§ Motion made, and Question proposed,
§ That this House do now adjourn.—[Mr. Hawkins.]
§ 11.7 p.m.
§ Mr. Harold Walker (Doncaster)
I do not know whether or not I am being presumptuous or creating a precedent by utilising the Dispatch Box on an occasion such as this. It is just that I do not like to see unused capital resources. In any case, it puts me nearer to parity with the Minister.
The Minister will know from our correspondence, from the Questions that I have tabled to him, and from the Press cuttings service in his Department, that the subject I am raising tonight is the source of sharp controversy in my constituency. The misuse of publicly-financed facilities for private medical practice has been a running sore in the National Health Service since its inception. At present it is being probed by a Select Committee. More recently it has been scathingly denounced in a withering attack by the Junior Hospital Doctors' Association and the Medical Practitioners' Union.
This alone makes the present a remarkably inopportune time to introduce private pay beds into the Doncaster Royal Infirmary. It is even more surprising as not only is there a very long queue of National Health Service patients waiting for admission into the hospital, on the most recent count 3,442, over one-third of whom have been waiting for more than a year, but also a large number of beds have not been brought into use since the new infirmary came into service.
543 The last time I queried this point with the Minister he told me that as many as 44 beds are still not in use. The reason is said to be staffing difficulties. I cannot and do not intend to explore that question now, but I feel bound to point out that to intrude private pay beds into that situation can only exacerbate the staffing problems.
As I understand it, the case for the introduction of the private pay beds rests, in the main, on the interests of consultants. It is argued that not only were the consultants promised the private beds so that they could augment their salaries with private practice fees, but that indeed the Sheffield Regional Board wrote them into their contracts at the time of appointment. Apparently, the board advertised the appointments as part-time, and the appointments were subsequently made on that basis, so that it appeared that, even had the consultants chosen to go full-time within the National Health Service, they were denied the opportunity to do so. They are, therefore, being currently paid as part-timers, without the chance of engaging in private practice.
If that is true, it is clearly wrong. They have been cheated. But I argue that the remedy is not to resort to the evil of introducing private practice. This would merely be piling wrong upon wrong. Surely, those who wish to opt for full-time National Health Service posting should be given the opportunity to do so. If then the consultants still feel that National Health Service salaries provide an inadequate income, they should do as the rest of the community has to do, that is, seek redress through the negotiating machinery. That should be the way to proceed, rather than further to erode the basic principle underlying the National Health Service.
Another argument has been that consultants will tend, naturally and understandably, to gravitate towards the most rewarding posts, with the consequence, it is said, that, if Doncaster cannot offer the inducements which flow from private practice, the best people will seek jobs elsewhere, and the calibre of the specialists at the Royal Infirmary will decline.
I submit that to succumb to that argument is to join in a rat race based on incentives which are wholly alien to the concepts on which the National 544 Health Service was founded. It would be to compromise with that which is itself bad. If anything, it is a powerful case in itself for the total abolition of private practice within the Service.
I suspect that the Minister will remind me of the provisions of the Nye Bevan Act of 1948. But I am sure that he will recall as well as I do the blackmailing threats of non-co-operation which the then Minister had to deal with from the British Medical Association, by means of which the concession was secured. I can recall also the more recent Act of 1968. I was the Government Whip on the Standing Committee on the Bill. I recall that the then Minister, Kenneth Robinson, secured the support of Labour back benchers in the Standing Committee for Clauses 1 and 2 only by firmly assuring them that he had no intention whatever of sanctioning any expansion of private pay beds. Moreover, although the original plans for the present Infirmary made provision for 16 private beds, in January, 1968, the same Minister told the Sheffield Regional Hospital Board that their use as such would not be authorised.
I do not want the Minister to be in any doubt about the weight of opposition to the proposal of the hospital management committee and the Sheffield Regional Hospital Board. Just over a week ago, the leaders of the Doncaster Trades Council, representing 30,000 trade unionists in that area, spent two hours with the local hospital management committee ramming home their opposition. This, they said, is bringing health into the market place. My own constituency Labour Party, which has for some time been seeing a meeting with the regional hospital board on the matter, bitterly opposed the move at a lengthy meeting which it had with the hospital management committee. The A.E.F. district committee at Doncaster has made absolutely clear that it is incensed at the proposal. Only last week, the large Bentley Urban District Council put on record its opposition to the move.
Perhaps all these people fear the abuses which have been so bitterly attacked by the Junior Hospital Doctors' Association and by the Medical Practitioners' Union. And who can speak with greater knowledge and authority than such as they? Among other things—I shall summarise 545 briefly the main points of their assault—they say that private beds lead to preferential admissions for private patients, to queue-jumping, to neglect of National Health Service patients, to excessive overwork for junior doctors, with serious disruption of their lives, accompanied by a loss of free time, loss of study time, and loss of sleep.
They allege that there are thefts of valuable equipment and costly anaesthetic by consultants. They say that there is resentment among nurses and other staff over the extra, unpaid work involved in looking after private patients, and that the inevitable consequential neglect of National Health Service patients distresses nurses and leads to serious conflict and loss of morale. The majority of nurses questioned by the doctors are reported as expresing strongly the opinion that private practice should be excluded from National Health Service hospitals.
The Association also says that long surgical waiting lists are an inevitable result of having private beds even where there is no abuse. In their ranks there is a strong feeling that a minority of consultants did nothing to reduce their waiting lists, in the certain knowledge that their private practices would benefit.
Those are not my opinions. They are the carefully prepared observations of a professional body representing qualified medical practitioners in the National Health Service, whose president is a consultant himself.
For the obvious reason that they have not got the beds, these charges cannot be levelled at the Doncaster consultants, nor am I suggesting that they are abuses which would inevitably occur if the opportunity arose. I do not question the integrity or the skill of the specialists I have had the chance to meet at Don-caster. The warm praise which I frequently hear from former patients leads me to pay tribute to the splendid work done by all the staff at this very fine hospital. But I want to keep it that way, free from the corrupting intrusion and debasing temptations of private practice. I want the first priority of this and any other National Health Service hospital to be the interests, health and well-being of those for whom they were built—the National Health Service patients.
546 The Sheffield Regional Hospital Board will have put its case for the beds to the Minister. Tonight I have taken advantage of the opportunity that the House affords to put part of what seems to me a very powerful case for rejecting the arguments advanced by the Board and turning down the application for private beds, and that is what I ask the Minister to do. If he remains unimpressed by the case I have put, the least I expect of him is that he should defer his decision until the Select Committee has had the opportunity to submit its report and recommendations. For him to do otherwise would be to treat the Committee, and hence the House, with contempt. If, sooner or later, he sanctions the beds, that will be worse, because then he will be endorsing a prostitution of the National Health Service and approving a sell-out of the health of working-class patients for the personal gain of a few.
§ 11.18 p.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Michael Alison)
I am glad that the hon. Member for Doncaster (Mr. Harold Walker) has given us this opportunity to discuss the question of the provision of pay beds at the new Doncaster Royal Infirmary. Pay beds at the hospital have been a concern not only to my right hon. Friend the Secretary of State but to his predecessors.
We have in Doncaster an example of increased facilities increasing the demand, coupled with the almost inevitable difficulties of running-in a new and differently-planned hospital. The pay bed problem is only part of the whole problem of opening and staffing new and redeveloped accommodation such as we now have at Doncaster.
On the general question of pay beds and private practice, I must make it clear that the Government think it right that a proper proportion of beds should be available in National Health Service hospitals for people who wish to pay for their treatment, bearing in mind the needs of people who do not wish to pay, who. I agree, constitute the vast majority.
The hon. Member has referred to the evidence submitted to the Sub-Committee on Expenditure by the Junior Hospital Doctors' Association. He will not expect me to comment on that at this stage. In any case, the report of the evidence has 547 not yet been published. However, I saw Press reports earlier this month about their memorandum and I did not understand that the Association was calling for the ending of all private practice in the hospital service.
I do not agree that the private sector "feeds off the N.H.S.", as I saw reported in one article. On the contrary, I agree with the British Medical Association, whose evidence to the Sub-Committee I have seen reported this morning, that a hospital gains from having pay beds. It is likely to attract consultants who would otherwise engage whole-time in private practice or might emigrate, and this is a positive advantage to the National Health Service.
Over the country as a whole there are 5,567 part-time consultants which is no less than 57.4 per cent. of the total number of consultants in post. We cannot afford to do without their services and it is a very real advantage to the National Health Service if they treat their private patients on hospital premises as they are then available for emergencies.
The hon. Member also suggests that we should delay any decisions on application for pay beds for Doncaster until the Sub-Committee has reported. With respect I cannot accept this suggestion. The health service is in continuous operation and is under almost constant review as a result and it is not realistic to suggest that its services should be disrupted or suspended while reports are awaited.
Boards apply from time to time for variation in the number of pay beds in hospitals in their regions and it would be quite wrong to defer consideration of these until the Sub-Committee has reported. Some people speak of private patients as if they came from another planet. The people who wish to use pay beds at the Royal Infirmary are probably all citizens of Doncaster who would naturally look to their local hospital for treatment. For their own good reasons, they wish to be the private patients of a particular consultant and they wish to pay for their treatment in hospital. I entirely repudiate any suggestions that there is anything wrong in this. Aneurin Bevan included in the National Health Service Act, 1946, provision for private 548 patients, and every successive Minister of Health has maintained the provision.
§ Mr. Alison
The hon. Gentleman, for whom I have a great respect, is a brave man to assert that Aneurin Bevan could be blackmailed into anything.
Private practice in National Health Service hospitals is now governed, as the hon. Member said, by the Health Services and Public Health Act, 1968, but the changes made by that Act do not affect the principle that patients may choose to be treated privately if they wish.
The 1946 Act lays upon the Minister the duty of providing hospital and specialist services for the people of this country and there is no doubt that the majority of these people wish to avail themselves of these services without charge. We must and we do keep their interest to the fore when we consider the total number of private patients we should allow to be treated at any one time at a hospital. Every application from a board is carefully considered in my Department and we know that before it reaches us the medical advisory or the medical executive committee, the hospital management committee and the appropriate committees of the board have looked at it in detail.
I concede that the Doncaster area is unusual in that there have never been pay beds in any of the National Health Service hospitals and, in addition, there is very little private accommodation available outside the health service.
When plans were drawn up to redevelop and enlarge the infirmary, the opportunity was taken to include provision for some pay beds. But in 1967–when the regional hospital board first applied to the Minister for pay beds—the waiting list was close on 4,000 and the then Minister of Health did not feel able to authorise accommodation for private patients immediately. The regional hospital board was confident that the additional accommodation amounting to 238 beds and increased medical staffing would bring about a dramatic improvement in the position.
It was decided, therefore, to delay a decision on the application for pay beds 549 until the waiting list had decreased. However, the waiting list did not at that time decline. Indeed, it increased to 4,737 at the end of December, 1969, though part of this increase was due to the transfer to the hospital in March, 1968, of the gynaecological patients from the Western Hospital.
In addition, the new hospital acted like a magnet and drew patients from a larger catchment area than the old hospital. As the hon. Gentleman knows, the management committee in 1970 reopened with the board the question of provision of pay beds, but as it had not proved possible to bring all the new accommodation into use, the board did not feel able to recommend to the Secretary of State an authorisation for accommodation for private patients.
The board is now making an urgent detailed assessment of the nursing and domestic requirements of the hospital to ensure that sufficient staff are provided for all the N.H.S. beds by 1st September. A team of officers from the board, including nursing, establishment and work study officers, made a preliminary visit to the hospital on 28th June, against that background.
On the assumption that all the beds will be staffed and available for use by 1st September, the board has applied to my right hon. Friend for authority to admit up to 12 private patients to Doncaster Infirmary at any one time. It would not propose to use for this purpose the accommodation which had been allocated on the 7th floor in the original plan, as this would make heavy demands on staff. Alternative uses for this accommodation are now under consideration. Private patients would be admitted to the single rooms on each of the six other floors, and as there are eight single rooms on each floor a sufficient number of single rooms will remain available for patients needing them on medical grounds.
My right hon. Friend and my Department are at present considering this request for pay beds from the board. We understand that the board, the hospital management committee and the medical executive committee are agreed that private patients should not for the present be admitted. They propose to wait until the hospital is brought fully into use and until the waiting list position shows signs of improvement. But, as I have 550 said, the board is hopeful that the staffing difficulties will be overcome by 1st September, so there is reasonable hope that the sought for improvement will not be long delayed.
§ Mr. Harold Walker
Is there any indication that the waiting list will show a dramatic drop from the present 3,442, which I am sure the hon. Gentleman accepts as not very different from the 4,000, on the strength of which the then Minister rejected the earlier application? Can he also tell us the approximate cost to those patients who will be utilising the private beds?
§ Mr. Alison
An element of the cost will be the private fees to consultants. As there is no precedent at Doncaster, I can only give average figures. The daily charge, according to an answer which I gave the hon. Gentleman on 19th April, varies between different types of hospital. For a single room in an acute non-teaching hospital—the patient making his own arrangements for private medical treatment—the daily charge is £10.10p. But that is an average and it may not reflect precisely what the charge will be in Doncaster if and when pay beds were authorised.
I was saying that everything turned on whether or not the staffing problems will be settled by 1st September. If the improving trend continues I see every reason why we should then authorise the admission of some private patients to this hospital. I have explained my general views on private practice and, as I have said, Doncaster is in an anomalous position in having no pay beds at all. I understand that there are a number of people in the area who are members of one or other of the provident funds. This is a comment on the allegation that £70 is a fabulous sum to pay, but, of course, many people are privately insured against such an event. We think it right that they should be allowed to exercise this choice, which is one that was embodied in the original National Health Service Act of 1946.
As I have said, we have now had an application from the board for authority to admit private patients later in the year. We are considering this and I hope circumstances will enable us to agree to it before long, not only for the sake of the people of Doncaster who wish to be 551 treated privately, but also for the sake of the consultants at this hospital, many of whom, as the hon. Gentleman suggested, accepted part-time contracts on the assumption that pay beds would be available where they could treat their private patients.
They have shown great restraint and a very proper sense of responsibility, but I think that the time has come when their 552 interest too should be considered. I look forward to the time when the staffing difficulties at this hospital have been overcome and a continued downward trend in the waiting list is clearly discernible so that a reasonable number of paying patients may be admitted.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-eight minutes to Twelve o'clock.