§ 7.0 p.m.
§ Mr. Norman Fowler (Sutton Coldfield)
I beg to move,That this House believes that the abolition of private beds in National Health Service hospitals would be against the interests of the Health Service, the patients and the medical profession.This is the first of a number of debates which the Opposition will be raising over the coming months on the state of the National Health Service. The reason why we have chosen this subject for 1085 debate today is that newsaper reports suggest strongly that the Secretary of State has decided to go ahead with plans to abolish private beds in National Health Service hospitals. Our aim today is not only to enable an announcement of the plans to be made in this House but to permit an immediate debate on the important issues involved.
Perhaps the House may think it right that, as the mover of this motion, I should declare an interest. I do so quite openly and without hesitation. The only hospital treatment that I have received has been in the public wards of National Health Service hospitals. I have not benefited from private rooms, amenity rooms or side rooms, and the public wards in which I have been have always been occupied by the public—by ordinary people like me and the Secretary of State for Employment, who, we hope, will soon be back among us.
It was the right hon. Gentleman's predecessor, Aneurin Bevan, who decided that a limited number of private beds in National Health Service hospitals should remain. That compromise—for compromise it was—was decided on by a Labour Government, and it has lasted for almost 30 years. It is our opinion that, as so often happens in this country, the compromise has worked, and, furthermore, that it has worked to the benefit of the National Health Service. It is also argued that when the National Health Service is threatened by so many problems the right hon. Lady's action to phase out, or, in plain English, to abolish, private beds is not only dangerously irrelevant but damaging to the interests of the National Health Service.
I assume that no one seriously claims that the total number of private beds is now out of proportion to the size of the National Health Service. There is, of course, some dispute about the number of private beds that are available for use. A recent report in the Daily Telegraph suggested that many beds had been closed down unofficially. If that were so, it would be a most serious situation. The right hon. Lady has had time in which to investigate that suggestion. I ask her to take the opportunity of this debate to state exactly what the position is.
Let me take the official figures, however. According to the Department's 1086 figures, there are now almost 5,000 private beds available. That figure makes up about 1 per cent. of the total number of beds in our hospitals. That is the tiny target which the right hon. Lady is spending so much time and energy to destroy.
What makes the right hon. Lady's action even more extraordinary is that the present compromise enables a number of results to be achieved which I should have thought would be welcomed by both sides of this House. First, it enables specialists not only to make invaluable contributions to the National Health Service but also to preserve for themselves the freedom to practice outside a full-time salaried service. What is more, it allows them to achieve this without the kind of separation facilities which the right hon. Lady seems now to envisage.
Last Tuesday, during Question Time, the right hon. Lady proclaimed her faith in separation. Rather than the present partnership, she wants to have a clear distinction between the private and National Health Service facilities. Yet how is separation in the interests of the National Health Service itself? Surely it is one of the advantages of the present arrangement that many consultants are on hand in the same hospital and are not wasting time travelling between one hospital and another. Although' I accept totally that it would be possible to provide separate facilities, the right hon. Lady must accept that in some cases it would be very difficult, and that the result in the end could be to the extreme disadvantage of the National Health Service.
I take, as an example, cancer treatment. There are obvious difficulties in providing privately the kind of expensive equipment and buildings required. The right hon. Lady knows of the fear and concern, which has been expressed by the London and South-East group of consultant radiotherapists, that cancer specialists, especially radiotherapists, have not made provision to meet a sudden withdrawal of National Health Service facilities because they believed that the compromise would be honoured by successive Governments.
Some consultants, therefore, may find it impossible to continue with private 1087 practice in this country. Therefore, it would not be surprising—I put it no higher, although I believe that the risk is greater—if some were to reconsider their future in this country, not because they want to go but because they may feel that they are being forced out. The question which the right hon. Lady has to answer is just how this could benefit the National Health Service. If consultant radiotherapists and other senior staff want to work abroad there are several countries which would jump at the opportunity of having them. At present, they are receiving invitations and inquiries from abroad, notably from the United States. Some have gone already. Many more are considering that move. What a tragedy it would be if the policy of this Government resulted in the right hon. Lady pushing more consultants abroad at a time when we cannot fill the posts available here.
There is a much more general point. As The Times reported last month, there has been an enormous increase in the number of doctors generally examining the prospects of a career abroad. There has been a fivefold increase in the number taking the qualifying examination for entry as medical practitioners to the United States. In 1975 there were 1,000 candidates for that examination. That, by any measure, is bad enough, but in January of this year—and the examination takes place twice a year—2,500 doctors registered to take the examination. The indications are that for the year the number could be more than 5,000. By any standards the Government must accept that as being a serious position. These people are doctors and consultants the country can ill afford to lose.
Surely it cannot be in the interests of the National Health Service if the policy being pursued by the Government simply adds to the numbers of doctors leaving both this country and the National Health Service itself. The figures I have given are an indication of what is taking place today. Emigration is increasing, and, in my view, it will increase further so long as the Government pursue this irrelevant policy on which they seem to have set their heart.
There is one further immediate effect which the abolition of pay beds will have. 1088 It is to deprive the National Health Service of the income that it receives from them. After the increased charges announced last month, I assume that no one will argue that their occupants are paying too little. The cost of a single room is now £37 a day in a London teaching hospital and £26 a day outside. The Secretary of State is throwing away that income by her policy of abolition.
The right hon. Lady will also have to make up the salaries of those consultants who are deprived of their private practice. At the last election we estimated that this would cost £30 million a year. Since then there has been an increase in charges for pay beds and increased pay for the consultants. Nevertheless, let us stick to that figure of £30 million. It used to be argued by the Minister of State that £30 million in the context of the health service and public expenditure was a matter of supreme irrelevance. I assume that that is not the argument today, for, if it is so supremely irrelevant, why did the Chancellor make so much of cancelling that mid-term census which cost less than £30 million and of the necessity for which the Minister of State assured us only a week or two before the Budget?
Why did the Government resist at every stage our suggestions that the national insurance contributions for the self-employed should be reduced—a reduction that would have cost only £21 million? We were told from the Government Benches that this was too expensive. The Government cannot have it both ways. If they continue with their plans let them explain how, at a time when everyone agree that the National Health Service is short of resources, it makes sense to throw away this income. Above all, let them explain how it is to the benefit of the National Health Service.
Perhaps let them explain one other thing. Much of the equipment, I think the Minister of State would agree, in the hospital service, and, indeed, some of the buildings, has been given by voluntary contribution of private patients in recognition of their treatment. Most hospitals have benefited from this. I shall give just one example which may have escaped the notice of Mr. Jamie Morris and his friends. As much as 75 per cent. of the equipment in the radiotherapy unit at Westminster Hospital has been donated by private patients who have been treated 1089 there. That equipment is used not only by private patients but also by National Health Service patients. The assumption must be that contributions such as those will be lost when pay beds are abolished.
Perhaps we are making a mistake in believing that this policy has any kind of relevance to the health service at all. Perhaps the true explanation is that it is a good old-fashioned Socialist attack against the rich in this country. Again, that is an argument that does not bear examination. The vast majority of people who use pay beds are those who are insured under medical insurance schemes, notably under BUPA. This scheme covers around 2½ million people, and I imagine that even Transport House does not define the rich quite as widely as that. Therefore, on what basis exactly is the Labour Party acting? I imagine that the Labour Party conference believes that its Government are acting to stamp out the privilege that money can buy.
Let that conference not think for one moment that the Government are eliminating the paying principle from National Health Service hospitals. There are about 3,600 amenity beds in England. This little-known facility enables patients to buy privacy, currently at the rate of £1 or £2 a night. Already that is a price outside the reach of many people in this country, and presumably, as inflation continues, that price will have to increase to £4 or £5 a night.
Although I do not agree, I can understand the argument of those who say that no one should have the right to pay for special treatment. It would be logical for those who take that view to argue for the abolition of pay beds and, of course, amenity beds, because the same principle is involved. However, this is not the position taken by the Government, not unless they have changed their policy fundamentally since February, when a resident in Newbury received a letter written on the notepaper of the Secretary of State for Social Services. The letter was signed by Mr. Jack Straw, who was once president of the National Union of Students and is now the Secretary of State's special adviser. In this letter Mr. Straw argued that treatment inside the National Health Service should in no way be related to the ability to pay. He went on to say: 1090There is a system within the NHS of `amenity beds' by which for a small extra payment (£1 or £2 a day) a NHS patient who is being treated in the normal way may be accommodated in a single room or small ward for those who want privacy, not required on medical grounds. The Government is a firm believer in extending these facilities for privacy for those who want it.The only special thing about that advice is its quite exceptional absurdity. On the one hand the Government are saying that they refuse to see people paying for private beds inside the National Health Service, and on the other hand, that they intend to expand the opportunities for people to pay for amenity beds inside the National Health Service. They abolish the pay beds, which make a real contribution to the finances and income of the National Health Service, and they expand paid-for amenity beds which are subsidised, presumably, by the general taxpayer.
The plain fact is that the Government are getting into the most enormous tangle on this subject. That is evident in the whole of the Government's approach to this subject. The right hon. Lady says that she wants to see separation of facilities. In other words, she is forcing into existence an alternative service. As Nye Bevan went down as the Father of the National Health Service, the right hon. Lady apparently wants to go down as the mother of the private health service. I am bound to say that that is an odd ambition for a Labour politician, but I assume that she knows what she is doing.
Already there are rumblings from the health service unions about this very point. They say that the number of private beds outside the health service should be limited. Presumably, they mean by some kind of ministerial decree. I hope that when the right hon. Lady replies she will make it clear that she has no intention of following up that particular demand.
In this debate we are arguing that the policy being pursued by the Government is harmful. I imagine that even some hon. Gentlemen opposite—if there are any hon. Gentlemen opposite—would thing it pretty irrelevant at this time.
§ Mr. Fowler
As the hon. Gentleman says, it is the quality that counts.
1091 Why is the Secretary of State acting in this way? It is true that she has come under pressure from some members of NUPE and that she has an ultimatum from COHSE to announce her plans before Thursday or else they will take action of their own. I imagine that she is not seeking to respond to that.
It is right that I should challenge one of the right hon. Lady's most frequent responses when she seeks to draw a comparison between the kind of action taken by NUPE members at hospitals such as Westminster and Charing Cross and the action taken by the consultants. In my view that comparison is entirely phoney. I am not supporting the continuation of the consultants' action.
As an Opposition we pressed the right hon. Lady to get back into talks. Eventually she took that advice, and we welcomed not only the resumption of the talks but also the discontinuation of the action by the British Medical Association. I made this clear in a statement, and I made the position clear to the HCSA. Let us have no more of that particular nonsense from the right hon. Lady.
However, what is so phoney about the right hon. Lady's comparison is this. Whether we agree or not, the consultants have taken action over the terms of their contract of employment and payment for it. Essentially, this is not what NUPE or COHSE are doing. They are making a clear attempt to dictate policy to the Government. They are attempting to take over a role which is not theirs. Their action is not industrial action, but political action.
Even those who believe that pay beds should go may, nevertheless, deplore the actions we have seen in this country over the past few months. Most people in this country regard the methods which have been used in those hospitals as completely odious, and the general tactics as dangerous in a democracy. I deplore the fact that the Government's action will be seen by those groups as a victory for those tactics.
Even at this point, however, I hope that the Government will make one point very clear: that just as the compromise of allowing pay beds in National Health Service hospitals was a compromise which was decided on by Parliament. so, too, 1092 will any proposals of the present Government to abolish them also be decided by Parliament. This is a subject for legislation. It is not a subject for regulation.
The policy of abolishing the pay beds has little public support and is opposed by the overwhelming majority of medical opinion in this country. It threatens to increase the disillusion which many doctors already feel, and it throws away resources at a time when the National Health Service needs every penny it can get. It destroys a compromise that has worked well, and it brings no benefit to the National Health Service. It is a policy which we shall oppose at every stage.
§ 7.21 p.m.
§ The Secretary of State for Social Services (Mrs. Barbara Castle)
The eagerness with which the Opposition have precipitated this debate shows that they have a very great desire to bring this question to a climax. The hon. Member for Sutton Coldfield (Mr. Fowler) really does not have to read the newspapers or reports from NUPE or anyone else in order to learn the Government's intentions, because they have been stated quite clearly in two election manifestos, and they were repeated by me in the debate on the Queen's Speech last November.
The Opposition must surely be aware that this has been one of the matters discussed or due to be discussed in the Owen Working Party ever since it was set up shortly after we came into office. In fact, a departmental paper was circulated, published and discussed. Unfortunately, as the House knows, the work of that particular sub-committee on private beds got caught up in the breach with the consultants over the new contract discussions. Happily, that breach has now been healed and discussions on modifications of the new contract in time for next year's review will be starting shortly in the joint negotiating committee.
The Opposition, however, are clearly very impatient to hear a more precise statement of the Government's intentions on pay beds without any more delay, and I think that the medical profession wants this also. Therefore, I shall give the House as much precise information as it is possible for me to give at this stage before detailed consultations have begun.
1093 As I have said, the Government have never hidden their intention to separate pay beds from National Health Service hospitals. It has been part of our Socialist policy for years. I must say that I find it a very strange accusation that we insist on carrying out our own policy. What is behind our policy? Why has the Labour Party very deeply adopted this policy of separation? The reason is that the whole ethic of the National Health Service is inspired by the principle that health care should be available to all, free at the point of use, and that access to treatment should be on the basis of medical priority alone and not ability to pay. That has infused our health service from the word "go". To us that is the most precious principle of all, one of the hallmarks of a really civilised society. Any hon. Members who have been to any other countries which have not got this particular kind of centrally organised and financed health service inspired by that ethic will know that it really carries our colours as a country throughout the world and in the thinking of people in other advanced countries who are not so fortunate.
I was really rather alarmed that the spokesman for the Opposition on this matter should have revealed himself as so ignorant about the question of amenity beds. He said "Oh, the people across there still believe in privilege. Amenity beds," he said referring to Mr. Straw's letter, "are about access to medical treatment." He then went on to describe the amenity bed, reading from Mr. Straw's letter, as one in which a patient was treated in the normal way but who could be accommodated in a single room—if one were not to be automatically available on medical grounds, as it is anyway to many people—for a small payment in order to meet the desire for privacy. But of course, that has nothing whatsoever to do with the question of queue jumping.
I want to tell the House very seriously that the knowledge that patients pay a private consultation fee to a consultant in order to go to the top of the queue really embitters all sorts of people, and not least the staff in the National Health Service. We on the Government side of the House believe it is an outrage that a patient should go into a private bed in a hospital as a result of crossing a consul- 1094 tant's palm with money and then get the extra facilities there, for which the only person who gets any financial benefit is the consultant himself.
I repeat what I and my hon. Friend the Minister of State have said time and again in these debates. I believe that no Government would be able to leave that situation unchanged, because it is outwith the whole concept of fairness and equality of treatment which inspires modern society today and which is so typified by the National Health Service. I say to the House very advisedly that the whole fabric of the National Health Service would rot away if the principle of treatment on the basis of medical priority only were ever to be seriously undermined.
The hon. Member for Sutton Coldfield then got himself into a rare old tangle. I could not make out whether he was trying to say how important this private element was in the National Health Service to reward consultants properly and stop them from emigrating, or whether it was so insignificant that I ought not to bother with it. He called it a "tiny target". He is right. It is a tiny element, relatively. But that cuts both ways.
What I am faced with is the insignificance of the role of private beds in the total health care of the people of this country. Yet it has a consequence on confidence in the National Health Service among the staff and a consequence in opportunities for abuse quite out of proportion to the amount of medical care delivered to the number of people involved. The fact is that the overwhelming majority of people in this country depend exclusively for their health care on the National Health Service, and this must be our main concern.
Of the 403,500 beds in National Health Service hospitals, as the hon. Gentleman said, only 1 per cent., or 4,500, are private beds. This number has barely been affected by the industrial action of which he tried to make so much. Our estimate is that about 200 private beds have been closed by industrial action—two-thirds of them, I gather, in the Merseyside Region. Therefore, the hon. Gentleman cannot make a great thing out of that.
However, the truth is that even most of the people who subscribe to private medical insurance schemes for the peripheral advantages they bring, such as 1095 being able to jump the queue for cold surgery, when the chips are down and they are faced with a serious emergency of life or death in their lives, turn to the National Health Service, and that is the vital underpinning of everyone's health care in our society. [Interruption.] Why should they not do so? Equally, why should they have a right, on the one hand, to undermine the morale and ethic of the NHS and yet admit, by their own actions, that the NHS is the important source of health care in this country?
If private beds are vital for health care, why are they so unevenly spread'? Taking the January 1973 figures, which are the latest I have, in Scotland, out of a total of 63.000 NHS beds, there were 370 pay beds. Of these, 139 were occupied, or a quarter of 1 per cent. of NHS beds. In Wales the figures were even more revealing. Out of 25,500 beds, a mere 68 were pay beds, and only 32 of those were occupied. That is 32 out of 25,500 or 0.15 per cent. No wonder the Secretaries of State for Scotland and Wales are associated with what I shall say tonight.
In England, there is a great disparity between regions in the use of pay beds. Occupied pay beds as a percentage of all occupied beds vary from 1.5 per cent. in north-west London to 0.3 per cent. in Newcastle. The average over the whole of England is 0.7 per cent.
The real give away is in the distribution of pay beds between different kinds of hospitals. Of authorised pay beds, 80 per cent. are in acute or mainly acute hospitals. On the other hand, there is a grand total of one pay bed in the mentally handicapped sector out of 50,796. So 80 per cent. of all pay beds are in the acute hospitals which account for only 35 per cent. of all hospital beds in England.
The reason is that for all but peripheral matters like non-urgent operations the people of this country overwhelmingly rely on the National Health Service for major urgent operations, for long-stay care, such as mental handicap, and even such basic needs as maternity. They do so because they know that they cannot get better treatment outside the National Health Service.
1096 Therefore, the primary aim of health policy should be to strengthen that service, which is the life and death matter for the overwhelming majority of our people. It is against that background that I am now able to tell the House how we propose to proceed with the development of our policy and to separate pay beds from National Health Service hospitals.
§ Mr. Paul Dean (Somerset, North)
As usual, the right hon. Lady has indulged in a tirade against those who pay for health services, the doctors who provide those services, and what they take out of the National Health Service. Before she moves on, to complete the picture will she now tell the House how much the National Health Service obtains in revenue from health service patients, how much it gets for research. equipment, and other scarce facilities which would not he available were there not the links between private practice and the health service?
§ Mrs. Castle
We all know of the hon. Gentleman's concern for private insurance, but I think that I should be allowed to explain and unfold the policy before being interrupted with questions which, the hon. Gentleman will find I shall deal with as part of the statement that I am about to make.
Our policy is designed to end the unfairness of queue jumping within the NHS and to release more facilities and services, particularly of staff, for the benefit of NHS patients. To this end, and in the light of representations which have been made to me by the medical profession and others—indeed, by hon. Gentlemen here tonight—the Government have decided that the programme of phasing out should be effected by legislation as soon as parliamentary time is available. I am entering into immediate consultations with all concerned about the details of the programme.
My right hon. Friend the Secretary of State for Scotland and my right hon. and learned Friend the Secretary of State for Wales are associated with this statement. The policy which I announce today will apply to Great Britain as a whole, as I have said, although pay beds already form only a tiny proportion of hospital beds in Scotland and Wales.
1097 In the meantime, I have observed that at present, on average, only 52 per cent. of pay beds in NHS hospitals in England are occupied by paying patients at any one time compared with 81 per cent. for all NHS hospital beds and an even lower percentage in Wales. Separately from the programme of phasing out I am, therefore, proposing to reduce the authorisations of pay beds in areas where these are under-utilised as was done by my predecessor, Kenneth Robinson, in 1967; and I am, therefore, putting this in hand at once. I expect the exercise to result in a reduction in England of about 10 per cent. in the total number of authorised pay beds as a start. I shall be watching the position to see whether further reductions are necessary. There is also continuing concern about the fact that some patients are admitted to pay beds with less delay than NHS patients with similar medical conditions. I will also approach the medical profession yet again to urge it to introduce common waiting list procedures both for its paying and non-paying patients.
Britain has a justifiable reputation as an international centre for specialised medical treatment. The Government are anxious that this reputation should be sustained. Many of the overseas patients coming into Britain specially for medical treatment already go to the wholly private sector outside the National Health Service, but some, wanting specialised services involving new techniques, go to NHS hospitals, particularly to specialist academic units in our teaching hospitals. We would wish to see NHS hospitals continuing to treat overseas patients needing specialised skills provided there is no queue jumping by them, that they are admitted as NHS and not private patients and that any fees they pay go to the hospital service and not to the consultants. My right hon. Friends and I already have power to charge aliens who receive treatment as NHS patients, and we would intend to review the level of charges to take account of the new situation.
The private sector at present relies heavily on the NHS for certain facilities, including blood, radiography and laboratory testing. We are reviewing what facilities, if any, should continue to be made available to the private sector. We would, of course, ensure that realistic charges would be made for any services 1098 provided. We would not, however, propose to make any charge for blood, other than the cost of services such as cross-matching.
One reason, as we all know, why individuals sometimes "go private" is that they wish for greater privacy than they think is available in the NHS. In fact, as the hon. Member for Sutton Coldfield said, Aneurin Bevan himself established a system of amenity beds under which, for a small fee, a patient receiving non-fee-paying NHS treatment could have a single or double room for extra privacy, where this room was not required on medical grounds for him or another patient. Contrary to the confused views of the hon. Gentleman, we have every intention of maintaining this system, and, indeed, of building on it. To date, this amenity bed facility has not been well used, partly at least, because it has been given so little publicity. We intend to rectify this situation. I shall also be discussing with all the staff how we might extend the use of amenity beds. The separation of pay beds will, of course, make more single rooms available for use by NHS patients generally. The Government are committed to providing every patient with the maximum privacy possible, as will be apparent from our designs for new hospitals.
§ Mr. Peter Viggers (Gosport)
Does the right hon. Lady accept that amenity beds are not very well known about? What she is proposing to do is to abolish decent capitalist beds honestly paid for by people who wish to have a choice of private beds and to expand the use of amenity beds which are allocated by those in responsibility. These are commissars' beds.
§ Mrs. Castle
That is an unworthy comment. The hon. Gentleman calls amenity beds commissar beds. He should make it known to his constituents what many of them do not know; namely, that any patient in the NHS within the facilities available in a hospital can ask for an amenity bed, and numbers of them do. A payment of £1 to £2 a day is a modest sum if people want to pay for their privacy.
I am interested in this sudden reaction of Conservative Members against amenity beds. They do not like amenity beds because they take away the alibi that 1099 what the private patient is paying for is privacy. If there are amenity beds, privacy can be had for a modest sum without jumping a queue. It becomes startlingly revealed that the support of Conservative Members for private practice is based on the fact that the fee is paid to jump the queue, and for nothing else. That is why they do not like the idea of amenity beds.
§ Mr. Norman Fowler
What we are objecting to is not the right hon. Lady's plans on amenity beds. We are drawing attention to the total inconsistency of what she is saying. At one stage the right hon. Lady is rejecting the paying principle of pay beds but now she is extending the paying principle with amenity beds.
Will the right hon. Lady now reply to the question asked by my hon. Friend the Member for Somerset, North (Mr. Dean) and say how much this policy will cost the British taxpayer?
§ Mrs. Castle
It is clear that I should not waste the time of the House by allowing such interruptions, because the hon. Gentleman keeps interrupting me in a way which prevents me from getting to the points which he is demanding should be answered. If he cannot see the real reason why the Conservative Party has suddenly been alerted to the danger to it of amenity beds. I am sure that the rest of the House can see it perfectly well.
As I was saying, as Secretary of State I am statutorily responsible in England for the nation's health and for the Quality of the care given to all patients whether they are treated within the National Health Service or the private sector. My right hon. Friends are similarly responsible in Scotland and Wales. I already have powers under the nursing homes legislation to license private nursing homes and to make regulations as to the conduct of such homes. But these powers are limited, and their adequacy must be reviewed, given the rôle which the wholly private sector may take on once the phasing out programme is completed.
The Government have, therefore, decided to consider the extension of my existing powers of licensing. This will enable me, as Secretary of State, and my 1100 colleagues, the Secretaries of State for Scotland and Wales, to regulate more closely than is possible under our existing powers the operation, extent and development of the private sector. We may also need to guard against the possible development of undesirable commercial or advertising practices. It is right that those representing the interests of the private medical sector should be consulted at a formative stage and before the details of the licensing system are settled. I shall, therefore, be issuing invitations to consultation to those interested in the very near future.
I hope that these consultations can be conducted speedily, and I intend as soon as possible thereafter to publish details of the way in which, subject, of course, to parliamentary approval, the licensing system will operate. In the meantime, to ensure that the operation and development of the private sector proceeds in an orderly way, I should make it clear that we intend that the extension of the licensing system should cover all existing nursing homes as well as any new developments or changes of use. In the light of this I have made arrangements for officials of my Department to be available for discussions with those contemplating new developments or changes of use before the extensions to the system come into force. Within the broad framework of policy which I have today outlined we are anxious, as I have indicated, to consult fully with the medical profession and the other staff of the NHS about the most sensible way of carrying out this programme.
The Government recognise that the phasing out of pay beds from NHS hospitals will involve some loss of revenue. On the other hand, the NHS will benefit from the additional beds that will become available for NHS patients. It is difficult to put precise figures on either of these two factors. However, the Government have decided that the appropriate funds will be made available so that the revenue allocations of health authorities are not affected as a consequence of phasing out pay beds.
§ Mrs. Castle
No, I must get on. It there are any specific points which the 1101 hon. Gentleman wishes to raise in his speech the Minister of State can deal with them later.
§ Dr. Gerard Vaughan (Reading, South)
The right hon. Lady has made an important statement about licensing. Is she saying that she will limit by licensing any increase in the number of private beds available which could arise as a reaction to her changes within the National Health Service?
§ Mrs. Castle
I am saying that it is my duty to see that developments in the private sector do not operate to the detriment of the NHS. Therefore, it is necessary to review the powers which I now have and to consider their extent and scope. But I am not proposing any details tonight because it is right that all those interested should be consulted at the formative stage, and this I shall proceed to do very quickly in the context of this principle.
§ Mrs. Castle
I am sorry, but I have already taken up too much time. I do not want to take up so much time that it is not possible for others to take part in the debate, and there have been a number of interruptions.
This, then, is our plan of action to fulfil the policies in which we believe and the election pledges which we have made. It is a plan to end the queue-jumping which has caused so much bitterness and frustration and to restore the basic ethic of the NHS. It will release facilities and services, not least of staff, for the benefit of NHS patients as a whole. It will enable us to widen the provision of privacy for those who need it or desire it and help to reduce waiting lists. I believe that one of the most potent reasons for the resort to private consultations, private insurance and private fee paying is the length of those waiting lists.
As I have said, I hope that consultants will agree to introduce common waiting lists for all their patients but I am also convinced that the lists could be reduced by better management by health authorities and by the injection of comparatively small sums of money at crucial points to break bottlenecks or increase key posts. My Department has been studying this 1102 problem for some time together with the medical profession and I shall be issuing a circular of guidance to health authorities this month. I have also set aside £5 million this year out of our health expenditure total for allocation to health authorities to finance minor schemes and improvements which can reduce their waiting lists.
With this announcement of the Government's decision I hope we shall be able to make this separation of pay beds in an orderly way in the interests of all patients in our NHS hospitals.
Last July, in a statement on the dispute at. Charing Cross Hospital, I said: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 industrial disputes.…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.That has been my consistent position as Secretary of State in dealing with all industrial disputes which have arisen in the NHS—unlike hon. Members opposite, who have been only too quick to condemn action against pay beds, but whose silence to condemn the most serious and damaging industrial action against the NHS, by consultants, has been deafening. Today I have made clear, once again, that the decision on pay beds is one for this House, for Parliament, to take. I call on everyone in the service, however strong his feelings, to leave it to Parliament to legislate.
I do not expect the Conservative Party to greet that legislation with enthusiasm, although I note with pleasure that the Liberals, through their former spokesman on medical affairs, Dr. Winstanley, have come out robustly in favour of separating pay beds from the NHS. With their traditions in this field I would expect it of them. But Conservative Members are of a different ilk: they secretly believe in queue-jumping and have always blessed private insurance and, in fact. have openly encouraged it. I repeat to them what I have said many times: I am not abolishing private practice. What I am concerned with is the integrity of the NHS.
Conservative Members have always underestimated the moral power aid influence of a service in which people are 1103 treated on grounds of medical need and not of ability to pay. I would advise them and those in the medical profession who oppose our policy—to study what is happening in the United States, as I have done recently. I was struck during that visit by the alarm which is mounting there at the escalating costs of their health care under their system of private medical insurance and by the envy and curiosity they feel about our NHS. In the United States it is not only the patients who suffer; it is the medical practitioners as well.
I was interested to read in Friday's Guardian that there, too, the doctors and consultants are now threatening to go on strike—not for pay: Heaven knows their fees are big enough—but because of one of the in-built and growing hazards of the private medical insurance system which dominates health care in the United States. The report said:The first skirmish in what promises to be a nationwide showdown between physicians and surgeons and their insurance carriers started here today. The casualties are likely to be the patients. Last-minute efforts to resolve the crisis caused by staggering increases in the cost of medical malpractice insurance failed last night and many of the 4,000 doctors involved here refused to work today rather than pay the new rates. Citing losses from jury verdicts in malpractice lawsuits, the company, a financially troubled subsidiary of Teledyne Incorporated raised its rates for some doctors in Northern California by 400 per cent. to a maximum of nearly $10.000 a year for high-risk specialists.When I discussed health care in the United States, I was asked, "What do you do about the malpractice problem in your NHS?" They were staggered when I replied "It barely exists." I say advisedly that it barely exists here because people still believe in the ethic of the NHS. Health is not bought and sold here like a market commodity as it is in the United States. Patients do not sue the doctors and consultants: they write me letters of thanks and praise for the selfless care they have had under our free NHS.
This spirit is one of our most precious national assets. It is because the Opposition, with their passion for private beds, would damage it that I ask the House to reject their motion tonight.
§ 7.55 p.m.
§ Mr. Mark Carlisle (Runcorn)
The Secretary of State seemed almost to take 1104 objection to the fact that we are debating this matter. She took the view that it had been in the manifesto twice and that she had made her views clear, and therefore we were wasting our time. I believe, however, that the policy of the Labour Government in phasing out private beds from the National Health Service is a classic example of all that is craziest and all that is worst in the Socialist philosophy of this Government. It is right that Parliament should have an opportunity to express its view upon the matter.
It is now clear from the right hon. Lady's important speech, particularly what she said about the extension of her licensing powers, that the fear of many people that the attack on pay beds in the NHS hospitals was merely the thin end of the wedge in the attack against private hospital treatment in general was justified.
I said that 1 believed that the decision was both crazy and wrong. It is crazy because at this time of crisis in the NHS the effect will be to deny the service one of its existing sources of revenue. It is wrong because it is based on the Socialist philosophy that everyone should look to the State purely and wholly for his own dependence and should be actively discouraged from doing anything to provide for himself. This is done in support of what would appear to be a guiding principle of the present Government—that so long as there is anyone who cannot afford to provide anything for himself, no one should be permitted to do so lest by his own efforts, by his own exertions, indeed by his own choice as to how to spend his money, he may attain some advantage over other people. This decision is indeed economically crazy. I was not surprised that the Secretary of State, although pressed from this side, was coy about the cost of this decision. We know that the health service is short of money and that there are about 4,500 pay beds in NHS hospitals. We know that people who choose to go into such beds as a result of insuring themselves pay today anything up to £37 a day for the privilege. It cannot be disputed that the average cost of a pay bed in a National Health Service hospital under the charges which came into effect on 1st April must now be slightly more than £200 a week. It does not take a great mathematician to 1105 realise that, even accepting the general figure of 60 per cent. occupancy, as a result of the removal of these beds the NHS stands to lose at least £30 million a year.
I am not surprised that the Secretary of State was unwilling to advance a figure. That £30 million which is paid willingly today by the individual is now to be recovered from the already hard-pressed taxpayer. That is indeed absurd. It is stupid at any time, but at this time it is economic madness.
I should like to know the views of the Chancellor of the Exchequer, who is calling for a greater cutback in public expenditure while the right hon. Lady is abandoning £30 million that is now being contributed by private patients and will have to come from the taxpayers. This decision will denude the NHS of money that is now willingly provided, and instead the State will have to cope with the vast majority of patients. The decision totally ignores the fact that many people are still willingly prepared to pay more to provide for themselves than they are prepared to see compulsorily deducted from their incomes by way of taxation.
The right hon. Lady said—it was at this point that I wished to intervene—that the justification was that there was only 52 per cent. occupancy of pay beds against 85 per cent. occupancy of health service beds. I hope that the Minister of State will tell the House whether that is comparing like with like or whether the 85 per cent. figure includes geriatric and long-stay beds in the health service, because those make up about 50 per cent. of health service beds. What is the rate of occupancy in health service beds compared with pay beds in comparable hospitals?
However, it is the principle with which I am concerned. I cannot understand what is said to be wrong in principle with people being willing to provide against their own illness or their own ill health having paid their taxes and their national insurance contributions. Despite the right hon. Lady's speech, I cannot see what is objectionable in their choosing to pay more of their own money to provide for themselves. It is not, as Government spokesmen often suggest it is, anti-social; it is merely anti-Socialist, and that is why the right hon. Lady objects to it so much.
1106 If people wish to insure in this way to enable them to have the specialists of their choice and to have the advantage of the privacy of a private room, and to enable them, I accept, to extend that choice into the time of entering hospital in non-urgent cases, why on earth should they not be allowed to do so? We are, I hope, still democratic enough for people to be able to choose to spend their money as they like.
The right hon. Lady mentioned people coming from overseas to enter health service hospitals as private paying patients. If I understand her aright, she is now proposing that they should still come, provided that they do so as health service patients paid for by the British taxpayer. They cannot themselves pay for an operation.
§ Mr. Carlisle
The right hon. Lady shakes her head. That was what I understood from her speech. As, understandably, she was not prepared to give way, perhaps we shall have clarification later about those who come from overseas as private patients.
If people choose—and here I must declare an interest as I myself choose—to insure themselves against their own ill health in the way they wish, they should be actively encouraged to do so and not derided for taking that decision. The right hon. Lady's attitude as it came through in her speech is symptomatic of what is wrong with our society. Her approach is based on the philosophy that the State should provide for everyone rather than that people should be encouraged to provide for themselves.
No one questions the need for the health service or suggests that we are not proud of having a fine health service in this country. That is not the issue in this debate. No one doubts the right of every person in this country to have the best possible medical treatment when he needs it. What is in question is whether people should have the right to choose to provide additionally for themselves. By refusing that right the Government ignore a basic human attribute that motivates many people, namely, the desire to work so as to be able to provide for oneself and one's family. At a time when incomes are rapidly rising, we should be actively 1107 encouraging more people to insure themselves in this way rather than decrying the idea, which is the effect of the Government's policy.
The right hon. Lady must know that we have had two recent examples of leading members of the Government unfortunately having to go into hospital. On both occasions we have been assured with great pride and blowing of trumpets that the Ministers were going in as ordinary health service patients paid for by the State. In their case it should not be matter of pride; rather it is a matter of shame. With incomes in excess of £15,000 a year they should be able and responsible enough to provide through insurance for their own hospitalisation rather than expect the cost to be carried by taxpayers.
I question the view that everyone, whatever his position, should go into a health service bed at the expense of the taxpayer when many people are willing, having paid their taxes, to meet their own expenses. We should encourage more and more to do so. Tonight we should be discussing not phasing out pay beds, but the means by which to encourage more people to provide for themselves and so provide greater resources for the hospital services.
The right hon. Lady's announcement is wholly against the interests of the taxpayer and the medical profession. It is wholly against the interests of the patient and the health service as a whole. The service is looking for new sources of revenue, but it is to be denied the £30 million a year that now goes willingly into the hospitals. For those reasons, I very much hope that my hon. Friends will carry the motion to a Division.
§ 8.8 p.m.
§ Mr. William Hamilton (Fife, Central)
The hon. and learned Member for Run-corn (Mr. Carlisle) is liberal in many respects, but that speech was about the most reactionary that I have heard on the subject of the National Health Service in 20 years in the House. I do not know whether it is the new Toryism under the right hon. Lady the Member for Finchley (Mrs. Thatcher), or the old Toryism peeping out again. I suspect that it is the latter. Some of us still remember that the Tory Party voted against the 1108 health service in principle, and I still suspect that many Tories want to get rid of it. By extending rather than reducing the principle of pay beds, they undermine the service.
The hon. and learned Gentleman talked like a market huckster—people were only buying operations for themselves and if they could not foot the bill they could not have the operation. He suggested that people should have the right to buy better, presumably, facilities than those available under the health service.
§ Mr. Carlisle
The hon. Member and I have debated many issues on other occasions and I have always found him very fair. He knows that he has completely misquoted all that I said. I said that the best possible health service should be available to everyone, and no one should attack me on that. I said that we should also actively encourage those who were willing out of their own money to provide for themselves. That in no way contradicts my view of the importance of the health service.
§ Mr. Hamilton
My right hon. Friend has said more or less the same thing. She has not said that she is abolishing private practice. She has said that if there is to be private practice the whole lot should be outside the National Health Service. I have made the point in earlier debates that if there is one thing the Opposition have evaded debating it is the all-party report of the Expenditure Committee dealing with private practice in the health service. Virtually all the evidence shows gross abuse practised by the consultants within the health service. But the Tory Members of the all-party committee used their majority in the face of all the evidence to produce a brain-washing report saying that private practice was of benefit to the health service.
That was despite evidence of consultants stealing valuable equipment from the health service, taking it outside and using it in their private clinics in Harley Street and charging their patients as if it was their own equipment. Tory Members say "It's just a little vice". That is the special plea of the barmaid who had the bastard baby—"It's just a little one". But it deeply offends the people we represent. That is why my right hon. Friend was right to remind Conservative Members that in the first instance we fought for 1109 the health service because we regard health as being the equivalent in the civil area of defence in the military sphere. The burden ought to be shared by everyone in the community. No one ought to be able to contract out.
There is one private army in the north of Scotland. I believe that the Duke of Atholl has the only private army. It is relatively harmless. We say that the British people as a whole should pay for their defence collectively and that the same applies to health. A private army is illegal in this country. My right hon. Friend should consider making a private health service illegal. I would go further than that. I would say that there should he no right to exercise the power of the purse and to take away scarce resources. That is what is happening. Wealthy people are using such resources as a privilege.
There are some services which are collective services and ought to be paid for collectively. People ought not to be able to contract out of them any more than any one of us can contract out of the fire service, defence and many others. The initiator of the health service, Nye Bevan, made that clear. The compromise we are talking about was part of the price he had to pay to eliminate the opposition of the medical profession to the whole principle enunciated by my right hon. Friend.
§ Mrs. Jill Knight (Birmingham, Edgbaston)
Will the hon. Member bear in mind two points? The first is that these people who use private practice have already paid their full share through rates and taxes to the National Health Service. Secondly, he keeps talking about wealthy people with long purses. Will he remember that the average person paying into BUPA is getting £2,500 a year? That is not the wage of a wealthy person today.
§ Mr. Hamilton
They are buying privilege, buying a place in the queue to which they are not medically entitled.
§ Mrs. Elaine Kellett-Bowman (Lancaster)
The hon. Gentleman says that these people are using their privileged position to buy time and a place in the queue. If there were a common waiting list that argument would no longer apply. Why. in that event, would the hon. Gentleman be against these people using 1110 their money in this way if they have also paid their taxes?
§ Mr. Hamilton
If the common waiting list came there would be no need. I would guess that we should see a great reduction in the number of people who would want private treatment. Moreover, these people get tax concessions on their payments to BUPA so that they do not pay twice. I am glad to see that that is being ended in the Finance Bill. Often people's firms pay the subscriptions. It is a fringe benefit to buy privilege. If such people want a second health service financed in that way, let them have it. Let them provide their own buildings, equipment and everything else. But they should not abuse the health service and then speak about freedom of choice.
The hon. and learned Member for Runcorn said that these were the craziest and worst aspects of Socialist philosophy. It is Socialist philosophy certainly. That is what we were sent here to put into effect, and we shall do so—the quicker the better. [Interruption.] There is no prospect of Tory Members coming into power in the foreseeable future.
The hon. and learned Member went on to define what he meant in talking about these "crazy" aspects. He mentioned the loss of revenue of £30 million. Tory Members have a wonderful facility for reducing all argument to terms of cash. There are more important considerations. My right hon. Friend admitted that there might be a loss of cash. I do not know what the compensating advantage is in terms of beds released for NHS patients but there will be some. There is a feeling building up, deliberately instigated by right hon. and hon. Members opposite, that there is developing a two-tier health service—a service for those who can buy privilege and another for those who cannot and have to wait months, sometimes years, for surgery of one kind or another.
§ Mr. Crouch
Is the hon. Member aware that there are many of us on the Tory benches who are concerned that the Secretary of State's action today will cause the creation of a very much bigger private service outside the National Health Service, attracting to it not only 2½million insured people and a lot of money but also a lot of people working in the health service, thus weakening it?
§ Mr. Hamilton
I do not think that worries very many of my hon. Friends. I think that is what Tory Members want. They have always believed in that. Their speeches are based on the principle that if someone has money he should be able to buy privilege whether in the market place, the hospital or anywhere else. We on this side flatly reject that philosophy. The National Health Service would crash if it were based on that principle. We are determined that it shall not crash.
The health service is already in considerable difficulties and, if inflation continues at the present rate, it will get into worse difficulties. That makes it all the more important that people who can afford to contract out should be denied the opportunity to obtain privilege.
If we were to encourage any step that the Government might take to expedite the creation of a private health service, which is what one hon. Gentleman has said he fears will happen, the British people would revolt, because, despite its shortcomings, our health service is still the best in the world. We must find the resources for it.
I do not want to become involved in a broader debate on the economic situation. Unless and until we get the national economy right, the National Health Service and the sane principles underlying it will be undermined. I should be the last to want to see that. I do not believe that anything that my right hon. Friend is doing or has proposed today will further that undesirable aim. On the contrary, I believe that her actions will encourage many people working in the health service. I declare an interest. I am a sponsored member of the Confederation of Health Service Employees. That union and the National Union of Public Employees did not dictate this policy to the Government. The Government had this policy, anyway. Those unions approve of it. The workers in the health service want to see fair play, and the abolition of pay beds is just one step in that direction.
§ 8.22 p.m.
§ Mr. David Penhaligon (Truro)
This is the second debate on this subject that I have attended since becoming a Member of Parliament. At least this debate is specifically about the subject of pay beds. The last debate was supposedly about the 1112 National Health Service but we spoke about pay beds for the whole debate.
We have been given the precise figure of 4,500 pay beds in National Health Service hospitals. That works out at about seven pay beds per parliamentary constituency. We have also been told that there are 68 pay beds in Wales—two for each parliamentary constituency —and 139 in Scotland.
Do the Opposition really believe that the abolition of this minuscule number of beds can cause all the damage that the motion claims, namely, that it willbe against the interests of the Health Service, the patients and the medical profession"?The speeches we have heard have sought to suggest that there will be far more serious consequences than the motion suggests and that the mere removal of seven pay beds per parliamentary constituency will bring about the total collapse of the Health Service within a few days.
If the Opposition argue that seven pay beds per parliamentary constituency prop up the entire Health Service, why not have 14? With 14 pay beds per constituency, many of the things that worry me about the Health Service could be overcome at a stroke. I therefore wonder—I have argued this point many times with Conservative Members—just how much enthusiasm they have for the National Health Service.
The matter has been presented with some vigour today. The great argument is about queue jumping. This does or does not exist. "Of course it does not exist", say Conservative Members. Of course it does, as anybody who has ever been anywhere near a hospital knows. We all know that it happens, particularly for what are jokingly called non-essential operations. An operation for a hip that hurts a great deal is very much a non-essential operation, but we know that the way to get such an operation performed quickly is by paying the necessary £400 or £500.
It is said that people must be able to have privacy. I go along with the argument as to privacy. For many people the intimate discussion that takes place in some medical wards with one patient insisting on telling other patients all his problems is all too much. Some people are prepared to afford the relatively small 1113 sum involved to escape from that embarrassment. Why should they not do so? Therefore, the amenity beds are greatly appreciated.
I become frustrated by the amount of time we spend discussing this subject inside and outside the House. The real problem facing the National Health Service is not queue jumping. It is the length of the queues. Perhaps we should be spending this time today discussing the important problem of how to reduce the length of the queues.
I know that nothing like 600 Members are present, but I have calculated that this debate represents 1,800 man-hours, or nearly half an hour for every pay bed. We are giving this subject more attention than it deserves.
I ask both sides of the House to try to drop some of the dogmas. We should ask ourselves which way we want the service to go, and we should try to answer some basic questions. I have always believed in a really free National Health Service. It is noticeable that at one time or another the vast majority of Members have voted for prescription charges, which I have always regarded as a retrograde step.
I will pose some important questions. Why is the amount we spend on health as a percentage of the gross national product the lowest for any of the industrialised nations? Why is Britain dropping down the league tables of life expectancy and infant mortality?
What about geriatric accommodation? There are not many pay beds in geriatric accommodation. There is a town of about 15,000 people in my constituency where the nearest geriatric bed is 15 miles away. Those who know anything about rural transport know that 15 miles in a county like Cornwall can be a very long distance for anyone of advanced years. With accommodation that far away, it, perhaps, involves separating a couple for the first time for 10, 20, 30 or 40 years. The result is often that we mend one and that by the time that one is returned to his home the other has unfortunately fallen ill. That is a subject to which it is worth devoting the time that we are devoting to this subject.
Yesterday I read in the local newspaper of the Minister of State that one of his local hospitals has announced that it will 1114 recruit no more nurses because it does not have the money to pay them. In Plymouth, therefore, there is a waiting list with a difference: it is a waiting list of qualified nurses who wish to have a job in a hospital in the hon. Gentleman's constituency. That is a subject on which it is worth spending this amount of time.
It is most important that the House should discuss what we are to do about the effects of technology on national health. The more I look into the subject the more I realise that we are by our own skills evolving technologies which we cannot afford to give to all the people in this country. That is something that precious few people will admit in public, but we all know it to be true.
Perhaps some of the criteria that exist in the National Health Service for deciding who does have treatment and who does not should be discussed on the Floor of the House. That would be worth 1,800 parliamentary man hours, whereas this motion is not. I do not promise that we shall necessarily support the licensing regulations when they are given to us in greater detail, because we shall want some time to consider them. However, the Liberal Party will oppose the motion.
§ 8.30 p.m.
§ Mr. Peter Hardy (Rother Valley)
Labour Members note with interest the comments of the hon. Member for Truro (Mr. Penhaligon) and believe that his party is right to take a view, similar to them, that the whole question of privilege within the National Health Service should be reconsidered.
I came to listen to the debate, and I had little intention of participating until I heard a rather vicious attack from the hon. Member for Sutton Coldfield (Mr. Fowler) about the trade unions representing employees in the hospital service. I must declare an interest as a sponsored Member of the National Union of Public Employees.
The hon. Member for Sutton Coldfield has allowed the more bitter comments of the more biased newspapers to create this impression rather than reality. The Rotherham hospital branch of the National Union of Public Employees wrote to me on this issue only a week or two ago expressing not a revolutionary view but a very moderate view, believing, as hospital workers throughout Britain 1115 do, that people who purchase the right to occupy a pay bed in the National Health Service do so often because they feel it will allow them to jump the queue.
It is rather unbecoming of the Conservative Opposition not to make their position clear. Some of us believe that the Conservative Party has changed quite seriously in the past six or seven years. When one looks at the debate on the 1968 Act one sees that the Shadow spokesman for the Opposition speaking at the Opposition Dispatch Box made it clear that the Opposition at that time believed that:It is extremely important that there should be no question of private patients jumping the queue for medical need ….—[Official Report. 7th December 1967; Vol. 755, c. 1700.]In other words, there should be no question of queue-jumping. However, what we have heard today seems to suggest that that is perfectly acceptable to some, or perhaps all, of the Conservative Party.
Many of us believe that a great amount of extra resources needs to be devoted to the National Health Service. Many of us believe that the National Health Service should be improved and enhanced. One thing which will be required to attain that improvement is the confidence of the people, an overwhelming proportion of whom receive their care through the State service. If the people of this country are to have confidence in the National Health Service, it needs to be clearly demonstrated that privilege cannot be bought.
I want my hon. Friend to make very clear the position which has been expressed to me by a number of union members who are interested in this subject. The National Health Service Act 1946 made provision for the setting aside of pay beds. This legislation was quite markedly changed by the legislation in 1968. The effect of the 1968 legislation, as I see it, was to remove the designation of beds as exclusively pay beds for the use of private patients only, making it possible for the hospital authorities to use all beds in their hospitals for the National Health Service and to allocate beds as and when and where required for pay bed facilities. If that is the position, the present situation is unclear and possibly a contradiction of the law as it is at present.
1116 My hon. Friend knows a great deal more about this than I do, and I hope that when he winds up the debate he will make clear what the situation is at present with regard to the implementation of the 1968 Act.
I believe that it is essential to demonstrate that the people of this country can have confidence in the National Health Service. If they feel that in order to obtain prompt service they have to pay—whether they can afford it or not—the service is brought into question.
§ Mr. Alan Clark (Plymouth, Sutton)
Every hon. Member who has spoken today has mentioned the dreadful business of jumping the queue as if it was a most deplorable and heinous offence. It could be said that one of the things that are most wrong with this country is that everybody is meekly prepared to line up in queues. If people wish to use the resources which they have accumulated through their own thrift and providence to jump ahead of those who for various reasons such as torpor or sluggishness are prepared to wait in a queue, why on earth can they not?
§ Mr. Hardy
The difference between the hon. Gentleman and myself seems to be so fundamental that it is scarcely worth comment. However, before becoming a Member of Parliament I was a teacher in a South Yorkshire mining area. I remember speaking to a parent, not in affluent circumstances, who was prepared to sacrifice, quite excessively in my view, because the family felt it necessary for the child to have a routine operation promptly and the alternative was to wait a long time. The family did without a holiday for two or three years. Hon. Members may feel that that illustrates strength of character. I think that it illustrates a situation which should not exist, because that degree of sacrifice should not be demanded in any civilised society, and it is a civilised society that we are seeking to serve.
The figures which have been given today are illuminating. There are very few pay beds in Scotland, Wales and certain areas of the North of England. That is relevant because it is in Wales, Scotland and the North of England and other older industrial areas that the situation is becoming less tolerable. The Conservative Party, unfortunately, is becoming 1117 more and more concerned with the affluent areas of the South. It is not a British party any more. It is the party of the stockbroker belt and of the comfortable affluent suburbs, and it is the interests of those areas which it is seeking to preserve. [Interruption.] The hon. Member for Lancaster (Mrs. Kellett-Bowman) is a temporary custodian of the Lancaster constituency. By a fluke, she remains a Member, but I do not suppose it will be for much longer. One of my hon. Friends suggested that an alternative career as a football referee might be more appropriate.
§ Mr. Norman Fowler
If the hon. Member proposes to continue on this peculiar tack, may I ask him how he explains last week's results in the local elections in the North and the Midlands?
§ Mr. Hardy
It is unfortunate that the people of this country have very poor memories and cannot recall that the 1972 local government reform was carried out by the Conservative Party. Some of us will be remedying that omission in the next few weeks. Perhaps we assume too lightly that people's memories are longer than reality. But that is changing the subject, perhaps because the hon. Member for Sutton Coldfield does not want us to look at the reality of the situation.
In the North of England, Scotland and Wales the number of pay beds is declining. In the more affluent areas the numbers are high. That seems to me to present a dangerous situation, because we should be trying to reduce differences and inequalities between the regions. The present situation emphasises inequality and is intolerable. We should not emphasise regional differences. We should not try to "con" people into believing that they must pay for adequate and prompt treatment to satisfy their needs.
I hope that before we conclude this debate hon. Members opposite, on the back benches if not on the Front Bench, will make clear their attitude to the policy which my right hon. Friend the Secretary of State announced about common waiting lists. If the Conservative Party maintains the view which was expressed on its behalf in 1968—namely, that it spurned the idea of queue jumping—it is entitled to give a welcome to my right hon. Friend's pronouncement. The Opposition must come 1118 clean on this matter. I believe that my right hon. Friend's policy is right and just, and that if the Conservative Party is interested in Britain as a whole it will offer a welcome to my right hon. Friend's statement.
§ 8.40 p.m.
§ Mr. Hal Miller (Bromsgrove and Red-ditch)
I believe that we should be discussing the pursuit of excellence in the National Health Service, excellence in the care of the patients and excellence in the training of the profession. It is to my regret that we have already embarked upon a discussion overladen with ancient memories and a great deal of emotional antagonism that will serve only to cloud the argument. Only the hon. Member for Truro (Mr. Penhaligon), who is no longer in the Chamber—whenever the Liberals have made their contributions they depart—directed our attention towards the management of resources in the National Health Service. I think that on calm reflection all of us would agree that that is the real problem, and that the eradication of pay beds will not eradicate the waiting list in any shape or form.
I am afraid that a false prospectus is being offered to the people by the Government. The Government are pretending that they will bring about a radical improvement when, by the admission of the Secretary of State in the very figures she gave us, there is no possibility of that improvement coming about as a result of the action that she has announced to the House.
The right hon. Lady's statement has raised a fundamental political philosophical question—namely, whether a mixed economy is to continue in the National Health Service as allegedly it is the intention of the Government that it should continue in commercial and industrial life. The mixed economy, so to speak, has already been brought under attack in the educational sphere. We need to have that question answered clearly and without equivocation.
I press the Minister of State when he replies to elaborate a little more about the right hon. Lady's plans for the licensing of medicine in the private sector. If it is to be separated out—I must say at once that I should regret that step, because I can see it doing nothing but 1119 ill and leading only to greater divisions in society apart from the question of allocation of resources—is the private sector in medicine to be limited, restricted and controlled with the aim of buttressing the public sector? I hope that the Minister of State will be able to enlighten us a little further in advance of the consultations which are so properly and recognisably necessary for the profession. However, I think that the principle needs to be made clear before the consultations take place. It is a principle that should be made clear on the Floor of the House.
I revert to my concern with the pursuit of excellence in the National Health Service and my belief that Aneurin Bevan was entirely correct to house private and public medicine within the NHS. Labour Members have already tried to make capital out of the fact that for serious emergency operations people customarily go to NHS hospitals. That is something of which we should be proud. It indicates a recognition of the fact that the reputation of the profession is made and retained largely in the NHS.
It is only when a reputation is established that patients are referred from other sources for treatment. I am sure that the Minister of State, being himself in the profession, is well aware of how a consultant's practice is established and developed. It is by the pursuit of excellence and by performance that consultants attract private patients both from this country and more particularly from overseas.
I hope that the Minister will explain a little more clearly the remarkable assertion made by the Secretary of State for Social Services that private patients from overseas would come to this country on a common waiting list as National Health Service patients but with private amenities and paying their fees to the NHS.
My contention is that, apart from any other consideration, patients from overseas come here in the hope of treatment from the consultant whom they believe to be uniquely able to offer them a way out of their afflictions. That is why they come—for treatment by that man rather than treatment in that hospital. I shall come later to the point relating to the consultant who has built up his 1120 practice and who attracts to his hospital not only the clinical material, as f have heard it chillingly described—in other words, overseas patients with peculiar diseases—but also the staff who learn and improve their skills in the treatment of those illnesses. It is the team concept that is important. It is the attraction of other doctors from all over the world to the unit which builds on that discipline by teamwork and develops the machinery and techniques. That is what attracts people to a consultant.
In answer to a Question which I tabled in the House last week, the Secretary of State pretended to reply that it was adequate reward for such a man that his fees should be paid to the National Health Service. We know that in the Soviet system the rewards take the concrete form of villas or motor cars. In this country. Up to now, we have been accustomed to there being some tangible monetary form of reward. Are we to move to another system of reward, while not going quite as far as the suggestion of my hon. Friend the Member for Gosport (Mr. Viggers), who suggested the possibility of a commissar system? My hon. Friend was right to point out that once we depart from some form of monetary reward, we shall move towards a more nebulous, less clear and less overt reward —a reward which up to now people in this country have found entirely objectionable.
§ Mr. Neville Sandelson (Hayes and Harlington)
I am interested in the hon. Gentleman's philosophy. When he talks of rewards, does he think that those rewards should be for the benefit of, for example, the child of well-off parents compared with the child of poor parents, either in the medical sphere or, for that matter, in education? Does he think that the better-off have a natural right, simply through their possession of rewards, and that they should be enabled to have greater enterprise in passing on those rewards for the benefit of children or members of their own families to the exclusion of those who are less well off?
§ Mr. Miller
I am talking about rewards for performance. We are not discussing inherited wealth or inherited advantage.
§ Mr. Miller
We are discussing the excellence of performance and rewards for performance. That has nothing to do with what goes on in respect of children. We need to encourage initiative and excellence in the National Health Service. I have been discussing the benefits that accrue to the National Health Service from the presence in that service of consultants of standing.
I should like to cite an instance. I refer to the Midland Neuro-Surgery Centre, which is an example of the sort of co-operation which should commend itself to everybody. It was established in 1949 by the Birmingham Regional Hospital Board. It was opened in 1954. Since that date there has been the most remarkable advance in the treatment of patients. There was only one pay bed in that hospital. Private practice is carried out by the consultants' team established there, which has attracted to this country not only patients but considerable resources from the private sector for the further development of the facilities of that centre and of extensive post graduate medical education and research. None of that would have been possible without the additional resources made available from the private sector not merely to the National Health Service as a whole but to a man who had shown himself capable of excellence, who developed the technique, who built up the team and who showed himself capable of further advance. That form of co-operation should pave the way. It should not be rooted out in pursuit of some theoretical egalitarianism.
In Questions in the House I have referred to the need for the further regulation of the profession. I said earlier that reputations were made and retained in the public sector. However, I hope that the Minister will pay attention to that fact and ensure that performance is the criterion for the appointment of consultants.
We have heard a great deal about consultants paying too much attention to their private patients. There is a great deal of hypocrisy in remarks of that sort.
1122 It is equally well known, although not so frequently uttered, that there are full-time consultants on the skive, if I may so describe it, in the health service, just as much as there are private consultants who take too much time out of the health service to look after their private patients. We are not concerned with "two bit" consultants of one kind or another. We are concerned with those who are capable of making a real contribution.
I hope that the Minister will look into the question of instituting short-term consultants' appointments, so that continuing performance will be the requirement for further appointment or subsequent promotion, rather than the system of merit award. I join forces with Government supporters who have opposed that system. I hope that in his concluding remarks the Minister will assure us that that aspect is being look at. The contracts need to be dynamic, not static. They should not be regarded as a kind of parson's freehold once a person becomes a consultant at the age of 30 or whatever the age may be. We should pursue excellence, not egalitarianism. We should strive for emulation and not envy, for cohesion and not division.
The measures which were announced by the Secretary of State bring no guarantee that waiting lists will be shortened. They give no assurance that if private medicine is to be separated, which is most regrettable, it will be allowed to continue and develop.
The right hon. Lady's predecessor who started off this whole service once said that imaginative tolerance was the mark of a civilised mind. The intensity of the right hon. Lady's passions and her political commitment are well known, but I hope that she will find time to pause and reflect upon this verse from the Litany:From all blindness of heart; from pride, vain-glory, and hypocrisy; from envy, hatred and malice …Good Lord, deliver us.I hope that she will also deliver the National Health Service.
§ 8.55 p.m.
§ Mr. Bruce Grocott (Lichfield and Tamworth)
The hon. Member for Bromsgrove and Redditch (Mr. Miller) has attempted at least, albeit forlornly, to elevate the Opposition's arguments to the level of principle. He was one of the 1123 first Opposition speakers to do so. The principle which he tried to enunciate was the pursuit of excellence. One of the reasons why a debate of this kind, which affects only a relatively small part of our national life, seems to arouse such gut reactions on both sides of the House and amongst both the main political parties is that it is about a principle which separates us and is fundamental in the gap dividing us.
The hon. Member for Bromsgrove and Redditch talked about the pursuit of excellence. If I may try to put it in terms which he will probably defend, he seems to be saying that, somehow or other, inequality, whether it be inequality of income or, in this case, inequality in medical care and medical provision, is defensible because the inequality itself leads to an improvement of standards, to an expansion of provision and, in the long run, to a better medical provision and better medical care. That viewpoint runs through Tory Party philosophy at all levels of its arguments.
The view of Government supporters is almost exactly the opposite, but I shall come to that in a moment. I say simply that the view put forward by the hon. Member for Bromsgrove and Redditch, that inequality in the National Health Service or in any other area will somehow lead to better standards for everyone, is defensible only to those who believe that the cake—in this case the cake of medical care—is infinitely expandable and can go on getting bigger and bigger; therefore, that it does not matter how big one's slice is; in other words. if the cake is getting bigger the inequalities do not matter because the small slicers are getting bigger just as the large ones are.
As soon as anyone begins to appreciate that there is a limit to the size of the cake—and for all practical purposes there is a limit to the size of the National Health Service cake—the argument moves away from the inequalities and towards the importance of ensuring that whatever we have is distributed fairly and evenly. The argument of Government supporters is that the distribution must be on the basis of need, which in this case means medical need.
If the Opposition attempt to defend their viewpoint on the level of principle, 1124 though I suspect that they know they cannot if they think for a moment of the queue-jumping which goes on, and if they once accept that this inequality exists and that the cake is limited in size, logically they will be obliged to look for equality in the distribution of resources. which is all-important.
I am still searching for the principle behind the Opposition's motion. I should like some concrete answer from an Opposition Member to a simple question. Is what they are doing at the moment trying to defend the existing balance between private beds and the other beds in the National Health Service, or do they feel that the balance should be shifted one way or the other?
It seems to me an odd accident of fate if the figures that we have at the moment —3.1 per cent. of beds in acute hospitals, or 3,042 out of 98,213—give a balance that is magically just right to allow this pursuit of excellence, of which the hon. Member for Bromsgrove and Redditch and other hon. Members have spoken. It is possible that that balance may need to be altered and that far more of these beds should be provided. It really is a most fortunate coincidence if we have achieved the right balance.
However, this is not the principle on which Conservative Members are operating. They are concerned simply to hold the line as it stands and to make a last-ditch defence of pay beds.
§ Mr. Hal Miller
When the Minister replies I hope he will be able to assure the hon. Gentleman and myself that the number of pay beds is flexible and that a maximum limit is set. But if pay beds are not taken up—this is a question on which the Minister should be pressed—why is there not a greater occupancy of those pay beds by National Health Service patients? This is in addition to my point that there is an entirely false argument about the waiting list and the effect on it of the abolition of pay beds.
§ Mr. Grocott
This is an Opposition motion. It would be interesting to know the balance which the Opposition would like to see made in the health service, and whether they look on the high or the low side. What is this magic figure which will allow the pursuit of excellence, of which we have heard so much?
1125 Not only is this motion wrong in principle, for the reasons I have suggested, but it is absurd in some of its details, especially where it says:That this House believes that the abolition of private beds in National Health Service hospitals would be against the interests of the patients…I should be interested to know which patients hon. Members opposite are talking about. No doubt they will respond "Oh, all patients." It is patently not in the immediate interests of the patients in private beds. It is a strange view to hold that all patients will suffer from the removal of a few private beds.
On the contrary, the best possible guarantee that people in this country can have of the excellence of the National Health Service is that everyone in the community, whether wealthy or poor, influential or with no influence, in positions of authority or with no authority, should be subject to the same kind of medical treatment. That is the finest guarantee that can possibly exist.
As soon as we have a situation, in this society or in any other, in which the influential and the leaders can opt out of a system and acquire for themselves privileged facilities in whatever area, it is at that point that the rights of the community start to decline and standards start to decline. Philosophers have recognised, for as long as they have talked about this subject, that it is vital that the people in authority, those in Government and those who lead industry, should have exactly the same kind of provision as the rest. That is the only possible safeguard that the rest of us can have.
Let us try to see that this debate is conducted at the level of principle. I have heard of no principles that are satisfactory or that I can understand from Conservative Members yet. They have been strangely quiet and mute throughout most of the debate. However, if they have a principle that they can defend, which stands up and which is one other than simply the defence of queue jumping, in the relatively few minutes that remain for this debate I think that the House would like to hear it.
§ 9.4 p.m.
§ Mr. Paul Dean (Somerset, North)
The right hon. Lady the Secretary of 1126 State was vague in some parts of her speech, and she was contradictory in others. There were veiled threats in one part, and, above all, there was the usual criticism and abuse of the medical profession which one hears from her in very nearly every speech she makes.
Of course, there arc some black sheep in the medical profession, as in any other. Where there is queue-jumping, it is an abuse of the system that no one on the Opposition side of the House would defend. But it is quite wrong for the right hon. Lady—who has left the Chamber for the moment—to tar the whole of the medical profession with this brush. When will she learn that she cannot, and will not, win the trust of this honourable and dedicated profession by trying to visit the sins of the very few on them all? She ought to have learned this already through the discussions she has been having over the consultants' contract and other matters of that kind.
It was very significant that the right hon. Lady, in making a very long speech —it went on for over half an hour—said not one word about the effect of her proposals on the emigration of the medical profession from this country. Not a word was said about that, but, of course, we know that medicine is international and that if doctors are not satisfied with the conditions provided in Britain they can very easily take their services elsewhere.
I mentioned that the right hon. Lady was vague. She was vague in particular about the cost of her proposals. Here is a Minister who comes to the House boasting that for many years it has been the policy of her party to phase out private beds in the National Health Service, but she cannot even give the House an estimate of the amount of revenue that will be lost. When I pressed her on the matter she made some vague statement to the effect that it was difficult to get an exact indication of the cost. Here is a Minister who spends more public resources than anyone else, and one really would think that when she comes to the House with a proposal which will lose revenue to the National Health Service she would at least have some estimate of the cost.
I shall try to give that estimate for the House. My reckoning is that the loss 1127 of revenue to the National Health Service as a result of this proposal could very easily be £50 million a year; indeed, possibly more than that. One must also take into account not only the loss of revenue from paying patients but also the risk, to which I shall come shortly, of the loss of resources, research money, equipment and other things. We hear about the problems of queue-jumping. One of the reasons why we hear about these problems is the waiting lists. Those lists are likely to be longer, not shorter, if the right hon. Lady is denying herself the substantial sum of money which at present comes in from the private patients.
Then the right hon. Lady was contradictory. We now have a new doctrine on amenity beds. It is all right to pay as long as one does not pay the full cost. That appears to be the new Socialist doctrine which is involved in relation to payment in the National Health Service.
Then there are the overseas patients. It is all right that they can come here, as long as they do not pay—as long as the British taxpayer pays. These are really the most extraordinary reasons to put forward for this proposal.
Finally, I mentioned the veiled threats I am thinking particularly of the new proposal which was mentioned, but in no way developed, about a licensing system. Licensing for what? I hone that the Minister of State will be able to tell us a great deal more about what the Government have in mind. I appreciate that consultations are to take place, but surely the Government must have some indication of what they have in mind, otherwise they would not have come up with this proposal tonight. Licensing for what? For fire hazard? For hygiene? For staffing standards? The Government already have power to do that. What else can it be? I have an ugly suspicion that this is licensing for quantity, that this is a disguised way to try to squeeze out private medicine in this country, to deny people the freedom to pay for the health of their families, if they wish, and to deny doctors the freedom to practise privately. I hope that the Minister of State in reply will tell us that this suspicion is entirely unfounded. If not, this is easily the most 1128 sinister and serious statement so far made in the debate.
Against that background I should like to give some reasons why. in my judgment, the National Health Service and the private sector are complementary. I declare an interest, as I think the House knows, in health insurance and an organisation which provides not only health insurance but medical facilities.
I believe that as a result of this proposal the National Health Service will suffer and that its patients will suffer most. I say that for three main reasons. The first is the loss of revenue, to which I have referred. The second is the real risk that skilled medical manpower will find working conditions in this country so hostile that they will take their services abroad. One point about British medical education is that those who have been trained here are in great demand in other countries. Therefore, there is a real risk that the shortages that we already suffer in our hospitals will be accentuated by this measure.
The third reason relates to beds in the private sector which are at present on contract to the National Health Service. Have the Government thought about that matter? I hope that the Minister of State will be able to tell us. Beds in the private sector fulfil a vital role in the provision of health services and facilities as a whole.
The final point concerns the pioneering work which is often done by the private sector. There are numerous examples. I will mention only two.
The first concerns preventive medicine. The State is often hesitant regarding research into preventive medicine because it has to cope with an enormous load of ill health and the treatment that is required. But BUPA is an organisation in the private sector which has been pioneering health screening and medical check-ups in this country. It is now doing good work in one particular aspect of health screening of great concern to women— cancer of the breast. Not only does it have facilities at its medical centre in London, but those facilities are now available on a mobile basis throughout the country. That is one example of pioneering.
Another even more sophisticated example concerns research into and treatment for cancer. I think that it is fair 1129 to say that we are leaders in this sphere. The facilities for radio-therapy in the NHS have been developed by a combination of Government finance and private donation. The multi-disciplinary teams, which have been working and growing together, have world-wide reputations. However, that could not have been done on National Health Service funds alone. Much of the expensive equipment and research funds and, indeed, the after-treatment accommodation, has been provided by private individuals or groups.
I fear that if these links between the private sector and the National Health Service are severed there is a real risk that the private donations which go to the NHS will go to private clinics. There is a real risk that the multi-disciplinary medical teams which are now happy to work in this country will find themselves going to more attractive facilities in the United States, France and other places which have similar enterprises. There is a real risk, too, that patients who now come from abroad will also go to these other countries.
This is an occasion on which the right hon. Lady has written her own epitaph while she is still in the job. She has united the doctors for the first time ever by her unfeeling and dictatorial attitude. She has been too weak to prevent mob rule in the National Health Service. She has severed the links between the NHS and private medicine, thereby depriving the National Health Service of consultants, research projects and money. In sum, she has created two standards of service. What a monument to Socialism in the National Health Service Barbara Castle style!
§ 9.16 p.m.
§ Mr. Peter Viggers (Gosport)
First I should declare an indirect interest, although it is not connected with private medicine. My wife is a doctor working part-time as an anaesthetist in the NHS. We have no financial interest in private medicine. I think that the first and overwhelming interest of everyone here should be, and mine is, to improve the National Health Service.
The National Health Service has severe problems. Over recent years it has been moving from a doctor-controlled system which is paternalistic in tone and based essentially on personal and local relation- 1130 ships. That type of system is becoming a thing of the past, and instead we are getting a health service which has all the features of big business. It is controlled by specialist administrators and its keynote is efficiency. Within this system doctors, even specialists who are leaders in their fields, take their place as middle-grade executives. They do not like it, but it is true.
The change which I have been describing is inevitable, but it is one which has caused problems and pressures within the medical profession. The change has been accelerated by the extraordinary growth in the number of old people who need care and some degree of medical attention. Increasingly the problems of the social services are those of old people, with specialist medical and surgical care remaining critically important but forming an increasingly small proportion of the overall picture. The growth in the number of the elderly has caused a drain on financial resources and the National Health Service is under great pressure from lack of money and lack of staff.
From the point of view of the doctors there are other pressures. A large number of doctors in the NHS, and particularly in hospitals, come from abroad. Many have a limited ability to speak English and this, combined with their training in a completely different cultural environment, means that communication between doctors and patients is often defective. It is difficult to weld together an efficient team from people of widely different training and background.
The other side of the same coin is that doctors of the greatest ability are finding emigration increasingly attractive. Several of the most capable hospital doctors have said that they feel that they have no alternative but to leave this country. This argument derives partly from unattractive pay and high tax rates in this country but mainly from loss of status and responsibility which follows the downgrading of the medical profession.
That is the background, and those are the conditions, that we are talking about when we discuss the controversial issue of pay beds.
At present a consultant may be either full-time or part-time. When a position as part-time consultant becomes vacant, the calibre and range of persons who 1131 apply for the job is higher than the calibre and range of those who apply for full-time jobs. Part-time consultancy practice, with the ability to take on private patients, is attractive from a doctor's point of view, and this deserves to be taken into account, but the paramount interest is that of patients under the National Health Service.
On that I make three points. First, the pay bed system is a compromise, but it is an efficient compromise which allows the highest quality medical staff to give most of their time to the National Health Service at a comparatively small cost to that service.
To eliminate pay beds would cost, we are told, about £30 million annually, or probably more. I do not know whether we are becoming punch-drunk on figures, but last week, having been told by the Chancellor that we had a borrowing requirement of £9,100 million, we discussed the expenditure of a further £6,100 million, taking into account £3,000 million to £4,000 million on the Community Land Bill, £1,200 million on British Leyland, £900 million on the British National Oil Corporation and another £500 million or so on aviation and shipbuilding. But we should not be so punch-drunk as to forget that £30 million or more is an important amount.
The second point is that of individual choice. Surely it is right to have as wide a range as possible available to people in medicine as in other things. The effect of choice is far more important than the right of a few individuals to decide their own medical treatment. A small number of people who can make a choice has a leavening effect on the whole system and adds an edge by focusing attention on the best within the system.
My third point relates to amenity beds, which I described earlier as a commissar system. I am glad to be able to expand on that. I am sure that it is right, for instance, that Members of the Cabinet should have private rooms so that they may keep their papers confidential and work upon documents and have private discussions with their staff. Similarly, many people in positions of responsibility and confidentiality should have private accommodation. But who is to say that a Cabinet Minister deserves and needs 1132 privacy but that a less exalted individual who seeks privacy should not be able to have it in the National Health Service?
Pay beds in hospitals may be capitalist beds—I am not against capitalism—but amenity beds are commissar beds. By that I mean that when we eliminate pay beds and encourage amenity beds, what we are doing is limiting the choice of the individual and broadening the power of the people who allocate privileges. That is what I mean by a commissar system. That is why the current debate is so important and raises such important points of principle.
If this principle of abolition is set over pay beds, it will not help the NHS. I understand that meetings are being held this week with British Airways—a completely different organisation but nevertheless a nationalised one, in which the pilots have no alternative but to work for that employer. The fact that the Government are the sole employer has not prevented about 40 senior pilots, some on salaries of £14,000, from demanding salaries of about £28,000 to fly Concorde. That is an example of the Government being the sole employer but not being able to prevent individuals from demanding high wage increases.
The principle could extend further. If we reject a working compromise in medicine and pursue a doctrinaire line there, the same principle could be applied to Parliament: arguments could be amplified that MPs should be full-time servants of the State, not part-time. That argument is fallacious, just as the argument is fallacious in medicine.
The Labour Party has not always been too bigoted to accept compromise. Aneurin Bevan accepted compromise when he set un the National Health Service. On Second Reading of his National Health Service Bill he said:The same principle applies to the hospitals. Specialists in hospitals will be allowed to have fee-paying patients. I know this is criticised and I sympathise with some of the reasons for the criticism, but we are driven inevitably to this fact, that unless we permit some fee-paying patients in the public hospitals, there will be a rash of nursing homes all over the country. If people wish to pay for additional amenities, or something to which they attach value, like privacy in a single ward, we ought to aim at providing such facilities for everyone who wants them. But while we have inadequate hospital facilities, and while rebuilding is postponed it inevitably happens that some people will want to buy something more than the 1133 general health service is providing. If we do not permit fees in hospitals, we will lose many specialists from the public hospitals for they will go to nursing homes. I believe that nursing homes ought to he discouraged. They cannot provide general hospital facilities, and we want to keep our specialists attached to our hospitals and not send them into nursing homes."— [Official Report, 30th April, 1946; Vol. 422, c. 57.]With that I completely agree. Again I quote Mr. Aneurin Bevan, who told the Standing Committee on the Bill:I admit at once that specialists are being given very favourable treatment, but I believe that by this means we shall eventually obtain a far higher standard of service for the patient. Let me answer one or two points in order that I may illustrate what I mean by that.… What we are endeavouring to do, and what we must try to secure, is that the specialist is induced, as far as possible, to spend all his time at the hospital, both for his own sake and for the sake of the patients in the hospital. and—in the case of the teaching hospitals—for the sake of the students, and indeed, the whole atmosphere of the hospital…would point out to my hon. Friends that it might not only arise in this country.He was then talking about the growth of nursing homes. He concluded:There is speedy transport available now, and we might find the specialists hopping across somewhere else, and attending patients there. We should then be losing the services of those men who are, after all, invaluable in the present circumstances."—[Official Report, Standing Committee C, 21st May 1946; c. 1155.]That is the answer to any pleasure that the Secretary of State may have from curtailing or limiting private nursing homes. That is the answer to the abolition of pay beds.
The Labour Party should now be broad enough and far-sighted enough to realise that compromise is often far better than dogma. It should respect the views of the medical profession and above all pay regard to the interests of the patients by allowing pay beds to continue.
§ 9.26 p.m.
§ Dr. Gerard Vaughan (Reading, South)
We have had a wide-ranging debate and some heartfelt views have been expressed from both sides of the House. I have a deep devotion to the National Health Service. I do not think that anybody brought up within it, as I have been, could feel otherwise. Any remarks that I make are not in any way an attack on the service. It has been suggested by several hon. Members this evening that the Opposition do not want the health service to continue 1134 in its present form. They know and we know that that is deeply untrue.
One thing that the debate has demonstrated is how complex is the situation that we arc discussing and how very unwise it is for the Secretary of State—I am sorry that she is not here now; having taken her 35 minutes, she obviously has other duties that have called her away—to run the risk of disrupting the service by ending pay beds.
Sadly, the debate has followed a wholly predictable course. My hon. Friend the Member for Sutton Coldfield (Mr. Fowler) presented us with a cogent and closely reasoned statement of why the motion was before us and why pay beds should be retained. That was followed by the extraordinary and unclear statement by the right hon. Lady. It was as important for what she did not say as for what she said. I understood her to propose the abolition of private beds by legislation. Like the reluctant lover, she wants to say "Yes" but she will not say when—this year, next year, some time, but never "Never". That is not satisfactory to the House and I hope that the Minister of State will confirm that at any rate it cannot be in the current Session, because there is not the legislative time.
The right hon. Lady tied herself into knots over privilege and principle. It is apparently wrong to buy privacy by patients' private facilities and yet it is right to buy privacy and privilege by subsidised beds, which is what amenity beds are. It is all right to pay a little but it is quite wrong to pay a lot. We hear a good deal about philosophy and underlying principles, but I cannot see that if the principle is right for amenity beds it is wrong for totally private, fully fee-paying beds.
§ Mrs. Knight
Could my hon. Friend also explain how it can be right to have private beds for foreign visitors and yet not right to have pay beds for people who live in this country?
§ Dr. Vaughan
I am grateful to my hon. Friend. I shall come to that point later if there is time.
Most of all, the Secretary of State has attacked queue jumping. Why? We all know that there are no queues for acute cases. As the hon. Member for Truro (Mr. Penhaligon) said. it is not the queues 1135 but the length of the waiting list that matters. My hon. Friend the Member for Somerset, North (Mr. Dean) has pointed out that we do not accept queue jumping. It is a deplorable practice which we would not countenance in any circumstances. What is the right hon. Lady's solution? She puts forward a single waiting list. I tell the Minister of State that I do not see how it will work—[Interruption.]I am pleased to see that the Secretary of State has joined us again. Had she arrived a moment or two earlier, she would have heard me say that she has proposed the solution of a single waiting list.
As a medical person, and I have no vested interest in private beds, I cannot see how a single waiting list can be made to operate. I ask the right hon. Lady, through the Minister of State, to tell us what she proposes. Are we to go down the list and say "Yes, that person will come into an amenity bed at this stage" without regard to any convenience for that person, without taking account of people's employment? Are we to say that someone from overseas will have to wait in a queue after he has made arrangements to come in? I do not understand what the Secretary of State has in mind.
The most significant part of the right hon. Lady's speech concerned licensing. This seemed to be a direct threat to the medical profession. Licence for what? Licence on quality or quantity? If it is on quantity, it must be a licence to say "Thou shalt not practice medicine in this place, of this quality, of this standard". That seems to be a gross intrusion into the fundamental rights of democracy.
By all means let us have licensing throughout the health service. Let us licence National Health Service facilities and private facilities. Let us licence them for quality. I assure the right hon. Lady, and she knows this, that many of the worst examples of medicine are to be found not in the private sector but in the NHS sector. That could benefit from regular inspections from her Department. Licence for standards by all means, but not to set an arbitrary limit on numbers, not to bring about a refusal to allow people to set up, for example, private nursing homes where there is a need for 1136 them. I hope that the Minister of State will tell us exactly what his right hon. Friend means.
I hope that before making her extraordinary statement the right hon. Lady consulted at least the spokesmen of the medical profession. If she did, what was the reaction? Did she issue a diktat telling them only what would happen, or has she really gone in for discussions with them as an employer with her employees? That is what she was advocating last year. My hon. Friend the Member for Sutton Coldfield has explained why the pay bed issue is irrelevant because it solves none of the major problems besetting the NHS.
The Secretary of State knows that we are facing a period in the NHS when morale is at a low ebb. This is a time when 65 per cent. of kitchen and ancillary staff come from overseas, as do 67 per cent. of junior doctors. It is a time when reorganisation of the service has so far failed to reduce the muddles and uncertainties and the lack of decision which besets the service. It is a time when accidents in the service—and that means deaths in many cases—are increasing. Anybody within the health service will confirm what I am saying.
It is at a time when the most serious thing of all has happened, something which I thought could never be brought about, at a time when in the last year, under the right hon. Lady's direction, a great vocation, because that is what medical service has meant, has been turned into a job. Many doctors are now forced by the right hon. Lady's actions to look at their natural vocational interests as a term of work. As a result of recent conflict, many of them will not go back to their previous modes of working. The right hon. Lady knows this. There has been a fundamental and major change within health service attitudes within the last year.
Surely it is reasonable to ask the right hon. Lady why she is doing all this at a time when there is a massive shortage of resources within the health service and why she is trying to alter something which has worked satisfactorily over the past 25 years. It was an arrangement which the vast majority of the medical profession—whole-time as well as part-time, junior doctor as well as senior doctor—asked should continue.
1137 Why not consult the medical profession before doing this? The right hon. Lady knows, just as I know, that no proper consultations took place.
We had a very sad foretaste of today's debate in 1972 when I had the honour to sit on the Expenditure Sub-Committee under the wholly impartial chairmanship of the hon. Lady the Member for Wolverhampton, North-East (Mrs. Short). Unfortunately, the hon. Lady is not in the Chamber, but I gave her notice that I intended to raise this matter tonight.
The hon. Member for Fife, Central (Mr. Hamilton) talked a great deal about abuses by doctors within the health service. We on that committee, under the hon. Lady's enthusiastic chairmanship, with great care—with almost desperate care, I would say—searched for a justification for the view that private beds had caused harm to the health service, that they had led to resentment by more than a very small number of the staff, that there was corruption and abuse.
We were presented with a number of very vague and general accusations made by a small group of important people within the health service. When we tried to substantiate them and find actual examples we were unable to do so. In fact, at the end of that inquiry we came to the opposite conclusion, although I am sure that there are individual instances of abuse. We found that the part-time doctors put in great amounts of time over and above their contracts and that private work brought in assets to the National Health Service.
In the time available I shall find it difficult to do more than touch on these, but there are five reasons why private beds should remain within the National Health Service. I know of no country —[Interruption.]—where a wholly State system has been able to maintain a high level of medical care. I am very concerned indeed about the effects on emigration. [Interruption.] One organisation tells me that within the last six months there have been 59 resignations of consultant colleagues who are planning to leave the country. [Interruption.] Another organisation tells me that about 170 consultants and 52 senior registrars have gone abroad. [Interruption.]
§ Mr. Speaker
Order. I am trying to conduct this debate so that the Minister will be able to rise quite quickly. This sort of behaviour is delaying matters.
§ Dr. Vaughan
About 170 consultants and 52 senior registrars have gone abroad in approximately the past year. When answering a question this week the right hon. Lady said that she was very concerned and keeping a close watch on the situation. To have figures which are two years out of date on a situation as critical as this is not satisfactory, and she should urgently have them brought up to date.
There are also overseas reasons. I have a letter from one of the universities saying that there would be serious damage to the experience which people can get in their training if patients did not come to this country from overseas.
There are, of course, the aspects of income from patients as well as from relatives. There is also the waiting list reason. At present, at least 11,000 beds are empty because of the shortage of nurses. On any one day in the National Health Service, about 80,000 beds are empty. That is where the Secretary of State should be looking for the cure for the waiting list.
Many of us have found the attitude of the Secretary of State increasingly worrying in recent months. At a time when the most urgent and pressing problems are besetting the National Health Service, she either attacks the private sector, as she has done today, or chooses to remain silent. She was silent when at the Westminster Hospital a small group of non-medical people endeavoured to "stir it up" and starve out patients. She was silent when a small group of non-medical people at the Holt Radium Institute tried to dictate who should or should not have investigations for urgent treatment. She was silent at Portsmouth recently when a small group of non-medical people not only stopped volunteers from working in the National Health Service but stopped them from doing jobs which they could not take over themselves.
We know the Secretary of State to be a courageous, sensitive and humane woman, and I plead with her to recognise now the errors she is making within the National Health Service before the whole thing collapses about her feet.
§ The Minister of State, Department of Health and Social Security (Dr. David Owen)
In some ways this has been a depressing debate. From the Opposition benches we have heard nothing about the feelings of the staff in the National Health Service. We have heard one small section of the National Health Service interests constantly represented—the consultants who elect to do private practice.
It is worth remembering that many thousands of our doctors do not undertake private practice and deliberately decide not to collect fees. The debate would have been better balanced if we had heard a little about that. Many other people in the National Health Service, whether they be nurses, ancillary workers or scientific staff, also have very strong feelings about the issue of private beds.
We have not had any recognition at all from the Opposition of the problem that faces any Secretary of State. It must be recognised that the problem of private beds and private practice existing in the National Health Service is one that will affect any Secretary of State for Social Services who is looking at the whole of the National Health Service and not just a small section.
We have heard little from the Opposition about the small number of private beds in Scotland or Wales. Are they unable to have high standards of medicine? What about the great London teaching hospitals? St. Bartholomew's Hospital by statute is unable to have private practice. Are we saying that its standard of practice has deteriorated and that it is unable to attract doctors? What about the University Hospital of Wales at Cardiff? There are no permanently authorised pay beds allocated there. A better balance in the debate would certainly have helped it.
Hon. Members opposite have suddenly discovered the great patron saint of Conservative values, Mr. Aneurin Bevan. The many quotations of what the founder of the National Health Service said have been one of the most striking features of the debate. We have had a canonisation of Aneurin Bevan. In a chapter on a free health service in "In Place of Fear" in 1952 he said:Another defect in the service which was seen from the beginning is the existence of pay beds in hospitals.1140 He goes on to discuss the concept of geographical and whole-time service. Eventually he said:The number of pay beds should be reduced until in course of time they are abolished unless the abuse of them can be better controlled. The number of amenity beds should be increased.It is important that the hon. Member for Sutton Coldfield (Mr. Fowler) should understand what an amenity bed is. He seemed to think that one could understand the abolition of pay beds if it were accompanied by the abolition of amenity beds. He said that the principle was exactly the same. The principle is not the same. The first thing about amenity beds which needs to be established is that anyone who is granted such a bed does not have a pre-emptive right to it. If someone else in the hosptal becomes seriously ill and needs a single room on medical grounds, the person in the amenity bed can be, and would be, moved.
The second and perhaps most important principle after that is that the treatment which a person gets in an amenity bed is exactly the same as any NHS patient get. Unlike the private patient, such patients do not buy scarce skills. Unlike the private patient, they do not buy a place in the queue. They do not jump queues. What an amenity bed gives them is the right to privacy. People who take an amenity bed purchase privacy. [Interruption.] We now understand that the freedom which the new Tory Party will espouse is that one should not be able to purchase a modest measure of privacy.
§ Mr. Norman Fowler
What we on this side of the House are trying to preserve is the present compromise. We are pointing out to the hon. Gentleman the total inconsistency of what he is putting forward. However he seeks to argue it, some people can afford to buy privacy and amenity beds and some cannot.
§ Dr. Owen
The hon. Gentleman must recognise that if pay beds are phased out completely about 3,000 beds will be made available for the National Health Service. That is the proportion in use, because the 4,500 are not fully utilised. In reply to the hon. and learned Member for Runcorn (Mr. Carlisle), may I point out that the under-occupancy of acute beds in the private sector is still considerable 1141 —about 55 per cent.—and of equivalent beds in the National Health Service it is 76 or 78 per cent.? There is a slight difference from figures quoted earlier but not a great difference.
If the present pay beds become available—and most of them are in single rooms—some will be available for NHS patients as amenity beds, and many of them, probably the vast bulk, will be available to NHS patients without any payment. The privacy which we on this side of the House value every bit as much as the Opposition will be made much more available for everybody in the health service.
The Opposition find it very hard to understand that we want to improve the service. We want to make privacy more widely available to people. We should like people to have greater choice during the time they are in hospital, and we want to ensure that people obtain not only the best treatment available but the best service available. It is an odd way of trying to strengthen the service to put an obstacle in the way of NHS patients having privacy.
Having dealt with that matter, I come to the question of finance. The cost of pay beds is not just a revenue cost—an estimated £17 million for the last year for England and about £20 million for Great Britain. The Opposition should also put into the equation the capital costs and the capital gain. What the National Health Service will have available is the addition of new beds in some hospitals. Some hospitals will have, for example, the disadvantage of beds in separate private wings. Such beds are very costly to run, and they may well decide not to continue using them. But there will be at Charing Cross Hospital. for instance, the addition of some 40 new beds. They will suddenly be made available to the NHS representing a capital cost of anything from £1¼ million to £2 million. That example can be repeated in many new hospitals throughout the country.
I have been asked about costs, and I point out that we have said that we will meet any additional revenue cost. There will not be a charge on the health authorities. But we cannot give an exact costing of course, we have to take account of the revenue costs.
1142 The beds in new hospitals will provide additional facilities but we might decide not to continue to run beds which are now very expensive to operate. Those beds may be found in places where it is not possible to run NHS wards for lack of nurses or where we have to continue to run private pay beds because we are committed to do so. It is impossible to put a cost on these matters. The one thing that should come out of this debate loud and clear is that the cost will not be borne by the NHS authorities.
There is no Government with a better record of increasing resources for the NHS than this one. The Government have increased spending on the NHS over and above the figure that was cut by the Conservatives in 1973. That is a fact that Conservatives find difficult to understand. The Government have lifted the moratorium on all hospital buildings. On coming into office we faced the possibility that we would not be able to start any new hospital buildings. However, we have increased the resources in both capital and revenue terms. There has been a larger increase in the percentage of the gross national product devoted to the National Health Service than has ever occurred in any one year. That will be seen when the final estimates are completed for the past year.
I turn to some points of detail. I deal first with the hon. Member for Somerset, North (Mr. Dean), who raised the question of licensing. He asked whether there was an intention to stop private patients choosing to have private care. The answer is "No". We are embarking on a policy of separation. In the same speech the hon. Gentleman asked for greater contact between the NHS and the private sector. He must know that that sort of contact is a subject for discussion and consultation and that the balance is a difficult matter to decide.
It is problems of that sort that must be dealt with by licence. The one thing that my right hon. Friend is not prepared to accept is the emergence of anything which will damage the NHS. It is not easily understood in the House that our present powers of licensing are limited. It is possible, for instance, under the Medical Termination of Pregnancy Act 1967, to refuse to allow an operating theatre to be used for an abortion in the private sector in a private clinic, yet the same 1143 operating theatre can be used for a major operation, such as a gastrectomy, without our having power to intervene. There are many areas of licensing which need to be discussed.
It is in that spirit that we shall enter into discussions. We shall have the firm determination not to allow the growth of the private sector to damage the NHS.
The retention of medical staff has been raised constantly. It is interesting that in evidence to the Public Expenditure Committee which considered the whole question of private medicine the Royal College of Physicians of Edinburgh stated that the fears that consultants who were deprived of adequate private patient facilities would emigrate was exaggerated. That attitude probably stems from their experience of having little private medicine in Scotland. People leave the National Health Service and this country for reasons quite apart from the existence or otherwise of private practice. They are much more likely to be concerned with lack of facilities.
The hon. Member for Somerset, North spoke about private beds on contract. That is not an issue. There is nothing in our plans for phasing out which will affect them. They are mainly denominational: they provide long-term care which is extremely valuable.
On the question of bed utilisation, we know of hospitals with two or three private beds where it is not easy to secure a high rate of occupancy of well over 50 per cent. We propose to reduce the beds more where the occupancy figure is less than 60 per cent. We hope to make a 10 per cent. reduction overall, although we shall be prepared to hear representations from anybody in the localities concerned if people feel that this acts unfairly.
The main point of principle raised in the debate was raised by my hon. Friend the Member for Bother Valley (Mr. Hardy) and my hon. Friend the Member for Lichworth and Tamfield—I mean—[Laughter.]—Lichfield and Tamworth (Mr. Grocott). Hon Gentlemen should not laugh at these matters. Mention was made of the size of the National Health Service cake. The facts of life are that no health service in this country would be able to meet all the demands 1144 and all the requests made on it. We have, in effect, a rationed service. There can never be a health service that can meet all demands. It is in that context that we must look at how we can distribute resources fairly and evenly. This is the problem for the NHS.
Labour Members and also Liberal Members are concerned about the allocation of scarce skills. They are skills which have been well developed in the National Health Service, and reputations have been built at a high cost to the National Health Service. These medical personnel have been trained first as registrars, then as senior registrars and then as consultants. Those scarce skills should be allocated to patients who most need them, not to the patients who can most afford them. That is the issue of principle.
Conservative Members should face the fact that when they seek to purchase private practice they are purchasing scarce skills. It is the allocation of those scarce skills that matters. Conservative Members would also purchase earlier treatment. We have heard some conflicting evidence from the Opposition about the role of queue jumping. The same hon. Gentlemen who speak about queue jumping do not seem able to support us when we go to the profession and ask for a common waiting list. Will they give some idea of how they would avoid queue jumping? The hon. Member for Plymouth, Sutton (Mr. Clark) revealed the true Tory mind. He said "If people wished to jump the queue, why on earth should they not do so?" The hon. Member for Gosport (Mr. Viggers) talked of capitalist private beds and commissar controlled amenity beds.
We on the Labour benches believe that the National Health Service involves ethical principles, values of altruism, values that we believe are worth maintaining. We are determined to see that the NHS is strengthened by the separation of private practice. We believe that the law of the market place has no place in the NHS. Conservative Members who so recently have discovered Mr. Aneurin Bevan should remember what he said:A free health service is a triumphant example of the superiority of collective action and public ownership applied to a segment of society where commercial principles are seen at their worst.1145 We believe that the existence of private medicine in the NHS damages the expression of altruism displayed by all the staff who work in it. We do not want to see profit being made in NHS hospitals and laboratories. We reject the law of the market place and I ask the House to reject the motion.
That this House believes that the abolition of private beds in National Health Service hospitals would be against the interests of the Health Service, the patients and the medical profession:
§ The House divided: Ayes 246, Noes 278.1149
|Division No. 196.]||AYES||10.0 p.m.|
|Adley, Robert||Galbraith, Hon T. G. D.||Macfarlane, Neil|
|Aitken, Jonathan||Gardiner, George (Reigate)||MacGregor, John|
|Alison, Michael||Gilmour, Rt Hon Ian (Chesham)||Macmillan, Rt Hon M. (Farnham)|
|Amery, Rt Hon Julian||Gilmour, Sir John (East Fife)||McNair-Wilson, M. (Newbury)|
|Arnold, Tom||Godber, Rt Hon Joseph||McNair-Wilson, P. (New Forest)|
|Atkins, Rt Hon H. (Spelthorne)||Goodhart, Phillip||Madel, David|
|Awdry, Daniel||Goodhew, Victor||Marshall, Michael (Arundel)|
|Baker, Kenneth||Goodlad, Alastair||Mates, Michael|
|Banks, Robert||Gorst, John||Mather, Carol|
|Bell, Ronald||Gow, Ian (Eastbourne)||Maude, Angus|
|Bennett, Sir Frederic (Torbay)||Gower, Sir Raymond (Barry)||Maudling, Rt Hon Reginald|
|Bennett, Dr Reginald (Fareham)||Gray, Hamish||Mawby, Ray|
|Benyon, W.||Grieve, Percy||Mayhew, Patrick|
|Berry, Hon Anthony||Griffiths, Eldon||Meyer, Sir Anthony|
|Biffen, John||Grist, Ian||Miller, Hal (Bromsgrove)|
|Biggs-Davison, John||Grylls, Michael||Mills, Peter|
|Blaker, Peter||Hall, Sir John||Miscampbell, Norman|
|Body, Richard||Hall-Davis, A. G. F.||Mitchell, David (Basingstoke)|
|Boacawen, Hon Robert||Hamilton, Michael (Salisbury)||Monro, Hector|
|Bowden, A. (Brighton, Kemptown)||Hampson, Dr Keith||Moore, John (Croydon C)|
|Boyson, Dr Rhodes (Brent)||Hannam, John||Morgan, Geraint|
|Braine, Sir Bernard||Harrison, Col Sir Harwood (Eye)||Morgan-Giles, Rear-Admiral|
|Brittan, Leon||Harvie Anderson, Rt Hon Miss||Morris, Michael (Northampton S)|
|Brotherton, Michael||Hastings, Stephen||Morrison, Charles (Devizes)|
|Brown, Sir Edward (Bath)||Havers, Sir Michael||Morrison, Hon Peter (Chester)|
|Bryan, Sir Paul||Hawkins, Paul||Neave, Airey|
|Buchanan-Smith, Alick||Hayhoe, Barney||Nelson, Anthony|
|Buck, Antony||Heath, Rt Hon Edward||Neubert, Michael|
|Budgen, Nick||Heseltine, Michael||Newton, Tony|
|Bulmer, Esmond||Hicks, Robert||Normanton, Tom|
|Burden, F. A.||Higgins, Terence L.||Nott, John|
|Carlisle, Mark||Holland, Philip||Onslow, Cranley|
|Churchill, W. S.||Hordern, Peter||Osborn, John|
|Clark, Alan (Plymouth, Sutton)||Howe, Rt Hon Sir Geoffrey||Page, John (Harrow West)|
|Clark, William (Croydon S)||Howell, David (Guildford)||Page, Rt Hon R. Graham (Crosby)|
|Clarke, Kenneth (Rushcliffe)||Howell, Ralph (North Norfolk)||Pattie, Geoffrey|
|Clegg, Walter||Hurd, Douglas||Percival, Ian|
|Cockcroft, John||Hutchison, Michael Clark||Peyton, Rt Hon John|
|Cope, John||Irvine, Bryant Godman (Rye)||Pink, R. Bonner|
|Cormack, Patrick||Irving, Charles (Cheltenham)||Prior, Rt Hon James|
|Corrie, John||James, David||Raison, Timothy|
|Costain, A. P.||Jenkin, Rt Hon P. (Wanst'd&W'df'd)||Rathbone, Tim|
|Critchley, Julian||Jessel, Toby||Rawlinson, Rt Hon Sir Peter|
|Crouch, David||Johnson Smith, G. (E Grinstead)||Rees, Peter (Dover & Deal)|
|Crowder, F. P.||Jones, Arthur (Daventry)||Rees-Davies, W. R.|
|Davies, Rt Hon J. (Knutsford)||Jopling, Michael||Renton, Rt Hon Sir D. (Hunts)|
|Dean, Paul (N Somerset)||Joseph, Rt Hon Sir Keith||Renton, Tim (Mid-Sussex)|
|Dodsworth, Geoffrey||Kaberry, Sir Donald||Rhys Williams, Sir Brandon|
|Douglas-Hamilton, Lord James||Kellett-Bowman, Mrs Elaine||Ridley, Hon Nicholas|
|Drayson, Burnaby||Kershaw, Anthony||Ridsdale, Julian|
|du Cann, Rt Hon Edward||Kimball, Marcus||Rifkind, Malcolm|
|Durant, Tony||King, Evelyn (South Dorset)||Rippon, Rt Hon Geoffrey|
|Dykes, Hugh||King, Tom (Bridgwater)||Roberts, Michael (Cardiff NW)|
|Eden, Rt Hon Sir John||Kirk, Peter||Roberts, Wyn (Conway)|
|Edwards, Nicholas (Pembroke)||Kitson, Sir Timothy||Rodgers, Sir John (Sevenoaks)|
|Emery, Peter||Knight, Mrs Jill||Rossi, Hugh (Hornsey)|
|Eyre, Reginald||Knox, David||Ross, William (Londonderry)|
|Fairbairn, Nicholas||Lamont, Norman||Royle, Sir Anthony|
|Fairgrieve, Russell||Lane, David||Sainsbury, Tim|
|Farr, John||Langford-Holt, Sir John||St. John-Stevas, Norman|
|Fell, Anthony||Latham, Michael (Melton)||Scott, Nicholas|
|Finsberg, Geoffrey||Lawrence, Ivan||Scott-Hopkins, James|
|Fisher, Sir Nigel||Lawson, Nigel||Shaw, Giles (Pudsey)|
|Fletcher, Alex (Edinburgh N)||Le Merchant, Spencer||Shaw, Michael (Scarborough)|
|Fletcher-Cooke, Charles||Lester, Jim (Beeston)||Shelton, William (Streatham)|
|Fookes, Miss Janet||Lewis, Kenneth (Rutland)||Shepherd, Colin|
|Fowler, Norman (Sutton C'f'd)||Lloyd, Ian||Shersby, Michael|
|Fox, Marcus||Loveridge, John||Sims, Roger|
|Fraser, Rt Hon H. (Stafford & St)||McAdden, Sir Stephen||Sinclair, Sir George|
|Fry, Peter||McCrindle, Robert||Skeet, T. H. H.|
|Smith, Dudley (Warwick)||Tebbit, Norman||Warren, Kenneth|
|Speed, Keith||Temple-Morris, Peter||Weatherill, Bernard|
|Spence, John||Townsend, Cyril D.||Wells, John|
|Sproat, Iain||Trotter, Neville||Whitelaw, Rt Hon William|
|Stainton, Keith||Tugendhat, Christopher||Wiggin, Jerry|
|Stanbrook, Ivor||van Straubenzee, W. R.||Winterton, Nicholas|
|Stanley, John||Vaughan, Dr Gerard||Wood, Rt Hon Richard|
|Steen, Anthony (Wavertree)||Viggers, Peter||Young, Sir G. (Ealing, Acton)|
|Stewart, Ian (Hitchin)||Wakeham, John||Younger, Hon George|
|Stokes, John||Walker, Rt Hon P. (Worcest[...])|
|Stradling Thomas, J.||Walker-Smith, Rt Hon Sir Derek||TELLERS FOR THE AYES:|
|Tapsell, Peter||Wall, Patrick||Mr. Richard Luce and|
|Taylor, R. (Croydon NW)||Walters, Dennis||Mr. Cecil Parkinson.|
|Taylor, Teddy (Cathcart)|
|Anderson, Donald||Dunnett, Jack||Jones, Barry (East Flint)|
|Archer, Peter||Dunwoody, Mrs Gwyneth||Jones, Dan (Burnley)|
|Armstrong, Ernest||Eadie, Alex||Judd, Frank|
|Ashley, Jack||Edge, Geoff||Kaufman, Geraid|
|Ashton, Joe||Edwards, Robert (Wolv SE)||Kelley, Richard|
|Atkins, Ronald (Preston N)||Ellis, John (Brigg & Scun)||Kerr, Russell|
|Atkinson, Norman||Ellis, Tom (Wrexham)||Kilroy-Silk, Robert|
|Bagier, Gordon A. T.||English, Michael||Kinnock, Neil|
|Barnett, Guy (Greenwich)||Evans, Fred (Caerphilly)||Lambie, David|
|Barnett, Rt Hon Joel (Heywood)||Evans, Gwynfor (Carmarthen)||Lamborn, Harry|
|Bates, Alf||Evans, Ioan (Aberdare)||Lamond, James|
|Bean, R. E.||Evans, John (Newton)||Leadbitter, Ted|
|Beith, A. J.||Ewing, Harry (Stirling)||Lee, John|
|Benn, Rt Hon Anthony Wedgwood||Faulds, Andrew||Lestor, Miss Joan (Eton & Slough)|
|Bennett, Andrew (Stockport N)||Fernyhough, Rt Hon E.||Lever, Rt Hon Harold|
|Bidwell, Sydney||Fitch, Alan (Wigan)||Lewis, Arthur (Newham N)|
|Bishop, E. S.||Flannery, Martin||Lipton, Marcus|
|Blenkinsop, Arthur||Fletcher, Raymond (Ilkeston)||Litterick, Tom|
|Boardman, H.||Fletcher, Ted (Darlington)||Loyden, Eddie|
|Booth, Albert||Ford, Ben||Luard, Evan|
|Boothroyd, Miss Betty||Forrester, John||Lyon, Alexander (York)|
|Bottomley, Rt Hon Arthur||Fowler, Gerald (The Wrekin)||Lyons, Edward (Bradford W)|
|Boyden, James (Bish Auck)||Fraser, John (Lambeth, N'w'd)||Mabon, Dr J. Dickson|
|Bray, Dr Jeremy||Freeson, Reginald||McElhone, Frank|
|Broughton, Sir Alfred||Freud, Clement||MacFarquhar, Roderick|
|Brown, Hugh D. (Provan)||Garrett, John (Norwich S)||McGuire, Michael (Ince)|
|Brown, Robert C. (Newcastle W)||Garrett, W. E. (Wallsend)||Mackenzie, Gregor|
|Buchan, Norman||Gilbert, Dr. John||Mackintosh, John P.|
|Buchanan, Richard||Ginsburg, David||Maclennan, Robert|
|Butler, Mrs Joyce (Wood Green)||Golding, John||McMillan, Tom (Glasgow C)|
|Callaghan, Jim (Middleton & P)||Gould, Bryan||McNamara, Kevin|
|Campbell, Ian||Graham, Ted||Madden, Max|
|Canavan, Dennis||Grant, George (Morpeth)||Magee, Bryan|
|Cant, R. B.||Grant, John (Islington C)||Mahon, Simon|
|Carmichael, Neil||Grocott, Bruce||Marquand, David|
|Carter, Ray||Hamilton, James (Bothwell)||Marshall, Dr Edmund (Goole)|
|Cartwright, John||Hamilton, W. W. (Central Fife)||Marshall, Jim (Leicester S)|
|Castle, Rt Hon Barbara||Hardy, Peter||Mason, Rt Hon Roy|
|Clemitson, Ivor||Harper, Joseph||Maynard, Miss Joan|
|Cocks, Michael (Bristol S)||Harrison, Walter (Wakefield)||Meacher, Michael|
|Cohen, Stanley||Hart, Rt Hon Judith||Mellish, Rt Hon Robert|
|Colquhoun, Mrs Maureen||Hatton, Frank||Mendelson, John|
|Concannon, J. D.||Hayman, Mrs Helene||Millan, Bruce|
|Cook, Robin F. (Edin C)||Healey, Rt Hon Denis||Miller, Dr M. S. (E Kilbride)|
|Corbett, Robin||Heffer, Eric S.||Miller, Mrs Millie (Ilford N)|
|Craigen, J. M. (Maryhill)||Hooley, Frank||Mitchell, R. C. (Solon, Itchen)|
|Cronin, John||Horam, John||Moonman, Eric|
|Crosland, Rt Hon Anthony||Howell, Denis (B'ham, Sm H)||Morris, Alfred (Wythenshawe)|
|Cryer, Bob||Howells, Geraint (Cardigan)||Morris, Charles R. (Openshaw)|
|Cunningham, G. (Islington S)||Hoyle, Doug (Nelson)||Moyle, Roland|
|Cunningham, Dr J. (Whiteh)||Huckfield, Les||Mulley, Rt Hon Frederick|
|Davidson, Arthur||Hughes, Rt Hon C. (Anglesey)||Murray, Rt Hon Ronald King|
|Davies, Bryan (Enfield N)||Hughes, Robert (Aberdeen N)||Newens, Stanley|
|Davies, Denzil (Llanelli)||Hughes, Roy (Newport)||Noble, Mike|
|Davies, Ifor (Gower)||Hunter, Adam||Oakes, Gordon|
|Davis, Clinton (Hackney C)||Irvine, Rt Hon Sir A. (Edge Hill)||Ogden, Eric|
|Deakins, Eric||Irving, Rt Hon S. (Dartford)||O'Halloran, Michael|
|Dean, Joseph (Leeds West)||Jackson, Colin (Brighouse)||O'Malley, Rt Hon Brian|
|de Freitas, Rt Hon Sir Geoffrey||Janner, Greville||Orbach, Maurice|
|Delargy, Hugh||Jay, Rt Hon Douglas||Ovenden, John|
|Dell, Rt Hon Edmund||Jeger, Mrs Lena||Owen, Dr David|
|Dempsey, James||Jenkins, Hugh (Putney)||Padley, Walter|
|Doig, Peter||Jenkins, Rt Hon Roy (Stechford)||Palmer, Arthur|
|Dormand, J. D.||John, Brynmor||Pardoe, John|
|Douglas-Mann, Bruce||Johnson, James (Hull West)||Park, George|
|Duffy, A. E. P.||Johnson, Walter (Derby S)||Parker, John|
|Dunn, James A.||Jones, Alec (Rhondda)||Parry, Robert|
|Peart, Rt Hon Fred||Silkin, Rt Hon John (Deptford)||Torney, Tom|
|Penhaligon, David||Silkin, Rt Hon S. C. (Dulwich)||Urwin, T. W.|
|Perry, Ernest||Sillars, James||Wainwright, Edwin (Dearne V)|
|Phipps, Dr Colin||Silverman, Julius||Walden, Brian (B'ham, L'dy w'd)|
|Prescott, John||Skinner, Dennis||Walker, Harold (Doncaster)|
|Price, C. (Lewisham W)||Small, William||Walker, Terry (Kingswood)|
|Price, William (Rugby)||Smith, John (N Lanarkshire)||Ward, Michael|
|Radice, Giles||Snape, Peter||Watkins, David|
|Richardson, Miss Jo||Spearing, Nigel||Watkinson, John|
|Roberts, Albert (Normanton)||Spriggs, Leslie||Weetch, Ken|
|Roberts, Gwilym (Cannock)||Stallard, A. W.||Weitzman, David|
|Robertson, John (Paisley)||Steel, David (Roxburgh)||Wellbeloved, James|
|Roderick, Caerwyn||Stewart, Rt Hon M. (Fulham)||White, James (Pollok)|
|Rodgers, George (Chorley)||Stoddart, David||Whitehead, Phillip|
|Rodgers, William (Stockton)||Stott, Roger||Whitlock, William|
|Rooker, J. W.||Strang, Gavin||Wigley, Dafydd|
|Roper, John||Strauss, Rt Hon G R.||Willey, Rt Hon Frederick|
|Rose, Paul B.||Summerskill, Hon [...] Shirley||Williams, Alan (Swansea W)|
|Ross, Rt Hon W. (Kilmarnock)||Swain, Thomas||Williams, Rt Hon Shirley (Hertford)|
|Ryman, John||Taylor, Mrs Ann (Bolton W)||Williams, W. T. (Warrington)|
|Sandelson, Neville||Thomas, Jeffrey (Abertillery)||Wilson, Alexander (Hamilton)|
|Sedgemore, Brian||Thomas, Mike (Newcastle E)||Woodall, Alec|
|Selby, Harry||Thomas, Ron (Bristol NW)||Woof, Robert|
|Shaw, Arnold (Ilford South)||Thorne, Stan (Preston South)|
|Sheldon, Robert (Ashton-u-Lyne)||Tierney, Sydney||TELLERS FOR THE NOES:|
|Shore, Rt Hon Peter||Tomlinson, John||Miss Margaret Jackson and|
|Short, Rt Hon E. (Newcastle C)||Tomney, Frank||Mr. Laurie Pavitt.|
§ Question accordingly negatived.