HC Deb 19 November 1976 vol 919 cc1731-8

Lords amendment: No. 3, in page 3, line 1, leave out subsections (1) and (2) and insert— (1) Within 12 months after the passing of this Act the Board shall submit to the Secretary of State proposals for reducing, in the case of each Area Health Authority, Health Board and group of preserved Boards in Great Britain, the number of beds at NHS hospitals administered by that Authority, or by Boards within that group, authorised under section 1(1) of the 1968 Act to be made available to resident private patients, provided that the total number of beds proposed for such reduction shall not exceed 1,000. (2) It shall be the duty of the Secretary of State to give effect to the said proposals by revoking the authorisations for those beds, and to make those beds available for use by resident patients who are not private patients.

Mr. Ennals

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

Mr. Deputy Speaker (Mr. Bryant Godman Irvine)

With this we may discuss Lords Amendments Nos. 4, 5, 6, 69, and Lords Amendment No. 7 and the last amendment in lieu.

Mr. Ennals

The effect of the amendment would be to remove the Secretary of State's duty to phase out 1,000 beds and would require the Board to put proposals to the Secretary of State within 12 months for withdrawing not more than 1,000 beds. The early phasing out of pay beds was part of the Goodman compromise and the amendment would have a severe delaying effect.

Over several months we have been in constant consultation with area health authorities in preparation for the provisions contained in Schedule 2 and the amendment would simply mean a delay of six months in phasing out pay beds. Since the determination of the House is clear, I am certain that hon. Members will accept that there is no reason why we should delay making progress.

I now turn to a point raised by my hon. Friend the Member for Birmingham, Perry Barr (Mr. Rooker) about the treatment of private patients at Hammersmith Hospital. It appears to be true, according to the health authority, that certain whole-time hospital consultants have been charging professional fees contrary to the regulations. The charging of fees by whole-time consultants has never been approved by the authority. I am assured that the matter is being reviewed and that controls will be strengthened.

Sir George Young (Ealing, Acton)

My hon. Friends and I attach great importance to Lords Amendment No. 3 which would oblige the Health Services Board, not the Secretary of State, to choose the first 1,000 pay beds to be phased out. We see little merit in setting up a Health Services Board, giving it obligations to phase out pay beds, and laying down criteria by which that shall be done, if the Secretary of State himself decides to phase out the first 1,000 pay beds, which may be the only beds to be phased out under the Bill. The Secretary of State is buying himself an expensive pedigree dog and doing all the yapping himself. He will be yapping at the wrong things at the wrong time.

The criteria he can use could be totally different from the criteria that the Health Board decides upon, which could lead to a completely illogical phasing out. We think that the process requires more time, which is why we suggest 12 months rather than six. We have seen the consequences of the hasty consultation process in which the Secretary of State is currently engaged.

Amendment No. 4 is consequential. Amendment No. 6 inserts the important condition that the alternative facilities shall be of a satisfactory standard. That is the amendment to which Lord Goodman spoke in another place.

Amendment No. 7 is one of the most important. We want the Secretary of State in deciding which 1,000 beds are to be phased out to ensure that those beds are used by National Health Service patients. We do not want the dust covers put on them. That would be a grievous insult to common sense and a total waste of resources.

We have given examples of where that has and might happen in certain hospitals with a shortage of resources. While that may satisfy the left wing of the Labour Party, it would be deplored by the general public.

We are delighted that, after repeated pressure by the Opposition, the Government have at last conceded and have produced an amendment. It would be churlish of us not to welcome that belated recognition of our arguments. It would be helpful if the Secretary of State would confirm that his amendment will preclude the use of private wings in hospitals as administrative offices, which is one solution that he suggested in Committee.

Amendment No. 69 relates to Schedule 2. We do not accept that 1,000 pay beds should be phased out and we do not accept the way that that is being done in the schedule. We believe that the allocation of cuts among the area health authorities is inconsistent with the criteria in Clause 4 and that the Lords amendment should be upheld.

12.15 p.m.

Mr. Kilroy-Silk

I was disappointed that the hon. Member for Ealing, Acton (Sir G. Young) spoiled an otherwise sincere speech by making churlish remarks about the left wing of the Labour Party. Of course we want pay beds to be phased out so that the beds can be made available to others in the National Health Service.

I join with the hon. Member in saying that private facilities should not be turned into administrative wings. The facilities should be used for National Health Service patients—that is the point of the Bill. It ill becomes the hon. Member to suggest that we want to end the pay bed system out of spite and to see the beds lying idle.

We strongly resist the Lords amendments. As it stands, the Bill would call for the separation of 1,000 pay beds by the end of six months. That in itself is not strong enough. Many of my hon. Friends feel deeply that the whole point of the Bill is to separate pay beds from the National Health Service and to end once and for all the division between the facilities and quality of care available in the Health Service and the much superior and quicker service available to private patients. We can end that anomaly and ensure that we have a Health Service free to be used only if we eliminate private practice entirely from the Service.

To suggest that ending even 1,000 pay beds in six months is a radical move in that direction is nonsense. It is not sufficient. We want the Bill strengthened in that respect, even more as a result of that compromise effected by the ubiquitous Lord Goodman.

The Lords are suggesting not 1,000 beds eliminated within six months, but X number of beds phased out within 12 months. That is another delaying tactic and is a clear indication that they have no belief at all in the principles of the National Health Service or any intention of trying to make the Bill work. Their intention is to strike at the heart and core of the Bill and to destroy it.

If we are serious about the principles underlying the National Health Service and the Socialist philosophy behind it, we must be equally serious about dealing with the aberration and anomaly of pay beds. There cannot be any more compromise by the Government. We must go ahead clearly and determinedly to end pay beds in the National Health Service. For that reason, if for no other, we must strenuously resist these wrecking amendments.

Mrs. Barbara Castle (Blackburn)

I entirely agree with my hon. Friend the Member for Ormskirk (Mr. Kilroy-Silk) that the purpose of all the Conservative amendments, faithfully embellished and echoed in another place, is to destroy the Bill. They are presented to us with all sorts of specious and selective arguments. Once again, the Opposition have quoted Lord Goodman in their aid when it suited them, carefully ignoring the essential parts of the compromise when they thought that they could.

Lord Goodman's approval of Amendment No. 6 was quoted. We have not had quoted to us his total silence on Amendment No. 3. He did not vote for it, and I have not the slightest doubt that he would consider that it was an unwise and disruptive amendment for their Lordships to press upon this House.

Therefore, I join my hon. Friend in thanking the Secretary of State for standing firm on this, as he has stood firm on all the principles of the Bill. To my hon. Friends who do not feel that the Bill goes far enough it must be some consolation to know the energy and verbosity with which the Opposition and their Lordships have fought it line by line. It proves that we are on our way to the fulfilment of the guiding principle of the Bill as set out in Clause 2(1)—to separate private practice from the NHS.

Mr. Michael Shersby (Uxbridge)

I wish to speak with particular reference to the proposal to delete Schedule 2. What I am concerned about in my constituency is not so much the loss of the four pay beds mentioned in the second column of the schedule but the loss of 24 beds when my cottage hospital at Uxbridge closes in order to save £103,000 a year. The Hillingdon Area Health Authority has made that proposal because of the financial stringency in my borough.

My constituents are getting a very bad deal as a result of the Bill. They stand to lose 24 beds in an excellent cottage hospital, one with a long history of success and much loved in the community. In return, all that the Bill offers them is the number of beds to be withdrawn, a total of four. That is a matter of serious concern.

I do not propose to debate the principle of the Bill, with its effect of reducing NHS income, but the other element of the Lords amendment is very important—namely, that the Board shall submit to the Secretary of State proposals concerning the reduction of pay beds within the area. If Hillingdon is to lose the Uxbridge cottage hospital with its 24 pay beds—plus, I understand, a number of other vital hospitals in the London borough of Hillingdon—it is only right that any reduction in the number of pay beds should be a matter for consideration by the Board. It has a much more intimate knowledge of the local situation than the Secretary of State, with his many other responsibilities, can have.

I hope that the Minister can tell me what benefits my constituents will receive from this part of the Bill in return for losing their four beds. How will it benefit them when they stand to lose 24 beds at a very important cottage hospital providing the kind of facilities which are not easily provided in a large district hospital?

Mr. John Farr (Harborough)

It is sickening to listen to the Secretary of State as he pushes through a Left-wing Bill to abolish 1,000 pay beds, when he does not seem to understand the crying need of the National Health Service in the country as a whole. That need is not for additional bed accommodation. Like other hon. Members, I have written to the right hon. Gentleman many times complaining about the lack of theatre space for certain operations. I have written to him time and again about, for instance, the fact that in some parts of the country an NHS patient must wait for up to three years for an orthopaedic operation.

Can the right hon. Gentleman get his head out of this mess of party dogma, forget his determination, come what may, to abolish 1,000 pay beds, and instead pay a little attention to the crying need of the Service—certainly in the East Midlands and I believe nationally—to provide more theatre accommodation? I have here a letter that I received yesterday. It is written by the chairman of the area division of orthopaedic surgery, Trent Region. He says: while some small progress is being made in the direction of improving the facilities, I cannot foresee any improvement in the present situation of an ever-increasing waiting list for joint replacement surgery until provision is made for extra operating time. That was written in response to the complaints I have continually conveyed to him.

Like nearly all my hon. Friends, I am a great supporter of the NHS, but we are tired of making excuses for it. We are fed up with having to send complaints to different Ministers when constituents say "I cannot afford to wait any longer. I must find a way to borrow the money to go private, because I cannot wait two or three years for an NHS operation". Time and again, my hon. Friends and I have pressed Ministers of both Governments to create a National Health Service that works. We should have a service of which we can be proud.

The Minister is not tackling the most important problem. The chairman of the area division of orthopaedic surgery is already applying considerable pressure for the provision of a second orthopaedic theatre within the area. He understands that new beds will be available in 1978, and says that if they are staffed there will be a very small improvement in the situation. He adds: But the main problem is that joint replacement surgery requires a considerable amount of operating theatre time", and he says that until a substantial amount of extra operating theatre space is made available in the area, the waiting lists will continue to grow. That is a problem which concerns any hon. Member with a constituency interest.

We wish that the Secretary of State would forget this spiteful Bill and concentrate instead on what the general public wants, which is a proper Health Service in which people can have an NHS operation without having to wait so long that they have been known to die of old age before their turn comes.

Mr. Ennals

I was surprised by the remarks of the hon. Member for Harborough (Mr. Farr). He must know that, as a result of decisions taken by my right hon. Friend the Member for Blackburn (Mrs. Castle) to redistribute resources on a regional basis, the Trent Region has received additional resources—admittedly, at the expense of some other regions, particularly in London and the Thames regions, which are having to operate on a basis of nil growth or less. It ill behoves the hon. Gentleman, who comes from a region that is benefiting from the redistribution, to say that there is a crying need for more beds.

Mr. Farr

I said that there was a crying need for more theatre space, for more operating beds.

Mr. Ennals

It is for the region and the area to decide on the basis of their experience how best to allocate the resources at their disposal.

In the amendment we are dealing with the phasing out of 1,000 beds. It was recognised by all concerned that there was a great deal of under-utilisation of those beds, and it was acknowledged that the phasing out could be done by the Secretary of State. There was capacity available in the private sector.

Here it may be convenient to refer to the amendment in my name to Lords Amendment No. 7. In Lords Amendments Nos. 3 and 7, the other place put forward the idea that the beds released by the phasing out of 1,000 pay beds must be used for the benefit of NHS patients. The underlying principle was good but the wording was not acceptable. As it is clearly the wish that we should as far as is practicable make beds available to National Health Service patients—after all, that is the purpose of the whole operation—and improve the service within the NHS, I felt it would be right to table the amendment. I am grateful to the hon. Member for Ealing, Acton (Sir G. Young) for recognising that.

12.30 p.m.

My noble Friend explained in another place that the amendments as we have received them from that place would not be acceptable. They fail to recognise the value that the released beds might have for day-patients. They insisted that they should be for in-patients use or in association with out-patient treatment. Moreover, it would be wrong and could lead to a wasteful use of staff to oblige hospitals in every case to use every one of these beds for in-patients, as the Lords amendments would have bound us to do.

However, I sympathise with the underlying points made in the Lords amendments and at a late stage yesterday I tabled an amendment in lieu which provides that The Secretary of State shall so far as is practicable ensure that the beds released by the reduction made under this section are made available for the use of patients other than private patients. I hope that the House will decide to approve the amendment.

Question put:—

The House divided: Ayes 274, Noes 249.

[For Division List No. 424 see c. 1815]

Question accordingly agreed to.

Lords Amendments Nos. 4, 5 and 6 disagreed to.

Lords Amendment No. 7 disagreed to.

Amendment made to the Bill in lieu thereof: in page 3, line 30, at end insert— ' (3A) The Secretary of State shall so far as is practicable ensure that the beds released by the reduction under this section are made available for the use of patients other than private patients.'—[Mr. Moyle.]

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