HC Deb 08 July 1974 vol 876 cc946-54
Sir Geoffrey Howe (by Private Notice)

asked the Secretary of State for Social Services whether she will make a statement about the negotiations in which she took part last Friday in connection with the dispute about private practice in the National Health Service.

The Secretary of State for Social Services (Mrs. Barbara Castle)

I am circulating in the OFFICIAL REPORT the text of the statement, the relevant parts of which were agreed with all parties concerned in last Friday's discussions, which was circulated to the Press early on Saturday morning. I am also circulating copies of correspondence which has since passed between me and the Secretary of the British Medical Association confirming some of the points of principle which affect its members.

The esentials of the statement are these. The work of the working party on the consultants' contract is to be speeded up. The Government's declared policy of phasing private pay beds out of National Health Service hospitals remains a firm commitment, but, as I have made clear on several occasions, it is the Government's intention to proceed in an orderly way and after the fullest discussions with those most directly concerned.

The BMA and the Hospital Consultants and Specialists Association have said that they do not agree with phasing out and hope to persuade the Government not to proceed.

I would remind the House that the joint working party is concerned not only with the future of private practice in NHS hospitals. This is only one part of our discussions which are intended to result in a new charter for hospital consultants. The Government will consider the report of the working party and will base their detailed proposals on that.

Meanwhile, although I have a discretionary power to reduce or withdraw the authorisation of pay beds, I have no intention of making any arbitrary reduction in the present allocation of pay beds while awaiting the report of the working party.

So far as Charing Cross Hospital is concerned, it was agreed that, though the authorised number of pay beds would not be reduced, when private patients are treated for clinical reasons in special units elsewhere in the hospital, the equivalent number of beds in the private floor will be occupied by NHS patients. Thus, a mixed floor will result without in any way interfering with the clinical freedom of the consultant staff.

On this basis NUPE and COHSE agreed to issue a call to their members throughout the country to discontinue their action and to await the working party's report. For their part, the BMA and HCSA agreed to withdraw their threat of working to rule.

This settlement depends for its success on the good will of all parties. It is not, as has been suggested, a victory for any party: rather it is a victory for common sense. We all know that the service is faced with major difficulties in present financial circumstances. There is the added danger that conflicts between various groups will destroy it. We can maintain the National Health Service only if all are prepared to work together and accept that changes must take place on the responsibility of the Government of the day after proper consultation and negotiation.

Sir G. Howe

The whole House will welcome the last sentence of the right hon. Lady's reply together with her statement that it is not her intention to make any arbitrary reduction in the present allocation of pay beds.

Will she confirm that it follows from what she said that there will be no reduction in the number of beds available for private patients at the Charing Cross Hospital and that until the report of the working party under the chairmanship of her hon. Friend the Under-Secretary of State for Health has been considered and agreed it will remain the Government's policy to permit the provision of private beds in National Health Service hospitals on the present basis?

Does she accept that doing away with private beds can only serve to weaken the finances of the National Health Service at a time when she has acknowledged that the service is facing major difficulties in our present financial circumstances?

What estimate have the Government made of the loss in income to the National Health Service from doing away with private beds, of the cost of treating at public expense extra patients who would thus have to be treated, and of the cost of compensation, in whatever form, to consultants from any such change?

Finally, does she acknowledge that it is the view of the House that it is absolutely intolerable for a matter of this kind to be resolved by competing deployment of industrial strength and that it is wholly to be regretted if either side, in the light of her statement, seeks now to deploy a political case at the expense of innocent patients by means of anything resembling industrial action?

Mrs. Castle

I had hoped that in his opening remarks the right hon. and learned Gentleman would have welcomed the whole settlement. I think that it is an important step forward in a very tricky situation indeed. Most of the questions put to me by the right hon. and learned Gentleman have already been dealt with in my original answer to the House this afternoon. In that answer I made it clear that I shall not use my discretionary power, pending the publication of the working party's report, to reduce the number of pay beds. I cannot guarantee that no reduction will take place because, owing to shortage of staff, a number of hospitals are having to curtail various facilities. If that happens, pay beds must play their proper part. However, that is a matter for local discussion and decision, not for intervention by me.

I cannot accept that the phasing out of pay beds from National Health Service hospitals will weaken the service. On the contrary, those of us who believe in a service in which treatment is given on medical priority alone believe that such a step will strengthen the purpose for which the National Health Service was originally created.

The loss of revenue due to the phasing out of pay beds this year is estimated to be £17 million. However, that means that we would have £17 million worth more facilities available to NHS patients.

Mr. English

Being slightly fractured, I suppose that, according to the rules—and as the House will observe my bandaged arm—I should declare an interest. My services were not those of the private patient, but of the NHS and the free service of a kindly professional medical Conservative Whip. That should suit both sides.

May I ask my right hon. Friend to refer to the working party the question of the serious discrepancies between different areas in the country? Since 1948 Nottingham has been the city worst served by the NHS. The discrepancy goes back before the National Health Service in this and other respects. Will my right hon. Friend take care to ensure that an equal service is provided throughout the whole country? I hope that she will refer that specific point to the working party.

Mrs. Castle

This is a point which may come up in the discussions. As my hon. Friend knows, my hon. Friend the Member for Plymouth, Devonport (Dr. Owen) is chairman of that working party, and he has been here listening to and noting what has been said.

Mrs. Knight

May I ask the right hon. Lady what criteria she intends to use in future for the allocation of single rooms for patients? If single rooms are not to be allocated to people who will pay for them, can the right hon. Lady say that they will not be allocated to powerful political figures who use their weight to obtain them?

Mrs. Castle

At present, the allocation of single rooms to patients is done by the consultant on clinical grounds, and that freedom is something that we must preserve. I remind the House and the hon. Lady that there is such a provision as amenity beds for those who wish to have privacy, and it is our intention to extend this provision.

Dr. M. S. Miller

Will my right hon. Friend accept congratulations on her decision not to resile from the phasing out of pay beds? Will she also accept that when she is deliberating on whatever report comes from the working party she should ensure that the National Health Service is not dominated by the great white chiefs of the scalpel and the syringe but is used for the benefit of patients and that the provision of beds is dependent upon the need for treatment when it is necessary and not on the ability to pay?

Mrs. Castle

It would be my intention to stress the value to the National Health Service of all who work in it—and this is a point that emerged in the consciousness of all who argued during those long hours of last Friday. We must respect the part played by everyone. I repeat that the purpose of the working party is to examine the present consultant contract—and the arrangements for private practice are inextricably involved in this—with a view to giving hospital consultants the charter to which they are entitled.

Several Hon. Members


Mr. Speaker

Order. This is Private Members' time and I think that we have encroached upon it sufficiently. I had my doubts whether to allow this Question. These matters must be debated on some other occasion.

Following is the information:


I have made the Government's position on this dispute over private beds in NHS hospitals clear both in statements in the House and in my letter of 4th July to the Chairman of the Ealing, Hammersmith and Hounslow Area Health Authority—a copy of which has been made public. The following are the relevant extracts:— In all these discussions the concern of the AHA has been, and will be, to safeguard the interests of the patients as a whole. As the House is aware, it is the policy of the Government as set out in our Manifesto and reiterated since to phase out private practice from the hospital service. While therefore I can understand the feelings of the staff I cannot condone the action they are taking. We believe that this issue must be dealt with by the Government of the day, and in an orderly way. In the past in industrial disputes in the hospital service it has always been recognised by all concerned that whatever the difference of view the health of patients must not suffer. My responsibility is to do everything in my power to ensure that ill patients whether private or NHS do not become the innocent victims of any action taken in any industrial disputes. I have already in the House of Commons made clear the Government's position on its policy as to private practice in the hospital service. I cannot stress strongly enough that all concerned should leave this to the Government to pursue in an orderly way through normal negotiating procedure. I have already said that I do not condone the action which is being taken. I deplore anything which could damage the health of patients or the interests of the NHS.

It is the present policy allowed by statute and agreed with the medical profession to include pay beds in NHS hospitals. The Government has however set up a joint working party with the medical profession to consider the terms on which consultants are employed, including the arrangements for private practice, and had it in mind to present its proposals early next year. For their part, the BMA and HCSA and the Government, have agreed to expedite very considerably the work of the working party, both on the consultant contract and on private practice within NHS hospitals, and it was decided to aim at agreement in the working party in November 1974.

The BMA and HCSA welcome the Secretary of State's intervention in the dispute at Charing Cross Hospital and in view of this have agreed to call off their threatened action on Monday, on the understanding that the other parties will also call off their action in any NHS hospitals involved.

In the circumstances of such a general agreement and while awaiting the report of the working party, the Secretary of State has made it clear that it is not her intention to make any arbitrary reduction in the present allocations of pay beds.

With regard to the distribution of private beds at Charing Cross Hospital, when private patients are treated for clinical reasons in special units elsewhere in the hospital the equivalent number of beds in the private floor will be occupied by NHS patients thus ensuring a mixed floor, and releasing acute beds elsewhere in the hospital. In the light of this NUPE and COHSE have agreed to call on their members throughout the country to discontinue their action and await the report.

From the British Medical Association—6th July 1974:

Dear Mrs. Castle,

I am writing on behalf of the Chairman of Council, Mr. Walpole Lewin, about the reports which have appeared in today's Press following our 10 hour discussions last night. Whilst I agree that the hour was very late, we were under the impression that we would have an opportunity to talk to the Press late last night. In the event, we were able only to have a brief interview with the Press Association.

To put the record straight, I wish to emphasise that we felt able to call off our threatened action only because

(1) you had agreed to include in the statement the fact that you "did not condone the action which had been taken at Charing Cross and deplored anything which could damage the health of patients or the interests of the NHS";

(2) that there would be no reduction in the number of private beds at Charing Cross;

(3) that until the Owen Working Party had reported it will remain the policy of the Government to permit pay beds in NHS hospitals.

(4) that it was not your intention to make any arbitrary reduction in the present allocation of pay beds;

(5) that the BMA and the Government have agreed to expedite the work of the Owen Working Party both on the consultant contract and on private practice. You have made your Government's position on the future of private practice quite clear. We for our part have made our position quite clear that we wish to preserve private beds in the public sector. Everything must therefore depend on the finding of the Owen Working Party which we agreed must be hastened.

Finally, I wish to make it known that the BMA's delegation throughout yesterday's discussions included 2 representatives from the Hospital Consultants and Specialists Association, including their President.

In the interests of those whom we represent it is essential that all these points should receive the earliest publicity and with your knowledge I am therefore issuing a copy of this letter to the Press."

Yours sincerely,



From the Secretary of State for Social Services—8th July 1974:

Dear Dr. Stevenson,

Thank you for your letter of 6th July about our discussions on Friday evening. Like you I am sorry that owing to the lateness of the hour when we completed our discussions, you did not have a full opportunity of making your position clear to the Press, and I welcome this chance of confirming your explanation of what we agreed.

You will of course accept that the Government is committed through its Manifesto to the phasing out of private practice from the hospital service and I for my part fully recognise that the BMA remains opposed to this policy. In setting up the Joint Working Party we neither of us surrendered our basic point of view but we desired genuinely to work out together a new charter for consultants and, as far as the question of private practice in the hospital service is concerned, we no doubt each hope we can convert the other. As you say in your letter I do not in any way condone attempts to pre-empt our discussions by industrial action from any quarter and I was happy to assure you, that as part of our firm settlement and in this spirit, I do not intend to withdraw authorisations for pay beds or arbitrarily to reduce their number while await ing the report. I also confirm that the agreement reached over the private floor at Charing Cross does not involve a reduction in the number of pay beds but affects their distribution throughout the hospital group.

I am glad we were able to agree to speed up the work of the Joint Working Party and I still cherish the hope that we might be able to reach a degree of agreement at any rate.

Yours sincerely,