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Dr. Harris: Perhaps the hon. Gentleman will offer more legal advice.
Mr. Dismore: It is all very well hearing about such situations in theory, but, in practice, such situations do not occur. A docket is sent in, and it is paid. What is all the fuss about? The BMA may have established a long and complicated procedure, but such situations are dealt with very differently in reality.
Dr. Harris: I question that. I have asked the BMA what action GPs must take to collect the fee. I should prefer to
believe the BMA and former colleagues of mine about the advice given by the BMA than to believe the advice of a solicitor who may or may not be involved in the case. It depends on whether GP practices have a contract with a local firm of solicitors.
On many occasions, I have heard the Secretary of State call for less NHS time and money to be spent on legal fees and more on patient care. The interventions of the hon. Member for Hendon (Mr. Dismore) suggest that he would like that reversed and thinks that every GP should have a contract with a local firm of solicitors to maximise their income. That may be good for solicitors, but it is not good for general practitioners and it certainly is not good for patients, who, directly or indirectly, are on the receiving end of the demands for payment.
The guidance given to doctors under existing legislation suggests that they must approach an accident victim within seven days of an accident to ask for the money. The £21.30 fee has not been raised since the introduction of the provision in 1988, but it is still a significant sum. The measure is highly regressive because it is a charge made to patients. It is offensive to them in principle and because of the time scale.
The GP may well not know who the driver was. It is not the first question that a doctor at the scene of an accident asks and it may not even be the last. The guidance helpfully goes on to explain:
The BMA advice goes on:
Dr. Harris:
If the hon. Gentleman does not mind, I shall let him make his comments when I have finished this point.
The guidance goes on:
Mr. Dismore:
The hon. Gentleman is not reflecting reality. He has had a few pot-shots at lawyers. No lawyer will ever get rich on this fee. In 20 years in practice, I have never known a GP sue a victim to get the money back. It is just an extra line to add to the column of calculations. I have never charged anyone for it and I do not know anyone who has.
Dr. Harris:
That adds to the force of my argument. No one benefits from the regulations. I was being charitable to the Government, who want to retain the charge, by supposing that there might be some group of professionals lobbying for the retention of the system. I do not blame GPs for wanting to retain the income, but they can do that through item-of-service claims from the health authority. If lawyers are not getting rich on it, patients find it offensive, GPs find it hardly worth the trouble and health authorities eventually have to pick up the tab, that is the definition of a bad law. Bad laws are repealed when a suitable legislative opportunity arises and the Minister must accept that this is such an opportunity. I am simply asking the Government to accept new clause 1, either here or in another place.
Mr. Simon Hughes (Southwark, North and Bermondsey):
Can my hon. Friend tell the House what percentage of the total revenue value is collected under present arrangements? Another argument in support of his proposition that a bad law is one that practically nobody uses is the fact that most people do not avail themselves of the legislation.
Dr. Harris:
I thank my hon. Friend for that intervention. Indeed, the hon. Member for Rutland and Melton (Mr. Duncan), who cannot be here today, asked that question in Committee. The Minister replied that he did not know how much money was collected and said that the
If the Government were able to ascertain by means of a simple survey of a random sample the sum of money that was collected by GPs, I expect that they would find that it was precious little. I am sure that health authorities have accounts of how much they dole out under the emergency treatment provision, although the road traffic cases would have to be separated from the rest.
I accept that the information is impossible to obtain, except by means of survey, but all the evidence so far suggests that it is hardly collected. Even if the fee were to raise a substantial sum, the Liberal Democrats would still consider it inappropriate. The fact that it offends patients and is a direct charge on drivers who may be patients for NHS care is sufficient reason for that charge to be abolished, just as the Government propose to abolish the hospital emergency treatment fee.
The Minister said in Committee:
There is no difference between the GP emergency treatment fee and the hospital one. Indeed, hospitals could arrange for solicitors to act on their behalf. I did not notice the hon. Member for Hendon proposing on Second Reading or in Committee that hospitals could employ solicitors. What applies to GPs should also apply to hospitals. As the Minister pointed out, the only difference is that GPs are independent contractors. I accept that, but there is still a provision for those independent contractors to receive the fees to which they are entitled.
Will the Minister consider accepting the new clause? Ultimately its implementation will cost nothing as the fee can be collected by health authorities. The new clause would fulfil what I believe to be the intentions of those who drafted the Bill and avoid offending drivers and patients who are asked to pay directly that small but significant fee to the NHS.
Mr. Philip Hammond (Runnymede and Weybridge):
The Opposition support the new clause, as it is identical to the one tabled in Committee by my hon. Friend the Member for Rutland and Melton (Mr. Duncan), who sadly is unable to be here today. He sends his apologies, as he is attending the funeral of His Grace the Duke of Rutland.
The issue was debated extensively in Committee, but was not voted on owing to some confusion over the interrelationship between new clause 1 and clause 18 of the Bill. I understand that it has now been established that new clause 1 stands alone, and can be considered alone today.
As the hon. Member for Oxford, West and Abingdon (Dr. Harris) said, all parties to the discussion recognise that the emergency treatment fee has caused disproportionate costs to those collecting it and distress to those from whom it is collected. The previous Government made it clear that it was their intention to abolish the emergency treatment fee as soon as a convenient legislative opportunity arose. It was not a burning issue--more of a tidying-up exercise. This Bill is such an opportunity.
The Minister's immediate predecessor--now the Chief Secretary to the Treasury--referred to the charge as a "sick tax" and a "tax on accidents". Fortunately for the right hon. Gentleman, fate intervened to prevent the Committee from hearing his explanation of the retention of what my hon. Friend the Member for Rutland and Melton has described as a "fag-end" of a charge.
The Minister has indicated in Committee that his motivation for retaining the charge is essentially permissive, and that he seeks to leave it to individual GPs to decide whether or not it is worth collecting the charge. That runs the risk of different practices being adopted in different places, and of public confusion being generated. The Minister will agree that concern about different treatment of similar cases is one of the consistent themes of the debate about the NHS.
At £21.30, the charge is probably irrelevant to most GPs, but it is also insulting. Either they are expected to attend accidents as part of their contracted NHS work--and should, as the hon. Member for Oxford, West and Abingdon said, be suitably rewarded by the NHS for that work--or, if that work is viewed as independent and outside the NHS GP contract, they should be able to levy a charge that reflects the real contribution that they make at the incident. We should bear it in mind that, for the most part, the patients are not the GP's own patients but passing strangers, and that the GP has happened to be the first person available at the scene.
The Minister and the House may recall a case that was widely reported in the press a few months ago, in which a doctor on an American Airlines flight rendered life-saving assistance to another passenger, and sent the airline a bill for £240 which the airline refused to pay. The doctor, in a much-publicised case, sued the airline in London for payment of his bill. The public attitude at the time was that the airline's compensation to the doctor--a bottle of champagne, which probably had about the value of the £21.30 charge that we are talking about--was wholly inappropriate and insulting in the circumstances of a life-saving intervention. It was widely thought to be a mean recompense for the work that he had done.
The Minister has presented the retention of the emergency treatment fee as an opportunity for GPs--as essentially a permissive measure, allowing GPs to charge the fee. However, is it not in fact essentially restrictive in its operation? Does not the emergency treatment fee define the amount that a GP--a private contractor--is able to charge for attending a road accident, and set that amount at an artificially low level?
"When a practitioner experiences difficulty in ascertaining the name and address of the person who was using the vehicle, s/he should make application to the appropriate chief constable."
That is astonishing advice to give busy front-line staff. It continues:
"In these circumstances this official is required by the Act to supply the practitioner with any information at his/her disposal as to the identification marks of any motor vehicle which the practitioner alleges to be a vehicle out of the use of which the bodily injury arose, and as to the identity and address of the person who was using it at that time."
That is overly bureaucratic. It is a waste of time and energy for the front-line staff in the health service. Chief constables and their officers have better things to do than to chase £21.30 fees across counties, across police authorities and across the country to reimburse GPs for roadside advice given. I believe that in their heart of hearts, the Minister and the other Labour Member present--Labour Members, I should say, because I see the Whip as well--know that it is nonsense. It would be easier and more logical for them to accept the new clause. We should be happy to support them if they did. I hope to hear specific reasons from the Minister why that cannot be done.
"The fees payable under the Act are recoverable by court proceedings as if they were a simple contract debt due from the person who was using the vehicle to the practitioner rendering service."
That may be why lawyers are so interested in the retention of the measure. If no money comes forward, there is more work for solicitors.
"However, in the event of a doctor being unable to obtain this fee, s/he may claim an ordinary 'Emergency Treatment Fee' from the relevant health authority (as covered by paragraph 33.8 of the Statement of fees and allowances)."
That means that after the general practitioner has gone through all those hoops without making progress and all that time and money has been wasted, there is provision to claim an ordinary fee for treatment from the health authority, just as a GP would for a patient who was not on his list but needed urgent and necessary treatment. Surely the Government can accept the new clause and recognise that the usual way to provide for such a fee is for doctors to be able to claim it back from the health authority without going through such hoops.
1.30 pm
"information . . . is not collected centrally"
and acknowledged that that was a familiar refrain. Many of us consider it to be a euphemism for saying that the information is not collected deliberately.
"we are removing the right of NHS hospitals to collect the emergency treatment fee. It is right that we do that because it is a nightmare to collect. Front-line NHS staff are involved in recovering charges, which is not appropriate; the fee is set at a level that calls into question its worth; and we sympathise with the plight of some drivers who are faced with a bill for treatment."
--[Official Report, Standing Committee B, 12 January 1999; c. 65-6.]
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