HC Deb 12 October 1976 vol 917 cc262-300

If the Board under the provisions of this Act have not submitted to the Secretary of State by 1st January 1980 proposals for the complete withdrawal of National Health Service facilities from private patients, then:

(1) Notwithstanding the provisions of this Act for securing the progressive withdrawal of accommodation and services at National Health Service hospitals from use in connection with the treatment of persons at such hospitals as resident or non-resident private patients, the Secretary of State shall not later than 1st January 1980 reduce to nil the number of beds authorised under section 1(1) of the 1968 Act to be made available to resident private patients.

(2) So soon as the Secretary of State has affected the reduction in the number of beds under subsection (I) of this section, the functions of the Board under Part III of this Act shall be transferred to the Secretary of State and Part III shall be read accordingly.'—[Mr. Pavitt]

Brought up, and read the First time.

Mr. Laurie Pavitt (Brent, South)

I beg to move, That the clause be read a Second time.

Mr. Deputy Speaker (Mr. Oscar Murton)

With this we may take the following:

Amendment (a), in the first paragraph, leave out '1980' and insert '1978'.

Amendment (b), in subsection (1), leave out '1980' and insert '1978'.

New Clause 4—(Commencement of Part 11 of Act).

Amendment No. 8, in Clause 3, page 3, line 1, leave out 'passing' and insert: 'coming into force of this Part'.

Amendment No. 50, in Clause 11, page 14, line 2, leave out 'Act is passed' and insert: 'this part of this Act comes into force'.

Amendment No. 63, in Clause 23, page 24, line 19, leave out 'two' and insert 'twelve'.

Amendment No. 64, in page 24, line 19, leave out 'this Act is passed' and insert: 'Part II of this Act comes into force'.

Mr. Pavitt

In moving New Clause 2, I should like to give thanks to the printers of the House because the new clause would seem to have so much merit that they printed it twice on the Amendment Paper, once as New Clause 2 and again as New Clause 7. Perhaps they may have good reason to see the value of the new clause inasmuch as there are more than 80 signatories from the Back Benches on this side of the House in support of the principles contained in it. When we get more than 80 signatories from the Back Benches when my party is in Government, they represent nearly everybody except Ministers, Parliamentary Private Secretaries and other hon. Members attached specifically to the Government.

The purpose of the new clause is quite simple. In Committee we argued the case time and again that the compromise which the Government had entered into, which found its expression in the framing of the Bill, was not acceptable to all members of the Committee or to all Members of the House. One of the greatest problems we found was not concerned with the first part of the Bill, in Part II, under which 1,000 beds would be phased out and taken outside the National Health Service. These pay beds under Section 5 of the original Act would be taken out within six months from the time the Act went on to the statute book. The problem rested with the remaining 3,500, because their phasing out seems to be absolutely open-ended. Many of us feel that under the provisions of the Act, and without the new clause, some pay beds will still be in existence long after my grandchildren may be seeking the services of the National Health Service.

I assure my right hon. Friend that we understand fully the Government's position in this matter. I say that also to my right hon. Friend the Member for Blackburn (Mrs. Castle), who had prime responsibility at the time when the negotiations were reached with the various interests under the arbitration of Lord Goodman. We understand that, having reluctantly reached a compromise which may have been unsatisfactory to them even at the time, nevertheless the Government must continue to try to follow their part of the agreement. I take the view that they were acting very much under duress. There was a tremendous amount of pressure coming from consultants, specialists and others inside the hospital service, and in order to seek progress the Government were more or less forced to accept a compromise which in other circumstances they would have been unlikely to accept.

It has been said time and again in the House and in Committee that the Government are perfectly entitled to reach executive decisions and to make such compromises if they wish, but in the last anlysis any such agreement which in enshrined in legislation can be passed only by this House, because ultimate responsibility rests with Parliament and not with the Government. It is because we have that right that I am seeking to exercise it in New Clause 2, which would make alterations to the compromise agreement accepted by the Government.

One of the things which gave me cause for great alarm and disquiet was the newspaper articles written by Lord Goodman which appeared after the statement by my right hon. Friend's predecessor about the agreement on 15th December. Lord Goodman made it abundantly clear that he was not an independent arbitrator not having a view. He was an arbitrator with a view, and his view was that private practice should remain inside the National Health Service. His view was that, as a result of the compromise, pay beds would remain inside the National Health Service for a long time. That is why I seek in the new clause to make a termination date.

By setting a terminal date of 1st January 1980, I think I am giving a fair chance for the board which will be established and for the other arrangements within the Bill to have some time, as distinct from Amendments (a) and (b). I understand fully the point of view of my hon. Friends the Members for Ealing, North (Mr. Molloy) and Fife, Central (Mr. Hamilton), who seek to bring the time much closer to the first six months, and if it were possible I would welcome a shorter time. However, I have tried to be fair, giving perhaps more time than is necessary, because I hope that I am a fairly reasonable Member of the House.

The time limit that I have given is sufficient for the board to do the job within the terms of the compromise and within the terms of the Bill. By so doing, if we put the new clause into the Bill we would relieve thousands of patients from months of sheer misery where acute discomfort and pain are aggravated by continued anxiety and mental stress.

I give the House two examples of why think I can make that claim. First, I refer to gynaecology. I believe that if there were more lady Members of the House there might be more force behind this argument. In no area of clinical medicine inside hospitals, including both in-patient and out-patient sectors, do we get greater stress area than at the time when a woman reaches the change in life and because of this, biologically and psychologically, she needs to have a good deal of medical attention. Our consultants and specialists in hospitals are first class inasmuch as they will never at any time refuse to admit and immediately deal with matters of urgency which relate to the illness of a patient.

4.30 p.m.

In a number of specialities, however, the treatment which is needed can be deferred for a while. In gynaecology this means in physical terms—which men can understand only theoretically—months and months of acute discomfort, pain and anxiety. But one does not die from it, and eventually one can have one's treatment. The fact that a woman may have to wait some time is unfortunate, but she puts up with it. Perhaps because women are braver than men—I suppose that I risk being called a chauvinistic feminist in saying that—because they are used to bearing pain, they accept this situation too readily.

One example has arisen in my constituency within only the last three weeks. One of my constituents had been waiting for two years for the call to hospital for 44 "gynae" treatment. In despair in such situations, one hopes that each day will be the day when the post brings the summons to enter a hospital ward. This call was for admission to the Willesden General Hospital. Fortunately, one par- liamentary privilege is the use of the telephone on behalf of one's constituents, and I am pleased to say that after two years my constituent has now had the necessary treatment.

I understand the position of the consultant with a heavy case load and waiting list who cannot deal with all the people who need treatment. He has to make some choice and in gynaecological cases he becomes case-hardened; even if he works full stretch, he will still have a heavier work load than he can manage.

The present situation of Section 5 beds and private practice and the ability to go to Harley Street and pay to jump the queue has two results. Apart from giving the consultant an added income, it helps to resolve his responsibility of making difficult choices when he does not have all the social data, such as how many children the woman has and what her home conditions are. On this ground alone, therefore, I commend the terminal date in New Clause 2.

This problem does not apply only to females. Another example that I should like to quote never affects females. That is the classic case of prostatectomies. The details of one case reached me only yesterday. They concern a hospital in the area of the Stockport Area Health Authority. Over the years I have had an interest in the National Health Service, and when these matters are before the public and the Press I get a large correspondence from all over the country. This letter is typical of a number that I have received since Second Reading.

The patient in question was referred to the hospital by his general practitioner in September 1972. Ten months later he went to the hospital and saw the specialist. Two months later he had the results of his X-rays. On 3rd January 1973 he saw the specialist with the results of his X-rays, and the specialist said that an operation was vitally necessary. Then there was dead silence until three weeks ago, in 1976, when a circular from the area health authority asked whether he still wanted the operation.

There is an atmosphere of unconcern which appals the layman. The majority of patients, as their name implies, have more patience than one would expect. They do not go worrying the doctor. If they are told that an appointment is to be made, they simply wait and wait.

After two years of agony, my correspondent had the operation done privately. He finishes with these words: I think the performance of the hospital shows a complete lack of consideration … so far as they know I am still in pain after 3¾ years waiting for the post every day for the call to go to hospital. By inserting a terminal date we will ensure that the phasing out of pay beds means that this kind of story will also have a terminal date and that the thousands of patients in these two categories will not find that the only way to get rid of their pain and anxiety is to jump the queue. If they do so, they may be jumping a queue of others in equal clinical need and perhaps worse social conditions.

In framing the new clause, I naturally looked to our debates in 1973 on the reorganisation of the NHS to see whether there were other ways of achieving my purposes. Alas, there are not. I agree with this conclusion: We trained hard, but it seemed that every time we were beginning to form up into teams, we would be reorganised. I was to learn later in life that we tend to meet any new situation by reorganising, and a wonderful method it can be for creating the illusion of progress while producing confusion, inefficiency and demoralisation. Apt as that might be to the 1973 Act, in fact it was said nearly 2,000 years ago, in 66 AD, by Petronius Arbiter.

Subsection (2) of the new clause is consequential on the subsection (1). Thanks to the noble Lord's compromise, we are erecting a massive machinery. There will be a board of five people trying to phase out 4,500 of the 500,000 beds in the NHS. There will be a Scottish Committee, a Welsh Committee, all the necessary civil servants, filing clerks, typists and offices to back up that machinery. If we can achieve the terminal date which I suggest, it seems nonsense to preserve that machinery at great public cost. No one is more anxious than Conservative Members to contain public expenditure. This machinery is needed for other purposes—other parts of the Bill deal with other important provisions —to ensure that private practice stands on its own feet without the taxpayer's help.

I hope that subsection (2) will ensure that we shall also phase out the costly machinery and revert to the Secretary of State to exercise responsibility under other parts of the Bill dealing with private practice carried on the back of When the last pay bed is phased out after two and a half years and these beds can be used particularly for the young chronic sick—at the moment there is a gross shortage of beds for such patients —these 3,500 would help to implement that part of the Chronically Sick and Disabled Persons Act 1970.

Without a definite date for the end of private practice carried on the back of the NHS, we not only extend the years of conflict and unrest and the tensions within the NHS between different sections of personnel—medical, ancillary and auxiliary—but we also set up a barrier to grappling with some of the far more important problems facing the NHS. These problems must be overcome if we are to give the kind of service that we all should like to see given to the sick and disabled, who need our help most. I therefore hope that the House will give the new clause a Second Reading.

Mr. Patrick Jenkin

I was a little astonished that the hon. Member for Brent, South (Mr. Pavitt), to whom we have listened with pleasure, should have sought to commend his clause to his right hon. Friend by saying that it bore the signatures of over 80 of his right hon. and hon. Friends. I should have thought that, after the events at Blackpool the week before last, the larger the number of signatures it bore, the less likely it was to commend itself to his right hon. Friend.

We are debating this Bill against the background of the most serious economic crisis we have faced since the war. There is no dispute that the crisis arises because of the huge Budget deficit which has to be covered by borrowing. There is no dispute that we needed a 15 per cent. minimum lending rate to be able to finance the deficit—although we seem to be back, after less than a week. to the level the pound had reached before that rate was imposed.

There is no dispute that there are nearly 1½ million unemployed as a direct consequence of inflation due to excess Government spending. Yet, within a couple of days of coming back after the recess, we are to plunge into a Bill which if implemented at once, is bound to take the Government further down that which my right hon. Friend the Leader of the Opposition in a magnificent speech last night referred to as the wrong road. By simply chucking away tens of millions of pounds which would otherwise have flowed into the National Health Service through the use of private beds, the Government are making the problems worse.

There is no dispute that there will be the loss of at least £20 million a year from the phasing out of pay beds. We believe that the eventual loss will be even higher —nearer the estimate of £40 million which was based on figures supplied to the House by the right hon. Member for Blackburn (Mrs. Castle). That is money paid to the National Health Service by patients who are ready and willing to finance their own treatment—in many cases through insuring with provident funds. In other words this is money which pound for pound reduces the burden on the Exchequer of financing the National Health Service.

The Government have been at pains to point out that it is not the National Health Service that will suffer from the loss of this money but that the loss will be made up out of Exchequer moneys. That makes the Opposition's case precisely. Because of the loss of pay bed revenue, Exchequer borrowing is higher than it need be. Against the hundreds of millions of pounds that the Labour Party is seeking to squander on nationalisation, North Sea oil, indiscriminate subsidies and so on, the tens of millions of pounds involved in this Bill may not be significant. But when every extra pound borrowed pushes up interest rates and has an effect on inflation—and of course inflation causes unemployment—we are entitled to say "For God's sake abandon the Bill". At least the Government should put it on ice until the immediate crisis is over.

The Chancellor's ship is sinking fast and if the Bill is put into effect on the basis of the planned timetable, it will simply punch further holes in a hull that is already leaking. On social, economic and financial grounds alone it is utter madness to proceed with the Bill at present.

Mr. Kenneth Lomas (Huddersfield, West)

On a point of order. Will the right hon. Member for Wanstead and Woodford (Mr. Jenkin) address his remarks to New Clause 2. He is making a Second Reading speech, which is out of order. It would be acceptable to the House if he referred to the remarks made by my hon. Friend the Member for Brent, South (Mr. Pavitt).

Mr. Jenkin

That may be acceptable to the hon. Gentleman but I am addressing my remarks to New Clause 4.

We are asking for at least Part II of the Bill to be put on ice. In a period of acute financial crisis the nation simply cannot afford this ridiculous piece of Socialist nonsense.

There are other reasons why Part II should be put into cold storage. There is no dispute that there is a crisis of morale in the National Health Service, not just among doctors but among many others who are responsible for providing the services upon which patients depend.

The Secretary of State has been frank. In an interview with the Health and Social Service Journal at the beginning of the month he said: I must make some contribution during my stay at the Department to improving the morale of staff in the health service.… the sense of commitment to patients has a much lower priority than it had. We have to go some way to recreate the spirit of commitment. But I do not want to put forward my ideas on how to do this yet. How could he put forward ideas when the Government are thrusting through this absurd Bill with its damaging effect on morale within the service.

4.45 p.m.

Another reason for putting the Bill on ice is that we are now facing a virtual standstill in the growth of resources going into the service. The service is, too, still suffering from the disastrous regime of the right hon. Member for Blackburn when she made the service a plaything of Socialist politics. I agree that reorganisation created some problems, but Labour hon. Members are quick to forget the pressure, discussions and negotiations that went on for years before the National Health Service Reorganisation Act 1973 reached the statute book. The situation is worsened now that that is to be combined with cuts in resources and the political shenanigans which the right hon. Lady played with the service.

The cuts are having severe consequences, particularly for the four Thames regions which are the hardest hit. I have two examples of what is happening and which illustrate why morale is so low. Yesterday I heard that the West Middlesex Hospital is currently closing 20 per cent. of surgical beds by removing the appropriate number of beds from each surgical ward. In the St. Mary's group of hospitals there is to be a withdrawal of all student nurses from 11 acute general medical and surgical wards. [Interruption.] I understand that hon. Members opposite do not want to hear the facts but they will have to. The withdrawal of student nurses will have a severe effect on teaching.

The examples that I have given are mirrored all over the country and are leading to despair in the service. What does the Secretary of State think will be the effect on morale if, after withdrawal, pay beds are closed down and do not become available to National Health Service patients? That is what is likely to happen as a result of the West Middlesex situation. There will not be enough money to keep open the 22 pay beds in the Ealing, Hammersmith and Hounslow AHA which are mentioned in the schedule.

Will that help morale in the service? What does the Secretary of State think will be the reaction of part-time consultants when they are told that there is no money to give them full-time consultancies? They will be without jobs or they will have to emigrate. Will that help morale? It is not surprising that the Secretary of State was coy when he told the Journal that he was not going to produce ideas for helping morale just now. These are compelling reasons for postponing phasing out. It does not make sense with the present resources of the service.

What about political interference? The Secretary of State was frank about why he replaced the right hon. Member for Blackburn. He was asked: How do you differ, politically, from Barbara Castle? He replied: Because I am less militant and do not stride into battle with so much gusto as Barbara, I may be less effective. She enjoys an argument whereas I don't like conflict. He was right. The right hon. Gentleman was brought in to restore peace and to try to bring back a little harmony into the NHS. Indeed, when he made a statement immediately after his appointment, he said: I shall never seek confrontation for the sake of a fight. I shall try to mediate and conciliate. Yet was he not desperately unwise not to see in his appointment an opportunity to drop the Bill and to try to do something to restore morale? Instead he let it go forward when he could scarcely have had time to read it.

We are now in a new ball game. The economic crisis is threatening, the NHS is having severe financial problems, and morale, on the right hon. Gentleman's own admission, is low. Surely this is the moment at which the Government might pause to consider whether they are not going down the wrong road. Can the right hon. Gentleman not even now recognise that by putting Part II of the Bill on ice he could do more for morale than by taking almost any other step?

There is a third reason—and here I come to the speech of the hon. Member for Brent, South. At no stage during the prolonged Committee proceedings were we given any convincing reason for the Bill. All we got, as we have had again today, was the same tired old Socialist complaints about queue-jumping.

The hon. Gentleman will remember that perhaps one of the most effective and constructive debates in Committee was on Clause 6, dealing with waiting lists and the proposal for the examination of common waiting lists. I am sure that all those who took part in the Committee will remember the profound analysis of the problems of waiting lists given by my hon. Friend the Member for Wells (Mr. Boscawen) in a speech which I am sure will be a source of guidance on these problems for a long time.

But throughout the debates on Clause 6, no Minister was unwise enough to seek to argue that the abolition of pay beds would have any effect at all on the waiting lists. Indeed, from the letter sent by the Department whilst the right hon. Member for Blackburn was Secretary of State we know that the Department does not seek to argue that it will have any effect on the waiting lists, because the waiting lists stem from wholly different reasons.

Mr. Ennals

The right hon. Gentleman is absolutely wrong. It is untrue to say that in Committee no Minister was unwise enough to argue that the abolition of pay beds would have an effect on the waiting lists. On the contrary, every Minister clearly indicated the view that the passing of the Bill would make a contribution towards easing the problem of the waiting lists by releasing resources. We did not make any false claims that the passing of the Bill would of itself, without other means, resolve the problem of the waiting lists.

The right hon. Gentleman has quoted the Department's letter ad nauseam. We have made our position clear. This Bill will make a contribution towards resolving the very heavy problem of the waiting lists. Quite apart from the fact that the passing of the Bill will make provision for common waiting lists, it will ensure that people will not be able to buy their turn in the queue in NHS hospitals.

Mr. Jenkin

The waiting list argument is entirely different. If we were confronted with a measure to deal with those abuses identified by the Select Committee, with a measure that would examine the feasibility of common waiting lists, in the meantime retaining all the advantages flowing to the NHS and its patients from pay beds, the right hon. Gentleman might have found himself with an agreed measure. Instead, he proposes to chuck the pay beds out of the NHS and to get rid of the geographical whole-time consultants and the rest, when there is no evidence beyond the hope—which is really all that Ministers are able to say—that that may make some contribution. If pay beds are to be phased out only to be closed down altogether, where is the advantage to the waiting lists or to NHS patients? On this issue, the hon. Member for Brent, South is much more concerned to do down Dives than to help Lazarus. He is more concerned about doctors' incomes than he is about the waiting lists of the patients.

I turn now to the question of abuse. There was a lot of reference to that in Committee. We disposed of it, very interestingly, in one brief debate on Clause 5, in which we exploded the argument that the Bill was necessary in order to prevent abuse. Clause 5(6) expressly preserves the provisions of Sections 1 and 2 of the Health Services and Public Health Act 1968. Section 1(6) of that Act says: Nothing in this section shall prevent accommodation from being made available for a patient … other than a private patient if the use thereof is needed more urgently for him on medical grounds than for a patient so mentioned and no other suitable accommodation is available. I asked the then Minister of State why that provision was not adequate to prevent abuse—not a question, I may say, ever asked in the Select Committee. I asked why it was not used. It is, after all, clearly in an Act passed by a Labour Government, and it provides that an NHS patient shall have priority if that is needed on medical grounds.

The Minister first answered a different question. He said that the process of phasing out could have been done without legislation, but I was not arguing that point. I was asking why Section 1(6) was not being used to prevent abuse. When pressed, the Minister gave an interesting answer. He said: Secretaries of State under successive Governments did not interpret subsection (6) in the way I believe they could have done."—[Official Report, Standing Committee D, c. 744. 8th July 1976.] With that one sentence the whole argument that this Bill is necessary to deal with abuse goes out of the window. It is wholly destroyed. So that is the answer to those who say that we have to have this Bill because it is necessary to deal with abuse.

Then there is the argument about the trade unions. I shall deal with the question of what the trade unions really think about the Bill. I accept that the activists in the trade unions, those who attend meetings and conferences, and their leaders, remain resolutely opposed to independent practice remaining in the NHS, but I question whether that view is representative of the ordinary members of the unions concerned.

I quote one or two figures taken from a poll conducted by NOP, whose validity has not been impugned in any way. It is a highly professional survey of opinion based on a probability sample survey. I read it out in Committee and I shall not read again all the conditions under which the survey was taken. The question was asked: Do you feel that the number of beds for private patients in NHS hospitals should be … and the options were whether it should be increased, greatly increased or remain as it was, or whether it should be decreased, greatly decreased or removed altogether.

Of the members of NALGO interviewed, 71 per cent. said that the beds should remain as they were or be increased, while only 29 per cent. said that they should be decreased or removed altogether. Of the NUPE members interviewed, 62 per cent. fell in the first group and 30 per cent. in the second. The ASTMS members interviewed were even more extreme, for 74 per cent. of them agreed that the number of pay beds should either be increased or remain as it was, and only 16 per cent. felt that the number should be decreased or that the beds should be removed altogether. These figures are so overwhelming that those trade union leaders who profess to argue on the basis that abolition is what their members want are simply talking through their hats.

5.0 p.m.

Mr. Doug Hoyle (Nelson and Colne)

Who commissioned the survey? Is the right hon. Gentleman prepared to take the views of whoever commissioned the survey rather than the views of members expressed democratically through their trade unions?

Mr. Jenkin

Of course, it was commissioned by the Campaign for Independence in Medicine. [HON. MEMBERS: "Oh".] All right, but is the hon. Member for Nelson and Colne (Mr. Hoyle) saying that a highly professional organisation such as National Opinion Polls would fiddle the results to suit its clients? I concede at once that, if the results did not suit the client, we should not have heard of them, but if the hon. Gentleman is seriously saying that NOP has fiddled the results to suit its clients, I invite him to say it outside.

Mr. Hoyle

I invite the right hon. Gentleman to say whether he is prepared to take the views of the survey rather than the views of the members of trade unions expressed democratically through their annual delegate conferences. I ask that question again.

Mr. Jenkin

If the hon. Member is sincerely saying that the views of delegate conferences represent the views of the members of their unions, he can try to persuade some of his hon. Friends of that, but he will not convince us.

Again and again the views of the great mass of members of the unions are not represented by the activist leaders. I am quoting the polled opinions of individual union members. The opinion survey even asked the political affiliations of those who were questioned. The same questions were put to those who professed to be Labour supporters—"Should the number of beds be increased or stay the same, or be reduced or taken out altogether?"—and in that case 54 per cent. said that the number should remain as it was or be increased and only 39 per cent. said that it should be reduced.

Plainly, therefore, hon. Members on the Government side do not even speak for their own party, because people outside realise the madness of what they propose. The result was the same with all the other questions. When the specific question was put as to whether people agreed with the proposals of the right hon. Lady the Member for Blackburn to phase out 1,000 beds, the figures were even more remarkable than those I have already given.

All this adds up to an overwhelming case against proceeding with phasing out now. The country cannot afford the cost. The National Health Service cannot afford the loss of revenue. The policy is gravely damaging morale throughout the National Health Service. There is no evidence that it is in the interests of health service patients either on waiting lists or in relation to abuses of the scheme. Moreover, there is no evidence that the policy has the support even of those whose organisations are calling for it most loudly.

There must be time for the whole question to be considered by the Royal Commission as part of its study of the finances and manpower of the National Health Service. The Government have had opportunity after opportunity to get themselves off the hook on which they hung themselves in their 1974 manifestos. The right hon. Member for Huyton (Sir H. Wilson) had an opportunity when he announced the appointment of the Royal Commission on 20th October last year. There was another opportunity during the crisis talks at No. 10 Downing Street which led up to the Goodman compromise. There was an opportunity after the CCHMS ballot in February this year which showed an overwhelming majority of consultants against the two main proposals in the Bill.

There was another opportunity when the present Secretary of State took office. He could have asked for time for thought as to whether he ought to proceed with such a divisive measure. There was an opportunity when it became apparent in July that only through the unprecedented use of the guillotine procedure combining five Bills in one motion could the Government save their legislative programme.

In New Clause 4 we are now giving the Government another opportunity. I ask the Secretary of State to seize it, to accept New Clause 4, to put Part II on ice and to let the Royal Commission have a look at it.

Mr. Lomas

I have not entered the debate with any prepared notes. I have always assumed in the time that I have been in the House that the right hon. Member for Wanstead and Woodford (Mr. Jenkin) has been a rational and reasonable human being, but what we heard from him today seemed to be touched by the winds of Brighton. Indeed, even his Leader got mixed up between Blackpool and Brighton, and I am not sure sometimes which conference she was at.

It seems to me that New Clause 2, moved by my hon. Friend the Member for Brent, South (Mr. Pavitt), makes admirable sense. I am not speaking entirely on behalf of my own union, the National Union of Public Employees. I accept most of what it says, but I recognise also that I have an obligation to my constituents, to my constituency party and, indeed, to the House to speak the truth. I believe that the time is right for private beds in the National Health Service hospitals to be abolished. That seems to me to be the right thing to establish.

I appreciate also, from personal experience over the last two and half years, the tremendous amount of hard work that is done by junior doctors and consultants, and I respect their request for clinical judgment and freedom in dealing with the many problems that come before them. I hope that we on the Government side recognise that fact and that they are entitled to exercise their judgment as they think fit. But the proposal in New Clause 2 is simple, that If the Board under the provisions of this Act have not submitted to the Secretary of State by 1st January 1980 —that is four years hence— proposals for the complete withdrawal of National Health Service facilities from private patients, then: (1) Notwithstanding the provisions of this Act for securing the progressive withdrawal of accommodation and services at National Health Service hospitals from use in connection with the treatment of persons at such hospitals as resident or non-resident private patients, the Secretary of State shall not later than 1st January 1980 reduce to nil the number of beds authorised under section 1(1) of the 1968 Act to be made available to resident private patients. As I say, that seems to make sense. Why should we not move with the times? I shall not drag in the hoary old argument which the Opposition have heard from us many times, true though it may be, that it was they who, in the late 1940s, voted against the introduction of the National Health Service to begin with.

Mrs. Jill Knight (Birmingham, Edgbaston)


Mr. Lomas

I need no interruption from the hon. Lady, because we see that the Conservative Party has now come round to the point. However, I give way.

Mrs. Knight

I am obliged to the hon. Gentleman. Is he aware that Mr. Aneurin Bevan at that time gave a solemn pledge and promise that the treatment of private patients would be allowed in NHS hospitals?

Mrs. Renée Short (Wolverhampton, North-East)

A long time ago.

Mrs. Knight

It was the hon. Gentleman who referred to it, not I.

Mr. Lomas

The hon. Lady may be described by Andrew Roth as a "cuddly toy", but in my opinion she is totally misleading the House. When Nye Bevan introduced the National Health Service Bill, he made perfectly clear at that time —one has only to look back at the various volumes of Hansard—that in order to get the co-operation of the doctors working inside the health service he made a compromise and said that there should be a limited amount of private practice allowed under the National Health Service Act itself. Fair enough. I am now saying that, 30 years on, the time has come to look at this again. We should now question whether it is right that public money should be put into the National Health Service and at the same time there should be people who gain advantages in terms of private practice.

As I say, I fully appreciate the right of consultants and doctors to have freedom of clinical judgment in their cases. I am not against private practice, but I am against private practice being operated inside the National Health Service as such.

However, there is a dilemma here. If we say that private practice should be divorced from the National Health Service, and if as a consequence there is the building of new hospitals or private nursing homes—whatever they may be—we have to face the possibility that the best doctors and the best consultants may be attracted from the public sector to the private sector. I do not want that to happen.

The vast majority of people who enter hospital are entitled to, and receive, the best clinical treatment and judgment that can be given by doctors, nurses and consultants. The proposition in New Clause 2 is perfectly reasonable. We are giving four years in which to phase out private practice from National Health Service hospitals. I do not think that we have present any hon. Member representing CHSE, which sought to insert 1978 instead of 1980 in Amendments (a) and (b) to New Clause 2.

That is a pity. Private practice in itself may be all right, provided it is carried on outside the NHS and does not create a two-tier system, which is what worries me. If I had my way, in a perfect world there would be only one kind of health service, open to all, in which doctors, consultants and nurses work for the good of the community and people had no longer the right to buy good health.

I have spent some time in hospital over the past two or three years. I was treated as an emergency case, as someone who had to be taken into hospital, not because I was a Member of Parliament. That is what the NHS is all about. We rightly say that if a person's needs are such that he should be treated we shall deal with him and he will have the best assistance and advice from consultants and doctors, and this I believe to be true.

I cannot understand the right hon. Member for Wanstead and Woodford, who has led the opposition to these proposals, arguing that New Clause 2 should be ignored. Is it not right that 30 years on we should think of making the NHS what its title says it is—a National Health Service, for the good of all?

I accept the Goodman proposals. My union probably will not like my saying that, but I am prepared to tell it and the House the facts of life. I accept the proposals because I do not see any way out of doing so. We could play clever and put down many amendments which would no doubt please Alan Fisher and the whole of the NUPE executive. They would say what a marvellous job I had done. But I do not want to do it, because the amendments would not be passed. I have been in politics since 1937, and have a great deal of experience —more experience of politics than many trade union leaders, quite apart from Conservative Members.

5.15 p.m.

I agree with my right hon. Friend the Secretary of State that the Goodman proposals are in line with what the Labour Party said it would do. They mean the beginning of the phasing out of pay beds. It seems to me logical to carry that process to its conclusion by New Clause 2, on which I hope the House will divide, by saying that by 1980 there shall be no private patients in National Health Service hospitals. That is a legitimate step forward. Without it, we are standing still. The hon. Member for Birmingham, Edgbaston (Mrs. Knight), who is known in the House and outside for various views, must accept the logic that as we advance as a nation, we advance in our concern for the aged, the sick the weak and the feeble.

Let us be sensible and stop being bloody politicians. Like it or not, the fact is that we shall accept the Goodman proposals. No matter what great speeches are made from dizzy heights at Blackpool or Brighton, on this side of the House or from the Opposition Benches, a thousand beds will go and 3,500 will then go to a commission to decide where they will end up. We are saying in New Clause 2 that by 1980 they must all go.

The House should accept the arguments and, when the Division comes, recognise the inevitability. We should recognise that doctors, nurses, junior doctors and consultants have a right to be consulted on the matter, and we have four years in which to do it. But let us not create a two-tier system, a first-class and second-class health service. We do not want that. Let us create one service that is good for everybody. Let us say that those who need operations or other assistance shall receive it as of right and shall not have to wait. Let us have a common waiting list. That is an eminently sensible proposition. If necessary, I am prepared to be a Teller for a Division on New Clause 2 if my hon. Friend the Member for Brent, South cares to put it to the vote.

Mr. Paul Dean (Somerset, North)

I agree with some of the points made by the hon. Member for Huddersfield, West (Mr. Lomas), but I find it difficult to agree with many of his conclusions. However, the whole House is pleased to see him back after his illness, in good voice and addressing the House on the Bill.

Yesterday's debate on the economy was at least relevant to the grave problems facing the country. Today and for most of the next four weeks the Government intend that we shall spend most of our time debating Bills which are totally irrelevant to the economic crisis, Bills which will aggravate our severe economic problems and divide and distract the nation, when the Government should be giving a lead for a united national effort. I suppose that after Blackpool it is too much to hope that the Government will listen to the nation, that they will govern in the national interest and put aside divisive legislation instead of being led by a Left-Wing minority. If they will not do that, at least they should recognise that after long months of debate they have failed to make out a case for the Bill. If they dare not abandon it for fear of the wrath of Blackpool, they could postpone it, as New Clause 4 suggests.

We are told that there is a mandate for the Bill and that therefore it must proceed, but since when have fewer than 30 per cent. of the electors constituted a mandate for a Bill? What about the evidence in recent opinion polls which shows that a large proportion of people, including Labour supporters, are opposed to the Bill? What sense of responsibility can there be in bashing on, regardless of changed circumstances and the economic crisis?

The main reason why Part II should be postponed is that it will aggravate the pressure and problems facing the National Health Service. We are not talking in the Bill only about private patients and about private practice. We are talking about the future health or ill-health, the future strength or weakness, of the National Health Service and of National Health Service patients.

What does the National Health Service need above all else? It needs money and it needs skilled men and women. But our case, which has never been answered by the Government, is that it will lose on both these counts as a result of the Bill.

It is beyond argument that the National Health Service will lose tens of millions of pounds of revenue from private patients as a result of the Bill, at a time when the National Health Service is more short of money and when the prospects of getting money are more gloomy than for many years.

But it is not only the revenue from the private patients at home that is involved. There is also the loss of revenue from patients from abroad. This is an aspect on which it is extremely difficult to put a figure, but it is absolutely sure that the loss of revenue from patients both at home and abroad will deprive the National Health Service of much-needed money.

Another aspect on the financial side, which was discussed at some length in Committee, is the effect of the Bill in diminishing the valuable source of donations and the like which at the present moment go into education, into training and into research. When we probed in Committee as to the likely effects of the Bill on money going into research from grateful patients and from other private sources, and asked the Government how much they felt would be lost in this respect, they had to admit their ignorance—that they simply did not know how much would be lost.

The evidence that we were able to produce from those running the medical schools of Britain suggests that here is another loss of revenue which will be bad for the National Health Service, bad for National Health Service patients, and which could well have a serious effect on the future of research, which is so important for the National Health Service.

Then there is the effect on skilled men and women—a point which the hon. Member for Huddersfield, West mentioned a few minutes ago in his speech. Here we have to remember that medicine is international. Thank goodness, one of the things in which our country is still world renowned—and justifiably so—is the quality of our medical schools. A doctor trained in this country, if he finds that conditions here are not suitable to him, can emigrate and command a good job in any country of the world. including advanced countries such as the United States or Canada. Many British doctors are holding down key positions in those countries and gaining key positions because of their training in this country.

Medicine being international, we cannot hold skilled medical manpower here unless it wishes to stay. If the conditions are hostile, and there is a fear that clinical freedom will be put into second place and political considerations put into first place, these skilled men will emigrate. They will go where their skills will be better appreciated, and where they feel they can use them to the benefit of their patients without extraneous political considerations being introduced. This is all linked with the crisis in morale, to which my right hon. Friend the Member for Wanstead and Woodford (Mr. Jenkin) referred a short while ago.

A third aspect of importance concerning the men and women in the service is the most effective use of their time. One of the arguments that we have put time and time again during the passage of the Bill is that once the National Health Service patients and the private patients are separated, and have to be treated in different buildings, probably miles apart, there will be less effective use of skilled and scarce medical manpower because of the travelling time and other factors involved.

This is an area in which I disagree with what the hon. Member for Huddersfield, West said. He maintained that if the Bill is passed and pay beds are phased out, we shall no longer have two different standards of service. I suggest to the hon. Gentleman that the opposite is likely to happen, and that we shall have different standards building up. Rather than having the services collectively used for the patients as a whole, we shall find barriers and divisions building up which do not exist at the present moment. Therefore, from a very similar premise to that which the hon. Gentleman put forward, I draw the opposite conclusion.

My final point concerns the Royal Commission on the National Health Service. The Secretary of State who is now in charge of the Bill took it over at a very late hour. It was virtually published when he took over, and it is understandable in many ways that he could not go back on a process which had already gone so far. But at least now the Secretary of State has the opportunity to postpone this legislation in order to give the Royal Commission a real opportunity to look at the whole question.

It is clear from the terms of reference of the Royal Commission that the matters we have discussed during the passage of the Bill are relevant to the inquiry. I therefore appeal once again to the right hon. Gentleman to use the opportunity to enable the Royal Commission to consider the question in its entirety. I appeal to him to recognise that in present economic circumstances it would be an act of folly, and bad for the National Health Service and for the National Health Service patients to proceed at this time with this divisive legislation.

Mr. Stan Thorne (Preston, South)

It was most unfortunate that the right hon. Member for Wanstead and Woodford (Mr. Jenkin), in opposing New Clause 2 and advocating New Clause 4, found it necessary again to refer to my right hon. Friend the Member for Blackburn (Mrs. Castle) and the role she has played in regard to the National Health Service. It must be recognised, and has been recognised from time to time in the House, that in the debates which have taken place in the Cabinet over the past two years concerning the level of public expenditure, the right hon. Lady has put up a tremendous fight within the Cabinet to protect the National Health Service from the cuts that the Government wished to impose upon it.

In the period since 1948, for about half the time the Conservative Party has been in power, and for the rest of the time the Labour Party has been in power. I believe, along with a number of other hon. Members, that neither party has anything to be particularly proud about concerning the allocation of resources to the National Health Service. But, if we compare the performances of the Conservative and Labour Governments during this period, we are forced to the conclusion that the Labour Party has protected the National Health Service far better than the Conservative Party has done. In this regard the right hon. Lady has done a tremendous job.

Mr. Pavitt

I am grateful to my hon. Friend for giving way to me because the right hon. Member for Wanstead and Woodford (Mr. Jenkin) made a swingeing attack upon my right hon. Friend the Member for Blackburn (Mrs. Castle) and then refused to give way. However, I am delighted that my hon. Friend the Member for Preston, South (Mr. Thorne) has put the record straight. We had an increase of £880 million under my right hon. Friend the Member for Blackburn, and we went up to 5.4 per cent. for the first time. Even with the cuts which have now been announced, we are to have £6,500 million for the National Health Service, and a good deal of the credit for that must go to the present Secretary of State and to my right hon. Friend the Member for Blackburn.

5.30 p.m.

Mr. Thorne

I am indebted to my hon. Friend the Member for Brent, South (Mr. Pavitt) for putting that on the record. It is essential to get some of these matters on the record so that people understand the arguments.

I was saying that the right hon. Member for Wanstead and Woodford was being perfectly reasonable when he argued that the present economic situation was relevant to any decision of this House in favour of New Clause 4. He was right to bring in the public expenditure cuts. However, some of us are entitled to remind him that those, paradoxically or coincidentally, who are now interested in the progress of this Bill have also been extremely concerned about these public expenditure cuts. In fact, we have argued against the cuts in the National Health Service when he and his party have been advocating higher cuts in the services. I shudder to think where we would have been had they been involved in applying those cuts.

Mr. Patrick Jenkin

Perhaps I might be allowed to repeat what I said to a conference of the Institute of Health Service Administrators. In the consideration of public expenditure which we on this side of the House are giving, we are not currently looking for further cuts in spending in this area. It is true that we have in mind charges, as I am sure, does the Secretary of State, and we shall no doubt consider them in relation to the problem of motor insurance. But at the moment we are not looking for cuts. The National Health Service needs all the resources that it can get.

Mr. Thorne

I hope that I shall be forgiven for suggesting that some of the speeches made by Opposition Members outside this House are not quite like those which they make in this Chamber. I have distinct recollections that their party would slash the social services, the health service, housing and various other sectors far more viciously than this Government have done, and we on the Government side of the House have at least been consistent in our criticism of the Government in respect of public expenditure cuts.

My chief interest is in New Clause 2, and I hope that the House will divide upon it because it seems to me that the Government are on the wrong course. I understand the position of my right hon. Friend the Member for Blackburn. I appreciate that she may find it difficult to follow others of us into the Division Lobby in favour of New Clause 2. However, it seems to me that it is consistent with our view about public expenditure cuts to argue in favour of the new clause.

Put in simple terms, pay beds mean privilege for an elite in our society. They mean access to treatment via the cheque book. When Aneurin Bevan set up the National Health Service, he had in mind a free health service in times of need. To a great degree, he bought that by accepting pay beds within the health service, and in my view he regretted ever having done so. I believe that the job on which we are engaged at present is putting right that piece of blackmail which occurred at that time.

The Opposition, consistent with their general practices, are trying to protect the profits of the consultants in the health service. Their concern for the patient is revealed by the discussions that we had in Committee on this question.

For me, common waiting lists mean that there can be no queue-jumping. Queue-jumping takes place among people who are able to go to a consultant and pay £200 or £300 to get a hospital bed. Everyone knows that it takes place. It has occurred in my own constituency in the past few weeks.

My hon. Friend the Member for Huddersfield, West (Mr. Lomas) spoke about private medicine. I regret that private medicine is not really at issue in this Bill. To some degree the Bill tends to institutionalise private medicine. I should like to erase private medicine altogether. Others of my colleagues would like to maintain it. So long as we have a position in education, in health or in any other sphere where access can be obtained on the basis of wealth, we shall have the sort of class divisions that we see in our society today and the poor will always find it difficult to get their rights.

It seems to me, therefore, that private medicine, private schooling, private this and private that should be opposed on moral grounds as well as on political grounds. It is with those considerations in mind that I hope that there will be a considerable vote in favour of New Clasue 2.

Lord James Douglas-Hamilton (Edinburgh, West)

It is always refreshing to listen to speeches by the hon. Member for Preston, South (Mr. Thorne) because we always know exactly where we stand with him. He has made his position perfectly clear. He would like to see the end of the private health service. However, when he touches on the question of cuts, he puts his finger on the nub of the whole matter because in Scotland today, for example, we find that these cuts are hitting very hard in certain areas, especially in Strathclyde, where home helps cannot be provided and where this is a very sore point in that area in which 2 million people live. I suggest to the hon. Member for Preston, South that throwing away an enormous amount of income will not help the National Health Service.

The Opposition are not opposed to the principle of the creation of a common waiting list. Certainly none of the representations which I have received from medical practitioners in Scotland has objected to the principle of a common waiting list. What they object to is the throwing away of a great deal of income at a time when cuts are biting very hard.

It is only fair to mention that during the Committee stage of this Bill a Scottish Office Minister was always present. I notice today that there is no Labour Member present in the Chamber who represents a Scottish seat. Since Scotland is very much in issue and since health has not yet been devolved to a Scottish Assembly, I think that it is only right that a Scottish Office Minister should be listening to these debates.

Scotland has 5.3 per cent. of the pay beds in Britain. The plan at present is to phase them out at a rate of roughly 50 a year, which would mean that within five years all the pay beds in Scotland would have disappeared. In 1974–75, the income from those beds was £536,749. In a Parliamentary Answer on 21st June, a Scottish Office Minister confirmed that the cumulative annual loss would eventually amount to £450,000. Taking inflation into account, I suggest that in five years the cumulative annual loss will be in excess of £600,000. Besides that, the running costs of the Scottish Committee in the first year will be £25,000. A similar sum will represent the costs of the Welsh Committee. The Health Services Board itself will cost £205,000 in the first year of operation. So, we shall have additional public expenditure of £225,000, and in Scotland alone we shall eventually have a loss of income amounting. to £600,000.

If we had an abundance of money, this would not matter so much. But we do not. I have pointed out already that home helps have been cut out in Strathclyde. There is strong feeling about massive unemployment in Scotland and the inadequacy of the job creation programme I would suggest that these are excellent reasons for delay as these measures will have detrimental effects. They will mean more public expenditure, more taxation, and probably a deterioration in service, because contrary to what the Secretary of State has suggested I cannot help believing that many people who are using the private health service will opt for the National Health Service, and thus waiting lists wil become longer.

The British Medical Association, Lothian Branch, said in Edinburgh that the concept of complete separation of private medicine and the National Health Service was quite alien to the willingness of consultants to discuss NHS problems at all times, both in private consulting rooms and at all other times when they were available in hospitals to deal with NHS patients. Clearly the hon. Member for Preston, South would like to see the end of part-time consultancy. But he is at loggerheads with the Secretary of State because part-time consultancy is safeguarded in this Bill. This upheaval in making part-time consultants less readily available to deal with NHS patients could lead to a deterioration in services.

I think that it was Nye Bevan who said that the language of priorities was the religion of Socialism. In looking at these priorities we should bear in mind what the Chairman of the Scottish General Medical Services Committee of the BMA wrote recently: We consider that the Act as tabled could be used to create a monopoly by the State of health care provisions in Scotland—perhaps not now, but at a future date. This Bill cannot do anything but harm to the people of Scotland and the Health Services which they receive. For these reasons postponement of the Bill can do nothing but good.

5.45 p.m.

Mr. Ron Thomas (Bristol, North-West)

I welcome the opportunity to speak in favour of New Clause 2 and I very much hope that it will be carried. I hope that the Government have had second thoughts, and that when the Minister replies he will accept the new clause.

I was not a member of the Committee on this Bill but I have listened with interest to those who were. As far as public expenditure is concerned, this argument has been exposed by my hon. Friend the Member for Preston, South (Mr. Thorne). However, I, too, emphasise that I doubt very much whether there has been any increase in real terms, if we take out the cost of reorganisation of the NHS and of local government, in the provision of resources for these two areas of public expenditure.

On many occasions I have tried to get information from the Secretaries of State concerned about the kind of index or indices they use to arrive at decisions on increases in real terms. It is no good taking the index of retail prices because, in particular, part of the NHS increased prices or commodities, including expenditure on capital equipment and so on, differs very much from the simple index of retail prices. I doubt whether there has been any increase at all in real terms.

My hon. Friend the Member for Preston, South is right to emphasise that the Tories continue to insist on cuts in public expenditure of anything between £5 billion and £10 billion. They keep on about this continually, but whenever attempts are made to pin them down on the particular services which they would cut—the social services and social workers, the National Health Service or education—they shy away from making any clear commitment or decision. The Shadow Chancellor keeps saying that he would look at each one of these items.

I hope that there are very few Members of the House who continue to support the abhorrent and even obscene practice of queue-jumping. We all have constituents who come to us and say that they have been to their doctors and have found that they are suffering from a whole range of serious or painful complaints. They are told that, while they cannot get into a National Health Service bed for two or three years, if they can pay they can get into a private bed next week. Can anyone in this House support that kind of system? Bed availability should be based clearly on the need for medical treatment and not on whether a patient can afford to buy private or quasi-private facilities.

It is no longer the case that only individuals are buying these private facilities. It is firms up and down the country which are buying them for their managers, executives and others whom they wish to keep out of trade unions—their selected few. And it is the consumer of their products who pays for the bed. One gets the impression that many managers and directors go into hospital for a week to recover after having many heavy business lunches or a night out on the binge. This is becoming a growth industry—it is about the only one we have. One has only to see the advertisements from BUPA which are aimed at companies. They say "Protect your manager and protect your executives." This is so that these people can hop in and out of hospital when it pleases them.

Another appalling part of this is, in my judgment, that there would be no private health services whatsoever if there was no NHS. It is because private medicine uses the facilities of the NHS, the back-up services and the expensive capital equipment, that it can survive for one minute.

I was employed at a university, and I wonder what the ratepayers would have thought if I, in my capacity as a lecturer at the university, had said that I was going to select one or two of my students and use the facilities of the university to give them private coaching—they would be paying me, of course—in an attempt to get them a first-class honours degree.

Mr. Robert Kilroy-Silk (Ormskirk)

My hon. Friend is quite right to point out that a lot of the NHS facilities are used for private medicine, but it goes much further than that. A report of this House shows that there have been serious allegations of consultants mis- appropriating machinery, equipment and facilities from NHS hospitals for use outside in their private clinics.

Mr. Thomas

My hon. Friend is quite right. That is a further indictment of the system. My own union, ASTMS, which has many members in the National Health Service, continually complains about this kind of situation where public resources are used for private profit. Why stop with the NHS? Why should not firemen select the fires they go to, or police select the break-ins they attend, and keep a few on the side to deal with privately in order to add to their incomes? One could go on giving such examples ad nauseam.

Lord Goodman has been mentioned in the debate. Many of us are becoming worried about the influence he seems to have over legislation. Apart from this Bill, he came up with a compromise on the Trade Union and Labour Relations Act. We wonder what will come next. I do not know whether there is any truth in the rumour that he may be heading some kind of national Government. That is always a possibility.

Many Labour Members are concerned that the Bill will give legislative respectability to the growth of private medicine in Britain. We fear that it will enshrine in legislation the principle that there should be a private sector. We talk about attempting to control that private sector, but many of my hon. Friends and I maintain that we are not in politics or in the Labour Party to foster a private sector for medicine. We ask my right hon. Friend the Secretary of State once again to reconsider this provision, because many of us feel unable to support legislation which clearly states for the first time that the principle of a private sector in medicine should be supported and that it will be supervised in some vague way.

Mr. David Crouch (Canterbury)

We never ignore the passion which comes from Labour Members sitting below the Gangway. It is obviously seriously meant, even if sometimes, as was the case with the speech by the hon. Member for Bristol, North-West (Mr. Thomas), it seems to make nonsense of the actions of those who are trying to help the National Health Service. Nevertheless, I understand the passion that lies behind devoted Socialists in these matters.

No one in this House is prepared to support queue-jumping, but it seems that members of the Tribune Group believe that they are the only ones who can argue passionately against it and take opposition to it as their creed. That is where they are wrong.

Let me now deal with the Secretary of State. I pay him the compliment of saying that it is very pleasant to make a speech from the Back Benches and to find the Secretary of State still in his place. Without robbing him of any dignity or status, I must say that it is equally pleasant to see his predecessor the right hon. Member for Blackburn (Mrs. Castle) sitting two rows behind him. The Bill has a great deal to do with both the right hon. Lady and the Secretary of State.

I have to stop and think where I am when I hear an hon. Member as responsible as the hon. Member for Brent, South (Mr. Pavitt) putting forward the arguments we heard this afternoon when he introduced the new clause. It has nothing to do with the basic intentions of the Bill as originally devised and presented to the House by the right hon. Lady. To use an old-fashioned word, I believe that the hon. Member for Brent, South is trying to hornswoggle us. That word, which dates from the 1920s, means to practise a form of deception. It is perfectly parliamentary and respectable and it describes exactly the hon. Member's actions today. He is trying to overturn three months' work in Committee upstairs. The Committee engaged in serious discussion extending over 28 sittings, but in spite of that discussion the hon. Member has introduced a clause which seeks to hustle the House into doing something which was not agreed upstairs.

The hon. Member is perfectly entitled to produce a new clause on Report, but his proposal today is not in line with the right hon. Lady's intentions. She underwent great trials before she brought the Bill before the House and argued it so forcibly. She had to accept the compromise put forward by Lord Goodman on 15th December. I do not think she liked that compromise, but she is a sufficiently distinguished parliamentarian to do so. She said in the House in April this year, in describing how far she had been prepared to go in meeting the arguments of the doctors, and particularly the consultants, about the phasing out of pay beds, that she had accepted Lord Good-man's proposals. She added There is in this legislation the essence of a reasonable compromise".—[Official Report, 27th April, 1976; Vol. 910, c. 242.] At the end of her speech, the right hon. Lady reminded the new Secretary of State in very strong language that he should not go any further down the line of compromise suggested by Lord Goodman. She said that she would be watching him every inch of the way in Committee, in the House and elsewhere. It was the Secretary of State's first week in office, and her action was an interesting reminder of the power of former Ministers and of Back Benchers.

The right hon. Lady did not suggest that she would renege on her agreement with Lord Goodman. The hon. Member for Brent, South, however, is saying that he is dissatisfied with what was done in Committee. He said today that he had studied the early proceedings in Committee, and he referred to there being 3,500 beds in question. The figure is not as high as that, but, whatever might be the residue of beds to be phased out by agreement under the Goodman proposals, the hon. Gentleman is not satisfied with the arrangement. He wants matters hustled forward. The Government are being asked to forget the responsible delay which was built in during the long discussions and negotiations with the consultants.

I am concerned that the new clause is not only contrary to what the House intended when it voted for the Bill on Second Reading but is not what the House and the public understood the Bill to provide. The Secretary of State never intended that these 3,500 extra beds should be hustled out of the National Health Service. That was not what the former Minister of State intended when he spoke in Committee about his intention to create peace again in the service. To hustle these beds out now without further consultation, or without enough consultation, would not be a step towards creating peace in the service.

6.0 p.m.

Mr. Ennals

Surely part of the purpose of Report stage is to give Members who are not satisfied with what has happened in Committee the opportunity of putting forward their proposals. If it were to be suggested that we should not now be discussing anything which was not intended when the Bill first came to the House, I should have to say that almost all the Opposition's amendments should be withdrawn. I suppose that that would be satisfactory in that we could finish by supper time.

Mr. Crouch

In a way, I stand corrected by the Secretary of State. If I gave the impression that I do not think it right to bring forward amendments and new clauses on Report, I stand corrected. I do not object to that being done, but we are having a debate about a legitimate parliamentary procedure for bringing forward a new proposal. It is a different proposal from that which is written into the Bill. It is a different idea from that originally suggested by the former Secretary of State and agreed with the consultants, using Lord Goodman as an intermediary.

In the early days of the proceedings in Committee, the former Minister of State said: The limitation that the Bill imposes on the Secretary of State is that he can phase out no more than 1,000 beds, and that this power should be exercised within six months of Royal Assent. A little later he said: Where the Secretary of State is circumscribed under this legislation is that within any area health authority he cannot take out any more beds than are within the schedule. There is that limitation."—[Official Report, Standing Committee D, 18th May 1976; cc. 26–27.] That was accepted at the time by Labour Members. That is how we understood the Bill was to proceed. Now it is proposed that something entirely different should be added. I have described it as a hustling measure. My right hon. Friend the Member for Wanstead and Woodford (Mr. Jenkin) has spoken to New Clause 4, which tries to do the very opposite.

The House knows that I work in the National Health Service as one of those much-disliked persons have have been appointed or nominated by the Secretary of State. My nomination was not cancelled by the right hon. Member for Blackburn. Indeed, it has recently been reinforced by the present Secretary of State.

Mr. Ron Thomas

My right hon. Friend the Member for Blackburn (Mrs. Castle) is a member of the Tribune Group.

Mr. Crouch

The right hon. Lady does not make mistakes like that. She must have liked me. At least, I hope she did. I have not yet said anything unkind about her. I have not even said that she has hornswoggled me.

My right hon. Friend the Member for Wanstead and Woodford, in speaking on New Clause 4, left me with the understanding that his objectives are entirely the same as those of the former Minister of State. The right hon. Gentleman wanted, as I want, to see peace established again within the service. In fact, we are getting very nearly back to peace in the National Health Service. I am talking not only about consultants but about all those who work in the service.

The proposal contained within the new clause is very different from the intentions of the Bill. The clause seeks to hustle something through at the last minute. That attempt is made during the last stages of the Bill's progress through Parliament. I believe that it could do incredible harm in disturbing peace in the service. It would be seen by those within the service not as a legitimate parliamentary device but as something that is wrong, and even a deception. They would see it as a breaking of the word that was given at an earlier stage.

Above all, we need time for the contentious proposals that lie behind the Bill itself to be received and for a settling-down period. I am not seeking to scrap the whole proposal contained in the Bill, although I do not like the idea of removing some 4,000 or so pay beds from the 500,000 beds within the service.

I have always said—I said it on Second Reading—that the Bill will have a disruptive effect within the service. I have said that it could be positively harmful to our already disturbed service. I do not believe that the addition of 1,000 beds, or even 4,000, will help the waiting list problem. I recognise that this problem will have to be considered. I admit that I say this from a position that is many times removed from that which is occupied by many of those in the service—namely, as an administrator in a regional health authority.

Quite honestly, the addition of 113 beds in the region where I work would not make any difference. It would be a drop in the bucket. I can understand that some people think it will have a psychological effect, but I am talking about the real effect. At this stage, 1,000 beds are what might be termed peanuts. There are many more things that have to be done in the service. Indeed, the NHS is about to undergo its greatest trial of all—namely, the real cuts now being imposed on it.

We must recognise that the cuts are now operating. It is not right for anyone to suggest that the cash limits are not yet being applied throughout the service. The directive has come from the Secretary of State. He means business. However, after a few more Cabinet meetings I am certain that he will be given still further cash cuts to make in the service. Those of us who work in it dread the day when we have to implement those cuts. We dread what they will mean. That is a trial that the service will have to go through in the next few months, and perhaps over the next two or three years.

All those who work in the service, whether nominated persons such as myself who sit at the top of a region or consultants, nurses, ancillary workers and porters, will be fighting to continue to give the type of service that is now being given. The NHS will be attempting to offer the same service but with less money.

There is a great feeling of service within the NHS. Maybe there are disputes involving the unions, the junior doctors, the consultants, the nurses and the ambulance men, but collectively there is the greatest possible harmony when it comes to giving a service leading to the cure and the care of the sick and the ill. I have nothing but the greatest admiration for that harmony. It should be made to exist in a health centre, in a hospital or throughout an area or district. All our energies must now be directed towards saving the service and continuing to give a service to those who are sick or ill.

We shall need every penny we can get if we are to be able to continue with the service. This is no time to rob the NHS by taking money out of the service to satisfy—

Mr. Leslie Spriggs (St. Helens)

The hon. Gentleman is speaking as a selected or nominated member of a regional board. Has he ever considered the feelings of those who are suffering illness and who have been on a waiting list for two to three years? What have the hon. Gentleman and his committee done about those cases?

Mr. Crouch

I accept that. On many occasions constituents have come to me with that sort of problem. There is a way of dealing with it apart from rushing to the Press and saying "This is disgraceful". There are instances when people have to wait two years for a hip operation. It is often necessary to wait that long for what are described as non-acute operations, although they probably are acute when people cannot sleep because of the pain. However, it is possible for a Member to do something. [Interruption.] Perhaps I might be allowed to continue as I know that the hon. Member for Wolverhampton, North-East (Mrs. Short) likes to hear me occasionally.

If someone comes to me to tell me that he has waited two years for an operation, the reason is usually that the consultant he is attending has a number of beds in one or two hospitals where he is a consultant and where, perhaps, there is a crowd. If one gets to work on the service through the areas and districts, one can usually find a vacancy in another hospital. Time and again I have succeeded in getting people placed in another hospital well outside their original area—I do not mean in a pay bed, but in a National Health Service bed. Hon. Members can help people to get service in the NHS. That is what we are meant to do, and those working in the service must also try to help in that way. Instead of getting so much publicity about problems, they should try to help people to get the services they desperately need.

I recently stopped for petrol in my constituency on the road to Margate, and the attendant reminded me that some years ago I helped him to get into hospital for a hip operation. I suggested that he should try at a different hospital, and he was admitted within six weeks. This sort of thing is possible. I know because I have done it.

I believe in private beds because some illnesses require privacy. There are private beds—not amenity beds—in the National Health Service for all types of illness where a person is judged to need special privacy. A friend of mine suffered a severe stroke recently and was admitted to Guy's Hospital, which I know well. I expected to find him in a public ward, but it was thought that his case deserved the privacy of his own room and he was in a private room much better than any of the private beds I have seen at Guy's Hospital. I am delighted that the NHS can provide such services. I would be the first to support an increase in these private facilities.

At this desperate time for our country, we should be considering the real problems we face in the care of the sick and not the sort of problem thrown up by a Bill which has been before the House for four or five months.

We should be doing something about our out-of-date acute hospitals and their old-fashioned equipment. We should be doing something about the lack of accident centres which means that a person seriously injured in a road accident may have to be driven up to 30 miles to hospital in an ambulance. It is good that people are taken to a hospital with the best facilities, but sometimes the distance is too great. There are not enough acute accident centres.

We should be looking at the awful problem in our psychiatric hospitals. We cannot hustle this problem and get rid of it in a year or two, but we should be putting pressure on the Government and the NHS to give priority in this direction.

I do not regard my job on the regional board as simply to check the figures presented to us. My job is to get out into the hospitals and health centres and meet the doctors and patients. Sometimes it is disturbing to spend a whole day in a hospital for the mentally handicapped or, as the Secretary of State did recently in my constituency, at a hospital for the mentally ill. We should be thinking of the need to spend money for the rehabilitation of many mentally handicapped patients into society.

I have seen hospitals where the only X-ray equipment available was 20 years old and out of date. I have seen operating theatres where it is almost impossible to keep out sepsis. It is amazing what operating teams manage to achieve in them. I have seen operating theatres set up in wooden huts that were built in 1916.

There is a great lack of brain scanners in this country. When I asked at Guy's Hospital, I was told that there was no brain scanner there. The last scanner I saw was in Saudi Arabia, where there was also a full body scanner. We do not have enough facilities for kidney transplant operations. We do not have the necessary back-up or enough nursing staff or operating teams, let alone enough principal surgeons trained to do the operations.

6.15 p.m.

These are the sort of problems which should be concerning us now. Not only is it wrong to change the nature of the Bill as is proposed by New Clause 2, but the Bill has now become a greater waste of time than it was before. There is so much more for us to do here. The Bill does not deserve to be passed by Parliament. It should be put on ice, and I suggest that the House should accept the reasonable proposal in New Clause 4. Let us give it pause.

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