HL Deb 18 November 1976 vol 377 cc1463-515

3.21 p.m.


My Lords, I have it in command from Her Majesty the Queen to acquaint the House that Her Majesty, having been informed of the purport of the Health Services Bill, has consented to place Her prerogative and interest, so far as they are affected by the Bill, at the disposal of Parliament for the purposes of the Bill.


My Lords, I beg to move that this Bill be now read a third time

Moved, That the Bill be now read 3a.—(Lord Wells-Pestell.)

On Question, Bill read 3a with the Amendments.

Clause 13. [Authorisations to construct or extend controlled premises]:

Baroness YOUNG moved Amendment No. 1:

Page 16, line 11, at end insert— ("(5) With the consent of the Board (which shall not be unreasonably withheld) an applicant may at any time transfer an authorisation to another person.").

The noble Baroness said: My Lords, I am moving the Amendment as my noble friend Lord Kinnoull is unfortunately unable to be present this afternoon. I do not think that there is anything further that I need say about the points raised in debate last night. The essential point is that when a planning application is before a local authority planning committee, the merits of the case shall be entirely decided for planning reasons and that no other outside points shall be raised.

In this case, the point is that the authorisation from the Board that has been given to one particular person should be able to be transferred to another person, because there would be a number of cases when another person might be taking on the building company or whatever it was. It would be very difficult for such a person to apply to the Board for authorisation when authorisation had already been received. Of course, it would also be much less efficient. I believe that it would be very helpful to hear what the noble Baroness has to say in answer to the points that were raised in the debate rather late last night. I beg to move.

Baroness STEDMAN

My Lords, when we discussed the Amendment yesterday, I thought that the noble Earl was satisfied with the reply that I gave him. I am therefore a little unsure what is now troubling noble Lords opposite about the issue. It might perhaps be helpful to your Lordships if I repeat the remarks that I made yesterday.

When we were discussing the Bill earlier at the Committee stage, the noble Earl, Lord Kinnoull, asked whether it would be possible for a developer, having been granted an authorisation, to sell his company and, by that means, transfer the authorisation among the assets of the company. I said then that I thought this would be possible and I wanted to take the opportunity yesterday evening to confirm what I had said. I realise that this could be used purely as a device for transferring authorisations, but I submit that it would be a rather cumbrous procedure for a developer to adopt. The Board, as I said in Committee, would have no reason to refuse to transfer an authorisation in respect of the same development if none of the circumstances had changed.

I should also remind noble Lords that, if an authorisation is part of the assets of a company and passed with that company's assets to a new owner, it would remain subject to the terms on which it was originally issued, which could include a time limit after which the authorisation would expire if the controlled development in question had not begun. It would then be up to a new developer to reapply for authorisation to build in the way that had been agreed earlier on.

Baroness YOUNG

My Lords, I should like to thank the noble Baroness for that reply. I do not want to go on at length about the difficulty of not having a print of Hansard after 10 o'clock last night so that we have not had an opportunity to read what the noble Baroness said, but I am grateful for the trouble that she has taken. I beg leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

Baroness YOUNG moved Amendment No. 2:

Page 16, line 11, at end insert— ("(5) An authorisation granted under this section shall be for a period not less than three years.").

The noble Baroness said: My Lords, here again, the point that was raised was that when the Board gives an authorisation for the building of a private hospital the authorisation shall run for not less than three years. Again, this is a matter that was debated last night and it would bring the provision more in line with common planning procedure, where an approved planning application does not lapse until five years have passed. I believe that it is important that there should be some time limit in the Bill so that when somebody receives an authorisation from the Board he knows that it cannot be revoked within a given period of time. Again, if the noble Baroness has anything further that she can say on the point I should be glad to hear it. I beg to move.

Baroness STEDMAN

My Lords, I have, as promised, looked again at this Amendment and I am still certain that the matter cannot be dealt with appropriately in Statute. Accordingly, I give this firm assurance to the noble Baroness. We will draw this debate and the concern of noble Lords to the attention of the Board once it is set up. I am certain that the Board will take account of it and it will, I expect, want to have discussions with those concerned in the private sector before coming to a decision on their procedure and on the manner of setting the conditions on which the authorisations are issued. Accordingly, I hope that the noble Baroness will be satisfied and will not feel it necessary to press the Amendment.


My Lords, this is a fundamental change from normal procedure. I accept absolutely what the noble Baroness has just said in offering to draw the attention of the Board to what had been said. But I do not think that it has been the practice in the past—nor ought it to have been, nor ought it to be the practice in the future—for the words in the Bill to be disregarded as a result of having substituted for them what has been said in this House by way of unauthorised exchanges in debate. I feel that this is a matter that ought to have been included in the Bill. I believe that it ought to have statutory weight behind it. I do not think it right that any Board or planning authority or anybody who administers the Acts that we have passed in this House should have to take into account what is said across the Floor of the House.

While I know that the noble Baroness has said what she said in good faith, I doubt whether it would be a good thing, or even whether it would be accepted, that the mere indication of what has been said in this House alters the meaning of the words in the Act itself. I should have thought that, in order to give some sort of confidence to people to do things which we clearly want them to do, they ought to be certain that they have a three-year certainty irrespective of what they do.

Baroness YOUNG

My Lords, of course I am not satisfied with the reply of the noble Baroness because, like my noble friend Lord Harmar-Nicholls, I think that this matter ought to be written into the Bill. However, I appreciate the trouble that the noble Baroness has taken over this. I believe that it is a very important matter and I hope that, if, as I imagine they will, the Government issue a circular explaining the Bill, they will indicate these various planning points to the Board on general lines. All that is being asked is that the Board should bring itself into line with what is common practice and is, indeed, the law governing planning applications. I beg leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

Clause 15 [Planning permission for works requiring authorisation]:

3.29 p.m.

Baroness YOUNG moved Amendment No. 3:

Page 18, line 7, at end insert— ("(4A) For the purpose of any application for planning permission for any controlled works and any appeal as aforesaid, an authorisation for those controlled works shall be conclusive as to the matters referred to in subsections (2) and (3) of section 13 above.").

The noble Baroness said: My Lords, of all the three Amendments concerned with planning, this, in my view, is the most important because it is essential to get the assurance that the matters that will concern the planning committee when a planning application for a private hospital is made will be only those that are rightfully the concern of a planning committee and not other matters that could be extraneous to that. There have been most unfortunate cases in which an application to build a private hospital has been refused by a planning authority for a variety of reasons, one of which was that the people on the committee did not like private medicine.

Whatever one's view about that, this is not a planning consideration and it ought not to be allowed to be a planning consideration in law, not simply because it affects this Bill but because, once it could ever be thought that planning committees were concerning themselves with matters outside the rightful concern of the planning authorities, the country would get itself into very great difficulties and planning applications would be subject to the prejudices of committees up and down the country. The matter is therefore wider than this Bill, and it would be very helpful if the noble Baroness could give us any further assurances since we last debated the matter, because I think that the Government appreciate this point just as we do on this side of the House. I beg to move.

Baroness STEDMAN

My Lords, as promised we have given further consideration to this Amendment this morning. The effect of the Amendment would be to state in the Bill that the fact of an authorisation having been given for a project ought to be conclusive when the planning authority considers the planning application for that project with respect to the matters in Clause 13(2) and (3). These are: whether or not the project would cause detriment to the National Health Service by virtue of the amount of its accommodation; the facilities which it will provide; and the staff which it will require. With the greatest respect, the Amendment is completely unnecessary. The planning authority must have regard only to planning considerations, and planning considerations most definitely do not include questions about detriment to the National Health Service or disadvantage to National Health Service patients. They would be going outside the scope of the matters to which the Town and Country Planning Act 1971 requires them to have regard if they took any account at all of the matters dealt with in Clause 13(2) and (3).

Indeed, to my certain knowledge the Secretary of State for the Environment has reversed the decision of a planning authority that planning permission should be refused for a private hospital because in its view there was over-provision of hospital accommodation in its area. On appeal my Secretary of State took the view that in refusing the permission the authority was exceeding its powers. I hope that that will satisfy the noble Baroness.

Baroness YOUNG

My Lords, I am grateful to have that statement on the record. Can the noble Baroness say to which authority this applied?

Baroness STEDMAN

My Lords, my understanding is that it was Westminster.

Baroness YOUNG

My Lords, I thank the noble Baroness. Although I should have preferred to have had this written into the Bill, nevertheless it is useful to have it on the record, and I hope that on this matter it will be taken by planning authorities as guidance. Having said that, I beg leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

Baroness YOUNG had given Notice of her intention to move Amendment No. 4: Schedule 1, page 25, line 9, at end insert ("who holds or has held high judicial office")

The noble Baroness said: My Lords, I have reflected on this matter and I do not wish to move this Amendment.

3.34 p.m.


My Lords, I beg to move that the Bill do now pass.

Moved, That the Bill do now pass.—(Lord Wells-Pestell.)

Baroness YOUNG

My Lords, I do not believe that anybody who has taken part in the proceedings on the Bill over the past fortnight, and who has considered all the very many detailed matters that have been raised, can fail to realise that a Bill which is entitled the Health Services Bill in fact has nothing to do with patients at all, either patients in the National Health Service or private patients. So far as I can see, it has very little to do with medicine. As we have now discovered it is a narrow minded document, the result of the Government's promise to the doctors to legislate on what have come to be called the Goodman Proposals, and the guarantee of legislation was given in return for a promise from the doctors that they would stop working to contract.

It is a narrow Bill, and we have been constantly told by both the noble Lord, Lord Wells-Pestell, and the noble Baroness, Lady Stedman, that the Government are implementing the Goodman Proposals; and they have appeared like a religious tract from which no one can move at all, and in which every single word must be enacted, and indeed was enacted, precisely as the document was drawn up. It is a Bill with a sting in its tail. Part III is outside the Goodman Proposals; it is outside the Government Manifesto; and it is outside what was written into the Queen's Speech. I shall comment on that later, but it is I think a very unpleasant Part of the Bill, with sinister overtones.

Therefore, it is not surprising that we have had what has seemed to myself and my colleagues to be rather a curious stand on the Bill by the Government. With the notable exception of the Amendment on the question of right of appeal, moved by the noble and learned Lord, the Lord Chancellor, for which we are very grateful, there have been no Amendments from the Government at all. Allowing for that one notable and very good exception, the Government clearly believe that they have produced a perfect Bill. At times we have been criticised for putting down Amendments to the Bill, yet surely the principal function of the House of Lords is to amend legislation. It has a particular function in this case, as when this Bill was being debated in another place there were tied votes on 52 occasions in Standing Committee, the Bill was guillotined at the Report stage, and proceedings from this House will be guillotined when they return for consideration in the House of Commons.

This Bill is, in truth, a Government Bill. With the notable exception of the time when it was debated on Second Reading in another place, the only times it has been debated in either House of Parliament have been in your Lordships' House at the Committee stage, at the Report stage, and at the two other stages—the Second Reading and the Third Reading. It seems to me that if we have fulfilled no other function we have given an opportunity for some detailed discussion on many of the very important points that will arise.

I speak this afternoon conscious that almost everything we have said will be guillotined without discussion in another place. I am tempted to feel that perhaps I should just state our principles without giving our reasons. But, unlike the Health Services Board, I am not somebody suitably independent, suitably well qualified, whose word can be taken as law and as perfection, and somebody for whom there is no reason at all why reasons for our Amendments should be given. I am inclined to think that if one is making a case one should give one's reasons and then ask others to comment upon them having seen the way that one's thought is going. This will not be open to the Health Services Board, which of course will not be required to give its reasons. But then, as the Government have told us, the members of the Board will be very exceptional people.

However, even if I am only one of those curious, what might be called hybrid Members of your Lordships' House—a Life Peer—not of course of the excellence of the members of the Board, I should like to give the reasons for the Amendments that we have put down and which we think are at least worthy of consideration by another place. There are five of them. None of them goes against the principle of the Bill, but all of them are designed to help patients in hospital. I would single out as the first and most important of those the fact that the first 1,000 beds to be phased out ought to be given over to National Health Service patients. It seems to me incredible that a Bill, the purpose of which was to shorten the National Health Service queue, to improve the lot of National Health Service patients, and for which therefore 1,000 beds in the private sector in National Health Service hospitals are to be phased out, is not at the same time to require that those beds should be used by National Health Service patients. The accommodation arising from phasing out those beds could be used for offices; it could be used for a whole variety of reasons. That is why the Government will not accept this. But it is not true for them to say that it is going to shorten the queue in any way, if the beds are not to be used for patients.

The second Amendment, to which we would attach great importance, relates to the question of medical confidentiality. I know that there have been great discussions on Clause 6, as to whether or not there should be common waiting lists between patients in the National Health Service and private patients. Personally, I am very happy to abide by the decision that there should be a common waiting list, and I would never quarrel with that. But I think it is essential that the fundamental belief of doctors in the confidentiality of medical information between a doctor and his patient should be kept, and it is very difficult to see how this will be done under the Bill. Furthermore, we believe that patients ought to be given the maximum freedom, whether they are in the National Health Service or outside, to have a consultant of their choice: whether this involves a Roman Catholic patient and a Roman Catholic consultant, a woman patient who would like a woman consultant, or a Pakistani patient who would like a Pakistani consultant. I cannot see that that goes against the principle of the Bill, or does anything other than provoke the kind of thing that most people would like but unfortunately are not always able to achieve.

There are two other points about the staff. I believe that one ought to consider the needs of the staff in the best and widest meaning, both those who work in any of the ancillary services of the hospitals and the consultants. I find it quite extraordinary that the noble Lord, Lord Wells-Pestell, can say that there will be no detriment to anybody, nobody will lose their jobs, nobody will be worse off as a result of this reorganisation. It is stretching belief too far to think that we can accept that statement at its face value. It is even more disturbing that the letter he wrote to me on the subject is not the same as the statement made by his honourable friend Dr. David Owen in another place, and it is very difficult to draw any other conclusion than that the Government are not very concerned about this point. As far as the consultants are concerned, it is no use saying that a part-time consultant can automatically become a full-time consultant in the National Health Service following upon this Bill if, when he wishes to do so, there is no job for a full-time consultant and the Area Health Authority has not the money to pay a full-time consultant. He will inevitably suffer financial detriment and this will be one of the consequences of this Bill.

Part III was not in the Manifesto, and in our view it sets a dangerous precedent. As the noble Lord, Lord Hill of Luton, said during the Report stage; Why have a limit on private hospitals? Why should it be necessary to authorise certain numbers of beds? If there is a demand, why should it not be met? The reason given by the noble Lord, Lord Wells-Pestell, was that nothing must be done to damage the National Health Service. What is sinister about this is the implication that the National Health Service standards might fall so that it could be damaged by private practice. If the National Health Service is as good as it is made out to be people should choose it freely rather than something else which would be implied by an enormous expansion of private medicine at whatever the cost of that might be. So it seems to me that the doctors are right to be frightened of this Bill because there is an implied threat to their professional freedom.

The fact that private medicine is ultimately going to be limited, as Part III suggests, would indicate that not only are the doctors right to be frightened but also all those who wish for nothing more than the right to ask for a private room when they are ill. I believe that the number of people who would like that and would choose it is far greater than the very narrow group of people referred to. I think there are hundreds of trade unionists who would subscribe and who would choose to go to their own private hospital and private convalescent homes—and why not? There are a great many people who, of all the things they would wish to spend their money on, would choose to do it on a private room when they are ill.

I once read that a lot of people would not like to share a room when they are well, let alone doing so when they are ill, and I cannot see that there is anything morally wrong in choosing to spend your money in that way. The Bill is not for them; in fact it is not for the sick and distressed, it is the official stamp of the Government on the Goodman Proposals. We indicated at Second Reading that we were opposed to it on principle and I reiterate that now, not because I do not want to see anything done to improve certain things in the Health Service. There are many things that are wrong with the Health Service and those are the matters to which we should be addressing ourselves, not to creating a medical apartheid which will help neither patients in the National Health Service nor as private patients. That is the ultimate tragedy of this Bill.

3.45 p.m.


My Lords, it has always struck me as rather sad that so many of us have to make mistakes in order to learn sense. Children have to be permitted to do unwise things in order to acquire wisdom. It seems to me that the same principle applies to politicians as well, and in this Bill we see that it certainly applies to Governments. I would suggest that nothing illustrates this principle more vividly than this misconceived and misguided measure. I agree with the noble Baroness, Lady Young, that your Lordships' House has improved the Bill in many respects, though neither she nor I would suggest that what your Lordships have done to the Bill has made it wholly acceptable. Far from it. It seems to me that at a stroke this Bill reverses the principle upon which 30 years of growth in the National Health Service has taken place. I think that takes us back to the beginnings of the Bill and the beginnings of the Health Service by Mr. Bevan in 1946.

Perhaps I could briefly remind your Lordships of what Mr. Bevan said in 1946 at Second Reading. Let us be quite clear: Mr. Bevan held no brief for private practice. In talks I had with him he told me that when the Health Service was functioning effectively, private practice would disappear because there would cease to be a demand for it—and I agree with him. But he decided that it was preferable to allow private practice within the National Health Service rather than have a separate private service developing outside, as a threat and almost in opposition to the Health Service. Lest it should be thought that he did this as a sop in order to induce the profession to come in, one should look at his Second Reading speech in which he made it utterly clear. May I quote his Second Reading speech on 30th April 1946, column 57: Specialists in hospitals will be allowed to have fee-paying patients. I know this is criticised and I sympathise with some of the reasons for the criticism, but we are driven inevitably to this fact, that unless we permit some fee-paying patients in the public hospitals, there will be a rash of nursing homes all over the country. He went on: We want to keep our specialists attached to our hospitals and not send them into nursing homes."—[Official Report, Commons, 30/4/46; col. 57.] He elaborated this point and went further into it in Standing Committee, when he said: What he must try to secure, is that the specialist is induced, as far as possible, to spend all his time at the hospital, both for his own sake and for the sake of the patients in the hospital and—in the case of the teaching hospitals—for the sake of the students, and indeed, the whole atmosphere of the hospital. The more he spends his time in the hospital, the better for everyone concerned. I would encourage the specialist to have as much consultation in the hospital as possible. I do not want him to go to his surgery; I want him to be there on the spot and to see the people in the hospital. It would be disastrous if as a consequence of not accepting this principle, there grew up in Great Britain a rash of nursing homes, where the specialist would be intelectually isolating himself."—[Official Report, Commons Standing Committee, 21/5/46; col. 1155.] It seems to me that this Bill puts that principle precisely in reverse and at a stroke we are embarking on the creation of a separate private service outside the National Health Service. It is my belief that once that develops it will in the end bleed the National Health Service white. I believe that it will increase the view of some people—a regrettable view, I would suggest—that somehow they can get better treatment by paying for it. If they see a separate service outside, I think more people rather than less will opt for private treatment, particularly in those areas in which they see the National Health Service having certain difficulties. In addition, by setting up this separate service outside, we are diverting all sorts of resources in an unfortunate way to an undesirable development.

So far as the building industry is concerned, they will be encouraged to invest and to use their energy in building nursing homes and private hospitals rather than in concentrating their efforts on more socially acceptable work. So far as investment is concerned, this will encourage investment in an area which, while it may create wealth, will not create wealth of the kind that I think the Government, and indeed all of us, would like to see this country now creating.

The Bill will in the end, of course, cost money—a lot of money—in administration and in bureaucracy; and it will lose money, since it will forfeit the money which private practice at present earns for the National Health Service; and this is at a time when our National Health Service is starved of resources and is, indeed, very short of money. I think it will encourage many people—doctors, perhaps—to feel that they will have better opportunities, more freedom, outside rather than inside the National Health Service. I think they will be mistaken, but I believe many will think that. I think even those who leave money in bequests for research will begin to think that they will leave it to a private institution rather than to one of the National Health Service hospitals. Indeed, as time goes on I think we shall see a threat to the National Health Service growing up outside the Service which will not assist the Service but which, as I say, could in the end bleed it white.

My Lords, for once I hope that I am proved wrong. I do not think that is likely to be the case. Indeed, I think that as time goes on we shall see the kind of developments of which I have great fears. But I have a ray of hope, my Lords, and that, I think, comes from the Goodman Proposals. I welcomed the Goodman Proposals, not only because they secured a compromise of a kind, and a kind of agreement—perhaps not complete agreement, but they did something, I think, to cool the atmosphere and to bring the two sides together—but even more because I think the Goodman Proposals now written into the Bill spread out the whole process and make it take a lot longer. Therefore, my Lords, stemming from the Goodman Proposals is time—time which will possibly give us and others in another place an opportunity for second thoughts before we pass too far down a rather dangerous and, indeed, damaging route. I hope that we shall concentrate on what really matters, which is putting the Health Service to rights; and those who want to see the end of private practice should surely realise that nothing could end it more quickly and more certainly than establishing a truly effective, humane and efficient Health Service—and once we have that we shall all look in vain for private practice.

My Lords, my noble friends and I will watch with sadness as this Bill passes, as it must pass for reasons unconnected with health or with the National Health Service. But I think it is a sad occasion, not for private practice but for the National Health Service.

3.53 p.m.


My Lords, in Lord Goodman's absence may I ask permission of the House to speak before he does. First I should like to thank the noble Lord, Lord Wells-Pestell, and his Front Bench supporters for their patience and for the clarity with which they have considered our many Amendments. I must enthusiastically congratulate my noble friend Lady Young on the way she has spoken in this most complicated debate, with such good will throughout. After our marathon all-night session, which started at 3.0 p.m. and went on to 7.0 a.m., we had breakfast. I sat next to her. She did not seem unduly tired. We both agreed that we had hardly ever eaten a better breakfast! I am sure your Lordships will agree that seldom in your Lordships' House has a noble Baroness spoken for so long, so well.

As your Lordships must know by now, nearly all members of the medical profession are convinced that this is a bad Bill even with the comprise proposals of the noble Lord, Lord Goodman, in it. They fear that it may harm the National Health Service in the ways we have already discussed and perhaps disrupt relationships between it and the private sector of medicine in Britian. That could happen if it encouraged militant trade unions of hospital workers, and some others in the Labour Party, to pursue their declared doctrinaire policy of trying to abolish private medical practice in this country, leading to a salaried medical service and a State monopoly in medicine. This policy has been clearly put forward in recent Labour Party and certain trade union conferences. In spite of what the noble Lord, Lord Wells-Pestell, said to me so soothingly in the Committee stage of our debate, one cannot help being worried. I am told that Labour Party Conferences differ from those of other Parties in that their resolutions are supposed to be rather more mandatory towards Party policy than the others, which are regarded as more advisory. If your Lordships obstruct this Bill, that, as the right honourable Mrs. Barbara Castle said so militantly in another place on 12th October, would reopen the gates for industrial action and we in your Lordships' House will for certain be blamed and held responsible.

On the other hand, if in spite of its deficiencies this Bill becomes law I see the possibility of infinite troubles lying ahead over its implementation. There will be arguments about how quickly private beds can be phased out of NHS hospitals. And there will be a pile of difficulties for consultants to face in trying to obtain, outside the NHS, the private accommodation, facilities and equipment for their work of reasonably the same standards and availability (for them and for their patients) as those of which they have been deprived. To find good accommodation may not be too hard; but to provide in small hospitals and nursing homes, even for quite simple and straightforward illnesses and operations, adequate medical, surgical anaesthetic, recovery-room, intensive-care, resident-medical-officer, X-ray, pathological, physiotherapeutic and other facilities may be very difficult indeed in many places. Does all this suggest that the parts of the Bill about reasonably equivalent, alternative, standards do not mean as much as they imply? Or, owing to difficulties in achieving these standards in small hospitals, will only a few pay beds be phased out until sufficient and adequate private hospitals can be built? That may take several years.

Woe betide British medicine if, when this Bill is on the Statute Book, the Goodman compromises are not strictly adhered to and if people do not co-operate in what has been agreed! If there is interference in future on doctrinaire, ideological grounds by the Government, trade unions, local authorities or by anyone else with the planning, building or running of the private hospitals referred to in this Bill, or with pay beds not yet phased out, doctors will be justified in opposing that in the words of the noble Lord, Lord Taylor, "by every means in their power". As I indicated to your Lordships on 21st October, unless some practical and effective conciliatory mechanism is evolved before then many doctors are now prepared to fight, and they have learned how to do so. They are very likely to resist firmly such a threat to their profes- sional freedoms, and they will be supported in this by many of their patients.

If that happens, the passing of this politically motivated, impractical medical Bill, of which nearly the whole of our medical profession disapproves, will do enormous harm to relationships between the public and the private sectors of medicine, just at a time when co-operation between the two is so badly needed. It may open up a running sore which will take many years to heal. The blame and full responsibility for all that disruption, unpleasantness and unhappiness will then lie squarely on the shoulders of those who gave birth to this Bill and who have forced it through Parliament with several guillotines, without even allowing Parliamentary discussion on parts of it, and who have obstinately refused against so much advice to refer to the Royal Commission this very debatable pay beds issue which involves only 1 per cent. of the beds in the National Health Service. In time, if these troubles are not avoided, I believe that those who introduced this Bill, who really do have the welfare of the National Health Service and of British medicine at heart, may well wish that they had never thought of it.

My Lords, let us hope that during the next two or three years this Government (or any other which may take their place) and the trade unions will have the good sense to ensure, with the help of the BMA and the Royal Colleges and Faculties, that the Goodman compromise proposals are given a fair chance to be implemented by all concerned. In that way the possibility of a harmful immediate conflict will be reduced. Even then, we may be in for some serious trouble later if trade unions and others do not play fair. But if this moderate and conciliatory course which we are now adopting does by chance succeed, this will encourage and help the public and the private sectors of medicine in Britain to work together amicably and peaceably in future—which is what a great many patients and a great many doctors in our country now want.

4.1 p.m.


My Lords, I am not sure whether your Lordships are attending a funeral or a christening and my mood of uncertainty has been confirmed by the speeches we have heard so far today. Certainly, the Bill which we are now discussing is a major change and, as the noble Lord, Lord Winstanley, has said, it marks the end of the historic compromise achieved by Mr. Bevan over a quarter of a century ago. Whether the Health Service in its new form will succeed one cannot tell, but certainly this Bill has been very much improved by what your Lordships have done to it. Whatever we think about the Bill, your Lordships have given it a great deal of attention and, in the light of the amount of debate it did not receive in another place, I think we have fulfilled a useful Parliamentary function and I hope that it is one that will be recognised outside the House.

I should like to pay tribute to the Government Front Bench for their steadfastness under fire, and particularly I should like to pay tribute to my own noble chieftainess, Lady Young, on her unflagging energy in directing that fire from this side of the House. The funeral mood is appropriate because this Bill contributes nothing to the resources of the National Health Service. I noted in today's The Times that Mr. Albert Spanswick, General Secretary of the Confederation of Health Service Employees, said yesterday that last summer there were 2,300 nurses unemployed and that now there are 6,500 unemployed. What is this Bill going to do for those nurses? Nothing at all. The Government would not even introduce a provision to protect nurses and others from the consequences of the Bill. They would not accept our Amendments to do with "no detriment"; yet this is the background against which we are debating this major change in the Health Service.

It would not be a proper use of a Third Reading debate to try to run through all the many arguments of principle that have come from both sides. Looking at this small, rather unpleasant Bill, if we are to see what its nature really is we must have some more information from the Government about what they think its effect is likely to be. I have sat through most stages of the Bill in this House and I have read nearly everything that passed in another place. There are still two major questions that the Government have not yet answered or, at least, I have not discovered the answer. The first question is this: what effect will this Bill have on waiting lists? It is said that this Bill has been introduced to help with the problem of waiting lists. I notice that the Labour Party programme for 1976 said this (in page 59): We believe that this measure together with the strengthening of primary care and other steps will help to reduce waiting lists for hospital beds. Do the Government agree with the Labour Party? What is the Government's view? How much reduction in the waiting lists will this Bill achieve? Could we have some figures?

The second question—which may have been answered by a Parliamentary Written Answer to the noble Baroness, Lady Hornsby-Smith; but I have not seen it in Hansard—is this. What loss is the National Health Service suffering in income from the withdrawal of pay beds? We have never had a firm statement about this that I have been able to discover. What price are the Government prepared to pay for this measure? Could we have it spelled out and could we hear how the Government plan to restore that loss that all patients will suffer because the amount of resources available to the National Health Service is bound to decline as a result of the passing of the Bill?

My Lords, it may be that I should not act as an evil god-father to this legislative baby and cast a bad spell on its future, but I do not think that the reasons for its birth are really all that wholesome. All that we can hope is that some of the promises and the fears that we have heard about its consequences will be belied by the facts and the Government, having freed themselves from this commitment, will now be free to devote themselves to the real problems of the Health Service and leave behind the corroded atmosphere that the noble Lord, Lord Goodman, sought to remove when he introduced his proposals. In that hope, I think we should give this Bill a Third Reading.

4.8 p.m.


My Lords, I am sorry to say that during the last days—or is it now weeks?—that we have been discussing this Bill I have been appalled at the apparent ignorance of the Government on a lot of the issues which we have been debating and a lot of the solutions which have been put forward in this Bill. In saying that, I do not wish to make any personal attack on the noble Lord, Lord Wells-Pestell, who has battled on most valiantly on an impossible brief. If I use words as strong as that I must have some reason or some standing for doing so. I think that most noble Lords know that I have perhaps a unique experience in this matter, having been in consulting practice, having been a professor of medicine without private patients and having occupied a large number of other positions which brought me into touch with research and medical education and so on.

As chairman of Distinction Awards, I visited every medical school in England and Wales regularly every year and also a lot of the smaller areas where there are important hospitals which are not teaching hospitals; areas such as, for instance, Bath, Middlesbrough and so forth. The first indication of this appalling ignorance was when the noble Lord told us what this Bill was about. The Government had no objection to private practice. He said, "All we want to see is that those who want it pay for it", as if he did not know that they already paid for it once or twice over. This shook me a great deal. When I raised that question, I received nothing but an evasive reply, I am sorry to say.

I raised a lot of other points to which there has been no reply. For instance, I raised the question of whether the hospitals which are going to sacrifice a certain number of beds in the first round of closing down the first 1,000 pay beds should be mentioned in an Act of Parliament. Who had been at the root of making these decisions? There was no reply to that. Yesterday the ignorance of the Government spokesman was revealed once again over the question of the hospitals which had very few pay beds. We were told—and no doubt the figures are correct—that in a large number of cases there are no more than five pay beds in a hospital. These are areas in which there is no great demand for private practice, but some physicians and surgeons like to carry out some private practice. Maybe it increases their income; maybe it is because the patients want to attend a private consultation.

Some of those patients need to come into hospital for further investigation or an operation; these few beds allow these people to do this practice. The Government argument was that, as there were so few beds, it did not really matter whether or not they were closed. That was the impression that was given; no doubt it will be denied. Those surely are the very beds which you should not close because those physicians and surgeons have every right to the private practice of medicine if they wish to pursue it. They will lose that right if those few beds are taken away. That seems to me to show very great misunderstanding of what really goes on at the present time in the practice of medicine.

Then there was further ignorance regarding research. The actual money that comes from pay beds, patients in the private wing of hospitals and so on, compared with the whole amount of money spent on research in the whole country, may be small. But, as the noble Lord, Lord Stamp, told us—and he has been on the staff of the London Postgraduate Medical School for many years—last year £83,000 came in. This is the lifeblood of research in the most important postgraduate medical school in this country, if not in the world. I am repeating what I said yesterday, and I will repeat it tomorrow if necessary. This is absolutely disastrous.

We are told that it can be supported from other funds. What other funds? No doubt it is the Medical Research Council, of which I was a member for seven years. Do the Government think that the Treasury would welcome an application for an extra grant of £83,000 because of the closing down of pay beds at the London Postgraduate Medical School? I would not have thought so in the present state of the country. Arguments were brought up about the educational value of private beds. We were told that this is of no importance, and the whole argument seemed to be on the question of whether this brought the subject of rare diseases into postgraduate and undergraduate education. It does to some extent, but I point out that we medical educators (I speak of myself in the past tense of course) were not concerned just to teach about rare diseases which anybody can look up in a book. We were out to teach the handling of patients and the general conduct of consultation. Private practice is very good postgraduate education for consultants, and it is very good education for nurses. I only cite those as examples of how little the Government seem to know of what goes on.

I asked more than once: who is going to monitor what goes on in this rash of private hospitals to which the noble Lord, Lord Winstanley, referred? Yes, they are to be inspected to see whether they have the requisite facilities for carrying on medicine and surgery. But who is to monitor the people who work in them? Is there to be some entrance examination or is it to be confined to people who are already consultants in the National Health Service? We do not know anything of this, neither is it laid down in the Bill and neither has my question been answered.

One of the great advantages of doing private practice within your own hospital is that you are under the scrutiny of your colleagues and nursing staff the whole time. People cannot get away with what they do, I may say, in the United States of America. The ethical standards of people are known at the moment, whereas we know nothing about who is going to work in these private hospitals. However, I received no reply to that at all. There was no mention of it in the noble Lord's various speeches.

How will the private hospitals keep up with new advances which are often extremely expensive ones? Is the country in its present state really going to duplicate a lot of new and extremely expensive apparatus so that it can be used either privately or in National Health hospitals? Is not the present system much more sensible, where the NHS hospitals have the apparatus and the private patients can use it under certain conditions? The private patients, do not forget, pay their share of the total cost of running a hospital.

Regarding the abuses, the only abuse which is referred to very frequently—and not without reason—is the abuse of queue-jumping. It is not a question of a person paying to go into a private bed and therefore jumping the queue, because if there are beds reserved for private patients you cannot put other people into them. A patient sees a consultant in his private consulting rooms, which he has every right to do, and the consultant says, "You must come into hospital". This may be for investigation or treatment. The patient replies, "How much is it going to cost me?" to which the consultant says, "It may cost £300 or £400." If the patient replies, "I cannot afford it", does the consultant put the patient higher up in the queue because the patient has paid him a fee? I know this happens.

I said to the noble Lord, Lord Wells-Pestell, that the point I was making was not that these abuses do not exist but that this Bill would do absolutely nothing whatever to correct them. Your Lordships know what his reply was: it is to be found in col. 1583 of Hansard of 21st October: that remains to be seen. My Lords, are we going through all this—are we making changes in the National Health Service which will possibly be even as disastrous as the reorganisation of 1973—to see whether it works? I have never heard such an answer in my life. As others have already pointed out today, the Bill will do nothing to reduce the queues and, indeed, it may increase them. The question of a common waiting-list and the criteria of only medical need are fine in theory but absolutely impossible in practice. Of course, that is not to say that we should not work towards that end.

Finally, I want to raise again several points. Whom does the Bill benefit? My answer is: Nobody. National Health Service patients will be worse off for various reasons. For example, their consultants will not be so often on the premises but driving their cars across London in the middle of the day and so on. The private patients in their new nursing homes will not be better off, either. They would be much better off under the present system in a private bed in a National Health Service hospital.

The second question is: Who wants this Bill? I think I am right in saying that not a single speech from the Government Benches has been in favour of it. In fact, there have not been any speeches from those Benches, except an intervention from, I think, the noble Lord, Lord Leatherland. The Liberals have spoken against it, the Conservatives have spoken against it, and people from these Benches have spoken against it. In addition, Members of the Government Party whom I know well enough to address rather wicked remarks to and to ask: "If you had a free vote, would you vote for this Bill?" have all said, "No". Of course, I admit that is a highly selective sample because these people are my pals; but they do not want it and I do not not know who does.

A good many consultants are not enthusiastc one way or the other. I am told that in fact half the consultants are working full-time at present in the National Health Service and not doing any private practice work. I think that is right; but do not let us forget that the half who are not doing private practice includes a good many pathologists and biochemists who work in laboratories and never come face to face with the patient at all. Also, it would include anaesthetists who face the patient for only a few fleeting moments before the patient loses consciousness. It also includes a large number of university staff and research workers in places such as the famous postgraduate medical schools. They work part-time because, apart from their duty to the patients, their first duty is to research: that is what they are primarily interested in. Therefore, that particular statistic does not really interest me at all.

I have been a supporter of the National Health Service ever since its inception in the very early days and when the BMA was trying to persuade doctors not to join it I was on this side of Bevan and Lord Moran. We wanted this Service because we thought it would do good to millions of people. It has turned out that way, and so it is now very sad to me to see the Party who brought it in under such opposition now taking a course which may very well wreck it.


My Lords, before the noble Lord sits down, while not in any way questioning the content of his speech I want to put to him that I am directly in touch with a number of young women anaesthetists and they have great care for their patients and great concern for the National Health Service. I think it was a little unfortunate that the noble Lord rather suggested that they saw the patient only for a few seconds and had not any great interest. I wonder whether the noble Lord would like to correct that, because they do care as much as other people.


My Lords, I entirely accept that correction, but of course they do not have the lasting care of the patients that physicians and others have. But I accept what the noble Baroness says.

4.26 p.m.


My Lords, I should like, first, to add my compliments and congratulations on the way the noble Baroness has led the debate on this Bill, together with her colleagues. All day and all night the noble Baroness has kept her temper and her cool and has led us in a way that I think few others could have done. My Lords, I do not like this Bill. I do not like any part of it, and that is mainly for two reasons. I think, first, it is a mean Bill because the phasing out of the pay beds means that three and a quarter million people who are members of BUPA and other private schemes will not now be able to have the private beds that they have up to now been paying for. I do not accept the contention put forward by the Government that there will still be sufficient private beds. I do not believe that that will be so. Nor do I believe that BUPA or any of the other schemes will be able to provide the hospitals and nursing homes that are needed in time to compensate, first of all, for the 1,000 beds to be phased out in the early stages, and then for the full complement of 4,000 beds to be phased out within the next two years.

That figure of 3¼ million people does not represent just the white-collar workers, and they are not people with a lot of money. They are the people who have chosen, perhaps instead of buying a car or even new clothes, to put money aside year by year in the hope and expectation that through these organisations they will be able to have some privacy when they are ill. We do not all want privacy, but in this day and age those of us who are getting older may not like the clatter and banging that is a normal occurrence in a big ward.

I was a member of the Magistrates' Association, which had thousands of members of all shades of creed, denomination and political belief who were members of BUPA (I happen to know more about that organisation than the others) and willing to pay for the benefits they wanted. There is the very large trade union called NALGO. They, too, have an enormous membership in BUPA, and I suggest that in the very near future those people who have been paying not inconsiderable amounts of money for many years will not be able to get the privacy for which they have been paying. That is why I think this Bill is particularly mean in its effect on those people. I believe it is about time that the Government got their priorities right as regards the allocation of funds. Surely, the most important people—almost the paramount people on the list of priorities—should be those who are in ill health in our country. I would put it second only to education.

Secondly, I dislike this Bill because of the Socialist political philosophy of bringing everyone down—and I emphasise the word "down"—to being equal. But when we are told by the Secretary of the National Union of Public Employees that half a million people are waiting to enter hospital, and that because of the lack of finances, and finances only, nurses are finding that having finished their training there are no jobs for them—as my noble friend Lord O'Hagan told us—surely something has gone very radically wrong with the planning of the financial priorities of this Government.

Despite the fact that during our many debates here we have managed to make a few amendments to this Bill—for instance, making sure by our votes that X number of pay beds will be used as beds by National Health patients and will not be turned into offices; that the membership of this Board, which we have heard so much about and with which I have absolutely no sympathy at all (I doubt very much whether it will be of a high enough calibre) should be composed of seven members; and that the chairman should be a man of very high stature and calibre—I feel that nothing has been done to increase the welfare of the patients, nothing has been done to increase the welfare of the staff and nothing has been done to shorten the waiting lists. This is what we understood this Bill was intended to achieve, but if ever it is put into operation—and I hope it will not be—I do not think that any of the Government's priorities, or any of the promises which they have made as a result of the Goodman Proposals, will be fulfilled, and therefore I deplore this Bill.


My Lords, will the noble Baroness kindly tell us what is the cost of a pay bed? Secondly, and much more important, can she tell us whether BUPA are prepared to pay the full cost or merely a fraction?

4.33 p.m.


My Lords, it is a great joy to me to follow my noble friend Lady Macleod. It is also a coincidence, because many years ago I followed with pride her husband Iain Macleod as Minister of Health. During that short period when I was Minister of Health, I developed an immense respect and affection for the National Health Service and those who worked in it. But I also had a determination, so far as it was in my power, to keep the National Health Service out of Party politics. I felt that it had enough battles of its own, without being involved in the political battle. There was the constant fight of successive Ministers with the Chancellor of the Exchequer to get adequate finance. There was the problem in the war against disease that you found in one sector that you were winning a victory, only to find a strong attack in another sector. Then there was the whole problem—which is probably the most difficult of all—of trying to humanise the Health Service and to attract to it the voluntary help, the local patriotism and the generosity of people, without which I do not believe any Health Service can survive. It is for those reasons, and because I felt that I wanted to keep the Health Service out of Party politics, that I have carefully abstained during all these debates from making any contribution at all. But I want this evening, as the Bill passes, just to say how much I deplore it.

Before 1948, we had two standards of hospital care. We had the voluntary hospitals which were desperately short of money and relying on charitable gifts, local patriotism and schemes such as the penny-a-week scheme, but they were good hospitals. Then we had the local authority hospitals which had the aura and atmosphere of the Poor Law. During the war, it was the unanimous view of the Coalition Government that that system should be swept away, and that there should be a comprehensive Health Service. With the war over, the Coalition Government disappeared and Labour came to power. Let it be said to his honour, that Aneurin Bevan loyally accepted the decision of the Coalition Government. The noble Lord, Lord Winstanley, has robbed me of my best quotation and I am grateful to him for it, but let me just go on with what Aneurin Bevan said later on that same day. He said: But while we have inadequate hospital facilities, and while rebuilding is postponed, it inevitably happens that some people will want to buy something more than the general health service is providing. If we do not permit fees in hospitals, we will lose many specialists from the public hospitals for they will go to nursing homes"[Official Report, Commons, 30/4/46; col. 57.], and I would add—these are my words and not Aneurin Bevan's—and abroad.

I must say that when I was Minister I found that there was a good deal wrong with the National Health Service. There was a tripartite division, which meant that medical time and valuable medical brain power were wasted far too much in committees, and I am afraid that even under the new dispensation it still is. I found, as we have all found, that somehow the nation is not paying enough for health. I remember going up to Aneurin Bevan, when I was Minister, and saying "You have given me a very defective machine", and I remember his reply. He said "Yes. I only got halfway through my work. I wanted to make a really unified service and bring in all the medical services". I do not agree with his view, but I want the House to realise that what Aneurin Bevan was trying for was a unified Health Service, because he believed that that was right. No doubt, he wanted to have enough money from his Chancellor to make that possible.

I fear that this Bill will gravely weaken the National Health Service, because once pay beds are removed from National Health Service hospitals consultants will be attracted more and more away from the National Health Service and towards private hospitals and nursing homes. If those are affected by Part III of this Bill, then let this noble House realise that the result will be to draw consultants, and indeed patients, abroad to Eire and other countries, rather than here. That is the warning to me.

If perhaps I may make one further point, I have attended a good many of the debates—although I am afraid that because of my age I escaped the all-night sitting—and I do not believe that this House realises the difference between the problem of London and the large cities, where a great many private hospitals, clinics and nursing homes are available, and that of rural England where there are large distances to be covered, with a much lighter population per mile, or shall I say hectare? As a result a different system exists. In each National Health Service hospital a certain number of private beds are set aside because there is no other alternative accommodation. Let me make the position quite clear because I know what happens in rural England. Emergencies go into either a private or a public bed, because they have complete priority. However, the private bed enables those people to whom time is a factor in their business to buy earlier treatment, and when this facility disappears great hardship will be created for very many people. I hope that the Health Services Board will take that point further into consideration.

Finally, I believe that this is a very sad day for those who take pride in the National Health Service, for there was another course open. This Bill is so untimely. Hospital beds are being closed. There are long waiting lists because hospitals cannot be staffed as a result of financial stringency in the National Health Service. This additional wound is grievous to the National Health Service, especially since there was such an easy way out that would have avoided all Party political controversy. The solution would have been to put this matter before the Royal Commission and let them make a considered judgment. That solution the Government have declined. For that this country will never forgive them.

4.45 p.m.


My Lords, first may I thank the noble Lord, Lord Wells-Pestell, for correcting what he said at col. 1433 yesterday afternoon when I questioned him about the 75 and the 100 beds. I feel, as must all your Lordships, that there is a spirit of sadness about the Chamber this afternoon, a spirit so thick that it could almost be cut with a knife. That is because we are doing something today which we know we shall regret most profoundly if we do not have an opportunity, in good enough time, to correct the mistakes which we are making. Yesterday the noble Lord, Lord Hill of Luton, stated so well the position regarding the disclaimed or private hospitals that it would be superfluous of me to try to improve upon it. Therefore noble Lords understand their position in relation to this Bill.

If your Lordships will forgive me for speaking of my own experience, I have spent 20 years in the administration of just such a hospital, either as chairman of the board of management, or as trustee, or in some capacity of that kind. I am simply horrified that Part III of the Bill seeks in the long run—if we accept, as most of us do, that the Bill does not further the cause of national health but is a Socialistic measure—to scrub out the private practice of consultants in this country. It is in this rather mean and underhanded way that the Government have gone about it. It was not contained in the Manifesto; it was not even recommended by the noble Lord, Lord Goodman.

The smallest alteration, and I really mean small—not the addition of a new operating theatre but quite tiny alterations to any private hospital which is over the specified number of 100 beds in London and 75 beds in the country—must be notified to the Board and permission must be obtained. The Board can refuse its permission if it thinks that a National Health Service hospital is going to suffer as a result, thus taking away the last chance the private person and also the consultant have of doing what they were told should be their right by the father of the National Health Service. That is what I most deeply regret about the whole of the Bill. It is a bad Bill and I hope that things will so work out that one day, before it is too late, we shall have the opportunity to correct it.

4.47 p.m.


My Lords, if I were to cite one area of the Bill which gives me particular cause for concern it is its potential to affect our great teaching hospitals. However, it is not to make a speech of a general character that I rise this afternoon. I am very conscious, in the wake of so many significant contributions, that when I speak to a detailed and narrow point I am going to strike a somewhat thinner and less interesting note than has been struck in the speeches which we have already heard.

It is not unusual during the course of the passage of a Bill through this House that points arise or are brought to notice during its later stages. Last evening I raised verbally with the noble Lord, Lord Wells-Pestell, a point that concerned me in Clause 12. Subsequently during the course of last evening I wrote to the noble Lord on another point connected with the same clause. The first point, that which I raised verbally, is potentially a point of considerable importance. The other is of less importance and more of a purely drafting nature. In the last two days I have fallen victim, and perhaps I am not the only victim, to the concertinaed timetable for the Bill in this House. I have fallen victim in part, perhaps, through a lack of aggression on my own part and because I did not wish wantonly to bring before your Lordships Amendments for debate when the Government before this afternoon could perhaps have reassured me that my fears were groundless. I intervene now lest perchance one part of the Bill should fall victim by default.

The points which I raised last night and to which I wish to return this afternoon concern Clause 12 of the Bill and are to be found on pages 14 and 15. The point of significance—that is, the point that I mentioned last night—relates to the use of the word "premises" which occurs some nine times in Clause 12 (2) and which occurs once or twice elsewhere in the Bill. As I read and understand the word, it could be interpreted as referring not merely to a single premises within one self-contained boundary, albeit that there might be different buildings going to make up the premises, but it could equally be interpreted as referring to a multiplicity of premises within separate boundaries geographically separate one from another.

If that interpretation, which I am certain—and I have been assured—is contrary to the Government's intention, is possible, then it would have a most unfortunate bearing upon words which my noble friends have sought on previous occasions to amend within this clause; namely, those words which cite the number of beds which are to be the criteria then we are faced with questions of authorisation concerning controlled works and controlled extensions. If the interpretation could be wider than I believe is intended, I think it is self-evident that the effect would be considerable and disastrous.

When the noble Lord, Lord Wells-Pestell, replied to me last evening, I thought then, and on reading Hansard I still feel, that his answer—and I intend no discourtesy—was not directed precisely to the point which I was making. There are obviously two separate instances where my concern could arise. One would concern the group of hospitals under one management which are geographically separately situated in different parts of the metropolis or in different parts of an area outwith the metropolis. Or, if a computation is to be based upon a number of premises when considering the number of beds to be provided, it could relate to separate, unrelated, individual establishments.

I think I have said enough to make my fears clear—perhaps too much—but before sitting down I should like to bring forward the point which I raised in writing with the noble Lord, Lord Wells-Pestell. It related to line 8 on page 15, where we find paragraph (b). It strikes me that this paragraph is miswritten. I intend no disrespect to the draftsman, but I believe he has left out certain words. At present it reads: To extend or adapt works used in conjunction with the controlled premises". I fail to see how "works"—that is, works of construction—can be used in conjunction with operative controlled premises. I should have thought—and I realise that I should not draft on my feet—that someone has accidentally omitted the words, "designed to be". That is a very small point and I hope it has not detracted from the major, and I think considerable, question of concern which I have placed before your Lordships.

Before I sit down, it would be churlish of me not to acknowledge the help and courtesy which I have received from the noble Lord, Lord Wells-Pestell, during the last few hours. I want also to express my thanks to his team in that direction. Having done that, it would be singularly inappropriate not to acknowledge my thanks to my noble friend Lady Young and her colleagues, not only for the way in which they have conducted the Bill from this side of the House but for the help which they have given me.

4.55 p.m.


My Lords, if the House with its customary indulgence will forgive a personal note, I should like to say that in the greater part of a lifetime, now over more than 50 years, during which I have been a member of the Labour Party, I have always been accorded the greatest degree of toleration and understanding on certain issues where I have found myself slightly at variance with Party policy. In my opinion it is symbolical of the greatness of our Party that it is able to embrace within its ranks members of all shades of opinion who do not always necessarily toe the line in accord with Party policy, and I rise with the very greatest reluctance during the closing stages of this Bill to express, perhaps as one lone voice from these Benches, my own sadness at its passing. I have refrained from participating in any of the stages until now. I abstained on the Divisions because I have always felt that a cast-iron majority has no need of one extra vote to carry its weight, nor of one extra voice to add to the expert body of opinion which has been able to express itself on medical lines and, as I firmly believe, entirely in the interests of the patients.

May I then, with the greatest possible reluctance, say that I deplore perhaps more than anything else about this Bill the Government's intention to separate private medicine from National Health medicine. To me the two ought to be inseparable. I regard them—I have not always done so, but of late years I have come to regard them—as a case of Siamese twins, almost a perfect example of symbiosis. In my view, to effect their separation is to perform an operation which is fraught with the gravest dangers to both sides. I would always like to hold the view that the Government might have been wiser to bend their efforts towards bringing them closer together, so that they could not only share their common circulation, but be able to nourish, feed and sustain each other, rather than submit them to this enforced surgical separation which might run the risk of leaving them gravely enfeebled and in a more precarious state of health than if they were left alone. I feel that the Government are embarking on a course where dangers that we are afraid of now may even become intensified as the years go on.

It is on record, as a matter of interest, that the survival incidence of Siamese twins has lasted in one instance for as long as 62 years, which, according to my impression, is probably longer than the lifetime of this Bill. I can only express the hope that my own fears of the harm that this Bill may cause, not only to the medical profession, not only to the workers in our magnificent hospitals, but also the harm which it may cause in the last resort to the patient himself may be unrealised, and that in the long run the wisdom, the common sense, the understanding and the dedication of all the parties involved in the working of the National Health Service will combine to triumph in the end.

5 p.m.


My Lords, I hope that it will not be any embarrassment, however small, to the noble Lord, Lord Segal, when I say that I think that he has just exemplified the highest level of public life in this country. He has just shown that we still have that high attribute which I always thought was the strength of our system, of being able to be a loyal Party man and, at the same time, retain one's individualism and one's honest convictions even when temporarily they may be in conflict with the leaders of one's own Party. I congratulate him upon it, and I think he has set an example that people who follow, and those of us who are here now, ought to take up on many occasions. I hope that that is no embarrassment to the noble Lord, Lord Segal, who is a friend of mine outside this House. What he has just said from those Benches is in keeping with the sort of character he has shown to me in his private capacity.

I apologise for trying to jump the gun an hour ago. I did not know there was a list of speakers on the Bill passing. In this House sometimes there is a list and sometimes not; you do not know where you are. In the other place—and the noble and learned Lord on the Woolsack will know this—unless you jump up at the earliest stage you do not get called at a later stage, and so one is perhaps still remembering that sort of experience. I apologise to noble Lords if I inadvertently conflicted with what is a very excellent convention of knowing where you are.

I merely want to say what has already been so well said by my noble friend Lord Tranmire. This is a bad Bill, and it is a bad Bill because it brings the National Health Service into the cockpit of Party politics. This is bad. I believe that Defence, foreign policy, education, and the Health Service should be matters which are outside the normal conflict of Party politics. They are matters which cover everything and all attitudes, and they ought not to be there at all. To some extent the National Health Service has been outside it for a good number of years. This Bill brings it back again into Party politics, and that is bad.

I do not mean that in a general sense. What I mean about bringing it back into Party politics is that this Bill which I have in my hand, and which will obviously become an Act, has left so much in the hands of the Secretary of State that people who want to do things within what is permitted within this Bill know that at the end of the day they will be dependent on the views of the Secretary of State. My noble friend congratulated the Government on accepting a certain Amendment which has given more power to the Secretary of State, and that was better than not having that appeal court there at all. But noble Lords will recognise that that brings an important part of the application of this Bill, if it becomes an Act, within the orbit and the views of some individual. Could they deny that if one wanted to do something on the private side of this Bill, they would get different treatment from the right honourable lady Mrs. Barbara Castle, if she were Secretary of State, than from my noble friend Lady Young, if she were Secretary of State? It is clear from the honestly held convictions of both of those ladies that their views, as a final court of appeal, would be quite different.

The uncertainty at a very important time when you are trying to organise a new hospital, which has cost a lot of money, time and energy in getting it properly equipped, is dependent upon the will of the person. So in legislating that the Secretary of State, whoever it is, has the final word brings the matter within the cockpit of Party politics, because the Secretary of State happens to be a Party politician. I believe that the uncertainty as to whether sympathy will be with you will injure the implementation of an important section of this Bill because of the uncertainty of Party politics. I hope that the situation will not develop on those vicious lines, but my fear is that it might.

Your Lordships may remember that I intervened for one minute when one of the Amendments was being discussed just prior to this debate. We could not get from the Government an undertaking that a temporary approval for the extension of one of these matters would have certainty for even three years. They will not guarantee even three years of a scheme that is to cost money and a lot of thought to put into operation. We were told by the noble Baroness in the exchanges in this House that the Government would like any future Secretary of State to be generous in giving at least three years or more. But those of us who have been in politics long enough—and I speak only as a Parliamentarian in this sense and not from a business context—know that what we say in debates in this House does not matter at all. What matters, when it is implemented, is what is in the Act.

It is not right that what is said in the course of debate should be taken into account. It is our duty to put words in the Bill which are clear and cannot be contested and which will put into effect what we want done. Time and time again the courts have made it perfectly clear that they cannot be responsible for interpreting an Act other than on the words that are in the Act. To allow ourselves to be fobbed off, if I may use that term, by saying that what has been said here may well be taken into account, means nothing at all. The only words in this Bill are words which make it very discouraging for anybody who may want a private hospital or private health service running alongside the National Health Service.

I believe that the noble Lord, Lord Hill of Luton, was absolutely right in his normal common sense approach to this question. Why should there be any restriction at all as to what private hospital or health service should run alongside the National Health Service? Why should any fear be put in the mind of anybody who may want to extend that second tier of health by having the Bill say that there might be some doubt as to whether one can get it or, having got it, as to how long one can pursue it. I believe that for all of those reasons this Bill brings something back into the cockpit of Party politics that ought not to be there.

I did not altogether agree with the conclusion of the noble Lord, Lord Winstanley, although what he said was absolutely right. I do not think the fear is that this will prevent people from entering into the private health service part of this Bill. My fear is that it may well drive them out of the country completely. This was a point made by my noble friend Lord Tranmire. I do not know whether your Lordships are aware of it, but when there was a suggestion in another field that a similar Bill to this would be brought in which would end the public school system in this country, it did not mean that the public school system would end. It was made known in many quarters that if that Bill to end the public school system had been operated in the same way as this Bill would be operated, plans were afoot for those public schools to go to Ireland. You would not have stopped parents who wanted their children to go to that sort of school from sending them there because the school was not domiciled in this country any more but was in Ireland. The only effect of that would have been, not that you were ending the public school system; you would be driving that service, which has so much to offer to the country, to another country, which would have all the benefits.

That is what I fear, as a consequence of this Bill, may well happen to our private hospital service. Those who want to be a member of BUPA, as my noble friend Lady Macleod said, and who truly want to spend their money on preserving their health, and that of their family rather than on other things, will go elsewhere if they cannot get the sort of hospital services they want in this country, and the services are set up in another country, be it Ireland or anywhere else, they will go there. The only effect will be that, instead of this country being one of the leading centres for health and hospital services generally, that drive and that impetus will be in another country altogether.

Nor should your Lordships be bamboozled by all this talk about the Goodman Proposals. They are very good; the noble Lord, Lord Goodman, is one of the best ambassadors in the world at trying to arrive at a consensus. Nevertheless, his proposals are only proposals and once the Bill becomes an Act they will remain merely words, no matter what has been said about them and what half-promises have been given. This measure will be enacted and in five or 10 years from now the Goodman Proposals will be history. The provisions will be operated according to the Act and the noble Lord's proposals are not written into it. Therefore, let us not persuade ourselves that simply because sensible points have been made by Lord Goodman and sensible answers have been given by he noble Lord, Lord Wells-Pestell, and the noble Baroness, Lady Stedman, that automatically means that they can replace what is in the Bill. In other words, do not let us be side-tracked by what has been said about the Goodman Proposals. What is in the Bill is what matters.

In my view, the Bill can only result in what was an all-embracing National Health Service centred in this country becoming not so all-embracing because a good part of it will be driven abroad. In this connection, I want to kill a myth, one accepted by my noble friends as much as by noble Lords opposite. Mr. Aneurin Bevan and the Labour Party did not invent a free National Health Service. It is a myth to think that the Service, which we all praise today, began in 1946 when the Labour Government came to power. My father was a miner, for what that is worth; to me it was worth a lot because he was a great father; and the whole of my life I lived in the industrial Midlands of England. The Nicholls family never paid a doctor's bill. When my brothers and I were young my parents paid one penny a week to the Free Gardeners Friendly Society and that society operated precisely in the way the NHS operates today; it gave us a free health service and, later on, we paid threepence a month to one of the local works and that gave us free hospital service. One had to get a certificate but that was invariably given and that service worked in the way the NHS works today. The Nicholls family was typical of most families in the country and for our one penny to the Free Gardeners Society and threepence to a local works we received health and hospital services equivalent to those now offered in the NHS, and in some instances better because the system was not surrounded by bureaucracy.

As my noble friend Lord Tranmire said, those of us who fought the 1945 Election know only too well that the introduction of the NHS was a coalition idea accepted by us all, underwritten in a broadcast by Mr. Winston Churchill as he then was. It so happened that the Labour Party were elected to government and implemented the idea. Those who fought the 1945 Election worked hard to try to get it implemented, not by setting up this nationalised bureaucracy but by having it implemented through the various friendly societies which had the equipment and organisation to do it, and I believe they would have done it more cheaply and efficiently. I want to kill the idea that those of us who criticise the Bill because it comes from a Labour Government are criticising those who invented and brought about the free Health Service. They did not invent it. It was a logical next step from a free Health Service that already existed and from which my family and millions of others throughout the country benefited.

I have spoken for rather longer than I had expected. I feel strongly about these matters and I am anxious to point out that the Bill will undermine something which is very precious to this country. It involves something much more dangerous than the aspects that have been raised in the debates we have had in your Lordships' House. Those debates have been interesting, but they do not matter. What matters more is the fact that the health and facilities offered to our children will be much weakened as a consequence of the Bill. I hope that future Secretaries of State, who are given powers under the Bill and on whom much of the authority will rest as a result of it, will take into account the general propositions I have been putting. I want them to realise that they are not carrying on as the inventors of an idea but are merely the trustees of a Health Service which grew and evolved and which was in existence before the 1946 Labour Government and before the 1935 Tory Government. To break away from that on the Party political partisan grounds embodied in the Bill is a sad thing to be doing. If the power of the Secretary of State can mitigate those dangers, that will be all to the good. I may have taken a few minutes longer over my speech than noble Lords would have wished, but I trust that my remarks will have served their purpose.

5.16 p.m.


My Lords, I hope the House will forgive me if I make a brief intervention. The need to attend a funeral this afternoon prevented me from being here for the whole of the debate and was the reason why I did not put my name down to speak. However, I have attended the whole of the Committee and Report stages of the Bill. It must be said that the debates have been conducted at an exceedingly high level; by the noble Baroness, Lady Young, with astonishing clarity, courtesy and persistence and by the noble Lord, Lord Wells-Pestell, with his customary courtesy and tremedous care and thought. I am particularly grateful to him, although he may not regard it as true gratitude, for never pretending that the Bill was anything but a political exercise to serve a particular non-medical purpose.

Confronted with a Bill of this kind, it is reasonable to ask; what does it do for the National Health Service? That is a fair question. Does it make more easily available the skilled services of consultants? It does nothing of the kind. In fact, it may do the opposite. It will certainly involve more time being spent journeying between hospitals and nursing homes. Let us bear in mind that from next month under the EEC provisions it will be possible for doctors in this country, without re-qualification, as of right to move within the Community and set up in practice in other countries. I hope they will not do that. Like most noble Lords, I would not leave this country for another, whatever happened. Nevertheless, it might encourage a drain which would have a damaging effect on the quality of the consultant and specialist services.

Secondly, will the Bill ensure that pay beds are not closed before alternative private provision is available? Lord Wells-Pestell has said time and again that this is not an exercise to destroy private practice, and I believe him to mean that. But if private beds are closed before alternative accommodation has been established, that will reduce the quantity of bed service available. If one looks at the small print of the Bill one sees that 12 months after it comes into operation the Board must produce proposals for the closure of private facilities in part or in whole. It takes into account the alternative provision, but 12 months after it comes into operation there must be a reduction, even though there has been no time to establish alternative facilities. Thirdly, one would have thought, bearing in mind the shortage of hosiptal beds in so many parts of the country, that at least there would have been an assurance that the beds and bedrooms that are closed will be available automatically for NHS patients.

There may be some weakness in the Amendment in using the word "resident", but one would have expected at least as a gain from an otherwise unfortunate Bill that the beds freed from private patients would automatically be made available for public patients. Not a bit of it. It is not so provided, and the noble Lord, Lord Wells-Pestell, did not feel able to do other than give us a debating reply about the wording of the Amendment. This is a political exercise and nothing else. It is making it less likely that the people who want to buy privacy will be able to get it. Is it a wicked thing for a man whose wife is going into hospital to want to buy privacy for her either directly or through insurance? It is aimed at that kind of thing. People can spend their money in scores of other ways but not in this way. I regard this as a rather shabby, narrow Bill with a wholly political purpose, with no benefit whatsoever for the National Health Service and reasonable potential for damage to the National Health Service, not only to private patients but for patients in the general wards of the National Health Service.

5.22 p.m.


My Lords, we have had a long and, I hope, fruitful debate. The first thing I should like to do is to thank my noble friends on this side of the House—and I know that my noble friend Lady Young will wish to join me in this—and all those who have participated throughout the long course of the debates. Your Lordships will be aware that the Bill was introduced on 21st October. It is something of an achievement that we have reached the end of this very substantial Bill in such a short time in the face of a Parliamentary programme of almost unique difficulty and conflict. I should like to say to the noble Lord, Lord Wells-Pestell, and the noble Baroness, Lady Stedman, that in their speeches and replies, in handling a number of questions which were directed to them outside this Chamber, they have done as much as they possibly could in the circumstances. We are most grateful to them fortheir courtesy, knowing full well that both of them have laboured under disabilities of colds and toothache and other things in the course of these past weeks.

My Lords, this does not in any way affect our views on the Bill, but it is a fact that the way in which we conduct our business in your Lordships' House by the use of the usual channels in enabling affairs to progress is a very important factor. It is certainly not our role, as Her Majesty's Opposition, to enable the Government to achieve one clause in this Bill, but I should like to stand back for a moment and look at the Bill in the context of the scene as it is this afternoon. I entered the Library this morning and looked at a paper, and a most alarming headline confronted me. It read: Big London Hospital Cut-back"— and it went on: A London health region is planning to axe 4,600 beds in an attempt to save nearly £50 million. Quite rightly, my noble friend Lord O'Hagan suggested to your Lordships that in listening to this debate this afternoon, he was attending a funeral.

This is a particularly sad day for the National Health Service, not only in the context of the Government's Third Reading of the Bill but on the background of cuts in a service which we all wish to prosper. How right my noble friend was when he referred to the situation of nurses. I think he quoted the figure of 2,300 nurses unemployed last year, which has risen to no less than 6,500 this year. This is an alarming situation, a background against which the Government are pursuing relentlessly their intention to phase out a further 1,000 beds in the private sector. There is no doubt that the question of staff is most intimately tied up with the proposals under the Bill, and I totally disagree with what the Government have said on the matter of no detriment, which we have dealt with in great detail.

My Lords, I shall make my remarks very brief. Many of your Lordships have addressed yourselves to important speeches, and this will be among the briefest, but I should like to make a few remarks. I believe that in quoting the debates held in 1946, the noble Lord, Lord Winstanley, did the House a great service. It was very important, too, to hear from another doctor, the noble Lord, Lord Segal, about the situation as he saw it in the separation of the private sector from the National Health Service. As a doctor, he would speak with great professional knowledge on a subject about which I know nothing; that is, symbiosis. This word has been used once or twice in your Lordships' House and I understand it means "one feeding upon another".

Two medical practitioners of great eminence were followed by the noble Lord, Lord Platt, whose experience in the particular field of medical education is unrivalled in this House. He brought forward one very important factor on which I addressed your Lordships, both on Committee and on Report; that is, the question of medical education and also research. I quoted the Todd Report and went into great detail. I believe that this is of the first importance, and further, that the damage being done to medical education in this country through the bringing into force of this Bill will be very substantial. We have been accused of exaggeration; we totally deny it. We have behind us many experts in the medical profession. The very important speech of the noble Lord, Lord Platt, this afternoon bore this out to a great extent.

There is one further factor, and that is the matter of research, on which he addressed your Lordships, and I feel that it would be unnecessarily repetitious to return to the matter of the gains brought to research through the very important postgraduate school at Hammersmith. In my researches I went back to 29th July 1975, when the noble Lord, Lord Wells-Pestell, may remember that he answered a Question set down by my noble friend Lord Cottesloe. My noble friend sought from the Government information on the rebuilding of that very important hospital, and at that time, July 1975, the Government were unable to give any encouragement. What can we hope today, after a period of 14 or 15 months has elapsed with the further economic ills which beset this country?

I believe also that my noble friend Lord Tranmire brought in a very important element. If I may be allowed to say so, as a former Minister he brings unique experience to your Lordships' House as, indeed, he did to another place. He contrasted the needs of rural areas with the needs of London, and I am certain that as the Bill makes progress over the coming months it will certainly do rural hospitals a great deal of damage.

I will not detain your Lordships very long except to remind you of one final matter—the question of public accountability. I regret particularly that the Government, having enforced a closure of a number of beds, would not agree that the Board should give its reasons. This is absolutely crucial. The present Government have shown a tendency to pass public affairs over to a public board and a chairman. They disqualify or disallow the possibility of the Secretary of State of the Department concerned being answerable for the Board in the House of Commons. This is a matter of the greatest public importance as a principle. It relates particularly to the present Bill, but it follows a very wide coverage in other areas, notably the Post Office and other public Corporations. This is a black day, my Lords. I should be wearing a black tie on this occasion. However, I feel that, in giving this Bill a Third Reading, your Lordships have expressed their particular sorrow over what the Government have done.

5.31 p.m.


My Lords, it is a very long time since I have listened to so much pessimism coming from a group of people who are blessed with a great deal more intelligence than have a good many people one meets outside your Lordships' House.

A Noble Lord

Is it hereditary, my Lords?


My Lords, if the noble Lord really wants me to answer that, I will, but intelligence, like knowledge, is not the monopoly of any one particular group in our society, although, when I listened to the noble Lord, Lord Platt, I thought that the monopoly of intelligence rested only with the medical profession.

It has been unusual until these last few weeks to have so many speakers on Third Reading or, to be more precise, on the Question That this Bill do now pass. It has become a habit since September 27th. May I give due warning that it has not passed unnoticed by Members of my Party? No doubt there will come a day when we shall change places[...]

Several Noble Lords

Hear, hear!


Oh yes, my Lords! I should like to see the Party opposite try to cope with the difficulties that we are in today.

A Noble Lord

Who made them, my Lords?


My Lords, if the noble Lord really wants to know who made them, we can choose a time and I will tell him. However, let me go on. This device has not passed unnoticed and I think I can promise that we shall use it to great advantage if we are ever in a position to do so. Having said that, I should like to take the opportunity of thanking the noble Baroness, Lady Young, for her conduct of the Bill from her side of the Chamber. There were times when, like me, she got a bit warm under the collar and it is only right that she should do so. However—and I have said this many times before, and I think that the noble Baroness knows that I mean it—I always find it a joy to be opposite her. She always presents a challenge and a test. She knows. She has done her homework and, in consequence, when I find myself up against her, I have to do mine as well. Perhaps I cannot pay her any greater compliment than that. I can take a chance on some others.

I should also like on behalf of myself and my colleague Lady Stedman, who is associated with me in my remarks to the noble Baroness, Lady Young, to thank the noble Lord, Lord Sandys, the noble Viscount, Lord Long, and the noble Lord, Lord O'Hagan. I am probably doing a very dangerous thing because I am missing people out and I shall probably fall foul of somebody, but the noble Lords have made a tremendous contribution and we are grateful for it.

There have been 13 speakers who have been totally—and I feel that that is the right phrase—against this Bill. I cannot hope to answer all their questions, nor would I if I could, because nothing has been said by any speaker this afternoon that was not said time and again on Second Reading, in Committee and on Report. There is no point in my trying to answer because the bulk of the minds of noble Lords opposite are closed to anything I may say. I realise that there is no possibility of my being able to give them a satisfactory answer or of convincing them that some of their arguments are wrong.

I have been thinking of a suitable way to comment on something said by the noble Lord, Lord Harmar-Nicholls. I thought of the word "audacious". I thought of the phrase, "the biggest piece of cheek I have come across for some con-desirable time". He had the audacity to stand tip in your Lordships' House and say that what the Bill has done is to bring the National Health Service into the cockpit of politics. Had there been no Labour Government just after the war, there would have been no National Health Service. The noble Lord's Party voted against it time and again and, if the noble Lord does not accept that, let him look at Hansard for the period in question. I accept that during the war there was a Coalition Government and a Beveridge Committee and that a good many things came from both. However, from 1945 onwards, when the blueprint of the National Health Service was drawn up and presented to Parliament, the Conservative Party voted against it. As I said some time ago in your Lordships House—


My Lords, I wonder whether the noble Lord will allow me to intervene.


My Lords, will allow the noble Lord to intervene, but I shall not give way to anybody else.


My Lords, does the noble Lord recollect that on the Second Reading of the National Health Service Bill the Conservatives opposed merely the taking of the private money from the voluntary hospitals and that the Amendment was limited to that? That was the vote that was taken.


My Lords, I think that we might perhaps both do well to read Hansard for that particular period. I gave way to the noble Lord because we on this side of the House pay tribute to the way in which the noble Lord fought hard when he was a Minister to get money for the National Health Service. I believe that he may have antagonised his own side to his own ultimate disadvantage by doing so. I want to go on record as paying tribute to the way that the noble Lord fought for the National Health Service.

As I said, however, the noble Lord, Lord Harmar-Nicholls, having had very grave reservations about the National Health Service when it came into being, has the further cheek to appear in this House today as its champion. The two do not go together.


My Lords—


My Lords, I did not interrupt anybody while they were speaking and I ask noble Lords to afford me the same courtesy. The object of the Bill is to separate the private sector from the National Health Service. The divide between us is so deep that there is no meeting point at all. Therefore, as I said, it is problematical whether it is worth while making any serious comments. The noble Baroness referred to the intransigence of the Government. I do not think that she used that word, but that was precisely what she meant. We have been intransigent.

We think that this Bill is a good Bill. We examined it in great detail and it presented in terms of clauses precisely what we wanted. If we believe in something which we think is right and it is worded in the way we want it, why should we give way on matters to which we are totally opposed? We know that the Conservative Party in this House, with its built-in majority, can play ducks and drakes with any Labour Government, and it does not hesitate to do so. What chance did this Party have with the Industrial Relations Act? We knew that we could not win a single Amendment. What chance did this Party—now in Government—have with the Local Government Act? None at all! What chance did this Party—now the Government—have with the legislation relating to the National Health Service reorganisation? So I say to noble Lords opposite, do not appear righteous today about the intransigence of the Government. The Party opposite, with its built-in majority, can always defeat the Labour Party in your Lordships' House, when the Labour Party is in Government, and it never hesitates to do so.

I do not want to say what I have said so many times about the Goodman proposals and the purpose of those proposals. As I said, the purpose was to try to heal a growing breach between the medical profession and the Government, and those proposals, whether or not noble Lords opposite like it, will, we believe, achieve something, and achieve something that is really worth while. I think that the noble Lord, Lord Platt, as well as others, asked, what will it achieve? We believe that it will achieve a good deal. We believe that it will get rid of some of the abuses in the National Health Service today. We have no quarrel at all with people who want privacy and who want to buy that privacy. None whatever. But we say that they must do it outside the National Health Service, in the private sector.

Do not let us shut our eyes to the fact that there is a good deal of abuse; and I am referring not only to queue-jumping, but also to privilege generally. Noble Lords opposite know better than anybody that money will buy anything and everything, and this is something that we are pledged, and have been pledged for years, to stop in the National Health Service. We believe—we may be mistaken, but time will tell—that the gloom of the noble Lord, Lord Winstanley, will be dispelled within the foreseeable future. I say this because I think that members of the medical profession will come to see that the private sector will turn out to be a very good thing for them and that the National Health Service, under its new régime, will also prove to be very beneficial to the people of this country.

I believe that one noble Lord asked what support is there for this measure. There is no support at all from the other side of this Chamber, nor from the supporters of the Conservative Party. I believe that there may be some support for it among the several millions of people who vote Liberal in this country. But there are millions of people in this country, in the Labour Party and in the trade union movement—and they do number millions—who attach considerable importance to it.

Here I wish to address my remarks particularly to the noble Lord, Lord Hunt of Fawley—I had a go at him once before on this—and to the noble Lord, Lord Platt. I do not think that I have to do it quite so much to the noble Lord, Lord Hill of Luton, whom I think is a little ambivalent towards me. I think he likes only half of me because he uses only half my name. I do not know what the "Wells" side has done to him. But I want to say to noble Lords who are members of the medical profession that they could do much to improve the relationship between the Government and the medical profession if they were not so aggressive in their outlook, and if they would work towards looking at this matter in a positive way, rather than talking about difficulties, taking action, and so on. I would urge—I say this very sincerely—members of the medical profession who are Members of your Lordships' House to take a much more positive view.

The noble Lord, Lord O'Hagan, said that this is the end of an historic compromise. He is absolutely right—but he often is. It is his emphasis that is so often wrong. He asked, how will this Bill help? He wanted to know about loss of income from private beds. I have said before, and I say again, that there will be very little loss so far as the 1,000 beds are concerned because they are so grossly underused that they produce little or nothing. No doubt there will be a loss on the remainder when they are finally phased out. But many times I have tried to remind your Lordships of Clause 8, and there is some reason to believe that under this clause we shall recoup a great deal of what Members opposite describe as loss. At least the losses will be cut down because eventually we shall not have paying patients who bilk the National Health Service, as so many of them do; who come into private beds, pay their physician, pay their surgeon and undertake to pay whatever the private bed costs, but then leave without doing so. We are involved in a very considerable expense every year trying to recover this money. Let me say, if it has never been said publicly before, that we have to write off quite substantial sums because we cannot recover them.

The noble Lord, Lord Platt, referred to the appalling ignorance of the Government. He talked about what he regarded as unsatisfactory replies. I am sure that he is absolutely right on this matter of unsatisfactory replies, because if I do not get the kind of reply I want I always regard it as being very unsatisfactory, and in politics it is found more than ever that when a person asks a question, if he does not then get the answer he wants he regards it as unsatisfactory. My very good friend the noble Baroness, Lady Ward of North Tyneside, is a classic example of this. It is only recently, after about two and a half years, that I have been able to get her to say, "I thank the noble Lord for his most satisfactory reply", and I look forward to the next occasion when I hear her say that.

One must bear in mind that people who do not get the kind of reply they want will always dismiss it as being unsatisfactory. It may well be that some of us on this side have fallen short of our responsibilities. It may well be that we have not always come up with what noble Lords opposite think is the fullest possible answer. I can only say that my noble friend Lady Stedman and I have given an awful lot of time to this matter, as I know people on the Bench opposite me have done, and we have tried to deal frankly and honestly with your Lordships' questions. I am grateful to the noble Lord, Lord Hill of Luton, who said at least that I made no bones about what the Bill is about. As a Socialist, it is something I have been looking forward to for years and, let me say, working for; and it gives me very great pleasure to feel that we are at last going to achieve this. I do not say that with any maliciousness at all but because I think it is right that the National Health Service should be able to provide a comprehensive service—and I know there are financial difficulties—to people in this country who want it, and that our waiting lists and our admissions into hospital should have one test and one test only, and that is of need and urgency, which is not the case today. I do not want to give examples of how one can by-pass this by going to a consultant and paying a fee. The noble Lord, Lord Platt, has admitted, as he admitted once before, that this is so in some instances.

The noble Baroness, Lady Macleod, made some reference to 3¼ million BUPA payers who will be denied the National Health Service pay beds. It is perfectly true that ultimately they will. This is what the Bill is all about: that if they want private medicine, with a private consultant and with a private bed, they must go into a private hospital. This is the whole point of BUPA. BUPA owns hospitals into which people go; and pay beds will be made available by such organisations as BUPA. When the noble Baroness expresses some anxiety as to whether BUPA and such organisations will be able to meet their responsibility, let me say here and now that there seems to be no evidence—no evidence at all—that the private sector is short of money. Many hospitals have been built and are used; many others are in the process of being built; and there are many others for which plans have been accepted by the responsible planning authorities. There is no evidence at the moment that they will not be able to meet the demand. I think that, again, it was the noble Lord, Lord Hill, who said that the size of the private sector will depend on demand. I think that is roughly what he said on one occasion. We have no quarrel with that at all, but we want to know what is going on. If they want to build hospitals of a particular size, they must be authorised. Below that size they can build what they like, but they have got to notify.

The noble Lord, Lord Tranmire, raised the question of the Royal Commission. He will forgive me if I do not go into that deeply again except to say this: we feel—and I have said this before—that the decisions to take away pay beds is a political one, and, as a political decision we accepted it and made it. Your Lordships may say that we are wrong about this, but we regard it as a political decision, and everyone listening to me now, on both sides of the Chamber, would accept that it is a political decision. It is one that we on this side, with certain exceptions, welcome, and it is one that noble Lords on the other side do not welcome; but it is a political decision. Why ask a Royal Commission to make what is, after all, a political decision? That is why we decided that we could not refer it to a Royal Commission.

I am grateful to the noble Lord, Lord Gray, who wrote me a brief note last night about matters, at the bottom of page 14 and the top of page 15, on the meaning of "premises". I saw him, I admit for a brief moment, with my advisers, and we came up today with an answer—an answer in which we said that the fears of the noble Lord, Lord Gray, were not necessary, that in our view there was no justification for his apprehension. We have had a further talk, and we have decided—because we, too, want to be absolutely right—that we shall take further advice of a legal nature on this, and before we met today I undertook to write to the noble Lord.

My Lords, I have spoken for 24 minutes, which is much longer than I wanted to, but your Lordships will understand that when one is trying to reply, however inadequately and superficially, to 13 speakers, that is less than two minutes per speaker. I believe—and I believe this most sincerely—that this Bill is right; that it is right that we should separate the private sector from the public sector. There has been a great deal of criticism of Part III but if you look at Part III dispassionately you will see that what we have done is to lay down certain conditions for notifications and authorisations. When you look at them I think you will see, if you can look at them dispassionately, that they are not such terrible things after all. In every community every local authority wants to know what is happening in the planning field and to give authorisation or not, as the case may be; and one really must know what is going on. It is nothing more than an extension of that: of giving liberties to do certain things below a certain bed occupancy, and saying that there must be authorisations if you want to go above it and notification if you keep below it. It is, I believe, perfectly reasonable.

As I say, my Lords, I suppose certainly more than half the noble Lords present today do not like this Bill. I hope to see it on the Statute Book, and I hope—because I think most of us, if not all of us, in your Lordships' Chamber consider that our outlook is democratic—that once it gets on the Statute Book we shall see what we can do to make it work. There is no reason why the private sector should be any worse off than it is at the present time—and I do not think it is badly off at the moment. I am expressing a personal opinion, but I think it may well be better off in the future. Once it is on the Statute Book, let us concentrate what resources we have, both in manpower and in time, and in money, on equipping the National Health Service so that it becomes the kind of Service which I believe certainly the noble Baroness, Lady Young, and her noble friends want to see, because as far as that is concerned I do not think there is anything between us at all.

On Question, Bill passed, and returned to the Commons.