HL Deb 15 December 1975 vol 366 cc1233-42

3.57 p.m.


My Lords, with the permission of the House, it might be convenient if I were now to repeat a Statement made in another place by my right honourable friend the Secretary of State for Social Services on private practice and the National Health Service. The Statement reads as follows:

"The House will be glad to know that this morning I have met representatives of the medical and dental professions on the Government's proposals for phasing private practice out of NHS hospitals. As a result of this meeting, they are ready to call the Central Committee for Hospital Medical Services and the British Medical Association Council and the Council of the Hospital Consultants and Specialists Association together later this week and submit proposals to them for urgent consideration. It is hoped that they will be accepted and normal working resumed.

"As the House will be aware, the Prime Minister and I met a representative delegation of the professions on 3rd December at which the professions expressed anxiety that the Government's proposed legislation on phasing out private practice from NHS hospitals could render nugatory the practice of private medicine in this country which the Government have always said they do not intend to abolish. At that meeting outline proposals were put forward by the noble Lord, Lord Goodman, which were regarded as the basis for urgent exploration. The Prime Minister undertook that these proposals would be examined and that the professions would be informed of the Government's response.

"Since that time a process of clarification has been taking place with me through the noble Lord, Lord Goodman, and proposals have been evolved which the Government hope will lead to an end to this dispute. If the professions as a whole agree these proposals and normal working is resumed, the Government will embody these proposals in their legislation.

Under the proposals, a copy of which has been placed in the Library, the professions make clear their continuing opposition to the phasing out of private practice and reserve their right to try to influence Parliament's decision on the point of principle, but they acknowledge that this may become the will of Parliament. It is proposed that the legislation would embody two principles: first, that private beds and facilities should be separated from the NHS and, secondly, an expression of the Government's commitment to the maintenance of private practice in this country through the renewal of the provision in the National Health Service (Amendment) Act 1949 which maintains the right to private practice by entitling doctors to work both privately and in NHS establishments. These two commitments will be related through the establishment of an independent board set up by the Government. The board will have an independent chairman, two members drawn from the medical profession and acceptable to it and two members appointed after consultation with NHS staff and other interested parties.

"The criteria under which pay beds and facilities would be phased out in the legislation will be the reasonable availability of alternative facilities for private practice. It is accepted that there are some pay beds and facilities which on this basis, and on the basis of their under-use, could be phased out without delay. The Bill will therefore contain a Schedule, giving details of 1,000 pay beds which will be phased out of the NHS within six months of Royal Assent. The Schedule will be drawn up on the criteria which I have mentioned and after consultations with all concerned. The phasing out of the remaining pay beds would be determined by the independent board which would be guided by the following criteria: that there should be a reasonable demand for private medicine in the area of the country served by a particular hospital; that sufficient accommodation or facilities existed in the area for the reasonable operation of private medicine, and that all reasonable steps had been, or were being taken to provide those alternative beds and facilities. This would be kept under continuous review. Where all reasonable steps were not being taken, that would, after due warning, be in itself grounds for withdrawing pay beds and facilities in the hospitals concerned.

"One of the factors the board would bear in mind in deciding whether private facilities for specialised operations, treatments and investigations should be phased out would be the willingness of the NHS to make such facilities reasonably available on an occasional basis in specified circumstances and at an appropriate charge. The Secretaries of State would have to be satisfied that there would be no disadvantage to NHS patients and that such patients were admitted on the same basis of medical priority as NHS patients.

"As stated in the Queen's Speech the regulation of the private sector following the separation of pay beds will be subject to further consultation with the professions. In the meantime the Government need to be satisfied that developments in the private sector do not significantly endanger the service the NHS gives to its patients and will enter into consultation with the medical profession as to how this can be achieved by voluntary means. The consultations would cover the point as to whether any reserve powers that it proved necessary to take in the legislation might be exercised by the independent board.

"The Government believe that the smooth phasing out of pay beds would be facilitated if, pending their withdrawal, a system of common waiting lists were to be introduced. The professions have expressed reservations on this matter, but it is proposed that the legislation should instruct the board to examine this and make recommendations to the Secretaries of State within six months of Royal Assent to the Bill.

"I hope that, in the light of these proposals—with which the Secretaries of State for Scotland and for Wales associate themselves—the professions will now accept that this is a matter for Parliament and end the damaging industrial action by senior medical staff. The issue of private practice in National Health Service hospitals has long been one of great controversy, not least within the Service itself. These proposals will ensure that the policy of separation is achieved, but in a way which should allay the fears of the medical profession, and provide an enduring settlement."

My Lords, that is the end of the Statement.

4.6 p.m.


My Lords, the House will be grateful to the noble Lord, Lord Wells-Pestell, for having repeated a very long and somewhat complicated Statement which we shall be glad to study in detail at a later stage. Many matters are raised in this Statement—matters which your Lordships' House debated at length in a debate earlier this month. First, there is a primary matter, to which we take particular exception, the phasing out of 1,000 pay beds. Here I quote the Statement: …which will be phased out of the NHS within six months of Royal Assent. This is wholly repugnant to the professions who have been in close touch with the noble Lord's right honourable friend. It is also wholly repugnant to this side of your Lordships' House and to all those concerned with the prosperity of the National Health Service and private practice in concert.

We believe most sincerely that the arbitrary nature of this decision will not lend itself to future harmony within the profession. Perhaps the noble Lord would be able to tell the House the reason for this decision. We take the view that it would be better to defer this decision so that it becomes a matter to be considered by the board which is to be set up at an early stage. We are naturally glad that in the terms of the Bill there will be provision for the re-enactment of the National Health Service (Amendment) Act 1949,which will maintain the right to private practice in the profession and will entitle doctors to work both privately and in National Health Service establishments. We believe that this is fundamental, and we are pleased that the Government have at last yielded to the very real arguments put forward by the profession.

Finally, what particularly concerns us is the question of the private sector in its various establishments after the Bill has been laid before your Lordships' House. I remind your Lordships of what the Secretary of State said in her speech at Folkestone on, I think, 9th October, relating to the circumscribed way in which Her Majesty's Government see the private sector operating. This has no mandate whatever in the Government's programme. There was nothing whatever in the programme about the circumscribed way in which they foresee private beds being made available. We recognise that it may be necessary to reach a new distribution of private beds, but this is a wholly different matter and one on which we hope the board will work in close consultation with the profession.

4.10 p.m.


My Lords, I should like to welcome in a very warm fashion the Statement which has been made because I am pleased to see that it has now been accepted that it is the will of Parliament which must remain supreme. This means that there is a good chance that the consultancy profession will call off the strike in which they are indulging now—because although it may be covered up by the words "industrial action", it is in fact a strike—and that, as I said to your Lordships the other day, is something in which I do not think members of my profession should indulge. The other thing about which I am a little uncertain, although I do not disagree with it at all, is that we are told the facilities for private work will be separated from the National Health Service but will be allowed to continue on the understanding that there is no interference with the work for the National Health Service patients. My Lords, apart from the pay bed issue I have never come across any example of facilities being available to private patients which has militated against work for the National Health Service, and I have worked for the National Health Service for a period of20 years.

One further point I should like to make concerns the waiting lists. It has always seemed to me that there was an enormous amount of work to be done on waiting lists because, from what little experience I have had of them, I have never been certain how genuine they are. I see that the board is to make a recommendation about waiting lists at the end of six months. I wonder whether six months will really be long enough to do what will be an extremely difficult and intricate job. Finally, my Lords, I am rather disappointed that the Statement contains no reference to the Royal Commission which, about six weeks ago—I cannot remember exactly; it is so long ago that I have almost forgotten when it was—we were promised would be set up. I am surprised there was no reference to it in the Statement, and one wonders whether, again, this is to be an egg which will be addled from the start.


My Lords—


My Lords, I am sorry, but I think that the practice of the House requires me to answer the two Front Bench spokesmen first. I think this is an inopportune moment to have another debate on the National Health Service, and if I may say so with very great respect to noble Lords, I hope we shall not be tempted to do that. I am surprised that the noble Lord, Lord Sandys, should talk about a certain repugnance on the part of the consultants at the idea of phasing out at one fell swoop 1,000 beds. I think that, if he consulted them, he might well find that that repugnance does not exist. They recognise, as we all recognise. that we have 4,451 private beds within the National Health Service. Only about 2,500 of them are in full occupancy. I admit that some of the others are used for a few weeks in the course of a year, but when you total them it amounts only to something like 2,500. I think that most people who are aware of the situation would recognise that we could dispose of 1,000 beds without any detriment at all to private practice. The question of the remaining beds will be one for the board to deal with. It will be for the board to see whether there is a sufficient number of pay beds available in any one district. This is their function, and it will be their decision. Perhaps I could leave that there.

My Lords, I am grateful to the noble Lord, Lord Amulree, for his contribution, which I thought was a very balanced one. As to his point about the Royal Commission, the only comment I would want to make is that the function of the Royal Commission is to look at the whole of the National Health Service. This Statement deals with a specific problem, so far as private practice and the consultants are concerned, and my right honourable friend the Secretary of State wanted to deal with this separately in view of the pressing and urgent need to get this result.


My Lords, may I ask the noble Lord two questions? First, will the board, whose functions are at the moment rather difficult to follow, be able to take into account the problem of pay beds in teaching hospitals, where private beds have always had a special importance for a variety of reasons? Secondly, what will be the position about foreigners? Am I right in saying that British subjects will not be encouraged to use pay beds in National Health Service hospitals, but that such beds will still be available to foreigners? Will those be included in the 1,000 or not?


My Lords, I cannot answer the noble Lord's second point. I just do not know; but I will find out, and I shall certainly let him know what the position is.


My Lords, with respect, it is a rather important point.


My Lords, the noble Lord is talking about private beds available to foreigners. I was saying that, so far as private medicine is concerned, 1,000 beds can be disposed of without imposing any difficulties on private practice in this country. With regard to pay beds in the teaching hospitals, this will be a matter for the board to look at and to review, and it will be for them to make a decision on it.


My Lords, I do so agree that we should not turn this into an occasion for a major debate. I understand that a certain compromise is within our reach, or our possible reach, and anything which will prevent the medical profession behaving as it has been doing in recent times would be very greatly to my satisfaction. I endorse everything that the noble Lord, Lord Amulree, has said about that. With regard to waiting lists, to which he also referred, I think there is an enormous amount of bogus in waiting lists. When you really go into them I think you will find that an enormous percentage of them are in fact children waiting for tonsil and adenoid operations which are probably much better not done. It is high time that somebody looked into this matter very seriously.

As your Lordships know, I have no personal advantage to gain by the continuance of private beds, but I reiterate what I have said before; that is, that I think private practice is an enormously important education to any consultant and, so far from private practice militating against the National Health Service, it has always been my view that private practice increases a doctor's experience of medicine in the populace as a whole, and that this is to the advantage of the Health Service. I hope that a satisfactory compromise will be reached.


My Lords, I wonder whether the noble Lord, Lord Wells-Pestell is aware that, though he has a facility for making complex matters sound easy, the Statement was a complex one. He must be aware that, however favourably one may view its outcome, it is full of face saving and reflects the fact that there is a conflict into which ideology seems to enter. It is vital that we should be objective about this important matter. Is it too late for it to be put to a Royal Commission where it could be brought back into objective consideration the result of which everybody would accept, instead of passing it on in this way in which, clearly, there is a conflict of thought which can only be damaging in the future?


My Lords, the noble Lord is quite right. There are ideological differences and I have never been at any pains to deny that that is so. I believe that there must be a certain point where noble Lords on different sides of the House will not meet. The obvious thing to do is something which we have always been very good at; that is, trying to effect a compromise. I can only say what I said when we had the National Health Service debate in this House on 3rd December; that is, that, rightly or wrongly, we regard the issue as a political one and feel that it must, therefore, be determined by Parliament. We may be wrong about that, but that is how we feel. We do not believe that this is a matter which can be decided by the Royal Commission. Anything else, yes, but I should have thought that we had here not only grounds for reason and understanding but grounds upon which a solution to this rather distressing problem can be built.

May I add while I am on my feet that I have been looking again at the Statement in the light of the remarks of the noble Lord, Lord Reigate. It is a difficult Statement to take in. I said that the National Health Service would need to …make such facilities reasonably available on an occasional basis in specified circumstances and at an appropriate charge. I feel that the answer is that beds for such purposes as the noble Lord described would be provided in that way.


My Lords, would not the Minister agree that, whatever we feel about the private beds issue—whether or not we feel it to be a matter of principle—it is true that private beds and private practice are no threat to the National Health Service, which can be run only as a public service?


My Lords, before the noble Lord, Lord Wells-Pestell, replies, may I ask whether he has considered how much Her Majesty's Government and, indeed, all of us owe to the noble Lord, Lord Goodman, who has played a great part in this business, as in many others? Indeed, in so far as the Government are governing the country at all, the noble Lord seems to be doing most of it, and I feel should be paid a tribute.


My Lords, the noble Lord, Lord Boothby, has anticipated what I wanted to say. No one will get a perfect ideological solution, but I should like to feel that, when Members have read their Hansard and had time to consider this complex Statement, they will feel that we should send our congratulations to the Minister responsible, to the noble Lord, Lord Goodman—who is lurking in the background— and to the representatives of the medical profession.


My Lords, briefly to reply to my noble friend, the whole purpose of this operation is to ensure that the National Health Service is able to offer a really comprehensive, effective and efficient service, while alongside it there is private practice. I would endorse what the noble Lord, Lord Boothby, said, but it is hardly for me, occupying such a junioir capacity in your Lordships' House, to extend the thanks of my right honourable friend to the noble Lord, Lord Goodman. I am sure that she will have done this herself much more effectively than I could do.


My Lords, since the phasing out of the first 1,000 beds over a period of six months is a very considerable compromise on the part of the Government would my noble friend not agree that it would go a long way to provide reassurance to the various contributory schemes, as well as providing a very useful source of extra revenue to the National Health Service, if the phasing out of the remaining 3,000 beds were considerably slowed down after the end of the first six months?


My Lords, I cannot make any comment on the speed. This matter will depend entirely on the Board and it may well take some appreciable time before they are phased out. It may well be that there will be pockets—or perhaps I had better say "areas"—in the United Kingdom where it may take an extremely long time before one can offer a comparable service. So I believe that we must think in terms of a long-term operation rather than something which will take effect in six or 12 months.