HC Deb 12 October 1976 vol 917 cc301-60

Question again proposed, That the clause be read a Second time.

Mrs. Barbara Castle (Blackburn)

It is refreshing to have had so many new participants in this debate. When a small number of people are closetted together in Standing Committee day in and day out, week after week, they tend to develop a slightly incestuous political relationship. When the hon. Member for Somerset, North (Mr. Dean) gives us his familiar and hackneyed line that the Government have not made out the case for this Bill, it merely shows that during the long period in Committee he was not listening. I am glad that more of my hon. Friends are here for this debate and that there are also fresh faces opposite. It is right that we should widen the debate to bring these arguments to the public's attention.

I totally accept the right of my 80 hon. Friends to table New Clause 2. They are exercising the parliamentary rights to which the Opposition also have been laying claim by seeking to amend the Goodman proposals and compromise but in exactly the opposite way. That is what they are doing in New Clause 4, which is also a direct violation of the Goodman proposals. It is beyond me to understand how the hon. Member for Canterbury (Mr. Crouch) can lecture us on the need to stand by the Goodman proposals and end his speech by asking us to vote for New Clause 4. He cannot have read the Goodman proposals or he would not be advocating the acceptance of that clause.

I have enormous sympathy with my hon. Friends and I stand here subject to very severe temptation. I understand exactly their anxiety and their aim. Our aim and our goal are the same. I accept the analysis of my hon. Friend the Member for Brent, South (Mr. Pavitt) in which he pointed out the obscenity of queue-jumping. Abolition of queue-jumping has always inspired us on these benches and it made us the real architects of the NHS which is always being sniped at and undermined by the Opposition.

The existence of private beds within what is aptly named the National Health Service is a violation of the concept on which that service was built. The fact that Nye Bevan had to make a temporary accommodation, contrary not only to his principle but the principle of the very service that he was creating, does not prove anything to the contrary.

One important part of this legislation is the principle of phasing out which is embodied in the Bill. I hope that there will not go out from this House any suggestion that this legislation authorises the indefinite continuation of pay beds in NHS hospitals.

This is set out in the terms of reference of the independent board which is to be set up. The Goodman proposals—if they had not contained this proposal, I should not have been a party to accepting them—in paragraph 2 state: The legislation would contain first a broad declaration that private beds and facilities should be separated from the NHS. That declaration of principle has been embodied in Clause 2(1) of the Bill. We had a lengthy discussion about it in Committee simply because it is unique to embody a declaration of principle in legislation like this.

Therefore, there is no difference of principle between me and my hon. Friends on the urgent need for phasing out pay beds from National Health Service hospitals.

We have had a number of specious arguments to the contrary from the Opposition. We have been told—the hon. Member for Canterbury dilated on this aspect at some length—that the handing over of pay beds to the NHS will not make any difference to the waiting lists. What the Opposition fail to understand is that there is a built-in commercial incentive, even to the most high-minded consultant, not to be entirely wholehearted about dealing with the problem of waiting lists. Of course, there is the element of the lack of resources in this problem, but there is also the question of management. If it pays somebody not to get his patients to the top of the waiting list, because they will then have to go privately and pay him instead, how can we expect an enthusiastic attempt to tackle the problem of waiting lists?

Hon. Gentlemen opposite said that they were in favour of common waiting lists and that, if we had put forward proposals along those lines, we could have had an agreed measure. Again, they are listening only to what they want to hear. I have explained many times, as has my right hon. Friend the Secretary of State and his former Minister of State, that we have tried to get agreement on common waiting lists. The first proposition that we put to the medical profession to deal with the problem of queue-jumping was that we should have one common waiting list under which all patients, whether NHS or private, would be dealt with strictly in order of medical priority. That was rejected as a piece of arrant Socialism. Of course it is, but it was intended as such.

We must get this matter straight on the record. When I was at the Department this proposal was debated at a representative meeting of the consultants and a motion was put forward in the name of East Kent: That this meeting rejects any proposal for a common waiting list for admission to public and private wards in the National Health Service. That motion was accepted with acclamation. Dr. Astley, the chairman of the CCHMS, the consultants' negotiating body with which we were negotiating, made a great speech which was reported in the British Medical Journal. I will send a copy to anybody who wants it. It said: Dr. Astley, referring again to the common waiting list, explained the notion of queue-jumping as being one of the reasons why pay beds should be abolished. It was said it was morally dishonest that people should get a bed more quickly simply because they were prepared to pay for it. Mrs. Barbara Castle had suggested a system of a common waiting list: Mrs. Castle had also closed some 450 so-called under-utilised pay beds. His committee had no sympathy for the common waiting list: in its view, pay beds were part of a mixed economy. Britain was, after all, still a capitalist country, and the committee would refuse to have anything to do with common waiting lists. Let us get that clear once and for all. That was the official spokesman for the consultants, and that view has not been altered.

I know that my hon. Friends have many anxieties about the Goodman proposals. I should like to refer them to another important achievement. As part of the agreed package we have got accpetance by the medical profession that one of the first tasks of the board should be to examine the possibility of common waiting lists. Perhaps we can inch our way forward towards a better understanding of each other's needs in our relationship with the medical profession. We cannot run the health service in a state of total war. Therefore, we need to make advances where we can and let light break through.

I hoped that the Opposition would say that they welcome this reference in the Goodman proposals to the need to examine the possibility of establishing a common waiting list and that it ought to have been done years ago. That is what they should be saying, but, on the contrary, they have tried to pretend that it was always acceptable to the profession. I have proved that it was not.

A further specious argument they have called in aid is the economic crisis. We are told "It is the wrong time." It was also the wrong time, in the view of the Conservative Party, to set up the National Health Service in 1946. It is always the wrong time. That was a time of great economic difficulty. The post-war Labour Government were struggling with one economic crisis after another. Yet, looking back, who will deny that, by establishing the NHS in 1946, we produced what the Prime Minister has called "social cohesion" to an extent not achieved before? If we had not done it in the post-war years we should have had a far more violent history in the post-war period.

The same argument applies now. At a time when we are telling everybody that we must all tighten our belts, we cannot say that some people must tighten their belts more than others. I find it nauseating when Members of the Conservative Party, whose supporters can afford everything from private yachts to private aeroplanes to fly dogs over the Atlantic, lecture us about the need to tighten our belts and say we cannot afford to abolish queue-jumping.

6.30 p.m.

It is also hypocrisy for Opposition Members to pretend that if they were returned to power they would insulate the NHS from further cuts. It must be hypocrisy. The Shadow Chancellor told us only yesterday that he wants £4 billion more cut from public expenditure. At the Conservative Party conference a resolution was passed to the effect that every Government Department must make its contribution to cuts, with the exceptions only of defence, the police, and what the Conservatives called "those in need". How does one identify those in need in the NHS? It is not operated by a means test. Do the Conservatives mean that they will operate a means test? It is impossible to cut £4 billion from public spending without making savage inroads into the NHS along with everything else.

Of course I believe in my consultative document. I would not have put it forward otherwise. However, in the very hectic discussions and consultations that went on it was strongly urged upon me that the adoption of this alternative way of handling the principle of phasing out—I repeat that that principle remains—would produce a cessation of the worst tension and hostilities. Having argued and negotiated over every single word—every word has its meaning and its opportunity—I accepted the proposals and put them to the House.

On this matter the Government have kept all of their promises. There was fullest consultation, as promised. There has been the fullest and most exhaustive debate at all stages of the Bill. The Bill contains full Goodman, and nothing else. The Opposition have never played it straight, like that. They want the bits of Goodman that suit them. They lecture us if my hon. Friends put down amendments to amend Goodman, and then put down amendments of their own that would fundamentally wreck the compromise.

I have been gravely concerned tonight about how I should vote. If I thought that the Bill retained pay beds indefinitely I should be going through the Lobby with my hon. Friends, because that is not the compromise that I negotiated. If that is what the right hon. Member for Wan-stead and Woodford (Mr. Jenkin) thought the Bill would do he would not he attacking the Bill as vigorously as he is; nor would the medical profession. That is the proof that is needed.

The Bill does not contain a final date, but it contains criteria of operation for the independent board which will in due course give us finality. In answer to the hon. Member for Canterbury, I do not call the three and a half years which my hon. Friends visualise a "hustle". Let us all meet again in three and a half years' time. Some of my hon. Friends may be surprised at what we achieve when the Bill becomes law. Let us remember that not only do 1,000 beds go out on the Secretary of State's schedule within six months of the first date, but during the first six months after the passing of the Act the board is under an obligation to review the pay bed situation in the light of the criteria and to produce recommendations for further phasing out, and it must do so regularly at six-monthly intervals, of which there are seven in three and a half years. If the board has not made recommendaitons for phasing out at any stage, it will have to explain to the House why.

If we find that the Bill is not working, we can move in again. My hon. Friend the Member for Brent, South may be surprised to find that my compromise might prove to be a faster hare than his New Clause 2 snail, for all I know. It is a matter for the independent board, which will be a balanced body, to decide. I stand by the compromise because it was a sincere effort to bring industrial peace to the NHS.

I issue a warning. It is not addressed to my right hon. Friend the Secretary of State, who has, with one or two small exceptions where I disagree with him, stuck firmly to the compromise agreement reached and has not reneged on it. My warning is to another place. If this compromise is to be challenged and injured in another place and if Lord Goodman does not carry out his part of the bargain and tell their Lordships that this was negotiated to bring peace to the NHS, there will be no peace in the NHS. Their Lordships will have reopened the gates for industrial action, and it will be upon their own heads, because this is an attempt to heal old wounds and allow the NHS to revert to its true original principles.

My hon. Friends have my heart but not my head.

Mr. Cyril Smith (Rochdale)

The right hon. Member for Blackburn (Mrs. Castle) referred to the obscenity of queue-jumping. I certainly go along with her in her description of queue-jumping. I also go along with her in her plea for peace in the NHS. I found it a little difficult to reconcile her plea for peace with her attack on the consultants when she virtually accused them of deliberately keeping waiting lists long in order that they could take private patients and draw money from them. I find it a little difficult to balance the plea for peace with that sort of statement.

I listened to the speech of the hon. Member for Bristol, North-West (Mr. Thomas). I felt that someone should educate him and explain to him matters such as private tuition, private detective agencies and even private fire brigades, of which obviously he has never heard in his whole experience.

I do not go along with the Conservative Party's political strategy as expressed in terms of the economic debate on Monday. Where I was last night was no accident. I do not go along with trying to force a General Election for political ends and selling the country short in the process. [AN HON. MEMBER: "What is your majority?"] It is sufficient to give me confidence about the next General Election should I decide to take part in it.

However, although I do not go along with Conservative economic strategy, I believe that the Conservative Party is right in describing this Bill as irrelevant to the country's present economic situation and irrelevant at this moment in our history. I have always taken the view that health services should be available on the basis of need rather than the basis of wealth—although doubt has been expressed by at least one Labour Member today as to whether one can assess need in terms of the NHS. However, I have always felt that the service should be available on the basis of medical need.

Incidentally, I also take the view, which should not be overlooked, that members of schemes like BUPA which have been attacked—I am not a member of any private health schemes at all—pay their NHS contributions as well. [An HON. MEMBER: "They have to."] Not always, but in most cases, yes. All I am saying is that this ought not to be overlooked in the argument.

I believe that the surest way of stopping people jumping the queue is to abolish the queue. I very much doubt whether the Bill will do anything material—possibly it will do something minor—to affect the long waiting lists which exist for particular skills in the medical field. One thing I am certain of is that we will not reduce the size of waiting lists by creating an atmosphere which encourages consultants and doctors to emigrate. I am certain that we will not reduce the waiting lists in that way.

I have talked to dozens of consultants about the Bill. It is no secret that Rochdale has not been the happiest area in terms of the reorganised National Health Service. Indeed, on more than one occasion I have presided at committees of trade unions such as NUPE and CoHSE and consultants and doctors to try to get a bit of peace into the local scene. Indeed, a colleague of the right hon. Member for Blackburn at the Department of Health and Social Security thanked me personally for the efforts I made in regard to conciliation in those troubled days.

Having talked to consultants, my view is that they are not desperately worried about pay beds. What they are worried about is the political implication behind the abolition of pay beds. Having listened to more than one Labour Member below the Gangway this afternoon, I get the view that the consultants' fears are based on fact. The consultants are not desperately worried about the abolition of pay beds. What they are worried about is whether they are to be allowed to continue with matters such as private patients, private medicine and so on. There have been Members on the Benches opposite, not members of the Government, who this afternoon have virtually indicated that they wish to abolish private medicine. That is what is upsetting the consultants, not the abolition of pay beds. Perhaps the fears of consultants, who have been attacked, are based on fact rather than fiction and on the fact that they have cause for concern and worry.

While I have really no objection to the abolition of pay beds, I object to any step which pushes us a little further along the road of taking away private choice. Labour Members say that they object to private medicine, but the Bill does not abolish private medicine. Labour Members below the Gangway are making speeches about what they want to achieve and are using the Bill as a means to an end, but not as an end in itself. It is for that very reason that my colleagues and I will vote against New Clause 2 and in favour of New Clause 4.

6.45 p.m.

Miss Jo Richardson (Barking)

I was interested, as I am sure we all were, in the remarks of the hon. Member for Rochdale (Mr. Smith). I can assure him that a large number of hon. Members on this side—I include myself among them—would have liked the Bill to phase out private practice altogether. We were not successful, but that is not to say we will not go on and perhaps at some future date achieve what we want to do.

I should like to refer to one of the remarks made by the hon. Member for Canterbury (Mr. Crouch) in response to an intervention put to him by my hon. Friend the Member for St. Helens (Mr. Spriggs). In his response, the hon. Member for Canterbury was at great pains to admit that because there were waiting lists some people were disadvantaged and that he as a public representative—as we all are as Members of Parliament—was from time to time faced with constituents and others who needed help to get into hospitals and get treatment which they deserve and which is their right.

The hon. Gentleman made great play, as I recall, of the fact that he had been able, as we all have been on some occasions, to get people into hospital perhaps not in their own areas but a long way away. That is not the kind of health service we want. We do not want to have to search around miles away from the homes of people who are sick to find places for them because there is no space in a hospital which is nearer their homes.

Mr. Eddie Loyden (Liverpool, Garston)

That entails visiting.

Miss Richardson

My hon. Friend refers to visiting, and that is a problem. We want to see waiting lists as short as possible in every hospital and that all patients under the NHS have the opportunity of getting into the hospital which is nearest to them as quickly as possible.

Mr. Percy Grieve (Solihull)

I have listened with interest to what the hon. Lady has said. How does she think that the complete abolition of private medicine, which will drive freedom- loving doctors away from this country, will shorten the waiting lists of patients?

Miss Richardson

I am grateful for that intervention. I intended to come to that a little later, but perhaps I may deal with it now. I believe that there are something like 25,000 beds in the private sector of medicine which are not operated by the National Health Service and which, therefore, are not the subject of the Bill. As I understand it, there are some 29 private hospitals for which planning permission has been given and that a similar number in the pipeline have not yet reached that stage.

The hon. and learned Member for Solihull (Mr. Grieve) says that all good doctors would flee the country. [HON. MEMBERS: "Freedom-loving."] I beg pardon. I should have said that all the freedom-loving doctors would flee the country. I do not happen to have the same view of doctors as the hon. and learned Gentleman seems to have. I believe that a very large number of doctors in this country are dedicated to the NHS and would not take that sort of freedom-loving flight to another country or take their talents elsewhere.

Throughout the passage of the Bill we have seen the Government hamstrung by the Goodman proposals because, in my view and in the view of a number of my hon. Friends, the Bill is not the Bill which we would have had if Lord Goodman had not, as it were, interfered. On the one side, we have therefore had the Government hamstrung by the Bill with the Goodman principles and proposals injected into it. On the other side, we have had the Opposition doing everything they could during the passage of the Bill, particularly in Committee, to give the Goodman proposals even more of a nudge in the direction of favouring the retention of private beds and enhancing the opportunities for private practice. Some of us on this side tried in Committee—alas, without success—to inject some of the original proposals back into the Bill. This is why we support New Clause 2.

Much has been said, sonic of it jocularly, to this effect: "If private beds, why not private other things?" One can think seriously about this. A number of instances have been given. All hon. Members would blanch at the thought that we might go back to private electricity companies, gas companies, water companies or telephone companies, or at the thought that some people might get extra private benefits by paying a little more in national insurance contributions.

We must get away from the idea that paying privately should give someone a privilege. I believe that all of us on this side believe that a National—like my right hon. Friend the Member for Blackburn (Mrs. Castle), I stress that word—Health Service entitles everyone to a free and comprehensive service and that it is the existence of the principle of pay beds within that service to which we object and which we want phased out as quickly as possible.

It has been said that under the Bill as it stands the Secretary of State will phase out the first 1,000 beds. Of course, I accept absolutely that the Government want the remainder of the beds phased out as soon as possible too. But the consultants, the BMA and the Opposition, may—I am sure they will—take the totally different point of view that the time should be extended. That is why my hon. Friends and I would prefer a safeguard to be written into the Bill by means of a time limit for phasing out the remaining beds.

There have been several references tonight to the late Nye Bevan. Many of us remember the bitterness he felt when he felt forced, as he said himself, to stuff the consultants' mouths with gold in order to get acceptance of the principle of a free health service for the majority of the people. I think he had hoped that not too long after the passage of his Bill, and certainly not long after his unfortunate death, pay beds would begin to be phased out. It is now nearly 30 years since that Bill was brought in, and he must be turning in his grave at the thought that we are still resisting their final phasing out.

Mr. Pavitt

May I remind my hon. Friend that in his book "In Place of Fear", written in 1951, Nye Bevan made it explicit that he thought that within a few years the pay beds would be phased out?

Miss Richardson

That is the point I am trying to make. I am absolutely sure that if Nye Bevan came back now he would be taken aback at the thought that we still have not phased out pay beds.

I repeat that some of us make no secret of the fact that we would have preferred a Bill not simply to separate private practice and allow it to flower in a private sector but to phase out all private practice altogether. But that is not to be. I do not expect the Opposition to support New Clause 2, but I would have hoped that the Government would seriously consider its intentions. It is not that we disbelieve the Secretary of State. We believe that he hopes and desires that these beds will be phased out. It is simply that we do not trust the other fellows. We want to make sure that the phasing out is spelt out in a way that no one can circumvent. That is why I hope that the Government will have a rethink and support New Clause 2 as well.

Sir George Young (Ealing, Acton)

One cannot but feel sorry for the Secretary of State, who has sat there throughout the debate waiting for one favourable speech from his colleagues supporting the Government's policy. With the exception—it was only just an exception—of the right hon. Member for Blackburn (Mrs. Castle), not one Labour Member is prepared to support the Government's policy. Perhaps the Whips could find one Labour Back Bencher in the Tea Room who is prepared to come here and defend what the Government are doing. It might be a courtesy to the House if they could also find the mover and seconder of sub-amendments (a) and (b).

In his speech yesterday the Prime Minister said that when our standards were changing in many ways and there were different values it was important not to stretch what he described as "ideologically pure remedies". Yet the very next piece of legislation that he brings forward is the purest and most irrelevant piece of Socialist idealogy of the whole Session—namely, this Bill.

The Bill is totally irrelevant to the fundamental problems of the National Health Service at the moment. The Prime Minister went on to say that the sensible policy for this Government—and. indeed, for this country—to pursue is to work on a constanty diminishing percentage of the public sector borrowing requirement as a percentage of the gross domestic product, and to work it down over the next two to three years."—[Official Report, 11th October 1976; Vol. 917, c. 162.] If the House does not adopt New Clause 4 the Bill will do the opposite: it will increase public expenditure by up to £20 million by 1980.

Earlier yesterday the Chancellor of the Exchequer said: We have always insisted that export demand must be the main foundation of our recovery". He referred to it as one of the basic objectives of the Government's economic strategy."—[Official Report, 11th October, 1976; Vol. 917, c. 40.] Without New Clause 4 the Bill will hit our exports by making it more difficult for the medical profession to earn valuable foreign currency by treating overseas patients. The only export which will be accelerated by the Bill is the export of skilled medical practitioners whom we can ill afford to lose.

Therefore, by their own standards, the Government's economic and social objectives are totally in conflict with the Bill. That is why we believe that New Clause 4 should be accepted and the implementation of the Bill delayed.

The Government should recognise that circumstances have now changed. The Bill was conceived two years ago in totally different economic conditions. The money which they have had to allocate towards phasing out the beds is now desperately needed to maintain services in the NHS. A Bill like this can be introduced only in the context of economic growth. To try to introduce it in the context of recession and a cut in services is political lunacy.

I would amplify that statement by reference to my own constituency. The Secretary of State has directed the Ealing, Hammersmith and Hounslow Area Health Authority to balance its books by the end of the current financial year. That authority now proposes the closure of three hospitals, one home of recovery and one chest clinic, and a reduction of services at three other hospitals, including Acton Hospital, one TB hostel and one drug dependency unit.

It is nonsense for the Secretary of State to say that he will release private pay beds to the NHS by this Bill when the NHS cannot maintain those that it already has and is closing them down. On top of the cuts which affect services to constituents, jobs will be left vacant, expenditure on equipment will fall, agency staff will be eliminated and overtime will be cut back. Even so, the authorities will not be able to comply with the Secretary of State's directive to balance the books this year.

7.0 p.m.

Does the Secretary of State believe that constituents will accept the cuts because he says that part of the money is needed to phase out pay beds? The priority of the people is to have services maintained, rather than cut to get the Bill through. The Government are not alive to the political realities of the Bill and people will equate the cuts in health service expenditure with the Bill.

Postponing Part II till December 1978 will give the Government time to answer a question which I asked on Second Reading. Who will benefit if the Bill is passed? Secondly, why is an arrangement which four previous Labour Administrations found acceptable suddenly to be removed? I attended nearly all the Standing Committee debates and I still do not know who will benefit from the Bill.

The National Health Service patient certainly will not benefit. He will have to compete for National Health Service resources with people who would previously have opted for private treatment. He will also have to compete with others for the services of specialists, many of whom will opt out of the National Health Service, and even leave the United Kingdom. The medical profession will net benefit from the Bill. It will become more difficult for it to treat patients in one hospital. The National Health Service will lose revenue from pay beds.

All we are left with are the members of COHSE, NUPE, NALGO and the ASTMS. They probably do not realise that the resources to be used to implement the Bill could be used to improve conditions in hospitals or to fill some of the vacancies that cannot now be advertised. They could be used to employ nurses who cannot find jobs. The foreign exchange earned by consultants could be used to build up the National Health Service. The members of the unions do not realise that the resources for the implementation of the Bill could be used for purposes having a higher priority in their eyes. Do the union members realise the implications if the lifeline to a vigorous private sector is whipped away from a sinking, bankrupt health service? The Bill is not about elimination but separation.

The Government have spent much time recently asking people to make sacrifices. It is now time for the Government to make a sacrifice. If they accepted New Clause 4 the Bill would remain on the statute book, the implementation of Part II would be delayed and Parts I and III could proceed. Many constituents will have to defer things that they cannot now afford for at least two years, and the Government should do the same.

Mr. Hoyle

I am disappointed with the lack of radicalism on the part of the Liberals. I thought that they would vigorously attack privilege. I hoped that they would be with us in supporting New Clause 2.

Mr. Cyril Smith

The hon. Member should take note that while the Liberals may or may not attack privilege they do defend freedom.

Mr. Hoyle

The hon. Member for Rochdale (Mr. Smith) is saying that he defeinds the freedom of those with a thick cheque book to jump the queue ahead of the needy. That is not like him, and it is unusual for him to put forward such an argument. In other circumstances he would have been with us. I wonder who has intervened.

Throughout the debate, the stench of hypocrisy has drifted across the Chamber. The hon. Member for Ealing, Acton (Sir G. Young) attacked cuts in National Health Service spending in his constituency. Does he say that he is opposed to the present cuts, and, if so, that if there are further cuts he will support us in the Lobby against them? Does he mean that the Tories are not in favour of any cuts at all?

What are the Tories talking about? They are always sneaking of expenditure cuts, and it is only when they get down to a particular subject that they decide that cuts should take place elsewhere. I am more and more confused about their policy, because if they return to power it is obvious that they will slash spending on the National Health Service. I wish that they had the decency to come clean and say where they stand on this matter.

The right hon. Member for Wanstead and Woodford (Mr. Jenkin) referred to a survey commissioned by private medicine. I challenge him about the views of the trade unions. He did not say what was the size of that survey. The trade unions are totally opposed to private pay beds, but the right hon. Member prefers to rely on the evidence of a small and insignificant survey commissioned by an interested party.

Mr. Patrick Jenkin

The hon. Member is trying to slide away from the issue. He has not answered the question which I put to him when he interrupted my speech. Is he prepared to say outside the House that one of the leading polling organisations has distorted the results to please its clients? Is he prepared to accept that NOP conducted the poll honestly and competently according to the highest standards of polling?

Mr. Hoyle

The poll was commissioned by private medicine. The right hon. Member must tell the House the size of the sample.

Mr. Patrick Jenkin

The sample was just under 2,000 people, the normal size for probability sample surveys of this kind.

Mr. Hoyle

There are 450,000 members of my union but the right hon. Member is claiming to represent their views on the basis of a sample of 2,000. That is nonsense, and it puts the matter in perspective.

The issue is one of privilege in our society, and the Conservative Party is defending one of the last bastions of privilege. My hon. Friend the Member for Bristol, North-West (Mr. Thomas) suggested that other private agencies might be set up. If the Tories are so concerned about freedom of choice, I cannot understand why they do not put forward the case for train drivers employed by British Rail being allowed to run private trains based on a split contract under which they would work part of the week for British Rail and for the rest of the week run a private train. Naturally, they would only run main-line services and allow branch services to die.

It has been an empty debate, but my right hon. Friend the Member for Blackburn (Mrs. Castle) is always worth listening to. I fully understand her dilemma. She rightly accepts the compromise—and it was a compromise—which was forced upon her. Of course, we are not bound by machinations. The hon. Member for Canterbury (Mr. Crouch) objected that what went on upstairs might be defeated on the Floor of the House. I object to what goes on behind closed doors. That is what has happened in the case of these proposals for the phasing out of pay beds. They came from Lord Goodman. That is the truth of it. I am filled with great suspicion. Within six months, 1,000 pay beds will be phased out, but it is no secret that they are already very much under-used, and, indeed, that many of them are not used at all.

We are, therefore, not really getting to the core of the matter. It is the remaining pay beds that we are arguing about here. The hon. Member for Canterbury talked about hustling. Four years is proposed by one amendment. The hon. Member could have mentioned two other amendments proposing 1978 instead of 1980. It is right that we should have a period of time, but what we are saying is that we want a date when private practice within the NHS will come to an end.

I am one of those in favour of the total abolition of private practice. I have not agreed with a great deal of what has been said by hon. Members opposite, but I agree with the hon. Member for Somerset, North (Mr. Dean) in his warning that we should beware that in getting private practice out of the NHS we do not create new standards outside it. I recognise that danger in that at present we have some control over private practice while it is within the NHS but that immediately it goes outside the service different standards may be set for it, as is the case in education with the public schools. It is a fair comment and many of us share that fear.

We are concerned that we do not set up another monster, another set of privileges accruing to the wealthy in our society. That is why I would like to see not only the abolition of private practice within the NHS but its abolition altogether. I am not afraid to say that, nor have my hon. Friends been afraid to say it.

I understand the position of my right hon. Friend the Secretary of State. He, like his predecessor, has been bound by the decisions which have been arrived at, but we are not. We believe that different proposals could have come back to us if Lord Goodman had not been called in to intervene. That is why I appeal to my hon. Friends to vote with us tonight if we divide the House so that we insert a date when private practice within the NHS will come to an end.

Mr. George Thompson (Galloway)

As has already been pointed out by the hon. Member for Edinburgh, West (Lord James Douglas-Hamilton), this is very largely an English debate. I am glad to see that the hon. Member for Aberdeen, North (Mr. Hughes) has come in. I can see that he is going to help us come to a decision by giving us his advice on the matter.

Mr. Robert Hughes (Aberdeen, North)

I hope that the hon. Gentleman will take it.

Mr. Thompson

That remains to be seen. I must await the arrival of the hon. Gentleman's advice before I can say whether I can take it. I never swallow medicine without looking at it first, especially when I have some doubts about the doctor.

This is an English debate, but it is remarkable that no Scottish Minister is present, although on Second Reading when I got up to speak I attracted the Under-Secretary of State for Scotland for a brief period, so who knows what fleeting apparition may grace this debate yet?

In Scotland we already have a health service which is overwhelmingly committed to the service of the whole community, the sort of health service to which the hon. Member for Huddersfield, West (Mr. Lomas) referred earlier and which he posited as being desirable in England. We have it in Scotland already. If people wish to pay twice for medical care, they may do so, but they must do it outside the NHS.

Pay beds are not a burning issue in Scotland, because there are so few of them. The Dumfries and Galloway Health Board is not mentioned in Schedule 2 so little are we afflicted in my constituency by the problem of pay beds in the NHS. Their number has been steadily declining in Scotland, and I believe that even without the Bill they would have disappeared in due time. Nevertheless, as I said on Second Reading, we in the Scottish National Party are not averse to helping the progress on its way. The hon. Member for Edinburgh, West asked whether we could afford to phase out the Scottish pay beds. I believe that we can, because there are certain things that we could cut out.

7.15 p.m.

The other morning I was having my breakfast, doing no harm to anyone, and listening to the radio, when I heard the Minister of State, Department of Industry, tell us that he was seriously thinking of geting on with a super-Concorde—a super-Concorde at this time. Let us hope not.

If the Government wish to cut something in Scotland I can tell them some things they could cut quite readily, to the benefit of the health and safety not simply of this generation but of generations ahead—indeed, I understand for something like the next 50,000 years, because of the length of the half life of nuclear waste. They can discard their plans to have a plant producing tritium, attached to the plutonium factory at Chapelcross, which is disguised as a nuclear power station. We have no need for it.

No Scottish Government would have squandered money on the Concorde. No Scottish Government would have the money to squander on a super-Concorde. I believe that the good sense of the Scottish people would prevent any Scottish Government, even if that Government had the money, from squandering it on such a useless project. Nor would a Scottish Government ever want to produce tritium.

Let those who want to be in the super-Power class delude themselves if they want to, but we believe that it is high time that the United Kingdom came off its high horse and recognised where it really is in the Power league—and in any case we hope to get off this horse in due course.

Like the right hon. Member for Blackburn (Mrs. Castle), I am emotionally attracted to New Clause 2, but, as I have said, the problem is not a serious one in Scotland, where we can expect pay beds to disappear anyway. So I am prepared on this occasion to accept the view of the Secretary of State.

I fully accept that he has to consider the position in England, and especially South-East England, since it was pointed out on Second Reading that the position in the North of England is somewhat different from the position in the South-East. If the right hon. Gentleman finds himself so convinced by the arguments for New Clause 2 I am perfectly prepared to advise my hon. Friends to follow him along that line. Equally, if he rejects New Clause 2, I shall follow him in that. I take the point that a clean, sharp break would, as the hon. Member for Brent, South (Mr. Pavitt) said, save time, energy and money. After all, I take the same view about the contrast between devolution and independence for Scotland. However, as I have said, it seems to me that I ought to have regard to the situation in South-East England, because it is one which concerns people at their most vulnerable.

In considering New Clause 4 I have sometimes had the thought that perhaps the Tories are hoping for a General Election before the implementation date set out in that clause, in which case the Bill might not be implemented at all. If that is the Machiavellian thinking behind their proposal, I do not go along with them. Furthermore, I assure them that they need not count on the return of Galloway to their fold at the next General Election in order to allow their Machiavellian policy to prevail.

I am always being attacked in Galloway by Tories who tell me that I have maintained a deafening silence about freedom—freedom, they tell me, in education and freedom in medicine. The question is, freedom for whom? In Galloway 99 per cent. of the people have never had freedom in education. Indeed, I am quite sure that 99 per cent. of us never wanted it, because we were perfectly satisfied with the system that was there for our use. I suppose that the fact that at least two of us have arrived in this Chamber is some sign that our education system was indeed very good. In medicine, as I have said, we have not had the choice. I was recently talking to doctors in Stranraer, and they put it to me that they wanted to see pay beds continue. I asked them whether they had any pay beds, and they replied that they had none. Did they have any private practice on the side? Again, no.

It seems to me, therefore, that in Galloway we are happy with the situation we have, and all the talk about freedom is simply talk about freedom for one narrow class of people. However much money they may wield, that is not the sort of freedom we are looking for in Scotland.

The freedom we are eagerly awaiting in Scotland is freedom to run our own health service in our own way so as to promote the health of the whole people of Scotland, freedom to direct our own resources—since we do not intend to scrounge off anybody—towards housing, the social services, health, education, and more especially, towards those areas which suffer from the scourge of multiple deprivation. Devolution will give us the opportunity to start on that task. Independence will give us the opportunity to carry it through to a successful conclusion, so that the people of Scotland will be able to look the rest of the world in the eye with pride—pride in our health service, in our education service, and in all aspects of our life.

Mr. Robert Hughes

I understand that at an earlier stage the hon. Member for Edinburgh, West (Lord James Douglas-Hamilton) made some chastising remarks about the absence of Scottish Labour Members from the Chamber. He is entitled to make that remark since none of us was here, but we cannot always plan our affairs and the way in which we spend our day in Parliament. A number of us, including myself, have today had a long and fruitful meeting with shop stewards from the yards in Scotland involved in the building of oil rigs, modules and so on connected with work in the North Sea. The shop stewards were especially concerned about future employment prospects and the immediate problem of redundancies.

Therefore, I believe that my absence from the Chamber this afternoon can be justified on the basis that that is an important problem and my plans could not have been made in advance. When the arrangements were made for the shop stewards to come here to see us, we could not at that time foresee what the debate would be. Nevertheless, I hope that my presence in the Chamber this evening will assure the hon. Member for Edinburgh, West that I am very concerned about the National Health Service in Scotland and about the pay beds situation there, which I want to see ended as soon as possible.

Lord James Douglas-Hamilton

When the hon. Gentleman was a Minister with responsibility for health, he was extremely conscientious in attending Committees and debates in the House in which health matters were discussed. Is it not only fair that a Scottish Office Minister should be present when important matters relating specifically to Scotland are discussed?

Mr. Hughes

In view of the fulsome compliment with which the hon. Gentleman began his intervention, I must agree with the first part of what he said. As for the second part, however, I must remind him that Ministers may equally well have valid reasons which prevent their being in the Chamber. I assure him that my hon. Friend the Under-Secretary of State would have been here if he had not had a pressing engagement which kept him elsewhere.

I turn now to the speech of the hon. Member for Galloway (Mr. Thompson). Although I agree with much of what he said, especially on the question of freedom for whom, I think that he takes a rather simplistic attitude to this whole subject and I quarrel with him when he begins his remarks by saying that this is an English debate. It is not an English debate. It may well be the case—the figures in the schedule show it—that the vast bulk of pay beds is to be found outside Scotland, but we have 234 pay beds within Scotland. Moreover, even if we had no pay beds in the whole of Scotland, it would still, in my view, be an issue on which Scottish Members with an interest in the National Health Service as a whole ought to take part and take an interest in what happens south of the border. I reject entirely the suggestion that between north and south of the border there is suddenly some difference in people and suddenly a great difference of principle in the way our affairs should be run.

I welcome the hon. Gentleman's remark that, although the majority of pay beds were in the South-East of England, he thought it right to take part in the debate. Indeed, I wish that the Scottish National Party would take a more global interest than it does at present in the affairs of the United Kingdom. It is too simplistic to say that, come the day of independence, all will be well, manna will fall from heaven and suddenly everything which is ideal will come to pass in Scottish life.

Looking back into Scottish history, the Scottish National Party will find that the greatest obscenities practised against the Scottish people were practised by Scots themselves on their own people. In fact, it is still true today. I find it astonishing that one of the SNP's great supporters, one of the so-called great patriots of Scotland today, is a man now under investigation because of insider dealings in his shares. I refer, of course, to Sir Hugh Fraser, who is such a Scottish patriot that he pays his workers in London more that he pays his workers in Glasgow. However, I do not wish to be diverted along that road, since it is no more than ancillary to the National Health Service, although the point is worth making since we are dealing here with the question of resources.

How should we use resources in the National Health Service, and how should the service operate in relation to individuals? We are sometimes inclined to regard the pay beds issue, as we regard some other issues, as though it were some sort of esoteric matter which had no impact on people's lives.

I should make plain that I have always been against the system whereby consultants in the NHS were able to operate private practice on the side. I make no bones about that. I believe in an integrated health service. But if I had any doubt about the way in which consultants behaved towards patients, those doubts would have been dispelled by an incident which, although it took place a number of years ago, I believe could still occur.

The granddaughter of a lady—she was at one time my landlady—had a heart complaint. It was picked up in the normal routine checking by the school health service, and it was discovered that she needed remedial surgery. Anybody who knows about heart complaints in children knows that surgeons like to do the operation before the child passes from primary to secondary school. Quite apart from the stress of changing schools, there is also the fact that physical activity in secondary school is much greater than it is in primary school. Therefore, as I say, surgeons wish to have the operation done before the time of transfer.

In Scotland, because of our individuality, because we have a different education system, that transfer takes place at the age of 12, not 11. Although we sometimes fall into the trap of glibly speaking of the 11-plus, the transfer in fact takes place at the age of 12.

After the child had passed eight years of age, time went by and the parents and grandparents were extremely concerned that the operation should be carried out. At that time, it could not be done in Aberdeen—I suspect that it still could not be done in Aberdeen—so it had to be done elsewhere, and the parents and grandparents consulted the surgeon about what was to be done. "You have told us", they said, "that you want it done before the girl goes to secondary school". His response was "It is very difficult. I have a long waiting list, and it will take time." They were not wealthy people, and they asked the consultant whether there was any way in which they could have the operation done before the child transferred. He said "If you care to come on to my private list, it can be done in six months' time". I believe that the activities of that kind of consultant besmirch the name of the medical profession.

I do not blame the parents and grandparents for taking out a second mortgage to pay for the operation. I do not blame people who have recourse to private medicine in such circumstances. I suspect that if it happened to one of my children I would set my principles aside and do the same. When I am speaking about not just the health but possibly even the life of a child of 10, I cannot say that I would be a man of principle. There are times when people may decide that they must have recourse to private medicine.

7.30 p.m.

That incident has burned in my memory all these years. I believe that the medical profession owes a great deal to society because of its failure to recognise exactly what pay beds do. When we speak about jumping the queue, we are not speaking about cosmetic operations, perhaps carried out simply because someone wants to remove a facial disfigurement. In probably nine cases out of ten we are speaking about an individual's future health and happiness. I do not know how any Conservative Member can defend the mercenary outlook which I have described.

I have always had a strong belief in the views of Nye Bevan, but I believe that he made a mistake at the time of setting up the NHS when he agreed to consultants being private contractors to the service and to the whole business of private consultants and GPs. If he were alive, he would probably tell me that it was all right to say that with the benefit of hindsight but that the Labour Government of the time had to face the consistent and virulent hostility of the medical profession and the Tory Party, who were opposed to the setting up of the NHS. He might say that in the circumstances the Government of the day had no choice.

From time to time I see cars with a little sticker in the back window saying "Patients before politics". That is nothing but sheer hypocrisy, because the medical profession has always played politics with the lives of its patients when it comes to the question of resource management in the NHS.

Mr. Patrick Jenkin


Mr. Hughes

The right hon. Gentleman knows perfectly well that it is a fact.

When the Government, I believe with the support of the whole country, were anxious to see the family planning service extended into the NHS, I think that we were faced with an ultimatum from a small number of consultants. I have had many representations from consultants in the city of Aberdeen opposed to the principle of an item by service payment for family planning. I apologise if my figures are wrong—I have had no oppor- tunity to check them—but I understand that it will cost the Grampians Health Board about £40,000 a year to pay consultants to provide a family planning service within the NHS.

The medical profession contains some of the best trade unionists, some of the people most able to use the weapon of power to put pressure on Governments and others to get their way. They may be in a minority, but they have a powerful minority voice.

The time has come when there should be an end to the argument about pay beds. The Bill does not go far enough. I would prefer the separation of the NHS from private practice. When people speak about freedom, it almost always comes down to cheque-book freedom. That is true in education, housing and the health service.

Mr. Hector Monro (Dumfries)

When the hon. Gentleman is ranting on, will he not accept that the last pay beds authorised in Scotland were authorised by the Labour Government in 1968?

Mr. Hughes

Even if that were so, it still would not make it right.

I believe in the kind of freedom within which people are treated as individuals, irrespective of class. I am not one of those who think that we are all equal in the sense that we all have the same physical or mental capabilities and the same ability to take the opportunities that are available. I believe, however, that we are all equal to the extent that, whatever our class or status, we are entitled to treatment within the National Health Service as of right. The idea that it should be possible to buy privilege is obnoxious to me. I know that it is obnoxious to the Government. They may well have had to compromise, but I hope that my hon. Friends who share my views will go into the Lobby to put an end to the present system, which is long overdue for complete eradication.

Mr. Robert Boscawen (Wells)

The hon. Member for Aberdeen, North (Mr. Hughes) spoilt what would have been quite a good speech by his suggestion that the consultants' profession spent its time engaged in hypocrisy and political action within the health service.

The hon. Gentleman is correct in his ideals, that no matter whether the individual is a private patient or an NHS patient, and no matter whether the consultant is a full-time or part-time NHS consultant, the quality of service given to the patient should be the same, whatever his race, colour or creed. I believe that that is an ideal we all share. I certainly do.

I do not think that the Labour Party fully understands the implications of the Bill. It is creating a double standard by separating private health care from the State, the very thing that Labour Members profess not to want to do. I hope that they will think very hard about the fact that it is what they are doing.

One of the reasons why consultants hang on so strongly to the private patient concept dates back to the very beginning of the NHS. It has often been said that the general practitioner was given the patients and the consultants were given the beds. The consultants lost a one-to-one relationship with their patients when the NHS started. They do not have much of a one-to-one relationship with their NHS patients. I wish they did. They see the NHS patient for 15 minutes or half an hour before they have to carry out an operation on him, and then see him again in the few days while the patient is recovering. That is the end. The consultant can follow a private patient through. That is much more interesting and rewarding work for the doctor concerned. It is one of the reasons why the consultants have been so strongly opposed to the removal of all private patients from the NHS.

Mr. Robert Hughes

I am very grateful to the hon. Gentleman for giving way. I do not understand why it is impossible within the National Health Service for a consultant to see his patient through from beginning to end, as the hon. Gentleman suggested. It is a matter of organisation. I have been a member of a health board, and never in my experience of the National Health Service has any agency outside the medical profession at any time sought to dictate to it how it should deal with the patients within the service Nor would I ever agree that there should be any outside dictation.

Mr. Boscawen

Of course, the hon. Gentleman is right. It is a matter of organisation and of resources. At the present time we have not that organisation or those resources. Indeed, I am quite appalled at the state of waiting lists in the National Health Service throughout the country. It is by far the worst feature of the whole of health care in this country. I was asked to look into it some weeks ago. I did so, and the more I have looked into it the worse I have found it to be. It is not necessary to go very far for the evidence. All the evidence we need can be found in Adjournment debates in the House of Commons, night after night, in which Members of Parliament tell the same story. It is an appalling situation. We all know these cases. We all have them.

The hon. Gentleman told us of the sad case of a small girl who needed treatment, and I fully sympathise about that. I know a young woman who is in considerable pain and who cannot get treatment within the National Health Service for another six months. During this period she will be under the care of an anaesthetist. Her family relationships are harmed, her work is impaired, and she and the family are going through the most miserable period they have ever known in their lives.

That, I am afraid, is the NHS of 1976. We ought to be talking of what can be done about this—[HON. MEMBERS: "What about the cuts?"] Yes, I will talk about the cuts. If serious cuts in the National Health Service have to be made there will be a great deal more suffering in this country than we have known for a long time. Anyone who wants to create that suffering should not be a Member of this House. It will be a tragic day if one Government or another are forced to cut further into the resources of the National Health Service, but from the look of the figures I am afraid this may happen. We do not wish to see cuts made in the National Health Service.

I want to see a reorganisation of the resources of the National Health Service, because I know that they are not being deployed correctly. There is still tremendous waste. Far too many people are pushing pens and paper around in the health service. I cannot absolve Conservative Governments from this. We brought in the change in the organisation of the National Health Service and it did not work as well as we had hoped. We should concentrate our efforts on reorganising the resources of the National Health Service, and not on this Bill, which will not shorten a single waiting list in this country—rather the reverse.

People do not go for private treatment because they want to queue jump. That is not their basic reason for seeking private care. There are other reasons, too. It is not just queue jumping for the sake of getting there first. It is because many of them have very strong social reasons. If we are to have a common waiting list, we have to allow for the social reasons for putting people in the queue, as well as their medical priority. It cannot be done otherwise. If all the private patients are to be put into the NHS queues, in the same mix, quite rightly, as other people—I have no objection to that—many of them will still have strong social reasons for going above others who may be awaiting non-urgent operations. In some cases there may be an improvement, but in the main—and I have looked at this fairly carefully—I do not think the Bill will make the slightest difference to the length of the waiting lists. That is why it is quite irrelevant and wrong to bring in the Bill at this time.

The right hon. Member for Blackburn (Mrs. Castle) said that we stand by Goodman, and that if we were to delay the Bill another six months that would be breaking the Goodman agreement. The Goodman agreement was hammered out after months of turbulence, anger and hard feeling within the National Health Service. I am glad that the right hon. Lady has just come into the Chamber, because I am talking about the Goodman agreement which she managed to achieve after months of argument, lack of confidence and turbulence among all sides of the National Health Service.

7.45 p.m.

A year has passed since then. I think that the right hon. Lady will agree that the situation has calmed down somewhat, and that the doctors are not acting in the way that they did a year ago, nor are some of the staff or nurses in the hospitals. A different situation has arisen. That is why I think there is a very good case for rethinking on the Bill and delaying it another six months, before we lose more of the resources which are so badly needed by the NHS.

We should think again before dividing health care into a private service and a public service, with two standards of care in the country. That is what will happen if the Bill goes ahead and results in separating private medicine from the NHS. I believe that the Government would do well not to push the Bill so far and so fast. They are not achieving their ends. Their ends, I believe, are the same as ours—to improve the health care of all patients in this country, irrespective of who they are. The Government are not achieving that end with the Bill.

Let the Government get down to the task of trying to reorganise the National Health Service as soon as possible within the existing resources in order to make better use of them. Having done this, the Government could ask us to look again at the question of private practice and whether it is harming the service as much as they believe.

Mr. Martin Flannery (Sheffield, Hillsborough)

After listening to the hon. Member for Wells (Mr. Boscawen), my viewpoint held hitherto, and which I am now reiterating, is stronger than ever on this issue. In my opinion, there is no group in the world more skilled and able at holding up human progress than the British Conservative Party. It uses every trick in the book. It makes every ploy that it is capable of making. Those things are said blandly as though they were profound truths.

I listened with great interest to the boring statement of the Shadow Minister, the right hon. Member for Wanstead and Woodford (Mr. Jenkin), and to his sheer blandness in endeavouring to preserve elitism and privilege. This was visible from almost every sentence. In the light of our history, it is almost inconceivable that such arguments can be deployed in 1976 by the Conservative Party. No doubt many Conservative Members, if they get the chance, will be doing the same in 2076. Certainly their arguments are amazing to those of us on the Labour Benches.

We have had mention of firms which literally raid the National Health Service like the Seventh Cavalry. We hear of BUPA struggling for privilege. We hear speeches in defence of, for instance, some grouping called "freedom-loving doctors". My right hon. Friend the Member for Blackburn (Mrs. Castle) quoted the representative of the consultants some time ago and was prompty accused of almost waging war against the consultants. We heard a quotation from one of my hon. Friends from a speech by Aneurin Bevan about having to stuff the mouths of the consultants with gold.

Well, Mr. Deputy Speaker, you pays your penny and you takes your choice. We can make up our minds about the vivid statements made by Opposition Members in defence of their beliefs, but I hope that the message goes out loud and clear to the people that the Conservative Party has not changed one iota. It will still defend privilege and elitism and want everything for itself as long as it can manage it.

I speak as a ex-teacher, as hon. Members know, and for long years I have gazed at private schools and all that they mean with their small classes and favoured treatment for their children, as opposed to the children of our people generally.

Perhaps I might briefly return to these "freedom-loving doctors". I have always been of the opinion that the vast majority of people in the National Health Service struggle manfully to do their duty by their patients. I hold to that belief. I believe that more and more of them are doing that. But there is still a small section who see the service as a means to wealth. In other words, they wish to capitalise on the sickness of their fellow human beings. It is that small group which really is our trouble in the service.

The vast majority of our doctors, nurses and others who work in the service are doing their utmost under very trying conditions. Many of us well remember what happened before the war when people could not send their children to a doctor if they had not the money and when even bad debts were peddled from one doctor to another. That was the kind of situation against which we were struggling when we fought for the National Health Service, which the Conservative Party opposed tooth and nail and finally had to accept but against which it is still fighting a delaying action.

When I hear statements to the effect that the Government's proposal will make practically no difference, I ask whether a principle is any the less a principle simply because it deals with a minority. It seems to me that the principle is all the more a principle when it is helping a minority. In this case, however, it is helping the vast majority. It is helping all those people who need help.

When we talk about cuts, we should examine exactly what it is that we are discussing. Day in and day out, Government supporters have asked Opposition Members, who want massive cuts in public expenditure of an order which makes the imagination boggle in the present context, to specify to us where those cuts should fall. There is never a day that goes by that from the Government Benches, assuming that the opportunity does not arise in formal debate, someone does not shout "Where would you make the cuts?" We know that the cuts would not be made in defence and, therefore, that we are discussing matters other than defence. We know as sure as I am standing here that those cuts would fall upon the National Health Service on a grand scale. We know that, and the Conservative Party knows it.

Once again I say to the Conservatives "Tell us what cuts you would make in the National Health Service or he quiet about it and let the British people know exactly what the difficulties would be when people wanted to go to hospital, when they were in pain and when there was urgency about life." I ask the Opposition to let us know exactly what cuts would be made by those who constantly say that they would not make such cuts.

Mr. Thorne

Does not my hon. Friend agree that the two questions—extending private medicine and cuts in public expenditure—are linked in the minds of the Opposition and that they would cut public expenditure in the National Health Service and force people to pay through private medicine to get treatment when in need?

Mr. Flannery

That is absolutely true, and the Opposition know it.

We on the Government Benches know that we are struggling for the right of people to use the National Health Service when in need. We know that the Conservative Party would substitute for this what we call queue-jumping where, if the patient's purse is a long one, he can all the quicker get to hospital, where all the expensive equipment provided for the National Health Service from public funds is used by the consultants to line their own pockets in the cases that I am discussing.

That is what Government supporters are against, and we place it on public record repeatedly. If it is suggested that because we tell this truth we are to be blackmailed by a minority of consultants, so be it. It is very sad, but they should be seen to be doing precisely that—blackmailing and wanting their mouths filled with gold. If these are the "freedom-loving doctors" let them go to freedom-loving areas like South Africa and Rhodesia where these things go ahead without let or stay. However, we believe that that would not happen. We believe that the worst that would happen is that those doctors would go into private practice and that they would not go away. They could do that if they wished, but we do not believe that they would.

In supporting New Clause 2, there is for us in this struggle a deep abiding principle which we will not forgo. It is the right of all to a service without having to pay through the nose for it if they have the money to do so. It is the right to a free service for all our people. We believe that that is what our people want us to stand up and fight for in this House.

Mr. Grieve

I rise to intervene in this debate because I have felt horrified throughout its course by attack after attack which has been made upon the medical profession by Government supporters—by the hon. Member for Sheffield, Hillsborough (Mr. Flannery), by the right hon. Member for Blackburn (Mrs. Castle) who assumed the mantle of the enemy of the medical profession and waged war upon it when she was Secretary of State, by the hon. Member for Barking (Miss Richardson) and by the hon. Member for Aberdeen, North (Mr. Hughes) who made a most cruel attack upon a dedicated profession.

No one in this House is more qualified than I to speak of the dedication of the medical profession. Having spent 15 weeks this year as a National Health Service patient I owe to the dedication, the devotion and the care of the doctors and nurses in the hospitals where I was not only my health but my life. They were doing their duty night and day to everyone under their care despite appalling material difficulties, many of them caused by an overweighted administration—

Mr. Kilroy-Silk

Brought about by the Conservative Government.

Mr. Grieve

I accept that intervention. I believe that the administration of the medical profession and of the National Health Service is top-heavy. It is over-administered. That over-administration should be cut in favour of the medical care and the subvention which should go to the medical care in our hospitals.

Mr. Flannery

Did the hon. and learned Gentleman pay, I wonder.

8.0 p.m.

Mr. Grieve

I said a moment ago that I was a National Health Service patient for 15 weeks, so of course, as a NHS patient, I did not pay. However, I got the care and attention everyone gets from doctors in the NHS and I pay tribute to the medical profession.

I am horrified to hear the kind of attack which has been made on the medical profession tonight by hon. Members opposite. There will never be any peace in the service while that kind of attitude prevails. In my 15 weeks in a public ward I did not hear one voice raised by a doctor, a nurse or a fellow patient in support of this scheme to phase out pay beds.

When the right hon. Lady the Member for Blackburn was dismissed from her post as Secretary of State for Social Services and it was announced in my ward there were cheers from the patients and the nurses. [Interruption.] Yes, it is true, and it is right that I should say it because the right hon. Lady has brought this on herself by her attitude to the medical profession. When she says, as she did today, that it was greed and desire for money which actuated the consultants in their opposition to the abolition of pay beds, she overlooks the fact that some of the consultants who are most opposed to it are those who are opposed for reasons of clinical freedom only because they do not get a penny of the fees of private patients. They are the ones who are serving in teaching hospitals where they give their services so nobly. It is a monstrous slander on a great profession by someone who has held the highest office, in respect of that profession, under the Crown, and she should be ashamed of herself.

There are three reasons why I believe this Bill should be delayed. It will separate private and public medicine altogether. At the moment the two are under the same roof, and when NHS patients desperately need attention it is available, straight away whatever the time of day. It may be in the middle of the night, or, as in my case, at 6 a.m. when my pacemaker failed. What will happen when consultants are serving a clinic at one end of London, and Hammersmith Hospital, Guy's or Westminster at the other end? They will be rushing between the two. The convenience of the present system is one of its greatest advantages.

Secondly, this scheme for phasing out pay beds means that we—or members Opposite—are cutting off their and our noses to spite their and our faces. The health service will be deprived of much needed funds which are at present going into it by the use of private beds not only by the oil sheiks but also by thousands of modestly-off people who are ready to pay for privacy by schemes as such as BUPA or the Private Patients' Plan.

Thirdly, it is disgraceful that for purely ideological reasons we should be subjected in this country to something which will do infinite damage to the health service, and that in support of this we should hear the kind of diatribe against the medical profession that we have heard tonight. I pay tribute to this great profession, which gives itself unsparingly to the care of the needy and sick, and I have been disheartened and appalled by what I have heard from many hon. Members on the Government Benches tonight.

Mr. Kilroy-Silk

I join the hon. and learned Member for Solihull (Mr. Grieve) in paying tribute to the medical profession. The vast majority of those in it, whether they are consultants, doctors or ancillary workers, are dedicated to the profession and to the patients they serve. I do not think that my hon. Friends have made the kind of attack that the hon. and learned Gentleman talks about. Whether they have or not, I agree with him about the dedication of the vast majority of the profession. Nevertheless, the hon. and learned Member will have to accept that there is still in that profession a militant minority which has, in fact, waged war on the previous Secretary of State.

There was, and still is, a militant minority which puts its own privileges and vested interests before those of the patients and which is prepared to play politics, and does so, with the patients. This minority is holding the sick to ransom. What kind of medical profession is it that resorts to industrial action, using patients as pawns in that action, as was the case recently in the junior hospital doctors' dispute and in the protest over pay beds? That is not exactly the kind of behaviour one expects from doctors if one gives a cursory glance at their Hippocratic oath. It does not add to the prestige or general demeanour of their profession; in fact, it demeans the whole profession. While accepting that the vast majority are dedicated people who work hard, we must also realise that there are others who are more concerned with lining their own pockets than they are with the health and welfare of their patients.

The hon. and learned Member for Solihull said that there would be difficulties if private and public medicine were separated because doctors would have to spend time travelling from an NHS hospital to a private clinic. He claimed that this would be a waste of time and resources. It would not, because there is no need for them to travel to their private clinics. Let there be a full-time salaried National Health Service.

The hon. and learned Member also claimed that by eliminating pay beds we were depriving the NHS of resources. Far from it. By separating the NHS from private medicine we are devoting far more resources to the service where they properly belong. The hon. Member for Wells (Mr. Boscawen) said in an impassioned speech that there were desperately long waiting lists at NHS hospitals, yet his hon. and learned Friend who is sitting almost next to him wants to continue this elitist, separate and selfish, queue-jumping sector alongside the NHS. How can he possibly square the two?

It has been said on many occasions that this is an ideological battle. Whose ideology is it? The ideology is coming not only from this side of the House. It is coming also from the Opposition. They keep talking this nonsense about freedom. The Conservative Front Bench makes this its catch phrase. But whose freedom are we talking about? Are we talking about the freedom of a few consultants to have freedom of clinical practice, or are we talking about the freedom of the vast majority of people in this country to get proper and adequate medical care at the time when they need it? That is the freedom that we on this side are talking about, not the freedom of the privileged elitist few.

When one looks around the country one sees that the Conservatives have less than a handful of seats in Scotland, and they have been virtually decimated in Wales. They have no grip at all in any major industrial city in England. They draw their support from the suburbs and their hinterland—the suburban, privileged, cossetted hinterland of England. They will do anything to protect and advance the interests of this minority. That might be forgivable if the minority were underprivileged and deprived. But this minority, which the Tories support and whose cause they advocate, can afford the wherewithal for private medicine and for the consultants who practise it, who have a large enough purse to purchase private education and those who will provide it, and who will get tax relief on their mortgages and the rest.

Those were the kinds of things we heard repeatedly in Committee on the Finance Bill. The Conservatives were always speaking for a minority group which was already cossetted and privileged and which had a vested interest to protect. It is no wonder that the Conservative Party is no longer representative of the geographical entity of the United Kingdom and will be seen to be less so.

There are many defects in the Bill. I described many of them on Second Reading, and that may be why I was not selected as a member of the Standing Committee. One of the major defects is its failure to put a time limit on the separation of pay beds from the National Health Service hospitals. I wholeheartedly support my hon. Friends in their proposal to include New Clause 2 in the Bill.

Pay beds are an affront to the whole concept of the National Health Service. They are a blight on what was considered to be a national service which would be guided by the principle that health care would be available to all. determined only by need and not by the ability to pay. That principle is in no way served by the existence of this separate pay bed sector within the National Health Service.

In spite of what the Conservatives may say, pay beds are there so that those who can pay can jump the queue. There is no other conceivable reason why they should exist. It is no good the hon. Member for Wells saying that they give people the freedoms to choose. None of my constituents has the choice or the freedom to purchase private medicine or private education. They do not have the wherewithal, but their need is just as great and just as serious as that of the privileged sectors—such as the business men—for whom the hon. Member speaks.

It is nonsense to talk about its being necessary to have pay beds for certain people who have social reasons or to suggest that the beds are there to enhance freedom. They enhance only the freedom of the consultants and those who can afford to pay. The pay beds are parasitic on the National Health Service. They could not exist without the resources available within the NHS hospitals. We know from a report produced by the House that many consultants go further in that they not only use the NHS facilities without proper charge to themselves but they take those facilities outside to use in their own private rooms and clinics. That is a great abuse of the facilities provided at the taxpayer's expense, but the taxpayer has to wait for them at the end of a long waiting list.

We have heard many indications of how quickly a patient can get an operation, a hospital bed or a consultancy if he is prepared to pay. My nine-year old son needs an operation. It is not serious or urgent, but he needs it. He will have to wait 18 months on the NHS list. I was told by the consultant that if I was prepared to pay my son could have the operation next week. is that not a glaring demonstration of the whole raison d'être of pay beds, that they are there to enable those who can afford to pay to jump the queue and to get privileges and treatment at the expense of those who cannot afford but whose illnesses may be just as serious, or even more so?

Pay beds will not be separated from the National Health Service unless my right hon. Friend the Secretary of State tonight takes his courage in both hands and accepts the new clause. He knows that this is neither his nor his predecessor's Bill. It is Lord Goodman's Bill. He knows that the Government have already abdicated their responsibility for governing, as is exhibited in the Bill. We have strayed a great deal away from our principles and the proposals in the manifesto. We were pledged and our principles demand that once and for all we should separate pay beds from the NHS. There is no reason to go further than that and take out some kind of guarantee for the eixstence of private medicine.

I do not know what this so-called Socialist Government are doing in guaranteeing the existence of private medicine. If we are to ensure that the people who need treatment get it, irrespective of their income and when it is clinically necessary for them to receive it, only one conclusion can be drawn. We must once and for all take out this excrescence in the National Health Service, which is there only because of medical politics a long time ago.

I do not believe that 1980 is an unreasonable date. I would want it to be much earlier, but I hope that my right hon. Friend tonight can accept that we on this side and our constituents who do not have the privilege of the Conservatives and who do not have the ability to get what they want when they want it are entitled to and should have a truly national health service.

8.15 p.m.

Mr. Patrick Mayhew (Royal Tunbridge Wells)

It is profoundly saddening, at a time when the National Health Service, which we in this House all cherish and support, is in crisis, that our debate should have been stained and disfigured by several speeches which demonstrate the profound and atavistic hatred of certain hon. Members, a hatred which is quite impervious to argument. I think particularly of the speech by the hon. Member for Sheffield, Hillsborough (Mr. Flannery), who seems to hold about this party a view which bears no resemblance to the truth. The hon. Member for Ormskirk (Mr. Kilroy-Silk) made a speech so impregnated with hatred that I fear that his mind must be totally closed. I wish to assure them both, not because I believe my words will have much effect on their minds, but because I want to get them on the record, that my arguments will be advanced out of a desire to preserve the health service and to improve its standards, and out of a desire to improve the standard of care which any Government in this country can afford to give to our sick.

Neither I nor any member of my family belong to any of the insurance schemes which provide for private treatment. I cannot match the recent record of my hon. and learned Friend the Member for Solihull (Mr. Grieve), I am glad to say, but years ago I spent quite a long time in St. Thomas' Hospital as a NHS patient. I came to the firm conclusion then that I could not hope to get better treatment in a private ward and I resolved never to seek it. I was influenced, too, by the fact that at any time of the day or night there was a large number of extraordinarily pretty girls in the public ward. That is a situation which does not obtain in a private room and that, no doubt, was a factor in my judgment.

If I were a consultant I do not know whether I would wish to practise privately. I am pretty sure that I would, although I would want the majority of my service to be in the NHS. I would want to practise privately in part because I would relish the independence that would give me. I should not wish to serve as a full-time salaried servant of the State because I should find that incompatible with exercising my profession with the independence that I should want. I defend resolutely the right of a consultant or doctor to practise medicine privately. That is the Government's position, and that has been the position of successive Governments since the war.

I have already said that I should not wish—for a practical reason, namely, that I do not think that I could get better treatment outside the National Health Service—to be a private hospital patient. At the same time I defend resolutely the right of those who wish to do so to set aside money in insurance premiums to enable them to be operated upon by the surgeon of their choice and to recover in the environment of their choice. I recognise the advantages which many people believe lie in private treatment. By no means all of them are well off or even middling off.

Successive Governments have declared their support for the principle of private medicine that operates in tandem with medicine practised under the NHS. They recognise the need for the services of doctors to be available in NHS hospitals. They know that they can get a far better bargain for the NHS if they have a small proportion of private beds under the same roof as NHS beds in NHS hospitals. They know that they can get a better bargain because they thereby secure a greater proportion of doctors' and surgeons' time. Their time would otherwise be taken up in travelling to the separate institutions that would have to be established.

I firmly believe that the present arrangement confers benefits on both sides. It confers benefits, of course, on private patients. Those benefits are obvious and they do not need to be enumerated. It also confers benefits on NHS patients. On balance, I believe that they get the better of the bargain. They get a larger proportion of the time of the consultants and doctors than would otherwise be the case. To abolish private beds in NHS hospitals on the time scale envisaged by the Bill must be a bad thing in that it will have substantial disadvantages for the Government, for National Health Service patients and for private patients, to say nothing of the interests of the doctors.

Presumably there must be a substantial countervailing advantage. I have listened to this debate as well as earlier debates and the only advantage I have heard i3 the abolition of what is called queue jumping. What is the evil of queue jumping? It surely lies in the fact that it makes those who are waiting in the queue wait longer. That is exactly what will happen if doctors have to attend private patients elsewhere in private institutions—namely, nursing homes and hospitals built specially for the purpose —instead of looking after them under the same roof as at present.

If there is no advantage, there are many defects. It is absolutely right for Governments to be concerned about the length of queues. I agree with everything that has been said by my hon. Friend the Member for Wells (Mr. Boscawen) and by Labour Members about the appalling length of the queues in NHS hospitals. Of course, the Secretary of State must be concerned about this matter. He is responsible for the length of the queues in the sense that he has to answer for them. As the hon. Member for Rochdale (Mr. Smith) said, the best thing to do with queue jumping is to seek means of abolishing it. As we all know, that means money. We all know that to phase out private pay beds in the health service hospitals will cost £20 million.

I have a sort of horrified respect for the hon. Member for Brent, South (Mr. Pavitt), who introduced the clause, and his hon. Friends who sit below the Gangway. I have that respect because at least they follow the logic of their policy. They are prepared to acknowledge that they are against all private medicine. I have horror, however, because of the vision that they hold out before us, the vision of a society that will have lost all freedom of choice for anybody. I acknowledge that there are many people who do not have freedom of choice in education or in medicine, but the vision that is held out by the hon. Gentleman and his hon. Friends is that of a society where there shall be no choice for anyone.

Although I have a sort of horrified respect for the hon. Gentleman and his hon. Friends, what about the Secretary of State and his supporters? They must exist somewhere, although we have neither seen nor heard one during the debate.

The right hon. Gentleman is responsible for the health service and we know that it is in a desperate crisis. The right hon. Gentleman cannot afford to lose one penny for the NHS by a self-inflicted wound when its resources are already haemorrhaging away through inflation week after week. He cannot afford to lengthen one waiting list as they are miles too long already. However, that is what he will do with most of them if he phases out the pay beds.

The right hon. Gentleman cannot afford to allow double standards of treatment to exist in medicine, but that is what will develop if he forces private medicine to be conducted completely separately from the NHS. That is why I believe it is entirely right that New Clause 4 should be supported. That clause suggests putting on the brakes for the moment. At this moment of desperate crisis for the health service it must be madness to lose money, to lengthen the queues and to work towards the development of separate standards. I beg the right hon. Gentleman to heed that, whatever his wilder hon. Friends below the Gangway may have said, and to say at this late hour "Yes, we shall put on the brakes".

Mr. Loyden

I shall not take up the arguments that were presented by the hon. and learned Member for Royal Tunbridge Wells (Mr. Mayhew) except to make one important point. When referring to the National Health Service, the hon. and learned Gentleman referred to the desire of Opposition Members to preserve the service. I think that subconsciously he probably applied the right word. Those who have taken part in the debate have been unified on at least one point—namely, an acceptance that the present queues and waiting lists for hospital attention are matters that we should not accept any longer than is necessary.

I understand that to "preserve" means that something is taken in its existing state and is preserved for a time in the future. In that way we should be preserving the state of the NHS as it is now. A tendency which has become more obvious in the recent past is for Opposition Members to create a political language when talking about such things as the National Health Service, education, insurance schemes and other aspects of our life. It seems that they want to see a clear divide between the elitist sections of our community and those who depend on the public sector for the provision of such services.

There is no doubt in my mind that the new clause will begin to deal with the total argument concerning the NHS. It will begin to deal with the principles that have been argued by my hon. Friends. There is a political idealogy involved in advancing the service and not preserving it. We wish to advance it to new levels. That is what is needed, and that is what was anticipated when the service was set up. There has been a detrioration in the National Health Service and, as has been clearly demonstrated by my hon. Friends today, if private medicine is allowed to continue as at present it will have a detrimental effect on the service.

We are talking about resources which ought to be made available to the mass of the people in this country. Those who are opposed to that view argue that, because they are able to afford private medicine and education, they can abrogate their responsibilities for the standards of health and education in the public sector. In those circumstances, it is clear that we would have a deteriorating National Health Service.

My hon. Friend the Member for Barking (Miss Richardson) has made clear in her reference to the resources already planned for the private sector that we are talking not about a few hospitals and few beds but about resources which will have a direct effect in the short term and an even more dangerous effect in the longer term on the NHS. For that reason, we should resist any attempt to continue the present position of private medicine and the NHS operating under the same umbrella.

Some Opposition Members have argued about the value and efficiency of consultants working with both private and NHS patients under the same roof. The fact is that NHS hospitals provide operating theatres and consulting rooms which would not be available outside the NHS. Preparations for the private provision of these facilities are being made now, and that is one reason why some people are seeking a delay in the implementation of the phasing out of pay beds.

We have expressed our grave concern about the Bill, and it is our intention to make clear that the present situation should not remain unaltered. New Clause 2 establishes that we support the continuance of the National Health Service on the basis that the service shall be made available to all at the time and place it is needed.

8.30 p.m.

Dr. Gerard Vaughan (Reading, South)

Once again the gauntlet is down for the Secretary of State, not only from this side but from his own Back Benchers. Once again we have seen him in a position which is becoming all too familiar where virtually every speaker from the Government side has been against what the right hon. Gentleman is doing.

Not for the first time, I find myself following soon after a speech of the hon. Member for Ormskirk (Mr. Kilroy-Silk). He made a most vicious and misleading speech. He is perfecting the technique of coming into the Chamber late in a debate, making an appalling speech full of vindictiveness and then walking out. I deplore that kind of action. It makes me wonder what kind of past the hon. Member has experienced that he should be so blatantly against every part of establishment and security in this country.

The hon. Member for Ormskirk believes that a flow of words makes the truth. He has no idea of how the majority of people in the NHS feel about the work they do and about the Bill. I am talking not only of doctors and nurses but about the majority of porters, ward maids, technicians and other people whom I meet.

One of the sad things about the Bill has been not only that Labour Members disagreed with us—we expected that—or that their contributions ranged from the rather whimsical ignorance of the hon. Member for Brent, South (Mr. Pavitt) to the vicious comments about consultants made by the right hon. Lady the Member for Blackburn (Mrs. Castle), but that speech after speech has demonstrated an appalling gap in understanding between what Labour Members think goes on in the NHS and what actually occurs. They have been describing a National Health Service that I have not come across.

The people I meet are overworked, dedicated people struggling to make do with diminished resources. Only the other day I met a surgeon who could not get funds to replace the basic instruments that he needs for his job.

We are talking about people who have looked after sick children, seen men and women in the last minutes of their lives and dealt with people who are in great pain. How can the right hon. Member for Blackburn say that that kind of person would turn his mind to making a little extra financial benefit by putting a patient through a private rather than a free bed? In my working life, my experience has been that doctors endeavour to provide the services for which patients ask. If patients want private care, the doctors will try to provide it. If the patients want other facilities, the doctors will try to provide them.

I have not come across the coercion and dishonesty to which the hon. Member for Aberdeen, North (Mr. Hughes) referred in his quite disgraceful remarks when he said that doctors had always been ready to play politics with their patients' lives. That is an absolute travesty of what goes on. It is this gap between what Labour Members have said in the debate and the reality of what goes on that I find so appalling.

Mr. Lomas

Will the hon. Gentleman give way?

Dr. Vaughan

The hon. Member for Rochdale (Mr. Smith) was right when he said that there was a widespread feeling within the National Health Service that freedom was at stake—

Mr. Lomas

I am trying to help the hon. Gentleman. Will he give way?

Dr. Vaughan

—not freedom to make money, but freedom to choose the kind of treatment most suited to the patient.

Mr. Lomas

In my speech, which the hon. Gentleman did not hear because he was not present—which was most regrettable—I was arguing in the nation's interests for the good of people who go into hospital. New Clause 2, so eloquently moved by my hon. Friend the Member for Brent, South (Mr. Pavitt) proposes that we should continue with the existing system but that by 1980 we should phase out private beds in the National Health Service. What is wrong with that? Why cannot the Opposition agree? I am sorry that they missed my 12-minute speech.

Mr. Deputy Speaker (Sir Myer Galpern)

Order. I hope that this intervention will not be used for the purpose of making another speech.

Dr. Vaughan

The hon. Member for Huddersfield, West (Mr. Lomas) is mistaken. Not only was I present during his speech, but I listened with interest to the whole of it. I remember thinking how persuasive the hon. Gentleman was and how appreciative he was of his recent experience of the National Health Service. I was pleased to see him back in the Chamber.

We deplore that at a time of great national economic crisis we should be wasting our time on a Bill which not only will cost more money to the National Health Service and cause it to lose fees but is a petty and vicious political act at a time when so much needs to be done within the NHS.

I associate myself entirely with the remarks made by my hon. Friends the Members for Canterbury (Mr. Crouch) and Ealing, Acton (Sir G. Young) about the great needs within the service.

The hon. Member for Rochdale said that there is a widespread feeling, whether we agree with it or not, within the National Health Service that freedom is at stake. That is not the freedom to charge fees, but the freedom to choose the kind of treatment that one feels is most suited to a patient. It is the freedom to practise professional skills in the way they have been taught.

One striking feature in Committee was the way in which my hon. Friends were constantly able to draw on practical experience from right across the country, whereas Government supporters were generally content to talk in generalities and ideology.

I have here a letter from Kent in which the writer says: This Government is attempting to nationalise our skills. It will lead to a disgruntled profession unwilling to continue to work the NHS treadmill. It will also lead to grave dangers for the old, the inadequate and the inconvenient. That is very true. Sadly, the Bill will cause extensive damage to the care of patients. That is what we deplore about it.

The same person says: I have myself cooked, made beds, swept floors, typed letters, put patients on to empty bed-pans, stoked boilers, pushed trolleys, but I doubt if any member of NUPE or CoHSE could do the work that I do. If I choose to ration or withdraw my skill no one will be better off. That is the sort of dilemma that is being faced by people.

To the hon. Member for Nelson and Colne (Mr. Hoyle) I say that it is not from the Conservatives that support for industrial action has come. We have consistently said that we deplore, are against and cannot support industrial action in the health field, and we have called on the Secretary of State and his colleagues to say that they deplore it equally—but we hear that from them in a very muted voice in times of crisis.

The hon. Member for Nelson and Colne is obviously out of touch with many of his union's members. Did he not know that one of the CoHSE branches produced a 12-point charter for the future of the NHS? Point 5 of that charter says that abuses are to be deplored and that professional conduct must be regulated, and point 11 says that the phasing out of pay beds is inappropriate where this would result in the lowering of standards of patient care. Is the hon. Gentleman unaware that at the NALGO annual conference this year there was a number of resolutions in favour of keeping pay beds? I have some of them in front of me. They are from Wigan, Kent and Warwickshire. They were defeated on a very narrow margin indeed. Therefore, it is absolute rubbish for the hon. Gentleman to say that he speaks for the majority of the union members.

My right hon. Friend the Member for Wanstead and Woodford (Mr. Jenkin) has stated clearly why the Opposition are opposed to the Bill and why we think that even now, and especially in the present economic situation, the Government should drop it. We believe that it would be far better, even now, to refer the question of pay beds to a Royal Commission. It would make great sense and it would bring peace and harmony back into the NHS.

Mr. Flannery

Nothing of the kind.

Dr. Vaughan

While we had expected in Committee to find that the Government and their supporters did not agree with us about withdrawing the Bill or amending it widely, we did not expect to find that the Government had not thought through the Bill's implications. I question the Government's competence over the Bill. In this Chamber we have a right to expect legislation to be well thought out and capable of being applied properly. That is not the case with this Bill. It was repeatedly demonstrated in Committee that the Government had not done their home work before bringing the Bill before us. We know why the Bill was brought forward in a rush. We know why it was left until late in the Session. We know all the problems that the Government mounted for themselves. However, that is not justification for producing a faulty Bill.

We came across the first problem when discussing the composition of the board —five very important independent people. There was to be a chairman; that was agreed. There were to be two professional representatives; that was agreed. Two other people were to represent interested parties. From where will they come? Who will they be? Will patients be represented on this board? We do not know. We could get no straight answer on this question from the Secretary of State. It has all been left to the future.

8.45 p.m.

Following speech after speech from the right hon. Member for Blackburn saying how much these beds were needed and how they would release further facilities—we have heard it again in the debate today—we did not expect to find, as we did in Committee, that in the majority of cases these beds will not be available for patients. We already have an example at University College Hospital, where the private beds released have gone over to administration. There are many other examples of that in other parts of the country.

It is becoming apparent to many members of the unions that they have mounted a wrong horse on this matter because, instead of reducing unemployment in the health field, the Bill and its proposals will increase unemployment. We already see the prospect of nurses, porters, technicians and ward maids being thrown out of work.

The Secretary of State spoke in Committee about the size of staff which would be needed and he used it as a justification for restricting the size of private hospitals. When we came to it in Committee, we discovered that his figures were a fantasy, based not on reality, as our figures were, but on a theoretical model. That was the way the right hon. Gentleman mounted his argument in favour of licensing each private unit. I have a long list of other inadequacies, but in view of the hour I will not go through all of them.

We were told that consultation had taken place, and we heard that again this evening. The public knowledge and truth of the matter is that regular, proper consultation has not taken place. The only real consultation which took place started during the time of the Committee. Even then we were assured that the question of beds being phased out would be discussed right down to hospital level.

Only yesterday, however, I got a letter from the chairman of the hospital area in Cambridgeshire, which will be particularly affected, saying that the consultations have been an absolute travesty and that all the authority has received so far is a formal circular, to which it replied but got no answer other than an acknowledgement. It simply got a letter saying that the Bill had now passed through Committee. Without proper consultation, it is an absolute travesty of what ought to have happened. It is no wonder that the health profession feels thwarted and frustrated by what it hears and by what is going on.

The Government must deal with their own Back Benchers in respect of New Clause 2. That is not for us. We leave their problems to them. Our view is quite clear. We believe that at a time like this we should not proceed with the Bill, and we shall vote in favour of New Clause 4.

Mr. Ennals

I was fascinated that in his last sentence the hon. Member for Reading, South (Dr. Vaughan) actualy reached the amendment that we are debating. He debated a number of other amendments which we shall come to later, and made a thunderous attack on the Government's handling of the Bill.

I would remind him that the last time we discussed the Bill in this House was on 20th July when we had a timetabling motion. Had we not had that time-tabling motion we would not have had detailed consideration in Committee for 29 sittings lasting 74 hours until we were able, even with one sitting over at the end which we did not need, to go right through the Bill and would not now have two days on Report. The one advantage of having two days on Report is that we have been able to have a very long debate on one group of amendments.

If we did not know it from the Committee proceedings, we know from what has happened in the House that, whatever differences there may be between the position which I shall take and that of my hon. Friends, the real division is absolutely clear between the two sides of the House. We have heard arguments about what is called the defence of freedom. In fact, they have been arguments for the defence of privilege. On this side it has been said that there should be a terminal date. As some of my hon. Friends say, whatever differences there may be between us, we are all united on our side in our determination that the time has come, nearly 30 years after the health service was established to separate the private from the public sector.

When I hear Conservative Members quoting Nye Bevan in this respect it makes me physically sick. I own only one personal portrait and that is of Nye Bevan. I never thought that I would have the privilege of taking it down into the office of Secretary of State for Social Services. He stands there on my desk and looks at me. The thought that, when he introduced the health service, he would have wished to defend the right of the private sector to remain within the public sector of the NHS is absolutely ludicrous. He was obliged to enter into a compromise at that time. I have no doubt that, had he been Secretary of State today, Nye would have been standing with my right hon. Friend and myself in introducing a measure like this. It might have been a measure which would not have been the sort of compromise which this one is.

I want to pay a tribute to my right hon. Friend the Member for Blackburn (Mrs. Castle). She has been attacked in her absence and in her presence during this debate. I must pay to her a tribute which, I believe, should be respected in all quarters of the House. No Secretary of State has stood more firmly by the principles of the National Health Service or has fought more effectively for resources for the National Health Service. She may sometimes criticise me, but I will not stand here and listen to criticisms of her integrity in the way in which she has tried to do her job.

I should also like, as no one has yet done, to defend the role of the noble Lord, Lord Goodman. I do not necessarily agree that the compromise reached was the best. That is not for me to decide. It was a compromise genuinely negotiated at a time when the NHS was in sore sickness. It was agreed—it was a fair agreement—that the proposals put forward by Lord Goodman, if they were found by the professions to be acceptable as a basis of legislation, would be put into effect and legislated by the Government on that basis. That was the bargain. It was put to the professions, it was accepted that that should be a basis for legislation.

Our side of the bargain is to stand by it. That my right hon. Friend has loyally done, and she has supported me in my position in Committee. l therefore want to make it clear to Conservative Members that we shall not abandon or postpone the implementation of the Bill. Let there be no question about that.

The hon. Member for Rochdale (Mr. Smith) and the hon. Member for Ealing, Acton (Sir G. Young) referred to the irrelevance of the Bill to the country's economic needs. The Bill not not introduced to deal with the nation's economy, but it is very relevant in terms of the needs of the health service.

What I find difficult to understand is that hon. Members opposite do not see the strength of principle which is held not only by my right hon. and hon. Friends but by those who work in the health service. I was surprised to hear the hon. Member for Reading, South imply—whether he based it on some sort of survey or not I do not know—that those who work in the health service are somehow united with the consultants in thinking that things should stay as they are. That is just not so. If this Government were to decide, which I can say we will not, to postpone the implementation of the Bill or to refer it to the Royal Commission, there would be great rifts within the health service. It is part of my responsibility to be concerned with the morale of the health service, with the way in which the different professions work together within it—whether they be consultants, nurses, technicians or porters—in making their contribution to tile health service.

The Opposition seem to think that somehow or other all will be peace and light if we drop the Bill. They do not realise that for some of those who work within the health service it is offensive and a challenge to their principles to be involved in a service which makes special provision for those who can pay and does not simply provide for the generality of the nation's needs. It would be greatly against the interests of the health service if the Bill were dropped or the Opposition's proposals were carried out.

The Opposition have referred to the unions, but I have not heard any hon. Member mention the Royal College of Nurses which is as much committed to the phasing out of pay beds as the unions. The members of the Royal College have said that to me and they welcome our stand on the issue. I, too, spent part of the summer in a National Health Service hospital, and I found a different attitude from that described by members of the Opposition.

The right hon. Member for Wanstead and Woodford (Mr. Jenkin) quoted extracts from an interview which I gave. I do have a very heavy responsibility to strengthen and improve the National Health Service and to improve the morale within it. I do not go along with those who make either particular or generalised criticisms against sections of the health service, I do not accept some of the statements made by my hon. Friends against consultants in a general sense, although some of the accusations apply individually. I also totally dissociate myself from criticisms of irresponsible union action. Most of those who work within the health service genuinely want it to succeed and I have a heavy responsibility to try to bring together the different strands of the service to ensure that they work together as a team and get away from the confrontation from which the service has been suffering.

Mr. Lomas

Will my right hon. Friend stop trying to convince the Opposition because we know they will not accept the proposals? The hon. Member for Reading, South (Dr. Vaughan) made a terrible speech. Will my right hon. Friend try instead to convince us why the Government should not accept New Clause 2?

Mr. Ennals

If my hon. Friend will be patient I shall seek to do precisely that and I hope that I shall succeed in convincing him.

One suggestion in the argument for postponement was that the matter should be put to a Royal Commission, but my hon. Friend the Member for Aberdeen. North (Mr. Hughes) was right when he said that the time had come to end the argument and the idea that the health service would be better if the issue were postponed. Not at all. It is the right decision to be taken now and it is right that we should proceed to implementation and then get back to the task of making improvements in relationships.

The hon. Member for Ealing, Acton referred to a sinking, bankrupt National Health Service. It is no such thing. There is much exaggeration about cuts in the service. Everyone knows that there are not nearly enough funds to meet the needs of the service, but I doubt if there ever were. While we all recognise that the rate of growth and expenditure has been reduced there is still increased expenditure on the National Health Service. Too many statements are lightly made, without examination, and they may lead to despondency and concern.

9.0 p.m.

The right hon. Member for Wanstead and Woodford referred to an alleged 20 per cent. cut in surgical beds at the West Middlesex Hospital. The fact is that there has been a temporary closure of 20 per cent. of the surgical beds there because of shortage of nursing staff. It is a difficulty of recruiting suitable staff. It is not a cut-back as an economic restraint. I have been assured today that it is hoped that the beds will be staffed and opened again within a month. The spreading of such rumours about the NHS can do very much damage, and. as was the case yesterday, the right hon. Gentleman would do better to ask for information first instead of making such statements in the House of Commons.

Sir George Young

I hope that the right hon. Gentleman is not implying that the cases I listed in my speech were imagined. Will he acknowledge that these cases have been announced by the North-West Thames Regional Health Authority?

Mr. Ennals

I am not suggesting that there are not closures, in some cases of hospitals and in some cases of units, but if one looks across the country one sees that it is inevitable that when one opens new hospitals there will be closures of old. The hon. Member for Ealing, Acton will recognise, coming as he does from London, that one of the things the Government are trying to achieve is to adjust the imbalance between the heavy preponderance of resources made available to the Thames Regions at the expense of other parts of the country. It is difficult for area health authorities and regional health authorities to carry this process through, but it has to be done in order to ensure that we have greater fairness across the land in the availability of resources.

Mr. Patrick Jenkin

I have refreshed my memory about the information given to me concerning the West Middlesex Hospital. The story I have been told is quite different from the right hon. Gentleman's. It is that the area health authority is holding vacant a number of posts in order to avoid redundancies when other hospitals within its remit are closed later in the year. It is a financial reason. The authority is having to close down the beds. I will examine the information which the right hon. Gentleman has given, but it is inconsistent with what I was told by a leading consultant at the hospital.

Mr. Ennals

My information comes from the area health authority. In view of the nature of this debate, I do not know whether the leading consultant to whom the right hon. Gentleman has referred wishes perhaps to put information into his head in order to influence the debate, but as I have said, I have had my information from the authority itself, which is responsible for appointments and for the allocation of resources. I say to the Opposition that I shall not accept their proposal for a postponement or deferment of part of the Bill.

I turn now to New Clause 2. I have a lot of sympathy with the argument of my hon. Friend the Member for Brent, South (Mr. Pavitt). He wants to get the job done quickly—I understand that—but he will not expect me to accept New Clause 2. I shall not accept it for precisely the same reason as was put by my right hon. Friend the Member for Blackburn. A bargain was struck, and a bargain is a bargain.

Throughout the 29 sittings of the Stand-Committee the Opposition sought to undermine that bargain, but we pledged ourselves to put that bargain before the House. It was put before the consultants. There was a commitment from the Prime Minister. The bargain stands.

One could debate on another occasion whether every bit of the bargain was all right. I am not claiming that my right hon. Friend the Member for Blackburn would say that she was wholly satisfied with the bargain, but that is not the question tonight. It was a bargain. If I were to say now that I am withdrawing from that bargain, from the central principle within it, which was not that there should be a terminal date but that there should be strict criteria on which an independent board could arrive at a decision, I would be betraying both the bargain and my trust to this House. However, I wish to give my hon. Friends some assurances.

Mr. Dennis Skinner (Bolsover)


Mr. Ennals


The assurances that I give are that the objectives of the Bill are set out very clearly, and anyone who agrees to be a member of the board will be under an obligation to ensure the carrying through of the purposes of the Bill, which are to phase pay beds out of the National Health Service. That will be the board's task and the task of all its members.

I believe that it would be a mistake to tie the board's hand by imposing a particular date. I have no doubt that the board will have made considerable progress by 1980. For all I know, it may have completed the task by 1980. Certainly, I would guess, it will have made more rapid progress in London than in other parts of the country, in the very nature of the situation.

This legislation is designed not to protect pay beds within the National Health Service. It is designed to phase them out, and it carries out absolutely to the letter the commitment made in two election manifestos. We said that we would phase out pay beds. That is what we are about to do, and, while I have every sympathey for the views my hon. Friends have expressed, I believe that those who will form the membership of the board will sense the feeling that the task must not be done too slowly. There will be a recognition of what hon. Members have said.

I hope, however, that my hon. Friends will not vote for the new clause. I hope that they will accept that, as Secretary of State, I have been fulfilling my responsibilities properly in maintaining a bargain which was struck, which was announced in the House, which was inscribed in the Bill and which has been carried through the Standing Committee.

Mr. Pavitt

I shall be brief in exercising my right of reply to the debate, and I greatly welcome some of the assurances given by my right hon. Friend.

I was disappointed by the speech of the hon. Member for Rochdale (Mr. Smith). I had hoped that he would lend his weight in support of my new clause, having heard him speak previously on health matters, when he looked to a much wider horizon. However, it was not to be. As for the hon. Member for Galloway (Mr. Thompson), I hope that he will have second thoughts. He came three-quarters of the way towards my New Clause 2, and I hope that he will come the rest of the way within the final few minutes.

As for the right hon. Member for Wan-stead and Woodford (Mr. Jenkin), who opened the debate on New Clause 4, I think that he always finds it difficult to dissociate himself from the Treasury. Every time he makes a speech on the National Health Service, I recall him in his previous incarnation as Chief Secretary to the Treasury. Invariably we have from him a Treasury-type speech, and he did not disappoint us today. The hon. Member for Galloway put very precisely the point which the right hon. Gentleman was making—that we should keep the matter in cold storage under New Clause 4, because in two years' time we may have a Tory victory, in which event it would stay in cold storage for all time. That, therefore, is one of the reasons why my hon. Friends and I shall resist New Clause 4.

The hon. Member for Reading, South (Dr. Vaughan) spoke as a consultant of Guy's Hospital and with a good deal of knowledge. However, I must tell him that this was the first occasion in any debate on the National Health Service—I have attended every one in the past 16 years—when anyone has stated that I speak from ignorance of the service. I assure the hon. Gentleman that, although he may have a subconscious urge—he knows all about the subconscious through his speciality—always to see the National Health Service in terms of what doctors want and request, we on these Benches speak for the patients, and that is always our approach.

More in sorrow than in anger, I assure my right hon. Friend, as I said when moving New Clause 2, that I accept both his position and that of my right hon. Friend the Member for Blackburn (Mrs. Castle). We on this side are well aware of and have very sympathy and understanding for the stand which he takes. He struck a bargain. But we did not strike a bargain, and, so far as we are concerned, when we have to go into the Lobby tonight, as I am afraid we shall, we shall not do it in any attempt to undermine either his authority or his purpose.

We know that if our very reasonable New Clause 2 were implemented, before the due date came there would have been seven reports to the House as a result of the efforts which my right hon. Friends the present Secretary of State and the Member for Blackburn made in including their provisions in the Bill. Therefore, there would be eternal vigilance.

We must press the clause to a Division to show that there is a strong body of opinion on the Labour Benches and outside the House that feels it imperative to include a date, even though it is four years away, otherwise the Bill will be too open-ended. Should there be a change of Government or Minister, or a number of other changes, we could see the thwarting of the purposes to which I am sure my right hon. Friend the Secretary of State is just as devoted as I and my right hon. Friend the Member for Blackburn are. Therefore, I ask as many of my right hon. and hon. Friends as feel able to join me in the Lobby to do so.

Question accordingly negatived.

Question put, That the clause be read a second time:

The House divided: Ayes 50, Noes 144.

Division No. 313. AYES [9.11 p.m.
Allaun, Frank Heffer, Eric S. Rooker, J. W.
Anderson, Donald Hoyle, Doug (Nelson) Rose, Paul B.
Buchan, Norman Hughes, Robert (Aberdeen [...]) Short, Mrs Renée (Wolv NE)
Callaghan, Jim (Middleton & P) Hughes, Roy (Newport) Sillars, James
Carmichael, Neil Kilroy-Silk, Robert Silverman, Julius
Clemitson, Ivor Lambie, David Skinner, Dennis
Colquhoun, Ms Maureen Lestor, Miss Joan (Eton & Slough) Spearing, Nigel
Cook, Robin F. (Edin C) Litterick, Tom Taylor, Mrs Ann (Bolton W)
Corbett, Robin Lomas, Kenneth Thomas, Dafydd (Merioneth)
Davies, Bryan (Enfield N) Loyden, Eddie Thomas, Ron (Bristol NW)
Edge, Geoff McDonald, Dr Oonagh Thorne, Stan (Preston South)
Evans, Gwynfor (Carmarthen) McMillan, Tom (Glasgow C) Wigley, Dafydd
Evans, Ioan (Aberdare) Madden, Max Wise, Mrs Audrey
Fernyhough, Rt Hon E. Maynard, Miss Joan Woof, Robert
Flannery, Martin Mendeison, John
George, Bruce Noble, Mike TELLERS FOR THE AYES:
Grocott, Bruce Roberts, Gwilym (Cannock) Mr. Laurie Pavitt and
Hatton, Frank Roderick, Caerwyn Miss. Jo Richardson.
Archer, Peter Fletcher, Ted (Darlington) Morris, Charles R. (Openshaw)
Ashton, Joe Foot, Rt Hon Michael Moyle, Roland
Atkins, Ronald (Preston N) Ford, Ben Murray, Rt Hon Ronald King
Atkinson, Norman Forrester, John Ogden, Eric
Bagier, Gordon A. T. Eraser, John (Lambeth, N'w'd) Orbach, Maurlce
Bain, Mrs Margaret Freeson, Reginald Orme, Rt Hon Stanley
Barnett, Guy (Greenwich) Golding, John Pardoe, John
Bates, Alf Gould, Bryan Park, George
Beith, A. J. Gourlay, Harry Parker, John
Benn, Rt Hon Anthony Wedgwood Grant, George (Morpeth) Pendry, Tom
Bishop, E. S. Grant, John (Islington C) Panhaligon, David
Blenkinsop, Arthur Gray, Hamish Reid, George
Boardman, H. Hamilton, James (Bothwell) Roberts, Albert (Normanton)
Booth, Rt Hon Albert Hardy, Peter Robinson, Geoffrey
Bray, Dr Jeremy Harper, Joseph Roper, John
Brown, Hugh D. (Provan) Harrison, Walter (Wakefield) Ross, Stephen (Isle of Wight)
Brown, Robert C. (Newcastle W) Henderson, Douglas Ross, Rt Hon W. (Kilmarnock)
Buchanan, Richard Hooson, Emlyn Rowlands, Ted
Campbell, Ian Howell, Rt Hon Denis (B'ham, Sm H) Ryman, John
Cant, R. B. Howells, Geraint (Cardigan) Silkin, Rt Hon S. C. (Dulwich)
Castle, Rt Hon Barbara Hughes, Rt Hon C. (Anglesey) Small, William
Chalker, Mrs Lynda Hunter, Adam Smith, Cyril (Rochdale)
Cocks, Michael (Bristol S) Hutchison, Michael Clark Smith, John (N Lanarkshire)
Cohen, Stanley Irving, Rt Hon S. (Dartford) Snape, Peter
Coleman, Donald Jackson, Miss Margaret (Lincoln) Spriggs, Leslie
Conlan, Bernard Jay, Rt Hon Douglas Stewart, Ian (Hitchin)
Cox, Thomas (Tooting) Jenkins, Hugh (Putney) Stoddart, David
Craigen, J. M. (Maryhill) John, Brynmor Strang, Gavin
Cronin, John Johnson, James (Hull West) Swain, Thomas
Crowther, Stan (Rotherham) Jones, Alec (Rhondda) Thompson, George
Cryer, Bob Jones, Barry (East Flint) Tinn, James
Cunningham, G. (Islington S) Jones, Dan (Burnley) Urwin, T. W.
Cunningham, Dr J. (Whiteh) Lamond, James Wainwright, Edwin (Dearne V)
Davidson, Arthur Lewis, Ron (Carlisle) Walker, Harold (Doncaster)
Davies, Denzil (Llaneill) Lipton, Marcus Walker, Terry (Kingswood)
Davies, Ifor (Gower) Lyons, Edward (Bradford W) Weetch, Ken
Deakins, Eric MacCormick, Iain Welsh, Andrew
Dempsey, James McElhone, Frank White, Frank R. (Bury)
Doig, Peter MacFarquhar, Roderick White, James (Pollock)
Dormand, J. D. McGuire, Michael (Ince) Willey, Rt Hon Frederick
Douglas-Hamilton, Lord James MacKenzie, Gregor Wilson, Alexander (Hamilton)
Duffy, A. E. P. Mackintosh, John P. Wilson, Gordon (Dundee E)
Dunn, James A. Mahon, Simon Wilson, William (Coventry SE)
Eadie, Alex Marks, Kenneth Young, David (Bolton E)
Edwards, Robert (Wolv SE) Marquand, David Young, Sir G. (Eating, Acton)
Ellis, John (Brigg & Scun) Marshall, Dr Edmund (Goole)
Ennals, David Marshall, Jim (Leicester S) TELLERS FOR THE NOES:
Ewing, Harry (Stirling) Meacher, Michael Mr. A. W. Stallard and
Faulds, Andrew Miller, Mrs Millie (Ilford N) Mr. Ted Graham.
Fletcher, L. R. (Ilkeston)
Forward to