RESTRICTION ON POWER UNDER SECTION 31 OF 1968 ACT TO ALLOW USE OF NHS FACILITIES BY PRIVATE PATIENTS (Hansard, 19 November 1976)

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

§ Mr. Deputy Speaker
With this we may take Lords Amendments No. 39 to 43.

§ Mr. Moyle
Clause 8 makes some limited provision for private patients to be treated by the NHS after the Bill becomes law on an occasional basis for certain scarce facilities. The group of amendments that we are now considering attempts to extend these exceptions.
Amendment No. 38 tries to remove from the Secretary of State the decision about admitting people for NHS treatment. Apart from the fact that the Secretary of State is responsible to this House for the administration of the NHS, we feel that the solution proposed—to place on the Board the duty of considering whether individual private patients shall be treated for occasional facilities by the NHS—is inappropriate in that these decisions can be made only at local level and in the knowledge of local circumstances.
The Board is not equipped in any way to have the necessary information to give meaningful advice on the sort of applications which are likely to come forward under the amendment if it were to be accepted. By requiring the advice of the Board, a national institution, on these matters, the amendment might result in delay in patients receiving facilities from the NHS, which in the case of emergencies could be unfortunate.
Amendment No. 39 seeks to extend to private patients access to NHS accommodation or services, not only if they have a need for the specialised equipment or 1775 skills which we shall occasionally allow to be made available to them but also if the need for such facilities is likely to arise during the course of their treatment. In other words, some assessment would have to be made about the future course of treatment of such patients.
The Goodman agreement proposed that health authorities should allow private patients access to facilities at NHS hospitals if specialised treatment were not available in the private sector, and it is not envisaged in the agreement that the Government should provide facilities for private patients to undergo routine treatment purely on the hypothetical assessment that they might need specialised facilities in due course because complications might arise. That is right outside the Goodman proposals and we ask the House to reject it.
My hon. Friend the Member for Birmingham, Perry Barr (Mr. Rooker), who has now left the Chamber, might have been interested to know it can be arranged for a private patient receiving treatment outside the NHS, if complications arise, to transfer into the NHS for that specialised treatment.
Amendment No. 40 proposes that a demand for access for private patients to NHS facilities should be based not only on the situation of the patient but also on the convenience of his practictioner. We have proposed that demand should be assessed purely on the basis of the treatment needed by the patient. We cannot see any way in which the operation of the access to NHS treatment can be extended to private patients on the basis of the convenience or inconvenience of the practitioner. I therefore ask the House to reject that amendment also.
Amendment No. 41 would require the Secretary of State to permit private patients access to NHS facilities only in accordance with arrangements which, in the opinion of the Board, are best suited to secure that all patients, private or NHS, are admitted on the same basis of medical priority. The Secretary of State has discretionary powers under Section 31 of the 1968 Act. This amendment seeks once more to remove this discretion and to transfer it to the Board. Again, it would be an erosion of my right hon. Friend's power with regard to provision in NHS hospitals.

§ Mr. Ennals
Monstrous.

§ Mr. Moyle
My right hon. Friend feels that that would be a monstrous curtailment of his powers. I agree with him, to the extent of asking the House to reject that amendment also. Again, it is not an appropriate function for the Board, which has no locus in deciding in which circumstances patients should be admitted under Clause 8. I ask the House to reject that amendment on the same grounds as I adduce for opposing Amendment No. 38.
Finally, Lords Amendment No. 43 would enable the Secretary of State, on the advice of the Board, to set aside accommodation at NHS hospitals for the exclusive use of private patients. As I have said several times today, such a proposal misconceives the purpose of the Board, which is generally to phase out private practice from the NHS. The Goodman agreement on which the Bill is founded proposed that NHS accommodation should be made available to private patients only on an occasional and specific basis for the use of specialised facilities. The amendment is totally at variance with that agreement, in that it would allow the NHS to set aside whole groups of beds for private patients. For that reason, I ask the House to reject it.

§ Dr. Vaughan
We support this group of amendments. If the Secretary of State regarded the previous group of amendments as a monstrous curtailment of his powers, it is interesting that his colleague the Minister of State should have spoken in a much more restrained way on this group of amendments which, if anything, we regard as even more important than the previous group.
The justification for wanting to put more discretion into the hands of the Board and less into the hands of the Minister lies in the partisan way in which the Minister responded to the remarks made by the hon. Member for Birmingham, Perry Barr (Mr. Rooker). It is characteristic that the hon. Member for Perry Barr, having delivered himself of some remarks, most of which were irrelevant to the amendment, should then leave the Chamber.
We think it important to replace "satisfied" by "advised by the Board". As the Minister said, this subject is highly complicated and specialised. The grounds on which the Secretary of State can allow 1777 a patient to use the private facilities in National Health Service hospitals can be very complicated.
We are concerned about the patient who goes into a private medical unit suffering from a mild illness and who subsequently develops unexpected and perhaps serious complications. It is clearly in his interests to be able to be transferred quickly and easily. We are concerned about patients who need specialised deep X-ray and radiotherapy. We are concerned about heart operations, organ transplant operations and technically skilled operations of that kind. We are also concerned—this is relevant to discussions we have recently had in the Chamber—about patients admitted for general malaise who are discovered to be suffering from a serious infectious disease which needs specialised care.
On all these issues it is not enough to leave the decision in the hands of the Secretary of State. Having set up the Board, the Government should take the Board's advice. The Board's remit is to decide how the facilities should be best used in the patients' interests. We wish to see the amendments accepted.

§ Mr. Pavitt
I heard with interest the arguments put forward by the hon. Member for Reading, South (Dr. Vaughan). What is being ignored is the finite nature of the Board. On 23rd May next year the first 1,000 bed pay beds will have gone and the Board will be concerned with the remaining 3,500. Every six months the House will bring pressure to bear to see that the remaining beds are phased out quickly. If power is transferred temporarily from the Secretary of State to the Board, within a short time it will have to be transferred back again to the Secretary of State because, once the phasing out operation has taken place, the Board will no longer be needed.
Lords Amendment No. 39 deals with specialised facilities. A person is entitled to specialised facilities whether those facilities have previously been provided privately or otherwise, and the National Health Service covers that.
I am concerned about the abuse that might occur. I remember, for example, that when patients in private abortion clinics suffered severe haemorrhage, the 1778 National Health Service had to provide plasma at short notice because of the inadequate service provided by the abortion clinic. The clinic made an enormous amount of money out of the plight of pregnant young girls, but when the life of the patient became endangered, the NHS would have to come to the rescue by sending a complete medical team, and plasma. I am glad that my right hon. Friend proposes to reject Lords Amendment No. 39.

§ Mr. Ennals
I beg to move, That this House doth disagree with the Lords in the said Amendment.

§ Mr. Deputy Speaker
With this we may take Lords amendment No. 45.

§ Mr. Ennals
This amendment would deprive the National Health Service of funds which it would otherwise receive from private patients. Paragraph 3(e) of the Goodman proposals suggested that: Charges will be made to these patients —those are patients admitted under Clause 8— and there would be no subsidy by the NHS. It is quite right that there should not be a subsidy. Part-time consultants will fix and charge their own fees, as they do at present, and the NHS will not be involved in this arrangement. On the other hand, whole-time consultants are paid a salary by the NHS and it is appropriate that the NHS should include an element in the charge made to a private patient treated by a whole-time consultant to cover the costs of his services. This element would in many cases be paid into research funds as it is at present. That would be lost if the amendment were to be sustained in the Bill.