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Column 275Government produce more statutory instruments each year than the last Labour Government did. They now produce them at the rate of 2, 500 a year.
Such is the Government's predilection for subordinate legislation that, during the past 18 months, they have produced 23 subordinate instruments containing Henry VIII clauses, which empower a Minister to change private legislation. In some of those cases, there was no further reference to the House because they did not have to be debated under the affirmative procedure ; nor were they subject to the negative procedure and a prayer, unlike the one that we are dealing with tonight.
The result of all that is that the House does not have adequate time to deal with statutory instruments. Today, we have been rushed ; I have had to distribute copies of the memorandum and the instrument to those of my hon. Friends who were interested. That is not good enough. The Select Committee is not being allowed to carry out its functions.
Last week, there was no copy in the Vote Office of the report of the debate upstairs on another statutory instrument--a substitute for a debate on the Floor of the House, due to lack of time. On that occasion, we were debating a statutory instrument which the Committee reported on the same day and which was placed in the Vote Office in the same hasty way as happened today. Such achievements are possible only because of the Committee Clerks' great devotion to duty, making that extra effort for the benefit of the House. Nevertheless, the procedure is still unsatisfactory.
Moreover, we did not have the verbatim report of the Committee's proceedings from Hansard, because Hansard itself is over-burdened with the Government's legislation. The way in which the Government machinery is spewing out Bills of one sort or another and a massive number of statutory instruments is becoming quite oppressive. Let me comment briefly on the merits of the instruments. I do so not as Chairman of the Committee, because the Committee does not deal with the merits of an instrument--only with its technicalities--but I am sure that the Committee would share my concern about the pressure on it to deal with instruments and to carry out our duties to Parliament. If the Government reduced the number of statutory instruments that they are producing and honoured their pledge of 1979 to reduce the legislative burden, they would be doing us all a favour.
The Government are producing this legislation hastily, to mount a partial attack on the NHS. No matter how much the Government proclaim their devotion to the NHS, the privatisation of services, the opting-out scheme for NHS hospitals, the indicative drug budgets being imposed on doctors, and these statutory instruments giving tax concessions to people who are already benefiting from the private sector are all part of a general erosion of the NHS. The Government show a strong mistrust of the medical profession, which is not shared by the population at large.
The Government are not prepared to confront the NHS, because they know that it is far too popular. People see it as part of their freedom--a freedom from fear. That was the title of a book writen by Aneurin Bevan, following his experiences. A person's life is enriched if he has no fear
Column 276of doctors or hospital bills. The Government know that the NHS is deeply etched into the lives of the British people, who are determined to defend it.
In 1948, the consultants threatened strike action against the development of the NHS, but now the consultants, doctors, nurses, porters and the people at large are organising to defend the NHS. That is what the ambulance men and women are doing. They are defending the service by seeking to maintain their standards of payment and training.
The statutory instruments are part of that general attack on the NHS. Even a Conservative Member has criticised this tax relief. This is a politically willed tax relief and has nothing to do with equity, justice or fairness. It is simply part of the Government's attempt to erode the NHS but, like all the other attacks on the NHS, it will fail.
Mrs. Gwyneth Dunwoody (Crewe and Nantwich) : Often, there is a kind of logic behind the Treasury's gifts to a reluctant nation. It is not that the Treasury wants to give presents that bear a strong resemblance to Miss Haversham's wedding cake--more a case of the political objectives that they can help to achieve.
The Treasury knows very well that the tax concession before the House will make no difference to the elderly people using the National Health Service. However, it knows too that an increasing number of people who have paid premiums for private health care, or who had those premiums paid for them, discover as they grow elderly and start to suffer from routine conditions that if they can continue to receive cover at all, it will be at a much increased premium. That is the case not only in respect of private scheme members suffering from perfectly straightforward conditions, but in relation to exclusions. We all know of people who contributed to private health care schemes all their working lives. When they retire or, even worse, contract a chronic illness, they may discover that they are no longer welcomed by private insurers--who regard their schemes as offering protection only for as long as the benefit is on their side.
Because the Treasury understood the political import of that situation, it had to do something to encourage the public at least to maintain their existing payments to private health care schemes. I know of many people who paid into schemes almost from the first day they started work, only to discover that when they began to develop the early symptoms of a major carcinoma, for example, their insurers started making it clear that they would not continue to receive payment for treatment. As that becomes public knowledge, increasing numbers of the elderly, on reaching a point in their lives when they must consider a reduced standard of living in managing on a pension, will decide that one thing that will not benefit them is private health care.
Politically, that situation is extremely damaging for the Government, because even after squeezing the Health Service quite brutally, as they have done over the past 10 years, they still need large numbers of people to contribute to private health schemes, if only because they are part of the political ethos that the Government want to promote. People who suddenly cease to pay premiums when they reach 60 are a political embarrassment--particularly as they are mainly those who have always supported the
Column 277Conservative party and who will express their views on the difficulties that they have encountered in no uncertain terms. The Treasury has come along with a scheme that is not intended to help the NHS. That is its last purpose. Nor is it intended to provide better cover for those who have contributed to private schemes and who are now elderly--because many schemes automatically exclude such members if they develop a major illness. Instead, the regulation is designed to make a political point--to keep up the numbers of those paying for private health care.
That is being done not because the private sector offers the best way of delivering health care, because we know that it is one of the worst and most expensive. It is being done because the Conservative Government want to make a political point, which they will be unable to make if the public cease to contribute to private health care. The Minister can hardly believe that it is in anyone's interest to make such tax relief available unless it is meant as a useful political gesture. It may be exactly that, but that is all that it is. The average voter will not be taken in. Not even the average Conservative voter who has contributed to private health care for many years will be taken in. Certainly the scheme will do nothing to shift the burden of expense, because the elderly require more health care, and they need it delivered to them by the most direct and efficient route possible. The scheme is designed to maintain the miasma, the impression, the image that somehow, if one contributes to private health care schemes, one will get better treatment in the long run. That is not a fact.
If this is meant to be a tiny thin edge of a devastating wedge, the Minister has made a mistake, as has the Conservative party, for it is largely Conservative voters who have always had the firm belief that contributing to private medicine produces better care. That is manifestly not the case, and in many instances it contributes to worse care.
We have not yet reached the point where, for example, in Marseilles, private doctors are killing one another to take control of private clinics. Who knows, such an ethos may develop here if people get into the cut-throat business of providing private care solely on the basis of profit. We have not yet reached that stage, but what the Government are proposing is designed to convince people that private care is better than the NHS. Frankly, I do not think that the electorate are that stupid.
Mr. Lilley : Opposition Members have made a number of attacks, some detailed and some general, against the regulations. The hon. Member for Berwick-upon-Tweed (Mr. Beith) said, reasonably, that it was possible to oppose tax reliefs of this kind without being opposed to private medicine. I agree, and I was simply saying that Her Majesty's loyal Opposition, rather than the Liberal party--or the SLD--were opposed to it on that ground.
I recognise that the fiscal purists believe in the absence of all reliefs and therefore oppose the relief that we are discussing. I am not sure that the hon. Member for Berwick-upon-Tweed falls into that category. He favours some tax reliefs for certain things of which he approves but not for other things, of which he thinks we approve more. That is why I gather he is against this relief.
Column 278My hon. Friend the Member for Beaconsfield (Mr. Smith) is, and can proudly claim to be, a fiscal purist. His position is consistent and reasonable. I have always been more inclined to believe that, though one should do away with reliefs wherever they are unnecessary and very expensive, there is scope for closely targeted reliefs, and the one before us falls into that category, which is why we accepted it. It also brings the benefits on the public expenditure side that I spelt out.
The hon. Member for Berwick-upon-Tweed also said that these instruments sent out the wrong signals, would somehow demoralise people and would lead them to believe that at some unspecified date at the end of this century or the beginning of the next something terrible would happen to the NHS. That is so much rubbish and bunkum. No such message is drawn from other tax reliefs that exist in the system, and he knows as well as I do that the vast majority of people, including all Conservative Members, are wholly committed to improving the NHS, the national well-being and the national health generally.
The hon. Gentleman suggested that the logic of the system implied that we should limit the relief to those with existing schemes. We are keen and anxious that more people should, if they so desire, take out private medical insurance and thereby relieve the pressure on waiting lists, as I spelt out.
The hon. Gentleman asked, paradoxically, why we excluded alternative medicine from the scheme. He is against the scheme, but he wants to extend it more widely than the facilities available on the NHS. If the NHS does not think that a particular type of treatment is appropriate to be financed from the public purse, it would seem odd that it should be encouraged by this tax relief. It certainly would not, by definition, if we extended the relief in that way, have the effect of relieving any pressure on the NHS as the NHS does not carry out such operations.
The hon. Gentleman mentioned the misprints at the bottom of the principal note in the schedule, for which I apologise unreservedly. My hon. Friend the Member for Beaconsfield said that he hoped that the Inland Revenue had "crawled over" the measure to ensure that it was as tightly drawn as possible, and I assure him that it was while doing just that that the Revenue discovered the mistakes. Although it is regrettable that they appeared in the first place, I am glad that they were discovered and that their existence was made known to the House.
Mr. Cryer : The Department has said that it will introduce changes at the earliest opportunity and issue a schedule identifying the errors. Will that be issued to recipients of the instrument free of charge?
Mr. Lilley : I will find out and let the hon. Gentleman know, but I do not think that this is the most expensive piece of paper available--or, indeed, that it is likely to go to people who are unable to afford a second copy.
I hope that it will not embarrass the hon. Member for Bradford, South (Mr. Cryer) if, for the second time in recent debates, I pay tribute to him and the Select Committee on Statutory Instruments for their work in general and for their work in this regard particularly. He has sought elucidation, and, if it is appropriate, I shall make it available directly to him or to the Committee. He asked whether the correction to the misprints would be issued free. A correction slip will be issued free. I hope that that satisfies him.
Column 279The hon. Gentleman suggested that the prayer was being debated too soon. I understand that his Committee's timetable is involved, but the statutory instruments came into force three weeks ago, and it was appropriate to debate them as soon as possible. This was the first opportunity that was compatible with an early debate and with the Committee's being able to go through them.
The hon. Gentleman went on--in his private, or political, rather than his Committee capacity--to suggest that the measure represented an attack on the National Health Service, foreshadowing the remarks of the hon. Member for Crewe and Nantwich (Mrs. Dunwoody). There is a degree of paranoia among Opposition Members about private medicine and the National Health Service, but it is perfectly possible for the two to exist side by side to the benefit of each. That is the aim of all the measures that the Government have introduced : there will be no conflict.
We are often invited to compare this country--to its
disadvantage--with countries such as Germany and France, which allegedly spend a higher proportion of their gross domestic product on health. The main difference, however, is the much greater percentage of GDP that those countries spend on private medical care. In the eyes of the Opposition, that apparently does not undermine the national health services of those countries ; nor need a thriving private medical sector undermine this country's National Health Service.
The hon. Member for Bradford, South suggested that the NHS hospital trusts that are proposed as part of our Health Service reforms would in some way undermine the service--that they would be opting out. He knows that that is bunkum. The fact that he has to resort to such allegations suggests that he is trying to feed people's fears rather than that he believes what he is saying.
The hon. Member for Crewe and Nantwich said that the private medical insurance schemes ceased to provide effective cover for patients beyond a certain point, and that this measure was meant to redeem that weakness. In fact, she is almost certainly wrong, at least in many cases. I offer no broad defence of all medical insurance schemes. In one respect she is certainly wrong. I cannot see how, as she suggested, this particular tax relief would resolve the problem that she alleges to exist. On that ground her attempt to find some obscure reason for the introduction of this scheme falls.
Mrs. Dunwoody : When people who have been contributing to private health schemes become elderly many of them suddenly realise that they are not covered for the diseases from which they are suffering. They then cease to contribute because, even if they stayed in the
Column 280schemes, their premiums would go up and their cover down. On the whole, they are not silly enough to continue that arrangement. This tax relief will result in many people continuing to pay into schemes in the belief that, somehow or other, they will get a tiny amount of cover. But the question of real health care will not be taken care of.
"There are no additional exclusions of any kind applied to elderly subscribers Overall somewhere between 96 to 97 per cent. of the hospital and surgical claims that we receive are paid in full."--[ Official Report, House of Lords, 17 January 1990 ; Vol. 514, c. 695.]
I quote those words without endorsement. If the hon. Lady wishes to disagree with the noble Lord and show him that he is wrong, she is entitled to take up the matter in correspondence with him. I conclude by reiterating -- [Interruption.] --to the obvious support and enthusiasm of my hon. Friends, that these two instruments will implement the measure introduced in the last Finance Act, which had the overwhelming support of this House. It will do so in a sensible way, which will limit that relief to the provision of treatments available on the National Health Service, and, in so doing, make life easier for those who are retiring and wish to continue their private medical insurance, and will relieve pressure on the National Health Service.
Question put :--
The House divided : Ayes 128, Noes 168.
Division No. 58] [11.23 pm
Ashdown, Rt Hon Paddy
Barnes, Harry (Derbyshire NE)
Beith, A. J.
Bennett, A. F. (D'nt'n & R'dish)
Bray, Dr Jeremy
Brown, Gordon (D'mline E)
Brown, Nicholas (Newcastle E)
Brown, Ron (Edinburgh Leith)
Campbell, Menzies (Fife NE)
Campbell-Savours, D. N.
Carlile, Alex (Mont'g)
Clark, Dr David (S Shields)
Clarke, Tom (Monklands W)
Clwyd, Mrs Ann
Cook, Robin (Livingston)
Davis, Terry (B'ham Hodge H'l)
Duffy, A. E. P.
Dunwoody, Hon Mrs Gwyneth
Fields, Terry (L'pool B G'n)
Gilbert, Rt Hon Dr John
Golding, Mrs Llin
Griffiths, Nigel (Edinburgh S)
Griffiths, Win (Bridgend)
Harman, Ms Harriet
Home Robertson, John
Howarth, George (Knowsley N)
Hughes, John (Coventry NE)
Hughes, Simon (Southwark)
Jones, Martyn (Clwyd S W)