That, for the purposes of any Act of the present Session to make further provision with respect to the making and recovery of charges in respect of services provided under the National Health Service Act, 1946, and the National Health Service (Scotland) Act, 1947, and for purposes connected therewith, it is expedient to authorise—
§ Motion made, and Question proposed, "That this House doth agree with the Committee in the said Resolution."—[Mr. Crookshank.]
§ 4.3 p.m.
§ Mr. Geoffrey Bing (Hornchurch)
I hope the House will excuse me for intervening on this matter before having given an intimation either by letter or by postcard to the Leader of the House, but I think that it would be a great pity if the House were to part with the Money Resolution without giving it rather more consideration than we were able to give it in Committee, when the debate was closured.
I do not for a moment intend anything I say to be a criticism of the Chairman in accepting the Closure after the Minister of Health had spoken. His speech was of such a nature it was felt that nothing could be done to continue the debate. However, it would be unfortunate if this House were to pass this Resolution without warning the Government that possibly the Resolution is not wide enough to cover the Bill. Therefore, I want for a few moments to direct the attention of the right hon. Gentleman to the Money Resolution.
I hope that hon. Members, for what, I hope, will be a fruitful if not an unduly prolonged debate, have equipped themselves—[Interruption.] I am sorry Mr. Speaker, but I find it a little difficult to make myself heard in the Chamber because of the noise, and I think it is 1923 difficult for you to hear me. I was saying that I hope that hon. Members have thought to equip themselves with a copy of the Money Resolution from the Vote Office so that they can take part in what, I hope, will be a useful debate, and so that they will be able to follow me in the points I want to make with regard to it.
If hon. Gentlemen have a copy of the Money Resolution, and will look at the passage which deals with payments into the Exchequer of sums received by the Ministry of Health or the Secretary of State, they will see why it seems to me that—and this is the point on which I should like to have an answer from the Minister of Health—it is an absolutely mandatory provision that these payments must be made into the Exchequer. The difficulty in which I think the House will find itself will be when we come to discuss the Bill and Clause 6, where we shall find that some of those payments, far from going to the Exchequer, may be made to the regional hospital boards.
I do not want to delay unduly over what hon. Members may think a very technical point—a point which was illumined last time by the hon. Member for Orpington (Sir W. Smithers), who had an opportunity of discussing the matter at some length. I shall not read the report of the debate on the matter, but only refer to the point on it which is dealt with in Erskine May. There was a debate on the Coal Mines Bill, and there was in that Money Resolution—I hope I have the attention of the Minister of Health, because it would be a great mistake if we were to embark on this Bill at this stage only to find that our discussions were out of order, and that, by a deplorable mistake, the right hon. Gentleman had produced a Money Resolution which made it impossible for us to proceed with the Bill.
I hope the right hon. Gentleman will give serious consideration to the point I want to put to him. The right hon. Gentleman never pays attention to the points put from this side of the House. He may recall saying, this time last week, when he was asked to consider whether it would be necessary to give a second day for the consideration of the Army and Air Force (Annual) Bill, that that would be quite unnecessary, and that we 1924 could deal with that Measure and another one on the same night. If he is as wrong about this matter as he was about that, he ought, perhaps, to give some attention to and take notice of points put to him from this side of the House, where we, occasionally, are right about questions of procedure.
The point that arises is that the Money Resolution provides entirely for payments into the Treasury, and there is no authority, as far as I can see, for moneys to be paid anywhere else. There have been attempts on Bills of this sort, when the Government have provided for payments into the Treasury, to have Amendments moved so that moneys, instead of being' paid into the Treasury, could be paid elsewhere.
The case to which I want to refer the right hon. Gentleman, and which, I am sure, is familiar to him, because it was dealt with by a number of leading Members of his own party, is the case of the Coal Mines Act, 1930. I will not delay the House at this stage with any too long extracts from the Rulings by the Chairman and Deputy Chairman at that time in regard to that matter, but I would just read a passage from Erskine May which deals with the point:The Coal Mines Bill, 1930, and the related resolution directed that certain charges should be repaid to the Board of Trade by the owners of coal mines. The resolution also contained general words authorising the payment by the Board of Trade of such other expenses as may be required to be defrayed for the purposes of the said Act. After drawing attention to those words, a Member sought to move an amendment whereby the charges which might be incurred under the Bill could be met out of public money, but the Chairman ruled that the general words covering the payment of expenses in the Bill did not override the specific directions relating to charges in the Financial Resolution, and that the amendment was therefore out of order.In this Resolution we have, of course, a specific direction, that all funds should be paid into the Treasury. Paragraph (b) of the Resolution says that all we are authorised to do is to direct that sums shall be paid into the Treasury—that there shall be payment into the Exchequer of any sums received by the Ministry of Health. Therefore, if we pass this Resolution, the right hon. Gentleman is not authorised, in my submission to him and to the House, to make 1925 payments anywhere else. Clause 6 (6) of the Bill says:Regulations made under the principal Act or this Act providing for the making and recovery of charges in respect of any services may provide for the reduction of the sums which would otherwise be payable by a Regional Hospital Board.Here is a provision, not for paying the money to the Treasury but for paying the money to a regional hospital board. These charges are to be collected and not paid as we are authorising under the Money Resolution but paid direct to the regional Hospital Boards.
Now, this may be a very convenient and effective method of dealing with it; I am not saying that it is not, but I think it would be very unfortunate for the House to embark on the Committee stage of a Bill before making quite certain that the issues are entirely covered by the Money Resolution. All I ask the right hon. Gentleman to do is this. If he thinks there is anything in my argument, let us not get to a stage where we shall have to start arguing with the Chair in Committee on whether this or that Clause is out of order.
Let him take the Resolution away and look at it again; let him adjourn this discussion and give us an opportunity of going on to some other and more valuable Measure, such as the Army and Air Force (Annual) Bill. Let him look at this again to make certain that our discussions are in order.
Now may I just refer, very generally, to the other issues which I think arise out of this Resolution?
§ Sir Patrick Spens (Kensington, South)
The hon. and learned Gentleman has told the House that Clause 6 (6) provides that these moneys shall be payable to a regional hospital board, and he used the phrase "payable to a regional hospital board" on several occasions. If he will read the subsection he will see that it provides thatRegulations made under the principal Act or this Act providing for the making and recovery of charges in respect of any services may provide for the reduction of the sums which would otherwise be payable by a Regional Hospital Board, Hospital Management Committee, Board of Management, Board of Governors or Executive Council to persons by whom those services are provided by the amount of the charges authorised by the regulations.1926 I suggest that the hon. and learned Gentleman has not even taken the trouble to read the subsection.
§ Mr. Bing
I have taken the trouble to read it. Naturally, I would not detain the House on this matter unless it was something to which I had given some study. The hon. and learned Gentleman has occupied a very high judicial position, and it would be of great value if he were to join in this debate. I may be entirely mistaken in my view, but whether we have been Lord Chief Justices or not, once we come into this House we are all equal, and we are all equally entitled to express what we think is our view of the law.
Mine may be, and very often is, an entirely mistaken view of the law, and I should be wrong if I were to conceal it from the House. I hope that the hon. and learned Gentleman, who has far greater experience in these matters than I, will take the opportunity of correcting me if I am wrong and putting the position right. All I am doing is, not laying down the law, but merely trying to state—
§ Mr. Speaker
I hope that the hon. and learned Gentleman will, as he very well can, crystallise more clearly the precise objection he has to this Money Resolution.
§ Mr. Bing
I am grateful to you, Mr. Speaker, for saving me from the distraction of the hon. and learned Member for Kensington, South (Sir P. Spens). If I might just deal with his intervention, the point here is, I think, a comparatively simple one. As I understand, all this Money Resolution entitles us to do is to collect the sums which are obtained from these charges and pay them into the Treasury. What the Government are proposing to do under Clause 6, if it were in order, is paying those moneys to the hospital boards instead of into the Treasury, and the hospital boards will then not pay so much to the Treasury as they normally would have done before. That, as I understand it, is the position. I may be entirely wrong, but if I am I am sure that in the course of the debate I shall be corrected by other hon. and learned Gentlemen who have given more study to the matter than I have.
1927 4.15 p.m.
I do not want to delay the House unduly on this, but I should just like to turn to another and more important aspect of this Resolution. The Resolution is in two parts. It provides, in the first part, forthe payment out of moneys provided by Parliament of any increase attributableunder the Bill. That is the first issue. Therefore, there is a sum going out of the Exchequer.
Under the second part of the Resolution there are sums coming into the Exchequer, and it does not seem to me that under the Resolution there is any authority—and this is the matter which I hope the right hon. Gentleman will deal with—for any accounting to take place earlier than that. The sums have either to come out of the Treasury or to go into the Treasury. What we want from the right hon. Gentleman is what those sums are; some indication of the magnitude of the sums he has in mind. We particularly want to know whether the sum to which he refers in paragraph (a) will be greater or less than the sum in paragraph (b).
The right hon. Gentleman's argument, as I understand it, is that the sum under paragraph (b), and the justification for this Measure, will be £400 million plus whatever are the sums collected. Thus he will arrive at a global figure. There will be, on the one hand, a total expenditure out of the Exchequer of £400 million under the Health Service, and that will be met by sums coming in. We ought to get clear from the right hon. Gentleman what we tried to get from him in Committee, namely, roughly speaking, what sums of money he envisages are represented by these two items. Otherwise, the House passes to consider the Bill under a quite confused and mistaken point of view.
I do not want to take up any more time of the House on this matter, although I think it is a serious matter. It is very important on the Report stage of a Money Resolution, if we have this type of procedure—to which I think there are certain disadvantages—to adhere strictly to it, and I hope that the Minister of Health will deal with this point in a serious way and not in the flippant way in which he sometimes deals with Parlia- 1928 mentary procedure. It really is not in accordance with the dignity of the Leader of the House just to ignore any points which any hon. Member cares to raise on the procedure to be adopted.
§ Mr. Speaker
I should like to intervene here, because I doubt whether any speech either asking for or giving an estimate of the sums involved would be strictly in order. As I read the Financial Resolution, the magnitude of the sums will depend upon regulations to be made later under the various Clauses, so it would seem to me that the Resolution itself is debatable upon a very narrow issue.
§ Mr. Aneurin Bevan (Ebbw Vale)
May I be permitted to draw your attention, Mr. Speaker, to the fact that the regulations will have to be drawn up within the boundaries of the Bill, and will not exceed the boundaries of the Bill? Paragraph (b) of the Financial Resolution says:the payment into the Exchequer of any sums received by the Minister of Health or the Secretary of State under the said Act.May I call your attention to the complicated nature of the administrative machinery which immediately invokes this Resolution? The executive councils are in contract with the chemists, the dentists and the general practitioners. The dentists and the chemists will have certain claims upon the executive council, but if, in the meantime, they receive certain payments from the patients, then the executive councils would have a contra account. So, in the case of the executive councils the position is quite clear: the chemists and dentists would receive from the executive councils net amounts and not gross amounts.
With the regional hospital boards, however, the situation is entirely different, because under the Bill the regional hospital boards are permitted to make charges to patients for certain apparatus, and for those charges payments will be made automatically, we gather, into the Treasury. Therefore, the Ministry of Health will not be able to set those incomes from those patients as a contra account against their expenditure, but automatically the Minister will receive those payments.
If that be the case—I am not sure that I am correct, and I hope the right hon. Gentleman will correct me if I am wrong—is a payment to a regional hospital board construed as a payment into the 1929 Exchequer or a payment into the Ministry of Health, which must automatically go to the Exchequer? In that case, they are unable to set that receipt of money off against the expenditure of the money, so that under the Bill we get a net loss of money to the regional hospital boards, which they will only be able to recover by restricting their services to the patients.
That is the difficulty we are in. It is a very serious and real difficulty. It is not merely procedural. What is the nature of the Financial Resolution to which we are being asked to agree? We raised this question the other day, and we did not receive from the right hon. Gentleman a clear reply. I put the question specially to him: Is a regional hospital board entitled, after the passage of this Bill, to use any receipts it may receive from charges made for abdominal belts and things of that kind to be set off against the rest of their expenditure? If they are able to do that, then the position is clearer.
The situation with regard to the executive councils is quite clear. The chemists will receive so many shillings. If they do not receive the shillings, there will be more money for the executive councils, and if they receive the shillings that amount will be deducted from the amount received from the executive councils. The position is clear about the chemists, but it is not clear about the hospital boards which are not in contract with anybody but provide the services themselves and the charges for their services. Are we clear that they are able to use that money and set it off against increased expenditure in other fields?
§ Mr. Crookshank
I am sorry if the hon. and learned Member for Hornchurch (Mr. Bing) thought that I was being inattentive, but I listen better when I do not watch the speaker. I listened to every word that he said. I find it easier to do it that way. Of course, the more attractive the speaker the more important it is not to look at him.
I did, as a matter of fact, do my best to explain this matter the other night. I spoke twice on the Money Resolution, but may I remind the House again that it is, in my submission, drawn in very wide terms in order that we should not get into any difficulty during discussions on the Bill. As I reminded the Committee at the time, that was not always 1930 the case years ago, but now the normal practice is to draw the Money Resolution so wide that there is practically never a debate on a Money Resolution nowadays, because it is not restricted in form. I do not consider that this Money Resolution is restricted in form.
Paragraph (a) relates to the payment out of moneys provided by Parliament, and, as I pointed out the other day, that was put in to provide for hardship cases. Paragraph (b) relates to the payment into the Exchequer of sums received by the Ministry of Health. The right hon. Gentleman the Member for Ebbw Vale (Mr. Bevan) put it perfectly clearly when he said that in certain cases the money received in cash by chemists and others would be a set-off and that is what is referred to in Clause 6 (6).
He and the hon. and learned Gentleman want to know what will happen to the rest. This only applies at present in the Bill to the provision that deals with appliances. The present intention is that money recovered in that way—cash recovered through the appliances account, so to speak—will, in fact, be paid into the Exchequer. It will not be a set-off to the hospital boards.
In the normal course it is usual for all cash which comes into the Government's hands to be paid into the Exchequer, and afterwards, what happens to it and how it may be returned or redistributed over the field of public expenditure, including the regional hospital boards, is another problem. In the first instance, the cash, as always in the past, comes into the Exchequer in these sort of cases. That is all that this Money Resolution does, in fact, provide.
§ Mr. Bevan
That is a serious statement. What the right hon. Gentleman is saying is that any money received by a hospital regional board as a result of a charge on appliances is automatically conceived to be paid into the Ministry of Health and, therefore, automatically, in its turn, goes into the Treasury. That means, therefore, that in no circumstances whatever can the regional hospital board do what the executive council can do, make a set-off against their expenditure.
It really means that we are starting off this year either with a severely contracted hospital service or with a Supplementary Estimate immediately in mind. If the right hon. Gentleman felt himself 1931 able to say that in his administration the regional hospital boards could regain the money they received from the charges and set that money off against the rest of their expenditure, then the Financial Resolution would not have been so restricted.
As the Resolution is now drawn, it is restricted, and the money must automatically go into the Treasury. That seems to be an exceedingly serious restriction of the Resolution. Either the regional hospital boards will be financially restricted throughout the year, or we have to envisage at once a Supplementary Estimate. Hon. Members opposite have said so many naughty things about Supplementary Estimates that it is rather grotesque if we start off the financial year knowing that we are to have one.
§ Mr. M. Turner-Samuels (Gloucester)
Will the Minister look for a moment at the Money Resolution, because I am certain that he does not want to deal with any academic, far-fetched and technical point. I would ask him not to follow the observations made by the hon. and learned Member for Kensington, South (Sir P. Spens) because, in my submission, he was quite wrong in what he said in that he has overlooked an important statement in subsection (6). It is perfectly true that it says that these charges can be made payable by a regional hospital board, and I think that it is equally true that my hon. and learned Friend the Member for Hornchurch (Mr. Bing) said that the charges can be made payable to a regional hospital board.
It is, however, perfectly clear that the Money Resolution seeks to provide only for payments to the Exchequer. That is the beginning and end so far as I can see. This limits the boundary that is set to the ability to pay out any money under this Money Resolution. If the Minister will look at Clause 6 (6) of the Bill, he will see that in its most obvious meaning it not only includes paying moneys to the Exchequer, but also means paying moneys to persons, hospital committees and so forth. The point that the hon. and learned Member for Hornchurch was making was that we cannot do that. It would, of course, so far as the Money Resolution is concerned, be all right if the Bill referred only to the payment of moneys 1932 into the Exchequer, but it goes further than that.
The reason why the Money Resolution becomes inadequate and loses capacity to operate over the full course set by the Bill is that the Bill refers to more than payments to the Exchequer and goes on to provide for other payments. If this Money Resolution is passed it seems to me, with all respect—and I am merely putting this forward for the Minister's consideration—that the Money Resolution will stretch so far as reference to any payment into the Exchequer is concerned, but not go so far as to embrace the payments obviously adumbrated in Clause 6 (6), namely, the reference to other payments. That seems to be the issue. As I understand it, that is the point which the hon. and learned Member for Hornchurch has made. It appears to me that this Money Resolution might fall short of what is needed, by its language, in order to cover the whole purview of Clause 6 of the Bill.
§ 4.30 p.m.
§ Dr. Barnett Stross (Stoke-on-Trent, Central)
The Minister stated that the field we were discussing was very narrow, for it referred only to the hospital service and, in that service, only to the charges for appliances. He may be mistaken in that. Many hospitals which supply outpatients who are required to pay for part of the service, also supply drugs and medicines. Therefore, "appliances" is not the only term with which we are dealing.
On the other hand, Clause 6 (6) does not seem to be as complicated as some of us thought. Is it not the case that these regional hospital boards, boards of management, and boards of governors must be empowered to be in relationship with persons who are providing the service?
§ Mr. Speaker
I do not want to be unduly strict, but it seems to me that in discussing the Report stage of this Resolution hon. Members are tending to discuss the provisions of the Bill, and that is really not in order.
§ Dr. Stross
I was merely pointing out something which I think makes the matter clear, namely, that if the persons who are providing the service, and who are mentioned in subsection (6), receive moneys from people served, naturally they cannot have the same amount of 1933 money paid to them as they would otherwise have got if they had not received partial payment.
§ Mr. Turner-Samuels
On a point of order. In view of what you have just said, Mr. Speaker, I realise that on Report stage of the Money Resolution one would not ordinarily discuss the Bill; but I ask you to consider this point. Suppose, for argument, that the Money Resolution is defective, or suppose the contention is that it is defective. Is it not proper now to refer to it so that, if necessary, it can be reconsidered?
§ Mr. Speaker
The Resolution says, in paragraph (a):the payment out of moneys provided by Parliament of any increase attributable to the said Act of the present Session …It seems to me as wide as it can be.
§ Mr. Turner-Samuels
Of course, the Money Resolution refers in the most precise, clear terms to:the payment into the Exchequer. …There is no doubt about that, and there is no area for dispute there. But what is being contended is that, although that is stated, it does not go far enough with reference to the provisions of the Bill. The Bill goes further, in that it refers to payments to persons. Whatever the definition of "persons" may be, it does not include the Exchequer. That is the point.
§ Mr. Speaker
Paragraph (a) provides for:the payment out of moneys provided by Parliament of any increase attributable to the said Act of the present Session in the sums payable under any enactment out of moneys so provided;If there are payments to be made, surely that would be covered.
§ Dr. Stross
I should like to finish what I was saying. Obviously, if some persons have received part payment from someone else, there must be a reduction. That is clear. In that respect the matter is fairly safe, but could the Minister explain whether the technique in which we are involved is not more complicated by the fact that we are dealing with other kinds of services which are charged for in part, such as drugs and medicines for outpatients and, much more complicated still, the services to T.B. out-patients and those services given by chest clinics or 1934 venereologists? We are in a complicated situation. I cannot see my way clearly, and I should like the Minister to help us.
§ Mr. John Baird (Wolverhampton, North-East)
I, too, am rather puzzled. Two types of appliance are supplied. First, dentures are supplied by dentists, and other appliances are provided by opticians.
§ Mr. Baird
Yes, but the Resolution refers to:the payment into the Exchequer of any sums received by the Minister of Health.…I was referring to what happened with the dentists and opticians, but the position is different with regard to appliances supplied in hospitals. Those appliances have to be paid for. The material has to be bought.
§ Mrs. E. M. Braddock (Liverpool, Exchange)
I want to ask a question which has not been mentioned so far. I do not see anything in the Money Resolution which makes provision for the transfer of money obtained from the National Assistance Board by people who have to apply to the Board for the purpose of paying for the surgical appliances, and so on, that they require. What happens? Where is the regulation about money in that connection? There is no power here to transfer money which has to be applied for from the National Assistance Board in payment of these appliances.
Is that provided for? I shook like to know how that matter is dealt with, because there is no reference at all to it. In the very nature of the Bill, vast sums of money are bound to be requested from the National Assistance Board by people who are unable to pay for the surgical appliances. Where does that come under the Money Resolution?
§ Mr. Bevan
We do not want to part with the Report stage of the Money Resolution until we know to what extent the Resolution may restrict us in Committee. It is true that in the Bill no specific charges are mentioned. There is merely the power to make regulations to make charges. When we come to the Committee stage and when we move Amendments to extinguish altogether a charge for an appliance, is it the Minister's view that those Amendments would be strictly in order?
§ Mr. Speaker
That question would be for the Chair in Committee. I should imagine, if my opinion is of any value to the right hon. Gentleman, that the Resolution is amply wide enough. I have been looking at it since this little debate started, and I think that it is wider than the Bill.
§ Mr. Speaker
The Amendment would be perfectly in order. It would not be restricted by this Resolution.
§ Mr. Speaker
So far as I can see, there is nothing in the Resolution which restricts the right hon. Gentleman. It only authorisesthe payment out of moneys provided by Parliament of any increase attributable to the said Act of the present Session in the sums payable under any enactment out of the moneys so provided.Then (b) says that… any sum received by the Minister of Health or the Secretary of State under the said Act of the present Sessionshall be paid into the Exchequer. It does not authorise the Minister to receive sums. It says that if he does receive them he pays them into the Exchequer.
§ Mr. Bevan
That is most valuable advice and will be of great assistance to us when we come to the Committee stage, because it will be obvious to Members of the House that any moneys that would be received, if any charges are made, will not assist the hospital authorities at all, but would automatically go to make up the £40 million for the general practitioners.
§ Mr. Crookshank
I can only speak again with permission of the House, but if I may say so, the right hon. Gentleman the Member for Ebbw Vale (Mr. Bevan) has now agreed that this is the widest possible Resolution which could be put down.
§ Mr. Crookshank
I am not the Chairman of Committees and I was trying to explain to the House what were my intentions and those of the Government in drawing the Resolution so widely. I thought, as indeed has happened, the right hon. Gentleman would be able to read between the lines.
The hon. Lady the Member for Liverpool, Exchange (Mrs. Braddock), asked me about the National Assistance Board 1937 and the payments that they would be making. That is quite without this Bill. We do not, in this form of legislation, give authority to the Board to do what they are already empowered to do. We are merely saying if, under existing Acts, certain sums are payable then any increases which are attributable to this Act can also be paid in the same way. It authorises us to carry on, and this is one of the things on which the Board can make payments.
§ Mrs. Braddock
Does it authorise the regional hospital boards or the hospitals to make a charge upon the Assistance Board? In those cases where patients are unable to make any contribution themselves because the whole of their income comes from the Assistance Board, will the regional hospitals boards be able to make a levy upon the Board and get back the money they cannot get from the patient?
§ Mr. Crookshank
I do not know how far we can go with this, because it is discussing the Bill itself.
§ Mr. Crookshank
It would not be in order for me to make a Second Reading speech in answer to the hon. Lady, but perhaps I may be allowed, quite briefly, to repeat what I said on Second Reading. In cases of hardship those who are unable to pay would be able to get the necessary assistance from the Assistance Board. The hospital would not come into it one way or the other. It has nothing to do with the hospital recovering from anywhere. The patient or applicant, whichever term hon. Members like, would automatically refer his own case to the Assistance Board and would get paid through that channel. The hospitals boards would not be in it at all.
§ Mr. Tom Brown (Ince)
The question raised by my hon. Friend the Member for Liverpool, Exchange (Mrs. Braddock), is covered, I think, in Section 64 of the National Assistance Act, 1948. There has been no dispute about that; they are covered.
§ Question put, and agreed to.