§ Motion made, and Question proposed, That this House do now adjourn. —[Mr. Fallon.]11.14 pm
§ Mrs. Ann Taylor (Dewsbury)
I am grateful for the opportunity of raising a problem that involves one of my constituents, but is also faced by many other people. The more I have looked into the difficulties faced, not only by my constituent but by others in her position, the more sympathy I have with the case that I am pressing. I hope that the Minister will be responsive this evening.
Many people who require essential medical treatment are not exempt from prescription charges, and it is absolutely necessary that they should be. The specific problem to which I draw the Minister's attention is the difficulty faced by those people—mainly, but not exclusively, women—who have to use catheters regularly, several times a day, but who have to pay for the prescription that they get on the health service from their doctors for the equipment that they need.
The constituent who brought the matter to my attention is a woman in her early 50s, who had a job that she found enjoyable and satisfying, helping elderly people. She had an accident at work that led to a spinal injury which resulted in problems with her nerves, and she required a great deal of treatment. She has been left with permanent nerve damage and is unable to pass water in the normal way. She has to self-catheterise herself at least three times a day. She finds it difficult to come to terms with that. Having spoken to doctors and continence advisers, I find that that is not unusual for such patients. She finds it an embarrassment and a disability, and also frustrating.
My constituent is also angry that, at the same time that she is having to cope with this difficult medical problem, she has to pay for the prescription for the equipment she requires. She feels that that is unfair, and I agree. There are three reasons why I believe my constituent is right to feel that she, and others in a similar position, have a genuine grievance.
First, we are talking about an essential bodily function. My constituent manages by using catheters three or four times a day. If she did not do so, the National Health Service would be faced with a patient in a crisis, and it would be an emergency. My constituent has no alternative; there is no way that she can cut down on the prescribed items she uses. Her needs are essential, on a day-in, day-out basis.
Secondly, many other comparable items of equipment are exempt from prescription charges. Colostomy bags are, in many ways, comparable. Those who need colostomy bags receive them free. The Minister may say, as one Minister has in a letter to me, that there is a difference between needing catheters and needing a colostomy bag. The reason that Ministers have given in the past is that if a patient needs to use catheters he or she does not have a permanent fistula. That is the distinction which Ministers have made when deciding who should be exempt from presciption charges. I do not accept that it is as simple as that or that that should be the deciding factor.
§ Mrs. Taylor
As my hon. Friend says, colostomies are often reversible. We are talking about similar problems. Both conditions involve essential bodily functions and, on occasion, there is an option available for some people who choose to self-catheterise, rather than have a permanent fistula. Some of those involved were given the option of having a urostomy, which is a permanent fistula. If a urostomy——
§ Mrs. Taylor
—which is sometimes reversible, though not always—is performed, the appropriate bags are available on prescription with no charge being levied. One woman in my constituency in her early 30s suffered nerve damage after intense gynaecological surgery and was left with the problem of lack of bladder control because of nerve damage. She was given the option of having a urostomy, but chose to use catheters instead, despite the difficulties—perhaps because of the dangers sometimes associated with irritation and the other difficulties that can arise with a fistula.
It would be ludicrous if a patient, having been advised that she could opt for either treatment, chose a urostomy on the ground that it would not cost her anything in the future because all the prescription items she needed would be exempt. If the same patient chose a catheter, thus saving the health service the cost of the operation, she would have to pay for every prescription. Patients should not have to make a decision on that basis.
There is also a straightforward medical reason why the items required should be available free of charge. I refer to the serious risk of infection that arises from reusing catheters. I understand that two different types are in regular use. One kind, preferred by many patients, is supplied already lubricated, which makes for ease of use. The other kind is not and has to be lubricated by the user. That second type may not be as good at preventing infection.
Manufacturers of the prelubricated catheter recommend that they are used only once. I appreciate that it may be in their commercial interests to give that advice, but there could be a problem, in terms of the possible transference of infection if further lubrication is required. For that reason, many users feel far safer using a catheter only once.
When patients have to pay for the catheters they obtain on prescription, there may be a temptation to wash and reuse them, giving rise to associated health risks. While patients may get away with that practice to a limited extent, it is surely wrong to encourage them to do anything that increases the risk to their health. Many users who self-catheterise are strongly dissuaded from reusing their catheters overmuch by their medical advisers, doctors and continence advisers. They are certainly dissuaded from reusing them outside their own homes, as that introduces additional risks. In any event, the risk increases if, because of the cost involved, users decide to reuse their catheters.
Let me sum up. The Minister should take the matter seriously for the following reasons. The equipment is needed for an essential bodily function; other comparable items are exempt from charges; moreover, there is a risk of infection from the reuse of catheters, involving a subsequent cost to the health service.
There may not be many cases of self-catheterisation at present—although we do not know the exact number: the 586 information is not collected centrally, and even the health centres must rely on information from hospitals, which is sometimes slow in arriving. Nevertheless, it is an increasing problem. I spoke to Mrs. Anita Barker, a continence adviser based at one of the health centres in my part of West Yorkshire and she gave me an insight—for which I am grateful—into the many problems that arise. Her specialty is relatively new; I understand that the first continence adviser was appointed only about 10 years ago. Now, however, there is increasing awareness of the problems that face many people, most—although not all —of them women, and some of them relatively young.
New techniques are being developed. When the lists were first drawn up, the fact that catheters were not exempt from prescription charges was probably not a problem, as very few people were self-catheterising. I gather that the constituent of mine who raised the matter was one of the first people in the north to be taught how to do it. Now, however, more people are being considered as candidates for the technique, although it is not suitable for everyone.
The Department should spend more time thinking about the number of people who could be affected. I understand that such problems as incontinence—which are not the glamorous end of medicine, by any means—have not been the subject of a great deal of work recently. A 1984 study showed that 3 million people suffered from incontinence, although that was thought to be an underestimate: as I am sure the Minister will agree, many people do not want to tell others that they have such a problem. I am told that many sufferers buy the equipment that they need by mail order or from the chemist without seeing their doctors, because they mistakenly see their problem as one of which they should be ashamed.
Although the debate is specifically about catheters, may I suggest to the Minister that all incontinence equipment should be available from GPs free on prescription? That might help to reduce the stigma associated with such health problems.
The Minister may say that many people who use catheters will in any event be exempt from all prescription charges for other reasons. Incontinence or bladder control problems are sometimes a consequence of a larger health problem, such as multiple sclerosis or a colostomy. That does not apply to everyone, however. I am told that many young men with spinal injuries must pay for the male-incontinence sheaths that they have to use regularly.
It is all very strange. Some patients are exempt while others are not. Some items are exempt, such as collection bags—which are necessary following urostomies—and the same items, if issued by a health authority, can be given to patients free of charge.
I hope that the Minister will look sympathetically at the problems affecting an increasing number of people, and I hope that he will realise from the debate that there is a need to carry out more research into this issue. When the prescription exemption list was first drawn up it was very rare for people to self-catheterise. It is now becoming increasingly common. Perhaps there will be further technological advances, which will make it a suitable procedure for more people.
I hope that the Minister will not close his mind to the possibility of helping people who are faced with this situation, because it is essential to every one of them. Having to pay for the equipment required adds insult to injury for many people.
§ The Parliamentary Under-Secretary of State for Health (Mr. Stephen Dorrell)
It is a great pleasure to respond to the hon. Member for Dewsbury (Mrs. Taylor). She and I spent quite a long time in each other's company when I was in an earlier incarnation in the Whips' Office. We both served on the Criminal Justice Bill Standing Committee. On that occasion she had plenty to say and I was unable to respond to any of it, so it is nice to be able to respond, even if I am not in total agreement with her, this evening.
The hon. Lady advanced the case of her constituent who feels that there is an injustice associated with the fact that the supply of catheters on prescription leads to a prescription charge and that, in her own phrase, that "adds insult to injury" to the position in which her constituent finds herself.
The hon. Lady drew attention to three arguments which, in her view, justify her case that her constituent should not be required to pay a prescription charge for the supply of catheters: that the bodily functions involved are essential and that if self-catheterisation did not continue it would lead to substantial problems for the health authority and, of course, for the patient, the hon. Lady's constituent; that other similar conditions lead to free prescriptions; and that there is a significant health risk attached to the hon. Lady's constituent. The hon. Lady also made some general remarks about research on unglamorous medical issues, which I shall return to at the end of my speech.
General policy on prescription charges is one of the issues that has been hotly debated ever since the national health service was set up, and perhaps it is a debate which, over the years, has generated a great deal more heat than light. It is hard to think of anything new to say on the subject of prescription charges after 40 years. It remains the Government's view that it is reasonable that those who can afford to make a contribution towards the costs of medicines prescribed to them should do so, and that regimes of exemption from prescription charges should be properly directed and should be justified by medical or social considerations.
As a background to the debate it is worth remembering that, of more than £2 billion spent on pharmaceutical services, prescription charges now comprise £177 million, or roughly 8 per cent. of the total cost of the pharmaceutical services of the national health service. Therefore, the prescription charge, while it raises a significant sum, cannot by any stretch of the imagination be said to finance the majority, or even a substantial minority, of the cost of pharmaceutical services.
Furthermore, we should also remember that the charge that we are discussing is £3.05 for each prescription, with a maximum charge, because of the season ticket system, of £43.50 during the year. Not only are the charges relatively modest, but they are levied on only a quarter of all prescriptions dispensed, as 75 per cent. of prescriptions are dispensed free. That is the issue to which the hon. Lady has referred. She has argued that her constituent should be among the 75 per cent., not the 25 per cent.
To assess the robustness of that argument we must look at the rules and see who is entitled to free prescriptions. The main determinant, which covers the vast majority of free prescriptions, is income. We believe that those who find it difficult to meet prescription charges on income grounds should be entitled to free prescriptions. That is 588 why the list includes all men over 65 and all women over 60, all children under 16, all students under 19 in full-time education and all those receiving income support and family credit—the main means-tested benefits.
Furthermore, there is an independent system within the NHS, outside the means-tested benefits system, to ensure that those over 16 on low incomes do not have to pay prescription charges. Expectant mothers and mothers with a baby of under 12 months do not have to pay prescription charges. Ministry of Defence disablement pensioners do not have to pay prescription charges if the prescription is related to the cause of their disablement. Finally—this is the only exception from the principle of income determination—there are those who are exempted from having to pay prescription charges because they receive a particular type of medical treatment. Viewed in the context of the entirety of that list, they are very much the exception rather than the rule.
With those who are exempt on grounds of the medical treatment that they receive, the list of treatments is relatively short. It originated when charges for prescriptions were reintroduced in 1968. The list is substantially unchanged from that which was introduced over 20 years ago. It was drawn up as a means of exempting some of the chronically sick from prescription charges. It has been reviewed on a number of occasions by Governments of both political complexions since 1968—most recently in 1986. On each occasion the conclusion of the review was that the exemption arrangements should not be altered.
There are two reasons. While the cost of adding any one medical condition, such as the requirement for catheters, to the list is not great, it is important to remember that if the principle were accepted for one condition, I should quickly be summoned back to the Dispatch Box on behalf of patients suffering from another condition. The case that the hon. Lady advances for those who need catheters is neither stronger not weaker than the case that could be advanced for those who suffer from cystic fibrosis, multiple sclerosis—which the hon. Lady mentioned as one condition that she wished the Government to consider—cancer, asthma and Parkinson's disease. If we sat down together for 10 minutes, I am sure that the hon. Lady and I could think of a number of other conditions for which a case, on medical grounds, could be made that was as strong as that for the conditions that are already included on the list.
§ Mrs. Taylor
I did not intervene when the Minister referred to the income aspect. However, many women who are in the same position as my constituent are in employment and earning money. Dependency adds to their difficulties. My point was that we are referring to a natural and daily bodily function. Absence of such equipment is life endangering. It would lead to a person having to be readmitted to hospital very quickly. It is the life-saving nature of the equipment that we are discussing. That is why I believe that it should be included.
§ Mr. Dorrell
I understand what the hon. Lady says. Neither she nor I is sufficiently well qualified in medical matters to be able to quote the treatment that would be required to deal with the diseases that I have listed. We would not be able to bandy treatments in that way. If, however, we were to compare those illnesses with the medical conditions that are linked with free prescriptions, it would be difficult to justify the inclusion of those that are 589 on the list and the exclusion of others, condition by condition. If the force of the hon. Lady's argument for including catheterisation on the list were accepted, the floodgates would be opened and it would be difficult to resist the arguments of those who campaign for other groups. Once the argument is accepted, the resource implications become more considerable than on the basis of the hon. Lady's argument alone.
That is only one of the two reasons that the hon. Lady should consider in reflecting on the force of her argument. The other concern reflects on what I said earlier about the exemption rules being principally income oriented, being designed so that those in most financial need are protected from the requirement to pay prescription charges while those who can afford to contribute something towards the cost of their medicines do so. Many of those who are chronically sick already qualify for exemption in one or more of the other groups. I understand that the exemption list would almost certainly not help directly those in most immediate need if the measurement of need was based on income. Only the chronically sick whose resources exceeded the low-income qualifying level would benefit from such a change.
Extending the list would provide additional assistance for those who are not in the greatest need when income is taken into account and measured. In my view, that would not be the best use of the resources that are available to the NHS.
I should prefer to see the use of scarce resources to secure other advances, and the hon. Lady suggested one or 590 two in her concluding remarks. I do not want to commit myself at this time of night to a great research programme without having thought about it further, but her comment that the Department of Health should remember the need to undertake research programmes in the less glamorous aspects of medicine as well as in the leading-edge technologies, which can always guarantee good press coverage and media interest, is an entirely sensible proposition to advance. If the result of that research were to suggest that treatments were not being allowed to develop in the way that she fears, policy makers would have to take that seriously into consideration.
§ Mrs. Taylor
I am grateful to the Minister for his constructive comments. Would he be willing to meet some of those who feel that they are facing difficulties, and who could suggest areas of research and refer to others that are not being covered?
§ Mr. Dorrell
Yes. I should be happy to meet them and hear their proposals for research programmes, or how others might direct research programmes, to achieve the objectives to which the hon. Lady has referred. I hope that on that basis she will feel that she has made some progress this evening. I look forward to seeing her with a delegation.
§ Question put and agreed to.
§ Adjourned accordingly at seventeen minutes to Twelve o'clock.