§ Mr. Deputy Speaker (Mr. Ernest Armstrong)Before I call the hon. Member for Fife, Central (Mr. Hamilton), I should tell the House that Mr. Speaker has said that the next debate will take 30 minutes.
§ Mr. William Hamilton (Fife, Central)On 29 November 1982 there was an article in the New Statesman headed:
Profits in Scottish Ill HealthThat article outlines some of the problems that I shall raise. It described "the unseemly scramble" to build private profit-making hospitals in Scotland with the active connivance and encouragement of the present Government. Side by side with that development, the Government have relaxed controls on full-time National Health Service consultants doing private work. The consequence of that has been that increasing numbers of those consultants throughout Scotland have applied to use National Health Service facilities for their private patients. There appears to be an alarming increase in the evidence suggesting that a minority of consultants are systematically misusing National Health Service facilities for their private patients and their own selfish personal gain.Some cases and names were specifically mentioned in the New Statesman article. For example, it quoted a case, in which I was involved, of how last year Mr. Alec Spence, an orthopaedic consultant in Fife, was reprimanded by the Fife health board for allowing a private fee-paying patient to jump the queue for beds at the Victoria hospital in Kirkcaldy. It was fortuitous that that was found out, by methods that I need not go into now.
Another consultant was identified as Dr. J. A. Kennedy, a consultant cardiologist at the Glasgow Western infirmary. He had been sending his private paying patients to the hospital's exercise testing unit for free tests, although when he was charged with that he said that that was not happening now. However, it is believed that private patients have had access to that facility for at least two years, although the number of patients involved is not yet known. I have been advised that that case is now subject to a criminal investigation, but that Dr. Kennedy is still working. I should like to ask without prejudice to the case why Dr. Kennedy was not suspended on full pay. Any other employee in that position would have been dealt with in that manner.
The next example comes from the Scottish Daily Record, a popular newspaper in Scotland, of 10 September 1982. The article concerns Dr. William Irvine, an immunologist of world renown at Edinburgh Royal infirmary. Apparently that consultant was carrying out work, using facilities provided by the British taxpayer, for a hospital in Indianapolis in the United States. The Daily Record article describes how Dr. Irvine entered into an
agreement for a 2 year series of tests to be carried out in Edinburgh on deep-frozen serum from 500 American patients using pancreas tissues taken from Scots' kidney donors.The allegation has been made that Dr. Irvine could have earned as much as £60,000 from that source in 1981–82. Other irregularities have been discovered in the conduct of that gentleman, so much so that, according to the Daily Record article, Dr. Irvine is now the subject of a Crown Office probe. Will the Minister tell me what progress has been made in that case and in the case that I mentioned earlier? Is Dr. Irvine still engaged in that work?1086 Another example concerns an arrangement with Flow Laboratories of Irvine, and to a lesser extent with Gibco Europe Ltd., by which the biochemistry department of the Glasgow Royal hospital for sick children was being used to do quality control tests for those two private companies. The fee charged to the companies was most recently £12.10 per test. Over 300 of those tests were carried out per year, which was half the total work load of a four-person laboratory.
The income from those tests was therefore only about £4,000 to £5,000 a year. However, the running costs of the laboratory, paid by the taxpayer, were approximately £50,000 a year, so those two private profit-making companies were getting for less than £5,000 what was costing the taxpayer £25,000. If those tests had been done in a private laboratory, they would have cost £50 to £85 each, not £12.10, which was being charged in the public laboratory.
Worse than that, it is significant that none of the money collected was given to the health board, but was diverted to Glasgow university. The health board seemed to be completely unaware of that massive involvement, which presumably has now stopped. There is a strong suspicion that more than £12.10 per test was being paid, although to whom I am not sure.
I have a considerable file of correspondence on that scandal. The last copy letter in my possession was written by the district administrator of the western district of the Greater Glasgow health board, dated 2 June 1982, stating that investigations were continuing and that a further report would be made, firstly to the board. Has that investigation been completed? Has a report been made to the board? If so, what action has been taken, or will be taken?
I turn now to one or two queries concerning the Fife health board. Following certain allegations made to me of suspected irregularities, I wrote to the treasurer of the Fife health board on 9 December 1982 about possible abuses in the payment of fees in certain parts of the service in Fife. In that letter I asked a number of questions about certain activities in, for instance, the family planning service and in post-mortem examinations. The names of two consultants were mentioned but I will not identify them here for reasons which might be well understood, but I will give the facts as I understand them to be.
It is known that at a health board meeting on 3 February 1981 a figure in excess of £14,000 was specifically mentioned. It was apparently paid to one of those consultants. The validity of the claim for that payment was challenged, and in a letter from the board to my informant dated 31 August 1982 it was said:
I would, however, confirm that the investigations referred to in the Minute"—the minute of the meeting of 3 February—were carried out and the entire matter has been concluded"—I emphasise these words—to the satisfaction of both the Board and the Scottish Home and Health Department".What was it in that particular case that satisfied the Home and Health Department? Did it involve the repayment in whole or in part of any of the moneys obtained by that particular consultant? Was he reprimanded or disciplined in any way for his conduct? Will the Minister confirm that where a case of fraud or theft is suspected by a health board it has no legal option but to refer such a matter to the procurator fiscal? Has it 1087 no right to take it to the Home and Health Department of the Scottish Office, and has the Home and Health Department no right to take a decision one way or the other on the matter? I want an answer from the Minister.There are two other cases which concern Fife and I put them on the record. In the family planning unit in Fife vasectomy operations take place from time to time. Normally, I gather, a vasectomy is a fairly simple operation that can be done in a matter of minutes with the aid of a local anaesthetic. I believe that over Scotland as a whole that is the normal method of operation. I would be glad if the Minister could confirm that one way or the other and give us some figures to show what overall proportion of vasectomies in Scotland is done by local anaesthetic and how many by general anaesthetic.
Can the Minister also confirm that where an operation is done by local anaesthetic two fees are involved and the total cost is about £30 but if it is done by general anaesthetic no less than four fees are concerned, namely, to the surgeon, to the anaesthetist, to the histopathologist and to a haematologist—it is amazing—at a total cost of £50 to £60 per operation? I pose those questions. I am trying to get the figures from the health board in Fife. I am told, although I cannot confirm this, that the number of vasectomy operations done by general anaesthetic is, for some strange reason, increasing in Fife as against the number done by local anaesthetic. The presumption is that that happens because the extra fees are there for the doctors.
Lastly, I come to the question of the figures relating to post-mortems in the Fife region. According to figures supplied to me, between 1969 and 1981—a period of 12 years—the number of post-mortems done in hospitals went down from 281 to 154. In the same period fiscal post-mortems went up from 70 to 167. There was a startling jump in the number of fiscal post-mortems from 58 in 1972 to 141 in 1973, rising to a peak of 184 in 1977.
There may be a simple explanation for that phenomenon, but it is worth remarking, and my informant so remarked, that when a post-mortem takes place in hospital no fees are involved but when it is a fiscal post-mortem there is a fee of £35 or more. If 100 post-mortems can be transferred from hospital to fiscal post-mortems, £3,500 is involved. Assuming that the cost is about £35 for a post-mortem, the figure of 167 in 1981 would give an income of £5,845.
I could quote other cases but I shall not do so in view of the time. I hope that the Government will take these facts and these allegations seriously. It is felt that in the interests of safeguarding public money—I hope that we are agreed on this—all misuses of public money, whether by individuals or organisations, must be eliminated. I may say that as a member of the Public Accounts Committee of this House I am considering whether I should send all this information to the Comptroller and Auditor General so that he and his staff may take all measures to eradicate as far as possible, and certainly expose, the abuses that I believe that are there at the moment. Failing the Comptroller and Auditor General, then I think by one means or another I would seek to direct the matter to the attention of the National Health Service Ombudsman.
It is an extremely serious matter that I am raising. There is no doubt in my mind—here I speak unapologetically as a party politician—that the present Government have done everything to encourage the growth of private medicine and the intrusion of private profit-making into the public 1088 Health Service. That is destroying morale and also reducing codes of conduct that have hiterto existed in the National Health Service. I for one am determined to do everything that I can to stamp out this gross abuse of the Health Service and its facilities. I cannot give an undertaking for my party, but I think that it is well known that my party is committed politically and generally to get rid of the private element from the National Health Service. We cannot get rid of it altogether but we will separate it completely from anything to do with the taxpayers' money which is sunk in large amounts in a wonderful Health Service of which we should all be proud.
§ The Under-Secretary of State for Scotland (Mr. John MacKay)The hon. Member for Fife, Central (Mr. Hamilton) was kind enough to give me notice of some of the points that he intended to raise, and for that I thank him. I am not sure whether I congratulate him on or thank him for having the Adjournment debate today. Perhaps I shall tell him that tomorrow when I find out how easily I get home due to the rather snowy conditions which may be prevalent in the west of Scotland today.
I know that it is Christmas and I shall attempt to be charitable in what I say. However, despite that, I think that the hon. Gentleman is attempting to whip up a storm of scandal and alarm, giving an impression that we have considerable financial abuse in the Health Service and that members of an honourable profession are concerned only to exploit the NHS in order to line their own pockets. I do not think that the kind of language we have heard, which I believe is extravagant and misleading, properly represents the position in the Health Service.
More than 9,000 doctors work in the NHS in Scotland. The number of cases to which the hon. Gentleman referred, even if one adds the number at which he merely hinted, is insignificant by comparison. Certainly his allegations are insufficient to serve as a foundation for claims of widespread exploitation of the Health Service or singling out the medical profession to blacken its name.
The hon. Gentleman said that he was considering sending his accumulated evidence to the Comptroller and Auditor General. The House should not be misled into supposing that the audit of public expenditure into the Health Service in Scotland is neglected. Financial administration by health boards is subject to regular scrutiny by statutory auditors and to the attention of officials of the Exchequer and Audit Department. If the hon. Gentleman's evidence about financial mismanagement is well founded, of course it should be referred to the Comptroller and Auditor General. I should point out, however, that the Comptroller and Auditor General has not neglected the Health Service over the past few years.
As the hon. Gentleman is a member of the Public Accounts Committee which receives the report of the Comptroller and Auditor General, he knows that the Comptroller and Auditor General has reported to that Committee on the management of money voted by the House in support of the NHS. Nor has the Committee been slow to summon the accounting officers of the health departments to question them on all aspects of the financial management of the service. The reports placed before the Committee are the outcome of extensive and searching inquiries by the officials of the Exchequer and Audit Department and in the past few years have covered such important matters as accountability and control of 1089 manpower, control of stores and linen, working practices, especially productivity schemes and emergency duty payments, and the fees paid to building consultants.
The hon. Gentleman referred to a number of specific cases and named two doctors. I cannot respond to questions about the cases of Dr. Kennedy and Dr. Irvine as the papers that he mentioned are with the Crown Office, so I am debarred from commenting on them. In any case, however, as the hon. Gentleman well knows, the local management of the Health Service is in the hands of the health boards. Although overall responsibility clearly rests with Ministers, it is to the boards that hon. Members should turn in the first instance when seeking information about the boards' decisions on personnel. If consultants are involved and there is any possibility of disciplinary action, the Secretary of State has an appellate function which must rule out premature comments such as the hon. Gentleman asks me to make on the rights and wrongs of health board reactions.
On the subject of the two firms sending specimens to the laboratory at the Royal hospital for sick children, the payments were going to the university. As the honorary senior lecturer in charge was an employee of the university, the firms may have thought that the fees were supposed to go there. The boards' attention having been drawn to the matter, however, the work is no longer undertaken in that laboratory.
Some of the hon. Gentleman's allegations relate to the Fife health board. He said that he had written to the board on 9 December asking a serious series of questions about the cases that interest him. He might have done the board the courtesy of waiting for its reply and thus perhaps saved the time of the House today. The board promised an early reply and I believe that it is now on its way, although I appreciate that the Christmas post may delay it. I believe that it is going today, so it may be a couple of days before the hon. Gentleman receives it.
The hon. Gentleman referred to abuses in connection with fees for post-mortems carried out by the procurator fiscal service. Pathologists employed by the Health Service are free to undertake such post-mortems provided that in the opinion of the health board such work does not interfere with their other activities or with the proper discharge of their contractual duties. They are paid for such work. I understand that the fee currently paid by the procurator fiscal is £28 per post-mortem and not £35 as the hon. Gentleman suggested. Under a long-standing rule, in the case of routine post-mortems no charge is made for the use of NHS facilities, but where special laboratory examinations are required in addition appropriate fees are paid and one-third of the fee is paid to the health board.
The hon. Gentleman's question about why there has been an increase in fiscal post-mortems would be better directed to the procurator fiscal service in Fife which instigates post-mortems in cases that it believes require further investigation.
On family planning fees, the hon. Gentleman mentioned a case that he said involved about £14,000 worth of fees. In answering his question about the outcome of that case, I assume that I am thinking of the same case when I say that all the claims were submitted in accordance with NHS circular 1975/PCS/1979 covering the payment of fees for family planning services carried out by medical staff in accordance with their employment in the hospital 1090 services. This was reported to the board's general purposes committee on 3 February 1981. On the basis of further advice received from the central legal office, it was agreed that all the claims had been made in accordance with current regulations.
The hon. Gentleman asked about the board referring cases to the procurator fiscal and suggested that that had to be done automatically. I will explain the circumstances in which certain matters require to be referred to the procurator fiscal. They are set out in NHS circular 1976/GEN/1978, paragraph 3 of which states:
the Secretary and the Treasurer will of course make such preliminary inquiries in strict confidence as are necessary to eliminate the possibility that the circumstances merely indicate a misunderstanding arising in good faith.If those inquiries suggest that further action is warranted, paragraph 5 of the circular states:In more serious cases and especially cases involving persons of standing full particulars (including all original documents) should be forwarded to the Department for submission to Crown Office.It is therefore clear that each case must be considered on its own merits before any decision is taken to refer the matter to the procurator fiscal.When the free family planning service was introduced in 1975, a special arrangement had to be made with the medical profession due to the additional work entailed for it. Under that agreement, all hospital doctors involved in family planning work, whether surgeons, anaesthetists or laboratory specialists, are entitled to the payment of NHS fees. This is one of the few elements in a hospital doctor's work that is paid on an item of service basis rather than by salary. A haematologist responsible for laboratory testing of specimens in connection with family planning cases is entitled to a fee per specimen. Anaesthetists are entitled to a fee for each family planning case in which they are involved.
The hon. Gentleman alleged that patients undergoing vasectomy operations received general anaesthetics purely to increase the anaesthetists' income. Whether a local or a general anaesthetic is given is a clinical decision for the medical people on the spot and one on which I cannot offer any authoritative view. If the hon. Gentleman is implying that there is a conspiracy on the part of anaesthetists in general to gain fees by using general rather than local anaesthetics, he should seek the comments of the Royal College of Anaesthetists as that is a very serious accusation.
In referring to a handful of cases, the hon. Gentleman has sought to paint an alarming picture of financial laxity and abuse in the Health Service. I am at a certain disadvantage in that I cannot complete the picture of all the cases that he mentioned due to the constraints imposed by the fact that some are sub judice and all may involve my right hon. Friend the Secretary of State in an appellate role. I assure the House, however, that the picture suggested by the hon. Gentleman is exaggerated. The ASTMS is not the only watchdog of taxpayers' interests in ensuring that money voted for the Health Service and its care of patients is used in accordance with the wishes of Parliament and to the maximum advantage of patients. As is right and proper, the way in which the health boards discharge their role of financial management is regularly examined by statutory auditors and is closely watched by the Exchequer and Audit Department and by the accounting officer of my Department. Such controls are essential in all areas of the Health Service.
1091 At a time when we all hope that any strain in personal relationships in the service due to the Health Service dispute can be mended as quickly as possible, it is unfortunate that such generalised accusations are bandied about. Nothing is more likely to damage personal relationships inside the Health Service than the suggestions that have emerged in the debate and in the dossier to which the hon. Gentleman referred that ASTMS moles are spying on their colleagues and reporting back to their boss in order to compose such files and dossiers. That sounds as if there is a kind of latter-day McCarthyism in the Health Service. It does nothing for personal relationships inside the Health Service if medical people feel that they are being spied on by colleagues.