§ Mr. Jeremy Hanley (Richmond and Barnes)
I beg to move amendment No. 1, in page 2, line 1, leave out
`in the employment of a health authority'.I thank you, Mr. Speaker, for separating these two amendments. They have nothing to do with each other, although they are both concerned with this important Bill. This is not Third Reading but I know, Mr. Speaker, that you will allow me to pay a quick tribute to my hon. Friend the Member for Exeter (Mr. Hannam) for this Bill. I should like to say more about that later.
In Committee we discussed health authorities and their relevance to the licence to allow properly qualified technicians to remove corneal tissue. There was some discussion, especially from my hon. Friend the Member for Weston-super-Mare (Mr. Wiggin) as to the intention of the Bill with regard to the words:in the employment of a health authority".There was some question whether the technicians, who would be suitably qualified to carry out the task of removing corneal tissue, had to be within the public health service and, therefore, whether the private health service was excluded.
Many of us know that many private health organisations play a valuable role, not only in health generally but in transplantation of organs, especially American Medical International which has a unique record in the transplantation of kidneys. There is no reason on earth why private clinics could not gather the expertise, as many of them do now, in the area of corneal tissue transplantation.
The Bill's intention is to precipitate the removal of an increased number of corneas when the next of kin and the deceased want that to happen. If the body happens to be under a private health organisation, this clause might cause problems for those who want to remove the cornea for transplantation.
When explaining this point in Committee, my hon. Friend the Minister said that employees of private clinics 1154 are in the employment of a health authority, perhaps by the facility of an honorary contract. In fact, my hon. Friend the Member for Exeter (Mr. Hannam) mentioned the honorary contract concept and the fact that all doctors and properly qualified technicians would be under either a direct contract with a local health authority or an honorary contract. I believe that this is an unsatisfactory position. I do not like to hear of things such as honorary contracts merely to facilitate what I think is a desirable intention of the Bill. Therefore, I would like further clarification on this point. If the technician is properly qualified, working under the instructions of a properly qualified doctor, I cannot see why the clause is necessary.
We are not talking about people trying to fight for kidneys in the private sector or trying to claw their way to the front of a paying queue. I do not think that anybody believes that. All we are flying to do is ensure that the bureaucracy and difficulty currently involved in the removal of corneas is removed, so that much-needed therapeutic help can be given. I believe that this little phrase will cause confusion and should be removed.
§ Mr. John Hannam (Exeter)
My hon. Friend the Member for Richmond and Barnes (Mr. Hanley) was a valued member of our Committee, especially because of his personal experience of a corneal transplant following the excruciating illness that he had in 1979. My hon. Friend the Member for Kingswood (Mr. Hayward), who had serious eye trouble, and was on the Committee, is also here. I very much welcome, and am grateful for, their support for the Bill.
I have some reservations about the amendment. I fully understand the motives behind it. It would extend the scope of the Bill to cover work carried out in the private sector. In principle, I do not oppose that objective. However, I believe that the amendment will remove an important safeguard.
As with kidney transplants, demand for eye tissue exceeds supply. Therefore, we must prevent any unethical methods by people trying to procure tissue for financial gain. All those in the professional medical organisations who have supported the change that I propose in the Bill have done so in the light of proper safeguards for the removal of corneal tissue carried out by properly trained technicians.
In Committee, as my hon. Friend the Member for Richmond and Barnes said, concern was expressed about the possibility of entrepreneurial activity in the procurement of eye tissue. We must be extremely careful to preserve the integrity of the transplant system, especially at this stage. Of course, the Bill as it stands does not squeeze out the private sector, where many removals already take place. These are carried out by ophthalmic surgeons, but in future I hope that they will be carried out by skilled technicians, approved by the surgeons. Health Service employees from the eye hospitals or trained in the new eye banks will be able to carry out their work in private hospitals or at private homes, wherever the donor material is available.
The amendment would not prove a great disaster, but it needs further consideration before it is included in the Bill. I leave it to my hon. Friend the Under-Secretary to offer the expert advice that we need to assist us in our decision, so I await his comments before deciding whether I can support the amendment.
§ The Parliamentary Under-Secretary of State for Health and Social Security (Mr. Ray Whitney)
I studied with great care the amendment proposed by my hon. Friend the Member for Richmond and Barnes (Mr. Hanley). As my hon. Friend the Member for Exeter (Mr. Hannam) said, to whose assiduity and expertise we owe our presence here today, my hon. Friend the Member for Richmond and Barnes has personal and important experience, so we take careful note of any amendments that he tables to this excellent and much-needed Bill.
As we recognise, the objective of the Bill is to increase the supply of tissue for corneal grafting by removing the most significant constraint on its procurement. That is why the Government have no hesitation in supporting the main provision of the Bill, which is that staff who are not medically qualified should be permitted, subject to certain safeguards, to remove corneal tissue from cadavers. But the removal of organs from bodies, as I am sure the House agrees, needs to performed competently, safely and sensitively. Therefore, there is no doubt that there is a great need for adequate safeguards. One of those safeguards, to which we attach great importance, is that the members of staff who are permitted to undertake those procedures should be employees of health authorities.
I appreciate that my hon. Friend the Member for Richmond and Barnes is concerned to ensure that corneal grafting is not excluded from private hospitals. I certainly accept that. We would wish to see that procedure undertaken in private hospitals, but there is no doubt that, under the operation of the proposals that we have in mind, that will be able to happen without the beneft of my hon. Friend's amendment. I hope that private hospitals that wish to perform that procedure will enter into agreements with health authorities or the United Kingdom transplant service in Bristol for corneal tissue to be supplied to them.
There would be no objection to that, provided that the supply of corneal tissue is sufficient to meet the health authorities' own needs. If private hospitals wish to make their own arrangements for the procurement of corneal tissue, either the tissue will have to be removed by a registered medical practitioner, as now—I do not envisage that presenting any difficulties—or they will need to enter into an agreement with a health authority for the use of health authority staff. I do not believe that that provision will be an unreasonable constraint on private hospitals.
As the House will know, we recognise the contribution made by private hospitals to health care. Although it is marginal to the huge volume of care that is provided under the National Health Service, we recognise the importance of its contribution, complementing the resources of the Health Service and demonstrating that people have a right, should they wish, to dispose of some of their income in that area.
I do no wish to turn this exercise into a party political exchange, but earlier in the week when I had the pleasure of participating in a debate on television with the hon. Member for Holborn and St. Pancras (Mr. Dobson), who is apparently determined to prevent people from spending part of their income on the provision of private health care, I was dismayed that that seemed to be the policy of the official Labour party spokesman on health. That is regrettable, and I am sure that that will be the view of most people.
1156 I wish to ensure that we are committed to the existence of the Health Service, complemented by private health care. I do not, however, believe that the extension of the facility, as envisaged in the amendment of my hon. Friend the Member for Richmond and Barnes, would be necessary.
The requirement that the non-medical staff who will be permitted to remove corneal tissue be employees of the Health Service has implications beyond private hospitals. As employees of health authorities, those members of staff would be subject to whatever procedures the health authorities consider necessary. I am confident that health authorities will exercise those responsibilities wisely. As I have said, the procurement of corneal tissue needs to be undertaken competently, safely and sensitively. We would not wish it to become an entrepreneurial activity undertaken outside the control of health authorities.
Therefore, I hope that my hon. Friend the Member for Richmond and Barnes will accept that we have considered the issue carefully, that we believe that there would be sufficient freedom under the arrangements that we have in mind, to implement the changes that flow from the Bill of my hon. Friend the Member for Exeter, and that we have the balance right between that freedom and the control that we still consider necessary in this important but delicate area. I urge my hon. Friend the Member for Richmond and Barnes to withdraw his amendment.
§ Mr. Frank Dobson (Holborn and St. Pancras)
I was not intending to speak in the debate, but I am a proud opponent of all forms of non-National Health Service provision, particularly as most of it is exceedingly heavily subsidised by the taxpayer and the NHS hospitals nearby.
I hope that the hon. Member for Richmond and Barnes (Mr. Hanley) will accept the Minister's advice on the matter, because the amendment could have a knock-on effect. I am not suggesting that there is any likelihood of scandalous behaviour in a private hospital. But if there were to be one scandal involving what some people have described as entrepreneurial activity, or perhaps super-entrepreneurial activity, often known as theft, the whole of the corneal transplant scene might well be set back and people would be reluctant to agree to what they readily agree to at the moment. I do not wish to be contentious, but for those reasons alone I hope the hon. Member for Richmond and Barnes will accept the advice of his hon. Friend and withdraw the amendment.
§ Mr. Hanley
I am grateful to have had the opportunity of this small debate on amendment 1. This matter needs airing, because the objective of the Bill, steered so cleverly and with so much co-operation throughout by my hon. Friend the Member for Exeter (Mr. Hannam), is intended to increase the numbers of corneas available for transplantation. I was fearful that perhaps there might be a limitation which, because of the way the clause was originally written, could be opened up by this amendment.
The character of my hon. Friend the Member for Exeter and the high esteem in which he is held on both sides of the House encourages me to agree with what he said about the amendment. My hon. Friend the Minister has, in effect, given a guarantee of co-operation between health authorities and the private sector, and that allays one of my major fears.
We had some worries in Committee. As I said earlier, the fact that the health authority can employ on short term 1157 or honorary contracts technicians employed in the private sector was a messy way to proceed with the Bill. I now understand the reasons for the control and believe it is desirable. The private sector will not exploit a more ready supply of corneas. I trust the private sector. I know that the hon. Member for Holborn and St. Pancras (Mr. Dobson) dislikes and distrusts the private sector. However, an increasing number of trade unionists are turning to private health schemes, and it is also for them that I moved the amendment. However, bearing in mind the comments of my hon. Friends, I am prepared to withdraw the amendment. I am grateful for the consideration that has been given to it. I beg to ask leave to withdraw the amendment.
§ Amendment, by leave, withdrawn.