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Mr. Hugh Bayley (City of York): Where is the evidence?

Mr. Letwin: The hon. Gentleman asks where the evidence is. We have an interesting dialectic here, similar to that which we find in relation to the European Union. First, we get an unimportant little measure about which we are told not to worry. Secondly, there is an accusation that it may lead to greater things. Third comes the riposte, "Where is the evidence?" Then, it comes true and we are told, "Goodness me, you must have noticed that at the beginning." I fear that what I am describing is a logic, and logic is powerful. Even in this Government, it captures people.

Ms Drown: I might accept that this could be the start of a huge, fantastical operation by the Government if the Bill proposed new charges, but it does not. The charges have been in place since 1930. Given that and the fact the hon. Gentleman's Government in 1988 discussed the matter and reinforced the charges, he is on very weak ground.

Mr. Letwin: That is the brilliance--

Mr. Deputy Speaker: Order. This is not an abstract debate but one on the Second Reading of the Road Traffic (NHS Charges) Bill. It would be helpful to hear a little more about that. The hon. Gentleman has travelled rather far from the core of the subject.

Mr. Letwin: I stand corrected and shall swiftly bring my remarks back to the Bill, but the hon. Member for South Swindon (Ms Drown) illustrates the brilliance, power and subtlety of the Secretary of State's mind beautifully. He has chosen a case in which he can argue that he is not even doing what he is doing. By vastly increasing the take in circumstances where he can find an ancient peg, he can argue that the Bill is not a Bill at all but merely a tidying-up. There were moments in his

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speech when I doubted that he was introducing a Bill because he seemed to be talking about an administrative measure that would not have required parliamentary approval.

The Secretary of State is, of course, making a major change. He is introducing legislation; he is occupying the time of the House to go through First Reading, Second Reading and so forth precisely because he is trying to raise a large amount of money. He is doing something that will have an impact in precedent. We may hardly believe it any more, but legislation passed by the House is important in the development of the way in which people think about the subject of the legislation. If legislation is introduced about the NHS that has the effect of raising a large extra sum from insurance, the logic that I describe becomes all too easy to apply.

To move back to the remarks that I was making before I gave way--but very much in the context of the Bill, Mr. Deputy Speaker--I want to argue that the extension of compulsory insurance under the Bill is a major conceptual change in the allocation of NHS payment and funding. Ultimately, every activity carries risk. The mere act of breathing is risky. Compulsory insurance could easily be widened to the point at which it covers all the costs of the NHS. The Secretary of State knows that; his officials know that; his Ministers know that. If and when the Secretary of State begins to build what I suspect he privately intends to build on the basis of this measure, Labour Members will be surprised to find that this little, apparently unimportant Bill was a paving Bill in the most exceptional sense--a conceptual paving Bill.

The Bill is reminiscent of much else that the Government are doing. In many cases, they are slowly beginning to persuade members of their own party to accept vast changes to positions held only by the Conservative party before now by persuading them to accept things that are apparently innocuous. I fear that Labour Members have illustrated beautifully this afternoon exactly the tendency that the Secretary of State hoped that they would illustrate, namely, the tendency not even to notice that there lies within the Bill the seeds of something that they at present do not wish to see grow into a tree.

Mr. Gareth R. Thomas: I have been struggling to follow the logic of the hon. Gentleman's argument. He now says that the Bill is some sort of paving device for new charges. Although he was not a Member of Parliament at the time, I am sure that he supported the Road Traffic Act 1988. Why was that not the paving Bill for wider charges?

Mr. Letwin: I cannot be said to have supported the 1988 Bill because I had no idea that it existed. Had I been a Member of Parliament, I might or might not have supported it. The reason why it is perfectly appropriate that my right hon. and hon. Friends should have tabled a reasoned amendment this afternoon is not that the Bill is in principle objectionable, but that the explanation that has been given of it and the logic that has been advanced as lying behind it are wholly beside the point. The truth has not been brought out. It is the role of the Opposition to oppose that which they need to oppose and to bring out the real character of measures.

I believe that the real purpose of the debate this afternoon is precisely to illustrate to the public that the Bill has far wider implications than has been admitted to

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them and that the Bill has been defended on a basis that is not open or honest with them. It falls to the Government to admit what lies behind the Bill. Then perhaps in later stages, Labour Members may have their own doubts about the wisdom of this measure, even if Opposition Members have, as my right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe) said, some sympathy with the principle.

6.24 pm

Ms Julia Drown (South Swindon): In following the hon. Member for West Dorset (Mr. Letwin), it might be helpful if I bring the House back to reality. Although his speech was interesting, and perhaps it used up some useful time of the House, it has not been useful in making progress on the Bill.

I am disappointed that the Opposition do not support the Bill, but perhaps it serves as a useful example of the difference in priorities between the political parties. While the Labour Government believe that the NHS should get the funds to which it is entitled, the Conservative party seems more concerned about letting insurance companies off the charges that they have been set up to cover. Other Opposition Members seem more concerned to discuss the philosophical purities of differing charging regimes.

The hon. Member for Southwark, North and Bermondsey (Mr. Hughes), who is not in his place, suggested that £100 million was not a lot out of the £40 billion that the NHS needs every year. I suggest that £100 million can make an awful lot of difference to the NHS. If the hon. Gentleman does not want that money for his constituency, I can guarantee him that my constituents could well use the money for their health services.

Dr. Evan Harris (Oxford, West and Abingdon): The hon. Lady must accept either that a significant amount would be saved which could replace money raised from income tax for the NHS or that too little would be raised to re-establish the principle--I take the point that the Bill re-establishes something that has already been legislated for--that patients should pay towards their care. In our reasoned amendment, however, the Liberal Democrats propose as a fairer way of funding the NHS in general than through patient charges.

Ms Drown: I do not accept that. I see the charges as money to which the NHS is entitled and has been entitled since 1930, when the legislation was first introduced. The NHS has not been collecting all that money, but the Government are setting up the proper administrative arrangements to ensure that the money goes to where it is needed in the NHS.

I am pleased to be able to speak on the Bill because I am one of the few people in the House who has personal experience of managing the existing system under which the NHS can reclaim from insurance companies some of the costs of treating people who have been injured in road traffic accidents. My brief experience was instructive and I remember it well. Two things stand out in my memory and both of them lead me to welcome the Bill.

First, I remember how inappropriate it seemed to visit the accident and emergency department as an administrator, trying to establish which of our patients were there as a result of a road traffic accident and which had been injured in other ways in order to set up the appropriate paperwork

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for road traffic accident victims. The other hospital staff were rightly concentrating on giving their patients the best clinical care that they could; neither patients nor staff wanted to be disturbed at that time by what they saw, reasonably in my view, as intrusive bureaucracy. The existing system for reclaiming the treatment costs of road accident victims makes such intrusion inevitable by putting the onus on the hospital to establish not only which of their patients have been injured in road accidents but a series of details about the accident.

The principle that the NHS should be able to reclaim some of the costs of providing medical treatment to people injured in road accidents is well established. The Road Traffic Act 1930 introduced the charges, which have been levied since 1934. Motorists are covered by their insurance for those costs yet those charges are little understood by motorists or even Members of Parliament. Motorists are compulsorily insured, and that creates a distinction between the charges set up in 1930 and other possible charges that have been mentioned by right hon. and hon. Members.

Of the charges covered by the Bill, the emergency treatment fee--currently £21.30--is the most unpopular as it is payable by the vehicle user in an accident regardless of who is at fault. The Government intend to abolish that charge for hospitals, and I congratulate them on that. Its abolition will be welcomed by the NHS, motorists and insurance companies alike. It makes sense for everyone involved to concentrate on the payments for out-patient and in-patient treatment.

Over the past 50 years, NHS administrative staff have been trying to collect those funds--often in difficult circumstances. Staff collecting those sums have had to deal extremely sensitively with patients. It is only right that the House congratulates them and the administrative and other staff who have managed a difficult administrative system in a professional and sensitive manner. The Government's proposals would shift the onus of collecting payments from NHS hospitals to insurance companies. In doing so, those difficult situations can be avoided and more money spent on what is important--NHS care.

My second abiding memory of running the existing system is of how complicated and bureaucratic it is. I remember the forms, the checks and the chasing letters--they were almost charming in their detail. I also remember the filing cabinets and the frustration of chasing bills, in some cases for relatively small sums. The only thing missing from the overall Dickensian impression was a quill pen. I applaud the Government's determination to find a way to reclaim some of the cost of treating road accident victims that cuts the mass of paperwork in hospitals.

The difficulty of operating the current system has led many hospitals to reclaim less of the cost of treating such victims than they were entitled to under existing legislation. That inevitably means that there is less NHS money available to treat patients. The sensible way forward, of abolishing the emergency treatment fee for hospitals and properly recovering the money due for patient treatment, will let the NHS see the wood for the trees, and contrasts starkly with the actions of the previous Government, who merely introduced measures to increase

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the piles of paper in the NHS. I welcome the Labour Government's steps to make additional money available to the NHS and to reduce paperwork.

I have three questions about the implementation of the proposed schemes which I hope will be considered during the Bill's passage. First, there is the question of transitional arrangements. On 2 July last year, my right hon. Friend the Chancellor of the Exchequer announced that steps would be taken to recover the money due to hospitals in respect of the treatment of people injured in road accidents. I understand that the new system will cover treatment given to road accident victims from that date, but if the Bill is passed, it will still be some time before guidance can be issued to hospitals and insurance companies setting out the precise details of the new system. If the Bill becomes law, I hope that the Government will make careful arrangements for cases arising between 2 July 1997 and the time when the new guidelines are issued. There will be scope for confusion and double counting in respect of such cases, so care will be needed to ensure that confusion is minimised. Some hospitals will have already billed for road accident treatment since 2 July 1997, whereas others will not. Clear guidelines are needed on who is to claim what money, from whom and when it should be claimed.

My second question relates to the nature of the records that hospitals will be expected to keep under the new system. Although I welcome the Government's aim of cutting down NHS bureaucracy by requiring insurance companies to initiate and follow through payments to hospitals, it is important that steps be taken to ensure that the new system succeeds in reducing bureaucracy. I presume that insurance companies will not simply be left to get on with the job of administering the system without checks. There will have to be incentives to ensure that the companies comply with their new duties and make all the payments they should. However, if the operation of the new system requires hospitals to keep detailed records of which of their patients have been injured in road accidents and the exact cost of their treatment, there is a risk that the new system will simply replicate the troublesome and time-consuming bureaucracy of the existing system.


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