HC Deb 19 November 1976 vol 919 cc1724-30

Lords amendment: No. 2, in page 2, line 43, at end insert— (3) Nothing shall be done under or by virtue of this Act, and nothing in this Act shall be construed, so as to operate to the detriment of any person (whether or not a consultant), who was on 12th April 1976 employed whole-time or part-time in one or other of the national health services or concerned with the interests of patients at NHS hospitals, whether or not such detriment occurs under, by reason or in consequence of the terms of his employment.

The Minister of State, Department of Health and Social Security (Mr. Roland Moyle)

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

The main reason for our opposition to the amendment is that it is drafted in exceptionally wide terms, even if one could be confident that it was related only to employees in the National Health Service. Under one construction of the amendment it could be assumed that it applies to people other than those who are employed in the NHS, as one class possibly referred to in the amendment is those who were on 12th April 1976 concerned with the interests of patients at NHS hospitals, whether or not detriment occurred to them by reason or in consequence of the terms of their employment. That would be a wide class of persons and it would be impossible to envisage who might be covered by the amendment.

In addition, employees of the NHS are to a large measure protected, and there is little danger that any employees will suffer serious detriment as a result of the phasing out of pay bed operations.

We would welcome those consultants on part-time contracts who wish to convert to full-time contracts with the NHS. Pay beds are to be phased out at a rate which will enable suitable provision to be made outside the NHS. Consultants, therefore, will have appropriate notice to enable them to adjust to the new arrangements.

It is very unlikely, although a complete guarantee cannot be given, that NHS employees who are not consultants will lose their jobs by reason of the phasing out of pay beds. They all have excellent trade unions and comprehensive Whitley machinery which will afford them protection. I therefore ask the House to reject the amendment.

11.45 a.m.

Mr. Paul Dean (Somerset, North)

The Opposition regret that the Government have not been prepared to accept at least the principle of the amendment. I get the impression from what the Minister of State said and our earlier debates that the Government are rather uneasy about this because at different times they have used different arguments.

The amendment could concern all NHS staff, especially consultants. The background is that we are dealing with members of a profession who feel battered and bruised by the Government and suspicious after having been badly handled by the right hon. Member for Blackburn (Mrs. Castle). They fear for their independence and their clinical freedom. In view of the hostile remarks which have been made against the medical profession by Government supporters, and the fact that the Labour Party Conference wished to go much further than the Bill goes and to abolish entirely private practice, it is no wonder that the medical profession has these fears. That is the background against which we ask the Government to consider the amendment.

We wish to establish the simple principle of no detriment. It is a principle to which the trade unions, rightly, have attached particular importance over the years. We say that what is sauce for the goose should be sauce for the gander. If the principle of no detriment is right for trade unions, it should equally be right for consultants and others in the NHS.

People who suffer through no fault of their own because the Government have changed the law should be compensated. The Government have tried to argue, as the Minister did today, that there is no need for the amendment because people will not suffer. But they could suffer. The Government have given no guarantee that there will not be some people who suffer.

I take, first, the maximum part-time consultant who wishes to go whole-time. The Minister said that the Government would welcome that, but there is no guarantee that the consultant will get a whole-time contract. There is no guarantee that there will be a job available or that the hospital concerned will be able to afford it. The former Minister of State in earlier debates said that this must be subject always to the needs of the service.

There could be a loss here. The consultant who, feeling that he cannot conscientiously under the new arrangements do both his NHS work and private work, decides to give up his private work and to concentrate on his NHS patients, will almost certainly suffer a loss of income. There is no guarantee that that loss will be even partly made up by his being able to go full-time. This could involve a considerable disruption for the individual consultants concerned, some of whom may have had this arrangement for 30 years since the NHS started.

It could also work the other way round. A consultant who, because he is losing pay beds, decides to give up his NHS work and go entirely private has no guarantee that he will be able to do that. It may be said, if he decides to go private, that it is his own choice and he should stand on his own feet, but there may not be alternative facilities available.

The Government have turned down numerous Opposition amendments designed to ensure that phasing out should be dependent upon alternative private facilities being reasonably available. We say that the Government should either accept that phasing out should be dependent upon adequate alternative facilities being available or be prepared to provide compensation in the event of loss. The Government have refused to do either. It may be that very few people will suffer. We hope that few will suffer, but even if only one individual suffers it is the duty of the House when changing the law to protect that one individual.

There are ample precedents in the NHS for what is being suggested, and I very much regret that the Government have not seen fit to accept this simple, well-established principle. If the Government do not have second thoughts, I hope that the House will divide so that we may state clearly our strong feeling that it is wrong that the Government in changing the law should expose individuals to possible loss without providing any compensation.

Mr. Michael Spicer (Worcestershire, South)

I do not want to delay the proceedings, and I certainly do not want to delay proceeding towards a vote on this matter. However, I cannot help but support my hon. Friend the Member for Somerset, North (Mr. Dean). Surely this amendment goes to the very root of the matter.

If we do not have some kind of built-in guarantee against detriment, the Government must accept that many of the consultants concerned will go into the private sector and be lost to the National Health Service.

That, to Opposition Members, might not be totally objectionable were it not for the fact that we frequently read the pronouncements of Labour Members below the Gangway who wish to abolish the private sector. That is clearly behind our worries throughout the entire proceedings on this Bill. We and the consultants are concerned that, if there is no built-in guarantee against detriment, they will go private.

We fear that a future Labour Government will abolish the private sector and that the consultants, therefore, will go abroad, and that yet another future Labour Government will abolish the right to practise and the right to have private treatment abroad. That is the direction in which we are heading. This amendment goes to the root of that objection. [Interruption.] I hear a Government supporter say "Sixth-form stuff". But every other Socialist State—presumably that is what the Labour Government want—has controls on the movements of its citizens both within and across its borders. If we do not give our consultants the kind of returns which they need and can get abroad, they will go abroad. A future Socialist Government will then no doubt forbid them to practise and give treatment abroad.

Unless, at this stage, we can build in some kind of guarantee against detriment, it seems that we shall inevitably move towards a situation where, first, people will go exclusively to the private sector—I have never heard the Government argue that that will be the trend—and, secondly, a future Labour Government will abolish that. On those grounds, I support what was said by my hon. Friend the Member for Somerset, North.

Mr. Rooker

This amendment, which seeks to ensure that there is no detriment to people employed in the National Health Service, refers also to whole-time consultants. Until 20 minutes ago, I had always understood that whole-time consultants were not allowed to charge fees or to treat private patients. Having read Amendment No. 2, which we are seeking to remove from the Bill, and having read the minutes of a meeting of the Ealing, Hammersmith and Hounslow Area Health Authority of 10th November, when it discussed the audit report, I understand that whole-time consultants have been treating and charging private patients, contrary to the regulations.

Mr. Paul Dean

Would the hon. Member for Birmingham, Perry Barr (Mr. Rooker) address his remarks to the other part of the amendment, which deals with part-time consultants? We are concerned not with whole-time consultants, but with part-time consultants.

Mr. Rooker

Of course, the hon. Member for Somerset, North (Mr. Dean) would wish me to deal with part-time consultants, because they can charge fees for private treatment. But that is not the point. The amendment also refers to whole-time consultants.

Mr. Robert Boscawen (Wells)

Of course, whole-time consultants are entitled to charge private patients.

Mr. Rooker

Frankly, the auditors of the Ealing, Hammersmith and Hounslow Area Health Authority do not think so. It was reported to that authority, in private session on 10th November, that whole-time consultants had been charging professional fees contrary to the regulations. Six consultants were concerned, and the losses were made between May and June 1976.

The Opposition claim to be seeking to ensure that people do not suffer any detriment. I shall stick to the question of whole-time consultants. It seems that whole-time consultants, because of laxity of control in the NHS over private patients, are already jumping on the gravy train notwithstanding that, by and large, private patients do not pay the bills. Massive amounts have to be recovered by legal action.

Mr. Robert Kilroy-Silk (Ormskirk)

Shame!

Mr. Rooker

It is correct. We hear stories from the Opposition about people not paying their bills and scrounging on the Welfare State, but private fee-paying patients do not pay their bills and a great deal of the money has to be recovered by legal action.

I have no wish to spoil the debate or to be out of order, but that is the position of whole-time consultants. Opposition Members are concerned to ensure that whole-time consultants do not suffer any detriment. I should like my right hon. Friend to confirm that what I have said is correct. I should also like him to confirm that the Department will look into the position at Hammersmith Hospital and the illegal practice of whole-time consultants which the auditors have drawn to the attention of the Area Health Authority.

The Opposition and the House of Lords are seeking to protect a procedure which is not right and proper but which continues to be part of the gravy train of milking the National Health Service and allows queue-jumping which forces people to accept that they must go private to get the necessary treatment for themselves or their families.

I think that it is disgraceful that the Opposition should seek to protect whole-time consultants who, in practice, should not need protection, because they should not suffer any detriment under the Bill. It is the part-time consultants whom the Opposition should take steps to protect. The decision whether to continue part-time or to go whole-time places those consultants in a dilemma. Whole-time consultants will not suffer detriment, but those who have been fiddling the system should suffer some sort of detriment. On that point, I should imagine that I have the support of my hon. Friends. [HON. MEMBERS: "Hear, hear."] It seems that I clearly have that support.

I hope that the Government will look into the situation at Hammersmith Hospital where the auditors have drawn attention to the malpractices of whole-time consultants.

Question put:—

The House divided: Ayes 278, Noes 249.

[For Division List No. 423 see c. 1811]

Question accordingly agreed to.

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