§ Motion made, and Question proposed, That this House do now adjourn.—[Colonel J. H. Harrison.]
§ 9.59 p.m.
§ Mr. Denis Howell (Birmingham, All Saints)
I wish to raise the question of the charges made by doctors in the National Health Service for cremation certificates. This subject may seem a little pedestrian after the debate we have just had, but perhaps it is not without some connection. Anyway it is a matter which in my view ought to be debated by this House, and I am delighted to see the Parliamentary,Secretary to the Ministry of Health here to answer the debate. I say that because those of us who have from time to time tried to ask Questions on the matter have had the misfortune to have our Questions, which we directed at the Minister of Health, deflected to the Home Secretary. The latter gave us the kind of answer we did not want, because the Home Secretary has the power to regulate these charges under an Act of Parliament. It is not on that aspect of the matter I want to speak tonight, although I have no doubt that the Minister will touch upon it.
§ It being Ten o'clock, the Motion for the Adjournment of the House lapsed, without Question put.
§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Hughes-Young.]
It is well known that before a person who has died can be cremated, there must be two death certificates. This is a wasteful and an extravagant method. I do not consider the second death certificate necessary. Indeed, from my researches, I am sure that the formality of examining the body as carried out by most doctors is little short of farcical. In many cases, they hardly know whether they are viewing the right body, especially when they do it in the chapels of rest of funeral undertakers.
There is a lot to be said for getting rid of the second certificate altogether, but I do not wish to pursue that point 503 because it would probably require a change of legislation and would be out of order in this debate. I wish, therefore, to concentrate on the fact that we have in the hospital service highly-paid consultants and specialists who, when a request is made for cremation, have to give two certificates.
I understand that by the Regulations of the Ministry—"Terms and Conditions of Medical and Dental Staffs, Great Britain"—there are two categories. The first certificate comes within the first category and no fee can be charged. Under the second category, however, a fee can be charged for the second certificate, which is not necessary for an ordinary interment but is necessary for a cremation.
The first certificate, it is interesting to note, is normally issued free, but it is the second certificate to which I wish to direct my attention. I am quite certain that practice varies throughout the country. The British Medical Association has, I understand, suggested to its doctor members that for these certificates they should charge a fee of two guineas, which they consider to be reasonable. I know that this fee is not binding, but in practice some doctors will sign a certificate without any fee, very few charge two guineas, although some do, the majority of doctors in the hospitals charge at least double the fee recommended by the B.M.A.—that is four guineas—some doctors charge six guineas and there are isolated examples of charges much above six guineas. This is obviously wrong.
It is not without interest—and it is important in view of the Minister's responsibility for the Health Service—that I am told by some of the largest undertaking firms, who have to pay the fees for the cremation certificates, that they rarely get a receipt for them. In other words, we are dealing with tax-free "perks" for the medical profession, money which its members get for these certificates but for which they rarely give a receipt. I have no doubt that they regard it as a small addition to their salary. I would not object so much if that applied to junior members of hospital staffs, who are underpaid, although I object in principle to all tax evasions. In the case of the consultant and specialist staffs, however, who get very good salaries 504 indeed, the objection is much more strenuous.
Why should there be any charge at all for these certificates when these people are full-time employees of the Health Service, full-time public employees, paid from the public purse? Why should they receive a fee from the relatives of a deceased person for doing a job which the public is paying them to do? They know from what complaint a person who has been in their care has died. If they do not know—and this applies in all the cases of the people with whom I am concerned—then in hospitals there is usually a first class pathological service, also paid for by the Health Service, to find out the cause of death.
These medical officers either know, or, as the result of a service provided by the taxpayer, can easily find out the reason for a person's death and in those circumstances the signing of the form is a formality and should not attract any charge. In other words, members of the public are paying twice for this service of having a death certificate provided, once as taxpayers and once as the unfortunate relatives.
If there is to be a fee, it should be regulated. It has come to my knowledge that in at least one hospital in the Midlands the medical staff has recently had a meeting where it decided that instead of four guineas for the second cremation certificate, the charge would be six guineas. I understand that that has not been put into effect because in the meantime I started asking one or two Questions and the medical staff at that hospital is awaiting the answers. However, the staff had that meeting and, inflation being what it is, decided that the charge should be increased from four guineas to six guineas, although nobody could suggest that any extra effort would be involved in the task of signing the second certificate.
The matter was first brought to my attention by a senior official in the Health Service who became aware that while most hospital doctors signed these certificates as a matter of routine, there were one or two who were certainly exploiting the position. I know of at least one case concerning an old couple. The man died and his unfortunate widow, an elderly lady, wanted to have his last wish—to be cremated—respected. However, 505 she was asked a fee in the higher range I have mentioned and because she was not able to afford it, her husband had to he buried and not cremated. One can easily see that if these charges are to be imposed, that sort of situation can easily arise.
I do not want to make too heavy weather of this, but I want to put some propositions to the Minister. Firstly, he must accept responsibility for all this. It is no good telling us that the Home Secretary can make regulations, and that it is quite legal to charge a fee. I know that it is legal to do so; that is one of my complaints. I want the Minister to look into the question and to accept responsibility for what goes on in the Health Service. These people are paid to do their job and look after the sick, and if they are unsuccessful in keeping people alive it is their duty to give a certificate showing the cause of death. There is no reason why, in performing that duty, they should make money by imposing an extra charge.
If a charge has to be levied it should at least be uniform throughout the country. We should not have a situation where the doctors at one hospital can get twice or three times as much money as doctors in other hospitals for issuing second death certificates. The Minister cannot object to that proposition.
I suggest that in any case where the public pays money over to a servant of the Health Service the Minister is responsible for accounting to the House and to the public for it. He should state to whom the money has been paid. By virtue of their employment in the Health Service these people are receiving extra money for which they are not accountable to anyone. I am a member of a hospital management committee, as other hon. Members are, and I have no doubt that this question has never come before any such committee in the past. Although we are responsible for what goes on in our hospitals, this is a private arrangement between the doctors, whereby they fix and pocket the fees. If we must have fees they should be regulated by the Minister, and he should know what is being paid by the public to full-time servants of the Health Service.
That is the burden of my complaint. I do not know whether, at such short 506 notice—since I first said that I would raise this matter only last Thursday—I can expect the Parliamentary Secretary to have made a full inquiry so that he can provide all the answers. All I am asking is that he should at least agree with me that these certificates should either be free or should be provided at a regulated and uniform charge. At least he should undertake to examine what is going on and inform himself of the exact details. If he cannot give us all the information today I hope that he will find out what is the practice and give us much more detailed information later.
This is not a subject that I want to make a great deal of, but it shows that there is an inconsistency in the Service which can bring hardship. It has done so in at least one case, and I have no doubt that it has done so in others. I hope that the Minister will look into the matter in this spirit.
§ 10.13 p.m.
§ Mr. Joseph Reeves (Greenwich)
It is not my object to eat into the time of the Parliamentary Secretary, but I want to support my hon. Friend. He said that the Parliamentary Secretary had not had time to investigate the situation thoroughly, but I would point out that the Parliamentary Secretary must be fully apprised of the situation. Many of us have been informing him and the Home Secretary of the situation which is developing and which, if it develops much further, will become an absolute scandal.
During the Third Reading debate on the Cremation Act, 1952, the Joint Under-Secretary of State for the Home Department made a very significant statement. He said:In the course of the Committee stage, I said it was certainly the desire of the Government the fees which were to be prescribed should be maximum fees. The question was raised in Committee, and I have checked on the point; and I can assure the House the fees will be maximum fees and that it will be open to a doctor to charge a lower fee in appropriate circumstances… I hope and believe that it will be possible to reach an agreement and that no regulation will be necessary, therefore because the agreement will be binding and satisfactory to everybody concerned."—[OFFICIAL REPORT, 23rd May, 1952; Vol. 501, c. 848–9.]There was no agreement; there was an arrangement with the B.M.A. and it was quite a voluntary affair. The result is 507 that doctors are charging what they can get. Some of the charges now being made are extortionate. I have before me the report of the Annual Conference of the Cremation Society. During that Conference it was revealed that in many cases charges were excessive. I can give the Parliamentary Secretary details should he require them. In twenty-six cases in a certain area various doctors were charging three guineas, but 10 guineas were charged in another district. The whole of these fees are quoted in this document.
The Home Office and the Ministry of Health should do something about this. It is high time we had another Departmental Committee to make investigations into the whole of the regulations governing cremation. Cremation is becoming acceptable in this country. In more than 28 per cent. of registered deaths the bodies are now cremated, and local authorities are establishing crematoria in various parts of the country. Many of them subsidise the loss of burial departments of local authorities. In view of that, an investigation is required. If we can persuade the Home Office and the Ministry of Health to institute an inquiry, I hope that the Cremation Society and the Federation of Cremation Authorities will be invited to serve on such a committee of investigation. My hon. Friend has revealed a very serious situation. I hope that his speech this evening will not have been in vain.
§ 10.18 p.m.
§ The Parliamentary Secretary to the Ministry of Health (Mr. Richard Thompson)
I am much obliged to the hon. Member for Birmingham, All Saints (Mr. D. Howell) for raising this matter, which is of some public interest, and for the manner in which he has raised it. I think I am right in saying that there are two points for me to answer. The first is a question of principle. Should whole-time National Health Service employees be allowed to make a charge for certificates of this character? The second point is, whether we agree with it or not, are the present charges too high and should they be regulated by Statute? I think it would be right if I concentrated my reply on those two questions.
Whole-time hospital doctors, as the hon. Member well knows, are debarred from private practice. They may not 508 make any charge for work within the scope of hospital and specialist services under Part II of the National Health Service Act, 1946.
This principle was agreed between the Health Department and the profession in 1949, and it was incorporated in the terms and conditions of service under which hospital doctors are employed. Section 14 of these terms and conditions of service, however, specifically recognises that hospital doctors can perform a number of tasks not strictly within the scope of the hospital and specialist service. By way of example, I will quote medical examinations for purposes of insurance, medical examinations for prospective employers, medical examinations required by prospective emigrants and the issue of reports and certificates of various kinds.
It might interest the hon. Member to have a copy of these terms and conditions of service, which I will gladly send him, because in the matters which we are discussing we are bound, to a great extent, by what is laid down in them. He will find listed therein certificates and reports for which no charge can be made, and I am sure that this will rejoice him because that is what he feels ought to be the general situation. He will also find listed certificates and reports of the kind which are considered to be outside the scope of the hospital service and for which charges at present may be made.
We ought to consider what is the dividing line between these two sets of cases. Broadly speaking, it is that a certificate or a report arising from examinations undertaken in the care of the patient or on a reference of the patient from another doctor is considered to be part of the hospital service work and no charge may be made for any certificate arising from it. On the other hand, a certificate or report which is not connected with the health of the patient and not on the reference of the patient from another doctor is considered to be outside this scope and a fee may be charged.
In cremation, two certificates are required. The first is from the doctor who has attended the patient in hospital and has a knowledge of the case and of the cause of death, and that is free. A charge can be made for the second, which requires a separate examination, 509 but not an examination in the course of treatment.
I thought that perhaps the hon. Member might take the line that as this second certificate is required and as, in his view, it should not be provided as a paid item by somebody in the full-time service of the National Health Service, then somebody in the part-time service might more appropriately supply it, but the hon. Member indicates his dissent to that and I will not pursue that theme beyond saying that it would be impracticable to require a part-time medical practitioner in the hospital service to sign that kind of document. Such a man might not be found when he was wanted.
§ Mr. D. Howell
The hon. Member is entitled to reply to any conceivable permutation of what I said, but in fact I did not say that, despite what is in the hon. Member's brief.
§ Mr. Thompson
Perhaps I may say that my advisers probably have some experience of dealing with the hon. Gentleman's requirements, and, quite properly, they regard the scope of his remarks as being quite wide on almost every possible occasion.
Any question of changing these terms and conditions in order to alter the situation, which, quite clearly, is what the hon. Gentleman wants, is a matter for discussion by the Medical Whitley Council, in pursuance of an undertaking given to the medical profession in 1949, when we said that we would not seek to make any changes in these conditions without first discussing the matter with the appropriate body.
The hon. Gentleman, having made his case, may reasonably ask what we propose to do about all this, and I have just two things to say which, I hope, he will find helpful. The first is that, as he well 510 knows, the Royal Commission on the Remuneration of Doctors and Dentists is now sitting. I can tell him that my Department has drawn the attention of the Commission to the fact that whole-time as well as part-time consultants in the hospital service may receive payment for services outside the scope of the hospital and specialist service under the 1946 Act. In other words, the situation to which he has referred has been made known to the Royal Commission, which is looking at the remuneration of hospital doctors in the broadest way.
The second point is the size of the fees. Here, I do not think that I can be very helpful to the hon. Member because, quite frankly, as these fees are outside the National Health Service my right hon. Friend has no jurisdiction over them. Of course, my right hon. Friend the Home Secretary has power to regulate the fees that may be charged for medical certificates required under the Cremation Act, although, so far, it is true that he has not found it necessary to exercise his powers. It is also perfectly true that the British Medical Association has recommended a fee of two guineas, plus mileage allowances, as an average that would be appropriate up and down the country.
The best that I can tell the hon. Gentleman is that I will certainly draw the attention of my right hon. Friend the Home Secretary to what has been said in this debate, including the observations of the hon. Member for Greenwich (Mr. Reeves). I have no doubt at all that my right hon. Friend will give the most careful consideration to this, and I think that that is probably about as far as I can go.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-eight minutes past Ten o'clock.