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Hospital Charges

Volume 487: debated on Tuesday 24 April 1951

The text on this page has been created from Hansard archive content, it may contain typographical errors.

Motion made, and Question proposed. "That this House do now adjourn."—[ Mr. Popplewell.]

10.27 p.m.

The subject of my Adjournment debate this evening certainly is topical, because it deals with certain aspects of the National Health Service which we have been discussing for most of the day. It may not be a subject of quite such importance as some of those we have been discussing, but I maintain that it is a subject of principle and an important subject of humanity; and I am sure we all agree that humanity and help go hand in hand.

At present, particularly in this Festival year, there will be a large number of foreigners who will get free treatment in this country under the National Health Service. I understand that there are a certain number of people who come over from the Continent to have a free operation in this country—what one might call "one on the house." Be that as it may, that is all the more reason that the very greatest consideration should be given to British contributors in this country to their own National Health Service.

It is, I think, inevitable that Government Departments and Ministries tend to become inelastic and somewhat inhuman, whatever party may be in power. It is a thing we always try to avoid, but it is never easy to do so. In fact, at Question Time this afternoon, I heard two hon. Members on the benches opposite refer to to the War Office as both inflexible and inhuman. The hon. Member for Cardiff, West (Mr. G. Thomas), went so far as to say that he considered that the War Office in some respects was so inhuman that he would bring up that matter on the Adjournment.

Rules and regulations we must, of course, have—they are essential—but I maintain that there must be room at the same time for a certain amount of elasticity and humanity. I think also that Ministers must not be allowed to get too regulation-bound. I suggest that the predecessor of the present Minister of Health allowed himself and his Department to get regulation-bound. If we can help the present Minister of Health to unwind some of the red tape which at present wraps him round, I am sure we shall be doing him and national health a service.

I want to put this case as briefly as I can, and in doing so I should like to thank the Minister for his courtesy to me in answering the numerous letters I have written to him and for his kindness in allowing me to go to the Ministry and talk over this matter with him. The fact that we did not come to any conclusion is beside the point. He was bound by regulations and I was bound by my duty to my constituent and by my belief that in this case there had been a certain amount of inhumanity and even injustice which could have been avoided.

Mr. Harris, my constituent, is in the motor trade in a small way. He gets something approaching £600 a year, of which he sees about £525. On 9th August of last year, his wife was suddenly taken seriously ill and Mr. Harris at once sent for a doctor. The doctor wrote a letter to me afterwards about Mr. Harris's case which I think puts the position clearly and briefly. She wrote:
"Mr. Harris sent for me urgently on August 10 as his wife was in severe pain and was vomiting continually. I found an irreducible femoral hernia strangulating, and sent her to hospital with the least possible delay, so that an operation might be performed at once, and Mrs. Harris has made an excellent recovery. Delay might have been fatal."
When I got that letter, I telephoned to the doctor and asked if she could expand her letter a little and she said that when she called at Mr. Harris's house—and this was confirmed by Mr. and Mrs. Harris in a conversation I had with them—she telephoned King's College Hospital, which is only a few minutes' travel by car from Mr. Harris's house. She asked the public casualty ward if they had any public beds. They replied that they had none. By this time Mr. Harris was in an acute state of distress and anxiety. His wife seemed to be getting worse, and the doctor suggested that she should inquire whether there were any private or semi-private beds. She rang up the hospital again and they said there were semi-private beds.

Whether or not she told Mr. Harris that those beds would be on payment or not is a matter of some dispute; but I would say that in 1944, Mrs. Harris had had another abdominal operation in King's College Hospital, and both Mr. and Mrs. Harris thought very highly, as they still do to-day, of the hospital and the treatment they received there. On that occasion in 1944 Mr. Harris was charged five guineas a week and the surgeon charged him three guineas, a total of 13 guineas. Mr. Harris has told me that even if the doctor did say that he would have to pay a charge for a semi-private bed, it would not have worried him very much, because he was thinking in terms of the 10 to 13 guineas which he had had to pay before. His one thought was to get his wife into hospital as early as possible.

If I might interrupt the hon and gallant Gentleman to get this point clear, the lady doctor concerned does say quite clearly in a letter to us, which the hon. and gallant Gentleman knows about.

"I warned him"—
that is, Mr. Harris—
"…that the fees for a semi-private ward had recently gone up to about 13 or 14 guineas, and that there would also be the surgeon's fee, but Mr. Harris still said he would like his wife to go into the semi-private ward."
I do not think that there is any dispute about that.

That may be, but it is still vague. Mr. Harris says that no indication was given that the surgeon's fee was going to be £52 10s., and I think the Parliamentary Secretary will acknowledge, from what he has read out, that there was no indication in it that what was a colossal sum for Mr. Harris was to be charged. Mrs. Harris was moved in for the operation. A form was put in front of her husband, which he signed, but he does not know what was written in it. He signed it, and he says that if it was going to let him in for £1,000, he would have signed it in order that his wife should get the operation as early as possible. It was a matter of life and death, as the doctor has made clear.

The operation was successful, Mrs. Harris was a fortnight in hospital and when she came out on 25th August, Mr. Harris was given a bill for £85. That was for 14 days in hospital at 12 guineas a week—24 guineas—surgeon's fee of £52 10s., an anæsthetist's fee of £7 7s. The bill was marked in red "An early remittance will oblige." Mr. Harris tells me that he took the bill to the doctor, who was completely dumbfounded at the amount of the surgeon's fee. So Mr. Harris came to see me. I wrote to the hospital, and they merely replied that all the regulations had been complied with, that Mr. Harris had seen the form and had signed it, the operation had been carried out, and now he had to pay. I then wrote to the Minister.

Is the hon. and gallant Gentleman alleging any improper conduct or behaviour on the part of King's College Hospital, which, as he knows, is in my constituency?

I think I have made it absolutely clear that Mr. Harris had, and still has, as I have—and I have sent many patients there—the highest opinion of King's College Hospital. I have raised this as a matter of principle. I wrote to the Minister who, as in all his communications to me, seemed to be terribly regulation-bound. He said:

"As Mr. Harris signed a form, I regret there is nothing I can do."
I admit that Mr. Harris did sign the form, but I hope for a little humanity in a case of this sort. On 29th November the Minister gave me that reply, and I asked him to reconsider it. On 15th December the Minister wrote to me again, and said that because Mr. Harris had expressly requested that his wife should be admitted to King's College Hospital and had signed the form, there was nothing that could possibly be done for him.

On 1st February I raised this question on the Floor of the House and there was a good deal of sympathy for the point that I put forward, so much so that the Minister very kindly suggested that I should come round to the Ministry and talk it over with him. When I did talk it over with him, we got so far as his suggesting that Mr. Harris should go round to the hospital and disclose his means, what money he was actually getting, and that the hospital would then consider whether they would let him off part of the charges. Well, I advised Mr. Harris to do that; but I had reckoned without Mr. Harris. He absolutely refused to give way on what he considered to be a matter of principle. He did not think that he had done anything wrong. He admitted that he had been in a highly nervous state at the time. Even if the hospital had let him off some of the 12 guineas a week, the surgeon was still bringing a separate action against him in the courts, and his solicitors maintained that the course suggested would not have helped him in the surgeon's action.

On 27th February the Minister wrote me a letter, part of which disturbed me a lot. He said:
"The board of governors naturally feel that they have not been treated too well by Mr. Harris in this matter, and they wish to exercise their right to recover their debt to demonstrate the justice of their cause."
I cannot really believe that the board of governors meant and thought they were being victimised by Mr. Harris. I think that that was a little bit of bureaucracy, either in the office of the Ministry or in the office of the hospital. Immediately after I got that letter, both the hospital and the surgeon threatened to bring legal actions against Mr. Harris. Mr. Harris wished to fight the case, but his solicitor and I got together and we decided that, as we had to admit that he had signed the form, legally he was responsible and might be let in for a large sum of money, and that somehow or other the money must be raised. Where it was raised I do not know. It was a very great sacrifice for a man on that salary to raise £85 in cash right away; but the money was raised; the bills were paid, and the Minister then wrote to me finally on 15th March:
"I have carefully considered all the statements made. I realise that Mr. Harris was in a state of acute anxiety when he signed the pay-bed agreement and I sympathise with him in the unhappy circumstances in which he found himself. But he did sign, and I have no power under the National Health Service Act to reimburse the cost of private arrangements."
He went on to say:
"I understand that Mr. Harris has paid the account,"
and intimated that the matter was now closed. But neither Mr. Harris nor I agreed to let the matter drop, and that is why I have brought it before the House this evening.

Finally, I should like to make these points. I feel that there should be some distinction between the patient who is going to have treatment or an operation in a private ward and makes his arrangements beforehand, knowing exactly what he is letting himself in for, and the man or his wife who is taken desperately ill suddenly. There should be a definite distinction between those two, and I ask the Parliamentary Secretary what would have happened in the hospital if Mr. Harris had refused to sign the form when his wife was being wheeled into the operating theatre. We know perfectly well that they would not have wheeled her out again. They would have operated at the expense of the National Health Service. It is only because Mr. Harris was a law-abiding citizen and wanted to do what he thought was right that he made no complaint at all.

I feel also that the Minister should have more power and latitude in these cases and that his attitude should be not one of asking, "What regulation can we find that will debar this man from getting any help from the National Health Service?" but of asking, "How can we help this man who, through no fault of his own, has had this misfortune?" I think many of us would agree that we are inclined to spend public money in the National Health Service rather too freely and lavishly on prescriptions, cotton-wool and that sort of thing. But this was a matter of life and death for one of my constituents and the £85 he had to pay was for him a very big sum of money. I feel that there should have been more humanity and give-and-take in this case, and I ask the Parliamentary Secretary to reconsider it.

10.46 p.m.

I am afraid that in view of the time I cannot really allow anyone else to speak on this subject, although I appreciate that it raises a quite important principle and one for which we have a great deal of sympathy. It also raises problems which we have been attempting to meet for some considerable time.

Many cases of something of this nature arose in the early days of the service. To try to meet these cases we brought in the particular document to which reference has been made, so as to try to ensure that all those who went into pay-bed accommodation would know they had to meet the charges for that accommodation and for any specialist attention they might receive. We have done our utmost to try to ensure that everyone does know precisely what sort of financial burdens he will have to meet.

Perhaps I should explain first that, as hon. Members realise, there are three types of accommodation becoming available, even if they are not all available everywhere now. First of all, there is pay-bed accommodation for which the patient pays the full cost both of the bed accommodation and of any specialist attention. Secondly, there are what are called amenity beds where there is a moderate extra charge made for the convenience of a certain amount of privacy but no special consultant fees are charged. Thirdly, there are the free beds.

There is a proviso in the Act regarding pay-beds which says that in cases of emergency pay-beds may be used without charge where there is urgent medical need and where other accommodation is not available. I want to bring to the attention of hon. Members the fact that at this very hospital, King's College Hospital, during the last six months they have admitted 65 cases to pay-bed accommodation free under that proviso of the Act. We ourselves are most anxious that the proviso should be fully operated. In the case of this hospital, as in the case of many others, we have been holding discussions about the proportion of pay-bed accommodation as against free bed accommodation. I understand that before very long at King's a further 30 beds will be changed over from pay-beds either to amenity or free bed accommodation.

The normal procedure in cases of this kind is that the general practitioner rings up the hospital, as the doctor did in this case, to find out whether there is accommodation available. If the hospital says there is no ordinary accommodation available, it is the normal practice for the general practitioner to let the hospital know that the case should be regarded as an emergency case.

I am afraid that did not happen in this case. There is a mixture of views about this, but we are satisfied the hospital had no idea at the time that this was being pressed upon them as an emergency case. When the doctor later applied for a pay-bed in a semi-private ward, they understood it to be an application in the ordinary way for a pay-bed. They knew nothing of its being an emergency case and requiring free treatment. They treated it as they naturally would be expected to treat it. Of course, they knew it was an emergency operation when the case was admitted to hospital.

No, it is true that there was not in that hospital a general bed available, but there might have been in another hospital which was, in fact, nearer—the Dulwich Hospital—where, I understand, it would have been possible to provide accommodation free. Of course, we cannot guarantee that admission can be made automatically to any particular hospital, but the interesting point is that even after admission, we do find, on occasion, that admission has been made through some misunderstanding to a pay-bed. Of course, the hospital does not wish to whip someone out of a pay-bed and send him or her somewhere else if they have no general bed available. But if the question had been raised—and not necessarily at that time, for we appreciate how the husband would feel in a case of this sort—when the first bill was presented after his wife had been in hospital for a week. Mr. Harris could have made some complaint to the hospital, or at any rate he could have asked the hospital whether some arrangement could be made.

We find in many cases over the country that that kind of approach is made, and an effort is made to meet it. If there seem to have been difficulties or misunderstandings, changes are made at a time when the anxiety is not so great and those concerned understand the situation. But Mr. Harris did not do that. When the first account was presented, after the first week, he did not pay it and he let it run on. The hospital never got a complaint from him until after the hon. and gallant Member raised the matter. The hospital heard the first about the matter through the hon. and gallant Member raising it with us.

It seems to me that this is not really a case of red tape and bureaucracy. We have tried to make it as easy as possible, and to encourage hospitals generally throughout the country, to adopt a reasonable attitude in these cases, but I think the hon. and gallant Member himself will recognise that there must be regulations of some kind if it is decided that there ought to be pay-bed accommodation available. We have given definite pledges to the medical profession that there shall be some pay-bed accommodation, and as long as there is that accommodation, surely it is reasonable to try to ensure that it is put to the best use for the purposes for which it was intended, except under emergency conditions.

As I have shown, King's College Hospital has always been willing to consider such emergencies. But that is not quite the end of the matter. Even though Mr. Harris did not raise it himself, even though he did not raise it at the time when he might have done so, but waited until the treatment was completed and the final bill presented before he raised the matter—and then raised it with the hon. and gallant Member—and even though we might have said, "I am afraid you have not taken any notice of any of the warnings which have been given you and we really cannot do any more,"—even after all this, we approached the hospital in connection with their amenity funds, with which they have been particularly generous in cases of this type.

My right hon. Friend took very great care to ask the hospital if they would be willing to look at this matter in as generous a way as possible; and whether they could use their amenity money to reduce the charges and so help this particular case. They said they would do that if Mr. Harris would call and discuss the matter with them. Of course, that might mean giving what information he could to show if this was a hardship case; but I do not think that is unreasonable. He did not wish to do so. Let me tell the House that this very hospital has used its amenity money for cases of this kind on more than one occasion recently on our suggestion. So it cannot be said that my right hon. Friend is taking any hard or harsh line in the matter.

I should like to get it absolutely clear that it was only after five months that it was suggested that he should go to the hospital. That was in February, and we had been battling over this since August.

But Mr. Harris did not do what most of us would have done; that is, have a talk with the hospital in order to see if any arrangement could be made. The hospital have had quite a few of these cases in which they have tried to be as generous as possible; they no doubt want to safeguard their amenity funds for hard and difficult cases, but they have done their best.

The Question having been proposed after Ten o'Clock and the Debate having continued for half an hour, Mr. DEPUTY-SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at Three Minutes to Eleven o'Clock.