HL Deb 08 November 1976 vol 377 cc97-169

7.45 p. m.

Baroness STEDMAN

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

Moved, that the House do again resolve itself into Committee.—(Baroness Stedman.)

On Question, Motion agreed to.

House in Committee accordingly.

[The Baroness TWEEDSMUIR of BELHELVIE in the Chair.]

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

On Question, Whether Clause 2 shall stand part of the Bill?


Before we finally leave Clause 2, in the Committee stage at any rate, I would remind your Lordships that this is the important clause which really declares the intentions of the Bill. What I want to question are the really remarkable words—I am sorry to say so— of the noble Lord, Lord Wells-Pestell, during the first day of the Committee stage; namely, on November 4th last and reported in the Hansard of that date in col. 1496 in which he said inter alia: 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. Is it not a fact that private patients pay enormous sums to the hospitals for private beds and private attention and that, in addition, they pay their physicians' fees or their surgeons' fees? The sum which is charged nowadays can amount, I am told, on some occasions to £200 or £300 a week.

This is worked out on a basis which is supposed to be an economic basis of what it costs to keep such a person in hospital. If that basis is not right and they should be paying more, well, that can be put right without an Act of Parliament because it has been increased many times. So I do not understand the meaning of the words; "that if people want it they must pay for it". They are paying for it in full measure and they are paying their Health Service contributions in addition. I should like clarification on that point.


If the noble Lord had referred to my Second Reading speech he would have seen that I there dealt with the matter rather more fully. There is no question that people who require the services of consultants privately and who wish to have a pay bed do, in fact, pay the consultant. That has never been in dispute. They also pay whatever the National Health Service considers to be appropriate in respect of the bed they are occupying. What I was trying to make clear was in answer (if my memory is correct) to the suggestions which have been made, not explicitly but implicitly, in this House that this is the thin end of the wedge on the part of the Government to get shot of private medicine altogether. I have said on at least two occasions, and this will be the third, that that is not the Government's intention. The Government have no intention of doing away with private medicine. They have no plans—and when I say that they have no plans I do not wish to imply "no plans at the moment"—for getting rid of private medicine.

I think that my words on that occasion—and I am trusting entirely to memory— were that we believe in a mixed economy; we believe that there should be a place in our society for State intervention, State ownership and for private enterprise. All I was trying to say is that on the one side we shall have State enterprise which is the National Health Service and that, as I cited at the time about those people who have feelings about the educational field and who want to send their child or children to independent schools, people should have a right of choice and should have the right to pay. This is our philosophy so far as medicine is concerned.


Why should they not have that right in a National Health Service hospital? It seems totally irrelevant to the Bill. If the intentions of the Government are that they should pay for their treatment—and they are paying for it—I do not see that the Bill has any particular purpose.

Baroness YOUNG

I would support the noble Lord, Lord Platt. I think he has made a valuable point. I do not think anybody doubts the word of the noble Lord, Lord Wells-Pestell, when he says that he certainly does not believe in the phasing out from the Health Service of private medicine. What I think is disturbing to the noble Lord, Lord Platt, to other doctors, to those of us on this side and indeed to a great many people in the country, is that an enormous number of undertakings were given at the inception of the National Health Service that it would be a partnership between the two; that doctors could practise and have their pay beds within the National Health Service. That undertaking is disappearing under the present Bill and people are doubtful of what credence can be put into guarantees that private medicine will be allowed to exist.


Is the noble Baroness really suggesting that things that were mentioned by her Party 30 years ago would hold good today? She knows very well that circumstances change with each decade. With each generation you have to look afresh at things. Her Party has done this time and time again. It is a perfectly reasonable thing to do. I do not quarrel with it at all. I know that the difference between the noble Lord, Lord Platt, and the Government is not going to be reconciled. We are wanting to separate private practice from the National Health Service because we believe that by having private practice within the National Health Service certain people get a measure of priority. In the National Health Service hospitals people are not given pay beds because of urgency. They are very often dealt with for social and personal reasons. Because they have the money to go to a consultant for a private bed they are taken over and above a long list of people who have been waiting for treatment for some considerable time.


There is a rhetorical device called the ignoratio elenchi, in which one side of the argument takes a long time to prove something which the other person never contested.


We have had a debate on the Question, Whether the clause shall stand part of the Bill?, and I believe that this marks a stage in our discussions on the Bill. The Committee will be grateful to the noble Lord Lord Platt, for what he has said because it has crystallised the view expressed at Standing Committee. The right honourable friend of the noble Lord, Mr. Ennals, quoted what he said to the COHSE conference in the latter part of the summer. I quote: We are in the realm of a political debate. This Government was elected on a Manifesto calling for the phasing out of pay beds. We have introduced a Bill to do just that and the Conservatives are determined to block it if they can. That is a statement in the baldest possible terms.

When we look at Clause 2 we have an extraordinary incompatability of the two Parts of the Bill. When we addressed ourselves to our Amendment, we endeavoured to demonstrate to the Government that there was an incompatibility between subsection (1) and subsection (2). Subsection (1) states the Government's present policy and subsection (2) proposes to restate the rights of National Health Service part-time consultants. What the Government are giving with one hand, they are taking away with the other. We feel that Clause 2 is an unsatisfactory clause in that as a declaratory statement it says something which is both incompatible and difficult to appreciate. We have addressed ourselves to these Amendments. We consider that this clause would be very much better left out of the Bill and I think that we can leave it at that.


We shall make a great deal of progress if the Opposition understands clearly that the purpose of this Bill is to separate private practice from the National Health Service based on what has come to be known as the Goodman proposals. It is all very well for the Opposition time and time again to pursue a policy of non-co-operation. We understand this. But they are repeating themselves and nothing can be done about the matter. I would remind your Lordships that when the Goodman proposals were drafted they were sent by the British Medical Association to 12,200 consultants (and I may say the question posed was heavily weighted by the BMA) who asked whether the consultants would be prepared to see these proposals in the legislation or prefer to resign from the National Health Service. As I said on Second Reading, over 5,000 consultants did not bother to reply, so one is entitled to assume that they were not very stirred up about it.




Of course noble Lords opposite will not agree. If people are stirred up about something, presumably they will say so. I am not going to give way to the noble Lord, Lord O'Hagan. I am sorry about this. If noble Lords want to waste time—I realise that this is part of their policy—we will find other ways of dealing with it.




No, that is not a threat; that is a promise. However, 7, 039 consultants were in favour of embodying these proposals in legislation. Out of 12,200 consultants only 21 per cent. voted against the proposals. Can noble Lords opposite really say that the Government have failed to discharge honourably their undertaking to embody the Goodman proposals in the Bill? They know very well that the Government have acted honourably in this matter. They have included all the Goodman proposals in this Bill. We have done precisely what Goodman was able to arrange between the BMA, who spoke on behalf of the consultants, and the Government. What more can your Lordships want?

Clause 2 agreed to.

Clause 3 [Immediate duty of Secretary of State as regards withdrawal of NHS beds. from resident private patients]:

The PRINCIPAL DEPUTY CHAIRMAN of COMMITTEES (Baroness Tweedsmuir of Belhelvie)

Before I call Amendment No. 10, I should point out that if it is agreed, I cannot call Amendment No. 11

8 p. m.

Baroness YOUNG moved Amendment No. 10:,

Page 3, line 1, leave out subsections (1) and (2) and insert— ("(1) Within 12 months after the passing of this Act the Board shall submit to the Secretary of State proposals for reducing, in the case of each Area Health Authority, Health Board and group of preserved Boards in Great Britain, the number of beds at NHS hospitals administered by that Authority, or by Boards within that group, authorised under section 1(1) of the 1968 Act to be made available to resident private patients, provided that the total number of beds proposed for such reduction shall not exceed 1,000. (2)It shall be the duty of the Secretary of State to give effect to the said proposal.")

The noble Baroness said: Perhaps might preface my remarks by saying that we shall make better progress on this Bill if we assume that both sides are acting in good faith. Some of us were disturbed that the Government did not see fit to put down any Amendments at all. The fact that we have gone through the Bill very thoroughly and put down a number of Amendments that we are concerned about should not be attributed to the desire to spin out proceedings on the Bill. We believe this is a very important matter which concerns a number of highly controversial issues.

If I may give my interpretation of what have come to be called the "Goodman Amendments", it is perfectly true that the Government are bound by those because, as I understand it, they were introduced to stop the doctors striking. But the House of Lords need not necessarily feel themselves bound by the Goodman Amendments. We are, after all, one of the Houses of Parliament and it is our job to look at legislation. This is the point, as I understand it, that came up last time. We were told that we could not move at all because of the Goodman Amendments and I said that the Government treated them rather like a Hebrew scholar looking at a Biblical text. There is a very good purpose for that kind of study and I should be the last to deny it; but legislation should not simply be considered in that way. Of course, the wording must be correct, but so must the principle.

The Amendment I am now moving has a very important principle behind it. Its purpose it to try to ensure that it will be the Board and not the Secretary of State which will be responsible for phasing out the first 1,000 beds. We are by no means clear why it is the Secretary of State who has to do that and perhaps the noble Lord, when he comes to reply, will tell us why that is so. We have simply been given Schedule 2—to which we shall be turning later—with a list of those beds that are to be phased out. I. have discovered in conversation and from correspondence that an enormous amount of work is already being done on the 1,000 beds that are being phased out without, once again, waiting until Parliament has decided to pass the Bill before the whole thing is put into effect. Of course, the Government have given themselves an absurdly tight timetable on the phasing out and we shall be looking at that again in later Amendments. The fact is that it is very difficult for the Government to say they can phase out 1,000 beds in six months.

How can they foresee that the beds they have phased out or that they propose to phase out, are the right ones? How do they now that something may not happen? Let us suppose there is a terrible disaster; for example, a fire in some hospital. If the hospital is burned down, does that mean that the whole situation will have to stand or will alternative arrangements have to be made? In the case of a shifting population, will alternative arrangements also have to be made? All sorts of things can happen.

However, the most important reason for this Amendment is that if the Government believe, as I assume they do—and certainly it is my reading of the Goodman Amendments that that is the intention—that the Board should be the key to the success of the working of the private and the National Health Services, then it must be seen to have certain functions. It seems to me that in Clause 3 it would be right for the Board to be given the function of phasing out the first 1,000 beds, as proof on the part of the Government that they believe it should have the power and that if it has the power to phase out the remaining 3,500 beds it could perfectly well phase out the first 1,000. I hope the Government will feel able to accept this Amendment. It does not in any way damage the principle behind the Bill because everyone agrees that the first 1,000 beds shall be phased out, so they have the principle as it stands. But surely it is more sensible for the Board to be responsible, and not the Secretary of State. I beg to move.

8. 5 p. m.


I am glad the noble Baroness emphasised the point that what we are considering are the Government's proposals and not the compromise put forward by the noble Lord, Lord Goodman. I am getting a little weary of hearing the name of the noble Lord, for whom I have a great admiration, just as I have for Henry Kissinger—and they have something in common—but we are not here to bow the knee to the Gospel according to Saint Arnold; we are here to consider specific proposals on their merits. And what is the proposal that is contained in this clause? It is that from above, whether it be the Secretary of State or the Board, there is this decision that there has to be at the outset a reduction of a 1,000 beds, without considering whether that is the right figure or whether it will reduce the amount of private bed accommodation, to the worsening of public services.

It is an arbitrary decision from above; and I should like to know how that number was arrived at. Please do not say in reply that it was arrived at by the workings of the intricate mind of the noble Lord, Lord Goodman. We are considering the public interest, or should be. What are the arguments in terms of the public interest for selecting this figure of 1,000 beds and then in Schedule 2 arbitrarily dividing it up between the various areas? It seems to me that we need to be convinced that that is the right figure. Perhaps it has been chosen for purely political reasons, following pressure by various trade unions. If that is so, then I hope the noble Lord, with his customary candour, will say so. Otherwise I hope he will explain to us why it is 1,000 and not 900, or why it is 1,000 and not 1,100, for we are considering provision for sick people, even though they are people who are willing to pay for privacy and private attention.

I suggest that although in the case of subsequent reductions criteria are to be applied, as laid down in the Bill—criteria of the adequacy of services and so on—in this case there is an arbitrary fixing of the figure of 1,000. I think this Chamber, is entitled to know upon what human medical and social grounds that figure of 1, 000 was determined. Do not, please, tell us that the noble Lord, Lord Goodman, in his omniscience divined that figure. He was fixing things to avoid a strike. He was preparing a compromise, and very skilled he is at that business. But the fact that in his fixing he tries the figure of 1,000 does not prove that it is right, that it is in the public interest or that it is one we should support.


I do not want to intervene too often and I shall not repeat the arguments which have already been put so well by the noble Baroness and by the noble Lord, Lord Hill. But is it not very unusual for a Bill of this kind to contain, before we have had any time to discuss it, an actual list of all the hospitals it is proposed to close? Are we supposed to be taking each hospital into account if we pass this Bill? I suggest this is the wrong way to go about it.


I should like to support this Amendment because I have an extreme dislike of direction from the Secretary of State or other officers who are divorced both in position and influence from the grass roots, concerning things such as how many private beds are wanted in any given area or how many of the beds can be phased out in a given area. Such things must depend on the conditions where an arrangement is to be carried out.

I agree with the noble Lord who has just spoken that whether it is 1,000 beds, 800 beds or 900 beds, we do not know why the figure was chosen. It is just a figure which has been put forward. But what we ought to know about, and ought to be able to have some influence on, is the way in which this phasing out is to be done. It should not just be done by the Secretary of State, when boards are being appointed to supervise and run the scheme, and when it is said that they are the people who will do it. The people who will do it are those in Whitehall. That is all very well, but it is a long way away from the hospitals mentioned in the Bill in these different areas of the North of England, Scotland, West Wales and so on. The conditions are so very varied.

There is aleady a list in Schedule 2, stating the number of pay-beds that will be withdrawn. Who suggested that? Was it the local people, was it the people in Cleveland, Cumbria, Durham, Northum-berland, Gateshead, et cetera, or was it the people in Whitehall? What we want to be certain about is that the operation of the Bill, which none of us likes, shall be as close to the hospitals, to the doctors, to the nurses and to the patients as it can possibly be, because the local conditions can be known only by the Board and its subsidiary companies running the different areas, and not by the Secretary of State. Therefore, I support this Amendment most wholeheartedly.


I, too, should love to support this Amendment, but before I say why I should like to say something about the great play which the noble Lord, Lord Wells-Pestell, has made of this ballot that went out to all members of the medical profession, and of the fact that only 21 percent. voted against the Goodman proposals. I am very worried that unless we think about it very carefully, this matter will go by default. If you know that you are faced with a Bill of some kind, you will obviously accept the better part of it that you are offered, and the Goodman proposals enabled an enormous number of the medical profession to accept it as better than they originally hoped they would be offered. On the other hand, I cannot envisage an enormous proportion of the medical profession, with their dedication to looking after their patients, resigning from the National Health Service as an alternative. In my view, it was an unfair question to ask in the ballot and that was the fault of the BMA. So when we are talking about these figures we should keep that in our minds, because they do not create a fair picture of the medical profession.

On Second Reading, I appealed to the Government, now that we have a Royal Commission, to send this problem to them. It is for the same reason that I want to support this Amendment. We seem to be setting up bodies of various kinds, and then taking the decision-making out of their hands. We are setting up the Health Services Board in order for it to make sense out of the proposals, and I believe that in future we should avoid taking decisions for the bodies which we are setting up under the Bill. The same arguments apply for the whole Bill vis-ù-vis the Royal Commission, and the 1, 000 beds vis-ù-vis the Health Services Board.

Baroness VICKERS

I, too, should like to support this very practical Amendment. The noble Lord, Lord Wells-Pestell, may be interested to know that I have never been a patient in a pay-beds hospital, and the only time I went to hospital it was to the Middlesex Hospital where I was in a public ward. The noble Lord will re-member that we were talking about various aspects, and I thought I should like to learn for myself, and, therefore, I have some knowledge of the care that can be taken in a public ward. Also, of course, I have visited friends in private wards in order to see how they were treated. I have no complaint to make, but I understand that not everybody wishes to go into a public ward if they want privacy. Though I booked my bed some time ahead, I felt rather guilty that I was perhaps taking a bed that could have been used by somebody who could not afford to pay.

I think that this Amendment is very practical and worthy of consideration, because I should like to know how some of the decisions stated in Schedule 2 have been made. I have to take an area known to me, which is the County of Devon, which is now the biggest administrative area in the Kingdom, and Schedule 2 just states that 25 beds will be taken away from 70. There is no indication of where these will be taken from. This is very interesting, because Plymouth has by far the largest population of over 250,000, and it is also the catchment area for East Cornwall and North Devon. Then there is the Torbay area, where there are a great many elderly people. If there are to be no pay-beds for them, they will therefore fill as long-stay patients other beds which should be given to people who need them. In that area there are only four district hospitals, and we do not know whether the new one at Derriford will come to fruition and have any pay-beds. Furthermore, in the whole area there are only two small BUPA hospitals. It is also suggested that a hospital for women is to be closed, and we wish to know what is to happen in future.

In another place, it was said that the district administrators or the hospitals concerned have confirmed that they have resources available to use the beds for NHS patients. I am sure that the Minister does not want to be accused of having empty beds, rather than have them occupied by private patients. Also, many of the hospitals have private wings which are quite separate, and which makes administration very difficult. As the Minister will know, many of these beds are now serviced by agency nurses. Furthermore, I read in the newspapers that the North-West Thames Region will have to find annual savings of £2 million next year, and that is only one region. So I should have thought it was much better not to cut the number of pay-beds too quickly, because they will bring in some income. In the East Bucks district, there are 100 nurses who must be axed if staff levels are to be kept at the numbers which they can easily afford. Here, again, it will help if we have pay-beds. So one fears that because of these cuts the NHS patients will suffer, and already in some areas there are waiting lists of three years for minor operations, while in one area of which I know there is a waiting list of six years.

It is stated by the Royal College of Nursing that 2, 000 newly qualified nurses cannot get jobs, and it has been suggested in another place that they might become mobile. But that is not possible, because most of them are married. Therefore, if the number of pay-beds is cut too quickly those nurses will be out of work and many will not be encouraged to train for the future. We realise, too, from what the Chancellor of the Exchequer said, that there may also be overall cuts. With £20 million cut off capital spending on the Health Service next year, it would surely be more helpful to phase out these beds more slowly and continue to get the income. That would also give the Government an opportunity to find out whether there is a real need for pay-beds, and also to consult local people. Many of the hospitals are well-known to foreigners who come here in large numbers, and if they cease to come the Government will lose that income.

I gather that the Department of Health and Social Security discussed in a document the occupancy rates at April, 1976, and that the Royal Marsden had 95.5 per cent. of occupancy and the Maudesley 75 per cent., with only eight pay beds. In another place the Minister stated at col. 1442: In none of the areas will there be elimination of all pay beds". I should like this fact to be confirmed, because once the figure of 1,000 pay beds has been passed they may gradually eliminate the others. None of the cuts needs to result in any private patient or any consultant losing access to pay bed facilities within six months of Royal Assent, but I do not think that this is very helpful because we do not know what will happen after that period of six months.

I should also like to ask what is to happen to the endowed beds; quite a lot of beds are endowed. Are the endowed beds also to be taken off the list of beds available to private patients? I should like to suggest that the Amendment, so very well put forward by my noble friend Lady Young, is practical, not political, and that it would be in the interests of both patients and the National Health Service if it were accepted.


May I support what my noble friend Lady Young has said. We have been told over and over again that the country is practically broke. Also we have been told that the Health Service is not paying its way. It is Socialist Party political dogma, which was apparent in the Manifesto, that pay beds must be withdrawn. However, their withdrawal does not make sense. Nobody who can add up two and two can believe that to phase out at great expense beds which represent an enormous amount of money per week to the Service makes sense. These beds are to be withdrawn for purely political purposes. When the National Health Service is not paying its way, surely it does not make sense to withdraw pay beds.

I notice that in the list of hospitals in Schedule 2 there is an Area Health Authority for Calderdale where no pay beds are to be taken away. There are 32 pay beds in that area. I should like to know why this has been prearranged. I agree with other noble Lords who have spoken that already the Department have tied the hands of the Board, a Board which is not yet in being, by telling it what it shall do. I think that this is very wrong. It will be difficult to get people of great eminence to serve on this Board. They will want to do other jobs, and I doubt very much whether the Ministry will be able to find people of eminence who will be willing to give up their time to do something which the Department has already decided upon in advance. With other noble Lords I believe that this is a bad principle and I should like to hear what the noble Lord has to say about it. I will not make any comment on my own area where half of the pay beds are to be done away with. However, Calderdale, where no pay beds out of the 32 are to be withdrawn, sticks out. I suggest that all 32 pay beds should be kept in that area.

Obviously we are going to fight this right the way through. For the reasons I have given, I believe that the concept of phasing out pay beds, when people want to pay money for privacy, is wrong. I support the noble Baroness in her Amendment.


I do not wish to become embroiled at this stage in too much argument over Schedule 2 because we shall be coming to it later, but I had occasion at Second Reading to mention one area with which I am acquainted; namely, Cambridgeshire which includes Addenbrooke's Hospital, one of our leading provincial teaching hospitals. It contains a kidney unit, and at Second Reading I mentioned that 20 out of 56 pay beds there were being phased out. The noble Lord, Lord Wells-Pestell, no doubt on advice from his Department, mentioned that there are a number of private institutions around Cambridge; but surely this argument applies to many other areas, too. I should have thought that, of all areas, Cambridgeshire—which contains one of the leading provincial teaching hospitals and which will have a great need for nurses, doctors and consultants in the future—was an ill-chosen area for the noble Lord to take.

May I return to the "teeth" of the Amendment. According to the Bill, the first 1, 000 beds are to be phased out within six months. This puts a very onerous task on to a Board which is to have only five members. We on this side of the House tried to make it seven members in Clause 1, but five have been accepted for the time being. Those five members will have enormous decisions to take within a very short time. Leaving aside the mathematics, which the noble Lord, Lord Hill of Luton, very properly mentioned, this is going to put the Board into an impossible situation. I think that it would be in no way wrecking the Bill, which is in its early stages of discussion, if the time limit proposed in the Amendment moved by my noble friend Lady Young were to be studied again. After all, 12 months would give to the Board a much longer period of time in which to hold consultations up and down the country—in the North of Scotland, in West Wales, in the extreme South-West—where developments are taking place and where there will be a need for more hospital beds. I hope—and I say this in no partisan, political spirit—that the Government will consider this matter very carefully.

8. 28 p. m.


I should also like to support my noble friend's Amendment, although for a reason I did not mention at Second Reading. It is a quite different reason which I hope the noble Lord, Lord Wells-Pestell, will consider. The noble Lord will be aware that every year the principal medical officer lays before the Department and produces for the public service a document, which in 1974 was entitled On the State of Public Health in the Year 1974. No doubt the document had the same title in 1975 and 1976. That document, On the State of Public Health in the Year 1974, which bore the signature of the principal medical officer, as he then was, raised a number of important issues.

It is an interesting document which very properly considers the problems of administration within the National Health Service. A number of issues concerning administration were raised—for instance, the question of blood transfusions and of industrial unrest—but at no point in this report for the year 1974 was the question of pay beds raised. I believe that it is highly significant that the principal medical officer should not make a point of mentioning pay beds as an issue which the Secretary of State and his or her advisers should consider. Further, I believe that in examining a report of considerable length and value in regard to the structure of the Hospital Service as a whole, it will not be found—at least on my reading it will not be found—that this matter was at any time put forward as a paper for discussion within the Ministry. This may have been not raised as a matter of policy, and the noble Lord, Lord Wells-Pestell, can tell us about this report. It is important.

Secondly, I think it is of great importance to consider the county plans for emergencies. Each county is under an obligation to the Home Secretary to produce a plan, and to up-date it from time to time, on emergencies within their area. They can be emergencies of the magnitude of Flixborough; they can be of the magnitude of that which took place about 18 months ago only a short distance outside London when a very large plane crashed. These issues demand very substantial consideration in the areas of local authorities. I wonder whether the Secretary of State has regarded this matter worthy of consideration in looking at the question of 1,000 beds. The figure does appear to be arbitrary, and I do believe that in the Amendment as set out my noble friend has made a very positive suggestion, that the Board shall undertake it and not the Secretary of State.


I can accept what the noble Baroness says about the fact that she and her friends are not bound by the Goodman proposals. We, the Government, are bound by them, for the simple reason that this was the outcome of discussions which took place between the Government, the consultants and the medical profession, with Lord Goodman being present to give what assistance he could. I should have thought that as this was an agreement between all parties this was a reasonable thing to put in the Bill. If the noble Baroness feels that it is not incumbent upon her to support the medical profession, who apparently are in agreement with the proposals, I am tempted to ask who she is representing in your Lordships' Chamber.

Baroness YOUNG

If the noble Lord, Lord Wells-Pestell, is asking me who I represent. I, and we on this side of the Committee, represent all the people at present in National Health Service hospitals, the patients, and others in private hospitals. We are interested in promoting a good medical service. That is our interest.


May I intervene to say that I wish the noble Lord would not refer to the noble Baroness and her friends. We are all her friends. So far there has been a notable speech from the Liberal Benches, several from the Tory Benches, two from the Cross-Benches and none from the other side.


There are none from the other side because the other side happen to agree with the Government's proposal in this matter. I should like do deal, so far as I can, with the questions that have been raised. I take the point made by the noble Lord, Lord Hill. The Government are not suggesting that the noble Lord, Lord Goodman, is infallible; nor do we suggest as a Government that what have come to be known as his proposals are holy writ, although from my point of view I might feel inclined to say they are. I think the mistake that a large number of your Lordships make is in overlooking the fact that Lord Goodman did not devise the proposals which bear his name. They were the result of negotiations, as I have said time and time again, between Her Majesty's Government and the medical and dental professions, in which Lord Goodman acted as an intermediary.


If the noble Lord will forgive me, he keeps referring to the agreement. He should, I think, tell the Committee of the last paragraph of the then Prime Minister's letter to the medical profession, in which he referred to this as an agreement, and also made abundantly plain that, even though this agreement had led them not to proceed with industrial action, they were free, as he assured them, to express critical, indeed adverse, views of the Goodman proposals.


I accept every word the noble Lord has said, but he admits that there was an agreement; and if there was an agreement, which the vast majority voted should be included in legislation, it seems to me the Government have carried that out. The noble Lord also asked about Schedule 2 which sets out the pay beds which are to be phased out within the six months. I would point out that they are quotas for areas and not individual hospitals, so when the time comes to phase them out that number of beds will be withdrawn from a particular area; the hospitals they are to be withdrawn from will then be decided upon. The noble Lord, Lord Hill, quite rightly, raised the question, "Why 1,000 beds?" "Why not 900?", I think he said. The reason is that it was felt, not by Lord Goodman but during the discussions, that 1,000 beds could be withdrawn within a comparatively short period without in any way damaging the private sector. One has to bear in mind that there are 4,444 pay beds in this country. The average bed occupancy for private beds throughout the country is less than 50 per cent. per annum—49 per cent, in point of fact—which means to say that 1, 000 beds can be withdrawn without having any damaging effect; and on the quota basis per area it can then be decided which of the hospitals can best release one, two or three, as the case may be.


I am not quite sure I understand the formula of the quota, how this was worked out.


By the bed occupancy of private beds in each area. As I say, taking the country as a whole, the 4,444 beds were used on average for only about 49 per cent. of the year; so less than half that total number were fully occupied. I accept that some are occupied more than 49 per cent. and some less. In the areas that are set out in Schedule 2 careful inquiry and discussion took place to see which areas could release private beds without upsetting the demand for them, and the number arrived at will be withdrawn from the hospitals in that particular area. I do not think I can put it more simply than that.


If the noble Lord would allow me to intervene on the point of private bed occupancy rates, would be acknowledge that many of the private beds which were not occupied by private patients were in fact being occupied, quite properly, by National Health Service patients, and it would be quite impossible to shove in a private patient at the other end.


I am not going to say that this did not happen from time to time, but when one has a certain number of private beds in a particular hospital for the exclusive use of consultants one has to be very careful about putting a Natonal Health Service patient in them unless there is a very real emergency.

The noble Baroness, Lady Robson, raised the question of the Royal Commission. She will forgive me if I say that I do not intend to deal with that in detail. I thought I dealt with it in detail at Second Reading. We regard this as a political decision. This is not a matter for a group of people to get round a table and discuss. This is a political matter, a political policy. Like all political matters and political policies it must be decided by the Party that wishes to see it in being. Because it is in our view essentially a political matter we took the political decision to say this is what we are going to do, but we have done it, I venture to suggest, with agreement and with understanding.

The noble Baroness, Lady Vickers, raised a similar question about the wisdom of doing this, but I notice that she did not say that she knew of a single hospital which had in fact informed her that they were opposed to this. The Secretary of State's decision to phase out 1,000 beds within the first six months was taken at the beginning of this year. It has been known since then to the hospitals concerned, to all the Area Health Authorities, that these beds were going to be phased out. They have known for months the number of beds that were going to be phased out in their particular area. Apart from a few rumblings in various places there has been nothing at all. When the Bill is passed, which may be a month or two yet, there will still be six months before those beds will be phased out, so they will have had upwards of one year's notice of the Government's intention.

There is only one other point I want to add, and I am not sure whether the noble Baroness raised this or not. I think perhaps it was the noble Lord, Lord Auckland, who spoke about putting a tremendous responsibility on the Board to do this in the first six months. The Board has nothing to do with the phasing out of these 1,000 beds. This is a decision which has been taken by the Secretary of State, subject to the agreement of Parliament. The Bill has not yet passed and is not on the Statute Book, so it must be subject to the decision of Parliament. But it was made perfectly clear at the beginning of the year that 1,000 beds would be phased out.

This is the Secretary of State's decision. It is his responsibility. It has nothing to do with the Board, and the Board will have no responsibility for it at all. The responsibility of the Board will be to concern itself with the gradual phasing out of the remaining 3,444 beds. The conditions under which they will be phased out are clearly set out in the Bill. It will be the responsibility of the Board during its first six months to send a report to the Secretary of State saying how it proposes to start on this task. I think your Lordships will find in the Bill that if for any reason it cannot complete its task to produce a first report within six months, it can ask the Secretary of State for an extension.

The noble Baroness, Lady Macleod of Borve, rightly referred to the loss of income. But there will be, so far as these 1,000 beds are concerned, very little loss of income, because they are the beds which are considerably under-utilised. I am not going to say that when the other beds are phased out there will not be a loss of income—there will be a loss of income—but immediately the loss of income will not amount to very much. As they are gradually phased out and the various conditions and provisions within the Bill come into being, the National Health Service will earn, I imagine, a considerable amount of money as a result of making available to the private sector certain facilities within the National Health Service which will not be available in the private sector and which the private sector will want to take advantage of. So this loss of money is not necessarily as serious as some noble Lords think.


Is the noble Lord serious when he tells us that 1,000 beds paying £250 a week is chickenfeed to the Health Service? It is a considerable amount of money.


If 1,000 beds were paying £250 a week to the National Health Service their withdrawal would be a considerable loss, but I have been at some pains to point out that they are 1,000 beds which are hardly used by private patients. It is no good noble Lords shaking their heads and smiling. This is one of the facts of life. Facts of life are not always pleasant, but this is a fact of life.

The noble Lord, Lord Sandys, referred to there being no reference in the 1974 Report by the Chief Medical Officer of Health to pay beds. I hope there would not be. The Chief Medical Officer of Health is an official. He is a servant of the Departmant, and he would have known, as the whole of the Department knew in 1974, what the Government's intention was. I should have thought that it was improper for somebody holding a position such as he held to make a comment on this subject without being invited to do so.


In saying that the noble Lord has acknowledged that the intention expressed by the Government in the Bill is a purely political intention, which we know already, but further it is a grossly misleading factor in the Government's policy to suggest at any stage that it is for the benefit of the Health Service as a whole.


The noble Lord knows that if we were to stand here for the next year and discuss this matter we should not agree.


We certainly would not.


We think that it is going to be a very good thing for the National Health Service, and if the noble Lord were to talk privately to a good many of the consultants and members of the medical profession I am sure they would tell him that they too regard it as a very good thing for private practices as well.




No. The only other point I want to refer to is the one raised by the noble Baroness, Lady Young, who asked what happens if there is a fire at a hospital after the withdrawal of 1,000 beds had been settled. I think she will find that the answer is probably in Clause 5, which allows the Secretary of State to authorise beds temporarily for private use if there is some misfortune—that is not a very good word: some emergency. If there is an emergency, due to almost any cause whatsoever, then the Secretary of State is able to authorise pay beds on a temporary basis.

We cannot accept—and I imagine this is perfectly clear to your Lordships—the Amendment before the Committee. As the Principal Deputy Chairman said, if Amendment No.10 is accepted or carried then she cannot put Amendment No.11, but with the greatest respect I would suggest that what I have said applies also to Amendments Nos.12 and 13. I think we would be going over the same ground again, because the principles involved are much the same, so when I attempted to answer Amendments Nos.10 and 11 I was in fact speaking to 12 and 13.

8. 50 p. m.

Baroness YOUNG

I thank the noble Lord, Lord Wells-Pestell, for his reply but, as he will appreciate, there are very great difficulties for us in view of what he said. I am grateful to all those who have supported me in the Amendment, in particular the three noble Lords who are doctors and for whose advise we are always grateful and the many noble Lords who have spoken from personal experience. It is useful to have my noble friend Lady Vickers talk of Devon, my noble friend Lady Macleod of Borve talk of Hertfordshire and my noble friend Lord Auckland talk about Cambridge. It brings reality to the discussion when noble Lords speak about places they know. I think we would all agree with what the noble Baroness, Lady Robson of Kiddington, said; that we only wish the whole matter could have been referred to the Royal Commission, and I am surprised that the Government do not think so, too.

It is clear from what Lord Wells-Pestell said that the Government are in great difficulties over the Bill. He has explained time and again that the Bill is the outcome of the agreement reached through the good offices of the noble Lord, Lord Goodman, and discussions with the medical profession. But nothing can take away the fact that it is, as he said, a political policy; it has brought politics into the National Health Service and into medicine in a most undesirable way. Thus, he cannot object when we raise points about it. We are deeply concerned about the Bill because when I said in reply to his earlier remark that the Government gave undertakings to the doctors in 1946, I was pointing out that this was not just a change of matter on a political policy; like, for example, reorganising the National Health Service, which could be subject to change in the light of events. This was a fundamental principle about the right of a professional person to sell his skill in the market place after he has fulfilled his contract to the NHS, and to change one's mind on that is a very serious matter indeed.

We have talked about Schedule 2 and the noble Lord explained that there will be quotas for areas. This is a subject to which we shall return later because nowhere is "area" defined in the Bill. I was interested to hear that the details have not yet been decided because the Committee should know of a letter which I have received from a consultant dermatologist at Farnborough Hospital in Kent, who writes: First of all, we are told that the cuts have been agreed after consultation. As far as my colleagues and I know, no consultations have occurred. There may have been consultations up at the Elephant or with some remote BMA committee, but the people on the spot who are going to be affected have not been consulted at all. Secondly, the cut in bed numbers is about a third of the total which, apparently, is the average over most of the country. In our locality there are virtually no private beds available outside the Health Service, yet our beds are cut as severely as everyone else's. It is clearly unrealistic to expect our patients to be treated by us in nursing homes up in the West End of London. This is the consequence of phasing out the 1,000 beds in this arbitrary way, and to argue that the patients will be better served as a result seems extraordinary. I am pressing the Amendment because we think it would be far better, in the interests of

both the NHS patients and others working in the Service and private practice, if it were the Board rather than the Secretary of State who was responsible for phasing the first 1,000 beds. We might then get some shift on this arbitrary figure in an arbitrary time-scale.

Now that we know the reason why the figure of 1, 000 was fixed on—because Lord Goodman thought that, 1,000 beds could be withdrawn without harming the Health Service—one is bound to ask how much detailed preparation there was before the figure was arrived at. I am extremely sceptical about average figures for bed occupancy. I am sure that Lord Wells-Pestell was speaking the truth when he said that pay beds had an occupancy rate of 49 per cent., but an average rate conceals a great many things; many will be above average and many below and, as the noble Lord, Lord Winstanley, rightly pointed out, many beds will be occupied at intervals by NHS patients, many will be kept for specialist subjects, specialist illnesses, and must be kept pending those cases arriving, and many will always be kept empty for emergencies.

However, if the argument on the whole of the Bill is the occupancy rate, there is no doubt that the Government will accept our Amendment No.16 which insists that the 1,000 beds shall be used for NHS patients, and we will return to that and the arguments to be adduced when we debate that Amendment. In the meantime, I cannot withdraw the Amendment we are discussing because I believe it to be a matter of importance and I therefore urge noble Lords to join me in the Division Lobby to support it.

8.54 p. m.

On Question, Whether the said Amendment (No.10) shall be agreed to?

Their Lordships divided: Contents, 69; Not-Contents 40.

Amory, V. Craigmyle, L. Gisborough, L.
Amulree, L. Denham, L. [Teller.] Gowrie, E.
Auckland, L. Drumalbyn, L. Greenway L.
Balerno, L. Ellenborough, L. Hanworth, V.
Belstead, L. Elles, B. Harmer-Nicholls, L.
Berkeley, B. Elliot of Harwood, B. Henley, L.
Broadbridge, L. Faithfull, B. Hill of Luton, L.
Campbell of Croy, L. Ferrers, E. Home of the Hirsel, L.
Carlisle, Bp. Gainford, L. Hornsby-Smith, B.
Cottesloe, L. Garner, L. Hunt of Fawley, L.
Hylton-Foster, B. Morris, L. St. Just, L.
Inglewood, L. Mottistone, L. Sandys, L. [Teller.]
Kemsley, V. Mowbray and Stourton, L. Seebohm, L.
Killearn, L. Newall, L. Stamp, L.
Kinnaird, L. O'Hagan, L. Swansea, L.
Lindsey and Abingdon, E Onslow, E. Tranmire, L.
Long, V. Pender, L. Tweedsmuir, L.
Lyell, L. Platt, L. Vickers, B.
Macleod of Borve, B. Rankeillour, L. Vivian, L.
Marley, L. Rathcreedan, L. Ward of North Tyneside, B.
Merrivale, L. Redesdale, L. Windlesham, L.
Monson, L. Robson of Kiddington, B. Winstanley, L.
Montgomery of Alamein, V. Ruthven of Freeland, Ly. Young, B.
Birk, B. Janner, L. Plurenden, L.
Blyton, L. Kagan, L. Popplewell, L.
Brockway, L. Kirkhill, L. Ritchie-Calder, L.
Castle, L. Lee of Newton, L. Shepherd, L.
Champion, L. Llewelyn-Davies of Hastoe, B. Stedman, B.
Collison, L. McCluskey, L. Stewart of Alvechurch, B.
Davies of Leek, L. Maelor, L. Stone, L.
Davies of Penrhys, L. Morris of Kenwood, L. Strabolgi, L. [Teller.]
Donaldson of Kingsbridge, L. Murray of Gravesend, L. Taylor of Mansfield, L.
Elwyn-Jones, L. (L. Chancellor.) Northfield, L. Wallace of Coslany, L.
Fisher of Camden, L. Oram, L. Walston, L.
Hale, L. Peart, L. (L. Privy Seal.) Wells-Pestell, L.
Houghton of Sowerby, L. Peddie, L. Winterbottom, L. [Teller].
Jacques, L.

On Question, Amendment agreed to.

Resolved in the affirmative, and Amendment agreed to accordingly.

9. 3 p. m.

Baroness YOUNG moved Amendment No.12: Page 3, leave out from beginning of line 13 to ("due") in line 18 and insert ("In making such proposals the Board shall have").

The noble Baroness said: I beg to move this Amendment, which is consequential.

Baroness YOUNG moved Amendment No.13: Page 3, line 25, leave out ("and").

The noble Baroness said: I beg to move Amendment No.13 and will speak at the same time to Amendment No.14, because, of course, Amendment No.13 is a paving Amendment. We come now to a series of Amendments which, for want of a better title I shall call the "Goodman Amendments". Those of us who heard the noble Lord, Lord Goodman, speak on Second Reading, will know that he himself asked the Government whether they would consider looking further at the definitions of various parts of the Bill to see whether it was possible to tighten up the arrangements that had been made. This is the first of a series of Amendments that we have tabled to that end. As the noble Lord will appreciate, they in no way go against the principle of the Bill. They are Amendments which the noble Lord, Lord Goodman, suggested ought to go into the Bill, and, indeed, the noble Lord, with whom I discussed them last week, had hoped to be here. However, shortly before we entered the Committee stage I had a note to say he was ill. The note says that he is in a pay bed and he hopes that the pay beds will last. I simply quote his note. I hope that that commends the particular Amendments before the Committee.

Amendment No. 14 adds to this clause the very important words, "at a satisfactory standard". It will be seen that the point of this matter is that as the pay beds are phased out subsection 3(b) states: the extent to which, in the case of each NHS hospital in Great Britain, alternative accommodation and facilities for the private practice of medicine and dentistry are reasonably available … We wish to add the words after "facilities", "at a satisfactory standard". It will easily be seen, therefore, that this is in no way a wrecking Amendment, but is designed to ensure that the alternative facilities which will replace private beds in hospitals will not only be facilities but facilities "at a satisfactory standard". On reflection, I would add the words, "and at a reasonable cost". We shall have to return to this matter at Report stage because I do not wish to add a manuscript Amendment at such short notice.

The noble Lord will agree that the last thing anyone would wish to do would be to provide alternative facilities that were providing a second-class service or facility for private patients. Not only is this of course undesirable on medical grounds, but it would be grossly unfair that people who had not been party to the agreements, and who might have expected to have a private room in a hospital, have now to have a private room in a nursing home. They must expect the facilities to be "at a satisfactory standard". But even if we were not concerned with the patients, it would be equally important that the facilities should be "at a satisfactory standard" for the consultants and doctors.

Nothing would be worse for them than to find that what they had expected as a result of the Goodman agreements, which were facilities for private practice entirely in keeping with what the Government have said they wish to preserve—that is, the private practice of medicine—were facilities at a standard lower than they would have had had the facilities been in a hospital. It is because we want to make quite sure that the alternative facilities are of a standard equal to those that have been phased out that we have put down the Amendment. It is in line with those proposed by the noble Lord, Lord Goodman, on Second Reading. It does not go against the principle of the Bill, and I very much hope that the Government will be able to accept it. I beg to move.

9. 9 p. m.


I am sorry to hear of the indisposition of the noble Lord, Lord Goodman, and I am glad that he was good enough to let somebody know that he would not be here this evening. With regard to Amendment No. 13, I do not see how the removal of the requirement to consider both criteria in Clause 3(3) together would help the task of the Board. The effect of the Amendment would be to allow either one or the other of the criteria in Clause 3(3)(a) and (b) to be ignored by the Board. Frankly, I do not see what the purpose of that is, or what use it would serve. The clause as drafted is, I believe, a fair and honest interpretation of the compromise—if I may use that word—which is before us this evening. It was the essence of that compromise that the only way of determining the distribution of the reductions which is fair and reasonable to both viewpoints was by having regard to both criteria as envisaged in the proposals of 15th December, and six months was the time allowed in that compromise. It is because we do not see that this will help in any way—it will not improve the situation—that we certainly cannot accept it.

With regard to Amendment No. 14, the effect of the Amendment would be to alter the statement in subsection (3) of the criteria followed in determining the distribution made by Schedule 2 of the overall reduction of pay beds required by the clause to the extent that the alternative facilities referred to in paragraph (b) would be those whose standard was satisfactory. The Bill, as drafted, corresponds to paragraph 3(b) of the proposals of 15th December. The criteria were there stated as: the extent to which the pay beds are being used and the reasonable availability of alternative beds and facilities for the practice of private medicine The terms of Clause 3 subsection 3(a) and (b) fairly reflect this, to the extent that the legal drafting allowed.

The proposed Amendment covers ground that has largely been covered in previous debates in another place. The Amendment seeks to incorporate into the terms of the criteria at subsection 3(b) the concept that the reasonable alternative facilities shall be, "at a satisfactory standard". The Committee in another place debated a similar Amendment to Clause 4(7). It was explained on that occasion that the Government did not think it was desirable or necessary to add these words to the criteria, which do not appear in the 15th December proposals. My right honourable friend said on that occasion, as reported at cols. 883 and 884 of the Official Report: I am aware of the concern of the medical and dental professions, and, in particular, of the Royal Colleges, that the Health Services Board should be required to take into account the standard of alternative facilities in the private sector when considering its proposals for progressive revocation of authorisations of pay beds and other facilities for private practice in NHS hospitals; and discussions have been taking place with them on this. There are two points to be made. First, the Government accepted in the 15th December proposals that in phasing out pay beds and facilities the Board could have regard to the intention of the Government to allow occasional admissions of patients privately to specialised National Health Service facilities if these particular services could not reasonably be provided in the private sector to a satisfactory standard, and that this would not disadvantage the National Health Service patients. This, of course, is embodied in the provisions of Clause 8 of the Bill, which we shall be discussing later. This means that there is no question of the private sector being driven to duplicate, possibly in an unsatisfactory way, every sophisticated feature of the National Health Service. The second point is that, in determining the programme for phasing out, both the Secretary of State, in relation to the 1,000 beds, and the Board are obliged to look at the provision which is reasonably available in the private sector. I want to emphasise that this will inevitably involve a reasonable degree of matching up the nature of what is provided by the pay beds or other facilities at present as compared with the nature of what the private sector can already, or will in future be able to, provide. On the other hand, the Government have never said that they intend pay beds to remain until it can be guaranteed that private practice will be everywhere available as fully and completely as it might be while pay beds and private facilities remain authorised in the National Health Service hospitals. The Secretary of State had several meetings with the BMA on this matter, and this is really what transpired at those meetings. The Government are allowing time for a measure of development and improvement of private sector facilities. The process of matching up will take reasonable account of the character of the private sector provision, and therefore of the kinds of medical practice which could be satisfactorily carried out in it. The private sector is subject to control by registration under the Nursing Homes Act 1975, and if it were shown that this control did not sufficiently maintain standards the Government have made clear—my right honourable friend and his predecessor—that they are prepared to consider, in consultation with the professions, what improvements there might be. Primarily, of course, it is for the professional people who work in private hospitals and nursing homes to maintain professional standards. The criterion in the Bill already requires the exercise of judgment as to the extent of alternative accommodation reasonably available. It would make for greater uncertainty to bring in specifically the further concept of "satisfactory" standards. I would not have thought that there was any need for this Amendment, because I would have thought that the two things would go together automatically. For that reason, the Government are not able to accept the Amendment.


Before the noble Lord sits down, could I ask him one question in the light of the explanation which he has given of this clause and of the clauses which it is proposed to amend? In the light of what he has said, could he tell me, looking again at the Bill, in line 28, what is the purpose of the adverb, "reasonably" in the phrase, "reasonably available"? If the adverb "reasonably" applies merely to availability, surely things are either available or not available. What does "reasonably available" mean? Or is the noble Lord now saying that the adverb, "reasonably" there should relate to the nature of the facilities in the line before? Could he explain to me what that adverb, "reasonably" is doing in this paragraph? What does it mean? What are we to interpret from it?


I should have thought the question of distance. Presumably you cannot hold that a thing is reasonably available unless it is very accessible.


I listened to the explanation of the noble Lord, Lord Wells-Pestell, with great care, and I did my best to understand the complex argument that he deployed. I am not sure that I followed him in all his remarks. I think we are in the realms of textual criticism and scholarly debate about the exact interpretation to be put on the words used in the Goodman proposals, … reasonable availability of alternative beds and facilities These occur in paragraph 3(d) of the document issued on 15th December. As I understand it the noble Lord, Lord Wells-Pestell, maintained that the word, "reasonable" applied to distance only and that the question of standards, as mentioned in the Amendment moved by my noble friend Lady Young, is not relevant, or if it is relevant is already sufficiently contained in the word "reasonable". If that is his position, I do not follow the logic of his argument because when the noble Lord, Lord Goodman, was in better health and able to attend your Lordships' deliberations and spoke on Second Reading he said that he hoped that the word, "reasonable" would be interpreted as meaning reasonable in every sense, which I would understand not to be restricted wholly to matters of geography but also to the question of standards.

So we are in the realm of biblical disputation as to what the intention of the noble Lord, Lord Goodman, was in using the word "reasonable" in the context in which it is now being used. If your Lordships are asked to choose between the interpretation offered by the noble Lord, Lord Wells-Pestell, and that of the noble Lord, Lord Goodman, I hope that you will incline towards the noble Lord, Lord Goodman, who intended a wider meaning than did the noble Lord, Lord Wells-Pestell. The logic of the noble Lord, Lord Wells-Pestell, is that the alternative facilities may be of an unsatisfactory standard. If he does not wish to include the words, "at a satisfactory standard", it implies that he may consider that the alternative will be at an unsatisfactory standard and still acceptable under the terms of the Bill.

Clause 2 is declaratory and explains things which it is not necessary to explain fully in the law and outlines the general intention of the Board. If we are going to have explanatory proposals, let us include this one because it is in the spirit of the Goodman proposals. I hope that the noble Lord, Lord Wells-Pestell, will see fit to accept the interpretation of the noble Lord, Lord Goodman.


May I support what the noble Lord, Lord O'Hagan, has just said. It may be increasing senility, but I fail to grasp the meaning of much that the noble Lord said. It sounded like departmental "gobbledegook" Look at the simple issue: the facilities should be reasonably available. The adverb qualifies the adjective "avail-able". To my mind that refers to physical access to the facilities. When it comes to the alternative accommodation and facilities is it not reasonable to ask that before you reduce the number of pay beds in National Health hospitals you have regard to the satisfactory or other character of those facilities? What is it all about? No wonder Parliament is often accused of spending wasted hours in obscurities. The simple fact is that, if for an important decision you are to take account of what is alternatively available, surely it is right that the facilities said to be available should be facilities that are satisfactory. That is the simple and unambiguous issue and I should hope that the noble Lord, Lord Wells-Pestell, unless he is under strict instructions to accept nothing, will accept this reasonable proposition.


What worries me is the alternative accommodation. We have heard that it has to be reasonably accessible; I will accept that. There seems to be an argument about how good the facilities should be. Nobody says how good the doctors are going to be. The fact is that anybody who goes into a pay bed in an NHS hospital knows that his surgeon or his physician is a consultant and has reached a fairly high degree of proficiency. Whatever the facilities of a private nursing home, nobody is going to monitor its work, whereas in the NHS hospital everybody knows what everybody else is doing, what their standards are and what their ethical standards are. This is why I dislike this Bill so much.


To my mind one of the weaknesses in the Goodman proposals is how we are to define and provide satisfactory and reasonable alternative accommodation and facilities in the many small hospitals which are suggested. I believe that good accommodation will be easier to supply in these small hospitals than good facilities. A comfortable bed in a nice room is not too hard to give a patient; but to give him and his consultants access which is as good as they have at present to pathology, x-rays, nursing, physiotherapy and so on, is much more difficult. Will they have a resident house physician or house surgeon to help them care for their patients in these small hospitals? I know from personal experience how difficult it is to find resident medical officers for even the best of the smaller private hospitals which exist at present, hospitals such as the King Edward VII Hospital for Officers (Sister Agnes) or the BUPA Hospital in Bryanston Square.

I submit that it is a nonsense to suggest that it will be possible to provide facilities in all these smaller hospitals of anything like the standard that the consultants and their assistants now have for their patients (and for which their patients pay) in the larger National Health Service hospitals.

9. 27 p. m.

Baroness YOUNG

I am sorry to have to tell the noble Lord, Lord Wells-Pestell, that I thought that he gave a completely deplorable answer to my Amendment. It seems to me that he might look very carefully at his own Bill, where he will see that the words "at a satisfactory standard" are in fact taken from Clause 8(2) of the Bill at the top of page 10. There it says: In this subsection 'privately available' means available at a satisfactory standard otherwise than at an NHS hospital. If it is possible to use this definition in one part of the Bill I should have thought it was not asking too much to use it in another part of the Bill.

As the noble Lord, Lord Winstanley, and my noble friend Lord O'Hagan made clear, this was a definition that Lord Goodman himself felt ought to be included in the Bill because it made much clearer what were the intentions behind the agreements which were reached. The fact is that as the noble Lord, Lord Wells-Pestell, indicated to the Committee, the Government are quite happy that private facilities will not always be as good as those that existed in National Health Service Hospitals. I shall read carefully what he has said in Hansard tomorrow, but I think that this is a deplorable statement. It means that by this Bill we are committing

a lot of people to what could be a secondclass situation—not only the patients but, of course, the doctors as well. I think therefore that this is not a matter which I can leave as it is.

As I have said, it is the first of a number of Amendments that the noble Lord, Lord Goodman, felt ought to be included in the Bill. It is one that clearly has the support of a number of our medically qualified colleagues who have spoken this evening. I am grateful for what the noble Lords, Lord Hill, Lord Platt and Lord Hunt of Fawley, have had to say. To argue that a private room that may be a comfortable room is an equal facility is simply not good enough. It must mean medical facilities at a satisfactory standard which is implied in Clause 8 and should be stated consistently through the Bill. I cannot withdraw this Amendment, and I will therefore press the matter to a Division.

9. 31 p. m.

On Question, Whether the said Amendment (No. 13) shall be agreed to?

Their Lordships divided: Contents, 72; Not-Contents, 40.

Amory, V. Gowrie, E. Newall, L.
Ampthill, L. Greenway, L. O'Hagan, L.
Amulree, L. Hanworth, V. Onslow, E.
Auckland, L. Harmar-Nicholls, L. Pender, L.
Balerno, L. Henley, L. Platt, L.
Banks, L. Hill of Luton, L. Rankeillour, L.
Beaumont of Whitley, L. Home of the Hirsel, L. Rathcreedan, L.
Belstead, L. Hornsby-Smith, B. Redesdale, L.
Berkeley, B. Hunt of Fawley, L. Robson of Kiddington, B.
Carrington, L. Inglewood, L. Ruthven of Freeland, Ly.
Colville of Culross, V. Kemsley, V. St. Just, L.
Cork and Orrery, E. Killearn, L. Saint Oswald, L.
Cottesloe, L. Kinnaird, L. Sandys, L. [Teller.]
Craigmyle, L. Lindsey and Abingdon, E. Seear, B.
Denham, L. [Teller.] Long, V. Seebohm, L.
Drumalbyn, L. Lyell, L. Stamp, L.
Ellenborough, L. Macleod of Borve, B. Swansea, L.
Elles, B. Marley, L. Tranmire, L.
Elliot of Harwood, B. Merrivale, L. Tweedsmuir, L.
Faithfull, B. Monson, L. Vickers, B.
Ferrers, E. Montgomery of Alamein, V. Ward of North Tyneside, B.
Gainford, L. Morris, L. Windlesham, L.
Gisborough, L. Mottistone, L. Winstanley, L.
Gladwyn, L. Mowbray and Stourton, L. Young, B.
Birk, B. Davies of Penrhys, L. Janner, L.
Blyton, L. Donaldson of Kingsbridge, L. Kagan, L.
Brockway, L. Elwyn-Jones, L. (L. Chancellor.) Kaldor, L.
Castle, L. Fisher of Camden, L. Lee of Newton, L.
Champion, L. Hale, L. Llewelyn-Davies of Hastoe, B.
Collison, L. Houghton of Sowerby, L. Lovell-Davis, L.
Davies of Leek, L. Jacques, L. [Teller.] McCluskey, L.
Maelor, L. Plurenden, L. Strabolgi, L. [Teller.]
Morris of Kenwood, L. Popplewell, L. Taylor of Mansfield, L.
Murray of Gravesend, L. Ritchie-Calder, L. Wallace of Coslany, L.
Northfield, L. Shepherd, L. Wells-Pestell, L.
Oram, L. Stedman, B. Winterbottom, L.
Peart, L. (L. Privy Seal.) Stewart of Alvechurch, B.
Peddie, L. Stone, L.

Resolved in the affirmative, and Amendment agreed to accordingly.

9. 38 p. m

Baroness YOUNG moved Amendment No 14: Page 3, line 28, after ("facilities") insert ("at a satisfactory standard").

Resolved in the affirmative, and Amendment agreed to accordingly.

9. 47 p. m.

Viscount LONG moved Amendment No. 15: Page 3, line 30, leave out ("area") and insert ("district").

The noble Viscount said: I beg to move Amendment No. 15, and with the leave

The noble Baroness said:I beg to move.

On Question, whether the said Amendment (No. 14) shall be agreed to?

Their Lordships divided: Contents, 70: Not-Contents, 39.

Amory, V. Greenway, L. Newall, L.
Ampthill, L. Hanworth, V. O'Hagan, L.
Amulree, L. Harmar-Nicholls, L. Onslow, E.
Auckland, L. Henley, L. Pender, L.
Balerno, L. Hill of Luton, L. Platt, L.
Banks, L. Home of the Hirsel, L. Rankeillour, L.
Beaumont of Whitley, L. Hornsby-Smith, B. Rathcreedan, L.
Belstead, L. Hunt of Fawley, L. Redesdale, L.
Berkeley, B. Inglewood, L. Robson of Kiddington, B.
Carrington, L. Kemsley, V. Ruthven of Freeland, Ly.
Colville of Culross, V. Killearn, L. St. Just, L.
Cork and Orrery, E. Kinnaird, L. Saint Oswald, L.
Cottesloe, L. Lindsey and Abingdon, E. Sandys, L. [Teller.]
Craigmyle, L. Long, V. Seear, B.
Denham, L. [Teller.] Lyell, L. Stamp, L.
Drumalbyn, L. Macleod of Borve, B. Swansea, L.
Ellenborough, L. Marley, L. Tranmire, L.
Elles, B. Merrivale, L. Tweedsmuir, L.
Elliot of Harwood, B. Monson, L. Vickers, B.
Faithfull, B. Montgomery of Alamein, V. Ward of North Tyneside, B.
Ferrers, E. Morris, L. Windlesham, L.
Gainford, L. Mottistone, L. Winstanley, L.
Gisborough, L. Mowbray and Stourton, L. Young, B.
Gowrie, E.
Birk, B. Kagan, L. Peddie, L.
Blyton, L. Kaldor, L. Popplewell, L.
Brockway, L. Kirkhill, L. Ritchie-Calder, L.
Castle, L. Lee of Newton, L. Shepherd, L.
Champion, L. Llewelyn-Davies of Hastoe, B. Stedman, B.
Collison, L. Lovell-Davis, L. Stewart of Alvechurch, B.
Donaldson of Kingsbridge, L. McCluskey, L. Stone, L.
Elwyn-Jones, L. (L. Chancellor.) Maelor, L. Strabolgi, L. [Teller.]
Fisher of Camden, L. Morris of Kenwood, L. Taylor of Mansfield, L.
Hale, L. Murray of Gravesend, L. Wallace of Coslany, L.
Houghton of Sowerby, L. Northfield. L. Wells-Pestell, L.
Jacques, L. Oram, L. White, B.
Janner, L. Peart, L. (L. Privy Seal.) Winterbottom, L. [Teller.]

of the Committee I should also like to speak to Amendments Nos. 40, 44 and 88. All these Amendments relate to the same word. The difficulty here is to define the word "area"—how large that is in practice—and I should like the Government to give us their definition of that word. The sensible course to take would be to try to break down areas into districts because they would then be much easier to operate economically and also much more personal.

At this stage, it is preferable to disregard London and the other major cities and to look at the countryside where a much larger mileage has to be covered. May I take as an example the County of Cumberland or Yorkshire where perhaps there will be a National Health Service hospital at one end of the county and a private hospital at the other, with a top gynaecologist or consultant having to travel between the two hospitals. if this large mileage in Cumberland or Yorkshire could be broken down into districts it would be much less expensive for that consultant, especially when one considers the cost of petrol, at nearly £1 a gallon, the travelling time of the consultant and the speed at which that consultant would have to travel between the hospitals in those counties. We want to try to help consultants to narrow down the area.

Therefore I should like the Government to give us their definition of the word "area" I would be very interested if they could explain what an "area" consists of, whether it is so many square miles. As yet I do not think anyone has been able to define "area". I am probing to investigate how big an area is in the minds of the Government. When looking at a large county such as Cumberland, one immediately thinks of the patients and their relatives. I had the experience, when my boy was in hospital, of visiting quite often the orthopaedic hospital in Bath. It was in the 1960s, when the new Areas took over, and I believe it was the orthopaedic hospital at Taunton—I stand to be corrected—which was broken up and moved into the orthopaedic hospital at Bath. It is a very difficult road from Taunton to Bath at week-ends for parents visiting their children or relatives visiting one another in hospital. The best thing is a small area so that people can visit their relatives and friends easily. I hope the Government can see that.

I have known of great hardship among people in the country districts trying to get about at week-ends, and not everybody has a car. Economically this is an extravagant way of going on. Your expenses for your consultants are bound to rise over a larger area with larger mileage. I should like to see these huge areas reduced down to smaller districts. It works, if I understand rightly, with district councils; it certainly brings the personal touch into the district. I am still trying to find out how big this "area" is in mileage. I should like the Government to give us their views and the reason why they want this word "area" in the Bill. At this moment it could well be something of a disaster to the efficient working of the hospitals. I beg to move.


I should very much like to support the noble Viscount in questioning the meaning of "area", and I support the change to the word "district" for perhaps a slightly different reason. It is only two years since we reorganised the Health Service and we based the whole structure of the Health Service on the district within the Area, and that district is, on the whole, co-termininous with the local planning authority. Much of this Bill is concerned with planning permission when we get further on, and I should have thought we ought to be exact and use the same terminology. It is for that reason that I should like the word changed to "district".

9. 54 p. m.

Baroness STEDMAN

I share the concern of noble Lords opposite about the use of "area" and "district", and I think we all probably agree that we have had more than our fair share of reorganisation of one form or another. There are various meanings for "areas" and "districts" in all the forms of reorganisation we have had. The noble Baroness, Lady Young, said earlier that she could not find "area" defined anywhere in the Bill. In fact, the area in Schedule 2 to which she was referring is the Area Health Authority, which is mentioned and interpreted in Clause 11. I think perhaps the noble Baroness was confused with Schedule 2 and the "area" with a small "a" we are now discussing in Clause 4. Amendment No. 15 is one that could indicate that the private sector facilities that have been taken into account in the preparation of Schedule 2 are only those that are allocated in the same management district of the hospital. This Amendment I could not commend to the Committee, because it would be to negate the basis on which the Goodman proposals for the 1, 000 beds in Schedule 2 were drawn up.

The term "district" has no statutory backing in the National Health Service, and has come to be equated with a sort of unit of management within an Area Health Authority's area. For instance, in the case of Great Ormond Street, which serves as the Hospital for Sick Children, it would be impossible to define an area. It serves in a dual capacity, and is the specialist hospital for children for the whole of the country. In the same way, in Camden and Islington the Area Health Authority is divided into two districts for the purpose of management, and I think no one in the authority would claim for one moment that the area or district served by University College Hospital, or the Hospital for Tropical Diseases, had to be confined to the South Camden District.


We are not talking purely about teaching hospitals and post-graduate teaching hospitals. I am concerned with the picture all over the country, and in the countryside certainly "district" has an enormous meaning. I agree that in London it is confused, but then we know that the National Health Service in London, the hospital distribution in London, the number of teaching hospitals, have been creating a problem for as long as I can remember, and are likely to go on creating a problem. We are trying to legislate for the whole of the country, and "district" has a meaning in the National Health Service all around the country. What I said originally is that it is largely coterminous with the local authority, and that this is very important for planning purposes.

Baroness STEDMAN

Although the district is co-terminous with local authority districts, it is not necessarily the right sort of area for a hospital. I do not think that we can confine a hospital to a district in the meaning of "district" under local authority organisation. It is rather more like the schools having their catchment areas. I prefer to think of an area being a catchment area; the area served by the hospital, but not having any closely defined boundaries or districts, or being parts of an Area Health Authority's administrative areas.

What we have to look at in Amendments Nos. 15 and 88, which go together, and the ones to which the noble Viscount spoke, Amendments Nos. 40 and 44, is the fact that they have a relation to the criteria which were laid down in the Goodman proposals. I know that noble Lords opposite do not like the reference to the Goodman proposals, but the Bill before the House incorporates the agreement that was arrived at through the offices of Lord Goodman, and the phrase, "area served by that hospital" in the subsection is not synonomous with the area administered by the Area Health Authority. Nor will it necessarily be the same as the district in which and by which the hospital is primarily managed. Not all the hospitals in the district serve the whole of the district, talking of districts in the terms of local authority districts.


The noble Baroness's noble friend Lord Wells-Pestell has already told us that the words, "reasonably available" which appear in the clause immediately adjacent to the words we are discussing mean "accessible". If that means "accessible", why do we need the words, "in the area served by that hospital"? Are they not redundant? Are they needed at all?

Baroness STEDMAN

No, because some hospitals serve a wider catchment area than others, and are not necessarily the same as part of the Area Health Authority's area. They may have some sort of speciality that they can offer in that area which has to be open to a wider number of people in a wider acreage than we have in the ordinary sense of "area" as in Area Health Authority

Baroness SEEAR

This is all madly confusing. Cannot the Government think of a better word? When "area" is spelt with a capital "A" it means one thing but when it is spelt with a small "a" it means something else. When one is talking one cannot articulate a small or capital "a" and naturally people become confused. Surely it is not beyond the wit of the Government, even at this late stage of their career, to think of a better term to describe "area" with a small "a". While on my feet, let me register a protest against the idea that Parliament is here to confirm an agreement arrived at between the noble Lord, Lord Goodman —for whom I have the greatest respect, well or ill—and the Government outside the walls of Westminster. We have protested throughout this Session that arrangements fixed up outside Parliament with any bodies, however virtuous they may be, are not appropriate ways of presenting legislation to us for Parliament to receive, approve and agree. Parliament is not a rubber stamp, especially over something which Lord Goodman and the Government have fixed up in private.

Baroness STEDMAN

The proposals embodied in the Bill are to give power to implement decisions which were arrived at following consultations with the medical and dental professions in which the noble Lord, Lord Goodman, acted as an intermediary. I would be the last person to yield that Parliament does not have the right and duty to have the final say as to what should be in their legislation. But the Bill was introduced and embodies the agreement that was reached with the professions. I know that noble Lords opposite dislike it and that they do not accept that the Goodman proposals have any significance, as it were, in your Lordships' House. Nevertheless, the Government have brought forward the Bill to separate pay beds and private practice from the NHS and, in so doing, are embodying the principles that were within those agreed proposals.

I go along with the noble Baroness in wishing that we could find another word that would mean the catchment area of the hospital without having to use the word "area" and I am sure that the Department has given great thought to this. If noble Lords opposite can come up with an alternative word which means the same as a catchment area and will not confine us to absolute boundaries for all hospitals, I am sure the Government would be happy to consider it; but at the moment I must ask the Committee to reject the Amendment.


This is a difficult Amendment to discuss because while the Bill deals with the phasing out of pay beds—about which the noble Lord, Lord Goodman, had quite a lot to recommend, with most of which I did not agree—I suggest that we should, in discussing this subject, go back to the question whether we have sufficient hospitals in every area to deal with the population who use them. In doing that, we should discuss the Amendment in connection with the relevant Schedule.

In Durham County, for example, we must consider whether we have sufficient hospitals to cater for all the accidents that occur in the mining areas, and in a way that has nothing to do with the phasing out of pay beds. I want as many hospitals as we can get and I find it difficult to discuss the Amendment in these terms because, with great respect, it seems to have nothing to do with the phasing out of pay beds. I do not want the Committee to get into a bigger muddle than the Government are already in but I felt that I had to make this point; in a way I am saying something rather nice about the Government, something I do not often do.

I know Cumbria very well. I think that in Cumbria we might probably require some more hospitals. That would not fit in either with the pay bed issue or this Amendment. I find this a difficult Amendment. I would rather discuss it when we come to debate the Schedules with the areas and the question of whether we ought to have more hospitals before starting to phase out pay beds.


I believe my noble friend Lord Long has brought before your Lordships an Amendment which needs much greater perseverence because the reply given by the noble Baroness—and of course we welcome her to the Committee as she is making her first contribution to the Committee stage—was highly unsatisfactory from our side of the Committee, because she referred to Clause 11 which deals, of course, with the interpretation. She told us that Area with a capital A means what is set out in that clause. She added that she did not think we could confine "district" to the interpretation given in local authority legislation— I believe I took down her words correctly.

However, there is the strongest argument —and I think many of my noble friends set this out—that the context in which we should discuss this Amendment is a local context; that is for the district. The noble Baroness referred to the catchment area which is not precisely the same. She dealt in some detail with the situation in London and I think was taken to task, quite correctly, by the noble Baroness, Lady Robson, on the question of catchment areas for teaching hospitals. But I think our concern is in the broader context of districts throughout the country.

One principal difficulty about the word "area" is its vagueness. It is undefined in Clause 11, and the Government know perfectly well that their principal reason for not accepting this Amendment is that it conflicts with Schedule 2. Schedule 2 as set out does not concern districts at all. Therefore, we are saying to the Government, "In order that Clause 3 shall be satisfactorily drafted in this very unacceptable Bill, so far as we are concerned it is of no importance whatever at this stage that it should conflict with Schedule 2 in regard to their arrangements". It is of far greater importance, as mentioned by my noble friend, that in small areas parents should be able to visit children in hospital, and similar matters; and the economic factors are of course overwhelming, especially the high energy costs which affect everything involving the hospital problem. I do not think it is necessary to say anything further except that I believe this Amendment is most important to the Bill.

Viscount LONG

This Amendment seems to have had a very good airing. My noble friends and noble Lords on the Liberal side have expressed great interest in it. But if I might tell the noble Baroness and noble Lords opposite why we do not like this Bill, it is because of the poisonous way politics were placed into it. We are dealing with a profession in the medical world, a very old-established body of people going back thousands of years, who do not know about the roughing-up or viciousness of politics. This situation has been placed in their camp, and I find it sad that all the time we on this side of the Committee are accused of not liking this or that. We are trying to defend the doctors, nurses, consultants and patients.

Having said that, I am still no nearer as to what is the definition of an area. It struck me just now that we had in Wiltshire certain hospitals called district hospitals in small areas. I believe they are still district hospitals. Some of them were previously known as cottage hospitals. But all the time we are coming up against the idea of London and the cities. But in the country people have to travel many more miles, and at night and during the snow and other bad weather it can be very difficult. There is also the cost and other problems. I know that parents and relatives already find it very difficult travelling long distances to hospitals around the county. However, we have expressed the point and have aired the Amendment, and I beg leave to withdraw it.

Amendment, by leave, withdrawn.

10. 11 p. m

Baroness YOUNG moved Amendment No. 16:

Page 3, line 30, at end insert (";and (c) the extent to which, in the case of each NHS hospital, the resources exist to put the beds so withdrawn to good use for resident patients who are not private patients.").

The noble Baroness said: In moving this Amendment it may be helpful to the Committee if I try to put us procedurally slightly further back on the track. I have spoken already to Amendment No. 13, which is necessary for Amendment No. 16, but Amendments Nos. 13, 14 and 16 go together. It will be apparent that Clause 3(3) is a declaratory clause, setting out in relation to the Area Health Authorities and the preserved Boards how the phasing out will be arranged. Amendment No. 16 will come in as paragraph (c), and it means that it is necessary to take out the word "and" in paragraph (a) in order that it reads grammatically. The effect of this procedurally is that Amendment No. 16 is dependent upon the paving Amendment No. 13.

This we regard as another important Amendment because it seems to me very necessary that the beds that are phased out of National Health hospitals should be for use for patients who are not private patients but who are other patients in the National Health Service. There is no guarantee at all in the Bill that the beds phased out will be so used, and at any rate in one case known to a number of noble Lords the accommodation resulting from phased out beds has now been used for offices. Therefore, if this happens it is very unlikely that there will be any alteration to the length of the queue. This is important to the argument, because as the noble Lord, Lord Wells-Pestell, said on Second Reading, at column 1472 of the Official Report of 12st October: In short, it is a widely held belief that the continued existence of pay beds has conferred, at the expense of the majority, an unacceptable degree of privilege on those who can afford to pay a premium for jumping the queue.

He went on to argue that this was the main purpose behind the Bill. If this is the purpose which was behind the whole of the Goodman proposals, behind the Bill—to prevent queue jumping—so that those who went into a hospital bed should do so only on medical grounds, and not because they could afford to pay, it is absolutely essential that the phased out beds should be used by National Health Service patients.

Therefore, I hope very much that the Government will accept the Amendment. When we were talking about Amendment No. 10, the first talked about, it became quite clear that the Government felt that the 1,000 beds that will be phased out at first ought to be used by National Health Service patients. At any rate, one of the reasons for not accepting this Amendment, so far as I could see, was that this was part of the Goodman agreement and it would therefore satisfy those who felt that there was something very unfair about the present system. If there is something unfair about the present system, the only way you could put it right would be to make quite sure that those at present in the queue will get into the beds pay now being occupied by private patients—and that is what this Amendment is intended to do.

I think it becomes even more important if one looks at the figures which have been given, showing a decline in the number of hospital beds in the National Health Service over the last 10 years. These figures, which were given by the Department of Health and Social Services in their Annual Report of 1975, show that the number of available beds in National Health Service hospitals in England has decreased over the last 10 years by 11 per cent. In 1965 there were 437,000 beds, and in 1975 only 387,000. There has therefore been a steady fall in the number of beds in National Health Service hospitals. This is undoubtedly a fact, and one way at least of being constructive in what really is a very difficult situation is to make sure that those beds which are phased out will be used by National Health Service patients.

I cannot see any reason why the Government should not accept this Amendment. It seems to me to be entirely in line with what they would want to see. It certainly cannot be considered against the principle of the Bill. It does something which I am sure everybody who cares about the Health Service at all would want: it tries to put all the available capital equipment to the best possible use, and it ensures, I hope, that the queue would get shorter, because there would be, within six months if the Government do not accept our Amendments in another place or at any rate within a very short time, 1,000 more beds for the National Health Service. I hope, therefore, that the Government will accept this Amendment, because it seems to me a constructive suggestion. I beg to move.


I should like warmly to support this Amendment. Like many noble Lords in this Committee, I know a great many hospitals from the inside—as a patient, in connection with leagues of hospital friends and in other capacities. All noble Lords will know that in the past there have been what have been called amenity beds, which are beds which have been made available to National Health Service patients and which, very often, are beds only curtained off at the ends of wards. They are in no way private beds at all. My reason for supporting this Amendment is that I also know that the private beds which have so far been used in hospitals are in private rooms. They are in properly constructed rooms which are not always very nice but which have been used for private patients in the past. It is because they are rooms that they are private, because they are unable to be got at by other people in the wards.

In other words—and I have a lot of knowledge of this—if somebody of importance (be it a Minister in the Government; be it somebody who is very important in industry; be it anybody whom the Press, for instance, want to get hold of) is in hospital, the only way of ensuring that they cannot be got hold of is by putting them in a private room. That is not an amenity room, as I have said, because an amenity bed is hardly ever private. As most people will know—at least, all of us who have been patients—if the patient is very important (as I know to my cost with my late husband) then directly he comes out of an anaesthetic there is a secretary waiting, there are the television people waiting.

Everybody wants to know how you are and the only method of keeping people away is by putting you in a room, now called a private room. I urge that those rooms should in future be amenity rooms. That would be the right way to use these rooms which have in the past been used for private patients. It is vitally important that all hospitals should be urged to use these rooms correctly. Waiting lists are now far too long. In the foreseeable future, if this Bill goes through Parliament, the use of these rooms would enable waiting lists to be cut down. The people who need privacy as the result of an accident or illness, and who have not booked, should be able to have these rooms. They should not be turned into offices as they have been in some hospitals. I hope the Minister will accept this Amendment. I believe it is vital for the future of those rooms in the hospitals.


My Lords, I feel in some sympathy with the point of view put forward by the noble Baroness, Lady Young, but what disturbes us is the use of the word "resident". The effect of this Amendment would be to add a further condition, that no pay bed authorisation should be withdrawn unless each hospital affected has sufficient resources to put the beds to good use for resident patients who are not private patients. This is the substance of the Amendment. It also seeks to ensure that any resources released are directed to the benefit of patient services rather than used, for example, for administrative purposes. Obviously it would seem quite reasonable and proper that all beds released from being pay beds should be made available for the use of patients but the Amendment says, "for resident patients".

Generally pay beds as single wards attached to general wards will fairly readily be absorbed into the general pool, while those in larger traditional pay bed wings may not lend themselves so readily to adaptation for general National Health Service use. One also has to take into account the fact that a good many of our hospitals need fundamental reorganisation and that accommodation in some of our National Health Service hospitals leaves much to be desired. In some places there are too many beds in one ward and beds are much too close together. When the pay beds are gradually phased out we have to look at the whole picture. Living and working conditions in some of our hospitals leave much to be desired. I do not say that that applies to every hospital but certainly to a good many. We have to look at it from the point of view of making more room available not only for patients but also for nursing, medical and doctors' use. One often hears complaints of the close proximity of working. All that has to be taken into account.

Coming back to the purpose of the Amendment, with which I find myself in some considerable sympathy, if one has the word "resident" one is immediately tied down to using it for resident patients. Our casualty departments are dealing with more and more patients. It would be a very good thing if we could use beds perhaps for day patients. Our out-patient departments are doing more and more surgery. I am not saying that they are doing surgery of a particularly onerous kind, but they are doing various forms of surgery where it would be a good thing to be able to put somebody who had some minor surgery in the morning into bed for the rest of the morning or the rest of the day. I think, too, that our out-patient departments need recovery rooms. Bearing all this in mind, the word "resident", I think, means exactly what the noble Baroness intends it to mean; that is, not somebody who is going to occupy a bed for an hour or two in the morning but for a whole day.

I do not think that in principle there is anything between us because, obviously, we have got to see that, so far as is humanly possible, these beds are put to the best possible use. Bearing in mind that people are working in conditions where they may need more room, there must be some kind of reorganisation to provide more room; but, having said all that, I think that an increasing number of beds will be used for day patients recovery rooms, out-patients or people who can stay in the hospital for a morning or an afternoon. I would ask the noble Baroness to take that into account when considering whether, in the light of what I have said, this is an Amendment which she ought to press.


I understood from what the noble Lord said that he was in general in sympathy with the objective that the Amendment tries to achieve. My noble friend's paragraph (c) would add a third criterion to the two already in the subsection. All these criteria are qualified by the words, "the extent to which", so there is some degree of qualification for each of these three criteria because the authorities and boards called upon to examine these beds in question under these criteria do not just have to examine, as it were, bed by bed or item by item; they have to take a general view of the "extent to which". There is some degree of flexibility in the two paragraphs already in the Bill and this degree of flexibility is retained in the additional subsection introduced by my noble friend.

What I want to ask the noble Lord is this. Given that the same freedom of manoeuvre to deal with particular circumstances is contained in all three paragraphs (a), (b) and (c), consistently; and given his only real objection is to the word "resident", is he saying to the Committee that he would be prepared to accept this Amendment in some other form or that he would be willing to look at it again and perhaps hope to introduce his own Amendment?—because the burden of his remarks was not at all against the spirit of my noble friend's Amendment, but in fact the reverse. Yet at the end I was waiting for him to say something about how he would prefer to have the objective which he shares achieved by words added to the Bill.

10. 30 p. m.


I should like to follow that point. The noble Lord, Lord Wells-Pestell, made it utterly clear that he is in sympathy with the spirit of this Amendment, and, indeed, he would like to think that the facilities made available through the withdrawal of private beds from NHS hospitals were going to be used for the broad interests of non-paying patients. I have total sympathy with that aim and objective. He has implied that the only difficulty is the presence of this unfortunate word, "resident". I take some of the points he has made. There are occasions where casualty departments or out-patients operations require beds for purposes which could hardly be described accurately as "resident". That is a real point.

I wonder whether his expression of sympathy is quite as real as it may seem. I should like to follow the question already put to him. know that boble Lords on the Front Bench are not given to answering hypothetical questions, but I should like him to tell me whether, had this Amendment been set down without the word, "resident", he would have accepted it. I wonder whether the noble Lord will tell us. It is beginning to become my suspicion that he has not the slightest intention of accepting any Amendments. If that is the case, I wonder why we are going to discuss all these Amendments and why we do not just vote on them.


I do not know whether I am speaking out of turn. I am certainly not knowledgeable about the Health Service. What has struck me from listening to this debate is that in this Amendment it says: …the resources exist to put the beds so withdrawn to good use… The Minister has said that what they need is more room, more use of space. I suggest to the Government that what they need is more money. They are very short of it. Yet, in withdrawing these beds from the Health Service they are doing away with millions of pounds. Can they afford to do this? This means a loss of millions of pounds of revenue from private patients.


I am inclined to agree with the noble Lord, Lord Winstanley, that the expression of sympathy which the noble Lord, Lord Wells-Pestell, addressed to the Committee had a somewhat synthetic flavour. I should like to link Amendment No. 16 with Amendment No. 9, which my noble friend Lady Young moved, concerning no detriment. The two Amendments are closely linked in matters touching upon the trades unions. The staff implications contained in this Amendment, as indeed in Amendment No. 9, are important. The following have special interests, so far as the staffing is concerned: COHSE, NUPE, NALGO, the General and Municipal Workers' Union and the smaller unions. Of course also very important are the Royal College of Nursing and the Royal College of Mid-wives, the BMA and British Dental Association.

Another point is Lord Wells-Pestell's attitude on no detriment. I must confess I thought he was far from sympathetic at column 1509 on Thursday, 4th November, in the Official Report. The noble Lord referred to no detriment, and he cast doubt about the suggestion that it was very important. He said at the end of the column: 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". We do not know, and cannot quantify from outside, what number of jobs may be concerned either in the initial phasing out—does the noble Lord wish to intervene?


Can the noble Lord tell me what this question of detriment has to do with the present Amendment?


Yes. It is very closely associated with the question of resources, and resources principally concern the aspect of staffing and equipment. I believe this to be very closely cognate with the Amendment we are discussing.

Finally, I concern myself with the "swap" arrangement, under which private beds were made available to the National Health Service, and have been over the last 30 years or so. That has been strongly to the benefit of the National Health Service, because on many occasions private beds have not been fully occupied. Occupation levels are referred to in a very considerable document published by the Department. I will not go into details here, because it is a lengthy, tricky and technical matter; but I will say that one situation has been overlooked by the Government. That is where a charity has over a period, either long or short, endowed either a single bed or a group of private beds, and those beds or groups of beds in wards or wings of hospitals are to be phased out. There could be a breach of charitable law there, and there is a case for concerning ourselves on Amendment No. 16 with this very important aspect. I have not chosen to raise charitable law hitherto, but I suggest to the noble Lord, in the kindest possible way, that the Government should look on this as a matter of some seriousness.

Baroness YOUNG

I am afraid I find it very difficult to follow the argument of the noble Lord, Lord Wells-Pestell, on my Amendment. The whole time he spoke about the need to use the rooms and the beds to be phased out for a whole variety of uses, most of which were for out-patients. He quoted—and I hope I understood him correctly—the instance of someone involved in an accident and needing a bed for the morning, and someone else needing to stay in hospital for one day, together with rooms that are in general use, and so on. Yet, if the noble Lord looks at Clause 3, he will find it is not concerned at all with out-patients but with in-patients. That is my under-standing of it, having looked at the 1968 Act. Section 1(1) is concerned with in-patients. Therefore Clause 3 is concerned with the phasing out of resident patients. When the noble Lord wants to talk about the phasing out of private out-patients, he needs to refer to Section 1(2) of the 1968 Act. He does that in Clause 4. We cannot possibly amend Clause 3 to make it apply to out-patients. It can apply only to in-patients, which are perhaps more correctly described as "resident patients". That is why the noble Lord referred to it in these terms.

When we come to Clause 4, we have Amendments to meet the point about out-patients, which is just as important a matter of principle as the matter concerning resident patients. But I do not think he could really criticise the Amendment on those grounds, because his reply does not seem to be relevant to Clause 3 at all. What in fact we got into, if I may say so with respect to him, was a very delightful philosophical discussion about "when is a resident not a resident?" It reminded me very much of the kind of essay I was asked to write as an under-graduate: "How do you know that you arc not now dreaming?"—which in fact seems a rather suitable topic for some of the proceedings of this Committee.

When we are dealing with a clause which refers entirely to resident patients, and I put down an Amendment which refers entirely to resident patients, only to be told that I should be talking about out-patients, I find myself somewhat confused. As the noble Lord, Lord Winstanley, and my noble friends Lord O'Hagan and Lord Sandys all made clear, there is a case here for using the beds flexibly. I am not at all against that, and if I could get an undertaking from the Government that they would redraft the Amendment so that the beds could be used by out- patients as well as by in-patients, I should be perfectly satisfied.

What will not satisfy me or, I believe, any of my colleagues—and I think I speak here for those on the Cross-Benches and the Liberal Benches—is that we should go through this whole performance of phasing out beds, only to discover that they would be better used for offices, which is one of the uses to which the noble Lord, Lord Wells-Pestell, said they could be put, which seems to me a fantastic reason when the Government have said that the reason for having the Bill is to shorten the National Health Service queues. The whole thing is so inconsistent as to defy imagination.

As my noble friend Lady Macleod said, there is a great need for more amenity beds. They could be used for that reason, and we should not be averse to anything like that. I concluded from what the noble Lord, Lord Wells-Pestell, said to my noble friend, that he is not prepared to take this Amendment back and redraft it to meet these very real points. If that is the case, I found his reply so unsatisfactory that I shall press this Amendment.


It is obvious that either I am not making myself clear—and I thought I had done so—or the noble Baroness chooses not to follow what I have been saying. The Amendment states: …the resources exist to put the beds so withdrawn to good use for resident patients". All I said was that if the word "resident" was left in it would make it difficult—and the noble Lord, Lord Winstanley, agreed with me—to use them for persons who, although attending hospital for help and treatment, would not be resident patients. I see nothing inconsistent in that, and I am astounded that the noble Baroness seems to do so. The noble Lord, Lord Sandys, talked about things which, with the greatest respect, had no bearing at all on the Amendment.


With due respect to the noble Lord—and, of course, I admire his knowledge of this subject—I sincerely suggest that matters affecting detriment touch upon this Amendment.


On that we must disagree. My difficulty is that the phrase "resident patients" would make it impossible to use the beds for any other purpose whatsoever. Before the noble Baroness was so insistent about putting this to the Committee, I was prepared to say that I would take it back and look at it, but I must say that, as it stands at the moment, we could not accept the Amendment. I do not know whether it is possible to find a phrase other than "resident patients", to include persons who will not he resident. I must leave it to the noble Baroness to decide what she wants to do.


Might I suggest that the common term "in-patients" would suffice?


Why is the noble Lord so choosy about the questions he answers? He has answered part of the questions, but the noble Lord, Lord Winstanley, put a very clear one. He asked: is the sympathy of the noble Lord, Lord Wells-Pestell, strong enough for him to say that if the word "resident" is left out, or if some other words are added to allow day or temporary patients to come in, he will find the Amendment acceptable? That is the kind of answer which I am certain my noble friends are waiting to hear. The noble Lord offered to take back the Amendment. Is the noble Lord able to say that he will take it back with a view to finding words which will remove the restriction on residence? If the noble Lord could say that, I have no doubt that my noble friend would think twice about putting the Amendment to the Committee; but he has not done so. Will the noble Lord answer the question which was put by the noble Lord, Lord Winstanley, instead of the other questions which were not pushed with the same emphasis and clearness?


I am not prepared to say to your Lordships that will take it back "with a view to finding words", because I am not sure that words

can be found which will enable these beds to be used for in-patients as well as out-patients. I am quite prepared to take back the Amendment and have a look at it but I can make no promise other than that.

Baroness YOUNG

I do not think that the noble Lord has made a very satisfactory offer. The noble Lord has said that he would like these beds to be used, yet he criticises my use of the phrase "for resident patients" although Clause 3 makes it perfectly clear that the 1968 Act, to which reference is made, speaks of making beds available to resident private patients. I do not believe it is good enough if the noble Lord, with all the skills which are available to him, is unable to say, "I sympathise with your point; the Government would like to make the best possible use of these beds and we could redraft the provision so as to include out-patients as well as in-patients". After all, it is not a major matter of principle but what we all want to do. I think, however, we are going to be told that it is not the Government's intention that these beds should always be used for patients. That is the reason why the Government are not prepared to accept this draft.

In the circumstances, I shall press my Amendment, although I should find it quite acceptable if the Government came back with an Amendment of their own on Report. I would willingly withdraw the Amendment we have moved today if it were found to be inconsistent with anything that the Government were prepared to do.

10. 47 p. m.

On Question, Whether the said Amendment (No. 16) shall be agreed to?

Their Lordships divided: Contents, 63; Not-Contents, 39.

Amory, V. Carrington, L. Ferrers, E.
Ampthill, L. Colville of Culross, V. Gainford, L.
Amulree, L. Cork and Orrery, E. Gisborough, L.
Auckland, L. Cottesloe, L. Gowrie, E.
Balerno, L. Craigmyle, L. Harmar-Nicholls, L.
Belstead, L. Denham, L. [Teller.] Harvington, L.
Berkeley, B. Drumalbyn, L. Henley, L.
Blakenham, V. Ellenborough, L. Hill of Luton, L.
Bridgeman, V. Elles, B. Hornsby-Smith, B.
Broadbridge, L. Elliot of Harwood, B. Hunt of Fawley, L.
Brooke of Cumnor, L. Faithfull, B. Kemsley, V.
Kinnaird, L. Newall, L. Seear, B.
Lindsey and Abingdon, E. O'Hagan, L. Stamp, L.
Long, V. Onslow, E. Strathcarron, L.
Lyell, L. Pender, L. Swansea, L.
Macleod of Borve, B. Platt, L. Tranmire, L.
Marley, L. Rankeillour, L. Vickers, B.
Monson, L. Redesdale, L. Ward of North Tyneside, B.
Montgomery of Alamein, V. Robson of Kiddington, B. Winstanley, L.
Morris, L. Ruthven of Freeland, Ly. Young, B.
Mowbray and Stourton, L. [Teller.] Saint Oswald, L.
Sandys, L.
Beswick, L. Janner, L. Peart, L. (L. Privy Seal.)
Birk, B. Kagan, L. Peddie, L.
Brimelow, L. Kaldor, L. Popplewell, L.
Brockway, L. Kirkhill, L. Ritchie-Calder, L.
Castle, L. Kissin, L. Shepherd, L.
Champion, L. Lee of Newton, L. Stedman, B.
Collison, L. Llewelyn-Davies of Hastoe, B. Stone, L.
Davies of Penrhys, L. Lovell-Davis, L. Strabolgi, L. [Teller.]
Donaldson of Kingsbridge, L. McCluskey, L. Taylor of Mansfield, L.
Elwyn-Jones, L. (L. Chancellor.) Maelor, L. Wells-Pestell, L.
Fisher of Camden, L. Morris, of Kenwood, L. White, B.
Hale, L. Murray of Gravesend, L. Winterbottom, L.
Harris of Greenwich, L. Northfield, L.
Houghton of Sowerby, L. Oram, L. [Teller.]

Resolved in the affirmative, and Amendment agreed to accordingly.

On Question, Whether Clause 3, as amended, shall stand part of the Bill?

10. 56 p. m.

Baroness YOUNG

Now that we have moved a number of what we regard as important Amendments to this Bill, we hope that the clause will stand part of the Bill in another place. Not only have we the Amendment that we have just moved whereby the beds phased out will at any rate be used by National Health Service patients and not turned into offices, or something like that, which has been the fate of some of them phased out, and that at least the interests of the patients will come first, but we shall have produced a much more realistic timetable in Clause 3(1), and put in an important Amendment that it should be the Board and not the Secretary of State who shall decide on the first 1,000 beds to be phased out. This seems to us on this side of the Committee to cover two very important matters of principle.

Thirdly, we have put in an Amendment which Lord Goodman wanted, that the alternative facilities should be at a satisfactory standard. None of these Amendments is in any way against the principle of the Bill, but all of them are designed to see that all patients, whether they are in the National Health Service or as private patients, have the best possible treatment that is available. That is the principle that we wish to see carried out throughout this Bill. Whether it is based on the narrow definition of the Goodman agreements or not, it is after all the patients whose interests should come first, and it is that which has motivated us to move the Amendments as we have.

Clause 3, as amended, agreed to.

Clause 4 [Functions of Board as regards withdrawal of NHS facilities from private patients]:

Baroness YOUNG moved Amendment No. 17: Page 3, line 38, leave out ("progressive") and insert ("grant or").

The noble Baroness said: The Board and its functions are an integral part of the proposals under this Bill. Amendment No. 17 is designed so that power shall be given to the Board not only to phase out private beds from National Health hospitals but, where it thinks right, to increase the number. This Amendment received a tied vote in another place. It was never debated at all on Report because it was guillotined before it was reached, and this is the first opportunity for anybody to express a further opinion on it and to say what is wanted. It would be unfortunate if, as seems likely, the proceedings of this House are to be guillotined in another place when they go back and possibly there might not be an opportunity to debate this matter again in another place.

The functions of the Board as at present proposed have what can only be described as a ratchet effect. It progressively phases them out, and there is no provision at all for increasing the number anywhere at any time.

The noble Lord, Lord Wells-Pestell, took me to task earlier for saying that on one issue the Government had changed their mind. He replied that all Governments changed their minds because circumstances change. I put it to him on this matter that many circumstances could change in the NHS. After all, who could have foreseen 15 years ago that we would have a Bill like this, that the doctors would ever contemplate going on strike or that the trade unions would feel the way they do? Perhaps we should all have been more farseeing, but in the event probably most people did not expect many of these things. I will, therefore, put to the noble Lord some of the things that might occur in the next 10 to 20 years.

If Lord Wells-Pestell looks at the Registrar General's forecasts of population he will see that already they have changed enormously. Ten years ago the Registrar General was forecasting a large increase in the population. Now we know that we have a declining birth rate but that we have an enormous increase in the population in the age group 75-plus. I am not an expert in these matters, but it is not unreasonable to suppose that, with the largest growth in the population of those over 75, the need for hospital care for them will increase. The Government have argued that the 1,000 beds being phased out will not necessarily be used for those patients. Is it not possible that some of them or their relatives may wish to make private provision for an elderly relative who perhaps has some long terminal illness and will want that provision in hospital? And when the statistics—we cannot argue about this; it is a fact stated in the Government's own publication Priorities for Health and Personal Social Services in England—make it perfectly clear what the problems of the future may be, how are we to know that those people will not want private provision? The document, in paragraph 11, also highlights two problems: … the extent of unsatisfied need in the provision for the mentally ill and the mentally handicapped and the pressure on services due to the rising numbers of elderly".

What about provision for the mentally handicapped, now living longer than ever? Suppose a family wishes to make provision for a mentally handicapped child or adult in a long-stay hospital as a private patient? What about new medical developments? Who is to say that there will not be some startling new medical developments that cannot possibly all take place in private hospitals but will take place in others? What about the change in the population? We already have down an Amendment on the question of new towns.

Consider, for example, the way in which the noble Lord's colleague, the Secretary of State for the Environment, has now changed his view, as has his Department, on what should happen in inner cities. Far from trying to take industry and offices out of inner cities, he has discovered that because of what has been the policy and the building up of new towns, inner cities are becoming denuded. That policy is to go into reverse and people are to be encouraged to return to live in the inner cities. Surely that means that there should be provision for private medical facilities where the population goes. Should it not sometimes be the case, in order to meet the Goodman proposals, that that provision should be within the Health Service? It could be in a hospital in a separate block, if that would satisfy everybody's feelings about it. As the useful and important document Priorities for Health and Personal Social Services in England makes clear, there are to be cuts in capital expenditure and more in domiciliary provision. Is it not sensible that there might have to be more provision for private patients because there will be less provision in NHS hospitals?

I put these as hypothetical questions, but when one is legislating one tries to take a view of the kind of things that might happen in the future, and it seems not unreasonable to assume that for any of these reasons, or even for one of them—or for none of the reasons I have given but for some others I have not suggested—we might at some future date need to make provision for more private patients.

It is for that reason that this Amendment has been put down which would make it the duty of the Board to submit from time to time, only when it thought necessary, not only that the number of private beds in hospitals should be reduced, but that they could, if it was considered necessary, be increased, not generally, but in a particular part of the country at a particular time if the circumstances arose. I do not press that they should. I am not asking that the number of beds should be increased. All I ask is that a provision should be written into legislation to make it possible, simply because no Government can foresee all the eventualities in the future. This at least would be playing safe on a number of complicated issues which will affect many individuals. I beg to move.


Perhaps this is a suitable moment to remind the House of "Ferrers Law" because, as my noble friend Lord Ferrers has been at pains to remind the House from time to time, the purpose of almost every piece of legislation is ultimately confounded by what turns out in the end; in other words, its purpose is reversed.

I believe those of us who have frequently argued passionately for things which have now disappeared into oblivion can perhaps regard the situation with some care. May I perhaps refer to certain events in the past? There was the Severnside Study, argued passionately during the sixties; the South-Eastern Study, a document of great technical specification and very considerable expertise. Both have been thrown into the waste paper basket. There was the Third London Airport at Foulness, a subject which your Lordships have discussed on many occasions and in very great detail. But who today would stand up from the Government Benches and propose a Bill?

I think it was the noble Baroness who proposed the withdrawal of the final portions of the initial legislation. So we do change our minds in a short space of eight or nine years. Therefore, what my noble friend Lady Young has said is of very great significance in this context; that is, that the legislation must be flexible. It must aim at providing for circumstances unforeseen but which may occur within quite a short space of time, perhaps 10 years or less. I do not think it is necessary to emphasise the obvious any further, but I believe that the Amendment is highly desirable.


I should have hoped that the noble Baroness who will reply would keep in mind the clear advice given by the longest-serving Prime Minister in this century. He made it clear on many occasions that the thing to do in Government or in Opposition is to keep all of your options open. What this Amendment does is to keep an option open, to grant or to remove. I do not think one can do better than urge upon the noble Baroness in replying for the Government that the Government who initiated this legislation was led by the same Prime Minister who always said, "Keep your options open." I hope that in those circumstances she feels that this is an Amendment which does just that. It need not be used if one's principle does not think it right that any extra provision should be granted, but it is an option, I believe, that, whoever the Government may be, they should keep in their locker as being one they may want to use.

11. 10 p. m.

Baroness STEDMAN

Far be it from me never to try to keep all my options open, but on this case I am here to present this part of the Bill which the Government are putting before your Lordships. The effect of the Amendment which the noble Baroness has moved would be to remove the Board's duty to make proposals for the progressive revocation of authorisations under Sections 1 and 2 of the 1968 Act, and to impose on the Board a duty to make proposals to the Secretary of State for the grant of authorisations of pay beds and facilities for private non-resident patients as well as for their revocation.

I must remind your Lordships of what my right honourable friend, a former Minister of State, said in another place; namely, that the private sector would have to stand on its own feet, and that the Government are in the business of providing a separation of pay beds from the National Health Service. I accept that the forecast that we are given today on population shows that there will be quite a shift in the age groups of our population. I accept that there are people with all kinds of disabilities, mental and physical, and there are many more elderly people who may require pay beds. But there were Government Amendments tabled to Clauses 4 and 5 at the Committee stage in another place which took into account the representations which were made to them by the medical profession, and these provide for pay bed authorisations to be granted where a hospital with pay beds is permanently or temporarily closed.

So far as new towns are concerned, where a new hospital is built in a new town, and where this involves the closure of an existing hospital in the area, then any pay beds which existed at the original hospitals could, if the Board recommended, be re-provided in the new hospital. But where there were no existing pay beds in the area, any new demand for private practice which arose from the expansion of population would have to be satisfied by the private sector. I should be failing in my duty if I did not again remind your Lordships that the purpose of the Bill is not to perpetuate the existence of pay beds in the National Health Service, but to provide the machinery for effecting the separation of private medical practice from National Health Service hospitals in a reasonable and orderly manner. I hope that the Committee will reject the Amendment.

Baroness YOUNG

I always enjoy listening to the very clear and concise way in which the noble Baroness, Lady Stedman, makes her points, and I only wish that I could agree with her. She says that it was maintained in another place that in matters of this kind the private sector must stand on its own feet. One of my concerns about the Bill is that I think that in many instances the private sector will stand on its own feet, with difficulty in places, but very successfully. The question which the noble Baroness needs to ask herself is: Will the National Health Service be able to stand on its own feet? It is rather wobbly in places and it is hardly likely to be improved by the Bill. That is our concern about it.

The argument of the noble Baroness about new towns is the kind of argument that rings every single alarm bell on this side. She said quite fairly that any pay beds that already exist in new towns could be re-provided in some other form of hospital, but that any new demand would have to be provided by the private sector. As the noble Baroness knows far better than I do, new towns take a long time to develop. Her own new town of Peterborough would be one example. There may not now be a demand for private beds. There may not be a big enough population. It is most unlikely that there was a private nursing home, for example, in Peterborough new town. I should be very surprised to hear that there is one. But neither she nor I can say that into the indefinite future there will never be one.

In the meantime, any pay beds phased out mean that the inhabitants there will not have the options. I should remind Members of the Committee who talk as if it is very easy to get a good bed in hospital, that if you live in London you are very fortunate; you are very well provided with all kinds of facilities which do not necessarily exist in other parts of the country, and people are perfectly entitled, if they so wish, to make private provision for them.

My argument does not rest merely on new towns. I quoted this as one example; and I was very glad that the noble Baroness recognised that there is a very real problem with the ageing population that we have. I think that before very much longer we shall find ourselves in increasing difficulty with the number of very old people in the population for whom provision will need to be made. As I cannot see that it is at all unreasonable to ask in this matter that the Board should have powers, either to increase or to decrease the numbers of pay beds, I feel that I cannot withdraw this Amendment.

11. 16 p. m.

On Question, Whether the said Amendment (No. 17) shall be agreed to?

Their Lordships divided: Contents. 53; Not-Contents, 33.

Ampthill, L. Gowrie, E. Newall, L.
Belstead, L. Harmar-Nicholls, L. O'Hagan, L.
Berkeley, B. Harvington, L. Onslow, E.
Blakenham, V. Henley, L. Pender, L.
Bridgeman, V. Hill of Luton, L. Platt, L.
Broadbridge, L. Hornsby-Smith, B. Rankeillour, L.
Brooke of Cumnor, L. Hunt of Fawley, L. Redesdale, L.
Carrington, L. Kemsley, V. Robson of Kiddington, B.
Colville of Culross, V. Kinnaird, L. Ruthven of Freeland, Ly.
Cork and Orrery, E. Lindsey and Abingdon, E. Saint Oswald, L.
Craigmyle, L. Long, V. Sandys, L.
Denham, L. [Teller.] Lyell, L. Seear, B.
Drumalbyn, L. Macleod of Borve, B. Strathcarron, L.
Elles, B. Marley, L. Swansea, L.
Elliot of Harwood, B. Montgomery of Alamein, V. Vickers, B.
Faithfull, B. Morris, L. Ward of North Tyneside, B.
Ferrers, E. Mowbray and Stourton, L. Winstanley, L. [Teller.]
Gisborough, L. Young, B.
Beswick, L. Houghton of Sowerby, L. Oram, L.
Birk, B. Janner, L. Peart, L. (L. Privy Seal.)
Brimelow, L. Kagan, L. Peddie, L.
Castle, L. Kaldor, L. Ritchie-Calder, L.
Champion, L. Kirkhill, L. Shepherd, L.
Davies of Leek, L. Llewelyn-Davies of Hastoe, B. Stedman, B. [Teller.]
Davies of Penrhys, L. Lovell-Davis, L. Strabolgi, L. [Teller.]
Donaldson of Kingsbridge, L. McCluskey, L. Wells-Pestell, L.
Elwyn-Jones, L. (L. chancellor.) Morris of Kenwood, L. White, B
Fisher of Camden, L. Murray of Gravesend, L. Winterbottom, L.
Harris of Greenwich, L. Northfield, L.

Resolved in the affirmative, and Amendment agreed to accordingly.

11. 23 p. m.


Would I be right in supposing that Amendments Nos. 18, 19, 20 and 21 are consequential on the Amendment which has just been agreed to?

Baroness YOUNG

That is so. I beg to move Amendments Nos. 18 to 21 en bloc.

Page 3, line 39, leave out first ("the")

Page 3, line 41, leave out from ("patients") to ("and") in line 43.

Page 3, line 44, leave out ("the")

Page 3, line 46, leave out from ("patients") to end of line 2 on page 4.

On Question, Amendments agreed to.

Lord SANDYS moved Amendment No. 22: Page 4, line 9, leave out ("six") and insert ("twelve")

The noble Lord said: This group of Amendments is concerned with the timetable of the working out of the Bill and proposes to omit the period "six months" and insert "twelve months". It was the group of Amendments previously referred to as "the Goodman proposals" and was the subject of a tied vote in the House of Commons. For that reason, I think it is very important that we should pay particular attention to this opportunity of re-examining the situation because, as I understand it, none of the three Amendments Nos. 22, 23 and 24 was reached on Report in another place and were subject to the guillotine. The question of the timetable in the Bill is of vital significance. In the Bill as drafted, the Secretary of State was required to phase out the beds within six months, and the Board in the present drafting are required to produce their proposals. But this really is quite impossible within the very narrow limits of six calendar months provided by the Government timetable.

Let us consider what the Board are expected to do. On being convened as a Board by the Secretary of State, they will presumably receive their appointments and meet on the first occasion. They will have to decide on their method of working; they will have to appoint their secretaries and set up their administrative procedures and organise their staff at such a place and in such a way as to be most economical and to facilitate their operation. But it is not purely a matter of setting up an office, because they have a very clearly defined job to do in a very short period of time.

We ought to see what those jobs are once they are administratively organised. One of the first things they must do is to establish working relations with a Scottish and Welsh Committee. These Committees have to be set up; as indeed the four lists of assessors which are set out in Schedule 1(5) on page 23 of the Bill. There are many further problems they will have to examine, because the centre of it lies in the review of investigations of facilities in the private out-patient consultation department and facilities for accommodation. Here really lies a very particular problem for the Board. It is a matter of receiving reports from authorities tabulating equipment and, above all, recognising what equipment is located in which hospital.

It is a technical matter of the first order to identify the location of equipment: first, for radio therapy; secondly, for diagnostic pathology; thirdly, for diagnostic radiology; fourthly, for scanning; fifthly, for ultra-sonics and methods using radio isotopes. Of course, there are several hospitals in London specially skilled in this particular facility, but remarkably few in other parts of the United Kingdom. Hammersmith is well known to have been the leading hospital in this particular field for many years; but how many other principal centres of population can say, "We are as well equipped as Hammersmith"? Apart from specifying what equipment is installed in hospitals, one of the very important things to recognise is the age of the equipment, its suitability, the way in which it has been used in the past and, "Has it been perhaps underused?" There is the question of whether the catchment area to which the noble Baroness referred (highly significant in this whole field) relates to particular facilities.

The Board are being asked in the period of six months to investigate the beds after the first thousand. Of course, the Bill as drafted now has been revised after the Amendment so ably moved by my noble friend Lady Young. We hope that that Amendment will remain in the Bill. But the problem which will concern the Board is the post-Schedule 2 situation—which beds from which hospitals? This really is a particularly difficult task.

My noble friend Lady Young has referred to the demographic problem, where centres of population change. Here one can see a very difficult task facing the Board. They will have to organise themselves in such a way as to collate information from both the Department of Health and Social Security and also from the Department of Environment. Quite substantial parts in the catchment areas referred to change comparatively quickly in areas where redevelopment has taken place.

I believe that the collection of tasks to which I have referred is impossible to carry out within a period of six calendar months. During that period it will be possible to establish the initial procedures—that is, for the Board to get to know one another (a very necessary proceeding); to establish lines of communication; to recognise what their role is and to identify their relationship with both the Department of Health and also their other roles in connection with the Scottish and Welsh Committees and the assessors. Their roles with the BMA, and their consultants, and with the other organisations concerned in the whole operation is very significant.

Private practice will be very strongly affected. It is one of the tasks of the Board to so enable the smooth transition between the phasing out of pay beds in the National Health Service in such a manner as it will not affect patients in the National Health Service hospitals. I hope they will achieve their task in a satisfactory manner; but surely a period of six months is grossly inadequate. I believe that this Amendment, and its successor Amendments, are most certainly necessary to the Bill. I beg to move.

11. 32 p. m.


I should like to emphasise from practical experience, as I know the noble Baroness has had from her local government days, that six months is a short time. When you are dealingwith anything as bureaucratic as this, six months amounts only to minutes. If you take into account holiday periods, the time when people whose advice is essential are away doing other jobs, six months is asking for this important task to be done in a slip-shod way. If it is not done in a slip-shod way, it is asking for decisions to be made by one official in order to fit in with the timetable, and you are not going to have the collective wisdom of the Board with their special contacts.

The noble Baroness has sat on planning committees, as I have. She knows that things which are not as intricate as this have been submitted, and she has found it impossible to give either planning approval or disapproval within 12 months, 18 months and two years. I sympathise with her in the advice she has to give and I hope that she can officially recognise tonight what a short period six months is and will put that on the record. I do not think that 12 months is long enough. I would leave it as open as possible to make certain that the job is well done. There is no merit in having it done in six months or 12 months; the merit is having it properly done. It will not be able to be done well in six months.


My attitude as to whether this should be six months or 12 months depends on the ultimate fate of the group of Amendments we have just passed. If this clause is going to read: … in accordance with this section proposals for the grant or revocation of … the authorizations … that makes rather a difference. If one of the roles of the Board is to alert the authorities to possible dangers and damage to the service, I should like them to do that at the earliest possible stage.

I make no secret of the fact that I have spoken in these debates on this Bill from the point of view of one who is anxious, above all else, to protect and defend the National Health Service; and because I wish to do that I should like to see National Health Service specialists spending as much time as possible in the National Health Service. One of my fears in the phasing out of private beds is that they will go a long way away—"somewhere in the catchment area" as the phrase has become. Frankly, I should like to see National Health Service specialists in the National Health Service hospitals. A measure such as this will take many of them away from these hospitals for certain periods, and at a very early stage it will have a damaging effect on the Service. If those damaging effects are apparent, I should like the Board to alert the authorities at the earliest possible moment so that steps can be taken. I know this is permissive rather than obligatory, but my attitude to whether the period is six months or twelve months rather depends on whether the Amendments which have gone through this Committee ultimately remain in the Bill.

Viscount LONG

In support of the Amendment of my noble friend Lord Sandys, I must say that after he had read out some of the things the Board would have to do in this six months' period, I have come to the conclusion that the Government are really pressurising the Board members to fulfil their task, especially as most of them are expected to be in private practice. I really do not see how they will be able to form themselves into a Board and carry out this work (bearing in mind also that there will be Scottish and Welsh Committees), and still be in their own practices at the same time. Six months, in my view, is much too short, and I think it would be better to leave it open rather than pressurise them in this way, or else to leave it at a year, if not more.

Baroness STEDMAN

The noble Lord, Lord Harmar-Nicholls, will not expect me to support him in his views tonight, and he will have got used to the fact that over a period of 25 years I have not supported him as my Member of Parliament. I have not changed my views during the time he has been in this Chamber, and therefore shall have to oppose the view he has given tonight.

So far as the noble Lord, Lord Winstanley, is concerned, he would not expect me to give any assurances as to what will happen to Amendments made to this Bill when they get to another place. Therefore, I cannot satisfy him as to whether this is the right period of time in his view. What I can say is that the extension of this interval would unnecessarily and unacceptably prolong the period of withdrawal from the National Health Service of pay beds and of authorised facilities for private out-patients.

The Government accept the principles enunciated in the proposals of 15th December for determining the phasing out of pay beds and facilities from the NHS, which are listed in Clause 4(7). Those principles were, first, that for the retention of beds or facilities for private practice in NHS hospitals there should be reasonable demand for private medicine in the areas of the country served by those particular hospitals. Secondly, that for the abolition of beds or facilities for private practice in NHS hospitals there should be available sufficient accommodation or facilities for the reasonable operation of private medicine in the areas of the country served by those particular hospitals. Also, in those areas of the country presently served for private practice by a particular NHS hospital, all reasonable steps had been or were being taken to provide private beds or facilities outside NHS hospitals and that this would be kept under continuous review; and also, that where all reasonable steps to provide in the area of the country concerned alternative private beds and facilities outside an NHS hospital that could be taken were not being taken, this would, after due warning, be itself grounds for recommending the withdrawal of facilities for private practice in that particular NHS hospital. While showing a proper understanding of the difficulties which developers may encounter in seeking to provide alternative facilities, the Board should none the less approach this part of its remit with an appropriate sense of urgency.

In the Government's view, a requirement on the Board to look at the state of play every six months is a reasonable interpretation of these principles. It puts the onus on developers, and those who believe there is a substantial public demand for private practice, to demonstrate their conviction by taking steps to provide facilities to meet that demand promptly, though not of course with undue haste or without adequate preparatory planning. None the less, it is foreseen that a point could be reached when, after thorough review on a particular occasion, the Board might not be able, in following the principles in Clause 4(7), to propose any more beds or facilities for phasing out, for the time being. In that case, it can report that no proposals are at that time necessary. This is allowed for in Clause 4 (2)(b). It is up to the chairman to make a case to the Secretary of State, if he thinks it unreasonable that he should submit his first report in six months. Since the object of the Bill is progressive phasing out, we should be losing the impetus in doing the job which we have set ourselves if there were too long an interval. Therefore, I must ask the House to reject these Amendments.

11. 42 p. m.


I must confess that if I were appointed chairman of a Board, which is highly unlikely, my first recourse would be to Clause 4(2)(b), which is what any chairman would do, faced with an overwhelming situation wherein it would be totally impossible to reach the conclusion of his work in that period. The noble Baroness used the phrase, "unnecessarily and unacceptably prolonging the process of withdrawal" and she did not, I regret to say, convince me that there would be a satisfactory argument, because the phrases which followed from her brief, which she read with an assumed conviction, carried with them all the arguments which we know so well, and the phraseology which we know from another place. That phrase, which has such a familiar ring to it, "kept under continuous review" is a term of art which is so well known that it brings shouts of laughter in another place when a Minister attempts to use it.

I believe that the situation is this. The Government are attempting a piece of window-dressing in trying to force the programme unnecessarily fast. If they seriously think that this Amendment is either a wrecking or disruptive one, they have cause to reconsider it, because any reasonable chairman reading Hansard, and looking at the list of operations which he would have to complete, would say straight away, "It is out of the question that this could be fulfilled".

There is one final point, which I believe is a practical one. I make no complaint about the postal arrangements. I merely make the observation that, now that weekend collections have been discontinued, the whole operation of a week's mail has changed its cycle. It means that for someone writing a letter on a Friday or a Saturday, and failing to get it into the post, the whole cycle is thrown out of phase. I believe that there is a point here, and I also feel that communications with these Welsh and Scottish Committees will take a great deal longer than the Government believe.

House resumed.