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Earl Howe: I am grateful to the Minister. Did I correctly hear him say that in respect of a part day no charge would be levied?

Lord Hunt of Kings Heath: The regulations will make clear that the daily rate charged applies from the date of admission, increasing with every midnight stay.

Earl Howe: Again, I am grateful to the Minister. I understand the need for simplicity in such a scheme; the fewer complications that are introduced the better. I have less experience of the NHS than the Minister, but I should have thought that it was a simple enough matter for the staff on a ward to record the time of admission and discharge. I believe that it is done as a matter of routine practice in any event. I am grateful to the Minister for his full explanation and I shall reflect upon what he has said. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

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Earl Howe moved Amendment No. 14:

Page 3, line 31, after ("out") insert ("in").

The noble Earl said: I shall speak also to Amendment No. 15. I hope that the Minister will be minded to accept Amendment No. 14 because it seeks to put right what appears to be an infelicity of syntax in Clause 3(2).

As regards Amendment No. 15, the wording on the Marshalled List is designed to highlight my unease at the thought of regulations being brought forward which do not specify in terms the prescribed charges. As the clause is drafted, it would appear that regulations might simply set out a formula which could be open to misunderstanding or interpretation and whose full implications might not be obvious to the House when the regulations are made. I should be grateful for the Minister's comments on that.

I should also be grateful if he would confirm precisely what level of charge the Government have in mind for both in-patient and out-patient treatment. On Second Reading, he mentioned a ceiling of £10,000 for in-patient charges and he has repeated that today. Can he confirm the figures he gave on Second Reading and say how often the Government intend to review the tariff? We are told that the charges will be based on the actual cost of treatment in the NHS. Will the Minister confirm that the way in which the costs are assessed will be a matter of public record?

When I learnt basic accountancy, I was taught that there is no such thing as "the cost" of anything; it all depends what you build into your formula. You may build in direct costs only; or direct costs and some overheads; or all overheads, depreciation and some head-office costs; or all overheads, including the cost of capital. But then if you decide to charge out the costs of a particular activity--in this case, the treatment of road accident victims--you have to work out what proportion of your cost base this activity represents in an average year. In arriving at a sensible daily charge there is a lot of scope for subjective judgment. However you take account of part days of treatment, do you fix the charge at a level which is designed to over-recover charges if part days are treated as whole days, or do you aim as far as possible not to recover costs in any way and, if so, how? I should be grateful if the Minister would say a little more about the methodology of underpinning the charges.

Finally, what account has been taken in calculating the cost of attendance and treatment by ambulance staff at the scene of an accident and of subsequent transport to hospital? Are those costs to be included in the charge for in and out-patient treatment? I beg to move.

Lord Hunt of Kings Heath: I am grateful to the noble Earl for so clearly describing the purpose of the amendments. First, the method of calculation has been published in the regulatory appraisal. We have no reason to suppose that future calculations will not be in the public domain.

The noble Earl suggested that there was an error of syntax. However, I believe that as drafted the clause is clear. Changes can be set out by regulation or determined in accordance with them. At this stage, we are not minded to change that.

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In relation to the substantive matter which the noble Earl raised, if we accept that we are to have a system of NHS recovery, we have to decide how to go about that recovery. The Bill provides the mechanism; how it is done. It contains the outline or framework of a simple, centralised system. The flexibility to adjust or develop the system is contained in regulations. One of those flexibilities is to have a system whereby a tariff can be used for charges with a simple formula to produce costs in each individual case. The costs in each case are not found in the tariff, but are derived from it. The amendment appears to remove that flexibility and, taken at face value, could be read to mean that the actual costs for every possible permutation should be laid down in regulations.

It is important to emphasise that we are pledged to review the system when it has been in operation for about six months. That will be the time to judge how our tariff structure is working. The noble Earl's amendment would result in less flexibility. Should change to the tariff be desirable after a period of operation, these amendments would have removed the flexibility which we have built into the system to deal with such problems.

The noble Earl asked detailed questions about how the figures were arrived at. That falls to be debated in Amendment No. 16 and perhaps I may comment more fully then. However, as regards the tariff structure and charges, I can confirm that for in-patients the figure is £435 a day, with a maximum of £10,000, and for out-patients it is £354 flat rate fee. On that basis, I invite the noble Earl to withdraw the amendment.

Earl Howe: I am grateful to the Minister and understand the point about flexibility. I do not mind how the regulations appear, so long as everything is crystal clear when we debate them. It should be clear to everyone what the charges will be and we should not have to work them out by some labyrinthine process.

I am a little disappointed at the Minister's response to Amendment No. 14. It seems to me that the phrasing could be improved in a minor way. Clause 3(2) states:

    "The amount or amounts to be specified are to be those set out, or determined in accordance with, regulations".
If one takes out the phrase between the commas, the subsection reads:

    "The amount or amounts to be specified are those to be set out ... regulations".
I merely suggest that one should insert the words "in". Does the Minister agree that it is better to have legislation which contains sentences that he and I would rather use?

Lord Hunt of Kings Heath: I am sure that one would always desire to see legislation that is as clear as possible. Nonetheless, what is meant is clear by the wording as presently in the Bill.

5 p.m.

Earl Howe: I do not agree. It is not clear. Of course, one can understand that this is a kind of pidgin English which is being used in the Bill, but that is not

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appropriate for a piece of legislation which is going on to the statute book. I do not wish to press the point too much and I do not know whether any other Members of the Committee wish to join in the debate. The noble Lord, Lord Mishcon, may wish to contribute.

Lord Mishcon: These are extremely interesting and technical debates on amendments. I do not know whether he will appreciate my support, but I definitely support the noble Earl in his application of English to this Bill. If those commas were not there, I could just see the point of the Minister saying that it is quite clear that the words "set out" are in regulations, but there are commas there quite unnecessarily. It is always dangerous to punctuate in a Bill. The noble Earl is absolutely right that as it now reads the word "in" is missing and it should be included.

I do not suppose that anyone regards this as one of the most weighty points to be made in Committee on the Bill, but as a lover of the English language, I must support the noble Earl.

Lord Monson: I wholeheartedly support the noble Earl, Lord Howe, and the noble Lord, Lord Mishcon. It may not be one of the most weighty matters but it is important that we get the wording right.

Earl Howe: I am grateful to both noble Lords who have intervened. In withdrawing this amendment, I invite the Minister to have another look at the matter between now and Report stage. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment No. 15 not moved.]

Lord Clement-Jones moved Amendment No. 16:

Page 3, line 32, at end insert--
("( ) Where the amount or amounts specified in regulations made in accordance with subsection (2) consist of a daily rate for in-patient treatment, such daily rate shall not exceed the average daily cost of NHS in-patient treatment for motor accident casualties from time to time specified.").

The noble Lord said: The Minister has used the word "flexibility" a good deal in connection with this Bill. On this side of the Committee, we prefer to use the word "transparency". In many parts of the Bill, there is something of a battle between the Government's desire to have flexibility and our desire to have transparency. Amendment No. 16 seeks to make explicit what I suspect is implicit in the department's intentions.

However, it is important that there is a degree of transparency and certainty about the charges to be levied under Clause 3. Currently, the regulations are very broad. Subsection (4)(a) is very broad and gives a wide discretion.

Obviously, one is given assurances as the Bill passes through its stages, but it seems to us on these Benches that there is a need to enshrine protection against charges being levied which are higher than the average. I heard what the Minister said in response to a previous amendment about average charges being levied. I take some comfort from that. However, I believe that that

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protection should be included in the Bill even at some small, fairly negligible, risk to flexibility. Those daily rates must be pegged to a particular level and it will also give some incentive to those less efficient hospitals which have costs which are higher than the average. I beg to move.

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