Public Expenditure

Part of the debate – in the House of Commons at 12:00 am on 18th January 1968.

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Photo of Mr Laurie Pavitt Mr Laurie Pavitt , Willesden West 12:00 am, 18th January 1968

I hope that the hon. Member for Ton-bridge (Mr. Hornby) will forgive me if I do not follow him in his remarks. This is a package debate and I wish to address my mind to another part of the package, namely, prescription charges. We have been urged to be precise. I hope to make my contribution quickly in the hope that some of my colleagues may be able to speak after me.

The only point in the previous debate which I should like to pick up is the suggestion being urged upon my right hon. Friends in various Ministries to resign. On the question of the National Health Service, I would urge my right hon. Friend the Minister of Health not to resign, although I know that this must have been a bitter package for him to swallow. The Minister of Health has a long record of fighting against prescription charges. He has had to concede this because of forces outside, but I hope that eventually he will be able to persuade his colleagues to change their minds.

I want to address myself to the principle underlying the debate which we are having on this part of the package. The whole basis of the Health Service was that those who were sick should be looked after by those who were well? If a man was sick or disabled or needed help, this was to be paid for by those who did not suffer his particular disability. It is the old tradition in the pit, in the factory and in the neighbourhood of East London, where I was brought up, that when one was in trouble the neighbours came in to help or if a workman was in difficulty his workmates went round with the hat.

This particular part of the package is totally unacceptable to me because it stands this principle precisely on its head. The Health Service is financed by taxation to 90 per cent. Any income from charges goes into taxation and because of that it will be the sick who will have to help the country out of its difficulties and pay the healthy. It is even worse, because the more sick one is the more one has to pay. It is an indirect tax that only the sick will pay and only the healthy will be completely exempt from. It is because of that that I find it totally unacceptable.

This principle was followed in the whole of the thinking of this side of the House about health in this country over the last 25 years. It has created a radical change in our approach to health. We established the National Health Service with a great deal of pride as the fifth freedom. We have it as a right, not a privilege. It was not a commodity that one purchased; it was not something one dealt with as consumer choice in the market place. Nobody chooses to be ill. If one was healthy, one was a normal person. If someone had the misfortune not to be healthy, then he needed to be brought up to the norm. The person who needs no medicine, no spectacles, or no hearing aids, is the one who is normal and enjoying his rights. Those who need these things are not getting extras and privileges with spectacles and hearing aids—who wants to wear a hearing aid? I do not—but they are being helped by their colleagues to get back to the norm.

Hon. Members will recall that since 1st February, 1965 an unprecedented campaign on this subject has gone on in the Press throughout the country. I find it difficult to understand the change in doctors. The B.M.A. opposed health charges consistently throughout until 1964. In 1956 and 1961 doctors said, "Put no barrier between the patient and the doctors. We want to treat sickness. We do not want a financial intervention between doctors and patients."

It was so bad that when health charges were first imposed and then increased the Health Service bill rose because doctors, objecting to the charges, prescribed 8 ozs. instead of 4 and 100 tablets instead of 20. The change occurred in 1964, not because of a change of Government but because of the trouble that was going on between the G.P.s and the Government over their pay charter, which has since been completed.

The case for prescriptions charges rests upon two points. One is that this is something which is abused by patients; Secondly, it is the weakness or irresponsibility of general practitioners in giving unnecessary medicines. This is the 1968 equivalent to the argument we had against decent houses for ordinary people which we on this side of the House called "coals in the bath." An odd person may have had coals in the bath, but very few. This argument is dead. People may abuse the Health Service, but I guarantee that every hon. Member knows far more people who are reluctant to worry their doctor and do not go early enough and as a consequence very often have an illness which could have been avoided by early diagnosis. To try to reorganise the way in which a doctor treats his patient on the basis of a few abuses is wrong. The majority of doctors do not prescribe unnecessarily or give expensive medicines without cause. They seek to do the best for their patients.

As a result of the campaign which has gone on I am well aware that the Chancellor can say that there is a wide acceptance that people should pay for their medicines. But why the sick? Some people can afford to pay for the police force and some can afford to pay for the fire brigade; and we subsidise the food we eat to the extent of about £250 million although some people can afford to pay more for that. So why choose the sick, who have already paid through taxation and through insurance stamps? We are, apparently, told, "Because you can afford to pay you pay again because you are sick. That is your crime."

There may be right hon. and hon. Members opposite who suffer from arthritis— a most painful and difficult disease to cope with. If I, because I do not suffer that pain, have to pay something for somebody who has, I do not mind doing so. It is the least compassionate thing I can do. I do not wish to argue about the money. Let him cope with his disability and let me not worry about whether it is costing me a few shillings, because I am grateful to the Almighty that I have not got arthritis.

The fact remains that sound finance has made this into a sacred cow for businessmen. "Sacrifice it, cut its throat in public, and we shall know you have renounced Socialism." Ian Trethowan, in The Times last week, said that the Minister of Health said that this is to be "the touchstone" of confidence; unless the Government do this we have no confidence in them.

Yesterday, in the Sun Mr. Paul Bareau said: Foreign opinion will, on second thoughts, give more credit to the domestic measures which sounds a major retreat from deeply and emotionally cherished Socialist principles. In other words, the demand on the Government is to depart from their principles if they are to have creditability.

I doubt the arithmetic. Ministry of Health figures given to me show that the half-crown prescription with no exemptions will lead on the present basis, assuming no decrease because of the new system, to £35 million at most. But my doctor colleagues know that the number of exemptions which are being put forward will make this figure very much less. My arithmetic tells me that if the exemptions are effective this is unlikely to yield much more than £12 to £15 million rather than £25 million, and it may be very much less. If we get the exemptions, we do not get the money; and if we get the money we lose the comprehensive exemptions. I think that it will be very much less. If it is, we shall be scrapping a principle which we have held for a generation for a matter of £12 million to £15 million.

My right hon. Friend the First Secretary, under whom I served as P.P.S., last night threw me a challenge which I gladly accept. He said, "Parts of the package are unacceptable, but if you accept the general principle what can you put in its place?". I left elementary school at 15, and I am hurt by the cut in education, and, in fact, by all the cuts. If my colleagues in the Government tell me that the economy needs to be cut back and that economies must be made in the National Health Service, let them take the money from the superstructure, from the outside. Let us not nibble away at the roots. Let us not take the money from the foundations.

Since 1965, there has been a 10 per cent, growth in the Health Service. A 1½ per cent, cut across the board, though difficult, would give the Chancellor the £25 million that he wants, and we shall still have an increase on what we spent last year. Last year, we spent £119 million more than we spent the year before, and in that year we spent £96 million more than in the previous year. We are scrambling about to scrub our principles for a matter of £10 million, £12 million, or £15 million.

The right hon. and learned Member for Wirral (Mr. Selwyn Lloyd) put a ceiling on hospital expenditure. It was to increase by no more than 2 per cent, over the previous year's estimate. Since we have been in power the figure has gone up to 2¾ per cent. Difficult though it would be, I would be prepared to cut that back to 2¼ per cent, which would still be one-quarter per cent, more than the right hon. and learned Member allowed for, and this would raise about £12 million.

We are too hospital-minded. We still think in terms of a "National Illness Service". We are too concerned with bricks and mortar, with the chromium-plated palaces which we can open, and not sufficiently concerned with the people who serve within them. A plea has been made that whatever we do we should not touch the hospital service, but the fact is that it takes £873 million, or 60 per cent, of the total, while the general practitioner, who is the first line of defence, for keeping patients out of hospital takes only 7½ per cent.

If we must touch something it must include the hospital service, and if the First Secretary wants a shopping list I can give him one. Reduce the hospital building programme for the first quinquennium and build more at the end and not so much at the beginning. Expedite the closure of small hospitals, agreed to by hon. Gentlemen opposite and accepted by this Government, where we have about 40 per cent, bed occupancy. Close these quickly and use the resources elsewhere.

We should not merely implement the Sainsbury Committee's recommendations, but should take more powers to save £10 million from the present £160 million drug bill. At the moment, £15 million is being spent on representatives and glossy literature to persuade doctors what to prescribe. About £250 a year is being spent for every doctor. There is a possibility of making enormous economies in this sector.

Why not speed the elimination of duplicated work? Factory doctors are doing the same work as general practitioners, and so are school doctors. If my right hon. Friends in the Cabinet want £25 million, although it hurts I will find it for them, not from the base, but from the superstructure. To do it my way is, of course, more difficult than charging the sick, but since when has the Labour Party sacrificed principles because that is the easy way out? I am talking about millions, not candle ends.

This is a complete reversal of our policy made in 1952, when we voted solidly against the imposition of charges. At that time 266 members of the Labour Party, led by the late Lord Attlee, went into the Lobby and voted against them. The Prime Minister, in his resignation speech in 1951, put his finger on the reason for that. He said that once a breach is made in the principle the road is opened for a torrent.

I remember how many of us suffered during the first five years that I was in the House. Every time there was a debate on the subject, we were told, "You did it first". This party has always set its face against the likely torrent which may result from this decision, namely, a first and second-class service. Those who can pay get first-class treatment, and those who cannot get the second class service. The right hon. Member for Wolverhampton, North-West (Mr. Powell) knows better than anyone else the battles which were fought in 1961. Night after night we fought against the increases which were made at that time. I battled on in all seriousness. I thought that we believed what we said. What has altered the position? What difference is there now? Have our principles altered because of this economic crisis?

I remember the 13 difficult years which followed the making of that wrong decision in 1950–51. I plead with my colleagues in the Cabinet not to make us go through all that again. Let us not have another 10 years trying to get back what we have lost.

I welcome the exemptions, but even with these the people in South Wales will pay three times more than those in Surrey. The chronic sick are to be exempted, but when a person has a sudden illness after, say, 10 years of good health, it is then that he will find that he has to pay more.

I recall two deputations which I received in 1961 from pharmacists in my constituency. They asked "What does one do if a man says that he has four items on his prescription and wants to know which is the most important so that he can pay for it then and come back for the other three on Friday night?" The Chancellor of the Exchequer says that it is to be paid by those who are at work. What will happen to those suffering from the after effects of coronary thrombosis or bronchitis who remain at work? What will happen to the chronic bronchitic who needs expectorants?

We will place an impossible task on two Ministers and on doctors by asking them to work out the exemptions. I ask the Government to withdraw this part of the package, not using this as an excuse to reverse a wrong decision, but because it is the truth that one cannot work out a fair system of exemptions without causing considerable damage from the point of view of both health and equity. If the Government cannot do that, I hope that tonight my right hon. Friend will say that this is a temporary measure and that it will be withdrawn not only as soon as possible, but before the next Genera" Election.

I apologise for taking up the time of the House, but I feel that I must make a statement on what I am going to do tonight. Many of my hon. Friends have done me the honour, and I feel humble about it, of asking me what I am going to do when it comes to the vote, and I have been asked the same question by the Press. If I could reverse the imposition of this prescription charge by voting against my Government tonight, I would not only do so but would take the consequences and resign my seat. There would then be a by-election in West Willesden.

But I do not believe in gestures. It would not achieve what I hope to achieve. I am a Lansbury-type Socialist and a Gandhi disciple. When I take action, I do it because I want to achieve that which I have set out to do. If I abstain, I say, in effect, that I am prepared for a Tory Government, and if that were to come about this small breach may well lead to a torrent. I cannot accept that in any circumstances, so I remain. It may be that at the moment the Government are "a sorry thing but mine own". I have to make the decision for myself. I cannot make it for any of my hon. Friends. I propose to remain to fight this issue, both here and in the country, and I pledge myself so to do.

As chairman of my party's health group I have called a meeting for Monday, which the Minister will attend. We shall put our case to him. I am asking my colleagues who agree with me to form a working party to consider the ways and means by which we can get this decision reversed and get a speedy removal of the charges.

I am not prepared to jettison the faith of a lifetime for a temporary expedient. I shall continue doing all in my power, both inside and outside the House, to get this decision reversed.