' The National Health Service (Scotland) Act 1978 shall be amended as follows:—
I beg to move, That the clause be read a Second time.
A number of points arise on this new clause directly related to affairs in Scotland, which I am not directly seized of. No doubt one of my hon. Friends will later expound the problem with regard to bringing Scottish law in line with English and Welsh legislation.
In regard to Mr. Speaker's ruling on the points of order, in so far as this clause relates also to charges for testing eyesight, it is an opportune moment—
I beg to move, That the clause be read a Second time.
I apologise. I was out of the Chamber for two or three minutes meeting teachers who are complaining about the cavalier way in which the Government are treating their wage claim. I was anxious to tell them that they could not expect anything better from the Government.
The matters contained in the clause are directly related to Scotland, an aspect of United Kingdom affairs with which I am not especially familiar. However, the new clause deals with charges for sight testing and the comprehensive treatment in Scotland of those with poor sight. Those people would therefore have come within the provisions of any clause that might have been laid before the House with regard to sight-test charges.
Shortly before we began debating this new clause, the Government withdrew new clause 1, which also related to charges for optical tests. It dealt with a consultation charge, which is a totally new principle for charging within the Health Service and directly against what the Prime Minister promised during the election. We greet the withdrawal of new clause 1 with almost unalloyed joy. We are afraid only about the horrors that might replace it. We shall fight any charges that the Government attempt to introduce to replace the sight-test charge. There is more joy
in heaven over one sinner that repenteth
and so forth, and with 300 repenting the joy is considerable. That is the first evidence of a U-turn by the Government. We look forward to many more between now and the next election.
I hope that the Minister for Health will tell us how a firm Government intention to legislate on sight testing was completely overturned in the latter part of yesterday evening. The hon. Gentleman is most anxious to contribute to the debate, so I shall sit down.
I do not want to disappoint the right hon. Member for Lewisham, East (Mr. Moyle). However, I am distressed that any hon. Member should feel that he has been inconvenienced. That was not our intention. I sent an apology to Mr. Speaker this morning, hoping that no one would be inconvenienced. I also consulted the right hon. Member for Lewisham, East at a late hour last night. For reasons that he knows best, it was difficult to contact him earlier in the evening when I telephoned him from the House of Commons.
Strong representations have been made that the way in which charges for sight testing were proposed was not necessarily in the best interests of patients. There was the fear that some patients might be deterred from seeking sight testing. We feel strongly that the needs of individual patients must always be considered most carefully. We therefore decided that it would not be right to proceed without further discussion. We hope to put down a modified clause in time for Report.
Will my hon. Friend accept my congratulations and those of many hon. Members on the ready way in which he and his right hon. Friend listened to representations and, even at a late hour, accepted the possibility of changing plans?
As usual, my hon. Friend has not only demonstrated her invariable charm but has understood the wider implications that Labour Members appear not to have understood. I appreciate her remarks.
It might be easier to congratulate the Minister if we knew what he was doing. The reason for the agitation this afternoon is that we have been unable to find out. We shall not complain if the Government are merely getting rid of the obnoxious notion that people should be charged at the point where they first seek access to the Health Service—in this case the opthalmic service. I am delighted that the Government appear to be abandoning the idea that people should be charged for sight testing.
In the brief remarks that the Minister addressed to us on the new clause he gave the impression that it was merely the arrangement of the charge for sight testing that the Government would modify and come back with at a later stage. It is in the interests of all hon. Members to have a clearer picture of what the Government intend, and at what stage they intend to move further. I am especially anxious about what now seems to be the possibility that when the Bill goes to another place there will be a new clause on sight testing that merely modifies the charge.
The Minister said that he had received representations that suggested that the manner in which he would seek to obtain these moneys was not satisfactory. That is true. The complaints that have come to me from those who know most about it—those engaged in the ophthalmic services—have been of that kind. Those involved say that if—it is not a matter that they view with enthusiasm—further charges are to be imposed on the ophthalmic services, which already bear a heavy proportion of charging, they should be raised by increasing existing ophthalmic charges rather than by charging people for having their sight tested in the first place. That makes very clear the distinction between sight testing and charges, later on, for spectacles, lenses and similar items.
In what he said this afternoon the Minister made no distinction. He seemed to imply that sight-testing charges were still with us and that there would be an improvement or tidying up of the form.
Perhaps for the next few moments I may talk about another subject, so that what may be fruitful consultations may continue. Clearly, events are moving fast. Who am I to discourage what could be beneficial developments?
I should like to summarise my views and those of my hon. Friends. We intensely dislike charges in the National Health Service. We do not want to see them increased. One of the worst points at which to place them is that at which people first seek aid, when diagnosis first takes place. The dangers that that imposes are already apparent in dentistry. We do not want to import them now into the care of the eye. I am particularly anxious that at a later stage sight-testing charges in a slightly modified form should not be smuggled back into the Bill.
I do not seek to be carping or hostile to the Minister in making this plea. He owes it to the House to give us a slightly fuller explanation of what I hope are the good intentions of abandoning this principle. I am aware that he is working within financial constraints and that he is under orders to seek savings in various places. If he cannot give us an assurance this afternoon that sight testing will not become a chargeable item he will not have deserved the praise that the hon. Member for Birmingham, Edgbaston (Mrs. Knight) heaped upon him a moment ago. I should be most grateful to him if he would seek a further opportunity in the debate on this new clause to make the position a little clearer.
I take the view, as I think do many Government supporters, that the Government have been wholly realistic and sensible in two regards. They said, first, that there would be no cuts in expenditure on the National Health Service. In spite of the difficult economic situation that the Government inherited, they said that they intended to retain the expenditure programmes, however swollen, which they inherited from the previous Administration. I welcome that as a correct allocation of priorities.
The Government also said that to ensure the most vital services in the National Health Service should continue, there are areas in which additional resources can be raised through charges. I welcome the Government's intention to do that and to raise additional resources in that way. It will mean that some vital areas of the service which may otherwise have to be cut, possibly as a result of the ramifications of the Clegg Commission, may now be retained in their entirety. I welcome the Government's attitude.
On the question of eye testing and examinations, many of us felt that here was a new principle that had not so far applied in the National Health Service. There have been charges for appliances and prescriptions and in a number of other areas. However, hitherto we said that the preventive area—going to see a general practitioner or to have an eye test—should be free of charge. That door should be open on the grounds that we should encourage people, wherever possible, to go at the earliest opportunity, on the principle that in the long run there would be a saving on National Health Service expenditure.
I do not blame the Government for examining all the possible areas in which money may be raised to assist the National Health Service. The Conservative Party talks about open government. It is amazing that when we have spoken to the Government, or when various outside interests have put a case to them, all we received at first were complaints and groans. However, when the Government listened to the arguments they were eventually prepared to concede them. The right hon. Member for Lewisham, East (Mr. Moyle), if he had any grain of responsibility left in him, should have congratulated the Government. Having listened to the arguments, he should have conceded them.
I should like to finish my point first.
The Opposition demonstrated the height of irresponsibility. When a point is put forward and the Government, having listened to it, eventually agreed that the argument was worthy of recognition and that they were prepared to concede it, surely that is Parliament in action. That is Government listening to outside interests. There are on the Opposition Front Bench two ex-Ministers who held responsibility in this Department. They should have been the first to congratulate the Government on having conceded the point.
The hon. Gentleman is working hard to earn his keep in the Conservative Party, I agree. He says that all measures should be considered to raise money for the health service. Does he include those areas to which the Prime Minister referred, when she said, before the last election, that the Conservative Party had no plans to introduce any new charges for the National Health Service? That would be helpful to know, as then we should know that we must watch everything.
The right hon. Gentleman is now trying to change the point. I suspect that if I pursued that point I might incur your displeasure, Mr. Deputy Speaker. If I may, I shall stick to the narrow but important point that I have been making.
The Government deserve great credit for listening to the arguments that were put forward. I hope that it will be possible for my hon. Friend the Minister of State, before the debate is completed, to give a little more indication of what the Government have in mind.
It is clear that the Opposition are not prepared to treat this extremely serious matter seriously. We are. We are resolved to try to get this matter right and to assist the Government in arriving at an economically sensible solution.
I hope that before the debate is over my hon. Friend will be able to say a little more about the economics of the matter and about the Government's thinking. If, as I hope, the Government have decided, having listened to representations, that it is inappropriate to make charges for examinations, that must surely mean that certain revenue that would otherwise be raised—possibly amounting to £10 million or £11 million—will no longer be available. I should greatly regret seeing that amount of money sacrificed; it would not be available for other areas of the NHS. Therefore, I hope that my hon. Friend, having conceded the argument on eye examinations, will be able to tell us of other areas within the charging structure in which a similar or equivalent amount of money can be raised.
I should be prepared to see more charges for appliances. There are what are called the hybrid prescriptions. The interests that argued the case strongly for no payment for examinations said—with their realistic approach to the matter, in contrast to that that of the Opposition— that if the Government had to raise money elsewhere they should look at the hybrid prescription or other areas. I should be ready to support the Government if they made proposals, now or later, to raise the equivalent sum on appliances rather than examinations.
I contrast the Opposition's wholly irresponsible attitude to the matter with the attitude of the Government, who have been prepared to listen to the arguments. I hope that before the debate is over my hon. Friend will be able to give a little more indication as to what the Government have in mind for raising the additional revenue that I am sure we need in order to preserve the basic fabric of the National Health Service.
I should like to return, even if temporarily, to the new clause and the precise reasons why it was tabled. It concerns a small but important number of people who suffer from severe visual handicap and who are expected to make full payment for assistance to their sight.
My right hon. Friend the Member for Manchester, Wythenshawe (Mr. Morris) persuaded the previous Government to make available the money that could have exempted people with severe visual handicap from payment of optical charges. At that stage an anomaly manifested itself as between the law in England and Wales and that in Scotland. In England and Wales such an exemption could have been effected simply by the laying of regulations under existing legislation in the National Health Service Acts. However, to give the equivalent measure of exemption in Scotland would have required primary legislation.
In order not to upset the sensitivities of the time, the Government decided that primary legislation would be embarked upon for Scotland to allow the laying of regulations to occur at precisely the same time as in England and Wales. There would have been considerable inequity if the laying of regulations and the exemption in England and Wales had not been accompanied by similar regulations and exemptions in Scotland. Although, with the benefit of hindsight, some of us now wish that at least the first measure could have been carried out, it is clear that at the time the inequity would have been a source of major friction in the country at large.
It was as a consequence of the outstanding commitment to those who suffered from severe visual handicap that my right hon. Friend the Member for Wythenshawe and a number of right hon. and hon. Members on both sides of the House tabled a Private Member's Bill, the Optical Charges (Exemption) (Scotland) Bill, which would have provided the primary legislation for the Secretary of State for Scotland to lay regulations similar to those in England and Wales. We intend in the clause to provide precisely the power that would have been given in that Bill. It would allow and, we would hope, encourage the Secretary of State for Scotland to introduce regulations allowing for the exemption of those with severe visual handicap.
My hon. Friend is probably right if he is referring to the Government's laying the regulations and even making available the money to make the laying of regulations meaningful. I shall come on to that matter shortly.
I should like to emphasise the great problems experienced by those with severe visual handicap who are not classified as being completely blind. My hon. Friend the Member for Coatbridge and Airdrie (Mr. Dempsey) would have wished to take part in the debate, because he freely acknowledges the visual handicap from which he suffers, and the inordinate expense of the implements that can sometimes assist those in a similar position.
The provision in the clause would not mean an increase in public expenditure. It is simply an enabling provision that would bring the law of Scotland into line with that in England and Wales. It would empower the Secretary of State for Scotland to exempt people with severe visual handicap.
That is not to say that I do not believe that the Government should not implement such regulations. I know from a letter I received towards the end of last year that the Under-Secretary of State for Scotland, who looks as though he is to wind up the debate, will tell the House that paragraph 4 of schedule 5 will provide precisely the powers that we seek to introduce in the clause. If that is so, I give the Government due credit for taking the point about the Scottish Office commitments that existed when they took office.
However, I believe that those in Scotland who suffer from the affliction in question will hope that this evening the Minister will not resort to tactical subterfuge in explaining that the complexities of paragraph 4 of schedule 5, simply providing the power to make regulations, take him off the hook. They will properly expect him to commit himself to laying regulations in the near future.
We know the hon. Gentleman's commitment to the Health Service. Although we have often questioned his constant assertions that the NHS in Scotland is being protected from Government cuts, there is at least an argument that those in the community who suffer from the affliction should at this stage receive the small extra resources that would be needed to implement this provision.
I am interested to know that my hon. Friend has received a letter from the Under-Secretary of State giving assurances on schedule 5(4). Is he aware that the name of the Secretary of State for Scotland was attached to new clause 1, specifically providing for the new increased charges? Although the Government say that they are taking power to help these people, it is the case that the Secretary of State and the Scottish Office were committed to increasing these charges. It is, therefore, not likely that they will give any assurance tonight that sufficient funds will be provided for the purposes contained in this new clause.
My hon. Friend displays his normal realism. I dare say that I was being unduly optimistic in hoping for a commitment to any additional resources at a time when the Minister is supervising some major cutbacks in the real resources of the Health Service in Scotland.
I hope that the Minister, a reasonable man, who has been persuaded to bring in powers to introduce legislation and who has served as chairman of the Scottish Conservative Party, will recognise the real case that can be put for people with severe visual handicap. I trust that he will throw off the chains of dogma that are tying him so closely to the cash limits of the national administration and make resources available.
This is a simple provision to help those in the community whom no one in this House would dream of passing by. They must pay large sums of money for modern technical assistance to alleviate the lack of sight that the rest of us take for granted. Now that the Secretary of State for Scotland will have power to lay regulations, it is to be hoped that the use of these regulations will be made a matter of some priority.
I should like to preface my remarks by informing the House that I could be said to have an interest. My husband is an ophthalmic optician. However, he does not practice in Scotland. Nor would he be concerned with the sight test fee directly, since his job is mainly concerned with the provision, prescription and supply of contact lenses.
It is important to attempt to clarify a mistake into which I believe the House may easily fall. There is all the difference in the world between levying a charge on an examination to see whether a need exists, or a condition exists, which must be treated, and actually charging for appliances. Throughout the National Health Service—the medical side, the dental side and the ophthalmic side—it has been a long-accepted principle that examinations should be free. The reason is that the early warning system that the eyes provide of the need for appliances or treatment is real and important.
Examination will indicate whether a person has glaucoma. Without an early decision in such cases, sight can be lost. Examination can also indicate whether there is a detached retina. Again, if not treated immediately, this can lead to loss of sight of the eye. Other diseases, including sclerosis of the blood vessels, can show themselves first in the eyes. The importance of keeping the early warning system—the putting of a fence at the top of the cliff rather than an ambulance at the bottom—is immensely important. It saves the National Health Service much-needed funds. It would be absurd if people were not able to check on the need for a simple step, taken at once, rather than waiting until a stage when treatment was more difficult and perhaps even impossible. 4.45 pm
I want to make it crystal clear that I see a great deal of difference between the supplying of an appliance and an actual test. Those who need an appliance, an operation, a pair of glasses, or any other treatment under the Health Service should have that free if they are genuinely unable to afford to pay for the appliance. It is absurd for Opposition Members to cry " Tut, tut", because appliances do not fall free and fully formed out of the sky. They cost a great deal of money. The money has to be found from somewhere. That " somewhere " is the public purse. Those of us responsible for spending public money must see that the money goes to people who really need it.
I could not support the totally free provision of appliances for many people who are able to afford to pay for them. I will go all the way to the barricades to ensure free treatment and appliances for those who genuinely cannot afford to pay. My understanding is that my right hon. and hon. Friends on the Government Front Bench feel the same about the need to supply appliances free to those who need them but cannot afford them. It is surely not so extraordinary to expect those who are well able to afford to pay for their treatment to do so. If that theory is not accepted, much-needed areas of the Health Service will be in dire trouble.
1 am delighted, as I stated in an intervention, by the withdrawal of the plan for charging for sight tests. I believe firmly that the Government have seen that the principle being embarked upon was wrong. I am confident that the proposal will not re-surface later in debate on the Bill.
It is clear that money must be raised for the Health Service in other ways—
I apologise for not having done so. I thought that the hon. Lady was intending to make her speech. How does she know that the matter will not be raised in later debate on the Bill? There has been no indication of the Government's plans.
I am obviously putting forward my opinion, which I am entitled to hold. My right hon. and hon. Friends have listened to a great deal of argument. It is incomprehensible to me that, having listened to the arguments and taken the action that they have, they will now go back on that action. The matter seems perfectly clear.
It is well understood in many quarters of this House that the Health Service cannot be free. The money is not available to enable it to be totally free at the point of distribution. There now arises the question of how to raise the money that is necessary. I have no doubt that we shall hear about that. My hon. Friend the Minister can have my support for charges that will overcome the financial difficulty in which this section and other sections of the Health Service find themselves so long as he does as he has indicated he is doing and leaves sight tests alone.
I wish to make clear that the only reason why the ophthalmic service has been able to operate in this country is that ophthalmic opticians and others have earned their bread and butter and paid their rent, rates, their telephone bills, their staff and other costs because they are encouraged, and have been so encouraged by successive Governments, to charge for frames. There has never been any secret about that. Professional men with between five and seven years training, much of it in hospitals, find it a bone of contention that they are able to continue in practice not because of their expertise at conducting eye tests or for understanding the early warnings of eye trouble but because they earn their bread and butter from frames.
It is important to remember that optical services cost less than any other part of the National Health Service. I beg my right hon. and hon. Friends to appreciate that there is real admiration for the way in which they have listened to the arguments. The. Government will have our support for the reasonable steps which I have no doubt will be taken to overcome this serious deficiency.
If it proves necessary I shall have great pleasure in following the hon. Member for Birmingham, Edgbaston (Mrs. Knight) to the barricades. However, I hope that it will not be necessary. Much as I enjoy the hon. Lady's company, I shall resist the temptation to deal with her other arguments.
I abominate and totally detest all charges on the sick and the disabled. Those who are healthy should remember that it is more a privilege not to wear glasses than to wear them. They should be prepared to pay for that privilege rather than that those with a disability should have to pay.
The House is in a difficulty. The new clause is important to Scotland. The reply will come from the Scottish Minister. However, the debate began with one of the most unclear statements that I have heard from a Government Front Bench when we were told about the withdrawal of new clause 1. I echo the sentiments of the hon. Member for Berwick-upon-Tweed (Mr. Beith) and those expressed by the hon. Member for Somerset, North (Mr. Dean) in the last part of his speech. We must have a clear indication of the Government's intention rather than a vague suggestion that we shall have something at a later stage.
The House must know whether the Government intend to impose for the first time a charge for early diagnosis which would prevent people from having the necessary treatment. Alternatively, are the Government planning another round of charges to make up the £11 million which will have to be found from elsewhere if they do not proceed with new clause 1?
The hon. Gentleman said that the Scottish Office Minister was expected to reply to the Scottish points and that, therefore, the Minister for Health would not be making a further contribution to the debate. The Minister for Health has been paying careful attention and making notes. We hope that both Ministers will contribute.
Will my hon. Friend take into account the fact that the Scottish Office Under-Secretary is a Minister in the Government and should be capable of replying on behalf of the Government? He is a Government Minister who happens to have responsibilities for Scottish matters. He should be able to reply competently and authoritatively on behalf of the Government.
I do not care which Minister replies, provided that we have a clear explanation. New clause 1 is damaging to and undermines the principle of the NHS. I am grateful to the Minister for the fact that he apologised for any inconvenience caused, because hon. Members prepare their speeches. I shall keep in my pocket the brilliant speech that I should have made on the new clause in case I need it later.
I regret that I cannot agree with the hon. Gentleman. I was listening most carefully, because the Minister was discussing the item that concerns me most. The Minister gave the impression that he was more worried about the technicalities and the way in which the proposal was being implemented than about whether it was being implemented. It is easy for the Minister. All that he has to do is to stand up and tell us and then we shall be clear where we stand.
New clause 6 is extremely important for Scotland. It involves the problem of preventing blindness. When a patient has low visual acuity, there is a need to change spectacles frequently. It is a pity that we must examine two Acts and that Scotland has to make its own amendments.
The wording causes difficulty. For many years there has been a registered list of blind persons which is covered by an Act. After my right hon. Friend the Member for Manchester, Wythenshawe (Mr. Morris) did the House and the country a service by putting the Chronically Sick and Disabled Persons Act on the statute book local social services departments established a complete register of the disabled, including the blind.
However, there is some reluctance by many blind persons to be included on the local authority register because they are already on one register for employment. They are anxious not to confuse the issue in case inclusion on one register prejudices them in relation to the other. The paraplegic person is able to move freely from sheltered employment to unsheltered employment and back, but the blind are not. Once they are in sheltered employment they must remain. One in 10 blind persons is unemployed.
I have received representations from the National League of the Blind but not from the Scottish branch.
The argument expressed by Scottish colleagues is important. It affects one of the most disadvantaged sections of our community. All disabilities are difficult to live with. People understand what it is like not to see and what it is like to miss some of the beauties of life. Sometimes, because of my deafness, people say " You can always turn off." Nobody says to a blind man " You do not need to look, because it is ugly." Everybody understands the difficulties of a blind person.
Therefore, when the Minister replies I hope that, even if he does not accept the wording of the new clause, he will accept the principle that there should be no barrier to a person who suffers from failing eyesight. I sometimes think that this Government hate those in the 50–60 year age group. The Government are aware of the under-fives and the over-65s, but it seems that they are determined to put every barrier in the way of those who have not yet reached 65 and who need the Health Service. The Government appear to be prepared to allow free treatment to people only when they have reached the age of 65.
Many problems arise in relation to low visual acuity. We are not just dealing with one disability. When we speak of eye trouble the problem can reflect the general health of a person and be an indication of other problems.
Therefore, no barrier should be placed in the way of the people of Scotland, or anywhere else, when they need treatment. If a person needs to have an eye test every six months and that means that lenses must be changed every six months, that person should not have to pay for those new lenses because he suffers from a serious disability.
Even though the Minister may not accept the precise words of the new clause, I hope that he will guarantee that the meaning and the principle of the new clause will be incorporated into the Bill before it reaches the statute book.
I wish to say something more on the subject of charges for sight testing, since a number of hon. Members have raised the issue. I accept entirely the case which my hon. Friend the Member for Birmingham, Edgbaston (Mrs. Knight) advanced so ably. I admire the courageous and forthright way in which she puts her views on this and other subjects. I also support the case made by my hon. Friend the Member for Somerset, North (Mr. Dean).
This is an important matter. In no way do we wish to create a deterrent for people seeking eye testing who need treatment. Representations were made—in many cases strong representations—by my right hon. and hon. Friends and people outside the House, but I am not aware that strong representations were being made by Opposition Members.
On a point of order, Mr. Deputy Speaker. If an hon. Member begins to mislead the House as to the facts of a situation, what remedy have I got to ensure that the record is correct? The Minister must be aware that the Opposition imposed a three-line Whip to vote against the charges and we would have voted against them. I do not know how he can say that he received no representations.
I am sorry if I have upset Opposition Members. I realise that they have strong views on this issue. I was merely stating what I thought to be a matter of fact. In this case I have not had any strong representations from Opposition Members. If hon. Gentlemen have strong views on the issue, I shall be glad to hear them.
It is characteristic of this Government, and of our democratic process, that when strong representations are made to us we are only too willing to consider them carefully. The hon. Member for Berwick-upon-Tweed (Mr. Beith) was right to question what opportunities there will be for further debate. It is not our intention to proceed with charges for sight testing. I make that absolutely clear to hon. Members on both sides of the House.
It is our intention to recover the amount that would have been raised by other charges in the optical service. We will consult further with the professions, and it is our hope that we will be able to bring forward a modified clause and schedules in time for a full debate when the Report stage is resumed.
We have just heard the second stage of the Minister's statement. I wonder whether we shall have a third stage before the debate is concluded? The Minister is notorious for doing this, both in Committee and on the Floor of the House.
I wish to refer the House to the representations made by the Association of Optical Practitioners, which form the basis of the objections to which the Minister referred. When the Minister said that substantial representations were made about sight-testing he was right. The Minister knows that he walked into a political minefield on this issue.
The Association of Optical Practitioners in its representations to all Members of Parliament said quite clearly:
To introduce a statutory charge of any kind payable by the patient for an examination, whether medical, detail or ophthalmic".
The House will note the reference to medical and dental as well as ophthalmic examinations. We hope that there will not be a reintroduction of charges for dental assessment as was originally envisaged in the schedule. The Minister did not say anything about that just now. Can we assume—I mention this in passing—that the charges for dental assessment are still likely to be reintroduced? Perhaps that is something the Minister will tell us later?
I am grateful for your ruling, Mr. Deputy Speaker, but I am suspicious of the intentions of the Government in this context. The Opposition have every right to be suspicious in view of the performance we have witnessed from the Minister today. The Association of Optical Practitioners went on to say that the introduction of statutory charges:
would breach a fundamental principle of the NHS which should be preserved, namely, 'examination without charge'.
The association then went on to make an important point in its representations about charges for optical assessment. It said:
The public interest will not be best served by seeking an anticipated saving of £11 million on eye examinations. The General Ophthalmic Service already represents by far the lowest charge on the Exchequer of the primary health services (medical, dental, optical and pharmaceutical), and the highest contributor in terms of patients' charges.
The association said that patients' charges currently amounted to 32 per cent. of the cost of the ophthalmic services, whereas the patients' charges in
the dental service represented 21 per cent. and in the pharmaceutical service 4 per cent. We know that these figures may have been calculated before the Government increased prescription charges in two waves recently. Prescription charges were increased to 45p in April last year and were further increased to £1 in December. The percentage figures I have quoted, therefore, may be slightly out of date.
Generally speaking, however, the figures are right. Charges in the ophthalmic service represent a far higher proportion of the total cost than is the case in the other services. That is an important point when the Government are arguing that they wish to see higher charges for spectacles, frames and lenses to National Health Service patients. Those patients are already contributing much more substantially to the cost of their appliances than people elsewhere in the NHS. I am not arguing that the charges that were to be made in the ophthalmic sector should be shifted to another sector of the NHS. I am saying that there is no need whatever for the reintroduction by the Government at the further Report stage, which I understand we are to have after Whitsun, of a new charge or of additional charges in the ophthalmic sector to recover that £11 million.
I could not disagree more with Conservative Members who say that we must recover this money somehow. If the Government insist that the Chancellor has got it wrong—that is what is being said: as far as I can recall, this charge was referred to in the Budget Speech—and if the Minister is now saying that the Chancellor was wrong in principle when he said that the Government would be introducing that charge, it is the Chancellor's job to produce the money which would otherwise have been brought in by this tax. Therefore, I do not agree that the NHS should be asked to provide this £11 million. It should be found from the contingency reserve.
My hon. Friend will recollect that we both served on the Standing Committee which considered this Bill and the Standing Committee which considered the Social Security (No. 2) Bill. When we were talking about savings and this £11 million, I had my defence Blue Book with me—the defence White Paper—and I easily calculated that I could save the £11 million by not spending £10 million on five Tornado aircraft. It would be much better not to spend that money, and to allow people treatment under the ophthalmic or other services of the NHS.
Yes, that is right.
The point that my hon. Friend makes is absolutely right. This shows the Government's political priorities. That is what the new clause that we were to have debated this afternoon was to be all about.
Clearly, if the Minister of State wants to make representations to the Chancellor of the Exchequer about the way in which he might recover this £11 million, if he does not want to load it on to patients in the NHS, he might refer the Chancellor to the contribution made on this issue by my hon. Friend the Member for Fife, Central (Mr. Hamilton).
My hon. Friend and I both served on the Standing Committee. Does he agree that it would have been more appropriate for this kind of question, which is most important, to have been brought forward to the Standing Committee, when we could have gone thoroughly into the matter, rather than bringing it up on Report?
My view about that may be slightly different from that of my hon. Friend. As I understand it, this charge was to have been introduced in practice in April 1981. If the Government had wanted to introduce this charge in a proper fashion, with proper consultation with all those concerned, they could have done so by introducing legislation, if that was required, at a much later stage, in the next Session. But they chose not to do that.
I make this point very seriously to the Ministers responsible for the Bill. When one brings together the expenditure and the revenue sides of the Budget equation on Budget day and publishes one's public expenditure White Paper and the assessment of the Chancellor as to the kind of taxation that he will be bringing forward, that telescopes any possibility of consultation on this kind of issue. We saw that on the Social Security (No. 2) Bill, precisely because the reductions in social security benefits were defined as Budget measures, financial measures. There was no consultation with any of the interested parties.
With new clause 1 we have got ourselves into exactly the same situation. What the Government really said about new clause 1 was that it was a financial measure arising from the Budget. The Government really ought to take note about what has happened over this issue and the climb-down that they have had to make over it. If it means anything at all—I am sure that the Minister will understand this—it means that they did not consult the people who knew about the issue, and, because they did not consult them, they got their fingers badly burned with this political hot potato—and it serves them right.
Therefore, I believe that what we need to see, if the Government are to bring forward expenditure measures and taxation measures at the same time, on Budget Day, is a situation in which new charges or reductions in benefits of the kind that we have seen from the present Government will be subject to proper consultations with the interested parties, even though they are Budget measures. In other words, before they are announced, there should be proper consultation about the way in which they are to be implemented and the character of the charges themselves.
I think that the Minister will agree, on reflection, that this charge, which was foreshadowed in new clause 1, was a political hot potato which would have been avoided, without any political embarrassment to the Government, if such a procedure had been followed. I strongly advise the Minister to consult the Leader of the House and the Chancellor of the Exchequer about the way in which these sorts of measures are introduced. This is a very serious matter.
We are very glad to have the opportunity of discussing new clause 6 and the putative new clause 1 together. In my view, the loading of charges on to other sections of the ophthalmic service, to which the Minister has just alluded, would be completely unacceptable to Opposition Members. We are opposed to charges in the NHS. We are certainly opposed to swingeing increases in charges for lenses and frames. If the Government want to increase those charges to the extent that they would have to increase them to obtain the £11 million saving in public expenditure, they will incur the wrath not only of those on the Opposition Benches but of a substantial section of the ophthalmic profession and of the people of this country.
For that reason, I believe that the Government ought to ignore the views of the hawks on their own Back Benches and the hawks in the Cabinet and they ought to listen to the representations made to them by the ophthalmic profession. Without such consideration, we shall see a swingeing increase in charges which would not be justified.
Given that there may well be an objection such as the hon. Gentleman is putting forward to increased optical charges of any kind, which is the less distasteful to the hon. Gentleman and his colleagues: a charge for sight testing, or an increase of the equivalent amount in the cost of either lenses or frames?
The simple answer to that is that we do not want any new charges and we do not want to see an increase in any of the existing charges. As I understand it, the Labour Party's policy is to abolish charges in the NHS. That statement has been made not only from the Opposition Back Benches but the Opposition Front Bench as well. The Minister would be well advised to listen to our representations. He is laughing his head off at the prospect of more people in the NHS being charged more money for the privilege of obtaining spectacles that they need in the ophthalmic sector. Is he laughing about that? Is he happy about people being forced to pay substantially increased amounts for the glasses that they need?
What he is really saying to the House is this: " We shall not charge you for the privilege of having your eyes tested, but we shall charge you through the nose for the glasses that you need." There is little difference in principle between the new charge that was originally proposed and the vastly increased charges that will be proposed by the Government in the near future.
I do not wish to delay the House, but I wonder whether my hon. Friend would give a further opportunity to the hon. Member for Birmingham, Edgbaston (Mrs. Knight) to explain matters? I received two or three letters from opticians asking me, if all else failed, to vote for the hon. Lady's amendment. I do not think that she ever tabled an amendment. If she did, I am not aware that she was advocating any increase in charges for optical equipment. The House and the country deserve a greater degree of honesty and openness from the hon. Lady.
My hon. Friend has hit the nail on the head. I am absolutely certain that the hon. Member for Birmingham, Edgbaston (Mrs. Knight) did not table an amendment on that point. I carefully watched the Order Paper to see whether her amendment would appear. No doubt she will tell us what proposals she intended to introduce.
Certainly. I made it absolutely plain that I went to the Table Office for advice. I looked at the new clause tabled by my right hon. Friend the Secretary of State. I was quite clearly opposed to the amendment as it was drafted. The advice given to me was that it would be quite useless to table an amendment to an amendment, which would delete that amendment. As we were discussing the question of sight testing, and not appliances for optical needs, there was clearly no point in tabling an amendment about that.
Now we know the truth, which is that the hon. Member for Edgbaston would have had to vote against new clause 1. That is the point. The Minister has avoided the political embarrassment of the hon. Lady and some of her supporters voting against the Government. No doubt the Government have avoided a politically bruising defeat on this matter. The hon. Lady would have been voting against new clause 1, and she was not advocating—as I understand the matter—any increase in charges to replace the revenue—
Does not my hon. Friend agree that if the hon. Member for Birmingham, Edgbaston (Mrs. Knight) intended to oppose the whole of new clause 1, she was not only opposing charges for sight testing but charges for dental check-ups? Will she confirm that she intends to continue along that line, or will she differentiate between the two? That is extremely important. Some of us feel that she took an attitude on one matter which was coloured for various reasons other than simply her concern for the patient.
Is my hon. Friend aware that it is the simplest thing in the world to go along to the Table Office and table an amendment to a new clause to delete the proposed charge on sight-testing? If the hon. Member for Birmingham, Edgbaston (Mrs. Knight), would care to come with me to the Table Office after the debate, I shall show her exactly how to do that. I do not believe that she tried.
On a point of order, Mr. Deputy Speaker. I have taken time to consider the statement made by the hon. Member for Fife, Central (Mr. Hamilton). It seems to me that, whatever way we interpret it, he is calling my hon. Friend the Member for Birmingham, Edgbaston (Mrs. Knight) a liar with regard to her recent remarks. Will you, Mr. Deputy Speaker, give a ruling about whether that is in order?
I am punctilious about the words that I use. When I say that I doubt somebody's word, it is far removed from calling him or her a liar. I know well that to call somebody a liar in the House is unparliamentary, which is precisely why I used the words that I did.
Further to that point of order, Mr. Deputy Speaker. I wish to clear up the whole matter. If the hon. Gentleman doubts my word, perhaps he would not doubt the word of the Clerks in the Table Office, who would, I am sure, be ready to confirm my statement. If the hon. Gentleman cares to visit the Table Office he will be able to check that I dealt with the matter. If he does not accept my word, perhaps he will accept the word of the Clerks.
Further to that point of order, Mr. Deputy Speaker. The operative word is " deliberately". I said that I doubted the word of the hon. Member for Edgbaston. If she can prove me wrong, I shall withdraw my remark. At the moment I am doubting her word because I know the procedures of the House. I repeat that it is the easiest thing in the world to go to the Table Office and table an amendment to a new clause that is already on the Order Paner.
Further to that point of order, Mr. Deputy Speaker. The essence of the point made by the hon. Member for Fife, Central was that " Erskine May " referred to an hon. Member " deliberately " misleading the House. My hon. Friend the Member for Edgbaston has stood in her place and repeated the statement that she previously made. The hon. Member for Fife, Central suggested that perhaps, in my hon. Friend's first speech, and by a slip of the tongue she said something that she did not mean to say. She has now stood in her place and confirmed that she did mean to say it. In other words, she has twice deliberately made a statement to the House which has been doubted by the hon. Member for Fife, Central. I ask for a ruling on whether that is not tantamount to calling my hon. Friend a liar and therefore, in contravention of the Standing Orders of the House. If it is not, I should like an explanation of the difference between doubting someone's word and calling someone a liar, taking into account the two deliberate statements made by my hon. Friend, if that is acceptable to the Chair.
Mr. Deputy Speaker:
I have already made it clear to the hon. Member for Fife, Central that it appeared to me from what he said that he was indicating that the hon. Lady was deliberately misleading the House. In those circumstances, he is not in order.
I shall withdraw in my own way and in my own time. I repeat that I doubt the word of the hon. Lady about what happened when she went to the Table Office. However, if Mr. Deputy Speaker chooses to interpret the words which I used as meaning that I was calling the hon. Lady a liar, I of course, withdraw them. However, I have made very clear exactly what I mean.
I return to the debate. I want to come on to the important point about the alleged difference between consultation charges and charges for lenses and frames, which no doubt the Minister will increase substantially in due course. No doubt he will tell us later—I was asking this question when the points of order arose—how much those charges will have to be increased in order to recoup the £11 million.
There is very little difference in practice between a consultation charge of say, £2 to have one's sight tested, and a 20 or 30 per cent. increase in the charge for replacing glasses or frames or for providing them for the first time. Both charges act as a disincentive. A charge for sight-testing is a disincentive which applies to all individuals who are not exempted from charges under the Bill. The increased charges which will be levied on frames and lenses will also affect everyone who is not exempted by the Bill. Therefore, there will be a strong disincentive to attend the optician's.
The opticians whom I know believe that the average interval between eye examinations is at present too long, and that anything which increases that interval would be a very bad thing indeed. Therefore, I do not accept the distinction that has been made by some Conservative Members between the proposal to increase charges for frames and lenses and the consultation charge.
With that, I welcome the removal of new clause 1, even if it is just for the time being. We shall watch like hawks to see whether there is any proposal to reintroduce that charge at a later stage, or, indeed, whether there is any proposal substantially to increase charges in other parts of the ophthalmic sector in order to recoup the £11 million.
I have considerable sympathy with those who are pleading on behalf of the partially sighted. It is precisely for that reason that I am delighted that the Minister has withdrawn the proposal to charge for sight testing. I am astounded at the grudging reception which the Minister's action has received, both from the Liberal and Labour Benches.
To my mind, it is democracy at its best when representations are made to a Minister and he accedes to them.
This would have been the only test in the whole of the NHS for which a charge would have been made. That may be serious with regard to spectacles, but what I am concerned about is the early detection of disease. There are so many diseases which can be detected through the eyes which, in a sense, are quite unrelated to the eyes. In addition, diseases of the eyes can be cured if attacked at an early stage. For that reason, I am particularly glad that the Minister listened to the representations and withdrew the charge, which both sides of the House would have found regrettable. I thank him very much.
I am not surprised that in a case such as this the reactions of the Opposition parties to the withdrawal of the new clause are rather strange. After all, that seemed to be a fruitful subject to attack. It seemed to be something which was so full of political overtones that it could be exaggerated. Perhaps Opposition Members are rather sorry that in some respects they now do not have the opportunity of hitting down the target.
Both the hon. Gentleman and his hon. Friend the Member for Lancaster (Mrs. Kellett-Bowman) have suggested that I was grudging in my response to the Minister's decision. Far from it. I suggested that had the Minister come to the Dispatch Box at the beginning of our proceedings and made clear, as he later did, what he intended, he would at least have got a cheer from me, we would have saved a lot of business time this afternoon and we would have made rather faster progress.
I made no particular allegations against the hon. Gentleman. I think that all Oppositions are wrong in taking the view that it is a defeat for Ministers or a Government to change their minds.
I do not suppose that my hon. Friend the Under-Secretary would say anything off the cuff at that moment, and in the circumstances that is not surprising.
What has happened today is gratifying. It is right and proper, especially if a Government or Ministers have made an error, and in this case I believe that there was an error. I agree with my hon. Friend the Member for Birmingham, Edgbaston (Mrs. Knight). I believe that the error was probably made through a natural desire to study every possible method of readjusting and rearranging the costing of NHS as a whole.
Nevertheless, I believe that that zeal induced that rather serious error. It is most undesirable, without more mature consideration for any Administration to branch off in such a new direction, because I believe that that is much more serious than has been suggested. It is undesirable to impose a charge when an eye patient comes into contact with the NHS for the first time. It would also be grossly inconsistent to impose such a charge only in respect of eye patients and not in regard to other branches of the NHS. Obviously, it would be grotesque if a neighbour of mine had a free examination for some obscure tropical disease, costing an infinite amount of money over a long period, whereas I had to pay quite a significant charge for a comparatively minor examination of the eyes.
I echo what both my hon. Friends the Members for Edgbaston and for Lancaster (Mrs. Kellett-Bowman) said about the value of an early examination in all cases, not only in regard to incipient eye disease but also with regard to the possibility of some other illness or disease which might be revealed by a careful and competent examination of the eyes.
I hope that this and future Administrations will stand back before they take any decision to embark on charges of this nature—whether they are for eye tests or any other areas of the National Health Service. There are far less objectionable ways of obtaining necessary revenue support for the Health Service.
I wish that this country were richer and more successful economically and industrially so that we could afford much more spectacular advances, and we would not need to study methods of sustaining the work of the Health Service by charges. But if we wish to sustain and improve the quality of the social and the welfare services generally, we shall have to do so by charges until industry is much more buoyant and productive.
I am glad that we have not taken the proposed undesirable step in the wrong direction. This is not in any way a defeat for the Minister or the Government. It is a kind of democracy in action, and Governments which are not prepared to take such steps are weaker rather than stronger.
The hon. Member for Birmingham, Edgbaston (Mrs. Knight) began her speech by drawing attention to the fact that her husband is an ophthalmic specialist. I acquit her of any financial motive and I am sure that she is not influenced in any way by her husband's income. However, I am equally certain that she has been greatly influenced by her husband's optical knowledge as an ophthalmic specialist. She is a walking advertisement for polyandry. If she were married also to a gynaecologist, a dental surgeon and a general practitioner, she might bring knowledge of a much wider spectrum to our debates on the National Health Service. People are always prepared to come forward and say that they are opposed to particular charges, but they are not opposed to others. It is all a matter of where we draw the line.
I appreciate the courtesy of the hon. Member in giving way, I assure him that I have been married only once—to my husband—and if I were to confine my parliamentary contributions to those areas in which I have a matrimonial connection outside, they would be extremely limited.
I think that I had better draw a veil over the hon. Lady's matrimonial life.
It is bit much to be chided by the hon. Members for Edgbaston and for Somerset, North (Mr. Dean), who has a distinguished record as a former Health Service Minister, for being churlish about the withdrawal of new clause 1 on optical charges.
The Government tell us that as a result of the withdrawal, £11 million will be lost from the Health Service budget. We are also told that the Government are considering other ways of raising this £11 million. I am certain that at present the Health Service cannot absorb £11 million. Ministers travel the country telling people that the Health Service budget is growing and that there will be a 2½ per cent. increase this year. But that is not true. The Health Service budget is based on the proposition that inflation will run at 14 per cent. this year. That is the target set for the health boards, and Ministers have told them that they will not get a penny more. At that time inflation was running at 18½ to 19 per cent. and now it is widely forecast—and the Prime Minister did not deny it today—that tomorrow the RPI will show that inflation is running at an annual rate of 21 per cent. If we average out the 14 per cent. between now and the end of the financial year, it means that in 12 months inflation will need to be about 8 per cent. No one in his right mind in the Treasury or in this House can believe for one second that the annual inflation rate next year will be 8 per cent.
If Ministers say that there is a 2½ per cent. growth rate in the NHS budget, based on 14 per cent. inflation, and the inflation rate is 50 per cent. higher than the figure that has been allowed for, how can there be any real growth at all? It means that there has been a deliberate cut in expenditure on the National Health Service. Ministers should not tell the health boards that 14 per cent. is their target figure unless they can say that the Government will make sure that general economic conditions are such that the NHS will be protected against inflation. In fact, they are now saying that the health boards will get 14 per cent. and not a halfpenny more. How can anyone claim that that is a growth in the Health Service budget?
Ministers should make up their minds about where they stand. Ministers in virtually every other Department are going around the country saying that public expenditure will be cut. The Financial Secretary to the Treasury has predicted three years of misery. The Minister for Social Security has said that everyone will suffer and every area will take a cut, but not Health Ministers. For some curious reasons they are shamefaced about it. I would have much more time for them if they would stand up and tell the health boards that they will get less money. The Government will have to find the extra £11 million from somewhere else—certainly not the Health Service budget.
I do not object to the Minister giving credit for the withdrawal of new clause 1 to his hon. Friends the Members for Somerset, North and for Edgbaston. They kicked up a fuss, went to him and persuaded him. It is right to give credit to Back Benchers, but it is unworthy of him and the traditions of Ministers of the Crown to suggest that there have been no objections from elsewhere on this matter. I did not know that the Minister intended to make this concession, otherwise I would have brought my correspondence with me. If he cares to check with the departmental files, he will find that I have raised this issue strongly by correspondence. I hope that he will give credit where it is due.
I fear that the hon. Members for Somerset, North and Edgbaston will find that they have won a Pyrrhic victory. One set of charges has been withdrawn, but others may be imposed elsewhere. However, I admire hon. Members who stand up to their own Government and are prepared to carry their opposition into the Division Lobby. I give them credit, but let it not be said that there have been no objections from other hon. Members.
Like most of my hon. Friends, I welcome the fact that new clause 1 has been withdrawn, though the test of the Government's good intentions is their attitude to new clause 6. If they had care and concern, they should have indicated by now that they are prepared to accept that new clause.
Why did the Government withdraw new clause 1 only last night, thereby presenting the House with considerable procedural difficulties? If pressure had been building up from a number of sources it would have been reasonable for the Government to withdraw the new clause at the beginning of the week and to have put its replacement on the Amendment Paper so that we could debate it.
If the Government intended not to replace new clause 1 we should be happy, but the Minister has indicated that something else is to be inserted. Time was found to debate new clause 1 because it was being introduced on report and had not been in the Bill on Second Reading or in Committee. I assume that more time will be found to debate any new proposals that come before us in the form of a new clause taking back part of what has been removed by the withdrawal of new clause 1. It is important that we get an undertaking from the Government that they will find extra time if any of the obnoxious proposals contained in new clause 1 and schedule 15 are brought back in another form.
It was discourteous to the House for the Government to act in this way, because it is difficult to debate any of the new clauses until we know the Govment's intentions. If we made progress today and got beyond the new clauses, we should be in difficulty, because we would not have an opportunity of debating the Government's proposals, and they would have to be introduced in another place, which would be unacceptable. I hope that the Minister will accept new clause 6. We all have constituency examples of the problems faced by the partially sighted. The new clause deals only with Scotland, but if the Government accepted it they would be saying that they would adopt the regulations for the rest of the United Kingdom.
I hope that we shall have an indication that the Government are prepared to find time at a reasonable hour to debate any proposals that they intend to bring forward to replace new clause 1. That will be particularly important if the Government intend to introduce a differential principle between sight-testing and teeth inspections. Most of my hon. Friends would regard it as unacceptable if the Minister said that sight-testing was to be exempted but that dental inspections were not.
We have had an interesting two-hour debate, ranging from what were almost Second Reading speeches to contributions on a clause that has not been tabled. I hope that you, Mr. Speaker, will not rule me out of order if I speak about new clause 6, which, I am told, we are meant to be debating, but which, in the brevity to which it has been alluded—
The new clause does not deal with sight-testing; it deals with charges for optical appliances. It is right to get that on the record at the start.
I do not want to stray too much into a Second Reading debate on erstwhile new clause 1, but there has been some talk of financial irresponsibility, and my problem is that Labour Members are forward in telling us how they would spend money but backward on how they would earn it.
The jollity on the Government Frent Bench to which the hon. Member for Wood Green (Mr. Race) referred was caused not by his general remarks but by his comment that a future Labour Government would withdraw all NHS charges. Previous Labour Governments have introduced new charges and increased existing charges.
In the light of the way in which the debate was conducted by Labour Members it was not surprising that the hon. Member for Fife, Central (Mr. Hamilton) moved the new clause formally so that the speeches that were prepared yesterday could still be made.
The hon. Member for Hamilton (Mr. Robertson) made a good speech about new clause 6. I appreciate some of the things that he said, particularly the fact that we have in the House the hon. Member for Coatbridge and Airdrie (Mr. Dempsey), who suffers from the affliction of being partially sighted. We know how difficult it is for him to carry on with the duties that he performs so well and we can therefore appreciate what it must be like for those outside in their careers.
The hon. Member for Hamilton also anticipated, to some extent, the reply that I shall give. He knows, as he said, that I would never stoop to any tactical subterfuge. The hon. Gentleman referred to my commitment to the Health Service, and I shall come to that later.
We had two interventions from the hon. Member for Aberdeen, North. (Mr. Hughes). The first was a tease, when he asked me to reply for the Government to the general debate. If I had done that he would have asked me to restrict myself to the Scottish aspect.
The rest of the debate was answered so adequately by my hon. Friend that I had already decided to limit myself to the Scottish aspect.
Before turning to clause 6, I confirm what the hon. Member for Aberdeen, North said about my visiting health boards and pointing out that the increase of 2 per cent. this year' was based on a 14 per cent. rate of increase in both pay and inflation throughout the 12-month period. If that figure is not achieved, not just the NHS but the whole of Britain will be in trouble. This year we are spending £1,600 million more on the NHS than we did last year. That is no mean figure.
I oppose new clause 6 on three grounds. First, now that the inclusion of schedule 5—has been agreed in Committee, the apparent intentions of those who support new clause 6 have already been met.
Section 105(7) of the National Health Service (Scotland) Act 1978, as amended by paragraph 4 of schedule 5, provides that the Secretary of State may make regulations " with variable application" under virtually all the regulation-making powers conferred on him by the Act. That includes the power to prescribe optical charges under section 70. By variable application I mean regulations that apply in a specific way to specific cases or classes of case.
Secondly, this extension of the regulation-making powers available to the Secretary of State in relation to charges for optical appliances would allow him to prescribe either a reduced level of charge, or no charge at all, to certain categories of patient. That category could include partially sighted patients as specified in the new clause. However, it could also include others who are blind in a technical, legal sense, but who have limited powers of vision, and who could sometimes benefit from optical appliances.
Thirdly, it is wrong to use two nails where one will do. I therefore assure the Opposition that the new clause adds nothing to the effect of paragraph 4 of schedule 5. However, it draws particular attention to the cases of optical charges and partially sighted persons. If the new clause were inserted in the Bill, it might prove unhelpful. It could imply the early relaxation of optical charges.
I shall not give an answer off the top of my head. I shall look into that question and advise the hon. Gentleman accordingly.
I can give no assurance that there is an early prospect of lower charges. As the Committee knows, the Government have carried out a review of the range of possibilities that exist for modifying the present arrangements for exemptions from health charges. In the light of this review the Government have decided that they cannot give priority to extending exemptions from optical charges, especially as help is already available for those in need and those on low incomes.
I have explained fully why we consider that new clause 6 is unnecessary. I understand that Opposition Members still consider voting in favour of the new clause. I ask them to oppose it. If they vote in its favour they will be kicking at an open door.
I wish to intervene only briefly from the Opposition Front Bench. I do so for two reasons. First, the new clause stems directly from my Optical Charges (Exemption) Scotland Bill, which I drafted and sponsored as a Private Member's Bill under Standing Order No. 37. My Bill is, in fact, still before the House.
The second reason for my intervention is that I was the Minister with responsibility for the disabled in the previous Labour Government. I then secured approval to exempt the severely visually handicapped from paying optical charges. In England and Wales exemption could have been given by the laying of regulations. In the case of Scotland, primary legislation was needed and, but for the fall of the Labour Government, this would have become law by last summer. Pending the enactment of the Scottish Bill, it was agreed to delay the laying of the regulations for England and Wales in order to avoid creating any inequity between people with the same handicap in different parts of the United Kingdom.
Following last May's change of Government, there was no indication that the Government intended to bring Scottish law into line with the law of England and Wales. I therefore introduced my Bill. The Government now say that the purpose of my Bill and the purpose of the new clause has been met by their Bill. If that is so, why did they block my Bill—which appeared before theirs—so sneakily and so repeatedly? My Bill could have been law by now if it had not been for the Government's ruthless blocking tactics. As the Minister knows, my Bill and the new clause seek to help those who suffer from a severe visual handicap short of blindness itself.
I am pleased that my hon. Friend the Member for Coatbridge and Airdrie (Mr. Dempsey) was among the sponsors of my Bill, along with many of my hon. Friends who have spoken tonight. We all listen with respect to the views of my hon. Friend the Member for Coatbridge and Airdrie on this important matter. When I last checked the figures, it was estimated that the reform proposed by my Bill would cost between £500,000 and £750,000. About 50,000 visually handicapped people were thought likely to benefit from the reform. These may be underestimates but, on any assessment, the cost and the number of beneficiaries cannot be greatly in excess of those figures. So it is only a modest step forward we have been seeking.
After all, in their first Budget, the Government crammed £1,500 million into the pockets of the richest 7 per cent. of taxpayers. By contrast, we are seeking a modest reform indeed.
I am grateful to my right hon. Friend for his kind references to me. I have the distinct feeling that even the Minister does not understand the type of visual aids involved, their cost and the general problems involved. I have to go to the eye infirmary in Glasgow to obtain them. Few people could afford to pay for them. I do not think that that is understood. I am delighted that my right hon. Friend is stressing the importance of this subject.
As I said, the House as a whole listens to my hon. Friend with great respect. He is eminently right to argue that a very heavy cost falls on those who are severely visually handicapped. I hope that the Minister has listened at least with some sympathy to our proposition. Not only should the necessary power be acquired, but also the exemption itself. Had the Labour Government remained in office, the exemption could have been given last summer. The Minister has said that he does not want to make any off-the-cuff decisions. Last October, my hon. Friend the Member for Hamilton (Mr. Robertson) was in touch with the Minister. My hon. Friend pointed out then that the exemption should be given at the earliest possible date. We are therefore asking him not only to acquire power but to give the exemption.
The Minister spoke of our intentions towards the disabled. Between 1974 and 1979 the previous Labour Government increased spending on the chronically sick and disabled by £1,100 million. We are entitled to be judged on our record. The issue raised in new clause 6 is now very urgent. We shall show our feelings on this important subject by voting in the Lobby tonight.
My right hon. Friend the Member for Manchester, Wythenshawe (Mr. Morris) has argued the case much better than I could have done. He has been intimately concerned with these matters for a long time. In some ways it is a pity that he did not speak earlier in the debate.
My right hon. Friend has put many facts before the House. I suspect that the Minister might not have been too well aware of some of them. However, he must have been aware that my right hon. Friend and others have been putting considerable pressure on the Department for months to give exemption. A relatively small sum is involved. It is no good the Minister saying that the powers exist in schedule 5. That is the equivalent of saying " Our intentions are good." Intentions cost nothing. If the Government are not prepared to supply the means to translate that intention into practical effect, it is a worthless intention.
It is true that the debate has widened considerably from the fairly narrow confines of the clause. That was in the nature of events. The Government withdrew their new clause 1, which provided for new charges for various items, including optical tests. The withdrawal of that clause presented the House with a different ball game. Mr. Speaker said—in my view rightly—that wider issues could be raised while discussing new clause 6. Those issues have been properly raised, and the debate has ranged much more widely as a consequence.
The Minister said that the clause deals with optical charges. It does, and such charges are extremely important for a small and very handicapped section of the community. The Minister made jibes about the previous Labour Government ignoring inflation. He well knows that inflation had been reduced to less than 10 per cent. when the Conservative Government took office. The Government have been so successful in tackling inflation that it has risen from 9 per cent. to 21 per cent., as will be declared tomorrow.
On the basis of that argument, the Minister is not likely to translate his declared intentions into practical effect. On the contrary, the Minister of State went out of his way to say that while the proposed optical charges are being withdrawn other charges—no doubt equally indefensible ones—are to be substituted.
My hon. Friend the Member for Stockport, North (Mr. Bennett) advanced the valid argument that such proposals make the Bill a completely different measure from that to which the House gave a Second Reading some months ago. If the Government are to introduce additional charges at a later stage, we are entitled to ask for additional time in which to debate the new proposals.
If the Government are intent, as I hope they are, on consulting the proper authorities outside the House, it will be some time before they present the House with their proposals. Conservative Members have made great play of the value of the democratic process by which the Government's mind can be changed. If it can be changed overnight on the proposed charges in new clause 1, to such an extent that the Government see fit to withdraw that clause, they should tell us at an early stage precisely what they have in mind for new, substitute charges to raise £11 million. They should proceed to consult the appropriate professional and trade union organisations before they bring forward their proposals in the form of a new clause.
If they produce their proposals without consultation and they receive the hostile reaction that met new clause 1, the House may witness the strange situation of the Government withdrawing a second new clause and saying " We shall forgo this new clause 1 the second time round in favour of a new clause the third time round, so that we may produce a clause that will eventually be approved by professional and other bodies outside the House."
It is no good a Minister saying that new clause 6 is already provided for in schedule 5. As my hon. Friend the Member for Hamilton (Mr. Robertson) has said, schedule 5 is purely an enabling power. The Minister is giving himself an enabling power, but he was careful not to say that any group, either generally or specifically as in the new clause, will benefit by money being provided to translate a declaration of intent into practical effect. On the contrary, we have every cause to believe that no money will be made available and that the powers provided in the schedule will have no practical value.
To show our contempt for the case that has been advanced by the Government against the new clause, I ask my right
|Division No. 308]||AYES||[6.16 pm|
|Abse, Leo||Foulkes, George||Mellish, Rt Hon Robert|
|Adams, Allen||Fraser, John (Lambeth, Norwood)||Mikardo, Ian|
|Allaun, Frank||Freud, Clement||Millan, Rt Hon Bruce|
|Archer, Rt Hon Peter||Garrett, John (Norwich S)||Miller, Dr M. S. (East Kilbride)|
|Armstrong, Rt Hon Ernest||Gilbert, Rt Hon Dr John||Mitchell, Austin (Grimsby)|
|Ashley, Rt Hon Jack||Ginsburg, David||Mitchell, R. C. (Soton, Itchen)|
|Ashton, Joe||Golding, John||Morris, Rt Hon Alfred (Wythenshawe)|
|Bagier, Gordon A. T.||Gourlay, Harry||Morris, Rt Hon Charles (Openshaw)|
|Barnett, Guy (Greenwich)||Graham, Ted||Morris, Rt Hon John (Aberavon)|
|Barnett, Rt Hon Joel (Heywood)||Grant, John (Islington C)||Moyle, Rt Hon Roland|
|Beith, A. J.||Grimond, Rt Hon J.||Newens, Stanley|
|Bennett, Andrew (Stockport N)||Hamilton, James (Bothwell)||Oakes, Rt Hon Gordon|
|Booth, Rt Hon Albert||Hamilton, W. W. (Central Fife)||Ogden, Eric|
|Bottomley, Rt Hon Arthur (M'brough)||Hardy, Peter||O'Halloran, Michael|
|Bradley, Tom||Harrison, Rt Hon Walter||O'Neill, Martin|
|Bray, Dr Jeremy||Hart, Rt Hon Dame Judith||Orme, Rt Hon Stanley|
|Brown, Hugh D. (Provan)||Hattersley, Rt Hon Roy||Owen, Rt Hon Dr David|
|Brown, Robert C. (Newcastle W)||Haynes, Frank||Palmer, Arthur|
|Brown, Ron (Edinburgh, Leith)||Hogg, Norman (E Dunbartonshire)||Park, George|
|Buchan, Norman||Holland, Stuart (L'beth, Vauxhall)||Parker, John|
|Callaghan, Jim (Middleton & P)||Home Robertson John||Parry, Robert|
|Campbell, Ian||Homewood, William||Pavitt, Laurie|
|Canavan, Dennis||Hooley, Frank||Pendry, Tom|
|Cant, R. B.||Horam, John||Penhaligon, David|
|Carmichael Neil||Howell, Rt Hon Denis (B'ham. Sm H)||Powell, Raymond (Ogmore)|
|Carter-Jones, Lewis||Howells, Geraint||Price, Christopher (Lewisham West)|
|Cartwright, John||Hudson, Davies, Gwilym Ednyfed||Race Reg|
|Clark, Dr David (South Shields)||Hughes, Mark (Durham)||Radice, Giles|
|Cocks, Rt Hon Michael (Bristol S)||Hughes, Robert (Aberdeen North)||Richardson, Jo|
|Cohen, Stanley||Hughes, Roy (Newport)||Roberts, Allan (Bootle)|
|Conlan, Bernard||Janner, Hon Greville||Roberts, Ernest (Hackney North)|
|Cowans, Harry||Jay, Rt Hon Douglas||Roberts, Gwilym (Cannock)|
|Craigen, J. M. (Glasgow, Maryhill)||John, Brynmor||Robertson, George|
|Crowther, J. S.||Johnson, James (Hull West)||Robinson, Geoffrey (Coventry NW)|
|Cryer, Bob||Johnson, Walter (Derby South)||Rodgers, Rt Hon William|
|Cunliffe, Lawrence||Johnston, Russell (Inverness)||Rooker, J. W.|
|Cunningham, George (Islington S)||Jones, Rt Hon Alec (Rhondda)||Roper, John|
|Cunningham, Dr John (Whitehaven)||Jones, Barry (East Flint)||Ross, Ernest (Dundee West)|
|Dalyell, Tam||Jones, Dan (Burnley)||Ross, Stephen (Isle of Wight)|
|Davidson, Arthur||Kaufman, Rt Hon Gerald||Rowlands, Ted|
|Davies, Rt Hon Denzll (Llanelli)||Kerr, Russell||Ryman, John|
|Davies, Ifor (Gower)||Kilfedder, James A.||Sandelson, Neville|
|Davis, Clinton, (Hackney Central)||Kilroy-Silk, Robert||Sever, John|
|Davis, Terry (B'rm'ham, Stechford)||Kinnock, Nell||Sheerman, Barry|
|Deakins, Eric||Lambie, David||Sheldon, Rt Hon Robert (A'ton-u-L)|
|Dean, Joseph (Leeds West)||Lamborn, Harry||Shore, Rt Hon Peter (Step and Pop)|
|Dempsey, James||Lamond, James||Short, Mrs Renée|
|Dewar, Donald||Leadbitter, Ted||Silkin, Rt Hon S. C. (Dulwich)|
|Dixon, Donald||Leighton, Ronald||Silverman, Julius|
|Dobson, Frank||Lestor, Miss Joan (Eton & Slough)||Skinner, Dennis|
|Dormand, Jack||Lewis, Arthur (Newham North West)||Smith, Rt Hon J. (North Lanarkshire)|
|Douglas, Dick||Lewis, Ron (Carlisle)||Snape, Peter|
|Douglas-Mann, Bruce||Litherland, Robert||Soley, Clive|
|Dubs, Alfred||Lyon, Alexander (York)||Spearing, Nigel|
|Duffy, A. E. P.||Lyons, Edward (Bradford West)||Spriggs, Leslie|
|Dunn, James A. (Liverpool, Kirkdale)||McCartney, Hugh||Stallard, A. W.|
|Dunnett, Jack||McDonald, Dr Oonagh||Steel, Rt Hon David|
|Dunwoody, Mrs. Gwyneth||McElhone, Frank||Stoddart, David|
|Eastham, Ken||McGuire, Michael (Ince)||Strang, Gavin|
|Ellis, Raymond (NE Derbyshire)||McKay, Allen (Penistone)||Summerskill, Hon Dr Shirley|
|Ellis, Tom (Wrexham)||McKelvey, William||Taylor, Mrs Ann (Bolton West)|
|English, Michael||MacKenzie, Rt Hon Gregor||Thomas, Jeffrey (Abertillery)|
|Ennals, Rt Hon David||Maclennan, Robert||Thomas, Dr Roger (Carmarthen)|
|Evans, John (Newton)||McNamara, Kevin||Thorne, Stan (Preston South)|
|Ewing, Harry||McWilliam, John||Tilley, John|
|Faulds, Andrew||Magee, Bryan||Torney, Tom|
|Field, Frank||Marks, Kenneth||Urwin, Rt Hon Tom|
|Flannery, Martin||Marshall, David (Gl'sgow, Shettles'n)||Varley, Rt Hon Eric G.|
|Fletcher, Ted (Darlington)||Marshall, Dr Edmund (Goole)||Wainwright, Edwin (Dearne Valley)|
|Foot, Rt Hon Michael||Marshall, Jim (Leicester South)||Walker, Rt Hon Harold (Doncaster)|
|Forrester, John||Mason, Rt Hon Roy||Weetch, Ken|
|Foster, Derek||Maxton, John||Wellbeloved, James|
|Welsh, Michael||Williams, Rt Hon Alan (Swansea W)||Wrigglesworth, Ian|
|White, Frank R. (Bury & Radcliffe)||Williams, Sir Thomas (Warrington)||Wright, Sheila|
|White, James (Glasgow, Pollok)||Wilson, Gordon (Dundee East)|
|Whitehead, Phillip||Wilson, William (Coventry SE)||TELLERS FOR THE AYES:|
|Whitlock, William||Winnick, David||Mr. George Morton and|
|Willey, Rt Hon Frederick||Woodall, Alec||Mr. James Tinn.|
|Adley, Robert||Fell, Anthony||MacGregor, John|
|Aitken, Jonathan||Fenner, Mrs Peggy||MacKay, John (Argyll)|
|Alexander, Richard||Fisher, Sir Nigel||Macmillan, Rt Hon M. (Farnham)|
|Alison, Michael||Fletcher, Alexander (Edinburgh N)||McNair-Wilson, Michael (Newbury)|
|Ancram, Michael||Fletcher-Cooke, Charles||McNair-Wilson, Patrick (New Forest)|
|Arnold, Tom||Fookes, Miss Janet||McQuarrie, Albert|
|Aspinwall, Jack||Forman, Nigel||Madel, David|
|Atkins, Rt Hon H. (Spelthorne)||Fowler, Rt Hon Norman||Major, John|
|Atkins, Robert (Preston North)||Fox, Marcus||Marland, Paul|
|Atkinson, David (B'mouth, East)||Fraser, Rt Hon H (Stafford & St)||Marlow, Tony|
|Baker, Kenneth (St. Marylebone)||Fraser, Peter (South Angus)||Marshall, Michael (Arundel)|
|Baker, Nicholas (North Dorset)||Fry. Peter||Mates, Michael|
|Beaumont-Dark, Anthony||Galbraith Hon T. G. D||Maude, Rt Hon Angus|
|Bendall, Vivien||Gardiner, George (Reigate)||Mawby, Ray|
|Bennett, Sir Frederic (Torbay)||Gardner, Edward (South Fylde)||Mawhinney, Dr Brian|
|Benyon, Thomas (Abingdon)||Garel-Jones, Tristan||Maxwell-Hyslop, Robin|
|Benyon, W. (Buckingham)||Gilmour, Rt Hon Sir Ian||Mayhew, Patrick|
|Berry, Hon Anthony||Glyn, Dr Alan||Mellor, David|
|Best, Keith||Goodhart, Philip||Miller, Hal (Bromsgrove & Redditch)|
|Bevan, David Gilroy||Goodhew, Victor||Mills, lain (Meriden)|
|Biggs-Davison, John||Goodlad, Alastair||Mills, Peter (West Devon)|
|Blackburn, John||Gow, Ian||Miscampbell, Norman|
|Blaker, Peter||Gower, Sir Raymond||Mitchell, David (Basingstoke)|
|Body, Richard||Gray, Hamish||Moate, Roger|
|Boscawen, Hon Robert||Greenway, Harry||Monro, Hector|
|Bottomley, Peter (Woolwich West)||Grieve, Percy||Morris, Michael (Northampton, Sth)|
|Bowden, Andrew||Griffiths, Eldon (Bury St Edmunds)||Morrison, Hon Charles (Devizes)|
|Bright, Graham||Griffiths, Peter (Portsmouth N)||Morrison, Hon Peter (City of Chester]|
|Brinton, Tim||Grist, Ian||Mudd, David|
|Brittan, Leon||Grylls, Michael||Murphy, Christopher|
|Brocklebank-Fowler, Christopher||Gummer, John Selwyn||Myles, David|
|Brooke, Hon Peter||Hamilton, Hon Archie (Eps'm&Ew'll)||Needham, Richard|
|Brown, Michael (Brigg & Sc'thorpe)||Hamilton, Michael (Salisbury)||Nelson, Anthony|
|Browne, John (Winchester)||Hampson, Dr Keith||Neubert, Michael|
|Bruce-Gardyne, John||Hannam, John||Newton, Tony|
|Bryan, Sir Paul||Haselhurst, Alan||Normanton, Tom|
|Buck, Antony||Hawkins, Paul||Onslow, Cranley|
|Budgen, Nick||Hawksley, Warren||Oppenheim, Rt Hon Mrs Sally|
|Bulmer, Esmond||Heddle, John||Page, John (Harrow, West)|
|Burden, F. A.||Henderson, Barry||Page, Richard (SW Hertfordshire)|
|Butcher, John||Hicks, Robert||Parkinson, Cecil|
|Butler, Hon Adam||Higgins, Rt Hon Terence L.||Parris, Matthew|
|Cadbury, Jocelyn||Hill, James||Patten, Christopher (Bath)|
|Carlisle, Kenneth (Lincoln)||Hogg, Hon Douglas (Grantham)||Pattie, Geoffrey|
|Carlisle, Rt Hon Mark (Runcorn)||Holland, Philip (Carlton)||Pawsey, James|
|Chalker, Mrs. Lynda||Hooson, Tom||Peyton, Rt Hon John|
|Channon, Paul||Hordern, Peter||Pollock, Alexander|
|Chapman, Sydney||Howell, Rt Hon David (Guildford)||Porter, George|
|Clark, Hon Alan (Plymouth, Sutton)||Howell, Ralph (North Norfolk)||Powell, Rt Hon J. Enoch (S Down)|
|Clark, Sir William (Croydon South)||Hunt, John (Ravensbourne)||Prentice, Rt Hon Reg|
|Clarke, Kenneth (Rushcliffe)||Irving, Charles (Cheltenham)||Price, David (Eastleigh)|
|Clegg, Sir Walter||Jenkin, Rt Hon Patrick||Proctor, K. Harvey|
|Cockeram, Eric||Jessel, Toby||Rathbone, Tim|
|Colvin, Michael||Johnson Smith, Geoffrey||Rees, Peter (Dover and Deal)|
|Corrie, John||Jopling, Rt Hon Michael||Renton, Tim|
|Cormack, Patrick||Kaberry, Sir Donald||Rhodes James, Robert|
|Corrie John||Kellett-Bowman, Mrs Elaine||Rhys Williams, Sir Brandon|
|Costain, A. P.||Kershaw, Anthony||Rifkind, Malcolm|
|Crouch, David||Knight, Mrs Jill||Roberts, Michael (Cardiff NW)|
|Dean, Paul (North Somerset)||Knox, David||Roberts, Wyn (Conway)|
|Dickens, Geoffrey||Lamont, Norman||Rossi, Hugh|
|Dorrell, Stephen||Lang, Ian||Rost, Peter|
|Dover, Denshore||Latham, Michael||Royle, Sir Anthony|
|Dunn, Robert (Darttord)||Lawrence, Ivan||Sainsbury, Hon Timothy|
|Durant, Tony||Lawson, Nigel||Scott, Nicholas|
|Dykes, Hugh||Lee, John||Shaw, Michael (Scarborough)|
|Eden, Rt Hon Sir John||Le Marchant, Spencer||Shelton, William (Streatham)|
|Edwards, Rt Hon N. (Pembroke)||Lennox-Boyd, Hon Mark||Shepherd, Colin (Hereford)|
|Elliott, Sir William||Lewis, Kenneth (Rutland)||Shersby, Michael|
|Emery, Peter||Lloyd, Ian (Havant & Waterloo)||Skeet, T. H. H.|
|Eyre, Reginald||Lloyd, Peter (Fareham)||Smith, Dudley (War. and Leam'ton)|
|Fairbairn, Nicholas||Loveridge, John||Speed, Keith|
|Fairgrieve, Russell||Lyell, Nicholas||Speller, Tony|
|Faith, Mrs Sheila||McCrindle, Robert||Spence, John|
|Farr, John||Macfarlane, Nell||Spicer, Michael (S Worcestershire)|
|Sproat, lain||Thorne, Neil (llford South)||Watson, John|
|Squire, Robin||Thornton, Malcolm||Wells, Bowen (Hert'rd & Stev'nage)|
|Stainton Keith||Townend, John (Bridlington)||Wheeler, John|
|Stanbrook, Ivor||Townsend, Cyril D. (Bexleyheath)||Whitelaw, Rt Hon William|
|Stanley, John||Trippler, David||Whitney, Raymond|
|Steen, Anthony||van Straubenzee, W. R.||Wickenden, Keith|
|Stevens, Martin||Vaughan, Dr Gerard||Wiggin, Jerry|
|Stewart, Ian (Hitchin)||Viggers, Peter||Wilkinson, John|
|Stewart, John (East Renfrewshire)||Waddington, David||Williams, Delwyn (Montgomery)|
|Stokes John||Waldegrave, Hon William||Winterton, Nicholas|
|Stradling Thomas, J.||Walker, Rt Hon Peter (Worcester)||Wolfson, Mark|
|Tapsell, Peter||Walker, Bill (Perth & E Perthshire)||Young, Sir George (Acton)|
|Taylor, Robert (Croydon NW)||Walker-Smith, Rt Hon Sir Derek||Younger, Rt Hon George|
|Taylor, Teddy (Southend East)||Waller, Gary|
|Tebbit, Norman||Walters, Dennis||TELLERS FOR THE NOES:|
|Temple-Morris, Peter||Ward, John||Mr, John Wakeham and|
|Thompson, Donald||Warren, Kenneth||Mr. Carol Mather.|