Skip to main content

Road Accidents (Payments For Treatment)

Volume 980: debated on Monday 3 March 1980

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

10.23 pm

I beg to move,

That an humble Address be presented to Her Majesty, praying that the Road Traffic Accidents (Payments for Treatment) (England and Wales) Order 1980 (S.I., 1980, No. 111), dated 31st January 1980, a copy of which was laid before this House on 8th February, be annulled.
The charges were first imposed in 1936 under the Road Traffic Act before the introduction of the National Health Service. Of course the idea of charges then conformed with thinking in the 1930s. They were a substantial way of guaranteeing that doctors, nurses and other health professionals who tended road accident injuries were paid. By some unexplained legislative error and process, when the National Health Service was created in 1946 these charges escaped abolition and have staggered on in an anaemic and weak condition over the intervening years. Occasionally they have been adjusted upwards, but there is a constant temptation for Governments to raise them whenever the going gets a bit rough.

What does the order do? It says that where someone has to undergo in-patient treatment, from the date of operation or the order whereas the present charge is a maximum of £200 that shall be increased to £1,250. That is an increase of about 525 per cent. When it comes to outpatient treatment, 'whereas the maximum charge at present is £20, from the date of operation of the order the maximum charge will increase to £125, which is a similar percentage increase. If emergency treatment has to be provided at the location of the accident the charge at present is £1·25. After the date of operation of the order that will increase to £6·75, which is an increase of similar magnitude.

According to an answer given to me by the Minister for Health, I understand that the amount to be collected in charges in the financial year 1978–79 increases to £1.4 million. Although when that information was being sought no answer could be given, the Royal Automobile Club estimates that there is a collection cost of about £600,000 so that the balance earned by the Government at present is about £800,000. One wonders why the alternative course of abolishing charges altogether was not followed.

These are substantial increases. In their own small way they will add to the inflationary spiral. The Government's calculations seem to vary between an extra £1·8 million and £3 million gathered. My own calculations are that if the increase is to be about 500 per cent. the amount of money gathered should rise by about the same percentage and that therefore about £6 million to £7 million will be gathered because of the new level of charges.

I say advisedly that the inflationary spiral will be given an added twist because the insurance companies, which in effect pay these charges, will seek to recoup the added cost from the motorist by increasing premiums. That will be one more cost for the average motorist and one more calculation for him to make when considering his next pay or salary claim. That will also have an impact on inflation. We have the Government saying with one voice that they want to reduce inflation, and, as on so many other occasions, acting in a way which adds to the inflationary spiral.

There is no way in which an innocent party can escape these charges, if there are guilty and innocent parties in accidents. All motor insurance holders—by law that means everybody who drives a motor car—will have to pay the increased premiums whether they are potentially guilty or innocent parties in any road accident. As we all know, guilt or innocence will have to be determined at law and that is far from being a tidy arrangement, as anyone who has been involved in the process knows.

These charges are totally anomalous. By this legislative freak, road accidents only are covered. No other form of accident is dealt with in this way. If a person breaks his arm in a road accident he has to pay charges. If he breaks his arm by falling downstairs at home he does not have to pay. Accidents at work are not covered by this process. A man who deliberately sets out to drink or smoke himself to death, no matter what burden he throws on the NHS, is not covered by this process. No other form of accident—including aircraft and shipping accidents—is covered by this sort of arrangement. Road accidents are covered only because they were forgotten when the original NHS legislation was passed.

There can be no disincentive effect in the charges. I have yet to meet someone who volunteered to take part in a road accident. Surely the Government are not arguing that the charges have to be increased in order to deter that no doubt large section of the population that enjoys throwing itself under the wheels of passing motor cars purely out of pleasure, and to restrain its unnatural delight in these vices.

Alone and unsupported the arrangement breaches the principle of a Health Service which is free at the point of use, and that is the essential principle towards which we in the Labour Party wish to work. This is one of a group of charges that we inherited in 1974 which we were leaving to the processes of inflation to erode to the point at which we could abolish them happily and painlessly. Increasing these charges is in direct opposition to the policy that we wished to see followed.

Another powerful argument has come forward for the abolition of these charges. It is our knowledge that the Conservatives would like to proceed to a Health Service based on an insurance principle. We know that a study has already been initiated by the Secretary of State. Ideally, the form of charge we are considering this evening indicates the way in which the Government would like to see the NHS funded. For that reason, if for no other, we feel that we should record our total opposition to the order, and I shall therefore be asking my right hon. and hon. Friends to vote against the order and in conformity with the prayer.

10.32 pm

I congratulate the right hon. Member for Lewisham, East (Mr. Moyle) on ably building a case out of nothing. The order is simply an uprating of the figures specified in the parent legislation. We have before us a Government proposition that the sum of £200 shall be increased to £1,250 and that £20 shall be increased to £125. I understand that the increases are simply to allow for the effect of inflation.

The right hon. Gentleman made a plausible and effective case to show that the Labour Party was proposing to allow the existing sums to wither on the bough so that they could be abolished. The whole thing, Labour Members believe, was a mistake. The fact that it was a mistake that persisted through year after year of Labour government is carefully forgotten.

The Minister has quite rightly come forward with a proposition to remedy the situation. It seems to me eminently reasonable that we should update the sums to amounts that are appropriate to this day and age.

However, the right hon. Member for Lewisham, East gave the game away when he said that the principle at stake is that the NHS should be free at the point of use. That is his argument, and he forgets about prescription charges which the Labour Government increased year after year.

The hon. Gentleman must know that that is totally untrue. We did not increase prescription charges the whole time we were in government.

Perhaps I am mixing up my Labour Administrations, but I think that the right hon. Gentleman will find that Labour Administrations have increased prescription charges. We can check on that afterwards.

The right hon. Gentleman is speaking of the previous Labour Government, but they at least maintained prescription charges, so that nothing was free at the point of service under the National Health Service. Of course, Labour Governments have charged. They have increased optical charges and other charges.

The right hon. Member for Lewisham, East should be concerned with the quality of service which the public receive. Is he not concerned with the amount of resources which can be directed towards providing a better hospital service? That is what he should be concerned with.

This is a modest measure directed to increasing the amount of resources available to the National Health Service. My question to my hon. Friend the Under-Secretary is this. Why is it so modest? I am not at the moment complaining about the level of charges. What I do not understand is why this system, which imposes hospital charges for certain classes of accident and by statute imposes them for all emergencies, produces so little revenue.

My understanding is that, even with these increases—the right hon. Gentleman said that it was 500 per cent., but I make it 600 per cent.—the charges will produce an extra revenue of £1·8 million. Let me relate that to the number of accidents. In 1978—the latest year for which I have figures—the total number of serious injuries and fatalities was about 89,000. In that year, 89,000 people were killed or seriously injured on the roads. Those are terrible figures, and hon. Members on both sides recognise that. In fact, the total number of all injuries, including many minor injuries not requiring hospitalisation, though a good proportion did, was about 350,000. In one way or another, 350,000 people were injured in road accidents.

Those are terrible figures. I shall not go into detail on the question of road accidents now, but I cannot understand how, with that vast number of road accidents, so little was produced in revenue from what is, after all, a statutory charge.

It seems to me that this Government, and the previous Government, have something to explain in respect of the way in which these revenues are or are not collected. If they are to be applied by statute, they should be applied meaningfully.

I recognise that what I am about to say may not be popular with the industry with which I have had a long connection, the insurance industry—

or with the motoring organisations, with which also I have fairly close connections. Indeed, the motoring organisations and the insurance companies will complain bitterly at the idea that motorists should be charged twice—through tax and insurance contributions and again through hospital charges—if they are involved in accidents. But it seems to me that at a time when all of us, including the Opposition Front Bench, should be concerned to raise extra revenue to improve our hospital services, we should look wherever we can for substantial extra revenues for that purpose.

If the accident statistics are as I have described them, putting such a colossal burden on the Health Service, it is not unreasonable to look at this as a means of raising revenue. As I see it, the figures we are talking about here are substantial —£1,250 for persons treated as in-patients and £125 for persons treated as outpatients—and if those sums were collected, as I suspect they are not being collected, whenever accidents of this kind occured, we should be talking about not £1·8 million of revenue for our Health Service but of tens of millions of pounds.

I know that the right hon. Members for Lewisham, East and for Salford, West (Mr. Orme) have immense experience of the health services, and have travelled around many casualty wards and accident centres. They know how much extra resources are needed if we are to provide first-class casualty centres. They know how much those extra tens, and perhaps even hundreds, of millions of pounds could be used to provide better hospital services.

Why should we not look to the insurance companies and the motorists to provide that extra revenue? That is certainly an area that we ought to examine. It is certainly an area where we ought to demand that the statutes are applied properly. That means up-rating the returns so that they accord with what has happened because of inflation.

I had assumed, wrongly I think, that Labour Members had tabled this prayer in order to secure a wide-ranging debate. But, in view of the almost empty Labour Benches, it is clear that that is not their objective. They are seeking a vote. They are voting against the effects of legislation, which is an extraordinary proposition, and they are voting against extra revenues to the Health Service, which is another extraordinary proposition.

I hope that my hon. Friend will persevere in securing the extra revenue that is available by the order for the benefit of our health services. I hope that he will go further. Despite the scepticism and opposition that will be mounted by the motoring organisations and the insurance companies, which I may be upsetting tonight, I hope that he will examine this whole question to see whether we can, through the insurance principle, secure more revenues to our health services, and hospitals, whether through motoring accidents, industrial accidents or wherever else the insurance principle can be used. We should spread the cost so that it dos not fall heavily on the individual but falls across the whole range of the insurance system. Through that method, we might be able to secure the revenues which would be of so much benefit to all the people of this country.

I pointed out that in 1978, the last year for which I have accident statistics, about 89,000 people were seriously injured or killed. The motoring insurance premium was well over £1 billion, whereas the amount about which we are talking is £1·8 million. I am sure that Labour Members will realise that there is tremendous scope within that system for finding extra revenues for our deprived health services. I find it strange that the Opposition should be voting against the order. It is short-sighted and, I suspect, ideological. I am very sorry about that, because we should be looking for extra ways of helping our health services. Above all, it is better hospitals and casualty centres which the motoring organisations, insurance companies and the people of this country are after. I suspect that within this rather modest order we could find the seeds of something far more substantial. We should look to it to find ways of expanding the resources for our health services.

10.44 pm

When I look at article 3, I find it strange that Labour Members should even have considered a prayer against the order. I should like to bring to their attention a heart-felt plea brought to me by Dr. Farn of Atherstone, who is one of my constituents. He pointed out the difficulties of doctors who, under article 4, are asked to go out late at night to deal with road accidents. The amount of money that is paid to those doctors under article 3 of the present regulations is so extraordinarily small as to defy belief.

My constituency contains the M6 and a large part of the A5. We are asking doctors to answer emergency calls for a fee of £1·25
"for emergency treatment of traffic casualties and a sum of 2½ new pence for each mile".
Is it suggested that it is unreasonable to offer these gentlemen £6·75
"and for the sum of 2½ new pence there shall be substituted the sum of 16 new pence"?
These sums are even less than those given to hon. Members for carrying out their duties. If a doctor is summoned under paragraph 4 to
"an accident giving rise to … death or bodily injury"
he should receive at least the same payment that hon. Members receive for carrying out their duties. It seems inconceivable that there should be a prayer against article 3.

If we wish doctors to provide medical services and to carry them out reasonably at all times of the day and night, the order seems only reasonable.

I understand that the motoring organisations may be concerned about the double payment factor. However, realities have to be accepted. If we wish there to be the right sort of medical treatment for the users of our crowded roads, we shall have to pay. This is a most reasonable measure.

10.47 pm

I have heard some extraordinary speeches. The hon. Member for Faversham (Mr. Moate) talks about £1·8 million, but it is up to him to explain how his scheme will work. Those of us who have had some experience in hospitals are aware of the problem of trying to recover costs. If the hon. Gentleman considers the amount of effort that is being devoted to recovering the money that should have been paid by private fee-paying "passengers" for private treatment, he will understand some of the problems. The hon. Gentleman knows how it is necessary to chase after Arabs to get them to pay their bills. They are private patients.

I trust that the hon. Gentleman will be able to tell me the cost to the hospital service in its efforts to get the bills paid by those who have chosen to have private treatment. How much of the £1·8 million will be spent by the hospital administration services to recover outstanding bills?

If that is to be done, there will have to be an increase in staff levels. The hon. Gentleman is arguing that the Health Service should be an income-producing service. If it is to be that sort of service, it will have to have the necessary personnel available. Hospital administration departments are in dire straits. They do not have sufficient staff to undertake the necessary work to help people get well. If the Service is to be a money-raising scheme, if it is to be some form of exchequer, the hon. Gentleman must agree to have an increased number of staff.

What is the anticipated increase in staff that the hon. Gentleman considers necessary to enable the Service to carry out the work to which he has referred? I have heard the order described as modest. Is it to cost £2 million to save £1·8 million? Indeed, the chances are that the money will not be collected. Is it not fraudulent of the hon. Gentleman to pretend that he will recover money from those who have been hurt—ghouls hanging around to determine the cost—when in fact he does not want to get it because that will entail the cost of the recovery?

It is no good the hon. Gentleman smiling. He knows that hospitals in my constituency are in a disgraceful condition. He knows that, yet he is helping to close them.

Hospitals are being closed because there are insufficient funds. The hon. Gentleman knows that £1·8 million throughout England and Wales will not save one hospital that he is helping to close in my constituency. Above all, it is fraudulent to suppose that there will be some influx into the Treasury's coffers. The hon. Gentleman knows that this is not so. He is attempting to satisfy his fellow Back Benchers by pretending that money will be gained.

I am afraid that the hon. Gentleman has flowed past the point at which I had wished to cross the river. However, he suggested that some Conservative Members had been put up to making these points. I feel that that is rather uncharitable. We are in very little collusion with the Government. Secondly, the hon. Gentleman said that money would be difficult to collect. This is a serious point. Does he not agree that the bulk of the money—if not all—should be collectable from British insurance companies? Surely he does not suggest that it would be more difficult to collect money from them than from certain clients from the Middle East. They may fly home when the treatment has finished. That money would benefit our constituents.

The collection of moneys will be just as difficult. Which insurance companies will pay? There will be arguments about who is directly responsible for the accident. Such arguments would apply particularly to serious accidents. Large sums of money are involved. Several vehicles may be involved in an accident. Many people may be hurt. Different insurance companies would then argue about responsibility. It will take a long time to get the "knock for knock" idea right.

Who will remind the insurance companies that it is time to cough up the money and to pay? How many insurance companies will a person have to write to? Surely the hon. Gentleman will agree that, if a section of a hospital has to deal with that, a substantial amount of work will be involved. The hon. Member for Faversham drew our attention to the large numbers of people involved. He provided astronomical figures concerning the numbers of those killed and hurt in road accidents. He is right. A staggering amount of transactions will pass through our major hospitals.

Clerical assistance will therefore be needed. Further staff will then be required. We would need decision-makers. Who would make the decisions? Perhaps we will be told that area health authorities should make those decisions. Which columns in the area health authority's accounts will show the amounts that have been taken? How will the sums be paid? Whose account will they be paid into? How will the money be distributed? How will that affect "RAWP-"ing? Are we to understand that money will come in one way and go out another? Are we to understand that £1·8 million does not matter? A hospital may have to "RAWP" to another area. However, its resources could be used in this way. Who will get the money?

There are so many unanswered questions. This is a pathetic little order. Insufficient homework has been done. It is another burden on the backs of hospital staff. It will prevent a hospital from directing its efforts towards the improvement of health. I shall heartily vote against the order tonight.

10.54 pm

It has so far been a modest little debate, and none the worse for that. I detect little enthusiasm on the Opposition Benches for the prayer that they have tabled this evening.

My hon. Friends the Members for Faversham (Mr. Moate) and for Meriden (Mr. Mills) swiftly demolished the argument put forward by the right hon. Member for Lewisham, East (Mr. Moyle). I propose to pick off one or two stragglers, and deal with the hon. Member for Hackney, South and Shoreditch (Mr. Brown), whose imagination ran away with him.

I can say straight away that no extra administrators are required by the order. There will be no extra burden on the Health Service. We are merely updating the amounts collected through the existing system. The prayer will simply deprive the NHS of resources.

I am well aware that the principle of charging for treatment following a traffic accident is controversial and, on occasions, the subject of misunderstanding by both the public and the media. I am therefore glad to have this opportunity to debate the order and deal with the points raised. The law is a little complex in this field and I believe that it will be helpful to set out briefly the legal provisions and clarify the extent to which charges are actually collected by the NHS following road traffic accidents, which was a point raised by my hon. Friend the Member for Faversham.

Sections 154 and 155 of the Road Traffic Act 1972 consolidate earlier legislation and provide for payments to be made for the medical treatment of persons injured in road accidents. Section 154 provides that where an insurance company has made a payment in respect of a person killed or injured in a road traffic accident and, to the company's knowledge that person has received treatment at hospital, the insurers and not the individual are required also to make a payment to the health authority in respect of the cost of in-patient and out-patient treatment within statutory limits, so the saga about the Arabs simply does not arise.

Such payments are based on the motorist's insurance company having made a payment to the person injured, and do not cover the costs of treatment of the driver of the vehicle that caused the injury.

As a result, recovery is effected only in about 20 per cent. of the total number of cases of road casualties. I believe that that explains the discrepancy mentioned by my hon. Friend the Member for Faversham. The scheme is therefore not applicable to all road accident casualties. Payment for hospital treatment costs applies only where third party compensation payments have been made by insurance companies.

Furthermore, the Act provides for charges to be made within well-defined limits. There is no open-ended commitment. Only the actual cost of treatment is recovered.

Currently these limits are £200 for inpatient treatment and £20 for out-patient treatment—maxima that are now hopelessly out of date. The order seeks to raise these limits to £1,250 and £125 respectively. Those are not arbitrary figures but restore the purchasing power in terms of the amount of treatment which the present limits gave more than 10 years ago.

There are certain exemptions from making payments, and, as the Act allows for the owner of the vehicle to opt to bear his own liability, in well-defined circumstances it will sometimes be the owner and not the insurer making the payment. However, such cases are comparatively exceptional, and for the purposes of the debate I shall refer to the payer being the insurance company.

I am not sure that I am convinced by my right hon. Friend's answer. What is the total revenue at present from that source? If it is as low as I suspect, judging by the figures given, is my hon. Friend satisfied that it is even being collected in those places where it ought to be?

I shall be coming to the figures that my hon. Friend asks for in a moment.

Turning to section 155 of the Act, this does not involve any question of guilt or negligence. In consequence, I am aware that that aspect is especially unpopular with motorists, although I believe that it is normal for insurers to make the payment without effect on the "no claims" bonus.

The section provides for the payment of a fee, known as the emergency treatment fee, which my hon. Friend the Member for Meriden referred to, by the person using the motor vehicle in respect of each person given emergency treatment in a hospital. If a doctor gives such treatment at a road traffic accident, the fee is claimable by him and not the hospital. The section also enables the doctor to claim a mileage allowance from the vehicle user in respect of any distance travelled in excess of two miles. Where the emergency treatment fee is payable and the driver of the vehicle is not responsible for the accident, it is always open to him to seek to recover the payment from the other person. The Act requires all motor insurance policies to cover payments for emergency treatment. We wish to increase the fee from £1·25 to £6·75 and raise the mileage rate that the general practitioner can claim from 2½p to 16p per mile.

Let us be absolutely clear what the order we are debating is intended to do, so that we can get the matter into perspective. We are merely seeking to increase the limits for in-patient and outpatient charges and to increase the emergency treatment fee and mileage rate to a realistic level. Both the fee and the limits have remained unchanged for more than 10 years, while the mileage rate which general practitioners can claim from the user of the vehicle still stands at 2½p, a rate which has remained unchanged since 1934. The increases that we wish to make do nothing more than bring the limits up to date.

Am I to understand that the death grant, which has remained unchanged for many years, will be increased immediately?

The death grant has been debated in extensor in Committee.

These charges, therefore, are not new. Indeed, some of them have been with us for 50 years. The provision for hospitals to recover from insurance companies the treatment costs of road traffic accident casualties dates back to the Road Traffic Act 1930. The emergency treatment fee was introduced for the first time in 1934 and the Labour Government continued the charges on the inception of the NHS. The weakest section of the speech of the right hon. Member for Lewisham, East (Mr. Moyle) was when he tried to explain how that anomaly had been overlooked for 35 years by successive Labour Governments.

Successive Governments have upheld the principle of motorists continuing to contribute to the NHS costs of treating road traffic accident casualties. Apart from the updating by the Labour Government in 1968, the scheme has remained unchanged since the 1930s. The failure over the past 10 years or so to update means that the limits are badly out of date, while the costs of collection have increased considerably. Clearly that is an unsatisfactory position and one which we feel must be put right.

On coming into office we reviewed a number of different charges and found that one to be particularly badly out of date. We notified the insurers, the motoring organisations and the British Medical Association of our intention to increase the level of charges from the beginning of the next financial year, 1 April 1980. That, we felt, would give the insurers ample time to make any adjustments to premiums that they felt were necessary. In response, the motor conference, on behalf of the insurers, reiterated its view that it objected to the charges in principle, mainly on the grounds that the motorist pays twice for NHS treatment in these circumstances, both through taxation and through insurance premiums.

Some of the motoring organisations also made strong objections in principle to the charges, again because of the motorist being singled out and paying twice, and also because of the heavy burden of taxation currently levied on motorists. I can well understand the wish of the motoring organisations to protect their members' interests. That is, of course, commendable. The Government's view is that the principle of requiring motorists to make a contribution to NHS costs has been long established and is perfectly reasonable. If the power is to be retained, the limits on charges must be set at a level which makes sense, and not be allowed to get so hopelessly out of date as has been the case in the past.

The uprating is part of a series of measures aimed at maintaining the levels of expenditure of the National Health Service despite the very grave economic problems we were bequeathed, and we have little option but to increase the charges to a realistic level. To fail to do so would be to risk a reduction in patient services.

The Automobile Association complained that the order would lead to a sixfold increase in charges. That is not the case, and the right hon. Gentleman made the same mistake. There is an important difference between charges and limits. If treatment costs less than the limit, that will be the amount charged. In many cases the order will enable hospitals to recover something more like the full costs of treatment in a larger number of cases

Any form of charging involves singling out those who pay from others who do not, and it has been claimed that those who pay charges pay twice. In paying charges they are paying separately for one element of service cost, and are contributing through general taxation not to that element but to the rest of the service cost. Increasing the share met from charges, of course, reduces the amount to be contributed through general taxation. The proposed increase in charges is in line with our policy of recovering from users more of the cost of running the NHS. Any increase in insurance premiums should be modest—with £3 million extra income expected and 15 million vehicles on the road, simple arithmetic suggests that the cost will be 20p per motorist per year.

I should now like to deal with points which have been raised in the debate. Why single out the motorist for these charges? Motorists place a heavy bur-dent on the NHS. They are involved in accidents which result in death or injury not only to themselves but to others—some 94,000 passengers and 72,000 pedestrians in 1978. Most of the other high risk groups placing a burden on the NHS do not involve such a high chance of injury to others. Many such groups are comparatively small in number, and hence it would not be economic to seek to obtain a financial contribution from them. Furthermore, there is no legal obligation on them to be compulsorily insured as there is on motorists.

I am surprised that Labour Members are opposing the order which requires such a modest contribution to be made by motorists towards NHS costs of treating road accident victims. So convinced were the Opposition of the principle of charging motorists for NHS costs that they made an attempt in 1976 to ensure that the full costs of treating road casualties were recovered from motorists by means of a levy collected through insurers.

I refer to an answer given in February 1977 by the then Secretary of State who said:
"In October last year I put forward as a basis for discussion with insurers and motoring organisations proposals for recouping the full cost to the NHS of treating road traffic casualties by a levy on individual motorists."
The Opposition's action tonight is sheer hypocrisy.

I shall give way in a moment. Subsequently the then Government announced that they proposed to drop the Road Traffic Casualties Bill because of administrative difficulties and costs of collection. The Secretary of State's parliamentary answer in which that information was contained went on:

"I have therefore withdrawn the proposals and do not now intend to meet this cost by a levy."—[Official Report, 14 February 1977; Vol. 926, c. 46.]
There was no objection to the principle of taxation of the motorist. Our order will bring in a mere £4 million in a full year. The Opposition when in government were seeking to introduce a scheme which would currently be recovering £50 million or £60 million from motorists. Their approach tonight is strangely inconsistent. If they feel that the motorist is overburdened by taxation, why did they not seek to reduce the charges when they were in office?

To sum up, the income from the charges, although modest, provides the NHS with money that it can ill afford to lose. The principle of requiring motorists to contribute towards the heavy burden that they place on health services is one which goes back nearly 50 years and has been accepted by successive Governments since the 1930s. The level of charges is now well out of date and we simply wish to bring it into line with 1980 costs.

Should the order be annulled, charges under the Road Traffic Act will continue, but we will be in the unfortunate position of maintaining charges which are collected from motorists at levels set in 1968 and in some cases even earlier. That is unacceptable, and I hope that the House will agree to the order.

11.8 pm

It is not surprising that the Government are a little upset that the Opposition have tabled the prayer, but we object to the order in principle. Some Conservative Members, including the hon. Member for Faversham (Mr. Moate), have argued that we ought to raise any charge that has been on the statute book for some time—indeed, the hon. Member advocated more and higher charges for those using the NHS—but that argument also applies to the dog licence. May we expect the Chancellor of the Exchequer to raise the 37½p dog licence to £5 or £6 in the Budget? No Chancellor has yet had the courage to take that step.

The hon. Member for Meriden (Mr. Mills) said that doctors were hard done by in having to visit the victims of road accidents, but doctors do not get extra pay for visiting accident victims in factories. They get general charges for running their practices. We reject that sort of special pleading.

The order is clearly the thin end of the wedge. As my right hon. Friend explained, the provision was left on the statute book in 1946 more by oversight than by design. The Government are reviewing all the charges that they can make within the NHS—contrary to their election manifesto—and will seek to introduce new charges and increase existing charges. We will oppose them all the way.

It does not matter what tripe we hear from the Tories about the actions of the previous Labour Government. We are in a different position from May last year. Some of us are not ashamed to quote the manifesto on which we fought the election. It is the policy of the Labour Party to abolish all Health Service charges. That was put to the electorate last May and remains the policy of the Labour Party in Opposition. I do not accept that motorists should be singled out. There has been no logical argument for saying that the cost of motor accidents should be treated differently from home accidents. Far more accidents occur in the home than on the road.

The National Health Service has to fork out £85 million-plus to treat smoking-related illness. The Government have not produced that argument. It is not fair to say there is a tax on tobacco. Those dying of lung cancer in hospital are not specially charged. Perhaps that is a loophole that the hon. Member for Faversham will bring forward for support.

It is estimated that 50,000 to 80,000 a year die as a result of smoking-related diseases. That is almost the same number, as hon. Members on the Government side of the House have indicated, of people who die as a result of road accidents. The same arguments do not apply. The Government are singling out the motorist. I acknowledge what the Minister stated. The motoring organisations are not happy. Insurance companies are not happy. The hon. Gentleman slipped out the remark that this order would be introduced in plenty of time for the insurance companies to adjust their premiums. He did not use the words "raise their premiums". But the companies will not lower their premiums following this imposition.

Insurance companies will not put up the premium by the minimum necessary to conform with the order. They will see an excuse for a general increase in motor premiums which will act as a further ratchet on the price inflation brought about by the Government.

I am not surprised that the Minister referred to the levy proposed by the previous Labour Government. It was not actually proposed. It was put to that Government by the same people—we should make no bones about this—who put it to the present Government, the Treasury, which is looking for every possible increase in charges. The Minister laughs. Is he saying that extra money raised by the order will not be deducted from the cash limits available to the National Health Service?

There will be no extra money for the National Health Service from this order. The Treasury mandarins will see to that. It is dishonest of the Minister not to put that point to the House.

Will my hon. Friend also consider the case of people who undertake boat races in bad weather with the consequent calling-out of enormous resources? Are we to understand that there will be a miserable little Bill or order to deal with those effects?

My hon. Friend gives another example. Hon. Members could give umpteen different examples of various types of accident for which people do not go looking. Some are due to natural disaster. But no extra charge is imposed for use of the National Health Service. It is hypocritical of the Government to take this step.

The suggestion of a levy was thrown out by the previous Labour Government. It was never put before the House. It was withdrawn. The Opposition fought the last general election on the pledge of abolishing all Health Service charges. We include in that pledge prescription charges and this charge. The previous Government allowed the charge over the last five years to be eroded by inflation. It was becoming next to worthless.

Our objective is not only to oppose the order. My right hon. Friend the Member for Barrow-in-Furness (Mr. Booth) has tabled for the Standing Committee on the Transport Bill new clause 7 to abolish the statutory provision under which the Minister brings forward this order. We are root and branch opposed to two-tier charges in the NHS whether for road accidents or anything else. The Government should take fair warning. They are

Division No. 209]AYES[11.15 pm
Anderson, DonaldField, FrankMoyle, Rt Hon Roland
Ashton, JoeFlannery, MartinOgden, Eric
Atkinson, Norman (H'gey, Tott'ham)Fletcher, L. R. (Ilkeston)Orme, Rt Hon Stanley
Barnett, Guy (Greenwich)Garrett, W. E. (Wallsend)Penhaligon, David
Bray, Dr JeremyGraham, TedPowell, Raymond (Ogmore)
Brown, Ronald W. (Hackney S)Hamilton, James (Bothwell)Prescott, John
Callaghan, Jim (Middleton & P)Hamilton, W. W. (Central Fife)Race, Reg
Campbell-Savours, DaleHarrison, Rt Hon WalterRadice, Giles
Clark, Dr David (South Shields)Haynes, FrankRoberts, Ernest (Hackney North)
Cocks, Rt Hon Michael (Bristol S)Home Robertson, JohnRooker, J. W.
Cook, Robin F.Homewood, WilliamRoss, Stephen (Isle of Wight)
Cryer, BobLamond, JamesSever, John
Cunliffe, LawrenceLeadbitter, TedSoley, Clive
Davis, Terry (B'rm'ham, Stechford)Litherland, RobertSpearing, Nigel
Deakins, EricLyons, Edward (Bradford West)Summerskill, Hon Dr Shirley
Dean, Joseph (Leeds West)McCartney, HughWelsh, Michael
Dormand, JackMcDonald, Dr OonaghWhitehead, Phillip
Dubs, AlfredMcKay, Allen (Penistone)Wigley, Dafydd
Duffy, A. E. P.Maclennan, RobertWinnick, David
Eadie, AlexMcNamara, Kevin
Eastham, KenMarks, KennethTELLERS FOR THE AYES:
Ellis, Raymond (NE Derbyshire)Mitchell, R. C. (Soton, Itchen)Mr. George Morton and
English, MichaelMorris, Rt Hon Charles (Openshaw)Mr. James Tinn.
Evans, John (Newton)

Alexander, RichardCockeram, EricHunt, David (Wirral)
Alison, MichaelCope, JohnJopling, Rt Hon Michael
Beaumont-Dark, AnthonyDickens, GeoffreyKnight, Mrs Jill
Best, KeithDorrell, StephenKnox, David
Bevan, David GilroyDouglas-Hamilton, Lord JamesLawson, Nigel
Biggs-Davison, JohnDover, DenshoreLe Marchant, Spencer
Blackburn, JohnDunn, Robert (Dartford)Lennox-Boyd, Hon Mark
Blaker, PeterEdwards, Rt Hon N. (Pembroke)Lester, Jim (Beeston)
Boscawen, Hon RobertElliott, Sir WilliamLloyd, Peter (Fareham)
Bowden, AndrewEyre, ReginaldLyell, Nicholas
Boyson, Dr RhodesFairgrieve, RussellMacKay, John (Argyll)
Braine, Sir BernardFenner, Mrs PeggyMajor, John
Bright, GrahamFookes, Miss JanetMarlow, Tony
Brinton, TimFowler, Rt Hon NormanMarshall, Michael (Arundel)
Brocklebank-Fowler, ChristopherGarel-Jones, TristanMarten, Neil (Banbury)
Brooke, Hon PeterGorst, JohnMather, Carol
Brotherton, MichaelGriffiths, Peter (Portsmouth N)Maude, Rt Hon Angus
Brown, Michael (Brigg & Sc'thorpe)Grylls, MichaelMaxwell-Hyslop, Robin
Bruce-Gardyne, JohnGummer, John SelwynMeyer, Sir Anthony
Bulmer, EsmondHamilton, Hon Archie (Eps'm&Ew'll)Miller, Hal (Bromsgrove & Redditch)
Carlisle, John (Luton West)Hannam, JohnMills, Iain (Meriden)
Carlisle, Kenneth (Lincoln)Hawkins, PaulMoate, Roger
Carlisle, Rt Hon Mark (Runcorn)Hawksley, WarrenMonro, Hector
Chalker, Mrs. LyndaHeddle, JohnMontgomery, Fergus
Chapman, SydneyHenderson, BarryMorrison, Hon Charles (Devizes)
Clark, Sir William (Croydon South)Hicks, RobertMorrison, Hon Peter (City of Chester)
Clarke, Kenneth (Rushcliffe)Hogg, Hon Douglas (Grantham)Myles, David

pledged to increase Health Service charges by any conceivable means, whether through new or extra charges for the doctor or hotel charges for hospitals. These will be put before the House in the long run. It is also likely that there will be deductions from pensions when pensioners receive treatment in NHS hospitals. We shall oppose every increase in NHS charges.

It is no good Ministers describing what happened in the past. Things changed in May 1979. When a Labour Government are returned we shall fulfil our pledge.

Question put:—

The House divided: Ayes 66, Noes 119.

Neale, GerrardRhodes James, RobertTrippier, David
Needham, RichardRhys Williams, Sir BrandonWakeham, John
Newton, TonySainsbury, Hon TimothyWaldegrave, Hon William
Normanton, TomSt. John-Stevas, Rt Hon NormanWaller, Gary
Page, Rt Hon Sir R. GrahamSkeet, T. H. H.Ward, John
Parris, MatthewSpeed, KeithWatson, John
Patten, Christopher (Bath)Speller, TonyWickenden, Keith
Patten, John (Oxford)Spicer, Jim (West Dorset)Williams, Delwyn (Montgomery)
Pattie, GeoffreyStainton, KeithWolfson, Mark
Pollock, AlexanderStevens, MartinYoung, Sir George (Acton)
Price, David (Eastleigh)Stradling Thomas, J.
Proctor, K. HarveyTebbit, NormanTELLERS FOR THE NOES:
Raison, TimothyThompson, DonaldMr. John MacGregor and
Rathbone, TimThorne, Neil (Ilford South)Mr. David Waddington.

Question accordingly negatived.