§ '(1) Any person (whether or not a consultant) who was on 12th April 1975 employed whole-time or part-time in one or other of the National Health Services or concerned with the interest of patients of NHS hospitals who claims to have suffered significant loss or diminution of income, or reduction in his earning capacity, attributable to the passage of this Act may make a claim in respect thereof to the Board, and the Board shall consider such claim.
§ (2) If the Board is satisfied that any person making a claim under this section has suffered such loss or diminution of income, it should give notice thereof together with the Board's determination of the appropriate sum to be paid to compensate such persons, to the Secretary of State who shall thereupon compensate such persons accordingly.
§ (3) Notwithstanding any payment of compensation under this section, if the Board is satisfied that any person making a claim has suffered a reduction in his earning capacity it shall make a proposal to the Secretary of 364 State to secure that that person may obtain more advantageous conditions of service in his NHS employment, to such extent as the Board shall determine after hearing the representations of the claimant, and it shall be the duty of the Secretary of State to ensure that effect is given to such proposal'.—[Mr. Paul Dean.]
§ Brought up, and read the First tune.
§ Mr. Paul DeanI beg to move, That the clause be read a Second time.
The clause deals with compensation for loss of income or reduction in earnings capacity. It will be recollected that this important subject was discussed briefly in Committee on two occasions. First, the individual case of a constituent was raised by my hon. Friend the Member for Ealing, Acton (Sir G. Young). The second time it was raised was on the last day of the sitting of the Committee, when I moved a similar new clause to this one.
It will be recollected that we had an extremely brief debate on this subject in Committee as it was the last day under the guillotine motion. We responded to 365 the Government's request to have rapid debates on the new clauses so that we could rise at lunch-time rather than continue in the afternoon.
We attach special importance to this subject since the debate was in Committee extremely brief. Another reason for our attaching importance to it is that following the brief debate in Committee there was a tie in the voting, seven Members voting in favour and seven against. The Chairman, as was entirely proper and in accordance with precedent, voted with the Ayes on the first occasion—namely, that the clause should be read a Second time—and, also according to precedent with the Noes when the Question was put that the clause be added to the Bill. It was for only a brief and fleeting moment that the principle of compensation was accepted.
It is partly for that reason that we are trying again on the Floor of the House. Another reason is that we feel that the answer we received from the Government was unsatisfactory and unsympathetic.
The object of the clause is simple and clear—namely, that if someone who works in the National Health Service suffers a significant loss of earnings or earning capacity as a result of the passage of this measure he should be offered compensation and better conditions of service. This is the "no detriment" principle, which I think will be accepted on both sides of the House. In particular, I hope that it will appeal to right hon. and hon. Members on the Government Benches. I hope that it will appeal to the right hon. Member for Blackburn (Mrs. Castle), whom I am glad to see in her place.
I remind the right hon. Lady of an answer she gave as Secretary of State at the end of last year. She said:
we appreciate that the principle of no detriment is a very good trade union principle".[Official Report, 1st December 1975; Vol. 901, c. 1268]If the Government do not feel disposed to accept the clause, I hope that the right hon. Lady will speak in favour of it and, if necessary, record her vote in favour of it in due course.
§ Mrs. Castlerose—
§ Mr. DeanI am putting to the right hon. Lady and to the House that what is sauce for the trade unions should be sauce for the consultants. It is largely the part-time consultants who are most likely to suffer and who will need the assistance that is proposed in the clause.
§ Mrs. CastleI hope that the hon. Gentleman will not give the House the impression that I was using "no detriment" in this context. He will be aware that the whole purpose of having a phased-out policy operated by the criteria of the independent board is for it to act as an alternative to the sort of compensation principle for which he is pressing and which I do not support.
§ Mr. DeanI am disappointed to hear the right hon. Lady say that. Nothing in her intervention diminishes my argument that we have always attached considerable importance, as have trade unions, to ensuring that, if Governments change the rules under which people work so that they suffer as a result, the "no detriment" principle should apply and that the people should be compensated for any losses.
There are ample precedents inside and outside the NHS. There is a precedent in the 1946 Act which set up the National Health Service and there are other precedents in later National Health Service Acts. Why should not the principle apply here? Surely it is right that, if a Government alter the rules and people suffer as a result through no fault of their own, the Government should ensure that the individuals should be compensated for any loss. It is a simple but very important principle.
I am not proposing a blanket provision. It is carefully drawn, and each person would have to show the merit of his case. The provision will be available to anybody working in the NHS who feels that he has suffered as a result of the Bill, though it is most likely to apply to surgeons, anaesthetists and others using highly sophisticated equipment. One relevant example might be a consultant who at present does his private work in an NHS hospital where he does his National Health Service work. Under the Bill, that consultant would have to divide his time between the NHS hospital and an independent hospital where he would see his private patients. He 367 might feel that the extra travelling time and complications involved in such an arrangement would prevent his doing justice to both his private and his NHS patients, and he might decide for perfectly proper professional and ethical reasons to give up his private practice and work full time on NHS patients. The result could be a permanent loss of earning capacity.
Alternatively, a consultant might wish to change from a maximum part-time contract with the NHS to a part-time contract which allowed him the additional time needed properly to look after his private patients.
9.45 p.m.
The Government have a special obligation in these cases. The Bill will make it impossible, in some circumstances, for consultants to do both NHS work and private practice together. Indeed, in Committee the Government turned down a number of amendments designed to stop the phasing out of pay beds where alternative private facilities were not reasonably available. I suggest that there is here a clear obligation on the part of the Secretary of State to compensate on the basis of the "no detriment" principle, of past precedent and of his refusal to deal with this problem in other ways that were put forward in Committee.
It is important in these and other debates to consider the possible damaging and disturbing effect that the Bill could have on the National Health Service as a whole and on the attitude of consultants and others towards their future in the service. Unless staff, including consultants, feel reasonably secure, unless they feel that they can practise medicine without undue political interference and unless they feel that they can care for their patients without Big Brother breathing down their necks, they will take their talents elsewhere. They will emigrate to countries where they are appreciated. If they feel that there is to be one monopoly employer, that could be the last straw which could turn the present medical brain drain into a torrent.
I beg the Secretary of State to recognise these fears about maintaining the necessary skilled manpower in the NHS. That is the broad context in which I commend this comparatively modest and, I suggest, wholly reasonable proposition to the House.
§ The Minister of State, Department of Health and Social Security (Mr. Roland Moyle)I rise with some diffidence to plunge into the complexities of the Health Services Bill which has engaged the attention of most hon. Members in the Chamber for a considerable time.
The hon. Member for Somerset, North (Mr. Dean) moved the new clause with his characteristic courtesy and clarity, but I shall have to disappoint him by indicating that the Government do not accept it as being appropriate for the Bill.
The hon. Gentleman urged that what was sauce for the trade union goose should be sauce for the consultant gander. I take my stand on that principle. The Government are fully committed to compensation for loss of employment or office as such. It happened under reorganisation. That is totally different from what is proposed in the new clause. Despite the claims made by the hon. Gentleman for its careful drafting and the fact that it is not a blanket clause, it struck me as being rather vague and sweeping in that it would apply to anybody concerned with the interests of patients in NHS hospitals. It covers a wide class of people. It might, in the opinion of a court, bring in people who had an indirect connection with patients in NHS hospitals.
The clause proposes that, despite the fact that compensation could be paid or recommended by the board,
it shall make a proposal to the Secretary of State to secure that that person may obtain more advantageous conditions of service in his NHS employment".I have never yet heard a trade union affiliated to the TUC argue that redundancy should be taken as an opportunity for possible promotion or improvement in terms and conditions of service. However, according to the wording of the clause, that would be allowed.However, the great thing is that we are not saying that people shall not carry on their service as private practitioners. We are saying that they will not carry it out over a period of time in the NHS. They will be able to be fully free to carry on outside the NHS and to earn their emoluments in that way if they so desire. Indeed, they will not be deprived of an opportunity of working in the NHS till reasonable alternative facilities are available outside the NHS.
§ Mr. Paul DeanI am obliged to the hon. Gentleman for giving way. I should like to wish him well in his new appointment—although not of course, a long time in it. The point that I was trying to make to him is that it will be much more difficult when the private sector and the NHS sector are divorced from each other for the part-time consultants to be able to give proper service to both types of patients, that the Bill is creating a dilemma for them, and that there will be loss as a result of this. Where loss is proved, the Government should respond.
§ Mr. MoyleThe hon. Gentleman may well believe that, but as far as I can gather, from talking to consultants, consultants do not believe that. They believe that there is a tremendous demand for private facilities in health. Therefore, they should have absolutely no difficulty, given a reasonable period of notice—which is essential. I agree—in transferring their employment to private facilities outside the NHS. On that point, I do not accept what the hon. Gentleman has said.
§ Mr. Patrick JenkinI join my hon. Friend in welcoming the Minister to his post. The Minister is laying great stress on the freedom, which the Bill enshrines, for the consultant to carry on his independent practice outside the NHS. Presumably he is also envisaging that consultants will continue with a part-time consultancy within the NHS. Is he prepared to accept amendements at a later stage, amendments which were resisted in Committee, which would link the availability of accommodation outside the NHS, for the purpose of phasing out pay beds, not merely to its availability and suitability for the patient but its availability and suitability for those who are practising within the NHS? Such amendments were resisted time and again in Committee, but the Minister's argument now says that they must be accepted.
§ Mr. MoyleNot at all. I am arguing that given the situation that consultants seem to me to think exists, there is no need for the sort of provision for which the right hon. Gentleman has just been arguing, and I would resist that sort of amendment on the same grounds.
There are a number of other detailed difficulties in dealing with the plea for compensation argued by the hon. Mem- 370 ber for Somerset, North. The position of consultants has been fully discussed with representatives of the professions, including the British Medical Association and the British Dental Association.
First, a consultant who wishes to increase his commitment to the NHS as pay beds are phased out may protect his position by transferring from a maximum part-time contract to a full-time contract. That course is always available to him. My right hon. Friend the Secretary of State and we on the Government side of the House would welcome any number of consultants who are willing to do that.
The other thing is that, subject to the normal procedures of negotiation, it would be quite wrong to make in the Bill a provision which would allow the board to interfere in the normal processes of negotiation by which terms and conditions of service in the NHS are laid down. That applies particularly to the provision that says that a person may obtain more advantageous conditions of service in his NHS employment. There is proper Whitley Council machinery throughout the NHS for negotiation of these terms and conditions of service freely between the authorities, on the one hand, and the trade unions and the associations, on the other hand.
No National Health Service employee will lose pay or emoluments due to him under his NHS contracts because of the Bill. No Government can be expected to guarantee part-time consultants against what may be hypotheical loss of income simply because Parliament has decided to separate private practice from NHS hospitals and not to prevent it. That is the important thing. It is to separate it and not prevent it. If separation is to be achieved in an orderly manner, then reasonable time will be allowed to ansure that people whose financial interests are affected will have sufficient notice in order to adjust their financial circumstances to the situation. This is a built-in part of the Goodman proposals. The provisions in the Bill are entirely necessary and the new clause is entirely undesirable.
A great deal of consideration has been given to the problem of overmanning. One of the things I found particularly interesting about the proposal of hon. Members opposite is that people will be 371 taken into the NHS on more advantageous terms and conditions of service than they enjoy at the moment of phasing out, whether there is work for them in the NHS or not. That is not the normal sort of noise we expect to hear from the Conservative Party on the subject of providing jobs and overmanning, yet that is what this could easily turn out to be.
In those circumstances I therefore reject the addition of the new clause to the Bill.
§ Mrs. KnightShortly after the dark day when the Bill becomes law. I foresee the setting up of a new national society, the SPCMP—the Society for the Prevention of Cruelty to the Medical Profession. I am amazed that the Minister is so blind to the points made by doctors in their arguments against the Bill and of the very detailed points they raise such as the ones covered in the new clause so ably moved by my hon. Friend the Member for Somerset, North (Mr. Dean).
The Minister said that the matter had been discussed. It may have been discussed, but I would lay any money that it was not agreed. It is perfectly true to say that any trade unionist would not be satisfied by mere compensation for loss of employment or loss of office. Any trade unionist would be quite right to say that if this House passed legislation which directly led to a drop in his salary, he had every right to complain to this House and expect that the salary would be made up. There is no doubt whatsoever that it would be made up, and damned quickly too.
The Minister also went on to say that it was perfectly open to any doctors who found themselves in the unhappy position of having to take a drop in salary because of the Bill to take on full-time contracts. I have a letter in my hand from a professor at the University of Birmingham Department of Surgery, the Queen Elizabeth Hospital. It is right that the Minister should hear what he has to say about that suggestion.
I quote:
I think that economic considerations would force many of my colleagues to become whole time and I think to do this under a sense of financial duress would not be in the best interests of the National Health Service and it will be deeply resented by many people forced into this situation for what 372 are overt political reasons. It will in fact lead to the introduction of a whole time salaried service for very many of these colleagues no matter how loud the protestations of the politicians are to the contrary.What the Government ought to learn—but I am sorry to say that I see absolutely no sign or inclination of their learning—is that the NHS cannot and will not be able to function properly if we do not have the good will of the doctors who work in it.10.0 p.m.
I should like to draw to the attention of the House the comments of four doctors, most of them junior hospital doctors, when confronted with this situation. One house officer, post-registration, says:
I suppose I do about 108 hours a week. I believe in traditional British medicine, but I am increasingly worried at the way the Government is interfering with the way we practise. We face more and more restrictions, a limiting of hospital facilities and attempts to direct our prescribing. Meanwhile, more and more money is ploughed into administration. The patient must come first, but if the Government continues to curtail our freedom and I find I can no longer serve the sick public then I shall go abroad.That is precisely the sort of situation which might be facing any young doctor or consultant after the Bill is passed. In continuing roaring inflation, he will be expected to take a cut in salary. The Government take no responsibility for that although it is directly their responsibility.A young woman doctor said:
I do not want to be forced into general practice or to emigrate. I still want to become a consultant—but I can predict nothing with a Government which makes a promise today and breaks it tomorrow.[An HON. MEMBER: "Nonsense."] Those are not my words. Those are—[Interruption.] In a debate of this kind—
§ Mr. SpeakerOrder. If anyone wishes to intervene, there is a well-known procedure for doing so—to get up and ask leave to intervene.
§ Mrs. KnightI am grateful, Mr. Speaker. When we are dealing with subjects so close to the hearts and livings of our constituents in the medical profession, surely it is right to purvey their words to the House.
373 The third doctor said:
I am so disillusioned that I have given up my original burning ambition to have a consultancy of my own.The Bill makes that a very difficult decision.The fourth doctor says:
The entire pay structure is wrong. A senior registrar can earn up to £9,000 a year with overtime…and get paid £1,500 a year less if he is promoted to a consultancy.If, on the passage of the Bill, he finds his salary reduced still further, he will be in a difficult position if the new clause is not accepted.Whatever we do here in our arrogance and deafness, I beg the House to realise that we must accept that, unless we act in the best interests of those who serve us in the National Health Service, even part-time—there is nothing disgraceful about that—the whole of the service which we can provide for sick people will be at risk.
§ Mr. CrouchIf I am interrupted, either from a seated position or properly, it will probably be from my own side, because I do not feel entirely sympathetic with the new clause moved so wisely and clearly by my hon. Friend the Member for Somerset, North (Mr. Dean).
I, too, welcome the Minister of State to his appointment. I am sure that he will bring to it much constructive thought and sympathy, which is what it needs. He has exposed something which is harmful to the whole Bill. The new clause would provide that compensation should be paid to anyone working in the service who found himself worse off because of the Bill. The Minister said, "But I am assured that consultants will find plenty of remunerative employment in the private sector." The implication was that they would do much better than before as part-time personnel in the NHS, using NHS facilities, and part time in the new private sector which the Government are creating.
That is what disturbs me most of all. The Bill is creating a new force in medicine. It is a small cloud at present, but it is a most dangerous cloud which is coming over the care of the sick. It is created out of the good will, the good intentions and the zeal and devoted attention of strong Socialist feeling which is determined to get the Bill through. Yet 374 that will create something which will give part of the service to the private sector and part to the public sector. If the Minister of State is right and consultants find that the private sector pays better than the National Health Service, the drain will begin of the quality of service that we get from all those who are valuable in the National Health Service.
It is perhaps strange for a Conservative to contrast private with public in this somewhat derogatory manner, but we have a fully-established National Health Service which we want to sustain and maintain and which we want to grow from strength to strength. That is the Opposition's view and I feel it strongly. It is the conclusion that a new Minister of State draws from this interesting suggestion which I do not believe is absolutely necessary because of the hint given by the Minister—namely, that the private sector will prove attractive. That is the danger, and I do not want that to happen.
§ Mr. EnnalsI regret having to interrupt an hon. Member who is arguing on my side, but I wish to clear up any misunderstanding. All I was doing was reporting to the House views which had been put to me. In explaining any consequences, I do not see how those views can be used as the basis for a claim for compensation.
§ Mr. CrouchThose views cannot be used as the basis for a claim for compensation. That is why I am not fully sympathetic to the new clause.
I use the debate to make a point which has worried me for a long time. My point is important. I am glad of the opportunity to discuss it and grateful that my hon. Friend's proposal has drawn that concern from me. I hope that the Secretary of State will bear it in mind. I am sure that he does not wish to see a migration of people from the National Health Service either into the private sector or abroad. It is perhaps schizophrenic, but I accept the argument that lack of compensation could be the last straw which persuades people to move.
We must not make over-emotional arguments about the problems, but they are real. There are many reasons why someone might feel that he should seek his fortune elsewhere. There are the economic and social reasons and the 375 frustration which is felt today in our country, which has fathered so much of value in medicine and the care of the sick. This small Bill could create something much bigger in terms of danger to the service which is so important to our people.
§ Mr. A. P. Costain (Folkestone and Hythe)I know that my hon. Friend is much more experienced in hospital administration than I am. Will he help me? The consultants who saw me on this matter are worried because, they say, when they have operated on a private patient in a public hospital they are able to visit ordinary National Health Service patients following that operation. If they are forced by the Bill to operate in private nursing homes, they will not have the same opportunity to slip in and out to see their NHS patients. What is the answer to that?
§ Mr. CrouchI accept that argument. It is the dilemma with which consultants will be faced. They will have to decide whether to become full time in the NHS because they want to give devoted service to their patients. Only one hon. Member today has said that some men and women in medicine put politics before patients. I have never met such persons. No doubt they exist somewhere, but I have not met any of them.
When my wife went into Guy's Hospital for a major operation two years ago, the professor of surgery there said "I would rather have you in a public ward because you will get better attention there, and I will see you more often than if you go to the Nuffield home." The facilities around the NHS beds in Guys are better 'than in private rooms. But that is another point. It is so easy when one gets worked up about the Bill to make Second or Third Reading speeches when one should not do so.
§ Mr. Kilroy-SilkIf facilities are so superior in public wards, why is there all the fuss about eliminating private beds from NHS hospitals?
§ Mr. CrouchWe are making a fuss now, but the Labour Party started it. The hon. Gentleman is still short of experience in this House. I have a certain affection for him. He is sitting in 376 a seat usually reserved for former Prime Ministers. He declared before he came to the House that he wanted to be Prime Minister. But I think that he should move back a little now, because he is apt to make me stray from the point I am trying to make. However, I shall answer his question, but first I want to answer the question raised very properly by my hon. Friend the Member for Folkestone and Hythe (Mr. Costain)namely, whether there will be disadvantage in the future because the part-time consultant will have the problem of how to split his time economically between an NHS hospital and a private hospital or nursing home.
Many consultants will have to choose whether to be whole-time in the NHS or to pack it up completely. That is what worries me. This is where I come back to the question of compensation. If a consultant chooses to become whole-time in the NHS he could be disadvantaged by the Bill, with his income reduced. Therefore, the new clause has some force in it which I can understand.
Of course, the consultant could make another decision. If he found himself disadvantaged by losing a certain amount of income in going full-time in the NHS, no longer treating private patients, I fear that he might go out of the NHS altogether. We could lose good men and women in that way. This applies not only to consultants but to nurses, anaesthetists, ancillary workers and even porters.
I am worried about the prospect, I know of plans in my constituency for large country houses to be used as new private hospitals. I deride such suggestions. I do not like them.
§ Mr. EnnalsI am grateful to the hon. Gentleman for giving way to me, but as I appointed him to an area health authority perhaps I have a right to interrupt. Does he not think it likely that a considerable number of consultants are likely to become whole-time instead of maximum part-time? If that is so, even if it is only marginal, it will help to reduce the waiting lists within the NHS. I understand the hon. Gentleman's fear that there might be a movement to set up a larger private sector which would challenge the NHS, but in that case does he not think that we are right to bring 377 in legislation to impose a certain limit on the size of growth of the private sector to avoid creating such damage?
§ 10.15 p.m.
§ Mr. CrouchThat is the very part I dislike so much. While I can go along with the right hon. Gentleman in saying that we must preserve the National Health Service, it must not be done at the diktat of even the Secretary of State. That is not the way I want the country run. That is the worst form of comporate State, the worst form of soviet State. [HON. MEMBERS "0h."] I am not using words extravagantly. I am very worried, because the Secretary of State and the Government want to achieve these tiny ends, getting rid of the private sector, and they say that they must take strong measures, as are proposed in the Bill, to ensure that the private sector does not grow. That is dictatorial, the Government taking to themselves a "Big Brother" attitude and saying, for example, that they will not want to see a building in my constituency made into a private hospital, and they will dictate that it shall not happen.
§ Mr. EnnalsIt is accusations of that kind about dictatorship, again from a member of a regional health authority, which I find so disturbing. We have decided to establish—it is in the Bill—an independent board with an independent chairman. [An HON. MEMBER: "Rubbish"] It is not rubbish. It will be done not by some "Big Brother" taking decisions but with an independent board taking those decisions. That is the essence of it.
§ Mr. CrouchAll right, that is the essence of it; but at the end of the line the board will report to the Secretary of State, who will make the decision.
§ Mr. EnnalsNo.
§ Mr. CrouchI think that I understand the matter correctly. However, we are straying, and I shall say no more about that.
I am concerned that as a result of the Bill there will be a migration of good men and women out of the National Health Service into the private sector, and some even overseas. This is the pity of it. The Government have a fall-back and they say that they will stop that from 378 happening. There are important, strong clauses in the Bill. The Secretary of State says that it will be decided by a board. Very well. That is the limit of democracy in the Bill. Eventually it comes to Whitehall. That is what worries me.
The Secretary of State says that it is strange that a member of a regional health authority should use such words as "dictatorship". Why should not a member of a health authority who is also a Member of Parliament talk about dictatorship when dictatorship is written into the Bill?
§ Mr. EnnalsI am grateful to the hon. Gentleman for giving way again. I was in no way challenging his right to criticise, but I am disagreeing with what he said. He understands the Bill. Surely he will recognise that the Secretary of State already has power, if he chooses to use it, to end pay beds. Steps have been taken previously by Secretarys of State to reduce the number of pay beds. They are at the discretion of the Secretary of State. In fact, the Bill takes power away from the Secretary of State and gives it to an independent board, establishing certain criteria. I do not understand how one can call that dictatorship.
§ Mr. CrouchI have given way to the Secretary of State several times, and this is a good debate. The right hon. Gentleman has been rising to his feet, speaking without a note and from his heart and his head on this matter. We are learning a lot. [An HON. MEMBER: "Has he a head?"] He would not have reached his present office by using his heart alone.
The Bill is much bigger than we may now imagine it to be. It has within it ingredients that can destroy the National Health Service as it is today. It should be the intention of Parliament, of men and women of good will in all parties, large and small, to ensure that we do nothing to weaken the National Health Service. I believe, however, that there are in the Bill—I speak passionately as a supporter of the National Health Service —elements that could produce a weakening of the service.
§ Mr. Patrick JenkinIt is right that we should have devoted a little time on Report to what is still regarded by the 379 profession, despite everything the Minister of State said about the consultations he has had, as a matter of considerable importance. He may have unwittingly misled the House when he seemed to suggest—I wrote down his words carefully—that the consultants did not think that there was any need for this provision. I ask him to return to the BMA and see whether it thinks there is any need for it. I think that if he consults the records in his Department he will be able to satisfy himself that he has far from allayed the anxieties of those who represent the consultants in the hospitals about the damage that will flow from the Bill.
The Minister used a number of arguments to justify the absence of any right of compensation. The first was that the consultant would be free to carry on his private practice outside the NHS. In the light of our debates on a number of clauses in Committee he cannot rely on that argument. The Government have consistently resisted any attempt to build into the criteria or the phasing out of pay beds the fact that the facilities outside the health service should be reasonably available to the practitioner. Where reasonable availability has to be a criterion, the Bill refers throughout to the patient. For example, Clause 4(7)(b) says
are otherwise reasonably available (whether privately or at NHS hospitals) to meet the reasonable demand for them".That demand is demand by the patient. Clause 8(2) says:is not privately available there at a place which is reasonably accessible to the patient".In Committee we gave a number of examples of where the difficulty would be overcome for the patient because for a particular speciality he might reasonably be expected to travel a considerable distance, but where it would be impossible for a part-time consultant. I gave the example of a NHS part-time consultancy in Bristol, with the nearest facility providing private practice in Exeter. It would be reasonable for the patient to be expected to go to Exeter rather than Bristol, but it would be impossible for the consultant to mix his practice by doing part of it in Bristol and part in Exeter. It is in those circum- 380 stances that the need for compensation will arise.The Minister took refuge in the argument that the consultant could transfer to a full-time contract. He used those words quite unqualified. In the debate on the new clause in Committee his predecessor, the right hon. Member for Plymouth, Devonport (Dr. Owen), stressed:
subject always to the needs of the service". —[Official Report, Standing Committee D, 3rd August 1976; c. 1577.]The question is what is to happen to the consultant where the needs of the service do not require a further full-time consultancy and yet he is precluded from carrying out an independent practice. He will be stuck with a part-time consultancy or with the option of abandoning it and moving to another part of the country, where he can, perhaps, combine the NHS with an independent practice—or of emigrating, as my hon. Friend the Member for Somerset, North (Mr. Dean) said.It is not only a question of need. It will increasingly be a question of resources. My hon. Friend the Member for Ealing, Acton (Sir G. Young) has drawn my attention to an answer given by the Minister of State's predecessor last year, when he said:
The notional cost of all part-time and maximum part-time consultants taking up whole-time employment in the NHS would be about £13 million a year in England and Wales excluding any consequential adjustments to distinction award payments."—[Official Report, 9th December 1975; Vol. 902, c. 163-4.]That was one of the bases upon which we arrived at the figure of £40 million as the cost of implementing the Bill when it takes full effect, but the £13 million, as an additional burden on the health service, is a very substantial amount indeed.If an area or region is confronted with all the various demands which are now being made, and if the option of going full-time is one that it might be prepared to offer a consultant, but it is not of the highest priority, it might say, "Yes, there is a need but we cannot afford it, and you will have to stay part-time". What is to happen to that consultant if pay beds are phased out on the ground that there is an alternative facility reasonably available for the patients but no reasonable opportunity for him to practise? This seems to me to be a very strong case indeed.
381 The Minister of State then argued that there would be a considerable growth of practice outside the National Health Service. I do not want to get involved in the argument put by my hon. Friend the Member for Canterbury (Mr. Crouch). On this issue I happen to share his view and belief that it will not be a good thing in the long run if we have two services existing side by side—a thriving, prosperous, well-financed private service, and a struggling, under-financed, increasingly shabby National Health Service. I do not believe that that will be viable or desirable. I shall have something more to say about that when we come to Third Reading tomorrow.
If we do not get the growth of the private sector, why should there not be some right of compensation for the consultants who will suffer a serious detriment to their position as a result of the Bill? If that view is right, and there are ample opportunities outside the National Health Service, it will cost the Government nothing to include the clause, because there will be no demand for it. If the Government are wrong and there will not be a thriving, booming private sector outside which will snap up the consultants who are no longer able to practise privately in National Health Service hospitals, it seems to me that it is incumbent on them to provide this right to compensation.
My hon. Friend the Member for Somerset, North said that there were ample precedents for this, and I shall quote only two of them. The Minister of State will recollect that in the 1946 Act general practitioners were deprived
§ of their right to buy and sell practices and that a lump sum of £66 million was provided in the Bill to be paid out as compensation for the loss of the rights that the Bill took away from them.
§ Another example, not in the National Health Service but not wholly inappropriate, is to be found in the Acts dealing with local government reorganisation. I was concerned with London in 1963. There were very sophisticated rights indeed in the case of any local government officer who lost his job or had his prospects seriously harmed. I had a case where a man had to fight for about 10 years before he was finally able to establish his rights under the London Government Act 1963 to compensation, because the change which Parliament had enforced had deprived him of the expectation of promotion. That is the particular point that the Minister of State mentioned.
§ It is in these circumstances that we should consider the position of a consultant who has his pay beds taken away and is deprived of the right to carry on independent practice on which he has relied for a substantial slice of his income. If there is no opportunity open to him—and that is what the clause says—compensation should be offered to him.
§ In these circumstances, I think that the new clause is perfectly reasonable and I would have thought it wholly right that my right hon. and hon. Friends should divide the House in favour of it.
§ Question put, That the clause be read a Second time:—
§ The House divided: Ayes 137, Noes 185.
383| Division No. 315.] | AYES | [10.30 p.m. |
| Atkins, Rt Hon H. (Spelthorne) | Cooke, Robert (Bristol W) | Gow, Ian (Eastbourne) |
| Awdry, Daniel | Cope, John | Gower, Sir Raymond (Barry) |
| Bennett, Dr Reginald (Fareham) | Cordle, John H. | Grant, Anthony (Harrow C) |
| Benyon, W. | Cormack, Patrick | Gray, Hamish |
| Bitten, John | Costain, A. P. | Grieve, Percy |
| Blaker, Peter | Craig, Rt Hon W. (Belfast E) | Griffiths, Eldon |
| Body, Richard | Crouch, David | Grist, Ian |
| Boscawen, Hon Robert | Dean, Paul (N Somerset) | Grylls, Michael |
| Bottomley, Peter | Dodsworth, Geoffrey | Hell, Sir John |
| Boyson, Dr Rhodes (Brent) | Douglas-Hamilton, Lord James | Hall-Davis, A. G. F. |
| Brocklebank-Fowler, C. | Eden, Rt Hon Sir John | Hamilton, Michael (Salisbury) |
| Brown, Sir Edward (Bath) | Fairbairn, Nicholas | Hannam, John |
| Buchanan-Smith, Allck | Fairgrieve, Russell | Harvie Anderson, Rt Hon Miss |
| Buck, Antony | Fell, Anthony | Hayhoe, Barney |
| Bulmer, Esmond | Fisher, Sir Nigel | Hicks, Robert |
| Burden, F. A. | Fletcher-Cooke, Charles | Hordern, Peter |
| Carlisle, Mark | Fookes, Miss Janet | Hunt, David (Wirral) |
| Chalker, Mrs Lynda | Forman, Nigel | Hunt, John (Bromley) |
| Clark, Alan (Plymouth, Sutton) | Fowler, Norman (Sutton C'f'd) | Hurd, Douglas |
| Clarke, Kenneth (Rushclitle) | Gardiner, George (Relgate) | Hutchison, Michael Clark |
| Clegg, Walter | Gilmour, Rt Hon Ian (Chesham) | James, David |
| Jenkin, Rt Hon P. (Wanst'd & W'df'd) | Moore, John (Croydon C) | Silvester, Fred |
| Johnson Smith, G. (E Grinstead) | More, Jasper (Ludlow) | Sims, Roger |
| Jopling, Michael | Morgan-Giles, Rear-Admiral | Sinclair, Sir George |
| Kaberry, Sir Donald | Morrison, Hon Peter (Chester) | Speed, Keith |
| Kershaw, Anthony | Mudd, David | Spence, John |
| Kilfedder, James | Neave, Alrey | Sproat, Iain |
| Kimball, Marcus | Neubert, Michael | Stanbrook, Ivor |
| King, Tom (Bridgwater) | Newton, Tony | Stewart, Ian (Hitchin) |
| Kitson, Sir Timothy | Nott, John | Stradling Thomas, J. |
| Knight, Mrs Jill | Page, Rt Hon R. Graham (Crosby) | Taylor, R. (Croydon NW) |
| Knox, David | Parkinson, Cecil | Taylor, Teddy (Cathcart) |
| Latham, Michael (Melton) | Percival, Ian | Tebbit, Norman |
| Lawrence, Ivan | Prior, Rt Hon James | Vaughan, Dr Gerard |
| Le Marchant, Spencer | Pym, Rt Hon Francis | Wakeham, John |
| Lester, Jim (Beeston) | Raison, Timothy | Walder, David (Clitheroe) |
| Luce, Richard | Rathbone, Tim | Wall, Patrick |
| McCrindle, Robert | Rees, Peter (Dover & Deal) | Weatherill, Bernard |
| Macfarlane, Nell | Rifkind, Malcolm | Whitelaw, Rt Hon William |
| Marshall, Michael (Arundel) | Rippon, Rt Hon Geoffrey | Winterton, Nicholas |
| Marten, Neil | Roberts, Wyn (Conway) | Wood, Rt Hon Richard |
| Maxwell-Hyslop, Robin | Rost, Peter (SE Derbyshire) | Young, Sir G. (Earing, Acton) |
| Meyer, Sir Anthony | Sainsbury, Tim | Younger, Hon George |
| Miller, Hal (Bromsgrove) | Scott, Nicholas | |
| Mills, Peter | Shaw, Giles (Pudsey) | TELLERS FOR THE AYES: |
| Mitchell, David (Basingstoke) | Shepherd, Colin | Mr. Anthony Berry and |
| Monro, Hector | Shersby, Michael | Mr. Carol Mather. |
| NOES | ||
| Allaun, Frank | Evans, loan (Aberdare) | MacFarquhar, Roderick |
| Anderson, Donald | Ewing, Harry (Stirling) | McGuire, Michael (Ince) |
| Archer, Peter | Faulds, Andrew | Mackintosh, John P. |
| Ashton, Joe | Fernyhough, Rt Hon E. | McMillan, Tom (Glasgow C) |
| Atkins, Ronald (Preston N) | Flannery, Martin | Madden, Max |
| Atkinson, Norman | Fletcher, L. R. (Ilkeston) | Mahon, Simon |
| Bagier, Gordon A. T. | Fletcher, Ted (Darlington) | Marks, Kenneth |
| Bain, Mrs Margaret | Foot, Rt Hon Michael | Marquand, David |
| Barnett, Guy (Greenwich) | Ford, Ben | Marshall, Dr Edmund (Goole) |
| Bates, All | Forrester, John | Marshall, Jim (Leicester S) |
| Beith, A. J. | Fraser, John (Lambeth, N'w'd) | Maynard, Miss Joan |
| Benn, Rt Hon Anthony Wedgwood | Freeson, Reginald | Meacher, Michael |
| Bishop, E. S. | George, Bruce | Mendelson, John |
| Blenkinsop, Arthur | Golding, John | Morris, Charles R. (Openshaw) |
| Boardman, H. | Gould, Bryan | Moyle, Roland |
| Booth, Rt Hon Albert | Gourlay, Harry | Murray, Rt Hon Ronald King |
| Bray, Dr Jeremy | Grant, George (Morpeth) | Noble, Mike |
| Brown, Hugh D. (Provan) | Grant, John (Islington C) | Ogden, Eric |
| Brown, Robert C. (Newcastle W) | Grimond, Rt Hon J. | Orbach, Maurice |
| Brown, Ronald (Hackney S) | Grocott, Bruce | Orme, Rt Hon Stanley |
| Buchan, Norman | Hamilton, James (Bothwell) | Park, George |
| Buchanan, Richard | Hardy, Peter | Parker, John |
| Callaghan, Jim (Mlddleton & P) | Harper, Joseph | Pavitt, Laurie |
| Campbell, Ian | Harrison, Walter (Wakefield) | Pendry, Tom |
| Cant, R. B. | Hatton, Frank | Panhallgon, David |
| Carmichael, Nell | Heffer, Eric S. | Reld, George |
| Castle, Rt Hon Barbara | Henderson, Douglas | Richardson, Miss Jo |
| Clemitson, Ivor | Hooson, Emlyn | Roberts, Albert (Normanton) |
| Cocks, Michael (Bristol S) | Howell, Rt Hon Denis (B'ham, Sm H) | Roberts, Gwilym (Cannock) |
| Cohen, Stanley | Howells, Geraint (Cardigan) | Robinson, Geoffrey |
| Colquhoun, Ms Maureen | Hoyle, Doug (Nelson) | Roderick, Caerwyn |
| Conian, Bernard | Hughes, Rt Hon C. (Anglesey) | Rodgers, George (Chorley) |
| Cook, Robin F. (Edin C) | Hughes, Robert (Aberdeen N) | Rooker, J. W. |
| Corbett, Robin | Hughes, Roy (Newport) | Roper, John |
| Cox, Thomas (Tooting) | Hunter, Adam | Rose, Paul B. |
| Craigen, J. M. (Maryhill) | Irving, Rt Hon S. (Dartford) | Ross, Stephen (Isle of Wight) |
| Cronin, John | Jackson, Miss Margaret (Lincoln) | Ross, Rt Hon W. (Kilmarnock) |
| Crowther, Stan (Rotherham) | Jay, Rt Hon Douglas | Rowlands, Ted |
| Cryer, Bob | Jenkins, Hugh (Putney) | Ryman, John |
| Cunningham, G. (Islington S) | John, Brynmor | Short, Mrs Renée (Wolv NE) |
| Cunningham, Dr J. (Whiteh) | Johnson, James (Hull West) | Silkin, Rt Hon S. C. (Dulwich) |
| Davidson, Arthur | Jones, Alec (Rhondda) | Silverman, Julius |
| Davies, Bryan (Enfield N) | Jones, Barry (East Flint) | Skinner, Dennis |
| Davies, Ifor (Gower) | Jones, Dan (Burnley) | Small, William |
| Deakins, Eric | Kilroy Silk, Robert | Smith, Cyril (Rochdale) |
| Dempsey, James | Lambie, David | Smith, John (N Lanarkshire) |
| Doig, Peter | Lamond, James | Spearing, Nigel |
| Dormand, J. D. | Leadbitter, Ted | Spriggs, Leslie |
| Duffy, A. E. P. | Lestor, Miss Joan (Eton & Slough) | Stallard, A. W. |
| Dunn, James A. | Lewis, Ron (Carlisle) | Stoddart, David |
| Eadie, Alex | Lipton, Marcus | Strang, Gavin |
| Edge, Geoff | Loyden, Eddie | Swain, Thomas |
| Edwards, Robert (Wolv SE) | Luard, Evan | Taylor, Mrs Ann (Bolton W) |
| Ellis, John (Brigg & Scun) | Lyons, Edward (Bradford W) | Thomas, Dafydd (Merioneth) |
| Ennals, David | McDonald, Dr Oonagh | Thomas, Ron (Bristol NW) |
| Evans, Gwynfor (Carmarthen) | McElhone, Frank | Thompson, George |
| Thorne, Stan (Preston South) | Welsh, Andrew | Wise, Mrs Audrey |
| Tlnn, James | White, Frank R. (Bury) | Woof, Robert |
| Urwln, T. W. | White, James (Pollok) | Young, David (Bolton E) |
| Wainwright, Edwin (Dearne V) | Wigley, Dafydd | |
| Walker, Harold (Doncaster) | Wilson, Alexander (Hamilton) | TELLERS FOR THE NOES: |
| Walker, Terry (Kingswood) | Wilson, Gordon (Dundee E) | Mr. Ted Graham and |
| Weetch, Ken | Wilson, William (Coventry SE) | Mr. Donald Coleman |
§ Question accordingly negatived.