HC Deb 19 November 1976 vol 919 cc1738-51

Lords amendment: No. 8, in page 3, line 38, leave out "progressive" and insert "grant or"

12.45 p.m.

Mr. Moyle

I beg to move, That this House doth disagree with the Lords in the said amendment.

Mr. Deputy Speaker

With this we are to take Lords Amendments Nos. 9 to 12 and 15 to 20.

Mr. Moyle

I do not think that this matter need detain the House for long, not because it is a matter of no importance—it is of fundamental importance—but because I think that it shows a clear division of principle between the two sides of the House which can be readily and easily described.

It is the Government's policy to phase pay beds out of the National Health Service. It is the object of the Goodman proposals to do that. The Bill is the vehicle for achieving the phasing out of pay beds from the service, and the Health Board is the instrument for doing it.

The amendment seeks to conceive that the Board will say in its deliberations "we must withdraw some pay beds here, but perhaps there is a need for pay beds somewhere else, so we shall put some in there". That is not the job of the Board. Its job is to phase out pay beds from the service. It is clear in the objects of the Bill.

There may be one or two marginal cases. I refer in passing to Clause 5, whereby if there is a temporary cessation of the use of pay beds the Board may recommend alternative provision, and perhaps where some form of emergency reduces the number of pay beds in certain areas, again the Board may recommend some alternative provision in the aftermath of damage by fire, storm or something of that sort. However, apart from those two small exceptions, the object of the Bill is to phase out pay beds and it is the duty of the Health Board to do that. Therefore, I ask the House to reject the amendment.

Dr. Gerard Vaughan (Reading, South)

The amendment is based on an amendment in Committee the vote on which was tied and which was never debated on Report in this House because it was guillotined. We feel very strongly that if the Government genuinely care about the care of patients and the quality of care, they should accept the amendment.

I am surprised that the Minister should say that it is only a matter of principle. It is much more than that. We feel that it is necessary that the Board should be free to give beds as well as to take them away, to be able if necessary to authorise new private beds within the NHS in areas in which they are needed, as well as to close them down. This is a very important and necessary aspect of flexibility for the Board to have.

We are concerned for three particular reasons. First, the Registrar-General's reports show that there are very great changes in the size of population in different areas, and it is very difficult now to forecast where all these changes will take place. Secondly, as the Minister knows from our discussions in Committee, we are very concerned about the new towns. We spent much time discussing Peterborough, for example, where there is an excellent modern hospital. However, that hospital is not big enough and does not have the facilities to cater for the extra people moving into that area.

We find it extraordinary that people are encouraged by the Government to move into a new area when we know that there is inadequate hospital provision for their health care, and that not only will there be no new provision for private facilties but there is no adequate NHS provision. This is a very serious situation.

Mr. Moyle

Will not the hon. Gentleman agree, therefore, that the priority should be to provide the facilities through the National Health Service before any question of pay beds arises?

Dr. Vaughan

No, I would not. If we look at the wording of the Goodman proposals, we find that the Government have accepted a responsibility to cover health more generally and to see that people who wish to have private facilities are still able to have them, certainly during the phasing-out period.

Thirdly, we are particularly concerned for the elderly and the mentally ill. We all know that the number of elderly patients will rise rapidly in the next few years. There will be inadequate provision for them. We are concerned, for example, for the people who wish to arrange for long-term private care for an elderly or a mentally sick person.

It is on these grounds that we oppose the Government and ask the House to accept the amendment.

Question put:—

The House divided: Ayes 278, Noes 253.

[For Division List No. 425 see c. 1819]

Question accordingly agreed to.

Lords amendments Nos. 9 to 12 disagreed to,

Lords amendment: No. 13, in page 4, line 21, leave out "and".

1.0 p.m.

Mr. Ennals

I beg to move, That this House doth disagree with the Lords in the said amendment.

Mr. Deputy Speaker

It will be convenient to consider at the same time Lords Amendment No. 14.

Mr. Ennals

The effect of Lords Amendment No. 14 would be to require the Board to give reasons for its proposals for phasing out. The Government consider that that is quite unnecessary. The Board has to have regard to the four criteria set out in subsection (8) before making recommendations to the Secretary of State. It must also consider representations from those concerned with or interested in any proposals which it may make. The Board having discharged its obligations as an independent board, in the Government's view, there is no need for it to give reasons for its recommendations.

The task of the Board is to phase out pay beds. It might make more sense if the amendment required the Board to give reasons for not phasing out pay beds. In any case, the Board is, in effect, answerable to Parliament because its annual report will be presented to Parliament by the Secretary of State. It is my responsibility to lay the report before Parliament.

Lord James Douglas-Hamilton (Edinburgh, West)

It seems only fair that the Board should give its reasons, in the same way as virtually any Government Deartment or Minister gives reasons for decisions. It is laid down in the clause that the Board will consider representations from medical practitioners, dental practitioners or persons employed in one or other of the national health services or concerned with the interests of patients at NHS hospitals. Obviously, the Board would have to weigh the representations and make a decision accordingly. It seems only appropriate that, having made a decision, it should give its reasons.

I am grateful to the Secretary of State for having accepted at an earlier stage that exactly the same criteria should apply to the Scottish and Welsh Committees and that they also should have to take full account of representations made to them.

It seems only appropriate that the Board should act reasonably, just as reporters do at planning inquiries or as the Ombudsman or Government Departments do, and give reasons. I do not regard this as a matter of such pressing importance as to encourage my right hon. and hon. Friends to press it to a vote, but we wish to record our disagreement with the Government and express our view that the giving of reasons could do nothing but good.

Question put and agreed to.

Lords Amendments Nos. 14 to 20 disagreed to.

Lords amendment: No. 21, in page 6, line 8, after "facilities" insert "at a satisfactory standard".

Mr. Ennals

I beg to move. That this House doth disagree with the Lords in the said amendment.

Mr. Deputy Speaker

I suggest that it will be convenient to consider at the same time Lords Amendments Nos. 22 and 23.

Mr. Ennals

The effect of the Lords amendment would be to require the Board to take into account the standard of alternative facilities in the private sector when considering proposals for the progressive revocation of authorisations of pay beds and other facilities for private practice. We discussed this issue for a long time in the Standing Committee.

In phasing out pay beds and facilities, the Board could have regard to the Government's intention to allow occasional admissions of patients privately to specialised NHS facilities if the particular services could not reasonably be provided in the private sector. Thus, the private sector will not be required to duplicate.

possibly in an unsatisfactory way, every sophisticated feature of the NHS.

The Secretary of State—in relation to the 1,000 beds—and the Board are obliged to look at the provision which is reasonably available in the private sector. This will inevitably involve a comparison with what is available in the private sector. In any case, the private sector is subject to control by registration under the Nursing Homes Act 1975. In the Government's view, it is unnecessary and unwise to make the proposed change.

Mr. Hal Miller (Bromsgrove and Redditch)

The Secretary of State gabbled through his departmental brief and failed entirely to deal with the nub of the matter which this group of amendments rightly raises, which goes to the heart of the Goodman proposals, as was admitted by the previous Minister of State in Standing Committee. What we are seeking to do here—as Baroness Young did in the other place—is to establish a basis of trust among patients, among the professions and among all who work in the Health Service as to how standards are to be maintained.

One vital element in that essential confidence is the Goodman proposals, which have been characterised in some neo-Marxist terminology as the proposals of 15th December but which are the Goodman proposals. The Goodman proposals make clear that the Government are 'committed to the maintenance of private medical practice in this country' and ' intend to guarantee this in the legislation '". We are seeking to establish by the amendments the extent to which that commitment is being honoured by the Government.

The Goodman proposals went on to say: The criterion for phasing out"— that is what we are discussing in Clause 4— shall be the reasonable availability of reasonable alternative facilities … within a reasonable geographical distance and to which reasonable access is available to those patients and practitioners desiring to avail themselves of it". There is no point in pretending that there is an alternative if it is not accessible and is not within a reasonable geographical distance". These amendments deal with the standard at which the alternative facilities are available and the question of accessibility, together with the matter of cost, which is another important criterion of reasonable availability.

In Committee the Minister said that the Goodman proposals were subject to the interpretation of complex criteria. That is the point with which we are dealing today. How are the Government interpreting those criteria? Unless that is clearly established, there can be no basis of confidence and trust.

It is disappointing that in Committee the previous Minister of State appeared to go a little further than the Secretary of State has been able to go today when discussing the point about the matching of private facilities with the withdrawal of National Health Service facilities. His remarks on that subject are reported in column 602 of the Official Report of the Standing Committee proceedings on 29th June.

We understood that there would be consultation with the professions on improvements, for example, in the standards of private sector provision. I am sure that the Secretary of State would not wish to take the position of not caring about the standards of provision available in the private sector. I accept that the Government see no responsibility for maintaining the private sector, but I am sure that the right hon. Gentleman would wish to address himself to the question of standards in the private sector. His rejection of the amendment would seem to suggest that he is not exercising that responsibility.

Mr. Ennals

The hon. Gentleman will know that the private sector is subject to control under the Nursing Homes Act 1975. To require the Health Services Board to fulfil that function would be a duplication. It would put on it a burden much greater than would be tolerable.

Mr. Miller

In Committee the former Minister of State appeared not to accept that the control exercised under the Nursing Homes Act 1975 was adequate. He went on to say that the Government had made clear that they were prepared to consider what improvements might be made. We are trying to pin down the Secretary of State to saying how far the consultations have progressed and what improvements are considered to be necessary. The right hon. Gentleman has made no attempt to reply to that.

1.15 p.m.

Mr. Ennals

The point I tried to make was that this is not and should not be the responsibility of the Board.

Mr. Miller

It is apparent that the Secretary of State is not willing to address himself to the question of the standard that should be available. That is all the more surprising because Clause 8(2) deals with the power of the Secretary of State to refuse private patients admission to NHS hospitals unless satisfied that the accommodation or services … required are not privately available, or, if they are available, are not privately available there at a place which is reasonably accessible or available at a satisfactory standard". Therefore, even the Government's own Bill lays down two of the criteria which the amendments seek to establish. We cannot understand why the Government are reneging on their clear responsibilities. What is the meaning of "reasonable availability" if it does not cover those elements?

I wish to deal with some of the earlier remarks of the Secretary of State. His sham indignation about the action of the House of Lords in seeking to establish the criteria on which the Bill and the Goodman proposals were framed and his remarks about the will of the people do not accord with the opinion poll commissioned in the summer, which was discussed in Committee and which showed clearly that most Labour voters and trade unionists were opposed to everything that the Government were trying to do by the Bill. Happily, that was confirmed by the recent by-election results at Workington and Walsall. So let us have no more of the right hon. Gentleman's sham indignation and no more remarks by the hon. Member for Bolsover (Mr. Skinner) about fighting a phoney war. The Government are about to realise that it is for real.

Mr. Patrick Jenkin

I wish to express my grave disappointment that the Sec- retary of State has not been able to accept these amendments. As he knows, Lord Goodman commended amendments in this sense when he spoke on Second Reading in another place. Indeed, he went further. He said that he had discussed them with the Secretary of State and had gained the impression from the right hon. Gentleman's reaction that he would have liked to have accepted the amendments.

Lord Goodman spelled out—and it would be out of order to quote what he said—why it would cost the Government nothing to give this small extra assurance to the medical profession that the Health Services Board would have to have regard to the standard of the alternative accommodation and that it should be reasonably accessible to the practitioner as well as to the patient.

Somebody has got at the Secretary of State and has persuaded him that this would be a concession which perhaps his hon. Friends below the Gangway would not accept. They would be unwise to bring any such pressure on the Secretary of State, and I hope that even now the right hon. Gentleman will indicate that if this amendment returns to another place he will be prepared to consider it and accept it before it comes back to this House. This is an eminently sensible amendment which Lord Goodman suggested would cost the Government nothing and its acceptance would be immensely reassuring to the profession.

Mr. Ennals

I make it clear that at no stage and in no context did I suggest that I was prepared to accept this amendment. Nor have I been under pressure from any of my hon. Friends.

Question put:—

The House proceeded to a Division—

Mr. Deputy Speaker

I should let the House know that I have had a report that the Bells were not ringing at the time the Division was called. They have now started to ring, and the Division will be timed from now.

The House having divided: Ayes: 279, Noes 247.

[For Division List No. 426 see c. 1823]

Question accordingly agreed to.

Lords Amendments 22 and 23 disagreed to.

Mr. F. P. Crowder (Ruislip-North-wood)

On a point of order, Mr. Deputy Speaker. For the purpose of the record, there are no Labour Members present, apart from the Parliamentary Private Secretary, the Minister and his assistant—

Mr. Deputy Speaker

Order. The hon. and learned Gentleman is well aware that that is not a matter for the Chair.

Lords amendment: No. 24, in page 6, line 13, leave out paragraph (c).

1.30 p.m.

Mr. Ennals

I beg to move, That this House does disagree with the Lords in the said amendment.

Mr. Deputy Speaker

With this we may take Lords Amendments Nos. 25, 26 and 27.

Mr. Ennals

It is nice to have the hon. and learned Member for Ruislip-North-wood (Mr. Crowder) with us. Presumably he felt that he ought to come back because we had a substantially increased majority on the last vote. We improve steadily as we go along.

The principal purpose of this group of amendments is not in the initial amendment, which would remove the third of the four principles. The main amendment is No. 26, which would add an additional principle for the Board to consider in making its proposals, namely, that revocation would be permissible only if those trying to provide alternative facilities have not met unreasonable obstruction from planning authorities or others.

The proposed additional principle would require the Board to form a view whether local planning authorities were exercising their planning powers reasonably and where it considered they were not doing so to withhold proposals for revoking pay bed authorisation.

This would be most inappropriate in legislation. In any case, it is unnecessary because there is a right of appeal against planning permission to the Secretary of State for the Environment and, in certain circumstances, to the court. It would be inappropriate for the Board to involve itself in these matters.

For these reasons, I certainly oppose that amendment as well as the others in the group.

Mr. Boscawen

The purpose of the four amendments, which we support, is to ensure that the private sector gets a fair chance to set up alternative accommodation. Although subsection (8)(c) was lifted straight out of the Goodman compromise proposals almost unamended, we feel that it could be taken in any way one liked to read it. It could well be taken to indicate that the Board need pay no attention to what efforts are being made to provide reasonable accommodation outside. It could be read in exactly the opposite way to that which is intended. It is badly drafted. That is why both in Committee and in the other place we felt that the Bill would be better if that subsection were taken out.

It will be extremely hard in some areas of private facilities to replace pay beds. It may take a long time to do so, particularly in the present financial crisis. We do not want the Board in any way to start rushing the phasing out of private beds when there is a possibility that in a few years' time—when conditions may be better—the private sector will be able to set up alternative facilities in order to improve the area of choice for all patients.

Our objection to the Bill is that it limits the area of choice in health care available to the citizen. If the Government persist with both paragraphs (c) and (d), they are saying that rather than wanting separation they want total abolition of private health care.

That is the message that we wish to put across. The whole point of the compromise is to achieve separation of a continued thriving private sector of health care in the country in order to give citizens better freedom of choice to have the doctor they wish to have.

We believe that Amendment No. 26, which is an insertion into the Bill, is a reasonable one. It would be quite wrong for the Board to allow pay beds to be phased out in an area where the private sector was trying to obtain facilities in order to keep the opportunities available for private practice in that area. We do not feel that it is interfering in the judgment of a local authority for the Board to take into account that planning permission for alternative accommodation may have been obstructed.

We have had warnings, particularly by NALGO, that planning permission for alternative accommodation in respect of large hospitals over 100 beds in the London area and 75 beds outside would be obstructed. This provision should be kept in the Bill.

Amendment No. 27 is an entirely new one, of which none of us thought in Committee over all those long months, but it is very important. We want to ensure that patients continue to be able to obtain the kind of doctor or treatment that they have been used to outside the NHS, once separation has taken place. That is a reasonable attitude. If a large number of, say, Roman Catholics in an area have been used to going to a Roman Catholic consultant who can use pay beds in an NHS hospital, the Board should ensure that there are private facilities outside where a Roman Catholic consultant can practise or is practising before pay beds in that area are phased out.

This is a blow that we should try to strike for freedom. Patients must be able to continue to choose the kind of doctor they want. It has been suggested that this is a wrecking amendment, but I do not agree. It refers to a "substantial reduction" in the freedom of patients. In other words, we want facilities offered outside similar to those which private patients in NHS hospitals were getting before. It is a good amendment and I invite my hon. Friends to vote for it.

Mr. Patrick Jenkin

I would emphasise what my hon. Friend the Member for Wells (Mr. Boscawen) has said about Amendment No. 27. This is a new point which was accepted in another place, with support not only from the Cross-Benches but also from the Bishops' Bench. It was stressed as of importance, for instance, to Roman Catholics. It was said that, if one of the results of phasing out pay beds was a substantial reduction in the freedom of patients to choose a doctor of the religion or of of the race or language of their own, that factor should be taken into account by the Health Services Board.

The Secretary of State—certainly this is true of his noble Friend in another place—appears to persist in misunderstanding both the language and the purpose of the amendment. There is no suggestion that a Nigerian should be expected to go to a Nigerian doctor or an Indian to an Indian doctor. People should simply have the freedom to choose. Many do not have choice, but that is no reason for reducing the ambit of choice. We want to widen it.

If the effect of the Bill is to reduce choice—for instance, the choice of a woman to be treated by a woman consultant or a Roman Catholic to be treated by a Roman Catholic consultant—that would be just one more diminution of the right of patients to choose the kind of medical care they want.

The Secretary of State has not spoken on this amendment. I hope that he will undertake to consider it carefully because it seems to be one of some importance. I commend it to him.

Mr. Ennals

The hon. Member for Wells (Mr. Boscawen) somewhat misinterpreted the four criteria. It is the Government's aim to give the private sector a reasonable opportunity to provide its own facilities, where necessary, before phasing out pay beds. We have sought to write that in, in terms which I think represent that aim.

However, on paragraph (d), which their Lordships have also sought to delete, I said in Committee that it is not the Government's intention to allow pay beds to continue where the private sector is unwilling to take the necessary steps to provide decent facilities. Of course there is a responsibility on the private sector, so far as it wishes, to provide its own facilities. It cannot simply, by failure to do so, frustrate the purposes of the Bill.

I do not think that my noble Friend misunderstood Amendment No. 27. The reason for opposing it is that it puts an impossible task upon the Board and is absolutely outside the intended scope of its activities. In practice, more often than not, the patient's freedom of choice is already limited by the advice and information of his private doctor. Of course he is free to ask for a second opinion, but for that he would need in almost every case to go back to his family practitioner for guidance and advice.

Therefore, if a patient has already chosen—for reasons of sex, religion, colour or language—a particular family practitioner, he can return to him if he is dissatisfied. That situation would not be changed by the phasing out of pay beds. It would be almost impossible for the Board to fulfil that responsibility and I cannot offer to reconsider the matter. I have considered it carefully and this is not an amendment which it would be reasonable to accept.

Question put and agreed to.

Mr. Speaker

We have been discussing a group of amendments. I understand that the Opposition would like to divide on Lords Amendment No. 27.

Mr. Patrick Jenkin

indicated assent.

Mr. Speaker

With permission of the House, and only with permission of the House, I will put the Question on Lords Amendments Nos. 25 and 26 together.

Lords Amendments Nos. 25 and 26 disagreed to.

Lords amendment: No. 27, in page 6, line 30, at end insert— () that the authorisation of any such accommodation or services under those provisions for use in that connection should not be revoked if the revocation would result in a substantial reduction in the freedom of resident or non-resident hospital patients to engage the services of medical or dental practitioners of the sex, race, colour, language, religion or national or social origin of their choice.

Motion made, and Question put. That this House doth disagree with the Lords in the said amendment:—

The House divided: Ayes 277, Noes 254.

[For Division List No. 427 see c. 1827]

Question accordingly agreed to.

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