SECRETARY OF STATE'S POWERS TO PRO VIDE SERVICES ETC. OTHERWISE THAN FOR PURPOSES OF SERVICES UNDER NATIONAL HEALTH SERVICE ACTS (Hansard, 19 November 1976)

§ Mr. Ennals
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. 35 to 37.

§ Mr. Ennals
This amendment is a monstrous onslaught upon my powers as Secretary of State. The very fact that the right hon. Member for Wanstead and Woodford (Mr. Jenkin) is supporting this monstrous onslaught must mean that he never himself expects to hold office. I congratulate him on retaining his very shadowy post.
1765 The amendment provides that the Secretary of State could exercise the powers conferred upon him in the three NHS Acts of 1946, 1947 and 1968, to make supplies of blood, human tissues, accommodation and services, and so on, and supplies of goods, available to the private sector, only if he has been advised by the Board that use of the powers would not to a significant extent interfere with his duties to provide accommodation and service to NHS patients and would not to a significant extent operate to the disadvantage of NHS patients.
This would be an absolute bureaucracy. The Opposition are attempting to put responsibilities on the Board which it would be quite improper for the Board to have and would require of it an absolutely unnecessary cost and number of staff. The amendment would make the Board responsible for advising the Secretary of State on matters on which it would not be competent to give advice.
In addition to making facilities available to the private sector, the relevant sections of the Acts cover the use of NHS supply departments, kitchens, laundries and so on. The amendment would require that many decisions at present taken at a local level by district and area authorities should be referred to the Board. Inevitably, it would cause delay and disruption of services to the private sector, which the Opposition are trying to protect.
It is an absurd amendment which I urge hon. Members not to press any further.

§ Mr. Patrick Jenkin
The right hon. Gentleman has used quite unjustifiably strong language to describe an amendment that falls within the main stream of the theme of the Goodman proposals, as he has sought to embody them in the Bill. That is that interposed between the National Health Service and the Minister there should be an independent Board to adjudicate in those areas in which there is likely to be conflict, as he sees it, arising out of the use for private patients of NHS facilities.
All that another place has sought to do is to say not that the Board should take the decision but that the Board should advise the Secretary of State, and that that should apply to the provision of the services that the Secretary of State 1766 has just described—the availability of blood from a blood bank, human tissues and other services of that nature which may be available from the NHS.
It is a matter for judgment when difficulties arise and questions crop up as to whether NHS patients are being in any way prejudiced by the supplies that a particular hospital may have been accustomed to make for private patients whether it would not be unreasonable for the Secretary of State in those circumstances to take the advice of the Board, which, after all, will have the duty of holding the balance.
That is the case that the Government have consistently made for the Bill. I think that on reflection the right hon. Gentleman might regret the somewhat extreme language that he used to describe the amendments. To some extent the point is the same as that which arises on the next group of amendments, on Clause 8, which concerns the much more important area of policy on the use of specialised surgical and medical facilities in hospitals.
In these circumstances, as we are constrained by time, perhaps I need not advise my right hon. and hon. Friends to vote on Lords Amendment No. 34. Nevertheless, it is not the foolish amendment that the Secretary of State has suggested. It has been put forward in good faith, and I regret very much the language that the right hon. Gentleman used about it.
The only other point that arises is that on Lords Amendments Nos. 35 and 36. I am advised that there is no statutory precedent for the use of the words "to a significant extent" and that where legislation has to eliminate the insubstantial and the insignificant, in the past the word used has always been "substantially". I cannot claim to have scrutinised the entire statute book, as the right hon. Gentleman will recognise. Nevertheless, no one has been able to provide a precedent for the use of these words, and I should have thought that the usual word, "substantially"—in other words, a word that would eliminate the insubstantial, which is what it is intended to do where the detriment would be insubstantial and could be ignored—would be preferable. It is only where something is substantial that the 1767 necessary powers should be used to prevent the availability of the services concerned.
This is an entirely reasonable amendment. The Government have considered it and rejected it on two or three occasions. Perhaps, therefore, I should not be justified in asking my right hon. and hon. Friends to go into the Division Lobby. It is a perfectly sensible amendment. The Bill would be the better for it. But perhaps we ought to allow the amendment to be negatived.

§ Mr. Rooker
This will be the last time that I shall intervene in the debate today. Instead of their Lordships putting into the Bill the word "substantially", it would have been better if they had put in the word "any", so that NHS patients were not disadvantaged to any extent, let alone to a significant or a substantial extent. Any diminution of the services offered to NHS patients because of private patients coming in and using NHS facilities is not on as far as the Government side of the House is concerned.
The time has long since passed when we could quibble about the word "significant". If the House of Lords wanted to revise the Bill in a proper manner for the benefit of the people of this country, it would not have put in the word "substantial" but would have used the word "any".
3.0 p.m.
I was not present in Committee because I was busy at the time trying to get the Dock Work Regulation Bill through the House. Much time was wasted on that. Perhaps I would have been better employed in discussing this Bill.
There is considerable disquiet as to the charges made for NHS facilities provided to private patients. In July the Secretary of State or his predecessor admitted that the Department of Health and Social Security had no knowledge of the fact that—

§ Dr. Vaughan
That is not in order.

§ Mr. Rooker
Is it in order, Mr. Deputy Speaker, for someone on the Conservative Front Bench to shout from a sedentary position that my remarks are not in order?

§ Mr. Deputy Speaker
I did not hear what was said and I should have thought 1768 the best course would be for the hon. Gentleman to continue to make his speech to the House.

§ Mr. Rooker
You, Mr. Deputy Speaker, are the proper person in this Chamber to call Members to order if they become out of order.
My argument is made in the context of the Lords amendment which we are seeking to remove. It is a fact that some people who have used NHS facilities in a private capacity have not paid for the use of those facilities. Quite naturally, records are kept. My hon. Friend the Minister of State has written to me pointing out that in the last financial year £170,000 was recovered following legal action in relation to services provided under Clause 7 of the Bill—a clause which the House of Lords has sought to butcher completely by its amendments. I will name only the North-West Thames Area Health Authority. In that instance the figure was £43,000.
What is disturbing is that the regional boards actually have the power to write off debts under £500 without recourse to anyone. They do not have to get Treasury permission. I asked my right hon. Friend yesterday whether he would collect and publish the relevant information, and his reply was "No".
It is not right and proper that anybody should be able to write off debts owing by pay bed patients who have used NHS facilities and not paid their bill. I want information about the debts which have been written off to be published by region and by area. I want this information to be made public as soon as possible after the Bill gets the Royal Assent. Clearly, it will not get it today.
I invite my right hon. and hon. Friends to comment on this, bearing in mind especially all the claptrap which has been heard from Conservative Members about scroungers on the Welfare State. It turns out that those who abuse the Welfare State by using pay bed facilities—I consider it an abuse—have not paid for the use of those facilities.
We cannot go back to the consultant for the money. There is no redress to be obtained from him. He gets his fee. I am concerned with the services provided to these people by the National Health Service, and I want the information about the debts to be published. As 1769 my right hon. Friend said in introducing the motion, the services include food, accommodation, and also blood bank facilities—even that is included—and I do not think that the debts in respect of these services should be written off. Information about those which have been written off ought to be made public, and I invite my right hon. and hon. Friends to give a commitment to publish as soon as possible the figures for which I have already asked twice.

§ Mr. Kilroy-Silk
I am alarmed and disturbed by the facts that my hon. Friend the Member for Birmingham, Perry Barr (Mr. Rooker) has put before the House today. If so much money has to be collected as bad debts by the National Health Service, this is a clear case, as I assume the right hon. Member for Wanstead and Woodford (Mr. Jenkin) will agree, of people scrounging. I am a little surprised that, in all his forays and excursions into so-called abuses of the Welfare State and the scroungers in our society, he has not, prior to my hon. Friend's comments today, himself elicited this information.
These are people who clearly can afford to pay and who are not paying after they have had the benefit of facilities and services. They are parasitic on the NHS. They have been stealing from the NHS and stealing from the community as a whole. If there were no other demonstration of the iniquities of private medical practice co-existing alongside the NHS, this would be a convincing enough demonstration of the need to eradicate private medicine from the NHS.
The people of whom we are talking here have already jumped the queue by promising to grease the palm of the consultant. They have done that—he has had his money—but the hospital or the general fund has not had its money. These debts have to be collected as part of an attempt to recoup expenses incurred by the NHS at a time when it is desperately short of funds and resources and when so many essential services—kidney machines for example—are having to be curtailed or, at best, not enlarged at the rate we should like to see. It is scandalous that people who jump the queue are depriving the rest of the community—the poorest, the most needy and the sick—of much-needed and highly valued resources.
1770 The only gleam of satisfaction which I can gain from the figures given by my hon. Friend is that the rate of collection is lowest for the Merseyside Area Health Authority. I can only assume that my constituents and those of my hon. Friends from Merseyside are honest—or perhaps efforts have not been so effective in catching them. Another reason may be that there are fewer pay beds in Merseyside than in other regions.
Reinforcing what my hon. Friend said, I should like from my right hon. Friend a clear indication not just of the amount of bad debts that have been collected but of the amounts written off. We have a right to know the amount of our money and resources which has, in effect, been given free, gratis and for nothing to private health service patients.

§ Mr. Pavitt
My hon. Friend may be interested to know that I have a Question down, with reference to the whole of England, Scotland and Wales, asking for details of the amounts which have been recovered by litigation and of the amounts which have been written off. I hope to have an answer in a few days.

§ Mr. Kilroy-Silk
I hope that my hon. Friend will be joined in his inquiries and efforts to root out these abuses by right hon. and hon. Members opposite, who show such enthusiasm—indeed, hysteria —in pursuing this kind of activity on other occasions, directing their attention to other sections, the most defenceless and vulnerable sections, of the population.
Here we have a clear case of people stealing, not just scrounging but stealing, from the NHS. What comments do hon. Gentlemen opposite have to make? I hope that the right hon. Member for Wanstead and Woodford will take the opportunity to condemn in as forthright terms as he has applied to others this group of people who are milking the National Health Service. I hope also that my right hon. Friend will give a clear commitment today that he will not tolerate this kind of activity in future, that he will make strenuous efforts to find out the total sums that have been written off, and that he will make every possible effort to recoup the money and put it back into NHS resources.

§ Mr. John Lee (Birmingham, Hands-worth)
I rise to give more power to the 1771 elbow of my hon. Friend the Member for Birmingham, Perry Barr (Mr. Rooker). The House has been quite unjustifiably deprived of the inestimable services of the hon. Member for Aberdeen, South (Mr. Sproat), who, as we know, is such a strict guardian of our social services and so stern a critic of of abuses of public services and taxpayers' money.

§ Mr. Kilroy-Silk
Who is that?

§ Mr. Lee
He is the hon. Gentleman who was concerned in a certain privilege matter this week.
The clause is concerned with the protection of Health Service patients' rights when they are threatened or encroached upon by others. Much of what has been said illustrates the case that there should be no private health facilities; that we should have a full-time, wholly comprehensive National Health Service and no private medicine. There is an arguable case for that so that the two things do not jar against each other and there is no invidious competition between the two concepts.
Whatever the right hon. Member for Wanstead and Woodford (Mr. Jenkin) may think—and it may be that the word that he prefers is the more usual one that comes to the assistance of a legal draftsman in this matter—when one compares the two words and their meanings one sees that there can be little doubt that the word that their Lordships prefer, though more familiar, is the weaker one. In other words, the effect of the Lords amendment would be to diminish somewhat the protective powers provided by the clause.
I turn now to the point raised by my hon. Friend the Member for Birmingham, Perry Barr. On 26th July I asked my right hon. Friend how many law suits had been instituted since 1974 by the West Midlands Regional Health Board to recover fees from patients who had occupied pay beds in the region, how much money was outstanding, and how much had been recovered. My right hon. Friend the Member for Plymouth, Devonport (Dr. Owen), who was then the Minister of State at the Department, said that about 200 pay bed law suits had been the subject of legal proceed- 1772 ings, resulting in the recovery of about £13,500. That is not in itself a particularly large sum, but it is interesting to note that there is a considerable amount of activity in this connection and that in a number of instances legal action is necessary to recover money from pay bed patients. My right hon. Friend went on to show that the situation was not satisfactory. He also said: Figures relating to current pay bed debtors are not specifically identified, but health authorities are required to pursue all outstanding debts, seeking the aid of the regional health authority's legal department as necessary."— [Official Report, 26th July 19976; Vol. 916, c. 103]

§ Mr. Thorne
Did the reply to my hon. Friend's Question reveal how much it costs the NHS to bring such actions and collect the money?

§ Mr. Lee
That information was not revealed, and, as I think my hon. Friend appreciates, it is an unsatisfactory aspect of certain kinds of civil litigation—and this may be one of them—that even when someone is successful in a law suit he does not necessarily recover all his costs. It may be that there are some totally irrecoverable debts that the taxpayer and the NHS as a whole have to bear as a result of action having been taken to recover money and winning the case but not being able to recover costs.
On the same day as I asked my Question, my hon. Friend the Member for Perry Barr asked my right hon. Friend what procedure was taken for writing off debts, and it was said that Treasury approval had to be given. It was said that such approval had been obtained for all debts in excess of a delegated limit, which was currently £500. What is the position about debts of other amounts? Who authorises action in those cases? How stringently are these matters pursued.
Earlier this year and towards the end of last year there was a lot of discussion about writing off the debts of the Clay Cross authority. Everybody knows how stringent the district auditor can be. He is an independent quasi-judicial authority and is not beholden to any Minister. He can act independently of Government Departments. The Treasury, on the other hand, is a Government Department, and we should like to know whether the criteria adopted by the Treasury are 1773 more or less strict than those adopted by the auditor when dealing with the Clay Cross situation. Many of my hon. Friends would be grateful if the Minister would be good enough to give us that information. Since the debate has been going on for some minutes, with the assistance of his officials, perhaps the Minister will now be in a position to tell us what the total bad debt currently outstanding is and how many law suits are currently being pursued.
3.15 p.m.
It will be interesting to know whether there are certain cases where no law suits are being pursued and for what reason. There may be certain compassionate cases where it might not be wholly desirable to do so, but I would expect the Minister to say that his Department is pursuing these matters, that he expects to recover the moneys concerned and that he will not hesitate to take legal action in order to do so.
My hon. Friend the Member for Birmingham, Perry Barr asked what the effect of indebtedness would have been on a person's right to transfer to Health Service status. The Minister replied: Under present arrangements failure by a private patient to settle their account does not itself justify a reversion to NHS status."— [Official Report, 26th July 1976; Vol. 916, c. 101] One would like to know how many abuses of the system a private patient has to perpetrate before he can be said to have defaulted.

§ Mr. Rooker
Does my hon. Friend reckon that someone in the middle of a course of treatment under the private pay bed system who cannot pay is in fact sent home because he cannot pay? Does my hon. Friend think that happens? Clearly what happens is that such a person is wheeled into an NHS ward.

§ Mr. Lee
Yes, and that would probably be right. I do not think anyone would want to treat a patient in any other way. It would be inhuman to do so.
What we are concerned with is that there shall be no more abuse. As the present ballyhoo continues on the subject of scroungers, we are anxious to see that there is no scrounging at the expense of the Health Service. I am sure the whole House, including hon. Members opposite who are so concerned about the need for 1774 meticulous care in Government expenditure, will join us in being guardians of the public purse.