HC Deb 25 May 1979 vol 967 cc1441-52

3.25 p.m.

Mr. Anthony Beaumont-Dark (Birmingham, Selly Oak)

It is a great honour for me to have been able to address the House, however sparsely attended it may be, twice in one week. I wish to raise the question of private medicine, particularly in relation to the the National Health Service.

It cannot be forgotten that my party won the last general election on a programme, endorsed by the people, of three freedoms—the right of people living in public housing to buy their homes, that those in State education should have a choice, and that those who endured ill health should, if they desired, be able to contribute to, and benefit from, private medicine within the National Health Service.

The programme was laid out clearly and was endorsed by the people in the greatest plurality of the voters that this country has seen in my lifetime. We have now come up against a great principle, namely, whether this House and Parliament shall decide who runs a service or whether those who work for the service decide who runs it.

A rather odious person, who is a carpenter-cum-builder-cum-baker-cum-nothing, has said—I shall not use his exact words—that every rich illegitimate who is in a pay bed from 1 January next will not get the service which this House has laid down over the past 33 years, through periods of Labour and Conservative Governments, is the people's right. It is important for the new Government to make clear where they stand on that issue.

There are certain matters open for negotiation and some problems that are matters of administration, but on the principle of who rules and whether the voice of the people, through Parliament, or the voice of a union and a few petty tyrants, which is often not the voice of its members, is to decide who is allowed what, I hope that the Minister will say loudly and clearly and without equivocation that the House, representing the people, will decide what happens in the lawful running of our country.

On 30 April 1946, Aneurin Bevan, who was not a noted Conservative, and was not even a noted middle-of-the-road Socialist but was one of the full-blooded Socialists who built the Socialist Party that we have today, made clear that although he might not approve of fee-paying patients and although he criticised some of the philosophy behind private medicine, he believed that it was right to keep doctors and specialists within the NHS so that the country could have a good and rounded service.

Less than a month later, Mr. Bevan said that the more time that a specialist spent in hospital, the better it would be for all concerned. He said: I would encourage the specialist to have as much consultation in the hospital as possible. I do not want him to go to his surgery; I want him to be there on the spot and to see the people in the hospital. It would be disastrous if, as a consequence of not accepting this principle, there grew up in Great Britain a rash of nursing homes, where the specialist would be intellectually isolating himself".—[Official Report, Standing Committee C, 21 May 1946; c. 1155.] Not all doctors wish to be in private medicine, but they wish to have the right, the privilege and the freedom to choose. Choice is what all our freedoms are about. Yet that little man Geddes says that the hand of the private patients is throttling the NHS. What utter rubbish it is! About 1 per cent. of the beds in all our hospitals are occupied by private patients, but they are contributing about £40 million towards the NHS.

There are people who purport to speak for egalitarianism and the freedom of the so-called little man. All that they are really doing is speaking up for a principle of envy and malice. They do not really care about the individual that they purport to speak for. All that they wish to make sure of is that everyone has an equality of misery.

The NHS, which most people in their right minds would wish to see strengthened and further advanced, believes that the right to choose is one of the greatest benefits that the House can give people. Private patients are not rich illegitimates, as Mr. Geddes called them. They are people like myself and 2,800,000 others who pay out of income taxed at exorbitant rates in case they fall ill. I pay about £200 a year so that my wife and family, all my loved ones, and I can be treated if we strike times of physical handicap. Does that make one a rich illegitimate? I think not. It makes one prudent. One does this in the same way as one insures one's car through the AA or the RAC. Why not stop that?

Mrs. Gwyneth Dunwoody (Crewe)

Will the hon. Gentleman give way?

Mr. Beaumont-Dark

No. What we pay is a premium to protect ourselves against what may befall us. We insure our houses against being burnt down on the same principle.

I hope that the Government will state firmly and clearly that they support the principle that we advanced in the election, that Nye Bevan put forward and that was put forward by a Select Committee, chaired, I believe, by the hon. Member for Wolverhampton, North-East (Mrs. Short). That principle is that there is a balance of advantage in favour of the present arrangements for the provision of some facilities for private patients alongside those for National Health Service patients.

Doctors have their rights. Are we and they to accept Mr. Geddes' principle that he and other NUPE people will decide who can be treated, as happened during those odious goings-on in October and November when they decided who was ill and who could be treated and who could have X-rays? They, the non-medical trade, decided who were sick and who needed help.

I hope that the time has come when the House will make clear to all concerned that it is those who are elected to serve the people in the round, in this Chamber, who will decide who runs what. Then, if people who work for the NHS but think that the NHS works for them do not like what the House decides on behalf of the people, they have the same wonderful freedom as we all have. Mr. Geddes can go back to being the poor baker that I believe he was or to being a carpenter wherever he wishes to be.

Whether the House is controlled by the Labour Party or the Conservative Party is irrelevant. It is elected by the people in their wisdom, or their lack of wisdom, to determine who runs what. I say as a Back-Bench Member, albeit newly elected, that there can be no compromise on who runs the Health Service. The people have decided. The private health service within the National Health Service must be allowed not only to survive but to thrive, because the money would do good for the National Health Service.

The freedom within the private health service will help to keep the doctors and the best of the specialists within this country instead of driving them overseas. But, in the end, the freedom of our people is enshrined here. It is not enshrined within the NUPE conference or in the mouthings of some man who cannot even do properly the job that he was selected and paid to do.

I hope, therefore, that the Minister will make clear that it is not a matter for negotiation but it is a matter of fact that private medicine within the National Health Service will not just survive but will thrive.

Mrs. Dunwoodyrose—

Mr. Deputy Speaker (Mr. Bryant Godman Irvine)

Has the hon. Member the Minister's permission to intervene in the debate?

The Minister for Health (Dr. Gerard Vaughan)

indicated assent.

3.37 p.m.

Mrs. Gwyneth Dunwoody (Crewe)

I believe that the Minister will allow me a moment to intervene. The hon. Member for Birmingham, Selly Oak (Mr. Beaumont-Dark) is obviously a man of Great tolerance and understanding, but I wish to query one matter with the Minister.

When talking about the whole funding of the National Health Service, will the Minister make clear that many people do not object to private medicine as long as it is economically maintained outside the National Health Service? We on these Benches will not accept that the facilities of the National Health Service should be used by those who have the money to pay for them and to queue-jump over those who are in urgent need of treatment. Will the Minister make clear that it is the Government's intention, whatever their views, to make sure that need is the most important criterion in the National Health Service?

3.38 p.m.

The Minister for Health (Dr. Gerard Vaughan)

I should like to thank my hon. Friend the Member for Birmingham, Selly Oak (Mr. Beaumont-Dark) for raising an important subject. I am glad that the hon. Member for Crewe (Mrs. Dunwoody) was able to join in for a moment and make her point. I have followed carefully what my hon. Friend the Member for Selly Oak said. It is clear that we have a common objective and a common goal to see that the conflict which grew up between the National Health Service and the private sector, especially in the last few years under the previous Administration, is resolved as soon as possible. This can do no good to either sector.

As the hon. Member for Crewe will know, the Government have strong views that the two sectors working together can be to their mutual advantage and not to their disadvantage. My hon. Friend the Member for Selly Oak will understand that, as a new Minister, I do not entirely agree with every point he made. He said that important and delicate issues were involved and that it was important that there should be consultations. He will understand that I wish to have full discussions with the various people concerned before we dive in with lots of specific proposals which may or may not be satisfactory for those who have to carry them out. I followed carefully what he said. He seems to have some doubts about what we shall do—some lack of confidence in the new Government. Why should he have these doubts? I want to reassure him.

Our commitments and our intentions in this sphere are clear. We intend to restore the vitality of and improve the health care in this country provided by the National Health Service. That is a clear commitment. We intend to do this both in the National Health sector and also in the private sector. It will not be easy, and it will take a little time.

In our manifesto we were quite clear. We said that National Health Service standards were falling. We know this at first hand. We know how desperate the situation is in many parts of the country. My right hon. Friend the Secretary of State and I have made it our job not just to read papers but to visit many parts of the country to see for ourselves the conditions in both the National Health Service and the private sector. We have gone to both because we see the two as collaborators in providing health care. We do not see them as working in separate compartments. Under our Administration, we see them working more closely together.

We also said in our manifesto that too often patient needs did not come first. I am afraid that is so. Far too often under the previous Administration the care of patients did not appear to be the first consideration when decisions were being made. We shall change that, but it will take a little time. Waiting lists, for example, have risen to the most appalling level. They stand at just on 750,000 and might be even higher if the full figures were known. That is a dreadful and deplorable state of affairs. In terms of personal suffering, pain and anxiety, that situation cannot go on. It will be one of our top priorities.

In our manifesto we said: It it not our intention to reduce spending on the Health Service; indeed, we intend to make better use of what resources are available. So we will simplify and decentralise the service and cut back bureaucracy. Over and over again during the election, we were told that Conservatives would cut spending on health. That is not true. It is totally false, but it was used in the election to try to discredit us. We wish to raise, not lower, standards in health care. We are pledged to a National Health Service available to everybody who wishes to use it—at the time of need and irrespective of their financial position.

Before making major changes, it seems to us common sense that we should wait for the recommendations of the Royal Commission. We expect the Royal Commission to report very soon. But make no mistake, we are committed to restoring authority and control to the local level to bring it back more closely in touch with the real needs of patients. That is one reason why we are so sympathetic to the retention of small hospitals, wherever this is possible.

However, already we are running into some legal difficulties. We are stopping the appalling lack of decision and the drift which went on under the Labour Government. I am amazed and appalled at the number of decisions coming to me which seem to have drifted on for no clear reason for years. One was brought to me today which was unresolved for four years, yet all the information is there and all it needs is a decision.

So we see the need to restore greater professional freedom so that skills can once again be used without a mass of bureaucracy interfering. We should like to see nurses and other staff much more able to practise their skills in the way they were trained to do.

Mrs. Dunwoody

Is the Minister suggesting that the clinical judgment of doctors was interfered with under the previous Administration? I should have thought that he would have found that extremely unlikely.

Dr. Vaughan

No. I am saying that, if one has to work in a stressful and demanding role in life with a welter of committees and directives of various kinds, it cannot be good. It distracts and leads one off into side issues which are not always relevant to the care of patients We shall aim to free the professional groups from that.

We see the private sector and the community playing an important part together in developing ways of improving health care and the National Health Service. We hope that the raising of funds for the Elizabeth Garrett Anderson hospital by an appeal will be only one example of stopping the indecision which has gone on and will enable valuable parts of the NHS to continue to run in a satisfactory way. We hope that will become a model for other joint developments in the NHS.

Mrs. Dunwoody

Charity funding?

Dr. Vaughan

Turning again to our manifesto, we said: When resources are so tightly stretched it is folly to turn good money away from the NHS and to discourage people from doing more for themselves. We shall therefore allow pay-beds to be provided where there is a demand for them; end Labour's vendetta against the private health sector; and restore tax relief on employer-employee medical insurance schemes. We shall honour those commitments.

My hon. Friend the Member for Selly Oak will have seen the reference to a Bill in the Gracious Speech. This will be presented as soon as our consultations are completed. Meanwhile, until a new Bill is introduced, we are in an unavoidable legal difficulty under the present Act.

It is important that we should realise that the Health Services Board is required legally to continue its activities. My right hon. Friend the Secretary of State has discussed this matter with its chairman, Lord Wigoder. Only yesterday, he wrote to Lord Wigoder. This is an important letter. Therefore, hon. Members will understand if I read three paragraphs in full. My right hon. Friend wrote: I have now laid before Parliament the Board's latest proposals for the revocation of a further 49 section 65 authorisations. The proposals will be published shortly. He has laid 49 revocation proposals before Parliament. We spoke about the possibility of the Health Services Board not making further revocation proposals in anticipation of the Government's commitment to repeal the Board's powers to make such proposals. I recognise that the Board operates independently of the Secretary of State and has statutory duties which it must fulfil until such time as the Act is repealed. I believe the legislation allows the Board some discretion in the effective timing and extent of the exercise of its powers of proposing revocations and I hope the Board will feel able to take account of the Government's intentions in the interests of avoiding unnecessary difficulty for the NHS. I hope that the Health Services Board will be able to modify its activities a little in the light of that important letter from the Secretary of State. It would be foolish if we and the Board went ahead with changes which we all knew not to be in the best interests of the service.

I should like to go on a little further. We are discussing an important part of our Health Service. For example, in 1977 2¼ million people—that is, more than 4 per cent. of the population—were covered by private medical insurance of various kinds. Three-quarters of them were members of group schemes. Although I do not have more up-to-date figures than those, we know that the proportion has been increasing steadily recently. At that time, the total subscription income for the major private insurance schemes was £86 million a year. That is a considerable sum. We do not have precise information about the total expenditure on private medical care. However, in 1976 it was thought that this was more than £134 million a year. It seems certain that that figure would be higher today.

There are about 30,000 beds in 1,100 private nursing homes and hospitals, of which about 5,000 beds are registered for surgery. The Nuffield Nursing Homes Trust forms one of the largest single groups of private acute hospital beds in the country. It is interesting that whereas in 1970 it had 493 beds, by 1978 it had more than 1,000. I have more detail about these aspects of health care which I can make available to those hon. Members who are interested.

The proposed new private sector acute beds notified to the Health Service Board under the 1976 Act total about 2,000 at the moment. Many of those will not actually see the light of day. However, that gives some idea of the extent of the demand. We are discussing a significant part of the country's services.

I believe strongly that the encouragement of private medicine is in the interests not of a select few people but of every- body, including those who rely—and who will probably always rely—on the National Health Service. We know that we are not discussing buying a car or a pair of shoes, when we may decide whether we shall or shall not buy. We are discussing how sick people get their care, which they must have anyway if they are to be looked after properly. We are clear that every penny spent in the private sector releases a penny in the National Health Service sector, which may then be spent on areas which need it desperately, such as children, the mentally sick and care of the elderly.

The issue of private medicine versus the National Health Service is a sad feature of the past few years. It caused a great deal of unrest. It has done a great deal of harm to the National Health Service. In particular, it damaged relationships between different groups of staff in an area in which good relationships were of the utmost importance. Those who oppose private medicine and believe that it should be driven out from the National Health Service are mistaken. Even more mistaken are those who go further and demand that it should somehow be banned altogether.

Private medicine is not a threat to the existence and quality of the NHS, nor is it contrary to the principles on which the Health Service is based. I believe that a great deal of the recent unrest could have been avoided by the previous Government. Instead of adopting doctrinaire policies and forcing measures through regardless of the consequences to the NHS, thereby denying the service very large sums amounting, at the moment, to between £26 million and £30 million, they should have taken the trouble to look properly at the relationships between private medicine and the National Health Service. Had they done that, they would have found that private medicine can help the NHS. I submit that the previous Government's energies would have been much better spent in understanding and developing this relationship than in driving private medicine from the National Health Service and turning their back on what the private sector had to offer.

Mrs. Dunwoody

How does the Minister reconcile his statement about growing waiting lists and the lengths of time that people have to wait with his suggestion that private pay beds are in no way detrimental to those who use the NHS? Why do people in this country not pay the same insurance for health care as is paid in America if, as the Minister suggests, they are paying an economic rate here?

Dr. Vaughan

I think that the hon. Lady has missed the point. She should look at some other countries where there are no major waiting lists. She should consider why, of all countries in Western Europe, we have the longest and most rapidly growing waiting lists.

Mrs. Dunwoody

Ask the consultants.

Dr. Vaughan

These are the questions that the hon. Lady should be considering. I suggest that the previous Government's policy had precisely the reverse effect to what they intended. It created a split between the National Health Service and the private sector which has done the NHS great harm. In addition, they achieved what they did not want but which I welcome—the development of the private sector. I do not believe that the conflict was necessary, and I shall do my best to undo all the damage that has been done.

Our aim as a Government will be to improve the nation's health services—that is, the whole health care of the nation. The only way to achieve that when resources are limited is to take advantage of all available resources. By that I mean not only improving the National Health Service but developing collaborative schemes between the private and State sectors.

It will not be easy to repair the damage that has been done over the past few years. Let no one think that I underestimate the difficulty we shall have in persuading some of the Health Service unions that there is a legitimate and advantageous place for the private sector, working alongside, with and in the National Health Service. We should like to secure co-operation from all those concerned. We hope that as a result of the consultations which are now beginning to take place, we shall overcome the prejudices and fears which underlie the sort of provocative remarks to which I think my hon. Friend the Member for Selly Oak was referring and the hostile attitudes that we heard from some quarters earlier this week.

I do not believe that those views are representative of the National Health Service staffs as a whole. I shall do all I can to persuade everyone working in the NHS and in health care generally that private medicine is not a bogy that has to be phased out and got rid of but that, properly handled, it will benefit the health care of us all.

It being Four o'clock, the motion for the Adjournment of the House lapsed, without Question put.