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The Chairman: Order. The hon. Gentleman will realise that the more he dilates, the more he attracts interventions. If he were to return more to the detail of the amendment, the Committee would benefit.

Mr. Bercow: You are always fair, Sir Alan. You are right to castigate me in your gentlemanly fashion, and I shall do exactly as you say. I am very grateful to you for providing me with the protection of the Chair from the needless dilations suggested by right hon. and hon. Members.

Dr. Evan Harris: Will the hon. Gentleman give way?

Mr. Bercow: I shall give way once more, on the explicit understanding that the hon. Gentleman intends to focus his remarks very specifically on the purport and contents of the amendment.

Dr. Harris: The amendment deserves careful scrutiny because it raises important issues. If the increase in national insurance contributions is used to pay for improvements in the health service or extra resources not only for elective surgery, but for primary and emergency care, and given that most people with private health insurance use their insurance to pay for elective surgical care and a few other things, but generally not for primary or emergency care, is it reasonable to say that they are paying twice for emergency and primary care when, in fact, most of them use the NHS for those services? Should not the hon. Gentleman be talking about—not that I support this—a third relief, not a full relief in this measure?

Mr. Bercow: The answer is no. [Interruption.] A couple of my hon. Friends generously observe from sedentary positions that the hon. Gentleman alludes to the third way. I am not sure whether it is the third way, the second way, the first way or the fourth way, but it is a characteristically confusing and muddle-headed Liberal Democrat way, which I do not intend to follow. I want

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specifically to deal with the unfairness—possibly even the incongruity—of employers financing packages that their employees will use while being obliged to pay in full the increase that the Government are demanding to provide for the NHS.

If the hon. Gentleman disagrees with me, he will no doubt have the opportunity to catch your eye, Sir Alan. However, I have a little sheaf of material on such matters through which I should like briefly to canter before proceeding to other amendments. The Committee will be relieved if I resist the temptation to refer to any hon. Member's intervention before those arguments have been reasonably aired.

We are talking about employers providing private medical insurance. It is important to place this debate in the context of subscriber numbers. The Committee will be very familiar—if it is not, it should be—with "Laing's Healthcare Market Review 2001–2002". [Interruption.] As the hon. Member for Ealing, North (Mr. Pound) rightly observes, I am sure that his constituents speak of little else. He will probably be very familiar with paragraph 3.2 on the demand for private medical insurance and, indeed, some of the subsidiary paragraphs. [Interruption.] The hon. Gentleman says that it is the best paragraph. I am not sure about that; it is a copious document that contains many good nuggets, and I would not want to discriminate between them, except inasmuch as time requires me to focus on only a part of the report.

Paragraph 3.2 states:

The significance of that is that, between 1991 and 1999, the growth trend in demand was fairly flat. Subscribers rose by 3.6 per cent. in 2000, following a fall of just under 1 per cent. in 1999. The important point is that the private health insurance market has struggled in relative terms—to some degree, it has struggled absolutely—in relation to individual subscribers.

We have witnessed strong growth in corporate business since 1997. That is relevant in the context of arguing for a modicum of tax relief in the corporate sector. There has been a substantial increase in the quantity of private medical insurance provided by the corporate sector. For example, since 1990—this has happened over a substantial period—the number of company-paid subscribers has grown by an estimated 23 per cent. A number of factors are commonly cited to explain that trend: the underlying strength of corporate economic performance; high employment and low unemployment; and strategic price discounting.

Mr. Stephen Pound (Ealing, North): And the Labour Government.

Mr. Bercow: No, I want to focus in particular on the factor of strategic price discounting, which is important and of which the hon. Gentleman will have a full and impressive grasp. The other factors include the increased concentration of marketing and, indeed, changing employers' attitudes to private medical insurance. We are talking about the use of strategic price discounting—in which I am encouraged to hear that the hon. Gentleman

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has a substantial interest—in the context of an increasingly competitive marketplace. That is what we now see. The review observes:

of which I know that the hon. Gentleman will approve—

6.30 pm

Mr. Francois: My hon. Friend makes the point that growth in private medical insurance has often been because of group schemes, which he is talking about in the context of employers who have participated in such schemes for their employees. It is also interesting that several trade unions, including those that oppose bringing further private capital into the health service, have private medical schemes of which they encourage their members to take advantage. Is that not a curious dilemma from the point of view of some Labour Members?

Mr. Bercow: As so often over the years, my hon. Friend anticipates me. We have known each other as long as I have known the hon. Member for Bassetlaw. I shall not bore the House excessively on this matter, Sir Alan, as you would not allow me to do so, but I have jousted with the hon. Member for Bassetlaw since we joined Lambeth council together in 1986. It is fair to observe, however, in the context of the important point made by my hon. Friend, that he and I have also been jousting against each other—although we now do so together—since 1986, when we competed for the chairmanship of the Federation of Conservative Students. He was always more quick-witted than me at the time, and he clearly remains so now.

My hon. Friend alludes to an important point about the use of private health care by trade unions on behalf of their members and employees. I was tempted to focus for a little longer on "Laing's Healthcare Market Review 2001-2002", but the central point will be clear to the House: a substantial number of companies provide private medical insurance for their employees, and there is merit in the argument that, if they are doing that, they should not also be burdened with the tax hike that the Government wish to foist on them. My hon. Friend gently prods me to remember the importance and perhaps even the curious tension and inconsistency on the part of trade unions in relation to this matter. He has effectively fed me a bone, and he would be disappointed if I did not choose to chew on it. We know that trade unionists who are publicly critical of private health care have benefited from health care themselves or led unions that offer forms of private health care insurance. That is the point that he keenly picked up. In the context of the advocacy of relief for employers spending money on these matters, it is notable.

The Conservative party agrees with the Government that more money needs to be spent on health, but we disagree with their view that the NHS is the only

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mechanism by which to deliver that health care. That is why we have looked around Europe at alternative social insurance schemes.

John Mann rose

Mr. Bercow: I shall not give way to the hon. Gentleman just yet, Sir Alan, as I have had an instalment from him. It was stimulating, and I should like to store him up. It would be unfair to squander him at this relatively early stage, so if he can be patient I shall return to him in due course.

We have looked around Europe at alternative social insurance schemes and the work of a range of for-profit, not-for-profit and voluntary health care providers. In that context, it is interesting to focus, as I shall in a moment, on the attitude of trade unions to this important subject.

Mr. Weir: I was under the impression that most of these schemes also had an employee contribution. Nothing in the amendments affects employees who contribute to these schemes; only employers' contributions are involved. Is that deliberate or an oversight? Can the hon. Gentleman explain why he has gone down this route?

Mr. Bercow: The hon. Gentleman makes an interesting point. As he will be aware, the bulk of the cost of the schemes in question is borne by the employer providing those schemes for the employee. The relief was therefore intended to be targeted on the employer providing the scheme and footing the bulk of the bill. If the hon. Gentleman is asking whether it is a fair point and factually correct that the employee bears some costs as well, the answer is yes. Our amendments, however, are focused on assistance in terms of national insurance contribution relief on the employer.

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