HC Deb 21 January 1999 vol 323 cc1035-49 '.—Section 158 of the Road Traffic Act 1988 (Payment for emergency treatment of traffic casualties) shall cease to have effect.'.—[Dr. Harris.]

Brought up, and read the First time.

1.14 pm
Dr. Evan Harris (Oxford, West and Abingdon)

I beg to move, That the clause be read a Second time.

In previous debates on the Bill, we have heard the Government boast of the abolition of the emergency treatment fee as it applies to hospitals. The Liberal Democrats strongly support that on the basis that the fee was bureaucratic and on the basis of the Government's further justifications for the move, which are that it is offensive to patients arriving in hospital to be asked to pay a fee and that the amount raised does not compensate for the bureaucratic nightmare of collecting it.

The Bill, in its current form, is inadequate because it does not remove the emergency treatment fee as chargeable by general practitioners. Liberal Democrats see hardly any difference between the bureaucracy involved in collecting the general practitioner emergency treatment fee and that involved in collecting the hospital emergency treatment fee. There is also very little difference between the difficulties of approaching people who may have been injured in an accident, albeit always the driver in the case of the GP fee, and patients arriving in hospital for treatment following a road traffic accident. There is certainly no difference in the lack of information about whether it is worth while for the fee to be collected by front-line health service staff.

I wonder whether the Government, even at this late stage, will consider accepting the new clause on the basis that it fits in with the rationale of their original motives in the Bill.

The Parliamentary Under-Secretary of State for Health (Mr. John Hutton)

As I understand it, the hon. Gentleman is seeking to remove the right of independent contractors—GPs—to claim the emergency treatment fee. Has the hon. Gentleman sought the views of the British Medical Association on this matter and what opinion has it expressed to him?

Dr. Harris

I intend to deal with those points during my presentation of the rationale behind this new clause.

Two questions need to be answered by those proposing the new clause. First, should GPs receive a fee for the treatment given and, secondly, if they do, should that come direct from an individual patient? General practitioners receive a fee for giving contraceptive advice. That fee comes not from the person to whom they have given the advice but from the health authority and it is in addition to their capitation fee. They are also rewarded for meeting screening targets. The normal way for GPs to be reimbursed, other than through their capitation fee, is through an item-of-service claim.

General practitioners are used to claiming from health authorities for specific items of service. Those proposing this new clause are not suggesting that GPs should not be reimbursed for their time, but that the current method is discriminatory because, in the first instance, GPs must approach a patient or even a third party for the fee. That does not fit in with the current arrangements for GP reimbursement. I can assure the Minister that, if an alternative mechanism of claiming for a GP's time and effort in a roadside attendance can be arranged through regulation, no GP need be out of pocket.

In case the Minister is not aware of this, I shall remind him of the difficulties that GPs face currently when collecting the fee. I asked the BMA for its view on the collectability of the fee and, in the first instance, it could not find any GP who regularly made an effort to collect it. My hon. Friend the Member for Isle of Wight (Dr. Brand), who is a practising GP, although on a part-time basis because of his onerous parliamentary duties, said that during his time as a GP, he has never found it worth the effort to collect the fee. He said that he does know some people who do put in the effort, but they question whether it is worth while.

If I explain the procedure that GPs have to follow to collect the fee, the House will begin to see why it is not worth retaining, even if there were not strong arguments for the principle being wrong. The BMA has produced a guidance sheet for GP members on the Road Traffic Act 1988 emergency treatment fee. Section 158 of that Act applies and that is what the new clause would abolish. The guidance says: Under the Road Traffic Act 1988 doctors may generally claim a fee for providing emergency medical or surgical treatment to a person suffering bodily and/or fatal injury arising out of the use of a motor vehicle on a public highway. A fee of £21.30 may be claimed for rendering treatment to an individual involved in a road traffic accident; and a fee of 41p may be claimed for each complete mile and additional part of a mile for any distance in excess of two miles which a practitioner must travel in order to provide the emergency treatment. The payment may be claimed by any doctor whenever he or she is the first person to provide treatment. The person who is using the vehicle at the time the event occurred out of which the bodily injury arose is the person responsible for the payment of the practitioner's fee. We therefore have a situation in which GPs are approaching drivers of vehicles who may or may not have been injured—presumably they have survived—to ask for 41p per mile, perhaps after quickly hammering out the figures on a calculator. Such a situation is highly inappropriate, as the Government have recognised elsewhere in the Bill by abolishing the hospital emergency treatment fee.

Mr. Andrew Dismore (Hendon)

The hon. Gentleman is making a mountain out of a molehill. As a personal injury solicitor, I have had to deal with cases on behalf of accident victims many times, and it was a straightforward matter. If a claim is made, the docket is passed to a solicitor, who will either pass it to the driver's insurers or claim it back from the other insurance company. It is a very straightforward process that is easily administered. Sometimes, the victim will pay out the fee and collect it back. I do not see what all the fuss is about.

Dr. Harris

Lawyers involved in processes in which they are paid always claim that the process is smooth and easy. If the hon. Gentleman will be patient, I shall explain the advice that the BMA gives to its doctors on how to claim the fee, with or without the services of the legal profession. I should say that I know of no solicitor who would charge a lower fee. Perhaps the hon. Gentleman is particularly generous—which is why he is no longer practicing—in being prepared to do such work for less than the £21.30 plus 41p per complete mile in excess of two miles, assuming that a doctor is the first person to reach an accident. Another invidious principle is the requirement to work out who is the first doctor on the scene, and therefore who can claim the fee. If the hon. Gentleman is patient, I shall explain the process as GPs see it.

The BMA advice continues: Practitioners should take the following steps to recover their fees: (i) An oral request may be made to the person who was using the vehicle at the time of the occurrence which led to the provision of the emergency treatment. That presumes that the person is alive, conscious and able to hear such an oral request. I suspect that any GP who pauses at the scene of an accident to make such a request is being forced by the current regulations—if he or she is obeying them—to put secondary considerations before his or her duty of care to patients.

The advice goes on to say that, if an oral request is not made, A written request must be made to the above-defined person. This request must be served upon that person within seven days from when emergency treatment was given. It must be signed by the claimant, stating his name and address, the circumstances in which the emergency treatment was effected, and that the claimant was the first person to provide such emergency treatment. The request may be served by delivering it to the person who was using the vehicle, or by sending it by recorded delivery addressed to him/her at his/her usual or last-known address. The amount of administration that such a process involves for a GP, or for his or her staff, makes it not worth while to collect the fee. A greater consideration is the offence that might be caused to a person in hospital who receives such a request within seven days of an accident. Nothing could be better calculated to damage doctor-patient relationships.

Mr. Dismore

rose—

Dr. Harris

Perhaps the hon. Gentleman will offer more legal advice.

Mr. Dismore

It is all very well hearing about such situations in theory, but, in practice, such situations do not occur. A docket is sent in, and it is paid. What is all the fuss about? The BMA may have established a long and complicated procedure, but such situations are dealt with very differently in reality.

Dr. Harris

I question that. I have asked the BMA what action GPs must take to collect the fee. I should prefer to believe the BMA and former colleagues of mine about the advice given by the BMA than to believe the advice of a solicitor who may or may not be involved in the case. It depends on whether GP practices have a contract with a local firm of solicitors.

On many occasions, I have heard the Secretary of State call for less NHS time and money to be spent on legal fees and more on patient care. The interventions of the hon. Member for Hendon (Mr. Dismore) suggest that he would like that reversed and thinks that every GP should have a contract with a local firm of solicitors to maximise their income. That may be good for solicitors, but it is not good for general practitioners and it certainly is not good for patients, who, directly or indirectly, are on the receiving end of the demands for payment.

The guidance given to doctors under existing legislation suggests that they must approach an accident victim within seven days of an accident to ask for the money. The £21.30 fee has not been raised since the introduction of the provision in 1988, but it is still a significant sum. The measure is highly regressive because it is a charge made to patients. It is offensive to them in principle and because of the time scale.

The GP may well not know who the driver was. It is not the first question that a doctor at the scene of an accident asks and it may not even be the last. The guidance helpfully goes on to explain: When a practitioner experiences difficulty in ascertaining the name and address of the person who was using the vehicle, s/he should make application to the appropriate chief constable. That is astonishing advice to give busy front-line staff. It continues: In these circumstances this official is required by the Act to supply the practitioner with any information at his/her disposal as to the identification marks of any motor vehicle which the practitioner alleges to be a vehicle out of the use of which the bodily injury arose, and as to the identity and address of the person who was using it at that time. That is overly bureaucratic. It is a waste of time and energy for the front-line staff in the health service. Chief constables and their officers have better things to do than to chase £21.30 fees across counties, across police authorities and across the country to reimburse GPs for roadside advice given. I believe that in their heart of hearts, the Minister and the other Labour Member present—Labour Members, I should say, because I see the Whip as well—know that it is nonsense. It would be easier and more logical for them to accept the new clause. We should be happy to support them if they did. I hope to hear specific reasons from the Minister why that cannot be done.

The BMA advice goes on: The fees payable under the Act are recoverable by court proceedings as if they were a simple contract debt due from the person who was using the vehicle to the practitioner rendering service. That may be why lawyers are so interested in the retention of the measure. If no money comes forward, there is more work for solicitors.

Mr. Dismore

rose—

Dr. Harris

If the hon. Gentleman does not mind, I shall let him make his comments when I have finished this point.

The guidance goes on: However, in the event of a doctor being unable to obtain this fee, s/he may claim an ordinary 'Emergency Treatment Fee' from the relevant health authority (as covered by paragraph 33.8 of the Statement of fees and allowances). That means that after the general practitioner has gone through all those hoops without making progress and all that time and money has been wasted, there is provision to claim an ordinary fee for treatment from the health authority, just as a GP would for a patient who was not on his list but needed urgent and necessary treatment. Surely the Government can accept the new clause and recognise that the usual way to provide for such a fee is for doctors to be able to claim it back from the health authority without going through such hoops.

Mr. Dismore

The hon. Gentleman is not reflecting reality. He has had a few pot-shots at lawyers. No lawyer will ever get rich on this fee. In 20 years in practice, I have never known a GP sue a victim to get the money back. It is just an extra line to add to the column of calculations. I have never charged anyone for it and I do not know anyone who has.

Dr. Harris

That adds to the force of my argument. No one benefits from the regulations. I was being charitable to the Government, who want to retain the charge, by supposing that there might be some group of professionals lobbying for the retention of the system. I do not blame GPs for wanting to retain the income, but they can do that through item-of-service claims from the health authority. If lawyers are not getting rich on it, patients find it offensive, GPs find it hardly worth the trouble and health authorities eventually have to pick up the tab, that is the definition of a bad law. Bad laws are repealed when a suitable legislative opportunity arises and the Minister must accept that this is such an opportunity. I am simply asking the Government to accept new clause 1, either here or in another place.

1.30 pm
Mr. Simon Hughes (Southwark, North and Bermondsey)

Can my hon. Friend tell the House what percentage of the total revenue value is collected under present arrangements? Another argument in support of his proposition that a bad law is one that practically nobody uses is the fact that most people do not avail themselves of the legislation.

Dr. Harris

I thank my hon. Friend for that intervention. Indeed, the hon. Member for Rutland and Melton (Mr. Duncan), who cannot be here today, asked that question in Committee. The Minister replied that he did not know how much money was collected and said that the information.… is not collected centrally and acknowledged that that was a familiar refrain. Many of us consider it to be a euphemism for saying that the information is not collected deliberately.

If the Government were able to ascertain by means of a simple survey of a random sample the sum of money that was collected by GPs, I expect that they would find that it was precious little. I am sure that health authorities have accounts of how much they dole out under the emergency treatment provision, although the road traffic cases would have to be separated from the rest.

I accept that the information is impossible to obtain, except by means of survey, but all the evidence so far suggests that it is hardly collected. Even if the fee were to raise a substantial sum, the Liberal Democrats would still consider it inappropriate. The fact that it offends patients and is a direct charge on drivers who may be patients for NHS care is sufficient reason for that charge to be abolished, just as the Government propose to abolish the hospital emergency treatment fee.

The Minister said in Committee: we are removing the right of NHS hospitals to collect the emergency treatment fee. It is right that we do that because it is a nightmare to collect. Front-line NHS staff are involved in recovering charges, which is not appropriate; the fee is set at a level that calls into question its worth; and we sympathise with the plight of some drivers who are faced with a bill for treatment. —[Official Report, Standing Committee B, 12 January 1999; c. 65-6.]

There is no difference between the GP emergency treatment fee and the hospital one. Indeed, hospitals could arrange for solicitors to act on their behalf. I did not notice the hon. Member for Hendon proposing on Second Reading or in Committee that hospitals could employ solicitors. What applies to GPs should also apply to hospitals. As the Minister pointed out, the only difference is that GPs are independent contractors. I accept that, but there is still a provision for those independent contractors to receive the fees to which they are entitled.

Will the Minister consider accepting the new clause? Ultimately its implementation will cost nothing as the fee can be collected by health authorities. The new clause would fulfil what I believe to be the intentions of those who drafted the Bill and avoid offending drivers and patients who are asked to pay directly that small but significant fee to the NHS.

Mr. Philip Hammond (Runnymede and Weybridge)

The Opposition support the new clause, as it is identical to the one tabled in Committee by my hon. Friend the Member for Rutland and Melton (Mr. Duncan), who sadly is unable to be here today. He sends his apologies, as he is attending the funeral of His Grace the Duke of Rutland.

The issue was debated extensively in Committee, but was not voted on owing to some confusion over the interrelationship between new clause 1 and clause 18 of the Bill. I understand that it has now been established that new clause 1 stands alone, and can be considered alone today.

As the hon. Member for Oxford, West and Abingdon (Dr. Harris) said, all parties to the discussion recognise that the emergency treatment fee has caused disproportionate costs to those collecting it and distress to those from whom it is collected. The previous Government made it clear that it was their intention to abolish the emergency treatment fee as soon as a convenient legislative opportunity arose. It was not a burning issue—more of a tidying—up exercise. This Bill is such an opportunity.

The Minister's immediate predecessor—now the Chief Secretary to the Treasury—referred to the charge as a "sick tax" and a "tax on accidents". Fortunately for the right hon. Gentleman, fate intervened to prevent the Committee from hearing his explanation of the retention of what my hon. Friend the Member for Rutland and Melton has described as a "fag-end" of a charge.

The Minister has indicated in Committee that his motivation for retaining the charge is essentially permissive, and that he seeks to leave it to individual GPs to decide whether or not it is worth collecting the charge. That runs the risk of different practices being adopted in different places, and of public confusion being generated. The Minister will agree that concern about different treatment of similar cases is one of the consistent themes of the debate about the NHS.

At £21.30, the charge is probably irrelevant to most GPs, but it is also insulting. Either they are expected to attend accidents as part of their contracted NHS work—and should, as the hon. Member for Oxford, West and Abingdon said, be suitably rewarded by the NHS for that work—or, if that work is viewed as independent and outside the NHS GP contract, they should be able to levy a charge that reflects the real contribution that they make at the incident. We should bear it in mind that, for the most part, the patients are not the GP's own patients but passing strangers, and that the GP has happened to be the first person available at the scene.

The Minister and the House may recall a case that was widely reported in the press a few months ago, in which a doctor on an American Airlines flight rendered life-saving assistance to another passenger, and sent the airline a bill for £240 which the airline refused to pay. The doctor, in a much-publicised case, sued the airline in London for payment of his bill. The public attitude at the time was that the airline's compensation to the doctor—a bottle of champagne, which probably had about the value of the £21.30 charge that we are talking about—was wholly inappropriate and insulting in the circumstances of a life-saving intervention. It was widely thought to be a mean recompense for the work that he had done.

The Minister has presented the retention of the emergency treatment fee as an opportunity for GPs—as essentially a permissive measure, allowing GPs to charge the fee. However, is it not in fact essentially restrictive in its operation? Does not the emergency treatment fee define the amount that a GP—a private contractor—is able to charge for attending a road accident, and set that amount at an artificially low level?

If the levying of a charge by a GP at the scene of an accident is to be seen as an act of private medicine—something that the GP carries out outside the terms of his NHS contract—the charge is limiting, and too low. If, on the other hand, it is to be seen as part of a GP's NHS duties, it is very important that the application of the emergency treatment fee, and the charging of it to patients, should be universal, because it will rightly lead to public discontent if people in the same situation are treated in different ways on different occasions.

The emergency treatment charge, and the cost and distress caused by its collection, can no longer be justified by the same logic that the Government have used to argue for the abolition of the charge in hospitals. It is a fag-end of a charge and no longer has any constructive use in the context of the rest of the Bill.

Mr. Hutton

We discussed this aspect of the Bill extensively in Committee. Most of the arguments that we have heard today were substantially rehearsed then. I made it clear in Committee that I had some sympathy with the arguments but, for the reasons that I gave then, and which I will briefly rehearse again today, I will invite the House to reject the new clause if the hon. Member for Oxford, West and Abingdon (Dr. Harris) forces a Division.

I must correct one or two misunderstandings that have arisen today. The hon. Member for Oxford, West and Abingdon implied that the emergency treatment fee was last increased in 1988; that is not the case—I am sure that it was merely a slip on his part—as it was last increased in 1995 by the previous Government. The hon. Member for Runnymede and Weybridge (Mr. Hammond) said that they intended to abolish it—unfortunately, they never got round to doing it, although they had 18 years in which to have a fist at it—but I understand that, far from the position being as the hon. Gentleman said, Ministers in the previous Administration decided ultimately not to abolish it. That might be food for thought for the hon. Gentleman when he considers whether his hon. Friends should support the new clause.

I want to re-emphasise the fact that we have received no representations at all from the medical profession asking us to remove the right to claim the emergency treatment fee. The failure of the hon. Member for Oxford, West and Abingdon to tell the House the result of his consultation with the medical profession was conspicuous. I asked him whether it had expressed a view to him about whether the emergency treatment fee should be abolished. I understand its position to be that it wants the right to claim the fee to be retained in the legislation.

As a general principle of how we legislate, I am not sure that it is a terribly good idea to introduce changes at this stage of a Bill's progress without consulting the relevant people—in this case, the medical profession—in the way that the hon. Member for Oxford, West and Abingdon implied that he had.

Dr. Harris

I made it clear at the beginning of my speech that we were seeking to abolish not the right of general practitioners to claim the fee but the provision whereby they have to approach the patient, whether directly or through a solicitor. That is crucial. The general practitioners to whom I spoke—at least one of whom is present in the House—would welcome the opportunity to claim the fee through the health authority, in the normal way, and not directly from the patient.

Mr. Hutton

I will come to that point in a minute, but we should be quite clear that the hon. Gentleman and his supporters, without having first sought the views of the medical profession, are proposing to remove from general practitioners the right to claim the fee. As I understand it, the profession's views are clear: it wants to retain the option to claim an emergency treatment fee. He is proposing a change in the law that does not command the support of the medical profession, to whose views he has turned only very late in the day. That is not a scientific or appropriate way in which to progress the argument.

Mr. Hammond

The Minister appears to be allowing the medical profession to dictate the legislative agenda. I will be very interested to see whether that deference continues when we consider the NHS Bill later in the Session.

Mr. Hutton

The hon. Gentleman is perhaps reading more into my remarks than he should. I am saying that the Liberal Democrats are proposing a change in the law that they have not trailed in advance with the medical profession and on which they have not sought its views. The point I am making is that it is appropriate, when the law is being changed, to consult properly those parties who will be affected by the change. The hon. Member for Oxford, West and Abingdon has not done that on this occasion and that is another reason why I will urge my hon. Friends to reject the new clause.

1.45 pm
Mr. Simon Hughes

The Minister is trying to use an answer that is not the substantive answer as a defence to the proposition made by my hon. Friend the Member for Oxford, West and Abingdon (Dr. Harris). My hon. Friend's case has two elements, the most important of which is that it is inappropriate for somebody to seek the fee from the victim at the roadside, or later through solicitors. What would be the Minister's view if the proposition were simply that a different method of collecting the money for the service were used? For example, the health authority could be asked for payment rather than the person affected directly.

Mr. Hutton

As the hon. Gentleman is aware, that is a possible option. It was raised by the hon. Member for Oxford, West and Abingdon and I shall try to deal with the points that he raised in a minute. We have considered the issue carefully and the Department has received approaches from various representative bodies. We know that general practitioners continue to want the right to collect the fee as independent contractors, if they consider collection worthwhile in terms of effort and the effect on those from whom the fee is claimed. We are not minded to remove a right that has belonged to GPs since 1934.

It was suggested in Committee that if collecting the emergency treatment fee were a problem for hospitals, that must also be true for GPs and independent doctors. We have checked that point. We also received no representations from independent doctors on the emergency treatment fee, other than ones wishing to see it remain. Indeed, some representations suggested that it should be increased. We have not received any representations from the profession asking us to abolish the right to claim the emergency treatment fee.

Dr. Peter Brand (Isle of Wight)

Can the Minister say how many independent contractors have made those representations? I am not surprised that we have not seen massive numbers of GPs calling for the abolition of the charge, because most GPs do not claim it or even carry the paperwork to claim it. It is against the ethos of most people working in primary care in the health service.

Mr. Hutton

I wish to correct one misunderstanding held by the hon. Gentleman. The right to collect the emergency treatment fee is not limited to GPs in the national health service but is, in theory, available to any legally qualified medical practitioner, whether he has a contract with the national health service or not. I said earlier that I had some sympathy with the arguments made by the Liberal Democrats, but the profession has not made representations to the Government for such a change.

Mr. Simon Hughes

Answer the question.

Mr. Hutton

I have answered the question. I have repeatedly made it clear to the House that no representations have been made asking Ministers to abolish the emergency treatment fee. Those members of the profession whom we have consulted want to retain the right as an option.

The hon. Member for Oxford, West and Abingdon also raised the issue of the impact of the change on the national health service's budget. Although we are able to recover the loss of income in the hospital sector through the new tariff, if the emergency treatment fee were scrapped for GPs, health authorities would have to meet the costs in every case. There is no method to recoup the lost income in that situation. The new clause would impose an additional, unquantifiable financial burden on the national health service, and the Liberal Democrats have not told us where the additional resources to pay for that would come from. I have some sympathy with the argument of the hon. Member for Oxford, West and Abingdon, but for the reasons that I have advanced, today and in Committee, I shall urge my hon. Friends to reject the new clause.

Dr. Harris

That answer is wholly unsatisfactory for a series of reasons, and I have to press the Minister further. Although these points were discussed in Committee, the extra information that the Minister has given has been much less satisfactory than that given in Committee.

It is not the job of an Opposition party to consult on legislative opportunities. If we were to be given some civil service time, we could do a poll within a few days, and certainly well before the Bill completes its proceedings here and in the other place. Our question would not be the Minister's, which is, "Do general practitioners want to retain the right to receive income for this item of service?" We would ask, "Do GPs wish to retain the right to receive income from individual patients rather than claiming it back from the health authority?"

Sir Robert Smith (West Aberdeenshire and Kincardine)

Ministers confuse the situation further by saying that they want to keep the option. They may not want to use the option, but they want to keep it. Out-patients lying in the street will not know as a general practitioner approaches whether or not that GP plans to use the option. There will be random charges on people depending on who is their GP.

Dr. Harris

That is an important point. In the last part of what the Minister said, he stated that switching the claim from patient to health authority would increase costs on health authorities. If he says that that cost would be unquantifiable, he must accept that there is currently an unquantifiable direct cost on patients. The difference between the situation that he envisages and the current situation is that patients pay the difference. The unquantifiable cost is put directly on patients.

In making his point, the Minister concedes my other point: doctors do not mind where the income comes from. In fact, doctors would largely object, as does my hon. Friend the Member for Isle of Wight, to claiming the money directly, or through a solicitor, from the patient.

Dr. Peter Brand

There is some confusion about emergency treatment and fees for road accidents. There is a perfectly respectable way in which to pay GPs for providing emergency treatment to people other than their own patients. Most GPs accept that they have an obligation to patients on their own list and on the lists of their partnership. The national health service is there to provide all necessary treatment.

When the need arises for a doctor to give emergency help to someone else's patients, the GP can, under every circumstance except that of a road traffic accident, make a perfectly proper claim to the NHS through his or her health authority. We urge the Minister to remove the limitation on emergency treatment—

Mr. Deputy Speaker (Mr. Michael J. Martin)

Order. The hon. Gentleman is making a speech rather than an intervention.

Dr. Harris

I understood my hon. Friend's point although it was curtailed. If he feels that I did not, I should be happy to hear him make a speech.

At present, the retention of the provision allowing general practitioners to claim a fee directly from the patient makes a difference only to those patients already on the relevant GP's list. If the patient is not on the GP's list, the general trend is to claim an emergency treatment fee from the health authority. The law forces the GP to make an extra claim only on those patients who have a relationship with that doctor. Nothing is so calculated to damage the doctor-patient relationship as people on a GP's list being asked by their doctor for an additional treatment fee for treatment outside the surgery in a car crash.

The Minister has not said how many doctors have written, of their own volition, to say that they want to retain the option to reclaim the fee. The question should be whether doctors want to retain the fee from the patient, not the health authority. Will the Minister quantify the representations that he has had, and, if possible, will he place them in the Library before the Bill goes to the other place?

It is the Government's duty to ask questions of the profession. The key question is whether GPs think it appropriate to have the power to collect the money directly from the patient.

The Liberal Democrats believe that progress can be made on health service provision even in the face of opposition from doctors. The Minister put a most un-Bevanite concept to the House when he said that if an unquantified number of doctors object to the way in which they are paid, no legislative progress can be made. We Liberal Democrats do not accept that concept. As the hon. Member for Runnymede and Weybridge (Mr. Hammond) hinted, this Government have a tradition of caving in to general practitioner vested interests, for example, on the composition of primary care groups and a number of other issues.

If the question were put in the way that I suggested, I do not believe that the medical profession would object or, even if it did, that the Government should not legislate. After all, hospitals were not consulted on whether their emergency treatment fees should be abolished and they are so strapped for cash that I am sure that they would want to claim that extra income if they thought it worth while.

I shall hone down my questions for the Minister. How many responses to the consultation were received? Will he place them in the Library, so that we can see them? Will he ask the question correctly before the Bill ends its progress in another place? Does he agree that, regardless of the view of the medical profession, if the policy is deemed to be right and in the patient's interests, he should follow it?

Finally, what is the view of patients? That question remains unanswered, I suspect because it was not asked. It is a simple matter for the Minister to ask the Patients Association whether patients should be liable to pay a general practitioner for NHS treatment within seven days in an emergency situation.

I regret that the Minister's reply did not satisfy me. He placed the burden of legislation on the Liberal Democrats, which we would be more than willing to accept if the Government were prepared to ask us for legislative ideas outside the House. The Government are capable of undertaking those consultations, finding the answers and considering the principle of the charging mechanism. I urge the Minister to come back with more encouraging comments.

Mr. Simon Hughes

We want to bring this matter to an early conclusion. I hoped that the Minister would respond positively to my hon. Friend the Member for Oxford, West and Abingdon. I shall add one point and, if we still receive no response from the Minister, I think both the Conservatives and the Liberal Democrats will have to press the matter, because we should have had a concession.

The Minister is new to his post, but he gave some of the weakest arguments in defence of the Government's position that I have ever heard during debates on health service legislation. He does not have the figures and he did not say that the change would bring in a large amount of revenue for the health service. Nor did he say that it would be in the patients' interests. All he said was that the provision gives an option, which virtually no one uses, to collect some money, which is probably not very much. That is no way to run the health service. If we were talking about the Government forgoing billions of pounds, I could understand it, but we are not.

My hon. Friend the Member for Isle of Wight (Dr. Brand), who has regular experience of these matters, pointed out how general practitioners in the health service reclaim fees for work that they do that is over and above work for their patients and their practice. In a rationed, streamlined and intelligent health service for the next century, what on earth is the argument for having one system to reclaim money for all sorts of activities, and a different system—which most GPs do not want to use because they consider it embarrassing and unethical—to reclaim money for one small category of people for one sort of work that GPs do? There is no logic to such a system. If we are trying to reduce the burden of bureaucracy on my hon. Friend the Member for Isle of Wight, his wife and other practitioners in the health service, for heaven's sake let us have one system, which will allow one piece of paperwork whereby one collects money in one way at one time and reduces the charges to the rest of the system.

Unless the Minister gives the House some comfort, we will not only force the new clause to a vote now, but we will be obliged to oppose the Bill on Third Reading because the Government's position has no logic. Also, we will ask our colleagues in the other place, where the Government do not yet have a majority, to ensure that common sense prevails. If we cannot get common sense from Ministers in this House perhaps, before the consistutional changes up the Corridor, there will have to be another Government defeat in the Lords, in the interests of the patients of the British national health service.

Dr. Harris

I should like to sum up because there are now more Labour Members in the Chamber than before. I wish to make it clear to the Government that it is because of their motives and words that we shall press the new clause to a Division. As the Minister said in Committee, the money is a nightmare to collect. Front-line staff are involved in recovering charges. If Government policy is dictated by what is acceptable to GPs, today's announcement by the General Medical Services Committee on the Government's outrageous rationing decisions will give the Government serious pause for thought. On that note, I commend new clause 1 to the House.

Question put, That the clause be read a Second time:—

The House divided: Ayes 28, Noes 208.

Division No. 43] [2 pm
AYES
Kirkwood, Archy
Livsey, Richard
Allan, Richard Llwyd, Elfyn
Beith, Rt Hon A J Moore, Michael
Bell, Martin (Tatton) Morgan, Alasdair (Galloway)
Brake, Tom Öpik, Lembit
Brand, Dr Peter Rendel, David
Bruce, Malcolm (Gordon) Russell, Bob (Colchester)
Burnett, John Sanders, Adrian
Chidgey, David Stunell, Andrew
Cotter, Brian Tyler, Paul
Foster, Don (Bath) Willis, Phil
George, Andrew (St Ives)
Hancock, Mike Tellers for the Ayes:
Harris, Dr Evan Sir Robert Smith and
Heath, David (Somerton & Frome) Mr. Colin Breed.
Hughes, Simon (Southwark N)
Kennedy, Charles (Ross Skye)
NOES
Ainsworth, Robert (Cov'try NE) Chisholm, Malcolm
Allen, Graham Clapham, Michael
Anderson, Janet (Rossendale) Clark, Dr Lynda (Edinburgh Pentlands)
Ashton, Joe Clarke, Tony (Northampton S)
Austin, John Clelland, David
Barnes, Harry Coaker, Vernon
Bayley, Hugh Coffey, Ms Ann
Beckett, Rt Hon Mrs Margaret Coleman, Iain
Begg, Miss Anne Colman, Tony
Benn, Rt Hon Tony Connarty, Michael
Berry, Roger Cook, Frank (Stockton N)
Best, Harold Cooper, Yvette
Blizzard, Bob Corbyn, Jeremy
Borrow, David Corston, Ms Jean
Bradley, Keith (Withington) Cox, Tom
Bradley, Peter (The Wrekin) Cranston, Ross
Bradshaw, Ben Cryer, Mrs Ann (Keighley)
Brown, Russell (Dumfries) Cryer, John (Hornchurch)
Buck, Ms Karen Cummings, John
Butler, Mrs Christine Cunningham, Jim (Cov'try S)
Campbell, Mrs Anne (C'bridge) Davies, Rt Hon Denzil (Llanelli)
Campbell, Ronnie (Blyth V) Davies, Geraint (Croydon C)
Caplin, Ivor Davis, Terry (B'ham Hodge H)
Caton, Martin Dean, Mrs Janet
Cawsey, Ian Dismore, Andrew
Chapman, Ben (Wirral S) Doran, Frank Chaytor, David
Dowd, Jim Marshall, Jim (Leicester S)
Drew, David Martlew, Eric
Eagle, Angela (Wallasey) Merron, Gillian
Eagle, Maria (L'pool Garston) Michie, Bill (Shef'ld Heeley)
Efford, Clive Milburn, Alan
Ellman, Mrs Louise Miller, Andrew
Etherington, Bill Mitchell, Austin
Fisher, Mark Moran, Ms Margaret
Fitzpatrick, Jim Morgan, Ms Julie (Cardiff N)
Flynn, Paul Mullin, Chris
Follett, Barbara Murphy, Denis (Wansbeck)
Foster, Michael Jabez (Hastings) Naysmith, Dr Doug
Foulkes, George Norris, Dan
Fyfe, Maria O'Brien, Bill (Normanton)
Galloway, George O'Hara, Eddie
Gardiner, Barry Organ, Mrs Diana
Gerrard, Neil Osborne, Ms Sandra
Godman, Dr Norman A Palmer, Dr Nick
Goggins, Paul Pearson, Ian
Gordon, Mrs Eileen Perham, Ms Linda
Griffiths, Jane (Reading E) Pickthall, Colin
Griffiths, Nigel (Edinburgh S) Pike, Peter L
Grocott, Bruce Plaskitt, James
Grogan, John Pollard, Kerry
Gunnell, John Pond, Chris
Hall, Patrick (Bedford) Pope, Greg
Hanson, David Pound, Stephen
Heal, Mrs Sylvia Prentice, Ms Bridget (Lewisham E)
Healey, John Prentice, Gordon (Pendle)
Henderson, Ivan (Harwich) Prosser, Gwyn
Heppell, John Quin, Ms Joyce
Hill, Keith Quinn, Lawrie
Hinchliffe, David Radice, Giles
Hoey, Kate Rammell, Bill
Home Robertson, John Rapson, Syd
Hughes, Ms Beverley (Stretford) Reed, Andrew (Loughborough)
Hughes, Kevin (Doncaster N) Rooker, Jeff
Hurst, Alan Ross, Ernie (Dundee W)
Hutton, John Ruane, Chris
Iddon, Dr Brian Russell, Ms Christine (Chester)
Jackson, Helen (Hillsborough) Ryan, Ms Joan
Jenkins, Brian Salter, Marlin
Jones, Helen (Warrington N) Savidge, Malcolm
Jones, Ms Jenny (Wolverh'ton SW) Sawford, Phil
Jones, Martyn (Clwyd S) Sedgemore, Brian
Keeble, Ms Sally Shaw, Jonathan
Kelly, Ms Ruth Sheldon, Rt Hon Robert
Kennedy, Jane (Wavertree) Shipley, Ms Debra
Kilfoyle, Peter Simpson, Alan (Nottingham S)
King, Andy (Rugby & Kenilworth) Skinner, Dennis
Kingham, Ms Tess Smith, Rt Hon Andrew (Oxford E)
Ladyman, Dr Stephen Smith, Angela (Basildon)
Laxton, Bob Smith, Miss Geraldine (Morecambe & Lunesdale)
Lepper, David Smith, John (Glamorgan)
Leslie, Christopher Soley, Clive
Lewis, Ivan (Bury S) Southworth, Ms Helen
Linton, Martin Starkey, Dr Phyllis
Lloyd, Tony (Manchester C) Steinberg, Gerry
Lock, David Stewart, David (Inverness E)
Love, Andrew Strang, Rt Hon Dr Gavin
McAllion, John Stringer, Graham
McAvoy, Thomas Stuart, Ms Gisela
McCabe, Steve Sutcliffe, Gerry
Macdonald, Calum Taylor, Rt Hon Mrs Ann (Dewsbury)
McDonnell, John Taylor, David (NW Leics)
McGuire, Mrs Anne Thomas, Gareth R (Harrow W)
McIsaac, Shona Timms, Stephen
McNulty, Tony Tipping, Paddy
McWalter, Tony Todd, Mark
Mahon, Mrs Alice Touhig, Don
Mallaber, Judy Turner, Dr George (NW Norfolk)
Mendelson, Rt Hon Peter Twigg, Stephen (Enfield)
Marek, Dr John Vis, Dr Rudi
Marsden, Paul (Shrewsbury) Wareing, Robert N
Marshall, David (Shettleston)
White, Brian Worthington, Tony
Whitehead, Dr Alan
Williams, Rt Hon Alan (Swansea W) Tellers for the Noes:
Wood, Mike Mr. Mike Hall and
Woolas, Phil Mr. Clive Betts

Question accordingly negatived.

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