New Clause. — (Cost of Conveyance of Certain Persons Under Section Twenty-Seven of Act.)

Orders of the Day — National Health Service (Amendment) Bill – in the House of Commons at 12:00 am on 19 October 1949.

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Where a person has travelled from a place in the area of one local health authority to a hospital in the area of another local health authority for the purpose of attending at, or being accommodated in, that hospital in order to avail himself of any hospital or specialist services and, immediately after such attendance or on the termination of the period of his accommodation in the hospital (not being a period longer than three months beginning with the date of his admission to the hospital), he is conveyed by ambulance or other means of transport made available by the local health authority for the area in which the hospital is situated in pursuance of their duty under section twenty-seven of the Act of 1946 from that hospital to the place from which he travelled as aforesaid or to any other place in the area of the local health authority within which the first-mentioned place is situated, the cost of that conveyance shall be repaid by the last-mentioned authority to the local health authority by whom the ambulance or other means of transport was made available as aforesaid:

Provided that any local health authority may agree to waive their rights under this section against any other local health authority, either in consideration of a periodical payment or without consideration.—[Mr. Linstead.]

Brought up, and read the First time.

Photo of Sir Hugh Linstead Sir Hugh Linstead , Wandsworth Putney

I beg to move, "That the Clause be read a Second time."

The parent Act imposes upon the local health authorities responsibility for the ambulance service and leaves at large the question of the charges for that service. It works on the basis that the local authority for the place where the patient's home is situated has the responsibility for the conveyance of the patient from the home to the hospital, and the local authority where the hospital is situated has the responsibility of providing the conveyance for the patient from the hospital back to his home. No provision was made for inter-authority accounting in the general expectation that swings and roundabouts would operate; that over a period of time the cost would even itself out as between one local authority and another. In fact, it has been found from experience that this has not been the case.

Generally speaking, the hospitals are situated in the areas of county boroughs which serve the surrounding counties, with the result that the general flow of patients has been from the counties into the county boroughs. The county boroughs are finding that they have to provide transport back to the homes of a large number of patients who are not residents of the county borough but of the county. There is, therefore, very little reciprocal flow in the other direction of borough residents out into the counties. In these circumstances, both the associations of the county councils and of the municipal corporations have considered the matter and come to the conclusion that there is a sufficient lack of balance as between one local authority and another to make it worth while introducing a system of inter-authority accounting, and the proposals which commend themselves to the local authorities are those contained in this Clause.

The only matter to which I might draw attention is the phrase in brackets— not being a period longer than three months beginning with the date of his admission to the hospital. It has been agreed between the authorities that after such a period it is not unreasonable to regard the patient as the responsibility of the authority within whose area he remains. In a large number of cases it will be a patient at a sanatorium, who will, of course, be a long-term patient.

Photo of Mr Aneurin Bevan Mr Aneurin Bevan , Ebbw Vale

The hon. Member has pointed out that this matter has been discussed between the representatives of the various local authorities and that they have reached agreement between themselves that some local authorities believe they are suffering under the present arrangement and will be able to have relief in this way. Whether the amount of relief will be as much as some of them think will rest on actual practice, but in the circumstances, as this is a matter for the local authorities and they have reached agreement, I see no reason at all for standing in the way and I accept the Clause.

Clause read a Second time, and added to the Bill.