§ Order for Second Reading read.4.26 pm
§ The Secretary of State for Health (Mr. Frank Dobson)
I beg to move, That the Bill be now read a Second time.
The Bill does not introduce any new charges. It simply makes it easier for hospitals to collect from insurance companies charges that they have been entitled to collect for nearly 70 years. The present arrangements simply do not work, so the health service is losing a great deal of money. Nobody really knows how much. Estimates range from about £50 million a year to £500 million. Whatever the figure is, it is clear that, if the charges were collected properly, national health service hospitals would be a lot better off.
Under the present law, there are two charges. One is an emergency treatment fee of £21.30, which is supposed to be collected directly from any driver who needs immediate treatment from a doctor after a road accident. The other charge is supposed to be levied on insurers when a motor accident victim makes a successful claim for compensation. At present, this charge can be up to £295 for out-patient treatment and up to £2,949 for in-patient treatment.
Those charges do not work. They combine minimal income with maximum inconvenience. Last year, they raised just £16 million. To collect the emergency treatment fee, NHS staff must ask injured motorists for the money in the immediate aftermath of an accident. That causes maximum offence to the motorists, who may be in shock or pain. They sometimes get the impression that it is a charge for the use of an NHS ambulance. It is not.
Asking for the money is a rotten task for the staff who are supposed to do it. It is a diversion from their real job of looking after patients. In many cases, the emergency treatment fee is literally more trouble than it is worth.
Such problems are not confined to the emergency treatment fee. Motorists and other victims may be pressed while in accident and emergency, or even in a hospital bed, to say whether they are going to make a claim against somebody who caused the accident. Alternatively, they may be sent a letter out of the blue to ask them the same question.
The problems of collecting the charges do not end there. Hospitals sometimes send out letters to motorists to demand payment of one or both charges. That is because it is up to each hospital to track down the organisation responsible for paying the compensation. Each hospital must calculate the costs of the individual treatment provided to each motor accident victim, separating in-patient treatment costs from out-patient treatment costs. Each hospital then has to track the progress of each compensation claim.
The average motor accident injury claim takes two years to process, and many take much longer. The hospital must bill the insurer, and then chase them up and make sure that the debt has been paid. The motorist can get dragged into the process at various stages.
161 Faced with such protracted and laborious arrangements, most hospitals do not get much income from the charges. Some employ collection agencies, but they have to pay them for their service, which reduces the takings for the hospitals.
We have decided to end that shambles, and to help to make sure both that hospitals can collect the money to which they are entitled and that charges reflect the true cost of the treatment involved. For a start, we have decided to abolish the right of NHS hospitals to levy the emergency treatment fee. General practitioners who attend road accident victims will still be able to levy the fee if they choose to do so.
Having decided that the main charge should be collected properly in future, we considered very carefully how best to go about it. We consulted widely not just within the NHS but with the Association of British Insurers and some individual insurers. We also kept the Law Commission and the Law Society informed of developments. I am most grateful to them all for their advice and help. All concerned with the present scheme wanted a simpler, clearer, quicker and less costly system, and that is what we intend to deliver.
§ Mr. Simon Hughes (Southwark, North and Bermondsey)
During the debate on the Queen's Speech, the Secretary of State said that it had been estimated that the charge might raise anything between £30 million and £500 million. Can he be more specific today, and if not, why not? Given that he previously led the House to believe that the Government did not favour the introduction of any new charges—presumably he will say that these charges are old charges that are merely being collected—can he confirm that the Government are happy about, and supportive of, all the other charges currently placed on people who use the NHS?
§ Mr. Dobson
The Bill is about one charge that hospitals have lawfully collected since 1930, and another that has been lawfully collected by hospitals since 1933. I understand that both were introduced with the support of the Liberal party. All we are doing is getting rid of one of them, and making the other one work. There is nothing new about either of them.
We propose that the compensation recovery unit of the Benefits Agency should take on the job of getting the money in and distributing it to hospitals. The compensation recovery unit was set up in 1990 by the previous Government to recover state benefits where both benefits and compensation had been paid out in respect of the same accident, injury or illness. Insurers are required to notify the recovery unit of claims for compensation, so the unit is well placed to take on the additional task of collecting NHS charges.
There are many advantages to our proposal: the recovery unit has a good track record; the unit has good relations with the insurance industry and proven procedures; insurers will need to deal with only one central unit instead of several hundred individual hospitals; the work will be done at minimum administrative cost to all concerned; hospitals will be relieved of an onerous task; the process will require minimal involvement of motorists; and the proposal will secure around 50 jobs on Tyneside, where the recovery unit is situated. The insurance industry supports the proposal.
162 In a further effort to simplify and reduce administrative costs, we propose to introduce a tariff of charges so that every hospital, every insurer and the recovery unit will know how much the charge is likely to be in every case. In most cases, the only patient information that will need to be transmitted is whether motorists were treated in an NHS hospital as out-patients, and how many days they spent in hospital if they were treated as in-patients. The insurance industry supports that proposal, too.
The charges will be set out in regulations, and will be made up of two items. The first will be a flat rate fee for those who do not need to stay in hospital. Initially, the flat rate fee will be set at £354, no matter how many out-patient attendances are involved. The second item will be a daily rate charge for those who need to stay in hospital, and that will be set at £435 per day initially.
The new tariff has been calculated to reflect the current cost of treating road accident victims. It is expected to bring in a total amount that broadly reflects the costs of treating those who make a successful claim against another driver. As part of the arrangement, I have concluded that it would not be in the spirit of the proposed new system to impose open-ended liabilities on insurers, so there will be a ceiling of £10,000 on a single charge. Both the tariff and the ceiling will be set by regulations, and uprated as necessary.
Following our consultations with the motor insurance industry, we propose that the new charges should apply to treatment given in respect of accidents that happened on or after 2 July 1997, when the Chancellor first announced our intention to collect the full cost of treatment. Treatment for accidents that happened before that date will be charged at the new tariff, but subject to a ceiling of £3,000.
§ Mr. Robert Syms (Poole)
Does the £10,000 limit relate to an individual or to an accident? For example, in the case of a coach, 30 or 40 individuals might be involved. Would the liability be multiplied by the number of people in the coach?
§ Mr. Dobson
It would be per person, as would all compensation claims of that sort. There is nothing different about the claim in question.
As the House knows, the Motor Insurers Bureau, financed by the insurance industry, pays compensation to victims of road accidents caused by drivers who are either uninsured or have disappeared. Under the Bill, the NHS will be able for the first time to collect charges from the Motor Insurers Bureau. By regulations, we will make it clear that payments will be sought from the bureau only in respect of accidents that happen after the Bill is enacted.
The new charging process will be straightforward. It involves adding just one question to the existing standard form, which insurers are already required to send to the recovery unit. It will report which NHS hospital, if any, treated a motor accident claimant. The recovery unit will then get from the hospital concerned confirmation that the claimant was an out-patient, and, if an in-patient, how many days he or she spent in the hospital.
The unit will then be able to collect the charge from the insurer as soon as the overall claim is settled, and pass it on to the hospital. Unless there is some dispute, 163 each motorist's involvement should amount to nothing more than telling his or her insurer if he or she received treatment in an NHS hospital.
§ Mr. Michael Jack (Fylde)
Will the Secretary of State clarify one point? If, as a result of a subsequent court case, a motorist were found to be entirely innocent of any blame in an accident that led him or her to receive hospital treatment, would the other party, who was blameworthy, have to accept the entire bill for all the parties involved in the treatment?
§ Mr. Dobson
The whole question rests on there being a successful compensation claim in the first place. If there is such a claim, it will include the NHS costs. If there is not—possibly, in the circumstances to which the right hon. Gentleman referred—the NHS would not get any money.
We also propose to give insurance companies, for the first time, the right to ask for a review of charges in a particular case, and, where appropriate, to appeal to a tribunal.
There have been a number of scare stories about what we propose. Some people have claimed that we are introducing new charges. Others have claimed that what we are doing will lead to large increases in motor insurance premiums. Neither is true. Nothing is new in principle about what we propose. Insurers have been liable for such charges since 1930. We are merely ensuring that, in future, NHS hospitals will get the money to which they have been entitled for the past 68 years.
The present collection arrangements are such a shambles that no really firm data exist on which to base estimates of the likely sums that may be raised under the new scheme. The best estimates that I can come up with range from around £100 million to about £150 million in England—about £120-odd million to £165 million in Great Britain. The ABI estimates that, if the total impact of what we propose were to be passed on to motorists, premiums might rise by 2 to 3 per cent., or around £6 to £9 per policy holder. That is the ABI's estimate, not mine.
To put this in perspective, again according to the ABI, motor insurance premiums have risen by an average of 16 per cent. for comprehensive policies and 12 per cent. for non-comprehensive policies since 1996. The proposals will have no impact on the no claims bonus of the drivers making the claim for compensation.
In any case, there is good reason to believe that not all the costs will be passed on to motorists' premiums. It was in July last year that we first announced our intention to collect the actual cost of treatment, and we hope to introduce the new scheme from April next year. That means that, by the time the new scheme comes into operation, insurers will have had nearly two years to adjust. That was borne out the other day, when Direct Line was quoted as saying:rises would be minimal as most insurers have already factored in potential NHS claims".The Association of British Insurers was quoted as saying:
most companies already take their liability under the existing law into account when assessing premiums.The principal concern of the insurers has been the fear of retrospective action to recover the sums not collected over the years. In a meeting with me, the ABI said that it 164 would be prepared to accept 2 July 1997 as the operative date for the changes. It welcomes the simplified arrangements and the tariff system that we propose, so our proposals will not place a large burden on motorists or motor insurers.
The new scheme will bring order out of chaos. It is a sensible, practical measure that will raise much needed extra funds for hospitals in every part of the country. It is sound in principle, and it will work in practice; that is why I commend it to the House.
§ Miss Ann Widdecombe (Maidstone and The Weald)
I beg to move, To leave out from 'That' to the end of the Question, and to add instead thereof:
`this House declines to give a Second Reading to the Road Traffic (NHS Charges) Bill because the Bill further adds to the burdens the Government has imposed on both commercial and private motorists in that insurance premiums will rise; notes that the proposal did not appear anywhere in the Labour Party's election manifesto, and conflicts with the Government's express opposition to extending charges in the NHS; further notes that these charges will apply only to motorists and not to victims of other insurable accidents; and calls on the Government to clarify its future intentions with regard to both the level and range of any future additional charges in the NHS, and to take into account the impact on the motorist when determining the amounts to be charged.'It may reassure the Secretary of State to know that the Opposition have some sympathy with some of the aims in his Bill, but we will press our amendment, because certain aspects concern us, and I would welcome clarification of them when the Minister replies.
All Government measures must be considered in the context of overall policy. At the moment, it seems that the Government are determined to penalise motorists. I might have been sympathetic to a proposal to make more effort to collect charges from insurance companies, but I am bound to observe that the Bill will have a disproportionate effect on one group of people who use the NHS.
The Government have already raised fuel duty by 20 per cent., and vehicle excise duty by 3.4 per cent. They have taken powers for an entirely new registration tax on new vehicles. By the end of this Parliament, they will have charged motorists more than £9 billion in extra taxation. If we were to use the Secretary of State's quaint method of counting, that would probably come to £18 billion over three years. If so, one would be tempted to observe that motorists were being asked to fund all the increases that he has promised for the NHS. Perhaps he will not on this occasion insist on his favoured method of counting increases.
It has been estimated—the Secretary of State more or less confirmed it when he mentioned a figure of up to £9—that the proposals will add another £10 or so to motor car insurance premiums; I am happy to come down to £9. On its own, that might not have been too serious, whether the figure was £6, £7, £8, £9 or £10, but, in combination with all the other costs that the Government have inflicted on the motorist, it is of more significance than it otherwise would have been.
Can the Secretary of State explain the position of uninsured drivers? As I read his proposals—I am happy to be corrected—the NHS will not write off the cost if the driver is uninsured, and will not charge the driver directly. Rather, law-abiding motorists will effectively be 165 charged twice, in that their insurance premiums will have to reflect the costs of uninsured drivers' treatment, even though they have already paid taxes to cover such treatment. What guarantees are there that the income from this charge will not end up as a substitute for Treasury funding? What assurances, if any, will the Government give that they will not increase insurance premium tax?
Where does this stop? What about victims of other insurable accidents? Will the Secretary of State extend such charges to them, or will he give an absolute guarantee that that is not the Government's intention?
What about cases of self-inflicted injury? If the Secretary of State proposes to extend his charges to that group, does he agree that he is introducing a new principle into the NHS of a double whammy on anyone prudent enough to take out insurance? if he does not intend to extend such charges, why pick on the motorist rather than those whose actions are entirely self-inflicted and cost the NHS a great deal in care and treatment? What about those who practise dangerous sports? Where does it stop? Does it stop at all?
§ Mr. Eric Martlew (Carlisle)
Perhaps the right hon. Lady will explain to the House why she voted for the legislation in 1988.
§ Miss Widdecombe
We did not add the measure to the cumulative effect of a series of taxes that penalise one group of people who may use the NHS. That is exactly what the Government are doing. If the hon. Gentleman had listened—he usually does—he would have found that, right at the beginning, I said that we might have had some sympathy for the Bill but for the cumulative effect on motorists.
§ Miss Widdecombe
No, I have just given way on that point. I now want to make some progress.
I was about to say, before I was interrupted, that I was grateful to the Secretary of State for one thing—the assurance that the new charges would not be levied retrospectively. I am glad that he has said that. I take it from what he has said that, even though the hospitals could have collected the money under the 1988 powers and too often did not, there is no suggestion that that should now be recovered. I am sure that that will be welcome both to the insurance companies and to motorists.
Will the Secretary of State accept that the measure is proof positive that we ration health care services in the NHS, and that there is only a limited amount that can be done? After all, the Government have boasted, with their quaint method of accounting, that they have put £21 billion extra into the NHS, yet they still find it necessary to fine motorists £10 for the crime of needing hospital treatment. Does that not say it all? Is it not true that the National Institute for Clinical Excellence will ration treatment and services throughout our health care system?
I wonder how comfortable the Minister of State feels today. He described the Road Traffic Act 1988 as a sick law. He has tried to get out of that since then by saying that he was referring to the 1930s regulations, but his 166 comments were made in 1995, when the issue of the day was an order that simply increased the scale of charges for the liability incurred. So what was he then complaining about? Was he complaining that a little more money was being collected from insurance companies? So today he decides to collect a vast amount more. He described the 1988 Act as a tax on accidents, and today he seeks to increase that very tax.
§ The Minister of State, Department of Health (Mr. Alan Milburn)
We have heard this tired old record from the right hon. Lady before. Unfortunately, it does not quite fit with the facts.
My concerns in 1994 arose from a case in which two of my constituents faced an emergency treatment fee following an accident involving their three or four-year-old daughter. I thought that the emergency treatment fee was wrong in principle, as it was levied by the hospital. I argued then that it should be abolished. I am pleased that the Government are abolishing it now. I know that the right hon. Lady is intent on torturing the facts until they confess, but she might spend a little time explaining why her Government promised to abolish the emergency treatment fee, and then failed to deliver on that promise.
§ Miss Widdecombe
The right hon. Gentleman refers explicitly to a tax on accidents. There is not much other description that one can give to the charges that the Government are now extending than a tax on accidents. That is what he condemned, and what he is now promoting.
On the emergency fee, let me again give some comfort to the Secretary of State, and say that we welcome that measure. We shall not seek to oppose it. We said that, when a suitable legislative vehicle, arose we would use it to abolish the fee.
§ Miss Widdecombe
No. I have given way to the Minister on this point.
The Secretary of State has consistently said, "No new charges," but now he proposes just that. So much for Labour's sacrosanct principle of an NHS free at the point of consumption.
Lastly, I am somewhat concerned—I am open to conviction on this—that the mechanisms that are being put in place will be expensive and bureaucratic. Those who are responsible for collecting moneys have claimed that the problem is not so much the method of collection as the fact that the sums involved for individual trusts are so small compared to the bureaucracy of claiming them in the first place that there has been no incentive to claim. In what way do the proposed methods represent increased simplicity over the old methods?
We have some sympathy with the measure—[HON. MEMBERS: "Then show it."] We are pressing our amendment to a vote. We have some sympathy with the measure, but I am concerned by the cumulative effect on motorists.
§ Mr. Dobson
So why does the amendment state:this House declines to give a Second Reading to the … Bill"?
§ Miss Widdecombe
That is how a reasoned amendment is phrased. The right hon. Gentleman has 167 been in the House all these years, but appears not to know that—he learns something new every day, does he not? If the Bill receives Second Reading, we shall examine in detail in Committee some of the points that I have raised today.
The Bill would result in a most unfortunate additional imposition on motorists, at a time when substantial impositions have already been levied. If the measure stood alone, it might not be so significant. The Labour Government generally seek to bash the motorist, and the frivolity with which Labour Members have treated the subject lends credence to our belief that they do not take such matters seriously.
I hope that the Minister will be able to reassure us on uninsured drivers. Why should law-abiding motorists pay twice? Why are they, uniquely, being picked on? I have no complaint about the fact that the Secretary of State is, quite properly, reviewing the collection of the charges, but why has he not reviewed the groups from whom the charges are collected? Why does he not perceive the obvious illogicality in picking on only one group of people, who use the national health service at a time when they are extremely vulnerable—in an emergency, when they are often badly injured, ill and in need of major treatment? Surely that is not the group that should be singled out for progressive taxation.
§ Mr. Dobson
The arguments that the right hon. Lady has adduced over the past few minutes suggest that she believes that the charge should be repealed entirely. It has been in existence since 1930; it was reconfirmed and extended in 1933; and it was last reaffirmed by the House in 1988, under the Conservative Administration of which she was a member. All we are doing is ensuring that, in future, insurers will pay the money that they should pay.
§ Miss Widdecombe
All the right hon. Gentleman is doing is putting an extra charge on the motorists. [HON. MEMBERS: "No, he is not"] Yes, he is: he is saying that he will raise a great deal of extra money through the proposed collection method. He is fond of referring to events that occurred under the Conservative Government, so let me point out that, when we introduced more efficient collection procedures to raise money from existing taxes, the then Labour Opposition counted that as a tax rise. Now they are getting a dose of their own medicine.
The Secretary of State is levying an extra charge on motorists, at a time when substantial charges have already been levied. The Bill is not the most sensible of measures, but I hope that it can be improved in Committee, and that the right hon. Gentleman will stop laughing at the plight of the law-abiding motorist, who will have to pay twice for the rest.
§ Mr. Eric Martlew (Carlisle)
To listen to the right hon. Member for Maidstone and The Weald (Miss Widdecombe), one would think that there was a 168 charge on the patient, but there is no charge whatsoever on the patient. The idea that the Government will take money from vulnerable people is nonsense. What they will do is take money from the insurance companies that should have been paying it in the first place. The fact is that fewer bills will be sent out after the Bill is passed, because the Government are getting rid of the emergency charge. That is the charge that causes aggravation and distress to people who are asked for the money when they are in casualty, or who get a letter in the post. The Conservative never achieved the objective of getting rid of that charge, but the Labour Government are doing it.
I congratulate my right hon. Friend the Secretary of State on having found a slot in the legislative programme for the Bill. I am disappointed that it is to be opposed and will therefore take more time. If the Opposition, both here and in another place, were more co-operative, we could get through more legislation, but that is obviously not going to happen.
On 22 July, I asked the Secretary of State about this matter and he said that it was wrong for the insurance companies not to pay. His Department had calculated the figure at £50 million, but the Automobile Association estimated that it was £440 million. The correct amount of money will now be paid to the national health service.
The legislation will not affect all those who are injured in road accidents; it will affect only the innocent victims. For example, if I fall asleep behind the wheel, have an accident and I am treated in hospital, I obviously will not be able to claim against anyone else's insurance. In the absence of any claim, the NHS will continue to treat me for free. However, if there were a passenger in the car, he or she could claim against my insurance. The NHS will still bear the vast cost of treating road accident victims.
The charge was first drawn to my attention as a Member of Parliament when I took up the case of a constituent who had received an emergency bill. I was told that the legislation had been on the statute book for decades and that my constituent simply had to send the money to the insurance company. The bill would then be paid and there would be no problem with the no-claims bonus. Initially, it seemed to be a good way of raising money for the NHS. However, the emergency fees have caused problems, and I am glad that the Government have decided not to pursue the issue and to abolish those charges.
I have examined the real terms cost to hospitals and the amounts that they receive in compensation. In one year, my local hospital received back about £80,000 after treating 1,000 patients. I pressed my local hospital about the matter—there was a Conservative Government and the trust budget was facing a shortfall—and it managed to raise more than £100,000. However, that is not a great deal of money when viewed in the context of 1,000 road accidents.
I am pleased that the money will now go to the hospitals that treat the patients. That is a great advantage for areas such as Cumbria, where we have a sparse population but many tourists. This measure is better for rural areas as it is not fair to put the money into a general pool. My local hospital will benefit considerably. Many visitors to Cumbria—probably too many—travel by car and there is a considerable number of road accidents each year. The hospital received £100,000 last year, but the treatment of one overseas tourist in the Cumberland 169 infirmary cost £45,000. That puts the matter in context. In that case, the German insurance company paid the bill and there was no problem.
Although we expect this legislation to raise considerable extra money for the NHS, the reality is that the health service will never have enough money. Cumbria has done very well under this Government: we are to have a new district general hospital and there is a health action zone in the north of the county. However, my constituents realise that resources will always be scarce and it is wrong to claim that this legislation is unpopular with the general public. The Conservatives and the Liberal Democrats have picked the wrong approach—the Liberals always do.
My local newspaper, the News and Star, surveyed the population on this issue—it is called a vox pop. Nine out of 10 people interviewed thought that it was a good idea that their insurance companies—not they—should pay the NHS to treat road accident victims in the same way as those companies pay to repair the vehicles involved in the accidents. The proposal is popular. I am pleased that the Secretary of State is introducing the Bill and that it will be implemented by April. [Interruption.] I am glad that the right hon. Member for Maidstone and The Weald thinks that that is funny.
§ Mr. John Randall (Uxbridge)
My point is not meant to be confrontational. I know that the hon. Gentleman's constituency is in Cumbria. Does he think that the Bill's principle should be applied to people who come from outside that area to do mountaineering or hill walking because the local health service pays for their care if they are injured while taking part in those activities?
§ Mr. Martlew
The principle is specific to the Bill. The existing legislation, which has been in place since the 1930s, was amended by the previous Government in 1988, and all sides of the House have agreed to it. There is now some carping about the level of the charges. People are prepared to pay a little extra—that is all it will cost and if competition works properly, there might be no extra cost—through their insurance to ensure that payment is made to the NHS. If the Opposition do not believe that, they are out of tune with their electors.
§ Mr. Alan Duncan (Rutland and Melton)
Will the hon. Gentleman explain what he believes to be the difference between motor insurance paying for someone's health care and general health insurance paying for such care?
§ Mr. Martlew
There is a great difference. This proposal is acceptable and has been since the 1930s. Any other proposal would be unacceptable and would go against our commitments. We gave a commitment on this measure and we shall stick to it.
§ Mr. Martlew
We made a commitment on charges and we are getting rid of several charges for people who are affected by the legislation. We shall reduce the number of those charges by three quarters. I am sure that when hospitals receive the money, the right hon. Member for Maidstone and The Weald and her hon. Friends will not say, "Send it back to those poor insurance companies. 170 They cannot afford it." They will accept the situation. Conservative Members are making mischief. I shall support the Bill.
§ Miss Widdecombe
The hon. Gentleman continually refers to insurance companies paying. How does he think that insurance companies get money if not from the people who insure with them?
§ Mr. Martlew
I have already said that if there is an extra charge, my constituents will accept that it is a price worth paying to support the health service. The insurance companies should have been paying that money all along. In some cases they have frustrated the hospitals' and trusts' claims for money by not co-operating. Time and time again, we find that the Tories would sooner support insurance companies than support the national health service.
§ 5.3 pm
§ Mr. Simon Hughes (Southwark, North and Bermondsey)
My colleagues and I will vote for the reasoned amendment in our names if it is selected by Madam Speaker or by you, Mr. Deputy Speaker. If it is not selected, we will vote for the amendment tabled by the right hon. Member for Maidstone and The Weald (Miss Widdecombe) and her colleagues.
Mr. Deputy Speaker
Order. Perhaps the hon. Gentleman was not present at the beginning of the debate when Madam Speaker announced that she had selected the amendment in the name of the Leader of the Opposition. That is the decision on the selection of amendments.
§ Mr. Hughes
In that case, we shall, perforce, support the amendment tabled by the Conservative Opposition because we cannot vote on our reasoned amendment. We have reservations about the way in which the right hon. Member for Maidstone and The Weald has drafted the amendment because it is rather pro-motorist.
§ Mr. Hughes
We are unhappy about that stance. The debate should be about how the health service raises money rather than whether motorists are clobbered by the measure. I shall turn to the details of that issue in a moment.
I apologise to hon. Members for the fact that the reasoned amendment in the names of my colleagues and myself, as I have already pointed out to the Secretary of State, the right hon. Member for Maidstone and The Weald and Madam Speaker, should have read, "on the grounds that it makes provision for payment by requiring those who successfully claim compensation for personal injury sustained in road traffic accidents but not by any other means". I do not know whether that omission was caused by my handwriting, my drafting or by an error somewhere else, but I hope that I have corrected the record.
As I told the Secretary of State during the debate on the Queen's Speech, we support the abolition of the emergency treatment fee. It was too bureaucratic to collect 171 the charge, and the cost of collection was not worth the candle of the payment. I share the Secretary of State's view that it had an indignity about it.
If that is out of the way, this debate is about changing the rules for collecting another source of money which, as the Secretary of State rightly said, has been available for collection since the 1930s. The Secretary of State's researchers may have done a better job than me. If it is true that my predecessors and the Secretary of State's predecessors—old though he is, he is not that old—voted—[HON. MEMBERS: "Old Labour."] No, not old Labour, just old. If our predecessors voted for the measure in 1930 or 1938, that was almost two decades, or thereabouts, before the NHS came into being. Raising money for health services in those days was a whole different ball game from when we set up the national health service, which was voted for in this place by the Labour party and the Liberals and opposed by the Conservatives. We put in place a health service paid for by taxes, not charges. This debate is about whether this is a proper charge, a new charge and whether it should be supported.
I accept that, as the Secretary of State said, this is not a new charge. Therefore, I accept that in this Bill the Government have not broken any commitment not to raise any new charges to pay for the health service. It is an old charge, but it was not collected. It is a convenient source to which the Government can turn to add a bit more money to the kitty. I understand their reasons for doing it. It provides a way of raising money that is consistent with the Government's commitments.
However, it changes the amount of money raised through charges and, in that context, it is a little like the Government's announcement about raising prescription charges earlier in the year. Last year their policy was that raising prescription charges would be a tax on patients, the poor and the sick. This year, lo and behold, they raised them. This measure will mean that more money will be collected from charges, directly from the insurance companies but inevitably, as the right hon. Member for Maidstone and The Weald said, indirectly it will come from those who pay insurance companies. Insurance companies have no money of their own other than that paid to them. The Bill will increase the charges collected for the NHS from some of the people in Britain when they pay their motor insurance.
I doubt whether the motor insurance industry believes that it can do all that without putting up our premiums by a penny—only time will tell. I have never known a free lunch and I have never known insurance companies reduce charges when the bill for them has gone up. We will hear that debate in Committee and, no doubt, we will debate how much the charges might go up and when.
The reasons why my hon. Friends and I have reservations and cannot support the Bill on Second Reading are summarised in our reasoned amendment. We do not believe that it is principled to raise more money for the health service from charges. My party stands by a national health service paid for through taxation. There is a range of charges that contribute to the health service including prescription charges and appliance charges. There are also charges paid by pensioners, who are the only group in society who have money recouped if they 172 go into hospital because some of their pension is taken back. That does not mean that adding to an anomalous hotch-potch of charges is right. We do not think that it is.
At my party's conference this year we agreed a motion committing us to looking at all charges in the health service. I do not know the outcome of those deliberations, but, when we reach our conclusion, which will be well before the next election, we may decide to commit the party to abolishing those charges. It may be—
§ Mr. Hughes
We are moving towards that position as fast as the Labour party was before the general election.
§ Mr. Hughes
I shall give way in a moment.
As an eternal optimist and as someone who watches the political runes, I think that we are well on the way to being in government long before the hon. Member for Doncaster, North (Mr. Hughes) retires from politics, and certainly long before I and my hon. Friend the Member for Taunton (Jackie Ballard) retire.
§ Mr. Martlew
How much will the policy of abolishing charges cost and how much would it be necessary to increase income tax to ensure that exactly the same amount of money went into the NHS as goes in now? There will be no betterment by abolishing charges and increasing tax, will there?
§ Mr. Hughes
The hon. Gentleman has asked a proper question. We have asked our policy people to examine the implications this year and in future years. The hon. Gentleman is right that abolishing charges means that the money lost must be recouped. If it has to be recouped through taxation, more money must come from taxation somewhere. It may not be taxation for those at the lower end of the income scale. It may be, as my party believes, that taxpayers at the higher end of the income scale should pay more tax. That is a policy that we reaffirmed this year, a policy that is not yet supported by the Government in spite of their historic commitment to redistribution of wealth.
§ Mr. Hughes
No. The hon. Lady asks a perfectly proper question but it is mischievous.
The reality is that if we examine whether we should keep charges or lose them, everything might be considered. I have heard no voices in my party saying that we should introduce additional charges to the health service. My presumption is that my party will want to reduce charges rather than increase them. However, in 173 theory it is possible that things might go in a different direction. In a democratic, one-person, one-vote party, the members will decide.
§ Mr. Hughes
Certainly not Millbank and certainly not through the block votes of anyone because we all come with a block vote of one.
Secondly, we are not faced with a coherent policy for reviewing charges. I would have liked the Secretary of State to make the announcement at the time of the comprehensive spending review. I would have liked him to say, "We have reviewed all the charges and for a reason that I shall now explain there is a reason behind this charge but not any other." No such luck. The charge is before us only because it happens to exist.
It is a rather funny policy. It is rather like a policy that I do not hear espoused regularly from the Government Benches: "We will support the hereditary peers because they happen to exist." The Government's charging policy is being supported only because it happens to exist. That is hardly a principled basis for keeping a policy. It would have been far better to examine all charges and ascertain whether the Government's proposal is supported by logic.
§ Mr. Letwin
I am tempted by the hon. Gentleman's most recent remarks to ask him whether he will confirm that the Government have rather said that they will be perfectly happy to have hereditary peers, or at any rate 91 of them, because they are there in the House of Lords.
Mr. Deputy Speaker
Order. The hon. Member for West Dorset (Mr. Letwin) is following the track along which he went last night in introducing entirely extraneous matter.
§ Mr. Hughes
I had not dreamt of being distracted, Mr. Deputy Speaker.
Thirdly, if the Government are considering introducing charges, I flag up the question whether there are some people who use the NHS who perhaps should pay—not those who are United Kingdom residents, not nationals of countries with reciprocal arrangements with the UK and not those who come as asylum seekers and therefore ask to use NHS benefits—such as those who come to this country as income earners who are perfectly well financially endowed. They come here on that basis and yet they are treated under the NHS. There is an issue there. The Government have raised it and the previous Conservative Government raised it. It is one that seems to be outside the debate about whether UK residents should pay taxes, or those to whom we have obligations in this country.
The fourth reason why the Government's approach is problematic has been alluded to by the right hon. Member for Maidstone and The Weald. If we charge people who use their cars through their insurance, it is not a 174 progressive tax. The reality is that the poor pay as much as the well off in many senses. For example, those in rural areas have no alternative but to have a car. They have to pay motor insurance and if their premiums increase, they will suffer. That will adversely affect the less well off, if the charge impacts on the insurance payer at all.
Lastly, as the right hon. Member for Maidstone and The Weald said, the proposal is absolutely illogical. It is not logical that we should recover money from someone who receives compensation for being injured in a road accident, regardless of his or her responsibility for the accident, but not from someone who is injured—I shall deal only with transport—in a train, shipping or aircraft accident. Ministers might say, "You do not have to be insured compulsorily to use those forms of transport", but such insurance is required for some of them.
There is, nevertheless, no logic in claiming money from those who have been compensated for a motor accident, but not from those who have been compensated for an accident at work when the employer is obligated to ensure that employees are insured, or from those who are compensated for tripping over a footpath or in a park that the local council is responsible for maintaining and when the authority is obliged to have an insurance policy.
What about climbers, sailors or—as my hon. Friend the Member for Montgomeryshire (Mr. Öpik) will have in mind—hang-gliders who are treated wonderfully by the national health service for injuries caused because of a choice that they have made? Although people make a choice to sail, to climb or to hang-glide, if they are injured, they will not be asked to make a contribution for their treatment. There is therefore absolutely no logic in the Bill, which is simply an ill-logical means, without principle, to gain access to a pocket of money.
§ Mr. Syms
The hon. Gentleman is perfectly right about aircraft accidents. A few years ago, an aircraft overshot Northolt and went on to the A40, hitting cars. In such a situation, a millionaire in a private jet would not be caught by his insurers, whereas the poor person driving his or her Ford might well be caught.
§ Mr. Hughes
Such examples may be wrong. However, debates on such matters should be left for the Committee stage rather than Second Reading. There will be a debate in Committee on the Bill's details, which I do not want to dwell on now. If the Bill is given a Second Reading today, as I think that it just might be, my hon. Friends will test in Committee whether the charging system proposed—if we are to have such a system—is the best one.
If we are to have such a system, the system proposed in the Bill seems to be better than the current one. It seems that flat-rate charges are better than variable ones, and that a common charging system is better than a localised one. Therefore, for as long as we shall use such a system to raise revenue for the health service, I guess that the Bill's provisions will offer the least worst option.
Ultimately, if the charges raise £100 million, it will of course be welcome—but it will hardly make a huge contribution to the health service's £45 billion budget. I only wish that the Government had proposed an overall 175 review—on a basis of principle and logic—of health service charges, and not simply plucked a convenient little extra off the shelf.
§ Mr. David Hinchliffe (Wakefield)
I am very happy to support the measure, which is sensible and tidies up procedures that—as my right hon. Friend the Secretary of State said—have been in the system and operating since the 1930s. The system has had cross-party support, and I think that its historical and political context has been generally understood. Nevertheless, I agree with my hon. Friend the Member for Carlisle (Mr. Martlew) that the public have not fully understood the system.
Like my hon. Friend the Member for Carlisle, I have had constituents raise with me their concern about charges for emergency treatment within what they perceive to be a free national health service. Many constituents are completely unaware of fees, and are shocked when a demand for fee payment is pressed on them. In each of my 11 or 12 years as an hon. Member, I have received two or three letters expressing their concerns about the system, which the Bill will sensibly amend.
I specifically welcome, for reasons that I have already given, the Bill's proposal to remove the emergency treatment fee. I welcome also the proposal on removing from national health service providers the role of collecting money. Like my hon. Friend the Member for Carlisle, I particularly welcome the Bill's proposal on returning funds to the providers who provided the treatment.
The right hon. Member for Maidstone and The Weald (Miss Widdecombe) and the hon. Member for Southwark, North and Bermondsey (Mr. Hughes) asked about extending the principle of charging to other spheres. I do not think that any hon. Member has yet mentioned in the debate the contents of the Law Commission's 1996 consultation paper. It raised the possibility of a reclaiming scheme for other personal injuries for which damages are paid. As I said to my right hon. Friend the Secretary of State last week, in my long lost youth I played a good deal of rugby league and, as a consequence, spent a lot of time in local hospitals receiving treatment. I was well insured above the costs of any loss of time at work resulting from the injuries and made a substantial profit on each claim.
I am not suggesting backdating, but some people have asked about extending the practice to other areas, particularly those for which there is compulsory insurance. That may be tempting for the Treasury, but I urge caution, because such a scheme would depart from some important basic principles governing how our NHS has operated since its introduction in the 1940s. I am worried that extending the principle of recouping insurance payments to other areas could result in a USA-style system, which I have seen, where insurance arrangements are established for each patient before a pulse reading is taken. I am sure that we would all oppose any changes in that direction.
I have listened with great interest to the comments of the Conservatives. I am sorry that the right hon. Member for Maidstone and The Weald has left the Chamber, because I wanted to raise some concerns about what she 176 said, particularly the inconsistency between her arguments today and the record of the Conservative Government, who moved health provision ever more towards a USA-style system. If the Tories have a health policy, it is to move increasingly towards private insurance. She has made that clear in debates since the general election.
We should examine how the introduction of market mechanisms by the previous Government and the increased emphasis on paying for elements of health care have led to some of the problems in the national health service that the Government are trying to unravel.
I was interested in the right hon. Lady's attacks on the Government's proposals for motorists. In 1988, I served on the Standing Committee that considered the Health and Medicines Bill, which was all about introducing wider fundraising duties and powers for the national health service as part of a move towards the American-style system that the Conservatives favoured. The Tory reasoned amendment talks about burdens imposed on private motorists and complains thatthese charges will apply only to motorists".I should like to hear the views of Opposition Front Benchers on what arose from their Act in 1988. One of the first results was the imposition of car parking charges in hospitals. In a spirit of consistency with their reasoned amendment, do the Conservatives believe that the previous Government were wrong to bring about a system that penalised people using cars when they visited hospitals? Elderly people who travel to see their loved ones in hospital have to pay to park at that hospital.
§ Mr. Randall
Many hospitals, including that in my constituency, have tokens for those who are genuinely visiting the hospital or staying there. We had a problem at Hillingdon hospital with people parking for free and going into town, depriving others of the use of the car park. There is a way of getting around the problem.
§ Mr. Hinchliffe
That may be the case, but it seems inconsistent that the Opposition have tabled a reasoned amendment and made remarks bashing the motorist when the previous Government—the right hon. Member for Maidstone and The Weald was a Minister at the time—introduced hospital parking charges.
I now turn to another issue which also resulted from the policies of the previous Government. My constituency received national attention when the general manager of Wakefield health authority received from the Conservatives the national prize for innovation for introducing a remarkable scheme under the Health and Medicines Act 1988 which earned the NHS £10 a head—perhaps that is the wrong term. When someone was lying dead in the hospital mortuary awaiting collection by the local undertaker, for a fee of £10 the mortuary attendants would measure the corpse to ensure that the undertaker arrived with the correct-size coffin. That cost was passed on to the bereaved relatives—yet another charge that the right hon. Lady has conveniently forgotten, but one that gained Wakefield something of a reputation shortly after the introduction of the Health and Medicines Act.
The Conservatives also presided over the total privatisation of care of the elderly in private nursing homes and care homes. People ended up paying for services that they had previously received free from the NHS. Those charges impacted on the most vulnerable 177 people—as do the increasing charges for domiciliary care and the anomalies that persist today as a consequence of those charges.
I welcome the Government's resistance to calls for more charging and their response to the direction that the previous Conservative Administration were taking. I welcome my right hon. Friend's arguments against charging for GP consultations and hotel prices for NHS beds and the steps that he is taking to return the NHS to its basic principles. In particular, I welcome the massive sum of money that he and his colleagues have obtained from the Treasury; it is having an impact in my constituency and throughout the country.
§ Mr. John Randall (Uxbridge)
In giving the Bill a Second Reading, the House will not be introducing a new principle of NHS funding; rather, the Bill will ensure that the NHS entitlement to recover its costs for treating accident victims, which is already enshrined in law, is achieved more readily.
The NHS is currently entitled to recover the costs of treating the casualties of road traffic accidents. The difficulty has been that, to date, it has not been very successful in doing so. The Bill will attempt to change the position by shifting to insurance companies the responsibility for making payments to the relevant trust or hospital.
According to Department of Health figures produced last July, NHS trusts recovered £13.7 million from insurance companies during the financial year 1995–96. Estimates as to the sums that could have been recovered vary hugely. The Department has estimated that around £50 million could have been claimed, whereas the Automobile Association claims that the figure could be as high as £400 million.
During the financial year 1996–97, 190 trusts out of a total of 429 claimed back absolutely nothing from the insurance industry. To illustrate the diversity of claims being made, during 1996–97 the Leicester Royal infirmary raised £365,000, but Guy's and St. Thomas's Hospital NHS trust raised only £15,000 and Derby City hospital raised absolutely nothing.
It would seem that, in the light of those figures, the NHS could begin to recover fairly large sums of money previously left unclaimed. It would be helpful if the Minister would enlighten the House on the difference between the estimated sums that are not claimed, in order to give the House a realistic idea of the scale of the problem.
One reason for the apparent failure of trusts to reclaim money from the insurance companies is the perception that the current system is bureaucratic and legally complex. A Department of Health circular has advised NHS trusts to consider more carefully how they pursue claims under the Road Traffic Act 1988. Perhaps the Minister will shed some light on how far that misperception has been corrected through more rigorous enforcement of current guidelines. What improvements resulted from the circular?
Under the Bill, the Secretary of State will issue certificates to the insurance companies specifying the NHS charges that are due. The responsibility will be delegated to the Department of Social Security's 178 compensation recovery unit. The certification scheme, which is outlined in clauses 2 and 3, is designed to be as similar as possible to current schemes involving the unit and the insurance industry. The aim is to make the new scheme's introduction cheaper and easier, but will the Minister provide us with any Department of Health figures on the estimated costs and say what alternatives have been considered?
The initial response to the Bill has been relatively muted. The two parties that will most obviously be affected—the NHS and the insurance industry—have had different reactions to it. In the NHS, there has been a slightly different emphasis, depending on to whom one speaks. The NHS Confederation has welcomed the Bill as a way for hospitals cost-effectively to recover the money to which they are entitled, whereas the British Medical Association doctor-patient partnership and members of the Royal College of Nursing have expressed concerns about the knock-on effect on NHS funding. There are fears that the Bill will provide a precedent whereby the door is open to fund other areas of health care through insurance schemes for health-damaging life styles—from the heavy drinker to those who indulge in dangerous sports.
It is not clear why the victims of road traffic accidents should be singled out. What about any other injured individual who makes an insurance claim after receiving medical treatment? Why should the victim of a road traffic accident be the focus of recovering moneys from the insurance industry when others are immune? It would be of great interest if the Government would say what view they take on that difficulty and whether they have plans to extend the Bill's principle to funding for other areas of health care. I am sure that, even on road traffic accidents, the Government acknowledge that road users other than car drivers are involved in or even cause accidents. Are there plans, for example, to extend the system to compulsory insurance for cyclists or pedestrians? That is a genuine matter of debate, although I would not particularly welcome any such extension of the scheme.
On the Bill's implications for the insurance industry and the motorist, the Automobile Association has estimated that the increase in premiums for drivers will be higher than the Department of Health has said. The Government have produced a figure of between £6 and £9, whereas the AA has put it at nearer £10 on the average motor policy.
§ Mr. Dobson
For the record, the Association of British Insurers has estimated that, if the full costs are passed on to motorists, there will be a 2 to 3 per cent. increase—between £6 and £9—in the price of a policy. I assume that the ABI knows more about the matter than the Automobile Association does, as its members will have to pay.
§ Mr. Randall
I am grateful for the Secretary of State's intervention and his dismissal of the Automobile Association's opinion. In fact, the ABI has cited an amount as great as £20 on motorists' premiums. If there were less of a discrepancy between the estimates, that would help us to make up our minds about the Bill. The motorist will be hard pressed by a range of new charges from the integrated transport policy, in addition to the 179 increased costs proposed by the Bill. The motorist does not want further large increases in premiums on top of everything else.
Rebecca Hadley of the AA has said:
Britain's estimated one to two million uninsured drivers will continue to dodge the charge. It is also an unfair levy: if you fall off a ladder while cutting your hedge, the hospital would provide treatment without claiming the cost from your home insurance, so why are motorists singled out, yet again, to pick up the tab?In light of the AA's comment on the number of uninsured drivers on the roads, it would be helpful if the Minister would tell us what discussions he has had with the Home Office about reducing the number of uninsured drivers who continue to exploit the situation. If the Bill achieves its aim, dealing with that problem will become more of a priority.
The Bill aims to make the current way of recovering money from insurance companies for traffic accidents easier and more efficient. However, the Government must say in more detail how much money the Bill will save for the NHS. How much will it cost to implement? What guarantees can be given about not extending the principle to other areas of funding? What will be the effects on the ordinary driver? What is proposed for all those on our roads who are driving without insurance?
Principally, I am asking the Government why attacking the motorist once again is their priority. Without answers to those fundamental questions, I am afraid that I cannot support the Bill.
§ Miss Anne Begg (Aberdeen, South)
I would like to take this opportunity to describe my experience of the existing legislation. Let me take the House back to a snowy January morning in 1996, when I was driving my fairly new car—a spanking red car that was only two months old—near Brechin and Arbroath as I was going to work. It was a snowy morning with a lot of black ice. Water had been running across the road and had frozen. I was tentatively driving up a narrow, winding back road—taking my time because I knew of the dangers of the road. It was a classic accident spot.
Imagine my shock and horror when I saw another driver come around the corner towards me. I could see the fear and alarm on her face, and it was obvious that her car had hit a piece of black ice. I do not know whether anyone in the House has been in the situation where an accident is about to happen, but it happens in slow motion. I could see the expression on her face as her car slid across the road. She would quite happily gone off the road and into some trees, but I happened to be in the wrong place at the wrong time. Before the impact, my last thought was, "My nice new car!" There was nowhere for me to go as her car ploughed straight into the side of my car.
I was lucky—I had my mobile phone and I quickly dialled 999 to report the accident. Before long, an ambulance was there to cart me off to hospital. It was an occasion when it was quite good that I was in a wheelchair because, in standing on my brakes to try to stop the accident, I had done something to one of my feet. It had swollen; possibly a bone was broken—I did not know. I got my wheelchair out of the car and got myself 180 into it. By the time the ambulance had arrived, I was mobile, but obviously something was fairly seriously wrong. Also, I had broken my sternum from wearing the seat belt. The ambulance took me to the local hospital, Stracathro hospital, where I was patched up and duly dispatched home.
At this point, I was glad that I had ticked the small box on my insurance form that ensured that I would have legal representation should I have an accident. The insurance company appointed a lawyer, who went into action on my behalf to claim some personal injury compensation.
I was able to claim a small amount to compensate for my pain and suffering, but I also had to claim back my wages for the two days for which I had been off work, despite the fact that my employer would have paid my wages in any case. As a teacher working for a local authority, I was covered by all the normal statutory sick pay arrangements, but because I was claiming personal injury compensation, my employer expected recompense for the two days' work that he did not get from me.
I expected to have to claim something to pay for hospital bills, but it did not happen. I had that expectation because, 20 years earlier, I had had another accident. I do not want hon. Members to think that I make a habit of having accidents. It was a snowy evening in March, and on this occasion I was driving down a road in Dundee when someone came out of a side road, tried to brake, did not stop and came straight across my path—another example of my being in the wrong place at the wrong time. I was collected by an ambulance and taken to the Dundee royal infirmary.
After that earlier accident, a bill arrived at my house, which I thought was to cover the cost of the ambulance. I have learnt only this afternoon, by listening to my right hon. Friend the Secretary of State, that the bill was not for the ambulance. I remember feeling alarmed that I had to pay for the ambulance, until someone told me that the bill would be met by the other person's insurance.
Therein lies the problem: two different health authorities, and two almost identical accidents, but in one I—or the insurance company of the person who caused the accident—was not charged, while in the other a charge was made. That is the anomaly that the Bill will put right. The power already exists, and is exercised in some areas, to charge for hospital treatment resulting from an accident; but it is used sporadically and inconsistently. It is used by some health authorities on some occasions and by others not at all.
What is the point of legislation if it cannot be enforced and the money cannot be recouped? That is why I welcome the Bill. It will make the recovery of costs much easier and there will be much greater consistency. It is different from existing legislation because of the compensation recovery unit, which will take the responsibility for recouping the money for the hospital out of the hands of the individual and put it squarely on the shoulders of the insurance companies. The law will be more coherent and therefore much better.
I welcome the Bill because it will create a much fairer system. It will apply to everyone equally and I hope that, as a result, the health service will continue to be able to put extra resources in the areas of greatest need, improving accident and emergency treatment, modernising the equipment in ambulances and reinvesting funds in the health service to make it the jewel in the crown that makes us so proud to be British.
§ Mr. Robert Syms (Poole)
In such an interesting debate on the subject of charging in the national health service, one can confidently predict that each side will accuse the other of being inconsistent. On both the Government and the Opposition Benches we have a history of arguing certain cases. Car parking charges are one of the topics that have already been mentioned. Consistency may not ring out from either side of the Chamber tonight.
Regardless of the existing law, the NHS charges have not been collected. If the Bill introduces a more efficient collection system, motorists will ultimately have to pay via their insurance companies. In effect, the Bill brings about an indirect tax rise, against the background of major increases in motoring costs initiated by the Government, as my right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe) argued.
Everyone contributes to the NHS through general taxation. Motorists will, in effect, be charged twice. Having paid through general taxation, they will be expected to pay again through their insurance. It is estimated that the Government's proposals will cost motorists an extra £10 a year in increased premiums. Seen in the context of £9 billion of extra motoring taxes, it is clear that many motorists will find the additional cost difficult to meet.
During the debate, the Opposition will seek assurances that the proposals are not the thin end of Labour's charging wedge. It is easy to claim that increased charges are justified in one part of the NHS, but good arguments can be made for higher charges for other NHS services.
The Bill has implications for bureaucracy. Additional money may well be raised, but that will entail costs, as 50 people will be employed in the collection unit.
Insurance premiums will rise by about £9 a year. As my hon. Friend the Member for Uxbridge (Mr. Randall) noted, the Automobile Association estimates a £10 increase, but that remains to be seen. The fact that costs will be absorbed by the Motor Insurers Bureau means that the uninsured may be paid for by the insured. That is not compatible with natural justice. Higher insurance premiums are hardly likely to increase the number of motorists who take out insurance. The Association of British Insurers estimates that uninsured drivers will cost motorists £250 million in 1999. The Bill could increase that sum substantially.
Many motorists' costs are paid by businesses, so business costs will rise. There are 1.6 million company cars. The additional burden on business will have to be financed from trading.
The charges could be judged to be an unfair levy. Motoring in the United Kingdom is already more expensive than elsewhere in Europe.
Anomalies will inevitably arise, and perhaps the Minister will respond on this point at the end of the debate. I mentioned earlier the example of an aircraft careering off a runway into a road. If someone falls off a ladder in his home, there would not necessarily be a claim against his home insurance. The case of cyclists has been mentioned. Other examples are that of a ferry sinking or a train or aircraft crashing.
§ Mr. Andrew Dismore (Hendon)
Aircraft and shipping accidents are covered by international conventions, so a 182 Government could not legislate for those cases, even if they wanted to do so. The Athens convention deals with shipping accidents and the Warsaw convention with aircraft accidents.
§ Mr. Syms
The hon. Gentleman makes an interesting point. I am sure that such issues will be explored more fully in Standing Committee, on which I may volunteer to serve. The Bill creates a regressive tax without regard for whether someone is rich or poor. Indeed, some poorer households pay rather more of their income in insurance than do some richer households.
The Bill also raises questions about the future funding of the national health service. If we introduce the principle that motorists should contribute through their insurance companies, we shall have to deal with arguments about why that should not be so for smokers, drinkers or the overweight. Self-inflicted injury has been mentioned. Those who take part in dangerous sports might also be affected. We must address the anomaly of having a charge for motorists—probably because there is already a substantial insurance market which can be tapped—while there is no charge in other areas. There is also concern about extra bureaucracy.
§ Ms Drown
Did the previous Government point out that anomaly during discussion on the Road Traffic Bill in 1988? Can the hon. Gentleman distinguish between the compulsory insurance required by people who drive cars and non-compulsory insurance, which applies to some of his other examples?
§ Mr. Syms
The hon. Lady makes a good point. Motoring insurance is compulsory, although not everyone takes it out. A number of people caught in accidents are not in fact insured, and one of my problems with the Bill is that it fails to address that situation. The burden will fall on law-abiding citizens who conform to rules, regulations and laws, and who may have to pick up the tab for the bad apples who are uninsured.
The principle of insuring oneself for certain activities is recognised. People take out insurance for various sports.
§ Mr. Syms
I am not suggesting that; I am merely saying that it is a fact of life that many people who should be covered by motor insurance are not covered. Under the Bill, the Motor Insurers Bureau run by the insurance companies will have to cover claims for those people who have not done their duty.
§ Mr. Syms
No, that is not my point. Many people are insured. The Government's proposals will hit law-abiding citizens, who have already been hit by increased motoring taxes, including an increase in fuel taxes. The Bill does nothing to deal with uninsured drivers, and we should put 183 more emphasis on making sure that they are insured, and on punishing them if they are not. I am sure that hon. Members on both sides of the House will agree with that.
My more general point is that to argue for the principle that drivers should pay through their insurance—compulsory or otherwise—is to set off on the slippery slope of arguing the same for other, more voluntary, activities. In rural areas, people need cars, and most Members of Parliament need cars to conduct our business.
§ Mr. Gareth R. Thomas (Harrow, West)
May I bring the hon. Gentleman back to the point made by the hon. Member for Uxbridge (Mr. Randall) about great variations in the amounts that hospitals claim? The reason suggested was the complexity of the process. Does the hon. Gentleman agree that the Bill is excellent, in that it will simplify the process and help to eliminate variations in what is claimed around the country?
§ Mr. Syms
We shall have to test that point in Committee to see whether the Government's intentions—with some of which I agree—will have the planned results. Aspects of the Bill are positive, but many questions will be raised as the Bill progresses. There are concerns about the precedent being set, which may affect other areas. As a Conservative, I believe that the NHS must be basically free and paid out of national taxation. Income can be supplemented in one or two ways, but we all know that there is no effective way to pick up the NHS bill, except through general taxation.
§ Laura Moffatt (Crawley)
There will be a huge cheer throughout national health service trusts today when staff learn that the Bill has set off on its passage. Anyone in the NHS who has had to collect the £21.30 charge will tell hon. Members what nonsense that was. The Bill only makes possible what should have happened already. It contains nothing new, and it breaks no principles. Anyone who claims that a new principle is being introduced is neither right nor honest.
Is it reasonable to expect hard-pressed NHS staff to chase small sums? Those staff become completely disillusioned, dropping the chase when they have had enough. My local trust serves part of the M25, and it has to deal with lots of accidents, but it raised only £70,000 last year from the charge. Two people had to be dedicated to collecting small sums, and they were driven into the ground and became fed up. It is little wonder that some trusts paid heed to companies that offered to collect the debts, raising cash for the trusts, but taking a cut for themselves. That is clearly unacceptable.
However, matters are even worse than that. Some companies offer to look into the people involved in accidents, and then to organise retrospective insurance. The company then gets a cut for the hospital, and for the person who is making the claim. Tacky, nasty arrangements are being made over funds that should by right go to the NHS. I am glad to see the back of all that, and I look forward to putting a stop to companies making money from a difficult situation.
184 Charging should be in the hands of people who know what they are doing. The compensation recovery unit is used to dealing with such matters.
§ Mr. Letwin
How successful has the compensation recovery unit been? What percentage of claims sought over the past five years has the unit managed to obtain?
§ Laura Moffatt
Clearly, I am not able to answer that. I can answer only for constituents who have experienced the work of the compensation recovery unit, and who have had no complaint about the ways in which they were asked to pay back benefit that they had received while waiting for claims to be resolved.
The compensation recovery unit is used to dealing with such matters. I hope that patients and hospitals will see little evidence of administration, and that the emotive subject of money need not be raised with people at difficult times. I trained as a nurse with my local trust, and I worked in the accident and emergency department, in which everyone had an opportunity to work, both during and after my training. It is awful to have to tell a patient that he or she may be charged a levy, and that we need a name and address so that we can make the charge. False names and addresses are still given to hospital staff, and that is clearly unacceptable.
The hon. Member for Uxbridge (Mr. Randall) mentioned the response of the Royal College of Nursing. I was interested to hear the hon. Gentleman say that the royal college was concerned, as it very much welcomes these moves. It produced two pages welcoming what the Government are trying to do, and its one small word of warning concerned ensuring that the principles were not taken further, which would be my warning too. I can support the measure only because compulsory insurance is involved, and I support it wholeheartedly. We will stick to that principle. The Royal College of Nursing, as a caring organisation, is right to say that we must be sensitive when we are claiming money from people who have been involved in difficult and horrible situations. I do not want the principle to be extended to other accidents.
I listened with interest when my hon. Friend the Member for Wakefield (Mr. Hinchliffe) talked about insurance and said that he would be covered if he had an accident. That would not be true of my three sons, who play for Crawley rugby club. The club encourages a sporting activity that enables our young people to join in, have great fun and keep fit. The last thing that I want is to cause them difficulty. The principle must rest there; it would not be acceptable to take it further.
I support the Bill because motor insurance is compulsory and the money will go back to the NHS, as it so rightly deserves. As a nurse in the NHS for 25 years, I have been waiting for such a measure. Staff are involved in issues with which they do not feel comfortable. The Government say that they will do something about that. They will ensure that staff do not have to be involved and that the NHS merely needs to know the names, addresses and types of treatment that have been given in a hospital. They will take the matter out of the nurses' hands, which will clearly be music to the ears of people who work in the NHS throughout the land.
§ Mr. Randall
Given the hon. Lady's experience as a nurse, does she think that the measure will involve more paperwork for nursing staff?
§ Laura Moffatt
I can envisage only a reduction in paperwork. The hon. Gentleman should speak to those working in his local trust. In mine, two people have to spend most of their day chasing small sums. There will be a great reduction in the amount of paperwork. The job will be done elsewhere, by people who are used to doing it, which seems to be the only way forward.
§ Mr. Randall
I thank the hon. Lady for giving way again. She is most kind. With respect, I accept, as I said in my speech, that the money that trusts get back varies greatly. Under the Bill, will there have to be paperwork for all, or nearly all, patients who have been involved in a road traffic accident—paperwork that will have to be sent to the central collection point?
§ Laura Moffatt
Perhaps the hon. Gentleman has not noticed, but there is paperwork when most patients are admitted to an accident and emergency department. That work has to be done—there is no question about it—and it is the way in which it is done that matters. Another authority will deal with it further and the staff will be relieved when they hear that they will no longer have to pursue claims. The Bill is about bringing fairness back into the system. If a Labour Government are about anything, they are about fairness. Military hospitals have been included in the provisions of the Bill and will now be able to claim money. They will get the money that is due to them.
The Bill is a fitting tribute and a fitting approach to the national health service in its 50th year. I am glad that the Labour Government are taking us along that path and ensuring that the NHS gets the money that it so rightly deserves. NHS staff throughout the country will be grateful.
§ 6.7 pm
§ Mr. Oliver Letwin (West Dorset)
With your eagle eye, Mr. Deputy Speaker, you will have noticed that I have been translated not merely from the Front to the Back Bench—I hope temporarily, for the purposes of this debate—but to the very Back Bench, as I would not want my remarks to constrain or embarrass my right hon. and hon. Friends on the Opposition Front Bench in any way.
I must begin by admitting that I am becoming something of a "Dobsonist", or perhaps, a "Dobsonite". I am startled by the magisterial way in which the Secretary of State is gradually building the case for the privatisation of the national health service—a case that he and his colleagues spent their time in opposition explaining that they regarded as an abomination.
When I was new to the House, my first parliamentary question was to the Secretary of State. I wanted to know whether he recognised that, in the first measure proposed by the Government for the NHS, he was paving the way for the privatisation of clinical services. The right hon. Gentleman, with his usual charm, grinned slightly and evaded the question wholly, since when it has become evident in the popular press and elsewhere that that was indeed the tenor of the measure concerned.
The Bill was presented as entirely uninteresting by the Secretary of State, who went out of his way to diminish the interest and importance of his own measure. I have not been long in the House, but I cannot recall an occasion on which a Secretary of State made so brief and so 186 low-toned a speech on Second Reading—a speech so calculated to induce silence, and possibly sleep, on the Benches behind and opposite him. He intended to put us to sleep so that we should be pleasantly anaesthetised, to use a health service metaphor, and should not notice that there was anything remotely interesting in this legislation.
§ Mr. Letwin
As I said at the beginning of my speech, I am increasingly an admirer of the Secretary of State and I certainly do not want my remarks to be taken as an accusation against his acumen. I hope that by the end of my speech, the hon. Lady may be persuaded that, although the Bill is simple in the sense that it is short, it does not by any means involve simple principles. In fact, it probably involves the most subtle principle to be connected with the NHS and it constitutes one of the more important measures to come before the House this Session, as will probably come to light gradually in the next five, 10 or 20 years.
I shall explain. The fundamental question about health payment—not the administration of the NHS or the way in which people are cured—which has been a vexed political issue for almost half a century, is not whether there should be charges at the point of use. No major political party has advocated that since the war and, in large part, no party has advocated it since the 1920s. Everyone has aimed at a health service that is free at the point of use. The great debate—sometimes open and sometimes covert, sometimes pursued intelligently and sometimes with partisan zeal and much less intelligence—has concerned whether the health service should be insurance or tax based. Members on both sides of the House will recognise that that has been the serious issue that people have pondered, debated and failed to resolve.
The measure before the House is extremely interesting. It appears to extend the tax base for payment for NHS services. It has that appearance because it so happens that under the laws governing motoring, insurance for motorists is compulsory, so Labour Members have been able to argue that this is a special case—the Secretary of State did not bother to do so, so keen was he to avoid the issue altogether—and have salved their consciences, so to speak. The hon. Member for Crawley (Laura Moffatt) salved her conscience by explaining that this was a special case, quite unlike all the other cases that she did not want to see flow from it, because motoring insurance is compulsory.
§ Laura Moffatt
The hon. Gentleman says that we are salving our consciences by saying that because compulsory insurance is involved, the Bill is easy to justify. Can he cite any other compulsory personal insurances in the United Kingdom that might relate to the Bill?
§ Mr. Letwin
No, but I fear that I will alarm the hon. Lady a little by explaining that the distinction that she has erected will be subject to an onslaught from the Secretary of State.
§ Mr. Duncan
I suggest that my hon. Friend start his list with employer liability and local authority liability.
§ Mr. Letwin
With his customary acuity, my hon. Friend is right. There are other such cases, but my argument goes well beyond the cases where there is already compulsion.
187 The hon. Member for Crawley argues that this is a special case. My hon. Friend the Member for Rutland and Melton (Mr. Duncan) pointed out that it is not so special, but there is a restricted set of cases that involve compulsory insurance. Labour Members have effectively argued that compulsory insurance schemes through which the NHS seeks to recover its costs from insurers are de facto taxes. This is another sort of tax, but one that happens not to pass into the Consolidated Fund but directly to the NHS, if that is indeed the case; I plead ignorance on the point. I find it a little odd in terms of Treasury theology that it should be so designated but perhaps it is. If so, it is all the more interesting because that would suggest that it is not quite a tax. If it were seen by the Treasury as a tax, it would enter the Consolidated Fund. The Treasury therefore regards it as a charge, but the hon. Member for Crawley and others would argue that it is a de facto tax because it is raised from an insurance company in a case where the insurance is compulsory.
The problem with that line of argument from the Government's point of view is striking because we must ask why compulsory insurance is applied only in a very select group of cases, in particular, motoring and the two others that my hon. Friend the Member for Rutland and Melton mentioned. Why is compulsory insurance so restricted in its application? The answer is that it happens by historical accident to be rather restricted. Now enters upon the scene the majestic figure of the Secretary of State, with his logic and his needs.
The Secretary of State intends to pile large sums that the Chancellor of the Exchequer does not have, and will have less of in due course, into the NHS. He argues—and has introduced a Bill to this effect—that it is legitimate for the NHS to charge the insurers of people who suffer from accidents the cost of caring for them because the insurance involved is compulsory. It is at that point that he will ask the Home Secretary to do something that is perfectly rational under that rubric or logic—to expand the scope of compulsory insurance.
It is rational to propose that anyone engaging in an activity with a high chance of leading to medical care costs should by compulsion be insured. It is rational because it covers a social inequity. If they are honest, Labour Members will admit that as much as would Conservative Members. It is equitable to suggest that people who decide to do something dangerous should not impose additional costs on the rest of the community. It follows that if the Secretary of State believes that the right way for the NHS to recapture the costs from the right people is to make insurance compulsory, the Government will argue for making such insurance compulsory for a wide range of activities.
The more I think about the matter, the less I can see the slightest objection on the part of the Government to the widening of compulsory insurance. Some Conservative Members would object to a vast widening of compulsory insurance on libertarian grounds. It may well be that my hon. Friend the Member for Rutland and Melton would, because he is one of the most noted of the libertarian tendency of Conservative Members—perhaps its most distinguished exponent in print. Among Labour Members, I see no libertarians. I have heard no such logic or rhetoric from them so far, and do not expect to hear 188 any before the Government's period in office ends, to suggest any objection to a vast application of compulsory insurance across a wide range of activities.
Such a course would be consonant with Ministers' desperate efforts to prevent people from killing themselves by smoking. The Government specialise in trying to deal with what they regard as the problem of individuals taking risks that they should not take. Why else spend large amounts of public money trying to persuade people not to smoke? Why else does the Minister for Public Health spend her time circulating the heads of the royal colleges and desperately assuring them that the single most important thing in the health service is preventing people from smoking? Why would it not be a natural extension from that to get the Secretary of State to agree to something that would be introduced as an unimportant, obvious little Bill to which we need not pay much attention, and would create a compulsory insurance scheme for smokers? Labour Members could argue that, de facto, it was a tax if the NHS could recover the cost of cancer treatment from a compulsory insurance scheme for people who smoke. I believe that treating cancer is one of the major costs of the NHS, although I am not an expert. That logic could be extended across a vast range of activities.
§ Mr. Letwin
The hon. Gentleman asks where the evidence is. We have an interesting dialectic here, similar to that which we find in relation to the European Union. First, we get an unimportant little measure about which we are told not to worry. Secondly, there is an accusation that it may lead to greater things. Third comes the riposte, "Where is the evidence?" Then, it comes true and we are told, "Goodness me, you must have noticed that at the beginning." I fear that what I am describing is a logic, and logic is powerful. Even in this Government, it captures people.
§ Ms Drown
I might accept that this could be the start of a huge, fantastical operation by the Government if the Bill proposed new charges, but it does not. The charges have been in place since 1930. Given that and the fact the hon. Gentleman's Government in 1988 discussed the matter and reinforced the charges, he is on very weak ground.
Mr. Deputy Speaker
Order. This is not an abstract debate but one on the Second Reading of the Road Traffic (NHS Charges) Bill. It would be helpful to hear a little more about that. The hon. Gentleman has travelled rather far from the core of the subject.
§ Mr. Letwin
I stand corrected and shall swiftly bring my remarks back to the Bill, but the hon. Member for South Swindon (Ms Drown) illustrates the brilliance, power and subtlety of the Secretary of State's mind beautifully. He has chosen a case in which he can argue that he is not even doing what he is doing. By vastly increasing the take in circumstances where he can find an ancient peg, he can argue that the Bill is not a Bill at all but merely a tidying-up. There were moments in his 189 speech when I doubted that he was introducing a Bill because he seemed to be talking about an administrative measure that would not have required parliamentary approval.
The Secretary of State is, of course, making a major change. He is introducing legislation; he is occupying the time of the House to go through First Reading, Second Reading and so forth precisely because he is trying to raise a large amount of money. He is doing something that will have an impact in precedent. We may hardly believe it any more, but legislation passed by the House is important in the development of the way in which people think about the subject of the legislation. If legislation is introduced about the NHS that has the effect of raising a large extra sum from insurance, the logic that I describe becomes all too easy to apply.
To move back to the remarks that I was making before I gave way—but very much in the context of the Bill, Mr. Deputy Speaker—I want to argue that the extension of compulsory insurance under the Bill is a major conceptual change in the allocation of NHS payment and funding. Ultimately, every activity carries risk. The mere act of breathing is risky. Compulsory insurance could easily be widened to the point at which it covers all the costs of the NHS. The Secretary of State knows that; his officials know that; his Ministers know that. If and when the Secretary of State begins to build what I suspect he privately intends to build on the basis of this measure, Labour Members will be surprised to find that this little, apparently unimportant Bill was a paving Bill in the most exceptional sense—a conceptual paving Bill.
The Bill is reminiscent of much else that the Government are doing. In many cases, they are slowly beginning to persuade members of their own party to accept vast changes to positions held only by the Conservative party before now by persuading them to accept things that are apparently innocuous. I fear that Labour Members have illustrated beautifully this afternoon exactly the tendency that the Secretary of State hoped that they would illustrate, namely, the tendency not even to notice that there lies within the Bill the seeds of something that they at present do not wish to see grow into a tree.
§ Mr. Gareth R. Thomas
I have been struggling to follow the logic of the hon. Gentleman's argument. He now says that the Bill is some sort of paving device for new charges. Although he was not a Member of Parliament at the time, I am sure that he supported the Road Traffic Act 1988. Why was that not the paving Bill for wider charges?
§ Mr. Letwin
I cannot he said to have supported the 1988 Bill because I had no idea that it existed. Had I been a Member of Parliament, I might or might not have supported it. The reason why it is perfectly appropriate that my right hon. and hon. Friends should have tabled a reasoned amendment this afternoon is not that the Bill is in principle objectionable, but that the explanation that has been given of it and the logic that has been advanced as lying behind it are wholly beside the point. The truth has not been brought out. It is the role of the Opposition to oppose that which they need to oppose and to bring out the real character of measures.
I believe that the real purpose of the debate this afternoon is precisely to illustrate to the public that the Bill has far wider implications than has been admitted to 190 them and that the Bill has been defended on a basis that is not open or honest with them. It falls to the Government to admit what lies behind the Bill. Then perhaps in later stages, Labour Members may have their own doubts about the wisdom of this measure, even if Opposition Members have, as my right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe) said, some sympathy with the principle.
§ Ms Julia Drown (South Swindon)
In following the hon. Member for West Dorset (Mr. Letwin), it might be helpful if I bring the House back to reality. Although his speech was interesting, and perhaps it used up some useful time of the House, it has not been useful in making progress on the Bill.
I am disappointed that the Opposition do not support the Bill, but perhaps it serves as a useful example of the difference in priorities between the political parties. While the Labour Government believe that the NHS should get the funds to which it is entitled, the Conservative party seems more concerned about letting insurance companies off the charges that they have been set up to cover. Other Opposition Members seem more concerned to discuss the philosophical purities of differing charging regimes.
The hon. Member for Southwark, North and Bermondsey (Mr. Hughes), who is not in his place, suggested that £100 million was not a lot out of the £40 billion that the NHS needs every year. I suggest that £100 million can make an awful lot of difference to the NHS. If the hon. Gentleman does not want that money for his constituency, I can guarantee him that my constituents could well use the money for their health services.
§ Dr. Evan Harris (Oxford, West and Abingdon)
The hon. Lady must accept either that a significant amount would be saved which could replace money raised from income tax for the NHS or that too little would be raised to re-establish the principle—I take the point that the Bill re-establishes something that has already been legislated for—that patients should pay towards their care. In our reasoned amendment, however, the Liberal Democrats propose as a fairer way of funding the NHS in general than through patient charges.
§ Ms Drown
I do not accept that. I see the charges as money to which the NHS is entitled and has been entitled since 1930, when the legislation was first introduced. The NHS has not been collecting all that money, but the Government are setting up the proper administrative arrangements to ensure that the money goes to where it is needed in the NHS.
I am pleased to be able to speak on the Bill because I am one of the few people in the House who has personal experience of managing the existing system under which the NHS can reclaim from insurance companies some of the costs of treating people who have been injured in road traffic accidents. My brief experience was instructive and I remember it well. Two things stand out in my memory and both of them lead me to welcome the Bill.
First, I remember how inappropriate it seemed to visit the accident and emergency department as an administrator, trying to establish which of our patients were there as a result of a road traffic accident and which had been injured in other ways in order to set up the appropriate paperwork 191 for road traffic accident victims. The other hospital staff were rightly concentrating on giving their patients the best clinical care that they could; neither patients nor staff wanted to be disturbed at that time by what they saw, reasonably in my view, as intrusive bureaucracy. The existing system for reclaiming the treatment costs of road accident victims makes such intrusion inevitable by putting the onus on the hospital to establish not only which of their patients have been injured in road accidents but a series of details about the accident.
The principle that the NHS should be able to reclaim some of the costs of providing medical treatment to people injured in road accidents is well established. The Road Traffic Act 1930 introduced the charges, which have been levied since 1934. Motorists are covered by their insurance for those costs yet those charges are little understood by motorists or even Members of Parliament. Motorists are compulsorily insured, and that creates a distinction between the charges set up in 1930 and other possible charges that have been mentioned by right hon. and hon. Members.
Of the charges covered by the Bill, the emergency treatment fee—currently £21.30—is the most unpopular as it is payable by the vehicle user in an accident regardless of who is at fault. The Government intend to abolish that charge for hospitals, and I congratulate them on that. Its abolition will be welcomed by the NHS, motorists and insurance companies alike. It makes sense for everyone involved to concentrate on the payments for out-patient and in-patient treatment.
Over the past 50 years, NHS administrative staff have been trying to collect those funds—often in difficult circumstances. Staff collecting those sums have had to deal extremely sensitively with patients. It is only right that the House congratulates them and the administrative and other staff who have managed a difficult administrative system in a professional and sensitive manner. The Government's proposals would shift the onus of collecting payments from NHS hospitals to insurance companies. In doing so, those difficult situations can be avoided and more money spent on what is important—NHS care.
My second abiding memory of running the existing system is of how complicated and bureaucratic it is. I remember the forms, the checks and the chasing letters—they were almost charming in their detail. I also remember the filing cabinets and the frustration of chasing bills, in some cases for relatively small sums. The only thing missing from the overall Dickensian impression was a quill pen. I applaud the Government's determination to find a way to reclaim some of the cost of treating road accident victims that cuts the mass of paperwork in hospitals.
The difficulty of operating the current system has led many hospitals to reclaim less of the cost of treating such victims than they were entitled to under existing legislation. That inevitably means that there is less NHS money available to treat patients. The sensible way forward, of abolishing the emergency treatment fee for hospitals and properly recovering the money due for patient treatment, will let the NHS see the wood for the trees, and contrasts starkly with the actions of the previous Government, who merely introduced measures to increase 192 the piles of paper in the NHS. I welcome the Labour Government's steps to make additional money available to the NHS and to reduce paperwork.
I have three questions about the implementation of the proposed schemes which I hope will be considered during the Bill's passage. First, there is the question of transitional arrangements. On 2 July last year, my right hon. Friend the Chancellor of the Exchequer announced that steps would be taken to recover the money due to hospitals in respect of the treatment of people injured in road accidents. I understand that the new system will cover treatment given to road accident victims from that date, but if the Bill is passed, it will still be some time before guidance can be issued to hospitals and insurance companies setting out the precise details of the new system. If the Bill becomes law, I hope that the Government will make careful arrangements for cases arising between 2 July 1997 and the time when the new guidelines are issued. There will be scope for confusion and double counting in respect of such cases, so care will be needed to ensure that confusion is minimised. Some hospitals will have already billed for road accident treatment since 2 July 1997, whereas others will not. Clear guidelines are needed on who is to claim what money, from whom and when it should be claimed.
My second question relates to the nature of the records that hospitals will be expected to keep under the new system. Although I welcome the Government's aim of cutting down NHS bureaucracy by requiring insurance companies to initiate and follow through payments to hospitals, it is important that steps be taken to ensure that the new system succeeds in reducing bureaucracy. I presume that insurance companies will not simply be left to get on with the job of administering the system without checks. There will have to be incentives to ensure that the companies comply with their new duties and make all the payments they should. However, if the operation of the new system requires hospitals to keep detailed records of which of their patients have been injured in road accidents and the exact cost of their treatment, there is a risk that the new system will simply replicate the troublesome and time-consuming bureaucracy of the existing system.
§ Laura Moffatt
Does my hon. Friend agree that, in addition to all the difficulties with collection that she describes, there is a seven-day limit on the time in which a claim can be made, which adds to the bureaucratic nightmare suffered by administrators?
§ Ms Drown
The system can certainly be described as a nightmare, because of the forms and bureaucracy resulting from existing legislation. That is why I urge the Government to pay close attention to ensuring that any new system results in the NHS receiving the money to which it is entitled and in a genuine reduction in paperwork and hospital administration.
My third point relates to the fact that the Government have rightly stressed the importance of encouraging innovation in the NHS and of making the best use of hospital beds. Care in the home has been emphasised as an alternative to hospital treatment—an alternative that many patients prefer. The Bill allows the NHS to recover from insurance companies the cost of hospital treatment given to people injured in road traffic accidents. In 1930, when the Road Traffic Act was introduced, I suspect that no thought 193 was given to alternatives to treating people in hospital and that the emphasis on acute hospital care rather than community care was even stronger than it is now.
Given that motorists are insured for the cost of NHS treatment resulting from road accidents, should not the Bill reflect the modern reality of the NHS and allow the cost of treating road accident injuries to be charged whether treatment takes place at hospital or in the home? If that provision is not made, an incentive will remain for the NHS to treat road traffic accident patients in hospital or at out-patient clinics, instead of allowing them to be treated at home. It is illogical to say that the cost of treatment should be recoverable when that treatment is given in hospital, but not when it is given in the patient's home, for example, by a physiotherapist or district nurse. I urge the Government to examine the possibility of amending the Bill to enable the recovery of the cost of treatment given either in hospital or at home. That would be wholly appropriate given the shifts in the culture surrounding hospital and non-hospital care.
I congratulate the Government on their sensible proposal, which will be welcomed by hospital staff, both clinical and administrative. I hope that the points I have made will be addressed during the Bill's passage.
§ Dr. Evan Harris (Oxford, West and Abingdon)
Although Liberal Democrat Members found the principle of the Bill quite attractive and were tempted to support it on Second Reading, and various minor parts of it in Committee and at later stages, we have set out our objections to the principles behind the Bill in a reasoned amendment.
We welcome certain of the Bill's provisions, such as the abolition of the emergency treatment charge, which was, and is perceived as being bureaucratic and upsetting to many patients. However, we have serious concerns about some of the principles that the Bill reflects or that it re-establishes from existing legislation, which overcome the advantages contained in those welcome provisions.
Our amendment states our concern that the Billmakes provision for requiring those who successfully claim compensation for personal injury sustained in road traffic accidents, but not by any other means",with the result that the measure appears to operate in a vacuum. We should be grateful if the Government gave a clear statement of the principles behind the way in which they want to treat co-payment and patient charges. Secondly, the Billproposes no coherent policy for raising or reforming NHS charges or for making them fair".We still await detailed clarification of whether the Government believe that current prescription charges, as an example of co-payment, are fair in their operation; whether there are any proposals to make them fairer; and what is the future of those sort of co-payments.
Our third objection is that the Billmoves public policy and practice further away from the principle of paying for the NHS from general taxation".That point has been made by hon. Members on both sides of the House, in particular by the hon. Member for 194 Wakefield (Mr. Hinchliffe). Later in my speech, I shall return to the points he made. Our fourth concern is that the Billcontains no mechanism for protecting those on low incomes against increased insurance costs"—small though those compulsory insurance costs may be. Finally, we are concerned about the fact that the Billadds to bureaucracy without any sufficient compensatory benefit.Such compensatory benefit would include clarification of some of the areas I have mentioned.
Our approach must be contrasted with that of the Conservatives. We can see from their reasoned amendment that much of their opposition to the Bill—apart from the Oppositionitis from which they are suffering—relates to their love of the motor car. The Opposition's reference to the motorist in their reasoned amendment might suggest that their love of the motor car is at least as great as, if not greater than, their love of the principles upon which the NHS was founded. I shall take this opportunity to explain our concerns about how the legislation may affect NHS founding principles.
We accept that, although the Bill does not introduce a new principle, it re-establishes an existing one. The Government had the opportunity in this Bill to abolish both the charges that apply to road traffic accident patients, but chose to abolish only one. Therefore, it is impossible for the Government to ignore the fact that they are re-establishing a principle that they had the opportunity to remove.
That principle which they have chosen to retain is that income for the NHS can be raised from patients. My hon. Friend the Member for Southwark, North and Bermondsey (Mr. Hughes) expressed concern about that matter earlier. The Secretary of State admitted that there will be an increase in the cost of motor insurance. Estimates of that increase range from £10—the figure suggested by the Opposition—to a lesser figure favoured by the Government. I am sure that if their own estimates were revised upwards the Government would opt for talking of an increase of £9.99, rather than £10, in the interests of good public relations.
That insurance increment is regressive as it will be compulsory and will generally have no regard for the income of the person seeking to take out car insurance. Everyone will be affected equally. That is not the case with the current main source of revenue for the NHS: income taxation. We believe that the principle of fairness should be upheld in all NHS policy. That is why we are concerned about the perpetual increases in prescription charges and why we went to the election calling for a freeze in those charges prior to a review. The current system has a regressive effect at the margins for those who just fail to qualify for exemption from prescription charges.
We are also concerned about where the process will end. Some hon. Members have tried to make reassuring comments, but we are not convinced. If the charge is restricted to compulsory insurance, it will not apply to injuries incurred during sporting activities where there is no compulsory insurance. My hon. Friend the Member for Southwark, North and Bermondsey asked whether the Government will soon introduce legislation to recover charges arising from employer liability—which is compulsory in many areas—as a result of industrial accidents; or from local authority liability that currently applies to injuries incurred through the negligence of local authorities.
195 A further example comes hard on the heels of the interesting and thought-provoking speech by the hon. Member for South Swindon (Ms Drown). If the key issue is that insurance is compulsory, what will happen to those with compulsory buildings or insurance for mortgages? What will prevent the Government from introducing legislation to charge the victims of house fires, through their buildings insurance, for the cost of expensive burns treatment? The Liberal Democrats will not be satisfied until the Government confirm that the measure will stop at this point and not affect other forms of compulsory insurance—whether that be mortgage insurance or car insurance.
§ Dr. Harris
I addressed that point earlier in my speech. No one is suggesting that this is a new charge. This legislation presented an opportunity for the Government not only to re-establish those parts of the charges that they are maintaining but to take the alternative view and move away from charging patients directly. That opportunity has been missed.
§ Mr. Hutton
Will the hon. Gentleman confirm when his party discovered its opposition to this proposal? As I understand it, the Liberal Democrats have supported these measures previously.
§ Dr. Harris
My party, like the Labour party, has serious long-standing concerns about those charges. Unlike the Labour party, we demonstrated our concern in our manifesto commitment to freeze prescription charges. The Labour party did not presage in its manifesto the introduction of this legislation which will increase the average cost of car insurance. According to the Association of Community Health Councils for England and Wales and other groups, there was little consultation with patient groups about the Bill. The Government will be on shaky ground if they look to their past record both in and outside this place—particularly regarding indications of intent in party manifestos. I am grateful to the Minister for giving me the opportunity to make that point.
Anyone who is concerned about the regressive nature of the proposals, which re-establish the charges, could maintain that there are better cases than car insurance for making claims on insurance companies and making insurance compulsory. For instance, what about injuries incurred in certain sports to which the less well-off do not have easy access? I refer not to the rugby games enjoyed by the children of the hon. Member for Crawley (Laura Moffatt) but to skiing, for example—which I have had neither the funds nor the courage to try for myself. I do not believe that skiing could be described as a sport that is generally enjoyed across the social classes, yet there are significant costs involved with the treatment of skiing injuries. If one were to argue that the present charge is reasonably fair, one could envisage the 196 Government's introducing other legislation where my arguments about the regressive nature of the charges apply less.
§ Mr. Hutton
I am grateful to the hon. Gentleman for giving way again; I appreciate his courtesy. I am sure that he understands that the legislation has nothing to do with self-insurance: it is do with third party compulsory insurance.
§ Dr. Harris
That is a reassuring comment. I hope that the Minister will confirm that the Government will not move any further towards those sorts of schemes. However, the principle will be breached if the Government seek to raise additional funds for the health service—they make no bones about it; that is what they are doing—by increasing motor insurance when that money could be raised more fairly, transparently and less regressively through general taxation.
There has been debate, some of which I have not followed—particularly the contribution by the hon. Member for West Dorset (Mr. Letwin)—about the nature of compulsory insurance. It has been claimed that because it is compulsory insurance, the charge is okay. That implies that people with optional insurance should not be asked to fund the health service. One can understand the moral pressure that could be brought to bear on people who were asked to contribute voluntarily to the NHS. That could cause philosophical and political problems for the Government.
However, I feel strongly about the way in which the Government have attached national lottery funds to improvements in cancer treatment. One could argue that that is not funding NHS core services—although the Government would have difficulty claiming that improved cancer care is not core to the NHS. The policy is a move away from the position adopted by my party and the Labour party in opposition that lottery funding should not be used to support NHS core services. Cancer is a particularly evocative subject for patients. Because the Government have chosen to fund cancer treatment through that indirect charge—it is the type to which we refer in our reasoned amendment—patients feel that they are somehow doing the NHS the world of good by spending money, which in many cases they do not have, on that form of gambling. Commentators have said that funding the NHS through the national lottery is another example of the rich finding ways to make the poor pay more for the services that everyone uses.
§ Dr. Harris
I understand the hon. Lady's point and I shall listen carefully for a ruling from you, Mr. Deputy Speaker, rather than from the hon. Lady, if my remarks are not in order. My point is that the principle of co-payment of charges can extend much further than this matter and our objection on Second Reading is based on the fact that if we concede the point and support the Bill, as Government Back Benchers will, we do not know where that extension will end. I know that the Minister has been listening carefully to my remarks, and I seek 197 clarification on that point. In Committee, I shall take a constructive approach on my specific concerns, which I shall address later.
§ Mr. Gareth R. Thomas
Should not the hon. Gentleman view the Bill in the same way as the Government's attempt to tackle prescription fraud? The Bill aims to make an existing system work more effectively and fairly and no great new principles are being advocated, as he is suggesting.
§ Dr. Harris
Liberal Democrat Members are prepared to accept that the Bill will achieve greater efficiency and, by abolishing the emergency treatment charge, more fairness in the existing system. However, the point that I have already made twice—once in response to one of the hon. Gentleman's colleagues—is that by introducing the Bill the Government are re-establishing a principle that can be challenged. They could use this legislative opportunity to say that they will not fund the NHS through flat-rate increases on compulsory insurance. We have a genuine disagreement with the terms of the Bill, and it is valid to oppose it on Second Reading because of the missed opportunity to revoke that principle.
Car parking charges have also been mentioned. One can accept, as I have at my local hospital, the use of car parking charges to encourage people to use public transport and to avoid providing a free parking facility on hospital grounds for people who may have no business to park there. That is a legitimate way to level the playing field and ensure that there is no financial incentive for people to use their cars, particularly in congested areas. That is why the Liberal Democrats support a tax on employers' car parking perks, including those that apply to hon. Members.
When hospital authorities justify high charges by saying that any money raised will go to patient care, they breach the principle that patient care should be funded according to means. I see that the hon. Member for Wakefield is back in his place. He will not have heard me say that I agreed with much of what he said about the principle of sticking to general taxation for raising the bulk of NHS funding. When patient care directly benefits from people paying high car parking charges over and above those needed to control transport congestion, users of the service are being made to pay more than the average taxpayer, which I oppose. After all, on that basis one could argue that there should be a hike in canteen charges over and above what is necessary to break even so that hospitals can make a profit.
Those arguments are of relevance if this legislative opportunity to re-establish a principle is then used to open the floodgates.
It is seen to be an advantage of the Bill that the money to pay for patient care will go directly to hospitals and that the charges have been worked out on a notional basis, such that if all the money was reclaimed it would pay the hospital costs of all road traffic accidents. However, it is worrying that through direct hypothecation, an entire area of the NHS will effectively be paid for by indirect patient charges. Although that may not be the Government's intention, it sets a precedent for future Governments or, perhaps, for this Government in another Session. The costs of road traffic accidents will be paid entirely by co-payment by insurance companies, albeit directly 198 to hospitals. That is a grave concern, however much the Government assure us that the principle will not be extended.
We must consider the principle mentioned by the hon. Member for South Swindon—I am glad that she made the point for me—who said that it seems illogical to stop at hospital costs. I might support her in Committee if she tables an amendment, because without one, there will be a perverse incentive for hospitals not to discharge patients for community nursing because they will be able to retain the £435 a day that they are able to charge for in-patients.
Another incentive is created by the flat-rate out-patient charge. It may be that it already exists but because hospitals do not collect the charge, it is not at the forefront of administrators' minds. It would be much more cost effective for hospitals to see people once in out-patients, rather than recurrently, because no matter how often people are seen in out-patients, the revenue to the hospital is the same. I question whether purchasers will take note of the Secretary of State's words that the charges are deemed to pay for the entire cost of road traffic accidents and will not be willing to fund such accidents as a part of their contracts with hospitals.
For all those reasons, Liberal Democrat Members cannot support the Second Reading of the Bill. We will work constructively in Committee to improve the Bill, but we seek reassurances from Ministers on the points of principle that I have raised.
§ Mr. Andrew Dismore (Hendon)
I first took an interest in this subject in the late 1980s, during my work as a solicitor specialising in personal injury litigation. In 20 years of practice as a PI lawyer, I have found it increasingly unfair that, under private health insurance policies, I could be forced by the likes of BUPA to claim back their expenditure on the private treatment of accident victims who were their members, while the NHS could not effectively make similar claims. As a passionate believer in the NHS, I found it particularly galling to send cheques for thousands of pounds to private health insurers, but not to the NHS.
I first flagged up that problem in a pamphlet that I wrote for the Association of Personal Injury Lawyers in 1990. I should say that I have a non-pecuniary interest as a member of APIL's executive committee. I again raised the issue in 1996, in a book published by the Society of Labour Lawyers entitled "Law Reform for All", when I wrote:Private medical insurers such as BUPA are entitled to recover their outlays, and the NHS should not be put in a more disadvantageous position than a medical insurer.Of course, as hon. Members have said, there is nothing new in what the Bill proposes. Recovery of medical expenses was first introduced in Herbert Morrison's Road Traffic Act 1930, which also introduced compulsory insurance for motor vehicles.
Equally, there is nothing new about the tort principles of common law, which have provided restitutory rights going back centuries. In its response to the Law Commission in April 1997, APIL said:We believe that not to provide a right of recoupment would grant the tortfeasor an unjust benefit, paid by the taxpayer, in that the taxpayer is righting the wrong committed by the tortfeasor through the payment for the treatment of the victim.199 What is new is that people have been waking up to the unfairness of the system for the NHS, and, more importantly, its patients. In Personal Injury magazine in 1996, the general editor, Frederick Holding, said:the medical and legal communities should wake up to the fact that the insurance industry is having a parasitic effect on the taxpayer, the welfare state and NHS emergency services in particular. It is little wonder that the NHS is in crisis when victims of serious accidents, who have the legal right to have their treatment paid for by the insurers of the tortfeasor, are still draining the resources of an NHS system".That, of course, was the position under the previous Government, and there have been great improvements in the health service since then, but the basic principle still applies.
I was pleased that the Law Commission took an interest in the subject in its full and well-argued consultation paper No. 144, which was published in December 1996 and in which it flagged up the issues involved. My only regret at the time was the Tory Government's complete failure to take on board the possibilities raised by the Law Commission. I am extremely pleased that my right hon. Friends the Secretary of State and the Chancellor have reacted so quickly by introducing this Bill.
This is not a tax on accidents, as the Tories have claimed. The Bill allows the NHS to get back what it is rightly owed. A great deal of debate has focused on motorists, but half the road accident victims are pedestrians, cyclists and passengers, and are not responsible for insurance; they just need to be treated.
The hon. Member for Poole (Mr. Syms) mentioned uninsured drivers. There is a general problem in people failing to take out insurance, and the amount involved in this Bill is a fleabite compared to the total bill of the Motor Insurers Bureau. One way forward could be through the introduction of insurance discs for motor vehicles in a similar way to tax discs, so that we can catch those without insurance.
Despite the provisions of the Road Traffic Act 1930 and the various amendments now consolidated in the Road Traffic Act 1988, the insurance industry has been getting away with ripping off the NHS for years. Of course, the NHS did not pursue its rights effectively, and has let the insurance industry off the hook. However, the fact remains that insurers have not been paying out what they should. They have made windfall profits at the expense of NHS patients for decades.
We are told that premiums may have to go up. The best estimate so far is that they may go up by £6 to £9. I believe that the competitive market for insurers could well absorb that expenditure. That figure overlooks a number of key advantages introduced by this scheme. First, there are advantages for road safety. Car insurance is worked out according to risk, and bad drivers pay more. If part of the impact of the scheme is that bad drivers have to pay more for their insurance, they may improve their driving standards. One third of a million people are injured on our roads each year, and we need to look at the advantages for road safety.
A further advantage is the care of the victims. In the personal injury world, there is a new and growing concern for the victim's wider interests, going beyond compensation alone. Increasingly, we are seeing moves to 200 look much more at issues such as the need for rehabilitation care, intensive physiotherapy and so on, so that we can do all that can be done to improve a victim's recovery. Regrettably, such services are somewhat patchily available in the NHS, and some places are better than others.
There are discussions in principle and on individual cases between those who represent victims and the insurers, trying to persuade the insurers that it is in their interests as well as those of the victims to fund such care packages. In the long run, it is cheaper to compensate a fully or better recovered victim than someone with on-going disabilities. If the on-going cost of NHS treatment is to be met by insurers, it will be a real incentive for them to look to the better and quicker recovery of the injured person
In APIL' s submission to the Law Commission, we said:We believe that recoupment will encourage insurers to adopt a broader approach to the plaintiff's condition beyond mere damages. Insurers will be encouraged to organise private care regimes at an earlier stage, where the extent and cost of the care regime can be negotiated and agreed between the parties, to their mutual benefit.That could also relieve some pressure on NHS services.
The measure will also generate additional funds for the NHS, as the money recovered will be ploughed back into the hospitals concerned, allowing more patients to be treated more quickly.
According to the reply that I received to a parliamentary question last year, currently only £13 million comes back to the NHS. The Wellhouse Trust, which is the acute service provider in my area, clawed back only £45,000 in 1996–97, despite treating almost 89,000 patients in the accident and emergency department, let alone any follow-up in-patient care or elective surgery that might have been needed. That works out at just 50p per casualty. Of course not all those patients were road accident victims, but that shows the scale of the problem.
In 1990, the total cost to the NHS of all accidents was estimated at £1 billion. According to a 1984 study, road accidents account for 18.5 per cent. of all accidents, and result in 34 per cent. of victims bringing claims. Allowing for a proportion of those not succeeding, the estimate of about £50 million or £60 million seems fairly accurate—four times what is currently being recovered, but significantly less than some of the scare stories being put around by some in the insurance industry. I wish that it was higher, but we have to be realistic.
I hope that we will look at a substantial capping of the ceiling. A total of £10,000 is all well and good, but I recall in the past having to send cheques to BUPA for tens of thousands of pounds in response to its incredibly itemised bills. The NHS should be on the same level playing field. I believe that a tariff-based approach is correct, but as we get into better benchmarking of NHS treatment costs, I hope that we can produce a more sophisticated tariff based on the benchmark costs of various procedures. That would result in rewarding efficient hospitals, and encouraging the less efficient to improve towards the average.
I do not believe that the Bill deals well with the length of the recoupment period. The Department of Social Security has a sensible rule, limiting recovery to the date of settlement or five years from the accident. That provides an added incentive to insurers to deal with claims promptly, which I am sure we all wish to see.
201 I believe that the Government are correct to put the administration of the scheme into the hands of the compensation recovery unit. When that was first set up by the Tories in 1989 for DSS recoupment, it was a real disaster. It worked unfairly against the interests of victims, and led to many calls for its reform, not least from the Association of Personal Injury Lawyers, the Trades Union Congress, the Law Society and others, and ultimately the Select Committee on Social Security.
Having done some work on this, I found myself in the rather peculiar position of advising the then Tory Government, Labour Front Benchers and Liberal Democrat Front Benchers at the same time on reforms to the legislation. That emerged as the Social Security (Recovery of Benefits) Act 1997, which dealt with many of the problems we were experiencing. The CRU is now a major success story.
The hon. Member for Uxbridge (Mr. Randall) mentioned the cost of the CRU. I took that up at the time, and was told that the unit cost of a recoupment claim for the DSS was less than £10. The system that we are introducing with this Bill will be cheaper, because it is simpler. In response to the question raised by the hon. Member for West Dorset (Mr. Letwin), the CRU recovers £180 million a year, one third of which is from road accidents. It has done so efficiently, and by respecting the necessary confidences of all parties involved.
My right hon. Friend the Secretary of State is right to ensure that victims are excluded from the operation of the scheme. That problem was always one of the failings of the DSS scheme, and it remains a problem, although it is dealt with in a much better way now. By keeping the victims out, we reinforce the message that there is no question of the victim having to pay for medical treatment. That must remain free at the point of delivery.
However, in that way, we can also enlist the help of victims in recovering what is due to the NHS. If victims are given copies of the certificates, they can say whether they are accurate or whether there is an under-estimate. Victims are much more likely to co-operate with the Department's CRU than with some of the private companies that have sprung up. I am sure that the Government have had many approaches from such companies saying that they could do a better job. Compared to the present system, that is undoubtedly so, but we should resist their blandishments, because the CRU will knock spots off them when the new scheme is set up.
The confidentiality of the CRU will help to reduce the growing abuse of claims assessors, putting pressure on victims to bring claims via their dubious services. That often results in victims recovering less compensation overall at a higher price to them through the contingency fee arrangement. Many of the companies involved in road traffic accident recoupment so far on behalf of trusts have a "claims assessor" arm. I believe that there is some evidence that they have abused the information given them by the trusts to drum up trade, putting pressure on victims. Victims must be properly informed of their rights, but they must not be pressured into bringing claims that they would not otherwise bring.
If I have one concern about the Bill, it is that perhaps it does not go far enough. I hope that, when the Law Commission report is published, it will be carefully considered by the Government. I believe that that report 202 is promised for February 1999. It is proper for us to await the outcome of that report before looking further at these proposals, but there are some extensions that we should look at.
First, there is the NHS drugs bill. For donkey's years, accident victims have recovered the amount they spend on prescription charges and proprietary medicines. Of course, the total cost to the NHS of the medicines involved is far greater, and we should look to the insurers for the difference between the amount paid by the patient and the cost to the NHS. That may be an administrative problem at the moment, but, with better computerisation, it can be overcome. For example, I once recovered over £500 in prescription charges for a victim. Just think what the total cost to the NHS must have been for the medication received by that victim. The topping up to the full cost requires further examination.
Secondly, we have heard a great deal in the debate about how the scheme could be extended to other areas. I believe that we should look at other areas of compulsory insurance, particularly accidents at work and employers' liability. Such accidents account for half as many injuries again as road accidents—27 per cent. compared with 18.5 per cent of all personal injury accidents. With the help of trade unions' well-developed legal assistance schemes, 24 per cent. of victims claim. Such an extension of the scheme would probably double the amount recoverable.
I can see no philosophical difference between those two areas of compulsory insurance, and believe that both could be made subject to NHS recoupment. In fact, there are positive advantages. In the same way as these proposals could impact on road safety and better care of road accident victims, they could have an impact on health and safety in the workplace, by strengthening the drive for better working conditions through insurers being tougher with bad and unsafe employers, and through better rehabilitation, helping injured employees to get back to work more quickly.
My third suggestion concerns the cost of long-term care, which is sometimes borne by the NHS but more often by local authorities. The legal position on recoupment of these costs is very unclear. Some local authorities expect accident victims or their representatives to sign subrogation agreements, and either expect the victims' lawyers to get the moneys from the insurer, or, even worse, try to claw it back after the event from victims' compensation.
This uncertain area of the law means that disputes are often long drawn out, making cases harder to settle. Sometimes it results in satellite litigation, such as the case of Avon v. Hooper in December 1997, in which Avon county council tried to get the money out of the deceased victim's family, adding to that family's distress. It would be far better if the legal position were clarified through legislation such as this. I should certainly like to see local authorities in a similar position to the NHS in being able to recover their costs.
I very much welcome the Bill, which is long overdue. It will bring in additional and badly-needed resources to the NHS. It will ensure that those responsible for road accidents meet the full costs, through their insurers, of their negligence. I hope that we shall continue this reform process along the lines that I have described.
§ Mr. Gareth R. Thomas (Harrow, West)
I shall speak briefly to support the Bill, and perhaps I can set it in its proper context, as only one small part of a package of measures that will modernise our approach to health. That package clearly includes the £21 billion of extra investment from the comprehensive spending review. It also includes various measures to tackle prescription fraud. It ranges from the reforms of the national health service modernisation Bill to many of our public health measures, such as extra investment in housing and modernisation of local government, through to the Government's work to tackle financial exclusion.
The Bill is not about the introduction of a tax on motorists, and there are no great new issues of principle involved. I remember being in the Chamber when the hon. Member for Rutland and Melton (Mr. Duncan) promised us mature and constructive opposition. The shadow Secretary of State, the right hon. Member for Maidstone and The Weald (Miss Widdecombe), was never so ambitious. I assume that that is why the hon. Member for West Dorset (Mr. Letwin) was allowed to run with the scare story that compulsory health insurance would somehow result from the Bill.
For more than 60 years, hospitals have had the right to recover some of the costs of treating victims of road accidents. Indeed, since the introduction, under the Conservative Government, of the Road Traffic Act 1988, those costs are in theory recoverable from an insurance company. I say that that is the position "in theory", because the system, mirroring the wider Conservative approach to health care in the late 1980s and early 1990s, was highly bureaucratic and overly complex, and created unnecessary administrative burdens. The Bill will simplify and improve the way in which money is collected, so that the NHS gets the money to which it has been entitled for the past 50 years.
The hon. Member for Uxbridge (Mr. Randall) did the debate a service when he highlighted the wide variations in moneys that have been collected by hospitals. That variation is clearly because of the complex bureaucracy that has been so lucidly outlined by my hon. Friend the Member for Hendon (Mr. Dismore) and others. My hon. Friend the Member for Wakefield (Mr. Hinchliffe), in highlighting many of the health charges facilitated by the health reforms introduced by the previous Conservative Government, performed a useful service in signalling the double standards that lie behind the Opposition's amendment.
In contrast to the scare stories of the Liberal Democrats, the Bill will abolish a charge on patient care. It will move the NHS even closer to its founding principle of a service available when needed, where it is needed, with clinical need, not income, the key determinant.
The Bill will abolish the emergency treatment fee which has to be collected by NHS staff from injured motorists. As my hon. Friend the Member for South Swindon (Ms Drown) said, that process causes offence and embarrassment. It is a completely unwelcome distraction from what NHS staff do so well, which is looking after the injured.
§ Dr. Harris
Does the hon. Gentleman feel that the proposal returns the NHS to a mainly taxation-funded system, even if the increased efficiencies of the scheme 204 increase the proportion of NHS revenue that is raised from such charges? Does that return the NHS more to the principles of taxation?
§ Mr. Thomas
In the sense that the purpose of the Bill is to abolish one of the charges on patient care, it will clearly return to the founding principles that I have outlined.
The emergency treatment fee is highly unfair. It is levied regardless of whether the injured person was responsible for the accident. It is clear that the NHS has not been receiving the moneys to which it has been entitled. We know that only £13.17 million was recouped for the NHS in 1995–96 under existing legislation. According to recent estimates, NHS trusts could have claimed £50 million, £100 million, or—much less likely—anything up to £440 million.
The first beneficiaries of the reforms in the Bill will be the Opposition parties, whose difficulties on health service financing are well documented. It will not solve those difficulties for them, but it will provide some small fig leaves to small parts of the holes in their funding plans. The right hon. Member for Maidstone and The Weald cannot obtain permission from the shadow Chancellor of the Exchequer to welcome the £21 billion of new investment in the NHS, or to offer positive suggestions on how that money should be spent. Apart from some vacuous waffle about more private sector investment, the shadow health team has not suggested where the money will come from for more investment in the health service.
The Liberal Democrats, too, will benefit. They threw out the plans of the hon. Member for Southwark, North and Bermondsey (Mr. Hughes) at their conference, without one vote in favour. Indeed, the party's plans were described as shambolic. It is therefore not surprising that both the Conservatives and the Liberal Democrats have rushed to exaggerate, quoting the highest estimates they can find of the likely income that the Bill will generate.
As the Liberal Democrat approach to finances owes more to Heath Robinson than to accounting guidance, I am certain that, just as with their 1p on income tax, the modest moneys raised through the Bill will be spent many times over in the coming months.
Even £100 million extra would make an important difference to the services that hospitals can supply. Such a sum will provide small additional increases in income over and above the £21 billion that will be invested throughout the health service. That investment was described by the NHS Federation as beyond its wildest dreams. It was described by the Institute of Health Service Management as amassive injection of new cash.The truth, sadly, is that, such has been the scale of under-investment in patient care by the Conservative party, it would be entirely irresponsible to fail to secure these extra funds, to which hospitals have always been entitled, for the treatment of road traffic accidents.
The Bill is an entirely sensible measure, which is long overdue. It will help to modernise the way in which we collect moneys due to the health service, and I warmly welcome it.
§ Mr. Alan Duncan (Rutland and Melton)
We have had a lively and wide-ranging debate. Indeed, it has perhaps been rather more lively than some right hon. and hon. Members expected when they entered the Chamber this afternoon.
Perhaps the Bill and the Road Traffic Act 1988, which goes in harness with it, can best be described as measures that allow the national health service to piggy-back successful claims for compensation so as to recoup some of the health treatment costs from insurance companies. As every Opposition Member has said, including my right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe)—I am happy to reiterate this—we do not challenge that principle. However, we challenge the Government to explain how what they are doing by means of the Bill fits into any policy that they have previously expressed on charging in the NHS. We challenge them also to justify increasing the incidence and burden of costs on motorists, who are already very hard pressed.
The House will have noticed that what the Government are doing was never in the Labour party's manifesto. Labour did not give a clue to the electorate, whose vote they sought, that it would do something like this. It is yet another typical example of Labour saying one thing and doing another.
The Bill comes at a cost to the motorist in the form of a compulsory charge. We have tabled our reasoned, and reasonable, amendment to highlight that cost, and I welcome the Liberal Democrats' decision to join us today in the Lobby.
I listened very carefully to the Secretary of State's speech. He brazenly said that the proposals in the Bill will not cause the imposition of any new charges. Technically, in some respects, he is right. However, the magnitude—[Interruption.] As I told the House and Labour Members, I am nothing in debating these matters if not reasonable and constructive. I should think that even Labour Members will appreciate that the charge's magnitude and incidence will be dramatically increased. The charge will therefore be bigger and more burdensome.
Opposition Members agree with the Government on the proposal to abolish the emergency treatment fee. I do not quite understand why—perhaps the Minister will explain it to the House—general practitioners and hospitals can still collect that fee. I look forward to hearing the Minister's explanation of why they can do so.
The hon. Member for Carlisle (Mr. Martlew) is a very confused man. He said that the case of the German tourists who incurred a £45,000 bill in his constituency was a simple one because the insurance company paid the bill, although he was unable to explain to us the difference between insurance charges—which he was advocating and said were acceptable—and general health insurance. His exact words were that his constituents would feel that insurance charges were "a charge worth paying to support the health service." In a subsequent intervention, he supported charges in principle and criticised proposals to abolish them. Thus, he became the first Labour Back Bencher to support insurance premiums for national health service treatment.
The hon. Member for Southwark, North and Bermondsey (Mr. Hughes) was quite right that the Bill would increase the scale of the current scheme. He also argued that a premiums increase would be a regressive 206 tax. He was quite right also to say that the Government think of charges as an easy little pot of resources on which to draw.
The hon. Member for Wakefield (Mr. Hinchliffe) mentioned the Law Commission, and said that it might well recommend extending the scope of the type of scheme proposed in the Bill. He appeared to endorse such an extension. He said that he does not want health insurance. However, in one respect, he will have it—and he is supporting it—in the Bill.
§ Mr. Hinchliffe
If the hon. Gentleman reads my speech tomorrow, he will see that I did not say that. I specifically distanced myself from proposals to extend the scheme, as he is suggesting. Will he deal with the point that I made on the inconsistency between the reasoned amendment tabled by the shadow Health Secretary and her colleagues and the previous Government's introduction of car-parking charges?
§ Mr. Duncan
The inconsistency today is among Labour Members—some of whom want to extend the scope of the scheme, some of whom want to reduce it and some of whom want to keep it as it is. They are totally at odds one with another.
My hon. Friend the Member for Uxbridge (Mr. Randall) rightly pointed out the effect on motorists of charging.
The hon. Member for Aberdeen, South (Miss Begg) vividly described the crash that she herself suffered. So well did she describe it that, for a moment, I almost felt that I was in that car. However, she was yet another Labour Member welcoming NHS charges as proposed in the Bill.
My hon. Friend the Member for Poole (Mr. Syms) made it clear that a charge is a charge. He spoke of the effect of uninsured motorists, and drove a coach and horses through any remaining pretence that the Government have any consistent principle in their thinking.
The hon. Member for Crawley (Laura Moffatt) seemed to give full support for national health service health insurance, and admitted that it would be a compulsory charge for NHS treatment.
My hon. Friend the Member for West Dorset (Mr. Letwin)—who has apologised to you, Mr. Deputy Speaker, and to the House for not being able to stay for the conclusion of the debate—ably described how the Government are so devoid of principle that, in the Bill, they are doing the opposite of what they led the electorate to expect before the general election. Although I was very grateful for his kind words about my libertarian credentials, I was more grateful to him for cogently dissecting what I and everyone else now recognise as the Government's intellectual poverty.
The hon. Member for South Swindon (Ms Drown) is a public sector accountant. Therefore she, above all, should know about compulsory insurance. However, she made no case as to why only motorists should face paying such a charge.
The hon. Member for Oxford, West and Abingdon (Dr. Hams) made yet another plea for some expression of principle by the Government. I fear that his plea will have fallen on deaf ears.
207 The hon. Member for Hendon (Mr. Dismore) clearly is new Labour. He tried to give credit for the Bill to the grandfather of the Secretary of State for Trade and Industry. If the hon. Gentleman drives as fast as he speaks, he will always be done for speeding. He wishes to extend the charging concept, whereas the hon. Member for Wakefield—who is sitting behind him—does not.
The hon. Member for Harrow, West (Mr. Thomas), too, seems to be totally at odds with the hon. Member for Wakefield.
The Government's approach to the Bill demonstrates their incoherence on the overall issue of national health service charging and on the way in which money in the health service works. The Secretary of State keeps saying that there is no rationing; yet the Government—as they always have done—ration. He said that NHS charges must never exist; yet—in this very Bill—the Government most clearly will charge. The Bill will broaden the incidence of charging. The Secretary of State rails against charges, but today he promotes them. It is an extraordinary volte-face.
The Bill will increase the scope of charging for treatment, but where is its logic? What will happen next? Let us consider an example that is currently in the news. Barry Horne, an animal rights activist, is on hunger strike. No one has injured him; he is inflicting his condition on himself. He is in a hospital in Yorkshire and is a cost to the national health service. Does the Secretary of State think that he should be charged in some way for the treatment that he is receiving? Does he think that he should pay the costs of the delayed opening of the hospital's new cancer ward, if it is delayed?
Does the Secretary of State think that charging will eventually be applied to other places that are insured, such as offices and homes, where there might be a fire or an accident? Will charging be applied to train crashes or to dreadful, massive events such as Hillsborough or Zeebrugge when compensation is paid out?
Does the Secretary of State intend—perhaps he will do the House the courtesy of listening—that, one day, charging might extend to what is deemed a "class action" against tobacco manufacturers, so that those smokers—whose treatment clearly has imposed a cost on the NHS—also have to pay?
The logic of the legislation shows that it is not about risks that are compulsorily insured but about cases in which compensation happens to be delivered and in which, in the case of motorists, there happens to be compulsory insurance. It is an easy route to a wider charge. No proof of fault is required. There was no principle in the Secretary of State's statement about insurance being compulsory. The simple fact is that compensation in such cases can easily be traced and then returned to the national health service.
The costs of charging will be passed on. Estimates of the costs range from £50 million to £450 million. Even if the costs figure falls between the high and low estimates, they will cause motorists a notable expense.
Let us be clear about it: the Government's proposals will hereby extend compulsory charging for NHS treatment of motorists. Let us ignore the Secretary of State's words; let us look at his deeds.
Motorists will be hit—perhaps, if the higher estimate applies, quite hard. Motorists have already had to pay £9 billion extra in fuel tax. After today's announcement 208 by the Deputy Prime Minister, they will probably have to pay road charges. Their vehicle excise duty has gone up, and they face a new car registration tax. Now, they will have to pay for the Bill's proposals.
I think that the Secretary of State probably used to attack the insurance premium tax, but now he is introducing another tax. He even had the gall to say that insurance premiums will not rise, and cited the case of Direct Line insurance, which essentially said that it already factored in the charges. A charge on an institution does not mean that the individual is not eventually charged. The Government are proposing a wider and more burdensome charge that will fall on the hard-pressed motorist. I urge the House to support our reasoned amendment.
§ The Parliamentary Under-Secretary of State for Health (Mr. John Hutton)
As the hon. Member for Rutland and Melton (Mr. Duncan) said, this has been a lively debate. More importantly, it has been a well informed and useful debate, in which several hon. Members, particularly Labour Members, have brought their professional and personal experiences to bear on the issue. I should like to respond as fully as possible to the points that have been raised. If I am not able to cover all the points, I shall write to the relevant hon. Members when I have an opportunity for more detailed consideration.
I am afraid that the speech by the hon. Member for Rutland and Melton has come roughly 70 years too late. The subject matter of the Bill has been on the statute book for that long. As I am sure that he would be the first to admit, when the Conservatives had the opportunity to consider the issue, they endorsed the principle that we are debating.
We have heard sensible contributions from my hon. Friends the Members for Carlisle (Mr. Martlew), for Wakefield (Mr. Hinchliffe), for Aberdeen, South (Miss Begg), for Crawley (Laura Moffatt), for South Swindon (Ms Drown), for Hendon (Mr. Dismore) and for Harrow, West (Mr. Thomas). I shall also deal with some of the points made by Opposition Members.
My hon. Friend the Member for Carlisle welcomed the abolition of the emergency treatment fee, as did many other hon. Members. It will be widely welcomed, particularly in the national health service. He highlighted the inefficiencies of the present scheme and mentioned the benefits that the new arrangements will bring to the national health service in Cumbria.
The hon. Member for Southwark, North and Bermondsey (Mr. Hughes) appeared to be in favour of statutory mechanisms for setting the price of motor insurance, which I found curious. He proceeded to read out most of the Liberal Democrat reasoned amendment, which did not add much to our proceedings. He then tried manfully to distinguish it from the Conservative reasoned amendment, which he went on to say that he would vote for anyway. That is the Liberal Democrats.
§ Mr. Simon Hughes
Oh dear! We had hoped better of the new Minister, but he has yet to amend his ways. He 209 has mentioned insurance contributions. Can he guarantee that insurance premiums for car drivers will not go up as a result of the Bill?
§ Mr. Hutton
I intend to deal with that later in my speech.
My hon. Friend the Member for Wakefield also welcomed the abolition of the emergency treatment fee and pointed out the inconsistencies in the Opposition position. He did us all a favour by drawing attention to the ambiguous position adopted by the Conservatives.
My hon. Friend the Member for South Swindon referred to her experience of trying to administer the existing arrangements. She spoke for many in the national health service when she welcomed the proposals. She described the existing arrangements as complicated and bureaucratic. I assure her that we want the new arrangements to be clear and straightforward. Local hospitals should benefit directly.
My hon. Friend the Member for Aberdeen, South made a persuasive and effective speech, drawing attention to the absurdities of the present arrangements and the fact that the national health service loses out. I welcome her support for the Bill. She also pointed out that the new arrangements will apply to the national health service in Scotland.
The hon. Member for Poole (Mr. Syms) repeated his concerns about the impact on motorists. I shall deal with that in a moment. He also expressed concerns about what he described as new bureaucracy in the arrangements. That is rich coming from the Conservatives. We are proposing a streamlined system for recovering the charges that are owed to the national health service. It is the best and least bureaucratic scheme that we can devise and it will deliver benefits to the national health service. Intriguingly, he said that he supported some parts of the Bill, but declined to say which. It is a shame that he is going to join his hon. Friends in voting against the Bill.
My hon. Friend the Member for Crawley welcomed the involvement of the compensation recovery unit. She brought her experience as a nurse to the debate on the emergency treatment fee. She rightly said that the Bill is about fairness.
I am sorry that the hon. Member for West Dorset (Mr. Letwin) is not in his place. Of course, that gives me an opportunity not to refer to his speech, which is a serious temptation. However, I should let my right hon. Friend the Secretary of State know that the hon. Gentleman expressed his admiration for him, which was gratefully received by Labour Members. Unfortunately, the hon. Gentleman spoiled it by failing to understand the terms of the Bill or the Government's policy. That revealed the confusion that underpins the Conservative response to our proposals. Sadly, he allowed the hatred of everything European to surface again. He deserves some praise for his ingenuity in getting Europe into the debate. Like other Opposition Members, he has sought to read more into the Bill than he should.
The hon. Member for Oxford, West and Abingdon (Dr. Harris) joined the hon. Member for Southwark, North and Bermondsey in showing that the Liberal Democrats do not have a coherent or rational position on this occasion—as on many other occasions. It is a mistake for them to join the Conservatives in opposing the Bill.
§ Mr. Simon Hughes
The Minister cannot seriously say that the Government's position is coherent. They say that 210 they are against more charges, but they are bringing forward a Bill that would allow charges in one area to go up. No charges were mentioned in the Labour manifesto, but suddenly, hey presto, the Government are to produce more money from somewhere and charge the public for it.
§ Mr. Hutton
The hon. Gentleman has not understood the Bill. No new charges are being introduced. I thought that he had tried to make that point. The logic of his argument, although he did not spell it out in detail, is that he wants to increase taxes substantially. He will have to deal with that when the voters make their judgment at the next general election.
I should like to return briefly to the subject of the debate—the Bill. As my right hon. Friend the Secretary of State pointed out, it will enable hospitals to benefit fully for the first time in more than 60 years from the provisions that successive Administrations have endorsed, although they have never been given practical effect. This is not the first step on a slippery slope towards charging for NHS treatment. Let me make it crystal clear—no patient is to be charged and no one will be required to insure themselves against the cost of future treatment. The principle that has been in force throughout the existence of the NHS remains: the road user is required to insure against risk to third parties. That includes reimbursing hospitals for the cost of treating third parties.
We are not talking about charging everyone involved in a road accident for the cost of NHS treatment. The charges will be levied only when a claim for compensation arising from a road traffic accident has been made. The charge will be levied against the insurer of the person responsible for the accident. We estimate that approximately 40 per cent. of all road traffic accidents will be covered by the Bill.
Reference has been made to insurance premiums. Much of what has been said and written is patently untrue. Our figures show that if insurers pass on the charge—which is by no means certain, as some insurers have been open enough to admit—the effect on the average premium should be very small indeed—around 2 to 3 per cent. or £6 to £9. Insurers already factor potential NHS charges—whether or not they are collected—into premiums.
As many of my hon. Friends have said, our new system will see in NHS hospitals the end of the iniquitous charging of the emergency treatment fee. That will be better for drivers, hospitals and insurers. Each year there are hundreds of thousands of small transactions between hospitals and drivers and drivers and their insurance companies which will end when the Bill receives Royal Assent. At the current rate of £21.30, the cost of that process must certainly outweigh the benefit. The abolition of the emergency treatment fee will be welcome news to many people in and outside the national health service.
NHS care is and will remain free to all those who need it. The Bill does not affect that principle. It does not usher in a free season on that principle and it does not remotely hint at a change in direction. Nobody will be denied care or be prevented from seeking it as a result of the Bill. NHS patients stand to benefit directly from the practical steps brought in as a result of the measure and on that basis I commend it to the House.
§ Question put, That the amendment be made:—
§ The House divided: Ayes 150, Noes 347.214
|Division No. 18]||[7.41 pm|
|Ainsworth, Peter (E Surrey)||Jenkin, Bernard|
|Allan, Richard||Keetch, Paul|
|Arbuthnot, Rt Hon James||Key, Robert|
|Atkinson, Peter (Hexham)||Kirkbride, Miss Julie|
|Baker, Norman||Kirkwood, Archy|
|Ballard, Jackie||Laing, Mrs Eleanor|
|Body, Sir Richard||Lait, Mrs Jacqui|
|Bottomley, Peter (Worthing W)||Lansley, Andrew|
|Brady, Graham||Leigh, Edward|
|Brake, Tom||Lewis, Dr Julian (New Forest E)|
|Brand, Dr Peter||Lidington, David|
|Brazier, Julian||Lilley, Rt Hon Peter|
|Breed, Colin||Lloyd, Rt Hon Sir Peter (Fareham)|
|Browning, Mrs Angela||Loughton, Tim|
|Bruce, Ian (S Dorset)||Luff, Peter|
|Bruce, Malcolm (Gordon)||Lyell, Rt Hon Sir Nicholas|
|Burns, Simon||MacGregor, Rt Hon John|
|Butterfill, John||Maclennan, Rt Hon Robert|
|Campbell, Menzies (NE Fife)||McLoughlin, Patrick|
|Chapman, Sir Sydney (Chipping Barnet)||Malins, Humfrey|
|Maude, Rt Hon Francis|
|Chidgey, David||Mawhinney, Rt Hon Sir Brian|
|Chope, Christopher||May, Mrs Theresa|
|Clappison, James||Michie, Mrs Ray (Argyll & Bute)|
|Clark, Rt Hon Alan (Kensington)||Moore, Michael|
|Clark, Dr Michael (Rayleigh)||Morgan, Alasdair (Galloway)|
|Clarke, Rt Hon Kenneth (Rushcliffe)||Moss, Malcolm|
|Clifton-Brown, Geoffrey||Oaten, Mark|
|Colvin, Michael||Öpik, Lembit|
|Cotter, Brian||Ottaway, Richard|
|Cran, James||Page, Richard|
|Day, Stephen||Paterson, Owen|
|Duncan, Alan||Pickles, Eric|
|Emery, Rt Hon Sir Peter||Prior, David|
|Evans, Nigel||Randall, John|
|Ewing, Mrs Margaret||Redwood, Rt Hon John|
|Faber, David||Rendel, David|
|Fabricant, Michael||Robathan, Andrew|
|Fallon, Michael||Robertson, Laurence (Tewk'b'ry)|
|Foster, Don (Bath)||Roe, Mrs Marion (Broxbourne)|
|Fox, Dr Liam||Rowe, Andrew (Faversham)|
|Gale, Roger||Ruffley, David|
|Garnier, Edward||Russell, Bob (Colchester)|
|George, Andrew (St Ives)||St Aubyn, Nick|
|Gibb, Nick||Sanders, Adrian|
|Gill, Christopher||Sayeed, Jonathan|
|Gillan, Mrs Cheryl||Shephard, Rt Hon Mrs Gillian|
|Gorman, Mrs Teresa||Simpson, Keith (Mid-Norfolk)|
|Gorrie, Donald||Smith, Sir Robert (W Ab'd'ns)|
|Gray, James||Spicer, Sir Michael|
|Green, Damian||Spring, Richard|
|Greenway, John||Stanley, Rt Hon Sir John|
|Grieve, Dominic||Steen, Anthony|
|Gummer, Rt Hon John||Stunell, Andrew|
|Hammond, Philip||Swayne, Desmond|
|Harris, Dr Evan||Swinney, John|
|Harvey, Nick||Syms, Robert|
|Hawkins, Nick||Taylor, John M (Solihull)|
|Hayes, John||Taylor, Matthew (Truro)|
|Heath, David (Somerton & Frome)||Tonge, Dr Jenny|
|Hogg, Rt Hon Douglas||Townend, John|
|Horam, John||Tredinnick, David|
|Howard, Rt Hon Michael||Trend, Michael|
|Howarth, Gerald (Aldershot)||Tyler, Paul|
|Hughes, Simon (Southwark N)||Tyrie, Andrew|
|Hunter, Andrew||Viggers, Peter|
|Jack, Rt Hon Michael||Wallace, James|
|Jackson, Robert (Wantage)||Walter, Robert|
|Wardle, Charles||Wilshire, David|
|Waterson, Nigel||Winterton, Mrs Ann (Congleton)|
|Webb, Steve||Winterton, Nicholas (Macclesfield)|
|Wells, Bowen||Woodward, Shaun|
|Whitney, Sir Raymond||Young, Rt Hon Sir George|
|Widdecombe, Rt Hon Miss Ann||Tellers for the Ayes:|
|Willetts, David||Sir David Madel and|
|Willis, Phil||Mr. Tim Collins.|
|Abbott, Ms Diane||Colman, Tony|
|Adams, Mrs Irene (Paisley N)||Connarty, Michael|
|Ainger, Nick||Cook, Frank (Stockton N)|
|Ainsworth, Robert (Cov'try NE)||Cooper, Yvette|
|Alexander, Douglas||Corbett, Robin|
|Allen, Graham||Corston, Ms Jean|
|Anderson, Donald (Swansea E)||Cousins, Jim|
|Anderson, Janet (Rossendale)||Cranston, Ross|
|Armstrong, Ms Hilary||Crausby, David|
|Ashton, Joe||Cryer, Mrs Ann (Keighley)|
|Atherton, Ms Candy||Cryer, John (Hornchurch)|
|Atkins, Charlotte||Cummings, John|
|Austin, John||Cunliffe, Lawrence|
|Barnes, Harry||Cunningham, Rt Hon Dr Jack (Copeland)|
|Battle, John||Cunningham, Jim (Cov'try S)|
|Bayley, Hugh||Curtis-Thomas, Mrs Claire|
|Beckett, Rt Hon Mrs Margaret||Dafis, Cynog|
|Begg, Miss Anne||Dalyell, Tam|
|Benn, Rt Hon Tony||Davey, Valerie (Bristol W)|
|Bennett, Andrew F||Davidson, Ian|
|Bermingham, Gerald||Davies, Rt Hon Denzil (Llanelli)|
|Berry, Roger||Davies, Geraint (Croydon C)|
|Betts, Clive||Davis, Terry (B'ham Hodge H)|
|Blackman, Liz||Dawson, Hilton|
|Blears, Ms Hazel||Dean, Mrs Janet|
|Blizzard, Bob||Denham, John|
|Blunkett, Rt Hon David||Dismore, Andrew|
|Boateng, Paul||Dobbin, Jim|
|Borrow, David||Dobson, Rt Hon Frank|
|Bradley, Keith (Withington)||Donohoe, Brian H|
|Bradley, Peter (The Wrekin)||Doran, Frank|
|Bradshaw, Ben||Dowd, Jim|
|Brinton, Mrs Helen||Drew, David|
|Brown, Russell (Dumfries)||Drown, Ms Julia|
|Browne, Desmond||Dunwoody, Mrs Gwyneth|
|Buck, Ms Karen||Eagle, Angela (Wallasey)|
|Burden, Richard||Ellman, Mrs Louise|
|Burgon, Colin||Ennis, Jeff|
|Butler, Mrs Christine||Etherington, Bill|
|Byers, Rt Hon Stephen||Field, Rt Hon Frank|
|Caborn, Richard||Fisher, Mark|
|Campbell, Mrs Anne (C'bridge)||Fitzpatrick, Jim|
|Campbell, Ronnie (Blyth V)||Flint, Caroline|
|Campbell—Savours, Dale||Flynn, Paul|
|Canavan, Dennis||Follett, Barbara|
|Cann, Jamie||Foster, Rt Hon Derek|
|Caplin, Ivor||Foster, Michael Jabez (Hastings)|
|Casale, Roger||Foster, Michael J (Worcester)|
|Chapman, Ben (Wirral S)||Foulkes, George|
|Chaytor, David||Fyfe, Maria|
|Chisholm, Malcolm||Galbraith, Sam|
|Clark, Rt Hon Dr David (S Shields)||Gapes, Mike|
|Clark, Dr Lynda (Edinburgh Pentlands)||Gardiner, Barry|
|Clark, Paul (Gillingham)||Gibson, Dr Ian|
|Clarke, Eric (Midlothian)||Gilroy, Mrs Linda|
|Clarke, Rt Hon Tom (Coatbridge)||Godman, Dr Norman A|
|Clarke, Tony (Northampton S)||Godsiff, Roger|
|Clelland, David||Goggins, Paul|
|Clwyd, Ann||Gordon, Mrs Eileen|
|Coaker, Vernon||Griffiths, Jane (Reading E)|
|Coffey, Ms Ann||Griffiths, Nigel (Edinburgh S)|
|Cohen, Harry||Griffiths, Win (Bridgend)|
|Coleman, Iain||Grocott, Bruce|
|Grogan, John||McIsaac, Shona|
|Gunnell, John||McKenna, Mrs Rosemary|
|Hain, Peter||Mackinlay, Andrew|
|Hall, Mike (Weaver Vale)||McLeish, Henry|
|Hall, Patrick (Bedford)||McNulty, Tony|
|Hamilton, Fabian (Leeds NE)||MacShane, Denis|
|Harman, Rt Hon Ms Harriet||Mactaggart, Fiona|
|Heal, Mrs Sylvia||McWilliam, John|
|Healey, John||Mahon, Mrs Alice|
|Henderson, Ivan (Harwich)||Mallaber, Judy|
|Hepburn, Stephen||Marek, Dr John|
|Heppell, John||Marsden, Paul (Shrewsbury)|
|Hesford, Stephen||Marshall, David (Shettleston)|
|Hill, Keith||Marshall, Jim (Leicester S)|
|Hinchliffe, David||Marshall—Andrews, Robert|
|Home Robertson, John||Martlew, Eric|
|Hood, Jimmy||Maxton, John|
|Hoon, Geoffrey||Michael, Alun|
|Hope, Phil||Michie, Bill (Shef'ld Heeley)|
|Hopkins, Kelvin||Milburn, Alan|
|Howarth, Alan (Newport E)||Miller, Andrew|
|Howarth, George (Knowsley N)||Mitchell, Austin|
|Howells, Dr Kim||Moffatt, Laura|
|Hoyle, Lindsay||Moonie, Dr Lewis|
|Hughes, Kevin (Doncaster N)||Moran, Ms Margaret|
|Humble, Mrs Joan||Morgan, Ms Julie (Cardiff N)|
|Hurst, Alan||Morgan, Rhodri (Cardiff W)|
|Hutton, John||Morley, Elliot|
|Iddon, Dr Brian||Morris, Ms Estelle (B'ham Yardley)|
|Illsley, Eric||Mountford, Kali|
|Jackson, Ms Glenda (Hampstead)||Mudie, George|
|Jackson, Helen (Hillsborough)||Mullin, Chris|
|Johnson, Alan (Hull W & Hessle)||Murphy, Denis (Wansbeck)|
|Johnson, Miss Melanie (Welwyn Hatfield)||Murphy, Jim (Eastwood)|
|Naysmith, Dr Doug|
|Jones, Barry (Alyn & Deeside)||Norris, Dan|
|Jones, Mrs Fiona (Newark)||O'Brien, Bill (Normanton)|
|Jones, Helen (Warrington N)||O'Brien, Mike (N Warks)|
|Jones, Ms Jenny (Wolverh'ton SW)||O'Hara, Eddie|
|Jones, Jon Owen (Cardiff C)||O'Neill, Martin|
|Jones, Dr Lynne (Selly Oak)||Organ, Mrs Diana|
|Jones, Martyn (Clwyd S)||Osborne, Ms Sandra|
|Jowell, Ms Tessa||Palmer, Dr Nick|
|Kaufman, Rt Hon Gerald||Pearson, Ian|
|Keeble, Ms Sally||Pendry, Tom|
|Keen, Alan (Feltham & Heston)||Pickthall, Colin|
|Keen, Ann (Brentford & Isleworth)||Pike, Peter L|
|Kelly, Ms Ruth||Plaskitt, James|
|Kemp, Fraser||Pollard, Kerry|
|Kennedy, Jane (Wavertree)||Pond, Chris|
|Khabra, Piara S||Pope, Greg|
|Kidney, David||Powell, Sir Raymond|
|Kilfoyle, Peter||Prentice, Ms Bridget (Lewisham E)|
|King, Andy (Rugby & Kenilworth)||Prentice, Gordon (Pendle)|
|King, Ms Oona (Bethnal Green)||Primarolo, Dawn|
|Kumar, Dr Ashok||Prosser, Gwyn|
|Lawrence, Ms Jackie||Purchase, Ken|
|Laxton, Bob||Quin, Ms Joyce|
|Lepper, David||Quinn, Lawrie|
|Leslie, Christopher||Radice, Giles|
|Levitt, Tom||Rammell, Bill|
|Lewis, Ivan (Bury S)||Rapson, Syd|
|Lewis, Terry (Worsley)||Reed, Andrew (Loughborough)|
|Lloyd, Tony (Manchester C)||Reid, Rt Hon Dr John (Hamilton N)|
|Lock, David||Robinson, Geoffrey (Cov'try NW)|
|Love, Andrew||Roche, Mrs Barbara|
|McAllion, John||Rogers, Allan|
|McAvoy, Thomas||Rooker, Jeff|
|McCabe, Steve||Rooney, Terry|
|McCafferty, Ms Chris||Ross, Ernie (Dundee W)|
|McCartney, Ian (Makerfield)||Rowlands, Ted|
|McDonagh, Siobhain||Roy, Frank|
|Macdonald, Calum||Ruane, Chris|
|McDonnell, John||Russell, Ms Christine (Chester)|
|McGuire, Mrs Anne||Ryan, Ms Joan|
|Salter, Martin||Taylor, David (NW Leics)|
|Sarwar, Mohammad||Temple—Morris, Peter|
|Savidge, Malcolm||Thomas, Gareth (Clwyd W)|
|Sawford, Phil||Thomas, Gareth R (Harrow W)|
|Sedgemore, Brian||Tipping, Paddy|
|Shaw, Jonathan||Todd, Mark|
|Sheerman, Barry||Touhig, Don|
|Sheldon, Rt Hon Robert||Trickett, Jon|
|Shipley, Ms Debra||Truswell, Paul|
|Simpson, Alan (Nottingham S)||Turner, Dennis (Wolverh'ton SE)|
|Singh Marsha||Turner, Dr Desmond (Kemptown)|
|Skinner, Dennis||Turner, Dr George (NW Norfolk)|
|Smith, Rt Hon Andrew (Oxford E)||Twigg, Derek (Halton)|
|Smith, Angela (Basildon)||Twigg, Stephen (Enfield)|
|Smith, Jacqui (Redditch)||Vaz, Keith|
|Smith, John (Glamorgan)||Walley, Ms Joan|
|Smith, Llew (Blaenau Gwent)||Ward, Ms Claire|
|Snape Peter||Wareing, Robert N|
|Soley Clive||White, Brian|
|Southworth, Ms Helen||Whitehead, Dr Alan|
|Squire, Ms Rachel||Wicks, Malcolm|
|Starkey, Dr Phyllis||Williams, Rt Hon Alan (Swansea W)|
|Stevenson, George||Williams, Alan W (E Carmarthen)|
|Stewart, David (Inverness E)||Winnick, David|
|Stewart, Ian (Eccles)||Winterton, Ms Rosie (Doncaster C)|
|Stinchcombe, Paul||Wise, Audrey|
|Stoate, Dr Howard||Wood Mike|
|Stott, Roger||Woolas, Phil|
|Strang, Rt Hon Dr Gavin||Wray, James|
|Straw, Rt Hon Jack||Wright, Anthony D (Gt Yarmouth)|
|Stringer, Graham||Wright, Dr Tony (Cannock)|
|Stuart, Ms Gisela||Wyatt, Derek|
|Taylor, Rt Hon Mrs Ann (Dewsbury)||Tellers for the Noes:|
|Mr. David Hanson and|
|Taylor, Ms Dari (Stockton S)||Mr. David Jamieson.|
§ Question accordingly negatived.
§ Main Question put forthwith, pursuant to Standing Order No. 62 (Amendment on Second or Third Reading), and agreed to.
§ Bill accordingly read a Second time, and committed to a Standing Committee, pursuant to Standing Order No. 63 (Committal of Bills).