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National Health Service

Volume 486: debated on Tuesday 10 April 1951

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I come, finally, to the National Health Service. The gross estimate for the Service, in England and Wales and Scotland, is nearly £470 million which is brought down by receipts primarily from the Insurance Fund and from staff pension contributions to a net figure of £398 million. I must tell the Committee that this figure of £398 million in the estimate is some £25 million less than the original figure submitted to me, which was £30 million above last year's estimate, the increase being due, in the main, to higher prospective expenditure on hospital services. The Committee will appreciate that, with the improvements in pensions and other benefits I have just announced, the increase in total social services expenditure over last year already amounts to nearly £50 million. We did not feel that, in present circumstances, and with all the other burdens which have to be carried, it was reasonable to put upon the Exchequer, and, therefore, on the taxpayer, another £30 million. We decided that the Health Service estimates must be brought within a total of £400 million, which, for the time being, would have to be a ceiling.

My right hon. Friends will make all practicable economies in the course of their administration, but it is plain that the only way to keep within this limit without reducing the standards of the hospital, family doctor and consultant services below what is really essential is to find some other source of revenue. The Government have, therefore, decided to introduce a modest charge in respect of some dental work and optical services. We shall leave all extractions and conservation free as at present, but we propose to charge about half the scale fee for all denture work in future, and about half the cost of each pair of glasses. There will be no charge for children's spectacles. Expectant and nursing mothers will continue to receive free dental treatment, including dentures, from the local authority services, and children will, of course, receive free treatment in schools as now. Those for whom the charge involves hardship will receive reimbursement, in whole or in part, from the National Assistance Board in the ordinary way. Legislation will be introduced shortly and the details of these proposals will then be further explained by the Secretary of State for Scotland and the Minister of Health. The yield of these charges is put at about £25 million in a full year and £13 million in 1951–52. The intention to make all practicable economies in administration and to impose these charges was allowed for in the Estimates already presented to the House.

The Government naturally regret having to make these charges, but I believe the vast majority of our fellow countrymen will agree that, while it was reasonable to allow a slight increase in expenditure on health—some £7 million above last year—it was also necessary, against the background of our general financial position, the increase in pensions that we are nevertheless providing, and the higher expenditure on the hospital service, to impose a limit and accept that some charges should be made. We think that in this we have struck a fair balance between one item of social service and another. The charges will not normally fall on those who are seriously ill, such as hospital patients. They apply where there is least danger of hardship and perhaps more danger of abuse than anywhere else in the Health Service.