§ Lord HARMAR-NICHOLLSMy Lords, I beg leave to ask the Question which stands in my name on the Order Paper.
§ The Question was as follows:
§ To ask Her Majesty's Government how many of the 1,000 pay-beds in NHS hospitals that were to be phased out by the end of June 1977 have since been used by NHS patients; how many have been used for administrative purposes or left unused; when will the remainder of pay-beds be withdrawn; and what is the estimated loss to the NHS funds that has so far accrued as a consequence of the phasing out of these beds.
§ Lord WELLS-PESTELLMy Lords, I apologise for the length of the reply, but I know that this is a matter which concerns a number of your Lordships and therefore the Answer is longer than a normal one. I regret to inform the House that the information is not comprehensively available in the form requested by the noble Lord. An authorisation to admit private patients to an NHS hospital is not related to particular beds. Any bed in a hospital which is authorised to receive private patients may be used by a private patient according to the treatment he needs, provided that at any one time the number of such patients in the hospital does not exceed the maximum number contained in the authorisation. As the same bed may be used at other times by a NHS patient, it is for most hospitals impracticable to identify beds which may as a result of phasing out become permanently available for use by NHS patients.
1414 As your Lordships know, 1,000 authorisations were withdrawn in May 1977 under the terms of the Act. A further 356 authorisations were withdrawn from 1st January 1978 in accordance with proposals made by the Health Services Board. The further rate of reduction will be determined solely by the Board in accordance with the principles embodied in what are now Sections 68 to 70 of the National Health Service Act 1977. The loss of income from private patients was not expected to exceed £1.8 million in 1977–78. There may be a further loss of about £1 million in 1978–79. Health authorities' allocations have been adjusted accordingly.
§ Lord HARMAR-NICHOLLSMy Lords, is the noble Lord aware that, while one can see that there is some difficulty in identifying the actual use of beds, he should have no difficulty at all in telling me how many rooms that contain beds are now being used for other purposes, such as administrative purposes, store rooms and so on? Is the noble Lord aware that even the Socialist Medical Association itself has it on record that already beds are not being transferred for use by National Health Service patients, as was put forward when the legislation was introduced? It says that many of the rooms will be converted into store rooms, laboratories or day rooms. Does not the noble Lord think that, in view even of his own Answer, we have sufficient evidence up to now that this was mainly a Party political exercise, to some extent based upon spleen, and ought it not to be stopped even on the evidence that we have today? If it cannot be stopped, could not power be given to the committee that is deciding the phasing out so that it can slow it down or stop it if it considers that the beds are not being used by National Health Service patients, as was envisaged when the argument was first presented?
§ Lord WELLS-PESTELLMy Lords, I shall try to pick up all the points that the noble Lord, Lord Harmar-Nicholls, has mentioned. However, let me say at the outset that during the whole of the passage of the Health Services Bill I never denied that this decision was anything but a political decision. I admitted that; I defended it and I believe it to be 1415 absolutely right. However, having said that, I did point out at the time that, out of 4,150 private beds in our hospitals, at no time in recent years were more than about 1,800 in use. In fact, in 1975 the total number of beds used on a daily basis was 1,840 and not 4,150. In 1976 that figure had fallen to 1,704. I am saying that the first 1,000 beds were withdrawn because they were not used. In point of fact, the best part of nearly 3,000 of the beds reserved for private patients are not in daily use. Therefore, nobody is really being deprived. If the noble Lord asks whether they are being used for National Health Service patients, the answer in my view is, yes. The noble Lord shakes his head. I am saying that not all of them are necessarily in use, but as resources become available—and we must think in these terms because a good many resources are necessary before a patient in bed can be serviced—so these beds are being used.
§ Lord JACQUESMy Lords, is my noble friend aware that in any organisation, whether it be public or private, if there is a shortage of rooms needed for administration, storage or anything else, it is usually wise to use any accommodation that becomes vacant for those purposes?
§ Lord HARMAR-NICHOLLSMy Lords is the noble Lord, Lord Wells-Pestell, aware that there is no point in pursuing the practical point such as that raised so far, once the noble Lord has admitted that this was a political decision? It was a political decision which is costing the country money and which has deprived ordinary people of the valuable services of consultants. It is a political decision which is wasting hospital beds. As the Government have changed their minds on so many political decisions in other areas, will they not do the same in this case?
§ Lord WELLS-PESTELLMy Lords, I do not intend to apologise for the fact that this is a political decision. We say on this side of the House that the National Health Service should be available free for anybody who wants to use it. If people want to pay for privilege then they must get it elsewhere. That seems to me to be a perfectly reasonable line to 1416 take. The Act lays down that beds for private patients in National Health Service hospitals cannot be withdrawn unless there are comparable medical facilities available in the area, and therefore the Health Services Board will not withdraw private patients' beds unless it is satisfied that the facilities that private patients would want are available in the particular area.
§ Lord SANDYSMy Lords, are the Government aware that we shall study their reply with the keenest interest? Is the noble Lord also aware that a particular Amendment which was introduced into the Health Services Bill in your Lordships' House, concerned with the re-use of beds so phased out, had the following words attached: "as far as possible" should be used for health services? Does the reply which he has given this afternoon not fall rather contrary to its purpose?
§ Lord WELLS-PESTELLMy Lords, I thought that I had just said precisely the same thing but in different language. The noble Lord uses his particular phrase, but I said that it was clearly understood under the Act that beds would only be withdrawn in certain circumstances. There is nothing at all between us on that.
§ Lord BLYTONMy Lords, is the Minister aware that I hope we do not depart from the Socialist policy of equality in the Health Service, rather than allowing the rich to jump the queue to get private beds, thus making the ordinary citizen stand in the queue and wait for service?
§ Lord BOYD-CARPENTERMy Lords, if, as the noble Lord has suggested, a good many of the beds which were withdrawn were not being used, how does he account for the substantial loss in revenue to a hard-pressed Health Service?
§ Lord WELLS-PESTELLMy Lords, I am saying that the majority of beds that have been allocated to National Health Service patients are not being used in the course of the year. In the course of a day there are not more than about 1,700 in use; that means that there is an income from the beds, and that was the income which I gave.
The Earl of HALSBURYMy Lords, will the noble Lord agree that there would be some justice in the principle that if somebody, for his own reasons, wishes to be treated elsewhere, that "elsewhere" should receive a capitation subsidy proportional to the taxes that have been paid by those who are treated there?
§ Lord WELLS-PESTELLMy Lords, the noble Earl tempts me, but the matter is outside the scope of the Question.
§ Baroness BROOKE of YSTRADFELLTEMy Lords, will the noble Lord tell us whether the Government will use these National Health Service pay-beds which are now being withdrawn with a view to reducing the ever-increasing waiting list of patients who want surgical and medical treatment?
§ Lord WELLS-PESTELLMy Lords, the answer to the noble Baroness is, Yes. When the Health Services Bill was before your Lordships' House, I tried to deal with this matter by saying that there are many people in the community who need the kind of help that it is difficult to give them because they need to be in hospital for a day. If my memory serves me correctly, I used the expression that many of them would be used for "day-patients". That would take people, albeit for only one day, off the waiting list. As is the case at the moment, I hope that the availability of many of these beds, which are being used for day-patients, will increase for some considerable time.
§ Lord PLATTMy Lords, may I say that I do not want to carry any further the argument about the Health Services Bill, which I have always absolutely opposed, but Her Majesty's Government must take into account that if there are to be pay-beds, wherever they are, and if people are to pay very high prices for them, one of the things they pay for is availability. We shall never get 100 per cent., 90 per cent., or even probably 80 per cent., of beds in use in a private hospital or a private wing of a National Health Service hospital.
§ Lord WELLS-PESTELLMy Lords, I think that noble Lords will appreciate it when I say that the Government hope that, eventually, people who want pay-beds will find them outside the National Health Service.