HOSPITALS (PAY BEDS) (Hansard, 20 February 1967)

§ Mr. Paul Dean (Somerset, North)
rose—

§ Mr. Speaker
Has the hon. Member informed the Minister that he proposes to raise this matter on the Adjournment?

§ Mr. Dean
Yes, Mr. Speaker, I have, and I understand that the Minister will be attending.

§ Mr. Speaker
Thank you.

§ Mr. Dean
I am grateful for this opportunity of raising a subject which was down for debate last Wednesday in the form of a Prayer but unfortunately was not reached on that occasion owing 1071 to the length of time which was taken with earlier business. I am grateful, too, to the Minister who has agreed to come here to answer the points which I wish to put to him.
The Statutory Instrument to which I wish to draw attention is No. 1553 which came into operation on 1st January of this year. It deals with changes in the pay-bed Regulations, and I wish to ask a number of questions on this which are of considerable interest to those people who are personally concerned. The Regulations make minor amendments in charges for pay beds and amenity beds, and abolish the limit on charges by doctors and dentists for hospital inpatient treatment.
As I say, this is of personal interest to the growing number of people who are prepared to pay for the specialist of their choice. Many of the people concerned are of moderate means. Indeed, more than 2 million people now have health insurance cover through provident associations, and membership of these schemes is growing at an accelerated rate. Quite often employers help with the subscriptions through group schemes. In fact, more and more employers are coming to regard assistance of this kind as a valuable fringe benefit which they consider is an appropriate one to offer to their employees.
It is possible to get good cover for hospital treatment for a man with a wife and two children for the modest sum of about 10s. a week. I do not wish on this occasion to discuss the significance of these developments, but I should like to pay a tribute to the provident associations and to employers for the way in which they have brought this type of cover within the reach of a large number of people. In our view people should be free to spend their money on health if they so wish. We shall not get an improvement in the National Health Service by preventing people from doing things for themselves, and we should be ware that in the pursuit of public affluence we do not end up with private squalor.
In that connection, I believe that the memorandum produced by the Central Consultants and Specialists Committee made a very appropriate defence of these arrangements when it said: 1072 There are sound social and economic reasons for allowing the continuance of private practice in hospitals and, indeed, for extending the meagre facilities at present available. The opportunity of treatment as a private patient should not be denied to those who desire, for perfectly legitimate reasons, to have the Consultant of their choice, to choose a time for admission which is convenient to themselves and to enjoy privacy in the hospital. Patients who opt for private accommodation thereby reduce the pressure on public accommodation. Moreover, a leaven of private practice has a stimulating effect upon standards of service.

§ Dr. David Owen (Plymouth, Sutton)
Would not the hon. Gentleman admit that though it might provide a good deal of privileged service for those who pay, by allowing private patients to take consultants' time, this acts against that very valuable time being spread fairly and evenly throughout the National Health Service?

§ Mr. Dean
I take the hon. Gentleman's point, and I shall be dealing with this a little later, but I believe, at the same time, that the more we can encourage people to make provision for themselves, the more likely we are to raise the standards of service, to reduce pressure on the National Health Service, and, perhaps, more important, to prevent doctors going abroad who might otherwise stay. These seem to me to be valuable points.
I am grateful to the Minister for coming here at fairly short notice. I have not as yet put any questions in the course of the few remarks that I have made. I would merely say that I welcome the Minister's statement that he does not intend to abolish pay beds, but to uphold the pledge which was given by the late Mr. Aneurin Bevan when the National Health Service was introduced.
After those preliminary remarks, may I now turn to these Regulations and ask one or two questions about them? The first point, and perhaps the least important, is that these Regulations give a small but welcome relief in the charges which private patients pay when they are away from their beds, when they are not occupying their beds for more than one day. This will be appropriate, particularly in the case of psychiatric patients who may well go home perhaps for a long weekend. Does this apply to what are called the "no ceiling" beds? In other words, does it apply to all private beds? 1073 My second question concerns the proviso to Regulation 3. As I understand it, Regulation 8A does not apply in the case of Section 4 patients paying charges less than those prescribed in the National Health Service (Pay-Bed Accommodation in Hospitals etc.) Regulations 1961, and such patients should not have their charges reduced during periods of absence. Perhaps the Minister can explain why the charges are not to be reduced in this case.
Much more important than that relatively minor change is the charge for pay beds as a whole, which has been rising steeply, and requires a fairer method of assessment. We shall await with interest the Minister's subsequent statements on this matter.
The main change in these Regulations concerns the abolition of the limit on charges made by doctors for patients in hospitals. As the House knows, these limitations were introduced in 1948, and they have an honourable history. Before the National Health Service, the majority of private beds were established by donors to help people of moderate means. This principle was carried forward in the National Health Service in respect of limitation on fees but not, of course, on charges for accommodation. None the less, in spite of the honourable history of it, I agree that fees are now out of date, that there are many anomalies in them, and the matter is now best left for arrangement between the doctor and the patient. It is true also, now that they are firmly established and covering a growing number of people, that provident associations are in many respects meeting the needs of people of moderate means which were met by the old arrangements in earlier times.
For these reasons, I do not dispute the Minister's conclusion that the limitations on charges should be abolished, but, now that they are abolished, it is important that restraint be exercised. I am sure that we can confidently look to doctors and specialists to exercise restraint in the matter. They know as well as anyone else that it would be in no one's interest if they priced private patients out by sharp increases in their fees. I am glad to see that the Joint Consultants Committee is keeping in close touch with 1074 the provident associations on the subject, and I am sure that doctors will respond to the appeal which has been made by the Joint Consultants Committee.
This is what the appeal said: Given that we may expect continuing high charges for accommodation, the pocket of the private patient can be protected only by full consideration on the part of the doctor concerned. It is hoped and expected that the tradition of charging modified fees to those of moderate means and to subscribers to provident schemes will continue to be observed. Failure on the part of individuals to be reasonable in this respect could easily invite public criticism and endanger the whole status of private practice within the hospital service. I very much agree with that appeal for moderation, and I am sure that we can look confidently to doctors to respond to it, as they have done in the past.

§ Mr. Kenneth Lewis (Rutland and Stamford)
Do I understand that we are debating these Regulations, and is my hon. Friend speaking to them?

§ Mr. Dean
My hon. Friend may be a little puzzled by the procedure. As I understand it, we are on the Adjournment, but I am directing my remarks entirely to the Regulations, Statutory Instrument No. 1553. Does that help?

§ Mr. Lewis
Yes, it does, but, in the circumstances, I wish now to raise a point of order with you, Mr. Deputy Speaker. May we know where we are getting with morning sittings? They are becoming more farcical than ever. I turned up for this Instrument, and the rest of the business, apparently, collapsed.

§ Mr. Evelyn King (Dorset, South)
The Minister was not here.

§ Mr. Lewis
The Minister had to come very quickly in order to be here, and I came in after the debate had started.
This is what I should like to know, Mr. Deputy Speaker, and I raise it with you as a point of order. We are now debating the matter on the Adjournment and we are not really discussing the Regulations. As I understand it, if we put down a Motion against the Regulations, it would be out of order anyway, so that, even though we may discuss the Regulations, we can have no effect on them. This seems to be an extraordinary state of affairs. What can we do about it, Mr. Deputy Speaker?

§ The Minister of Health (Mr. Kenneth Robinson)
Further to that point of order, Mr. Deputy Speaker. I have some sympathy for the hon. Member for Rutland and Stamford (Mr. Kenneth Lewis). This is a rather unusual procedural arrangement. He says that morning sittings are becoming a farce, but I think that the position which we have reached on these Regulations is the result of confusion on the part of the Opposition. The Regulations were down to be prayed against last Wednesday morning, which was the last day on which a Prayer could be tabled against them, it being, I think, the fortieth day since the laying of the Instrument. Because the Opposition chose so to arrange their part of the proceedings on Wednesday morning, the Prayer was not reached. Naturally, one thought that the Prayer against the Regulations had fallen. I understand that there was some talk of tabling a Motion to discuss the Regulations, but it was ruled out of order.
If we are now reaching a situation in which any Prayer which is out of time can be raised on the Adjournment, it seems to me that we might abandon the 40-day limit on Prayers. Perhaps this is a matter to which Mr. Speaker might give his attention.

§ Mr. Deputy Speaker (Mr. Sydney Irving)
All I can say from the Chair is that we are not debating the Instrument itself. That would be out of order because the time has expired. But, as we are on the Adjournment and any subject is admissible, it is quite in order to discuss the subject of the Regulations which might have been put down or prayed against in the past.
The question of morning sittings is not for the Chair. It is a matter for the House, and I can rule only that what is being done this morning is in order. I call the hon. Member for Somerset, North (Mr. Dean) to continue.

§ Mr. Dean
I am much obliged, Mr. Deputy Speaker. All I say in answer to the Minister is that the Regulations were put down to be prayed against last Wednesday. The Prayer was not reached, and the Opposition have exercised their undoubted right to introduce a debate on them. We have been fortunate enough, with the business collapsing this morning, to have plenty of time, far more 1076 time than we should have had on the other occasion, to talk about this important matter.
I was saying that we can look confidently to specialists to exercise moderation in the charges which they make to their private patients. But the appeal which the Joint Consultants Committee made clearly implies that the Minister, too, has his part to play because he is responsible for charges for private bed accommodation.
While I in no way dispute the conclusion to which the Minister has arrived in this matter, I can regard the timing only as exceedingly strange. Why has the right hon. Gentleman chosen to abolish this limitation during the period of severe restraint on prices and incomes? Paragraph 4 of the White Paper, Prices and Incomes Standstill: Period of Severe Restraint, says: The Government will use their statutory powers for the sole purpose of ensuring that the voluntary support of the majority is not undermined by the actions of a few". In this instance, the Minister is one of the few, and he is using his statutory powers in order to be one of the few. This is a strange interpretation of the whole theme of voluntary support and statutory powers being used only to prevent the minority getting out of step with the majority. As I say, the Minister is using his statutory powers to be one of the few and is undermining the principles of the severe restraint White Paper.
The right hon. Gentleman cannot be surprised if the wage-frozen and now wage-restrained private patient takes a rather jaundiced view of a Minister who acts contrary to his own Government's policy. I hope, therefore, that he will tell us why he has selected this moment to take the action he has.
My next question relates to the charges for private out-patients. When, in answer to a Question on 31st January, 1966, the right hon. Gentleman announced that he proposed to make various changes, of which these Regulations are part, he said that he intended at the same time to revise and bring up to date the schedule of hospital charges for private out-patients. Perhaps he can explain why that change was not included with the other changes proposed in Statutory Instrument 1553. Can the 1077 Minister also say whether the Secretary of State for Scotland proposes to make similar changes for Scotland?
This is just one part of the Minister's proposals concerning private patients. We believe strongly that people who choose to provide for the health needs of their families out of their own resources should not be denied this right, and we look to the Minister to uphold the assurances which he has given in this respect.

§ Mr. Evelyn King (Dorset, South)
I wonder whether I might be allowed to animadvert to what the Minister said when my hon. Friend the Member for Rutland and Stamford (Mr. Kenneth Lewis) said that morning sittings were a farce. I shall not dwell on that, but when one looks at the benches on both sides of the House it is hard not to take that view. However, the Minister went on to say that we had done something which he seemed to think was wrong because we had raised this matter on the Adjournment. I find this impossible to follow.
It is true that it would have been better if the Motion had been discussed last Wednesday. There are many Motions to negative Orders which we should like to discuss. I hope that the Minister will not take the view that it is not within our rights to raise on the Adjournment anything that we cannot discuss in other ways. As it has turned out, it is better that the matter has been raised on the Adjournment because we can take a much wider view and range much further than we would have been able to do had we been confined to the Regulations.
The second part of the Regulations provide that a doctor or dentist can charge anything he likes—there is no limit—for the services which he performs. This is a most remarkable state of affairs at this time. This is what puts the Opposition in difficulty. What the Instrument says, in effect, is that it is impracticable for the Government to seek to impose a prices standstill and to limit fees and that the idea should be abandoned. We on this side of the House entirely agree. I have long thought that any kind of price dictation by Government Departments was impracticable and that it would break down. We agree 1078 with the Minister, and this is what places the Opposition in difficulty.
Out of whose mouth do these strange words come? Does the Prime Minister know what the Minister is arguing? Does the Secretary of State for Economic Affairs know what the Minister is arguing? How far is this doctrine, which we welcome, to be pushed? There has been nothing like it since the conversion of Paul on the road to Damascus. However, in the week when we are being urged on every side that to raise any price is a crime against the State, the Minister says, "Abolish all price levels; charge what you like". This is one of the most extraordinary debates which I have heard for a very long time.
If one goes further, this month is the month in which, for example, the fees of solicitors are to be referred to the Prices and Incomes Board. It is the month in which we have heard criticism of estate agents' fees. It is the month in which Minister after Minister has said that the price freeze must apply, not only to goods sold in the shops, but to professionals and to anyone who charges a fee on price. Yet along comes the Minister and shoots the whole thing down.
This is a repetition of the blunder made last week. I ventured to put down a Motion of censure on the Government because they raised the salary of one of their Ministers by 50 per cent. for doing the same work. The difficulty is that the Minister concerned is one of their best Ministers. This is nothing personal against her. Will the Government ever understand that they cannot lay down a doctrine, which I believe to be false, that incomes and fees are not to increase, and then, first, make an exception in the case of one of their own Ministers and the following week make a huge exception in the case of a whole profession? There can be no logic or sense in what the Minister seeks to do.
I take the view, and many of us on this side of the House take the view, that Government economic policy is defined as unworkable. Whatever view one takes, it is difficult to see how anyone can argue that that policy will work and then breach it week by week. This is what is happening in selected cases.
Narrowing the question down, it comes back to doctors as such. I would doubt, even in the narrower medical context, 1079 whether this is the most useful thing that can be done. This concession, which I say again I welcome, will help mainly senior doctors and senior dentists. The whole weakness, which I thought was generally admitted, was not that senior doctors and dentists were underpaid, but that junior doctors and junior hospital consultants were underpaid.
Whether one looks at the matter from the narrower point of view or from the point of view of national policy, I find this a most extraordinary doctrine to present to the House. I hope that the Minister understands that if the Order becomes law and comes into practice, it is going forth from the House that, in the Government's view, there should be no limit placed on the fees which a profession charges. That is our view. I am glad that the Government have adopted it. I hope that they will implement it in more cases than one.

§ Dr. David Owen (Plymouth, Sutton)
It was not my intention to intervene in the debate, but I think that it would be for the benefit of the House to realise that there is another viewpoint and that there are some people, particularly on these benches, who view the growth of private medicine in this country with considerable concern. The growth of private medicine, as judged by prescriptions, has risen dramatically over the last few years. At a time of intense shortage in the National Health Service this represents a menace to the provision of an equal and fair Health Service to those people who are eligible to benefit from it.
Let me make it clear that I am not opposed to private medicine in principle, but I believe that the place for private medicine is outside the National Health Service hospital, and that if private medicine wishes to continue it should do so in private nursing homes separate and distinct from the National Health Service.
We should analyse the decision to increase fees because of its relevance to the policy of the National Health Service and the way it is going. There is considerable evidence that private beds in the National Health Service are a source of inequality and waste. The Ministry of Health has said that their average occu- 1080 pancy of 51 per cent. is considerably less than the approximate occupancy of 85 per cent. of public beds. We are discussing whether this should be allowed to continue. The decision of the Minister to allow no restriction on fees is right if private medicine is to continue, because in many cases fees have been ridiculously low.
I ask the Minister whether he is worried about the increase in private medicine and whether he believes that it is good for the Health Service to have a private sector within it. This is what I am criticising. I am not criticising private medicine outside. I am criticising the situation in hospitals in which private beds are vacant while there is a large waiting list for public beds. The tendency is for a consultant to say either to the patient or, often, to the general practitioner, "You can come into hospital tomorrow if you pay, but if you do not, I am afraid that you will have to take your place on the waiting list." I do not believe that anybody thinks that doctors engaged on serious life-saving surgery will make that distinction. They will always find a bed for somebody who is seriously ill. I would not wish it to go out that that is my view, but there are delays, because of the shortage of beds, for some who are suffering from quite serious complaints.
It is reasonable to accept that some people want privacy in hospital and I have never been against them having it. Privacy of that kind, if it is not required medically, must be paid for, however, and in this respect there is something to be said for amenity beds. I am pleased to note that the Minister is on record as having said that the knowledge of the facilities and availability of amenity beds will be made more widespread.

§ Mr. Kenneth Lewis
The hon. Gentleman will be aware that one cannot obtain an amenity bed purely on the grounds of privacy.

§ Dr. Owen
One can, even if there is no medical reason to use an amenity bed. The whole purpose of amenity beds is to provide privacy, but a proviso is always made in that if somebody is seriously ill and if no privacy is available, one does not have the right to such a bed and, in such cases, people must 1081 return to the general ward. It is a fair principle. After all, one is not paying the full price for the amenity bed but the price of the privacy. That is the purpose of the amenity bed and it is obvious that the hon. Member for Rutland and Stamford (Mr. Kenneth Lewis) is not aware of the facts.
I wish to see an extension of the amenity bed principle, with this facility being provided, where possible, throughout the National Health Service. I accept that there are business people who want privacy while they are in hospital and who, perhaps, want their secretaries with them for part of the time. However, if a hospital is short of beds and there is a sudden demand—perhaps a bad road accident—the people in those amenity beds must return to the general ward.
I am not suggesting that, because there are 6,500 private beds compared with 466,000 general beds, all hospital waiting lists for beds would be drastically reduced if those private beds were brought into general use. It would make only a fractional difference if that were done. I am attacking the whole principle of private medicine in this respect, because it is obviously a bastion of privilege. It is a constant sore and irritation to people to know that, while they must wait for months or even years to get a bed under the National Health Service, those who can afford to pay can get a bed tomorrow. It is particularly irritating when National Health Service patients know that those private patients will be looked after by National Health Service nurses, have their operations probably in exactly the same theatres, be using precisely the same X-ray facilities and that the same anaesthetic machinery will be used on them.
The sole criterion operating in the National Health Service should be that a patient goes into hospital because of his or her illness or disease. The growth of private medicine is a menace to the whole concept of the National Health Service, and every regulation or provision introduced by my right hon. Friend which is likely to bolster up private medicine must he watched carefully.
I am dubious about whether or not we should go on with the principle of part-time consultants. I appreciate that 1082 the system cannot be abolished overnight. However, I should like to see more full-time appointments being made in the National Health Service, with full-time consultants being appointed particularly at the teaching hospitals, with them being given merit awards at the appropriate times, perhaps earlier than at present. There should not be this competition for the time of consultants between private and National Health Service patients.
I look upon private medicine not in the way in which it is viewed by hon. Gentlemen opposite—as a great sign of freedom—but as something which is a privilege, which is challenging the National Health Service and which is taking us back 30 or 40 years. I confess that the growth of private medicine in recent years is, in many respects, due to the National Health Service falling short in providing a full and adequate service. The answer is not to increase private medicine but for the Government to provide the money and facilities to ensure that an adequate service is provided.

§ Mr. Anthony Grant (Harrow Central)
I appreciate the hon. Gentleman's argument about the National Health Service requiring more money to enable it to provide more amenity beds, better services, and so on. Would not the hon. Gentleman accept that the reintroduction of prescription charges would help the Service to obtain the money it requires to make these improvements?

§ Dr. Owen
That is hardly relevant to the subject under discussion. We are discussing private medicine. My answer to the hon. Gentleman's question is "no", because I supported the abolition of prescription charges, as did the B.M.A. for about nine years. Hon. Gentlemen opposite need to be reminded that the medical profession was strongly in favour of the charges being abolished. We are discussing whether to encourage the growth of private medicine. I accept that certain measures must be introduced and that these matters cannot be dealt with overnight, but if any Labour Minister of Health introduced measures to bolster and encourage private medicine within the National Health Service, he would not have my support and, I suspect, many of my hon. Friends would take the same view. We are dedicated to the National Health Service and we 1083 strongly hold to the view that it must provide an adequate service for everybody.
The Government can encourage amenity beds, by all means. The fees which we are discussing will, I believe, adjust themselves to the circumstances. In this connection, one must also consider the question whether there should be a limitation on the charge for beds. If we are to have private medicine inside National Health Service hospitals—and I hope that this is on the wane—the charges for these beds must be adequate to take account of all the services provided, including nursing facilities and so on. Many people who support the Labour Party, including doctors, view with grave concern the growth of private medicine in the National Health Service. I hope that my right hon. Friend will be able to put some of our worries to rest.

§ The Minister of Health (Mr. Kenneth Robinson)
I wish, first, to reassure the hon. Member for Dorset, South (Mr. Evelyn King, that I was not suggesting, in my intervention on a point of order, that it was not within the right of the Opposition to raise the subject of pay beds on the Adjournment. If it were not within the right of hon. Gentlemen opposite to do this, Mr. Speaker would not have permitted them to do it. I was merely saying that it seemed somewhat unusual that a lightly disguised Prayer against this Instrument should have been moved without due notice having been given, the 40 days for the tabling of a Prayer having expired. I thought that it was a matter to which Mr. Speaker might give his attention.

§ Mr. Kenneth Lewis
While accepting this procedural point which the right hon. Gentleman is making, would not he agree that he is speaking with a little pique when referring to this Adjournment debate? After all, the right hon. Gentleman must realise that if he believes that these Regulations are important—and my hon. Friends and I believe that they are—then this debate, whether on the Adjournment or by any other means, is perfectly justified and the House is perfectly right to be discussing this topic.

§ Mr. Robinson
I wish to make it perfectly clear that I sincerely welcome this opportunity to explain the purposes of the Regulations. However, I should have thought that the Opposition were sufficiently interested in the matter to have arranged affairs so that they had a proper Prayer within the prescribed time.
It was something of an understatement for the hon. Member for Somerset, North (Mr. Dean) to have said that I had come here at "fairly short notice". In fact I left for the House in the middle of a meeting in my Department. I had been told earlier that a Motion would be tabled. When I saw that no Motion was on the Order Paper, I not unnaturally assumed that the Opposition had once again changed their mind.

§ Mr. Dean
I do not want to argue about this. I assure the Minister that no discourtesy was intended. My information is that he was told earlier in the day that this particular procedure might well be adopted. It has, perhaps, taken place a little earlier than expected because there were so few hon. Members on the Government side to speak in the earlier debates.

§ Mr. Robinson
I had the information about two minutes before the hon. Member started to speak. However, I repeat that I welcome the opportunity to explain these Regulations.
The hon. Member prefaced what he had to say by one or two general remarks about private practice within the National Health Service. He expressed satisfaction that I had reiterated the pledge that Mr. Aneurin Bevan gave in the earlier days of the Service about private practice and pay beds. Perhaps I should inform him of the terms in which I gave that undertaking, because they were quoted in a letter to all consultants from the Chairman of the Joint Consultants Committee, Sir Thomas Holmes Sellors.
That letter finishes: It is happy in this connection to record that the present Minister has reiterated the assurances of his predecessors that he has 'no wish to withdraw facilities for admitting private patients to N.H.S. hospitals.' That is true. At the same time, ever since I became Minister I have always made it clear to the medical profession that I would take no steps actively to 1085 encourage the growth of private practice within the National Health Service, because I broadly take the view expressed by my hon. Friend the Member for Plymouth, Sutton (Dr. David Owen) that any substantial expansion of the private sector in medicine could be achieved only at the expense of the public sector. This clearly will be true at any rate so long as there is a serious shortage of doctors in Britain.
The Regulations did two things; they removed the limits prescribed by previous Regulations on the fees that hospital doctors and dentists could charge their private patients treated in N.H.S. hospitals; and they empowered hospital authorities to reduce hospital charges to paying patients in amenity beds or in private beds when those patients were temporarily away from hospital and when their accommodation was reserved for them.
The Regulations are, as I think the hon. Gentleman appreciated, one of a series of measures I decided to take following my review of pay bed policy and after discussions with the Joint Consultants Committee. They were among the measures I referred to in a statement which I made to the House on 31st January, 1966, in reply to a Question by my hon. Friend the Member for Willesden, West (Mr. Pavitt). Whilst I am quite ready, and fully intend, to defend these Regulations on their own, I must emphasise that they should be looked at as part of a related series of measures concerning paying patients and private practice in N.H.S. hospitals.
The object of the series of measures I announced is not to withdraw facilities for private practice but to rationalise them and to provide for the more effective use of consultant manpower and hospital beds. They included a review of the existing number of pay beds. This review is now well advanced, and I am considering the recommendations of the hospital boards following their review, and shall be reaching decisions on them very shortly. Some of the other measures will have to await a suitable opportunity for amendment of the National Health Service Act. Meanwhile, these Regulations that we are now discussing have been made, and they fit in with the general pattern.
1086 Incidentally, when I announced my proposals just over a year ago the only step taken at the time by hon. Members opposite was to ask why Socialist Members always seem to think it a crime that anyone able to pay for health services should do so if they wish. At least the Regulations do not inhibit this.
Section 5 of the National Health Service Act gives the Minister power to prescribe by regulation the maximum fees that hospital doctors may charge their patients treated privately in N.H.S. hospitals. Maxima were first prescribed in the 1948 Pay-Bed Regulations and some revision was made by the 1953 Regulations, but until the maxima were removed last month the fees had remained substantially unaltered since 1948. There was therefore a case for revision. There were also a number of features which in my view made this control of fees highly unsatisfactory.
In the first place—and this is partly the answer to the hon. Member for Dorset, South—the limits applied only to treatment in N.H.S. hospitals; they did not apply to treatment in private hospitals or in nursing homes, or to consultations in private consulting rooms which often precede or follow treatment in N.H.S. hospitals. Secondly, they did not necessarily apply even to all private treatment in N.H.S. hospitals. Hospital authorities could agree to their being increased on certain grounds, and could also agree to their being removed altogether if they were satisfied that the patient had agreed to pay more; although they could not be removed in respect of more than 15 per cent. of designated pay beds—such beds, where the limits had been removed, being colloquially known as "no ceiling" beds—at any one time in any one hospital. Moreover, it was not the function of the hospital authority to see that in any particular case the fees being charged were within the prescribed limits.
It has always been the position that the amount of fees to be charged was a matter to be settled between the doctor and his private patient—subject, of course, to the prescribed limits where applicable. In view of the unsatisfactory position as I found it, and of the inadequacy of any effective control, I came to the conclusion that the proper course was to remove the limits altogether and leave 1087 the question of fees to be settled entirely between patient and doctor, as it is in private practice outside N.H.S. hospitals. The profession welcomed this decision, and I should have thought that it would have been supported by hon. Members in all parts of the House.

§ Mr. Dean
I do not wish to interrupt the Minister, but I hope that he understands quite clearly from what I said that I am in no way opposing the general principle which he is now putting forward. The main point I made was on the timing.

§ Mr. Robinson
Yes, I rather gathered that this decision did not meet with opposition from the benches opposite, but that it was merely a question of the timing, with which I shall deal in a moment.
Before deciding to proceed with Regulations to abolish the statutory limits on fees, I gave very careful consideration, with my colleagues in the Government, to the implications of the Prices and Incomes Policy, under which professional fees are expected to continue under restraint.
In the first place, as I have said, the prescription of maximum fees was limited in its application; it did not cover private practice outside the National Health Service, and the limits were not necessarily applied even to all private treatment in N.H.S. hospitals. Moreover, the removal of the limits was one of the measures I had discussed with the profession as part of a series of related measures concerning private practice which I had announced in January, 1966. One of these measures has already been implemented; hospital boards have been reminded that, where necessary, they can advertise full-time consultant appointments without offering the alternative of a maximum part-time appointment. Another, the review of the number of pay beds, is well advanced.
In view of these two factors, I saw no cause to hold up beyond 1st January the implementation of the decision to remove the statutory limits on fees. It could have been done during the standstill—we have the right to do it—but I thought it desirable to leave it until 1st January, and I decided to proceed accordingly.

§ Mr. Kenneth Lewis
rose—

§ Mr. Robinson
No. I have already given way twice to the hon. Member.
Even before the issue in July of Command Paper 3073, Prices and Incomes Standstill, I had sought and had received assurances that the profession appreciated the importance of ensuring that the removal of the statutory limits would not lead to the charging of excessive fees. Since then I have received an assurance that the profession recognises the need for special restraint in this matter and will exercise it. I understand that the Chairman of the Joint Consultants Committee is writing to all consultants on this point. In their own interest they should exercise restraint lest the numbers willing to pay for private treatment diminish. In all the circumstances removal of these prescribed limits can hardly be regarded as a breach of the prices and incomes policy.
The new Regulation 8A inserted by Regulation 2(1) empowers hospital authorities to reduce hospital charges to paying patients when they are temporarily away from hospital and accommodation is reserved for them. This mainly affects long-stay patients in amenity and pay beds in psychiatric and some other hospitals who may go away for weekends and holidays. When they do so there is some saving in hospital costs, but I was advised that under the previous Regulations there was no power to make reductions. The new Regulation remedies this. Reductions will not be made for absences of less than 24 hours and the first and last days of absence count as one day as they do under the 1953 Regulations for the purpose of calculating the charges. Subject to that, a reduction of 12½ per cent. is to be made for each day's absence. This is based on savings that can be expected in respect of such things as food, drugs, laundry and so on when a patient is not occupying the accommodation. Salaries and wages and other standing charges continue during his absence and these account for the balance of 87½ per cent.
In the case of patients in the Section 4 amenity beds, there is a straight 12½ per cent. reduction on the prescribed charge. Because of the somewhat complicated way of determining charges for 1089 Section 5 accommodation, according to whether medical treatment is given privately and paid for separately, the reduction for Section 5 beds is on the standard daily charge as defined in the earlier Regulations.
The hon. Member for Somerset, North asked about those amenity bed patients who pay less than the current standard rate for amenity beds, in other words, those who were admitted before 1st March, 1961. Perhaps I may explain how this arises. In 1948 amenity bed charges were fixed at 6s. a day or 2 guineas a week for single rooms and 3s. a day or 1 guinea a week for accommodation in small wards. In 1952 the single rate was increased to 4 guineas and in 1961 to 8 guineas a week. Each time they were increased, there was a saving for existing patients so that some are still paying the pre-1961 charges. In the case of Section 5 patients, of course, the Regulations provide for charges to be revised annually. Therefore, clearly, a number of amenity bed patients are paying only half the rate already.
Another point which the hon. Member raised was in connection with outpatients. It is true that in my statement in January, 1966, I said that I would introduce Regulations to revise and bring up to date the schedule of hospital charges for private out-patients prescribed by the 1953 Regulations. My intention was to bring up to date the charges for procedures and treatments included in the schedule, and also to make it more comprehensive by including other treatment and procedures not at present included and to prescribe charges for them. I decided, in view of the incomes policy, that it would not be appropriate at this time. The present Regulations, therefore, do not include a revised schedule.
Hon. Members have asked why we found it possible to postpone an increase in out-patient charges if we could not postpone the increase in in-patient charges, since both are governed by the provisions of Section 5 of the National Health Act, 1946. The answer is twofold. In the first place, the 1953 Regulations deal with the two sets of charges differently. They prescribe the method by which hospital authorities determine pay bed charges, including their annual revision on the basis of the costs of the previous financial year; 1090 whereas they specify definite out-patient charges for particular procedures and these cannot be altered except by Regulations.
Secondly, while in-patient costs are precisely ascertainable and the charges are capable of annual revision, charges to out-patients cannot be calculated with such precision and, therefore, are not susceptible to frequent revision. It is not, therefore, inconsistent with the requirement of the National Health Service Act to postpone a revision of the out-patient charges in order to comply with the Government's policy of prices and incomes, and I propose to deal with them at a future date.

§ Mr. John Wells (Maidstone)
On a point of order, Mr. Deputy Speaker. I must deprecate the Minister seeking to catch your eye when he did although I was on my feet seeking to do so also, as I had given him notice of a specific point which I sought to raise. I appreciate that the Minister wrote a hastily scribbled note from his place on the Front Bench saying that he considered the matter which I sought to raise to be the responsibility of the Ministry of Labour, but I submit that that is not so. The health of the nation is the responsibility of the Minister of Health. The fact that health in factories may be the responsibility of the Minister of Labour is another matter. The point which I would have raised had I been able to catch your eye was that blue asbestos is undoubtedly a cancer-forming agent. I think the Minister of Labour is doing research in factories, but some of my constituents far removed from a factory have been writing to me on this point.

§ Mr. Deputy Speaker (Mr. Sydney Irving)
Order. I understand the hon. Member's difficulty. He was good enough to give me notice that he wanted to raise this matter. At that time we were under the impression that it was the responsibility of the Minister of Health. I now understand that that Minister does not accept the responsibility. The practice of the Chair is always to pay regard to the responsibility which a Minister himself accepts for his own Department, so in this case the practice of the Chair would be to proceed to the next debate and to protect the interests of the hon. Member for 1091 Norwood (Mr. John Fraser) who has the Adjournment debate today.

§ Mr. Norman Atkinson (Tottenham)
Before you proceed to the next debate, Mr. Deputy Speaker, may I rise on a point of order. My right hon. Friend has raised a number of contentious points and, in all fairness, this discussion should be allowed to go on. It is only right that he should give some clarification on two points. I am not accusing him of deliberately misleading the House—

§ Mr. Deputy Speaker
Order. This is not a point of order for the Chair. The hon. Member must accept that the only person who can decide who should catch the eye of the occupant of the Chair is the occupant of the Chair. We cannot have a debate on anything that the right hon. Member has said, however contentious it may be, and I must protect the interests of the hon. Member for Norwood (Mr. John Fraser) who has the Adjournment debate.

§ Mr. Kenneth Lewis
We are in an extraordinary situation because, when the Minister rose, two of us rose from our places to participate in the debate on pay beds. In the normal course of events, we would have had one and a half hours' debate, but we have not had anything like that amount of time. The Minister rose precipitately, and cut us out of the debate. This he did, probably not knowing—

§ Mr. Deputy Speaker
Order. This is not a point of order for the Chair. If I might give some guidance to the House, I have responsibility to protect the position of the hon. Member for Norwood. Once that Adjournment debate is over, it is open to other hon. Members to endeavour to catch my eye, and I believe that the hon. Member for Maidstone (Mr. John Wells) has already given notice of his intention to try to raise another subject. The sooner we can get on to the Adjournment debate, the sooner that can be done.

§ Mr. Dean
May I put another point to you, Mr. Deputy Speaker? As you will be aware, only the fact that we have had this debate has saved the bacon of the hon. Member for Norwood (Mr. John Fraser). But for that he would 1092 have lost his chance entirely. I wonder if you can consider the possibility of calling some of my hon. Friends who have sat here throughout this debate?

§ Mr. Deputy Speaker
I understand the difficulties of the hon. Member. I accept that what he says about the continuation of the debate is perfectly correct, but I think that in all the circumstances I must adhere to my decision and call the hon. Member for Norwood (Mr. John Fraser).

§ Mr. Atkinson
rose—

§ Mr. Kenneth Lewis
On a point of order, Mr. Deputy Speaker. Can we be assured, therefore, that the Minister of Health will stay to listen to my hon. Friend the Member for Maidstone (Mr. John Wells), who wishes to speak later?

§ Mr. Deputy Speaker
I understand that the hon. Member for Maidstone (Mr. John Wells), if he catches my eye, wishes to raise a matter which is the responsibility of the Minister of Labour and I believe that he has given notice. Mr. Fraser.

§ Mr. Atkinson
rose—

§ Mr. John Wells
rose—

§ Mr. Deputy Speaker
Order, I can take only one hon. Member at a time. Mr. Atkinson.

§ Mr. Atkinson
rose—

§ Mr. Deputy Speaker
Is this a point of order?

§ Mr. Atkinson
Relative—

§ Mr. Deputy Speaker
I hope that the hon. Gentleman will not raise the same point of order again.

§ Mr. Atkinson
All I am doing is asking for your guidance, Mr. Deputy Speaker, as to whether the Minister will be here for the debate which you suggest will take place after the Adjournment debate of my hon. Friend the Member for Norwood (Mr. John Fraser).

§ Mr. Deputy Speaker
Order. I have not pronounced on whether a debate will take place. I have indicated only that it is open for the hon. Member to catch my eye, if the time allows. Mr. Speaker and successive Speakers have said that, if hon. Members wish to raise issues 1093 on the Adjournment, they should give notice to the Minister. It that has been done, all the requirements of the Chair will have been fulfilled.

§ Mr. John Wells
Further to the point of order, Mr. Deputy Speaker. I do hope that, if I am fortunate enough to catch your eye later, and if a Minister from the Ministry of Labour is in his place to answer me, he will be in a position to say why the Minister of Health will not accept responsibility—

§ Mr. Deputy Speaker
Order. I understand the hon. Gentleman's difficulty, but this is a matter he must raise if he catches my eye at the appropriate time. Mr. Fraser.