Order for consideration, as amended (in the Standing Committee), read.
Motion made, and Question proposed,
"That the Bill be re-committed to a Committee of the Whole House in respect of the Amendments to the Schedule, page 22, line 9, and the Schedule, page 23, page 8, standing on the Notice Paper in the name of Mr. Bevan, and in respect of the Amendment to the Schedule, page 26, line 21, standing on the Notice Paper in the name of Mr. Woodburn."—[Mr. Aneurin Bevan.]
I beg to move, as an Amendment to the Motion, at the end to add:
I understand that my hon. Friend the Member for Putney (Mr. Linstead) has a manuscript Amendment, which I trust Mr. Speaker will allow him to move, in view of the fact that this Motion is newly on the Order Paper."and in respect of the Amendments to the Schedule, page 22, line 4, and to the Schedule, page 26, line 16, standing on the Notice Paper in the name of Lieut.-Colonel Elliot."
I think it would be better if the hon. Member moved his manuscript Amendment later on. I must first put to the House the Amendment moved by the right hon. and gallant Gentleman.
I think it is very unusual that there should be a manuscript Amendment at this stage. I am prepared to accept the Amendment moved by the right hon. and gallant Gentleman, but without prejudice to my attitude on the manuscript Amendment. Of course, it is a matter for the Chair whether it accepts a manuscript Amendment in such circumstances, but it is a little hard for me, not having seen the manuscript Amendment, to be asked to accept that a manuscript Amendment may now be moved.
It is only in order to allow a Clause with regard to the cost of conveyance of certain persons under Section 27 of the Act to be discussed. If the Minister will look at it, he will see that it raises the question of some charge falling upon certain local authorities. As he knows, it is impossible to impose a charge upon local authorities upon the Report stage. There is no reason to suppose that we shall be in any way delayed in dealing with the Measure, and I trust very much that with expedition and a certain amount of accommodation on both sides we shall be able rapidly to dispose of this business.
I understand there is some misunderstanding here. It is not, in fact, a manuscript Amendment at all; it is merely proposed to bring forward during this stage a new Clause with respect to the cost of conveyance. I am myself not able to understand why it is being brought forward; nevertheless, it has been brought forward, I understand, by the House authorities, and I am prepared to accept it. I accept the Amendment.
If I may say so, the manuscript Amendment is a proposed Amendment to the Minister's Motion on recommittal, not a manuscript Amendment dealing with anything in the Bill; it is merely in order to bring the Clause within the scope of the Debate.
Amendment agreed to.
I beg to move, as an Amendment to the Motion at the end, to add:
I move this manuscript Amendment on behalf of my hon. and learned Friend the Member for Chester (Mr. Nield), who has been advised that it is technically necessary for the new Clause standing in his name to be recommitted, because it imposes a certain charge. For that reason, and with your permission, Mr. Speaker, I move this manuscript Amendment."and in respect of the Clause (Cost of conveyance of certain persons under Section twenty-seven of Act), standing on the Notice Paper in the name of Mr. Basil Nield."
I beg to second the Amendment.
I should like to ask for your guidance here, Mr. Speaker. The Amendment which has been moved by the right hon. Gentleman I am prepared to accept. The manuscript Amendment has the effect of transferring to the Committee stage from the Report stage the Clause to which reference has been made. It is being moved, as I understand it, because the hon. Member has been told there are technical reasons why this should be re-committed. I do not know what the technical reasons are, because this does not impose a charge but merely transfers a charge from one local authority to another. It is perfectly true that this is a grant-aided matter, but nevertheless the cost which one local authority pays, another local authority does not pay
The fact that a local authority pays an additional charge takes the matter out of the Report stage.
Amendment agreed to.
Main Question, as amended, put and agreed to.
"That the Bill be re-committed to a Committee of the whole House in respect of the Amendments to the Schedule, page 22, line 9, and the Schedule, page 23, line 8, standing on the Notice Paper in the name of Mr. Bevan, and in respect of the Amendment to the Schedule, page 26, line 21, standing on the Notice Paper in the name of Mr. Woodburn; in respect of the Amendments to the Schedule, page 22, line 4, and to the Schedule, page 26, line 16, standing on the Notice Paper in the name of Mr. Elliot; and in respect of the Clause (Cost of conveyance of certain persons under section twenty-seven of Act), standing on the Notice Paper in the name of Mr. Basil Nield."
Bill immediately considered in Committee.
[Mr. BOWLES in the Chair]
New Clause—(Cost Of Conveyance Of Certain Persons Under Section Twenty-Seven Of Act)
Where a person has travelled from a place in the area of one local health authority to a hospital in the area of another local health authority for the purpose of attending at, or being accommodated in, that hospital in order to avail himself of any hospital or specialist services and, immediately after such attendance or on the termination of the period of his accommodation in the hospital (not being a period longer than three months beginning with the date of his admission to the hospital), he is conveyed by ambulance or other means of transport made available by the local health authority for the area in which the hospital is situated in pursuance of their duty under section twenty-seven of the Act of 1946 from that hospital to the place from which he travelled as aforesaid or to any other place in the area of the local health authority within which the first-mentioned place is situated, the cost of that conveyance shall be repaid by the last-mentioned authority to the local health authority by whom the ambulance or other means of transport was made available as aforesaid:
Provided that any local health authority may agree to waive their rights under this section against any other local health authority, either in consideration of a periodical payment or without consideration.—[ Mr. Linstead.]
Brought up, and read the First time.
I beg to move, "That the Clause be read a Second time."The parent Act imposes upon the local health authorities responsibility for the ambulance service and leaves at large the question of the charges for that service. It works on the basis that the local authority for the place where the patient's home is situated has the responsibility for the conveyance of the patient from the home to the hospital, and the local authority where the hospital is situated has the responsibility of providing the conveyance for the patient from the hospital back to his home. No provision was made for inter-authority accounting in the general expectation that swings and roundabouts would operate; that over a period of time the cost would even itself out as between one local authority and another. In fact, it has been found from experience that this has not been the case. Generally speaking, the hospitals are situated in the areas of county boroughs which serve the surrounding counties, with the result that the general flow of patients has been from the counties into the county boroughs. The county boroughs are finding that they have to provide transport back to the homes of a large number of patients who are not residents of the county borough but of the county. There is, therefore, very little reciprocal flow in the other direction of borough residents out into the counties. In these circumstances, both the associations of the county councils and of the municipal corporations have considered the matter and come to the conclusion that there is a sufficient lack of balance as between one local authority and another to make it worth while introducing a system of inter-authority accounting, and the proposals which commend themselves to the local authorities are those contained in this Clause. The only matter to which I might draw attention is the phrase in brackets—
It has been agreed between the authorities that after such a period it is not unreasonable to regard the patient as the responsibility of the authority within whose area he remains. In a large number of cases it will be a patient at a sanatorium, who will, of course, be a long-term patient."not being a period longer than three months beginning with the date of his admission to the hospital."
The hon. Member has pointed out that this matter has been discussed between the representatives of the various local authorities and that they have reached agreement between themselves that some local authorities believe they are suffering under the present arrangement and will be able to have relief in this way. Whether the amount of relief will be as much as some of them think will rest on actual practice, but in the circumstances, as this is a matter for the local authorities and they have reached agreement, I see no reason at all for standing in the way and I accept the Clause.
Question put, and agreed to.
Clause read a Second time, and added to the Bill.
Schedule—(Minor Amendments Of The Act Of 1946 And 1947)
I beg to move, in page 22, line 4, at the end, to insert:
It will be within the recollection of the right hon. Gentleman that when the Lord Advocate moved the Second Reading of this Bill he explained that there were three main purposes for it. The first was to deal with partnerships, the second with promises which have to be implemented, and the third—"In subsection (1) of section five (which provides for accommodation for private patients) after the words 'the whole cost,' the words 'or such proportion of the cost as may be determined,' shall be inserted."
This is an Amendment in the spirit of the third purpose as laid down by the Lord Advocate. It seeks to introduce a measure of flexibility into a section of the existing Act which is somewhat rigid, and which experience has shown is creating and has created difficulties of interpretation and administration and anomalies which tend to a feeling of injustice or unfairness on the part of some of the people affected. It has been at least a partial failure in achieving the object the House had in mind when it inserted the provision. The Section in question is Section 5 of the principal Act, which gives power to the Minister to permit the continued use of accommodation which was at the time in existence and had been specially provided for fee-paying patients to be treated by their own doctors. It was accommodation already provided, and the provision was to enable this accommodation still to be used in hospitals which had now become public hospitals. It is important that the Committee should appreciate quite clearly the difference between Section 5 and Section 4. Section 4 makes it possible to provide small wards or special rooms for cases requiring special medical treatment, or for those prepared to pay a little extra for additional comfort and amenities. By Section 4 a patient is required to pay only that portion of the cost attributable to the extra amenities he is considered to be getting and he does not have the right of attendance by his own doctor; he has to be attended by the doctor who is provided as part of the service. By Section 5 the patient is required to pay the whole cost and does not get the benefit of having his contributions to the National Health Service credited to him, although he does have the privilege of being attended by a doctor of his own choice. It is important that we should bear that clearly in mind. 4.0 p.m. It is not necessary for me to argue in favour of the principle embodied in Section 5 because the Minister himself commended it to the House when dealing with the Bill on Second Reading. He made it clear that he appreciated that there were a number of people who had doubts as to the theoretical wisdom of making this provision at all. But he also made it clear that there were at least three practical reasons why it was desirable that this provision should be made. Perhaps I may quote from what the Minister said on the Second Reading of the 1946 Act:"to make certain minor administrative changes which experience has shown are desirable for the smooth working of the machine. The Bill is essentially a minor Measure which embodies no change of principle or policy. It makes no fundamental alterations."—[OFFICIAL REPORT, 24th May, 1949; Vol. 465, c. 1066.]
I entirely agree, but it is because that purpose is not being wholly met that I have moved this Amendment. The Minister gave two other reasons why it was important that this principle should be adopted. The first was that there were certain disadvantages in guiding patients towards nursing homes. There are good nursing homes, but there are quite a number which are not so good, and there is no doubt whatever that there can be few, if any, nursing homes where there will be available to the patient the same facilities as will be available in a good general or special hospital. The second reason which the Minister put forward, and about which there can be no dispute, was that there would be economy on the demands of the services of the specialists concerned in that if it were possible for them to treat private patients in the public service hospital where they were doing their other work, they would be able to devote more of their time to public service work. In paraphrasing the Minister's remarks I hope I have not done them any injustice. When, in 1946, Parliament provided that the whole cost of these beds should be met by the persons using them, it may have seemed a perfectly proper provision but, unfortunately, as all who are connected with hospital services know, since 1946 costs have rocketed. I need not go into the reasons why they have rocketed, but in a large measure they are due to other provisions in the National Health Service Act. Although costs have rocketed, however, the incomes of people who might have been able to avail themselves of these services have not rocketed. I should not like to say what would be the right word to describe what has happened to their incomes, but there is clear evidence—I do not put it higher; it is not wholly conclusive—that some of the facilities are not in fact available owing to the cost to the people who desire to use them. The operative instrument for putting into effect this Section of the Act was a statutory instrument which was issued by the Minister in 1948, No. 1490, I think it was. It had to be put forward coterminously with the coming into force of the Act on the appointed day, and as a result it was only laid on the Table on 1st July and came into operation on 5th July. It was quite impossible for Parliament to enter into any proper discussion of that instrument. I am not denying that before it was drafted there were many consultations and that the Ministry took advice, but its exact effects could not have been known to Parliament at the time. Broadly speaking, that statutory instrument dealt with the very difficult question of determining what items should be included and what should be excluded in arriving at costs. By a very masterly use of words—and I hope this is not an unfair description of it—it laid down that there should be standard daily charges which could be calculated in one of two ways: the first was that where there was data available for calculating those charges that data should be used; and the second was that where no such data was available the cost should be calculated on the cost of the ordinary public bed, to which had to be added an arbitrary and fixed percentage to arrive at the assumed cost of the private bed. I have not heard of any great difficulties arising in hospitals where the full data was in existence. There have been some complaints, but they have been comparatively few, and it may well be that in some cases the actual charges being made are on the low side. But in other cases, where there is no appropriate data and the assumed yardstick has to be used, there have been great difficulties and the results have shown that there will be very considerable overcharges. The reason why this yardstick must be unsatisfactory is because of the vast variety of hospitals and the enormous difference in the nature of the services they provide. May I give two examples of the sort of anomalies which must arise? It will be quite clear that if there is a hospital where buildings are widely dispersed, or where they are rather old and are perhaps not in accordance with modern ideas, there is at least the likelihood that the costs of running that hospital will be greater than they will be in a more recently planned modern hospital. It is also clear that the actual value of the accommodation in the new and modernly planned hospital should be, and usually is, much better than that in an old hospital. But the costs will be greater in the old hospital, and the unfortunate patient will have to pay more for less good accommodation. That will apply whether there is existing data available for making calculations or not. The second example I want to put will only apply in the latter case. I could take the Minister to a hospital not 100 miles away from here where he could see it actually in being. On one side of the building, which is apportioned to the use of private patients, there is a busy thoroughfare with a tramway junction. Even those members of the Committee who have been in the habit of trying to sleep over a tramway junction will know exactly how difficult that is. The other side of the building, apart from war damage which has not yet been cleared up, looks over a quiet, peaceful, green garden. It is obvious that the value to the occupants of the two rooms, one on a noisy road and the other overlooking a quiet garden, will be quite different; yet the cost of running those two rooms will be exactly the same. Under this statutory instrument, the hospital concerned will be bound to make the same charge for these two quite different types of accommodation. The result of this is that some of the hospitals are feeling that they have to collect charges which they really do not feel justified in asking, and some of the payments which the patients are being asked to make bear very little relation to the real value of the facilities which those patients are getting. The main criticism is in part obvious. The intentions of Parliament are not being entirely fulfilled, and this Amendment will enable the Minister to do what he cannot do now. The supplemental point is that it is contended that overcharges are arising because these patients are, in fact, being required to pay twice over for some of the services which they are obtaining. This arises because, although they are patients in public service hospitals, they receive no credit whatever for the contributions which they themselves make towards the provision of the public service. May I put it in this way? I am quite prepared to buy a 2½d. stamp at the Post Office counter, although I would rather have a penny one, in order that at some future time I may post a letter. If, having written my letter, I took it to the post and found that before I actually put it into the letter box I had to pay another 2½d., I would feel that I was being done. That is exactly the feeling which these patients have, and which in a large measure is justified. I do not believe that anyone should be given special favours or amenities without being required to pay for them, but I believe that when assessing the amount that should be paid regard should be paid to and credit given for whatever payment has already been made. 4.15 p.m. The effect of this Amendment strengthens and fortifies the Minister in implementing the declared objects of Parliament, objects which he himself commended to the House when he was piloting the Bill through. This Amendment will not compel him to do anything to which so far as I know he personally objects, but it will enable him to do what at present he is prevented from doing by the actual wording of the Act. Finally, it will improve the whole services which are available to the public by meeting that portion of the public demand which is not being wholly met today, and by encouraging a portion of the public to make payment to the public hospital services where they will get the best medical treatment, instead of diverting them to other forms of hospital or nursing homes where they may get treatment which is not as good. It will also be of benefit perhaps in the most important way of all, in economising the demands on the time and energy of some of our consultants and specialists, for whose skill there is a demand today, which is far greater than it is in their personal power to supply. I commend this Amendment to the House and I hope the Minister will accept it."We are driven inevitably to this fact, that unless we permit some fee-paying in the public hospitals there will be a rash of nursing homes all over the country. If people wish to pay for additional amenities, for something to which they attach value, like privacy in a single ward, we ought to aim at providing such facilities for everyone who wants them."—[OFFICIAL REPORT, 30th April, 1946; Vol. 422, c. 57.]
The hon. Member for St. George's, Westminster (Mr. Howard) has moved this Amendment in moderate terms, and has argued it with considerable cogency. Nevertheless, my hon. Friends and I on this side of the Committee are still unconvinced of the necessity or the justice of doing what he has suggested. In the first place, there is no evidence that the existing situation is resulting in an increase in the demand upon private nursing homes. It has been said that that is the case, but there is no evidence that it is so. I confess at once that if it were the case that a very substantial number of patients were being diverted from the great general hospitals to the private nursing homes, it would be a tendency that it would be desirable to check, for it would be conflicting with the principles that he read out from the Second Reading speech which I made to the House. However, until that condition is proved, it does not seem to me at this stage that any case has been made out for accepting the Amendment.On the contrary, it might give rise to resentment in other quarters. Hon. Members will remember that when the National Health Services scheme was being shaped, a great many of my hon. Friends on this side of the Committee took exception to benefits to different classes of patients in the public service hospitals. They always felt there was a danger that if there were some patients who were paying patients as against those who were free, there would be a tendency to discrimination inside the service itself and create a two tier system of treatment. Whilst admitting that there might be some danger of that, I myself nevertheless believed that by administrative action we could prevent not only discrimination but a sense of discrimination, and I still believe that is true. It is of course a fact that there is a hangover from the past and that certain habits of mind will take some time to eliminate. Nevertheless, I believe the tendencies are all in a healthy direction and that before very many years are over there will not be any sense of discrimination or unfairness in the hospital administration. The hon. Member is surely at fault when he says that injustice is being done. The persons who are taking advantage of Section 5 are doing so by their own election. He says that it is unfair that they should be charged twice, but it is not we who are the cause of that but they themselves. They make their contribution through the taxes to the National Health Service and then they elect to go outside the service. They are provided with a public service but they go outside the free service. It is only by physical association that it can be said to be outside the public service. It is outside the free public health service. I know this has been argued again and again. It cannot be said that injustice has been done to people in those circumstances, because the free Health Service is available to them. If they like to go outside the free service that is a matter of their own choice.
Would my right hon. Friend have regard to the fact that there is great delay in some hospitals in the patients securing immediate treatment, and that therefore some patients elect to be treated privately because they can get into hospital much more quickly in that way?
The answer is that that always was the case, even more so than today. In any case, I should be very unhappy to learn that anybody had been able to pay his way into hospital ahead of another patient who could not afford to do the same.
It is done regularly.
I am unhappy to hear about it. If my hon. Friends would give me particulars I should like to know more about it. It is understood that patients are admitted to hospital primarily on grounds of medical urgency. Cases might arise, I admit, of two patients in the same degree of medical urgency, one able to go into the private, paid-bed block, because a bed would be there, and the other unable to do so. I admit that that might happen, but what my hon. Friends have said is no argument for accepting the Amendment. It merely means that we must go ahead and provide additional hospital accommodation. When it is available these anomalies will disappear.On the point whether an injustice is being done to the private patient, it seems to me that an injustice would be done to the Health Service as a whole if we charged a private patient less than it costs to maintain him. Why should the public service subsidise the person who has elected to be a private patient? If it can be made out in principle that there should be a subsidy at all, what should be the proportion of subsidy? If I admitted that there should be any subsidy at all from the public to private patients, no matter how small that subsidy, it would then be argued that I had conceded the principle itself. Then, if by some unhappy chance an Administration of a different political character took our places here, the charge to the private patient might be reduced still further on the ground that we had already admitted that the private patient ought not to pay the full charge. Surely the fair principle is that if a person has elected to go into the private, pay-bed block, he should pay the full charge. Where the individual concerned is anxious to obtain privacy as an additional amenity, he may be able to do so. As the hon. Member opposite knows, such amenity beds are being increased. All over the country it is becoming easier for persons to purchase privacy. It always seemed to me to be reasonable, until we can provide perfect conditions for everybody, that persons who want privacy in hospital should be able to obtain it. They get the rest of the service free, but they pay for the additional amenity of privacy.
Would the right hon. Gentleman agree that in those cases they are not likely to have the benefit of the doctor of their choice?
I said that they are paying only for the amenity in such a case. The hospital staffs are available to them. I think it will be discovered before very long by most people that when they pay for the separate specialist of their choice they are having exactly the same one as they would have had in the free ward, and that therefore they are paying for something which they are not in fact enjoying.I hope that hon. Gentlemen opposite will realise that their Amendment would have the effect of increasing the cost of the National Health Service. I am continually being criticised about the cost of the service, but almost every time an Amendment is moved from the other side it is a proposal to increase that cost. Hon. Members opposite cannot have it both ways. The present practice is one of the ways in which administrative cost is kept down.
I should like to put two considerations to the Minister which have not so far arisen in the speeches made to the Committee on this point. I agree with him that it is as well that we should try to keep the discussion of this subject on the basis of the Health Service rather than on a political basis. I think also we can say that there has been no misuse of the provisions of Section 5 in regard to paying for accommodation in hospital. Taking the hospital service as a whole, I am certain that medical priority determines whether beds are given to any particular patient or not. It is only when that principle has been satisfied that the paying patient can have any advantage.The two points that I would put to the Minister are these. One of the principles of the service has been the free choice of the doctor by the patient. On the whole, that principle operates fairly in the general practitioner service. Once every six months, I think it is, a dissatisfied patient has the opportunity to change his doctor. Free choice of doctor does not operate in relation to hospital specialist services, except under a very heavy penalty. The only way to get a specialist of our choice in hospital is by becoming a Section 5 patient and paying the full cost of the bed into which we go.
And the specialist's fee.
Yes; on top of that you pay the specialist's fee.
Is the hon. Member suggesting that free choice of specialist existed before the Health Service came into operation? It was most uncommon for a patient to know anything about the specialist, except in a very small proportion of cases.
I would go a very long way with the hon. Gentleman, but would add that the free choice of specialist was in that the general practitioner made his recommendation to the patient by saying, "You ought to see so-and-so." In the majority of cases the patient accepted that advice. That situation has completely disappeared now. When the patient goes into hospital he has either to accept the specialist who goes with the bed or to take the specialist chosen by himself or recommended by his general practitioner, in which case the only way is by paying the full cost. The principle of free choice of doctor is being greatly violated by the conditions tied to certain Section 5 beds, but they are laid down in the Act.4.30 p.m. The second point I wish to put to the Minister is much more pertinent to the Amendment. In the country there are something like 500 hospital management committees, and there are probably 1,500 or 2,000 individual hospitals to which Section 5 may apply. Each of those hospitals has to make its own calculation and arrive at its own weekly figure for Section 5 charges. It is not even that each hospital management committee can fix a figure for these beds. We have something like 1,500 possible variations in the weekly charge according to the upkeep costs of each institution. I saw figures the other day showing weekly charges varying from £8 to £12, and I was told today of charges which are considerably higher than £12 a week for the beds. It does not seem to be satisfactory that in a national scheme patients coming into Section 5 beds should have to pay fees varying from £8 to £15 or £16 a week—
Even £20 a week.
my hon Friend says £20 a week—according to the chance of the overhead costs of the hospital which they enter.If we are to keep the Section 5 principle the least that can be done is for the Minister to fix a standard charge for all hospitals and not to leave it to the luck of the administration—whether it is a new hospital or an old one—as to whether the charges are high or low. I am rather surprised that the Minister is not prepared to accept the powers in the Amendment which would enable him to equalise charges which at present vary by 100 per cent. I hope he will give this matter further consideration if only on the basis that we ought not to present people in the National Health Service with charges varying from £8 to £20 for identical accommodation.
It seems to me that the Minister is a little complacent about the danger of discrimination under the present arrangement. Under Section 4 we have the right to set up amenity beds and the patients will pay a small sum for a certain amount of privacy. Under Section 5 we have the pay beds, and in this case the patient pays 10, 12 or 14 guineas a week for the service and at the same time has to pay the specialist's private fees. That is all right, but it seems to me that if the Opposition are complaining about high charges for pay beds, the solution is not to reduce the cost of pay beds and make them more popular, but to develop amenity beds faster than is being done at present.I have a very close relative who had to go into hospital in the London area last week. There was not a single amenity bed in the hospital although there were a large number of private pay beds. I believe that this is common all over the London area. The patient wanted privacy. The only way she could get it was by paying 10 guineas a week for a private bed plus 50 guineas specialist's fees. There are not enough amenity beds. Would it not be a solution to the problem to reduce the number of pay beds and hand them over for use as amenity beds? I believe that to be the right approach, and I hope the Minister will look into this. I want to point out that this does not happen in my division. In the Wolverhampton Royal Hospital we have no private pay beds, and I should like that to be the case in the London area.
I do not know what this is if it is not an extension of the amenity bed principle. The Minister says that it is right to develop amenity beds and right that a small charge should be made for them, but that when it comes to the provision of extra services on top of that, amenity bed patients are in some degree private patients, and he turns his back on the whole thing and says that the whole cost, including what is provided by the National Health Service, should be borne by the private patient. The Minister was not consistent in his argument. At first he inveighed against the whole principle of private practice in the hospital and then he turned to Section 4 which admits half the principle already. I should have thought that the Amendment only sought to extend the amenity bed principle and to provide that where specialists are brought in and extra services are given, there should still be subtracted that part of the cost provided by the general hospital service.The Minister welcomed privacy and said that it must be provided and a little addition must be paid by the patient. What follows privacy? Why should there not be special accommodation, such as slightly more comfortable beds? There can be no objection to that. Why does the Minister stop at privacy? Why does he not accept the principle that there should be a sector of private payment to apply to the whole range of the services right up to the private ward and the consultant and specialist? We ask for that and nothing more. The Minister has destroyed the principle by admitting what is already in Section 4.
The Committee will be aware that in many cases it is easy for people who have money at their disposal to buy their way out of the queue and obtain preferential admission to special beds or blocks in various institutions. Would it not give the case away completely if we agreed to the Amendment? There are complaints in many parts of the country about the ever-growing cost of the private beds in the pay bed blocks. There are complaints in my city that probably in the near future the cost will be £20 a week, a figure which it is almost impossible for many of the present occupants of the beds to pay. Those complaints are followed by the suggestion that the Minister should arrange, as the Amendment suggests, to subsidise this section of hospital work. It was with considerable gratification that I heard the Minister say categorically that he is not prepared in any circumstances to subsidise this hospital accommodation. The pressure of the demand for these pay beds has shown no reduction, and even if the pressure declined I suggest that that accommodation should be transferred for ordinary hospital purposes, thus extending the accommodation for people who certainly cannot afford to pay the sums which will shortly be asked of them for this accommodation.
I merely wish to answer one point made by the Minister, that this proposal would increase the cost of the service. On the face of it that would appear to be so, but I believe that in practice it would have exactly the opposite effect, for this reason. A large number of people are anxious to be treated as private patients when they become sick and, when they enter hospital, would prefer to make a reasonable payment for their beds and to pay a reasonable fee for their specialist or consultant. Many, however, are people of moderate means who could not find a large sum, so when it is a question of finding the amount required to pay a specialist's fee, and on top of that they have to pay 20 guineas a week for perhaps four or five weeks, they cannot face it. All they can do is to go into the hospital completely free, without making any contribution whatever, instead of paying some reasonable amount, perhaps five guineas or 10 guineas a week for accommodation and services while in the hospital.If the right hon. Gentleman would look into the question, I am certain he would find that he could expand the area in which hospitals could admit paying patients, and that the net result to the service would be to derive a larger financial benefit than the service would suffer by reason of any immediate reduction.
I think it would be fair comment on this Amendment to say that it is inopportune. Although a case could be argued for it, and some of us on this side of the Committee might feel a good deal of sympathy with it, yet when the resources of the Minister are limited, as we all know they are, they should be concentrated where the need is greatest. For the moment we should not introduce into the framework of the Bill these little ancillary frills which are not as desperately urgent as the main work that lies ahead. Perhaps in a few years time this Amendment may be worthy of fuller consideration but, in the meantime, it is the duty of the Minister to concentrate all his efforts where the need is greatest.
It is important that we should not do anything this afternoon which would tend to encourage an increasing demand for private beds, treated by private specialists in hospitals to the detriment of the general Health Service patient who desires to have treatment. In London particularly there is a serious shortage of accommodation in most of our hospitals for the Health Service patient who cannot afford to pay for an amenity bed and a specialist's fee. Consequently there is a fairly long waiting list in some areas, people are having difficulty in getting in as Health Service patients, and too often it is the practice to persuade such persons to sign a document agreeing to be private patients of the specialist.A case recently brought to my notice involved a lady who, unable to get into her local hospital as a Health Service patient because of the long waiting list, was persuaded by a private doctor to become a private patient of the specialist. Because she was in pain she elected to do this. She was taken into hospital and after treatment her husband was presented with a bill, which he cannot afford to pay, for 50 guineas, together with the full charge of the pay bed. There is another way of helping patients apart from reducing the maintenance charge for the use of pay beds in hospitals. If hon. Gentlemen opposite could persuade the specialists to reduce their fees a little to poor people, that would help considerably in overcoming the difficulty which they themselves have adumbrated this afternoon, whereas this Amendment would tend to encourage the increasing demands upon hospital accommodation for private patients to the detriment of poorer people who cannot afford the specialist service.
I want to ask a question, Mr. Bowles, if I may be allowed to do so at this point. My experience is exactly the same as that of the hon. Members for East Wolverhampton (Mr. Baird) and for Acton (Mr. Sparks). I speak with feeling because it concerns a near relative of mine in the City of London. Is it not wrong that a person, who when in great pain agreed to pay three guineas a day for a private bed in a hospital, should not be notified that the specialist service is to be paid for, and should receive a bill for £25 two weeks later? In the case I have in mind, the individual concerned wrote to the general practitioner three times to ask what was the origin of it and why he was not notified before, and he did not even receive a reply. The bill has to be paid, but it seems to me to be an abuse of the present situation.I am not speaking necessarily for this Amendment but I am saying that the situation in London at present is being abused—
I am sorry to interrupt the hon. Member who is not speaking to this Amendment. It does not refer to specialists or doctors, but to accommodation.
Indeed I am speaking about the service, which includes specialist service. That is half the point of the Amendment, Mr. Bowles.
With respect, I doubt very much whether it does. I think it comes later, when the Bill will be considered on Report stage.
The point made by the hon. Member for Acton (Mr. Sparks) is met completely by the proviso to Section 5 (1) of the 1946 Act. The risk to which he drew attention really is an impossibility if the Minister carries out the express words of the Act. I am not questioning for one moment that the hon. Member thought he had a point which was perfectly germane to the Amendment, but really it does not tell one way or the other as regards the Amendment before the Committee. Having said what I thought needed pointing out, I do not wish to intervene further in a matter which has been dealt with by those who have far greater knowledge of the working of the hospitals than I have.
May I interrupt the proceedings for a moment in order to give a piece of information? I asked for an investigation to be made—not an exhaustive one because that would have occupied too much time and clerical work, but a spot investigation of the number of free patients in pay bed blocks in order to check to what extent free patients were not admitted on medical grounds entirely to these blocks. My information is that at least 40 per cent. of the pay bed blocks are occupied by free patients, which is itself a tribute to the way in which the administration is carrying out the terms of the Act.
On a point of information, would my right hon. Friend say what he means by a free bed patient? Does he mean that the patient pays for the bed only?
I was referring to Section 5 beds—that is to say, where in ordinary circumstances, if a bed is occupied by a fee-paying patient, both the bed and the specialist fees are paid.May I be permitted to reply to the question of the hon. Member for the Combined English Universities (Mr. K. Lindsay), because it was a point of some substance? I sent out some time ago an instruction that the patient was to be informed by the general practitioner or the specialist, or both, whether in fact he was to be treated under the National Health Service or as a fee-paying patient. That is to say, the patient ought not to be unaware of his position and subsequently be confronted with bills. It is the obligation of the doctor, to inform, or to ask, the patient whether he or she wishes to be treated as a free patient or as a fee-paying patient. I should be grateful for examples of where this procedure is not being followed, for it is obviously a monstrous hardship on a patient who has been assuming throughout that he or she was being treated inside the free service to be faced with heavy bills.
Is it in order for any medical practitioner or specialist to promise that a person can get into hospital for treatment sooner and quicker by becoming a private patient?
It is not proper to do so. It is the duty of the hospital authorities to admit patients on medical grounds and, where medical grounds are satisfied, to admit patients into the free bed block. The figures I have given show that in most cases this has been carried out. I hope that where it is not being carried out, this Debate will be read by the hospital authorities concerned, because it is an abuse of the service not to follow this procedure.
The right hon. Gentleman, if he will allow me to say so, has this afternoon been very concilatory—I might even say, unusually concilatory. If the force of his arguments equalled the gentleness of his manner, we should not have to ask the Committee to divide on the Amendment, but I cannot see that in either his opening speech or the explanation he has just given there is anything which really justifies him in rejecting the Amendment. I should like to examine some of the arguments which he has given to the Committee. He said that there was no evidence of any increase in the demand for private nursing homes. Of course, he is a far better judge than we are of what the evidence is. He said also that if there were evidence, then, of course, he would have to reconsider the position and possibly accept proposals of this kind. Whether or not evidence exists at this moment, it is surely quite clear that if the existing tendencies continue and if prices continue to rise, the private patient will be effectively driven out of the National Health Service hospitals—the public hospitals—and that these nursing homes are bound to come into being. That seems to me to be inevitable.One point which the Minister made seems to me to be, not disingenuous, but very one-sided. He said that, after all, even if the choice which private patients in Section 5 beds had to make was a hard one, the choice was free. Of course, that is perfectly true. Patients know when they go into private beds of this kind that they will be called upon to pay twice. In a sense, as the right hon. Gentleman said, the choice which faces somebody going into a Section 5 bed is a free choice. He knows that if he goes into that private bed he will be asked to pay double: he will be asked to pay as a taxpayer and as a subscriber to the social security scheme—
He does that.
—and he will be asked to pay the whole charge of the private bill That, in a sense, is a free choice, but the framework of that choice is not free. It would be equally a free choice if one were to say to somebody, "You can either have nothing or you can have bread and water." The choices that the right hon. Gentleman poses are unfair choices compared with the choice posed to the ordinary citizen who does not go into a Section 5 bed. If it is the case, as, I think, the right hon. Gentleman will admit, that the patient is in a sense paying twice over, both as a citizen and as a private patient, the argument of the right hon. Gentleman would be equally sound if the patient were paying four or ten times over.
Or if he goes to a nursing home.
Or if he goes to a nursing home. In fact, the Minister is presenting the private patient with a choice whit is hard by comparison to the choice presented to the public patient.
That happens right throughout the service. A person can go to a dentist and either pay for his treatment or have it under the free service; or he can go to an ophthalmic optician and either pay for his spectacles or have them free. He can do that throughout the whole service. It is the individual consumer of the service who decides into which category he is to place himself.
The individual consumer of the service may be obliged to go into hospital, but the choice with which the Minister presents him is, surely, not a fair one, because he could have presented him with the other choice—the same choice, for example, as is presented to the people who use the amenity beds of Section 4. The right hon. Gentleman said that it would be wrong to charge the private patient less than the cost of the service. I will not suggest to him that that is begging the question, because everybody who goes into hospital is charged less than the service costs—that is the purpose of the National Health Service; people who are unfortunate enough to become ill and need hospital attention get it as a right and without paying the whole charges.All we are asking under the Amendment is not that the private patient should be specially treated, but that he should be treated in exactly the same way as the public patient. We are not asking that he should get his private accommodation for nothing; all we are asking is that whatever hypothetical allowance might be made for the public patient, whatever his costs might be, that amount might be deducted from the sum which is chargeable to the private patient. We are not asking that the private patient should have special privileges. We are asking that he should have exactly the same privileges as the public patient. The last point made by the right hon. Gentleman on the increase in the cost of the National Health Service was a very neat and fairly obvious debating point, but I think it was disposed of by my hon. Friend the Member for South Hendon (Sir H. Lucas-Tooth). The fact remains that if through increasing costs the private patient is driven out of the private ward, the contribution which he would make to the National Health Service will disappear, and, therefore, the cost of the National Health Service will go up, and not down. I should have thought that there were strong arguments, on grounds of both national and administrative economy, for accepting the Amendment, for I am sure that in the long run the charge on the taxpayer would diminish and not increase, as the right hon. Gentleman seemed to imagine.
I think that the Committee might come to a decision.
I am surprised at the arguments used by the other side of the Committee, because the plea which is made is that the National Health Service should become a private service for private individuals with a discrimination in favour of the wealthy. As one who has just had experience of both the National Health Service and private beds in a teaching hospital and one in an exempted hospital, I think that the whole of the argument used here today is in favour of discrimination for the wealthy patient.The Act is working well, and the first thing the Minister has to see is that any discrimination should be on medical grounds; secondly, that any further discrimination should be on amenity grounds, from the point of view of the patient having solitude and so on, and thirdly, that if a patient has additional amenities and chooses a specialist, for which he has to pay he should also have to pay for his bed. We should have no further extension of the paying beds system by which certain patients can get additional benefits. This subject is controversial and has been fought out in the medical profession. The professional men have decided in favour of the Act as it stands. I know them and am in close touch with the profession, and I know how the profession is feeling on this matter. The Opposition should think twice before they press for a system of this kind, which is so contrary to the whole Act.
Question put, "That those words be there inserted."
The Committee divided: Ayes; 139; Noes, 256.
Division No. 250.]
|Agnew, Cmdr. P. G.||Harden, J. R. E.||Peto, Brig. C. H. M.|
|Amory, D. Heathcoat||Harris, F. W. (Croydon, N.)||Pickthorn, K.|
|Baldwin, A. E.||Harvey, Air-Comdre A. V.||Ponsonby, Col. C. E.|
|Barlow, Sir J.||Head, Brig. A. H.||Poole, O. B. S. (Oswestry)|
|Baxter, A. B.||Henderson, John (Cathcart)||Price-White, D.|
|Beamish, Maj. T. V. H.||Hinchingbrooke, Viscount||Raikes, H. V.|
|Bennett, Sir P.||Hollis, M. C.||Reed, Sir S. (Aylesbury)|
|Birch, Nigel||Holmes, Sir J. Stanley (Harwich)||Roberts, P. G. (Ecclesall)|
|Bowen, R.||Howard, Hon. A.||Roberts, W. (Cumberland, N.)|
|Bower, N.||Hudson, Rt. Hon. R. S. (Southport)||Robertson, Sir D. (Streatham)|
|Boyd-Carpenter, J. A.||Hutchison, Lt.-Cm. Clark (E'b'rgh, W)||Robinson, Roland (Blackpool, S.)|
|Bracken, Rt. Hon. Brendan||Jarvis, Sir J.||Ropner, Col. L.|
|Bromley-Davenport, Lt.-Col. W.||Jeffreys, General Sir G.||Ross, Sir R. D. (Londonderry)|
|Buchan-Hepburn, P. G. T.||Jennings, R.||Sanderson, Sir F.|
|Butcher, H. W.||Joynson-Hicks, Hon. L. W.||Savory, Prof. D. L.|
|Butler, Rt. Hn. R. A. (S'ffr'n W'ld'n)||Keeling, E. H.||Scott, Lord W.|
|Carson, E.||Lancaster, Col. C. G.||Shephard, S. (Newark)|
|Channon, H.||Law, Rt. Hon. R. K.||Shepherd, W. S. (Bucklow)|
|Clarke, Col. R. S.||Legge-Bourke, Maj. E. A. H.||Smiles, Lt.-Col Sir W.|
|Cl fton-Brown, Lt.-Col. G.||Lennox-Boyd, A. T.||Smith, E. P. (Ashford)|
|Corbett, Lieut.-Col. U. (Ludlow)||Linstead, H. N.||Smithers, Sir W.|
|Crookshank, Capt. Rt. Hon. H. F. C.||Lipson, D. L.||Snadden, W. M.|
|Crosthwaite-Eyre, Col. O. E.||Lloyd, Maj. Guy (Renfrew, E.)|
|Crowder, Capt. John E.||Lloyd, Selwyn (Wirral)||Spearman, A. C. M.|
|Darling, Sir W. Y.||Low, A. R. W.||Spence, H. R.|
|De la Bère, R.||Lucas-Tooth, Sir H.||Stewart, J. Henderson (Fife, E.)|
|Digby, S. Wingfield||Lyttelton, Rt. Hon. O.||Stoddart-Scott, Col. M.|
|Donner, P. W.||Macdonald, Sir P. (I. of Wight)||Strauss, Henry (English Universities)|
|Dower, Col. A. V. G. (Penrith)||McFarlane, C. S.||Stuart, Rt. Hon. J. (Moray)|
|Drayson, G. B.||Mackeson, Brig. H. R.||Sutcliffe, H.|
|Drewe, C.||McKie, J. H. (Galloway)||Taylor, Vice-Adm. E. A. (P'dd't'n, S.)|
|Dugdale, Maj. Sir T. (Richmond)||Maclean, F. H. R. (Lancaster)||Thomas, Ivor (Keighley)|
|Duncan, Rt. Hn. Sir A. (City of Lond.)||Macpherson, N. (Dumfries)||Thorneycroft, G. E. P. (Monmouth)|
|Eccles, D. M.||Maitland, Comdr J. W.||Thornton-Kemsley, C. N.|
|Eden, Rt. Hon. A.||Manningham-Buller, R. E.||Turton, R. H.|
|Elliot, Lieut.-Col. Rt. Hon. Walter||Marshall, D. (Bodmin)||Wadsworth, G.|
|Erroll, F. J.||Mellor, Sir J.||Wakefield, Sir W. W.|
|Fleming, Sqn.-Ldr. E. L.||Molson, A. H. L.||Webbe, Sir H. (Abbey)|
|Fox, Sir G.||Morris, Hopkin (Carmarthen)||Wheatley, Colonel M. J. (Dorset, E.)|
|Fraser, Sir I. (Lonsdale)||Morris-Jones, Sir H.||White, Sir D. (Fareham)|
|Fyfe, Rt. Hon. Sir D. P. M.||Mott-Radclyffe, C. E.||Williams, C. (Torquay)|
|Galbraith, T. G. D. (Hillhead)||Nicholson, G.||Williams, Gerald (Tonbridge)|
|Gates, Maj. E. E.||Nield, B. (Chester)||Willoughby de Eresby, Lord|
|Glyn, Sir R.||Noble, Comdr. A. H. P.||Winterton, Rt. Hon. Earl|
|Gomme-Duncan, Col. A.||Odey, G. W.||Young, Sir A. S. L. (Partick)|
|Grimston, R. V.||O'Neill, Rt. Hon. Sir H.|
|Hannon, Sir P. (Moseley)||Orr-Ewing, I. L.||TELLERS FOR THE AYES:|
|Mr. Studholme and Major Conant.|
|Albu, A. H.||Brown, T. J. (Ince)||Dodds, N. N.|
|Allen, A. C. (Bosworth)||Bruce, Maj. D. W. T.||Donovan, T.|
|Allen Scholefield (Crewe)||Burden, T. W.||Driberg, T. E. N.|
|Alpass, J. H.||Burke, W. A.||Dye, S.|
|Anderson, A. (Motherwell)||Butler, H. W. (Hackney, S.)||Ede, Rt. Hon. J. C.|
|Attewell, H. C.||Carmichael, James||Edwards, Rt. Hon. Sir C. (Bedwellty)|
|Austin, H. Lewis||Champion, A. J.||Edwards, Rt. Hon. N. (Caerphilly)|
|Awbery, S. S.||Chater, D.||Evans, Albert (Islington, W.)|
|Ayles, W. H.||Chetwynd, G. R.||Evans, E. (Lowestoft)|
|Ayrton Gould, Mrs. P.||Cluse, W. S.||Evans, John (Ogmore)|
|Bacon, Miss A.||Cobb, F. A.||Evans, S. N. (Wednesbury)|
|Baird, J.||Cocks, F. S.||Ewart, R.|
|Balfour, A.||Collindridge, F.||Fairhurst, F.|
|Barnes, Rt. Hon. A. J.||Colman, Miss G. M.||Farthing, W. J.|
|Barton, C.||Cook, T. F.||Fernyhoush, E.|
|Battley, J. R.||Cooper, G.||Forman, S. C.|
|Bechervaise, A. E.||Corlett, Dr. J.||Fraser, T. (Hamilton)|
|Benson, G.||Cove, W. G.||Freeman, Peter (Newport)|
|Bevan, Rt. Hon. A. (Ebbw Vale)||Crawley, A.||Gallacher, W.|
|Bing, G. H. C.||Cullen, Mrs.||Ganley, Mrs. C. S.|
|Binns, J.||Daggar, G.||Gibson, C. W.|
|Blackburn, A. R.||Daines, P.||Gilzean, A.|
|Blenkinsop, A.||Davies, Edward (Burslem)||Glanville, J. E. (Consett)|
|Blyton, W. R.||Davies, Harold (Leek)||Gooch, E. G.|
|Boardman, H.||Davies, Haydn (St Pancras, S. W.)||Goodrich, H. E.|
|Bowden, H. W.||Davies, R. J. (Westhoughton)||Greenwood, Rt. Hon. A. (Wakefield)|
|Braddock, T. (Mitcham)||Deer, G.||Greenwood, A. W. J. (Heywood)|
|Brook, D. (Halifax)||Delargy, H. J.||Grey, C. F.|
|Brooks, T. J. (Rothwell)||Diamond, J.||Grierson, E.|
|Broughton, Dr. A. D. D.||Dobbie, W.||Griffiths, D. (Rother Valley)|
|Griffiths, Rt. Hon. J. (Llanelly)||Mallalieu, J. P. W. (Huddersfield)||Sharp, Granville|
|Griffiths, W. D. (Moss Side)||Mann, Mrs. J.||Shurmer, P.|
|Guest, Dr. L. Haden||Manning, Mrs. L. (Epping)||Silverman, J. (Erdington)|
|Gunter, R. J.||Mathers, Rt. Hon. George||Silverman, S. S. (Nelson)|
|Hairs, John E. (Wycombe)||Medland, H. M.||Simmons, C. J.|
|Hamilton, Lieut.-Col. R.||Mellish, R. J.||Skeffington-Lodge, T. C.|
|Hannan, W. (Maryhill)||Messer, F.||Skinnard, F. W.|
|Hardy, E. A.||Mitchison, G. R.||Smith, H. N. (Nottingham, S.)|
|Harrison, J.||Monslow, W.||Smith, S. H. (Hull, S. W.)|
|Hastings, Dr. Somerville.||Moody, A. S.||Snow, J. W.|
|Henderson, Joseph (Ardwick)||Morgan, Dr. H. B.||Sorensen, R. W.|
|Herbison, Miss M.||Morley, R.||Sparks, J. A.|
|Hobson, C. R.||Mort, D. L.||Stewart, Michael (Fulham, E.)|
|Holman, P.||Moyle, A.||Stubbs, A. E.|
|Holmes, H. E. (Hemsworth)||Nally, W.||Summerskill, Rt. Hon. Edith|
|Houghton, Douglas||Naylor, T. E.||Sylvester, G. O.|
|Hoy, J.||Neal, H. (Claycross)||Symonds, A. L.|
|Hubbard, T.||Nicholls, H. R. (Stratford)||Taylor, H. B. (Mansfield)|
|Hudson, J. H. (Ealing, W.)||O'Brien, T.||Taylor, R. J. (Morpeth)|
|Hughes, Emrys (S Ayr)||Oldfield, W. H.||Taylor, Dr. S. (Barnet)|
|Hughes, H. D. (W'lverh'pton, W.)||Oliver, G. H.||Thomas, D. E. (Aberdare)|
|Hynd, H. (Hackney, C.)||Orbach, M.||Thomas, John R. (Dover)|
|Hynd, J. B. (Attercliffe)||Paling, Will T. (Dewsbury)||Thurtle, Ernest|
|Irving, W. J. (Tottenham, N.)||Pannell, T. C.||Tiffany, S.|
|Janner, B.||Pargiter, G. A.||Timmons, J.|
|Jeger, Dr. S. W. (St. Pancras, S. E.)||Parker, J.||Tolley, L.|
|Jenkins, R. H.||Paton, Mrs. F. (Rusholiffe)||Turner-Samuels, M.|
|John, W.||Paton, J. (Norwich)||Ungoed-Thomas, L.|
|Jones, D. T. (Hartlepool)||Peart, T. F.||Vernon, Maj. W. F.|
|Keenan, W.||Piratin, P.||Viant, S. P.|
|Kenyon, C.||Platts-Mills, J. F. F.||Wallace, G. D. (Chislehurst)|
|Key, Rt. Hon. C. W.||Poole, Cecil (Lichfield)||Wallace, H. W. (Walthamstow, E.)|
|Kinghorn, Sqn.-Ldr. E.||Popplewell, E.||Warbey, W. N.|
|Kinley, J.||Porter, E. (Warrington)||Watkins, T. E.|
|Kirby, B. V.||Porter, G. (Leeds)||Watson, W. M.|
|Kirkwood, Rt. Hon. D.||Price, M. Philips||Webb, M. (Bradford, C.)|
|Lang, G.||Pritt, D. N.||Wells, P. L. (Faversham)|
|Lavers, S.||Proctor, W. T.||Wheatley, Rt. Hn. John (Edinb'gh, E.)|
|Lee, F. (Hulme)||Pryde, D. J.||White, H. (Derbyshire, N. E.)|
|Lee, Miss J. (Cannock)||Pursey, Comdr. H.||Whiteley, Rt. Hon. W.|
|Leonard, W.||Randall, H. E.||Wilkins, W. A.|
|Lewis, A. W. J. (Upton)||Ranger, J.||Willey, O. G. (Cleveland)|
|Logan, D. G.||Rankin, J.||Williams, D. J. (Neath)|
|Longdon, F.||Reeves, J.||Williams, J. L. (Kelvingrove)|
|Lyne, A. W.||Reid, T. (Swindon)||Williams, W. R. (Heston)|
|McAdam, W.||Rhodes, H.||Willis, E.|
|McEntee, V. La T.||Richards, R.||Wills, Mrs. E. A.|
|McGhee, H. G.||Ridealgh, Mrs. M.||Woodburn, Rt. Hon. A.|
|Mack, J. D.||Robertson, J. J. (Berwick)||Woods, G. S.|
|McKay, J. (Wallsend)||Robinson, Kenneth (St. Pancras, N.)||Wyatt, W.|
|Mackay, R. W. G. (Hull, N. W.)||Ross, William (Kilmarnock)||Yates, V. F.|
|Maclean, N. (Govan)||Royle, C.||Zilliacus, K.|
|McLeavy, F.||Sargood, R.|
|MacPherson, Malcolm (Stirling)||Scollan, T.||TELLERS FOR THE NOES:|
|Macpherson, T. (Romford)||Scott-Elliot, W.||Mr. Pearson and|
|Mainwaring, W. H.||Segal, Dr. S.||Mr. Richard Adams.|
|Mallalieu, E. L. (Brigg)||Shackleton, E. A. A.|
I beg to move, in page 22, line 9, at the end, to insert:
The purpose of this Amendment is to enable general practitioners to treat private patients in health centres. This proposition has given rise to considerable controversy, and at one time I set my face against it. The reason I did so was because at that time it was uncertain what proportion of the population would actually register with practitioners. Now, however, the number of persons outside the scheme is so infinitesimal that no danger can arise to the structure of the Service as a whole by allowing general practitioners to take their private patients into the health centres when they are available. It would not have been unreasonable that if a general practitioner had a substantial proportion of private patients he should treat them in his own private surgery and go to the health centre to treat his public patients. Also, there was always a doubt in my mind whether, if there was a large number of private patients and a large number of public patients at the health centre, there might not be the danger of discrimination which we have already discussed in connection with the hospital service as a whole. In view of the fact that the number of people outside the Health Service is very small, it would be unreasonable, where a health centre is available, to expect the general practitioner to maintain a private surgery at which to treat his private patients. However, we shall make it quite clear by regulation, when the health centres are available, that there shall be no two doors in the health centre—one through which shall go the private patient and another through which shall go the public patient—because that would create the very atmosphere which we are anxious to avoid. If a person wishes, for some strange reason which I am afraid I cannot distinguish, to attend a private practitioner in a health centre, that private patient must take his proper place along with the general public in seeking the services of his doctor. 5.15 p.m. As I say, we shall, when the time comes, frame regulations so as to prevent a discrimination which I am sure everyone on both sides of the Committee would be anxious to avoid. We shall, of course, also be making provision that a doctor shall have a substantial number of patients in the public scheme before he can avail himself of private facilities at a health centre. If a doctor had a very large number of private patients and a very small number on his list it would be unreasonable for him to be able to use the services of a health centre for his private patients. In the meantime we have had the help and advice of the Central Health Services Council. After having examined the whole matter, they recommend that it should be possible for a general practitioner to treat private patients in a health centre."At the end of paragraph (a) of subsection (1) of Section twenty-one (which requires facilities at health centres to be available for the provision of general medical services), there shall be inserted the words 'and, on such terms and conditions as may be determined by the Minister, for the provision by medical practitioners of such other personal medical services (if any) as may be so determined in the case of a particular health centre.'"
The right hon. Gentleman is currently reported to be taking some fairly realistic decisions about the main issues of our time. I am rather surprised that he should come from that atmosphere into this Committee and construct castles in the air. There are no health centres, as he knows full well. There might be, if the labour to build them had not been fully employed 40 hours a week elsewhere; there might be if it had been possible for the raw materials to build them to be acquired either at home or abroad—and we know that there are no incentives to acquire them operating in our economy.There are no health centres. The Minister's speech was largely irrelevant, although one might well say that this is an additional service which, when the time comes in three or four or five years' time, when this country is in a condition to build these elaborate and costly structures, might fit in with the other subsections in the Section of the Act which detail the content and purpose of these health centres. The main fact of the matter is that this is an irrelevant little Amendment—
On a point of Order. The noble Lord has not yet said a single word about the Amendment. This is not really an argument whether there may be health centres or not or whether there are health centres or not. It is merely an Amendment to make it possible for general practitioners to treat private patients in health centres which do exist.
I was saying that the health centres do not exist. There may be just one experimental health centre which was started years before the Minister had anything to do with the health service. In the last four years, during which he has had full opportunity to build them if he had used his building resources aright, he has not been able to build them. This Amendment is therefore quite irrelevant.
The noble Lord must not say that the Amendment is irrelevant. He can speak either for it or against it, but it has been selected by the Chair and it is relevant to this stage of the Bill.
I would ask the Minister to go a little further on one point which he raised, when he implied that there would be some sort of filter through which the doctor would have to pass if he wished to treat his private patients in a health centre amongst other patients on the doctor's list. He also implied that it would not be possible within the terms of the Amendment, or rather I should say, he did not propose that it should be possible, according to the words in his Amendment, for a doctor with a large proportion of private patients to be able to treat them in a health centre and that it would only be possible if the doctor had a high proportion of patients on his list. If the right hon. Gentleman did not mean that, will he explain what he said?
I was being perfectly frank with the Committee. If they will look at the words, they will see:
I did not want to leave the Committee unaware of what I had in my mind in putting in those words. What I really had in mind was that it ought not to be possible for a general practitioner who would nominally enter the Health Service by having a small list then to do most of his practice, which would be private practice, in the health centre. That would be an abuse of the privilege. I also said originally that there should be an intermingling of both public and private patients in order to prevent unsavoury discrimination."… there shall be inserted the words 'and, on such terms and conditions as may be determined by the Minister.…'"
The second point with which the Minister has dealt is perfectly clear. It is the first point on which I wish he would enlarge if he can. He is fixing in his own mind some sort of proportion between the private patients of a general practitioner and the listed patients. Can he give us any indication of what sort of proportion he is aiming at? I do not want to be meticulous in this matter. Supposing 50 per cent. were private and the other 50 per cent. were listed patients, would that enable him to make use of the health centre? I want some indication. I do not know whether the Minister is able to carry that further.
The answer is that it is really a matter for the House to discuss when the regulations are made. The regulations will be laid before the House. I am merely saying that the reason I am taking the power in the Amendment to make regulations is because I have such a matter in my mind. The proportions will be contained in the regulations, and the House will be in possession of them.
I do not think there will be any difference of opinion about this. It is desirable that, on the whole, both private and public practice should be kept in step with one another. We are all agreed that we must have both forms of practice in a hospital and it is desirable to have both forms in the health centre. The Minister has quite properly suggested that there would have to be certain terms and conditions upon which practitioners might have the advantage of using the health centre for their private patients, but I do not think he said whether this would include financial conditions—
In other words, does he intend—
That will be in the next Amendment.
I think the Minister is going our way. We shall, as he says, see when the regulations are laid how far he is going our way. But a step along the right road is a step along the right road, and we welcome it.
Amendment agreed to.
I beg to move, in page 23, line 8 at the end, to insert:
The purpose of these words is to enable the executive council, when prescribed by the Minister, to make differential charges to general practitioners which will vary with the amount of use they will make of the health centre for their private patients. It is quite clear that the general practitioner will have to pay a charge to the executive council, in the first place because he will have been relieved of the necessity of maintaining his surgery. That is a matter for future discussion with the representatives of the medical profession, and I am sure that those discussions will take place. At the same time, obviously if in addition a general practitioner is earning money at the health centre by treating private patients, it is also reasonable that he pays an additional fee, as rent, because he also will have been relieved of the necessity of providing a surgery. I do not think any general practitioner will quarrel with this. It is merely to take power to make those varying charges when the time comes.In section forty-six (which provides for the use of health centres by practitioners) after the words "general medical services" there shall be inserted the words "or other personal medical services or," after the words "subject to regulations," there shall be inserted the words "and to any determination by the Minister under section twenty-one of this Act," and after the words "the Executive Council may," there shall be inserted the words "subject to any such determination as aforesaid."
Again, we welcome the Minister's step. This is a further step along the right road. He is making private practitioners who are treating a large percentage of private patients rather more eligible tenants of the health centre. It may seem to some rather an extreme measure, but we welcome it, and we only wish that the argument had prevailed on him earlier when we were considering the analogous case of the hospital. If health centres are provided, the further use of them by practitioners for private patients is in line with what we have always argued, but, I should have thought, rather against what has been argued by hon. Members on the other side of the Committee. However, with the powerful influence of the Minister behind it, not merely the Minister but Government supporters are moving our way. We are delighted to see that, and we welcome this Amendment.
Amendment agreed to.
I beg to move, in page 23, line 8, at the end, to insert:
The Committee may be aware that some while ago, I believe it was before the Health Service Act in fact came into operation, my right hon. Friend the Secretary of State for Scotland and myself appointed a Committee to try to weed but the number of certificates which doctors have to provide. It is fairly obvious that a little streamlining can be done in this direction, and that committee, which was known as the Safford Committee, have issued an interim report in advance of its general report in order that some effect may be given to their recommendations."In paragraph (d) of subsection (2) of section thirty-three (which provides for the issue by medical practitioners providing general medical services of certificates reasonably required under or for the purposes of any enactment) after the word 'of,' there shall be inserted the words 'such certificates as may be prescribed being'."
We all welcome anything that will cut down paper work on the part of medical practitioners, but I ask the Committee to look at this for a moment from the point of view of the patient.Section 33 of the 1946 Act gives the Minister power to make regulations for certain purposes under paragraphs (a), (b), (c) and (d). The one we are concerned with is (d):
The Minister is taking power to limit the certificates which may be issued. Looking at it from the point of view of the patient, he may require a certificate for the purposes of some enactment, for some statutory purpose. The Minister is proposing to curtail the freedom of the patient to get that certificate, I suppose, free of charge. That is the effect of any limitation imposed by any regulations. I should like some assurance from the Minister that he has that point in mind; that the effect of powers he is now taking may be to prevent certain patients getting certificates free of charge which they require for the purposes of some statutory enactment. It seems rather a strong thing to do. If it is a certificate for some private purpose that is another matter, but some of these certificates may be for a statutory enactment."for the issue to patients or their personal representatives by medical practitioners providing such services as aforesaid of certificates reasonably required by them under or for the purposes of any enactment."
The words of the original statute are very extensive indeed, and in the opinion of the Safford Committee throw the net far too wide. It would include a certificate required by the Minister of Transport in connection with an application for a licence to act as a conductor of a public service vehicle. That seems to me to be rather wide for a free certificate. As the free certificates required will be listed in the regulations I think that probably will be the time when we can raise this matter.It is necessary to do it one way or another. The Safford Committee have stated that a list of free certificates which can be obtained should be provided and the words of the Statute should not be applied.
I should like to pursue that example. That is presumably the extreme type of case which the Minister would rule out by regulation. Is it not unreasonable that somebody who is making an application—be he the driver or conductor of a vehicle—who is required to produce a certificate of general good health should have to pay for that certificate and should be unable to get it free of charge?
Let us consider that at the time. What we are now considering is not my argument for this or that. We are considering a proposal of the committee set up for the purpose that the free certificates which it should be possible to obtain from a general practitioner should be listed.
Is there any likelihood of the report or the recommendations being published soon?
This is a very complicated matter. I should not like to hurry the committee in its work because it is necessary that when the report is made there should be fairly general acceptance of it. Otherwise, there will be a lot of irritation.
I feel sure that the Committee will welcome what the Minister said about the elimination of unnecessary clerical work on the part of the doctors or any other members of the community. However, there is one point upon which I am a little doubtful. These certificates can mean a great deal to individuals. I gather that there is nothing in this Amendment to prevent a person in ill-health from getting a medical certificate for the purpose of obtaining extra milk, but it behoves the House of Commons when we get a Minister like the present one who suddenly starts streamlining, to be sure that he is not one of those people who will indulge in cuts to an excessive extent. When we get this sudden conversion in favour of cuts in a person like the Minister of Health, we ought to be careful and watch him. At the same time, I congratulate him on this very small beginning towards putting this service on a better administrative footing, because all of us realise that the doctors have to do a tremendous amount of clerical work. I congratulate the Minister on the step he has taken today. Now he will be able to say that he is one of those in favour of bigger and far more drastic cuts.
Will the Minister give a simple assurance that if this Amendment is passed it will not tie the hands of the House of Commons on any future occasion should a wish be expressed for a certain class of certificate seekers to be included in this list?
We shall have to await the report of the committee before we know what the recommendations are likely to be and we shall have to consider the regulations in the light of that report. Obviously we shall be guided very substantially—but not bound—by what they recommend. The committee will always be able to make its observations on whether the list is too wide or too narrow.
Yes, but are we binding the hands of the Minister or of the House of Commons by passing this Amendment?
All we are doing at the moment is amending the original statute by inserting the words:
"such certificates as may be prescribed being."
Will it not be necessary to prescribe the certificates immediately this provision comes into operation? The only certificates available will be those which are prescribed, and therefore it will be necessary to have ready the list of prescribed certificates at the exact moment when this Bill comes into operation.
I do not think that it will be necessary at the exact moment.
I think so.
Amendment agreed to.
I beg to move, in page 26, line 21, at the end, to insert:
"At the end of section fifteen (which requires facilities at health centres to be available for inter alia the provision of general medical services) there shall be added the following subsection:—
This Amendment gives effect to the principle which was discussed in two earlier Amendments in relation to the English Bill dealing with the right of doctors to use health centres for private purposes. Owing to the different structure of the two Acts we have been able to compartment this into a single Amendment. There is no differentiation in principle between the Amendments.'(6) Any medical practitioner providing general medical services at a health centre, may, with the consent of the Secretary of State, make use of the facilities available at the centre for the provision of such other personal medical services on such terms, in- cluding terms as to the payment of charges by the practitioner, and such conditions as the Secretary of State may determine.'"
Of course, we should not seek to debate this matter again. There are several occasions upon which, when a principle has been decided by the Committee, it will obviously apply in our Northern Kingdom as well as south of the Border. Therefore, the Committee having decided upon this in the case of England, we certainly should not wish to make an alteration in the case of Scotland.
Amendment agreed to.
Schedule, as amended, agreed to.
Bill reported with Amendments; as amended (in the Standing Committee and on recommittal), considered.
New Clause—(Prohibition Of Full Time Salaried Dental Practitioner Service)
Subsection (1) of section forty of the Act of 1946 and subsection (1) of section thirty-nine of the Act of 1947, (which require Executive Councils to make arrangements in accordance with regulations for the provision of general dental services by dental practitioners) shall be amended by the addition at the end of each of those subsections of the following provision:
Provided that the remuneration to be paid under such arrangements to a dental practitioner who provides general dental services elsewhere than at a health centre shall not, except in special circumstances, consist wholly or mainly of a fixed salary.
—[ Mr. Bevan.]
Brought up, and read the First time.
I beg to move, "That the Clause be read a Second time."The purpose of this Clause is to carry out in the case of dentists the same guarantees or undertakings that were advanced in the case of general practitioners. It provides that, except at health centres, dentists should never be paid wholly or mainly by fixed salary. There are special exceptions, as there were in the case of general practitioners, but there is no need to explain the matter. It has been asked for by the dental profession and there is no reason why we should not make the provision.
Question put, and agreed to.
Clause read a Second time, and added to the Bill.
New Clause—(Reception Into Mental Hospital Of Person Under Sixteen As Voluntary Boarder)
A person under sixteen years of age shall not be received as a boarder in a mental hospital under section fifteen of the Lunacy (Scotland) Act, 1866, as amended by section fifty-nine of the Mental Deficiency and Lunacy (Scotland) Act, 1913, on his own application, but may be so received on an application by his parent or guardian, and the said section as so amended shall, in its application to any such person, have effect subject to the following modifications—
—[ The Lord Advocate.]
Brought up, and read the First time.
I beg to move, "That the Clause be read a Second time."The purpose of this new Clause is to enable children under the age of 16 to be treated as voluntary patients in mental hospitals on the initiative of their parents or guardians. According to the law at present, the admission of a voluntary patient to a Scottish mental hospital depends on the initiative of the patient himself. By this children under the age of 16 will not be admitted as voluntary patients except on the initiative of the patient. Manifestly, that is wrong in relation to children of tender years; a datum line has to be fixed, and we feel that the age of 16 is the appropriate datum line. By this Amendment, therefore, a child under 16 will now be admitted as a voluntary patient on the application of the parent or guardian. There is a great deal of good remedial work which could be done to such children if they are admitted as voluntary patients, without the need for certification, in cases where they might otherwise be certified, or in other cases where there is no mental condition that would justify certification. The developments in this line of medicine are such that it is desirable that young children should be able to get full advantage as voluntary patients. Reference has had to be made to the previous Acts of 1866 and 1913. According to the original Act of 1866, a voluntary patient could not be received in hospital except with the prior assent in writing of a Commissioner of the Board of Control. The 1913 Act amended that to enable the assent in writing by the Commissioner to be given any time within three days after admission. We feel that, in amending the law, it is desirable that no child under 16 should be admitted as a voluntary patient on the application of the parent or guardian unless, prior to admission, there had been this consent in writing by a Commissioner of the Board of Control. Therefore, that prior assent is now necessary before the child can be admitted. That has been the position in England since 1930, and the child could be admitted as a voluntary patient on the application of the parent or guardian. It has worked very well, and we think that this is one occasion when we might profitably follow the course which has been taken in England.
We offer no objection to the new Clause being added to the Bill. As a rule, as the Lord Advocate will agree, our provisions regarding the voluntary admission to mental hospitals in Scotland have been of a more informal nature than those in England. On the whole, we have taken up a more advanced attitude in that section of therapy, and it is interesting on this occasion to find that England has gone ahead of us. I think it is a sound power to ask for, but, like all powers involving the liberty of the subject, it will need careful supervision. I trust that the consent of the Commissioner of the Board of Control will be sufficient, though some kind of added care will be necessary in such cases as will inevitably arise, though we cannot yet conceive them. At the same time, I think this is a power which may properly be entrusted to the authorities in Scotland, whose enlightened attitude to the treatment of mental cases is recognised throughout the world as being of a more advanced, more humane and more sympathetic character.
I should like to endorse what has been said by my right hon. and gallant Friend. I think the safeguards, and particularly that mentioned by the Lord Advocate in the later part of his speech, will be adequate to meet any kind of possible abuses, but I hope that the right hon. Gentleman and all those concerned in administering this new Clause at the Scottish Office will bear carefully in mind the fact that we are here giving them considerable powers and that we may be opening the door to abuses. I am sure that every hon. Member would wish to guard against these possible abuses. After all, we are giving great powers, which must be very carefully watched in order that there may not be any possible loophole for unscrupulous persons.The kind of case which I envisage is that in which a young child may be left with one parent or may be completely orphaned and placed under the care of guardians who do not care very much about carrying out their onerous responsibilities. I am not for one moment disparaging the good work that has been done in the past and will be done in the future under this new Clause in the treatment of these cases, but the right hon. Gentleman will be aware that there are cases where the guardians of a child may be only too ready to avail themselves of the provisions of this Clause in order to rid themselves of their responsibility, about which they do not care very much. There are also cases in which the parents of children have always wished to spare those children the necessity of being placed in an institution at all, no matter how good the treatment meted out to them in such institutions may be. I am not saying that that is a wise attitude for parents to take up, but we have to accommodate ourselves to these sentimental reasons, and, where we have cases of feeble-minded children, we find that the parents are very touchy indeed. We do not wish to give parents the impression that, if they die and leave behind them weak-minded children, there will be any possibility in the future of their having to face the very thing against which the parents have tried to guard them during their lifetime and of the children being placed in institutions simply because the guardians who were appointed to look after them wished to rid themselves of that responsibility. I think the safeguard concerning the Commissioner's assent will go a long way to meet the point put by my right hon. and gallant Friend, and I hope that those responsible for administering this provision, both under this Government and its successors, will bear in mind the points which we have placed before them.
Question put, and agreed to.
Clause read a Second time, and added to the Bill.
New Clause—(Prohibition Of Part Time Dental Practitioners)
No dental practitioner who is on the list of a Local Executive Committee and is accepting patients under the National Health Service shall be entitled to accept remuneration from private patients.—[ Mr. Baird.]
Brought up, and read the First time.
I beg to move, "That the Clause be read a Second time."I should declare my interest in this matter as a practising dentist, but I should like to point out that I am not speaking as a dentist, but as a Member of this House, not in the interests of the dental profession, but in the interests of a large number of my constituents who are suffering because of the unethical practices of a considerable number of dentists in my division. The new Clause is supported by between 50 and 60 other Members of this House. I wish to make it quite clear, that, when the National Health Service Act was discussed two years ago, I myself and Members on both sides of the House fought for the liberty of the two professions, dental and medical, in being able to treat both private and public patients. I was in favour of that course, and, therefore, it is with some reluctance that I am now moving this new Clause, which will withdraw that right from the dental profession. I make no apology for moving it, however, because, in my opinion, the racket now going on in the dental profession in regard to public patients must be stopped. I want to quote one or two examples of what is going on in my own division at the present time. There is, first of all, Racket No. 1. A patient who is in pain—perhaps it is his own fault, because he ought to have had his teeth cared for earlier—goes along to a dentist and asks to have the tooth removed, and, of course, the pain removed at the same time. The dentist tells him that he is fully booked up for six weeks, a fortnight or perhaps only a week ahead, but that, if the patient comes back after some days, he will see what he can do for him. If the patient offers to pay, the dentist will take the case right away, or within an hour, which immediately cancels out the argument that he was too busy. Racket No. 2, which is very prevalent, arises from the fact that the National Health Service Act is a compromise. Payments are offered to dentists by means of an itemised scale of fees for every operation. According to this scale, some operations pay much better than others. In our efforts to encourage people to save their teeth, we try to induce them to have fillings, and this operation is better paid than that for fitting dentures. A number of dentists are accepting patients who require fillings and refusing those who require dentures, or are telling the latter that they must either wait or have it done privately. The third racket—I am only quoting three—is that of talking down the National Health Service Act. The dentist says to the patient, "If you come to me under the Act, I can only give you a second rate type of treatment, especially with regard to dentures. They are cheap; we cannot supply the best materials. If you want a good job, come to me privately." This sort of thing is going on in spite of the fact that the dentist is being paid to carry out the best possible type of treatment.
Has the hon. Member brought any cases of this sort to the notice of his right hon. Friend?
Perhaps the hon. Gentleman does not know the position as well as I do. I have had particulars of such cases sent to me from all over the country, being, as I am, one of the two dentist Members of this House, but there is great difficulty in proving such cases. The discussion usually takes place between the patient and the receptionist, and not between the patient and the dentist himself. Moreover, most of these things are quite legal in themselves, within the meaning of the Act.As a result of pressure from hon. Members opposite, dentists have the right to treat both private and public patients. I do not know how general is the situation I have described, but, so far as my own division is concerned, I have made a survey from which I would estimate that at least 75 per cent. of dentists are turning away patients in pain unless they are prepared to pay, and I believe that sort of thing is fairly general throughout the country. I once argued that there was only a small minority of the profession carrying out this unethical practice, but I am now convinced that there is a fairly large proportion. I do not know what the solution is, but if the Minister can suggest other ways of stopping or minimising this practice, I shall be only too pleased to hear them. To my mind the real solution is large-scale health centres with a fully salaried dental service. Only in that way shall we stop it. Another temporary way would be for the regulations which allow a patient to make representations to the local executive council to be simplified. They are very cumbersome at the present time and are difficult for the patient to understand. Apart from this new Clause, the only other solution is for the profession itself to discipline its members. When I put down this new Clause some three months ago I received letters from two of the dental organisations. I shall read one of them to the House. It says:
I replied to that letter in a tone which I think hon. Members on both sides will agree was reasonable. I replied:"Our attention has been drawn to the Amendment sponsored by you to the National Health Service Act (Amendment) Bill which, if successful, would deprive dentists on the list of, executive councils from treating private patients. I am instructed to inform you that our association is completely out of sympathy with you in this matter and desires to place on record its strong disapproval of your action. In conclusion, should the proposed Amendment be pursued further, our association will resist it to the utmost."
Up to date, I have received evasive letters from two of the dental organisations, but not one of them has accepted my challenge, and nothing has been printed in any of the dental journals, condemning this attitude and asking dentists to act more ethically. That is the brunt of what I want to say. This sort of position is not due to the fact, as some dentists argue, that they are too busy to treat all these people. I know that dentists are busy and are doing good work, but they are being well paid for doing it. It would not be difficult to organise a system of priorities whereby those suffering pain, and expectant mothers and young children could get immediate treatment under the service. Even if the Minister cannot accept this new Clause just now, I appeal to him to let it go out from this House that its Members condemn the attitude of those dentists who turn away patients in pain unless they are prepared to pay for the treatment they receive."My attitude is well known. I fought with the profession to have the principle of the freedom of the dentist to treat both private and fee-paying patients incorporated in the Act. This right is now, however, being abused and the abuse must be stopped. I would much rather that the dental profession itself disciplined those of its members who are betraying the high standards of the profession, and I am writing this letter to promise you that if the three dental organisations will come out in the open and condemn the unethical practices of some of their members I will withdraw my new Clause tomorrow. If, however, by their silence they condone this degrading of the profession, I have no alternative but to continue my agitation, which I am convinced is in the best interests of dentistry."
I beg to second the Motion.I support this Clause because I think it is important that the matter should be cleared up in the interests and for the benefit of the patient under the National Health Service scheme. Very wide publicity has been given to the provisions of the new Act providing the dental service, and, consequently, a number of people go to the dentist expecting to receive treatment under the scheme and they simply cannot understand why a particular dentist should refuse to treat them in an emergency unless they are prepared to go as private patients and pay the ordinary fee. In the public interest, therefore, it ought to be clearly established that where a dentist is practising under the Act, he only treats National Health Service patients and not private patients. This would mean that those dentists who wanted to pursue a private practice could take the private patients, and those who elected to practise under the Act would look after those people who wish to take advantage of the National Health Service Act. If that were done, it would avoid a great deal of confusion and a great deal of disappointment in the minds of a large number of members of the public who when they go for immediate treatment find they cannot receive it under the scheme. Owing to the sort of practice described by my hon. Friend the Member for East Wolverhampton (Mr. Baird), many of them think that the whole National Health Service scheme is a bit of a fraud. They are quite wrong, we know, but when they go for treatment and find that by the payment of 15s. or £1 they can have extractions straightaway, whereas if they go as National Health Service patients they have to wait anything up to six weeks, they naturally cannot understand the justification of it—nor can anybody in this House. The Minister has had a large number of these cases brought to his attention by hon. Members, including myself, and I receive continuous complaints of this sort of thing from my constituents. That being so, I think that the Minister should lay down quite clearly that those dentists who elect to practise under the Act should confine themselves to treating National Health Service patients. As my hon. Friend pointed out, the dentists are being paid extraordinarily well under the scales laid down by the Minister, and, in view of that fact, I think that they should be prepared to do their very best for the National Health Service patients. Those dentists who do not like the idea of the National Health Service scheme should be left free to practise privately and the public would then know that if they wanted private attention they could receive it by going to such a dentist, and that, on the other hand, if they wished to be treated under the scheme they could receive such treatment by going to a dentist operating the scheme. Such an arrangement would avoid a great deal of confusion and clear up some of the very bad practices which my hon. Friend has brought to the attention of the House and which have now continued for a considerable time, and are likely to continue unless something is done to end them. Some arrangement can surely be come to between my right hon. Friend and the dental profession to clear up this abuse which is taking place in a very large number of dental surgeries throughout the country at the moment.
The Minister of Health has at times accused some of us on this side of the House of stirring up controversy in connection with the National Health Service. It would now appear that some 50 or 60 of his own supporters have stirred up by this new Clause a more acute controversy than anything we have succeeded in doing, because this Clause is like taking an electric drill to an exposed nerve. The hon. Member for East Wolverhampton (Mr. Baird) knew that fact perfectly well6.0 p.m. We on this side of the House are utterly and fundamentally opposed to this new Clause in principle. In the first place, if a Clause of this kind were to be added to the Bill it would be the grossest possible breach of faith with the dentists. They have come into the scheme on the footing that the scheme will allow them to engage both in public and in private practice.
Does not the hon. Member consider that the action of these dentists in turning away patients is a breach of faith with the patients?
I shall say something about that in a minute. The fact remains that the dentists came into the scheme because they were assured that the scheme allowed them to carry on both their private and their public practices. If anything were now done to go back on that, it would certainly be regarded—as indeed it would be—the grossest possible breach of faith with the dentists.The hon. Member for East Wolverhampton spoke of a "racket." Indeed he enlarged upon it, and indicated certain things which would certainly amount to a racket if they occurred. When this scheme was first brought forward in this House I remember putting down a Prayer to annul the order constituting the scheme and arguing on that Prayer that the scheme as presented would necessarily lead to just the sort of complaints which the hon. Member for East Wolverhampton has made this afternoon. We saw then quite clearly that the scheme was bound to create a certain amount of difficulty, which would necessarily mean that certain wrong things would be done under the service. I do not think any hon. Member on either side of the House would have disagreed with the hon. Member for East Wolverhampton if he had said that a number of bad things are being done under this service. It is clear that among the many thousands of dentists, there are some who will take advantage of the present circumstances, but the overriding difficulty of the dental service is that there is a great deal more work to be done than the dentists can possibly do. It is because that fact was apparently overlooked when this scheme was put into operation that we have the present difficulties of which the hon. Member has complained.
If there is an area which is under-doctored, do we say that it is ethical for a doctor there to treat patients who pay him and reject those who cannot afford to do so, even if they are dying?
I am perfectly certain that there are doctors, dentists and professional men of all sorts who are prepared to work 10, 12 and even 15 hours a day for the public good, but I am also certain that there are quite a lot of very respectable professional men who are not prepared to work beyond a certain point for no advantage whatsoever. Under the scheme as it was first introduced, and to some extent still, certain dentists are working far longer hours than they should do. They say to themselves, "I am prepared to work eight or 10 hours a day," or whatever number of hours it may be, "in the public service, and I shall reserve two or three hours for my own private practice." There is nothing unethical about that.It is because that has occurred in a number of cases that certain dentists today are not taking any more patients under the scheme but still have a certain amount of room for private patients. It may be that that is not the highest possible standard of ethics, but it was the result which was bound to follow upon the scheme.
Because it too great a pressure is put—
Who put it?
The right hon. Gentleman. The right hon. Gentleman must have known the number of dentists in existence. He must have had some sort of an idea of the kind of pressure that would be brought to bear on them if a free service were introduced in the whole country in the place of a paying service. I do not wish to pursue that point at great length, but if the right hon. Gentleman really wishes to investigate this subject he might read the Report of the Select Committee on Estimates of this House which shows the position extremely clearly.
Is the hon. Gentleman aware that some dentists devote one day a week to National Health Service patients and keep the rest of the week for private patients? They have plenty of time but they will not take National Health patients on the days which they reserve for private patients. Is that ethical?
The hon. Member has asked me whether that is, ethical—
No doctor would do that.
The hon. Member is getting very hot under the collar.
I am, very.
The right hon. Gentleman has admitted that it is perfectly ethical for a dentist to remain out of the service altogether. If instead of remaining out altogether, he gives one day a week to the service, surely he is, on the whole, doing a better service to the country—
There is a difference between the words "legal" and "ethical."
The hon. Member would be right if he accepts this standard of ethics, that it is right to compel any professional man, whether doctor, dentist, or whatever it may be, to work for the State.
He is working for his patient, not the State.
We are discussing whether he should be compelled to work under a public scheme or whether he should still have the right to work in either capacity, or only to some extent for a private person. It is quite fair for any doctor or dentist to say that he will divide his time between both.
He is breaking his contract.
I cannot really deal with all these interruptions; if I did I should take up the entire time of the House.If this new Clause were added to the Bill every dentist would have to make up his mind whether he would be a dentist in the public service or whether he would carry on a purely private practice. We should, therefore, have two services. The profession would be split completely and there would be no overlapping. That would be entirely and fundamentally wrong. If this service is to be a success it must be linked up with private practice. We shall get only bad results if we have a free public service catering for a certain section of the population and a separate private service for a different section of the population paying fees. I think that can only have bad results and I should deplore its coming into effect. It must be remembered that although this new Clause is applicable only in the case of dentists, if the right hon. Gentleman were to accept it then the principle would be equally applicable all along the line. If we can say that a dentist who enters the service must be compelled to give up his private patients, then we should be equally justified in saying that a doctor who enters the service should be compelled to give up his private patients.
That is not so. The whole point is that the doctors have played the game and the dentists have not.
That is a very interesting interruption from the hon. and learned Member because it would appear that his reasons for supporting the Clause—as I understand he does—is that he intends it as a punitive action against the dentists for what they have done. Is that so?
If the hon. Member is asking me, I want the proper service for the ordinary patient who has toothache. If the position was that the dentists played the game and gave that proper service, when they were doing both private and public patients, as the doctors have done with their patients who are ill, we should say, "Go on with it." They have not played the game and, therefore, we have to adopt other methods.
In other words, the hon. and learned Member simply wishes to visit retribution on the heads of the dentists. Let me remind him of this. The position of the dentist is, in fact, different from the position of the doctor in that the dentist receives a fee whether he takes a public patient or a private patient. I think it is beyond controversy that, even now, the fees paid in respect of public patients are fully as high as those which are paid by private patients.
The hon. Member does not seem to realise that every penny of the dentist's income received from the State is declared to the Income Tax authorities for tax purposes, but that there is no way of checking so far as his private patients are concerned.
There were so many noises coming from the hon. Member's side of the House that I could not hear what he said.
The remuneration received by the dentists from the State is 100 per cent. taxed because it has to be declared, but—and I am making this charge after due consideration—there is a considerable amount of the dentist's private income, at least in a large number of cases, which is not declared because it is so difficult for the Income Tax authorities to prove what is his real income.
The hon. Member is himself a dentist. I have seen a good deal of fouling of one's own nest, but I do not think I have ever seen such an example as this.
I came into this House to represent my constituency, East Wolverhampton, not the dental profession.
Before the hon. Member interrupts me again, I must warn him that I shall not be able to give way any further. He has made a charge against the dentists which, broadly speaking, I believe to be quite unjustified. There are certainly exceptions. Among so large a body of men it would be astonishing if there were not. But the fact remains that these difficulties have arisen because the scheme is top-heavy and did not take account of the tremendous load which would rest upon it. We have these difficulties because of that. If this Clause were accepted, it would be a breach of faith with the dentists and it would be a splitting up of the service into two, which would be a bad thing for the community as a whole. I hope very much that, on behalf of the Government, the right hon. Gentleman will indicate that he is not willing to accept it.
If I had been in any danger of accepting the new Clause it would be in consequence of the speech to which we have just listened. I have never seen such a complete exposure of general ethics as that which we have had from the other side of the House this afternoon. What the hon. Member for South Hendon (Sir H. Lucas-Tooth) suggests is that if the patient goes to a dentist's surgery in pain, it would be ethical, on the part of the dentist to prefer to treat a private patient who would pay more.
I never said anything of the sort.
If the hon. Member will look at what he said, in HANSARD tomorrow, he will find that, if he did not say it in those precise terms, he said practically the same thing.
I took great trouble to point out that the fees paid by private patients were, in fact, lower than those paid by public patients.
It is no good hon. Members saying that. I am the very last person to be bullied. When we have general charges echoed by the noble Lord the Member for Horsham (Earl Winterton)—
I have not yet finished my sentence about the noble Lord. When the noble Lord says "Hear, hear" to a charge that my hon. Friend was fouling his nest, the "Hear, hear" meant that hon. Members opposite would put professional solidarity against the public interest.
I am not concerned in the argument at all. In fact, I was not following it; I was reading my Notice Paper. My attention was called to the fact that for the first time in my long experience in this House an hon. Member opposite thought fit to bring a most discreditable accusation against his own profession. That is why I cheered when my hon. Friend said that the hon. Member for East Wolverhampton (Mr. Baird) was fouling his own nest. It is the first time I have known it to happen.
I make no comment to the House about the statement that has been made, but it is the duty of hon. Members to consider the general and the public interest against the sectional interest. That is the proper standard of conduct for a Member of this House, but we have had all the time from the other side of the House, ever since I have been a Member of it, surrender to every professional pressure group, and always a general neglect of the public interest before a professional pressure group. We have had it again tonight. In fact, the dental profession has been guilty of worse conduct than any other profession in the Health Service. That is obvious from the cases which have been brought forward. It would have been much better if hon. and right hon. Members opposite had deprecated that conduct, and not tried to apologise for it, to explain it away and to blame it on to the scheme. I should have thought it was their duty, as hon. Members of this House, and the duty of everybody who has the well being of the patients at heart, to deprecate unprofessional conduct and not to try to find justification for the ethics of the jungle—commercial discrimination against people in pain.As a matter of fact, what we have to consider here this evening is which practice is on the increase; whether the good practice or the bad practice is on the increase. Is the Health Service operating to drive out the bad behaviour and is it encouraging the good behaviour, or is the reverse taking place? If I were satisfied that the misconduct of a part of the dental profession—and we must always bear in mind that we are talking about a part of the dental profession and not of the dental profession as a whole—was on the increase, then I should accept the new Clause, because I would then consider that it was necessary to defend the public patient against the misbehaviour of some of the dentists. But I am satisfied, on experience, that the misconduct is on the decrease and that the behaviour of the dentists, generally speaking, is improving. Therefore, I say it is far better for us to allow the disciplinary machinery which has been established under the scheme to operate against the person who is misbehaving, and I hope that before long the opposite of Gresham's law will prevail, and that the good will drive out the bad. I have had instances brought to my notice of discrimination which I consider to be not only unjust but cruel. There is, for example, the case of a schoolteacher who applied for dentures. She was not able to do her work at all without dentures. I have it on the authority of one of my hon. Friends here that, because this was not an offence against the Service, against the legal contract, she was informed by the dentist, "If you want them under the National Health Service you must wait for four or five months, but if you want them privately you can have them in a week." That is monstrous misconduct. [HON. MEMBERS: "Is not that true?"] Yes, but it is wrong.
Surely that is, in fact, true, and that is what is the matter with the Service.
No. It is what is wrong with the dentists. If the dentist realises he has a schoolteacher who must have those facilities to do her work rightly, he is doing a disservice if he deliberately says to her, "If you want them free you will have to wait for them." By saying she will have to wait he leads to the assumption that he has not time to do the work. How, then, would he have time to supply the dentures privately? This is exploitation of the principle of free choice. I am surprised at the hon. Member. I am astonished at him. This is the kind of moral morass into which the Opposition fall in these matters. If the dentist in this case were doing his duty, if he were behaving with a proper sense of public spirit—and mark you, Mr. Speaker, the hon. Member has said that, in many instances, the dentist is better paid for public service than for his private services—then that selection—
I gave the right hon. Gentleman a perfectly good explanation. The dentists are overworked. A very large number of them quite deliberately devote a certain proportion of their time and efforts to the public service and a certain proportion to private service.
Does not the hon. Member realise the dilemma he gets himself into every time he interrupts? If the dentist is overworked, how is it possible to do the work privately and not publicly? It is the same work, and the dentist is in the position that he will do a certain amount publicly and a certain amount privately. What has actually happened in this instance is that we have had no control whatsoever on the money which the patients have been paying for private work. None at all. We have no evidence about which costs less.When the hon. Member speaks about the pressure that we unreasonably brought to bear against the dental profession, I point out that in the beginning it was pressure brought to bear upon this House by the dental profession. Really, what was the matter at the beginning of this scheme was that we had exploitation of scarcity value by the dental profession as a whole. When he speaks about a contract between the Minister of Health and the dental profession, I point out that the largest organisation did not advise its members to join the National Health Service. They came in as individuals. There is no contract in existence. I could accept this new Clause without breaking any contracts with the dental profession. The hon. Member has got his facts as bad as his morals. Nevertheless, I am not going to be influenced by what he has said.
Before the right hon. Gentleman leaves the question of dental ethics, is there not in the dental profession a body similar to that in the medical profession, which has the General Medical Council? That would deal with dentists who behave unethically. If there is not such a body, will he set up one?
What is wrong here is social ethics. It is not a case of a dentist's misbehaving himself in respect of his patient when he has taken the patient as a patient. This is bad social morality, by which the dentist inflicts unnecessary hardship and pain upon people on account of the fact that they are poor, because if they are not poor they can buy his services. That is the whole point. That is the reason why we have the National Health Service. It is to enable ordinary citizens to have access to medical skill without having to be blackmailed in doing so. That is the whole point of it. It is the Opposition that have led me into this obiter dictum. I hope they will be silent, or that, if they speak, they will pay more regard to the general welfare and less to a number of pressure groups.As I said when I rose to speak, I do not propose to accept this new Clause, because I believe it would not be in the best interests of the Service as a whole. I think a number of dentists might immediately say that they would not give any public service at all, in which case we should have a large number of patients who would not be treated. It is obvious that a very considerable volume of patients has been treated by the dentists already, and that a great deal of relief has been given. So I would deprecate any move just now which would have the effect of depriving people of the services of dentists. As I said at the very beginning, I am satisfied that the good practices are driving out the bad practices. It is obvious, for example, from the number of emergency cases that what happened in the beginning is not happening now on the same scale. Extractions are taking place, giving immediate relief, on a far greater scale than before. Furthermore, we have tightened up the situation so that a dentist cannot say now that he will extract the teeth under the National Health Service and provide the dentures privately. That is an offence against the Service. It is an offence against the regulations. Once a dentist has agreed to treat the patient, the full treatment must be under the National Health Service and the dentist cannot discriminate between different parts of the treatment. He can reject the patient if he wishes, but he cannot reject any particular part of the treatment once he has started it. I hope, therefore, that, in all the circumstances, and for the welfare of the scheme as a whole, this new Clause will not be pressed. I am sure that the many first-class people in the dental profession will be deeply pained by the belief that the general public do not hold the dental profession in the esteem in which they would like it to be held, and I hope, therefore, that we can put this bad thing behind us and look forward to a general improvement in the Service.
I am sure that with the concluding sentences of the Minister's remarks there will be general agreement, but I think his tongue led him into betraying himself when he said that he had been led away into this obiter dictum—with the emphasis on the "bitter," for bitter indeed the emphasis was. The fact that emerges from his discussion is that the Minister agrees with my hon. Friend the Member for South Hendon (Sir H. Lucas-Tooth) and rejects the views of the hon. Member for East Wolverhampton (Mr. Baird). [HON. MEMBERS: "No."] Yes. The Minister asks the House to accept the view of my hon. Friend the Member for South Hendon that the new Clause should be rejected, and to reject the view of the hon. Member for East Wolverhampton that the Clause should be accepted.Furthermore, he accepts the view of my hon. Friend that the practices are the practices of a minority—a tiny minority—of the profession, and rejects the view which led my hon. Friend to remark that he had never heard of such a case of fouling his own nest as that of the hon. Member for East Wolverhampton, who said that 75 per cent. of the profession in his division were not merely carrying out unethical and unsocial practices but were, indeed, engaged in frauds on the Inland Revenue.
I said no such thing. I said that 75 per cent., on my estimate, were turning away patients in pain because they would not pay the dentist's fee.
Yes, but he went on to say much more dangerous, damaging and libellous things than that. He said that the reason they took these fees was that the fees returned under the scheme were subject to tax and the fees which they were getting back under the counter, black market, were not subject to tax. That was the accusation of the hon. Member for East Wolverhampton.
If, as the hon. Member for South Hendon (Sir H. Lucas-Tooth) says, the dentist is often paid a smaller fee for the work which he does privately than the fee which he would get if he treated the patient publicly, why does he treat the patient privately? Why does he not treat him as a public patient?
What the hon. Member has to justify before the House is the accusation of fraud upon the Inland Revenue which he brought against the vast majority of the dentists in his own division, and, by implication, upon the rest of the profession throughout the country. He was bringing forward his division as typical of divisions throughout the country.
Yes. He did not bring forward Wolverhampton as a cesspool of iniquity singular and unique in the country. He said that he was bringing forward this Clause, which does not apply only to Wolverhampton but which applies throughout the country, and which could only be justified on the basis that the practices and proportions which he mentions would also apply throughout the country. That was a contention rejected by the Minister of Health and on that he asked the House, if there is a Division on this Clause, to go into the Lobby on the side of the hon. Member for South Hendon and against the hon. Member for East Wolverhampton. That seems to me to be the position in which the hon. Member for East Wolverhampton has got himself and from which I leave him to extricate himself.
I am not in a position to express an opinion about that any more than the right hon. and gallant Gentleman. He may not be in a position to express an opinion, but he expressed it. The right hon. and gallant Gentleman will read HANSARD tomorrow and there he will see how that statement is not correct. What he says is that I have repudiated the statement made by my hon. Friend that there was a disposition to pocket cash receipts. I am not in a position to confirm or deny that statement, any more than is the right hon. and gallant Gentleman.
The right hon. Gentleman is, I think, a little forgetful, which is not surprising in view of the wild and woolly words which he uses. He has appealed unto Caesar and to Caesar he must go. I also appeal to HANSARD. He will there find that he said that the proportion that was mentioned by the hon. Member for East Wolverhampton was not the proportion he had in mind and he mentioned a smaller proportion. No one can call 75 per cent. a small proportion.
He said a minority.
Does the hon. Member think that 75 per cent. is a minority? Let him get his arithmetic right before he intervenes in the House. The Minister has said that he does not believe that the charges which the hon. Member for East Wolverhampton made, and the extent to which they were made, were justified.
He never said any such thing.
The hon. Member for Western Renfrew (Mr. Scollan) has no right, I think, to come in and defend the Minister. The Minister, on the whole, is perfectly capable of defending himself. I have never heard of his sheltering even behind the hon. Member for Western Renfrew.
There are certain areas of the country where this practice has been carried on to a much greater extent than in others. I quoted my division because in my division it is being carried on to a great extent. I know of other areas where there is co-operation to a great extent with the Minister.
The hon. Member now begins to modify his charge. He does not modify his Clause. His Clause remains an accusation over all the country. It is a proposed remedy for all the country—a proposal, which the Minister has turned down, applying 10 all the country. He cannot get out of it by saying that his own division is particularly bad in this respect, because he has brought forward a general Clause, and if he says that 50 or 60 other hon. Members have signed it, I take it that he wishes us to believe that the reasons which he gave for the Clause are also widespread throughout the country.The hon. and learned Member for Northampton (Mr. Paget) said that he was very concerned in the relief of patients suffering from pain through toothache. That is what everyone is concerned with. The question is how will it best be brought about. The hon. Member for East Wolverhampton said that it would be best brought about by passing this Clause, and the Minister says that it will best be brought about by not passing this Clause.
I am afraid the right hon. and gallant Gentleman is "passing the buck."
We are not "passing the buck." We are engaged in the examination of as fouling a speech about an honourable profession as was ever delivered in this House, and I am refuting it out of words from the mouth of the Minister of Health. That is very important and necessary.Now we come to the actual merits of the new Clause. The amendment is a danger because it may militate against what we want. I think that the Minister was perhaps a little cavalier in the dismissal of the arguments of the hon. Member for South Hendon, when he said that he thought this thing was due to heavy pressure placed on the dental profession. I think that is so. I think that is how these practices arose, that the pressure was so great as to produce a perfectly legitimate income, in some cases up to £20,000 or £30,000 a year, and that the pressure was out of all proportion to the pressure put on other professions.
May I ask the right hon. and gallant Gentleman to qualify that statement, otherwise his friends the dentists will be more angry with him than they probably will be already. He must always think of these figures as gross payments and not net payments and very often as involving a group of people.
I am well aware of that. I think that the Minister will not deny that the pressure and the facts—both the way in which the remuneration worked out and the length of hours which the dentists were willing to work—were both out of all proportion to what he had envisaged when he brought in the scheme. As for the remuneration, the mere fact that twice, purely by a overhead cut, he reduced the remuneration is proof of that, and the report of the Committee on the subject, showing that dentists were working chair-side hours far beyond what had been expected, is proof of the other. Both are evidence of a great strain placed on the profession. The only way in which it can be fundamentally remedied, is by an expansion of the number of dentists. That will take time, and it cannot be done in time to remove this strain.It is for those reasons that hon. Members on this side drew attention to the strain which the scheme would put on a number of dentists which was insufficient to carry it out. The strain is shown in one extreme case which has been mentioned in connection with the school dental service.
Is the right hon. and gallant Gentleman trying to justify the practice of which we complain, of a dentist declining for a period of six weeks to extract a tooth which is causing pain, but agreeing to extract it at once provided the person pays 15s. to have it done? Is he or is he not justifying that practice? That is the kernel of our case.
Certainly not. What I am discussing is the new Clause. This is the House of Commons, and we are not debating an abstract question about whether an extraction should or should not take place.
I hesitate to give way again. If I do so, I hope I shall not later on be accused of holding up the proceedings.
If the right hon. and gallant Gentleman had been listening to me earlier on, he would know that I admitted that this new Clause was cumbersome. I said I did not know that it would really work, because I had always been in favour of the principle of the choice of a professional man. I said the best solution was for the dental organisations themselves to discipline their members. Does the right hon. and gallant Gentleman agree that both sides of the House should appeal to the professional organisations to discipline their own members? If so, I will at once withdraw my new Clause.
Certainly, we would all agree, on both sides of the House, that the dental profession should be actuated by the highest professional motives, and should conduct itself on a high social and ethical level. But does the hon. Member for East Wolverhampton seriously think that the best way to produce that is by hurling the wild and reckless abuse at them that he has done—or, indeed, to a lesser degree, some of the more inaccurate remarks of the Minister of Health? I do not blame the Minister of Health so much, because he is a man of high temper, of very active and vigorous reactions, who has been under great strain recently, much of whose advice has been turned down—the advice given by his powerful newspaper was rejected.I therefore sympathise with the right hon. Gentleman. I am sure that later on he will regret the somewhat vehement way in which he rejected the Clause, because sometimes, I will not say the cloak-and-dagger attitude, but the bladder-and-poniard attitude of which he is such an exponent, leaks into his conciliatory speeches. The weapon which he naturally seizes, the poniard, is not naturally the one which is most useful for dispelling suspicion. Therefore, I would only say that tonight his conclusions are very sound, but I think the supporting contentions which he advanced are not so sound. What we are concerned with in this House is his final conclusions, and all we can say is that his conclusions are unexceptionable. We agree with his view, but we disagree with the view of his hon. Friend the Member for East Wolverhampton, and if he divides the House against his hon. Friend we shall be only too pleased to give him every support in the Lobby.
I wish briefly to say a few words about the rights of the professional man himself, which seem to me to have been overlooked in this Debate, and overlooked in general. I say this quite advisedly. I do not believe that there is a medical man or a dentist who would deliberately cause pain to any person, rich or poor, paying or non-paying, by neglecting him when he came into the surgery. At the same time, I do say that a man has a right to determine, to some extent and to some degree, the kind of work he will undertake, and that right should not be wholly denied to him.The Minister of Health himself would undoubtedly feel that he renders some service to the community by espousing the cause of those who believe in him up to the present, and by generally saying a word for Wales and for Labour supporters—and, he would probably say, for the people. But suppose he chose to retire and to become a professor of philosophy in a university of Wales. Who would say that he had been cruel to the people by denying them services he alone can render—services as poignant and important as that of pulling out a tooth at the right moment? If he chooses to say "I prefer to do politics only one day a week in Caernarvonshire County Council, and on the other days of the week I will study philosophy", has he not the right at least to choose to some extent what he will do with his talents? 6.45 p.m. Why should the right hon. Gentleman say that men who are dentists, doctors, physiotherapists, or members of other ancillary services of the National Health Service, must do what they do in a particular way, and that if they do not do it in that particular way they are knaves? They may merely be people who choose to do their work in a particular way. I cannot myself see that any harm is done by, broadly speaking, giving the medical men and women, the dentists and the ancillary practitioners, the right to be partially in the Service and partially out of it. Indeed, we may get a much wider and broader viewpoint by taking that more tolerant view. For my part, I am very glad that the Minister has taken that view. My reason for rising to speak is that I discern such a strong view being taken upon this matter by some of those behind the Minister. I think they are making a mistake, I am sure they are doing an injustice, and I want to try to persuade them by my arguments, and by putting before them and the House a particular example, that they ought not to go so far in this matter of trying to destroy and encouraging the destruction of private practices. It is quite clear that if this view is taken by back benchers of the Labour Party, if they remain in power or come back to power and go on pressing the Minister or his successor, some day or another a Clause like this will be passed, and it will be the thin end of a wedge. When they have got the dentists compelled to work full time they will then have the doctors, and finally the physiotherapists—the people I am interested in. This is a very brief illustration of how people can be hurt and have harm done to them without it being meant. There are just a couple of hundred blind physiotherapists. There are not so many things blind people can do, but they can do this, and do it extremely well. It suits them best to be in private practice, but the system of this scheme discourages their private practice. The Minister, at my request—and I thank him for this—wrote to all the hospitals and said "Give these men jobs in the hospitals." Well, that is something. I want them to have part-time jobs in the hospitals so that during the other part of their time they can undertake private work for which there is a call, which they need and which they can do extremely well. Up to the present the Minister has not refused this part-time work, but if this kind of agitation goes on behind him against part-time work for dentists and doctors, the time will come when the private practices of these men will be destroyed; they will not be able to give so many days or hours a week of public service in the hospital and then do some private work in the evenings, or during the other part of the week. While we realise the doctors' oath and the dentists' ethics, the kindly feeling of all of us must support the view—which I am sure is general—that any of us, whether we do it by pulling out teeth or by giving kindly advice, try to relieve pain and to help people, perhaps by seeing them, even when we are overworked and tired, whether or not we get fees for it. Most people behave in that way, but we have at least a right to choose in general the way we do what we do. If we do not want to be engaged primarily in the public service, or partially so, then let us choose to do the work we can do in another way. My protest, therefore, is not against the Minister, for he has been right here, but against those back benchers who would destroy all the liberty and all the freedom of the professions one after the other.
Despite the arguments of the right hon. and gallant Gentleman, and after listening to my right hon. Friend, I beg to ask leave to withdraw the Motion.
Motion and Clause, by leave, withdrawn.
New Clause—(Disqualification Of Persons Providing Pharmaceutical Services)
After subsection (7) of section forty-two of the Act of 1946 and subsection (7) of section forty-three of the Act of 1947 (which relates to the disqualification of practitioners), the following new subsection shall be inserted:—
"(8) In any regulations applying to persons undertaking to provide pharmaceutical services and relating to the investigation of complaints, the holding of inquiries or the making of appeals, where the circumstances appear to call in question the conduct of a pharmacist who is not himself a person undertaking to provide pharmaceutical services, provision shall be made for securing to that pharmacist the same opportunity of appearance audience, calling witnesses and producing evidence in relation to the complaint as is afforded under the preceding subsection to the person undertaking to provide pharmaceutical services."—[Mr Linstead.]
Brought up, and read the First time.
I beg to move, "That the Clause be read a Second time."This Clause arises from a discussion in the Committee stage on an Amendment which I withdrew after hearing what the Minister had to say. One of the things which struck me, when listening to the discussion on the previous Clause, was the fact that we shall never get this Service running smoothly unless the Minister can carry with him all the professions and each of them as a whole. This Clause deals with the pharmaceutical service. I am attempting to insert something which will help to establish the responsibility of pharmacists who are actually giving pharmaceutical services. It will be realised that there are many chemists' shops under the management of pharmacists which are not owned by pharmacists. Owing to the structure of the Service and the provisions of the parent Act, the contractor with the Minister in this case is not the pharmacist who is actually giving the service but the owner of the pharmacy. I believe that for a really healthy pharmaceutical service the more the Minister can bring in the pharmacist manager and make him feel he has a live responsibility for what goes on in the premises he manages, the better and fuller the service he will get. I attempted to bring this about during the Committee stage by an Amendment which used a phrase that said that the Minister should be responsible for the service, but after discussion I realised that that was not the appropriate way of doing what I had in mind. Therefore, I have brought forward this Clause, which brings in all pharmacist managers by the provision that in the event of any complaint being made about the quality of the pharmaceutical service in a particular pharmacy, it shall not merely be the proprietor who shall be responsible to the committee but also the pharmacist manager. The present position is not satisfactory. If a complaint is made, the person who has to answer that complaint is the owner, not the man who gave the service and is responsible for what happened. It does not seem satisfactory that an owner of a business can go before the committee and give information which may involve the conduct of the manager without the manager knowing what is being said or having an opportunity of saying anything on his behalf. It is provided here that where a complaint is made, notice of the complaint shall go to the responsible pharmacist as well as to the owner of the business, and that he shall have the same opportunities as the owner of attending before the committee. There can be no possible objection to this because it is only elementary justice. I have been a little surprised, however, to hear that quite recently some of the trade union representatives of the pharmacist managers do not consider this to be a useful provision. If I understand their position aright, they are rather lukewarm in their support and want something stronger to establish the position of the pharmacist managers. If the Minister can see his way to go at least as far as this, he will be doing something for the man who really gives the service, and I think the trade unions will realise that there is a substantial gain for their members.
I beg to second the Motion.I support this Clause for reasons that are illustrative of the point raised by the hon. Member for Putney (Mr. Linstead). The position of the qualified pharmacist manager is something that has caused a great deal of perturbation among pharmacists generally, because, as is well known, it may be that a qualified pharmacist runs the National Health Service side of a business which is owned by someone who has no professional qualifications whatever. When an inquiry takes place on a complaint, it is obvious that the proprietor of any business must be called to account, because he is responsible for the employee, but the employed person may have a professional responsibility which is wider than his position as an employee. While this Clause is a safeguard for the qualified pharmacist against whom a complaint is made, it does not safeguard his position in other respects. It is for that reason that their representative organisations are lukewarm towards this piece of justice to the qualified man vis-à-vis his unqualified employer. One small doubt exists in my mind. I am wondering whether it is absolutely essential to obtain the safeguard we seek by means of a Clause in a Bill and whether this could not be done more simply and effectively by way of regulation. I am sure that the Minister will inform us about that. I think that the position which has been moderately stated by the hon. Member for Putney is worthy of consideration and feel sure that my right hon. Friend will be sympathetic.
I have very great sympathy for the intention that lies behind this Clause. The position is a simple one. The company will be in contact with the executive council for the supply of drugs. There may be a complaint by the executive council against the company. The case may be heard by the executive council, although in fact the concrete complaint might lie against the employee who will not have been heard by the committee making the investigation. The purpose is that the individual whose professional character or industry may have been called into question shall have an opportunity to defend himself before a decision is reached. I am in entire sympathy with that, but I suggest that a Clause in a Bill is an extremely ambitious vehicle to convey what can be done much better by regulation, which I propose so to do.
I belong to a trade union which caters for pharmacists and chemists. Is there no right of representation when there is any question involving the integrity or ability of a particular chemist?
If he is in direct contract with the executive council he would normally be heard, because the charge would lie against him. If he has an employee who is involved, the employee would be heard under the regulation.
With no trade union representation on his behalf?
Yes, I am prepared to make a provision either for him to be heard himself or through a person he might nominate.
I am grateful for what the Minister has said, and I beg to ask leave to withdraw the Motion.
Motion and Clause, by leave, withdrawn.
New Clause—(Charges To Be Paid By Certain Classes Of Persons)
(1) Regulations may provide for such charges as may be prescribed to be made to persons not normally resident in the United Kingdom for services provided under the Act of 1946 or the Act of 1947.
(2) Regulations may provide that in such cases as may be prescribed the charges may be made and recovered by the person providing the services:
Provided that this section shall not apply to any person normally resident in any country with which His Majesty's Government have made such reciprocal arrangements as may appear to the Minister to be satisfactory.—[Lieut.-Colonel Elliot.]
Brought up, and read the First time.
I beg to move, "That the Clause be read a Second time."I am sure this Clause will appeal to the Minister. He has been saying that all the Opposition's Amendments tended to increase the cost of the scheme, but by this Clause there is no such danger. The Minister has objected to the suggestions outlined in the Clause because he feared they would place an unreasonable administrative burden on those who would have to administer them, but I think we have met that point. We have made it a simple test of ordinary residence in the country. Further, I think we have been able to deal with his point that administrative difficulties might involve prolongation of the practice of carrying an identity card. That cannot arise because even at present the Minister, in the case of applications for dentures or appliances of one kind or another, requires the production of an identity card. It must be ascertained that a person has not gone to a number of places and obtained a number of subscriptions for sets of dentures or spectacles. The Minister's vigilant eye has to be turned in the direction of those who make no contribution to the expenses of the scheme. He said that these people make certain contributions by paying indirect taxation, but the great weight of that taxation is escaped by them. The amount may not be great, but it is felt to be an anomaly which, in our present straitened circumstances, should be removed. It is an anomaly which could be removed without difficulty. We have given full latitude to the Minister to prescribe conditions by means of regulation. A number of visitors from America and elsewhere are insured. It would be easy for them to pay a charge, and all the Minister is doing by not charging anything is to relieve the funds of certain large insurance companies abroad. I am sure that this is not a line which he would wish to follow. The Minister has been so impressed by this argument that he himself has taken steps to deal with it, though we contend that those steps are of an indefensible character. He stated at a Press conference, and his words were subsequently broadcast, that he had arranged for immigration officers to turn back aliens who were coming to this country to secure benefits of the Health Service—
For the purpose of securing them.
The Devil himself cannot detect the mind of man, yet this burden is placed on the immigration officers. To place this duty on them is placing an entirely unheard of responsibility on them; it is asking them to carry out duties which they are in no way competent to do.
It is the normal thing for the immigration officer to ask immigrants what is their intention in visiting this country.
The Minister has a powerful and able wrist, but he is flagging this evening in dropping his guard to an extent to which he would not drop it if he fully applied his mind to the subject. Does he suggest that any alien coming to this country for the purpose of carrying out a fraud on the Revenue would volunteer a statement to that effect to the immigration officer?
That applies to every other question which is put.
The right hon. Gentleman has himself at times animadverted on the singular folly of the questions put by immigration officers and to which affirmative answers are expected, notably the one in America, "Is it your intention to overthrow the constitution of the United States?" the suggestion being that the answer would be "Yes," thus leading to the instant rejection of the immigrant.Here we have an opportunity of removing this question from those which the officer has to ask. I wonder whether, in these circumstances, the late Lord Snowden would have ever got into any country at all. Anybody with his obvious physical defect would be held by an immigration officer to be likely to be coming into the country for the purpose of obtaining treatment. Will it be said to me on shore, when I have been hanging over a ship's rail, after a rough crossing, "You are entering the country for the purpose of benefiting under the scheme"? I have seen many of my fellow passengers in this position. I ask the Minister to consider whether he has not admitted a wrong and is choosing an impossible administrative vehicle for correcting it. He says it is not desirable that people should come into this country solely for the purpose of obtaining benefits under the scheme. Surely, the proper person to examine and discuss that matter is one with medical skill, to whom the visitor would eventually apply. What would have been the position of the Chancellor of the Exchequer at the Swiss frontier if such a set of questions had been asked of him? This would happen if the Minister tried to make the Service free, without any check at all. There has been produced a new kind of check administered in a new way by people who are not suitable to administer it. The proper person to check whether someone applying for medical assistance is genuine is one with proper qualifications. I do not believe that an immigration officer is the kind of person to judge. We propose a solution here which would meet the difficulty which the Minister himself has agreed. It would meet it in a practical way. The Minister could allow a person who was seeking assistance to pay a sum according to circumstances which the Minister would determine. He could get rid of the difficulties of the foreign seaman whom it was desirable to treat in an emergency, or somebody in poor circumstances to whom there could be no objection on humanitarian grounds. These are all left in the hands of the Minister. What we say is that the difficulty is here. The Minister has produced a solution, which we contend is ineffective as a solution, and what we propose would have in addition the advantage of relieving the financial strain upon the National Health Service, an ideal which the Minister himself has held out to us as being a very desirable one, and one which should be brought forward by the Opposition. Having, therefore, fulfilled all these criteria, we trust that the right hon. Gentleman will be able to accept the new Clause.
Earlier on, when we were discussing other matters, there was some discussion on ethical values, and in the course of some researches, which I happened to be making in the Library on another matter, I came across an old Book in the reference department, which contained a passage from which the right hon. and gallant Gentleman opposite and probably some of his friends, who have put this case in a much more raucous manner than he has done, probably drew their moral. The passage in this particular Book dealt with a stranger and foreigner who was on a journey to a place called Jericho. In the course of this journey he fell among thieves and was wounded and left for dying. Then it happened that two members of the ruling class passed, and they, realising that in the interests of national economy they should restrict their personal expenditure, passed him by on the other side. It happened that a little later there came some untutored fellow from an outlandish part—
Would the hon. Gentleman tell us whether that untutored man asked the Immigration Officer, who examined this injured man, if he had pronounced upon his fitness for relief?
That part of the story is left untold. This untutored person from, I suppose, what would roughly correspond in the Palestine of those days to Wales in this country, without making any proper inquiries at all as to the origin of the stranger, stooped and at once gave him medical attention. Not only that, but he made a small monetary payment towards his support, and, worse than that, he said—I have taken the exact words:
thus leaving the way open for a supplementary estimate. This parable has been quoted time and time again to show the contrast between the prudent conduct of the ruling class and the reckless extravagance of this ordinary man, who was prepared to squander not only his own money, but that of his fellows on helping a mere stranger. It is, after all, purely a question of principle, because the amount involved through providing strangers with medical attention does not come to a very big amount. I do not know whether the right hon. and gallant Gentleman the Member for the Scottish Universities (Lieut.-Colonel Elliot) has looked into the figures, but there are about 635,000 visitors to this country in the course of a year, and on an average they stay rather less than a month, so that would make it that on a whole they would be equivalent to a population of round about 50,000 extra people requiring the health services, and the cost, even supposing they made the same demands as the people in this country, would be somewhere between £200,000 and £250,000. In order to exclude these people, the very machinery that would be required to insure the presentation of identity cards would, in itself, involve an administrative cost that was probably as great as, if not greater than, the cost of the health service. What would be said by hon. Members opposite if somebody came along needing urgent treatment, and because his or her identity card could not be found he or she would have to be denied the service? This service would be denounced by hon. Members opposite. What would happen if we did not treat any of our visitors from the Dominions or from the United States? What would hon. Members say then?"Take care of him; and whatsoever thou spendest more, when I come again, I will repay thee,"
I do not think the hon. Member for Hornchurch (Mr. Bing) is doing himself justice. He should read the powerful remarks of the Minister of Health on this subject, where he says
These are the steps which have to be taken now."… if a foreign visitor or a British visitor falls ill he immediately goes along, if he wishes, to a general practitioner, and if he wishes to take advantage of the Service he must enter into a contract with that practitioner, who must sign a form, and the local executive council must agree with it and approve it."—[OFFICIAL REPORT, Standing Committee B; 6th July, 1949, c. 158.]
That may well be, and I should think it is proper. I am glad that the right hon. and gallant Gentleman refutes the more inescapable statements which appeared in some newspapers which, at any rate, nominally support his side, that this Health Service is being wantonly squandered on foreigners. They are subject to the same obligations as people in this country.
As temporary visitors.
As my right hon. Friend says, as temporary visitors. Is not really the basis of it—and I do not blame the right hon. and gallant Gentleman because I think he was extremely moderate—a general complaint and a general attack on foreigners, rather a sort of thoughtless attack that the foreigners are doing us out of something? It is rather a peculiarity in some people's mind that that is the way we ought to behave to foreigners. There is a class of person in this country who, instead of extending the warm hand of friendship, will if possible present the cold muzzle of the dog in the manger. There is no question, after all, from hon. Gentlemen opposite of any economies in the Health Service. That is not their object, because if one reads a document entitled, "The Right Road for Britain," which I understand has, at any rate, the support of some hon. Members opposite, they will see very interesting proposals for giving free medical treatment to people who are well enough off to pay for a private medical service. In other words, hon. Gentlemen opposite, while they would be prepared to save £250,000, would, at the same time, be prepared to spend on the wealthy an extra sum of £5 million.Visitors to this country are not, after all, all wealthy people. Visitors to this country, one is glad to think, are very often poor people, delegations of ordinary working people and such like. There is no reason at all why these people should not be given an opportunity of experiencing something which is now a National Health Service and part of our national life. Hon. Members opposite quite often spend their time decrying this country, and putting forward all sorts of reasons why people should not visit us because, so they say, they cannot get the same sort of food as can be obtained in other places or cannot get this or that. But when there is an actual service, which visitors can enjoy, then they suggest that we should cut them out. In fact, what they would be prepared to do is, in order to save one-tenth of the money that they spend on rich people, to deprive us of giving to the ordinary man or woman from other countries who comes to this country the same sort of service as our people enjoy. I hope my right hon. Friend will not give way to that. If there is any abuse of the service by foreigners—and there may be some—that abuse must pass through the practitioner. Therefore, if there is any charge to be made it must be against the practitioner, for the charge made that foreigners are exploiting the Health Service means that they are only exploiting it by the connivance of the medical profession in this country. This, if it is the charge made by hon. Members opposite, is a far more serious charge than that made by my hon. Friend the Member for East Wolverhampton (Mr. Baird), for which he was reproved by hon. Members opposite. But I do not believe that that is so. I do not believe that there are all these abuses. The right hon. Gentleman the Member for Woodford (Mr. Churchill) has described what a paradise other countries are compared with his own, and it is a little odd that from these paradises, as described by the right hon. Gentleman, there should be this pathetic stream of people in search of glasses, teeth and all the rest of it. There may be some impoverished nobleman from some other country who may think it possible to pick up an eyeglass here on the cheap, and if, in fact, that is so, it is very desirable that we should deal with it by regulation. This country has a great reputation for the hospitality of the ordinary men and women of the country. I do not think many people grudge the way in which we give to foreigners who are visiting this country the Health Service that we ourselves enjoy. I hope that, while my right hon. Friend will deal with abuses, he will preserve the reputation for hospitality which this country so rightly deserves.
I am very glad that this subject is being discussed in the atmosphere which exists in the Committee, and which is very different from the kind of climate of opinion which irresponsible newspapers try to create around some subjects and irresponsible speakers also attempt, when they address mass meetings and do their utmost to denigrate the Health Service, while pleading at the same time that they are supporters of it. It has been rather sickening in the last 15 months to witness members of the party opposite trapesing around the country, following their extensive posters on the hoardings saying that they fought for the Health Service, yet spending most of their time on the platform poking fun at it, denigrating it and undermining it. This subject is one of the categories under which that has been done.It amazes me that we should assume that there is something wrong in treating a stranger who is visiting this country with medical attention if he or she falls sick. That assumption is one of the curses of modern nationalism. It was not part of the ethics of mediæval society or of the Dark Ages. Any person wandering about the Continent of Europe could seek the sanctuary of the Catholic Church and get treatment. It was never considered at that time to be wrong that a sick person should receive the hospitality, medicaments and skilled attention that were available at the time. The present attitude is a by-product of the existence of the Conservative Party.
Surely the right hon. Gentleman will agree that that was a reciprocal arrangement?
Oh, yes. The Catholic Church was not a narrow nationalist church. It existed in all countries. It was done under a reciprocal arrangement. Reciprocal arrangements are specifically provided for in the proposed new Clause.
I thought I had reached that part of the argument just now. I did not know that there had been any contract drawn up between high contracting parties in mediæval Europe, sitting as a sort of Council of Nice, deciding what service they should give each other if they happened to wander into each other's countries. It was regarded as part of the normal conduct of a citizen.
Certainly it was regarded as hospitality but not necessarily as mutual.No convent or hospice at which a traveller presented himself for lodging or treatment in the way of nursing, asked: "If we went to your country would they do this for us?" They did not even know about that. They did it as part of normal behaviour. I agree with my hon. Friend the Member for Hornchurch (Mr. Bing) that one of the anti-foreigner complexes that insular parties like the Conservative Party can stir up from time to time has been responsible for this agitation. I have tried to point out on a number of occasions that if we set an example of this sort in this country there is every prospect that other nations will follow. Somebody must start. The health services of the whole world are being stimulated by what is happening in Great Britain. It is astonishing—I do not know whether hon. Members are aware of this—to witness the constant stream of visitors to this country coming from all parts of the world to find out what we are doing in this matter. Most of them go back praising what is happening and hoping that what we are doing will succeed so that they can imitate it in their own countries. If people come here from abroad for the purpose of exploiting the Health Service that is a different matter entirely. They ought not to be allowed to exploit it any more than a person in this country. If, for example, a person leaves another country deliberately for the purpose of going to Roehampton to get an expensive artificial limb, I would consider that to be an abuse and not a proper thing to do. Unless we stop that sort of thing we shall be drained. If a person comes to this country and falls sick, it is perfectly proper that he should be treated. Indeed, some of our great institutions always did so. The great Scottish hospitals treat visitors freely. Does the right hon. and gallant Gentleman suggest that we should turn our backs on that splendid tradition and set the almoner at work upon people who, for generations and even for centuries, have been enabled to enjoy these benefits? The same thing is true of many of our great London hospitals. Until quite recently a very large number of them were following that tradition. It is only in recent years when revenues have fallen drastically and the costs of health ministration have been raised very substantially, that they have found it necessary to make charges at all. It seems to me that the complaints—I am not making accusations against the right hon. and gallant Gentleman, because the façade presented this evening is one of comparative benevolence—conceal the grinning visage of malice.
No more poniards?
It is part of the duty of the House to deprecate the irresponsible propaganda which has been created around this issue and to try not to pander to the worst appetites of people but to elevate them to a higher standard of citizenship.The second point is that even if we wanted to withdraw this decent altruism the expense of doing so might be very substantial indeed. The administrative apparatus that we should have to establish would be very considerable. The right hon. and gallant Gentleman shakes his head. I assure him that under his proposed new Clause we should have to divide applicants for medical assistance into three categories. They would be those who came from countries with which we had reciprocal arrangements, those from countries with which there were no reciprocal arrangements and, lastly, our own people. Obviously, if we have reciprocal arrangements we shall merely reciprocate. We shall provide merely according to the reciprocal agreement. Let me put a case in point. If one country was only able to give our citizens bare hospital treatment, should we make available to their citizens the full range of the Health Service of this country? That would not be reciprocity, because it would go beyond reciprocity. 7.30 p.m. Therefore, it would be necessary to have at least three classifications. The right hon. and gallant Gentleman shakes his head. Suppose that a person turns up at the dentist. He does not go to the dentist from the G.P., so there is no complication to start with. The man probably has an aching tooth, and the dentist says, "What is your name and address? How long have you been in this country? Where did you come from? Are you French? We have a reciprocal arrangement with France for hospitals only and not dentistry. With Belgium we have a reciprocal arrangement for dentistry as well. Or are you English? "By the time all these questions are asked and answered the poor man would be mad with pain.
The right hon. and gallant Gentleman says, "Really, really," but this point—some of my hon. Friends might call it the point of production—is the one at which the operation has to take place. That is the first time it happens and that is where the screening would take place. The dentist would have to satisfy himself whether the person was a proper applicant for free dental treatment or not.
The dentist has to do that now.
No. What happens now is that each person has to have a number—for convenience it is the registration number—for classification purposes. If registration were withdrawn some other number would have to be found, but it would be for classification and not for identification purposes. The right hon. and gallant Gentleman is confusing identification with classification. In this case the applicant would have to prove that he belonged to a particular class. The same thing is true about the general practitioner. We made arrangements with the medical profession—I apologise for speaking at length but there is such misunderstanding about the subject that I think I am entitled to be detailed—for them to accept collective responsibility for the population of Great Britain. It was a very important principle because it enabled us to deal with our mobile population; that is to say, we could deal with such people as visitors to the seaside. Such cases are met out of a general pool because these visitors who fall ill at the seaside are on the lists of other doctors and we had to have arrangements for them to have access to doctors at the seaside.We therefore have the temporary visitor form, the purpose of which is to enable the doctor to claim his fee, not to screen the patient. The doctor satisfies himself that the patient needs attention. The form is for the purpose of enabling the doctor to recover the payments to which he is entitled from the general pool. It is not a form to discriminate between classes of people. Immediately that is introduced there must be more forms so that the doctor may be able to reject persons who cannot satisfy him, and, of course, if the person who comes to Great Britain can tell a lie to the immigration officer, so can the person who is ill and goes to the doctor. A lie can be told on a form just as well as by word of mouth. The same answer holds good. I do not suggest that there are no circumstances in which regulations can be made for the purpose of preventing people abusing the service, but I am not prepared to establish administrative arrangements which would harass the whole population merely to deal with a handful of people who were visiting this country and might need treatment. Hon. Members will agree that we ought to examine each regulation and each protection on its merits and not have a general principle saying that no one visiting this country shall have access to the free Health Service. [Interruption.] Is that not what the Opposition want? I should like to know. It is a very important point.
It is the Minister who says that somebody visiting this country must not have access to the Health Service. We say that the Minister should have power to make regulations by which the examination could be carried out by the medical man instead of the immigration officer, who is most unsuitable.