PURPOSE OF SS. 3 TO 5

HC Deb 13 October 1976 vol 917 cc459-80

Mr. Patrick Jenkin

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

1. (a) making available in Great Britain the best possible facilities for the prevention, diagnosis, and treatment of illness, both at premises vested in the Secretary of State and under private arrangements; and
2. (b) to that end securing the availability of sufficient accommodation and services of a satisfactory standard at both National Health Service and other hospitals for use in connection with the treatment of persons at such hospitals as resident and non-resident patients'.

Mr. Deputy Speaker

With this, we may take the following amendments:

No. 4, in page 2, line 23, leave out subsection (1).

No. 6, in page 2, line 33, at end insert: 'Provided that such separation or withdrawal shall not impair the reasonable availability of such facilities, accommodation or services to patients or practitioners desirous of obtaining or providing treatment on a private basis.'

Mr. Jenkin

Before I discuss the amendment I would like to associate myself with the words of the hon. Member for Brent, South (Mr. Pavitt) in congratulating my hon. Friend the Member for Ealing, Acton (Sir G. Young) upon having been instrumental in making a notable addition to the Bill.

We now come to Clause 2 of the Bill, and as there is not much time left before the Report stage I will move this amendment briefly. We had a long debate in Committee about Clause 2, which is the declaratory clause intended to reflect the propositions in the Goodman proposals, that is, that the Bill should contain a broad declaration that private beds and facilities should be separated from the NHS, and the expression of the Government's commitment to the maintenance of private medical and dental practice in this country. In Standing Committee we divided on the amendments which were in the same form as those on the Notice Paper now, and on each occasion the Committee came to a conclusion only with the casting vote of the Chairman. This not only entitles us but obliges us to raise the matter again.

Obviously Clause 2 and particularly Clause 2(1), by setting out the principle of phasing out, raises the temptation to have yet another Second Reading debate, but we had a very full and interesting debate yesterday, and we heard points of view not only from those hon. Members who served on the Committee but from others who did not. I shall try to speak directly to the issue whether this clause should be in the Bill and whether, if so, it should be in this form.

5.0 p.m.

I do not think that there is a dispute between us that subsection (1) is wholly without effect. It is wholly declaratory. I am sure that the Minister of State has studied the debate which took place in Committee. We made the point that the board, in exercising its functions in the phasing out of pay beds, should be governed by all the succeeding clauses in Part It and that those succeeding clauses should determine whether a particular bed or group of beds should be phased out at the time that the board was considering the matter. Therefore, those clauses could not have regard to the general statement of intention in Clause 2, which is purely declaratory.

The same to some extent is true to subsection (2) which is wholly otiose and would not be there at all if the Goodman proposals had not stated that it would be. It merely repeats, and the Bill elsewhere repeals, the provision guaranteeing that consultants should not be bound to be in full-time service in the National Health Service.

When I questioned the desirability of having these entirely otiose and declaratory statements in the Bill I was confronted with precedent: it had happend before. Indeed, it was said that my name, when I was Chief Secretary, had been on the Health and Safety at Work etc. Bill, one of the early clauses of which was wholly declaratory.

I suggest that there is a difference between that kind of Bill, which came before the House as a largely agreed measure—certainly, wholly agreed in objective—and this Bill which is put before the House very much as the view of the Labour Party and is in no sense supported even by those who took part in the Goodman discussions. We should not put broad statements of intent in a disputed matter of this kind when later there is spelt out in great detail the exact conditions which are to apply when the Bill comes to be operated.

It is primarily on that ground that I believe that subsection (1) ought not to be in the Bill. For that reason, I should not mind if subsection (2) were removed, provided that the original provision of the 1946 Act were to remain. Of course, we should then, as it were, need to repeal the repeal.

The Bill came before the House following the Report of a Select Committee. Unlike the vast majority of Bills this measure is in direct conflict with the Report of that Select Committee. I remind the House that the Select Committee, in paragraph 49 of the Report stated: We recommend:

1. (i) that no major changes to the system are needed;
2. (ii) that control procedures in hospitals should be more strictly observed;
3. (iii) that all charges for private patients should be reviewed regularly at least every two years; and
4. (iv) that more publicity be given to the availability of amenity beds."

Mr. Pavitt

Will the right hon. Gentleman inform the House of the circumstances surrounding that Select Committee Report? The Select Committee was set up under one Government and there was then a change of Government. Because a Select Committee cannot have a minority report, the recommendations which finally emerged were the result of a majority decision, the strength of the Committee having been changed from that under the previous dispensation.

Mr. Jenkin

The hon. Gentleman is entitled to make his explanation. The Report makes clear that it is a Report of the Expenditure Committee, Session 1971–72, and the Expenditure Committee was nominated on 3rd November 1971. Whether some other Committee appointed on some other occasion with different members would have come to a different conclusion seems wholly irrelevant. The Committee appointed and set up to examine the matter came to its conclusions, which I have just read.

That is another reason why it seems wrong to state in the front of a Bill, as though it were a broad, agreed objective, a proposal which is in fact hotly contested. The danger is that it may in some way detract from the later conditions which have been carefully drawn up—we examined them in depth in Committee— regarding the application of the principle. It is not right that we should in any sense risk muddying the water by putting in broad general propositions of this kind when they are not agreed. When there is broad agreement, there is no harm and it may be desirable, as a matter of cosmetics for public presentation, to put the proposition in, but when there is not broad agreement the Bill should be strictly confined to those matters which will govern the operation and duties of the Health Services Board.

If the Government think that it is necessary to have something in, for goodness' sake let us have something which has more relevance to the real needs of the health service, not merely a restatement of what appears later in the Bill.

Amendment No. 5 proposes: (1) The Board shall exercise its functions under Parts II and III of this Act with the object of—

1. (a) making available in Great Britain the best possible facilities for the prevention, diagnosis, and treatment of illness, both at premises vested in the Secretary of State and under private arrangements; and
2. (b) to that end securing the availability of sufficient accommodation and services of a satisfactory standard."

In Committee is was suggested, just as it was a few minutes ago by the Secretary of State, that if we included those as the considerations which subsection (1) should have, we would somehow be transferring to the board the responsibility for running the health service. I suggest that the amendment could not conceivably have that purpose, because the introductory words would read The Board shall exercise its functions with the object of". Since these presumably are the objectives of any sensible Secretary of State—that is, making available the best possible facilities and securing sufficient accommodation and services—all we are asking is that the board should have the same objectives as the Secretary of State and that it should not be deflected into the by-ways of what in a sense, as I have said on other occasions, is the almost irrelevant battle being fought out by the medical profession, on the one hand, and some members of some trade unions, on the other.

The ultimate responsibility for the Health Service would remain with the Secretary of State.

In parentheses, I may say that I am attracted by the report that the right hon. Gentleman has had from the three regional chairmen indicating how his responsibilities in this regard might be more effectively devolved upon the regions and areas, leaving him with only major policy and monitoring functions. That is by the way. All we are suggesting is that, in carrying out its functions, the board should have in mind these two objectives.

A second slightly more sinister reason was given by the former Minister of State why the subsection is in its present form. If the Minister of State is to reply he will need to give us some firm undertakings on this matter.

The Minister of State's predecessor said: The reason for putting this broad declaration is that it should be made quite clear to anyone who wishes to be considered for nomination to the Board, and it should be clear to anyone who is considering the issues about which the Bill is concerned, that its prime central purpose is to separate private practice from NHS hospitals. Do not let there be any misunderstanding about that."—[Official Report, Standing Committee D, 17th June 1976; c. 405.]

We must have a categoric assurance that there is no intention to pack the board with members who are predisposed to phasing out. That passage in the Minister of State's speech filled me with deep suspicion. We have referred already to the procedures for appointing the chairman, the two medical representatives and the two others. There is nothing in the Bill about the opinions of the people whose names are to go forward. They are to be appointed by the Secretary of State after consultation. He has told us how he has reached a list of eight people from whom he will have to choose the members. We want an assurance that there is no question of the Government asking for a sort of loyalty test, or that members might have to sign a declaration that they are prepared to co-operate in the phasing-out process. As the former Secretary of State in an earlier debate, this is intended to be a balanced board. Its composition was arived at after hard negotiation in Committee.

We need a reassurance that the purposes of Clause 2(1) are not intended to prejudice the detailed operation of subsequent clauses or the appointment of members of the board. It stands in the Bill as a statement of principle, and there was discussion about it yesterday. The Secretary of State said that hon. Members opposite do not see the strength of principle which is held not only by my right hon. and hon. Friends but by those who work in the health service. …They do not realise that for some of those who work within the health service it is offensive and a challenge to their principles to be involved in a service which makes special provision for those who can pay and does not simply provide for the generality of the nation's needs."—[Official Report, 12th October 1976 Vol. 917, cc. 352–353.]

I should be much more impressed by the principle which is supposed to actuate hon. Members opposite if we did not hear in speech after speech from the Government side—from the hon. Members for Preston, South (Mr. Thorne), Aberdeen, North (Mr. Hughes), Sheffield, Hillsborough (Mr. Flannery), Ormskirk (Mr. Kilroy-Silk) and the like-words which give the impression that they are more concerned with hammering the income of consultants—

Mr. Stan Thorne (Preston, South)

On a point of order, Mr. Deputy Speaker. I may have been mistaken, but I understood the right hon. Member for Wan-stead and Woodford (Mr. Jenkin) to use the word "louts" as a description of the hon. Members to whom he referred.

Mr. Jenkin

The hon. Member must have misheard me. I would never dream of using such a word about hon. Members.

The hon. Members to whom I referred give the impression with their constant repetition of phrases such as "Thrusting gold down the throats of the consultants" that they are more concerned with dragging down Dives than with elevating Lazarus. That is why I view with scepticism the so-called principle enunciated by the Secretary of State yesterday. The whole principle is made suspect when all the cliches of the class war are dragged out by hon. Members opposite.

5.15 p.m.

I contend that the great majority of those working in hospitals and the vast majority of those treated in NHS hospitals are entirely content with the present arrangements. For the most part, they are entirely unaffected by them. Those in stoutest support of the principle we are discussing are entirely unaware of the advantages which flow to the NHS and its patients through the operation of the pay bed system.

They should be helped to understand, and that is why I propose that the money received from pay beds should go to the hospital where the work is done and be used for ear-marked projects or equipment which people could identify and so realise that but for the money from private beds, those projects or equipment could not be afforded.

I have also suggested that some of the money might go to those who work directly with the private patients. This is a matter which I should be happy to explore further as I have already with a number of trade union leaders concerned.

I was interested to see an article by Katharine Whitehorn in the Daily Mirror. She said of hon. Members opposite: Their action is going to have exactly the opposite effect of what they want. It's going to hurt the Health Service more than anything else could do. She concluded: Let the nurses and radiotherapists and cleaners get their whack, too, and not just the doctors. The reaction from readers was interesting. The Daily Mirror reported: Katharine Whitehorn's article 'Why we should save the pay beds' in the Mirror's Private Opinion series, provoked a heavy postbag. Most letters supported her view that pay beds should be retained within the Health Service. There followed a selection of readers' letters.

Mr. Ennals

Is it not rather arrogant for the right hon. Gentleman to suggest that we should try to educate those who work in the National Health Service about what they should think of the principles on which they do their work? He misunderstands the position when he says that the wisdom of the consultants should be conveyed to the lesser orders within the service, who do not understand all the benefits they get from pay beds. The right hon. Gentleman should understand that there is a very deep feeling among many of those in the National Health Service about the principle on which the Bill is based and that there is a great deal of support for it. I have found from a large number of consultants that, although they may not agree with the Bill in all its parts, and may even disagree with the principle, they want it passed and want us to get on with the job because the health service will be the healthier for it.

Mr. Jenkin

The Secretary of State misunderstands me. I was not talking about education on the principle involved. I said that people should understand the facts, which we have already rehearsed, about the solid financial and health advantages which flow to the NHS from doctors being able to conduct private and NHS practices under the same roof.

The right hon. Gentleman persists in the view that his opinion is supported by the majority. I shall not quote the National Opinion Poll from which I have quoted before. A new poll, asking a new question, carried out on the same basis as the previous poll, has been made available to me today. The question was: There has been a lot of discussion recently on 'pay beds' in NHS hospitals. Some people say that 'pay beds' are a way of jumping the queue and ought to be stopped, others that people should be allowed to spend their money on private medical treatment if they wish to do so. Which of these points of view do you tend to agree with? The results were: The use of pay beds ought to be stopped, 22 per cent.; ought to be allowed, 63 per cent.

Mr. Ennals

Before the right hon. Gentleman sits down. It is clear—

Mr. Deputy Speaker

Order. I understand that the right hon. Member for Wanstead and Woodford (Mr. Jenkin) has sat down.

Mr. Pavitt

This place is a constant source of wonder and amazement to me. I find it so not least because the right hon. Member for Wanstead and Woodford (Mr. Jenkin), who led the Opposition through 29 sittings in Committee, should find it a source of amazement that the Bill seeks to separate pay beds and private practice from the National Health Service and that the board is given that responsibility in various parts of the Bill. The right hon. Gentleman seems to find something sinister in the fact that that is laid on the line as the purpose of the Bill in Clause 2.

I am grateful that the right hon. Gentleman quoted my right hon. Friend the Member for Blackburn (Mrs. Castle), the former Secretary of State. In the long debate in Committee it could have been possible not to make Clause 2 so explicit. However, it was obviously the more honest that we should seek to make that clear so that that which followed would logically stem from a statement of intent.

One of the amendments would completely emasculate Clause 2. I take issue with the part of the amendment that seeks to duplicate the small responsibility of this Bill with the whole responsibility of the National Health Service. The right hon. Gentleman made it plain in his introductory remarks that he thinks it is right and proper that the same responsibility that rests upon the Secretary of State should rest upon the board.

If the amendment were accepted in its present form, it would give the board responsibility for diagnosis and treatment outside the NHS. It is fairly clear that if that responsibility were to be incorporated into the Bill it would not be the job of the board merely to phase out the last 3,500 pay beds, it would also be its responsibility to ensure that private practice existed. It would be its responsibility to ensure an extension of private practice. If there is any greater negation of the purposes of the Bill, I cannot see it. As the House will imagine, I shall be voting against the amendment.

Mr. Crouch

I was not a member of the Committee, but the Committee room was packed when the clause was debated, 19 of the 20 members being present, including the Chairman. There was great excitement on both sides of the Committee. The report of the debate occupied a great deal of space. Both sides of the argument were well argued and well debated. When it came to the vote the debate was well voted upon. The Committee divided exactly half and half—namely, eight votes to eight votes—on three occasions. On each occasion the Chairman, in accordance with precedent, had to vote with the Government to sustain the status quo. That is accepted.

I wonder whether you can do anything now, Mr. Deputy Speaker, to fill the House to the equivalent of eight Members on each side of a Committee. The House would then hear what an important and vital amendment this is. It is no small matter although it has been dismissed so easily by the hon. Member for Brent, South (Mr. Pavitt). The hon. Gentleman merely says that it is necessary to have a declaratory statement.

Mr. Pavitt

rose—

Mr. Crouch

If the hon. Gentleman wants to interrupt me before I really get under way, I shall give way.

Mr. Pavitt

If a Committee is composed of the same number of Members on the Government side as on the Opposition side, how can we avoid having equal votes?

Mr. Crouch

If the Government had better judgment, they would get many more votes. Given better judgment they would have managed to get more votes than they received day after day in Committee. On no fewer than 58 occasions the Chairman had to intervene to sustain the Government's case in this terribly thin argument and thin Bill.

From the arguments advanced this afternoon it is quite clear what the Bill is about, or rather what it is not about. It is not about producing the best possible facilities for the prevention, diagnosis and treatment of illness in both the premises vested in the Secretary of State and under private arangements. That has been vigorously denied by the Government. That is not what the Bill is about. That has been denied. It is not about securing the availability of sufficient accommodation and services of a satisfactory standard at both National Health Service hospitals and other hospitals for use in treating patients at such hospitals. It is not about that. It is about the dogmatic belief with which the Government are determined to proceed and which is set out in the Bill. The Bill is not about securing the best services for the curing of patients and sick people in hospital.

Even the worthy Member for Brent, South, who has been speaking on health matters for the past 15 years, dismissed the question of producing and securing the best possible facilities for the cure and prevention of illness. He has become the dogmatic Socialist again. He is concerned only with securing the separation of facilities. He is concerned only with securing the progressive withdrawal of services. The hon. Gentleman and his hon. Friends are eaten up with the idea of separating the private patient from the NHS. There is no question of producing a better service.

Clause 2 is always the most important part of a Bill. The first clause sets out an important statement but the guts of most Bills are in the second clause. Clearly the guts of this Bill are in Clause 2. My right hon. Friend is right in saying that when we get to the guts of the Bill it is a declaratory statement about Socialist dogma. It is a pity that we should have that dogma when talking about sickness, illness and serving the people.

I only wish that the House would fill. I only wish that the television screens would bear the message "This is an important amendment and the hon. Member for Canterbury is making an important statement." In the old days the House would have filled up. If I continue for another 10 minutes, perhaps we shall attract the attention of most Members and you will find, Mr. Deputy Speaker, that you hardly have room to sit in your Chair. However, that will probably not be the situation.

We are now considering the very guts of the Bill. My right hon. Friend was right to say that it is wrong that we should have such a statement in Clause 2. If the Government are determined to go ahead with the removal of the private sector, let them—let me not be interrupted by the activities of my Deputy Chief Whip. I suppose that a nod is as good as a wink. I trust that he understands what I mean. Let the Government declare their intention of pursuing their dogmatic progress, their real intention, but above all let them show that they believe in producing a health service worthy of the people.

The wording of Clause 2 is not worthy of that objective. Instead they have given us a minor objective and a minor aim. That is what I must condemn and that is why I welcome the amendment. I hope that it will be solidly supported by all my hon. Friends.

Mr. George Thompson (Galloway)

I cannot see what objection there can be to a declaratory clause setting out the purposes that the board will have to fulfil. I take the Secretary of State's point that candidates for the board must be sure of what they will be called upon to do before they can accept or reject an invitation to be nominated.

5.30 p.m.

In Scotland we do not want an extension of the private sector. If people are willing to pay for treatment, let them do so, but I do not see why that purpose should be written into the Bill. It has been said that the Committee was always split right down the middle. If the Committee of Selection had had the wisdom to appoint an SNP Member to the Committee, the split would not have been down the middle. There would have been a clear majority for sensible solutions to this problem.

I was much struck by the opinion poll that was cited. Unless I mistook what was said, it appeared to me that the dichotomy that was proposed to those who answered this poll was not in a perfect form at all but was, indeed, false. One cannot say "Are you in favour of pay beds in the NHS"? and put that as the precise oposite of "Are you against private practice?" It is quite false. If that was what the poll asked, it was quite unworthy of the British Press that such a thing was done. It is perfectly possible to be willing to allow private practice to continue and to be against pay beds in the NHS. That is precisely the policy of my party.

Mr. Kenneth Clarke (Rushcliffe)

The hon. Gentleman has probably misheard the explanation of the NOP survey. The particular question begins with a clear statement: There has been a lot of discussion recently on 'pay beds' in NHS hospitals. Then follows the question. Therefore, I think it is clear that if the hon. Gentleman had had the opportunity of seeing the survey, he would have seen that it is directed to the question of pay beds in NHS hospitals.

Mr. Thompson

Yes, but my point was that the dichotomy of the two questions was false, because it is perfectly possible to be in favour of allowing private prac- tice and, at the same time, to be against pay beds within the NHS. Unless I was wrong in that, I think that my objection must be sustained.

Mr. Ennals

This is absolutely typical of a loaded question. Perhaps I may read it. Some people say that 'pay beds' are a way of jumping the queue and ought to be stopped, others that people should be allowed to spend their money on private medical treatment if they want to do so. This survey showed that a large proportion of all respondents, 63 per cent., said that people should be allowed to spend their money on private medical treatment if they wanted to do so. It did not imply for a moment that it should be private medical treatment within the NHS, so this is an absolutely bogus alternative, and the hon. Member for Galloway (Mr. Thompson) is absolutely right.

Mr. Thompson

I am most grateful to the Secretary of State for confirming me in my opinion that the logic of the question was quite false.

I want once again to commend to the House and to English Members present tonight our experience in Scotland. Our experience is not the product of some dogmatic theorising, any more than the intentions of the Government are based on dogmatic theorising. Our experience in Scotland is based on how the health service, the medical profession and so on have grown up in Scotland in a much more profoundly democratic way than they have grown up in the South of England. I commend to the House a consideration of our experience in Scotland as backing up what the Government are endeavouring to do for the ordinary people of southern England.

In view of what I have said, I shall be advising my hon. Friends to support the Government on this matter.

Lord James Douglas-Hamilton (Edinburgh, West)

I wish to take up a comment made by the hon. Member for Galloway (Mr. Thompson) when he spoke about our experience in Scotland. The areas of Scotland differ from each other in this respect. Everyone knows that in the hon. Gentleman's constituency there is not a single pay bed. However, in Edinburgh, which is recognised internationally as a medical centre, there are a considerable number of pay beds. Circumstances differ from one area of Scotland to another.

However, I am glad that the hon. Gentleman has firmly placed on record the fact that the SNP supports the Labour Government on this Bill and has done so throughout. I am grateful to him for that information. He has nut it on record absolutely clearly for Scotland. This matter has received virtually no publicity in Scotland. When doctors and surgeons come there, they will know full well that SNP Members are giving full support to the Labour Government.

The survey asked the question whether the number of pay beds should Remain as they are or be increased? The proportion of people who said that pay beds should remain as they are or be increased was 71 per cent. An overwhelming majority in Scotland would like pay beds retained in some form. The hon. Gentleman has not put that matter to the test. There are no pay beds in his constituency. He may speak for his constituency, but he does not speak for Scotland as a whole.

Mr. Moyle

I am in some difficulty because when the right hon. Member for Wanstead and Woodford (Mr. Jenkin) started this debate, he said that Opposition Members were anxious to make rapid progress. However, he then deployed his arguments at somewhat greater length than his opening statement had led me to believe he would. Nevertheless, I hope to make a brief reply in order to accommodate Opposition Members, who quite understandably want to get away from this matter and move on to other topics.

If we were to accept the amendment, we should be emasculating an important part of the Bill. The clause is declaratory, as the debt hon. Gentleman said, but nevertheless its words are controlling provisions and act as an essential part of the Goodman proposals, to which the right hon. Gentleman referred—namely, that the legislation which should emerge from the Goodman proposals should contain Clause 2 (1) and Clause 2 (2). We have done our best in our policy of accepting the Goodman proposals as a settlement of this problem. We have carried out the proposals and put them into the Bill. That is essentially why they are there.

This also has some other advantages in that it makes clear to the members who will be appointed to the board, as my right hon. Friend the Member for Plymouth, Devonport (Dr. Owen) said, what their duties will be in accepting membership of the board. I do not see that there is any reason why the Government should attempt to fudge the clarity of their attitude on this matter.

The right hon. Gentleman asked us to give an undertaking that there is no intention to pack the board with supporters of the phasing out policy. We shall not give that undertaking because there is no need to give it, as membership of the board is quite clearly laid down in the legislation. There is to be an independent chairman, who is to be a lawyer as a guarantee of his independence—if, indeed, being a lawyer is such a guarantee. However, as the right hon. Gentleman and I were at one time members of that profession, I think that he will take what I have said in the right spirit.

Another two members of the board will be members of the medical profession. We shall consult the medical organisations on that matter, as my right hon. Friend the Secretary of State has said. I do not think that there is any possibility that the representatives of the medical profession will be in favour of phasing out as an initial attitude to the problem of the NHS.

If the remaining two members of the board were people who were totally in favour of immediate phasing out of pay beds in the NHS—although I do not know what my right hon. Friend's intentions are—there would still be a complete balance on the Health Services Board. Therefore, I do not see that there is any need to give the undertaking requested.

The right hon. Gentleman then said that he did not think that broad statements ought to be written into the Bill because they tended only to muddy the waters and to obscure the points being made in all of the subsequent clauses. That may well be a very wise piece of advice, but I wish that he and his hon. Friends had taken it instead of tabling Amendment No. 6, which is a very generalised statement that he proposes to insert into Clause 2 but which attempts to do what the whole of Clauses 3 and 4 set out to do. The only effect of taking Amendment No. 6 into the Bill would be to create just that muddying to which the right hon. Gentleman is so much opposed. Therefore, consistency of argument would have been a good thing.

Amendment No. 5 seems totally to misconceive the situation that exists at present. The Secretary of State is responsible for providing all the treatment that the amendment urges the Health Board should provide. My right hon. Friend not only has the powers and the duties, but the facilities, to do what is required, which the Health Board does not.

Mr. Patrick Jenkin

The Minister has not answered my point. The introductory words in Amendment No. 5 make it clear that we are not imposing these provisions as duties on the Health Board but are saying that it shall exercise those functions with the objective of achieving the purposes achieved by the Secretary of State.

Mr. Moyle

I do not think that that alters the situtaion greatly, because my point is that the Secretary of State has the powers and duties to do all these things. In addition, succeeding legislation has provided him with the facilities and resources to do what is required. The board does not have those facilities and resources and no provision is made to give them to the board by any of the amendments put down by the Opposition.

My right hon. Friend has made the point that he is capable of carrying out all these duties and responsibilities in so far as they affect NHS patients. The Opposition are seeking to persuade the House that the Secretary of State should look after not only NHS patients but private patients, too. I should have thought that that was a direct contravention of the whole concept of private treatment. The whole idea of private treatment is to escape from the toils of the organisations that owe allegiance to my right hon. Friend. Having paid money, the idea is that someone escapes from my right hon. Friend and the employees and profesional people who work for him. The idea is that by paying money people go into the private sector entirely.

What a shock it would be for private patients, as I understand them—and I admit that my understanding is limited—if, having paid their money to escape from the toils of my right hon. Friend, they found his tentacles reaching into the private sector to interfere with their treatment. We accept that we have a responsibility to ensure that minimum standards are maintained in private hospitals under the Nursing Homes Act, but beyond that the provision of adequate facilities for treatment is a matter entirely for the managers and owners of private nursing homes, subject again only to the criminal law.

The amendment does not show any great confidence in the ability of the private sector to look after private patients when it gets them within its ambit. I should have thought that that was the last thing the right hon. Gentleman would want to convey. For the reasons that I have given, the Government cannot accept these amendments and will resist to the ultimate their introduction into the Bill.

Mr. Patrick Jenkin

I remain totally unconvinced by the Minister's argument when he talks about the Secretary of State's tentacles reaching into the private sector. Because of the guillotine, the Minister will not have bothered to read Part III, because we shall not reach it. We shall not debate that part of the Bill, but why the Minister thinks that those provisions should not be regarded as the tentacles of the Secretary of State reaching into the private sector defeats my understanding.

The tentacles to which I have referred reach every kind of health facility in the private sector, for example, to see whether the notification procedure is carried out. I have seen the draft regulations, and we shall wait to see whether they come out in their present form. The larger organisations have to run the gauntlet of the Health Board, which is in a sense the Secretary of State's tentacles reaching into the private sector. The two objectives which we say the board ought to have in mind when exercising its functions under the Bill will give a reality and relevance to the needs of patients in both the private and the public sector. That is something that the Bill singularly lacks.

The Minister has failed to answer the argument, and I gather that the Secretary of State misquoted the opinion poll during the time that I was out of the Chamber.

Mr. Ennals

I read it.

Mr. Jenkin

The right hon. Gentleman had to be corrected by my hon. Friend the Member for Rushcliffe (Mr. Clarke).

For all those reasons, I think that my right hon. and hon. Friends are justified in dividing the House in favour of the amendment.

Question put, That the amendment be made:—

The House divided: Ayes 191, Noes 220.

Division No. 317.]	AYES	[5.46 p.m.
Alison, Michael	Grylls, Michael	Page, Rt Hon R. Graham (Crosby)
Atkins, Rt Hon H. (Spelthorne)	Hall-Davis, A. G. F.	Pardoe, John
Awdry, Daniel	Hamilton, Michael (Salisbury)	Parkinson, Cecil
Baker, Kenneth	Hampson, Dr Keith	Penhaligon, David
Beith, A. J.	Hannam, John	Percival, Ian
Bell, Ronald	Harvie Anderson, Rt Hon Miss	Peyton, Rt Hon John
Bennett, Sir Frederic (Torbay)	Hawkins, Paul	Prior, Rt Hon James
Benyon, W.	Hayhoe, Barney	Pym, Rt Hon Francis
Bitten, John	Higgins, Terence L.	Renton, Rt Hon Sir D. (Hunts)
Biggs-Davison, John	Holland, Philip	Renton, Tim (Mid-Sussex)
Blaker, Peter	Hooson, Emlyn	Ridsdale, Julian
Boscawen, Hon Robert	Howe, Rt Hon Sir Geoffrey	Rifkind, Malcolm
Bottomley, Peter	Howell, David (Guildford)	Roberts, Michael (Cardiff NW)
Bowden, A. (Brighton, Kemptown)	Howells, Geraint (Cardigan)	Roberts, Wyn (Conway)
Boyson, Dr Rhodes (Brent)	Hunt, John (Bromley)	Ross, Stephen (Isle of Wight)
Brittan, Leon	Hurd, Douglas	Rossi, Hugh (Hornsey)
Brocklebank-Fowler, C.	Hutchison, Michael Clark	Rost, Peter (SE Derbyshire)
Brotherton, Michael	Irving, Charles (Cheltenham)	Royle, Sir Anthony
Brown, Sir Edward (Bath)	Jenkin, Rt Hon P. (Wanst'd & W'df'd)	Sainsbury, Tim
Bryan, Sir Paul	Jessel, Toby	St. John-Stevas, Norman
Buchanan-Smith, Alick	Jones, Arthur (Daventry)	Shaw, Giles (Pudsey)
Buck, Antony	Jopling, Michael	Shepherd, Colin
Budgen, Nick	Joseph, Rt Hon Sir Keith	Sinclair, Sir George
Bulmer, Esmond	Kaberry, Sir Donald	Skeet, T. H. H.
Burden, F. A.	Kilfedder, James	Smith, Cyril (Rochdale)
Chalker, Mrs Lynda	King, Evelyn (South Dorset)	Smith, Dudley (Warwick)
Channon, Paul	King, Tom (Bridgwater)	Speed, Keith
Churchill, W. S.	Kitson, Sir Timothy	Spence, John
Clark, Alan (Plymouth, Sutton)	Knight, Mrs Jill	Spicer, Michael (S Worcester)
Clarke, Kenneth (Rushcliffe)	Knox, David	Sproat, Iain
Clegg, Walter	Lamont, Norman	Stainton, Keith
Cockcroft, John	Langford-Holt, Sir John	Stanley, John
Cooke, Robert (Bristol W)	Latham, Michael (Melton)	Steel, David (Roxburgh)
Cope, John	Lawrence, Ivan	Steen, Anthony (Wavertree)
Corrie, John	Le Merchant, Spencer	Stewart, Ian (Hitchin)
Costain, A. P.	Lester, Jim (Beeston)	Stokes, John
Craig, Rt Hon W. (Belfast E)	Lewis, Kenneth (Rutland)	Stradling Thomas, J.
Davies, Rt Hon J. (Knutsford)	Lloyd, Ian	Taylor, R. (Croydon NW)
Dean, Paul (N Somerset)	Luce, Richard	Taylor, Teddy (Cathcart)
Dodsworth, Geoffrey	McCrindle, Robert	Tebbit, Norman
Douglas-Hamilton, Lord James	Macfarlane, Neil	Temple-Morris, Peter
Dunlop, John	McNalr-Wilson, M. (Newbury)	Thatcher, Rt Hon Margaret
Durant, Tony	Madel, David	Townsend, Cyril D.
Eden, Rt Hon Sir John	Marshall, Michael (Arundel)	Trotter, Neville
Emery, Peter	Marten, Nell	Tugendhat, Christopher
Eyre, Reginald	Mather, Carol	van Straubenzee, W. R.
Fairbairn, Nicholas	Maudling, Rt Hon Reginald	Vaughan, Dr Gerard
Fell, Anthony	Maxwell-Hyslop, Robin	Viggers, Peter
Fisher, Sir Nigel	Meyer, Sir Anthony	Wainwright, Richard (Colne V)
Fletcher-Cooke, Charles	Miller, Hal (Bromsgrove)	Wakeham, John
Fookes, Miss Janet	Mills, Peter	Walder, David (Clitheroe)
Forman, Nigel	Miscampbell, Norman	Walker, Rt Hon P. (Worcester)
Fowler, Norman (Sutton C'f'd)	Moate, Roger	Wall, Patrick
Fox, Marcus	Molyneaux, James	Walters, Dennis
Fry, Peter	Monro, Hector	Warren, Kenneth
Gilmour, Rt Hon Ian (Chesham)	Montgomery, Fergus	Weatherill, Bernard
Glyn, Dr Alan	More, Jasper (Ludlow)	Whitelaw, Rt Hon William
Goodlad, Alastair	Morgan-Giles, Rear-Admiral	Wiggin, Jerry
Gorst, John	Morris, Michael (Northampton S)	Wood, Rt Hon Richard
Gow, Ian (Eastbourne)	Mudd, David	Young, Sir G. (Ealing, Acton)
Gower, Sir Raymond (Barry)	Nelson, Anthony	Younger, Hon George
Gray, Hamish	Neubert, Michael
Griffiths, Eldon	Newton, Tony	TELLERS FOR THE AYES:
Grimond, Rt Hon J.	Onslow, Cranley	Mr. Anthony Berry and
Grist, Ian	Oppenheim, Mrs Sally	Mr. Fred Silvester.
NOES
Abse, Leo	Golding, John	palmer, Arthur
Allaun, Frank	Gourlay, Harry	Park, George
Anderson, Donald	Grant, George (Morpeth)	Parker, John
Archer, Peter	Grocott, Bruce	Pavitt, Laurie
Armstrong, Ernest	Hamilton, James (Bothwell)	Perry, Ernest
Ashley, Jack	Hardy, Peter	Prentice, Rt Hon Reg
Ashton, Joe	Harper, Joseph	Price, William (Rugby)
Atkins, Ronald (Preston N)	Harrison, Waller (Wakefield)	Reid, George
Atkinson, Norman	Hatton, Frank	Richardson, Miss Jo
Bagier, Gordon A. T.	Heffer, Eric S.	Roberts, Albert (Normanton)
Bain, Mrs Margaret	Henderson, Douglas	Robinson, Geoffrey
Barnett, Guy (Greenwich)	Hooley, Frank	Roderick, Caerwyn
Bates, Alt	Horam, John	Rodgers, George (Chorley)
Benn, Rt Hon Anthony Wedgwood	Howell, Rt Hon Denis (B'ham, Sm H)	Rooker, J. W.
Bennett, Andrew (Stockpott N)	Hoyle, Doug (Nelson)	Roper, John
Bidwell, Sydney	Huckfield, Les	Rose, Paul B.
Bishop, E. S.	Hughes, Rt Hon C. (Anglesey)	Ross, Rt Hon W. (Kilmarnock)
Blenkinsop, Arthur	Hughes, Robert (Aberdeen N)	Sandelson, Neville
Boardman, H.	Hughes, Roy (Newport)	Sedgemore, Brian
Booth, Rt Hon Albert	Hunter, Adam	Shaw, Arnold (Ilford South)
Bottomley, Rt Hon Arthur	Irvine, Rt Hon Sir A. (Edge Hill)	Sheldon, Robert (Ashton-u-Lyne)
Bradley, Tom	Irving, Rt Hon S. (Dartford)	Short, Mrs Renée (Wolv NE)
Bray, Dr Jeremy	Jay, Rt Hon Douglas	Silverman, Julius
Brown, Hugh D. (Provan)	Jeger, Mrs Lena	Skinner, Dennis
Brown, Ronald (Hackney S)	Jenkins, Hugh (Putney)	Small, William
Buchan, Norman	John, Brynmor	Smith, John (N Lanarkshire)
Buchanan, Richard	Johnson, James (Hull West)	Snape, Peter
Callaghan, Jim (Middleton & P)	Jones, Alec (Rhondda)	Spearing, Nigel
Campbell, Ian	Jones, Barry (East Flint)	Spriggs, Leslie
Cant, R. B.	Jones, Dan (Burnley)	Stallard, A. W.
Carter-Jones, Lewis	Judd, Frank	Stoddart, David
Cartwright, John	Kerr, Russell	Stott, Roger
Castle, Rt Hon Barbara	Kinnock, Nell	Strang, Gavin
Clemitson, Ivor	Lambie, David	Summerskill, Hon Dr Shirley
Cocks, Rt Hon Michael (Bristol S)	Lamborn, Harry	Swain, Thomas
Cohen, Stanley	Lamond, James	Taylor, Mrs Ann (Bolton W)
Coleman, Donald	Latham, Arthur (Paddington)	Thomas, Dafydd (Merioneth)
Concannon, J. D.	Leadbitter, Ted	Thomas, Jeffrey (Abertillery)
Con Ian, Bernard	Lestor, Miss Joan (Elton & Slough)	Thomas, Mike (Newcastle E)
Cook, Robin F. (Edin C)	Lewis, Ron (Carlisle)	Thomas, Ron (Bristol NW)
Corbett, Robin	Lipton, Marcus	Thompson, George
Cox, Thomas (Tooting)	Litterick, Tom	Thome, Stan (Preston South)
Crawford, Douglas	Loyden, Eddie	Tierney, Sydney
Crowther, Stan (Rotherham)	Lyon, Alexander (York)	Tinn, James
Cryer, Bob	Mabon, Dr J. Dickson	Tomlinson, John
Davidson, Arthur	McCartney, Hugh	Torney, Tom
Davies, Bryan (Enfield N)	McDonald, Dr Oonagh	Wainwright, Edwin (Dearne V)
Davies, Ifor (Gower)	McElhone, Frank	Walden, Brian (B'ham, L'dvw'd)
Davis, Clinton (Hackney C)	MacFarquhar, Roderick	Walker, Terry (Kingswood)
Deakins, Eric	McGuire, Michael (Ince)	Watkins, David
Dell, Rt Hon Edmund	MacKenzie, Gregor	Watkinson, John
Dempsey, James	Mackintosh, John P.	Wellbeloved, James
Doig, Peter	Maclennan, Robert	Welsh, Andrew
Dormand, J. D.	McMillan, Tom (Glasgow C)	White, Frank R. (Bury)
Douglas-Mann, Bruce	McNamara, Kevin	White, James (Pollok)
Duffy, A.E.P.	Madden, Max	Whitehead, Phillip
Dunnett, Jack	Mahon, Simon	Whitlock, William
Eadie, Alex	Mallalleu, J. P. W.	Wigley, Dafydd
Edge, Geoff	Marshall, Dr Edmund (Goole)	Willey, Rt Hon Frederick
Edwards, Robert (Wolv SE)	Maynard, Miss Joan	Williams, Alan (Swansea W)
Ellis, John (Brigg & Scun)	Mendelson, John	Williams, Alan Lee (Hornch'ch)
Ennals, David	Millan, Rt Hon Bruce	Williams, Rt Hon Shirley (Hertford)
Evans, Fred (Caerphilly)	Miller, Dr M. S. (E Kilbride)	Wilson, Alexander (Hamilton)
Evans, Ioan (Aberdare)	Miller, Mrs Millie (Ilford N)	Wilson, Gordon (Dundee E)
Ewing, Harry (Stirling)	Moonman, Eric	Wilson, William (Coventry SE)
Faulds, Andrew	Morris, Alfred (Wythenshawe)	Wise, Mrs Audrey
Fernyhough, Rt Hon E.	Morris, Charles R. (Openshaw)	Woodall, Alec
Flannery, Martin	Moyle, Roland	Woof, Robert
Fletcher, Ted (Darlington)	Mulley, Rt Hon Frederick	Wrigglesworth, Ian
Forrester, John	Murray, Rt Hon Ronald King	Young, David (Bolton E)
Fowler, Gerald (The Wrekin)	Newens, Stanley
Fraser, John (Lambeth, N'w'd)	Noble, Mike	TELLERS FOR THE NOES
Freeson, Reginald	Orbach, Maurice	Mr. Ted Graham and
George, Bruce	Orme, Rt Hon Stanley	Mr. Tom Pendry.
Gilbert, Dr John	Ovenden, John

Question accordingly negatived.