Commons Sitting of 13 October 1976

Preamble
The House met at half-past Two o'clock
PRAYERS
[Mr. SPEAKER in the Chair]
PRIVATE BUSINESS
  COITY WALLIA COMMONS BILL [Lords]
  Considered; to be read the Third time.
  CROMARTY HARBOUR ORDER CONFIRMATION
  Mr. Bruce Millan presented a Bill to confirm a Provisional Order under Section 7 of the Private Legislation Procedure (Scotland) Act 1936 relating to Cromarty Harbour; and the same was read the First time; and ordered to be considered upon Tuesday next and to be printed. [Bill 225.]
ORAL ANSWERS TO QUESTIONS
  SCOTLAND

    Scottish Assembly
    Mr. Tim Rentonasked the Secretary of State for Scotland how much money the Government have now spent in adapting the Royal High School in Edinburgh for a Scottish Assembly.
    The Under-Secretary of State for Scotland (Mr. Harry Ewing): £650,000 has been spent in purchasing the former Royal High School site.
    Mr. Renton: At a time when economic pressures in the United Kingdom are so great that they are likely to cause serious trouble, is it not foolish for the Government to pursue a further element of disintegration in our society? Will Ministers pause and think again, and postpone the devolution Bill until the next General Election, when it can be discussed with the whole electorate?
    Mr. Ewing: It is not the Government's purpose to pursue any element of disintegration in our society. One of the fundamentals of the devolution proposals is the preservation of the economic and political unity of the United Kingdom. We are committed to put this Bill on to the statute book, and we will do so in the next Session.
    Mr. Gordon Wilson: Will the Minister resist English interference in Scottish affairs and admit that the amount of money being spent on the Scottish Assembly is a mere bagatelle compared with the £2½ million coming from Scottish oil every day?
    Mr. Ewing: I always welcome interest rather than intervention in Scottish affairs from all parts of the House and all parts of the United Kingdom. This sort of interest will help to preserve the unity of the United Kingdom. As far as costs are concerned, the amount spent on the Royal High School, and in particular on its conversion, is very good value for money.
    Mr. Sillars: Would it not help to get things in perspective if the Minister took

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    the costs involved in devolution and compared them with the cost of our joining the European Economic Community and of direct elections to Strasbourg?
    Mr. Ewing: I am not necessarily sure that both matters are related. We have studied the costs involved in devolution and we are satisfied that we will get adequate value for money.
    Mr. Galbraith: Can the Minister explain to the House why he is so sure that this expensive Assembly will stop the disintegration of the United Kingdom? Is it not a fact that it will be a stepping stone to the creation of a separate Scottish State?
    Mr. Ewing: I know that that is the view which the hon. Member has held for some time and which he has expressed forcibly. However, it is not a view which is shared by many hon. Members of his own party. There is no evidence, in looking at other parts of the world where there is a devolved system of government, to show that this will lead to separation. I do not think that the hon. Member should take the threats of the Scottish National Party all that seriously.
    Mr. Alexander Wilson: I hope that my hon. Friend will not listen to advice given by the Scottish National Party in relation to English interference. Will he also—[HON. MEMBERS: "Reading."] I am not reading. I resent that remark. Will my hon. Friend also ask the Scottish National Party what it intends to do with the Scottish coal industry if it does not want English interference? The Scottish coal industry is dependent on English coalfields.
    Mr. Ewing: In many respects my hon. Friend has hit the nail on the head. Hitherto, the Scottish National Party has not been in a position to talk about policies, whether in relation to the coal industry, housing, education, the health service or anything else. On the day the Scottish Assembly elections are held, politics in Scotland will be transformed and the SNP will no longer be able to campaign on slogans.

    Fisheries Policy
    Sir John Gilmourasked the Secretary of State for Scotland whether he is satisfied that progress has been made in
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    renegotiation of the EEC fisheries policy which is satisfactory to the Scottish inshore fishing fleet.
    The Secretary of State for Scotland (Mr. Bruce Millan): It is premature to talk of satisfactory progress. The Commission's latest proposals have only recently been tabled, and substantive discussion on them with our EEC partners begins next week.
    Sir J. Gilmour: Does the right hon. Gentleman agree that, in view of the present economic situation and the need to produce as much food as we can ourselves, it is absolutely essential to have the widest possible fishing limits to preserve the Scottish inshore fishing industry?
    Mr. Millan: I certainly agree that it is important that we should have an economic, effective and viable fishing industry in Scotland. That is what I intend to achieve.
    Mr. Robert Hughes: For the avoidance of all doubt, will my right hon. Friend make it absolutely clear that the proposals being made by the Commission are totally unacceptable to the Government? Does he appreciate that as long as he pursues a policy of getting the maximum limits and catch potential for the British fishing fleet he will have our wholehearted support?
    Mr. Millan: I am grateful to my hon. Friend for his closing remarks. I have already made it clear that the Commission's proposals regarding limits are wholly unacceptable to the Government.
    Mr. Grimond: Is the right hon. Gentleman aware that if, as is sometimes alleged, the Government feel that they are in a weak bargaining position over fishing policy alone, they might broaden the negotiations to include trade and agriculture, where we have considerable bargaining power? Will the Secretary of State confirm that the Government are going into the negotiations with the firm intention that we must have a 50-mile limit?
    Mr. Millan: The Government's position on limits was made clear on 4th May. I have nothing further to add to what was said then. We are aware that discussions about fishing must be related

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    to the general context of EEC discussions and negotiations as a whole.
    Mr. Henderson: Is the Secretary of State aware that since 4th May his Under-Secretary of State, the hon. Member for Glasgow, Provan (Mr. Brown), said in Aberdeen on 3rd September that the United Kingdom had not a hope in hell of getting a 50-mile limit, and that this has caused considerable distress throughout the industry? Will he take this opportunity of publicly reprimanding his Under-Secretary of State for that absurd remark?
    Mr. Millan: Certainly not. I have every confidence in my hon. Friend. The statement on 4th May did not call for a 50-mile limit all round the United Kingdom. It talked abouts limits up to 50 miles. That remains the position.
    Mr. Buchanan-Smith: I welcome the Secretary of State's firmer line this afternoon in contrast to what was said in Aberdeen last month. I assure him of support as long as he takes a firm line on this important issue for Scotland. In view of the importance of this issue to Scotland, will he be taking part in the EEC negotiations next week on behalf of the Scottish fishing industry?
    Mr. Millan: On the last point, yes. On the first point, I should listen rather more attentively to the hon. Gentleman if I did not have in mind the miserable record of the Conservative Government in the original negotiations.

    Edinburgh
    Mr. Rifkindasked the Secretary of State for Scotland when he next intends to pay an official visit to Edinburgh.
    Mr. Millan: I am normally in Edinburgh every week on official business.
    Mr. Rifkind: Has the Secretary of State considered the transcript of evidence of the recent Tartan Army trial in Edinburgh? Is he aware that, as a result of that trial, the Scottish National Party has announced an internal inquiry to determine the amount of infiltration into that party of men of violence? Will the right hon. Gentleman call upon the SNP to make its findings public? Will he also indicate the Government's view on the
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    likelihood of further acts of political violence in Scotland?
    Mr. Millan: Some of those questions are not for me. It is up to the Scottish National Party to put its own house in order.
    Mr. Gordon Wilson: Does the Secretary of State accept that the SNP has always puts its house in order regarding anything of that kind, just as the other political parties in Scotland have done in relation to criminal charges which may arise in connection with any of their members? Furthermore, does he accept that the implication made by the hon. Member for Edinburgh, Pentlands (Mr. Rifkind) is the kind of thing which does not do any good to politics? Finally, is there to be any inquiry into the handling of the case by the Crown Office?
    Mr. Millan: That is not a matter for me. I notice that the hon. Gentleman is sensitive to criticism when it is directed to his party but that he is free with abuse of others.
    Mr. Monro: When the Secretary of State next comes to Edinburgh, will he call a meeting of those involved in maintaining discipline at football grounds? Will he tell the House why the guidelines laid down by the Government have not been fulfilled in either England or Scotland? Is he satisfied that the magistrates and district courts have sufficient powers to deal with anything which may happen at a football ground?
    Mr. Millan: I do not think that this has much to do with a visit to Edinburgh. The hon. Gentleman knows that I am arranging to meet the SFA. I have also arranged a meeting with chief constables on Friday. I shall be discussing with them some of the matters that he has mentioned. I am extremely concerned about what happened last Saturday. Concerning penalties, the answer is that adequate penalties are available. It is for the courts to use these penalties, as I hope they will in suitable cases, in a very severe way.

    Fishing Industry
    Mr. Sproatasked the Secretary of State for Scotland when he next plans to meet representatives of the fishing industry.
    The Under-Secretary of State for Scotland (Mr. Hugh D. Brown): My right hon. Friend and I are meeting representatives of the industry later this afternoon and tomorrow.
    Mr. Sproat: Is the hon. Gentleman aware that the industry regards his proposals on limits as totally inadequate and spineless? Will he tell the fishing industry this afternoon that when his right hon. Friend goes to Brussels he will stick out for a 50-mile limit, no less, and that if he does not get it we shall apply a direct or an indirect veto?
    Mr. Brown: My right hon. Friend has already made the Government's position clear. A 50-mile exclusive limit or, indeed, a 50-mile protected zone, whatever that means—that was the phrase used by the right hon. Member for Sidcup (Mr. Heath)—would mean that our fishermen would be fishing in the plains of Normandy or the bogs of Donegal. I wish that the Conservative Party would get off this simplistic 50-mile exclusive zone all round the United Kingdom.
    Mr. Welsh: Is the hon. Gentleman aware of the anger and frustration felt by Scottish fishermen at the financial and other implications of the Government's new safety regulations, as was shown at a meeting recently held at Arbroath? Will he ensure that his English ministerial colleague fulfils his promise of a review of these regulations after they have been in operation for one year?
    Mr. Brown: I should prefer it if the hon. Gentleman would write giving me the details of what was said at the meeting to which he referred. We have assured the fishing industry that we will deal with the question of safety in as sympathetic a way as possible.
    Mr. Robert Hughes: Will my hon. Friend give an assurance that there will be no reduction in standards in the safety regulations for fishing vessels sailing from any British port, since the lives and safety of those who go to sea are of first importance and are to be considered as more important than the cost of such regulations? Will he also give the latest figures regarding the viability of the Scottish fishing fleets?
    Mr. Brown: I assure my hon. Friend that there will be no reduction in the safety requirements for the fishing industry. Earnings of white fish trawlers over 80 ft. in the first eight months of 1976 were 28 per cent. up on 1975. Average earnings per day at sea were 48 per cent. up on 1975. The earnings of the industry as a whole were 42 per cent. up on 1975. [HON. MEMBERS: "Answer the question."] I am answering the question that was put to me. All I can say in the short term is that the industry is in a healthy state.
    Mr. Fairbairn: Appreciating as I do that the Under-Secretary of State, as a Socialist, is entitled to speak with authority about hell, may I ask why he sold his negotiating pass by announcing to those with whom we have to negotiate that we had not a hope in hell of getting what we were looking for?
    Mr. Brown: That is too sophisticated for me. I suggest that it is high time that Tory leaders injected a degree of realism and showed some courage and honesty in facing the difficult negotiations that lie ahead of us.

    Unemployment
    Lord James Douglas-Hamiltonasked the Secretary of State for Scotland if he will make a statement on the most recent state of unemployment in Scotland.
    Mr. Millan: Although there was a welcome fall of 8,700 in total unemployment in Scotland between August and September, the current level remains a matter of serious concern to the Government. Our regional and economic policies are directed towards curing the underlying causes of unemployment.
    Lord James Douglas-Hamilton: Does the right hon. Gentleman accept that the Labour Party has become the natural party of massive unemployment as a direct consequence of its policies? Will not the vicious increase in interest rates produce a further decrease in the confidence of British industry and probably lead to even worse unemployment figures in future?
    Mr. Millan: I cannot accept any of the hon. Gentleman's assertions. I do not believe that the recent increase in interest rates will have the serious effect

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    on unemployment that some hon. Members suggest.
    Mr. Thorne: Does my right hon. Friend agree that when the Scottish Assembly is elected it will be much more effective in dealing with unemployment if it is given more economic power than is proposed in the dissolution Bill?
    Mr. Millan: It is the devolution Bill, not the dissolution Bill, and it has not been published yet. We believe that the proposals already outlined for control of the Scottish Development Agency, for example, give an effective balance between the genuine powers of the Assembly and the maintenance of the economic unity of the United Kingdom.
    Mrs. Bain: Will the right hon. Gentleman undertake to ascertain how many youngsters have gone back to school because no jobs were available for them? How many jobs does he expect to be available for youngsters leaving school at Christmas?
    Mr. Millan: There was a substantial reduction in youth unemployment in the latest figures. I cannot give the information for which the hon. Lady asks in the first part of her question. It is a matter not only of those who go back to school but also of those who decide to stay on after the leaving date. This is sometimes a desirable development and I do not consider it necessarily to be an adverse feature of the situation. It is the Government's intention to make jobs available for young people who want to leave school. They have the right to expect that employment will be available for them.
    Dr. M. S. Miller: What action does my right hon. Friend intend to take to ensure that multinational companies such as STC respect their obligations to the British taxpayer, since this is one of the causes of unemployment in Scotland? Does he intend to pursue the efforts which some of us are making to get Rolls-Royce to review its policy in Scotland, particularly in the East Kilbride constituency?
    Mr. Millan: On my hon. Friend's second point, he will be aware of the letter sent out by my right hon. Friend the Secretary of State for Industry the other day. My hon. Friend was also at a meeting with the Secretary of State
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    and therefore knows the overall prospects of Rolls-Royce, not only for this year but for next year and a little further forward as well. He also knows the context in which the decision on Blantyre was taken. On my hon. Friend's first question, my experience is that multinational companies are no worse, if no better, than other companies in dealing with redundancies. I do not think that the problems in Scotland can be attributed to multinational companies or to any other source of employment in Scotland.
    Mr. Buchanan-Smith: Can the right hon. Gentleman elaborate on his earlier assertion that the increased interest rates, coupled with an increased payroll tax through national insurance contributions, will have no effect on unemployment in Scotland? Is he really so out of touch with the economy of Scotland and the economy of business there that he believes this? When will he face the fact that it is as a result of his Government's policies since 1974 that we have such long jobless queues? He is living in the same cloud-cuckoo land as the Chancellor of the Exchequer.
    Mr. Millan: I did not say that the increased interest rates would have no effect on investment intentions. It would be absurd to claim that. I said that they would not have the serious effects which some hon. Members opposite have claimed. The July survey of industrial trends by the Scottish CBI confirmed the upward trends first indicated in January and April this year. Taken as a whole, Scottish industry now has much more confidence in the future than for a long time, and this is confirmed at my meetings with industrialists.

    School Examination Results
    Miss Harvie Andersonasked the Secretary of State for Scotland if he will now publish the analysis of examination results as announced in July and considered by the Scottish Examination Board, in the light of the use of calculators.
    The Under-Secretary of State for Scotland (Mr. Frank McElhone): This is a matter for the Scottish Certificate of Education Examination Board—but since it was raised by the right hon. Lady on 21st July we have been in touch

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    with the board and it is pursuing the matter.
    Miss Harvie Anderson: Does the hon. Gentleman realise that his reply is wholly unsatisfactory? Is it not possible to make an analysis of recent results? Surely it must be possible to identify pupils who used calculators and those who did not. If, as I suspect, there is shown to be an inbuilt benefit to those using calculators, will the hon. Gentleman undertake either to supply them to all pupils taking examinations or to say that calculators must not be used in examinations?
    Mr. McElhone: This is a matter for the board, which is keenly aware of the need to ensure equity and fairness in examinations where some candidates are using caluculators. The board believes that its arrangements and the way in which it presents examination papers do not give a significant advantage to anyone using calculators, contrary to what the right hon. Lady said in her supplementary question on the last occasion when she raised this subject. The board is today re-examining its attitude to this matter.
    Miss Harvie Anderson: In view of the unsatisfactory nature of that reply, I beg to ask leave to give notice that I shall seek to raise the matter on the Adjournment at the earliest opportunity.

    Kinross and West Perthshire
    Mr. Fairbairnasked the Secretary of State for Scotland if he will pay an official visit to Kinross and West Perthshire.
    The Minister of State, Scottish Office (Mr. Gregor MacKenzie): My right hon. Friend has at present no plans to do so.
    Mr. Fairbairn: As the Secretary of State is responsible for transport in Scotland, although one might not believe it, may I ask whether he has considered the effect on the tourist industry, other industries and life in general in Perthshire of the proposed closure of Motorail in Perth by British Rail? If so, what steps is he taking to prevent it?
    Mr. MacKenzie: This is a matter for the day-to-day management of British Rail. If the hon. and learned Gentleman wants helpful answers on matters of this
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    kind, he ought to put down the Question which he wants answered.
    Mr. Crawford: Is the Minister aware that I welcome the rather belated interest shown in this matter by the hon. and learned Member for Kinross and West Perthshire (Mr. Fairbairn)? Will he personally intervene with British Rail to ensure that this piece of economic lunacy is not perpetrated?
    Mr. MacKenzie: I am sure that the Chairman of British Rail will have noted the comments made today.
    Mr. Budgen: If the Secretary of State does visit Kinross and West Perthshire, will he do what all his fellow Ministers have so far failed to do and tell the people of Scotland exactly how many extra people will become unemployed as a consequence of the recent increase in interest rates?
    Mr. MacKenzie: The last time I made a speech in Kinross and West Perthshire was during the General Election of 1959, and nobody paid very much attention to me then. Over the past couple of months, members of the Government have made 50 or 60 visits in Scotland and we have met representatives of many organisations to explain Government policies.
    Several Hon. Members rose—
    Mr. Speaker: Order. May I draw to the attention of the House that it is now 3 o'clock and we have reached only Question No. 7. It would be a great help if hon. Members would try very hard to ask only one supplementary question when they are called and if answers could be correspondingly brief.

    Mortgage Funds
    Mr. Robin F. Cookasked the Secretary of State for Scotland if he will make a further statement on the operation of the special mortgage fund set up by the Building Societies Association in consultation with local authorities.
    Mr. Hugh D. Brown: As I indicated in my reply to my hon. Friend the Member for Kirkcaldy (Mr. Gourlay) on 24th March, progress with the scheme has not been all that I would have wished. Discussions continue with the building societies about their taking a wider view of lending policies, and we are encouraging

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    local authorities to seek to involve individual societies more closely in meeting local housing needs.
    Mr. Cook: Does my hon. Friend agree that the answer he gave to my Question on the last day the House sat before the Summer Recess indicated that the building societies were unduly restrictive in operating the scheme, since only a handful of families in the whole of Scotland have succeeded? Is he aware of the difficulties which this poses for the regeneration of inner city areas? If the building societies will not be more flexible in their arrangements, will my hon. Friend consider increasing the sums available to local authorities for lending?
    Mr. Brown: I accept that. The lending to local authorities is being maintained at £13 million this year, but I admit that this matter is giving me concern in our total housing strategy. I accept what my hon. Friend has said.
    Mr. Younger: Is the hon. Gentleman aware that, as a result of the Government's recent action in increasing interest rates, many of our constituents who are trying to buy their own homes will be paying upwards of £5 a week more in mortgage repayments? As this is a result of the social contract, will the hon. Gentleman ensure that home buyers are separately represented in future discussions of the social contract so that they can have their case heard?
    Mr. Brown: I am more concerned with the matters raised by my hon. Friend the Member for Edinburgh, Central (Mr. Cook)—namely, looking after first-time borrowers, especially in the large cities, where there is tenement property for which the building societies will not lend. That is the stumbling block in encouraging people into owner-occupation.
    Mr. Carmichael: Does my hon. Friend agree that the ring that the building societies are throwing round certain areas is deplorable? Will he urge local authorities, and perhaps the Government, to aid the inner city areas, especially areas such as the West Centre of Glasgow, by environmental improvement schemes? That may, by a backdoor method, encourage the building societies to give more money for some of these houses.
    Mr. Brown: I have enough bother about exclusive limits without trying to define the ring that the building societies put around certain areas. I think it is to the credit of Glasgow that there is environmental improvement in the private sector. It has been an enormous boost and encouragement to building societies to go in and lend on property where the environment has been improved. We shall give Glasgow every encouragement in that direction.
    Mr. Welsh: What specific representations has the Under-Secretary made to the joint Government and building society liaison committee on this matter? Is he aware of the net outflow of building society funds from Scotland which could be used to help low-income families and young married couples? Why not use some of the oil revenue? I am sure that the Shah of Iran would be willing to help if the hon. Gentleman could not get resources from other sources nearer at hand.
    Mr. Brown: The hon. Gentleman must know that there is constant discussion and dialogue between the Government and building societies at United Kingdom level and at Scottish level—indeed, I have had them myself. In that respect there is nothing wrong with the discussions. It is the outcome with which we are a wee bit dissatisfied.
    Mr. Teddy Taylor: Does the hon. Gentleman agree that the horrifying increase in mortgage rates and the reduction in the availability of mortgages generally, not only for old property, will have a desperately severe effect not only on couples buying houses but on the Scottish building industry, particularly bearing in mind that owner-occupation in Scotland is at a low level? Has the Secretary of State been successful in getting any form of exemption for Scotland in terms of this difficult problem?
    Mr. Brown: That is a typical exaggeration. The hon. Gentleman must be aware of the statement made yesterday by the chairman or managing director of the largest building society in the country to the effect that it does not think that the increased rate of interest will have any bearing on the number of people looking for mortgages.

    Ross and Cromarty
    Mr. Ronald Atkinsasked the Secretary of State for Scotland if he has plans to make an official visit to Garve, Achnasheen, Plockton and Kyle of Lochalsh.
    Mr. Gregor MacKenzie: My right hon. Friend has at present no plans to do so.
    Mr. Atkins: Is my right hon. Friend aware that the most civilised way of getting there is by a railway that is both a tourist attraction and an infrastructure that is more important to the life of the community than regional grants? Will he keep it open after the oil platform at Kishorn has been completed?
    Mr. Mackenzie: The future of individual services is a matter in the first instance for the British Railways Board. I have not heard of any proposals for the withdrawal of passenger services on the line my hon. Friend has mentioned. As regards the future of the railways as a whole, the Government's transport policy consultation document gives an opportunity for discussion of these matters.
    Mr. Gray: Will the right hon. Gentleman bear in mind that it was only after years of fighting with successive Governments that the line was retained? Will he note that it is imperative that any future plans for rail cuts do not refer to this line?
    Mr. Mackenzie: I remind the hon. Gentleman that it was this Government who saved the line.
    Hon. Members: No.
    Mr. Monro: How on earth can the Minister justify—
    Mr. Speaker: Order. Mr. Hector Monro, Question No. 10.

    Scottish Economic Planning Council
    Mr. Monroasked the Secretary of State for Scotland when he next intends to meet the Scottish Economic Planning Council.
    Mr. Millan: On 29th October.
    Mr. Monro: Does the Secretary of State realise that the reputation of the Scottish Office is now reaching an all-time low? Will he explain to the House
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    and the Economic Planning Council what estimate has been made of the loss of jobs that will arise from 15 per cent. interest rates and the 2 per cent. payroll tax?
    Mr. Millan: Any loss of jobs arising from the increase in interest rates will be as nothing compared with the loss of jobs that would come if we followed the Opposition's policy of indiscriminate cuts in public expenditure.
    Mr. David Steel: When the right hon. Gentleman meets the council, will he discuss with it the development of Tweed-bank in the Borders? Bearing in mind that this has been a central part of Government policy since 1966, why was the announcement made to the Press by the SSHA rather than by the right hon. Gentleman to the House, or at least to Members of Parliament for the region?
    Mr. Millan: This is not on the agenda for 29th October. If the hon. Gentleman tables a Question about Tweedbank, I shall be glad to answer it.
    Mr. Dempsey: Is my right hon. Friend aware that we are likely to lose more jobs because of the action of the district valuer in North Lanarkshire in trebling rents for industrial factories, which is bound to force many individuals to return south? Will my right hon. Friend take the initiative of advising this officer that he should pay as much attention to the unemployment market as the rent market and not worsen the situation in parts of Scotland where we have 10 per cent. of the insurable population unemployed?
    Mr. Millan: I shall look into what my hon. Friend has said, but generally speaking rents for industrial premises in Scotland are very competitive. Under regional policy certain incentives are available, such as rent-free periods. I do not accept that the Scottish situation is uncompetitive. It is very competitive for industry, whether it is coming in or is already established.

    Economic Situation
    Mr. Fairgrieveasked the Secretary of State for Scotland if he is satisfied with the industrial and economic position in Scotland.
    Mr. Teddy Taylorasked the Secretary of State for Scotland if he will publish a White Paper on the economy.
    Mr. Hendersonasked the Secretary of State for Scotland if he will make a further statement on the prospects for the Scottish economy for the remainder of 1976.
    Mrs. Bainasked the Secretary of State for Scotland if he will make a statement on the present state of the Scottish economy.
    Mr. Crawfordasked the Secretary of State for Scotland if he will make a further statement on the progress of the Scottish economy.
    Mr. Millan: Prospects for the Scottish economy are closely linked to developments in the United Kingdom economy, where output, particularly of manufacturing industry, is now running well above the levels of a year or so ago. Recent surveys of industrial trends in Scotland also show a rising value of output and export deliveries.
    I have no plans to issue a White Paper on the economy as I am satisfied that the Government's policies are the right ones to put the national economy on a sound footing and that they will strengthen employment prospects in Scotland as elsewhere.
    Mr. Fairgrieve: I am not quite sure whether I understand exactly what the right hon. Gentleman meant by that answer. I shall ask him a simple question. Is there not one sector of the Scottish economy that can more quickly put matters right than any other sector—namely, small businesses? If we changed our interest and taxation policies, that sector could immediately take on one more person per firm and halve unemployment in Scotland immediately.
    Mr. Millan: I do not accept that. However, I accept that the small business sector of the Scottish economy is very important. It is not true that it has been neglected by the Government. Similarly, the Scottish Development Agency is paying particular attention to encouraging the small business sector, attention that I very much welcome.
    Mr. Henderson: What contribution does the Secretary of State consider that the Scottish Development Agency is making towards improving employment prospects? When is it likely to receive a realistic budget?
    Mr. Millan: The agency is already making a very significant improvement in the Scottish economy, and that improvement will be considerably developed over the next few months. Apart from one particular major acquisition that it has announced, for example, I know that it is considering a number of other prospects at present.
    Mr. Buchan: Has my right hon. Friend considered the implications for the industrial regeneration of Scotland if we failed to bring forward a new power generating station order for Babcock and Wilcox? Further, will he consider what implications it would have for industrial development if the Scottish National Party's wish to cut back on electricity expenditure and to cut us off from the possibility of ordering from an English nationalised generating board were fulfilled?
    Mr. Millan: I am very well aware of the particular problem of Babcock and Wilcox. The Government have promised a statement about generating capacity and orders generally before the end of the year. If Babcock and Wilcox were to rely simply on the Scottish generation programme, it would be in a very bad way indeed. It is only if we look at the whole United Kingdom generating capacity, as well as exports for that matter, that there is any future for Babcock and Wilcox. In saying that, I am simply saying what the company and its workers recognise. However, there is a problem there and I hope that we shall be able to end the uncertainty as soon as possible.
    Mr. Taylor: Will the Secretary of State say whether he has made an estimate of the extra unemployment that will stem from the higher interest rates and the payroll tax, or whether he is simply not prepared to tell the House of Commons?
    On a different question, does he not agree that his answers to all of these questions have been deplorably complacent in view of the fact that unemployment in Scotland is at 150,000? Is it not a further sign of the right hon.

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    Gentleman's total ineffectiveness in safeguarding Scotland's interests?
    Mr. Millan: On the first point, it is not possible to give a precise figure. [Interruption.] The hon. Gentleman wants figures on unemployment in Scotland. In Scotland so far, approvals under the temporary employment subsidy, the job creation scheme and the subsidy for school leavers have saved about 32,000 jobs. I hope that Opposition Members welcome that.
    Mrs. Bain: Does the Secretary of State agree that one major way in which we could help the Scottish economy and employment prospects would be to operate a policy of preference for orders at home? Will he undertake publicly today to ensure that all platform orders that may be forthcoming over the next few years for the development of North Sea oil will be given to yards working in Scotland, thereby guaranteeing employment for the men?
    Mr. Millan: We have provided the capacity in Scotland, and to a lesser extent in England, which may be available for, as far as we can see, any orders for production platforms which may be likely to come forward. I shall certainly expect to see those orders placed in Scotland. We have a memorandum of understanding with the oil companies on that matter. However, it is not possible, for various good international reasons, simply to make an absolute commitment to home preference in these matters. Nevertheless, the capacity exists and I certainly look forward to the orders, when they come, coming to Scotland.
    Mr. Robert Hughes: Will my right hon. Friend also understand that a vast number of people who have been employed in oil rig construction on Teesside have recently lost their jobs? If we are to take the view that orders for the North Sea should go only to Scotland, there will be a demand from England and a loss to Scotland of orders that could be placed in Scotland. That is the way to economic disaster for all the working people of Britain.
    Mr. Millan: Yes, my hon. Friend is quite right, and in so far as his question contains a reprimand for forgetting to mention the Teesside yard I accept it, because that is a very efficient yard and
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    it is a considerable tragedy for the United Kingdom that it has run out of orders. I am talking specifically about United Kingdom orders, but the fact is that the bulk of these orders go to Scotland because that is where the capacity is.
    Mr. Crawford: Leaving aside the fact that small businesses were not helped in 1973 by the imposition by the Conservatives of the levy on the self-employed, is the right hon. Gentleman aware that the simplest way of creating jobs in Scotland and reducing unemployment to the Norwegian level of 1 per cent. is by the injection of Scottish oil revenues, which are now running at £700 million a year?
    Mr. Millan: As far as Scottish oil, so-called, is concerned, there has been far more expenditure on North Sea oil than there has been revenue from it so far.
    Mr. Buchanan-Smith: The Secretary of State has mentioned some of the temporary schemes that the Government have introduced to help employment in Scotland. Worthy as they are and much as we welcome them, does he not realise that the fact that they are necessary at all is a measure of the failure of the Government's economic policies? Will he lift his eyes to the future instead of giving such complacent answers, and realise that what we need in Scotland is the prospect of productive industry with a future? In that respect, what relevance have high interest rates and the payroll tax? It is new jobs and modern industry that we want.
    Mr. Millan: There has been concern in the United Kingdom as a whole about investment levels in many areas. No one expressed it more eloquently than the right hon. Member for Sidcup (Mr. Heath) when he was Prime Minister. Indeed, the particular speech concerned was quoted in the House in the economic debate on Monday. Therefore, to suggest that there is some particular worry about investment which has come only from the announcement last week is really no way of solving the present problem. I have already said that high interest rates, by themselves, are not an incentive to investment. Obviously that is the position. But the investment trends generally in Scotland are more favourable now than they have been for a considerable time, and I expect that situation to continue.

    421
    From meeting Scottish industry, I do not find that it shares the pessimism of Opposition Members.

    Local Authority Expenditure and Services
    Mr. Youngerasked the Secretary of State for Scotland what representations he has received from the Convention of Scottish Local Authorities regarding reductions in expenditure and curtailment of services.
    Mr. Millan: The Convention of Scottish Local Authorities has recognised the necessity for its member authorities to continue to exercise the utmost economy. It has also conveyed to me the views of member authorities that the reductions in local authority expenditure required to conform with the last White Paper on Public Expenditure (Cmnd. 6393) would entail the curtailment of services and some redundancy.
    Mr. Younger: As the total failure of the Government's economic policies is forcing them to demand these cuts by the local authorities, will the right hon. Gentleman say whether Sir George Sharp has made it clear that if the Government's cuts are insisted upon there will be a large number of redundancies? Will the right hon. Gentleman introduce a ceiling on rate increases to make sure that spendthrift councils do not merely pass on their higher costs to their ratepayers, who are already hard-pressed enough?
    Mr. Millan: I consider that question to be utter hypocrisy. The hon. Gentleman is a member of an Opposition party which as recently as Monday of this week called for savage cuts in public expenditure, and they must include local authority expenditure. What we have called for is a freeze, and even a freeze has employment implications, as I indicated in my original reply.
    Mr. Robin F. Cook: Is my right hon. Friend aware that if the rate support grant is cut by the rate projected, it will mean in the Lothian Region 700 redundancies among teachers and a 40 per cent. cut in street lighting? Is he prepared for cuts that would have that result?
    Mr. Millan: I have not yet said what the rate support grant settlement for 1977–78 will be. That will be a matter
    422
    for negotiation between me and the Convention at meetings starting on 5th November. Therefore, I do not accept the figures that my hon. Friend has just given.
    Mr. MacCormick: Does the Secretary of State accept, from the SNP Bench, that the setting up of the ridiculous Strathclyde Region was due entirely to the previous Conservative Government and that the biggest change and improvement we could make would be to get rid of it?
    Mr. Millan: Again, I do not accept that a reform of local government would make a significant impact on the problem of local authority expenditure.
    Mr. Rifkind: Does the Secretary of State accept that it would be quite unfair for local authorities which in the past have obeyed the Government's guidelines about expenditure to be treated in exactly the same way as those which have deliberately rejected the Government's requests? Does he not agree that there should be a differential in the approach to local authorities based on their past response to pressure from the Government?
    Mr. Millan: That is a matter that I shall be discussing with the Convention. However, if the hon. Gentleman knows anything about the rate support grant system—which is, perhaps, doubtful—he will know that it is extremely difficult to make the kind of discrimination that he is suggesting for Scotland.
    Mr. Budgen: Will the right hon. Gentleman please cease his insulting evasions and tell the House what his calculations are for the increase in unemployment in Scotland as a consequence of the increase in interest rates?
    Mr. Millan: I have answered that question on a number of occasions, but in any case it does not arise out of this Question.

    SCOTTISH LAW COMMISSION
    Mr. Fairbairnasked the Lord Advocate when he next expects to meet the Scottish Law Commission.
    The Lord Advocate (Mr. Ronald King Murray): I had a meeting with the Scottish Law Commission on 14th June last.

    423
    I have not made any arrangement of a formal nature to have a further meeting with the Commission. There is, of course, a constant exchange of views and information between the Commission and my departments.
    Mr. Fairbairn: When the right hon. and learned Gentleman meets the Scottish Law Commission, will he ensure that the excellent principle of the 110-day rule is neither interfered with nor watered down, nor in any way given the blame for the disreputable and incompetent prosecution of what is colloquially called the Tartan Army case, the blame for which rests entirely with the Department for which he is responsible? Will the right hon. and learned Gentleman offer his resignation as an indication of that incompetence?
    The Lord Advocate: I always enjoy listening to the hon. and learned Gentleman when he is waxing indignant. The answer to the last point is that I shall not resign.
    The case to which the hon. and learned Gentleman has referred, while not technically covered by the sub judice rule, is nevertheless one in which the time for appeal has not expired. In those circumstances, it is highly desirable that I, as the public prosecutor, should refrain from making any comments on the merits of the case.
    Accordingly, what I should say about this matter is to mention the 110-day rule to which the hon. and learned Gentleman referred. Procedural difficulties arise for the Crown. They arise out of the operation of the 110-day rule in a situation where justice required the prevention of unfairness to the last three accused to be arrested. Injustice could have arisen if the two accused who were arrested before had been tried before the others in a separate trial. I am sure that that was a proper view to take.
    Those difficulties reinforce the case for the implementation of the reform proposed by the Thomson Committee, namely, that the 110-day period ought to run from the date of full committal to commencement of the trial and not to the conclusion of the trial, as the rule now requires. The hon. and learned Gentleman will see from this answer that I am not as enamoured of the 110-day rule as it stands as he appears to be.
    Mr. Robin F. Cook: Can my right hon. and learned Friend say what pressure he received from the Scottish Law Commission for a consolidation Bill on sexual offences? Does he believe that it would be wise for the House to re-enact the potpourri of nineteenth century legislation without first having an opportunity to consider whether that legislation requires reform?
    The Lord Advocate: My hon. Friend will appreciate that legislative time is at a high premium during the present sittings of Parliament, and it is difficult to get time in all Parliaments for matters of law consolidation. For those reasons, this small measure is a useful contribution to the consolidation of the law. I can understand that people who have strong feelings about certain aspects of the law therein dealt with may wish to take the opportunity when such a Bill is before the House to air their desire for changes in the substantive law, but such changes are not the proper subject of a consolidation Bill and they do not fall within my jurisdiction as Lord Advocate.
    Lord James Douglas-Hamilton: Can the Lord Advocate say when he will bring proposals before the House arising out of the Thomson Committee, which I understand reported some months ago?
    The Lord Advocate: My right hon. Friend the Secretary of State for Scotland and I have a committee working on this subject. As soon as that committee reports, we hope to have proposals to put before the House in this regard.
    Mr. Rifkind: Reverting to the question asked by the hon. Member for Edinburgh, Central (Mr. Cook), may I ask whether the Lord Advocate realises that in asking Parliament to approve this consolidation Bill he will be asking Parliament to approve one clause of it that will retain as a criminal offence conduct which the Crown, by his own person, said will not be subject to prosecution, despite its being a criminal offence? Will he accept that it is contrary to public interest that Parliament should be asked in 1976 to approve laws which the Government and he himself have no intention of enforcing?
    The Lord Advocate: The hon. Gentleman, with his legal qualifications, will appreciate that what he has put to me is grossly over-simplified. I content myself

    425
    with saying that for 60 years the Crown Office has adopted a humane and reasonable policy of prosecution in connection with the matter that he has in mind. If people feel that that is not enough and that the substantive law ought to be changed, the hon. Gentleman knows as well as I do that the proper way is not by a consolidation Bill, which has totally different objectives, but by trying to introduce a Private Member's Bill, which can be properly considered by both Houses of Parliament in a context that will allow all moral views to be considered properly.
    Mr. David Steel: Surely it is one thing for the Crown Office to base its policy on an antiquated statute of the last century but quite another thing to update the law in a consolidation measure and thereby reinforce a policy which his Department has ceased to implement. It is that to which we are objecting.
    The Lord Advocate: I take note of what the hon. Gentleman has fairly said, but I reiterate what I said to the hon. Member for Edinburgh, Pentlands (Mr. Rifkind). The matter is not as simple as the hon. Gentleman has put to me. If it were as simple as he suggests, it would be attractive.

    GLASGOW SHERIFF COURT
    Mr. Teddy Taylorasked the Lord Advocate when he next intends to pay an official visit to the Glasgow Sheriff Court.
    Mr. Monroasked the Lord Advocate when he next proposes to visit Glasgow Sheriff Court.
    The Lord Advocate: I have no plans at present to make an official visit to Glasgow Sheriff Court.
    Mr. Taylor: If the Lord Advocate will not go to Glasgow, will he discuss with the sheriffs of Scotland the appropriateness of the sentences that they impose for hooliganism at football matches? In particular, will he consider whether powers are available to sheriffs to require people found guilty of football hooliganism to report regularly on Saturday afternoons to police stations in a sober condition?
    The Lord Advocate: I take note of the suggestion made by the hon. Gentleman about hooligans reporting to police
    426
    stations. I think it may be that we require wider powers of disposal for our courts than we have now. However, that is not a matter directly put to me in the Question.
    As regards prosecutions for which I am responsible, we ensure that, so far as possible, serious cases of football hooliganism, which arise mainly inside football grounds, are dealt with only in sheriff courts. That ensures that the penalties that can be imposed are substantial. When incidents arise outside football grounds, where possible we prosecute such cases in district courts, unless there is a specially serious aspect which deserves consideration by the sheriff court.
    We do our best in the Crown Office and the procurator fiscal service to ensure that these incidents are treated with the seriousness they deserve. It is not for me to comment on the sentences that are imposed. The courts are wholly independent in their sentencing.
    Mr. Monro: I appreciate what the Lord Advocate has said about the severity of sentences, but will he take an early opportunity to have further discussions with procurator-fiscals and the police to see whether individuals are being charged with severe enough offences which can result in the imposition of long custodial sentences by the courts?
    The Lord Advocate: I shall be happy to do that.
    Mr. MacCormick: Would the Lord Advocate care to say whether he has considered the question of hooliganism at political meetings in Cathcart and Glasgow, and therefore make a comment?
    The Lord Advocate: I am happy to say that the last time I was in Cathcart canvassing I found it to be very peaceful.

    THOMSON COMMITTEE
    Mr. Sproatasked the Lord Advocate what evidence he has submitted to the Thomson Committee.
    The Lord Advocate: I have regular meetings with the Lord President of the Court of Session as business demands.
    Mr. Sproat: My Question is No. 33.
    The Lord Advocate: I have regular meetings with the Lord President—
    Hon. Members: Wrong Question.
    Mr. Speaker: The Question to be answered is No. 33.
    The Lord Advocate: I have not personally submitted evidence to the Thomson Committee.
    Mr. Sproat: Arising out of the Thomson Committee, will the Lord Advocate support a change in the system whereby a trivial procedural error by a member of the legal profession, such as we have just seen, can result in legal proceedings being totally abandoned, resulting in a travesty of justice for those concerned, as happened recently in the case of my constituent Mr. L. M. Cameron at Perth?
    The Lord Advocate: Now that I have the right Question, it would be desirable not to comment. If the hon. Gentleman has specific points that he wishes to make about that case, he should perhaps write to me.

    COURT OF SESSION
    Mr. Gordon Wilsonasked the Lord Advocate when he next proposes to meet the Lord President of the Court of Session.
    The Lord Advocate: I think I am now entitled to say that I have regular meetings with the Lord President of the Court of Session as business demands.
    Mr. Wilson: While one would recommend the use of a calculator to the Lord Advocate for the purpose of selection of answers to Questions, at his next meeting with the Lord President, who is responsible for fixing court fees, will he note that divorce expenses in an undefended divorce cost three times as much as those for an undefended separation action in the sheriff court? What facilities will there be for transferring divorces to the sheriff court?
    The Lord Advocate: That matter will have to be taken into account by the Government in future when this issue next arises. It is only fair to say, however, that I think that practitioners would certainly not accept that the work done in a divorce case is necessarily the same as the work done in the lesser cases of separation in the sheriff court.
    Mr. Fairbairn: Assuming that the Lord Advocate can tell whether he is meeting the Thomson Committee or the Lord President, and that he is meeting the Lord President, may I ask him to use his influence to break the particularly restrictive bonds on the criminal fees paid to solicitors who engage in more work, paid for out of the same Treasury, when very much more is paid to English practitioners for the same work, a fact which is prejudicial as against comparative work undertaken by solicitors in Scotland?
    The Lord Advocate: I am not sure that I understand the hon. and learned Member's point, but I can say that charges for divorces in Scotland are very reasonable.

    HOUSE OF COMMONS CHAMBER (DIGITAL CLOCKS)
    Mr. Speaker: I have a short statement to make. Right hon. and hon. Members will have noticed the installation during the Summer Recess of two digital clocks above the Government and Opposition Back Benches. These are synchronised with the digital clocks on the Clerk's Table. Since there is occasionally a discrepancy between the time shown by the digital clocks and that shown by the more conventional clocks at each end of the Chamber, I propose in future to go by the time shown on the digital clocks, which I think are clearly visible to all hon. Members.
    If, when hon. Members are addressing the House, they keep their eyes on the clock rather than on me, I shall not take it as a personal affront.

NORTHERN IRELAND (FIRE SERVICES)
Mr. Craig: I beg to ask leave to move the Adjournment of the House, under Standing Order No. 9, for the purpose of discussing a specific and important matter that should have urgent consideration, namely:
"the emergency caused by the dispute with the fire services in Northern Ireland."
This is a matter which puts at risk to an even greater extent the lives and property of the people of Northern Ireland. Such a matter can never be dismissed as unimportant or lacking in

429
urgency. It arises out of action taken by firemen in the Northern Ireland Fire Service who are in dispute with their employers over a matter of pay.
Unhappily, because of the way in which that dispute has developed, the firemen have felt it necessary to withdraw fire cover in all incidents arising out of terrorist action affecting commercial property and places of public entertainment. They have said—and I believe they mean it—that they will do what they can to see that fires which would put life at risk will be covered. But how can anyone judge whether a fire will put life at risk? Any fire is a potential risk to life. No matter how good their intentions are, unless something is done speedily, a most unnecessary tragedy could occur in Northern Ireland.
This is an avoidable risk. I should like the House to consider urgently what we can do to remove the additional risk. It is not enough to say that the Army can give some assistance.
I know that I may not debate the issue now, but it would be wrong to dismiss this as just another pay dispute or as the action of some wildcat men. These are men who have bravely and courageously served the community in very difficult circumstances, in a war situation, for about eight years now. Some of them have been shot at and some killed while attending fires. They have done their job without complaint or reservation. The fact that they now take this action calls for investigation at the highest level. It is a matter of confidence. I believe that the House would consider it such and would agree that if the Government would intervene, this problem could be solved. That is why I ask that the House should be able to consider this matter.
Mr. Speaker: The right hon. Member for Belfast, East (Mr. Craig) asks leave to move the Adjournment of the House for the purpose of discussing a specific and important matter that he thinks should have urgent consideration: namely,
"the emergency caused by the dispute with the fire services in Northern Ireland."
As the House knows, under Standing Order No. 9 I am directed to take into account the several factors set out in the Order but to give no reasons for my decision. The right hon. Gentleman gave me notice this morning that he would be raising this matter and I have given careful thought to it. But I have to rule that the right hon. Gentleman's submission does not fall within the provisions of the Standing Order. Therefore, I cannot submit his application to the House.

BILL PRESENTED
  CINEMATOGRAPH FILMS (PREVENTION OF BLASPHEMY)
  Mr. Marcus Kimball presented a Bill to prohibit the production of certain cinematograph films; And the same was read the First time; and ordered to be read a Second time to-morrow and to be printed. [Bill 232].

STATUTORY INSTRUMENTS, &c.
Ordered,
That the Value Added Tax (General) (Amendment) Regulations 1976 (S.I., 1976, No. 1234), be referred to a Standing Committee on Statutory Instruments, &c.—[Mr. Foot.]

PROHIBITION OF SPECULATION
3.38 p.m.
Mr. J. W. Rooker: I beg to move,
That leave be given to bring in a Bill to prohibit speculation in currencies or commodities; and for connected purposes.
If this Bill had been law last March, the result of the Bank of England's treasonable mismanagement of the money markets would not have led to the run on the pound caused by the speculators and leading to the present crisis which, as we all know, is not a new one but simply an extension of what has gone on before.
Speculation fuels inflation, it causes unemployment and in many countries it causes extreme poverty and starvation on a large scale. Decent and honourable financial journalists—there are some—admit that inflation in recent years has been largely fuelled by speculators.
Indeed, John Palmer, the Business Editor of The Guardian, writing in the middle of the June election in 1974, said:
"Alarming evidence is emerging that the activity of speculators on the London commodities market has played a major role in worsening both the rate of inflation and the balance of payments deficit. One estimate in the City suggested that in some cases as much as half the increase in prices of some commodities in the previous year was caused by speculative buying of futures contracts."
He said that the uncontrolled access to the City commodity markets of large investors anxious to seek a hedge against inflation and currency uncertainties caused prices to rise twice as fast as they would have done without the speculators there. The Economist in March 1975 claimed also that uncontrolled commodity markets of the previous two years had contributed handsomely to our hair-raising inflation.
I know that some economists argue that currency speculation is far more damaging than commodity speculation and it is this which makes the Government's constant attempts to persuade speculators to buy sterling all the more unforgiveable. The value of a currency, even in a capitalist free market system, should depend on the buying and selling of currency and commodities for legiti-
432
mate trade purposes only—not on operators making a living selling the pound and Britain short constantly as they do. There is something sick about the major opposition party in that it supports and advocates such activities in the City of London.
It was announced yesterday in the Financial Times that the Stock Exchange is to seek to engage in what will be the ultimate casino operation of all time—the opening up of a market in trading options. This is a system which has been used in the United States of America for the past few years to perpetuate large-scale frauds on small investors, rendering many of them penniless. The American Government have taken action to control the activities of that market. In the past, my right hon. Friend the Member for Huyton (Sir H. Wilson) has accused the City of operating a gigantic casino where the nation is the only loser. It was 25 years ago that he made that accusation. I hope that he will seek to ban any new speculative markets until his official inquiry into the City of London has reported.
My right hon. Friend's inquiry will be strengthened by the action of this House in granting me leave to introduce the Bill. After a quarter of a century of criticism my right hon. Friend now has a great chance to take some action and change the City from the casino that it undoubtedly is. My Bill would outlaw the situation whereby the modern speculator with no factory, no warehouse and no transport facilities but with a telex machine and the co-operation of the banks can use the highly sophisticated markets in this country and abroad to buy commodities he does not need and to sell currencies he does not have. That situation only fuels inflation in the long term.
The Bill will outlaw such action by stopping all agreements where legitimate trade is not involved and will impose penalties in line with the scale of the offence. I accept that futures markets play an important part in manufacturing industry. The City of London attempted to educate me during the recess when it saw my motion on the Notice Paper in late July. I fully accept that manufacturers wish to buy commodities and goods in advance of production so that they may plan their marketing and pricing policies.

433
They will not be affected by my Bill as long as they intend to produce something and not just buy and sell without the intention of ever producing anything.
The same will apply to currencies. There is no good purpose served, for the country, the workers, or this Government, in allowing the present casino situation to exist for much longer. I hope therefore—given this short outline of my Bill, which is extremely simple—that speculation can ultimately be outlawed by making sure that agreements that do not contain legitimate trade clauses are not agreements that can be enforced in the courts. It is as simple as that. I hope that the House will give me leave to introduce the Bill.
3.44 p.m.
Mr. Peter Bottomley rose—
Mr. Speaker: Does the hon. Gentleman rise to oppose the motion?
Mr. Bottomley: I do. I rise with not much hope of convincing the hon. Member for Birmingham, Perry Barr (Mr. Rooker) that he is wrong-headed in putting forward this proposed Bill. If he has failed to benefit from the education which has been offered to him in the past few months, a little bit more from me might just help.
I want to take up the two bases on which he has built his argument. The first was that speculation is a major cause of inflation and that it has led to a major part of the balance of payments deficit. It is now commonly agreed, certainly between the Chancellor and many of my colleagues, that Government action leads to inflation and that often such Government action is a reaction to pressures imposed on them by trade unions, manufacturers or whoever.
Mr. Kevin McNamara: Speculators.
Mr. Bottomley: If trade unions are speculators, fair enough. Perhaps they will be caught by this proposed Bill, if it is enacted. I have not heard anyone suggest that speculation is either endlessly profitable or a major cause of inflation. Things which are inherently unprofitable in a mixed or free economy are not followed by many people for long. However disastrous the rise in
434
house prices may have been during the time of the last Conservative Government, many people have learned their lesson in the domestic, industrial and commercial property market. The great thing about speculation is that people learn from their mistakes.
One of the unfortunate things about the Labour Party, which has a constitution written in 1918 tied round its neck, is that it does not get the opportunity to learn from its mistakes because it is sufficiently wrong-headed and pig-headed not to understand where it goes wrong. I am directing my remarks generally rather than to anyone in particular.
The hon. Member's second point about speculation leading to a balance of payments deficit seems to be equally wrong. As I understand it, the balance of payments deficit comes about because people do not produce as much as they want to consume and have the opportunity of buying more of what other people are producing without paying directly for those goods. Let me give a simple example concerning the rise in earnings and the production of car workers in this country as compared with their German counterparts over the past 10 or 15 years. Pay increases in this country have been 200 per cent. while in Germany they have been 100 per cent. Yet the value of the paper wages in this country are greatly reduced because production is not sufficiently high. If there could be more speculation about the causes of that and an attempt to tackle the underlying problems perhaps we would get away from the balance of payments deficit.
I refer the hon. Member to page 11 or page 13 of Labour Weekly. There are about nine or ten pages in that publication every week saying how wrong it is for people to speculate. That paper would condemn the hon. Gentleman if he were to set up a bicycle factory and sell bicycles perhaps £5 cheaper than those sold by the Royal Arsenal Co-op or department stores. He might become so successful that he ends up with £500,000. Because of his speculation, or enterprise, everyone else would be better off. Many Labour Members would see that as being wrong, despite the fact that the hon. Member would be helping to lower the retail price index and enable more people to get bicycles. These bicycles could be

435
sold in Germany and would help to put right our balance of payments deficit. Were the hon. Gentleman to do this he would be hit by capital transfer tax, corporation tax, wealth tax and so on.
Yet, on page 11 or page 13 of Labour Weekly, week after week, there appear the words suggesting that to win £500,000 on the football pools people should use
Labour Weekly perm No. 7. That condemns the sort of argument the hon. Member is using.
Question put, pursuant to Standing Order No. 13 (Motions for leave to bring in Bills and nomination of Select Committees at commencement of Public Business):—
The House divided: Ayes 164. Noes 139.

Division No. 316.]

AYES

[3.50 p.m.

Allaun, Frank

Graham, Ted

Oakes, Gordon

Archer, Peter

Grant, George (Morpeth)

Orbach, Maurice

Ashton, Joe

Grocott, Bruce

Orme, Rt Hon Stanley

Atkins, Ronald (Preston N)

Hamilton, James (Bothwell)

Ovenden, John

Atkinson, Norman

Hardy, Peter

Park, George

Bain, Mrs Margaret

Harrison, Walter (Wakefield)

Pavitt, Laurie

Bales, Alf

Hatton, Frank

Price, C. (Lewisham W)

Benn, Rt Hon Anthony Wedgwood

Henderson, Douglas

Price, William (Rugby)

Bennett, Andrew (Stockport N)

Hoyle, Doug (Nelson)

Richardson, Miss Jo

Bidwell, Sydney

Huckfield, Les

Robinson, Geoffrey

Bishop, E. S.

Hughes, Rt Hon C. (Anglesey)

Roderick, Caerwyn

Blenkinsop, Arthur

Hughes, Robert (Aberdeen N)

Rodgers, George (Chorley)

Booth, Rt Hon Albert

Hughes, Roy (Newport)

Rooker, J. W.

Bottomley, Rt Hon Arthur

Hunter, Adam

Roper, John

Bray, Dr Jeremy

Irvine, Rt Hon Sir A. (Edge Hill)

Ryman, John

Brown, Hugh D. (Provan)

Jeger, Mrs Lena

Sandelson, Neville

Brown, Ronald (Hackney S)

Jenkins, Hugh (Putney)

Sedgemore, Brian

Buchan, Norman

Johnson, James (Hull West)

Shaw, Arnold (Ilford South)

Callaghan, Jim (Middleton & P)

Jones. Dan (Burnley)

Short, Mrs Renée (Wolv NE)

Cant, R. B.

Judd, Frank

Sillars, James

Carter-Jones, Lewis

Kaufman, Gerald

Silverman, Julius

Cartwright, John

Kilroy-Silk, Robert

Small, William

Clemitson, Ivor

Kinnock, Neil

Smith, John (N Lanarkshire)

Cocks, Rt Hon Michael (Bristol S)

Lambie, David

Snape, Peter

Cohen, Stanley

Lamborn, Harry

Spriggs, Leslie

Coleman, Donald

Lamond, James

Stallard, A. W.

Colquhoun, Ms Maureen

Latham, Arthur (Paddington)

Stoddart, David

Concannon, J. D.

Leadbitter, Ted

Summerskill, Hon Dr Shirley

Conlan, Bernard

Lewis, Ron (Carlisle)

Swain, Thomas

Cook, Robin F. (Edin C)

Lipton, Marcus

Thomas, Ron (Bristol NW)

Cox, Thomas (Tooting)

Litterick, Tom

Thompson, George

Crawford, Douglas

Loyden, Eddie

Thorne, Stan (Preston South)

Crowther, Stan (Rotherham)

Lyon, Alexander (York)

Tierney, Sydney

Cryer, Bob

McCartney, Hugh

Torney, Tom

Davies, Bryan (Enfield N)

McCusker, H.

Urwin, T. W.

Deakins, Eric

McDonald, Dr Oonagh

Wainwright, Edwin (Dearne V)

Dempsey, James

McElhone, Frank

Walker, Harold (Doncastsr)

Doig, Peter

MacFarquhar, Roderick

Walker, Terry (Kingswood)

Dormand, J. D.

Maclennan, Robert

Watkins, David

Dunlop, John

McMillan, Tom (Glasgow C)

Welsh, Andrew

Eadie, Alex

McNamara, Kevin

White, Frank R. (Bury)

Edge, Geoff

Madden, Max

White, James (Pollok)

Edwards, Robert (Wolv SE)

Mahon, Simon

Whitehead, Phillip

Ellis, John (Brigg & Scun)

Mallalieu, J. P. W.

Whitlock, William

Ennals, David

Marshall, Dr Edmund (Goole)

Willey, Rt Hon Frederick

Evans, Fred (Caerphilly)

Maynard, Miss Joan

Williams, Rt Hon Shirley (Hertford)

Evans, Gwynfor (Carmarthen)

Mendelson, John

Wilson, Alexander (Hamilton)

Evans, Ioan (Aberdare)

Miller, Dr M. S. (E Kilbride)

Wilson, Gordon (Dundee E)

Ewing, Harry (Stirling)

Miller, Mrs Millie (Ilford N)

Wilson, William (Coventry SE)

Fernyhough, Rt Hon E.

Moonman, Eric

Wise, Mrs Audrey

Flannery, Martin

Morris, Alfred (Wythenshawe)

Wrigglesworth, Ian

Fletcher, Ted (Darlington)

Morris, Charles R. (Openshaw)

Young, David (Bolton E)

Foot, Rt Hon Michael

Moyle, Roland

Forrester, John

Murray, Rt Hon Ronald King

TELLERS FOR THE AYES

George, Bruce

Newens, Stanley

Mr. Russell Kerr and

Golding, John

Noble, Mike

Mr. Dennis Skinner

NOES

Adley, Robert

Blaker, Peter

Bulmer, Esmond

Aitken, Jonathan

Boscawen, Hon Robert

Burden, F. A.

Alison, Michael

Bowden, A. (Brighton, Kemptown)

Chalker, Mrs Lynda

Beith, A. J.

Boyson, Dr Rhodes (Brent)

Churchill W. S.

Bell, Ronald

Brittan, Leon

Clarke, Kenneth (Rushclifle)

Berry, Hon Anthony

Brotherton, Michael

Cooke, Robert (Bristol W)

Biggs-Davison, John

Brown, Sir Edward (Bath)

Cope, John

Corrie, John

Jopling, Michael

Rathbone, Tim

Costain, A. P.

Kaberry, Sir Donald

Ronton, Rt Hon Sir D. (Hunts)

Craig, Rt Hon W. (Belfast E)

Kershaw, Anthony

Ridsdale, Julian

Crouch, David

King, Evelyn (South Dorset)

Roberts, Michael (Cardiff NW)

Davies, Rt Hon J. (Knutsford)

Kitson, Sir Timothy

Roberts, Wyn (Conway)

Douglas-Hamilton, Lord James

Knight, Mrs Jill

Rossi, Hugh (Hornsey)

Durant, Tony

Lamont, Norman

Rost, Peter (SE Derbyshire)

Eden, Rt Hon Sir John

Langford-Holt, Sir John

Royle, Sir Anthony

Eyre, Reginald

Latham, Michael (Melton)

Shaw, Giles (Pudsey)

Fairbairn, Nicholas

Lawrence, Ivan

Shepherd, Colin

Fairgrieve, Russell

Le Marchant, Spencer

Shersby, Michael

Fletcher-Cooke, Charles

Lester, Jim (Beeston)

Silvester, Fred

Fry, peter

Lewis, Kenneth (Rutland)

Sinclair, Sir George

Gardiner, George (Reigate)

Lloyd, Ian

Skeet, T. H. H.

Gilmour, Rt Hon Ian (Chesham)

Luce, Richard

Smith, Cyril (Rochdale)

Glyn, Dr Alan

McCrindle, Robert

Smith, Dudley (Warwick)

Goodhart, Philip

Macfarlane, Neil

Speed, Keith

Goodhew, Victor

Marshall, Michael (Arundel)

Spence, John

Goodlad, Alastair

Marten, Neil

Spicer, Michael (S Worcester)

Gorst, John

Mather, Carol

Sproat, Iain

Gow, Ian (Eastbourne)

Mawby, Ray

Stanley, John

Gower, Sir Raymond (Barry)

Maxwell-Hyslop, Robin

Steel, David (Roxburgh)

Gray, Hamish

Mayhew, Patrick

Steen, Anthony (Wavertree)

Grimond, Rt Hon J.

Miller, Hal (Bromsgrove)

Stradling Thomas, J.

Hamilton, Michael (Salisbury)

Mills, Peter

Tebbit, Norman

Hannam, John

Moate, Roger

Townsend, Cyril D.

Harvie Anderson, Rt Hon Miss

Monro, Hector

Tugendhat, Christopher

Hawkins, Paul

More, Jasper (Ludlow)

Vaughan, Dr Gerald

Hayhoe, Barney

Morgan-Giles, Rear-Admiral

Warren, Kenneth

Higgins, Terence L.

Morris, Michael (Northampton S)

Weatherill, Bernard

Holland, Philip

Morrison, Hon Peter (Chester)

Whitelaw, Rt Hon William

Howe, Rt Hon Sir Geoffrey

Mudd, David

Wiggin, Jerry

Howell, David (Guildford)

Neave, Alrey

Winterton, Nicholas

Howells, Geraint (Cardigan)

Neubert, Michael

Wood, Rt Hon Richard

Hunt, John (Bromley)

Newton, Tony

Young. Sir G. (Ealing, Acton)

Hurd, Douglas

Onslow, Cranley

Younger, Hon George

Hutchison, Michael Clark

Page, John (Harrow West)

James, David

Page, Rt Hon R. Graham (Crosby)

TELLERS FOR THE NOES:

Jenkin, Rt Hon P. (Wanst'd & W'df'd)

Pardoe, John

Mr. Peter Bottomley and

Jessel, Toby

Pattie, Geoffrey

Mr. Peter Hordern.

Jones, Arthur (Daventry)

Penhaligon, David

Question accordingly agreed to.
Bill ordered to be brought in by Mr. J. W. Rooker, Mr. Dennis Skinner, Mrs. Audrey Wise, Mr. Max Madden, Mr. Neil Kinnock, Mr. John Evans, Mr. Geoff Edge, Mr. Dennis Canavan, Mr. Robert Kilroy-Silk, Mr. Martin Flannery, Mr. Joan Evans and Mr. Andrew F. Bennett.

PROHIBITION OF SPECULATION
Mr. J. W. Rooker accordingly presented a Bill to prohibit speculation in currencies or commodities; and for connected purposes: and the same was read the First time; and ordered to be read a Second time tomorrow and to be printed. [Bill 231.]
ORDERS OF THE DAY

  HEALTH SERVICES BILL
  [2ND ALLOTTED DAY]
  Order read for resuming adjourned debate on amendment [11th October] on Consideration of the Bill, as amended (in the Standing Committee).

  HEALTH SERVICES BILL
    Clause 1

      THE HEALTH SERVICES BOARD AND ITS COMMITTEES
      Which amendment was: No. 1, in page 1, line 10, leave out 'five' and insert 'seven'.
      Mr. Speaker: I remind the House that with this 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.'
      4.1 p.m.
      Mrs. Jill Knight: When the guillotine fell last night, I was in the process of moving an amendment concerning the composition of the Health Services Board. The composition of the board is extremely important. It is not going too far to say that the success or otherwise of the arrangements made will depend upon the right, just and good composition of the board.
      Last night I explained the vast number of functions which the board will have. I said that there was a real need to have seven instead of five members, not least because the board will cover seven major areas of responsibility. It is absurd to suggest that a tiny committee of five will
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      be able properly to cope with all those areas. Five members might be able to do the job by skimping, but they will be unable to do it properly. The board's duties will be immense, and if it has seven members it will have a better chance of doing the job adequately. A membership of seven is neither large nor unwieldy.
      Last night I also dealt with the representatives who will be on the board. There will be the chairman, two medical practitioners and two others. Of these last two the Secretary of State may recognise one as being representative either of the doctors or the dentists. The second will represent one of the trade unions whose members work in NHS hospitals.
      It is extremely unfair that no one will be appointed to look after the interests of private patients. It is wholly and completely wrong to set up a board which will so greatly affect the ability of persons to have private medical care but to leave those persons unrepresented upon it. Last May the then Minister of State said in Standing Committee:
      "the hon. Lady seemed to imply that doctors were not the sole representatives of the interests of private patients."—[Official Report, Standing Committee D. 18th May 1976; c. 53.]
      I do not even say that. I say that doctors will have quite enough to do under the Bill looking after their own interests without extending their activities to safeguarding the interests of private patients.
      Doctors will have difficult decisions to make under the Bill. They will have to deal with the whole question of how far they will have to extend their hours to take account of travelling between their private patients and their other patients in National Health Service hospitals. They will have to decide what sacrifices to make in order to provide that time.
      There is also the question of remuneration, and many other questions. There is the problem of the common waiting list, with all that that implies in terms of the duties it will put upon the doctors on the board. It is totally wrong to imagine that the doctors can look after the private patients' interests in these circumstances. It is totally unjust to deny a place on the board to those persons who will be most affected by the Bill.
      The third amendment of the group sets out to overcome what appears to be

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      very odd verbiage. I have explained why this phraseology is divisive. I am not against National Health Service patients being represented on the board and their interests being catered for. I cannot see, however, how a continuing interest will be maintained when and if no private patients remain in NHS hospitals. Why in that situation is there a need for one member of the board to deal with the interests of NHS patients?
      Perhaps the Secretary of State envisages that the very presence of private patients in any hospital will have some sinister and detrimental effect on patients in NHS hospitals. The case for that, however, has not been made out. The private patients and the private insurance companies, therefore, have a much better case for representation on the board than have the NHS patients.
      Unless the Secretary of State envisages direction of labour in the medical profession, I cannot see how a representative of the NHS side is to remain on the board at all. Surely the time will come when he will not be involved. Hospital patients generally will be and must be the main concern of the board. While the vast majority of the trade unionists working in the two main trade unions concerned are sensible, moderate and reasonable people, there is no doubt that a vicious minority have set out in the past to harm the interests of patients. They must not be allowed to do that. We want no more cases like that of the hospital porter in Manchester who took upon himself the duty of deciding whether patients could be admitted to the hospital. Some of the patients involved were cancer patients. That person was acting completely beyond his responsibilities.
      I seek to ensure that the board acts in the interests of patients. I had hoped for unanimity in the House on that issue. People such as the hospital porter I have described are anathema to the sensible trade unionists who would be more than glad to see them sent packing.
      Mr. David Crouch: I wish to support my hon. Friend the Member for Birmingham, Edgbaston (Mrs. Knight) in her argument about the advisability of increasing the membership of the board to seven. I find it difficult, however, to suggest to the Government from where these two members might be recruited.
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      The Bill provides that the membership should consist of a chairman, two medical practitioners and two other persons who will be selected after consultation with certain bodies. The bodies are those which the Secretary of State might recognise as being representatives of persons employed in one of the health services, or concerned with the interests of patients at NHS hospitals. But if there is to be a chairman, two medical practitioners and two persons concerned with the bodies described in the Bill there will still be no one on the board, which will be so important to the decisions which have to be made on the phasing out of pay beds and the control of the private sector, distinctly representing the interests of the patients.
      It is difficult to know where to find such representatives or how to define in a schedule a person who could be seen independently to represent those interests. But I think that there is a case here for increasing the number to seven, which is not an unwieldy composition for such an important body.
      The Secretary of State and his predecessor increased the size of the regional health authorities in order to widen the responsibilities they carried on behalf of the public, the patients and those who work within the NHSS for its administration. In setting up this new board, which has a transitional role to perform, it is important that the Government should, as it were, fall over backwards to see that the patients are in some way represented distinctly and independently—independent of the medical practitioners and all those other persons in the NHSS who are very important and work within it. It should not be beyond the right hon. Gentleman's wit to be able to find persons who can be seen to be clearly outside the working of the NHS and holding an independent view in representing the patients. My hon. Friend has made a valuable contribution in suggesting this improvement to the Bill.
      Mrs. Barbara Castle: This group of amendments forms yet another example of the Opposition's desire in all these discussions to have the best of both worlds—in other words, to argue, as they have done throughout our debates, that the Government are bound by the Goodman proposals—but they are not. The first simple answer to the hon. Lady the

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      Member for Birmingham, Edgbaston (Mrs. Knight) is that her proposals conflict with the Goodman proposals.
      The proposals of the Goodman compromise were the result of many hours of detailed negotiation and balancing of argument. They resulted in an agreement on the exact composition of the board. Indeed, paragraph 3 of the Goodman proposals spelt out the membership of the board, in that it should consist of an independent chairman and four other members appointed by the Government. It went on to define how they should be chosen. It said that two would be members of the medical profession, adding that it would be the Government's intention to ensure that those members were acceptable to the profession, while the remaining two would be appointed after consultation with other NHS staff and interested parties.
      In drafting the Bill, we sought in this provision, as we did throughout, adhere rigidly to the compromise which had been reached. But now the hon. Lady wants to go much further in differing from the spirit which underlay the compromise. One could well argue that the figure of five laid down in the statement I made to the House on 15th December is not sacrosanct and could be raised to seven, but the hon. Lady's real purpose is revealed by Amendment No. 67. All this chatter about the large range of functions which will fall to the board is irrelevant. Also irrelevant is the talk about the need to think of the patients first, because Amendment No. 67 gives the game away.
      What the hon. Lady and her hon. Friends propose is to add
      "… two other persons representing the interests of patients …"
      —it does not stop there—
      "who wish to undergo medical treatment privately."
      That is the kernel of the change that the hon. Lady is trying to bring about, and in doing so she is trying to put a gloss on the Goodman proposals which would never have led to the agreement that was reached.
      4.15 p.m.
      What does this mean in practice? The hon. Member for Canterbury (Mr. Crouch) more or less admitted that one
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      cannot conjure representatives of patients out of the air, that one cannot have a ballot of NHS patients asking them to elect two members of the board. Therefore, this aspect would be difficult to define. What kind of board does the hon. Lady want?
      The hon. Lady wants a board consisting of two representatives of doctors, two representatives of BUPA and two representatives of the health service unions, which would, with the independent chairman, give the board a membership of seven and also give her a massive majority against any phasing out of private beds from NHS hospitals. The hon. Lady should not be so blatant in her manoeuvres.
      Mrs. Knight: Will the right hon. Lady be good enough to confine herself to telling us what she wants and stop telling us what she thinks I want?
      Mrs. Castle: I am going on to tell the House what I want. I want the Goodman compromise, for all its faults. Despite the fact that I like it much less than the consultative document, I am standing by it absolutely consistently. As the Minister who negotiated it, I ought to know the nature of the compromise. It was that there should be an even balance between the medical profession, which does not want phasing out, and the health unions, which do, under an independent chairman. In that balance, the board, working to the overriding principle that pay beds should be separated from NHS hospitals, taking into account the criteria laid down, will proceed to phase out pay beds in a way which gives the medical profession a greater sense of security about the speed and so on at which it will be done. It is as simple as that.
      That was the nature of the compromise. To inject into that compromise now two members of the board representative of people who presumably do not want pay beds phased out at all would make a ludicrous nonsense of the whole compromise, and hon. Members opposite know it perfectly well. They may be devious but they are not daft and they know what they are up to. It is all part of their attempt to distort the Goodman compromise in their own way.
      Underlying the Bill and the proposals on which it is based is an undertaking

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      that the right to private practice should be maintained—again, Lord Goodman spelled it out by repeating the pledge which Aneurin Bevan gave, that no one working in the NHS would be compelled to work full time. That, too, is built into the Bill. Otherwise, the sole aim is to separate private practice from the NHS, but the Government take on no obligation under the agreement to ensure that private practice flourishes or even survives outside. That is the responsibility of those who want to get their medicine commercially. If they can do it, let them get on with it. It is no part of the Government's responsibility to ensure that, whatever happens, somehow private practice in itself, as against the right to it, shall survive.
      Therefore, the board will not be concerned with the sort of responsibility which the hon. Lady has in mind. It is a nonsense to argue, on a Bill the overriding principle of which is that pay beds should be separated from the NHS, that the board's membership should include two people who object to that principle. That is a nonsense.
      Mr. Crouch: I am grateful to the right hon. Lady for giving way. Cannot she see the point of the argument, even if she feels that it has been put forward perhaps too passionately for her? All we are saying is that the patients' interests should be represented on the board. The medical profession is to be represented by two practitioners, or perhaps by the medical unions. What about the patients? There is to be an impartial chairman. Why should the right hon. Lady not agree to the patients' interests being represented? It might well be that the patients' representatives would support her view. Surely they should be represented.
      Mrs. Castle: The hon. Gentleman has not read the Bill. Schedule I says that the two practitioners are to be appointed after consultation with
      "such bodies as the Secretary of State may recognise as being representative of medical practitioners or dental practitioners".
      There are also to be two other persons appointed after consultation with
      "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."
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      We have been generous enough to include in relation to the two non-medical profession representatives a reference to "the interests of patients". The medical profession did not assume that that reference should also go into the guidance as to the choice of its two representatives. But there is a reference in Schedule 1 to
      "the interests of patients at NHS hospitals".
      The hon. Member for Edgbaston wants to have two people on the board representing the interests of those who wish to undergo medical treatment privately inside the National Health Service. That is absurd, because it would put completely out of balance a board which is supposed to be handling the delicate relationships between the two views. It is a jolly good try-on, but I know that my right hon. Friend the Secretary of State is not fooled by it.
      Mr. Eddie Loyden: The points made very lucidly by my right hon. Friend the Member for Blackburn (Mrs. Castle) have exposed the real intention behind this group of amendments. This is not the first occasion on which the Conservative Party, after having opposed measures taken by the Government, have then attempted to fight a rearguard action. They are attempting to dig their last trench in order to continue to fight against the principles established by legislation.
      A good example of this was the Conservative Party's action in relation to the Dock Work Regulation Bill. Conservative Members opposed this measure violently, but when they saw that it was going steadily through the various stages they decided in the end to concentrate on the body that would be responsible for running the industry after the legislation had gone through Parliament. They sought then to draw into the areas of influence and decision-making the so-called apolitical independent people. At that time the Conservatives referred to them as consumers. Today, in the Health Services Bill, they refer to patients.
      Most of the patients in any hospital are from the working population of this country, who are dependent on the National Health Service. Therefore, we should have on the board people who are committed to the idea of the complete withdrawal of pay beds from the NHS.

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      That is a prerequisite to having health services that will provide properly for patients in the future and have a proper concern for them.
      My right hon. Friend has already indicated the real intention of the amendments. Conservative Members have the audacity to argue that those representing private medicine should be on the board.
      It is a pity that the amendment in the name of my hon. Friends and myself has not been selected, because we would have gone further in advancing the argument that there should be a total commitment by those who serve on the board to carry out the spirit and intention of NHS legislation.
      My right hon. Friend has completely demolished the argument that this is an innocent amendment designed to broaden the basis of the board. She has shown that it is intended to introduce into the board people who would be completely opposed to the real interests of the NHS.
      Mr. Robert Boscawen: The hon. Member for Liverpool, Garston (Mr. Loyden) complained that we have the audacity to advance the argument that the board should have upon it representatives of private medicine. I remind the hon. Gentleman that the whole basis of the Goodman proposals was that these arguments should be continued in Parliament. It was on that basis that industrial action was withdrawn. The proposals were accepted by the profession—the right hon. Member for Blackburn (Mrs. Castle) has stated it many times—and the industrial action was withdrawn because of the Goodman compromise, on the ground that the argument could continue through the normal parliamentary process. I hope that the hon. Gentleman will consider withdrawing his remark that we have the audacity to propose that representatives of private medicine should be on the board.
      The Secretary of State for Social Services (Mr. David Ennals): I am grateful to the hon. Gentleman for giving way. I hope he will accept that the bargain contained in the proposals put forward by Lord Goodman, and presented to the consultants, was that industrial action would end if the consultants and the profession accepted that the Goodman
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      proposals would be the basis of legislation—not that they would be the beginning of a debate on the basis of the legislation. That is what my right hon. Friend the Member for Blackburn (Mrs. Castle) has been standing by, and that is what I have been standing by.
      Mrs. Castle: That is right.
      Mr. Boscawen: If these words mean anything, surely they mean that the basis can be contested in Parliament. The ultimate intention to replace pay beds by alternative facilities is not in question, but I still feel that we have a perfect right to put forward suggestions and proposals to improve the board's representation.
      The right hon. Member for Blackburn would have had a better case if the board were to be phasing out the first thousand beds. It is the Secretary of State who will be responsible for doing that.
      We have heard from the Secretary of State many times that the first priority of the board, which very much affects the patients, is to work out a system of common waiting lists. That is very difficult to do but it is a task of considerable value. The only thing of value that will come out of the Bill will be that an independent board will look at this terribly difficult problem of common waiting lists.
      The board will have to take some very difficult policy decisions early in its life. What will be the basis of the common waiting lists? Will it be the single hospital? Will it be a single specialty? Will it be on an area board basis? These are very difficult questions and it will be very difficult to produce the right answer to them.
      There are other difficult problems that the Board will have to face, such as the balance between the medical specialties and the surgical specialties within the hospital. There have always been grounds for very considerable discussion and, indeed, argument in this respect. These are all difficult matters which affect patients. If it had been suggested that one of the representatives of the patients should be from the NHS and the other from private practice, I should not have objected. That would have been perfectly fair and reasonable. But let us have the patients' views on this board,

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      because they are not the same as those of the professions and those of the unions.
      I feel that my hon. Friend the Member for Birmingham, Edgbaston (Mrs. Knight) has done the House a great service even at this late stage of the Bill by moving her amendment.
      4.30 p.m.
      Mr. Ennals: My task has been made much easier by the speech of my right hon. Friend the Member for Blackburn (Mrs. Castle). I do not think that I disagreed with anything that she said except her reference to whether the Opposition were devious. I do not think that there is any deviousness about the amendment. What the hon. Member for Birmingham, Edgbaston (Mrs. Knight) proposes is completely open. She wants a board which is not balanced, as was proposed by Lord Goodman. I am not certain about the hon. Member for Canterbury (Mr. Crouch). Perhaps he is confused, or it may be that he simply does not agree with this amendment.
      The amendment is quite clear. The wish of the hon. Member for Edgbaston is for two other persons representing the patients who wish to undergo medical treatment privately—
      Mrs. Knight: One.
      Mr. Ennals: Two other persons. The hon. Lady must have read her amendment. It refers to two other persons representing the patients who wish to undergo medical treatment privately.
      The hon. Member for Canterbury was arguing the case of other patients, presumably the vast majority of patients in the National Health Service, who do not want or do not have the opportunity to undergo treatment privately. So I must accept that the hon. Gentleman does not agree with the amendment, as he did not last night.
      Mrs. Knight: Surely the Bill says
      "… representing the interests of patients in the National Health Service."
      I am merely arguing, because there are union representatives as well, that the one person who will be most affected should also have representation. I do not want an unbalanced board. I want fairness.
      Mr. Ennals: In that case, when I have completed my answer, no doubt the hon. Lady will be happy to withdraw her amendment. I shall be saying how the procedure is working as it was laid down and accepted in Standing Committee for the establishment of the members of the board.
      I hardly need add to what my right hon. Friend the Member for Blackburn said. I said yesterday that a contract was a contract and that it would be stood by. My right hon. Friend read the appropriate paragraph from the Goodman agreement. It was that there was to be a board of five members—a chairman and four other members—and that it would be an evenly balanced one. If we add to that board the two who represent the interests of those patients who wish to undergo private treatment, we shall have an unbalanced board and, if I accept the amendment, we shall destroy the basis on which this legislation has come forward.
      I must say also that, listening to the hon. Member for Edgbaston outlining the role of the board, one might have been forgiven for thinking that we were setting up a board to take over the role of the Secretary of State in his responsibilities for the running of the NHS. I accept that the board has an important task. Its two main functions are progressively to withdraw facilities and accommodation for the treatment of private patients in NHS hospitals and to consider whether the development of a relatively large private nursing home or hospital is likely to operate to a significant extent to the disadvantage of the NHS. The suggestion that those tasks and the preparation of a policy on common waiting lists will be more easily done by seven than by five is one which the hon. Lady has not proved.
      I think that it would be helpful if I indicated the nature of the consultations, because I agree with the hon. Lady that the interests of National Health Service patients, who basically are us, are those of people who will go into hospital, especially those who have not a special interest in private treatment. So the consultation has proceeded.
      As regards the agreed methods for the two medical members, the Government are following the method by which

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      medical members of the Medical Practices Committee and the General Practice Finance Corporation are chosen. The bodies to be consulted have been invited to send to me six to eight names of people all of whom they would find acceptable. They have now supplied those names. I am considering them and, in due course, I shall choose two.
      As for the non-medical members, again I have accepted and carried out what was agreed in Standing Committee. I have formally consulted the Staff Side of the General Whitley Council on which all staff who work in the NHS are represented. I have asked that body for from six to eight names. I have also consulted the TUC and also the Patients' Association which is set up specifically for the purpose of taking an interest in the welfare of patients in the NHS. I mentioned the TUC. It represents 8 million members and their families—a high proportion of the working population—and it may well be an important body to be consulted in looking at patients' interests. The names have now been submitted by the Staff Side of the General Whitley Council, and they are being considered. Once the Patients' Association has made its views known, I shall be in a position to choose two members from among the suggested names.
      Mr. Patrick Jenkin: Is the right hon. Gentleman yet able to say anything about the chairman of the board?
      Mr. Ennals: I am not yet in a position to make any announcement about the chairman. I shall go through the process which was accepted in Committee which is to discuss the nominations for the chairmanship with the interests concerned which are set out in the Bill. I cannot yet make an announcement, but I have every confidence that we shall be able to see the board established with its chairman and its other members in time to proceed with its task without delay.
      Mr. Crouch: One of the last things that I like in this House is having words and thoughts attributed to me which are untrue. It misleads the House. I am sure that the Secretary of State, in his generous way, will agree that in my short intervention supporting my hon. Friend the Member for Birmingham, Edgbaston
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      (Mrs. Knight) I was supporting Amendment No. 1 and Amendment No. 69. I was not so much supporting Amendment No. 67, which specifies the type of membership. I was talking about patients. A patient can be a person who wants to be served by the National Health Service and nothing else or one who wants to be served by a National Health Service and a private service. But I was talking about patients. The right hon. Gentleman suggested that I was perhaps solely interested in the aspect of patient representation to deal with a private health service. That is quite wrong.
      Mr. Ennals: I may have misunderstood what the hon. Gentleman said. I thought that he was saying that basically patients in the National Health Service should be represented and that in so doing he must have been disagreeing with Amendment No. 67 which refers to two other persons representing the interests of patients who wish to undergo medical treatment privately. I was attributing to the hon. Gentleman a point of view which was accepted by Government supporters and with which I thought he was in agreement. But I am glad that he has made himself clear. He having done so, I am sure that he will not now suggest that we should undergo an operation to change the basis of compromise which has been an integral part of the whole of this legislation.
      Mr. Patrick Jenkin: What the Secretary of State said about the procedures for choosing the two medical members and the non-medical members has been noted with interest. However, the key difficulty will be the chairman, and I have no doubt that the right hon. Gentleman will be making his decision in due course. We shall watch that with great interest.
      My hon. Friend the Member for Birmingham, Edgbaston (Mrs. Knight) is right to say that the people who are the most affected by the process of this legislation are the private patients who will no longer be able to have their treatment by the consultant of their choice at a National Health Service hospital and will have to go somewhere else. Therefore, at first sight, it seems not unreasonable that that category of patients should have special representation. The vast majority of NHS patients will never know the difference.

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      I see the strength of the point made by the right hon. Member for Blackburn (Mrs. Castle) that if we went down that road it would upset the balance of Goodman. However I ask the Government to bear in mind that we are here debating a Report stage with a whole series of amendments on which there were tied votes in Committee. The advice that we received was that an amendment on which the vote was tied would be almost bound to be selected for debate on Report, whereas if we put down a different amendment it would be within the discretion of Mr. Speaker whether to select it. We wanted a debate on patients, and we have had a debate.
      I would particularly commend Amendment No. 69 to the House, but there is no prospect of our reaching it. If we were not suffering under the guillotine I would advise my hon. Friend not to press her Amendment No. 1 and tell the House that we should vote on Amendment No. 69, which contains a proposition that it would be very difficult for the Government to vote against:
      "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."
      We seem to be getting a board which will be something of a battleground for those representing the interests of the medical profession and those representing the interests of others employed in the National Health Service. The board is being appointed not to have regard to the interests of patients generally but to pursue the policy which has been introduced by the Labour Party for phasing out and for licensing. Therefore, if we had been able to do it, we would have voted on Amendment No. 69. I would have been interested to see Government Members trooping through the Lobbies to vote against a proposal that the board should have regard to the interests of patients.
      That vote will be denied us, but I do not think that we should revert to voting on Amendment No. 1. I hope that my hon. Friend will feel it right in the light of the debate to ask to withdraw her amendment. No doubt, note will be taken in another place of what has been said on Amendment No. 69.
      Mrs. Knight: In the light of the advice given by my right hon. Friend the Member for Wanstead and Woodford (Mr. Jenkin) on the Front Bench, I beg to ask leave to withdraw the amendment.
      Amendment, by leave, withdrawn.
      The Minister of State, Department of Health and Social Security (Mr. Roland Moyle): I beg to move Amendment No. 2, in page 2, line 7, leave out
      "or a certificate under section 14 below".
      This amendment is consequential on the acceptance of an amendment to Clause 14 in Committee. That amendment removed the necessity for certifying the smaller private hospital developments outside the National Health Service and substituted a process of notification.
      Mrs. Castle: I fully recognise that the amendment is merely consequential on other matters and cannot therefore be sensibly resisted, but in Committee I expressed some regret at the change in procedure from certification to notification. I do not think that my hon. Friend was able to attend the Committee that morning, but I would just draw his attention to my continuing anxieties about this. I ask him to watch very closely to make sure that the simplication of procedure which he has introduced does not lead to abuses, and to take the necessary steps to amend the legislation if it does.
      Mr. Moyle: I undertake to do so.
      Amendment agreed to.
      4.45 p.m.
      Mr. Ennals: I beg to move Amendment No. 3, in page 2, line 16 leave out "Part IV" and insert "Parts IV to VI".
      Mr. Deputy Speaker (Mr. Oscar Murton): With this we are to take Government Amendments Nos. 71 and 113.
      Mr. Ennals: Amendment No. 113 is consequential on Amendment No. 3. The effect of Amendment No. 71 is to make the Health Services Board and the Scottish and Welsh Committees subject to investigation by the Health Service Commissioners for England, Scotland and Wales respectively.
      In Committee, my right hon. Friend the Member for Plymouth, Devonport (Dr.

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      Owen) undertook to consider whether the Health Service Commissioners should be empowered to investigate allegations of maladministration by the Board on its Welsh and Scottish Committees. We consulted the Commissioner, Sir Idwal Pugh, who expressed the opinion that the Health Services Board and its committees were bodies which could properly be made subject to his investigations. The Government accepts the Commissioner's view and seek to give effect to it by introducing this series of amendments.
      The scope of the Commissioners' investigations is laid down in Section 34(3) of the National Health Service Reorganisation Act 1973. The Commissioners may investigate:

      "(a) an alleged failure in a service provided by a relevant body; or

      (b) an alleged failure of a relevant body to provide a service which it was a function of the body to provide; or

      (c) any other action taken by or on behalf of a relevant body,

      in a case where a complaint is duly made by or on behalf of any person that he has sustained injustice or hardship in consequence of the failure or in consequence of maladministration connected with the other action."
      The Commissioners will therefore not be empowered to express an opinion on the merits of—for example—proposals for phasing out pay beds. Nor will they be able to investigate an allegation that an incorrect decision was given by the board on an application for authorisation of new hospital premises. The Commissioners will be empowered to investigate allegations that someone has suffered injustice or hardship because the board had not considered observations that had been submitted to it about phasing-out proposals, or because an application for an authorisation was not dealt with within a reasonable period of time.
      The Secretary of State does not have a power of direction over the board and the amendment takes account of this by requiring that reports of the results of the Commissioners' investigations should he sent to the person who made the complaint, to the Health Services Board or to the Scottish or Welsh Committee and to the person who is alleged to have taken or authorised the action complained of, but not to the Secretary of State.
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      Similarly, the annual report of the Commissioners upon their functions relating to the board and the committees, and any special reports they decide to make on instances of hardship or maladministration suffered as a consequence of maladministration by the board or either of the committees, will be laid before both Houses of Parliament and not submitted to the Secretary of State.
      I hope that with this explanation the House will accept the amendments. They are again a reflection of points made in Committee, and a further indication of ways in which we have sought to improve the Bill as a result of consultation in Standing Committee.
      Sir George Young: When the Bill was published it did not permit the Health Service Commissioner to investigate complaints against the proposed board or its committees. The Government's original intention was that this important constitutional redress should not be extended to those who might suffer as a result of maladministration by the board. The argument for bringing the Health Services Commissioner into the picture was movingly made on 27th May, as reported at columns 195–202 of the Official Report of the Committee proceedings, and I do not propose to regurgitate it. But one does not see the proposals purely as negative. I see them as a positive step, giving the board the benefit of the fund of wisdom which the Health Service Commissioner now has about how the NHS is run. I hope reinforcing rather than reducing public confidence in the board.
      The Commissioner refers in his reports to a number of cases in which he has invited authorities to review their administrative practices and procedures. It might be a good idea if the Commissioner made informal contact with the board before it started work to give its members some advice which might help them in dealing with maladministration later.
      I have a number of points on Amendment No. 71. The original amendment, I think No. 264, was brevity and clarity itself:
      "The Health Service Commissioner shall be empowered to investigate allegations of maladministration by the board."

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      In 15 succinct words it said it all. Since then the parliamentary draftsman has spent the Summer Recess translating that into 70 lines of incomprehensible legal prose which one cannot understand without three other Acts of Parliament and a trained barrister at one's elbow.
      I refer to the point raised in Amendment No. 71 which sets out who shall receive the reports compiled by the Health Services Commissioners. As I understand the application of Section 37 of Part III of the National Health Service (Reorganisation) Act 1973 to this Bill, the person who made the complaint and the Health Service Board or the Committees will get a copy of the Commissioners' reports. No one else will receive a copy unless the Commissioners so decide. Sub-paragraph (i) of the amendment relieves the Commissioner of the obligation to send the report to the Secretary of State, and as far as I can see he is not obliged to do so by any other part of Section 37. Under subparagraph (ii) each House of Parliament will get a copy of special reports only when the injustice or hardship has not been and will not be remedied. This seems to exclude a number of other reports which no one will read about unless the Health Service Commissioner decides to send a report.
      Then there is the question of staff. I assume that there wilt be sufficient spare capacity in the Health Service Commissioner's office to take on this extra task without the need to employ any more people.
      I cannot help wondering whether we have got the right Commissioner. The Health Services Board is a new constitutional animal and its functions under Part II are purely administrative. Under Part III its functions are quasi-judicial when it comes to licensing. Ministers have said time and time again that the Health Service Board is an independent body. But independent of whom? Schedule 1, paragraph 6, says
      "The Board shall not be regarded as the servant or agent of the Crown …"
      Presumably it is independent of the Secretary of State, his Department and of central Government generally. But it is also intended to be independent of the area health authorities, the regional health authorities and other bodies within the National Health Service administration.
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      The Parliamentary Commissioner has jurisdiction over central Government departments and the Health Service Commissioners have jurisdiction over the administration of the NHS. If the board is to be independent of both administrations, strictly speaking it should be neither the Parliamentary Commissioner nor the Health Services Commissioners involved here. Therefore, who is the right ombudsman? When we originally debated this matter both the Minister of State and I were somewhat confused about this matter.
      The Government have plumped for the Health Services Commissioner but that indicates that the board will form part of the administration of the National Health Service and therefore may not be seen to be independent of that administration. Perhaps this is an area which could be debated in the Lords where they will have more time to devote to it. Perhaps the issue could go to the Select Committee for the Parliamentary Commissioner, which has an interest in his work.
      However, having said that we welcome the inclusion in the Bill of the Health Service Commissioners in response to our amendment in Committee, it would be churlish of me not to thank the Government for their response.
      Mr. Laurie Pavitt: I think that the hon. Member for Ealing, Acton (Sir George Young) can take a considerable amount of credit for the way in which he put this argument forward in Standing Committee. He had done his homework on this issue and as a result I think that he has been instrumental in improving the Bill, and all sides of the House will recognise that.
      In his submission he said that there was a wealth of information with the Health Service Commissioners because they look at a whole range of events which take place within the National Health Service administration. He then queried the fact that the Health Service Commissioners should be involved because the Health Service Board is an independent body. He wondered whether it would not be more appropriate for the Parliamentary Commissioner to have these duties. But his first point was far more relevant than his second. The Health Service Commissioner looks at things with a considerable amount of knowledge of the background

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      and the kind of representations which are being made to him. So I hope that my right hon. Friend will stick to the provisions he has made and leave the Health Service Commissioners in the Bill.
      Mr. Ennals: I agree with my hon. Friend the Member for Brent, South (Mr. Pavitt). Perhaps I could have been more fulsome in my appreciation of the efforts of the hon. Member for Ealing, Acton (Sir George Young) and I will not be done down by my hon. Friend on this issue.
      One of the advantages of a substantial Committee stage is that we are able to treat seriously proposals for strengthening the Bill. The reason we did not include this provision in the original Bill was that the board is an independent body and not a servant of the Crown or the Secretary of State. If it had been the servant of either it would have been obvious and sensible to make it subject to one of the two Commissioners.
      I agree that it is more appropriate to include provision for the Health Service Commissioner. I am prepared to discuss the matter with Sir Idwal wearing his other hat, but he accepts that this is a sensible proposal and I am glad that the hon. Member for Ealing, Acton, supports it.
      I explained earlier the reasons why the reports would not be sent to the Secretary of State. That indicates that I am not responsible for the operation of an independent board. The board will have been established by Parliament although I may have made appointments to it. Although there is no statutory obligation for reports to be submitted to me, I do not think it will be difficult for me to see copies of such reports. The annual reports of the Commissioners and their functions, and any special reports on hardship or maladministration, will be laid before both Houses of Parliament and it will be very surprising if copies do not reach me in the process.
      Amendment agreed to.

    Clause 2

      PURPOSE OF SS. 3 TO 5
      Mr. Patrick Jenkin: I beg to move Amendment No. 5, in page 2, line 23, leave out subsection (1) and insert:
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      '(1) The Board shall exercise its functions under Parts II and III of this Act with the object of—

      (a) making available in Great Britain the best possible facilities for the prevention, diagnosis, and treatment of illness, both at premises vested in the Secretary of State and under private arrangements; and

      (b) to that end securing the availability of sufficient accommodation and services of a satisfactory standard at both National Health Service and other hospitals for use in connection with the treatment of persons at such hospitals as resident and non-resident patients'.

      Mr. Deputy Speaker: With this, we may take the following amendments:
      No. 4, in page 2, line 23, leave out subsection (1).
      No. 6, in page 2, line 33, at end insert:
      'Provided that such separation or withdrawal shall not impair the reasonable availability of such facilities, accommodation or services to patients or practitioners desirous of obtaining or providing treatment on a private basis.'
      Mr. Jenkin: Before I discuss the amendment I would like to associate myself with the words of the hon. Member for Brent, South (Mr. Pavitt) in congratulating my hon. Friend the Member for Ealing, Acton (Sir G. Young) upon having been instrumental in making a notable addition to the Bill.
      We now come to Clause 2 of the Bill, and as there is not much time left before the Report stage I will move this amendment briefly. We had a long debate in Committee about Clause 2, which is the declaratory clause intended to reflect the propositions in the Goodman proposals, that is, that the Bill should contain a broad declaration that private beds and facilities should be separated from the NHS, and the expression of the Government's commitment to the maintenance of private medical and dental practice in this country. In Standing Committee we divided on the amendments which were in the same form as those on the Notice Paper now, and on each occasion the Committee came to a conclusion only with the casting vote of the Chairman. This not only entitles us but obliges us to raise the matter again.
      Obviously Clause 2 and particularly Clause 2(1), by setting out the principle of phasing out, raises the temptation to have yet another Second Reading debate, but we had a very full and interesting debate yesterday, and we

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      heard points of view not only from those hon. Members who served on the Committee but from others who did not. I shall try to speak directly to the issue whether this clause should be in the Bill and whether, if so, it should be in this form.
      5.0 p.m.
      I do not think that there is a dispute between us that subsection (1) is wholly without effect. It is wholly declaratory. I am sure that the Minister of State has studied the debate which took place in Committee. We made the point that the board, in exercising its functions in the phasing out of pay beds, should be governed by all the succeeding clauses in Part It and that those succeeding clauses should determine whether a particular bed or group of beds should be phased out at the time that the board was considering the matter. Therefore, those clauses could not have regard to the general statement of intention in Clause 2, which is purely declaratory.
      The same to some extent is true to subsection (2) which is wholly otiose and would not be there at all if the Goodman proposals had not stated that it would be. It merely repeats, and the Bill elsewhere repeals, the provision guaranteeing that consultants should not be bound to be in full-time service in the National Health Service.
      When I questioned the desirability of having these entirely otiose and declaratory statements in the Bill I was confronted with precedent: it had happend before. Indeed, it was said that my name, when I was Chief Secretary, had been on the Health and Safety at Work etc. Bill, one of the early clauses of which was wholly declaratory.
      I suggest that there is a difference between that kind of Bill, which came before the House as a largely agreed measure—certainly, wholly agreed in objective—and this Bill which is put before the House very much as the view of the Labour Party and is in no sense supported even by those who took part in the Goodman discussions. We should not put broad statements of intent in a disputed matter of this kind when later there is spelt out in great detail the exact conditions which are to apply when the Bill comes to be operated.
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      It is primarily on that ground that I believe that subsection (1) ought not to be in the Bill. For that reason, I should not mind if subsection (2) were removed, provided that the original provision of the 1946 Act were to remain. Of course, we should then, as it were, need to repeal the repeal.
      The Bill came before the House following the Report of a Select Committee. Unlike the vast majority of Bills this measure is in direct conflict with the Report of that Select Committee. I remind the House that the Select Committee, in paragraph 49 of the Report stated:
      "We recommend:

      (i) that no major changes to the system are needed;

      (ii) that control procedures in hospitals should be more strictly observed;

      (iii) that all charges for private patients should be reviewed regularly at least every two years; and

      (iv) that more publicity be given to the availability of amenity beds."

      Mr. Pavitt: Will the right hon. Gentleman inform the House of the circumstances surrounding that Select Committee Report? The Select Committee was set up under one Government and there was then a change of Government. Because a Select Committee cannot have a minority report, the recommendations which finally emerged were the result of a majority decision, the strength of the Committee having been changed from that under the previous dispensation.
      Mr. Jenkin: The hon. Gentleman is entitled to make his explanation. The Report makes clear that it is a Report of the Expenditure Committee, Session 1971–72, and the Expenditure Committee was nominated on 3rd November 1971. Whether some other Committee appointed on some other occasion with different members would have come to a different conclusion seems wholly irrelevant. The Committee appointed and set up to examine the matter came to its conclusions, which I have just read.
      That is another reason why it seems wrong to state in the front of a Bill, as though it were a broad, agreed objective, a proposal which is in fact hotly contested. The danger is that it may in some way detract from the later conditions which have been carefully drawn up—we examined them in depth in Committee—

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      regarding the application of the principle. It is not right that we should in any sense risk muddying the water by putting in broad general propositions of this kind when they are not agreed. When there is broad agreement, there is no harm and it may be desirable, as a matter of cosmetics for public presentation, to put the proposition in, but when there is not broad agreement the Bill should be strictly confined to those matters which will govern the operation and duties of the Health Services Board.
      If the Government think that it is necessary to have something in, for goodness' sake let us have something which has more relevance to the real needs of the health service, not merely a restatement of what appears later in the Bill.
      Amendment No. 5 proposes:
      "(1) The Board shall exercise its functions under Parts II and III of this Act with the object of—

      (a) making available in Great Britain the best possible facilities for the prevention, diagnosis, and treatment of illness, both at premises vested in the Secretary of State and under private arrangements; and

      (b) to that end securing the availability of sufficient accommodation and services of a satisfactory standard."

      In Committee is was suggested, just as it was a few minutes ago by the Secretary of State, that if we included those as the considerations which subsection (1) should have, we would somehow be transferring to the board the responsibility for running the health service. I suggest that the amendment could not conceivably have that purpose, because the introductory words would read
      "The Board shall exercise its functions with the object of".
      Since these presumably are the objectives of any sensible Secretary of State—that is, making available the best possible facilities and securing sufficient accommodation and services—all we are asking is that the board should have the same objectives as the Secretary of State and that it should not be deflected into the by-ways of what in a sense, as I have said on other occasions, is the almost irrelevant battle being fought out by the medical profession, on the one hand, and some members of some trade unions, on the other.
      The ultimate responsibility for the Health Service would remain with the Secretary of State.
      In parentheses, I may say that I am attracted by the report that the right hon. Gentleman has had from the three regional chairmen indicating how his responsibilities in this regard might be more effectively devolved upon the regions and areas, leaving him with only major policy and monitoring functions. That is by the way. All we are suggesting is that, in carrying out its functions, the board should have in mind these two objectives.
      A second slightly more sinister reason was given by the former Minister of State why the subsection is in its present form. If the Minister of State is to reply he will need to give us some firm undertakings on this matter.
      The Minister of State's predecessor said:
      "The reason for putting this broad declaration is that it should be made quite clear to anyone who wishes to be considered for nomination to the Board, and it should be clear to anyone who is considering the issues about which the Bill is concerned, that its prime central purpose is to separate private practice from NHS hospitals. Do not let there be any misunderstanding about that."—[Official Report, Standing Committee D, 17th June 1976; c. 405.]
      We must have a categoric assurance that there is no intention to pack the board with members who are predisposed to phasing out. That passage in the Minister of State's speech filled me with deep suspicion. We have referred already to the procedures for appointing the chairman, the two medical representatives and the two others. There is nothing in the Bill about the opinions of the people whose names are to go forward. They are to be appointed by the Secretary of State after consultation. He has told us how he has reached a list of eight people from whom he will have to choose the members. We want an assurance that there is no question of the Government asking for a sort of loyalty test, or that members might have to sign a declaration that they are prepared to co-operate in the phasing-out process. As the former Secretary of State in an earlier debate, this is intended to be a balanced board. Its composition was arived at after hard negotiation in Committee.
      We need a reassurance that the purposes of Clause 2(1) are not intended to prejudice the detailed operation of subsequent clauses or the appointment of members of the board. It stands in the Bill as a statement of principle, and there was discussion about it yesterday. The Secretary of State said 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. …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."—[Official Report, 12th October 1976 Vol. 917, cc. 352–353.]
      I should be much more impressed by the principle which is supposed to actuate hon. Members opposite if we did not hear in speech after speech from the Government side—from the hon. Members for Preston, South (Mr. Thorne), Aberdeen, North (Mr. Hughes), Sheffield, Hillsborough (Mr. Flannery), Ormskirk (Mr. Kilroy-Silk) and the like-words which give the impression that they are more concerned with hammering the income of consultants—
      Mr. Stan Thorne: On a point of order, Mr. Deputy Speaker. I may have been mistaken, but I understood the right hon. Member for Wan-stead and Woodford (Mr. Jenkin) to use the word "louts" as a description of the hon. Members to whom he referred.
      Mr. Jenkin: The hon. Member must have misheard me. I would never dream of using such a word about hon. Members.
      The hon. Members to whom I referred give the impression with their constant repetition of phrases such as "Thrusting gold down the throats of the consultants" that they are more concerned with dragging down Dives than with elevating Lazarus. That is why I view with scepticism the so-called principle enunciated by the Secretary of State yesterday. The whole principle is made suspect when all the cliches of the class war are dragged out by hon. Members opposite.
      5.15 p.m.
      I contend that the great majority of those working in hospitals and the vast majority of those treated in NHS hospitals
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      are entirely content with the present arrangements. For the most part, they are entirely unaffected by them. Those in stoutest support of the principle we are discussing are entirely unaware of the advantages which flow to the NHS and its patients through the operation of the pay bed system.
      They should be helped to understand, and that is why I propose that the money received from pay beds should go to the hospital where the work is done and be used for ear-marked projects or equipment which people could identify and so realise that but for the money from private beds, those projects or equipment could not be afforded.
      I have also suggested that some of the money might go to those who work directly with the private patients. This is a matter which I should be happy to explore further as I have already with a number of trade union leaders concerned.
      I was interested to see an article by Katharine Whitehorn in the Daily Mirror. She said of hon. Members opposite:
      "Their action is going to have exactly the opposite effect of what they want. It's going to hurt the Health Service more than anything else could do."
      She concluded:
      "Let the nurses and radiotherapists and cleaners get their whack, too, and not just the doctors."
      The reaction from readers was interesting. The Daily Mirror reported:
      "Katharine Whitehorn's article 'Why we should save the pay beds' in the Mirror's Private Opinion series, provoked a heavy postbag. Most letters supported her view that pay beds should be retained within the Health Service."
      There followed a selection of readers' letters.
      Mr. Ennals: Is it not rather arrogant for the right hon. Gentleman to suggest that we should try to educate those who work in the National Health Service about what they should think of the principles on which they do their work? He misunderstands the position when he says that the wisdom of the consultants should be conveyed to the lesser orders within the service, who do not understand all the benefits they get from pay beds. The right hon. Gentleman should understand that there is a very deep feeling among many of those in the National Health

      467
      Service about the principle on which the Bill is based and that there is a great deal of support for it. I have found from a large number of consultants that, although they may not agree with the Bill in all its parts, and may even disagree with the principle, they want it passed and want us to get on with the job because the health service will be the healthier for it.
      Mr. Jenkin: The Secretary of State misunderstands me. I was not talking about education on the principle involved. I said that people should understand the facts, which we have already rehearsed, about the solid financial and health advantages which flow to the NHS from doctors being able to conduct private and NHS practices under the same roof.
      The right hon. Gentleman persists in the view that his opinion is supported by the majority. I shall not quote the National Opinion Poll from which I have quoted before. A new poll, asking a new question, carried out on the same basis as the previous poll, has been made available to me today. The question was:
      "There has been a lot of discussion recently on 'pay beds' in NHS hospitals. Some people say that 'pay beds' are a way of jumping the queue and ought to be stopped, others that people should be allowed to spend their money on private medical treatment if they wish to do so. Which of these points of view do you tend to agree with?"
      The results were: The use of pay beds ought to be stopped, 22 per cent.; ought to be allowed, 63 per cent.
      Mr. Ennals: Before the right hon. Gentleman sits down. It is clear—
      Mr. Deputy Speaker: Order. I understand that the right hon. Member for Wanstead and Woodford (Mr. Jenkin) has sat down.
      Mr. Pavitt: This place is a constant source of wonder and amazement to me. I find it so not least because the right hon. Member for Wanstead and Woodford (Mr. Jenkin), who led the Opposition through 29 sittings in Committee, should find it a source of amazement that the Bill seeks to separate pay beds and private practice from the National Health Service and that the board is given that responsibility in various parts of the Bill. The right hon. Gentleman seems to find something sinister in the fact that that
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      is laid on the line as the purpose of the Bill in Clause 2.
      I am grateful that the right hon. Gentleman quoted my right hon. Friend the Member for Blackburn (Mrs. Castle), the former Secretary of State. In the long debate in Committee it could have been possible not to make Clause 2 so explicit. However, it was obviously the more honest that we should seek to make that clear so that that which followed would logically stem from a statement of intent.
      One of the amendments would completely emasculate Clause 2. I take issue with the part of the amendment that seeks to duplicate the small responsibility of this Bill with the whole responsibility of the National Health Service. The right hon. Gentleman made it plain in his introductory remarks that he thinks it is right and proper that the same responsibility that rests upon the Secretary of State should rest upon the board.
      If the amendment were accepted in its present form, it would give the board responsibility for diagnosis and treatment outside the NHS. It is fairly clear that if that responsibility were to be incorporated into the Bill it would not be the job of the board merely to phase out the last 3,500 pay beds, it would also be its responsibility to ensure that private practice existed. It would be its responsibility to ensure an extension of private practice. If there is any greater negation of the purposes of the Bill, I cannot see it. As the House will imagine, I shall be voting against the amendment.
      Mr. Crouch: I was not a member of the Committee, but the Committee room was packed when the clause was debated, 19 of the 20 members being present, including the Chairman. There was great excitement on both sides of the Committee. The report of the debate occupied a great deal of space. Both sides of the argument were well argued and well debated. When it came to the vote the debate was well voted upon. The Committee divided exactly half and half—namely, eight votes to eight votes—on three occasions. On each occasion the Chairman, in accordance with precedent, had to vote with the Government to sustain the status quo. That is accepted.
      I wonder whether you can do anything now, Mr. Deputy Speaker, to fill the House to the equivalent of eight

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      Members on each side of a Committee. The House would then hear what an important and vital amendment this is. It is no small matter although it has been dismissed so easily by the hon. Member for Brent, South (Mr. Pavitt). The hon. Gentleman merely says that it is necessary to have a declaratory statement.
      Mr. Pavitt rose—
      Mr. Crouch: If the hon. Gentleman wants to interrupt me before I really get under way, I shall give way.
      Mr. Pavitt: If a Committee is composed of the same number of Members on the Government side as on the Opposition side, how can we avoid having equal votes?
      Mr. Crouch: If the Government had better judgment, they would get many more votes. Given better judgment they would have managed to get more votes than they received day after day in Committee. On no fewer than 58 occasions the Chairman had to intervene to sustain the Government's case in this terribly thin argument and thin Bill.
      From the arguments advanced this afternoon it is quite clear what the Bill is about, or rather what it is not about. It is not about producing the best possible facilities for the prevention, diagnosis and treatment of illness in both the premises vested in the Secretary of State and under private arangements. That has been vigorously denied by the Government. That is not what the Bill is about. That has been denied. It is not about securing the availability of sufficient accommodation and services of a satisfactory standard at both National Health Service hospitals and other hospitals for use in treating patients at such hospitals. It is not about that. It is about the dogmatic belief with which the Government are determined to proceed and which is set out in the Bill. The Bill is not about securing the best services for the curing of patients and sick people in hospital.
      Even the worthy Member for Brent, South, who has been speaking on health matters for the past 15 years, dismissed the question of producing and securing the best possible facilities for the cure
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      and prevention of illness. He has become the dogmatic Socialist again. He is concerned only with securing the separation of facilities. He is concerned only with securing the progressive withdrawal of services. The hon. Gentleman and his hon. Friends are eaten up with the idea of separating the private patient from the NHS. There is no question of producing a better service.
      Clause 2 is always the most important part of a Bill. The first clause sets out an important statement but the guts of most Bills are in the second clause. Clearly the guts of this Bill are in Clause 2. My right hon. Friend is right in saying that when we get to the guts of the Bill it is a declaratory statement about Socialist dogma. It is a pity that we should have that dogma when talking about sickness, illness and serving the people.
      I only wish that the House would fill. I only wish that the television screens would bear the message "This is an important amendment and the hon. Member for Canterbury is making an important statement." In the old days the House would have filled up. If I continue for another 10 minutes, perhaps we shall attract the attention of most Members and you will find, Mr. Deputy Speaker, that you hardly have room to sit in your Chair. However, that will probably not be the situation.
      We are now considering the very guts of the Bill. My right hon. Friend was right to say that it is wrong that we should have such a statement in Clause 2. If the Government are determined to go ahead with the removal of the private sector, let them—let me not be interrupted by the activities of my Deputy Chief Whip. I suppose that a nod is as good as a wink. I trust that he understands what I mean. Let the Government declare their intention of pursuing their dogmatic progress, their real intention, but above all let them show that they believe in producing a health service worthy of the people.
      The wording of Clause 2 is not worthy of that objective. Instead they have given us a minor objective and a minor aim. That is what I must condemn and that is why I welcome the amendment. I hope that it will be solidly supported by all my hon. Friends.
      Mr. George Thompson: I cannot see what objection there can be to a declaratory clause setting out the purposes that the board will have to fulfil. I take the Secretary of State's point that candidates for the board must be sure of what they will be called upon to do before they can accept or reject an invitation to be nominated.
      5.30 p.m.
      In Scotland we do not want an extension of the private sector. If people are willing to pay for treatment, let them do so, but I do not see why that purpose should be written into the Bill. It has been said that the Committee was always split right down the middle. If the Committee of Selection had had the wisdom to appoint an SNP Member to the Committee, the split would not have been down the middle. There would have been a clear majority for sensible solutions to this problem.
      I was much struck by the opinion poll that was cited. Unless I mistook what was said, it appeared to me that the dichotomy that was proposed to those who answered this poll was not in a perfect form at all but was, indeed, false. One cannot say "Are you in favour of pay beds in the NHS"? and put that as the precise oposite of "Are you against private practice?" It is quite false. If that was what the poll asked, it was quite unworthy of the British Press that such a thing was done. It is perfectly possible to be willing to allow private practice to continue and to be against pay beds in the NHS. That is precisely the policy of my party.
      Mr. Kenneth Clarke: The hon. Gentleman has probably misheard the explanation of the NOP survey. The particular question begins with a clear statement:
      "There has been a lot of discussion recently on 'pay beds' in NHS hospitals."
      Then follows the question. Therefore, I think it is clear that if the hon. Gentleman had had the opportunity of seeing the survey, he would have seen that it is directed to the question of pay beds in NHS hospitals.
      Mr. Thompson: Yes, but my point was that the dichotomy of the two questions was false, because it is perfectly possible to be in favour of allowing private prac-
      472
      tice and, at the same time, to be against pay beds within the NHS. Unless I was wrong in that, I think that my objection must be sustained.
      Mr. Ennals: This is absolutely typical of a loaded question. Perhaps I may read it.
      "Some people say that 'pay beds' are a way of jumping the queue and ought to be stopped, others that people should be allowed to spend their money on private medical treatment if they want to do so."
      This survey showed that a large proportion of all respondents, 63 per cent., said that people should be allowed to spend their money on private medical treatment if they wanted to do so. It did not imply for a moment that it should be private medical treatment within the NHS, so this is an absolutely bogus alternative, and the hon. Member for Galloway (Mr. Thompson) is absolutely right.
      Mr. Thompson: I am most grateful to the Secretary of State for confirming me in my opinion that the logic of the question was quite false.
      I want once again to commend to the House and to English Members present tonight our experience in Scotland. Our experience is not the product of some dogmatic theorising, any more than the intentions of the Government are based on dogmatic theorising. Our experience in Scotland is based on how the health service, the medical profession and so on have grown up in Scotland in a much more profoundly democratic way than they have grown up in the South of England. I commend to the House a consideration of our experience in Scotland as backing up what the Government are endeavouring to do for the ordinary people of southern England.
      In view of what I have said, I shall be advising my hon. Friends to support the Government on this matter.
      Lord James Douglas-Hamilton: I wish to take up a comment made by the hon. Member for Galloway (Mr. Thompson) when he spoke about our experience in Scotland. The areas of Scotland differ from each other in this respect. Everyone knows that in the hon. Gentleman's constituency there is not a single pay bed. However, in Edinburgh, which is recognised internationally as a medical centre, there are

      473
      a considerable number of pay beds. Circumstances differ from one area of Scotland to another.
      However, I am glad that the hon. Gentleman has firmly placed on record the fact that the SNP supports the Labour Government on this Bill and has done so throughout. I am grateful to him for that information. He has nut it on record absolutely clearly for Scotland. This matter has received virtually no publicity in Scotland. When doctors and surgeons come there, they will know full well that SNP Members are giving full support to the Labour Government.
      The survey asked the question whether the number of pay beds should
      "Remain as they are or be increased?"
      The proportion of people who said that pay beds should remain as they are or be increased was 71 per cent. An overwhelming majority in Scotland would like pay beds retained in some form. The hon. Gentleman has not put that matter to the test. There are no pay beds in his constituency. He may speak for his constituency, but he does not speak for Scotland as a whole.
      Mr. Moyle: I am in some difficulty because when the right hon. Member for Wanstead and Woodford (Mr. Jenkin) started this debate, he said that Opposition Members were anxious to make rapid progress. However, he then deployed his arguments at somewhat greater length than his opening statement had led me to believe he would. Nevertheless, I hope to make a brief reply in order to accommodate Opposition Members, who quite understandably want to get away from this matter and move on to other topics.
      If we were to accept the amendment, we should be emasculating an important part of the Bill. The clause is declaratory, as the debt hon. Gentleman said, but nevertheless its words are controlling provisions and act as an essential part of the Goodman proposals, to which the right hon. Gentleman referred—namely, that the legislation which should emerge from the Goodman proposals should contain Clause 2 (1) and Clause 2 (2). We have done our best in our policy of accepting the Goodman proposals as a settlement of this problem. We have carried out the proposals and put them into the Bill. That is essentially why they are there.
      474
      This also has some other advantages in that it makes clear to the members who will be appointed to the board, as my right hon. Friend the Member for Plymouth, Devonport (Dr. Owen) said, what their duties will be in accepting membership of the board. I do not see that there is any reason why the Government should attempt to fudge the clarity of their attitude on this matter.
      The right hon. Gentleman asked us to give an undertaking that there is no intention to pack the board with supporters of the phasing out policy. We shall not give that undertaking because there is no need to give it, as membership of the board is quite clearly laid down in the legislation. There is to be an independent chairman, who is to be a lawyer as a guarantee of his independence—if, indeed, being a lawyer is such a guarantee. However, as the right hon. Gentleman and I were at one time members of that profession, I think that he will take what I have said in the right spirit.
      Another two members of the board will be members of the medical profession. We shall consult the medical organisations on that matter, as my right hon. Friend the Secretary of State has said. I do not think that there is any possibility that the representatives of the medical profession will be in favour of phasing out as an initial attitude to the problem of the NHS.
      If the remaining two members of the board were people who were totally in favour of immediate phasing out of pay beds in the NHS—although I do not know what my right hon. Friend's intentions are—there would still be a complete balance on the Health Services Board. Therefore, I do not see that there is any need to give the undertaking requested.
      The right hon. Gentleman then said that he did not think that broad statements ought to be written into the Bill because they tended only to muddy the waters and to obscure the points being made in all of the subsequent clauses. That may well be a very wise piece of advice, but I wish that he and his hon. Friends had taken it instead of tabling Amendment No. 6, which is a very generalised statement that he proposes to insert into Clause 2 but which attempts to do what the whole of Clauses 3 and 4 set out to do. The only

      475
      effect of taking Amendment No. 6 into the Bill would be to create just that muddying to which the right hon. Gentleman is so much opposed. Therefore, consistency of argument would have been a good thing.
      Amendment No. 5 seems totally to misconceive the situation that exists at present. The Secretary of State is responsible for providing all the treatment that the amendment urges the Health Board should provide. My right hon. Friend not only has the powers and the duties, but the facilities, to do what is required, which the Health Board does not.
      Mr. Patrick Jenkin: The Minister has not answered my point. The introductory words in Amendment No. 5 make it clear that we are not imposing these provisions as duties on the Health Board but are saying that it shall exercise those functions with the objective of achieving the purposes achieved by the Secretary of State.
      Mr. Moyle: I do not think that that alters the situtaion greatly, because my point is that the Secretary of State has the powers and duties to do all these things. In addition, succeeding legislation has provided him with the facilities and resources to do what is required. The board does not have those facilities and resources and no provision is made to give them to the board by any of the amendments put down by the Opposition.
      My right hon. Friend has made the point that he is capable of carrying out all these duties and responsibilities in so far as they affect NHS patients. The Opposition are seeking to persuade the House that the Secretary of State should look after not only NHS patients but private patients, too. I should have thought that that was a direct contravention of the whole concept of private treatment. The whole idea of private treatment is to escape from the toils of the organisations that owe allegiance to my right hon. Friend. Having paid money, the idea is that someone escapes from my right hon. Friend and the employees and profesional people who work for him. The idea is that by paying money people go into the private sector entirely.
      What a shock it would be for private patients, as I understand them—and I
      476
      admit that my understanding is limited—if, having paid their money to escape from the toils of my right hon. Friend, they found his tentacles reaching into the private sector to interfere with their treatment. We accept that we have a responsibility to ensure that minimum standards are maintained in private hospitals under the Nursing Homes Act, but beyond that the provision of adequate facilities for treatment is a matter entirely for the managers and owners of private nursing homes, subject again only to the criminal law.
      The amendment does not show any great confidence in the ability of the private sector to look after private patients when it gets them within its ambit. I should have thought that that was the last thing the right hon. Gentleman would want to convey. For the reasons that I have given, the Government cannot accept these amendments and will resist to the ultimate their introduction into the Bill.
      Mr. Patrick Jenkin: I remain totally unconvinced by the Minister's argument when he talks about the Secretary of State's tentacles reaching into the private sector. Because of the guillotine, the Minister will not have bothered to read Part III, because we shall not reach it. We shall not debate that part of the Bill, but why the Minister thinks that those provisions should not be regarded as the tentacles of the Secretary of State reaching into the private sector defeats my understanding.
      The tentacles to which I have referred reach every kind of health facility in the private sector, for example, to see whether the notification procedure is carried out. I have seen the draft regulations, and we shall wait to see whether they come out in their present form. The larger organisations have to run the gauntlet of the Health Board, which is in a sense the Secretary of State's tentacles reaching into the private sector. The two objectives which we say the board ought to have in mind when exercising its functions under the Bill will give a reality and relevance to the needs of patients in both the private and the public sector. That is something that the Bill singularly lacks.
      The Minister has failed to answer the argument, and I gather that the Secretary

      477
      of State misquoted the opinion poll during the time that I was out of the Chamber.
      Mr. Ennals: I read it.
      Mr. Jenkin: The right hon. Gentleman had to be corrected by my hon. Friend the Member for Rushcliffe (Mr. Clarke).
      For all those reasons, I think that my right hon. and hon. Friends are justified in dividing the House in favour of the amendment.
      Question put, That the amendment be made:—
      The House divided: Ayes 191, Noes 220.

      Division No. 317.]

      AYES

      [5.46 p.m.

      Alison, Michael

      Grylls, Michael

      Page, Rt Hon R. Graham (Crosby)

      Atkins, Rt Hon H. (Spelthorne)

      Hall-Davis, A. G. F.

      Pardoe, John

      Awdry, Daniel

      Hamilton, Michael (Salisbury)

      Parkinson, Cecil

      Baker, Kenneth

      Hampson, Dr Keith

      Penhaligon, David

      Beith, A. J.

      Hannam, John

      Percival, Ian

      Bell, Ronald

      Harvie Anderson, Rt Hon Miss

      Peyton, Rt Hon John

      Bennett, Sir Frederic (Torbay)

      Hawkins, Paul

      Prior, Rt Hon James

      Benyon, W.

      Hayhoe, Barney

      Pym, Rt Hon Francis

      Bitten, John

      Higgins, Terence L.

      Renton, Rt Hon Sir D. (Hunts)

      Biggs-Davison, John

      Holland, Philip

      Renton, Tim (Mid-Sussex)

      Blaker, Peter

      Hooson, Emlyn

      Ridsdale, Julian

      Boscawen, Hon Robert

      Howe, Rt Hon Sir Geoffrey

      Rifkind, Malcolm

      Bottomley, Peter

      Howell, David (Guildford)

      Roberts, Michael (Cardiff NW)

      Bowden, A. (Brighton, Kemptown)

      Howells, Geraint (Cardigan)

      Roberts, Wyn (Conway)

      Boyson, Dr Rhodes (Brent)

      Hunt, John (Bromley)

      Ross, Stephen (Isle of Wight)

      Brittan, Leon

      Hurd, Douglas

      Rossi, Hugh (Hornsey)

      Brocklebank-Fowler, C.

      Hutchison, Michael Clark

      Rost, Peter (SE Derbyshire)

      Brotherton, Michael

      Irving, Charles (Cheltenham)

      Royle, Sir Anthony

      Brown, Sir Edward (Bath)

      Jenkin, Rt Hon P. (Wanst'd & W'df'd)

      Sainsbury, Tim

      Bryan, Sir Paul

      Jessel, Toby

      St. John-Stevas, Norman

      Buchanan-Smith, Alick

      Jones, Arthur (Daventry)

      Shaw, Giles (Pudsey)

      Buck, Antony

      Jopling, Michael

      Shepherd, Colin

      Budgen, Nick

      Joseph, Rt Hon Sir Keith

      Sinclair, Sir George

      Bulmer, Esmond

      Kaberry, Sir Donald

      Skeet, T. H. H.

      Burden, F. A.

      Kilfedder, James

      Smith, Cyril (Rochdale)

      Chalker, Mrs Lynda

      King, Evelyn (South Dorset)

      Smith, Dudley (Warwick)

      Channon, Paul

      King, Tom (Bridgwater)

      Speed, Keith

      Churchill, W. S.

      Kitson, Sir Timothy

      Spence, John

      Clark, Alan (Plymouth, Sutton)

      Knight, Mrs Jill

      Spicer, Michael (S Worcester)

      Clarke, Kenneth (Rushcliffe)

      Knox, David

      Sproat, Iain

      Clegg, Walter

      Lamont, Norman

      Stainton, Keith

      Cockcroft, John

      Langford-Holt, Sir John

      Stanley, John

      Cooke, Robert (Bristol W)

      Latham, Michael (Melton)

      Steel, David (Roxburgh)

      Cope, John

      Lawrence, Ivan

      Steen, Anthony (Wavertree)

      Corrie, John

      Le Merchant, Spencer

      Stewart, Ian (Hitchin)

      Costain, A. P.

      Lester, Jim (Beeston)

      Stokes, John

      Craig, Rt Hon W. (Belfast E)

      Lewis, Kenneth (Rutland)

      Stradling Thomas, J.

      Davies, Rt Hon J. (Knutsford)

      Lloyd, Ian

      Taylor, R. (Croydon NW)

      Dean, Paul (N Somerset)

      Luce, Richard

      Taylor, Teddy (Cathcart)

      Dodsworth, Geoffrey

      McCrindle, Robert

      Tebbit, Norman

      Douglas-Hamilton, Lord James

      Macfarlane, Neil

      Temple-Morris, Peter

      Dunlop, John

      McNalr-Wilson, M. (Newbury)

      Thatcher, Rt Hon Margaret

      Durant, Tony

      Madel, David

      Townsend, Cyril D.

      Eden, Rt Hon Sir John

      Marshall, Michael (Arundel)

      Trotter, Neville

      Emery, Peter

      Marten, Nell

      Tugendhat, Christopher

      Eyre, Reginald

      Mather, Carol

      van Straubenzee, W. R.

      Fairbairn, Nicholas

      Maudling, Rt Hon Reginald

      Vaughan, Dr Gerard

      Fell, Anthony

      Maxwell-Hyslop, Robin

      Viggers, Peter

      Fisher, Sir Nigel

      Meyer, Sir Anthony

      Wainwright, Richard (Colne V)

      Fletcher-Cooke, Charles

      Miller, Hal (Bromsgrove)

      Wakeham, John

      Fookes, Miss Janet

      Mills, Peter

      Walder, David (Clitheroe)

      Forman, Nigel

      Miscampbell, Norman

      Walker, Rt Hon P. (Worcester)

      Fowler, Norman (Sutton C'f'd)

      Moate, Roger

      Wall, Patrick

      Fox, Marcus

      Molyneaux, James

      Walters, Dennis

      Fry, Peter

      Monro, Hector

      Warren, Kenneth

      Gilmour, Rt Hon Ian (Chesham)

      Montgomery, Fergus

      Weatherill, Bernard

      Glyn, Dr Alan

      More, Jasper (Ludlow)

      Whitelaw, Rt Hon William

      Goodlad, Alastair

      Morgan-Giles, Rear-Admiral

      Wiggin, Jerry

      Gorst, John

      Morris, Michael (Northampton S)

      Wood, Rt Hon Richard

      Gow, Ian (Eastbourne)

      Mudd, David

      Young, Sir G. (Ealing, Acton)

      Gower, Sir Raymond (Barry)

      Nelson, Anthony

      Younger, Hon George

      Gray, Hamish

      Neubert, Michael

      Griffiths, Eldon

      Newton, Tony

      TELLERS FOR THE AYES:

      Grimond, Rt Hon J.

      Onslow, Cranley

      Mr. Anthony Berry and

      Grist, Ian

      Oppenheim, Mrs Sally

      Mr. Fred Silvester.

      NOES

      Abse, Leo

      Golding, John

      palmer, Arthur

      Allaun, Frank

      Gourlay, Harry

      Park, George

      Anderson, Donald

      Grant, George (Morpeth)

      Parker, John

      Archer, Peter

      Grocott, Bruce

      Pavitt, Laurie

      Armstrong, Ernest

      Hamilton, James (Bothwell)

      Perry, Ernest

      Ashley, Jack

      Hardy, Peter

      Prentice, Rt Hon Reg

      Ashton, Joe

      Harper, Joseph

      Price, William (Rugby)

      Atkins, Ronald (Preston N)

      Harrison, Waller (Wakefield)

      Reid, George

      Atkinson, Norman

      Hatton, Frank

      Richardson, Miss Jo

      Bagier, Gordon A. T.

      Heffer, Eric S.

      Roberts, Albert (Normanton)

      Bain, Mrs Margaret

      Henderson, Douglas

      Robinson, Geoffrey

      Barnett, Guy (Greenwich)

      Hooley, Frank

      Roderick, Caerwyn

      Bates, Alt

      Horam, John

      Rodgers, George (Chorley)

      Benn, Rt Hon Anthony Wedgwood

      Howell, Rt Hon Denis (B'ham, Sm H)

      Rooker, J. W.

      Bennett, Andrew (Stockpott N)

      Hoyle, Doug (Nelson)

      Roper, John

      Bidwell, Sydney

      Huckfield, Les

      Rose, Paul B.

      Bishop, E. S.

      Hughes, Rt Hon C. (Anglesey)

      Ross, Rt Hon W. (Kilmarnock)

      Blenkinsop, Arthur

      Hughes, Robert (Aberdeen N)

      Sandelson, Neville

      Boardman, H.

      Hughes, Roy (Newport)

      Sedgemore, Brian

      Booth, Rt Hon Albert

      Hunter, Adam

      Shaw, Arnold (Ilford South)

      Bottomley, Rt Hon Arthur

      Irvine, Rt Hon Sir A. (Edge Hill)

      Sheldon, Robert (Ashton-u-Lyne)

      Bradley, Tom

      Irving, Rt Hon S. (Dartford)

      Short, Mrs Renée (Wolv NE)

      Bray, Dr Jeremy

      Jay, Rt Hon Douglas

      Silverman, Julius

      Brown, Hugh D. (Provan)

      Jeger, Mrs Lena

      Skinner, Dennis

      Brown, Ronald (Hackney S)

      Jenkins, Hugh (Putney)

      Small, William

      Buchan, Norman

      John, Brynmor

      Smith, John (N Lanarkshire)

      Buchanan, Richard

      Johnson, James (Hull West)

      Snape, Peter

      Callaghan, Jim (Middleton & P)

      Jones, Alec (Rhondda)

      Spearing, Nigel

      Campbell, Ian

      Jones, Barry (East Flint)

      Spriggs, Leslie

      Cant, R. B.

      Jones, Dan (Burnley)

      Stallard, A. W.

      Carter-Jones, Lewis

      Judd, Frank

      Stoddart, David

      Cartwright, John

      Kerr, Russell

      Stott, Roger

      Castle, Rt Hon Barbara

      Kinnock, Nell

      Strang, Gavin

      Clemitson, Ivor

      Lambie, David

      Summerskill, Hon Dr Shirley

      Cocks, Rt Hon Michael (Bristol S)

      Lamborn, Harry

      Swain, Thomas

      Cohen, Stanley

      Lamond, James

      Taylor, Mrs Ann (Bolton W)

      Coleman, Donald

      Latham, Arthur (Paddington)

      Thomas, Dafydd (Merioneth)

      Concannon, J. D.

      Leadbitter, Ted

      Thomas, Jeffrey (Abertillery)

      Con Ian, Bernard

      Lestor, Miss Joan (Elton & Slough)

      Thomas, Mike (Newcastle E)

      Cook, Robin F. (Edin C)

      Lewis, Ron (Carlisle)

      Thomas, Ron (Bristol NW)

      Corbett, Robin

      Lipton, Marcus

      Thompson, George

      Cox, Thomas (Tooting)

      Litterick, Tom

      Thome, Stan (Preston South)

      Crawford, Douglas

      Loyden, Eddie

      Tierney, Sydney

      Crowther, Stan (Rotherham)

      Lyon, Alexander (York)

      Tinn, James

      Cryer, Bob

      Mabon, Dr J. Dickson

      Tomlinson, John

      Davidson, Arthur

      McCartney, Hugh

      Torney, Tom

      Davies, Bryan (Enfield N)

      McDonald, Dr Oonagh

      Wainwright, Edwin (Dearne V)

      Davies, Ifor (Gower)

      McElhone, Frank

      Walden, Brian (B'ham, L'dvw'd)

      Davis, Clinton (Hackney C)

      MacFarquhar, Roderick

      Walker, Terry (Kingswood)

      Deakins, Eric

      McGuire, Michael (Ince)

      Watkins, David

      Dell, Rt Hon Edmund

      MacKenzie, Gregor

      Watkinson, John

      Dempsey, James

      Mackintosh, John P.

      Wellbeloved, James

      Doig, Peter

      Maclennan, Robert

      Welsh, Andrew

      Dormand, J. D.

      McMillan, Tom (Glasgow C)

      White, Frank R. (Bury)

      Douglas-Mann, Bruce

      McNamara, Kevin

      White, James (Pollok)

      Duffy, A.E.P.

      Madden, Max

      Whitehead, Phillip

      Dunnett, Jack

      Mahon, Simon

      Whitlock, William

      Eadie, Alex

      Mallalleu, J. P. W.

      Wigley, Dafydd

      Edge, Geoff

      Marshall, Dr Edmund (Goole)

      Willey, Rt Hon Frederick

      Edwards, Robert (Wolv SE)

      Maynard, Miss Joan

      Williams, Alan (Swansea W)

      Ellis, John (Brigg & Scun)

      Mendelson, John

      Williams, Alan Lee (Hornch'ch)

      Ennals, David

      Millan, Rt Hon Bruce

      Williams, Rt Hon Shirley (Hertford)

      Evans, Fred (Caerphilly)

      Miller, Dr M. S. (E Kilbride)

      Wilson, Alexander (Hamilton)

      Evans, Ioan (Aberdare)

      Miller, Mrs Millie (Ilford N)

      Wilson, Gordon (Dundee E)

      Ewing, Harry (Stirling)

      Moonman, Eric

      Wilson, William (Coventry SE)

      Faulds, Andrew

      Morris, Alfred (Wythenshawe)

      Wise, Mrs Audrey

      Fernyhough, Rt Hon E.

      Morris, Charles R. (Openshaw)

      Woodall, Alec

      Flannery, Martin

      Moyle, Roland

      Woof, Robert

      Fletcher, Ted (Darlington)

      Mulley, Rt Hon Frederick

      Wrigglesworth, Ian

      Forrester, John

      Murray, Rt Hon Ronald King

      Young, David (Bolton E)

      Fowler, Gerald (The Wrekin)

      Newens, Stanley

      Fraser, John (Lambeth, N'w'd)

      Noble, Mike

      TELLERS FOR THE NOES

      Freeson, Reginald

      Orbach, Maurice

      Mr. Ted Graham and

      George, Bruce

      Orme, Rt Hon Stanley

      Mr. Tom Pendry.

      Gilbert, Dr John

      Ovenden, John

      Question accordingly negatived.

    Clause 3

      IMMEDIATE DUTY OF SECRETARY OF STATE AS REGARDS WITHDRAWAL OF NHS BEDS FROM RESIDENT PRIVATE PATIENTS
      6.0 p.m.
      Dr. Gerard Vaughan: I beg to move Amendment No. 7, in page 3, line 1, leave out Clause 3.
      I said yesterday, when we were debating New Clause 4, that in our view the Government have not looked sufficiently closely at many of the local effects of the proposals in this Bill. This is particularly so when we come to this amendment, which refers to Clause 3, dealing with the thousand beds, and the accompanying schedule which sets out the number of beds to be closed in each area. We suggest that the Government should recognise that the numbers of beds set out have not been looked into carefully enough. This is not a party political point. We suggest that the Government should drop Clause 3 and hand over to the independent board the investigation of the details of the beds—how many there should be, where they should come from and how soon they are to be handed over.
      The Goodman proposals say:
      "Subject to Parliament's decision, it is accepted that there are some pay beds and facilities which could be phased out from the NHS without undue delay, there being already reasonable alternative beds and facilities;"
      When we discuss areas and individual proposals we shall want to try to explain to the Secretary of State that in many areas there are no alternative reasonable facilities. Lord Goodman went on to discuss the schedule and said:
      "In determining this Schedule the Government will wish to consult fully with the medical and dental professions and with those responsible for providing private medical and dental facilities outside the National Health Service."
      There follow some key words:
      "The Government will also wish to consult at the level of the individual hospital."
      This is where our main contention comes.
      We appreciate that this is a difficult and complicated matter. But we know from first-hand experience that in many parts of the country consultations have not yet taken place at individual hospital level. Lord Goodman used the word
      482
      "accepted" but we do not agree that the majority of the medical profession, the majority of members of the public or the majority of union members have accepted this. We went into this yesterday and my right hon. Friend the Member for Wanstead and Woodford (Mr. Jenkin) has referred to the most recent opinion poll. It is our contention that adequate consultations have not yet taken place.
      I ask the Secretary of State, as we asked him in Committee, can he say that this undertaking in the Goodman proposals has been satisfactorily carried out? We do not think it has. This is not a party political point but it is a crucial one in the eyes of many local authorities. I referred yesterday to a letter from the chairman of the Cambridgeshire Area Medical Advisory Committee. I will refer to it again today because it is a clear letter. We have had direct comments and letters from other parts of the country, too. Cambridgeshire is an area of constantly increasing population because of the Peterborough New Town. In Committee one of our main anxieties about the new towns concerned the fact that no arrangements had been made to provide hospital facilities for those settling in the new towns.
      The chairman of the advisory committee makes the point that Cambridgeshire is an area of constantly increasing population. He goes on to say:
      "The Area Medical Officer was instructed to draft a letter which was ultimately sent to the Department of Health and Social Security outlining our objections and asking for reconsideration of the proposed cuts. This letter was acknowledged but no further reply has been received. The Area Health Authority has now been informed that the Bill has passed through the Committee stage and will be placed before the House in due course. It has also asked that any further evidence about the proposed cuts should be forwarded."
      It has been pointed out that no comment has yet been received to the first letter, so the Committee finds it hard to follow this up with any reasoned argument because it does not know what objections may have been raised to that first letter. The chairman concludes:
      "This seems a most scandalous state of affairs, which is highly unsatisfactory."
      That is a reasonable point of view. What would make more sense, if the consultations are not complete—and I accept that

      483
      they may be complicated—would be for the whole of this area—
      Mr. Ennals: May I say that it is perfectly true that the chairman of the advisory committee did not get a comment from the Department. I have already apologised to him for this. There was a certain misunderstanding within the office. This came to my attention and I wrote to the chairman specifically apologising to him for this. I think that the hon. Member will know that the needs of Cambridgeshire were specifically dealt with by my right hon. Friend the Member for Plymouth, Devonport (Dr. Owen), the then Minister of State, in Committee on 29th July. The hon. Gentleman knows that those considerations were taken into account even though the chairman had not been contacted. I hope the hon. Gentleman will accept that I have apologised for what was a misunderstanding.
      Dr. Vaughan: That is an interesting answer because this letter to which I am referring has only just arrived. Whatever apologies and communications have taken place they do not yet seem to have got through to the people who feel aggrieved. I shall wait with great interest to hear from the Secretary of State whether, in his opinion, the local hospital consultations have taken place satisfactorily. Our view is that such a complicated matter as this should be carefully looked at. Before we write into the Bill the detailed figures for each area it would be better to think again, to take this clause out of the Bill and to hand over the provisions within it to the independent board.
      Mr. Ennals: The hon. Member for Reading, South (Dr. Vaughan) will not expect me to accept this amendment. He was selective when reading out the statement of 15th December. It was made perfectly clear that the Bill would include a schedule dealing with 1,000 beds. It would, once again, be a breach of that agreement if we do not do what we are committed to in the Goodman proposals. It would be helpful, since the hon. Gentleman was specifically concerned about the question of consultation, if I tell the House the way in which we have proceeded with these consultations.
      It is now more than seven months since my right hon. Friend the Member for
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      Blackburn (Mrs. Castle) initiated consultations about the selection of the thousand beds to be phased out within six months of the Royal Assent being given to the Bill. It was a period of seven months during which the Government have given every opportunity to those most affected to consider and make representations about the proposals.
      The hon. Gentleman said that insufficient time was allowed for consultation. I emphatically reject that charge. The Government were so anxious to allow as long as possible, within the constraints of the parliamentary timetable, for consultation with field authorities, representatives of the medical and dental professions, other National Health Service workers and with the private sector that we undertook to consider representations up to the end of the Committee stage. As we approached the end of a long and thorough examination of the Bill in Committee, the Government decided to allow still more time for representations on the content of Schedule 2. We set a deadline of 30th September—only 12 days ago—leaving us less than two weeks in which to study and evaluate comments and criticisms on Schedule 2.
      Since then I have reappraised Schedule 2 carefully in order to satisfy myself and the House that the quotas set out in column 3 of the schedule are those that will best secure that the overall reduction of 1,000 pay beds is effected with due regard to the extent to which existing pay beds were under-utilised and to the reasonable availability of alternative accommodation and facilities for private practice outside the National Health Service.
      Dr. Vaughan: Is not the right hon. Gentleman supporting my point by saying that he has had only two weeks to examine this complicated matter? Does he not agree that the only consultation that has taken place in Cambridgeshire is one circular asking for views?
      Mr. Ennals: What I am saying is that I left myself only 12 days after giving a deadline for consultation. I have given the maximum opportunity for representations to be made and the Department has been weighing the situation carefully.
      I shall explain how we have considered the situation. First, we started from the

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      basis that the Government were committed in the Goodman proposals to publish in the Bill a list of 1,000 beds to be phased out, having regard both to the extent of demand as evidenced by occupancy by private patients in a year unaffected by industrial action and to the availability of reasonable alternative facilities in the private sector.
      The first aim was to find the 1,000 beds that most nearly satisfied those criteria. Starting there, we first considered those areas in which it was agreed that there were no alternative facilities to which displaced patients and consultants could go. There are 51 such areas in England and Wales, and we calculated the number of pay beds that would have been required to meet the demand from private patients in 1972 or 1973, whichever year had the higher demand. We took those years because they were unaffected by industrial action. This would give an average daily occupancy of 70 per cent.—slightly less than the average daily occupancy of acute beds in NHS hospitals. We can see no justification for recommending any reduction in the quotas originally proposed in Schedule 2.
      Next we considered the position in those areas outside London where some alternative facilities were known to exist. The quotas for these areas originally proposed in Schedule 2 were based on a notional average daily occupancy of 80 per cent. We calculated the reduction needed to secure the same throughout of patients as in 1972 and 1973 assuming a notional occupancy of 80 per cent. In doing so, we recognised that one consequence of this would be to force some private patients to seek treatment in the private sector. I do not apologise for that since the purpose of the Bill, as so many right hon. and hon. Members opposite and some representatives of the medical profession outside this House seem conveniently to forget, is to bring about complete separation of private practice from NHS hospitals.
      6.15 p.m.
      Finally, I turn to London, where the number of private beds already greatly exceeds the number of authorised pay beds where the number of acute beds in the private sector will have increased between publication of my predecessor's
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      initial proposals last February and the end of the initial period by no fewer than 278 beds and where patients are in the habit of travelling further for treatment to the hospital of their own or their general practitioner's choice. We thought it right to treat the whole of the GLC areas as a single entity. The fact that alternative private sector facilities in Kensington, Westminster and Chelsea greatly exceed those in Camden is surely irrelevant—or so it seemed to us—since it would involve no hardship for most patients who have been accustomed to seeking private treatment in the private wings of, say, UCH or the Middlesex to look to the alternatives in Harley Street, Nottingham Place or, for that matter, Lissom Grove.
      Relatively few private patients who are treated in London teaching hospitals actually live in the same London borough. Most come from all over London and some from outside it altogether. Bearing in mind this and the size of the private sector in London, we calculated the number of pay beds needed to deal with the same throughput of patients as in 1972 or 1973—whichever year had the highest throughput—with a notional occupancy of 85 per cent. Again, we recognised that such a notional occupancy would involve some transfer of demand to the private sector.
      Lest is should be argued that enforced transfer of this kind is unfair because it may result in longer waiting times for private patients, I would say that this seems to me irrelevant. The vast majority of the people of this country are obliged to rely on the NHS for the whole of their health care and sometimes have to wait for non-urgent treatment much longer than any of us would like. I see no reason for shedding tears if one result of separation is the extension of this kind of experience to those who hitherto have used their cheque books to avoid a queue.
      What has been the result of our review? We have considered the representations made to us in the light of the broad principles I have just described. We have satisfied ourselves that the proposals in Schedule 2, as the then Minister of State and I maintained in Standing Committee, were broadly right and do not call for the widespread modifications favoured by hon. Members opposite.

      487
      We have checked and re-checked our calculations and looked carefully at any discrepancies pointed out by health authorities. We have studied particularly the cases drawn to our attention in Standing Committee to make certain that their representations have been noted. In the final analysis we have found only four instances in which we think it would be proper to propose modifications, and these are set out in Amendments Nos. 108, 114, 115 and 116.
      Dr. Vaughan: The figures of bed occupancy are based on 1972 and 1973. There is a widespread belief that what the Minister said is not the case. It has been pointed out in Wirral or Tameside that industrial action took place in the years selected for the bed occupancy figures. Will the Minister comment on that?
      Mr. Ennals: I can give an assurance that all the figures were related to 1972 and 1973. We chose those dates because they were not affected by industrial action. In no part of the country were the figures based on any other year.
      Mr. Hal Miller: I wish to support my hon. Friend the Member for Reading, South (Dr. Vaughan) in seeking to omit Clause 3. We are unconvinced that the necessary consultations have taken place. When I say "consultations" I mean effective consultations, not just circulars. We were hoping that the numbers would have behind them some rationale and that due regard had been paid to the matters set out in the clause.
      I wish to say a few words on the subject of bed occupancy and the availability of alternative accommodation. The Goodman proposals referred in paragraph 3(b) to the words "subject to Parliament's decision". It is accepted that some pay beds and facilities could be phased out of the NHS without undue delay because there are reasonable alternatives. We understand that the Government will publish in a schedule to the Bill the location of the 1,000 beds to be released to the NHS within six months after Royal Assent.
      I hope that tonight we shall get clarification of how the total of 1,000 pay beds was arrived at. In Standing Committee the Secretary of State told us
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      that there had been a reduction in the occupancy requirement from 85 per cent. to 80 per cent. Later he told us that it was easier to negotiate down than up. We were told in Standing Committee that the figures referred to England only. We were never told clearly whether in the discussions leading up to the 1,000 figure it was decided that beds in Northern Ireland had not been included.
      Mr. Ennals: I must have answered that question many times in Standing Committee. At no stage did the Government intend or imply that the figure would include any beds in Northern Ireland. All sorts of allegations have been made by the Opposition on this matter and I am happy, therefore, to repeat my assurance.
      Mr. Miller: I accept that that was never the Government's intention, but the Government were only one party to the Goodman proposals. There was a great deal of misunderstanding among those who were involved in the negotiations.
      If we examine the figure and the basis of calculation it is clear that the results of information received up to 30th September have led to no changes in the schedule. We had an exhaustive discussion in Standing Committee of the various issues covered by Schedule 2. We were given the impression that there would be a detailed examination of the points that we raised. I subsequently found that some of the information I was given about the Northern area was not entirely accurate. I take this opportunity to apologise to the very reverend father in charge of the St. John of God Hospital at Scorton who wrote to me in an uneasy frame of mind asking where my information had come from about the radiology facilities available at his hospital.
      The Minister seized my main point that in areas such as the Northern area, but particularly in Cumbria, which he admitted was a particular difficulty, the figures need to be looked at again in the light of the distances which have to be travelled and the weather conditions obtaining on roads at certain times of the year. I do not think that the Secretary of State has done justice in his remarks so far to those very valid points. I hope that he will expand on them at

      489
      a later date, because people need to be reassured about them.
      It is not a question of making wider use of the facility of group authorisations. That was a helpful proposal which had to some extent been put into effect before our Standing Committee discussions. But the right hon. Gentleman agreed that there was possibly the need for an enlargement of that method of dealing with the situation.
      We are here discussing reasonable availability so that not only patients but doctors may continue in private practice. Whatever Labour Members below the Gangway may say, the former Prime Minister in his statement of 20th October gave the Government commitment to the maintenance of private medicine. That means that there must be reasonable facilities for such private medicine to be practised. It is no good saying to someone in Cumbria that he has the right to engage in private practice if geographic considerations render that impossible.
      Let me turn now to the examination of other matters referred to in subsection (3). In Standing Committee the Opposition were by no means satisfied with the criteria for use as applied to the occupancy of pay beds in NHS hospitals. There is of course a limit in any hospital to the number of beds which may be used as pay beds at any time. They can be found in different parts of the hospital in different specialities in different wards.
      But in Committee the Secretary of State did not deal with a point I raised previously. In the returns from the hospitals on which these occupancy rates are established pay beds are calculated on a totally different basis from NHS beds. The pay bed occupancy rate takes no account of public holidays, the closure of wards for redecoration or maintenance, and so on. There is therefore a great deal of uncertainty about the occupancy calculations, and so far the Secretary of State and his colleagues have done nothing to dispel that uncertainty. When the right hon. Gentleman talks about reducing the rate from 85 per cent. to 80 per cent., he carries no conviction, because the beds figure is suspect on the basis of the returns made to his Department from the hospitals, as evidenced in a Written Answer to me, and as made plain to us
      490
      by representatives from the medical profession.
      There are further points about pay beds being used largely for acute cases, and the need for a patient to reduce his stay to the minimum possible. One would in any case expect a shorter occupancy. The pay bed occupancy is not calculated during daylight hours but at the witching hour of midnight. At that time, of course, if one has managed, having bound up one's wounds, to leave the previous evening in order to avoid an extra night's cost, it cannot be realistic to expect anyone to take over that bed at five minutes to midnight. So the basis of the occupancy figures is not beyond challenge and has not been clarified.
      6.30 p.m.
      The second matter referred to in subsection (3)(b) of the clause is
      "the extent to which…alternative accommodation and facilities…are reasonably available…"
      This also leaves behind a great deal of imprecision and has aroused much uncertainty in the minds of medical practitioners, because, as I have said, what is the worth of the right to private practice to the profession, or of the freedom of choice to the patient, if the necessary facilities are not available?
      We went into this matter at great length in discussing Schedule 2 in Committee. We were then promised a number of replies which have not so far been available. Indeed, it is apparent that not all the consultations have effectively taken place or been digested in the Department. This was one of the reasons why we proposed postponing phasing out and the reference of the matter to a Royal Commission, or, in the case of either of these two suggestions failing, the replacement of the Secretaty of State by the board to be established so that it should be able to satisfy itself about the criteria for the 1,000 beds and the matters that are to be held in due regard.
      This has been a somewhat technical discussion and perhaps somewhat dry. I have purposely tried to refrain from political polemics, but I do not want the Secretary of State to be in doubt about the seriousness of the matters I have raised or that they go to the heart of the concern about the Bill. Indeed, this

      491
      was recognised by the Government in Committee, when Clause 3 was taken out of order in order to allow time for further consultations. But those consultations had not been completed by the time we came to consider the clause in Committee. Some of us feel that they have still not been satisfactorily completed, and the right hon. Gentleman has not given us the reassurances we want on this point. That is one reason why I oppose the clause.
      Mr. Tom Litterick: In opposing the amendment it is worth pointing out that it is really an attempt to destroy the Bill completely, because Clause 3 is at the heart of the Bill. Without it, the Bill would have no meaning.
      I was impressed by the contention of the hon. Member for Reading, South (Dr. Vaughan) to the effect that my right hon. Friend the Secretary of State was not justified in defining specific numbers, as he does in Schedule 2, of pay beds which should be withdrawn within the first six-month period. The hon. Gentleman alleged that insufficient consultation had taken place, and the hon. Member for Bromsgrove and Redditch (Mr. Miller) took up the same point at considerable length.
      Quite apart from the fact that my right hon. Friend has given his assurances on this matter, it is of some wonder to me, if the Opposition can assert with such confidence that a great Department of State like the Department of Health and Social Security cannot conduct sufficient consultations to the satisfaction of the Opposition, what kind of consultations took place which led them to specify in amendments before the House various figures for pay beds. The Opposition, having objected to the definition of specific numbers in Schedule 2 because, they say, the Department has been unable to conduct sufficient consultation, then proceed, presumably on the basis of consultations conducted on their own less sufficient resources, to propose such figures as 876, 946, 967, 988, and 991.
      The figures proposed by the Opposition are so very precise that the House is agog to hear the explanation of the special logic contained in each of them and how the Opposition arrived at them.
      492
      I am surprised, indeed, that hon. Members opposite are not moving amendments against one another, or that they did not nominate every number from one to 1,000 in 1,000 amendments.
      The fact is that the Opposition are simply playing the numbers game. Until such time as a rational explanation of the figures they propose comes forward, it is obvious that the Opposition are playing a spoiling game, their usual attempt to nibble away at the central strength and position of the NHS as a universally available medical service.
      So many years after the inception of the NHS, the Conservatives still resent it bitterly because it reduces the opportunity for private commercial operators to make a profit, which is central to the Conservative attitude throughout society, let alone the NHS. A central feature of their philosophy is that if someone is not making a profit, the service concerned is at least unnecessary and at worst wholly undesirable.
      An interesting light was thrown on this continuing doctrinal bigotry by the Tories in some remarks by the hon. Member for Bromsgrove and Redditch. He was not aware, apparently, of the intrinsic effrontery of his remarks when he complained that what he described as the right to private commercial medical practice would not be genuine unless the public underwrote it with their taxes and were prepared, in thinly populated areas, to provide subsidies in the form of physical resources which would be used by private commercial medical operators to make a profit. It is the old game always played by the Tories. They detest State intervention in the economic life of the community except in so far as it serves the interests of private commercial operators. In doing so, they make the interests of the citizen, whether he be a patient, tenant or anything else, very much secondary to the central doctrinal element in their philosophy. That is what the debate is all about on this clause. As I said at the beginning, this clause is the heart of the matter.
      Mr. Hal Miller: Will the hon. Gentleman kindly recall that I stressed that patients needed to have reasonable access to alternative private facilities? Will he not also accept that such patients

      493
      seeking the doctor of their choice and the treatment that he chooses to prescribe for them have paid their taxes and are fully entitled to be in a National Heatlh Service hospital?
      Mr. Litterick: I do not think that anybody can be under any illusion about what the hon. Member for Bromsgrove and Redditch was actually saying. To be sure, he phrased it in terms of the propagandist rhetoric of his party. He said that it is the patients who must have the choice, and therefore the taxpayer has to provide the facilities whereby private medical practitioners are able then to stand with their begging bowls saying "Come to me so that I can make some money out of your anxiety"—and, maybe, even the patients' foolishness.
      We all know very well that a significant part of the individual patronage of private practice is not unconnected with the notions of what public medicine is and what private medicine means in terms of social significance. This is played upon constantly. But the heart of the matter is the production of profit.
      As has so often happened during the life of this Government, a piece of legislation has been brought forward and greeted with howls of rage and anger by the Conservatives. There have been evocations of red revolution, rivers of blood, and so on, and the terms "extremism" and "left-wing" have been trotted out. But this is in fact a very modest proposal indeed. That word "modest" implies relatively, and I am talking about its modesty in relation to my own party's ambition—the total abolition of private medicine within the facilities of the National Health Service.
      The Bill is not offering the instant abolition of private medicine within the National Health Service. The only specific quantification of withdrawal is to be found in those marginal figures defined in Schedule 2, and the period of six months. Beyond that there is nothing specific. The matter of the abolition of pay beds within the National Health Service has been left almost indeterminate. That is very clear from the structure of the Bill.
      From my point of view, not only does this make it a rather modest proposal:
      494
      it also clearly leaves the door open very substantially for an expansion of the private sector within the National Health Service, should there be, for example, a change of Government within the next two years. This is not impossible. The private beachhead within the National Health Service is left substantially intact.
      To use only one example; in Birmingham, my own city, only 28 private beds are to be phased out within the time limits defined, leaving more than 100 from the original 129. That is still a very significant private, commercial beachhead within the medical services of the Birmingham area. The pattern is the same throughout the country.
      I quite understand the Secretary of State's point of view. He is trying to please everybody. With the greatest respect, I think he has bent over too far backwards and tried to please too many people. Members of the Labour Party of long standing have always known that if we concede our own objectives, or a significant element of them, in order to pacify the Conservatives, their reaction is always to want more concessions.
      Mr. Stan Thorne: Their thirst is insatiable.
      Mr. Litterick: If the Labour Party wins an election, the Conservatives do not like it because they have not got the jobs. The next best thing for them is that the Labour Party should do their job for them. Sadly, all too often this transpires and, in effect, the Labour Party winds up doing the job of the Conservative Party. All too often it ends up doing the dirty jobs which Conservatives would rather not do.
      6.45 p.m.
      I understand the reasons for the Secretary of State's moderation. What I cannot understand are the continual doctrinaire attacks being waged by the Conservative Party, under the cover of social concern for this mystical, vast number of people who wish to enrich a very small minority of doctors, fundamentally damaging the service. It always seems possible to mobilise large sums of money for this purpose, the intention being that the service, which was originally conceived as a universal and comprehensive service, should be reduced once again to the status of a charity organisation to be patronised only by the deserving poor.
      Mr. Thompson: The amendment appears to me to be an attempt to slow down the process of phasing out pay beds, and I want to say why I oppose the amendment. But first I should like to clarify a matter raised by the hon. Member for Edinburgh, West (Lord James Douglas-Hamilton) in our debate on the last amendment, because the hon. Gentleman's remarks are very relevant and my response to him is very relevant to our debate on this amendment. The hon. Gentleman gave the impression that the Scottish National Party was in a sense now coming out in its true colours, as though it had never concealed these colours. He gave the slight impression—he is much too honest a man to do other than merely that—that the medical men in Edinburgh would be surprised by what I said in the debate yesterday and by what I have said today.
      No doubt he thought that the reading of my speeches in the Official Report would act as a sort of revulsion therapy, dissuading any of these gentlemen from supporting the SNP at the next General Election and from supporting the cause of Scottish independence. Of course, the hon. Gentleman is perfectly entitled to set before people in Scotland objections to anything that I or my party may say. Indeed, it is his duty to do so. But I have to tell the hon. Gentleman that the Scottish National Party's policy on health and on private practice was published in the spring of this year. It was voted on at our annual conference at Motherwell in May. I assume that the coverage was sufficient to have reached even Edinburgh.
      Mr. Nicholas Fairbairn: It did not reach Kinross.
      Mr. Thompson: If the hon. and learned Gentleman has not had a copy, I shall be very willing to send him one, and to the hon. Member for Edinburgh, West as well. I can tell both hon. Gentlemen and the House that copies were widely distributed within the Scottish medical profession. The SNP's policy was commented upon in the British Medical Journal, if I remember correctly, and it has been reasonably well received by many in the medical profession in Scotland.
      In that document, in paragraph 18, under a heading printed in stout black
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      type, "Private Medicine", the first sentence reads:
      "Pay beds within the Scottish Health Service will be phased out."
      That is a very plain, very Scottish statement of the position.
      Mr. Fairbairn: And very wrong.
      Mr. Thompson: The hon. and learned Member for Kinross and West Perthshire says that it is very wrong. I have no doubt that in his opinion it is. However, in my opinion and I believe in the opinion of the vast majority of the people in Scotland it is very right. I am afraid that if the hon. Member for Edinburgh, West and the hon. and learned Member for Kinross and West Perthshire rush hot foot to their constituences to tell the surgeons and doctors there of what I have said in this Chamber, both will find that the news is very old and, by now, rather cold, though no doubt they will try to stir up the embers.
      When the hon. Member for Edinburgh, West spoke of the pay beds in Edinburgh, I assumed that there was a large number of them. However, I find on consulting the schedule that in the Lothian area there are 34 beds. I assume that the bulk of them are in Edinburgh, and it is proposed in the first stage of the Government's plans to phase out 13 under Clause 3, thus leaving 21. I do not consider that to be an excessive lopping off of pay beds in the city of Edinburgh.
      The hon. Member for Edinburgh, West also mentioned our pride in Scotland in the medical school of the University of Edinburgh and in the medical schools of those of our other universities which have them. I seem to remember that we produce 25 per cent. of the medical graduates in the United Kingdom in our Scottish medical schools, and we are very proud of this fact. It has to be borne in mind that our medical students in Edinburgh and elsewhere are trained in the general hospitals, and I feel that this is one reason for the very strong commitment among the Scottish medical profession to the service of the whole community of Scotland and that it is one reason why we are not afflicted by the pay beds problems which appear to deflect attention from the National Health Service in the South-East of England.

      497
      Now I have to say why on this occasion I am prepared to follow the Secretary of State in his reaction to this amendment. I find that his mind works along the same lines as my own, and I should need to be convinced either that he is an ogre who is intent on inflicting pain and suffering upon patients in England or that he is mistaken in his views. I have no reason from my observation of his behaviour or from what he has said to conclude that he is, in any sense of the word, an ogre. What is more, I am content to believe that he has taken as good advice as the Tories have taken. Since he is working for the same ends as my own party is, I must veer to his conclusion rather than to those of the party which is acting in exactly the opposite way to that which I should wish to go.
      It is for these reasons that I shall be advising my hon. Friends to support the Government in rejecting this amendment.
      Lord James Douglas-Hamilton rose—
      Mr. Deputy Speaker (Sir Myer Galpern): Order. I understand that the hon. Gentleman has already spoken.
      Lord James Douglas-Hamilton: I wish to speak again for only one minute, Mr. Deputy Speaker.
      I wish first to say to the hon. Member for Galloway (Mr. Thompson) that I was not accusing him of concealment. He has confirmed a policy about which we have known for some time.
      I want, secondly, to ask the Secretary of State whether he will refer to the position in Wales. I do not want to go into it in detail now as we dealt with it in Committee. However, the amendments dealing with it may not be reached tonight. If he can confirm that there will be reasonable facilities available to all patients in Wales if the measures proposed in the Bill go through and if he can confirm that the problems of access to and of getting to and from hospital
      can be coped with, I shall be grateful to hear what he has to say.
      Mr. Ennals: In the case of Wales and other parts of the United Kingdom covered by the Bill, there are later amendments which I expect will be dealt with, but I can give the assurance asked for by the hon. Member for Edinburgh, West (Lord James Douglas-Hamilton).
      I want to answer the question raised by the hon. Member for Bromsgrove and Redditch (Mr. Miller), who is worried about the way in which the bed count is taken and about the occupancy rates. He referred especially to public holidays, temporary closures, and so on. Of course, it is true that people's preferences may be for not being in hospital at Christmas time or during public holidays. But, whatever comparison we make, precisely the same basis is used for general bed occupancy and bed occupancy in relation to private beds. In 1974, the average daily occupancy of all beds was 72 per cent. That of private beds by paying patients was 49 per cent. On that basis and other bases, it would have been perfectly reasonable for this legislation to have proposed the phasing out of more than 1,000 in the first six months. The fact that it is 1,000 shows how very modest this proposal is.
      I can see no reason from anything said by hon. Members in the debate for doing other than urging the rejection of the amendment.
      Mr. Hal Miller rose—
      Mr. Deputy Speaker: Order. Is the Minister giving way, or has he concluded his remarks?
      Mr. Ennals: No, I have sat down.
      Question put, That the amendment be made:—
      The House divided: Ayes 185, Noes 212.

      Division No. 318.]

      AYES

      [6.57 p.m.

      Alison, Michael

      Blaker, Peter

      Bryan, Sir Paul

      Atkins, Rt Hon H. (Spelthorne)

      Boscawen, Hon Robert

      Buchanan-Smith, Alick

      Awdry, Daniel

      Bottomley, Peter

      Buck, Antony

      Baker, Kenneth

      Bowden, A. (Brighton, Kemptown)

      Budgen, Nick

      Beith, A. J.

      Bradford, Rev Robert

      Bulmer, Esmond

      Bell, Ronald

      Braine, Sir Bernard

      Burden, F. A.

      Bennett, Sir Frederic (Torbay)

      Brittan, Leon

      Chalker, Mrs Lynda

      Beny, Hon Anthony

      Brocklebank-Fowler, C.

      Channon, Paul

      Biffen, John

      Brotherton, Michael

      Churchill, W. S.

      Biggs-Davison, John

      Brown, Sir Edward (Bath)

      Clark, Alan (Plymouth, Sutton)

      Clarke, Kenneth (Rushcliffe)

      Jopling, Michael

      Rees-Davies, W. R.

      Clegg, Walter

      Joseph, Rt Hon Sir Keith

      Renton, Rt Hon Sir D. (Hunts)

      Cockcroft, John

      Kilfedder, James

      Renton, Tim (Mid-Sussex)

      Cooke, Robert (Bristol W)

      King, Evelyn (South Dorset)

      Rifkind, Malcolm

      Cope, John

      King, Tom (Bridgwater)

      Rippon, Rt Hon Geoffrey

      Corrie, John

      Kitson, Sir Timothy

      Roberts, Michael (Cardiff NW)

      Costain, A. P.

      Knight, Mrs Jill

      Roberts, Wyn (Conway)

      Craig, Rt Hon W. (Belfast E)

      Knox, David

      Ross, Stephen (Isle of Wight)

      Davies, Rt Hon J. (Knutsford)

      Lamont, Norman

      Rost, Peter (SE Derbyshire)

      Dean, Paul (N Somerset)

      Lane, David

      Sainsbury, Tim

      Dodsworth, Geoffrey

      Langford-Holt, Sir John

      St. John-Stevas, Norman

      Douglas-Hamilton, Lord James

      Latham, Michael (Melton)

      Shaw, Giles (Pudsey)

      Dunlop, John

      Lawrence, Ivan

      Shepherd, Colin

      Durant, Tony

      Le Marchant, Spencer

      Silvester, Fred

      Eden, Rt Hon Sir John

      Lester, Jim (Beeston)

      Sinclair, Sir George

      Emery, Peter

      Lewis. Kenneth (Rutland)

      Skeet, T. H. H.

      Eyre, Reginald

      Lloyd, Ian

      Smith, Cyril (Rochdale)

      Fairbairn, Nicholas

      Luce, Richard

      Smith, Dudley (Warwick)

      Fletcher-Cooke, Charles

      McCusker, H.

      Speed, Keith

      Fookes, Miss Janet

      Macfarlane, Neil

      Spence, John

      Forman, Nigel

      McNair-Wilson, M. (Newbury)

      Spicer, Michael (S Worcester)

      Fowler, Norman (Sutton C'f'd)

      Madel, David

      Sproat, Iain

      Fox, Marcus

      Marshall, Michael (Arundel)

      Stainton, Keith

      Fry, Peter

      Marten, Neil

      Stanbrook, Ivor

      Gardner, Edward (S Fylde)

      Mather, Carol

      Stanley, John

      Gilmour, Rt Hon Ian (Chesham)

      Maudling, Rt Hon Reginald

      Steel, David (Roxburgh)

      Glyn, Dr Alan

      Maxwell-Hyslop, Robin

      Steen, Anthony (Wavertree)

      Gorst, John

      Meyer, Sir Anthony

      Stewart, Ian (Hitchin)

      Gow, Ian (Eastbourne)

      Miller, Hal (Bromsgrove)

      Stokes, John

      Gower, Sir Raymond (Barry)

      Mills, Peter

      Stradling Thomas, J.

      Gray, Hamish

      Miscampbell, Norman

      Taylor, R. (Croydon NW)

      Griffiths, Eldon

      Moate, Roger

      Tebbit, Norman

      Grimond, Rt Hon J.

      Molyneaux, James

      Temple-Morris, Peter

      Grist, Ian

      Montgomery, Fergus

      Thatcher, Rt Hon Margaret

      Grylls, Michael

      More, Jasper (Ludlow)

      Townsend, Cyril D.

      Hall-Davis, A. G. F.

      Morgan-Giles, Rear-Admiral

      Tugendhat, Christopher

      Hamilton, Michael (Salisbury)

      Morris, Michael (Northampton S)

      van Straubenzee, W. R.

      Hampson, Dr Keith

      Morrison, Hon Peter (Chester)

      Vaughan, Dr Gerald

      Hannam, John

      Mudd, David

      Viggers, Peter

      Harvie Anderson, Rt Hon Miss

      Nelson, Anthony

      Wainwright, Richard (Colne V)

      Hawkins, Paul

      Neubert, Michael

      Wakeham, John

      Hicks, Robert

      Newton, Tony

      Walder, David (Clitheroe)

      Higgins, Terence L.

      Onslow, Cranley

      Walker, Rt Hon P. (Worcester)

      Holland, Philip

      Oppenheim, Mrs Sally

      Wall, Patrick

      Hooson, Emlyn

      Page, Rt Hon R. Graham (Crosby)

      Warren, Kenneth

      Howe, Rt Hon Sir Geoffrey

      Paisley, Rev Ian

      Weatherill, Bernard

      Howell, David (Guildford)

      Pardoe, John

      Whitelaw, Rt Hon William

      Howells, Geraint (Cardigan)

      Penhaligon, David

      Wood, Rt Hon Richard

      Hunt, David (Wirral)

      Percival, Ian

      Young, Sir G. (Ealing, Acton)

      Hurd, Douglas

      Peyton, Rt Hon John

      Younger, Hon George

      Hutchison, Michael Clark

      Powell, Rt Hon J. Enoch

      TELLERS FOR THE AYES:

      Jenkin, Rt Hon P. (Wanst'd & W'df'd)

      Prior, Rt Hon James

      Mr. Cecil Parkinson and

      Jones, Arthur (Daventry)

      Pym, Rt Hon Francis

      Mr. W. Benyon.

      NOES

      Abse, Leo

      Castle, Rt Hon Barbara

      Evans, Fred (Caerphilly)

      Allaun, Frank

      Ctemitson, Ivor

      Evans, Gwynfor (Carmarthen)

      Anderson, Donald

      Cocks, Rt Hon Michael (Bristol S)

      Evans, Ioan (Aberdare)

      Armstrong, Ernest

      Cohen, Stanley

      Ewing, Harry (Stirling)

      Ashley, Jack

      Coleman, Donald

      Faulds, Andrew

      Ashton, Joe

      Corcannon, J. D.

      Fernyhough, Rt Hon E.

      Atkins, Ronald (Preston N)

      Conlan, Bernard

      Flannery, Martin

      Atkinson, Norman

      Cook, Robin F. (Edin C)

      Fletcher, L. R. (Ilkeston)

      Bagier, Gordon A. T.

      Corbett, Robin

      Fletcher, Ted (Darlington)

      Bain, Mrs Margaret

      Crawford, Douglas

      Ford, Ben

      Barnett, Rt Hon Joel (Heywood)

      Cronin, John

      Forrester, John

      Bates, Alf

      Crowther, Stan (Rotherham)

      Fowler, Gerald (The Wrekin)

      Benn, Rt Hon Anthony Wedgwood

      Cryer, Bob

      Fraser, John (Lambeth, N'w'd)

      Bennett, Andrew (Stockport N)

      Davidson, Arthur

      George, Bruce

      Bidwell, Sydney

      Davies, Bryan (Enfield N)

      Gilbert, Dr John

      Blenkinsop, Arthur

      Davis, Clinton (Hackney C)

      Golding, John

      Boardman, H.

      Deakins, Eric

      Gourlay, Harry

      Bottomley, Rt Hon Arthur

      Dell, Rt Hon Edmund

      Grant, George (Morpeth)

      Bradley, Tom

      Dempsey, James

      Grocort, Bruce

      Bray, Dr Jeremy

      Doig, Peter

      Hamilton, James (Bothwell)

      Brown, Hugh D. (Provan)

      Dormand, J. D.

      Hardy, Peter

      Brown, Ronald (Hackney S)

      Douglas-Mann, Bruce

      Harper, Joseph

      Buchan, Norman

      Duffy, A. E. P.

      Harrison, Walter (Wakefield)

      Buchanan, Richard

      Dunnett, Jack

      Hatton, Frank

      Callaghan, Jim (Middleton & P)

      Edge, Geoff

      Heffer, Eric S.

      Cant, R. B.

      Edwards, Robert (Wolv SE)

      Henderson, Douglas

      Carter-Jones, Lewis

      Ellis, John (Brigg & Scun)

      Hooley, Frank

      Cartwright, John

      Ennals, David

      Horam, John

      500

      501

      Hoyle, Doug (Nelson)

      Madden, Max

      Spriggs, Leslie

      Huckfield, Les

      Mahon, Simon

      Stallard, A. W.

      Hughes, Rt Hon C. (Anglesey)

      Mallalieu, J. P. W.

      Stoddart, David

      Hughes, Robert (Aberdeen N)

      Marshall, Dr Edmund (Goole)

      Stott, Roger

      Hughes, Roy (Newport)

      Maynard, Miss Joan

      Strang, Gavin

      Hunter, Adam

      Mendelson, John

      Summerskill, Hon Dr Shirley

      Irvine, Rt Hon Sir A. (Edge Hill)

      Miller, Dr M. S. (E Kilbride)

      Swain, Thomas

      Irving, Rt Hon S. (Dartford)

      Moonman, Eric

      Taylor, Mrs Ann (Bolton W)

      Jay, Rt Hon Douglas

      Morris, Charles R. (Openshaw)

      Thomas, Dafydd (Merioneth)

      Jeger, Mrs Lena

      Moyle, Roland

      Thomas, Mike (Newcastle E)

      Jenkins, Hugh (Putney)

      Murray, Rt Hon Ronald King

      Thomas, Ron (Bristol NW)

      John, Brynmor

      Newens, Stanley

      Thompson, George

      Johnson, James (Hull West)

      Noble, Mike

      Thome, Stan (Preston South)

      Jones, Alec (Rhondda)

      Orbach, Maurice

      Tierney, Sydney

      Jones, Barry (East Flint)

      Ovenden, John

      Tinn, James

      Jones, Dan (Burnley)

      Palmer, Arthur

      Tomlinson, John

      Judd, Frank

      Park, George

      Torney, Tom

      Kaufman, Gerald

      Parker, John

      Wainwright, Edwin (Dearne V)

      Kelley, Richard

      Pavitt, Laurie

      Walker, Terry (Kingswood)

      Kerr, Russell

      Pendry, Tom

      Ward, Michael

      Kilroy-Silk, Robert

      Perry, Ernest

      Watkinson, John

      Kinnock, Neil

      Prentice, Rt Hon Reg

      Wellbeloved, James

      Lambie, David

      Price, William (Rugby)

      Welsh, Andrew

      Lamborn, Harry

      Reid, George

      White, Frank R. (Bury)

      Lamond, James

      Richardson, Miss Jo

      White, James (Pollok)

      Leadbitter, Ted

      Roberts, Albert (Normanton)

      Whitehead, Phillip

      Lestor, Miss Joan (Eton & Slough)

      Robinson, Geoffrey

      Whitlock, William

      Lewis, Ron (Carlisle)

      Roderick, Caerwyn

      Wigley, Dafydd

      Lipton, Marcus

      Rodgers, George (Chorley)

      Willey, Rt Hon Frederick

      Litterick, Tom

      Rooker, J. W.

      Williams, Alan (Swansea W)

      Lomas, Kenneth

      Roper, John

      Williams, Alan Lee (Hornch'ch)

      Lyon, Alexander (York)

      Rose, Paul B.

      Williams, Sir Thomas (Warrington)

      Lyons, Edward (Bradford W)

      Ross, Rt Hon W. (Kilmarnock)

      Wilson, Alexander (Hamilton)

      Mabon, Dr J. Dickson

      Sandelson, Neville

      Wilson, Gordon (Dundee E)

      McCartney, Hugh

      Sedgemore, Brian

      Wilson, William (Coventry SE)

      McDonald, Dr Oonagh

      Shaw, Arnold (Ilford South)

      Wise, Mrs Audrey

      McElhone, Frank

      Sheldon, Robert (Ashton-u-Lyne)

      Woodall, Alec

      MacFarquhar, Roderick

      Short, Mrs Renée (Wolv NE)

      Wool, Robert

      McGuire, Michael (Ince)

      Silverman, Julius

      Wrigglesworth, Ian

      MacKenzie, Gregor

      Skinner, Dennis

      Young, David (Bolton E)

      Mackintosh, John P.

      Small, William

      Maclennan, Robert

      Smith, John (N Lanarkshire)

      TELLERS FOR THE NOES:

      McMillan, Tom (Glasgow C)

      Snape, Peter

      Mr. Thomas Cox and

      McNamara, Kevin

      Spearing, Nigel

      Mr. Ted Graham.

      Question accordingly negatived.
      7.0 p.m.
      Sir George Young: I beg to move Amendment No. 9, in page 3, line 2, leave out 'one thousand' and insert 'eight hundred and seventy-six'.
      Mr. Deputy Speaker: With this we are to take the following amendments:

      No. 74, in Schedule 2, page 31, line 7, column 3 leave out '2' and insert 'Nil'.

      No. 75, in page 31, line 8, column 3 leave out '16' and insert '6'.

      No. 76, in page 31, line 9, column 3 leave out '10' and insert '4'.

      No. 78, in page 31, line 11, column 3 leave out '22' and insert '10'.

      No. 79, in page 31, line 14, column 3 leave out '15' and insert '9'.

      No. 80, in page 31, line 18, column 3 leave out '9' and insert '4'.

      No. 81, in page 31, line 19, column 3 leave out '9' and insert '5'.

      No. 82, in page 31, line 21, column 3 leave out '15' and insert '8'.

      502

      No. 83, in page 31, line 22, column 3 leave out '15' and insert '5'.

      No. 84, in page 31, line 23, column 3 leave out '11' and insert '5'.

      No. 85, in page 31, line 24, column 3 leave out '56' and insert '30'.

      No. 86, in page 31, line 25, column 3 leave out '19' and insert '10'.

      No. 87, in page 31, line 27, column 3 leave out '7' and insert '4'.

      No. 88, in page 31, line 28, column 3 leave out '8' and insert '3'.

      No. 89, in page 31, line 29, column 3 leave out '28' and insert '15'.

      Sir George Young: As the Whip on the Committee I express some regret that the results on the Floor of the House are not quite as close as those upstairs.
      These 16 amendments bear a striking resemblance to Amendments Nos. 483 and 446 to 460 which we discussed in detail in Committee on 28th July, as reported at columns 1389 to 1416 of the Official Report of the Committee proceedings for

      503
      that date. That was one of the many matters on which Standing Committee D was unable to come to a conclusion. I much regret that in making slight alterations to the number of pay beds to be phased out the Government did not take on board the strong representations made on behalf of the London area about the harsh treatment meted out to it.
      I should like to deal with an argument raised in the last debate as to why we chose 876 rather than the 1,000 on which the Government have insisted. The figure of 1,000 was plucked out of the air by Ministers and civil servants, and it bears no relation to reality. The figure of 876 is based on representations made to us by the regions and area health authorities. It represents much more closely the actual number of pay beds which can be phased out.
      Over the past three months since we debated this matter, the need in London to reverse the phasing out has become even more acute. Today I spoke to a number of district administrators in London to see whether there had been any change in the circumstances since 28th July. As far as pay beds are concerned the situation is now more urgent because of the worsening economic conditions.
      This is particularly so in teaching hospitals. St. Thomas's has to find £750,000 and Charing Cross £800,000, and neither of them has any hope of finding the extra money. The deficit will have to be carried forward, and the economic crisis superimposed on the loss of pay beds is lowering morale in London hospitals. Recently I have seen representatives of the Royal College of Nurses and they confirm that morale is at an all-time low in their hospitals.
      District administrators are worried about pay beds because the one source of buoyant income they had will be progressively withdrawn. The four Thames regions have 37 per cent. of pay beds and have to accept 40 per cent. of the cuts. This is clear evidence of the inequity in London. There will have to be a reduction of 26 per cent. in the number of pay beds in London compared with 23 per cent. in England generally.
      This is particularly unfair because many National Health Service hospitals in London have a higher pay bed occupancy than elsewhere. This is because many
      504
      of them have a higher incidence of specialised treatment and a greater number of overseas patients bringing in much needed foreign currency. The treatment of London should be more rather than less favourable.
      This is supported by the Independent Hospital Group which produced a schedule for phasing out 1,000 pay beds and in that schedule London would not have received the punitive treatment which it is receiving from the Government. Then there is the peculiar treatment of inner London, compared with outer London. In inner London there is greater access to alternative facilities because this is where these facilities are concentrated, yet inner London has been dealt with more generously than outer London. Ministers have seriously underestimated the difficulties in the cost of travelling within the Greater London area.
      In drawing up the schedule for phasing out pay beds for London the Minister has jumped the gun in arriving at his figure. He has taken account of 295 beds which are under construction but not yet ready for use. This shows that the Government are ready to poach on the preserves of the Health Service Board. If the new beds come into the stream after the Bill is passed, this is one factor which should be taken into account in making recommendations to the Minister for further phasing out. If the Government take the beds into account now, this will trespass on the preserves of the so-called independent Health Services Board and prejudge its decisions.
      I refer to the notional occupancy figures implied in the Government's reasoning on pay beds. Their notional figures are that 91 per cent. of these beds are occupied in inner London, 92 per cent. in outer London and 67 per cent. in England as a whole. No wonder there is a great sense of inequity in London.
      I urge the Secretary of State to come clean and tell the House how many redundancies will be needed to cope with the cuts. We tried to press the Minister on this point in Committee, but he was unable to give any figures. The Secretary of State owes it to the House to come clean about the number of redundancies the policy implies. I plead with the Minister to make some concessions and to

      505
      give London better treatment. I hope that my pleas will not fall on deaf ears.
      7.15 p.m.
      Mr. Pavitt: One of the difficulties in following the hon. Member for Ealing, Acton (Sir G. Young) is that he always makes very nice speeches. Sometimes, as in a previous debate today, I am able to commend the effectiveness of the case he has put, but on other occasions, as now, he makes a very good speech but I find that I do not agree with one word of it.
      The purpose of the amendments, which propose reducing the first phasing out of 1,000 pay beds, is exactly the opposite to mine. The decision on what kind of criteria one should apply in the early phasing out and in any further examinations is a matter of judgment. The hon. Member for Ealing, Acton gives the judgment of representatives of area health authorities. I have gone into the same kind of judgment, but personally I prefer to look at the occupancy of beds.
      The hon. Member mentioned the London teaching hospitals. One of the difficulties facing Londoners is that half their beds are in teaching hospitals. We have 25 teaching hospitals and I have the figures for bed occupancy in 1973, 1974 and 1975. Charing Cross Hospital has an average daily occupancy of only 28 of its 40 pay beds. Middlesex Hospital has an average daily occupancy of 41 of its 67 pay beds. This is in London which is a tremendous magnet for the whole country and people from abroad as well.
      It is rather a disadvantage to Londoners that 50 per cent. of the NHS bed occupancy as well is in teaching hospitals, and one would hope for a better balance between teaching hospitals and general district hospitals. One of the failures of successive Governments since the war has been in giving permission for the building of further teaching hospitals in the London area. It would have been better not to rebuild Charing Cross Hospital in Fulham and not to go ahead with the tremendous building programmes at Guy's or Westminster. This building should have been spread out over the country as a whole.
      On the criterion of bed occupancy alone there is a strong case for rejecting the amendment, and for tabling a whole series of amendments which would make
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      the number not 1,000 but something nearer 1,750. I am not a truly rebellious character, but I contemplated following the example of the hon. Member for Ealing, Acton and putting down a series of amendments altering the numbers in Clause 3 in order to bring in a few more.
      In Ealing, Acton there are 31 pay beds but only 21 of these are occupied for more than 50 per cent. of the time—
      Mr. Patrick Jenkin: These occupancy figures for pay beds are based on occupation by paying patients. The implication is that somehow the beds are empty for much of the time. This is not true. The passage which I read out from the 1968 Act yesterday shows that many pay beds are occupied by National Health Service patients and their occupation may have precluded occupation by private patients who may have to wait for some weeks. Therefore I would not place too much reliance on the occupancy figures.
      Mr. Pavitt: The right hon. Gentleman tells me something that I know only too well. We debated this matter on several occasions in Committee. I am aware that, given normal bed admissions, whether emergency or otherwise, Section 5 beds can be and are used for National Health Service patients. Nevertheless, that does not invalidate the argument that to earmark beds in that way is the right way to get the most successful use of them.
      In Willesden Hospital there is 23 per cent. occupancy and in Wembley Hospital there is 42 per cent. occupancy. The highest occupancy is at Northwick Park, because it is not only a district general hospital, but it has 200 beds from the Medical Research Council for clinical research. There is a 70 per cent. occupancy there. Therefore, there is probably a strong case initially for phasing out more beds.
      The right hon. Member for Wanstead and Woodford (Mr. Jenkin) referred to the use of beds for other purposes. One of the uses which is not possible while they are scheduled is the specific provision in the Chronically Sick and Disabled Persons Act 1970 that the young chronically sick, if they are to be long-stay patients, should not find themselves surrounded by people who, because of

      507
      their age and condition, are facing death day in, day out. One important provision was that beds should be provided for the young chronically sick.
      In Brent there are no such beds. The only way that we can deal with the young chronically sick is to send them to Putney. In these financially stringent times that is a heavy additional expense on the area health authority. Because, in effect, it means transferring funds to another area health authority, it is naturally reluctant to send patients there.
      Since the 1968 designation of beds is no longer attached to actual beds, there is a strong argument for releasing more than 1,000 beds to cope with the problem of finding beds for the young chronically sick, because those designated beds would be permanently available. They are not available at the moment. Although a pay bed can be occupied by a National Health Service patient, it cannot be occupied by a long-term patient, because that would negate the idea of having the pay bed. The pay bed would be taken out of service probably for years.
      Mr. Patrick Jenkin: We always listen with respect to the hon. Gentleman, because he comes to these matters with long experience. However, he cannot let that argument stand, that since 1968 they have not been designated beds. If a long-stay patient occupies a bed, obviously, from the point of view of the number of authorised beds, other beds in the hospital have to be used.
      Mr. Pavitt: The right hon. Gentleman seems to think that, because a bed can be moved about, it is not fully occupied. But we must have flexibility, and the flexibility does not exist. If we had more flexibility, we should have fewer pay beds than we have in my area at present. For that reason, I shall oppose the amendment.
      I should tell my right hon. Friend that I did not put down 90 amendments to Schedule 2 and one amendment to this part of Clause 3, because I am confident that the board will look into some of these matters in greater depth than we have done so far and that we shall get rapid phasing out. I believe that when we get the first of the reports from the board we shall have a speedy phasing out of the second 1,000 beds after the first 1,000 beds.
      Mr. Peter Bottomley: I rise with some trepidation to take part in this debate because I did not serve on the Committee stage of the Bill. After listening to the excellent speech by the hon. Member for Brent, South (Mr. Pavitt), it would seem that the argument for this amendment and for destroying the Bill has already been made.
      We have been told that certain things cannot be done because we have not got the money. On the assumption that pay beds generate income—as far as I know, that has not been denied by any Labour Member—surely more things can be done within the National Health Service. This applies to providing beds for the young chronic sick, to whom the hon. Gentleman referred, or for those who, like myself, are trying to maintain National Health Service beds in my constituency for the use not only of my constituents but of those of the Minister of State, some of whose names appear on a petition which I received this morning from an 11-year old girl who feels very strongly about the matter. Therefore, the argument for more income has been established not only by the Opposition but by Government supporters.
      We were told by the hon. Member for Brent, South that the beds are not designated and that the only limitation on the number of pay beds is the maximum number of private patients who can be within a hospital at a time. That is a limitation on the top level which, as my hon. Friend the Member for Ealing, Acton (Sir G. Young) said in Committee, means that in some teaching hospitals there is a longer wait to get in as a private patient than as a National Health Service patient. I hope that the Secretary of State will be able to deny that. From my reading of the Committee proceedings, it was not denied.
      If, as I assert—I see no head shaking in disagreement, and there are many assembled experts here—the number of pay beds is a maximum, that they are not designated and that they are available to the NHS when not being used in any other way, what is the point of the Bill? I am referring specifically to Amendments Nos. 83 and 85 which affect South-East London, parts of which the Minister of State and I have the honour to represent.
      I should like to refer to one of the hospitals in my constituency, the Eltham

      509
      and Mottingham General Hospital, known locally as the Cottage Hospital. It was started 100 years ago by voluntary effort, extended by voluntary effort and brought up to NHS standards by voluntary effort. Now, because it has been nationalised, everyone is beginning to rail against the NHS because there are threats, or proposals, from the regional health authority and the area health authority, with mild interest shown by the Department, to close it.
      The Cottage Hospital has a small number of beds. We are told that the beds are uneconomic, that there is not the money available to keep it going, and so on. However, we are told that we can afford the extra £40 million a year involved in getting rid of pay beds and that we shall be able to provide a better service to NHS patients. This hospital is under threat.
      Many people are beginning to rail against the National Health Service not because they are against it, but because they are against the results of Government ineptitude and not having the money to keep hospitals in places where they are needed.
      There are many council estates in my area, four major secondary schools and six primary schools. We are told that if somebody suffers a broken leg or needs minor surgery, he or she can go to the Brook Hospital. Of course, most of those who go to hospital for minor things are the elderly or the young, neither of whom is likely to have a car. Such people are likely to be more isolated now because their parents or children will not be able to visit them easily. Yet we are told that the cost of ambulance transport will be paid by the local authorities and that that does not count.
      Amendment Nos. 83 and 85 affect the area from Lambeth to Bexley and cover part of Greenwich and my constituency. If it can be shown that the income generated from the pay beds could keep the Eltham and Mottingham Hospital going, we would see not the results shown in the National Opinion Poll quoted by my right hon. Friend the Member for Wanstead and Woodford (Mr. Jenkin), where over 70 per cent. of people are shown as wanting to keep pay beds going, but a situation in which I could
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      guarantee that in my area 99 per cent. of people would say "Let us keep these pay beds. Let us have the income and the National Health hospital that we want because we need the money to keep it going."
      7.30 p.m.
      In her letter, which I received today, 11-year-old Hilary Kear says:
      "I attended the protest meeting on Saturday 11th September, and I agree with everything the speakers said. I signed the petition at the meeting, and I have asked people of all ages to sign my sheets. I think that anyone who has been in a small hospital such as Eltham and Mottingham will agree that if one wants peace and quiet, or a minor operation, small hospitals are perfect. Maybe they don't pay as much as big hospitals, but surely human life matters more."
      One reads that cottage hospitals are being re-established in outlying areas. Perhaps, as with high rise flats, we shall discover that the trend to have minor operations in big hospitals is not the way of dealing with the problem and we may be seeing more delinquency films such as that shown on BBC television about the situation in Liverpool applied to hospitals and the demoralisation there.
      The hon. Member for Brent, South and I both want more money for our hobby horses. The petition to which I referred earlier has been signed by more than 10,000 people. At the meeting to which Hilary Kear refers, the prospective Labour and Liberal candidates for my constituency, a number of members of the local authority from both political parties and myself were present. All 10,000 names on the petition want the hospital retained. We have been told that it will have to be closed because of lack of money. A reduction in the number of pay beds will guarantee a further reduction in revenue for the NHS.
      The hon. Member for Brent, South wants more money for chronically sick young people, but he destroyed his own case in the elegant way in which he usually destroys other people's cases when he confirmed that these young people could go into unoccupied beds because such beds are no longer designated.
      We shall have to face a reduction of medical services because of this paltry Bill. The Secretary of State has no answer

      511
      to that. I was at a meeting earlier of constituents who are very worried about the future of the local hospital. I told them that I had to return here and watch the Government reducing the income of the National Health Service. When they asked whether that would affect the future of the local hospital, I said that there would be cuts anyway and that this Bill would mean cuts of another £40 million.
      If this is the way the Government operate, the sooner they get out of health as well as out of the economy, the better.
      Mrs. Castle: This is not a Second Reading debate. The hon. Member for Woolwich, West (Mr. Bottomley) has joined in our discussions rather spasmodically and obviously does not appreciate that fact. We are discussing whether the number of beds to be included in the schedule should be 1,000 or rather fewer. This amendment seeks to make the figure 14 fewer.
      The hon. Member for Ealing, Acton (Sir G. Young) said that the figure of 1,000 had been plucked out of the air and bore no relation to reality. I ought to correct that statement. The hon. Gentleman is being unfair to the medical profession's negotiators. The figure of 1,000 was agreed as rational in the Goodman proposals.
      It seems to be my function in these debates to remind hon. Members of the proposals. Paragraph 3(b) says that subject to Parliament's decision on the principle.
      "it is accepted that there are some pay beds and facilities which could be phased out from the NHS without undue delay, there being already reasonable alternative beds and facilities; and that the Government will publish in a Schedule to the Bill the location of 1,000 pay beds to be released to general NHS service within six months after the Bill has received Royal Assent."
      Mr. Patrick Jenkin: The right hon. Lady has gone back no further than the proposals published on 15th December. We have never been told about any item of the discussions which led up to that document. I understand that those who participated in the discussions concluded that it would be better for all concerned if none of the discussions leading up to the document became public while the matter is one of controversy.
      512
      Merely to point to the document saying that 1,000 beds is accepted is to ignore the fact that the medical profession never accepted that there should be any phasing out. We do not consider ourselves bound by any figure of that sort and nor should the House feel so bound. The figure needs to be justified. We have never had a justification.
      Mrs. Castle: The right hon. Gentleman is trying to have it both ways at once. In Committee, he pilloried the Government on the details of the proposals and then complained that some of my hon. Friends in their amendments were trying to go back on the Goodman proposals.
      This must be a two-way bargain. Part of it is that the profession should be free to fight the principle of the Bill. That has never been denied. The Prime Minister did not argue that in his letter for which the profession asked.
      It has been established—and it is the basis of the bargain—that, should Parliament decide to legislate, the Goodman proposals should be in the legislation. If that were not the case, there are other things which hon. Members, including myself, would have liked to see included in the Bill. The hon. Member for Ealing, Acton is criticising the profession when he said that the figure of 1,000 beds bears no relation to reality. The Goodman proposals say that 1,000 beds is a reasonable figure to include in the schedule. That is part of the deal.
      If the Opposition want to consider the whole of this Bill tonight, they should skip the next four groups of amendments, all of which are treading ground which has already been trampled. The Opposition would merely be wasting their own time.
      Mr. A. P. Costain: I congratulate the right hon. Member for Blackburn (Mrs. Castle) on making a speech without mentioning yachts or people flying their dogs across the Atlantic. When I was secretary of the House of Commons Yachting Club, there was a greater tonnage of yachts on the Labour side.
      The fact that we lost the last amendment will be a great disappointment to my constituents. The Bill is an attempt to satisfy the doctrinaire members of the Labour Party so that they can abolish

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      pay beds and say that they got their own way.
      We could argue all night about how many beds should be phased out, but we can discuss in detail the effect such reductions will have on hospitals in our constituencies. In my constituency I have exactly the same problem as that raised by my hon. Friend the Member for Woolwich, West (Mr. Bottomley). The Secretary of State knows my constituency very well as he was my next door neighbour for some time. I am glad to see his successor in his place—namely, my hon. and learned Friend the Member for Dover and Deal (Mr. Rees). The argument against pay beds is that somehow someone who is ill might get abandoned. It is argued that others might use the facilities that have been provided by the National Health Service, although they have helped to pay for those facilities in the first place.
      I have some news for the Secretary of State. At the Royal Victoria Hospital at Folkestone—we shall probably hear a great deal of talk about it before many years are out—the sister in charge of the pay bed section, who happens to be the mayoress, recognised that the hospital was short of some facilities and was responsible for a public appeal for £3,000 to buy a heart machine. In fact, £6,000 was raised in two weeks. In case the right hon. Gentleman thinks that it was raised by taking the begging bowl to the homes of rich folk, I must point out that the sister received large subscriptions from Dungeness. Over £2,000 was raised immediately. Everyone wanted to help the hospital. Perhaps that feeling has been removed by the National Health Service running our hospitals. The voluntary concept had a great deal to do with people in the locality wishing to help. Every time we abolish a pay bed we take away the concept of making that hospital something special.
      When all the public services are short of money it is surely ridiculous to abolish anything which can provide an income. People will have to go to nursing homes, and we know that more and more nursing homes are being built, or that attempts are being made to build them. The Bill tries to stop that trend. Only today I spoke on the telephone to someone who was saying that he wants to raise £1
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      million to provide a nursing home not in my constituency but in Surrey, where I live at the weekends.
      Clearly the more we talk of abolishing pay beds the more we take away the concept of voluntary help. I ask the Secretary of State to recognise that he can accept the amendment and satisfy the doctrinaire argument that his right hon. and hon. Friends have put forward.
      Mr. Peter Rees: Before my hon. Friend sits down, may I ask whether he is aware that because of the Government's intervention there is a move to set up a private hospital in East Kent, which will involve a great diversion of public money into that area?
      Mr. Deputy Speaker: Order. I allowed the hon. Member for Folkestone and Hythe (Mr. Costain) to go rather wide of the mark. We have disposed of the question of pay beds and we are discussing a difference of 124 beds as proposed in the amendment.
      Mr. Ennals: I shall try to be brief in summarising the debate. I was delighted to have the hon. Member for Folkestone and Hythe (Mr. Costain) as my neighbour for a time some years ago. However, that does not mean that he did not talk absolute nonsense tonight. The idea that the love of a hospital by the people whom it serves is based on the number of pay beds that it has available is too ludicrous for words.
      I hurriedly move on to deal with the points raised by the hon. Member for Woolwich West (Mr. Bottomley).
      Mr. Peter Bottomley: I remind the right hon. Gentleman that if he continues getting rid of pay beds and the income from them he will be involving hospitals that were built by voluntary subscription.
      Mr. Ennals: I was about to deal with that point.
      Mr. Ronald Brown rose—
      7.45 p.m.
      Mr. Ennals: No, I must proceed, although I am grateful to my hon. Friend.
      Although it was not directly concerned with the amendment, the hon. Gentleman

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      referred to a touching letter by a young lady of 11 years. As far as I am aware it was not related to pay beds. Certainly it provided the hon. Gentleman with the opportunity to deliver an interesting speech. The question of his hospital and its future is basically a matter for the health authority. If the authority determines that part of its programme is that that cottage hospital should close, unless the community health council agrees it will be a matter that the Secretary of State will have to decide. I shall listen to the hon. Gentleman's arguments, but he must not say—it is absolutely incorrect for him to do so—that a decision taken by the regional health authority in this connection is based on income from pay beds. It has been made clear in the House—if the hon. Gentleman had been present on earlier occasions he would know—that there will be no reduction in the sums available to a health authority as a result of the implications of the Bill.
      The hon. Member for Ealing, Acton (Sir G. Young) referred to unemployment, presumably basically nursing staff, as a result of the Bill. His hon. Friend the Member for Edinburgh, West (Lord James Douglas Hamilton) raised a Question about the matter in July. He asked the Secretary of State for Social Services to give an estimate of the number of National Health Service staff who may become unemployed as a result of the Bill. I replied:
      "There is no reason to suppose that the progressive separation of private facilities including pay beds from National Health Service hospitals should lead to unemployment of health service personnel."—[Official Report, 5th July 1976; Vol. 914, c. 443.]
      That is as much so today as it was when the Answer was given. That is partly because there are some agency nurses. As I said yesterday in relation to another hospital, there are still unfilled places at London hospitals for trained staff. I cannot guarantee that those who are under training in a particular hospital will necessarily gain a job in that hospital. There is much less wastage in the nursing profession now than there was at one time. It may be that nurses have to be more mobile, but we are not dealing with a significant problem of unemployment among nurses
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      as a result of the Bill, or as a result of any other policies.
      There is no reason for me to accept the proposals put forward in advancing the amendment. The total reduction for tile four Thames regions that is proposed in Schedule 2 is 402. We need look no further for justification of these figures than the number of acute beds in the private sector in the Thames region registered since 1st April 1974. In fact, there are 327. There are 295 in the process of being built. The number registered and those that are to be produced will give a total facility of about 600. That demonstrates that 402 is a modest figure for London.
      Mr. Patrick Jenkin: Does the right hon. Gentleman appreciate that I cannot accept that he is entitled to take account of beds that are not in existence? If he studies the Bill, he will see that Clause 3(3)(b) refers to beds that are "reasonably available"—
      "alternative accommodation and facilities…that are reasonably available".
      Beds that are merely a twinkle in the developer's eye are not reasonably available. His right hon. Friend did that in Committee. He has no right to place any reliance on beds that do not exist.
      Mr. Ennals: The right hon. Gentleman knows perfectly well that there is a large private sector within the health service in London. That is one reason for London taking a higher share of the 1,000 beds than the rest of the country. I do not base the 402 beds in anticipation of hospitals that are in the process of being built. I said that 327 new beds have already been registered. That is not very much below the 402 figure. The four Thames regions now have 37 per cent. of all the pay beds in England. The proposed reduction of 402 in Schedule 2 is 40 per cent. of the total reduction of 1,000. That represents 26 per cent. of the existing number and compares with an overall reduction in England of 23 per cent. Given the concentration and relative accessibility of existing private facilities in London, and the balance and distribution of the 1,000, I believe the reduction to be fair and reasonable.
      As I said in an earlier debate, I have taken very carefully into consideration

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      the views expressed in Committee. I have also given regional and area health authorities a further opportunity to present new evidence or to draw attention to any inequalities in the distribution of the 1,000 beds in Schedule 2.
      Three of the four Thames authorities, in consultation with their area authorities, had no comments to offer. The fourth formally took note of the contents of Schedule 2. There is, therefore, no basis from the health authorities in the Thames Region to suggest that the figures put into the Bill need in any way to be changed.
      Opposition Members are simply playing a numbers game and spinning out the time.
      Mr. Patrick Jenkin: I am not sure why the Secretary of State should accuse the Opposition of spinning out the time. We have only just over one and a half hours left for the Report stage, because of the guillotine. The fact is that these are very serious issues which ought to have been developed and debated over a much longer period than we have been allowed under the guillotine.
      In Committee we had a substantial debate on this matter. The Minister of State answered it but failed to satisfy the Committee. The amendment moved in Committee was rejected only by the Chairman's casting vote. Therefore, it is entirely proper that we should return to this matter and to some other areas of the country on Report.
      The right hon. Gentleman has failed to address himself to the question. The difficulty is that his hands are tied, because he feels himself bound by this wholly arbitrary figure, which was plucked out of the air. Whatever the right hon. Member for Blackburn (Mrs. Castle) may have said, it was plucked out of the air, I suspect, by the noble Lord, Lord Goodman. It is a nice round figure that looked about 25 per cent. of the total. It is some sop that the Government could throw to the Left-wing Members below the Gangway—although Left-wing Members are not even here to receive it. I was sorry that the right hon. Gentleman did not give way to his hon. Friend the Member for Hackney, South and Shoreditch (Mr. Brown). If he had given way, he might have
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      heard the first words of support for the Bill from any hon. Member on the Government side of the House.
      Mr. Ennals: Was this or was this not part of the contract?
      Mr. Jenkin: This is a contract that does not bind the Opposition, and about which the Prime Minister wrote to the medical profession, perfectly properly—I had not appreciated, until the right hon. Member for Blackburn said so, that it was at the request of the medical profession—saying that the profession was to be entirely free to oppose the Bill.
      Mrs. Castle: The principles.
      Mr. Jenkin: All right—the principles, but with the principles go the details throughout the Bill's passage through Parliament.
      It was a document that was thrashed out, but in no sense of the word can it be said to have been agreed. It was not agreed. It has been forced upon the profession. The profession managed to claw back something from the outrageous proposals in the original document of 15th August and has got something. However, the idea that somehow we are reneging on an agreement by arguing that fewer than 1,000 beds would be appropriate for phasing out does not stand up, because the right hon. Gentleman, in order to justify the figures for the four Thames regions, had to drag in beds in the private sector which do not even exist. That is notwithstanding that in his own Bill the criterion is intended to be beds that are "reasonably available"—
      "alternative accommodation and facilities…are reasonably available."
      The right hon. Gentleman has conceded the case made by my hon. Friend the Member for Ealing, Acton (Sir G. Young) that the four Thames regions are bearing a higher proportion of the total than a strictly proportional reduction would justify. The right hon. Gentleman has gone no way at all to answer the very fair point made by my hon. Friend the Member for Woolwich, West (Mr. Bottomley) that the phasing out and the threat of phasing out is costing the areas concerned the revenue that they might have had. Of course there has been a reduction as a result of the vendetta of the right hon. Member for

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      Blackburn against private practice and the inspired political and militant action in some of the hospitals. Of course there has been some reduction in the demand for pay beds.
      In the letter that the right hon. Gentleman wrote to me, arising out of the Enfield and Haringey AHA report—which I took up with him directly, as he will recall—he did not deny that there was to be no compensation to the areas for the reduction in pay bed revenue which is simply caused by the amount of usage falling below the estimated amount in the current year. Yet this can be seen to be as a direct result of the militant action against pay beds. This is one of the reasons why many of these authorities are now short of revenue and are having to scratch around with very great difficulty in order to try to find economies to keep within their cash limits. We do not oppose cash limits. On the contrary, we believe that it is extremely important that all elements of the public sector should be constrained. However, the fact is that by legislation and the threat of legislation the authorities have lost revenue, and as a result of that, other things are having to be cut out.
      I could not go into detail about the four Thames regions, as we did in Committee, but I shall not do that at this stage. There is no doubt that the four Thames regions are having to bear a wholly disproportionate share of the cutback, and for no reason other than that the Secretary of State's hands are tied completely by this arbitrary figure of 1,000. I hope, therefore, that when the Bill reaches another place, perhaps their Lordships will consider it right to look at these matters again—that is for them to decide and not for us—to see whether it can conceivably be consistent with the intentions of the 15th December proposals. [Interruption.] There is a basic inconsistency here. The right hon. Member for Blackburn may laugh, but if the Government can justify the figure of 1,000 beds and this proportion coming out of the four Thames regions only by reference to facilities in the private sector that do not yet exist, there is an inherent inconsistency in the document.
      It is up to Parliament to expose that and to put it right. The right way to do
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      it is to reduce the figure of 1,000, so that actual reductions in pay beds—if we have to accept this wretched Bill—bear at least some relationship to the criteria set out. The reductions do not. My hon. Friends have demonstrated that categorically.
      However, we must press on. We do not want to waste time between now and 9.30 p.m. spending a quarter of an hour, or whatever it is, traipsing through the Division Lobby. I do not suggest that my hon. Friend the Member for Ealing, Acton should withdraw his amendment but that it should be allowed to be negatived so that we may press on.
      Amendment negatived.
      Mrs. Knight: I beg to move Amendment No. 10, in page 3, line 2, leave out 'one thousand' and insert 'nine hundred and forty-six'.
      Mr. Deputy Speaker: With this we are to take the following amendments:

      No. 73, in Schedule 2, page 30, line 42, column 3, leave out '20' and insert '10'.

      No. 92, in page 31, line 35, column 3, leave out '8' and insert 'Nil'.

      No. 94, in page 31, line 43, column 3, leave out '13' and insert'9'.

      No. 95, in page 31, line 44, column 3, leave out '14' and insert '7'.

      No. 96, in page 31, line 46, column 3, leave out '5' and insert '1'.

      No. 97, in page 31, line 47, column 3, leave out '28' and insert '16'.

      No. 98, in page 31, line 48, column 3, leave out '3' and insert 'Nil'.

      No. 99, in page 31, line 50, column 3, leave out '2' and insert 'Nil'.

      No. 100, in page 32, line 7, column 3, leave out '7' and insert '3'.

      Mrs. Knight: These amendments deal with Cambridgeshire, Buckinghamshire, Oxfordshire, Shropshire, Warwickshire, Birmingham, Dudley and Sandwell. I may not be the only Member who is struck forcibly by a feeling of déjà vu this evening, as we spent a considerable time in Committee putting forward very lucid and clearly argued objections to the figures in the schedule. We did not at that time carry the argument. However,

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      looking back at what was said in Committee, the interesting point is that one is most impressed with the air of sweet reasonableness that the Minister of State gathered unto himself on this matter. Of course he would listen and consider. It all sounds absolutely marvellous. However, he was torpedoed in his efforts to spread sweet reasonableness by certain of his hon. Friends.
      8.0 p.m.
      The hon. Member for Brent, South (Mr. Pavitt) made it clear in the middle of the debate that he felt that sick people who had the temerity to wish to be private patients were undeserving cases. That was a shocking thing because, to my hon. Friends and myself, sick people are sick people and need to be cared for and not turned away simply because they wish to have their treatment privately.
      I draw the attention of the House to one or two quotations from the Committee proceedings to underline the sweet reason which a moment ago I said emanated from the Minister of State. With regard to the first of the areas dealt with in the amendment, Peterborough, I made the case then for deleting 10 beds instead of 20 from the Cambridge area, and I was strongly supported then, as I have been today, by my right hon. Friend the Member for Wanstead and Woodford (Mr. Jenkin).
      My right hon. Friend said in Committee:
      "The Minister of State has a serious question to answer here, because the area administrator has raised issues which show that Cambridgeshire is being unduly penalised."
      A few columns later the Minister of State said:
      "I come back to Cambridgeshire. I shall gladly look at the problem, but I do so without any commitment."
      We see today that the figure for Cambridgeshire is the same as it was in Committee.
      I made the case for Buckinghamshire, and I must have made it reasonably well because the Minister of State said:
      "I come now to the Buckinghamshire area health authority…we accepted in the discussions we had that the availability was to some extent uncertain."
      With those thrilling words in my mind I turned to look at what had happened
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      about beds in Buckinghamshire and I found that the number was the same as when the argument was advanced in Committee.
      The next area is Warwickshire. The Minister of State said:
      "We recognise that alternative facilities in the private sector are not believed to be reasonably available. The informal exchange of information with the IHG confirms this view."
      That was wonderful. We had made a point, we had won an argument, and so we turned eagerly, with shaking fingers, to see the new statement about this authority, and we found that the figure was exactly the same as before.
      I now come to Coventry, which is one of the other authorities mentioned. The Minister of State said:
      "I agree with the hon. Lady that alternative facilities in the private sector are not believed to be reasonably available. The informal exchange of information with the IHG confirms this view.…"
      Those are almost the same words as the Minister used about Warwickshire and, alas, with the same result—no change.
      A little later, when dealing with Sand-well, the Minister said:
      "Again, I accept that alternative facilities in the private sector are not believed to be generally available."
      Again one presumes that the case for a change was made but, alas, with the same result—no change.
      I spoke at some length in Committee about my own city of Birmingham and pointed out that there was a difficulty. We were not discussing what kind of beds would have to be disposed of. The hon. Member for Birmingham, Selly Oak (Mr. Litterick) has an unhappy habit of coming into the Chamber, making an intervention speech and then disappearing for the rest of the debate. He felt that just over 100 beds—the figure is 101—represented far too many. Birmingham is a city of more than 1 million people, and it is not only the city that has to be catered for by the hospitals there. The Birmingham hospitals deal with a wide catchment area.
      The children's hospital in Birmingham is the second largest in the United Kingdom. It draws children from Northamptonshire in the east, to the Welsh border

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      in the west. It has an enormous catchment area. There are to be only 101 private beds in the whole area.
      I spoke in Committee about special needs. I said that the question of obstetric and gynaecological facilities was important for Birmingham because there are no facilities for private maternity work anywhere within the city. I was told that matter would be dealt with, and the Minister of State said:
      "Birmingham is a more complex area…
      I shall consider carefully what she"
      the Minister was referring to me—
      "said."
      The Minister went on to say:
      "if we adopt considerations of this sort in the light of consultations about the assumed lack of reasonable alternative facilities available and any initial over-estimation which we may have made, and we respond to pressure in places such as Birmingham, it is very difficult for us then also to take on board the arguments used by the Opposition in earlier debates."—[Official Report, Standing Committee D; 29th July 1976, c. 1438–47.]
      In other words, we are again hoist with the petard of the 1,000 beds, and the Minister of State was saying "No matter how good the case, no matter how valid the points put forward, they do not matter two hoots because we have decided on 1,000 beds and we shall not alter that figure".
      I do not think the House will be surprised to learn that although the Minister of State took on board some of the points that I made about Birmingham, the situation with regard to that city is the same now as it was at the time we were meeting in Committee. The same number of beds will be withdrawn although the case has been made over and over again that what is proposed is not enough for a city of this size and which has such a large catchment area.
      The arguments were made for Shropshire and, as I have said, Sandwell, and in each case one felt that the Minister of State was listening, but in each case nothing has happened.
      Earlier today the Secretary of State spoke about the consultation that has gone on since the Committee stage. Let me tell the House what consultation there has been in the Birmingham area. I imagine that similar consultation has gone on with other parts of the country.
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      A letter went out from the Elephant and Castle to the administrator of regional and area health authorities on the question of the withdrawal of pay beds in their areas. One must bear in mind that those concerned were well aware of the case that had been made in Committee for the retention of pay beds. There is one doom-laden paragraph in the letter. It said:
      "Only in the most exceptional circumstances would variations above or below the total of 1,000 beds be considered."
      In other words, this flimsy pretence of consultation amounts to a letter in that form. It is no wonder that the health authorities are dispirited and feel that although their case was put strongly in Committee by hon. Members who had taken considerable trouble to read and learn the facts of the matter, all the arguments fell on deaf ears. It is no wonder that a certain feeling of despair has obtained and no further representations have been made. The case is a strong one, and if the Minister of State will not listen today I cannot blame people for feeling that he will not listen to anything.
      One point should be borne in mind when we talk about hospitals that have been endowed. I want to raise particularly the question of endowed beds, because many hospital beds have been donated specifically to certain hospitals for the use of private patients. When I asked in Committee about these endowed beds, the Minister of State said:
      "the advice I have is that the terms of the trust must be followed so long as that remains feasible."—[Official Report, Standing Committee D; 29th July 1976, c. 1450.]
      In other words, it is all right to go back on the terms of a trust in certain circumstances, and the Minister went on to point out that in certain circumstances that had already been done.
      An interesting dichotomy arises here. In the days when we were arguing the matter of museum charges I recall Labour Members making fervent and passionate arguments that it was impossible to remove a museum bequest or a collection of pictures which had been endowed so that people could enjoy them for free. I think that that argument had some strength then—
      Mr. Moyle: Hon. Members opposite did not accept it then.
      Mrs. Knight: We did accept it then, and if it had strength then, it is valid now.
      Hon. Members must surely take the point that if a bed is endowed for a certain purpose it is nothing but daylight robbery to steal that bed for another purpose. I have not yet been satisfied on the legal side of this matter and I am concerned about the legalised robbery which is apparently going on. I would bet that many people who endowed beds in the belief that their wishes would be respected will now wish that they had not made those endowments.
      I do not want to prolong this debate. We have already made a strong case against the proposals in the Bill. We always come up against this 1,000 beds nonsense. However good our arguments, they cannot be carried out because the 1,000 beds pledge is in the Bill. I ask the Government to listen once again to the voice of reason of people who know what they are talking about, who have urged the Government not to carry out the proposals with regard to the areas at present in Schedule 1.
      Mr. Stephen Ross: I wish to speak to Amendment No. 10, which will replace the figure 1,000 with the figure 946. I hope that two of the 54 beds which will be restored are the two which are due to be withdrawn from the Isle of Wight. I have to put it that way because my amendment has not been called.
      In a debate on the health service about 12 months ago, I was able to address my remarks direct to the then Secretary of State, the right hon. Member for Blackburn (Mrs. Castle), who listened to me. At that time the proposal was to withdraw four of our pay beds on the Isle of Wight. Whether due to my advocacy or not—I cannot believe that it was—two have been restored. As I said then, we in the Isle of Wight are in a unique situation. There is no private hospital provision there, so our consultants—we are lucky to have excellent consultants—are now thinking hard about whether they can continue to live and practise there.
      Certainly we are worried about the future. A number of consultants are approaching retirement age. We believe that we shall have great difficulty in re-
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      placing some of those consultants if there is not sufficient incentive for them in the way of private practice, which means sufficient beds for them to make a living.
      Already, our consultant gynaecologist, a man of great repute, has left us to go to Newfoundland. We hope that he will come back—he has gone on a two-year contract—but I suspect that he will decide to remain.
      I have never occupied a bed in a private ward, and I subscribe to no private hospital schemes, but I defend the right of an individual to go into a private ward if he wishes. Our situation is different from that of our immediate neighbours. If consultants cannot practise where there are sufficient private beds for the patients who want them, the Government are putting at risk the whole service on the Isle of Wight, and this view is supported by the whole Isle of Wight medical profession. It is likely that we shall not get the quality of consultant in future that we have been fortunate enough to have in the past.
      I therefore ask the Minister seriously to take on board my plea that even if the amendment is not carried, at least before the Bill goes to another place further consideration will be given to our situation. I hope that the two beds which are to be withdrawn will be restored and that therefore no change will be made on the Isle of Wight.
      8.15 p.m.
      Mr. Patrick Jenkin: Before the Minister of State replies, I should like to draw one matter to his attention so that he can consult and deal with it. It refers to the Cambridgeshire AHA. He will know that in Committee I raised at some length with his predecessor strong points which had been put to the Department by the area administrator, of which copies had been supplied to Members of Parliament covered by the AHA, particularly my right hon. Friend the Member for Cambridgeshire (Mr. Pym).
      As my hon. Friend the Member for Birmingham, Edgbaston (Mrs. Knight) said, the Minister of State made considerable reference to this matter in his reply col. 1443–4 of the bound volume of Hansard—on 29th July. Since then, we know from the Bill that there has been absolutely no change. There have been

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      no Government amendments to take account of the strong points which were made about why the number of beds to be phased out in that AHA was considerably in excess of what it should have been.
      But there has been a further difficulty. I should like to quote from a letter from Dr. Robinson, Chairman of the Consultant Staff Council of Addenbrooke's Hospital, writing to my right hon. Friend. He referred to the letter of 18th June which the Cambridgeshire AHA had sent to my right hon. Friend, enclosing a copy of the letter from the authority to Mr. Illingworth of the DHSS:
      "That letter contained the Area Health Authority's view on the above subject, formulated after consultation with local interested parties, including Consultants at local hospitals. Although receipt of this letter was acknowledged no further communication was received, despite the fact that the letter required a reply.
      Further enquiry by an official of our Area Health Authority would indicate that our letter was 'mislaid', presumably a departmental euphemism for 'lost'.
      This matter has given rise to considerable anxiety and anger amongst our medical colleagues and hence our enclosed letter to the Secretary of State. You will see that we ask from him an assurance that our position is in no way jeopardised by the possible failure of our views to be appropriately presented.
      We write to you in the hope that should this assurance not be forthcoming you may be willing to personally lend your support."
      My right hon. Friend has passed me the letter—I expect that the Minister has it—dated 22nd September, addressed to the Secretary of State and signed by Mr. Wilkey, the Chairman of the Cambridge Health District Medical Executive Committee, and by Dr. Robinson.
      That letter expressed considerable anger at the fact that, although they were invited to put these representations to the Department, in fact all that happened is that after the Minister of State's predecessor had read it—he actually referred to it in his reply—the letter was apparently mislaid. We know that no account was taken of it because no changes have been made.
      This brings me back to the whole question of consultation. I use this amendment as a peg on which to hang this point. It arises directly in the case of the Cambridgeshire Area Health Authority. The letter of 28th May sent
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      by Norman Illingworth of the Department, addressed to RHAs and AHAs and the boards of governors, referred to the obligation in the Goodman document to hold consultations:
      "at the level of the individual hospital."
      The Government owe it to all those doctors, administrators and members of AHAs and district medical teams who have submitted views in response to this letter to let them know exactly how the Department conducted these consultations at the level of the individual hospitals.
      I understand that in the debate on Amendment No. 7 my hon. Friend the Member for Reading, South (Dr. Vaughan) asked what the Government had done to honour their undertaking to consult down to the level of the individual hospital. I understand, too, that there was no answer. We must be told. Time and again Ministers, in the House and in Committee, have refused to make any concession to the views put forward by those representing the medical profession or certain areas or districts. They have said that they could not depart from Goodman because it was holy writ and they were bound by it. Yesterday and today we heard that this was a contract by which everyone was bound. But part of that contract was that consultations should be conducted down to the level of the individual hospital.
      Before we part with this group of amendments the Minister of State must come clean and tell the House and those outside how this consultation was carried out. He might also say what happened to the letter of 18th June after the previous Minister of State had read it. He referred to it in his reply. Why has it been lost? What account was taken of the views put forward in it? If any account was taken of them, why has there been no change in the number of beds to be phased out in the Cambridgeshire district?
      The hon. Member for Isle of Wight (Mr. Ross) raised what seemed to be a strong point. The Isle of Wight is a place where there are no alternative facilities. On the basis of Clause 3 there ought to be no beds phased out because there is nowhere else to go. My hon. Friend the Member for Edgbaston ranged across a number of issues covered by these amendments.

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      We feel that the Government have treated this matter in an exceedingly shabby way. They have made no attempt to justify the figures in the schedule. In some cases they are the same as but in some cases they are different from those attached to the original DHSS letter circulated in February. Often they bear no relation to any figures put out by the Independent Hospitals Group. They appear to have been plucked out of the air.
      All of this is done against the background of the self-imposed straitjacket of the figure of 1.000 beds. Again and again we return to the point that the figure of 1,000 is totally inconsistent with the criteria appearing in the Goodman document. Of course the figure was plucked from the air. It was made without any reference to the adequate provision of alternative facilities or to the real usage of pay beds as opposed to the bogus figures which are constantly quoted.
      When we examine the position, hospital by hospital, district by district, area by area, we see that there is no way in which one can produce a result that is consistent both with the criteria of Clause 3 and the figure of 1,000 beds. The Government must think again about this. They must go back and be bold enough to tell their hon. Friends below the Gangway that the figure of 1,000 beds cannot stand.
      They will get a rocket from the hon. Member for Preston, South (Mr. Thorne), I have no doubt. As always, he will trot out the old "Iron Curtain" arguments about why this ought to be done tomorrow. But Ministers have to stand up to that. It is no good the Minister of State shaking his head. Ministers must stand up to that and produce a result that is meaningful in health terms. In health terms, as spelled out in the criteria, a figure of 1,000 beds is palpably several hundred too high.
      It is time that the Government recognised this. We much prefer that this should not be left to the Government at all but handed to the Health Services Board. We shall come to that later if we have time. The Government must tell us how the consultation was carried out and what account was taken of it and how they will square this circle of criteria related to usage and availability of private
      530
      accommodation with the figure of 1,000 beds. I do not believe that they can. They will have to think again.
      Mr. Moyle: I have listened to the debate carefully and I am afraid that it seems that the major contours of the ground over which we have to travel are well known to all of those who have interested themselves in this issue. It is some of the topographical detail only that has to be filled in.
      I can tell my hon. Friend the Member for Preston, South (Mr. Thorne) that I foresee no possibility of dissension between him and myself on this schedule and Clause 3. To that extent I can give no encouragement to the right hon. Member for Wanstead and Woodford (Mr. Jenkin). He knows that the figure of 1,000 beds is one of the major contours to which I have referred and which will not be shifted. If there were any prospect of its being shifted, I believe, as the Secretary of State has said, that it could easily be shifted in the direction of a greater rather than a lesser number. We stand by the total.
      The hon. Member for Isle of Wight (Mr. Ross) suggested that if any alteration were made in the reductions in these regions which we are considering two of the beds might go in the direction of the Isle of Wight. If any movement were made—and none is to be made—the benefits of such a movement would go to East Anglia, the West Midlands or Oxford, which are the regions we are discussing this evening.
      The right hon. Member for Wanstead and Woodford raised the question of the Cambridgeshire area which had made representations during the course of the Bill. I accept that the people of the Cambridgeshire area feel that they have been hardly done by. I suspect that a good deal of their resentment arises from the fact that they thought that their letter of 18th June had gone astray.
      Mr. Patrick Jenkin: "Mislaid."
      Mr. Moyle: That is what they were told by someone lower down the line. I have here a letter from my right hon. Friend which says:
      "I can assure you that the letter of 18th June setting out the Cambridgeshire Area Health Authority's views on the content of Schedule 2 of the Bill was not only received in the Department but that the Authority's

      531
      representations were personally considered by Ministers."
      The letter and the representations were fully considered. We are accepting a target occupancy rate of beds in that area of 73 per cent., based on the 1972–73 figures, whereas the occupancy rate proposed in Committee was 57 per cent., which is a great deal below. We have come to the conclusion that there are alternative facilities in the Cambridge area. The Independent Hospitals Group proposed a reduction in pay beds in the area by one more than the Government propose in the schedule. To that extent we have improved on the IHG's view of the situation.
      There was a great deal of argument as to the ways in which certain specialties should be dealt with. They can be dealt with when we come to deal with Clause 8, and Professor Calne and other consultants can use the National Health Service facilities under that clause for specialties and can put the fees into the research funds of the area. For all those reasons my right hon. Friend sees no reason to change the situation in Cambridgeshire.
      The right hon. Gentleman asked about the details of consultation. A letter was sent out by the Department on 6th May to all regional and area authorities and to boards of governors setting out the details of what was proposed and asking for comments. It also asked whether they would ensure that consultation should be taken to the level of local professional committees, staff bodies and community health councils. From that exercise we derived our original proposals and we have gone back to re-check. Up to 30th September we allowed a further round of submissions to be made. Therefore, it was only 12 days ago that we finally closed representations. That has been the consultation procedure.
      8.30 p.m.
      Mrs. Lynda Chalker: Could the Minister explain how his last comment ties in with the comment he made three or four minutes ago that there would be no alteration in numbers? First he said that there would be no alteration in the numbers, and he then appeared to want to alter the numbers. What is he
      532
      doing? Does he indeed know what he is doing?
      Mr. Moyle: If the hon. Lady is as dim as she appears to be, she will not have appreciated that when I spoke of no alteration I was talking of a figure of 1,000 beds. There is no alteration in that. Within that figure of 1,000 beds we have done our best to ensure that we have deployed the figure in the best interests of the NHS as we see the situation. If people have made a sufficiently convincing case there would be room for us to alter the figure within the 1,000 beds and to redeploy it. There is no doubt that we are committed to 1,000 beds in the Goodman proposals, and I see no point in disguising that fact.
      Mr. Stephen Ross: From what the Minister said, it looks as though the exercise involving the canvassing of representations up to 30th September was a waste of time. He is completely ignoring the appeal I made to him on behalf of a particular part of this country which will certainly suffer from the proposals set out in the Bill.
      Mr. Moyle: I have attempted to indicate to the hon. Gentleman that I should be out of order if I dealt with this point. The hon. Gentleman is lucky enough to have an indulgent occupant of the Chair who has allowed him to make that point. I think that the hon. Gentleman should rest content with the situation as it is. I do not seek to criticise the Chair, and no doubt I would have adopted the same course had I been in that office. If the hon. Member for the Isle of Wight, who has not graced these debates with any great degree of assiduity, stays for the next group of amendments, he will get an idea of what I have in mind.
      I turn to the detailed amendments. Amendment No. 10 is a paving amendment to other amendments. Broadly speaking, in respect of these three regions we believe that what we propose is as right as we can manage. The number of pay beds to be reduced in the three regions are 30 in East Anglia, 31 in Oxford, and 90 in the West Midlands. They have altogether 15 per cent. of the total number of pay beds in England and their share of the 1,000 reductions in Schedule 2 is also 15 per cent.

      533
      Every amendment put forward by the Opposition seeks to introduce a lower level of reduction even than that proposed by the Independent Hospitals Group as a fair distribution of the 1,000 beds. For example, in the 18 areas covered by the three regions the IHG suggested reductions greater than those in Schedule 2 in nine instances, in six instances it agreed with the Government's proposals, and in only three areas did the IHG suggest a smaller reduction than we are proposing in Schedule 2. In each instance the difference was only one bed.
      Therefore, the outcome of the exercise is probably about as good as can be achieved in the circumstances. I do not think there could be any better illustration that the figures we have achieved result in a proper and careful balance of the two criteria which must be taken into account.
      The hon. Member for Birmingham, Edgbaston (Mrs. Knight) raised a technical point about endowed beds. The position is not quite as black and white as she seemed to think. Certainly endowed beds vested in the health service in 1946 involve trusteeships which, I understand, were transferred to the Ministry of Health free of any trust existing before that date. Although the Secretary of State retains the duty to try to carry out the objects of the trust where that is possible in any new circumstances, there is, I understand, no legal obligation on the Secretary of State to do so. Therefore in the circumstances in which we now find ourselves that group of beds can be phased out without breaking any legal trust.
      Mrs. Knight: Was it not the case that those endowed beds were permitted to be taken into what became health service hospitals because private patients were using them in those hospitals on vesting day? When they were first endowed they were in a hospital which was not owned by the State but which became a National Health Service hospital. Surely they moved into a new category after the legislation was enacted since they were still being used for private patients under that arrangement. Does the Minister of State agree that it seems that there will be a change in that whereas they were being used for the purpose for which they had been endowed, after the passage of this Bill they will not be.
      Mr. Moyle: I do not wish to set myself up as an expert on the law of trusts The key to the position is whether they were vested in the Secretary of State when the health service legislation was passed in 1946. If they were, although there was an obligation on the Secretary of State to try to apply them for the purposes for which they were endowed, whatever those purposes might be, as I understand it there was no obligation on him to do more. Therefore it is likely that those endowed beds could be phased out of those NHS hospitals.
      There is a second group of beds which were endowments specifically given on trust to the NHS authorities to provide private patient facilities. They were made since 5th July 1948, which was the vesting date for the National Health Service. The position here is different since the original trusts remain operative. What would happen in the case of an individual endowment of this kind after the separation of private facilities from NHS hospitals would depend on the legal construction of the terms of the trust. In that case I cannot take any further the position of beds endowed since the health service came into operation.
      Amendment negatived.
      Dr. Vaughan: I beg to move Amendment No. 11, in page 3, line 2 leave out 'one thousand' and insert 'nine hundred and sixty-seven'.
      Mr. Deputy Speaker: With this we are also to take Government Amendments Nos. 114 and 115 and the following amendments:

      No. 101, in Schedule 2, page 32, line 8. column 3 leave out '13' and insert '5'.

      No. 103, in page 32, line 12, column 3 leave out '7' and insert '4'.

      No. 105, in page 32, line 13, column 3 leave out '20' and insert '10'.

      No. 106, in page 32, line 16, column 3 leave out '28' and insert '20'.

      No. 107, in page 32, line 17, column 3 leave out '1' and insert 'Nil'.

      We are also to take Government Amendments Nos. 108, 109 and 116.
      Dr. Vaughan: I was interested in the Minister of State's remark just now about this group of amendments. I took it to

      535
      mean that he would be coming forward to tell us that there have been some changes as a result of the consultations. So far remarks by both the Secretary of State and the Minister of State have not led us to believe that these consultations have produced any results at all. They appear to have been a farce and based purely on one questionaire to the various authorities.
      The figures in Amendment No. 11 refer to the Wolverhampton health area. They are precise because they are based on factual information given to us by the staff in the Wolverhampton area. The hon. Member for Birmingham, Selly Oak (Mr. Litterick) asked earlier why our suggested figures are so precise. I point out to him that the distribution of the 1.000 beds is based on a model developed in the Department, whereas our figures are based on information given to us from the areas concerned.
      I am pleased to refer particularly to the Wolverhampton area because it well demonstrates the problem I raised in debate on Clause 3. It is a difficult matter. Many complicated local issues have to be looked at. I have said that it is not a party point, that we believe that the right hon. Gentleman in the circumstances would be wiser to take the whole of these provisions out of the Bill and hand the matter over to the independent board for consideration.
      I shall not refer to all the hospitals in the area, but only to some where major anxieties lie. At Chester, for instance, there are 70 private beds spread over 11 hospitals. In Committee, I pointed out that the figure we have for that area is 72 as against the figure of 70 in the Bill. On 29th July I asked what was the correct number, because, quite clearly, to the consultants and hospital staffs locally there is an important difference in an area of this size, between 70 and 72.
      It does not build confidence in the Department that there should be doubt about what the actual number of beds is. But—and this is important—it is only in Chester itself, where there are 23 of these beds, that private alternatives exist. We asked in Committee—and again there has been no answer—whether the 13 beds scheduled to go would come from the area outside Chester, which would cause
      536
      considerable hardship, or whether they would all come from Chester. It would be easier in Chester because there are alternative facilities in that area, although even so there would be great problems which would affect the care of patients, because there are travelling problems in Chester.
      We have discussed at intervals the damage that we believe these proposals will do to the care of patients. We have discussed the fact that patients in an NHS hospital who are looked after by a part-time consultant who will in future have to travel considerable distances to see his private patients will be put at needless risk. This is because, however urgently the consultant may wish to go back to them, he cannot simply drop other patients and then travel perhaps a considerable distance through traffic and give service to NHS patients. The reverse is true, of course. In such circumstances he could not simply drop NHS persons and travel perhaps considerable distances through traffic to give service to private patients. We have pointed out that there are great advantages from the point of view of the quality of care of patients, particularly in emergencies and post-operative complications, in having geographical whole-time consultants who spend the whole or most of their time in one place, even though in that one place they may be seeing both NHS and private patients.
      Again, it is not simply a matter of the care of patients. Many peripheral activities of importance will go in many areas if travelling time has to be found to carry the present clinical load. I make no excuse for referring to a letter which is typical of many we have had. I referred to it in Committee. It is from a consultant who sets out in detail the restrictions he has already had to make in order to find travelling time because some of the beds have been closed down.
      For example, he has had to stop giving weekly lectures to nurses between 8.15 and 9.0 a.m.—an important matter to those nurses. He has had to stop giving lunch-time tutorials to his house officers.
      At a time when many junior staff are coming from overseas, this kind of help is absolutely invaluable to the junior staff concerned. He has had to stop attending

      537
      and contributing to post-graduate clinical meetings held weekly at 5 o'clock. He has had to resign from the membership and chairmanship of one committee which is held between 5 and 7 o'clock. He writes:
      "I very infrequently attend my own departmental meeting previously held monthly between 5 and 7 p.m. but now far less often."
      He also says:
      "I have stopped a weekly teatime tutorial for medical students attending my hospital from medical schools in London."
      He concludes:
      "I would point out that, apart from the nurses' lectures for which I was paid, the remainder were carried out willingly and with goodwill outside normal working time and without any financial remuneration."
      It is this kind of additional devoted service, on which a great deal has been built in the past, that will be damaged and destroyed in many parts of the country as a result of the provisions in the Bill. I do not think that these aspects have been looked into fully.
      8.45 p.m.
      We have had as yet no answer at all to where the beds in the Chester area are expected to come from. Also in this area there are the proposals for the Wirral. Here there is to be a loss of seven out of 35 private beds. We know a good deal about the Wirral area. We spent a considerable time in trying to find out the staffing figures on which the Minister had based the statement on staffing that he made in the House. It was from places such as the Wirral that we found out that the figures he talked about were a model and bore no relation at all to the actual circumstances existing in the local areas.
      In the Wirral there is very strong local feeling that to close down seven beds will be very damaging to the care of patients. We are dealing with very small numbers here. It is felt that four would be the sensible figure to aim at. This is an area in which there is a high demand for private care, and there are no alternative facilities within a reasonable distance.
      Ironically, it is in this area that there is a special requirement that consultants should live within a short distance of the hospital. Apparently when it comes to caring for a National Health Service sick patient, the consultant must be readily available, but when it is a matter of
      538
      caring for a different kind of sick patient, the nearness of the consultant is nothing like as important. This causes a great deal of damage to morale in a local area.
      Mr. Leslie Spriggs (St. Helens): Will the hon. Gentleman take it from me that during the General Election campaign of 1974, when the Labour Party's programme was clearly laid down, informing the nation that the election partly related to dealing with pay beds on the basis of queue jumping—the Labour Party had a policy before the nation to prevent queue jumping in the National Health Service—not one person, medical, nursing or otherwise, came forward with any alternative scheme?
      Dr. Vaughan: This point was brought up in Committee. The fact is that we have had very anxious representations made to us right across the country from many people who, I should have thought, were unlikely to vote for us. The hon. Gentleman can hardly speak for the whole country when only a third of the voters in the country could possibly have supported the Labour Party manifesto.
      But, even more important, does the hon. Gentleman think it likely that someone would write to him making representations knowing that his mind was closed beforehand? This is the problem. The right hon. Member for Blackburn (Mrs. Castle) made the point that no one had written to her. What a farce it would have been if anyone had done so, remembering that the right hon. Lady is on record as saying that she has no intention of changing her views.
      This question of the care of patients is a very serious matter and, as we look from area to area, we find anomalies, problems and anxieties. In the Lancashire area, there are 92 beds spread over 19 hospitals, and 20 of those beds are due to be closed. The local view is that 10 could be closed without damage to the service, but that closing any more would produce great problems locally. In fact, the only part of the area where there are adequate alternative facilities is in the Blackburn area, which is rather ironic. I keep coming back to this fundamental issue. Part of the Goodman proposals was that there should be adequate alternative provision, and that is not the case in a great many parts of the country.

      539
      In Manchester, there are 138 beds, and it is proposed that it should lose 28 of them. At first sight, that may seem rather generous, but in fact in the Manchester area there is only one private unit as an alternative. It is at St. Joseph's Hospital, where there are 140 beds in the unit. That sounds a lot, but 36 beds are set on one side for geriatric cases and the chronically sick, so that there are only 99 beds available for acute medical and surgical problems.
      Even there, however, there are problems about the facilities for staffing, with the result that at St. Joseph's it has been found necessary to limit the number of doctors who can work in a hospital. There will be no room there to take in doctors from outside. What is more, St. Joseph's Hospital covers not only the Manchester area but a very wide area outside, and it is already unsatisfactory for that reason.
      I cannot see how further calls can be made on St. Joseph's Hospital. In fact, the local view is that the closure of pay beds in the area will affect not only the acute medical private patients but will also have an effect on the geriatric and chronically sick in other kinds of beds in the area. So, like a stone dropped into a pool, when we start to look into this, the ripples spread and we find more and more complications which have not been thought through properly.
      As I say, I could go on to other hospital areas within this Wolverhampton health area, and I am perfectly prepared to do so. However, I think that I have touched on where the main anxieties lie. I say yet again to the Minister "Please be straight and open about this. Look at what you are doing. Have some proper consultations." If the right hon. Gentleman does that and does not come back with the feeling that he has got the wrong mix for the spread of his 1,000 beds, I shall be very surprised.
      Mr. Thorne: The hon. Member for Reading, South (Dr. Vaughan) described my right hon. Friend the Member for Blackburn (Mrs. Castle) as having a closed mind, and he described how people have tried to reach her with various ideas only to find her failing to listen. The whole debate indicates that Conservative Mem-
      540
      bers also have closed minds and they also fail to listen to the ideas that are put to them. It seems to me that the hon. Member for Reading, South is doing a very good job in protecting what he considers to be the interests of his profession and, in his way, possibly the interests of the people concerned in this subject. I do not quarrel with that.
      However, I find it very difficult to follow some of the arguments put by the Opposition. For example, yesterday there was a good contribution by the hon. and learned Member for Royal Tunbridge Wells (Mr. Mayhew) who had had personal experience of being a National Health Service patient. He spoke with some delight about the service that he had received and one could only applaud his response. We hear at the same time that what is involved is the right to choose, freedom of choice. It is fairly clear that that hon. and learned Member, on the basis of his experience, would choose to be a National Health Service patient. That is very good.
      The hon. Member for Canterbury (Mr. Crouch) indicated that it was clearly better to be a National Health Service patient, because one got better consideration within the service. I wonder what this talk about choice is. If we are sick we want to be made well again. The criterion of payment to be made well seems to me almost obscene. Yet Opposition Members, in spite of their delight about what is offered to them in the National Health Service, continue to prate about private medicine.
      The hon. Member for Reading, South said that we were talking now only about small numbers. Because of the need to make progress I shall only ask my hon. Friend the Minister to assure me that there is nothing wrong with my arithmetic but something wrong with Mr. Speaker's provisional selection of amendments. It suggests that Amendment No. 109 is a Government amendment. I do not think that it is. [An HON. MEMBER: "Amendment No. 108 is."] That is so. I have added Amendments Nos. 114, 115 and 118 together to make an alteration of three beds, which is covered by Government Amendment No. 116. Therefore, the number remains the same. However, if Amendment No. 109 is a Government amendment, we have lost two. I

      541
      hope that my hon. Friend will assure me that we shall not lose two beds at this late stage.
      Mrs. Chalker: This group of amendments refers to an area which in one sense is not unlike the Isle of Wight. The peninsula of Wirral is surrounded on three sides by water, and communications through the tunnels to Liverpool sometimes take longer than in many other areas of the country where transportation is also difficult.
      Within the Wirral there is a special hospital which carries out radiology treatment for many women who are suffering from increasing cancer. These women come from all over the Mersey hospital region and not solely from the Wirral or the connected land up from Cheshire.
      Amendment No. 103, which seeks to reduce from seven to four the number of private beds which will be taken out of the Wirral, is very important in this respect. The Minister will not he unaware of the increasing incidence of cancer among women in middle age. This can be retarded by radiology treatment. Therefore, it is essential that the facilities which are offered within the Wirral to the whole region are easily accessible to the patients and that they shall get the best care. It is also the sort of illness which is highly embarrassing to large numbers of women and there are not enough amenity beds to give them the privacy they need.
      9.0 p.m.
      It was with considerable regret that I saw no movement on the part of the Department on this issue. It does not intend to look at the very real problems which this one speciality—and I could mention many others—will face as the number of private beds is reduced still further in this particular area.
      There is the difficulty of locality and proximity. We ask, because of the difficult locations, that specialists should live in the areas. This is an increasing problem which is being exacerbated by the action of this Government. This is one of the major hospitals in our region and people who need treatment come from a wide area to use its facilities. This matter is a disgrace.
      Mr. Moyle: Only one major point which has not been considered before in
      542
      earlier debates has emerged from this discussion and that was the suggestion by the hon. Member for Reading, South (Dr. Vaughan) that the whole of the phasing out of pay beds, including the first tranche of 1,000, should be referred to the Health Services Board.
      In fact, as the law stands, the Secretary of State already has full powers to phase out any number of private beds at the moment. This exercise of phasing out 1,000 beds is an exercise in principle which has taken place before. There is nothing new in this. It is a matter of concession on the part of the Secretary of State that he has set up the Health Services Board to supervise the phasing out of the remainder of private beds. To that extent he is making a substantial curtailment of his normal powers by bringing this Bill to the House at all.
      The hon. Member for Reading, South raised detailed points about the Cheshire area and he asked how many pay beds existed in this area health authority. The area health authority has told us that the existing number of beds is 68, but my departmental officials have carried out their own researches and have come to the conclusion that the number of private pay beds is, in fact, 70 as set out in Schedule 2. We have submitted evidence of our conclusions to the AHA which is free to comment on them if it wishes. Distribution of reductions in the authority's area is a matter for it. My right hon. Friend has said that he is prepared to consider granting group authorisation if any particular AHA asks for it.
      I will vary the theme which has come from this side of the House in commenting on recent groups of amendments by saying that my right hon. Friend accepts Amendment No. 108 in respect of the Tameside Health Authority. He has looked at the case it has submitted. In his view it is not a clear-cut case by any means, but he thinks that possibly the application of the criteria in the formula is a little too harsh in this particular area. I know that Conservatives do not necessarily accept the validity of that formula but it is the one on which we are working, and we are satisfied that it is the best available. Therefore, Amendment No. 108 will be accepted.

      543
      The Government have moved some other amendments resulting from the review which was concluded on 30th September. I would not like the House to think that there is much earth movement involved here, but it does mean that we have decided to readjust as a result of the review.
      We have checked and rechecked our calculations and looked carefully at the discrepancies pointed out by health authorities. We have particularly studied the cases drawn to our attention in Committee to make sure that there have been no mistakes. We have found only four instances in which we think we could propose modifications. Those modifications are on the Amendment Paper in the name of my right hon. Friend.
      The South Tyneside Area Health Authority—Amendment No. 114—has only six pay beds. The Bill proposes a reduction of four. That would require an occupancy rate of 85 per cent. to be achieved. We think that this is probably unrealistic, particularly as there are no alternative facilities. If the reduction in beds is only three, then percentage occupancy drops to 56 per cent., but this lower rate would be more in keeping with the general approach in the Northern region as a whole. For example, the neighbouring area of North Tyneside has a target occupancy of only 47 per cent. A reduction of three would be in line with the Independent Hospital Group's suggestions.
      In Amendment No. 115 we turn to the Barnsley Area Medical Advisory Committee's contentions that there are no alternative facilities within 15 miles of Barnsley. There is some justification, therefore, in its complaint that the proposed reduction is too harsh. Schedule 2 proposes a reduction of three beds—from five to two. The Independent Hospital Group thinks that a reduction of one would be fairer, and the Opposition supported that suggestion in Committee. Because of the small number of existing beds, small variations in numbers, as will be readily appreciated, produce disproportionate changes in target occupancy rates. Because of the lack of alternative facilities, the area should be rated as about 70 per cent. occupancy. However, the Schedule 2 reduction of three beds would require an occupancy of 85 per
      544
      cent. Alternatively, a reduction of two beds would set a target of only 56 per cent. Clearly the amendment tabled by the Opposition in Committee would go too far; but, on reflection, I believe that it would be fairer to make the amendment now proposed.
      I turn now to Amendment No. 116 which deals with the preserved boards. We originally proposed a reduction of 47 beds from the present total of 227, but this was subsequently reduced to 30. In Committee, the Opposition brought to light an anomaly which we thought it right to consider.
      The right hon. Member for Wanstead and Woodford (Mr. Jenkin) said:
      "Even more curious is the fact that inner London, which has a higher proportion of beds in independent facilities outside the NHS, is being treated less harshly than outer London.…I do not understand this."—[Official Report, Standing Committee D, 28th July 1976; c. 1407.]
      The hon. Member for Ealing, Acton (Sir G. Young) supported that point of view. Indeed, he went on to contend that the imbalance needed restoring, although the Opposition thought that the way to solve the problem was to seek fewer reductions in the outer London areas.
      We have looked at this problem again and concluded that the Opposition were right in drawing attention to the imbalance. Our aim generally was to secure reductions which would have required remaining beds to be used at a notional occupancy rate of about 95 per cent. However, the effect of the reductions in Schedule 2 would have raised occupancy in the post-graduate teaching hospitals to only 92 per cent. The amendment which we are now proposing will increase this to 94 per cent. and will restore the balance in London and in the schedule as a whole.
      I am happy to reassure my hon. Friend the Member for Preston, South (Mr. Thorne) that Amendment No. 109 is not a Government amendment.
      The hon. Member for Wallasey (Mrs. Chalker) referred to her district and some difficulties for women in securing appropriate treatment in certain cases of cancer. I do not know the details of the circumstances to which she referred. If she would

      545
      care to make representations on a solution to the problem or on any discrepancies or deficiencies in her area, we will do our best to ensure that the NHS provides all the facilities necessary for curing these diseases and for maintaining a first-class service for her constituents.
      Dr. Vaughan: We welcome very much what the Minister has just said. There were signs of flexibility and even an indication that a little chink of local in-information is getting through to the Department. We particularly welcome his remarks about Tameside—that cockpit of freedom. First an education victory, now a health victory.
      Tameside had been unfairly treated. It lost two of its six pay beds last year and under the present proposals was about to lose another. The district made the strong point that the occupancy rate of 50 per cent. was based on figures taken at a time when industrial action was being carried out by local technicians and laundry staff. I was pleased to hear the Secretary of State say that the occupancy figures now being used were based on 1972–73 and not on a time when industrial action was being taken.
      We welcome what has been said about Barnsley and Tameside.
      Amendment negatived.
      Mr. Paul Dean: I beg to move Amendment No. 12, in page 3, line 2, leave out 'one thousand' and insert 'nine hundred and eighty-eight'.
      Mr. Speaker: With this we are to take the following amendments:

      No. 90, in Schedule 2, page 31, line 32, column 3, leave out '16' and insert '10'.

      No. 93, in page 31, line 38, column 3, leave out '6' and insert 'Nil'.

      Mr. Dean: Amendment No. 12 is a paving amendment for Nos. 90 and 93 which deal with the problem in Wiltshire and Avon. We have less than 20 minutes before the guillotine falls on a large number of undiscussed amendments. I shall be brief because I know that my hon. Friend the Member for Conway (Mr. Roberts), whose amendment is next on the Order Paper, is particularly anxious to make representations about the position in Wales, especially in North Wales.
      546
      Amendment No. 90 relates to Wiltshire where the local medical committee feels there is a lack of alternative facilities in the Salisbury and Swindon districts. In the Bath district, private nursing homes have an occupancy rate of 85 per cent. The committee says, justifiably, that the criteria for phasing out have not been met because adequate alternative facilities are not available.
      The local medical committee at Swindon is concerned at the possibility of any reduction in the number of pay beds since, when the new hospital was built, medical staff were encouraged to utilise private beds and this resulted in the closure of the local private hospital. The committee also points out that the occupancy of pay beds in the National Health Service hospital is such that it is impossible to obtain a pay bed on an emergency basis.
      When we discussed this matter briefly in Committee the then Minister of State said:
      "I am not in a position to answer the specific point which the hon. Gentleman put to me about the new hospital at Swindon,"
      I hope that the Minister of State will answer that specific point tonight.
      The Salisbury Medical Advisory Committee considers that the four pay beds at the Plastics and Maxillo Facial Centre should not be included in the total of pay beds for the area because this is a regional unit and the beds are fully committed with a six-month waiting list. When we discussed this matter briefly in Committee the then Minister of State said:
      "We shall have to try to make an arrangement".—[Official Report, Standing Committee D; 29th July 1976, c. 1502.]
      I hope that today the Minister of State will be able to assure me that a satisfactory arrangement has been made.
      9.15 p.m.
      I turn briefly to Avon and Amendment No. 93, which proposes that there should be no reduction instead of a reduction of six. The general point is that we are dealing with a teaching area health authority with universities at Bristol and Bath, with centres of medical excellence and teaching which are known not only throughout the region but throughout the country. In that

      547
      general context two points are made by the local medical committees. They say that there are very few pay beds in Avon anyway—in fact there are only 23—and that they are used substantially for high technology medicine and regional specialities. They are used by teaching hospitals. We have had no assurance so far that this vital work will be able to continue uninterrupted if we get the proposed reductions. I hope that the Minister of State will be able to give some assurance tonight.
      The next issue concerns the Weston district. The local medical committee justifiably makes the point that there should be no reduction because of an absence of alternative facilities and inadequate road communications. There is considerable concern in the area about medical facilities generally.
      Those are the particular points that I have had to describe all too briefly. I hope that the Minister of State will be able to give some assurance to the two regions.
      Mr. Moyle: In spite of the way in which the hon. Member for Somerset, North (Mr. Dean) moved this group of amendments, I must say that as a result of the rounds of consultation the Government see no grounds for accepting any change in the regions to which the hon. Gentleman has addressed himself, either in Wessex, to which he addressed himself mainly, or even in the South-West, which comes within this group of regional health authorities.
      Clearly the first amendment is of a paving nature. Therefore, I turn to Amendments Nos. 90 and 93. The total reduction for the two regions is 91. That is about 23 per cent. of their existing number. The regions have 9 per cent. of the existing number of pay beds, and their share of the 1,000 reduction is also 9 per cent. It seems that overall they are making their fair contribution.
      Both the amendments would introduce a lower number of reductions than that represented to us as reasonable by the Independent Hospitals Group. For example, in the Avon area the amendment seeks to ensure that there is no withdrawal of pay beds when the private sector itself suggested a reduction of seven. I think that the Government are
      548
      exercising the benefit of the doubt towards pay beds rather than against them. Throughout these debates I believe there has been a remarkable degree of consistency between the Independent Hospital Group's list and Schedule 2 when considering the two regions.
      I propose that we reject both amendments. In the latest round of consultations the Wiltshire Area Health Authority has repeated earlier comments about the lack of alternative facilities, especially in the Swindon and Salisbury districts. Schedule 2 proposes a reduction from 57 to 41. The Independent Hospital Group is again in agreement with that reduction, although in Committee right hon. Members of the Opposition proposed a reduction of only 10 beds, similar to the reduction that they are proposing now.
      The present proposals assume a target occupancy rate for the remaining beds of 70 per cent. That was the lowest level of target occupancy generally applied in this exercise. Full account has been taken by the Government in their consultations with regard to alternative facilities, and even though there are some private facilities in Bath, as the area health authority itself has acknowledged, 28 per cent. of the existing pay beds are now in the Bath district and occupancy has fallen from 40 per cent. in 1972 to 20 per cent. in 1975.
      On balance, therefore, the Government feel that in respect of the point raised by the hon. Gentleman it is erring on the side of generosity and therefore we cannot accept the amendment.
      Amendment negatived.
      Mr. Wyn Roberts: I beg to move Amendment No. 13, in page 3, line 2, leave out 'one thousand' and insert 'nine hundred and ninety-one'.
      Mr. Speaker: With this we are to take the following amendments:

      No. 110, in Schedule 2, page 32, line 28, column 3, leave out '5' and insert 'Nil'.

      No. 111, in page 32, line 31, column 3, leave out '3' and insert 'Nil'.

      No. 112, in page 32, line 34, column 3, leave out '1' and insert 'Nil'.

      Mr. Roberts: This paving amendment and the consequential amendments were ably moved in Committee by my hon. Friend the Member for Edinburgh, West

      549
      (Lord James Douglas-Hamilton). They were defeated by the Government, like so many other amendments in Committee, with the aid of the Chairman's casting vote.
      The purpose of the amendments is to reduce the number of pay beds to be done away with by nine. Nine out of 1,000 does not appear to be too many for the Government to concede, especially as the entire concession relates to Wales, which even now has only 60 pay beds in all for a population of 2·7 million.
      Amendment No. 110 relates to the Clwyd area, where there are now 22 pay beds, which the Government propose to reduce by five. Amendment No. 111 relates to my own county of Gwynedd, where there are 13 pay beds, which the Government propose to reduce by three. Amendment No. 112 relates to West Glamorgan, where there are four pay beds, which the Government propose to reduce by one. Our amendments seek to eliminate those reductions altogether and to preserve those beds, largely on the grounds that there are no alternative facilities available, as in Gwynedd, or that there are insufficient alternative facilities available as in Clwyd and West Glamorgan.
      The area health authorities concerned, consultants and members of the public feel strongly on this issue. I have received numerous letters of protest from constituents and members of the medical profession against this gratuitous deprivation, which reduces the health facilities available in these areas and makes them less attractive as areas of settlement. The Government must remember that Wales is always threatened with some cut-back or other, and that this cut-back in health facilities will be lumped with others—threatened cut-backs in transport, and so on—which all conspire to hinder our development, both social and economic.
      In Committee the Secretary of State argued that the low number of pay beds in Wales reflected the lack of public interest in them. I do not believe that that is so. I am told that about 50 per cent. of acute admissions cannot get a private bed, as they would wish to do, and that many areas have more private patients than they can cope with. The Government also argue from the low bed occupancy figures for pay beds in Wales
      550
      as compared with those in England—46 per cent. in 1972 for Wales as compared with 52 per cent. in England.
      Let us look at Gwynedd, my own county. There was a 49 per cent. bed occupancy rate last year, and that was with the 13 beds scattered throughout the area—four at the C and A Hospital, Bangor, two at St. David's, Bangor, four at Llandudno General Hospital, and one at each of three other hospitals. The Secretary of State knows only too well that bed occupancy figures are bound to be low in these circumstances where the pay beds themselves are scattered.
      The Secretary of State for Wales has made it clear to all area health authorities that he is willing to consider applications for "grouped authorisations" to give greater flexibility of use, and the Secretary of State for Social Services believes that that will ease whatever problems there may be. Would it not be wise to allow such grouping in the first place, see how it works, and then reduce the figure if a reduction is justified? That would be the proper way to go about making a reduction if a reduction is called for.
      I urge that course particularly in view of the situation that exists now, which is that half the acute admissions requiring pay beds are unable to get them. That fact seems to be far more relevant than bed occupancy statistics which, as the Secretary of State knows, are very misleading. Some of the most active hospital units have low occupancy rates because of their high turnover of patients.
      My basic argument against these reductions is that Wales is being deprived of yet another facility, one that is a valuable attraction to incoming industry and incoming settlers of all kinds as well as to the people already there.
      Mr. Moyle: One of the attractive features about the debates on this Bill is that they allow me to trespass outside my bailiwick into Wales.
      These amendments are designed to reduce the Government's proposals in respect of three health districts—Clwyd, Gwyned and West Glamorgan. The Government cannot accept the case that has been argued by the hon. Member for Conway (Mr. Roberts). There are at

      551
      present 60 pay beds in Wales, and the Government's proposal is that 13 of them should be withdrawn. I confirm that our information is that the average use of pay beds in Wales is generally low compared with that in England, and has been falling. I believe that the hon. Gentleman put forward figures of 46 per cent. in 1972, 44 per cent. in 1973 and 35 per cent. in 1975, which is the latest figure. By comparison, the figures for England are 52 per cent., 49 per cent. and 44 per cent., so there is a substantial discrepancy. The occupancy of the small number of pay beds in Wales is therefore much lower than the occupancy of pay beds in England but, even so, we are proposing a marginally smaller reduction in Wales than in England, to the extent that the reduction will be a little under 22 per cent. in Wales, compared with 22 per cent. for England.
      Sir Anthony Meyer: Is the hon. Gentleman aware that withdrawing pay beds may be a partial inducement to consultants to leave practice in Wales altogether?
      Mr. Moyle: That argument has been put in general terms throughout the debate, and it has been replied to in general terms. We do not believe that that will happen to a substantial extent.
      The same criteria have been used for a reduction in England as have been used for Wales. I do not think that the hon. Member for Conway can make a case for a particularly greater burden—if that is the right word to use—of deprivation in Wales by the removal of pay beds than will be the case in England. There are probably some hon. Members from that part of the world who would regard the situation as an improvement
      There is a problem that pay beds are spread over a fairly wide area.
      It being half-past Nine o'clock, Mr. SPEAKER proceeded, pursuant to Orders [20th July, 3rd August and the Resolution yesterday] to put forthwith the Question on the Amendment already proposed from the Chair.
      Amendment negatived.
      Mr. SPEAKER then proceeded, pursuant to the said Orders and Resolution to put forthwith the Questions on the
      552
      Amendments to the Bill, moved by a member of the Government, of which notice had been given.

    Clause 4

      FUNCTIONS OF BOARD AS REGARDS WITHDRAWAL OF NHS FACILITIES FROM PRIVATE PATIENTS.
      Amendment made:
      No. 28, in page 5, line 25, at end insert—
      '(6) Without prejudice to the preceding provisions of this section, the Board shall, as regards the revocation of authorisations under sections 2(1) of the 1968 Act, submit separate proposals under this section relating to—

      (a) accommodation and services available for the specialities other than radiotherapy mentioned in subsection (5)(b) above; and

      (b) other accommodation and services available for diagnostic purposes,

      and shall do so not later than the end of the twelve months following the initial period (or, if a period longer than the initial period is allowed under subsection (2;(a) above for the submission of the Board's first proposals under this section, the twelve months following that longer period,'—[Mr. Ennals.]

    Clause 16

      REGULATIONS IN CONNECTION WITH PROVISIONS OF PART III
      Amendment made:
      No. 59, in page 19, line 30, leave out paragraph (b).—[Mr. Ennals.]

    Clause 21

      GENERAL PROVISIONS AS TO REGULATIONS
      Amendment made:
      No. 61, in page 22, line 38, leave out '8' and insert '10'.—[Mr. Ennals.]

    Clause 23

      CITATION, COMMENCEMENT AND EXTENT
      Amendments made:
      No. 62, in page 24, line 9, leave out from 'and' to the end of line 17 and insert—
      'Part II of this Act—

      (a) so far as it applies to England and Wales, shall be included among the enactments which may be cited together as the

      553
      National Health Service Acts 1946 to 1976; and

      (b) so far as it applies to Scotland, shall be included among the enactments which may be cited together as the National Health Service (Scotland) Acts 1947 to 1976.'.

      No. 65, in page 24, line 22 leave out
      'or the Northern Ireland Assembly Disqualification Act 1975'.—[Mr. Ennals.]

  Schedule 1

    THE HEALTH SERVICES BOARD AND ITS COMMITTEES
    Amendments made:
    No. 70, in page 30, line 3, leave out from '1975' to 'there' in line 5 and insert
    'bodies of which all members are disqualified under that Act'.
    No. 71, in page 30, line 9, at end insert—

  'PART V

    LIABILITY OF BOARD AND WELSH COMMITTEE TO INVESTIGATION BY HEALTH SERVICE COMMISSIONERS
    25. Part III of the National Health Service Reorganisation Act 1973 (the Health Service Commissioners for England and Wales) shall have effect subject to the following provisions of this Part of this Schedule.
    26.—(1) In section 34(1) of the said Act of 1973 (definition of "relevant body"), after paragraph (j) insert—
    "(k)the Health Services Board and its Welsh Committee,".
    (2) In section 34(2) of that Act (relevant bodies in respect of which the Health Service Commissioners for England and Wales respectively are not empowered to conduct investigations) after "the Welsh Hospital Board" insert "the Welsh Committee of the Health Services Board,".
    (3) In section 37 of that Act (reports of Commissioners), after subsection (5) add—
    "(6) In the case of the Health Services Board or its Welsh Committee, the preceding provisions of this section have effect subject to paragraphs 27 and 28 of Schedule 1 to the Health Services Act 1976".
    27. Section 37 (reports by Commissioners) of the said Act of 1973 shall have effect subject to the following modifications, that is to say—

    (a) in relation to an investigation conducted under the said Part III in respect of the Board or the Welsh Committee—

    (i) paragraph (d) of subsection (1) (report to be sent to Secretary of State) shall not apply, but the Commissioner who conducted the investigation may, if
    554
    he thinks fit, publish his report under that subsection; and

    (ii) subsection (3) (special reports) shall have effect with the substitution for the words from "make a special report to the Secretary of State" to the end of the subsection of the words "lay before each House of Parliament a special report";

    (b) without prejudice to paragraph 28 below, the reference in subsection (4) (annual and other reports to Secretary of State) to a Commissioner's functions under the said Part III shall not include his functions there-under in respect of the Board or the Welsh Committee;

    (c) subsection (5) (privilege) shall have effect as if the reference to subsection (4) included a reference to paragraph 28 below.

    28. Each of the Commissioners mentioned in subsection (4) of the said section 37 shall annually lay before each House of Parliament a general report on the performance of his functions under the said Part III in respect of the Board and the Welsh Committee, and may from time to time lay before each House of Parliament such other reports with respect to his said functions under that Part as he thinks fit.

  PART VI

    LIABILITY OF SCOTTISH COMMITTEE TO INVESTIGATION BY HEALTH SERVICE COMMISSIONER FOR SCOTLAND
    29. Part VII of the National Health Service (Scotland) Act 1972 (the Health Service Commissioner for Scotland) shall have effect subject to the following provisions of this Part of this Schedule.
    30.—(1) In section 45(1) of the said Act of 1972 (definition of "body subject to investigation"), after paragraph (e) add—
    "(f) the Scottish Committee of the Health Services Board."
    (2) In section 48 of that Act (reports by Commissioner), after subsection (5) add—
    "(6) In the case of the Scottish Committee of the Health Services Board, the preceding provisions of this section have effect subject to paragraphs 31 and 32 of Schedule 1 to the Health Services Act 1976".
    31. Section 48 (reports by Commissioner of the said Act of 1972 shall have effect subject to the following modifications, that is to say—

    (a) in relation to an investigation conducted under the said Part VII in respect of the Scottish Committee—

    (i) paragraph (d) of subsection (1) (report to be sent to Secretary of State) shall not apply, but the Health Commissioner for Scotland may, if he thinks fit, publish his report under that subsection; and

    (ii) subsection (3) (special report) shall have effect with the substitution for the words from "make a special report to the Secretary of State" to the end of the subsection of the words "lay before each House of Parliament a special report";

    555

    (b) without prejudice to paragraph 32 below, the references in subsection (4) (annual and other reports to Secretary of State) to the Commissioner's functions, under the said Part VII shall not include his functions there-under in respect of the Scottish Committee;

    (c) subsection (5) (privilege) shall have effect as if paragraph 32 below were contained in the said section 48.

    32. The Health Service Commissioner for Scotland shall annually lay before each House of Parliament a general report on the performance of his functions under the said Part VII in respect of the Scottish Committee, and may from time to time lay before each House of Parliament such other reports with respect to his said functions under that Part as he thinks fit.'.—[Mr. Ennals.]

  Schedule 2

    AUTHORITIES AND GROUP OF BOARDS WITHIN SECTION 3
    Amendments made:
    No. 114, in page 30, line 26, column 3, leave out '4' and insert '3'.
    No. 115, in page 30, line 39, column 3, leave out '3' and insert '2'.
    No. 108, in page 32, line 21, column 3, leave out '1' and insert 'Nil'.—[Mr. Ennals.]
    Amendment proposed: No. 116, in page 32, line 25, column 3, leave out '30' and insert '33'.—[Mr. Ennals.]
    Question put, That the amendment be made:—
    The House divided: Ayes 219, Noes 193.

    Division No. 319]

    AYES

    [9.30 p.m.

    Abse, Leo

    Ennals, David

    Kerr, Russell

    Allaun, Frank

    Evans, Fred (Caerphilly)

    Kilroy-Silk, Robert

    Anderson, Donald

    Evans, Ioan (Aberdare)

    Kinnock, Neil

    Armstrong, Ernest

    Ewing, Harry (Stirling)

    Lambie, David

    Ashley, Jack

    Fernyhough, Rt Hon E.

    Lamborn, Harry

    Ashton, Joe

    Flannery, Martin

    Lamond, James

    Atkins, Ronald (Preston N)

    Fletcher, L. R. (Ilkeston)

    Leadbitter, Ted

    Atkinson, Norman

    Fletcher, Ted (Darlington)

    Lee, John

    Bagier, Gordon A. T.

    Ford, Ben

    Lestor, Miss Joan (Eton & Slough)

    Bates, Alt

    Forrester, John

    Lewis, Ron (Carlisle)

    Benn, Rt Hon Anthony Wedgwood

    Fowler, Gerald (The Wrekin)

    Lipton, Marcus

    Bennett, Andrew (Stockpon N)

    Fraser, John (Lambeth, N'w'd)

    Litterick, Tom

    Bidwell, Sydney

    Freeson, Reginald

    Lomas, Kenneth

    Blenkinsop, Arthur

    George, Bruce

    Luard, Evan

    Boardman, H.

    Gilbert, Dr John

    Lyons, Edward (Bradford W)

    Bottomley, Rt Hon Arthur

    Golding, John

    Mabon, Dr J. Dickson

    Bradley, Tom

    Gould, Bryan

    McCartney, Hugh

    Bray, Or Jeremy

    Gourlay, Harry

    McDonald, Dr Oonagh

    Brown, Hugh D. (Provan)

    Graham, Ted

    McElhone, Frank

    Brown, Ronald (Hackney S)

    Grant, George (Morpeth)

    MacFarquhar, Roderick

    Buchan, Norman

    Grant, John (Islington C)

    McGuire, Michael (Ince)

    Buchanan, Richaru

    Grocott, Bruce

    MacKenzie, Gregor

    Callaghan, Jim (Middleton & P)

    Hamilton, James (Bothwell)

    Mackintosh, John P.

    Cant, R. B.

    Hardy, Peter

    Maclennan, Robert

    Carter-Jones Lewis

    Harper, Joseph

    McMillan, Tom (Glasgow C)

    Cartwright, John

    Harrison, Walter (Wakefield)

    McNamara, Kevin

    Castle, Rt Hon Barbara

    Hatton, Frank

    Madden, Max

    Clemitson, Ivor

    Heffer, Eric S.

    Magee, Bryan

    Cocks, Rt Hon Michael (Bristol S)

    Hooley, Frank

    Mahon, Simon

    Cohen, Stanley

    Horam, John

    Mallalieu, J. P. W.

    Concannon, J. D.

    Howell, Rt Hon Denis (B'ham, Sm H)

    Marshall, Dr Edmund (Goole)

    Conlan, Bernard

    Hoyle, Doug (Nelson)

    Maynard, Miss Joan

    Cook, Robin F. (Edin C)

    Huckfield, Les

    Mendelson, John

    Corbett, Robin

    Hughes, Rt Hon C. (Anglesey)

    Miller, Dr M. S. (E Kilbride)

    Cox, Thomas (Tooting)

    Hughes, Robert (Aberdeen N)

    Moonman, Eric

    Cronin, John

    Hughes, Roy (Newport)

    Morris, Alfred (Wythenshawe)

    Cryer, Bob

    Hunter, Adam

    Morris, Charles R. (Openshaw)

    Davidson Arthur

    Irvine, Rt Hon Sir A. (Edge Hill)

    Moyle, Roland

    Davies, Bryan (Enfield N)

    Irving, Rt Hon S. (Dartford)

    Murray, Rt Hon Ronald King

    Davies, Ifor (Gower)

    Janner, Greville

    Newens, Stanley

    Davis Clinton (Hackney C)

    Jay, Rt Hon Douglas

    Noble, Mike

    Deakins, Eric

    Jeger, Mrs Lena

    Oakes, Gordon

    Dell, Rt Hon Edmund

    Jenkins, Hugh (Putney)

    Ogden, Eric

    Dempsey, James

    John, Brynmor

    Orbach, Maurice

    Doig Peter

    Johnson James (Hull West)

    Ovenden, John

    Dormand, J. D.

    Jones, Alec (Rhondda)

    Palmer, Arthur

    Douglas-Mann, Bruce

    Jones, Barry (East Flint)

    Park, George

    Dutfy, A. E. P.

    Jones, Dan (Burnley)

    Parker, John

    Dunnett, Jack

    Judd, Frank

    Pavitt, Laurie

    Edge, Geoff

    Kaufman, Gerald

    Pendry, Tom

    Edwards, Robert (Wolv SE)

    Kelley, Richard

    Perry, Ernest

    Prentice, Rt Hon Reg

    Spriggs, Leslie

    Watkins, David

    Price, William (Rugby)

    Stallard, A. W.

    Watkinson, John

    Rees, Rt Hon Merlyn (Leeds S)

    Stoddart, David

    Wellbeloved, James

    Richardson, Miss Jo

    Stott, Roger

    White, Frank R. (Bury)

    Roberts, Albert (Normanton)

    Strang, Gavin

    White, James (Pollok)

    Robinson, Geoffrey

    Summerskill, Hon Dr Shirley

    Whitehead, Phillip

    Roderick, Caerwyn

    Swain, Thomas

    Whitlock, William

    Rodgers, George (Chorley)

    Taylor, Mrs Ann (Bolton W)

    Wigley, Dafydd

    Rooker, J. W.

    Thomas, Dafydd (Merioneth)

    Willey, Rt Hon Frederick

    Roper, John

    Thomas, Jeffrey (Abertillery)

    Williams, Alan (Swansea W)

    Rose, Paul B.

    Thomas, Mike (Newcastle E)

    Williams, Alan Lee (Hornch'ch)

    Ross, Rt Hon W. (Kilmarnock)

    Thomas, Ron (Bristol NW)

    Williams, Sir Thomas (Warrington)

    Ryman, John

    Thorne, Stan (Preston South)

    Wilson, Alexander (Hamilton)

    Sandelson, Neville

    Tierney, Sydney

    Wilson, William( Coventry SE)

    Sedgemore, Brian

    Tinn, James

    Wise, Mrs Audrey

    Shaw, Arnold (Ilford South)

    Tomlinson, John

    Woodall, Alec

    Sheldon, Robert (Ashton-u-Lyne)

    Tomney, Frank

    Woof, Robert

    Short, Mrs Renée (Wolv NE)

    Torney, Tom

    Wrigglesworth, Ian

    Silverman, Julius

    Urwin, T. W.

    Young, David (Bolton E)

    Skinner, Dennis

    Wainwright, Edwin (Dearne V)

    Small, William

    Walden, Brian (B'ham, L'dyw'd)

    TELLERS FOR THE AYES:

    Smith, John (N Lanarkshire)

    Walker, Terry (Kingswood)

    Mr. Donald Coleman and

    Snape, Peter

    Ward, Michael

    Mr. John Ellis.

    Spearing, Nigel

    NOES

    Alison, Michael

    Gower, Sir Raymond (Barry)

    Miscampbell, Norman

    Arnold, Tom

    Gray, Hamish

    Moate, Roger

    Atkins, Rt Hon H. (Spelthorne)

    Griffiths, Eldon

    Montgomery, Fergus

    Awdry, Daniel

    Grist, Ian

    Moore, John (Croydon C)

    Beith, A. J.

    Grylls, Michael

    More, Jasper (Ludlow)

    Bell, Ronald

    Hall-Davis, A. G. F.

    Morgan, Geraint

    Bennett, Sir Frederic (Torbay)

    Hamilton, Michael (Salisbury)

    Morgan-Giles, Rear-Admiral

    Benyon, W.

    Hampson, Dr Keith

    Morris, Michael (Northampton S)

    Biffen, John

    Hannam, John

    Morrison, Hon Peter (Chester)

    Biggs-Davison, John

    Harvie Anderson, Rt Hon Miss

    Mudd, David

    Blaker, Peter

    Hawkins, Paul

    Neave, Alrey

    Boscawen, Hon Robert

    Hayhoe, Barney

    Nelson, Anthony

    Bottomley, Peter

    Hicks, Robert

    Neubert, Michael

    Bowden, A. (Brighton, Kemptown)

    Higgins, Terence L.

    Newton, Tony

    Braine, Sir Bernard

    Holland, Philip

    Nott, John

    Brittan, Leon

    Hooson, Emlyn

    Onslow, Cranley

    Brocklebank-Fowler, C.

    Howe, Rt Hon Sir Geoffrey

    Oppenheim, Mrs Sally

    Brotherton, Michael

    Howell, David (Guildford)

    Page, Rt Hon R. Graham (Crosby)

    Brown, Sir Edward (Bath)

    Howells, Geraint (Cardigan)

    Pardoe, John

    Bryan, Sir Paul

    Hunt, David (Wirral)

    Parkinson, Cecil

    Buchanan-Smith, Alick

    Hunt, John (Bromley)

    Penhaligon, David

    Buck, Antony

    Hurd, Douglas

    Percival, Ian

    Budgen, Nick

    Hutchison, Michael Clark

    Prior, Rt Hon James

    Bulmer, Esmond

    James, David

    Pym, Rt Hon Francis

    Burden, F. A.

    Jenkin, Rt Hon P. (Wanst'd & W'df'd)

    Rathbone, Tim

    Chalker, Mrs Lynda

    Jessel, Toby

    Rees-Davies, W. R.

    Channon, Paul

    Jones, Arthur (Daventry)

    Renton, Rt Hon Sir D. (Hunts)

    Churchill, W. S.

    Jopling, Michael

    Renton, Tim (Mid-Sussex)

    Clark, Alan (Plymouth, Sutton)

    Joseph, Rt Hon Sir Keith

    Ridsdale, Julian

    Clarke, Kenneth (Rushcliffe)

    Kilfedder, James

    Rifkind, Malcolm

    Clegg, Walter

    King, Evelyn (South Dorset)

    Rippon, Rt Hon Geoffrey

    Cockcroft, John

    King, Tom (Bridgwater)

    Roberts, Michael (Cardiff NW)

    Cooke, Robert (Bristol W)

    Kitson, Sir Timothy

    Roberts, Wyn (Conway)

    Cope, John

    Knight, Mrs Jill

    Ross, Stephen (Isle of Wight)

    Corrie, John

    Knox, David

    Ross, William (Londonderry)

    Costain, A. P.

    Lamont, Norman

    Host, Peter (SE Derbyshire)

    Craig, Rt Hon W. (Belfast E)

    Lane, David

    Sainsbury, Tim

    Davies, Rt Hon J. (Knutsford)

    Langford-Holt, Sir John

    St. John-Stevas, Norman

    Dean, Paul (N Somerset)

    Latham, Michael (Melton)

    Shaw, Giles (Pudsey)

    Dodsworth, Geoffrey

    Lawrence, Ivan

    Shepherd, Colin

    Douglas-Hamilton, Lord James

    Le Marchant, Spencer

    Sinclair, Sir George

    Drayson, Burnaby

    Lester, Jim (Beeston)

    Skeet, T. H. H.

    Dunlop, John

    Lewis, Kenneth (Rutland)

    Smith, Cyril (Rochdale)

    Durant, Tony

    Lloyd, Ian

    Smith, Dudley (Warwick)

    Eden, Rt Hon Sir John

    Luce, Richard

    Speed, Keith

    Eyre, Reginald

    McCrindle, Robert

    Spence, John

    Fairbairn, Nicholas

    Macfarlane, Neil

    Spicer, Michael (S Worcester)

    Fletcher-Cooke, Charles

    McNair-Wilson, M. (Newbury)

    Sproat, lain

    Fookes, Miss Janet

    Madel, David

    Stainton, Keith

    Fowler, Norman (Sutton C'f'd)

    Marshall, Michael (Arundel)

    Stanbrook, Ivor

    Fox, Marcus

    Marten, Nell

    Stanley, John

    Fry, Peter

    Maudling, Rt Hon Reginald

    Steel, David (Roxburgh)

    Gardiner, George (Reigate)

    Mawby, Ray

    Steen, Anthony (Wavertree)

    Gardner, Edward (S Fylde)

    Maxwell-Hyslop, Robin

    Stewart, Ian (Hitchin)

    Gilmour, Rt Hon Ian (Chesham)

    Mayhew, Patrick

    Stokes, John

    Glyn, Dr Alan

    Meyer, Sir Anthony

    Stradling Thomas, J.

    Gorst, John

    Miller, Hal (Bromsgrove)

    Taylor, R. (Croydon NW)

    Gow, Ian (Eastbourne)

    Mills, Peter

    Tebbit, Norman

    558

    559

    Temple-Morris, Peter

    Wakeham, John

    Wood, Rt Hon Richard

    Thatcher, Rt Hon Margarat

    Walder, David (Clitheroe)

    Young, Sir G. (Ealing, Acton)

    Townsend, Cyril D.

    Walker, Rt Hon P. (Worcester)

    Younger, Hon George

    Tugendhat, Christopher

    Wall, Patrick

    van Straubenzee, W. R.

    Warren, Kenneth

    TELLERS FOR THE NOES

    Vaughan, Dr Gerald

    Weatherill, Bernard

    Mr. Carol Mather and

    Viggers, Peter

    Whitelaw, Rt Hon William

    Mr. Fred Silvester.

    Wainwright, Richard (Colne V)

    Wiggin, Jerry

    Question accordingly agreed to.

  Schedule 5

    ENACTMENTS REPEALED
    Amendment made: No. 113, in page 34, line 9, column 3, before 'Section 43(2)' insert—
    'In section 34(1)(i), the word "and".'.—[Mr. Ennals.]
    Order for Third Reading read. [Queen's Consent, on behalf of the Crown, signified.]
    Mr. Speaker: Before I call the right hon. Gentleman to move the Third Reading, may I make a brief appeal to hon. Members? We have one-and-a-quarter hours of debate on Third Reading and a number of hon. Members wish to speak. Therefore, I appeal to all Back Bench Members—and I am sure that my words will also be heard by those on the Front Benches—to recognise that other hon. Members wish to make contributions.
    9.45 p.m.
    Mr. Ennals: I beg to move, That the Bill be now read the Third time.
    It is almost six months since the House gave a Second Reading to the Bill, and almost a year since my right hon. Friend the Member for Blackburn (Mrs. Castle) worked out with representatives of the medical and dental professions, through the intermediary of Lord Goodman, the principles by which we would give effect to our manifesto commitment to
    "phase out private practice from the hospital service."
    Those were the words in our February manifesto. We stand by them. What we were prepared to discuss was the mechanism for achieving our essential aim: that is what the Goodman compromise proposals were all about. They were a compromise; a middle course. And since those proposals were drawn up I have stuck firmly to the middle of the road—though I am increasingly con-
    560
    scious of the fact that the middle of the road is a place where one is liable to get hit by traffic coming both ways.
    The Government have been criticised on the one hand by those who wish to see an immediate separation of private practice and, in some cases, its complete abolition and, on the other, by those who would prefer to defend a position of privilege. We have met these criticisms from the firm and unshakeable position that, as a Government, we stand by the undertaking given last December: that if the Goodman proposals proved acceptable to the profession as a basis for legislation, we would incorporate them in statute, recognising that the profession would reserve its right to try to influence Parliament's decision on the principle of phasing out. It has sought to do that, assisted by the Opposition. That is what we said we would do. That is what we have done.
    I have constantly upheld the principles and spirit of the Goodman proposals but, as I said on Second Reading, I would not adopt an unbending attitude to amendments genuinely designed to improve the Bill. On that, too, the Government have kept their word.
    I need hardly remind the House of the very long and careful scrutiny which the Bill received in Standing Committee D during the summer. In all, the Committee met 29 times and, as a result of its labours and the further examination the House has given yesterday and today, I think we can confidently claim that the Bill has been appreciably improved.
    I suspect from his statements and hints that the right hon. Member for Wanstead and Woodford (Mr. Jenkin) has been paving his way to saying that the Bill has not had adequate attention because of the timetable motion. Had there not been a timetable motion we would not have had the opportunity we had in Committee of careful examination—we even had the final sitting left over. On Report, but for so many Second Reading speeches from Conservative Members, we should have been able to deal with far

    561
    more amendments than we have dealt with today.
    Before asking the House to give the Bill a Third Reading I should like briefly to remind hon. Members what the Bill seeks to do and—just as important—what it does not seek to do. It is not and never has been this Government's policy to abolish private medical practice. What we promised the electorate—in two General Elections—was that we would separate private practice from the National Health Service. We were convinced, and we remain convinced, that the co-existence of private practice and NHS practice in our hospitals would not be a peaceful co-existence. On the contrary, it had become a constant source of grievance, recrimination and sometimes serious industrial unrest, with action and counteraction by the medical profession and other health service employees. All this meant damage to the health service and risk to the lives and health of the patients it exists to serve. No responsible Government could allow such a situation to continue.
    Some hon. Members opposite may think the problem could be solved by ignoring it—that is the talk they often pursue. That is their favourite policy prescription. Like their defence of privilege, it is the essence of Conservatism. But we were determined to deal with this festering sore once and for all, so that we could protect the interests of patients, put an end to industrial unrest and restore the morale of the service.
    Mr. Julian Ridsdale: I have spent time in hospital recently, and what the right hon. Gentleman is saying is far from the truth. The medical profession looks after people fairly and reasonably. He is making a complete exaggeration of what is happening in hospitals.
    Mr. Ennals: I am glad that the hon. Gentleman has just joined the debate. I am glad that he has recovered from his illness. I am sure that he had excellent treatment from the doctors. Several hon. Members spent some time in hospital during the Summer Recess and they all received excellent treatment, as I have done myself. I have said nothing against the treatment given in our hospitals, but I thank the hon. Gentleman for his strange intervention.
    562
    None of this could be achieved unless we phased out pay beds and ended the scandal of queue jumping. But from the very start my right hon. Friend and predecessor the Member for Blackburn made it clear that it was in the interests of patients and the service that the separation should take place in a reasonable and orderly manner. In the Government's view, the Goodman proposals will do precisely that.
    First, they provide for the early elimination of the many pay beds which have been seriously under-used—1,000 beds will be phased out in the first six months. Secondly, they provide for the progressive withdrawal of the remaining beds on the recommendation of an independent board working within the principles approved by Parliament—principles which leave reasonable time for those who wish to do so to make alternative arrangements for private practice, but outside the NHS. Thirdly, the Goodman proposals—proposals which, as I said, have been embodied in this Bill—were acceptable as a basis for legislation to the majority of those who participated in the consultants' ballot, although the majority also opposed phasing out on principle.
    These points, taken together, mean that we can achieve, in an orderly way, our aim of removing a major source of dissension and dispute from the health service. That is the answer to the right hon. Member for Wanstead and Woodford and his hon. Friends when they say that the Bill is irrelevant to the needs of the NHS. On the contrary, it is essential to those needs.
    I said earlier that the Government had been taken to task from both sides of the House. I know that some of my hon. Friends feel that the Bill does not go far enough, in particular that it should set a time limit on the separation of pay beds—they stated their view quite clearly in the Division Lobby yesterday. They fear that, without a final date, pay beds may continue indefinitely in our hospitals, especially if the private sector is slow to make alternative arrangements But the Bill is quite clear.
    Clause 2 makes the purpose of the Bill and the task of the board crystal clear—the progressive withdrawal and separation of private practice from NHS hospitals. The board has a duty to supervise this phasing out and to make regular reports

    563
    which will be available to the House. Clause 4 provides the board with guidelines which leave no doubt that if the private sector fails to take reasonable steps to provide alternative facilities, that failure in itself is ground for phasing out the particular private facilities concerned.
    So my hon. Friends may rest assured that our intentions will not be frustrated. We are determined to uphold the principles on which the National Health Service was founded—the principle that health care is not a commodity like any other to be sold in the market place to the highest bidder, but that it is a human right to be enjoyed equally by all without regard to their financial power, the principle that health care should be free at the point of use and available equally to all on the basis of medical priority alone; the principle that there should not be one standard of care for the rich and another for the poor, but that there should be one standard. That is what we mean by a national health service.
    We will no longer endure the injustice of queue jumping. It is a scandal that has gone on long enough, and that is why Clause 6 lays a duty on the board to make recommendations to the Secretary of State within six months on achieving a common waiting list for NHS and private patients. The pay beds will go, but for the temporary period while some remain those who use them must be admitted on the same basis of medical priority as all other patients. Varicose veins and hernias hurt the poor just as much as the rich. That simple truth underpins this Bill.
    The professions have reserved the right to oppose the principles of the Bill and the Government have recognised that right. But, equally, the professions will recognise that they must accept the decision of Parliament that private medical practice will from now on be separated from NHS hospitals. That is our policy. It has been endorsed twice by the electorate and I commend it to the House both because it is right in principle and because it offers the opportunity for doctors and all other staff in our hospitals to work together in a spirit of co-operation, providing the highest possible standard of health care for our people
    564
    in what we can at last truly call a National Health Service.
    9.56 p.m.
    Mr. Patrick Jenkin: I had not intended to refer to the guillotine under which we have debated a large part of the Committee stage and the whole of the Report stage, but the Secretary of State's remarks leave me with no option. He said that in the Committee stage we finished with a sitting left over at the end. If that is how he uses it, that is the last time I shall make a bargain with him. We agreed at his request that we should finish the last sitting at lunch time. The debates on the new clauses were extremely short in order to enable the Government to complete the Committee stage by lunch time.
    We have now finished the Report stage with over 50 amendments totally undiscussed, including some of the Government amendments—which certainly in one case made a substantial change in the Bill—and most of the amendments which were debated in Committee and defeated only by the Chairman's casting vote. We have not had a word about any of those.
    As to the Secretary of State's comment about Second Reading speeches, we spent five hours yesterday, one for one, from either side of the debate, on the amendment moved by his hon. Friend the Member for Brent, South (Mr. Pavitt). The guillotine has undoubtedly severely curtailed debate on the Bill. No doubt note of this will be taken in another place.
    But a Third Reading is a welcome occasion because it provides the opportunity to express thanks to one's hon. Friends who have played a very notable part in the proceedings on the Bill. I thank my hon. Friend the Member for Reading, South (Dr. Vaughan), who brings not only a deep humanity but a very considerable knowledge to the subject. I am sure that my other hon. Friends will forgive me if I mention my hon. Friend the Member for Ealing, Acton (Sir G. Young), who acted also as Whip on the Committee and made a most valuable contribution to the debates.
    I thank, too, the hon. Member for Preston, South (Mr. Thorne) and his hon. Friend the Member for Barking (Miss Richardson), because they served

    565
    throughout our proceedings as the headlight beaming ahead down the wrong road, showing us where we would go if we followed their recipes.
    Mr. Thorne: That is praise indeed.
    Mr. Jenkin: The hon. Gentleman may take it as he wishes. I also pay tribute to the hon. Member for Brent, South, who provided us with one of the new concepts coming from the Labour Benches. He has never been slow to remind us how many years of study he has made of health matters. He coined the remarkable classification of patients not as National Health Service and private patients but as deserving and undeserving patients. From the Labour Benches we now have, in addition to the undeserving poor, the undeserving sick.
    It is right that I should set out in the Third Reading my party's view on the Bill. We believe that on balance it has been to the advantage of the National Health Service and of the ordinary National Health Service patient that consultants have been able to treat their private patients in the same hospitals as they treat their NHS patients. We believe, therefore, that the system should continue.
    We believe, too, that at a time when the acute services in the NHS are under very great strain due to the virtual standstill on resources, it is an act of consummate folly deliberately to throw away the revenue which pay beds bring in.
    More fundamentally, we believe that the concept which my hon. Friend the hon. Member for Bromsgrove and Red-ditch (Mr. Miller) described as "medical apartheid"—the concept embodied in the Bill—inevitably will lead to just those double standards which the Secretary of State said that it was his intention to avoid. We shall have a vigorous, efficient, well-equipped private sector financed by the market through the growth of provident funds contrasting with a struggling, inadequate and overburdened public sector financed by taxation. As the gap widens, as inevitably it will, so will the best talent not only of doctors but of nurses, radiographers, therapists and others be attracted into the private sector. Success will create its own momentum, and the process will intensify. Within a few years, this system of medical apart-
    566
    heid will have returned this country to the pre-1948 situation when the voluntary hospitals provided first-class care and attracted first-class talent while the municipal hospitals were almost always the poor relations.
    This dilemma is there, and the gut Socialist reaction to it has been to ban independent medicine altogether. The House will remember that yesterday, in speech after speech by Government supporters sitting below the Gangway, they advocated precisely that authoritarian Marxist solution. It is also the policy which has been adopted repeatedly by Labour Party Conferences. The Government's answer was a different one. Although not going as far as an outright ban, their initial reaction was to put an absolute ceiling on the size of the private sector at its March 1974 level. Something else which is sometimes forgotten is that they also proposed to ban advertising of independent medical, surgical or maternity facilities to the general public.
    Even the right hon. Member for Blackburn (Mrs. Castle) was forced to concede that that was not compatible with the kind of free society in which she at any rate believes. It would make the provision of additional medical care outside the National Health Service a criminal offence like trafficking in narcotics or selling pornography to juveniles.
    Instead, we have in the Bill the watered-down Socialism of Part III—a new quantity licensing system which Ministers justify wholly on account of the need to protect the health service. But what can one think of a philosophy of medicine which is viable only if citizens of this country who already pay their full taxes for the National Health Service have to go on bended knee to the authorities for permission to make separate health provision above a certain size?
    Of course, there must be quality control. No one disputes that. But quantity control is just one more nail in the coffin of the plural society about which the right hon. Member for Birmingham, Stechford (Mr. Jenkins) spoke earlier this year.
    Yet without restraint, the dilemma remains—a steadily widening gap between standards of care in private medicine and standards in the National Health Service.

    567
    It is no accident that today a growing number of the new subscribers to the provident funds are people who have had an unhappy experience as National Health Service patients and are determined to avoid a repetition.
    What is the way ahead? Surely it must be to abandon the concept of medical apartheid. This Bill goes diametrically in the wrong direction. As The Times said after the publication of the right hon. Lady's consultative document in August 1975,
    "The wiser course has always been to interweave them if anything more closely so that they could share, with a proper division of cost, the use of scarce resources both of facilities and manpower. In that way private medicine could benefit from some of the specialised facilities of the NHS, and the money flowing into private medicine might be used to irrigate the British medical system more generally."
    We agree with that philosophy.
    A future Conservative Government will therefore reverse the policy of phasing out pay beds. We want to keep the best consultants in the National Health Service and not drive them out. We want to increase the flow of money to the National Health Service hospitals, not to reduce it. We want to ensure that the best care for all National Health Service patients is available in National Health Service hospitals.
    We have heard much about queue-jumping, by which in practice one means having two queues, one for private patients and one for National Health Service patients. The Tribune Group's remedy is simple—have only one queue. In the view of its members all private medicine must be outlawed. Although it is wholly abhorrent to those who believe in a plural society and a free society, that remedy has a certain cold logic.
    The Government's remedy is wholly without logic. What they say is that two queues are all right provided they are at different hospitals. That amounts to the old doctrine of "Out of sight, out of mind". Provided the other queue is somewhere down the road, it does not matter how many people jump it. What is offensive, according to the Government, is not that one patient should be treated ahead of another—that will certainly happen under the Bill—but that people
    568
    should see that that patient is being treated ahead of another. That is nothing more nor less than the politics of envy. That is what the Bill is all about.
    We on the Conservative Benches are not interested in envy. The real evil is the size of the waiting lists. No other country suffers waiting lists like ours. No other country faces the prospect of waiting lists growing longer and longer month by month. For us, therefore, the real question about two queues is how to shorten the waiting lists for everybody. One way not to do it is to shorten the number of hours that consultants spend in National Health Service hospitals, which is one certain effect of the Bill.
    The remedies lie not in pandering to the politics of envy but in improving the efficiency of hospitals, cutting down the length of hospital stays and increasing bed usage, all of which must depend, in some measure at least, on creating the right pressures and incentives within the NHS to ensure the most effective use of resources. For that reason we are examining in some depth how other EEC countries and developed Commonwealth countries deal with these problems. We are examining alternative methods of health financing, perhaps involving greater dependence on insurance.
    Clearly, major changes must await the Royal Commission, but it is already clear that if the health service is to survive and to go on making its vital contribution to the nation's health, we must recognise that changes are needed. The assumption on which Lord Beveridge and Aneurin Bevan based their proposals—that as the nation's health improved demand would be reduced—has not been borne out. Instead we have what is called the infinity of demand having to be met by finite resources.
    Of one thing we can be sure, that the Bill is wholly irrelevant to these major questions that confront the health service. It is nothing less than tragedy that so much of the energy of Ministers, officials, Parliament, trade unions and others should have been expended on such a fruitless effort, a product of nothing more than blind prejudice. I invite my right hon. and hon. Friends to divide against the Bill when the guillotine falls.
    10.9 p.m.
    Mrs. Castle: It is obviously a matter of very great pleasure to me that a Bill which saw the light of day under my administration should now be reaching the end of its journey through the House. I want very sincerely to congratulate my right hon. Friend the Secretary of State on standing firm behind the principles which inspired the Bill.
    I am sure that he will be the first to join me in congratulating also, in his absence, my right hon. Friend the Member for Plymouth, Devonport (Dr. Owen), who did such a brilliant job in Committee—as I know my right hon. Friend the Secretary of State agrees—in carrying all the detailed work. I am well aware of what I owe to him as my right-hand man when I was Secretary of State. It is only right to place on record the great debt that the National Health Service owes to him.
    We have reached the end of one of the most protracted discussions on any Bill of similar length that I have known in my 31 years in Parliament. We have had a guillotine so generous that it has exceeded life itself. It has given us a massive amount of time and full opportunity to explore every nook and cranny of the Bill. Indeed, those of us who served on the Standing Committee know that during the Report stage we have been retracing ground which was exhaustively covered in detail in Committee. In fact, we have retraced that ground to the point of utter tedium to Members on both sides who served on the Committee. I fully accept the right of other hon. Members who did not serve to join in the discussions, but I would point out that tedious repetition has been caused by the procedures of the House.
    Mr. Speaker: Order. May I inform the right hon. Lady, because I made the selection of amendments, that 56 amendments were carried in Committee by the casting vote of the Chairman? In these circumstances, it is customary to call such amendments on Report.
    Mrs. Castle: Out of my eternal and deep respect for you, Mr. Speaker, I was going to make that point and say that because of the procedures of the House this repetition was an inescapable necessity because decisions in Committee were made by the casting vote of the Chairman.
    570
    Under our curious procedures we were level-pegging in Standing Committee. The hon. Member for Ealing, Acton (Sir G. Young) admitted earlier this evening, rather regretfully I thought, that, now that the Bill has been brought back into the gladiatorial contest on the Floor of the House, the majorities have been larger than they were in Committee. It has been extremely interesting to note the votes tonight. We have had three Divisions and we could have had a great many more if the Opposition had dared to continue to put the issues to the test. In the three Divisions we had, the majorities on the Floor of the House were all higher than the majority on Second Reading, which shows that as a result of the exhaustive examination of the Bill the House has become more convinced of its merit, and not less convinced. All the efforts of the right hon. Member for Wanstead and Woodford (Mr. Jenkin), who led for the Opposition with such passion, have resulted merely in convincing more hon. Members that he is wrong.
    Support for the Bill has increased, not diminished, as it has gone through the parliamentary process. Earlier this evening there was a very significant vote on the major principle embodied in Clause 2—the principle of phasing out. That principle of separation was endorsed by the House by 29 votes. I hope very much that this fact will be noted in another place. The right hon. Gentleman, with his customary incendiary tendencies, tried to insult another place with pathetic pleas that we had not properly considered this measure and that it had not been properly dealt with by this House. A majority of 29 can hardly be called a minority attitude of this House.
    We all know that on Report, as a result of the lengthy discussions at earlier stages, we have not, to my intense regret, had a rediscussion of Part III, which deals with licensing. I have no doubt that the right hon. Member for Wanstead and Woodford is already calculating in his brain how he can persuade their Lordships, when it comes to their turn, that there has not been proper discussion of the principle of licensing of the private sector, that it was not in the Labour Party's manifesto and that their Lordships ought to throw it out.
    Therefore, through the right hon. Gentleman, I should like to remind their

    571
    Lordships that we had adequate discussion in Committee of the licensing sections of the Bill. Indeed, so adequate was the discussion that the Opposition ran out of arguments before we ran out of time. We had a situation in Committee when, under the guillotine, another half day of discussion would have been available. Some of my hon. Friends, including me, pleaded to be allowed to go to the full span of time. Unfortunately, there was not enough argument left in the Opposition's lockers to keep the Committee going for the full length of the guillotine. Therefore, I say advisedly to the right hon. Member for Wanstead and Woodford that he should not try any incendiary nonsense about any part of the Bill not having been adequately discussed or backed by adequate majorities.
    I repeat, we are talking about a bargain. This House has endorsed the bargain. Nothing has been included in the Bill that was not included in the bargain that was struck. When the Opposition try to throw out the licensing provisions, let them remember that part of the bargain. The authenticity of those provisions comes from the Goodman proposals. That is what validates them. When we—I, as my right hon. Friend's predecessor, and my right hon. Friend the then Minister of State—discussed how to reconcile the Government's commitment to phase pay beds out of National Health Service hospitals with our desire to do it peaceably by democratic means, we struck a bargain. I made great compromises. Of course, I would have preferred my consultative document. All my hon. Friends know that. But I made sacrifices for the sake of a peaceful acceptance by the medical profession that this was a matter for Parliament to decide. It is odd that we should have to make major policy compromises to persuade the medical profession to leave the decision to Parliament, but that is what we had to do. I did it for the sake of the NHS because I knew that it was being torn in two.
    The Opposition have talked about the interests of patients. It was I who, in that situation, put the interests of patients and peace in the NHS first. I warn the Opposition that, if they carry on this battle as though that bargain had not been struck, they will be jeopardising
    572
    peace and setting law and order at naught. I say that advisedly to those who may be contemplating such action in another place.
    I should like to remind the House of the terms of the bargain that was struck. I quote from paragraph 3 of the Goodman proposals:
    "Despite its continuing opposition"—
    fair enough; nobody objects to that—
    "the medical and dental professions acknowledge that the phasing out of pay beds in NHS hospitals may, through legislation, become the will of Parliament. In that event the phasing out should he subject to the safeguards outlined below".
    Every one of those safeguards—nothing else—is embodied in the Bill. I ask both Houses to think seriously on that. The will of Parliament has been clearly expressed.
    The safeguards stand or fall as a whole. One is that the Government need to be satisfied that the development of the private sector will not jeopardise the interests of NHS patients. If someone attempts to split the safeguards and pick and choose, the whole issue of war or peace will be opened again. The message going out from here tonight is that this democratically-elected House of our Parliament has said that it believes the time has come to phase pay beds out of NHS hospitals and that, in doing so, it wishes not to abolish private practice but to make it stand on its own feet.
    The right hon. Member for Wanstead and Woodford made great play of the fear that the Bill would result in the development of two standards in medicine and the creation of a medical apartheid. But there has been a financial apartheid written into the heart of our NHS. There have always been two standards.
    We all know of people close to us who have been worried not about a major crisis or emergency operation but about an important operation which could have enduring effects if it were not carried out rapidly and who have been told that they would have to wait two or three years under the NHS but that they could have the operation done next week if they were willing to pay.
    The right hon. Member for Wanstead and Woodford said that our philosophy on private practice was "out of sight, out

    573
    of mind". Private practice has been bolstered by the massive resources of the NHS, and the proper epigram should be "out of subsidy, out of existence".
    I do not believe that the separation of pay beds from the NHS will lead to the building up of a great separate private health service. The people of this country could not afford the economic cost of meeting their whole medical care without the sustenance of the public financed NHS. Perhaps a few Arab potentates or, dare I say it, Lady Beaverbrook might be able to afford it. Those people might fill the London Clinic and other such places, but 99 per cent. of our people have depended on the National Health Service, free at the point of use, and will continue to do so. When they get into an inconvenient or uncomfortable situation, perhaps with tonsillitis or a hernia, they have to take their turn in a medical queue.
    We believe that is the only way to unify society, and in the present acute economic emergency society must be unified or it will fall.
    10.24 p.m.
    Mr. Thompson: I congratulate the Secretary of State on guiding the Bill through the House, but I cannot say the same for Labour Members from Scotland. They have not been much in evidence in our debates. The hon. Member for Edinburgh, West (Lord James Douglas-Hamilton) and I have constituted the Scottish representation on the Bill most of the time.
    The Bill does not take away from the wealthy or the less wealthy the freedom to pay for private medical practice if they wish to spend their money in this way. The Bill accords well with SNP policy. Our stated health policy is to phase out pay beds within the Scottish health service. But we envisage a separate private sector that is serviced by part-time consultants. I do not think that Scotland could support full-time consultants in private practice, a private sector having minimum standards of staffing and facilities prescribed for it to ensure the proper care of private patients. I very much hope that after independence our Scottish health service will be so good that the desire for private treatment will
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    decrease over the years and perhaps in the end fade away entirely.
    The SNP was accused yesterday of having the expectation that manna will fall from Heaven and that the millennium will be ushered in by the attainment of Scottish independence. That is not so. I do not share the Utopian expectations of the Marxists. If we are bidden by William Blake to strive to build the new Jerusalem here below, I rather incline to the opinion of St. John the Divine that the new Jerusalem will in part at least come down from Heaven. I believe, however, that we must strive, and the Bill seems to be part of the striving, to bring fair treatment to the common folk of our respective countries.
    I have several times said during our debates on the Bill that it has a special relevance to England. That is because Scotland has relatively few pay beds. Galloway, which is my own constituency, has none. If, in helping in the phasing out of pay beds in Scotland, we have helped forward the cause of the common folk of England in their struggle against privilege, and if there is a politics of envy, there is also a politics of privilege that is represented by the Tory Party. If we see that we have helped on the cause of the common folk of England, that gives an added pleasure to the work we have accomplished on the Bill. My hon. Friends and I will support it on Third Reading.
    10.27 p.m.
    Mr. Thorne: I approached the Bill some time ago in the expectation that a real attack on privilege was to be made. However, on reading the Bill before it went into Committee it was apparent that that was not to be the case in the terms that some of us had envisaged. Therefore, in the early stages in Committee we approached various problems with mixed feelings. We were concerned—my hon. Friend the Member for Barking (Miss Richardson) and myself in particular—about the apparent support for private medicine that appeared to be contained within the Bill. We were anxious to proceed with the phasing out of pay beds as expeditiously and efficiently as possible. That was a manifesto commitment. Unhappily, the Bill had

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    no target date—nor did the manifesto. We have already debated that during the past 48 hours.
    We all know that the Bill now refers to 1,000 beds that have been largely under-used recently. It seems that when the Bill becomes an Act we shall have to be concerned with two major areas. We shall have to apply considerable vigilance if we are to achieve even the modicum of advance that my right hon. Friend the Member for Blackburn (Mrs. Castle) has always argued will be possible should we accept the Bill. The two specific areas relate to the activities of the board in phasing out the further beds following the 1,000. It seems that the House will continually have to address itself to the progress that is being made by the board in that task.
    As has been said before, the price of freedom is eternal vigilance. I point out to my right hon. and hon. Friends that we shall need to apply that vigilance to the board's progress.
    I am also concerned—I do not think I am on my own—about the Bill's contents relating to private medicine. I believe that we could well see a mushrooming of private medicine. Here I part company with my right hon. Friend the Member for Blackburn. I think that it is possible for certain organisations, individuals and collectivities within Britain to amass enough capital to give a considerable fillip to private medicine in Britain. I believe that it can stand on its own feet. What I deplore is that the resources that will then be used by that amassed capital are resources that should go to the NHS for the use of the majority of the people.
    It is in those two areas that I feel a certain degree of scepticism. Hope springs eternal. I have promised to be brief. I am a little sad in saying that probably hope is all that some of us have left in regard to the Bill. It is only hope that will persuade me to vote for the Third Reading—and then urge upon my hon. Friends, as I have said, the maximum vigilance about the progress of the Health Services Board in carrying out its tasks.
    10.31 p.m.
    Lord James Douglas-Hamilton: I should like to express gratefulness to the Secretary of State for one amendment that
    576
    was accepted in Committee—that account be taken of representations made by interested parties in Scotland to the Scottish Committee. I am at least thankful for small mercies.
    I should like to tell the hon. Member for Galloway (Mr. Thompson) that half of the area health boards in Scotland have pay beds. They are much in use. In 1974–75 more than £500,000 of income came as a result of them.
    One problem that has been raised by the Bill is the prospect of loss of money for research purposes. A few days ago the Secretary of State wrote to my right hon. Friend the Member for Wanstead and Woodford (Mr. Jenkin) saying that at least £50,000 would be lost. He did not give any evidence in his letter. It may well be that the figure will be very much higher, because, as hon. Members appreciate, consultants give some of their fees towards research in teaching hospitals, and it seems that many private patients give a lot of money as well.
    One of the most poignant matters mentioned in the debate was when the hon. Member for Aberdeen, North (Mr. Hughes) said that a family had taken out a mortgage to get an operation. He said that if he were in a similar situation he might put aside his principles and do the same thing.
    The essence of our case can be summed up in one sentence. Rather than restrict opportunity, we want more opportunity for more people.
    10.33 p.m.
    Mr. Pavitt: Most hon. Members who served on the Standing Committee will heave a sigh of relief at the passing of the Third Reading stage. Of all the Committees on which I have served, the Committee on this Bill was unique. I have previously been in situations in which there has been a majority of one on the Government side. This was the first time I served on a Committee which was exactly even. The result of that was that on one occasion when, under the rules of procedure, the Chairman had to give a casting vote, it meant that the normal procedures for further sittings was defeated and we had to keep going on. One of the results of that was that we had more Second Reading speeches on amendments than have been made in

    577
    Committee on any other Bill with which I have been concerned.
    However, we continued with the Bill. I pay tribute to the Opposition's acting unpaid Whip, the hon. Member for Ealing, Acton (Sir G. Young), and to our paid Whip, my hon. Friend the Member for Stalybridge and Hyde (Mr. Pendry). I also add the customary tribute to the hon. Member for St. Albans (Mr. Goodhew), the Chairman of the Committee, because he had to sit at his place, with good humour, and listen to more nonsense than I have ever heard in relation to any other Bill.
    I want to put this matter in to perspective. We have been talking about a majority and a minority. The majority are the cases in the NHS, which in 1975 totalled 5,296,136. The minority sector which has been the subject of all the argument and conversation, in Committee, in the corridors, in the House and in the country, is the sector of privilege in which 97,641 cases were dealt with last year. I appreciate the fact that minorities always have rights, but the majority have more rights than the minority. That is what the Bill is about, and that is what the Third Reading has been about.
    The Opposition have argued strongly on the question of something being done about waiting lists and the ending of waiting lists. Clause 6 contains provisions for that. I hope that the medical profession will reverse its original decision. We pleaded with its members to do what we proposed, but they refused. I hope that the Opposition will add their voice and persuade the medical profession to implement this proposal.
    There will be a lot of talk over the next six months while 1,000 pay beds are being phased out, but the point made by my hon. Friend the Member for Preston, South (Mr. Thorne) is well taken. In six months' time we shall want to see progress, and six months after that we shall want to see more progress. I have been speaking for only two minutes tonight, but I assure the House that I shall speak a lot more unless we get the kind of results that we expect from the passage of the Bill.
    I congratulate my right hon. Friend the Secretary of State and add to his tribute to our right hon. Friend the Member for Plymouth, Devonport (Dr. Owen). I admired the way in which he steered so
    578
    much of the Bill through the Committee because my right hon. Friend the Secretary of State had to be at Cabinet meetings. The House owes a debt of gratitude to my right hon. Friend the Member for Devonport.
    10.36 p.m.
    Sir George Young: The House listened with interest to the threat that the right hon. Member for Blackburn (Mrs. Castle) made publicly to her husband in another place. While he may respond to it, I very much hope that others of their Lordships will not, because there is a fund of medical knowledge in the other place which should be focused on the Bill.
    I should like to put right something that was implied about support for the Bill. On Second Reading there was a majority of 20 in favour of it. Since then there have been by-elections, and tonight there have been majorities of between 25 and 29 in favour of the measure. I do not think it can be said that there has been a great tide of support for the Bill since the earlier occasion.
    I refer to the principles of the Bill which the Secretary of State set out on Second Reading. He said:
    "The separation of pay beds from the Service is the only solution that will end tension and conflict within the service."—[Official Report, 27th April 1976; Vol. 910, c. 204.]
    If I believed the right hon. Gentleman to be right I should not be so uneasy about the passage of the Bill, but he is wrong. I say that for two reasons. First, in the speeches of some of his hon. Friends yesterday we heard disgraceful language about the medical profession, and I propose to give some examples.
    The hon. Member for Aberdeen, North (Mr. Hughes) said that
    "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."
    The hon. Member for Sheffield, Hillsborough (Mr. Flannery) said:
    "they wish to capitalise on the sickness of their fellow human beings."
    Finally, there was the disgraceful speech of the hon. Member for Ormskirk (Mr. Kilroy-Silk), who referred to some consultants as
    "holding the sick to ransom,"
    being
    "more concerned with lining their own pockets, than they are with the health and welfare of,

    579
    their patients."—[Official Report, 12th October 1976; Vol. 917, cc. 325–39.]
    The hon. Gentleman referred finally to the "excrescence" of private practice in the National Health Service.
    If the Secretary of State believes that that provides a foundation for the resolution of tension and conflict—
    Mr. Robert Kilroy-Silk: Will the hon. Gentleman give way?
    Sir G. Young: No. These are the professional medical practitioners upon whom the Secretary of State has to rely if he is to build the service up to the standards that he wishes to see, and it is clear that there will be no resolution of tension and conflict while the medical profession continues to be attacked in the way that it has been by Labour Members below the Gangway.
    Mr. Kilroy-Silk rose—
    Sir G. Young: No. I wish to conclude my speech quickly.
    The second reason why this is not the end of the story is to be found in the peroration of the Secretary of State, when he said that he hoped the Bill would lead to the end of dual standards. It will do no such thing, because private practice will continue and there will be pressure on the right hon. Gentleman from his hon. Friends to curtail private practice. This is not the end of the story, but the beginning of another story, and there will be more tension and conflict because of the Bill than there would have been without it. The right hon. Gentleman is polarising dual standards to a far greater extent than would otherwise be the case. That is why I am sad that the Bill is going through. It is not the end of the story but is the beginning of another story.
    10.40 p.m.
    Mrs. Renée Short: I was not one of those fortunate enough to serve on the Standing Committee. [An HON. MEMBER: "Shame."] Yes, it was a shame. I should have been glad to be there with the hon. Gentleman. Nevertheless, the House has been able to hear the Opposition today and yesterday. I sat through most of yesterday's debate but was not able to
    580
    be called. One gets somewhat concerned at the repetition of certain tedious and jejune arguments by Conservative Members such as references to the politics of envy and a Marxist philosophy.
    The hon. Member for Ealing, Acton (Sir G. Young) attacked my hon. Friend the Member for Ormskirk (Mr. Kilroy-Silk) for his remarks about the attitude of certain consultants. No one on this side is saying that all consultants are rogues and rascals. What we are saying, and what we have documented evidence for, in spite of what the hon. Member for Birmingham, Edgbaston (Mrs. Knight) said yesterday, is that certain doctors are taking a good deal of advantage of the situation to make considerable amounts of money at patients' expense. By eliminating a number of private beds, we are restricting that opportunity to make money at the patients' expense.
    The fact that private practice is available and that waiting lists can be, have been and are being built up means that there is an incentive to allow waiting lists to expand in order to pressurise patients into going private and paying considerable fees. We have evidence of elderly patients with cataract, for example, being 18 months on the waiting lists, and of doctors saying "I am building up my waiting lists so that they will eventually go private."
    The hon. Member for Reading, South (Dr. Vaughan) had all that evidence, just as I had and all the other members of the Select Committee had, yet he chooses to say that all this evidence should be discounted and that it is not true. But the evidence came from members of his own profession. One supposes that, as a doctor, he assumes that all members of his profession are honourable men and that the evidence they submit should therefore be taken into account.
    We welcome this reduction in the number of pay beds. Opposition Members have made great play in recent days about public expenditure. One is surprised that they are not concerned that the NHS has been deprived of some money in return for the services it provides for consultants working with their private patients. We have evidence of the junior hospital doctors' time which is wasted. We have evidence of the time and resources of pathology laboratories

    581
    in hospitals being devoted to testing the samples of private patients. We have evidence about the use of out-patient departments. This is all without charge to the private patients but a burden on the NHS. [HON. MEMBERS: "Of course they pay."] No—hon. Members have not read the evidence. There is provision in the regulations for separate billing for all these services, but there is also a good deal of evidence that hospital administrators do not pursue the matter and that private patients do not pay for these additional services.
    I endorse what my hon. Friend the Member for Preston, South (Mr. Thorne) said, that we need to take a careful look at the way in which the board operates and private beds are phased out. Unless we are very careful, we shall see a two-tier service developing again and the clock put back to the position before the National Health Service was established if private practice is allowed to expand. We need to be vigilant.
    Several Hon. Members rose—
    Mr. Speaker: Order. May I remind the House that the Opposition Front Bench spokesman hopes to begin his reply at 10 minutes to 11 o'clock.
    10.45 p.m.
    Mrs. Knight: I shall confine myself to two points raised by the hon. Member for Wolverhampton, North-East (Mrs. Short). The first point I wish to make is that the passage of the Bill will make no difference at all to the waiting lists and may even make them worse because money is being diverted elsewhere. I detest the fact that in Birmingham, and I am sure in many other areas, people have to wait a quite unconscionable time before undergoing even simple operations. It will now take six months, or even nine months, for someone to receive care from a skin consultant in my area. During that time a person will be away from work. A child who needs a heart operation may have to wait so long that his life is endangered. None of these things will be altered by the passage of the Bill, and it is nonsense to suggest the contrary.
    Private patients have paid into the National Health Service as much as any other patients. The way some Labour Members talk, one would think that private patients do not pay tax. Private
    582
    patients have paid all, and more, than the ordinary NHS patient has paid. To talk about the facilities being available to those people as if there was something wrong with that is quite unjust and totally wrong.
    This is a sad day for the British medical profession and a sad day for the National Health Service. What we are doing tonight has nothing whatever to do with the welfare of patients. This is what we should be concerning ourselves with, not this politically-motivated load of rubbish that the Government have given us.
    10.47 p.m.
    Mr. Crouch: I do not feel terribly strongly about the question of private beds. The House must know this. I do feel strongly, however, about the preservation and improvement of the National Health Service. This tiny piddling Bill, which has lasted so long, will harm the service and the public it serves. In this brief intervention I cannot change the way the House will vote. It is difficult enough to cope with the Secretary of State. It is like trying to wrestle with a shadow. It is even more difficult to cope with a second shadow behind the right hon. Gentleman who makes an even longer speech.
    This measure will not improve the service in the care it gives to the sick. This is what upsets me most of all. The Bill seeks to bring about the removal of 1,000 beds now—and perhaps 2,000 or 3,000 later by regulation—from the private sector so as to produce a Socialist purge of the National Health Service. It I could believe that this would produce a better service for the sick and suffering, I would support the Bill. The Bill will do positive harm to the service. It will create a new private sector health service which will rob the National Health Service, which we should all be seeking to serve and improve, whether we were originally supporters of Aneurin Bevan or supporters of the Joseph proposals. This measure will do harm, and that is why I am against it.
    10.49 p.m.
    Dr. Vaughan: Nothing could have demonstrated more clearly the disruptive, unfeeling views which have so damaged the National Health Service in recent months and the arrogant disregard for undertakings entered into than the words

    583
    we heard from the right hon. Member for Blackburn (Mrs. Castle) tonight. However strident her cries, the plain fact is that over 50 amendments which resulted in a tied vote in Committee have not been debated tonight because of the guillotine. That is a disgraceful reflection on the way in which an issue such as this is handled these days.
    Nothing that has been said in this debate could possibly change our view that the Bill is totally irrelevant to the real needs of the National Health Service. With low morale, a desperate lack of resources and staff leaving in ever-increasing numbers, the Bill will increase, not decrease, those problems in the NHS.
    The words of Nye Bevan have rightly rung round the Chamber several times in this debate. The right hon. Member for Blackburn said that Nye Bevan would have welcomed the Bill. He would not. He would not have welcomed it because he recognised what the right hon. Lady does not—namely, the danger if health care is split into two separate services, a State service at one level and a private service at another. Is this what Labour Members want?
    Mrs. Renée Short: No.
    Dr. Vaughan: It is certainly not what the majority of people in the National Health Service want but it is certainly the situation that will be brought about by the Bill. Nye Bevan would have seen such a Bill as a measure that would cause great damage in the service, and that is how we regard the Bill.
    What has come out of this debate more clearly than anything else is the appalling gap between the views of Labour Members and the views of the majority of people working in the Service. Labour Members do not like to accept that truth, but they are not members of a party which concerns itself with the care of patients and for high standards. They are members of a party which displays envy and a desire for destruction and prejudice in the health field, and they know it.
    The Secretary of State was asked on Second Reading and again yesterday to say who will benefit from the Bill, but he did not answer. Indeed, he could not answer—or certainly did not want to.
    584
    It is certainly not the patients who will benefit from the Bill. The overwhelming opinion in National Health Service circles is that patient care will suffer very seriously indeed. That was the opinion of the Presidents of the Royal Colleges, and they are careful not to take a party political view. Their charge is to look after the standards of the service. They see great dangers for the care of patients.
    The majority of union members, as we know from the opinion polls, also do not believe that the Bill will bring any great benefits. Indeed, trade union members believe that the Bill will increase rather than decrease unemployment in the National Health Service. A factor has arisen which has not reared its head before—namely, a shortage of nurses in certain parts of the country and a surplus of nurses elsewhere.
    The truth is that only the militants will welcome the Bill. It is interesting to note when one listens to the most militant militants that they are people who have only recently come to this country from overseas or people who admit that they have never worked in a hospital. Those are the people who lead the revolt.
    Mrs. Renée Short: Name them.
    Dr. Vaughan: Certainly the Bill will not help the Chancellor of the Exchequer. An extra sum of £12 million or £15 million will have to be found to pay for the administration of the Bill—money to be found at a time when £40 million of private money will be lost to the National Health Service and at a time when the basic standards of the service are falling rapidly. It will certainly not help the Exchequer in any way at all. The damage done by this purely political Bill will be deep and widespread.
    The Bill will certainly not help professional people working in the service. Labour Members have repeatedly tried to say that my right hon. and hon. Friends and I represent only the views of the doctors. That is blatantly untrue. We represent the views of the dentists, the nurses, the physiotherapists, the radiographers, the porters and the ward maids. If Labour Members are honest with themselves, they will accept that the majority of people in the service see the

    585
    Bill as a major intrusion into their professional freedom.
    Mr. Ennals: Does not the hon. Gentleman accept that it is the considered view of the National Health Service unions and of the Royal College of Nursing—[HON. MEMBERS: "Rubbish".] It is not rubbish. A deputation came to see me to record the views of the Royal College in support of the measures the Government were taking to phase out pay beds. It is the considered view of the vast majority of those working in the National Health Service that this measure is essential and that it will bring peace to the service.
    Dr. Vaughan: I do not accept that. What the Secretary of State has said is totally untrue, and he is misrepresenting the views of the nurses. Labour Members' speeches will have increased fears over freedom. The Bill will not sow peace. It will sow the seeds of resentment which will continue for years to come.
    Labour Members will come to regret the Bill. It is a squalid, vindictive

    Division No. 320.]

    AYES

    [11.00 p.m.

    Abse, Leo

    Cohen, Stanley

    Fletcher, L. R. (Ilkeston)

    Allaun, Frank

    Coleman, Donald

    Fletcher, Ted (Darlington)

    Anderson, Donald

    Concannon, J. D.

    Foot, Rt Hon Michael

    Archer, Peter

    Conlan, Bernard

    Ford, Ben

    Armstrong, Ernest

    Cook, Robin F. (Edin C)

    Forrester, John

    Ashley, Jack

    Corbett, Robin

    Fowler, Gerald (The Wrekin)

    Ashton, Joe

    Craigen, J. M. (Maryhill)

    Fraser, John (Lambeth, N'w'd)

    Atkins, Ronald (Preston N)

    Crawford, Douglas

    Freeson, Reginald

    Atkinson, Norman

    Crawshaw, Richard

    Garrett, W. E. (Wallsend)

    Bagier, Gordon A. T

    Cronin, John

    George, Bruce

    Barnett, Guy (Greenwich)

    Crosland, Rt Hon Anthony

    Gilbert, Dr John

    Barnett, Ht Hon Joel (Peywood)

    Crowder, F. P.

    Golding, John

    Bates, Alf

    Cryer, Bob

    Gould, Bryan

    Bean, R. E.

    Cunningham, G. (Islington S)

    Gourlay, Harry

    Benn, Rt Hon Anthony Wedgwood

    Cunningham, Dr J. (Whiteh)

    Graham, Ted

    Bernett, Andrew (Stockport N)

    Davidson, Arthur

    Grant, George (Morpeth)

    Bidwell, Sydney

    Davies, Bryan (Enfield N)

    Grant, John (Islington C)

    Bishop E. S.

    Davies, Denzil (Lianelli)

    Grocott, Bruce

    Blenkinsop, Arthur

    Davies, Ifor (Gower)

    Hamilton, James (Bothwell)

    Boardman, H.

    Davis, Clinton (Hackney C)

    Hardy, Peter

    Booth, Rt Hon Albert

    Deakins, Eric

    Harper, Joseph

    Bottomley, Rt Hon Arthur

    Dell, Rt Hon Edmund

    Harrison, Walter (Wakefield)

    Bradley, Tom

    Dempsey, James

    Hart, Rt Hon Judith

    Bray, Dr Jeremy

    Doig, Peter

    Hattersley, Rt Hon Roy

    Brown, Hugh D. (Provan)

    Dormand, J. D.

    Halton, Frank

    Brown, Robert C. (Newcastle W)

    Douglas-Mann, Bruce

    Healey, Rt Hon Denis

    Brown, Ronald (Hackney S)

    Duffy, A. E. P.

    Heffer, Eric S.

    Buchan, Norman

    Dunnett, Jack

    Henderson, Douglas

    Buchanan, Richard

    Eadle, Alex

    Hooley, Frank

    Butler, Mrs Joyce (Wood Green)

    Edge, Geoff

    Horam, John

    Callaghan, Rt Hon J. (Cardiff SE)

    Edwards, Robert (Wolv SE)

    Howell, Rt Hon Denis (B'ham, Sm H)

    Callaghan, Jim (Middleton & P)

    Ellis, John (Brigg & Scun)

    Hoyle, Doug (Nelson)

    Campbell, Ian

    Ennals, David

    Huckfield, Les

    Cant, R. B.

    Evans, Fred (Caerphilly)

    Hughes, Rt Hon C. (Anglesey)

    Carmichael, Neil

    Evans, Gwynfor (Carmarthen)

    Hughes, Robert (Aberdeen N)

    Carter, Ray

    Evans, Ioan (Aberdare)

    Hughes, Roy (Newport)

    Carter-Jones, Lewis

    Ewing, Harry (Stirling)

    Hunter, Adam

    Cartwright, John

    Faulds, Andrew

    Irvine, Rt Hon Sir A. (Edge Hill)

    Castle, Rt Hon Barbara

    Fernyhough, Rt Hon E.

    Irving, Rt Hon S. (Dartford)

    Clemitson, Ivor

    Fitch, Alan (Wigan)

    Jackson, Miss Margaret (Lincoln)

    Cocks, Rt Hon Michael (Bristol S)

    Flannery, Martin

    Janner, Greville

    irrelevance, pushed through by people who do not understand what they are doing. We will reverse that policy. We will encourage private skills into health care. We will develop schemes for reintroducing private resources into the National Health Service so that we may free State money to be better spent in other areas, such as on the young, the old and the chronically sick. Ours is a policy of compassion.
    People in the National Health Service who are afraid for their freedom and for the freedom of their patients are quite right to be concerned and to see the Bill as an attack on their future. They are right to believe that Labour Members care more for ideology than for patients. We believe in freedom in all areas. We believe in freedom in the National Health Service. The Bill will reduce freedom, and we shall unhesitatingly vote against it.
    Question put, That the Bill be now read the Third time:—
    The House divided: Ayes 288, Noes 264.

    Jay, Rt Hon Douglas

    Moonman, Eric

    Spearing, Nigel

    Jeger, Mrs Lena

    Morris, Alfred (Wythenshawe)

    Spriggs, Leslie

    Jenkins, Hugh (Putney)

    Morris, Charles R. (Openshaw)

    Stallard, A. W.

    Jenkins, Rt Hon Roy (Stechford)

    Morris, Rt Hon J. (Aberavon)

    Stoddart, David

    John, Brynmor

    Moyle, Roland

    Stott, Roger

    Johnson, James (Hull West)

    Mulley, Rt Hon Frederick

    Strang, Gavin

    Johnson, Walter (Derby S)

    Murray, Rt Hon Ronald King

    Strauss, Rt. Hon G. R.

    Jones, Alec (Rhondda)

    Newens, Stanley

    Summerskill, Hon Dr Shirley

    Jones, Barry (East Flint)

    Noble, Mike

    Swain, Thomas

    Jones, Dan (Burnley)

    Oakes, Gordon

    Taylor, Mrs Ann (Bolton W)

    Judd, Frank

    Ogden, Eric

    Thomas, Dafydd (Merioneth)

    Kaufman, Gerald

    O'Halloran, Michael

    Thomas, Jeffrey (Abertillery)

    Kelley, Richard

    Orbach, Maurice

    Thomas, Mike (Newcastle E)

    Kerr, Russell

    Orme, Rt Hon Stanley

    Thomas, Ron (Bristol NW)

    Kilroy-Silk, Robert

    Ovenden, John

    Thompson, George

    Kinnock, Neil

    Owen, Rt Hon Dr David

    Thorne, Stan (Preston South)

    Lambie, David

    Padley, Walter

    Tierney, Sydney

    Lamborn, Harry

    Palmer, Arthur

    Tinn, James

    Lamond, James

    Park, George

    Tomlinson, John

    Latham, Arthur (Paddington)

    Parker, John

    Tomney, Frank

    Leadbitter, Ted

    Pavitt, Laurie

    Torney, Tom

    Lee, John

    Pendry, Tom

    Urwin, T. W.

    Lestor, Miss Joan (Eton & Slough)

    Perry, Ernest

    Varley, Rt Hon Eric G.

    Lever, Rt Hon Harold

    Phipps, Dr Colin

    Wainwright, Edwin (Dearne V)

    Lewis, Ron (Carlisle)

    Prentice, Rt Hon Reg

    Walden, Brian (B'ham, L'dyw'd)

    Lipton, Marcus

    Price, C. (Lewisham W)

    Walker, Harold (Doncaster)

    Litterick, Tom

    Price, William (Rugby)

    Walker, Terry (Kingswood)

    Lomas, Kenneth

    Rees, Rt Hon Merlyn (Leeds S)

    Ward, Michael

    Loyden, Eddie

    Reid, George

    Watkins, David

    Luard, Evan

    Richardson, Miss Jo

    Watkinson, John

    Lyons, Edward (Bradford W)

    Roberts, Albert (Normanton)

    Weetch, Ken

    Mabon, Dr J. Dickson

    Roberts, Gwilym (Cannock)

    Weltzman, David

    McCartney, Hugh

    Robinson, Geoffrey

    Wellbeloved, James

    McDonald, Dr Oonagh

    Roderick, Caerwyn

    Welsh, Andrew

    McElhone, Frank

    Rodgers, George (Chorley)

    White, James (Pollok)

    MacFarquhar, Roderick

    Rodgers, Rt Hon William (Stockton)

    Whitehead, Phillip

    McGuire, Michael (Ince)

    Rooker, J. W.

    Whitlock, William

    MacKenzie, Gregor

    Roper, John

    Wigley, Dafydd

    Mackintosh, John P.

    Rose, Paul B.

    Willey, Rt Hon Frederick

    Maclennan, Robert

    Ross, Rt Hon W. (Kilmarnock)

    Williams, Alan (Swansea W)

    McMillan, Tom (Glasgow C)

    Rowlands, Ted

    Williams, Alan Lee (Hornch'ch)

    McNamara, Kevin

    Ryman, John

    Williams, Rt Hon Shirley (Hertford)

    Madden, Max

    Sandelson, Neville

    Williams, Sir Thomas (Warrington)

    Magee, Bryan

    Sedgemore, Brian

    Wilson(Alexander (Hamilton)

    Mahon, Simon

    Selby, Harry

    Wilson, Gordon (Dundee E)

    Mallalieu, J. P. W.

    Shaw, Arnold (Ilford South)

    Wilson, Rt Hon Sir Harold (Huyton)

    Marks, Kenneth

    Sheldon, Robert (Ashton-u-Lyne)

    Wilson, William (Coventry SE)

    Marquand, David

    Shore, Rt Hon Peter

    Wise, Mrs Audrey

    Marshall, Dr Edmund (Goole)

    Short, Mrs Renée (Wolv NE)

    Woodall, Alec

    Marshall, Jim (Leicester S)

    Silkin, Rt Hon John (Deptford)

    Woof, Robert

    Mason, Rt Hon Roy

    Silkin, Rt Hon S. C. (Dulwich)

    Wrigglesworth, Ian

    Maynard, Miss Joan

    Silverman, Julius

    Young, David (Bolton F)

    Meacher, Michael

    Skinner, Dennis

    Mendelson, John

    Small, William

    TELLERS FOR THE AYES:

    Millan, Rt Hon Bruce

    Smith, John (N Lanarkshire)

    Mr. Frank R. White and

    Miller, Dr M. S. (E Kilbride)

    Snape, Peter

    Mr. Thomas Cox.

    Miller, Mrs Millie (Ilford N)

    NOES

    Adley, Robert

    Brotherton, Michael

    Crouch, David

    Aitken, Jonathan

    Brown, Sir Edward (Bath)

    Davies, Rt Hon J. (Knutsford)

    Alison, Michael

    Bryan, Sir Paul

    Dean, Paul (N Somerset)

    Amery, Rt Hon Julian

    Buchanan-Smith, Alick

    Dodsworth, Geoffrey

    Arnold, Tom

    Buck, Antony

    Douglas-Hamilton, Lord James

    Atkins, Rt Hon H. (Spelthorne)

    Budgen, Nick

    Drayson, Burnaby

    Awdry, Daniel

    Bulmer, Esmond

    du Cann, Rt Hon Edward

    Baker Kenneth

    Burden, F. A.

    Dunlop, John

    Beith, A. J.

    Carlisle, Mark

    Durant, Tony

    Bell, Ronald

    Chalker, Mrs Lynda

    Eden, Rt Hon Sir John

    Bennett, Sir Frederic (Torbay)

    Channon, Paul

    Edwards, Nicholas (Pembroke)

    Benyon, W.

    Churchill, W. S.

    Elliott, Sir William

    Berry, Hon Anthony

    Clark, Alan (Flymouth, Sutton)

    Emery, Peter

    Biffen, John

    Clark, William (Croydon S)

    Eyre, Reginald

    Biggs-Davison, John

    Clarke, Kenneth (Rushcliffe)

    Fairbairn, Nicholas

    Blaker, Peter

    Clegg, Walter

    Fairgrieve, Russell

    Body, Richard

    Cockcroft, John

    Fell, Anthony

    Boscawen, Hon Robert

    Cooke, Robert (Bristol W)

    Fisher, Sir Nigel

    Bottomley, Peter

    Cope, John

    Fletcher-Cooke, Charles

    Bowden, A. (Brighton, Kemptown)

    Cordle, John H.

    Fookes, Miss Janet

    Boyson, Dr Rhodes (Brent)

    Cormack, Patrick

    Forman, Nigel

    Bradford, Rev Robert

    Corrle, John

    Fowler, Norman (Sutton C'f'd)

    Braine, Sir Bernard

    Costain, A. P.

    Fox, Marcus

    Brittan, Loon

    Craig, Rt Hon W. (Belfast E)

    Fraser, Rt Hon H. (Stafford & St)

    Brocklabank-Fowler, C.

    Critchley, Julian

    Fry, Peter

    588

    589

    Galbraith, Hon. T. G. D.

    Lawrence, Ivan

    Ridsdale, Julian

    Gardiner, George (Reigate)

    Lester, Jim (Beeston)

    Rifkind, Malcolm

    Gardner, Edward (S Fylde)

    Lewis, Kenneth (Rutland)

    Rippon, Rt Hon Geoffrey

    Gilmour, Rt Hon Ian (Chesham)

    Lloyd, Ian

    Roberts, Wyn (Conway)

    Gilmour, Sir John (East Fife)

    Loveridge, John

    Rodgers, Sir John (Sevenoaks)

    Glyn, Dr Alan

    Luce, Richard

    Ross, Stephen (Isle of Wight)

    Godber, Rt Hon Joseph

    McAdden, Sir Stephen

    Rossi, Hugh (Hornsey)

    Goodhart, Philip

    McCrindle, Robert

    Rost, Peter (SE Derbyshire)

    Goodhew, Victor

    McCusker, H.

    Royle, Sir Anthony

    Goodlad, Alastair

    Macfarlane, Neil

    Sainsbury, Tim

    Gorst, John

    Macmillan, Rt Hon M. (Farnham)

    St. John-Stevas, Norman

    Gow, Ian (Eastbourne)

    McNair-Wilson, M. (Newbury)

    Scott, Nicholas

    Gower, Sir Raymond (Barry)

    McNair-Wilson, P. (New Forest)

    Shaw, Giles (Pudsey)

    Grant, Anthony (Harrow C)

    Madel, David

    Shepherd, Colin

    Gray, Hamish

    Marshall, Michael (Arundel)

    Shersby, Michael

    Grieve, Percy

    Marten, Neil

    Silvester, Fred

    Griffiths, Eldon

    Mather, Carol

    Sims, Roger

    Grimond, Rt Hon J.

    Maude, Angus

    Sinclair, Sir George

    Grist, Ian

    Maudling, Rt Hon Reginald

    Skeet, T. H. H.

    Grylls, Michael

    Mawby, Ray

    Smith, Cyril (Rochdale)

    Hall, Sir John

    Maxwell-Hyslop, Robin

    Smith, Dudley (Warwick)

    Hall-Davis, A. G. F.

    Mayhew, Patrick

    Speed, Keith

    Hamilton, Michael (Salisbury)

    Meyer, Sir Anthony

    Spence, John

    Hampson, Dr Keith

    Miller, Hal (Bromsgrove)

    Spicer, Michael (S Worcester)

    Hannam, John

    Mills, Peter

    Sproat, Iain

    Harvie Anderson, Rt Hon Miss

    Miscampbell, Norman

    Stainton, Keith

    Hastings, Stephen

    Mitchell, David (Basingstoke)

    Stanbrook, Ivor

    Havers, Sir Michael

    Moate, Roger

    Stanley, John

    Hawkins, Paul

    Molyneaux, James

    Steel, David (Roxburgh)

    Hayhoe, Barney

    Monro, Hector

    Steen, Anthony (Wavertree)

    Heath, Rt Hon Edward

    Montgomery, Fergus

    Stewart, Ian (Hitchin)

    Heseltine, Michael

    Moore, John (Croydon C)

    Stokes, John

    Hicks, Robert

    More, Jasper (Ludlow)

    Stradling Thomas, J.

    Higgins, Terence L.

    Morgan, Geraint

    Tapsell, Peter

    Holland, Philip

    Morgan-Giles, Rear-Admiral

    Taylor, R. (Croydon NW)

    Hooson, Emlyn

    Morris, Michael (Northampton S)

    Taylor, Teddy (Cathcart)

    Hordern, Peter

    Morrison, Charles (Devizes)

    Tebbit, Norman

    Morrison, Hon Peter (Chester)

    Howe, Rt Hon Sir Geoffrey

    Mudd, David

    Temple-Morris, Peter

    Howell, David (Guildford)

    Neave, Alrey

    Thatcher, Rt Hon Margaret

    Howells, Geraint (Cardigan)

    Nelson, Anthony

    Thomas, Rt Hon P. (Hendon S)

    Hunt, David (Wirral)

    Neubert, Michael

    Townsend, Cyril D.

    Hunt, John (Bromley)

    Newton, Tony

    Trotter, Neville

    Hurd, Douglas

    Nott, John

    Tugendhat, Christopher

    Hutchison, Michael Clark

    Onslow, Cranley

    van Straubenzee, W. R.

    Irving, Charles (Cheltenham)

    Oppenheim, Mrs Sally

    Vaughan, Dr Gerald

    James, David

    Page, John (Harrow West)

    Viggers, Peter

    Jenkin, Rt Hon P. (Wanst'd & W'df'd)

    Page, Rt Hon R. Graham (Crosby)

    Wakeham, John

    Jessel, Toby

    Paisley, Rev Ian

    Walder, David (Clitheroe)

    Johnson Smith, G. (E Grinslead)

    Pattie, Geoffrey

    Walker, Rt Hon P. (Worcester)

    Jones, Arthur (Daventry)

    Penhaligon, David

    Wall, Patrick

    Jopling, Michael

    Percival, Ian

    Walters, Dennis

    Joseph, Rt Hon Sir Keith

    Peyton, Rt Hon John

    Warren, Kenneth

    Kaberry, Sir Donald

    Pink, R. Bonner

    Weatherill, Bernard

    Kershaw, Anthony

    Powell, Rt Hon J. Enoch

    Wells, John

    Kilfedder, James

    Price, David (Eastleigh)

    Whitelaw, Rt Hon William

    King, Evelyn (South Dorset)

    Prior, Rt Hon James

    Wiggin, Jerry

    King, Tom (Bridgwater)

    Pym, Rt Hon Francis

    Winterton, Nicholas

    Kitson, Sir Timothy

    Raison, Timothy

    Wood, Rt Hon Richard

    Knight, Mrs Jill

    Rathbone, Tim

    Young. Sir G. (Ealing, Acton)

    Knox, David

    Rawlinson, Rt Hon Sir Peter

    Younger, Hon George

    Lamont, Norman

    Rees, Peter (Dover & Deal)

    Lane, David

    Rees-Davies, W. R.

    TELLERS FOR THE NOES:

    Langford-Holt, Sir John

    Renton, Rt Hon Sir D. (Hunts)

    Mr. Spencer Le Marchant and

    Latham, Michael (Melton)

    Renton, Tim (Mid-Sussex)

    Mr. Cecil Parkinson.

    Question accordingly agreed to.
    Bill read the Third time and passed.

  HARTLEPOOL (EMPLOYMENT)
  Motion made, and Question proposed, That this House do now adjourn.—[Mr. Graham.]
  11.14 p.m.
  Mr. Ted Leadbitter: What I have to say in this debate about the problems in my constituency is bound
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  to take into account the realities of the economic situation in the United Kingdom and throughout the international industrial trading world. I have a responsibility to be objective, for the greatest help I can afford my constituents is to bring to the attention of my hon. Friend the Minister an appraisal of the facts. We are still fighting to bring down inflation. We are still faced with the attack on the pound. We are still in the trough of the worst international economic recession for 40 years.

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  Our basic troubles did not start a few months ago or even two years ago. More than one authority has pinpointed the manner in which this country failed to face the rising economic storm. More recently, comments in the Investors Chronicle included the following observations:
  "To see it in perspective we need to go back to 1973. In that year money supply on the broader definition increased by not far short of 30 per cent.… In other words, not only was Britain pointing in the wrong direction in almost every aspect of its economic management but the country was determined to move even faster down the wrong road.… Most of the figures—wage increases, inflation rates, and above all Government borowing requirement— are still frightening. But three years ago they were all in the wrong direction. Most of them are now moving in the right direction."
  Certainly our economic strategy is beginning to show signs of turning the tide. The rate is not as we would like, and it must be conceded that, taking recent monthly figures separately, the position can be said to be erratic. Our general position is related to a worldwide hesitation in growth during the second quarter of this year. A report in the Financial Times this morning states:
  "While growth has slowed down throughout the world in the second and third quarters, the check to the recovery in the United Kingdom is more marked and it is clearly disturbing that it even occurred before the latest crisis."
  We must be on guard, in the knowledge that our strategy hopes can quickly be blown off course. Strategy changes in these circumstances will be needed.
  There is, however, a trend in industrial output showing in the latest quarterly recorded figures a rise of 1·4 per cent. That is an annual rate of 6 per cent. As my right hon. Friend the Chancellor of the Exchequer said on Monday, this increase has led to an increase in employment. Other indicators show that at least we are developing the right priorities. The rise in export volume for the past 12 months is approximately 10 per cent. Chemicals, metals and principal manufactures are up by 20 per cent. Exports to Germany have jumped by 24 per cent. in real deutschemark terms since 1975. There are new engineering orders rising at the rate of 20 per cent. during
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  the year. This also applies to chemical exports.
  Sixty per cent. of our foreign customers have already declared satisfaction at our improvement of delivery dates. A CBI survey shows that 88 per cent. of our customers have acknowledged that British prices are competitive. Our exports to the Middle East have improved. During my visit there recently I was exceptionally impressed by the growing British involvement. All this points to a substantial shift of gross domestic product into exports.
  I therefore approach the Government with the problems of my constituency, fully acknowledging the formidable tasks they had to face on coming to office. Among these I include the highly costly form of local government introduced by the previous Conservative Administration, the unsatisfactory reorganisation of the National Health Service and the economic damage which had been done by that Government's policies of confrontation. I also acknowledge the present Government's measures since coming to office.
  But my constituency has suffered sorely. Unemployment and a denial of the standard of public and personal servicing which we once enjoyed are burdens my constituents should not be asked to bear. The registered unemployed in Hartlepool in September this year totalled 4,623, representing 10·9 per cent. unemployed. Some 1,065 females are out of work, and in addition 274 girl school leavers have not had either a first offer or an offer which has kept them off the unemployment register. We also have 3,284 men and boys wholly unemployed. This is 12·3 per cent. of the male working population. In fact, the total unemployed has risen by nearly 300 in one month.
  These are not acceptable figures. They are a much higher proportion than those of the region. The figure for men is 3 per cent. higher and for women it is 2·3 per cent. higher. Our total figure of 10·9 per cent. out of work, compared with 5·5 per cent. for Britain as a whole, in-dictates a measure of the gravity of the problem.
  But that is not the complete story. We still have steel closure proposals, involving about 4,000 jobs, which we must

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  fight. If we place that fact against the recorded increase of unemployment of 1,200 people since January, we have the spectacle of a trend which, if not halted, will be damaging to the social fabric of my constituency. I ask the Minister to call urgently upon the Secretary of State —indeed, the Cabinet as well—to examine the case for special treatment. My close experience with the industrial trends, the economy and the social life of my constituency over more than a quarter of a century must be heard against the prognostications of planners who during the same period have had a remarkable track record of being proved wrong.
  Unless steps are taken over matters where the Government have control, the unemployment levels could rise in the short term to the alarming figure of about 20 per cent., and 25 per cent. for men. Now is the time for action. If the Government's own argument this week is that we have the strategy right, within that strategy at least one factor is beginning to show. Our regional figures are slightly improving, but those of Hartlepool are worsening. This is linked with the likelihood of a major industry leaving the constituency. The job multiplier for Hartlepool has been assessed, and the full meaning of this is that for every job lost in Hartlepool in the basic industries 1·3 other jobs are lost. In other words, 1,000 jobs lost in this way means the loss of another 1,300 elsewhere in the town where the immediate impact is on ancillary and supply services.
  Some of this can be taken up either by migration of labour or by other job provisions being made available. But in a town where the net redundancy figures are of the order of about 500 per year the latter is academic and the former a serious loss of skills which could take years to replace.
  But we also have the loss of purchasing power in the community which will be harmful to the retail trade, our commercial prospects, our forward planning and, in fact, the aspirations of all councillors seeking to provide, through local government, essential amenities to provide the right conditons for the people they represent.
  The continuation of the present trend will involve the loss of apprenticeships. These will be very difficult to replace. At
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  the other end of the scale, men and women over 55 years of age have little hope of either new training facilities or a job. These groups, and the centre core of workers still bringing up their families, have a right to expect something better. There are grave social and psychological considerations to be taken into account where traditional industries have played such a great part in developing the character and nature of a town.
  Certainly a number of Government measures have helped. The temporary employment subsidy, the job creation programme, the more recently announced work experience programme and the job release scheme have brought out of unemployment many thousands of men and young people throughout the country. I know that many officers, trade union officials, employers and others are doing sterling work under these schemes in Hartlepool and the North. They are to be commended for their approach to a very difficult task. Nevertheless, Hartlepool has not fared as well as it might have done, and in any case there is a need to consider to what extent in the circumstances we are merely creating palliatives and even dead-end jobs.
  As I understand it, the Government are satisfied that the level of training for industry, both in house training and that provided in Government training centres, has been maintained to the level established in the boom years. That may be so, but are we providing the right kind of training to meet the requirements of a rapidly changing society? There is no point in having a training course and raising expectations if at the end of the course the person trained is either not wanted or no vacancy is available. This only produces a waste of public money on the one hand and disillusionment for the people affected on the other.
  The same is true of professional training. I fail to understand the logic, or indeed any argument, which supports conditions where teachers and students are in the same dole queue. There must be something wrong with our society when trained nurses and other hospital trained staff, as well as patients, are kept out of hospitals. The social cost of this state of affairs is both a waste and a tragedy. I put it to the House that we cannot afford to lose skills of this kind. Indeed,

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  it raises the very question of the total costs of keeping people idle. In thousands of cases it is a well-known fact that it is more costly to keep a man or woman out of work than in work.
  In describing the levels of unemployment in my constituency, it can be seen already that I must enter the wider field of matters other than the dramatic statistics. I have referred to nurses, teachers and lost opportunities following industrial training. But I cannot forget the need to measure other losses. There has been a downturn in the provision of home helps. Many old people's homes are overcrowded and the staffs are overworked to a point where some danger may exist. Our social workers in the field are strained to the utmost and most of the staffs closest to the public requirement are overtaxed. I am not surprised to find a great deal of discontent in local government. But, for what it is worth, there is a need to tackle waste, to get better value for money by concentrating on the grass roots provision of services, and to ask ourselves whether the present system provides the right balance for efficiency.
  The director of social services in Cleveland has kindly given me his observations though at short notice. He states that rising unemployment will cause greater distress than already exists in the community. I accept that that claim can be made by many, but I am dealing with a special case where the developing situation is critical and industrial inquiries for development are fewer.
  The director of social services adds that the effect on families will be to cause stress factors which may result in an increased need for medical and social work care. Many families are unable to adjust to a reduced income. Increasing debts add to the appeals for social services and social security at a time when the departments concerned are fully stretched. He expects an increase in mental illness and delinquency. The rise in unemployment will make it more difficult to place handicapped people of many categories in gainful employment. These are costly consequences providing pressures on our services which are bound to mean that for many there cannot be a service.
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  I have sought the considered opinion of our probation and after-care service. I am informed that there is no difficulty here in identifying people who have suffered through loss of work. There are instances when debts accumulate with rent and hire-purchase commitments and people fall into increasing arrears followed by fines and maintenance payments. Gas and electricity bills have increased markedly in recent months. These provide added pressures on the unemployed and, in fact, on all low-income groups.
  The probation service states that there is some worry now about the emotional effects of unemployment. While there are varying degrees of motivation to work, those who are highly motivated are suffering excessive frustration where unemployment experience has become chronic. I am informed that people looked after by the service experience a number of problems—material, emotional, psychological and social—which interact and are mutually influential. In this context, a high unemployment rate can be seen as an additional problem which the staff and their clients could well do without.
  I am informed that there is a problem arising from pressures on accommodation to deal with the number of care orders. Accommodation is needed where, as I understand the position, the magistrates are not happy if the present stretched position causes young offenders to be sent to remand homes and places where they will have to mix with adult prisoners.
  I have examined the number of care orders, supervision orders and attendance care orders. The comparative figures over the years, while showing some decline, only illustrate the concern of magistrates and the tendency of the police to caution more than bring offenders to court. This may be a desirable social tendency, but in the light of the reasons for it—namely, overcrowding—I can only conclude that the magistrates ought to be thanked for their expressed worries and the police for the excellent work they are doing in this field.
  Finally, I want to bring urgently to my hon. Friend the Minister one social consequence which is heart-rending. The wives and mothers struggling to meet the many problems facing their families suffer extremely the daily worry of sustaining

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  their husbands and sons and daughters, Family morale is of the highest importance. These are the people making the greatest sacrifice even when their families are considerate. But wife-battering is not unrelated to unemployment, frustration, and all the consequent friction which boils up in a world where costs are rising and the means of meeting them are perpetually in doubt. Broken homes and lives are there for us all to see, and from personal experience I can tell the Minister that I am ashamed that even today it is the woman who is hardest hit when this happens.
  I should like to end by expressing my appreciation of this opportunity to raise the problems of my constituency and of the co-operation I have received from every Government Department with which I have discussed these matters from time to time. I enjoy good relations with my hon. Friend who is to reply to this debate, and I am sure he will convey to the Secretary of State not only this factual account of the situation in my constituency but my personal request for some early action on matters over which I am sure that the Government have some control. I shall appreciate an undertaking from my hon. Friend that there will be continuing discussions to deal with this matter.
  11.32 p.m.
  The Under-Secretary of State for Employment (Mr. John Golding): I am grateful to my hon. Friend the Member for Hartlepool (Mr. Leadbitter) for raising the serious matter of unemployment in Hartlepool in a most moving and lucid speech. I begin by assuring him that we constantly have under review the problem of unemployment throughout the country and we shall certainly pay attention to Hartlepool.
  No one can exaggerate the seriousness of the situation, both in terms of loss to the community and in the damaging effect described so graphically by my hon. Friend on the unemployed workers and their families. We share with him a deep concern for all those affected. The problem is due both to the general recession and to the decline in the area of those industries which have in the past been so important to the town—iron and steel, shipbuilding and ship repairing.
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  The reduction in the amount of employment in the iron and steel-making industry has posed serious problems for Hartlepool. The relatively high level of unemployment in the area was, of course, one of the reasons which led the Government to decide to give Hartlepool special treatment and to grant it special development area status. This in itself is evidence of the high priority which the Government give to attracting new jobs to the area. We try to encourage and persuade firms to go to Hartlepool and are able to offer the full range of regional financial incentives to prospective employers. These include the regional employment premium, regional development grants and Government factories with rent-free periods of up to three years.
  The Government advance factory programme has, in fact, played a big part in attracting employers to the area. Altogether there are now seven factories already occupied and another 11 under construction, and the Department of Industry is currently looking for more land for factory building. The ready availability of these advance factories should be a particularly attractive proposition for employers who will be looking for room to expand when the upturn in the economy comes. Employers may also be eligible for selective assistance in the form of loans and interest relief grants, and so far under this heading alone £2½ million has been well spent in Hartlepool in creating some 2,200 additional jobs.
  We recognise that from all points of view Hartlepool has many advantages to offer employers, not the least of which is hard-working workpeople.
  To help mitigate some of the worst effects of the present situation, the Government have introduced a number of special measures to save and create jobs —the temporary employment subsidy, the job creation programme and the recruitment subsidy for school leavers. There is also a community industry project in Hartlepool. Together, these schemes have secured some 450 jobs in Hartlepool. It will be known that we have now introduced a work experience scheme to provide young people under the age of 19 who might otherwise be unemployed with a realistic introduction to working life. We have introduced the youth employment subsidy, under which a £10 weekly

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  allowance can be paid for up to 26 weeks to employers who engage young people under 20 who have been continuously registered as unemployed for a period of six months or more.
  I ask my hon. Friend to do all that he can to bring to the attention of employers in Hartlepool the importance of playing their part by recruiting young people and by making it possible for the work experience scheme to be the great success we expect it to be.
  For the reasons which my hon. Friend has outlined, we recognise that we have a special responsibility to the young, but we have not neglected the needs of all others. We are aware of the problem of older workers to which my hon. Friend referred. We are particularly concerned to see the success of the job release scheme under which men over 64 years of age and women over 59 in full-time employment in assisted areas will be offered an allowance of £23 per week free of tax until they reach pensionable age, provided that they leave their jobs and are replaced by unemployed workers or if unemployed people agree to cease looking for work. This scheme should give help in Hartlepool where many manual workers have led a very arduous working life, and it will also help to provide jobs for younger men and women who would otherwise remain unemployed.
  My hon. Friend says that we are satisfied with the level of training. The Government have allocated additional funds to the Manpower Services Commission so that it can provide extra training facilities to enable more workers to fit themselves for jobs in skilled trades and in the expanding industries which we aim to encourage to take the place of those in decline.
  We cannot say yet that we are satisfied with the level of industrial training. We realise, moreover, that these special measures do not provide the regular jobs which my hon. Friend the Member for Hartlepool is seeking for his constituents.
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  We believe that these will be stimulated by our industrial strategy and aided by regional policy. Already there are encouraging signs that additional regular work will be coming available for building workers. There is the new BSC benzole plant, the ICI micro-organism animal feed stock plant, and new plants for Monsanto Chemicals and W. R. Grace. These projects, all in the Billingham area, are expected to provide about 1,500 jobs, many of which will be taken by workers from Hartlepool. For other workers in Hartlepool we believe that a total of 1,350 new jobs will appear in the next two years if the expansion plans of various local employers are put into effect.
  This, of course magnified, is the solution to this general problem. Only through the improvement of our industrial performance can we bring down and keep down the present intolerable level of unemployment. Defeating inflation is the essential condition for that improvement, and the social contract has given us the means to do that. The next step, which depends, as so much else does, on bringing inflation down to the level of that of our competitors, is the regeneration of industry. This is the strategy to which the Government pledged themselves along with the TUC and CBI at Chequers last November and which we are now developing in the National Economic Development Council.
  As the TUC's "Economic Review" says,
  "The aim of the strategy is to put Britain on the path to a high wage, high output, full employment economy, by improving productive potential and the performance of manufacturing industry in particular with a priority for industrial development over other objectives."
  Reducing unemployment in Hartlepool, as elsewhere in Britain, which we very much want to do, means making a success of that policy.
  Question put and agreed to.
  Adjourned accordingly at nineteen minutes to Twelve o'clock.