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5.15 pm
Mr. John Bercow (Buckingham): I am grateful to my hon. Friend for giving way because he is making a powerful speech. Does he agree that the phenomenon of differential treatment by postcode that he describes has no basis either in logic or in equity? Does he experience in his constituency of Altrincham and Sale, West the same backlash against that injustice that I experience in my Buckingham constituency?
Mr. Brady: I think that I am probably experiencing the same kind of response as my hon. Friend. More often than not, it comes down to the fact that, if there appears to be a danger that adverse publicity will arise from treatment being denied, then treatment is provided, whereas if a person is prepared to suffer in silence, treatment may never be provided. That is a real concern. It is also a concern that relates to waiting list figures, which, of course, are being massaged throughout the whole country. Many health authorities have a miraculous ability to find it in their powers to treat a patient who makes a bit of a fuss about a long delay in receiving treatment. That is nothing short of a scandal; we are beginning to see a different standard of treatment and certainly a different length of waiting time for treatment, depending on the area in which one lives or on whether one is prepared to make a fuss.
Mr. Hammond: Has my hon. Friend observed--as I have--that the most effective way to move oneself up the waiting list is to get one's name mentioned in the Chamber?
Mr. Brady: I am reluctant to be drawn on that point.
Mr. Deputy Speaker: Order. We are again straying a long way from arrangements on the border. Will the hon. Gentleman return to them?
Mr. Brady: That is why I was reluctant to be drawn by the question of my hon. Friend, Mr. Deputy Speaker.
In relation to the specifics of the new clause, we are exacerbating the situation. We are enshrining in law that it will be not merely a matter for health authorities--depending on where they are in the country--to provide different levels and types of treatment at different costs, but that there will also, in effect, be a statutory system allowing individual patients to make choices that exploit the inevitable anomalies in the treatment systems available. A patient might have the choice of registering with one GP practice or another, or might be able to register with an English GP or a Scottish one. A patient
might register with an English GP, but will be aware that Scottish health care facilities may, none the less, be available to him. That is one of the serious question marks over the way in which the new clause was drafted.
The point made by the Minister when he replied to the question put by my hon. Friend the Member for Lichfield relates precisely to the question of which areas the measure applies to. The Minister is right to point out that subsection (5) states:
In my view, the truly relevant distinctions would be geographically defined far more tightly than simply according to the administrative boundaries of health authorities. The Minister must accept that there might be people living in parts of Northumbria, Cumbria and the Scottish border areas who have no need of the provisions set out in the new clause but who may, none the less, derive benefit from them.
Mr. Denham:
The reason that those health authorities and health boards are covered is that they encompass practices in which people are registered on both sides of the border. Therefore, those are the sensible health authorities and boards to draw into the legislation.
Mr. Brady:
The Minister says that that is the reason for the inclusion of those health authority and boards, but the new clause does not limit the application of the procedures and situations set out in it to those people who are registered with practices which have patients on both sides of the border. In short, the Government are creating a potentially serious anomaly.
I am not familiar with the health authority boundaries, but as one who knows that part of the country reasonably well, I would hazard a guess that they encompass large geographical areas. Therefore, the Government are attempting to define in legislation extremely large areas to which the provisions will be applicable, even where there is no real need for those provisions or where the real need could be far more tightly defined, for example, by restricting the application of the provisions to those people who are registered with practices which have patients on both sides of the border. The new clause is badly drafted and it gives the legislation extremely wide scope.
Mr. Bercow:
The Minister's intervention was interesting. Does my hon. Friend agree that, if the Minister is to offer a convincing rebuttal of my hon. Friend's case, it is necessary for him to show that, in the areas concerned, every practice, without exception, has patients registered on both sides of the border? If the Minister does not take this opportunity to rise and say that, my hon. Friend's case will rest.
Mr. Brady:
I do not expect the Minister to leap to his feet, because he knows full well that he cannot demonstrate that that is so, and that is precisely what makes my point.
For the vast majority--probably 99 per cent.--of the residents in the health authority areas which will be affected by the new clause, the provisions are not a necessity. However, the new clause will change the nature of the health care provision that is available to them, and it will do so in a way that distorts the planning and provision of health care in a stretch of land along either side of the border between England and Scotland that is remarkably broad. That part of the country is, in the main, rural, so the health authority and health board areas are relatively large.
The new clause, in effect, blurs the border between England and Scotland for certain purposes. For the administrative basis of health care provision, the border could, in principle, be blurred away from the geographical border to the administrative border of the health authority or health board adjacent to the geographical border. As for the reason why the Government are trying to do that, I can only suggest that it is a conscious attempt to fudge some of the difficult problems raised by the progress toward devolved government in Scotland, for example, the inequities between England and Scotland in tax and spending arrangements that might arise from devolution. It is a cause of great concern. Many people in England and Wales are beginning to question the constitutional balance created by devolution. English voters are becoming increasingly concerned about the Barnett formula and the fact that their taxes will be used disproportionately to fund services in Scotland. The new clause will add to that effect.
For example, the Scottish Parliament might vote to increase taxation--by introducing the tartan tax that was debated at length during consideration of the devolution legislation--in order to provide better health services. However, that tax increase would cease to be acceptable to the Scottish people in the context of the new clause, which would cause those who are not the sole beneficiaries of that expenditure to provide the additional revenue.
The relationship between taxation and the democratic accountability for raising and spending it is ludicrously complicated. The Barnett formula and the existing anomalies in expenditure levels in England and in Scotland have been accepted--if only as a result of the passage of time. However, an additional complication could arise. Scottish electors could be asked to support the decision of the Scottish Parliament to raise taxation for the express purpose of augmenting health provisions on the northern side of the border. However, new clause 18 could lead to Scottish electors being taxed in order to spend more money not just on people south of the border, but on a relatively small and arbitrarily fixed group of them.
It is not appropriate to legislate to create an absurd anomaly. A small number of people may derive a disproportionate benefit for which others have paid and for which their elected politicians are not accountable. That could cause grave concern and a good deal of controversy. Our concerns would be lessened if the Minister would respond to the suggestion by my hon. Friend the Member for Buckingham (Mr. Bercow) and define the areas precisely. If he would come to the Dispatch Box and tell us that the new clause will affect only 50 or 100 people living in the most remote rural
areas of Cumbria, Northumbria and the Scottish Borders, we might be prepared to say that its constitutional abhorrence pales into insignificance.
Mr. Hammond:
Does my hon. Friend agree that, in order to provide such an assurance, the Minister would have to contemplate freezing the lists of GPs in those border areas? Given the relative paucity of choice available to people living in those sparsely populated areas, would my hon. Friend not find that an unacceptable restriction?
Mr. Brady:
I think I probably would--I certainly think that those affected would. Difficulties may arise if the lists are not frozen and this legislation is passed. Rather than registering with local practitioners, people who live outside the areas directly affected that would normally be served by border practices--they could live 20, 30 or 40 miles from the border--might find it advantageous to register with GPs close to the border in order to benefit from higher levels of expenditure. In very rural areas, people's local practice may conceivably be 10 miles south of them.
"'English border area' means the area of any Health Authority adjacent to Scotland,
However, will he tell us why? What makes that a logical assumption for the purposes of the measure?
'Scottish border area' means the area of any Health Board adjacent to England."
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