§ Order for Second Reading read.7.46 pm
§ The Minister for Health (Mr. Barney Hayhoe)
I beg to move, That the Bill be now read a Second time.
This short Bill contains provision on three health issues. All reflect the Government's underlying objective for the Health Service: a continuing commitment to promote the interest of patients while making the best use of available resources.
Clause 1 seeks to apply the food hygiene legislation to health authorities, and thus remove Crown immunity from hospital catering.
Catering in the NHS involves three cooked meals a day, seven days a week and 52 weeks a year. Most of those meals have to be served to patients in their wards, which may be far from the kitchens in which the meals have been prepared. On any day there are about 350,000 patients occupying hospital beds in England and Wales, many with special dietary needs. That is a million meals a day—over 350 million meals a year—just for the patients. Also, the staff require catering facilities throughout the day and night.
Many patients suffering from chronic or acute infections, which lower their natural resistance to disease, acquire food-borne infections more easily than healthy people. They are also likely to be more severely affected by such infections.
There can be no doubt about the difficult catering task facing health authorities and the need for very high standards of hygiene to be maintained in hospitals. This need was brought home by the tragic events at Stanley Royd hospital, Wakefield, in August 1984, which resulted in the deaths of 19 patients.
The Bill will apply the Food Act 1984 and associated regulations to health authorities in England and Wales. In Scotland, it will apply the Food and Drugs (Scotland) Act 1956 and the Control of Food Premises (Scotland) Act 1977 to health boards. This will make hospital catering subject to hygiene standards in the handling, storage and temperature control of food. Lifting Crown immunity will also give local authority environmental health officers a legal right to enter health authority premises, and infringements of the food legislation could lead to prosecution.
I want to make it clear to the House that these changes should not greatly affect the day-to-day position in the vast majority of hospitals which maintain high standards. Circular HC(77)24 gives clear guidance about the need to maintain standards, in line with food hygiene regulations. The circular sets out arrangements for open access to NHS catering. Health authorities have invited local authority environmental health officers to inspect kitchens at will and to make appropriate recommendations. Environmental health officers have not been able, because of Crown immunity, to enforce the food legislation through the courts.
796 Where authorities have allowed standards to slip, there will need to be some re-ordering of priorities to ensure compliance.
The Bill's provisions will change the legal relationship between health authorities and environmental health officers, but in practice it should not change the good working relationships that exist in most cases. In general, I would not expect the effects of this Bill to place any significant new burden on local authorities.
Environmental health officers, in carrying out the important task of inspecting food establishments, are engaged for the most part in giving advice and guidance both to management and staff. While they have at their disposal the very important sanction of being able to threaten legal proceedings if standards are inadequate, the use of this sanction is very much a weapon of last resort. Environmental health officers are well qualified professionals, not only in the sense of being well-versed in the principles and practice of food hygiene, but in terms of the way in which they go about their business. They are well aware that giving encouragement and sound, practical advice is far more effective in achieving good standards than the use of legal sanctions.
§ Mr. D. N. Campbell-Savours (Workington)
The Minister will be aware that a report produced last year identified 97 hospitals as being capable of prosecution in the sense that their standards of hygiene were unsatisfactory. If at that time they were in a position to be prosecuted but could not be, may I assume that, with the passage of the Bill, they would be prosecuted? May I also assume that, if they are not prosecuted, it is because their standards have improved? Can we be assured that resources will be made available to ensure that standards are raised in each of those hospitals?
§ Mr. Hayhoe
Resources would not affect the decision to prosecute. The environmental health officer would decide whether to prosecute if he found infringements of the food regulations which were not being corrected.
Last autumn much publicity was given to allegations of poor standards of hygiene in the NHS. The survey conducted by the Institution of Environmental Health Officers suggested that 10 per cent. of hospitals contravened the food hygiene regulations to such an extent that prosecutions would have been pursued had they been allowed. In calling for urgent action by the health authorities concerned to deal with unsatisfactory kitchens, I also put in hand a review of the case for continued Crown immunity for hospital kitchens.
As my right hon. Friend announced on 6 February, the Government concluded that further steps needed to be taken to ensure effective management and supervision in hospital kitchens. General managers, who are responsible and accountable for these matters, are now in place. To assist them, my Department will soon be issuing revised guidance to make clear the standards which must be achieved, to emphasise the need for staff to receive proper supervision and training, and to ensure that there is no doubt about our serious intention to safeguard patients and staff in hospitals. My right hon. Friend announced that Crown immunity would be removed from hospital catering.
§ Mr. Allan Rogers (Rhondda)
I agree with the Minister's proposition that the Health Service must be examined, especially the standard of hygiene in some 797 institutions. Will he give an assurance that, if an environmental health officer discovers that a health authority is in breach of the hygiene regulations, money will be made available to that health authority to bring the kitchens up to standard; or is the Minister saying hypocritically that he has appointed general managers, that environmental health officers will point out the problems, and the Government will urge improved hygiene without making more resources available? Will the Government say to health authorities, as they did with the nurses' pay award, "You can have it as long as you find it from somewhere else."?
§ Mr. Hayhoe
The position on resources has been made perfectly clear in the House many times. I repeat that additional resources of £650 million are being allocated during this financial year. Within those budgets, the health authorities must deploy their resources and give adequate priority to meeting the task. That position is entirely fair. It was made clear by my right hon. Friend the Secretary of State for Social Services when he was asked much the same questions, so I shall maintain that position.
§ Mr. Hayhoe
No, I will not give way, because the position is entirely clear.
This legislation will make hospitals subject to the same food hygiene requirements, with the same enforcement powers, as apply to other premises where food is stored, prepared and served. Together with the—
§ Mr. Deputy Speaker (Mr. Harold Walker)
Order. The hon. Gentleman must not persist. The Minister has made it clear that he will not give way.
§ Mr. Hayhoe
Together with the strengthened guidance, and helped by a constructive relationship with environmental health officers, it will underpin—
§ Mr. Hayhoe
Together with the strengthened guidance, and helped by a constructive relationship with environmental health officers—
§ Mr. Deputy Speaker
Order. The hon. Gentleman must not persist in defying the Chair. It is for the Minister to decide whether he gives way. It is clear that he does not intend to give way. The hon. Gentleman must not persist in ignoring instructions from the Chair.
§ Mr. Hayhoe
Perhaps the hon. Gentleman thinks that this is a meeting of the Finance Bill Committee, where Ministers continually give way courteously. I see no point in giving way now. The matter has been made clear many times, and no doubt the hon. Gentleman will make the point in his own way in his speech.
Our proposals will underpin management action to ensure high food standards in hospitals.
798 Before leaving this issue, I should like to pay tribute to my hon. Friend the Member for Aldridge-Brownhills (Mr. Shepherd), whose private Member's Bill on Crown immunity helped to focus public attention on the importance of this issue.
Clause 2 of the Bill proposes to change the arrangements for retail pharmacists to take up NHS contracts. It provides powers for family practitioner committees to grant a pharmacist's application for an NHS contract in circumstances only where it is considered to be necessary or desirable for patient services.
Let me set out the background to this proposal. In 1985, after more than a year of complex and hard negotiations, between the pharmacists' negotiating body, the Pharmaceutical Services Negotiating Committee, and officials, agreement on a new NHS contract for pharmacists was reached. Both sides agreed on the desirability of early implementation. However, in the light of legal advice, the Government decided they could not proceed with the new contract until new powers in main legislation had been obtained. Clause 2 should remove doubt about the legal basis for the new contract and allow implementation later this year. The overall aim of the new contract is to develop a pharmaceutical service which will better satisfy the interests of the patient, the profession and the taxpayer.
§ Mr. Jim Craigen (Glasgow, Maryhill)
Leaving aside the special problems that arise in London, is the Minister not concerned about the impact of these proposals on small chemists' shops in housing estates, inner-city areas and rural areas in Scotland, and indeed in England and Wales? Does he not realise that many small chemists fear that they will go out of business as a result of these changes?
§ Mr. Hayhoe
I do not think that is true. In fact, the small chemists in rural areas will perhaps feel that their future is more secure as a result of these proposals. From the information that has come to me, as regards the chemists' negotiating body, there is overwhelming support for the introduction of this new contract. I have received more than 300 letters from hon. Members, the vast majority urging the implementation of the contract and only a tiny handful expressing some reservations.
The new contract will enable family practitioner committees to make progress towards a more even distribution of NHS pharmacies, which will better meet the needs of patient without being wasteful of NHS resources. As things now stand anybody who owns a pharmacy can apply for an NHS contract. Except in rural areas where special arrangements already operate, that application must be granted. The local family practitioner committee has no discretion in the matter. Contractors are paid on a cost-plus basis, so every additional NHS contract automatically adds further costs to the NHS to be met by the taxpayer. Therefore, under existing arrangements, there is little to promote efficiency, innovation or improved services for patients.
Over the past five years, the number of pharmacies with NHS contracts has risen by about 150 a year net. The present rate of increase is higher still. Most of the increase has been in urban areas, where provision for NHS purposes is often already entirely adequate, if not even somewhat excessive, For example, in one part of London there are 21 pharmacies within one square mile. Therefore, the present system has developed so that the 799 costs to the taxpayer of providing a satisfactory pharmaceutical service are rising, without providing any real extra benefits to patients.
The proposed new arrangements on the allocation of contracts will help to bring about a better distribution of services. But this is not the only feature of the new contract.
§ Mr. Michael Forsyth (Sterling)
Will not the effect of this new contract be to insulate pharmacies from competition? If so, will that not result in a worse service for the consumer? In the end, would it not be remarkably surprising if pharmacists were not to welcome the new contract, because it will increase the capital value of their businesses, enable them to merge with their competitors and receive substantial subsidies from the state?
§ Mr. Hayhoe
I do not believe that it will lead to inefficiency. What does lead to inefficiency is when anyone can establish a pharmacy and demand a contract as of right. The contract should not be there just for the having, at the taxpayer's expense. I am very surprised that my hon. Friend should be moving in that direction. Surely what he wants is that contracts between the pharmacies and the National Health Service which contain an element of taxpayer subsidy should be awarded only when they are in the interests of the NHS and of patient services. In these circumstances, the arrangements that we propose will provide a better service for patients.
The new contract, which has been negotiated as an integrated package of measures, provides—
§ Mr. Graham Bright (Luton, South)
As the decision is to be made by the family practitioner committees, will the Government offer criteria or guidelines on which the committees can base their decisions?
§ Mr. Hayhoe
Broadly speaking, the family practitioner committee will make its decision in the interests of ensuring an adequate and proper service for the patients in its area. That seems to me a proper and reasonable course. If my hon. Friend wishes to pursue the detail of this matter, it wll be appropriate for him to do so in Committee.
§ Mr. Charles Kennedy (Ross, Cromarty and Skye)
Why has the Minister's section, in common with its other branch on the social security review and the social fund, set its face so firmly against some form of proper appeal mechanism? Why is the argument being trotted out yet again that this is simply excessive bureaucracy, when there must surely be some method whereby those whose applications are unsuccessful can pursue the matter, if they feel that there has been discrimination, at a higher level—preferably at ministerial level?
§ Mr. Hayhoe
There will be an appeal system at local level. I do not know whether the hon. Gentleman wants this appeal system to be local, regional and national, with all the bureaucracy that that would entail, particularly since the issues are those of local need and local determination.
Another advantage of this contract is that there will be more frequent and effective inquiries associated with the annual remuneration settlement.
§ Mr. Hayhoe
I have been giving way rather a lot, but, knowing my hon. Friend's particular interest in these matters, I give way again.
§ Mr. Michael Morris
Can my right hon. Friend explain why, if the rural dispensing committee of the family practitioner committee for dispensing practitioners has a national appeal mechanism, there is not automatically an appeal for what, in a sense, is the complementary body?
§ Mr. Hayhoe
We are trying to reduce the amount of bureaucratic apparatus related to these matters. I would have hoped that would commend itself, at least to many Members on the Government Benches.
There will also be a new payment structure, which is simpler to understand, with incentives for efficient contractors. There will be enhanced support for essential local pharmacies in sparsely populated rural areas, which goes some way to meeting the point made by the hon. Member for Glasgow, Maryhill (Mr. Craigen).
Perhaps I should add that the committee of inquiry into pharmacy, established by the Nuffield Foundation, has recently produced a report which I have little doubt we shall all be discussing in different forums at a later stage. I note the committee's general support for the new pharmacist's contract.
§ Mr. Rogers
The Minister has just given way to the hon. Member for Northampton, South (Mr. Morris). I hope that he will not take too much notice of what the hon. Gentleman says, especially as, in the Register of Members' Interests, he is shown as being paid by various drug companies to represent their interests in the House of Commons. I hope that the Minister will take more notice of ordinary Members than of those on the Government Benches who are constantly interrupting him, who have strong vested interests and who receive remuneration from drug companies to represent their interests in the House.
§ Mr. Hayhoe
The hon. Gentleman seems to be very wide of the mark, as he was in his earlier intervention. We are talking not about the pharmaceutical industry, but about pharmacies. If, even at this stage of the evening, hon. Gentlemen do not know the difference between pharmaceutical companies and local pharmacists, I hope that they will keep their bottoms firmly on the Benches and not seek to intervene again.
I am delighted to see that the Nuffield Foundation committee's important report contains an endorsement of the new arrangement for allocating NHS contracts which, it considers, are "basically well conceived". I agree. I believe that overall the new contract represents an imaginative, comprehensive and integrated package which is, above all, fair to the patient, the profession and the taxpayer.
Clause 3 deals with the remuneration and reimbursement arrangements for the four NHS contractor professions: general practitioners, dentists, opticians and pharmacists. Since the NHS was set up, the principle underlying payments to these contractor professions has been that they should receive their average costs plus an element for profit or professional remuneration. Their true costs can only be established restrospectively, through periodic inquiries. In the interim period, payments are based on cost estimates.
Under such an arrangement, it is only fair, both to the professions and to the taxpayer, that there should be a mechanism for correcting past payments which are shown to have been inadequate—that is being fair to the professions—or excessive—that is being fair to the 801 taxpayer. Payments to contractors include £2.5 billion a year to reimburse them for the average costs of the service they provide. So even small margins between estimated and actual costs can represent considerable sums due to one side or the other.
These arrangements, which have been established and operated for many years, have recently been challenged by legal action. Let me briefly explain the position.
The National Health Service Act 1977 gives Health Ministers powers to make regulations and determinations for the fees payable to the four contractor professions. In 1984, the legal basis of the long-standing arrangements was challenged by the body which represents retail pharmacists—the Pharmaceuticial Services Negotiating Committee. The High Court ruled against this challenge and in favour of the existing arrangements. But, in order to make the statutory position clear, the Government, as part of the 1984 Health and Social Security Bill, proposed to Parliament, which agreed, amendment of the 1977 Act. This amendment had a single intention: to clarify the arrangements as they have been understood and operated by the professions and successive Governments for many years.
The Government and most professional interests believed this had been achieved, but two organisations representing opticians—the Association of Optical Practitioners and the Federation of Optical Corporate Bodies—challenged the use of these powers in both the English and the Scottish courts. They questioned the Government's attempts to recover £11 million over-reimbursed for NHS spectacles. In England the court ruled that powers to reflect overpayments in future fees were too obliquely expressed to achieve the effect originally intended. In Scotland the court found that power to recover overpayments of one type of fee—for example, optical dispensing—by adjusting other fees for opticians—for example, for sight testing—was inadequate. The 1984 legislation was therefore shown to be defective in that it did not achieve what had been intended. This clause will, I hope, re-establish the position.
However, the opticians have made strong representations to me that the powers in this clause should not be used to make a further attempt to recover the £11 million which was the subject of recent court proceedings. There were indeed some special features attached to that over-reimbursement, which relates to periods that go as far back as 1977. In the circumstances, I think it is right that the opticians should not be deprived of the fruits of their court victory, and I give the clear undertaking on behalf of the Government that no further attempt to recover the £11 million will be made.
I can also give the assurance that there is no intention whatsoever to change the current system for determining the pay of medical and dental practitioners, which is based on the recommendations of their independent review body.
This clause does not represent any change in Government policy. It does not widen the powers which were thought to be available on the determination of fees for the professions, but it does seek to put beyond reasonable doubt the legal basis of the long-standing arrangements for remuneration of NHS contractor professions in the interests of both the professions and the taxpayer.
I commend the Bill to the House.
§ Mr. Frank Dobson (Holborn and St. Pancras)
I will make myself even more popular by trying to be as brief as possible to enable the maximum number of my right hon. and hon. Friends to get in. Indeed, I shall attempt to be as unprovocative as possible in order to minimise the number of interventions from the Government Benches.
In general, we welcome the proposals in the Bill, but there are many important issues which need to be clarified and changes which we believe should be made in Committee. It is necessary to follow the Minister in praising the very substantial number of people who earn their living and do a decent job of work trying to provide good standards of food for patients and other staff in hospitals all over England, Wales and Scotland. Many of them work in very difficult circumstances and we should bear in mind the difficulties they face and try to make sure that those difficulties are kept to a minimum.
One of these difficulties is that Crown immunity has prevented environmental health officers, with the full benefit of the law, from monitoring what happens in hospital kitchens. Consequently, standards have not been as high as they should be. The Bill proposes to lift Crown immunity from hospital catering, to make hospital kitchens subject to the same rules, inspection procedures and possible prosecution as other kitchens, and quite right too.
§ Mr. Geoffrey Lofthouse (Pontefract and Castleford)
Does my hon. Friend not agree that the report on the Stanley Royd outbreak showed that the absence of Crown immunity would not have prevented the situation there? What is the position in circumstances such as those at Stanley Royd? Does my hon. Friend not agree with me that the only answer there is increased resources?
§ Mr. Dobson
I know my hon. Friend's close involvement with the Stanley Royd hospital, and I was going on to say that the lifting of Crown immunity is not the full answer to the problem, although I never really accepted the judgment of those responsible for producing the Stanley Royd report that the lifting of Crown immunity would not have a substantial effect. I thought that its impact on the way people behaved was minimised. It is a pity that, after all the pressure exerted by the environmental health officers organisations and the trade unions within the National Health Service it took the deaths at Stanley Royd to jolt the Government into giving way and accepting that a change in the law was necessary.
The Opposition believe that the Government should go further than they have gone and remove Crown immunity from all NHS premises and every aspect of NHS activity. In particular, they should apply the full rigours of the Health and Safety at Work etc. Act 1974 to the NHS. If the removal of Crown immunity from the kitchens is intended to give better protection to the patients, the staff are entitled to the protection that is given to the people in other places of work. We see no reason why they should be excluded, particularly as a large number of the materials and many of the processes in hospitals are intrinsically rather more dangerous than many of those in industrial premises.
The Opposition would like to praise the environmental health officers and the NHS trade unions for the pressure that they have brought to bear to create the change in the law which the Government now propose.
803 To return to the point which my hon. Friend made in his intervention, we do not believe that just lifting Crown immunity from hospital catering will of itself do what is necessary to improve conditions in hospital kitchens. I have said before and I will say again that we need to remember that the Stanley Royd hospital was built as the West Riding paupers lunatic asylum in 1818, when Napoleon was still alive. Yet we expected, and continue to expect, professional and ancillary workers in that hospital to provide a good standard of service. If they are to do this, a lot more money will have to be spent.
In the Stanley Royd report the highest estimate of the cost of bringing the kitchens there up to scratch was about £600,000. We believe that massive additional sums of money will be necessary throughout the Health Service to improve hospital kitchens enough to make them safe from prosecution. No one wants to lift Crown immunity so that hospital managements can be taken to court. We want to bring the statutory pressures to bear to make sure that the standards in the kitchens are raised. That is the end that every hon. Member wishes and, having willed that end, the Government must will the means.
The Government also know that their efforts to privatise hospital catering have so far not been very successful. Most catering companies will not touch these contracts with a barge pole. Hospital staff and patients will want some reassurance from the Minister tonight and in Committee that the cost of bringing the sub-standard hospital kitchens up to standard will not be used as an excuse to promote more privatisation of catering. If the lifting of Crown immunity is exploited for that purpose, any credit that the Government might justly claim for getting rid of Crown immunity will be exposed simply as cynical manipulation.
Above all, the Government must recognise that high standards in hospital kitchens, like high standards in the rest of the hospital, cost money. High standards cannot be achieved on the cheap. Whatever the learned people who produced the Stanley Royd report may have concluded, I cannot get out of my mind the fact that Stanley Royd hospital was spending £25 per patient per day for everything when the national average spending was £40 per patient per day. I believe that there are connections between what we spend and what we get. We need to go into those matters in detail in the later stages of the Bill.
I should like to deal with the proposed changes in the pharmacists' contract. Here again, the Labour party supports the Government's intention to promote the rational distribution of pharmacies by changing the current licensing system. We note with pleasure that the Government accept that only a licensing system will achieve what is required and that the free play of market forces, so precious to the hon. Member for Stirling (Mr. Forsyth) who, having made his point, has just disappeared, would result only in larger areas of the country being denuded of proper pharmaceutical services.
Here again, we have severe doubts about the detailed proposals and we wish to explore them carefully in Committee. In particular, we do not want to create the possibility of useful local pharmacies taking the Government's compensation and shutting up shop. I am not suggesting for one minute that the Government are trying to bring about the premature, unnecessary and damaging closure of useful pharmacies. However, as they presided over a massive surge of people taking redundancy payments within the NHS and then had to re-employ some 804 of them on new contracts so that they got their redundancy money and pay as well, I think that the Department of Health and Social Security will need to look carefully at any system for compensating people who are going out of business. Basically, we want to keep the most useful pharmacies in business.
As someone representing an inner-city area, I view with concern the strict application of the proposed rule that pharmacies will be permitted to have what is called essential small pharmacy status and the income support that goes with it if, and only if, they are 2 km from the next pharmacy. That is a long way in some inner-city areas, with many main roads to cross and high crime rates, especially if the person crossing the roads or walking along crime infested streets is old or a woman, or, as in some cases, both.
We recognise the desire of the Government not to give subsidies to chains of chemists' shops which probably decide their locations and opening hours on an assessment of their prospects of selling rubber ducks or pocket calculators to tourists rather than providing a pharmacy service to local people. I suspect that the Minister was talking about my constituency when he referred to the area with the maximum number of pharmacy contracts. Underwoods has opened many branches in my constituency, particularly on Tottenham Court road and Charing Cross road. It seems to work on the principle that no Underwoods shop is safe unless it is within sight of the next one. Those shops provide a pharmacy as a peripheral activity. The bulk of their activity is in general merchandising. I think that it is eminently sensible that the Government should not want to provide them with a public subsidy.
In my constituency—not 2 km from the nearest Underwoods—I know people who value their small local pharmacy with a familiar face dispensing prescriptions who knows the family and knows the person who has come in. We believe that that sort of relationship should be encouraged. We also believe that that would be particularly important if the future of the pharmaceutical profession is to lie, as suggested in the Nuffield report, in greater and more effective collaboration with other local health care professionals.
We also welcome the possibility that pharmacies should specify the services they will provide, such as domiciliary services. I hope that the family practitioner committees will use their new powers to promote more and better pharmaceutical services geared to the needs of local people. In some areas that should include the co-ordination of opening hours with those of doctors, which does not always occur. It should also include some effort to ensure that opening hours are related, especially in rural areas, to the public transport services so that people can catch a bus, go to their doctor, pick up the dispensed prescription and get home all on public transport, if it is possible.
We would not like the Bill to do anything that puts at risk the dispensing services in rural areas, which are now protected by the Rural Dispensing Committee, introduced by the previous Labour Government. We are very keen, and we will be keen in Committee, to ensure that nothing accidentally damages the best parts of the existing local pharmacy services. We shall use the Committee to propose amendments to secure the best interests of patients and the profession of pharmacy.
Here, I shall make a personal point, rather than expressing the view of the Labour party. It has to be said 805 that there remains an ever present conflict between the professional conduct of a pharmacy and the running of a shop. Until that is resolved it seems unlikely that society will be prepared to make as much use as it could of the potential of the pharmaceutical profession to make a bigger contribution to improvements in the nation's health.
I now turn to the proposal to legalise the clawback of overpayments to opticians, pharmacists, doctors and dentists. I will not follow the Minister's able recitation of the long and dubious history of this arrangement, dodging in and out of the courts. However, I notice that none of those responsible for the unlawful decisions which were made at one time or another were disqualified from office or surcharged for the cost of what they brought about. We have no objection to the concept of genuine clawbacks. However, it is not logically possible to claw back that which was never given in the first place. We will not support any proposals which would legalise retrospective changes in the conventions under which one lot of contract terms were originally agreed.
I said that I would be brief and I have been brief. I emphasise that we broadly welcome the proposals in the Bill. However, we would look in Committee and on Report to a constructive arrangement with the Government to ensure that all that is done brings about improvements in our hospitals and improvements in our pharmaceutical service and other family health services, and that nothing, either deliberately or accidentally, damages the good parts of what we have already.
§ Mr. Michael Morris (Northampton, South)
As always, I inevitably declare an interest on National Health Service matters—but not the interests that the hon. Member for Rhondda (Mr. Rogers) mentioned, because neither of those is relevant. The two interests I shall declare are relevant. The first is that my wife is a dispensing practitioner and, therefore, in a sense is providing a complementary service to pharmacists in the rural areas where she dispenses. Secondly, in 1985 I was an adviser to Underwoods and I am likely to be so again. Those two interests are relevant unlike the interests which the hon. Member for Rhondda tried to toss across the Floor of the House. I think that I can say that he would have to get up very early to catch me out in not declaring an interest.
Further, on clause 3, as a member of the Public Accounts Committee, I might have to declare an interest, in that that Committee is urgent in its desire to ensure that savings that are made in the National Health Service are put back into the budget of the NHS.
I should like to consider the broad principles of the Bill and pick out one or two areas on which I should like to question my right hon. Friend the Minister. It is unusual, to say the least, to find a Conservative Government setting up a cartel. There would have to be overwhelming benefit to patients for it to be totally acceptable to me and, I suspect, others of my hon. Friends. The Pharmaceutical Services Negotiating Committee has tried for nearly 30 years to set up that cartel.
My right hon. Friend the Minister said that he did not envisage the number of pharmacies declining. Most of the evidence to date is that the number is likely to decline, but 806 let us assume for the moment that the number remains reasonably constant. It is a fact that in Britain today there are fewer pharmacies per thousand of the population than anywhere else in Europe except Switzerland. Compared with France, we have half the number of pharmacies per thousand of the population. The comparison with Germany and Italy is similar. Therefore, we are not over-endowed with pharmacies. That is the point that the hon. Member for Holborn and St. Pancras (Mr. Dobson) was making.
I thought that the distance given in the guidelines was 1 km between pharmacies. The hon. Member for Holborn and St. Pancras said 2 km. I suggest that the walk from Trafalgar square along the length of the Strand to the Law Courts, which is 1 km, is quite a long walk—not that people like me are the fittest of the population, but certainly for elderly people it is too far to walk. Hon. Members must consider that distance in Committee. There is the other dimension, that if there is to be a geographical difference, there will be more pressure on the general practitioner service. I thought that part of the Government's policy and, indeed, accepted policy across the Benches, was to reduce some of the pressure on that service.
The planned distribution proposal was rejected by the Royal Commission in 1979. The only other time in the Health Service when we have had a planned distribution service was under the Willneck committee, for medical students. We all know what happened then. We ran short of doctors, and we have only just come out of that crisis. Therefore, I do not think that the portents for planned services are that good.
There is talk of how much money will be saved. I believe that the figure started at £4 million, and it is now reckoned to be £5 million. That is to be welcomed. Anything that saves public money is to be welcomed. However, I note that already local pharmacy committees are talking about having the back-up of a secretarial service. There are about 100 LPCs. Half a secretary per LPC, at about £4,000, with overheads, pushes the figure up to £1 million before one can say Jack Robinson. That needs to be watched carefully.
I interrupted the speech of my right hon. Friend the Minister to ask him about the machinery for appeals and the reviewing of applicants. I question how it can ever be right, in a commercial world, to have an applicant reviewed by other commercial applicants. The criteria make it almost impossible for anyone to be totally objective. I see that the committees are to have three chemists and four lay people. Unless one says that there will be no traders, no one with any family links, no one who is a member of the same golf club and so on, that creates a difficulty.
I am worried about the new entrants, particularly individual pharmacists—the young man or woman who has recently qualified. Such people will have to go through the hoop to get started. They will have to go to the local authority for planning permission, find the site and make arrangements for this, that and the other. When they go to the estate agent, all that they will be able to say is that they do not have their contract yet, but they hope to get it. If they are competing with someone else in the high street for a desirable site, the odds are that they will lose it. The guidelines refer to a time scale of two months, with an appeal mechanism of perhaps three months. In a competitive environment, the young entrants will lose 807 those good sites. That disadvantage is not there for the multiple, which will come in and set up shop, apply for the contract and take a risk.
I refer to the large stores. How will any lay person choose between Boots, Savory and Moore and Kingswood—any of the major multiples that may be competing for a contract?
The appeals machinery is absolutely central. At the moment it is proposed that a neighbouring LPC should be involved, but that will give rise to all the problems of regional interests. My right hon. Friend the Minister already has the mechanism of the Rural Dispensing Committee. It is not bureaucratic. It works smoothly and is relatively inexpensive. Why on earth do we not have the same procedure under the Bill?
Finally, I refer to the future of chemists. The PSNC represents about 10,000 contractors and there are about 34,000 qualified pharmacists. However, this worries me. What chance is there for the 15,000 employees working in pharmacies up and down the country to set up their own business? It seems to me that everything is militating against them. What chance is there for qualified pharmacists in the hospital service or industry who want to set up their own small chemist shop? The dice are loaded against them.
I ask my right hon. Friend the Minister to think again about certain aspects of clause 2. The Nuffield report on pharmacies challenges the basis of payment. We are expecting the Green Paper on primary care any minute. I am not a betting man, but I suspect that elements of that will be contrary to clause 2.
The Minister has to look at the appeal mechanism closely. He must ensure that, whatever selection process the Committee ends up with, it is a disinterested means of selecting pharmacists. I, for one, do not know how that will be achieved.
§ Mr. Jack Ashley (Stoke-on-Trent, South)
I do not intend to follow the argument of the hon. Member for Northampton, South (Mr. Morris), if he will forgive me.
The aspect of the Bill that I want to deal with is Crown immunity. The Government have gone some way towards redeeming their reputation on Crown immunity, although it is a very short way—about 50 yards out of the mile that is necessary. The fact is that on the issue of Crown immunity we have had evasion and prevarication from the Government for years, and Ministers have refused to act until they have practically been compelled to do so.
When he opened the debate, the Minister for Health disingenuously paid tribute to the hon. Member for Aldridge-Brownhills (Mr. Shepherd), then ignored all those who actively campaigned and forced his hand. I want to leave the House under no illusion. The hon. Member for Aldridge-Brownhills did a marvellous job, and handled that Bill superbly, but the Minister was pretending that nobody else was active, by mentioning only that hon. Member. The fact is that the prime movers outside Parliament were John Edmonds of the General, Municipal, Boilermakers and Allied Trades Union and his colleagues in the union, and Clive Wadey and his colleagues in the Institution of Environmental Health Officers. They were joined in the campaign by the Royal College of Nursing, the Association of District Councils and other organisations.
808 That was outside Parliament. Inside Parliament, I have tabled many scores of questions, written letters to Ministers, taken deputations along to see them, tabled early-day motions, and so on. I finally drew up a ten-minute Bill, and it was that which the hon. Member for Aldridge-Brownhills took on. He did a marvellous job, but let us be under no illusion. The Government were facing tremendous pressure from all these organisations and individuals, and the media backed up those campaigns. The TV programme "World in Action", The Guardian and the Daily Express all played significant roles in alerting public opinion, but it required the deaths of 17 people and the food poisoning of hundreds of others at Stanley Royd and elsewhere to force the Government to act on Crown immunity, even though they had refused to do so hitherto. They were compelled to do so by that sense of public outrage.
The Minister now says that the Government want to act. I welcome the Bill, so far as it goes, on Crown immunity. It will end the Dickensian conditions in hospital kitchens and put pressure on the health authorities. But it is only a beginning, because hospital kitchens are only a part of hospitals. Other parts and other institutions will also have to be dealt with.
The Bill gave the Government the opportunity to put things right, but they have ducked the challenge. They have neglected the evidence of people such as pest control officers—who helped in the campaign—about the extent of the invasion of vermin throughout some hospitals. Such vermin are not merely found in the kitchens, but are all over some of our hospitals—in the wards, in the packs of sterilised dressings and even in hypodermic needles. This legislation will not prevent health authorities from neglecting those problems, just as they neglected the kitchens. It is not too late, because the Bill can be extended and changed in Committee and elsewhere. I hope that such changes will be introduced.
Equally serious is the Government's neglect of workers in the NHS. It is unfair and unjust to give such workers less protection than elsewhere. The Crown notice system is an abysmal flop, because without sanctions Crown notices cannot be taken seriously. There is plenty of evidence that the system is a flop. I warn the Government that the campaign is now beginning again. I have been informed that the British Medical Association passed a resolution at its annual representative meeting, stating;That this Meeting believes that Health and Safety at Work Regulations should be enforced on Crown Property".The BMA will be joined by the GMBATU and the Institution of Environmental. Health Officers, as well as by myself, the hon. Member for Aldridge-Brownhills and other hon. Members who have campaigned on these issues. We are not prepared to allow this small step forward to pose as the answer to the major problems of Crown immunity.
The Minister was deplorably evasive about resources when questioned by my hon. Friends. Money must be made available to ensure that conditions in our hospitals are put right. If that money is not made available, poor, old patients will continue to suffer. The Government should not be seen to be doing the right thing if they are not prepared to pay for it. To coin a phrase, there is no point in willing the ends if they are not prepared to provide the means. The Government should extend the provisions on Crown immunity and provide the cash that is necessary.
§ Dame Jill Knight (Birmingham, Edgbaston)
The Bill affects several parts of the Health Service, but I shall speak of its effects on only one—the opticians. I assure hon. Members that I have absolutely no pecuniary interest whatever in the Bill. However, the more I study clause 3, and the more I ponder its implications, the more worried I become. The House is tonight being asked—somewhat stealthily, in an omnibus Bill—to give the Secretary of State power to act in a way at which, had there been more publicity and had the Bill not been so complicated, there would have been howls of indignation all over the place.
Some time ago, the Secretary of State got it into his head—Lord knows why, or on what grounds—that between 1978 and 1985 opticians had been overpaid by some £14.2 million. This is a long-running saga, and on several occasions I asked for the basis of that claim. I was never given it. Others also asked, and were met by the same enigmatic silence.
In August 1985, still with no proper justification explained, the DHSS attempted, quite illegally, to recover the moneys from opticians by reducing their professional fees. I should explain that opticians get their money in two ways. First, they are paid a professional fee for sight-testing carried out by professionally trained men and women, and that fee is negotiated between the Government and opticians. There is also the question of the rates of reimbursement for providing the glasses, and the dispute was about the reimbursement, not the fee.
This debate is all the more extraordinary when one appreciates that the opticians have absolutely nothing to do with fixing the reimbursement that they should get for providing glasses. The Secretary of State fixed what they should get, and did so after consultation with the manufacturers of optical appliances.
It was neither just nor logical for the Secretary of State to say last August, "Oops, I am afraid that I fixed those fees too high. I shall just take a big slice back." The only justification ever given was that the mandarins at the DHSS decided that some opticians, not all—not even a large number—had bought frames at cut prices. The sin of it!
If one orders any commodity and agrees a price, one will pay when that commodity is ready. When presented with a bill after receiving the goods, it is totally unaceptable to say, "I think that you have paid less for the materials than you might have done, so I shall not pay what I agreed."
If the Ministry of Defence signs a contract to make 1,000 uniforms and agrees a price, it cannot, some time after the uniforms have been delivered and the bill has been paid, say, "We think that we paid too much. All of you must share in paying it back." We just cannot behave like that. Such niceties apparently do not bother my right hon. Friend—incredibly, since he is a very nice and reasoning man—because he then tried to screw the money out of the whole profession, those guilty of buying job lot frames and those not guilty of buying them. He decides all must be punished for the enterprise of some.
§ Mr. Campbell-Savours
There is a precedent in defence contracts for the taxpayer being rebated, where the whole procedure of post-costing provides that where excess profits are made they be returned to the Exchequer.
§ Dame Jill Knight
In this case, there is a legal contract. The sum I am talking about was fixed by my right 810 hon. Friend the Secretary of State, not by the people who actually received it. At this point, justice reared its head, because my right hon. Friend was taken to court, and he lost. Mr. Justice MacPherson, who adjudicated on the matter, said:In my judgment there is here an indentifiable illegality … in that the Secretary of State has not acted within his legal powers in the process of deciding what is the fair determination of fees for sight-testing and dispensing.He added that he was comforted by the conviction
that this result is just since the opticians played no part in fixing the payments for appliances over the relevant years and, if there was fault or failure in the assessment of those payments, it was the fault or failure of the DHSS and thus the Secretary of State.The DHSS lodged an appeal, and then thought better of it. I suppose that someone read the judgment carefully and decided, "Why bother to go to court when you can change the law and make what was illegal suddenly legal. Why bewail losing a game when you can change the goalposts and retrospectively claim that the ball was in?"
I referred earlier to clause 3. There is no doubt that the legal interpretation of that clause is, first, to give the determining authority power to recover at any time moneys which on further thought it considers to have been overpaid, however long ago the alleged overpayments occurred and without the agreement of the professions concerned. That cannot be fair. Money can be recovered despite the fact that every part of such money must have been paid under a determination of the authority itself. It can be despite the fact that such determinations gave individual contractors who rendered services relying on such determinations as part of their contracts a right at law to be paid such moneys. The authority is to able to recover such moneys, not specifically from the persons who actually received them, but by way of adjustment or reduction of future fees for work to be done by them or others—and that seems extraordinary—and to do so despite the fact that such a system must inevitably produce at least one result which Mr. Justice MacPherson described as unjust and unfair, that is, that part of the moneys allegedly overpaid would be recovered from people who did not receive some part, or indeed any, of the soi-disant overpayments.
All that has to be shown, under clause 3, by the determining authority is that, if the earlier determination had been made at the date of a later determination, it would have been made on the basis of different information. This seems to be regardless of whether the persons to be penalised had any responsibility for the fact that the determining authority did not have that information or even any knowledge of it.
I have tried to make a brief speech on matters I judge to be of grave concern, because the law is being changed to achieve something that is now widely acknowledged to be grossly unfair.
When my right hon. Friend spoke at the beginning of this debate, I understood him to give an assurance that this Bill would not be used to get back the money to which the court said the DHSS had no entitlement. I want to be absolutely clear that I have understood my right hon. Friend correctly, and I ask him one question. He mentioned the sum of £11 million, but the sum mentioned earlier, which was the matter of a court determination, was £14.2 million. What happened to the extra sum? Is that somehow magically outside the circle of protection? I 811 would not wish this small Bill, which contains the possibility of such grave injustice, to pass without at least one hon. Member stating her reservations.
§ Mr. Charles Kennedy (Ross, Cromarty and Skye)
Without following entirely the specific clauses and aspects of the Bill dealt with by the hon. Member for Birmingham, Edgbaston (Dame J. Knight), I wish to say briefly that, when she described this as an omnibus Bill, that was an accurate description. As it has developed, it has become something of a Pandora's box. It is worth recalling its background.
Originally, the Government negotiated a new contract with NHS pharmacists in relation to the distribution of pharmacists and, rather uncharacteristically, tried in another place to tag it on to the back of a law reform Bill relating to that part of the new distribution procedure for pharmacists that would relate to Scotland. That was a bizarre approach. When we consider the Official Report, perhaps the Minister will appreciate it if I put the case even more strongly. For whatever mischievous, malevolent or merely misconceived reasons the other place may have defeated the Government on that occasion, a Government who manage to get Lord Bruce-Gardyne, Lord Harris of High Cross—their general views make the Daily Telegraph look like a tabloid—Lord Kilmarnock, Lord Ross of Marnock, and Lord Tordoff all into the one lobby have achieved an exercise in coalition politics that even the alliance could not hope to emulate.
A furore greeted that slap in the face to the Government, with the announcement of the Minister of State some time later that he could not see that any legislative time could be made available to introduce the contract. Then petitions were presented at Downing street by the Pharmaceutical Services Negotiating Committee and so on. The Government then came forward with this fairly wide-ranging Bill, as it has become. It is worth remembering why this has happened. It has partly been because of a degree of maladministration, if not political incompetence.
The window of opportunity that presented itself to the DHSS came in some ways for the saddest of reasons—an outbreak of food poisoning at Stanley Royd hospital. There followed the Secretary of State's statement in the House on 21 January, and thereafter the general build-up of pressure to have some fairly drastic and definite action taken to remove Crown immunity from hospitals. That was followed by the legal challenges to the DHSS in the courts north and south of the border, which led to the measures in clause 3.
There are positive reasons for the introduction of the entire measure, but negative pressure led to individual provisions being presented in their present shape and form. I echo the general views on Crown immunity and the need to set up a more satisfactory system with a rational distribution of pharmacies. Most people think that is desirable. My hon. Friend the Member for Roxburgh and Berwickshire (Mr. Kirkwood) and I welcome and support the idea of setting up that system.
The Secretary of State gave a categorical commitment on the remuneration and reimbursement arrangements for NHS contractors. Like the hon. Member for Birmingham, Edgbaston (Dame J. Knight), I hope that it remains a categorical commitment. We welcome it. Without being churlish, I point out that time and again the DHSS is 812 finding that its actions on remuneration, clawback affecting opticians, and board and lodgings payments have been against the law. The hon. Member for Edgbaston rightly referred to the steps taken by the DHSS to alter the arrangements so that it does not fall foul of the procedures. I am glad that the Department has had the good grace to say that it will not exercise the powers it will be given under the Bill and seek to claw back money.
It would be nice if the measures abolishing Crown immunity were extended. Hon. Members on both sides of the House have received material from the Consumers Association, various local authorities, and so on, arguing for an extension of Crown immunity. I hope that that aspect will be explored in Committee.
A more rational system of distribution of contracts for pharmacists is necessary and desirable. I echo the points made by the hon. Member for Holborn and St. Pancras (Mr. Dobson), although his constituency contrasts dramatically with mine. Tie-ins with local transport in rural areas are obviously not matters for the Bill, but I hope that we can move towards that end.
I am disappointed by the Government's dog-in-the-manger attitude to the appeals mechanism. Recently I received a letter from a pharmacy in a small town in my constituency which summed up the logic of the Government's actions with respect to a distribution pattern. He said that 70 per cent. of his pharmacy's turnover came from prescriptions and that he was faced with the prospect of a pharmacy moving in next door. It is questionable whether there is room for both pharmacies in that community. I am concerned with the Government's move to set up a regulatory system.
The Highland health board has referred to the pharmacy practice sub-committee, which will comprise four lay members and three pharmacist or chemist contractors appointed by the health board after nominations submitted by the area pharmaceutical committee. The health board stated:In effect, this committee will comprise three chemists drawn from the Health Board area"—the same will apply south of the border—who may find it difficult to be wholly impartial when considering applications for inclusion in the pharmaceutical list"—the conclusion contains the most telling point—
and probably even more difficult to convince unsuccessful applicants that they have been."Objective" decisions may be made, but inevitably allegations of vested interests, or at least competing interests, will be made. It is therefore not satisfactory for the Government to say that nothing can be done.
The Government estimate that £4 million will be saved, £2 million of which will go direct to the DHSS. I am not against that, and I hope that that sum will be reinvested in other health care. It could also be used to improve pharmacy. The other £2 million will be directly earmarked under the "incentive payments" for the development of pharmacy and the development of the up-front role of the pharmacist and his contribution to general primary care.
If an extra £2 million is coming to the DHSS, I cannot honestly believe that there will be so many cases of appeal and of Ministers having to make second judgments on decisions taken locally or regionally that all that money and savings will disappear simply in the administration of the scheme. There is either a sense of bureacratic inertia 813 within the Elephant and Castle or there is a lack of political will on the part of Ministers. We will return to this in Committee.
I welcome the assurance given by the Minister of the status of the NHS contractors. Many hon. Members were concerned, when the Government broke the opticians' monopoly, about the subsequent effect that that would have on opticians' services.
Recently I attended a seminar in Edinburgh. I learned from that and from contacts with other opticians that there is a great malaise stemming from the lack of morale in the opticians' service. There is an economic question mark over the distribution of that part of the Health Service. The Minister has assured us that he will back off, but it will take a little more to restore the position. We give the Bill our general support but will seek amendments at a later stage.
§ 9.7 pm
§ Mr. John Hannam (Exeter)
The hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) represents the Highlands, whereas I represent an urban seat in the lowlands of Devon. However, I follow the approach he has outlined in supporting the Bill.
First, I should like to declare two interests. One is, as the vice-president of the Institution of Environmental Health Officers. That organisation has campaigned strongly for the removal of Crown immunity from NHS hospitals. My other interest is as an adviser to the Pharmaceutical Society of Great Britain. That body has wide responsibility for the operation of the pharmacists profession.
I congratulate my right hon. Friend the Minister for Health on tackling the Crown immunity issue. I was the sponsor of a private Member's Bill of my hon. Friend the Member for Aldridge-Brownhills (Mr. Shepherd) which preceded, if not prompted, Government action to deal with the growing problem of unsatisfactory food hygiene standards in our hospitals.
I shall quote a couple of examples which were given at the last environmental health officers congress. They will explain my concern and that of the environmental health officers. Last September, a paper was presented to the congress. The following examples were given:The kitchen at a leading teaching hospital had jelly containing bird droppings, rice coated with bacteria, infestations of ants and several large dead oriental cockroaches. Sparrows were flying around the restaurant at Charing Cross Hospital London, slicing machines were thickly coated in grease and gulleys in the washroom were choked with debris and slime".So reported the Hammersmith environmental health officer, Mr. David Rowley. He continued:A cutting board was on the floor next to a dead cockroach and mouse droppings littered a disused oven. Live cockroaches were near the washing machines and a week after the management was asked to bring in pest controllers, the place was still infested.Those examples underline the need for the proposed action.
As a result of my experience in the world of catering, I am sure that the problem is one of management failure to instil proper standards. I have always argued that legislative action is needed to give teeth to the efforts of hospital managers to instil necessary hygiene discipline. I fully endorse clause 1.
814 As for clause 2 and the pharmacists' contract, I welcome the speed with which my right hon. Friend has carried out his promise to reinstate the new contract for community pharmacists. That was agreed in May 1985 and originally intended to be introduced by regulation, but the Department decided that it did not have the necessary powers.
I know that there are some people such as my hon. Friend the Member for Northampton, South (Mr. Morris) who are not entirely happy that control of entry into the pharmacists' profession is being introduced, and I understand their anxiety. The excessive costs incurred in a proliferation of small pharmacists dispensing NHS prescriptions had to be dealt with, and a better system of distributing pharmacies was worked out between the DHSS and the pharmacists' negotiating committee.
The bunching of pharmacies in the high street, each with an NHS contract, and the resulting shortage of rural pharmacies will, I believe, be resolved by the new contract. I fully support it, although I take on board the reservations about the 2 km distance which has been laid down.
The Pharmaceutical Society feels strongly that a national appeal body is required. Like my hon. Friend the Member for Northampton, South, it has always argued that appeals should be considered by a panel convened by, but independent of, the local family practitioner committee. It is felt that there should be a national appeal procedure, as is the case with the regulations that implement the Clothier agreement.
There would be more confidence in a central appeal body. A local one might easily be prejudiced. A central appeal body would also help to provide uniformity throughout the country. The Bill proposes that the local appeals panels would consist of three non-pharmacists and three pharmacists, or pharmacy contractors, with a lay chairman. Although they would not be drawn from any FPC which has already commented on an application, they would be from near enough at hand to allow for the suggestion that their local knowledge could have influenced their decision. That is all the more likely when the non-pharmacists are medical practitioners with a vested interest in the subject, if not the case.
Contractors are likely to start from the point of view that a new contract should not be granted where there is already a contracted pharmacy. Such dangers would be averted if a wider based non-local appeal body were established. I hope that my hon. Friend the Minister will consider the strong representations that have been made about them. I sincerely thank my right hon. Friend for presenting the Bill and, subject to such changes as I have described being made in Committee, I should like to give it my full support.
§ Mr. Gordon Oakes (Halton)
I also support this useful little Bill. I should like to declare my interests, which are almost a mirror image of those of the hon. Member for Exeter (Mr. Hannam). I am an honorary vice-president of the Environmental Health Officers Association, and have been for many years, and I advise the Pharmaceutical Society of Great Britain. It is a professional body that looks after the standards and registration of pharmacists.
I should like to deal first with clause 1. The Environmental Health Officers Association has battled for years against the ludicrous concept of Crown immunity. 815 Crown immunity is a legal fiction which held that the Queen or the King could do no wrong and that therefore a Department of State could do no wrong. There have been recent terrible incidents in old people's homes or in hospitals for old people, and in hospitals that care for the mentally ill. Those are people who are least able to cope and need the greatest protection from the state. Things have gone badly wrong, people have suffered illness and many have died. The Bill is an advance against Crown immunity and I congratulate the Minister for taking what all hon. Members have said is but one small step.
Prisons are not within the province of the Minister but people in prison do not have the power held by the rest of us to object to something and prisons ought to be inspected by environmental health officers. Indeed, I would feel happier if environmental health officers from Westminster council came to this place and had a look at our kitchens from time to time. The concept of Crown immunity is nonsense and the sooner it disappears from the law the better.
The Minister is to be congratulated on clause 2. For years the pharmaceutical profession had negotiated with the Government about a new contract. Agreement was reached last year but in the autumn it looked as if all was in jeopardy because the Government were doubtful about the legality of introducing the new contract and said they did not think they had time to deal with it in this Session. There was utter despair in the pharmaceutical profession, bearing in mind all the work that had been carried out. I congratulate the right hon. Gentleman and his Under-Secretary of State on finding the time and adding clause 2 to the Bill. That is greatly appreciated by pharmacists.
The new contract will help a number of people. It helps the Government and creates necessary savings, but as the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) said, at least half of those savings will go back to the profession to improve standards, especially in areas that are short of pharmacists. It helps the profession because the people running many small pharmacies can retire only with great hardship, and the provisions of the Bill will allow such people to retire with some decency and lessen the numbers in the profession.
It is not generally recognised in the House that a small pharmacy dealing with fewer than 16,000 prescriptions per year is not only costly in an administrative sense but receives an enhanced payment for the number of prescriptions it issues. A small pharmacy is not necessarily a small shop. It may be a big shop but the pharmaceutical side of it may be small. As the hon. Member for Exeter said, that is what happens when chemists bunch up and there are four or five pharmacies almost within yards of each other. In housing estates and suburban areas, the Bill will encourage new pharmacies to open and all hon. Members have wanted that for a long time.
In my constituency there is a housing estate in a place called Upton. It is about two and a half miles from the centre of the town. Many old people live in Upton. There is a very dicey bus service between Upton and the centre of the town. Although there are two doctors in Upton, there is no pharmacy. It is very difficult to persuade a pharmacy to open there, because pharmacists rely not only upon their pharmaceutical prescriptions but upon the sale of other goods. Therefore, it does not pay pharmacists to open in Upton. The Bill may encourage them to set up in 816 areas like Upton where there is no pharmacy. It would help to get rid of the system under which four, five or six pharmacies operate virtually cheek by jowl.
I echo what was said about the appeals procedure by the hon. Members for Exeter, for Ross, Cromarty and Skye (Mr. Kennedy) and for Northampton, South (Mr. Morris). I do not like the arrangement whereby a neighbouring family practitioner committee makes a decision on appeal. I dislike it because it is too near. The FPC will make a decision not about the inclusion or exclusion of a pharmacy in its own area but about the inclusion or exclusion of a pharmacy in a neighbouring FPC area. There will be jealousies and vested interests.
I agree with the hon. Member for Exeter that a national procedure is needed. I do not think that it would he abused. It would lay down national standards. It may be slightly more expensive, but justice is never cheap. Justice must be seen to be done. If a pharmacist appeals, he must not feel that he has been done down by neighbouring pharmacists, who may be situated only a mile or two from where he has his business.
I listened with care to what the hon. Member for Birmingham, Edgbaston (Dame J. Knight) had to say about clause 3. I received a letter from the opticians. I thought that they were being unjustly treated by the Bill. The Minister for Health gave a specific and clear undertaking that clause 3 is not an attempt to overrule by back door methods the October 1985 judgment. There is one discrepancy. The Minister referred to £11 million, but the hon. Lady referred to £14.5 million. I hope that when he replies to the debate the Under-Secretary of State will explain that discrepancy. All aspects of the Bill do a service to the public of this country. Therefore it is to be welcomed by both sides of the House.
§ Mr. Roger Sims (Chislehurst)
If I confine my remarks to clause 2, it is simply in the interests of time, and not because I underestimate in any way the importance of the other clauses in the Bill. I echo the congratulations enunciated by the right hon. Member for Halton (Mr. Oakes) to both sides on having negotiated this agreement. In particular I congratulate my right hon. Friend the Secretary of State for Social Services on having ensured that that agreement is to be turned into legislation in the form of this Bill. There were certain difficulties about that.
If anybody sets up in business as a chemist, he can apply to the family practitioner committee for the right to prescribe under the National Health Service. The FPC is obliged to grant the contract, provided only that the premises are registered with the FPC and that a qualified pharmacist is in attendance. The chemist is then immediately entitled to a basic practice allowance of £3,000 plus negotiated fees for each prescription that is dispensed.
This might have been a justifiable arrangement when there were relatively few chemists and when chemists were shops of the traditional type that old hon. Members will remember, but now it is very different. There are many more chemists and there are many more shops where dispensing is only a very small part of the business. We are all familiar with Boots and we know that, although having a large dispensing business, it is involved in expensive activities, retailing a large range of consumer goods. We are also familiar with other multiple stores, one or two of which have been mentioned in the debate, that 817 have come on to the scene in recent years and offer an even larger range of consumer goods attractively priced and presented. I make no criticism of the business that they run—it certainly meets a need.
Although they offer a dispensing service, that is only a tiny part of their business and they do not pretend that it is otherwise. Indeed, one of the major chains estimates that only 3 per cent. of its turnover is in dispensing, yet each of those stores is entitled to a £3,000 basic allowance. This produces a ridiculous situation in which in theory at least a store could dispense only 10 prescriptions a year and would be costing the National Health Service £300 per prescription. The new contract will introduce a far more straightforward and understandable reimbursable scheme based on the cost plus basis. It will also introduce a scheme whereby in areas where there are more pharmacists than are strictly necessary some can now relinquish their contracts on a reasonable basis of competition.
There will be control of the number of pharmacies that are to be given a contract. This does not, of course, prevent anybody from setting up a pharmacy if he or she wishes. It simply controls the number of pharmacies that can be given the right to dispense NHS prescriptions. The mechanism is to be by a pharmacy sub-committee of the family practitioner committee which will decide whether and where new pharmacies are necessary and desirable. The details are not in the Bill. I appreciate that the details of the mechanism are to be incorporated in regulations that will be issued by the Secretary of State subsequent to the Bill becoming law.
Although I realise that many of these details will have been the subject of internal discussion, I hope that the Minister in his wind-up may have time to say a little about the appointment and composition of these sub-committees and the criteria that they will use, or are likely to be invited to use, when they are considering whether to approve new pharmacies.
I consider that both the new cost structure and the scheme to allow rationalisation of the provision of pharmacies is eminently sensible, it has been negotiated with the Pharmaceutical Services Negotiating Committee and it has the support of the National Pharmaceutical Association, an association that numbers 7,500 people collectively owning more than 8,600 pharmacies, and representing 98.5 per cent. of all pharmacy proprietors. The association says:
We believe that the new contract, as negotiated between the DHSS and the PSNC, will be to the ultimate benefit of the health service, to patients and to community pharmacy as a whole.I strongly endorse that view and hope that the House will do the same.
§ Mr. D. N. Campbell-Savours (Workington)
I wish to declare an interest. I am a sponsored member of the Confederation of Health Service Employees. I want to make clear what that means. I receive no personal remuneration at all, I do not claim any expenses from the trade union involved and the moneys that it pays are paid directly to my constituency party to fund a service and advice bureau for the general public who have problems.
The Bill is of importance to the Confederation of Health Service Employees. It is a Bill that in part the confederation has sought vigorously over the years in so 818 far as COHSE members are in the front line of arguments and problems that arise over the whole question of Crown immunity. The union has a reservation. The Bill is a disappointment in that it does not remove from the National Health Service its immunity to the full enforcement procedures for breach of the Health and Safety at Work etc. Act 1974. The union looks forward to further legislation to deal with that.
Over the years, members of the union have seen a grave deterioration in standards within the NHS arising directly out of an absence of resources and not just a deficiency in legislation. They saw the report produced by the Institution of Environmental Health Officers in 1978 which identified 1,000 hospitals as unsatisfactory and which stated that 100 hospitals warranted prosecution and would have been prosecuted if they had been in the private sector. Members of the union then saw the report of 1985 which identified 60 per cent. of National Health Service hospital kitchens as breaking the current health regulations and identified 97 hospitals as warranting prosecution.
That brings us back to the Stanley Royd affair. It might be worth spending a minute examining what has happened. In that hospital, where I am told that 26 elderly people unfortunately died, contaminated beef was served to patients, mouldering vegetables were found in the kitchen, liver with fluke was found in the catering department, kitchens were infected with cockroaches, dirty drains were found, kitchen procedures and handling practices were likely to spread contamination and appalling cooking facilities and food storage deficiencies were also identified.
I cannot understand how the report which was produced dealt with those problems. In relation to those deficiencies it said:All the environmental health officers we heard"—that is, those who were carrying out the inquiry—agreed, perhaps surprisingly in the light of the contents of their reports and despite strong pressure to say otherwise, that the conditions at Stanley Royd, though sometimes far from ideal, at no time would have justified a prosecution. The Chief Environmental Health Officer for Wakefield was supported by all the EHOs called before us in saying repeatedly that there was nothing in the kitchen at Stanley Royd that would have warranted taking legal action. Their visits were uninhibited and they did all that they regarded as being necessary.In paragraph 230 the report said:We think that, if the reports had been in stronger terms"—that is, the reports by the environmental health officers—the kitchen would have been improved at an earlier date, but that the environmental health officers did not regard the kitchen as giving rise to any imminent risk of danger to health or as justifying stronger criticism … the evidence given to us by the professional environmental health officers was to the effect that the sanctions of the criminal law would not have been employed in respect of the kitchen at Stanley Royd, even if they had been available.That is a remarkable statement in the light of the report on conditions in that hospital. It focuses our attention on whether the law, as it stands, is sufficient and whether, even with powers, environmental health officers will have the necessary power available to them to ensure that higher standards are imposed.
The 1977 arrangements have not worked. Certainly some hospital authorities have ignored the very important recommendations made by environmental health officers, The question now is, will the environmental health officers of local authorities do their job? Will they push for 819 prosecutions? Some may not, due to pressure from local authority members who want to use precious health resources within their health district for their pet projects. Political pressure may be exerted through environmental health committees and local authorities on environmental health officers not to go into certain hospitals and not to draw up reports but only to ensure that money earmarked within those health districts for particular projects is not taken aside to be used on upgrading certain facilities. All that arises not because of any deficiency in the professionalism of environmental health officers but because of a deficiency in resources available to district health authorities for these important works.
Conversely, some, for reasons of promoting privatisation, may wish vigorously to pursue higher standards in National Health Service provision. An unholy conspiracy might develop, with private enterprise contractors wanting to get into certain hospitals contacting sympathetic people in the local authorities who sit on environmental health committees, and demanding that they insist that local authority environmental health officers be required to attend district health authority premises and produce reports which contain expensive recommendations and which demand more and more resources from Health Service budgets, forcing up the costs and values of in-house tenders. I see dangers in every way.
This brings us back to the question of resources and the need for the Government to ensure that where moneys are necessary for raising standards in this area there should be some way of earmarking cash for such work.
Will environmental health officers be able to be thoroughly objective? I know that they will want to be professional, but will they be allowed to press the recommendations of the British Pest Control Association, which recommends that every hospital should have a person who is suitably trained and responsible for pest control measure? It says that it is not acceptable that only one in seven hospitals has someone who has attended a DHSS course in pest control awareness. I would like to think that EHOs have the power to ensure that district health authorities appoint those people, because only by reciprocation within district authority facilities will their jobs be possible in the difficult resource circumstances.
I have confidence in environmental health officers as a profession, and in the institution to which they belong. I am worried that, as the Bill goes through and when the legislation is enacted, we shall see increasing political attempts to meddle with them, but I know that they will stand up to such pressure professionally and will protect the objectivity of their positions.
§ Mr. Neil Hamilton (Tatton)
The chief Opposition representative of the Committee of Public Safety, the hon. Member for Rhondda (Mr. Rogers), has just re-entered the Chamber. I am sure that I can satisfy him by saying that I have no interests which might affect what I say in this debate, unlike the hon. Gentleman, who I see, from a cursory glance at the Register of Members' Interests, is, like the hon. Member for Workington (Mr. Campbell-Savours), sponsored by the Confederation of Health Service Employees. As he has chosen to leave this debate to the tender mercies of hon. Members such as my hon. Friend the Member for Stirling (Mr. Forsyth) and me, that union may decide that it is not getting value for money, and reconsider the arrangement.
820 The hon. Member for Rhondda, who is amiable and whom I like very much, is normally foremost in condemning private contractors, where they have been allowed to work in the National Health Service, for having reduced standards and for visiting all sorts of unimaginable horrors upon the system. What does he say to the comments of the hon. Member for Workington about the laxity in food hygiene standards in National Health Service hospitals, the overwhelming majority of which are staffed by members of unions such as COHSE and the National Union of Public Employees, which are implacably opposed to private enterprise coming into the system?
I join other hon. Members in welcoming the Government proposals on Crown immunity, which will remedy a long-suffered injustice, and will be greatly to the benefit of the National Health Service.
I shall, however, confine my remarks to clause 2 and the restrictions that the Government propose to place upon new pharmacies being set up as a result of the new contracts which will be imposed.
The aim behind the Government's proposal is laudable. They seek to establish a more rational system of location of pharmacies, which will be welcomed by everyone, not least by the pharmaceutical, profession. That is why the six leading pharmaceutical associations have agreed, and set out in a joint statement, that, by means of financial incentives and disincentives, the deficiencies of the present system might be remedied. Several suggestions in the joint statement have been welcomed by the Government. Owing to pressure on time, I shall not go into great detail on that point, save to say that I welcome whole-heartedly the central assertion of the joint statement.
The aim of the six leading pharmaceutical associations is encapsulated in two sentences:If financial incentives were implemented, a better distribution of pharmacies would result, with an improved advisory service in adequately-staffed premises. It would also avoid an increase in unit costs, except in those areas where there is an overriding need for a service and for a subsidy to be paid.As the pharmacists and pharmaceutical bodies had embarked upon a means of providing, by voluntary agreement, what the Government seek to achieve by compulsion, it is a shame that the Department has gone down the road of coercion and restriction. which I would have thought goes against the grain of what we are seeking to achieve in other areas of policy.
The negotiations were conducted behind closed doors between the DHSS and the Pharmaceutical Services Negotiating Committee, whose 25 members were forbidden to report back to those whom they are supposed to represent. On 14 May, last year, the Department presented it with a fait accompli when it revealed an unprecedented proposal to control entry to the National Health Service pharmaceutical list. That proposal is contained in clause 2(1)(c), under which a proposed entrant must satisfy a sub-committee of the family practitioner committee that it would be "necessary or desirable" to grant it a licence.
As my hon. Friend the Member for Northampton, South (Mr. Morris) said so eloquently, those committees which comprise three local pharmacists and three non-pharmaceutical members, who might be closely but not directly connected with the phramacists, might give less than open-minded consideration to the applications for new entrants to the profession. The proposals in relation 821 to appeals, as the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) and others said, leave much to be desired. I hope that amendments will be introduced to remedy those deficiencies. The best way to remedy the deficiencies would be to strike out the clause altogether. I can see no reason why newcomers to the trade should be restricted so as to confer a monopolistic benefit upon existing pharmacists.
The Government propose to fossilise the existing pattern of pharmacies and to freeze out young pharmacists wishing to set up in business and, therefore, encourage the concentration of ownership by the large multiples. There are examples from other countries of the baleful effect which such systems have had. In France, the licensing system has had the effect of driving up prices of a wide range of other goods that pharmacists can sell.
The Government's aim in this ill-considered proposal is to rig the market and to deny qualified individuals the right to set up shop. That will happen in effect if not in law, because on average 70 per cent. of pharmacists' income comes from NHS prescribing. Of course, my right hon. and hon. Friends on the Front Bench will argue that this is something which the profession itself wants because the conference of local pharmaceutical committees in June 1985 agreed with the Government's proposal and, therefore, it should be acceptable. It would be very surprising if the conference had not agreed because it was directly in its members' pecuniary interest to do so. We might remember the wise words of the great Scottish moralist and economist, Adam Smith:
People of the same trade seldom meet together, even for merriment and diversion, but the conversation ends in a conspiracy against the public, or in some contrivance to raise prices.What the Government propose in this Bill is to create a closed shop among pharmacists and to save the derisory amount of £2 million out of a total dispensing bill which now exceeds £500 million—
§ Mr. Hamilton
I am reluctant to give way because I know that we ought to finish this debate relatively quickly.
We do not address ourselves to the real reasons why the dispensing bill has got out of control—the cost-plus system of pricing which is employed. From my discussions with members of the Government, it does not seem that we intend to address the areas where we could make massive savings on the NHS bill—by introducing compulsory tendering and contracting out, so as to provide a better service at a lower cost for patients and taxpayers.
The president of the Pharmaceutical Society, writing in The Pharmaceutical Journal last year, denounced the Government's proposals. He said:The recent proposals strike at the basis, structure and operation of the entire pharmaceutical profession.That is quite an indictment, and one that I am happy to endorse.
The hon. Member for Ross, Cromarty and Skye said that this was not the first canter that we had had over this field. It happened in another place last year on two occasions, the first of which was in an unstarred question put down by Lord Harris of High Cross. The dangers which are inherent in the Government's proposal were 822 adequately ventilated, so adequately that the other place threw it out of the Law Reform (Miscellaneous Provisions) (Scotland) Bill which passed in the last Session.
I am pleased to say that two of those who assisted in the gutting of that Bill, in respect at least of this provision, were my predecessor in this place, my noble Friend Lord Bruce-Gardyne, who was the Member for Knutsford which I now represent, and Lord Tordoff, a former Liberal candidate, unsuccessful, but nevertheless a candidate, for the same constituency. I am pleased, therefore, to endorse my predecessors' views on this Bill and to advise the Government that the opposition that they faced last year will be there once again, if this provision is not removed from the Bill.
As we now know that Whips are merely invitations to attend and to go no further, I have the endorsement of the Patronage Secretary for the action that I shall take in due course if what is recommended is not taken up by the Government. As with the Shops Bill yesterday, I can warn the Govenment that in the new mood of militancy among Back Benchers, although I was a keen supporter of the Government yesterday I cannot promise that I shall be able to support them in future. So I counsel my right hon. and hon. Friends to be true to the principles of our party, and to remove this clause from the Bill.
§ Mr. William Cash (Stafford)
I was a sponsor of the Crown Immunity Bill. I want to congratulate my hon. Friend the Member for Aldridge-Brownhills (Mr. Shepherd). I believe that the Government should be congratulated on bringing the Crown Immunity Bill proposals into this Bill. This, however, applies only to food legislation. In the case of Wood v. Leeds Area Health Authority 1974, it was made clear that area health authority employees were and are Crown servants. Against this background, what worries me is that, effectively, what we have here is half a crown.
In my own constituency, Stafford, we had the disastrous and tragic occurrence of legionnaires' disease, and my constituents are gravely concerned about it. We would like the removal of Crown immunity to be extended to the whole of an area health authority's activities. We see no real reason why it should be confined to food.
There is also a great deal of confusion in the law relating to Crown service and Crown immunity, and this Bill could make the position more complicated because, effectively, hospitals will be in a half-Crown position, not exempt and immune in respect of food, but exempt and immune in respect of other activities.
I therefore ask that the provisions of this Bill be extended to all aspects of area health authority work.
§ Dr. John Marek (Wrexham)
We have had a very useful debate and many hon. Members have made a number of very useful comments. My only regret is that they have been very much shorter than they could have been, and I am quite sure that we could have debated for a whole day.
Apart from what was said by the hon. Member for Tatton (Mr. Hamilton), I have agreed with nearly every point that Back-Bench Members have made. I have not said that I agree with what the Minister said, and I shall say why.
823 The problem is, of course, that the Government trot out their propaganda and try to make the country believe that there has been real growth in the Health Service, that services are better than before and that there is no need to put any more money in beyond the extra money which the Government are supposedly putting in at the moment.
My attention has been drawn to the British Medical Association scientific meeting at Oxford recently. One of the speakers there, Dr. John Ledingham, put it in a nutshell. He made four points in his speech. He said:Figures showing a 12 per cent. increase in the number of patients treated between 1978 and 1983 did not distinguish between new patients and patients readmitted for further treatment.This is symptomatic of the way in which the Government seek to beguile and mislead the nation. There could be readmissions because the patients had not been properly treated originally, then the readmission counts as a new patient and the Government wrongly interpret this as an advance in the Health Service.
The doctor then said:Another Government claim that 11,000 new hospital beds opened between 1980 and 1984 does not mention that the total number of hospital beds available dropped in fact by 12,900 in the same period.That is a typical Government misrepresentation about the National Health Service. He went on to say:
Official figures showing a large rise in the number of nurses also failed to mention that the nurses' working week had been cut.Of course, we in the House know the truth of the matter, but the Government misrepresent it and proclaim that the patient in the National Health hospital is better served.
The fourth point is very important and it is one that the Minister made in opening the debate this evening. Dr. Ledingham said:
Government figures also showed that hospital spending would rise by 6.7 per cent. in the coming year when inflation would be only 4.5 per cent., but they omitted to emphasise that half the extra money had to be found by health authorities themselves from greater efficiency in the use of resources.It is no wonder that the Minister did not give way to me earlier this evening, because he knew that he was perpetrating a misrepresentation. He hoped that the people of this country would swallow it and believe that the Government in their munificence had provided extra services and extra provision for the Health Service. But the Government are not doing that above the rate of inflation, they are doing it below the rate of inflation and hospital service administrators will have to find the money from cost-efficiency savings.
How do they find it? There are not that many savings that hospital administrators can make now. They do it basically by cutting ancillary staff, because they want to preserve patient-care services. They cut down on cooks, cleaners and maintenance, in particular in kitchens. There we have the problem, and now the Government have been forced to bring forward this Bill in order to try to improve the conditions in hospitals, but it says on the first page of the Bill:
Clause 1 has no implications for public expenditure.Some of my hon. Friends and some hon. Gentlemen have given vivid, graphic descriptions of beetles, oriental cockroaches, lice and so on in almost every hospital in this country. I do not pretend for one moment that this is something that has grown up since 1979, but it has been made very much more serious since this Government took 824 office. It will not do simply to say in this Bill that we can apply the Food Act 1984 to hospital premises and there will be no revenue consequences.
Like my hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) I welcome the general tenor of the Bill. It will need extra finances and extra resources if it is to be meaningful and not just something on paper. We do not want a statute that lacks the power to provide sufficient environmental health officers to inspect the kitchens and, even if the kitchens are inspected, the hospital authorities do not necessarily have the money to put things right.
I agree with my right hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley) and my hon. Friend the Member for Workington (Mr. Campbell-Savours) that the Bill should be extended. The Health and Safety at Work etc. Act 1974 should be taken account of in hospital premises. Crown immunity should be removed from the premises that are covered, environmental health officers should be given powers to issue enforcement notices under the food hygiene laws, which they already have under the Health and Safety at Work etc Act 1974 and the food hygiene laws should be amended so that employee representatives receive the same information from enforcement officers as they do under section 28(8) of the Health and Safety at Work etc. Act 1974.
I hope that the Opposition will table appropriate amendments in Committee—I am sure that we shall—in order to seek to broaden the scope of the Bill so that we may have an Act with teeth and so that when any member of the public goes into an NHS hospital they know that they will not catch any disease or become more ill as a result of bad conditions in the hospital.
Clause 2 talks about the pharmacists' contract. We generally welcome that. However, we are worried about certain matters, for example, the distance of 2km between pharmacies in urban areas might be too large. It may be that the small pharmacists will sell out because of the money on offer. It may be that large companies will take over small pharmacies, perhaps even in urban areas. We are worried that regulations may not be drawn wide enough to allow pharmacies to expand their functions with time, and we are worried about the appeals machinery.
I must say that if the Conservative Back Benchers who have spoken in this debate find themselves on the Standing Committee I suspect that the Minister will be powerless and we would have a national appeals machinery. I sympathise somewhat with the Minister. A national appeals machinery could be time consuming and expensive and involve much paper work. However, I wonder whether we could have a national appeals machinery which overturns decisions only if they were manifestly unreasonable when initially made. I hope that there is possible scope here for discussion and compromise.
I welcome the Minister's statement that he will not try to claw back any payments to opticians. Opticians have suffered as a result of the Government's legislation over the past few years. There is a certain amount of lost professionalism for opticians and there will be more difficulties for them. I do not think that the situation is right and I would like to see further legislation for opticians. If the Government do not provide that the next Labour Government will do so. However, I must give credit where it is due. The Minister made a welcome 825 statement that there will be no clawback. Will he write that into the Bill? Clause 1 clearly says that there will be no retrospection. Perhaps we could do that for clause 3.
I should like to make one small point. I hope that the powers that the Government are taking will not mean that they will meddle with the arrangements that have been worked out on a year-to-year basis between the various professions. I hope that they will not come along every two or three months and say that they have new information and that there will have to be readjustment payments or that there has been an overpayment. That should be ensured by provisions in the legislation, certainly in the regulations if there are to be any, so that incessant meddling will not be allowed. It does not make for good government. I am not accusing the Government of doing that, but they could be doing it and subsequent governments could have the opportunity to do it. There should be as much certainty as possible for the professions and the public, and I hope that the Government will take that on board.
I am short of time. The Opposition will not divide the House on the Bill. We are not happy with all of it, but we generally welcome what it is trying to achieve in all its three clauses.
§ The Parliamentary Under-Secretary of State for Health and Social Security (Mr. Ray Whitney)
In the constructive spirit in which the debate has been conducted, I shall attempt to emulate the unaccustomed brevity of the hon. Member for Wrexham (Dr. Marek).
I welcome the response from both sides of the House to the positive approach that the Government have demonstrated by deciding, at long last and after much public debate under Governments of both persuasions, to do away with Crown immunity, following the extraordinary and disastrous affair of the Stanley Royd hospital at Wakefield.
§ It being Ten o'clock, the debate stood adjourned.