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Laura Moffatt: Does my hon. Friend agree that, in addition to all the difficulties with collection that she describes, there is a seven-day limit on the time in which a claim can be made, which adds to the bureaucratic nightmare suffered by administrators?

Ms Drown: The system can certainly be described as a nightmare, because of the forms and bureaucracy resulting from existing legislation. That is why I urge the Government to pay close attention to ensuring that any new system results in the NHS receiving the money to which it is entitled and in a genuine reduction in paperwork and hospital administration.

My third point relates to the fact that the Government have rightly stressed the importance of encouraging innovation in the NHS and of making the best use of hospital beds. Care in the home has been emphasised as an alternative to hospital treatment--an alternative that many patients prefer. The Bill allows the NHS to recover from insurance companies the cost of hospital treatment given to people injured in road traffic accidents. In 1930, when the Road Traffic Act was introduced, I suspect that no thought

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was given to alternatives to treating people in hospital and that the emphasis on acute hospital care rather than community care was even stronger than it is now.

Given that motorists are insured for the cost of NHS treatment resulting from road accidents, should not the Bill reflect the modern reality of the NHS and allow the cost of treating road accident injuries to be charged whether treatment takes place at hospital or in the home? If that provision is not made, an incentive will remain for the NHS to treat road traffic accident patients in hospital or at out-patient clinics, instead of allowing them to be treated at home. It is illogical to say that the cost of treatment should be recoverable when that treatment is given in hospital, but not when it is given in the patient's home, for example, by a physiotherapist or district nurse. I urge the Government to examine the possibility of amending the Bill to enable the recovery of the cost of treatment given either in hospital or at home. That would be wholly appropriate given the shifts in the culture surrounding hospital and non-hospital care.

I congratulate the Government on their sensible proposal, which will be welcomed by hospital staff, both clinical and administrative. I hope that the points I have made will be addressed during the Bill's passage.

6.36 pm

Dr. Evan Harris (Oxford, West and Abingdon): Although Liberal Democrat Members found the principle of the Bill quite attractive and were tempted to support it on Second Reading, and various minor parts of it in Committee and at later stages, we have set out our objections to the principles behind the Bill in a reasoned amendment.

We welcome certain of the Bill's provisions, such as the abolition of the emergency treatment charge, which was, and is perceived as being bureaucratic and upsetting to many patients. However, we have serious concerns about some of the principles that the Bill reflects or that it re-establishes from existing legislation, which overcome the advantages contained in those welcome provisions.

Our amendment states our concern that the Bill


with the result that the measure appears to operate in a vacuum. We should be grateful if the Government gave a clear statement of the principles behind the way in which they want to treat co-payment and patient charges. Secondly, the Bill


    "proposes no coherent policy for raising or reforming NHS charges or for making them fair".

We still await detailed clarification of whether the Government believe that current prescription charges, as an example of co-payment, are fair in their operation; whether there are any proposals to make them fairer; and what is the future of those sort of co-payments.

Our third objection is that the Bill


That point has been made by hon. Members on both sides of the House, in particular by the hon. Member for

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Wakefield (Mr. Hinchliffe). Later in my speech, I shall return to the points he made. Our fourth concern is that the Bill


    "contains no mechanism for protecting those on low incomes against increased insurance costs"--

small though those compulsory insurance costs may be. Finally, we are concerned about the fact that the Bill


    "adds to bureaucracy without any sufficient compensatory benefit."

Such compensatory benefit would include clarification of some of the areas I have mentioned.

Our approach must be contrasted with that of the Conservatives. We can see from their reasoned amendment that much of their opposition to the Bill--apart from the Oppositionitis from which they are suffering--relates to their love of the motor car. The Opposition's reference to the motorist in their reasoned amendment might suggest that their love of the motor car is at least as great as, if not greater than, their love of the principles upon which the NHS was founded. I shall take this opportunity to explain our concerns about how the legislation may affect NHS founding principles.

We accept that, although the Bill does not introduce a new principle, it re-establishes an existing one. The Government had the opportunity in this Bill to abolish both the charges that apply to road traffic accident patients, but chose to abolish only one. Therefore, it is impossible for the Government to ignore the fact that they are re-establishing a principle that they had the opportunity to remove.

That principle which they have chosen to retain is that income for the NHS can be raised from patients. My hon. Friend the Member for Southwark, North and Bermondsey (Mr. Hughes) expressed concern about that matter earlier. The Secretary of State admitted that there will be an increase in the cost of motor insurance. Estimates of that increase range from £10--the figure suggested by the Opposition--to a lesser figure favoured by the Government. I am sure that if their own estimates were revised upwards the Government would opt for talking of an increase of £9.99, rather than £10, in the interests of good public relations.

That insurance increment is regressive as it will be compulsory and will generally have no regard for the income of the person seeking to take out car insurance. Everyone will be affected equally. That is not the case with the current main source of revenue for the NHS: income taxation. We believe that the principle of fairness should be upheld in all NHS policy. That is why we are concerned about the perpetual increases in prescription charges and why we went to the election calling for a freeze in those charges prior to a review. The current system has a regressive effect at the margins for those who just fail to qualify for exemption from prescription charges.

We are also concerned about where the process will end. Some hon. Members have tried to make reassuring comments, but we are not convinced. If the charge is restricted to compulsory insurance, it will not apply to injuries incurred during sporting activities where there is no compulsory insurance. My hon. Friend the Member for Southwark, North and Bermondsey asked whether the Government will soon introduce legislation to recover charges arising from employer liability--which is compulsory in many areas--as a result of industrial accidents; or from local authority liability that currently applies to injuries incurred through the negligence of local authorities.

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A further example comes hard on the heels of the interesting and thought-provoking speech by the hon. Member for South Swindon (Ms Drown). If the key issue is that insurance is compulsory, what will happen to those with compulsory buildings or insurance for mortgages? What will prevent the Government from introducing legislation to charge the victims of house fires, through their buildings insurance, for the cost of expensive burns treatment? The Liberal Democrats will not be satisfied until the Government confirm that the measure will stop at this point and not affect other forms of compulsory insurance--whether that be mortgage insurance or car insurance.

Ms Drown: The legislation refers to compulsory insurance for drivers of motor vehicles. Does the hon. Gentleman accept that the charge has been in place since 1930 and has been discussed and agreed at various times since then?

Dr. Harris: I addressed that point earlier in my speech. No one is suggesting that this is a new charge. This legislation presented an opportunity for the Government not only to re-establish those parts of the charges that they are maintaining but to take the alternative view and move away from charging patients directly. That opportunity has been missed.

Mr. Hutton: Will the hon. Gentleman confirm when his party discovered its opposition to this proposal? As I understand it, the Liberal Democrats have supported these measures previously.

Dr. Harris: My party, like the Labour party, has serious long-standing concerns about those charges. Unlike the Labour party, we demonstrated our concern in our manifesto commitment to freeze prescription charges. The Labour party did not presage in its manifesto the introduction of this legislation which will increase the average cost of car insurance. According to the Association of Community Health Councils for England and Wales and other groups, there was little consultation with patient groups about the Bill. The Government will be on shaky ground if they look to their past record both in and outside this place--particularly regarding indications of intent in party manifestos. I am grateful to the Minister for giving me the opportunity to make that point.

Anyone who is concerned about the regressive nature of the proposals, which re-establish the charges, could maintain that there are better cases than car insurance for making claims on insurance companies and making insurance compulsory. For instance, what about injuries incurred in certain sports to which the less well-off do not have easy access? I refer not to the rugby games enjoyed by the children of the hon. Member for Crawley(Laura Moffatt) but to skiing, for example--which I have had neither the funds nor the courage to try for myself. I do not believe that skiing could be described as a sport that is generally enjoyed across the social classes, yet there are significant costs involved with the treatment of skiing injuries. If one were to argue that the present charge is reasonably fair, one could envisage the

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Government's introducing other legislation where my arguments about the regressive nature of the charges apply less.


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