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Column 906

Rhodes James, Robert

Riddick, Graham

Ridley, Rt Hon Nicholas

Ridsdale, Sir Julian

Rifkind, Rt Hon Malcolm

Roberts, Wyn (Conwy)

Roe, Mrs Marion

Rossi, Sir Hugh

Rost, Peter

Rowe, Andrew

Rumbold, Mrs Angela

Sackville, Hon Tom

Sainsbury, Hon Tim

Sayeed, Jonathan

Scott, Rt Hon Nicholas

Shaw, David (Dover)

Shaw, Sir Giles (Pudsey)

Shaw, Sir Michael (Scarb')

Shelton, Sir William

Shephard, Mrs G. (Norfolk SW)

Shepherd, Colin (Hereford)

Shersby, Michael

Skeet, Sir Trevor

Smith, Sir Dudley (Warwick)

Smith, Tim (Beaconsfield)

Smyth, Rev Martin (Belfast S)

Soames, Hon Nicholas

Speed, Keith

Speller, Tony

Spicer, Sir Jim (Dorset W)

Spicer, Michael (S Worcs)

Stanbrook, Ivor

Stanley, Rt Hon Sir John

Stern, Michael

Stevens, Lewis

Stewart, Allan (Eastwood)

Stewart, Andy (Sherwood)

Stewart, Rt Hon Ian (Herts N)

Stokes, Sir John

Stradling Thomas, Sir John

Sumberg, David

Summerson, Hugo

Tapsell, Sir Peter

Taylor, Ian (Esher)

Taylor, John M (Solihull)

Taylor, Teddy (S'end E)

Tebbit, Rt Hon Norman

Thompson, D. (Calder Valley)

Thompson, Patrick (Norwich N)

Thorne, Neil

Thornton, Malcolm

Thurnham, Peter

Townend, John (Bridlington)

Townsend, Cyril D. (B'heath)

Tracey, Richard

Tredinnick, David

Trippier, David

Twinn, Dr Ian

Vaughan, Sir Gerard

Waddington, Rt Hon David

Wakeham, Rt Hon John

Waldegrave, Hon William

Walden, George

Walker, A. Cecil (Belfast N)

Walker, Bill (T'side North)

Waller, Gary

Wardle, Charles (Bexhill)

Warren, Kenneth

Wells, Bowen

Wheeler, John

Whitney, Ray

Widdecombe, Ann

Wiggin, Jerry

Wilkinson, John

Winterton, Nicholas

Wood, Timothy

Woodcock, Dr. Mike

Yeo, Tim

Tellers for the Noes :

Mr. Tony Durant and

Mr. Alastair Goodlad.

Question accordingly negatived.

Question, That the proposed words be there added, put forthwith pursuant to Standing Order No. 30 (Questions on amendments), and agreed to.

Mr. Deputy Speaker forthwith declared the main Question, as amended, to be agreed to.


That this House supports the introduction of the community charge, the principles of which are manifestly fairer and simpler than those that now apply to domestic rates ; welcomes the exemptions conferred on those who cannot be asked to pay and the generous discounts, rebates and increased income support available for those on low incomes ; recognises that the unified business rating system introduces a valuable stability for non- domestic ratepayers ; congratulates Her Majesty's Government on implementing proposals that will improve the accountability of local government by insisting that all who benefit from their services should have a say in their quality and cost ; and notes that either a local income tax or a two-tax system based upon local income tax and capital value tax would be much more expensive to implement, much more unfair and make local government much less accountable.

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Health Policy

7.13 pm

Mr. Robin Cook (Livingston) : I beg to move,

That this House welcomes with enthusiasm the Prime Minister's pledge that no-one will go private again for medical treatment ; invites the Secretary of State for Health to demonstrate his commitment to her pledge by withdrawing the provision for tax relief for private medical insurance, and by abandoning his proposals that self-governing hospitals should trade for private patients and that general practitioners should use practice budgets to purchase private treatment ; notes that general practitioners on a ballot have rejected the contract offered by the Secretary of State by a majority of three to one ; regrets that the Secretary of State has threatened to impose the new contract irrespective of this vote ; and calls upon the Secretary of State to reopen negotiations on his proposal to increase capitation-based payments which will give doctors an incentive to seek longer patient lists.

Tonight's debate is prompted by two important developments in the health debate last week. Half the motion is inspired by the Prime Minister, who last week addressed the 1992 Committee in visionary terms about the Government's intentions for the Health Service. [ Hon. Members :-- "1922."] I stand corrected. Plainly, the 1992 committee of the Conservative party will be smaller than the 1922 Committee.

I give assurances to Conservative Members, who may be worried about the Opposition quoting the Prime Minister in a Supply day debate, that this is likely to be the only time that we shall welcome anything that the Prime Minister has said. I suggest to Conservative Back Benchers who are unhappy with the Government's proposals for the National Health Service that this could be the easiest wicket on which to rebel. After tonight's debate, should they vote for the Labour motion, they will be able to look their Whips straight in the eyes and say that they voted to support the Prime Minister's pledge--and a very remarkable pledge it was. She said, "No one will ever go private again".

Mr. Jerry Hayes (Harlow) : She did not say that.

Mr. Cook : I am interested to hear the comments of the hon. Gentleman, to whom I am happy to give way in a moment. I went to the Library and asked for a copy of the Prime Minister's speech to the 1922 Committee. I was advised that I could not have a copy because it was confidential. Since then, I have been distressed to see that, in the Government amendment, the reference to the Prime Minister is deleted.

I understand that the Secretary of State could not have heard the speech, because I believe that, like me, he is not permitted to attend those meetings. Perhaps some kindly Back Bencher--

Mr. Hayes rose --

Mr. Cook : As we now have one on his feet, perhaps he can tell me whether the words reported were used, and if so, how many of his hon. Friends were so impressed by them that they have since cancelled their premiums to BUPA.

Mr. Hayes : Perhaps I can breach a confidence and tell the House that the Prime Minister said, "What I aim to do is to make the National Health Service so good that no one need ever go private again."

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Mr. Cook : I have to confess that the hon. Gentleman made me uneasy when he began because I thought he said that he had taken to writing the Prime Minister's speeches on the Health Service, and that would be a sad loss to debates in the House.

If that is what the Prime Minister said, two questions obviously arise from it. The first is a small matter of whether, if it is what the Prime Minister said, she includes herself in the commitment. It is not clear, at the moment, whether she was implying the royal no one. The Prime Minister is much given to referring to herself as "one", but this would be the first time that she referred to herself as "no one". The truth is, as hon. Members on both sides of the House know if they have been round the doorsteps discussing it, that the public do not believe that they can trust the National Health Service in the hands of the Prime Minister because she takes good care never to trust herself in the hands of the NHS.

The second, and rather more important, question is whether the Secretary of State will sit down during the recess and rewrite the White Paper in the light of the Prime Minister's prediction according to the hon. Member for Harlow (Mr. Hayes). Certainly the White Paper needs urgent revision if she is right. For example, there is the proposal to provide for tax relief on private medical insurance. One can understand why the Secretary of State might be loth to let go of that commitment in the White Paper, because it is the only reference to the health needs of elderly people. Excise that and the White Paper will be absolutely about the needs of an age group who account for almost half of the entire health output of Britain. The Secretary of State must face reality. If no one need go private again, it would surely be cruel to deceive elderly people into paying for what they will not need. However, I note that shares in AMI Healthcare Group, the largest private hospital group, have leapt by a quarter in the month since the White Paper was published. There is not much faith there that no one will ever need to go private again.

Paragraph 9.6 of the White Paper says that general practitioners "will be able to use NHS funds to pay for treatment in the private sector".

What is that doing there if nobody need go private again? Why can NHS funds not be used to pay for NHS treatment in NHS hospitals? Then there is the matter of paragraph 3.6 of the White Paper, which provides that opt-out hospitals may trade for private patients. I hope that the Secretary of State will save us from the humbug that this proposal will bring money into the NHS. Providing for private patients in NHS hospitals takes beds, staff and even blood out of the NHS.

That has already happened. A leaflet that has been distributed by Hillingdon district health authority advertises the authority's fixed price scheme. One can jump the queue in Hillingdon for a fixed price. For £370 one can have what is described as "removal of lumps and bumps". For £3,500, one can have a total hip replacement. On reading that leaflet, I felt a sense of rising outrage that a great public service that once prided itself on treating patients according to need was so reduced to chasing money that it touted its facilities by offering a fast track to those who could pay.

Against that record, no one will ever believe the Secretary of State and the hon. Member for Harlow when they promise that it is their objective to make the public

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