Bevan’s speech on the introduction of the prescription charge 9 December 1949


It may perhaps be for the convenience of the House if I speak at this stage, because the speeches – and I make no complaint about it – have tended to repeat themselves. Hon. Members are, of course, speaking under difficulties. They are difficulties that are inherent in the proposal to take powers to do something, when what is intended to be done is not in fact before the House. This is always the case in every Statute where it is found necessary to take power to make regulations of a detailed character. Everybody, I think, who has experience of this matter will agree that we have found it almost impossible to escape that necessity.

I know that the hon. Member for Northern Dorset has expressed, as I have done on many occasions when sitting on the back benches, deep distrust of conferring on a Minister the power to make regulations which would not be subject to amendment. In the course of this Parliament, we have altered that procedure in one or two instances in order that there might be an instrument of discussion rather less restrictive than merely a discussion on a Prayer to annul a regulation. Therefore, I sympathise wholeheartedly with those who say: “Here we are giving this power blindly, and we do not know how it is going to be used.”

I have been asked a number of questions as to how I propose to use this power. I say frankly that if I could give the answer there is no excuse for my not having had the regulation ready. I do not myself yet know all the answers. Before this can be made into a practical scheme, it will have to be discussed with representatives of chemists and doctors to see how it is to be worked out.

The proposal to have a charge up to 1s. creates no administrative difficulty at all. The administrative difficulties arise out of the necessity of exemption. I am not myself displeased that we have had this discussion this morning. I am not displeased that hon. Members have been brought up against the administrative difficulties of carrying out principles which many people have so glibly proposed.

We have had, in the course of the last year, a large number of allegedly erudite letters written by professional men and journalists in the daily newspapers advocating charges of various kinds on the National Health Service and pointing out how large sums of money could be saved if these charges were made. All the time they have assumed that there is an economy in transferring a charge from the State to the individual. That in itself is not an economy at all. I am not suggesting that it is. It is not an economy merely to transfer a charge; a proper economy is a more efficient way of giving the service. I have read some of these letters and communications with a good deal of quiet pleasure because I knew that the time would come when the legislature would be faced with the working out of some of these principles.

The same problem arises on the next Amendment, although in that case it will be rather easier when we are asked to distinguish between foreigners and our own nationals. We have had that argument raised, and the newspapers supporting the Opposition have been carrying headlines for almost 15 months on this particular matter. When we come to make a distinction and go from the easy realm of abstract principle to that of practical discrimination, all kinds of administrative problems arise. I can quite see that, in some instances, the cost of administration would exceed the economy, so I am not at variance with a good deal of what has been said this morning.

I want to answer the charge that this proposal was only made in consequence of a demand for economy. If that were the case, how do hon. Members who have made that charge explain that these are powers only to deal with the pharmaceutical services? If indeed the Government wanted to take power to make a charge to the citizens for the use of the Health Service, then we would have general power for making a charge. We have not done that. What we have done is to say that we want to take power to make a charge in respect of the pharmaceutical service alone. Why have we done that? This is a complete answer to the hon. Member for Thurrock. It is because our experience has gone to show that it was this very vital part of the service in which the general practitioner was most involved and where the greatest load had fallen, and that the service was inclined in some respect not to give the standard of service we wanted from it. It is quite incorrect to say that it was the purely financial aspect of this matter that weighed most with me when I accepted this tentative proposal. In fact the exaggeration we have had this morning – I am bound to say that my hon. Friend is an innocent Parliamentarian if he imagines for a single moment that any Minister is going to stand at this Box and give a detailed description of the internal communications that take place between the members of the Cabinet and himself; he really is more than ingenuous. There is a principle of collective Cabinet responsibility.

What I am saying is that on the face of it the proposal does not bear out the sinister interpretation placed upon it by the hon. Member for Thurrock, because we are in fact confining the power to make regulations to withholding free sales up to a certain amount ?not to impose a charge. This is not a power to impose a charge. This is to restrict the free service on the pharmaceutical side up to 1s.

Let us look at the actual facts. It is not the National Health Service that would be making a charge to the patient. It is the National Health Service that would be saying to the patient: ‘Where a doctor has given you a prescription that costs more than a shilling, the National Health Service will pay the cost above a shilling, but up to the shilling you will pay.” We could quite as easily restrict the new service in another direction.

Nor it is true to say, as the right hon. and gallant Member for the Scottish Universities said, that we are putting the National Health Service contributor in a worse position than he has been in since the beginning of the National Health Service Act. That is not true. What is actually happening at the present time is that the National Health Service is giving him a far wider range of services than he had under the National Health Insurance Act; therefore, even if this were imposed, what would be left to the National Health contributor would be a far wider range of service than was ever available before.

What is true is that in certain cases where the National Insurance contributor is having his bottle of medicine free, he will now have to pay up to 1s. for it. All the rest of the service which he gets is infinitely more valuable than that “bob,” and he will have a far greater service than before. If he had to choose between the two, ask him which he would prefer.

We have had the experience, as I said earlier, that it is on this particular side of the service that the greatest burden has fallen. In those circumstances, we had to ask how that burden could be mitigated, and we came to the conclusion that if we could in some way reduce the queues at the surgeries and the unnecessary expenditure at the chemists’ shops, it would be a good thing.

It is not correct to say it is only on the side of bottled medicine that some of the abuse has taken place – it is aspirins, bandages, and so forth, costing less than a 1s., which in a large number of cases could have been purchased by the patient without having to call on the general practitioner, or without making a second call on a doctor for a prescription. That is where the abuse arises. It is no use my hon. Friends telling me that this is not the case, because this proposal has not, in fact, been received with much indignation, as it is generally accepted that there is an awareness of the abuse which has been taking place.

If my hon. Friend can tell me how to visit it on the doctor, I will gladly consider the position, but we must presume, until it is proved to the contrary, that it is not in the interests of the patient to have too many prescriptions. We cannot go beyond that at the moment. We do know, however, on the purely subjective side, that this proposal would have met with far greater indignation had there not been this awareness of abuse. We thought, therefore, it would give rise to easement on the general practitioner’s side in the early stages of this scheme. I am not suggesting that this ought to be a permanent feature of the National Health Service.

My hon. Friends need not be apprehensive about this matter, because I am as deeply concerned with maintaining the Socialist approach to this service as any one on this side of the House. Therefore, as far as I am concerned, this is put forward only for the purpose of a temporary easement, if it be practicable, and there will then be a residual financial advantage, the extent of which no one knows, because we do not yet know what the exemptions will be. What is practically certain is that the figure of £10 million was based on the assumption that there would be no exemptions, and that any exemptions will reduce that amount, although to what extent no one knows at the moment. All I can say is that the House will have an opportunity of discussing the regulations before they are put into effect.

It is impossible to have the regulations in a form in which Amendments can be made. I want the House to be quite clear about this. These are not the only regulations which are made under a Statute. A whole series of regulations concerning the assistance board have been made, and there is no reason why these regulations should be in a different position from those regulations which are infinitely more important. I see no reason why we should have an extra-Parliamentary procedure for what amounts to a very small aspect indeed of the whole administration.

A lot of exaggeration has gone on that is not revealed in comparison with the figures involved. We are speaking here of a service involving £340 million a year, of which this figure of £10 million is but a small proportion. We must keep our sense of proportion, because we shall then see that what we are considering is not a considerable retreat from the position we have taken up, but merely a mitigation of the burden which has fallen on the general practitioner service at the present time.

No, Sir. They will be regulations requiring the negative Resolution procedure, but that does not affect the situation seriously because I will so arrange the dates that before the regulations are put in operation, an opportunity will be given to the House for a Prayer, so that as far as Parliamentary procedure allows we shall refer the matter back to the House of Commons before any incidence fails on the citizens of the country.

There is already some evidence, as a consequence of the publicity which has been given to this aspect of the service, of a reduction in some cases of the burden on the general practitioners. There is a growing consciousness that people ought not to abuse the service in any particular. I am convinced that, as the service develops, there will be a growing sense of responsibility, and that discipline of this sort will not eventually be necessary in the service as a whole. I hope, therefore, that with those assurances and those explanations the House will permit me to have the powers for which I am now asking.

Certainly; I am giving consideration to it. As I have said, I am not anxious to burden myself with a complicated administrative machine if I can achieve the same results by other means.