§ Mr. Bob Cryer: (Bradford, South)On a point of order, Mr. Deputy Speaker. There is a note on the Order Paper that
The Instrument has not yet been considered by the Joint Committee on Statutory Instruments.That is no longer accurate. It was considered by the Committee this afternoon. We did not have time further to examine the instrument, but the Committee does not wish to draw the attention of the House to any defect in it.
§ Mr. Deputy Speaker (Sir Paul Dean)I thank the hon. Gentleman for making that clear.
§ Mr. Donald Dewar (Glasgow, Garscadden)I beg to move,
That an humble Address be presented to Her Majesty, praying that the National Health Service (General Medical and Pharmaceutical Services) (Scotland) Amendment (No. 2) Regulations 1989 (S.I., 1989, No. 1990), dated 31st October 1989, a copy of which was laid before this House on 1st November, be annulled.I want to draw the attention of the House to a large number of defects in the regulations. I intend to do so briskly because there is just over an hour in which to debate them, and many of my hon. Friends wish to participate in the debate.We have some fundamental objections to the regulations. I make no apology for having prayed against them and I make no apology either, for inviting my right hon. and hon. Friends to vote against them. Our first and very obvious objection, with which the Minister will be familiar, is that the GPs' contract is being imposed despite the overwhelming opposition of the vast majority of doctors in Scotland. Their dislike of and objections to the contract are shared by the public and are certainly supported by the Opposition.
I want to make it clear that not every proposed change is offensive or unacceptable in itself. For example there are provisions to give individual patients more information about practices and to give them the ability to move from list to list, there is an incentive for doctors to undertake their own night calls and there are a number of other matters with which there is no great quarrel and which will have a fair degree of support. But that is not the essence of the matter.
The imposition of the contract has been necessary because it represents a substantial switch in general paractitioners' incomes to capitation fees. There is no doubt that there has been a marked switch of emphasis. I understand that it is intended that capitation fees should rise from about 45 or 46 per cent. of the income of a practice to about 60 per cent. We fear that the effect will be that fewer doctors will see more patients and that that will build in an incentive to increase patient numbers and cut the time that a doctor spends with each patient. That has been considered over a lengthy period and there has been a spirited public debate. In the parallel debate on the English instruments, my hon. Friend the Member for Livingston (Mr. Cook) drew attention to the findings of the Select Committee on Social Services in 1987 which recorded: 290
the proposal to increase the proportion of a general practitioner's income derived from capitation was universally opposed.Since then, the opposition has become even more marked, more vociferous and more strongly based on public opinion.As the Minister will no doubt concede, the proposals before us represent the reversal of a change in policy that took place in the 1960s. Until then GPs' remuneration was based almost entirely on capitation fees. That became unpopular and was widely considered as an unsatisfactory system. In 1964, or around that time, under the then Labour Government, there was a major renegotiation which produced a hybrid system. Capitation fees remained important, but there was a substantial switch to fees and allowances. At the same time the Government guaranteed two thirds of the cost of practice workers and a number of other matters.
That essential shift in the balance between capitation and other forms of income, was negotiated on the basis of experience and consensus with the medical profession and with those who were interested in the future of primary medicine under the Health Service. We are now seeing an about-turn. We are being asked to move backwards at the command of the new Right and if we do that it will be to the detriment of the service and the disadvantage of the patient.
No doubt the Minister will argue that there are safeguards in the new Scottish contract, and perhaps he will say a word or two about them. He may point to the operation of the Scottish rural practice fund which is well established and well understood and has been a well-targeted project based largely on a capitation element for smaller practices. Of course there will have to be an increase in the Scottish rural practice fund. I am particularly interested in how that will be paid and whether it will be indexed to keep pace with the cost of living or will take account of the substantial shift towards capitation fees in general practitioners' remuneration. Clearly, if the capitation fee becomes more important and increases as a proportion of the total, small practices are likely to suffer as it grows. If they are to get anything like satisfactory protection, it is essential that we receive assurances from the Minister that the rural practice fund will increase more than simply by the cost of living to take account of that. If our protestations are to carry any credibility, it would be very helpful if the Minister were specific on that point.
The deprivation allowance is a new payment introduced by the contract. It is referred to in paragraph 12 of the contract as an amendment to regulation 31. We know that deprivation is a problem in Scottish society. I draw the House's attention—I do not know whether the Minister is familiar with it—to an article that appeared in the 7 October issue of the British Medical Journal. The authors of the article, Vera Carstairs and Russell Morris, set out the stark facts of deprivation in Scotland and the marked connection between those facts and mortality rates. The comparison between the percentage value of components of deprivation in Scotland and those in England and Wales is harsh. Male unemployment is 12.7 per cent. in Scotland but 8.7 per cent. in England and Wales. The figure for housing overcrowding is 25.3 per cent. in Scotland but 5.8 per cent. in England and Wales. 291 Among the social indicators, 41.2 per cent. of the population in Scotland have no car, whereas the figure for England and Wales is 24.4 per cent.
The article says that 24 per cent. of the population of England and Wales live in what are described as affluent conditions—category 1 conditions—whereas the same category embraces only 6 per cent. of the population of Scotland. That is a worrying factor and is perhaps a reproach to us all, but it is directly reflected in the workload of general practitioners and in the Scottish mortality rates. It is depressing to discover that mortality rates in Scotland are 16 or 17 per cent., depending on gender, above those in England and Wales. That is a startling fact.
The Minister may say, "So what?" There may be a tendency to shrug that off, or we may be told that it will be cured by a good dose of the enterprise culture blown away by the healthy enema of Thatcherism, but none of us believes that for a moment.
The impact of deprivation on GPs' work loads is well documented. Research shows that male patients in Scotland aged 65 to 74 have six consultations per annum, whereas in England and Wales it is only five. The figure for females is seven in Scotland and five in England and Wales. Perhaps that difference is marginal, but if it is aggregrated across the caseload of a busy practice or across a community it represents a substantial distinction and underlines the potential importance of the deprivation premium. It futher underlines the importance of how funds will be allocated once they are being paid. That is the second point that I ask the Minister to consider and say a little about.
I understand that over the years the Scottish Office has established acceptable methods of calculating deprivation factors in individual practices. I should like to know what the allocation to Scotland will be for the deprivation allowance. If it is to be paid on a population ratio, we should expect about 9 or 10 per cent., but clearly that would be a mockery given the facts to which I have referred and the overwhelming rate of deprivation in rural and industrial Scotland. I am told that the Jarman index suggests that a fair apportionment of the national total for Scotland would be between 15 and 20 per cent.
A decision must be made, in principle at least, between the Scottish Office and the Department of Health. I hope that the Minister will say that the allocation will be based on the incidence of deprivation and not on a more arithmetical calculation that depends on population ratios. I know that the Minister will be in a position to help us, and I very much hope that he will do so.
I shall confine the rest of my remarks to list sizes because I am aware that I must discipline my comments if other hon. Members are to speak. It would be a tragedy if the considerable advantage which is enjoyed in the Health Service in Scotland were eroded. The average practice list in Scotland is about 1,650 patients. In England, it is marginally under 2,000. There is a significant gap between the two—one gap that I do not want to see closed.
The Under-Secretary seems determined to close that gap. That is the clear implication of his policy. The regulations are offensive because they impose a contract against the wishes of the majority of Scottish doctors and introduce changes which are not in the best interests of 292 patients. They make Scottish GPs more dependent on a simple head count. They build in a financial incentive to increase list sizes. They mean fewer doctors treating more patients.
The Opposition's interest is the future of the Health Service. Efficient general practice is the necessary foundation for the specialist services that often make the headlines. I fear that the regulations are another illustration of the Government's so-called business approach to patient care taking second place to accountancy practice. For that reason, I invite my right hon. and hon. Friends to oppose them.
§ The Parliamentary Under-Secretary of State for Scotland (Mr. Michael Forsyth)I am astonished at the speech of the hon. Member for Glasgow, Garscadden (Mr. Dewar), who is normally more assiduous in doing his homework on these matters. He said that he had taken a lot of advice. I shall give him one piece of advice. It is certainly correct to say that GPs in Scotland enjoy smaller list sizes than doctors south of the border. One reason is the fact that, since 1979, under the Government, the number of GPs in Scotland has been increased by 14.9 per cent. The number of women doctors has been increased by about 60 per cent. Under the Conservative Government, average list sizes have fallen from 1,856 to 1,605. If we enjoy the benefits of smaller list sizes, it is because the Government have provided more doctors.
§ Mr. ForsythThe hon. Gentleman says that they have always been small. In 1979, the average list size was 1,856.
§ Mr. ForsythIn 1988, it was 1,605 because of the increase in the number of doctors that we provided.
§ Madam Deputy Speaker (Miss Betty Boothroyd)Order. The Minister appears not to be giving way.
§ Mr. ForsythThe hon. Member for Garscadden should take account of that fact. He has asked whether this will continue. The answer is yes. We will continue to increase the number of general practitioners. How can the hon. Gentleman argue that average list sizes will have to increase when he knows that the Government are committed to increasing the number of GPs and to increasing expenditure on these primary care services while the population remains broadly static? Elementary mathematics would enable anyone to determine that, in those circumstances, average list sizes cannot increase. I hope that the hon. Gentleman will now withdraw his accusation.
§ Mr. ForsythWill the hon. Gentleman explain how it is possible to increase the number of GPs—
§ Mr. Robert Hughes (Aberdeen, North)Will the hon. Gentleman give way?
§ Mr. ForsythI am addressing my remarks, through you, Madam Deputy Speaker, to the Front-Bench spokesman—the hon. Member for Garscadden—who said that 293 average list sizes will have to increase. If we are going to increase the number of GPs and the population remains broadly static—everyone agrees that it will—how is it possible to argue that average list sizes will increase?
§ Mr. DewarI am fascinated by the Minister's comments. Obviously, we will see what happens over the next year or two. If the hon. Gentleman is saying that no incentive is being built into the scheme to increase list sizes, he is the only person in Scotland who thinks so. He is used to being the only person in Scotland who thinks certain things. We have had to put up with that for a long time. Even the Secretary of State does not usually think the same things as the hon. Gentleman. The truth is that that incentive is being built in. If there is not the increase in list sizes that we predict, we will be in the odd position that the Minister's plans clearly have not worked as he intends.
§ Mr. ForsythOn the contrary. The hon. Gentleman has changed his ground. He started off by arguing that the average list size would increase. The Hansard account will show that. He is now arguing that there will be an incentive for doctors to attract patients. That is entirely different from arguing that the average list size will increase. The hon. Gentleman cannot argue that the average list size will increase if the number of doctors will increase. The Government have increased the number of GPs in Scotland every year by about 100 and we plan to continue to do so.
The hon. Gentleman said that we shall see what happens in a few years. I take that as a tacit admission that his assertion about the average list is incorrect.
§ Mr. Robert HughesDuring the summer, I had occasion to visit a GP in Aberdeen as a result of a minor dietary indiscretion. He told me that the principal in the practice had retired, and that if he had known the Minister's plans, he would not have replaced the principal but carried on with fewer doctors. That is how list sizes will rise. Doctors will not be replaced. The Minister's fond claims that the number of GPs will increase will be found to be a gross overstatement.
§ Mr. ForsythI hear what the hon. Gentleman says, but his constituent was making the same mistake as the hon. Member for Garscadden. He is making a judgment, but no hon. Member, me included, and no doctor, knows what the result of the new contract will be for incomes. The contract will be priced not by the Government but by the doctors and dentists review body on the basis of evidence that the Government will give to it.
We have made it perfectly clear that the purpose of the contract is to encourage doctors to extend their range of services, and to ensure that those who provide screening and meet their targets, who encourage their patients to come for check-ups and who provide additional services such as day surgery will be rewarded for doing so. I do not know what kind of service the constituent of the hon. Member for Aberdeen, North (Mr. Hughes) provides, but many GPs in Scotland provide exactly the type of service that we want to encourage. They are the doctors who turn out in the middle of the night. The hon. Member for Garscadden was kind enough to acknowledge that there are many attractive aspects of the contract. There are doctors who are available at weekends and those who provide day surgery services. They are not sufficiently 294 rewarded for providing such extra services, and the contract will enable them to benefit in a way that has not been possible in the past.
§ Mr. Allan Stewart (Eastwood)How many hours per week does the average Scottish general practitioner work?
§ Mr. ForsythThere is no such thing as an average general practitioner, but some figures have been done as a result of the work study. If my hon. Friend will bear with me, I shall come to them later in my speech.
§ Mr. William McKelvey (Kilmarnock and Loudoun)There are average budgets.
§ Mr. ForsythThere are indeed average list sizes and budgets. I said that there is no such thing as an average GP. Each GP provides a range of services that are considered appropriate to his or her patients. The contract will reward most those doctors who do most for their patients, and encourage patients to choose their doctors.
The hon. Member for Garscadden was good enough to say that the retention of the Scottish rural practices fund will make a difference to doctors in Scotland. I think that I am entitled to observe that the contract was negotiated on a United Kingdom basis—Scottish doctors were not prepared to negotiate on a Scottish basis—and my right hon. and learned Friend was able to get the contract amended to reflect Scottish circumstances, including a reduction in list sizes required to qualify for basic practice allowance and changes, which are unique to Scotland, to reflect the position in rural and deprived areas. The pricing of the Scottish rural practice fund is a matter on which we shall be giving evidence to the doctors and dentists review body.
§ Mr. Archy Kirkwood (Roxburgh and Berwickshire)That has nothing to do with the Minister.
§ Mr. ForsythThe hon. Gentleman is right to say that it has nothing to do with me. I should have thought that he would have been reassured rather than alarmed by that. I should have thought that the hon. Gentleman would be pleased that such a body will price the contract and look at the position. I should have thought that the hon. Gentleman would also give some credit to Ministers for having secured that. He wrote to me about the matter and has been prepared to discuss it in correspondence.
The hon. Member for Garscadden and I can perhaps agree to acknowledge the importance of the Scottish rural practice fund. I hope that he acknowledges that it will help doctors in rural areas. What will, of course, eventually matter is the weighting that is applied and the sums of money involved—if one is concerned with incomes rather than patient care.
§ Mr. DewarIt is pleasant to have the Minister being so pleasant to me, although it is also rather worrying. He has said that he will give evidence so he must know what his Department is pressing for in this matter. Will he confirm that the evidence will be made public? What advice does he think that he will be offering to the pay review body on this matter?
§ Mr. ForsythIt is amazing how, in the past, our evidence to review bodies has become public, whether on a voluntary or involuntary basis. On the principle at stake, both my right hon. and learned Friend the Secretary of State and I have said repeatedly that the purpose of the 295 contract is to ensure that doctors who provide the services that we wish to encourage benefit from it and that doctors who work in rural areas, perhaps with smaller list sizes, should not suffer. Our evidence to the review body in respect of doctors in rural areas and doctors in deprived areas will reflect that.
The hon. Member for Garscadden also asked me about the position—
§ Mr. Robert HughesThe Minister does not know.
§ Mr. ForsythThe hon. Member for Aberdeen, North may say that I do not know, but in fact we shall say that we wish to secure a contract which ensures that doctors who are providing those services benefit as they have not done in the past. The hon. Member for Garscadden has doctors in his constituency who do that and he should be pleased that they will be in that position.
The hon. Member for Garscadden asked me about deprived areas and, rightly, pointed out that there were substantial areas of deprivation in Scotland, and problems of poor housing—many of them exacerbated by municipal Socialism, I might add. He says that there are problems that have an impact on the work load of GPs, and that is true. The capitation will be weighted to take account of that.
The hon. Member for Garscadden also pressed me on how that will be done. It will be done on the basis of Jarman indices and we are currently discussing with the Scottish General Medical Services Council the most appropriate way to achieve that. As with the genesis of the contract, I want very much to proceed on the basis that in Scotland we take the advice and help that are available to us from the SGMSC. We do not always come to the conclusions that it would like, but we are entitled to say that the so-called "tartan contract" went a long way towards meeting its needs.
§ Mr. DewarI appreciate that the Minister is being helpful and has given an interesting response. I do not want to pin him down to specific figures because that would be unfair when negotiations are in train. Would it be fair to say that the Jarman indices suggest a figure of between 15 per cent. and 20 per cent. of the total coming to Scotland?
§ Mr. ForsythThe hon. Gentleman begs the question. He has no doubt studied these matters carefully so he will know that the key question is whether one goes for a figure of 20 per cent., 30 per cent. or 40 per cent.—I had better say a number of figures so that people do not latch on to a particular one—of the Jarman indices to define the level of deprivation. That is one point that is being considered at present. The other matters on which we need to be satisfied is that those indices will operate effectively within Scotland, and we are moving towards that.
I would be happy to consider establishing a committee drawn from various interests, as we have done successfully with the rural practice fund, to consider the implementation of this matter. I hope that I have answered as well as I could all the points made by the hon. Member for Garscadden.
My hon. Friend the Member for Eastwood (Mr. Stewart) asked me the average number of hours worked by GPs in Scotland. The figure from the 1985–86 work load survey 296 showed that 38 hours per week were worked—[Interruption.] Opposition Members seem surprised, but that is the figure and there has been no disagreement about it.
The contract will ensure that services are more responsive to consumers' needs and that we raise standards of care, promote health and prevent illness, give patients the widest range of choice in obtaining high-quality primary care services, enable clearer priorities to be set for the family practitioner services in relation to the rest of the NHS and reward those doctors who do most for their patients by providing the good-quality services that we all want.
§ Mrs. Margaret Ewing (Moray)Is it not the case that the new idea of paying a certain amount according to the percentage of immunisation and cervical cytology may penalise the doctor working in a difficult area who tries extremely hard to persuade people to come forward for immunisation or cervical cytology? I am thinking particularly of inner-city areas where there is a high mobility within the population and doctors have great difficulty reaching the 50 per cent. mark that has been set, particularly for cervical cytology.
§ Mr. ForsythThe hon. Lady refers to a difficulty that we identified in our discussions in Scotland—which is why we opened up the possibility of the staging of target payments. I opened a health centre in Pollok, Glasgow—the sort of area the hon. Lady is thinking of—which had achieved immunisation targets in excess of 98 per cent. It had done so because it had made that goal a priority. I do not doubt that it is much harder to achieve success in some areas than in others. However, as I have just explained, in those areas where it is harder, because of the weighting on capitation to reflect deprivation, doctors will receive remuneration in addition to that which they would receive as a result of achieving their targets.
The hon. Lady will also know that there have been anxieties about achieving the targets for cervical cytology because of, for example, patients who may have had hysterectomies. But allowance has been made for them.
At the margin we can demonstrate that the Government have taken a flexible view, but it cannot be wrong to set as targets for Scotland—as we have done for immunization—World Health Organisation targets which have been set for developing countries. It must be right and in the interests of overall health care that those targets are achieved in Scotland.
The remuneration of GPs in Scotland has increased dramatically under this Government. The average total remuneration went up by 37.2 per cent. ahead of inflation to £67,066. The net remuneration—perhaps the best figure to consider—is up by 22.3 per cent. ahead of inflation to £31,105. In Scotland, the number of doctors has risen since 1979 by 15 per cent. and the number of women unrestricted principals by 61 per cent., with average list sizes dropping. Our existing plans for expenditure of £525 million in the current year, rising to £560 million in 1990–91, and £610 million in 1991–92, stand. No doubt a further announcement will be made as part of the 1989 public expenditure survey.
The contract is the logical outcome of our decision to promote better health. I commend the regulations to the House and ask for their endorsement.
§ Madam Deputy SpeakerOrder. At this reasonably early stage, I should let hon. Members know that there is a lot of interest in this debate. I appeal for short speeches so that I can call most of the hon. Members who wish to take part.
§ Mr. Michael J. Martin (Glasgow, Springburn)As late as 6 o'clock this evening, I got in touch with the local general practitioner in Springburn, Dr. Henry Bruce, and he told me that he does not know a GP who wants the Minister's contracts. That should he put on the record. Dr. Bruce also told me that, although these contracts are to be implemented in April, not a doctor in Scotland knows what remuneration he will get. The Minister tells us that there will be more doctors. Why is it that, in the Springburn-Possilpark area, health boards have refused to replace three doctors who have retired? That is not consistent with what the Minister is saying.
The Minister keeps talking about practice budgets.
§ Mr. Allan StewartHe did not mention them.
§ Mr. MartinHe may not have mentioned them tonight, but the hon. Gentleman knows that the Minister has often, in correspondence with doctors in my constituency, quoted the cash budget. The Minister knows that only 6 per cent. of the practices in my constituency will benefit from this budget, because only 6 per cent. have 11,000 patients. That is the type of GP service that the Minister wants—big practices with nine doctors. That is not consistent with the personal care he talks about. He wants practices that have been in the city of Glasgow for generation after generation, passed down from father to son and now from father to daughter, to disappear, to be replaced by these big practices.
The hon. Member for Moray (Mrs. Ewing) spoke of smear tests. For one in every 10 smears taken, a fee is granted, and that fee can cover the other nine tests. Under the new proposals, it is unlikely that doctors will get a payment.
What is the Minister talking about when he speaks of special clinics? We are talking about general practitioners who are prepared to give a comprehensive service, so that, if a patient comes in complaining of a headache and high blood pressure, that will be attended to. The Minister wants the GP to become involved in an exclusive service, with the result that one practice will specialise in high blood pressure, and others in other illnesses. That could cause patients to leave the practice that they have been going to for many years.
The Minister knows that there have been cases in Glasgow, and other urban areas, of drug addicts calling doctors out on bogus calls and ambushing them. Some have been seriously assaulted. This happened to a Doctor Turner in Springburn. With all its faults, at least the deputising service means that in these areas, a deputising doctor can turn up with a driver, who can have the engine running so that, if there are any difficulties, they can get out quick. That is an unfortunate aspect of the society in which we live, but we have to be realistic.
It is insulting that the Minister is prepared to offer a GP three times the amount of money to go to one of his patients that a deputising doctor will get. I do not see the logic in that. I should like to see my doctor fresh from his 298 surgery in the morning, and if I needed a doctor in the middle of the night, I would prefer to get a deputising doctor for that reason. The Minister knows that safety factors must be looked into in the different areas of Glasgow.
I finish by referring briefly to the deprivation allowance, Madam Deputy Speaker, because I am mindful of your earlier remarks. How will the Minister draw boundaries in any city in Scotland? In some of the most deprived areas of Glasgow, there are also the most beautiful streets where well-off people live, and the reverse is also true—there are well-off areas with streets that have serious social problems. How is the Minister going to set about allocating a deprivation allowance in such a situation?
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§ Sir Hector Monro (Dumfries)I am glad that we are reaching a conclusion tonight in considering these contracts because it is the end of a sad story of misinformation and misunderstanding. I know that in my constituency patients have been left in the fear that they might have a reduced medical service. That is quite incorrect. They believed, too, that general practitioners could not prescribe the required drugs; that general practitioners might send patients to hospitals far from home; and that the number of general practitioners would decrease. However, my hon. Friend the Minister has proved tonight that that is certainly not true.
I am not surprised that, on account of all this misinformation, there was a flood of letters to many hon. Members. Patients were reacting to leaflets published by the British Medical Association and to advertisements in their local papers, which left a great deal to be desired.
General practitioners have an important role to play in the National Health Service. I wish to pay a tribute to family doctors and their staffs for the hard work that they put in, often in inclement weather in the winter. Their work is of a high standard. The new National Health Service reforms and these doctors' contracts will make it an even better service.
There will be more doctors—it is quite wrong for the Opposition to imply that that is not the case, because we know that the number of doctors has increased enormously under the present Government, as has the number of nurses, dentists and other specialists.
It is right that that excellent service should be rewarded. As has been said, pay is fixed by the doctors and dentists review body. My hon. Friend the Minister stated that the average gross remuneration is about £67,000, which is 37 per cent. up in real terms since 1979. We know that there are heavy costs in any practice and that the target income or the net average return is certainly considerably less. I understand that it is about £31,000, with huge variations depending on the capitation fees. In any event, the increase in salary is certainly about 22 per cent. in real terms.
As my hon. Friend stated, in Scotland we also take into account the rural practice fund—and all credit to my right hon. and learned Friend the Secretary of State for Scotland for negotiating that so satisfactorily in the spring. There is also an allowance for general practitioners who work single-handed in isolated areas.
Thus, the contracts have many benefits for general practitioners. In the future, doctors will be paid for minor surgery, for child health surveillance and for health promotion clinics—all very good things. They will have 299 financial incentives to maximise childhood immunisations and, of course, screening for cancer, to which we all attach great importance.
The system of target payments has already been mentioned. I think that it is perfectly fair that we set a high target of 70 to 90 per cent. for children and 50 to 80 per cent. for women. Those are the World Health Organisation's targets and I believe that in a country that has prided itself for years on its medical care, we should set our targets as high as possible. There will be a post-graduate education allowance, we have discussed the deprivation supplement and there will be more money for the capitation fee.
In view of the criticisms that were expressed in the early spring and summer, it is important to note the benefits for women doctors. I was glad to hear the Minister say that the numbers of women doctors were up by 60 per cent. The new part-time arrangements will enable women doctors to contract to work half time or three-quarters time, and we can look forward to having many more part-time women doctors employed in practices in Scotland.
§ Mrs. FyfeDoes the hon. Gentleman believe that women doctors want to work part time on such contracts? Has he not noticed the views of women doctors who are bitterly opposed to the new contract?
§ Sir Hector MonroThat does not add to the debate—[Interruption.] We have 60 per cent. more women doctors and they are being given opportunities to work on a part-time basis. I should have thought that women doctors would appreciate that. As the Minister said, we are also giving higher rates for personal night visits and for the encouragement of students.
There has been a great deal of misinformation about the practice budget. The hon. Member for Glasgow, Garscadden (Mr. Dewar) pointed out that it was voluntary for practices of 11,000 or more patients. The important point is that it is voluntary, so that nobody need feel that that form of auditing must be undertaken.
The misinformation about prescribing has been extremely annoying. It was suggested that doctors would run out of money and would not be able to prescribe what they felt was clinically essential. They will not run out of money. They will be able to prescribe whatever they consider to be necessary up to £5,000, after which they will seek authority from the area health board, which I am sure will be forthcoming. It was wrong for patients to be given the impression that doctors might run out of money and be unable to prescribe what they required.
Under the new arrangements, there will be many advantages for patients. Doctors will be available at times which suit them and it will be easier to change doctors if necessary, although I hope that that will not often be so. Elderly patients will be entitled to regular checks from 75 years of age, there will be more immunisation and preventive medicine and local facilities will be much better advertised—[Interruption.] It is surprising that Opposition Members are not taking this matter seriously. This debate is concerned with the health of the people of Scotland. The Government's proposals will do much to raise the standard of health care in Scotland and will provide more chiropodists, physiotherapists and other specialists.
300 All in all, this will prove to be a good contract for doctors and patients. Doctors should be better off if they provide a better service. We should encourage them to accept the contract with more enthusiasm than they have shown—[Interruption.] I do not know why the hon. Member for Garscadden finds this amusing. The health budget for Scotland this year stands at £2,797 million, far more than ever before, and I am confident that it will be increased when we hear tomorrow about public expenditure. We can expect a better health service than we have enjoyed before, and certainly better than we ever had when Labour Members were in power.
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§ Mr. Archy Kirkwood (Roxburgh and Berwickshire)It is deeply unfortunate that we are required to debate the regulations in such a short time. I am not criticising anyone for speaking for too long, but these are extremely important matters. I am sure that there is real frustration on both sides of the Chamber that there is so little time available to us.
I accept that there are benefits under the new contract. Anyone who did not recognise that would be daft. I accept also that there is a need for change. Since 1966, when the previous substantial reform took place, many things have changed. It is proper that the Government should consider afresh the position that now obtains.
I do not attribute any direct link to Scottish Office Ministers, but Ministers have behaved scandalously nationally in introducing imputations and insinuations against general practitioners. They have sought to advance an argument on the basis of doctors' pay, and that is wrong. The GPs to whom I have spoken are more concerned about the provision of patient care than the provision of their income.
Some profoundly damaging consequences could flow from the changes that are being introduced if some of the worst fears that are being bruited by GPs and their representatives in Scotland come to pass. The new regulations could dramatically increase practice income. I listened with care to what the Minister said about more money being spent and more money being provided. I understand the difficulty about average lists, for example, and I agree with him that the decrease in the length of waiting lists and the increase in the number of doctors are welcome. My constituency, which is in the borders, has benefited from both trends since 1966.
However, that is not an argument that the Minister should adduce in favour of the Government and their regulations. After all, Governments of both complexions have moved in those directions. The average list in the borders is 1,450; the Scottish average is 1,650. The percentage of income that is generated by the capitation fee is about 29 per cent., which becomes about 55 per cent. of future income. I do not see how doctors' incomes can do anything other than plummet. The Minister says that that the Government will pay for more doctors, for example, but doctors cannot obtain more patients in the Monynut valley, the Ettrick valley or in other rural practices. No matter how good, persuasive or outward-going a GP might be in an area such as my constituency, and no matter how he responds to the Government's blandishments to improve his performance, he will not get more skulls to 301 treat. That is an unfortunate phrase. I would prefer to say that the individual GP will be unable to find more patients on which to lavish his loving and tender primary care.
How will the Minister's formula work in a constituency such as mine? How will it work in other rural areas? The hon. Gentleman suggested that the rural practice fund and inducement practice payments will bridge the gap, and it was on that issue that the hon. Member for Glasgow, Garscadden (Mr. Dewar) asked a fundamental question. The money put into the rural practice fund must increase, or the fund will diminish, there will be early retirements and women doctors will move on, as they are sometimes obliged to do because they get married and they move with their families. The net result must be a reduction in the number of doctors who are available. I have studied these matters as carefully as most, and I am expressing the views of GPs. The Minister shakes his head, and I trust that when he replies to the debate he will explain where I am wrong.
The importance of the deprivation index should be underlined. A Scottish weighting is essential if we are to make sense of the provision for the central industrial belt. Another issue, perhaps at a more subsidiary level, is the fear that the GPASS software that has been developed in Scotland and is serving extremely well, will not measure up to the new requirements of information technology throughout the United Kingdom. It would be a retrograde step if GPASS were to be thrown out with the bathwater in the rest of the United Kingdom. I hope that the Minister will give us an assurance on that when he replies.
§ Mr. Allan Stewart (Eastwood)I hope that the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) will forgive me if I do not follow his points because of the shortage of time.
The hon. Member for Glasgow, Garscadden (Mr. Dewar) said that a large number of his hon. Friends wanted to speak in the debate, roared on by the hon. Members for Glasgow, Springburn (Mr. Martin) and for Kilmarnock and Loudoun (Mr. McKelvey)—the only two Opposition Members present at the time.
I am grateful to my hon. Friend the Minister for responding to my question and providing a number of important statistics. Of course the quantity of services provided by GPs varies; there is no reason why it should not. The trend of Government thinking rightly aims at providing incentives to improved services. That is common ground in the House.
There is much to be commended in the new contract—the increasing availability of doctors, the fact that it will be easier to change doctors, the check-ups for elderly patients, and so on. It must be right that there will be financial incentives to doctors to maximise childhood immunisation and screening for cancer of the cervix. It is also right that GPs working in deprived areas should receive a deprivation supplement, about whose calculation the hon. Member for Garscadden asked a number of questions.
My first question is perhaps a minor one. The age targets are different in England and Wales and in Scotland. The age range quoted in the English contract is 25 to 64, but the age range in Scotland is 20 to 60, and I am not sure why. Can my hon. Friend explain that?
302 Secondly, doctors in my constituency have expressed their concern about the difficulties of meeting targets for cervical cytology in some areas, not because these areas are deprived but because of large ethnic minorities who might not be prepared, for religious, social and historical reasons, to come forward for such screening.
Thirdly, the success of screening programmes such as those for cervical and breast cancer depend strongly on working from an adequate database. Can my hon. Friend assure the House that the database is good enough?
The Labour party is absurdly hypocritical to criticise the Government's record on women doctors. Certainly, many of them want to work part-time, but there are 60 per cent. more women doctors in Scotland now than there were under the last Labour Government.
§ Mr. William McKelvey (Kilmarnock and Loudoun)We and the people of Scotland revere most doctors as caring and sympathetic people who are motivated not by profit but by job satisfaction. The Secretary of State for Health thinks that they are motivated by profit; or perhaps he thinks that they are as thick as he believes the rest of the Scots are.
As eight out of 10 GPs have rejected the new contract, it must be fundamentally wrong, despite assurances to the contrary from the Minister this evening.
The Minister has already agreed that the issue of cervical cytology is difficult for the Government to explain. My information is that GPs are paid, per item of service, for cervical smears done once every five years on women between the ages of 36 and 60. They receive no payment for most of the smears that are done now. Even with active screening campaigns, few practices in inner cities and in areas such as Kilmarnock, in which there are no ethnic minorities, ever achieve a take-up rate of more than 50 per cent.
The proposed changes rely on target figures being reached, and if less than 50 per cent. of the target figure is reached, no payment will be made, making it completely impractical for many practices to do any smears. That is the great danger that we want to point out on behalf of the GPs who write to us.
Again, that will affect the poorer areas, not the ethnic minority areas, where the uptake rate is always much lower, not because the women form an ethnic minority but because many of them do not have time for a smear because they have so much trouble worrying about how they will meet the next poll tax bill and look after their children with no increase in the family allowance.
The low uptake rate is not just a Scottish phenomenon: it is the same in poorer English areas. For example, a recently published survey by Wendy Savage, consultant gynaecologist at the London hospital, showed that only one in 10 women surveyed in the Tower Hamlets area of London fully understood that the purpose of the smear test was to identify pre-cancerous cell changes for the purpose of eliminating them. Worse still, seven out of 10 women believed that the smear test would detect fully developed cancer and did not present themselves for testing because they believed that it would only confirm their worst fears, not save their lives. That situation is mirrored in the poorer areas of Scotland.
The imposition of such targets will not only not tackle the scandal of more than 2,000 completely preventable 303 deaths from cervical cancer every year in the United Kingdom, but is likely to lead to an increase, and that is something that the Minister will have on his conscience. Scotland, with its many poor areas, is likely to bear a disproportionately high percentage of the 2,000 deaths. Since figures are not readily available, I hope that the Minister will collect them to show whether Scotland is affected disproportionately.
The situation will be made worse. A GP is meant to achieve 60 per cent. of a given target in order to receive payment. Does the Minister have any idea how difficult that will be to achieve in an area which could not possibly be described as poor or ill-informed, let alone the areas that have previously been described as poverty-stricken?
In one part of my constituency, Darvel, not a poor area, where local GPs decided on a highly intensive campaign to persuade 173 women to have a cervical smear test, despite a real blitz, only 110 attended for testing. If I am not mistaken, that is the bare minimum of 60 per cent. required before payment is made, and that is in an area of many well-informed—dare I say, middle-class—people.
I hope that that example amply shows that targets will not mean great preventive health care, but less and less, particularly in areas of medicine in which the risk of death should have been eliminated long ago.
There are areas that might benefit from the Minister's plans, but they will be the well-informed, middle-class areas and I am really concerned about the extremely poor people who are least likely to be served by such an ideology.
§ Sir Nicholas Fairbairn (Perth and Kinross)My hon. Friend the Minister should consider the point made by the hon. Member for Kilmarnock and Loudoun (Mr. McKelvey) on whether the cytology figures can be achieved. That is an important point which requires study.
The Opposition are clearly in a difficulty tonight. First, they have to admit that Scotland has an infinitely better Health Service, and an infinitely better share of medical expenditure per capita, than in England. They cannot tell us that in England there are not deprived areas, and so on.
What is the justification for our having such an enormous benefit that others do not have. Why are the Opposition and the medical profession so ambitiously resistant to any improvement for patients in Scotland and in the Health Service? The variety of services available, whether in rural practice, hospitals or urban practice is vast. What we want to see is encouragement so that the patient is given a better service everywhere. I find it profoundly depressing that the medical profession has consistently set its face against the possibility of improvement. I fear that there may be times when its members feel that the good of the patients is not as important as that of the doctors.
As we move towards spending money more effectively and improving medical services, I find it extraordinary that the Opposition should object to our proposals to try to restrict the amount spent on drugs. When did they suddenly become the promoters of the international drug companies that are ripping off patients—for that, effectively, is what they are doing? When did the Opposition suddenly decide that they wanted such 304 companies to make bigger profits at the expense of patients? I should have expected them to say, "Hurrah for the contract: thank goodness, the patients will benefit and the international drug companies will not."
That is just one of the hypocrisies of the Opposition. The Minister has proposed a contract that would give vast benefits to patients. We in Scotland should be far more concerned about them than about those who ought to be proud to serve them—those who have taken the Hippocratic oath, and should abide by it.
§ Mrs. Margaret Ewing (Moray)The hon. and learned Member for Perth and Kinross (Sir N. Fairbairn) should. I think, have the modesty to read some of the articles that define the problems of the Scottish health service. I recommend the article in volume 299 of the British Medical Journalof 7 October this year, which was mentioned by the hon. Member for Glasgow, Garscadden (Mr. Dewar). It was written by Vera Carstairs and Russell Morris, and based on research funded by the chief scientist of the Scottish Home and Health Department.
If that does not convince the hon. and learned Gentleman of the need for improvement in the Health Service in Scotland, perhaps he would like to read the report by the alternative Select Committee on Scottish Affairs, and to note the references made in it to Glenn and Hulbert. He can have it for the reduced rate of £1 per copy; I think that he will find it useful bedtime reading.
Many GPs and others interested in the Health Service will find it difficult to believe the Minister's assertion that GPs work only 38 hours per week. I find it amazing that he can say such a thing as though there were no possibility of contradiction: indeed, he himself was contradicting all the evidence from GPs. I understand that they work an average of 73 hours per week, of which 30 are spent providing general medical services; in addition, they are on call and have other health-related responsibilities.
Let me deal next with the vexed question of list sizes, and the role of women GPs—as a female Member of Parliament from Scotland, I should like to say something about how the legislation is likely to affect them. The new predictions for list sizes show a move away from allowances. Practices have always been attracted by the idea of employing a woman GP as a partner on a 20-hour-per-week basis, because she will put various allowances into the kitty. Generally, though not always, those women have been involved in obstetric, gynaecological and antenatal practice, and have played a fundamental role. As a result of the contract, they seem to be faced with alternatives: increasing their hours of work to 26 per week or taking on a new contract. Both will have deleterious effects on their family life. Women GPs often work only 20 hours a week because of their family commitments, but they bring that particular facility to the practice.
The Minister was right to refer to the large increase in the number of women GPs working in Scotland and elsewhere in the United Kingdom. We welcome that increase, but I must point out to him and to the hon. Member for Eastwood (Mr. Stewart) that the new contract could reverse a trend that is attracting women GPs into general practice. The Government argue strongly in favour of people being given a choice, but they could restrict their choice because many patients wish to have a woman doctor.
§ It being half-past Eleven o'clock, MADAM DEPUTY SPEAKER put the Question, pursuant to Standing Order No. 15 (Prayers against statutory instruments, &c. (negative procedure)).
§ The House divided: Ayes 174, Noes 212.
308| Division No. 409] | [11.30 pm |
| AYES | |
| Alton, David | Hattersley, Rt Hon Roy |
| Anderson, Donald | Haynes, Frank |
| Archer, Rt Hon Peter | Henderson, Doug |
| Armstrong, Hilary | Hinchliffe, David |
| Barnes, Harry (Derbyshire NE) | Hogg, N. (C'nauld & Kilsyth) |
| Barron, Kevin | Home Robertson, John |
| Beckett, Margaret | Hood, Jimmy |
| Bell, Stuart | Howells, Dr. Kim (Pontypridd) |
| Benn, Rt Hon Tony | Hoyle, Doug |
| Bennett, A. F. (D'nt'n & R'dish) | Hughes, John (Coventry NE) |
| Bermingham, Gerald | Hughes, Robert (Aberdeen N) |
| Boateng, Paul | Hughes, Roy (Newport E) |
| Boyes, Roland | Hughes, Simon (Southwark) |
| Bray, Dr Jeremy | Illsley, Eric |
| Brown, Gordon (D'mline E) | Ingram, Adam |
| Brown, Nicholas (Newcastle E) | Jones, Barry (Alyn & Deeside) |
| Brown, Ron (Edinburgh Leith) | Jones, Martyn (Clwyd S W) |
| Bruce, Malcolm (Gordon) | Kaufman, Rt Hon Gerald |
| Buckley, George J. | Kirkwood, Archy |
| Caborn, Richard | Lamond, James |
| Callaghan, Jim | Leadbitter, Ted |
| Campbell, Ron (Blyth Valley) | Leighton, Ron |
| Campbell-Savours, D. N. | Litherland, Robert |
| Canavan, Dennis | Livsey, Richard |
| Carlile, Alex (Mont'g) | Lloyd, Tony (Stretford) |
| Clark, Dr David (S Shields) | Lofthouse, Geoffrey |
| Clay, Bob | Loyden, Eddie |
| Clelland, David | McAllion, John |
| Clwyd, Mrs Ann | McAvoy, Thomas |
| Coleman, Donald | McCartney, Ian |
| Cook, Frank (Stockton N) | Macdonald, Calum A. |
| Cook, Robin (Livingston) | McFall, John |
| Corbett, Robin | McKelvey, William |
| Corbyn, Jeremy | McLeish, Henry |
| Cousins, Jim | McWilliam, John |
| Crowther, Stan | Madden, Max |
| Cryer, Bob | Mahon, Mrs Alice |
| Cummings, John | Marek, Dr John |
| Cunliffe, Lawrence | Marshall, David (Shettleston) |
| Darling, Alistair | Martin, Michael J. (Springburn) |
| Davies, Rt Hon Denzil (Llanelli) | Martlew, Eric |
| Davies, Ron (Caerphilly) | Maxton, John |
| Davis, Terry (B'ham Hodge H'l) | Meacher, Michael |
| Dewar, Donald | Meale, Alan |
| Dixon, Don | Michael, Alun |
| Dobson, Frank | Michie, Bill (Sheffield Heeley) |
| Douglas, Dick | Michie, Mrs Ray (Arg'l & Bute) |
| Duffy, A. E. P. | Moonie, Dr Lewis |
| Dunnachie, Jimmy | Morgan, Rhodri |
| Eadie, Alexander | Morley, Elliot |
| Eastham, Ken | Mowlam, Marjorie |
| Evans, John (St Helens N) | Mullin, Chris |
| Ewing, Harry (Falkirk E) | Murphy, Paul |
| Ewing, Mrs Margaret (Moray) | Mellist, Dave |
| Fatchett, Derek | O'Brien, William |
| Field, Frank (Birkenhead) | Orme, Rt Hon Stanley |
| Fields, Terry (L'pool B G'n) | Parry, Robert |
| Fisher, Mark | Patchett, Terry |
| Flannery, Martin | Pendry, Tom |
| Flynn, Paul | Pike, Peter L. |
| Foster, Derek | Powell, Ray (Ogmore) |
| Fraser, John | Prescott, John |
| Fyfe, Maria | Primarolo, Dawn |
| Galloway, George | Quin, Ms Joyce |
| Gilbert, Rt Hon Dr John | Randall, Stuart |
| Godman, Dr Norman A. | Redmond, Martin |
| Gould, Bryan | Rees, Rt Hon Merlyn |
| Griffiths, Nigel (Edinburgh S) | Richardson, Jo |
| Griffiths, Win (Bridgend) | Robertson, George |
| Grocott, Bruce | Rogers, Allan |
| Harman, Ms Harriet | Ross, Ernie (Dundee W) |
| Rowlands, Ted | Wall, Pat |
| Salmond, Alex | Wallace, James |
| Sedgemore, Brian | Wardell, Gareth (Gower) |
| Sheldon, Rt Hon Robert | Wareing, Robert N. |
| Shore, Rt Hon Peter | Watson, Mike (Glasgow, C) |
| Short, Clare | Welsh, Andrew (Angus E) |
| Skinner, Dennis | Williams, Rt Hon Alan |
| Smith, C. (Isl'ton & F'bury) | Williams, Alan W. (Carm'then) |
| Soley, Clive | Wilson, Brian |
| Spearing, Nigel | Winnick, David |
| Steel, Rt Hon David | Wise, Mrs Audrey |
| Steinberg, Gerry | Worthington, Tony |
| Stott, Roger | Young, David (Bolton SE) |
| Strang, Gavin | |
| Taylor, Mrs Ann (Dewsbury) | Tellers for the Ayes: |
| Taylor, Matthew (Truro) | Mr. Allan McKay and Mrs. Llin Golding. |
| Thompson, Jack (Wansbeck) | |
| Turner, Dennis |
| NOES | |
| Adley, Robert | Evans, David (Welwyn Hatf'd) |
| Alexander, Richard | Evennett, David |
| Alison, Rt Hon Michael | Fairbairn, Sir Nicholas |
| Amess, David | Fallon, Michael |
| Amos, Alan | Favell, Tony |
| Arbuthnot, James | Fenner, Dame Peggy |
| Arnold, Jacques (Gravesham) | Field, Barry (Isle of Wight) |
| Arnold, Tom (Hazel Grove) | Fishburn, John Dudley |
| Ashby, David | Fookes, Dame Janet |
| Atkins, Robert | Forman, Nigel |
| Baker, Nicholas (Dorset N) | Forsyth, Michael (Stirling) |
| Batiste, Spencer | Forth, Eric |
| Bellingham, Henry | Fox, Sir Marcus |
| Bendall, Vivian | Franks, Cecil |
| Bevan, David Gilroy | Freeman, Roger |
| Blaker, Rt Hon Sir Peter | French, Douglas |
| Bonsor, Sir Nicholas | Gale, Roger |
| Boscawen, Hon Robert | Gardiner, George |
| Boswell, Tim | Garel-Jones, Tristan |
| Bottomley, Peter | Gill, Christopher |
| Bottomley, Mrs Virginia | Glyn, Dr Alan |
| Bowden, Gerald (Dulwich) | Goodson-Wickes, Dr Charles |
| Bowis, John | Grant, Sir Anthony (CambsSW) |
| Boyson, Rt Hon Dr Sir Rhodes | Greenway, Harry (Ealing N) |
| Brazier, Julian | Greenway, John (Ryedale) |
| Bright, Graham | Gregory, Conal |
| Bruce, Ian (Dorset South) | Griffiths, Sir Eldon (Bury St E') |
| Buck, Sir Antony | Griffiths, Peter (Portsmouth N) |
| Budgen, Nicholas | Grist, Ian |
| Burns, Simon | Hague, William |
| Butler, Chris | Hamilton, Neil (Tatton) |
| Butterfill, John | Hargreaves, A. (B'ham H'll Gr') |
| Carlisle, John, (Luton N) | Harris, David |
| Carlisle, Kenneth (Lincoln) | Higgins, Rt Hon Terence L. |
| Carrington, Matthew | Howarth, G. (Cannock & B'wd) |
| Carttiss, Michael | Irvine, Michael |
| Channon, Rt Hon Paul | Jones, Gwilym (Cardiff N) |
| Chapman, Sydney | Kirkhope, Timothy |
| Chope, Christopher | Knapman, Roger |
| Churchill, Mr | Knight, Dame Jill (Edgbaston) |
| Clark, Dr Michael (Rochford) | Knowles, Michael |
| Clark, Sir W. (Croydon S) | Knox, David |
| Clarke, Rt Hon K. (Rushcliffe) | Lang, Ian |
| Colvin, Michael | Lawrence, Ivan |
| Conway, Derek | Lennox-Boyd, Hon Mark |
| Coombs, Anthony (Wyre F'rest) | Lester, Jim (Broxtowe) |
| Coombs, Simon (Swindon) | Lightbown, David |
| Couchman, James | Lilley, Peter |
| Cran, James | Lloyd, Peter (Fareham) |
| Currie, Mrs Edwina | Lord, Michael |
| Curry, David | Luce, Rt Hon Richard |
| Davis, David (Boothferry) | Lyell, Sir Nicholas |
| Day, Stephen | MacGregor, Rt Hon John |
| Dicks, Terry | MacKay, Andrew (E Berkshire) |
| Dorrell, Stephen | Maclean, David |
| Douglas-Hamilton, Lord James | McLoughlin, Patrick |
| Dunn, Bob | McNair-Wilson, Sir Michael |
| Durant, Tony | McNair-Wilson, Sir Patrick |
| Dykes, Hugh | Mans, Keith |
| Emery, Sir Peter | Martin, David (Portsmouth S) |
| Mates, Michael | Shaw, Sir Michael (Scarb') |
| Maude, Hon Francis | Shelton, Sir William |
| Mawhinney, Dr Brian | Shephard, Mrs G. (Norfolk SW) |
| Maxwell-Hyslop, Robin | Shepherd, Colin (Hereford) |
| Meyer, Sir Anthony | Shepherd, Richard (Aldridge) |
| Mills, Iain | Shersby, Michael |
| Mitchell, Andrew (Gedling) | Sims, Roger |
| Mitchell, Sir David | Skeet, Sir Trevor |
| Monro, Sir Hector | Smith, Tim (Beaconsfield) |
| Montgomery, Sir Fergus | Speller, Tony |
| Morrison, Sir Charles | Spicer, Michael (S Worcs) |
| Morrison, Rt Hon P (Chester) | Squire, Robin |
| Moynihan, Hon Colin | Stanbrook, Ivor |
| Nelson, Anthony | Stanley, Rt Hon Sir John |
| Neubert, Michael | Stern, Michael |
| Nicholson, Emma (Devon West) | Stevens, Lewis |
| Norris, Steve | Stewart, Allan (Eastwood) |
| Onslow, Rt Hon Cranley | Stewart, Andy (Sherwood) |
| Oppenheim, Phillip | Stokes, Sir John |
| Page, Richard | Stradling Thomas, Sir John |
| Paice, James | Sumberg, David |
| Parkinson, Rt Hon Cecil | Summerson, Hugo |
| Patten, Rt Hon Chris (Bath) | Taylor, Ian (Esher) |
| Patten, John (Oxford W) | Taylor, John M (Solihull) |
| Pawsey, James | Taylor, Teddy (S'end E) |
| Peacock, Mrs Elizabeth | Tebbit, Rt Hon Norman |
| Porter, David (Waveney) | Temple-Morris, Peter |
| Portillo, Michael | Thornton, Malcolm |
| Price, Sir David | Thurnham, Peter |
| Raison, Rt Hon Timothy | Townend, John (Bridlington) |
| Renton, Rt Hon Tim | Tracey, Richard |
| Rhodes James, Robert | Tredinnick, David |
| Ridsdale, Sir Julian | Trotter, Neville |
| Rifkind, Rt Hon Malcolm | Twinn, Dr Ian |
| Roberts, Wyn (Conwy) | Vaughan, Sir Gerard |
| Roe, Mrs Marion | Waller, Gary |
| Rossi, Sir Hugh | Ward, John |
| Rost, Peter | Wardle, Charles (Bexhill) |
| Rumbold, Mrs Angela | Warren, Kenneth |
| Sackville, Hon Tom | Wheeler, John |
| Sayeed, Jonathan | Widdecombe, Ann |
| Shaw, David (Dover) | Wilkinson, John |
| Wilshire, David | Young, Sir George (Acton) |
| Winterton, Mrs Ann | |
| Wolfson, Mark | Tellers for the Noes: |
| Wood, Timothy | Mr. Greg Knight and Mr. Irvine Patnick. |
| Woodcock, Dr. Mike | |
| Yeo, Tim |
§ Question accordingly negatived.
§ Mr. Win Griffiths (Bridgend)On a point of order, Madam Deputy Speaker. On 26 October, I received a reply from the Under-Secretary of State for Wales saying that he would place in the Library copies of undertakings for the purpose of section 20(5)(b) of the Water Act 1989 and relaxations granted under regulations 4(1)(c) and 4(2) of the Water Supply (Water Quality) Regulations 1989. Yesterday I was promised that that information would be in the Library today. It still is not there. I seek your advice, Madam Deputy Speaker, on how I can obtain it.
§ Madam Deputy SpeakerThe matter has nothing to do with the business that we are about to consider. Indeed, it has nothing to do with the Chair. I hope that it has been noted by the Department concerned.
§ Mr. Dennis Skinner (Bolsover)Further to the point of order, Madam Deputy Speaker. Today, I heard my hon. Friend the Member for Livingston (Mr. Cook) say that the Government were using the opportunity of Prorogation day to release certain information, without us knowing. The Government said that they had not got the information to the printers on time. Another planted question was raised. It all shows that the Government are now a total shambles—
§ Madam Deputy SpeakerOrder. That is not a matter for the Chair. We must proceed with the business of the House.