§ The Secretary of State for Social Services (Mrs. Barbara Castle)
With permission, Mr. Speaker, I would like to make a statement on private practice and the National Health Service.
The House will be glad to know that this morning I met representatives of the medical and dental professions on the Government's proposals for phasing private practice out of NHS hospitals. As a result of this meeting they are ready to call the Central Committee for Hospital Medical Services and the BMA Council, and the Council of the Hospital Consultants and Specialists Association together later this week and to submit proposals to them for urgent consideration. It is hoped that they will be accepted and normal working resumed.
As the House will be aware, the Prime Minister and I met a representative delegation of the professions on 3rd December at which the professions expressed anxiety that the Government's proposed legislation on phasing out private practice from NHS hospitals could render nugatory the practice of private medicine in this country, which the Government have always said that they do not intend to abolish. At that meeting outline proposals were put forward by Lord Goodman which were regarded as the basis for urgent exploration. The Prime Minister undertook that these proposals would be examined and that the professions would be informed of the Government's response.
Since that time a process of clarification has been taking place with me through Lord Goodman and proposals have been evolved which the Government hope will lead to an end to this dispute. If the professions as a whole agree these proposals and normal working is resumed, the Government will embody these proposals in their legislation.
Under the proposals, a copy of which has been placed in the Library, the professions make clear their continuing opposition to the phasing out of private practice and reserve their right to try to 972 influence Parliament's decision on the point of principle, but they acknowledge that this may become the will of Parliament. It is proposed that the legislation would embody two principles: first, that private beds and facilities should be separated from the NHS and, secondly, an expression of the Government's commitment to the maintenance of private practice in this country through the renewal of the provision in the National Health Service (Amendment) Act 1949 which maintains the right to private practice by entitling doctors to work both privately and in NHS establishments.
These two commitments will be related through the establishment of an independent Board set up by the Government. The Board will have an independent chairman, two members drawn from the medical profession and acceptable to it and two members appointed after consultation with NHS staff and other interested parties.
The criteria under which pay beds and facilities would be phased out in the legislation will be the reasonable availability of alternative facilities for private practice. It is accepted that there are some pay beds and facilities which on this basis and on the basis of their under-use could be phased out without delay.
The Bill will therefore contain a schedule giving details of 1,000 pay beds which will be phased out of the NHS within six months of Royal Assent. The schedule will be drawn up on the criteria which I have mentioned and after consultations with all concerned.
The phasing out of the remaining pay-beds would be determined by the independent Board which would be guided by the following criteria; that there should be a reasonable demand for private medicine in the area of the country served by a particular hospital; that sufficient accommodation or facilities existed in the area for the reasonable operation of private medicine, and that all reasonable steps had been, or were being, taken to provide those alternative beds and facilities. This would be kept under continuous review. Where all reasonable steps were not being taken, that would, after due warning, be in itself grounds for withdrawing pay beds and facilities in the hospitals concerned.
One of the factors the Board would bear in mind in deciding whether private 973 facilities for specialised operations, treatments and investigations should be phased out would be the willingness of the NHS to make such facilities reasonably available on an occasional basis in specified circumstances and at an appropriate charge. The Secretaries of State would have to be satisfied that there would be no disadvantage to NHS patients and that such patients were admitted on the same basis of medical priority as NHS patients.
As stated in the Queen's Speech, the regulation of the private sector following the separation of pay beds will be the subject of further consultation with the professions. In the meantime the Government need to be satisfied that developments in the private sector do not significantly endanger the service the NHS gives to its patients and will enter into consultation with the medical profession as to how this can be achieved by voluntary means. The consultations would cover the point whether any reserve powers that it might prove necessary to take in the legislation might be exercised by the independent Board.
The Government believe that the smooth phasing out of pay beds would be facilitated if, pending their withdrawal, a system of common waiting lists were to be introduced. The professions have expressed reservations on this matter, but it is proposed that the legislation should instruct the Board to examine this and make recommendations to the Secretaries of State within six months of Royal Assent to the Bill.
I hope that in the light of these proposals—with which the Secretaries of State for Scotland and for Wales associate themselves—the professions will now accept that this is a matter for Parliament and end the damaging industrial action by senior medical staff. The issue of private practice in National Health Service hospitals has long been one of great controversy, not least within the service itself. These proposals will ensure that the policy of separation is achieved, but in a way which should allay the fears of the medical profession and provide an enduring settlement.
§ Mr. Norman Fowler
May I endorse one thing that the right hon. Lady said—namely, that this is an issue to be decided in Parliament? Is the right hon. Lady aware that the arrangement which 974 she has announced does nothing to reduce our opposition to her policy, which is both wrong in practice and indefensible in principle?
I ask the right hon. Lady two questions. First, does she not understand that as it still remains her declared aim to abolish pay beds, the fact that execution is to be independent or delayed is irrelevant to the main issue? Second, will she confirm that her licensing proposals remain? If they do, how does she justify a position in which the State can intervene to control the size of the private sector and prevent it from developing and flourishing?
I hope that the right hon. Lady understands that we shall continue to fight her all the way on these proposals in Parliament.
§ Mrs. Castle
I cannot say that I ever expected anything else. Naturally, I recognise the right hon. Gentleman's right to fight these proposals just I and my colleagues have the right to put these proposals to Parliament, because we believe in them.
The hon. Gentleman has totally misunderstood the purpose of the exercise embodied in the proposals I have spelled out to the House. The Bill will make it clear that pay beds are to be separated from the National Health Service. It was always my intention that this should be done in such a way as not to damage the interests of those who wished to pursue private practice and who had not got readily available facilities to hand outside the National Health Service. These proposals will enable facilities to be phased out as the opportunities for alternative facilities build up, although it is clear from what I have said that if the opportunity to build up alternative facilities is not reasonably taken the beds will be phased out.
I have always made clear that my proposals concerning licensing are, as the Gracious Speech said, a matter for further consultation. It is widely accepted that it would be wrong, pending the phasing out, for private developments to take place which threatened the well-being of the NHS, which remains the backbone of the health care of our people. This matter is being further considered in consultations and the possibility is being examined of any reserve powers we might 975 have to take being placed in the hands of the Board.
§ Mr. MacFarquhar
Can my right hon. Friend confirm the impression I have gained from her statement, namely that in the great metropolitan areas where the resources and the demand for private medicine exists in large amount, pay beds will be phased out rather quickly, but that outside these areas, where there is not much demand and few resources for totally private medicine, pay beds are likely to persist for a long time?
§ Mrs. Castle
The schedule for phasing out the beds will take into account the criterion that there should be adequate and reasonably suitable alternative facilities available. My hon. Friend is right to say that we are likely to find that London is more plentifully supplied with alternative private facilities than are some other areas of the country. As for the length of time it will take to phase out pay beds altogether in areas where private facilities barely exist outside the National Health Service, that remains to be seen. The independent Board will be examining these positions in the light of the criteria I have mentioned.
§ Mr. Michael Morris
Is the right hon. Lady saying with regard to the licensing proposals—to use her own words the "further consultations" that she is having—that she is withdrawing the relevant paragraph from her consultation paper? Secondly, is she also saying that the directive that went out to certain area health authorities saying that practitioners in health centres would no longer be allowed to undertake private practice is also being reconsidered?
§ Mrs. Castle
I have said, and the Gracious Speech makes it clear, that the licensing proposal is a matter for further consultations and that those consultations have not yet begun. They will take place on all the possible ways in which we might give reasonable safeguards to the National Health Service so that its ability to provide a service to its patients is not undermined.
As for the hon. Gentleman's question about the circular concerning health centres, this misrepresentation of the position has already been scotched in the 976 House in the answer to a Question by my hon. Friend the Minister of State not long ago. There has never been a circular on the lines the hon. Gentleman suggests. As I made clear in my speech to the conference of Family Practitioner Committees not many weeks ago, family doctors can continue to see their private patients in health centres. I have made this clear to the House before and there is no need to withdraw anything.
§ Mr. Penhaligon
Can the right hon. Lady tell the House whether the hospital consultants with whom she has been having consultations are prepared to recommend acceptance of this document?
§ Mrs. Castle
The wording I have read out to the House more adequately reflects their point of view. They will put these proposals for urgent consideration—[Interruption.] Unlike some Tory Members I do know something about negotiations. When the representatives whom I met this morning expressed a willingness to put those proposals for urgent consideration they insisted that it would be wrong for them to pre-empt the decision of the bodies they represented. I respect their judgment of the right way to handle their side of the discussions. I made clear in my statement that the Government's willingness to embody these proposals in their legislation is conditional upon the proposals being endorsed by the medical and dental professions as a whole and normal working being resumed. We must wait and see what the expressions of views are at meetings to be held later this week.
§ Mr. Raphael Tuck
Is my right hon. Friend aware that the setting up of this independent Board will come as a great relief not only to myself but to a number of my hon. Friends whose names I am not at present even allowed to mention? Is she further aware that her proposals for phasing out pay beds may, as I said last Friday, decimate the medical population of this country with disastrous effects?
§ Mrs. Castle
I must tell my hon. Friend that the remit of the Board will be to phase out pay beds but to do that in an orderly way, using the criteria to which I have referred.
§ Mr. Bryan Davies
Will my right hon. Friend accept that many of us on the Labour Benches will view this compromise with a degree of anxiety? Will she further accept that she is vesting this independent Board with powers which ought more appropriately to be located in her Department, which is backed by the views of the people as represented in Parliament? Is there any chance that these independent members of the Board who are not nominated by the medical profession may be drawn from those sectors of society which neither wish nor have the resources to take advantage of private medicine?
§ Mrs. Castle
It would certainly be the Government's intention to secure a balance in the membership of the Board. I point out to my hon. Friend that the Board's activities remain under the control of Parliament in the sense that the criteria by which it must be guided will be laid down in considerable detail in the legislation. These criteria will be matters on which the House can adjudicate and deal with in any way it wishes.
§ Mr. Paul Dean
While welcoming the possible help that the proposed independent Board may be able to give, may I ask the right hon. Lady to recognise that one of the fears in this situation is that the licensing system will be used as a way of getting rid of private practice altogether? In view of this genuine fear may I ask the right hon. Lady to consider the possibility of the Board having some function in this respect?
§ Mrs. Castle
The question of licensing is a matter for further consultation, as the Gracious Speech made clear. The legislation for phasing out pay beds will go ahead at the earliest possible date. Licensing remains to be further considered. As I said in my statement, one matter which we shall cover in the consultations is whether any necessary reserve power to prevent damaging developments to the National Health Service should be embodied in the independent Board.
§ Mr. Cryer
We realise that my right hon. Friend has had many difficulties with the medical profession, which wants to keep its hands on the lucrative bodies of private patients. There are two items which cause special concern. First, will not the Board be effective only as a machine for delaying the abolition of private beds within the National Health Service? Secondly, my right hon. Friend said that the ending of separate waiting lists will be considered by the Board six months after legislation. That means that the scandal of queue jumping by people who have money will not be brought to an end as soon as it might be. Does not my right hon. Friend feel that it is for her Department to make the decision? Is not my right hon. Friend concerned that the Board will be waiting to establish the amount of investment in private practice and, given our economic circumstances, is it not wrong for investment to take place in the private sector?
§ Mrs. Castle
I do not share my hon. Friend's anxieties because the legislation will make clear that the remit of the independent Board is to phase out pay beds. The principle of separation will be accepted and embodied in the legislation, but it will be related to the opportunity for the development of alternative facilities for private medicine outside the NHS. It has always been my intention, in areas where alternative facilities do not exist, to allow a reasonable period for phasing out pay beds to give an opportunity for the facilities to be built up if there is a demand for them. I am merely embodying that approach in a different form.
I agree with my hon. Friend on the desirability of common waiting lists, and wish that we could get the profession to accept the principle. At the moment we have not been able to do so, but a reference to the Board, with a time limit, will be helpful in showing us ways in which common waiting lists might be introduced. I do not think that six months is a long time. We cannot set up the Board until Parliament has decided whether it is to operate.
§ Mr. Crouch
I accept that the Board is a compromise towards finding a solution to this difficult problem, but the right hon. Lady is giving to the Board a remit to separate the National Health Service into two health services. Is she prepared 979 to go into the negotiations with an open mind and not see, as a result, the division of the health services into two?
§ Mrs. Castle
No, I am sorry, but I do not accept the hon. Gentleman's view. It has been the policy of the Government and we fought two elections on it. I know that there is disagreement about the policy but we stand by it. No one would expect us to do anything else, and I am not prepared to abandon that policy.