Orders of the Day — Health Services Bill

Part of the debate – in the House of Commons at 12:00 am on 27 April 1976.

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Photo of Mrs Barbara Castle Mrs Barbara Castle , Blackburn 12:00, 27 April 1976

No: it is practiced by trade unionists.

Some consultants operate in what may be called geographically unattractive areas, of which there are a few in my constituency. In those areas there are only a few pay beds and there are not the fat pickings that are to be found in the South. In the southern part of England consultants can easily transfer into private institutions, but that process is much more difficult in the remote and less attractive areas.

When I considered this matter originally I envisaged a Bill that would lay down a reasonable period of phasing out, not the abolition of all pay beds from the date of Royal Assent. I believe that phasing out would be a good Socialist and trade union principle. It would give people a fair chance to adjust their lives. I have always believed in phasing out, and, indeed, it is a phrase that we have used in all our manifestos. The difference now is that these matters will be controlled not by the Secretary of State for Social Services but by an independent body. The constitution of that body has been carefully argued and agreed in our negotiations with the medical profession conducted through Lord Goodman.

It is clear that the profession does not trust me, but not just me. Indeed, as Nye Bevan said, the medical profession has never trusted any Minister of Health. In two minutes flat it will be found that they will not trust my right hon. Friend the Secretary of State for Social Services. The profession feared that the approach I have outlined would not be applied. Therefore, the idea of an independent board was thought to give it security. I must admit that it gives me a sense of security, too.

We all know that Secretaries of State change. Powers that might be operated by me in a certain way could be operated in a different manner by somebody else —and I am not referring to my right hon. Friend the Secretary of State for Social Services. I know that he and I are of the same kidney in this respect, but there are other future Secretaries of State to be considered. There is even the horribly remote contingency that we shall have another Tory Government, and the wicked successor syndrome is very much in my mind.

We are to have an independent board on which trade unionists as well as members of the medical profession will sit, working under an independent chairman. That will be a guarantee that no Secretary of State in future can come along and administratively wreck the whole programme of phasing out because that power is within his or her discretion. In this situation there is something to be said for limiting the administrative discretion. I should love to have that discretion personally, but I should not be so happy if it were to be in the hands of some other people. I shall not name names, but I am certainly referring to Members of the Opposition.

There is in this legislation the essence of a reasonable compromise. However, I believe that Lord Goodman is now pushing his luck by making the sort of statement he made last weekend. Now that I have been removed from office he is trying unilaterally to reinterpret the agreement, an agreement which I and my hon. Friend the Minister of State, Department of Health and Social Security worked out with the medical profession, through the intermediary of Lord Goodman.

Let us make no mistake about the fact that detailed discussions took place on these matters, although the medical profession now refuses to call them negotiations. The profession is terrified of commiting itself to anything. If they were not negotiations, all I can say is that they certainly resulted in an agreement containing proposals that were argued line by line and word by word.

It is important for the debate that lies ahead for us to understand the nature of that compromise. It was set out in my statement to the House on 15th December. Incidentally, every word of my statement had been seen and approved by Dr. Derek Stevenson of the BMA as a fair interpretation on the outcome of these arms-length talks. I said in my statement: It is proposed that the legislation would embody two principles: first that private beds and facilities should be separated from the NHS"— a crucial part of the package compromise. Secondly, I expressed the Government's commitment to the maintenance of private practice in this country through the renewal of the provision in the National Health Service (Amendment) Act 1949, which maintains the right to private practice by entitling doctors to work both privately and in NHS establishments.' —[Official Report, 15th Dec., 1975; Vol. 902, c. 972.] Both those principles are embodied in this package and are crucial to it.

I wish to draw attention to a letter from my right hon. Friend the then Prime Minister which was sent to the profession on the same day as I made the statement. The former Prime Minister referred to the fact that discussions had been going on and said that he understood that detailed proposals had "evolved" and were to be placed before the profession and its committees and councils for urgent consideration. The Prime Minister wrote as follows: I am writing to inform you that if the proposals are accepted by the professions as a whole and normal working is resumed, the Government would embody the proposals in the legislation. He went on: I fully appreciate that your willingness to submit these proposals does not mean that you and your colleagues have in any way withdrawn your opposition to the passing out of private practice and that you will reserve your right to try to influence Parliament's decision on the principle of phasing out I stress the word "principle". One important thing to remember is that it was always accepted that the profession should have the right to try to stop the Second Reading of the Bill. Put the profession also accepted the following which is in paragraph 3 of the Goodman proposals: Despite their continuing opposition the medical and dental professions acknowledge that the phasing out of pay beds in NHS hospitals may, through legislation, become the will of Parliament. In that event the phasing out should be subject to the safe-guards outlined below. That is a very clear deal which has been struck, and the Prime Minister acknowledged the profession's right to try to defeat the Bill, but if any Bill goes forward, the deal is that it is to be a Bill along these lines. Of course, I accept absolutely that it is for Parliament to decide the contents of any legislation, and the right hon. Member for Wanstead and Woodford was right to make that point.

However, as far as the Government are concerned, what the Government are committed to and what they are obliged to ask their supporters to vote for is this compromise package and nothing else. If it is weakened, and if attempts are now made to say" We have to look now at the schedule because 1,000 beds is too many and we must cut them to 750"—I have even read that—I would point out that the commitment to phase out 1,000 beds within the schedule within six months is in the proposals the acceptance of which by the profession led to the Government embodying them in the legislation. If we are told that the profession is now going back on that then, by heavens, there are some things that some of the rest of us would want to go back on. I say to my comrades and to the House that what the Government of which I was a member tried to do was to bring peace to the NHS by striking a balance between their commitment to separate private practice from NHS hospitals and the fears of the medical profession that this would be a step towards the total abolition of private medicine, which was never our policy.