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Mr. Hughes: The hon. Gentleman has asked a proper question. We have asked our policy people to examine the implications this year and in future years. The hon. Gentleman is right that abolishing charges means that the money lost must be recouped. If it has to be recouped through taxation, more money must come from taxation somewhere. It may not be taxation for those at the lower end of the income scale. It may be, as my party believes, that taxpayers at the higher end of the income scale should pay more tax. That is a policy that we reaffirmed this year, a policy that is not yet supported by the Government in spite of their historic commitment to redistribution of wealth.

Ms Drown: Will the hon. Gentleman give way?

Mr. Simon Hughes: I will give way one more time.

Ms Drown: Is a possible outcome of the hon. Gentleman's party's review of charges also that it may end up supporting current charges and the method of collection that is being proposed by the Government, or is that being ruled out in his party's review of charges?

Mr. Hughes: No. The hon. Lady asks a perfectly proper question but it is mischievous.

The reality is that if we examine whether we should keep charges or lose them, everything might be considered. I have heard no voices in my party saying that we should introduce additional charges to thehealth service. My presumption is that my party will want to reduce charges rather than increase them. However, in

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theory it is possible that things might go in a different direction. In a democratic, one-person, one-vote party, the members will decide.

Jackie Ballard (Taunton): Not Millbank.

Mr. Hughes: Certainly not Millbank and certainly not through the block votes of anyone because we all come with a block vote of one.

Secondly, we are not faced with a coherent policy for reviewing charges. I would have liked the Secretary of State to make the announcement at the time of the comprehensive spending review. I would have liked him to say, "We have reviewed all the charges and for a reason that I shall now explain there is a reason behind this charge but not any other." No such luck. The charge is before us only because it happens to exist.

It is a rather funny policy. It is rather like a policy that I do not hear espoused regularly from the Government Benches: "We will support the hereditary peers because they happen to exist." The Government's charging policy is being supported only because it happens to exist. That is hardly a principled basis for keeping a policy. It would have been far better to examine all charges and ascertain whether the Government's proposal is supported by logic.

Mr. Oliver Letwin (West Dorset) rose--

Mr. Hughes: I hope that in a moment I shall be able to persuade the House that it is not.

Mr. Letwin: I am tempted by the hon. Gentleman's most recent remarks to ask him whether he will confirm that the Government have rather said that they will be perfectly happy to have hereditary peers, or at any rate 91 of them, because they are there in the House of Lords.

Mr. Hughes rose--

Mr. Deputy Speaker: Order. The hon. Member for West Dorset (Mr. Letwin) is following the track along which he went last night in introducing entirely extraneous matter.

Mr. Hughes: I had not dreamt of being distracted, Mr. Deputy Speaker.

Thirdly, if the Government are considering introducing charges, I flag up the question whether there are some people who use the NHS who perhaps should pay--not those who are United Kingdom residents, not nationals of countries with reciprocal arrangements with the UK and not those who come as asylum seekers and therefore ask to use NHS benefits--such as those who come to this country as income earners who are perfectly well financially endowed. They come here on that basis and yet they are treated under the NHS. There is an issue there. The Government have raised it and the previous Conservative Government raised it. It is one that seems to be outside the debate about whether UK residents should pay taxes, or those to whom we have obligations in this country.

The fourth reason why the Government's approach is problematic has been alluded to by the right hon. Member for Maidstone and The Weald. If we charge people who use their cars through their insurance, it is not a

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progressive tax. The reality is that the poor pay as much as the well off in many senses. For example, those in rural areas have no alternative but to have a car. They have to pay motor insurance and if their premiums increase, they will suffer. That will adversely affect the less well off, if the charge impacts on the insurance payer at all.

Lastly, as the right hon. Member for Maidstone and The Weald said, the proposal is absolutely illogical. It is not logical that we should recover money from someone who receives compensation for being injured in a road accident, regardless of his or her responsibility for the accident, but not from someone who is injured--I shall deal only with transport--in a train, shipping or aircraft accident. Ministers might say, "You do not have to be insured compulsorily to use those forms of transport", but such insurance is required for some of them.

There is, nevertheless, no logic in claiming money from those who have been compensated for a motor accident, but not from those who have been compensated for an accident at work when the employer is obligated to ensure that employees are insured, or from those who are compensated for tripping over a footpath or in a park that the local council is responsible for maintaining and when the authority is obliged to have an insurance policy.

What about climbers, sailors or--as my hon. Friend the Member for Montgomeryshire (Mr. Öpik) will have in mind--hang-gliders who are treated wonderfully by the national health service for injuries caused because of a choice that they have made? Although people make a choice to sail, to climb or to hang-glide, if they are injured, they will not be asked to make a contribution for their treatment. There is therefore absolutely no logic in the Bill, which is simply an ill-logical means, without principle, to gain access to a pocket of money.

Mr. Syms: The hon. Gentleman is perfectly right about aircraft accidents. A few years ago, an aircraft overshot Northolt and went on to the A40, hitting cars. In such a situation, a millionaire in a private jet would not be caught by his insurers, whereas the poor person driving his or her Ford might well be caught.

The Parliamentary Under-Secretary of State for Health (Mr. John Hutton): That is wrong.

Mr. Hughes: Such examples may be wrong. However, debates on such matters should be left for the Committee stage rather than Second Reading. There will be a debate in Committee on the Bill's details, which I do not want to dwell on now. If the Bill is given a Second Reading today, as I think that it just might be, my hon. Friends will test in Committee whether the charging system proposed--if we are to have such a system--is the best one.

If we are to have such a system, the system proposed in the Bill seems to be better than the current one. It seems that flat-rate charges are better than variable ones, and that a common charging system is better than a localised one. Therefore, for as long as we shall use such a system to raise revenue for the health service, I guess that the Bill's provisions will offer the least worst option.

Ultimately, if the charges raise £100 million, it will of course be welcome--but it will hardly make a huge contribution to the health service's £45 billion budget. I only wish that the Government had proposed an overall

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review--on a basis of principle and logic--of health service charges, and not simply plucked a convenient little extra off the shelf.

5.18 pm

Mr. David Hinchliffe (Wakefield): I am very happy to support the measure, which is sensible and tidies up procedures that--as my right hon. Friend the Secretary of State said--have been in the system and operating since the 1930s. The system has had cross-party support, and I think that its historical and political context has been generally understood. Nevertheless, I agree with my hon. Friend the Member for Carlisle (Mr. Martlew) that the public have not fully understood the system.

Like my hon. Friend the Member for Carlisle, I have had constituents raise with me their concern about charges for emergency treatment within what they perceive to be a free national health service. Many constituents are completely unaware of fees, and are shocked when a demand for fee payment is pressed on them. In each of my 11 or 12 years as an hon. Member, I have received two or three letters expressing their concerns about the system, which the Bill will sensibly amend.

I specifically welcome, for reasons that I have already given, the Bill's proposal to remove the emergency treatment fee. I welcome also the proposal on removing from national health service providers the role of collecting money. Like my hon. Friend the Member for Carlisle, I particularly welcome the Bill's proposal on returning funds to the providers who provided the treatment.

The right hon. Member for Maidstone and The Weald (Miss Widdecombe) and the hon. Member for Southwark, North and Bermondsey (Mr. Hughes) asked about extending the principle of charging to other spheres. I do not think that any hon. Member has yet mentioned in the debate the contents of the Law Commission's 1996 consultation paper. It raised the possibility of a reclaiming scheme for other personal injuries for which damages are paid. As I said to my right hon. Friend the Secretary of State last week, in my long lost youth I played a good deal of rugby league and, as a consequence, spent a lot of time in local hospitals receiving treatment. I was well insured above the costs of any loss of time at work resulting from the injuries and made a substantial profit on each claim.

I am not suggesting backdating, but some people have asked about extending the practice to other areas, particularly those for which there is compulsory insurance. That may be tempting for the Treasury, but I urge caution, because such a scheme would depart from some important basic principles governing how our NHS has operated since its introduction in the 1940s. I am worried that extending the principle of recouping insurance payments to other areas could result in a USA-style system, which I have seen, where insurance arrangements are established for each patient before a pulse reading is taken. I am sure that we would all oppose any changes in that direction.

I have listened with great interest to the comments of the Conservatives. I am sorry that the right hon. Member for Maidstone and The Weald has left the Chamber, because I wanted to raise some concerns about what she

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said, particularly the inconsistency between her arguments today and the record of the Conservative Government, who moved health provision ever more towards a USA-style system. If the Tories have a health policy, it is to move increasingly towards private insurance. She has made that clear in debates since the general election.

We should examine how the introduction of market mechanisms by the previous Government and the increased emphasis on paying for elements of health care have led to some of the problems in the national health service that the Government are trying to unravel.

I was interested in the right hon. Lady's attacks on the Government's proposals for motorists. In 1988, I served on the Standing Committee that considered the Health and Medicines Bill, which was all about introducing wider fundraising duties and powers for the national health service as part of a move towards the American-style system that the Conservatives favoured. The Tory reasoned amendment talks about burdens imposed on private motorists and complains that

I should like to hear the views of Opposition Front Benchers on what arose from their Act in 1988. One of the first results was the imposition of car parking charges in hospitals. In a spirit of consistency with their reasoned amendment, do the Conservatives believe that the previous Government were wrong to bring about a system that penalised people using cars when they visited hospitals? Elderly people who travel to see their loved ones in hospital have to pay to park at that hospital.

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