HC Deb 20 December 1966 vol 738 cc1377-86

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Bishop.]

12.30 a.m.

Sir Eric Errington (Aldershot)

I do not think my constituency of Aldershot has been particularly fortunate in regard to hospitals. We anticipated that we would have a large general hospital, but that looks as if it is postponed for a considerable period. The point which I desire to raise tonight, and I am glad to have the opportunity of doing so, is the question of the pay beds for private patients in the public hospital. The charges appear to be quite out of any logical order.

I do not think that it is wise to say that the object of raising the prices is to prevent queue jumping, because all beds, whether pay, amenity or ordinary, can be used without payment in cases of emergency or acute need, but I desired if possible to emphasise the variation in prices at different hospitals. In passing, let me say that it appears now that approximately 4,000 private hospitals have pay beds and something like 6,500 public hospitals have pay beds.

Before I deal with the position in Aldershot I should like to quote the example of two hospitals which are within a few hundred yards of each other and where the difference is £20 a week in the charges for pay beds; Bromley, £51 per week, and Farnborough—not the Farnborough in my constituency, but Farnborough in Kent—only a short distance away, £31. Each of the two hospitals has had its fees raised, contrary, as I would submit, to Part IV of the Prices and Incomes Act of this year.

The effects of raising the prices at Aldershot in spite of the freeze are that costs have escalated, and I should like particularly, if I may, to indicate the very considerable amount by which they have been raised. In Aldershot General Hospital the figures for 1964–65 were £45 1s. per week. Those have escalated in the present year, 1965–66, to £57 1s., while next door, at Farnham, it is true there are no actual fee-paying beds, but if there were, it is estimated that the cost for them would be £34 6d.

I promised my hon. Friend the Member for Worcestershire, South (Sir G. Nabarro) that I would mention the hospital at Cheltenham, where the rise has been from £35 14s. to £39 11s. In the case of the Cambridge Military Hospital in Aldershot, without which Aldershot would be in still greater medical difficulty, although there are no records for 1964–65, in 1965–66 the costs per bed would be £40 per week.

The average over the whole South-West Metropolitan Region has gone up from £35 14s. 9d. to £39 13s. 0d. Looking at the estimated cost at Farnham, which is only a few hundred yards from Aldershot, it means that the Aldershot patient will pay £22 15s. per week more than anyone who is able to get a bed on the basis of the costs of the Farnham Hospital.

On average, the costs have gone up in 1965–66 over the country by 11½ per cent. Wages, salaries and higher prices are given authoritatively by the Ministry as being the cause. But we have the extraordinary position that the Aldershot Hospital is higher than the average of the London teaching hospitals for the year 1965–66 by 9s. 6d. per week. That may not sound very much, but when one considers the facilities which are available at the London teaching hospitals, it indicates the quite illogical position.

In the first part of what I want to say, I would refer the Minister, whose presence here tonight I greatly appreciate, to paragraph 32 of Command Paper 3073, under the heading "Public Sector". The subheading is "Prices, Charges and Fees of Government Departments", and the paragraph reads: The Government intend to apply the principles of the standstill to all prices, charges and fees of Government Departments. On 14th November, in answer to a Question, the Minister stated that the annual revision of prices was deferred while the implications of the prices and incomes policy were considered. I should like to ask him for a clear and definite statement of what consideration was given and why the annual revision was proceeded with. In the light of the statement in the White Paper to which I have referred, it would appear not to be justified.

Apart altogether from the breaches of the prices and incomes policy, is there not a case for considering the method of arriving at pay bed costs? I know that in January of this year the Minister announced a review of the pay bed policy which would involve legislation to calculate the cost of pay beds nationally, rather than from hospital to hospital, but for obvious reasons I do not propose to discuss possible legislation in this debate.

There are, however, matters which I think can be dealt with by amending Regulation 1953/420, which lays down the rules for calculating these costs. The view which I submit be adopted is the businesslike one of making certain that specially heavy charges can be carried forward over a period. For example, I am informed that decoration work has been done at Aldershot which will last for more than seven years, and, indeed, that other work has been done which might last even longer. The point is that if someone happens to be ill during the year following that in which the heavy work is done, it means that he pays more for a bed in that year than he would in another year. If a business-like approach were adopted, and the costs were spread over a period, the payments would be fairer for patients for each year.

There are a number of hospitals, particularly the smaller ones, in which it is necessary to carry out special work. I have heard that in one re-roofing is necessary. This will throw all the costs out of gear, and this sort of thing can cause great hardship to people who have only quite modest means when they are ill. If there is this differentiation from time to time, great difficulty can result.

I think that I would not be wise to talk too much about the very technical matter of bed occupancy, but I am assured by those who have spoken to me about it that it is a very important issue, and it needs to be examined very carefully indeed. As it is almost impossible to tell when a particular maternity case will require admission, a bed has to be kept free for a certain period to cater for that contingency. This, of course, involves the loss of the use of a bed for that period though overheads continue. This does not apply to surgery cases, because a bed is available and can be used.

To sum up, I submit that there are two things which ought to be done. First, there ought to be a full explanation why this matter is not covered by the prices and incomes policy, and exactly what the position is about this. Secondly, I submit that this is an opportunity for the Minister to consider the appointment of a committee with a view to a more business-like arrangement about the costs and the work that has to be done in the hospitals, so that the payments may be more moderate than they have been in the cases about which I have spoken.

12.45 a.m.

Mr. Bernard Braine (Essex, South-East)

My hon. Friend has touched on a point of principle which affects hospitals not merely in his constituency but all over the country. The fact that the Minister has had the courtesy to attend tonight—which we all very much appreciate—is an indication of the importance of the matter. I read in today's Guardian that Southend Hospitals Management Committee decided last night to refer to the Prices and Incomes Board proposals by the Ministry of Health to increase the cost of private beds. The Ministry says the increases, which were due to have been made in October, can no longer he deferred, but the committee claims they contravene the price. The Minister will be aware that the Southend group of hospitals covers my constituency. I do not question for a moment the Minister's right to bring the relationship between the provision of and the demand for private beds more into line with that which obtains for other hospital beds. It makes sense to use the resources of our hospitals in the most economic and most efficient way.

I am fully aware that the 1953 Regulation lays down a formula which requires annual adjustment, and am aware also that the Minister intends to introduce Regulations shortly which touch on the subject. As regards the present position, however, there would have been an adjustment on 1st October, when the prices and wages freeze was on, and yet within a few weeks of that date the right hon. Gentleman has directed that hospitals should raise their charges. Why? Local authorities have been asked not to raise their rates and private firms are under art obligation not to increase their prices. Why should the hospital service be exempt from requirements imposed on everybody else? Of course, the newspaper is wrong; it is not possible for a hospital management committee to refer the matter to the Prices and Incomes Board. Only the Government can make a reference to the Board. But I hope that the Minister will give the House and my constituents an explanation of what has happened.

12.47 a.m.

The Minister of Health (Mr. Kenneth Robinson)

First, I agree with the hon. Member for Aldershot (Sir E. Errington) that the existing hospital facilities in the part of the world that he represents leave much to be desired. I agree, too, that the only satisfactory solution is the provision of a new district general hospital. I would not wish tonight to deny or confirm the speculations that the hon. Member offered about the possible timing of that development, but the needs of his constituents are well in the forefront of the mind of the South-West Metropolitan Regional Board, which is responsible for planning hospital development in that area.

Mainly the hon. Member talked about the increase in the price of pay beds at Aldershot General Hospital. I propose to deal first with the general question asked by the hon. Member for Essex, South-East (Mr. Braine) why, in view of the prices and incomes policy, have these charges recently been revised? Then I shall deal with the specific question raised by the hon. Member for Aldershot.

The White Paper on Prices and Incomes Standstill stated that the Government intended to apply the principles of the standstill to all prices, charges and fees of Government Departments. I can assure both hon. Members that very careful consideration was given to the implication of this statement in relation to pay bed charges, which were in any case due for revision in October. Hospital boards were told in September that my Department was studying the matter and that pending advice hospitals should make no changes in the charges then in force. Subsequently, at the end of October, they were told that the revised charges should be introduced as soon as possible.

There was nothing sinister behind this decision. It was not a case of the Government's ignoring the principles of the standstill when it happened to be convenient to them, nor—I can assure the hon. Member—of any discrimination against private patients. Earlier this year, in my reply of 31st January to the hon. Member for Willesden, West (Mr. Pavitt), I announced a number of measures that I proposed to take following my review of pay bed policy. These were designed not to abolish facilities for private treatment in National Health Service hospitals but to promote the more effective use of hospital beds and to bring the relationship between provision and demand for pay beds more closely in line with that obtaining for National Health Service beds. These measures are in course of being implemented, although some will have to await legislation.

I have already explained in my replies of 14th November to the hon. Member for Oswestry (Mr. Biffen) and, later, to the hon. Member for Aldershot that the decision to introduce revised charges was taken because of the statutory requirement under the National Health Service Act, 1946. Section 5(1) of that Act provides that the Minister may set aside special accommodation for patients who undertake to pay such charges as may be determined in the prescribed manner, being charges designed to cover the whole cost of the accommodation and services provided for the patient at the hospital, including an appropriate amount in respect of overhead expenses". Thus, the wording of the Section requires charges to be very closely tied to costs. Neither I nor the hospital authorities are free to fix or vary charges at our discretion.

The manner of determining the charges is prescribed in the National Health Service (Pay Bed Accommodation in Hospitals etc.) Regulations, 1953. I hasten to assure the hon. Member that the Regulations under which I have been acting were introduced not by me, but by the right hon. Member for Enfield, West (Mr. Iain Macleod) when he was Minister.

Those Regulations require hospital authorities to revise their pay bed charges annually in accordance with the costs of the previous financial year and to introduce revised charges on 1st October. Although this annual revision may in a few cases result in decreased charges, obviously in the majority of cases the charges go up, just as hospital costs go up.

The Act thus imposes a statutory requirement for private patients to pay the whole cost of their treatment and for hospital authorities to determine their charges in accordance with the Regulations. This statutory obligation is not overridden by the Prices and Incomes Act. I am sure that the hon. Member does not advocate that I should have ignored or invited hospital authorities to ignore so precise a statutory requirement.

The introduction of these revised charges was deferred for a short time while I considered whether there was any legal means whereby a standstill could be imposed on pay bed charges so that they could remain unchanged during the standstill and the period of severe restraint. I was, however, advised that in view of the provisions of Section 5(1) of the Act, which I have quoted, and of the knowledge which hospital authorities already possessed of what the proper charges should be under that Section, it was not possible, without risk of legal challenge, to make regulations postponing for this period the implementation of the revised charges. Accordingly, I had no alternative but to instruct hospital authorities to introduce these revised charges as soon as possible.

Private patients admitted at the old rates before hospital authorities acted on these instructions will not be charged the higher rates until they have been in hospital for three months. This is in accordance with an existing provision in the Regulations. For patients who have not yet been admitted, the revised rates apply, except that I have told hospital authorities that where, in their view, a legal or a moral commitment exists to admit at the unrevised rates, they should do so.

The hon. Member may be interested to know that the Joint Consultants' Committee, too, on learning of my instructions to hospital authorities, had its doubts and decided to take legal advice. The advice which that Committee received was published in the British Medical Journal of 10th December. That advice proved to be identical with that which I received, namely, that any action to postpone the revision of the charges due in pursuance of Section 5 of the Act would be open to challenge.

Before turning to the charges at Aldershot General Hospital, I must explain that it is for each hospital authority to determine the pay bed charges for each of its hospitals. Where the pay bed accommodation can be separately costed, the charges are based on that cost, but in the vast majority of hospitals, including the Aldershot General, the charges are based on the average daily cost per in-patient for the hospital as a whole. Charges therefore vary from one hospital to another and reflect the costs at particular hospitals.

Aldershot General Hospital is a small hospital of 66 beds, with two pay beds. Before the recent revision, the pay bed charge was £45 10s. a week, based on the costs for the financial year ending 31st March, 1965. The charge is now £57 1s. a week, based on the costs for the year ending 31st March, 1966. This is an above average increase, but I am assured that the charges were correctly calculated according to the Regulations.

The main reason for the high cost at Aldershot General is the general shortage of beds in the Farnham Group. In an effort to keep up with the pressure of work, patients have a shorter stay than in most hospitals. The average length of stay per case in Aldershot General was under seven days in 1965–66 and 1966–67, compared with the regional average of about 14 days for similar hospitals.

The short stay entails more medical and staffing care and, as the flow of patients is quicker, calculations of the paper occupancy rate gives a lower rate than average, although the hospital is busier than most, since the turnover is faster, with beds vacated every seven instead of every 14 days. The average net cost per case at Aldershot General for 1965–66 at £54 was, in fact, less than the regional average of £67 for similar hospitals.

In 1964–65 the average in-patient cost per week for all patients, both paying and non-paying, at this hospital was £45 3s. Id. and for 1965–66 this had increased to £55 6s. 3d. The main reasons for this increase—which is, of course, reflected in the pay bed charges—were the recruitment of six additional nurses, together with salary increases, which accounted for £5 6s. of the increase, and more domestic and clerical staff and wage increases, which accounted for £1 of the increase. At the same time, administrative expenses, including additional clerical assistance, increased by £2 12s., and extra expenditure on maintenance, repairs and considerable decoration undertaken came to £1 4s. per week. Those figures account for most of the increases quoted by the hon. Member for Aldershot.

The hon. Member for Essex, South-East referred to the Southend Hospital Management Committee. I saw the report in the newspaper and it is correct to say that the Committee could not refer the matter to the Prices and Incomes Board. I understand that the Committee has put into effect the revised charges, and I have no doubt that when it reads the report of this debate, it will appreciate the reasons for the action it was asked to take.

I agree that the disadvantage in the present method of relating pay bed charges directly to the cost at the particular hospital is that this can result in quite different charges for hospitals offering similar facilities, sometimes even in the same locality. I have already stated my intention, when opportunity permits, to introduce legislation to enable charges to be determined on a national basis for different classes of hospital.

Question put and agreed to.

Adjourned accordingly at one minute to One o'clock.