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Health and Social Care Bill [Ways and Means]

I am grateful to you, Mr. Speaker. The fact that we have to vote on this now means that we must raise the issues about where fee charging is dealt with. I recognise that that is the definition of your ruling. Absolutely germane to what my hon. Friend the Member for Woking (Mr. Malins), with all his experience, rightly says, is the question of whether what two bodies carry out, through two distinct functions, in relation to a matter that was previously dealt with under one body, has a significant bearing on the costs and amounts that may be charged through them as a tax, not necessarily falling on general taxation powers. Perhaps it would have been helpful to have had the benefit of the opinion of the Chairman of the Select Committee on Health; it is a shame that he is not here. [Interruption.] Indeed—as he is a GMC member. Critical to our decision on the resolution is whether we have resolved an issue of serious contention in Committee—whether the new bodies being set up under the Bill, not just this body but other bodies, are truly independent of Government. As an indicator of the Government's intent, if those bodies are truly independent, we would expect them to be able to charge a fee. I have to say that based on all the evidence so far in Committee, it has not yet been established that they are truly independent—far from it—and we have criticised them for that. If they are not independent, we are not considering a fee but a substitution of vicarious taxation of the members of professions covered by the new body for recovery of costs. We have to consider who might be affected by the passing of this resolution. For the doctors, optometrists, dispensing opticians, student opticians and optical businesses of this country, the fees proposed in the resolution will be garnered from the General Medical Council and the General Optical Council, as the Minister has admitted. That will have a direct impact on the fees charged by those bodies to their membership. The full GMC registration fee on the medical register will rise to £390 per annum with effect from April this year, having been frozen at £290 per annum since 2002. GOC registration stands at £169 per year. My hon. Friend the Member for Buckingham (John Bercow), whom I see is still just in the Chamber, raised the essential question of what the costs were, and we heard that there will be a massive increase. According to the Minister, it will be £11.5 million, which, by a quick calculation, means an extra £100 per doctor. It is that sort of detail that my hon. Friend was trying to winkle out of the Minister to find out what extra costs to constituents and the professional community we are truly sanctioning. I recognise your strictures to stay in order according to the resolution's narrow definition, Mr. Speaker, but the other serious unanswered question is that we have not seen the secondary legislation upon which the resolution depends, even in draft. As my hon. Friend the Member for Buckingham said, that makes it a bit of a pig in a poke. It certainly means that we are flying blind. The other thing absent from our consideration of the resolution—the final financial point that needs to be addressed—is the question of VAT. Currently, neither the GMC or GOC is registered for VAT, partly because of their charitable status; I hope that that is not news to hon. Members. However, the new office of the health professions adjudicator will immediately slap a 17.5 per cent. uplift on the fees payable to it, irrecoverable against the fees paid to the GMC or the GOC. The Minister should explain fully how the resolution will affect that arrangement. Where will the VAT loss fall, and upon whom? We have a serious worry about the costs included in the Bill that are, by virtue of this resolution, yet unknown. In addition to what is currently proposed to ensure that a fee is passed on vicariously to the members of the various professions involved—because it is no longer an independent body in our view, we consider this to be a tax-raising power—the Minister told us in Committee on Thursday that the establishment of the care quality commission as a successor body to the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission will cost £7 million, as outlined in the regulatory impact assessment. The transition cost will be £140 million, which includes the costs of redundancies, estate rationalisation and a planned reduction of operating costs. Creating responsible officers will cost between £3.1 million and £16.7 million per year, and extending direct payments will cost £1.5 million to £8 million a year. The social enterprise investment fund will cost £98.1 million and the health in pregnancy grant is a one-off payment. So, in addition, we have the ways and means resolution, which is the only means whereby the Government can press ahead with insisting that the fees chargeable by the OHPA are recoverable. It effectively constitutes a new tax on members of the professions I have listed. The resolution appears ill prepared and panicky, and has been tabled after the Bill was introduced. The Bill also presents a significant worry because the money for pregnant women is to be paid at the end of the second trimester. All the evidence that we have established shows that, despite the Prime Minister's assertions, the only benefit to be derived for better diet is before conception and in the early weeks of pregnancy. That contrasts with the Prime Minister's comments. Notwithstanding that we are discussing £175 million in the first year—