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National Health Service (Amendment)

Volume 579: debated on Wednesday 11 December 1957

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3.46 p.m.

I beg to move,

That leave be given to bring in a Bill to amend section thirty-eight of the National Health Service Act, 1946, and for purposes connected therewith.
The Bill which I am asking leave to introduce seeks to ensure that every private patient of a registered medical practitioner shall be entitled to be supplied with drugs, medicines and appliances on the same terms as patients who are registered with a medical practitioner who provides general medical services under the Act.

This Bill, the principle of which is supported by the British Medical Association, is designed to remedy a longstanding injustice which has been the cause of a continuing and growing irritation and grievance not only among private patients, but among the medical profession as a whole. Before the introduction of the 1946 Act—which came into force in July, 1948—the Ministry of Health issued a circular entitled, "The New National Health Service", in which it was stated that
"Everyone, rich or poor, man, woman or child, can use it"—
that is, the National Health Service—
"or any part of it. You are paying for it mainly as taxpayers."
The last part of that statement is certainly very true. We are all paying for the National Health Service, both in the form of the recently doubled contributions and in the form of taxation.

But the first part of that statement is true only if one is registered with a National Health Service practitioner. If one prefers to be a private patient and not to clutter up the out-patients' department, or to fill a hospital bed, one not only has to pay for one's doctor but also for drugs and medicines.

Why was this unfair discrimination first introduced into the 1946 Act, despite the Conservative opposition at the time? I think that the answer lies in a speech made by the right hon. Member for Ebbw Vale (Mr. Bevan), who was then Minister of Health when, in an Adjournment debate on 19th July, 1948, he said:
"I should also like to make it quite clear, because there seems to be misunderstanding in some quarters about it, that if a person remains as a private patient, that person will also have to pay for drugs. That of itself, may have a chastening effect as time goes by. When individuals find that, having become private patients, they not only have to pay the doctor himself, but have to pay the chemist's bills as well, and as that knowledge grows, it may be that the area of private practice will progressively diminish."—[OFFICIAL REPORT, 19th July, 1948; Vol. 454, c. 197.]

That is apparently what hon. Members opposite like. How right the then Minister was; private practice has diminished. Today, it is estimated that of the population available for registration about 3 per cent. only are not registered as National Health Service patients. That is a 25 per cent. drop since the figure was first estimated in 1949.

On a point of order. Some of us are a little confused, and would like your guidance, Mr. Speaker. If this Bill became law it would seem to involve a substantial increase in public expenditure. Is it in order to bring in such a Bill under private Members' procedure?

I was listening to the hon. Member with the same point in mind. The Standing Orders provide that if a Bill places a charge upon public funds it cannot be brought in until there has been a Resolution of a Committee of the whole House sanctioning the expenditure. I was waiting to see whether the hon. Member who is addressing the House had any proposals to meet this point. I must decline to put the Question if he has no scheme for financing it which does not put a charge on public funds, or there has not been a Resolution of the Committee of Ways and Means.

As I understand the rules of order governing this procedure, one cannot introduce a Bill which proposes a charge upon the Consolidated Fund or the Revenue. This Bill, by one of its Clauses, imposes a charge upon the National Land Fund, which, I understand, is in order.

Procedurally, that would be in order. Whether it be feasible is not for me to say.

I understand that during the course of an earlier discussion on the use of the National Land Fund it was ruled that it would be a charge upon the Exchequer. On a previous occasion when the advice of the Clerk of the House was sought on this matter, that is the advice which was given.

I understand not. I understand that it would not involve a charge on public funds, because the National Land Fund is not a fund, as I understand it, which is progressively refreshed by contributions from the Exchequer according to its expenditure. It is a fund which, when it is finished, no more exists, and the fact that a heavier charge were placed upon it would not of itself inevitably imply a charge on public funds.

Since the funds on which the hon. Gentleman proposes ultimately to rely—if he gets the leave of the House to introduce his Bill—are to be disposed of in a manner already determined by the House, which does not include any such purpose as the hon. Member says, and as it is clearly and manifestly inappropriate in any case to use funds of that kind for so different a purpose as is involved in this Bill, does not it become clear that to seek to obtain leave to bring in a Bill on that basis is sheer impertinence and an abuse of the procedure of the House.

Order. I hope that the House will take this matter calmly.

The position of the National Land Fund is that if the House decided to put a charge on it which exhausted it, that is the end of the Land Fund. It is for the House to determine whether it will do that. The rest of the hon. Member's argument was addressed to the merits of the proposal. I think it in order to move for leave to introduce a Bill placing the charge on the Land Fund. As I said earlier, whether that is a feasible, desirable or practical course is not for me to say.

This is really a matter of great importance. I think that I may say with respect, Mr. Speaker, that no one has defended the rights of private Members in these matters more than I have and I do not seek now to stifle the discussion; but unless the rules are observed, the whole procedure which the hon. Member is praying in aid becomes an absurdity and loses any authority in the House. You, Mr. Speaker, have said that when the moneys in this Fund have been absorbed by charges which the House has already placed upon it, there will be nothing left. In that case, the hon. Member would have to rely on some other way of raising funds and it must, therefore, become a public charge and require a Resolution of the Committee of Ways and Means.

I do not think that that necessarily follows. If the hon. Member obtained leave to introduce the Bill, and it was supported in the House, no money from the Exchequer could be spent under it without a Resolution of a Committee of the whole House. But I have only to deal with the narrow, procedural point of whether it is in order to make the proposition with which the hon. Member for Wycombe (Mr. John Hall) is dealing, and I must rule that it is.

It so happens that I have personal experience of this matter, Sir. At an earlier date I sought to make a charge upon the Land Fund in respect of expenditure upon National Parks. The proposal was ruled out of order, because it was argued that it was impossible to make a charge of that kind. I suggest that this case is completely parallel so far as the rules of order of the House are concerned. Here the hon. Member is seeking to impose a charge by the use of the Land Fund, which is the very procedure I attempted to use some time ago.

I do not recollect the incident to which the hon. Member refers, but I have made inquiries on this point, having foreseen the difficulty which the hon. Member might experience when I was informed that he had this proposition to make. I am acting on the best advice I can procure. I am told that it is in order. I have ruled on the matter and I cannot say more.

Without wishing in any way to challenge your Ruling, Mr. Speaker, may I put this point to you as one who has a day-to-day contact with the working of the National Health Service? If what the hon. Member for Wycombe (Mr. John Hall) proposes comes to pass, and private patients, about whom he is rightly concerned, obtain what he desires them to obtain, the dressings and medicines which they would receive under the Health Service would be provided with money which comes from the Exchequer to the Ministry of Health. Is it not an abuse of the privileges of this House to talk about the National Health Service and a charge on the National Land Fund when, in fact, the money comes direct from the Exchequer, and we should have to get more money from the Exchequer to do what the hon. Member for Wycombe desires?

The hon. Member is addressing himself to the merits, or, as he might say, the demerits of the proposal to which the House has been asked to listen. This House has before now entertained proposals of which it did not approve, but that does not mean that they were out of order, and I must ask the House to allow the hon. Member for Wycombe to continue.

I should like your guidance, Mr. Speaker, on whether it would be in order for me to bring in a Bill to amend the National Insurance Act—

—and for the expense involved to be covered by the Land Fund. I should like to amend Section 62—

Order. I shall be glad to consider the hon. Member's Bill when he presents it. Mr. Hall.

I must respectfully draw your attention, Mr. Speaker, to the fact that my hon. Friend's question, hypothetical though it may be, bears very closely on what we are discussing. If this procedure upon which the hon. Member is relying is in order, it must follow that the sacredly guarded rule, which has existed for many generations, that proposals which involve a charge on public funds cannot be made by private Members is completely overthrown. It cannot be limited to this case, which means that in future any hon. Member who wishes to introduce a Bill, which otherwise would be out of order, can render it in order by this highly controversial and, as I submitted earlier, impertinent procedure.

On a point of order. Having listened to the comments of the hon. Member for Wycombe (Mr. John Hall) about the purpose of the Bill, Mr. Speaker, I wish to ask you this question. Drugs and medicines, etc., are very often dispensed even for private patients by dispensers working in hospitals. Their salaries are a charge on the Treasury. What will be the position if this Bill is accepted? Will the amount of money necessary to pay the salaries of those people in the hospital service, whose time will be taken in making up medicine and dispensing the requirements of private patients, be taken from the Land Fund and paid over to the Treasury to help meet the added expense to the hospital service?

That may be an insuperable obstacle to the House's accepting the Bill, but it is not a point of order.

May I, on that point of order, Mr. Speaker, respectfully put it to you that involved in this matter is an issue of fundamental Parliamentary importance and common sense? Surely the hon. Member for Wycombe (Mr. John Hall), by bringing in the Land Fund, is obviously engaging in a subterfuge to avoid one of the oldest constitutional doctrines behind the procedure of the House of Commons, namely, that nobody can propose public expenditure except a Minister of the Crown. That doctrine is of importance from the point of view of responsible control of public finance.

Therefore, I suggest that, on grounds of constitutional tradition of Parliament and on grounds of common sense, the hon. Member, whether on this occasion or on any other one, ought not to be allowed to go in for a little bit of clever foolishness—[HON. MEMBERS: "Oh."]—certainly it is—for the purpose of cynically evading the constitutional rule.

I have listened to what the right hon. Gentleman has said, and with a great deal of interest. Of course, it is a fact that there are in existence these funds, whatever the merits or demerits may be, and it has been held that the proposed imposition of charges upon them does not require a Money Resolution. I am bound by the narrow precedent. The House can listen to all the arguments, and decide whether the Bill is desirable or feasible.

I do not wish to speak outside my jurisdiction, but I would like to hear how the proposal of the hon. Member for Wycombe would work.

This is an important matter, Mr. Speaker. You may recall, Sir, that the Economic Secretary to the Treasury brought forward proposals a short time ago to reduce the size of the Land Fund. When he was deploying his arguments he insisted that any claim upon that Fund was a charge upon the Exchequer. That was the argument which he put before this House and it was on the basis of that argument that the reduction which he proposed in the Land Fund was finally agreed to in this House.

Apart from that argument, which supports the understanding I had, and was given, in fact, by the Clerk of the House, that any proposals for the use of the Land Fund would be a charge on the Exchequer, there is the fact that the reduced sum of money which now remains in the Land Fund may well prove to be insufficient to meet the demand of any proposals for providing free drugs to private patients.

I submit, therefore, that unless evidence can be given that there is a sufficient sum of money in the Fund as now reduced—the Fund is now at a very low ebb, and would not be sufficient to meet any charges such as are proposed by the Bill which the hon. Member seeks to introduce—the inevitable extra charges would fall upon the National Exchequer.

The true position would then be—so far as the hon. Member for Wycombe has been allowed to tell us what is in his mind; and if he has his way and the Land Fund is exhausted—that the purposes of the Bill become nugatory. That is all. There is yet no proposal to put a proper charge upon the Exchequer, apart from the charge on the Fund. That is the procedural point. Mr. Hall.

I hope that the House will allow this matter to proceed. I may be wrong about it, but I am acting on the best advice I can obtain. If I am wrong, we can put it right. I have stated what I believe to be the position and I am, therefore, bound to listen to the hon. Member for Wycombe. Otherwise, I should have refused to put his Motion to the House.

On another point of order, Mr. Speaker, which has not so far been touched upon. In view of the Ruling which you have just given, Mr. Speaker, suppose that the Bill is introduced, has a Second Reading and goes to Committee. Would it then be in order in Committee for an hon. Member to seek to delete the Clause dealing with the Land Fund and to submit in its place another Clause to finance the Bill by another means?

If it were a proposal to finance the Bill by means of a charge upon the Exchequer, that proposal would be out of order, because it would need a Resolution of the Committee of Ways and Means. Mr. Hall.

I have listened with great interest to the guidance you have given hon. Members and to the Rulings on the points of order. I hope that the time which has been taken up by them will not be deducted from my own allocation of time. I was dealing with the 25 per cent. fall in the number of private patients since 1949, and I was about to add that in a debate in a Standing Committee on 6th July, 1949, the right hon. Member for Ebbw Vale declared that if doctors were permitted to prescribe for private patients the number of private patients would increase rapidly and that would sabotage the National Health Service. That fear would only be well founded if the standard of medical attention given under the National Health Service were lower than—

On a point of order. Is it not now perfectly clear from the argument of the hon. Member for Wycombe that the hon. Member is concerned with a charge on public funds? The arguments which he is quoting from the speech of my right hon. Friend the Member for Ebbw Vale (Mr. Bevan), and that with which the hon. Member is combating it, are that one was saying that the State ought to pay more and the other was saying that the State ought not; and the purpose of the hon. Member's Bill is to reverse the decision which my right hon. Friend made as Minister of Health. It is clear that the Land Fund point is merely a transparent subterfuge to undermine one of the constitutional safeguards in our procedure in the House of Commons and I again invite you to say, Mr. Speaker, that this is an outrageous abuse of the procedure of the House.

I shall be glad to go on with my argument, Sir, if I can do so uninterrupted. I was pointing out that the fear that a great number of private patients would sabotage the National Health Service was unfounded unless the service given by the National Health Service was grossly inferior to private practice. What is true is that the standard in private practice is very high, and provides a basis of comparison with the National Health Service which must be of great value.

Nevertheless, there are two difficulties which have, so far, prevented an Amendment of this kind to the Act. The first is the problem of applying to private doctors the same control over excessive prescribing as exists over National Health Service doctors. Secondly, there is the additional cost, to which much reference has already been made. The first objection is no longer valid. It has been made abundantly clear that private doctors, almost without exception, are prepared to subscribe to the same conditions as apply to control of the National Health Service doctors. The second objection is much more serious, in view of the Government's present economic policy and fight against inflation.

In April, 1953, the cost of medicines which might result from a Bill of this kind was estimated by the Ministry of Health to be about£1½ million. Since then, despite the higher cost of medicines, and allowing for the charges that have been imposed on the Service, the number of private patients has fallen to such an extent that the present estimate is about £1 million. That estimate does not take into consideration the saving which would accrue when a private patient decides to take his treatment at home instead of, as is too often the case now, being forced into hospital by the present high cost of medicines.

It does not take into account the saving in time and money where patients have two doctors. It has been reliably estimated that more than 50 per cent. of them have a National Health Service doctor as well. It does not take into account the saving to the State where a doctor elects to do private instead of National Health Service work. Taking all that into account, it has been estimated by those better qualified than myself that the additional cost may be £500,000. There is enough money in the National Land Fund if that is the basis of the objection.

As the hon. Member says that there is enough in the Fund, will he kindly say how much is in the Fund at present to meet the charges he is proposing to impose on it?

On a point of order, Mr. Speaker. The hon. Member is proposing the use of funds and does not know how much money there is in the Fund. He cannot propose in this House to use funds for this purpose when he cannot tell the House whether there are funds there. Therefore, there is obviously a charge on the Exchequer. I suggest that this is completely out of order.

Further to that point of order, Mr. Speaker. It is quite clear that there is a great deal of disquiet—probably on both sides of the House—[HON. MEMBERS: "No."]—certainly among hon. Members on this side. I am sorry that it does not include hon. Members opposite. There is a feeling that the hon. Member for Wycombe (Mr. John Hall), who has brought the Motion before the House, is trying to circumvent the Standing Order. That may or may not be a right impression, but it appeared to me, a few moments ago, that you yourself entertained some slight doubt on this point.

The point I want to put to you now is whether it would not be to the convenience of the House and in the best interests of our traditions and procedure if, in view of the difficulties which have arisen, the hon. Member would now ask leave to withdraw the Motion, on the understanding that he could bring it before the House when you have had time to consider your opinion.

If I may be allowed to continue my argument, I was about to point out that the figure of £500,000, estimated to be the maximum additional cost, is about one-tenth of 1 per cent. of the total service—

Order. I have listened to all that has been said on this matter and we are making no progress at all on this so-called Ten Minutes Rule Bill. I do, therefore, ask the hon. Member for Wycombe to allow me to consider this matter a little further. I have no power to stop him. So long as he is procedurally correct it is not my place nor in my power to stop him and I would not attempt to do so; but in view of what has been expressed about the dubiety of these proposals, I think I ought to have a further chance of studying the matter. That would be without prejudice to the hon. Member's right to reintroduce the Bill at another time. I make that suggestion, but if he proceeds I will not stop him.

On a point of order, Mr. Speaker. Is it not the case that Her Majesty's Government introduced a Bill imposing a charge on the Land Fund without the Queen's Recommendation? Does not that precedent clearly establish the fact that this proceeding is in order?

No, this is a proposal by a private Member; Governments have different powers.

I had some difficulty, Mr. Speaker, in hearing exactly what you were proposing to me, because of interruptions on the other side of the House, but I understand that you are suggesting that I should withdraw the Motion without prejudice to my right to bring it forward again. In those circumstances, if I did withdraw it, could I bring it forward again tomorrow?

I think that tomorrow would be a little early to let me have a chance of considering the whole position further. I suggest Tuesday or Wednesday next week; it cannot be done on a Thursday.

In view of the discussion that has taken place on points of order and without any wish to offend the proprieties of the House—[HON. MEMBERS: "Oh."] Hon. Members should not attribute to other motives they might have themselves—and in view of the fact that my right is safeguarded and that this does not prejudice my opportunity of bringing forward the Bill again under the same procedure, I am prepared now to withdraw the Motion.

On a point of order. When you consider your Ruling, Mr. Speaker, will you consider not only the point about Standing Orders and precedents, but future trends which will be engendered by this and the precedent it will set up by which anyone on any occasion could bring forward any Bill by this artifice? Will you consider—as I know you will—the general well-being of the House in that respect?

It was for that reason I made my request to the hon. Member for Wycombe. I want to have a further look at the possible repercussions. I am anxious to preserve the rights of hon. Members to introduce Bills if they are procedurally correct, but I thought that I should have a further look at this and, therefore, I am obliged to the hon. Member for Wycombe for the action that he has taken.

Further to that point of order, Sir. When giving the matter your consideration, including its general significance, will you bear in mind that this particular point was brought to the attention of the Select Committee on Procedure, which has just reported to the House, and that the Select Committee did not recommend any change about availability of these funds for charging without the Queen's Recommendation?

I shall be obliged if the hon. Member will direct me to the reference so that I can study it further.

May I ask that in considering this you will bear in mind, Mr. Speaker, the statements made by the Financial Secretary to the Treasury when this matter came under discussion during last year's Finance Bill and he tried to prove that there was no money in the Fund if anybody wanted to use it?