Orders of the Day — Road Traffic (NHS Charges) Bill

House of Commons, 21 January 1999.

ABOLITION OF EMERGENCY TREATMENT FEE

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I beg to move, That the clause be read a Second time. In previous debates on the Bill, we have heard the Government boast of the abolition of the emergency treatment fee as it applies to hospitals. The Liberal Democrats strongly support that on the basis that the fee was bureaucratic and on the basis of the Government's further justifications for the move, which are that it is offensive to patients arriving in hospital to be asked to pay a fee and that the amount raised does not compensate for the bureaucratic nightmare of collecting it. The Bill, in its current form, is inadequate because it does not remove the emergency treatment fee as chargeable by general practitioners. Liberal Democrats see hardly any difference between the bureaucracy involved in collecting the general practitioner emergency treatment fee and that involved in collecting the hospital emergency treatment fee. There is also very little difference between the difficulties of approaching people who may have been injured in an accident, albeit always the driver in the case of the GP fee, and patients arriving in hospital for treatment following a road traffic accident. There is certainly no difference in the lack of information about whether it is worth while for the fee to be collected by front-line health service staff. I wonder whether the Government, even at this late stage, will consider accepting the new clause on the basis that it fits in with the rationale of their original motives in the Bill.

John Hutton (Labour, Barrow and Furness)

As I understand it, the hon. Gentleman is seeking to remove the right of independent contractors—GPs—to claim the emergency treatment fee. Has the hon. Gentleman sought the views of the British Medical Association on this matter and what opinion has it expressed to him?

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I intend to deal with those points during my presentation of the rationale behind this new clause. Two questions need to be answered by those proposing the new clause. First, should GPs receive a fee for the treatment given and, secondly, if they do, should that come direct from an individual patient? General practitioners receive a fee for giving contraceptive advice. That fee comes not from the person to whom they have given the advice but from the health authority and it is in addition to their capitation fee. They are also rewarded for meeting screening targets. The normal way for GPs to be reimbursed, other than through their capitation fee, is through an item-of-service claim. General practitioners are used to claiming from health authorities for specific items of service. Those proposing this new clause are not suggesting that GPs should not be reimbursed for their time, but that the current method is discriminatory because, in the first instance, GPs must approach a patient or even a third party for the fee. That does not fit in with the current arrangements for GP reimbursement. I can assure the Minister that, if an alternative mechanism of claiming for a GP's time and effort in a roadside attendance can be arranged through regulation, no GP need be out of pocket. In case the Minister is not aware of this, I shall remind him of the difficulties that GPs face currently when collecting the fee. I asked the BMA for its view on the collectability of the fee and, in the first instance, it could not find any GP who regularly made an effort to collect it. My hon. Friend the Member for Isle of Wight (Dr. Brand), who is a practising GP, although on a part-time basis because of his onerous parliamentary duties, said that during his time as a GP, he has never found it worth the effort to collect the fee. He said that he does know some people who do put in the effort, but they question whether it is worth while. If I explain the procedure that GPs have to follow to collect the fee, the House will begin to see why it is not worth retaining, even if there were not strong arguments for the principle being wrong. The BMA has produced a guidance sheet for GP members on the Road Traffic Act 1988 emergency treatment fee. Section 158 of that Act applies and that is what the new clause would abolish. The guidance says: Under the Road Traffic Act 1988 doctors may generally claim a fee for providing emergency medical or surgical treatment to a person suffering bodily and/or fatal injury arising out of the use of a motor vehicle on a public highway. A fee of £21.30 may be claimed for rendering treatment to an individual involved in a road traffic accident; and a fee of 41p may be claimed for each complete mile and additional part of a mile for any distance in excess of two miles which a practitioner must travel in order to provide the emergency treatment. The payment may be claimed by any doctor whenever he or she is the first person to provide treatment. The person who is using the vehicle at the time the event occurred out of which the bodily injury arose is the person responsible for the payment of the practitioner's fee. We therefore have a situation in which GPs are approaching drivers of vehicles who may or may not have been injured—presumably they have survived—to ask for 41p per mile, perhaps after quickly hammering out the figures on a calculator. Such a situation is highly inappropriate, as the Government have recognised elsewhere in the Bill by abolishing the hospital emergency treatment fee.

Andrew Dismore (Labour, Hendon)

The hon. Gentleman is making a mountain out of a molehill. As a personal injury solicitor, I have had to deal with cases on behalf of accident victims many times, and it was a straightforward matter. If a claim is made, the docket is passed to a solicitor, who will either pass it to the driver's insurers or claim it back from the other insurance company. It is a very straightforward process that is easily administered. Sometimes, the victim will pay out the fee and collect it back. I do not see what all the fuss is about.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

Lawyers involved in processes in which they are paid always claim that the process is smooth and easy. If the hon. Gentleman will be patient, I shall explain the advice that the BMA gives to its doctors on how to claim the fee, with or without the services of the legal profession. I should say that I know of no solicitor who would charge a lower fee. Perhaps the hon. Gentleman is particularly generous—which is why he is no longer practicing—in being prepared to do such work for less than the £21.30 plus 41p per complete mile in excess of two miles, assuming that a doctor is the first person to reach an accident. Another invidious principle is the requirement to work out who is the first doctor on the scene, and therefore who can claim the fee. If the hon. Gentleman is patient, I shall explain the process as GPs see it. The BMA advice continues: Practitioners should take the following steps to recover their fees: (i) An oral request may be made to the person who was using the vehicle at the time of the occurrence which led to the provision of the emergency treatment. That presumes that the person is alive, conscious and able to hear such an oral request. I suspect that any GP who pauses at the scene of an accident to make such a request is being forced by the current regulations—if he or she is obeying them—to put secondary considerations before his or her duty of care to patients. The advice goes on to say that, if an oral request is not made, A written request must be made to the above-defined person. This request must be served upon that person within seven days from when emergency treatment was given. It must be signed by the claimant, stating his name and address, the circumstances in which the emergency treatment was effected, and that the claimant was the first person to provide such emergency treatment. The request may be served by delivering it to the person who was using the vehicle, or by sending it by recorded delivery addressed to him/her at his/her usual or last-known address. The amount of administration that such a process involves for a GP, or for his or her staff, makes it not worth while to collect the fee. A greater consideration is the offence that might be caused to a person in hospital who receives such a request within seven days of an accident. Nothing could be better calculated to damage doctor-patient relationships.

Andrew Dismore (Labour, Hendon)

rose—

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

Perhaps the hon. Gentleman will offer more legal advice.

Andrew Dismore (Labour, Hendon)

It is all very well hearing about such situations in theory, but, in practice, such situations do not occur. A docket is sent in, and it is paid. What is all the fuss about? The BMA may have established a long and complicated procedure, but such situations are dealt with very differently in reality.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I question that. I have asked the BMA what action GPs must take to collect the fee. I should prefer to believe the BMA and former colleagues of mine about the advice given by the BMA than to believe the advice of a solicitor who may or may not be involved in the case. It depends on whether GP practices have a contract with a local firm of solicitors. On many occasions, I have heard the Secretary of State call for less NHS time and money to be spent on legal fees and more on patient care. The interventions of the hon. Member for Hendon (Mr. Dismore) suggest that he would like that reversed and thinks that every GP should have a contract with a local firm of solicitors to maximise their income. That may be good for solicitors, but it is not good for general practitioners and it certainly is not good for patients, who, directly or indirectly, are on the receiving end of the demands for payment. The guidance given to doctors under existing legislation suggests that they must approach an accident victim within seven days of an accident to ask for the money. The £21.30 fee has not been raised since the introduction of the provision in 1988, but it is still a significant sum. The measure is highly regressive because it is a charge made to patients. It is offensive to them in principle and because of the time scale. The GP may well not know who the driver was. It is not the first question that a doctor at the scene of an accident asks and it may not even be the last. The guidance helpfully goes on to explain: When a practitioner experiences difficulty in ascertaining the name and address of the person who was using the vehicle, s/he should make application to the appropriate chief constable. That is astonishing advice to give busy front-line staff. It continues: In these circumstances this official is required by the Act to supply the practitioner with any information at his/her disposal as to the identification marks of any motor vehicle which the practitioner alleges to be a vehicle out of the use of which the bodily injury arose, and as to the identity and address of the person who was using it at that time. That is overly bureaucratic. It is a waste of time and energy for the front-line staff in the health service. Chief constables and their officers have better things to do than to chase £21.30 fees across counties, across police authorities and across the country to reimburse GPs for roadside advice given. I believe that in their heart of hearts, the Minister and the other Labour Member present—Labour Members, I should say, because I see the Whip as well—know that it is nonsense. It would be easier and more logical for them to accept the new clause. We should be happy to support them if they did. I hope to hear specific reasons from the Minister why that cannot be done. The BMA advice goes on: The fees payable under the Act are recoverable by court proceedings as if they were a simple contract debt due from the person who was using the vehicle to the practitioner rendering service. That may be why lawyers are so interested in the retention of the measure. If no money comes forward, there is more work for solicitors.

Andrew Dismore (Labour, Hendon)

rose—

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

If the hon. Gentleman does not mind, I shall let him make his comments when I have finished this point. The guidance goes on: However, in the event of a doctor being unable to obtain this fee, s/he may claim an ordinary 'Emergency Treatment Fee' from the relevant health authority (as covered by paragraph 33.8 of the Statement of fees and allowances). That means that after the general practitioner has gone through all those hoops without making progress and all that time and money has been wasted, there is provision to claim an ordinary fee for treatment from the health authority, just as a GP would for a patient who was not on his list but needed urgent and necessary treatment. Surely the Government can accept the new clause and recognise that the usual way to provide for such a fee is for doctors to be able to claim it back from the health authority without going through such hoops.

Andrew Dismore (Labour, Hendon)

The hon. Gentleman is not reflecting reality. He has had a few pot-shots at lawyers. No lawyer will ever get rich on this fee. In 20 years in practice, I have never known a GP sue a victim to get the money back. It is just an extra line to add to the column of calculations. I have never charged anyone for it and I do not know anyone who has.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

That adds to the force of my argument. No one benefits from the regulations. I was being charitable to the Government, who want to retain the charge, by supposing that there might be some group of professionals lobbying for the retention of the system. I do not blame GPs for wanting to retain the income, but they can do that through item-of-service claims from the health authority. If lawyers are not getting rich on it, patients find it offensive, GPs find it hardly worth the trouble and health authorities eventually have to pick up the tab, that is the definition of a bad law. Bad laws are repealed when a suitable legislative opportunity arises and the Minister must accept that this is such an opportunity. I am simply asking the Government to accept new clause 1, either here or in another place.

Simon Hughes (Liberal Democrat, North Southwark and Bermondsey)

Can my hon. Friend tell the House what percentage of the total revenue value is collected under present arrangements? Another argument in support of his proposition that a bad law is one that practically nobody uses is the fact that most people do not avail themselves of the legislation.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I thank my hon. Friend for that intervention. Indeed, the hon. Member for Rutland and Melton (Mr. Duncan), who cannot be here today, asked that question in Committee. The Minister replied that he did not know how much money was collected and said that the information.… is not collected centrally and acknowledged that that was a familiar refrain. Many of us consider it to be a euphemism for saying that the information is not collected deliberately. If the Government were able to ascertain by means of a simple survey of a random sample the sum of money that was collected by GPs, I expect that they would find that it was precious little. I am sure that health authorities have accounts of how much they dole out under the emergency treatment provision, although the road traffic cases would have to be separated from the rest. I accept that the information is impossible to obtain, except by means of survey, but all the evidence so far suggests that it is hardly collected. Even if the fee were to raise a substantial sum, the Liberal Democrats would still consider it inappropriate. The fact that it offends patients and is a direct charge on drivers who may be patients for NHS care is sufficient reason for that charge to be abolished, just as the Government propose to abolish the hospital emergency treatment fee. The Minister said in Committee: we are removing the right of NHS hospitals to collect the emergency treatment fee. It is right that we do that because it is a nightmare to collect. Front-line NHS staff are involved in recovering charges, which is not appropriate; the fee is set at a level that calls into question its worth; and we sympathise with the plight of some drivers who are faced with a bill for treatment. —[Official Report, Standing Committee B, 12 January 1999; c. 65-6.] There is no difference between the GP emergency treatment fee and the hospital one. Indeed, hospitals could arrange for solicitors to act on their behalf. I did not notice the hon. Member for Hendon proposing on Second Reading or in Committee that hospitals could employ solicitors. What applies to GPs should also apply to hospitals. As the Minister pointed out, the only difference is that GPs are independent contractors. I accept that, but there is still a provision for those independent contractors to receive the fees to which they are entitled. Will the Minister consider accepting the new clause? Ultimately its implementation will cost nothing as the fee can be collected by health authorities. The new clause would fulfil what I believe to be the intentions of those who drafted the Bill and avoid offending drivers and patients who are asked to pay directly that small but significant fee to the NHS.

Philip Hammond (Conservative, Runnymede and Weybridge)

The Opposition support the new clause, as it is identical to the one tabled in Committee by my hon. Friend the Member for Rutland and Melton (Mr. Duncan), who sadly is unable to be here today. He sends his apologies, as he is attending the funeral of His Grace the Duke of Rutland. The issue was debated extensively in Committee, but was not voted on owing to some confusion over the interrelationship between new clause 1 and clause 18 of the Bill. I understand that it has now been established that new clause 1 stands alone, and can be considered alone today. As the hon. Member for Oxford, West and Abingdon (Dr. Harris) said, all parties to the discussion recognise that the emergency treatment fee has caused disproportionate costs to those collecting it and distress to those from whom it is collected. The previous Government made it clear that it was their intention to abolish the emergency treatment fee as soon as a convenient legislative opportunity arose. It was not a burning issue—more of a tidying—up exercise. This Bill is such an opportunity. The Minister's immediate predecessor—now the Chief Secretary to the Treasury—referred to the charge as a "sick tax" and a "tax on accidents". Fortunately for the right hon. Gentleman, fate intervened to prevent the Committee from hearing his explanation of the retention of what my hon. Friend the Member for Rutland and Melton has described as a "fag-end" of a charge. The Minister has indicated in Committee that his motivation for retaining the charge is essentially permissive, and that he seeks to leave it to individual GPs to decide whether or not it is worth collecting the charge. That runs the risk of different practices being adopted in different places, and of public confusion being generated. The Minister will agree that concern about different treatment of similar cases is one of the consistent themes of the debate about the NHS. At £21.30, the charge is probably irrelevant to most GPs, but it is also insulting. Either they are expected to attend accidents as part of their contracted NHS work—and should, as the hon. Member for Oxford, West and Abingdon said, be suitably rewarded by the NHS for that work—or, if that work is viewed as independent and outside the NHS GP contract, they should be able to levy a charge that reflects the real contribution that they make at the incident. We should bear it in mind that, for the most part, the patients are not the GP's own patients but passing strangers, and that the GP has happened to be the first person available at the scene. The Minister and the House may recall a case that was widely reported in the press a few months ago, in which a doctor on an American Airlines flight rendered life-saving assistance to another passenger, and sent the airline a bill for £240 which the airline refused to pay. The doctor, in a much-publicised case, sued the airline in London for payment of his bill. The public attitude at the time was that the airline's compensation to the doctor—a bottle of champagne, which probably had about the value of the £21.30 charge that we are talking about—was wholly inappropriate and insulting in the circumstances of a life-saving intervention. It was widely thought to be a mean recompense for the work that he had done. The Minister has presented the retention of the emergency treatment fee as an opportunity for GPs—as essentially a permissive measure, allowing GPs to charge the fee. However, is it not in fact essentially restrictive in its operation? Does not the emergency treatment fee define the amount that a GP—a private contractor—is able to charge for attending a road accident, and set that amount at an artificially low level? If the levying of a charge by a GP at the scene of an accident is to be seen as an act of private medicine—something that the GP carries out outside the terms of his NHS contract—the charge is limiting, and too low. If, on the other hand, it is to be seen as part of a GP's NHS duties, it is very important that the application of the emergency treatment fee, and the charging of it to patients, should be universal, because it will rightly lead to public discontent if people in the same situation are treated in different ways on different occasions. The emergency treatment charge, and the cost and distress caused by its collection, can no longer be justified by the same logic that the Government have used to argue for the abolition of the charge in hospitals. It is a fag-end of a charge and no longer has any constructive use in the context of the rest of the Bill.

John Hutton (Labour, Barrow and Furness)

We discussed this aspect of the Bill extensively in Committee. Most of the arguments that we have heard today were substantially rehearsed then. I made it clear in Committee that I had some sympathy with the arguments but, for the reasons that I gave then, and which I will briefly rehearse again today, I will invite the House to reject the new clause if the hon. Member for Oxford, West and Abingdon (Dr. Harris) forces a Division. I must correct one or two misunderstandings that have arisen today. The hon. Member for Oxford, West and Abingdon implied that the emergency treatment fee was last increased in 1988; that is not the case—I am sure that it was merely a slip on his part—as it was last increased in 1995 by the previous Government. The hon. Member for Runnymede and Weybridge (Mr. Hammond) said that they intended to abolish it—unfortunately, they never got round to doing it, although they had 18 years in which to have a fist at it—but I understand that, far from the position being as the hon. Gentleman said, Ministers in the previous Administration decided ultimately not to abolish it. That might be food for thought for the hon. Gentleman when he considers whether his hon. Friends should support the new clause. I want to re-emphasise the fact that we have received no representations at all from the medical profession asking us to remove the right to claim the emergency treatment fee. The failure of the hon. Member for Oxford, West and Abingdon to tell the House the result of his consultation with the medical profession was conspicuous. I asked him whether it had expressed a view to him about whether the emergency treatment fee should be abolished. I understand its position to be that it wants the right to claim the fee to be retained in the legislation. As a general principle of how we legislate, I am not sure that it is a terribly good idea to introduce changes at this stage of a Bill's progress without consulting the relevant people—in this case, the medical profession—in the way that the hon. Member for Oxford, West and Abingdon implied that he had.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I made it clear at the beginning of my speech that we were seeking to abolish not the right of general practitioners to claim the fee but the provision whereby they have to approach the patient, whether directly or through a solicitor. That is crucial. The general practitioners to whom I spoke—at least one of whom is present in the House—would welcome the opportunity to claim the fee through the health authority, in the normal way, and not directly from the patient.

John Hutton (Labour, Barrow and Furness)

I will come to that point in a minute, but we should be quite clear that the hon. Gentleman and his supporters, without having first sought the views of the medical profession, are proposing to remove from general practitioners the right to claim the fee. As I understand it, the profession's views are clear: it wants to retain the option to claim an emergency treatment fee. He is proposing a change in the law that does not command the support of the medical profession, to whose views he has turned only very late in the day. That is not a scientific or appropriate way in which to progress the argument.

Philip Hammond (Conservative, Runnymede and Weybridge)

The Minister appears to be allowing the medical profession to dictate the legislative agenda. I will be very interested to see whether that deference continues when we consider the NHS Bill later in the Session.

John Hutton (Labour, Barrow and Furness)

The hon. Gentleman is perhaps reading more into my remarks than he should. I am saying that the Liberal Democrats are proposing a change in the law that they have not trailed in advance with the medical profession and on which they have not sought its views. The point I am making is that it is appropriate, when the law is being changed, to consult properly those parties who will be affected by the change. The hon. Member for Oxford, West and Abingdon has not done that on this occasion and that is another reason why I will urge my hon. Friends to reject the new clause.

Simon Hughes (Liberal Democrat, North Southwark and Bermondsey)

The Minister is trying to use an answer that is not the substantive answer as a defence to the proposition made by my hon. Friend the Member for Oxford, West and Abingdon (Dr. Harris). My hon. Friend's case has two elements, the most important of which is that it is inappropriate for somebody to seek the fee from the victim at the roadside, or later through solicitors. What would be the Minister's view if the proposition were simply that a different method of collecting the money for the service were used? For example, the health authority could be asked for payment rather than the person affected directly.

John Hutton (Labour, Barrow and Furness)

As the hon. Gentleman is aware, that is a possible option. It was raised by the hon. Member for Oxford, West and Abingdon and I shall try to deal with the points that he raised in a minute. We have considered the issue carefully and the Department has received approaches from various representative bodies. We know that general practitioners continue to want the right to collect the fee as independent contractors, if they consider collection worthwhile in terms of effort and the effect on those from whom the fee is claimed. We are not minded to remove a right that has belonged to GPs since 1934. It was suggested in Committee that if collecting the emergency treatment fee were a problem for hospitals, that must also be true for GPs and independent doctors. We have checked that point. We also received no representations from independent doctors on the emergency treatment fee, other than ones wishing to see it remain. Indeed, some representations suggested that it should be increased. We have not received any representations from the profession asking us to abolish the right to claim the emergency treatment fee.

Peter Brand (Liberal Democrat, Isle of Wight)

Can the Minister say how many independent contractors have made those representations? I am not surprised that we have not seen massive numbers of GPs calling for the abolition of the charge, because most GPs do not claim it or even carry the paperwork to claim it. It is against the ethos of most people working in primary care in the health service.

John Hutton (Labour, Barrow and Furness)

I wish to correct one misunderstanding held by the hon. Gentleman. The right to collect the emergency treatment fee is not limited to GPs in the national health service but is, in theory, available to any legally qualified medical practitioner, whether he has a contract with the national health service or not. I said earlier that I had some sympathy with the arguments made by the Liberal Democrats, but the profession has not made representations to the Government for such a change.

Simon Hughes (Liberal Democrat, North Southwark and Bermondsey)

Answer the question.

John Hutton (Labour, Barrow and Furness)

I have answered the question. I have repeatedly made it clear to the House that no representations have been made asking Ministers to abolish the emergency treatment fee. Those members of the profession whom we have consulted want to retain the right as an option. The hon. Member for Oxford, West and Abingdon also raised the issue of the impact of the change on the national health service's budget. Although we are able to recover the loss of income in the hospital sector through the new tariff, if the emergency treatment fee were scrapped for GPs, health authorities would have to meet the costs in every case. There is no method to recoup the lost income in that situation. The new clause would impose an additional, unquantifiable financial burden on the national health service, and the Liberal Democrats have not told us where the additional resources to pay for that would come from. I have some sympathy with the argument of the hon. Member for Oxford, West and Abingdon, but for the reasons that I have advanced, today and in Committee, I shall urge my hon. Friends to reject the new clause.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

That answer is wholly unsatisfactory for a series of reasons, and I have to press the Minister further. Although these points were discussed in Committee, the extra information that the Minister has given has been much less satisfactory than that given in Committee. It is not the job of an Opposition party to consult on legislative opportunities. If we were to be given some civil service time, we could do a poll within a few days, and certainly well before the Bill completes its proceedings here and in the other place. Our question would not be the Minister's, which is, "Do general practitioners want to retain the right to receive income for this item of service?" We would ask, "Do GPs wish to retain the right to receive income from individual patients rather than claiming it back from the health authority?"

Robert Smith (Liberal Democrat, West Aberdeenshire and Kincardine)

Ministers confuse the situation further by saying that they want to keep the option. They may not want to use the option, but they want to keep it. Out-patients lying in the street will not know as a general practitioner approaches whether or not that GP plans to use the option. There will be random charges on people depending on who is their GP.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

That is an important point. In the last part of what the Minister said, he stated that switching the claim from patient to health authority would increase costs on health authorities. If he says that that cost would be unquantifiable, he must accept that there is currently an unquantifiable direct cost on patients. The difference between the situation that he envisages and the current situation is that patients pay the difference. The unquantifiable cost is put directly on patients. In making his point, the Minister concedes my other point: doctors do not mind where the income comes from. In fact, doctors would largely object, as does my hon. Friend the Member for Isle of Wight, to claiming the money directly, or through a solicitor, from the patient.

Peter Brand (Liberal Democrat, Isle of Wight)

There is some confusion about emergency treatment and fees for road accidents. There is a perfectly respectable way in which to pay GPs for providing emergency treatment to people other than their own patients. Most GPs accept that they have an obligation to patients on their own list and on the lists of their partnership. The national health service is there to provide all necessary treatment. When the need arises for a doctor to give emergency help to someone else's patients, the GP can, under every circumstance except that of a road traffic accident, make a perfectly proper claim to the NHS through his or her health authority. We urge the Minister to remove the limitation on emergency treatment—

Michael Martin (Deputy Speaker, Glasgow Springburn)

Order. The hon. Gentleman is making a speech rather than an intervention.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I understood my hon. Friend's point although it was curtailed. If he feels that I did not, I should be happy to hear him make a speech. At present, the retention of the provision allowing general practitioners to claim a fee directly from the patient makes a difference only to those patients already on the relevant GP's list. If the patient is not on the GP's list, the general trend is to claim an emergency treatment fee from the health authority. The law forces the GP to make an extra claim only on those patients who have a relationship with that doctor. Nothing is so calculated to damage the doctor-patient relationship as people on a GP's list being asked by their doctor for an additional treatment fee for treatment outside the surgery in a car crash. The Minister has not said how many doctors have written, of their own volition, to say that they want to retain the option to reclaim the fee. The question should be whether doctors want to retain the fee from the patient, not the health authority. Will the Minister quantify the representations that he has had, and, if possible, will he place them in the Library before the Bill goes to the other place? It is the Government's duty to ask questions of the profession. The key question is whether GPs think it appropriate to have the power to collect the money directly from the patient. The Liberal Democrats believe that progress can be made on health service provision even in the face of opposition from doctors. The Minister put a most un-Bevanite concept to the House when he said that if an unquantified number of doctors object to the way in which they are paid, no legislative progress can be made. We Liberal Democrats do not accept that concept. As the hon. Member for Runnymede and Weybridge (Mr. Hammond) hinted, this Government have a tradition of caving in to general practitioner vested interests, for example, on the composition of primary care groups and a number of other issues. If the question were put in the way that I suggested, I do not believe that the medical profession would object or, even if it did, that the Government should not legislate. After all, hospitals were not consulted on whether their emergency treatment fees should be abolished and they are so strapped for cash that I am sure that they would want to claim that extra income if they thought it worth while. I shall hone down my questions for the Minister. How many responses to the consultation were received? Will he place them in the Library, so that we can see them? Will he ask the question correctly before the Bill ends its progress in another place? Does he agree that, regardless of the view of the medical profession, if the policy is deemed to be right and in the patient's interests, he should follow it? Finally, what is the view of patients? That question remains unanswered, I suspect because it was not asked. It is a simple matter for the Minister to ask the Patients Association whether patients should be liable to pay a general practitioner for NHS treatment within seven days in an emergency situation. I regret that the Minister's reply did not satisfy me. He placed the burden of legislation on the Liberal Democrats, which we would be more than willing to accept if the Government were prepared to ask us for legislative ideas outside the House. The Government are capable of undertaking those consultations, finding the answers and considering the principle of the charging mechanism. I urge the Minister to come back with more encouraging comments.

Simon Hughes (Liberal Democrat, North Southwark and Bermondsey)

We want to bring this matter to an early conclusion. I hoped that the Minister would respond positively to my hon. Friend the Member for Oxford, West and Abingdon. I shall add one point and, if we still receive no response from the Minister, I think both the Conservatives and the Liberal Democrats will have to press the matter, because we should have had a concession. The Minister is new to his post, but he gave some of the weakest arguments in defence of the Government's position that I have ever heard during debates on health service legislation. He does not have the figures and he did not say that the change would bring in a large amount of revenue for the health service. Nor did he say that it would be in the patients' interests. All he said was that the provision gives an option, which virtually no one uses, to collect some money, which is probably not very much. That is no way to run the health service. If we were talking about the Government forgoing billions of pounds, I could understand it, but we are not. My hon. Friend the Member for Isle of Wight (Dr. Brand), who has regular experience of these matters, pointed out how general practitioners in the health service reclaim fees for work that they do that is over and above work for their patients and their practice. In a rationed, streamlined and intelligent health service for the next century, what on earth is the argument for having one system to reclaim money for all sorts of activities, and a different system—which most GPs do not want to use because they consider it embarrassing and unethical—to reclaim money for one small category of people for one sort of work that GPs do? There is no logic to such a system. If we are trying to reduce the burden of bureaucracy on my hon. Friend the Member for Isle of Wight, his wife and other practitioners in the health service, for heaven's sake let us have one system, which will allow one piece of paperwork whereby one collects money in one way at one time and reduces the charges to the rest of the system. Unless the Minister gives the House some comfort, we will not only force the new clause to a vote now, but we will be obliged to oppose the Bill on Third Reading because the Government's position has no logic. Also, we will ask our colleagues in the other place, where the Government do not yet have a majority, to ensure that common sense prevails. If we cannot get common sense from Ministers in this House perhaps, before the consistutional changes up the Corridor, there will have to be another Government defeat in the Lords, in the interests of the patients of the British national health service.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I should like to sum up because there are now more Labour Members in the Chamber than before. I wish to make it clear to the Government that it is because of their motives and words that we shall press the new clause to a Division. As the Minister said in Committee, the money is a nightmare to collect. Front-line staff are involved in recovering charges. If Government policy is dictated by what is acceptable to GPs, today's announcement by the General Medical Services Committee on the Government's outrageous rationing decisions will give the Government serious pause for thought. On that note, I commend new clause 1 to the House.

DUTY OF INSURERS TO SUBMIT ANNUAL REPORT TO PARLIAMENT

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I beg to move, That the clause be read a Second time.

Michael Martin (Deputy Speaker, Glasgow Springburn)

With this, it will be convenient to discuss new clause 3—Secretary of State's report on payments made under the Act— '—The Secretary of State shall submit a report to each House of Parliament by 30th June in each year following the passing of this Act stating in respect of the preceding financial year the total of any payments made to him under the provisions of this Act.'.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

The new clause would open up the legislation to the wider public so that its effects as a whole are explicit. The Minister and the House may know from the Second Reading debate that we are opposed to the Bill in principle because we believe that it surreptitiously introduces indirect charging of patients for NHS services. It is clear that, if the Bill became an Act, car insurance premiums would increase to cover the money that insurers would have to pay to the NHS for trauma treatment of third parties injured in road traffic accidents. We oppose that, and on Second Reading we made clear the reasons for our opposition. New clause 2 sets out to bring to the attention of the House and to the public at large the effect of indirect charging of patients through their insurance. It creates a duty on insurance companies liable for the charge to present to each House of Parliament by 30 June each year a report stating in respect of the preceding calendar year, first, the total of any payments made to the Secretary of State and, secondly any effect of making those payments on the costs to their customers of purchasing motor insurance. There has been a great deal of debate about how much car insurance premiums will rise as a result of the Bill. It must be noted that the debate has been about not whether premiums will rise but how much they will rise. We have had various estimates. The Department of Health is quoted in a House of Commons Library research paper as saying that every insurance premium would increase by £6 to £9. The Association of British Insurers says on page 1 of its newsletter No. 28 from December 1998 that the Bill will "lead to premium increases." The Automobile Association is quoted on page 17 of the Library research paper as saying that the Bill would have the effect of adding around £10 to the cost of the average £260 annual motor policy. The Independent said in December 1997 that the NHS bill may put £20 on car premiums". It is not disputed that the Bill will lead to an increase. The figures are all within the same ball park. The Minister may argue that the Bill should not lead to an increase in car insurance premiums because hospitals already have the power to charge the insurers of third parties injured in road traffic accidents, but they do not do so because of the bureaucratic difficulties involved. That is by the by. Premiums were not loaded to cover reimbursement of the NHS to the extent that is now envisaged. Indeed, the Government expect that the Bill will generate income for the health service over and above that which is generated at the moment. That is predicated on an increase in payments to the NHS. If we are to have a sensible debate about paying for the NHS, it is vital that people are aware of how they are paying for it. People know that they pay income tax. The polls show that people would gladly pay more to improve the services provided by the NHS. We are unable to have that debate with more than one party as other parties have decided that they will not use that approach to raising income. It is important that the general public know, and are allowed to find out, how much they are paying through the back door, because the amount that they pay through general taxation has been politically limited by political parties, and newspaper proprietors who beseech political parties not to pursue certain policies.

Philip Hammond (Conservative, Runnymede and Weybridge)

Will the hon. Gentleman confirm for the record whether he seeks to start a debate on a genuinely new approach to NHS funding? Or is the Liberal Democrats' only proposal to increase income tax to fund the NHS yet further out of general taxation?

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

Not at all. The hon. Gentleman will know that his party—somewhat later than mine—has called for a debate on NHS funding. We have made it clear that we are not minded to believe that the private sector is an effective source of income to help take the strain of NHS provision. We do not believe that it is possible to save the NHS by urging people not to use it, but we accept that that argument and others could be put in such a debate. If the Government intend to increase direct charges for prescriptions and other items, or to increase indirect charges through some form of insurance, they could be explicit and honest in such a debate. We would welcome that debate. We have our own ideas to put forward, but we are certain that, until we have an explicit, honest and rational debate, it is premature to increase surreptitiously the amount that individual users of the NHS pay through regressive, indirect means such as charges on motor insurers.

Simon Hughes (Liberal Democrat, North Southwark and Bermondsey)

I wish to make a point supplementary to the point made by the Conservative spokesman, the hon. Member for Runnymede and Weybridge (Mr. Hammond). The debate goes much wider than the question whether income tax should rise. We should put on the agenda what charges should remain—including prescription charges. The debate is also about funding residential care and nursing care for the elderly, which could be a subject for a royal commission, and where the social security system fits in. I hope that my hon. Friend will make it clear to his colleagues in today's debate that we are willing to participate with all other parties in what we would call a commission on the future of the health service. We should have the debate outside Parliament, in the open, with patients, the professionals and the pharmaceutical industry.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

That is the critical point. If people do not know by how much car insurance premiums have risen, they will not know the effect that the Government's legislation is having on their pockets. Far too little attention is given to indirect charges in other public services. That is why we seek to make that information available by means of new clause 3, which has been tabled by Conservative Members and which we support, and of new clause 2. I do not accept the ABI's rather mild representations that the information will be commercially sensitive. It has said that premiums will increase, and I do not believe that it will be impossible for insurance companies to work out how much they are paying to the NHS and by how much premiums have had to rise to take on the onus of funding the health service as well as insuring people. Car insurance is a highly competitive market, and of course some information will be commercially sensitive, but the information called for in new clause 2 cannot be refused by the Minister on the basis of the ABI's objections. The Government claim that they support open government and wish to be honest with the people. We hear such rhetoric. Indirect charging is a litmus test of whether the Government will be explicit about costs. I urge the Minister to accept new clause 2 in the name of openness. It will certainly improve the Bill.

Philip Hammond (Conservative, Runnymede and Weybridge)

I listened with interest to the hon. Member for Oxford, West and Abingdon (Dr. Harris). I was a little surprised to hear him say that he supported new clause 3, tabled by my hon. Friends and me, because it was tabled as an alternative to new clause 2, tabled by the Liberal Democrats. Parliament will want to monitor the Bill carefully, as it introduces a major new charge in the NHS. Hon. Members will want to look at the legislation's effect on both NHS revenues and insurance premiums paid by the motoring public for two reasons: first, because it is important to see the impact of the measure; and, secondly, because the measure is innovatory, so people will be anxious to establish its overall effect. One issue that it will be important to consider is whether its impact is equitable. The hon. Member for Oxford, West and Abingdon spoke about the increases in insurance premiums that will undoubtedly flow from the introduction of the measure, but it is not clear whether insurance premiums will increase uniformly across the board. Different insurance companies have different client profiles and claims experiences, and the measure's impact on insurance premiums is likely to differ radically between different groups of motorists. An issue that deeply concerns us is the anti-rural bias, which this side swipe at the motorist by the Labour Government undoubtedly has. We shall bear that in mind when we monitor closely how the measure impacts not just on motorists in the aggregate, but on sub-groups of motorists. It is undeniable that careful parliamentary scrutiny of what flows from the legislation will be needed. When considering new clauses 2 and 3 as alternatives to each other, the question is what is practicable and workable, and how much commercially sensitive information it is reasonable to expect private sector companies to provide. In Committee, the Minister referred to the opportunities that will arise for parliamentary scrutiny when the Government change the charges levied under the Bill, as they propose to do periodically. To ensure that the scrutiny debates that take place on those occasions are properly informed, information about the measure's overall impact must be available.

John Hutton (Labour, Barrow and Furness)

It may help the hon. Gentleman if I make it clear now, as I did in Committee, that we want hon. Members to have access to the fullest possible range of information to allow them to review the operation of the scheme. I made that clear in Committee; if it will help the hon. Gentleman now, I am happy to repeat it on the Floor of the House.

Philip Hammond (Conservative, Runnymede and Weybridge)

I am grateful to the Minister for repeating that. If he can answer in the affirmative the specific question that I am about to ask, it will go a long way towards reassuring Opposition Members. New clause 3 proposes that the Secretary of State submit a report to each House of Parliament annually, giving details of the total amount raised through charges under this legislation. That differs somewhat from new clause 2, proposed in the name of the Liberal Democrats, which places a duty on insurers—those who will pay the charges—to report to Parliament, giving detailed information on the impact that those charges have had on the calculation of their premiums and on their specific businesses. The Association of British Insurers agrees with us that companies that operate in a commercially sensitive area should not be asked for too much information about how they run their businesses and calculate their premiums, and about the profile of their customers. Those experienced in these matters, of whom I am not one, could deduce valuable commercial information from the type of information that new clause 2 proposes should be supplied to Parliament. I am relatively new in this place, but I find it curious that an outside body such as a commercial company should have to report directly to Parliament. It seems more appropriate that the Secretary of State should gather whatever information is needed and report to Parliament; he could then be answerable for his report in this place. New clause 3 achieves, without the disadvantages of new clause 2, much of what the Liberal Democrats seek to achieve. Information about premiums may be difficult for a commercial company to define in a meaningful way for the lay reader, and I would question the value of some of the information that the Liberal Democrats seek to have provided to the House. Indeed, in a briefing note that it has issued to all hon. Members, the ABI says: Insurers are already required to produce company accounts and should not be bound to reveal additional commercial information to Parliament. Information on total receipts should be available from the NHS itself". That is the essential point. The information that would have to be presented to Parliament under new clause 3 could be derived by the Secretary of State entirely from the compensation recovery unit, from his own records and from Government agencies, without imposing additional burdens on companies operating in the commercial sector. It could be derived without imposing additional burdens on the machinery of government and its agencies because, in a properly run organisation, which I am sure the compensation recovery unit is, that information will be readily available. Thus new clause 3 seeks to use aggregate information that is readily available. Because it is presented in an aggregate form, it avoids the pitfalls that the ABI has identified in terms of the revelation of confidential information, while still providing the House with the critical overall figures that will tell us how successful the measure has been in terms of funding the NHS. That information would be directly available under new clause 3. It would also inform an intelligent analysis of the impact, in aggregate, on motor insurance premiums. I suspect that trying to use central data to determine the impact on individual groups of motorists or individual motorists would be a fruitless exercise. On the sound basis of some aggregate data which the Secretary of State could provide, hon. Members, in pursuing the scrutiny process, may rely on anecdotal information collected from constituents on the differing impact on premium rates across the spectrum.

Tim Collins (Conservative, Westmorland and Lonsdale)

Is there not another difficulty with new clause 2 in addition to those that my hon. Friend has brilliantly analysed? New clause 2 requires insurers to provide information according to the preceding calendar year, yet many insurers operate on entirely different financial years, so the new clause is even more onerous than it seems.

Philip Hammond (Conservative, Runnymede and Weybridge)

I thank my hon. Friend for that contribution. He is absolutely right. The problem is compounded by the fact that settlements of claims are often not made for two, three or four years. It may be difficult to gain an informed view from information that relates to the preceding year. The hon. Member for Oxford, West and Abingdon referred to what the Opposition health team calls the "information not collected centrally" syndrome. In Committee, the Minister, with some humility, recognised that syndrome. We have seen it on innumerable occasions when seeking information from the Department through parliamentary questions. The Department hides behind the decentralised structure of the health service as it was: it is becoming an increasingly recentralised structure, as the Government implement various measures. The decentralised structure of the health service enables the Secretary of State to say that information is not collected centrally. It is perfectly clear that a well-run health service requires information to be collected centrally. We have no doubt that it is available to NHS regional executives, and could be collected by the Secretary of State if he chose to do so.

Simon Hughes (Liberal Democrat, North Southwark and Bermondsey)

I agree with the hon. Gentleman. Now that it has been accepted across government that the collection of statistics should be more independent and that there should be an independent statistical department, there is no excuse for the Government not to do what is necessary. In the health service in England, statistics could be collected regionally—no one would object if it were done region by region, because we could add up the figures for each region ourselves —or centrally by the Department in Richmond house. The information can be gathered without the Government saying, "No, we don't like it."

Philip Hammond (Conservative, Runnymede and Weybridge)

I entirely agree with the hon. Gentleman. The NHS is a vast organisation spending billions of pounds and employing hundreds of thousands of people. The collation of information is essential for the proper management of an organisation of that scale. I hope that the Minister will reflect on that. Indeed, the Secretary of State has shown his willingness to make more information available. He famously told the BBC "Today" programme back in September that he would ensure that, as soon as possible, data on total waiting lists—those awaiting a first consultation with a specialist and those awaiting in-patient surgical treatment—would be available. The Secretary of State seems not to be keen on an independent audit or examination of the figures. On the same broadcast, he referred to a reputable firm of chartered accountants that specialises in collating data on the NHS as a "tinpot firm". That appropriately sums up the Secretary of State's attitude to the independent scrutiny of these matters. We want an assurance that the Government will not hide essential information about the impact of the Bill behind a smokescreen by saying that the money is distributed to individual hospital trusts and that the information is available only at that level. In Standing Committee, reference was made to the fact that information was available in the published accounts of hospital trusts. It is not practical for parliamentarians who want properly to scrutinise these matters to plough through the annual accounts of thousands of hospital trusts up and down the country and aggregate the information. In a well-run Department of Health, the information should be available in an aggregate form. Can the Minister satisfy the Conservative Opposition that the data referred to in new clause 3 will be regularly made available to Parliament? We would be satisfied if he could assure us that information on the amount of money collected by the compensation recovery unit and distributed to NHS trusts will be included in the quarterly data series. Alternatively, if the Secretary of State is unable to do that, the presentation to Parliament of that information in an annual report, as the new clause suggests, would achieve the same end, although somewhat more tardily. The intentions of the new clause would be better served by an assurance from the Government that the data required will be included in the quarterly data series. If the new clause were carried and the data were provided annually, the information could be out of date when any proposed changes to the amounts to be charged were scrutinised. We seek an assurance that the aggregate figure, which is readily available to the Secretary of State, will be regularly made available to Parliament. I can see no basis on which the Government could object to that. It would enable Parliament to perform its work of properly scrutinising the outcome of the legislation. That is important in itself, but also because these are the first new charges of any substance that the Government have introduced in the NHS. We and the Government will want to assess carefully the effectiveness of these measures and their impact on the overall funding of the NHS. I hope that the Minister can give us some reassurance about his willingness to make the data available.

Robert Syms (Conservative, Poole)

I support my hon. Friend on new clause 3. It is less prescriptive than new clause 2. Having listened to what the Minister said, I do not think that the Government and the official Opposition are too far apart. We are looking for reassurance that statistical information will be available by which we can measure the effectiveness of the operation of the legislation. The Association of British Insurers supports the concept of parliamentary scrutiny, as we all do. It is important that the collection system be seen to be fair and efficient. Earlier, the Government took credit for raising between £120 million and £140 million through this proposal, and said that it would not cost anyone anything. However, as we have heard, insurance costs will be incurred. How the data can be collected efficiently will be an important matter for hon. Members to consider. The impact on insurance premiums may be different for different categories. The young may pay disproportionately higher premiums, so may be hit much harder. If the Minister could move a little more in our direction, we could be reassured that there will be enough information to have a sensible, reasonable debate about the effectiveness of the legislation, how it is operating and what impact it has on the national health service, insurance payers and our constituents; and, having sat on the Committee considering the Bill, I for one would be satisfied.

John Hutton (Labour, Barrow and Furness)

The arguments in support of both these new clauses rest on a number of assumptions that I do not accept. The first assumption is that the Government have been less than open about the impact of the legislation, especially on motorists and on NHS funding. That is not so. The new clauses would lay down new obligations to disclose information, but that is unnecessary for reasons that I shall outline. The Opposition assume that the Government are trying to withhold information, but we are not. Throughout the passage of the Bill, we have tried to help Members to appreciate the fundamental issues underpinning the legislation. We want to make the maximum amount of information available to allow proper scrutiny by the House of the proposed measures. For a general reason, I feel that there is no substance in the underlying arguments in favour of either new clause. Both would impose additional obligations on the Government to disclose information to the House. The arguments for the new clauses are based on a second false assumption —that we are imposing a new charge on people who use the national health service. We are not doing that. The Bill will simply streamline and improve arrangements for collection of existing charges, which are recoverable under legislation dating back to the 1930s. It is concerned with ensuring that the NHS can recover the costs of treating road accident victims, not from motorists or patients but from insurance companies, when a successful claim for compensation has been made following a road traffic accident.

Philip Hammond (Conservative, Runnymede and Weybridge)

I do not accept the Minister's assertion that this is not a new NHS charge. The Government are giving teeth to a mechanism that has enabled the collection of a piffling £15 million or £16 million a year in charges, to ensure that £150 million a year is collected. The man in the street, however, sees little difference between the introduction of a wholly new charge and the ratcheting up tenfold of an existing charge, converting a relatively meaningless exercise into the raising of a significant amount.

John Hutton (Labour, Barrow and Furness)

With respect, I think that most members of the public can distinguish between the more effective collection of an existing charge and the laying down of a new charge for the use of the national health service. I do not think that the hon. Gentleman's argument is very coherent, and I am not sure that he will consider it to be so after he has had a chance to reflect on it. There is no logic, or foundation in fact, for hon. Members' justification of the new clauses. It is underscored by the assumption that the Government are trying to withhold information from the House and from individual Members, which has led to the demand in new clause 2 for an unprecedented obligation on insurance companies to give the House information directly in the form of annual reports, and the demand in new clause 3 for the Secretary of State to make that information available annually. The hysteria among Liberal Democrats seems to have subsided. I assume that they now have the hustings for the leadership vacancy that has arisen under better control. Perhaps, in the current spirit of harmony between the two sides of the House, we can begin to examine the real issues created by the Bill, rather than the fantasy and hyperbole that featured in much of what the Liberal Democrats said in Committee. We are discussing a simple mechanism that will facilitate the recovery of NHS charges. We want the NHS to benefit from significant additional resources. We have some sympathy with what the hon. Member for Runnymede and Weybridge (Mr. Hammond) said, but we want to be sensitive to issues of commercial confidentiality. We are aware of the burdens on business, and we do not intend to impose unnecessary and unreasonable burdens on insurance companies, which is one of the reasons why we do not support new clause 2. I should make it clear that the Department has never refused to offer MPs information about amounts collected by the NHS under existing road traffic legislation—

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

Will the Minister give way?

John Hutton (Labour, Barrow and Furness)

No, I will not. As I said, the Department has never refused to offer information, and we have no intention of withholding it in the future. The hon. Member for Runnymede and Weybridge helpfully stated that, according to information received, just over £16 million was recovered last year under the existing scheme. The Department of Health already collects such information: we aggregate trust accounts relating to road traffic income. The information is readily available now, and will continue to be available to hon. Members in future.

Philip Hammond (Conservative, Runnymede and Weybridge)

I suspect that the information to which the Minister refers will be extracted from trust accounts, and that there will therefore be a delay. The new regime for which the Bill provides will give the Minister an opportunity to obtain the information directly from the compensation recovery unit, a Government agency. Assuming that the unit is computerised, I would expect the information to be available on a quarterly basis, and very soon after the event.

John Hutton (Labour, Barrow and Furness)

The hon. Gentleman has done the House a favour by drawing attention to one of the benefits of the changes that we are introducing. The compensation recovery unit will have the advantage of up-to-date information technology, including new software, that will enable the information to be available to the House more quickly. I am not sure that we shall be able to provide it on a quarterly basis, but as a result of access to more efficient information technology, we shall generally be able to provide it sooner. I assure the hon. Gentleman, and others who are worried, that we have no intention of withholding such information from the House. It is important information; it will inform debates on any regulations laid before the House; and we want scrutiny of the legislation to be as well informed as possible. One of the difficulties that we have encountered with the Bill so far is caused by the desire on the part of Liberal Democrats in particular to misrepresent what we are doing. I understand that—it is a purely opportunistic political exercise—but we do not intend to withhold crucial information from the House. We want the House to be well informed, and we will ensure that it is. For the reasons that I have given, I do not believe that there is any substantive argument for either new clause.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

Will the Minister give way?

John Hutton (Labour, Barrow and Furness)

No. We do not accept the arguments of the hon. Member for Oxford, West and Abingdon (Dr. Harris) for his new clause, which we consider to be unreasonable and unfair. We do not intend to legislate along those lines. I hope that the hon. Member for Runnymede and Weybridge and his colleagues will accept my assurance that we intend to make it absolutely clear that the information will be made readily available. We are committed to reviewing the scheme after six months, and to publishing the results of our review. I hope that, on that basis, the hon. Gentleman will not press new clause 3, and the hon. Member for Oxford, West and Abingdon will not press new clause 2.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

It is interesting that the Minister should ask me not to press new clause 2, but—with uncharacteristic churlishness—should refuse twice to allow me to intervene to ask him a specific question that might have enabled me to decide whether to press it. We do not doubt that information, particularly that requested in new clause 3, can be made available, and that the Government will do their best to make it available. That is why the Liberal Democrats did not table a similar new clause. We are reassured. Although we support—as we did in Committee—measures to enable the Government to provide the information, I believe that it will be available by means of parliamentary questions, the six-monthly review and other channels. As I said in Committee, I feel that it would be more readily available if payments were made to health authorities — which I think should be done for other reasons—but I think that it can be obtained from trusts and, probably, from the compensation recovery unit. We tabled new clause 2 because we feel that the crucial information that is required relates not to the global sum raised, but to the effects on individuals' car insurance. That will, of course, be a matter for debate. I was trying to help the House to decide whether this is a valuable way of raising money for the NHS by urging the Government to consider incorporating measures that will force insurance companies to make their own calculations on the effects, to help Members and the general public to educate themselves as to how much NHS revenue will result from the higher premiums. I understand the Conservatives' views on commercial information. I am sure that it is possible to word legislation more tightly to enable information to be obtained from insurance companies and examined without the sharing of commercially confidential information. Liberal Democrats want to extract a flat figure representing the amount that insurance companies think ordinary people are contributing to the increased amount that is being collected. I accept the Minister's opening point that the charge is not new. If hon. Members check the record, they will find that Liberal Democrats have at no point stated that we believe the charge to be new. We think that there was an opportunity to get rid of a charge, but it is clear at any rate that the Government will have increased income. That is one of their reasons for introducing the legislation. The measure will generate additional income from an existing charge by making its recovery more compulsory, by nationalising it, in effect, and by making it more efficient. If one wants to raise revenue by that method, the Bill is a good way in which to do it. Because we do not want to do that, we oppose the measure; it is not because the Bill is badly drafted, or would achieve its aim inefficiently. However, we do want to see exactly how the extra amount is raised from individual drivers' car insurance. Global sums of millions of pounds are difficult for people to understand in their everyday life. Indeed, the Government rely on fazing people with large figures when, uniquely and cleverly—although rather sneakily—they present extra money for the health service in three-yearly cumulative totals, not the usual year-on-year totals. I hope that any figures that come from the Government do not, if they apply to more than one year, repeat the habit of rolling up matching funding from one year with the previous year's allocation and the new allocation. That is a bad habit, which makes it difficult for people to understand. People understand the amount of money that they pay in the pounds, shillings and pence on their car insurance. I ask the Minister to give me some assurances that there will some way to estimate, even from the Government's figures— although I am not convinced that I would necessarily accept them 100 per cent.—what the charges will be.

Philip Hammond (Conservative, Runnymede and Weybridge)

I am delighted to hear a Liberal Democrat using the currency of pounds, shillings and pence. I am not sure where that leaves the hon. Gentleman in the Liberal Democrat leadership stakes. The hon. Gentleman said that he wanted to know what the extra cost of the measure to ordinary people would be. Does he not understand that the problem is that there is no single ordinary person—there is no average motor insurance payer? The impact will range from zero on some insured people to substantial on others. The figure that has been quoted of £9 or £10 as an average—

Michael Martin (Deputy Speaker, Glasgow Springburn)

Order. I sometimes give leeway to those on the Front Bench, but I cannot allow the hon. Gentleman to get away with a speech during an intervention.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I think that the hon. Member for Runnymede and Weybridge (Mr. Hammond) would have been helped by leaving out his preface, which I am sure hon. Members will be bored with in a few weeks. It is not my intention to digress on to those matters. You will note, Mr. Deputy Speaker, that Liberal Democrats have been careful not to rise to provocation from other hon. Members. I understand the point that the hon. Member for Runnymede and Weybridge makes—that there is no single figure, but there will be ranges. We would like an undertaking from the Government that they will do their best to put their research capabilities to the task of giving a range, from zero to what the extra cost will be for each individual car insurance payer because of the charges. What is certain is that £160 million means nothing to people in terms of what they pay on their car insurance. The range of costs that the hon. Gentleman talks about—from zero to £20—would mean something. I think that hon. Members on both sides of the House accept that it would be more sensible to have those figures collected in an orderly way, rather than hearing scare stories from the insurance industry, the AA or political parties of any persuasion about what those costs will be. I return to my original proposition: it is important not only that the Government should be open about the amount of income that is raised by the measure—I accept the Minister's assurances on that—but that it be clear to individual taxpayers, drivers, voters and patients how much the Government's decision not to use this opportunity to abolish these indirect charges is costing them. I still look to the Minister for advice on that point. However, even if he is unable to give me any help, it is not our intention to divide the House on the matter.

Philip Hammond (Conservative, Runnymede and Weybridge)

I am happy to take what the Minister said at face value and to accept his good intentions. However, we will look to ensure that the data is made available as quickly as the technology used by the compensation recovery unit allows.

John Hutton (Labour, Barrow and Furness)

indicated assent.

Philip Hammond (Conservative, Runnymede and Weybridge)

The Minister nods. If we can accept that there is a genuine intention by the Government to make that data available regularly as fast as possible, we will be satisfied. I thank the Minister for that assurance.

John Hutton (Labour, Barrow and Furness)

I can give the hon. Member for Runnymede and Weybridge the assurance that he seeks.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I beg to ask leave to withdraw the motion.

INFORMATION CONTAINED IN CERTIFICATES

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I beg to move amendment No. 2, in page 3, line 43, leave out '2nd July 1997' and insert '1st April 1998'. I am sure that the House is aware that the amendment is the last to be considered at this stage of the Bill. It seeks to right an injustice. It would leave out 2 July 1997 and insert 1 April 1998 as the date for which the charges will apply for in-patient treatment—and it should be out-patient treatment as well. The Government have defended 2 July 1997 as the date from which the charges will apply on the basis that that was when the Chancellor of the Exchequer first said that the Government were going indirectly to raise additional money for the NHS from people, through their car insurance. Presumably, they thought that insurance companies could make provision to weight their insurance premiums accordingly from 2 July 1997, so that the extra income that was raised through the Bill could be collected from their customers through increased insurance premiums; that is the logical approach that one might imagine the Government were taking. If that is the case, surely the Government must accept that there will be some lag time before the insurance industry is able to adjust to the more efficient way in which the Government are collecting the charge, and the increased amount of charge that the Government are collecting. I think that hon. Members on both sides of the House will recognise that it would have been impossible for someone to change his car insurance premium on 2 July 1997 after he heard that car insurance premiums might be affected from 2 July 1997. The insurance industry has said reasonably that costing the effects of the measure outlined briefly by the Chancellor on 2 July 1997 might take about three months. Logically, assuming that insurance renewals come due evenly throughout the year, another six months would elapse before, on average, insurance companies were able to reclaim, or to build into their costing, the effect of the more efficient collection of charges—and, indeed, a higher overall collection of charges. That is why, by simple arithmetic, 1 April 1998 has been chosen by the Liberal Democrats as the date on which the new tariff should apply. In Committee, we looked at 1 April 1999, so that everyone would be able to see car insurance premiums increase as the insurance industry adjusted to the new situation; but following debate in Committee, we felt that, on Report, a compromise of 1 April 1998 would be fair. It would not be seen retrospectively to penalise those insurance companies that were either no longer in a position to seek to redress the losses that they will make because of the new legislation and the Government's failure to build in a time lag, or that felt that they were unable to make provision in the marketplace to make up for the loss of income from premiums to pay the charges to which they would be due. Can the Minister defend the date of 2 July 1997 on any basis other than the one that he gave in Committee? Will he not recognise that even a fast-acting insurance industry that accepts the Bill must have some time to adjust, so that it does not penalise those members of the industry that are not selling insurance, and does not seek to reclaim old debts by stacking the insurance premiums for new customers over and above those who were lucky enough to reinsure just before 2 July 1997.

Philip Hammond (Conservative, Runnymede and Weybridge)

Conservative Members are always concerned about retrospection in legislation. From Second Reading and from reading the debates in Committee—I was not privileged to be a member of the Standing Committee that considered the Bill—the only argument that has been advanced for setting the start date at 2 July 1997 is that that is the day on which the Chancellor announced his intention to legislate. I submit that, announcing an intention to do something, is not the same as doing it, especially when it relates to parliamentary legislation. Businesses should not be required to change their patterns of operation or, in some cases—in this instance it may be a relatively minor issue—make major changes to their businesses, on the basis of an announced intention by the Government of the day. That could have pernicious and unfortunate effects if it were carried into other areas. We at least maintain the fiction that Government proposals are subject to scrutiny by both Houses of Parliament and to amendment during that process. The Government, and the Minister who is with us today, maintain the fiction that the Government listen attentively to the points raised in Committee and will consider any worthwhile amendments. It is perhaps not surprising that substantial amendments are not often accepted in Committee. The suggestion that, once the Chancellor or some other such estimable person has announced an intention to do something that requires legislation, everybody in the country should drop tools and act as if it were already the law of the land, displays a tremendous arrogance. It displays the Government's arrogant attitude towards the legislative process. Even if the industry should have responded immediately to the announcement by so great a person as the Chancellor, by its very nature, the insurance industry could not have adjusted its prices immediately to take account of the additional effective burden being imposed upon it. I do not like to second guess the Minister, but no doubt he will say that the charges were always in place and, in theory, could always have been collected. However, it is an essential part of the Government's argument for the Bill that they were not collected. It is beyond doubt that a reasonable commercial organisation will base its behaviour on what is happening and what will happen in the world rather than on what might be theoretically capable of happening. Humble Back-Bench Members—Ministers have the privilege of being driven around—will be familiar with the process of purchasing motor insurance for themselves. They will know that, customarily, it is done on an annual basis. Indeed, annual motor insurance is the best deal available because cover for shorter periods tends to be more expensive. On 2 July, any insurance company faced with the Chancellor's announcement, would have had a portfolio of current motor insurances, some of which might have had only one day to run and some of which might have had up to 364 days to run. It would be impossible for an insurance company to respond equitably to an increased burden of costs imposed upon it by the Government on the day that the announcement is made, even leaving aside the question of whether business should feel obliged to respond immediately to a mere announcement of an intention to legislate. When I say that an insurer would be unable to respond equitably, I mean that the insurance company needs to ensure that the relevant insured persons bear the additional cost of the measure. Inevitably, the only action open to an insurer will be to increase the premiums on renewal from the date of the announcement. That means that those who, by definition, are not covered for some part of the first year after the announcement, will gradually be forced to pay the additional cost of meeting the unrecovered portion of the extra premiums that that company would have charged had it issued policies—there are no such policies in the United Kingdom—that would enable it to make immediate changes and collect supplementary premiums from it policyholders. The Liberal Democrat amendment appears to be illogical. The date mentioned should be 2 July 1998, the date by which all annual motor policies—the vast majority of policies—in force on 2 July 1997 would have fallen due for renewal. It would have been more appropriate for the amendment to have proposed the date of 2 July 1998 or a date after the Bill is enacted. I note from the briefing presented by the Association of British Insurers that it supports the Liberal Democrat amendment. I suspect that, behind that lies the belief that something is better than nothing and that it is seeking to limit the damage done to the business by the element of retrospection involved in a start date of 2 July 1997. Going beyond the motor insurance business, an important point of principle for the insurance industry is at stake. The industry operates on the basis of actuarial calculations of risks faced during the insured period. It would be a serious matter for the insurance industry in its broadest sense if the Government took to introducing legislation which impacted on the costs of that industry and which took effect from the date of announcement, notwithstanding the fact that, by its very nature the insurance industry needs a lead time in which to levy additional charges in the form of increased premiums on its customers. That would leave insurers facing risks that they had not taken into account when setting their premiums for a period up to one year for motor insurance or even longer for other forms of insurance. A further anomaly can be seen in the treatment of the Motor Insurers Bureau. Under the Bill as currently drafted, the Motor Insurers Bureau will have this charge imposed upon it on a date after the Bill has become an Act. I accept that it may not have been clear at the time of the Chancellor's announcement that the Motor Insurers Bureau was to be included in the scope of the measure. For the Government to be logical and consistent, however, they should now be saying that the start date for the bureau should be the date on which it first became publicly recorded that the bureau would be subject to the charges under this Act. Either commercial insurance companies should benefit, as the Motor Insurers Bureau will, from a start date after the Bill's passage, or the Motor Insurers Bureau should be treated the same as insurance companies. If the latter option were chosen, the start date should be not 2 July 1997—I accept that the Chancellor did not announce on that date that the provisions would be extended to the bureau—but 8 December 1998, which, as far as I can determine, is the date on which Ministers first announced in the House that the provisions would extend to the Motor Insurers Bureau. Is the Minister able to deduce any logic in applying a seemingly entirely arbitrary start date to the Motor Insurers Bureau? I do not expect for one moment that the Government will accept amendment No. 2, but the issue of start dates and retrospection is worthy of reconsideration. I ask the Minister to assure the House that he will examine the issues that have been raised, not only as a means of tidying up the legislation but of addressing an important issue of principle that may have greater implications for the insurance industry in the future. It would be unfortunate if the Bill set a precedent of retrospection which may have much more serious consequences in the future. I hope that Ministers may yet decide that, in the other place, they want to tidy up that part of the Bill.

John Hutton (Labour, Barrow and Furness)

The Government have already very carefully considered all those issues of principle. We believe that the arrangements that we have established in the Bill, and the way in which we plan to implement them, are the fairest and most sensible way of proceeding. The entire purpose of the exercise is to ensure that the national health service properly recovers the costs of treating road accident victims, and that has always been the principle behind the legislation. We are simply ensuring that that principle—which has been accepted in the House for 70 years—operates in practice. The beneficiaries of the arrangements will be the NHS and those who use it, our constituents. A significant extra sum will be collected for the NHS because of our proposed arrangements. The fundamental reason why we cannot accept amendment No. 2 is that it would strike at the very heart and purpose of the Bill, by denying the NHS significant new resources for a further considerable time. We are not prepared to allow that to happen.

Robert Smith (Liberal Democrat, West Aberdeenshire and Kincardine)

rose—

John Hutton (Labour, Barrow and Furness)

I shall not give way to the hon. Gentleman. The hon. Member for Runnymede and Weybridge (Mr. Hammond) made it sound as though our announcement on 2 July was made in an insignificant place. It was not. The announcement was made in the House, during the Chancellor's Budget statement. In such circumstances, it was therefore perfectly reasonable to say to the insurance industry, "You have been given sufficient notice of our intention to proceed on those lines." That is our view.

Robert Smith (Liberal Democrat, West Aberdeenshire and Kincardine)

rose—

John Hutton (Labour, Barrow and Furness)

I shall not give way. The Government are therefore unable to give the assurance sought by the hon. Member for Runnymede and Weybridge—that we might review the operation of that aspect of the Bill. We do not intend to do so.

Philip Hammond (Conservative, Runnymede and Weybridge)

Will the Minister give way?

John Hutton (Labour, Barrow and Furness)

With very great respect, we need to make some progress. The issues have already been discussed in Standing Committee, and hon. Members are anxious to conclude the proceedings. The hon. Member for Runnymede and Weybridge also mentioned the Motor Insurers Bureau. The point is that, for the first time, the MIB is being introduced into the arrangements, which is a significant change. We have therefore decided to propose the arrangements outlined in the Bill. As it is a new departure, we believe that our proposed arrangements are the appropriate and most sensible way of proceeding. Our argument is clear and consistent. Our arrangements are sensible and will guarantee maximum income for the NHS, which is what we want to ensure. We cannot accept the Liberal Democrats' amendment.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

The Minister's answer was entirely unsatisfactory, as it did not deal with the points that I made or the points that were made so clearly and precisely by the hon. Member for Runnymede and Weybridge (Mr. Hammond). It is not adequate for the Government simply to say, "We're not going to be fair to the insurance industry. We'll be quasi-retrospective about it, because we want to maximise income." The issue is not one of income maximisation. If it were, why do we not simply set unfair higher fees, which would be another way of maximising income? I listened very carefully to every word that the Minister said. At no point did he address the substantive issue of dates; indeed, no date other than 2 July passed his lips. Our amendment to change the date on which the changes will apply will not strike at the Bill's "heart and purpose" but merely create the appropriate date on which the changes should apply. It is difficult for me to be persuaded by the Government's argument if they do not deal with the substantive points that have been made. I should like to know whether the official Opposition feel that the Minister's reply dealt with the arguments that they made. Merely reciting the Bill's purpose is not a sufficient way of debating significant concerns about retrospectivity. It is a matter of fairness. The Government of course want to maximise income, but if that is the only principle they are pursuing, they will be riding roughshod over the principle of natural justice. As the Minister has not addressed the substantive issues raised by me and the hon. Member for Runnymede and Weybridge, the Liberal Democrats shall press the amendment to a vote. The hon. Member for Runnymede and Weybridge has just finished making a very clear speech, which the Minister entirely failed to answer. It is therefore incumbent on Conservative Members to put their votes where they mouths are, and not continue to abstain in Divisions on substantive legislation simply because they want to spend more time on Thursday afternoons shoring up their constituencies. We did not change the hours of the House so that they could abstain in Divisions, as they did in the previous one. It is still mid-afternoon, and Liberal Democrat Members are keen to engage the Government in debate. When I press the amendment to a Division—as I shall if the Minister has nothing further to say—I hope that Conservative Members will support us with their votes and not only with their words.

Philip Hammond (Conservative, Runnymede and Weybridge)

rose—

Michael Martin (Deputy Speaker, Glasgow Springburn)

Order. I should tell the hon. Member for Runnymede and Weybridge (Mr. Hammond) that the tradition in the House is that the hon. Member who moved the amendment should be the last to speak to it, so that he or she may be able to withdraw it.

Philip Hammond (Conservative, Runnymede and Weybridge)

I should like merely to respond to the point that the hon. Member for Oxford, West and Abingdon (Dr. Harris) made—

Michael Martin (Deputy Speaker, Glasgow Springburn)

Perhaps the hon. Gentleman can do so on another occasion.

John Hutton (Labour, Barrow and Furness)

I beg to move, That the Bill be now read the Third time. Today and in Committee we have had the opportunity to look carefully at the Bill and its purpose. We are trying to streamline, improve and manage more effectively the existing scheme for recovering the cost to the national health service of treating road traffic accident victims. We are determined to do that for a number of reasons that we have repeatedly spelt out during proceedings on the Bill. The NHS needs the extra resources that the scheme will provide, and the Bill is badly needed. It will free hospital staff from the burden of questioning patients when the care and treatment of those patients should be uppermost in everyone's mind. Patients will no longer be confused or worried about a scheme that does not affect them directly. It is worth emphasising that since the 1930s the insurance industry has had the primary obligation to meet the costs of treating road traffic accident victims. We want there to be no misunderstanding about the Bill. The scheme will raise a good deal of money for the NHS, not, as some hon. Members wanted, going to another tier of NHS administration—an outcome that the Liberal Democrats tried to secure in Committee—but going directly to hospitals, where it can be used to the immediate benefit of patients. In the overall scale of NHS finance, the amounts may not be great, but they are substantial injections to the budgets of the hospitals that stand to receive them and the sooner the Bill is enacted, the sooner the benefits will be received. A number of specific concerns have been raised and it would be helpful if I took the opportunity to set the record straight. We reject the accusation that we are imposing a new tax or a new charge. It is vital to remember that NHS charges can be recovered only when it has been recognised that the patient has a claim against another person in respect of his or her injuries. In such cases, insurers have always known that the victim is entitled to use and claim for private sector treatment if he or she so wishes. The insurer has no choice but to pay. However, insurers have largely escaped paying equivalent NHS charges simply because of the lack of a system for their recovery. The Bill will fundamentally address that by putting into place a new, effective, streamlined costs recovery system. There has also been concern about the new scale of charges. What is new about the Bill is the move towards recovering amounts more closely in line with the actual costs to the NHS. Many of the points made during scrutiny of the Bill have concerned the move to those new, higher costs and some unease has been expressed about their calculation and their future uprating. Much of that concern has been needless and has involved party political point scoring, primarily by the Liberal Democrats. The figures have been arrived at openly and honestly using information which is in the public domain and freely available. Our costs have been derived from work undertaken by the Transport Research Laboratory and published in its research paper 272, with co-operation from the police, the NHS and the Department of Social Security compensation recovery unit. The calculations and source data were all contained in the regulatory appraisal—we have nothing to hide. We have rightly rejected calls for reports to be filed at set intervals on the tariff, the amounts collected and so on. The Bill is no different from any other—including all the previous road traffic measures which have governed NHS charge recovery. Its subordinate legislation, which I understand is the source of some concern to hon. Members, will come before the House in the normal fashion and hon. Members will have every opportunity to question and discuss planned changes. In response to a direct question from the hon. Member for Runnymede and Weybridge (Mr. Hammond) today, I made it quite clear that it is the Government's intention to assist hon. Members in discussing the impact of the Bill and the new arrangements that we are introducing and to make sure that all hon. Members have access to the most up-to-date, relevant and timely information to allow them to reach their own decisions about the operation of the new arrangements. Some concern has been expressed about the effect of the changes on the motorist. Much of it has been based on ill-informed speculation. Large insurers have gone on record as saying that the measure probably will not affect their premiums, yet the scaremongers persist. Let me make it quite clear today that we have calculated and openly published our estimate of what the scheme would mean if the total NHS charges were averaged out and spread evenly among all drivers. If that were the way in which the insurance industry raised the charges, we estimate that the effect would be an increase of 2 to 3 per cent., or £6 to £9 on the average premium.

Philip Hammond (Conservative, Runnymede and Weybridge)

I understand what the Minister is saying, but does he accept that the costs will not be averaged out and will affect some motorists more seriously than he suggests?

John Hutton (Labour, Barrow and Furness)

The hon. Gentleman has tended to anticipate my remarks and he has done so again. We expressed the figures in those terms to make it quite clear that under our insurance system, drivers who cause accidents carry a greater risk and pay higher premiums. If there were an effect on premiums, it would be likely that careless drivers would contribute most. The allegation by some Opposition Members that the Bill would affect rural motorists as a specific group of drivers is completely unfounded. The premiums will reflect risk. Drivers at high risk will pay more. Safe drivers should face no increase.

Robert Smith (Liberal Democrat, West Aberdeenshire and Kincardine)

Will the Minister give way?

John Hutton (Labour, Barrow and Furness)

No. For those reasons and many others, this is a sensible and sound Bill. It will assist the NHS in recovering the costs of treating road traffic accident victims. It will provide additional resources to the national health service. It is what our constituents want. The money will benefit the hospitals in our constituencies. I endorse the Bill and urge the House to support it on Third Reading.

Philip Hammond (Conservative, Runnymede and Weybridge)

I should make it clear at the outset, as my right hon. and hon. Friends have done during the Bill's progress, that we do not object in principle to the Government's purpose in introducing the legislation. Indeed, I welcome the shift in the Labour party's thinking that it represents. The Minister is sheltering—as Ministers have done before—behind the claim that the measure represents no new charge. That is disingenuous. The Minister has made it quite clear that the Bill will increase tenfold the yield from road traffic accident victims. It is currently £15 million or £16 million. Technically I am sure that the Minister is right to say that it is not a new charge, but the impact on the tax and charge-paying public will be that of a new charge. One cannot increase something tenfold and then say that nothing has changed. To say that, because the charge was there in theory but was not used in practice, starting to use it is a mere technicality and not a change in policy is similar to saying that because we have had nuclear weapons for 50 years, suddenly starting to use them would not be a major decision or a major change. The Government have also sought to gain some comfort from the fig leaf of indirect charging. I understand the political attractiveness of that, but the fact that insurance companies will pay the NHS charges and then recover the cost through premiums to motorists is not intellectually distinct from directly charging users of the NHS. Worse, perhaps, is the fact that taking the fig leaf and using it to protect themselves has led the Government to set their face against the logic of the Bill, and the way in which, quite possibly, that logic must be extended. The Bill represents an important turning point. The Labour party has crossed the Rubicon with this measure. After years of arguing against charges, the Labour Government have used precious legislative time not to abolish a charge that was yielding very little, but to beef it up so that it produces substantial sums. The Government could have abolished the charge in the same amount of legislative time that it has taken to make it effective and productive of large amounts of revenue. It appears that Labour has overcome its objection to the principle of charges. I do not seek to beat the Government over the head, as this is a small but important victory in the battle to end the dominance of dogma in their approach to the health service, but to begin the rational debate, for which my right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe) and I have called—as have the Liberal Democrats today—about how to fund the voracious appetite of a modern health service for resources. The Government and the official Opposition are both publicly committed to year-on-year, real-terms increases in spending on the NHS from general taxation. That is not an issue. Except for a few diehards—who are usually to be found, although not today, below the Gangway on the Government Benches—and the Liberal Democrats, almost no one now believes that we still live in a era where taxes can be jacked up endlessly to meet the demands of the NHS. Notwithstanding the commitment to year-on-year, real-terms increases—and whether it is 0.5 per cent. more over the life of this Parliament, as the Government are now delivering, or 0.5 per cent. less is very interesting, but makes no real or meaningful impact on the resource constraints facing the NHS—the fact remains that a health service that is funded exclusively from general taxation in an environment of broadly low tax, both domestically and internationally, will remain heavily resource-constrained. My right hon. and hon. Friends and I argue that without compromising or eroding in any way that commitment to year-on-year rises in spending from general taxation on our health care system, the system in its totality needs more resources than general taxation is likely to be able to provide. To address that issue, we must think laterally. If the Bill signals the Government's willingness to consider any source of funding for the NHS, it is a small but important start to the process. The basis for considering any method of providing additional funds for health services must be the test of whether it is fair, equitable and sensible. It might surprise the Minister to learn that, for the most part, we believe that the Bill passes that test. It is sensible to introduce it and to put on the statute book the measures that the Minister proposes. The principal area where, in our opinion, it does not pass the test—and the principal concern that we have expressed throughout the Bill's passage—is the discriminatory targeting of the motorist. We have seen the interesting spectacle of two Labour demons colliding in the Bill; the taboo on NHS charges has run smack into the desire to clobber the motorist at every opportunity. The charge on the motorist to be introduced by the Government is regressive, and has an anti-rural basis. It comes on top of the £9 billion of extra taxes that the Chancellor is imposing on the motorist over the lifetime of this Parliament. In effect, the motorist is being double-taxed. He is being asked to pay more than his fair share into the Consolidated Fund of general taxation through the dramatic increases in motoring taxes proposed by the Government. He is then being asked to pay again, on a discriminatory basis, for his use of the NHS. The Government have done something else—they have accepted the principle of insurance as a basis of spreading the burden of costs of health care. Indeed, they are sheltering behind the existence of compulsory motor insurance as an argument for the motorist being a unique category. Everybody would agree that the Government would never have considered introducing a £10,000 cap on the charge to be levied on an individual without any means test if the individual himself had had to pay the charge, rather than its being paid by his insurance company and the very considerable costs involved being spread across all motorists through the mechanism of insurance premiums. There are other areas where those treated on the NHS—often at very great expense—are insured. It is not logical for the Government to ignore that and say that the motorist is in a unique category and everybody else is different. Some poor, rural motorists may find it odd that they are being targeted to pay the additional charges when people returning to the United Kingdom from expensive skiing holidays with broken arms or in need of complex knee surgery—with insurance companies that have paid for their treatment in Switzerland, France or Italy—have their often very expensive treatment here on the NHS, without any requirement at all for them, or more precisely their insurers, to contribute as motorists are being asked to contribute. Ministers have often said that the principle of equity in the NHS is important, and Labour Back Benchers support that. One is bound to ask, "If motorists, then why not also other insured, compensated victims who need NHS treatment?" I did not know much about the operation of the compensation recovery unit until I started to look at the provisions of the Bill. I have learnt that one of the unit's main functions is to recover benefit that has been paid out in cases where, for example, employers have paid compensation after industrial accidents. If benefit is clawed back by the compensation recovery unit on behalf of the Treasury—where it has been paid out to the victim of an accident who, subsequently, has been reimbursed or compensated by the insurer of the employer—why should the NHS charges that that person has incurred, or has imposed upon the system, not similarly be recovered from insurers? I cannot understand the logic of the Government's position. They are saying that someone who carries compulsory motor insurance must be expected to pay for the cost to the NHS caused by treating third-party victims, while someone who carries compulsory employers' liability insurance need not reimburse the cost of NHS treatment carried out following an industrial accident or another insured risk—while the insurer must reimburse the cost of the benefits paid out. Where is the logic? There is none—it is as simple as that. It is unfortunate that the Government have closed their mind to the logic, as that has led to a clearly inequitable outcome, with motorists being the victims. Effective charging is being introduced for one group of the population only, and that charging is being introduced without any form of means testing. Undoubtedly, if the Government were to propose any wider form of charging, they would be looking at the ability of those charged to pay. In this case, everyone's insurance premiums will go up. As Liberal Democrat Members noted, the effect will be highly regressive, and I believe that it will be especially burdensome in rural areas. The Government have repeatedly assured the House that the proceeds of the charges will constitute extra money and be a little bonus for the NHS hospitals involved. I do not believe that. The original statement of the intention to make the charges effectively collectible was made by the Chancellor in his 1997 Budget. It is not credible to suggest that the revenue to be raised in that way had not been factored into the Government's calculations in deciding what total Treasury spending on the NHS should be. Surely the Chancellor must have considered that revenue as part of the wider equation in setting the Department of Health budget in aggregate. I am concerned about the impact on individual health authorities. The measure will channel about £150 million from insurers to individual hospital trusts, but it is extremely unlikely that that money will be spread evenly, principally because the incidence of road accidents varies. Certain hospitals specialise in high-level trauma such as is often suffered in accidents, and hospitals near the motorway network routinely treat many accident victims. It is likely that the revenue will be heavily skewed towards such hospitals. In allocating money to individual health authorities, will the Government ensure that the revenue that a hospital trust receives as a result of the Bill will not be taken into account and used as a reason for reducing the overall allocation to the hospital's health authority from general taxation? I am tempted to suspect that, over time, the Department of Health will take into account the revenue streams flowing to hospitals that specialise in trauma when setting the allocation to the host health authority. At a disaggregated level the money from the charges could be used to reduce the receipts of the authorities involved. The Labour party used to recite almost as a mantra the slogan, "An NHS free at the point of need and funded out of general taxation". We have reaffirmed our commitment to a service that is free at the point of need and to increasing year on year the real-terms expenditure on that service from general taxation. Beyond that, we believe that there is a need to bring in additional resources by other means and that we should consider every option, provided that it is fair, equitable and sensible. There is an urgent need for an open debate on the subject. If the Bill represents a genuine transformation in Labour party attitudes—a rejection of stale dogma and a willingness to engage in constructive debate about how to feed the voracious appetite of our health services over and above the funding that can be found from general taxation—we welcome that as an important step forward.

Robert Smith (Liberal Democrat, West Aberdeenshire and Kincardine)

I did not intend to speak, but the Minister refused to take an intervention on a point that interested me. It is a pity that Ministers are not more willing to take interventions; if they were, that could speed up our proceedings. He seemed to be saying that the fact that a motorist pays a higher premium proves that he is a more dangerous driver than others. It would be more correct to say that the motorist comes from a category that insurance companies consider to be a higher risk. Young motorists can be perfectly safe drivers, but they are penalised with a higher premium because they come from a group that is seen to have a higher risk of causing accidents. The Bill will cause some drivers to pay considerably higher premiums because, as others have said, one cannot get something for nothing. If the Government are right, and the money can be delivered to the health service at no extra cost, why are they not aiming for a higher sum? If there is no cost to be met, they should be raising far more. On Second Reading, our health team made it clear that the Bill should be opposed on principle. Having heard the arguments in Committee, I feel even more strongly that it should also be opposed on Third Reading. I am disappointed by the Government's attitude to the concept of retrospective legislation and their inability to accept any compromise or meeting of ways. They insist that, because something has been announced by a Minister, it must, de facto, be assumed that it will become the law of the land. That is absurd if we are to continue to have a legislative process and a House of Commons. Other Departments have accepted amendments or compromises and agreed to introduce changes on Report or in another place, in response to concerns expressed in Committee or by groups outside. To say that, because insurance companies will have read in the newspapers that the Chancellor has declared that he wants to do something, it must be calculated, ipso facto, that that will definitely happen is a disgraceful way to treat the House and the country. The Chancellor has made other claims on which he has not delivered. He cannot have it both ways. It must be accepted that, until legislation has passed all its stages, the process of lobbying and the right to make changes continue to exist. In this Parliament, with such a large majority, the Government seem to have decided to close their ears to representation and they are telling the wider public that they do not want to hear their views because they do not plan to act on them. Someone planning an energy Bill in the previous Parliament would have been slightly put out by an increase in VAT on energy consumption, because the then Government were defeated in trying to pass such a measure. I hope that, in another place, perhaps with different Ministers and the more considered debate that is possible there, the Government will amend the Bill and make it less damaging.

Robert Syms (Conservative, Poole)

I have followed the Bill's progress on Second Reading and in Committee. The debate has been interesting and we have not always reached the expected conclusions. The Minister said that the legislation would be judged on whether it streamlined the process and created an improved, more efficient scheme. Certain aspects of the Bill will certainly improve the scheme. The abolition of the emergency treatment charge has been widely welcomed by Government and Opposition Members. Our earlier debate on whether the charge should remain for general practitioners or private hospitals was somewhat bedevilled by lack of information on both sides. We were not quite sure what was collected, who collected it or whether it was worth collecting. The Government said that they did not want to get rid of it because the GPs would be unhappy and some Opposition Members said that perhaps it was not worth having, but we did not have enough information to take the debate much further. As my hon. Friend the Member for Runnymede and Weybridge (Mr. Hammond) said, there is a point of principle at stake, because the Government have gone for a group of insured people in order to raise money. Throughout debate on the Bill, we have asked whether the Government have started on a slippery slope that will lead to more charges for, perhaps, home owners or for people involved in skiing or other sporting accidents. The official Opposition have expressed concerns that the Bill will breach a principle, and consequently affect many people's lives. We support funding the national health service through general taxation and we believe that it should be free to those who use it. However, all Governments have to consider ways to supplement the health service's income and it has been an education to watch how quickly this Government have moved to try to raise money from private motorists. The Minister said that careless drivers would pay the charge, but, as the hon. Member for West Aberdeenshire and Kincardine (Sir R. Smith) pointed out, the young pay higher insurance premiums than other drivers, as do certain categories of people with medical difficulties. The insurance companies determine those charges, but if—as most Conservative Members believe—the Bill leads to higher insurance premiums, some of those least able to afford the charges may be affected. In Committee, I raised the pot of gold argument. The Government have taken the credit for some £120 million to £160 million additional resources for the NHS, but they seemed to suggest that it would come from nowhere and not cost anyone because the charge was in place and the insurance companies were collecting it. However, as my hon. Friend the Member for Runnymede and Weybridge said, the money will have to come from somewhere, and we all know that it will come from charges by insurance companies on motorists. Motorists will pay an extra £120 million to £160 million, which will fund the NHS. That may not be a bad outcome, but the Government should be more open and acknowledge that motorists face an additional charge. We also raised the issue of retrospective legislation. On 2 July 1997, the Chancellor announced a charge, without giving any details. Even if an insurance company had rapidly decided that it wanted to recoup the charge, it would not necessarily have been able to do so. I hope that the Government will reconsider that issue. We have been accused of scaremongering, but we have pointed out that the money will have to come from somewhere. It will be raised by charging more to certain categories of motorists and some people will pay much more than they currently do. My hon. Friend the Member for Runnymede and Weybridge pointed out that we have to judge whether the Bill is a fair, equitable and sensible measure. Indeed, we are in favour of the Bill in principle, but the devil is in the detail. It is important that we have full scrutiny of the Bill's effect, and we must review the collection agency and its efficiency and effectiveness in collecting the charges. We must also review how the money is distributed to hospitals and health authorities. I was pleased by the assurances that the Minister gave during the Bill's progress that the Government did not want to hide statistics. When a new computerised system is set up, it is possible to arrange affairs so that information can be provided to Members of Parliament, and I am sure that the Minister will endeavour to achieve that. We have had an interesting debate and I look forward to hearing contributions from other hon. Members.

Simon Hughes (Liberal Democrat, North Southwark and Bermondsey)

We are coming to the end of proceedings on this short Bill and I am grateful to my hon. Friends the Members for Oxford, West and Abingdon (Dr. Harris) and for West Aberdeenshire and Kincardine (Sir R. Smith), who looked after our interests so diligently in Committee. On Second Reading, when we supported the Conservatives' reasoned amendment, we said that this measure was not the right way to raise money for the health service. When the Labour party came to office, it discovered a potential source of extra money for the NHS and, as the hon. Member for Runnymede and Weybridge (Mr. Hammond) said, it decided to make it produce more money—10 times more, an increase from £16 million to £160 million. However, we still do not know whether the Bill is an admission that the Government will look openly at the funding of the health service or a one-off response to an opportunity to raise more money by increasing an existing charge. The Government said nothing about such a move in their manifesto or during the general election, but it will mean that some people will make an additional contribution to the health service. On Second Reading, we said that we did not like the Bill but that we would see what happened to it in Committee. I was not a member of the Committee, but I understand that proceedings there followed the same pattern as today's. For example, we made the sensible proposition, in new clause 1, that we should abolish the system under which general practitioners, such as my hon. Friend the Member for Isle of Wight (Dr. Brand), may collect money directly from someone involved in a road accident. General practitioners do not like to do that and most of them do not do so. We suggested that GPs should be paid for that service in the same way that they are paid for emergency treatment. That is a sensible proposition, but we have seen no movement in our direction by the Minister. We also argued, with support from the Conservatives, that the legislation should not be retrospective. I am a lawyer by training and I have always sought to defend people against retrospective legislation. Whether its effect is big or small, the principle is wrong. We suggested that the date should be changed, but the Government have not conceded the point. The only concession made was on the need for clearer statistics, although the Minister was not very helpful when he was asked by my hon. Friends how many non-NHS and NHS doctors had said that they were in favour of the system. The Minister said that he had received representations, but he would not tell us how many. The core issue is the financing of the health service. We will vote against Third Reading of the Bill because we cannot have uncertainty about how money for the NHS will be raised. It will be the Government's fault if, in the future, different categories of people are required to make contributions to the health service because they have been injured when undertaking certain activities. There is no difference in principle between people who drive and are involved in an accident paying into the health service through their insurance companies and people who go on sporting holidays and are injured—like my hon. Friend the Member for Montgomeryshire (Mr. Öpik), when he went paragliding—doing so. If we extend the principle behind the Bill, there is no reason why my hon. Friend should not pay for his treatment. By the same token, people who are injured in their local park, at their place of work or climbing up a ladder at home should have to pay. There is no logic in charging only those involved in road accidents because they could have been charged in the past. People do not believe the Government's claims on that point. I am in favour of more funds for the health service, but I would also like to see a public debate about how to raise them and the Government have not so far responded to that. As my hon. Friend the Member for West Aberdeenshire and Kincardine said, we feel less reassured after proceedings on the Bill than we did before. We have supported from the beginning the Government's uncontroversial proposals to abolish the emergency treatment, but the Bill contains much more. We shall once again try, therefore, to defeat the Bill, this time on Third Reading. It is, I expect, unlikely that we shall succeed, but if we do not try, we cannot succeed. Our consolation is that, whatever the hon. Member for Bolsover (Mr. Skinner) may think, we have a two-chamber Parliament. The other House has no Labour majority, and it contains many independent people of expertise and knowledge who may amend the Bill. We hope that the Bill will be amended in the way that we have proposed. The Government have not done so, and, no matter how unsupportable their arguments have been, they have remained resolute in opening the door to charges in the health service that have never been part of rational debate. We ask the House to reject the Bill, and to reconsider health service charging in another place, at another time and in a more comprehensive way.