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Mr. Hutton: We discussed this aspect of the Bill extensively in Committee. Most of the arguments that we have heard today were substantially rehearsed then. I made it clear in Committee that I had some sympathy
with the arguments but, for the reasons that I gave then, and which I will briefly rehearse again today, I will invite the House to reject the new clause if the hon. Member for Oxford, West and Abingdon (Dr. Harris) forces a Division.
I must correct one or two misunderstandings that have arisen today. The hon. Member for Oxford, West and Abingdon implied that the emergency treatment fee was last increased in 1988; that is not the case--I am sure that it was merely a slip on his part--as it was last increased in 1995 by the previous Government. The hon. Member for Runnymede and Weybridge (Mr. Hammond) said that they intended to abolish it--unfortunately, they never got round to doing it, although they had 18 years in which to have a fist at it--but I understand that, far from the position being as the hon. Gentleman said, Ministers in the previous Administration decided ultimately not to abolish it. That might be food for thought for the hon. Gentleman when he considers whether his hon. Friends should support the new clause.
I want to re-emphasise the fact that we have received no representations at all from the medical profession asking us to remove the right to claim the emergency treatment fee. The failure of the hon. Member for Oxford, West and Abingdon to tell the House the result of his consultation with the medical profession was conspicuous. I asked him whether it had expressed a view to him about whether the emergency treatment fee should be abolished. I understand its position to be that it wants the right to claim the fee to be retained in the legislation.
As a general principle of how we legislate, I am not sure that it is a terribly good idea to introduce changes at this stage of a Bill's progress without consulting the relevant people--in this case, the medical profession--in the way that the hon. Member for Oxford, West and Abingdon implied that he had.
Dr. Harris:
I made it clear at the beginning of my speech that we were seeking to abolish not the right of general practitioners to claim the fee but the provision whereby they have to approach the patient, whether directly or through a solicitor. That is crucial. The general practitioners to whom I spoke--at least one of whom is present in the House--would welcome the opportunity to claim the fee through the health authority, in the normal way, and not directly from the patient.
Mr. Hutton:
I will come to that point in a minute, but we should be quite clear that the hon. Gentleman and his supporters, without having first sought the views of the medical profession, are proposing to remove from general practitioners the right to claim the fee. As I understand it, the profession's views are clear: it wants to retain the option to claim an emergency treatment fee. He is proposing a change in the law that does not command the support of the medical profession, to whose views he has turned only very late in the day. That is not a scientific or appropriate way in which to progress the argument.
Mr. Hammond:
The Minister appears to be allowing the medical profession to dictate the legislative agenda. I will be very interested to see whether that deference continues when we consider the NHS Bill later in the Session.
Mr. Hutton:
The hon. Gentleman is perhaps reading more into my remarks than he should. I am saying that
Mr. Simon Hughes:
The Minister is trying to use an answer that is not the substantive answer as a defence to the proposition made by my hon. Friend the Member for Oxford, West and Abingdon (Dr. Harris). My hon. Friend's case has two elements, the most important of which is that it is inappropriate for somebody to seek the fee from the victim at the roadside, or later through solicitors. What would be the Minister's view if the proposition were simply that a different method of collecting the money for the service were used? For example, the health authority could be asked for payment rather than the person affected directly.
Mr. Hutton:
As the hon. Gentleman is aware, that is a possible option. It was raised by the hon. Member for Oxford, West and Abingdon and I shall try to deal with the points that he raised in a minute. We have considered the issue carefully and the Department has received approaches from various representative bodies. We know that general practitioners continue to want the right to collect the fee as independent contractors, if they consider collection worthwhile in terms of effort and the effect on those from whom the fee is claimed. We are not minded to remove a right that has belonged to GPs since 1934.
It was suggested in Committee that if collecting the emergency treatment fee were a problem for hospitals, that must also be true for GPs and independent doctors. We have checked that point. We also received no representations from independent doctors on the emergency treatment fee, other than ones wishing to see it remain. Indeed, some representations suggested that it should be increased. We have not received any representations from the profession asking us to abolish the right to claim the emergency treatment fee.
Dr. Peter Brand (Isle of Wight):
Can the Minister say how many independent contractors have made those representations? I am not surprised that we have not seen massive numbers of GPs calling for the abolition of the charge, because most GPs do not claim it or even carry the paperwork to claim it. It is against the ethos of most people working in primary care in the health service.
Mr. Hutton:
I wish to correct one misunderstanding held by the hon. Gentleman. The right to collect the emergency treatment fee is not limited to GPs in the national health service but is, in theory, available to any legally qualified medical practitioner, whether he has a contract with the national health service or not. I said earlier that I had some sympathy with the arguments made by the Liberal Democrats, but the profession has not made representations to the Government for such a change.
Mr. Simon Hughes:
Answer the question.
Mr. Hutton:
I have answered the question. I have repeatedly made it clear to the House that no
The hon. Member for Oxford, West and Abingdon also raised the issue of the impact of the change on the national health service's budget. Although we are able to recover the loss of income in the hospital sector through the new tariff, if the emergency treatment fee were scrapped for GPs, health authorities would have to meet the costs in every case. There is no method to recoup the lost income in that situation. The new clause would impose an additional, unquantifiable financial burden on the national health service, and the Liberal Democrats have not told us where the additional resources to pay for that would come from. I have some sympathy with the argument of the hon. Member for Oxford, West and Abingdon, but for the reasons that I have advanced, today and in Committee, I shall urge my hon. Friends to reject the new clause.
Dr. Harris:
That answer is wholly unsatisfactory for a series of reasons, and I have to press the Minister further. Although these points were discussed in Committee, the extra information that the Minister has given has been much less satisfactory than that given in Committee.
It is not the job of an Opposition party to consult on legislative opportunities. If we were to be given some civil service time, we could do a poll within a few days, and certainly well before the Bill completes its proceedings here and in the other place. Our question would not be the Minister's, which is, "Do general practitioners want to retain the right to receive income for this item of service?" We would ask, "Do GPs wish to retain the right to receive income from individual patients rather than claiming it back from the health authority?"
Sir Robert Smith (West Aberdeenshire and Kincardine):
Ministers confuse the situation further by saying that they want to keep the option. They may not want to use the option, but they want to keep it. Out-patients lying in the street will not know as a general practitioner approaches whether or not that GP plans to use the option. There will be random charges on people depending on who is their GP.
Dr. Harris:
That is an important point. In the last part of what the Minister said, he stated that switching the claim from patient to health authority would increase costs on health authorities. If he says that that cost would be unquantifiable, he must accept that there is currently an unquantifiable direct cost on patients. The difference between the situation that he envisages and the current situation is that patients pay the difference. The unquantifiable cost is put directly on patients.
1.45 pm
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