HL Deb 01 August 1980 vol 412 cc1226-34

1.33 p.m.


My Lords, I beg to move that this Bill be now read a third time. This Bill contains a number of different provisions, but at this stage I do not intend to deal with them at any length. Those that have attracted most attention—the structure of the Health Service, fund-raising and private practice —are three on which I shall say just a few words, although there are other very important parts of the Bill.

At the beginning I should very much like to thank my noble friends Lord Cullen and Lord Sandys, and my noble and learned friend Lord Mackay for their great help in the earlier stages of this Bill, and to pay tribute to the noble Lord, Lord Wells-Pestell, for the helpful way in which we have been able to deal with the business, and to the noble Lord, Lord Winstanley.

I am pleased that the House has been able to make a positive contribution to the Bill, and that there have been included in it amendments giving an enabling power to make payments to doctors' wives and, of course, a later amendment on the inclusion of representatives of district councils to be included on the list of those who may be local authority representatives on district health authorities.

First, on the future structure of the National Health Service, I believe the use that we shall be making of the powers in these clauses is widely welcomed as a way of providing a better and more efficiently managed Health Service, more quickly responsive to local needs. Secondly, I come to fund-raising. We have debated this provision at some length and I hope that although we may not have persuaded all the noble Lords opposite that this provision is not to be feared, we have at least explained to them that what it allows is no more than the sort of activity carried on by a whole host of perfectly respectable fund-raising bodies. It is a useful but modest extension of existing powers. Voluntary funding is not an alternative way of funding the National Health Service; it is a supplement, small in national terms but helpful locally.

Finally, I come to private practice. I hope that we have made our policy on private practice quite clear. We believe that private provision should be allowed to develop subject only to the condition that in doing so it does not prejudice the National Health Service. We have applied this principle to both private practice in the National Health Service and in the private sector, and it is effected by the legislative and non-legislative safeguards which we have discussed. Our encouragement of private practice in no way undermines our commitment to the National Health Service. Indeed, as we have explained, we support private medicine because it helps the National Health Service by relieving pressure, filling the gaps where the National Health Service is relatively weak, and bringing in pay bed income. We believe that it adds to the total resources for health care in the country and we believe that nothing but good can come of co-operation between the two sectors. They are not incompatible.

I should like to conclude by repeating something which my noble friend Lord Cullen of Ashbourne said at the end of the Second Reading debate: If we can achieve that consensus view, then I believe that we shall have performed a valuable service which will allow the NHS and the private sector together to get on with their proper job, which is to provide the best health service possihle."—[Official Report, 23/6/80; col. 1433.] I hope that your Lordships will now agree that this Bill be read a third time.

Moved, That the Bill be now read 3ª. —(Baroness Young.)

1.36 p.m.


My Lords, I am grateful to the noble Baroness the Minister for her opening comments, and I should like to say how much I and my colleague Lord Wallace of Coslany are grateful to the noble Baroness and to the noble Lord, Lord Cullen, for always being available if we wanted to see them to discuss any matter with them. We have found this of considerable, and, I think, mutual, value. It was my intention to raise a number of points this morning, but in view of the fact that we have had the intervention of a very long Government Statement on this Friday and that other matters have taken much longer—and if I am perfectly honest with the House, I have a train to catch at two o'clock if I am fortunate enough to do so—I propose to be much briefer than I had intended.

We are really concerned with three of the clauses which are the major clauses so far as we are concerned: Clause 8, which deals with the repeal of provisions relating to the withdrawal of pay beds and the dissolution of the Health Services Board, and Clauses 9 and 10, which cover the treatment of private patients in National Health hospitals.

As your Lordships will know, we were glad to see that in Clause 1 there would be a major change in the structure of the National Health Service. The more we have read the Bill—and some of us on this side have read it several times—and read about the Government's intentions as regards linking private medicine with the National Health Service, the more we have become concerned. It is perhaps not generally recognised that the National Health Service, as a separate service from the private sector in this country, has always been of supreme importance to the Labour Party. It has not been just one of the sacred cows; it is, in fact—and I think will always remain—the most important sacred cow in the Labour movement.

I was particularly concerned yesterday —less than 24 hours ago—when my attention was drawn to a circular issued by the Government some weeks ago—but, understand, not publicly released—urging health authorities to involve the private sector in planning the pattern of local services and calling for far-reaching co operation between the National Health Service and the private sector, and the loosening of the present limitations on contractual arrangements. I informed the noble Baroness the Minister yesterday about this circular, although I have not seen it, but I am well aware of its contents. It seems to me from what I know of the circular that there will be a very real incursion by the private sector into the National Health Service.

I want to ask the noble Baroness—and I do not necessarily want replies today; she is pressed in much the same way as I am pressed at the present moment—whether the circular also suggests that health authorities might offer financial assistance to private companies to help maintain or develop independent companies. This is what I understand is in the circular, and I understand that comments have been requested from the administrators of the regional health authorities, the administrators of the area health authorities, and the secretaries of the boards of governors of the postgraduate teaching hospitals.

It seems to mean that the National Health Service will be allowed to make contractual arrangements with profit-making hospitals and nursing homes, I think for the first time. I see arising from that that, if used by the National Health Service, it is going to be involved in exorbitant fees. We are concerned at the suggestion of using non-national health facilities as a proper way of providing services. As I understand the situation, it is suggested that where National Health Service patients are dealt with in the private sector—and I am quoting from a circular which I admit I have not seen—they could be charged for optional amenities which are not part of the hospital provision. Does this mean that national health patients could get certain private patient facilities over and above what they would have got under the National Health Service, provided they pay for it? My friends and I are concerned at the way the Government are, if my information is correct, proposing to let the private sector play such an important role in the provision of health facilities.

I think that all this amounts to an attack by the Government on public health. It is clear they are planning to make the private sector a much more important part of health care in this country. I do not have to tell the noble Baroness the Minister that private health in this country is a growing and expanding industry, and it can only grow, and it can only expand, at the expense of the National Health Service. I believe that the Government are already conducting a long-term survey of the possibility of extending private medicine by insurance schemes. This seems to me to be a step in the wrong direction, because it rather looks as though we are moving not towards a real National Health Service but towards a National Health Service where people will be expected to pay, where they will be encouraged to undertake private medicine by insurance schemes; and unless we are careful we shall return to the system of voluntary hospitals.

I became aware of this circular only yesterday, and it is one which gives rise to a great deal of concern. I would say to the noble Baroness the Minister that if any Government department—and particularly in this case the Department of Health and Social Security—is going to issue circulars of any kind during the passage of a Bill through this House and the circulars are going to be concerned with the content of the Bill, it would be a good thing if shadow Ministers were given an opportunity of seeing them so that they could comment on them before the Bill has been passed.

1.44 p.m.


My Lords, I too should like to express my appreciation to the noble Baroness, Lady Young, and the noble Lords, Lord Cullen and Lord Sandys, for their courtesy and the fair manner in which our representations have been met. True, differences of opinion still exist, but that is expected in a true democracy such as ours. I would go further and, so far as Clause I is concerned, congratulate the Government on realising the major error in a previous Conservative Government's reorganisation, and acting so promptly to put matters right. I only wish that the Government had the same courage to put right many of the bureaucratic errors made in the local government reorganisation by the same previous Government headed by Mr. Heath.

The reorganisation proposed in Clause 1 will involve great responsibility on those involved in the inevitable staff changes. Some promising officers will be lost to the service, and some careers blighted. This will no doubt be the most worrying and agonising situation created by the Bill. We shall watch the position closely. In the meantime, one can only hope that the maximum understanding and generosity will be shown in handling such a difficult and, to some, painful operation.

The Government's attitude and action on pay beds are regrettable. One can only hope that this will not create difficulties among staff. In the main, the only section that welcomes pay beds in the National Health Service is a majority of consultants, and it would appear to me that this is mainly for financial reasons. I am glad to be assured by the noble Baroness in a courteous letter that amenity beds will continue undisturbed in National Health Service hospitals, provided that there are National Health Service patients who require the privacy of a small room or a bed in a small ward, at a cost of £3 or £1.50 per day depending on the type of accommodation provided, as against pay beds for private treatment at about £57 to £113 a day. I fully accept that people have a right to choose private or public service. All I can say from personal experience is that my family have every reason to express very sincerely our gratitude for the skill and care given—and still being given—to us by the National Health Service medical staff, doctors and nurses, over a long period. To us the National Health Service has been the greatest social change in our lifetime.

At various stages of the Bill I have expressed doubts about the necessity of Clause 5 and the fund-raising efforts implied. However, the decision is taken. Those of us involved in voluntary effort will, I am certain, do our utmost to ensure that in any effort involving voluntary spheres of activity, co-operation will be fully given to ensure maximum success. A recent fine example has shown that anyone with large capital resources can give generously of personal finance to the National Health Service. Those of us not so generously endowed can continue to give voluntary effort and co-operation. There is plenty of scope and room for voluntary effort in the National Health Service.

Finally, my Lords, I would say this. Miracles cannot be achieved overnight. The new reorganisation will of necessity take time, and a great deal of patience will have to be exercised. On all sides of the House we must exercise all the influence and example we can to ensure the success of Clause 1. The principle of a National Health Service available to all irrespective of colour, class or creed, is a great ideal. It must be preserved at all cost, and protected from clashes of political ideologies.

1.49 p.m.

Baroness YOUNG

My Lords, I should like to thank the noble Lords, Lord Wells-Pestell and Lord Wallace, for what they have said about the arrangements as this Bill has proceeded through the House. I would, as a new issue has been raised, like to reply briefly to the noble Lord, Lord Wells-Pestell, on what he has said. To myself and my noble friends it is a matter of regret that he should continue to feel that anything that we may have said about private patients is in any way designed to take away our support for what is done in the National Health Service. This is clearly the most important part of the health services of our country and we stand by it; we support it, and we are great respecters and admirers of what it does.

That said, I think we would all recognise that it is helpful at a time of economic difficulties that we should make the best use of all the resources that the country has, and, above all, that in anything we do we would be putting patients first and not some kind of principles about private practice or National Health Service as a way of helping sick people. The letter referred to by the noble Lord, Lord Wells-Pestell, was sent to health authorities by the Department of Health and Social Security on 30th June. A similar letter was sent to professional and private sector bodies. The last part of the letter deals with contractual arrangements and other forms of co-operation between the National Health Service and the private medical sector. It covers a draft circular on the subject on which health authorities have been asked to comment.

The circular sets out revised guidance on contractual arrangements—arrangements whereby the National Health Service uses private sector facilities as a way of providing services to the National Health Service patients. I should make it clear that there is nothing new about this sort of arrangement. As the circular points out, since its inception the National Health Service has entered into contractual arrangements, and this is a recognised way of providing services. About 3,000 private beds are used in this particular way.

The noble Lord asked about contracts with profit-making bodies. One of the things we have done is to lift the administrative bar on contracts with profit-making institutions. This seems to us to be an unnecessary restriction. There may be circumstances where buying a service on a contractual basis and including an element for this may still be the best option to a health authority. Our aim is to secure the best use of resources, and if such a contract is the best use then we see no reason why it should be prohibited. The noble Lord also asked about optional extras and payment. The sort of situation that we envisage is where a National Health Service patient is in an NHS-used bed in a private hospital and asks for an extra amenity such as a colour television. The patient pays for this in exactly the same way as he would pay for it if he were in an NHS hospital bed. The fact that this is a contractual NHS bed in a private hospital makes no difference at all to the arrangements.

The noble Lord also asked about assistance to private hospitals. The body of the circular deals with contractual arrangements between NHS and private hospitals. The NHS is able to help such private hospitals, but only to the extent that this is of benefit to the NHS patients using the private facility on a contractual basis. Finally, if I may just comment on this point, there is nothing in the draft circular that depends in any way on the content of the Bill before the House. The power to use non-NHS facilities for National Health Service patients is in Section 23 of the 1977 National Health Service Act, quite unaffected by this Bill.

I have covered very briefly a number of the points which the noble Lord, Lord Wells-Pestell, raised. At an earlier stage, when there were a number of issues like this, we did feel that if this was a matter which the House would like to discuss further a debate on these matters could always be arranged through the usual channels when we return, in another Session. I should like to thank the noble Lord, Lord Wallace. I am glad that we agree on both sides of the House about private fund-raising. The fact that all of us have taken part in this from time to time—I know the noble Lord does a great deal in this respect to raise money for hospitals—means that we are both agreed on the value that this can be, and I should like to give a last assurance that we are not by these means suggesting that the National Health Service should be financed in this way. At an earlier stage of the Bill we debated very fully the question of staff, and I hope I have been able to give the noble Lord the assurance that we are as concerned as he and his noble friends are that the interests of the staff will be safeguarded in any reorganisation.

On Question, Bill read 3ª, with the amendments, and passed, and returned to the Commons.