HC Deb 20 October 1975 vol 898 cc35-45
The Prime Minister (Mr. Harold Wilson)

The Queen has been pleased to approve a recommendation that a Royal Commission on the National Health Service should be set up with the following terms of reference: To consider in the interests both of the patients and of those who work in the National Health Service the best use and management of the financial and manpower resources of the National Health Service. The Royal Commission will also cover the parallel services in Northern Ireland.

Its membership will be announced later.

A great deal of concern has been expressed in the House and outside it about the state of the National Health Service. Despite the real cause for concern, Members on all sides of the House will know that the vast majority of its staff continue to give without complaint the skilled and devoted professional service which the nation has come to expect and which has made our health service the object of admiration and emulation throughout the world. But the fact remains that the National Health Service, like other services in all sectors of our national life, is under severe pressure from the economic difficulties which the country faces.

In the case of the National Health Service, the situation has been accentuated by the upheaval of a major administrative reorganisation following the National Health Service Reorganisation Act, 1973, and, in Scotland, the National Health Service (Scotland) Act, 1972; by the unrest which followed from the service's employees falling behind in pay before the substantial pay increases which they received over the last 12 months; and above all, perhaps, by the pressure of rising expectations as medical science advances and new and higher standards of care and service become attainable.

The Government have responded positively to the needs of the National Health Service. Since we took office much more money has been put into it—£750 million extra in the last financial year—but pressure on the nation's resources will make it impossible to do all that is desirable over the years ahead. There is widespread and understandable concern about the future of the National Health Service in these circumstances. And it is essential that profound and careful thought is given to the question how the National Health Service—within the inevitable limits of what the taxpayer can provide—can make the best possible use of the finance and manpower available to it, in the interests of the patients and of those who care for them, in whatever capacity they serve.

The Government concluded, therefore, that it would be right to establish a Royal Commission to carry out an independent examination of how this might be achieved.

I should repeat that the Government's commitment—made clear in the two elections we fought and won in 1974—namely, the phased separation of pay-beds from National Health Service hospitals—remains unchanged and legislation will be introduced as soon as the parliamentary timetable allows. My right hon. Friends the Secretary of State for Social Services and the Secretaries of State for Scotland, Wales and Northern Ireland will therefore continue with the consultations on the proposals in the Government's consultative document.

I must also make it clear, as my right hon. Friends have already made clear, that the Government are equally committed to the maintenance of private medical practice in this country and we intend to guarantee this in the legislation we propose.

My right hon. Friend has stated that her proposals on licensing will not conflict with this and she has invited consultations on how the right to private practice can be combined with the need to prevent a drain of essential resources from the National Health Service, particularly in individual regions and locations.

While, therefore, pay-beds and the provision for them of National Health Service facilities at the expense of the service are, in our view, a matter for Parliament, there are important questions touching on the borderline between the National Health Service and private practice, and on the important and continuing contribution which we expect and want private practice to make, which the Royal Commission will of course be free, if it wishes, to consider, and on which evidence can be presented.

I hope that all those concerned with the National Health Service, and all others to whom the National Health Service means so much, will take this opportunity to present their views to the Royal Commission and I am confident that the work of the Commission will prove to be a landmark in ensuring that the National Health Service is maintained and strengthened.

Mrs. Thatcher

Is the Prime Minister aware that we recognise, with him, that the National Health Service has been able to continue to serve the patients only because of the devoted service, which is being sorely tested at present, of all its staff, and the fact that he has made this statement today does not in any way lessen the need to find immediate solutions to the very pressing problems in the National Health Service about which we read daily?

We welcome the setting up of an independent inquiry, but will it really be independent and will it command the co-operation and respect of the medical profession if, in spite of the announcement that there is to be a Royal Commission, the Government go ahead and restrict pay-beds to private practice? We are well aware that, according to one Minister, the Government are not likely to be impressed by demands from people in the medical profession who are never likely to vote for the Labour Party, but whether or not they are impressed, the Government will need both the confidence and the respect of the medical profession in the interests of the patient. I see nothing in the terms of reference of the Royal Commission which will prevent it from considering the question of pay-beds in the National Health Service. Therefore, will the Government legislate on a question which the Royal Commission will be considering?

Can the Prime Minister give us some idea of the timing of the Royal Commission and how long he expects it to take? According to one of his previous comments, the announcement of a Royal Commission takes minutes and wastes years. How long does the right hon. Gentleman think it will be before the Royal Commission reports, and will he direct it to make an interim report?

Will the Prime Minister say whether there is any precedent, for announcing both a Royal Commission and its terms of reference by Press notice from Downing Street, not in this House?

The Prime Minister

I thank the right hon. Lady for her welcome of the announcement, despite the questions which she perfectly fairly put about it.

To deal with the last question first, I regret that it was not possible to make the announcement in Parliament. My right hon. Friend the Leader of the House said that an inquiry would be announced, but I think that the right hon. Lady is referring to the precedents for a Royal Commission. My right hon. Friend the Secretary of State for Social Services did not conclude her meeting with the doctors until well after Question Time on Thursday, and I regret that I had to be out of London on Friday or I would have announced it to the House then. There are precedents. I am sure that the right hon. Lady is aware of them—[Interruption.] I shall do my best to continue my researches and enlighten her as to the results.

I think that the Royal Commission will command confidence, because I am sure that the medical profession, in particular, but others as well who have been asking for a full inquiry, will want to take the fullest advantage of the fact that one has been set up. When I met all the leading representatives of the National Health Service more than a year ago, they asked for an inquiry. They may think that it has been unduly delayed, but I think that they will welcome it and will co-operate fully.

On the question of pay-beds, I am sure that the right hon. Lady will agree that it is important to separate two issues. One is the separation of pay-beds from the National Health Service. She will be aware of anxieties about the continuance of this practice, which we believe is a matter for Parliament anyway—indeed, we have made this clear and it has been debated in the House. But as long as pay-beds are incorporated in the National Health Service many other people in the National Health Service are having to provide their services at national expense to make this possible. I do not want to press that point too far.

However, I distinguish very sharply, as I am sure the right hon. Lady does, between that issue and the issue of private practice. I have made it clear in my statement that the Government are committed to the continuation of private practice. We expect to see it continue, and we want to see it continue, and we shall guarantee it in our legislation. There are questions touching on the borderline between the health service and private practice and on the contribution which we expect and want private practice to make which the Royal Commission will be able to consider and on which it will be able to take evidence and report.

Mr. Thorpe

Is the Prime Minister aware that the setting up of the Royal Commission will be welcomed? Does he agree that the two controversial issues of pay-beds and agency nurses have a direct relationship to the manpower and financial resources of the National Health Service? Therefore, whatever view is taken, is it not somewhat illogical to exclude them from the remit of the Royal Commission? They are far more than borderline considerations. They are extremely relevant.

Therefore, will the Prime Minister reconsider the possibility of including those issues in the terms of reference and asking for an interim report, say, in six months, on them and the issue of junior nurses, thereby obtaining the widest degree of consultation and avoiding a possible confrontation which to many of us would be as unnecessary and divisive as the confrontation which happened under the Conservative administration in February 1974?

The Prime Minister

No, Sir. We made clear many times in two general elections our position on the separation of pay-beds and the facilities provided by the National Health Service from the National Health Service. That is one question. The question of private practice can be very fully examined in this matter, and it is not for me to prejudge what evidence will be given, or, indeed, what the Royal Commission will say on these questions. I think it right that, fully within the terms of the reference, it will be able to consider the second of those matters.

Mr. Wrigglesworth

Is my right hon. Friend aware of the considerable degree of support given to the Government's policy of devoting more than ever of our national resources to the health service and to phasing out private practice from the National Health Service? Is he further aware that many of us on the Government side deeply deplore the hysterical statements made by some sections of the medical profession over recent weeks, which have done great damage to the National Health Service, and will he therefore give us an undertaking that the Government will pursue the policy of phasing out the private beds from the National Health Service by introducing legislation in the next Session of Parliament?

The Prime Minister

I have already answered the last part of the question, except that, so far as the next Session is concerned, I obviously cannot anticipate the Gracious Speech opening Parliament as to the exact timing.

Concerning the other points made by my hon. Friend, the real resources devoted to the health service have increased by 5.8 per cent. over the past two years, and the proportion of GNP now spent on the service, 5.4 per cent., is the highest ever in the history of the health service.

My hon. Friend asked me to deplore statements that have been made. I will not do that, because I recognise the great strength of feeling, particularly concerning the problems of the junior doctors. My right hon. Friend has made every possible effort to find solutions and has made proposals to them, as is recognised by their own statements. They have to choose now between three possible options. I am sure that the whole House, including right hon. and hon. Members opposite, would not feel it right, even in the extreme case of the junior doctors problems at this time, for us to depart from what has been laid down as national policy on counter-inflation, approved by this House by such a large majority.

Mr. Baker

If the Royal Commission examines, as it must, the drain of medical talent from Britain, and comes to the conclusion, as it will, that this drain is inexplicably involved with the whole question of the boundary between the public sector and the private sector of medicine, and if, indeed, as the Prime Minister has indicated, the Royal Commission can look into this matter, is it not more sensible for the Royal Commission to report and for the House itself to have considered these views before legislation is proceeded with?

The Prime Minister

While the question of the membership of the Commission is still to be decided—indeed, I hope to meet the representatives of the profession and have invited them to meet me concerning the whole work of the Commission—I had not up to this point thought that the hon. Member was likely to be the chairman of the Commission. Therefore I do not know by what authority he tells the House what the Commission will report. I do not agree that anyone has the right to say that, except the Commission itself, and I am sure that the Commission will want to consider all the evidence before forming any conclusions on this matter.

Mr. Henderson

Will the Prime Minister confirm that one of the factors which the Commission will be able to take into account is the appalling increase in bureaucracy since the reorganisation of the health service? Will he also accept that, since the health service is organised quite separately and differently in Scotland, there should be a separate part of the Commission's report concerning the recommendations for Scotland?

The Prime Minister

I have already referred to the part to be played by my right hon. Friends the Secretary of State for Scotland, the Secretary of State for Wales and the Secretary of State for Northern Ireland. It will be for the Commission to report on these matters.

In my opening statement I made it clear that the National Health Service has gone through a very unsettling phase. The hon. Member referred to the bureaucracy as a result of these technocratic provisions in the legislation of 1973, which has caused great unsettlement and—some people think—very great addition to the cost of the services. Whether that is true is a matter for the Royal Commission to say, but certainly the whole organisation of the Commission's work, so far as the Government are concerned, and the establishment of it, will enable it to take full account of the differences between the legislation in Scotland and that south of the border, and to take full account of differences in the practice of the National Health Service in different parts of Britain.

Dr. M. S. Miller

Will my right hon. Friend accept that we on the Government side of the House, while welcoming the setting up of the Royal Commission, utterly refute the panicky and stupid allegations as to the imminent collapse of the National Health Service? Will he also accept that we on the Government side of the House have nothing at all to fear in regard to what may come out in the Royal Commission's recommendations, because, unlike hon. Gentlemen opposite, some of us have some experience of what the Royal Commission will be setting out to do in this instance?

Will my right hon. Friend further accept that what we are hoping for and think will come from the Royal Commission is a statement continuing commitment to what the Labour Government implemented in 1948, that is, the cardinal principle that medical treatment and medical services should be available to people regardless of their ability to pay?

The Prime Minister

Yes. I should like to thank my hon. and—if I may use the word—medical Friend for what he has just said. Certainly I agree with him in saying that the National Health Service is not on the verge of collapse. There are a number of matters giving a great deal of concern—I have mentioned the junior doctors—in the health service, and there are other matters as well which I tried to deal with in answer to earlier questions.

As to what the Commission will report on—my hon. Friend touched on this in his question—that is not, of course, a matter for me or for the House, though I am quite sure that the Royal Commission, will, in addition to the evidence it takes, pay full attention to the views expressed about the National Health Service in the debate which is due to take place on Monday, which I think has been chosen by the Opposition. I am sure that the Royal Commission will pay full attention to what is said in all parts of the House on that question.

Mr. Paul Dean

In welcoming the setting up of the Royal Commission, may I ask the Prime Minister whether he recognises that there are very genuine fears about clinical freedom for doctors and the choice for patients, and that these matters concern the National Health Service just as much as they concern private practice? Does he recognise that, if these decisions are either pre-empted by the Government or vetoed by the Government, the Royal Commission is at risk of getting off on the wrong foot?

The Prime Minister

I thank the hon. Member for the opening words of his question. He expressed anxieties not merely as between the Health Service and patients in private practice but also, I thought he said, within the National Health Service. This is a matter which the Royal Commission will very much have to consider. As between private practice and the health service, this question is again one on which evidence can be given, and the Commission will be perfectly free to report.

Several Hon. Members

rose—

Mr. Speaker

Order. As the Prime Minister stated, there is to be a debate on the subject next Monday. I intend to allow two more questions.

Mrs. Colquhoun

Will the Prime Minister accept the overwhelming support of every Member on the Government side for our right hon. Friend the Secretary of State for Social Services and the manner in which she is tackling this very important job? Will he further accept that some of us think that there is something quite anti-woman and deplorable in the attitude of the medical profession towards the Secretary of State for Social Services? Finally, will he ensure that when the Royal Commission is set up, instead of its being a Commission of experts, there will be at least a high proportion of sensible women who use the National Health Service?

The Prime Minister

I thank my hon. Friend. I do not think there is any prejudice in this matter, and I certainly do not accept that anyone in the National Health Service, in whatever capacity, can be guilty of the accusation of being a male chauvinist pig. Indeed, my right hon. Friend has been criticised considerably by the junior doctors' national officer who happens, I think, to be a lady doctor. But it is a fact that from time to time great anxiety is expressed. We see this reflected in the media and all the rest of it.

I want to make clear, in answer to my hon. Friend—[Interruption.] Well, it is always more interesting when it is a woman—that despite these attacks, my right hon. Friend has my full support and that of the whole Government, as well as, I am sure, the majority of the people in this country.

Dr. Vaughan

Listening to at least some of the Prime Minister's remarks, I could not help wondering whether he has really appreciated the very low level to which morale in the health service has sunk within the last 18 months. He pay-bed issue—

Mr. Speaker

Order. The hon. Member must put his remarks in an interrogative form.

Dr. Vaughan

Is the right hon. Gentleman aware that the pay-bed issue is directly relevant to professional freedom and to the care of patients? Why should not legislation wait until the Commission has reported? Should not the Prime Minister instruct the Secretary of State to hold up all controversial measures until the Commission has reported?

The Prime Minister

The hon. Member has reason to know that I will never make any attack on him because I remember, when my former PPS was ill, the dedication with which the hon. Gentleman gave service to him when he came to my room. So he will understand that anything I say is not personal.

No, Sir, I do not agree with what the hon. Gentleman has said. [Interruption.] I wonder whether there is anything which hon. Members opposite do not titter at. I feel that the tribute to the hon. Gentleman was deserved and was right. But on the pay-bed issue he will recognise that the problem here is the question not so much of the private practice involved but the deployment of National Health Service resources paid for by the taxpayers in terms of other staff, nurses and many others. That is why—I hope with some understanding in the House—I have tried to separate the pay-bed issue from the wider issue of private practice, the continuance of which, as I have said, the Government are committed to support, and intend to guarantee in legislation.