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Mr. Gareth R. Thomas (Harrow, West): I shall speak briefly to support the Bill, and perhaps I can set it in its proper context, as only one small part of a package of measures that will modernise our approach to health. That package clearly includes the £21 billion of extra investment from the comprehensive spending review. It also includes various measures to tackle prescription fraud. It ranges from the reforms of the national health service modernisation Bill to many of our public health measures, such as extra investment in housing and modernisation of local government, through to the Government's work to tackle financial exclusion.

The Bill is not about the introduction of a tax on motorists, and there are no great new issues of principle involved. I remember being in the Chamber when the hon. Member for Rutland and Melton (Mr. Duncan) promised us mature and constructive opposition. The shadow Secretary of State, the right hon. Member for Maidstone and The Weald (Miss Widdecombe), was never so ambitious. I assume that that is why the hon. Member for West Dorset (Mr. Letwin) was allowed to run with the scare story that compulsory health insurance would somehow result from the Bill.

For more than 60 years, hospitals have had the right to recover some of the costs of treating victims of road accidents. Indeed, since the introduction, under the Conservative Government, of the Road Traffic Act 1988, those costs are in theory recoverable from an insurance company. I say that that is the position "in theory", because the system, mirroring the wider Conservative approach to health care in the late 1980s and early 1990s, was highly bureaucratic and overly complex, and created unnecessary administrative burdens. The Bill will simplify and improve the way in which money is collected, so that the NHS gets the money to which it has been entitled for the past 50 years.

The hon. Member for Uxbridge (Mr. Randall) did the debate a service when he highlighted the wide variations in moneys that have been collected by hospitals. That variation is clearly because of the complex bureaucracy that has been so lucidly outlined by my hon. Friend the Member for Hendon (Mr. Dismore) and others. My hon. Friend the Member for Wakefield (Mr. Hinchliffe), in highlighting many of the health charges facilitated by the health reforms introduced by the previous Conservative Government, performed a useful service in signalling the double standards that lie behind the Opposition's amendment.

In contrast to the scare stories of the Liberal Democrats, the Bill will abolish a charge on patient care. It will move the NHS even closer to its founding principle of a service available when needed, where it is needed, with clinical need, not income, the key determinant.

The Bill will abolish the emergency treatment fee which has to be collected by NHS staff from injured motorists. As my hon. Friend the Member for South Swindon (Ms Drown) said, that process causes offence and embarrassment. It is a completely unwelcome distraction from what NHS staff do so well, which is looking after the injured.

Dr. Harris: Does the hon. Gentleman feel that the proposal returns the NHS to a mainly taxation-funded system, even if the increased efficiencies of the scheme

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increase the proportion of NHS revenue that is raised from such charges? Does that return the NHS more to the principles of taxation?

Mr. Thomas: In the sense that the purpose of the Bill is to abolish one of the charges on patient care, it will clearly return to the founding principles that I have outlined.

The emergency treatment fee is highly unfair. It is levied regardless of whether the injured person was responsible for the accident. It is clear that the NHS has not been receiving the moneys to which it has been entitled. We know that only £13.17 million was recouped for the NHS in 1995-96 under existing legislation. According to recent estimates, NHS trusts could have claimed £50 million, £100 million, or--much less likely--anything up to £440 million.

The first beneficiaries of the reforms in the Bill will be the Opposition parties, whose difficulties on health service financing are well documented. It will not solve those difficulties for them, but it will provide some small fig leaves to small parts of the holes in their funding plans. The right hon. Member for Maidstone and The Weald cannot obtain permission from the shadow Chancellor of the Exchequer to welcome the £21 billion of new investment in the NHS, or to offer positive suggestions on how that money should be spent. Apart from some vacuous waffle about more private sector investment, the shadow health team has not suggested where the money will come from for more investment in the health service.

The Liberal Democrats, too, will benefit. They threw out the plans of the hon. Member for Southwark, North and Bermondsey (Mr. Hughes) at their conference, without one vote in favour. Indeed, the party's plans were described as shambolic. It is therefore not surprising that both the Conservatives and the Liberal Democrats have rushed to exaggerate, quoting the highest estimates they can find of the likely income that the Bill will generate.

As the Liberal Democrat approach to finances owes more to Heath Robinson than to accounting guidance, I am certain that, just as with their 1p on income tax, the modest moneys raised through the Bill will be spent many times over in the coming months.

Even £100 million extra would make an important difference to the services that hospitals can supply. Such a sum will provide small additional increases in income over and above the £21 billion that will be invested throughout the health service. That investment was described by the NHS Federation as beyond its wildest dreams. It was described by the Institute of Health Service Management as a


The truth, sadly, is that, such has been the scale of under-investment in patient care by the Conservative party, it would be entirely irresponsible to fail to secure these extra funds, to which hospitals have always been entitled, for the treatment of road traffic accidents.

The Bill is an entirely sensible measure, which is long overdue. It will help to modernise the way in which we collect moneys due to the health service, and I warmly welcome it.

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7.18 pm

Mr. Alan Duncan (Rutland and Melton): We have had a lively and wide-ranging debate. Indeed, it has perhaps been rather more lively than some right hon. and hon. Members expected when they entered the Chamber this afternoon.

Perhaps the Bill and the Road Traffic Act 1988, which goes in harness with it, can best be described as measures that allow the national health service to piggy-back successful claims for compensation so as to recoup some of the health treatment costs from insurance companies. As every Opposition Member has said, including my right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe)--I am happy to reiterate this--we do not challenge that principle. However, we challenge the Government to explain how what they are doing by means of the Bill fits into any policy that they have previously expressed on charging in the NHS. We challenge them also to justify increasing the incidence and burden of costs on motorists, who are already very hard pressed.

The House will have noticed that what the Government are doing was never in the Labour party's manifesto. Labour did not give a clue to the electorate, whose vote they sought, that it would do something like this. It is yet another typical example of Labour saying one thing and doing another.

The Bill comes at a cost to the motorist in the form of a compulsory charge. We have tabled our reasoned, and reasonable, amendment to highlight that cost, and I welcome the Liberal Democrats' decision to join us today in the Lobby.

I listened very carefully to the Secretary of State's speech. He brazenly said that the proposals in the Bill will not cause the imposition of any new charges. Technically, in some respects, he is right. However, the magnitude--[Interruption.] As I told the House and Labour Members, I am nothing in debating these matters if not reasonable and constructive. I should think that even Labour Members will appreciate that the charge's magnitude and incidence will be dramatically increased. The charge will therefore be bigger and more burdensome.

Opposition Members agree with the Government on the proposal to abolish the emergency treatment fee. I do not quite understand why--perhaps the Minister will explain it to the House--general practitioners and hospitals can still collect that fee. I look forward to hearing the Minister's explanation of why they can do so.

The hon. Member for Carlisle (Mr. Martlew) is a very confused man. He said that the case of the German tourists who incurred a £45,000 bill in his constituency was a simple one because the insurance company paid the bill, although he was unable to explain to us the difference between insurance charges--which he was advocating and said were acceptable--and general health insurance. His exact words were that his constituents would feel that insurance charges were "a charge worth paying to support the health service." In a subsequent intervention, he supported charges in principle and criticised proposals to abolish them. Thus, he became the first Labour Back Bencher to support insurance premiums for national health service treatment.

The hon. Member for Southwark, North and Bermondsey (Mr. Hughes) was quite right that the Bill would increase the scale of the current scheme. He also argued that a premiums increase would be a regressive

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tax. He was quite right also to say that the Government think of charges as an easy little pot of resources on which to draw.

The hon. Member for Wakefield (Mr. Hinchliffe) mentioned the Law Commission, and said that it might well recommend extending the scope of the type of scheme proposed in the Bill. He appeared to endorse such an extension. He said that he does not want health insurance. However, in one respect, he will have it--and he is supporting it--in the Bill.


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