Commons Sitting of 11 December 1989

Preamble
The House met at half-past Two o'clock
PRAYERS
[MR. SPEAKER in the Chair]
Oral Answers to Questions
  WALES

    Nature Conservancy Council
    Mr. Stern: To ask the Secretary of State for Wales what organisation will take over the responsibilities of the Nature Conservancy Council in Wales when the council is abolished.
    The Minister of State, Welsh Office (Mr. Wyn Roberts): Subject to parliamentary approval, it is intended that, with effect from 1 April 1991, the responsibilities in Wales of the Nature Conservancy Council and Countryside Commission will be undertaken by a new statutory body, the Countryside Council for Wales.
    Mr. Stern: Will not this announcement be widely welcomed throughout the Principality, as it shows the extent of the Government's commitment to the environment and conservation in Wales?
    Mr. Roberts: I am happy to tell my hon. Friend that the announcement was warmly and widely welcomed in Wales. It is an improvement. The two advisory committees of the Nature Conservancy Council and the Countryside Commission will be replaced by a single executive committee.
    Dr. Thomas: The Minister will remember that I welcomed his decision in the House on behalf of my colleagues. Will he assure the House that the Welsh and Scottish Offices will not surrender to the sort of campaigns that are being mounted in England? The future of the NCC in England is a matter for the English, but the decision is to be welcomed in Wales.
    Mr. Roberts: I am grateful to the hon. Gentleman for his support. We have consulted a number of bodies. The chairman of the NCC committee for Wales and the chairman of the Countryside Commission committee for Wales both welcomed the proposal. We have had discussions with the Council for the Protection of Rural Wales and the chairmen and chief officers of the national parks and there has been a general welcome for the scheme. Matters affecting Scotland and England are the concern of my right hon. and learned Friend the Secretary of State for Scotland and my right hon. Friend the Secretary of State for the Environment.

    British Rail
    Dr. Marek: To ask the Secretary of State for Wales when he next expects to meet the chairman of British Rail to discuss transport infrastructure in the Principality.
    Mr. Nicholas Bennett: To ask the Secretary of State for Wales when he next expects to meet the chairman of British Rail to discuss British Railways' operations in Wales.
    Mr. Wyn Roberts: My right hon. Friend last met the chairman on 12 December. He hopes to meet the present chairman and the future chairman in the early months of 1990.
    Dr. Marek: Is the Minister aware that the European Commission is prepared to pay, through grants, 75 per cent. of the cost of electrifying the north Wales main line from Crewe to Chester and to Holyhead? Does he agree that such a sum of money—perhaps £30 million—should not be turned away lightly, as the electrification of the line would be a valuable addition to the infrastructure of north Wales? If he agrees, will he do what he can to persuade the Secretary of State for Transport that, if British Rail applies for permission to electrify the line, it does not dock money equivalent to the grant for infrastructure developments elsewhere?
    Mr. Roberts: The electrification of the north Wales line, and any other line, is a matter for British Rail. I doubt whether the hon. Gentleman's assumption about the European regional development fund grant is correct. My right hon. Friend the Secretary of State for Transport has announced that spending on railways will be about £3·7 billion during the next three years, which is 75 per cent. more in real terms than has been spent over the past three years. There does not seem to be a shortage of finance.
    Mr. Bennett: When my hon. Friend sees the chairman of British Rail, will he draw his attention to the continuing anxiety of people in Pembroke about the decline of rail services west of Swansea, the type of trains used and the number of trains operating on Sundays? There are now no trains west of Swansea before 3 pm on a Sunday, and that is not good enough.
    Mr. Roberts: We shall take up various issues with the present chairman and the new chairman of British Rail. We shall discuss services in west Wales, especially Pembrokeshire, and other areas.
    Mr. Alex Carlile: When the Minister next meets the chairman of British Rail, will he take him on an unannounced journey on the Shrewsbury to Aberystwyth line so that he can witness the decimation of stations, the lack of staff and lavatory facilities, the overcrowded and miserable trains and the general air of neglect that are causing many people to complain to me about the state of that line?
    Mr. Roberts: The hon. and learned Gentleman paints a somewhat dismal picture of railway services in mid-Wales and, by implication, elsewhere. There has been substantial investment in the mid-Wales and Cambrian lines. We no longer hear talk of the closure of the Cambrian railway, as we did a few years ago, so things have improved. Nevertheless, I dare say that there is scope for further improvement.
    Mr. Raffan: When does my hon. Friend expect British Rail to be able to increase from 70 to 90 mph the maximum speed of trains on the north Wales line? Will he ensure that overcrowding in trains is reduced and safety is assured before that happens?
    Mr. Roberts: I am sure that British Rail will not permit a maximum of 90 mph on the north Wales line until it is absolutely safe.
    Mr. Denzil Davies: Is the Minister aware that the Channel tunnel could have serious consequences for the economy of south-west Wales, especially as firms in the congested south-east might be tempted to go to the French end of the tunnel and supply the island from the continent rather than come to south Wales? Will the Secretary of State, with local authorities and British Rail, start planning a fast rail link from south-west Wales to the Channel tunnel, bypassing London?
    Mr. Roberts: The right hon. Gentleman is well aware that British Rail has been charged with producing a plan before the end of this year. I understand that its publication is imminent. To judge from what I know of what may be in it, I do not think that the people of Wales will be disappointed.
    Mr. Adley: My constituents in Dorset might think Wales quite well served by railways. Will my hon. Friend bear it in mind that there is no direct relationship between the Government's quite proper pride in increasing capital investment on the railways and reducing the public service obligation grant which, in the case of the lines from Cardiff to Crewe and from Cardiff to Portsmouth, means that Sprinters are overworked, clapped out and, as one railwayman recently told me, being worked into the ground? Will he ensure that, in discussions about railway investment, PSO grant is recognised as separate from capital investment and essential?
    Mr. Roberts: I shall bear in mind what my hon. Friend said, but I assure him that my information is that new Sprinters are being introduced, or are due to be introduced, in several parts of Wales.

    EC Funding
    Mr. Anderson: To ask the Secretary of State for Wales what discussions he has had with Community officials about the funding of infrastructure projects.
    The Secretary of State for Wales (Mr. Peter Walker): I am in constant touch with the negotiations with the European Commission on Community support frameworks. Officials of my Department are playing an active part in discussions with Commission officials on this issue.
    Mr. Anderson: The Secretary of State will be aware of my interest in the cross-valley link from Hafod, in the lower Swansea valley, to the Pentrechwyth bypass. Is he aware that, at last, tenders for it are to be invited this week? The assessment of infrastructure grants affects the whole of Wales. Will there be a transitional period before the new regime comes into effect? Has the right hon. Gentleman been successful in his lobbying in Brussels?
    Mr Walker: Negotiations with the Commission continue. There is considerable pressure from all member
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    states as there is widespread European interest in the decisions taken. We have not been sastisfied with the Commission's proposals, and negotiations continue.
    Mr. Morgan: Will the Secretary of State come clean with the House about what has been happening in the negotiations between his Department and the European Community, following the recent statement by Bruce Milian, the responsible Commissioner, at the conference in Cardiff that there will be no further grants for highway infrastructure projects in areas such as Wales? If that is so, was that loss of grant, which will probably amount to £40 million, and was caused by his Department debarring county councils such as South Glamorgan and West Glamorgan from applying for grants, the reason why he has had to cut the capital allocation to areas such as Cardiff by £40 million in the next financial year?
    Mr. Walker: I am grateful to the hon. Gentleman, who kindly always prefaces his questions to me by releasing them to the newspapers the morning before. One can read the nonsense in advance in the papers. What he has just said is equal nonsense. There is no link between capital expenditure in Cardiff and that in South Glamorgan. His previous allegations about Welsh Office blunders with respect to grants are also wrong. I suggest that, in future, he checks the facts before he makes press releases.
    Mr. Barry Jones: Does the right hon. Gentleman agree that one of our problems in Europe is that the Prime Minister is in a disturbing minority of one? Will he take her aside and tell her to stop damaging the interests of our country? Is it not the case that rather than leading Britain in Europe she is humiliating us and that the interests of Wales are also being seriously hurt?
    Mr. Walker: I welcome the conversion of part of the Labour party to Europe. As the Commissioner involved in the negotiations is a former Socialist Cabinet Minister responsible for regional policy, I hope that his proposals will suit Britain in Europe.

    Pupil Assessment
    Dr. Thomas: To ask the Secretary of State for Wales what progress his Department has made in implementing its policy for assessment of school pupils.
    Mr. Wyn Roberts: The School Examinations and Assessment Council is making good progress in the development of assessment measures and advice to support the national curriculum in England and Wales.
    Dr. Thomas: Is the Minister satisfied with the relationship between SEAC in Wales and the Welsh joint education committee? The entire operation of assessment in Wales is organised on a part-time basis with one official who commutes. Is that satisfactory in view of discussions in the Standing Committee when I proposed a SEAC for Wales, just as we have a curriculum council for Wales?
    Mr. Roberts: I am satisfied that the relationship between SEAC, Welsh Office officials and the Welsh joint education committee is satisfactory. That is shown by the progress that we are making on standard assessment tasks.
    Dr. Kim Howells: Is the Minister aware that the assessment of school pupils depends in the first place on teachers having the appropriate time, facilities and funds

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    to carry it out in classrooms? Is he further aware that morale among teachers, at least in south Wales, is low and that many teachers are looking for jobs outside the education system? What will he do about making more resources available to teachers in Wales?
    Mr. Roberts: Teachers have an important part to play in the assessment of pupils. Their assessment continues throughout the period when the child is at school, whereas standard assessment tasks are carried out when the child is seven, 11, 14 and 16. The teachers whom I have met in Wales are doing a marvellous job, and I believe that that is true of the majority.
    Mr. Raffan: Is my hon. Friend aware of the widespread anxiety among teachers, not only about the amount of time that assessment will take in classes of 30-plus, but that too much emphasis on assessment has an adverse effect on pupils and that assessment at seven is too early? Will he assure teachers on those two points?
    Mr. Roberts: Testing at the age of seven will be different from testing at later stages. I know that there is some anxiety about the time being devoted to assessment, but I am sure that after it is introduced the task will be eased.

    Wages
    Mr. Flynn: To ask the Secretary of State for Wales what percentages of Welsh (a) full-time and (b) part-time workers are currently earning wages below 68 per cent. of the average British wage.
    Mr. Peter Walker: Information is not available in the form requested. Between 1988 and 1989 average earnings of full-time workers on adult rates in Wales increased by 9·9 per cent., a figure higher than in six of the other nine regions of the country.
    Mr. Flynn: Had the information been available, the Secretary of State would have discovered that Wales has fallen further down the low wages ladder and that tens of thousands of Welsh workers have been conscripted into junk jobs that pay dirt wages. Is he aware that thousands of Welsh workers once earned above-average wages whereas now they are at the bottom of the nation's average wages? Is he aware that there is a higher percentage of low-paid, male workers in Wales than anywhere else in Britain and that Dyfed has the lowest average male wages of any county in Britain? Will he answer the question put to him by my hon. Friend the Member for Alyn and Deeside (Mr. Jones)? Does he agree with the Prime Minister that clause 5 of the European social charter, which seeks fairer remuneration for workers, is of no value? Is he content for Wales to remain the low-paid capital of Britain?
    Mr. Walker: The figures used in the hon. Gentleman's question were taken from a remarkable Council of Europe report which has not been endorsed by any member state.
    Mr. Flynn: That is not true.
    Mr. Walker: The hon. Gentleman complains about the level of wages in Wales. In 1979, the average adult wage was £87 a week, whereas now it is £216 a week. That is a massive increase in real terms.
    Mr. Gwilym Jones: Does my right hon. Friend agree that the greatest tragedy of unnecessarily high wages
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    would be a halt in the creation of new employment? He is to be congratulated because since the general election unemployment in Wales has fallen by 70 per cent. Can he tell the House by how much unemployment in Newport has fallen in the same period?
    Mr. Walker: At the time of the general election unemployment in Newport was 100 per cent. higher than it is now.
    Mr. Barry Jones: What is the right hon. Gentleman doing to persuade the Prime Minister that the European social charter will help the poorest in Wales best of all? Does he agree that the Prime Minister's stubborn style in Europe hurts the prospects of the lowest paid in Wales? Does he further agree that if we are frozen out of Europe, Britain cannot play a leading role to help the lowest paid in Wales?
    Mr. Walker: I am glad to say that what is substantially improving earnings in Wales is the Government's enormous success in getting inward investment into Wales. It is probably a more successful region than any other in the European Community. I am delighted that this massive creation of good jobs in Wales is taking place. It is a great pity that, by their noise this afternoon, Labour Members show that they do not appreciate what is going on.

    Local Government
    Mr. Murphy: To ask the Secretary of State for Wales when he last met local government associations in Wales; and what matters were discussed.
    Mr. Peter Walker: I met representatives of the Welsh counties committee and the Council of Welsh Districts at a meeting of the Welsh consultative council on local government finance on 2 November to discuss local government finance matters.
    Mr. Murphy: Is it not time that the Secretary of State stopped blurring the picture about what will happen in Wales when the poll tax hits us next year? Will he admit that individual poll tax payers in Wales are likely to pay an average of £200, not the figure that he has predicted over the past few weeks? Why has he been so reticent about the fact that of the 100,000 business premises in Wales, at least 70,000 will be worse off as a direct result of his business tax? Cannot he see that the Welsh people regard him as the architect of this wretched tax as much as they do the Prime Minister?
    Mr. Walker: The hon. Gentleman read that out beautifully. I only hope that he rehearsed it before delivering it.
    Mr. Murphy: The right hon. Gentleman will read his answer.
    Mr. Walker: No, I will not read the answer. The community charge in Wales will provide only 15 per cent. of all local government expenditure. As a result, community charges in Wales will be at least £100 lower per person than in either England or Scotland. It is time that the Welsh Labour party stopped being so churlish on this issue.
    Mr. Rogers: Does the Secretary of State accept that local authorities in Wales are grossly underfunded? People

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    are not getting the municipal housing, social services and care for the elderly that they enjoyed 10 years ago. Does he acknowledge that next year after the introduction of the poll tax the position will be even worse?
    Mr. Walker: Government grants to Wales, in terms of the statutory requirements regarding house improvements, will be unlimited in the current year. Our pursuit of such a policy for 10 years is doubtless why so many houses in the Rhondda have been improved.
    Mr. Livsey: Will the Secretary of State admit that the Welsh Office has hopelessly underestimated the poll tax figures? The Welsh Office says that the figure for Brecon and Radnor should be £130 per head, but the local authority treasurers say that it will be nearer £200. Does that mean that the Welsh Office accountants are not wizards but dunces?
    Mr. Walker: No, Sir. What the hon. Gentleman said is not true. The increase in the total standard spending grant is sufficient to allow the average charge of £174 to be set. The expenditure demands of the local authority associations are, in my view, overstated. There is also room for efficiency savings. All councils, especially high-spending authorities, should seek to contain their budgets within affordable levels.
    Mr. Gwilym Jones: Has my right hon. Friend discussed the actions of councils such as the two Cardiff councils, which have given up any pretence of fixing a community charge to match their spending and instead have already determined the level of their community charge, with the result that they are now scrabbling round to find spending to soak up the revenue? According to my right hon. Friend's calculations, the charge in Cardiff should be £163, but my constituents will have to pay £250. What will he do about it?
    Mr. Walker: There have been some remarkable increases. For example, this year Cardiff is planning a capital spending programme of £60 million, an increase of 35 per cent. on the previous year and the year before. Cardiff is using all its receipts and reserves for the year, with the result that recently there were some remarkable newspaper articles on the topic.

    Illegal Discharges
    Mr. Ieuan Wyn Jones: To ask the Secretary of State for Wales how many incidents of notified discharges into rivers in Wales took place in 1988 and to date in 1989; and how many prosecutions have taken place during the same period in respect of illegal discharges.
    The Parliamentary Under-Secretary of State for Wales (Mr. Ian Grist): The latest published figures, in Welsh Water's report and accounts 1988–89, show that there were 2,185 substantiated river pollution incidents in Welsh Water's area in 1988, 12 per cent. less than in 1987. During 1988, 74 prosecutions were brought by Welsh Water, resulting in 72 convictions. In the period to the end of October 1989 there have been 1,140 substantial incidents and 45 prosecutions have been brought.
    Mr. Jones: When the Government are seeking to promote their green image, does the Minister consider it a scandal that the level of trade effluent discharges and
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    untreated sewage into our rivers is increasing substantially? Will he examine the claims of the Farmers Union of Wales that discharges into rivers in my constituency are 200 per cent. greater than they were two years ago? If that is the case and consents have been given, will the Minister assure us that the consents were not given to prevent the National Rivers Authority from undertaking prosecutions in the run-up to water privatisation?
    Mr. Grist: I am afraid that the hon. Gentleman is talking absolute rubbish—and populist, scaring rubbish at that. Nevertheless, I shall pass his query to the National Rivers Authority, because it has the responsibility.
    Mr. John Marshall: I congratulate my hon. Friend on the successful privatisation of Welsh Water today. Does he agree that the privatisation of Welsh Water and the National Rivers Authority is the best guarantee of cleaner rivers in Wales?
    Mr. Grist: Absolutely. My hon. Friend is quite right. At last we have separated the gamekeeper from the poacher, and we have a licensing authority that is free of the charge of polluting. I am afraid that the hon. Member for Ynys Môn (Mr. Jones) does not seem to have understood that point.

    Welsh Office (25th Anniversary)
    Mr. Wigley: To ask the Secretary of State for Wales what events were organised by his Department to mark the 25th anniversary of the Welsh Office in November.
    Mr. Peter Walker: The 25th anniversary of the establishment of the Welsh Office falls on 1 April 1990. I intend to mark the anniversary in an appropriate manner and will announce my plans early in 1990.
    Mr. Wigley: Is the Secretary of State aware that on radio programmes in Wales commemorating the 25th anniversary of the establishment of the Secretary of State's office, which was the embryonic Welsh Office, in November 1964, two former senior officials of the Welsh Office, Mr. Richard Hall Williams and Sir Goronwy Daniel said that the major challenge now facing the Welsh Office was to get a degree of democracy into its oversight? Will he confirm that any celebrations next April will bring about that democracy, or will we be lingering behind Lithuania, Latvia and Estonia?
    Mr. Walker: I find such admirable institutions as the Welsh Grand Committee, the Welsh Select Committee and the constant activities of lively Welsh Members of Parliament such as the hon. Gentleman marvellous reflections of democracy in Wales that would be envied in Lithuania and elsewhere.
    Mr. Denzil Davies: Is the Secretary of State aware that during the past 10 years while his party has been in charge of the Welsh Office, income per head in Wales has fallen faster than in any other area in Britain and is now almost as low as that in Northern Ireland? Is that evidence of an economic miracle or an economic disaster?
    Mr. Walker: I repeat that average wages in Wales have massively increased as has the diversity of opportunity in Wales. Wales now has a strong diversified economy which is recognised and rejoiced in by anyone who has any regard for the future of Wales.
    Mr. Nicholas Bennett: Does my right hon. Friend agree that one of the important advantages of a Welsh Office is that Welsh matters are debated here in the United Kingdom Parliament and not in some Mickey Mouse assembly in Cardiff? Does he agree that the hallmarks of a Conservative Welsh Office are prudence and value for money for the taxpayer? Will he ensure that any celebrations bear that in mind?
    Mr. Walker: The enormous resources that have been put into regional development in recent years and the fact that domestic ratepayers in Wales will be paying only 15 per cent. of all local government expenditure are reflections of the considerable advantages for Wales of being part of the United Kingdom.
    Mr. Geraint Howells: I am sure that the Secretary of State knows that the people of Wales demand their own Parliament within the United Kingdom. On reflection, which position would the Secretary of State like to hold in that Parliament?
    Mr. Walker: Ambassador.

    Nature Conservancy Council
    Mr. Ron Davies: To ask the Secretary of State for Wales when he next intends to meet the Nature Conservancy Council to discuss nature conservation in Wales.
    Mr. Wyn Roberts: My right hon. Friend has no present plans to meet the council.
    Mr. Davies: I am surprised at the Minister's answer in view of the current controversy in Wales. Is it not the case that the Nature Conservancy Council in England is being retained to allow the English authorities to resist development pressure and that the effective abolition of the NCC in Wales means that we shall have a lower standard of protection for our national heritage than exists in England? Does the Minister agree that that is why the Council for the Protection of Rural Wales now opposes his plan for the dismemberment of the NCC? Does he acknowledge that that view is shared by every other conservation body in Wales and is endorsed by every serious politician in Wales and all but six of the NCC staff? In view of that, when the Minister gets around to meeting the NCC will he announce that he will reconsider the matter?
    Mr. Roberts: The hon. Gentleman has totally misled the House, I am sure not deliberately. I repeat what I said earlier which is that our proposals for Wales have received a wide welcome. I do not agree that the purpose of our new Countryside Council for Wales is to lower standards of protection for the environment. It is nothing of the kind and I can assure the hon. Gentleman that his belief is not shared by any of the people in Wales to whom I spoke, including the Council for the Protection of Rural Wales.

    Interest Rates
    Mr. Rowlands: To ask the Secretary of State for Wales what assessment he has made of the impact of current interest rates on the development of small businesses in Wales.
    Mr. Peter Walker: The high inflation of previous Governments proved that high inflation is more damaging to small businesses than a period of high interest rates. I hope that the fall in inflation during the coming year will lead to lower interest rates as well as lower inflation.
    Mr. Rowlands: The Secretary of State's complacent statement completely underestimates the crippling effects of high interest rates on small businesses and on their cash flows and investment decisions. The right hon. Gentleman is supposed to be a man of independent thinking. What independent thoughts has he about helping small businesses through this period of high interest rates?
    Mr. Walker: Much help is being given through various forms of regional aid, such as the Welsh Development Agency and local authorities, to small businesses. I am delighted to say that in 1988 there was a faster rate of increase in the number of production businesses in Wales than in any other region—it was more than double the average for the United Kingdom as a whole. I am glad to say that the latest returns and applications show that that trend is continuing.
    Mr. Foot: When does the right hon. Gentleman propose to make his annual speech in which he tells us what he thinks of Government economic policy? This year, will he be making it in the constituency of the hon. Member for Clwyd, North-West (Sir A. Meyer)?
    Mr. Walker: I should prefer to make it in the right hon. Gentleman's constituency so that I could point out all the successes that we have had.

    Community Health Councils
    Mr. Michael: To ask the Secretary of State for Wales when he last met the chairmen of community health councils in Wales; and what topics were discussed.
    Mr. Grist: We have received no request from community health council chairmen to meet them, although I would be happy to do so should the need arise.
    Mr. Michael: Did the Minister seek a meeting, or was he afraid that they would ask him why he was entering into a period of so-called consultation on his proposal to undermine our system of community health councils in Wales, when that proposal had already been rejected? Surely the Minister must accept that it is manifest nonsense for a council with the word "community" in its name to represent views from areas as widespread as mid-Glamorgan, Dyfed, Powys and even South Glamorgan. Will he allow community health councils to continue to represent the health interests of communities, instead of forcing them to reconcile the needs of different communities, which should be a matter for health authorities and, ultimately, the Minister?
    Mr. Grist: The hon. Gentleman has rather missed the point of our proposals, which, as he knows, are out to consultation. The community health councils should be strengthened by the change because they will be able to stand up and shadow their health authorities much more effectively and deploy their assets and finances to much greater effect on behalf of patients.
    Mr. Win Griffiths: Is the Minister aware that Ogwr community health council is concerned about the fact that,

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    because of a lack of staff to attend all the intensive care beds in the Princess of Wales hospital, one patient has been sent home three times when expecting an operation for cancer of the oesophagus, and another has been sent home once for the same reason? Will he arrange for extra funding to be made available to ensure that intensive care units throughout mid-Glamorgan are fully staffed?
    Mr. Grist: I shall certainly consider the particular instance that the hon. Gentleman mentioned, although I believe that the intensive treatment unit at the Princess of Wales hospital has recently been affected by sickness among its staff.

    Railway Electrification
    Mr. Coleman: To ask the Secretary of State for Wales whether he has recently discussed the electrification of main line railway services in south Wales; and if he will make a statement.
    Mr. Wyn Roberts: Electrification is unlikely to have any significant effect on the quality of services on the south Wales main line. Improved frequency, greater reliability and reduced overcrowding on the high-speed 125 services are the critical factors.
    Mr. Coleman: That was an appalling answer from the Minister. What estimate has been made of the cost of electrification of the railway line in south Wales? Is he aware that the cost of electrifying the east coast railway was overestimated? Will not the fact that our railway is not electrified serve Wales badly in 1992?
    Mr. Roberts: I can only repeat what the hon. Gentleman already knows-that British Rail has produced a study of the railway network in connection with the Channel tunnel. It considers that the level of demand for through-passenger services for south Wales will be insufficient to justify electrification. As for freight, it makes no difference whether traction is by diesel or electrificity.

    Water Sports
    Mr. Jack: To ask the Secretary of State for Wales what support he is giving to the development of water sports in Wales.
    Mr. Grist: Welsh Office financial support for bodies concerned with the development of water sports in Wales is provided through the Sports Council for Wales which grant aids the relevant governing bodies and provides a national watersports centre at Plas Menai.
    Mr. Jack: My hon. Friend will be aware of the excellent facilities for the promotion of water sports at the national watersports centre at Plas Menai. May I prevail on him to send a message to those concerned to look again at the financial arrangements for this excellent institution, which is used by many of my constituents and people from the north-west of England, and ensure that they have sufficient funding next year fully to exploit commercially the potential of this institution?
    Mr. Grist: The attachment of my hon. Friend and his family to Plas Menai is well known to us. My hon. Friend will appreciate that the Sports Council for Wales received a grant in the current year of some £4,396,000, an increase
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    of 6·1 per cent. over its previous grant. The council has been looking for some time at the financing of the centre at Plas Menai and the efficiency with which it carries out its work. At all times, it is looking for sponsorship and other forms of support for those sports that are not big money raisers.

  CHURCH COMMISSIONERS

    Redundant Churches
    Mr. Tony Banks: To ask the right hon. Member for Selby, as representing the Church Commissioners, what is the current policy of the Church Commissioners in respect of redundant churches.
    Mr. Michael Alison (Second Church Estates Commissioner, Representing the Church Comissioners): The Commissioners' policy is governed by the Pastoral Measure 1983, which provides for the future of a redundant church to be settled by a suitable alternative use, by preservation by the redundant churches fund, by care and maintenance by the Diocesan Board of Finance or by demolition. The measure lays emphasis on finding a suitable alternative use for the church, if at all possible, and that is what is most commonly achieved.
    Mr. Banks: I am grateful to the right hon. Gentleman for that courteous reply. Does he share my concern about the fate of old organs—not, I hasten to add, those attached to old clerics but those fine musical instruments which are in many redundant churches and many churches generally and which do not get adequate protection? Is he aware that such historic organs as we have would be given protected status in most other European countries? Will he ask the Church Commissioners to conduct an inventory of all the organs in their areas of responsibility so that adequate protection can be extended to them?
    Mr. Alison: I am grateful to the hon. Gentleman for the interest that he takes in not only redundant churches but the valuable fixtures in them. Under any redundancy scheme, the bishop of a diocese has the decision on the final disposal of valuable fixtures. He is advised by an expert committee with a standard code of practice. Church organs are recognised as valuable. They are nearly always preserved or sold for use in other churches or in other historic buildings.

    Publication Programme
    Mr. John Marshall: To ask the right hon. Member for Selby, as representing the Church Commissioners, if he will make a statement about the Church Commissioners' publication programme during the current year.
    Mr. Alison: The Commissioners have produced a range of publications during 1989 including their report and accounts for 1988, the 17th report of the Central Stipends Authority and a brochure on commended entries for the parsonage design award competition.
    Mr. Marshall: Will the Church Commissioners publish a commentary on the recent blatantly partisan declaration on poverty? Does such a commentary commend the massive increase in private giving since 1979, which shows that the parable of the good Samaritan is alive and well in Thatcherite Britain?
    Mr. Alison: The declaration by the Church Action on Poverty group is not an official Church of England publication and the Commissioners have no responsibility for it. I agree with my hon. Friend that it is a robustly party political publication whose great weakness is to decry the alleged inadequacy of public expenditure while denouncing the basis of wealth creation in Britain through the social market economy which has to fund that public expenditure. My hon. Friend's point about charitable giving is well taken.
    Mr. Sedgemore: Will the Church Commissioners publish a commentary on the report which the Archbishop of Canterbury is suppressing on homosexuality among priests?
    Mr. Alison: The hon. Gentleman is referring to a report that is, I understand, under consideration by the Archbishop of Canterbury. It originates from the General Synod of the Church of England and I cannot, having no direct responsibility in that area, tell the hon. Gentleman what its future will be. No doubt the inquiry, which will be registered in the official report, will elicit a response of some sort, which I shall convey to the hon. Gentleman.

    Financial Assistance
    Mr. Harry Greenway: To ask the right hon. Member for Selby, as representing the Church Commissioners, what financial assistance the Church Commissioners give to the cost of running (a) Lambeth palace and (b) the palace of the Bishop of Durham; what financial assistance is given to producing the speeches of prelates; and if he will make a statement.
    Mr. Alison: The Church Commissioners are wholly responsible for the housing of all diocesan bishops and for the provision of supporting staff. Lambeth palace and Auckland castle are listed grade 1 buildings. The total running costs of Lambeth palace are currently 1·4 million a year, 60 per cent. of which is office expenses, including the salaries of the 34 members of the Archbishop's headquarters staff. The costs of Auckland castle are £159,000 a year.
    Mr. Greenway: Does my right hon. Friend believe that the Church Commissioners and Church members receive value for money from that enormous expenditure? Will he confirm that the Church Commissioners will press the Archbishop to suppress the report on homosexuality if, as is rumoured, it encourages the blessing of unions between gay and lesbian couples in church?
    Mr. Alison: I have noted my hon. Friend's inquiry about the costs of running Lambeth palace and Auckland castle, the official residence of the Bishop of Durham. I hope that he will bear in mind that the Church of England bureaucracy is usually a great deal more frugal and financially efficient than the normal Civil Service bureaucracy's administration of public expenditure. On the second part of the question, I can add nothing to the reply that I have already given to a similar question.

  HOUSE OF COMMONS

    Disabled Persons
    Mr. Simon Hughes: To ask the hon. Member for Berwick-upon-Tweed, as representing the House of Commons Commission, what percentage of the staff employed by the House on 1 November were then registered as disabled persons.
    Mr. A. J. Beith (On behalf of the House of Commons Commission): The percentage of staff of the House registered as disabled at 1 November 1989 was 0·5 per cent. That figure does not include those disabled persons who work in the House, but who are employed by the Property Services Agency.
    Mr. Hughes: Does my hon. Friend accept that that is an extremely low figure and that were we not exempt from the rules that apply to employers in general, we should be well below the minimum percentage of 3 per cent., which should be upheld by all employers? Will my hon. Friend tell the House what steps are being taken to increase that number substantially and quickly, not just at junior levels of employment in the House of Commons?
    Mr. Beith: The Commission is not satisfied that the percentage is adequate and it is the Commission's policy to consider itself as if bound by the regulations, including the 3 per cent. quota, that apply throughout the general community. The vacancies that come up in the House are notified to local disablement resettlement officers and positive preference among candidates of equal merit is given to registered disabled people. Many advertisements for House of Commons posts make it clear that applications are welcomed from disabled people. Disablement is, of course, no bar to promotion in the House as long as the work of the post can be carried out.

    House Sittings
    Mr. Allen: To ask the hon. Member for Berwick-upon-Tweed, as representing the House of Commons Commission, what savings the Commission would make if the House were to adopt hours of work which both started and finished earlier.
    Mr. Beith: The total savings possible as a result of the House deciding to arrange its business so that it could start and finish earlier would depend on a number of factors such as the number of staff affected, the predictability of the duration of the sitting and the terms of any renegotiated conditions of service that might be necessary as a consequence. Those factors would be difficult to quantify.
    Mr. Allen: Does the hon. Gentleman accept that as well as the House of Commons becoming more efficient if the hours were adjusted, it would be much cheaper to run? At present, we have to keep on the policemen, the door keepers, the catering staff and many others, often not knowing what the overtime bill will be, and all that is done to subsidise those hon. Members who work part time and who wish to keep a day job in the City or in business. Will the hon. Gentleman go back to the House of Commons Commission and find out the extent to which this House is subsidising those hon. Members?
    Mr. Beith: There is a difference betwen different hours and shorter hours. If the House were simply to rearrange its hours into an earlier part of the day, there would not necessarily be as great a saving as the hon. Gentleman suggests, as the work that was done formerly in the early part of the day would still have to be carried out.
    The hon. Gentleman must recognise that it is the job of the House to decide what hours it will sit and the job of the Commission to ensure that the House is adequately staffed. Some of the work carried out by our staff has to continue even when the House is not sitting, not least that concerned with security.
    Mr. Latham: Will the hon. Gentleman disabuse the hon. Member for Nottingham, North (Mr. Allen) of the idea that the House begins work only at 2.30 pm? There are things called Standing Committees, and some of us have letters to answer. Will he also remind the hon. Gentleman of the evidence against this proposal in the experience of the late Richard Crossman, who started morning sittings which very soon collapsed?
    Mr. Beith: The hon. Gentleman makes a fair point about the work that the staff of the House do, particularly during the mornings. The hon. Member for Nottingham, North (Mr. Allen) could perhaps usefully bear in mind that the printing day by day on the Order Paper of his motions about the reform of the House—whatever their merits—is likely to be costing the House about £400 a week.
    Mr. Allen: Cheap at the price.

    Televising of Proceedings
    Mr. Tony Banks: To ask the honourable Member for Berwick-upon-Tweed, as representing the House of Commons Commission, if he has received any representations from staff involved in televising the House.
    Mr. Beith: No representations have been received by the Commission in relation to those staff employed by the House. I understand, however, that representations have been made to the Supervisor of Broadcasting, and they are being dealt with.
    Mr. Banks: Is the hon. Gentleman aware of the exceedingly cramped conditions that the staff who provide the excellent televising of the House have to endure? Is he prepared to sit down and discuss with representatives of the staff concerned the possibility of extending their facilities; and will he guarantee that when—I assume that it will be when—we get around to confirming the televising of the House, additional premises and accommodation will be found for them within the Palace of Westminster?
    Mr. Beith: Few staff are employed directly by the House in broadcasting, but the staff from the various agencies who work hard to provide the television pictures are indeed accommodation in temporary conditions, and should the House decide to make the experiment permanent it would be a matter for the Services Committee to determine whether any improvements were required.

  LORD PRESIDENT OF THE COUNCIL

    Procedure Reform
    Mr. Simon Hughes: To ask the Lord President of the Council if he will make a statement on his assessment of the case for reform of the procedures of the House.
    The Lord President of the Council and Leader of the House of Commons (Sir Geoffrey Howe): Procedures are essentially a matter for the House as a whole. If the procedures appear to be failing in their purpose, we should be ready to consider change. The best forum for the initial consideration of such issues is the Procedure Committee. I, too, am always ready and willing to consider ideas for improvement.
    Mr. Hughes: In the light of events in eastern Europe and of the move towards real democracy in which all these countries are setting up multi-party Governments and deciding that they do not want to follow many parts of our system, will the deputy Prime Minister consider that we shall not be a real democracy until we thoroughly reform nearly all the procedures of this House? We must sit at reasonable times and make sure that all parts of the United Kingdom have a proper chance to discuss their business. We must delegate when possible and, above all, all parties, in proportion to their size in the House, must have a proper chance to have their say in all debates and procedures on the Floor of the Chamber. When can we have real democracy in Britain, given that other countries can no longer look to us for an example?
    Sir Geoffrey Howe: It is not my function to respond to the hon. Gentleman's general political point, but I have visited every one of the countries belonging to the Warsaw pact in recent years and heard their views about our parliamentary system, and they have a much higher degree of admiration for it than does the hon. Gentleman.
    Sir Charles Morrison: I am glad that my right hon. and learned Friend agrees that the Procedure Committee is the best forum for assessment of reform, but does he agree also that it comes forward with some excellent recommendations? Unfortunately, most of my right hon. and learned Friend's predecessors have not shown as much desire to accept its excellent recommendations as many hon. Members would have liked. Even more unfortunately, on some occasions some recommendations have not been accepted, not because they are not excellent but because the House is intensely conservative in its attitude to reform.
    Sir Geoffrey Howe: I have described the Procedure Committee in carefully qualified language as the best forum for the initial consideration of such ideas, but I agree that it makes proposals that deserve careful consideration. I am glad that one of the first changes made since I assumed my present responsibility was the Sessional Order which varies the provisions of Standing Order No. 13 and which provides for an additional day for private Members' Bills, in so doing going beyond what the Procedure Committee recommended or expected.
    Mr. Spearing: Does the Leader of the House agree that most hon. Members would agree with him that the Procedure Committee is the best forum for evidence and recommendations on those matters? In view of the speed

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    up in institutional developments in the European Economic Community, will he also now consider the recommendations of the Procedure Committee in that respect which are surely now even more relevant than they were when the Committee began its investigation?
    Sir Geoffrey Howe: I certainly would have expected that question from the hon. Gentleman. The Government have already welcomed the Procedure Committee's report on matters affecting European issues. We recognise the importance of that and I shall be discussing it with my colleagues because the matter touches on many aspects of Government. We hope to respond to the Procedure Committee shortly. I agree with the hon. Gentleman about the importance of the issue that he raised.

    Wines
    Mr. Harry Greenway: To ask the Lord President of the Council what English and French wines are available in House of Commons refreshment rooms; and if he will make a statement.
    Sir Geoffrey Howe: The Dining Rooms offer at present a range of 68 French and seven English wines. The red and white House wines available in the cafeterias and bars are both French. The full range is shown on the House of Commons wine list.
    Mr. Greenway: Will my right hon. and learned Friend confirm the obvious—that much more French wine than English wine is sold in the House of Commons? Does he agree that that is because real English wines like elderberry, dandelion and parsnip are not available here? Will he take steps to make those English wines available in the House?
    Sir Geoffrey Howe: My hon. Friend's question comes from a very curious vintage. For every bottle of English wine sold in this place, some 40 bottles of French wine are sold. That is notwithstanding the fact that English wines are given special prominence on the wine list to promote their sale. In those circumstances, I do not think that I can find either the space or anything else to allow the promotion of the more exotic native brews that my hon. Friend recommends.

    Procedure Reform
    Mr. Allen: To ask the Lord President of the Council what changes in procedure he is bringing forward in order to make the proceedings of the House more understandable (a) to hon. and right hon. Members and (b) to the television viewer.
    Sir Geoffrey Howe: I have no plans at present, but I am always ready to consider such changes.
    Mr. Allen: Will the Lord President consider improving the level of debates in this House by supporting the extension of a 10-minute limit on speeches and allowing Mr. Speaker to have discretion to operate that limit—excluding Front-Bench spokesmen—whenever he feels that that is appropriate in a debate? Will he also consider, as a way of improving debates, that as well as a 10-minute limit, time should be set aside—perhaps three or five minutes—for interventions when the clock would stop and hon. Members would not lose that time from their 10 minutes? At the moment many hon. Members simply read
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    their speeches into the record. Would not my two proposals improve debates not simply for the television viewer, but for Back Benchers as well? Will the Lord President now add his weight to the proposals?
    Sir Geoffrey Howe: I can find more sympathy in the House for the relative simplicity of the hon. Gentleman's proposal than for the more complex arrangements that he visualises in his second proposal. It is open to the Procedure Committee to look again at the possibility of extending the scope for the 10-minute limitation. It is essentially a matter on which the views of the House as a whole must be taken into account. However, I can see the case for considering it.
    Mr. Teddy Taylor: Can the Leader of the House explain to right hon. and hon. Members and to the television viewer why our only opportunity to discuss the EEC budget will be from midnight tonight for about an hour and a half? Does he not believe that with the advance of television, many people will gain the impression that the attention that we give to EEC matters is a bit of a sick joke?
    Sir Geoffrey Howe: My hon. Friend will know that there is a question about that later on the Order Paper from which it will become clear that during the 1988–89 Session, the total amount of time devoted to European Community matters was some 90 hours. That is a very substantial allocation of time.
    Dr. Cunningham: When the Leader of the House is considering ways in which to improve understanding of television broadcasts of our proceedings, will he bear the interests of deaf people very much in mind? I know that he is aware of the considerable pressure exerted not only by deaf people and the organisations that represent them but by Members of Parliament for subtitles to be included to make it easier for the deaf members of our communities to understand—and, we hope, enjoy—those television broadcasts. Will he consider how that might be achieved, and report back to us?
    Sir Geoffrey Howe: I can certainly give an affirmative answer to that question. The whole House will sympathise with the wishes of deaf people who would like to gain a better appreciation of what takes place here. As the hon. Gentleman knows, the Select Committee on Televising of Proceedings of the House is currently giving the matter active consideration. We are looking at evidence from both sides—that is, from both those who represent the deaf and those who represent the broadcasters—and we are taking the problem very seriously.
    Mr. Tebbit: May I ask my right hon. and learned Friend not to underestimate the difficulty of persuading the broadcasting authorities to use subtitling for the deaf in any broadcasts? When I was chairman of the Conservative party and sought to persuade the BBC to allow subtitling for the deaf in party political broadcasts, the BBC opposed my suggestion bitterly, on the ground that the Labour party had made it first.
    Sir Geoffrey Howe: I cannot undertake to achieve an arbitral conclusion to this important question that is compatible with the legitimate aspirations of my right hon. Friend, but we are discussing it with broadcasting

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    organisations of both kinds. Both are showing an active interest, while at the same time drawing attention to legitimate difficulties.

    Facilities (Visitors)
    Mr. Skinner: To ask the Lord President of the Council if he has any further statement to make with regard to providing improved facilities for visitors to the Houses of Parliament; and if he will make a statement.
    Sir Geoffrey Howe: Arrangements have now been agreed with the other place to enable visitors to gain access to the line of route by the Sovereign's entrance. The screening facilities in the Norman Porch are to be duplicated to speed up the process. While awaiting admittance, visitors will be allowed to shelter beneath the archway of Victoria Tower. It is hoped that these arrangements will be in operation early next year. Other possible improvements are being considered by the Catering Sub-Committee.
    Mr. Skinner: Ought not the Leader of the House and the sub-committee to agree that it would be a good idea to allow the thousands of people who visit the House every day to come into Westminster Hall to get out of the rain and other inclement conditions? They could wait there until called upon to move into the Central Lobby.
    Would it not also be a good idea to allow those visitors proper catering facilities, instead of bothering about claret, dandelion and parsnip wines and all the rest? If there are to be 16 or 20 different rooms for Members of Parliament, surely it would not be a bad thing for the visitors who pay our wages to be able to get a cup of tea in this place.
    Sir Geoffrey Howe: I might have expected the hon. Gentleman, while making a legitimate point about the lack of shelter for visitors, to acknowledge the value of the changes that we have now been able to announce. He knows that many of the existing catering facilities are already under substantial pressure, but he will be glad to learn that the Catering Sub-Committee is considering possible ways of improving the arrangements, particularly when new opportunities may be presented on completion of phase I of the new buildings.

War Widows' Pensions
3.32 pm
The Secretary of State for Defence (Mr. Tom King): With permission, Mr. Speaker, I should like to make a statement about war widows. The Government recognise the great strength of feeling that has been shown by Members of this House and of another place, and by so many throughout the country, in support of improving the position of the widows of members of the armed forces and others who gave their lives in the service of our country.
Previous Governments have sought to give special recognition to the position of war widows, and this Government in particular have steadily improved the pensions and allowances payable to them. The war widows' pensions, which are paid to all war widows, are the responsibility of my right hon. Friend the Secretary of State for Social Security. Quite apart from the 10 upratings over this period, in 1979 my right hon. Friend the Lord President, as Chancellor of the Exchequer, made the pensions completely tax free. My right hon. Friend the Secretary of State for Social Security has already announced that the amount of those pensions that is not counted in assessing income-related benefits will be further increased.
At the same time, the structure and the value of age allowances have been significantly improved, and my right hon. Friend has already announced a further real improvement, especially for the war widows over 80, to take effect next April. These improvements have helped the vast majority of pre-1973 war widows, who are aged 65 or over. In addition, war widows who have paid national insurance contributions are uniquely entitled to receive a retirement pension, based on those contributions, in addition to their pensions as war widows.
The armed forces pension scheme, which is the responsibility of my Department, and to which significant improvements were made in 1973, provides an occupational pension scheme for service personnel. This scheme also includes a provision for widows. Although the scheme is formally described as non-contributory, it in fact involves an effective contribution from a service man's salary. This is the adjustment made by the Armed Forces Pay Review Body on an annual basis as part of the process of recommending pay levels for service personnel, which is currently equivalent to a deduction in pay of 10 per cent. Occupational pension schemes of different kinds cover a vast number in the public service—including about 2 million pensioners—and it is clearly not possible to apply restrospectively the benefits of improved schemes to those whose husbands were never members of them. There will therefore be no change to the armed forces pension scheme.
The Government have, however, taken full note of those who have argued strongly that much more should be done to improve the income of those earlier war widows who cannot benefit from the later pension schemes, and have been giving urgent attention to how best this could be done. The Government accordingly propose to bring forward arrangements which will be implemented, along with the other improvements to which I have already referred, in April next year, to give the pre-1973 widows a new special payment of £40 a week. This additional payment will be entirely free of tax. Further, my right hon. Friend the Secretary of State for Social Security will be
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taking steps to ensure that this whole sum is not counted for the purposes of calculating income-related benefits. Both these advantages do not in fact apply to the armed forces pension scheme. The new scheme will cover all those currently eligible to receive benefits under the pre-1973 war pension scheme, and will be administered by the Department of Social Security on behalf of the Ministry of Defence.
The payment proposed will be increased in line with the normal annual uprating. The cost of these proposals is some £110 million in the first year, which will be met from the reserve, within the public expenditure planning totals announced in the Autumn Statement.
The Government recognise the very special place that these widows hold in the affections of this country and the particular debt which we all owe them and the strong feeling of many Members of both Houses and the public throughout the country that they should be treated as a quite exceptional and distinctive case. I believe that the proposals that I have announced today are a proper and fair response to that public interest and concern, and a genuine recognition to those whose husbands gave their lives for our country.
Mr. Roland Boyes: I am sure that hon. Members of all parties will welcome today's response to the financial problems experienced by war widows.
This is a major, although acceptable, U-turn. Only two weeks ago, on 23 November, in an Adjournment debate called by my right hon. Friend the Member for Manchester, Wythenshawe (Mr. Morris), the Minister of State for the Armed Forces firmly ruled out any concessions on this matter when he stated that it was unlikely that there would be any change in Government policy.
We recognise that pressure from the public, from the many war widows' organisations and from hon. Members of all parties has led the Government to re-examine the case for improving the lot of pre-1973 war widows. The nation owes a special debt to the widows of those men who gave their lives in the service of their country. They brought up families and carried a burden through the hardest years of their life, often alone. They are now in their old age and extreme old age, Christmas is approaching, and it is important that the major problem has at long last been recognised.
Have the Government accepted the principle that an injustice exists by adding an arbitrary block date within the existing rules? Will the Secretary of State confirm that the increase will be a net increase for all elderly war widows, and in his summary will he give a comparison of United Kingdom war widows' pensions with those of war widows in other countries?
Today's statement still leaves many thousands of widows below parity with those widowed after 1973. Will the Secretary of State come to the House with further proposals some time in the near future? That is the least that he can promise to do for those women who have suffered so much over the years, especially as it is so near to Christmas.
Mr. King: I appreciate the general welcome that the hon. Member gave to the statement, and I am conscious of the anxiety of all right hon. and hon. Members about the issue. I do not accept that we have made a U-turn.

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Throughout their period in office the Government have made steady progress in improving the situation for war widows, and I am proud of what we have done.
The hon. Gentleman referred to the stance of my hon. Friend the Minister of State for the Armed Forces. All right hon. and hon. Members realise the difficulty one faces as a Minister when one is aware that a matter is under consideration, but one has to maintain the line until a statement is made. My hon. Friend has taken a considerable amount of flak during that period, and the House should know the true facts.
The hon. Gentleman mentioned the arbitrary block date. I have heard other phrases, and I have heard that referred to as a technical bureaucratic rule. Everyone in industry or any organisation throughout the country is familiar with the problem that, when a new pension scheme is introduced—we had a similar problem in a company that I was involved in—existing pensioners are not able to enjoy the benefits of the new scheme. One seeks to make available to them, through ex gratia payments, some of the financial advantages that they have lost, and that is what we have sought to do.
Mr. Nicholas Winterton: Speaking as the chairman of the all-party group for pre-1973 war widows, I thank my right hon. Friend and the Government for their unique gesture. My right hon. Friend has answered every request we made. On behalf of all pre-1973 war widows, I say that the Government's action is greatly appreciated and that we are indebted to the Government.
Mr. King: I am well aware of the close interest and the active part that my hon. Friend has taken in the matter. He wanted a significant and substantial increase in pension provisions, and I hope that he feels that that is what I have announced today. I commend the provisions to the House.
Mr. Alfred Morris: In welcoming the improvement for elderly war widows, can I ask the Minister about the crucially important change that was made in the 1973 scheme in June 1988? That change made the higher pension paid to post-1973 widows non-contributory in that, even if their husbands opted out of the 1973 scheme, their entitlement to the higher widows' pensions is not affected. Does that not destroy the argument that there has been no change since the 1970s? Is the Secretary of State aware, on present calculations, that 1,200 war widows whose husbands died in the two world wars will die before next April? Can he help them at all?
Mr. King: The first matter that the right hon. Gentleman raised—I have heard him mention it in other quarters and on the radio—is wrong. Deductions are made in the assessment of the rate of pay. That means that even if some men opted out, it was only just that their widows should continue to be included in the scheme because, effectively, they continued to make their contributions. A unique feature of the scheme is that, even if people had opted out, they could not reduce the contribution that they were assessed to make.
My right hon. Friend the Secretary of State for Social Security has done something which I think the whole House recognises is hugely important. My right hon. Friend intends to ensure that war widows do not receive with one hand and lose with the other. That is a crucial
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feature of the arrangement. It will involve a certain amount of work and consultation with local authorities to ensure that, when people declare their income for community charge or housing benefit purposes, they understand that they do not have to declare this additional special payment. While one might have hoped for things to be different, the overall package should commend itself to the House.
Mr. Michael Mates: Does my right hon. Friend agree that there will be widespread rejoicing that the Government have acted quickly, fairly and generously, given the justice of the cause which was giving us the problem? Will my right hon. Friend assure those who may still think that the settlement is not what it should be because he has not conceded parity—for technical reasons, which many of us understand? Will he assure us that the scheme with regard to tax and benefit disregards will mean that the most needy pre-1973 war widows will be as well off as, if not better off than, post-1973 widows?
Mr. King: I agree with the latter part of my hon. Friend's question, although it depends on housing costs. The sum will be disregarded from housing benefit, and tax free. A younger war widow of the pre-1973 group is bound under these proposals to get £100 on which she will pay not a single penny of tax. In addition to this £40 disregard, there will be another £10 as a result of changes that my right hon. Friend the Secretary of State for Social Security is making in April. One of the older widows who also receives an old-age pension will get close to £170, on my assessment, which is subject to no tax at all.
Mr. Menzies Campbell: I am sure that the Secretary of State agrees that the group of people whom these proposals are intended to benefit have behaved in an entirely dignified way throughout the campaign which has been waged on their behalf. I have no doubt that they will welcome these proposals, as do I. May we take it that the Secretary of State will ensure that these arrangements will be kept under constant review and that, if it is thought that there is any deterioration for any external reason, the Secretary of State, or his successor, will be willing to consider similar recognition of the special place these ladies have in the affections of the people of the United Kingdom?
Mr. King: I am grateful to the hon. and learned Member. War widows will continue to be entitled to various other benefits in appropriate circumstances. I believe that this announcement makes a significant contribution. This extra special payment will be subject to uprating. I hope that, with increases in age allowance, which my right hon. Friend the Secretary of State for Social Security has already announced, and the disregards that I have announced, these people will be much better placed.
Mr. Terence L. Higgins: Does my right hon. Friend agree that there is a close analogy between pre-1973 war widows and those who were not allowed to contribute to the national insurance scheme when it was introduced because they were too old? As a previous Conservative Government should be proud of having helped non-pensioners in the circumstances I have described, so my right hon. Friend and the Government should be proud of what they have announced today.
Mr. King: I know of my right hon. Friend's interest in this matter and I am grateful for what he said.
Mr. Jack Ashley: I warmly welcome the statement. Is the right hon. Gentleman aware that he has just demolished the case of his predecessor, who argued that ex-service men and women who were disabled due to negligence before 1987 could not be helped because the legislation of that year, which enabled such people to sue for negligence, was not retrospective? The Secretary of State has today accepted the principle of retrospection. As those men and women helped others, will he consider doing what he can to help them and to give them a special payment?
Mr. King: I do not accept what the right hon Gentleman says, I made it clear in my statement that retrospection was not a possibility but that we were anxious to do something to help what the whole House has agreed and so many campaigning on this issue have promoted as a uniquely deserving category. In the presentation of their case the special position of war widows was underlined, and it was on that basis that the Government felt able to act.
Mr. Peter Viggers: I thank my right hon. Friend warmly for the statement, which will bring great satisfaction in the country and a greater sense of dignity to the ladies involved. Does he agree that the campaign on their behalf was, rightly, all-party and non-party? Does he further agree that we on the Conservative Benches can take a greater sense of pride that we have found the money to act and show recognition of those who died and their widows?
Mr. King: That is correct. I said in my statement that the campaign and the cause have been supported throughout the House, in another place and throughout the country. It is only because of the strength of the economy and of the Exchequer that we are able to take action. No one in his right mind would dream for a moment that. whatever their good intentions, Opposition Members would ever be in a position to make an equivalent statement.
Mrs. Rosie Barnes: I warmly welcome the Government's change of heart towards pre-1973 war widows. However, several anomalies and disparities still exist between pre-1973 and post-1973 widows. Will the Secretary of State clarify whether the Government are committed in principle and in practice, and by whatever means, to complete equality between the two groups?
Mr. King: I am afraid that the hon. Lady did not understand my statement. If by "equality" she means retrospection of the armed forces pension scheme, I made it clear that that is not possible. However, we have sought to embrace a slightly wider group. My hon. Friends may be interested to know that the special payments will be available to more people than those who technically would have qualified for retrospection of the armed forces pension scheme. The scheme will include the widows of merchant seamen and some in the civil defence who lost their lives in the war. There are differences because the payment will be tax free and will not count against benefits. In view of the impossibility of retrospection, the arrangements are the most viable that could be made.
Mr. Neil Thorne: I, too, congratulate my right hon. Friend on his caring and sympathetic attitude on this matter as soon as he became aware of the full facts of the case. Will he confirm that he has made war widows a special case because he was aware that so many men who died did so as volunteers or conscripts and clearly did not have the resources to make provision for their wives and families and that is why we needed to treat war widows as a special case?
Mr. King: I recognise my hon. Friend's active and energetic participation in the campaign. I agree with him, and I said in my statement, that we consider war widows as a special case. To quote the Officers Pension Society,
"No other group could claim the special nature of the debt of honour."
We believe that that is right, and that is why we have taken action.
Mr. A. E. P. Duffy: Now that the Secretary of State and his right hon. Friend the Secretary of State for Social Security are prepared to make pension adjustments for a wider range of those penalised by war, will he look at those disabled in the second world war? I should perhaps declare an interest, and I hope that the Secretary of State will accept that it is not a special plea. I have had personal acquaintance with and knowledge of many tragic cases of war widows. Will the right hon. Gentleman undertake to consider carefully the wider gap that is opening up between the second world war disability pensioners and those categories that all hon. Members have been so concerned about today?
Mr. King: The difficulty in and obstacle to making any improvement in a scheme or arrangement is often the anxiety about how much more widely the change may spread. That was undoubtedly an obstacle to the improvement in the position of pre-1973 war widows. The right hon. Member for Manchester, Wythenshawe (Mr. Morris) said that the top priority of the ex-services' organisations was proper financial provision for elderly war widows. Others also emphasised that. That is the only basis on which I have been able to make this announcement today.
Several Hon. Members rose—
Mr. Speaker: Order. I must have regard to the subsequent business before the House. It is an important debate in which many hon. Members wish to speak, so I shall take three further questions from each side. Then, regrettably, we must move on.
Sir Geoffrey Johnson Smith: Is my right hon. Friend aware that those of us who take a close and special interest in the conditions of the armed services, especially the widows of those who served in the armed forces, are grateful to him for taking this problem under his wing so soon after assuming the office of Secretary of State for Defence? I am sure that both sides of the House agree that he has gone through a difficult exercise trying to preserve a balance between one group and another and that he has emerged with credit to his office and the Government.
Mr. King: I appreciate my hon. Friend's kind words. I am not sure that I took the matter under my wing so much as had it shoved forcibly there by many right hon. and hon. Members. Those of us who have been working on this in the Department, especially the Ministers of State and

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Under-Secretaries of State, are aware of the assistance we have received from my hon. Friend the Secretary of State for Social Security and, never to be forgotten, the Chief Secretary to the Treasury.
Mr. Merlyn Rees: I welcome the increase. May I declare an interest? I am a war pensioner, my mother who came into this category and was nearly 90, died recently, and I am an honorary adviser to the British Legion. When I go to ex-service men's conferences, I do not find them to be as partisan or advantage-seeking as many hon. Members whom I have heard today. These are complicated matters.
My hon. Friend the Member for Sheffield, Attercliffe (Mr. Duffy) asked about the disabled. Is it not time that we had, as they have in Europe and the United States, a department of ex-service men's affairs, instead of their affairs being split between about 11 Departments? Unless the Prime Minister steps in and knocks everybody's heads together, as in this instance, nothing is done. There is a case for a Department that looks after the interests of ex-service men.
The number of war widows who will be dead before next April is large. That is the nature of life. Could the increase be introduced more quickly? Could the bureaucracy be speeded up, as it has been in the past fortnight, so that war widows would not have to wait until next April?
Mr. King: I note what the right hon. Gentleman says from his personal and, obviously, intimate experience of the problem. I cannot add anything to what I said about the problem of the date. The right hon. Gentleman suggested that heads were clashed together. I think that the Prime Minister would give me authority to say that one or two others were equally anxious about the problem.
Mr. Julian Brazier: In welcoming my right hon. Friend's extremely positive statement, which does so much to repay the great debt we owe to war widows and their dead husbands, may I suggest that a reason why the Government found it possible to make this unusual and generous offer was precisely because several other groups, including BLESMA, which represents the war disabled, generously and disinterestedly made statements promising that they would not try to climb on the bandwagon if something special was done for the war widows?
Mr. King: I am grateful to my hon. Friend. He has made a very important point. Those who promoted the cause of war widows, and many other organisations, made it clear that this was a unique case. It was against that background that it has been possible to make the statement.
Mrs. Margaret Ewing: On behalf of the Scottish and Welsh National parties, I thank the Secretary of State for his positive and most welcome statement. I pay
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tribute to those organisations outwith this place who have consistently and honourably fought in the campaign. Will it be possible for the right hon. Gentleman's Department to publish a table that is similar to the one circulated by his ministerial colleague on 28 November so that hon. Members are able to study closely the significance of disregards and tax allowances? All of us are interested in how close the parity between pre-1973 and post-1973 war widows will be.
Mr. King: I am grateful to the hon. Lady for what she has said. However, it will be difficult to do that; it will depend on individual circumstances: on whether the £40 not being taken into account for housing benefit and community charge will affect their cost of living and what advantage they will gain from the increase. However, I shall consider what the hon. Lady has said and see what we can do to help.
Mr. Churchill: I warmly congratulate my right hon. Friend and the Government on the statement. Will he accept no carping or criticism from Opposition Members who had an opportunity to acquit this debt to war widows, but did not choose to avail themselves of it? His announcement will go far towards acquitting that debt of honour to those who laid down their lives for our freedom and to their widows who have suffered for a lifetime since then.
Mr. King: I am grateful to my hon. Friend. He takes a keen interest in the issue. I hope that it will be seen as a very real response to people who deserve our interest.
Mr. John McWilliam: I thank the Secretary of State for the real progress that he has made in finding a solution to the problem. I ask him not to dismiss the idea that the hon. Member for Moray (Mrs. Ewing) advanced. His package is extremely complex and will depend on individual circumstances. An illustrative table would help us to judge the basis of the award.
The Department's expenditure on war widows fell by £25 million in the last financial year. The number will continue to fall as many of these ladies die. The problem will therefore, unfortunately, eventually solve itself. Will the Secretary of State undertake to re-examine whether, within the expenditure constraints, he could achieve complete parity without breaching pension regulations for the armed forces?
Mr. King: I am aware of the interest that the hon. Gentleman has taken in the matter and the early-day motion in which he is very much involved. He referred to my announcement as a complicated one. It is not complicated at all; it is extremely simple. The complexities arise from the circumstances of the people to whom it applies. We shall certainly do what we can to help; but even if we produced illustrative examples, I think that I am right in saying that my right hon. Friend the Secretary of State for Social Security does not have information on how many would fall into the individual categories. We shall do what we can to help, but that will be one of the problems.

Hong Kong (Chinese People)
4.3 pm
Mr. Tony Marlow: I beg to ask leave to move the adjournment of the House, under Standing Order No. 20, for the purpose of discussing a specific and important matter that should have urgent consideration, namely,
"The Government's intention to give settlement rights to between 150,000 and 200,000 Hong Kong Chinese as set out in yesterday's Observer."
It is a massive number of people, which is sufficient to populate a town the size of Northampton. It is an urgent matter, for in the past whenever Governments have given commitments, Parliament has been unable to uncommit. Therefore, it is vital that the views of our people are clearly made known before any decision is taken, particularly as immigration policy is driven initially by the needs of foreign policy rather than the desires of our citizens. Perhaps it is easier to confront the censored censure of the electorate once every four years than the hypocritical hostility of less-worthy Governments on a daily basis.
We need to debate whether the figure of 200,000 is for primary immigration alone and what are the future rights of unknown quantities of potential dependants. Will individual decisions be based on administrative discretion or will a panoply of rights and appeal procedures be attached? In all these cases the initial figures could be massively exceeded.
Vast areas of our inner cities have already been colonised by alien peoples with little commitment to our country or our way of life. The recent reactions to Salman Rushdie should make that plain even to the Opposition. Should we not urgently debate the extent to which our multicultural experiment has succeeded before deciding whether it is prudent to extend it?
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There may be little blood flowing in the Tiber yet, but all the most likely scenarios are filled with great foreboding. Ulster could be but a skirmish compared with the holocaust that could follow. Surely it would be a massive error further to aggravate the delicate balance of our society—[Interruption.) Surely that is something which we know our people in their good sense do not want. We must listen to them.—[Interruption.]
Mr. Speaker: Order. The hon. Gentleman has as much right as anyone else in the House to make his speech.
Mr. Marlow: It is easy to sign the cheque today, knowing that the bill will become payable much later. It is easy, but it is cowardly and irresponsible. We need an urgent debate.
Mr. Speaker: The hon. Member for Northampton, North (Mr. Marlow) seeks leave to move the Adjournment of the House, under Standing Order No. 20, for the purpose of discussing a specific and important matter that he believes should have urgent consideration, namely,
"the Government's intention to give settlement rights to 150,000 to 200,000 Hong Kong Chinese as set out in yesterday's Observer."
As the House knows, under Standing Order No. 20 I have to announce my decision without giving my reasons to the House.
I have listened with care to what the hon. Member has said. I have to decide whether his application comes within the Standing Order, and, if so, whether I should give it precedence over the business set down for today or tomorrow. I regret that the matter that he has raised does not meet the requirements of the Standing Order, and. I cannot, therefore, submit his application to the House.
Several Hon. Members rose—
Mr. Speaker: No. I have a further application under Standing Order No. 20.

Steel Making (Scotland)
4.7 pm
Dr. Jeremy Bray: I beg to ask leave to move the Adjournment of the House, under Standing Order No. 20, for the purpose of discussing a specific and important matter that should have urgent consideration, namely,
"The future of steel making in Scotland in the light of British Steel's impending decisions on plate mill capacity."
In a letter to a Mr. Lawson, published last Friday, Martin Llowach chief executive of the British Steel Corporation cast doubt on the viability of British Steel's two plate mills at Scunthorpe and at Dalzell in my constituency. He said that the plate business is a vital component of the company's concentration on and success in structural steels. He said that capital costs for entirely new mills are extremely high, and that British Steel had supported the acquisition by Davy McKee of an existing plant from abroad. That plant from Japan is now stored in the Teesside works of British Steel.
When the privatisation of British Steel was announced in the House on 3 December 1987, the then Chancellor of the Duchy of Lancaster said that the chairman of British Steel had that day made a statement saying that
"subject to market conditions, there will continue to be a commercial requirement for steel making"—
and continuous casting at the corporation's five major plants—
"for at least the next seven years. The corporation also expects that, again subject to commercial considerations, there will be a similar requirement for plate rolling at Dalzell." —[Official Report, 3 December 1987; Vol. 123, c. 1107.]
That statement has been quoted several times by Ministers as an undertaking—even a solemn undertaking—and it was included in British Steel's privatisation prospectus. It was not a lightly made statement. Those seven years run to 1994. Does the statement still stand?
British Steel has thrown the steel industry in Scotland into great uncertainty. The suggestion of an independent steel industry in Scotland is nonsensical without finishing mills or markets. My steel worker constituents and their families have no wish to be treated as political footballs, but Ministers and British Steel owe the House an explanation of what is going on, and the House should debate the matter urgently before British Steel goes any further.
Mr. Speaker: The hon. Member for Motherwell, South (Dr. Bray) asks leave to move the Adjournment of the House for the purpose of discussing a specific and important matter that he believes should have urgent consideration, namely,
"the future of steel making in Scotland in the light of British Steel's impending decisions on plate mill capacity."
I have listened with care to what the hon. Gentleman has said, but I regret that I must give the same answer as I gave the hon. Member for Northampton, North (Mr. Marlow). I regret that his submission does not meet the requirements of the Standing Order. I therefore cannot submit his application to the House.

Points of Order
4.12 pm
Mr. Paddy Ashdown: On a point of order, Mr. Speaker. Over the weekend, the total failure of the Prime Minister's policy on Europe became cruelly apparent, and she moved this country to the brink of isolation in Europe. Is it not an abuse of the House, and typical of the contempt in which she holds it, that the Prime Minister is not prepared to address it this afternoon, but will seek to do so tomorrow, after our key European debate this evening? Is it not a matter of the gravest concern that this issue, which is so important to our nation, will not be debated or voted on this week or probably before Christmas because of the conspiracy of agreement between the two Front Benches? As this matter is not amenable to an application under Standing Order No. 20, may I seek your advice, Mr. Speaker, on how it could be debated and voted on before it is too late?
Mr. Speaker: The right hon. Gentleman knows that I am not responsible for the timing of statements, but I understand that the Prime Minister is to make a statement on the matter tomorrow. I am sure that what he said about the debate will have been heard by those on the Front Bench, but, again, the arrangement of such a debate is not a matter for me.
Mr. Graham Riddick: On a point of order, Mr. Speaker. Page 129 of "Erskine May" refers to improper but indirect attempts to influence Members. Having considered this, is there not clearly a case of privilege to be answered when an hon. Member feels it necessary to consider resigning and fighting a by-election because of the undue and overmightly influence of the same trade union block vote that sponsors the Leader of the Opposition?
Mr. Speaker: The hon. Gentleman mentioned the word "privilege." If he alleges that this is indeed a matter of privilege, he must write to me in the usual way and I shall deal with it. I cannot deal with it on the Floor of the House.
Mr. Riddick: I accept that, but, through you, Mr. Speaker, may I offer the hon. Member for Birkenhead (Mr. Field) my support and help in his fight to retain his seat?
Mr. Speaker: I am sure that the hon. Member for Birkenhead (Mr. Field) will be grateful for the hon. Gentleman's support.
Mr. Tam Dalyell: On a point of order, Mr. Speaker. Arising out of questions, may I raise a domestic House of Commons matter of some little consequence—the powers, authority and job of the House of Commons Commission? Question No. 47, about which I have been writing to you, Mr. Speaker, the Department of the Environment and others for over two years, on the truly disgraceful state of the Font in Welsh marble and its deteriorating stonework has been accepted by the Table Office. It is embarrassing to take knowledgeable visitors to see the fabric of the House of Commons and to find that the stone is crumbling. I know that there are complications involving the bomb that dropped in the 1940s and the destabilising of the Crypt floor.

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Is this not a matter for the House of Commons Commission? The Table Office took the view that it was. I am not quibbling about not being called at Question Time. I am making the point that it is about time the Speaker of the House of Commons put his weight behind doing something about our building.
Mr. Speaker: I do not know whether the hon. Member has received the letter that I wrote to him on 8 December.
Mr. Dalyell indicated dissent.
Mr. Speaker: Evidently the hon. Member has not received that letter. When he does so, I think that he will understand why his question was transferred. However, in my letter I said that I shared his concern. I have a family christening in the Crypt Chapel next week and, bearing in mind what the hon. Member has said, I shall look carefully at the Font.
Mr. Nicholas Bennett: On a point of order, Mr. Speaker. You will know that from time to time the Opposition complain about Ministers making statements outside the House rather than to the House. I understand that a statement was to be made at 4 o'clock by the Leader of the Opposition on the matter which was raised by my hon. Friend the Member for Colne Valley (Mr. Riddick), referring to the hon. Member for Birkenhead (Mr. Field). This is a matter of keen constitutional importance to all Members. I wonder whether some way can be found to change the procedures of the House so that the Leader of the Opposition can make a statement to the House and we can question him about it.
Mr. Speaker: That is as may be, but it is not a matter of order in the House.
Mr. Dennis Skinner: On a point of order, Mr. Speaker.
Mr. Speaker: Order. I remind the House that we have a very busy day ahead of us.
Mr. Skinner: I thought that I saw you wince when the hon. Member for Northampton, North (Mr. Marlow) submitted his Standing Order No. 20 application and
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spoke about the incitement of racial hatred. When Conservative Members want to stir up racial hatred, I wonder whether you could provide these members of the goose-stepping tendency with a pair of jackboots. They could be kept with the opera hat which is with the Serjeant at Arms. In that way, hon. Members could dress properly for the occasion and the viewers would know what they were up to.
Mr. Tony Marlow: On a point of order, Mr. Speaker.
Mr. Speaker: I shall take the point of order because the hon. Member was mentioned.
Mr. Marlow: I am grateful to you, Mr. Speaker. I am sorry that the hon. Member for Bolsover (Mr. Skinner) feels that it is wrong for a Member to put forward the views that he knows are held by the majority of his constituents. If that is his position, let the hon. Gentleman tell his constituency about it, because my constituents would rather have my views.
Mr. Speaker: Perhaps I can clear up the matter. Every Member has a right to make his speech in his own way. We often have to listen to speeches with which we may not wholly agree. The hon. Member for Northampton, North (Mr. Marlow) has a right to make his submission, and he has done so.

Statutory Instruments, &c.
Mr. Speaker: With the leave of the House, I will put together the two motions relating to the statutory instruments.
Ordered,
That the draft Driving Licences (Community Driving Licence) Regulations 1989 be referred to a Standing Committee on Statutory Instruments, &c.
That the draft European Communities (Definition of Treaties) (European School) Order 1989 be referred to a Standing Committee on Statutory Instruments, &c.—[Mr. Greg Knight.]

Orders of the Day

  National Health Service and Community Care Bill
  Order read for resuming adjourned debate on Question [7 December] , That the Bill be now read a Second Time.
  Question again proposed.
  [Relevant documents: Eighth Report from the Social Services Committee, Session, 1988–89, Resourcing the National Health Service: the Government's plans for the future of the National Health Service, (House of Commons Paper No. 214-III, 1988–89), the Government's reply to that Report (Cm. 851), the Second Report from the Social Services Committee, Session 1984–85, Community Care with special reference to adult mentally ill and mentally handicapped people (House of Commons Paper No. 13-I 1984–85), the Government's reply to that Report (Cmnd. 9674), Community Care: Agenda for Action (1988 HMSO), and the White Paper Caring for People: Community Care in the next decade and beyong (Cm. 849).]
  Mr. Speaker: I must announce to the House that I have not selected the amendment in the name of the right hon. Member for Yeovil (Mr. Ashdown), but the arguments that are advanced in that amendment can, of course, be made in the debate.
  I must repeat what I have said: a large number of hon. Members wish to participate. I therefore propose to put a limit of 10 minutes on speeches between 6 and 8 o'clock. The hon. Member for Nottingham, North (Mr. Allen) raised a point about the time limit on speeches, but I have no authority to limit speeches to 10 minutes before 8 o'clock. Nevertheless, I hope that hon. Members who are called before and after that time will bear that limit in mind so that more hon. Members may be called to put their points of view.
  4.18 pm
  The Secretary of State for Scotland (Mr. Malcolm Rifkind): Today is the second day of debate on the Bill. Before I address myself to the major issues that are covered by the legislation, I want to report to the House a welcome development on the position of doctors in the rural and more sparsely populated parts of Scotland of which, I believe, the House will approve. In the White Paper "Working for Patients", the Government gave a guarantee that they would seek to protect the position of such doctors, and that has been a priority for us.
  The new general practitioner contract already includes a transitional payments scheme which will help small practices to adjust to their new circumstances. However, the evidence that the Department of Health submitted to the doctors' and dentists' review body last week also stated that I intended to fulfil the undertaking given in chapter 10 of the White Paper by funding from Scottish block resources a scheme analogous to the transitional payments scheme, but on a long-term basis. Scottish doctors who are normally eligible for rural practice payments and who fulfil the obligations of the contract will have their level of income protected under the new contract. As a matter of practical convenience, the fund will be administered by the Scottish rural practices fund committee as the body best
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  placed to ensure that the payments are targeted to doctors who are entitled to receive them. I understand that the proposal has been welcomed by the British Medical Association and I am sure that it will be welcomed by the House as a whole.
  I want to begin by giving what I hope will be seen as friendly advice to the hon. Member for Glasgow, Garscadden (Mr. Dewar), who will speak on behalf of the Opposition. On a previous occasion, he expressed some criticism of the fact that the Government's Scottish proposals are incorporated in a Great Britain Bill. I advise him, in the friendliest way, not to pursue that line of reasoning. If he does, he should bear in mind that in the 40 years since the National Health Service was founded, no fewer than 13 Bills affecting it have applied throughout Great Britain as a whole and only three, including a consolidation measure, have dealt with specific aspects in Scotland. As the Government's proposals apply throughout Great Britain, this is the proper approach to take.
  Two debates are taking place in the House and in the country on the Government's National Health Service proposals. There is a bogus debate and a real debate. It is appropriate to address myself to both issues and I shall start with the bogus debate because I know that Opposition Members will be more interested in it as it dominates their thinking on the matter.
  Mrs. Margaret Ewing: Will the right hon. and learned Gentleman give way?
  Mr. Rifkind: I hope that the hon. Lady will allow me to continue for a moment.
  The bogus debate has taken three forms. It was begun by an assertion that the Government were seeking to destroy the NHS. It was then claimed that the Government's proposals were intended to lead to a reduction in NHS funding and, finally, it was suggested that the Government were putting profit before people and were seeking to commercialise the NHS. Let us address the evidence and see what justification those arguments have.
  In its submission to the Government, the BMA states categorically that, in its view, the Government's proposals will
  "destroy the comprehensive nature of the existing service."
  The Labour party, in a document produced by the hon. Members for Kirkcaldy (Dr. Moonie) and for Strathkelvin and Bearsden (Mr. Galbraith), stated that the Government's proposals represent "opting out" of the NHS. The National and Local Government Officers Association, in its—as usual—constructive contribution to the NHS debate, suggested that the Government are proposing the "break-up" of the NHS. It is a compliment to the Government in a sense that, as the critics are unable to direct their attention and concern to the contents of the White Paper and of the Bill, they seek to divert attention from those matters by referring to matters that have never been the Government's intention.
  One simply needs to quote from the White Paper, which says categorically and unequivocally:
  "The NHS is, and will continue to be, open to all, regardless of income, and financed mainly out of general taxation."
  Those are the principles on which the NHS is based and on which it will continue to be based. The first assertion—that we intend to destroy the NHS—is of such manifest absurdity as not to justify further attention by the House.

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  No less a body than the BMA then suggested that the Government sought to reduce the funding of the NHS. In paragraph 2.4 of its submission, the BMA said:
  "The Government's main proposals would appear to be to contain and reduce the level of public expenditure devoted to health care."
  That is a serious allegation from the BMA. I say to the BMA and to those who think similarly that when one puts forward such a proposition, it is proper to judge matters not by what people say, but by what they do. The achievements of the Government over the past decade make the falsity of that accusation undeniable.
  Over the past 10 years no fewer than 67,000 more nurses have been working in the NHS; no fewer than 14,000 more doctors have been working in it; and expenditure on the Health Service has risen from £8 billion in 1979 to about £26 billion. Before I give way to the hon. Member for Moray (Mrs. Ewing), I want to give her a Scottish aspect to this discussion. In 1979 expenditure on the NHS for every man, woman and child in Scotland was about £385 which, in today's prices on a common price basis, has risen to £509. I hope that when I give way to her she will concede that that represents a fundamental and real increase in the resources available to the NHS. I hope that if she is as fair about that as she would wish to be seen to be, she will happily acknowledge the point.
  Mrs. Margaret Ewing: The Secretary of State has raised so many points that it is difficult to include them all in a short intervention.
  There is a difference between funding and meeting the task that lies ahead. The requirements in Scotland are so extensive that we shall need to examine the NHS budget carefully. I welcome what the right hon. and learned Gentleman said about rural practices, but what provision has been made for part-time women doctors in practices? What provision is being made for state-enrolled nurses who want to take bridging courses to meet the requirements of Project 2000? If these nurses do not want to take bridging courses, what provision will be made to safeguard their contracts?
  Mr. Rifkind: I thank the hon. Lady for her welcome for my earlier remarks. We recognise the importance of those who want to work part time in the NHS—particularly female doctors and other female members of staff. For the first time a part-time contract is now available to them, and I am sure that the hon. Lady will welcome that.
  The third assertion to which I referred some moments ago was the claim that the Government somehow want to put profit before people or, in the quaint phrase used by the hon. Member for Livingston (Mr. Cook) on Thursday, that we are seeking to commercialise the NHS. I presume that he was not suggesting that we are seeking to obtain value for money—no: the implication of his remarks was that the Government see the NHS as a profit-making body, or believe that it should become one, working in a commercial way without giving priority to the needs of patients.
  I hope that the hon. Member for Garscadden will not associate himself with such a foolish argument. If the Government wanted to put profit before people they would hardly have brought forward these proposals, fundamental to which is the idea that any resources saved by a general practice budget will remain with the general practice to improve the quality of its service, and that any savings obtained by an NHS hospital trust will be
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  reinvested in that hospital for the benefit of its patients. In no circumstances can the Treasury or any doctor obtain financial benefit as a consequence of these changes. That adequately meets the point about the Government's priorities.
  The bogus debate should not detain the House for more than a few moments, so I turn to the real issue that should attract the attention of the House and the country. The real issue in the NHS debate of the past few months is simple and straightforward. It is how, in a modern society, we should administer the vast resources—the £26 billion or £27 billion—that are required to run the NHS. Can we continue to administer it in a centralised bureaucratic way, or can we, through the benefits of modern information technology, adopt a decentralised method of administration for the benefit of the patients whom the NHS exists to serve?
  In addition, we must examine the origins of the NHS and how it was administered when it was first set up. At the time of its inception some 40 years ago there was a basic belief, no doubt sincerely held, in the virtues of central planning and of a benign bureaucracy. There was undoubtedly a widespread belief, perhaps extending beyond the Labour party at the time, that the best way to administer resources of that scale was through a form of rigid, centralised planning which would then feed its way through the system to the benefit of the public as a whole. We did not see that approach only in the NHS; it was evident in various other sectors of the economy and our society. It was reflected in the great nationalised industry legislation of the Attlee Government. The assumption was that there should be nationalisation and many small concerns should be brought together into massive conglomerations and that would achieve the best use of resources. That view was shared in western and eastern Europe as well.
  The hon. Member for Garscadden and his colleagues should appreciate that a structure established 40 years ago does not necessarily make sense in the dramatically changed circumstances in the 1980s and 1990s.
  Mrs. Gwyneth Dunwoody: Does the Secretary of State accept that his Government have reorganised the NHS twice since then?
  Mr. Rifkind: The hon. Lady is quite correct. Of course there have been changes. However, even today we still have an essentially centralised system administering vast resources. The Government have realised that we must change constantly as circumstances change and it is unfortunate that the Labour party appears to be caught in a timewarp and is attached to a system of administration of the resources which might have been relevant 40 years ago, but is certainly not relevant to the vast sums of money and the vastly changing circumstances at the moment.
  It is also sad that the BMA, with its particular involvement in the NHS, should remain so resistant to change. It is resistant not because it is caught in a timewarp, but because it has a fundamental antipathy to change. The BMA opposed the NHS 40 years ago because setting up the NHS represented change. It opposes the Government's proposals today because they also represent change and that is something it cannot come to terms with.
  If we consider the way in which circumstances have changed over the past 40 years, I do not believe that Labour Members can seriously suggest that we should not

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  take cognisance of those changes. We have seen a vast increase in resources dating back 40 years. When the NHS was first formed, the expenditure in 1948 was £270 million for the whole of the NHS. Today it is £26 billion. Even taking account of inflation over the past 40 years we have seen an increase in real terms under both Conservative and Labour Governments of 610 per cent. It beggars imagination to suggest that the system of administration of such vast resources can remain untouched by those changes.
  It is not simply the scale of resources that has changed. In this country and elsewhere we have also seen a growing disillusionment with central planning and central control as a means of administering resources and getting the best benefit from the way in which we run the NHS. New information technology also offers an exciting opportunity. If we had wanted to decentralise control and the administration of NHS resources in the past, there would have been grave practical limitations on our ability to do that. Hospitals and health authorities did not have the information and could not have been expected to obtain information essential to making rational decisions between different priorities for resources.
  Mr. Michael Foot: If it was so evident to everyone that changes had to be made along the lines that the Government are now proposing, why did the Government make no mention of the proposition in their election promises to the country?
  Mr. Rifkind: As the right hon. Gentleman knows, the scale of the resources has increased as the years have passed. If he wants to accuse us of being a little tardy in approaching the need for reform, perhaps we will plead guilty to that. However, the right hon. Gentleman should at least appreciate that the Government are serious in their attempt to ensure that resources are used for the maximum benefit of patients.
  Perhaps the greatest single change since the inception of the NHS has been the extent to which both sides of the House now emphasise the virtue and importance of choice for patients as a crucial requirement for the way in which the system should be administered.
  Dr. Lewis Moonie: Will the Secretary of State give way?
  Mr. Rifkind: I will develop this point and then I will happily give way to the hon. Gentleman.
  I am glad that the hon. Member for Garscadden agrees with me that the desire for choice has now been represented as common to the views of both sides of the House. In its document "Patients First", a discussion document on the NHS in Scotland, the Labour party actually goes so far as to say, in the most eloquent terms:
  "The National Health Service should provide patients with treatment when they want it, where they want it, by whom they want it, and in suitable surroundings. In other words, choice. This choice must be available to all, and free at the time of need."
  The document goes on to refer to
  "Choice in primary care … Choice in the hospital service … Choice of day and time of hospital appointments … Choice of consultant … Choice within hospitals and health boards and between health boards … Choice of date for in-patient treatment … Choice of in-patient accommodation."
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  Those are fine words and fine sentiments, but the question to which the Opposition have so far failed to address themselves is how such fine aspirations can be translated into reality. We are dealing with a society of no fewer than 55 million men, women and children. How can individual men, women and children be provided with effective, meaningful choice without a dramatic decentralisation of the administration of our vast resources?
  Not only will we require such a massive decentralisation, but, if individual citizens are to be given effective choice, we must ask ourselves where they will exercise that choice. Such people do not enter the Department of Health or the Scottish Home and Health Department; they do not enter the regional or the district health authorities. The point of contact with the NHS for the vast majority of ordinary citizens is a visit to either their GP or their local hospital. Only if we can give GPs and local hospitals more freedom in how they use the resources provided for them will it be possible for them to respond to the individual wishes of individual members of the public.
  That is the crucial and fundamental point to which the Opposition have not yet addressed themselves. Fine words about choice, and marvellous sentiments about individual members of the public being able to determine which doctor or hospital they visit on which day, can have no hope of translation into reality unless those who provide the services—GPs and local hospitals—have sufficient autonomy in their use of their resources to be sensitive to individual wishes in any meaningful way.
  Dr. Moonie: Will the Secretary of State tell us how it will improve choice for patients to implement a directive such as that sent out by the Scottish Home and Health Department last week to all health boards, instructing them that once the Food Safety Bill becomes law all chicken served in hospitals will have to be irradiated?
  Mr. Rifkind: The hon. Gentleman knows perfectly well that the Government made some announcements about irradiation recently, and we shall no doubt have an opportunity to discuss that subject at an appropriate time.
  If the hon. Gentleman, who has a medical background, does not believe in the need for proper standards of public health, he is a very surprising example of his profession. We are talking about a view that is common to both sides of the House, and one that was expressed in the hon. Gentleman's own document—for it was his document to which I referred. When I gave way to him, I hoped that the hon. Gentleman would put forward real, serious propositions on how sentiment could be translated into reality, other than through the granting of far more autonomy to individual general practices and hospitals.
  Dr. Norman A. Godman: Has the Secretary of State seen the article in today's Glasgow Herald about the service offered by Yorkhill children's hospital? Serious allegations have been made there about delays in carrying out operations on young children. Will the Secretary of State give me an assurance that he will initiate an investigation into those allegations?
  Mr. Rifkind: I, too, was concerned when I read the press reports this morning. I have already made inquiries, and I understand that there has been a recent increase in demand for intensive care beds in a number of specialties, leading to the unfortunate postponement of a number of planned operations. The board has already funded an

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  increase of two beds in the intensive care unit and I understand from the board that there is no question of money being transferred away from paediatric-cardiac surgery. The recent unfortunate cancellation is now the subject of a full investigation by the board. I am grateful to the hon. Gentleman for raising that matter.
  I referred to the general agreement existing between hon. Members of all parties about the need for increased, meaningful choice for individual patients. However, the practical debate—the real debate—is about how one translates that sentiment into new administrative procedures that give the opportunity for effective choice rather than simply for splendid political rhetoric. Therefore, I turn now to the specific practical criticisms that the Opposition have sought to make about the Government's proposals. Essentially, when one removes the rhetoric and the emotional dimension to the Opposition's position, one comes down to allegations about two basic alleged failures in our proposals. First, the Opposition suggest that our proposals represent what they call a "fragmentation" of the National Health Service. Secondly, they seek to suggest that the effect of our proposals will be to reduce choice, rather than to increase it. Those are serious matters which represent the core of the serious part of this argument, rather than the wild political posturing on which I commented earlier.
  With regard to the first accusation—that our proposals represent a "fragmentation" of the National Health Service—clearly the word "fragmentation" has not been chosen unconsciously. It is an emotional word which seeks to suggest something improper or undesirable—
  Mr. Donald Dewar: It is a descriptive term.
  Mr. Rifkind: The hon. Member for Garscadden says that it is a descriptive term, but if we are talking about fragments, that term is appropriate only if we refer to the size of the fragments with which we will end up. The hon. Gentleman should look at, for example, the proposals for National Health Service trusts, which are proposed—at least in the first instance—to apply to the large and acute hospitals. If the hon. Gentleman examines the budgets for such hospitals, he will find that they range between £10 million and £50 million per hospital. If that is fragmentation, it is a pretty substantial fragment, as I am sure the hon. Gentleman will agree.
  Dame Elaine Kellett-Bowman: My point has nothing to do with Scottish hospitals. On my right hon. and learned Friend's point about fragmentation, I must advise him that I have received one or two letters from constituents who are diabetics, and who are worried that treatment may become more fragmented, as between care in the hospital and care in the community. Will my right hon. and learned Friend or his hon. Friend the Minister of State deal with that point at some stage?
  Mr. Rifkind: My hon. Friend is perfectly right to raise that matter. Clearly, it will be important for the health authority to continue to use its strategic role for ensuring provision of the services required by the public, including diabetic patients, in its locality. That is important when determining what contractual relations the health authorities should enter into with individual hospitals and others providing medical services. It is important that the needs of the community should continue to be identified
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  by the health authorities which will not, of course, provide resources unless they are satisfied that the services that are required will be met.
  I should have more time for the Opposition's accusation about fragmentation if their own position and the proposals in their documents did not point in the same direction, at least in theory. I read with considerable interest the document entitled, "Working with Patients—A Critique", of which the hon. Member for Kirkcaldy was co-author. There is a section on the White Paper, entitled, "What's Good in the White Paper". Indeed, it may delight the House to know that the hon. Gentleman has found a number of things that are good in the White Paper and presumably, therefore, in the Bill. He stated that the quality of care proposals in the White Paper are good. Indeed, they must be good in his view because he claims that they were taken from the Labour party's White Paper and it is always a good sign if the Opposition have to fall back on that claim. The hon. Gentleman welcomed efficiency in the delivery of care and more information being made available to consultants and general practitioners. He also welcomed a flexible accounting system to reflect clinical-led doctor-patient choice.
  However, most important of all, which is why I am drawing attention to this point, is the hon. Gentleman's particular welcome to what he describes as
  "further devolution of management to hospital and unit level".
  Indeed, the hon. Gentleman comes close to the Government's thinking in a way that must alarm some of his hon. Friends on the Opposition Front Bench. He stated, "This should be done", and claimed that it is done already under the current structure.
  The hon. Member for Kirkcaldy then went on to say what a Labour Government would do. This should he of particular interest to the House, because he said that a future Labour Government
  "would issue hospitals with their own budgets."
  —[HON. MEMBERS:"Oh."] We have suddenly discovered that, far from being antipathetic to hospitals having their own budgets, the Labour party, which spends half its time accusing the Government of creating an administrative shambles through such a scheme, is putting forward such a proposal itself. However, there is a qualification. Indeed, there is always a qualification and it is right that I should repeat it. The document states:
  "We would issue hospitals with their own budgets, but only WITHIN health boards. Savings should go back to the health board for use in priority areas."
  We know what that means. It means that hospitals will be given their own budgets, encouraged and no doubt praised for making savings, but they will not be allowed to keep the savings. Savings will have to be returned to the health board. We know of the prospects of hospitals striving as hard as possible to make savings if they themselves are not going to have any benefit as a result of their success in so doing.
  Dr. Moonie: I thank the Secretary of State for giving way again. Most of the debate seems to be about papers that were published last year. However, I should like to put two points to him. First, general management has been in place for only four years and the right hon. and learned Gentleman has not yet conducted an adequate evaluation of the success of that general management, which was established within an integrated community-based set-up, by which I mean involving both hospitals and the

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  community side. Does the right hon. and learned Gentleman recognise that it might have been better to evaluate the existing change in management before trying to bring in a separate structure?
  Secondly, the right hon. and learned Gentleman rightly referred to hospital budgets and savings therefrom. Does he not agree that, when we are dealing with finite resources, savings should be allocated to the most appropriate area of need in a community?
  Mr. Rifkind: On the hon. Gentleman's first point, his criticism would be valid if we were proposing that as from the enactment of the Bill every single hospital in Great Britain should be required to set up an NHS trust. However, we are not doing so. Not only is the proposal entirely optional, but inevitably there will be only a relatively modest number of participants to begin with and, depending on how matters then develop, that number will increase if the system is seen to be successful by those who have not so far volunteered. What better way could there be of moving towards a more decentralised system, which the hon. Gentleman claims in his document to support?
  On the hon. Gentleman's second point, he must appreciate that what he says may sound fine in theory, but will not be realised in practice—[Interruption.] No, because the hon. Gentleman knows as well as I do the practical consequences of telling individual hospitals that they will have a budget and that if they do not use the whole of that budget, any excess will be taken away immediately. The only practical way in which one can achieve the benefits of which the hon. Gentleman claims to be a supporter is by giving hospitals generous budgets and if, by careful use of those resources, the hospitals find that not all their resources are required for the purpose for which they were given, telling them that they may use those extra resources to improve the quality of the provision in the individual hospitals to make them even more attractive to the general public.
  Mr. James Couchman: Does my right hon. and learned Friend know whether the budgets suggested by the hon. Member for Kirkcaldy (Dr. Moonie) will be cash-limited and, should a hospital overstretch its cash limit, what penalties will be exacted by the hospital board? That is an interesting line of thought because it accords with some of our thoughts on this matter.
  Mr. Rifkind: My hon. Friend has asked a fair question, but I must advise him that we have not been blessed with such information. As is so often the case with Opposition proposals, generalised statements are made, but there is an unwillingness—or perhaps an inability—to expand on exactly what is meant. Perhaps the hon. Member for Garscadden, who is hoping to speak immediately after me, will be able to explain exactly the kind of budgets that the Labour party proposes to give to hospitals and will answer the relevant points raised by my hon. Friend.
  Mr. Tam Dalyell: Before we leave the subject of new information, the Secretary of State for Health, who is sitting beside the right hon. and learned Gentleman, has rightly in my view, for what it is worth,
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  said that he would be casting his vote in favour of research on embryos. Will the right hon. and learned Gentleman be in the same Lobby?
  Mr. Rifkind: The hon. Gentleman had better await that debate and then his curiosity will be satisfied.
  I shall turn to the other allegation that the Opposition made against the Government's proposal—that its practical consequence will be to reduce choice, rather than to increase it. The hon. Member for Livingston has said:
  "Patients will lose the right to go to the hospital of their choice—[Official Report, 27 November 1989; Vol. 162, c. 446.]
  I am not familiar with the existence of any such right at the moment. The hon. Member for Peckham (Ms. Harman) should appreciate that. A member of the public may express a preference, but the idea that a patient has a meaningful, enforceable right at the present time is not in accordance with the way that the National Health Service has operated at any time since its inception. The real question is whether individual GPs will be more able or less able to respond to the declared preferences of their patients in the future.
  The Bill provides for a system in which there will be an incentive for GPs with practice budgets to respond to the wishes of their patients, because that will materially influence the way in which the practice is financed. The consequence of that will be entirely to the patients' benefit.
  I hope that the hon Member for Garscadden will address himself to the objectives that he says his party is committed to—the practical consequence of the measures. The hon. Gentleman should appreciate that we are seeking, through group practice budgets and NHS hospitals, to provide a decentralised system of administration that will enable the individual GP and the individual hospital to be more sensitive to the wishes of the general public.
  Several Hon. Members rose—
  Mr. Rifkind: Many hon. Members wish to take part in the debate and I shall not give way.
  Opposition Members are perfectly entitled to express their views on the administrative consequences of the proposals in the Bill, and to give their own view of the Government's achievements. What they may not do is express a view that is based on the belief that the last Labour Government made a splendid contribution to the well-being of the NHS. During the period that they were in office, the proportion of resources devoted to the NHS fell, nurses' pay fell by no less than one fifth and waiting lists increased by a quarter of a million.
  In 1978 the then chairman of the British Medical Association said of the Labour Government's record on waiting lists:
  "The sum of human misery represented by those record figures is a scandal without parallel in any technically developed country".
  That was the last Labour Administration's achievement. When they comment on the Government's proposals, I hope that they will do so with the appropriate humility.
  4.53 pm
  Mr. Donald Dewar: I come to the Dispatch Box confident in the knowledge that I will be the first person in the debate today who has spoken about the Bill.
  The Minister gave us a suitably elegant lecture. He has obviously been working hard on the plane from Edinburgh

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  this morning. He started with a stylish anti-climax that I found amusing. We were told, or there was an implication, that there would be an announcement about the rural practice fund, and that he was glad to have the opportunity to make that announcement. However, what we wanted to know about the rural practice fund was to what extent it has been increased, and that was the one fact that the Minister failed to give us.
  We know that rural GPs will suffer particularly badly from the shift in the GP's contract towards an emphasis on capitation fees. If those GPs are to be fully compensated, the rural practice fund will have to be increased significantly above the cost of living figure. We will have to wait for an answer to that as well as to many other questions.
  I shall make on diversion, and I make no apology to the House for that. I came down to London on the overnight sleeper from Glasgow, and found myself in conversation with two members of the ambulance service from the west of Scotland. [Interruption.] During the conversation they told me of their determination to achieve what they and the majority of the public see as a just settlement.
  Dame Elaine Kellett-Bowman: What about the Bill?
  Mr. Dewar: I said that it was a short diversion.
  Mr. Jerry Hayes: The hon. Gentleman quite rightly criticised my right hon. and learned Friend for not talking about the Bill, but the ambulance dispute has nothing to do with it.
  Mr. Deputy Speaker (Mr. Harold Walker): The hon. Member for Glasgow, Garscadden (Mr. Dewar) must relate what he said to the Bill.
  Mr. Dewar: I have been on my feet for one minute, and the most notable fact has been that my mention of the ambulance dispute was greeted by gales of laughter from Conservative Members and by a frivolous intervention. 1 think that the ambulance drivers will be interested to read of that reaction in Hansard.
  I shall not speak at great length about the ambulance dispute, but I want to point out that the situation is deteriorating in Scotland. This week, staff in the west of Scotland have found themselves on and then off full pay three times. Many of them are getting as little as 25 per cent. of full pay, although they believe that they are honouring the agreed guidelines. The Government's insensitive approach, their machismo and the search for victory are doing an enormous amount of damage to morale and to the fabric of the service.
  I repeat my view that if the Government's case is so strong, then there seems to me to be no reason why they should not submit the dispute to the independent judgment of an arbitrator. I hope that Ministers will understand in time that it is in their interests to do so, as well as in the interests of the service.
  The Bill implements a White Paper which has been heavily and properly criticised. It is seen by many people as another campaign in the war of attrition that has been fought by the Government against the Health Service in recent years. We have had the regrading dispute, and competitive tendering, which makes workers struggle to save their own jobs at considerable cost to their terms and conditions. The threat of competitive tendering is getting nearer to the core of the Health Service.
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  Radiographers from Scotland are coming to London tomorrow to meet Opposition Members to put their case, and to express their fears and anxieties. Ministers have a duty to consider the effect on morale and to measure the difficulties against the proposals in the Bill.
  One minor point that I shall mention in passing is the meaning of paragraph 3 in schedule 5 of the Bill, which has had a number of public outings and has been a cause for concern. The Minister may remember that that paragraph refers to the transfer of officers and servants to other health boards in Scotland, and to the common services agency. I am not clear about the definition of a servant in that context, but I suspect that it means all employees, and I do not know the circumstances in which it is envisaged that the transfers will take place. Perhaps the Minister could give me that information by letter, if that is the most convenient, as I have received a number of representations about the matter, and I want to give accurate information in my replies.
  The White Paper and the Bill have hardly a friend in Scotland. I do not wish to overstate my case, but the Bill is almost as unpopular as the Minister responsible for health in Scotland, and that is saying something. Perhaps that is not surprising as the Bill is seen as being built in his image.
  There have been individual protests in plenty. One that I have mentioned before but that is worth recording again is the view of the hon. Member for Southend, East (Mr. Taylor). That gentleman has a special responsibility for the Conservative party's campaign tactics in Scotland. On 18 October he told The Guardian that the White Paper
  "has caused so much unnecessary harm. Unless we are prepared to concede a lot, I think we should scrap it."
  That is not a bad summing-up of what many people in Scotland feel.
  In July this year, at a conference in Inverness, a lady who is well known to many of us in Scotland, Mrs. Winnie Donaldson, a leading Conservative councillor in Edinburgh for many years, chairman of the social work committee of both the old Edinburgh corporation and the Lothian region and a former member of the Lothian health board, said:
  "The White Paper absolutely appals me … It seems to be like something out of another country … when out of the blue comes this document, which seems to be something from another world. How do we get sense into people?"
  That may not be the most technically complex of arguments, but it is a cry from the heart of somebody who, from a Conservative point of view, has given a great deal of service to the Health Service in Scotland.
  I and my colleagues are often attacked. The hon. Member for Stirling (Mr. Forsyth) is never tired of telling us that we represent nothing more than a narrow vested interest, that we reflect unworthy and prejudiced views. If the House looks a little more closely, it will find that we are being accused of speaking for doctors, nurses, auxiliaries and ambulance drivers. I make no apology for expressing some of their anxieties, but the proposals affect thousands of people in Scotland.
  This morning, I received a letter from the hon. Member for Stirling in his capacity as Minister with responsibility for health at the Scottish Office. He wrote:
  "You recently delivered a number of postcards to St. Andrew's house".
  Close to 50,000 postcards to be precise, each one completed and signed by a member of the public who had taken the trouble and was worried enough by what the

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  Government are proposing to fill it in. I gather—I welcome it—that each of those 50,000 is to receive a postcard from the Scottish health Minister. That is good news for the Post Office, although it might not have wished for it in view of the impending Christmas rush, but it will be a shock to many good, honest Scottish citizens who expect no such honour. Last year, by way of Christmas cheer, they got advertisements in almost every Scottish newspaper telling them of the joys of the poll tax. This year they will get a personalised postcard from the hon. Member for Stirling extolling the virtues of a business-oriented approach to the Health Service. It will be well calculated to take the bang out of anyone's cracker.
  In any event, we can take one thing from the Minister's responses—we have drawn blood. He is obviously conscious of his weakness with public opinion and realises that he cannot just shrug off this substantial evidence of disquiet. He was kind enough to send me a copy of his pamphlet, complete with a second-class postage stamp carefully drawn in. I appreciate the artwork. It is clear that someone in a high grade in St. Andrew's house has a second talent. The Minister's little pamphlet illustrates the peculiarity of the debate.
  That brings me to what the Secretary of State said. Many of the arguments are indeed common to both sides of the House. We both pay lip service to the concept, history and traditions of the Health Service. The question is not who uses that kind of rhetoric; the question people have to make their minds up about is what is the reality of what is happening and who is committed to preserving the Health Service. The Minister's letter says:
  "We support and will not change the principles that have guided it over the last 40 years … The Labour Party campaign has therefore been built on a misapprehension. I intend to ensure that this is removed."
  He sounds as though he is talking about an offensive gall stone. I do not think that he is likely to remove deeply-held convictions, based on the private experience of thousands of citizens, that the Government have got it wrong in terms of their fundamental theoretical approach to the Health Service. That is at the heart of the debate.
  Of course there is a problem with how efficiently to deliver services and the commitment to escalating costs that new technology brings to health care, but my suspicion is that the Secretary of State, if I interpret his speech aright, is saying, "Look at all the money we have poured in and all the troubles we still have. We have to find another way. That other way will be followed because it is financially prudent. We shall push to one side the genuine byproducts and difficulties which will flow from that."
  Much of what the Minister says in his little pamphlet cannot be sustained.
  Mr. Kenneth Hind: The hon. Gentleman speaks of the rhetoric that both sides of the House use in regard to the NHS and says that hon. Members and Governments will be judged by what they do. Will he cast his mind back to 1977–78, when Labour was in power and there was a 3 per cent. cut in real terms in the NHS? Surely that is the type of judgment that the public are entitled to make.
  Mr. Dewar: I recognise that every memory works in its own way, but most of my constituents remember the past five years more clearly than the events that the hon. Gentleman has trawled up.
  We are told in the pamphlet that the Government's proposals
  "do not involve patients having to pay for services currently provided free at the point of delivery."
  I accept that. There is nothing in the Bill that say that they will have to pay, but I am entitled to observe that the claim sounds a little hollow bearing in mind what has happened to prescription, dental and eye test charges. There is overwhelming evidence, which my hon. Friend the Member for Livingston (Mr. Cook) has given, to show that people are doing without. The pamphlet continues—this is an important claim—
  "The proposals do not involve any hospitals opting out of the NHS".
  I understand the linguistic nicety on which that statement is based. They are not opting out of the Health Service. I am tempted to agree that that is a fair statement because, in Scotland, there is so little support for this crazy notion that I suspect that no hospital will opt out for that very reason. Nevertheless, we are entitled to some explanation. The Secretary of State said almost nothing about a timetable and what he expects. We know that the Minister with responsibility for health is anxious to be a front-runner—to blaze a trail with opting out and to maintain his claim. Perhaps it is all to maintain his place in "her" heart, which has led to his becoming the leader of the Scottish Tory party. In any event, we know from The Scotsman that among the Minister's claims is the
  "creation of 'shadow' trusts. They would be ready to assume self-governing status and take over the running of hospitals immediately the necessary laws were approved … He is known to be anxious that Scotland should lead the way on implementation of the reforms"—
  then comes the sad anti-climax—
  "which have, however, met general resistance from the medical profession."
  I suppose that not everything can be perfect in this world. I listened in vain to the Secretary of State to learn what the plans are. There are few signs of genuine interest. We know that the target will be the 320 acute hospitals in the United Kingdom with 250 beds or more. The hospitals in Scotland that have been mentioned are peculiarly inappropriate. We are told that the Royal Scottish National hospital at Larbert is interested. It has 800 beds for mentally handicapped patients. Its aim under the new approach to care in the community is to work itself out of existence, not to become a brave new cutting edge for the peddling of services to other NHS agencies. We also have a group of three cottage hospitals in Forfar which I am told can muster 115 beds between them. I hope that I am not being unworthy when I say that they are interested because they fear for their survival in the brave new commercial world of the White Paper. That is not a good basis on which to become the favoured guinea pig in the opting out experiment.
  Mr. Bill Walker: That is a frivolous comment. Forfar is the largest town in my constituency and it is the county town of Angus. The people of Forfar will find it offensive that the hon. Gentleman is so dismissive of it. Its hospitals are important to the people of Forfar. The hospitals are considering self-governing status because local general practitioners and others want it.
  Mr. Dewar: The hon. Gentleman clearly wants to defend what is happening. As the constituency Member, he is entitled to do that, but on self-governing hospitals Scottish working paper No. 3 speaks of the target being
  "major acute hospitals providing a reasonably comprehensive service."
  Three cottage hospitals in the Forfar area do not spring immediately to mind as the most obvious example of that.
  A more dangerous and more plausible example involves Stracathro and Forresterhill. If, for example, Forresterhill were to opt out, the Grampian health board would be left without its main provider of acute services, to use an up-to-date parliamentary expression. Forresterhill is a major complex with which I am familiar from my days as the Member for Aberdeen. If that hospital opted out, it would not create the market and competition which I understand is at the heart of the Government's arguments. If not the monopoly provider, the complex is the main provider of acute services to the Grampian health board. To introduce competition, it would be necessary to look to Dundee and Glasgow. That would not be meaningful competition.
  Perhaps the Minister will tell me if I am wrong, but I believe that Mr. Kyle, the chairman of the Grampian health board, is a great enthusiast of opting out for Forresterhill. Scottish Office selection procedures are admirable because in almost every health board area one can count on at least one enthusiast for opting out—the chair of the health board. When we spoke to the consultants in Forresterhill, over 80 per cent. wanted nothing to do with opting out. Perhaps the Minister will tell us what he thinks about Scottish working paper No. 3, issued by his Department not long ago, paragraph 55 of which says that the health boards
  "will seek the views of those with an interest, particularly other health boards likely to be concerned, staff affected, general practitioners, local health councils and the local community."
  We know that the staff at Forresterhill are not interested and I defy the Minister to produce evidence that the local community will be interested in opting out. I do not believe that GPs or anyone else will support opting out. What are we to understand by paragraph 55? Was it just a deceitful aside to pad out the paragraph or will the health board have to consult before opting out? What form will consultation take and what will happen in cases such as that of Forresterhill where the overwhelming evidence is that there is no interest?
  The reasons why people discuss the crazy scheme for opting out are simple. One is bureaucratic. That may seem an odd argument from the Labour party but we are not interested in bureaucracy if it is expensive and fulfils no useful social or administrative purpose. Separate hospitals will be separately managed and will have separate legal, personnel and purchasing departments.
  The Parliamentary Under-Secretary of State for Scotland (Mr. Michael Forsyth): And separate budgets.
  Mr. Dewar: And possibly separate budgets. It is dishonest of the Secretary of State or at least highly misleading to suggest that a reference to budgets in the useful paper prepared by two of my colleagues can be equated with a trust which will own assets, hire and fire staff, borrow on the markets and buy and sell its services to the highest bidder at the most advantageous price in the market place. That is a completely different concept, and
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  the Secretary of State knows it. It is a mark of the weakness of his argument that he is reduced to drawing such false comparisons.
  Mr. Rifkind: Perhaps the hon. Gentleman will do the House a service by explaining what the Labour party means when it says that it would issue hospitals with their own budgets? What kind of budgets would be provided? To what extent would the hospitals be committed to keep expenditure within the budget? What would be the effect if they exceed the level set down? Would budgets be a meaningful change or just a form of rhetoric?
  Mr. Dewar: No doubt the Secretary of State will have time to discuss that on other occasions. We are discussing the Bill. [HON. MEMBERS: "Answer the question."] The Secretary of State may be interested to consider the possibility of a clinical budget for a ward and an extension of the principle of auditing. We are implacably opposed to the provisions for hospitals trusts outlined in the White Paper. They are divisive and will mean a loss of choice for patients and doctors. If, after discussion with a patient, a doctor decides that he wishes to send a patient not to the Western infirmary but to the Victoria infirmary or Southern General hospital, I am confident that he will be able to do so. However, if the patient needs a form of treatment for which the health board has drawn up a contract with a specific hospital, under the new market arrangements, clearly the patient will have to go to that hospital whether it is Ross Hall—[Interruption.] I have taken the trouble to talk to the people involved and they believe that that will be the case. If the Secretary of State is saying that we have misunderstood, that is an appalling comment on the quality of explanation that has been offered. [Laughter.] The Secretary of State had better clear the matter up. If the famous hip operations to which the Parliamentary Under-Secretary of State always refers are contracted out to a certain hospital by the health board, and that is the only outlet for that treatment, where will be the choice? Can the patient refuse to go there and ask to go somewhere else?
  Mr. Rifkind: Yes. The patient will be no more obliged to go to the hospital of the doctor's choice than he is now. Presumably a doctor will not enter into a contract with a hospital unless he believes that it gives a high quality of service. He may wish to recommend it to the patient, but it will be for the patient to decide whether he wishes to accept that advice. [HON. MEMBERS: "Rubbish."]
  Mr. Dewar: On occasions I think that debates in the House are useful. The Secretary of State has made an interesting statement which we shall look at carefully. If it is true, it is another example of a feature of the Government's conduct of this case. Every time that we approach the logic of what they say, whether in White Paper or Bill, they hasten to deny the obvious consequences.
  The Bill will move the Health Service towards a two-tier service over a period of time.
  Mr. Rifkind: Will the hon. Gentleman give way?
  Mr. Dewar: No, I am up against a time problem.
  It may not be the principle or immediate aim of the Government to create a two-tier service but it will be an acceptable by-product to the Government. The tax concessions announced in the Budget for those of

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  pensionable age who opt for private health care underlines that point. We shall see the private sector build wings on opted-out hospitals so that they can share facilities. We shall arrive at a point where a better service is available for those whose credit rating or employment conditions allow them to use private medicine than for those who are not in that position.
  I now come to my final point because I do not wish to delay the House for too long. Opting out will disrupt and undermine the planning function of the health boards in Scotland. Perhaps the Secretary of State will tell me if I have misunderstood but I assure him that that misunderstanding is widely shared, particularly by members of the Greater Glasgow health board who have examined the matter carefully. The board is considering its acute services and producing an overall planning framework based on six centres for the whole area. I have had my disputes with the health board about cross-boundary flow, demographic factors and reductions in the number of acute beds and the social assumptions that they have made, but I do not dispute the need for an overall framework. I recognise that many difficult decisions have been taken. A row is already raging about the placement of obstetric units in the health board area. Whether it has got it right or wrong, it is entitled to make such decisions and to have an overall view of how it organises its resources.
  What will happen to the overall strategy if a centre of acute care opts out and becomes a free-standing hospital? What will happen to the concept of overall planning and to the health board's role if a trust turns round and says, "The health board may think that the reorganisation is in the interests of patients and the community as a whole, but it is not in the interests of our hospital because we shall have to close wards and stop operations which are particularly profitable and bring us business. We shall not do it."? The Under-Secretary shakes his head fiercely, but many people in the Health Service at health board level see these problems as a negation of good management forced on the Health Service in the false name of efficiency. There will be casualties.
  Mr. Robert Hughes: Is my hon. Friend aware that a new unit for psycho-geriatrics has been built in Grampian region and that the health board is actively pursuing the possibility of contracting every aspect of care, not just cleaning and catering, but medical care, to a private medical company? During discussions with the board, it could not say what the medical plans were because it had to discuss costs with the private company. Does my hon. Friend agree that that is a complete negation of planning and, indeed, of the ethos of the Health Service?
  Mr. Dewar: I agree. These discrepancies and distortions will creep in increasingly. One of the tragedies is that there will be many casualties. I draw the attention of Tory Members to the view that:
  "Medical education, currently regarded as a proud obligation, will become merely tolerated under a market-led system."
  The principal of Glasgow university also said that medical education was being seen as an
  "add-on, a non-optional extra that NHS managers would have to put up with."
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  It would be sad if that were to emerge as the view on medical education. I would not think that Sir William Fraser, a former permanent secretary at the Scottish Office, was a tyro at looking behind the Scottish Office press releases to the reality of what is happening. Yet that is his considered view of the likely impact of the Government's plans on medical education in his university and in the west of Scotland.
  I have dealt with the opting-out issue at some length, partly because of interruptions. General practitioner practice budgets are unlikely to be a major feature in Scotland as only 5 per cent. of Scottish practices reach the 11,000 mark. Where they are introduced, administration will be a major problem. It takes time and effort to negotiate a contract and to shop around as envisaged, and that time will be taken from patients. I plead guilty to finding the practical arrangements obscure. If a GP sends his patient for a barium meal and the patient requires further investigation and ultimately major abdominal surgery, that will come out of the practice budget. Presumably, there will be standard charges to even out costs, but at the end of the day there is little evidence that the service will be improved for patients. I genuinely do not believe that there is much point in the exercise or that anyone will benefit from it. It is like the switch to capitation fees. Ministers spend their time explaining that what everyone thinks will happen will not happen and that everything will go on as before. That is a futile argument.
  I accept that, despite the indicative drugs budget, GPs will always be able to prescribe. I shall not go in for scare stories. I am prepared to accept that assurance. Perhaps the Under-Secretary of State will listen to my next point. If we move away from local general practice committees monitoring drugs budgets, we are in danger of putting a cash test in the place of medical criteria. If a doctor pumps out valium and is irresponsible at that end of the trade, he may not reach his indicative budget, but he may prescribe in a way which is clinically damaging and, because of the switch in the criteria, that may not be picked up. I cannot welcome that proposal.
  Some provisions in the Bill are good. Health councils survive, although in a different form. There is a medical audit. More important, the Bill provides for Griffiths's key recommendation: that local authorities retain the key role in community care. That decision must have stuck in the Under-Secretary's craw. The key is resources. We can have jointly planned projects, but they must be jointly funded. We can have protections and plans that will be as naught if patients leaving hospital and being maintained in the community do not have the support and services that they require. Perhaps the Minister, again in a letter, can tell me a little about the status of grants to the mentally ill under clause 52. Is it new money or top sliced from existing resources? What arrangements will be made for the co-ordination of community care planning, given the provisions for separate submissions of plans by health boards and local authorities? Will the Minister sit down with the voluntary sector and local government and consider the matter?
  I shall ignore the Government health warning that was given at the beginning of the debate. Whatever the precedents, I genuinely regret that there is no separate Scottish legislation. It would have made for better scrutiny and a more easily conducted debate. It is sad that good government has been subordinated to expediency.
  Mr. Rifkind rose—
  Mr. Dewar: No, I will not give way.
  Mr. Rifkind rose—
  Hon. Members: Sit down.
  Mr. Dewar: I apologise to the Secretary of State, but I have spoken for too long already. He knows that I normally give way to him, but he made his points about the statistics and precedents earlier.
  Whatever the precedents, it would have been better to have a separate Scottish Bill, particularly as we do not have a Select Committee on Scottish Affairs which could have provided useful back-up scrutiny.
  I regret even more the Bill's contents. Ministers will continue to claim that the best is being preserved and nothing is being lost. I can only say to the Secretary of State that if he thinks that, he does not understand the implications of his legislation. We in the Labour party are strongly opposed to the measure which in the long term threatens the basic principle of a comprehensive Health Service fully available at the time of need. It is on that that we cannot compromise.
  5.26 pm
  Mr. Roger Sims: Notwithstanding the stories that we hear from time to time from the Opposition, we have a good Health Service. Parts are very good and of a high standard. That was demonstrated last week at the Hospital of the Year awards which were sponsored by the Sunday Times. My right hon. and learned Friend the Secretary of State for Health attended the award ceremony. Throughout the proceedings emphasis was rightly placed on the quality of care.
  I enjoyed the high standards myself in a local National Health Service hospital during the summer when I underwent skilful surgery and received the most competent, sensitive nursing care. However, nobody would claim that all is as well as it could possibly be in the NHS. Each year more doctors and nurses are employed, more patients are treated and more money is spent. Yet each year we hear of longer waiting lists and more closed wards. That must show that more resources alone are simply not the answer. It points to the need to examine the structure of the Health Service, its administration and the way in which resources are distributed and used. It was just such an examination which the Government undertook two years ago.
  The key to success in the NHS must be the staff, from the bottom to the top and particularly the professionals. I understand why the Government in undertaking their review confined the involvement of those who work in the service to submitting papers. They were not involved in discussions. It was unfortunate that the Government then chose to publish the outcome of the review in a White Paper rather than a Green Paper and that in speaking to the White Paper Ministers used language that suggested to those in the service that the Government were presenting them with a fait accompli. It was a pity that the White Paper was not accompanied by a response to the Griffiths report. The review covers hospitals and general practice, but, as it does not refer to community care, it is rather like a three-legged stool with two legs. That omission has been remedied, but rather late in the day.
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  One result of the way in which the matter was handled was a somewhat hostile response to the review—much of it negative and some of it unpleasantly personal. The British Medical Association drew no credit to itself for the way in which it conducted its campaign.
  If we examine the reactions of some of the professional bodies, we find that they support many of the proposals and that their concern about some of the others relates to what could happen and what might be the result of implementing the proposals. Some of the comments and some of the literature were misleading; some were downright wrong. They caused unnecessary distress to patients, in particular to the most vulnerable patients. Some of the concerns, however, were perfectly genuine. They sprang from uncertainty and from lack of detail. I hope that the professional bodies—the colleges and in particular the BMA—will accept that the Government are committed in principle to their proposals and that they will take part in a constructive dialogue about the details.
  The differences are not all that great. For example, the BMA says that there should be pilot schemes for self-governing hospitals and practice budgets. My right hon. and learned Friend the Secretary of State has accepted that both will be introduced gradually, that each scheme will be a trial and that we shall learn as we go along. The difference between the two approaches does not seem to me to be very great. I am sure, therefore, that if both sides adopt a constructive approach, progress can be made.
  I know that my right hon. and learned Friend is fully committed to the National Health Service, but some of the things that he has said and the way that he has said them—in the press, on television and at meetings—have given the impression to the doctors and consultants to whom I have spoken that he is not concerned about their views. I am sure that that is not the case and that he will wish to correct that inaccurate image.
  I welcome the principle that underlies the Bill: to ensure that increased resources are devoted to providing the highest possible standards of service and care in the most efficient manner—for example, by giving district health authorities and doctors the freedom to purchase operations and treatment, with the money following the patients. In a debate on the Queen's Speech the hon. Member for Livingston (Mr. Cook) referred to Queen Mary's hospital in the Bexley health authority area and said that it had had to close wards. However, he did not go into the details. One of the reasons for the closures is cross-border patients, some of whom come from my own constituency, but who are a charge on Bexley health authority. That will be put right.
  It surely makes sense to bring responsibility down to local level, to let doctors have their own budgets, if they so wish, and to let hospitals be self governing. I am glad that Bromley district health authority's application has been approved. The corollary is local involvement in the service—especially for the local authority to be responsible for community care.
  I hope that we shall examine again the proposed composition of health authorities and self-governing trusts. I note that Members of Parliament are to be specifically excluded. Many of us remember our erstwhile colleague, David Crouch, was a member of a health authority and a particularly valuable Member of this

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  House for that reason. My hon. Friend the Member for Gillingham (Mr. Couchman) served for a time on a health authority.
  There are many examples of successful co-operation between the National Health Service and the private sector. It must be right to try to develop that co-operation. The private health sector is well established in community care. There is certainly scope for greater co-operation between local authorities and the private sector, as proposed in the Bill. However, standards must be set and maintained in all sectors—local, national, independent and voluntary.
  It is equally important that community care should be adequately funded. It is admirable that local authorities should be made responsible for this service, but they must be provided with adequate resources. They will be seeking assurances that sufficient cash will be made available to enable them to handle all the cases that come their way. I am sure that the Secretary of State does not underrate the strength of the ring fencing argument; the money at present being paid for social security purposes must be made available in full specifically for community care.
  I am particularly concerned about those who are living in residential homes and nursing homes. I am sure that all hon. Members could give examples of constituents whose social security benefit is insufficient to meet the cost of living in such homes. I am referring not to expensive private homes, but to places such as the Cheshire home in my constituency where the minimum cost for each resident is above the maximum social security benefit that some of the residents are able to obtain. I have been in correspondence with the Secretary of State for a long time about the problem. I was assured that it would be addressed in the Government's response to the Griffiths report. I was disappointed to find that it does not seem to have been adequately addressed in the report. I am particularly worried about those residents who, alas, may not be with us by 1991. The Government should take urgent steps to improve their position.
  Mr. Mark Wolfson: I support my hon. Friend's point as a result of my own experience of a Cheshire home in my constituency. Exactly the same problem has arisen and I, too, will be seeking reassurances from Ministers.
  Mr. Sims: I am grateful to my hon. Friend. I suspect that all hon. Members could tell similar stories. I hope that Ministers will take the point on board.
  Many hon. Members would like to know more about a number of details. For example, what are to be the criteria for the approval of self-governing hospitals? I dissented from my Select Committee colleagues who advocated that there should be a local ballot. I do not think that that would be practicable. However, we should be given more details about the criteria that the Secretary of State will set. How will those who are parties to a contract be held to it if it does not have legal validity? What definitions will govern a core service? Many other details need to be clarified. It could rightly be argued that these are Committee points, but they are very important to those who are working in the National Health Service. They will
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  have to implement the Bill when it becomes an Act of Parliament. They are also very important to those who are involved with community care.
  As these issues are so important, I hope that my right hon. and learned Friend will look sympathetically at the motion that I and other Select Committee members have signed. We urge that the Bill should be considered by a Special Standing Committee. I have some experience of this relatively little-used procedure and I commend it to my right hon. and learned Friend. It provides an opportunity for those who work in the National Health Service to put their point of view on how the Bill could best be implemented and the kind of problems that they envisage. The Secretary of State would then be able to consider those matters. The only alternative is that outside bodies have to find a friendly Back Bencher to present the case on their behalf. Even at this late stage, I hope that Ministers will be prepared to adopt that procedure. I do not believe that it would cause the proceedings to be unnecessarily delayed. In the long run, it may save time.
  We all want to make this good Bill better. Politicians, professionals and patients are united, and, as my right hon. and learned Friend the Secretary of State said when he moved Second Reading on Thursday, we all want to make a good National Health Service even better.
  5.39 pm
  Mr. Peter L. Pike: I oppose the Bill because I believe that it will be tremendously damaging to the Health Service in Britain. We all have to recognise the way in which the Government work. They often have to go part of the way in the direction they seek and then take it further in subsequent legislation. On Thursday, my right hon. Friend the Member for Blaenau Gwent (Mr. Foot) set out the reasons why the Government, who do not like the Health Service and do not want it to work, dare not go any further than the proposals in the Bill. They recognise that the Health Service has massive public support, and, therefore, they have to tread more cautiously.
  The Opposition believe that the two main priorities are that people are entitled to educational opportunities and to health care based on need and regardless of ability to pay. That is why we must not allow the Bill to make progress. It does not tackle the problems facing the Health Service which are based on resources and finances.
  I have copies of letters from a general practitioner to the hon. and learned Member for Putney (Mr. Mellor), now Minister of State, Home Department, and to the Under-Secretary of State for Health. After the correspondence had continued for some time the doctor's final letter concluded:
  "Alternatively, of course, you could propose to your Government colleagues that all pretence at improving the NHS should be dropped, and it should instead be admitted to the voting public that the only way to assure ourselves of high quality treatment and freedom of choice under the proposed new arrangements will be to obtain private medical insurance."
  The Bill underlines the fear that we are moving towards a two-tier Health Service; a Health Service providing for basic needs, but a better level of service for those who have the ability to pay. That would be regrettable.
  We have discussed the practice budgets and the indicative drug budgets. Whatever the Minister says about those figures, we all know that, although budgets might not be rigidly cash limited, they influence decisions. I have no doubt at all that when doctors are prescribing drugs,

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  although they accept that they may be permitted to prescribe a more costly drug, they will be influenced by that budget limit. The Minister should recognise that the Opposition know that to be true. We have only to look at what is happening in the Department of Social Security to community care grants. My local office recently wrote to me saying that it could no longer make certain community care grants for the remainder of the year because it had to retain enough of the budget to meet demands for the remainder of the year.
  Although Ministers say that doctors will be able to prescribe, general practitioners, the public and Opposition Members fear that the new system will affect their decisions. When I met local GPs and the BMA in my constituency they made two points about budgets.
  Mr. Nicholas Bennett: Presumably in 1985 the hon. Gentleman opposed the limited list on drug prescribing about which the BMA also protested. Does he now accept that that was right and that £75 million has now been allocated to pay for other things in the Health Service?
  Mr. Pike: I do not want to be sidetracked by the hon. Gentleman. In any event, many additions have been made to the original limited list which is constantly under review. I shall not be sidetracked on that point as it was not a finite decision at the time.
  The general practitioners made two points about the provision of services to their patients. They do not believe that the decisions that they take concerning the medical treatment of their patients should be influenced by politicians, in the House or anywhere else, or by accountants. They fear that their judgment will be affected if the Bill is enacted in its present form.
  The Under-Secretary of State wrote to me on 24 July stating:
  "It is not our intention that budget pressure would ever affect a clinical decision.".
  In a subsequent letter he wrote:
  "If a doctor spends significantly over his budget, he will be subject to peer review from another doctor who will consider whether there are sound clinical reasons for the level of spending. A doctor will only be subject to a financial penalty if he cannot give a clinical explanation for expensive prescribing practices."
  The Minister failed to recognise my point that in any event GPs' prescriptions will be influenced by the indicative drugs budget.
  Mr. Hayes: Will the hon. Gentleman give way?
  Mr. Pike: No.
  In his opening speech on Thursday, the Secretary of State referred to a practice with a list of 7,000 patients which was spending £800,000 a year on drugs. He said that was 185 per cent. above the average for its family practitioner committee area. He said that that practice dealt with the average number of elderly people, but he did not take into account other factors that may have affected that expenditure. Housing and working conditions also affect people's health and the problems for which they have to visit the GP and could therefore affect the prescriptions. We have to be careful how we judge these matters as we could reach hasty and wrong decisions when determining whether a doctor is overprescribing and that could be extremely dangerous.
  I am particularly worried by the Government practice that they always anticipate that their legislation will be
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  enacted. Burnley, Pendle and Rossendale health authority meets this Wednesday. This year it has an additional allocation from the North-West regional health authority of £149,500 to spend on preparation for the implementation of the Bill—before it has received parliamentary approval. The health authority received that extra money when it had to close a maternity ward—it has the highest perinatal death figures—and another hospital was closed in October to save money. Yet suddenly extra money is made available to health authorities. Lancashire has operated a quota system for ambulances since 1986 and we need money to deal with those problems.
  The Government do not like to talk in terms of hospitals opting out, but we know that if hospitals move in that direction the Health Service will be absolute nonsense. We should aim for a system in which hospitals provide the maximum possible services locally, although we will always have regional centres of excellence for certain specialised services and needs.
  Other hon. Members wish to speak, so I shall conclude by saying a few words about community care, which was hardly mentioned in the Minister's speech. I welcome the Government's decision to make county councils responsible for assessing and supervising the provision of community care, but I should have been much happier if they had made local authorities the major providers of services. Care for our elderly, mentally handicapped and sick people should be provided publicly. The massive growth in private homes and in the profit being made from old people is obscene—[Interruption.] Conservative Members obviously agree with that, but I believe that the care of our elderly, mentally handicapped and disabled people is a public responsibility. In my area, the Government are trying rapidly to run down and close Brockhall and Calderstones.
  The Government say that they accept that community care, which we all support and believe to be right, is not a cheap option, but however many times they say that, they still hope that it will be a cheap option. Community care will work only if we ensure that sufficient cash resources are made available and that there are sufficient adequately trained staff to provide services for our elderly, mentally handicapped and sick people.
  The Bill fails to tackle the problems facing community care and the Health Service. I hope that it is defeated and that the Government will tackle the problem by providing sufficient resources to deal with both issues.
  5.51 pm
  Mr. Michael Latham: I shall not follow the terms of the speech of the hon. Member for Burnley (Mr. Pike) because I do not agree with what he said.
  I apologise to the House for not being present to hear the speech of the Minister, but I was at the Public Accounts Committee. I am grateful to hon. Members in that regard.
  The Bill and the proposals in it were not in our manifesto, so when they were first produced I thought it necessary to think carefully about them. Having done so and, as other hon. Members have done in their constituencies, having listened to GPs in my constituency, it is right to give my hon. Friends on the Front Bench and the Secretary of State the benefit of the doubt; I shall support the Bill tonight.

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  However, there is still some doubt, and I hope that in discussions inside and outside the House, and while the Bill is passing through the House, Ministers will listen to members of the profession and continue to discuss it with them. In answer to the hon. Member for Burnley, my hon. Friend the Member for Pembroke (Mr. Bennett) mentioned the limited list, which was an example of how Ministers acted properly. They discussed the proposal with the profession and allowed changes to the limited list, which was much more acceptable and is the way to proceed. I hope that the pilot schemes and the proposals for introducing hospital trusts carefully and deliberately will be followed by the Government.
  I should like briefly to mention rural services, which are particularly important to me, as my hon. Friends on the Front Bench will know. Tomorrow, Leicestershire district health authority will visit the House to meet Leicestershire Members of Parliament. I have been dissatisfied with its policy of closing rural maternity units, which I regard as unacceptable, particularly as its chairman gave assurances that closures would not be allowed. He said that the Oakham maternity unit in my constituency would not be closed, but it closed last September. That was extremely regrettable because it deprived my constituents of a service that they regarded as extremely important.
  The hon. Member for Burnley referred to the interaction of community care and the Bill. I take it as axiomatic—I assume that Ministers will confirm this—that there will be no question of closing down old geriatric hospitals until community care supportive welfare is in place. We simply cannot allow that to happen—[Interruption.] Hon. Members shout, but in the paper that we shall be discussing tomorrow, regarding the Catmose Vale hospital in my constituency, Leicestershire health authority says that
  "Closure … will follow the opening of the new buildings"
  of the Rutland Memorial hospital in 1990–91. I believe that that is the proper way to proceed. New buildings should be provided at one hospital, and then the buildings at the old one can be closed. I expect community support to be in place before decisions are taken, which is essential for elderly people.
  I hope that Ministers have not closed their minds—originally it seemed that their minds were closed—to smaller hospitals being hospital trusts. The original intention undoubtedly was that district general hospitals should opt for the status of hospital trusts within the Health Service. I am concerned that smaller hospitals, particularly cottage hospitals in rural areas, may feel so threatened and isolated that they will want to set up their own trusts. I am sure that they would receive much local support for so doing, and I hope that that will not be ruled out by Ministers.
  I should like some assurances about the rights of GPs under the new arrangements to be able to send their patients where they want. I was a little concerned by some replies that my hon. Friend the Minister for Health gave. I asked:
  "to what extent … general practitioners who are not budget holders will be permitted to choose the hospital to which they send their patients for (a) non-emergency treatment on an in-patient basis and (b) maternity care, including the delivery of the baby".
  My hon. Friend replied:
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  "For all services, including non-emergency and maternity services, GPs should usually be able to choose the hospital that they consider most appropriate, taking account of their patients' needs and wishes. GPs who are not fund-holders will normally refer patients to hospitals with which the district health authority has placed contracts. In placing those contracts, the DHA will be expected to secure the referral patterns which local GPs wish to see put in place, unless there are compelling reasons for not doing so."—[Official Report, 28 November 1989; Vol. 162, c. 222.]
  I hope that that will be the proposal, because many excellent GP practices in my constituency will not be large enough to be budget holders. I should like them to have the right to send patients to local hospitals in Melton Mowbray and Oakham or across the border. I welcome this aspect of the Bill—to hospitals in Lincolnshire, Northamptonshire, the constituency of the Under-Secretary of State for Health, my hon. Friend the Member for Kettering (Mr. Freeman), or to Nottinghamshire if they believe that that is suitable for their patients. I hope that they will not be prevented from doing so but will be encouraged to do so because they are not large enough to be budget holders.
  With those reservations—I shall watch carefully how the Bill proceeds in that regard—I wish my hon. Friends well and will support the Bill tonight.
  Several Hon. Members rose—
  Mr. Deputy Speaker (Mr. Harold Walker): Order. I remind the House that earlier Mr. Speaker announced that he will impose the 10-minute limit on speeches between 6 o'clock and 8 o'clock.
  5.57 pm
  Mr. Andrew Welsh: I had hoped to address my remarks to Ministers at the Scottish Office, but none is present; indeed, I am the only Scottish Member present in the Chamber. Although they are not present, I hope that they will read Hansard tomorrow, because the Bill illustrates how inadequate the House is to deal with Scottish legislation. These are devolved matters that are very important to Scotland, yet the House is not capable of dealing with them properly. Fundamental changes affecting major Scottish institutions are being tagged on as afterthoughts to legislation for England and Wales. If ever there were perfect subjects for scrutiny by the Select Committee on Scotland, these are they. The House is in breach of its Standing Orders by not having a Scottish Select Committee.
  As with Scottish education, the Bill, affecting the National Health Service in Scotland and our community care system, is being pushed through with minimum Scottish input and little or no time properly to debate its Scottish aspects. I should like to place on record my disgust and protest at this cavalier treatment of Scotland. No Scottish Government would ever allow it, and it is to the shame of this place that such circumstances should occur.
  The Government are out of step with the majority of people in their treatment of the National Health Service. There is massive mistrust of the motives for the end product of the Governmnent's changes, and I certainly share those feelings. The National Health Service is not safe with the Government, and I fear that the concept of community care will suffer at their hands. Basically, we are being offered a managerial, cost accountancy solution which is inadequate to meet the health problems of the

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  decade that will take us into the 21st century. How do we cope with our increasingly aging population, which is estimated to be 1·1 million by the year 2001? How do we continue to shift resources towards health promotion and the prevention of illness? How do we ensure the supply of professional trained staff, both ancillary staff and those directly connected to health care?
  I look for answers but the Bill does not supply them. Nowhere in the proposal do I see consideration of quality of care in medicine and health provision. There is plenty of emphasis on finance and some on technology, but where are the quality assurances? There are dangers of fragmentation of national health services and the creation of a divided, warring, competitive system driven by the profit motive and cost-cutting, rather than a national, comprehensive health care system that is available when and as needed by each individual. That is what we all have a right to expect and what we should be working towards. I do not want a system that pits doctors against patient or hospital against hospital.
  The Government heard the united opposition of health care professionals and the general public, yet they have responded only reluctantly and in small measure to the range of thoughtful and considered responses to their NHS proposals. I am worried about the quality of care in the National Health Service and the community care system. The Scottish section of the White Paper dealing with community care is devoid of targets to be pursued. There are 10 references to discussion papers and guidance papers yet to be published, as well as matters which "require further consultation". This leaves a vagueness and tenuousness which all but obviates discussion on the Scottish aspects of the Bill. How can there be meaningful discussion or analysis when many fundamental matters are to be left to the diktat of the Minister?
  This Scottish vagueness is in direct contrast to the Welsh section of the White Paper which details the existing situation and sets out targets and objectives for community care in Wales. Why are we not given similar provision by the Scottish Office? Will such information be produced and, if so, when? Scottish legislation is in enough of a shambles without adding these extra handicaps.
  Despite the generally accepted underdevelopment, which even the Government have acknowledged, of community care in Scotland, the White Paper on which the Bill is based is weak and lacks a positive sense of direction. Since much is left to further consultation and guidance, how can there be effective debate on these issues without some flesh being placed on these bones? What is the Government's timetable for the 10 matters that require consultation in Scotland? Given their placing in the Bill, how can a full debate in Standing Committee be assured to deal with the Scottish clauses, some of which are very different from those applying to England and Wales? Given all that, are Scottish Office Ministers prepared to have joint meetings with repesentatives of the professional and voluntary organisations to discuss the details in the White Paper and the Bill, in view of the limited parliamentary time available for discussion? I should like them to take that on board. It is a matter of urgency for Scotland.
  More generally, what will be the relationship between local authorities, the Government and private provision as part of an overall strategy for community care? In contrast to the Welsh and English position, there appears to have been little positive thought about an overall co-ordinated
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  approach or even specific goals or targets on housing. Scottish Homes does not even rate a mention in the White Paper—perhaps that is a statement of the Government's opinion of its usefulness regarding the provision of housing in Scotland. Why is there no reference to homelessness or to people with mental illness? The approach of the Scottish Office seems to be less adequate than the English one. I should like assurances that something will be done during the Bill's passage to remedy these defects.
  In particular, why will not the Government provide proper income to carers? The bulk of caring in the community is met by informal carers, saving the Exchequer billions of pounds because of their work. The Government have failed to recognise that caring for a sick and sometimes terminally ill relative is a full-time job that puts tremendous strain on the carers. When carers cease their caring activities, they are not eligible for benefits in their own right. They have difficulty re-entering the labour market. The proposed review of disability benefits offers the Government the opportunity to provide support through the benefit system, for example, by providing training schemes for young carers. Those people should also he eligible for unemployment benefit.
  Changes in the pattern of community care are likely to affect women disproportionately. There is a danger that many women will be trapped into providing care for relatives and become a support safety net. That problem must be urgently addressed. What action will the Government take to protect carers in the front line?
  From statements made by Ministers earlier in the debate it could be thought that the NHS has few or no problems and that the Bill provides complete security for the NHS, its patients and work force. Like the majority of people, I have no confidence in the Government or in their approach to the NHS. The Bill is a trojan horse placed before the NHS. It is inadequate to meet the needs of proper health care. I hope that it will be strongly and unitedly opposed.
  6.5 pm
  Mr. Michael Morris: Once again, it gives me no pleasure to voice deep concerns about proposed changes to the National Health Service. Once again, I declare a series of interests in that two of my immediate family are doctors and another is a physiotherapist. For all my working life before becoming a Member, I was associated with the pharmaceutical industry, and I advise two companies—Upjohn, and Reckitt and Colman. As my hon. Friend the Minister knows, I have served on the Public Accounts Committee for some 10 years and have asked a fair number of questions on the NHS.
  I am the first to admit that changes in the NHS are necessary. A number of items in the Bill are right and should be supported, but—it is a big but—we all need to recognise that this is probably the most dramatic change that the NHS has faced since Aneurin Bevan set it up, based primarily on work done by a Conservative Member, Mr. Brown. Both sides can therefore take pride in the creation of the NHS.
  The big difference between then and now is that the NHS had a long period of gestation. There was time to reflect and a groundswell of opinion in favour of the changes. If I felt that the preparation for the Bill had been

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  as thorough as the preparation for the NHS, I could readily support it. I am afraid that I do not. I have studied the Bill in considerable depth and, unfortunately, I feel that there is a degree of shallowness and unreality and a feeling of policy being made on the hoof. It is not good enough that the White Paper referred to GP budgets of £700,000, when it transpired following academic work that the figure was nearer £1·4 million. Now in column 513 of Hansard for Thursday last week we are told that the matter is to be negotiated. This is far too reminiscent of what happened over the limited list, where we started with 31 products on the list, but then the number increased to 156, and it started with a claimed saving of £125 million, but ended with a claimed saving of £75 million, as yet unsubstantiated.
  The last thing that any Member should do is undertake ill-thought-out change. One need only look across the Atlantic to see what happens when one pushes through a Bill that is ill thought out in terms of health care. Two weeks ago in the United States, what was called the Catastrophic Health Act had to be repealed. It had been introduced to help the elderly, at their request, but it was found to have unrealistic time dimensions and budgets.
  There are some real problems, which we must face. We cannot get away from the fact that the first problem is money. We need to recognise that we spend about 6·5 per cent. of gross national product on health, that the United States spends about 12 per cent. and that the rest of Europe spends about 8·5 per cent. Those figures are indicative of the problem. Those of us from the Oxford region who attended a presentation the week before last had it made clear to us that if in the past five years—and Oxford is allegedly the most efficient region in the country—we had had increases to meet the cost of inflation, we should have had an extra £35·3 million, which would have gone a long way in helping us to deal with problems such as the closure of wards.
  If one plans to change the service radically, one must work with the people and with the grain. It is sad that last Thursday, my right hon. and learned Friend the Secretary of State said that waiting lists were a "badge of status" for consultants. They are not in Northampton or elsewhere.
  One also has to think clearly about what overseas experience teaches us. Recently, I had the opportunity to go to the United States and to try to relate the proposals for hospital trusts with what has been done there. The American experience suggests that in a market-based system, hospitals and other providers react quickly to changed financial incentives and that contract specification is crucial. The Bill does not seem to anticipate that problem. The American evidence also suggests that providers will change methods of service delivery to maximise income and will engage in favourable selection of patients if there is freedom to do so. What are the safeguards to prevent that?
  Quality of care in the United States is, to a great extent, dependent on elaborate arrangements for the external monitoring of quality. The Americans have peer review organisations and I do not know what we have to equal that. From the United States, one learns quickly that administrative costs spiral and we learn from previous announcements that administration costs may spiral here.
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  In the past 10 years, one of the areas that the Public Accounts Committee has challenged has been trying to bring down administrative costs.
  The medical audit raises another problem. We all accept that it is a vital area, but I find that the Government have set aside only £1·25 million in the coming financial year, which is less than £100,000 a region. Every experience, not only in the United States, but on the continent, tells us that it is an expensive area. Yet we have not provided major financial resources. A paper by the Medical Audit Advisory Group suggests that teams of general practitioners will go round GP practices. Where are all the GPs who can be spared for the medical audit?
  The hon. Member for Burnley (Mr. Pike) referred to the major problem of drug budgets. This is a real fudge issue. We already have the pharmaceutical pricing regulation scheme, prescribing analyses and costs—PACT—formularies, over-the-counter medicines, generic products and the limited list, yet on top of all that my right hon. and learned Friend the Secretary of State wants indicative drug budgets. Only 25 per cent. of GP practices are computerised, so the proposal will not work in the time scale that has been set.
  It is also incumbent on the House to understand that, although drugs represent 10 per cent. of NHS cost and are highly visible, many modern medicines are preventive medicines and will stop people having to go to hospital. We also need to understand that the number of elderly people will increase. One can work out that there will be an extra 4 million scripts for people who are 60 to 65 now and another 4 million for those over 75. On top of that, there will be screening and public health programmes, so the number of scripts is bound to increase and the drugs bill will also increase. We need urgently clarification of one central point. How is it that there is a Treasury fixed budget in overall terms for drugs, yet there is to be no restriction on GPs through indicative budgets?
  The pharmaceutical industry is important to this country. Such a strong, research-based industry, which makes an £850 million surplus for this country, should not be ignored or forgotten and we must recognise the importance of the new medicines that it has introduced.
  I believe in the ethos of the NHS, in good management and in strategic objectives to meet proven needs, but we should cost what has been achieved, experiment, test the market and assess the results before making decisions. We should involve the whole team and work with them. We should look at the implications of the decisions on others who are friendly to the industry. We should learn from the experience of others and we should set realistic time dimensions and realistic targets. Sadly, the Bill tries to do too much in wholly unproven areas, with too few resources. Sadly, I shall not support it.
  6.15 pm
  Mr. Joseph Ashton: I shall confine my remarks to local issues, because of the 10-minute rule, and I hope that the House will bear with me. Bassetlaw health authority is one of the three smallest in the country. After great pressure from myself and others under the Labour Government, it was agreed to establish Bassetlaw health authority, although the population is just over 100,000 and the population in the average health authority is about 370,000.

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  When the Bill was announced, there were immediate cheers from my local Tory-controlled health authority, which offered to opt out not just the local hospital, but the entire authority. That decision was greeted with acclaim by the Minister and the Social Democrats. The health authority sent out a letter asking staff to give it full support and stating:
  "The public opposition to our expression of interest has come so far, to the best of my knowledge, solely, from Minister Joe Ashton MP"—
  I assume that that meant Mr. Joe Ashton—
  "who represents part of our Health District … and a relatively small number of Labour Party activists; and this opposition has been couched in party-political, ideological terms."
  The authority gave press releases and said that it hoped that most staff would strongly support the scheme from its introduction.
  The authority spent a lot of money putting out the Update newspaper using money that should have been spent on health. The authority has been £1 million short of its budget for the past 12 months. The authority said that it would engage Price Waterhouse to investigate the method of setting up a trust and that staff at all levels should be prepared to support it. The authority aroused a great hoo-ha. It placed advertisements in local newspapers and spent a great deal of cash pushing the political idea of the whole health authority opting out.
  The authority also said, which I welcomed, that there would be a public referendum after consulation next year. When that was announced, the Parliamentary Under-Secretary of State for Health began to have second thoughts. He visited the area, as did the Secretary of State. The one thing they did not want at any price was any form of public referendum. Public consultation was entirely against their policies.
  While congratulations were levelled at the health authority, it suddenly had cold feet about the referendum. In June, the trumpets and fanfares were sounded. What happened last Friday? The local newspaper announced:
  "NHS trust abandoned. Bassetlaw Health Authority has abandoned its plan to set up an NHS trust. The opt-out plan, which met with strong opposition in the area, is, announced the Authority yesterday, no longer an option being pursued".
  When these opt-outs are analysed and costed they may not turn out to be such a good thing after all.
  The health authority maintains that it is going ahead with opting-out the hospital, but again with no mention of a referendum. The whole area has campaigned for many years, as have I, for a brand-new hospital. This is a mining area and we finally got the hospital, which the Government delayed for many years despite six visits by Ministers to the area, because, by an act of God, a miner was carried in on a stretcher, having broken his leg. Stinking, black and bleeding he was brought in from one of the many accidents in the pit and he had to be treated in a corridor in a collection of tin huts—that was what finally convinced Ministers that the need for our hospital should go to the top of the list, and we managed to get one built.
  Now we discover that all our pressure does not matter. The people at the top will decide whether the hospital will opt out, not the people who use it, who campaigned for it and who paid their stamps every week for it. The people who will decide are those at the top who wanted to keep their good administrative jobs by opting out the small health authority.
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  The staff have been consulted, meaning that they were told of this at a mass meeting and asked whether they had any questions. Naturally, they did not want to jeopardise their jobs or to be awkward and shout their disagreement like Oliver Twist. They all want promotion, so they say nothing, enabling the people who held the meeting to claim that the staff agreed without complaint.
  If there were a secret ballot it would be different. If a trade union wants a political fund it must hold a secret ballot of its members. If a council estate is to be sold off to, and run by, a private landlord the Government insist on a ballot, but hospital patients and visitors and people living in the area are not balloted on whether their hospital should opt out. The Secretary of State will not entertain that at any price.
  Last week the National Union of Public Employees conducted an opinion poll in the east midlands in which 400 people canvassed 7,000 respondents. In that reliable survey 94 per cent. of those questioned said that there should be a ballot. They did not say that the hospital should not opt out, but they were in favour of a ballot. Many were Conservatives who had voted Conservative all their lives and who might even support much of this Bill, but they want a referendum before the hospital decides to opt out.
  There has been much propaganda about how self-sufficient hospitals will be, but that will depend where they are. If a hospital is new and owns a lot of land, having bought an extra couple of fields paid for by the NHS, it will be able to survive the first few years by selling off surplus land, holding extra flag days and selling off ancillary services. Undertakers will set up in the foyer, flowers and food will be sold under franchise and people will be turned away and told that they should have gone private. Insurance may even be sold under franchise, and in that way the hospital will make a profit.
  The Minister has assured staff that they have nothing to fear. They have everything to fear. They are assured that they will be guaranteed Whitley council wages and the same sort of pensions and holidays as they receive now, but that is nonsense. Once hospitals no longer have to pay regular wages they can pay the market rate. There is still 9 per cent. male unemployment in my area, despite all the part-time jobs in supermarkets that have been created. Hospitals will pay a damn sight less than they have to pay under the NHS.
  I cite Mr. James Butler who held a top-level job as a commissioning officer in Bassetlaw hospital. He was made redundant in March last year and Bassetlaw health authority refused to give him an early pension even though it was guaranteed by the Whitley council and the Minister had said that he was entitled to it. God help him if he had not been in the union, which took the health authority to court. The authority took legal advice and then backed down because it realised that Mr. Butler, NUPE and the Minister were right—after having spent several thousand pounds on legal advice.
  This shows that once a hospital has opted out under these provisions it will pay any wages and pensions that it likes, it will privatise what it likes, it will adjust holidays and it will destroy the long tradition of fair conditions. And staff will have no comeback. Hospitals that have opted out will be run as they used to be—on flag days. If they are hospitals in Bournemouth, where there is plenty of local cash and millionaire do-gooders abound, they will make money as they did in the 1930s. If they are in places

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  such as Barnsley and Bassetlaw, people will put 20p in the box—the hospitals will not be left big legacies in wills—and the hospitals will have to scratch around, send people where it is cheaper and turn them away, sometimes advising them to go private.
  All these matters must be explained at length and in a democratic way to the people of the country, who must be given the chance to vote in a full referendum after extensive local discussions. I hope that the Minister will insert in the Bill a clause providing for referendums.
  6.26 pm
  Mr. Jerry Hayes: I listened carefully to what the hon. Member for Bassetlaw (Mr. Ashton) had to say. I suspect that hon. Members on both sides were none the wiser having heard his speech because if the hon. Gentleman puts his hand on his heart he must admit that he has not read the White Paper or the working documents or the Bill; if he had, he would not have said what he did.
  We are not talking about hospitals opting out of the Health Service; we are talking about self-governing National Health hospitals—[Interruption.] That is in the Bill. Why has the hon. Gentleman not read it?
  Thank heavens, the electorate are rather forgiving. They can forgive us for messing around with their jobs and taxes and perhaps even for messing around with their rates, but they will not forgive us if we misinform them about their health and about what will happen to the health of their loved ones, the frail and the vulnerable. The BMA and the Opposition have done for the truth of the White Paper and the Bill what King Herod did for babysitting.
  On 7 December the hon. Member for Livingston (Mr. Cook), the shadow Secretary of State for Health, made a speech which I should like to go through, analysing precisely what he said. I asked him whether he was going to commit his party to voting against medical audit, against money travelling with the patient and against resource management. All those points were medically led—they did not drip out of a back room of 10 Downing street or Richmond house. They were advanced by the medical profession and supported by it.
  The hon. Member for Livingston replied:
  "I am sorry to disappoint the hon. Gentleman. There is nothing in the Bill about a medical audit. If the hon. Gentleman is thinking of voting for the Bill because he supports the idea of a medical audit, I would … welcome his joining me in the Division Lobby".
  Of course the Bill does not mention medical audit; it does not mention resource management either—but these things are all in the White Paper. They are all in the working documents. So much has been written about it that I suspect that whole Amazonian rain forests have been destroyed.
  Mr. Tom Pendry: How irresponsible.
  Mr. Hayes: I expect nothing less from the hon. Gentleman.
  The shadow health spokesman then referred to money travelling with patients. He said:
  "Of course we do not oppose the idea of money following the patient. The question is whether the Bill does anything to provide for money following the patient."
  In other words, this is all about resources. If it was all about resources, the Government would have fudged it
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  long ago because we are spending 45 per cent. more now than in 1979. The difficulty is that we have a ridiculous state of affairs where there is no financial incentive for health authorities to reduce their waiting lists. In fact they are penalised. There is also no financial incentive for hospitals to treat more patients. At this time of the year, money runs out and beds and wards are closed.
  Mr. Doug Hoyle: That is scandalous.
  Mr. Hayes: It is absolutely scandalous. Opposition Members do not accept that that scandal is finally being laid to rest. Money is travelling with the patient and there will be a financial incentive to reduce waiting lists and to keep beds open.
  The Opposition claim that the amount of money involved is not mentioned in the Bill or in the White Paper. Of course, that is not mentioned there. It is a matter for the Autumn Statement. However, I can give the Opposition a clue. Believe it or not, a lot of people distrust politicians. They put us on the same level as journalists, estate agents and burglars. I want to remind the House of what Mr. John James, a senior civil servant, said to the National Association of Health Authorities. He made it clear that because of the system of money travelling with the patient, more money would have to flow into the Health Service. If hospitals and health authorities know precisely what their unit costs are and how much operations and treatment cost—which they do not know at the moment—they will be able to put in bids to the Treasury which would lead to more money coming into the Health Service.
  The Bill is all about resources and the patient.
  Mr. Kenneth Hind: What about the 12 per cent?
  Mr. Hayes: I want to draw the attention of the House to other points made by the shadow health spokesman on 7 December. He said:
  "The Bill does not extend choice to patients."
  He was making the same point as the hon. Member for Bassetlaw about self-governing trust hospitals. He wanted to know why we do not have a ballot and ask the patients, doctors, nurses and cleaners. How can we do that? We do not even do that under the present system when there is a proposal to close a hospital. In those circumstances, we consult the people in a proper and statutory fashion through the community health council involved. I believe that a ballot would divide communities and divert valuable resources and attention from patient care. [Interruption.] The hon. Member for Cardiff, South and Penarth (Mr. Michael) will say that I am shooting myself in the foot. How ridiculous. If we do not have a ballot or a referendum when a hospital closes, why should we not use the existing procedure which has worked perfectly for many years to express people's views?
  Mr. Alun Michael: Will the hon. Gentleman give way?
  Mr. Hayes: No, I want to make progress. The hon. Gentleman will have plenty of opportunities to hold himself spellbound in a few moments.
  The shadow health spokesman also said:
  "Under this Bill, the GP will not have the opportunity to send his patients to hospitals at which the district health authority does not have a contract."—[Official Report, 7 December 1989; Vol. 163, c. 518–20.]

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  That is nonsense. It has been made absolutely clear that a special fund will be available for those referrals. Has the shadow health spokesman not read the Bill or the White Paper? Has he not seen the guidance from the Department of Health stating that referrals will be much the same as they are now? Of course he has not. Regrettably that is the mass deception by the Opposition, the BMA and others.
  At last the BMA, the presidents of the royal colleges and the other caring professions accept 80 per cent. of the Government's proposals. Some Opposition Members say that the Health Service is just a wonderful quaint museum piece. They believe that we just have to pat it on the shoulder, patronise it and throw it a few more pounds and everything will be all right. Several thousand of my constituents have been waiting 24 months for elective surgery and they waited 12 months before that to see a consultant.
  Mr. Ian McCartney: And the Government are responsible for that.
  Mr. Hayes: The hon. Gentleman rather foolishly says that the Government and I are responsible. He knows nothing. The ludicrous and antiquated system of finance which the Bill will change is responsible. That is why I support the Bill.
  6.36 pm
  Mrs. Rosie Barnes: The Bill has much to commend it, but much more to condemn and criticise. I want to discuss the provision for hospital services in some detail and, if time permits, I will refer briefly to general practitioners and community care.
  The Secretary of State for Health must be congratulated on promoting a number of important initiatives within the hospital services—for example, the introduction of capital charging, the development of the resource management initiative and the empowering of the Audit Commission to scrutinise the NHS.
  Those three moves should together encourage better financial management of the Health Service. Other welcome aspects include the differentiation between purchasers and providers of service which should clarify the responsibilities in planning and operations, the introduction of clinical audit which will form a better framework from which to assess the effectiveness of the service, the streamlining of district and regional health authorities and the full participation of executive directors which will enhance proper decision-making.
  Why, if I find so much in the proposals to applaud, am I so adamantly opposed to them? First, the effectiveness of district health authorities will be seriously eroded by the operation of fund-holding general practitioner practices. It is ironic that after the Government have put so much effort into the development of the public health function within district health authorities over the past two years, they are about to undermine some of those achievements.
  The public health departments have been developing two vital functions—they have become increasingly powerful in promoting good clinical practice and they have been acquiring the necessary expertise to anticipate and thus facilitate the timely provision of the services that people need.
  I challenge the appropriateness of general practitioners making the market in hospital care. If it is to be made, let the patient do it and let the DHAs play a more pivotal role.
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  The error will be compounded by the limited authority that a DHA will be able to exercise over a National Health Service trust hospital.
  A trust hospital may become a model of good practice. If it does, will the local DHA be able to afford comprehensive access to its services? Conversely, a trust might become a bastion of backward-looking practice Would a DHA then want access to its services?
  It is far more likely that NHS trust hospitals will become more interested in the wider market at the expense of the local population. It is vital that a comprehensive definition of care services is incorporated in the Bill to safeguard the interests of local residents.
  My third and very important point is that the Minister has failed satisfactorily to integrate the primary service provided by general practitioners and hospitals at local level. I urge him to consider that fundamental problem. District health trusts, as a sensible, comprehensive alternative to self-governing hospitals, would enable district health authorities to ensure that proper services were provided within their areas, and to plan strategically for all the local population. They would also facilitate smoother transition from one part of the service to another, and thus deal with a considerable flaw in the current proposals.
  Fourthly, and critically, the Minister has failed to demonstrate any grasp of the dynamic relationship between quality, cost and timeliness. He talks glibly of raising the standards of all to the standard of the best, but fails to acknowledge that authorities have already been deciding on differing priorities for the best local use of scarce resources. We must ask the Minister to include absolute commitment to quality in the Bill, as well as clinical audit. Quality figures large in the White Paper but appears to be absent from the Bill, which is an unsatisfactory state of affairs. "Quality" must include adequate provision, accessibility and reasonable waiting times. While I am on the subject of quality, let me also ask the Government to make an unequivocal commitment to the work on "total quality" being carried out by the Kings Fund in its hospital accreditation programme.
  The Minister is to be congratulated in part on the proposals for GPs, who will certainly be more accountable for the services that they provide. I doubt, however, whether the new contract arrangements imposed on them will resource them adequately for their new responsibilities. I have already spoken at length in the House on my misgivings about fund-holding GPs' practices in conjunction with NHS trust hospitals, and the unwelcome complication that financial considerations will introduce to the relationship between GPs and their patients.
  Let me devote the remainder of my speech to the community care aspect of the Bill, which I think is long overdue and has tended to be ignored. Again, I must give credit where it is due: the Government must be congratulated on facilitating better differentiation between residential care, community or social care and the medical components of the service, while balancing that with a commitment to the joint working of all three. What is entirely unsatisfactory, however, is the lack of definition in the allocation of responsibilities.
  We have two key anxieties. First, we fear that the Government will progressively make more demands on local authorities to fund local services directly—and, as we all know, the areas in greatest need are often those least able to afford such services. Secondly, the Government are

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  demonstrating an unnecessary bias against the direct provision of residential accommodation by local authorities. We support a mixed market; if the Government truly supported that, they would have the courage of their convictions and allow local authority provision to flourish where it is working.
  Finally, let me make some general points covering all aspects of the Bill. First, I am concerned about the speed of change. The problems involved in this development are highly complex, not least in the way in which they are interrelated, but the targets are over-ambitious in their timing and owe more to party-politial considerations than to professionalism and concern for patients' well-being.
  Secondly, I am worried about the lack of genuine choice. There has been some slight modification to the way in which patients may choose their GPs, but the rest follows automatically and they will have very little say. As the hon. Member for Livingston (Mr. Cook) said earlier in the debate, the patient follows the money rather the money following the patient; the patient travels with the money but the money does not travel with the patient, as Conservative Members claimed earlier this evening.
  I am also very concerned about the lack of patients' rights. There are no tangible commitments or improvements, particularly as regards waiting time. I refer hon. Members to the amendment that I tabled, along with others, to the Health and Medicines Bill, proposing that statutory times should be laid down for treatment to be delivered, and for patients to exercise their right to go elsewhere if their own health authority could not deliver that treatment. If that provision were in the Bill the money would truly follow the patients, and they would have more control over their share of the Health Service's money.
  Resourcing is a major problem. The Government's achievements in that respect—as we hear week after week from the Dispatch Box—cannot be ignored or denied, but in return they must acknowledge that genuine need continues to outstrip their commitment to provide, especially in view of the aging population and the increasingly technological service that is now available across the board. In particular, the Minister must acknowledge that the great majority of the development moneys that he gave the NHS recently will be absorbed by inflation and the financing of existing workloads.
  I agree that the NHS requires organisational development to promote changes in its management and clinical practices, but I am concerned that the Government have responded by foisting on the service their uniform precription for the public sector: it is inadequate, it is dangerous and, in its present form, it must be rejected.
  6.46 pm
  Mr. Michael Irvine: Scaremongering and distortion have been the characteristics of the campaign against the Government's plans for reforming the National Health Service. I am afraid that both have been very much in evidence in many Labour speeches in this debate.
  Another feature of the opposition to the proposals for reform, and to the Bill, has been the almost unremittingly negative character of the criticisms that have been made. It seems that the only answer to the problems of the National Health Service from Labour Members and
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  others who campaign against the Government's proposals is a call for more resources. They are on dangerous ground there, because the record shows that, far from being a poor provider of resources, the Government have been a very good provider. My hon. Friend the Member for Harlow (Mr. Hayes) produced the acid figure: a real-terms spending increase of 45 per cent. since the Government came to power in 1979. Such a figure really stands up to examination; it shows the merit of the Government's health policy, and their ability to provide the necessary resources.
  It is not just a matter of resources, however. The key question is how we apply those resources. The great weakness in the present structure of the NHS is that it simply does not give sufficient account to cost. It does not reward efficiency; all too often indeed it stifles and suffocates good management. Several Conservative Members have given examples of how, time and again—especially at this time of year—hospital beds are left empty and operating facilities left unused.
  Why does that happen? Sometimes, but not always, it is due to bad management. Sometimes, however, it is the hospitals that have been particularly efficient, have maintained a good patient throughput and carried out more than their fair share of operations that run short of resources. The proposals for self-governing hospitals are directed towards remedying that fundamental flaw in the system. The managers of self-governing hospitals will be free to manage. They will be free to attract to the National Health Service those staff for whom there is a particular need. They will be free to provide incentives to overcome shortages. They will be able to make their hospitals more efficient, to make the administration more flexible and to make their hospitals more responsive to patients' wishes and better able to provide a better quality of patient care.
  That new freedom for management will have an additional effect. It will make it more likely that higher-calibre managers will be attracted into the National Health Service—
  Mr. McCartney: Will the hon. Gentleman explain the new freedom for managers? I refer to the Atherleigh hospital near my constituency, which cares for the elderly confused and those with senile dementia. Because of the shortfall in his budget, the district general manager gave 24 hours' notice to the community health council that he was closing the hospital and moving out as many patients as possible to the private sector. That was done without consultation with patients' representatives, their families or the community health council. Is that the type of management decision that will be taken because of unit costs and the need for local decision-making at Health Service district management level?
  Mr Irvine: I shall not follow the hon. Gentleman down that rather dangerous road into a precise problem affecting his constituency. However, perhaps the problem that he has identified shows that at the moment the National Health Service is not working as effectively as it should.
  There is one element of the criticisms that have been made about self-governing hospitals of which the Government should take careful note. An effective point was put to me by hospital doctors and consultants in my constituency when I met them. It is that there is some risk that self-governing hospitals may be tempted to skimp on medical training and education. I have in mind the

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  education and training not only of doctors and consultants, but of radiographers, technicians, nurses and others. There is also a risk that self-governing hospitals might be tempted to skimp on research and development. There is just an element of risk that some self-governing hospitals might not provide the resources that they should in those directions. We need to guard against that risk. Therefore, I was glad to hear my right hon. and learned Friend the Secretary of State for Health say on Thursday that he will indeed be on guard against that risk, that there are powers in the Bill to enable him to intervene if he feels that that is the case in any particular self-governing hospital and that he will stand ready to use those powers.
  Basically, I have no doubt that self-governing hospitals are an excellent idea. We should remember that they are optional. No hospital will be forced to become self governing against its will. Why then is there such hostility to the idea? I suspect that much of the opposition to self-governing hospitals is based on the fear that they will be successful and show up those hospitals that are badly administered and not up to standard. Self-governing hospitals will set a standard by which others are judged. That point is at the heart of much of the fear about self-governing hospitals and of the hysterical campaign that has been mounted against them.
  If there has been scaremongering and distortion about self-governing hospitals, there has also been quite a bit of the same about indicative drug budgets. For the vast majority of responsible and able doctors who prescribe sensibly and effectively and who have a proper regard for costs, indicative drug budgets hold no fears. The budgets are directed against the minority of doctors who prescribe wastefully. They are directed against those who prescribe Valium as if it were bubble gum and who do not have a proper regard for costs. If good doctors who prescribe carefully overrun their budgets, they will be able to justify that overrun by referring to special aspects of their practice affecting their need to prescribe. It will be the small minority of wasteful doctors who have no regard for costs who will be caught out.
  I am glad that the principle of the proper allocation of resources will characterise the new framework for community care. The great dangers to effective community care services are duplication, lack of co-ordination, overlap and fragmentation. By providing clear lines of accountability and care packages for individual patients, the Griffiths proposals will do a lot to overcome that risk. They will help to reduce waste and will save resources. Those resources will be needed because there is no doubt that community care will be expensive in the coming years, partly because of demography and the increase in the age of the population but also because the increased efficiency of the National Health Service, which I believe will result from these proposals, will place greater demands on community care. More operations will be carried out and people will be discharged from hospital at an earlier stage of their treatment. That in turn will place greater burdens on community care services.
  In my constituency of Ipswich much strain has been placed on the home help service, not because of any reduction in the amount of money being devoted to the home help service, but because people are being discharger from hospital at an earlier stage of their treatment. This means that personal care from the home help service is
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  becoming increasingly in demand. As a result, strains are building up on the home help service. However, by providing a more efficient framework—
  Mr. Deputy Speaker (Sir Paul Dean): Order. I am sorry to interrupt the hon. Gentleman, but he has overrun his time. I call Mr. Bradley.
  6.57 pm
  Mr. Keith Bradley: I thank you for calling me to speak in the debate, Mr. Deputy Speaker, because this issue is of immense importance to my constituents. Indeed, no more important area of concern has been expressed in correspondence from consultants, doctors, and the general public than the reform of the National Health Service.
  We cannot discuss the Bill without considering resource allocations—on which the Bill is silent. Whether we are talking about hospital services, community services or general practitioner services, the Government's proposals are silent on the need for extra resources. Ministers trot out figures time and again about the extra money that is spent on the Health Service, but they never put that in the context of the extra demands for health care, the growing numbers of elderly people who need health care and the new technologies that increase the cost of health care.
  We should consider the Bill in the light of what is found in individual health authorities, such as my own in south Manchester. It has been suffering from a financial crisis for many years and, despite all the cost improvement programmes that it has implemented, it is now £1·5 million short in its budget for this financial year. The health authority has therefore had to freeze vacancies, and 120 posts in the provision of health care have been lost this year.
  Despite repeated representations to the Secretary of State for Health for more resources for south Manchester, he has refused to entertain our request. The latest letter that we have received from him shows his thinking on how that financial crisis has arisen. He says:
  "I do not know whether the clinical regrading costs arise from previous errors in the original gradings or over-generous findings on appeal."
  The Secretary of State says that one reason for the problem is that south Manchester health authority, when it was assessing the grade of staff in the nursing service, was overgenerous, and gave them more money than it should have. That is the sort of Secretary of State we have; that is how he considers the needs of our staff.
  What is the health authority now doing to save money because of the financial crisis? It has published a consultation document on rationalisation of the service. That means further cuts in service. The document does not identify how much money it intends to save or give the figures. We can be sure that two things will be lost in south Manchester: the accident and emergency department at Wythenshawe hospital will be closed for major accidents and transferred to Withington—Wythenshawe is next to Manchester airport, but it will not have a major accident service—and Withington hospital maternity unit will be closed, with all mothers transferred to Wythenshawe. What patient choice does that mean?
  Let us consider the Second Reading debate to date. When asked about obstetric services, the Secretary of State said:
  "The other day, it was hinted that expectant mothers may lose local obstetric services because of our proposals. That is

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  nonsense. No right hon. or hon. Member would suggest any of that rubbish."—[Official Report, 7 November 1989; Vol. 163, c. 503.]
  South Manchester is having to close maternity services to save money. Can we believe the Secretary of State's statements about the Bill?
  I have the unhappy task of trying to defend one of the hospitals that is on the Government's long shortlist for opting out—Christie hospital in south Manchester.
  The Secretary of State justified opting out, saying that it will free nurses and doctors who have been frustrated by the constraints of bureaucracy for years, and will allow them to use their abilities and to work as they wish. When I asked doctors, consultants and nurses why they had expressed an interest in opting out, they identified one reason—lack of cash. They are heartily sick of a Health Service in which they cannot provide care to the number of patients they want because they are short of resources. That is the only reason why they have expressed an interest in opting out. They do not want to go down that road, but they want to get more money out of the Government. They are appalled that the regional health authority is bringing in extra staff to develop plans for opting out when there is a freeze on nurses' jobs in the hospital. There is a freeze on nursing staff, but more accountants can come into the Health Service. That shows the strength of the Government's commitment.
  A meeting of 185 local doctors in Manchester and of the local medical committee passed a resolution that was in absolute opposition to the Government's plans for GP services. GPs are fearful, regardless of the assurances given by the Secretary of State, about what cash-limited budgets will mean for the service delivered. As my hon. Friend the Member for Burnley (Mr. Pike) said, what is happening to the social fund is a good example.
  Last weekend a constituent came to me because she had been refused a community care grant. She was told that there was no money left in the budget. After further investigation, I found out that the Department of Social Security is having to reassess priorities within the budget, because the cash is running out rapidly. If my constituent had gone to the DSS earlier in the year, she would have got a grant, but at this stage, because of the change in priorities, she will not. GPs fear that the same thing will happen with their practice budgets. They may be able to prescribe a particular treatment for one patient at the beginning of the year, but when money is getting short they may have to prescribe another treatment for a similar patient later in the year.
  General practitioners are worried that they will not have the capital that they need to develop their clinics and practices to meet the demands of the extra treatment that they will have to undertake.
  In my area of Chorlton, the local health centre is already bursting at the seams. There is no room for a typewriter let alone a computer to undertake the administration that will be imposed by the Bill.
  General practitioners are anxious because they already face restrictions on where they can send patients. Last week they received a letter from the regional health authority which said that, because of financial and manpower resources constraints, neurosurgery would be
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  limited to which hospital a particular doctor in a particular area could send his patients. We already have restrictions on patient choice, and the Bill will make that worse.
  Finally, GPs are concerned that waiting lists will be transferred from the hospital to the GP's practice. GPs will have to determine where to send patients, but the amount allowed for under the contract with a particular hospital for a range of services may have run out. The waiting list will be at the GP's door, not at the hospital's door.
  Our opposition to the Bill is summed up best by a letter that I received from a constituent. He clearly reflects the Labour party's view when he says:
  "I am an ordinary citizen, with a wife, three young children, and elderly parents. We all have cause to be thankful that our GPs have given us the best treatment they could provide to meet our needs, rather than the best treatment they could offer within the limits of their local budgets. And they have referred us to hospitals near our homes which provided services the population needed, rather than those which managers decided they could market efficiently. I would like it to stay that way, and if that means I must pay more in tax, I will pay more in tax. I have never before written to make my feelings known to a Member of Parliament. That I do so now is a measure of my profound opposition to the Government's proposals."
  That letter is one of thousands that I have received. The people of Manchester and the other people of Britain will totally oppose the Bill.
  7.7 pm
  Miss Ann Widdecombe: I am grateful for the opportunity to speak in this debate because I am grateful for the Bill. It will herald a new era for the National Health Service and will turn it into the thriving, expanding concern that is should be.
  My constituents will benefit substantially from the proposals for self-governing hospitals. They will also benefit substantially from the greater flexibility in referral patterns, and the greater knowledge that will be available to doctors about where waiting lists are shortest.
  It is a matter of considerable regret to me that my constituents, in particular the elderly, the sick and the vulnerable, should have been frightened and misled by the utterly irresponsible campaign waged by the British Medical Association.
  An example of the way that my constituents have been frightened is that sick and elderly people have been literally shaking with fear when they come to my surgery. They told me that they would not be able to get medicine because their doctors would no longer be allowed to prescribe it when it became too expensive.
  The Secretary of State said, from the outset, that indicative budgets would not be cash limited. On the basis of those assurances, which he gave time and time again, I was able to circulate a leaflet to all my constituents, telling them that there was no truth in the BMA's claims.
  Several months later, when the BMA realised that it could not sustain its lies any longer, it said that the Secretary of State had done a U-turn, and had now said that indicative budgets would not be cash limited. That leaves us with three possible options. First, that the BMA simply did not understand what the Secretary of State was saying right at the beginning, and genuinely did not realise that drug budgets would not be cash limited. If that is the case, it is too stupid to represent a highly-educated profession. Secondly, it is possible that the BMA understood perfectly but chose to ignore it, and pushed it to one side. In that case, it is too irresponsible to represent a highly-respected profession. The third option is that the

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  BMA understood, did not ignore it, but thought that it would be effective if it could frighten people, so deliberately deceived the elderly, sick and vulnerable into believing that drug budgets would be cash limited. If it did that, it is too thoroughly dishonest to represent any profession which acted more like trade union bully boys than a group of respectable professionals.
  I am not surprised that two of the most respected local consultants in my constituency have resigned from the BMA and I am not surprised when local doctors tell me that they believe the BMA's campaign has been wholly unjustified. I think that, as the public realise that the BMA has misled them about indicative drug budgets, about the effects of opting out and about the effects of independent budget holding, the professional relationship between doctor and patient will be damaged far more than by anything that the Government are proposing.
  If the BMA wants to hold the confidence of the public, it should start to tell the truth pretty soon. I am delighted to have the Opposition Front Bench's confirmation that drug budgets will not be cash limited.
  Meanwhile, my constituents can be assured that they will benefit from the fact that, if Maidstone hospital chooses to become self-governing—I do not know whether it will—it will be able to fix pay and conditions there. One of the biggest problems that we have in the south-east is recruitment. Flexibility on pay and conditions will make it much simpler to cope with that problem.
  If there is one thing that I regret about the White Paper it is that it did not seize the opportunity to hold all consultant contracts at district rather than regional health authority level. It does not allow even self-governing hospitals to take on existing contracts rather than just new ones. For a self-governing hospital to be truly effective, it must have complete flexibility over who it employs, and consultants are obviously a key to the services that a hospital provides.
  We in Maidstone are efficient. Every year we have an enormously ambitious budget, and every year we comfortably exceed our activity levels. In future, with money following the patient, that will not lead to our being confronted with budget problems at the end of the year. We shall no longer be penalised for being efficient. I believe that the people of Maidstone will benefit greatly from the Bill.
  When I first came to the House, many constituents came to me complaining that they had been on waiting lists for too long and asking me whether they could go anywhere else to get operations done more quickly. Although I willingly took it on, it did not seem my role as a Member of Parliament to shop around the country on behalf of my constituents, so it is much to be welcomed that the technology which is to be made available will enable doctors to get speedy and efficient information on where there are shorter waiting lists. They will be able to give their patients a better service, and patients will not have to ask their Member of Parliament to do the shopping around for them. That will be an enormous plus.
  For all those reasons, I believe that the Bill is one of the best things that has happened for Britain, especially for my constituents. What I regret most is the party politicisation of a major asset such as the NHS. Opposition Members should join us to make these proposals work so that we can guarantee the future of the service.
  Mrs. Alice Mahon: It is party political when the district health authority confronts massive cuts every year. This year, my local authority faces yet another £500,000 cut. How can the hon. Lady think that that is not a political issue? People on waiting lists in my constituency think that it is political, and blame the hon. Lady's party.
  Miss Widdecombe: The hon. Lady should be honest enough to tell her constituents that my party is not to blame, and that the problem is a thoroughly overburdened system that will be much relieved by these reforms. Precisely because we have such problems, we should pull together to make the reforms work. Subject to refinements of detail, which I think necessary, particularly in regard to referral patterns, these reforms provide a basis for the future. They should not have become the object of party politics. They should be the object of a good, thorough, thriving, expanding, researching, developing and serving British health service for a century to come.
  7.14 pm
  Dr. Kim Howells: The National Health Service is not above criticism. It is not an untouchable monument. Indeed, it is no more unassailable than the former Chancellor of the Exchequer was.
  The NHS has been scarred by many shortcomings in many of its facets, whether lengthy waiting lists, miserable waiting rooms or a minority of consultants and registrars who seem to belong to a James Robertson Justice' impersonators' club treating patients with all the sensitivity and delicacy of a vet treating sheep for wind.
  Likewise, the managers of the NHS, like any management of a large high-spending organisation, need constant monitoring. I do not argue with any of that. Whatever its faults, however, the NHS was recognised as being infinitely preferable to the private service and panel systems which it replaced in the late 1940s. Indeed, it became during subsequent decades the most public image of governments and societies which viewed the health of the nation as a matter not to be determined by the vagaries of personal wealth or the market.
  During the past 40 years, the British people have come to regard the NHS almost as a birthright—the right of access to the best health care that can be provided, regardless of personal or corporate wealth. Most of us have moaned and groaned about the Health Service, but most of us are also inordinately proud and fond of it.
  That is why, it seems to me, the British people have reacted with such vehemence and distaste to key aspects of the Government's proposals. They regard the Health Service—general practitioners, practices, local hospitals and the long-term care facilities for the chronically sick and infirm—as a keystone in the structure of their communities. They do not want that keystone to be loosened. They do not want their elderly and very young to be hawked around in search of health care as their young are now being made to hawk themselves around in search of jobs in a metropolis such as this. They do not believe that health is a marketable product, but the Government do.
  The proof is in the Bill, or rather it is evident in what is not in the Bill. It is evident in the lack of explanation of what is to happen to those vital elements of NHS provision which relate to care of the chronically ill, the elderly and the mentally ill and to those areas of the NHS which cannot be milked for a fast buck.

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  The Bill smells of the same oily rag which the Government have used to clear the decks for the privatisation of other public services. The people know that smell, and it angers them. They want to know why the Bill does not concern itself with resolving the many problems that beset the NHS. The Bill will solve none of those problems. It has been drafted by a Government who are deaf to the huge sigh of protest and concern that has greeted it. The Bill is an abrogation of responsibility. It is drafted by a Government who are drunk on bootleg privatisation. I rejoice in the knowledge that that deafness and this ideological drunkenness will drag the Government to a well-deserved resting place at some miserable footnote on a page of history that most of us would have much preferred never to have read.
  7.18 pm
  Dr. Charles Goodson-Wickes: I have hitherto been reluctant to speak on the Government's proposals for the reform of the National Health Service. There are times when one is almost too close to an issue, caught between one's profession and one's political colleagues. Since becoming a medical student some 25 years ago, I have had more than a passing experience of the great matters involved, and I am grateful for the opportunity to comment on some of them today.
  St. Bartholomew's, where I trained, is arguably the oldest London teaching hospital as it was founded in 1123. St. Bartholomew's hospital has continuously adapted and developed for the past 866 years. It strikes me as peculiar in the extreme to assume that, after a mere 41 years, the National Health Service is incapable of modification and improvement. Indeed, any suggestion of change is interpreted in some quarters as an attack on the whole concept of the NHS.
  It was with distinct unease that I watched the posturing and skirmishes of the past few months. I imply a degree of blame on the Government, the Opposition and the British Medical Association respectively. I am utterly convinced that my right hon. and learned Friend the Secretary of State was right to extend to the NHS the challenge presented to so many of the institutions and vested interests in our society. We have tackled the City, trade unions, the teaching profession and the legal system. We have made them justify their practices or abandon them—all this in the interests of the consumer. Why should the medical profession be immune?
  As a practising physician and a non-practising barrister I suppose that I have cause to feel singled out for persecution. I make no complaint about that, but it was as a member of a trade union—the BMA—that I felt most uncomfortable. It was with astonishment and sadness that I saw the discredited techniques of old-style trade unionism adopted by a professional body. I cannot believe that ultimately it was in the interest of anyone to frighten vulnerable people in surgeries across the country with alarmist and mischievous literature. From sheer misinformation to merely putting the worst possible construction on virtually all the proposals in "Working for Patients", the BMA let itself down. However, I have had a series of civilised and constructive meetings with the chairman of the BMA council and his senior colleagues. We all agreed that it was time that peace broke out.
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  In extensive consultations with general practitioners and hospital doctors in my constituency anxieties have been aired and misunderstandings ironed out. I welcome the Government's flexible reaction to various practical objections which proved valid. Nothing is more unsettling than uncertainty. The sooner that we move on the better.
  The latest BMA literature uses the recurring theme of "risk of failure", a phrase which is hardly indicative of enlightened and optimistic thinking for the future. If the Government had baulked at the formidable range of problems presented to them during the past decade because of the risk of failure, their achievements would have been minimal.
  I have worked as a hospital doctor in various parts of the country. Despite believing that NHS treatment is the best in the world from a professional point of view, I recoil with horror at memories of queues of out-patients where tens of people were given identical appointment times. They waited phlegmatically and passively in outdated and uncomfortable hospital buildings that were either too hot or too cold. I recall the impersonal, condescending and sometimes almost patronising attitude of administrators, doctors, clerks and technicians. I remember the wastage of materials and time. I remember the blunderbuss ordering of expensive, poorly directed investigations into problems and the haphazard methods by which patients were called forward for admission. In out-patient departments people traipsed from the examination cubicle to further waits outside the X-ray department or blood laboratory and so on. It would be a rash person who, including travel by public transport, assumed that the whole process would take less than half a day. What happened next? They were told to come back in a week's time. They were extremely lucky to see the same doctor. Results were often delayed or mislaid or fell foul of technical problems and tests would have to be repeated.
  Mr. Paul Flynn: Will the hon. Gentleman give way?
  Dr. Goodson-Wickes: No, I shall not give way because of the time limit.
  I make no apology for putting over that litany. I do not say that that position was universal, but in every constituency one could still walk into an out-patient department and see a picture similar to the one that I have painted. The medical treatment may have been excellent, but did the patient come away feeling that he had been served by the National Health Service?
  In the first day of this debate, my right hon. and learned Friend the Secretary of State said:
  "Patients also tolerate variations in the times for which they must wait for treatment, and … facilities".—[Official Report, 7 December 1989; Vol. 163, c. 500.]
  He will agree with me that in the 1990s the time for tolerating inadequate services is over. His enlightened proposals should increase the pace of change for the better. Administrators and doctors should no longer communicate badly with each other, and with nurses, physiotherapists and technicians and all the people who make the management of a hospital possible. Good management and good morale follow each other inseparably.
  So much for personal accountability. What about financial accountability? A whole generation of doctors, patients and politicians have grown up knowing nothing other than the welfare state and the NHS. It may be free

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  at the point of delivery and financed mainly out of general taxation, but who knows the cost of anything? Only relatively recently have the best GPs become conscious of the cost of drugs, dressings and so on. How many know the cost of operations in the local hospital? More importantly perhaps, do the hospitals themselves know the cost of the operations carried out in them? Do they ever question the bed-stay times in different hospitals for identical operations, or, indeed, the waiting lists in different hospitals where the same surgeon operates? It is hardly surprisng that doctors have been labelled bad managers when they lack the data on which to make decisions and thus the opportunity to debunk that fallacy.
  We know the argument that medicine cannot be equated with a production line. However, the NHS cannot be regarded as immune from normal financial pressures. There is nothing paradoxical about a service run on prudent and businesslike lines. For far too long, this Government as well as their predecessors have chucked money at problems instead of solving them—a palliative if ever there was one. If each family had been asked to write a cheque for £35 each week of the year, specifically for the NHS, I suspect that minds would have been concentrated earlier.
  I commend wholeheartedly the combination of GP practice budgets, now called practice funds, and self-governing hospitals, now called NHS hospital trusts. I believe that each will play a part in increasing choice, efficiency and accountability linked to a developing internal market. I also hope that the new term "self-governing hospitals" will lay to rest the label "opting out" which is used with great effect but a lack of honesty by the Opposition. The Opposition's representation of self-governing hospitals has resulted in many people needing to be convinced that, far from opting out, NHS hospitals will opt in to a new standard of excellence in a service held in such great affection by the British people.
  I entirely endorse my right hon. Friend the Prime Minister's statement that the NHS should be so good that no one will want to go to the private sector. I say that as a practising physician in the private sector— [Interruption.]—no member of whose family has ever been treated other than in the NHS. My wife, my two sons and I have all been in-patients in the NHS during the past 10 years and have much admired the treatment that we were given.
  I welcome the biggest ever increase in the health budget announced in the Autumn Statement. Extra resources will go towards provision of new consultant posts, proper audits for managers, improved information technology and medical audits. Now at last Britain's biggest enterprise will have the opportunity to move away from charity, paternalism and rationing as we prepare for the next century in a time of great demographic and technological change.
  The ultimate test for the efficacy of the Government's proposals will be whether the changes are perceived to be for the better by the only person who matters—the patient. I am confident that owing to my right hon. and learned Friend's persistence—
  Mr. Deputy Speaker: Order. I am sorry to interrupt the hon. Gentleman, but he has overrun his time.
  7.29 pm
  Mr. Tom Pendry: I do not wish to follow the arguments of the hon. Member for Wimbledon (Dr. Goodson-Wickes) or those deployed by the hon. Member for Harlow (Mr. Hayes), whose contribution was a sharp reminder to us all that the pantomime season is upon us.
  My hon. Friends and I could talk at great length about the deep resentment of our constituents—doctors, nurses, ancillary workers, patients and would-be patients—about the monstrous proposals in the Bill, but, because of the restriction on time, I shall confine my remarks to part III which relates to community care.
  Many hon. Members said that the Secretary of State for Scotland did not mention the Bill when he introduced the debate. If hon. Members look at Hansard tomorrow, they will see that the words "community care" did not pass his lips. At least I can agree on one aspect of the Government's approach. Despite the shilly-shallying following the Griffiths report, they took notice of the advice of those consulted and agreed to let local authorities take charge of community care. That is where my appreciation ends. It is unfortunate and arouses much suspicion that the Government do not seem prepared to give the community care part of the Bill much debating time. That has been amply demonstrated.
  Since the Bill was produced only five working days after the White Paper was published, there has been no time for consultation. If hon. Gentlemen wish confirmation of that, they should look at their postbags today. They will find that many organisations have submitted views on the White Paper and the Bill, but they are too late for inclusion in this debate.
  Community care is of particular concern. As the House is aware, there are already some 6 million disabled people with about the same number of unpaid carers. By the year 2001, the number of people aged 65 and over will have reached 9 million, 1·15 million of whom will be over 85. The Bill in no way addresses itself to the magnitude of that problem.
  The Government may well have appointed local authorities to play a leading role in community care, but as usual they are unwilling to provide the resources that are essential for the system to function properly. The Bill is insubstantial. It needs to spell out clearly what is expected of local authorities which are undergoing ever-increasing demand on their ever-decreasing resources. The rhetoric of the White Paper has not been translated by the Bill into definitive proposals for action.
  To arrange, organise and devise the necessary services is a mammoth task which has huge resource implications. Again, the legislation lacks detail. How much cash will be available is open to speculation, as we know from arguments already made. By channelling money through the revenue support grant, there is every likelihood that some of it will be diverted into other urgent projects, and we cannot blame local authorities for doing so.
  In order to force local authorities to put their elderly people's homes up for sale, or, as the Government put it, to give them
  "every incentive to make use of the independent sector",
  the funding policy of the legislation deliberately discriminates in favour of private residential care at the expense of public provision. Clearly, that enables the Government to deny that they are introducing compulsory

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  privatisation of care, while effectively doing so for all but the severest of cases. As the House knows, the tendering is to be policed by the Secretary of State for Health who will "issue direction" and "give guidance", whatever that means, to authorities that do not seem to be doing their utmost to stimulate privatisation.
  Will the Minister for Health spell out what powers she intends to take to ensure that local authorities comply with community care plans? How is it possible for local authorities to balance this form of compulsory tendering to the private sector with the requirement to retain facilities where needed? Obviously, the Government have in mind commercially unattractive areas of the market with what they term "challenging patterns of behaviour", which the private sector will not touch with a barge pole.
  Private sector homes will probably concentrate their efforts on the 40 per cent. of the elderly who do not need financial assistance from the state. Others will be cared for in the community—or so the Government envisage. The White Paper called on local authorities to support unpaid carers, yet the Bill does not provide the means for them to do so. By encouraging private sector service provision, the Government believe that that vulnerable sector of society will benefit from the increase in choice, but, as with so many of the Government's ideas, that so-called choice exists only for those who can afford it.
  How can the provision of home helps be both good business for the private sector and yet affordable to the average pensioner, without there being a lowering of carers' working conditions and wages? Why should the elderly and disabled be subjected to the risk of corner cutting and slipshod standards, which will almost certainly arise from accepting the lowest bids for private sector services?
  he legislation seeks to encourage the voluntary sector to play an even greater role in care provision, while failing yet again to provide the resources needed to fund such a change. I have discussed the Bill's proposals with many national and voluntary organisations, of which Crossroads is the largest. It provides direct services to the disabled and to informal carers and families in their homes.
  Crossroads can give voluntary help to 12,000 families, but it already has 7,000 on its waiting list. It has told me that it fears that funding will be insufficient to fulfil all the unmet needs that already exist in our constituencies and that voluntary funding is not a realistic option. It raises as many funds as possible, but it cannot possibly be expected to meet all the cost by voluntary donation. Many depend on joint finance and are worried that local authorities will not pick up the bill, should joint finance come to an end, as the legislation implies.
  Crossroads has monitored a marked tendency among local authorities to focus dwindling resources on the highly dependent. If the legislation is implemented, even greater numbers of such people will be dependent on community care and local authorities will be forced to prioritise even further. Naturally, they will focus on the most dependent. That will leave carers, already a low priority group, even further out on a limb, increasingly burdened and possibly receiving poor standards of help.
  My local borough of Tameside has informed me that it may well prove difficult to develop the voluntary sector as
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  the Government want. Despite good contacts with Age Concern and other organisations, a common voice is lacking and there is little tradition of these groups working together.
  The Bill is a direct attack on the quality of life of many women in society, as women make up the vast majority of paid and unpaid carers. The provision on contracting out community care poses a threat to many jobs, especially among members of my sponsoring union NUPE. Those who manage to keep their jobs are likely to see pay and conditions deteriorate under the private sector. The legislation will lead to yet more women taking on the role of unpaid carer while receiving no extra financial help, at a time when the poll tax will add yet another heavy burden to their daily lives.
  This commercialisation of community care has been described as a "charter for despair". How true that description is. It is hardly surprising, knowing the Government's record, that the old, the disabled and the mentally handicapped now have cause to feel as though they have a shelf life rather than that they deserve a life which can be both longer and of greater quality.
  7.38 pm
  Mr. Kenneth Hind: As my right hon. Friends have recognised, the National Health Service is not a sacred cow that is incapable of reform. The 1987 Conservative manifesto suggested reforms. Now we face the reality of the considerations to change and improve it. The emphasis is on patient care. The Bill is about improving the standards of care for patients. If we look at the Bill from that point of view, we are looking at the driving force behind it.
  The new system is patient-led. It is based on demand and the needs of the patient. The money will follow the patient. We have tackled the problems connected with waiting lists and the closure of wards. Nobody has considered in the past where the demand really lies. With money following the patient, it will be made available where that demand exists. The demand is for hip replacements and cataract operations. They are among many of the items towards which Ministers have directed their waiting list initiative.
  There was a real need to tackle the problems in the National Health Service. Two years ago there were articles in the press and letters from our constituents suggesting that the NHS needed to be reformed. We have now devised a solution. It may not be acceptable to the Opposition, for the simple reason that we have not followed the old formula of throwing money at the problem and hoping that money will solve it. Money has to be adequately and efficiently spent if we are to provide maximum care for the patient.
  The Opposition can tell us nothing about care. In the 1970s when the Labour Government were in office there was a cut of one third in the hospital capital building programme. That is why so many people have had to wait for a very long time for new hospitals. Waiting lists increased by 250,000 and nurses' pay decreased by a fifth. There was a 3 per cent. cut in real terms in the National Health Service budget for 1977–78. The Opposition cannot, I repeat, tell us anything and they have offered no solutions in the debate. The public will judge them on their record. When the Bill is considered in Committee, the

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  Opposition will have to table amendments, which presumably will be based on the Opposition's ideas. We shall then be able to judge them.
  Various criticisms have been levelled at the Bill, including GP budgets. They do not exist; there is simply a guide for GPs as to the money available to them. Information about the treatments that a general practitioner has prescribed over the past three years can be fed into a computer. That will include the background and the age profile of the GP's panel. It can be allied to the panel's prescription patterns. It enables one to find out what the general practitioner is likely to spend on his patients in the forthcoming year. That is a sensible approach. We need to know what will be spent on patient care. The system is based on technology.
  If my constituents believe that the Government are imposing a cash limit on the budget for GP treatment, or the drugs that are prescribed, ignoring the fact that a doctor may have heart bypass patients, or AIDS patients, or people suffering from influenza, they must think that we are well and truly off our trolleys. The system has been devised to give guidance on how much money is spent, and that is all.
  The funding of the National Health Service has not changed. It is paid for by taxation and it is free at the point of delivery. All that has changed is the organisation of the funding, and the public should have no fears.
  On drugs and practice budgets, who will decide whether prescribing practice is adequate for modern treatments? That will not be decided by officials or Members of Parliament. Doctors will examine the practice of their fellow doctors. They will decide whether, in certain circumstances, it is reasonable to prescribe a certain drug, or whether there is an adequate generic substitute. Judgments will be made by one doctor about other doctors. Clinical decisions will not be made by those who are not qualified to make them. Doctors will make them.
  It has been suggested that because the money will follow the patient, he will be sent to the hospital that can provide the cheapest treatment and that he may have to travel a very long way for it. Today, 80 per cent. of patients are treated in their local hospitals. That pattern will, I am sure, continue. The hospital in my area is small and relies for certain essential services on hospitals in Liverpool, Manchester and Wigan. It will continue to rely on them for those services. If, however, there is a waiting list in a certain area, the patient will be able to say to his GP, "I need care urgently: can you look, using the new technology, for a bed somewhere else so that I can get help quickly?" No patient will be obliged to go to the hospital with which the GP has an arrangement. He will be able to choose his GP, the hospital and the consultant. My right hon. and learned Friend the Secretary of State for Scotland said that there will be a fund for those cases.
  The role of the district health authority will be crucial. People have asked how the provision of health care for particular groups will be protected under the new system. It will be protected because of the obligation on the district health authority to provide a full range of health care for the people in its area. In the vast majority of cases, people will follow the pattern of the past and go to their local hospital. For my constituents, for example, I expect some treatments to be available in Wigan, Manchester and Liverpool, but it will be for the DHA to ensure proper provision for their health care is made.
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  Hospitals, it is claimed, will be able to opt out. That is nonsense. They will be NHS hospitals, controlled by the NHS and funded by central Government. The Government have provided a 45 per cent. increase in real terms in health care. It has tripled since 1979—
  Mr. Deputy Speaker (Mr. Harold Walker): Order. Mr. Doug Hoyle.
  7.48 pm
  Mr. Doug Hoyle: As the joint president of the Manufacturing, Science and Finance Union I do not intend to refer to matters that have already been discussed. I intend to refer to the forgotten people, the 40,000 members, apart from junior hospital doctors, whom MSF represents. Most of them are speech therapists, clinical psychologists, medical laboratory scientific officers and hospital pharmacists.
  I know that the House has a great deal of goodwill towards speech therapists. An early-day motion signed by 96 hon. Members recognises that speech therapists in the Health Service are being treated most unfairly. Despite being highly skilled professionals, they are badly paid because it is almost entirely a female profession. Speech therapists are badly paid compared with other professions in the Health Service. We in MSF consider that they should be comparable with other professions such as clinical psychologists and hospital pharmacists. We are waiting for a review tribunal to look into the matter. Meanwhile, speech therapists have been offered an increase of only 6·5 per cent. and that is causing a great deal of concern. I received a letter from a speech therapist who has been qualified for 33 years, yet her salary is only £10,947. Will the Minister who replies to the debate say what the Bill offers speech therapists as a profession?
  Clinical psychologists are also highly qualified but they are leaving the Health Service in droves because the pay in the Health Service does not compare with that in the private sector. In the private sector they are used in top management and would not receive below £30,000 but at the top grade in the Health Service they receive just over £28,000. The Department of Health commissioned management consultants MAS for advice on clinical psychologists. There are rumours that the advice was that the conditions and salaries of clinical psychologists should he compared with those of consultants. Can the Minister confirm whether that is true?
  Hospital pharmacists are also on the front line. The Bill is the thin end of the wedge for privatisation. It has started in Greater Glasgow health board which is the largest regional health service in Britain. It was caught out because it placed a notice in the official journal of the European Community asking for private companies to tender for pharmacy and laboratory work. Studies are still being undertaken but there is no doubt whatsoever about its intentions.
  There are two major objections to the privatisation of hospital pharmacies. First, a private company would be looking to maximise profit. Hospital pharmacies will simply offer drugs over the counter, but at present they do far more than that. They give clinical advice to doctors and nurses about the correct drugs to use and that service will be lost. Secondly, an even more serious consequence is that many companies that retail drugs also manufacture them. There is a danger of double standards as those companies which obtain tenders will be pushing their own drugs in the

  733
  hospital pharmacy and there could be a conflict of interests. Far from reducing costs, that tendency might increase costs.
  Medical laboratory scientific officers are also in the forefront of privatisation because in certain areas laboratories will be privatised. Before we privatise the laboratory service we should consider what happens in north America where the service is privatised. In north America the staff are poorly trained and the laboratory equipment is old because of the need to maximise profits. Some doctors look at the samples themselves and the errors in diagnosis are as high as 27 per cent.
  Inaccurate tests have led to fatal consequences and many women have died of cervical cancer because they received a negative smear test and the error was discovered far too late. Financial compensation is not much good when lives are lost. The reverse also occurs when people receive a positive result instead of a negative one and again lives are lost. The staff maximise the number of tests. They even take work home. Because they are poorly paid they work long hours for overtime and they are not properly qualified. Laboratory staff are spending seconds on difficult tests which should take quite some time. That is because poorly qualified laboratory staff are working with outdated equipment and private laboratories are reluctant to install new equipment. That is what could result from the privatisation of the National Health Service. Instead of being a professional service, it will be concerned more about profit than about patients' needs. We should be very wary of the lessons to be drawn from north America.
  The Secretary of State will become the Arthur Daley of the Health Service and we all know who "'er indoors " is. The Government would flog off anything and this is only the beginning. The public should be warned because, although there will be a little privatisation before the general election, if the Government are returned to office, there will be wholesale privatisation of the National Health Service. I conclude by applying the words of Lady Macbeth to the Secretary of State:
  "Stand not upon the order of your going
  But go at once."—
  and take the Prime Minister with you.
  7.57 pm
  Mr. Nicholas Bennett: The speech by the hon. Member for Warrington, North (Mr. Hoyle) bore very little relation to the National Health Service and Community Care Bill. He sounded like a trade union spokesman making a bid for the next wage round. There is nothing in the Bill about privatisation and his speech was yet another example of the scare tactics that the Opposition have used in the past year. It is despicable that they should do that; they have managed to scare many ordinary people into believing that the Government would produce a totally different Bill.
  I support the Bill because it is important to examine what should be improved in the National Health Service after 41 years of existence and praise its qualities. I and my family have always used the National Health Service and I believe that it is the best health service in the world. But that does not mean that I do not recognise that it has many grave faults which could be corrected. I believe that the Bill will do that.
  734
  It is interesting that after two days of debate the Opposition have not yet addressed themselves to the many problems that have come to light. General practitioners' referral rates differ greatly. Some GPs refer 25 times as many patients to hospitals as do others and some GPs prescribe twice as many drugs as do others. Operating costs can vary by 100 per cent. between different hospitals in the same district for the same operation. Operations per session can vary greatly between different hospitals, and accident and emergency departments continually complain that most of the vast numbers of people they see are there for entirely the wrong reasons. They clog up casualty departments. Statistics show the difference in the use of the National Health Service from district to district and hospital to hospital. We are entitled to ask why there are such marked divergences in spending and use.
  We must ensure that the expenditure on our Health Service—£28 billion at the last count—is spent properly. That is what I wish to discuss. It is not new for the Health Service to have problems with its budgets and spending. I recently read John Campbell's biography of Aneurin Bevan. On page 177, he says that in 1949
  "there was inadequate financial discipline"
  of the National Health Service. A year after the National Health Service came into operation, Aneurin Bevan, speaking at a meeting in London on 15 November 1949, warned:
  "Now that we have got the National Health Service based on free prescriptions …I shudder to think of the cascade of medicine that is pouring down British throats at the present time. I wish that I could believe that sufficiency was equal to the credulity with which it is being swallowed."
  These problems with Health Service spending and ensuring that resources are properly used have not disappeared.
  It is interesting to read the works of academics who support the National Health Service and want it to be improved. Alan Maynard, writing in the Health Service Journal on 10 September 1987, said:
  "At present the majority of healthcare treatments cannot be demonstrated to be good value for money because their costs are uncertain and their outcomes largely unmeasured. Unless GPs and consultants can demonstrate the superiority of the costs and benefits of their activities, the economic case for financing these activities is absent.
  Consequently the argument that the NHS is underfinanced is seriously flawed. It may be—and only an evaluation of practices will demonstrate it—that the NHS is overfinanced and the existing improvements in health status, or benefits, could be achieved by a budget less than that currently available to the NHS."
  He further said that it is important, if we are to spend more on the Health Service, to ensure that resources are spent properly, that we know the outcomes of operations and that we know that resources have been targeted on the right sectors and operations.
  It was interesting to read shortly after that an article in the British Medical Journal entitled "Mr Q the surgeon", "Conversations with Consultants" by Tony Smith. The consultant said that his hospital formed an economy committee to consider the use of intravenous needles and other disposable materials by the National Health Service. It discovered that it could save £80,000 or £90,000 a year by changing the brand of needles, catheters, bags and other disposable items. Suddenly, there was a National Union of Public Employees strike, and overnight the hospital lost over £250,000 because it was not allowed to

  735
  use its pay beds. He asked what was the purpose of saving that money if the union can lose £250,000 in the next week simply by strike action? He says:
  "If you asked me what can we do about"
  resources in the National Health Service,
  "I would answer that we must stop the terrific wastage in the NHS. The reason for the wastage is that there is virtually no incentive to save in an enormous organisation like this. In your home you are paying the electricity bill and you turn off the lights as you walk out of the room, but in a hospital you don't. Even though many of us may turn out the lights as we walk out of the department in the evening when we come hack in the morning every single light is back on. The cleaners have been in in the night and left them all on."
  The consultant argued that the National Health Service would happily save money if it was told that for every pound that it saved by being careful with disposables, being more efficient, watching electricity, turning the lights off in the evening and the other things that people in the Health Service could do, it could be given back the 10p or 15p in the pound that it saved towards its research funds.
  What surprises me about Labour Members is that whenever we talk about budgets or finance, they say, "We do not want to hear about that; we do not want to hear about accountancy." But we all know that they are very careful with their own money. They somehow assume that there is an unending supply of public money that does not need to be monitored. I only wish that, like the rest of us, Labour Members would treat public money in the same way as they treat their private resources.
  Ms. Diane Abbott: Is the hon. Member aware that we have one of the most cost-effective health services in the world? It is four times more cost-effective than that in the United States, and we spend less per head on the Health Service than any other industrialised nation. Will the hon. Gentleman withdraw the slur that the National Health Service wastes money?
  Mr. Bennett: The hon. Lady's assertion is incorrect. Italy spends less than us. She should consider the figures for the amount of gross domestic product spent on health services in different countries. It is interesting that although Britain spends less of its GDP on health than other countries in Europe, it is largely because many of those countries have a far larger private sector. Much depends on the size of a country's GDP, and Britain has seen the largest increase in GDP over the past two years of any country in the European Community. We should bear in mind the fact that health spending has increased under this Government because we have had the resources to make increases and because we have increased prosperity so much since 1979.
  It is interesting to note the Labour party's policies, or the lack of them. I have read the debate of the first day, and I was present for the speech of the hon. Member for Livingston (Mr. Cook) and on the Welsh Grand Committee when the hon. Member for Alyn and Deeside (Mr. Jones) led for the Labour party in a debate on the National Health Service. What are its policies? We have not heard how it would improve the National Health Service.
  Mr. Hoyle: You are the Government.
  Mr. Bennett: The hon. Member for Warrington, North says, "You are the Government." We are, but the Labour party tries to claim that it is the Government-in-waiting. If
  736
  so, it has a duty to tell the public how it would spend the Health Service budget of £28 billion and ensure that the service was improved.
  Mr. Hoyle: The hon. Gentleman is intent on saying that, but why did not the Conservative party tell the electorate of its policies on the Health Service and seek a mandate for them?
  Mr. Bennett: The hon. Gentleman knows that every Queen's Speech says "Other measures will be laid before you", of which this is one.
  The Labour party believes that we should do nothing to the Health Service and leave it as it is. Let us consider its policies. When the Labour Government were in power between 1974 and 1979, they did not increase spending on the Health Service, as this Government have done, but cut it by 3 per cent. in real terms in 1977–78. They cut the hospital building programme by 30 per cent. in 1976, and hospital closures were 50 per cent. higher under the Labour Government than under this Government. Nurses' pay went down in real terms by 21 per cent. and GP's pay was cut by 16 per cent. The trouble is that the Labour party's policy is predicated not on what the people want but on what NUPE and the Confederation of Health Service Employees want. They want a Health Service run by NUPE and COHSE for the benefit of NUPE and COHSE, not for the benefit of the people of this country.
  I shall conclude by asking three questions, to which I hope my hon. Friend the Minister will reply. The first concerns the definition of "resident" in the Bill. I represent a health authority that, in the summer, covers three times as many people as it does in the winter because of holidaymakers visiting our beautiful county. Can we be assured that we shall be given the resources to deal with those holidaymakers and that they will be defined as being "resident" during that time?
  Secondly, what will happen when someone has been referred to another health district for an operation but it is not done properly and remedial work becomes necessary? Can we be assured that the health district which did the operation will pay for the remedial work and not the health district that sent the patient to the operating district? That is important because it would be unfortunate if the health district that sent the patient had to pick up the bill for unsuccessful operations.
  Thirdly, the family practitioner service authorities should have GP representatives who are elected locally by GPs in their areas. I hope that the Government will consider that carefully when we debate the clauses dealing with FPSAs, because it is an important worry of some GPs and it is worth considering further.
  I draw attention to my health authority, because it is important to talk from the experience of what happens in our districts. I have been immensely impressed by the fact that since Pembrokeshire health authority came into operation in 1982 it has managed to spend resources properly and carefully. It has managed to increase outpatient attendances by 34 per cent., radiology attendances by 24 per cent., occupational therapy attendances by 90 per cent. and operations by 153 per cent. It has managed to save £340,000 by tendering out some services within the hospital, and that money has been reallocated to other services carried out by the health

  737
  authority. The authority has been able to employ 80 more staff this year and the unit of work costs in the DHA are the lowest for all the Welsh authorities.
  It is therefore no surprise to me or my constituents that this year Withybush hospital in the Pembrokeshire health authority region has won an award from The Sunday Times for being the best district hospital in the United Kingdom. That is what can be done if resources are spent properly. The Bill is about making sure that that happens, and I commend it to the House.
  8.10 pm
  Mr. Ian McCartney: As a member of the Select Committee on Social Services, which for 12 months has been carrying out a review of the Government's proposals and the deliberate underfunding of the Health Service, it was my original intention to discuss the amendments which have been tabled in the name of my hon. Friend the Member for Birkenhead (Mr. Field). If my hon. Friend is not in his place, I intend to move those amendments formally at 10 o'clock.
  I should like to discuss the implications of the review for my constituency. Because of the proposals and the Government's preparation for the reorganisation of the Health Service, my constituents in the Wigan metropolitan borough find themselves in an incredible position. The health authority has proposed the closure of five hospitals which cover not only my constituency but those of my hon. Friends the Members for Wigan (Mr. Scott) and for Leigh (Mr. Cunliffe) and the hon. Member for Lancashire, West (Mr. Hind). This summer, I wrote to the Under-Secretary of State about the way in which the matter was approached by senior officers and the chair of the health authority and in general about the cavalier attitude towards the proposals, in that no proper consultation was taking place with the community health council, Members of Parliament or the local authority.
  At a meeting held in private, on the ground that it was not an issue that involved the public interest, the Wigan health authority decided to employ Amec consultants, an American company which owns Fairclough Construction and Fairclough Homes. The company was offered the use of public money to come forward with proposals to reorganise the health service in Wigan, in view of the Government's proposals in the White Paper and the need for the local authority to take account of the market-based economy which would thereafter operate both within the health authority and in terms of its relationship with other health authorities in the north-west.
  The contract was awarded without public scrutiny. People were not able to make submissions and there was no proper check on funding for the contract. Amec proposed that the health authority close all five hospitals —Billinge, a maternity and general hospital in my constituency, which has a large section for the mentally ill, Atherleigh, a hospital for the frail elderly and those with senile dementia, the Wigan Royal Albert Edward infirmary, an accident and emergency unit and general hospital, Leigh hospital, an accident and emergency unit and a general hospital with a new section for the mentally ill, and Astley general hospital.
  The proposal was to close the hospitals and to sell the land, without tender, to Fairclough Homes and
  738
  Fairclough Construction. Subsequently, the health authority decided to close all five hospitals and to approach the regional health authority to fund a new single-site hospital, which was to be built by Fairclough Construction without going to public tender. I wrote to the Minister asking him to intervene, taking account not only of any public impropriety but of the view of my constituents, the local authority and the community health council, which opposed the way in which the matter had been handled. The Minister not only rejected my appeal but wrote a letter supporting the idea.
  Four weeks ago, the situation changed for the worse. The health authority—because of Amec's recommendations—withdrew a request for funding for the reorganisation of Leigh hospital and its redevelopment phase. Two weeks ago, the North Western regional health authority advised the Wigan health authority that the Government had not made available a single penny of capital resources for construction of a new hospital. My health authority is going ahead with the programme of closure of five hospitals, with no plan for alternatives. That is happening because of the Minister's encouragement.
  This action is unhealthy and is a gross dereliction of duty by the health authority and the Under-Secretary of State, who could have intervened this summer but refused to do so because of his ideology on the review of the NHS. The hon. Member for Lancashire, West, who has left the Chamber, shares a constituency boundary with me. He should tell his constituents—in Up Holland—what will happen to the maternity unit at Billinge hospital, which covers the south-east of his constituency. He should tell them what is happening in terms of patients following money at the Wigan Royal Albert Edward infirmary. There will be no hospital to follow. What will prevent the health authority from implementing hospital closures? The Secretary of State has refused to provide the regional health authority with funding for construction of a single unit to replace the five hospitals.
  The Minister refused to intervene this summer when I wrote to him about Atherleigh hospital. With 24 hours' notice, the health authority was decanting patients into the private sector without consultation with the community health council, the social services department, patients their relatives, or their representatives—a huge proportion of the residents of Atherleigh—on the ground that the authority's financial position was so serious. A confidential report, which was leaked to the four Members of Parliament affected, showed that provision has already been made for the hospital to close and for the private sector to receive from Wigan health authority over 124 additional places for the frail elderly.
  A private sector nursing home in my constituency recently submitted a planning application to extend its premises, on the ground that the local health authority would provide additional patients because of the closure programme. To do that, the nursing home sought an amendment to a previous planning application to get rid of the physiotherapy unit, recreation area and the hydro-pool facility. Those facilities are important to the environment of people living in public or private sector homes and needing long-term care. Because of my health authority's decision, the home was prepared to get rid of those facilities to provide additional beds, at a cost to the taxpayer.
  The Minister owes us not just a scanty explanation. He failed to answer my points on the three occasions that I

  739
  raised them. He cannot do that now. He will have to sit down with the four Members of Parliament concerned and tell us and our constituents what we are to do about the crisis.
  The health authority is embarking on a programme of closure of our facilities, but with no alternative facilities with which to replace them. The Minister cannot simply hide behind the claim that it is a matter for the district general manager and the health authority. He positively encouraged the authority to go down that road. Nor can he hide behind the fact that the health authority needs to take account of changing circumstances.
  What would his position be if he were Under-Secretary of State for the Environment and a Labour or Conservative local authority sold off, without tender, large-scale public assets or became involved with a private sector developer in the wholesale disposal of public assets at a knock-down price? He would be the first person to bring in the district auditor to examine the way in which that local authority was operating, yet he, as a result of his inability or unwillingness to act in the matter over the summer months, has been a party to the asset stripping of resources in my constituency.
  He owes it to me and to my constituents to meet us at the earliest opportunity to resolve the issue.
  The Parliamentary Under-Secretary of State for Health (Mr. Roger Freeman): Before the hon. Gentleman sits down, I must point out that, as he probably knows, I shall not be replying to the debate. My hon. Friend the Minister for Health will be replying. However, I and my officials will read the record of what he has said because he has made a number of allegations about me personally. As I shall not have the opportunity to reply in this debate, I shall write to him and send copies to the hon. Members who are affected.
  Mr. McCartney: I thank the Under-Secretary for those comments. Perhaps he will also agree to meet us to discuss the activities of my health authority.
  Again as a result of the cut in resources, nurses leaving the training school in the hospital in my constituency this month have been informed that there is no placement for them in the health authority. That has happened at a time when the Government are, supposedly, spending £4 million on advertisements to encourage people to join the nursing service. At the end of this month, my local trainee nurses will be receiving in one hand a certificate saying that they are trained nurses and in the other hand a redundancy notice.
  What will the Secretary of State do about that? Is he prepared for public money to be wasted in that way? Is he prepared to see nurses going through a full training scheme and at the end of it being told that neither the health authority in Wigan nor nearby health authorities are able to give them a position as a result of cuts in their budget for this and next financial year? Those trained nurses will have to sign on the dole in January 1990. The reality of the Government's policy of public expenditure cuts is reductions in services, a reduction in the overall money spent on nurse training and the asset stripping of the resources of local district health authorities.
  Mrs. Mahon: Will my hon. Friend take on board what is happening to enrolled nurses? A scandal is being allowed to happen. The 150,000 enrolled nurses are the backbone of our nursing profession. Fifty thousand of them have
  740
  applied for conversion courses, but there are only 1,000 places. It will be well into the next century before even one quarter of those nurses are retrained under the Government's own training programme.
  Mr. McCartney: My hon. Friend is right. The Select Committee on Social Services, in an earlier report this year, pointed out to the Government their failure in trying to provide resources for training in other aspects of the Health Service. The Government are already damaging the Health Service at local level. The Bill will do nothing other than further damage it and that is the all-party view of the Select Committee, which has examined the matter in great detail not over just a few months, but over a lengthy period. The Committee's report on the way in which the Government have handled the issue has the support of both Conservative and Labour Members.
  8.23 pm
  Mr. Mark Wolfson: I welcome the clear confirmation that was given, once again, by the Secretary of State in the debate last Thursday that the fundamental principle on which the Health Service reforms are based is that free medical treatment should be provided regardless of means and financed largely by general taxation. I also welcome the undoubted fact that the resources that are being made available to the Health Service by this Government have been increased steadily and that the past two public spending rounds have themselves raised the available cash by more than 20 per cent. I am also aware of the essential need to make the best use of every penny of those resources. That requires a public Health Service that is efficient and where waste is minimised. Many of those who now work in the Service, dedicated and effective as they are, are not at all satisfied that the National Health Service today uses its resources as carefully or effectively as it should. They too want reform and they too look for improvement, even though they may disagree with some —or in some cases all—of the proposals.
  It is of key importance that the decision-making process in the Health Service and the objectives of each unit and department in it be clarified and improved, and that the opportunity for local leadership and more localised decision-making be increased. The Bill aims to do this and addresses the issues that can enable that to happen.
  During my 10 years as a Member of Parliament, my experience is that complaints against the quality of care that is given by the Health Service are very few and that, in the main, they refer to the length of the waiting list for consultation and for treatment in specific areas of difficulty. These are the orthopaedic and ear, nose and throat specialisations. There is also a continuing problem of providing adequate care for the elderly and infirm, and for those most vulnerable groups in our society—the mentally ill and handicapped. I accept that the provisions are designed to deal with those issues, but however good the intentions, they will not be realised unless the available resources are increased continually, as well as the organisation being improved to deliver the service as efficiently as possible.
  I am concerned, as other colleagues have already said that they are, about resources. The overall funding of the Health Service makes no provision for pay alone. A centrally-assessed allowance is included which is meant to cover pay and general price increases, and it is left to individual authorities to use that sum to suit best their own

  741
  circumstances. The point at issue is the overall adequacy of that allowance. For some years now, the level of inflation that has been experienced by the health authorities outside their control has exceeded the national provision. I know that extra resources have been given, especially for pay review body awards, but they have not covered the true additional costs.
  We are all aware that the Health Service is highly labour intensive and that any underfunding on pay is critical. It is a fact that there is a considerable difference between the index increases that the central allowance takes into account and the actual inflation in wage costs that the health authorities have had to pay. The result is that despite the necessary additional finance, which is welcome, health authorities have had to supplement their provision for inflation from their existing resources. I agree that that pressure has led to increased efficiency, a better use of resources and a more streamlined and cost-effective system, but there is a limit to the savings that can be achieved in that way. The squeeze has, in many cases, made the pips squeak, but when the pips themselves are dry the service will suffer and the level of care will decline.
  I accept that the demands on the Health Service are continuing to increase. That is for good reason. The benefits of medical advances keep people alive and well for longer and the expectation of a full life into old age is vastly greater than it was even 20 years ago. But that means that to fulfil its proper role the service must be adequately staffed on a cost-effective basis.
  In my health authority area the use of agency staff has been growing rapidly. Low rates of pay and a high level of local employment are making recruitment more and more difficult. Agency staff are required and must be used in all disciplines. The premiums paid to agencies represent a loss of purchasing power to the health authority, and the presence of such agency staff, often on higher pay rates and sometimes with less commitment to the unit in question, creates problems with staff morale.
  I highlight the problem of resources not as criticism of the Bill, which I support in principle and which I believe will provide the opportunity to deal with the issue of local wage rates more effectively, but because it is necessary continually to remind Ministers of local pressures and the problems on the ground.
  I now turn to community care, for which the proposals in the Bill are positive. They tackle the problem that has bedevilled community care for years—the split responsibility between local authority and health service—thus providing a better base for dealing with what is bound to be a mounting social and financial responsibility in the years ahead.
  I have important reservations, however, which I want to air. The first is that central funds for local authorities to cover community care should be ringfenced. I am not confident that without this local authorities will continue to direct those funds to the main purpose for which they are intended.
  Secondly, I want to emphasise that removal of patients from mental hospitals must be strictly limited from now on to equate exactly with the provision of alternative facilities in the community. Those new facilities require buildings and adequate staff; until now, the arrangements have too
  742
  often been the wrong way around—closing existing facilities before new ones are ready. I welcome the fact that recent ministerial statements have dealt with this important issue but we now expect to see the policy followed in practice. As I am sure the Minister of State knows, many professionals in the field exactly predicted the problems that have arisen when the wholesale closure was first mooted.
  Finally, I ask my right hon. and learned Friend to do his level best during the passage of this important Bill through both Houses to listen and respond to the continuing anxieties of many who work in the Health Service and in the service of community care. Some of those concerns are not necessarily politically motivated. They are genuinely based on professional knowledge and a wish to see the Health Service improve. I accept that the BMA's propaganda got it badly wrong.
  I shall support the Bill tonight, but with some reservations and with the firm expectation that a well-intentioned Bill can be improved during its passage through the House, provided that the Secretary of State is prepared to show flexibility and to respect views that may differ from his own. That is what well-respected doctors, highly qualified and thoughtful paramedics and sensible staff at all levels of the service in my constituency want, and I support their view.
  8.34 pm
  Mrs. Alice Mahon: This Bill and the White Paper on community care do not face the real health demands of a growing elderly population who are becoming more frail by the day and more dependent on all of us. The Bill does not deal with the problem of caring for the mentally ill or handicapped, or the problem of those who are languishing in prison and on remand and who would not be so doing had there been proper care in the community.
  The Bill does not address the problem of the large number of homeless people who have suffered from mental illness in the past—[Interruption.] If the Secretary of State would pay attention for a moment he might agree that it would be a good exercise to carry out a survey of the number of such prisoners on remand or of people who have ended up in cardboard boxes on the Embankment. He would then have to admit that his policies on community care have been a total failure; and to judge from the White Paper, they will get even worse.
  The Bill and the White Paper do not deal with how to shift our policies towards preventing bad health and they offer no strategy for real care in the community. Most of all, the Government proposals will do nothing to improve the low morale that is endemic among NHS staff.
  I have mentioned, in an intervention in the speech of my hon. Friend the Member for Makerfield (Mr. McCartney), what is happening to enrolled nurses. It is scandalous that neither document contains a word about retraining of and proper training for nurses.
  I cannot remember morale among nursing staff and everyone working in the NHS being so low. The Secretary of State said that I was not qualified to vote on the Bill; that highlights his attitude to the rest of us. At least I gave many years of my life to working in the NHS and I have a greater understanding of its problems and of the staff who work for it than he has.

  743
  The logical conclusion of the Government's proposals on opting out of district health authority control and setting up hospital trusts is privatisation, and no amount of denial by the Secretary of State, other Ministers or Conservative Members will convince the public otherwise. If these proposals go through, the hospitals in my area will be called "Halifax General plc" or "Halifax Royal Infirmary plc". Unless public pressure can make the Government change their mind, that will be the logical outcome. Once hospitals are set up as businesses, with information systems that show the cost of every treatment in the smallest detail and with the freedom to borrow in the City and to hire and fire at will, that will be the direction in which we shall move.
  The Secretary of State treats the rest of us with contempt if he does not realise that we have rumbled him and his plans. What he says about doctors scaremongering is rubbish. I hope that they carry on with what they are doing. The only people who appear not to be listening to them are the Secretary of State and those who support him.
  I asked the Secretary of State some months ago to give me a guarantee that the accident and emergency services in my district health authority area would remain there. He did not give that guarantee, and I warn all Government hon. Members that they could lose their accident and emergency services if managers decide that they can purchase them adequately from elsewhere. I am not willing to hand over that reponsibility without a damn good fight. The manager in my area came from British Steel, where he did a good job closing it down for the Government before being made redundant. Will a Minister give us a guarantee tonight that he or she has had a change of heart about this proposal?
  There has been much talk about privatisation and the saving of money. There was a small example of privatisation in my local authority area when the Secretary of State was a Minister at the Department of Health and Social Security in 1983—he was not then top dog. There were proposals to build a new laundry in Calderdale before the 1983 general election. The proposals had been worked up and costed and we were going to go ahead, but we were told that a decision could not be made for some months because of other priorities. After the election the Secretary of State said that the laundry had to be put out to tender and that we could not build a new one. We put it out to tender and won by a margin of just over £12,000. The Secretary of State said, "That's not good enough. Try again." With the help of the trade unions which are much maligned by the Conservative party, we worked up another scheme and won the tender by a margin of £250,000. The Minister said that we still had to privatise. So we did. Since then, the laundry service in my district health authority has gone from bad to worse. Elderly patients have had no underwear and patients were sleeping on paper sheets. There has been a series of disasters because the Minister said that privatisation had to go ahead regardless of the fact that it would have been cheaper not to privatise by a margin of £250,000.
  Mr. McCartney: The privatisation of laundry services highlights most effectively what goes wrong when a market philosophy is imposed on a health authority. The laundry services in my district health authority have been
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  privatised. The district general hospital had to cancel operations because the privatised service could not provide clean linen when the hospital required it.
  Mrs. Mahon: Many hon. Members have experienced similar difficulties in their constituencies.
  Privatisation in the NHS is bad for the patients. The Government introduced managers into the NHS from the business sector and they propose to introduce more of them under the Bill. The community health councils are not to be strengthened and the local authority representatives are to be kicked off DHAs because Government-appointed managers do not want any opposition. In many instances managers do not have the interests of patients at heart, as the Minister would like us to believe. In my district health authority a couple of years ago a manager referred to elderly patients as "bed blockers". I cannot think of a more dehumanising statement than that.
  The management have done their job for the Government. They have privatised the care of the elderly almost wholesale. What is left of that care is to be finished off under the White Paper. What choice does the White Papter offer to the elderly and their relatives? If all that the elderly have on offer is a private home, where is their choice to enter the public sector? There is no choice, as the Government are well aware.
  The Government have based the White Paper and the Bill on the model that they saw in America. Under that disgraceful model, 40 million people in the richest country in the world have no access to any kind of free health care. The future for Britain can be seen in the provision of health care in America.
  The Government do not want to improve access to decent free health care in this country. Their cynical and provocative attitude to the NHS staff over the past 10 years proves that. Indeed, nothing proves it more than the way in which the Secretary of State is upping the dispute with the ambulance service. We know what he is up to and we do not trust him.
  It has been said that the Secretary of State is ambitious. In the past, I understand that his name has been put forward as a possible leader of the Conservative party. That has nothing to do with me and if I pursue that I might be ruled out of order. However, the writing is on the wall for the right hon. and learned Gentleman and his career. Just about every section of opinion is against his proposals in the Bill and in the community care White Paper. He cannot fly in the face of that tide of human hostility and hope to get anywhere in politics. He is finished and I for one think that that serves him right.
  8.43 pm
  Mr. David Nicholson: I welcome the provisions in the Bill for community care, and I also welcome the presence of my hon. Friend the Minister for Health in the Chamber. I believe that this will be the first debate in which I have spoken to which she will reply, although I did speak in the debate on community care in October. I also support the points made about community care by my hon. Friend the Member for Sevenoaks (Mr. Wolfson).
  In The Times today there is a headline
  "Hospitals account for over 80 per cent. of mental health care".

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  The article states that a report published by the Office of Health Economics today points out that spending is concentrated in hospitals rather than in community provision. I welcome the fact that, since we debated community care in the House, my health authority in Somerset has produced a consultative document about the provision of services for health and community care and the measures it is taking to update those services.
  The report states that the current pattern of services does not provide the ideal network for ensuring that the population of Somerset, which the district health authority serves, has an equality of access to a modern health service. It states that through the introduction of efficiency savings and income-generation programmes additional funding has been provided. A good example of that are the major funding strategies supporting the successful care in the community policies for the mentally handicapped and mentally ill.
  The report states that large institutions, to which I referred in our earlier debate, such as Mendip and Tone Vale were an enormous drain on resources requiring huge expenditure every year on such items as fuel and maintenance. Many of the buildings in that care group have serious building defects and are uneconomic to repair and modernise. They are also too large and functionally unsuitable for modern mental health care practice. The sooner the authority's strategy of replacing those institutions with small community units can be implemented, the more it will be possible to avoid expenditure on repairs and fuel in those old buildings. I strongly commend that proposal by Somerset health authority and I hope that it will be able to serve the Bill's principles with regard to community care.
  I want to make three basic points about the main issues facing the National Health Service and its future. I want first to refer to resources to which my hon. Friend the Member for Harlow (Mr Hayes) and others have referred. I draw the attention of the House to the contrast between two sets of figures showing total NHS spending per head for England over the past 10 years. Over the four-year period1982–83 to 1985–86, inclusive total NHS spending per head rose by £52. Between 1986–87 and 1989–90 it rose by £104, the rise being from £340 to £444 per head. I have not translated those figures into real terms, but I believe that they show a marked increase in resources in the Health Service over the past four years.
  Hon. Members asked earlier why the proposals in the Bill did not feature in the 1987 Conservative party manifesto. All of us encountered strong pressure in our constituencies with regard to NHS resources at the time of the 1987 general election. Since then the resources have been provided and we have produced proposals to ensure tht those resources are used properly. Within the context of resources, I support the point made by my hon. Friend the Member for Sevenoaks with regard to the pay of certain NHS staff. I am not referring to the doctors, nurses or even the ambulancemen. I am referring to the semi-forgotten sections of staff who are badly paid. I hope that as a result of the thrust of the reforms in the Bill we shall see a certain negation of the trade unionism in the NHS. That trade unionism has meant low productivity and also low pay for so many people working in the NHS. I hope that the Bill will remedy that.
  Mrs. Mahon: Will the hon. Gentleman give way?
  Mr. Nicholson: I am afraid I will not give way, because, as the hon. Lady knows, several other hon. Members wish to speak.
  Earlier this year we saw a concentrated argument about GP services. The Government have made clear their commitment to GP services and made clear pledges against the deceitful propaganda put out by the British Medical Association. Last Thursday my right hon. and learned Friend the Secretary of State cited, as an example of the misuse of drugs under the present system, the fact that 1 million tablets had been found in the space of two weeks in Avon and Somerset. For me, that example was pretty close to home.
  In recent weeks the controversy has switched to the issue of self-governing hospitals. Certain hon. Members have suggested a referendum, but it is impossible to hold a referendum on such a hypothetical matter when everyone is being bombarded with propaganda to the effect that the service will get worse. I would have no objection, however, to a local poll to assess the performance of self-governing hospitals—two years, say, after they had become self-governing—and I hope that my right hon. and learned Friend will consider that suggestion. After all, if the measures in the Bill do not lead to an improved service, they are not worth enacting.
  My final point is political. The Bill's opponents—the Opposition, the British Medical Association and, at times, my hon. Friend the Member for Macclesfield (Mr. Winterton)—claim that the Bill will lead to lower standards of health care, and at the beginning of the debate the hon. Member for Glasgow, Garscadden (Mr. Dewar) claimed, like others, that a two-tier system would result. Let me emphasise that I have no intention of allowing my constituents, my neighbours or indeed my family to be dragooned into using private facilities instead of the National Health Service that we have all used hitherto. They are committed to the service, as am I, and I believe that my right hon. and learned Friend also uses and is committed to it. I entirely reject the accusation that the Government's proposals are a Trojan horse to promote the extension of compulsory private facilities.
  My hon. Friend the Member for Cheadle (Mr. Day) spoke about health in the debate on the Queen's Speech. He and I were the only Conservative Members from the 1987 intake to vote against the abolition of free eye tests, a subject on which the hon. Member for Livingston (Mr. Cook) has spoken forcefully, as he did in this debate. Many of us listened to the hon. Gentleman with rather more than respect on the earlier occasion; I am sorry that he did not find a rather more worthy cause to which to devote his talents today and on Thursday. Nevertheless, I think that lessons have been learnt from our experience in the Lobbies when we voted on eye-test charges, and that is one reason why I believe that the underlying principles of the NHS will be safe under the Bill.
  I do not believe for a moment that our opponents are right. They are on a high-risk road, because they do not simply claim that the Bill would make no difference. That might be credible, for we have all witnessed the introduction of legislation accompanied by a flourish of trumpets—the Health Service legislation of some 10 years ago is an example—only to find its implementation and

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  practice somewhat disappointing. Our opponents, however, have chosen to claim that the Bill will restrict and neglect the NHS, while my hon. Friends and I believe that it will enhance and expand it.
  As we draw near the end of this two-day debate we must ask, "What if our critics were right and virtually every Conservative Member was wrong?" In that event there would, I think, be three consequences. Two are fairly obvious, being political and personal, but the third would be much greater local political interference in the NHS. No hon. Member worth his salt would tolerate a worse or more inconvenient service for his constituents: we all want and intend to enhance the present service.
  As for the other two consequences, they would affect my party and my right hon. and hon. Friends who are in charge of the Bill. I do not believe for a moment that either my party or my right hon. and hon. Friends are bent on political suicide. For that reason, I strongly support the Bill and believe that, before the next general election, it will bring forth the fruits for which we aim. I therefore hope that the House will give it a powerful Second Reading vote.
  8.53 pm
  Mr. Eric Martlew: In the debate on the Gracious Speech, I spent some time comparing the amount that we devote to our Health Service with that devoted by Europe and America to its counterparts. The fact is that we devote a far smaller proportion of our gross national product to our Health Service, which means that our Health Service is very efficient. I wish that Conservative Members would accept that.
  I also spoke about reorganisation, pointing out that over the past 15 years the Health Service had been reorganised three times, each time by a Conservative Government. The Conservatives seem to accept that those reorganisations failed; what frightens me is that, if the Bill becomes law, it will succeed—succeed, that is, in privatising the NHS. For that is what the Bill is about: it is a privatisation enabling Bill.
  If we do not defeat the Bill, or defeat the Conservatives in the next election, within 10 years the spivs of the City, Wall Street and the Tokyo stock exchange will be picking over the bones of the National Health Service, and we shall see our local hospitals quoted on the Footsie index. The Secretary of State is encouraging such an outcome by attacking those who provide the care and deceiving the general public.
  Was it not the Secretary of State who accused the doctors of reaching for their wallets? Was it not he who gave the impression that GPs earned £65,000, when in reality they earn half that? Was it not he who gave the impression that they were working 24 or 38 hours a week, when the flu epidemic is forcing doctors in my constituency to work 50, 60, 100 or 138 hours a week to care for the sick? That is happening in every constituency, but the Secretary of State tries to tell us that doctors do not work hard. Was it not he who attacked the ambulance personnel? He said at the Dispatch Box that they had not been responding to emergencies; in fact, they have not only responded but done so without being paid for it.
  The Government told the nurses that their regrading and pay claim would be fully funded. I met a delegation from the Royal College of Midwives in my constituency. They were very perturbed that the core of the Bill made no
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  mention of maternity services, and were also very concerned about regrading. They know that they are worth more than East Cumbria health authority is prepared to regrade them to, but the fact is that the health authority cannot afford to regrade those midwives.
  I accept that a considerable sum of money went towards nurses' pay last year, but how the Government and Ministers can put that amount of money into a service and make such a hash of it that people are more demoralised after the pay increases than they were before is almost beyond me. The reality is that the Government are so inept that they squandered the resources. As a result, the nursing service is more demoralised now than in any of the 14 years in which I have been associated with the NHS. The National Health Service is the largest employer in western Europe. It needs great skills and great leadership in man-management at its head, yet we have a Secretary of State who goes around acting like a boorish bully.
  I turn now to community care. The principles of care in the community are excellent, but during the past 10 years those principles have been degraded by the Government's efforts. To the Government, care in the community has meant saving money and closing wards. As we leave the Chamber tonight and go home to our nice comfortable flats, we shall be able to see the results of that care in the community—on park benches, sleeping in shop doorways in Victoria street, and in cardboard boxes under Waterloo bridge. That is what community care has meant under this Government.
  I have received a letter from voluntary organisations in my constituency which are deeply concerned about the White Paper. In essence, they have said that they cannot be the substitutes for statutory services. The Government cannot get away with voluntary organisations doing that work on the cheap. Those volunteers volunteered to help society, or a specific part of it. They do not want anything to do with taking over statutory responsibilities.
  Mr. McCartney: I have had experience of the way in which the Government are attacking the voluntary sector in my constituency. An elderly lady in her 80s has been looked after at home for several years by her daughter who is now in her late 60s. That saves the National Health Service and the community care budget between £300 and £400 per week. However, the daughter was notified only last week that the number of incontinence pads would be cut from 300 to 120. The daughter, herself a pensioner, will have to make up the difference because the health authority does not have the resources to maintain the supply of pads so that that elderly pensioner can look after her elderly mother at home. That is the Government at work.
  Mr. Martlew: I accept what my hon. Friend says because there are similar cases in my own constituency.
  The voluntary organisations are also concerned because there is no talk in either the White Paper or the Bill of extra funding for community care. Community care is not a cheap option. It needs extra resources and we are fearful that the Government will not provide them.
  The question tonight is not whether the community cares, because the community that I represent certainly cares. The community cares for the sick, for the elderly and

  749
  for the dispossessed. The question is whether the Government care, and the answer is that they do not give a damn.
  9.1 pm
  Mr. Peter Thurnham: I welcome the Bill and congratulate the Government on their necessary reforms. I am sorry to hear the view expressed by Opposition Members. The hon. Member for Makerfield (Mr. McCartney) talked about ideology, but he is blinkered by his own ideology and is turning his back on private sector funding initiatives that will give better patient care. He reminds me of the old guard in eastern Europe, which the people of eastern Europe are busy throwing out so that they can have the benefits of a mixed economy.
  Mr. McCartney: Is the hon. Gentleman saying that I should not defend my constituents who are currently in beds in a National Health Service facility and who are suffering from senile dementia? My constituents, aged between 75 and 95, are being kicked out into the private sector without their relatives or the community health council having a say in whether the alternative facilities being provided are up to the standard required for their care.
  Mr. Thurnham: The hon. Gentleman's constituents will benefit from the Bill.
  I should like to speak principally about those aspects of the Bill relating to care in the community but, first, with regard to the National Health Service reforms, I was thankful of the opportunity to take a delegation to see my hon. Friend the Under-Secretary of State.
  Care in the community is a challenging and radical part of the Bill. Perhaps my hon. Friend the new Minister of State will find the opportunity to visit Bolton to see the scheme that was introduced there at an early stage to pilot some of the ideas that are now expressed in the Bill. The pilot scheme has been described as successful, and that success relates to the commitment of the officers and staff of the health authority and the local authority. As a result of the pilot scheme, nearly 100 people have been settled in neighbourhood network homes.
  However, although the scheme has been described as successful, there are problems, principally with funding. I have written to my right hon. and learned Friend the Secretary of State about those funding problems and now appeal to him to consider the funding deficit that has arisen in Bolton. As a result of the commitment given to the pilot scheme, there is a deficit of over £400,000 in the current year and a projected deficit of £200,000 for next year. The local authority has written to me, stating that it entered the pilot scheme in good faith. The local authority believes that it would be a betrayal of the initial good will if nothing could be done to help overcome the deficit that has arisen. The danger of leaving matters as they are is that we may end up with a two-tier service in Bolton. There is a good network scheme for some 100 people who have found places in neighbourhood network homes, but hundreds more people in Bolton desperately need a better service.
  Two priority areas were identified in the recent Audit Commission report, "Developing Community Care for
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  Adults with a Mental Handicap." One priority is the 19 or 20-year-old with challenging behaviour and profound handicaps, the other priority is older people with frail parents who can no longer look after them. In the normal course of events they might have looked for a home in one of the old institutions, but now they are unable to go there because the number of places has been run down. They cannot have a place on the neighbourhood network scheme because of the lack of funding for the provision of additional places.
  Will my right hon. and learned Friend the Secretary of State consider funding and ask the Audit Commission to examine Bolton's scheme to see what lessons can be learnt? The shortfall in funding arises from the need to have a ratio of one member of staff to three residents rather than one to four, which means that costs run nearer to £400 than £300. Those lessons can be learnt elsewhere in Britain. The more they are studied now, the easier it will be to introduce new proposals.
  I commend the success of the Bolton Handicap Action Group to my right hon. and learned Friend. I helped to set up that group after the last election, when I was besieged by people who had problems caring for handicapped children and adults at home.
  The action group has been extremely successful in lobbying local services and exposing scandals—for example, the fact that it takes a bus more than two hours to do a journey to a day centre and a further two hours to come back again. That scandal is just the tip of the iceberg of inadequate services.
  The recent social services inspectorate report on inspection of day services for people with a mental handicap says:
  "Units frequently had little contact with families. Few families and no clients were involved in overall planning of services."
  That is the most welcome part of the Bill.
  I hope that parents' groups and carers' groups will be incorporated into family services.
  Will the Secretary of State consider funding a pilot scheme allowing the Bolton Handicap Action Group to set up a charitable company to quote for the services that are so inadequately provided by the local authority at the moment? I mentioned the bus services, and there is also a problem with day centres that are grossly overcrowded and not sufficiently well-staffed to provide the service that people attending them want. It would be helpful if my right hon. and learned Friend would consider funding that pilot scheme so that the Bolton Handicap Action Group can provide those services itself.
  I notice that the Bill will enable local authorities
  "to provide community care services by making arrangements with any organisation capable of providing them."
  I think that a word stronger than "enable" is needed. Many local authorities will need a strong push to use a novel form of service that will provide better care to the mentally handicapped and to other patients.
  The Audit Commission's report says that the fundamental change will be that
  "in future the care manager must be the principal budget holder … This will come as a shock to many social workers and councillors."
  I am sure that we need a stronger Bill to ensure that reforms and changes are properly introduced.
  Many groups need to benefit from the changes outlined in the Bill which we shall consider closely in Committee. There are more than 125,000 mentally handicapped adults,

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  of whom about one half are at home and one half are in residential care. Those at home need the greatest help possible for carers, and a great deal more help than is available at the moment.
  The survey of the Office of Population Censuses and Surveys identified more than 5,000 handicapped children in institutional care. That is 5,000 too many. I appeal to my hon. Friend the Minister to do all that she can to help find families to care for those children, who should not be in institutions.
  9.10 pm
  Ms. Diane Abbott: Conservative Members have said that they do not believe that Ministers are bent on political suicide. We beg to differ. An enormous amount of cant has been spoken about Conservatives' care for the Health Service. Conservative Members and Ministers say how they want to preserve a free Health Service and that it is safe in their hands, but that is cant. The professional organisations know it, the public know it and the Opposition Members know it.
  To illustrate my point, 1 shall take the House back to November 1987, shortly after the last general election. Quite by chance, I happen to have the confidential minutes of the Carlton club political committee. The document is stamped "Confidential. Restricted circulation. Strictly private and confidential." I shall tell the House all it needs to know about the document in the few minutes available to me.
  The minutes are of a top secret seminar at which the future of the Health Service was discussed. Who was there? Nurses? Doctors? Patients? People from voluntary groups with a record of concern and care for the Health Service? No. Bankers. Plenty of bankers. At least 50 per cent. of the people there were from private health care companies. There were people from the Institute of Directors, people from Central Office, a man from the No. 10 policy unit and, above all, Ministers. What proposals did they come up with? First, opting out. Surprise, surprise. Secondly, proposals to extend the principle of charging and to create a costed service. Does that sound familiar to Opposition Members? Thirdly, a joint venture between the private sector and the NHS was proposed. Fourthly, there were proposals for tax relief on private insurance. All of those will be familiar to the House and the country.
  The seminar also came up with proposals which were too bizarre even for the Prime Minister. One was to rename the Health Service so that the public would know that the whole thing had changed. That seems to have been jettisoned. It came up with a proposal with which the Secretary of State seems now to be involved, to smash "old fashioned" Health Service unions such as the National Union of Public Employees and the Confederation of Health Service Employees to force the creation of a single union with professional sections for the Health Service. That appears to be the Secretary of State's aim with the ambulancemen.
  The seminar also came up with proposals to privatise intensive care, pathology and the ambulance service. These are proposals which business men, people who run private hospitals and Ministers discussed in November 1987. It is no surprise to us that the Bill has emerged in this form.
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  Behind it lies no concern for the Health Service. There is no real interest in what professional organisations and workers have to say. Behind it lies pure, naked ideology.
  When Ministers tell us that the underlying principle of the Health Service is that free medical treatment should be provided regardless of need, how can they expect people to believe them?
  Way back in November 1987 Lord Skelmersdale, a Government Minister, said at the secret Carlton club seminar:
  "the NHS has never been a full, comprehensive and entirely publicly funded system:"
  Among other things he said that there may be a
  "need to allocate resources which could involve establishing priorities so that elective procedures were either paid for by the patient or only took place when more urgent needs had been satisfied"
  The origin of the Bill is ideology and secret seminars. A major Bill has been introduced without proper consultation with nurses, doctors, patients or the public. The Government refuse to do pilot studies, but way back in 1987 they were consulting at the Carlton club. The Bill comes out of the Carlton club and ultimately will benefit only the members of such clubs.
  We know the reality of the Government's position on the Health Service. We remember what they said about charging for eye tests. We remember the Secretary of State telling the House that charging would have no effect on the level of eye tests and that at most the charge would be £10. We know that the average is higher and that the number of people having eye tests has plummeted. That means that the elderly, the poor and the sort of people that I and my hon. Friends represent are not having eye tests. We know the Secretary of State's purpose because of what he told us about eye tests and because of his sustained campaign to starve the ambulancemen back to work as a preparatory project for privatisation of that service, among others.
  We can see the reality of the Government's promises about the Health Service when we look around us at local areas. In my constituency in east London, St. Bartholomew's hospital, the oldest teaching hospital in London, is half empty because of Government cuts. The Government will not fund the nurses to keep the wards open. I receive letters every day from people who have spent years in pain waiting for surgery that the Government will not fund.
  We know the Government's purpose for the Health Service. The Bill is the first step towards privatisation. The public know it, Health Service workers know it, professional organisations know it and the public know it. As someone whose mother worked for more than 30 years in the Health Service until her retirement a few years ago, one of the many millions of ordinary people who have worked to build the Health Service, I shall be proud to go through the Lobbies this evening and vote against the Bill.
  9.17 pm
  Ms. Harriet Harman: This debate has been conducted against a background of overwhelming opposition to the Bill. The only response from the Government and from Conservative Members is that people oppose the Bill because they do not understand it. People do not want the Bill precisely because they do understand it. They understand that the family doctor service will be cash limited and that, for the first time, people will receive the treatment and care that their GP can afford rather than the treatment and care that they

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  need. They understand that, for the first time, they will lose the ability to choose which hospital they go to for treatment and that, instead, that choice will be made by managers. Patients will simply have to go where the managers have placed the contract. People understand that when placing contracts managers will look at the cost rather than the quality. A patient will be sent where the care is cheapest rather than where it is best.
  People understand that the Bill will enable the Secretary of State to allow their local hospital to opt out from the local National Health Service and that patients will have no way of stopping him. They understand, too, that the Government plan to cheat on community care spending and blame councils for the lack of local services. They understand that the Government are rigging the system so that people will have to go into private commercial care homes rather than have the choice of a council home or a NHS nursing home.
  I shall deal first with community care. The Secretary of State for Health said virtually nothing and the Secretary of State for Scotland said absolutely nothing about it. It is lamentable that the community care provisions have been tagged on to the Bill as nothing more than an afterthought. Undoubtedly the Government hoped that community care would be an uncontroversial appendix to the Bill.
  The publication of the White Paper and the clauses on community care in the Bill have met with widespread apprehension. In particular, there is anxiety that the Government will not make available the resources necessary to make good-quality care in the community a reality. Again and again the worry about resources surfaces from organisations such as Age Concern, MIND, Mencap and numerous others which represent those who will use the services in the community. Even the National Association of Health Authorities and the Institute of Health Services Management have expressed anxieties about resources.
  Why should the Government command any respect in this area? The Secretary of State for Health is fond of quoting the increase in services for people with mental illness, such as day and hostel places. But he never mentions that the increase in provision is far outweighed and cannot nearly match the numbers leaving mental hospitals. He quotes the increase in local authority social services spending as if somehow he can take credit for it, when councils' increases in social services spending have taken place despite the Government, not because of them, as hard-pressed Labour councils have tried to improve and increase the services they make available in the community despite Government spending cuts.
  The Conservative commitment to care in the community can be seen in action in Conservative-controlled local authorities where the provision of home helps and meals on wheels for the elderly, the vulnerable and the dependent takes second place because the priority is to keep rates down. Social services are already underfunded and my hon. Friend the Member for Wakefield (Mr. Hinchliffe) gave us a case in point. He told the House of a young disabled male constituent who lives with his parents. The social services authority could not provide enough domiciliary or respite care to enable that family to carry on caring for the young man, so he had to go into residential care. As no National Health Service
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  nursing care or council residential care was available, he had to go into a private home. That family now faces the prospect of having to sell their house to pay the private nursing home fees.
  Councils are already underfunded and their services are overstretched, yet downward pressure on spending, which is the intention of the poll tax, will reduce that already inadequate base still further. Councils throughout the country have been calculating what they will have to do if they are to levy a poll tax of £278, which is what the Government have said will be the average. A council in London calculated that if it had to rely on a poll tax of £278, it would mean a 30 per cent. cut across its social services. It would have to cut all its home help and all its meals on wheels services. A council in the north-west of England calculated that even to bring its poll tax down to £400 would mean that it would have to withdraw its home help services from 2,000 of the people who depend on it or find another way of cutting social services by £13 million.
  It is against that background that the Government make local councils responsible for care in the community. That is why there is deep suspicion that there is to be no earmarked funding for community care. The Government and their Back Benchers criticise us for asking for earmarked funding and say that that shows that we do not trust councils. It is not that we do not trust local councils. It is because we and local councils do not trust the Government that we demand earmarked funding for community care.
  As my hon. Friend the Member for Halifax (Mrs. Mahon) said, there is already little choice for someone who needs residential or nursing care in the community. As cottage hospitals and geriatric wards have been closed, those who might previously have been able to use their services have been forced into private nursing care. As my hon. Friend the Member for Makerfield (Mr. McCartney) said, virtually no NHS nursing care is left. As council spending is squeezed, fewer places are available for the elderly and the disabled. Despite the growing demand, there are fewer places in council residential care, with the result that people have been moved into private residential care homes. A major privatisation programme has been achieved by means of a combination of Department of the Environment spending cuts on local councils and social security handouts by means of payments to private homes.
  The Bill takes privatisation one step further. It is nonsense to say that it will provide a level playing field for private and council care. People will retain the right to income support and housing benefit only if they go into private care. To go into council care results in people losing their right to those benefits. Councils are unable to monitor the standard of care in private homes.
  I have read all the decisions of the Registered Homes Tribunal. They tell an appalling tale of abuse, neglect and ill-treatment. Vulnerable and dependent people are tied to chairs, drugged and abused. People with strings of convictions have set up private old people's homes because they see the chance of making a quick profit.
  I shall refer to two out of many cases. The first is Mrs. Scorer who ran a residential home in Cambridgeshire. According to the findings of the Registered Homes Tribunal,
  "There was mental cruelty … residents were … abused and insulted by being called names to their faces and humiliated by being shamed in front of other residents. They were physically abused in that some … were roughly

  755
  handled, pushed and pulled unnecessarily, frog-marched, slapped; … some had their clothes yanked off … Mrs. Scorer shouted at residents; insulted and humiliated them by calling them names (`fat old pig', 'stupid', 'dirty', 'smelly' and `filthy')".
  Mr. Hind rose—
  Mr. Hayes rose—
  Ms. Harman: The other case concerns Mrs. Canning who ran an old people's home called Warwick Hall. Witnesses to the Registered Homes Tribunal spoke of her using obscene and filthy language and that,
  "She said to one resident, 'I do hate you, your family hate you, that's why you're here.' A former employee said of Mrs. Canning … she loathed children and said mongols should be gassed.' Another former employee told of Mrs. Canning's attitude to a resident who had chronic diarrhoea.
  `If they mess the bed, don't change it, let them lie in it.' A relative said: 'New residents wanted to go home and stood by the door. She shouted at them loud and aggressive. It was awful and sad.'"
  For all their lip service to quality—
  Mr. Hind rose—
  Mr. Hayes rose—
  Ms Harman: —Ministers never talk about these cases. [Interruption.] Perhaps they do not even read the reports of such tribunals. Conservative Members do not care, because these homes are private. [Interruption.] The Government's commitment to the market takes priority over their commitment to the vulnerable and the dependent.
  Several Hon. Members rose—
  Ms. Harman: The Bill will—
  Hon. Members: Give way—
  Ms. Harman: The Bill will—[Interruption.]
  Mr. Deputy Speaker: Order. The hon. Lady has made it quite plain that she does not intend to give way.
  Ms. Harman: The Bill will do nothing to ensure that councils have the resources to provide the care that people need to stay in their own homes. It will do nothing to ensure that councils have the resources to monitor private care homes, or to provide resources so that people can choose whether to go into a council home. It will do nothing about giving carers a voice or about giving disabled people the chance to have the services that they need. Having established the supremacy of the private market in residential care homes, the Government now seek to bring market forces into health care.
  Mr. Hind: On a point of order, Mr. Deputy Speaker. In the circumstances, is it right that the hon. Lady should cast a slur—[Interruption.]
  Mr. Deputy Speaker: Order. I have heard nothing out of order in the hon. Lady's speech and bogus points of order only delay the progress of the debate.
  Ms. Harman: I have put on record on numerous occasions my condemnation of what happened in the Nye Bevan lodge. I should like to hear whether Conservative Members, and in particular Ministers, will condemn or at least show some concern about these cases.
  The Secretary of State for Health (Mr. Kenneth Clarke): Would the hon. Lady not concede that the Government introduced legislation giving local authorities and health authorities powers to inspect private nursing homes to expose just those cases? A moment ago the hon. Lady was making the absurd case that somehow such cases are typical of private nursing home care provision when hon. Members on both sides of the House are extremely anxious to stamp out all such behaviour whether it be in the private or the public sector. We are interested in the quality of care, not in whether it is run by the council or by a private owner.
  Ms. Harman: The Secretary of State appears not to be interested in facing up to the inability to monitor what happens in private homes. The Registered Nursing Homes Association, the organisation which represents the owners of private nursing homes, has said that the Government's expansion of private nursing homes through the social security system has led to such an enormous increase in the number of those homes that a cowboy element has entered the market. The Bill, inasmuch as it will fuel further the private sector and stamp out council homes, will make it more difficult to monitor the quality of care in the private sector.
  Having established the supremacy of the private market in residential care homes, the Government now seek to bring market forces into health care, and GP services are to be cash limited. Drug budgets will be cash limited as will GPs' practice budgets. That will have three disastrous consequences. First, some patients will not get the treatment they need because their GPs will be running out of money. Secondly, people with long-term chronic illnesses will be unattractive patients and will have less chance of getting the GP they want. Thirdly, it will poison the doctor-patient relationship. If GPs advise patients that they do not need drugs or tests, patients will not know whether that advice is based on their medical condition or on the GP's financial condition.
  Miss Widdecombe: Did the hon. Lady hear the clear statement from the hon. Member for Glasgow, Garscadden (Mr. Dewar) accepting that the drugs budget will not be cash limited?
  Ms. Harman: The hon. Lady misunderstands what my hon. Friend said. What he said clearly showed that he understands that there will be a chilling effect on GPs' prescriptions. Although the Government deny that there will be cash limits, if there are not to be cash limits, why are family practitioner committees drawing up plans to dock GPs' pay if they overspend their indicative drugs budget? If there are not to be cash limits on GPs' practice budgets, why did the White Paper consider it necessary to set up a system of watchdogs in accident and emergency departments of hospitals to find out whether all the patients are emergencies or whether some of them have been sent there by their GPs who cannot afford to get them into hospital under a normal contract because they had run out of money and had advised them to go to accident and emergency?
  The Government clearly believe that the family doctor service is costing too much. That is why in the Bill for the first time they have taken the power to restrict the number of doctors going into general practice. The Secretary of

  757
  State and the Secretary of State for Scotland talked about the money following the patient, but the Bill makes the patient follow the money.
  Either the Secretary of State for Scotland has not read the Bill and the White Paper or, if he has, he does not understand how things work at present. Let me give the example of maternity services. A pregnant woman has a choice of hospital in which she can have her baby delivered. She may choose to have her baby at the hospital closest to home, but she may decide that a hospital in a neighbouring district provides the care that she would choose for her delivery. Every year, thousands of women make exactly that choice, but under the Bill it will be taken away and she will have to go where managers have placed the contract. The Secretary of State shakes his head, but what is the point of a contract system if no one has to follow the contract?
  GPs, who at present advise their patients which hospital to go to, will find that they are locked in the straitjacket of the National Health Service contract and that they will no longer have the choice of where to refer their patients. That choice will have been made by managers and a patient who has a hernia will have to go where the block booking is for hernia—[Interruption.] I am basing my speech on the White Paper and the Bill, unlike the Secretary of State, who feels that he can make any claim whatever.
  The only way that GPs will retain their rights of where to refer a patient will be if they opt out of the frying pan and into the fire by opting for a cash-limited practice budget. Otherwise, managers will make all the decisions.
  What will a manager consider when placing a contract? The first thing will be cost. They are not recruited to know about quality, but they certainly will know about cost. To win contracts, hospitals will compete to cut costs. As they do so, they will cut corners, and that will cost lives. The lessons from America are clear—the fiercer the competition, the higher the mortality rate. Patients will be sent where care is cheapest rather than where it is best, and they will be required to travel anywhere managers see fit to place a contract.
  The core services that were mentioned in the White Paper, which were supposed to guarantee patients access to local services and to some crucial services, have not found their way into the Bill; they have stopped dead in the White Paper. People will no longer have automatic access to their local hospital if the Secretary of State opts-out their hospital. My hon. Friend the Member for Bassetlaw (Mr. Ashton) rightly said that the people who use the hospital, those who work in it and even its doctors will have no say in whether it opts out.
  Knowing how controversial the plans will be, the Secretary of State is going about them with secrecy and stealth, an example of which is the advertisement for shadow finance manager to make the application for the London hospital to opt out without telling the district health authority, its patients or even the general manager what will happen.
  The Government have sought to disguise the aim of the Bill. The only response that they have made to criticism is to change its language. They know that to have a cash-limited budget for GPs is unpopular, so it is now called not a budget-holding practice but a fund-holding practice. Clearly, they got out their "Roget's Thesaurus"
  758
  and thought that "a fund" sounded as though it had more money than "a budget". They know that local representatives are to be knocked off district health authorities, so we no longer mention the word "accountability"—that is a non-word—but use instead the word "leadership", which is a code for the Secretary of State deciding everything and local people having no say. The Government realised that people did not like the idea of people buying and selling health care, so we are told that the "purchaser" is to be called "the acquirer". The Secretary of State has just about trained himself to stop describing "opted-out" hospitals as such and now calls them "NHS trusts". We know that, whatever they are called—whether NHS trusts or anything else—they will be opted out of the local health authority.
  The Government imply that anyone who is against the Bill is against change in the NHS. That is a travesty. If we had a Government who could listen, they would know that the Health Service and patients' organisations are abuzz with ideas for changing and improving service deliveries. The real reason that people do not want the Bill—
  Mr. Michael Colvin: On a point of order, Mr. Speaker. I have no objection to the hon. Member for Peckham (Ms. Harman) reading her speech, but I object to her reading it to the Serjeant at Arms rather than to the Chair.
  Mr. Speaker: I think that the hon. Lady was turning from one side to the other.
  Ms. Harman: The real reason why people do not want the Bill is that they do not want to see their Health Service broken into a thousand fragments ready for privatisation. That is why we shall vote against the Bill.
  9.40 pm
  The Minister for Health (Mrs. Virginia Bottomley): The Government's overriding aim is to achieve the best for the individual patient, the individual carer and the dependant who requires social care. Our policy depends on caring for the patients, not scaring the patients. What we have heard from the Labour party is alarmist, frightening misinformation, calculated to misinform and to stir up people's strongest fears.
  We have had a lengthy debate about extremely important proposals. We speak at a time when the Government are spending more than ever before on the Health Service. The Conservative party has delivered improved health care. Where we have a competition in terms of the rhetoric of compassion, it may be that the Labour party could outbid us. If it comes to a competition in terms of delivery of health care, there is no doubt that the frail, the vulnerable and the sick have every reason to have confidence and to put their trust in the Conservative party. Every week of the year, 25,000 more patients are treated because of our investment in and commitment to the NHS. These proposals are intended to develop and build on our NHS.
  The management changes, which are fundamental in terms of producing health care of the highest quality in an age of rapidly increasing science and technology, are intended to benefit the individual users of our health and social care services. All our plans put the individual at the heart of things. My hon. Friend the Member for Newbury (Sir. M. McNair-Wilson) called last Thursday for a

  759
  patients' charter. As my right hon. and learned Friend the Secretary of State said after First Reading, the Bill is just that.
  I pay tribute to all the hon. Members who so fulsomely participated in the debate. There has been a robust exposition of Government proposals and a rebuttal of many of the more ludicrous Labour suggestions by my hon. Friends the Members for Harlow (Mr. Hayes), for Ipswich (Mr. Irvine), for Maidstone (Miss Widdecombe), for Wimbledon (Dr. Goodson-Wickes)—who speaks with special knowledge, having worked as a medical practitioner for many years—for Lancashire, West (Mr. Hind) and for Pembroke (Mr. Bennett). As they make clear, under the Labour Government, the National Health Service was run by the International Monetary Fund. We would rather leave our health care in the hands of the NHS.
  Only today we are announcing an increase of about 25 per cent. in NHS consultants in the past 10 years. There are 60 per cent. more female consultants. The number of hospital medical staff has increased by over 17 per cent. in the same period and, again, many more women are working in the Health Service.
  A major mechanism for improvement will be the new funding systems. Hospitals will be funded more directly for the patients whom they treat. Where they offer high quality service, they will find that additional patients and additional resources will flow towards them. The present system can all too often work against patients who are caught by a geographical boundary or by the so-called "efficiency trap". We are putting in place a system that will work for patients, not against them, and a system that will favour rather then frustrate the most efficient medical practitioners.
  My hon. Friends the Members for Harlow and for Ipswich talked about the perverse incentives of the present funding arrangements. We want to have a virtuous effect, not a vicious effect. Managing that system will be the central task of the strengthened district health authorities. They will look at all suppliers of services in their areas to find the best mix of NHS contracts to provide comprehensive services for their residents. It will be an open process—far more so than it is now. Each health authority will undertake extensive discussions with local general practitioners to ensure that the pattern of contracts properly reflects local referral patterns. The community health councils will have their voice heard. It is a recipe for patients and their representatives to have a far greater input in the decisions about their care.
  Much mention has been made about National Health Service trusts. Once again, this is not an attempt for hospitals to opt out of the NHS and it is not the first step to privatisation. The alarmist and irresponsible scare stories put about by the hon. Members for Glasgow, Garscadden (Mr. Dewar), for Bassetlaw (Mr. Ashton), for Halifax (Mrs. Mahon) and for Hackney, North and Stoke Newington (Ms. Abbott) have no part in our proposals for the Health Service. The fact is that the opportunities offered by the National Health Service trusts are not simply freedom from the shackles of unnecessary central control, but a new freedom to use resources more flexibly to raise standards of care.
  We mean standards in the widest sense. Shorter waiting time for admission is central, as are satisfactory systems of medical audit, better out-patient appointment systems and the personal treatment of all visitors and patients received
  760
  from each member of staff. There is every incentive for quality to run through every aspect of National Health Service work. Both patients and staff will have reason to be proud of what their local National Health Service has been able to achieve. The importance of quality has been registered by several hon. Members and we fully and warmly endorse that.
  My hon. Friend the Member for Chislehurst (Mr. Sims) asked about the definition of "core services". It will be for each district health authority to decide the precise pattern of services to meet its needs. We cannot and should not prescribe for that from the centre, but the Bill gives the Secretary of State powers of direction over the NHS trusts' ability to enter into contracts, which can be used to safeguard local access to services in the unlikely event of difficulties arising.
  My hon. Friend the Member for Chislehurst raised a further point about NHS contracts being enforced if they are to have legal status. NHS contracts will contain provision for the resolution of any disputes that may arise. The Secretary of State will be able to investigate any disagreements and to enforce a solution. That is a more appropriate response than the sight of two NHS bodies fighting each other through the courts. These are management rather than legal documents.
  My hon. Friend the Member for Rutland and Melton (Mr. Latham) asked about the size of the NHS trusts. We shall not be prescriptive about the type or size of unit that can apply for self-governing status. The reason why the Bill refers to NHS trusts, rather than NHS hospital trusts as we called them in the White Paper, is that the concept is proving attractive to all kinds of candidate, not just to the major acute hospitals. Many other hon. Members raised points about the trusts, but I shall not be able to do justice to all of them. The key point is to release NHS units from some of the shackles of bureaucratic control and interference and to allow centres of excellence with a corporate ethos to develop and flourish.
  Several hon. Members talked about the importance of dialogue with the medical profession. My hon. Friends the Members for Chislehurst, for Rutland and Melton, for Northampton, South (Mr. Morris) and for Sevenoaks (Mr. Wolfson) all spoke about the importance of discussion. I want to make it clear that all of us at the Department of Health have met about 100 different groups from the medical profession since last January. We are working closely on resource management and on many medically-led initiatives such as medical audit, and we shall continue to do so. Further, we are funding a range of pilot schemes so that we can learn lessons for implementing the Bill when it completes its passage through Parliament. I cite, for example, the enhanced role of the district health authority, the development of contracts, management budgets, and information to assist with the determination of cross-boundary flows.
  I turn now to the substantial part of the remarks made by the hon. Member for Peckham (Ms. Harman)—
  Dame Elaine Kellett-Bowman: There was nothing substantial in them.
  Mrs. Bottomley: I appreciate that, but I want to talk about some proposals of great importance—those on community care. It is deplorable to exploit people's fears about divisiveness and scandals in the public or the private

  761
  sectors. We want high quality community care for people; we want choice and proper standards and we shall ensure that we achieve precisely that in this Bill.
  In the Bill we set out the framework for care in the community for the next decade. The proposals will secure the delivery of successful community care services, ensuring the best use of resources to achieve diversity and flexibility of provision. That is welcome for local authorities, which have long argued that responsibility for social care should rest with them. I wondered, as she spoke, whether the hon. Member for Peckham wanted to deprive local authorities of this important responsibility, which is intended to build on the substantial work that they already undertake planning for the overall social care needs of their populations. I know that local authorities are keen to rise to the challenge, and there have already been many examples of innovative and pioneering work providing community care.
  Mr. Nigel Spearing: I am grateful to the hon. Lady for giving way and for rightly emphasising the importance of local councils in social services. If the Government are determined to retain councils' part in this area, why are they excluding them from the district health authorities in which co-operation and knowledge of what is going on in the community are almost as important?
  Mrs. Bottomley: It is clear from our proposals on district health management that the NHS—a £28 billion organisation—requires clear and decisive management. There will certainly be scope for consulting local people about their needs. I am not sure whether the hon. Gentleman wants to deprive local authorities of their important new responsibility of providing care in the community.
  Many local authorities are already developing excellent projects. I hope to take up the invitation of my hon. Friend the Member for Bolton, North-East (Mr. Thurnham), whose scheme is one of 28 pilot projects set up some time ago by the Department to develop new forms of care in the community. There are similar projects and developments in Kent, Newcastle and Bolton to ensure that people can live dignified and independent lives at home.
  Community care has too long been the victim of confusion over where responsibility lies for the public support of people in residential care and nursing homes. Not enough priority has always been given by local authorities to the development of high quality care, and we intend to set that right so that local authorities fulfil their responsibilities and high standards and choice are available.
  Some hon. Members have suggested that the proposals have come forward too swiftly. That lies ill with the former allegation that there has been a certain amount of delay. After Sir Roy Griffiths' report on community care, a great deal of detailed consultation on his recommendations was entered into. My right hon. and learned Friend made a statement last July, since when there have been further detailed discussions about the proposals. There was a full day's debate in the House to which many hon. Members contributed; then, last month, we brought forward our White Paper.
  It is right that the responsibility for providing all forms of community care should be entrusted to local
  762
  authorities, but equally it is essential that we ensure that local authorities fulfil those important responsibilities. Community care extends from good neighbourliness to 24-hour-a-day residential home care provision. Having heard Opposition Members, it would seem that their course of action would be to nationalise good neighbourliness. Government recognise that the majority of care is frequently provided by family, friends and neighbours. Most carers take on those responsibilities willingly. However, many need help to manage before they become overwhelmed with what can become a considerable burden.
  Mr. Tom Clarke: The Minister referred to consultation. I presume that that was a reference to the week between the White Paper being published and the week the Bill was published. Does that consultation mean that the Government accept the view of the Association of County Councils and the Association of Metropolitan Authorities that allocations for community care should be ring-fenced?
  Mrs. Bottomley: The key point is that my right hon. and learned Friend the Secretary of State made our intentions clear last July. At that time there were a great many allegations that it was high time that the proposals on care in the community were forthcoming. I shall refer to the particular point about resources shortly.
  This is the first time that the needs of carers have been properly recognised. The Bill is a very important mark in terms of our legislation for the dependent and the frail. The White Paper states that the key components of community care should be that
  "services should respond flexibly and sensitively to the needs of individuals and their carers"
  and to
  "ensure that service providers make practical support for carers a high priority."
  That is an important step forward from the time when the Labour party was in office. At that time I was involved in an organisation concerned with carers which received no assistance under that Labour Government. The carers' national association, with which I was involved, now receives £77,000. We give about £350,000 annually to various organisations supporting carers. We recognise the pivotal role that carers play and that the views of carers, their ability to provide care and their needs for support should all be fully acknowledged.
  It is important that there should be adequate resources for the provision of care in the community. We have made it clear that the amount of money presently used to fund those in private residential homes will be made available for the development of care in the community services. There have been several entirely unfounded allegations about the level playing field between public and private residential homes.
  The present situation inordinately favours the use of private residential homes as the local authority involved does not need to find any money. In future, we will establish a more level and fairer system. We will ensure that those in local authority homes receive the same personal allowances. At the moment they receive less. We will ensure that everyone entering a residential home will have a full assessment to discover whether the money that is currently used for residential care could be more

  763
  appropriately used to preserve their dignity and privacy and bring forward a package of domiciliary care to meet their needs.
  It was deplorable of the hon. Member for Peckham to try to arouse people's greatest fears about the provision of care in private homes. AH the residents of Nye Bevan house would have wanted the structure of care in the community including the inspections and local authority control that we are introducing in our measures.
  There is much to be done to translate our community care proposals into a successful and working reality. This is a Bill for people—the people who need care, and the people who provide it—and concern for individuals lies at the heart of our action in the NHS and community care. It is because of their importance that we are right to act quickly and decisively.
  We have clear and common aims: we intend to move from policy to implementation. The Bill is a key step along that road, and I heartily commend it to the House.
  Question put, That the Bill be now read a Second time:—
  The House divided: Ayes 323, Noes 247.

  Division No. 12]

  [10 pm

  AYES

  Adley, Robert

  Carrington, Matthew

  Aitken, Jonathan

  Carttiss, Michael

  Alexander, Richard

  Cash, William

  Alison, Rt Hon Michael

  Channon, Rt Hon Paul

  Allason, Rupert

  Chapman, Sydney

  Amess, David

  Chope, Christopher

  Amos, Alan

  Churchill, Mr

  Arbuthnot, James

  Clark, Hon Alan (Plym'th S'n)

  Arnold, Jacques (Gravesham)

  Clark, Dr Michael (Rochford)

  Arnold, Tom (Hazel Grove)

  Clark, Sir W. (Croydon S)

  Ashby, David

  Clarke, Rt Hon K. (Rushcliffe)

  Aspinwall, Jack

  Colvin, Michael

  Atkinson, David

  Conway, Derek

  Baker, Rt Hon K. (Mole Valley)

  Coombs, Anthony (Wyre F'rest)

  Baker, Nicholas (Dorset N)

  Coombs, Simon (Swindon)

  Baldry, Tony

  Cope, Rt Hon John

  Banks, Robert (Harrogate)

  Cormack, Patrick

  Batiste, Spencer

  Couchman, James

  Beaumont-Dark, Anthony

  Cran, James

  Bellingham, Henry

  Critchley, Julian

  Bendall, Vivian

  Currie, Mrs Edwina

  Bennett, Nicholas (Pembroke)

  Davies, Q. (Stamf'd & Spald'g)

  Benyon, W.

  Davis, David (Boothferry)

  Bevan, David Gilroy

  Day, Stephen

  Blaker, Rt Hon Sir Peter

  Devlin, Tim

  Body, Sir Richard

  Dorrell, Stephen

  Bonsor, Sir Nicholas

  Douglas-Hamilton, Lord James

  Boscawen, Hon Robert

  Dover, Den

  Boswell, Tim

  Dunn, Bob

  Bottomley, Peter

  Dykes, Hugh

  Bottomley, Mrs Virginia

  Eggar, Tim

  Bowden, A (Brighton K'pto'n)

  Emery, Sir Peter

  Bowden, Gerald (Dulwich)

  Evans, David (Welwyn Hatf'd)

  Bowis, John

  Evennett, David

  Boyson, Rt Hon Dr Sir Rhodes

  Fairbairn, Sir Nicholas

  Braine, Rt Hon Sir Bernard

  Fallon, Michael

  Brandon-Bravo, Martin

  Farr, Sir John

  Brazier, Julian

  Favell, Tony

  Bright, Graham

  Fenner, Dame Peggy

  Brown, Michael (Brigg & Cl't's)

  Field, Barry (Isle of Wight)

  Browne, John (Winchester)

  Finsberg, Sir Geoffrey

  Bruce, Ian (Dorset South)

  Fishburn, John Dudley

  Buck, Sir Antony

  Fookes, Dame Janet

  Budgen, Nicholas

  Forman, Nigel

  Burns, Simon

  Forsyth, Michael (Stirling)

  Burt, Alistair

  Forth, Eric

  Butler, Chris

  Fowler, Rt Hon Norman

  Butterfill, John

  Fox, Sir Marcus

  Carlisle, John, (Luton N)

  Franks, Cecil

  Carlisle, Kenneth (Lincoln)

  Freeman, Roger

  764

  French, Douglas

  Lord, Michael

  Gale, Roger

  Luce, Rt Hon Richard

  Gardiner, George

  Lyell, Sir Nicholas

  Garel-Jones, Tristan

  Macfarlane, Sir Neil

  Gill, Christopher

  MacGregor, Rt Hon John

  Glyn, Dr Alan

  MacKay, Andrew (E Berkshire)

  Goodson-Wickes, Dr Charles

  McNair-Wilson, Sir Michael

  Gorman, Mrs Teresa

  McNair-Wilson, Sir Patrick

  Gorst, John

  Madel, David

  Gow, Ian

  Major, Rt Hon John

  Grant, Sir Anthony (CambsSW)

  Malins, Humfrey

  Greenway, Harry (Ealing N)

  Mans, Keith

  Greenway, John (Ryedale)

  Maples, John

  Gregory, Conal

  Marland, Paul

  Griffiths, Peter (Portsmouth N)

  Marlow, Tony

  Grist, Ian

  Marshall, John (Hendon S)

  Ground, Patrick

  Marshall, Michael (Arundel)

  Grylls, Michael

  Martin, David (Portsmouth S)

  Hague, William

  Maude, Hon Francis

  Hamilton, Hon Archie (Epsom)

  Maxwell-Hyslop, Robin

  Hamilton, Neil (Tatton)

  Mayhew, Rt Hon Sir Patrick

  Hampson, Dr Keith

  Mellor, David

  Hanley, Jeremy

  Miller, Sir Hal

  Hannam, John

  Mills, Iain

  Hargreaves, A. (B'ham H'll Gr')

  Miscampbell, Norman

  Harg reaves, Ken (Hyndburn)

  Mitchell, Andrew (Gedling)

  Harris, David

  Mitchell, Sir David

  Haselhurst, Alan

  Moate, Roger

  Hawkins, Christopher

  Monro, Sir Hector

  Hayes, Jerry

  Montgomery, Sir Fergus

  Hayward, Robert

  Moore, Rt Hon John

  Heathcoat-Amory, David

  Morrison, Sir Charles

  Heddle, John

  Moss, Malcolm

  Heseltine, Rt Hon Michael

  Moynihan, Hon Colin

  Hicks, Mrs Maureen (Wolv' NE)

  Neale, Gerrard

  Hicks, Robert (Cornwall SE)

  Nelson, Anthony

  Higgins, Rt Hon Terence L.

  Neubert, Michael

  Hind, Kenneth

  Newton, Rt Hon Tony

  Hogg, Hon Douglas (Gr'th'm)

  Nicholls, Patrick

  Holt, Richard

  Nicholson, David (Taunton)

  Hordern, Sir Peter

  Nicholson, Emma (Devon West)

  Howard, Michael

  Norris, Steve

  Howarth, Alan (Strat'd-on-A)

  Onslow, Rt Hon Cranley

  Howarth, G. (Cannock & B'wd)

  Oppenheim, Phillip

  Howe, Rt Hon Sir Geoffrey

  Page, Richard

  Howell, Rt Hon David (G'dford)

  Paice, James

  Howell, Ralph (North Norfolk)

  Parkinson, Rt Hon Cecil

  Hughes, Robert G. (Harrow W)

  Patnick, Irvine

  Hunt, David (Wirral W)

  Patten, Rt Hon Chris (Bath)

  Hunter, Andrew

  Patten, John (Oxford W)

  Hurd, Rt Hon Douglas

  Pattie, Rt Hon Sir Geoffrey

  Irvine, Michael

  Pawsey, James

  Irving, Charles

  Peacock, Mrs Elizabeth

  Jack, Michael

  Porter, Barry (Wirral S)

  Janman, Tim

  Porter, David (Waveney)

  Johnson Smith, Sir Geoffrey

  Portillo, Michael

  Jones, Gwilym (Cardiff N)

  Rathbone, Tim

  Jones, Robert B (Herts W)

  Redwood, John

  Jopling, Rt Hon Michael

  Renton, Rt Hon Tim

  Kellett-Bowman, Dame Elaine

  Rhodes James, Robert

  Key, Robert

  Riddick, Graham

  King, Roger (B'ham N'thfield)

  Ridley, Rt Hon Nicholas

  King, Rt Hon Tom (Bridgwater)

  Ridsdale, Sir Julian

  Kirkhope, Timothy

  Rifkind, Rt Hon Malcolm

  Knapman, Roger

  Roberts, Wyn (Conwy)

  Knight, Greg (Derby North)

  Roe, Mrs Marion

  Knight, Dame Jill (Edgbaston)

  Rossi, Sir Hugh

  Knowles, Michael

  Rost, Peter

  Knox, David

  Rowe, Andrew

  Lamont, Rt Hon Norman

  Rumbold, Mrs Angela

  Latham, Michael

  Ryder, Richard

  Lawrence, Ivan

  Sackville, Hon Tom

  Lee, John (Pendle)

  Sainsbury, Hon Tim

  Leigh, Edward (Gainsbor'gh)

  Scott, Rt Hon Nicholas

  Lennox-Boyd, Hon Mark

  Shaw, David (Dover)

  Lester, Jim (Broxtowe)

  Shaw, Sir Giles (Pudsey)

  Lightbown, David

  Shaw, Sir Michael (Scarb')

  Lilley, Peter

  Shelton, Sir William

  Lloyd, Sir Ian (Havant)

  Shephard, Mrs G. (Norfolk SW)

  Lloyd, Peter (Fareham)

  Shepherd, Colin (Hereford)

  765

  Shersby, Michael

  Trippier, David

  Sims, Roger

  Trotter, Neville

  Skeet, Sir Trevor

  Twinn, Dr Ian

  Smith, Tim (Beaconsfield)

  Vaughan, Sir Gerard

  Soames, Hon Nicholas

  Viggers, Peter

  Speed, Keith

  Waddington, Rt Hon David

  Spicer, Michael (S Worcs)

  Wakeham, Rt Hon John

  Squire, Robin

  Waldegrave, Hon William

  Stanbrook, Ivor

  Walden, George

  Stanley, Rt Hon Sir John

  Walker, Bill (T'side North)

  Steen, Anthony

  Waller, Gary

  Stern, Michael

  Walters, Sir Dennis

  Stevens, Lewis

  Ward, John

  Stewart, Allan (Eastwood)

  Wardle, Charles (Bexhill)

  Stewart, Andy (Sherwood)

  Warren, Kenneth

  Stewart, Rt Hon Ian (Herts N)

  Watts, John

  Stokes, Sir John

  Wells, Bowen

  Stradling Thomas, Sir John

  Wheeler, John

  Sumberg, David

  Whitney, Ray

  Summerson, Hugo

  Widdecombe, Ann

  Tapsell, Sir Peter

  Wiggin, Jerry

  Taylor, Ian (Esher)

  Wilshire, David

  Taylor, John M (Solihull)

  Winterton, Mrs Ann

  Taylor, Teddy (S'end E)

  Wolfson, Mark

  Tebbit, Rt Hon Norman

  Wood, Timothy

  Temple-Morris, Peter

  Woodcock, Dr. Mike

  Thatcher, Rt Hon Margaret

  Yeo, Tim

  Thompson, D. (Calder Valley)

  Young, Sir George (Acton)

  Thompson, Patrick (Norwich N)

  Younger, Rt Hon George

  Thornton, Malcolm

  Thurnham, Peter

  Tellers for the Ayes:

  Townsend, Cyril D. (B'heath)

  Mr. Alastair Goodlad and

  Tracey, Richard

  Mr. Tony Durant.

  Tredinnick, David

  NOES

  Abbott, Ms Diane

  Clay, Bob

  Adams, Allen (Paisley N)

  Clelland, David

  Allen, Graham

  Clwyd, Mrs Ann

  Alton, David

  Cohen, Harry

  Anderson, Donald

  Coleman, Donald

  Archer, Rt Hon Peter

  Cook, Frank (Stockton N)

  Armstrong, Hilary

  Cook, Robin (Livingston)

  Ashdown, Rt Hon Paddy

  Corbett, Robin

  Ashley, Rt Hon Jack

  Corbyn, Jeremy

  Ashton, Joe

  Cousins, Jim

  Banks, Tony (Newham NW)

  Cox, Tom

  Barnes, Harry (Derbyshire NE)

  Crowther, Stan

  Barnes, Mrs Rosie (Greenwich)

  Cryer, Bob

  Barron, Kevin

  Cummings, John

  Battle, John

  Cunlitfe, Lawrence

  Beckett, Margaret

  Cunningham, Dr John

  Beggs, Roy

  Dalyell, Tam

  Beith, A. J.

  Darling, Alistair

  Bell, Stuart

  Davies, Rt Hon Denzil (Llanelli)

  Benn, Rt Hon Tony

  Davies, Ron (Caerphilly)

  Bennett, A. F. (D'nt'n & R'dish)

  Davis, Terry (B'ham Hodge H'i)

  Bermingham, Gerald

  Dewar, Donald

  Bidwell, Sydney

  Dixon, Don

  Blair, Tony

  Dobson, Frank

  Blunkett, David

  Doran, Frank

  Boateng, Paul

  Douglas, Dick

  Boyes, Roland

  Duffy, A. E. P.

  Bradley, Keith

  Dunnachie, Jimmy

  Bray, Dr Jeremy

  Dunwoody, Hon Mrs Gwyneth

  Brown, Gordon (D'mline E)

  Eadie, Alexander

  Brown, Nicholas (Newcastle E)

  Evans, John (St Helens N)

  Brown, Ron (Edinburgh Leith)

  Ewing, Harry (Falkirk E)

  Bruce, Malcolm (Gordon)

  Ewing, Mrs Margaret (Moray)

  Buchan, Norman

  Fatchett, Derek

  Buckley, George J.

  Faulds, Andrew

  Caborn, Richard

  Fearn, Ronald

  Callaghan, Jim

  Field, Frank (Birkenhead)

  Campbell, Menzies (Fife NE)

  Fields, Terry (L'pool B G'n)

  Campbell, Ron (Blyth Valley)

  Fisher, Mark

  Campbell-Savours, D. N.

  Flannery, Martin

  Canavan, Dennis

  Flynn, Paul

  Carlile, Alex (Mont'g)

  Foot, Rt Hon Michael

  Clark, Dr David (S Shields)

  Forsythe, Clifford (Antrim S)

  Clarke, Tom (Monklands W)

  Foster, Derek

  766

  Fraser, John

  Morgan, Rhodri

  Fyfe, Maria

  Morley, Elliot

  Galloway, George

  Morris, Rt Hon A. (W'shawe)

  Garrett, John (Norwich South)

  Morris, Rt Hon J. (Aberavon)

  George, Bruce

  Morris, M (N'hampton S)

  Gilbert, Rt Hon Dr John

  Mowlam, Marjorie

  Godman, Dr Norman A.

  Mullin, Chris

  Golding, Mrs Llin

  Murphy, Paul

  Gordon, Mildred

  Nellist, Dave

  Gould, Bryan

  Oakes, Rt Hon Gordon

  Graham, Thomas

  O'Brien, William

  Grant, Bernie (Tottenham)

  O'Neill, Martin

  Griffiths, Nigel (Edinburgh S)

  Orme, Rt Hon Stanley

  Griffiths, Win (Bridgend)

  Parry, Robert

  Grocott, Bruce

  Patchett, Terry

  Hardy, Peter

  Pendry, Tom

  Harman, Ms Harriet

  Pike, Peter L.

  Hattersley, Rt Hon Roy

  Powell, Ray (Ogmore)

  Haynes, Frank

  Prescott, John

  Healey, Rt Hon Denis

  Quin, Ms Joyce

  Heffer, Eric S.

  Radice, Giles

  Henderson, Doug

  Randall, Stuart

  Hinchliffe, David

  Redmond, Martin

  Hoey, Ms Kate (Vauxhall)

  Rees, Rt Hon Merlyn

  Hogg, N. (C'nauld & Kilsyth)

  Reid, Dr John

  Home Robertson, John

  Roberts, Allan (Bootle)

  Hood, Jimmy

  Robertson, George

  Howarth, George (Knowsley N)

  Robinson, Geoffrey

  Howell, Rt Hon D. (S'heath)

  Rogers, Allan

  Howells, Geraint

  Rooker, Jeff

  Howells, Dr. Kim (Pontypridd)

  Ross, Ernie (Dundee W)

  Hoyle, Doug

  Ross, William (Londonderry E)

  Hughes, John (Coventry NE)

  Rowlands, Ted

  Hughes, Robert (Aberdeen N)

  Ruddock, Joan

  Hughes, Simon (Southwark)

  Salmond, Alex

  Illsley, Eric

  Sedgemore, Brian

  Ingram, Adam

  Sheerman, Barry

  Janner, Greville

  Sheldon, Rt Hon Robert

  Jones, Barry (Alyn & Deeside)

  Shore, Rt Hon Peter

  Jones, leuan (Ynys Môn)

  Short, Clare

  Jones, Martyn (Clwyd S W)

  Sillars, Jim

  Kaufman, Rt Hon Gerald

  Skinner, Dennis

  Kennedy, Charles

  Smith, Andrew (Oxford E)

  Kinnock, Rt Hon Neil

  Smith, C. (Isl'ton & F'bury)

  Lambie, David

  Smith, Sir Cyril (Rochdale)

  Leadbitter, Ted

  Smith, Rt Hon J. (Monk'ds E)

  Leighton, Ron

  Smith, J. P. (Vale of Glam)

  Lestor, Joan (Eccles)

  Smyth, Rev Martin (Belfast S)

  Lewis, Terry

  Snape, Peter

  Litherland, Robert

  Soley, Clive

  Livingstone, Ken

  Spearing, Nigel

  Livsey, Richard

  Steel, Rt Hon David

  Lloyd, Tony (Stretford)

  Steinberg, Gerry

  Lofthouse, Geoffrey

  Stott, Roger

  Loyden, Eddie

  Strang, Gavin

  McAllion, John

  Straw, Jack

  McAvoy, Thomas

  Taylor, Mrs Ann (Dewsbury)

  McCartney, Ian

  Taylor, Matthew (Truro)

  McCrea, Rev William

  Thomas, Dr Dafydd Elis

  Macdonald, Calum A.

  Thompson, Jack (Wansbeck)

  McKay, Allen (Barnsley West)

  Turner, Dennis

  McLeish, Henry

  Vaz, Keith

  Maclennan, Robert

  Walker, A. Cecil (Belfast N)

  McNamara, Kevin

  Wall, Pat

  Madden, Max

  Wallace, James

  Mahon, Mrs Alice

  Walley, Joan

  Marek, Dr John

  Warden, Gareth (Gower)

  Marshall, Jim (Leicester S)

  Wareing, Robert N.

  Martin, Michael J. (Springburn)

  Watson, Mike (Glasgow, C)

  Martlew, Eric

  Welsh, Andrew (Angus E)

  Maxton, John

  Welsh, Michael (Doncaster N)

  Meacher, Michael

  Wigley, Dafydd

  Meale, Alan

  Williams, Rt Hon Alan

  Michael, Alun

  Williams, Alan W. (Carm'then)

  Michie, Bill (Sheffield Heeley)

  Wilson, Brian

  Mitchell, Austin (G't Grimsby)

  Winnick, David

  Molyneaux, Rt Hon James

  Winterton, Nicholas

  Moonie, Dr Lewis

  Wise, Mrs Audrey

  Worthington, Tony

  Tellers for the Noes:

  Wray, Jimmy

  Mr. Ken Eastham and

  Young, David(Bolton SE)

  Mr. John McFall.

  Question accordingly agreed to.
  Motion made, and Question put,
  That the Bill be committed to a Special Committee.—[Mr. McCartney.]
  The House divided: Ayes 244, Noes 312.

  Division No. 13]

  [10.15 pm

  AYES

  Abbott, Ms Diane

  Dobson, Frank

  Adams, Allen (Paisley N)

  Doran, Frank

  Allen, Graham

  Douglas, Dick

  Alton, David

  Duffy, A. E. P.

  Anderson, Donald

  Dunnachie, Jimmy

  Archer, Rt Hon Peter

  Dunwoody, Hon Mrs Gwyneth

  Armstrong, Hilary

  Eadie, Alexander

  Ashley, Rt Hon Jack

  Evans, John (St Helens N)

  Ashton, Joe

  Ewing, Harry (Falkirk E)

  Banks, Tony (Newham NW)

  Ewing, Mrs Margaret (Moray)

  Barnes, Harry (Derbyshire NE)

  Fatchett, Derek

  Barnes, Mrs Rosie (Greenwich)

  Faulds, Andrew

  Barron, Kevin

  Fearn, Ronald

  Battle, John

  Field, Frank (Birkenhead)

  Beckett, Margaret

  Fields, Terry (L'pool B G'n)

  Beggs, Roy

  Fisher, Mark

  Beith, A. J.

  Flannery, Martin

  Bell, Stuart

  Flynn, Paul

  Benn, Rt Hon Tony

  Foot, Rt Hon Michael

  Bennett, A. F. (D'nt'n & R'dish)

  Forsythe, Clifford (Antrim S)

  Bermingham, Gerald

  Foster, Derek

  Bidwell, Sydney

  Fraser, John

  Blair, Tony

  Fyfe, Maria

  Blunkett, David

  Galloway, George

  Boateng, Paul

  Garrett, John (Norwich South)

  Boyes, Roland

  George, Bruce

  Bradley, Keith

  Gilbert, Rt Hon Dr John

  Bray, Dr Jeremy

  Godman, Dr Norman A.

  Brown, Gordon (D'mline E)

  Golding, Mrs Llin

  Brown, Nicholas (Newcastle E)

  Gordon, Mildred

  Brown, Ron (Edinburgh Leith)

  Gould, Bryan

  Bruce, Malcolm (Gordon)

  Graham, Thomas

  Buchan, Norman

  Grant, Bernie (Tottenham)

  Buckley, George J.

  Griffiths, Nigel (Edinburgh S)

  Caborn, Richard

  Griffiths, Win (Bridgend)

  Callaghan, Jim

  Grocott, Bruce

  Campbell, Menzies (Fife NE)

  Hardy, Peter

  Campbell, Ron (Blyth Valley)

  Harman, Ms Harriet

  Campbell-Savours, D. N.

  Hattersley, Rt Hon Roy

  Canavan, Dennis

  Haynes, Frank

  Carlile, Alex (Mont'g)

  Healey, Rt Hon Denis

  Clark, Dr David (S Shields)

  Heffer, Eric S.

  Clarke, Tom (Monklands W)

  Henderson, Doug

  Clay, Bob

  Hinchliffe, David

  Clelland, David

  Hoey, Ms Kate (Vauxhall)

  Clwyd, Mrs Ann

  Hogg, N. (C'nauld & Kilsyth)

  Cohen, Harry

  Home Robertson, John

  Coleman, Donald

  Hood, Jimmy

  Cook, Frank (Stockton N)

  Howarth, George (Knowsley N)

  Cook, Robin (Livingston)

  Howell, Rt Hon D. (S'heath)

  Corbett, Robin

  Howells, Geraint

  Corbyn, Jeremy

  Howells, Dr. Kim (Pontypridd)

  Cousins, Jim

  Hoyle, Doug

  Cox, Tom

  Hughes, John (Coventry NE)

  Crowther, Stan

  Hughes, Robert (Aberdeen N)

  Cryer, Bob

  Hughes, Simon (Southwark)

  Cummings, John

  Illsley, Eric

  Cunliffe, Lawrence

  Ingram, Adam

  Cunningham, Dr John

  Janner, Greville

  Dalyell, Tam

  Jones, Barry (Alyn & Deeside)

  Darling, Alistair

  Jones, leuan (Ynys Môn)

  Davies, Rt Hon Denzil (Llanelli)

  Jones, Martyn (Clwyd S W)

  Davies, Ron (Caerphilly)

  Kaufman, Rt Hon Gerald

  Davis, Terry (B'ham Hodge H'l)

  Kennedy, Charles

  Dewar, Donald

  Kinnock, Rt Hon Neil

  Dixon, Don

  Lambie, David

  768

  Leadbitter, Ted

  Roberts, Allan (Bootle)

  Leighton, Ron

  Robertson, George

  Lestor, Joan (Eccles)

  Robinson, Geoffrey

  Lewis, Terry

  Rogers, Allan

  Litherland, Robert

  Rooker, Jeff

  Livingstone, Ken

  Ross, Ernie (Dundee W)

  Livsey, Richard

  Ross, William (Londonderry E)

  Lloyd, Tony (Stretlord)

  Rowlands, Ted

  Lofthouse, Geoffrey

  Ruddock, Joan

  Loyden, Eddie

  Salmond, Alex

  McAllion, John

  Sedgemore, Brian

  McAvoy, Thomas

  Sheerman, Barry

  McCartney, Ian

  Sheldon, Rt Hon Robert

  McCrea, Rev William

  Shore, Rt Hon Peter

  Macdonald, Calum A.

  Short, Clare

  McKay, Allen (Barnsley West)

  Sillars, Jim

  McLeish, Henry

  Skinner, Dennis

  Maclennan, Robert

  Smith, Andrew (Oxford E)

  McNamara, Kevin

  Smith, C. (Isl'ton & F'bury)

  Madden, Max

  Smith, J. P. (Vale of Glam)

  Mahon, Mrs Alice

  Smyth, Rev Martin (Belfast S)

  Marek, Dr John

  Soley, Clive

  Marshall, Jim (Leicester S)

  Spearing, Nigel

  Martin, Michael J. (Springburn)

  Steel, Rt Hon David

  Martlew, Eric

  Steinberg, Gerry

  Maxton, John

  Stott, Roger

  Meacher, Michael

  Strang, Gavin

  Meale, Alan

  Straw, Jack

  Michael, Alun

  Taylor, Mrs Ann (Dewsbury)

  Michie, Bill (Sheffield Heeley)

  Taylor, Matthew (Truro)

  Mitchell, Austin (G't Grimsby)

  Thomas, Dr Dafydd Elis

  Molyneaux, Rt Hon James

  Thompson, Jack (Wansbeck)

  Moonie, Dr Lewis

  Turner, Dennis

  Morgan, Rhodri

  Vaz, Keith

  Morley, Elliot

  Walker, A. Cecil (Belfast N)

  Morris, Rt Hon A. (W'shawe)

  Wall, Pat

  Morris, Rt Hon J. (Aberavon)

  Wallace, James

  Morris, M (N'hampton S)

  Walley, Joan

  Mowlam, Marjorie

  Wardell, Gareth (Gower)

  Mullin, Chris

  Wareing, Robert N.

  Murphy, Paul

  Watson, Mike (Glasgow, C)

  Nellist, Dave

  Welsh, Andrew (Angus E)

  Oakes, Rt Hon Gordon

  Welsh, Michael (Doncaster N)

  O'Brien, William

  Wigley, Dafydd

  O'Neill, Martin

  Williams, Rt Hon Alan

  Orme, Rt Hon Stanley

  Williams, Alan W. (Carm'then)

  Parry, Robert

  Wilson, Brian

  Patchett, Terry

  Winnick, David

  Pendry, Tom

  Winterton, Mrs Ann

  Pike, Peter L.

  Winterton, Nicholas

  Powell, Ray (Ogmore)

  Wise, Mrs Audrey

  Prescott, John

  Worthington, Tony

  Quin, Ms Joyce

  Wray, Jimmy

  Radice, Giles

  Young, David (Bolton SE)

  Randall, Stuart

  Redmond, Martin

  Tellers for the Ayes:

  Rees, Rt Hon Merlyn

  Mr. Ken Eastham and

  Reid, Dr John

  Mr. John McFall.

  NOES

  Adley, Robert

  Bendall, Vivian

  Aitken, Jonathan

  Bennett, Nicholas (Pembroke)

  Alexander, Richard

  Benyon, W.

  Alison, Rt Hon Michael

  Bevan, David Gilroy

  Allason, Rupert

  Blaker, Rt Hon Sir Peter

  Amess, David

  Body, Sir Richard

  Amos, Alan

  Bonsor, Sir Nicholas

  Arbuthnot, James

  Boscawen, Hon Robert

  Arnold, Jacques (Gravesham)

  Boswell, Tim

  Arnold, Tom (Hazel Grove)

  Bottomley, Peter

  Ashby, David

  Bottomley, Mrs Virginia

  Aspinwall, Jack

  Bowden, A (Brighton K'pto'n)

  Atkinson, David

  Bowden, Gerald (Dulwich)

  Baker, Rt Hon K. (Mole Valley)

  Bowis, John

  Baker, Nicholas (Dorset N)

  Boyson, Rt Hon Dr Sir Rhodes

  Baldry, Tony

  Braine, Rt Hon Sir Bernard

  Banks, Robert (Harrogate)

  Brandon-Bravo, Martin

  Batiste, Spencer

  Brazier, Julian

  Beaumont-Dark, Anthony

  Bright, Graham

  Bellingham, Henry

  Brown, Michael (Brigg & Cl't's)

  769

  Browne, John (Winchester)

  Grylls, Michael

  Bruce, Ian (Dorset South)

  Hague, William

  Buck, Sir Antony

  Hamilton, Hon Archie (Epsom)

  Budgen, Nicholas

  Hamilton, Neil (Tatton)

  Burns, Simon

  Hampson, Dr Keith

  Burt, Alistair

  Hanley, Jeremy

  Butler, Chris

  Hannam, John

  Butterfill, John

  Hargreaves, A. (B'ham H'll Gr')

  Carlisle, John, (Luton N)

  Hargreaves, Ken (Hyndburn)

  Carlisle, Kenneth (Lincoln)

  Harris, David

  Carrington, Matthew

  Haselhurst, Alan

  Carttiss, Michael

  Hawkins, Christopher

  Cash, William

  Hayes, Jerry

  Channon, Rt Hon Paul

  Hayhoe, Rt Hon Sir Barney

  Chapman, Sydney

  Hayward, Robert

  Chope, Christopher

  Heathcoat-Amory, David

  Churchill, Mr

  Heddle, John

  Clark, Hon Alan (Plym'th S'n)

  Heseltine, Rt Hon Michael

  Clark, Dr Michael (Rochford)

  Hicks, Mrs Maureen (Wolv' NE)

  Clark, Sir W. (Croydon S)

  Hicks, Robert (Cornwall SE)

  Clarke, Rt Hon K. (Rushcliffe)

  Higgins, Rt Hon Terence L.

  Colvin, Michael

  Hind, Kenneth

  Conway, Derek

  Hogg, Hon Douglas (Gr'th'm)

  Coombs, Anthony (Wyre F'rest)

  Holt, Richard

  Coombs, Simon (Swindon)

  Hordern, Sir Peter

  Cope, Rt Hon John

  Howard, Michael

  Cormack, Patrick

  Howarth, Alan (Strat'd-on-A)

  Couchman, James

  Howarth, G. (Cannock & B'wd)

  Cran, James

  Howe, Rt Hon Sir Geoffrey

  Critchley, Julian

  Howell, Rt Hon David (G'dford)

  Currie, Mrs Edwina

  Howell, Ralph (North Norfolk)

  Davies, Q. (Stami'd & Spald'g)

  Hughes, Robert G. (Harrow W)

  Davis, David (Boothferry)

  Hunt, David (Wirral W)

  Day, Stephen

  Hunter, Andrew

  Devlin, Tim

  Hurd, Rt Hon Douglas

  Dorrell, Stephen

  Irvine, Michael

  Douglas-Hamilton, Lord James

  Irving, Charles

  Dover, Den

  Jack, Michael

  Dunn, Bob

  Janman, Tim

  Dykes, Hugh

  Johnson Smith, Sir Geoffrey

  Eggar, Tim

  Jones, Gwilym (Cardiff N)

  Emery, Sir Peter

  Jones, Robert B (Herts W)

  Evans, David (Welwyn Hatf'd)

  Jopling, Rt Hon Michael

  Evennett, David

  Kellett-Bowman, Dame Elaine

  Fairbairn, Sir Nicholas

  Key, Robert

  Favell, Tony

  King, Roger (B'ham N'thfield)

  Fenner, Dame Peggy

  King, Rt Hon Tom (Bridgwater)

  Field, Barry (Isle of Wight)

  Kirkhope, Timothy

  Finsberg, Sir Geoffrey

  Knapman, Roger

  Fishburn, John Dudley

  Knight, Greg (Derby North)

  Fookes, Dame Janet

  Knight, Dame Jill (Edgbaston)

  Forman, Nigel

  Knowles, Michael

  Forsyth, Michael (Stirling)

  Knox, David

  Forth, Eric

  Lamont, Rt Hon Norman

  Fowler, Rt Hon Norman

  Latham, Michael

  Franks, Cecil

  Lawrence, Ivan

  Freeman, Roger

  Lee, John (Pendle)

  French, Douglas

  Leigh, Edward (Gainsbor'gh)

  Gale, Roger

  Lennox-Boyd, Hon Mark

  Gardiner, George

  Lightbown, David

  Garel-Jones, Tristan

  Lilley, Peter

  Gill, Christopher

  Lloyd, Sir Ian (Havant)

  Glyn, Dr Alan

  Lloyd, Peter (Fareham)

  Goodson-Wickes, Dr Charles

  Lord, Michael

  Gorman, Mrs Teresa

  Luce, Rt Hon Richard

  Gorst, John

  Lyell, Sir Nicholas

  Gow, Ian

  Macfarlane, Sir Neil

  Grant, Sir Anthony (CambsSW)

  MacGregor, Rt Hon John

  Greenway, Harry (Ealing N)

  MacKay, Andrew (E Berkshire)

  Greenway, John (Ryedale)

  McNair-Wilson, Sir Michael

  Gregory, Conal

  McNair-Wilson, Sir Patrick

  Griffiths, Peter (Portsmouth N)

  Major, Rt Hon John

  Grist, Ian

  Matins, Humfrey

  Ground, Patrick

  Mans, Keith

  770

  Maples, John

  Shersby, Michael

  Marland, Paul

  Skeet, Sir Trevor

  Marlow, Tony

  Smith, Tim (Beaconsfield)

  Marshall, John (Hendon S)

  Soames, Hon Nicholas

  Martin, David (Portsmouth S)

  Speed, Keith

  Maude, Hon Francis

  Spicer, Michael (S Worcs)

  Maxwell-Hyslop, Robin

  Squire, Robin

  Mayhew, Rt Hon Sir Patrick

  Stanbrook, Ivor

  Mellor, David

  Stanley, Rt Hon Sir John

  Mills, Iain

  Steen, Anthony

  Miscampbell, Norman

  Stern, Michael

  Mitchell, Andrew (Gedling)

  Stevens, Lewis

  Mitchell, Sir David

  Stewart, Allan (Eastwood)

  Moate, Roger

  Stewart, Andy (Sherwood)

  Monro, Sir Hector

  Stewart, Rt Hon Ian (Herts N)

  Montgomery, Sir Fergus

  Stokes, Sir John

  Moore, Rt Hon John

  Stradling Thomas, Sir John

  Morrison, Sir Charles

  Sumberg, David

  Moss, Malcolm

  Summerson, Hugo

  Moynihan, Hon Colin

  Tapsell, Sir Peter

  Neale, Gerrard

  Taylor, Ian (Esher)

  Nelson, Anthony;

  Taylor, John M (Solihull)

  Neubert, Michael

  Taylor, Teddy (S'end E)

  Newton, Rt Hon Tony

  Tebbit, Rt Hon Norman

  Nicholls, Patrick

  Temple-Morris, Peter

  Nicholson, David (Taunton)

  Thatcher, Rt Hon Margaret

  Nicholson, Emma (Devon West)

  Thompson, D. (Calder Valley)

  Norris, Steve

  Thompson, Patrick (Norwich N)

  Oppenheim, Phillip

  Thornton, Malcolm

  Page, Richard

  Thurnham, Peter

  Paice, James

  Townsend, Cyril D. (B'heath)

  Parkinson, Rt Hon Cecil

  Tracey, Richard

  Patnick, Irvine

  Tredinnick, David

  Patten, Rt Hon Chris (Bath)

  Trippier, David

  Patten, John (Oxford W)

  Trotter, Neville

  Pattie, Rt Hon Sir Geoffrey

  Twinn, Dr Ian

  Pawsey, James

  Vaughan, Sir Gerard

  Peacock, Mrs Elizabeth

  Viggers, Peter

  Porter, Barry (Wirral S)

  Waddington, Rt Hon David

  Porter, David (Waveney)

  Wakeham, Rt Hon John

  Portillo, Michael

  Waldegrave, Hon William

  Rathbone, Tim

  Walden, George

  Redwood, John

  Walker, Bill (T'side North)

  Renton, Rt Hon Tim

  Waller, Gary

  Rhodes James, Robert

  Ward, John

  Riddick, Graham

  Wardle, Charles (Bexhill)

  Ridley, Rt Hon Nicholas

  Warren, Kenneth

  Ridsdale, Sir Julian

  Watts, John

  Rifkind, Rt Hon Malcolm

  Wells, Bowen

  Roberts, Wyn (Conwy)

  Wheeler, John

  Roe, Mrs Marion

  Whitney, Ray

  Rossi, Sir Hugh

  Widdecombe, Ann

  Rowe, Andrew

  Wiggin, Jerry

  Rumbold, Mrs Angela

  Wilshire, David

  Ryder, Richard

  Wolfson, Mark

  Sackville, Hon Tom

  Wood, Timothy

  Sainsbury, Hon Tim

  Woodcock, Dr. Mike

  Scott, Rt Hon Nicholas

  Yeo, Tim

  Shaw, David (Dover)

  Young, Sir George (Acton)

  Shaw, Sir Giles (Pudsey)

  Younger, Rt Hon George

  Shaw, Sir Michael (Scarb')

  Shelton, Sir William

  Tellers for the Noes:

  Shephard, Mrs G. (Norfolk SW)

  Mr. Alastair Goodlad and

  Shepherd, Colin (Hereford)

  Mr. Tony Durant.

  Question accordingly negatived.
  Bill committed to a Standing Committee pursuant to Standing Order No. 61 (Committal of Bills)ֵ

BUSINESS OF THE HOUSE
Ordered,
That, at this day's sitting, the Ways and Means Motion may be proceeded with, though opposed, until any hour.—[Mr. Fallon.]

Points of Order
10.28 pm
Mr. David Winnick: On a point of order, Mr. Speaker. May I bring to your attention the fact that the forcible return of the Vietnamese boat people has just started and involves the riot police in Hong Kong? I know that you do not decide whether a statement is made, but in view of the deep anxiety in many quarters about the way in which these people are being treated, can the Leader of the House make arrangements for a statement to be made as quickly as possible? Surely the House should have been involved—whether by means of a statement or private notice question—in such a serious matter which arouses so much anxiety. I hope that if not tonight then tomorrow we shall have a full statement on what is going on in the prison camps. It appears that even tonight the forcible return of these people will continue.
Mr. Anthony Beaumont-Dark: Further to that point of order, Mr. Speaker.
Mr. Speaker: Is it the same point of order?
Mr. Beaumont-Dark: It is on the same point of order, Mr. Speaker. If we are to have statements in the House that are meant to be fair and balanced, could we have a statement from the Leader of the Opposition, who seems to be so keen to criticise everyone else without putting forward answers of his own about what the Opposition would do to help the people of Hong Kong to deal with the problem? It is sheer hypocrisy to say what—
Mr. Speaker: Order. We cannot have a debate on the matter.
Mr. Dave Nellist rose—
Mr. Speaker: Is it the same point of order?
Mr. Nellist: Yes. Further to that point of order, Mr. Speaker. You will have noticed that the Leader of the House is in his place. Would I be correct to assume that it would be entirely in order for him now to ask for your permission and that of the House to make an announcement, if he so desires, regarding the point of order raised by my hon. Friend the Member for Walsall, North (Mr. Winnick)? I have just returned from East Berlin. Could the Leader of the House explain why one set of refugees from Stalinism can be said to be seeking freedom while another set of refugees from a Stalinist regime, who have been made even poorer because of the wars launched against their country by the West, are economic refugees? Should not the Leader of the House take this opportunity, through you, to state that the forced repatriation of those people from Hong Kong will cease forthwith?
Mr. David Alton: Further to that point of order, Mr. Speaker. I support the calls that have already been made that a statement should be made to the House tonight about this most important question. Would it be possible to include in the statement details of what will happen to the unaccompanied children and orphans who are in those camps, many of whom have been there for many years and who are also facing forcible repatriation?
The Lord President of the Council and Leader of the House of Commons (Sir Geoffrey Howe): The House will recall that what is now happening was first foreshadowed in a statement that I made in Hong Kong some 15 months ago. The policy has been repeatedly explained to the House, most recently by my right hon. Friend the Foreign Secretary in his speech during the debate on the Loyal Address and during Question Time a few days ago. It has also been the subject of study by the Select Committee on Foreign Affairs, which commended the premises upon which the policy is founded.
There should be no doubt about the background to these very difficult decisions. It is right, even so, that the House should look forward to a statement on the subject. My right hon. Friend the Foreign Secretary intends to make a statement at the usual time tomorrow afternoon.
Mr. Jeremy Corbyn: Further to that point of order, Mr. Speaker.
Mr. Speaker: Order. There cannot be a point of order beyond that.
Mr. Corbyn: In the meantime—
Mr. Speaker: Order.
Dr. John Cunningham: I welcome the announcement by the Leader of the House that a statement will be made tomorrow, but, as on several other occasions in the past, the Government have got this the wrong way round. There ought to have been a statement before these events were set in train. That would have been the proper and appropriate course of action for any reasonable Government to take in the circumstances. They ought first to have announced in Parliament what was going to happen and then listened to what hon. Members had to say before taking their decision. I welcome the delayed acknowledgement that it is important that these matters should be announced first in Parliament. I hope that the Leader of the House has learnt his lesson and that in future statements will be made here before decisions are implemented.
Mr. Corbyn: On a point of order, Mr. Speaker.
Mr. Speaker: Order. Nothing arises from that.
Mr. Corbyn: Yes, Mr. Speaker. It does arise from the statement.
Mr. Speaker: It cannot arise from it. It is not a matter for me, anyway.
Mr. Corbyn rose—
Mr. Speaker: Order. I repeat that it is not a matter for me. The Leader of the House has said that the Foreign Secretary will come here tomorrow to make a statement. I can do nothing further.
Mr. Corbyn: The problem is that I understand that a number of people have been taken from Hong Kong to Vietnam. There is no guarantee that Vietnam will accept them.
Mr. Speaker: The hon. Gentleman will have to reserve that point until tomorrow.

National Health Service and Community Care Bill [Money]
Queen's Recommendation having been signified—
Motion made, and Question proposed,
That, for the purposes of any Act resulting from the National Health Service and Community Care Bill, it is expedient to authorise the payment out of money provided by Parliament of—

(a) any sums required by the Secretary of State for making loans to a National Health Service trust,

(b) any sums required by the Secretary of State for fulfilling a guarantee of a sum borrowed by a National Health Service trust,

(c) any amount paid as public dividend capital under any provision of that Act,

(d) any expenses of the Secretary of State under that Act, and

(e) any increase attributable to that Act in the sums so payable under any other enactment.—[Mr. Chapman.]

10.34 pm
Mr. Bob Cryer: We have a right to raise issues in the House. I am not deterred by the fact that it inconveniences some hon. Members who resort to vile shouts from a sedentary position.
Dame Elaine Kellett-Bowman rose—
Mr. Cryer: I would point out to the hon. Member for Lancaster (Dame Elaine Kellett-Bowman) that it will actually encourage me.
Dame Elaine Kellett-Bowman: It would be so much better if, instead of constantly speaking on money resolutions, the hon. Member for Bradford, South (Mr. Cryer) actually attended and took part in the main body of the debate.
Mr. Cryer: I wish to ask a few brief questions, which are not unreasonable bearing in mind that under the heading
"Financial Effects of the Bill,"
the Bill authorises some £200 million. Therefore, I hope that the Minister will be able to respond.
The first financial effect authorised by the money resolution includes an estimated £10·5 million in
"remuneration to non-executive members of health authorities and Family Practitioner Service Authorities".
As that is a fairly accurate sum, I have no doubt that the Minister will be able to tell the House the average payment to be made in that context.
Mr. Dave Nellist: On a point of order, Mr. Speaker. I apologise to you, Mr. Speaker, and to my hon. Friend the Member for Bradford, South (Mr. Cryer) for interrupting, but I wonder whether you could ensure that those Tory Members who want to leave the Chamber do so quietly. I believe that while we have a debate on the money resolution which concerns many millions of pounds, at least we should be able to hear the arguments. I cannot do that because of the Tory rabble.
Mr. Speaker: Will hon. Members kindly leave quietly please? Is that better?
Mr. Nellist: Much better, thank you.
Mr. Cryer: I shall not detain the House too long, but comments made from a sedentary position encourage me
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to repeat everything again to make sure that the Minister has a thorough understanding of the matter. Therefore, I would discourage hon. Members from so doing.
The second paragraph relates to
"The arrangements necessary for establishing contracts for services and setting up NHS trusts".
The money resolution refers to loans to NHS trusts. Will the Minister elaborate on that and explain whether grants will be made or whether NHS trusts are to be bribed with loans?
The amount of money listed in the paragraph on the financial effects of the Bill is quite considerable—£155 million in a full year. I am sorry that the Minister has not allocated any money for the holding of local ballots so that the people of an area can decide whether there should be an opted-out hospital and an NHS trust in the first place. The Government are keen on ballots for trade unions and virtually everything else.
Dame Elaine Kellett-Bowman: Will the hon. Gentleman give way on that point?
Mr. Cryer: I am trying to be brief—
Dame Elaine Kellett-Bowman: We have an hour and a half.
Mr. Cryer: The debate is limited to 45 minutes, so the hon. Lady is 100 per cent. wrong.
It would be better if the Minister allocated money for a local ballot so that there can be a clear democratic decision on whether an NHS trust is set up.
Dame Elaine Kellett-Bowman: Will the hon. Gentleman give way on ballots?
Mr. Cryer: The third paragraph concerns GP practice funds which are quite important, but, as the hon. Lady is piercing my ear drums and making them oscillate rather wildly, I shall give way.
Dame Elaine Kellett-Bowman: The hon. Gentleman did not give way when I asked him about ballots. In some specialties 49 per cent. of people being treated in Lancaster come from outside the district. What on earth would the hon. Gentleman regard as the catchment area for that vote?
Mr. Cryer: I am prepared to consider any proposal that the Minister might put forward. The Government have displayed much ingenuity in arranging ballots for trade unions, so I see no reason why they cannot have a shot at defining a catchment area for ballots for hospitals. I should like to see them show some political will to do that. Although they are spending £155 million on what appears to be loan finance to the NHS trusts, there is no provision to allow local people to take their own decisions. By and large, people in Bradford have shown themselves to be overwhelmingly against NHS trusts.
The third paragraph on the financial effects of the Bill says:
"There will be additional costs associated with the change in the functions of Regional Health Authorities".
That will cost £8 million in a full year, including extra tasks as a result of the introduction of GP practice funds. That significant sum of money will be spent on something that, by and large, GPs have said they are not enthusiastic about because they do not believe that it will strengthen the National Health Service.
The fourth paragraph says:

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"Under the GP practice fund scheme … the costs to practices of undertaking work in anticipation of becoming fund holders and in administering these funds will be reimbursed subject to a specified maximum amount."
Together with additional computer support, that will cost a total of £15·6 million. That is a lot of money for something about which GPs are not enthusiastic. No doubt the Minister will justify it by saying that it will produce greater efficiency, but these sums are for administrative measures, none of which is of direct benefit to patients. I should like the Minister to say how he foresees that £15·6 million producing greater value for money.
The fifth paragraph says that the initial capital cost of the information systems for the management of drug expenditure will cost £9 million,
"with ongoing costs thereafter of £3·3 million a year."
Is expenditure on drugs in the Health Service so lax that such an amount of money is necessary to provide information about it?
The sixth paragraph mentions audit costs and links with the fifth paragraph, because there will be an increase in the cost of auditing of between £12 and £16 million as a result of the transfer of the National Health Service audit function to the Audit Commission. I can see sense in transferring auditing to a central body, but one of the aims of doing so would be to reduce costs rather than increase them. Surely one of the aims of a central audit body would be to obtain economies of scale, expert knowledge and a reservoir or repository of audit knowledge and efficiency, yet it will cost an extra £16 million, which so far has not been explained.
The seventh paragraph, on asset registers, caused me some concern. I understand that the introduction of capital charges and the upkeep of asset registers will cost £5·5 million. Does not the Minister think that that will put pressure on authorities to get rid of assets that have a realisable value? Much concern has been expressed in Bradford, because Westwood hospital, which stands in attractive grounds, would be worth much money if it was sold to a speculative builder. It is a hospital for mentally handicapped people, and its staff and the relatives of its patients believe that it would be far better if the grounds were used for developing a village community.
When I raise this point, Ministers say, "That sounds like a reasonable idea, but it is not one of the schemes that is being promoted as an experiment in community care." The hospital provides a potential community. Decanting handicapped people into the community without adequate care provision and resources might result in the erosion of this valuable asset. If mistakes are made and the hospital's grounds are sold, there will be no reserve available to which people can be transferred back. Sometimes people are returned to the community, but there is mutual suspicion by patients and the community. The patients therefore return willingly to places such as Westwood hospital.
I hope that the paragraph reflects an administrative measure to keep a check on what assets the NHS has and to make good use of them and that this is not simply an asset-stripping pressure imposed on the NHS.
Mr. Nigel Spearing: My hon. Friend is voicing deep and widely held concerns about these hospitals. We wish to retain those hospitals for the very purposes that he has outlined. Is he aware that in London the realisation of so-called surplus assets, especially by the
776
North East Thames regional health authority, amounts to between 40 and 50 per cent. of the expected capital investment in new hospitals? These amounts have recently been cut because of the drop in the value of land sales.
Would not a transaction such as that described by my hon. Friend place an unenviable pressure on the regional hospital boards—to say nothing of the Secretary of State—to get rid of assets which should be retained for capital investment? That investment should come from the Exchequer, not from land sales which are supposedly surplus but are probably not.
Mr. Cryer: My hon. Friend makes the very point that I was outlining. There should not be pressure from central Government, saying, "You should realise the assets on the register and sell them at the highest possible price. Speculative builders want to purchase them, so you must sell them as part of your resources to provide community facilities."
Westwood hospital is a precious publicly owned asset. It is situated in grounds that look like college grounds. There are rolling acres. It could be part of an important pilot project. A village community could use the common resources of the hospital, providing a sheltered environment for patients. The patients would not live in the harshness of the community, where they and other members of the community may view each other with mutual hostility. The patients could be encouraged to achieve some independence in a protected environment. That is very much the aim of the patients, the staff and the relatives. Both the relatives and the children in the hospital are growing older, and aging parents are worried at the thought of their children being moved to an area where they do not receive the necessary care and attention because of a lack of resources. That is an important paragraph. I should be grateful if the Minister would assure the House that this village concept will be encouraged rather than scorned.
I greatly welcome the last paragraph on the removal of Crown immunity. Ten years ago, I argued that Crown immunity for all sorts of bodies should be removed. That was viewed as a slightly wild, Left-wing dictator's position. That is certainly not an accusation that can be levelled against the Secretary of State. It is right and proper, and the costs involved are relatively modest in view of the step forward that it represents.
On page xi, the Bill says:
"The changes enabling local authorities to make arrangements for the provision of nursing home care … amount to £20 million."
Will the Secretary of State give us the basis for the £20 million charge because it seems a rather small sum? The question of community care is important. I hope that the Secretary of State recognises that many people are extremely apprehensive about the resources that will be made available and that £20 million does not seem an adequate sum.
10.49 pm
The Secretary of State for Health (Mr. Kenneth Clarke): I congratulate the hon. Member for Bradford, South (Mr. Cryer) on his ingenuity in getting into the Health Service debate. Other hon. Members come during the debate, listen to other people and speak before we vote on the principles behind the measure. That does have inconvenient points, such as having to seek to catch your eye,

777
Mr. Deputy Speaker, in competition with other hon. Members. The hon. Member for Bradford, South prefers to steam in some time after we have voted and to speak on the money resolution, although he has raised some valid points. It also saves him from having to read the whole Bill. He always turns up the pages that describe the financial effects of the Bill and works steadily and carefully through them, paragraph by paragraph. I am genuinely in awe of his ingenuity and if there is ever a prospect of the Labour party winning an election, I hope to have a chance to do the same to him some day. Meanwhile, I shall seek to answer his points briefly.
We believe that payment for non-executive members is right, although we expect to make very modest payments, such as those that would be made to the non-executive director of a substantial board in the private sector. Nowadays, membership of a health authority or, in future, an NHS trust is not a minor matter of public service which people can take on for an hour or two a week, for which they can be quite unremunerated and in which they can expect to have some fairly honorific duties. The turnover of district health authorities can be £50 million or £80 million a year and such authorities are involved in crucial decisions about the use of assets and the development of services in their locality. To pay such members nothing would mean that the people making the appointment would have to go to a restricted group of the population. We are talking not about a full-time salary, but a small honorarium, which is now appropriate and compensates in part for the attendance allowance monies that are paid to councilors—
Mr. Nellist rose—
Mr. Clarke: I believe that the hon. Member for Coventry, South-East (Mr. Nellist) wants to ask me about that.
Mr. Nellist: That thought had occurred to me. Will the Secretary of State tell us how small the honorarium will be? Many local authorities' budgets are handled by people who receive a pittance for their attendance. Those budgets may run to many hundreds of millions of pounds. Does this reflect a change in Government thinking? The Department of the Environment still says that it does not intend to pay decent allowances to councillors, whereas the Secretary of State for Health appears to be saying that large sums will go to non-executive members. Can he give us some figures?
Mr. Clarke: I know some local authority members who appear to regard their local authority work as their sole source of income and make a full-time job of it. Admittedly, that tends to happen in councils in which large numbers of committees are formed and in which committees sit almost daily, so causing almost daily attendance. I do not contemplate any sum that we pay using this power would enable anybody to regard the membership of a health authority as a full-time source of income. People may devote many hours a week to it and on some regional health authorities some of the members are, in practice, full time. I was thinking of a few thousand pounds only to mark the fact that this is no longer an honorific or titular post.
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The next paragraph on page x refers to the sum of £155 million, which is the best estimate we can make of the initial cost of strengthening the management of the National Health Service in a variety of ways, such as the establishment of contracts for services, the setting up of NHS trusts and the general strengthening of management at all levels. I am sure that the sum will justify itself when one reflects that we are talking about the management of a service which gets through £28 billion each year at present. Financial and personnel management are not up to the strengths that one would expect of an organisation of this size. I am sure that the costs will be outweighed by improvements in the operation of the service and by the improved value for money that the strengthening of management should produce.
The next point the hon. Gentleman raised was about the additional costs of family practitioner service authorities. They do not arise solely from the Bill; in recent years we have changed the role of the old family practitioner committees. They play an important part in managing the contracts of the GPs, opticians, dentists and pharmacists in their locality. As they are staffed at present, they exist only to pay the cheques to doctors, so some strengthening of the service is required to enable them to carry out their new duties properly.
The amount spent on the GP practice fund scheme will depend on the number of participating practices. This is a modest investment for a part of the Bill that will prove popular with the GPs who take advantage of it, and with the patients in the affected practices. It is a great breakthrough for general practice that the more go-ahead GPs will have the chance to control the use of resources in their areas for the benefit of their patients in a way that has not been permitted them before.
The cost of the information systems for drug expenditure, at £9 million, is splendid value for money when one contemplates the huge expenditure of the Health Service on drugs. Despite all our discussions on drugs from time to time, every hon. Member agrees that it is worth seeing what we can do to avoid wasteful and unnecessary spending on drugs, as long as we ensure that the money goes back into the Health Service, as the Government intend that it will. Only the hon. Member for Peckham (Ms. Harman) still believes that our proposals might involve cash limits on GPs' prescriptions of drugs—she is the last survivor of an ever dwindling band. Everybody else welcomes the proposal.
Audit costs are also modest, given that they will extend value-for-money audit of the huge sums that we spend. Asset registers are concerned with ensuring that proper regard is paid to capital costs when determining value for money in the NHS. They will not have much bearing on longstanding policy on the disposal of surplus land which might occur in the case of Westwood hospital. When examining the best way of developing services, those responsible in the health authorities will not just go for capital-intensive solutions all the time—because they get a grant of capital, they can disregard the cost compared with the revenue they must seek. They will make the best judgments, taking account of the cost of the capital and comparing it with the revenue costs that might be incurred by other methods. That is a sensible accounting change.
This might result in some hospitals being retained for longer. In future, authorities will determine how to make better use of their premises, instead of always thinking in terms of great new capital building.

779
I am glad that the hon. Member for Bradford, South and I agree completely about Crown immunity. We are moving towards abolishing it altogether. All hon. Members agree that there is no place for the continuation of Crown immunity in the NHS, and no reason why health authorities should not be liable to the same controls—
Mr. Nellist: What about this place?
Mr. Clarke: This is not the time to give my opinion on the House of Commons having taken on responsibility for its own affairs some time ago. We have enough difficulties trying to improve the management of the NHS; improving the management of the House would be a labour of Hercules on which I have no intention of embarking.
Mr. Cryer rose—
Mr. Clarke: I hope that I have dealt with most of the hon. Gentleman's points. I am grateful to him for drawing attention to these important financial matters. I trust that he will now allow us to vote on the money resolution in the same way as we did on the Bill.
Mr. Cryer rose—
Mr. Deputy Speaker (Sir Paul Dean): Order. I do not think that the Minister is giving way.
Question put and agreed to.
Resolved,
That, for the purposes of any Act resulting from the National Health Service and Community Care Bill, it is expedient to authorise the payment out of money provided by Parliament of—

(a) any sums required by the Secretary of State for making loans to a National Health Service trust,

(b) any sums required by the Secretary of State for fulfilling a guarantee of a sum borrowed by a National Health Service trust,

(c) any amount paid as public dividend capital under any provision of that Act,

(d) any expenses of the Secretary of State under that Act, and

(e) any increase attributable to that Act in the sums so payable under any other enactment.

NATIONAL HEALTH SERVICE AND COMMUNITY CARE BILL [WAYS AND MEANS]
Resolved,
That, for the purposes of any Act resulting from the National Health Service and Community Care Bill, it is expedient to authorise—

(1) the imposition of charges to value added tax by a provision relating to the treatment of National Health Service trusts for the purposes of section 27(4) of the Value Added Tax Act 1983;

(2) payments into the Consolidated Fund.—[Mr. Chapman.]

European Communities (Budget)
[Relevant documents: European Community Documents Nos. 8848/89, Letter of Amendment No. 1 to the Preliminary Draft Budget of the European Communities for 1990 and 9627/89, Letter of Amendment No.2 to the Preliminary Draft Budget]
10.59 pm
The Economic Secretary to the Treasury (Mr. Richard Ryder): I beg to move,
That this House takes note of European Community Documents Nos. COM(89) 175, the Preliminary Draft Budget of the European Communities for 1990, 8271/89, the Draft Budget of the European Communities for 1990, and 9704/89 and the Supplementary Explanatory Memorandum submitted by Her Majesty's Treasury on 6th December 1989 relating to the European Parliament's proposed amendments and modifications to the Draft Budget; and welcomes the impact on the 1990 Budget of the new arrangements for budgetary discipline agreed at the European Council in February 1988.
Mr. Deputy Speaker (Sir Paul Dean): Mr. Speaker has not selected either amendment.
Mr. Tony Marlow: On a point of order, Mr. Deputy Speaker. You will be aware that there is a very important amendment on the Order Paper in the name of the leader of the Liberal party. You will also be aware that the leader of the Liberal party made a very passionate intervention on a point of order earlier today about the importance of this great debate in terms of the strategy of the European Community. As he is not in the Chamber yet, although it is obvious that he will arrive at some stage, is there some way in which we can delay the commencement of the debate until he arrives?
Mr. Deputy Speaker: I do not think that that would be at all popular with the House. As I have already said, Mr. Speaker has not selected either amendment.
Mr. Ryder: Earlier today I spoke to a Liberal supporter who told me that at the next general election their slogan will be "We're all mild about Paddy."
The European Community is central to Britain's foreign policy. Since 1979, the Conservative Government have been playing an active role in the Community's affairs. Today, Britain leads the way in searching out practical solutions to the practical problems that confront Europe and the European Community. Not least because we are the second largest net contributor to the Community budget, our political commitment to the Community is backed by a firm financial one.
Mr. A. J. Beith: Does the Minister regard the exchange rate mechanism of the European monetary system as a practical way of tackling the problems faced by the Community? Why is Britain not taking a lead in that?
Mr. Ryder: That particular point is not central to the budget. However, I reaffirm, no doubt much to the hon. Gentleman's surprise, that the Government have committed themselves to entering the European monetary system once the Madrid conditions are met. The question is not whether we shall enter the ERM, but when.
Mr. Marlow: My hon. Friend the Minister said that we are the second largest net contributor to the Community budget. We are all aware of the historic efforts of my right hon. Friend the Prime Minister in reducing the United
782
Kingdom's contributions some years ago. However, we are now net importers of European agricultural services and massive net importers of European industrial products. As I understand it, we are still contributing a massive £2,000 million to the European budget next year. That is obviously wrong. What are the Government going to do to ensure that our budget contribution is reduced to a much more modest figure, in keeping with the other benefits that we provide for other Community nations?
Mr. Ryder: But for the efforts of my right hon. Friend the Prime Minister the present position with regard to the budget would be even worse for this country.
Not long ago the common agricultural policy was out of control, the finances were chaotic and the budget had huge imbalances. The food mountains were piling up and the single European market was no more than a dream. Today's Community is no longer crippled by those problems. Reforms, proposed and supported by Britain, have transformed the Community so that today the Community budget is in surplus and agricultural expenditure in 1988 is estimated to have been some £750 million below the ceiling agreed.
Britain pays a much fairer share to the Community budget. Rebates likely to amount to £10 billion by the end of 1990 have put an end to the grossly inequitable contributions passed on to us by the previous Labour Government. The food mountains are dwindling fast, too, as the CAP comes under better control. The completion of the single market has moved from near the bottom of the Community's agenda to the top with a firm deadline for completion. As Jacques Delors stressed in his report at Strasbourg last week, of the 88 single market directives that should have cleared all legislative hurdles, Britain has passed 69. Our record is better than that of any country except Denmark, and it once again underlines the need to judge a country's commitment to the European Community as much by its deeds as by some of the claims that emanate from European capitals.
Mr. Rupert Allason: Will my hon. Friend confirm that, although the United Kingdom has passed 69 such directives into law, the European Community average is nearer 35?
Mr. Ryder: Unhappily, I confirm that. Jacques Delors talked about it when he gave his report to the Strasbourg summit last week.
Mr. Marlow rose—
Mr. Ryder: I have given way once to my hon. Friend. I know that several hon. Members on both sides of the House wish to speak, but I will give way once more; then I must proceed with my speech.
Mr. Marlow: My hon. Friend has said, rightly, how much better we are as Europeans than are other Community countries, but—sadly—we are not one of the wealthiest Community countries. Can my hon. Friend explain why we are still a massive contributor to the European Community budget? That seems most unfair.
Mr. Ryder: If my hon. Friend will allow me to proceed, the answer will become apparent to him.
This year's budget procedure has been overshadowed by the Community's commitment to underpin economic and social developments in Poland and Hungary. It is encouraging that the Budget Council has been able to

783
respond promptly and generously, while at the same time respecting the budgetary rules and parameters that were put in place after the February 1988 session of the European Council. Today's debate provides a useful opportunity to review how the new arrangements for budgetary discipline have been working, and how they have coped with developments in eastern Europe that could not have been foreseen when they were drawn up.
Two aspects of the arrangements are particularly relevant. First, there is the inter-institutional agreement, or IAA. The House will recall that that is a political agreement under which the Council, the European Parliament and the Commission have bound themselves to respect ceilings for each of the main categories of Community expenditure between 1988 and 1992. Those ceilings are set out in the so-called financial perspective, which was initially drawn up at 1988 prices. A technical revision to update the price base was made in April 1989. The Commission may propose a more substantive revision of the ceilings under article 12 of the IIA; that requires a qualified majority in the Council and the equivalent in the Parliament. So far no such proposal has been made, but a revision will be needed early next year to allow for Community aid for Poland and Hungary, which was discussed at Strasbourg last week. I shall return to that later in my speech.
Mr. Tam Dalyell: Is the Minister aware of the statement by Walter van Dieren, director of the Amsterdam environment and system analysis institute, that five guilders spent in Holland are worth only one guilder spent in eastern Germany? Environmental problems have no frontiers, and therefore expenditure in eastern Germany is more productive for the environment of Holland than is spending in Holland itself. Could that view at least be taken into account?
Mr. Ryder: It is inconceivable that such issues should not be taken into account now that the shape of Europe is beginning to change as a result of the transformation of eastern Europe during the past two or three months.
Mr. Anthony Beaumont-Dark: Will my hon. Friend give way?
Mr. Ryder: I will give way once more, and then I really must proceed apace.
Mr. Beaumont-Dark: I am much obliged to my hon. Friend, who is now dealing with a germane problem with which we are all concerned.
A good deal of sentiment—happy sentiment—has been prompted by the fact that the east European community is heading towards democracy. The Common Market, with its usual flabby attitude, talks about the vision splendid and the money that we are all going to give. When I was at the World Bank in late October, however, the experts talked about the need for $40 billion for Poland alone, and $15 billion for Hungary. Now we have Czechoslovakia and East Germany. It is super that they are going to join the free world, but what will two members of the Common Market hegemony—Greece and Portugal—think if the money that was going to go their way suddenly goes to eastern Europe? Who is going to pay for all these happy, joyful thoughts and items?
Mr. Ryder: The crucial programme for Poland is the IMF programme which my hon. Friend doubtless
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discussed on his recent visit to Washington. That programme is being drawn up at the moment and I understand that an announcement about it will be made in the relatively near future. That is the key programme, but in addition we have believed that direct inward foreign investment into countries such as Poland and Hungary is of greater benefit to them than anything else. When Mr. Walesa was in Britain recently, he met a number of my right hon. Friends and agreed with them that supply side changes and reforms were desperately required in Poland. Indeed, it is inconceivable that the Polish Government will not introduce those supply side measures as a result of the IMF programme that is now being drawn up.
The Council has undertaken to apply the IIA in accordance with paragraph 14 of the conclusions of the February 1988 European Council. This paragraph distinguishes between "privileged" and "non-privileged" expenditure. "Privileged" expenditure includes the structural funds, the research and development framework programme and the integrated Mediterranean programmes. The growth of this category of expenditure between 1988 and 1992 has been pre-ordained by Council decisions. However, for the remainder of non-compulsory expenditure—the "non-privileged" element—the Council has agreed to respect the maximum rate of increase calculated by the Commission at the start of each year's budget procedure, within the framework of article 203(9) of the treaty. The calculated maximum rate for the 1989 budget is 6·1 per cent.
The second aspect of the new budget discipline arrangements about which the House may wish to be reminded was to a large extent a product of our determination to prevent a recurrence of the overspending which brought the Community tottering to the edge of bankruptcy in 1987. I am referring to the financial guideline for agriculture. The guideline sets a legally binding limit on agricultural support expenditure. The annual growth of that limit is confined to 74 per cent. of the rate of growth of Community GNP. The guideline is buttressed by automatic, legally binding stabilisers that trigger price cuts whenever production of the main commodities exceeds maximum quantities set by the Council.
Mr. Teddy Taylor: Will my hon. Friend give way?
Mr. Ryder: I have given way five times already in a one and a half hour debate. I must proceed with my speech—
Mr. Taylor: That is shocking. What happened to cereal stabilisers?
Mr. Ryder: Cumulative expenditure in 1988 and 1989 was over 5 billion ecu below the guideline, and a further large shortfall is in prospect next year.
It may be helpful if I set out a chronology of this year's procedure so far—a ball-by-ball commentary of the highlights of the procedure, as my right hon. Friend the Secretary of State for Northern Ireland used to describe it when he spoke in these debates.
Mr. Bowen Wells: On a point of order, Mr. Deputy Speaker. I am sorry to disrupt the Minister's speech, but will he explain some of the technical terms that he is using so that the House can follow? I am sure that you, Mr. Deputy Speaker, are following what my

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hon. Friend is saying, but will he tell me what IAA means and what are obligatory and non-obligatory expenditure, and preferential and non-preferential expenditure? It is not easy for those of us on the Back Benches to follow what is being said.
Mr. Deputy Speaker: I hope that the hon. Gentleman is not asking me to explain these terms. Perhaps the Minister can.
Mr. Ryder: It is just as well that someone explained them to me, Mr. Deputy Speaker. I shall not go into all of them because as I have proceeded through my speech after each term or acronym I have said what it stands for or means. In fact, the IAA is the IIA, which stands for the inter-institutional agreement. The Council begins with the preliminary draft budget—[Interruption.] For my hon. Friend the Member for Hertford and Stortford (Mr. Wells), that is the PDB, which the Commission presented in July. The PDB was around 4·5 per cent. bigger than the adopted budget for 1989, but it was nonetheless more than 4 billion ecu within the overall ceiling in the financial perspective. Total provision was equivalent to around 1 per cent. of Community GNP and almost 2·5 per cent. of public expenditure by member states.
Two aspects of the PDB exemplified underlying trends in EC expenditure. First, the proportion of the total budget accounted for by expenditure on agricultural market support was down for the second year running. This largely reflected developments in the world market for agricultural produce, but the new budget discipline arrangements have also played an important part. For example, price cuts have been triggered by the automatic stabilisers—3 per cent. cuts in cereals have resulted this year and next.
Secondly, the PDB provided for an increase of over 20 per cent. in expenditure on structural operations and research and development. These areas now account for almost one third of the total budget.
I should also mention that the PDB included provision of 70 million ecu for measures to combat fraud. This was further tangible evidence of the Community's new-found determination to root out fraud. The Government spearheaded efforts in Europe to persuade our partners to combat fraud more robustly. That has led to the creation of the anti-fraud co-ordination unit, and anti-fraud cells are now in place in key directorates in Brussels.
The PDB was given a first reading at the Budget Council on 28 July. The United Kingdom argued strongly that the Council should stick rigidly to the letter of the Brussels conclusions and confine the growth of non-privileged DNO to half the calculated maximum rate—to 3·01 per cent. A majority in the Council agreed, and the Commission's proposals were accordingly pruned by around 280 million ecu in commitments and payments. Overall, the draft budget established on 28 July was some 700 million ecu in commitments and 650 million ecu in payments lower than the PDB.
It was at this point that the dramatic developments in eastern Europe started to occupy centre stage in the 1990 budget. In September, the Commission presented a letter of amendment to the 1990 PDB which provided for assistance of 200 million ecu towards the economic restructuring of Poland and Hungary and for a
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Community guarantee for loans to those two countries from the European Investment bank. The 200 million ecu is on top of the emergency food aid package of 100 million ecu which the Community agreed last July. It is intended to cover such things as special import programmes for pesticides, agricultural machinery, business training and environmental improvements.
When drawing up the letter of amendment, the Commission took the view that expenditure on economic aid to Poland and Hungary should be over and above the relevant ceiling in the financial perspective. The Commission accordingly included in the letter a so-called "negative reserve" of 200 million ecu. This was a stopgap measure enabling expenditure on the aid package to go ahead, pending a formal revision of the financial perspective under article 12 of the IIA. The Commission intends to propose such a revision in February next year.
Publicly funded aid is by no means a complete solution to the problems of the Polish and Hungarian economies, as I said to my hon. Friend the Member for Birmingham, Selly Oak (Mr. Beaumont-Dark), who has left the Chamber. The crucial role belongs to the private sector. The Government have nonetheless unreservedly welcomed the proposed EC aid package, as well as the fact that the Commission and the Council have managed to respond to those developments within the framework of budget discipline. Thus, when the amending letter was established at ECOFIN on 9 October, the Council made two important statements for the minutes. The first was that it would agree to the proposed revision of the financial perspective for 1990, provided that this was confined to the amount of the aid package for Poland and Hungary. The second was that the application of article 203(9) of the treaty in the 1990 budget procedure would be unaffected by the financing of the aid package. The purpose of this latter statement was to underline the need for genuine co-decision between the Council and the European Parliament on the overall level of DNO in the 1990 budget.
The first letter of amendment was quickly followed by a second one. The purpose was to bring to account 800 million ecu of savings in agricultural expenditure in 1989 that had been transferred to the monetary reserve. The monetary reserve is symmetrical in operation. It allows for expenditure on agricultural support of up to 1,000 million ecu above the guideline if, and only if, that is needed as a result of the ecu appreciating against the dollar. Conversely, budget appropriations of up to 1,000 million ecu which are no longer required because the dollar has appreciated against the ecu must be transferred to the reserve. In 1989 the latter situation has prevailed. The effect has been to create a budget surplus which, when carried forward to 1990, will reduce member states' contributions to the budget for that year.
In fact, the budget surplus in 1989 will be much larger than 800 million ecu, due mainly to underspending on agricultural support which has occurred for reasons other than exchange rate movements. The Commission declined to include this additional amount, which totals over 1 billion ecu, in the second amending letter, and thereby provoked the Council to take action at its second reading of the budget in November. I will come to this in a moment. But the next event in the chronology was the Parliament's first reading of the budget at the end of October.
The Parliament took the view that the current ceilings in the financial perspective could not accommodate the

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expenditure consequences of new legislation which the Community had adopted since 1988. It therefore demanded that the Commission propose a general revision of the financial perspective before the second reading of the budget.
In terms of numbers, the Parliament voted for amendments and modifications, adding over 1·2 billion ecu in commitments and almost 1 billion ecu in payments to the draft budget. Three amendments were especially significant: first, an increase of 100 million ecu in the package of economic assistance for Poland and Hungary; secondly, the removal of the negative reserve of 200 million ecu to which ECOFIN agreed on 9 October; and finally, the introduction of a so-called operational reserve of 184 million ecu over and above the relevant ceiling in the financial perspective. All that added up to a bid by the Parliament to increase the ceiling in category 4 of the perspective by 484 million ecu: 300 million ecu for Poland and Hungary and 184 million ecu for the other policies covered by the operational reserve.
The Budget Council on 14 November tried to persuade the Commission to revise its second amending letter by including a reasonable estimate of the agricultural underspending in 1989 stemming from factors other than exchange rate movements. The Commission was unwilling to do that and the Council therefore revised the letter on its own authority. It increased the figure by 1 billion ecu to a total of 1·8 billion ecu. That underlined the important principles that surpluses should be stripped out of the budget as soon as they are identified, and that own resources raised from member states should not exceed the amount strictly necessary to finance the budget.
The Council then turned to the Parliament's amendments and modifications. Its key strategic decision was to resist the Parliament's pressure for an immediate, wide-ranging revision of the financial perspective. In effect, the Council reaffirmed the position which ECOFIN had adopted on 9 October. That was that the revision to the financial perspective for 1990 should take place next February and should be confined to expenditure on aid for Poland and Hungary.
The Council did, however, agree to increase the aid package to 300 million ecu as the Parliament had proposed. The intention is that 200 million ecu of that will be inscribed in the 1990 budget before it is adopted, together with the corresponding negative reserve. The remaining 100 million ecu will be provided for in a supplementary budget next spring, following a revision of the financial perspective sufficient to cover the whole of the 300 million ecu, and thereby to cancel the negative reserve.
As regards other DNO, the Council accepted amendments totalling 219 million ecu in commitments and 96 million ecu in payments. That brought the growth of non-privileged DNO in the revised draft budget to a little over 5 per cent., comfortably within the calculated maximum rate of 6·1 per cent.
The upshot of all that is a revised draft budget in which commitments are around 4·6 billion ecu below the overall ceiling in the financial perspective, and in which member states' contributions are equivalent to less than 1 per cent. of Community GNP, compared with the annual sub-ceiling for own resources of 1·18 per cent.
We have not yet reached the end of the road. It remains to be seen whether the Parliament, at its second reading later this week, will try once again to push the Council further and faster than it has been prepared to go in
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relation to a revision of the financial perspective. At the very least, the Parliament can be expected to push DNO back up towards the relevant ceilings in the perspective.
The Council for its part has agreed the basis on which the Presidency can enter into a process of co-decision with the Parliament, under article 203(9) of the treaty, to agree the overall growth of DNO in the 1990 budget.
The Parliament's strategy in the 1990 budget has been to try to use the relative depressed level of agricultural spending as a pretext for a major hike in expenditure on other policies. The Parliament has tried to pressurise the Commission and the Council into an immediate revision of the financial perspective to cover aid for Poland and Hungary and a range of new policies for which the Council has allegedly failed to make adequate provision.
Several Hon. Members rose—
Mr. Ryder: I am coming to the end of my remarks and I must press on.
This strategy cannot easily be reconciled with budget discipline. The figures in the financial perspective are ceilings, not entitlements and still less targets. Spending on agriculture is below the relevant ceiling for largely fortuitous reasons, including the continuing effect on world prices of the United States drought in 1988. There is no case for recycling this surplus to other areas of the budget.
Moreover, even the Commission has refused to accept the Parliament's view that insufficient provision has been made for new policies in the 1990 budget. The Parliament is therefore alone in its wish to break through the existing financial perspective for 1990.
The budget procedure is always a tortuous affair and this year, as I have explained, has been no exception. The Community's ability to respond to events in eastern Europe must not be stifled by inflexible procedures. That response, however, must not become a pretext for chipping away at the fabric of budget discipline. I believe that the Council has managed to tread the line between these two essentials with some skill. Against that backcloth, I urge the House to agree to the motion.
11.27 pm
Mr. Chris Smith: Before dealing with the substance of the matters that are before us, perhaps I might be permitted to voice two complaints. My first complaint is about the manner of presentation of European Community budgetary details to the House, which is far from satisfactory. The explanatory memoranda from the Treasury do not explain much. There is a mountain of indigestible paper. Documents are unavailable from the Vote Office until well after they are presented in Brussels or Strasbourg. Even now, we do not have the full details of the most recent Council decisions on the budget. It is surely unsatisfactory that the House should not have the full details when trying to address itself to the extremely important issues that apply to the nature of the budget.
Mr. William Cash: Does the hon. Gentleman agree with my right hon. Friend the Prime Minister in her insistence that there should be political accountability for national parliaments in matters of this sort? If her views were to be agreed within the Community, we would get far more control and better surveillance over these matters.
Mr. Smith: There is little on which I agree with the Prime Minister. I would wish, however, to see the action of Ministers from national parliaments in the Council of Ministers being much more readily accountable to the national parliaments.
It seems that there is a lack of proper time—this is my second complaint—fully to debate these issues in the House. The budget has already gone to the Commission, to the Council, to the Parliament and back again. It is due for final decision by the European Parliament on Wednesday. Ministers have given their views and contributed to decisions at the Council of Ministers, and only now do we in our Parliament have a chance to discuss, and then only in a relatively academic manner, the decisions that are being taken. There must be a better way of going about the process.
From the point of view of the Opposition, there are some welcome features to the budget, and I shall draw attention to three in particular. First, the overall expenditure figures have been kept well within the ceilings imposed by the inter-institutional agreement and the financial perspective. The perspective imposes a discipline, especially on agricultural expenditure. It has its drawbacks, but the whole picture makes for an increase well below our rate of inflation. That perhaps says more about our rate of inflation than it does about the financial discipline imposed. We welcome the seriousness of approach that all parties have used in drawing up the budget.
The second feature to welcome is that the budget represents, whatever the Government may try to say, a shift in the balance of expenditure. There will be in the coming year less spending on agricultural guarantees and more on such sectors as regional aid, research and development and the social fund. That shift in expenditure priority within the Community budget is welcome. The decrease in the agricultural expenditure has come partly through the favourable position of the ecu in relation to the dollar, partly through changes in patterns of food consumption and production around the world, and partly as a result of some of the disciplines imposed by the financial perspective.
The improvements in expenditure on a number of social matters are those that even the Council of Ministers identified as its priorities from the outset, in sectors of expenditure such as the environment, education, research and international aid. The European Parliament added others, and from our point of view the more that the Community moves away from budgets overwhelmingly dominated by the CAP, the better.
The third point to welcome in the budget is that, from the early stages of the budget-making process, everyone has agreed that substantial economic aid should be made available for Poland and Hungary. With the enormous and exciting changes that have been taking place in eastern Europe in the past few months, it is surely important that the European Community—not just the national Governments of the Community, but the Community as a body—plays its part in supporting and facilitating those changes.
We shared the doubts of the Government and the European Parliament about the device of a negative reserve—a suggestion put forward by the Commission. This was an attempt to get round the constraints of the financial perspective that militate against unexpected and major items of essential spending that become needed
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during the course of the budget-making process. It was an unattractive way to go about solving that problem. The Council now appears to have decided on a revision of the financial perspective, to allow an increase at a later stage. It is a better way to do it, although we would have preferred a change to have occurred now so that the money could have been committed immediately.
As a result of the Strasbourg meeting over the weekend, the one point on which all the Twelve seemed to be unanimously agreed was that a new financial framework should be established to assist and provide economic aid to the whole of eastern Europe as it democratises. How will this new financial framework mesh with the provisions of the budget? That question is important even if the precise details of the framework proposed at Strasbourg have not yet been worked out.
I must ask a further question of the Government because the explanatory memorandum and the details from the recent Council of Ministers is unclear. The European Parliament recommended a budget total of 49,397 million ecu in commitments and 47,132 million ecu in payment. The Council has agreed to commitments totalling 48,375 million ecu and to payments totalling 46,200 ecu. That represents a cut in the European Parliament's recommendations of about 1 billion ecu in each category. We have to ask, since we have not yet been given the full information by the Council of Ministers, where the cuts are to be made. The Economic Secretary said that it was allowing only some 240 million ecu and 96 million ecu, respectively, of the European Parliament's recommended additional expenditure. It would be useful to know in more detail what items the Council agrees to and what items it is cutting from the European Parliament's recommended items of expenditure.
I hope that cuts will not be made in some of the progressive proposals that are to be found under the new policy and non-privileged headings that have been put forward by the European Parliament. I draw the Minister's attention to a few of the specific items of expenditure that were recommended by the European Parliament. They represent initiatives, ideas and programmes that this country sorely needs and that we shall not get from our Government. Under amendment No. 623 there is support for improvements in transport infrastructure. Under amendment No. 625 there is support for training in new technologies and for bringing together universities and industry in new training initiatives.
It is worth noting the European Parliament's comments, because it describes exactly Britain's needs when it states:
"Several regions of the Community have been affected by acute skill shortages which limit their prospects for future economic growth even though there is unemployment in these regions. These facts point to a mismatch of vocational training and the needs of industry in these areas."
That precisely describes one of the central problems of the British economy. The European Parliament has proposed a number of extremely important initiatives to tackle it.
Amendment No. 630 provides for assisting moves towards a more social Europe and the implementation of the social charter, which would provide enormous benefits in terms of the smooth working of British industry and better labour relations. Amendment No. 654 provides for a highly imaginative programme to regulate the trade in tropical hardwoods and to encourage tropical forest

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management and conservation in developing countries. That is a much-neglected area that greatly needs support and assistance.
Many other progressive and imaginative examples could be cited. The European Parliament was frequently supported by Conservative MEPs. It was proposed that these initiatives should be added to the budget. I hope that the British Government will not join the Council of Ministers in its attempt to scrap many of these extremely important initiatives.
While taking note of the documents and the budget proposals, it is worth remarking on the Government's lack of constructive thinking about the opportunities that developments in the European Community and beyond its eastern borders are opening up. If only our Government were willing to enter into prudent but constructive negotiations about membership of the exchange rate mechanism, if only they were able to embrace the social charter, because of the positive benefits that it could provide, if only, while acknowledging, as we do, the profound imperfections of stages 2 and 3 of Delors, they were willing to come forward with more positive proposals than the rather daft idea of equal validity for 12 circulating and competing currencies, andif only they were prepared to be more constructive, perhaps we would have a more powerful voice and a greater influence on the forward movement of the Community and a better chance to create new links with the East. In the meantime, we can welcome many of the budget proposals as steps in the right direction. However, I fear that our own Government still have a great deal to learn about the budget and the progress of Europe.
11.40 pm
Sir Richard Body: The hon. Member for Islington, South and Finsbury (Mr. Smith) spoiled his speech by decrying what the Government have been doing in the Community in the past few years. He should remember that we are one of the two principal paymasters of the Community and, as such, we should have some right to express our views a little more loudly than some. That applies particularly to the draft budget.
It is a bad budget and it will always be bad so long as agriculture is treated in the wrong way. My hon. Friend the Minister said that agricultural expenditure is under control. That is true when one considers the total figure which has shown a slight decline, but I draw his attention to the proportion of the budget spent on the guarantee section and the guidance section. The guarantee section receives 57 per cent. and the guidance section receives 3·5 per cent. and has been pegged at roughly the same figure for many years.
It is wrong that we are holding down the guidance section at the same time as the guarantee section. That is a clear contradiction. If we are to have a common agricultural policy there is some sense in having a guidance section to enable farmers to adapt, to allow them money to farm with regard to the environment and for other noteworthy purposes of which my hon. Friend has had great experience. But it is wrong to maintain the level of expenditure on guarantees. The purpose of a guaranteed price is to goad farmers into producing more. If it does not have that effect it has no effect at all because a guarantee must be above that market price. Once again the budget is putting the farmers of the Community into an intolerable
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position. It is goading farmers into producing more with guaranteed prices and maintaining the same proportion of expenditure as before, yet at the same time it is doing nothing to make life easier for them by increasing the money available in the guidance fund.
I hope that my hon. Friend will take one message with him. As one of the two principal paymasters of that policy, we should raise our voice and say that it is not fair on the farmers, the taxpayers or the consumers. It is not fair on millions of people, particularly in the Third world, who have to compete in the world market against dumped commodities and excessively high duties on imports from the Third world into the Community.
My hon. Friend the Minister dealt rather hastily with agricultural spending. I hope that he will not forget that only a few days ago the Council of Ministers showed its true colours in its attitude to agricultural expenditure by disregarding stabilisers for cereals. We were given to understand that they would be binding and that there would be no more nonsense about cereals, yet only a few days ago they were disregarded, at a cost of £38 million. We may say that £38 million is neither here nor there in a budget of this size, but it shows the attitude of the Council of Ministers, which the House should thoroughly deplore. As one of the two paymasters of the Community, we should raise our voice and say, "It is not good enough."
11.45 pm
Mr. A. J. Beith: A little earlier in the debate your assistance, Mr. Deputy Speaker, was sought to elucidate some of the terms being used by the Minister. That was, perhaps, an unfair burden to place on you. These debates could be conducted with a little less use of the jargon and abbreviations that pass in the European Community. Such habits are probably unwelcome to most citizens of the Community, and are a product of the bureaucracy at the centre. There is no need to talk about mecus, becus, IIAs and DNOs to such an extent that nobody has the faintest idea what is going on, least of all those who are responsible for scrutiny of these proceedings. Those outside the House and the European Parliament can hardly be expected to follow them, so let us do our best to reduce them to sensible and intelligible terms.
I want to refer particularly to some of the main features of the recent budget discussions, of which perhaps the most significant and widely reported was the assistance to eastern Europe. The Minister decried on the strictest budgetary grounds the transfer of any surplus in the Community's budget to any other activity, yet he acknowledged that the position in Poland and Hungary justified significant expenditure, which would not have been possible had the surplus in the budget not arisen. He did not try to argue against what Parliament and the Council have supported. Like most other people in the country, hon. Members support that, although I heard one or two murmurs of criticism from hon. Members, one of whom is no longer present.
It is clearly in the interests of democratic western Europe that the processes of economic recovery and democratic change in eastern Europe do not collapse because of an economic crisis. It is in the long-term trading interests of western Europe that it should have viable trading partners in eastern Europe as well as, we hope one day, viable partners in democracy. The moves in that

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direction have gathered pace quite remarkably since the new budgetary provisions were made, which has led to questions being asked about Czechoslovakia and East Germany, which are different in their economic character and achievement from Poland and Hungary, so the same considerations do not apply. The need for western Europe to have regard to the problems in eastern Europe is no less, despite that.
Questions are now being asked about the Baltic states and the Soviet republics and our attitude to their needs. Their economic and democratic needs seem to come to light simultaneously. The possibility of further developments was clearly recognised at the summit.
It would be helpful if the Minister said a little more about the European Bank for Reconstruction and Development, about which a major decision was made at the weekend, with the idea that negotiations about it may begin in January 1990. It will clearly have long-term budgetary implications and many other implications. The Council will receive support for what it is trying to do across the Community, but we need to know a little more about what is planned.
Mr. Ian Taylor: I have closely followed the hon. Gentleman's comments. He is right to say that we must do as much as possible to help eastern Europe. The European Commission is already co-ordinating many measures, including aid from the 24 countries, as agreed at the Paris summit. I hope that the hon. Gentleman did not imply that part of that process could be a reallocation of any savings on the agricultural budget. It would seem to be an important principle that that is not redistributed and that it becomes part of a separate decision in the Council as to whether any extra funds should be devoted to eastern Europe.
Mr. Beith: I am strongly in favour of the most careful examination of what is done with surpluses that arise from the budget and the application of budgetary disciplines. At different stages, the Parliament, Commission and Council have become committed to expenditure for eastern Europe which would otherwise have had to be financed by new contributions from member countries. As the Minister explained, the reasons had nothing to do with the need that had arisen, but these funds have made meeting that need a little easier.
Regional policy is another aspect which will be important in European budgetary matters and which already features in the budget. The Minister gave the impression that the Government often give—that most Community expenditure, except that on the common agricultural policy, is viewed with great suspicion by the Government. I have no doubt that regional policy falls into that category. The Government must recognise that developments which are taking place, including some that they oppose, will lead to a greater, not lesser, need for active regional policy. The developments towards 1992 will generate a need to ensure that the various parts of the United Kingdom that are furthest from the present transport to the Community can gain full access to the single market. That will involve expenditure which was previously assisted under the heading of "regional policy", particularly regional and transport infrastructure.
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That will become more important in the context of monetary union. The Government—or at least the Prime Minister—are very much opposed to a commitment to monetary union into which they have entered by treaty. They must recognise that, because other member countries will proceed at a pace that they choose, developments will take place in Europe which will give rise to a need to ensure that the peripheral regions in Europe can compete effectively and play a full part. That means that expenditure on regional policy will become more, not less, necessary.
Mr. Christopher Gill: On the question of regional policy—
Mr. Beith: I should like to give way before the hon. Gentleman launches into the subject of his intervention, but I give way.
Mr. Gill: I am interested in the hon. Gentleman's comments about regional policy. Does he agree that we have two regional policies—a regional policy as expressed by the European Community and a regional policy as expressed by the domestic Government? Does the hon. Gentleman contend that we should have one or the other, or that we should continue twin-tracking?
Mr. Beith: In this country, we do not have two regional policies. We have one, which is that of the European Community. In effect, there is no regional policy as expressed by the domestic Government. I have been interested in the map for assisted area status because of the removal from it of parts of my constituency with high unemployment. The only interest in getting assisted area status is in getting access to European regional policy. There is virtually nothing left of British regional policy. I lament that, because the British Government could play a role. If I am offered a choice, experience would lead me to believe that we will get more of a regional policy out of Europe than out of the kind of British Government under whom we have been living for the past 10 years.
I am prepared to put my support behind the development of European regional policy. It seems to make sense in an examination of Europe as a whole to accept that needs arising on the periphery of Europe differ from those in London, Paris, and the main centres of industrial and financial Germany. The needs in the north of England, Scotland, Wales and the west of England and in southern Italy, Greece and Portugal contrast markedly with the needs of places in the geographical centre of the Community which are most immediately connected by the Channel tunnel—all the places to which advantage is already conferred. That strengthens the reasoning behind the European regional policy.
Mr. Gill: Will the hon. Gentleman give way?
Mr. Beith: No, because I gave way to the hon. Gentleman and I sought to give a full and detailed answer to his question.
As we look back on the events of the past weekend in the circumstances of this budget debate, we are bound to inquire whether this was the summit at which the Prime Minister finally gave in, not to our European partners, but to her colleagues in Government, in adopting a more conciliatory public line on Europe. Was it the summit at which the Prime Minister finally recognised that there are few votes to be gained by posing as someone who wishes

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that she had never voted to enter the European Community in the first place? By doing so, she might win the enthusiastic support of the hon. Member for Southend, East (Mr. Taylor) and one or two of the other hon. Members who stay for these debates not just because of their genuine commitment to budgetary discipline, but because they wish basically that we were not in this show. They were against it from the start and they are still against it.
Mr. Chris Smith rose—
Mr. Beith: I give way willingly to the hon. Gentleman, who will certainly have something interesting to say on this topic.
Mr. Smith: Is the hon. Gentleman not wrong in one respect? The line at Strasbourg was not more conciliatory. It was the same as before, but the tone was more conciliatory.
Mr. Beith: That is what I sought to convey. I hope that no such criticism could be made of Opposition Front Bench Members in their attitude to Europe, because they have taken a more conciliatory line of late. I refer not especially to the hon. Member for Islington, South and Finsbury (Mr. Smith), but to some of his colleagues ,not least the hon. Member for Dagenham (Mr. Gould), who is now having to adopt a conciliatory line on Europe. I have known him for 25 years and his conciliatory line on Europe has come as a great surprise to me at a late stage in my long acquaintance with him. I am not yet convinced that the substance is there to match the conciliatory line.
Mr. Dalyell: Will the hon. Gentleman give way?
Mr. Beith: No, because I have given way many times. I am sure that the hon. Gentleman wants to take part in the debate and I should like to leave him the opportunity to do so.
One particular point that intrigued me about the Prime Minister when she was being nice about Europe was that she said:
"The moment … that you go from the rigid and valuable discipline of the German central bank and people … you lose the very thing that helps you get inflation down."
The Prime Minister has at last found something in Europe of which she should be in favour, but it does not seem to have influenced her line in general. She has rightly recognised, as I sought to explain to the Minister earlier, that a practical solution to the problems of inflation and exchange rate volatility has been found in the exchange rate mechanism and in the influence that the Bundesbank exercises in that exchange rate mechanism. Only the other day the Prime Minister seemed to argue that the reason why she could not stand the exchange rate mechanism was that it led to the undemocratic central bankers of Europe having an influence. Now she has discovered that that influence was no bad thing.
The Prime Minister must sort out the basis of her attitude. If she continues to try to cling to sovereignty on the basis that otherwise we shall have undemocratic central bankers across Europe influencing our policy on inflation, she will continue to look like a Prime Minister who is hanging on to sovereignty because it gives her the power to inflate, to print more money and to devalue the currency. That Prime Minister has not faced up to the reality of Europe or to the leading role that Britain should be playing in Europe.
11.58 pm
Mr. James Cran: I associate myself with those who, in previous years, spoke about this debate being a waste of time. Having sat through this debate thus far, I go as far as to say that it is a charade and nothing else. We have an hour and a half to debate this enormous subject, of which the Government and Opposition Front Bench speakers took up—and I counted it—40 minutes. There will, no doubt, be an answer by my hon. Friend the Minister, which will make the total 45 minutes. That means that Back-Bench Members will have had only half of this debate in which to register any point. I regard that as an absolute disgrace.
Unusually, I agree with the hon. Member for Islington, South and Finsbury (Mr. Smith) that the Treasury memoranda on the budget were singularly unhelpful. I found them wholly uninformative and indigestible. Perhaps the Treasury should have a look at how it puts these documents together. One might be forgiven for thinking that the Treasury regards this debate as a waste of time, too.
All I can do in the time available is highlight one point of the 29 budgetary headings. It is an important one concerning the internal market. The budgetary document outlines a considerable increase in the budget item termed "Industry and internal market". I hope that the Economic Secretary will be able to tell me in the fullness of time how that budgetary increase will bring about what the United Kingdom wants—the completion of the single market. All the signs are that we are nowhere near it. How will those budgetary increases dissolve the political objections of those in the Community who want to delay the single market? There are certainly plenty of such people.
I shall mention only three examples of delay in this connection. I am told that there are good and bad Europeans. We have been lectured on that subject by the hon. Member for Berwick-upon-Tweed (Mr. Beith), so let us examine the Germans. I discover that the Germans do not want to open up their insurance market to competition, for the good reason that they do not want to encounter the competition from British insurance companies.
We are told that the French are good Europeans. Why do the French—this is but one example of many—refuse to allow other European Community countries' ships to pick up and offload goods in France? We allow that, but the French do not. Who, therefore, are the good Europeans? I should have thought that we were. This therefore indicates that the debate on the internal market is oversimplified. Moreover, the French, Italians, Spaniards and Belgians do not want the full-scale liberalisation of telecommunications in Europe, but the United Kingdom does. Which country is a good European in those circumstances? I should have thought that again it was the United Kingdom.
We are in favour of the completion of the internal market; why are not many of the other states of the Community? Why are we called bad Europeans when under our presidency 40 single market measures were agreed—a record? Why are we accused of being had Europeans when the United Kingdom has voted against only three of the 152 measures that have been enacted for the internal market? All that seems to show that we are

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good Europeans. Lastly, why has the United Kingdom agreed 66 of the 68 measures that are presently in place for the internal market?
Clearly a great deal remains to be done for the completion of the market. That fact was notably missing from the speech of the hon. Member for Berwick-upon-Tweed. Only half the 300 measures that must be agreed on the internal market have been. That is a disgrace. How will the budgetary increase for industry and the internal market help? Even worse than all that, only seven of those measures for the internal market have been agreed by all the countries of the Community. Bearing in mind that we agreed to 66 of them, that shows who in the Community are dragging their feet—the United Kingdom is certainly not one of those.
As I believe that other hon. Members should take part in the debate—little time for which is left—I will bring my remarks to a close. I am particularly in favour of the single market in financial services. It represents 10 per cent. of the United Kingdom's gross domestic product and 1·2 million people work in that area. Financial services account for about £8 billion in the invisible trade surplus in this country. We want the free market in financial services, but several other Community countries do not. They want a liberalised United Kingdom market place for financial services so long as they can keep the barriers up in their own market places. That is wholly unfair.
The Select Committee on Trade and Industry, of which I am a member, recognised this and reported on financial services in the European market and made 37 recommendations. How many of those recommendations, referring to action by the Community, will be aided by the budgetary increase which it appears the Government have already agreed?
I should have liked to discuss many of the other subjects in the budget. I should have liked to discuss agriculture and the increases for the structural fund. Above all, I should have liked to discuss the controls, if they exist, for this budget. Alas, poor Back Benchers such as I do not get a look in in this debate.
12.6 am
Mr. Tam Dalyell: In any debate on Europe this week we should reflect that last week saw the death of Eduardo Amaldi, one of the architects of European science development since the war, a distinguished pre-war nuclear physicist and colleague of Belgium and friend to Britain. He should be mentioned in the House.
I want to ask several questions. First, what is the Treasury's view of the Sofia conference on co-operation? How much money is the Treasury prepared to put towards work with Poland? I do not think that we should say that we should slosh money to every country in eastern Europe, because conditions differ. I would rather stick to Poland, which has pollution problems like London smog, instead of aiding Hungary which seems to be doing much better.
Does the Treasury agree with the Amsterdam analyst, Walter van Dieren, and others who say that one guilder put into East Germany is worth, in terms of the European including the Dutch environment, five guilders spent in Holland? Surely there is an element of self-interest, to put it at its lowest, in helping to resolve the ecological troubles
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of eastern Europe. What is the Treasury view on that, and how much money is it prepared to put into the proposed European economic environment agency?
My next point occupied a large part of the day on 14 November at the interesting conference in Carlton gardens which the parliamentary and scientific committee had in conjunction with the Royal Society. That topic affects us directly in this House. Are we going to go the same way as the Bundestag in relation to embryo research? If so, what is the assessment of the British and international pharmaceutical firms in the light of the fact that Hoechst has, at short notice, become one of the great German firms which will have to transfer considerable sectors of their research elsewhere in Europe, or more likely to the United States, unless a British decision is forthcoming as a matter of urgency?
This is not the time to discuss the embryology Bill, but I think it fair to ask Treasury and other Ministers for an economic analysis of what would happen if we took such a course. Hon. Members should be under no illusions—whatever the final verdict that they reach in their personal capacities on a free vote—about what will happen to significant sectors of British industry if we decide to inhibit embryo research.
Let me couple that with a second question. In a Committee chaired by the hon. Member for Arundel (Mr. Marshall), we heard David Baldwin of Hewlett Packard issue a strong complaint supported by a powerful array of figures, just one of whom revealed that, for £900,000 given to charity, in Britain £135,000 had to be paid in VAT. What is the Treasury's attitude to charity payments in Britain compared with those in France? David Baldwin simply says that the French are entirely flexible in such matters. The great multinational firms, as they donate huge and significant sums for education and training, say to themselves, "Our good work will be much more valuable in France, Italy, Germany or the United States than it is in Britain", because of our unique tax laws. I believe that Baldwin's submissions—known to the Treasury—must be taken into account.
My third question was also raised by my hon. Friend the Member for Islington, South and Finsbury (Mr. Smith). I am not going to ask about the Government's attitude to the import of hardwoods, which is outside the bounds of the debate; what concerns rain-forest countries, however, is the extent of their debt—and here there must be either a co-ordinated response or no response at all. One reason why some of us are so reluctant to urge the case of Hungary, Bulgaria or Czechoslovakia is the desperate plight of south American and other rain-forest countries. Something must be done, or we shall be in enormous danger of having precious little rain forest left—let alone the threat of a botanical and biological holocaust.
Have the Government contemplated what is likely to happen to Brazil if its new president should be "Lula", representing a massive Left-wing force and giving expression to the aspirations of many people? I think that it is high time that European Governments got together on the question of debt—although that is no easy matter, as Kit McMahon found when he went out to Brazil on behalf of the Midland bank.
Other hon. Members wish to speak, so I shall leave it at that.
12.12 am
Mr. Graham Riddick: It is noticeable that, despite all the fine words that we have heard about the common agricultural policy, it continues to swallow up vast sums; it is also interesting to reflect that European countries spend twice as much money on protecting themselves from Third world agricultural imports as they contribute to developing countries. Because of the time pressures under which we all find ourselves this evening, I cannot develop the CAP theme; but let me say a bit about the structural funds and some of the other aspects of the budget.
I wonder whether the people of this country appreciate the fee that Britain pays for membership of the EEC. This year it is some £2 billion, that being our net contribution to the EEC. Without the efforts of our present Prime Minister, and had we still been governed by the arrangements of the last Labour Administration, our contribution would have been infinitely higher. What we do know is that the EEC budget has grown by 189 per cent. over the past 10 years, from £9,800 million in 1980 to £28 billion in 1990. I am still old-fashioned enough to translate all the figures that come to us in ecu into pounds. That represents an increase of over 100 per cent. in real terms because inflation during that period has averaged 75 per cent. throughout the Community. How much the National Health Service, the building programme or the education service in this country would have loved such an increase.
We know of the CAP's profligacy, but the two areas that have seen the greatest explosion in expenditure are the regional development fund and the social fund, the budgets of which have risen during the past 10 years by 547 per cent. and 352 per cent. respectively, to total nearly £5 billion in 1990. It is the Commission's objective to double the structural funds by 1993. Indeed, that is reiterated in the foreword of the preliminary draft that we are debating. Most of the support, which is designed to help the most disadvantaged regions, goes to the southern member states, such as Greece, southern Italy, Spain and Portugal. Whether my constituents are aware that £2 billion is flowing out of this country and, it could be argued, straight into those countries is debatable, but I doubt whether they would approve of it. I reckon that they would want any spare money that is leaving this country to be used to address the structural problems of some of the most poverty-stricken countries in the Third world.
What I object to is that, having just about succeeded in pulling the British people away from the idea that the economic prospects of the regions can be improved by pouring Government money into them, the EEC, in a rather grandiose fashion, is carrying forward exactly that policy throughout the Community, much of it with our money. Indeed, that is what the disagreements over the social charter and the exchange rate mechanism are all about. As we know, the social charter would impose increased costs on industry, and entering the exchange rate mechanism would take us back to the days of the operation of exchange controls. Anyone would think that membership of the ERM would solve all our economic problems, but since March 1979 the lira has fallen 40 per cent. and the franc 33 per cent. relative to the deutschmark despite being inside the ERM, while sterling has fallen only 17 per cent. Furthermore, during that period Britain performed better on inflation than both Italy and France
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until, I regret to say, about a year and a half ago when British inflation became higher. Far from being a reflection on the efficacy of the ERM, Britain's recent increase in inflation is, I am sorry to say, a reflection of my own Government's failure to run a proper and tight monetary policy.
The growth of the structural funds makes it all the more difficult for those countries which benefit so much from them to disagree with some of the more unacceptable interventionist proposals which are put forward by the European Commission. I find the reference by Commissioner Schmidhuber in the draft general budget to
"the Commission's political determination to continue the orderly growth of revenue and expenditure in its budget"
particularly unfortunate. The reference to the Commission's "political determination" is revealing. The Commission clearly knows what it is about.
I am afraid that time is against me and as other hon. Members wish to speak I shall not develop what I had been going to say. However, I hope that my hon. Friend will give his full support to our right hon. Friend the Prime Minister when she continues to stand firm against some of the EEC's worst excesses.
12.19 am
Mr. Bowen Wells: I see from the briefing that I have here that non-obligatory expenditure represents nearly 50 per cent. of the budget. I believe that it is the same thing as the non-privileged expenditure to which my hon. Friend the Minister referred. It is that which the European Parliament can influence, amend or modify to increase the budget.
In general terms, the House has welcomed the major increase of expenditure in favour of Poland and Hungary, but throwing money at the problem will be counterproductive, especially if my hon. Friend the Minister and the Community do not pay attention to their serious indebtedness. The EC should take a lead, finding a way to restructure those countries' debts so that they are not overhanging problems, and Poland and Hungary can invite investment from the public and private sectors to restructure productively. I hope that we are not simply throwing money at those countries through this budget.
I do not think that the House has noticed that the European Parliament is increasing expenditure but has no obligation or responsibility for raising the necessary revenue. In the context of an intergovernmental conference in which we shall have to participate, is it not time that we cut—stopped, indeed—that privilege? Is it not an important constitutional issue which the budget presents to this Parliament?
12.21 am
Mr. Teddy Taylor: There was one thing that I found strange in the Minister's difficult-tounderstand speech. I think that he found it difficult to understand himself, but that does not matter as we have no power in this regard and nobody is listening at this quite ridiculous hour to a discussion of the budget.
When, once again, we agreed to give the EEC lots more money, we were given two assurances: first, unlike in the past, budgetary controls were to be legally binding and, secondly, the new stabilisers were to be automatic. When we last heard of binding controls, the Europeans found a way out, and decided to have a 10-month year for spending and a 1—2-month year for raising income. That

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made 1987 a rather bad year. The EEC also did something wholly illegal—it agreed to the transfer of spending on butter dumping to member states. The Court of Auditors said that that was illegal, but the Council of Ministers decided not to consider the matter.
We were told, "Things have changed. We now have a new deal." The Minister must, however, be aware of what happened 10 days ago. We had the first breach of the stabiliser. Unfortunately, the automatic cereal production level, of 160 million tonnes last year, was breached. What happened? The Council of Ministers had a meeting and decided to disregard it. It disregarded a problem to the extent of £38 million. How on earth can the Government expect us to take them or the EEC seriously when the most clear and specific assurances are given to the House and simply do not work? Even more distressing, we find that there is nothing that we can do when assurances do not work. When the Court of Auditors told the EEC that it was acting illegally, nothing happened. When it decided to have a 10-month year, nothing happened. Now it has gone through the stabiliser which we were told was automatic, nothing will happen.
Therefore, it is understandable that my hon. Friend's excellent speeches show a feeling almost of despair. We have heard the usual reassuring messages from the Minister. We are told that contributions are down, yet the Library tells us that they are at an all-time high of £2,050 million, which is £3 a week per average family. We see scandalous expenditure. There is a new programme to combat alcohol abuse—a splendid idea for the Common Market—but at the same time it is dumping about 4·2 million hectolitres of wine at the crazy price of about 2p a pint. How on earth does it make sense to pump in money to fight alcohol abuse while spending hundreds of millions of pounds on dumping alcohol at crazy prices throughout the world? It is the same with tobacco. The Community has told us to change our advertisements, yet we are dumping 25,600 tonnes of high-tar tobacco at crazy low prices in Africa and the Third world, spreading all the damage with our alms.
Finally, does anyone look at how the Common Market spends its money? If the Minister would like education, I plead with him to find out what happened to the £130,000 which the Common Market out of its generosity gave to the institutions of Broadwater Farm. He will find that the money is handled by trustees, who are former solicitors struck off the list. There he will find the only nursery schools in the world with masses of receipts for whisky and vodka, which is a strange way for nursery schools to spend their money. I hope that the Minister will realise that it is sad for the country that we are talking about all this nonsense when we have no power to do anything about it and nobody is listening.
12.26 am
Mr. Ryder: In the brief time remaining to me I shall reply to as many points as possible. If the clock beats me, I shall write to the hon. Gentlemen concerned as soon as possible.
The hon. Member for Islington, South and Finsbury (Mr. Smith) and my hon. Friend the Member for Beverley (Mr. Cran) drew the attention of the House to the fact that
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documents are not made available early enough. I shall look into that and I assure both of them that I shall make every effort to remedy that problem. I shall ensure also that my right hon. and learned Friend the Lord President is made aware of the hon. Gentlemen's wish to bring forward this debate in future years.
The hon. Gentleman asked about the new financial framework for economic aid to eastern Europe. Further aid may well have implications for future budgets and we shall strive to keep it within budget discipline as this year's aid has been. The Strasbourg Council meeting has had no direct bearing on this.
My hon. Friends the Members for Holland with Boston (Sir R. Body) and for Southend, East (Mr. Taylor) understandably complained about last week's decision by the Agriculture Council. The Commission put forward a proposal to the November Agriculture Council that we should give it powers to waive the additional cereals co-responsibility levy in this and future years on unspecified de minimis grounds. The United Kingdom opposed the proposal and was prepared to abstain in the vote on condition that, first, the proposal should apply only to the current marketing year and, secondly, that a retrospective adjustment mechanism be introduced which would both tighten up the stabiliser by reducing the likelihood of underpayment of a levy and obviate the need for any future de minimis arrangements. Those conditions were met. I agree with my hon. Friends that it was a disappointing decision, but it could have been worse in the circumstances.
As a result of what has been said this evening, particularly by my hon. Friend the Member for Southend, East, the House may like to know more precisely about some of the figures on the United Kingdom CAP market support in real terms. The CAP market support based on 1987–88 prices was £1,393 million, in 1988–89 it was £1,079 million and we estimate for 1989–90 is £870 million—
It being one and a half hours after the commencement of proceedings on the motion, MR. DEPUTY SPEAKER put the Question, pursuant to Standing Order No. 14 ( Exempted Business).
Question agreed to.
Resolved,
That this House takes note of European Community Documents Nos. COM(89) 175, the Preliminary Draft Budget of the European Communities for 1990, 8271/89, the Draft Budget of the European Communities for 1990, and 9704/89 and the Supplementary Explanatory Memorandum submitted by Her Majesty's Treasury on 6th December 1989 relating to the European Parliament's proposed amendments and modifications to the Draft Budget; and welcomes the impact on the 1990 Budget of the new arrangements for budgetary discipline agreed at the European Council in February 1988.
Mr. Andrew Rowe: On a point of order, Mr. Deputy Speaker. I think that you will have noticed that virtually every contributor to the excellent debate on the European budget commented that our procedures for debating such issues are thoroughly inadequate. I ask you, Mr. Deputy Speaker, to ensure that Mr. Speaker knows of the strength of feeling that ran through the debate.
Mr. Deputy Speaker (Sir Paul Dean): I shall do so but, as the hon. Gentleman knows, Mr. Speaker is bound by the Standing Orders of the House. I have no doubt that what the hon. Gentleman has said will be noted by those who sit on the Government Front Bench.

European Community (Research and Development)
12.30 am
The Minister for Industry (Mr. Douglas Hogg): I beg to move,
That this House takes note of European Community Document No. 8375/89 and COR 1 and the Supplementary Explanatory Memorandum submitted by the Department of Trade and industry on 22nd November 1989 relating to the Framework Programme of Community research and development activities 1990 to 1994; and supports the Government's view that the Commission's proposals for expenditure need to be more clearly justified before the Programme can be agreed.
Despite the late hour, the debate is timely and important as the Research Council is to meet on 15 December and will discuss proposals for a third framework programme for Community research and development for the years 1990–94. I am therefore extremely grateful that I have this opportunity to learn both the views and the concerns of hon. Members. I shall endeavour to highlight the main areas of interest, but I will leave to the end of the debate my response to queries on the more detailed aspects of the proposal.
The first framework programme was for the years 1984–87, and the budget was of 3·75 billion ecu, or £2·5 billion. The second framework covers the years 1987–91 and has a budget of 5·4 billion ecu or £3·6 billion. It is that programme which is now in existence. The Commission is now proposing a programme of significantly expanded research activities in six main areas with a total cost of 7·7 billion ecu, or a programme of about £5·1 billion. Further details are given in the explanatory memorandum before the House. There would be a two-year overlap with the present framework programme.
The origins of the present proposal lie in the review required in the third year of the present programme. The Commission produced a paper on the state of science and technology in Europe. In addition, a report on the operation of the current framework was produced by a review panel of five eminent figures in European science and technology. The Commission concluded that a further five-year programme should be proposed. The framework programme sets out the broad objectives, technical coverage and funding of the main lines of activity. The detail of specific programme proposals would be the subject of subsequent decisions.
The Government have taken a constructive and prominent part in negotiations. Our objective is, if at all possible, to reach agreement on 15 December. We have a number of reservations, some of which are shared by other countries and most of which have been expressed at the past two meetings of the Research Council.
First, the Government were and indeed are not satisfied that the Commission has adequately justified the size and coverage of the new programme. We thought it essential that the proposal was fully supported by adequate technical information and that the Commission demonstrated the added value required for action at Community level. The original proposal was clearly deficient in both these regards.
To correct this lack of detail as to technical goals and purpose, we and other member states have worked with the Commission to produce a completely revised technical annex to the proposal.
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I am glad to be able to tell the House that, not least as a result of our efforts, the revised draft decision is now a great deal more satisfactory than it was and broadly accords with out expectations. Thus, the objectives for each area of proposed activity are made clear. It emphasises that Community research and development should concentrate on pre-competitive work and should avoid near-market activities. Support of product development is excluded. The importance of Community research and development in the context of setting European norms and standards is fully recognised. The programme will also include selective feasibility projects to validate such standards.
So far as the technical annex is concerned, only a relatively small number of technical issues remain to be resolved at the Council on 15 December. I can assure the House that I shall press for improvements where we deem them to be necessary. I shall also press for a more detailed breakdown of the proposed financing as between the lines and sublines of the programme. I also favour a larger number of specific programmes than the six originally proposed by the Commission. This is essential for coherent programme management and for satisfactory financial planning.
Mr. Tam Dalyell: What are the additions that are proposed?
Mr. Hogg: At the moment there are six programme lines. The problem with having such a limited number of them is that too much is subsumed within them. Therefore, we should like to expand the number of lines. We have in mind 20, but it might be possible to reduce that if the Commission would come to an agreement on a slightly lesser figure. We should be better able to define the exact context of the proposed work within a larger number of lines, and as we hope that each of the lines will have a management committee, it would be better to provide a more coherent system of management than we have. At the moment the programme has 37 lines, but I concede that that is too many.
Mr. Dalyell: What does Mr. Pandolfi think about a national Government interfering to this extent in what he might think is his business? Some of us had the impression at the Royal Society conference on 14 November that the Commission was less than happy about the attitude of the British Government.
Mr. Hogg: I do not think that that is right. We have a great deal of support for increasing the number of lines. I recall clearly, at the last meeting of the Council, the Dutch delegation arguing in favour of 20 lines, and I was able to support what it had in mind. There is considerable support in the Council for expanding the number of lines because it is felt that six lines are too few to reflect accurately the amount of work that is being proposed and does not permit of sufficiently direct and detailed control of that work. We are not isolated in this regard.
A second concern is the nature of the decision to be taken about the funding of the programme after 1992. The current budgetary perspective for the Community under the 1988 inter-institutional agreement runs to 1992. It is essential that any new funding proposals for research and development do not prejudge any arrangements which replace the IIA.

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There must therefore be a clear distinction between budgetary resources in the period covered by the present agreement and any new commitments beyond 1992 which must be subject to further decision, once the current IIA has been reviewed in 1992. That further decision will of course have to be unanimous.
By accepting the proposal for a new 1990–94 programme overlapping with the current 1987–91 programme, we are moving towards a series of rolling programmes, themselves subject to a mid-term review. As yet, the Government have not taken a final view on the desirability of continuing rolling programmes. However, it is obvious that they have real managerial and scientific advantages.
Mr. Matthew Taylor: I understand that the projected figures would simply carry forward the present spending levels. The Minister has said that such a level of spending would be unacceptable. May we assume, therefore, that there will be reductions in the Commission's research and development budget?
Mr. Hogg: I find it difficult to understand the hon. Gentleman's point. I shall be dealing with funding. If the hon. Gentleman thinks that I have done his question less than justice, when I have done so, I shall certainly give way again and he can make such criticism as he thinks fit.
Another concern is the lack of detail regarding management and evaluation. The Commission has suggested that these details can be resolved later. However, I have been insistent that these important issues should be clarified at the outset. Clear objectives, the procedures for programme management, including the role of member states, procedures for the appraisal of research and development proposals and the evaluation of programme results, together with specific provision for a mid-term evaluation of the whole framework programme, should all be included in the text.
Finally—this is the point that concerns the hon. Member for Truro (Mr. Taylor)—I come to the overall cost of the new framework programme. We have always thought that 7·7 billion ecu is far too high, on grounds of affordability and of programme content. It is this issue which will probably occupy most of Friday.
For the period 1990–92, 3·1 billion ecu is of course still available from the current programme. The present IIA includes a ceiling of 2·7 billion ecu for further work. That would be additional to the 3·1 billion ecu to which I have just referred.
In my view, the figure of 2·7 billion ecu for the period 1990–92 is too high. It is not justified by the content of the technical annex and should be reduced.
Mr. Dalyell: First, has any provision been made for the European proposals on means of research? Secondly, has environmental aid been taken into account, either through the proposed European environmental agency or by some other means, to assist research in eastern Europe?
Mr. Hogg: My recollection, after reading the technical annex, is no. However, I shall have my answer checked and if I am wrong I shall correct the error.
I have dealt with spending in 1990–92, but there are two elements to the spending during that period. The 3·billion ecu, which is the outstanding balance of the existing
806
programme, is the first element in the budget. The second element in the budget is the sum we can add up to a ceiling of 2·7 billion ecu. Our judgment is that that second element is too high and I shall be pressing for a substantial reduction in that figure.
Mr. Matthew Taylor: The Minister has certainly clarified his position. In principle, under the IIA those spending figures are already agreed and so the process of carrying them forward for another two years produces the 7·7 billion ecu figure. It appears that the Minister is pressing for a cut in a figure that has already been agreed.
Mr. Hogg: The hon. Gentleman misunderstands the position. The word, "ceiling" does not imply entitlement. It is a sum that is available, subject to a decision being made that it should be drawn down. That decision depends, for example, on the financial requirements of the work contained in the technical annex. Our judgment is that on grounds of programme content a spend of 2·7 billion ecu could not be justified. Therefore, I do not accept that the programme is being cut, merely that the programme in place does not justify a spend of 2·7 billion ecu. I shall be resisting such a suggestion and pressing for a lower amount when we discuss the matter on Friday.
Mr. Matthew Taylor: I assume that the Government would still seek to count the money that is put into European research and development against our own national budget on research and development spending.
Mr. Hogg: It is true that all those sums are drawn from a common pool. The hon. Gentleman has a detailed letter on precisely that point which explains the interrelationship between moneys that are available for domestic spend and moneys that become available for supporting the European research and development programme. The hon. Gentleman will find a fairly full explanation of the interrelationship between those two items in the supplementary memorandum which is now before the House. I hesitate to summarise it at this late hour, especially as it is already in written form. As it is about 12.45 am I am quite capable of misinterpreting it.
Mr. Dalyell: As a recipient of a number of letters, I should like to put on record that I am extremely impressed by the quality of much of the regular input by the British Civil Service into the European scientific decision making. One may have questions about the decisions, but the quality of our Civil Service in Europe is a credit to this country.
Mr. Hogg: The fact that the technical annex is now so much better than it was when first published by Mr. Pandolfi owes a great deal to the work carried out by civil servants in the DTI and in Brussels. I am grateful for the work done by officials and I am grateful to the hon. Gentleman for his kind remarks.
I have laboured slightly over the 1990–92 spending programme. I have still to deal with the period 1993–94. I suspect that additional resources will be proposed by the Commission as a result of the 1992 mid-term review. Therefore, it would be appropriate for the figures agreed at Friday's Council to taper down towards the end of the period. We are probably looking at only one part of the funds that are likely to be available for that period. If we proceed to rolling programmes further funds will be provided in 1992 for the forthcoming period. The

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Commission proposes 5 billion ecus for the period 1993—94, which we believe is too high and requires substantial reduction.
In the course of my speech, I have tried briefly to highlight the main issues in the knowledge that, with the leave of the House, I may be able to respond later to specific issues raised by hon. Members.
Since discussions first began with the Council, considerable progress has been made. In concert with other countries, the United Kingdom has succeeded in securing important changes, which have greatly improved the proposal that the Council is to consider on Friday. We enter those discussions with the hope that an agreement can be secured. We shall endeavour to reach an agreement, but the House will expect us to protect the proper interests of the United Kingdom, which we will seek to do.
12.50 am
Dr. Jeremy Bray: If the Minister will forgive me, I shall speak in pounds rather than billion ecus because I want to make a comparison with the United Kingdom's domestic funding of research and development.
The increase in Community funding of the framework programme from £3·7 billion over the five years 1987–91 to £7·2 billion over the overlapping five years 1990–94 is substantial. The average United Kingdom contribution to funds through the Community budget at 18 per cent. of the total would increase, therefore, from £133 million to £260 million a year. The House will forgive me for eliding the difference between the approved, the ceiling, the later years and so on. The increase from £133 million to £260 million is large.
By comparison, the United Kingdom's budget for 1991 for all the research councils will be £897 million and for the medical research council perhaps £200 million. The European Commission proposes that United Kingdom spending through the framework programme should just about double in three years—from two thirds the size of the medical research council's budget to four thirds. If it were a choice between the medical research council and the framework programme, I would choose the medical research council every time, but it is not.
As many of the Community's programmes are in industrial areas, it is perhaps more appropriate to make the comparison with total United Kingdom Government spending on civil research and development, which is projected to be £1·1 billion in 1990–91. The Commission proposes that the framework programme should increase from about one eighth to one quarter in three years. That is serious money. Is it worth it, or to the poor starved body of British science is it manna from heaven? What scientist will quibble about whether his money comes through the research council or the European Community?
The Council of Ministers, we are told, has not yet considered in detail the overall level of funding or the relative balance between the different lines of research. In total disbelief, or whatever it is that goes beyond scepticism, the Minister tells us in his supplementary memorandum of 22 November that the Commission and the Presidency hope for agreement by the Council by the end of 1989, and that the next Council discussion will be on 15 December. We wish him a happy Christmas in Brussels. As the Council will act by unanimity, I take it that the Minister is seeking the support of the House for
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delaying action. Our appropriate response is a flea in his ear. The Government's fault lies not in their stars—be they the stars of Europe or of science—but in themselves.
The House is indebted to the Select Committee on European Legislation, as always, for its prompt report on the draft Council decision, the Government's explanatory memorandum and the supplementary memorandum. The Select Committee has given us a comparison of Government funding of civil research and development at 0·58 per cent. of GDP in the United Kingdom, 0·71 per cent. in Italy, 0·92 per cent. in France and 0·96 per cent. in Germany. As usual, Britain is at the bottom of the European first division.
The Government perpetually speak of their nominal and, indeed, real increase in research and development since 1979, but as a percentage of GDP—which is the best measure of research intensity—Government funding of civil research and development stays paralytically fixed while, in an increasingly science-based world, other countries have been increasing their research and development rapidly to well above our previously higher levels. For example, the science budget in the United Kingdom was 0·16 per cent. of GDP in 1979–80 and is forecast to be 0·16 per cent. in 1990–91.
With the more direct effect on competitiveness of support given to industry, between 1964 and 1986 civil research and development funded from all sources increased from 1·5 to 1·8 per cent. of GDP in Britain, while in Germany it increased from 1·3 to 2·6 per cent. and in Japan from 1·3 to 2·8 per cent., leapfrogging the British effort.
For the United Kingdom, therefore, if the Government will not increase their funding of research and development and will take no serious steps to encourage industry to increase its funding of R and D, Britain cannot afford to look the gift horse of the European framework programme in the mouth. That is a tremendous pity. Britain and British science have a major contribution to make to European Community science. It does not lie in nagging away at the drafting of Council decisions which, with the best will in the world, can give only general guidance to the administration of major support programmes.
I agree that the drafting in the annex to the supplementary memorandum is an improvement on the original memorandum, but to expand the treatment of biomedical and health research from seven to 21 lines and to come up with statements such as
"325 million Europeans wish to maintain or improve their state of health by way of scientific advances"
is not a terribly profound statement on the management of scientific research.
The contribution from Britain does not lie in trying to impose criteria which, as the Select Committee correctly observed, cannot in practice be applied to Community expenditure in the same way as to domestic expenditure. United Kingdom Government Departments have only limited control over the cost and shape of Community research programmes. The Committee may agree with the Government that the information provided by the Commission remains insufficient for a proper appraisal of the programme, but can bureaucracies and assemblies appraise good research programmes properly? Does it really improve matters to increase the lines from five to 20

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or 30? Is it a matter of the Government satisfying themselves that a process has been set up among the scientists which works and produces results?
We do not ask in the House for details, line by line, of the expenditure of research councils. There are five research councils and they have discretion within the sums granted to them to conduct their research programmes. How can we hope to direct the far more complex aspects of European research programmes by proxy, through ministerial representatives on councils, which then give instructions to officials, who then set up advisory bodies, which then consider proposals put to them?
The Commisssion's tactics in proposing the extension of the framework programme have been to go for the greatest freedom that they can get away with in the administration of the programme and the largest increase. What will be the Government's response? Will it be to whittle away the increase in the framework programme as much as possible and then to deduct what remains from departmental expenditures on research and development?
United Kingdom Departments are not in charge of the European programmes in their areas. Will they fight their hardest to reduce those programmes and will their own urgent and perhaps quite different programmes be cut to the extent that they fail to reduce the European programmes? That seems to be the worst of all worlds. That would alienate others, lose us influence in Europe and starve activity at home.
An alternative approach which might eventually cost no more is to enter positively into the European programmes and thus be able to influence them in directions that can contribute to urgent United Kingdom priorities. With Britain a significant, but not dominant, partner in European programmes, the Government's aim should be first to encourage and help British scientists to use the European programmes effectively and, secondly, to improve the European programme systems from within, working with the grain of the European debate.
Britain probably has most to contribute, and will be most listened to, in the direction of research in basic science. We have much to learn about the organisation of industrial support services from Germany and in the management of big, high-tech projects from France. There are, of course, exceptional individuals and areas in which British management has been and will be superb, but we should not be afraid to learn from our European partners.
Having said that, we come back to the framework programme. Should we support the proposed virtual doubling of expenditure? Even if the whole increase is added to the British Government's civil research and development expenditure, we should still be below the level of Italy, our lowest European partner, in the percentage of gross domestic product that the Government spend in support of civil research and development. As the Government will not increase departmental research and development expenditure, the European framework programme increases cannot be objectionable in principle and should not be deducted from British departmental programmes.
Different approaches will be appropriate to different programmes. In some, it would be appropriate to depart from the shared cost contract which is the Community's principal instrument of research funding, flexible though it
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may be. In others, support should be given to a single research contractor, if that is the best way in which to do the work. An example outside the framework programme is that I hear more aircraft builders today asking whether the next generation of European aircraft would best be built by a single European corporation rather than by a consortium of separate national corporations.
The framework programme may be a suitable way in which to organise European participation in the proposed international astronomical institute to plan the next generation of space telescopes. What may be appropriate is still more flexible rolling funding in which a programme that does not need all its funding does not spend the money just because it is there and in which a programme that clearly deserves better funding can obtain it without having to wait for the rolling on of the next framework programme. That condition is met partly by the very broad lines of research that have been proposed and may not be quite as stupid as the Minister has suggested. It should still be possible even to switch funding between the broad lines that have been given. It is all a matter of building confidence in the administration and peer groups of the framework programme, to which Britain should make its full contribution.
With what seems likely to end up as a significant increase in the funding of the framework programme, whatever the British Government say or do, the basic end of research should not be neglected at the European level. That is well represented by the European Research Foundation, a modest body which is supported by our own research councils and science vote, and by corresponding bodies in other countries. The foundation should be encouraged to grow towards the status and role of a full European research council, for which it deserves modest additional funding, although it is small by comparison with the framework programme.
We wish the Council of Ministers success in its further consideration of the framework programme and we shall follow its development with great interest.
1.3 am
Mr. Roger King: I find it difficult to object to anyone—or any organisation—who suggests that we should, as a Community, spend more on research and development. If we do not, some of our competitors elsewhere will outperform us in activities that are essential to provide the wherewithal for our everyday life. Having said that, I have a feeling that the way in which the Community seeks to undertake research and development, as outlined in the extensive documents before us, is not the most successful way in which to proceed.
I have read that after the war we adoped a scatter gun approach to R and D and many of the projects that this country embarked on were subsequently found to be no good. The Bristol Brabazon leaps to mind—an aircraft which was supposed to conquer the world but which could barely get off the ground because some of the basic technological innovations in it—the engine, for instance—were ill engineered and ill devised.
We moved on to atomic energy, in the form of the Magnox reactors, which found a market in the United Kingdom but nowhere else. Then our engineers and scientists developed the AGR system, which found some favour in this country, although its performance has been

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open to doubt for many years. But as a product that could bring wealth to the country, it was a lamentable failure, and we have sought to embrace designs developed elsewhere in the world.
It is not as if the Community will spend small amounts of money. Since 1984 it has been engaging in R and D, and between 1987 and 1991 it will spend £3·6 billion on it. There should be accountability for the spending of that money, to see what it has produced in terms of everyday consumer goods and of an improvement in our factories. We need evidence that money spent by the Community for research's sake has benefited us.
I am reminded that research by committee is never the best way to push back the frontiers of technology. Scientists need a target at which to aim, a challenge to meet. The United States and Japan realise that. Much of what they do is commercially based and they do less research for its own sake.
The letter from Filippo M. Pandolfi is illuminating. One or two paragraphs in it clearly explain the difficulty that many of us have in accepting the merits of the proposals. For example, paragraph 10 on page 6 says:
"Against this, the funds allocated to research in the area of energy represent a net percentage reduction. This is due to the fact that, in the energy sector, one sees, on the one hand, the development of important projects arising from the current framework programme which, in many cases, will take several more years".
Presumably this research programme has been rolling at least since 1984 and we do not really know what these important projects are—yet we are being asked to carry on allowing this sort of expenditure.
On industrial and materials technology, page 24 of the letter states:
"Priority will be given to major integrated projects; among these, the development of the 'clean car'".
That does not mean a car that never gets dirt on its bodywork; I assume that it means a car that does not harm the environment. But every world car manufacturer is rapidly researching that, and the project hardly needs funds from a central bureacracy concentrated on it.
The European Commission and countries thoughout the world have made laws on exhaust emissions, thereby driving manufacturers to produce clean cars. They will not be able to sell cars that do not conform to these standards. Community taxpayers should not have to pay twice for this—once for the cars that they buy, at a price that includes development costs, and again through taxes, to enable someone else to develop what manufacturers are already developing.
I wonder what kind of system would encourage another agency to develop that kind of research. Perhaps such an agency would fund existing car manufacturers to develop those technologies. However, how could we fund that fairly among all the car manufacturers in Europe so that they all got the same slice of the cake and not one manufacturer was able to benefit from Community grant to press ahead with clean car technology?
Concentrating on the car industry for the moment because these points are relevant to our debate, the document from which I have already quoted states in relation to energy:
"The research includes the use of hydrogen and other suitable substitutes for liquid fuels in the transport sector."
That research is already being undertaken by virtually every car and vehicle manufacturer in the world. In the United States, California is taking the lead in introducing
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higher and more stringent restrictions on the internal combustion engine. California is obliging American, Japanese and European manufacturers that want to sell cars in California in the latter part of the next decade to develop engines that will run on alternative fuels. Those manufacturers hardly need another agency to spur them on. To stay in business, they must develop alternatives.
Throughout the memoranda, it appears to me that, although the research is worth proceeding with, it is already being undertaken by companies in their respective disciplines. We are aware that if we do not push ahead with that research and development, companies will cease to exist. The spur of global competition is probably already strong enough to promote that research.
If I had a choice, I would welcome the amount of money being allocated to research and development being channelled directly into companies to carry out their own research and development and to make bids for that money to carry out that research themselves. We do not need a concentrated bureaucracy in the centre of Europe deciding which way the Community should progress in research and development. Companies are best able to make that choice and can best decide what their lines of research and development should cover.
I welcome all kinds of funding for research. However, I am not happy that we are going about it in the right way. I am not sure that we are not creating a technological version of the common agricultural policy.
1.12 am
Mr. Matthew Taylor: To address the debate sensibly we must consider the background issues, the first of which relates to the low level of civil research arid development in this country over many years under both Labour and Conservative Governments. That dates back to the 1960s. Although we now manage to spend a lower level of our GDP on civil research and development than previously, the position is becoming worse.
Although the hon. Member for Birmingham, Northfield (Mr. King) said that we should by and large leave research and development to the private sector, a policy of not putting large amounts of money into research and development has not led to that development being carried out in the private sector. This country has been falling behind for want of research and development and for want of taking a technological lead in world markets. I do not believe that this country's policy has paid off. Even if that were not the case, as we watch developments occuring in the world market with the great advances by Japan and, not far behind, America—which sees the threat from Japanese research and development as substantial—it is increasingly important that we recognise that one-nation let alone one-company research and development programmes are unlikely to generate the kind of progress that we need to get back on to the world stage in terms of being leaders in research and development. That is where the role of Europe comes into play, and that Is why I think that it is such a shame that the Government's attitude has been to slow things down and backtrack on the plans that Europe has tried to introduce—plans that have already been approved in principle under the inter-institutional agreement, as pointed out earlier in a question to the Minister.
I have four criticisms of the Government's approach. First, I think that they are justified in saying that the

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programmes are so loose—certainly in the original draft form—that the result is what has been described as "research and development by committee". There is insufficient democratic control over what programmes may be pursued. I do not believe, however, that the answer should lie with Ministers asking for more and more detail, which can only end in a process that we have seen before—Ministers swapping programmes and saying, "We'll have a little of this because it is of advantage to Britain; a little of that, because it is of advantage to France; and none of that, because no one has a particular vested interest in it."
I think that that is precisely what Europe has been trying to get away from. Moreover, I do not believe that the Government are providing a solution to the problem of the programmes' present form. On the contrary, I think that they are offering a trawl back to narrow nationalism, which is certainly what the hon. Member for Northfield was advocating. We should be democratising the whole process, opening up decision-making on what programmes to pursue and ensuring that those who make the decisions are held accountable for them. The best way to do that is to make Europe itself more democratic, and to give power to those who are democratically elected to represent the European interest—that is, MEPs.
My second criticism relates to the narrow nationalism that I mentioned earlier. I do not believe that anything lies behind the Government's actions other than their steadfast rejection of the principle of research being undertaken at European level. Everything that the Minister said tonight suggested that.
My third point is this. One good reason—in a sense—for the Minister to object to the spending increases is that he intends to take the money directly out of our own research and development programme. Whatever he may have said tonight, I think that the underlying reason for his objection is his belief that he will have to come back and start cutting into British programmes. That would be a valid objection if it were not open to the Minister to invest more in research and development—which he ought to be doing, rather than attempting to block what is happening in Europe. He should tell the Treasury that not enough money is going into research and development in Britain—and in Europe—and that we should not only be embarking on this programme but expanding our R and D activities elsewhere.
That is all the more true when we consider the balance between our civil and our defence research and development. The best of our competitors—Germany and Japan—are concentrating on commercially oriented R and D and ensuring that it is put to commercial use, whereas our own research is overwhelmingly in the defence sector. Indeed, because much of the research is classified as secret: it never gets out or, if it does get out, it is too late to provide a competitive advantage.
Turning to the specific examples that we see in the papers, it is worth my making one point about the programmes outlined. Again, the hon. Member for Northfield referred to the energy programme and complained that there was insufficient detail. I found that there was more than sufficient detail to make one important criticism of the plans. As a whole, the research and development plans outlined turn more towards the
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environmental and green agenda than did the predecessor framework programme. However, on energy, where there is no intention of increasing the spend, we find a divison of resources, which go overwhelmingly into the nuclear sector. Fossil and renewable fuels and the use of energy are all lumped together with only 10 per cent. to 15 per cent. of the envelope spend. In my view, that is an extraordinary balance of priorities. It lumps together three areas between which Europe could take a lead far more significantly than could be the case in respect of anything that it is likely to do in the nuclear area and where we could be far more certain of success.
I find it particularly extraordinary that more investment is not directed towards energy conservation which, ultimately, must be the greenest of the approaches. Indeed, from most independent studies, it is also the area that would show the greatest financial return. I hope that if the Minister is to go into the detail of every programme and to argue out the rights and wrongs of every pound or ecu spent, he will at least take on board the fact that our Government are moving away from the nuclear option. Perhaps he should argue the same when he is in Europe.
Nevertheless, my overall view is that we would do far better to seek to encourage the research and development plans that are outlined and to take advantage of the opportunity to increase our research and development spend in order to increase our competitiveness and to live up to the realities of the world as it develops into the 1990s. When Ministers have valid criticisms about accountability and decision by committee, we should take advantage of the opportunity to seek to democratise these processes and to hand Europe to the people of Europe and away from the bureaucrats. We should not seek to grab the power back for the Ministers around the table who are all too inclined to bargain among themselves rather than to stand up for the interests of the Community as a whole.
1.22 am
Mr. Jim Cousins: Two things are to be welcomed about the European framework document. The first is that it is less vulnerable to the criticism that has been made by the hon. Member for Birmingham, Northfield (Mr. King) than either it or our own national research programmes have been in the past. There is much less focus on single large blockbuster projects. Indeed, far less of that appears in this framework programme than appeared in the previous one or in our national research programmes.
I have some sympathy with continuing the one large blockbuster commitment that survives, nuclear fusion, expenditure on which has given rise to the criticisms made by the hon. Member for Truro (Mr. Taylor). It is clear that if nuclear fusion is to be pushed forward to the point where it becomes a workable energy system, that energy expenditure and those commitments cannot be made by single countries. Indeed, the results of such research should not be the property of any single country. Therefore, although I do no like large blockbuster projects, and nor am I a particular enthusiast for nuclear power, there is something to be commended in Europewide research into nuclear fusion. The participation and influence of our advisers and researchers into the quality of the programme are to be welcomed.
Others have drawn attention to the vast improvement in quality between the first document, drafted by Mr.

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Pandolfi, and the second, which appears as annex B in the Government's report. That improvement is substantially due to the involvement of British researchers, co-ordinated in Brussels. If I thought that British scientific research was as well co-ordinated in London as it appears to have been in Brussels, I should be a lot happier about the future of British research. Our influence on the document has clearly been systematic, highly intelligent, well coordinated, extremely well crafted and effective. In all respects, it is unlike our national efforts.
The Government's stance seems much less than adequate in regard to money. I am not talking simply about the quantity of money or the old arguments about additionality and the impact of the European spending programme on our domestic spending. I agree with what other hon. Members have said about that. The relationship between domestic and European spending, as described in paragraph 21 of the Government's supplementary report, is worrying. Spending is to be conducted at the level of individual Departments. That is a recipe for disorder. If the Minister's suggestion of 20 lines of research rather than six were accepted, that would be a recipe for still greater disorder. It is not possible to tell from the documents that the Government have presented to us how the research is to be organised. It is not possible to tell which Department is responsible for which line, and how it is to conduct itself. If Departments adjust their expenditure programmes randomly, as expenditure is incurred in Europe, we shall have disorder in our national expenditure programmes.
This is one matter on which the Government must clarify the issues if we are not to find ourselves in an appalling muddle. Our researchers will not know, if they go to Europe, whether they are disrupting their companies', colleagues' or institutions' efforts to get domestic research spending for similar projects. We must be clear about the organisational relationship between domestic and European spending.
The Government's insistence on the distinction between near-market research and other forms simply will not hold up. The excellent contribution made by British scientists to the revisions of the framework programme show clearly the falsity of that distinction. The spirit that dominates the framework programme in annexe B is looking for standards which will be the basis of performance and regulation, and which will enable the efforts of researchers, users and producers to be combined. They will lay the basis for future European performance and technological progress, standards, which in pharmaceuticals, telecommunications and materials technology, do not permit of any clear distinction between near-market and non-near market.
For that reason I have great sympathy with the hon. Member for Northfield who asked, "Why not simply throw the research programme open to the companies and let them apply for the money?" That is entirely within the spirit of seeking a research programme that will develop and hone new standards of performance and regulation. But that approach stands in contradiction to the Government's approach. Far from throwing open research programmes to companies, the Government seek to put up a completely false Chinese wall between the market and research. That distinction will not hold up.
There is much in this framework programme that should commend itself to us. Perhaps the single most important aspect is the way in which the framework
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programme does not allow this false distinction between markets and research to exist. In its search for comprehensive standards which can be the basis for technical performance and environmental protection, it is a model for how we should conduct research in the United Kingdom.
1.31 am
Dr. Lewis Moonie: The House will be grateful to know that I do not intend to fill up the remaining time with my concluding comments.
It has been an interesting debate. Perhaps the sparse attendance is a reflection of the hour rather than hon. Members' interest in this important subject. The framework proposal for Community research undoubtedly represents the single most important programme in the EEC for the next five years. It comes at a time of major political and economic change in Europe. On the one hand, there is the move towards the single market in 1992 with all the opportunities and dangers for British industry that that represents. On the other, there is the prospect of enormous upheaval in eastern Europe, the welcome return to democracy there and the challenge for the EEC that it represents in providing the economic underpinning which that democratic process will require and a largelly untapped market for our goods and services which will develop in consequence.
We broadly welcome the proposal. It covers all the most important areas of applied research which we need to extend and develop if we are to compete successfully with the United States and Japan in the 1990s and beyond. If carried through to the market, these efforts will undoubtedly be repaid with a new generation of products for making Europe a dominant force in the new technologies under development.
To summarise the proposals briefly, the six areas are information and communication technologies, industrial and material technologies, the management of natural resources, covering environment, applied sciences and energy and, equally important, the management of intellectual resources, human capital and mobility. Each of those is a key area in the future development of our industry.
Unlike the Minister, I believe that the EEC has probably got the number of programmes about right. It leaves enough flexibility within these to direct money towards the projects that are likely to show the most promise over the next few years. In particular, in information technology it is clear that much research needs to be supra-national. In life science and technology, which unfortunately is not given much of a mention in the background documents although it is a major area, recent reviews in The Economist and other perhaps more appropriate professional journals have suggested that single markets in products which are coming through towards testing in human beings may be worth upwards of £1 billion each a year in total world markets. Clearly, that is an area where we require to spend a great deal of money.
I agree with some of the comments of the Select Committee on European Legislation: some issues remain to be clarified. The Committee agreed with the Government that the information provided with the proposal was insufficient for a proper appraisal of the programme. It mentioned the need for global environmental research into the problems that will be caused by future

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ocean levels. That is an important issue on which we would welcome some clarification. The Committee endorses the Government's concern that there should be appraisal of proposals and evaluation of results. That may be significant in the light of the comments of the hon. Member for Birmingham, Northfield (Mr. King). Many of the major projects of the past to which he referred suffered from a lack of ongoing appraisal. If they had been subject to that, they might have been modified, or even abandoned, at an earlier stage.
How does the programme fit into our own research efforts? It is generally agreed that the current predominance of military research in the United Kingdom has had an adverse effect on the civil research programme. Happily, the reduction in spending on arms in Europe, which is an inevitable consequence of the changes, always assuming that they persist, will free more resources for efforts elsewhere, especially in basic research where we have long held a commanding position in Europe. Perhaps that factor is less well covered in the proposals than it might be.
I say in passing that we could consider fruitfully European co-operation on military research and development, with Britain perhaps taking a lesser share of the burden than it has in the past.
Our contribution to EEC-wide research must not be seen as a substitute for our own efforts. Instead, it must be seen as an adjunct to them. It would not be acceptable for us merely to deduct the moneys from limited resources within the United Kingdom.
All these fine proposals will come to nothing if we fail to act to take advantage of them. Two serious matters must be addressed. First, there is an increased need for British companies to invest in their own research and development, especially in what the Government call near-market research. That is essential in a competitive market. Secondly, we must not lose sight of the fact that we face a critical shortage of skills in all the areas that we have been discussing, especially in the biological sciences, engineering and information technology.
It is said that the Government, with their hands-off approach, have not yet grasped the serious implications for our future in the deficiencies to which I have referred. Either we compete effectively and provide the skills needed, or Britain in the 1990s will face a sombre future. The Labour party welcomes the proposals for the next five years, but it recognises that they cannot be a final solution to our problems.
1.38 am
Mr. Douglas Hogg: I have the feeling that most of the criticisms that have been made of the Government's attitude were written and crafted before I made my speech. The hon. Member for Motherwell, South (Dr. Bray) was somewhat less than generous. He might recall that the United States Government's expenditure on civil research and development is 0·4 per cent. of gross domestic product, which is significantly less than our own. He will recall—no doubt the hon. Member for Kirkcaldy (Dr. Moonie) will remind him if he does not remember himself—that industry's investment in civil R and D over the past four years has increased by 30 per cent. in real terms. That
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is an extremely encouraging development and reflects in part industry's satisfaction with the increasing prosperity that it is achieving as a result of Government policy.
On the hon. Gentleman's second point, I should make it plain—to be fair to myself, I have already made it plain—that we are enthusiastic supporters of the framework programme. We are also determined to ensure that we get value for money, and that the ordinary criteria for European programmes, such as subsidiarity, are respected. He would expect us to do that, and we shall ensure that we do.
I have some sympathy with the points made by my hon. Friend the Member for Birmingham, Northfield (Mr. King). In particular, he focused on the clean car, and the presence of the clean car in the technical annex. I agree with much that he said. We are not in the business of product development or, for that matter, of near-market activity. It is not for the Commission to fund the manufacture of a clean car. However, it is for the framework programme to establish some common standards by pre-competitive research that enables manufacturers in general to make a product to common standards.
The hon. Member for Truro (Mr. Taylor) accused me of narrow nationalism. I do not understand that criticism. I suspect that he crafted it—although to use the word craft in the context of his speech is, I am afraid, to flatter those remarks—before he heard my speech. I say again that there is great merit in a framework programme. We support the concept of it, and its contents, but we are determined to get value for money and to ensure that the ordinary criteria are satisfied.
As to the impact on domestic funds of spending on European programmes, the funds come out of a common source of United Kingdom expenditure. It is right that increasing expenditure on the European programme should have an effect on domestic programmes. Clearly, if there be a reduction in baselines for domestic programmes it is possible for an attempt to be made to reinstate programmes, but the fear expressed by the hon. Gentleman—that existing domestic programmes would be cut as a consequence of an expansion in European spending—is not a legitimate concern.
Dr. Bray: International comparisons are important in a proper assessment of the European programme and its effect on different national economies. The Minister has to compare like with like. On civil research and development, I made a comparison with other European countries, and he made one with the United States of America. The sources used by the Select Committee show the United States of America spending 1·28 per cent. of total research and development, including defence, and the United Kingdom spending 1·13 per cent. If the Minister had had as much benefit from the United States of America's research programmes as I have had in the office of naval research, which supports fundamental research in mathematics and other subjects right across the spectrum, he would realise that one cannot compare United States of America defence research '.vith British defence research and say that they are the same thing. The former covers a great deal of fundamental research that in Britain would be counted as civil.
Mr. Hogg: The hon. Gentleman protests too much. He was careful, in his analysis, to focus on civil research and

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development, and I did him the courtesy of following him down that road. If we consider Government expenditure on civil research and development as a proportion of GDP, which is what he urged me to do, we have the consequence that I outlined. He wriggles too much.
Mr. Matthew Taylor: The Minister is not very convincing. Further to the point that has already been made by the hon. Member for Motherwell, South (Dr. Bray), much of the American defence research and development would not be classified as civil research and development in this country. Moreover, the Americans make much better use of their defence research and development in the civil area, whereas in this country our defence research and development tends to remain classified and not brought to the market.
Mr. Hogg: Both the hon. Member for Truro and the hon. Member for Motherwell, South are trying to have it both ways. First, they try to pin me down to civil research and development. When I give them a figure that is based on that assumption which they do not like, they tell me that I should take into account the military research and development budget. However, when they consider the overall spending on British research and development, they accuse the Government of spending too much on military research and development. They cannot have it both ways. They do themselves less than justice by trying to have it both ways.
The rather bizarre and foolish suggestion that the European Parliament should determine the content of the scientific and technical annex was based on two premises: first, that there would be no horse trading in that august body and, secondly, that the European Parliament knows better about the scientific programme. There is no place that does more horse trading than the European Parliament. The idea of a gaggle of European parliamentarians setting out the details of the European framework programme in a technical annex is sheer folly.
The hon. Member for Newcastle upon Tyne, Central (Mr. Cousins) made an interesting speech. However, it is worth remembering that most of the work that is being done within the framework programme is carried out by companies. It is not done by a central organisation.
The Government are an enthusiastic supporter of the framework programme. We believe that we should get value for money. It is a valuable adjunct to our scientific programme, especially our research and development. We hope to reach agreement on Friday. We shall do our best, but we must obtain value for money and protect this country's interests.
Question put and agreed to.
Resolved,
That this House takes note of European Community Document No. 8375/89 and COR 1 and the Supplementary Explanatory Memorandum submitted by the Department of Trade and Industry on 22 November 1989 relating to the Framework Programme of Community research and development activities 1990 to 1994; and supports the Government's view that the Commission's proposals for expenditure need to be more clearly justified before the Programme can be agreed.

Pensioners (Winter Heating)
Motion made, and Question proposed, That this House do now adjourn.—[Mr. Dorrell.]
1.47 am
Mr. Tom Clarke: I am grateful for this opportunity to discuss the problems of British pensioners this winter. Their problems have not been eased by the spread of 'flu. The reality for many is that to be old is also to be cold. The epidemic unfortunately means that the elderly are particularly vulnerable. The virus is exceptionally virulent, a point that ought to be borne in mind in the debate.
Pensioners' problems are not helped by the Government's mean-minded decision not to link pensions to earnings. The Labour Government's policy led to a 20 per cent. increase in real terms for pensioners, as against the 2 per cent. increase that they have experienced under the Tories since 1979. Pensioners face grave problems, particularly that of fuel poverty. That is a national scandal, on top of their private grief.
There is a constant and real worry about hypothermia, which leads to a substantial increase in the number of deaths during the winter months. High fuel prices lead to debt and disconnection, including self-disconnection, which has increased greatly since privatisation. There are still worries about standing charges which should have been phased out long ago and which do not help to solve the problems faced by pensioners in Britain today any more than the notorious social fund with its emphasis on loans rather than grants.
Severe weather payments have been debated each winter, certainly since I arrived in the House seven years ago. The provisions for triggering the system which existed a few years ago have been abolished, but the new system is not much better. It calls for 0 deg C for seven consecutive days. In reality that offers very little help to pensioners suffering from bad weather conditions. I understand that only two weather stations have been activated under present procedures. In Scotland, only stations in Dumfries and Glasgow have been triggered, although the Minister may be able to give the House other information about the rest of the United Kingdom. That means that in many parts of Scotland and the United Kingdom the system has not been triggered and elderly people have suffered in extremely cold conditions. If old people live on the east coast of Scotland or in Edinburgh where it is very cold in the morning and evening, simply because it may be mild in the afternoon they would not qualify under the rigid requirement of a seven-day consecutive period of 0 deg C. or less, and therefore would suffer hardship. Even if people qualified far more extensively it would have to be said that the system is restricted.
Last year the Department of Social Security in Scotland and in the United Kingdom paid out a paltry figure, although Scotland has more cold-related deaths than anywhere else in western Europe. The cold weather payments are completely inadequate to meet the problems that thousands of our pensioners are facing. Many pensioners who qualify for cold weather payments under the existing system are simply not claiming them. Many of them are confused and that is not at all surprising given the complex nature of the system.
The figure of £5, despite inflation, increased fuel costs and the consequences of electricity privatisation, is already

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three years out of date. We know that the average price of heating is £8 a week during the non-winter months and £16 a week during winter. Therefore, £5 hardly reflects the real cost of heating for elderly people today.
Mrs. Margaret Ewing: I am grateful to the hon. Gentleman for giving way as I recognise the importance that he attaches to this short debate. Does he accept the need for zoning as people in the north of Scotland are in very different circumstances from those in the south? Perhaps we should consider automatic payments to pensioners and to the handicapped to ensure that, wherever they live in the United Kingdom, they receive payments that recognise heating requirements.
Mr. Clarke: I accept that means testing is entirely inappropriate. Automatic payments should be made nationally.
The payments, inadequate though they are, have not been given to pensioners whose incomes are just above income support level. The Government's mean-minded attitude is that nobody should be in receipt of the miserable £5 if they have savings of £500 or more, which most elderly people would regard as the cost of a funeral. That is entirely unacceptable in modern times.
In 1986–87, only 500,000 of the 1,500 million pensioners who are entitled to claim did so. It is obvious that the Government's scheme is not working, and its administration is expensive. The money spent on publicity over the years could have made life much easier for many pensioners.
Throughout the United Kingdom, the plight of pensioners has been compounded by the 1988 change from supplementary benefit to income support, which led to the abolition of heating additions for the elderly, disabled and those with young children. Previously, payments of £5·65p a week were paid throughout the year regardless of the weather.
There is another great problem that all of us have constantly in mind. We know that in 1987 600 people of all ages died of hypothermia in Britain. The figure for 1988 was about 400. In Scotland, 138 people died of hypothermia last year, and many more were admitted to hospital with cold-related conditions. Everyone knows that the figures for hypothermia underestimate the extent of the problem that pensioners face. Most of the voluntary organisations with which I have had discussions over recent days suggest that some doctors believe that to place the word "hypothermia" on a death certificate is like stamping it with "neglect," and that doctors are therefore reluctant to do so.
Even more revealing than the figures for hypothermia are those for cold-related deaths, which I draw to the attention of the House and the Under-Secretary of State for Social Security. We are told by such organisations as Winter Action on Cold Homes, Age Concern and many others that a marked feature of British trends, even in mild winters such as that in 1987–88, is that the number of extra winter deaths is substantial—an annual average of 30,740 deaths each year over the past five years. Excess winter mortality among persons aged 60 and over has ranged from over 48,000 for the 12 months up to 31 March 1985 to just over 21,000 up to 31 March 1987.
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International comparisons are important when we consider these serious matters. The difference between the number of deaths reported in the winter months compared with the spring and summer months is significant. In February this year, we saw an increase of 24 per cent. in England and Wales, of 19 per cent. in Scotland, of 6 per cent. in France, of 6 per cent. in Sweden, which experiences much colder weather than the United Kingdom, and of 8 per cent. in the United States. I accept that the precise reasons for those differences need further analysis, but the evidence seems to suggest that other countries, which often have colder temperatures than Britain, manage to safeguard the lives of frail citizens in a way that does not happen in Britain. That invites serious examination.
Room temperatures clearly matter. The World Health Organisation recommends a minimum indoor temperature of 18 deg C, and 2 to 3 deg C warmer for rooms occupied by elderly or handicapped people or young children. For millions of people, this is clearly not happening. Forty-two per cent. of pensioners living alone have no central heating. More than most, and particularly in Scotland, they experience the great problems of dampness and condensation, which call for a more urgent response than the Government have given so far. We have not had a survey of these conditions since 1972, when we discovered that 54 per cent. of people aged over 65 lived at or below the minimum temperature specified for employees under the Offices, Shops and Railway Premises Act 1963.
The tragedy is that many pensioners have to choose between proper heating and proper eating. That is unreasonable in modern times. Pensioners face the problems of debts and disconnections. The South of Scotland electricity board has introduced "Power cards". In many ways, this has added to the problem. We are seeing the new dimension of self-disconnection. Pensioners, having used up the £15, which is the cost of the cards, feel that their money has been spent and simply discontinue heating. I make a plea to the Minister to encourage social work departments in Scotland and social service departments elsewhere in the United Kingdom to monitor this closely. The Government seem to have no major strategy to match the public worry about these matters and to co-ordinate activities, even between Government Departments.
On 22 November, the Government launched their "Winter Warmth" line. It was set on its journey by Ministers, with the help of Eddie "The Eagle" Edwards. That is a refreshing change from the hon. Member for Derbyshire, South (Mrs. Currie) telling pensioners to wear woolly hats and the Under-Secretary of State for the Home Department—the hon. Member for Fareham (Mr. Lloyd)—encouraging pensioners to go to jumble sales. Like Eddie, the Government's policy on these matters is all high hopes and poor performance. Of course, we can all laugh at Eddie, but most of us regard the Government's policy as pitiful. The most eloquent comment on the Government's scheme came from Mr. Malcolm Wicks, the chairperson of Winter Action on Cold Homes, who said:
"Beneath the glitter and gloss, there was a hole where there should be action".
Of course, nobody would discourage the use of the freephone "Winter Warmth" line, but it is no substitute for practical services, such as draught proofing and insulation projects. Those services have been hit hard by Government policies which often represent neglect. Changes to the

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employment training scheme have meant fewer projects, less practical work and parts of the country not being covered by it.
Fuel poverty among pensioners should be a priority in the Government's approach. However, apart from public relations exercises, there is little evidence that the Government see the matter in that way. According to Neighbourhood Energy Action in "Energy Efficiency and Employment Training One Year On", the number of jobs that were carried out by projects from October to December 1988 fell by 15,500 in draught proofing and by over 3,000 in loft insulation, compared with the same quarter in 1987. The period from September to December saw a huge drop in the number of operating energy projects, from 450 to 196. Between August 1988 and August 1989, there was a 54 per cent. drop in the number of projects giving energy advice and a drop of 74 per cent. in the number of clients who were advised. Moreover, under the Local Government and Housing Act 1989, low income groups will find it harder to obtain loft insulation grants from April 1990. From that date, there will no longer be a specific allocation of funds, which currently stand at £11·5 million, for this purpose. If they were honest, the Government would announce a closing down sale for those grants.
The House is right to be concerned about several policy questions that affect pensioners deeply, including social security, housing, insulation, energy efficiency and the impact of poverty, and to be concerned that our pensioners—our people—are facing year after year the cold facts of the misery of winter conditions. We cannot continue to accept a cold crisis which continues to blight Britain's pensioners' standard of living more than those in any other developed nation and which offers so drastically the prospect of a diminished quality of life for many elderly people and others on low incomes each winter.
The problem of fuel poverty for our pensioners is one of the most important issues that the House addresses this winter. The Government should respond and the British people should encourage them to do so. Surely pensioners deserve more than the cold approach of a Government who seem to have a cold attitude about the cold climate. Pensioners deserve far more than that and I hope that the Minister and the Government will seize the opportunity in response to this debate to give a positive reply to the drastic problems that British pensioners are facing.
2.7 am
The Parliamentary Under-Secretary of State for Social Security (Mrs. Gillian Shephard): I congratulate the hon. Member for Monklands, West (Mr. Clarke) on bringing this important matter before the House. As is customary for the hon. Gentleman, he has spoken with conviction and sincerity, and has demonstrated concern for the welfare of pensioners in winter which is, I am sure, shared on both sides of this House.
I shall begin by making some general points about pensioners' incomes because I was sorry that the hon. Gentleman's contribution ignored the broader context of Government achievements in improving those incomes. I want to remind the House of several points. Between 1979 and 1986, the average total net income of pensioners increased by 23 per cent. in real terms. Of those retiring now, 80 per cent. have incomes from other sources in addition to their state pensions.
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The hon. Gentleman mentioned the achievements of his party in government and said that pensions increased by 20 per cent. He failed to mention that the actual increase was 3 per cent. because of the inflationary policies that were pursued by his party. However, he is right to raise the question of those who, because they retired before the state earnings-related retirement pension opportunities and the change after SERPS, missed the opportunity to opt out. I must remind him that income support is available for all those who satisfy the income and capital rules. At May 1988, some 1·7 million claimants aged 60 years or more received income support. Where appropriate, those people would have also qualified for maximum help with housing costs of 100 per cent. for rent and 80 per cent. of general rates or, in Scotland, community charge. Even people whose income is above income support levels, and whose savings are less than £8,000, can claim housing benefit.
In addition to this normal help, the hon. Gentleman will recall that with effect from October this year help has been made available for poorer and older and disabled pensioners. This will help over 2·5 million pensioners on income support and housing benefit, with £2·50 a week extra for single people and £3·50 a week for couples.
We mounted a successful campaign to bring these new benefits to the attention of pensioners. Although it is too soon to judge the full effects of the campaign, over the four months from the start of the publicity in July until the end of October nearly 200,000 pensioners were newly awarded income support. That helps with the problem that the hon. Gentleman described.
Turning to help with heating costs through the social security system, I would remind the hon. Gentleman of the social security reforms introduced in 1988. He will know better than many hon. Members the unsatisfactory complexities of the old system. Although the Government made many improvements in the system to cater for the needs of individual groups, the system remained very difficult to understand. The new arrangements have provided a modern system of income maintenance through allowances with premiums for vulnerable groups such as the elderly. All the £417 million that was spent on heating additions in 1987–88, the final year of the old scheme, was incorporated in the income support premium support structure which, of course, is uprated each year. And, as I said, we have already used the new structure to direct extra help to those most in need.
In addition, when the weather is very cold, as the hon. Gentleman said, payments can be made under the social fund cold weather payments scheme. I note what the hon. Gentleman said about the capital limits on the social fund, and we are monitoring the position carefully.
The hon. Gentleman said that £5 was inadequate, but I remind him that income support already covers everyday needs. We believe that £5 is a reasonable amount to pay towards the extra expenses incurred for heating in cold weather.
We have kept the arrangements for claiming cold weather payments as simple as we can, for both claimants and the staff who operate the scheme. Each of the Department's local offices is linked to one of more than 60 national weather stations run by the Meteorological Office. The hon. Gentleman said that weather stations in Scotland are not always reliable. That claim is often made by hon. Members representing many different parts of the country. I am sure that my constituents would claim that they enjoy especially cold winds from Siberia. We feel,

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however, that the system is as fair as it can be. It is triggered automatically by the temperature reaching 0 deg Celsius, so if it is colder in Scotland and the temperature is 0 deg, the cold weather payment system will be triggered more frequently—
Mrs. Margaret Ewing: Is there any system of monitoring the difference between places in Scotland and the stations where temperatures are monitored? The highest village in Scotland is Tomintoul in my constituency, and the weather temperatures are measured in Kinloss. There is a vast difference between the climates of the two places. The Government have a responsibility to monitor those differences with regard to the triggering system.
Does the Minister agree that the notional fuel element in the state benefits to which she has referred takes us well beyond the £5 that she mentioned? The realistic figure must be nearer £8·80.
Mrs. Shephard: I assure the hon. Lady that the Department continually monitors the effectiveness of the triggering of the cold weather payment system. We consider the present £5 arrangement, plus the element within income support, adequate.
I must move on briskly because the hon. Gentleman raised several other matters. He referred to standing charges, which have fallen over the past five years. In the five-year period to October 1989, domestic gas prices fell in real terms by 16 per cent. Gas now costs less than in 1970. Similarly the price of domestic electricity has also fallen—by 8 per cent.—in the five-year period to October 1989.
The hon. Gentleman mentioned hypothermia. Any deaths from cold or from illnesses in winter naturally concern the Government. While the Government would
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never be complacent about those matters, it is encouraging to consider the fall in the excess winter mortality rate over the past 30 years. However, we would never be complacent about that and that is why we are continuing the "Keep warm, keep well" and "Keep warm this winter" campaigns. The hon. Gentleman criticised those campaigns, but it is worth running campaigns that will increase awareness of the dangers of cold weather among those at risk, their friends, relatives, and neighbours and so assist those agencies that care for them in multi-disciplinary statutory and voluntary co-operation in running campaigns.
It is worth reminding people that simple measures such as draughtproofing, sensible clothing, diet and exercise can help reduce the risks associated with cold weather. The hon. Gentleman referred to insulation and the problems caused by poor housing. I remind him that in 1988–89 local authorities spent £2 billion on renovating housing and on energy efficiency work. In Scotland this year £16 million is being spent to combat dampness and £62 million to combat condensation. I fully acknowledge that there were problems with the community insulation project network last year. However, I understand from Energy Action Scotland that there are now projects in every Scottish district council area. For the future, as my right hon. Friend the Secretary of State for Energy announced recently, it is intended to include powers in forthcoming social security legislation to introduce a new scheme of grants towards the costs of basic insulation measures in low-income households in England, Scotland and Wales.
I thank the hon. Gentleman for raising this important matter so that I could have the opportunity to explain three prongs of Government policy—
The motion having been made after Ten o'clock on Monday evening, and the debate having continued for half an hour, MR. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
Adjourned at seventeen minutes past Two o'clock.