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Dr. Evan Harris (Oxford, West and Abingdon): I welcome much of what the Secretary of State has to say, but will he accept a sixth invitation to agree with the statement that he was wrong to describe community care as failing outright? That gives major concern to people who work in the area. May I invite him to agree that community care may have failed in a few areas for a few patients, but that generally when it has failed, it is because it has never been tried, as it has always been inadequately funded?

Does the Secretary of State accept that in Oxfordshire, with a mental health trust that is effectively in receivership, and with experience of the failures in the tragic Raus and Darren Carr cases, we would be concerned to learn that the extra money allocated to

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mental health will not compensate for the real-terms cut in funding that Oxfordshire social services received in the standard spending assessment announced last week?

Does the Secretary of State finally accept that rationing--the "R" word that dare not speak its name from the Government Front Bench--has applied in mental health, the Cinderella specialty, not only in the use or lack of use of new anti-psychotics, but in the provision of beds for the mentally ill near where their families live, and not miles away? Many of my constituents have had to go to Wales to visit their loved ones. Does he accept that rationing exists and that his funding could at least reduce the amount of rationing that occurs in this specialty?

Mr. Dobson: One or two people seem to think that a system that has led to an unacceptable number of homicides and suicides has been a success, but I am afraid that that is not my interpretation. I think that the system of care in the community failed as a totality, because it failed in the most difficult circumstances. One cannot claim success for an arrangement that fails in a crisis. I fully accept that it delivered for a substantial number of people--

Miss Widdecombe: Ah.

Mr. Dobson: The right hon. Lady reacts as though I had never said that before, but I said it in the statement. No doubt she was preparing at the time to jump up and announce that the system had been a success. The people who have committed suicide or killed others are not the only failures. All over the country there are vulnerable people who have not been properly looked after, and that cannot be regarded as a success.

We have just announced that we are putting an extra £700 million into mental health care, on top of the £3 billion already being spent. That is a big step forward, and it is disproportionately greater than the increase in spending on other aspects of health care. We are moving in the right direction. We may not be moving as fast as the hon. Member for Oxford, West and Abingdon (Dr. Harris) would like, but then again, we have to find the money, and he does not.

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Tabling Questions

4.23 pm

Mr. James Gray (North Wiltshire): On a point of order, Madam Speaker. You will be aware that, since the amalgamation of the Department of the Environment and the Department of Transport after the general election, it has been the custom for Back Benchers to table oral questions on the environment and on transport separately. Were you aware that, as of today, that practice has been stopped and Back Benchers now have to choose between the environment and transport? Was that decision yours, or was it the Government's; if the latter, would you agree that it is another example of the Government's reluctance to face up to proper scrutiny from Back Benchers?

Madam Speaker: I am grateful to the hon. Gentleman for giving me an indication of his point of order in advance. He is of course right to say that questions will no longer be divided between environment and the regions on the one hand and transport on the other. As a result, hon. Members may submit only one oral question instead of two, as was the practice earlier. The question rota is issued on the instructions of the Government. In the normal course of events, changes are discussed through the usual channels. If the hon. Gentleman wants to pursue the issue, may I suggest that he pursues it through the usual channels?

Mr. Gray: Further to that point of order, Madam Speaker. I have checked with the usual channels, and it has not been discussed in that way so far.

Madam Speaker: That is not my business. The usual channels are the usual channels. My business is the Speaker's business.

Mr. Simon Hughes (Southwark, North and Bermondsey): Further to that point of order, Madam Speaker. The news of the change has only just filtered through. The information process does not seem to have worked. Will you inquire why hon. Members were not notified of the change? Until today, there were two opportunities for tabling questions to be answered in a fortnight. No notice or circular has been issued. Hon. Members have gone into the Table Office expecting to be able to table two questions--

Madam Speaker: Order. There has been no indication to hon. Members about the change, but of course it is clear on the Order of Questions, which is available to all hon. Members. All one needs to do is to look at the Order of Questions, and there it is.

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Orders of the Day

Road Traffic (NHS Charges) Bill

Order for Second Reading read.

Madam Speaker: I have selected the amendment in the name of the Leader of the Opposition.

4.26 pm

The Secretary of State for Health (Mr. Frank Dobson): I beg to move, That the Bill be now read a Second time.

The Bill does not introduce any new charges. It simply makes it easier for hospitals to collect from insurance companies charges that they have been entitled to collect for nearly 70 years. The present arrangements simply do not work, so the health service is losing a great deal of money. Nobody really knows how much. Estimates range from about £50 million a year to £500 million. Whatever the figure is, it is clear that, if the charges were collected properly, national health service hospitals would be a lot better off.

Under the present law, there are two charges. One is an emergency treatment fee of £21.30, which is supposed to be collected directly from any driver who needs immediate treatment from a doctor after a road accident. The other charge is supposed to be levied on insurers when a motor accident victim makes a successful claim for compensation. At present, this charge can be up to £295 for out-patient treatment and up to £2,949 for in-patient treatment.

Those charges do not work. They combine minimal income with maximum inconvenience. Last year, they raised just £16 million. To collect the emergency treatment fee, NHS staff must ask injured motorists for the money in the immediate aftermath of an accident. That causes maximum offence to the motorists, who may be in shock or pain. They sometimes get the impression that it is a charge for the use of an NHS ambulance. It is not.

Asking for the money is a rotten task for the staff who are supposed to do it. It is a diversion from their real job of looking after patients. In many cases, the emergency treatment fee is literally more trouble than it is worth.

Such problems are not confined to the emergency treatment fee. Motorists and other victims may be pressed while in accident and emergency, or even in a hospital bed, to say whether they are going to make a claim against somebody who caused the accident. Alternatively, they may be sent a letter out of the blue to ask them the same question.

The problems of collecting the charges do not end there. Hospitals sometimes send out letters to motorists to demand payment of one or both charges. That is because it is up to each hospital to track down the organisation responsible for paying the compensation. Each hospital must calculate the costs of the individual treatment provided to each motor accident victim, separating in-patient treatment costs from out-patient treatment costs. Each hospital then has to track the progress of each compensation claim.

The average motor accident injury claim takes two years to process, and many take much longer. The hospital must bill the insurer, and then chase them up and make sure that the debt has been paid. The motorist can get dragged into the process at various stages.

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Faced with such protracted and laborious arrangements, most hospitals do not get much income from the charges. Some employ collection agencies, but they have to pay them for their service, which reduces the takings for the hospitals.

We have decided to end that shambles, and to help to make sure both that hospitals can collect the money to which they are entitled and that charges reflect the true cost of the treatment involved. For a start, we have decided to abolish the right of NHS hospitals to levy the emergency treatment fee. General practitioners who attend road accident victims will still be able to levy the fee if they choose to do so.

Having decided that the main charge should be collected properly in future, we considered very carefully how best to go about it. We consulted widely not just within the NHS but with the Association of British Insurers and some individual insurers. We also kept the Law Commission and the Law Society informed of developments. I am most grateful to them all for their advice and help. All concerned with the present scheme wanted a simpler, clearer, quicker and less costly system, and that is what we intend to deliver.


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