§ 6.0 p.m.
§ Dr. Gerard Vaughan (Reading, South)
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 484 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 485 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.
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 486 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 (Bromsgrove and Redditch)
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 488 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.
The second matter referred to in subsection (3)(b) of the clause isthe 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 (Birmingham, Selly Oak)
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. 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.
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. 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 496 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. 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.
§ 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.
§ Question put, That the amendment be made:—
§ The House divided: Ayes 185, Noes 212.501
|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.|
|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|
|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'.
- 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 506 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 (Woolwich, West)
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 510 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."
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 (Folkestone and Hythe)
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 513 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 £1 514 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 (Dover and Deal)
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.
§ 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 515 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 516 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 517 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 518 heard the first words of support for the Bill from any hon. Member on the Government side of the House.
§ 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.
§ 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 519 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 520 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, 521 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.
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 522 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 523 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 shethe 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.
524 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—
§ 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 (Isle of Wight)
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- 526 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 527 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 528 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.
529 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. 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 (Wallasey)
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:
We are also to take Government Amendments Nos. 108, 109 and 116.
- 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'.
§ 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.
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.
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 (Somerset, North)
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.
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 (Conway)
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 (Flint, West)
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.