HL Deb 04 November 1976 vol 376 cc1455-516

3.56 p.m.


My Lords, I beg to move that the House do now resolve itself into Committee on this Bill.

Moved, that the House do now resolve itself into Committee.—(Lord Wells-Pestell.)

On Question, Motion agreed to.

House in Committee accordingly.

[The EARL OF LISTOWEL in the Chair.]

Clause 1 [The Health Services Board and its committees]:

Baroness YOUNG moved Amendment No. 1: Page 1, line 10, leave out ("five") and insert ("seven").

The noble Baroness said: We start at the beginning of the Committee stage of this important Bill, and before turning in detail to my first Amendment I should like to make two comments on matters of procedure. The first one is that I assume that we are going to take the Amendments simply in the order as printed on the Marshalled List.

I am bound to say—and I have already raised this point privately with the noble Lord, Lord Wells-Pestell—that I find this slightly surprising, but I believe it is now inevitable, as there has not been a Motion to group the Amendments. I would have thought it would have been much to the convenience of the Committee if they had been grouped and that we should take the appropriate Schedules with the clauses. If this is not to be the case, we shall have to be forgiven if we go from one part of the Bill to another; I cannot believe that this will always be the easiest way to follow it. However, this is not my decision and not a matter on which I can make a ruling; but I think it right that the Committee should appreciate this right at the beginning because I think it will make a difference in the way the Committee stage proceeds.

My second comment is a very general point. I am bound to say that I was surprised to find that the Government had not put down any Amendments at all to the Bill. I yield to no one in my admiration for the officials of the Department of Health and Social Services, particularly the draftsmen of the Bill. They are much to be congratulated. They clearly feel that they have produced a perfect Bill; not a word, not a comma, not a full stop needs to be altered. This, surely, must be an achievement. But, quite seriously, I hope that it means that the Government are taking this Bill seriously.

We on this side of the House believe that it is a very important Bill. It is actually about the lives and the health of a lot of people, and it would he most unfortunate if the impression were to be given outside the House, to the many people who are interested in the progress of this matter, that this House was in some way being used as a rubber stamp, and that the whole Bill, simply because of a Parliamentary timetable over which we have no control, has to be in this particular form. I find this a most extraordinary situation. I find it a particularly extraordinary situation as there were 50 tied Amendments in another place, which indicates how very close the Parties have come on various matters.

One would at least have thought that some of these issues would have been raised by the Government. It is ob- viously not to be so, and I think it is all the more unfortunate because of that. As I say, I do find it very strange that there are no Government Amendments of any sort, not even drafting Amendments; this is the first time, on any Bill with which I have been connected, I have found this to be so. I hope that the noble Lord who will be speaking for the Government will appreciate my genuine concern about this matter.

I turn now to the Amendment which is down in my name. This is the first Amendment that we are moving and, in a sense, it is a probing Amendment. Clearly central to the whole of this Bill is the Board that is to be established, with a chairman and, as matters stand now, four other members. What we on this side of the Committee should like to know is something more about the Government's intentions about the Board. The composition of the Board is clearly crucial to the success that must underline the whole of this Bill which, as I understand, is a piece of legislation designed to put into legislative form the proposals of the noble Lord, Lord Goodman.

If we turn to Schedule 1—and here we have a difficulty about not having grouped Amendments because we must turn to Schedule 1 which sets out the details of the composition of the Board—paragraph 8 makes it clear that two medical practitioners are to be appointed and two other persons appointed in consultation with other people employed in the health services. All sorts of other people are involved in the health services. Clearly, as its name implies, the National Health Service is a service and, as I indicated at Second Reading, the most crucial part of the Service is those who work in it, and that means all those who work in it. I should have thought it not unreasonable for the Government at least to consider for appointment to the Board representatives perhaps of the nursing professions, who seem to be left out of it altogether, or perhaps the nursing professions and others like physiotherapists and medical social workers. It does not appear to me at all unreasonable that their views which are, after all, crucial to the needs of the patients, should be considered, quite apart from the fact that at least it is arguable that the patients ought to be considered. Nowhere are their views, whether they are patients in the National Health Service or any other patients, going to be considered at all. There will he nobody representing them. At least we should find out from the Government why they have been excluded from membership of the Board, even if they are not positively able to propose why they should be put on it.

That is the first reason for this Amendment. There is another reason. It is not difficult to see a situation arising, under the proposals in the Bill, with a chairman and four members of the Board, of two members of the Board consistently voting one way and two consistently voting the opposite way, and effectively everything being decided by the chairman. Of course it is arguable that this could happen if there were six members, but it is less likely, I should have thought. So we might say there is hardly any point in having four members drawn up like this; we might just as well have a chairman who will decide everything.

Therefore it seems to me that there is a practical consequence to all this, but I do not believe that that is as important as the other point I have made: namely, that there are a great many people upon whom the Health Service completely depends whose views, certainly as the Bill stands at present, are not going to be considered. We on this side of the House should like to know how the Government intend, if indeed they do intend, to take the views of the nursing profession, or of the patients, in order to know what they think about matters which are going to be of immediate and real concern to them. I beg to move.


I should like to support this Amendment strongly. I am not, in a general way, in favour of large committees, but I do not think that one could call a committee of seven in such an important matter representing so many different kinds of work in the Health Services as being too big a committee. In fact, had I been drafting the Amendment I might have added two more, because I think we want real representation of many interests. It seems to me that this is a very harmless and proper Amendment, which should be agreed to.

4.4 p.m.


Before supporting the noble Baroness may I make one thing clear to your Lordships? I am national chairman of the Leagues of Hospital Friends. We are in no way a political body of any sort. We never discuss politics of any sort. We would never discuss pay beds, remuneration, the trade unions, the nursing profession, or anything except the good of the patients and staff of hospitals. We cover over 2,000 hospitals. I make this statement purely to show, I hope, that anything I say in this House has nothing at all to do with my leadership of the Leagues of Hospital Friends.

Having said that, I should like to go on to support my noble friend Lady Young in this Amendment. I have sat on local hospital committees, as well as others, and I think that five is much too small a number for this very important Board. My reasons are slightly different, in that I also know that people can be ill even in their own hospitals; they can have other engagements; and they can, if they are prominent people, have other things to do in public life and sometimes in home life. I think the number of seven will be far better than the number of five. I completely support what the noble Baroness has said.


I should like to support this Amendment with all the power that I can. For many years now I have been privileged to be a vice-president of the Royal College of Nursing. I should like to ask my noble friend who moved this Amendment whether she, representing this side of the House, has been in touch with the Royal College of Nursing to obtain their views on many aspects of this Bill, but in particular whether they feel that it would be advantageous to have more people on the Board.

The other point that I should like to make is that for many years when I was in another place I represented Parliament with a large "P". In those days I did not know anything about the procedure in this House, but for many years I represented Parliament on the committee which looked after physiotherapists. The committee used to make representations on their behalf. Sometimes we won our battles on our recommendations. This is not a Party matter at all; we had to make recommendations when the present Government were in power and when my own Government were in power. But it seems to me that over this very wide field it is important that we should have representatives of those sections of the community who help to operate the National Health Service, and I am sure do so very successfully. It is an important matter; therefore I think that through my noble friend Lady Young we are moving a very important Amendment.

I always like to put forward what I consider are the good sides of development. Over the years I have been connected with many hospitals and all developments in the part of the world which I have always had the honour to represent, and I was very pleased indeed to know that at last (I say "at last" because this is not a criticism of any Government) a State registered nurse was on the community health council. If that was felt necessary, it seems odd that no arrangement seems to have been made for the various members of the Health Service professions—physiotherapists, chiropodists and the wide range of people who go to make up the Health Service—to be adequately represented on this committee. I am therefore glad to support the Amendment, though I should like to know whether, as soon as the Bill was introduced, approaches were made to the members of the nursing profession and the others who play such a vital part in the Service about this question of representation.


I support the Amendment, not necessarily because it would not be possible for five people objectively to take the decisions that might have to be taken by this committee—I think that could be done by five or seven—and not even because I think the nursing profession has been left out, because under Schedule 1, paragraph 1(2)(b), it would be possible for the nursing profession to be represented. I support it basically because there are more interests in the Health Service than can be represented by four people, apart from the chairman. I support it above all because we tend these days to administer and talk about the NHS forgetting about whom it is there to serve. There must be a place on this board to represent not necessarily the patient but the ordinary person in this country who might one day become a patient. I appreciate that it is difficult to work out how this representation could be included, but we must in everything we do in the Health Service remember the patient and potential patient. That is why I should like to see the membership increased to seven.


I should not like it to be thought that there is any dissent on these Benches about the Amendment. Like my noble friend Lady Robson of Kiddington, I will wait with interest to hear the reply of the Minister on this subject. My inclination at present is to support the Amendment, but at the same time perhaps I should voice a disquiet that I have. The effectiveness of the committee will in the end depend not entirely on its numerical strength but on the quality, rather than the number, of people who serve on it. Probably we should be better served by seven than five, but I must sound a word of warning about any plea for representation.

I should regard it as regrettable if we allowed the committee to become so swollen that it consisted merely of delegates representing vested interests, physiotherapists, nurses, or anybody else. We want on this committee independent people who are aware of the problems in the various spheres of the Service—the difficulties and views of the physiotherapists, nurses, ancillary workers, doctors and patients—and to have that I think we need seven rather than five. But if we were to go above seven and say that we need one to represent nurses, one to represent the patients' association and so on, we should be on a dangerous course. I shall therefore preserve an open mind while waiting to hear what the Minister says on this issue.


There is an old adage that the most satisfactory committee would number two with one absentee. I support the view that this committee should not seek to be representative because in endeavouring to be so it would become too numerous and unwieldy. We should aim at a committee that is few in number, but I believe from experience that with five we would suffer the disability, probably serious in this case, of absenteeism making it too few in number and probably placing too much dependence on the decision and activity of the chairman. I do not know what all the fuss is about. It would seem better to concede seven, provided there is a clear understanding that it is not indicative of an attempt to be representative but rather, from the administrative standpoint, of advantage because it would avoid difficulties arising out of absenteeism.


I will, first, deal with some of the points made by the noble Baroness before she spoke to the Amendment. I will try to be as friendly as possible, though I did not feel very friendly about one of her observations. As for the arrangement of these Amendments, I take full responsibility. It is not always the custom to group Amendments. The noble Baroness, when she was at the Department of the Environment, found that to be the practice there and she did so, but there have been many Bills before your Lordships with schedules where Amendments have not been grouped. It is a matter of opinion as to whether one method is better than another. I prefer this, but had I been approached early enough I should certainly have considered whether there was some advantage in grouping the Amendments.

The noble Baroness referred to the fact that there are no Government Amendments. There are none simply because we did not think any were necessary, and it is as simple as that. We have been through the Bill, like certain people in another place, not only paragraph by paragraph but word by word and line by line, and we are satisfied with it as it is. If in the course of the Committee stage it should become apparent or necessary for the Government to consider tabling Amendments, the Government will do so, but we do not think it necessary at this juncture.

I tend to take exception to the remark made by the noble Baroness about whether the Government were taking the Bill seriously. We have never taken a Bill more seriously than this one. As I said on Second Reading, this is a matter of principle with us, as it is a matter of principle with noble Lords opposite. I said on that occasion that the divide between us was a very deep one. But make no mistake about it we take the Bill very seriously; and I acknowledge, as I did on a former occasion, that we recognise that noble Lords opposite, and for all I know noble Lords on the Cross Benches, also have very real and deepseated convictions about this matter.

It would, on the face of it, seem perfectly reasonable to have seven people on the Board, but it would only be reasonable to do so if one could be certain that one was going to achieve the purpose that so many people feel a seven member Board will achieve. Let us face it, seven people will not achieve the representation of all the interests in both the private sector and the public sector. Two members of the Board are to be from the medical profession. They have to be acceptable to the medical profession, so there will be two members over whom, if you like, the Government will have no control at all. The remaining two will be appointed after consultation with National Health Service staff and other interested parties.

I feel that I must point out to those of your Lordships who may not be familiar with the intricacies of the trade union movement that the bodies concerned with the interests of patients in National Health hospitals and consulted about membership of the Board are the Patients Association and the Trades Union Council. There is a very strong Patients Association in this country. Representatives of the interests of the two groups mentioned in the Amendment will be present on the Board. Nurses working in the National Health hospitals are represented by the staff side of the General Whitley Council, which has already been consulted about the appointment of the other members, as have bodies representative of the interests of patients. In addition, the medical members will, we imagine, be able to bring to the Board experience of the problems and methods of working in the private sector and will also bring to the Board experience of the treatment of private patients within the private sector.

If we are going to say that the nurses must have a special place, we must remember that there are a large number of different groups serving in our hospitals. There are a very large number of medical laboratory technicians, physiotherapists, occupational therapists; there are the domestics—and, let us face it, the success or failure of a hospital will very often depend on the contribution of the domestic staff. Stop the food and see what happens! There are engineers and porters, there are ancillaries, there is a large administrative staff and, as I said, there are midwives, biochemists, and one could go on. How do we bring together representatives of all those groups? The staff side of the General Whitley Council includes representatives of all the major National Health Service unions and of the Royal Colleges of Nursing and of Midwives.

We feel that there is some merit in this and I admit that this is open to the point of view that seven members might be better than five. However, we believe that there is no point in increasing a number simply for the sake of increasing it unless by increasing it one is going to be able to rope in a substantial number of interests that are not likely to be represented. Our view is that there is no particular merit in specifying seven members.


I fail to see how one could possibly accept that argument because one could increase it by two and yet at the same time reject—as I certainly do—the concept of extending it so as to get full representation from the various parties. I am supporting seven members purely from the standpoint of mechanics. If there are seven members, that will be far better as a number because the Board will be free from the difficulties that can be created by absenteeism. It has nothing to do with representation.


With very great respect and unless I have misread the Bill, the question of absenteeism cannot possibly arise because there is a section in the Bill under which deputies are to be appointed so that in point of fact—the noble Baroness looks surprised, but I believe there is a clause in the Bill which provides for deputies to be appointed, a deputy for the chairman and deputies for the members of the Board—so that if a member of the Board cannot attend for any length of time, the deputy who has been appointed will take his place. So there is no question, as I see it, of people being absent—

Viscount LONG

I am not quite with the noble Lord on this. I wonder if he means to say that in addition to these five members we shall have deputies behind the scenes who can be brought in. I do not think that we should be quite happy with that make-up of the group. I wonder whether the noble Lord could explain. It sounds as if people would be co-opted at a moment's notice and I do not think that would work very well.


It is not a question of co-opting people. I am trying to find out whether the Bill contains such a provision and where it is. t cannot remember every word of every clause, but my understanding of the situation is that the Board will have appointed a deputy for the members of the Board and for the chairman so that, if for any reason a member of the Board c mild not attend for three or four weeks or perhaps a month or two—for instance, he might be in hospital—the deputy who had been appointed would take his place so that there would always be a full membership of the Board. I believe that the time limit is that if the person in question will be away for three or four weeks and this is known, the appointed deputy will take his place. If, on the other hand, the Board was likely to meet several times during that period so that the member was likely to miss three or four meetings, a person would be appointed to deputise for him from the same discipline: that is, if it was a doctor, the deputy would be a doctor; if it was a member of the staff side, the deputy would be from the staff side. So the question of absenteeism does not arise. My train of thought was rather spoilt, but I do not think I had any other point that I wanted to make.


Can the noble Lord tell us where this substitute arrangement is to be found?


I am not sure whether I have understood the position correctly, but I hope that it is in order for me to refer to a schedule even though we are discussing Clause 1. As 1 understand it, paragraph 10 of Schedule 1 which appears on page 21 refers to deputies. Those deputies are only for Scotland and Wales so that the question does not arise for the parent Board. In the preceding paragraph, the provision for absenteeism refers to six months, but perhaps I have got it wrong as well.


The noble Lord is perfectly right. In paragraph 10 of Schedule 1 there is provision for the Secretary of State to make regulations appointing deputies, and my understanding and reading of it is that it applies not only to the Scottish and Welsh Committees but to the Board, covering circumstances in which they may act for members. I mention this only because the point was raised that there might be fewer than five people attending a committee. All I want to say in reply is that we do not think there is any particular merit at all in having seven as against five. We feel that there is some merit in keeping the Board as small as possible. I think it has been the experience of a good many of us that a commtitee can be too unwieldy, and it can be too unwieldy if there are seven members. We feel, perhaps wrongly, that the right number is five and that on this basis having two from the medical profession and two from the staff side, this will be the ideal number.

My only other comment is that I understand that five was the agreed figure in the Goodman proposals, and, as the Committee knows, the Goodman proposals were examined very carefully, not only by the Government but also by the British Medical Association, and, so far as I know, no question was raised about five being an insufficient number. Therefore this leads me to say that we do not feel that we can accept the Amendment of the noble Baroness.


With the leave of the Committee, I should like to ask the noble Lord a question in connection with the discussion of whether the figure should be five or seven. Perhaps I should have mentioned this when making previous comments. For years one has been aware of the satisfactory arrangement regarding the Whitley Council. Apart from the members representing the medical profession, are the other members, two of them at any rate, to be appointed through the Whitley Council, as has been the arrangement in the past in so many matters connected with the Health Service? It is extremely important to know this and I apologise that I did not raise this matter earlier. Of course I should have mentioned it.


I should like to point out to the noble Baroness that she does not have to ask the Committee for leave to speak. During the Committee stage Members are—I should say unfortunately—allowed to speak as often as they like. But I hope that that will not be an encouragement. In reply to the noble Baroness, I should say that all the members of the Board have to be appointed by the Secretary of State; hut, as I said earlier two of them must represent the medical profession. Of course there have been consultations with the British Medical Association regarding the two people that it wants as representatives. Two have to be appointed from the staff side and consultations are taking place with the staff side, the Whitley Council, the trade union movement and so on. The Chairman is to be an independent person. The Secretary of State is endeavouring—I cannot say more than this at present—to get somebody who is really independent in the strict sense of the word. I hope that it may be possible, even before we complete the Committee stage of the Bill, for me to say something more about that.


Before the noble Lord sits down I should like to press him a little further on this matter of the figure of five members. As he has just reminded the Committee, they are all appointed by the Secretary of State. I am the chairman of a board—a consumer council, as a matter of fact—of which all the members are appointed by the Secretary of State. In this council we have a backlog of 18 months to two years of people who have to be reappointed to fill vacancies. I am worried in the same way as the noble Lord, Lord Peddie, about the number of five, when perhaps one, two, or even three members might well have to resign for other reasons. They might even decease, and nobody could do anything about that. It takes a considerable length of time for Secretaries of State to appoint people to replace others. This I have found over many years, and I hope that the noble Lord will take some notice of this point when he is insisting, as I gather he is, on a figure of only five members.


I do not want to rise too often and I shall heed the words of the Minister on that subject, but the occasion has been taken at this very early stage to make some general comments, and I should like to make a remark on two of the comments. I think it is a pity if we feel that this is a matter that is already dividing the Government from the Opposition and that it is an argument between the Socialists on the one hand and the Conservatives on the other. I hope that the whole Committee, not only the Minister, will bear in mind that there are 18 medically qualified Members of your Lordships' House, only one of whom sits on the Conservative Benches. Therefore I do not think that this should become a wrangle between two Parties. My second comment is that it is easier to replace a member of the domestic staff than it is to replace a consulting physician or surgeon.


I am grateful to the noble Lord, Lord Platt. I will try to answer the noble Baroness, Lady Macleod of Borve. It is the responsibility of the Secretary of State to appoint members of the Board and of the Scottish and Welsh Committees. The consultations to which I have referred have been going on, and one advantage of having deputy members who will subsequently be appointed is that in the event of absenteeism—for whatever reason a member may be prevented from attending—the deputy will be available. Therefore if a member of the Board dies there will be a deputy who can take his place. I realise the difficulty of getting good people, but perhaps it is easier to get five good people than seven; I just do not know. But if there are seven members appointed then seven deputies have to be found; so in one sense the problem is reduced if the figure remains at five. We do not envisage the kind of problem which the noble Baroness has mentioned, for the simple reason that, as I say, we have foreseen these difficulties and we shall overcome them by having a deputy appointed in each case.

Viscount MONCK

I should like to raise a point before the noble Lord sits down. As your Lordships know, I am getting old, senile and deaf and I may have missed something, but I should like to clear up this deputy business. I understood that my noble friend Lord O'Hagan referred to page 27 of the Bill where according to Schedule 1, paragraph 10(1) The Secretary of State shall be"— I think that that should read "by"— regulations provide for the appointment … of … a deputy chairman or deputy member of the Board, to act in place of the chairman or a member … That presumably means a deputy chairman and one deputy member.


I should like to put to the noble Lord the simple issue in the form in which the noble Lord, Lord Peddie, put it. There are many noble Lords who have an all too long and intimate experience of committee life. We know from experience that five is too few a number and we know from experience that the system of deputies popping up occasionally when the person for whom they are deputising is ill just does not work. Is there some fundamental reason why five should be the figure rather than seven? I should have thought that on the simple basis of the experience of most of us a good small committee is one of seven, about five of whom are likely to be present on any one occasion. Do not let us make a doctrine of this. Simple common sense ought to lead the noble Lord to accept this Amendment and to allow us to get on with something much more important.


The noble Lord is making the mistake of thinking that there will be absentees. I am saying that that contingency has been covered by the fact that a deputy will be appointed, so that at any meeting of the Board the full number will be present.


I hope the noble Lord will not depart so frequently from ordinary experience. People do not come at the last minute. They do not give notice to deputies; they just do not come. They perhaps send a telephone message an hour before the meeting. This system of appointed deputies who are called on in the known and advertised absence of full members of a committee just does not work in practice. Surely we can rely on our common sense and accept the number of seven as likely to be the number that will provide a respectable proportion of members present on any one occasion.


My Lords, I think the noble Lord, Lord Hill of Luton, has made a particularly important point which follows up what my noble friend Lady Macleod has said. Of course, we have had this afternoon—and perhaps the noble Lord, Lord Wells-Pestell, will correct himself later—what I take to be a Freudian slip in his argument, because he said in regard to the composition of the Board that there will be two members over whom the Government will have no control at all. As we understood it, the object of having a Board in the first place was to establish an independent Board, and its independence was the subject of considerable discussion in Standing Committee in another place. Perhaps the noble Lord, Lord Wells-Pestell, will look at Hansard tomorrow. It may be that I have taken him out of context, but I detect a sort of dirigisme in the Government's attitude towards the Board which is perhaps a little unhealthy at this stage. I do not know whether the noble Lord might like to comment on that in a moment.

However, the noble Lord said that the composition of the Board is open to different points of view, and it is our view that seven is much better than five. I think that, if it were possible to find the perfect number, that number would have been suggested in the Goodman proposals, but no number was further recommended as a result of their discussions. So we are left with the Goodman recommendation of five and the suggestion by my noble friend Lady Young of seven, which appears to be far more practical.


I certainly have no recollection of saying that there would be two members over whom the Secretary of State would have no control. The Amendment seeks to provide for the appointment of two further members of the Board, which I understand, but so far as I can see it does not require that there should be consultation about the appointments. Nor does it say who shall decide whether the members represent the interests of two groups. In that sense I think the Amendment is rather weak; and I would come back to the point that I made earlier. When there was obviously very serious and real difficulties between the Government and the medical profession, the noble Lord, Lord Goodman, was invited to intervene in this matter, and he had long, protracted, detailed and complicated discussions with the medical profession on this Bill and on certain aspects of it, and in particular on the establishment of the Board. The agreement was—and it seemed to be acceptable, because I have no information that it was unacceptable to anybody—that the Board should consist of five members. If that is acceptable to the medical profession, with whom the noble Lord, Lord Good-man, had discussions, I would have thought, with the greatest respect, that that was good enough.


Since the noble Lord has invited us (indeed, encouraged us) to speak twice, or even more, perhaps I could add one other word and perhaps almost faintly come to his aid. I still adhere to my view that seven would be better than five, for the reasons given by many noble Lords and, particularly, recently by the noble Lord, Lord Hill of Luton, but I see a difficulty. If we increase the Board from five to seven without at the same time increasing the number of members acceptable to the medical profession, the number of doctors, from two to three, then I think one might indeed be in grave difficulties. So I still support those who would like seven, but if it is going to be seven we shall then have to increase the number of medical representatives, in my view, if we are to get acceptance of this, from two to three.

Baroness YOUNG

I am very grateful for the support that this Amendment has received from all parts of the Committee. I should like to assure the noble Lord, Lord Platt, that in my opening observations I was not wishing in any sense to score Party political points, because I take this Bill as not being that kind of Bill at all. It is not a Party political Bill, and the mere fact that we have spoken on this matter in the way which we have illustrates that. I am very conscious of the fact that we have 18 medically qualified Lords in your Lordships' House, and I hope very much that we shall hear from all of them. One of the great advantages of the House of Lords is that it is to a very large extent a House of experts, and if ever there was a time for the Lords who are doctors to speak it is now.

In answer to my noble friend who asked be about the Royal College of Nursing, perhaps I could say that I have taken advice from a number of members of the nursing profession, although I must be quite frank and say that I have not consulted the Royal College of Nursing itself. But I have had talks with a great many people in the nursing and other ancillary professions involved in the National Health Service.


May I ask my noble friend whether she would be kind enough to let us know who? Because it is tremendously important to know who has had discussions. We want discussions with everybody concerned; and, personally, I always like to know who have had the discussions.

Baroness YOUNG

I cannot possibly tell my noble friend Lady Ward what discussions the Government have had, but I can and I will let her know, not during the Committee proceedings, the entire list of people with whom I have discussed this Bill, because it is really quite extensive. I can assure her that in a very short period of time I seem to have talked to a lot of people, but I shall certainly let her know who they are if she would like me to. I should like to say to the noble Lord, Lord Winstanley, how grateful I am for his support. I quite see that he does not like the principle of representation at all. I do not like it, particularly; but, of course, that is what we have in the Bill. Therefore, once it is written into the Bill it usually seems more logical to continue from it. I take absolutely his point that if the number was increased from five to seven it would be desirable that three of them should be representatives of the medical profession. I think that is a very important point.

I was very grateful for the points made by the noble Lord, Lord Peddie, and the noble Lord, Lord Hill of Luton. It seems to me that they are both absolutely right on this point of a quorum. I shall be coming to this point later on in my Amendments. Indeed, Amendments Nos.123 and 124 are consequential to Amendment No. 1, because they deal with the question of a quorum, which, again, is not written into the Bill at all. But the practical point when there are only five, as the noble Lords, Lord Peddie and Lord Hill, have quite rightly pointed out, is that if somebody cannot come—somebody is ill on the day or is caught in a snow-storm, or something happens or does not happen which means that for some reason or other two of them cannot come—you could have three people deciding everything. You could even have one person deciding everything under the Bill as its stands at the moment. This surely cannot be the intention of the Government or, I should have thought, the intention of Lord Goodman. So there really is a very real point about numbers and attendance.

As I say, I and my colleagues are very grateful for the support we have received over this Amendment. I think that at this stage we should like now to consider again what the noble Lord, Lord Wells-Pestell, has said; and perhaps he, too, will take the opportunity, when he receives Hansard tomorrow, to read what noble Lords have said. I think this particular Amendment is not a matter on which I should like to start these Committee proceedings by dividing the Committee, but we shall be returning to the point when we get to Schedule 1, and I hope that between now and then the noble Lord will take the opportunity, with his advisers, to look at the very difficult points which remain unanswered as the Bill stands.

There are not substitutes for everybody ready and waiting at every committee meeting. There is nothing about a quorum and a great many people are not represented at all. I am not very happy about the reason that has been given for the way the particular representatives come in. I am much more impressed by the argument that this is the agreement reached by the noble Lord, Lord Goodman. It may be that this is one that we shall have to consider as well. As I said we shall not press this Amendment but shall be returning to the issues involved. I beg leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

4.51 p.m.

Baroness YOUNG moved Amendment No. 2: Page 1, line 10, leave out ("appointed by") and insert ("whom").

The noble Baroness said: This Amendment and Amendment No. 3 are, in a sense, paving Amendments which we shall need to consider before considering Schedule 1. If the noble Lord, Lord Wells-Pestell, will look at Clause 1(2) he will see that it says: The Board shall consist of five members appointed by the Secretary of State in accordance with Part I of Schedule 1 to this Act. But the fact is that the rest of the Bill says very little about filling vacancies and very little about a quorum; therefore this Amendment is very much on the same point that we have already been discussing. We on this side think that the wording ought to be strengthened so that when we come to look at Schedule I we can be assured that when the Board meets it shall have five members present and voting—because this is the key to the whole Bill—and should anything happen to one of the members, that someone can replace him or her in a short period of time: in other words, that we shall not be left with a Board operating on some occasions with perhaps one or two members. I am speaking to both Amendment No. 2 and No. 3 which, as I have already indicated, are paving Amendments to Amendment No. 134 later in Schedule 1, that Amendment indicating that the Secretary of State must fill occasional vacancies on the Board. I beg to move.


I am completely mystified by these Amendments. I can only say that I must have spent two hours looking at them, as well as taking advice, to see what they achieve. If your Lordships have a copy of the Bill before you I should like you to look at the subsection. It reads: The Board shall consist of five members appointed by the Secretary of State … The Amendments make it read: The Board shall consist of five members whom the Secretary of State shall appoint… For the life of me, I cannot see that the Amendments improve it, add to it, or really do anything at all. They do only one thing: they increase that sentence from 24 words to 25 words. Really I do not think they are necessary. Nothing could be clearer than the wording in the Bill at the moment. There cannot be a single valid reason for changing it. It may be said that if it makes no difference, then why not accept the Amendments? I am saying that the Amendment is quite pointless and one only accepts an Amendment if it adds something of substance or value. This does neither. The noble Baroness quite rightly says that this will refer to Amendment No. 134, I want to suggest to her that leaving it precisely as it is will not invalidate or affect in any way any reference she cares to make when we come to that Amendment.

There must be some experts in the English language present in the Committee. With the greatest possible respect, can they truly say that "The Board shall consist of five members appointed by the Secretary of State" is in any way improved by changing it to: "The Board shall consist of five members whom the Secretary of State shall appoint". I do not think there is any substance in this matter—certainly no substance that justifies altering the present wording.


I think that my noble friend explained this point perfectly. It is a paving Amendment and leads straight into Amendment No. 124. I think she referred to Amendment No. 134; that was a slip of the tongue. if you look at Amendment No. 124 you will see exactly why this Amendment is proposed. It is entirely grammatical and I think it follows logically.

Baroness YOUNG

We can debate points of language for a very long time, but it is necessary to get things correct in law. I am advised that this is the correct way to do this. I apologise for not referring to Amendment No. 124. This would be the correct way of leading into the further Amendment. Obviously, these are not Amendments on which I am going to divide, but I suggest to the noble Lord that we have not put down these Amendments just because we want to alter the wording in a meaningless way; we have done so because they are, as I have indicated, paving Amendments to a later Amendment.

While I have been looking at this Amendment and at Schedule 1 again, my eyes were caught by a printing error in Schedule 1 to which I can perhaps draw the noble Lord's attention. On page 27, line 24, at the beginning of paragraph 10(1), my copy reads: The Secretary of State shall be regulations … It is, of course, meant to be "by regulations."


That point has been raised already. It is acknowledged that that is a mistake. It should be "by".

Baroness YOUNG

May I suggest to the noble Lord that it will require a Government Amendment? I am delighted to feel that the Department of Health and Social Security has made a mistake and therefore has not produced a perfect Bill. It is a comfort that there should be something slightly wrong. I shall be feeling a little better myself as we proceed to think that this might happen. We shall have a further debate on the one which follows from these two paving Amendments when we get to that Part of the Bill. With that, I beg leave to withdraw the Amendment.


If I may say so, I know that the Opposition want to beat the Government with as many sticks as possible, but there is such a thing as a printer's error and not a Departmental error.

Amendment, by leave, withdrawn.

On Question, Whether Clause 1 shall stand part of the Bill?


May I ask the noble Lord a question which I could have posed when we were discussing the composition of the Boards? Two Boards have been put into the Bill, one for Wales and one for Scotland. I appreciate that the Secretary of State has put forward a very sensitive plan in order to meet the views of people living in Scotland and Wales. The number of pay beds which might be involved in this connection in Scotland and Wales is so small that I do not think that that alone would justify having separate committees for Scotland and Wales; but if the Committee is going to have the opportunity to, as it were, look after all the affairs in the Bill which apply to Scotland and to Wales in addition to the phasing out of the pay beds, then the situation is different because obviously there will be a continuing purpose behind these Boards which will go beyond the years in which the Goodman proposals are operating.

In, say, five years there may be no pay beds in Scotland or Wales at all. Will the Board be in charge of all the Welsh and the Scottish health services and therefore have a continuing use? If not, the Government should put in some clause to bring these Boards to an end—that is, if they are only to be in charge of the phasing out of pay beds. If they are to he in charge of all the other things in the Bill as well then perhaps they have a further use. I was thinking of this in order to save the Government money because they will be fairly expensive, and will perhaps cost a quarter of a million. It is worth spending a quarter of a million if that amount is needed and wanted. Could the noble Lord say whether he feels that these two Boards will have a continuing use after the phasing out of the pay beds has taken place?


I should like to follow that question and amplify it a little. I understand from what the Government said in another place and from the notes on clauses, that the introduction of Committees for Wales and Scotland was not something suggested by the noble Lord, Lord Goodman, and that the idea of having these separate Committees for Scotland and Wales is something that the Government themselves have introduced in order to improve—as the Government see it—the Goodman proposals and make them more workable. I want to check with the noble Lord that that is in fact so.

Could the noble Lord explain when he is answering the question asked by my noble friend Lady Elliot of Harwood, how the Government envisage these Scottish and Welsh Committees working if and when devolution takes place? Of course, I am not asking him to prejudge anything that may or may not happen in the next Parliamentary Session, but in the Government's White Paper, Cmnd.6348, Our Changing Democracy, the Government said that the Scottish Administration would be responsible for health matters in Scotland, including the National Health Service. The Administration would be able to decide policy on a whole number of matters that were listed, among which were private practice and the control of nursing homes. That statement was not altered in the supplementary statement on devolution which came out subsequently. How do the Government envisage these Boards working and how do the Government envisage pay beds continuing in circumstances when the Assembly in Scotland under whom the National Health Service in Scotland will be put, was against pay beds? What would happen if the Assembly in Scotland decided to abolish them unilaterally?—because we know that it is the declared policy of the Scottish National Party to eliminate pay beds totally. Could the noble Lord give us any light on that?

The other two questions I want to ask are, first, how does Northern Ireland fit into this? We are talking about Scotland, Wales and England. Are the Government going to come forward with a Statutory Instrument at some later date to deal with pay beds in Northern Ireland, or is some wholly separate procedure to be followed? Finally—and I am being as quick as I can as I had hoped to raise these matters on the Schedule hut as we have not got that I want to raise them now—Clause 1(3) of the Bill says: Without prejudice to the power of the Board to set up any other committees …. What other committees have the Government in mind to set up? We understand from this that it is envisaged that there may be other committees apart from the Scottish and Welsh Committees. Could it possibly be that the English are going to have a committee of their own?

5.5 p.m.


Perhaps I can deal with the questions from the noble Lord, Lord O'Hagan, first. What one hears last is always freshest in one's mind—at least it is in mine. The Bill at the present moment applies, as the noble Lord knows, to England, Scotland and Wales. At the moment there are no plans for dealing with the situation in Northern Ireland.

I cannot answer his question satisfactorily as to what ultimately happen in Scotland. We shall have to await the outcome of the devolution Bill. One has to bear in mind that that may take some considerable time and we want to proceed in the matter of this Bill as soon as we possibly can. We are committed to take certain steps, as the noble Lord knows, immediately upon the Bill getting Royal Assent. I do not think, therefore, that we can really wait to see what happens in Scotland. We shall have to decide what the future of the Scottish Committee will be in the light of any changes arising out of the devolution Bill. I think I have answered all the points raised by the noble Lord, Lord O'Hagan.


Clause 1(3), the "other committees"?


It is not an unusual practice when one is setting up a board or a committee—we did it, if I remember rightly, in the Race Relation Bill—to make provision for a situation which may arise. It may well be that the Scottish Committee, the Welsh Committee and the English Board may well find that it is necessary to set up a sub-committee to investigate a certain situation and we are taking powers in this Bill to do that.

I return now to the noble Baroness Lady Elliot of Harwood: the Scottish Committee has precisely the same power as has what has been called the English "Board", and so has the Welsh Committee. We felt that in the present climate, if we were going to do this, there was some merit in treating Scotland separately and treating Wales separately. We know that there was quite a body of opinion that felt that one Board could deal with England, Scotland and Wales. There are a number of private beds, as the noble Baroness knows. You will find them on page 34 of the Bill where they are set out under the heading of Scotland. I have not totalled them up.


For Scotland, 234, and 60 for Wales.


It was felt that it was rather important to have a Committee on the spot. The Board itself has to operate from somewhere and one presumes that it will operate from London. It is much easier to have its counterparts in Edinburgh—as I imagine it will be there for Scotland—and in Cardiff where I imagine it will be situated for Wales, charged with precisely the same responsibilities.

The only thing is that before the Health Services Board itself can make and take decisions in relation to Scotland it must have the opinions, the views, the observations, and, what is much more important, the recommendations of the Scottish Committee and precisely the same thing applies to the Welsh Committee. We feel that it is simpler and wiser for each of the two countries to have its own committee. But they are responsible to the Health Services Board, which must take them into account before making any decision, after the first 1,000 hospital beds, on the future phasing out of hospital beds and the question of new building notifications and authorisations. Looking at the matter dispassionately, I believe that that is a simpler way of working.

Baroness YOUNG

I thank the noble Lord for that reply to my noble friend Lady Elliot. But does he not think, in view of what he said—and one entirely accepts the reasons he has given for the Scottish and Welsh Committees, because I quite see that, politically, not to have them at this time might lead to rather unfortunate interpretations of the situation—and in view of the very few beds that are to be phased out anywhere, that it lends point to one of our later Amendments? That Amendment is to the effect that the Board should have power to increase the number of beds, as well as to phase them out, because, clearly, it will give the Scottish and Welsh Committees much more freedom to act, as it will give the main Board more freedom to act, and, when their work seems to be confined to relatively few beds, this seems a relevant point.


Am I to understand that all the pay beds in Scotland are fully occupied, and that it is therefore necessary to increase them? The duty on the Scottish Committee, as on the Health Services Board and the Welsh Committee, is to deal with those beds which are not in use, or not in full use, and the question of adding to them does not arise just because 1,000 of the 4,444 pay beds in Great Britain are not necessary.

Baroness YOUNG

We could have a very long debate on bed occupancy, because the noble Lord knows as well as I do that if every single hospital bed was permanently occupied there could be great difficulty in any kind of emergency. For a whole variety of reasons, not least the fact that you need to keep some beds empty in case there is a bad motor accident and a lot of casualties come into a hospital, there are always a number of beds empty. There are always a number of private beds empty and, as we both know, there are always a number of National Health beds empty. This is not a criticism of the service. Indeed, it merely shows that those who are running it are acting responsibly, and we should want a better argument than that about the numbers.


How much does a private bed cost each week?


It would depend entirely on where the hospital happened to be. I am speaking off the cuff, but a bed in a teaching hospital could cost as much as almost £300 a week. But I believe that not very far from your Lordships' House there is a private hospital where the cost of a bed per week varies between £504 and £904.


Speaking as someone who has been chairman of a hospital board at a disclaimed hospital for about eight years, I know something about bed occupancy. From what the noble Lord said I take it that there is only about 75 per cent. bed occupancy in the pay bed sphere. If that is so, it is not so bad as all that, because my experience was that if you had anything like 81 or 82 per cent. bed occupancy you were doing very well indeed. For the various reasons which the noble Baroness has touched upon, it is very difficult to get a bed occupancy beyond that. So I do not think that the noble Lord's argument about 1,000 empty pay beds will stand up very firmly on examination.


I do not want to be unkind to the noble Lord, but the question of pay beds does not come in Part I of the Bill. We have not yet reached the question of pay beds. It was only because the subject had been raised, that I felt it incumbent upon me to give some answer. I would remind the noble Lord that this is a matter which the noble Lord, Lord Goodman, went into very fully with the British Medical Association, the consultants, the medical profession generally and the Government. The figure of 75 per cent. occupancy of all pay beds is way out, and I will endeavour to find what the percentage is. But it is not a matter which we are discussing in this Part of the Bill.


So a pay bed is more expensive than a weekend in Paris?

Clause 1 agreed to.

Clause 2 [Purpose of ss. 3 to 5]:

5.16 p.m.

Baroness YOUNG moved Amendment No. 4: Page 2, line 24, leave out subsection (1).

The noble Baroness said: I beg to move Amendment No. 4, and I think it will be to the convenience of the Committee if I speak at the same time to Amendments Nos. 5 and 6. Amendment No. 4 is a paving Amendment for Nos.5 and 6 which, in a sense, are alternatives. It has been suggested to me that these are designed to be wrecking Amendments to ruin the Bill, but let me assure the Committee that that is not my intention and I do not believe that that is their effect. If we look at Clause 2, it will he seen that it is a declaratory clause setting out the intention of the Bill. Indeed, I looked again at the note on the clause which I was very glad to receive, and it begins: Subsection (1) declares the purpose of Sections 3 to 5. It is therefore a declaratory clause setting out what the Government believe to be the purposes of the Bill.

In many ways, it seems to me that Clause 2 is not at all necessary to the Bill and could be taken out. If it is felt necessary that the Bill should declare what it is trying to achieve, I should have thought a better way of doing it would be to state in the Bill what are the functions and objectives of the Board, because if the Bill is to confer a real benefit on the community and is not merely stating some kind of principle, the main object can only be to achieve a better service for all the patients in NHS hospitals and in private nursing homes. I should have thought that that was something on which the entire Committee could agree, because that is surely what we all want. Therefore, Amendment No. 5, unlike the passage in the Bill which it would replace, suggests guidance to the Health Services Board and places certain duties upon it. Paragraph (b) makes it clear that, apart from the role of the Board in controlling the rate of phasing out accommodation and services from National Health hospitals, it has a positive function and can therefore propose to the Secretary of State the redistribution of facilities and accommodation for private patients; or, indeed, adding to the amount of accommodation for private patients.

After all, who is to say in an area of population growth that this might not be desirable? As I am sure that the noble Lord, Lord Wells-Pestell, will know much better than I, there are great problems when there is a shift in population. I think I am right in saying that this is already being experienced in London hospitals where there has been a great drop in the population. On the other hand, you have only to go to a new town to find a great growth in the population, and in such areas there are usually no private facilities. It is not, therefore, unreasonable for the Board to have as its objective the improvement of services for both National Health Service patients and private patients and for the Board to be able not only to phase out private beds but, if it so wishes or if it is thought desirable, to increase them. That is what Amendment No. 5 is designed to achieve.

If I may now turn to Amendment No. 6, this, as I indicated at the beginning of my remarks, is an alternative proposal to Amendment No. 5. Again it assumes that we leave out the first subsection of Clause 2 and insert in its place the two proposals contained in paragraphs (a) and (b). These paragraphs are designed to give to the Board the object of achieving freedom of choice for everybody, whether within National Health Service hospitals or anywhere else.

In preparation for the debate on these Amendments I read again our Second Reading debate. Indeed, I read again the words of the noble Lord's honourable friend in another place when the proposals made by the noble Lord, Lord Goodman, were first debated last December. On each occasion we have been assured from all parts of the House—not least, I am very pleased to note, from the Government side—that it is not the intention of the Government to abolish private practice or private medicine. On the contrary, one of the objectives of the Bill is to allow it to continue. If you ask yourself why you are allowing it to continue and why it ought to be allowed to continue, the answer is that it is to give freedom to the doctor to practise and freedom to the patient to choose his own doctor or consultant.

Therefore, far from being in any way intended to wreck the Bill this Amendment is, we believe, very important. It seeks to secure that one of the objects of the Bill shall be to allow freedom to resident and non-resident hospital patients to have the services of their choice, whether they are provided in a National Health Service hospital or elsewhere. I should have thought that this was something on which we were all agreed and it is in that spirit that I move these Amendments.


I should like to support my noble friend. There is a suggestion in the Bill that National Health Service and private practice facilities should be separated and I should like to inquire of the noble Lord what is to happen to the many millions of pounds which have been poured into hospitals by the great medical charities. Those charities have provided extensive facilities to National Health Service hospitals, and those units are often maintained by the voluntary contributions of large charities. I am thinking of Cancer Research, the Heart Foundation and one charity in which I have a particular interest; namely, the Arthritis and Rheumatism Council for Research. There is cross-fertilisation of staff. The Kennedy Institute is maintained by voluntary effort but there is cross-fertilisation in terms of the help that that research unit gives to the West London Hospital and other hospitals and, not unnaturally, private patients as well as National Health Service patients are seen by consultants there. At this moment the same organisation is financing a bone research unit which is attached to the London Hospital. That voluntary organisation is building it and paying every penny for it. As this clause would debar consultants who are doing research there from using those facilities for their private patients, I support firmly the Amendment moved by my noble friend Lady Young.

5.26 p.m.


I rise to support the Amendment of my noble friend. In the first place, the Government owe us a little further explanation of Clause 2. Your Lordships have already heard that it is a declaratory clause. Declaratory clauses are fairly notorious because they can add everything or nothing to a Bill. So far as the force of law is concerned, most of your Lordships will agree that if Clause 2 were struck from the Bill it would be entirely the same afterwards so far as its examination before the courts is concerned. Therefore we have a statement before us in Clause 2 which follows very closely upon the Goodman proposals. It is my belief that the Government could have made a very much better exposition of their intentions in Clause 2. As I say, it follows upon the Goodman proposals but, to quote the noble Lord, Lord Wells-Pestell, he said earlier that one adds an Amendment only if it adds something of substance and value. With that I agree entirely and I believe that the three Amendments moved by my noble friend Lady Young, two of which we seek to import into the Bill, will do exactly that.

First, we have some drafting suggestions to make to the Government. In this connection I wish to draw your Lordships' attention to subsection (2) because there is a degree of obscure drafting about it which is wholly unnecessary. Whenever one reads: Nothing in this Act shall prejudice the operation of paragraph … one knows straight away that this is either a matter of padding or of strict declaration which, so far as the force of law is concerned, one can omit from one's reading. However, Clause 2(2) says something very important and it could say it much more clearly and substantially. It draws our attention to Schedule 1 to the National Health Service Reorganisation Act 1973.

I have had a look at this Schedule and it seems to me that it would be very easy to import into this subsection one sentence to which that schedule refers. As it is not provided for us by the Government, I will read paragraph 10(5) of Schedule 1: Regulations made in pursuance of this paragraph shall not require that all consultants employed by an authority are to be so employed whole-time. It seems to me that in the words of the Amendment we have a very much better exposition of intention. I will go a little further. What is this declaration for? I think my noble friend has already declared this: it is a restatement of an existing statutorily protected right of the part-time consultant to engage in private practice. Does the noble Lord wish to intervene?




Here, if in drafting that sub-paragraph greater emphasis had been laid on this point and greater clarity had been used, we should have something of value. Nevertheless, it is drafted as written in the Bill. I turn to what my noble friend Lady Hornsby-Smith said—and I think this is the really important point—as to whether private medical practice may use, to the extent that it wishes, facilities within National Health Service hospitals. It seems to me that the freedom is emphasised in Amendment No. 6 to a much greater extent under the wording of the second of the two alternatives. Under Amendment No. 5 a very positive suggestion is made and the phrase used is "the best possible facilities".

If a declaratory clause is to be of value in our view it should be relatively brief and, if possible, clear. I have in mind what I believe to be one of the better declaratory clauses known to your Lordships very well; that is, in the Countryside Act 1968. That is exceedingly brief and straightforward. So far as this Amendment is concerned, my noble friend will be deciding upon which alternative she will choose and your Lordships will no doubt make that decision very shortly unless my noble friend chooses to withdraw the Amendment. Nevertheless, it appears to me that a decision should be made by your Lordships to make a much clearer point of Clause 2.


As the noble Lord, Lord Sandys, and the noble Baroness, Lady Young, have said, the effect of this Amendment would be to remove from the Bill what we consider to be a vital declaration of the intentions of Clauses 3 to 5 relating to the withdrawal of pay beds and facilities for private patients and to the restrictions of the Secretary of State's powers under Sections 1 and 2 of the 1968 Act. I think one must understand—and every member of this Committee does understand—what this Bill is about. This Health Services Bill is designed to provide a vehicle for separating private practice from the National Health Service and, if I may say to the noble Lord, Lord Sandys, to provide that in certain circumstances consultants will be given the opportunity of using the National Health facilities for certain types of acute illness where they are not available in the areas in which the consultants happen to be. Is it unreasonable in a Bill that one should state the purpose of the Bill? I accept that this is declaratory; it may well be that perhaps it does not do a great deal for the Bill but one tends to put in a Bill what its purpose is.


Will the noble Lord forgive me for interrupting so early? I have been attempting to follow his argument clearly but he says that this subsection contains a vital declaration of the intentions of the Bill, and I agree with him, but if it does that, can he say why the same things are not contained in the Long Title of the Bill? If the separation of the two forms of practice and the gradual withdrawal are so crucial to the Bill why was that not incorporated in the wording of the Long Title of the Bill, which makes no reference to either of them?


Presumably it was because the Government considered that a better place for it was in the Bill itself and not on the cover, and I should have thought that was a very good reason. The effect of inserting in place of sub-section (1) the words proposed in the Amendment—and I think the Committee ought to consider this carefully—would be to give the Board additional powers and duties which would overturn the declared intention of the Bill and would in some respects put it into reverse.

The duties and responsibilities of the Health Services Board are clearly laid down. They have certain functions: one in respect of the phasing out of pay beds over a longish period, after the first 1,000 have been phased out by Schedule 2 within the first six months. It then has certain responsibilities and duties for new buildings, hospitals and nursing homes in London and outside London, to give authorisation and in other cases to receive notification. Also it has a tribunal responsibility. Their responsibilities are clearly defined. This particular Amendment and, if I may say so, the alternative Amendment No. 6, completely changes the responsibilities and duties of the Board and is to a very large extent in conflict with the purpose of the Bill.

The purpose of Clause 2 is to fulfil the commitment in the proposals of 15th December last which my right honourable friend the former Secretary of State in the Department of Health and Social Security made available and which subsequently became known as "the Goodman proposals". Perhaps I may just quote a short passage from them. The legislation would contain, first, a broad declaration that private beds and facilities should be separated from the National Health Service. Secondly, an expression of the Government's commitment to the maintenance of private medical and dental practice in this country through the renewal of the provisions of the 1949 Act, which maintains the right to private practice by entitling doctors and dentists to work both privately and in the National Health service establishments, and thirdly the establishment of an independent board to relate these two commitments. So there is a limited responsibility on the Board, and of course in some respects these Amendments would reverse it and in other respects they would impose new and different duties on the Board.

Baroness YOUNG

I am sorry to interrupt the noble Lord, but I wonder whether he can explain to me how my Amendment No. 5, which is simply designed to enable the Board to secure the best possible facilities within the National Health Service, could possibly be in contradistinction to the proposed separation? Is he really saying that the proposed separation will make things worse?


No, I am not saying that at all. What I am saying is that the Board has a limited responsibility. It has not got the responsibility under this Bill to inquire into and reorganise the whole of the medical services of this country. It has a limited responsibility. The Amendment tabled by the noble Baroness goes far beyond the responsibilities which we think the Board ought to have and which we certainly never envisaged and never intended that it should have. The statement in Clause 2(1) represents the first leg of the commitment; namely, a broad declaration that private beds and facilities should he separated from the National Health Service hospital.

I will not mention the statement in Clause 2(2) which is to fulfil the two commitments of Goodman, because the noble Lord, Lord Sandys, referred to them when he said that the power to make regulations governing the terms of employment shall not contain a requirement that all consultants should be employed whole-time. In another place, as your Lordships will know, there was a very full discussion on Clause 2 and its purpose, which covered something like 89 columns of Hansard.

In the discussions which led to the Goodman proposals of 15th December, those representing the medical profession thought it right to work for a renewal of the 1949–73 provisions enabling the consultants employed in the National Health Service to conduct a private practice. For their part, the Government rightly held to the need to state in the Bill its purpose, and that is why it is in the Bill. My right honourable friend the former Minister of State referred in Committee in another place to two directives or broad declarations of principle under which the National Health Service will operate. Later, my right honourable friend made the point again. He said: There is no point in anyone being under any illusions. The purpose of this legislation is to separate private practice and not to extend its life within the National Health Service indefinitely". The Government therefore maintain that Clause 2(1) is vital. This is why we feel unable to accept Amendment No. 4. As to Amendment No. 5, it would not only completely alter the sense of direction of the Bill, but in our view would make nonsense of the mechanism of the independent Board which I have already said on more than one occasion is very clearly defined.

The Amendment would give the Board the duty of exercising its function with the object of making available at National Health Service hospitals the best possible facilities for the prevention, diagnosis and treatment of illnesses, a duty, if I may say so, which already falls on the Secretary of State in Section 1(1) of the National Health Service Act 1946. This is an obligation which has been on the Secretary of State since 1946. If I may say so with the greatest respect, the Secretary of State needs no help from the Board in carrying that out, because he is obligated by Act of Parliament to provide the very things which the noble Baroness seeks in her Amendment

The Board will also be given the duty of exercising its functions with the object of making available the best possible facilities for the prevention, diagnosis and treatment of illnesses under private arrangements. This responsibility is out-side the intended scope of the Board. It is contrary to the purpose of the Bill, inasmuch as the facilities might be provided in National Health Service hospitals, and could not be achieved through the limited function given to the Board by Parts I and III of the Bill. The responsibility of providing the best possible facilities at private sector hospitals rests with the owners and managers of those hospitals, and not with the National Health Service, subject to the statutory control over standards which the Government have under the Nursing Homes Act 1975. The Board would be given the duty of exercising its functions with the object of securing the availability of sufficient accommodation and services of a satisfactory standard at National Health Service hospitals for the treatment of patients. But the functions of the Board under the Bill are not concerned with the treatment of National Health Service patients. The Board has no means at all of achieving that end. If I may say so, it would be quite wrong and quite inappropriate that it should. That is the function of the Secretary of State for Health, and of the Department.

The Board would also be given the duty of exercising its functions with the object of securing the availability of sufficient accommodation and services of a satisfactory standard in private nursing homes for the treatment of patients. The Board would have no means at its disposal for achieving this end, and therefore, we should not find it possible to accept Amendments Nos. 4 and 5.

In dealing with Amendment No. 6, to a very large extent I should be repeating myself, and that is the last thing I want to do in view of the magnitude of the task before your Lordships in dealing with the Amendments on this Bill. But I must say that the effect of inserting in place of subsection (1) the words proposed in Amendment No. 6 would be to give the Board a quite different responsibility, as I have already said. The Amendment proposes that the Board should have the responsibility for securing that hospital patients have a freedom of choice of doctor, either privately or within the National Health Service. This responsibility again is outside the scope of the Board. Although in theory responsibility for the choice of doctor rests with the patient, in practice the choice of the patient is normally that of his general practitioner. In the private sector, normally a patient would be seen and treated personally by the consultant to whom he had been referred by his general practitioner. In the National Health Service, though, he would not necessarily be assured of the same degree of personal treatment. Normally he would be under the supervision and care of the consultant to whom he was referred by his general practitioner, and the consultant would accept responsibility for his treatment. In these circumstances the Board is just not equipped to take, nor would it be practical for it to have, the responsibility for securing the purposes of sub-section (1)(a). It is one thing to guarantee the continuance of private practice in this country and quite another to seek to convert this into a right for individual practitioners to choose where they will exercise that right, whether it is in the National Health Service or outside it.

The effect of subsection (1)(b) of the Amendment would be to transfer from the Secretary of State and the health authorities to the Board part of their statutory responsibility for the day-to-day management of the National Health Service. Indeed, I do not think I should be putting it too high, but it might even include strategic planning. This cannot be left to a Board. It must be left to the Secretary of State who has the responsibility under the appropriate Act. No one is seeking to dictate to doctors where they should do their private practice. Under the proposals in the Bill the only restriction on their freedom of choice is that eventually, the facilities which they currently enjoy in National Health Service hospitals for treating private patients will be withdrawn, except for the occasional admissions to which I referred a moment ago in trying to reply to the noble Lord, Lord Sandys—all patients needing highly specialised facilities not available in private hospitals and nursing homes. We shall come to that in due course.

I do not think I want to say anything more about the purpose of the Bill, which is the progressive withdrawal of private facilities in National Health Service hospitals, and not the position to which I think the Amendment of the noble Baroness would give rise. In this Bill we are seeking to do a very simple thing, even if noble Lords do not like it. It is very simple. It is to separate private practice from the National Health Service, not to stop private practice. I have been at some pains to say that the Government recognise the need for private practice. We have not and never have had any plans for abolishing private practice. We think that if people want to choose a private doctor, if they want to choose a consultant, if they want a pay bed in a private hospital, they should have the right to so choose. We think it will be beneficial for private practice and beneficial for the Health Service for the two to be separated.

5.51 p.m.


Speaking as a general practitioner who is in practice now, I must confirm the attitude and the reasons which my noble friend has just given. This is how it works, how it has worked and how it should continue to work. The general practitioner has a choice and it depends on the consultant whom he chooses. This consultant may be a part-time or a full-time servant in the National Health Service. If he is in full-time service there is no room for him to do private practice outside. On the other hand in the teaching hospitals in particular, he will find that most consultants are on a part-time basis. The part-time is for the National Health Service to which they give a complete and satisfactory and adequate service; but on the other hand in the sessions in which they are contracted out of the National Health Service they have the full opportunity of working where they will in conjunction with general practice. They are under contract, and if they live by their contract those consultants who are not fully committed to the National Health Service are perfectly at liberty to use private nursing homes, private hospitals or any private facilities. They are there because—and I say it against my profession—the financial rewards of this have been going up enormously since my day of starting in general practice. These facilities are there for people who want to be patients in private nursing homes or private hospitals.

What is more, one finds that the largest number of consultants in the National Health Service are full-time salaried servants and in some of the lesser hospitals and non-teaching hospitals there is no opportunity for private practice. So we can only feel that those consultants who are in partial contract only get the benefit of all the finance that there is in and around the patients' ailments. I should like to point out too that when it comes to facilities there is nothing to stop a patient of any sort from going into any hospital. Even if there were private patients in that hospital, when it comes, for example, to intensive care, there is only one intensive care ward for the hospital and these people are looked after better in the public ward than in the private ward.


May I ask the noble Lord one question? Twice when he was speaking he referred to satisfactory standards. I should like to know whether it is the responsibility of the Secretary of State to see that the standards are satisfactory, or whether it is the responsibility of the Board. From things I have heard all over the country, it seems to me that the standards in some hospitals are not satisfactory. There is insufficient staff and some of the wards are shut. I am wondering whose job it will be in future to see that standards are satisfactory.


There is a general responsibility on the Secretary of State to see that the standards in our hospitals are satisfactory. I think he would be the first to say that in many places they are not satisfactory. We know this and we try to do something about it. Many of our hospitals are housed in buildings that ought to have been pulled down long ago. I have been in some of them. It is because of these conditions—shortage of staff, because the place is antiquated and so on—that we do not get satisfactory standards. We try to do something about it within the limit of the financial resources. A good deal has been done but there is a responsibility on the Secretary of State to see that the services supplied are satisfactory.


In discussing the clause which contains some definition of the Government's intention we are surely getting back to a Second Reading debate. We have had all that before. If anybody wants to know my views will they kindly read them. I am totally opposed to this separation of private from NHS practice. It is bad for the NHS patients and it is bad for the private patients. The noble Lord speaks about the inspection of nursing homes and seeing that conditions are all right. As I said in my Second Reading speech, who is to inspect the doctors who are going to work in those places? Who is going to say who can and who cannot operate? In the NHS hospitals all that is done. I also think that the separation is bad for the reputation of British medicine at home and abroad. I said that in my Second Reading speech and I hold that opinion very strongly indeed. As one who has had experience of private practice as a consultant and also as a full-time professor with no private practice, I would say that if the clause moved by the noble Baroness is going to make this Bill more difficult to pass I shall be with her.


I am not certain what the intentions of the noble Baroness, Lady Young, are but I would suggest that the noble Lord, Lord Wells-Pestell, has put up a powerful technical case against this Amendment in two respects. First, it would transfer to the Board functions that are statutorily imposed upon the Secretary of State, and, second, the present wording tells the truth about the intention; the Amendment does net. It is not the purpose to make available the best possible facilities for the prevention, diagnosis and treatment of disease and to secure the availability of the best accommodation. It does neither of these things. It seeks to do something which I think is narrow, trivial and contrary to the public interest. That is more a general story for a Second Reading debate, but at least it has the merit of honesty in describing what the narrow but well defined purposes are, and does not introduce words which, however comforting they may be, would not accurately or truthfully describe the real purposes of the Bill.


My Lords, I have listened to the noble Lord, Lord Wells-Pestell, with growing amazement. It seems to me incredible that the Board should be set up to make a fairly fundamental change in our health system without regard to the best possible facilities for the prevention, diagnosis and treatment of illness. My noble friend has expressed this very well. This is a most narrowly phrased Bill, but seeing that the Secretary of State has, by common admission, the duty of seeing to these things, is it not incredible that he should set up a Board to reorganise the Health Service without specific regard to the responsibilities which he has? Once Lord Wells-Pestell had admitted that, I find myself totally unable to follow the rest of his speech. I think, therefore, the wording suggested by the noble Baroness really ought to go into the Bill, which otherwise is so negative as to mislead, no doubt, as to the real intentions of the Secretary of State. I cannot believe that he wishes to act or wishes the Board to act without regard to the best possible facilities for the prevention, diagnosis and treatment of illness.


While quite appreciating what the noble Lord, Lord Wells-Pestell, said about not wanting to abolish private practice—and I am sure that he does think that—I would like to mention something which does worry many doctors. Many members of the Government do not feel like that, nor do many members of trade unions. Here is a resolution put forward at the Labour Party Conference this year by the Confederation of Health Service Employees. It reads: This Conference calls for the speedy passage of the Health Services Bill to phase out private practice from the National Health Service, while viewing these as interim measures only, and calls upon the Government to take urgent steps to abolish totally private medicine in this country. So often a resolution at a Labour Party Conference gets into a manifesto in a year or two, and this is what does indeed concern doctors—that this Bill is regarded by many people in the Government and elsewhere as just an interim measure.


I only want to say this to the noble Lord, Lord Hunt. Every political Party has conferences, and each of them comes to all sorts of conclusions. If you look at the Conservative Party annual conferences, they have had people on their left wing and people on their right wing; all sorts of things have been passed, but they have not found their way even into a Bill let alone on to the Statute Book. What I am saying is this—and it was put very admirably by my noble friend Lady Lee the other day when she was speaking on Second Reading—that we believe in a mixed economy.

This Government do not believe in total nationalisation any more than they believe in no nationalisation. The same view is taken in education. We are not opposed to private education. What we are saying is that if people want it they will have to pay for it. We are not opposed to private medicine. I do not think we shall ever be opposed to private medicine, but what we say is that if people want it they must pay for it. It really is as simple as that. I honestly say this; I can see no cause for concern on the part of members of the medical profession, least of all the consultants; there is no reason for them to harbour that idea.

The only other thing I want to say is this. My attention has been called to the fact that I said a little while ago that the responsibility of the Board was to phase out 1,000 beds. What I should have said is that it is the responsibility of the Board, the Health Services Board, to advise the Secretary of State on the withdrawal of pay beds after the first 1,000 listed in Schedule 2 have been removed.

6.5 p.m.

Baroness YOUNG

We have had a very useful debate on these three Amendments, and I am most grateful to all noble Lords who have taken part. I entirely take the point made by the noble Lord, Lord Hill. The noble Lord, Lord Wells-Pestell, has, of course, described absolutely accurately the intention of this Bill. It is a very narrow interpretation. We read the Goodman proposals, and there, my good- ness me, every comma and every full stop has been paid attention to. It is not a happy augury, because it means that everybody is going to refer to this rather like studying the Bible, to interpret every single verse without actually understanding the sense of what lies behind it. I think in fact it will prove, as the noble Lord, Lord Platt, has said, to mean that everybody will have worse care, and that is the tragedy of the situation.

We may accept what the noble Lord says, that on this very narrow interpretation that is what is wanted. But I wonder whether it is going to achieve what he has just said once again is the Government's intention, that there shall be freedom for the doctors to practise privately if they so wish. If, for example, we look at subsection (1)(b), it is of course an ultimate duty on the Board to secure the progressive withdrawal of accommodation and services at National Health Service Hospitals from use in connection with the treatment of persons at such hospitals as private patients. So the ultimate objective is to remove all private beds from the National Health Service hospitals. If this is to be so, it has to be read in conjunction with sub-section (2), where, of course, the Government are also giving the assurance that consultants will be able to practise, both full-time and part-time, for the National Health Service if they so wish.

It is no use saying consultants can practise part-time. The noble Lord will know much better than I do the complicated financial arrangements which are agreed with consultants who work part-time, whereby they are paid, I think I am right in saying, nine-elevenths of their salary. They do as much work for the National Health Service as a full-time consultant does, but they are free to have private practice as well. Lots of consultants have entered the Service on this understanding, and I am sure the Government do not in any way wish to mislead those who are in it now, and who cannot be held as party to these arrangements individually. If they suddenly find themselves in circumstances in which there are not alternative facilities in which they may practice, where those facilities have been phased out, there will be a dilemma; it was the dilemma to which the noble Lord, Lord Goodman, drew our attention at Second Reading. Unless there are the alternative facilities ready when beds have been phased out of National Health Service hospitals, part-time consultants will not be able to practise part-time unless they are prepared to accept a reduced salary for doing the same amount of work; they will be obliged to become full-time consultants.

There are all sorts of arguments and reasons why people prefer to remain part-time consultants rather than full-time, which I do not think it is right to debate under Clause 2. But I would draw the noble Lord's attenticn to what seems to me to be a contradiction in this clause. If the Government are saying that subsection (1)(b) stands and sub-section (2) stands, it is difficult to see how subsection (2) can apply if subsection (1)(b) is carried out. This is what creates the doubt in the minds of doctors, because they look at this narrow interpretation and see it as doing that. The Government make statements, but it is no use making a statement unless it can be translated into things that are going to happen. It looks very much as if these things will not be attainable, that once the great machine has started to work the bees will be phased out, that it will take a very long time in many places to have private alternative facilities, that the two are not possible.

I was delighted to know that Lord Stone is going to take part in the Committee proceedings, but he was, of course, talking about London, and, with all respects to Londoners, most people do not live in London. A great many people in other parts of the country are going to be very concerned about this; there simply are not alternative facilities once the private beds are phased out of hospitals. This is a serious matter, so I think we should be thinking about what will happen. I think he said that it was not a free choice, that a consultant was in fact chosen by the general practitioner and the patient did not choose.

I think I would be right in saying to him that the patient would choose a consultant on the advice of the general practitioner, but he does not have to take the general practitioner's advice and is perfectly entitled, if he so wishes, to ask for a second opinion on something. Therefore, it is very important when we are talking about freedom of choice for everybody that we know what we mean.

It is worth while to have aired this subject. We now know that we have a very narrowly defined Bill in which the Government are not prepared to say, or to repeat, in this declaratory statement that it is their intention that the facilities for patients in both National Health and private nursing homes should be improved, or should be maintained at the highest possible standard. I find that a very sad feature, but that is the conclusion to draw at the end of the remarks of the noble Lord, Lord Wells-Pestell.

Nor are we prepared to write into it that there should be a freedom of choice. This is outside the Goodman agreement. And because in fact it is going to be extremely difficult to implement this, it is perhaps as well not to put it in because I suspect it is not going to work. However, we can debate that again. I shall go back and consider once again this lengthy debate, because I am not satisfied with the answer that I have got, and I think that I should tell the noble Lord that if this Bill is going to work, and if the future of the National Health Service is to be assured, we must have a basis of trust; it will not be good enough to go back to that one document and say, "That is what it said, and that is what we are going to stand by because it is not a static situation, and we have to move on from it. I believe that a great deal more thought will have to be given to this. I shall at this point withdraw the Amendment, but I shall seriously consider coming hack to them on Report.

Amendment, by leave, withdrawn.

6.13 p.m.

Lord SANDYS moved Amendment No. 7: Page 2, line 24, at beginning insert ("Without prejudice to section 8 below").

The noble Lord said: With the leave of the Committee, I should like to move Amendments No. 7 and speak to No. 8, because Amendment No. 7 is in effect a piece of drafting machinery for Amendment No. 8. This is an Amendment which we believe to be very desirable because it places a qualification, and follows very closely upon the proposals which Lord Goodman laid before the Government after consultation. May I he allowed to refer to the Goodman proposals, and I shall do so in chapter and verse. My quotation lies in Section 3a of the Goodman proposals. I hope that your Lordships will permit me to read a portion and also quote from Lord Goodman's speech, because I believe it is strictly relevant to this Amendment. In the proposals it reads as follows: The criterion for phasing out shall be the reasonable availability of reasonable alternative facilities (including accommodation, services and equipment) within a reasonable geographical distance and to which reasonable access is available to those patients and practitioners desiring to avail themselves of it. The noble Lord, Lord Goodman, at Second Reading referred to the word "reasonable" and its importance in law, and he said at column 1500 of the Official Report in our debate on 21st October: My own interpretation of 'reasonable', which I think would be supported by better lawyers than I am, is that the word must mean `reasonable in every sense '. In my view it is not necessary to underline it but at the same time it would cost nothing to underline it. If the restoration of a little confidence can be achieved by adding a couple of words at the expense of the common printer, I would say let us add those words and make quite sure that everything the doctors want that is reasonably required by them should be provided and this Bill should be set off under the very best possible auspices.

The noble Lord in his proposals made the suggestion. Our Amendment, and the wording of our Amendment, follows closely upon it. We believe that it would be desirable to have a qualification on an important section of the Bill. Under the paving Amendment—that is, Amendment No. 7—I referred to "Section 8 below" of the Bill, and Clause 8 refers to a particularly important situation which will arise on restrictions on power under Section 31 of the 1968 Act to allow the use of National Health Service facilities by private patients. I should perhaps refer to the Act of 1968 because the Bill does not refer to the Act until Clause 8, and it is a very important section.

In his speech a little earlier, the noble Lord, Lord Wells-Pestell, referred to enactments since 1946 which allowed private practice to use National Health facilities. Of course Section 31 of the Health Services and Public Health Act 1968 does just that. I think it would be tedious if I recited the whole of the section. It is one sentence, but it gives a Minister power to make such use, and on such terms as he thinks desirable, of any services to private practice. I think that the situation which we shall come on to in our later Amendments under Clause 8 of the Bill will elucidate the position further. Nevertheless, it is particularly important at this stage to include in the Bill, as we see it, a qualifying clause as set out in the Amendment. I beg to move.

6.18 p.m.


May I deal with Amendment No. 7 first. Again I am bound to say that if the noble Lord—and I have no doubt that he has done so—has read his Amendment in relation to page 2, line 24, which he wants to begin, "Without prejudice to section 8 below" and then reads on, as I am sure he has done because he is a very thorough person as I know from past experience, he will see that Clause 8 lays down certain facilities and certain undertakings. Because of the very fact that it is already in Clause 8, I cannot see why in this particular part of Clause 2 it is necessary to say, "Without prejudice to section 8 below because it is so clearly set out in Clause 8 and there is no intention whatsoever of changing Clause 8 because it is so clearly set out. The clause declares the effect of Clauses 3 to 5, which provide for the phasing out of facilities of private practice in National Health Service hospitals.

This progressive phasing out is not inconsistent with the occasional use of facilities for individual patients in special circumstances. This will be provided by Clause 8. The words of the clause, by referring to the effects of Clauses 3 to 5 only, sufficiently allow for the effective operation of Clause 8 for the limited purposes spelled out in Clause 8. It is clear that Clause 2 is so drafted as to allow the special occasional use of the facilities in Clause 8 to continue unaffected by the phasing out. If that is so, and if the noble Lord accepts that that is so under Clause 8, then I cannot see the need to add in Clause 2 the words he proposes, and if he examines the matter I am sure he will come to the conclusion that they are not necessary.

Coming to Amendment No. 8, I do not want to quote because I suppose we shall all get tired of the Goodman proposals by the end of the Committee stage. While, therefore, I will not quote from them again, the statement in Clause 2(1) represents, as I said earlier, the first leg of the commitment; namely, a broad declaration that private beds and facilities—and we are concerned here with facilities—should be separated from the NHS. The Amendment seeks to water down and confuse this declaration by adding to it a proviso which is inappropriate. The proviso appears to be intended to reflect other parts of the proposals of 15th December, which appear elsewhere in the Bill; namely, the criteria for the selection of the 1,000 beds and the principles to which the Board is to have regard in Clause 4(7). But the proviso is not a full and faithfull reflection, no doubt because it attempts to do in a few words what requires 40 lines or more elsewhere in the Bill.

The words in the Amendment are also unnecessary since the operation of phasing out 1,000 beds is fully covered by the details of Clause 3, and the activities of the Board are fully covered by the details of Clause 4. The provisions in those clauses are the effective provisions which will govern the progress of separation. It seems that the words of the proviso have been designed to hold back the process of separation by casting doubt on the way the principles in Clause 4(7) are to be applied by the Board. For instance, there is the reference to … patients or practitioners desirous of obtaining or providing … private treatment. The words in the 15th December proposals refer to "reasonable demand". It would be inconsistent with the 15th December proposals, and lead to inordinate delay, if regard had to be had to any patient's or any practitioner's desire; there must be a reasonable demand. Moreover, there is no recognition in the proviso of the provisions in Clause 4(7)(c) and 4(7)(d) about the phasing out of pay beds where steps that could be taken to provide alternative facilities are not being taken.

In addition, by importing into the proviso the reference to availability of facilities to patients or practitioners for obtaining or providing private treatment, the Amendment substantially elaborates the principles of the 15th December proposals as these have been embodied in Clause 4(7), where the phrase used is "facilities for private medicine". This could mean that even if there was a negligible demand from patients, nonetheless the consultants could maintain the case for pay beds because they desired to practise privately. This is not part of the 15th December proposals which were agreed.

6.24 p.m.


May I ask the noble Lord, Lord Wells-Pestell, to reconsider his attitude on this matter? My noble friend Lord Sandys, when moving his previous Amendment explained that he was asking for the noble Lord's views on whether the wording of subsection (2) could be improved. He wanted to make the second part of the declaratory clause, Clause 2, more explicit and he gave some examples from the Countryside Act and others of ways by which this could be done. Lord Wells-Pestell did not answer that point and I hope he will take the opportunity to do so now or later, because this Amendment is very much in line with the previous constructive one which my noble friend moved. It raises a matter which will, I think, recur throughout the Committee stage and I will refer to it now rather than having to repeat myself inordinately.

It is easy for the Government to pick and choose and select those parts of the Goodman proposals which they feel are essential, crucial and vital, and say, "These are part of the Goodman commitment", yet at the same time not pay attention to parts to which the Government do not attach such importance or refuse to alter the emphasis in other ways. To give an example, what Lord Wells-Pestell has been saying in replying to this Amendment has been "the Goodman, the whole Goodman and nothing but the Goodman". However, when we were examining Clause 1, I asked him whether the Scottish and Welsh committees were in the Goodman proposals. They are not. Despite that, the Government have seen fit in that case to add to the Goodman proposals because they feel that this addition will make the Bill work better.

It is not fair for the noble Lord to criticise those of us who have moved Amendments by saying, "You are attempting to undermine or undercut the Goodman proposals", when a few minutes later—when it suits the Government—they are quite happy to alter the Goodman proposals. The question then is this: is the alteration a major or a minor one? Who has the judgment of Solomon as to what is a major or minor amendment to the Goodman proposals?

Lord Wells-Pestell said that the last Amendment would water down and confuse the issue. I suggest that it is a matter of judgment. In my judgment it would have done the reverse; it would have clarified the issue. The noble Lord, Lord Goodman, spoke of his desire to remove the corroded atmosphere in the Service, and that we all wish to see removed. But I would ask Lord Wells-Pestell to bear in mind this when he is using the proposals made on 15th December as an argument and when he is talking about the commitment to Goodman: please have an open mind, please be prepared to consider and please do not insist that the Government's interpretation of an agreement between various parties is the only interpretation.

There may be ways in which the implementation of the Goodman proposals, if they are to be implemented, could be improved. I believe that my noble friend's suggestion is constructive and I hope that the noble Lord will not repeat, every time an Amendment is moved from these Benches, that in the view of the Government it would represent a substantial alteration to the Goodman proposals, when the Government are themselves prepared to alter those proposals when it suits them.


The Government have embodied all the Goodman proposals in the Bill and, as the noble Lord, Lord O'Hagan, quite rightly pointed out, they have added to them. The reason for this is that a long time ago the Government formulated the type of Bill that they wanted to separate private practice from the National Health Service. I do not have to tell the noble Lord, or any noble Lord present tonight, the kind of difficulties that arose when the Government made it clear some time ago that they wanted to separate private practice from the National Health Service. In order to get some agreement between the Government and the medical profession, we got the Goodman proposals which we understood were acceptable and accepted by the medical profession. Therefore, we embodied them in a Bill and we think that we have faithfully embodied them in this Bill. We have added other things, as the noble Lord mentioned, in order to seek to do what we want to do.

The noble Lord has asked, "Why not take it back and have a look at it?". I do not want to mislead the House. I want to be perfectly frank, as I hope I always am in your Lordships' House. We have studied very carefully what has taken place in another place. We know that there were 29 Sittings of the Committee. We know that it considered word by word and line by line something like 500 Amendments. The result is that when the Bill came to us we again looked at it very carefully and quite independently. We came to the conclusion that the Bill spelt out exactly what the Government want. We have carefully considered all the 143 Amendments that face your Lordships' House at the present moment and when I say that we have carefully considered them I mean that we have carefully considered them, since we received them in, I admit, reasonably good time. We have spent long hours going into them and we have come to the conclusion that, by and large, we prefer the Bill as it is and do not think that it will be improved by the Amendments.


T hesitate to rise again, but the noble Lord referred to the Committee stage in another place. What about the Second Reading in your Lordships' House when the author of the Goodman proposals, the noble Lord, Lord Goodman, came here and made certain suggestions about the way in which his own proposals could be carried into effect? My noble friend Lord Sandys referred to this specifically and those words are reflected in the Amendment. He talked about the use of the words "reasonable in every sense" which the noble Lord, Lord Goodman, referred to in his speech on Second Reading. Are we to take it from the Government that they are not prepared to look at Amendments even when they are in the spirit not only of Goodman the first time round but of Goodman speaking in your Lordships' House? Surely, the speech that was made by the noble Lord in this House as well as the proceedings of the Committee in another place will be taken into account by the Government when answering the debates here.


I have said that we have studied not only the Good-man proposals—that is clear because they are embodied in the Bill—but also the speech of the noble Lord, Lord Goodman, on Second Reading, and that we have not seen fit as a result of that to put down any Amendments ourselves or, for that matter, if they are reflected in any Amendments before your Lordships' House, to feel that they would in any way improve the Bill.


Of course the Government think that the Bill is perfect, but there is a certain note of selfsatisfaction which is not to my liking or that of my noble friends. In examining the position, of course we went into the clauses that relate to this particular Amendment very carefully. The noble Lord, Lord Wells-Pestell, was good enough to say that we normally do so and of course we have done so in this particular case. However, we detect in Clauses 4, 7 and 8 a loosening of nuts and bolts in the Goodman proposals and I believe that this is especially important. I shall not go into detail now, because I shall shortly be withdrawing the Amendment, but I should just like to say this. The noble Lord, Lord Goodman, quoted from a letter that is particularly relevant to the two Amendments to which we are speaking. The letter was sent by the British Medical Association to its members before the ballot. It said: Clearly, it is difficult to assess the validity on the one hand of the assurances given by the Goodman proposals and on the other the anxieties expressed in debate that so much remains a matter of individual interpretation and, so far as implementation is concerned, a matter of good faith. My noble friend Lord O'Hagan referred to this as the judgment of Solomon and I am certain that he is right. The letter went on to say: If the proposals were to be implemented as intended by Lord Goodman, then a significant measure of protection for the future of the independent practice of medicine would be achieved. If, however, the proposals were to be distorted by the Government and Lord Goodman's aims were not to be preserved, then there is no doubt that both private practice and the independence of the profession would suffer. We believe that to be a very fair statement by the British Medical Association and I would not add one word to it. However, I feel that, at this stage, it would be better to withdraw the Amendment and return to the point at a later stage. I beg leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

6.38 p.m.

Baroness YOUNG moved Amendment No. 9:

Page 2, line 43, at end insert— ("(3) Nothing shall be done under or by virtue of this Act, and nothing in this Act shall be construed, so as to operate to the detriment of any person (whether or not a consultant), who was on 12th April 1976 employed whole-time or part-time in one or other of the national health services or concerned with the interests of patients at NIIS hospitals, whether or not such detriment occurs under, by reason or in consequence of the terms of his employment.").

The noble Baroness said: I must say that, having listened to the noble Lord, Lord Wells-Pestell, reply to Amendments Nos.7 and 8, I am embarking on this debate with a heavy heart. It looks to me as if the Government have made up their mind that they will not accept any of the Amendments, and of course we now understand why they have put down no Amendments. I made my remarks about a perfect Bill as a joke because we all know that nothing in this life is perfect, but I must say that I am now distressed to think that the Government have decided that they themselves could not put down any Amendments to meet the points raised by the noble Lord, Lord Goodman, on Second Reading and that they look as if they will not meet any of the points that we are raising.

I shall of course try with the present Amendment because I should have thought that it was one that would have appealed to the Government. We came to consider what is to happen to all those individuals who will be affected by the phasing out of 1,000 beds. On the last two Amendments that I moved I have already spoken about the difficulties that part-time consultants will face if there are no private facilities available where they can practice. As the noble Lord knows, they receive only part of the salary of a full-time consultant and if they cannot make up the difference in private practice they will clearly be worse off. Therefore, they are likely to suffer financially. The Amendment is intended to apply not only to them but to the other employees who may be affected. We are concerned here with what I understand is an accepted trade union formula of no detriment.

Not only would the consultants easily suffer; what about all the other individuals, the nurses, the physiotherapists, and all those who have to serve and cook the meals in relation to 1,000 beds that are to be phased out, if these beds are not to be filled with National Health Service patients? When I asked this question at Second Reading I never got a categorical assurance that every single bed phased out will be used by a National Health Service patient, and ill one instance of which we know the accommodation has already been used as offices. Nobody has to be very clever to see that it could mean that many people will be affected. It is possible to argue that they will all be found other jobs in the hospital, and of course we hope that they will, but nobody can he sure. One of the objects of legislation must surely be to make quite sure that all the eventualities arc covered, and it is for this reason that we have put down the Amendment.

It might have been possible to put down an Amendment which went into the whole question of compensation, but that is not a method which I particularly care for, and i did not wish it in any sense to be looked at as a kind of special pleading by a special group. I take the view about the National Health Service, and indeed medical service generally, that everybody involved in it is giving a service. They are obviously being paid, but they are giving a service, and that is surely the spirit in which it should all be looked at. At the same time anybody who is likely to suffer financially for it ought to have some kind of recompense. I purposely used this particular form of words because I believe it to be a leading trade union principle that no renegotiation of collective agreements may ever operate to the detriment of existing employees. That is, in effect what the Amendment says, and it means employees in the widest sense: everybody employed in this massive transfer of beds. Therefore I hope that, because the purpose of the Amendment is constructive and helpful, the Government will accept it. I beg to move.


I believe that in dealing with an Amendment of this kind it is essential to look at Schedule 2 to see where the beds are located. The greatest number of beds that are to be withdrawn happen to number 46 and they cover all the hospitals in Kensington, Chelsea, and Westminster. So the number of private beds likely to be closed in any one hospital will be infinitesimal. Let us look, for example, at the position in Sunderland, where five beds will be closed, while in the whole of Suffolk there will be only three, and Suffolk has a good many hospitals. It is not as if one is to close 1,000 beds in one place and get rid of a tremendous amount of labour. The fact is that the 1,000 beds are to be drawn from England, Scotland and Wales, from hundreds of hospitals, and I should think that the question of displacement of staff will hardly arise unless for any reason a member of a hospital staff wants to leave.

We can take this question of detriment to an absurd length. Who are the people who are to be affected? The Amendment is very wide ranging. Let me give your Lordships a case in point. A cleaner who has been working in a private section of a hospital might complain that by the closure of two or three beds she will loose a certain amount in tips every week. A junior hospital doctor whose consultant was more often away from the hospital for private practice, or a part-time consultant who, if he is to increase his income, has to travel a little farther, could, I suppose, say that he had a claim for detriment because he had to travel a little farther. One would assume that he would put that on to the fee of the other private patient. So I suppose that any staff who had a greater load of work as a result of treating National Health Service patients rather than private patients could complain. I suppose that hospital porters who had been serving the private wing of a hospital could complain that because that part of the hospital, or a few beds had been closed, they had suffered as a result of loss of tips.

But where is this detriment? If we are to have in the Bill a clause which deals with detriment let us be realistic about it. Let us satisfy ourselves that there is going to he detriment. When one talks about detriment in the trade union world that means loss of jobs, and very often the loss of a large number of jobs. But these thousand beds are to be phased out in England, Scotland and Wales. They are to cover the whole of the area, and the number of beds to be phased out in any one hospital can, in the majority of instances, be counted on one hand. I do not really see that the question of detriment arises or that there is any need, just for that reason, for this Amendment.


I cannot accept the noble Lord's answer because it must be manifestly clear to your Lordships that Clause 2 applies not only during, phasing out of the first 1,000 beds but throughout the period that the Bill, when it becomes an Act, is on the Statute Book, and in the course of action during which the Board intend to phase out all private beds. So it must follow automatically, as certainly as night follows day, that there will be a loss of jobs. There is bound to be a loss of jobs. The Amendment seeks to ensure that the minimum amount of detriment is suffered by those involved. The noble Lord referred to Schedule 2. He quoted Kensington, Westminster and Chelsea and mentioned 46 beds, which is perfectly accurate, according to the Schedule. But that confuses the issue, because it suggests that that is the maximum number. It is the maximum number in Phase 1, but of course this clause covers a very much longer period.

The second point which the noble Lord raised was the loss of minor income, and he referred to tips. It is not tips, it is jobs which we are seeking to preserve by promoting the Amendment. I suggest to your Lordships that the Amendment goes very much wider and is far more beneficial in its aims than possibly the Government have grasped. At present the attitude of the noble Lord is one of resistance, but if he will look at the matter a little more carefully and perhaps consult the trade unions concerned he will be of a different mind about it.

6.46 p.m.


The noble Lord referred, I think, only to hospitals around London, and this is quite typical. I am looking up those which are to be closed down in my part of the world; that is to say, in Cleveland, Cumbria, Durham, Northumberland, Gateshead, Newcastle upon Tyne, North Tyneside, South Tyneside, and Sunderland. I am becoming rather tired of the fact that in this place we are always having to discuss Bills all of which relate to London. I do not want anything to happen to London hospitals any more than I want anything to happen to hospitals in my part of the world. I should like to remind the noble Lord that in this area we have King George's and King Edward's Hospital Fund, so quite a number of problems can be faced by using money from King Edward's Hospital Fund. When I go into some of the hospitals around here I find that in the general wards there are curtains all around the place and they are almost private wards, but that does not apply in my part of the world, and we are very worried about this situation.

I am all in favour of passing the Amendment which we are now discussing, but I want to say this. If this Bill ever becomes law (which heaven forbid!), and if the Government ever get reelected (which I hope they will not), then when they come back we shall have another Bill. This is the point, is it not? The noble Lord has talked about all sorts of things relating to Lord Goodman. I have a great admiration for Lord Goodman, but I should have preferred to see him sitting here. Then we could have had a go at him. I do not like discussions on a noble Lord's arrangements and then that noble Lord not coming to listen to those discussions. I do not approve of that. The noble Lord said that this was going to close down only 1,000 beds all over, so far as I can make out, but if the Bill becomes law then, before you can say "Jack Robinson", the Government will be coming along with another Bill and we shall have exactly the same arguments. I think that my Party, and I hope the Liberal Party, should get at the Government and tell them that we are not going to have this sort of thing going on. As I say, it does not suit my part of the world.

I will quote just one thing. We had a very fine hospital provided by private money, endowed by private money, which housed, and was arranged especially for, crippled children. Not so very long ago—and this is in the area in which I live, so I know that I am telling the truth—the local authority and all the people who lived in the area subscribed money and built a wonderful swimming pool; because in recent years it has been discovered that it helps cripples if they can get into a very good swimming pool. We spent a lot of money on it; it is a beautiful pool. The hospital was endowed. The whole of the hospital was given; but, of course, it has been taken over by the National Health Service. We have argued and argued about this, without any result from the Government. Of course, many of the crippled children got better through new treatment over the years from when the hospital was originally established, and it is true enough that there were some empty beds. They were occupied by adults.

The National Health Service took the hospital over just after this beautiful pool was built. We had lovely grounds for the children, lovely gardens—everything. So far as I can make out, some of the children have now got to be moved to the new Freeman Hospital, which we do not find at all satisfactory. It is quite a long way away from this beautiful swimming pool, and we do not find that at all suitable. When the noble Lord quite rightly says that there is a shortage of beds all over the country, that there are lots of people wanting to get into hospital and that they cannot because there are not enough beds, why get rid of the beds in this hospital? Why fill up beds in the new Freeman Hospital, which we are all waiting for and which we have had to wait for for years and years and are just about to get? Here is this other hospital which they say, of course, will have some beds empty. Why? We could fill those as well, and use the Freeman Hospital and all the new beds very satisfactorily.

I am absolutely in favour of this Amendment. I hate to have to say this, because I sometimes trust members of the Government—not very often, but sometimes I do—but I certainly think that this Amendment is absolutely necessary unless the noble Lord can say that this will be the last Bill to phase out pay beds. I suppose he cannot say that, can he? Because I think that if the Government stay in much longer we shall have another Bill and there will be a whole lot more beds phased out, and there will be more losses. As for looking after my part of the world, we have the greatest contempt for what is done in my part of the world. I am sorry if the noble Lord wants to get up—


Perhaps I may say to the noble Baroness that this is the last Bill on this matter because the Government will phase out, eventually, all pay beds.


That is what I thought.


I think the noble Baroness was under the impression that it was going to be only 1,000. May I say to the noble Baroness that I will look at this. We feel, as to the displacement of staff—because, as I said earlier on, only a few beds will be affected in some hospitals, and some hospitals will not be affected at all—that they will he absorbed, or could be absorbed (not necessarily will; it depends on them, but they could) into the National Health Service. But I will look at this, and I think that perhaps the best thing to do is to write to her and send a copy of the letter to the noble Lord, Lord Sandys, so that they will have an opportunity to consider it before Report stage.


I thank the noble Lord, but I do not like letters. I like the thing in public, and I want the letter in Hansard. I do not want the letter sent to me. The bother of having to get a letter in Hansard is quite an operation, and I do not like private letters. I like letters that are public.


I was not proposing to write to the noble Baroness, as much as I should like to do so. I was proposing to write to the noble Baroness, Lady Young, on an entirely different matter from the one that the noble Baroness, Lady Ward, was speaking about.


I was not talking about her.


Before we go any further, I think the noble Baroness who has just spoken has in many ways been a great deal more honest than many of the other noble Lords who have spoken. I would say to the noble Baroness, Lady Young, for whom I have the greatest respect—I think she is extraordinarily able, and I would much rather have her on my side than against me—that I feel there is a certain element of hypocrisy about the way we are being told that they are sad that the Government will not accept any of the Amendments. When I sat on the Opposition Front Bench, the Conservative Government of that time, in the case of a major health Bill and of a major social security Bill, did not accept one small Amendment from our side of the Committee. We differ philosophically, and I think that the other Party does not like this Bill. I think that if they were honestly to admit that they do not like this Bill, instead of pretending that they are now the champions of the workers—that is very interesting, but it is certainly a change of heart—it would be a much more honest approach. Those who do not like the philosophy behind the Bill—we respect this, and we understand it—should use that approach rather than bringing in some of these things, which seem to some of us merely delaying tactics.


I must ask permission to say to the noble Lord, Lord Wells-Pestell, that I think his calculation of only 46 pay beds being done away with in London is a little incorrect. I have made a rough calculation, and I think it is well over 200.


I must interrupt the noble Baroness. I said 46 in Kensington, Chelsea and Westminster, not in London.


What I was going to say was that that affects all the teaching hospitals in London, and, to me, they are the most important, because they are the ones where instruction is given both to the medical students and to the nurses. My calculation is that well over 200 beds will be phased out.


I welcome the fact that the noble Lord, Lord Wells-Pestell, has undertaken to look again at this Amendment and certain of the matters underlying it, in particular the calculations about possible lost jobs, and so on. I am very glad, too, that he has finally acknowledged that this Amendment does not look only at the first phase of 1,000) beds; it looks at the ultimate situation—the situation which the noble Lord has now made totally clear: the Government's intention ultimately to eliminate all private beds in National Health Service hospitals. When that has happened, there is no doubt at all that there will be many people who will be detrimentally affected in a number of different ways. It is not only the lost jobs.

So I merely rise to ask him whether, while he is looking at the number of jobs, and things of that kind, he will also look at another point. There are consultants, many of whom I could name and who he will discover, I am sure—who are at the moment part-time consultants. Many of them would honestly prefer to be whole-time National Health Service consultants but they cannot get whole-time contracts because the hospital boards are not in a position to offer them. When private practice has been phased out altogether—I am not saying that they necessarily want it phased out altogether; I am saying that some of these people are doing private practice because they are obliged to do so, they are compulsorily part-time—when private practice has gone from within the hospitals, one would like to feel that they will have opportunities to opt for full-time contracts. I am mentioning this to make it clear that there are a number of aspects so far as detriment is concerned and not only loss of jobs. If the noble Lord is to look at part of it, then he might as well look at it all.

Baroness YOUNG

It had been my intention to press this Amendment because we on this side feel strongly about it. I think that the support that it has received on all sides showed that everybody was concerned about the placing of staff. I was pleased to hear what the noble Lord, Lord Winstanley, said, because it applies to those consultants who will not be able to get full-time jobs as well as to other staff. We have just debated at length subsection (1) and the noble Lord drew my attention to the fact that it is the Government's intention that all private beds should be phased out; so that we must talk about the 4,000 beds.

I should like to reassure the Committee that we on this side think that the conditions of the staff are important. I may not have had much to do with hospitals, but I have had a considerable amount to do with schools and re-organisation, and one of the things that always comes up is, "What is to happen to the staff?" I can say categorically that none of them is financially worse off at the end of the arrangements than at the beginning. They may not have the same status; but they have not lost any money. I think this is important. I welcome what the noble Lord, Lord Wells-Pestell, has said. If he does not like our Amendment, I hope he will be able to bring back an Amendment himself which meets this point. If there is not an Amendment produced, then we shall return to this again on Report and press it to a Division. I beg leave to withdraw the Amendment.

Amendment, by leave, withdrawn.


This may be a good moment to halt the Committee as agreed. I beg to move that the House do now resume.

Moved accordingly, and, on Question, Motion agreed to.

House resumed.