able to bear the charges, particularly the chronic and the elderly sick.
The charges deterred, among others, those whom the doctor would most wish to see and those with conditions which, although not at present serious, might prove to be the early symptoms of dangerous illnesses.
It is true that we did not anticipate that the financial effect would be as great as it has been. I have suggested—and I do not think this has been seriously disputed—that it is not possible, and I do not believe that it ever will be, to estimate precisely the financial effect of removing these charges.
The hon. Gentleman's estimate of £50 million is excessive, even as an estimate of the total increase of the drug bill over the previous year. It is important to recognise—and I think that hon. Gentlemen opposite have acknowledged this—that the total increase in cost, taking 1965 as against 1964, is by no means wholly to be reckoned against the removal of the charge. How much, for example, is due to the removal of the deterrent? We cannot say, but we believe, from what has happened, that the deterrent effect must have been greater than we supposed. How much is due to the incidence of sickness? We cannot say for certain, but as my hon. Friend the Joint Under-Secretary of State for Scotland observed on Wednesday, prescription numbers fluctuate with peaks of sickness.
The number of first claims for sickness benefit in the 18 months since charges were removed was nearly 5½ per cent. above the level for the corresponding months of 1964. This is in relation to the working population. It is reasonable to assume that among the old people and children the increased rate of sickness and the need for prescriptions was even higher.
I remind the House, however, that the increased number of prescriptions has been accompanied by an increase in the average cost of a prescription, which is less than we had anticipated. Year by year, since the very beginning of the Service, the average cost of prescriptions has risen and with it the total cost of the drug bill. This is a further factor which enters into the comparison between what the bill looks like this year compared with last year.
The hon. Member for Eastbourne spoke of half-empty bottles lying around unwanted in cupboards. This is an unwarrantable attack on the medical profession for unnecessary and excessive prescribing.
In that case only half should have been prescribed and what the hon. Gentleman is talking about is over-prescribing. That is what the charge of the hon. Gentleman boils down to. He must recognise—as I have said more than once—that it is the doctor and not the patient who writes the prescription form.
I come to the third limb of the argument by which the Government's action has been attacked; namely, that we have, by this action, deprived the Health Service of funds needed for improvements. I have made no secret of the fact that the change has cost money, although I hope that no further attempt will be made to quantify a difference which is accounted for by so many different factors.
As for the loss of income from the charges, what we have done is, of course, to transfer a tax incidence, from a tax falling on the sick, which we entirely reject, to a tax spread over the community at large, where the major burden of financing the Health Service has always lain. The right hon. Gentleman the Member for Leeds, North-East told the House on Wednesday:
If we find, on our return to office, that the National Health Service is severely starved of resources…we shall see, among other things, whether we can evolve practicable methods of exempting all those who could be hurt or deterred by a reimposed charge."—[OFFICIAL REPORT, 9th February, 1966, Vol. 724 c. 470.]
My hon. Friends and I were interested—and so will be the electorate—to hear this proposed solution, involving, as it seems to do, both the reimposition of the charges and the exemption from charges of the elderly, children, low-wage earners, chronic sick, disabled and other categories. I cannot help wondering why,
if the solution is so simple, it defeated the ingenuity of successive Conservative Ministers of Health. It is, in any event, plain that the Opposition would themselves forgo a substantial part of the receipts that resulted from the old 2s. charge.
It comes then to this; there is a sum which neither we on this side, nor hon. Members opposite can quantify, which we are spending on pharmaceutical services which they say they would not have spent. It is, however, misleading to talk, as some hon. Members have tended to do, as though the Government have, by abolishing charges, deprived the Health Service of money. This is not so. What we did was to choose this as one way of improving the Health Service. There are a great many ways in which the Service needs improvement and development. To list a number of these, and to point out that they will cost money, does nothing to establish that the Government chose wrongly.
In the first place, I do not myself see how it would be possible to establish that any one area of need in the Health Service ought to have been given preference above the removal of the financial barrier between the family doctor and his patient. In the second place, we can point to the substantial increased sums being made available in all other sectors of the Health Service. In a short time from now, the new Estimates will show what we intend for the coming financial year. Compared with the expenditure in 1964–65, the present year's expenditure, at 1965 prices, shows hospital capital spending up by £11 million; hospital current expenditure up by £14 million; local authorities health and welfare expenditure up by £9 million.
It would, however, be a mistake to debate this subject solely in financial terms. The effect on the workload of doctors should be mentioned—and was on Wednesday—and I think there probably has been some effect, though I believe that the increase in load from this cause was a good deal less than many doctors supposed. What clearly has placed an additional strain on the family doctor has been a continued rise in population, while the number of doctors has slightly fallen: a reduction of less than ½ per cent. in the total of principals in 1964 and of a fraction over one per cent. in 1965. This aspect has been very much in my mind during the recent negotiations which I have had with the profession. In the long run, the answer is to produce more doctors, and I have recently told the House that we shall soon be increasing medical school intake very considerably.
In the shorter term, the position will be improved by making general practice more attractive and making the load easier to carry. The steps we are taking include a completely new contract for general practitioners which will relate remuneration, more closely than has been the case so far, to workload and to the standards of service offered and will encourage the employment of ancillary help; a campaign to seek the co-operation of the public in making the best use of doctors' time; a reduction in certification work; Exchequer grants towards the cost of improving surgery premises; and, of course, the proposal in the National Health Service Bill itself to facilitate the financing of practice premises which we shall be discussing in Committee on Monday next.
These are all practical measures which the Government are taking, and the only purpose of mentioning them here today is to refute the idea that, somehow or other, by taking this very necessary step that we were pledged to take, we have somehow damaged the rest of the National Health Service. Nothing could be further from the truth and, having debated this subject twice in one week, I hope that the Opposition will now drop this particular bone and get down to a constructive discussion of how we can still further improve our great National Health Service.
Before the Minister sits down, perhaps he will allow me to ask a question. Did he not ignore the gravamen of my charge, which was that I would very much like to abolish prescription charges if I thought we were abolishing them, and could afford to do so? The charge I tried to make was that we were abolishing prescription charges on borrowed money.
I am sorry if I did not answer that point but, frankly, I did not take it very seriously. I do not think that the banks of Zurich paid all that amount of attention to my decision to abolish prescription charges, as the hon. Member suggests.