§ 4.7 p.m.
§ Mr. Leslie Huckfield (Nuneaton)
I am grateful for the opportunity of raising this important matter, although I came here in the hope that I should be voting on the Bill of my hon. Friend the Member for Fife, West (Mr. William Hamilton). Although of course I respect your Ruling, Mr. Speaker, I was very disappointed that we were not able today to have a vote on that important matter.
I am speaking as a member of the Birmingham Regional Hospital Board. I also speak as one who does not believe in private practice in the National Health Service. I raise this matter because I believe that the replies which have been given to me as a member of that hospital board are unsatisfactory. I speak in the sincere conviction that my constituents and the people of the Midlands have a right to know what is going on inside the Birmingham Regional Hospital Board. I must point out that I am prepared to say anything I say in this House this afternoon without the protection of parliamentary privilege. Indeed I am prepared to carry out my own little "Pearce Commission" over the weekend to test the acceptability of what is said to me in reply by the hon. Gentleman on behalf of the Government.
I am not talking of particular individuals on the Birmingham Regional Hospital Board. I am speaking this afternoon about something which happens unfortunately all over the country. The Birmingham R.H.B. is just one example. What we have is the development of a hospital Mafia inside the National Health Service. Unfortunately, this particular Mafia is not even as bright as the proper Mafia it gets found out. This is the kind of concern I want to express to the hon. Gentleman on behalf of my constituents.
This is the regional hospital board under whose auspices the Walsgrave Hospital in Coventry allowed 700 private patients to be seen and allowed £30,000 to be collected in fees in 18 months when no authorisation for private practice had been given. This is the regional hospital board that sacked Mrs. Theresa Stewart because she found out what was happening at Walsgrave. This 1848 is the regional hospital board that has owned up to having what I can only describe as private nursing homes run under National Health Service auspices.
I refer to the Queen Victoria Nursing Institute in Wolverhampton, an institute with some 55 beds, of which 34 are private and 4 amenity. The figures show that there has hardly been a National Health Service patient in those private beds. It is a hospital with an average unit cost per in-patient per week of some £16 above the regional average and its in-patients are paying only the ordinary private patient fee. I suggest that it is a hospital where private patients are being subsidised by the regional hospital board.
The Birmingham Regional Hospital Board says that certain things should be done to the Queen Victoria Nursing Institute, and certain modifications may be made. But, instead of closing down extravagant and under-utilised facilities like this, the hospital facilities of my constituents and those of my hon. Friend the Member for Rugby (Mr. William Price) are being attacked. That is apparently the order of priority.
We have the example of the South Bank Nursing Home at Worcester. There, there are 12 private beds out of 23, and hardly any National Health Service occupancy of those beds. That again is a veritable private nursing home.
Then we have Bromsgrove General Hospital which, in 1970, admitted 560 private patients and collected £108 in private patients' fees. That sum represents less than 20p per patient. When it was discovered, many of the private patients were allowed to get away without any charge.
We have Good Hope Hospital, Sutton Coldfield, which had 48 private nonresident patients in 1970. The sum involved there was £312. Again, no authorisation was given for this private practice.
Another example is the Royal Salop Infirmary at Shrewsbury. The hon. Gentleman does not know about this one yet. Again there has been non-authorised private non-resident practice. I submit that this is another example of a veritable private wing.
We have a situation where the regional hospital board is now meticulously 1849 coming to the Secretary of State to seek authorisation for all these examples of private practice, many of which have been going on quite illegally. I am urging the hon. Gentleman to ask his right hon. Friend the Secretary of State to reject these applications for authorisation outright.
I do not want to give the impression that the board itself has not been concerned. On 24th March this year it passed a resolution calling for the setting up of an independently-chaired inquiry into private practice in the region. Six months later, on 22nd September, the Board said that in spite of that resolution the inquiry could not be carried out because of practical difficulties.
What are the people of the Midlands to think of this regional hospital board? What are the Midlands newspapers to think of it? I want to praise the activities of the Sunday Mercury and the Birmingham Post, a couple of newspapers which have not been nobbled by the board's public relations department. I hope that they will both carry on their work.
The hon. Gentleman's Department cannot authorise these applications when in every case there is an increasing waiting list and a growing tendency to jump the queue. It is going on in almost every case in which the Secretary of State has been asked to authorise private practice. In many instances where the right hon. Gentleman is asked to increase the number of pay beds one sees a diminishing occupancy of them. In other words, instead of their being increased, in many cases they should be reduced in number.
How can the Department authorise increased private practice in the regional board's area when the chairman and officers of the board went before the Select Committee on Expenditure and told it that they had no overall control of private practice and that each individual hospital management committee was left to work out its own system of financial control? The Department must refuse the authorisations, and the Secretary of State must hold a full inquiry into the activities of the board. The public demand it.
I want to pay tribute to a great many consultants in the National Health Service. They do a fine job, not only in this country but abroad, in the way that 1850 they spread the reputation of the National Health Service. Unfortunately, we have a private wing, a Mafia. They have their own special advisory committee on merit awards. They have a bran-tub of goodies which they distribute amongst themselves with no public control or accountability. It can be described only as a consultants' Cosa Nostra. That is what we have going on at the moment among the consultants.
I am pleased to see my hon. Friends the Members for Coventry, South (Mr. William Wilson) and Rugby here. Their constituents are served by the Coventry Management Committee. The Secretary of State must not authorise any more applications for private practice, resident or non-resident, in the Birmingham Hospital Board area. He must set up an inquiry. The National Health Service is already in peril.
We already have the disappearance of National Health Service facilities in dentistry over large parts of the country. Will the Minister step in and do something about the National Health Service in the West Midlands?
§ Mr. William Wilson (Coventry, South)
Does my hon. Friend realise that in Coventry, which is part of the Birmingham Regional Hospital Board area, there are over 4,000 National Health Service patients waiting for beds?
§ Mr. Huckfield
I am grateful for that interjection by my hon. Friend. Many of my constituents have to go to the Walsgrave hospital for treatment.
I end as I began with the point which I have been making all through my speech. How can the Department even consider the authorisation of any more private practice in this region? Will the hon. Gentleman please get his right hon. Friend and the Department to hold a full inquiry into the Board immediately and try to salvage a tiny bit of the National Health Service in the West Midlands before it disappears?
§ 4.16 p.m.
§ Mr. William Price (Rugby)
I should apologise, Mr. Speaker, for my unorthodox dress. I am in something of a dilemma. Just before coming into the Chamber the zip came apart from my trousers and I have not had an opportunity to have repairs carried out.
§ Mr. Price
It is perhaps an inappropriate day for that to happen. The alternative would be to cause some embarrassment to myself and no doubt to the House as well.
In the two to three minutes available to me I want to say that I fully support my hon. Friend the Member for Nuneaton (Mr. Leslie Huckfield) and pay tribute to the work that he is doing on hospital matters in the West Midlands.
It is not easy when dealing with the Birmingham Regional Hospital Board, which is a monolithic organisation which operates with a secrecy which would do credit to any masonic order. As soon as a member of the board begins to cause trouble—as in the case of Mrs. Theresa Stewart, who has been mentioned—the officials of the board have a quaint way of sorting out the problem: he gets the sack. I warn my hon. Friend that he is the next likely contender for the chop. I have seen it coming for some time. I suspect that his days are numbered.
According to the Secretary of State, both he and I have been running a vendetta against the board. At least I have the consolation of knowing that the board cannot sack me. My part in this so-called vendetta has been rather narrower than that of my hon. Friend.
In the main I have been concerned with goings-on at the Walsgrave Hospital, Coventry, which serves my area. I was satisfied when the board announced its intention to set up an independent inquiry. I was astonished when it later decided not to go ahead. The reason given was rather curious. It was that two barristers had apparently declined to take on the job. That really is a shady excuse which has fooled nobody in the West Midlands.
There are more than 60,000 people awaiting admission to hospitals in the region. Serious allegations have been made, but no independent inquiry has been carried out. I regard that as a shameful state of affairs which the Minister should put right. I have a good deal of admiration for him and the work that he does. He has always been extremely helpful to me about hospital matters involving my constituency. He knows from a recent visit that it is a matter which arouses a lot of passion.
1852 It is right, too, that I should say one thing about the regional board. I believe—I do not know whether my hon. Friend will agree—that it does a good job under difficult circumstances. There are always too many priorities and too little money. I do not think that the board, apart from this argument over pay beds, has much to hide. In many respects it has a good record. I think that the present chairman is doing his best, but I ask the Minister to say to the board: "For God's sake, tell people what you are doing."
§ 4.18 p.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Michael Alison)
The hon. Member for Nuneaton (Mr. Leslie Huckfield) has shown a great deal of persistence in pursuing the matter of private practice in the Birmingham region and attacking the attitude and, indeed, the competence of the very regional board of which he is a notable member. At any rate, I cannot accuse him of partiality in this respect.
I am grateful to the hon. Member for Rugby (Mr. William Price) not only for the kind words he spoke about me but, more particularly, for the helpful and encouraging comments which he made about the board.
Since it came to light early last year that private patients had been admitted to Walsgrave hospital in excess of the authorised number, the hon. Member for Nuneaton and a number of his hon. Friends have raised the matter in many Questions to which they have had, I hope, extensive and full answers. I am not complaining about that. I mention it to remind the House that the subject has been extensively considered in the House. Indeed, papers going fully into this matter have been placed in the Library for scrutiny by hon. Members.
When the situation at Walsgrave Hospital came to light, the hon. Member knows that my right hon. Friend gave instructions that no more private patients should be admitted in excess of the authorised number and he asked the board to investigate and report to him any failure to observe the statutory procedure. The hon. Gentleman knows that the hospital board had been planned to accommodate private patients, but there had been lengthy correspondence between 1853 the board and the hospital management committee as to the actual amount of private accommodation for which my right hon. Friend's authorisation must be sought.
After considerable deliberation the board decided to seek authorisation for 18 pay beds overall, and that number was approved by my right hon. Friend. In due course the board's report was received, and copies of the document have been placed in the Library. The report confirmed that there had been a breach of the rules, although taking the hospitals in the Coventry sub-group as a whole the average occupancy of private patients had not exceeded the number of pay beds authorised in the group.
I ought to mention, by the way of correction, that the £30,000 referred to by the hon. Member for Nuneaton was not consultants' fees. We have no knowledge of what they are paid. The sum of £30,000 was collected by the hospital for the cost, so it is a net increment to the Exchequer and not to the consultants.
My right hon. Friend asked the board to convey to the Coventry Hospital Management Committee his concern at the failure to observe the statutory requirements. He was also satisfied that adequate arrangements had been made at Walsgrave Hospital to ensure that the amount of accommodation authorised for private patients would not be exceeded in the future.
I do not propose to go into detail about the other instances of irregularity, or alleged irregularity, elsewhere in the Birmingham region which the hon. Gentleman has mentioned, largely because my right hon. Friend has received from the hon. Lady the Member for Hitchin (Mrs. Shirley Williams) a memorandum which she has prepared. We have been going into this in great detail and we shall shortly reply to the hon. Lady.
I note the hon. Gentleman's supplementary point about a particular case which lay outside the memorandum which has been presented, and I shall attempt to include that in the reply. It is sufficient to say that, apart from Walsgrave, the instances mentioned where the number of private in-patients has exceeded the authorised number can 1854 really only be regarded as trivial. [Interruption.] I think that the hon. Gentleman will see this from my right hon. Friend's reply.
The hon. Gentleman has mentioned the use by private patients of National Health Service out-patient facilities—I think that he touched on this today, and it is certainly touched on in the memorandum—without authority and without the collection of charges. Some of the unauthorised use of facilities has been due to genuine misunderstanding on the transfer of services from one hospital to another. If there have been shortcomings in the collection of charges, I am confident that the authorities concerned, with the assistance of the Department's auditors, who have an important monitoring rôle, will see that there is strict control in future.
I now turn to the question of the inquiry to which the hon. Gentleman referred and which he has raised in the past by Questions and in other ways. Following the Walsgrave incident, the board resolved that there should be an inquiry, which it proposed to make with an independent chairman, throughout the region into a number of matters relating to private patients. However, after receiving legal advice as to the practicality of carrying out an inquiry with the terms of reference proposed, the board decided not to proceed. I understand that the difficulty of the inquiry in obtaining evidence on the subjects to be inquired into was the main factor in the legal advice received by the board. It was the decision of the board originally to set up an inquiry and it was the board's decision to abandon it. Both decisions were fully within the board's rights and we in the Department are perfectly content to concur.
On the basis of the allegations of misuse of National Health Service facilities which we have seen there is certainly no justification for a ministerial inquiry. Some of the difficulties mentioned in the legal advice received by the board would also arise. In any event, during the last few months the Employment and Social Services Sub-Committee of the House of Commons Expenditure Committee has been carrying out a detailed investigation into the use of National Health Service facilities for private patients. It has taken oral and written evidence from a 1855 number of bodies including the hon. Gentleman's own regional hospital board. Mr. Perris has been before the Committee and given evidence. The Committee will have ample opportunity to investigate any irregularities which may have come to light. I and my right hon. Friend await its report with great interest.
The Government think it right that a proper proportion of beds—as provided for by the hon. Member's own Government's 1968 Act—should be available in National Health Service hospitals for people to pay for their treatment, bearing in mind the needs of those who do not wish to pay, who, I agree, constitute the vast majority.
As areas change and hospitals merge or are developed, there are changes in the demand for pay beds and outpatient facilities for private patients, so there is a steady stream of applications from boards all over the country for increases and decreases in the extent of the accommodation to be made available to private patients.
In the Birmingham Hospital Board region in the last 18 months there has been a net increase of 14 pay beds, making a total of 341. This represents just short of 0.9 per cent. of all the beds in the region. If we include the 106 pay beds at the Queen Elizabeth Hospital in Birmingham, this represents 8.6 pay beds per 100,000 population. Leaving aside the metropolitan regions, Birmingham comes about midway in the national "league table" of pay bed provision.
We are at present considering a few applications from the Birmingham board for authority to provide facilities for private out-patients in the hospitals in the region. We are extremely impressed with the amount of detailed information which the hon. Member's board has provided for us, to enable us to come to a decision in each case.
§ Mr. Alison
Decisions will not be taken lightly and I am sure that additional facilities will not prejudice the position of N.H.S. patients. I understand that the number of private outpatients already seen represents a tiny proportion of total out-patients seen.
§ Mr. Leslie Huckfield
I have great personal respect for the hon. Gentleman and his right hon. Friend, because I know that they are both generally sincere in what they say and do. But cannot the hon. Gentleman accept that all the applications for authorisation which are coming before him now are taking place when National Health Service queues are lengthening and queue jumping is increasing? Surely he cannot authorise any more private practice in those circumstances.
§ Mr. Alison
The hon. Gentleman must remember two things. First, paradoxically, as hospital provision increases, so do waiting lists. That is one of the ironies of the situation. Second, the hon. Gentleman cannot overlook the wide range of opinion which considers that the availability of private practice and private facilities in regional boards is an asset from the point of view of most National Health Service patients as a whole, so far as it affects the encouragement of consultants to practise there.
Reference has been made to the size of the waiting lists in the region, so perhaps I should say something about the Government's attitude to this general problem and about the present position and prospects for the future. We intend to ensure that lists are reduced to the lowest level consonant with operational needs. Despite continuous increases in the numbers of patients treated, the waiting lists are still higher and in some specialities, though only some, a good deal higher than we would wish.
There is also a problem in some areas of waiting time for hospital consultation after a patient has been referred to the hospital by his general practitioner. These are two aspects of the same problem: that resources in certain areas and specialities are not sufficient to enable all patients seeking non-urgent treatment to receive it as soon as we should like. We are considering with the medical profession what measures can be taken to reduce long in-patient waiting lists and delays between referral and consultation for out-patients. But already my Department has offered advice to the hospital service on means—and they are significant and effective means—by which waiting lists might be reduced.
1857 What I have said applies, of course, also to the Birmingham region. I am aware of the particular problem of the region, which has the largest population of all the regions and at present less than the average number of beds in relation to population. It is not surprising, therefore, that the number of people on the waiting lists for admission to hospital, in relation to the population of the region, is slightly above the national average. Despite this the number of patients treated rose by about one-third in the 10 years up to 1969.
By reason of its special position, to which I have referred, the region received the highest allocation of revenue moneys of all the regions. It is also currently receiving the highest capital allocations. In 1970–71, £9.2 millions was spent on hospital building in the region. It is estimated that expenditure during the current financial year will reach £.13.7 million and a further substantial increase in spending is likely next year.
Our hope is that, with increasing resources becoming available in the region, the waiting list situation will before long show a considerable improvement, although it is also our experience that as resources increase, so does demand. It is an encouraging development that capital has appeared on the ground, as it were, and has had the effect, at least in this area, of reducing the waiting lists.
Since the Coventry area has figured in this debate, it may be of interest if I say that the latest available figures show that in the past two years there has been a marked reduction in the size of the waiting lists for admission to hospitals in this area. Undoubtedly this is related to the opening of the new Walsgrave Hospital.
Let us put all this in perspective. There are over 200 hospitals under the Birmingham Regional Hospital Board, 70 of which have pay beds. Out of a total of some 40,500 beds, there are 341 pay beds. I would not wish to condone any irregularities in the use of N.H.S. facilities for private patients, nor of course does the regional board. [Interruption.] I am sure that hon. Gentlemen opposite would not dream of suggesting that there was any attempt on the part of the board to condone any such irregularities. It is a 1858 board of the utmost integrity, enthusiasm and zeal in implementing its tasks under the N.H.S. Indeed, the bulk of the information on these points has come from the board itself. But those irregularities that have occurred can have had little or no effect on N.H.S. patients, and it is absurd to blow this up into a matter that requires a formal independent investigation.
These are matters essentially for local management, helped where necessary with advice, which is readily given, from the Department's auditors, and we have every confidence in the ability of the board, with the hospital management committee, to put right any defects that may occur in the system of local control.
I understand that the board's own monitoring arrangements have been strengthened and that whenever there have been indications that control needs strengthening, steps have been taken by both the board and the hospital management comittee concerned to ensure that the rules are strictly observed.
When the board decided not to proceed with an inquiry, the board's officers were instructed to carry out a detailed examination of the extent of the use made of private beds and of out-patient facilities for the treatment of private patients so that the needs could be re-assessed.
§ Mr. Alison
I understand that this review is proceeding.
The board's officers have devoted considerable effort to the whole field of private practice over the past year and I am sure that this has served a useful purpose and has enabled hospital authorities to make any necessary improvements in their arrangements for dealing with private patients.
If the hon. Member for Nuneaton claims that this information has not been published, I can only suggest that as a member of the board he pursues that aspect with the board and its chairman. As far as I am aware the detailed scrutiny to which I referred is not yet complete.
The time has now come to let the board get on with its work of administering the hospital services in the region, of which the provision of facilities for private patients is, as I have indicated, only 1859 a small part, without seeking to impose on it the additional burden of a special inquiry on the basis of a few irregularities which we believe it is competent to put right through normal administration and management machinery.
I stress that the private bed provision is a statutory one. It is provided for in Statutes agreed by Governments of 1860 both parties, and demands for endless scrutiny and calls for inquiries place on the officers of any board a demand for the expenditure of time which is out of all proportion to the number of beds involved in this operation.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-five minutes to Five o'clock.