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Dr. Peter Brand: There is some confusion about emergency treatment and fees for road accidents. There is a perfectly respectable way in which to pay GPs for providing emergency treatment to people other than their own patients. Most GPs accept that they have an
obligation to patients on their own list and on the lists of their partnership. The national health service is there to provide all necessary treatment.
When the need arises for a doctor to give emergency help to someone else's patients, the GP can, under every circumstance except that of a road traffic accident, make a perfectly proper claim to the NHS through his or her health authority. We urge the Minister to remove the limitation on emergency treatment--
Mr. Deputy Speaker (Mr. Michael J. Martin):
Order. The hon. Gentleman is making a speech rather than an intervention.
Dr. Harris:
I understood my hon. Friend's point although it was curtailed. If he feels that I did not, I should be happy to hear him make a speech.
At present, the retention of the provision allowing general practitioners to claim a fee directly from the patient makes a difference only to those patients already on the relevant GP's list. If the patient is not on the GP's list, the general trend is to claim an emergency treatment fee from the health authority. The law forces the GP to make an extra claim only on those patients who have a relationship with that doctor. Nothing is so calculated to damage the doctor-patient relationship as people on a GP's list being asked by their doctor for an additional treatment fee for treatment outside the surgery in a car crash.
The Minister has not said how many doctors have written, of their own volition, to say that they want to retain the option to reclaim the fee. The question should be whether doctors want to retain the fee from the patient, not the health authority. Will the Minister quantify the representations that he has had, and, if possible, will he place them in the Library before the Bill goes to the other place?
It is the Government's duty to ask questions of the profession. The key question is whether GPs think it appropriate to have the power to collect the money directly from the patient.
The Liberal Democrats believe that progress can be made on health service provision even in the face of opposition from doctors. The Minister put a most un-Bevanite concept to the House when he said that if an unquantified number of doctors object to the way in which they are paid, no legislative progress can be made. We Liberal Democrats do not accept that concept. As the hon. Member for Runnymede and Weybridge (Mr. Hammond) hinted, this Government have a tradition of caving in to general practitioner vested interests, for example, on the composition of primary care groups and a number of other issues.
If the question were put in the way that I suggested, I do not believe that the medical profession would object or, even if it did, that the Government should not legislate. After all, hospitals were not consulted on whether their emergency treatment fees should be abolished and they are so strapped for cash that I am sure that they would want to claim that extra income if they thought it worth while.
I shall hone down my questions for the Minister. How many responses to the consultation were received? Will he place them in the Library, so that we can see
them? Will he ask the question correctly before the Bill ends its progress in another place? Does he agree that, regardless of the view of the medical profession, if the policy is deemed to be right and in the patient's interests, he should follow it?
Finally, what is the view of patients? That question remains unanswered, I suspect because it was not asked. It is a simple matter for the Minister to ask the Patients Association whether patients should be liable to pay a general practitioner for NHS treatment within seven days in an emergency situation.
I regret that the Minister's reply did not satisfy me. He placed the burden of legislation on the Liberal Democrats, which we would be more than willing to accept if the Government were prepared to ask us for legislative ideas outside the House. The Government are capable of undertaking those consultations, finding the answers and considering the principle of the charging mechanism. I urge the Minister to come back with more encouraging comments.
Mr. Simon Hughes:
We want to bring this matter to an early conclusion. I hoped that the Minister would respond positively to my hon. Friend the Member for Oxford, West and Abingdon. I shall add one point and, if we still receive no response from the Minister, I think both the Conservatives and the Liberal Democrats will have to press the matter, because we should have had a concession.
The Minister is new to his post, but he gave some of the weakest arguments in defence of the Government's position that I have ever heard during debates on health service legislation. He does not have the figures and he did not say that the change would bring in a large amount of revenue for the health service. Nor did he say that it would be in the patients' interests. All he said was that the provision gives an option, which virtually no one uses, to collect some money, which is probably not very much. That is no way to run the health service. If we were talking about the Government forgoing billions of pounds, I could understand it, but we are not.
My hon. Friend the Member for Isle of Wight (Dr. Brand), who has regular experience of these matters, pointed out how general practitioners in the health service reclaim fees for work that they do that is over and above work for their patients and their practice. In a rationed, streamlined and intelligent health service for the next century, what on earth is the argument for having one system to reclaim money for all sorts of activities, and a different system--which most GPs do not want to use because they consider it embarrassing and unethical--to reclaim money for one small category of people for one sort of work that GPs do? There is no logic to such a system. If we are trying to reduce the burden of bureaucracy on my hon. Friend the Member for Isle of Wight, his wife and other practitioners in the health service, for heaven's sake let us have one system, which will allow one piece of paperwork whereby one collects money in one way at one time and reduces the charges to the rest of the system.
Unless the Minister gives the House some comfort, we will not only force the new clause to a vote now, but we will be obliged to oppose the Bill on Third Reading because the Government's position has no logic. Also, we will ask our colleagues in the other place, where the
Government do not yet have a majority, to ensure that common sense prevails. If we cannot get common sense from Ministers in this House perhaps, before the consistutional changes up the Corridor, there will have to be another Government defeat in the Lords, in the interests of the patients of the British national health service.
Dr. Harris:
I should like to sum up because there are now more Labour Members in the Chamber than before. I wish to make it clear to the Government that it is because of their motives and words that we shall press the new clause to a Division. As the Minister said in Committee, the money is a nightmare to collect. Front-line staff are involved in recovering charges. If Government policy is dictated by what is acceptable to GPs, today's announcement by the General Medical Services Committee on the Government's outrageous rationing decisions will give the Government serious pause for thought. On that note, I commend new clause 1 to the House.
Question put, That the clause be read a Second time:--
The House divided: Ayes 28, Noes 208.
Tellers for the Ayes:
Tellers for the Noes:
Question accordingly negatived.
Dr. Harris:
I beg to move, That the clause be read a Second time.
AYES
Allan, Richard
Beith, Rt Hon A J
Bell, Martin (Tatton)
Brake, Tom
Brand, Dr Peter
Bruce, Malcolm (Gordon)
Burnett, John
Chidgey, David
Cotter, Brian
Foster, Don (Bath)
George, Andrew (St Ives)
Hancock, Mike
Harris, Dr Evan
Heath, David (Somerton & Frome)
Hughes, Simon (Southwark N)
Kennedy, Charles (Ross Skye)
Kirkwood, Archy
Livsey, Richard
Llwyd, Elfyn
Moore, Michael
Morgan, Alasdair (Galloway)
Öpik, Lembit
Rendel, David
Russell, Bob (Colchester)
Sanders, Adrian
Stunell, Andrew
Tyler, Paul
Willis, Phil
Sir Robert Smith and
Mr. Colin Breed.
NOES
Ainsworth, Robert (Cov'try NE)
Allen, Graham
Anderson, Janet (Rossendale)
Ashton, Joe
Austin, John
Barnes, Harry
Bayley, Hugh
Beckett, Rt Hon Mrs Margaret
Begg, Miss Anne
Benn, Rt Hon Tony
Berry, Roger
Best, Harold
Blizzard, Bob
Borrow, David
Bradley, Keith (Withington)
Bradley, Peter (The Wrekin)
Bradshaw, Ben
Brown, Russell (Dumfries)
Buck, Ms Karen
Butler, Mrs Christine
Campbell, Mrs Anne (C'bridge)
Campbell, Ronnie (Blyth V)
Caplin, Ivor
Caton, Martin
Cawsey, Ian
Chapman, Ben (Wirral S)
Chaytor, David
Chisholm, Malcolm
Clapham, Michael
Clark, Dr Lynda
(Edinburgh Pentlands)
Clarke, Tony (Northampton S)
Clelland, David
Coaker, Vernon
Coffey, Ms Ann
Coleman, Iain
Colman, Tony
Connarty, Michael
Cook, Frank (Stockton N)
Cooper, Yvette
Corbyn, Jeremy
Corston, Ms Jean
Cox, Tom
Cranston, Ross
Cryer, Mrs Ann (Keighley)
Cryer, John (Hornchurch)
Cummings, John
Cunningham, Jim (Cov'try S)
Davies, Rt Hon Denzil (Llanelli)
Davies, Geraint (Croydon C)
Davis, Terry (B'ham Hodge H)
Dean, Mrs Janet
Dismore, Andrew
Doran, Frank
Dowd, Jim
Drew, David
Eagle, Angela (Wallasey)
Eagle, Maria (L'pool Garston)
Efford, Clive
Ellman, Mrs Louise
Etherington, Bill
Fisher, Mark
Fitzpatrick, Jim
Flynn, Paul
Follett, Barbara
Foster, Michael Jabez (Hastings)
Foulkes, George
Fyfe, Maria
Galloway, George
Gardiner, Barry
Gerrard, Neil
Godman, Dr Norman A
Goggins, Paul
Gordon, Mrs Eileen
Griffiths, Jane (Reading E)
Griffiths, Nigel (Edinburgh S)
Grocott, Bruce
Grogan, John
Gunnell, John
Hall, Patrick (Bedford)
Hanson, David
Heal, Mrs Sylvia
Healey, John
Henderson, Ivan (Harwich)
Heppell, John
Hill, Keith
Hinchliffe, David
Hoey, Kate
Home Robertson, John
Hughes, Ms Beverley (Stretford)
Hughes, Kevin (Doncaster N)
Hurst, Alan
Hutton, John
Iddon, Dr Brian
Jackson, Helen (Hillsborough)
Jenkins, Brian
Jones, Helen (Warrington N)
Jones, Ms Jenny
(Wolverh'ton SW)
Jones, Martyn (Clwyd S)
Keeble, Ms Sally
Kelly, Ms Ruth
Kennedy, Jane (Wavertree)
Kilfoyle, Peter
King, Andy (Rugby & Kenilworth)
Kingham, Ms Tess
Ladyman, Dr Stephen
Laxton, Bob
Lepper, David
Leslie, Christopher
Lewis, Ivan (Bury S)
Linton, Martin
Lloyd, Tony (Manchester C)
Lock, David
Love, Andrew
McAllion, John
McAvoy, Thomas
McCabe, Steve
Macdonald, Calum
McDonnell, John
McGuire, Mrs Anne
McIsaac, Shona
McNulty, Tony
McWalter, Tony
Mahon, Mrs Alice
Mallaber, Judy
Mandelson, Rt Hon Peter
Marek, Dr John
Marsden, Paul (Shrewsbury)
Marshall, David (Shettleston)
Marshall, Jim (Leicester S)
Martlew, Eric
Merron, Gillian
Michie, Bill (Shef'ld Heeley)
Milburn, Alan
Miller, Andrew
Mitchell, Austin
Moran, Ms Margaret
Morgan, Ms Julie (Cardiff N)
Mullin, Chris
Murphy, Denis (Wansbeck)
Naysmith, Dr Doug
Norris, Dan
O'Brien, Bill (Normanton)
O'Hara, Eddie
Organ, Mrs Diana
Osborne, Ms Sandra
Palmer, Dr Nick
Pearson, Ian
Perham, Ms Linda
Pickthall, Colin
Pike, Peter L
Plaskitt, James
Pollard, Kerry
Pond, Chris
Pope, Greg
Pound, Stephen
Prentice, Ms Bridget (Lewisham E)
Prentice, Gordon (Pendle)
Prosser, Gwyn
Quin, Ms Joyce
Quinn, Lawrie
Radice, Giles
Rammell, Bill
Rapson, Syd
Reed, Andrew (Loughborough)
Rooker, Jeff
Ross, Ernie (Dundee W)
Ruane, Chris
Russell, Ms Christine (Chester)
Ryan, Ms Joan
Salter, Martin
Savidge, Malcolm
Sawford, Phil
Sedgemore, Brian
Shaw, Jonathan
Sheldon, Rt Hon Robert
Shipley, Ms Debra
Simpson, Alan (Nottingham S)
Skinner, Dennis
Smith, Rt Hon Andrew (Oxford E)
Smith, Angela (Basildon)
Smith, Miss Geraldine
(Morecambe & Lunesdale)
Smith, John (Glamorgan)
Soley, Clive
Southworth, Ms Helen
Starkey, Dr Phyllis
Steinberg, Gerry
Stewart, David (Inverness E)
Strang, Rt Hon Dr Gavin
Stringer, Graham
Stuart, Ms Gisela
Sutcliffe, Gerry
Taylor, Rt Hon Mrs Ann
(Dewsbury)
Taylor, David (NW Leics)
Thomas, Gareth R (Harrow W)
Timms, Stephen
Tipping, Paddy
Todd, Mark
Touhig, Don
Turner, Dr George (NW Norfolk)
Twigg, Stephen (Enfield)
Vis, Dr Rudi
Wareing, Robert N
White, Brian
Whitehead, Dr Alan
Williams, Rt Hon Alan
(Swansea W)
Wood, Mike
Woolas, Phil
Worthington, Tony
Mr. Mike Hall and
Mr. Clive Betts.
'It shall be the duty of any person liable to pay a charge to the Secretary of State under section 1 to submit by 30th June in each year following the passing of this Act a report to each House of Parliament, stating in respect of the preceding calendar year--
(a) the total of any such payments made to the Secretary of State, and
(b) the effect, if any, of making those payments on the cost to that person's customers of purchasing motor insurance.'.--[Dr. Harris.]
Brought up, and read the First time.
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