I beg to move, That this House doth disagree with the Lords in the said amendment.

I call attention to the fact that privilege is involved in this amendment.

This amendment from the Lords is not acceptable to the Government. There is no need for the Health Services Board to be larger than the balanced membership of chairman and four members, as was provided for in the Bill to which this House gave a Third Reading by a majority of 24. That is a satisfactory size for the job the Board has to do.

Moreover, I have to remind the House that the principle on which this House gave this Bill its Second Reading and its Third Reading was that it embodies a compromise. That compromise was reached after lengthy and difficult discussions with the representatives of the medical and dental professions. The Government undertook to embody the terms of that compromise in legislation, and that the Bill does. The terms, published on 15th December 1975, included explicit provision for the constitution of the independent Health Services Board: a chairman and two members from the medical profession and two selected after consultation with bodies representative of the interests of other NHS staff and those representing the interests of NHS patients. That was what was in the Bill as it left this House, and it should remain.

It might be helpful if at the outset I were briefly to say a few words about our approach to today's debates. We shall be dealing today, if we can, with a large number of amendments on which there were tied votes in Standing Committee. Amendments were lost only by virtue of the Chairman's casting vote. When we debated these matters last month on Report, many of these amendments—more than 30—were never reached because of the operation of the guillotine.

A great deal of time has been spent in another place in debating the Bill, and many of the amendments on which there were tied votes in Committee and which were guillotined on Report in this House come before us again today to enable this House to reach a conclusion upon them. It is the constitutional duty of hon. Members to do their utmost to ensure that each of the amendments is the subject of a conclusive decision by the House and not to send the Bill back to another place, with whatever messages we prepare, with large numbers of amendments on which we have not reached a conclusion because of the operation of the guillotine.

In that case, because the right hon. Gentleman feels that all the available time is needed to debate matters in the Bill which, according to him, have not been properly examined, will he use every minute available to him today, Friday, under the terms of the guillotine?

The hon. Gentleman has misconstrued what I said. I said that it is important that the House should reach a conclusion upon the amendments Many of them are hotly contested, and it would be right that we should express our views in the Division Lobbies—and there will be a number of Divisions. The time for debate must be accordingly curtailed because of the guillotine. The hon. Gentleman is inviting me to let through the amendments without Divisions. [Interruption.] The hon. Gentleman is now inviting us to finish early.

No—the right hon. Gentleman is.

No, I am not.

Order. The hon. Member for Bolsover (Mr. Skinner) must not interrupt from a sedentary position. If he wishes to interrupt, he knows what to do.

I gave way to the hon. Gentleman—

On a point of order, Mr. Speaker. It is fair to say that an hon. Member speaking from a sedentary position should on occasion be challenged if it is being done continually. I have been a Member for some time, and in the past six years I have heard many hon. Members make remarks from sedentary positions. In the past two days, in debates in which I took no part, there were literally scores of such interruptions. I wonder whether this is a new ruling that you have decided to make—

Order. The hon. Member knows that this is not the first time I have had to tell him. I have told him before, as I have told the House, that interruptions from a sedentary position, especially when they are continued, as the hon. Member did three times, spoil debates in the House.

It is our intention to do our utmost to reach a conclusion on every amendment suggested by the other place. That will require a great deal of self-discipline on the part of myself and my hon. Friends, and I hope that Government Members will help the House to reach conclusions upon amendments on which this House has not had an opportunity to reach a final decision. That means that our speeches will need to be brief.

We have made no secret of the fact that we dislike the Bill intensely. We believe that it would be improved considerably if all the amendments from another place were accepted. The truth is, and it was made clear on Report in many speeches from below the Gangway on the Government side, that the phasing out of pay beds from our hospitals owes a great deal more to Left-Wing hostility to the professions than to any desire to help NHS patients.

In fact, the Bill is nothing more than the class war carried into law. The Goodman proposals had the effect of institutionalising this class war, and by what the Secretary of State calls a balanced Board of five members, two to represent the medical profession—and two to represent other interests, he is, in effect, institutionalising the continuation of this struggle that is such a source of bitterness and anguish within the National Health Service.

In another place Lord Wells-Pestell let forth an incautious statement about the Government's view of what the Board is supposed to be. After referring to the two members of the Board to come from the medical profession he said

"so there will be two members over whom, if you like, the Government will have no control at all."—[Official Report, House of Lords, 4th November 1976; Vol. 376, c. 1463]

The implication of that is that the other three members, the chairman and two appointed after consultation with other interests in the NHS, will be those over whom the Government have control. That is totally unacceptable to us. We believe that it is a disastrous approach, and that it will perpetuate the conflict that has disfigured the NHS on this issue.

I hope that the House will be prepared to accept the amendments that have been passed to us from another place, that the number of the Board should be increased from five to seven, that there should be three representing the medical profession, that there should be one representing, as it were, the nurses and the other supplementary professions, and appointed after consultations with the appropriate organisations, that there should be one representing all patients, and that one other member should be appointed after consultation with the other interests.

Such a Board would be far more likely to reach objective and harmonious decisions and avoid the institutionalised class war that will be involved in the Board as we have it. I therefore invite my right hon. and hon. Friends to divide the House in favour of retaining the amendment and against the Government's motion.

I shall respond to the request by the right hon. Member for Wanstead and Woodford (Mr. Jenkin) to be brief, because if he proposes to take us through the Lobbies 69 times today we shall need to keep our speeches to a minimum.

Reference has again been made to the fact that there were even votes in Committee upstairs. I put it to the House that if there are equal numbers on each side of the Committee there is no alternative to arriving at similar decisions on each occasion.

I shall not use the word "tedious" when I talk of repetition, otherwise I shall be criticising the Chair, but it is my contention that on this measure containing 24 clauses there have been more Second Reading speeches on amendments and on the Lords amendment than on any other measure that has come before the House.

The Board is part of a fine balance that the Government accepted—some of us thought wrongly—after it was put forward by Lord Goodman. It seems that their Lordships and the right hon. Member for Wanstead and Woodford are anxious to destroy that balance only when it favours their side of the case, but when my hon. Friends and I would like to see the terms of some provision as part of the compromise made a little stronger, Lord Goodman is the person whom the Opposition call in aid to oppose us.

Having seven members on the Board would make a nonsense of the delicate balance that has been struck of two in favour and two against separation, with the chairman independent. All of their Lordships' proposal would not improve the legislation, but would make a dog's dinner of it. There are more idiotic amendments to be Bill from the other place than I have ever seen, and if they were passed in toto they would make a nonsense of the Bill and of the Government's policies. Therefore, I shall vote with my right hon. Friend.

You will recall, Mr. Speaker, that when the right hon. Member for Wanstead and Woodford (Mr. Jenkin) commenced his remarks on the amendment he referred to the generality of the Bill and the way in which it had been handled in both Houses. I intervened to ask what I considered to be a pertinent question, namely, whether the Opposition would use the real weapon available to them to oppose a measure, and that is to debate it properly. I wanted to know whether, on this Friday, an unusual day for Government business, with a three-line Whip in operation, the Opposition would use all the time allocated to them under the guillotine motion to tell the nation what they say on public platforms about the contentious nature of the Bill and the way in which it will be carried out in practice.

I get the impression, from my intervention and the subsequent sedentary interventions, which were not occasions for shouting slogans, or "Rubbish", but merely continued the argument, that the Opposition do not intend to use the time that is available to debate the Bill but intend, instead, to run way from the issue.

I want to place it on record that the Opposition have a duty to stand by what they continually say outside the House about a measure such as this. I get the impression—I put it no higher than that—that what they are really doing is attempting to fight the issue in this House without fighting to the extent of which they are capable, as will be demonstrated today and as has been demonstrated on previous occasions, and are instead using the other place, with its massive majority of Tory peers, to fight their battles for them.

I want to get it on record that although so-called fights are put up on occasions in the House of Commons on some of these contentious measures, they really are phoney, and that what the Opposition are doing all the time is avoiding the real opportunities for debate in this House and using the House of Lords to try to obstruct measures that have been accepted by the electorate and agreed to on numerous occasions by democratic votes in this House.

I refer, first, to the point made by the right hon. Member for Wanstead and Woodford (Mr. Jenkin) about the comment of my noble Friend Lord Wells-Pestell. It was a little unfortunate that the right hon. Gentleman quoted something said by my noble Friend, when three pages later my noble Friend said that he did not recall using those words and immediately made it clear that what he was reported as saying was a slip of the tongue. The arrangement is that the chairman is independent, and there are four members of the Board, two from the medical profession appointed after consultation, and two representing other interests and also appointed after consultation and the Government have no control over any of them.

Would the right hon. Gentleman not agree that inadvertent slips of the tongue are often more indicative of intention than the carefully modulated phrases which one hears and which are shown in Hansard?

I have heard the right hon. Gentleman say things that he regretted later. I at least give credit to my hon. and noble Friend for, immediately after it was drawn to his attention —[Interruption.] I hope that the right hon. Gentleman will listen because, with respect, he has raised this point with me. The right hon. Gentleman ought to show me the courtesy of listening as well as showing courtesy to my hon. and noble Friend who dealt with this in the other place. My hon. and noble Friend immediately took the opportunity of correcting this on the record. Sometimes if hon. and right hon. Gentlemen opposite were as courteous in doing so we would proceed better.

I think that it would be anvantageous if we had as many votes as we could. My wish today is simply to show that the issues that we shall be debating have been thoroughly debated in Committee and on Report. In Committee the amendments were carried by a tied vote in many cases but this was because we did not have a majority. But every vote on Report was carried by a substantial majority. As we moved from Second Reading to Report the majorities increased, and this may well be so today.

The more votes we have the better, because it will then be seen that the elected Members in this House have spoken and that it ill-behoves the other place to challenge the views of the elected Members of this House. It is only on this amendment that I wish to pick up these few points. After that, I shall co-operate totally by simply proposing reasons why we should reject the Lords amendment.

This is a measure which has been carefully considered by this House in Committee and on Report. We are determined that the Bill will pass into law. [Interruption.] The right hon. Member for Wanstead and Woodford intervenes from a sedentary position. Since he has done so, I shall take no notice of what he said.

Our determinatioin is to get this measure through. The period of uncertainty about the Bill has gone on long enough. There is no benefit at all for the morale of those who work in the Health Service for the surgical operation to be postponed any longer. A lot has been said about waiting lists. The Bill has been on the waiting list since February 1974 and it is time that we got on with the job.

We wish to see this measure through Parliament. Of course, it is a compromise between two more extreme points of view. It is not satisfactory to everyone. I have heard hon. Gentlemen opposite sometimes say that it represents full-blooded Socialism. One of the criticisms of many of my hon Friends is that it is not. It is a compromise between extreme points of view. The author of the compromise, Lord Goodman, has recognised that it is in the interests of the Health Service that the Bill should now be carried through. The noble Lord said in another place, on the 21st October—

On a point of order, Mr. Speaker. I do not wish to interrupt the Secretary of State's flow of oratory but are we to understand that an exception is to be made from the normal rule that one can quote only speeches from members of the Government in another place? Is Lord Goodman now to be treated as a member of the Government?

Order. It is customary to paraphrase speeches by those Members of another place who are not Ministers.

I am happy to paraphrase, Mr. Speaker. What Lord Goodman said was that it was in the interests of the NHS that this compromise measure should now be completed and become law forthwith.

rose—

For Heaven's sake.

Would the right hon. Gentleman agree that Lord Goodman made it abundantly clear that he was against the whole principle of the legislation?

That was not the question at all. Here we are dealing with an issue which has been an open challenge within the Health Service. There are a number of people—Lord Goodman is one and my right hon. Friend the Member for Blackburn (Mrs. Castle) is another—who honestly wanted to bring a settlement to this dispute. That was the basis of the compromise put before the House in December last year. That is the basis of this legislation which has passed through this House on previous occasions. It is now in the best interests of harmonious relationships within the NHS that the Bill should become law.

I would pay tribute to Government supporters in the other place who nobly stood by the Bill presented by this elected House of Commons. I believe that any attempts to destroy the compromise by unrepresentative, unelected peers—certainly in alliance with the Conservative leadership—ought to be exposed. It should not be allowed to happen. It is playing party politics with the NHS.

We want to get the Bill through and do everything that we can to improve the morale of the NHS. The time has come to call a halt. On the following amendments I shall do no more than simply repeat the simple reasons why this House doth disagree with the Lords amendments.

I support my right hon. Friend. If I had my way I would reduce the Health Service Board to three, but I am happy to settle for five.

It is important to get on the record that even in the short period that we have been speaking this morning you, Mr. Speaker, have already been placed in a difficult position. I wish to seek your guidance with respect to the rest of the day. It has already been conceded across the two Front Benches that the Opposition require 13 Divisions.

It is implied, in what has also been said, that they require these Divisions before five o'clock. Divisions take on average a quarter of an hour. That is over four hours for Divisions within the six hours allocated for the Bill. We shall have less than two hours to debate the issues. That can be achieved only if debate is curtailed. I am told that in fact there is an agreement that only one speaker from each side will be called on each group of amendments. I seek your reassurance, Mr. Speaker, that any hon. Member who wishes to speak on any of these amendments, and who seeks to catch your eye, will not fail to be called simply because of what the two Front Benches require.

You are the guardian of the rights of Back Benchers and you are the guardian of the rights of this House against the other place. If no more is required of you today, it is make sure that those rights are fully put into operation. We would be prepared to stay here and vote all night if necessary to make sure that this legislation reaches the statute book and not to be subservient to a squalid little deal which has obviously been done between both Front Benches.

I appreciate what the hon. Gentleman said about my responsibility, and I agree with him. But the fact is that hon. Members will not be here voting all night because the guillotine will fall at five o'clock. I will ensure to the utmost of my ability that if any hon. Member seeks to speak, he will be heard.

I beg to move, That this House doth disagree with the Lords in the said amendment.

The main reason for our opposition to the amendment is that it is drafted in exceptionally wide terms, even if one could be confident that it was related only to employees in the National Health Service. Under one construction of the amendment it could be assumed that it applies to people other than those who are employed in the NHS, as one class possibly referred to in the amendment is those who were on 12th April 1976 concerned with the interests of patients at NHS hospitals, whether or not detriment occurred to them by reason or in consequence of the terms of their employment. That would be a wide class of persons and it would be impossible to envisage who might be covered by the amendment.

In addition, employees of the NHS are to a large measure protected, and there is little danger that any employees will suffer serious detriment as a result of the phasing out of pay bed operations.

We would welcome those consultants on part-time contracts who wish to convert to full-time contracts with the NHS. Pay beds are to be phased out at a rate which will enable suitable provision to be made outside the NHS. Consultants, therefore, will have appropriate notice to enable them to adjust to the new arrangements.

It is very unlikely, although a complete guarantee cannot be given, that NHS employees who are not consultants will lose their jobs by reason of the phasing out of pay beds. They all have excellent trade unions and comprehensive Whitley machinery which will afford them protection. I therefore ask the House to reject the amendment.

The Opposition regret that the Government have not been prepared to accept at least the principle of the amendment. I get the impression from what the Minister of State said and our earlier debates that the Government are rather uneasy about this because at different times they have used different arguments.

The amendment could concern all NHS staff, especially consultants. The background is that we are dealing with members of a profession who feel battered and bruised by the Government and suspicious after having been badly handled by the right hon. Member for Blackburn (Mrs. Castle). They fear for their independence and their clinical freedom. In view of the hostile remarks which have been made against the medical profession by Government supporters, and the fact that the Labour Party Conference wished to go much further than the Bill goes and to abolish entirely private practice, it is no wonder that the medical profession has these fears. That is the background against which we ask the Government to consider the amendment.

We wish to establish the simple principle of no detriment. It is a principle to which the trade unions, rightly, have attached particular importance over the years. We say that what is sauce for the goose should be sauce for the gander. If the principle of no detriment is right for trade unions, it should equally be right for consultants and others in the NHS.

People who suffer through no fault of their own because the Government have changed the law should be compensated. The Government have tried to argue, as the Minister did today, that there is no need for the amendment because people will not suffer. But they could suffer. The Government have given no guarantee that there will not be some people who suffer.

I take, first, the maximum part-time consultant who wishes to go whole-time. The Minister said that the Government would welcome that, but there is no guarantee that the consultant will get a whole-time contract. There is no guarantee that there will be a job available or that the hospital concerned will be able to afford it. The former Minister of State in earlier debates said that this must be subject always to the needs of the service.

There could be a loss here. The consultant who, feeling that he cannot conscientiously under the new arrangements do both his NHS work and private work, decides to give up his private work and to concentrate on his NHS patients, will almost certainly suffer a loss of income. There is no guarantee that that loss will be even partly made up by his being able to go full-time. This could involve a considerable disruption for the individual consultants concerned, some of whom may have had this arrangement for 30 years since the NHS started.

It could also work the other way round. A consultant who, because he is losing pay beds, decides to give up his NHS work and go entirely private has no guarantee that he will be able to do that. It may be said, if he decides to go private, that it is his own choice and he should stand on his own feet, but there may not be alternative facilities available.

The Government have turned down numerous Opposition amendments designed to ensure that phasing out should be dependent upon alternative private facilities being reasonably available. We say that the Government should either accept that phasing out should be dependent upon adequate alternative facilities being available or be prepared to provide compensation in the event of loss. The Government have refused to do either. It may be that very few people will suffer. We hope that few will suffer, but even if only one individual suffers it is the duty of the House when changing the law to protect that one individual.

There are ample precedents in the NHS for what is being suggested, and I very much regret that the Government have not seen fit to accept this simple, well-established principle. If the Government do not have second thoughts, I hope that the House will divide so that we may state clearly our strong feeling that it is wrong that the Government in changing the law should expose individuals to possible loss without providing any compensation.

I do not want to delay the proceedings, and I certainly do not want to delay proceeding towards a vote on this matter. However, I cannot help but support my hon. Friend the Member for Somerset, North (Mr. Dean). Surely this amendment goes to the very root of the matter.

If we do not have some kind of built-in guarantee against detriment, the Government must accept that many of the consultants concerned will go into the private sector and be lost to the National Health Service.

That, to Opposition Members, might not be totally objectionable were it not for the fact that we frequently read the pronouncements of Labour Members below the Gangway who wish to abolish the private sector. That is clearly behind our worries throughout the entire proceedings on this Bill. We and the consultants are concerned that, if there is no built-in guarantee against detriment, they will go private.

We fear that a future Labour Government will abolish the private sector and that the consultants, therefore, will go abroad, and that yet another future Labour Government will abolish the right to practise and the right to have private treatment abroad. That is the direction in which we are heading. This amendment goes to the root of that objection. [Interruption.] I hear a Government supporter say "Sixth-form stuff". But every other Socialist State—presumably that is what the Labour Government want—has controls on the movements of its citizens both within and across its borders. If we do not give our consultants the kind of returns which they need and can get abroad, they will go abroad. A future Socialist Government will then no doubt forbid them to practise and give treatment abroad.

Unless, at this stage, we can build in some kind of guarantee against detriment, it seems that we shall inevitably move towards a situation where, first, people will go exclusively to the private sector—I have never heard the Government argue that that will be the trend—and, secondly, a future Labour Government will abolish that. On those grounds, I support what was said by my hon. Friend the Member for Somerset, North.

This amendment, which seeks to ensure that there is no detriment to people employed in the National Health Service, refers also to whole-time consultants. Until 20 minutes ago, I had always understood that whole-time consultants were not allowed to charge fees or to treat private patients. Having read Amendment No. 2, which we are seeking to remove from the Bill, and having read the minutes of a meeting of the Ealing, Hammersmith and Hounslow Area Health Authority of 10th November, when it discussed the audit report, I understand that whole-time consultants have been treating and charging private patients, contrary to the regulations.

Would the hon. Member for Birmingham, Perry Barr (Mr. Rooker) address his remarks to the other part of the amendment, which deals with part-time consultants? We are concerned not with whole-time consultants, but with part-time consultants.

Of course, the hon. Member for Somerset, North (Mr. Dean) would wish me to deal with part-time consultants, because they can charge fees for private treatment. But that is not the point. The amendment also refers to whole-time consultants.

Of course, whole-time consultants are entitled to charge private patients.

Frankly, the auditors of the Ealing, Hammersmith and Hounslow Area Health Authority do not think so. It was reported to that authority, in private session on 10th November, that whole-time consultants had been charging professional fees contrary to the regulations. Six consultants were concerned, and the losses were made between May and June 1976.

The Opposition claim to be seeking to ensure that people do not suffer any detriment. I shall stick to the question of whole-time consultants. It seems that whole-time consultants, because of laxity of control in the NHS over private patients, are already jumping on the gravy train notwithstanding that, by and large, private patients do not pay the bills. Massive amounts have to be recovered by legal action.

Shame!

It is correct. We hear stories from the Opposition about people not paying their bills and scrounging on the Welfare State, but private fee-paying patients do not pay their bills and a great deal of the money has to be recovered by legal action.

I have no wish to spoil the debate or to be out of order, but that is the position of whole-time consultants. Opposition Members are concerned to ensure that whole-time consultants do not suffer any detriment. I should like my right hon. Friend to confirm that what I have said is correct. I should also like him to confirm that the Department will look into the position at Hammersmith Hospital and the illegal practice of whole-time consultants which the auditors have drawn to the attention of the Area Health Authority.

The Opposition and the House of Lords are seeking to protect a procedure which is not right and proper but which continues to be part of the gravy train of milking the National Health Service and allows queue-jumping which forces people to accept that they must go private to get the necessary treatment for themselves or their families.

I think that it is disgraceful that the Opposition should seek to protect whole-time consultants who, in practice, should not need protection, because they should not suffer any detriment under the Bill. It is the part-time consultants whom the Opposition should take steps to protect. The decision whether to continue part-time or to go whole-time places those consultants in a dilemma. Whole-time consultants will not suffer detriment, but those who have been fiddling the system should suffer some sort of detriment. On that point, I should imagine that I have the support of my hon. Friends. [HON. MEMBERS: "Hear, hear."] It seems that I clearly have that support.

I hope that the Government will look into the situation at Hammersmith Hospital where the auditors have drawn attention to the malpractices of whole-time consultants.

I beg to move, That this House doth disagree with the Lords in the said amendment.

With this we may discuss Lords Amendments Nos. 4, 5, 6, 69, and Lords Amendment No. 7 and the last amendment in lieu.

The effect of the amendment would be to remove the Secretary of State's duty to phase out 1,000 beds and would require the Board to put proposals to the Secretary of State within 12 months for withdrawing not more than 1,000 beds. The early phasing out of pay beds was part of the Goodman compromise and the amendment would have a severe delaying effect.

Over several months we have been in constant consultation with area health authorities in preparation for the provisions contained in Schedule 2 and the amendment would simply mean a delay of six months in phasing out pay beds. Since the determination of the House is clear, I am certain that hon. Members will accept that there is no reason why we should delay making progress.

I now turn to a point raised by my hon. Friend the Member for Birmingham, Perry Barr (Mr. Rooker) about the treatment of private patients at Hammersmith Hospital. It appears to be true, according to the health authority, that certain whole-time hospital consultants have been charging professional fees contrary to the regulations. The charging of fees by whole-time consultants has never been approved by the authority. I am assured that the matter is being reviewed and that controls will be strengthened.

My hon. Friends and I attach great importance to Lords Amendment No. 3 which would oblige the Health Services Board, not the Secretary of State, to choose the first 1,000 pay beds to be phased out. We see little merit in setting up a Health Services Board, giving it obligations to phase out pay beds, and laying down criteria by which that shall be done, if the Secretary of State himself decides to phase out the first 1,000 pay beds, which may be the only beds to be phased out under the Bill. The Secretary of State is buying himself an expensive pedigree dog and doing all the yapping himself. He will be yapping at the wrong things at the wrong time.

The criteria he can use could be totally different from the criteria that the Health Board decides upon, which could lead to a completely illogical phasing out. We think that the process requires more time, which is why we suggest 12 months rather than six. We have seen the consequences of the hasty consultation process in which the Secretary of State is currently engaged.

Amendment No. 4 is consequential. Amendment No. 6 inserts the important condition that the alternative facilities shall be of a satisfactory standard. That is the amendment to which Lord Goodman spoke in another place.

Amendment No. 7 is one of the most important. We want the Secretary of State in deciding which 1,000 beds are to be phased out to ensure that those beds are used by National Health Service patients. We do not want the dust covers put on them. That would be a grievous insult to common sense and a total waste of resources.

We have given examples of where that has and might happen in certain hospitals with a shortage of resources. While that may satisfy the left wing of the Labour Party, it would be deplored by the general public.

We are delighted that, after repeated pressure by the Opposition, the Government have at last conceded and have produced an amendment. It would be churlish of us not to welcome that belated recognition of our arguments. It would be helpful if the Secretary of State would confirm that his amendment will preclude the use of private wings in hospitals as administrative offices, which is one solution that he suggested in Committee.

Amendment No. 69 relates to Schedule 2. We do not accept that 1,000 pay beds should be phased out and we do not accept the way that that is being done in the schedule. We believe that the allocation of cuts among the area health authorities is inconsistent with the criteria in Clause 4 and that the Lords amendment should be upheld.

I was disappointed that the hon. Member for Ealing, Acton (Sir G. Young) spoiled an otherwise sincere speech by making churlish remarks about the left wing of the Labour Party. Of course we want pay beds to be phased out so that the beds can be made available to others in the National Health Service.

I join with the hon. Member in saying that private facilities should not be turned into administrative wings. The facilities should be used for National Health Service patients—that is the point of the Bill. It ill becomes the hon. Member to suggest that we want to end the pay bed system out of spite and to see the beds lying idle.

We strongly resist the Lords amendments. As it stands, the Bill would call for the separation of 1,000 pay beds by the end of six months. That in itself is not strong enough. Many of my hon. Friends feel deeply that the whole point of the Bill is to separate pay beds from the National Health Service and to end once and for all the division between the facilities and quality of care available in the Health Service and the much superior and quicker service available to private patients. We can end that anomaly and ensure that we have a Health Service free to be used only if we eliminate private practice entirely from the Service.

To suggest that ending even 1,000 pay beds in six months is a radical move in that direction is nonsense. It is not sufficient. We want the Bill strengthened in that respect, even more as a result of that compromise effected by the ubiquitous Lord Goodman.

The Lords are suggesting not 1,000 beds eliminated within six months, but X number of beds phased out within 12 months. That is another delaying tactic and is a clear indication that they have no belief at all in the principles of the National Health Service or any intention of trying to make the Bill work. Their intention is to strike at the heart and core of the Bill and to destroy it.

If we are serious about the principles underlying the National Health Service and the Socialist philosophy behind it, we must be equally serious about dealing with the aberration and anomaly of pay beds. There cannot be any more compromise by the Government. We must go ahead clearly and determinedly to end pay beds in the National Health Service. For that reason, if for no other, we must strenuously resist these wrecking amendments.

I entirely agree with my hon. Friend the Member for Ormskirk (Mr. Kilroy-Silk) that the purpose of all the Conservative amendments, faithfully embellished and echoed in another place, is to destroy the Bill. They are presented to us with all sorts of specious and selective arguments. Once again, the Opposition have quoted Lord Goodman in their aid when it suited them, carefully ignoring the essential parts of the compromise when they thought that they could.

Lord Goodman's approval of Amendment No. 6 was quoted. We have not had quoted to us his total silence on Amendment No. 3. He did not vote for it, and I have not the slightest doubt that he would consider that it was an unwise and disruptive amendment for their Lordships to press upon this House.

Therefore, I join my hon. Friend in thanking the Secretary of State for standing firm on this, as he has stood firm on all the principles of the Bill. To my hon. Friends who do not feel that the Bill goes far enough it must be some consolation to know the energy and verbosity with which the Opposition and their Lordships have fought it line by line. It proves that we are on our way to the fulfilment of the guiding principle of the Bill as set out in Clause 2(1)—to separate private practice from the NHS.

I wish to speak with particular reference to the proposal to delete Schedule 2. What I am concerned about in my constituency is not so much the loss of the four pay beds mentioned in the second column of the schedule but the loss of 24 beds when my cottage hospital at Uxbridge closes in order to save £103,000 a year. The Hillingdon Area Health Authority has made that proposal because of the financial stringency in my borough.

My constituents are getting a very bad deal as a result of the Bill. They stand to lose 24 beds in an excellent cottage hospital, one with a long history of success and much loved in the community. In return, all that the Bill offers them is the number of beds to be withdrawn, a total of four. That is a matter of serious concern.

I do not propose to debate the principle of the Bill, with its effect of reducing NHS income, but the other element of the Lords amendment is very important—namely, that the Board shall submit to the Secretary of State proposals concerning the reduction of pay beds within the area. If Hillingdon is to lose the Uxbridge cottage hospital with its 24 pay beds—plus, I understand, a number of other vital hospitals in the London borough of Hillingdon—it is only right that any reduction in the number of pay beds should be a matter for consideration by the Board. It has a much more intimate knowledge of the local situation than the Secretary of State, with his many other responsibilities, can have.

I hope that the Minister can tell me what benefits my constituents will receive from this part of the Bill in return for losing their four beds. How will it benefit them when they stand to lose 24 beds at a very important cottage hospital providing the kind of facilities which are not easily provided in a large district hospital?

It is sickening to listen to the Secretary of State as he pushes through a Left-wing Bill to abolish 1,000 pay beds, when he does not seem to understand the crying need of the National Health Service in the country as a whole. That need is not for additional bed accommodation. Like other hon. Members, I have written to the right hon. Gentleman many times complaining about the lack of theatre space for certain operations. I have written to him time and again about, for instance, the fact that in some parts of the country an NHS patient must wait for up to three years for an orthopaedic operation.

Can the right hon. Gentleman get his head out of this mess of party dogma, forget his determination, come what may, to abolish 1,000 pay beds, and instead pay a little attention to the crying need of the Service—certainly in the East Midlands and I believe nationally—to provide more theatre accommodation? I have here a letter that I received yesterday. It is written by the chairman of the area division of orthopaedic surgery, Trent Region. He says:

"while some small progress is being made in the direction of improving the facilities, I cannot foresee any improvement in the present situation of an ever-increasing waiting list for joint replacement surgery until provision is made for extra operating time."

That was written in response to the complaints I have continually conveyed to him.

Like nearly all my hon. Friends, I am a great supporter of the NHS, but we are tired of making excuses for it. We are fed up with having to send complaints to different Ministers when constituents say "I cannot afford to wait any longer. I must find a way to borrow the money to go private, because I cannot wait two or three years for an NHS operation". Time and again, my hon. Friends and I have pressed Ministers of both Governments to create a National Health Service that works. We should have a service of which we can be proud.

The Minister is not tackling the most important problem. The chairman of the area division of orthopaedic surgery is already applying considerable pressure for the provision of a second orthopaedic theatre within the area. He understands that new beds will be available in 1978, and says that if they are staffed there will be a very small improvement in the situation. He adds:

"But the main problem is that joint replacement surgery requires a considerable amount of operating theatre time",

and he says that until a substantial amount of extra operating theatre space is made available in the area, the waiting lists will continue to grow. That is a problem which concerns any hon. Member with a constituency interest.

We wish that the Secretary of State would forget this spiteful Bill and concentrate instead on what the general public wants, which is a proper Health Service in which people can have an NHS operation without having to wait so long that they have been known to die of old age before their turn comes.

I was surprised by the remarks of the hon. Member for Harborough (Mr. Farr). He must know that, as a result of decisions taken by my right hon. Friend the Member for Blackburn (Mrs. Castle) to redistribute resources on a regional basis, the Trent Region has received additional resources—admittedly, at the expense of some other regions, particularly in London and the Thames regions, which are having to operate on a basis of nil growth or less. It ill behoves the hon. Gentleman, who comes from a region that is benefiting from the redistribution, to say that there is a crying need for more beds.

I said that there was a crying need for more theatre space, for more operating beds.

It is for the region and the area to decide on the basis of their experience how best to allocate the resources at their disposal.

In the amendment we are dealing with the phasing out of 1,000 beds. It was recognised by all concerned that there was a great deal of under-utilisation of those beds, and it was acknowledged that the phasing out could be done by the Secretary of State. There was capacity available in the private sector.

Here it may be convenient to refer to the amendment in my name to Lords Amendment No. 7. In Lords Amendments Nos. 3 and 7, the other place put forward the idea that the beds released by the phasing out of 1,000 pay beds must be used for the benefit of NHS patients. The underlying principle was good but the wording was not acceptable. As it is clearly the wish that we should as far as is practicable make beds available to National Health Service patients—after all, that is the purpose of the whole operation—and improve the service within the NHS, I felt it would be right to table the amendment. I am grateful to the hon. Member for Ealing, Acton (Sir G. Young) for recognising that.

12.30 p.m.

My noble Friend explained in another place that the amendments as we have received them from that place would not be acceptable. They fail to recognise the value that the released beds might have for day-patients. They insisted that they should be for in-patients use or in association with out-patient treatment. Moreover, it would be wrong and could lead to a wasteful use of staff to oblige hospitals in every case to use every one of these beds for in-patients, as the Lords amendments would have bound us to do.

However, I sympathise with the underlying points made in the Lords amendments and at a late stage yesterday I tabled an amendment in lieu which provides that

"The Secretary of State shall so far as is practicable ensure that the beds released by the reduction made under this section are made available for the use of patients other than private patients."

I hope that the House will decide to approve the amendment.

I beg to move, That this House doth disagree with the Lords in the said amendment.

With this we are to take Lords Amendments Nos. 9 to 12 and 15 to 20.

I do not think that this matter need detain the House for long, not because it is a matter of no importance—it is of fundamental importance—but because I think that it shows a clear division of principle between the two sides of the House which can be readily and easily described.

It is the Government's policy to phase pay beds out of the National Health Service. It is the object of the Goodman proposals to do that. The Bill is the vehicle for achieving the phasing out of pay beds from the service, and the Health Board is the instrument for doing it.

The amendment seeks to conceive that the Board will say in its deliberations "we must withdraw some pay beds here, but perhaps there is a need for pay beds somewhere else, so we shall put some in there". That is not the job of the Board. Its job is to phase out pay beds from the service. It is clear in the objects of the Bill.

There may be one or two marginal cases. I refer in passing to Clause 5, whereby if there is a temporary cessation of the use of pay beds the Board may recommend alternative provision, and perhaps where some form of emergency reduces the number of pay beds in certain areas, again the Board may recommend some alternative provision in the aftermath of damage by fire, storm or something of that sort. However, apart from those two small exceptions, the object of the Bill is to phase out pay beds and it is the duty of the Health Board to do that. Therefore, I ask the House to reject the amendment.

The amendment is based on an amendment in Committee the vote on which was tied and which was never debated on Report in this House because it was guillotined. We feel very strongly that if the Government genuinely care about the care of patients and the quality of care, they should accept the amendment.

I am surprised that the Minister should say that it is only a matter of principle. It is much more than that. We feel that it is necessary that the Board should be free to give beds as well as to take them away, to be able if necessary to authorise new private beds within the NHS in areas in which they are needed, as well as to close them down. This is a very important and necessary aspect of flexibility for the Board to have.

We are concerned for three particular reasons. First, the Registrar-General's reports show that there are very great changes in the size of population in different areas, and it is very difficult now to forecast where all these changes will take place. Secondly, as the Minister knows from our discussions in Committee, we are very concerned about the new towns. We spent much time discussing Peterborough, for example, where there is an excellent modern hospital. However, that hospital is not big enough and does not have the facilities to cater for the extra people moving into that area.

We find it extraordinary that people are encouraged by the Government to move into a new area when we know that there is inadequate hospital provision for their health care, and that not only will there be no new provision for private facilties but there is no adequate NHS provision. This is a very serious situation.

Will not the hon. Gentleman agree, therefore, that the priority should be to provide the facilities through the National Health Service before any question of pay beds arises?

No, I would not. If we look at the wording of the Goodman proposals, we find that the Government have accepted a responsibility to cover health more generally and to see that people who wish to have private facilities are still able to have them, certainly during the phasing-out period.

Thirdly, we are particularly concerned for the elderly and the mentally ill. We all know that the number of elderly patients will rise rapidly in the next few years. There will be inadequate provision for them. We are concerned, for example, for the people who wish to arrange for long-term private care for an elderly or a mentally sick person.

It is on these grounds that we oppose the Government and ask the House to accept the amendment.

I beg to move, That this House doth disagree with the Lords in the said amendment.

It will be convenient to consider at the same time Lords Amendment No. 14.

The effect of Lords Amendment No. 14 would be to require the Board to give reasons for its proposals for phasing out. The Government consider that that is quite unnecessary. The Board has to have regard to the four criteria set out in subsection (8) before making recommendations to the Secretary of State. It must also consider representations from those concerned with or interested in any proposals which it may make. The Board having discharged its obligations as an independent board, in the Government's view, there is no need for it to give reasons for its recommendations.

The task of the Board is to phase out pay beds. It might make more sense if the amendment required the Board to give reasons for not phasing out pay beds. In any case, the Board is, in effect, answerable to Parliament because its annual report will be presented to Parliament by the Secretary of State. It is my responsibility to lay the report before Parliament.

It seems only fair that the Board should give its reasons, in the same way as virtually any Government Deartment or Minister gives reasons for decisions. It is laid down in the clause that the Board will consider representations from medical practitioners, dental practitioners or

"persons employed in one or other of the national health services or concerned with the interests of patients at NHS hospitals."

Obviously, the Board would have to weigh the representations and make a decision accordingly. It seems only appropriate that, having made a decision, it should give its reasons.

I am grateful to the Secretary of State for having accepted at an earlier stage that exactly the same criteria should apply to the Scottish and Welsh Committees and that they also should have to take full account of representations made to them.

It seems only appropriate that the Board should act reasonably, just as reporters do at planning inquiries or as the Ombudsman or Government Departments do, and give reasons. I do not regard this as a matter of such pressing importance as to encourage my right hon. and hon. Friends to press it to a vote, but we wish to record our disagreement with the Government and express our view that the giving of reasons could do nothing but good.

I beg to move. That this House doth disagree with the Lords in the said amendment.

I suggest that it will be convenient to consider at the same time Lords Amendments Nos. 22 and 23.

The effect of the Lords amendment would be to require the Board to take into account the standard of alternative facilities in the private sector when considering proposals for the progressive revocation of authorisations of pay beds and other facilities for private practice. We discussed this issue for a long time in the Standing Committee.

In phasing out pay beds and facilities, the Board could have regard to the Government's intention to allow occasional admissions of patients privately to specialised NHS facilities if the particular services could not reasonably be provided in the private sector. Thus, the private sector will not be required to duplicate.

possibly in an unsatisfactory way, every sophisticated feature of the NHS.

The Secretary of State—in relation to the 1,000 beds—and the Board are obliged to look at the provision which is reasonably available in the private sector. This will inevitably involve a comparison with what is available in the private sector. In any case, the private sector is subject to control by registration under the Nursing Homes Act 1975. In the Government's view, it is unnecessary and unwise to make the proposed change.

The Secretary of State gabbled through his departmental brief and failed entirely to deal with the nub of the matter which this group of amendments rightly raises, which goes to the heart of the Goodman proposals, as was admitted by the previous Minister of State in Standing Committee. What we are seeking to do here—as Baroness Young did in the other place—is to establish a basis of trust among patients, among the professions and among all who work in the Health Service as to how standards are to be maintained.

One vital element in that essential confidence is the Goodman proposals, which have been characterised in some neo-Marxist terminology as the proposals of 15th December but which are the Goodman proposals. The Goodman proposals make clear

"that the Government are 'committed to the maintenance of private medical practice in this country' and ' intend to guarantee this in the legislation '".

We are seeking to establish by the amendments the extent to which that commitment is being honoured by the Government.

The Goodman proposals went on to say:

"The criterion for phasing out"—

that is what we are discussing in Clause 4—

"shall be the reasonable availability of reasonable alternative facilities … within a reasonable geographical distance and to which reasonable access is available to those patients and practitioners desiring to avail themselves of it".

There is no point in pretending that there is an alternative if it is not accessible and is not

"within a reasonable geographical distance".

These amendments deal with the standard at which the alternative facilities are available and the question of accessibility, together with the matter of cost, which is another important criterion of reasonable availability.

In Committee the Minister said that the Goodman proposals were subject to the interpretation of complex criteria. That is the point with which we are dealing today. How are the Government interpreting those criteria? Unless that is clearly established, there can be no basis of confidence and trust.

It is disappointing that in Committee the previous Minister of State appeared to go a little further than the Secretary of State has been able to go today when discussing the point about the matching of private facilities with the withdrawal of National Health Service facilities. His remarks on that subject are reported in column 602 of the Official Report of the Standing Committee proceedings on 29th June.

We understood that there would be consultation with the professions on improvements, for example, in the standards of private sector provision. I am sure that the Secretary of State would not wish to take the position of not caring about the standards of provision available in the private sector. I accept that the Government see no responsibility for maintaining the private sector, but I am sure that the right hon. Gentleman would wish to address himself to the question of standards in the private sector. His rejection of the amendment would seem to suggest that he is not exercising that responsibility.

The hon. Gentleman will know that the private sector is subject to control under the Nursing Homes Act 1975. To require the Health Services Board to fulfil that function would be a duplication. It would put on it a burden much greater than would be tolerable.

In Committee the former Minister of State appeared not to accept that the control exercised under the Nursing Homes Act 1975 was adequate. He went on to say that the Government had made clear that they were prepared to consider what improvements might be made. We are trying to pin down the Secretary of State to saying how far the consultations have progressed and what improvements are considered to be necessary. The right hon. Gentleman has made no attempt to reply to that.

The point I tried to make was that this is not and should not be the responsibility of the Board.

It is apparent that the Secretary of State is not willing to address himself to the question of the standard that should be available. That is all the more surprising because Clause 8(2) deals with the power of the Secretary of State to refuse private patients admission to NHS hospitals

"unless satisfied that the accommodation or services … required"

are not privately available, or, if they are available, are

"not privately available there at a place which is reasonably accessible"

or

"available at a satisfactory standard".

Therefore, even the Government's own Bill lays down two of the criteria which the amendments seek to establish. We cannot understand why the Government are reneging on their clear responsibilities. What is the meaning of "reasonable availability" if it does not cover those elements?

I wish to deal with some of the earlier remarks of the Secretary of State. His sham indignation about the action of the House of Lords in seeking to establish the criteria on which the Bill and the Goodman proposals were framed and his remarks about the will of the people do not accord with the opinion poll commissioned in the summer, which was discussed in Committee and which showed clearly that most Labour voters and trade unionists were opposed to everything that the Government were trying to do by the Bill. Happily, that was confirmed by the recent by-election results at Workington and Walsall. So let us have no more of the right hon. Gentleman's sham indignation and no more remarks by the hon. Member for Bolsover (Mr. Skinner) about fighting a phoney war. The Government are about to realise that it is for real.

I wish to express my grave disappointment that the Sec- retary of State has not been able to accept these amendments. As he knows, Lord Goodman commended amendments in this sense when he spoke on Second Reading in another place. Indeed, he went further. He said that he had discussed them with the Secretary of State and had gained the impression from the right hon. Gentleman's reaction that he would have liked to have accepted the amendments.

Lord Goodman spelled out—and it would be out of order to quote what he said—why it would cost the Government nothing to give this small extra assurance to the medical profession that the Health Services Board would have to have regard to the standard of the alternative accommodation and that it should be reasonably accessible to the practitioner as well as to the patient.

Somebody has got at the Secretary of State and has persuaded him that this would be a concession which perhaps his hon. Friends below the Gangway would not accept. They would be unwise to bring any such pressure on the Secretary of State, and I hope that even now the right hon. Gentleman will indicate that if this amendment returns to another place he will be prepared to consider it and accept it before it comes back to this House. This is an eminently sensible amendment which Lord Goodman suggested would cost the Government nothing and its acceptance would be immensely reassuring to the profession.

I make it clear that at no stage and in no context did I suggest that I was prepared to accept this amendment. Nor have I been under pressure from any of my hon. Friends.

I should let the House know that I have had a report that the Bells were not ringing at the time the Division was called. They have now started to ring, and the Division will be timed from now.

On a point of order, Mr. Deputy Speaker. For the purpose of the record, there are no Labour Members present, apart from the Parliamentary Private Secretary, the Minister and his assistant—

Order. The hon. and learned Gentleman is well aware that that is not a matter for the Chair.

I beg to move, That this House does disagree with the Lords in the said amendment.

With this we may take Lords Amendments Nos. 25, 26 and 27.

It is nice to have the hon. and learned Member for Ruislip-North-wood (Mr. Crowder) with us. Presumably he felt that he ought to come back because we had a substantially increased majority on the last vote. We improve steadily as we go along.

The principal purpose of this group of amendments is not in the initial amendment, which would remove the third of the four principles. The main amendment is No. 26, which would add an additional principle for the Board to consider in making its proposals, namely, that revocation would be permissible only if those trying to provide alternative facilities have not met unreasonable obstruction from planning authorities or others.

The proposed additional principle would require the Board to form a view whether local planning authorities were exercising their planning powers reasonably and where it considered they were not doing so to withhold proposals for revoking pay bed authorisation.

This would be most inappropriate in legislation. In any case, it is unnecessary because there is a right of appeal against planning permission to the Secretary of State for the Environment and, in certain circumstances, to the court. It would be inappropriate for the Board to involve itself in these matters.

For these reasons, I certainly oppose that amendment as well as the others in the group.

The purpose of the four amendments, which we support, is to ensure that the private sector gets a fair chance to set up alternative accommodation. Although subsection (8)(c) was lifted straight out of the Goodman compromise proposals almost unamended, we feel that it could be taken in any way one liked to read it. It could well be taken to indicate that the Board need pay no attention to what efforts are being made to provide reasonable accommodation outside. It could be read in exactly the opposite way to that which is intended. It is badly drafted. That is why both in Committee and in the other place we felt that the Bill would be better if that subsection were taken out.

It will be extremely hard in some areas of private facilities to replace pay beds. It may take a long time to do so, particularly in the present financial crisis. We do not want the Board in any way to start rushing the phasing out of private beds when there is a possibility that in a few years' time—when conditions may be better—the private sector will be able to set up alternative facilities in order to improve the area of choice for all patients.

Our objection to the Bill is that it limits the area of choice in health care available to the citizen. If the Government persist with both paragraphs (c) and (d), they are saying that rather than wanting separation they want total abolition of private health care.

That is the message that we wish to put across. The whole point of the compromise is to achieve separation of a continued thriving private sector of health care in the country in order to give citizens better freedom of choice to have the doctor they wish to have.

We believe that Amendment No. 26, which is an insertion into the Bill, is a reasonable one. It would be quite wrong for the Board to allow pay beds to be phased out in an area where the private sector was trying to obtain facilities in order to keep the opportunities available for private practice in that area. We do not feel that it is interfering in the judgment of a local authority for the Board to take into account that planning permission for alternative accommodation may have been obstructed.

We have had warnings, particularly by NALGO, that planning permission for alternative accommodation in respect of large hospitals over 100 beds in the London area and 75 beds outside would be obstructed. This provision should be kept in the Bill.

Amendment No. 27 is an entirely new one, of which none of us thought in Committee over all those long months, but it is very important. We want to ensure that patients continue to be able to obtain the kind of doctor or treatment that they have been used to outside the NHS, once separation has taken place. That is a reasonable attitude. If a large number of, say, Roman Catholics in an area have been used to going to a Roman Catholic consultant who can use pay beds in an NHS hospital, the Board should ensure that there are private facilities outside where a Roman Catholic consultant can practise or is practising before pay beds in that area are phased out.

This is a blow that we should try to strike for freedom. Patients must be able to continue to choose the kind of doctor they want. It has been suggested that this is a wrecking amendment, but I do not agree. It refers to a "substantial reduction" in the freedom of patients. In other words, we want facilities offered outside similar to those which private patients in NHS hospitals were getting before. It is a good amendment and I invite my hon. Friends to vote for it.

I would emphasise what my hon. Friend the Member for Wells (Mr. Boscawen) has said about Amendment No. 27. This is a new point which was accepted in another place, with support not only from the Cross-Benches but also from the Bishops' Bench. It was stressed as of importance, for instance, to Roman Catholics. It was said that, if one of the results of phasing out pay beds was a substantial reduction in the freedom of patients to choose a doctor of the religion or of of the race or language of their own, that factor should be taken into account by the Health Services Board.

The Secretary of State—certainly this is true of his noble Friend in another place—appears to persist in misunderstanding both the language and the purpose of the amendment. There is no suggestion that a Nigerian should be expected to go to a Nigerian doctor or an Indian to an Indian doctor. People should simply have the freedom to choose. Many do not have choice, but that is no reason for reducing the ambit of choice. We want to widen it.

If the effect of the Bill is to reduce choice—for instance, the choice of a woman to be treated by a woman consultant or a Roman Catholic to be treated by a Roman Catholic consultant—that would be just one more diminution of the right of patients to choose the kind of medical care they want.

The Secretary of State has not spoken on this amendment. I hope that he will undertake to consider it carefully because it seems to be one of some importance. I commend it to him.

The hon. Member for Wells (Mr. Boscawen) somewhat misinterpreted the four criteria. It is the Government's aim to give the private sector a reasonable opportunity to provide its own facilities, where necessary, before phasing out pay beds. We have sought to write that in, in terms which I think represent that aim.

However, on paragraph (d), which their Lordships have also sought to delete, I said in Committee that it is not the Government's intention to allow pay beds to continue where the private sector is unwilling to take the necessary steps to provide decent facilities. Of course there is a responsibility on the private sector, so far as it wishes, to provide its own facilities. It cannot simply, by failure to do so, frustrate the purposes of the Bill.

I do not think that my noble Friend misunderstood Amendment No. 27. The reason for opposing it is that it puts an impossible task upon the Board and is absolutely outside the intended scope of its activities. In practice, more often than not, the patient's freedom of choice is already limited by the advice and information of his private doctor. Of course he is free to ask for a second opinion, but for that he would need in almost every case to go back to his family practitioner for guidance and advice.

Therefore, if a patient has already chosen—for reasons of sex, religion, colour or language—a particular family practitioner, he can return to him if he is dissatisfied. That situation would not be changed by the phasing out of pay beds. It would be almost impossible for the Board to fulfil that responsibility and I cannot offer to reconsider the matter. I have considered it carefully and this is not an amendment which it would be reasonable to accept.

We have been discussing a group of amendments. I understand that the Opposition would like to divide on Lords Amendment No. 27.

indicated assent.

With permission of the House, and only with permission of the House, I will put the Question on Lords Amendments Nos. 25 and 26 together.

I beg to move, That this House doth disagree with the Lords in the said amendment.

With this we may take Lords Amendments Nos. 29, 30 and 31.

I do not think that the House need be detained long on this group of amendments. Although they touch on an important principle, the House has already passed judgment on that principle earlier today. We do not see any need to extend the grounds upon which the Health Services Board may authorise new pay beds on the ground that the rôle of the Board is to phase out pay beds from the National Health Service. That is the task which it must perform under the Bill.

Some provision has been made for meeting emergencies and short-term and temporary closures. In those circumstances, we feel that there is no need to accept the group of amendments which the other place moved to extend the grounds of the authorisations.

The Minister will not be surprised that I disagree with almost everything he said, with one exception. I agree that the principle in these amendments was covered by earlier amendments considered in the debates in which my hon. Friend the Member for Reading, South (Dr. Vaughan) took part when we discussed whether new beds should be authorised in place of hospitals which are closed down. The Minister is absolutely right when he says that the principle in this group of amendments is exactly the same. Although we would dearly wish these amendments to be included in the Bill—there is no doubt about that—I am not sure that I should be justified in asking my right hon. and hon. Friends to divide the House on the issue.

I beg to move, That this House doth agree with the Lords in the said amendment.

The Minister is slipping.

I regret that I do not have 100 per cent. support for my motion. The Government have considered the amendment moved by another place to insert "shall" instead of "may" when it comes to authorising additional pay beds in certain circumstances. We do not intend to disagree with the amendment.

The effect of the amendment is to require instead of to enable the Secretary of State to grant temporary authorisations for pay beds or for private out-patient facilities if a hospital, which is still entitled to have authorised pay beds or outpatient facilities, is temporarily closed as a result of some physical event outside the Secretary of State's control, such as fire, flood, infection, landslide, act of God, or similar event. That means that the total number of authorised pay beds or out-patient facilities at any time will be kept at that level, but not in any circumstances increased, and will not be reduced by any of the emergencies which I have mentioned.

Obviously, as the operations of the Health Services Board proceed and the number of pay beds in the NHS is reduced, the opportunities for authorisation will be reduced. That does not necessarily mean that the authorisations would be operated if the time were short. But there will certainly be the requirement to authorise the appropriate substitute pay beds.

I thank the Minister for a small, but valuable concession. I am particularly grateful since his noble Friend the Baroness Stedman was very forthright when she said:

"There really is no reason for making this permissive power mandatory".—[Official Report, House of Lords, 10th November 1976; c. 499.]

The Minister has shown that he has an open mind on these matters.

It is entirely right to make this provision mandatory. If, for instance, a hospital which has pay beds is burned down or becomes infected and has to be closed by the Secretary of State, he may temporarily authorise pay beds in another hospital to replace them. This seems a necessary requirement. We should not leave it permissive as it is in the Bill. I thank the Minister for his open-minded-ness on this issue.

I beg to move, That this House doth disagree with the Lords in the said amendment.

In saying that we disagree with the Lords, we do not disagree that there is a problem here and that in principle the confidentiality of medical records should be preserved. We merely disagree with the concept that it should be protected by such an inflexible method as legislation.

Clause 6 makes provision for the Health Services Board to bring forward proposals for common waiting lists containing both private and National Health Service patients and ensuring that admission to health facilities is on the basis of medical priority only.

Obviously there will have to be a great deal of discussion of the various ailments from which the patients are suffering to assess the degree of medical priority. I understand the desire of doctors and patients to ensure that, as far as possible, confidential medical information is not freely bandied about in the process. The Government recognise that anxiety.

However, the proposal by their Lordships that this should be done by adding subsection (4) to the clause, is not the appropriate way of going about it. There are many occasions in the Health Service on which confidential information about patients and in-patients' records have to be considered to assess clinical requirements. We have been content, as a House and a country, to rely on the code of ethics of the professions dealing with this problem. The Government's view is that it is best to rely on the judgment of the professions as to how far they may go in this matter by using their judgment based on their general code of ethics.

Although we feel that there is a problem in principle here which has to be solved, we would prefer to leave it to the professions. We feel that it would be wrong to bind the Health Services Board tightly by a legislative provision where such a move has never before been thought necessary to protect the interests of patients or the profession.

I find that a disturbing and disappointing statement. I do not want to go over the very long debate we had on the whole waiting list problem in Committee and the further long debate we had in the other place about the worst manifestation of a deteriorating service in the public sector—the appalling waiting list problem.

It is a terrible reflection on this country that 44,000 people have been waiting for more than a year for non-urgent operations. We ought to be concentrating on and doing something about that problem. We should not be concentrating on this sideshow of a Bill which will not improve the waiting list problem.

There is no division in the House in the argument that blatant queue-jumping with the aid of a cheque book when there are no other factors involved is totally unacceptable. The Opposition have always agreed that. However, we do not agree that this Bill is the right way to overcome the problem. Government supporters must realise that the basis of medical priority alone will create considerable difficulties now that it is being written into a statute. It does not matter what is put in the statute. Medical priority will always include social grounds. Social grounds have always been taken into account by doctors and hospitals making up their waiting lists, and they will continue to be.

A new situation will arise now. The Bill may mean that in a common waiting list situation there will be a dispute about why one patient is put before another in a certain hospital. As a result, there will be pressure on doctors to reveal their reasons for placing that patient ahead of another patient on the waiting list. This is a new situation, and it may be necessary in the future to safeguard the long-established rights of members of the medical profession and others engaged in health care in terms of the complete confidentiality between patient and doctor and patient and nurse which has always been taken for granted in the past but which may be disputed under pressure in the future.

The Government should think again about this issue. A good deal of dispute could arise in the future in trying to introduce a common waiting list. We all know that it will be very difficult. The waiting list problem is immensely complicated. It does not offer an easy solution, and we do not want to make it worse by bringing pressure to bear on doctors. I do not believe that they will abuse the situation. They will not conceal deliberately the reason why a patient has been put ahead of another patient on the list. It is a great pity that we have spelt this out in the Bill, because dispute is bound to arise.

I am not sure how the hon. Gentleman can argue that the situation will be a new one. Regrettably, we have waiting lists now. Sometimes they are much too long. But doctors have to assess the priorities of people on the waiting list, anyway. They have managed to do so within the terms of their present code of ethics. Most people are on a common waiting list, in any event.

There is a new situation. We are interposing an outside independent board to set up a system of a common waiting list. That board will have to police its common waiting list and decide how it shall work. Somewhere, at some time, someone is bound to dispute it. In that dispute, there is bound to be cause for the doctor to reveal why he placed an individual in a certain position of the list, either on the day of the operation or during the month or year. There is a new situation. I hope that the hon. Gentleman will recognise it and realise that, if the Bill goes through as it is, the Government will have to answer for the consequences.

I wish to draw attention to the existing situation in the St. Helens and Knowsley area health authority district where I am informed that a private hospital is under construction at a time when nursing levels in other hospitals in the area are at a dangerously low level.

Apart from professional people in the National Health Service such as doctors, nurses and ancillary workers, we have a situation where, if the Minister is encouraged to accept any amendments to the Bill as it is at present, standards of care are in danger of being adversely affected. Hon. Members representing constituencies in the area are worried already about what those standards are likely to be in the future should an amendment be accepted which will affect the intake of nursing staff and others. In my view, my hon. Friend ought to resist with all his strength any amendment to this clause.

I appreciate that the hon. Gentleman is trying to help the Minister, but I do not see how my amendment dealing with confidentiality can upset the doctors and nurses in that area. I think that it will have the opposite effect, because they want it.

If I have followed the hon. Gentleman's argument, any amendment to the Bill will enable other authorities such as private health authorities to compete for the necessary staff to man new hospitals in the area.

I am very glad to hear that my hon. Friend the Minister of State is resisting this amendment. As the hon. Member for Wells (Mr. Boscawen) rightly pointed out, this part of the Bill which their Lordships seek to amend is one of the most constructive provisions. It arises because of the lack of success of the former Minister of State in his strong attempts to negotiate with the medical profession to secure common waiting lists without the need for legislation. For that reason, the whole of this clause is vitally necessary.

As a layman, I very much resent the idea that a doctor should not be accountable for his decisions over a wide range of matters including the way in which his waiting list is prepared. The essential objective of this amendment from the Lords is to argue that, because of the need for confidentiality in respect of both the clinical and the social reasons why a doctor selects one patient for admission before another, for some reason we cannot rely on the common sense of the medical profession whose members have been doing this for years and, therefore, need to write some provision into the statute to give them protection. From my knowledge of the medical profession, I know that this is nonsense. From the time that they qualify, automatically they have this responsibility to their patients. They do not need to have words written into legislation providing for confidentiality to be maintained.

I cannot think that the hon. Gentleman has read the amendment from another place. It is not that the doctor is being required to preserve confidentiality. It is that other people should not be entitled to make recommendations requiring the doctor to breach the confidentiality. It is entirely the other way round.

It is precisely because I have read the amendment that I intervene.

As for the common waiting list problem, in the past the way in which a person has been admitted for in-patient or out-patient treatment has rested solely on the clinical decision of the doctor concerned. As the hon. Member for Wells (Mr. Boscawen) said, when a number of candidates are waiting for admission for hernia or varicose vein operations, other conditions need to be considered.

If we are to have the kind of National Health Service that we want, we must have a hospital service which is based on team work and not on the old system where the consultant was God Almighty. Their Lordships are seeking to preserve the pre-eminence of the past where the only person making any decision was the consultant—not even his registrar or his team. Once again the Lords are trying to preserve this outdated system.

Inevitably there will be many pressures, not least from the community health councils, for a fairer waiting list system. At present, the case-hardened consultant has a quick way out if faced with 10 patients with equal claims. He can base his decision on who can pay the bill. That saves him many problems. As usual, the Lords are proposing an amendment which is unnecessary and which complicates the Bill. It proves the case for abolishing the House of Lords.

I hope that the Minister will think again. Surely hon. Members appreciate the importance of confidentiality between patient and doctor. The whole process depends upon it. Unless we accept the amendment, the patient will always wonder, however well meant the doctor, whether the Board, which will include laymen, might insist upon the doctor breaking confidentiality by telling it from what the patient suffers. It will break down the most important confidence between patient and doctor. Confidentiality must be retained and no one should be allowed to overrule it.

The confidence between patients and doctors which was created by the passing of the Bill in the form in which it left the House has now been destroyed by the Lords. Patients know that doctors can put pressures on them to jump the queue by paying the bill.

One of my constituents will considerably benefit from the Bill so long as the amendment is not passed. I shall not name her because her case is being considered by the Birmingham Area Health Authority. Hon. Members will know that general practitioners are sometimes also hospital consultants.

My constituent is a lady in her sixties who is having trouble with her eyes. Her family doctor referred her to the Birmingham Eye Hospital, where he is consultant. One of her eyes is deteriorating rapidly. Two years ago, her family doctor told her that both eyes would be treated together when that was necessary. That was her GP in his capacity as consultant. She did not see him between September 1975 and September this year, and she was told that the reason for the 12-month delay was the industrial action by consultants. I do not know why that should have caused such a long delay.

My constituent's daughter visited her GP from time to time during that year, told him that her eye was deteriorating and collected prescriptions for her. In September this year my constituent had an appointment to see her own GP at the Birmingham Eye Hospital. The lady is now blind in one eye. Her GP, in his role as consultant, told her that it would be two years before treatment could be given. But he added that he could deal with it in six months if she could pay £400 or £500. Where is that the doctor's medical priority? That story should convince the ragbag of the Opposition and the Lords that the Bill must remain as it was when it left this House.

It is disgraceful that a doctor-cum-consultant should behave in that way. I do not know whether he is fit to be a GP if that is the way in which he makes decisions. He has blackmailed this lady and told her that she will have to wait two years unless she can cross his palm with silver worth £400 or £500.

Many Labour Members believe that that GP is not fit to be a doctor.

I will if necessary say that outside the House after the health authority reports. I intend to send the facts of the case to my right hon. Friend the Secretary of State when the area health authority comes up with an answer, whatever it may be. Perhaps in the meantime medical priorities will change and my constituent will be treated under the National Health Service and that will be the end of the problem.

Does my hon. Friend accept that we all have cases such as that? I am sure that Opposition Members could quote them, too, if they chose. The case graphically demonstrates that unless we eradicate all vestige of commercialism from the National Health Service, abuses such as this will continue. It is an argument in favour of ensuring that there is no taint of profit or commercialism within the Service, and that all cases should be dealt with in the strict terms of medical priority.

It would be outrageous for the Lords amendment to be retained. Corrupt practices will be encouraged because doctors will not have to disclose information. The myths about the ethics of the medical profession that we hear of from the Opposition are rubbish. I am not tainting all doctors, because the great majority are good servants to their patients, but there are some who are not.

I have quoted one example, but there are others. I am sure that Opposition Members could give examples, but they do not want to do so. Perhaps they have an interest in not doing that. They, too, must receive letters from their constituents. This is not a party matter.

The only way to solve the problem is to take decisions of that kind out of the hands of the doctors. I have every confidence in a board of independent people laying down medical priorities. I am confident that such a board would make decisions fairly. It would take away from the doctors the taint of corruption and blackmail of the elderly, sick, poor and needy. In the case I mentioned, the lady was never asked whether she could afford £400 or £500. The doctor wanted to screw £400 or £500 out of my constituent for her to jump the queue.

That is not medical priority. I invite the right hon. Member for Wanstead and Woodford (Mr. Jenkin) or the hon. Member for Reading, South (Dr. Vaughan) on the Opposition Front Bench to refute what I have said, but they do not rise. They clearly have a vested interest in silence today. We have already seen that with six Divisions in three and a half hours and virtually no debate.

There is no great opposition to the Bill. No case for the amendment is advanced. Why do we go through this charade, with all the propaganda outside the House, with Conservative Members saying that they want the doctors to decide, that matters of confidence between them and their patients are of supreme importance? They say "We have made that case in Parliament. We went to the House on Friday 19th November, the last but one day of the Session, and fought to the death to protect confidence between doctor and patient."

2.30 p.m.

Half the Opposition are missing when the Divisions are called. Tory Members are moaning because they want to be away by 5 o'clock, and therefore they do not want to debate this amendment. No one seeks to intervene in my small contribution, even when I invite comment on my view that the amendment would add to the corrupt practices in the medical profession.

When I explain the position of my constituent who is blind in one eye and describe what has been said by her GP, wearing his other hat as a consultant, Tory Members laugh. I shall be interested in the reactions of my constituent, the doctor and the area health authority when they receive copies of today's Hansard. I shall also be interested in the reaction of the local Press. The hon. Member for Birmingham, Edgbaston (Mrs. Knight) is not here today. She has plenty of complaints about the Birmingham Eye Hospital and the waiting lists. She is always making a case in the local Press about lack of NHS facilities.

We have no case to answer against disagreeing with this Lords amendment.

If the facts turn out to be as the hon. Member for Birmingham, Perry Barr (Mr. Rooker) stated them—and he admitted that he would not say outside the House what he has just said until he had ascertained the facts—I believe that he has very good grounds for referring the doctor in question to the General Medical Council. No Conservative Member has ever sought to deny that there are abuses or to defend them. On the contrary, our argument all along has been that in order to check the abuses to which the Select Committee drew attention the Government have taken a sledgehammer which will do grave damage to the NHS and the NHS patient.

There is no need for the Bill in order to deal with the abuse that the hon. Gentleman described. If he had sat through the many hours of debate in Committee, and had read the Official Report of the debates in another place, he could not have said what in fact he said. To charge the Opposition with heedlessness of the interest of the NHS or the NHS patient is sheer impudence.

On a point of order, Mr. Deputy Speaker. I am a little concerned, on grounds of medical priorities, about the hon. and learned Member for Ruislip-Northwood (Mr. Crowder). I hope that he is quite well, because I think that, to judge by his appearance, he is no longer with us.

I am happy to say that the health of hon. Members is not the responsibility of the Chair.

I was interested to hear the right hon. Gentleman admit, for the first time from the Conservative Benches, that such abuses as were mentioned by my hon. Friend the Member for Birmingham, Perry Barr (Mr. Rooker) exist. His hon. Friend the Member for Reading, South (Dr. Vaughan) has never admitted that one of the ways in which doctors pressure patients to go private and pay fees is to allow the waiting list to mount. The case quoted by my hon. Friend is symptomatic and typical of hundreds and hundreds of similar cases. If the right hon. Gentleman says that the Bill is unnecessary to deal with that kind of abuse, how would he deal with it?

I hardly think that at this stage in the Bill's passage it would be appropriate for me to respond to the hon. Lady's question. She was here for the Second Reading debate, so she will know that I was extremely frank then about the results of the study undertaken by her Select Committee. I have said all along that the Bill is not the way to deal with the matter. It is not necessary to get rid of the geographical whole-time consultant in order to eliminate the abuses. It is sheer rubbish for the hon. Lady to suggest that we have today said for the first time, in answer to the hon. Member for Perry Barr, that there are abuses. I invite her to study the Official Report of the Committee stage.

The Opposition did not say it in Committee.

Of course we did. The hon. Gentleman knows perfectly well that what I have said all along is that it is absolute folly to force consultants to divide their time between the NHS hospitals and the private clinics outside simply to get rid of the few black sheep. I welcome the fact that the hon. Member for Perry Barr said that it was only a tiny minority of doctors who engaged in these undesirable practices. The whole arrangement set up by Aneurin Bevan 30 years ago is to be swept out of the window to deal with that tiny minority. That is rank bad government. The Government should never have yielded to this pressure.

The right hon. Gentleman was not prepared to answer the question put by my hon. Friend the Member for Wolverhampton, North-East (Mrs. Short). We are dealing with the matter of common waiting lists. Does the right hon. Gentleman accept that once the Bill become law, and common waiting lists have come forward from the Board, the injustice described by my hon. Friend the Member for Birmingham, Perry Barr (Mr. Rooker) will not be possible, and that this legislation will have brought that about?

As I told the right hon. Gentleman on Report, if he had introduced a Bill to deal with abuses and to establish an inquiry into the feasibility of common waiting lists he would have found himself with an agreed measure. We did not divide against Clause 6 in Committee. We spoke in favour of it, and my hon. Friend the Member for Wells (Mr. Boscawen) made a penetrating and profound speech analysing the whole question of waiting lists. To pretend at this late stage that the Opposition have condoned the abuses is utter nonsense, and the right hon. Gentleman knows it. He should not be supporting his hon. Friends below the Gangway in that kind of slur on the Opposition.

I beg to move, That this House doth disagree with the Lords in the said amendment.

With this we are to take Lords Amendments Nos. 35 to 37.

This amendment is a monstrous onslaught upon my powers as Secretary of State. The very fact that the right hon. Member for Wanstead and Woodford (Mr. Jenkin) is supporting this monstrous onslaught must mean that he never himself expects to hold office. I congratulate him on retaining his very shadowy post.

The amendment provides that the Secretary of State could exercise the powers conferred upon him in the three NHS Acts of 1946, 1947 and 1968, to make supplies of blood, human tissues, accommodation and services, and so on, and supplies of goods, available to the private sector, only if he has been advised by the Board that use of the powers would not to a significant extent interfere with his duties to provide accommodation and service to NHS patients and would not to a significant extent operate to the disadvantage of NHS patients.

This would be an absolute bureaucracy. The Opposition are attempting to put responsibilities on the Board which it would be quite improper for the Board to have and would require of it an absolutely unnecessary cost and number of staff. The amendment would make the Board responsible for advising the Secretary of State on matters on which it would not be competent to give advice.

In addition to making facilities available to the private sector, the relevant sections of the Acts cover the use of NHS supply departments, kitchens, laundries and so on. The amendment would require that many decisions at present taken at a local level by district and area authorities should be referred to the Board. Inevitably, it would cause delay and disruption of services to the private sector, which the Opposition are trying to protect.

It is an absurd amendment which I urge hon. Members not to press any further.

The right hon. Gentleman has used quite unjustifiably strong language to describe an amendment that falls within the main stream of the theme of the Goodman proposals, as he has sought to embody them in the Bill. That is that interposed between the National Health Service and the Minister there should be an independent Board to adjudicate in those areas in which there is likely to be conflict, as he sees it, arising out of the use for private patients of NHS facilities.

All that another place has sought to do is to say not that the Board should take the decision but that the Board should advise the Secretary of State, and that that should apply to the provision of the services that the Secretary of State has just described—the availability of blood from a blood bank, human tissues and other services of that nature which may be available from the NHS.

It is a matter for judgment when difficulties arise and questions crop up as to whether NHS patients are being in any way prejudiced by the supplies that a particular hospital may have been accustomed to make for private patients whether it would not be unreasonable for the Secretary of State in those circumstances to take the advice of the Board, which, after all, will have the duty of holding the balance.

That is the case that the Government have consistently made for the Bill. I think that on reflection the right hon. Gentleman might regret the somewhat extreme language that he used to describe the amendments. To some extent the point is the same as that which arises on the next group of amendments, on Clause 8, which concerns the much more important area of policy on the use of specialised surgical and medical facilities in hospitals.

In these circumstances, as we are constrained by time, perhaps I need not advise my right hon. and hon. Friends to vote on Lords Amendment No. 34. Nevertheless, it is not the foolish amendment that the Secretary of State has suggested. It has been put forward in good faith, and I regret very much the language that the right hon. Gentleman used about it.

The only other point that arises is that on Lords Amendments Nos. 35 and 36. I am advised that there is no statutory precedent for the use of the words "to a significant extent" and that where legislation has to eliminate the insubstantial and the insignificant, in the past the word used has always been "substantially". I cannot claim to have scrutinised the entire statute book, as the right hon. Gentleman will recognise. Nevertheless, no one has been able to provide a precedent for the use of these words, and I should have thought that the usual word, "substantially"—in other words, a word that would eliminate the insubstantial, which is what it is intended to do where the detriment would be insubstantial and could be ignored—would be preferable. It is only where something is substantial that the necessary powers should be used to prevent the availability of the services concerned.

This is an entirely reasonable amendment. The Government have considered it and rejected it on two or three occasions. Perhaps, therefore, I should not be justified in asking my right hon. and hon. Friends to go into the Division Lobby. It is a perfectly sensible amendment. The Bill would be the better for it. But perhaps we ought to allow the amendment to be negatived.

This will be the last time that I shall intervene in the debate today. Instead of their Lordships putting into the Bill the word "substantially", it would have been better if they had put in the word "any", so that NHS patients were not disadvantaged to any extent, let alone to a significant or a substantial extent. Any diminution of the services offered to NHS patients because of private patients coming in and using NHS facilities is not on as far as the Government side of the House is concerned.

The time has long since passed when we could quibble about the word "significant". If the House of Lords wanted to revise the Bill in a proper manner for the benefit of the people of this country, it would not have put in the word "substantial" but would have used the word "any".

3.0 p.m.

I was not present in Committee because I was busy at the time trying to get the Dock Work Regulation Bill through the House. Much time was wasted on that. Perhaps I would have been better employed in discussing this Bill.

There is considerable disquiet as to the charges made for NHS facilities provided to private patients. In July the Secretary of State or his predecessor admitted that the Department of Health and Social Security had no knowledge of the fact that—

That is not in order.

Is it in order, Mr. Deputy Speaker, for someone on the Conservative Front Bench to shout from a sedentary position that my remarks are not in order?

I did not hear what was said and I should have thought the best course would be for the hon. Gentleman to continue to make his speech to the House.

You, Mr. Deputy Speaker, are the proper person in this Chamber to call Members to order if they become out of order.

My argument is made in the context of the Lords amendment which we are seeking to remove. It is a fact that some people who have used NHS facilities in a private capacity have not paid for the use of those facilities. Quite naturally, records are kept. My hon. Friend the Minister of State has written to me pointing out that in the last financial year £170,000 was recovered following legal action in relation to services provided under Clause 7 of the Bill—a clause which the House of Lords has sought to butcher completely by its amendments. I will name only the North-West Thames Area Health Authority. In that instance the figure was £43,000.

What is disturbing is that the regional boards actually have the power to write off debts under £500 without recourse to anyone. They do not have to get Treasury permission. I asked my right hon. Friend yesterday whether he would collect and publish the relevant information, and his reply was "No".

It is not right and proper that anybody should be able to write off debts owing by pay bed patients who have used NHS facilities and not paid their bill. I want information about the debts which have been written off to be published by region and by area. I want this information to be made public as soon as possible after the Bill gets the Royal Assent. Clearly, it will not get it today.

I invite my right hon. and hon. Friends to comment on this, bearing in mind especially all the claptrap which has been heard from Conservative Members about scroungers on the Welfare State. It turns out that those who abuse the Welfare State by using pay bed facilities—I consider it an abuse—have not paid for the use of those facilities.

We cannot go back to the consultant for the money. There is no redress to be obtained from him. He gets his fee. I am concerned with the services provided to these people by the National Health Service, and I want the information about the debts to be published. As my right hon. Friend said in introducing the motion, the services include food, accommodation, and also blood bank facilities—even that is included—and I do not think that the debts in respect of these services should be written off. Information about those which have been written off ought to be made public, and I invite my right hon. and hon. Friends to give a commitment to publish as soon as possible the figures for which I have already asked twice.

I am alarmed and disturbed by the facts that my hon. Friend the Member for Birmingham, Perry Barr (Mr. Rooker) has put before the House today. If so much money has to be collected as bad debts by the National Health Service, this is a clear case, as I assume the right hon. Member for Wanstead and Woodford (Mr. Jenkin) will agree, of people scrounging. I am a little surprised that, in all his forays and excursions into so-called abuses of the Welfare State and the scroungers in our society, he has not, prior to my hon. Friend's comments today, himself elicited this information.

These are people who clearly can afford to pay and who are not paying after they have had the benefit of facilities and services. They are parasitic on the NHS. They have been stealing from the NHS and stealing from the community as a whole. If there were no other demonstration of the iniquities of private medical practice co-existing alongside the NHS, this would be a convincing enough demonstration of the need to eradicate private medicine from the NHS.

The people of whom we are talking here have already jumped the queue by promising to grease the palm of the consultant. They have done that—he has had his money—but the hospital or the general fund has not had its money. These debts have to be collected as part of an attempt to recoup expenses incurred by the NHS at a time when it is desperately short of funds and resources and when so many essential services—kidney machines for example—are having to be curtailed or, at best, not enlarged at the rate we should like to see. It is scandalous that people who jump the queue are depriving the rest of the community—the poorest, the most needy and the sick—of much-needed and highly valued resources.

The only gleam of satisfaction which I can gain from the figures given by my hon. Friend is that the rate of collection is lowest for the Merseyside Area Health Authority. I can only assume that my constituents and those of my hon. Friends from Merseyside are honest—or perhaps efforts have not been so effective in catching them. Another reason may be that there are fewer pay beds in Merseyside than in other regions.

Reinforcing what my hon. Friend said, I should like from my right hon. Friend a clear indication not just of the amount of bad debts that have been collected but of the amounts written off. We have a right to know the amount of our money and resources which has, in effect, been given free, gratis and for nothing to private health service patients.

My hon. Friend may be interested to know that I have a Question down, with reference to the whole of England, Scotland and Wales, asking for details of the amounts which have been recovered by litigation and of the amounts which have been written off. I hope to have an answer in a few days.

I hope that my hon. Friend will be joined in his inquiries and efforts to root out these abuses by right hon. and hon. Members opposite, who show such enthusiasm—indeed, hysteria —in pursuing this kind of activity on other occasions, directing their attention to other sections, the most defenceless and vulnerable sections, of the population.

Here we have a clear case of people stealing, not just scrounging but stealing, from the NHS. What comments do hon. Gentlemen opposite have to make? I hope that the right hon. Member for Wanstead and Woodford will take the opportunity to condemn in as forthright terms as he has applied to others this group of people who are milking the National Health Service. I hope also that my right hon. Friend will give a clear commitment today that he will not tolerate this kind of activity in future, that he will make strenuous efforts to find out the total sums that have been written off, and that he will make every possible effort to recoup the money and put it back into NHS resources.

I rise to give more power to the elbow of my hon. Friend the Member for Birmingham, Perry Barr (Mr. Rooker). The House has been quite unjustifiably deprived of the inestimable services of the hon. Member for Aberdeen, South (Mr. Sproat), who, as we know, is such a strict guardian of our social services and so stern a critic of of abuses of public services and taxpayers' money.

Who is that?

He is the hon. Gentleman who was concerned in a certain privilege matter this week.

The clause is concerned with the protection of Health Service patients' rights when they are threatened or encroached upon by others. Much of what has been said illustrates the case that there should be no private health facilities; that we should have a full-time, wholly comprehensive National Health Service and no private medicine. There is an arguable case for that so that the two things do not jar against each other and there is no invidious competition between the two concepts.

Whatever the right hon. Member for Wanstead and Woodford (Mr. Jenkin) may think—and it may be that the word that he prefers is the more usual one that comes to the assistance of a legal draftsman in this matter—when one compares the two words and their meanings one sees that there can be little doubt that the word that their Lordships prefer, though more familiar, is the weaker one. In other words, the effect of the Lords amendment would be to diminish somewhat the protective powers provided by the clause.

I turn now to the point raised by my hon. Friend the Member for Birmingham, Perry Barr. On 26th July I asked my right hon. Friend how many law suits had been instituted since 1974 by the West Midlands Regional Health Board to recover fees from patients who had occupied pay beds in the region, how much money was outstanding, and how much had been recovered. My right hon. Friend the Member for Plymouth, Devonport (Dr. Owen), who was then the Minister of State at the Department, said that about 200 pay bed law suits had been the subject of legal proceed- ings, resulting in the recovery of about £13,500. That is not in itself a particularly large sum, but it is interesting to note that there is a considerable amount of activity in this connection and that in a number of instances legal action is necessary to recover money from pay bed patients. My right hon. Friend went on to show that the situation was not satisfactory. He also said:

"Figures relating to current pay bed debtors are not specifically identified, but health authorities are required to pursue all outstanding debts, seeking the aid of the regional health authority's legal department as necessary."— [Official Report, 26th July 19976; Vol. 916, c. 103]

Did the reply to my hon. Friend's Question reveal how much it costs the NHS to bring such actions and collect the money?

That information was not revealed, and, as I think my hon. Friend appreciates, it is an unsatisfactory aspect of certain kinds of civil litigation—and this may be one of them—that even when someone is successful in a law suit he does not necessarily recover all his costs. It may be that there are some totally irrecoverable debts that the taxpayer and the NHS as a whole have to bear as a result of action having been taken to recover money and winning the case but not being able to recover costs.

On the same day as I asked my Question, my hon. Friend the Member for Perry Barr asked my right hon. Friend what procedure was taken for writing off debts, and it was said that Treasury approval had to be given. It was said that such approval had been obtained for all debts in excess of a delegated limit, which was currently £500. What is the position about debts of other amounts? Who authorises action in those cases? How stringently are these matters pursued.

Earlier this year and towards the end of last year there was a lot of discussion about writing off the debts of the Clay Cross authority. Everybody knows how stringent the district auditor can be. He is an independent quasi-judicial authority and is not beholden to any Minister. He can act independently of Government Departments. The Treasury, on the other hand, is a Government Department, and we should like to know whether the criteria adopted by the Treasury are more or less strict than those adopted by the auditor when dealing with the Clay Cross situation. Many of my hon. Friends would be grateful if the Minister would be good enough to give us that information. Since the debate has been going on for some minutes, with the assistance of his officials, perhaps the Minister will now be in a position to tell us what the total bad debt currently outstanding is and how many law suits are currently being pursued.

3.15 p.m.

It will be interesting to know whether there are certain cases where no law suits are being pursued and for what reason. There may be certain compassionate cases where it might not be wholly desirable to do so, but I would expect the Minister to say that his Department is pursuing these matters, that he expects to recover the moneys concerned and that he will not hesitate to take legal action in order to do so.

My hon. Friend the Member for Birmingham, Perry Barr asked what the effect of indebtedness would have been on a person's right to transfer to Health Service status. The Minister replied:

"Under present arrangements failure by a private patient to settle their account does not itself justify a reversion to NHS status."— [Official Report, 26th July 1976; Vol. 916, c. 101]

One would like to know how many abuses of the system a private patient has to perpetrate before he can be said to have defaulted.

Does my hon. Friend reckon that someone in the middle of a course of treatment under the private pay bed system who cannot pay is in fact sent home because he cannot pay? Does my hon. Friend think that happens? Clearly what happens is that such a person is wheeled into an NHS ward.

Yes, and that would probably be right. I do not think anyone would want to treat a patient in any other way. It would be inhuman to do so.

What we are concerned with is that there shall be no more abuse. As the present ballyhoo continues on the subject of scroungers, we are anxious to see that there is no scrounging at the expense of the Health Service. I am sure the whole House, including hon. Members opposite who are so concerned about the need for meticulous care in Government expenditure, will join us in being guardians of the public purse.

I beg to move, That this House doth disagree with the Lords in the said amendment.

With this we may take Lords Amendments No. 39 to 43.

Clause 8 makes some limited provision for private patients to be treated by the NHS after the Bill becomes law on an occasional basis for certain scarce facilities. The group of amendments that we are now considering attempts to extend these exceptions.

Amendment No. 38 tries to remove from the Secretary of State the decision about admitting people for NHS treatment. Apart from the fact that the Secretary of State is responsible to this House for the administration of the NHS, we feel that the solution proposed—to place on the Board the duty of considering whether individual private patients shall be treated for occasional facilities by the NHS—is inappropriate in that these decisions can be made only at local level and in the knowledge of local circumstances.

The Board is not equipped in any way to have the necessary information to give meaningful advice on the sort of applications which are likely to come forward under the amendment if it were to be accepted. By requiring the advice of the Board, a national institution, on these matters, the amendment might result in delay in patients receiving facilities from the NHS, which in the case of emergencies could be unfortunate.

Amendment No. 39 seeks to extend to private patients access to NHS accommodation or services, not only if they have a need for the specialised equipment or skills which we shall occasionally allow to be made available to them but also if the need for such facilities is likely to arise during the course of their treatment. In other words, some assessment would have to be made about the future course of treatment of such patients.

The Goodman agreement proposed that health authorities should allow private patients access to facilities at NHS hospitals if specialised treatment were not available in the private sector, and it is not envisaged in the agreement that the Government should provide facilities for private patients to undergo routine treatment purely on the hypothetical assessment that they might need specialised facilities in due course because complications might arise. That is right outside the Goodman proposals and we ask the House to reject it.

My hon. Friend the Member for Birmingham, Perry Barr (Mr. Rooker), who has now left the Chamber, might have been interested to know it can be arranged for a private patient receiving treatment outside the NHS, if complications arise, to transfer into the NHS for that specialised treatment.

Amendment No. 40 proposes that a demand for access for private patients to NHS facilities should be based not only on the situation of the patient but also on the convenience of his practictioner. We have proposed that demand should be assessed purely on the basis of the treatment needed by the patient. We cannot see any way in which the operation of the access to NHS treatment can be extended to private patients on the basis of the convenience or inconvenience of the practitioner. I therefore ask the House to reject that amendment also.

Amendment No. 41 would require the Secretary of State to permit private patients access to NHS facilities only in accordance with arrangements which, in the opinion of the Board, are best suited to secure that all patients, private or NHS, are admitted on the same basis of medical priority. The Secretary of State has discretionary powers under Section 31 of the 1968 Act. This amendment seeks once more to remove this discretion and to transfer it to the Board. Again, it would be an erosion of my right hon. Friend's power with regard to provision in NHS hospitals.

Monstrous.

My right hon. Friend feels that that would be a monstrous curtailment of his powers. I agree with him, to the extent of asking the House to reject that amendment also. Again, it is not an appropriate function for the Board, which has no locus in deciding in which circumstances patients should be admitted under Clause 8. I ask the House to reject that amendment on the same grounds as I adduce for opposing Amendment No. 38.

Finally, Lords Amendment No. 43 would enable the Secretary of State, on the advice of the Board, to set aside accommodation at NHS hospitals for the exclusive use of private patients. As I have said several times today, such a proposal misconceives the purpose of the Board, which is generally to phase out private practice from the NHS. The Goodman agreement on which the Bill is founded proposed that NHS accommodation should be made available to private patients only on an occasional and specific basis for the use of specialised facilities. The amendment is totally at variance with that agreement, in that it would allow the NHS to set aside whole groups of beds for private patients. For that reason, I ask the House to reject it.

We support this group of amendments. If the Secretary of State regarded the previous group of amendments as a monstrous curtailment of his powers, it is interesting that his colleague the Minister of State should have spoken in a much more restrained way on this group of amendments which, if anything, we regard as even more important than the previous group.

The justification for wanting to put more discretion into the hands of the Board and less into the hands of the Minister lies in the partisan way in which the Minister responded to the remarks made by the hon. Member for Birmingham, Perry Barr (Mr. Rooker). It is characteristic that the hon. Member for Perry Barr, having delivered himself of some remarks, most of which were irrelevant to the amendment, should then leave the Chamber.

We think it important to replace "satisfied" by "advised by the Board". As the Minister said, this subject is highly complicated and specialised. The grounds on which the Secretary of State can allow a patient to use the private facilities in National Health Service hospitals can be very complicated.

We are concerned about the patient who goes into a private medical unit suffering from a mild illness and who subsequently develops unexpected and perhaps serious complications. It is clearly in his interests to be able to be transferred quickly and easily. We are concerned about patients who need specialised deep X-ray and radiotherapy. We are concerned about heart operations, organ transplant operations and technically skilled operations of that kind. We are also concerned—this is relevant to discussions we have recently had in the Chamber—about patients admitted for general malaise who are discovered to be suffering from a serious infectious disease which needs specialised care.

On all these issues it is not enough to leave the decision in the hands of the Secretary of State. Having set up the Board, the Government should take the Board's advice. The Board's remit is to decide how the facilities should be best used in the patients' interests. We wish to see the amendments accepted.

I heard with interest the arguments put forward by the hon. Member for Reading, South (Dr. Vaughan). What is being ignored is the finite nature of the Board. On 23rd May next year the first 1,000 bed pay beds will have gone and the Board will be concerned with the remaining 3,500. Every six months the House will bring pressure to bear to see that the remaining beds are phased out quickly. If power is transferred temporarily from the Secretary of State to the Board, within a short time it will have to be transferred back again to the Secretary of State because, once the phasing out operation has taken place, the Board will no longer be needed.

Lords Amendment No. 39 deals with specialised facilities. A person is entitled to specialised facilities whether those facilities have previously been provided privately or otherwise, and the National Health Service covers that.

I am concerned about the abuse that might occur. I remember, for example, that when patients in private abortion clinics suffered severe haemorrhage, the National Health Service had to provide plasma at short notice because of the inadequate service provided by the abortion clinic. The clinic made an enormous amount of money out of the plight of pregnant young girls, but when the life of the patient became endangered, the NHS would have to come to the rescue by sending a complete medical team, and plasma. I am glad that my right hon. Friend proposes to reject Lords Amendment No. 39.

I beg to move, That this House doth disagree with the Lords in the said Amendment.

With this we may take Lords amendment No. 45.

This amendment would deprive the National Health Service of funds which it would otherwise receive from private patients. Paragraph 3(e) of the Goodman proposals suggested that:

"Charges will be made to these patients"

—those are patients admitted under Clause 8—

"and there would be no subsidy by the NHS."

It is quite right that there should not be a subsidy. Part-time consultants will fix and charge their own fees, as they do at present, and the NHS will not be involved in this arrangement. On the other hand, whole-time consultants are paid a salary by the NHS and it is appropriate that the NHS should include an element in the charge made to a private patient treated by a whole-time consultant to cover the costs of his services. This element would in many cases be paid into research funds as it is at present. That would be lost if the amendment were to be sustained in the Bill.

I beg to move, That this House doth disagree with the Lords in the said amendment.

The House has already rejected the proposal that the Health Services Board should have the power to authorise fresh pay beds. This amendment would have been consequential had that proposal been accepted.

I beg to move, That this House doth disagree with the Lords in the said amendment.

This amendment changed the definition of the initial period from six months to 12 months from the date on which the Act is passed. That was a further delaying tactic. I do not think that my hon. Friends would conceive of letting this go through.

I shall deal with this matter briefly, because we covered the point a number of times in Committee. The amendment concerns the considerable volume of work which will fall upon the Board if the initial period is to be only six months. I appreciate that there is a power of dispensation in Clause 4 in relation to that matter. But there are a number of other matters on which the Board has to present reports and to undertake work. It was said repeatedly in Committee that the six-months period was too short. That was a figure plucked out of the air for the purpose of the Goodman proposals. In another place the Minister freely acknowledged that Parliament was not necessarily bound by every detail of the Goodman proposals. Their Lordships came to the conclusion that the period ought to be 12 months and that we should proceed with a little less haste and with more deliberation on this matter. The chances are that the decisions which will be made by the Board are more likely to be sensible and rational if the Board is not obliged to proceed over-hastily.

I believe that this is an amendment of considerable importance. I therefore invite my hon. Friends to resist the Government's motion in the Division Lobby.

The Question is, That this House doth disagree with the Lords in the said amendment.

As many as are of that opinion say "Aye". [HON. MEMBERS: "Aye."] To the contrary "No." [HON. MEMBERS: "No."]

I think that the "Ayes" have it. [HON. MEMBERS: "Aye."] The "Ayes" have it.

The next amendment is Lords Amendment No. 48.

No.

I put the Question a second time on Lords Amendment No. 47 and there was no indication from the Opposition that they wished to have a Division.

I beg to move, That this House doth disagree with the Lords in the said amendment.

This amendment seeks to define "hospital premises" as premises which would have been controlled premises but for the fact that they provide fewer than 100 or 75 beds, depending upon whether the facilities are in London or in the provinces.

The purpose of the notification system is to provide the Board with a body of information about the scale and nature of private sector developments to enable the Board to perform effectively its functions, one of which is to limit the size of the private sector under Part III. The Government have been consulting on a definition which would provide the Board with the necessary and valuable information and, until that is realised, we ask the House to reject the amendment.

This was a point which we exposed in Committee almost as a side wind of an amendment moved by my hon. Friend the Member for Birmingham, Edgbaston (Mrs. Knight). This again was an amendment on which there was a tied vote in Committee and which was guillotined on Report.

As it left this House, the Bill provided that for the purposes of the notification procedure any premises used or to be used for the prevention, diagnosis or treatment of illness or the reception of patients had to be subject to the notification procedure. This would enable the Health Services Board and, through it, the Department to compile an entire Domesday Book of every conceivable sort of premise, however irrelevant for the purposes of the control of development of independent hospital premises that might be. It would include every kind of sick room and, for example, any facility for the treatment of accidents at sports grounds. My hon. Friend the Member for Edgbaston suggested that it would include even geriatric homes. All sorts of premises would be swept into the net for the purposes of the notification procedure.

This seemed to be totally unnecessary and a gross infringement. But then it turned out that it was the Government's intention to collect a comprehensive list of premises available in the private sector —[Interruption.] The Secretary of State appears to be trying to give the impression that he was not aware of that. However, that is what his hon. Friend said in Committee. He said that it was the purpose not just to complete the control provided for in Part III but to go widely beyond that and to compile an enormous dossier of every conceivable sort of premise which might be used for the treatment or diagnosis of illness or even for the prevention of illness.

This is entirely unnecessary for the purposes of the Bill. We recognise that, if we are to have a control of the kind provided for in Part III, there must be measures to make sure that the control is not being evaded and there must be some way, therefore, of notifying the authorities that a premise might come within that control, and it is for them to decide that it is one for which a permit is needed.

Therefore, we put forward an amendment, on which my noble Friends in another place are now giving this House an opportunity to express a view, so that the only premises to which notification applied were

"premises which would be controlled premises but for the fact that the number of beds which they provide or will provide is smaller than that specified in section 12(2)".

Clause 12(2) contains the definition of "controlled premises" and defines them in five specific categories—premises which are to be used for the carrying out of surgical procedures under general anaesthesia, obstetrics, radiotherapy, renal dialysis and radiology or diagnostic pathology.

The purpose of the control is to ensure a measure of surveillance over the construction of large independent hospitals providing acute medical services. According to Clause 12, only premises of that kind should be defined as hospital premises for the purposes of giving notice of notifiable works.

The amendment, which is exactly the same as that moved in this House but not debated, is sensible and will avoid the authorities being cluttered up with vast amounts of material which will require to be notified. I hope that the Government, on reflection, will accept the amendment. If they do not, I urge my hon. Friends to join me in the Division Lobby in its support.

I beg to move, That this House doth disagree with the Lords in the said amendment.

With this we may take Lords Amendment No. 68.

Amendment No. 68 requires that the quorum of the Board be seven, including deputies, for the taking of any final decision under either Part II or Part III of the Bill. The Goodman proposals suggested that the Board should be independent. It is the Government's view that it would be inconsistent with this aim if the Board had its working arrangements fixed by statute.

The Government believe that the arrangements should properly be left to the Board itself. The Government expect that the chairman and members of the Board will be people of standing who will act responsibly in deciding upon the Board's procedure. Therefore, we reject their Lordships' suggestion that this should be written into the Bill.

Lords Amendment No. 49 removes from the Bill the Secretary of State's power to make provisions in regulations for the quorum and procedure of the Board in relation to applications for authorisations. As Secretary of State I intend to carry out the required consultations on regulations. We have not laid down what the Board's quorum should be, but we would wish to lay down for the benefit of applicants and other interested people the procedures that the Board will follow when dealing with authorisation applications.

The Government wish to provide the Board as far as possible with the independence that was proposed for it in the Goodman agreement. We believe that it would be to the detriment of applicants and other interested people if there were not regulations giving them some indication of how the Board should carry out its work. It is for that reason that the Government also reject Lords Amendment No. 49.

The Secretary of State has raised a matter of constitutional importance, because paragraph (d) lays down that the quorum and the procedure should be dealt with by way of regulation. We feel that it is very much better that the House of Commons should deal with this matter and that it should not be delegated solely to the Civil Service. We know that the usual procedure when the Civil Service and the Minister deal with such matters is that they discuss the matter with certain sectional interests completely outside democratic control. As long as we have a democracy, we believe strongly that the House of Commons should deal with this matter and should write into the Bill exactly what the quorum should be.

It is not the Minister or civil servants who will decide the quorum but the members of the Board themselves. It is perfectly proper that they, as independent people, should decide that matter. It should not be laid down for them by the House of Commons.

That is even worse. Let us suppose, for the sake of argument, that there were a lazy Health Board. We might find that its members said that only one or two people should turn up. That would be the worst thing possible. In order to ensure that the Board does its job properly, it is only fair that the House of Commons should write into the Bill the nature of the quorum. The Goodman proposals regarded the balance of the Board as being of particular importance. In those circumstances it seems necessary that some view on the exact number of the quorum should be stated.

The right hon. Gentleman mentioned that the number of seven was voted on earlier on the first Lords amendment. None the less, I understand that it is perfectly competent to raise this matter again. I hope that it will be reconsidered by the Government. It would be to the satisfaction of those who work on the Board, whoever they may be, for the nature of the quorum to be laid down. If that were done, the Board members would feel obliged to attend and to do their job properly.

I beg to move, That this House doth disagree with the Lords in the said amendment.

With this we are to take Lords Amendment No. 51.

The amendment seeks to exclude from the regulation-making powers of my right hon. Friend the Secretary of State a power to make regulations allowing inspectors to enter premises for the purposes of considering authorisations under Part III of the Bill. I know that this is a sensitive issue and that the House would not wish the Government lightly to propose that inspectors should enter premises unless there were a real need for them so to do. We would not wish to include this power unless it were absolutely essential.

We have considered the matter and have come to the conclusion that the conduct of an inspection under Part III for the purposes of authorisation is essential since a proper assessment of premises in many cases cannot be made except from inside those premises—for example, of the standards of operating theatres, the numbers of beds, and matters of that sort.

I am sure that the House will agree that in these circumstances, therefore, entry for inspection is absolutely essential. I ask the House to reject the amendment.

There was a lot of discussion on this matter in Committee, where the voting was tied, but the House was not given the opportunity to debate it when the Bill came back on Report.

We regard this as a very important matter. Here once again is the sort of statutory requirement of all left-wing Socialist Bills of today—the break and entry clause. We have yet another group of inspectors being given power to come and snoop into the efforts of the private sector to produce alternative accommodation for health care.

As we said many times in Committee, we dislike this sort of thing. If the clause goes through, there will be four sets of inspectors from different bodies under different legislation empowered to inspect what is going on in a hospital or nursing home.

We object to this because of the amount of time that it wastes and the amount of money it costs. It would appear that the private sector cannot be trusted by the Government to carry out the regulations outlined in the Bill. It is not good enough to create even more inspectors and bureaucrats to see what is being done in the private sector.

I hope that my hon. Friends will feel that it is necessary to vote for the amendment. The second amendment is purely consequential on the first.

I beg to move, That this House doth agree with the Lords in the said amendment.

With this we may take Lords Amendments Nos. 53 to 56.

The Bill as it left the House contained provisions for appeal on a point of law to be made to the High Court in England and Wales, or the Court of Session in Scotland, and that the decision of the court on an appeal was to be final. The provisions of Clause 17 were extensively debated in Standing Committee D, in this House and in another place. The Government have given thought to the points raised then, and in another place, and as a result have decided to table a group of amendments to add provisions for a further channel of appeal. These amendments were agreed to in another place and appear on the Amendment Paper as Nos. 52, 53, 54, 55 and 56.

The effect of the amendments taken together is to make provision, on the pattern which is normally adopted under the Tribunals and Inquiries Act 1971, in cases where an appeal lies on a point of law from an inferior tribunal. This means that there might be an appeal as of right to a High Court in England and Wales. A further appeal would lie, with leave, to the Court of Appeal and thence, with leave, to the House of Lords. In Scotland an appeal will lie from the Court of Session with leave directly to the House of Lords.

The Government think it right that this provision for further appeal should be put into the Bill. It was powerfully argued by hon. Members in the Committee. Nevertheless, we naturally hope that the provision for further appeals will be little used. We are advised that points of law are not likely to arise in the context of the Board's decisions. We hope that one appeal will be sufficient to obtain an authoritative decision on any appeal which might arise.

I hope that the decision of the Government, to consider the points which were well argued in Committee, will be accepted and welcomed by the House.

We welcome the Government's acceptance of this amendment. The Secretary of State said in Committee that he was concerned about fairness and natural justice and that he would report to the House on this matter before the Report stage. We are grateful for these Lords amendments. It is right that someone should know the case brought against him and have the opportunity to answer it, and in particular that he should be able to answer back in return once the arguments have been put against him and heard.

The Secretary of State said, "We were advised that there was little likelihood of any appeals taking place." Who gave that advice?

It was simply legal advice, that it seemed unlikely that the new facility for appeal would be extensively used, but it can be used of course. I was in no way seeking to undermine the right of appeal or the additional rights of appeal which have been written into the Bill.

With great respect, the Minister has not answered the question. Who gave that advice?

It is not appropriate on the Floor of the House for me to indicate which of my advisers gave me what advice.

By leave of the House, and only by leave, I will put the consequential Lords amendments together.

I beg to move, That this House doth disagree with the Lords in the said amendment.

This amendment appears to justify the thesis of my hon. Friend the Member for Brent, South (Mr. Pavitt) that the House of Lords is not a suitable revising Chamber and that it makes a dog's dinner of much legislation.

Clause 14 provides that any applicant for planning permission for any notifiable works under the Bill must notify the Board of the proposed application by giving a notice in the prescribed form. Their Lordships did not disagree with that proposition. However, by this amendment, what they then proposed to do was remove from the Bill the necessity for the provision of the sort of information which the Board would require in order to consider the notification properly.

Although retaining the desire for notice in the prescribed form, their Lordships would also want us to remove the sanction which would be applied if the appropriate notice were not made. In the circumstances, I advise the House to reject the amendment.

I am at a loss to understand the Minister's argument. It appears that the Government have had a sudden change of heart. I looked up what was said in another place on the third day of the Committee stage and found that when the noble Baroness, Baroness Young moved the amendment which the Government now seek to reject, not one word was said on the Government side. I do not know about the other place having a dog's dinner: there was no dinner at all on this amendment.

The reason for the amendment was the question of the penalty. No one seeks to omit the detail from the scrutiny of the Board, but surely the penalty is quite inappropriate when the notice must have been served. If the notice has been served properly, as provided by other clauses, it is the question of the penalty applying to provision of the detail which concerns us.

If there is to be a question of subsequent planning detail the lawyers would have a dog's dinner in deciding which of the planning procedures prescribed would be covered by the penalty clause, Clause 18, as it relates to Clause 14(1) and (2). It would be a mess to throw out a sensible amendment from another place.

I beg to move, That this House doth disagree with the Lords in the said amendment.

The issue here is fairly straightforward. As the Bill left this House, Part III, setting out the procedure for authorising private facilities outside the NHS, was to be brought in two months after the Bill received the Royal Assent.

Their Lordships passed an amendment which provides that Part III shall come into operation 12 months after the Royal Assent to the Bill has been received. I find that difficult to understand from their point of view because it would mean that no authorisations under Part III could be given at least until well into 1977.

For those reasons, and in the confidence that the Government can carry out the necessary consultations within a two-month period after the Royal Assent, I urge the House to reject the amendments and replace the old starting date of two months after the date of the Royal Assent.

There is little likelihood that the Government can get the Board going and get Part III into operation within two months. The Board has an enormous job to do. Its first priority is to sort out the waiting list problem. We do not see two months as a practical possibility. We believe that it will take far longer to get the Board appointed and for the Board to settle down and find out what its job is. It will have to phase out the remaining pay beds after the first 1,000 before it gets on to Part II to investigate the aspirations of the private sector. We think that 12 months is a much more practicable and reasonable period.

I beg to move, That this House doth disagree with the Lords in the said amendment.

With this we are taking Lords Amendment No. 63, plus the Government amendment in lieu thereof, Lords Amendments Nos. 64 and 65, plus the Government amendment in lieu thereof, and Lords Amendments Nos. 66 and 67, plus the Government amendment in lieu thereof.

Their Lordships carried a group of six amendments, Nos. 62 to 67 to paragraph 10 of Schedule 1. Taken together, their effect is to require more than one deputy to be appointed for each member of the Board and each member of the Scottish and Welsh Committees.

The Government believe that there was some doubt in the minds of their Lordships about whether the Bill as sent to the Lords already provided for one deputy to be appointed for each member. We consider it possible that, mistakenly, their Lordships thought that the amendment they carried achieved what they had in mind. That is a good definition of a dog's breakfast. Their Lordships thought that thereby they were correcting a deficiency in the Bill.

It is not clear whether their Lordships intended more than one deputy to be appointed, so we thought it better to get the record straight. To remove all doubt, the Government wish to move certain amendments to the Lords amendments in this group to restore the effect of paragraph 10 of Schedule 1 to what it was before it left the House of Commons. There is to be one deputy each for the chairmen of the Board and the two committees and one deputy for each member of the Board and of the committees.

I should again like to thank the Secretary of State for having met the case put to him both in Committee and in another place. We seem to have a sensible arrangement now for the deputies both on the Board and on the Scottish and Welsh Committees.

As this is the last amendment which is grouped, though not the last to be called, perhaps I may say that I am delighted that on both sides of the House the plea that I made at the beginning of the proceedings has been so effectively harkened to, and that we shall have succeeded in reaching decisions on all the matters returned to us from another place.

I realise the strain that must have been imposed on the hon. Members for Preston, South (Mr. Thorne), Barking (Miss Richardson) and Lichfield and Tamworth (Mr. Grocott) who all took such a leading part in our proceedings on earlier stages of the Bill. I am appreciative that they should have remained wholly silent during the proceedings today and allowed us to make progress so that we shall be able to finish the Bill within the time set for us by the guillotine.

The right hon. Member for Blackburn (Mrs. Castle) and the hon. Member for Wolverhampton, North-East (Mrs. Short) spoke only once. That shows that we can make progress and reach a decision on the Bill provided that hon. Members on both sides of the House contain themselves. That has been wholly desirable. We have done fairly by interests outside the House and by another place. Although we have disagreed profoundly with many of the decisions taken by the House of Commons and voted no fewer than nine times today, we can honestly say that we have done our duty.

I, too, should like to thank my hon. Friends. Friday is not a good time—many hon. Members on both sides have had to forgo other engagements—but we have had a large attendance. We have had not only many votes, but substantial majorities throughout. It is a great advantage to be able to show the strength of feeling that exists in the House so that their Lordships may recognise that on major and contentious issues there have been substantial votes.

I must inform the House that I have had notice of a manuscript amendment to be moved to the next motion to appoint Mr. Enoch Powell to the Reasons Committee. When we come to the appropriate stage in this motion, I shall put the amendment.

The amendment is, at the end add the name "Mr. Enoch Powell". I apologise. The right hon. Member for Down, South (Mr. Powell) is to move the amendment, "That the name of 'Dr. Vaughan' be added."

I beg to move an amendment to insert, after the name of Dr. Vaughan, the name of Mr. Dunlop. [Laughter.]

Order. It has been a busy week!

I beg to move. That this House doth agree with the Lords in the said amendment in lieu.

I am pleased to see such numbers on the Opposition Front Bench.

We are glad that their Lordships have accepted the reasons this House gave for disagreeing with their amendments and are not involving us in protracted consideration at this stage of a measure which has enjoyed comfortable majorities at all stages. The Bill now before us is substantially the same as the one we sent to their Lordships on 22nd July. We have accepted the deletion of a clause on the responsibility of married 16-year-olds to receive full-time instruction and added one which amends the Education Act 1944 in respect of pupils' special educational treatment.

We propose that one further amendment be made. Last night my noble Friend Lord Donaldson of Kingsbridge moved an amendment which incorporates the substance of the last few lines of Clause 2(4) of the Bill we sent to the other place and which their Lordships deleted, and the Liberal amendment which tried to remedy some of the damage caused by that deletion by providing that the Secretary of State give reasons for finding proposals submitted to her unsatisfactory. Their Lordships accepted this amendment, which has the effect of requiring me to give reasons when I reject a proposal for comprehensive reorganisation. However, it would also enable me to specify conditions that any further proposals would have to fulfil in respect of any matters that I found unacceptable in the original proposal.

I know that everyone is anxious to go home but I do not think it would be right to pass the amendment on the nod. I wish to ask my right hon. Friend one or two questions about the amendment that the Government moved in another place.

As my right hon. Friend said, the amendment uses different language from that which was originally in the Bill to state the way in which the Secretary of State can, as it were, deal with phoney comprehensive schemes. It is right that the House, especially my right hon. and hon. Friends, should be concerned about my right hon. Friend's powers to deal with phoney comprehensive schemes because it is quite certain that some of the remaining local education authorities that have not gone comprehensive will use, instigated by the hon. Member for Chelmsford (Mr. St. John-Stevas), all sorts of stratagems to delay the day when they finally go comprehensive. This is made more serious since the House of Lords decision on Tameside, which I shall not characterise with the epithets that I used on an earlier occasion.

Why not?

I could use some epithets, but whatever one may say about that decision its effect will be to make some local education authorities even more dilatory, egged on and spurred on as before by the irresponsible individuals in charge of education matters on the Conservative Front Bench. I see that the hon. Member for Chelmsford has been joined in harness with the hon. Member for Brent, North (Dr. Boyson)—a fine pair they will make. There is a real danger that that pair who do not have the job of the local administration of education, may egg on Tory education authorities into litigation that could provide even further delays.

I hope I shall receive an absolute assurance from my right hon. Friend that the new wording, which has no doubt been drawn up by the expert lawyers in the Department of Education and Science, in whom we all have such confidence, gives her exactly the same powers as she had under the original Bill, will Hot inhibit her in any way from using her powers in respect of local education authorities who use the Bill to delay going comprehensive, and will not make her talks more difficult. If she can give those assurances, my right hon. and hon. Friends and I will be happy to go along with the amendment.

This is a minor amendment and we have had a minor speech from the Secretary of State. I am sorry that it has prevented her from going to the Cambridge Union tonight, where I had hoped to debate with her at somewhat greater length. I hope, even at this late stage, that she will change her mind and that we can depart for that purpose.

However, this is not an amendment of great substance or importance. Amendments of substance and importance were debated earlier in this House. This will hardly make a change, other than a drafting change, to the Bill. We do not, therefore, propose to divide the House against it. Unless the right hon. Lady is about to make a long speech, we can go home. However, as soon as the opportunity presents itself, we intend to repeal the Bill, with the amendment that the right hon. Lady has proposed.

By your leave, Mr. Speaker, I should like to respond to the point made by my hon. Friend the Member for Lewisham, West (Mr. Price).

I understand the reasons for being concerned about the amendment. Certainly, there have been worries about anything which would delay the intention of this House that we should reorganise schools in local authorities. However, the effect of the amendment is simply to allow me to give detailed responses and recommendations about how an authority might satisfy the requirement to become reorganised in fully comprehensive schools. I would not have accepted the amendment if I believed that that situation would be weakened. Therefore, I am pleased to give my hon. Friend that assurance.