THE HEALTH SERVICES BOARD AND ITS COMMITTEES (Hansard, 12 October 1976)

§ Mrs. Knight
I beg to move Amendment No. 1, in page 1, line 10, leave out 'five' and insert 'seven'.

§ Mr. Deputy Speaker (Sir Myer Galpern)
With it we may take the following amendments: No. 67, in Schedule 1, page 25, line 14, at end insert: '(d) two other persons representing the interests of patients who wish to undergo medical treatment privately.' No. 68, in page 25, line 21, leave out 'one or other of the national health services'. No. 69, in page 25, line 23, at end insert— '(3) In appointing all the members of the Board the Secretary of State shall, so far as is practicable, ensure that they will have as their sole concern the interests of hospital patients generally, and not the interests of any other group or class of persons.'

§ Mrs. Knight
The amendments seek to provide, first, that the board shall have seven members instead of five; secondly, for two other persons to represent the interests of private patients. They also seek to determine beyond what we already know precisely what is meant by the wording of Schedule 1: (b) such bodies not falling within paragraph (a) above as the Secretary of State may recognise as being representative of persons employed in one or other of the national health services or concerned with the interests of patients at NHS hospitals. It is far from clear what is meant by those words. Although we asked the Minister in Committee, we did not receive a satisfactory reply. The concept appears to be divisive. As no clear answer was given in Committee the amendment has been moved now. I trust that we shall have a clearer answer on this occasion.
10.45 p.m.
Amendment No. 69 is of great importance. We believe that there has been far too much interest and notice paid to other groups in this matter and far too little attention paid to the possible detrimental effect on patients as a result of what we are doing.
388 The case for extra members on the board is overwhelming. I doubt whether hon. Members have appreciated the vast number of duties which the Bill places on the shoulders of the board. It will have to check that reductions in all areas are being carried out according to the rules that are set out clearly in the Bill. It will have to investigate and submit plans for progressive revocation in accordance with Clause 4. That will be very much a continuing process. The Bill will involve careful scrutiny of all areas. Already in the health service there is far too little care and proper scrutiny given when cases are being made out.
A matter that reached my attention recently involved the children's hospital in Birmingham. It was found that very many more facilities needed to be made available. It is the second children's hospital in Britain. It covers a wide-ranging catchment area. It was reckoned in the early 1970s that the hospital needed to provide for 100 open heart operations a year and that the staff, especially the intensive care unit staff, should be geared to that number of operations. In fact, it has been found that the need is exactly double that estimate. It has been found that there needs to be at least 200 open heart operations. There are already most distressing cases of children who need heart operations who are not able to have them at present because of a shortage of staff.
I was told on a recent visit to the hospital that an application had been made for more staff to carry out the necessary duties. The request was put through the normal procedure and it was turned down flat with no one even visiting the hospital, no one even going to inquire why the children needed the extra members of staff.
That is the sort of thing that must now happen many times over in the health service. Applications are turned down by some distant administrator who does not even take the trouble to go to the hospital, examine the waiting lists, talk to the consultants and assess the real need.
Under the Bill responsibility is placed quite clearly on the board. It would be wrong if we were to fail to appreciate the extensive duties that the Bill places 389 on the board. It seems extraordinary to expect that five people will be able actively and properly to carry out all the duties laid upon them. The board will have to take account of all the difficulties that might be experienced by all hospitals after private patients are phased out. For example, it will have to give consideration to the case that is made by a hospital that its teaching programme will be adversely affected. That is a matter that the board will have to study.
The board will also have to consider research work. I do not know how many hospitals there are in Great Britain, but the board will have wide and extensive duties. It will be blamed if facilities deteriorate after the Bill becomes law and we must make the board big enough to cope with the duties we impose on it.
The board will also have to check that admissions to hospital are on medical grounds alone. We have heard a great deal of rubbish about waiting lists. Hon. Members opposite have ridden this old horse until it is almost dead on its feet. They will never accept the truth that no person in desperate need of medical care has ever been unable to get it because a private patient has been occupying a bed. No evidence has ever been provided to disprove this fact.

§ Mrs. Renée Short
If the hon. Lady says she has seen no evidence, she must have read the evidence to a recent Select Committee with her eyes closed. Cases were quoted by people working in hospitals and general practitioners said that they had patients in need of urgent operations who were having to wait.
The hon. Lady is being prompted now by the hon. Member for Reading, South (Dr. Vaughan) who sat on that Committee. If she says that no patient in urgent need of a serious operation has ever had to wait, she must have been reading the evidence with her eyes closed.

§ Mrs Knight
What I have said is true. The evidence to which the hon. Lady refers was never substantiated. I have checked.

§ Mrs. Renée Short
With whom?

§ Mrs Knight
I shall talk to the hon. Lady afterwards if she wishes. She is 390 well aware that there has never been a substantiated case of a sick person in desperate need of medical attention being unable to get it because a private patient occupied a bed.
It is extraordinary how some people refuse to see the truth even when it is in front of their face. No one on this side of the House would accept for a moment a situation in which a person needing desperate medical care was denied it because of private patients, but it simply does not happen. What does happen is that social considerations frequently have to be taken into account in admissions to hospital. For example, teachers may need to be admitted during school holidays or mothers admitted at times when their children can be cared for properly.

§ Mrs. Renée Short
Wealthy mothers.

§ Mrs. Knight
The hon. Lady may talk about wealthy mothers if she wishes. I am talking about ordinary working-class mothers like me who need care. We are all working class today. The hon. Lady perhaps had staff to look after her children if she needed care. I have not had that benefit. I am talking about mothers who need to make specific arrangements for their children to be taken into care and therefore have to ask the NHS to take them into hospital at a certain time. We discussed this matter in Committee. Some Labour Members recognised that there was often good reason to override the clear medical priority because of social considerations.

§ Mr. Boscawen
My hon. Friend is correct. It is done time and again every day in every hospital.

§ Mrs. Knight
This debate has illustrated the task that we are placing on the board in this regard. The first time that anyone finds that Mrs. So-and-So has been in hospital before Mrs. Such-and-Such, they will have to complain to the board. The duties that we are giving the board are extremely wide and difficult to cope with.

§ Mr. Ennals
I cannot see the relevance of the hon. Lady's remarks to whether the board shall consist of five or seven members. It may be that I am a bit dim. The hon. Lady seems to be referring to the board as if it were taking over responsibility from the Secretary of 391 State for running the health service. I do not understand her logic.

§ Mrs. Knight
I am merely following and enumerating the duties which the Bill places on the board. If the Secretary of State will look at the Bill and recall the debates in Committee, he might realise that everything I have mentioned is in the Bill as being the duty of the board.
The board has a wide variety of duties to perform. When a board is given such duties, surely it is not outrageous to suggest that its membership should be enlarged to cope with the large number of duties that have to be performed. That is not unreasonable.
As well as looking at the specialist services—radiotherapy, diagnostic, pathological, and so on—the board members have to work on planning permissions and notifiable works. The Secretary of State will recall that we had an interesting and lengthy debate on notifiable works. Adjudication on what is a notifiable work is difficult.
On page 17 of the Bill—this is what makes this part of the board's duties difficult—we are told: 'hospital premises' means premises of any prescribed class, being premises used or to be used for the prevention, diagnosis or treatment of illness or for the reception of patients". The difficulty is that any alteration to any premises so prescribed must come to the board for scrutiny. This is another reason why I beg the House and the Secretary of State to appreciate the variety of duties with which the board is being asked to cope.
Secondly, the number of persons is not sufficient. Above all, there ought to be at least one or, as I say, two other representatives on the Board, because there is no one on the Board to speak for private patients at all.
As I said in Committee, if a committee, a board or anything of that sort were to be set up to discuss matters vitally affecting trade unionists, their conditions of work, their freedoms or rights, I should be the first to go to the battlements and—