HC Deb 09 June 1986 vol 99 cc131-42
Mr. Dobson

I beg to move amendment No. 20, in page 3, line 20, at end insert 'and

  1. (iii) the times at which he will undertake to provide those services.'.

Mr. Deputy Speaker

With this we may take the following amendments: No. 24, in page 3, line 47, at end insert— '(e) for the Committee to consult local public transport undertakings about the hours of opening of the premises under consideration.'.

No. 25, in page 3, line 47, at end insert '(e) to ensure that every neighbourhood has reasonable access to the services of a pharmacist; that such services be advertised in such manner of language to be easily understood and that they be available at specific times outside normal trading hours.'.

Mr. Dobson

The main aim of amendment No. 24 is to ensure that the provision of pharmaceutical services and decisions about the services provided are not taken in isolation from consideration of the transport facilities that are available to get people to and from chemists' shops when they want to get a prescription dispensed.

Many people do not have their own transport and have to rely on public transport. The timing and routes of buses are often not convenient and not related to the location or opening hours of chemists' shops. That makes it difficult for people who are sick or are nursing sick relatives or friends to get drugs that they require.

We propose in amendment No. 24 that before deciding whether to accept a proposal for a chemist's shop in an area the committee responsible for making the decision should consult local public transport undertakings on the opening hours of the premises. It may be possible to get the people running the shop to vary their hours or to get the people running the transport system to vary their timings so that buses are run for people who do not have private transport. At some times of the day, those people are the majority.

My hon. Friend the Member for Islington, North (Mr. Corbyn) will no doubt explain his amendment No. 25, which proposes that every neighbourhood has reasonable access to the services of a pharmacist and that services should be made known in languages that are understood by people whose mother tongue is not English.

We argued in Committee that it would be useful for the committee that decides on applications to open chemists' shops to consider matters such as opening hours and ease of access and use of local pharmacies. We are in favour of people making better and more extensive use of their local pharmacies, and that is what the amendments are intended to secure.

As I am always willing to admit, there may be something wrong with the detailed drafting of the amendments. If there is, we should be happy for the Minister to accept the basic proposition and to introduce a more appropriately worded amendment in the House of Lords which will do better the job that we want done. I can see no reason why he should not accept the general drift of the amendments.

Mr. Corbyn

I support my hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson). When the National Health Service was set up, controls on pharmacies were exercised through family practitioner committees. Later, those controls were made more powerful, and now the Government wish to introduce more requirements for the opening of pharmacies.

Amendment No. 25 places a requirement on the Health Service to ensure reasonable access to the services of a pharmacist wherever people live. Although I can understand the argument that we should stop too many pharmacists opening shops in one high street or shopping area, it is also important to ensure that there are enough pharmacies in each neighbourhood. Increasingly in rural areas the idea of local shops is disappearing with the development of hypermarkets and motorised shopping centres. Village shops are also disappearing, and in the suburbs of small towns pharmacies tend to disappear altogether. It is important to ensure that pharmacies open in places which it is practical for people from every neighbourhood to reach.

A similar, although more complicated, problem arises in urban areas. Shopping centres tend to suffer from the growth of larger multiple shopping centres some distance from town, so urban areas lose many shops, especially pharmacies, which are needed by those who have difficulty in getting around. My hon. Friend mentioned the need to consider public transport facilities.

The committees involved must also ensure that the opening hours of pharmacies are well-advertised and that they open outside normal trading hours. Unfortunately, people do not require the services of a pharmacist only during office hours. Additionally—this applies to some areas more than others, but especially in my constituency—there is a need for multilingual advertising of such services. In my constituency, 41 languages are registered or spoken. Some are more dominant than others, including several African languages, Hindi, Urdu, Bengali, Greek and Turkish. At least six languages are commonly spoken, apart from English. It would be appropriate for the local committee to require that pharmacists' services be advertised in the languages commonly spoken in the locality. Elderly people from the subcontinent and other areas often have to ask children to vist the pharmacy and explain what is wanted or obtain the necessary information.

The suggestions in amendment No. 25 would change the Bill's approach from the entirely permissive to the more compulsory. They would ensure that pharmacies were located in reach of everyone, that they were open at convenient times and, importantly for areas such as Islington, that the services were advertised multilingually to ensure that no one is left out of this aspect of the Health Service.

1 am

Mrs. Clwyd

I should like briefly to support the comments of my hon. Friends. I was a member of the Royal Commission on the Health Service, and among the subjects that we dealt with were pharmaceutical services, and particularly access. Many of those who submitted evidence to us about pharmacists were concerned about the reduction in the number of pharmacists that has occurred in recent years. Thus, the points made by my hon. Friends are very relevant.

Although the number of trained pharmacists and those in training has been rising, the number of pharmacies in the community has fallen by more than a quarter since 1963. Most of the closures have been in urban areas, but their effect has been felt particularly in rural areas, and was the subject of comment by several community healthcouncils. For example, Bath CHC told us that the increasing trend for small pharmacies to close is giving more and more cause for concern, particularly in the small and rural communities where the alternative service may be some distance away. If that trend continues, the difficulties experienced at present by some of those who try to get to a pharmacy are likely to become more widespread. I should be grateful if the Minister could give us some assurances on that point.

Although the contract has in general received support, opposition has come, for example, from the recently formed British Pharmacists Association. It claims that at least 1,400 small chemists shops will close when the contract is first introduced, and that 3,000 could close in the first year. I should be interested to know whether the Minister has received any representations from CHCs, which would be the first to report on any concern about access voiced by patients. I have heard about the reaction of professional bodies to the new contract, but little publicity has been given to what potential patients think about reducing access to pharmacies as a result of the contract. Perhaps the Minister could give some assurances on that point.

Mr. Hayhoe

I shall begin by responding to the comments of the hon. Member for Cynon Valley (Mrs. Clwyd). I think that her remarks were more relevant to amendment No. 17, which was not moved. The opportunity for dealing with the opposition to the contract which has been expressed in some quarters has passed. Consequently, I shall confine my remarks to amendment Nos. 20 and 25, which have been spoken to by the hon. Member for Holborn and St. Pancras (Mr. Dobson) and his hon. Friend the Member for Islington, North (Mr. Corbyn).

Amendment No. 20——

Mrs. Clwyd

Will the right hon. Gentleman give way?

Mr. Hayhoe

No. Let me deal with the amendments that have been moved. Amendment No. 20——

Mrs. Clwyd

Will the right hon. Gentleman give way?

Mr. Hayhoe

I do not accept amendment No. 20——

Mrs. Clwyd

On a point of order, Mr. Deputy Speaker. The Minister said that my point was irrelevant to the amendment, but it is very relevant to it. I refer to amendment No. 25, which seeks to ensure that every neighbourhood has reasonable access to the services of a pharmacist. That is precisely the point that I was making.

Mr. Deputy Speaker: (Mr, Harold Walker)

That is riot a matter for me.

Mr. Hayhoe

I shall say something about amendment No. 25 in a moment. I said that that speech seemed to be more relevant to amendment No. 17. and particularly the reference that the hon. Lady made to the association which opposes the contract. That would have required the deletion of the whole of the clause. However, I shall return to that point.

I am broadly sympathetic to the idea behind all of' the amendments, which are concerned with trying to ensure a better service for the patient. I hope that that is common ground among us, and, indeed, it was certainly reflected in all our discussions in Committee.

The amendments are unnecessary as part of the primary legislation. With respect to amendment No. 20, there is already adequate provision on hours of service to ensure that patients receive an adequate service when they require it. Regulations state that the FPCs, after consultation with the local pharmaceutical committee, should prepare schemes to secure that one or more pharmacies should, at all reasonable times, be open. Any such scheme should specify the days and hours during which such pharmacies would be open, and all FPCs operate model hours of service schemes. Most of us know from our constituencies how effectively they work and how the information is made widely available.

On amendment No. 24, FPCs are responsible for planning local primary care services, which is a matter for local judgment. If the hon. Member for Holborn and St. Pancras is concerned that the draft guidance is not sufficiently specific, I shall be glad to look at the matter further when we reconsider the guidance to FPCs following the passage of this legislation. I hope that the hon. Gentleman is satisfied with that assurance.

That is broadly what I wish to say to the hon. Member for Islington, North about amendment No. 25. I agree that every neighbourhood should have reasonable access to the services of a pharmacist. Indeed, the underlying aim of the new arrangements for allocating the NHS pharmacy contracts is that patients should receive an adequate service that is not wasteful of NHS resources. That appeared to be a matter of common ground during our detailed discussions in Committee. Of course, the regulations cannot ensure that. All that we can do is provide the framework within which the FPCs can operate to obtain the best arrangements possible. Obviously, services should be advertised so that they are easily understood and give specific times for when they are available outside normal trading hours.

As I have said, I do not think that these matters are for this primary legislation. The need to consider the maintenance of out-of-hours services when considering new applications for contracts should, of course, be taken into account by FPCs. I assure the House that we shall emphasise that requirement in the guidance to FPCs. Although we are broadly sympathetic to the points that have been raised, I do not believe that they are appropriate for primary legislation. I am prepared to consider both what has been said tonight and any written representations before we issue the detailed guidance.

Mr. Corbyn

Can the Minister make it clear that while it is obvious that the House cannot legislate for every corner-shop pharmacist, he will take on board the necessity of ensuring that a pharmacist is available in every community? Secondly, the right hon. Gentleman has not answered the point about multilingual communities and the need to ensure that the services are clearly advertised in the languages of minority ethnic communities. There is a serious problem with the inability of some people to communicate with their pharmacist when obtaining medicines because of the of the enormous language difficulty. It is important that that point is included in the guidelines.

Mr. Hayhoe

The question of ensuring that that happens is not appropriate to this legislation. However, in the guidance to FPCs we shall seek to give positive guidance aimed at the objectives of proper coverage to suit the patients and details of out-of-hours service for local residents. That should cover the point of that information being given, as far as is practicable, in languages that as many of the local population as possible will understand.

Amendment negatived.

Dr. Marek

I beg to move amendment No. 21, in page 3, line 36, leave out 'or some of the services'.

Mr. Deputy Speaker

With this we shall take Government amendments Nos. 26, 27 and 34 and amendment No. 36, in page 5, line 17, leave out 'or some of the services'.

Dr. Marek

I shall be brief as the Government amendments go some way towards meeting the comments and criticisms which were expressed in Committee. I shall be interested to hear what the Minister has to say.

Mr. Whitney

As the hon. Member for Wrexham (Dr. Marek) has said, Government amendments Nos. 26, 27 and 34 go some way towards meeting the matters that he raised in Committee, during which we had a valuable and constructive discussion about whether family practitioner committees and health boards could accept an application in part only. For example, if an applicant said that he wished to supply three types of service and only two types were necessary, could the FPC accept the application only in respect of the services needed? It will probably be common ground that FPCs should have the right to make an appropriate judgment.

Clause 2 does not expressly permit FPCs to adopt a selective approach. Therefore, we gave a clear undertaking to consider the matter and, indeed, we have done so. The amendment makes it clear that FPCs have the right to be selective when considering applications for new contracts. Only these services needed locally would then be selected. As FPC would not be forced to accept an application because only some of the services on offer were required. Equally, it would not be forced to refuse an application where all but one type of service was necessary and desirable.

I am grateful to the hon. Member for Wrexham for tabling the original amendment in Committee and to my hon. Friend the Member for Chislehurst (Mr. Sims) for his contribution to the discussion. I hope that hon. Members on both sides of the House will accept the Government amendments.

Dr. Marek

I beg to ask leave to withdraw the amendment.

Amendment, by leave withdrawn.

Mr. Dobson

I beg to move amendment No. 23, in page 3, line 47, at end insert— (e) for the Committee to consult the Community Health Council for the area concerned before reaching any decision on the establishment continuance, or closure of a pharmacy.'. The purpose of the amendment is fairly clear in its wording. That is because I am incapable of writing anything that is not simple. The proposition is that the Committee considering an application for the establishment continuance, or closure of a pharmacy should, before reaching its decision, consult the community health council of the area concerned. That seems to be a sensible, simple and sound proposition, and no doubt the Government will be urging the House to reject it.

Community health councils are consulted — not as often or as carefully as they should be, and having been consulted their views are often ignored—over hospital closures and variations in services by the hospital service and the community health service, and it seems that they should be consulted over something as important to a community as the establishment continuance, or closure of a pharmacy". If a pharmacy is removed from a locality and it is the only one in the area, the local community suffers considerable inconvenience, and the difficulty and inconvenience of getting drugs dispensed may put some people in danger. It is a sensible and reasonable requirement that the committee considering the establishment continuance, or closure of a pharmacy should have to consider the local community health council, which to a limited extent represents the views of consumers of health services in the locality.

1.15 am
Mr. Corbyn

This is an important amendment, which I hope the Minister will take seriously.

One of the many problems in the Health Service is its fundamentally undemocratic nature. Health authorities are fairly undemocratic, and family practitioner committees are even less democratic than health authorities. Sometimes they take decisions without any apparent rhyme or reason. Until we have a Labour Government who will ensure that there is a much more democratic Health Service and an end to the false division between health authorities and family practitioner committees, the least that we can do is require that when the allocation of pharmacies is made, and when the closing down or reallocaton of pharmacies is considered, there is some public consultation. That already happens with doctors' surgeries. Because that happens, there has been a serious debate and public concern about the problem of elderly family practitioners in inner urban areas.

The same public concern has not been voiced about the shortage of pharmacies, simply because there is no means to voice it until the pharmacies have closed and gone, and been turned into newsagents, betting shops, or estate agents, as so often happens——

Mr. Dobson

Or massage parlours.

Mr. Corbyn


It is important that we have some form of public consultation. While community health councils do a valuable job and attempt to represent the views of people in their community, in addition to that there should be an opportunity, perhaps through the community health councils, for local authorities and other interested groups to make comments. It is a serious problem, particularly in a community with a large number of elderly people, if a pharmacy closes down and there is nowhere nearby or convenient where they can go to obtain medicines or make other purchases.

I hope that the Minister will ensure that there is consultation, because by that very process we could make sure that the family practitioner committees paid as much attention to the provision of pharmacies as they now do to the allocation of doctors' practices.

Mrs. Clwyd

I should like to reinforce what my hon. Friends have said. As a former member of a community health council, I know what a valuable voice those councils are for consumers in the community, despite the lack of resources allocated to them by the Government, who set up community health councils, but have given them no teeth. We argued for that in the Royal Commission on the National Health Service. We believe that more resources should be given to community health councils so that they can represent the consumer more adequately. That has not been done, but they still represent the only authentic voice of the community on Health Service matters, although they are able to do so only in a rather inadequate way because of the lack of resources.

I am pleased that the Secretary of State for Wales is here. He knows that the Health Service in Wales is even less democratic than in England, because the powers that were given to the regional health authority were removed by him to the Welsh Office, where Ministers are not really responsible for the day-to-day running of the Health Service because they have such a vast variety of subjects for which they are responsible and it is civil servants who take the major decisions on Health Service matters that affect consumers in Wales. Thus it is even more important that the voices of the community health councils are listened to in Wales than in the rest of Britain, perhaps, because of the less democratic nature of the Health Service there.

The Minister did not answer me when I asked him whether he had had any representations from community health councils on the new pharmacy contract. If he has not had them, he should ask for them. I am sure that they will have views. They gave views to the Royal Commission on the National Health Service. I am sure that they would do so again if asked. It is important that the Government hear them. if they think that services to patients are being run down by the closing of pharmacies, which has been predicted by one of the professional organisations, it is only right and proper that their voice should he heard. The views of community health councils are important. If there are such organisations, they should be used as the authentic voice of the consumer. I support this important amendment.

Mr. Campbell-Savours

I shall be brief, but I feel strongly about this matter.

I have some experience of the inadequacies of family practitioner committees. A surgery in my constituency was closed without any member of the public knowing what was happening. It was closed by a resolution carried by a FPC in Carlisle.

Mr. Deputy Speaker

Order. The amendment deals with the establishment, continuation or closure of a pharmacy.

Mr. Campbell-Savours

That is absolutely right.

Mr. Deputy Speaker

I hope that the hon. Gentleman will stick to it.

Mr. Campbell-Savours

That is precisely what I am doing. I am trying to draw attention to the fact that family practitioner committees are not competent to act on their own when the public interest is at stake. I am giving an example of one which failed in its public duty. The story that I gave shows their inadequacies. They should be required to consult community health councils, which are closer to the community.

In the case to which I referred there was a clear difference of opinion between the community health council and the family practitioner committee. Privately and, to some extent, publicly, the council said that it felt that the public had not been consulted and that the FPC had dealt with the matter inadequately. Pharmacies are an important part of local Health Service provision. There must be public consultation in every way, and there is no better means of doing that than consulting community health councils. I hope that the House will carry this important amendment.

Mr. Whitney

Such is the generosity of the Government that, even at this late hour, I should like to say that we have considerable sympathy with much of the reasoning behind the amendment. The draft guidance to family practitioner committees makes it clear that, when an application for a new contract is received the FPC will notify local community health councils. Those CHCs will have the right to make representations on the application to the FPC. CHCs will also be notified about applications for minor relocations at NHS pharmacies. It is the Government's intention to confirm these arrangements in regulations but, as the Secretary of State for Social Services already has the powers to make such regulations, the Government do not consider that extra powers in this Bill are necessary.

The hon. Member for Cynon Valley (Mrs. Clwyd) asked about the number of pharmacies. I am happy to be able to say that the number has risen and that, to the six months ending 31 December 1985, no fewer than 215 opened, 13 of which were in Wales. The hon. Lady also asked about representations from the CHCs on the new pharmacy contract. I am advised that we had no such representations.

In the great majority of cases, closure is decided by the contractor involved — the matter is not within the control of FPCs. There would, therefore, be little point in the FPCs consulting community health councils about something that they do not control.

Mr. Corbyn


Mr. Dobson

The Minister must bear in mind the fact that the Bill will offer financial incentives to some pharmacies to close, so there is a direct responsibility. The Government, with FPC involvement, will induce pharmacies to close. In those circumstances, FPCs have a function in regard to a proposed closure.

Mr. Whitney

That would be a judgment for the FPC. The Opposition amendment proposes that all closures are subject to consultation with the CHC. That is not within the gift of the FPC, given that in the majority of the cases closures are decided by the contractor.

Mr. Corbyn

This is the heart of the problem. The FPCs have a power to ensure that there is a doctor's surgery in every area. While Opposition Members have many criticisms of the way in which FPCs operate, it is right and proper that they should ensure that that is the case. The fact that they do not have the equivalent power for pharmacies is no reason for not passing the amendment and every reason to amend the primary legislation to ensure that FPCs, in a more democratised form, have control over pharmacies to ensure pharmacy services are provided in every community.

Mr. Whitney

The provisions go a long way towards ensuring that there is wide and appropriate coverage of pharmacies. The figures that I gave for the past six months demonstrate adequately that the coverage of pharmacies is good and increasing. I invite the House to reject the amendment.

Question put, That the amendment be made:—

The House divided: Ayes 9, Noes 103.

Division No. 216] [1.28 am
Clwyd, Mrs Ann Skinner, Dennis
Cocks, Rt Hon M. (Bristol S) Wallace, James
Corbyn, Jeremy
Hughes, Simon (Southwark) Tellers for the Ayes:
Kennedy, Charles Mr. D. N. Campbell-Savours and Mr. Bob Clay.
Lewis, Terence (Worsley)
Pike, Peter
Alexander, Richard Favell, Anthony
Amess, David Forsyth, Michael (Stirling)
Arnold, Tom Forth, Eric
Ashby, David Fowler, Rt Hon Norman
Baker, Nicholas (Dorset N) Franks, Cecil
Biggs-Davison, Sir John Freeman, Roger
Blaker, Rt Hon Sir Peter Gale, Roger
Boscawen, Hon Robert Galley, Roy
Bottomley, Peter Garel-Jones, Tristan
Bowden, Gerald (Dulwich) Gorst, John
Bright, Graham Gregory, Conal
Brinton, Tim Griffiths, Peter (Portsm'th N)
Brooke, Hon Peter Hamilton, Hon A. (Epsom)
Bruinvels, Peter Hamilton, Neil (Tatton)
Budgen, Nick Hargreaves, Kenneth
Burt, Alistair Harris, David
Butterfill, John Hayes, J.
Chope, Christopher Hayhoe, Rt Hon Barney
Clarke, Rt Hon K. (Rushcliffe) Hayward, Robert
Cope, John Heathcoat-Amory, David
Couchman, James Henderson, Barry
Currie, Mrs Edwina Hind, Kenneth
Dickens, Geoftrey Howarth, Gerald (Cannock)
Douglas-Hamilton, Lord J. Hubbard-Miles, Peter
Dover, Den Hunt, David (Wirral W)
Durant, Tony Jenkin, Rt Hon Patrick
Edwards, Rt Hon N. (P'broke) Jessel, Toby
Fairbairn, Nicholas Jones, Gwilym (Cardiff N)
Fallon, Michael Jones, Robert (Herts W)
Kellett-Bowman, Mrs Elaine Nicholls, Patrick
Key, Robert Page, Richard (Herts SW)
Lamont, Norman Percival, Rt Hon Sir Ian
Lang, Ian Powley, John
Latham, Michael Raffan, Keith
Lilley, Peter Rathbone, Tim
Lloyd, Peter (Fareham) Ridley, Rt Hon Nicholas
Lord, Michael Sackville, Hon Thomas
Lyell, Nicholas Sainsbury, Hon Timothy
McCurley, Mrs Anna Sayeed, Jonathan
MacGregor, Rt Hon John Shaw, Sir Michael (Scarb')
MacKay, John (Argyll & Bute) Skeet, Sir Trevor
McLoughlin, Patrick Squire, Robin
Major, John Taylor, Teddy (S'end E)
Marland, Paul Thompson, Patrick (N'ich N)
Mather, Carol Thurnham, Peter
Maude, Hon Francis Wakeham, Rt Hon John
Maxwell-Hyslop, Robin Walden, George
Mayhew, Sir Patrick Whitney, Raymond
Merchant, Piers Yeo, Tim
Miller, Hal (B'grove)
Mills, Iain (Meriden) Tellers for the Noes:
Mitchell, David (Hants NW) Mr. Gerald Malone and Mr. Mark Lennox-Boyd.
Moynihan, Hon C.
Newton, Tony
1.30 am

Question accordingly negatived.

Amendments made: No. 26, in page 4, line 1 at end insert— '( ) that an application to a Committee may be granted in respect of some only of the services specified in it;'.

No. 27, in page 4, line 8 at beginning insert 'that'. [Mr. Whitney.]

Mr. Dobson

I beg to move amendment No. 32, in page 4, line 23 after 'appeal', insert 'to a committee of such persons as should be appointed by the Secretary of State'.

Mr. Deputy Speaker

With this it will be convenient to take the following amendments:

No. 33 in page 4, line 24 at end insert 'on the ground of manifest unreasonableness at the time of the relevant decision and on no other ground.'.

No. 42, in page 5, line 46 at end insert 'on the ground of manifest unreasonableness at the time of the relevant decision and on no other ground.'.

Mr. Dobson

I shall be brief and give the extra corps the opportunity to go home.

The purpose of the amendments is to provide a national appeals machinery against the possibility of a family practitioner committee turning down an application. Doubt has been expressed by the pharmaceutical profession — or trade — because pharmacists are not happy about existing pharmacists sitting on a committee and turning down applications from people who want to open pharmacies. They have asked for a national appeals machinery and have been refused. We think that such a machinery is reasonable.

Mr. Kennedy

I support the amendment. During the Committee stage, the Parliamentary Under-Secretary of State, the hon. Member for Wycombe (Mr. Whitney), gave a clear undertaking, which led to a similar amendment not being pushed to a Division on that occasion, that he would, in due course, hold discussions with pharmaceutical representatives over the possibility of setting up an independent appeal mechanism on what they considered to be one of the most important central provisions for their well-being in the legislation. In good faith, the matter was not pushed to a Division on that occasion.

Recently, I wrote to the Minister for Health, because the pharmaceutical representatives are concerned that the implication in the Minister's remarks in Committee — that is, discussion—appears not to be the case. As far as they are aware, in their contacts with representatives of the Department, there is an outlook in the Department that some discussion would be in order prior to the tabling of any regulations coming from that part of the Bill.

The pharmaceutical representatives were disappointed. It is fair to say that they consider there to be a breach of faith on the Minister's part. Given the tenor of the remarks made in Committee, it is not what we would have expected tonight. The implication that alliance Members were left with was that the Government would table amendments to that part of the legislation. That was the impression that we received, in genuine good faith. On the basis of that understanding, a Labour Front Bench spokesman did not push the matter further. The Minister should be aware that the matter is causing concern among pharamaceutical representatives. I hope that he can put to rest the anxiety that they have expressed to us, and which I share.

Mr. Hayhoe

I made it clear in Committee that the Bill did not specify an appeal system. The details of the system were to be dealt with by way of regulations. Hon. Gentlemen will remember that I circulated, for the convenience of the Committee, the draft regulations which were prepared last autumn so it could see what was in mind. Indeed, that helped our discussions. I went on to say that I would look at the regulations again, taking into account the views expressed in Committee, the individual representations by hon. Members and the views of some outside representative bodies. I know that further representations are coming in. They were due in last week, but they have not arrived.

All those representations will be taken into account. The objective will be to establish a fair and objective appeal system that meets the needs of local people and takes account of what has been said. That assurance holds absolutely. I hope that the amendments will not be pushed. I assure both the hon. Member for Holborn and St. Pancras (Mr. Dobson) and the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) that the discussions will take place.

There was no commitment to bring forward amendments to the Bill on Report. The commitment is to bring forward new regulations embodying an appeal system which, I hope, will take account of what has been said. Different views have been expressed. Whatever system is set up, it must be monitored carefully. If it is not proven to be entirely satisfactory, there will be an opportunity for amending it at a later stage.

1.45 am
Mr. Corbyn

I am not sure that we have been given a helpful answer by the Minister. The issue about which he spoke and the amendment moved by my hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) go to the heart of one of the biggest problems in the Health Service — its fundamental lack of democracy and the neo-clandestine atmosphere in which many decisions are taken by the family practitioners committees. My hon. Friend the Member for Holborn and St. Pancras was talking about the need for a proper appeals system.

It is not good enough for the Government to introduce the National Health Service (Amendment) Bill which goes into considerable detail about the problems of pharmacies and the pharmacists' contract. I understand that there was much discussion in Committee about pharmacists' remuneration. Yet, when it comes to an appeal against a decision by the family practitioner committees, the world is silent and nothing is offered. There can be nothing more important than to know where to go if one wants to complain about one of those decisions. It is high time that the Minister accepted the amendment and told us what type of people will make up the committees and from where they will be drawn.

In the debate on an earlier amendment the role of community health councils was mentioned. They might have a role to perform in this respect, but the problems concerning the administration and structure of the Health Service are serious and the least the Minister could do is give us a straight answer to what is basically a simple question: is there to be an appeals system, or not?

Mr. Campbell-Savours

Does my hon. Friend accept that, if the Government had been wise enough to accept the earlier amendment and to vote with us during the last Division, we would not have needed to debate this matter now? We would have been satisfied that the consultative arrangement which we sought under the community health council amendment dealt adequately with the problem. The Government have brought this accusation upon themselves by once again refusing to accept an eminently sensible amendment tabled by my hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson).

Mr. Corbyn

There is some merit in that intervention but, unfortunately, the amendment that the Government chose to defeat did not go far enough. However, I do not wish to be drawn backwards. We are obviously anxious to go forwards and to ensure that there is a proper system in which community councils would have a role to play.

The amendments are simple, but important and fundamental. As with all aspects of the Bill, we must await the election of a Labour Government to have a proper democratic Health Service and to end the sort of fudge and backstairs manoeuvre by which it is now run.

Mr. Dobson

Sympathetic though I am to the propositions of my hon. Friend the Member for Islington, North (Mr. Corbyn)—having written them down myself—I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Amendment made: No. 34.. in page 5, line 28, at end insert— '( ) that an application to a Health Board may be granted in respect of some only of the services specified in it;'. —[Mr. Hayhoe.]

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