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Extension Of Powers Of Secretary Of State

Volume 131: debated on Wednesday 13 April 1988

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

I beg to move amendment No. 15, page 3,line 12, at end insert—

'(dd) to provide instruction for any person;'.

With this we will take Government amendment No. 19.

Amendments Nos. 15 and 19 are necessary to ensure that the National Health Service Training Authority is covered by the provisions of subsection (1) of the clause. The original drafting of clause 4 inadvertently created a situation where the NHSTA would have been able to recover only the full costs of services to non-NHS customers and not to make a profit. That is because the NHSTA's powers to charge for training come from different legislation—the Health Services and Public Health Act 1968. If we do not make the specific amendments that are before us today, the NHSTA will not be able to charge outside customers at commercial rates. The amendment merely brings the NHSTA into line with other health authorities. It does not permit the NHSTA to impose any sort of charge on health authorities.

Amendment agreed to.

With this, we will take the following amendments: No.45, in page 3, line 31, at end insert⤔

'( ) The directions may not apply to any action taken or commenced by the body so directed before the day following that on which the direction is given.'.

No. 46, in page 3, line 31, at end insert—

'( ) The directions may not be given to Community Health Councils nor to Local Health Councils.'.

No. 47, in page 3, line 37, after 'satisfied,' insert—

'after consulting such bodies as appear to him to represent the interests of the public within the National Health Service".

No. 49, in page 3, line 41, at end insert—

(b) will not be to any significant extent prejudicial, directly or indirectly, to the health of any person or group of persons;'.

No. 50, in page 3, line 48, at end insert—

'(6) In exercising the powers conferred by subsection (1) above, the Secretary of State shall have regard to the value of management time likely to be used in any proposal under consideration, and to the viability of the proposal under normal commercial circumstances having regard to the rate of return of the capital value of assets employed in whole or in part to the proposal'.

No. 51, in page 4, line 5, after 'determine', insert

'after consulting such bodies as appear to him to represent the interests of the public within the National Health Service'.

No. 52, in page 4, line 6, after 'determine', insert

'after consulting such bodies as appear to him to represent the interests of the public within the National Health Service'.

No. 54, in page 4, line 12, after 'satisfied', insert

'after consulting such bodies as appear to him to represent the interests of the public within the National Health Service'.

No. 55, in page 4, line 43, after 'satisfied', insert

'after consulting such bodies as appear to him to represent the interests of the public within the National Health Service'.

The amendment seeks to negate the very wide-ranging powers to be given to the Secretary of State under the various provisions of clause 4. It is a matter of some concern to Opposition Members that the Health and Medicines Bill has been generally presented as containing a series of reforming measures, designed to improve health care provision, and a number of largely unrelated provisions and proposals geared to making the National Health Service more efficient and effective. In reality, the Bill has a consistent and worrying theme—the further advancement of the market forces approach to health care.

While most attention has been given to clauses 8 and 10 of the Bill, particularly because of the threatened rebellion of Tory Members tomorrow—we will wait and see what happens then—by far the most serious implications for the future of the National Health Service are contained in clause 4. It is very sad that we should be discussing an issue as serious as this in the early hours of the morning, with so few hon. Members present.

The stated aim of clause 4 is to devolve fund-raising powers to district health authorities. The aim of the Government is clear. We discussed it in some detail in Committee. What they want to do with this particular clause is to get themselves off the hook as regards the under-funding of the National Health Service. I recall that the most recent report of the all-party Select Committee indicated that the current cumulative under-funding is in the region of £2 billion—a shocking indictment of present Government policy. So they want to get off the hook of their failure to invest in the health care of this country.

Clause 4 is a deliberate attempt to divert attention away from the Government's responsibility to fund the National Health Service because, if the clause goes through, district health authorities can be blamed for failing to tackle under-funding at local level through the powers that they will have if the Bill passes into law.

I already find that whenever I write to the Minister about Health Service issues she blames the local district health authority, no matter what subject I mention. I am primarily writing to her about under-funding and the lack of resources, and she puts the ball squarely in the court of the district health authority. I do not think that that is fair, but she will have an even greater opportunity to do that if this clause is passed.

The second aim of the Government in this clause is to gear district health authorities and area health boards to being more concerned with profit-making ventures than with provision for patient care. That worries me very much.

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To be fully understood, clause 4 needs to be considered in the context of several developments. I shall specify two to which some consideration should be given. The first is the introduction into the Health Service in the last couple of years of business-style general management since the Griffiths report on management structure and, in many areas, the arrival into the Health Service of personnel who have been brought directly from private business operations.

The second issue, which ties in with that and is worrying when one considers what could happen as a result of clause 4, is the introduction of performance-related pay, which will give financial incentives on the implementation of clause 4. When I ask the Minister how many general managers in my area have received incentive payments, it worries me that I am told that that is confidential. People in many areas are worried that those incentive payments are paid to managers for closing hospitals and wards and discharging patients who should not be discharged.

I was grateful that my hon. Friend the Member for Cumbernauld and Kilsyth (Mr. Hogg) raised earlier the issue of cook-chill because, as the Minister is aware, I have pursued that matter with some vigour since last summer because of concern about it in my area. I am sorry that the Minister for Health has left the Chamber because he now professes to be an expert on the issue, but I hope that he will read my brief comments on it. One reason why I feel so strongly about the provisions of clause 4 is that in Wakefield we have had a foretaste of the kind of situation to which I believe clause 4 will lead.

The Minister will be aware that one of the first ideas that the new Griffiths-style general manager in Wakefield introduced when he was appointed a couple of years ago—a gentleman by the name of Brian Birchall who, I understand, used to work for United Biscuits Ltd.—was that of generating income and saving money through sacking catering staff and adopting a cook-chill system. Now, nearly three years later, it is interesting to see what has happened. A newly built £1 million kitchen has been standing empty, doing absolutely nothing, for over a year because of concern about the safety of that system, which has been condemned as unsafe by the district health authority's own microbiologist.

The DHA is currently having to divert money from patient care to pay for the new system. The most recent example—I hope that the Minister is listening to this because I want a response on this point later in the debate—is that Wakefield district health authority has been directed by the regional health authority to spend its additional allocation of £230,000 on making its cook-chill system safe. That money, which was begrudgingly allocated by the Government way back in November or early December, had been earmarked for the purchase of vital surgical equipment and for urgent roof repairs at Fieldhead hospital, which was designed by a gentleman who, I am sure, would be a supporter of the Government's philosophy. His name was John Poulson. That hospital roof is collapsing and needs repairing urgently. However, money is being diverted from those urgent repairs by the RHA to deal with the cook-chill problem.

The Government have turned down the authority's demand for an inquiry into that issue. I have a good idea why. Clearly, it would expose the nature of the policies that are being pursued by the Government on privatisation and the proposals contained in clause 4. Frankly, the position in Wakefield is a shambles and a complete farce. It is precisely the position that we can anticipate when men of enterprise, who are now in general management, get their hands on the provisions in clause 4.

It is vital that the hidden agenda of clause 4 is fully understood, because it evidences the clear aims underlying the Government's policies. It is about establishing the framework for moving substantial parts of current National Health Service provision into the private sector. There is no doubt that the powers contained in the clause will allow that. That is what they are designed to do. It is about deliberately boosting private care within the National Health Service and privatising yet more essential services, with the obvious consequences for standards of service and employment conditions which we discussed earlier. It is about creating the right climate for the wholesale introduction of the private health care market. If the Government were honest, they would admit that that was their real agenda.

Amendment No. 2 seeks to delete dictatorial powers which the Government are taking on themselves to deliver what we regard as the real aims of the clause.

Amendment No. 45 seeks to prevent the Secretary of State making retrospective directions. It would be most unfair to health authorities and their managers if retrospective directions were made. I am sure that this is not the Minister's current intention—at least, I hope it is not—but we all know what happens as events develop. Eventually conditions will arise in which a future Minister may be tempted to make a retrospective direction. I am endeavouring to take that temptation away from him or her.

Amendment No. 46 removes the right to give directions to community health councils and to local health councils. It is of the essence of these bodies that they are independent and free to represent the public in their districts.

At present the only sphere in which anyone can issue directions to CHCs is in respect of their spending only the sums allocated to them. The effect of putting CHCs under potential ministerial control as regards the priorities for activities would be to detract from that independence. I am as sure as one can reasonably be that the Government have no intention of ever issuing directions to CHCs and LHCs. I believe that the fact that the bodies were covered by clause 3 did not occur to the draftsmen. I invite the Government in all seriousness to accept the amendment.

The five amendments in this set provide for the Secretary of State to consult such bodies as appear to him to represent the interests of the public within the Health Service before he takes action. Community health councils have this responsibility for the public in their districts, and national and local politics both have local effects. Of course, the National Association of Community Health Councils and the Scottish association would be available as channels for consultation, and the Secretary of State may have other bodies in mind. Consultation would give a local input where the Secretary of State is making a detailed intervention in local services. Amendment No. 47 requires him to consult before saying that he is satisfied that there will be no adverse effects from his proposals.

The clause as drafted says that the Secretary of State may not fail in carrying out a duty laid upon him by the National Health Service Act 1977. Amendment No. 49 writes in the other side of the same coin. Under it he would be proscribed from doing anything that had adverse side effects for the health of the community. Health promotion and the prevention of ill health are important. It is essential that the search for money should not finish up damaging the health of individuals and, incidentally, increasing the workload of the NHS.

Amendment No. 50 seeks to impose on the Secretary of State the same criteria of commercial viability as the Government impose on local government direct labour organisations. It would be wrong if subsidiary activity—which fund-raising must be in NHS terms—ate up a significant amount of management time and NHS resources. The function of the NHS is to improve the health of the population. All else is subsidiary If the Government are unwilling to abide by the same constraints as they apply to local government, we have the right to ask why.

The amendments do not set out to reverse the principle of the Government's proposals, which will inevitably go through. We seek to ensure that the proposals do not detract from mainstream health services and that they operate in a civilised manner. It is to be hoped that the Government will accept these minor amendments.

My remarks will be brief, because the Minister will go to the Dispatch Box replete with quotations from my good self about support for clause 4.

I support the methods by which the NHS can recoup funds that have been spent on its behalf through the intervention and behaviour of people and companies. In other words, the NHS is losing money that rightfully belongs to it. It is certainly time that the NHS was able to recoup that money. The Minister will remember that I suggested several methods by which the NHS might be able to recoup some money. Perhaps amendment No. 86, which deals with overseas patients, might have taken that point on board.

Despite liking some parts of the clause, I find it difficult to accept it, for two reasons. One is the point that was raised about health boards being instructed and not being given options. The other reason was raised by my hon. Friend the Member for Wakefield (Mr. Hinchliffe). Throughout the debate about the under-funding of the NHS, we have heard that, somehow, all problems will be solved by income generation. That is not the case. They are minimal amounts of money. Next year the figure will be about £10 million. and in the best possible year about £70 million. That is unacceptable, bearing in mind the inherent dangers in the clause. Therefore, it is worth making the position clear before the Minister reads out my quotations.

I shall not detain the House for too long, as some hon. Members probably wish to go home. We are dealing with the heart of the Bill and the most serious part of it. It is based on the false notion that the solution to the Health Service's financial problems is simply to turn each local health authority into some kind of income generation unit—that is, a local company—and start charging and recharging between various hospital departments and, indeed, within health authorities. Frankly, the whole matter is complete nonsense.

The Health Service exists to provide a health service for the people of this country. A district health authority exists to ensure the best possible provision of health care within its community. Income generation is not the business of a health authority. It is not competent to do it. It should not be asked to do it. It has nothing to do with it. Yet health authorities are being told that they must examine the commercial potential of everything that they do. They must examine the commercial potential of each piece of land that they own and each facility that has been built on it, state whether it was given by charity in the past or built more recently, and consider ways of income generation from such nonsense as advertising on nurses' uniforms to opening shops within hospitals, and so on. It is complete and utter nonsense. I hope that the House will at least look carefully at the amendments, which will minimise the kind of nonsense that is proposed.

Essentially, the Bill is quite clever. It claims to promote a form of local decision-making, autonomy and democracy by allowing a local health authority to make charges, to commercialise, to sell, to buy, to trade, or whatever else, but, at the same time, by a convenient sleight of hand, it effectively moves what remaining powers district health authorities have straight into the Minister's hands. In effect, the Minister can direct certain forms of sale or charging merely by withholding central grant from local health authorities.

First, I hope that the House will accept that the Minister's power of direction is wholly wrong. Secondly, the effect of the proposals within the clause will not be an improvement of local health care, but will be the appointment of a whole new generation of business managers and the establishment of a business advice centre within the DHSS. It will effectively make local health authorities commercial organisations that are more interested in balancing their books than in improving health care and examining the health problems of people in their communities and cause them to move away for ever from the real purpose of the service.

Rather than this nonsense about book-keeping exercises in local health authorities, we should be discussing the way in which central Government have consistently denied local health authorities sufficient funds to deal with the problems that they face and have sought to abuse them when they have criticised the Government for giving them insufficient funds. We should be talking about shifting power in the direction of some form of democracy in the Health Service rather than destroying it, as the Minister intends to do.

1.15 am

I hope that the House will consider the proposals and that the Minister will think again and realise that charging is not the solution to the financial problems of local health authorities. The only solution to those problems is a very large injection of central Government money into local health authorities rather than handing that money out in tax relief to those in our society who already have a great deal of wealth, which is no doubt the option that the Minister prefers.

As hon. Members will know, in very general terms, clause 4 is directed at giving health authorities more freedom to raise income for the good of the National Health Service. Indeed, the opening words of the clause are:

"in order to make more income available for improving the health service".
I should have thought, therefore, that the clause would be widely welcomed. We were a little surprised and disappointed that the reception to it has been less than enthusiastic in one or two quarters. However, I am grateful to the hon. Member for Strathkelvin and Bearsden (Mr. Galbraith) for what he has said. I shall desist from embarrassing him further, except to point out that he said in Committee that the clause had some good parts to it. From him, that is not damning with faint praise; it is an enthusiastic response, and we are grateful to him for it.

I listened with care to the hon. Member for Wakefield (Mr. Hinchliffe). He said that clause 4 is the most important part of the Bill. The Government think that it is very important, although the hon. Gentleman's hon. Friends clearly do not agree with him, as most of them appear to have gone home. The hon. Gentleman thinks that the clause is awful. We do not agree with that, and nor does NUPE. NUPE thinks that clause 4 is not bad at all. I wonder whether in his busy week the hon. Gentleman managed to come to terms with NUPE's submission to the Select Committee on Social Services, reported in The Guardian on 5 April this year. NUPE supports some ideas for income generation and says:
"It would add considerably to the attractiveness of hospitals if shops and banks were on the premises. There are also advantages in health authorities marketing some of the services they provide (eg laundry, catering) to other public bodies and the private sector."
That is NUPE's point of view. I am not sure how seriously I should take what NUPE says because later it says that the main cause of illness in this country is malnutrition, which is perhaps something that we should refer to the hon. Member for Kirkcaldy (Dr. Moonie).

It is interesting to see how attitudes have shifted. In Committee I said that I could hear the sound of a troglodyte moving on this matter. When clause 4 first appeared, the Opposition parties jumped up and down and objected. When they read it and thought about it, however, they gradually realised that raising money for the Health Service, as provided for by the clause, is a good idea and very sensible.

The hon. Member for Wakefield talked a lot about cook-chill. I cannot quite see what the catering system that they use in Wakefield has to do with income generation. The system to which the hon. Gentleman refers is not generating income; it has cost a lot of money. What we expect to have it generate fairly soon are some decent meals for the people who have paid for it through their taxes.

I mentioned cook-chill in the context of clause 4 because that system was introduced by the new general manager as a means specifically of saving money but also of generating income—just as the Minister suggests clause 4 will generate income to local district health authorities. I used cook-chill as an illustration of what can go wrong under clause 4.

We do not expect 100 per cent. success with all the things that we get up to in the largest business in western Europe, and I am sure that the hon. Gentleman has accurately described what will happen in the future in Wakefield. Surely any measure that helps us to increase the resources available for health care is welcome. We estimate that the income generation initiative will raise about £20 million a year at the beginning, rising to perhaps £70 million in three years. I say quite honestly to the House that I hope that our estimates are wrong and that health authorities will raise much more than that. The money raised will help us to provide better patient services. This is National Health Service money and it will stay in the National Health Service to go on buying patient services and patient care.

Will the Minister give her estimate of the cost of taking on new management staff in order to promote this income generation? Can she tell us specifically what work she has done and how much money has been spent on setting up the advice unit that the Minister said would be established in the DHSS to advise district health authorities on income generation schemes?

The new income generation scheme is not yet costing us much money. The person we have appointed, Mr. Kerr, is working on it at the rate of one day a week. That is partly because his powers depend on the passage of the Bill. We have every expectation that not only will he earn his peanuts but that he will help us put a great deal of money into the Health Service. That also applies to all the other staff.

Perhaps the hon. Gentleman would let me continue.

In Committee we dealt fairly with the notion that the clause will act in some way to the detriment of the NHS. I am sure that the House is aware that we spent eight sittings on this, which is probably more than the time that we spent on any other clause. I should like to make three general points. There is scope for health authorities to raise income in ways that are entirely sensible and reasonable. This will not lead to the NHS becoming a brash commercial organisation. We simply intend that authorities should be able to undertake relatively small-scale developments on a commercial basis for facilities that will satisfy a local need.

The typical large city centre hospital may have 250,000 visitors a year. They all stop to make a purchase before going to the hospital and will buy flowers or a card or chocolate. Why should the hospital not get that trade and make a profit? Let us go further. Why should the staff have to go outside? Many hospitals are much bigger than factories and employ more people. We will welcome banks, building societies, hairdressers, almost anything, provided it does not interfere with the running of the hospital. That is written into the clause.

As I said repeatedly in Committee, we want to look after the National Union of Public Employees. If NUPE wants to have a conference, we will be delighted to accommodate its members. They will be welcome and we shall charge them for the room and lay on a nice buffet. We shall charge for the buffet as well at highly competitive commercial rates. I shall be quite happy if the people who prepare the food are also members of NUPE.

Since the business of the Health Service is to provide a health service, I can well see money being made as our staff provide a much needed occupational health service on contract to local businesses, either on their premises or on ours. The possibilities are legion and very exciting.

The National Association of Health Authorities has just sent me a copy of its booklet "Income Generation in the National Health Service." That came out of a conference that the association organised in December, and it is quite clear that many of our ideas are already being implemented or are about to be implemented. Shropshire health authority is proposing to have advertising on closed circuit television, and that will raise an estimated annual income of £100,000.

The Greater Glasgow health board is looking at advertising and planning to maximise advertising potential on stationery, hoardings and vans. Consultation is under way on the feasibility of setting up a consortium of health boards in Scotland for advertising purposes and that will bring in an estimated income of about £25,000. If that was done in my constituency, it would go down a lot better than "Derbyshire supports nuclear free zones", which is the advertising that we get on all our public sector stationery at the moment.

The catering services in Brighton health authority provide meals to outside organisations, including resettlement centres and Age Concern. It has been in operation for some time and brings in an estimated income of £20,000. South Bedfordshire health authority runs its printing department on a commercial basis and has an estimated annual income of £20,000. Portsmouth and South-East Hampshire health authority has a very good central sterile supplies department and provides a service to other health authorities and to private industry. According to the National Association of Healrth Authorities, the estimated annual income is £600,000. I do not know whether that is a misprint, but it gives an idea of the sort of income that might be possible. The possibilities are exciting and we look to Ron Kerr and his staff to help carry the proposals forward.

I turn to the amendments tabled by the hon. Member for Southport (Mr. Fearn). On amendment No. 46, to the extent that community health services and other such bodies can make use of the powers, we see no reason why they should not be subject to the same powers of direction as the health authorities. We understand that amendments Nos. 47, 51, 52, 54 and 55 seek to require the Secretary of State or, where powers are delegated, the health authority to consult bodies representing the public before embarking on any income generation scheme, before setting amenity bed charges, before authorising pay beds and before setting pay bed charges. I welcome this opportunity to repeat the assurances I gave in Committee that there are adequate safeguards contained in clause 4 to ensure that nothing may be done that might affect adversely the duties of the Secretary of State under the National Health Service Act 1977. We already consult widely on all sorts of major issues and the views of the community health councils are taken along with, for example, the views of private sector health care providers and NHS staff on the issue of pay beds.

In the case of relatively minor income generation activities such as the creation of a florist's shop or newsagent, it hardly seems necessary to write into law that the health authority must consult the local community health council.

Our concerns apply in much the same way to some of the other points. For example, amendment No. 49 talks about activities that may be injurious to health. We do not intend that authorities should introduce any schemes that run counter to general health policies. That will be set out clearly in the guidance that we will be issuing to the health authorities. In that guidance we will be suggesting, with reference to amendment No. 50, that health authorities should consider approaches involving the leasing and franchising of different activities. I understand the concern expressed by the hon. Member for Wakefield, but I assure him that the amendments are unnecessary and should be rejected.

I will ask leave to withdraw the amendment, but I have to say that we will be watching the way in which the Government use—

Order. This is a technical point. The hon. Lady may speak to the amendment, but it must be withdrawn, if it is to be withdrawn, by the hon. Member who moved it.

We are concerned to see how the Government will be using the new clause. It is clear that it will not free district health authorities to do whatever they want. The clause gives power to the Secretary of State to force district health authorities to do things that they do not necessarily want to do.

It is clear that from the central Exchequer there is a deliberate policy of under-funding district health authorities. That has been recognised by all independent reputable bodies, and it is disgraceful at a time when there is plenty of money available in the Exchequer that could be used to finance the Health Service. We are in no doubt, and neither are Health Service managers, that if any money is raised locally by district health authorities, it will simply be clawed back by a further reduction in allocation from the Treasury. That point was recognised by the right hon. Member for Brentford and Isleworth (Sir B. Hayhoe). It is also generally recognised that forcing managers at local level to generate income rather than health care and improved quality of services would be a diversion from the task that we should be setting them, which is to improve the quality of care.

I hope that the Minister will not seek to continue to misrepresent our view or that of NUPE. We are certainly not against the idea of shops and so on being used as an amenity for those people who work in, are treated by or who come to visit people in the Health Service. We are against the idea of the Health Service as a whole having to be financed from peanuts raised at local level when there is plenty of money in the Exchequer to enable it to be run properly.

Basically, as my hon. Friend the Member for Wakefield (Mr. Hinchliffe) stated, this is more of a thrust towards commercialisation of the Health Service. We do not want to see that, nor do the Health Service professionals, others who work in the Health Service, the British people, or the managers. We shall be watching with concern, if the Government refuse to amend the Bill in the way that we want, to see how they operate this clause.

Had we been discussing this matter earlier in the day, I would have pursued it to a Division. For the reasons given by my hon. Friend the Member for Peckham (Ms. Harman), I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

I understand that Government amendments Nos. 16, 17 and 18 are not to be moved.

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I beg to move amendment No. 53, in page 4,line 34, leave out from 'section' to 'hospitals' in line 38 and insert—

'unless he is satisfied that sufficient accommodation and facilities are available for services provided by the National Health Service'.

With this it will be convenient to take amendment No. 56, in page 5, line 12, leave out from 'section' to 'hospitals' in line 16 and insert—

'unless he is satisfied that sufficient accommodation and facilities are available for services provided by the National Health Service'.

These amendments reverse the intention of the Bill. The Bill says that the Secretary of State shall revoke provision for private practice only if he is sure that there is adequate provision elsewhere. We say that he should revoke that authority unless he is sure that there is enough National Health Service provision.

The duty of the Secretary of State is to manage the National Health Service and to provide a comprehensive public service. Private services are a matter for the market; they have nothing to do with the Secretary of State.

What does the Secretary of State propose if there is insufficient provision for the National Health Service and the private sector? Under the clause he is to protect the private sector and let the National Health Service go hang. That is entirely wrong because anybody in the population can use the National Health Service, but only people who can afford to do so can use private services.

There can be no justification for the Government's view. It is a direct attack on National Health Service provision in places where there are poor services. It is happening at a time when the National Health Service is increasingly falling short of meeting public need. This is an issue of principle. If the Secretary of State acts in accordance with the terms of the clause, he will be failing the National Health Service.

The purpose of subsection (2) that is the subject of amendment No. 53 is simply to restate the powers that have been in place since the Health Service Act 1980. The Government have no intention to change the Secretary of State's powers to authorise or to revoke provision of pay beds. Amendment No. 56 covers the same ground for Scotland. I urge hon. Members to reject the amendments.

Amendment negatived.

I beg to move amendment No. 86, in page 5,line 18, at end insert—

'(9) In section 121 of the National Health Service Act 1977 (charges in respect of non-residents) after the word "charges", in the first place where it occurs, there shall be inserted the words "as the Secretary of State may determine".
(10) In section 98 of the National Health Service (Scotland) Act 1978 (which makes corresponding provision for Scotland) for the words "may be prescribed", in the second place where they occur, there shall be substituted the words "the Secretary of State may determine".
(11) The following paragraph shall be added at the end of the sections mentioned in subsections (9) and (10) above—"The Secretary of State may calculate charges under this section on any basis that he considers to be the appropriate commercial basis.'''.

The amendment could be christened the "Galbraith amendment." I shall explain later exactly what I mean by that. I must apologise to the House for tabling the amendment so late this week. It deals with the setting of charges in respect of National Health Service treatment of overseas visitors. At present, health authorities charge overseas visitors who are liable to pay for National Health Service treatment on the basis of the schedule of charges produced centrally. Those charges are largely derived from private patient charges. Since April 1987, health authorities have been able to set their private patient charges and clause 4 allows them to make commercial charges. We believe that it is sensible to bring the setting of charges to overseas visitors into line with private patients, and the amendment has that purpose.

We believe that there are good reasons for making that change. First, it will enable us to recover realistic charges from overseas visitors who are not coverd by inter-Government reciprocal arrangements or by other exemptions. From Royal Assent, the effect will be that overseas patients will be on the same footing as private patients. Secondly, it will be simpler because instead of having two sets of rules concerning overseas and private patients there will now be one, which will still be directed from the centre, although there will be a single set of rules and health authorities will set their rates according to the local market and their judgment thereon.

The hon. Member for Bearsden and Strathkelvin (Mr. Galbraith) convinced us of the value of tabling the amendment. He waxed eloquent about the subject on Second Reading and talked about it at length in Committee. I understand that there are restrictions on quoting an hon. Member, although I can quote a Minister's remarks, during the passage of a Bill. However, I refer hon. Members to a very long discussion that we had during the passage of the Bill. To recognise the conventions of the House, I shall not quote the hon. Gentleman exactly, but, broadly speaking, he said that often overseas patients are charged at a loss to the hospital.

People with considerable financial resources come to this country for highly specialised treatments that are available only in certain hospitals in certain countries. The hon. Member felt that there was no reason why hospitals should not charge non-residential patients at commercial rates. He said that it was not a major issue and he did not want to make a great deal of it, but he wondered whether the Minister would comment.The Minister is commenting. We checked the law, and the law as it stands would not allow us to do what he wanted, and that is why we tabled the amendment.

Many overseas visitors are exempt from NHS charges for various reasons—if they are European Community citizens, if they are covered by the reciprocal arrangements that we have with a number of countries, or if they are studying here. However, we agree with the hon.Gentleman that it is reasonable to expect the rest to be covered by travel and medical insurance, just as the British traveller abroad needs to be covered. It is entirely viable that, for those who have to pay, charges should be made on the same basis as those for private patients. Therefore, I urge hon. Members on both sides of the House to accept the amendment.

Amendment agreed to.

On a point of order, Mr. Deputy Speaker. I understood that we would adjourn on clause 4. Amendment No. 57 is part of clause 5.

No such motion has been moved. Does the hon. Member wish to move his amendment?.