The Rt. Hon. Sir John Major KG CH

Prime Minister of Great Britain and Northern Ireland 1990-1997

1979-1983 Parliament

Mr Major’s Commons Contribution to the National Health Service Debate – 31 March 1981

Below is the text of Mr Major’s comments during the National Health Service debate, held in the House of Commons on 31st March 1981.

Mrs. Dunwoody I must frankly say that I am not too delighted to be moving a matter of some considerable importance in what will be a foreshortened debate. I warn the Minister that if it is his intention to come to the Dispatch Box and to give us his normal, rather smooth, but not tremendously straightforward, appreciation of the reasons that he is putting forward for increasing the charges, that will not be acceptable.

The regulations are clear demonstrations of the attitude of the present Secretary of State and the Minister for Health and of the desire of the Conservatives to destroy the fabric of the National Health Service in any way they can. The Secretary of State thinks that that is not a defensible point of view. Let me tell him that when we look at the picture of change over the last two years, we can see certain clear facts.

The Conservative Party does not have the guts to attack the National Health Service head on, so it ceases to provide the right conditions in which the majority of our population can receive good health care. When the Black report showed clearly that there were enormous discrepancies between one social class and another, the Government made it plain that one of the problems arose because the access to good dental care and to good care in the provision of glasses was also lacking.

Why are we praying against these two inadequate sets of regulations? We may be told that the changes in the amounts are small and that there are so many exemptions that they cannot affect many people. The Government are good at tinkering with exemptions to make it look as if there has been some basic alteration, when they are trying to put off the majority of people from seeking proper health care when it is most needed. We ought to be talking tonight not only about the minor changes but about the political implications.

Before the creation of proper ophthalmic services, it was quite common for working class families – and particularly working class mothers – to buy spectacles over the counter in a chain store. That is very easily forgotten, and I have the impression that the Government would rather like us to return to that sort of practice.

There is at present a concentrated attack on the provision of proper ophthalmic services. One can enter on optician’s premises in the High Street and have one’s eyes properly tested by a qualified optician, and it is not always certain that spectacles will be prescribed. The optician has the early warning system at his command, so that, where there is eye disease, he not only refers the patient to a consultant but is able in many instances to give some indication of the sort of problem that a patient is likely to face.

That service would be materially changed if, by constantly moving away from that type of arrangement, and by changing the law, we encouraged large multinational companies to come into this country, making it easy for people to buy spectacles that are not specially prescribed for them.

The Minister may say that that is ridiculous and is something that I have thought up. But there is clear evidence that American multinationals, which are keen to expand their services in in-store department store units, are most anxious to do away with many of the restrictions on the way they operate. They would like to be able to advertise whenever and however they wish. They would like to have a very large throughput of people buying spectacles without any great difficulty in a department store.

Such practices would be entirely contrary to the sort of ophthalmic service that has been built up since the beginning of the National Health Service. The people who would be most damaged by that sort of change would be the ordinary families. People with a very high income never have difficulty in obtaining private health care. It is the people who are outside the exemption ranges but who are on a low income, who consequently cease to try to obtain for themselves proper spectacles or proper dental care.

It is plain that in social classes 4 and 5 the general level of dental care, even now, is not the same as it is among social classes 1 and 2. That has been made evident time and time again.

When the Government talk about a relationship of 75 to 25 between private health care and the National Health Service, they are really talking about lowering the standards. They are determined that the testing of eyes should go back to being a wholly commercial arrangement. They have not been prepared to increase the fee that is given to the opticians for carrying out proper eye tests. The sorts of changes the Government are suggesting will inevitably result in a reduction in use of the service.

The Government should be considering ways of making the average optician’s practice very much more balanced in terms of the work that he does. At present, the NHS work is a very large part of the optician’s work but represents a very small part of his income. An increase in charges will not encourage people to go to the optician with greater frequency. What is far more likely to happen is that in the future there will be a positive move – we see it already in many newspapers and in women’s magazines – towards propaganda for reduced eye care under the National Health Service.

If we return to a situation in which one can go into a department store and buy over the counter by self-selection what is really a very large twin magnifier, we shall not be providing proper health care for our people. As usual under this Government, we shall simply be seeking to create a two-tier system in which those who have the money can obtain proper health care while those who have not are dissuaded in every possible way from seeking help at the moment when it is most desperately needed.

What goes for ophthalmology certainly also goes for dentistry. There is absolutely no indication that the Government are seeking to deal with the provision of dentistry or to encourage dentists to undertake a greater proportion of National Health Service work. In some regions, such as my own in the North-West, there are considerable gaps in provision and many people have great difficulty when they wish to go to a National Health Service dentist. That will certainly not be changed by the price increases before the House tonight.

We should be asking the House to throw out both sets of regulations. Before the Minister intervenes, I should say that this is not because of some political hang-up about prescription charges. On a day on which he has had the effrontery to announce, almost as an aside, that in future prescription charges are to rise in line with inflation, he can hardly suggest that it is the Opposition who have a hang-up about prescription charges. We oppose the regulations because we believe that they demonstrate an attitude by the Conservatives that is inimical to good health care. The Government are not interested in providing a service free at the point of use when it is most needed.

Mr. John Major (Huntingdonshire) Will the hon. Lady explain to the House how the Government can be damaging the National Health Service and at the same time providing more money for it in real terms?

Mrs. Dunwoody As the hon. Gentleman well knows, when one considers the amount of money provided in the new allocations, despite the brave words of the Secretary of State today, because of the changes taking place in the population what is really occurring is a drop in the level of provision. If he has not noticed that, I can only say that he has not been looking at what is actually happening.

Both sets of regulations clearly demonstrate the attitude of the Conservatives. They think that if one has a privileged income and is capable of paying for good health care, one should enjoy a high standard of care. If, however, one is outside one or two very small means-tested groups, one should be dissuaded from going for proper care, either to the dentist or to those who would supply one with proper spectacles.

We shall be taking very positive action if we throw out these sets of regulations which lower the standards of care available to the majority of our people.