Lords amendments considered.
New Clause A
Services Provided By Relatives Of Doctors Providing General Medical Services
Lords amendment: No. 1, after clause 6, in page 18, line 3, at end insert—
'The following subsection shall be added at the end of section 29 of the Act of 1977 (arrangements and regulations for general medical services) as subsection (5) of that section and at the end of section 19 of the Scottish Act of 1978 (which makes corresponding provision for Scotland) as subsection (4) of that section:—
"( ) Regulations shall—
(a)include provision for the making to a medical practitioner providing general medical services of payments in respect of qualifying services provided by a spouse or other relative of his; and (b)provide that the rates and conditions of payment and the qualifying services in respect of which the payments may be made shall be such as may be determined by the Secretary of State after consultation with such bodies as he may recognise as representing such medical practitioners.".'
Motion made, and Question proposed. That this House doth agree with the Lords in the said amendment.—[ Dr. Vaughan.]
I inform the House that the amendment involves privilege.
I was half expecting the Minister for Health to advise general practitioners, if they find their wives uneconomic, to consider sub-contracting out their services to private contract, in the nature of recent circulars in the Health Service.This amendment was forced on the Government in another place. It pays lip service to the principle that was forced on them in another place, but it is effectively emasculated by postponing the payments to a time of the Secretary of State's choosing, which I suspect will be in the nature of the Greek calends. The problem is that general practitioners are entitled to claim 70 per cent. of the salaries of assistants as practice expenses. They are not entitled to do that at present if the helper is, in common parlance, a member of the family. A wife often gives great assistance to her general practitioner husband in carrying out his practice, particularly where the practice is single-handed and is conducted in a rural area. Hon. Members will be aware of the problems that can arise when professional life involves family members. For example, a secretary employed by a general practitioner would be entitled to have 70 per cent. of her salary paid out of the practice expenses, so long as she remained unmarried to the general practitioner who employed her. But if the general practitioner succumbed to her charms and married her the employment could continue but the 70 per cent. reimbursement would cease. When I was a Minister I initiated an experiment to reimburse wives in single-handed rural practices. How has that experiment turned out? I understand that it has gone on, is regarded as going well and has been extended for another two years. If it is going well, why extend it? Why not take action on it? The great obstacle to a solution of this problem is the possibility of abuse. We do not accept the spirit of this amendment, first, because it seeks to arrange salaries by law, which is an undesirable principle. These matters are best left to collective bargaining. Secondly, industrial relations do not only concern justice; they concern tact and timing. In a year when doctors have been awarded a 31 per cent. pay increase, it would be inadvisable if some of their members received substantial increased sums of money, particularly when the Government, despite my best endeavours, have persuaded Members of Parliament to set an example to the country by restricting their salary increase to 9.6 per cent. However, the Government amendment emasculates the principle of the original amendment, and we shall not oppose it.
I know of the great interest that the right hon. Member for Lewisham East (Mr. Moyle) has taken in this subject, and he rightly reminded us that he was instrumental in introducing the provision for single-handed GPs in rural areas.The introduction of this provision has been a success. About 190 GPs have taken advantage of it, and because of its initial success we thought it right to ex- it for at least another two years. I should be glad to give the right hon. Gentleman extra information if it would be of interest to him. It was partly because of the success of the provision and following discussions with the profession that we thought it right to widen the provision a little further. So, from I October we propose that it should be extended to wives of GPs who have professional training—in other words, wives who are nurses. We were concerned about the cost implications, and we felt that it was only right to move in a gentle way and to find out how much money was involved. We accepted the principle behind the amendment and we welcomed it. It was widely welcomed in another place, and I hope that it will also be welcomed in this House. We should like to wait a little while before introducing the provision because we have a financial responsibility, but with that one proviso we welcome the principle, and I commend the amendment to the House.
Question put and agreed to. [Special entry.]
Amendments Consequential On Changes In The Local Administration Of The Health Service
Lords amendment: No. 2, in page 41, line 5, after 'paragraph 5,' insert
'in sub-paragraph (1)(a) after the words "metropolitan district" there shall be inserted the words "a non-metropolitan district," '
I beg to move, That this House doth agree with the Lords in the said amendment.The purpose of the amendment to schedule 5 to the National Health Service Act is to include non-metropolitan district councils among the specified local authorities that may appoint several of the members of health authorities.
I agree with the purpose of the amendment. It was moved by the Labour Party in another place, with Conservative Back-Bench support. At present, there are administrative methods of including non-metropolitan district representatives on district health authorities, although they were omitted from the provisions of the 1977 Act."Patients First" suggested the reduction of local authority representation on district health authorities, with which we disagreed, and it implied that district council representatives could be included only if county councils cut back. In those circumstances non-metropolitan districts, because they were not specifically mentioned in schedule 5 to the 1977 Act, wanted specified legal guarantees. That is why this amendment was put forward. It gives them a bare minimum of representation. We accept that it is a minor improvement to the Bill. It is remarkable that the Government are so sensitive after causing such a massacre of local authority representatives on local health authorities. It reminds me of a famous French executioner who used to make sure that his victim's head was carefully and comfortably placed in the guillotine before bringing down the chopper. Nevertheless, we shall not oppose the amendment.
Question put and agreed to.