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5.30 pm
Mr. Hammond: My hon. Friend is absolutely right, but the issue is not simply the higher level of expenditure in general, but the availability in one area of a drug or treatment that is not available in another area. We have all heard stories of people selling up and moving house to get into a local health authority area where, for example, beta interferon is available. That could well happen across the border.
Mr. Brady: I absolutely agree with my hon. Friend. I would go further and say that not only is a clear incentive created for people to move house or register with a different GP--they might go to considerable lengths to benefit from treatment that they would otherwise be denied--but, giving due credit to health authorities and boards for their wit and intelligence in seeking to serve the interests of their population, it may be entirely appropriate for them to take into account their privileged status under new clause 18.
As designated health boards or authorities, part of their planning process may be to accept that they are part of a jigsaw that fits with the board or authority on the other side of the border. It would be perfectly possible under new clause 18 for a health authority or board deliberately to refuse a particular treatment in the knowledge that the corresponding board or authority on the other side of the English-Scottish border provided that treatment and that its own residents would not be disadvantaged by the decision.
Indeed, in aggregate, residents may benefit from such decisions because the Bill allows residents to have an a la carte health service in which they can pick a treatment that is available in their local health authority area and turn across the border to Scotland for a treatment that is not available where they live. Treatments such as beta interferon or erythropoetin, which was the treatment in question for the constituent to whom I referred earlier, may be available in one health authority area but not in another. That may become a permanent state of affairs
and may encourage co-ordination, whether formal or informal, in the provision of health services across the English-Scottish border.
Mr. Hammond:
Managed from Brussels.
Mr. Brady:
I am not sure whether my hon. Friend wants me to repeat his remark, but he said that it will be managed from Brussels, which is doubtless in the mind of the Government, although they may now think twice about their headlong rush towards integration, following yesterday's election results.
The result of new clause 18, however, for people who live in the border regions may be beneficial in that their health authority can co-ordinate treatment with the health board on the opposite side of the border. That would increase the number of treatments available to residents in that area, without any increase in total expenditure.
The disadvantage is to those people who live on the Scottish side of the border in the next tier of health board areas, but far more so to those people living in the next tier of health authority areas on the English side of the border because they are multiply disadvantaged by the Bill. They are already disadvantaged by having to pay taxes that disproportionately fund health services in Scotland under the Barnett formula.
Health authorities, with which we all deal, must make choices and decisions in conducting their daily business. They must make difficult decisions on how to divide the resources made available to them--whether the prescription of beta interferon is the best way in which to improve overall health in the area or whether money could be better spent on other treatment. Health authorities adjacent to the border would make fewer such choices under new clause 18.
Mr. Bercow:
I am sorry to agitate and interrupt the eloquence of my hon. Friend's flow, but the scope for the form of administrative table tennis which he has described is perverse in the extreme. On the strength of his listening to Ministers' statements, does he judge that they are guilty of knavery or of folly? In other words, is this a Machiavellian plot or has the Minister, whom we know to be capable of this, stumbled into the mess inadvertently?
Mr. Brady:
I thank my hon. Friend for that elegant intervention. I do not know whether the Minister has stumbled into this or whether his right hon. Friend the Secretary of State, who is perhaps even more capable of stumbling into problems, is responsible for it. My suspicion is that the proposed legislation is simply ill thought out.
The reason why the new clause has been tabled at this point is far from that in the picture painted earlier for my hon. Friend the Member for Lichfield: that there has been a crying need for such a provision for a long time and that it was absolutely necessary that the Government should now deal with something that has been causing difficulty. In fact, there had been no previous difficulty of any significance. Somebody suddenly realised that there might be one and thought that something ought to be drafted that might deal with it, subject to the approval of a suitable Order in Council by not only both Houses of
the Westminster Parliament but the Scottish Parliament. Perhaps I am more generous of nature than my hon. Friend the Member for Buckingham; I hesitate to attribute unkind motives to the Minister or suggest that he is making a foolish mistake.
The new clause appears to have been given minimal thought or consideration. It has been tabled on Report, instead of in Committee, where we might have had a much better opportunity to debate its implications. Had it appeared in the Bill in the first place, perhaps some of the very serious complications surrounding it could have been addressed earlier.
I suspect that there is no deliberate intention to deceive, although it may be convenient for the Government--if possible--to blur the inequities that arise from devolution, which are most obvious to those who live adjacent to the border. Those living nearer the border can see such inequities and problems in sharp contrast, whether in taxation, health care provision or other public services. Although I am far from convinced that the Government have made a deliberate attempt to blur such distinctions, my hon. Friend the Member for Buckingham was right to suggest that there is a possibility of knavery--and we should consider that.
Regardless of Ministers' motivation in tabling the new clause, this is an ill-judged piece of legislation. As has happened so many times in the relatively brief time that we have suffered the new Government's control of policy, legislation is being introduced which, as my hon. Friend the Member for Lichfield said, gives the Secretary of State very broad powers to introduce more detailed provisions without the facility for debate and amendment that there would have been, had they been included in the Bill.
That is unfortunate for Members of the House who, rightly, wish to debate these matters properly and in detail. Moreover, if the Labour Government are going to start paying attention to the concerns that the public plainly have about them, as demonstrated in the recent European election, they should address people's concern that the Government still behave in a way that sometimes consciously stifles debate. They are also concerned that, at other times, as in this instance, an over-reliance on delegated powers denies the Government the opportunity--they should start to understand that it is an opportunity--to enjoy the benefit of scrutiny in the House before they embody detailed matters in law.
If a tenth of the concerns that I and my hon. Friends have expressed about the new clause were to prove well-founded, the clause would constitute a bad piece of legislation. Those concerns will come back to haunt the Government, and Ministers will regret not acting on them. If they had had the good sense to put the detail of such material in the Bill, they would have benefited from hearing it debated, and from having the pitfalls highlighted.
Mr. Hammond:
My hon. Friend is making an extremely powerful point. He was not privileged to serve on the Standing Committee that considered the Bill, but he might like to know that the Government tabled a new clause at the end of that Committee's consideration and have been forced to come back today with a substantial number of amendments to it. That demonstrates the truth of my hon. Friend's case.
Mr. Brady:
I thank my hon. Friend. It is ludicrous to table the new clause in its current form yet still to fail
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