'(1) Notwithstanding the provisions of section 56 concerning certification of contracts, premiums paid under such contracts shall be eligible for relief under section 54 whether or not the costs which are the subject of the indemnity in the contract relate only to charges levied by a certified provider.
(2) For the purposes of this clause a certified provider is either:
(3) An annual report shall be made by the Board distinguishing relief available in respect of certified contracts covering certified providers.'.—[Dr. Marek.]
§ Brought up, and read the First time.
§ 5.3 pm
§ Mr. Deputy Speaker (Sir Paul Dean)
With this it will be convenient to discuss new clause 10—Private Medical Insurance (No. 2)—`(1) Notwithstanding the provisions of section 56 concerning certification of contracts, no premiums paid under such contracts shall be eligible for relief under section 54 unless the costs which are the subject of the indemnity in the contract relate only to charges levied by a certified provider.(2) For the purposes of this clause a certified provider is either:
- (a) the National Health Service or
- (b) a person providing treatments and medical services who:
- (i) undertakes training of staff to a standard which is certified by the Department of Health to be at least comparable to that provided within the National Health Service,
- (ii) when recruiting and employing staff trained within the National Health Service makes a payment to the NHS to reimburse that service for the full cost of the training provided; and
- (iii) are certified by the Department of Health as providing a full range of treatments and medical services for the elderly.'.
§ Dr. Marek
New clause 4 seeks to tighten up some of the handouts and giveaways that the Government propose with their tax relief on private medical insurance.
When the tax relief was hinted at in the Budget it came as a great surprise to the Opposition. That relief is contrary to the principles and statements that I have heard in Committees considering Finance Bills. It is certainly 1001 contrary to the principles that have been espoused by the Financial Secretary to the Treasury and by the Economic Secretary to the Treasury. They know that there is only a small difference between the way in which the Opposition would tackle the reform of certain parts of taxation and the way in which they have done it. We are completely at a loss to understand the introduction of tax relief on private medical insurance. The only explanation is that they have had their orders and that, faithful to their mistress, they have simply jumped to it and ordered their civil servants and the parliamentary draftsmen to allow her to get her way once again.
I shall not be accused of not telling the truth when I say that that tax relief is not wanted by the Treasury. For the life of me, I cannot perceive the principles that allow the Treasury to include this relief in the Finance Bill. The Financial Secretary will be replying to this debate, and we and people outside will want him to explain why that tax relief should be in the Finance Bill; after all, Government Members will have to vote for it later.
This tax relief is contrary to many of the financial principles that have been espoused by hon. Members on the Treasury Front Bench in recent years. It is also a dangerous proposal as it represents part of the scheme to break up the National Health Service. This afternoon we had a statement on the Griffiths report; it is difficult to say what the outcome of that statement will be in the long run. No doubt it will depend on the amount of money that the Government make available for the proposals that the Secretary of State for Health outlined. If the money is not there, however, it is likely that that part of the Health Service connected with community care will suffer and wither away. What is left will provide a second-class service for people who depend on the NHS while a first-class service will be provided in the private sector. The Government's proposals on medical insurance will play their part in that as tax relief will be given to people who have private medical insurance.
§ Mr. Ian Taylor (Esher)
The argument has been rehearsed in Committee. The hon. Gentleman should know that that tax relief does not mean the destruction, or even a move towards the destruction, of the NHS. In a sense the proposals are a means of strengthening provision to elderly people across the board by enabling those people, many of whom have already opted for private health care, to continue it during their retirement. It is an wholly interesting proposal and I am sure that the Treasury is as enthusiastic for it as are my hon. Friends on the Back Benches.
§ Dr. Marek
The Treasury will have to speak for itself in due course. Many hon. Members are extremely concerned about those proposals. New clause 4 would make the operation of those proposals more open and more available to the public for scrutiny.
If many people are already paying for private medical insurance, as the hon. Member for Esher (Mr. Taylor) suggested, what is the point of giving them further money in the form of tax handouts from the state purse? The hon. Gentleman cannot argue that the relief is an incentive to take out private medical insurance if people have already done so. From figures available to me it is clear that only 2.6 per cent. of pensioners are paying the 40 per cent. tax rate. It is those pensioners who will receive the greatest tax handout as they pay the highest rate of income tax.
1002 We have a deep-rooted objection to the proposals in the Finance Bill. We tried to defeat the relevant clauses in Committee, but the Government had a large majority and we did not have a chance. It was impossible to effect any opposition.
Even though I suspect that at the back of their minds and in their hearts many Conservative Members realise that this runs counter to many other policies in the Finance Bill, they are not prepared to stand up and say so. They are not prepared to say, "We have had to do this simply because the Prime Minister has decided for some reason or another that this tax handout is to be given to the rich and the super rich." I say that because the Financial Secretary would be disappointed if I did not use that form of words at some time while proposing the new clause.
If the proposals are not available for the public to scrutinise, a great deal of money will be given away, the public will be none the wiser and an activity that we believe to be dreadfully wrong will be carried out from year to year without public scrutiny. The new clause would prevent that. We seek to expose what is happening because we believe that the National Health Service is about to be broken up. We believe that not just because of the proposals that we heard this afternoon, but because of the Government's proposals in relation to the elderly and mentally ill, hospitals being able to opt out of the National Health Service and doctors being able to run their own budgets. Our worry is compounded by these proposals because people who take private medical care and opt out will receive tax handouts.
§ Mr. David Curry (Skipton and Ripon)
Does the hon. Gentleman accept that by repeating the words "opt out of the NHS" he is deliberately misrepresenting the Government's proposals? Hospitals are being invited to opt for self-governing status within the NHS. Will he cease to perpetrate this myth, which is carried on in the media and forms part of a campaign that simply misrepresents the Government's proposals? Can he not see that there is a distinction between hospitals governing themselves and being governed by their own management within the system and the "opt out" to which he refers? It does him no credit to keep perpetrating this myth in the hope that eventually it will be repeated, parrot-like, across the country.
§ Dr. Marek
For every time that the Opposition can be accused of trying to mislead the public, they can levy the charge 10 times against the Government for using selective statistics or figures. They start in 1979 when it suits them, or in 1983 when 1979 figures are not so suitable, or they use those for the past two or three years when 1979 or 1983 figures are unsuitable.
§ The Economic Secretary to the Treasury (Mr. Peter Lilley)
The hon. Gentleman admits to misleading the public.
§ Dr. Marek
I do not admit to trying to mislead the public, as the Economic Secretary suggests; I am being accurate. Hospitals will opt out of an integrated National Health Service that is free at the point of need. If they become self-governing, the cheque book mentality will come to the fore. But I shall not pursue that line because I could stray a little too far from the new clause, although 1003 that would ensure that any of these activities is open to public scrutiny and scrutiny by the House and that annual reports will he prepared.
The problem with medical tax insurance is that people must be rich enough to afford it. If they do not pay income tax, the Government will not give them anything. If they pay only a little bit of income tax, they will not receive much. They have to be rich to be able to afford to take advantage of the Government's proposals. The richer one is, the better off one will be. The Government's philosophy is that, to those who have shall be given.
Not only do people have to be rich enough, but they must be well enough to sign up. If they are chronically ill or have a bad medical history, no insurance company will take them on. It is yet again to a small class of people that this Government seek to, and will, give money from the Treasury which could well be spent elsewhere. We are being asked to subsidise, from our taxes, the private medical insurance of people who are already wealthy enough and who, by and large, already pay for private treatment without the need for subsidy.
Our new clause would constrain the Government by making them open their books and to account publicly for how the money will be given away. It also makes them justify the scheme's operation.
§ Mr. James Couchman (Gillingham)
The hon. Gentleman has just talked about people who are "wealthy enough" and do not need the help offered under the Government's proposals. He will be aware that old-age pensioners receiving state pension use almost all their age allowance with the state pension. Anyone who has a modest occupational pension or even earnings above that level will pay income tax at the standard rate and will therefore benefit from the proposals. By no stretch of the imagination could those people be called wealthy.
§ Dr. Marek
Exactly—there is much sense in what the hon. Gentleman has said. People with small occupational pensions, who, I agree, are certainly not wealthy, will not have enough money to take out private medical insurance and still have enough left for their daily needs and to be able to lead sensible lives in their old age. Those people are not the targets of this tax handout and giveaway. The targets are those who are much wealthier than people with ordinary occupational pensions. I hope that the hon. Gentleman understands that point.
Of course, it is possible for people who are paying income tax to benefit from this tax handout by obtaining private medical insurance. However, I suspect that people in those circumstances will be able to say, "I am sorry. The money that we have available at our disposal at the end of every week is insufficient for us to afford the luxury of private medical insurance." They could rightly say, "We shall stick with the National Health Service."
§ Mr. Nicholas Bennett (Pembroke)
The hon. Gentleman uses the terms "rich" and "super rich". For those of us who have not had the advantage of serving on the Committee, will he define those terms? Which level of income constitutes "rich" and which "super rich"?
§ Dr. Marek
The hon. Gentleman must sign up, become a member of the next Finance Bill Committee and take part in our discussions. The question that he posed has 1004 been asked before. I shall disappoint the hon. Gentleman if he thinks that I am about to give a cast-iron definition so that people with a penny less than the sum stipulated will not be in the super rich category and those with a penny more will definitely be in it. He must take me for being slightly naive. Perhaps I am sometimes, but I am not naive enough to give such a definition.
Some people are extremely rich and have so much money that they do not know what to do with it. They cannot even find out how much money they have. There are people in this country who do not know how much they are worth. They have millions of pounds—or at least hundreds of thousands of pounds—of ready, available liquid assets over and above any insurances, houses or property. They would fall into the class of the super, super rich. There are people who are not in that class, but I shall not take up any more of the House's time with that definition. I hope that I have been able to educate the hon. Member for Pembroke (Mr. Bennett) a little.
The Opposition object to the proposals because they represent bad taxation policy. There is no case for them. Hon. Members need only to cast their minds back to debates in Committee and yesterday when pleas were made for concessions. Hon. Members from both sides of the House said that this was not the right way to run a fair tax policy with a level playing field. The Opposition would be the first to say that, in some circumstances, we would not want a level playing field, but there must be justifiable reasons for it. Those reasons do not exist in this case.
For private medical insurance to receive tax relief is clearly against every principle that the Financial Secretary and the Economic Secretary espoused in Committee. It is the equivalent of the Financial Secretary going to Lord's on a dark night and digging up the cricket pitch. He had a level playing field but has now decided to roughen it up so that it slopes upwards and forces those without money to bowl uphill, whereas those with money can bowl the other way. That is a reasonable analogy for what the Government are doing.
The new clause would also bring under public scrutiny the point that the relief is not well targeted. Instead of targeting those who need more medical care or medical insurance, the Government are targeting those who can stay with the NHS or who already have money and do not need extra handouts. The Financial Secretary does not have up his sleeve an argument to contradict what I have just said. We accept that benefits have to be targeted, and we have listened to the Secretary of State for Social Security, the Secretary of State for Health and other Ministers tell us that every benefit must be targeted so that relief goes to those who need it. However, there is no targeting with this provision. It is a straightforward handout to people who have money and are already using it for medical insurance. There is no incentive argument or targeting argument for it.
§ Mr. Nicholas Bennett
The same argument applies to child benefit. Why is the Labour party opposed to targeting child benefit and taxing that?
§ Dr. Marek
I do not want to stray too far, but I can answer the hon. Gentleman. There is a difference with child benefit. It goes to the mother, there is a 100 per cent. take-up and, although the targeting is not perfect, it is not bad. The targeting percentage score for child benefit is between 60 and 80 per cent., but for this measure it is zilch.
1005 We should like to bring under public scrutiny the fact that if anybody wants family credit or income support, he has to fill up forms and be interviewed, and snooper squads come round to his house if there is any hint of impropriety or if a jealous neighbour tries to get his own back. The full panoply of state supervision and state regulation, and the overburdening authority of the state, are put on those people by the Government and the Conservative party.
However, if one wants private medical insurance, one need only send a little note to one's accountant and he will fix everything. There are no snoopers and no reams of forms to fill in. It is all straightforward. One does not have to appear in a social security office, wait in a long queue and waste a morning to get one's entitlement. The philosophy is completely different. That is another difference between the Government's attitude towards income support and family credit and their attitude towards this measure.
§ Mr. Couchman
I thank the hon. Gentleman for his generosity in giving way again. On this point, will he concede that there is a difference between making an allowance against income tax—that is, not taking away so much income tax—and distributing public funds by way of income support, which is distributing new money to the recipient? The hon. Gentleman said that there would be no snooping, but the Inland Revenue takes a healthy interest in our tax affairs, and if it has any suspicions, I am sure that it will be there just as enthusiastically as would be the Department of Social Security investigating team in other circumstances.
§ Dr. Marek
I hope that, if the new clause is passed, some of the reports that will be produced will bear out my point. If the Government appointed enough income tax inspectors so that the Inland Revenue could take proper control over those whom it thought were fiddling income tax returns—most of whom have something to do with the City—it would be more efficient. I know that most people in the City are honest, but some are not and they fiddle enormously large sums. Furthermore, if income tax inspectors were paid properly, they would not fly off to private industry as they do because of the Government's Scrooge-like policies.
On the hon. Gentleman's second point, the only difference is administrative. The effect of giving money, either as a tax allowance or as a grant, is to ensure that people can lead decent and dignified lives. Whether people receive that money by way of tax allowance or by way of grant from the Department of Social Security is neither here nor there. There is no effective difference. I hope that the hon. Gentleman will think about that. We have to treat people on the same basis even though the circumstances of some people are different from those of others.
I have here an important figure on which I hope that some of my hon. Friends will expand later: two thirds of pensioner households pay no income tax. Therefore, they will not benefit from these tax handouts. Only 2.6 per cent. of pensioners pay the top rate—40 per cent.—of tax. Only 2.6 per cent. of pensioners will benefit from this measure. It will be worse than that, because pensioners do not have to pay for these benefits. Often their yuppie children will pay for them, so this measure is a licence to allow a yuppie who wants to to pay money for the care of his or her elderly parents.
§ The Financial Secretary to the Treasury (Mr. Norman Lamont)
Why does the hon. Gentleman think that it is impossible for non-taxpayers to benefit from what is in the Bill?
§ Dr. Marek
It is not impossible. I have not examined the statistics, but I think that I am right to say that, by and large, pensioners who do not pay income tax cannot pay income tax and are not in a family group with yuppies so rich that they can pay for private medical insurance. I am prepared to be persuaded by the right hon. Gentleman, but he will have to see whether his civil servants can provide any statistics for his assertion. I think that they probably cannot.
We are against these proposals because treatment in the National Health Service is much cheaper than treatment in private hospitals. I can give a simple example. In the NHS, the cost of a tonsillectomy is £360, but the private cost can be anything from £600 to £1,400. This tax relief is aimed at the wrong target. Instead of using the money by way of tax relief, it should be given to the NHS so that it can provide for the medical welfare of our old-age pensioners direct, and when they need it.
We have tabled the new clause because we object to the original proposals and we want to make sure that the results of the clauses that the Government insisted should be included in the Bill are open to public scrutiny in due course. The sum involved is large—the Treasury suggests £40 million, but we suspect that it will be about £200 million. Some people suspect that it is an open-ended commitment.
I hope that the Government will recognise our need to be given the details of the scheme. Without those details, the new clause was restricted to providing that an annual report, covering various matters, should be made by the board. The Chief Secretary wrote to my hon. Friend the Member for Dunfermline, East (Mr. Brown) on 6 June, enclosing a copy of a letter to medical insurance companies asking for details of how the proposed scheme would operate. I believe that a copy of that letter has now been placed in the Library.
There are some curious aspects to the scheme. For example, treatment must take place at an NHS hospital, at a hospital instituted by a special Act of Parliament or incorporated by Royal Charter, or at premises registered under part II of the Registered Homes Act 1984. Does that mean that the public will be giving tax handouts to rich people staying in registered old people's homes? What is the substance of the Government's argument? Is the scheme supposed to be some sort of incentive? Earlier today the Secretary of State for Health said that, wherever possible, old people should be in the community. The proposals are contrary not only to previous Treasury policy, but to the policy of the Department of Health.
I am glad to note that there will be some rules and regulations on qualifying benefits. According to the consultation document, accommodation charges will qualify, including those for parents accompanying a child. Home nursing charges will also qualify. The only people who will benefit from that are the very rich, who would have home nursing anyway and do not need to be given a cash handout as a little sweetener. There will be a cash maternity benefit. It is surely no part of the state's job to give cash handouts to people who want to insure against 1007 maternity. Of course, it is part of the state's job to ensure that there is adequate maternity and paternity leave for all, irrespective of wealth. Parents should be able to bear a child without hardship. A proposal to give a cash handout to the rich people who want to insure against maternity shows the Tory party for what it is, who its friends are, what its priorities are and who it supports.
When we consider other amendments later, I might adopt a different tone because some of the Government's amendments are helpful. However, the medical insurance clauses are ill-advised, ill-thought-out and badly targeted because they serve only the rich. The Government have not even drawn up the regulations. I commend our new clause to the House.
§ Mr. Kenneth Hind (Lancaster, West)
As is usual in these debates, the Opposition have shown a mindless objection to anything that smacks of individual initiative or of benefit to those prepared to put their hands in their pockets to pay for it. Underlying the Opposition's arguments is their fundamental objection to private medical care. They will oppose any measure, no matter who it benefits, on that principle alone.
I wish to raise one important aspect of our health care. Britain's health spending in the public sector is comparable to that of most European Community and OECD countries. However, on health spending in the private sector Britain is a long way behind. The Opposition forget that, in general, the two expenditures are added together, so they criticise the Government and claim that other countries—especially West Germany—spend far more than Britain.
The Bill will help those in need to redress the imbalance by increasing the amount of private health spend and so provide a more realistic view of our overall health spending. The medical insurance clauses prime pump additional resources into Britain's health care facilities and will attract resources that otherwise would not come into the system. Without those additional resources, the cost of providing health care for the elderly would fall entirely upon the NHS and the taxpayers who fund it. It could even reduce the overall standard of care for all in our community.
Currently 14 per cent. of the population are old-age pensioners, but by the year 2010 the figure will rise to 18 per cent. With that demographic change will come heavier demands for the care of the elderly, especially home and hospital care and community care as a whole. The Bill will assist the provision of future health care for the elderly. Fewer people will be earning a wage by the year 2010, so fewer people, through tax and national insurance, will have to carry the burden of supporting a larger number of pensioners. The Bill looks to the future and provides sensible planning to meet future needs.
The new clause is an attempt to disrupt the Government's plans—
§ Mr. Hind
My hon. Friend is right; it is purely and simply a wrecking amendment. The Opposition want to make it as difficult as possible for the Government to give the elderly an opportunity to benefit from private health care. The major aspect of this wrecking amendment is the annual report by the board 1008distinguishing relief available in respect of certified contracts covering certified providers.As usual, the Opposition are suffering from quangoitis. They want to set up a national body to administer the system, but to restrict the number of people who can provide health care by confining it to certified providers. The Opposition's usual tactic when they cannot defeat an argument because of its intellectual soundness is to try to wreck it by introducing unworkable practices.
The Opposition's new clauses ignore those elderly people who, when they retire, will find that it is far more costly to obtain medical insurance. I emphasise the word "insurance" because it carries with it a risk. The older one is, the greater the risk and the higher the premium—and the less likely it is that people will enter into such a contract. New clauses 4 and 10 will allow people who want private health care to invest in it if they have the means to do so, and at the same time assist the state in providing increased resources.
My experience as a constituency Member of Parliament is that many people who have enjoyed private health care all their lives find it disheartening that they cannot afford it when they grow older. The new clauses, together with the increase in the number of pensioners and other demographic changes, will not help to provide good health care for the older members of the population.
The Opposition amendment adds nothing to the Bill. It is not helpful but rather attempts to undermine the Government's proposals. I have no hesitation in saying that my right hon. Friend the Financial Secretary should see the Opposition amendment for what it is and dismiss it.
§ Mr. A. J. Beith (Berwick-upon-Tweed)
Although the hon. Member for Lancashire, West (Mr. Hind) may speak sincerely on behalf of the elderly, he allowed himself to present a series of fallacies. One is the belief that it is impossible to be in favour of private health care and opposed to the provision of tax relief as an incentive to subscribe to such care. That is manifestly not the case. Even people on the Right among those who advise the Conservative party are in favour of private health care but do not believe that the tax system should subsidise it.
Similarly, it is not the case that we welcome the clause. The Social Services Select Committee, which has a majority of Conservative Members, commented in its fifth report:In our judgment, the creation of new tax subsidy on private health insurance cannot be demonstrated to extend total availability of health care. It would reduce the total public expenditure from which Health Service resources are drawn while at the same time narrowing the tax base still further.There are many critics of the Government's proposals in all parts of the House, and the authorship of those proposals is the subject of some discussion and dispute. To me, they are the Dulwich clauses, based on the Prime Minister's concept of retirement and of how she and her husband will be able to provide for their own. The clauses are not based on the perspectives of most ordinary people, on how they must provide for retirement, and on their dependence on a properly funded National Health Service.
The vast majority of people depend on a properly funded Health Service. If any money is available for health care, they want to see it invested in the Health Service, yet 1009 at the time when the NHS is under considerable pressure the public can see money being diverted to subsidise those who are able to take advantage of private health insurance.
§ Mr. Nicholas Bennett
The hon. Member for Berwick-upon-Tweed (Mr. Beith), like the hon. Member for Wrexham (Dr. Marek), who has left the Chamber, speaks in vague terms about a "properly funded Health Service". Given that there has been a 40 per cent. increase in real terms in Health Service spending since 1979, what percentage increase does the hon. Gentleman think would have been appropriate, and what is his party's projection for the future?
§ Mr. Beith
In our last general election manifesto, we said that a 2 per cent. increase in Health Service resources is required over and above that projected to meet the immediate pressures on the service. The Social Services Committee presented its own proposals for further funding of the Health Service. The hon. Gentleman cannot go anywhere in the National Health Service without finding people who are well aware that it cannot be properly run without additional resources. If the hon. Gentleman cannot see that, he is blinding himself to the obvious.
The resources that the Government are currently directing at the Health Service cannot keep pace with the considerable pressures that it faces, which include the increasing number of elderly people—the vast majority of whom are dependent upon the NHS—and the opportunities and demands that improving medical technology create, and of which we are all aware from our constituency case work. They all place on the Health Service a funding requirement that the hon. Member for Pembroke (Mr. Bennett) must be alone in not understanding.
Treasury Ministers in particular have some difficulty defending and explaining the proposals to which new clause 4 are directed. I am sure that in the Prime Minister's mind they are the beginning of a process whereby the private sector will be asked to bear much greater responsibility for the health of the people, based on the mistaken assumption that the private sector is capable of meeting that responsibility. I am not saying that the private sector cannot contribute to the country's health care, but it will inevitably select those activities that are most profitable and which best fit its framework. That will create even more work for the public Health Service. The more that the private sector can contribute to an increase in hip operations, for example, the more aftercare will have to be undertaken by the public service.
Treasury Ministers have moved to a different standpoint. They argue, as suggested by the hon. Member for Lancashire, West (Mr. Hind), that the clause is much more limited in scope and will assist only those elderly people who already have private health insurance and who will find it difficult to continue to meet that commitment when they reach retirement age. If that is the Government's objective, they could have drafted the clause more narrowly, which was the purpose of my earlier amendment. It is difficult for the Government to sustain that argument while maintaining the deadweight argument against other proposals.
1010 Last night, the House debated child care and workplace nurseries. I presented an amendment to provide tax relief for workplace nurseries and for wider child care provisions. The Financial Secretary responded:I have to reject his new clause on the grounds of cost and of its very large deadweight element … The effect of the new clause would give a large tax subsidy to people who are already making this provision."—[Official Report, 11 July 1989; Vol. 156, c. 896–97.]That is the same argument that the Chief Secretary to the Treasury used to defend the provisions of the Bill. He commented:In a ringfence way it will help many elderly people who wish to continue medical insurance cover on retirement but who are unable to do so because they have lost the benefit of the employer scheme."—[Official Report, 4 May 1989; Vol. 152, c. 351.]The clause apparently exists to help people who already make provision for private health care to continue doing so. It will also benefit many who do not suffer from the particular disadvantage to which the Chief Secretary referred, of starting in an employer's scheme and then finding on retirement that they no longer benefit from the employer's contribution.
The Government cannot have it both ways. They oppose tax reliefs that have a high deadweight cost because they give a subsidy to people who are already making their own provision, and then argue that the clause's primary purpose is to give just that type of relief. That is a nonsensical argument for the Government to make, and it illustrates that Treasury Ministers are being forced to adopt the Prime Minister's baby.
§ Mr. Hind
Does the hon. Gentleman agree that private medical care, with tax relief for pensioners, will be a pump-priming measure that will attract greater resources into the totality of our Health Service, both public and private, and that that will not happen unless the clause is implemented? The cost of providing extra health services will otherwise fall on taxpayers overall. The clause will help to improve the standard of health care, not the reverse.
§ Mr. Beith
I have never heard Treasury Ministers argue that the purpose of the clause is pump priming—that its objective is to enlarge the private health sector through the use of a public tax-relief subsidy. Perhaps they will decide to introduce that argument tonight. The Financial Secretary shakes his head: clearly he does not accept the pump-priming argument. In his view, the measure will help a limited number of elderly people who have already made commitments. The right hon. Gentleman would find it difficult to extend the pump-priming argument, because he must be aware—if he were not, I suspect that the Department of Health would have made him aware—that, far from reducing the total burden on the Health Service, the legislation is likely to increase it. In so far as it has any benefit, it will leave the most expensive kinds of provision in the hands of the Health Service. The Health Service will still be picking up the tab for all the tasks that the private sector cannot perform—all the long-term care, aftercare and residential care—and possibly adding to the volume of work.
§ Sir William Clark (Croydon, South)
The Health Service—in other words, the taxpayer—is doing precisely that now. The scheme to provide medical care for the elderly is intended not only to help the elderly, but to take some of the burden away from the National Health 1011 Service. It will mean more resources for the NHS, because some elderly people will take advantage of private health care.
§ Mr. Beith
It will not take the burden away from the NHS. It will take away staff who already do the work in the NHS—consultants who perform operations, and a work force that the NHS has trained—who will then be used to carry out a much more limited range of functions. The NHS will be left to provide aftercare for the same patients, and to care for all those for whom the private sector has made no attempt at provision.
All the publicity for private health care makes it pretty clear what cannot be obtained from it. It is obvious from a reading of that literature that the private system will be highly selective in what it offers. Many of those who work in the Health Service know full well how they could enhance the service if they had either £40 million or the much larger sums that may go into this form of tax relief in the future.
If Conservative Members really believe that the burden on the Health Service would be reduced by extensive tax relief for private care, they will not stop the pensioners; tax relief for private health care will become a general provision. I hope that the Minister will deal with that. His hon. Friends' case is that the measure will relieve the NHS of its burden so effectively that the effects will be seen most clearly where the burden is lighter. If the Minister accepts that argument, he will have to explain what further plans the Government have to extend tax relief throughout the system rather than confining it to the elderly. [Interruption.]
I hear hints that some Conservative Members may wish the Government to do that. If they took such a step—which many of us believe to be in the minds of some of their members, if not those of Treasury Ministers—they would deal a terrible blow to the Health Service and its morale. They would also convince the majority of people that they believe in a two-tier Health Service, with a private system for those who can afford it and a public system for the rest—the rest being the majority, who will be expected to accept second best. Those who work in the Health Service do not want to give second best: they are capable of, and have given, the very best, and they are entitled to the resources that they need to provide that level of service.
§ Mr. Couchman
I had not intended to speak, but I have listened with a growing sense of wonderment to the blind prejudice and dogma emanating from the other side of the Chamber. It was ever thus. It is worth reminding Opposition Members that it was Barbara Castle, when she was Secretary of State for Health and Social Security, who killed off paybeds in the National Health Service—no doubt with the support of every Labour Member who is present now. They would have seen them all go; and very few are left.
§ Mr. Couchman
No, I will not give way so early in my speech.
The new clause defines a certified provider as the National Health Service, but there is little private practice 1012 in NHS hospitals: that, of course, is the point of this wrecking measure. Subsection (2)(b)(i) goes on to give the extraordinary definition of a certifed provider as someone who willundertake training of staff to a standard which is certified by the Department of Health to be at least comparable to that provided within the National Health Service".What staff? Nurses? Doctors? Paramedical staff? Porters? The new clause does not say, but I think that the royal colleges, which determine the appropriate places in which training can take place, might well have something to say.
Subsection (2)(b)(ii) provides a further definition: a person who will,when recruiting and employing staff trained within the National Health Service, make a payment to the NHS to reimburse that service for the full cost of the training provided".Will that apply for ever? If a nurse has given 30 years of service to the NHS and, in her twilight years of nursing, decides to do some work in a private hospital, will that private hospital then have to reimburse the NHS for the full cost of her training 30 years previously? What nonsense. It is blind prejudice and dogma—but what else would one expect?
What the hon. Member for Berwick-upon-Tweed (Mr. Beith) said was not much better. He talked in a rather pejorative way abut the "Dulwich clauses". That, of course, is the kind of slogan that would appeal to the Liberals—or are they the Liberal Democrats, the Democrats or the Social and Liberal Democrats? Anyway, it would appeal to whatever party the hon. Gentleman currently supports.
§ Mr. Couchman
Certainly not. I have not got into my speech yet.
I said earlier, when the hon. Member for Wrexham (Dr. Marek) generously gave way to me, that it was not the rich who would primarily benefit. Many people, until they reach the age of 60 or 65, are members of private health care insurance schemes, for which they may pay under a company scheme or which may be paid for by the company. Alternatively, they may purchase individual health care insurance. When they reach the age of 60 or 65, their income drops and their ability to pay for private insurance becomes that much less. An allowance such as my right hon. Friend proposes would provide precisely the incentive that many such people need to continue paying for private health care insurance when they have retired. They have made their contribution through national insurance and income tax, and they will continue to contribute if they continue to pay income tax, as part of that tax funds the NHS. They are only being given back some of their own money.
The elderly, after all, make the heaviest use of health care generally, and private health care resources provide many of the services that enhance their quality of life—cold surgery, hip operations and so forth. It relieves pressure on the NHS at just the point where the pressure is greatest and the waiting lists are longest.
I shall have no difficulty in supporting my right hon. Friend and rejecting the silly, dogmatic ideological prejudice expressed in this new clause.
§ 6 pm
§ Dr. Lewis Moonie (Kirkcaldy)
I had not intended to refer to the speeches of the hon. Members for Lancashire, West (Mr. Hind) and for Gillingham (Mr. Couchman), and my generally charitable nature will lead me to forbear from commenting in this instance. They may, however, wish to intervene during my speech in order to make the same idiotic points as they have already made, using the ludicrously constructed briefs that they have obviously had from the Whips Office.
§ Dr. Moonie
No, I shall not give way on that point.
This is one of the least popular and least needed measures in this Finance Bill. The Government are proposing to give a large handout from the Exchequer to suppliers of private medical care, with no requirement being placed on them to account for how the money is spent. The new clauses are a very small attempt to remedy that failure.
Let me explain the reason behind those statements. The proposed tax break will be given to individuals or their relatives, regardless of need. The intention is to encourage more people to take out private health insurance, despite the fact that there must be a large question mark over the advisability of using public funds to entice people to make such a choice, one which they have clearly been free to make up to now but which they have chosen not to make. It surely cannot be a sound use of public money to prop up an expensive and unattractive service.
Moreover, a huge deadweight cost is involved—a tax break of up to £200 a year for all those currently holding such policies who, by definition, can afford to pay the premiums and who are healthy. If they are not healthy, they will not be covered by private medical insurance. Why on earth should we be spending taxpayers' money on people who are healthy and wealthy and who are so manifestly not in need of such help?
As my hon. Friend the Member for Wrexham (Dr. Marek) has made clear, we cannot believe that the Treasury Ministers favour such a stupid move. It is against all the principles of fair taxation and also of those principles that are involved in constructing a broad tax base. Where will the money go? Health care is expensive, especially in the private sector where it is up to four to five times dearer than in the National Health Service. Premiums have risen at a fantastic rate over the last few years. They will rise even faster, now that the Government are to subsidise up to 40 per cent. of the cost. Can any Conservative Member deny that that will be the case? It has been so in every other instance where the Government have stepped in to subsidise private insurance. Instead of the money being used to benefit the individuals concerned, it will go directly or indirectly into the pockets of those who provide health care through increased premiums.
Private medicine does not pay the true costs of the service that it provides. It is not complementary to the National Health Service. It exists in a parasitic relationship with the public service, preying on its skilled staff—nurses, laboratory technicians, scientific, medical and paramedical people, to name the main areas involved. All these staff are trained within the National Health Service. Their training is paid for out of the public purse. All the staff are either in short supply or need to be 1014 employed in much greater numbers within the National Health Service to make up for the disgraceful shortages that exist in so many areas.
The statement on community care that was made earlier today, which I welcome, will place additional pressures on the need for trained staff within the National Health Service. It is high time that the private sector showed that it feels some sense of responsibility to the service on which it preys. The new clauses would do just that.
If we look at them carefully, we see that new clause 4 provides that a register should be kept of private medical concerns which either provide training themselves or make a payment to the NHS to reimburse it for the full cost of the training of the people whom they employ. New clause 10 goes further. It stipulates that tax subsidies will be paid only to firms that do provide some form of reimbursement for the costs that have been incurred. For example, they would have to undertake staff training to a standard that is similar to or comparable with that in the National Health Service, or they would have to reimburse the National Health Service for the cost of the training that has been provided. Who could quarrel with such a reasonable proposal?
§ Mr. Bennett
Given that this country employs large numbers of teachers who have been trained abroad and large numbers of nurses who were trained in other countries, is the hon. Gentleman proposing that a Labour Government, should one ever be elected, would reimburse those countries for the staff who have been trained in those countries and who work over here?
§ Dr. Moonie
That sounds an excellent idea, one which I could not have imagined would be thought of by the hon. Member for Pembroke, since he contributes so much nonsense to our debates on health care, as witnessed by his comments earlier this afternoon.
The new clauses are reasonable. No fair person could possibly object to them. They will ensure either that private firms which recognise their responsibilities are given fair recognition for their investment or that this subsidy from everybody else's pocket to the private sector is paid only to those who carry out their responsibilities. I commend the new clauses to the House.
§ Mr. Tony Baldry (Banbury)
The debate provides us with a useful opportunity to highlight the Labour party's inherent hostility to private medicine. Much of the debate on the National Health Service in recent months has naturally tended to concentrate upon the proposals in the White Paper "Working for Patients", supplemented by the Budget provisions that we are considering. Very little attention has consequently been paid to the Opposition's policies relating to health care.
There are two things that we know about the Opposition's health care policy, both of which are damaging. First, they would abolish private practice in medicine, something which Barbara Castle sought to do in 1966. Secondly, they would undermine the concept of competitive tendering.
It is interesting to consider what the implications of the proposals would be if private health care in Oxfordshire 1015 were to be undermined, and also how much income private health care brings to the National Health Service. Private patient income in Oxfordshire amounts to approximately £2.5 million in this financial year. Competitive tendering will save the Oxfordshire district health authority approximately £700,000 this year.
If one combines the effect of private patient income and competitive tendering, the saving amounts to £3,200,000. If competitive tendering were to be abolished and if no private patients were to be treated within the National Health Service, as each NHS consultant costs approximately £46,000, the effect of the Opposition's proposals on Oxfordshire district health authority would be that the funding of about 96 consultants would be removed. That would be wholly negative, wholly damaging and wholly detrimental to the National Health Service, for no reason other than to satisfy Opposition dogma as to private health care and to meet the demands of certain public sector trade unions about competitive tendering.
If the Opposition ever came into office, it is important to highlight the fact that almost overnight they would considerably undermine the funding of district health authorities. The effect on one district health authority alone—Oxfordshire—would be the loss of 96 consultants.
§ Mr. Worthington
The major savings after privatisation have related to staff wages and staff conditions. Does the hon. Gentleman concede that, if we were to pay the staff nothing, we should be able to employ an enormous number of consultants?
§ Mr. Baldry
It must be for the hon. Gentleman to judge whether he really feels that that was a sensible contribution to the debate.
Competitive tendering has led to substantial savings in the National Health Service. Those savings have been and are being used for better patient care. The Opposition are blinded by ideology and trade union commitments.
§ Mr. Couchman
Does my hon. Friend agree that the tax allowance proposed in the Bill would generate more money than the actual saving in taxation? The figures show that two and a half to three times the amount given away will be generated in additional health care resources.
§ Mr. Baldry
My hon. Friend makes a very good point, which I had hoped would he taken on board much earlier in the debate. I had hoped that many of the points would be taken on board in Committee of the whole House. For many of us there is a sense of deja vu about the debate. We have covered the ground before, but it seems that the Opposition are incapable of taking on board the essential facts.
§ Mr. Baldry
I bow to my right hon. Friend's superior knowledge of French. Whether it is deja vu or deja non vu, the Opposition are not grasping it, so we have to take them through it yet again.
Many people have private health care as part of their remuneration package. Many employers negotiate private health care packages for their employees. Many trade unions now negotiate private health care. While those people are in employment, that private health care subscription is paid as part of their remuneration. When 1016 they retire, not only does their income drop but their health care subscription is no longer paid for them. That is nonsense. The provision in the Finance Bill encourages those who have medical insurance cover during their working lives to continue it in retirement. That is a perfectly straightforward provision. Many people in group schemes when their employers negotiate insurance cover for their employees could keep that cover, given some fiscal encouragement.
The Opposition have said on a number of occasions that that encouragement will simply go to those who are better off. That canard should be dismissed at every opportunity. About 5.5 million people—or one in 10 of the population—are now covered by medical insurance schemes, many of them through company or trade union schemes. The great majority of the tax relief that the provision would produce would go to standard rate taxpayers. About 80 per cent. of the provision would go to basic rate taxpayers aged over 60 or to those who are not liable to tax. The benefit of the provision will go mainly to those who have worked throughout their lives, and whose employers paid into a medical insurance scheme, and will enable them to continue that scheme into retirement.
§ Dr. Moonie
Will the hon. Gentleman tell us how many people he knows who pay no tax but could pay £600 a year in private medical insurance? I should dearly like to know.
§ Mr. Baldry
I hope that the hon. Gentleman accepts the general thrust of my point, that the provision will not affect primarily the higher rate taxpayer, as the Opposition have suggested, but will go to those paying the basic rate. The humorous interventions from the Opposition demonstrate that the Government and the Conservative party have won the intellectual argument. Clearly they are now finding it difficult to make any points of substance against this perfectly sensible provision. The Opposition have to make it clear to the country exactly where they stand on private medicine.
If one in 10 people now benefit from private medical insurance schemes, and if whole groups of employees throughout the country benefit from private medical schemes, what do the Opposition intend to do for them? Do they intend to revert to the position under Barbara Castle, when private medical health care was forced out of the National Health Service and consequently a number of private hospitals were set up so that the benefits of that did not go to the National Health Service? What is intended? There is no doubt that private medical care makes a considerable contribution to health care in Britain. It relieves pressure on the National Health Service and increases scope for co-operation between the National Health Service and the independent sector.
§ Mr. Baldry
The hon. Gentleman asks what evidence there is for private medicine relieving pressure on the National Health Service. I am not sure where he goes, but certainly in Oxfordshire a considerable amount of screening is carried out by the independent sector which, by definition, relieves pressure on the National Health Service. If my constituent, Mrs. Jones, can be screened privately more quickly than she could by the National 1017 Health Service, and consequently the National Health Service can fulfil its screening targets much more quickly, that will have relieved pressure on the National Health Service. If the Opposition cannot grasp that or understand how the private sector can contribute to enhancing standards in the National Health Service, I weep, as clearly they have a total lack of understanding of how the National Health Service operates.
§ Dr. Moonie
Will the hon. Gentleman explain the possible economic benefit to a country with a public health service to spend four times as much on providing the service privately? Is he aware of the least-cost approach to analysing expenditure? How can he possibly justify spending that amount of money?
§ Mr. Baldry
That intervention begs a number of questions. It begs the question whether the National Health Service inviting the private sector to work for it costs four times as much. Often, taking into account all the costs, the independent sector is cheaper. That is one reason why the National Health Service and district authorities have been inspired and have the incentive to look to the independent sector. The independent sector can often deliver services such as screening and ancillary services more cost-effectively than the National Health Service can.
§ Mr. Jeremy Hanley (Richmond and Barnes)
Does my hon. Friend agree that it is irrefutable that the major pressure on the Health Service is the growing number of elderly people, who, quite rightly, turn to the National Health Service? Many of the people who will benefit by the provision will already use private medicine, and because of the withdrawal of tax benefits through their firm will automatically have to turn to the National Health Service when they retire. They will be new patients for the National Health Service; therefore, the provision would be of great benefit in reducing pressure on the Health Service.
§ Mr. Baldry
My hon. Friend is right. It is incredible that the Opposition find it so difficult to understand that point. Of course, all the money that comes into the independent sector of private medicine is—
§ Mr. Baldry
It is not wasted. It is extra money for health services in this country as a whole. This year, in Oxfordshire alone, £2.5 million extra is going into the Health Service because of private medicine by way of fees to Oxfordshire district health authority. In addition to those direct contributions there is the money that the National Health Service saves because people who might otherwise go into NHS hospitals are treated by private or independent hospitals elsewhere. The private sector's contribution to health care overall is considerable.
I understand that the Opposition are saying that they do not believe that there is a place for private medicine or independent health care. I hope that they will explain that clearly throughout the land, so that each district health authority can note the impact that that would have on their financing. Taking just competitive tendering and private health care in my district health authority, it is the equivalent of 96 consultant posts.
§ Dr. Moonie
I am grateful to the hon. Gentleman for giving way to me again. I appreciate that I have intervened twice already. He has twice mentioned the method of tendering and the money coming from private medicine. Is 1018 he aware that the money raised from competitive tendering is taken into account and that the Government have calculated the extra money that the health board should get in the following financial year? Surely the hon. Gentleman is not suggesting that the £2.5 million to provide private medical treatment all goes in as extra money. That would be nonsense. About 95 per cent. goes into the costs of administration and the treatment of that group of patients.
§ Mr. Baldry
The hon. Gentleman is wrong about competitive tendering. On occasions too numerous to particularise, Secretaries of State for Health have made it clear that the moneys raised by district health authorities and saved by competitive tendering redound to their credit. That has certainly happened in Oxfordshire and in every other district health authority. The money raised by private health care—£2.5 million in Oxfordshire this year—is money that would otherwise not go into the district health authority's coffers. If one removes the potential for the district health authority to treat private patients, that £2.5 million will no longer go into those coffers.
We have demonstrated beyond peradventure two points about the Opposition. First, they have no intellectual arguments with which they can challenge this sensible provision. Their general hilarity and levity are testimony to the fact that they have run out of sound arguments. Secondly, the Opposition have a continuing and inherent antipathy towards private medicine. Much of their opposition to these provisions, such as it is, is born of their opposition to private health care. They do not understand that, despite their protestations, there is already a growing partnership between the NHS and the independent sector. Through our reforms, that partnership will open up further opportunities for the public and private sectors to work together to provide services for each other, sharing the use and spreading the cost of expensive hospital facilities. That will redound to the benefit of NHS patients and health care as a whole.
I hope that the House will pass these provisions, which will enable those who have had medical insurance until retirement to continue with it into pensionable age. I am sure that in five or six years' time we will see that they are continuing to be of considerable benefit to health care.
§ Mr. Worthington
The provision to which new clause 4 responds is part of the Government's long-term consistent attack on the Health Service. Conservative Members have made several interventions, saying that it is not the Government's intention to attack or undermine the NHS, but we cannot take consolation from that. We know that the Prime Minister takes her principal intellectual support in the Tory party from those who believe that Socialism should be driven out of this country, and the NHS is the prime example of successful Socialism.
Some Conservative Members do not believe in the post-war consensus that part of the rights of citizenship should be access to the best possible health care, regardless of issues such as class, income, age, gender or ethnic origin. We want to defend that belief. This provision, giving tax relief for private medical insurance, is but a small part of the larger attack that is being mounted against the NHS. The NHS should give us a universal right to a comprehensive range of services of the best quality.
There is a fundamental division between the Opposition and the Government. Why would people invest in a 1019 private medical sector unless it were better? There are no grounds for selling a private medical service unless it is better. Imagine going to a consultant who said, "On the one hand, you can have an operation on the NHS and it will be available in two weeks. On the other, we can offer you an operation in the private sector and it will be available in six months' time." Would people like to have that service in six months' time? Of course not. The success of the private health market depends on being able to offer something better—especially reduced waiting times—than the NHS.
It is clear that the Government are stimulating the private health sector so that the comparisons between it and the NHS become increasingly invidious. The intellectual justification for the NHS will become increasingly weaker and people will withdraw their support from it.
§ Mr. John Butterfill (Bournemouth, West)
Does the hon. Gentleman accept that in some cases—I can cite cases in my constituency—the delay time for certain disciplines is identical in the NHS and the private sector, but the advantage for the person who buys private treatment is that he can specify the date more precisely? For those who need a precise date, it may be worth paying the money.
§ Mr. Worthington
I have no alternative but to accept the hon. Gentleman's assurance. If that were the normal pattern of relationships between the private sector and the NHS, the prospect for private medicine would be grim. That is not the position. There are long waiting lists for some NHS operations.
Let us nail one myth. We are not talking about two separate services—a private sector and a National Health Service—but about services that are intertwined. A consultant may operate on a patient in the NHS or the private sector. National Health Service premises provide the opportunity for the private sector to lay out its market stall so that the private consultant can say that if one stays with the NHS the wait will be six months, but if one goes into the private sector the wait will be two weeks. It is strange that an employee of the NHS can increase his income by being able to sell his private services on NHS time.
§ Mr. Couchman
I am grateful to the hon. Gentleman for giving way. He is more gracious than 1 was to him.
Is the hon. Gentleman deprecating the fact that some NHS doctors who are not contracted full time to the NHS operate outside the NHS in private hospitals? Has he chapter and verse of anyone who has had a six-month wait for an operation on the NHS, but has been offered an operation tomorrow if he goes into a private hospital?
§ Mr. Worthington
Every hon. Member has chapter and verse on that because constituents constantly come to our surgeries—a fortunate use of the word in this case—and tell us what has happened to, for example, their children. I can give an example of the condition of glue ear. The consultant said that he could deal with the case within a fortnight if the child became a private patient, but that he regretted to say that if the child simply went on the NHS list there would be a wait of several months. If there is a single hon. Member who cannot give chapter and verse on 1020 that constantly occurring, he is not in touch with his constituency, because such cases happen repeatedly. In effect, one goes to see an NHS consultant sitting at an NHS desk, who can sell another product while being employed by the NHS. It is a strange relationship in which one's primary loyalty is not to one's major employer.
Undoubtedly, the major inspiration for this provision came from the Prime Minister, and I cannot see Treasury Ministers denying that. The Prime Minister is ignoring one of her basic principles—that one should not fiddle the market place to subsidise private industry. The Opposition have asked frequently for help for firms in particular constituencies, but hon. Members are told that the Government will not support lame ducks or subsidise firms that cannot stand up in the market place. Yet now it seems to be acceptable for public money to be used to support private health care.
I want to ask a question which will be asked by many others who will be paying, even if only in a small way, extra taxes because of this concession. Why should I? What are the principles by which those people who choose not to have private insurance or who cannot afford to do so have to subsidise this tax concession? Why has this tax concession been singled out? We all know that many people pay taxes and, as their income increases, lose benefits. In effect, they are being taxed at 80 per cent. They should be a priority. One would also have thought that the priority was to strengthen the NHS, but the Government say, "No, this concession is the priority." They say that this is how they want to use our money. How can that be justified?
§ Mr. Hind
Does the hon. Gentleman accept that if there is tax relief of 25 per cent., or of 40 per cent. for elderly people, for every £25 in tax relief, the pensioners themselves are paying £75? That £75 would not be put into health care. What would happen is that the state would have merely the £25. We are increasing the volume of the gross national product going into health care. That must be a good thing.
§ Mr. Worthington
I am afraid that I did not hear the hon. Gentleman's entire point because a more urgent message arrived in the middle of his contribution. I hope that I can deal with his point in the remainder of my speech.
The essential point is whether the private sector strengthens the NHS. The Government and Conservative Members say that it does. If that is so, why do they not commission research to see whether the relationship between the NHS and the private sector is complementary or parasitic? I can tell Conservative Members that the Government have commissioned such research. I asked whether they had and I received a reply that they had commissioned research from the university of Sheffield. Because of the lack of time I must go through the conclusions quickly, but the study shows that, in terms of doctors and nurses, any further expansion of the private health sector will be achieved only by arresting or reversing the development of the NHS. It states that, with the present level of private activity,It is difficult to see how in the short term private sector activity could increase further without NHS consultants doing more work outside the normal working week, which may have consequences for the cost of treatment, or without many full time consultants switching to part time work, thereby reducing their NHS caseload.1021 The nursing pool is finite and will be under great pressure in the future.
I do not have time to quote the research in full, but if the Minister wants to look at it, he will see that it is clear that further expansion of the private health care sector will be damaging to the NHS. This proposal is part of that damage.
§ Mr. Nicholas Bennett
One of the canons of taxation in which I believe most firmly is that the taxation system should be as simple as possible so that it can be well understood by those who pay tax. I am not normally in favour of increasing the number of tax reliefs available, but I have noted that the White Paper on public expenditure said that tax reliefs can be justified on two grounds—first, encouraging savings and home ownership and, secondly, encouraging enterprise and training to make the economy more efficient. I believe that there should be a third category for which tax relief should be available as a matter of public policy; to increase personal responsibility and encourage people to look after themselves as much as possible. It can be allied with the principle of tax relief for home ownership. It is, in itself, a good principle that people should own their homes and look after themselves as much as possible.
That category applies also to private health insurance. It is a basic principle that it should be public policy to encourage people to help themselves as much as possible, especially when they reach an age at which they would normally find it more difficult to help themselves.
I also believe that tax relief for those aged 60 and over is important because it extends their range of choice. That is a vital argument in its favour. I do not like the idea, regularly expressed by Opposition Members, that we must restrict choice and prevent the staff from working in the private sector and patients from having an alternative to state-provided medicine.
§ Mr. Bennett
I am sorry, but the winding-up speeches are about to start and I have only a few minutes in which to speak.
Thirdly, I believe that those who help themselves by paying twice should enjoy some form of relief to compensate them for the fact that they are not only paying for the state-provided service but are providing for themselves in the private service. As my hon. Friend the Member for Lancashire, West (Mr. Hind) said, by encouraging people to take up this tax relief we shall increase the total amount available for Health Service spending. We can increase the total amount spent on health not only by increasing the contribution to the state sector, but by increasing the total sum available to the private sector. We must take advantage of that opportunity. Other countries in Europe do not spend much more on the state sector but they do spend much more on private sector health insurance.
Fourthly, those who use private facilities are thus relieving the National Health Service of demand, especially in the case of operations such as hip replacements which are of special benefit to the elderly. If hip operations are performed in the private sector, the National Health Service can concentrate on the more technically difficult operations. That will remove much of the day-to-day surgery from the NHS. The proposal 1022 would also increase co-operation between the private and nationalised sectors of the Health Service, and that is important.
Even with tax relief, those who pay for private insurance are still making a contribution on top of the contribution that they make as taxpayers. We should remember that. It is depressing that the Opposition should talk about handouts and giveaways and that they should fail to recognise that we are talking about relief on money that people have already earned and on which they have paid tax. The hon. Member for Wrexham (Dr. Marek) could not define what he meant by super super rich, super rich, rich or even poor when I asked him to do so.
Finally, it is rather depressing that the Liberal party, which has such a long tradition of pluralism and has long believed that people should have a choice and that there should be a private sector, have now reached the point at which they believe that people should not be able to choose the private sector and that the state must control the entire Health Service provision. No wonder that, having abandoned their philosophy, the Liberals have now abandoned their name.
§ Mr. Calum Macdonald (Western Isles)
Because of the pressure of time, I have had to throw away the speech that I intended to make. Instead, I shall rely on the words of the Financial Secretary himself, who last night advanced the most cogent argument against the tax allowance for private medical insurance. Last night, of course, the right hon. Gentleman was arguing against a tax allowance in respect of children. So persuaded was I by his argument that I refrained from voting, although I understood and sympathised with the motives of those who argued the case for new clause 23.
The Financial Secretary's arguments on that occasion are entirely applicable to this tax relief—perhaps even more so. The Financial Secretary will correct me if I misquote him. I was so struck by what he said that I took the trouble of writing it down. In rejecting the case for the new clause, he said:Governments have to choose in a world of limited resources. The Government were right to decide to deploy resources more to help families in greatest need."—[Official Report, 11 July 1989; Vol. 156.]If that is true, this tax allowance is certainly not an example of the Government deploying resources to the people in greatest need.
The Financial Secretary said that he was concerned to do something for people at the bottom end of the scale. If that is the Government's objective, they will certainly not achieve it through this tax relief. Most strikingly, the Financial Secretary rejected a child tax allowance because he said that it would be of no help to the 25 per cent. of families who did not pay tax. How, then, can the right hon. Gentleman justify a tax allowance that will be of no help to the two thirds of pensioners who pay no income tax? His argument is entirely inconsistent.
The Financial Secretary concluded his attack on new clause 23 by describing in some detail how such an allowance would be terribly regressive in its impact. He said that those paying tax at the higher rate would gain much more than those paying at the basic rate. That would also be true of the allowance that the Government are trying to push through. The Financial Secretary said that 1023 such a regressive allowance would be difficult to justify, and it seems to me that his words were the epitaph of this allowance.
§ Mr. Norman Lamont
So far in the course of our proceedings on this year's Finance Bill we have not heard tirades about the super-rich from the hon. Member for Wrexham (Dr. Marek), but tonight he has reverted to form and type, although even when pressed by my hon. Friend the Member for Pembroke (Mr. Bennett) he refused to say who he thought were the super-rich, except that he thought that they were a few people who had money in the bank. The hon. Gentleman thinks that the super-rich are people who have access to private medical insurance. That means that there are apparently 5½ million super-rich among the working population and 600,000 pensioners who are super-rich. I find it extraordinary that the hon. Member should maintain that this was a tax relief that would benefit only the very well-off.
It is time that the hon. Gentleman forgot about the super-rich. In our final debate on last year's Finance Bill the hon. Gentleman paraded a book called "The Super Rich", which had an art deco cover and was published 50 years ago. The hon. Gentleman's political ideas are no more up to date than his rhetoric.
The hon. Members for Wrexham and for Western Isles (Mr. Macdonald) seemed wholly unaware that the scheme to encourage elderly people to take out private medical insurance is technically available to non-taxpayers because it operates on the same basis as MIRAS. That is an important point of equity. Of course, we do not expect it to be widely used in that way, but it is an important point of principle and it was quite wrong for Opposition Members to misrepresent the tax relief, which is, indeed, available to non-taxpayers. A more important point, of course, is that we expect no less than 80 per cent. of the beneficiaries of the scheme to be basic rate taxpayers, who can hardly be classed as super-rich.
The main argument advanced by the hon. Member for Wrexham was that the relief was not targeted, but the whole point of the proposal is to generate additional subscriptions. We want to involve more people in private health insurance so that—as my hon. Friend the Member for Lancashire, West (Mr. Hind) said—we can get more resources into health care as a whole, both public and private.
The hon. Member for Berwick-upon-Tweed (Mr. Beith) referred to what I had said about the deadweight effect of the relief that he proposed. Of course, we should not have proposed this tax relief if we thought that it would have a purely deadweight effect in the long term. Although it will have a deadweight cost for a year or two, over time the relief would act as an incentive and would generate more subscriptions and thus bring more resources into health care. That is the whole purpose of the relief—to generate more resources and therefore, as my hon. Friend the Member for Banbury (Mr. Baldry) said, to relieve pressure on the National Health Service.
My hon. Friend the Member for Banbury was asked what evidence there is that people using the private sector will relieve pressure on the National Health Service. It seemed a strange question, but my hon. Friend gave a good answer by saying that, by definition, a person who uses the private sector for a certain treatment is not using 1024 the National Health Service for that treatment at that moment, and is actually saving and releasing resources that can be used by other people.
The strangest intervention in the debate came from the hon. Member for Berwick-on-Tweed. He said that one of the consequences of this relief would be to add to the pressures on the National Health Service. His reason was that, if people had acute operations or hip operations, they would be in good health—the implication seemed to be that they would live longer—and might require after-care and more attention from the National Health Service. That is a strange argument. It is totally inconsistent with what the hon. Gentleman has always said—that we should put more resources into the National Health Service. That also causes people to live longer and to add to pressure on the Health Service. Apparently, it is legitimate and permissible to live longer if we do it on the National Health Service, but not if we do so in the private sector. That seems to be the hon. Gentleman's argument.
This is a limited and targeted relief. It is targeted to help the elderly and to help people when private health insurance premiums rise. That is the sense in which it is targeted.
§ Mr. Turner
The Financial Secretary is telling us that this measure is targeted at the elderly. He said that 600,000 elderly people will benefit from it. What about the other 10 million pensioners in this country? In my constituency we are closing down 127 beds. Seriously ill people cannot get into Health Service hospitals. How can we possibly justify spending £40 million or up to £200 million when we are closing beds? Many of the seriously ill people who are not admitted to hospital will be elderly people who are not paying income tax. Again, that is the redistribution of wealth from the poor to the rich.
§ Mr. Lamont
It would, of course, be possible to spend all the money in the public expenditure round each year on the National Health Service. I am quite sure that, even if we did that, hon. Members would say that the demand for medical care in their constituencies was unsatisfied. The demand for medical care is probably infinite. The £40 million represented by this tax relief is 0.2 per cent. of the increase in expenditure in the Health Service this year, and it is 0.15 per cent. of expenditure in the Health Service in total. It really is a small amount of money, and it is a modest tax relief.
My hon. Friend the Member for Lancashire, West made a good point when he said that, after all, this is a pump-priming exercise. Every £25 that is spent by a basic ratepayer generates £75 of his own money as well. If he is a higher ratepayer, every pound that he gets in tax relief has to be matched by two and a half times that amount of money from his own pocket. As my hon. Friend the Member for Lancashire, West said, this is definitely a way of getting more resources into the Health Service.
§ Mr. Lamont
I will not give way. I must get on.
The hon. Member for Kirkcaldy (Dr. Moonie) said that the private sector is more expensive. It is extremely difficult to compare National Health Service costs with private sector costs. I am not sure whether one is comparing like with like. It would be surprising if, to some extent, the private sector did not have higher costs. Insurance companies have administration and marketing costs. The 1025 real comparison is not with an insurance company, with all its overheads, but between a private sector hospital and a National Health Service hospital. If one wanted to make the sort of comparisons that Opposition Members have been making, one should add in more state administration costs such as the cost of administering the collection of taxes, administering the Inland Revenue, Customs and Excise, and so on. Perhaps even the salary of the Government broker in the Department for National Savings should also be added.
The new clause is a wrecking clause. It is designed simply to make the scheme non-operational. We believe in a partnership between the private and public sectors. The modest tax relief in the Bill will help to generate more resources and relieve pressure on the National Health Service, and I urge my right hon. and hon. Friends to reject the new clause.
§ Dr. Marek
We have had a good debate. I am particularly grateful to my hon. Friends the Members for Clydebank and Milngavie (Mr. Worthington), for Kirkcaldy (Dr. Moonie) and for Western Isles (Mr. Macdonald) for making all the pertinent points that the Opposition would wish to make in defending and advocating the new clause.
To some extent, the Government have come clean. The Financial Secretary has at last admitted that private medical insurance is pump priming, that it is not a matter of the subsidy being £40 million. If, as he says, it generates new private money into the Health Service, more and more people will take out medical insurance and more and more people will thereby be given tax handouts. Therefore, the estimated £40 million loss to the Treasury will probably be wide of the mark, and the Opposition's £200 million estimate will be nearer the mark. The Financial Secretary said that it is essentially an open-ended commitment.
The Government cannot have it both ways. They say that the measure will generate more resources for the Health Service, but the Financial Secretary says that all the money in the public expenditure round each year can be spent on the Health Service. There is an inconsistency.
§ Dr. Marek
The Financial Secretary is shaking his head. In a perfect world in which there is enough money and in which the National Health Service is absolutely provided for, he would be right, but we are not in a perfect world. The National Health Service is desperately short of money.
Conservative Members are not putting more money into the Health Service; they are buying privilege and choice at the expense of others who are not in a position to pay for privilege and choice. That is the essential difference between the Conservative and Labour parties. Of course some people are prepared to pay for that choice. The Government will give them that opportunity, and the Opposition can only table a clause to restrain some of the wilder excesses of the tax advantages that will go to people who do not need them. There is no incentive. It is right for the Financial Secretary to say that 80 per cent. of taxpayers will take advantage of it, but that is because only 2.6 per cent. of pensioners pay at the higher rates. I bet that 80 per cent. of the 2.6 per cent. of higher rate taypayers will also contribute and take advantage of these handouts.
§ Dr. Moonie
Before my hon. Friend leaves the absurdity of the Financial Secretary's statements, will he comment on the one in which he tried to equate spending on health insurance with spending on health care?
§ Dr. Marek
My hon. Friend makes a valid point, but I am afraid that the time forbids me to develop it.
The issue is clear. Although Conservative Members do not say so, their arguments that are based on more money for the Health Service have an extra facet. People who can take advantage of the provisions are, in effect, saying, "Yes, but we want choice and privilege and a better service than other people who do not have even the possibility of paying for treatment." It is on that basis that we have tabled our new clause, which we commend to the House.
§ Question put, That the clause be read a Second time:—
§ The House divided: Ayes 207, Noes 267.1029
|Division No. 295]||[16.59 pm|
|Abbott, Ms Diane||Fields, Terry (L'pool B G'n)|
|Allen, Graham||Flannery, Martin|
|Alton, David||Flynn, Paul|
|Anderson, Donald||Foot, Rt Hon Michael|
|Archer, Rt Hon Peter||Foster, Derek|
|Ashton, Joe||Foulkes, George|
|Barnes, Harry (Derbyshire NE)||Fraser, John|
|Barnes, Mrs Rosie (Greenwich)||Fyfe, Maria|
|Beckett, Margaret||Galbraith, Sam|
|Beith, A. J.||Garrett, John (Norwich South)|
|Bennett, A. F. (D'nt'n & R'dish)||Gilbert, Rt Hon Dr John|
|Bermingham, Gerald||Godman, Dr Norman A.|
|Bidwell, Sydney||Golding, Mrs Llin|
|Blair, Tony||Gould, Bryan|
|Blunkett, David||Graham, Thomas|
|Boateng, Paul||Grant, Bernie (Tottenham)|
|Boyes, Roland||Griffiths, Nigel (Edinburgh S)|
|Bradley, Keith||Griffiths, Win (Bridgend)|
|Bray, Dr Jeremy||Grocott, Bruce|
|Brown, Nicholas (Newcastle E)||Hardy, Peter|
|Brown, Ron (Edinburgh Leith)||Harman, Ms Harriet|
|Bruce, Malcolm (Gordon)||Hattersley, Rt Hon Roy|
|Buckley, George J.||Haynes, Frank|
|Callaghan, Jim||Heffer, Eric S.|
|Campbell, Menzies (Fife NE)||Henderson, Doug|
|Campbell, Ron (Blyth Valley)||Hinchliffe, David|
|Carlile, Alex (Mont'g)||Hoey, Ms Kate (Vauxhall)|
|Cartwright, John||Home Robertson, John|
|Clark, Dr David (S Shields)||Hood, Jimmy|
|Clarke, Tom (Monklands W)||Howarth, George (Knowsley N)|
|Clay, Bob||Howell, Rt Hon D. (S'heath)|
|Clelland, David||Howells, Geraint|
|Clwyd, Mrs Ann||Hoyle, Doug|
|Cohen, Harry||Hughes, John (Coventry NE)|
|Cook, Frank (Stockton N)||Hughes, Robert (Aberdeen N)|
|Cook, Robin (Livingston)||Hughes, Roy (Newport E)|
|Corbyn, Jeremy||Hughes, Simon (Southwark)|
|Cousins, Jim||Illsley, Eric|
|Cryer, Bob||Ingram, Adam|
|Cummings, John||Janner, Greville|
|Cunliffe, Lawrence||Jones, Barry (Alyn & Deeside)|
|Cunningham, Dr John||Jones, Ieuan (Ynys Môn)|
|Dalyell, Tam||Jones, Martyn (Clwyd S W)|
|Darling, Alistair||Kaufman, Rt Hon Gerald|
|Davies, Rt Hon Denzil (Llanelli)||Kennedy, Charles|
|Davies, Ron (Caerphilly)||Kinnock, Rt Hon Neil|
|Davis, Terry (B'ham Hodge H'I)||Kirkwood, Archy|
|Dewar, Donald||Lambie, David|
|Dixon, Don||Lamond, James|
|Dobson, Frank||Leadbitter, Ted|
|Doran, Frank||Lestor, Joan (Eccles)|
|Dunnachie, Jimmy||Lewis, Terry|
|Dunwoody, Hon Mrs Gwyneth||Litherland, Robert|
|Eadie, Alexander||Livingstone, Ken|
|Ewing, Mrs Margaret (Moray)||Livsey, Richard|
|Fearn, Ronald||Lloyd, Tony (Stretford)|
|Field, Frank (Birkenhead)||Lofthouse, Geoffrey|
|Loyden, Eddie||Richardson, Jo|
|McAllion, John||Roberts, Allan (Bootle)|
|McAvoy, Thomas||Robertson, George|
|McCartney, Ian||Robinson, Geoffrey|
|Macdonald, Calum A.||Rogers, Allan|
|McFall, John||Rooker, Jeff|
|McKay, Allen (Barnsley West)||Ross, Ernie (Dundee W)|
|McKelvey, William||Rowlands, Ted|
|McLeish, Henry||Ruddock, Joan|
|Maclennan, Robert||Sedgemore, Brian|
|McNamara, Kevin||Sheldon, Rt Hon Robert|
|Madden, Max||Shore, Rt Hon Peter|
|Mahon, Mrs Alice||Short, Clare|
|Mallon, Seamus||Skinner, Dennis|
|Marek, Dr John||Smith, Andrew (Oxford E)|
|Marshall, David (Shettleston)||Smith, C. (Isl'ton & F'bury)|
|Marshall, Jim (Leicester S)||Smith, Rt Hon J. (Monk'ds E)|
|Martin, Michael J. (Springburn)||Smith, J. P. (Vale of Glam)|
|Martlew, Eric||Soley, Clive|
|Maxton, John||Spearing, Nigel|
|Meacher, Michael||Steel, Rt Hon David|
|Meale, Alan||Steinberg, Gerry|
|Michael, Alun||Stott, Roger|
|Michie, Bill (Sheffield Heeley)||Strang, Gavin|
|Michie, Mrs Ray (Arg'l & Bute)||Straw, Jack|
|Mitchell, Austin (G't Grimsby)||Taylor, Mrs Ann (Dewsbury)|
|Moonie, Dr Lewis||Taylor, Matthew (Truro)|
|Morgan, Rhodri||Thompson, Jack (Wansbeck)|
|Morley, Elliott||Turner, Dennis|
|Morris, Rt Hon A. (W'shawe)||Vaz, Keith|
|Mowlam, Marjorie||Wall, Pat|
|Mullin, Chris||Wallace, James|
|Murphy, Paul||Walley, Joan|
|Oakes, Rt Hon Gordon||Wareing, Robert N.|
|O'Brien, William||Watson, Mike (Glasgow, C)|
|Orme, Rt Hon Stanley||Welsh, Michael (Doncaster N)|
|Parry, Robert||Wigley, Dafydd|
|Patchett, Terry||Williams, Alan W. (Carm'then)|
|Pendry, Tom||Wilson, Brian|
|Pike, Peter L.||Winnick, David|
|Powell, Ray (Ogmore)||Wise, Mrs Audrey|
|Prescott, John||Worthington, Tony|
|Primarolo, Dawn||Wray, Jimmy|
|Quin, Ms Joyce||Young, David (Bolton SE)|
|Randall, Stuart||Tellers for the Ayes:|
|Redmond, Martin||Mr. Allen Adams and|
|Rees, Rt Hon Merlyn||Mr. Ken Eastham.|
|Reid, Dr John|
|Adley, Robert||Bottomley, Mrs Virginia|
|Aitken, Jonathan||Bowden, A (Brighton K'pto'n)|
|Alexander, Richard||Bowden, Gerald (Dulwich)|
|Alison, Rt Hon Michael||Bowis, John|
|Allason, Rupert||Boyson, Rt Hon Dr Sir Rhodes|
|Amess, David||Braine, Rt Hon Sir Bernard|
|Amos, Alan||Brandon-Bravo, Martin|
|Arbuthnot, James||Brazier, Julian|
|Arnold, Jacques (Gravesham)||Brooke, Rt Hon Peter|
|Ashby, David||Brown, Michael (Brigg & Cl't's)|
|Aspinwall, Jack||Browne, John (Winchester)|
|Atkins, Robert||Bruce, Ian (Dorset South)|
|Baker, Rt Hon K. (Mole Valley)||Buck, Sir Antony|
|Baker, Nicholas (Dorset N)||Budgen, Nicholas|
|Baldry, Tony||Burns, Simon|
|Banks, Robert (Harrogate)||Burt, Alistair|
|Batiste, Spencer||Butcher, John|
|Beaumont-Dark, Anthony||Butler, Chris|
|Bellingham, Henry||Butterfill, John|
|Bendall, Vivian||Carlisle, John, (Luton N)|
|Bennett, Nicholas (Pembroke)||Carlisle, Kenneth (Lincoln)|
|Bevan, David Gilroy||Carrington, Matthew|
|Biffen, Rt Hon John||Carttiss, Michael|
|Blackburn, Dr John G.||Cash, William|
|Body, Sir Richard||Chalker, Rt Hon Mrs Lynda|
|Bonsor, Sir Nicholas||Channon, Rt Hon Paul|
|Boscawen, Hon Robert||Chapman, Sydney|
|Boswell, Tim||Chope, Christopher|
|Bottomley, Peter||Clark, Dr Michael (Rochford)|
|Clark, Sir W. (Croydon S)||Irvine, Michael|
|Clarke, Rt Hon K. (Rushcliffe)||Irving, Charles|
|Colvin, Michael||Jack, Michael|
|Conway, Derek||Janman, Tim|
|Coombs, Anthony (Wyre F'rest)||Jessel, Toby|
|Coombs, Simon (Swindon)||Jones, Gwilym (Cardiff N)|
|Cope, Rt Hon John||Jones, Robert B (Herts W)|
|Couchman, James||Key, Robert|
|Cran, James||Kilfedder, James|
|Critchley, Julian||King, Roger (B'ham N'thfield)|
|Currie, Mrs Edwina||Knapman, Roger|
|Curry, David||Knight, Greg (Derby North)|
|Davies, Q. (Stamf'd & Spald'g)||Knowles, Michael|
|Davis, David (Boothferry)||Knox, David|
|Day, Stephen||Lamont, Rt Hon Norman|
|Devlin, Tim||Lang, Ian|
|Dicks, Terry||Latham, Michael|
|Dorrell, Stephen||Lawrence, Ivan|
|Douglas-Hamilton, Lord James||Lawson, Rt Hon Nigel|
|Dover, Den||Lee, John (Pendle)|
|Durant, Tony||Leigh, Edward (Gainsbor'gh)|
|Dykes, Hugh||Lennox-Boyd, Hon Mark|
|Eggar, Tim||Lester, Jim (Broxtowe)|
|Emery, Sir Peter||Lightbown, David|
|Evans, David (Welwyn Hatf'd)||Lilley, Peter|
|Evennett, David||Lloyd, Sir Ian (Havant)|
|Fairbairn, Sir Nicholas||Lloyd, Peter (Fareham)|
|Fallon, Michael||Lord, Michael|
|Field, Barry (Isle of Wight)||Macfarlane, Sir Neil|
|Finsberg, Sir Geoffrey||MacGregor, Rt Hon John|
|Fishburn, John Dudley||MacKay, Andrew (E Berkshire)|
|Fookes, Dame Janet||McLoughlin, Patrick|
|Forman, Nigel||McNair-Wilson, Sir Michael|
|Forsyth, Michael (Stirling)||McNair-Wilson, Sir Patrick|
|Forth, Eric||Major, Rt Hon John|
|Fowler, Rt Hon Norman||Malins, Humfrey|
|Franks, Cecil||Mans, Keith|
|Freeman, Roger||Maples, John|
|French, Douglas||Marland, Paul|
|Gale, Roger||Marlow, Tony|
|Gardiner, George||Marshall, John (Hendon S)|
|Garel-Jones, Tristan||Marshall, Michael (Arundel)|
|Gill, Christopher||Martin, David (Portsmouth S)|
|Glyn, Dr Alan||Mawhinney, Dr Brian|
|Goodson-Wickes, Dr Charles||Maxwell-Hyslop, Robin|
|Gorman, Mrs Teresa||Mayhew, Rt Hon Sir Patrick|
|Gow, Ian||Mellor, David|
|Grant, Sir Anthony (CambsSW)||Miller, Sir Hal|
|Greenway, Harry (Ealing N)||Mills, Iain|
|Greenway, John (Ryedale)||Mitchell, Andrew (Gedling)|
|Gregory, Conal||Mitchell, Sir David|
|Griffiths, Sir Eldon (Bury St E')||Montgomery, Sir Fergus|
|Griffiths, Peter (Portsmouth N)||Moore, Rt Hon John|
|Ground, Patrick||Morris, M (N'hampton S)|
|Hague, William||Moss, Malcolm|
|Hamilton, Neil (Tatton)||Moynihan, Hon Colin|
|Hampson, Dr Keith||Mudd, David|
|Hanley, Jeremy||Neale, Gerrard|
|Hannam, John||Needham, Richard|
|Hargreaves, A. (B'ham H'll Gr')||Neubert, Michael|
|Hargreaves, Ken (Hyndburn)||Newton, Rt Hon Tony|
|Harris, David||Nicholls, Patrick|
|Haselhurst, Alan||Nicholson, David (Taunton)|
|Hawkins, Christopher||Nicholson, Emma (Devon West)|
|Hayes, Jerry||Norris, Steve|
|Hayhoe, Rt Hon Sir Barney||Onslow, Rt Hon Cranley|
|Hayward, Robert||Oppenheim, Phillip|
|Heathcoat-Amory, David||Paice, James|
|Heddle, John||Patnick, Irvine|
|Heseltine, Rt Hon Michael||Patten, Rt Hon Chris (Bath)|
|Hicks, Robert (Cornwall SE)||Pattie, Rt Hon Sir Geoffrey|
|Higgins, Rt Hon Terence L.||Pawsey, James|
|Hind, Kenneth||Peacock, Mrs Elizabeth|
|Hogg, Hon Douglas (Gr'th'm)||Porter, Barry (Wirral S)|
|Hordern, Sir Peter||Porter, David (Waveney)|
|Howarth, G. (Cannock & B'wd)||Price, Sir David|
|Howe, Rt Hon Sir Geoffrey||Raffan, Keith|
|Hughes, Robert G. (Harrow W)||Raison, Rt Hon Timothy|
|Hunt, David (Wirral W)||Redwood, John|
|Hunt, Sir John (Ravensbourne)||Riddick, Graham|
|Ridley, Rt Hon Nicholas||Stewart, Allan (Eastwood)|
|Ridsdale, Sir Julian||Stewart, Andy (Sherwood)|
|Roberts, Wyn (Conwy)||Stokes, Sir John|
|Roe, Mrs Marion||Stradling Thomas, Sir John|
|Rossi, Sir Hugh||Sumberg, David|
|Rost, Peter||Summerson, Hugo|
|Rowe, Andrew||Taylor, Ian (Esher)|
|Ryder, Richard||Taylor, John M (Solihull)|
|Sackville, Hon Tom||Thompson, D. (Calder Valley)|
|Sainsbury, Hon Tim||Thorne, Neil|
|Sayeed, Jonathan||Townsend, Cyril D. (B'heath)|
|Scott, Rt Hon Nicholas||Trippier, David|
|Shaw, David (Dover)||Waddington, Rt Hon David|
|Shaw, Sir Giles (Pudsey)||Wakeham, Rt Hon John|
|Shephard, Mrs G. (Norfolk SW)||Walker, Bill (T'side North)|
|Shepherd, Colin (Hereford)||Waller, Gary|
|Skeet, Sir Trevor||Wardle, Charles (Bexhill)|
|Smith, Tim (Beaconsfield)||Wells, Bowen|
|Speller, Tony||Wheeler, John|
|Spicer, Sir Jim (Dorset W)||Widdecombe, Ann|
|Squire, Robin||Winterton, Mrs Ann|
|Stanbrook, Ivor||Winterton, Nicholas|
|Stanley, Rt Hon Sir John|
|Steen, Anthony||Tellers for the Noes:|
|Stern, Michael||Mr. Alan Howarth and|
|Stevens, Lewis||Mr. David Maclean.|
§ Question accordingly negatived.