HL Deb 20 October 1975 vol 364 cc1170-9

3.53 p.m.


My Lords, it may be for the convenience of the House if I were to repeat a Statement that is now being made in another place by my right honourable friend the Prime Minister about the Royal Commission on the National Health Service. His words are as follows:

"The Queen has been pleased to approve a recommendation that a Royal Commission on the National Health Service should be set up with the following terms of reference: To consider in the interests both of the patients and of those who work in the National Health Service the best use and management of the financial and manpower resources of the National Health Service. "The Royal Commission will also cover the parallel services in Northern Ireland.

"Its membership will be announced later.

"A great deal of concern has been expressed in the House and outside it about the state of the National Health Service. Despite the real cause for concern, Members on all sides of the House will know that the vast majority of its staff continue to give without complaint the skilled and devoted professional service which the nation has come to expect and which has made our Health Service the object of admiration and emulation throughout the world. But the fact remains that the National Health Service, like other services in all sectors of our national life, is under severe pressure from the economic difficulties which the country faces. In the case of the National Health Service, the situation has been accentuated by the upheaval of a major administrative reorganisation following the National Health Service Reorganisation Act 1973, and, in Scotland, the National Health Service (Scotland) Act 1972;by the unrest which followed from the Service's employees falling behind in pay before the substantial pay increases which they received over the last twelve months, and above all perhaps by the pressure of rising expectations as medical science advances and new and higher standards of care and service become attainable.

"The Government have responded positively to the needs of the National Health Service: since we took Office much more money has been put into it—£750 million extra in the last financial year—but pressure on the nation's resources will make it impossible to do all that is desirable over the years ahead. There is widespread and understandable concern about the future of the National Health Service in these circumstances. And it is essential that profound and careful thought is given to the question how the National Health Service—within the inevitable limits of what the taxpayer can provide—can make the best possible use of the finance and manpower available to it, in the interests of the patients and of those who care for them, in whatever capacity they serve.

"The Government concluded, therefore, that it would be right to establish a Royal Commission to carry out an independent examination of how this might be achieved.

"I should repeat that the Government's commitment—made clear in the two elections we fought and won in 1974—to phase out pay-beds from National Health Service hospitals remains unchanged and legislation will be introduced as soon as the Parliamentary timetable allows. My right honourable friends the Secretary of State for Social Services and the Secretaries of State for Scotland, Wales and Northern Ireland will therefore continue with the consultations on the proposals in the Government's Consultative Document. I must also make it clear, as my right honourable friends have already made clear, that the Government are equally committed to the maintenance of private medical practice in this country and we intend to guarantee this in the legislation we propose. My right honourable friend has stated that her proposals on licensing will not conflict with this and she has invited consultations on how the right to private practice can be combined with the need to prevent a drain of essential resources from the National Health Service, particularly in individual regions and locations.

"While, therefore, pay-beds and the provision for them of National Health Service facilities at the expense of the Service are in our view a matter for Parliament there are important questions touching on the borderline between the National Health Service and private practice, and on the important and continuing contribution which we expect and want private practice to make, which the Royal Commission will of course be free, if they wish, to consider, and on which evidence can be presented.

"I hope that all those concerned with the National Health Service, and all others to whom the National Health Service means so much, will take this opportunity to present their views to the Royal Commission and I am confident that the work of the Commission will prove to be a landmark in ensuring that the National Health Service is maintained and strengthened."

My Lords, that concludes the Statement.

3.58 p.m.


My Lords, this is a sad and sorry Statement. None the less, I should like to express my gratitude to the noble Lord for having repeated it in this House. The fact of the matter is quite clear; the Government have been forced to appoint this Royal Commission by the rising tide of criticism that has been evident lately, both inside and outside the National Health Service, and it is a favourite resort of government, faced with a crisis and with a difficult decision, to appoint a Royal Commission. But much as we may welcome the conclusions of this Royal Commission in the long run it will do nothing whatever to meet the present problems of the Service, which are largely caused by the misjudgment and incompetence of the Government.

It is incredible that there should be such resentment within the Service against the Government when most of those who are working in the Service are largely, as this Statement has recognised, devoted men and women ready to accept considerable hardship and personal sacrifice in the interests of their patients. None of us can possibly welcome industrial action in the National Health Service, but that that is happening is in my view entirely due to the mishandling of the situation by the Government.

It would be quite wrong for us in the midst of the very important discussions we are having on the Trade Union and Labour Relations (Amendment) Bill to debate the failings of the National Health Service at the present moment. Unfortunately with the weight of legislation that faces this House it will also be impossible to give any time to it in the rest of this Session. But I hope that the noble Lord the Leader of the House will respond readily to a request which I am sure this House will wish to put to him, that we should debate the matter very fully in the new Session.

The only really surprising and utterly indefensible part of this Statement is that the issue of private beds in National Health Service hospitals should be excluded from the remit of the Royal Commission. This proposal lies at the heart of much of the medical profession's anxieties, and surely it would be best considered by a Royal Commission and not by the arbitrary action of government. It falls directly within the terms of reference, the best use and management of the financial and manpower resources of the National Health Service. Whereas one might have hoped that the appointment of this Royal Commission would take some of the steam out of the present situation, in the circumstances, with this exclusion, I doubt very much whether it will do so.


My Lords, I should like to welcome the appointment of this Royal Commission as going some way to explaining and trying to get around some of the problems which beset the National Health Service at the present time. Some people say that Royal Commissions take a very long time, and sometimes they do, but they can move quickly if they want to. I remember that there was a Royal Commission under the chairmanship of a late leader of this Party, Lord Samuel, on the coal industry, which took its evidence in six months and produced its Report within two months after that so things can go quite quickly. I share the disappointment of the noble Lord, Lord Aberdare, that the question of pay-beds has been excluded from the Royal Commission. I hold no particular brief for pay-beds, but they seem to me to bring a certain amount of valuable revenue into the Service, and they are very good for the practice of medicine in this country and for the reputation of British medicine in foreign countries.

I must say that it is a trifle ironical to me at the present time to remember that when I was on the staff of a London teaching hospital I had only two patients in the private ward there, not because I had anything ideologically against it but because it was not very practical or very convenient. One of those two patients was a very respected member of the Party opposite, who was admitted to a pay-bed against my better judgment at the urgent request of Transport House. So funny things do occur.

I have a good deal of sympathy with the problems of the junior doctors at the present time, because I think a lot of the trouble in the medical profession and the ancillary professions was caused by that extraordinary managerial revolution which occurred under the National Health Service Reorganisation Act 1973. I think that has thoroughly upset the members of the medical profession and the nurses and the ancillary services, and at the same time it did no good to the patients or the doctors. So I think there is some trouble there. But there is one thing which I really do not agree with at all. Members of the professions, and particularly of the medical profession, do not go on strike. The welfare of their patients comes before their feelings about their troubles, and therefore they do not go on strike, and that is why, I am afraid, a good deal of my sympathy with them goes. If I may make a suggestion before I sit down, I was wondering whether something could possibly be done—what, I cannot say—to look at their problems and grievances before the Royal Commission finishes its work.


My Lords, I am very grateful for the approach of the noble Lord, Lord Amulree, and I share with him the feeling that the National Health Service, despite the strains that are put upon its resources, is a very great one and that the staff in all sections, apart from some exceptions, do their utmost to provide a genuine Service and a Service of great humanity to the people whom they serve.

So far as the noble Lord, Lord Aberdare, is concerned, after 3½ years as Minister of State in the Department of Social Security I should have thought we would have had a response of greater understanding of the problems of the National Health Service. He was a Minister who was responsible for 3½ years, when the Service was under great strain. I should have thought, therefore, that he would have had a greater sense of the problems of the Service. I will say this to the noble Lord. I will willingly debate with him the whole problem of the National Health Service in the debate on the Queen's Speech, if he will agree with his noble friend the Opposition Chief Whip that we should set aside one day for that. We will be most happy to take the noble Lord on, not in a sense of vindictiveness but to see whether, by common consent and common understanding and common knowledge, we can make some contribution to solving the problems of the National Health Service. Therefore, I do not propose to reply any further to the noble Lord. I will leave it to the Queen's Speech, which is not so very far away. If he and his Chief Whip will agree, we will set aside one day of the debate on the gracious Speech to debate the National Health Service.


My Lords, as one involved in the National Health Service, and as one of the many thousands of workers in the Service who are concerned with administration, may I say that I deeply and bitterly regret the words uttered by the noble Lord, Lord Aberdare, who is usually quite a moderate individual. On this occasion, his words will not assist the present unofficial industrial action taking place which —let us face it—can and will endanger human life. In my own hospital we are closing down the accident and emergency centre, and another hospital at Bromley is closing down its centre. Where are the extremely serious accident cases to go, in spite of the offer of consultants to give assistance where necessary? This is not a sad and sorry Statement. This is a Statement which has been long overdue, and the quicker this Royal Commission gets down to work and produces an interim Report the better it will be for the Service. But for Heaven's sake, at this stage of unrest in the Health Service, let us all get political bias out of it and deal with the real principles.

Noble Lords

Hear, hear!


Noble Lords opposite can shout "Hear, hear!" but I well remember the opposition to the original Health Service, encouraged behind the scenes, and there is an insidious form of political bias being introduced into this present doctors' dispute.


My Lords, may I ask my noble friend one question? Without entering into the merits or demerits of the pay-bed controversy, can he explain why the proposed Royal Commission, which obviously has to deal with all aspects of the National Health Service, is excluded from consideration of one of the most fundamental principles involved? Would it not be better to exercise some restraint and leave the matter to the Royal Commission to come to some conclusion, or am I to understand that the Government are under some pressure from certain quarters to come to some conclusion on one iseue, leaving all the others to be dealt with by the Royal Commission?


My Lords, would the noble Lord allow me to follow the noble Lord, Lord Shinwell, because the point I want to make is about the terms of reference? I cannot help feeling that it is a great mistake to exclude the question of pay-beds from the terms of reference. I speak as a member of the Younger Commission on Privacy. In our terms of reference we were excluded from dealing with the public sector. We made representations both to Mr. Callaghan and Mr. Maudling, but we were told that we could not look at privacy in the public sector. This inhibited our inquiries, the evidence that we could take, and in my view did not allow us to do justice to what we were meant to be doing. This is not a matter of Party politics, but speaking as one who served on one of these Committees I can say that it is terribly frustrating not to be allowed to deal with the whole subject, as the noble Lord, Lord Shinwell, says.


My Lords, in reply to my noble friend and the noble Lord, Lord Byers, as the Statement made clear this was a clear commitment by the Government to deal with the whole question of pay beds within the National Health Service. The Statement refers to when time is available for the consideration of legislation, but equally the Statement refers to the borderline between the National Health Service and private practice, and on the contribution which we expect and want private practice to make. The Royal Commission has its terms of reference, it is for them to interpret them, but I could not indicate to your Lordships that the Government can avoid the clear commitment they made during 1974 in this respect. This is a matter which will be open to Parliament to consider when legislation is produced.


My Lords, may I ask just one question. Is there any time limit as to when the Royal Commission is to report?—because these things take a terribly long time. There was the very important question of the rating. The Layfield Committee was given 18 months, and it hopes to report at the end of this year. We hope it will do good, but is there to be any time limit by which it should report?


My Lords, in view of the public concern there is clearly a need for an early report, but Royal Commissions are what they are and one cannot put a time limit upon their considerations. Of course it would be open, as I see it, to a Royal Commission to make an interim report should it so wish.


My Lords, would not all sources of finance for the National Health Service come automatically within the terms of reference for the Commission, including, for example, prescription charges, which an earlier Labour Government promised to abolish, did abolish, and then brought back?


My Lords, the terms of reference refer to the management of financial and manpower resources of the National Health Service. The resources that are available to the Service are very much those of the Government, and in this time of financial stringency I should not have thought that any noble Lord would feel that this is a matter that should go beyond the authority of the Government.


My Lords, is the noble Lord aware that pay beds go to the root of the problem? May I ask him, echoing the noble Lord, Lord Shinwell, why they have been excluded from the terms of the Royal Commission? They were accepted by the brilliant creator of the National Health Service, the late Aneurin Bevan. They have played a great part in the development of the National Health Service, and why should they be excluded altogether from the terms of reference by the Government?


My Lords, before my noble friend replies, may I say that in In Place of Fear published in 1952, the statement is clearly made by Aneurin Bevan that the pay beds should be faded out and replaced with amenity beds because he, like, I should say, all Members of your Lordships' House, had a great concern for privacy and the need for privacy. So far as the pay bed issue is related to privacy, that was covered. There are other elements which we can discuss, I hope, when we have a full day's debate.


My Lords, I can only say to the noble Lord that I disagree with him wholeheartedly that the question of pay beds is central to the problem of the National Health Service. In my view it is essentially resources. There is today great opportunity, great knowledge, great advances, particularly in the field of technology. There is a real sense that much more could be done for the patient than is now being done solely because resources are not available. I believe that this goes well beyond the sense of grievance that there may be over pay. This is a matter which, I think, lies at the very heart of the Royal Commission. It is a question of how those resources should be used, and whether one should look again at the bureacracy that is being created by the recent reorganisation of the National Health Service. Having said that, I think that one should not create even more problems of morale by suggesting yet another change, but in my view the resources available and what could be done if the resources were available are at the heart of the problem.


My Lords, am I right in thinking that under the Standing Orders of this House it is not permissible to debate a Government Statement unless there is a Motion that such a debate should take place?


My Lords, my noble friend is, as usual, right. But it is one of the sins of your Lordships' House that what may be the rule is usually broken. So long as it is not broken too violently, we somehow accept it. But the noble Baroness has given me the opportunity to suggest that we move to the next business.