Health (Northern Ireland)

HC Deb 04 December 1986 vol 106 cc1135-48 6.57 pm

The Parliamentary Under-Secretary of State for Northern Ireland (Mr. Richard Needham)

I beg to move, That the draft Health and Personal Social Services and Public Health (Northern Ireland) Order 1986, which was laid before this House on 5th November, in the last Session of Parliament, he approved. I am sorry to learn that the hon. Member for Middlesbrough (Mr. Bell) has had an attack of asthma. I can only hope that it is not so bad that he is now in need of mouth-to-mouth resuscitation, because the Minister for Health in England has now left the Chamber and the hon. Member for Middlesbrough would probably have to put up with the Minister with responsibility for health in Northern Ireland. I can understand his worry about that.

The House will appreciate that this order contains a wide range of miscellaneous amendments to legislation concerning the health and personal social services and public health. Articles 3 to 14 of the order make a number of amendments to the Health and Personal Social Services (Northern Ireland) Order 1972, dealing with such matters as the dissolution of the Health and Social Services Council, arrangements for medical and dental practitioners who are suspended, and charges for accommodation. I do not propose to describe these amendments individually in my opening remarks, but if any hon. Members wish to raise points I will, of course, try to deal with them during my reply, if I should catch your eye, Mr. Deputy Speaker.

I shall therefore concentrate my remarks on the two remaining aspects of the draft order. The first concerns the tighter controls which we propose to introduce over the sale of tobacco products to children, under article 15. The second concerns the provisions we are introducing in articles 16 to 18 to control the spread of infectious diseases in the Province and bring our legislation into line with that in the remainder of Great Britain.

Article 15 amends the Health and Personal Social Services (Northern Ireland) Order 1978 and further restricts the sale of tobacco to the young. Many people and organisations have expressed concern at the amount of cigarette smoking by children in the Province. A survey sponsored by the Department of Health and Social Services in conjuction with the Ulster Cancer Foundation and carried out in 1983 showed that children in the Province aged 11 to 15 smoked £2,340,000 worth of cigarettes a year—that is, 39 million cigarettes—and that 24 per cent. of fifth-year pupils at secondary school smoked regularly. Further concern has been aroused by the manufacture and sale of new tobacco products, such as Skoal Bandits, which could be attractive to children and which constitute a considerable health hazard.

Article 15 strengthens controls on the sale of tobacco to young people in three important respects. First, it makes it an offence to sell any tobacco products to children and removes the seller's defence that he did not know that the tobacco was for the youngsters' use. Secondly, the definition of tobacco is extended to include products for sucking, chewing or sniffing. That will cover products such as Skoal Bandits. Thirdly, it increases control over automatic vending machines. In future, if it is proved that a vending machine selling tobacco is being extensively used by children, courts will be required to order the owner to prevent this or to remove the machine. These amendments match the provisions in the Protection of Children (Tobacco) Act 1986 which was sponsored by the hon. Member for East Lothian (Mr. Home Robertson). I will ensure that these amendments are brought to the attention of the police.

The remaining three articles amend the Public Health Act (Northern Ireland) 1967 and are intended to strengthen controls available in Northern Ireland to reduce the spread of infectious disease. The main interest to the House will be how these relate to AIDS, and I shall return to that later.

Article 17 gives powers to make regulations dealing with health risks which may arise from the arrival of ships or aircraft. Similar powers were originally contained in United Kingdom legislation, but certain provisions have now become transferred or reserved matters and new powers must be provided in Northern Ireland legislation. Secondly, article 17 gives the Department power to make regulations which could cover notifiable and other diseases.

Article 18 makes provision for the compulsory removal to or detention in hospital of people suffering from notifiable diseases. There are no existing powers, but there may be rare and very exceptional circumstances in which the clinical condition of a patient suffering from a notifiable disease places him in a dangerously infectious state, yet he refuses medical care and admission to hospital or to remain in hospital. In those circumstances, the new provisions in article 18 of the order empower health and social services boards to apply to a resident magistrate to make an order for the removal to or detention in hospital of someone with a notifiable disease if it is considered that there is a serious risk of infection to others.

Mr. William Cash (Stafford)

My hon. Friend said that he would come to the question of AIDS. Is he making a distinction between that and the procedure for notifiable diseases, or is he saying that AIDS is to become a notifiable disease? I did not quite follow his argument.

Mr. Needham

If my hon. Friend will bear with me for a moment, I shall come to the point that he has raised.

The new powers will not be used in respect of the many notifiable diseases which do not present a danger—for example, whooping cough and measles. A resident magistrate will decide, on the application of the health and social services board, whether a person suffering from a notifiable disease presents a serious risk of infection. If the magistrate is satisfied that that is the case, he will make an order removing the person to hospital or detaining him in hospital for a specified period.

I come now to the point raised by my hon. Friend the Member for Stafford (Mr. Cash). Notifiable diseases are specified in the schedule to the Public Health Act (Northern Ireland) 1967 and all are infectious diseases, such as infective hepatitis, typhoid, dysentery, whooping cough and measles. Various provisions in the 1967 Act enable controls to be applied to restrict the spread of notifiable diseases.

Finally, I should like to deal with the amendments in articles 17 and 18 as they affect AIDS. Those amendments match provisions in the Public Health (Control of Disease) Act 1984 and will bring about a common policy within the United Kingdom for the control of AIDS. It is the intention to make regulations under article 17, applying to AIDS some of the controls on notifiable diseases. Among these will be the new powers in article 18 for removal to and detention in hospital. The controls applied to AIDS will be similar to those already applying in Great Britain. I must make it clear that this order does not make AIDS a notifiable disease, and it is not the intention to do so. There is a real risk that people suffering from AIDS might be reluctant to seek medical help if the disease were to be made notifiable.

The draft order represents an important contribution to protecting public health in Northern Ireland, not only in terms of additional safeguards against disease but in reducing the risk to children from tobacco. I commend the order to the House.

7.5 pm

Mr. Peter Archer (Warley, West)

The Minister, with his customary clarity, has explained that the order has two basic purposes—to bring the law of Northern Ireland more closely into line with that of the United Kingdom and to provide the authorities with the powers to prevent the spread of infectious diseases, together with some of the other matters to which he referred. The whole House will approve both those purposes and, with certain reservations to which I shall refer in a moment, the Opposition welcome the order.

I find article 11 a little puzzling. The explanatory memorandum states: Article 11 repeals the statutory obligation of the Department, Board, Central Services Agency and the Training Council to produce annual reports but it fails to explain why. The Minister did not explain, either, but that omission may be rectified later. It is easy to argue that there are too many authorities producing too many annual reports and that we are all submerged beneath too much paper.

In this instance, however, we are dealing with a system which is not, in essence, controlled by elected representatives. The boards are not elected. They are not like local authorities in which decisions, achievements and failures are scrutinised by councillors who are themselves liable to be approached by members of the public. Moreover, Northern Ireland is governed by the system of direct rule, if "system" is the appropriate word, so not only are the boards not elected, but they are responsible to or monitored by an authority which itself is not elected. If the public are to have any prospect of knowing what is going on, it is important that those who run the system should at least have to formulate an account of what they have been doing and why. I should have thought that it would be a healthy exercise for them. I hope that the Minister will explain the thinking behind the proposal, if indeed there was any.

The Minister correctly diagnosed that some hon. Members would like to know a little more about articles 16 to 18. I am troubled by the second paragraph of the explanatory memorandum. We are told: The main purpose of the draft order is to strengthen the controls available in Northern Ireland to reduce the spread of infectious diseases so that they are more closely comparable with those available elsewhere in the United Kingdom. So far, so good, but it goes on: This would facilitate a common policy for the control of certain diseases, in particular Acquired Immune Deficiency Syndrome (AIDS). That seems to be the thrust behind what is happening. Article 17 empowers the Department to make regulations, with a view to the treatment of persons affected with any epidemic, endemic or infectious disease and for preventing spread of such diseases". There is also something about the spread of diseases on vessels. That is a wide power and is vested in some constitutional entity called "the Department" and not in the Secretary of State or in any Minister. It is clear that the Department does not even need to consult the Secretary of State except in relation to regulations affecting vessels. In itself, that is rather a wide power and it affects people in all sorts of ways. Of course we all appreciate the necessity for rules for that purpose.

Mr. J. Enoch Powell (South Down)

Has the right hon. and learned Gentleman fallen into the trap in the 1974 Act and failed to write in "Secretary of State" wherever he reads "Department" in one of these orders?

Mr. Archer

If I have overlooked a provision of that kind, I am grateful for the guidance of the right hon. Gentleman. If he says that "the Department" means "the Secretary of State", I am grateful for his guidance and no doubt he will elaborate on the point later in the debate. But if that is the case, why are we not told "Secretary of State"? That would set everyone's mind at rest and we would not need to refer back to the 1974 Act and would not have all this legislation by reference. Perhaps one day the Department will say what it means.

Mr. Cash

The right hon. and learned Gentleman might care to refer to the Interpretation Act (Northern Ireland) 1974 because that will solve his problem.

Mr. Archer

I am grateful to the hon. Gentleman, but a lot of people will have to operate these regulations not in a library with the Interpretation Act (Northern Ireland) 1984 and a row of textbooks to hand but out there where it counts. Perhaps the Minister will take this exchange to heart because it would be much easier if the regulations said what they meant and we knew who had power to do what.

We then come to some rather startling words. In article 17, new section 2A(2) of the Public Health Act says: Without prejudice to the generality of subsection (1), the Department"— apparently that means the Secretary of State— may by any such regulations apply, with or without modifications, to any disease to which the regulations relate any enactment relating to the notification of disease or to notifiable or infectious diseases. Perhaps there is some other intermediate instrument of construction that I have missed, but, on the face of it, the Department is authorised to decide the diseases to which the regulations are to relate. Clearly, it is intended that the Department shall be entitled to apply those powers to diseases which are not normally thought of as infectious or as notifiable. It also seems to have a wide if not absolute discretion about what diseases they shall be. I would be grateful for the further guidance of the hon. Gentlemen who intervened, but one day there may arise a king who knew not Joseph and we may find some Minister who wants to apply these regulations to something quite outside anything spoken about in this debate. One wonders why the powers must be quite so wide. However, that is not our real worry.

I looked to see what the position is in Britain. As I understand it, the Public Health (Control of Disease) Act 1984 confers wide powers on the Secretary of State and on local authorities to deal with infectious diseases. They may order someone to stay away from work, they may order people to keep their children away from school, they keep children out of places of entertainment, close infectious premises whether they are industrial or used for entertainment, and a justice of the peace is empowered to subject a person to a medical examination whether that person likes it or not or to order the person to be detained in hospital.

All that clearly restricts the freedom of individuals and might subject them to considerable inconvenience. Clearly, there may be good reasons for that and various considerations have to be placed in the balance. The decision must depend upon the nature of the disease and the seriousness of the consequences if it spreads upon the nature of the inhibitions on the freedom of the person concerned for preventing the spread of the disease.

The Public Health (Infectious Diseases) Regulations 1985 apply a wide range of these powers to deal with acquired immune deficiency syndrome, AIDS. Regulation 3(2) of those regulations provides for the compulsory detention in hospital specifically of someone suffering from AIDS. It does not apply some other power to AIDS, but provides a power which relates only and uniquely to AIDS.

So far as I am able to ascertain, those regulations were not debated. Perhaps the Minister can tell us a little about the powers in those regulations. Have any of them been used and if so in what circumstances? I was told of one case in Manchester of a person in hospital with AIDS being served with the order when apparently all he had sought to do was to spend what would probably be his last weekend on earth in his own home.

I raise these matters because, clearly, some serious considerations arise. If these provisions are effective and make an effective contribution to preventing the spread of AIDS, that is probably a decisive argument in their favour. But AIDS is not what we normally understand by the terms "infectious disease". We are told by those who know that there is no danger of anyone who carries AIDS communicating the disease simply by going about in public places. We are told that no one will contract AIDS simply because he has passed physically close to a carrier.

Why should someone with AIDS be confined to a hospital? If such a person says that he proposes to act in a sexually promiscuous way or if for some psychological reason he wants to spread the disease, it may be a different matter. But in the absence of such a factor, to the great misfortune of a person affected by AIDS we seem to be adding a further misfortune which does not make any obvious contribution to restricting its spread.

Is it proposed that people suffering from AIDS should normally be forcibly removed to hospital in the absence of any other factor? Who will decide who is to be subjected to these powers? Will it be the environmental health officers, for whom I have great respect? If it is, to whom will they be answerable and who will decide if there is a dispute about the matter?

The House would fail to address some important issues affecting the rights of people if it did not ask these questions, especially because the powers are to be conferred in such apparently wide terms. I raise these matters not because they arise directly from this order. Subject to the two matters that I have raised, we have no complaints about the order. But the Government may subsequently have to justify the next step which, according to the Minister and the memorandum, is now being contemplated. We will not divide the House on this issue, but I hope that the Minister can tell us more about the powers, because the argument for the proposal in such wide terms is not self-evident.

7.18 pm

Mr. J. Enoch Powell (South Down)

This is a miscellaneous order and comment upon it is therefore necessarily also miscellaneous. It may be convenient to the Minister if I designate first those articles with which I am not merely in agreement but in enthusiastic agreement. I will then come to the articles that I do not like and finish with the articles on which I and perhaps the House would welcome further explanation.

First, I shall list the things that I like. I like article 5. It is curious that we have had to wait for article 5 for the registration of common lodging houses to be brought into force. Certainly the registration process in relation to common lodging houses, like that in relation to old people's homes privately provided, is not merely an important safeguard but a gentle kind of instrument which results in the improvement of conditions generally. I am glad that at last article 5 will enable that power to be effectively exercised.

I like article 9. Although it is somewhat obscure, I understand that it will have the effect of facilitating short-term assessments of persons for admission to old people's homes, and also short-term stays in those homes. In so far as it does that, it will certainly be beneficial.

A recurrent tragedy with which hon. Members are confronted in their constituencies is that of old persons, still managing in difficult circumstances and sometimes in isolation, with the self-sacrificing assistance of others, usually relatives, but offering those relatives no relief whatsoever—a situation from which there seemed often no escape for any of the parties.

If short-term stays are rendered easier as a result of the facilitated assessment that the article provides, I hope that it will more often be possible to persuade the old person to enter a home temporarily while those normally responsible for his or her care get some opportunity for recuperation and recovery.

Such a stay may also assist the transition across that awful gulf between one's own home and, what is also known as a home, a residential home. That is a step before which too many elderly people, to their own disadvantage, hesitate for too long. Therefore, I commend and welcome what is achieved by article 9.

I also like article 15, which was one of the two articles to which the Minister referred. I like the fact that it brings in tobacco substitutes and other products, and I especially like the fact that it will be impossible in future for a vendor of those items to say that he "didna ken". It will not be possible for the boy or girl, as the case may be, to say that she "wants it for her mum or dad". The products simply cannot be supplied to a person under the age of 16 without a breach of the law. The only remaining loophole, presumably, will be if the vendor pretends that he does not know the age of the person; but there are means of following up and dealing with that evasion. So a welcome strengthening of the law for the protection of young people has been provided by article 15.

That ends my catalogue of enthusiastic approval, not necessarily excluding the articles, which I have not mentioned, but which I recognise as necessary.

I come to those articles that I do not like. I do not like article 6 which is a curious article. A Department is in possession of a piece of land and wishes to dispose of it. It cannot find a ready buyer for that land, except in association with a contiguous—I believe it is called "adjacent" here—piece of land. Therefore, the Department is given power to purchase the adjacent piece of land in order to sell both together, either more easily or more advantageously.

I simply wonder whether that is a necessary provision. It seems a strange one to come from a Government ideologically averse from unnecessary vesting of land: for that is the process we are discussing. I understand that the acquisition of land which is conferred is voluntary; nevertheless, if the Department can voluntarily acquire area B which is adjacent to area A which it already owns, why on earth cannot the potential purchaser of area A understand that he can also buy area B and, therefore, take area A off the hands of the Department? I wonder if this is not a bureaucratic provision that has been put in for convenience and is not strictly necessary. I hope that I shall have the Minister's agreement in saying that, as far as I am concerned, public acquisition of land, unless strictly necessary, is anathema.

My other objection is to article 16, which substitutes departmental determination for prescription by regulation. In general, it is bad practice, where an existing law requires a regulation to be made, to wipe out the regulation-making power and substitute mere determination. It is true that regulations which would be prayable elsewhere are not prayable under the present constitutional arrangements in Northern Ireland. Nevertheless, the mere making of a statutory instrument imposes a certain discipline upon those who make it, especially as in Northern Ireland we have an excellent Examiner of Statutory Instruments, whose successive reports we peruse with the same excitement as we once used to peruse the Boy's Own Paper Thanks to that assistance, I have no doubt that the necessity of making a regulation sharpens the minds of officials and Ministers much more than the power just to issue a determination. I do not like article 16, therefore, and I go on record as disliking it.

Now for my questions. I was surprised that the Minister did not offer the House at any rate a brief explanation of article 7, namely, the arrangements for general medical practitioners whose registration is suspended. To the untutored student, it appears as though that makes a provision for general medical practitioners whose registration is suspended to go on operating.

Mr. Needham

indicated dissent.

Mr. Powell

I am glad to receive a negative signal from the Minister, but I should be grateful—and I suspect that other hon. Members would be grateful—if he could explain at some little length how article 7 will work and why it is necessary.

I now turn to the area traversed by the right hon. and learned Member for Warley, West (Mr. Archer), covering articles 16 to 18, especially article 17. Studying, as I noticed that he has studied, the explanatory memorandum with more than usual care, I came across a constitutional curiosity, which I hope the Minister can clear up. It is referred to in the words: Since certain public health controls on vessels and aircraft have now become reserved or transferred matters". I would like to know when and how they became reserved or transferred matters. I think I guess—but guessing is not good enough—that under the old Stormont constitution those powers were not vested in the Government of Northern Ireland and were in consequence exercised under United Kingdom powers. Curiously, it looks as though somehow under the 1973 and 1982 Acts an odd power or two that was not embraced within the capabilities of the Stormont regime got made available for a sort of administration which does not exist and which many of us think it would be better never did exist. Perhaps the Minister could clear up that point of curiosity.

More important is the general operation of the regulations now that they have been rendered uniform with the powers existing in the rest of the United Kingdom. They are extremely onerous upon the individuals to whom they would be occasionally applied as I should like to illustrate by a query for which I should be grateful to have the Minister's answer.

The orders for dentention in hospital are made for a period. That period can be extended. Can it really be the case that an order made for a period could be indefinitely extended? Somewhere in the legislation there must surely be a superior power of appeal or review. I hope that the Minister will have been sufficiently briefed to be able to reassure the House that it will not rest simply with a magistrate making the initial orders and also making the renewal orders provided for in the regulation but that there is available somewhere a superior authority.

Those who are admirers of Surtees will recall how that redoubtable foxhunter, John Jorrocks, once found himself in a mental institution, from which he was liberated only by the visitation powers of the Lord Chancellor. By his replies to questions on foxhunting he succeeded in persuading the Lord Chancellor that he was sane, whereupon the Lord Chancellor, fortunately for him and the rest of us, ordered his release. There must be somebody who, in relation to this order, can perform the same liberating act as the Lord Chancellor did for the redoubtable John Jorrocks.

7.30 pm

Mr. William Cash (Stafford)

Are there provisions equivalent to those in article 15 for the United Kingdom? In other words, do such provisions already apply in Britain? I am sure that my hon. Friend the Minister will be able to answer that question sooner or later. That matter raises important questions which could apply to Britain.

I am grateful to my hon. Friend for his explanation of the difference between those provisions which apply to notifiable diseases and those which apply to AIDS. I recall tabling an early-day motion in 1984 on AIDS and I have followed that subject with some interest and grave anxiety for some time. I have in my constituency a consultant who specialises in sexually transmitted diseases and he was good enough to spend a couple of hours with me on that subject. Therefore, I am glad to discover that the regulations in article 17 will clearly help those in Northern Ireland who tragically suffer from AIDS.

Finally, I want to put it on record that the absence of Members from Northern Ireland—apart from the right hon. Member for South Down (Mr. Powell) and the hon. Member for Newry and Armagh (Mr. Mallon)—when we are discussing a matter such as AIDS which is of such great importance to public health in Northern Ireland is a great shame.

7.32 pm

Mr. Seamus Mallon (Newry and Armagh)

I shall confine my comments to three articles in the order.

I welcome article 5 on common lodging houses. When I first began to deal with the problem of common lodging houses I was astounded that such legislation simply did not exist, and when I inquired into it further I was appalled at the Dickensian arrangements that exist. I have details of cases which I shall give privately to the Minister, but in one lodging house in my constituency, for which the DHSS is paying, four women and three children are living in one room. In another, seven men are dwelling in one room. That shows how much that provision is to be welcomed. It is much overdue and must be ruthlessly enforced.

I have one slight reservation. Article 5 says: The Department may, by regulations, make provision with respect to common lodging-houses, and any such regulation shall include provisions"— this is where I have a slight worry— for the registration of common lodging-houses by Health and Social Services Boards". I ask the Minister most sincerely to ensure that such an inspection is thorough and rigorous. It is appalling to realise what public money is being used for. People coming to my surgeries and clinics have told me about the sheer Dickensian—I can only call it that—circumstances in which they live. I hope that the Minister will ensure that the inspection is the most thorough and rigorous possible.

I do not want to stray into another area, but I am concerned about the performance of area boards in assessing medical factors, especially in relation to housing allocations and transfers. There is a distinct lack of thoroughness and rigorousness in establishing a person's medical needs. When this provision is approved, I hope that the Minister will ensure that it sticks, and the only way to do that is for such an inspection to be carried out on at least a quarterly basis. A yearly inspection will not suffice. It should be carried out by someone from the board who has the power to be as ruthless as is humanly possible. Such a person should be supported in every way by the Department to ensure that what is happening today no longer happens.

I also have slight worries about article 40(b) in relation to rights of appeal. That appears to be the type of appeal that is available to private nursing homes at present. I hope that the Minister will tell me if that is the case. I am worried about some private nursing homes, the way in which they operate, and the way in which they are able to win their cases. From cases in the courts it is clear that the wool has been pulled over the eyes of the people from the health boards, and there is even more opportunity for that in relation to lodging houses.

I am slightly worried and confused about article 9—the limitation of charge for accommodation to minimum rate in relation to the intervening period. I understand and appreciate the points made by the right hon. Member for South Down (Mr. Powell). Looking at it from the other end of the spectrum, I am worried about the number of homeless young people who live in lodging houses. That number is increasing enormously. Two weeks ago there was a substantial lobby of Parliament by the young homeless. I wonder how their position will be affected by article 9. I may be reading it wrongly and being slightly too pessimistic, but there is a growing problem with the young homeless, for whom this provision may not be able to cater in the way that it caters for old people and those who may have to enter residential homes for a period.

With regard to article 11, I fail to understand how we can avoid having the type of annual report that we have always had in the past. There may be some substitute. I do not know.

I should like to leave the Minister with one thought that I trust he will take on board. During the past five weeks in my constituency there have been five different explosions—five different attacks. On one day during that period no acute emergency ambulance service was available. We have discussed this problem in great depth with the area board and those responsible for the ambulance service. This lack of provision has been substantiated by the unions, and it is causing them and myself great concern. If we cannot ensure that we have proper ambulance cover in this type of situation, I cannot for the life of me understand how we can do away with the annual report. It provides the only basis on which to assess the situation in relation to those problems.

7.40 pm

Mr. Needham

One of the joys of my present job is to reply to a number of detailed and highly articulate questions put on unamendable orders, covering miscellaneous provisions stretching from here to infinity. It is an intellectual test for which my predecessor, with his Balliol background, was perhaps better equipped than I am with the university of life degree as the only degree around my shoulders. I shall try to wade through as best I can and I am sure that hon. Members will interrupt me as I go on if they feel I have not adequately answered their questions.

The right hon. and learned Member for Warley, West (Mr. Archer) questioned why, under article 11, the Government are suggesting that annual reports should not be produced. We have decided not to continue these reports because they require a great deal of work. Those right hon. and hon. Members who have read reports will be aware of just how much detail goes into them, and that is a waste of resources.

I hope that the hon. Member for Newry and Armagh (Mr. Mallon) will not mind my saying that if no ambulance cover had been available last week when tragic events took place in Newry I do not believe that the annual report would necessarily highlight that problem. Some effective administrative and technical action would have to be taken to make sure that that service was provided at all times.

Mr. Mallon

I think that there is some confusion. I was not talking about the events of last week. I should like to take the opportunity to compliment the ambulance service, the fire brigade and all the emergency services on the tremendous job that they did during the events of last week. What I said was that during the past five weeks there had been five explosions and that on one specific night there was no ambulance cover.

Mr. Needham

I am sorry if I misunderstood the hon. Gentleman. However, that does not alter the fact that I am not convinced that annual reports are necessarily the best way in which to publicise such a problem. I feel that the hon. Gentleman would be a much better publicist of that problem than would any annual report.

It is necessary to point out how the health boards make facts and statistics available to the public. The Department has a regional strategic plan which, as right hon. and hon. Members will be aware, is in the process of consultation. That plan is reviewed every three years. The Department publishes strategic plans, and these are updated. We wish to put the information that is issued by the boards into a modified format. I am sure that many of the boards will continue to publish annual reports of some sort, but they will not be published in the same detailed and structured way as those of the past. Of course, the Department will continue to want to receive sufficient information from the boards to ensure that departmental strategy can be fulfilled.

The right hon. and learned Member for Warley, West said the boards were not elected, but he will be aware that some of the members of the boards are elected representatives. I hope that the elected representatives will not resign from these boards because they have an important part to play. The presence of those representatives on the boards, and the proposals in the order, will bring the boards into line with practice in the rest of the United Kingdom.

I am conscious of the need to make available as much background information and statistics as possible to the public. However, I am not convinced that the present form of annual reports has been either the most efficient or the most effective way of doing that. I do not believe that the annual reports of the Southern board are the main source of reading for a Saturday night in the bars and clubs in the constituency of the hon. Member for Newry and Armagh—much as I wish that they were.

Mr. Archer

May I offer the Minister a deal? If we may have more debates, at more convenient times, we will dispense with the annual reports.

Mr. Needham

The right hon. and learned Gentleman will be aware that the power to make such arrangements lies further down the Front Bench. However, I assure him that, in view of my lack of practice, I should be only too happy to have many more debates, with a better attendance, so that there will be some hon. Members present who will actually remember who I am and where I come from.

The right hon. and learned Gentleman, together with the right hon. Member for South Down (Mr. Powell), raised a fundamental question concerning article 17. The key to that article is the risk to public health. The right hon. Member for South Down was absolutely correct to say that, for this purpose, the Department is the equivalent of the Secretary of State. The key point is that the Department is empowered to make regulations under article 18 to detain in, or to remove to hospital, someone who is considered to be a risk to public health because he is suffering from a notifiable or infectious disease.

The right hon. and learned Member for Warley, West discussed the problem of AIDS, but I do not intend to get into an argument about whether AIDS is an infectious disease. I hope that the House accepts the serious nature of this disease. If, and for the reasons mentioned by the right hon. and learned Gentleman, someone with this disease could be a danger to public health, it is necessary for the Department to be able to go before a resident magistrate and ask for an order to be made to detain that person in, or remove him to, hospital.

I cannot give the right hon. and learned Gentleman the details for which he asked concerning the Manchester case. The fundamental question is not whether the regulation should apply to somebody who wants to go home for the weekend or for two or three days. The point is whether he is a risk to public health. If there were not that risk, it is inconceivable that a resident magistrate would say that that person should be detained in hospital over that period. I am sure the right hon. and learned Gentleman will accept that, in those circumstances, the court would show good sense.

The right hon. Member for South Down asked whether there was an appeal to this process. There is no provision for appeal in the Public Health Act (Northern Ireland) 1967. There is the general right of appeal against the decision of a magistrates court under article 143 of the Magistrates Court (Northern Ireland Order) 1981. In contrast, there is a specific right of appeal in Great Britain. I was not aware of that and it must be properly considered. I am sure the right hon. Gentleman will agree that the nature of these diseases is such—I am thinking particularly of the problems that we face with AIDS—that if someone suffering from one of them refuses to behave responsibly and reasonably and puts public health at risk, the Government and the Department must act in the interests of public health.

Mr. J. Enoch Powell

I am sure that the House is indebted to the hon. Gentleman for the candour with which he has recognised what I think we would all see as a deficiency in the order as it has been presented to us. I am sure that the hon. Gentleman will accept that this is yet another illustration of the general proposition that there is no substitute for making law by Bill.

Mr. Needham

We have debated this matter before. The present system of dealing in the House with unamendable legislation affecting Northern Ireland cannot be considered satisfactory. I think that I will stray from the point if I return to a debate in a previous Session in which hon. Members who gave reasons for that system were called to order. But it is fair to the House to state the present position.

The right hon. Member for South Down referred to the acquisition and disposal of land. The Department does not have the power to purchase land beside land which it occupies and which, if purchased, would make the total package much more valuable. The right hon. Gentleman referred to package A and package B. I can understand that a person might want to buy the Department's land—say package B—to put it with package A and then sell it. Surely it cannot be argued—I am sure that the right hon. Member for South Down would not dispute this—that when the Department owns package B and the addition of package A would make the two packages much more valuable, it would not be sensible to give the Department the right to purchase package A, put the two packages on the market and obtain the best value for the public purse.

We advocate article 16 to make a delicate matter simpler and less complicated. I appreciate that the right hon. Member for South Down is an avid reader of the proceedings of the Committee on the order. In terms of providing a certificate for a fee, it is administratively more sensible to proceed along the lines that we have suggested.

There are several reasons for allowing practitioners who are suspended to maintain their practices. Suspension does not mean that a practitioner is necessarily unfit to control his practice or that he will not return actively to take part in it. Suspension might be due to preliminary hearings concerning professional misconduct, but, if investigations show that there is no case to answer, the practitioner can be reinstated. Clearly, it would be extremely unfair in the meantime if the practice has been allowed to run down.

Suspension might be due to a general practitioner suffering from a mental or physical illness. Normally, a GP who is ill can arrange for his practice to be maintained and return to it after his illness. Sometimes, that may not be possible. He may be involved in a motor accident which leaves him with an impairment from which he eventually recovers and he could be reinstated. In those circumstances, it would be unfair to let the practice suffer.

Will the patients be properly protected under the arrangements? When a member of a practice is suspended, the service to the patients will be provided by properly qualified and registered doctors. In addition, when suspension is because of ill health, the General Medical Council and the General Dental Council have the power to impose further requirements on the practice for the protection of patients.

The proposals will enable the Department to remunerate doctors and dentists who have been suspended on grounds of ill health, but we make no provision for the remuneration of doctors and dentists suspended under the direction of the professional conduct committee, respectively, the General Medical Council and the General Dental Council. If suspension fell under that category, the order would not take effect. The corresponding provisions in Great Britain to articles 7 and 8 are sections 14, 15 and 16 and schedule 6 to the Health and Social Services and Social Security Adjudication Act 1983.

The right hon. Member for South Down asked why it was necessary in article 17 to have new regulatory powers in respect of public health risks from ships and aircraft and asked what had happened. I suspected that he would pick up that point. These matters were not reserved for or transferred to the old Stormont Government, but were covered by section 143(1) to (7) of the Public Health Act 1936, which was United Kingdom legislation. However, they were transferred to Northern Ireland under the Northern Ireland Act 1974. Because the regulations for control of certain diseases have continued to be made under the Public Health Act 1936, the time has come to bring the legislation into line and, if necessary, to alter it to include it in the transferred and reserved matters. That is why this aspect has been dealt with under the order.

I am afraid that I was so busy making notes to keep up with the right hon. Member for South Down that I missed the speech of my hon. Friend the Member for Stafford (Mr. Cash), except when he said that he felt it was unfortunate that there were no Northern Ireland Members present to join the debate. I agree with him. I shall, of course, study Hansard tomorrow and write in full to my hon. Friend.

The hon. Member for Newry and Armagh referred to common lodging houses. I feel strongly about this matter. I give him an undertaking that there will be rigorous and proper inspection of those houses. I have been concerned about the extent of rigorous and proper inspection of residential homes in Northern Ireland—I am not talking about common lodging houses—and I have asked the Southern board and other boards how they undertake visits to ensure that inspection is carried out properly and satisfactorily. There are now many more such residential homes than in the past. I shall continue to ensure that inspection is carried out properly and satisfactorily. Obviously, that will apply to common lodging houses as well.

I do not believe that article 9, to which the right hon. Member for South Down referred, covers the younger homeless. The right hon. Gentleman put forward the reasons for introducing that article. It does not make boards assist in the provision of respite care, but gives them the opportunity to give assistance to those people who want to go into such care. I hope that the boards can take advantage of that article, for the important reasons put forward by the right hon. Member for South Down.

I hope that, having dealt with these miscellaneous provisions in a miscellaneous way, I have answered most of the points raised by right hon. and hon. Members and that the order will receive the approval of the House.

Question put and agreed to.

Resolved, That the draft Health and Personal Social Services and Public Health (Northern Ireland) Order 1986, which was laid before this House on 5th November, in the last Session of Parliament, be approved.

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1. TEACHERS' PAY AND CONDITIONS BILL 44 words