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Mr. Randall: Many hospitals, including that in my constituency, have tokens for those who are genuinely visiting the hospital or staying there. We had a problem at Hillingdon hospital with people parking for free and going into town, depriving others of the use of the car park. There is a way of getting around the problem.

Mr. Hinchliffe: That may be the case, but it seems inconsistent that the Opposition have tabled a reasoned amendment and made remarks bashing the motorist when the previous Government--the right hon. Member for Maidstone and The Weald was a Minister at the time--introduced hospital parking charges.

I now turn to another issue which also resulted from the policies of the previous Government. My constituency received national attention when the general managerof Wakefield health authority received from the Conservatives the national prize for innovation for introducing a remarkable scheme under the Health and Medicines Act 1988 which earned the NHS £10 a head--perhaps that is the wrong term. When someone was lying dead in the hospital mortuary awaiting collection by the local undertaker, for a fee of £10 the mortuary attendants would measure the corpse to ensure that the undertaker arrived with the correct-size coffin. That cost was passed on to the bereaved relatives--yet another charge that the right hon. Lady has conveniently forgotten, but one that gained Wakefield something of a reputation shortly after the introduction of the Health and Medicines Act.

The Conservatives also presided over the total privatisation of care of the elderly in private nursing homes and care homes. People ended up paying for services that they had previously received free fromthe NHS. Those charges impacted on the most vulnerable

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people--as do the increasing charges for domiciliary care and the anomalies that persist today as a consequence of those charges.

I welcome the Government's resistance to calls for more charging and their response to the direction that the previous Conservative Administration were taking. I welcome my right hon. Friend's arguments against charging for GP consultations and hotel prices for NHS beds and the steps that he is taking to return the NHS to its basic principles. In particular, I welcome the massive sum of money that he and his colleagues have obtained from the Treasury; it is having an impact in my constituency and throughout the country.

5.27 pm

Mr. John Randall (Uxbridge): In giving the Bill a Second Reading, the House will not be introducing a new principle of NHS funding; rather, the Bill will ensure that the NHS entitlement to recover its costs for treating accident victims, which is already enshrined in law, is achieved more readily.

The NHS is currently entitled to recover the costs of treating the casualties of road traffic accidents. The difficulty has been that, to date, it has not been very successful in doing so. The Bill will attempt to change the position by shifting to insurance companies the responsibility for making payments to the relevant trust or hospital.

According to Department of Health figures produced last July, NHS trusts recovered £13.7 million from insurance companies during the financial year 1995-96. Estimates as to the sums that could have been recovered vary hugely. The Department has estimated that around £50 million could have been claimed, whereas the Automobile Association claims that the figure could be as high as £400 million.

During the financial year 1996-97, 190 trusts out of a total of 429 claimed back absolutely nothing from the insurance industry. To illustrate the diversity of claims being made, during 1996-97 the Leicester Royal infirmary raised £365,000, but Guy's and St. Thomas's Hospital NHS trust raised only £15,000 and Derby City hospital raised absolutely nothing.

It would seem that, in the light of those figures, the NHS could begin to recover fairly large sums of money previously left unclaimed. It would be helpful if the Minister would enlighten the House on the difference between the estimated sums that are not claimed, in order to give the House a realistic idea of the scale of the problem.

One reason for the apparent failure of trusts to reclaim money from the insurance companies is the perception that the current system is bureaucratic and legally complex. A Department of Health circular has advised NHS trusts to consider more carefully how they pursue claims under the Road Traffic Act 1988. Perhaps the Minister will shed some light on how far that misperception has been corrected through more rigorous enforcement of current guidelines. What improvements resulted from the circular?

Under the Bill, the Secretary of State will issue certificates to the insurance companies specifying the NHS charges that are due. The responsibility will be delegated to the Department of Social Security's

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compensation recovery unit. The certification scheme, which is outlined in clauses 2 and 3, is designed to be as similar as possible to current schemes involving the unit and the insurance industry. The aim is to make the new scheme's introduction cheaper and easier, but will the Minister provide us with any Department of Health figures on the estimated costs and say what alternatives have been considered?

The initial response to the Bill has been relatively muted. The two parties that will most obviously be affected--the NHS and the insurance industry--have had different reactions to it. In the NHS, there has been a slightly different emphasis, depending on to whom one speaks. The NHS Confederation has welcomed the Bill as a way for hospitals cost-effectively to recover the money to which they are entitled, whereas the British Medical Association doctor-patient partnership and members of the Royal College of Nursing have expressed concerns about the knock-on effect on NHS funding. There are fears that the Bill will provide a precedent whereby the door is open to fund other areas of health care through insurance schemes for health-damaging life styles--from the heavy drinker to those who indulge in dangerous sports.

It is not clear why the victims of road traffic accidents should be singled out. What about any other injured individual who makes an insurance claim after receiving medical treatment? Why should the victim of a road traffic accident be the focus of recovering moneys from the insurance industry when others are immune? It would be of great interest if the Government would say what view they take on that difficulty and whether they have plans to extend the Bill's principle to funding for other areas of health care. I am sure that, even on road traffic accidents, the Government acknowledge that road users other than car drivers are involved in or even cause accidents. Are there plans, for example, to extend the system to compulsory insurance for cyclists or pedestrians? That is a genuine matter of debate, although I would not particularly welcome any such extension of the scheme.

On the Bill's implications for the insurance industry and the motorist, the Automobile Association has estimated that the increase in premiums for drivers will be higher than the Department of Health has said. The Government have produced a figure of between £6 and £9, whereas the AA has put it at nearer £10 on the average motor policy.

Mr. Dobson: For the record, the Association of British Insurers has estimated that, if the full costs are passed on to motorists, there will be a 2 to 3 per cent. increase--between £6 and £9--in the price of a policy. I assume that the ABI knows more about the matter than the Automobile Association does, as its members will have to pay.

Mr. Randall: I am grateful for the Secretary of State's intervention and his dismissal of the Automobile Association's opinion. In fact, the ABI has cited an amount as great as £20 on motorists' premiums. If there were less of a discrepancy between the estimates, that would help us to make up our minds about the Bill. The motorist will be hard pressed by a range of new charges from the integrated transport policy, in addition to the

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increased costs proposed by the Bill. The motorist does not want further large increases in premiums on top of everything else.

Rebecca Hadley of the AA has said:


In light of the AA's comment on the number of uninsured drivers on the roads, it would be helpful if the Minister would tell us what discussions he has had with the Home Office about reducing the number of uninsured drivers who continue to exploit the situation. If the Bill achieves its aim, dealing with that problem will become more of a priority.

The Bill aims to make the current way of recovering money from insurance companies for traffic accidents easier and more efficient. However, the Government must say in more detail how much money the Bill will save for the NHS. How much will it cost to implement? What guarantees can be given about not extending the principle to other areas of funding? What will be the effects on the ordinary driver? What is proposed for all those on our roads who are driving without insurance?

Principally, I am asking the Government why attacking the motorist once again is their priority. Without answers to those fundamental questions, I am afraid that I cannot support the Bill.


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