Commons Sitting of 14 March 1990

Preamble
The House met at half-past Two o'clock
PRAYERS
[MR. SPEAKER in the Chair]
PRIVATE BUSINESS
  NOTTINGHAM PARK ESTATE BILL [Lords]
  Considered; to be read the Third time.
  STRATHCLYDE REGIONAL COUNCIL ORDER CONFIRMATION BILL
  Read the Third time, and passed.
Oral Answers to Questions
  TRADE AND INDUSTRY

    Business Innovation Centre, Cheshire
    Mr. Butler: To ask the Secretary of State for Trade and Industry what representations he has had concerning the funding of Cheshire's business innovation centre; and if he will make a statement.
    The Minister for Industry (Mr. Douglas Hogg): I have had several representations, including my hon. Friend's, asking for grants from the European regional development fund to be made available to the Cheshire business innovation centre. The centre is eligible to apply.
    Mr. Butler: Will my hon. Friend confirm that there are moneys available at the European level for the business innovation centre? Will he encourage the local authorities to apply for that money, and give the application fair wind?
    Mr. Hogg: It is not a matter for me to adjudicate upon, but moneys are available and I hope that an application will be made. My hon. Friend's urging is of great significance and will be taken into account by those who ultimately make the decision.
    Mr. Hoyle: If an application is made now that moneys are available, will the Minister give it his support in the right quarters in Brussels?
    Mr. Hogg: The application will be considered by the programme monitoring committee. Clearly, the application must satisfy the usual criteria—notably, that it represents good value for money and that there is no duplication. I am sure that those making the application will apply their minds to satisfying precisely those criteria.

    Single European Market
    Mr. Bellingham: To ask the Secretary of State for Trade and Industry what recent representations he has received from engineering companies in Norfolk about the single European market.
    Mr. Douglas Hogg: None, Sir.
    Mr. Bellingham: Is my hon. Friend aware that while Norfolk firms are gearing up for 1992 they are also helping the disabled and handicapped? Perhaps he will join me in paying particular tribute to Bead Engineering, which recently won a Fit for Work award for employing disabled people? Is my hon. Friend further aware that while Norfolk firms will definitely benefit from the Department of Transport's recent commitment to dual the main trunk roads into King's Lynn, they will have to compete on a level playing field in Europe? What steps will my hon. Friend take to ensure that a level playing field exists?
    Mr. Hogg: My hon. Friend played an important part in having the roads of King's Lynn improved and I take this opportunity to congratulate him on his success in that. I have no doubt that he also played a part in ensuring that unemployment rates have fallen by 14 percentage points in the last 12 months. As to the broader issue of a level playing field, my hon. Friend is right to say that the removal of state aids and the provision of level playing fields is an important policy objective.
    Several Hon. Members rose—
    Mr. Speaker: Order. I remind the House that right hon. and hon. Members should ask only one supplementary question, not more.

    Trading Standards Officers
    Mr. Martlew: To ask the Secretary of State for Trade and Industry when he last met representatives of local authority trading standards officers to discuss consumer matters.
    Mr. Maxton: To ask the Secretary of State for Trade and Industry when he last met representatives of local authority trading standards officers to discuss consumer affairs.
    The Parliamentary Under-Secretary of State for Industry and Consumer Affairs (Mr. Eric Forth): I met representatives of local authority trading standards officers on three occasions in 1989 to discuss consumer matters, and my officials have frequent meetings with trading standards officers.
    Mr. Martlew: Is the Minister aware that there is deep concern in trading standards offices and in British industry that the harmonisation of safety laws throughout Europe will mean the dumping of dangerous foreign goods on an unsuspecting British public?
    Mr. Forth: If there is such concern, it is misplaced. Authorities will still have powers to identify any items that are proved to be unsafe and to remove them from the market. That will be against the background of creating the single market and a single, verifiable and viable product safety standard so that consumers throughout

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    Europe can be equally assured of the safety of products on the market place. We shall continue to strive for that objective.
    Mr. Maxton: When the Minister met the trading standards officers, did he discuss with them the compulsory annual recording of car mileages? If he did, does he agree with them that it is an essential means of cutting down on fraud in the car markets? If so, when will he introduce legislation to carry it out?
    Mr. Forth: The answers are no, no and I do not have it in mind.
    Sir Anthony Grant: When my hon. Friend next meets the trading standards officers, will he discuss with them a serious problem which has arisen for small petrol retailers? The trading standards officers have said that pumps must be changed to allow for unleaded petrol by the end of the month, but the manufacturers and installers of the new pumps are unable to meet the demand, largely because they are overworked by the big oil companies. Will the Minister tell the trading standards officers to take things calmly in view of the backlog?
    Mr. Forth: I am slightly surprised that the matter has not been brought to my attention other than by my hon. Friend now. He suggests that I have some powers over trading standards officers. I am sure that the House will be reassured to know that I have no such powers and that the trading standards officers do their excellent work totally independently from the Government. However, I acknowledge the problem that my hon. Friend has described and I will find out what can be done to alleviate it.
    Mr. Holt: Does my hon. Friend agree that, far from Britain being a dumping ground, the stringent laws that have been introduced in Britain for the furniture industry make us unique in Europe so that no European manufacturer can sell in Britain without attaining our standards and we are leading the world?
    Mr. Forth: I am grateful to my hon. Friend for raising that point. I should like it to be more widely understood in Britain that throughout the furniture industry enormous efforts have been made to comply with our high furniture safety standards. I very much welcome that, and I believe that people in Britain can be reassured that they will enjoy the highest standards of furniture fire safety in Europe if not the world.
    Mr. Nigel Griffiths: Is the Minister aware of the public concern over his failure to reappoint Esther Rantzen to the National Consumer Council—[Laughter.]
    Mr. Speaker: Order. I do not think that it is really a laughing matter.
    Mr. Griffiths: I agree entirely, Mr. Speaker. It is far from a laughing matter. Is not the truth simply that the Minister cannot face the criticism that that consumer champion articulates on behalf of millions of people in Britain? Is not she paying the penalty for supporting the Consumer Guarantees Bill which the country and people overwhelmingly want and the Minister implacably opposes? Will he consider reappointing Esther Rantzen to the NCC as part of a Government contribution to world consumer day tomorrow?
    Mr. Forth: I am not aware of the source or the nature of the public concern claimed by the hon. Gentleman. Ester Rantzen has served three terms on the National Consumer Council. That is exceptional in itself and I felt that it was time for new blood and new ideas. Despite the fact that on her programme some three or four weeks ago Ester Rantzen invited people to write to Members of Parliament and to me expressing their public concern about the Bill that the hon. Gentleman mentioned, as of a few days ago I had received only one letter in reply.

    Manufacturing Facilities, Birmingham
    Mr. Roger King: To ask the Secretary of State for Trade and Industry how many overseas-based companies have now established manufacturing facilities in the Birmingham area.
    Mr. Douglas Hogg: To date, some 50 companies have established manufacturing operations in Birmingham. Recent announcements include projects from two West German companies, Kirsten Automotive Ltd and Keiper Recaro, which will be located on the Woodgate business park in my hon. Friend's constituency.
    Mr. King: Is my hon. Friend aware that the growing tide of foreign companies investing in Britain, certainly in Birmingham and the west midlands, is evidence of a strong resurgence of manufacturing capability in the region? Does he further agree that the role of the West Midlands development agency has been a spur to encourage much of that investment and that it is the wish of businesses in the region that that work should continue and increase?
    Mr. Hogg: I entirely agree with my hon. Friend about the West Midlands development agency, and he will know that I have been able substantially to increase the money that goes to that organisation. It must be said that my hon. Friend has also made a considerable contribution to attracting industry to his area. I was extremely grateful to him for his support of the Keiper Recaro project. I greatly valued my hon. Friend's representations, which enabled me to form a clear view of the matter, following which I was able to give the project a grant.
    Mr. Henderson: The Minister will know that, even with the inward investment in the west midlands, which we all welcome, manufacturing investment in the area is lower today than it was in 1979 and that even in high-tech industries, as defined by the Department of Trade and Industry, 10,000 jobs have gone since 1981. What will the Minister tell industrialists and workers in Lichfield in Mid-Staffordshire about Conservative economic policy?
    Mr. Hogg: I will tell them the truth, and they will be mightily impressed by it. Between 1984 and 1988, more than 260 inward investment projects in the west midlands created or safeguarded about 36,500 jobs. While we are talking about investment, I should point out that manufacturing investment in 1989 was 5 per cent. higher than in 1988 and 34 per cent. higher than five years ago. That is the fastest rate of growth in any three-year period since the war. That is what I shall tell them and they will find it very persuasive.

    Avionics
    Mr. David Evans: To ask the Secretary of State for Trade and Industry how much is to be provided by his Department in the form of grant for research into civil aircraft avionics under the first phase of the control technology programme.
    Mr. Doulglas Hogg: I am pleased to say that the Department has offered a grant of £3·88 million for the programme under the civil aircraft and aeroengine research demonstration budget.
    Mr. Evans: I welcome that reply. Is not that just the pump primer that we need to develop digital avionics bearing in mind how necessary that is for the next generation of civil aircraft? Does my hon. Friend agree that that is just what business and the Government should be doing so that we can develop our industry and rebut the Opposition's claims that we do not have an interest in the future redevelopment of our aerospace industry?
    Mr. Hogg: Absolutely—I entirely agree. My hon. Friend is a particular champion of the British aerospace industry and I am grateful to him for that. On the substantive question, pre-competitive collaborative projects are extremely important to the Government and we put a lot of money into them. That is one reason why the aerospace industry is so successful.
    Mr. Jack: Will my hon. Friend ensure that that excellent news is transmitted to the engineering unions, which so recently sponsored a strike in the aerospace industry which damaged the prospects of Airbus Industrie and the future potential for the research that my hon. Friend's Department is funding?
    Mr. Hogg: I shall certainly point out that the Government are showing a commitment to the engineering and aerospace industries which is not always apparent among Opposition Members or in the trade unions.

    Regulatory Obstacles to Business
    Mrs. Gorman: To ask the Secretary of State for Trade and Industry what actions he has taken to remove the regulatory obstacles to business.
    The Parliamentary Under Secretary of State for Corporate Affairs (Mr. John Redwood): The Department of Trade and Industry has a co-ordinating role around Whitehall in deregulation matters. In addition, each of the major Departments has a Minister and officials responsible for deregulation in their own areas. They are charged with the task of reviewing existing regulations to establish whether they can be simplified and reduced and for ensuring that new regulations meet the right standards so that they do not impose an unreasonable burden on business.
    On 21 December 1989, at columns 395–97 of Hansard, the Government listed the deregulation reviews currently under way. I am pleased to tell my hon. Friend that the Department is conducting a series of studies of the problems faced by new businesses trying to establish themselves in particular sectors to see whether further help can be given to them in the form of more deregulation.
    Mrs. Gorman: I thank my hon. Friend for that reply and I applaud his will to do something about the
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    over-regulation of the business community, but is he aware that the DTI still administers 48 quangos with esoteric functions such as the "persons hearing estate agents' appeals" body, and so on? Is he also aware that the section of the Civil Service guide dealing with the ramifications of the Department's interventionist bodies runs to 70 columns? When will those bodies be curtailed?
    Mr. Redwood: My hon. Friend may rest assured that the DTI is extremely keen to reduce unreasonable regulation. We are busy in many areas—for example. in the financial services. Tomorrow we shall take up the powers under the Companies Act 1989 to simplify the financial services regulations, without in any way endangering investor protection. We are also announcing the removal of the need for company seals under the Companies Act. We have set out arrangements for simplified financial statements and we have introduced a great deal of simplification in export licences.
    However, if my hon. Friend knows of specific cases of bodies that she thinks are unnecessary, or whose work could be handled better in some other way, I should be happy to hear of them.
    Mr. Matthew Taylor: As the Minister has referred to so many people involved in trying to help businesses to avoid the problems imposed on them by the Government, has he had any representations about—and is he planning to take action on—the problems caused to small businesses by plans to force them to administer and enforce attachment orders related to poll tax? There is considerable anxiety about the personnel problems as well as the administrative problems that they could cause.
    Mr. Redwood: If I receive representations I will forward them to my colleagues at the Department of the Environment. The burdens on business that the Government impose are modest compared with those that would be imposed by the policies of the Opposition parties. I was interested to see a recent study by Public Policy Consultants, an independent body, which said that if Labour policies were adopted the burdens on business would rise substantially, which would be deleterious to the conduct of business in this country.
    Mr. Grylls: Does my hon. Friend accept that despite his positive answer about the review of the work of the deregulation unit, which is certainly encouraging, there is a need to reduce the considerable hurdles that firms have to overcome when they start up and to prevent new hurdles from being placed in their way? My hon. Friend's Department may be good at preventing such hurdles, but not all the other Departments are so good. Will he therefore keep a vigilant eye on them because that is also part of his task?
    Mr. Redwood: As I explained earlier, the main responsibility lies with each Department and its deregulation Minister to see that its regulations are responsible and reasonable and that the burdens on business are not insupportable. That is what they are doing. Of course my Department will remain vigilant through its co-ordination role, and my hon. Friend is right that particular problems affect small businesses and new businesses. That is why the deregulation unit at the DTI, in conjunction with other Departments, is making a

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    special study of a group of small business start-ups problems to see whether we can cut through still more red tape.
    Ms. Mowlam: Will the Minister explain in what conditions he would use the existing regulatory structure applying to businesses under section 8 of the Company Directors Disqualification Act 1986? We should be interested to know under what conditions he would operate the phrase "public interest" if not in the case of the Fayed brothers and the House of Fraser.
    Mr. Redwood: I have nothing to add to the statement that my right hon. Friend the Secretary of State made on that subject last week, or to my right hon. and learned Friend the Attorney-General's remarks at Question Time. It was made quite clear that my right hon. Friend the Secretary of State had taken into account all necessary matters and had decided that it was not in the public interest to pursue that case.
    Mr. McCrindle: My hon. Friend has referred to the Companies Act 1989 and financial services. Is he satisfied that the whole approach of self-regulation, with its plethora of self-regulatory organisations, continues to operate in the interests of the investor and as expected when the legislation went through the House?
    Mr. Redwood: I think that the 1986 legislation is a major advance on what preceded it. A statutory framework operates through the Securities and Investments Board. I also welcome the fact that the SIB is currently keen to see regulation reduced to the minimum required to meet the necessary standards of investor protection and is working hard on the rule books with the self-regulatory organisations to ensure that that is so. I am also pleased that in the Companies Act 1989 the House passed the provision ensuring that the cost of compliance must be taken into account when forming regulations for financial services.

    Confederation of British Industry
    Mr. Haynes: To ask the Secretary of State for Trade and Industry when he next expects to meet the president of the Confederation of British Industry; and what matters he intends to discuss.
    Mr. Douglas Hogg: I look forward to a continuation of constructive dialogue with the president of the CBI on matters relevant to the well-being of British business.
    Mr. Haynes: Will the Minister take the opportunity to have a word with that dodo of a Secretary of State so that when he meets the CBI he appreciates the CBI's concern about investment in our manufacturing industry? The Government should be forced to help so that industry is competitive. Will he also have a word with the Secretary of State about the serious situation arising out of high interest rates which help to make our industry uncompetitive? The Minister should get his right hon. Friend up off his backside and let us have some industry working in the interests of the nation.
    Mr. Hogg: I look forward to the discussion, as we shall begin by discussing the fact that in the three years ending in 1989 investment increased by around 40 per cent. As I have already said, that is the largest three-year growth since the war. I shall express my pleasure at that and I shall
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    go on to say that no doubt such investment is at least partly responsible for the fact that in the past 12 months unemployment in the hon. Gentleman's constituency has fallen by 30 per cent.
    Mr. Dickens: When my hon. Friend next meets the president of the CBI will he ask him to congratulate his members on producing products that people want to buy, and which are of excellent quality, at competitive prices and are offered with good after-sales service and delivered on time? That is why the industrial base of our country is now outstripping the rest of Europe. We do not need any carping from the Opposition.
    Mr. Hogg: I entirely agree with that. One of the extraordinary things about the Labour party is its willingness to denigrate British industry. I shall certainly congratulate the president of the CBI on the fact that exports are 11 per cent. higher than they were 12 months ago. That is an extraordinary achievement and it is proper to congratulate the CBI on it.
    Mr. Gordon Brown: Now that the Secretary of State has virtually abandoned his responsibilities in relation to City fraud and is also winding down his responsibilities to the regions and even to export services, will the Minister at least wake up to the damage that his 15 per cent. interest rate policy is doing, particularly the 45 per cent. rise in business liquidations reported to the Lord Chancellor? Does he agree that a do-nothing Budget for industry will simply not do and will he urge upon the Chancellor an investment budget for industry and training which will help bring interest rates down?
    Mr. Hogg: You will recall, Mr. Speaker, that, in last Tuesday's debate, I referred to the hon. Gentleman as having made a speech composed of stale jokes and ignorance—on this occasion he left out the stale jokes. The liquidations point is a good example of the hon. Gentleman's ignorance. He seems unaware that there are 60,000 more firms opening each year—that is the difference between the number closing and the number opening. In a dynamic economy there are both closures and new firms starting. At present, there are many more new firms than closures, representing a fourfould increase on the previous 10 years. That is a basic fact. The hon. Gentleman should do just a little more homework, please.

    Hungary
    Mr. Butterfill: To ask the Secretary of State for Trade and Industry what plans his Department has to promote increased trade links between the United Kingdom and Hungary.
    Mr. Redwood: My Department is taking an active interest in promoting trade with Hungary. For example, it is leading trade missions. I led one myself, and last week there was a successful industrial delegation to Hungary. The Foreign Secretary also visited Hungary recently.
    We have established a know-how fund effective from the beginning of April and we have also involved ourselves with our European partners in developing European assistance for Hungary and other eastern European countries. We are making a wide amount of information available through the DTI in London and through Foreign Office posts in the relevant countries and capitals. We are also making information available more generally

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    —for example, through a seminar in May to be led by the DTI, the CBI and the London chamber of commerce, telling British business men about opportunities in Hungary. I am pleased to say that there has already been a vigorous private sector response.
    Mr. Butterfill: I congratulate my hon. Friend on the action that he is taking. Does he agree that Hungary represents excellent investment opportunities for British businesses and that it deserves special recognition as the first eastern bloc country to throw off the shackles of Socialism and to introduce democracy and the beginnings of a market economy?
    Mr. Redwood: It is certainly one of the more promising areas of central and eastern Europe where business opportunities are considerable. That is not just my view but the view of the investing companies of western Europe. Many successful joint ventures have already been created by western companies and some by British companies, which I especially welcome. The Government will, of course, extend the hand of friendship and assistance and ensure that the interests of British businesses are well represented in Hungary and in the other promising eastern European countries starting out on the process of enterprise and democratic reform.
    Dr. Hampson: Can my hon. Friend say whether he prefers, rather than direct investment at this stage, to support management training and the giving of technical assistance? Has he considered approaching British businesses to see whether they would second some of their younger managers to Hungary and other eastern European countries for a period? They could provide much assistance on matters such as marketing and distribution.
    Mr. Redwood: The purpose of the know-how fund is to encourage such links and to help in financing the transfer of know-how. Of course, I would welcome it if British businesses made talented managers available to help in that process. I believe that many will also decide to invest in countries such as Hungary where they will learn for themselves, at close quarters, of the trading conditions and opportunities in that country. British business men are already winning contracts there and I am pleased to announce that Rank Xerox signed a contract last week for £250,000 and has already done £700,000 of business in the year so far. That is a major improvement on the conditions which existed prior to the changes that we are discussing.

    GATT
    Mr. Kirkwood: To ask the Secretary of State for Trade and Industry if he will make a statement on the progress being made in reducing tariff barriers in interventional trade in the current general agreement on tariffs and trade round.
    Mr. Redwood: It has been agreed that participants in the Uruguay round of GATT negotiations should submit offers of tariff reductions by mid-March, to be followed by requests for improvements in others' offers by the end of April. I expect the European Community to offer a reduction of around one third in tariff levels, which is the target agreed by Ministers at the mid-term review of the round. This would be subject to review in the light of offers from others.
    Mr. Kirkwood: Does the Minister accept that for trade to be fair there must be reciprocal openings of other markets in third countries outside the EEC if the international conditions are to be stabilised and made productive for all parties? Does he recognise that the particular interests of the high-quality cashmere industry in the central and border areas of Scotland are vitally dependent on getting access to those new markets? Will he give the House an assurance that the special interests of the high-quality hosiery industry in those areas will be taken into account when negotiating the final EEC mandate for the GATT talks?
    Mr. Redwood: The hon. Gentleman is right. There needs to be reciprocal action by all parties to the GATT discussions so that there is progressive market opening on both sides. There is major asymmetry in current tariff levels with Japan at 2·5 per cent. and the European Community at 5·5 per cent. on average for industry, whereas India and Brazil are at 135 per cent. and 45 per cent. respectively.
    I can give my hon. Friend a pledge that the interests of important British industries will be taken into account in our advice to the European Community, but I stress that it is an EC matter and the EC will handle the negotiations for ourselves and the other 11 member states.
    Mrs. Currie: Is the Minister aware that there is concern in parts of the footwear industry in my constituency about the possible dumping of shoddy goods from abroad? Does he share with me a robust view about fair competition but, nevertheless, agree that where there is any evidence of unfair practices the Government will take action?
    Mr. Redwood: I agree with my hon. Friend that it is important to make trade more liberal and to open it as much as we can, but there need to be GATT disciplines—as there are—if trade is unfair. One of the negotiating objectives of our partners and ourselves is to ensure that there are sensible disciplines against sudden surges m imports of sensitive products and against dumping and other malpractice.
    Mr. Madden: Will the Minister make it clear that unless real safeguards are secured for international textiles within GATT the British Government remain committed to an extension of the multi-fibre arrangement? Will he say what progress is being made in persuading the Americans to abandon national quotas?
    Mr. Redwood: We have extensively debated the arrangements for the MFA and for the transition that would be necessary if successful negotiations were achieved in GATT. Those debates made it clear that GATT procedures and protections will need to be strengthened in several areas, such as design and intellectual property, surges of imports, dumping, subsidy and other problems of which the hon. Gentleman is aware. I reaffirm the pledge that those are matters for the GATT negotiations and that they will be handled by the EC negotiators. As we come near the end of the round—it has to be completed this year—it will be necessary for the EC as a whole to make a judgment about whether sufficient progress has been made and whether the right assurances have been achieved for the package to be in the EC's interests by giving us more free trade opportunities.

    Export Credits Guarantee Department
    Mr. Colin Shepherd: To ask the Secretary of State for Trade and Industry what representations he has recently received from the group of major British exporters in respect of ECGD.
    Mr. Redwood: Recent representations made by the Major British Exporters Grouping were taken into account in the report submitted to the Secretary of State by the official interdepartmental working group formed at his request to advise on the Kemp review of status options for ECGD.
    Mr. Shepherd: Is my hon. Friend aware of the concern felt by the group of major British exporters on the future of the project sector of ECGD, in that the international competition is much involved in utilising its own ECGD type of mechanisms? Is not the national interest involved? In view of the substantial contribution that the major British exporters make to our balance of payments, how does my hon. Friend view the future of the project sector?
    Mr. Redwood: My right hon. Friend the Secretary of State and my noble Friend the Minister for Trade made it clear when they announced their proposals for the ECGD that the project sector would be kept separate from the insurance sector. The insurance sector is already profitable and is suitable for privatisation. The project group will remain under the Government's aegis. I accept that there is a role for such assistance to leading British exporters.
    Mr. Skinner: Will the Minister confirm that the Export Credits Guarantee Department is bankrupt? Is he aware that the ECGD is supposed to help Third world countries as a sort of insurance against the lack of money that they suffer from time to time? Is not it odd that the Government, who pride themselves on their business activities, now find their insurance department in the red? On top of that, we hear today that invisibles are also invisible.
    Mr. Redwood: The hon. Gentleman has it the wrong way round. The purpose of the ECGD is to offer cover for British exporters doing deals in those countries and to protect them against specified risks in return for certain premiums. Of course ECGD is not bust—it is supported by Her Majesty's Treasury and it has money from the Consolidated Fund to make sure that it can fulfil its role and carry out its remit. The hon. Gentleman is right that there has been generous support for ECGD in past years. That was necessary, given the risks that were covered and the important role played by that organisation in helping to finance British trade.
    Mr. Ian Bruce: Will my hon. Friend say something about the review of the ECGD and that we would like to see a level playing field for European and worldwide trade? Surely other countries give better deals to their manufacturers and exporters. Unless we provide equal treatment for our traders, they will be at a great disadvantage, particularly as our trade is now suffering and needs a boost. Will my hon. Friend give an assurance that the ECGD will continue to back British industry?
    Mr. Redwood: The ECGD has to conduct its policy within the framework of the GATT disciplines and of the European Community policy against state aid. If my hon. Friend has evidence of unrealistically high levels of state
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    support by competitor countries I should be interested to see it, as would the European Commission, which is currently conducting an inquiry into the general issue of state aid. Of course, Britain does not wish to be undercut by other countries abusing state aids, but the British Government believe that the disciplines within the European Community and GATT should be strengthened to avoid an expensive and damaging trade war by escalating subsidies in that way.

    National Economic Development Council
    Mr. Roy Hughes: To ask the Secretary of State for Trade and Industry when he last met the director-general of the National Economic Development Council; and what was discussed.
    Mr. Douglas Hogg: My Department has frequent contacts with the director-general of NEDO and his staff on a wide range of business matters and my right hon. Friend the Secretary of State looks forward to continuing those when he chairs the council on 4 April.
    Mr. Hughes: Has the Minister discussed with the director general Britain's disastrous balance of trade figures, which show a £14·4 billion deficit with the EC for 1989? Did the Government consider a joint approach to the Chancellor of the Exchequer suggesting that an interest rate of more than 15 per cent. is hardly conducive to increasing trade and investment and thus reducing that tremendous deficit?
    Mr. Hogg: I am sure that my right hon. Friend the Secretary of State will wish to talk about exports because he will find the position rather encouraging. In the three months to January 1990, excluding erratics and oil, the volume of exports was up 4 per cent. over the previous three months and by no less than 11 per cent. on the previous year. Those are encouraging figures. I am also pleased to note that between January last year and January this year unemployment in the constituency of the hon. Member for Newport, East (Mr. Hughes) has fallen by 22 per cent.
    Mr. Nicholas Bennett: What does my hon. Friend think that the prospects of the British economy would be if we renationalised most of our industries, increased income tax and national insurance, put a levy on training and increased corporation tax, all of which are policies that have been put forward by the Opposition?
    Mr. Hogg: Experience has shown that the Labour party has not a clue how to manage the economy. Two things would happen. First, the competitiveness of British industry would plummet—let us not forget that the competitiveness of British industry plummeted by 25 per cent. when the Labour party was in office. Secondly, inflation would escalate—let us not forget either that it reached a high point of 26 per cent. or thereabouts in August 1975. That would be the inevitable consequences of the Labour party's policy.
    Mr. Caborn: I hope that if the director general ever meets the Minister he will get more sense out of him than we do. That apart, can the Minister say whether there will be discussions about the economy of the west midlands? As my hon. Friend said, the level of manufacturing investment has fallen and there has been a 70 per cent. fall

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    in apprenticeships in the engineering industry from 1979 to date. That is a serious problem for the engine of the British economy—the midlands—so what does the Minister intend to do about it?
    Mr. Hogg: The director general might be a little upset by the hon. Gentleman's offensive words. As usual, the Labour party has got it wrong. The west midlands has been extremely prosperous and is the chief magnet for inward investment. As we are discussing the west midlands, I shall mention manufactured exports, which rose by 3·5 per cent. in the past three months. That is jolly good news and it is a pity that the hon. Gentleman did not refer to that.
    Sir Ian Lloyd: May I divert my hon. Friend's attention to a more fundamental matter? Has he discussed with the National Economic Development Council the acute and dangerous dependence on the Japanese semi-conductor industry, not only in this country but in western Europe and America? If not, will he show the NEDC the recent advisory report to the President of the United States, highlighting the grave consequences if that dependence is not reduced?
    Mr. Hogg: I have not discussed the matter with the director-general, but I may find an appropriate occasion to do so, as I would welcome his views on the European programmes that we have in place, particularly on this matter. I think that they are the proper way forward and I am grateful to my hon. Friend for his support of them.

    Advice Centres
    Mr. Michael J. Martin: To ask the Secretary of State for Trade and Industry what funding he proposes to give citizens advice bureaux and consumer advice centres for 1990–91.
    Mr. Forth: My Department does not provide funds specifically for consumer advice centres or directly to citizens advice bureaux. Details of the DTI grant in aid for the National Association of Citizens Advice Bureaux and Citizens Advice Scotland in 1990–91 will not be available until after the Chancellor's annual statement on 20 March.
    Mr. Martin: That is a very disappointing reply, given that the Government's policy is to keep interest rates high. He will know that many thousands of families are in a desperate situation because of mortage rates. Banks and other lending societies are giving easy credit and the only bodies people can turn to are the advice bureaux. In view of the Government's policies, ought not the Government at least to consider financing those organisations?
    Mr. Forth: No, because since 1945 the system has been—correctly, I believe—that the responsibility for funding bureaux at local level lies principally with local authorities. We very generously finance the National Association of Citizens Advice Bureaux in London and Citizens Advice Scotland in Edinburgh to such an extent that Government funding has more than doubled in real terms over the past 10 years. It is worth noting that advice from the financial institutions, to those who seek it, is increasingly available from the private sector. We encourage that and think it right, and we look for the tendency to increase in the future.
    Mr. Wells: Will my hon. Friend ensure that the advice given by citizens advice bureaux is non-political, and that the money spent by the National Association of Citizens Advice Bureaux is not kept at the centre to promote politically-oriented advice?
    Mr. Forth: My hon. Friend voices an anxiety which I know is shared by many. It is legitimate when considerable sums of taxpayers' money—£9 million or £10 million per year—is given to an organisation such as the National Association of Citizens Advice Bureaux. I think and hope that those involved with the work of CABs are aware of the worries that my hon. Friend has expressed—[Interruption.]
    Mr. Speaker: Order. The hon. Member for Glasgow, Hillhead (Mr. Galloway) has not been called to ask a supplementary question.
    Mr. Forth: My hon. Friend seems to have touched a raw nerve among Opposition Members. I do not know what they are trying to conceal by their shouting and barracking, but I hope that the National Association of Citizens Advice Bureaux feels that it has nothing to conceal.
    Mr. Loyden: Does the Minister accept that many people will note what he and his hon. Friend the Member for Hertford and Stortford (Mr. Wells) have said about the citizens advice bureaux, which exist to represent the interests of their clients whatever the Government in power? If the national association is being seen as another Marxist cell, we have reached a point where few people will take seriously what the Government say on these issues.
    Mr. Forth: Methinks the hon. Gentleman doth protest a little too much. Everyone will wish to examine his words carefully as they were certainly not the words that I used.
    Mr. Favell: Does my hon. Friend agree that in towns and cities such as Stockport, which are well served with citizens advice bureaux, it is an utter waste of money to set up a welfare rights unit on the community charge?
    Mr. Forth: My hon. Friend is as assiduous as ever in drawing the attention of the House to what is going on in his constituency. He may wish to draw the same matters to the attention of the community charge payers of Stockport, who will wish to take a view at the local elections.

    Industry Council
    Mr. Graham: To ask the Secretary of State for Trade and Industry what matters he expects to discuss at the next meeting of the EEC Industry Council.
    Mr. Douglas Hogg: The next meeting of the EC Industry Council will be held on 28 May. It is provisionally scheduled to discuss audiovisual matters, industrial targeting in electronics, small and medium-sized enterprise (SME) Participation in Community research and development programmes and SME access to public procurement.
    Moreover, as the hon. Gentleman is perhaps aware, there was also a meeting yesterday of the Industry Council, which discussed automobiles, shipbuilding, textiles, footwear, biotechnology and mining policy.
    Mr. Graham: Is the Minister aware of the European study, which stated that the steel industry has a bright five years ahead of it? Will the hon. Gentleman stop procastinating about the Scottish steel industry and give it his full support to ensure that it takes part in that bright future and that steel workers who have given their all to this country remain in full employment?
    Mr. Hogg: My advice to the hon. Gentleman is that he should not lead with his chins but reflect more carefully before he asks questions. British steelmaking is among the most productive and profitable in the European Community. Incidentally, I always take it well from hon. Members if they preface their remarks by telling us by how much unemployment has fallen in their constituencies in the past 12 months. The hon. Gentleman did not do that, but I will tell the House that in his constituency it has fallen by 21 per cent.
    Mr. Allason: When my hon. Friend attends the EEC Industry Council, will he raise the issue of artificial obstacles to exports to Japan? Recently, a confectionery firm in the west country was required to obtain certificates from Harwell for each item of confectionery certifying that each item was not radioactive. There was also a requirement at the trade fair in Japan sponsored by the DTI demanding that the firm display a large sign over its stall stating that the items on show were not fit for human consumption and would be destroyed after the fair. Will my hon. Friend draw attention to that issue please?
    Mr. Hogg: I cannot guarantee to do that, but I am grateful to my hon. Friend for raising the matter. It would be helpful if he drew it to the attention of my right hon. Friend the Secretary of State. We are anxious for the Japanese to admit yet more British products into Japan and, so far, we have achieved considerable success. In the past 12 months, exports to Japan have increased by about one third. In the same period, the number of passenger cars imported into Japan from the United Kingdom increased by 75 per cent. If those figures are wrong, I will write to my hon. Friend.

    Assistance to Exporters
    Mr. Galloway: To ask the Secretary of State for Trade and Industry if he has any new plans to help British exporters.
    Mr. Redwood: The DTI and the Foreign and Commonwealth Office offer a comprehensive set of services to British exporters in overseas markets. We already have a good range of services in major markets, such as the United States of America, the EEC and the far east. In response to a previous question about Hungary, I announced the way in which we are strengthening our services in certain eastern European markets, especially Hungary.
    I am delighted to tell the House that exports increased by 15 per cent. in 1989 on 1988, although some Opposition Members seem to find that difficult to understand. Many exporters consider that sponsored trade fairs, the work of the British Overseas Trade Board and of our posts in those countries greatly assist their export efforts.
    Mr. Galloway: That all sounds patriotic, but why are the Government proceeding with the dogmatic privatisation nonsense in relation to the Export Credits Guarantee
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    Department, some parts of which are being privatised while others are left with a big question mark over their future? That is spreading uncertainty throughout the OECD and those who depend on it. Why are the Government advancing with the Union Jack in one hand and the privatisation axe in the other?
    Mr. Redwood: It is because privatisation works where other systems do not. That is why it is being adopted world wide to strengthen accountability and to improve services on a broad scale. I have already explained to the House that profitable insurance services are being privatised to bring them into line with EEC requirements, so that they continue to offer a good service to British exporters. The other services that we provide, costing £138 million a year, are welcomed widely by British industry, and exporters are proving to be successful.
    Mr. John Marshall: Does my hon. Friend accept that exporters need decent postal services, and that there is widespread dissatisfaction with the quality of those services? Will he encourage his ministerial colleagues to get rid of the Post Office monopoly, which has led to poor quality service?
    Mr. Redwood: I am sure that, like everyone else, exporters want high quality postal services. My hon. Friend the Under-Secretary of State with responsibility for postal affairs is present and no doubt has heard my hon. Friend's comments.
    Ms. Quin: Does the Minister agree that the prospects for exports have not been helped by recent Government decisions—for example, the strange decision to turn down the invitation to Britain to be special guest country at the Hamburg trade fair in 1992? Will he confirm that the French accepted that invitation since we declined it? Surely the German market is important for our visible and invisible trade now that the latter is also in the red. What does the Minister intend to do to ensure that we do not lose out in that market in the future? When will he take our trade problems seriously?
    Mr. Redwood: I have explained the numerous measures that the Government are taking and how the private sector is responding. That is why exports are rising and why we are doing well in many markets around the world. The hon. Lady is not listening to my answers. Many services are on offer; people are taking them up and the results are there for all to see in an improving balance of trade.
    Dame Peggy Fenner: Will my hon. Friend keep one of the old plans well in mind? I refer to the assistance to exporters for appearing at trade fairs. I follow the hon. Member for Gateshead, East (Ms. Quin) in this. We are a proud island race with a wonderful boat-building capability. British marine industries are doing very well and they need that extra help so that they can appear all over the world and contest what we fear will be the rise of Japan into that new market.
    Mr. Redwood: Yes, of course the Government will support British exporters, as I have already described. As my hon. Friend knows, the British Overseas Trade Board runs a system of sponsored trade fairs, which many British exporters find most welcome.

    Recycling
    Mr. Allen McKay: To ask the Secretary of State for Trade and Industry when he expects the Recycling Advisory Group to report on its consideration of recycling of domestic and industrial waste.
    Mr. Forth: The group is expected to complete the current phase of its work before the end of May.
    Mr. McKay: Given the absence of provisions for recycling in the Environmental Protection Bill, will the Minister arrange for the report to be printed in full and then immediately introduce legislation to implement that report?
    Mr. Forth: No. The hon. Gentleman perhaps misunderstands the purpose of the group. It was formed last September from a wide variety of interests to advise my Department and the Government generally about the way forward on recycling. We look forward to its preliminary conclusions, but they will not be part of a formal report. However, we expect that the group will provide a major input to the preparation of the environment White Paper later this year.
    Mr. Bowis: Does my hon. Friend agree that although it is excellent to encourage householders to segregate and dispose of waste so that it can be recycled, ultimately the only efficient way forward is to encourage waste disposal authorities to negotiate with recycling companies so that 90 per cent. of domestic waste can be recycled?
    Mr. Forth: My hon. Friend makes a fair point, but he tempts me to prejudge and pre-empt the recycling group's conclusions, which I am reluctant to do. The group will examine precisely those aspects and I look forward to its conclusions to ascertain how we can best put such recommendations into effect.

    Textiles
    Mr. Geoffrey Robinson: To ask the Secretary of State for Trade and Industry what is the current balance of trade in the textile industry.
    Mr. Redwood: The latest available figures show that imports of textiles exceeded exports by £1,565 million in 1989.
    Mr. Robinson: As the Minister knows, given today's dreadful news that our invisible balance is also in the red, those figures give no room for complacency. What objectives does the Minister have for the forthcoming multi-fibre arrangement talks in Europe? Will he specifically tackle the global quota requirement which the United States is establishing and which, as we all know, is simple protectionism?
    Mr. Redwood: I have already covered that in answer to a previous question and in extensive debates in the House. My hon. Friend the Minister of Industry has also answered such a debate.
    The hon. Gentleman should recognise that the bulk of that deficit is in trade with advanced countries not covered by the multi-fibre arrangement; indeed, £1,248 million of the adverse balance is with such countries, leaving in all probability only a little over £200 million with MFA countries. I have explained the safeguards that the EC will try to negotiate in the GATT round for the textile sector. Of course, when dumping is suspected, cases are pursued, and sometimes action is taken when those cases establish that dumping has occurred.
    Mr. Bill Walker: Does my hon. Friend agree that one of the best ways to help the textile industry, and any other industry in the United Kingdom in the export market, is to ensure that we do not indulge in practices such as sanctions which prevent our exporters from benefiting from the markets of people who want to buy from us?
    Mr. Redwood: My hon. Friend is right. Open trade is the best of all worlds. It creates prosperity for all who accept its disciplines. It has to be negotiated through GATT to ensure that everyone agrees with it. There are examples of great success within the textile industry. I pay tribute to the wool textile industry where exports are up 10 per cent. to record levels of £673 million in the last year and where there is a favourable balance of trade. Companies such as Courtaulds, Coats Viyella and Dawson International are among our leading exporters and I wish them every success in exporting still more.

Extradition Decision (Dublin)
3.30 pm
Mr. James Kilfedder (by private notice): To ask the Secretary of State for Northern Ireland if he will make a statement on extradition between the Irish Republic and the United Kingdom following the decision of the Supreme Court, Dublin, on 13 March.
The Secretary of State for Northern Ireland (Mr. Peter Brooke): The Supreme Court in Dublin yesterday overruled orders for the extradition to Northern Ireland of Dermot Finucane and James Pius Clarke. Both men are convicted terrorists who escaped from the Maze prison during the mass breakout in 1983. Clarke was serving 18 years for the attempted murder of a member of the Ulster Defence Regiment and Finucane was serving 18 years for possession of firearms and ammunition. Upon their apprehension in the Republic of Ireland, extradition of both was ordered by the district court. Appeals on behalf of both men were quashed by the High Court but were yesterday upheld in the Supreme Court, their last court of appeal. The Government are deeply disappointed at that decision.
Details of the judgments, which I understand are lengthy and complex, are not yet available to us, but I believe that the main ground of appeal was that their rights under the Irish constitution would be infringed by the treatment these prisoners would be thought likely to receive in the prison system of Northern Ireland. That this was upheld by the court is both disturbing and difficult to understand. It is an unacceptable slur on the professionalism of the men and women of the Northern Ireland prison service. I shall study the full judgment as soon as it is available and will pay particular attention to the references to Northern Ireland prisons. The conditions in the Maze prison, indeed throughout the prison system in Northern Ireland, are widely regarded as among the best in Europe.
Both the British and Irish Governments have pledged themselves to ensure that effective arrangements are in place for dealing with fugitive offenders. Extradition is a vital factor in this. I remind the House that it was the Irish authorities who originally sought these extraditions on our behalf and who have continued to make strenuous efforts, at every level of their judicial system, to bring these cases to a successful conclusion.
I shall obviously also be studying the full judgment carefully to see what implications it has for other cases. It is clearly right that each case should be considered on its merits. But our principal concern, shared with the Irish Government, is that the system as a whole should work effectively, as well as fairly. We will pursue this with the Irish Government.
Mr. Kilfedder: Is the right hon. Gentleman aware that the Dublin Supreme Court decision yesterday causes widespread anger and dismay among the people of this country, especially the people of Northern Ireland, who have suffered death, mutilation and agony at the hands of the terrorists for 22 years? More importantly, it generates disbelief and sadness—I wish, even in the anger of this moment, to emphasise the sadness—since the United Kingdom Government constantly stresses that the Irish Republic is whole-hearted in the fight against the IRA.
Does the right hon. Gentleman agree that the decision seems to provide a bar to the extradition from the Irish
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Republic of terrorists who commit their atrocities either in Northern Ireland or in Great Britain, so long as those atrocities are part of their brutal campaign to bomb Northern Ireland into an all-Ireland republic?
Finally, will the Secretary of State ask his right hon. Friend the Prime Minister to arrange an urgent meeting with the Prime Minister of the Irish Republic, Mr. Haughey, to ensure that the next six wanted men will be extradited from the Irish Republic to face justice in the United Kingdom?
Mr. Brooke: I am at one with the hon. Gentleman in much of what he has said, but I should reiterate that it was the Irish authorities that brought these cases on our behalf and it was the Irish court, which is independent, that ruled in the matter. Until the judgments of the Supreme Court have been received and studied, any comment on the effect on other cases would be merely speculative. However, if the judgments affect only cases involving Maze escapees, the immediate impact will be limited, as there are at present no other such cases before the Irish courts.
Mr. James Molyneaux: Does the Secretary of State share my bewilderment over the virtual suppression in the news industry of the earlier Supreme Court ruling of 1 March, that the claim to a united Ireland is no mere aspiration but a valid legal claim? Does he agree that that judgment discredited all the assurances given in the Anglo-Irish Agreement? Does he further agree that it provided grounds for yesterday's decision by the same Supreme Court, which probably felt that, having established its legal claim without any challenge from Her Majesty's Government, it was free to argue that it could not be expected to transfer or extradite its citizens from one part of what it considered to be its territory to another part?
Mr. Brooke: I am conscious of what the right hon. Gentleman said in the earlier part of his question, and he will recall that we had the opportunity for an exchange across the Floor of the House on Monday. As to the supplement to his question, I see no basis for the assertion that the Supreme Court's decision on the Finucane and Clarke extradition case is related to the McGimpsey judgment, which concerned the constitutionality of the Anglo-Irish Agreement, or for the right hon. Gentleman's inference that in the light of that judgment, the Irish authorities could no longer extradite persons to Northern Ireland. I am aware of no evidence from yesterday's judgments to suggest that the Irish now refuse to extradite people on the grounds that they consider that they have a legal claim to Northern Ireland.
Mr. Ian Gow: Is my right hon. Friend aware that the failure last year to extradite a suspected terrorist, Mr. Ryan, and the failure yesterday to extradite two convicted terrorists reveals—in the most awful way—the unsatisfactory nature of our extradition arrangements with the Republic?
Does not my right hon. Friend understand that those two whose extradition was refused yesterday are convicted terrorists who are likely to return to their terrorist organisations and maim and murder others? Will he undertake to the House that, as a matter of the highest priority, he and my right hon. and learned Friend the Attorney-General will put forward views and proposals to

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the Government of the Irish Republic on how we can achieve proper arrangements for extradition between our two countries?
Mr. Brooke: The disappointing results in the Finucane and Clarke cases yesterday, to which my hon. Friend refers must be set against the generally satisfactory working of the extradition arrangements between our two countries over the past two years. Since January 1988, 13 persons have been returned to the United Kingdom, and orders for delivery in respect of a further six persons are currently the subject of appeal proceedings before the Irish courts.
Additionally, the Irish state has successfully appealed against the decision of the district court not to order the return of a further two persons. I share my hon. Friend's disappointment at yesterday's decision, but it should be seen against a generally satisfactory working of the arrangements over the past two years.
Mr. A. E. P. Duffy: Does the Secretary of State agree that, contrary to the reaction in some quarters of the press and of some of his hon. Friends about the future of the Anglo-Irish Agreement, the forthcoming conference is all the more desirable to enable the Irish side to discuss coolly with him the fact that the judiciary is independent of the Executive and that the Supreme Court is specifically obliged to protect the constitutional rights of citizens?
Mr. Brooke: The hon. Gentleman is right to say that the Anglo-Irish Agreement offers a valuable framework within which the two Governments can discuss issues of mutual interest and concern, such as the one that we are debating this afternoon. Once we have had the chance to examine the Supreme Court's lengthy judgment more fully, we will make our response within the framework of the agreement. We have already made our representations through the secretariat.
Rev. William McCrea: Does the Secretary of State accept that the vast majority of people in the United Kingdom are disgusted at the failure of the southern authorities to extradite the two convicted terrorists? The judgment in the Supreme Court in Dublin has given great succour and joy to the terrorists' organisation. Can the Secretary of State understand the feeling of terror in my constituency, given that one of the terrorists was convicted of terrorising the people of my constituency along the border? What happened yesterday was another kick in the teeth for the Government.
Mr. Brooke: I have already registered our disappointment in the outcome of the case. However, we should respect the independence of the Irish judiciary in the same way that we would expect them to respect ours. [Interruption.]
Mr. Speaker: Order.
Mr. Brooke: I draw the attention of the House to the silence of the Irish Government in the context of a judgment in the House of Lords last week.
Mr. John D. Taylor: Is the Secretary of State aware that most people in the United Kingdom will be very disappointed by his reply to the House this afternoon? For him to say merely that he is disappointed will come as a shock to most people. He should have said that he was outraged at the Irish court's decision.
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Is the Secretary of State aware that, in addition to the reason given by the Supreme Court, which he mentioned—its suspicions about warders in the Maze prison—there was an even worse reason, which has not yet been mentioned in the press? I refer to the second judgment given yesterday, by Mr. Justice Walsh in the Supreme Court. As far as extradition is concerned—we are talking about convicted IRA men, not suspects—he said:
"political exemption … should not apply to persons charged with politically motivated offences when the objective of such offences was to secure the ultimate unity of the country."
So long as people kill outside Northern Ireland and so long as they do so in the interests of a united Ireland, it is allowed by Mr. Justice Walsh. That is the situation under the Anglo-Irish Agreement.
Does the Secretary of State recall that, when he and his colleagues tried to gain support in this House for the Anglo-Agreement, the headlines said, "It will bring normality into extradition"? Does he believe that normality exists in extradition?
Mr. Brooke: The right hon. Gentleman referred to the language that I used today. Yesterday, my right hon. Friend the Prime Minister referred to the sense of outrage at the implicit slur, which played a part in the judgment, on the Northern Ireland prison service. I endorse that, and referred to it in my statement.
The right hon. Gentleman referred to the judgment of Mr. Justice Walsh. I was aware of that aspect of the case. We shall examine that aspect of the judgment, together with all others, to see whether it moves the law forward from the Dominic McGlinchey case.
Mr. William Cash: Does my right hon. Friend agree that there is considerable disquiet in Eire about the decision, that Mr. Alan Dukes has expressed his view on the subject and that we have every reason to question how the judiciary arrived at its decision?
Mr. Brooke: I am aware that politicians in the Republic of Ireland have made comments about the case. I especially noted that they recommended that it should he handled at an early stage within the framework of the Anglo-Irish Agreement.
Mr. Gerald Bermingham: Does the Secretary of State agree that, until we know the raison d'etre of the judgment, we cannot make constructive comments? Would not it be wiser to wait until we know the reasons for the decision? Discussions may then take place with the Irish Government about possible improvements to the existing state of affairs.
Mr. Brooke: I hesitate to say this to the hon. Gentleman, but I am answering a private notice question. I was not volunteering a statement.
Several Hon. Members rose—
Mr. Speaker: Order. I remind the House that a private notice question is an extension of Question Time. I shall call two more hon. Members from each side, and then we must move on.
Mr. Ivan Lawrence: Since it is clear what reasons were given by the Supreme Court in Ireland yesterday, and since the court was dealing with convicted terrorists, does not it sound suspiciously like an excuse for a court to do something that it would otherwise be wrong

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for a court to do? If terrorists get the impression that courts of law are leaning towards their side, what chance have we of defeating terrorism?
Mr. Brooke: My hon. and learned Friend is right to enter that consideration. We would regard with horror any comment that encouraged murder in any part of the world.
Mr. David Winnick: While I personally found the decision odd and unhelpful in the fight against terrorism, would not it be unfortunate if a judicial decision in the Irish Republic—the Secretary of State stressed that it was a judicial decision—led to a state of hysteria in the House of Commons? Will the Secretary of State be frank enough to admit that some Members of Parliament—we know who they are—will do anything to create the maximum ill will between the Irish Republic and this country?
Mr. Brooke: I do not think that anything approaching an air of hysteria exists in the House. Hon. Members have expressed their understandable concerns about a decision which they found disappointing.
Mr. W. Benyon: May I follow the hon. Member for North Down (Mr. Kilfedder), and emphasise the sadness caused by the Court's decision? This decision and a previous decision made by the Supreme Court seem to render null and void article 1 of the Anglo-Irish Agreement, which will have to be reconsidered.
Mr. Brooke: I think that my hon. Friend is confusing the particular circumstances of this case with the other case to which he alluded. But I join my hon. Friend and the hon. Member for North Down (Mr. Kilfedder) in saying that there are unfortunate aspects to this case which we shall pursue through the framework of the agreement.
Mr. Kevin McNamara: We share the surprise and disappointment at yesterday's decision of the Supreme Court in the Republic of Ireland. But to echo what the Prime Minister said in the House yesterday—on the day when a politician could institute prosecutions, the rule of law would end. I am sure that the right hon. Lady would support the Supreme Court's desire to remain impartial, detached and free from all political or diplomatic pressures in its objective determination of the issues involved. However, the court's decision is still very disappointing.
Will the Secretary of State confirm that, until the announcement of the court's decision, arrangements had been set in train for handing over the two men at the
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border? Secondly, can the Criminal Law Jurisdiction Act 1976 be invoked to bring proceedings against the two men in the Republic?
Thirdly, on the advice that the right hon. Gentleman has now received, does the decision apply only to this case or to cases that were decided before the Irish Republic incorporated into its domestic law the convention against terrorism? When the case was presented before the Supreme Court, were any steps taken to try to contradict the evidence produced to support the appellants who based their case on Chief Justice Hutton's decision in the Pettigrew case? Was evidence produced to show how much the Irish prison service has improved over the years?
Let me take this opportunity to pay tribute to the Irish prison service for doing a job that none of us would undertake willingly. [HON. MEMBERS: "Northern Ireland prison service?"] One would pay tribute to the work of the men and women of the prison service, whether in Ireland or the rest of the United Kingdom, because none of us would want to do that job.
Finally, will the Secretary of State confirm that both Governments still regard extradition as an important weapon in the fight against terrorism and that he will raise those matters at the next Anglo-Irish Conference? If it did not exist, decisions such as this one of the Irish Supreme Court would more than justify the Anglo-Irish Conference and the decision to establish it under the Anglo-Irish Agreement.
Mr. Brooke: The hon. Gentleman's first question related to yesterday's arrangements for handing over the two prisoners at the border. He is perfectly correct—it was visible to everyone on television—that massive arrangements had been made on both sides of the border for the reception of the prisoners. In that respect, the court's judgment was a surprise.
Extra-territorial prosecution would be a matter for my right hon. and learned Friend the Attorney-General, but he would consider that only after having had the opportunity to study the judgment in full. The hon. Gentleman asked also about the effect of the convention on the suppression of terrorism. That would depend specifically on the particular charge in each case, and one would have to examine it on a case-by-case basis.
The Government provided substantial evidence to the Irish courts on the central issue of the behaviour of the Northern Ireland prison service, not least to the effect that any such treatment would be a crime in the jurisdiction of the North. The hon. Gentleman's final question was about the importance of extradition in the joint arrangements. We have discussed that matter before in the Anglo-Irish Conference and I confidently expect that we shall discuss it again at our next meeting.

Points of Order
3.53 pm
Ms. Joan Ruddock: On a point of order, Mr. Speaker. At about 1 pm today, the Evening Standard reported a horrifying near-collision between two underground trains at King's Cross. This information calls into question the one-person operation on the tube and has revealed serious signal faults.
Mr. Ivor Stanbrook: This is not a point of order.
Ms. Ruddock: The information came to us when the House was sitting and prevented me from applying to you, Mr. Speaker, for a private notice question. The matter is of such great concern to my constituents and to the constituents of all hon. Members representing London constituencies that I must ask whether you have any information that the Secretary of State intends to make a statement to the House on this matter, which could have been another horrifying tragedy at King's Cross.
Mr. Speaker: The whole House is anxious about such accidents, but fortunately there was no injury to people in this case. I have received no information from the Government, but I am sure that those on the Front Bench heard the hon. Lady.
Mr. Geoffrey Dickens: On a point of order, Mr. Speaker. Have not we today been hoist by our own petard? Was it not the much-praised prison service of Northern Ireland that allowed the prisoners to escape?
Mr. Speaker: That is not a point of order. Furthermore, I do not know what a petard is.
Mr. Norman Buchan: On a point of order, Mr. Speaker. I have given you notice of an extremely important matter. The Standing Committee that is considering the Broadcasting Bill has now reached its 36th sitting. I apologise for not raising the matter earlier, but I was given the courage to do so when I noticed that the Committee that considered the legislation that became the Aircraft and Shipbuilding Industries Act 1977 had 58 sittings before the matter of its hybridity was raised.
I want you to consider, Mr. Speaker, whether the Broadcasting Bill is hybrid and should follow another course of action, such as a referral to examiners or to a Joint Select Committee. The accepted definition of hybridity is that of Mr. Speaker Hylton-Foster, who said that a hybrid Bill was
"a public bill which affects a particular private interest in a manner different from the private interest of other persons or bodies of the same category or class."
That relates to the problems that have arisen in Committee.
The matter was brought to our attention when the Government tabled new clause 42, which was entitled
"Duty to provide advance information about programmes".
It affects only two journals in Britain. I refer again to Mr. Speaker Hylton-Foster's words:
"other persons or bodies of the same category or class".
The journals are the TV Times and Radio Times. The nature of their copyright possession on scheduling of programmes was to be changed. Without that element of control, the parent ownership of the Radio Times was left
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at the mercy of other competitors who could reschedule accordingly. Furthermore, the basic business of the TV Times and the Radio Times,which are both private companies—one is owned by BBC Enterprises Limited and the other by Reed International—was strongly affected.
My second reason for believing that the Broadcasting Bill is a hybrid Bill is—
Mr. Speaker: Order. The hon. Gentleman must not go into detail about what is going on in a Committee. That does not concern the House.
Mr. Buchan: I am giving a truly factual account of an amendment to the Bill. I am not concerned with what has happened in the Committee but what has been incorporated in the Bill.
Mr. Speaker: Order. The hon. Gentleman kindly gave me notice of the matter, and I have been able to consider it in some detail. I can help the hon. Gentleman and the House. I believe that the new clause and the amendment to which he has referred have not yet been disposed of in Committee. It is not out of order for a Committee to make amendments that make a Bill hybrid, but I should not wish to make a ruling on such a matter before the Bill has been reported.
Mr. Buchan: In that case, I shall stick to the second ground why I believe that the Bill is hybrid. I have also given you notice of that in my letter.
Mr. Speaker: Order. I have told the hon. Gentleman that I cannot rule on the matter until the Committee has reported.
Mr. Buchan: I understand that, but, according to the precedent, which I examined with care, the earlier such an issue was raised, the better. On the Aircraft and Shipbuilding Industries Act, 1977, the apology was begged for 58 sittings and I have already apologised for 36 sittings. The matter should have been raised on Second Reading, but it came to our attention only when new clause 42 was tabled.
Mr. Speaker: What, then, is the hon. Gentleman asking me to do?
Mr. Buchan: I am asking you, Mr. Speaker, to undertake to report, presumably tomorrow, to the House, as happened on the Aircraft and Shipbuilding Industries Act 1977, on whether you think that there is an element of hybridity in the Bill. If there is, a course of action other than proceeding with the Bill in its present form is then open to you, Mr. Speaker.
Mr. Speaker: Order. I cannot undertake to do that tomorrow but I shall certainly undertake to do that with the greatest care when the Bill has been reported to the House in the usual way.
Mr. Buchan: Would it not be more sensible and in the interests of everyone if that could be rectified? That is why I should like to proceed and it is important that I should proceed—
Mr. Speaker: Order. The debate has not yet been concluded. As I understand it, the new clause is currently under discussion. It has not yet been disposed of by the Committee.
Mr. Buchan: What I am trying to make clear is that I have two distinct grounds. This having been brought to my attention yesterday, I examined the Bill to deal with the second ground, which is—
Mr. Speaker: Order. I cannot rule upon it now. It is not in my power to do so. I must wait until the Bill has been reported. That is the moment when I shall look upon it with great care. If the House agrees to the timetable motion, our debate today must end at midnight. It is taking a lot of time to deal with a matter that I really cannot rule upon.
Mr. Buchan: I am proceeding according to the precedent set when the previous Bill was dealt with. I will have to find other means of drawing attention to the peculiar case of Mr. Murdoch, who is being exempted from the operations of the Bill. If that does not create hybridity, I do not know what does. We are now told that the Bill will not apply to one individual, although it affects everyone else. The Minister said that it was not for the Government to pull the plug on a venture that was already running and had cost Mr. Murdoch vast amounts of money. It therefore also means—this is why it is so serious—
Mr. Speaker: Order. I honestly think that the hon. Gentleman has asked me now to pre-empt a decision which I shall have to consider with the greatest care at the appropriate moment. I cannot do that in the middle of the Bill. The hon. Gentleman is taking time from other hon. Members.
Mr. Buchan: If the Bill is hybrid, this is the exact moment to raise the matter, so that it does not go through any more useless consideration by the Committee and we can follow the proper procedure. There is a different procedure for hybridity. That is why I must make the case to you, Mr. Speaker, to see whether you can prevent the Government from wasting their time and the House from wasting its time in Committee and later on Report. It would take me two minutes to finish, so that you could consider the matter.
The position of Mr. Murdoch and his holdings—above all, Sky Television—has apparently been exempted from the Bill, which means a lifting for him of those barriers to people possessing other groups and bodies. The maximum 20 per cent. holding rule for those who have other press holdings does not apply to Mr. Murdoch. He owns 35 per cent. of the national press of this country. The requirement
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to be a British citizen or a citizen of the EC will not be a barrier to Mr. Murdoch and Sky Television. He is an American. This puts him in a different position from all others who may compete for the licence. The Bill is hybrid. We should examine it so that we will no longer waste time on what is, in any case, a pretty inadequate Bill, and can treat it in the proper way.
Mr. Speaker: Order.
Mr. Robin Corbett: Further to that point of order, Mr. Speaker.
Mr. Speaker: There can be nothing further to it, because I have already made a ruling that I shall look at it with the greatest care when the Bill has been reported.
Mr. William Ross: The Secretary of State for Northern Ireland told the House a few moments ago that he had not volunteered a statement on the issue which was raised in the private notice question. Surely the matter is of such importance that we should have a statement, if not from the right hon. Gentleman, certainly from the Attorney-General. Have you any information, Mr. Speaker, about whether he will make such a statement? Furthermore, often when the business for the week is given on a Thursday, we are told that the necessary documents such as those relating to the EC will be printed in the Official Report so that we will have an opportunity to study the documents before the debate comes up. Could that general policy be followed before any statement is made or any debate takes place in the House regarding the two judgements of the Supreme Court in the Irish Republic, so that all hon. Members could study the judgments and form their opinions on them?
Mr. Speaker: I am sure that the hon. Gentleman's remarks will have been heard by those on the Government Front Bench. I granted today's private notice question, but I have no knowledge of a statement.
Mr. Andrew Faulds: On a matter of mutual assistance, Mr. Speaker. Would you, as an ex-military man, care to know what a petard is? I feel sure that the hon. Member for Littleborough and Saddleworth (Mr. Dickens) has no idea. Would you, Mr. Speaker, be interested to know?
Mr. Speaker: As a matter of fact, I would—but perhaps the hon. Gentleman will tell me later over a cup of tea.

London Local Government
4.5 pm
Mr. Simon Hughes: I beg to move,
That leave be given to bring in a Bill to amend the law to enable parish and community councils to be created within Greater London.
In one respect, London is uniquely disadvantaged. Wales, Scotland and the rest of England all have, wholly or in part, parish local community councils. Although London is based on the parish structure, as is the rest of the country, it cannot have parish councils.
When local government reform at a lower level last took place 20 years ago, there was a series of mergers between small local authorities, to form much larger authorities. Subsequently, we saw the removal of the countywide authorities—so in London, below central Government, there is only one level of lower local government—borough councils. There are 32 of them, plus the City of London. Below them there is nothing, and communities as large as my own of 215,000 people have no local form of assembly, democratic representation or decision-making. They have no true local authority.
There is provision for parishes to be created elsewhere than London. Under the Local Government Act 1972, a procedure exists for the creation of parishes other than in London. To my own knowledge, at least three attempts have been made in this House and in another place since 1972, on a cross-party basis, to remedy the disadvantage that London has suffered since the abolition of the smaller borough councils 25 years ago. The late Graham Page introduced the Urban Parishes Bill in 1978, and in another place Lord McIntosh of Haringey introduced in 1984 the Urban Parishes Bill, which, after completing all its stages in the Lords, fell in this House only because it came here for its Second Reading towards the end of the Session.
In 1987, my hon. Friend the Member for Liverpool, Mossley Hill (Mr. Alton), with support from hon. Members of four other parties, introduced the Directly Elected Neighbourhood Councils Bill to allow places such as London elsewhere in urban Britain to have, at the behest of ordinary people, the opportunity to establish the parish councils that people elsewhere take for granted.
The Bill will allow the process of creating parish councils to be instigated by the people in the areas that those councils would represent. London, like many other cities, is a collection of villages, not one unbroken metropolis. When people are asked where they live, they answer Willesden, Bromley, Bow or Walworth. They do not say that they live in Haringey or Brent. The place in which they live is much smaller than the boundaries of its borough council. People associate themselves with ancient communities having names that have come down through the ages and have their own histories and established traditions.
I seek to give the people of London the opportunity to petition the Boundary Commission for England, so that it may discuss with local people and their local authority the appropriate boundaries for a parish council—and then, in a short, time-limited period, make a proposal for a precise area in which parish council elections could take place.
The Bill would allow a proper democratic structure for representing the views of the local community to the borough council or to other authorities. There is no doubt
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that it would enhance community spirit, participation and pride. It would be an advantage, because some decisions could be made at the lowest possible level. It is certainly needed to counteract the remoteness and alienation that many people feel from local authorities throughout London.
There are very low turnouts at many local elections, largely because people neither know the candidates nor feel that the authority is near enough to be likely to do anything for them. As a matter of justice, if other places can have parish councils, I do not understand why we should not have them, too. Would it not be a good thing to build into our democratic structure the possibility of electing people to councils that represent the places where people feel most naturally at home?
What would such councils be able to do? They would be able to take part in planning consultation and possibly make devolved planning decisions. They would be able to provide community facilities such as community halls and street lighting and improve parks and benches. They might be able to take on the local management of schools and be the forum for police authorities and for the funding of community groups and act as a consultative network between the higher borough authority and the local community.
How would they be funded? They would not need to raise any money, but otherwise, like all other parish councils, they would precept a penny or two which the borough council would collect and they would be able to spend. All sorts of places would suddenly have the possibility of having recognised democratic community authority.
The Government have said that they do not receive much correspondence requesting that such councils be set up. That is what the Minister said when a similar Bill was last debated in the other place. I am in no doubt that, if people believed that they could have parish councils in London, the establishment of those councils would have enormous support. Certainly, in the boroughs of Bermondsey and Southwark, people would like them tomorrow, because they do not feel that they can relate to local government. I believe that parish councils would be as popular in London as the poll tax is currently unpopular, and that three out of four people would probably support them.
People would ask whether such councils would be just another layer of bureaucracy. The answer is no, because most parish councils have one part-time clerk, and that is often an honorary post. They do not have their own buildings or offices; they work out of a community building or community hall. There is no need for them to be bureaucratic or in any way to have the disadvantages of government at a higher level. They need not even be political bodies. Many parish councils have people elected as independents because they are known and respected arid willing to give their time to the community.
Of course political parties would not be banned, but they would not have to take a predominant role at that level of local government.
On all other occasions when such a Bill has been introduced, it has received widespread support. I believe that good local government requires real local government. It is time to bring to an end the anomaly that London cannot have the parish councils which the rest of the country enjoys.
Question put and agreed to.
Bill ordered to be brought in by Mr. Simon Hughes, Sir Rhodes Boyson and Mr. Ken Livingstone.

London Local Government
  LONDON LOCAL GOVERNMENT
  Mr. Simon Hughes accordingly presented a Bill to amend the law to enable parish and community councils to be created within Greater London: And the same was read the First time; and ordered to be read a Second time upon Friday 27 April and to be printed. [Bill 99.]

National Health Service and Community Care Bill (Allocation of Time)
4.14 pm
Mr. Speaker: We now come to the guillotine motion on the National Health Service and Community Care Bill. I have received three manuscript amendments—two in the name of the hon. Member for Livingston (Mr. Cook) and one in the name of the hon. Member for Bradford, South (Mr. Cryer)—and I have selected them all.
Mr. Robin Cook: On a point of order, Mr. Speaker. It may be for the convenience of the House if I explain that I intend to move the second, not the first, of my amendments as I understand that we can divide on only one of them.
4.15 pm
The Secretary of State for Health (Mr. Kenneth Clarke): I beg to move,
That the following provisions shall apply to the remaining proceedings on the Bill:

National Health Service and Community Care Bill (Allocation of Time)

  Report and Third Reading
  1.—(1) The remaining proceedings on consideration and Third Reading of the Bill shall be completed in two allotted days.
  (2) The proceedings on consideration shall be brought to a conclusion at midnight on the first allotted day.
  (3) The proceedings on Third Reading shall be brought to a conclusion three hours after their commencement.
  (4) Standing Order No. 80 (Business Committee) shall not apply.

  Dilatory Motions
  2. No dilatory Motion with respect to, or in the course of, proceedings on the Bill shall be made on an allotted day except by a member of the Government, and the Question on any such Motion shall be put forthwith.

  Extra time on allotted days
  3.—(1) On an allotted day, paragraph (1) of Standing Order No. 14 (Exempted business) shall apply to the proceedings on the Bill, but on the first allotted day it shall apply only for two hours after Ten o'clock.
  (2) On the first allotted day, any period during which proceedings on the Bill may be proceeded with after Ten o'clock under paragraph (7) of Standing Order No. 20 (Adjournment on specific and important matter that should have urgent consideration) shall be in addition to the said period of two hours.
  (3) If the first allotted day is one to which a Motion for the adjournment of the House under Standing Order No. 20 stands over from an earlier day, a period of time equal to the duration of the proceedings upon that Motion shall be added to the said period of two hours.

  Private business
  4. Any private business which has been set down for consideration at Seven o'clock on an allotted day shall, instead of being considered as provided by Standing Orders, be considered at the conclusion of the proceedings on the Bill on that day, and paragraph (1) of Standing Order No. 14 (Exempted business) shall apply to the private business for a period of three hours from the conclusion of the proceedings on the Bill or, if those proceedings are concluded before Ten o'clock, for a period equal to the time elapsing between Seven o'clock and the conclusion of those proceedings.

  Estimates
  5. Proceedings on the Bill or on any private business taken under paragraph 4 of this Order shall not be interrupted for the purposes of Standing Order No. 53 (Questions on voting on estimates etc.) and if on an allotted day Mr. Speaker is directed by that Standing Order (as modified by the Order of the House [12th March]) to put questions at Ten o'clock he

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  shall put those questions at Ten o'clock or at the conclusion of the proceedings on the private business, whichever is the later.

  Conclusion of proceedings
  6.—(1) For the purpose of bringing to a conclusion any proceedings which are to be brought to a conclusion at a time appointed by this Order and which have not previously been brought to a conclusion, Mr. Speaker shall forthwith put (so far as they are applicable and notwithstanding any Order of the House relating to the order in which the Bill is to be considered) the following Questions (but no others)—

  (a) any Question already proposed from the Chair;

  (b) any Question necessary to bring to a decision a Question so proposed (including, in the case of a new Clause or new Schedule which has been read a second time, the Question that the Clause or Schedule be added to the Bill);

  (c) the Question that such of the amendments 139 to 141, 158, 256, 275, 276 and 341 as remain to be made be made to the Bill;

  (d) the Question that the new Schedule (amendment 269) be added to the Bill;

  (e) the Question that all remaining amendments standing in the name of a member of the government be made to the Bill;

  (f) any other Question necessary for the disposal of the business to be concluded;
  and on a Motion so made for a new Clause or a new Schedule, Mr. Speaker shall put only the Question that the Clause or Schedule be added to the Bill.

  (2) Proceedings under sub-paragraph (1) above shall not be interrupted under any Standing Order relating to the sittings of the House.
  (3) If an allotted day is one on which a Motion for the adjournment of the House under Standing Order No. 20 (Adjournment on specific and important matter that should have urgent consideration) would, apart from this Order. stand over to Seven o'clock—

  (a) that Motion shall stand over until the conclusion of any proceedings on the Bill which, under this Order, are to be brought to a conclusion at or before that time;

  (b) the bringing to a conclusion of any proceedings on the Bill which, under this Order. are to he brought to a conclusion after that time shall he postponed for a period equal to the duration of t he proceedings on that Motion.

  (4) If an allotted day is one to which a Motion for the adjournment of the House under Standing Order No. 20 stands over from an earlier day, the bringing to a conclusion of any proceedings on the Bill which under this Order are to he brought to a conclusion on that day shall be postponed for a period equal to the duration of the proceedings on that Motion.

  Supplemental orders
  (7).—(1) The proceedings on any Motion made in the House by a member of the Government for varying or supplementing the provisions of this Order (including anything which might have been the subject of a report of the Business Committee) shall, if not previously concluded, be brought to a conclusion one hour after they have been commenced, and paragraph (1) of Standing Order No. 14 (Exempted business) shall apply to the proceedings.
  (2) If on an allotted day on which any proceedings on the Bill are to be brought to a conclusion at a time appointed by this Order the House is adjourned, or the sitting is suspended, before that time no notice shall be required of a Motion made at the next sitting by a member of the Government for varying or supplementing the provisions of this Order.

  Saving
  8. Nothing in this Order shall

  (a) prevent any proceedings to which the Order applies from being taken or completed earlier than is required by the Order; or

  (b) prevent any business (whether on the Bill or not) from being proceeded with on any day after the completion of all such proceedings on the Bill as are to be taken on that day.

  Recommittal
  9.—(1) References in this Order to proceeding on consideration or proceedings on Third Reading include references to proceedings at those stages, respectively, for, on or in consequence of, recommittal.
  (2) On an allotted day no debate shall be permitted on any Motion to recommit the Bill (whether as a whole or otherwise), and Mr. Speaker shall put forthwith any Question necessary to dispose of the Motion, including the Question on any amendment moved to the Question.

  Interpretation
  10. In this Order—
  "allotted day" means any day (other than a Friday) on which the Bill is put down as first Government Order of the Day, provided that a Motion for allotting time to the proceedings on the Bill to be taken on that day either has been agreed on a previous day, or is set down for consideration on that day;
  "the Bill" means the National Health Service and Community Care Bill.
  My right hon. and hon. Friends and I deeply regret the necessity to move a timetable motion given that the House has made such reasonable and rapid progress so far. There is so much interest in both parts of the Bill that, in the interests of Parliament and of both parties, it would have been an extremely good idea to have continued on a satisfactory basis until the end of the Bill's passage through the Commons and thus to have allowed hon. Members on both sides of the House to air all the matters that they wished to air.
  It has to be conceded that we were well on course to make that agreed progress until the events of last night. I believe that my desire to avoid a guillotine if we possibly could was amply demonstrated by the Government's behaviour. Hon. Members will recall that we began by making two days available for the Second Reading debate. That is not unprecedented, I know, but only major legislation receives such treatment, which involves the concession of a day of Government time. The Bill then entered its Committee stage—we discussed it in part this morning—during which, we are all agreed, reasonable progress was made. We succeeded in debating an enormous number of amendments covering provisions from the beginning to the end of the Bill and allowing us a full discussion. We then returned to the Floor of the House.
  I acknowledged this morning that the Bill's progress was facilitated by the agreement made through the usual channels—the best accompaniment to legislation—giving rise to an agreed timetable. We played by the rules on that agreed timetable. I always think that when the Government agree a timetable, we concede to the Opposition the whip hand when it comes to deciding how much time is devoted to each part. As the hon. Member for Livingston (Mr. Cook) said this morning, the Opposition were keen to devote four days to the community care part of the Bill. We reached the end of the Committee stage in a highly satisfactory fashion, but thereafter something appears to have gone wrong—[HON. MEMBERS: "You."] No, what went wrong was revealed this morning. We had an agreement that we would have two whole days for Report and half a day for Third Reading, which again was a generous provision of time.
  Several Hon. Members rose—
  Mr. Clarke: I shall give way later, although I should remind hon. Members that the more time we spend on the guillotine motion, the less time we shall have on Report.

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  The hon. Member for Livingston revealed this morning the reason for the sudden change in our hitherto smooth progress. It is true that I had said in public what was factually correct—that we had made smooth, steady, satisfactory progress on the Bill. I repeated my view—I shall do so again before I end my remarks—that one thing that has sped us along is that, although the detail of the Bill is extremely complicated, much of the political debate on it conceals wide agreement that the Health Service needs better financial management, quality control and many of the reforms that the Government propose. My remarks were reported in such a way as to cause a certain amount of sensitivity on the Opposition Front Bench. From time to time, we all read press cuttings that we would not necessarily have written ourselves or have had written on our behalf, but it is no good our looking at press cuttings like a debutante actress who is nervous about her write-up.
  When my comments that we were making smooth, steady and speedy progress on the Bill were drawn to the attention of the hon. Member for Livingston—in shadow Cabinet, I believe, which was perhaps an unfortunate setting—he reacted rather strongly. I shall not labour the point because I do not want to take up Opposition time, but in my opinion the Opposition made a misjudgment yesterday and decided to hold a machismo performance of the traditional kind on the Floor of the House, thereby reversing the extremely sensible conduct of debate in Committee. Given the agreement that we were to have two days on Report and half a day on Third Reading, they thereby put at risk the control over debate that they had won for themselves in Committee.
  Mr. Alex Salmond: The Minister's defence of this restriction on debate rests on the fact that some agreement between Front-Bench spokesmen has not been kept. I understand that the Labour party denies that, but I shall let it speak for itself. How does the Minister's point cover the many parties in the House that are not covered by formal arrangements through the usual channels; and how does he defend stopping contributions by my colleagues and me, who are not covered by the agreements that the Minister claims have been broken?
  Mr. Clarke: I welcome the hon. Gentleman to our proceedings 130 hours into their duration. I was here for part of the Scottish debate in the small hours of this morning and I cannot recall whether he was present—
  Mr. Salmond: I was.
  Mr. Clarke: I congratulate the hon. Gentleman. The fact is that the agreement, although conducted through the usual channels, provided ample time for discussion of all the issues in the Bill. Had we proceeded last night as we did in Committee we should by now be well advanced in consideration of the Report stage of the Bill, without disruption of the timetable of the House—
  Mrs. Alice Mahon rose—
  Mr. Charles Kennedy rose—
  Mr. Clarke: I shall give way once more and then I shall give an illustration of what I think happened last night to justify this motion.
  Mrs. Mahon: The Minister has said that he thinks that we were highly satisfied with the Committee's proceedings. I draw his attention to at least three amendments that I moved—one on enrolled nurses who cannot train; another on the lack of protection during staff transfers; and a third on care plans, about which the Minister for Health said that she was not particularly interested in doing anything that might harm the private sector. Far from being satisfied, I was bloody mad on all three counts.
  Mr. Clarke: The hon. Lady made it clear on a number of occasions in Committee that we had unfortunately failed to satisfy her with our replies. My point is that she had ample opportunity to deploy her arguments, which were considered and given reasonable replies. We could have resumed those sorts of exchanges today—and we have, but in a very slow and protracted fashion.
  Mr. Kennedy: I do not think that the Secretary of State's recollection of the Committee is accurate. We hit the buffers in the House last night because we reached, on a large-scale, the issue of income support for people in residential homes, and saw a repeat performance of what happened in Committee. Conservative Member after Conservative Member stood up to disagree with the Government's position. That was what took up so much time and it is why the debate ran so late last night. If the right hon. and learned Gentleman is looking to apportion blame, he need only look behind him at his right hon. and hon. Friends.
  Mr. Clarke: I have no complaint about new clause 1. I did not like the result, but I accept that what happened was a perfectly proper parliamentary procedure. Three Conservative Back-Benchers and quite a number of other hon. Members spoke against us last night, and I agree that we were making satisfactory progress until the vote at about 10 pm. Thereafter, it rapidly became clear that things had changed dramatically.
  I understand the choice that the Opposition have to make—I have been in opposition myself—of whether to filibuster or make reasonable progress—
  Mr. Alun Michael: The right hon. and learned Gentleman was guilty of a disgusting display of filibustering last night.
  Mr. Clarke: I shall do it again if the hon. Gentleman is not careful.
  When I turned up at the Scottish debate the warning signs were already apparent, but a reasonable debate appeared to be in progress on what I have no doubt was a serious issue. It took two hours. I could see the warning signs immediately, however, when we reached the Welsh debate on an undoubtedly important matter—the number of community health councils in Wales.
  My hon. Friend the Member for Pembroke (Mr. Bennett), who is not in his place—not surprisingly—made an extremely pithy contribution. He pointed out that the Opposition were saying that they thought the number of community health councils in Wales should be the same as the number of Welsh district councils, whereas the Government were saying that they should be the same as the number of health boards. In one sentence my hon. Friend expressed an idea which it took the hon. Member for Cardiff, South and Penarth (Mr. Michael) half an hour to expound repeatedly. The hon. Gentleman's point was so profound that it was repeated by every Welsh Member of

  499
  the House, who seemed to consist of a large proportion of the Welsh parliamentary Labour party, most of whom vanished from the Chamber the moment the debate concluded and who have not been seen from that moment to this.
  Mr. D. N. Campbell-Savours: I ask the Secretary of State to do one thing: will he tell us what is going to happen this evening? When does he expect us to have the opportunity to begin the debate again on Report? I understand that agreements have been reached and that people have made suggestions as to what should happen, but at what stage during the evening will certain clauses be taken? What will happen to the hundreds of amendments and dozens of new clauses that may remain outstanding at the end of the evening? We should like to know. Let us get off all this rubbish about what happened yesterday.
  Mr. Clarke: I confirm what I have already said—Report stage will begin as soon as the debate is concluded if the House agrees with the motion before it. I will not detain the House for long, but I insist on beginning by explaining why we are tabling a motion which I had no wish to table, especially as it is about to be challenged by the hon. Member for Livingston.
  We reached the end of the Welsh debate last night. I am not going to relay everything verbatim—
  Mr. Michael rose—
  Mr. Clarke: I shall give way, but, as I keep saying, this is encroaching on Opposition time.
  Mr. Michael: It is not satisfactory for the right hon. and learned Gentleman to try to write mythology into the record. Yesterday's record will show that the Welsh debate was conducted in an excellent manner by Opposition Members, but that the contribution from Conservative Members was pathetic. That debate showed that the Government have abandoned the consumer and the community. That is in the record and that will be noted by people and communities throughout Wales, whatever mythology the Minister tries to write into today's debate.
  Mr. Clarke: I find that judgment of the Welsh debate as predictable and partisan as most of the hon. Gentleman's contributions. I am talking only about the length of time it took to debate what seemed to me, as an English observer who was waiting to debate the Bill, a rather simple point.
  Mr. Kenneth Hind: Will my right hon. and learned Friend give way?
  Mr. Clarke: Let me just consider last night's proceedings, and then I shall draw a veil over them. Those proceedings are the sole explanation for why we are now debating the motion.
  About 12 hours after we had begun the debate—some of that time was no one's fault because of new clause 1—we started to discuss the English National Health Service. For more than 12 hours I had maintained total silence, apart from one intervention—no doubt a blessed relief to many Opposition Members.
  Mr. Campbell-Savours: What does the Minister propose to do tonight?
  Mr. Clarke: We then got on to a subject that is important, but a little tired to Committee members—consultations about the new NHS trusts.
  Mr. Campbell-Savours: On a point of order, Mr. Deputy Speaker. I am sorry to press this, but some of us have come into the Chamber for a constructive debate. We do not give a damn about what happened yesterday; we are looking forward to tonight's business. What proposals have the Government—
  Mr. Deputy Speaker (Sir Paul Dean): Order. What is the point of order for the Chair.
  Mr. Campbell-Savours: The Speaker selected nearly 200 new clauses and amendments—it was his decision which ones were to be called. We have five and a half hours and all that I want to know is at what stage in the evening 'will those matters be debated. That is a fair question. Let us forget yesterday and concentrate on the business tonight.
  Mr. Deputy Speaker: That is not a point of order.
  Mr. Campbell-Savours rose—
  Mr. Deputy Speaker: Order. It would be much better if the Secretary of State was allowed to get on with his speech.
  Mr. Clarke: I propose to make my own speech and I am not going to take advice on it from the hon. Gentleman.
  Mr. Campbell-Savours: What is going to happen tonight?
  Mr. Clarke: I shall certainly not take advice from the hon. Gentleman, who wasted the whole of the first morning of the Committee and part of the afternoon on the Floor of the House afterwards by raising a frolic of his own. So far as I can recall, he is the only person who, before last night, wasted time on the proceedings of the Bill. I am saying that, last night, when we got to the English NHS, the signs were clear when the Leader of the Opposition, who had made short, succinct speeches in Committee—
  Mr. Robin Cook rose—
  Mr. Clarke: The hon. Gentleman who leads for the Opposition on this subject. I do not want to start controversy or speculation on the Opposition side of the House of the kind that burst out in other parts.
  A speech lasting one hour and 50 minutes was made by the hon. Member for Livingston which, as I said last night, was a patched-together collection of various speeches that he had made in Committee on a subject—
  Mr. Campbell-Savours: On a point of order, Mr. Deputy Speaker.
  Mr. Deputy Speaker: Order. It would be far better, in this short debate, to allow the Secretary of State to get on with his speech.
  Mr. Campbell-Savours: The guillotine is about the arrangements for taking new clauses, amendments and Government amendments this evening.
  Mr. Deputy Speaker: Order. That is not a point of order for the Chair.
  Mr. Clarke: The hon. Gentleman is maintaining his record as the hon. Member who has made more points of

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  order in the proceedings on the Bill than any other, and probably more than all the others put together. He is merely taking up time.
  I am explaining the background of events which are in the memory of most of us who have followed the Bill. Last night, for reasons of pure machismo that I have already described, the Bill was suddenly filibustered. It is up to Opposition Members to raise whatever subjects and arguments they want, but I do not believe that we heard an argument that had not been deployed before in Committee. We heard the same arguments, largely from the same hon. Members, delivered at three times their previous length by all Opposition Members who spoke. They did not want to debate the Bill but wanted to show that they were capable of making long speeches in the small hours of the morning.
  Mr. Nicholas Winterton: I fully support my right hon. and learned Friend in his opposition in principle to imposing a guillotine and I shall support the Government in the Lobby at approximately a quarter past 7 o'clock. Does my right hon. and learned Friend agree that if the Government had advised the House that they would take on board the very clear message at the end on the debate on new clasue 1 that appropriate measures would be introduced in the Social Security Bill, that might have resulted in an orderly debate being held and the filibustering which went on last night would not have occurred?
  Mr. Clarke: First, I believe that we made a proper response to the debate last night. Secondly, my right hon. Friend made it clear that we will all respond properly to the vote of the House last night as soon as we can. Whatever may have been the feelings of my hon. Friend last night, I do not believe that that lay behind the Opposition's activity on the Bill thereafter. However, I am grateful for my hon. Friend's support of the guillotine as I do not always get it for other measures before the House.
  If I may be allowed to do so, I shall move speedily to my conclusion. I have explained that the reason for presenting the guillotine is to get back on to the satisfactory course of debate upon which we were set until there was a daft change of mind on the part of the Opposition at about midnight last night.
  We are also amply supported by precedent. There have been guillotine motions in previous similar circumstances and reference was made this morning to the Health Services Act 1976, a major piece of legislation taken through the House by Barbara Castle. More time has been spent in Committee than on that Bill—we have had more than 100 hours in Committee. In 1976, the Labour Government guillotined both the Committee and the Report stages and did not allow matters to proceed to the point that we had reached until we were provoked into the action that we are taking today.
  The hon. Member for Workington (Mr. Campbell-Savours) can scarcely contain himself any longer, although he looks more relaxed than he did during most stages of our proceedings. He will know that the motion will allow us to proceed in a perfectly reasonable fashion. As soon as the motion is passed by the House, if hon. Members accept my arguments, we shall proceed to Report, which will be finished by midnight tonight. If the hon. Gentleman has a
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  copy of the timetable motion, he will see that paragraph 6 describes the conclusion of proceedings and the Questions that will be put by the Chair, if necessary. How many debates we get through between now and midnight is entirely in the hands of Opposition Members.
  Not all my hon. Friends will be precluded from taking part in the debates, but I hope that I speak for them all—certainly those who followed the Bill through Committee—when I say that I expect that they will speak briefly. If the Opposition do not want to move some of their new clauses, they can move to others. They can command the time between now and midnight as they wish, making such progress as they can.
  In Committee, much progress was made in seven and a half hours. At midnight, the proceedings will come to an end, as described in paragraph 6. Tomorrow, we shall come to the Third Reading motion, which will allow a Third Reading debate tomorrow afternoon.
  Mr. Patrick Cormack: Of course, I understand my right hon. and learned Friend's dilemma. But can anyone pretend that adequate consideration can be given to one of the most important pieces of legislation placed before the House in the 20 years that he and I have been here?
  Mr. Clarke: My hon. Friend has been an hon. Member for exactly the same time as I have. He is an independent Back-Bencher, who puts his opinion quite frequently and is a strong parliamentarian. I hope that he will agree that, after two days on Second Reading and over 100 hours in Committee, it is reasonable to have two and a half days on Report. Our misfortune is that we are trying to make up in injury time for the eight or nine hours in the small hours of this morning when the Bill was filibustered. The Government cannot be fairer than that.
  I would like to resume a measured level of debate. I believe that there is a wide consensus on the National Health Service. There is no division between us on the principles of the Health Service, the commitment to free treatment paid out of general taxation, and the provision of a comprehensive service as good as that available under any other health care system. Obviously, when we come to the mechanics, there are detailed differences between us. But I believe that there is widespread support for a reform that will bring better financial management, better quality control, and a greater say for patients paving the way for a better patient service. There was more controversy on the care in the community part of the Bill.
  Mr. Andrew Mitchell: It seems that my amendment No. 158 is not likely to be reached this evening. My right hon. and learned Friend knows the great importance attached to extending and clarifying the role of the Audit Commission. Is my understanding correct that, in its place on the amendment paper this amendment will now receive Government support?
  Mr. Clarke: My hon. Friend will be glad to know that I have rescued his amendment from the debris. It is up to the Opposition to see what they can rescue from the debris. The hon. Gentleman's amendment is one of those listed in paragraph 6(1)(c) of the timetable motion and it will be put to a vote at 12 o'clock. It will be debated, and my hon. Friend can deploy the arguments that the Government

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  would have accepted had he had the opportunity of moving the amendment—if we make proper progress on Report between now and midnight.
  There is widespread agreement. Care in the community has caused controversy, but the Griffiths report received all-party support. For heaven's sake, we all accept the need to improve the system for providing care in the community to the elderly, the disabled, the mentally ill and the mentally handicapped. Why is not the House capable of having a sensible debate on the issues of detail that divide us?
  I invite the hon. Member for Livingston to agree to that sensible procedure, allowing us to get back to where we would have been had it not been for his behaviour from about one o'clock in the morning.
  Mr. Hind: On a point of order, Mr. Deputy Speaker. I seek your guidance. If the House decided to collapse the debate now, would it be in order immediately afterwards to debate the clauses that are the subject of the Report stage?
  Mr. Deputy Speaker: The answer to that is yes. Immediately this debate is completed—it need not last for three hours—we shall proceed to debate the clauses in the Bill.
  4.40 pm
  Mr. Robin Cook: I beg to move, as a manuscript amendment to the motion, in paragraph 6(e), to delete "that all" and insert "On each of the".
  To those of my hon. Friends who do not immediately apprehend the objective of the amendment, I should explain that it would enable the House to vote separately on Government amendments on which it wished to vote separately, as opposed to the iniquitious proposal in the timetable motion, which obliges the House to vote on Government amendments as a block. I shall return to that issue later.
  I refer to the point of order of the hon. Member for Lancashire, West (Mr. Hind). It may be proper for the House to find extra time for the new clauses and amendments that have appeared today in the amendment paper, but it would be possible for it to do that only by submitting without murmur or protest to such a constitutional outrage. A glance at the timetable motion confirms the contempt that the present Administration have for the right of parliamentary scrutiny and the ability to challenge legislation.
  Mr. Hind: Will the hon. Gentleman give way?
  Mr. Cook: I shall do so on this occasion, as I am conscious of the hon. Gentleman's observations, but other hon. Members wish to participate in the debate, so I shall not give way again.
  Mr. Hind: I am grateful to the hon. Gentleman for giving way. Will he accept that, if we were to pass the guillotine motion now, we would have two and three quarter extra hours in which to debate the clauses of the Bill, some of which are thought to be extremely important by all hon. Members? Will the hon. Gentleman reconsider his position in the light of that?
  Mr. Cook: If the Treasury Whip had not moved a motion to report progress six and a half hours ago, we should have had an additional nine hours of debate. It is
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  important for the House to consider the timetable motion. If it submits to the motion without a whimper of protest, it will happen every second sitting day.
  My hon. Friend the Member for Workington (Mr. Campbell-Savours) has repeatedly asked the Secretary of State to tell us the effect of his motion. There are important new clauses still to be debated. They refer to important issues, the first of which is not within the scope of even this Government to prevent us debating. That is the new clause tabled by my hon. Friend the Member for Peckham (Ms. Harman) referring to the rights of patients to appeal against the decision of a GP to delete them from his list. There are other important new clauses that I fear we will not reach under this timetable, such as the rights of staff who are transferred to self-governing trusts and the ring fencing of grants for community care, which was a central issue in the Griffiths report, and which should be central to the clauses on community care in this Bill.
  In addition to the new clauses, there are 212 amendments to 62 different clauses that still stand selected. The Secretary of State said that the motion would provide a perfectly reasonable way of handling the new clauses and amendments, but he has proposed 285 minutes in which to debate 252 new clauses and amendments. There is no way in which we can cram debates about those new clauses and amendments into such a finite time. There is no way in which the House could even vote on all those new clauses and amendments without any debate. There is not even an attempt in the timetable motion to pretend that it is possible to timetable that for useful debate on the new clauses.
  This is not a timetable motion; no times are fixed in the motion. This is a simple, unadorned guillotine that falls at midnight. The Secretary of State said that it would enable the House to finish the Bill. We will not finish the Bill at midnight; I doubt if we will even have started consideration of amendments to the Bill by then. What happens at midnight is that the Government get their Bill, and they will get it without any debate on the clauses on community care.
  I have to say to my hon. Friend the Member for Peckham, who served with me on the Committee, that, had I any doubt about the importance and correctness of our strategy in approaching the Committee sittings, and in seeking agreement to ensure that we had adequate days in which to air the issues in the Bill, that doubt would have been removed by a timetable motion that shows that, given half a chance, this Administration would block any debate on those clauses.
  Among the 212 amendments there are 100 Government amendments. The effect of the timetable motion—an effect about which the Secretary of State was rather coy—is that those 100 Government amendments will be put to the House in a single Division. I have checked with the authorities and have been advised that there was no parallel with such a proposal before this Government took office.
  There are a number of significant and important Government amendments, including an amendment to permit officers of health authorities to serve on health authorities and Government amendments relating to the transfer of assets to self-governing trusts. There is even a Government amendment on the restrictions on GPs. The House is being denied not only a debate on the amendments, and the opportunity to scrutinise them; it is even being denied a Division on them.

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  I turn from the effect of the motion to the observations by the Secretary of State. I assure the House that I shall be as brief as I can in dismissing them, but first I express some anxiety on behalf of all hon. Members who served on the Standing Committee. There is growing anxiety in our midst about what has become of the hon. Member for Derby, North (Mr. Knight). I do not recall seeing him on the Treasury Bench since the Division on new clause 1. I hope that he has not vanished down whatever oubliette is reserved in the Whips Office for the failed Whip.
  The Secretary of State was good enough to say—I hope that the hon. Member for Derby, North has the message brought to him wherever he is incarcerated—that he had no complaints about the debate on new clause 1. That debate lasted five and a quarter hours. I differ slightly from the interpretation put by the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) on the length of the debate. The hon. Gentleman suggested that the debate was long because large numbers of Conservative Members spoke against the Government.
  I believe that the debate, if it was unduly long, was so for the simple and self-evident reason that the House received no response from the Treasury Bench to what was patently the will of the House. If, throughout our proceedings, we had had Ministers who were willing to listen to the points of debate, and to take the sense of the debate and the will of the House, it would have been possible for us to make more rapid progress.
  Throughout the entire proceedings on the Bill, both in Committee and on Report, the Opposition have received not one concession. Indeed, if there is one thing that infuriates us more than not getting a concession it is the fact that we cannot even get the Secretary of State to agree that we disagree with him on the content of the Bill.
  Having said that, I have to say that the timetable motion is a fitting end to the proceedings on the Bill. It was conceived in secrecy, in a furtive review, behind closed doors, through which only Ministers were admitted. Those Ministers took no evidence, and held no consultations on the review; they issued no Green Paper to stimulate debate.
  This is a fitting end to a Bill that will centralise in Richmond house the powers of control of the Health Service. On Second Reading, I drew attention to the Bill's 127 references to the Secretary of State, all of which gave him powers to regulate, to order and to instrument. Each of those 127 references survived Committee, and each of them will now survive Report, without debate.
  It is fitting at this stage of the Bill that one of the four debates that we were allowed—before being muzzled—was one that exposed just how anxious the Government are to avoid democratic debate within the Health Service, and their determination to avoid people having a say in whether their local hospital opts out of local health authority control. The Government are terrified that they would not win a single ballot.
  This is a fitting end to a Bill for which the Government had no mandate in the previous election. The proposals have not gained support since then. The Bill enjoys more unpopularity in the opinion polls than the poll tax Bill did at the same point during its passage through Parliament. But although the timetable motion provides an appropriate end to our proceedings, it will not quite be the
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  end of the Bill. There is one ballot that Ministers cannot guillotine—the ballot that will take place in the forthcoming general election. Democracy will then take its revenge for the way in which the Government rammed the Bill through the House.
  From now until that election, we shall set the agenda on health. We shall measure and broadcast each shift to a commercialised marketplace in health care. We shall log and publicise each patient who is refused treatment. Each speciality that is forced to the wall by competitive contracts will be recorded and remembered.
  Each of those issues will be put in the reckoning on the day of the general election. I am confident that that election will return a Government who will re-create a Health Service that will give patients the treatment they need, not the treatment that they or their doctors can afford. As a result of the motion, the Bill will leave the House tomorrow. At that point, the Secretary of State's problems will start. The Bill will be leaving the one place in Great Britain where it could find a majority. It has no majority in the world outside. The right hon. and learned Gentleman cannot dragoon a majority for it by putting the Whips on to the world outside.
  The guillotine motion is the last throw of the discredited doctrine that "No. 10 knows best"—a doctrine of which the nation is heartily sick. When the electorate has its next turn to speak, the Bill that that doctrine seeks to protect will be rejected, along with the Government who imposed it.
  4.52 pm
  Mr. Patrick Cormack: I think that I have voted in almost every guillotine debate for the past 20 years, but for reasons that I shall explain, this guillotine is one guillotine too far.
  Much humbug is spoken by those on Conservative and Opposition Front Benches when guillotine motions are introduced. The sort of speech made by my right hon. and learned Friend the Secretary of State, for whom I have enormous respect and regard, is made from every Government Front Bench whenever a guillotine motion is introduced. I am delighted to see in his place the father of all guillotines, the right hon. Member for Blaenau Gwent (Mr. Foot). When he was Leader of the House, he entertained us hugely and introduced more guillotine motions than any other right hon. Gentleman.
  We owe it to ourselves and to our constituents to consider what we are about in this place in a way that we have not considered it so far. Those of us on the Back Benches have rights and duties. One duty is carefully to scrutinise legislation. Our constituents expect us to examine Bills seriously and in detail. This Bill affects vast numbers of our constituents. It could be said, without great exaggeration, to affect each one of them directly or indirectly.
  No doubt all of us have attended meetings in our constituencies, as I have done, with general practitioners and others who have been worried and sometimes alarmed at the Bill's contents. Many such worries have been based on misconstruction, and many alarms have been grossly exaggerated. There has been mischief-making against the Bill by those who should have known better. Nevertheless, this is a serious matter. The Bill affects all of our constituents and contains controversial elements that demand careful and detailed scrutiny.

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  Our debate this evening calls into question not only the Bill but how we deal with all legislation. It is time seriously to consider that aspect. We let down our contituents by our perfunctory approach—[Interruption.] It would be good if the hon. Member for Hackney, South and Shoreditch (Mr. Sedgemore) listened, because my argument is serious. We should get away from our perfunctory examination of all legislation.
  Let us consider what happens. A Bill comes before the House and has a Second Reading. By the very nature of things, even if it is a two-day Second Reading, few of us can pronounce on the general principles. The occupant of the Chair has an impossibly difficult task in knowing whom to call so that the various strands of opinion and parties in the House are represented. Few right hon. and hon. Members have the chance to take part in Second Reading debates.
  Next, a small number of Members go into Committee to debate the Bill in detail. As a Chairman of Committees, I know full well that Government Whips often exercise a certain persuasive power to curb the eloquence of Government Members, so that the Bill has a reasonably speedy passage through Committee. I do not point the figure at any particular Minister or Government. It happens, as all right hon. and hon. Members know.
  Mr. Andrew Rowe (Mid-Kent): Will my hon. Friend give way?
  Mr. Cormack: Not at the moment. I am trying to develop a serious argument, but I may give way later.
  The Bill then comes back to the Floor of the House, often lucky to have escaped a guillotine. The vast majority of us have had no chance to examine it in detail, to speak about how its provisions affect our constituents or to consider its implications for the country as a whole.
  We then come to the Report stage. Today, we have a grotesque example of what can then happen. It seems generally expected that this debate will last until 6 o'clock or thereabouts. We shall then have between five and six hours in which to consider hundreds of amendments and dozens of new clauses to a Bill that affects everyone in the land. That will not be debate, consideration, scrutiny or what our constituents expect us to do. It will be another perfunctory gallop. Many right hon. and hon. Members on both sides of the House who wish to speak will have little chance to do so. Those who are called to speak will have to truncate their remarks. Tomorrow, after a brief Third Reading debate on generalities, the Bill will go to another place. It will come back to the House only in so far as their Lordships make amendments to it, which I trust they will; but we must wait and see.
  What does it all mean? I do not criticise Front Benchers on either side of the House, but the House of Commons must consider how we go through our legislation. I believe that every Bill needs a proper timetable, not one agreed through the usual channels, nor cooked up at dead of night or in the early hours of the morning to cope with a crisis. What is needed is a proper timetable that is worked out by a scrutiny of legislation Committee of the House.
  We should consider setting up such a Committee at an early date. It should consist of senior and experienced Members from both sides of the House, not just Privy Councillors but those such as my hon. Friend the Member for Macclesfield (Mr. Winterton) and me and others who have experience of chairing Committees, who can consider
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  a Bill without regard to partisan points. They should consider what the Bill seeks to do, and its length and contents, then decide how reasonably it should be divided so that each clause can be properly debated. That is what our constituents expect us to do, and we let them down because we do not do it.
  At the root of the matter is the amount of legislation before the House. If we are honest with ourselves, we will admit that few of us have the chance to understand even a fraction of the Bills before the House. They come thudding from the Vote Office on to our desks or doorsteps. They are complex and affect the lives of people all over the country—I am speaking not only of this Bill.
  Let us consider the past Session or two and think of the reforms that have been introduced in this House. How many hon. Members can say that they have truly been able to understand and to follow the complexity of the legislation? I was privy to a Tea Room conversation only yesterday. A distinguished member of the Labour party was having a snack with me and a member of the other place came along and said, "Did you realise that that Bill which went through without a Division the other week had this measure in it?" He did not realise it, and neither did I. Frankly, I do not believe that any other hon. Member sitting round realised it.
  There is too much legislation. Every party that goes to the country aspiring to government promises to bring in less legislation, not more. It is a pledge that is repeatedly broken. We need a ration which allocates time properly between Government and Opposition, which must have time for proper debate of the policies and approach of the Government of the day, whichever party forms the Government.
  There should be time, far more than there is at present, for Select Committees. Select Committees labour away and produce far-reaching, stimulating and important reports which are frequently put into pigeonholes and never discussed on the Floor of the House. We do not have enough time for private Members, and legislation crowds out other things. Even the legislation itself is not fully and properly considered. That is highly unsatisfactory, and it is time that we put a stop to it.
  Today's proceedings are particularly unsatisfactory. From those unsatisfactory proceedings, I would like to see emerge a Committee of Members of the House, first perhaps even setting themselves up spontaneously and unofficially, to consider ways and means by which our procedure could be improved to ensure fair distribution of time between the separate interests and issues before us and the detailed discussion of every Bill.
  Dame Jill Knight: I am listening to my hon. Friend with great care. I agree with what he said about the advisability of having less legislation. My hon. Friend appears to be saying that every Bill should have its Committee stage on the Floor of the House, with all hon. Members involved in it. That troubles me, because, if hon. Members are interested in a particular subject, it is easy, through the Library or by reading the Official Report, to find out all that they need to know. I cannot envisage a House of Commons in which all the Committee work is done on the Floor of the House.
  Mr. Cormack: I apologise to my hon. Friend. If that was the impression that I gave, I must correct it immediately. I am grateful to her: if there were ambiguity

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  in my remarks, I should not like to sit down and leave that ambiguity in the minds of right hon. and hon. Members. I believe very much in the Committee procedure; I believe that all Committees should be properly timetabled, so that there is no risk of a suddenly imposed guillotine, and that matters are properly discussed in Committee.
  My point, which I obviously did not make as well as I should have, is that, for every piece of legislation—whether it be on student loans, the reform of the National Health Service, the privatisation of an industry or the introduction of the community charge—the vast majority of us are, inevitably, not on the Committee. When a Bill returns to the Floor of the House on Report, we should not run the risk of the sort of nonsense that we now face. There should be a procedure worked out by a scrutiny of legislation Committee, which would allocate a proper portion of time—for this Bill it should be at least four days—so that the legislation could be looked at properly and at a decent hour.
  Mr. William Cash: I am intrigued by what my hon. Friend—who is a neighbour of mine—is saying, because I am a member of the Committee that is considering the Broadcasting Bill. How much attention did members of the Committee that considered this Bill pay to the allocation of time to consider questions that might arise? We are often in danger of spending too much time waffling in Committee when we should be concentrating on important questions, some of which are arising now. [Interruption.] I accuse the Opposition—including the hon. Member for Hackney, South and Shoreditch (Mr. Sedgemore), who is muttering from a sedentary position—of waffling in Committee to precipitate the very situation that we are facing now: a guillotine. That happened when we considered the Telecommunications Bill, and it has also happened in this case.
  Mr. Cormack: My hon. Friend is merely making my point for me. If there were proper timetabling in Committees, there would be no temptation to waffle, there would be no self-induced—or Whip-imposed—vow of silence by Government Members, whichever party formed the Government, and there would be true debate in Committee.
  Mr. Rowe: I accept entirely what my hon. Friend says in so far as it applies to my experience of other Committees. However, on this Committee, Government Members were given as much freedom to speak as they wished. Because our speeches were almost universally short, every one of us had the chance to say as much as we wanted.
  Mr. Cormack: I am gratified to hear that. It is unusual, but my hon. Friend was on the Committee and I was not. I accept what he says and it is good to hear it.
  I was about to mention the time at which we hold our debates. People outside think that it is absurd that we go through the night. I saw a distinguished Secretary of State at lunch when we were attending the same function. It is ridiculous that he should have been up until 3 o'clock or 4 o'clock this morning when he has extremely important work to do in his ministerial capacity on behalf of everybody. The same applies whether it be a Labour or a
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  Conservative Secretary of State. For a few to keep their colleagues up through the night, often talking endlessly about nothing, is ridiculous.
  I should like to see a system whereby we finished our substantive business at midnight and no votes were taken after midnight. We owe the nation a quality of administration which, frankly, we are not providing. We must meet head-on the question of the procedure of the House, particularly now that we are under closer and more detailed scrutiny ourselves. I would say that whether we had a Labour or a Conservative Government. I am speaking without fear or favour when I say that, unless and until we do that, we shall not do our job as well as we should or earn the esteem which any legislator in a democracy ought to earn.
  I have just come back from a few days in Romania, where people are desperate for the sort of things that we take for granted. They face their first election for 50 years, desperately hoping that it will be free and fair. I am sure that I speak for all right hon. and hon. Members in devoutly hoping that it will be both free and fair.
  The Romanian people look to us to provide models. They look to this country as the mother of Parliaments. Although I much enjoyed trying to explain what we did here, I was conscious of the imperfections that riddle our procedures. I earnestly beg right hon. and hon. Members, especially my right hon. and hon. Friends on the Front Bench, to think seriously about changing our procedures.
  Because the Bill's consideration tonight will be a travesty, I shall have no part of it in the Division Lobbies. I do not propose to vote any more on the Bill today.
  5.11 pm
  Mr. Michael Foot: I am pleased to follow the hon. Member for Staffordshire, South (Mr. Cormack). I agree with his comments about the quality of the legislation that has passed through the House of Commons in recent years. There has been a considerable debasement of the quality, but my reasons for saying that are different from those of the hon. Gentleman. I do not believe that the hon. Gentleman's cure would be any good. It has been suggested in many other quarters and would be grabbed immediately by the Treasury Bench. The Government would love to have a system under which any measures presented to the House would go through according to a timetable which was understood. The Government would be certain of getting measures through at particular times, but it would not be good for the House of Commons and it would not guarantee any improvement in the quality of legislation.
  I should like to correct the misleading remarks that the hon. Member for Staffordshire, South made about me—quite unconsciously, I am sure—at the beginning of his speech. He called me the father of guillotines. I may be very old, but I am not so old as that. The father of guillotines can be traced back to the Liberal Benches and the pre-1914 Government. To discover who introduced guillotines, the hon. Gentleman would have to go back and have an argument with Mr. Gladstone's son, if not with Mr. Gladstone himself. The Liberals introduced the guillotine motion to deal with a House of Commons which would otherwise have prevented their legislation from being passed. Some of the people who were creating the biggest row were the predecessors of the hon. Member for Staffordshire, South, although they were not all on the

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  same side of the Conservative party, as he would have liked them to be. The origin of the guillotine therefore goes back a long way.
  The hon. Gentleman should also not say that I was responsible for more guillotines than anyone else. Many more guillotine motions have been introduced in the past five or six years than in any previous parliamentary period. They have been introduced in the most objectionable manner at a late stage in the consideration of Bills such as this one to deal with immediate crises.
  The previous Leader of the House did not seem to care at what stage he introduced fresh guillotine motions—he just introduced more and more of them. I am sorry that the present Leader of the House is not here to speak on this, although the Minister for Health—the hon. Member for Surrey, South-West (Mrs. Bottomley)—is a good substitute. I understand that the right hon. and learned Gentleman is in Chile, no doubt polishing up his methods by talking to Mr. Pinochet, to whom he gave so much support when he was at the Foreign Office. They probably have much to talk over, though not how a Parliament should be run. If the Bill is to be pushed through in this way, it is a pity that the Leader of the House has not been present throughout the proceedings. When I was Leader of the House, I considered it my duty to be present almost all the time and to be responsible for any proposals.
  I am glad to come along on these occasions, partly for the sake of auld lang syne and to remember what used to happen, but also because there is always the danger that some blithering ignoramus—I am not referring to the hon. Member for Staffordshire, South or to the Secretary of State for Health—will suggest that, as Leader of the House, I did something similar to what the Government are attempting to do today when in fact they are doing something quite different.
  There is the important question of the mandate. The Government cannot claim that it is not important. Whenever the Prime Minister is forced back to the House, as she frequently is, to defend measures such as the poll tax she refers to her mandate, saying that there was a mandate for the poll tax. The measures on which I asked for a guillotine, and which would not have had a chance of getting through the House without a guillotine, all figured in our party manifesto. The country had been able to vote on them and was familiar with many of the arguments. That is important for high quality legislation. Such was the quality of the five measures on which I introduced the guillotine that most of them are on the statute book today. People may not have liked the contents of those measures, but no one ever complained about their quality. Before introducing proposals in the House, we did our best to ensure that they were properly drafted and considered. We also wished to ensure that they were properly investigated by the House of Commons, which is at its best in Committee.
  People often deride the House and say that time is wasted late at night or that few Members of Parliament are present. In my long experience, I have found that some of the worst features of bad Government legislation have been dealt with on the Floor of the House, often on Report, and sometimes late at night. That is one of our great protections.
  One such debate took place last night and the Government were defeated. Even if they had not been defeated, the discussion would still have been beneficial. No one who listened to that debate could deny its quality.
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  The result was good for most of the country. It showed the House really working properly and it was not under a guillotine. Last night's debate could not have taken place under a guillotine or under the permanent guillotine that some Members desire. A debate such as last night's debate can take place only when the House is at its best. Great credit goes to my hon. Friend the Member for Livingston (Mr. Cook) who put the case so well, but a range of other speeches came from other quarters, which did not immediately change the Government's mind but which will do so eventually.
  No Member of Parliament who was present last night would deny that at the very moment when the House showed itself at its best the Government chose to bring down the guillotine and to say, "We will have no more debates like that. Look what happens—we actually get defeated. We must have no more of that, so we shall stop it right away." Under such a procedure, we shall have no more great debates. The way in which so many debates are jammed in together is a disgrace to the House of Commons.
  As my hon. Friend the Member for Livingston said, the crucial aspect of the debate is the origin of the Bill. Had the Bill been an item in the Conservative party manifesto and been debated during the last general election campaign by the general practitioners who now oppose it and by the hospital workers who are now affected by possible opting out, things would be very different, but we all know that there has been no investigation. When Aneurin Bevan carried through the National Health Service Act 1946, he said that there should be fresh discussions about it in the years to come. He did not claim that it was perfect in every way—he wanted a five-year clause in each piece of legislation to require people to re-examine it. Nothing like that has happened with this Bill, as the Minister for Health must know even if she cannot admit it.
  This measure started with the fatal decision at No. 10 to do for the Health Service what has been done already for education and social security. It is now being pushed through without proper discussion. That is especially disgraceful, given that the Government have spatchcocked another major Bill into the legislation by amalgamating two Bills. The future of compassionate care is a matter of major discussion throughout the country. Every hon. Member knows that that debate is real and no one would dare deny what I say. Yet the Government decided to manacle another measure to this highly unpopular, undiscussed Bill, and the two measures are interlinked. The Secretary of State could not come to the House to defend the Bill yesterday—his junior Minister had to do that—which further aggravates the offence of not allowing the House of Commons to discuss either measure properly.
  Great arguments about the poll tax are raging at this very moment. The poll tax is bad enough, but it was at least mentioned as a sidewind even though it was not discussed properly. The Government have become so arrogant that they think that they can push through any measure whatever. To return to the points of the hon. Member for Staffordshire, South, that is the real reason for the debasement of the quality of the legislation going through the House of Commons.
  The Prime Minister knows nothing of the House of Commons. She did not spend years on the Back Benches—the best place to learn about the House. I have had experience of both Front and Back Benches. The Prime

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  Minister simply hears of uproar in the Chamber. She arrived yesterday without even knowing what had happened. The guillotine decision on the Bill was made in the middle of the night. Yet the Bill touches the lives of people perhaps more than any measure since the National Health Service was set up. The Secretary of State occasionally dares to compare himself with Aneurin Bevan, but Aneurin Bevan had endless debates with doctors and invited them time and again to discuss his proposals. He constantly asked for debates in this House. Before that Bill was introduced, when there was so much pretence that it was unpopular, he suggested that there should be another debate in the House of Commons. No one believed more strongly than Aneurin Bevan that the best way to get a decent measure on to the statute book so that it lasts not just a few years but for generations is to have a decent debate in the House of Commons.
  That is how we got our great National Health Service, but on the orders of the Prime Minister the Government are injuring and destroying the National Health Service and the very process whereby we can maintain these proper institutions. What is happening is a disgrace to the House of Commons. The Secretary of State should go to Downing street and resign, like the Secretary of State for Wales. He should follow the example of some of his predecessors, pluck up his courage and say that he is not prepared to force such a measure through the House.
  5.25 pm
  Mr. Nicholas Winterton: I am delighted to follow the right hon. Member for Blaenau Gwent (Mr. Foot). He is a man of great experience and an outstanding parliamentarian. As he said, he is wonderfully comfortable on the Back Benches, whether his party be in government or in opposition. I thoroughly endorse much of what the right hon. Gentleman has said.
  Like my hon. Friend the Member for Staffordshire, South (Mr. Cormack), in my 19 years in the House, I have never tasted ministerial office or preferment of any sort. Like my hon. Friend, I sit on the Chairmen's Panel, which is a tremendous challenge and a highly responsible and very enjoyable task.
  I said in an intervention at the beginning of the debate that I shall support the Government in the Division Lobby, but with great reluctance. Sadly, I do not believe that any timetabling of clauses, new clauses and amendments would make it possible to have a meaningful debate on this critical Bill. The right hon. Member for Blaenau Gwent pointed out that the issues involved are vital to practically everyone in the country. I shall vote with the Government only with great reluctance.
  When my right hon. and learned Friend the Secretary of State introduced the timetable motion, I intervened to say that, if my views were of any importance, the House could have debated these vital matters constructively and positively if the Government had responded properly to the result of the debate on new clause 1. Conservative Members expressed their anxiety about care in the community and the dreadful problems that were occurring in all our constituencies, whether we be Labour, Liberal Democrat or Conservative Members, about the growing gap between the amount of income support that elderly
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  people in private residential or nursing homes receive from the Department of Social Security and the fees for those homes.
  I am unhappy that matters that relate to ring fencing will probably receive no coverage in later debates today. We shall face grave problems because, as a result of a decision that was made not by the House but by the Government, geriatric accommodation in the National Health Service is being phased out. Almost all the provision for those who require such accommodation and care will be provided in private nursing and residential homes. Thus, an increasing number of people will be dependent on the income support that they need to pass their final days receiving the care and consideration that they need and merit. For that reason, the debate later today will be unsatisfactory.
  I agree with my hon. Friend the Member for Staffordshire, South, whose view was shared by the right hon. Member for Blaenau Gwent, that we have too much legislation and not enough debate. I was not here, as the right hon. Gentleman was, when the National Health Service was introduced in 1948, so I did not have the privilege of attending the great debates that took place leading to the formation of the NHS, which is cherished by 99.9 per cent. of the British people.
  I wonder whether, if timetable motions had been used then as they are today, we would have got the Health Service that we all admire and respect and which, having travelled throughout the world as a member of the Social Services Select Committee, I can report is the envy of the world. I do not know a cheaper, better run or more comprehensive health system anywhere else.
  I am saddened by the Government's response to the outcome of the debate yesterday on new clause 1, which perhaps set the House on a trail which I deeply regret. It has meant that no meaningful debate can take place on one of the most critical Bills now before Parliament.
  In many Standing Committees, Back Benchers are beginning to exercise their rights over the usual channels. I have the privilege at present to be a joint Chairman of the Standing Committee on the Environmental Protection Bill. I am pleased to say that Back Benchers on both sides of that Committee are exercising their full rights to debate the measure to the full. I am anxious that the occupants of the Government Front Bench note my claim that hon. Members should be able on the Floor of the House to debate properly the legislation that comes before us.
  I have in mind, for example, new clause 73, which will receive no more than scant mention in the short debate that will take place under the guillotine. That clause relates to the funding of local authorities and the demand of the Select Committee on Social Services that money allocated for community care should be ring-fenced. That is not simply the overwhelming view of that Select Committee, which looked into the matter in detail and took evidence from experts. It is the view of Sir Roy Griffiths, who produced the Griffiths report, on which the community care provisions of the Bill are based. He urged that the money should be ring-fenced and proposed:
  "Central Government should provide directly to social service authorities by a specific grant a substantial proportion of the total funds it estimates are needed to meet national objectives."
  The Government are departing from a main proposal made in a report which they asked Sir Roy Griffiths to undertake, and the House is not being given proper

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  opportunity to debate the issue. I know that the hon. Member for Makerfield (Mr. McCartney), who is on the Select Committee with me, shares my view on that important matter.
  I make no apology for raising a constituency matter, because it greatly concerns me that we should be proceeding to a situation in which health authorities can ensure, through their senior management, all of whom are politically appointed, that hospitals should decide to opt out. There is in my constituency a small hospital called the Alderley Edge cottage hospital, which was founded and built by donation and public subscription. It was taken into the NHS when it took over the provision for health care in Britain in 1948. That facility is much valued by the people of the area, but what is happening there is not democratic and there has been no meaningful public consultation.
  My district health authority has decided to implement a temporary closure of the GP beds at that hospital—it is primarily a GP hospital—pending consultation. When I heard about this development from people in the NHS—people who know that they can come to me and get an objective hearing—I was appalled. I contacted Mr. Holt, the district general manager, who told me, "We have adopted this procedure before." I asked Mr. Holt, "Can you tell me of any hospital that has been reopened once a temporary closure has been imposed?" He hesitated and replied, "We have used that procedure before, but in respect of a hospital ward." I told him that hospital wards might reopen, but I could not discover a hospital on which a temporary closure order had been imposed and which had reopened.
  The people of my area are outraged, and the majority of them are Conservative supporters—
  Ms. Diane Abbott: At the moment.
  Mr. Winterton: I will allow that remark, made from a sedentary position, to pass.
  We are creating a situation in which the public, democratic representatives, those who are concerned for the NHS and those who serve in it, are having a decreasing influence over the decisions that are being taken. That is why I say that to have so many amendments, all selected for debate, discussed in just a few hours, with no set procedure for vital new clauses to be debated individually, is appalling.
  Ms. Harriet Harman: Why, then, does the hon. Gentleman intend to vote for the guillotine?
  Mr. Winterton: I said that I did not believe that, at this stage of the Bill, in view of what happened last night, we could have a constructive or meaningful debate. I hope that we shall have a considered Third Reading tomorrow. But, above all, I believe that the measure will receive a good hearing in the other place. Some Members of this House—although not the right hon. Member for Blaenau Gwent—fought hard for the preservation of the other place and for the amending opportunities that exist there. That Chamber can have a moderating influence on hastily considered legislation that has been forced through this House. I now have considerable trust in what may happen to the Bill in that House.
  Mr. Cormack: Trust in the Lords.
  Mr Winterton: Yes, I trust in the Lords, and in the Lord. My answer to the hon. Member for Peckharn (Ms. Harman) is that, sadly, I do not believe that we shall have a constructive, meaningful debate on the Bill as it proceeds through its remaining stages in this House.
  Mr. Tony Favell: Nobody has taken a greater interest in the Health Service over many years than my hon. Friend. He and I served together on the Select Committee on Social Services. Nobody takes a greater interest in things local and taking decisions at a local level. Is he for or against self-government of hospitals? He has been talking about the Alderley Edge cottage hospital, which is outside my constituency, but not far away. Its decision is being interfered with by the district health authority. Would it not be better if that hospital was running its own affairs, free from outside interference?
  Mr. Winterton: I can best respond to my hon. Friend, whom I regard with considerable affection, in the following way. He does a magnificent job in his constituency and has taken great interest in health care over many years. I was one of the few Government Members who opposed the Bill's Second Reading because I do not like the major proposals contained in it, not least that of self-governing hospitals, which will remove the comprehensive nature of our National Health Service, which is one of its major, most compelling and advantageous facilities.
  I disagree with my hon. Friend the Member for Staffordshire, South on one matter but I wonder whether I might have the support of the right hon. Member for Blaenau Gwent. All major Government legislation should be referred to the appropriate Select Committee before coming to the House, so that some of the major problems in the legislation can be discussed by an all-party group. That is certainly a feature of legislation in a number of other democratic western countries.
  Legislation put before this place could only be improved by being considered by an all-party Select Committee before it was presented to us. That might well shorten some of the debates in the Chamber, and those that did take place would be more realistic, constructive and rewarding because they would deal with the major issues that came through the scrutiny of a Select Committee.
  Mr. Cormack: How did my hon. Friend know that I disagreed with that sentiment? Although I did not address myself to it, I do not necessarily disagree with it.
  Mr. Winterton: I thought that my hon. Friend might disagree, because he put forward another proposition in his earlier contribution to this debate.
  I shall reluctantly go through the Government Lobby tonight. Sadly, the House cannot claim much credit for what occurred last night. How right the right hon. Member for Blaenau Gwent was—a magnificent debate took place on new clause 1 yesterday. That is how the House works best.
  I shall correct the right hon. Gentleman on one matter. New clause I is an all-party new clause. It was moved with great ability by the hon. Member for Livingston (Mr. Cook), but its sponsors also came from among Government Members. We had a magnificent debate on it, because all those contributing had some knowledge of I he subject and had made a careful study of it. They spoke

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  with experience—sadly, that does not always occur in this place. Therefore, it is with sadness that I support a Government who are prepared to abuse the House in the way that they are doing today.
  5.44 pm
  Mr. Alfred Morris: Time is at a premium, many other hon. Members want to express their sense of outrage about the motion and I shall be brief. This really is a quite shocking and, as my right hon. Friend the Member for Blaenau Gwent (Mr. Foot) said, a wholly disgraceful motion. Parliamentary shoddiness was never more shoddy. The Bill is not one Bill, but four: two about the NHS and community care in England and Wales and two Scottish Bills. That is why the Secretary of State's comparison of it with the Health Service Bill in 1976 so utterly falls apart. The making of that comparison was proof positive of the bankruptcy of his case in this debate.
  In Committee Ministers were tripping over themselves as a consquence of trying to squash too much legislatiton into one Bill. I shall give just one example. The hon. Member for Ealing, Acton (Sir G. Young) had some amusement at the expense of his hon. Friends in Committee, since the hon. Member for Stirling (Mr. Forsyth), the Under-Secretary of State for Scotland, introduced an amendment substantially the same as one previously resisted by the hon. Member for Surrey, South-West (Mrs. Bottomley), the Minister for Health. That may have been amusing in Committee, but it excites only incredulity and very deep concern among the disabled people who protest to right hon. Members on both sides of the House that these four Bills in one do not tackle key issues related to their well-being.
  The guillotine motion makes it virtually certain that my amendments about community care and, in particular, the problems and needs of disabled people will not be given even a moment's consideration by the House. Similarly, amendments tabled by Opposition Members will be pushed aside without debate. They are amendments that were inspired by the all-party disablement group in the House and it is contemptuous of the efforts, not only of the distinguished officers of that important group, but also of some of the best known voluntary organisations of and for disabled people in this country. The Association of Crossroads Care Attendant Schemes has put to me its deep concerns about this legislation; so has the Spinal Injuries Association. But since my amendments will not be debated, their submissions, along with many others, must go by default.
  Can we at least have an indication of the Government's response to new clauses 58 and 59, amendment No. 59, new clause 63, in the name of my right hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley), and the other new clauses and amendments that are so very important to disabled people, their families and carers? The hon. Member for Macclesfield (Mr. Winterton) talked about ring fencing, which is a profoundly important issue. Will there be a statement about the Government's attitude to that recommendation in the Griffiths report? Will there be any mention of the compelling need now fully to implement the Disabled Persons (Services, Consultation
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  and Representation) Act 1986, which was so ably promoted and piloted through the House by my hon. Friend the Member for Monklands, West (Mr. Clarke)?
  The Secretary of State, himself no innocent when it comes to speaking at length, has talked of filibustering, yet perhaps the longest debate on Report so far was that on an all-party amendment, so well and non-controversially moved by my hon. Friend the Member for Livingston (Mr. Cook). New clause 1, dealing with income support and residential care, produced a most impressive debate. It was a parliamentary occasion and, in fact, some of the longest speeches—none the less good for all their length—came from those on the Government Benches. The Government were defeated—their first such defeat for four years—and it is much to the honour of Conservative Members, as well as hon. Members on this side of the House, that the claims of needful people were put entirely above party considerations.
  I applaud the intervention during the Secretary of State's speech by the hon. Member for Staffordshire, South (Mr. Cormack). His sense of fairness is an example to other Conservative Members. As he said, it is preposterous that debate on legislation of such importance should be so truncated. Let us hope, for the reputation of Parliament, that the hon. Gentleman's words will have had some effect on other Conservative Members. It will be a stain on the reputation of the House of Commons if the motion is not strenuously opposed across the Floor of the House as well as by Opposition Members. There is still time for the hon. Member for Macclesfield to rethink his position. I hope he will do so, and vote with us tonight.
  5.49 pm
  Mr. Andrew Rowe (Mid-Kent): I am sorry that the hon. Member for Livingston (Mr. Cook) is not in his place. I wanted to tell him about a dream that I had last night. I must have nodded off for a moment, and I dreamt that time was 1,000 years into the future and that a fossil skeleton had been found. The anthropologist instantly recognised it as homo sardonicus—in other words, the hon. Member for Livingston. The fossil's jaw was very highly developed and, at first, that was thought to be because the animal was clearly carnivorous. However, after a great deal of scrutiny it became apparent that it was just the result of over-exercise. I was alarmed when I woke up and discovered that that skeleton was fully clothed and in the middle of a speech lasting almost one and a half hours.
  The guillotine motion owes a great deal to the efforts of homo sardonicus. He spoke at inordinate length throughout our proceedings, so the Opposition cannot complain if some attempt is made to move forward. During the late 1970s, the only matter under debate in the establishment was that Britain was ungovernable. It was assumed that Britain had gone over the edge into some sort of abyss and that it was no longer possible to govern it. During the past decade the Conservative Government have shown that to be a myth.
  The second great debate, which took place during the middle and late 1980s, was about the defects of the National Health Service. We could not go anywhere in the country and speak to an audience about the NHS without there being paraded a catalogue of those defects. All the journals discussed how to prioritise, how to finance, how to control, how to organise, how to give general

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  practitioners a proper place in the system and so on. As a result of that longstanding, widespread and universally indulged-in debate, the Government introduced proposals to alter and improve the way in which the NHS is delivered to the consumer. The moment that they did so, everyone who until then had denigrated the old-fashioned, archaic way in which the NHS operated tried to pretend that it was working perfectly and that all it required was the injection of a little more money and it could go on exactly as before, with just one or two cosmetic improvements.
  Mr. Ian McCartney: On a point of order, Mr. Deputy Speaker. I am not trying to be controversial but, apart from brief absences for cups of tea, about six hon. Members have been in the Chamber for twenty-seven and a half hours. We are here to discuss a guillotine motion that will mean amendments being lost. The hon. Member for Mid-Kent (Mr. Rowe) is not speaking to that motion; he is giving a poor Second Reading speech. So that we may all have an opportunity to discuss the motion, perhaps he would try to debate the matter before us.
  Mr. Deputy Speaker: Order. The hon. Member for Mid-Kent (Mr. Rowe) is in order. However, once again I appeal for brief speeches so that more hon. Members can participate in the debate.
  Mr. Rowe: I have been on my feet for three minutes. The hon. Member for Makerfield (Mr. McCartney) may have been so anxious to make his own speech that he did not notice that the right hon. Member for Blaenau Gwent (Mr. Foot) spent a long time blaming the Government for introducing proposals to reform the NHS without a debate. There has been a massive public debate about the defects of the NHS which has spread from John o'Groats to Land's End.
  Mr. Kennedy: If the debate that the hon. Gentleman claims started in the mid-1980s was such a burning issue and a priority for the Government, why did none of that appear in the Conservative manifesto?
  Mr. Rowe: My recollection is that the manifesto contained a statement that the NHS would be reformed. That was all that was said because we were trying to work out the detail. Since then, there has been a massive public debate about the proposals, in many cases fuelled by disgraceful misrepresentation by the British Medical Association and other groups. They have used every means in their power—they had plenty of them—to misinform large numbers of our constituents by telling them considerable untruths. However, that gave us the opportunity to discuss these matters in our constituencies. It is absurd to suggest that there has not been a debate about the issues.
  In the short time that the guillotine motion allows for debate, I wish to raise a number of issues in which I have an interest. One is the suggestion to open district health authority activities to public scrutiny. As is set out in new clauses 55 and 56, it is appropriate that health authorities come under the same discipline as local authorities and hold their meetings in public and open to public scrutiny. I hope that that proposal will be considered.
  It is also important—I believe that my hon. Friend the Minister will give me some comfort on this issue—that local authorities can give, without anxiety about whether they might be breaking the law, cash assistance to the disabled to organise their own affairs. That is the ultimate
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  in consumer power, and a great deal of the Bill is designed to strengthen the position of the consumer within the system.
  I have also tabled an amendment about costs in rural areas. There is no doubt that the delivery of community care in rural areas is, in many respects, more expensive than in the inner cities. The hon. Member for Monklands, West (Mr. Clarke) will agree that one issue that we need to canvass—if not in this debate, in the wider community outside—is the whole question of advocacy. It is improper to expect confused, vulnerable, disabled and frightened consumers to take an active part in the assessment procedure unless they have someone with them who can put their point of view and help them to understand what the process is about.
  The role of the voluntary organisations, whether in the delivery of health care or community care, is absolutely central to the way that those services must develop. Unquestionably they will be major contractors. They will continue to be major suppliers. I suspect that every hon. Member has been approached by voluntary organisations that are torn between their desire to become effective members of the contracting organisations that deliver care and their wish not to lose their freedom of action and their spontaneity, by being swallowed by public providers calling the tune. That is a central issue and I am sorry that there may not be time to debate it tonight.
  The motion is reasonable, given the extraordinary lengths to which the Opposition went to make their point during the long debate in our earlier proceedings.
  5.59 pm
  Mr. Charles Kennedy: As quite a few hon. Members want to contribute to the debate, I shall be brief. One comment arises out of the latter statement of the hon. Member for Mid-Kent (Mr. Rowe). In a sense the debate on the guillotine motion resembles the debate last night on new clause 1. With the sole exception of his speech—even he expressed hesitation about it—there does not seem to have been any strong argument in favour of what the Secretary of State for Health has put forward on the guillotine motion. The Government seem to be as isolated on this mechanical issue as they were on the issue of principle about income support and residential homes.
  It is sad also that, if the guillotine is passed, there may not be proper debate on another issue where we might have had a rerun of what happened last night, which was itself a rerun of the proceedings in Committee. I refer to the question of ring fencing which has already been mentioned by the hon. Member for Macclesfield (Mr. Winterton). A proper, full-scale Report stage debate on ring fencing would probably draw out speech after speech from Conservative Back-Bench Members who would find themselves at one with Members of all Opposition parties. That would act as a useful lever on the Department of Health, if not at this stage in this House, certainly in another place. I can only hope that the signal sent last night at least on the income support issue, will find an echo elsewhere and that the Government will be forced to compromise on it.
  The attitude of the Secretary of State for Health was epitomised by a phrase used in another political age—a period of silence would frequently be much appreciated. When he became more silent on the ambulance dispute we

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  suddenly found that there was progress and a settlement. His lack of belligerence at certain times in Committee made for smoother progress than might otherwise have been the case. It was only when he could not contain himself any longer and started saying that the constructive co-operation of Opposition Members in Committee represented a cave-in on the principles of the Bill that he got people's backs up. What he said was a crude misrepresentation of what had happened.
  The Secretary of State is on extremely thin ice in trying to refer to events during the night as filibustering after the dozens of hours spent on the Bill in Committee. It was wrong of him to talk about filibustering when, in last night's debate and consistently in Committee, the proceedings were distinguished by regular contributions from Conservative Back-Bench Members, unlike proceedings on many other Bills when Government Back-Bench Members are clamped. We had constructive contributions frequently from the hon. Members for Mid-Kent, for Ealing, Acton (Sir G. Young) and for Chislehurst (Mr. Sims), who spoke to great effect in last night's debate. Other Conservative Members also contributed to the debates, so there is no basis for saying that there has been filibustering or procedural nonsense. The Secretary of State, with his Jekyll and Hyde character, could not contain himself any longer and had to get belligerent and abusive about the Opposition. We all know what happened as a result. If he is looking for someone to blame, he should look no further than himself.
  The Bill is really composed of four measures. No doubt my colleague from the Scottish National party, the hon. Member for Banff and Buchan (Mr. Salmond), would echo my view that we should have had separate Scottish legislation. For the proceedings on the Bill to be guillotined compounds the problem. Members representing Scottish constituencies cannot give the legislation proper scrutiny at the all-important Report stage when they should have an opportunity to contribute. For the Secretary of State to say at the Dispatch Box, as he did in opening the debate, that things began to go seriously wrong during the Scottish section of the debate was ludicrous. Apart from Second Reading last autumn, that was the first time that Scottish Members other than the four who served in Committee had an opportunity to speak about the impact of the Bill on Scotland. It ill behoves an English Secretary of State to criticise the Scots for time-wasting when they were taking their first opportunity to talk about the implication of the Bill for Scotland.
  I echo the comments about the need for proper timetabling procedures for legislation. Procedure could be much improved if half the legislation which takes up time into the wee small hours at Westminster was hived off to a democratically elected Scottish Parliament in Edinburgh, where it could be properly scrutinised and debated. In the words of Lord Home, which should commend themselves to a Conservative Government, we want more decisions about Scotland taken in Scotland by Scots. The farce of the guillotine and the completely inadequate way that the remainder of this flagship of Government legislation will proceed underscore the need for root-and-branch constitutional reform.
  6.5 pm
  Mr. Michael Carttiss: "Parliament exists for no other object than that of wasting time". Those are not my words, although I have frequently thought that since I arrived here in 1983; they are the words of the great-grandfather of my hon. Friends the Members for Crawley (Mr. Soames) and for Davyhulme (Mr. Churchill). Lord Randolph Chuchill said that when he was a Member of the House, albeit after the disillusionment of having resigned as Chancellor of the Exchequer from Lord Salisbury's Government when he seemed to think that the Chancellor of the Exchequer, not the Prime Minister, should run the Government. That fact remains; it was ever thus.
  I have to register my disquiet at the timetable motion which was moved by my right hon. and learned Friend the Secretary of State for Health. Visiting Parliament here at the beginning of the 18th century, Peter the Great—incidentally, he introduced the poll tax in Russia in 1717, but it did not last—[Interruption.] In response to those comments, I might also say that he was the father of the Russian navy. I happen to believe that when a ship is in stormy waters, the ship's captain should not be thrown overboard while the crew argue among themselves about who should take the helm. There might be a case for removing some of the cargo.
  I echo the comments of my hon. Friend the Member for Staffordshire, South (Mr. Cormack), already repeated in this brief debate, who said that there is too much legislation. I believe that it is my function as a Conservative to reduce government rather than have legislation all the time. There is far too much legislation and it is not examined closely and carefully enough.
  I am sorry that the hon. Member for Livingston (Mr. Cook) is not here because, reluctantly, I have to pay tribute to his speech when moving new clause 1. It was one of the most powerful speeches that I have heard on the Health Service. I found the speech of my hon. Friend the Member for Maidstone (Miss Widdecombe) in support of new clause I very moving. It was backed up by irrefutable logic when she talked about the lack of cost-effectiveness. I understood the points made by my right hon. Friend the Secretary of State for Social Security in response. I understood his difficulty and I went along with him reluctantly on the losing side in the vote.
  Mr. Rowe: My hon. Friend will agree that both those powerful speeches related to defects in the present system of delivering care which the Bill is trying to improve.
  Mr. Carttiss: I wonder how many other defects in the present system could have been talked about to the benefit of the Bill if we had had more time. I am sorry that my right hon. and learned Friend the Secretary of State for Health, who moved this deplorable motion, is not present in the Chamber to hear my remarks. Of course, I understand that he has been on duty all night. However, I cannot agree with his comments about the debate on the Scottish parts of the Bill.
  I was present in the Chamber for most of that debate. Although I did not agree with Opposition Members, I do not believe that they can be accused of being particularly long-winded. They had points that they wanted to make, and they made them. Although the charge of long-windedness might be more attributable to Welsh Members, I do not believe that any of them were wasting

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  time when they debated Welsh issues in the Bill. I did not agree with my right hon. and learned Friend the Secretary of State when he referred to the Scottish and Welsh parts of the debate as though they were a waste of time. There is not much point sitting through the night on these matters. Indeed, I am not anxious to sit through the night once more and possibly lose my Adjournment debate on Thursday on the uniform business rate in the way that my hon. Friend the Member for Torridge and Devon, West (Miss Nicholson) lost her Adjournment debate earlier today.
  Doctors who make life-and-death decisions will be working all through the night this week—they did so last week and they will do so again next week. We are introducing proposals to change their working conditions radically. The least that we should be prepared to do is to give four days and, if necessary, four nights to what the right hon. Member for Blaenau Gwent (Mr. Foot) has already described as the most radical reform—which I support—of the Health Service since its establishment.
  I am glad that I am not a Parliamentary Private Secretary. However, my brief sojourn as deputy for my hon. Friend the Member for Croydon, North-West (Mr. Malins) assisting my hon. Friend the Minister for Health has not deflected me from voting according to how I think. I believe that it is a disgrace that discussion on the Bill has been cut short.
  As the hon. Member for Monklands, West (Mr. Clarke) said, there were nearly 250 amendments to the Bill. It cannot be right to try to squeeze those in during such a short time. My hon. Friend the Member for Staffordshire, South (Mr. Cormack) made some interesting observations about the way in which we should timetable our business and that point often crops up. My hon. Friend the Member for Lancashire, West (Mr. Hind) raised a point of order in which he explained that if we did not debate the guillotine motion we could spend more time discussing the Bill. My hon. Friend the Member for Lancashire, West has now left the Chamber. However, the fact remains that not taking time discussing whether we should be cutting short consideration of an important piece of legislation negates the parliamentary democracy that we are here to defend and support.
  A very high-powered Cabinet committee was rightly chaired by my right hon. Friend the Prime Minister. She showed her absolute commitment to an improved National Health Service which provides care free at the point of delivery. In parenthesis, I must state that I am sorry that we do not provide eye tests and dental inspections free at the point of delivery, too. If we had had time, perhaps I would have moved an amendment to that effect.
  When a Government are temporarily on the ropes, coming back for a knock-out blow that will floor Opposition Members at the general election to which the hon. Member for Livingston referred earlier, it is a good idea to come out fighting. The Government should not say to the referee, "Let us cut out the next 10 rounds."
  We have a first-class coast—I am sorry, I meant to say first-class case. I always talk about the coast because that is where I come from and I never miss an opportunity to refer to that excellent place. We have a first-class case for National Health Service reforms and the community care legislation.
  The James Paget hospital that I share with my hon. Friend the Member for Waveney (Mr. Porter)—whom I
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  am delighted to see in the Chamber now—has suffered particularly from the system of financing hospital services that dates back to a Labour Government. That system of financing hospital services penalises the efficient provider. By catering for far more patients than it is financed for, the James Paget hospital must cut beds and operations at the end of each financial year. It is a victim of the system of financing hospital services which the Bill will help to correct with its proposals for self-governing trusts and the policy of ensuring that funds follow patients.
  I have received many more letters over the past two years about the National Health Service reforms than about any other issue since I became an hon. Member. Opponents of Sunday trading sent me the second highest number of letters and the community charge, although generating a lot of mail, by no means compares with the concern expressed in numerous letters about the NHS, from patients, elderly people and doctors in my constituency.
  Earlier I went off at a tangent and declared my allegiance to my right hon. Friend the Prime Minister whom I regard as second to none. I was about to refer to the fact that for a year a Cabinet committee considered ways of improving what Opposition Members must admit is a service that needs significant improvement. Those improvements are not achievable just by pouring more money into the service.
  We all agree that the NHS should be improved. That high-powered Cabinet committee deliberated for a year and produced a White Paper in January 1989 entitled "Working for Patients". After a year of video performances the like of which have never been seen before—I cannot imagine what Lord Randolph Churchill would have thought of them—there has been a massive consultative campaign. However, we are now told that, because we had two days on Second Reading and many hours in Committee, we should limit ourselves now to a two-and-a-half day debate on Report and Third Reading of this vital legislation. We could win many arguments in the debates if we were prepared to have them here where they should take place.
  Reluctant as I am to join Opposition Members, particularly in view of the behaviour of a handful of them at the end of this morning's proceedings, I must vote against the timetable motion, because in reply to all the letters that my constituents have written to me, and having advanced the reasons why I consider that my right hon. and learned Friend the Secretary of State is right to want to reform the National Health Service, I have told my constituents that in the Houses of Parliament there will be the opportunity to move, consider and debate amendments to the legislation. Even if I do not agree with Oppostion Members, we should debate the points that they raise in the Chamber. If not here, where else?
  If we have a debate of only two and a half days limited by the guillotine, I cannot honestly face my constituents and say that amendments to and consideration of this important Health Service reform have received the time that my constituents have every right to expect.
  6.20 pm
  Mr. Bob Cryer: I shall be as brief as possible. I have tabled an amendment to the allocation of time motion which simply extends the time on the first day, that is today, for an hour. It is a gesture for all those

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  wavering Conservatives who will go into the Government Lobby with what they describe as a heavy heart. If they have the chance to vote, they can give us at least another hour without going boldly and courageously into the Opposition Lobby, as the hon. Member for Great Yarmouth (Mr. Carttiss) said that he would. He is scandalised by the way in which this elective dictatorship guillotines parliamentary and, indeed, party rights.
  The Secretary of State alleged that new clause 4 was the subject of delay. Four Members could not speak in the debate on that new clause, because the Government moved the closure. It was an important debate about proper, adequate and democratic consultation on the opting-out procedures for hospitals, which will affect so many of our constituents. To suppose that such a major item could simply be disposed of in two or three hours is to live in cloud cuckoo land. Every constituency is affected by the proposals for opting out, either now or in the future.
  I wanted to speak to new clause 4. The Westwood hospital for the mentally handicapped in my constituency is set in beautiful rolling acres. A trust is being set up by some officials without the consent of the staff or people in the area. A tiny clique of politically motivated people are setting up the hospital to become a self-governing trust. I believe that they intend to sell off the land to property developers because the hospital is set amidst many rolling acres of great value.
  The legislation now involves capital charges and a capital register. It will propel even people of good will who want the NHS to succeed and do not wish to shift out of it through the opting-out proposals to examine their capital assets with a view to flogging them off. In the case of the NHS, valuable potential development sites may be sold.
  I wished to speak in the debate, but I and three other hon. Members could not do so.
  Mr. David Hinchliffe: Five hon. Members.
  Mr. Cryer: Yes—in total, five hon. Members could not speak in the debate. They all had genuine reasons for wishing to participate. That shows the falsehood of the Secretary of State's suggestion that there were attempts to delay the legislation.
  Other new clauses will inevitably be curtailed by the fearsome guillotine motion. One deals with controlling excessive charges by private hospitals. We do not like the principle of the Bill, but the Opposition have to make a decision. It is a fairly grey area. Should we continue to oppose the principle or try to ameliorate the worst effects of the legislation by attempting to inject accountability?
  We are trying the latter course, but we have been denied the opportunity to pursue that course, not because we have taken a long time but because of the Government's absolute determination to cram the legislation through Parliament just as they have crammed Bill after Bill through the House.
  The Clerk's Department and Hansard are overloaded with work. Hansard Committee reports are being delayed because the whole system is strained by this wretched Government trampling on parliamentary rights. Not only Opposition Members take that view. Several Conservative Members have seen how the legislature is being abused. I shall not take up too much time telling you about it, Mr.
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  Deputy Speaker, but the Government are overstretching the House not only in primary legislation but in secondary' legislation. They pour out more statutory instruments than the Labour Government did. The Government are trampling through the legislature powers to enable Ministers to produce delegated legislation. The Minister for Health smiles. I inform her that such pieces of legislation now exceed 2,500 a year. Often they have criminal sanctions, which are signed and authorised by Ministers. Inadequate time is provided on the Floor of the House to deal with delegated legislation. Parliament is stretched and strained. It is time that we re-examined secondary legislation, because the Government have abused the system.
  We should have had time to debate private hospital charges. When the business statement was made, I suggested that the guillotine motion should include a little time for us to discuss the fact that some 22 Conservative Members have shareholdings in medical concerns that seek to make a profit out of people's pain and suffering. That is what it boils down to. I suggested to the Chief Whip that it would be handy if we had some time set aside to examine how P and O, British and Commonwealth Holdings, Trusthouse Forte and BET have all put their dirty fingers into privatisation. Such companies have given £1 million to the Tories since 1983. We should put that on the record to show that some hon. Members' votes are not as objective and neutral as might be supposed.
  New clause 8 deals with junior doctors. It would limit their week to 72 hours to give them an easy time.
  Mr. Nicholas Winterton: Easier.
  Mr. Cryer: I was being ironic. I know that I should not be ironic, because irony does not show in Hansard. The hon. Gentleman is right. I should have said "an easier time." Junior doctors are strained beyond endurance. Life and limb is at risk. On Boxing day, I joined a group of junior doctors outside Bradford royal infirmary who were demonstrating that they were reaching the point of going beyond endurance. I expect that other hon. Members met doctors in their constituencies on the same day. The doctors told me that lives are at risk.
  I feel slightly seedy today because I have not had any sleep during the past 24 hours, but junior doctors go without sleep for two or three nights. They deal with the most intricate—
  Mr. McCartney: Parts of our body.
  Mr. Cryer: Well, human beings are the most intricate items on our planet.
  The skill and dedication of doctors is a rare combination, yet we inflict such long hours on them. I wanted to debate new clause 8, because I had discussed the difficulties of junior doctors with those whom I met that day. It is because of the Government's action that junior doctors have to endure that penance for their professional determination. The new clause was another opportunity lost because of the Government's attitude of elective dictatorship. That phrase was used by Quintin Hogg about the Labour Government, who did not have a Labour majority. Yet a Government with an overall majority of 150 is abusing their powers in parliamentary legislation. It is time that that was stopped. I hope that many Members, including Tory Members, will vote against the guillotine motion.
  6.29 pm
  Mr. Peter Thurnham: The hon. Member for Bradford, South (Mr. Cryer) added little to the debate. Whenever he is on his feet, he seems to compete with junior doctors to see who can work the longest hours.
  The hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) compared my right hon. and learned Friend the Secretary of State to Jekyll and Hyde, but surely the comparison is more appropriate for the hon. Member for Livingston (Mr. Cook). In yesterday's debate, which I think we all felt was a good debate, he started by saying:
  "I stand at the Dispatch Box under the novel burden of speaking to a new clause that has attracted the signatures of more than 30 Conservative Members. I respect their support, in return for which I shall seek to be as non-partisan as it is possible for me to be. I may have to compensate later tonight for that non-partisan spirit."—[Official Report, 13 March 1990; Vol. 169, c. 197–8.]
  The hon. Gentleman is the Jekyll and Hyde; that is the reason why we are having to debate the guillotine motion now, which we are all sorry to debate, to curtail the Bill, which is what we want to discuss as it contains so many important issues. This gives us a chance to consider the important matter of how the House does its business.
  My hon. Friend the Member for Staffordshire, South (Mr. Cormack) commented on the work of Committees. Amendment No. 158 is tabled in the name of my hon. Friend the Member for Gedling (Mr. Mitchell). Perhaps I can remind him of the book "Lobby Fodder" written by the former Member for Gedling, Sir Philip Holland, shortly after he left the House. In it he referred to the history of Standing Committees and said that the original Standing Committees had a membership of only one. That must be the way to proceed rapidly in Committee. There is certainly no opportunity of waffling.
  Amendment No. 158 refers to the need for the Audit Commission to have greater involvement. On Second Reading, I pressed for greater involvement of the Audit Commission. I was aware from constituency experience of the need for the Audit Commission to look at the costs and quality of service provided in community care. Bolton faces a crisis in community care because of a £440,000 shortfall in funding for the neighbourhood network homes. I am pleased that the Under-Secretary of State is shortly to visit Bolton, when I hope that he will have an opportunity to look into that. I should have liked time to discuss these problems and how the Audit Commission should address them.
  The North-West regional health authority is fixed with a model for how community care should be conducted. It says that the dowry of £18,900 a year which it provides is perfectly adequate to care for people and to provide a reserve, so that those who cannot go into institutions, as they would have done in the old days, can also be cared for. The costs in Bolton are working out much higher, at £22,000 a year, so there is no spare provision to take people in, although there is a desperate need for that facility.
  I should like the health authority to consider alternative models. I have pressed for the chairman to visit Brookvale in the neighbouring constituency of Bury, South and see the high standard of care provided there, on a larger scale than neighbourhood network homes, but at a lower cost. It provides the ample therapy services which are so badly needed, within a total cost of £10,000 a year. Admittedly
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  the capital facilities are provided by voluntary donations. I should like to see a similar facility in Bolton, where is desperately needed as it has an historic lack of provision.
  It has not been possible to provide people with care in Bolton, and they have had to be moved elsewhere. Parents, some of whom are frail and elderly, are at their wits' end, unable to care for children who are now in their twenties. They are looking for the provision of those services in Bolton. I should have liked time to discuss that need and the reason for the Audit Commisssion to look closely into why there should be such variations in costs.
  Why should the costs be so high for Bolton's neighbourhood network homes when they are so much lower in Brookvale, where the standard of care is so high? The regional health authority says that there is a cushion for costs in its figure of £18,900. If that is so, what is it, and is it adequate to meet the great demand for care from families who need respite services and daytime therapy services? I am disappointed that the debate developed in a partisan way, as the hon. Member for Livingston clearly wanted. It has denied us the opportunity to discuss many of the positive aspects of the Bill and the need for the Audit Commission to look at a whole range of factors in the NHS and community care. For all of us, the Health Service must be a priority issue in our constituency. Clearly, in the next year or two, community care will have a high priority while we work out how the new arrangement will come into place.
  I welcome yesterday's debate. I should like more occasions like that and fewer when we are forced to debate a timetable motion to save us sitting up all night. Such behaviour is little understood by the public, who want us to discuss the meat of the issues.
  6.35 pm
  Mr Jim Cousins: The problem facing the House goes right back to the Bill itself. It puts a whole range of new bits of political and institutional machinery in place, but it does not spell out how they are to be used or paid for. That is why, after four days of discussion of community care in Committee, we identified two central issues, both of which have to do with money, as the hon. Member for Macclesfield (Mr. Winterton) pointed out. One related to income support rates, which are a basic building block of the system, and the other to ring-fencing grants. Yesterday evening we spent a further five hours debating income support rates. I doubt whether a single Member feels that even that issue has been sorted out. As the hon. Member for Macclesfield says, we shall not reach ring-fencing.
  Other issues emerged in Committee. On the last day we found that these NHS contracts could, through the back door of the medical negligence system, have some legal status. We were wholly unable to explore the implications of that, although that important point, which also leads back to cash, was there to be resolved.
  We discussed the issue of planning agreements, which is the Government's term for the connections between health services and local authority social services. We were unable to establish in Committee how that system was to be put in place. The Under-Secretary of State for Wales kindly offered a little note that he had done to clarify the position in Wales, but we were not told how the system would work in England.

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  Then we had the whole business of NHS contracts. Throughout the Committee stage we pressed for examples to show what those contracts would be like, so that we could see the new creature and sniff it. Finally, the document emerged after the Committee stage was concluded. That is why many more important issues must be discussed and why there are all these new clauses and amendments.
  The Secretary of State made a truly remarkable speech starting at 6.45 am. The bluster to which we have become accustomed was there in his style, but the language was entirely of retreat. Markets were out, prices were out and commerce was out. The whole language of the new system that we have spent many months discussing—all of that was out. The whole thing was going to be need-driven and quality-driven. We discovered that the entire financial system of the NHS that had been rejected was to come back in. In a series of throwaway remarks we discovered that there would be safety-netting for the teaching hospitals, that there would be a special deal for London, that there would be a whole series of special procedures to deal with matters that, having been bundled out through the front door, would be brought back in through the back door. And all that we learnt at a quarter to seven this morning in a speech that lasted for an hour.
  The interesting thing is that, because of the guillotine, we shall now be unable to explore with the Secretary of State the implications of those very important remarks. Was this a U-turn, or was it simply a giddy fit brought on by the hour? We shall never know. Possibly the Secretary of State himself does not know. Had we had an opportunity to explore the new clauses and the other amendments, we—the Secretary of State and the whole House together—might have clarified the position. With our assistance, we might have learnt what he thought. But we shall not now have that opportunity.
  It is interesting that as the Secretary of State was speaking at a quarter to seven this morning I was receiving a message that ward 1 of the Royal Victoria infirmary in Newcastle is about to close. The unit general manager at the hospital is assuring the world that the patients in ward 1, some of whom are seriously ill, could become day patients. That is care in the community with a will.
  That brings me back to the fundamental point: will we have an NHS that is refocused on the new needs that all of us, on both sides of the House, are now willing to recognise? I refer to the needs of the disabled and the elderly—needs that go not so much with life itself as with the quality of living. Are we to build on that? Shall we meet those needs by an entirely new means and drive the cash forward on that basis, or shall we go back to the old system of cash limits? This we do not know, and at a quarter to seven this morning the Secretary of State himself was somewhat confused. Perhaps, given the time, that was understandable.
  The debate about whether the NHS is to be need-driven or cash-controlled, and about what are to be the priority issues—elective acute surgery or the problems that I have just described—will continue. Those issues will remain to be resolved. The Secretary of State, by this guillotine and by other measures, may eventually get his Bill. He may have all these institutional toys to play with, but it is clear
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  that he has no answer to our question. However, as my hon. Friend the Member for Livingston (Mr. Cook) said, the people have the answer, and they will decide.
  6.42 pm
  Mr. Kenneth Hind: I am grateful for the opportunity to intervene briefly in the debate. It has been obvious to all hon. Members on the Government side that progress during the Committee stage of this Bill was excellent. The issues were being discussed. But then my right hon. and learned Friend the Secretary of State for Health made a remark that Front-Bench members of the Opposition interpreted as criticism of their handling of the position. They did not want to give their trade union paymasters and supporters outside the impression that they were fighting in Committee on a trench warfare basis; they wanted to give the impression that they were fighting a fierce battle. But what we saw after 10 o'clock last night was nothing more than an attempt to filibuster and, for the benefit of people outside, to place on the Government the blame for the shortage of time. Opposition Members have been trying to indicate that they are fighting this Bill much harder than they really are.
  Mr. John Battle: Will the hon. Gentleman give way?
  Mr. Hind: I will give way in good time. No doubt the hon. Gentleman will get his chance.
  As I looked round the Chamber earlier, it was clear that everybody wanted to debate the issues that are contained in the thick bundle of amendments, which no doubt we have all read carefully. But last night we had a filibuster. We had a two-hour debate on the changing of boundaries. We had a debate about matters in Scotland. We had debates about all sorts of things, including a speech of one hour and 48 minutes by the hon. Member for Livingston (Mr. Cook) who, no doubt, was trying to restore his reputation as a doughty fighter for the Health Service. I am afraid that it came too late.
  To me and, I think, to my colleagues it is very sad that if the obvious had not had to be recognised at 4.15 pm today by a decision that the filibustering tactics—the attempts to prevent reasonable debate on many of the items in these amendments—should be ended, we could have had an extra three hours' debate on many of these important issues. But that was not to be. When the hon. Member for Livingston gave way to me, I gave him an opportunity to agree with that. But he was not prepared to accept the inevitable; he wanted to carry on and to state his objections. Consequently, as was pointed out by the hon. Member for Newcastle upon Tyne, Central (Mr. Cousins), we have been denied the opportunity to deal with the issues of junior hospital doctors, contracts with private hospitals, registers of private contractors, joint financing, contracts of competitive tendering, and the provision of residential care. These are all items contained in this bundle of amendments which, with reasonableness on both sides, could have been debated more than adequately in two and a half days. Now the Opposition do not accept the two and a half days that was agreed through the usual channels, whereas at the beginning they did agree. Now their supporters outside are asking them why they agreed to a timetable, and they have had to demonstrate their parliamentary virility by fighting these matters tooth and nail.
  Mr. Allen McKay: Let me point out, for the hon. Gentleman's information, that there was no agreement. Secondly, in two and a half days there are 60 hours, not 17 hours.
  Mr. Hind: Clearly the hon. Gentleman and the Government Whips are in dispute over that agreement.
  It is a matter of deep regret that, because of last night's tactics, we are being denied the opportunity to debate some of these matters. I am afraid that last night the House of Commons, in the eyes of the public, did itself no good. The public will have seen for the first time the kind of tactics that lead to the need for the guillotine. I hope that they will recognise that, unfortunately, the guillotine is occasionally necessary. I shall go into the Lobby tonight to vote for this guillotine because I know that, by doing so, I can guarantee that, from this point, there will be a sensible debate on important issues.
  6.48 pm
  Mr. Alex Salmond: Daily, the House of Commons does itself no good in the eyes of the public. Last night was one of the few occasions when it has done itself some good in the eyes of the public.
  I shall be brief because other hon. Members will wish to take their only opportunity to comment on the remainder of the legislation. I wish to refer to the arrogance with which the Government have presented the guillotine. The Patronage Secretary and the Secretary of State said that the reason for the guillotine was a breakdown between the usual channels. What commitments were given, if any, is a matter of dispute. For many parties, never mind Members, the usual channels are irrelevant. We are not party to discussions between the usual channels. The Government's argument that we must be punished and denied our rights to comment on part of the legislation because they believe that there has been a breakdown between the usual channels is the ultimate insult to Members who are not responsible for the secret backroom deals between the two Front Benches.
  The hon. Member for Livingston (Mr. Cook) referred to the procedure that we are asked to authorise, whereby some 100 Government amendments will be taken together, thus depriving us of the right not only to debate them but to vote on them.
  There is another pernicious aspect of the guillotine which is without precedent—the nomination of seven favoured amendments among the 100 or more on the amendment paper. The Government, by some mysterious process, have chosen seven amendments to push through without debate. I should like them to say exactly how those seven amendments were chosen. What was wrong, for example, with new clause 72, tabled by my hon. Friend the Member for Angus, East (Mr. Welsh)? Was there any discussion on the Government Front Bench as to why that modest measure should not be given the favoured treatment given to the seven other amendments? That new clause provides for a commission to offer protection, in terms of quality control of community care in Scotland, for the most vulnerable sections of the community—the mentally handicapped.
  Obviously the force of the argument behind the sever. amendments cannot have caused the Government to accept them, because no argument will be deployed.
  Mr. Battle: New clause 12 has also not been chosen, It concerns last night's debate on residential homes and income support. The Minister promised us that we should return to that issue today. Is he afraid to have such a debate because the Government would suffer the same defeat today as they suffered last night on that issue?
  Mr. Salmond: The point is well made, and I well understand why the Government are frightened. Even in this debate on the guillotine motion, few Conservative voices have been raised to defend the truncation of debate.
  Scottish Members have long since lost the right to decide. On one Bill after another, we have expressed our view of what we believe and what we have learnt from our experience but have found that view swamped by English Members who often, with one or two honourable exceptions, do not even listen to Scottish debates. There is no better example of that than the poll tax legislation, when even the English Tory rebels did not vote against the Scottish legislation because they were not there to hear the arguments. We have lost the right to make decisions on legislation affecting Scotland and we are increasingly losing the right to debate it.
  The Bill is an example of Scottish and English legislation being coupled together denying Scottish Members the opportunity to make their points. We are increasingly losing the right even to register our protests on particular aspects of the legislation. What is so pernicious about the guillotine motion is that Scottish Members will not even be able to register their opposition to specific Government proposals or their support for specific Opposition amendments. That is not only intolerable and insupportable—I suggest to the Government that it will not be accepted by the Scottish people.
  6.54 pm
  Mr. James Couchman: I have only about a minute in which to make a quick point. As a member of the Standing Committee, I remind the House that this important Bill has been discussed in Committee, line by line and clause by clause. I hope that no one will suggest that the Opposition's antics to force the guillotine on us means that the Bill will not have been properly considered in the House. It has been properly considered.
  The hon. Member for Livingston (Mr. Cook) knows precisely why he has chosen his tactics on Report. The hon. Member for Barnsley, West and Penistone (Mr. McKay) talked of 60 hours being two and a half days, but he knows that that was a delusion. He knows what parliamentary days are because he is a very experienced Member. He should not deny that there were discussions between the Front Benches on how long the Report stage should last—[Interruption.] The hon. Member shakes his head, but I have seen letters written by an hon. Member who is sitting on the Labour Front Bench which expressed that conclusion.
  6.55 pm
  Ms. Harriet Harman: The guillotine motion is simply a Government attempt to extinguish debate on this most important of Bills. It is a fitting, if grubby, end to the Bill's passage through the House of Commons. The Government's conduct has been marked from the outset by obstinacy and irrationality. I should like to remind the House of the genesis of the Bill—in a cash crisis in the

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  National Health Service. Instead of responding to public opinion and the demands that the Government should invest sufficient resources in the Health Service to end the waiting lists and rebuild crumbling hospitals and community services, the Government's response was to set up a review. It was a closed review, undertaken by people with closed minds behind closed doors. There was to be no consultation. The Government were not prepared to enter into a debate.
  The White Paper was published with the announcement that there was to be consultation on the detail. The Government were not prepared to talk to anyone who had anything to say, except those who could suggest how to make these unworkable plans workable. They talked only to people who would agree with them. Even the presidents of the royal colleges were sent packing. The Bill and the White Paper were deeply unpopular among people who worked in the NHS and above all, among the public. That was the case in every region, in Scotland and Wales and among people from all walks of life.
  The Government's response to public opinion was to embark on a campaign of smears and misrepresentation.
  Dame Elaine Kellett-Bowman: No.
  Ms. Harman: Yes.
  Mr. Couchman: On a point of order, Madam Deputy Speaker. The House should know also of the smears offered by the hon. Member for Peckham (Ms. Harman) in her bogus press releases which were issued throughout the land—
  Madam Deputy Speaker (Miss Betty Boothroyd): Order. I thank the hon. Member very much, but that is nothing to do with the Chair.
  Ms. Harman: I was interested to hear the hon. Member for Gillingham (Mr. Couchman). What he says certainly does not agree with what the Secretary of State would have us believe, which is that the Committee stage was uncontroversial. Perhaps I could tell Members who were not on the Standing Committee that those press releases merely informed the constituents of members of the Committee of their representatives' actions to damage the the Health Service.
  The Government's response to the overwhelming tide of public opinion against the Bill was a campaign of smears and misrepresentation. Let me remind the House of those misrepresentations: that people who were opposed to the Bill must be stupid—they did not understand the Bill; that people who were opposed to the Bill must be dishonest—they understood the Bill but misrepresented it; or that people who were against the Bill must be reactionary and against any change in the Health Service.
  The Government tried to back up that campaign of smears and misrepresentation with £2 million-worth of public money spent on videos, travelling road shows and leaflets to try to dislodge from the public's mind its conviction that the Bill's proposals were profoundly against the public interest.
  Mr. Nicholas Bennett: Will the hon. Lady acknowledge that the reason why Labour filibustered and disrupted the House last night was that its paymasters in
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  COHSE and NUPE were unhappy with the Opposition for not fighting the Bill in Committee, and gave orders that they had to do so last evening?
  Ms. Harman: If the hon. Gentleman was really in touch with the views of voluntary, patient and medical organisations, and with the relevant unions, he would know that they cared as desperately as we did that we should not play into the Government's hands and risk having vital clauses on community care guillotined. We had the support of all those organisations.
  The opportunity was presented on Report for right hon. and hon. Members representing constituencies in Scotland and Wales who did not serve on the Committee but whose constituents are crucially affected by the Bill to make their contributions. Much has been said about the speech of one hour 40 minutes made by my hon. Friend the Member for Livingston (Mr. Cook), but the speech of the Secretary of State lasted one hour 10 minutes. When the Government's campaign of smear and misrepresentation failed, they resorted to cynical assurances and promises that they never intended to keep.
  Mr. McCartney: I thank my hon. Friend for giving way to me, as a Member of Parliament representing a constituency in the north-west that is also affected by the Bill, and who has also been denied an opportunity to participate in the debate.
  There is before the House a report by the Select Committee on Social Services which was prepared especially for the Bill's Report stage, but which has not yet been debated, despite attempts by members of that Select Committee over the past two days. The Secretary of State has made no attempt whatsoever to introduce that Committee's recommendations into the debate.
  What are we to do if the topics coverd by that report are guillotined out of debate tonight? What is to be done if the work of the Select Committee can be so positively ignored after it has been directed by the House to prepare a report for specific consideration at the Report stage of a Bill?
  Ms. Harman: My hon. Friend is absolutely right. The guillotine will prevent the House from hearing the views of members of that Select Committee and from voting on an amendment from those hon. Members that has been selected by Mr. Speaker. The Government are anxious to impose the guillotine because it will serve as a fig leaf to cover the Government's trail of broken promises and abandoned assurances that was exposed in Committee. We are to be denied an opportunity to insert into the Bill any of the safeguards promised by the Government.
  Last night, the House was given five hours to debate income support. It voted to give protection to the elderly, but it will not have an opportunity to register a similar vote in favour of safeguarding patients who will lose because of the cash limits on drug budgets. Nor will right hon. and hon. Members be allowed to vote on the cash limits on practice budgets, which will also severely harm patients.
  The House will be denied an opportunity to write into the Bill the safeguard that patients should have access to local services, or the Government's promise that patients will have a choice of hospitals. Right hon. and hon. Members will not be allowed to vote on the provision of adequate funds for making care in the community a reality. Nor will the House be able to write into the Bill the choice for people entering residential care of whether that care will be in the private or public sector.

  535
  The Report stage should give right hon. and hon. Members a chance to participate in debate on important issues on the Floor of the House if they were unable to do so in Committee. The guillotine denies them that opportunity. By doing so it also denies their constituents a voice in a matter of great importance to them. For the Government to take that action when they have no mandate to do so, and when there has been no consultation, is a stain on Parliament and on the Government. We shall vote against the guillotine.
  7.4 pm
  The Minister for Health (Mrs. Virginia Bottomley): By the time this 62-clause Bill leaves this House, we shall have completed 160 hours of debate. It is an important Bill and one about which right hon. and hon. Members feel deeply, and I shall respond to many of the points made during the debate on the timetable motion.
  The hon. Member for Livingston (Mr. Cook) argued that no accommodation had been made for many of the points raised in Committee. I dispute that assertion, because many of the suggestions made in Committee have been incorporated. The hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) asked for consultation with the medical practices committee before it is given directions, and two Government amendments to that effect have been tabled today.
  My hon. Friend the Member for Tayside, North (Mr. Walker) sought to extend the definition of pharmaceutical services, which is also covered by one of the Government amendments that will be allowed today. Incidentally, I appreciated the remarks of the hon. Member for Ross, Cromarty and Skye concerning the value of many contributions made by right hon. and hon. Members in all parts of the Committee. Certainly my hon. Friend the Member for Ealing, Acton (Sir G. Young) made a very forceful contribution. He spoke of the importance of consultation on community care plans, as did the right hon. Member for Manchester, Wythenshawe (Mr. Morris).
  It was pointed out that my hon. Friend the Member for Stirling (Mr. Forsyth), who is well known for his enlightened and benevolent social policies, had written into the Bill a requirement to consult to safeguard the interests of the disabled and the vulnerable. That is contained in an amendment tabled by my hon. Friend the Member for Acton which will be supported.
  The hon. Member for Monklands, West (Mr. Clarke) spoke of the importance of the Audit Commission, and that point was also taken up by my hon. Friend the Member for Gedling (Mr. Mitchell). Again, we have taken note of the views expressed in Committee, and such a provision will be included in the Bill. My hon. Friends the Members for Daventry (Mr. Boswell) and for Tayside, North produced clauses on charitable trust funds, which were also accepted by the Government. My hon. Friend the Member for Acton raised the question of university medical academic staff, and his proposals will also be reflected in the Bill.
  One proposal made in Committee that it has not been possible to translate into an acceptable amendment at this stage was from my hon. Friend the Member for Mid-Kent (Mr. Rowe) for a cash payment for the disabled. I anticipate that such a provision would meet with the approval of the right hon. Member for Wythenshawe. The
  536
  suggestion that there should be a system of empowerment certainly received the support of the hon. Member for Monklands, West in Committee. We shall return to that point with an amendment at a later date. As to the establishment of a complaints procedure, we also agreed to an amendment which will be incorporated in the Bill at a later stage.
  The question of improving assessment was raised several times in Committee, as was the desirability of linking housing and health services. Again, at a later stage we shall introduce amendments covering precisely those aspects.
  The hon. Member for Workington (Mr. Campbell-Savours) raised the question of the transfer of staff between the National Health Service and local authorities. Again, we shall be bringing forward proposals in that area.
  I hope that my right hon. and hon. Friends and Opposition Members will feel that we have responded to a great number of the concerns expressed in Committee. As was made clear then, much of the advice and guidance that has been made available is now being translated into further guidance for the benefit of local authorities and others.
  Mr. McCartney: The Minister refers to the advice and guidance that is being taken up. Will she give an assurance that when the Bill goes to another place it will incorporate amendments reflecting the recommendations in the Select Committee on Social Services report?
  Mrs. Bottomley: The hon. Gentleman will know that we shall be responding to the Select Committee report. Resources are important, and we have made it clear throughout that adequate resources will be made available. Detailed discussions are taking place between the Department of Social Security and local authorities about the precise nature of the resources. However, it is a misunderstanding of the importance of community care to think that it depends only upon the size of the cheque book. We are seeking to establish assessment, community care plans and inspection units—a framework of care for the frail and the vulnerable which will translate and transform the position of many people who in the past had only the perverse incentive of residential care rather than the range of support in the community for which many hon. Members have campaigned for so long. It is outrageous for hon. Members to argue, as some have today, that there are somehow two Bills which are not closely related. For how long were hon. Members arguing that it was time for the Government to produce proposals implementing the Griffiths report? We now have an ideal opportunity to ensure that people can benefit from enhanced care, better quality patient care and more efficient and effective services in the Health Service and in the community as it is enormously important that local authorities have the opportunity to take up that challenge.
  Returning to the points raised by hon. Members, my hon. Friends the Members for Staffordshire, South, (Mr. Cormack) and for Macclesfield (Mr. Winterton) and the right hon. Member for Blaenau Gwent (Mr. Foot) all spoke about procedure and the use of timetable motions. I shall of course ensure that my right hon. and learned Friend the Leader of the House is made aware of those concerns and thoughts.
  My hon. Friend the Member for Mid-Kent asked particularly about new clauses 55 and 56 on access to

  537
  information. Although we cannot meet those precise proposals at this stage, we support the objective of openness. The precise nature of the local authority arrangements compared with health authority arrangements are not entirely transferable, but we hope to incorporate some of the ideas in guidance.
  My hon. Friend the Member for Great Yarmouth (Mr. Carttiss) spoke warmly about the health proposals and the implications for hospitals such as the James Paget hospital in his constituency. Many hon. Members feel most strongly that under the new system of money following the patient virtue should be rewarded, and that by having a virtuous circle rather than a vicious circle we shall be in a much better position to provide the care that we of all Governments have provided the resources to achieve.
  The hon. Member for Bradford, South (Mr. Cryer), speaking to his amendment, mentioned the concerns of junior doctors and new clause 8. There has been considerable progress in reducing the hours that junior doctors work, but we are determined that all those involved in the deployment of junior doctors—the consultants, the doctors, the royal colleges and the management—should make further improvements in the hours worked by junior hospital doctors, but the hon. Gentleman will understand that we cannot support his amendment.
  A timetable motion is always regrettable. However, we have had a lengthy and detailed debate on the Bill. Our discussions in Committee have not properly been recognised for providing many constructive and detailed opportunities to examine the clauses line by line resulting in a number of changes and developments which we are incorporating into the Bill. It is a major Bill which provides a major opportunity to ensure that patients are better cared for and that the endeavours of those who work in the Health Service are properly rewarded and that often monopolistic and monolithic health services are devolved and made responsive to patients. It provides general practitioners with an opportunity to influence far more closely the care that they provide for their patients, and, above all, it is a patients' charter.
  It being three hours after the commencement of proceedings on the motion, MADAM DEPUTY SPEAKER put the Question necessary for the disposal of them, pursuant to Standing Order No. 81 (Allocation of time to Bills).
  Question put, That the amendment be made:—
  The House divided: Ayes 214, Noes 292.

  Division No. 123]

  [7.14 pm

  AYES

  Abbott, Ms Diane

  Bermingham, Gerald

  Adams, Allen (Paisley N)

  Blair, Tony

  Allen, Graham

  Blunkett, David

  Alton, David

  Boateng, Paul

  Anderson, Donald

  Boyes, Roland

  Archer, Rt Hon Peter

  Bradley, Keith

  Armstrong, Hilary

  Brown, Gordon (D'mline E)

  Ashton, Joe

  Brown, Nicholas (Newcastle E)

  Banks, Tony (Newham NW)

  Buchan, Norman

  Barnes, Harry (Derbyshire NE)

  Buckley, George J.

  Barnes, Mrs Rosie (Greenwich)

  Caborn, Richard

  Barron, Kevin

  Campbell, Menzies (Fife NE)

  Beckett, Margaret

  Campbell, Ron (Blyth Valley)

  Beggs, Roy

  Campbell-Savours, D. N.

  Beith, A. J.

  Carlile, Alex (Mont'g)

  Benn, Rt Hon Tony

  Carttiss, Michael

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

  Cartwright, John

  538

  Clark, Dr David (S Shields)

  Kirkwood, Archy

  Clarke, Tom (Monklands W)

  Lamond, James

  Clay, Bob

  Leadbitter, Ted

  Clelland, David

  Lestor, Joan (Eccles)

  Clwyd, Mrs Ann

  Lewis, Terry

  Cohen, Harry

  Livingstone, Ken

  Coleman, Donald

  Livsey, Richard

  Cook, Frank (Stockton N)

  Lloyd, Tony (Stretford)

  Cook, Robin (Livingston)

  Lofthouse, Geoffrey

  Corbett, Robin

  Loyden, Eddie

  Cousins, Jim

  McAllion, John

  Cox, Tom

  McAvoy, Thomas

  Crowther, Stan

  McCartney, Ian

  Cryer, Bob

  McCrea, Rev William

  Cummings, John

  Macdonald, Calum A.

  Dalyell, Tam

  McFall, John

  Darling, Alistair

  McGrady, Eddie

  Davies, Rt Hon Denzil (Llanelli)

  McKay, Allen (Barnsley West)

  Davies, Ron (Caerphilly)

  McKelvey, William

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

  Maclennan, Robert

  Dewar, Donald

  McNamara, Kevin

  Dixon, Don

  Madden, Max

  Dobson, Frank

  Maginnis, Ken

  Doran, Frank

  Mahon, Mrs Alice

  Duffy, A. E. P.

  Marek, Dr John

  Dunnachie, Jimmy

  Marshall, Jim (Leicester S)

  Eadie, Alexander

  Martin, Michael J. (Springburn)

  Eastham, Ken

  Martlew, Eric

  Ewing, Harry (Falkirk E)

  Maxton, John

  Ewing, Mrs Margaret (Moray)

  Meacher, Michael

  Faulds, Andrew

  Meale, Alan

  Fearn, Ronald

  Michael, Alun

  Field, Frank (Birkenhead)

  Michie, Bill (Sheffield Heeley)

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

  Michie, Mrs Ray (Arg'l & Bute)

  Fisher, Mark

  Molyneaux, Rt Hon James

  Flannery, Martin

  Moonie, Dr Lewis

  Flynn, Paul

  Morgan, Rhodri

  Foot, Rt Hon Michael

  Morris, Rt Hon A. (W'shawe)

  Foster, Derek

  Mowlam, Marjorie

  Foulkes, George

  Mullin, Chris

  Fraser, John

  Murphy, Paul

  Fyfe, Maria

  Nellist, Dave

  Galloway, George

  Oakes, Rt Hon Gordon

  Garrett, John (Norwich South)

  Orme, Rt Hon Stanley

  Garrett, Ted (Wallsend)

  Owen, Rt Hon Dr David

  George, Bruce

  Patchett, Terry

  Gilbert, Rt Hon Dr John

  Pendry, Tom

  Godman, Dr Norman A.

  Pike, Peter L.

  Golding, Mrs Llin

  Powell, Ray (Ogmore)

  Gordon, Mildred

  Prescott, John

  Gould, Bryan

  Primarolo, Dawn

  Graham, Thomas

  Quin, Ms Joyce

  Grant, Bernie (Tottenham)

  Radice, Giles

  Griffiths, Nigel (Edinburgh S)

  Randall, Stuart

  Griffiths, Win (Bridgend)

  Redmond, Martin

  Hardy, Peter

  Rees, Rt Hon Merlyn

  Harman, Ms Harriet

  Richardson, Jo

  Heffer, Eric S.

  Robertson, George

  Henderson, Doug

  Robinson, Geoffrey

  Hinchliffe, David

  Rogers, Allan

  Hoey, Ms Kate (Vauxhall)

  Rooker, Jeff

  Hogg, N. (C'nauld & Kilsyth)

  Ross, Ernie (Dundee W)

  Home Robertson, John

  Ross, William (Londonderry E)

  Hood, Jimmy

  Rowlands, Ted

  Howarth, George (Knowsley N)

  Ruddock, Joan

  Howells, Geraint

  Salmond, Alex

  Howells, Dr. Kim (Pontypridd)

  Sedgemore, Brian

  Hoyle, Doug

  Sheerman, Barry

  Hughes, John (Coventry NE)

  Sheldon, Rt Hon Robert

  Hughes, Robert (Aberdeen N)

  Shore, Rt Hon Peter

  Hughes, Sean (Knowsley S)

  Sillars, Jim

  Hughes, Simon (Southwark)

  Skinner, Dennis

  Illsley, Eric

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

  Ingram, Adam

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

  Janner, Greville

  Smith, J. P. (Vale of Glam)

  Jones, Barry (Alyn & Deeside)

  Smyth, Rev Martin (Belfast S)

  Jones, Ieuan (Ynys Môn)

  Soley, Clive

  Jones, Martyn (Clwyd S W)

  Spearing, Nigel

  Kennedy, Charles

  Steel, Rt Hon Sir David

  Kilfedder, James

  Steinberg, Gerry

  539

  Stott, Roger

  Wigley, Dafydd

  Taylor, Mrs Ann (Dewsbury)

  Williams, Rt Hon Alan

  Taylor, Rt Hon J. D. (S'ford)

  Williams, Alan W. (Carm'then)

  Thomas, Dr Dafydd Elis

  Wilson, Brian

  Thompson, Jack (Wansbeck)

  Winnick, David

  Turner, Dennis

  Wise, Mrs Audrey

  Wallace, James

  Worthington, Tony

  Walley, Joan

  Young, David (Bolton SE)

  Wardell, Gareth (Gower)

  Wareing, Robert N.

  Tellers for the Ayes:

  Welsh, Andrew (Angus E)

  Mr. Frank Haynes and Mr. John Battle.

  Welsh, Michael (Doncaster N)

  NOES

  Adley, Robert

  Davis, David (Boothferry)

  Alexander, Richard

  Day, Stephen

  Alison, Rt Hon Michael

  Devlin, Tim

  Allason, Rupert

  Dickens, Geoffrey

  Amery, Rt Hon Julian

  Dorrell, Stephen

  Amess, David

  Douglas-Hamilton, Lord James

  Amos, Alan

  Dover, Den

  Arbuthnot, James

  Dunn, Bob

  Arnold, Jacques (Gravesham)

  Emery, Sir Peter

  Arnold, Tom (Hazel Grove)

  Evans, David (Welwyn Hatf'd)

  Atkins, Robert

  Fallon, Michael

  Baker, Rt Hon K. (Mole Valley)

  Favell, Tony

  Baker, Nicholas (Dorset N)

  Fenner, Dame Peggy

  Baldry, Tony

  Field, Barry (Isle of Wight)

  Banks, Robert (Harrogate)

  Fishburn, John Dudley

  Batiste, Spencer

  Forman, Nigel

  Beaumont-Dark, Anthony

  Forsyth, Michael (Stirling)

  Bellingham, Henry

  Forth, Eric

  Bendall, Vivian

  Fowler, Rt Hon Sir Norman

  Bennett, Nicholas (Pembroke)

  Fox, Sir Marcus

  Benyon, W.

  Franks, Cecil

  Biffen, Rt Hon John

  Freeman, Roger

  Body, Sir Richard

  French, Douglas

  Bonsor, Sir Nicholas

  Gale, Roger

  Boscawen, Hon Robert

  Gardiner, George

  Boswell, Tim

  Garel-Jones, Tristan

  Bottomley, Mrs Virginia

  Gill, Christopher

  Bowden, A (Brighton K'pto'n)

  Gilmour, Rt Hon Sir Ian

  Bowden, Gerald (Dulwich)

  Glyn, Dr Sir Alan

  Bowis, John

  Goodhart, Sir Philip

  Boyson, Rt Hon Dr Sir Rhodes

  Goodson-Wickes, Dr Charles

  Braine, Rt Hon Sir Bernard

  Gorman, Mrs Teresa

  Brandon-Bravo, Martin

  Gorst, John

  Brazier, Julian

  Gow, Ian

  Bright, Graham

  Grant, Sir Anthony (CambsSW)

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

  Greenway, John (Ryedale)

  Bruce, Ian (Dorset South)

  Gregory, Conal

  Buchanan-Smith, Rt Hon Alick

  Griffiths, Peter (Portsmouth N)

  Buck, Sir Antony

  Grist, Ian

  Budgen, Nicholas

  Ground, Patrick

  Burns, Simon

  Grylls, Michael

  Butler, Chris

  Hague, William

  Butterfill, John

  Hamilton, Hon Archie (Epsom)

  Carlisle, John, (Luton N)

  Hamilton, Neil (Tatton)

  Carlisle, Kenneth (Lincoln)

  Hampson, Dr Keith.

  Carrington, Matthew

  Hanley, Jeremy

  Cash, William

  Hannam, John

  Chalker, Rt Hon Mrs Lynda

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

  Channon, Rt Hon Paul

  Hargreaves, Ken (Hyndburn)

  Chapman, Sydney

  Harris, David

  Churchill, Mr

  Haselhurst, Alan

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

  Hayhoe, Rt Hon Sir Barney

  Clark, Dr Michael (Rochford)

  Hayward, Robert

  Clark, Sir W. (Croydon S)

  Heathcoat-Amory, David

  Clarke, Rt Hon K. (Rushcliffe)

  Hicks, Mrs Maureen (Wolv' NE)

  Colvin, Michael

  Hicks, Robert (Cornwall SE)

  Conway, Derek

  Higgins, Rt Hon Terence L.

  Coombs, Anthony (Wyre F'rest)

  Hill, James

  Coombs, Simon (Swindon)

  Hind, Kenneth

  Cope, Rt Hon John

  Hogg, Hon Douglas (Gr'th'm)

  Couchman, James

  Holt, Richard

  Cran, James

  Howell, Rt Hon David (G'dlord)

  Critchley, Julian

  Howell, Ralph (North Norfolk)

  Currie, Mrs Edwina

  Hughes, Robert G. (Harrow W)

  Curry, David

  Hunt, David (Wirral W)

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

  Hunt, Sir John (Ravensbourne)

  540

  Hurd, Rt Hon Douglas

  Patten, Rt Hon Chris (Bath)

  Irvine, Michael

  Pawsey, James

  Irving, Sir Charles

  Peacock, Mrs Elizabeth

  Jack, Michael

  Porter, Barry (Wirral S)

  Jackson, Robert

  Porter, David (Waveney)

  Janman, Tim

  Portillo, Michael

  Jessel, Toby

  Price, Sir David

  Johnson Smith, Sir Geoffrey

  Raison, Rt Hon Timothy

  Jones, Gwilym (Cardiff N)

  Rathbone, Tim

  Jones, Robert B (Herts W)

  Renton, Rt Hon Tim

  Jopling, Rt Hon Michael

  Rhodes James, Robert

  Kellett-Bowman, Dame Elaine

  Ridsdale, Sir Julian

  Key, Robert

  Rifkind, Rt Hon Malcolm

  King, Roger (B'ham N'thfield)

  Roberts, Wyn (Conwy)

  Kirkhope, Timothy

  Rossi, Sir Hugh

  Knapman, Roger

  Rost, Peter

  Knight, Greg (Derby North)

  Rowe, Andrew

  Knight, Dame Jill (Edgbaston)

  Rumbold, Mrs Angela

  Knowles, Michael

  Sackville, Hon Tom

  Knox, David

  Sayeed, Jonathan

  Lang, Ian

  Scott, Rt Hon Nicholas

  Latham, Michael

  Shaw, Sir Michael (Scarb')

  Lawrence, Ivan

  Shelton, Sir William

  Lawson, Rt Hon Nigel

  Shephard, Mrs G. (Norfolk SW)

  Lee, John (Pendle)

  Shepherd, Colin (Hereford)

  Leigh, Edward (Gainsbor'gh)

  Sims, Roger

  Lennox-Boyd, Hon Mark

  Skeet, Sir Trevor

  Lester, Jim (Broxtowe)

  Smith, Sir Dudley (Warwick)

  Lightbown, David

  Smith, Tim (Beaconsfield)

  Lilley, Peter

  Speed, Keith

  Lloyd, Sir Ian (Havant)

  Speller, Tony

  Lloyd, Peter (Fareham)

  Spicer, Sir Jim (Dorset W)

  Lord, Michael

  Squire, Robin

  Luce, Rt Hon Richard

  Stanbrook, Ivor

  Lyell, Rt Hon Sir Nicholas

  Stanley, Rt Hon Sir John

  McCrindle, Robert

  Stern, Michael

  Macfarlane, Sir Neil

  Stevens, Lewis

  MacGregor, Rt Hon John

  Stewart, Allan (Eastwood)

  Maclean, David

  Stewart, Andy (Sherwood)

  McLoughlin, Patrick

  Stewart, Rt Hon Ian (Herts N)

  McNair-Wilson, Sir Michael

  Stradling Thomas, Sir John

  Madel, David

  Sumberg, David

  Malins, Humfrey

  Summerson, Hugo

  Mans, Keith

  Taylor, Ian (Esher)

  Maples, John

  Taylor, John M (Solihull)

  Marland, Paul

  Taylor, Teddy (S'end E)

  Marlow, Tony

  Tebbit, Rt Hon Norman

  Marshall, John (Hendon S)

  Temple-Morris, Peter

  Marshall, Michael (Arundel)

  Thatcher, Rt Hon Margaret

  Martin, David (Portsmouth S)

  Thompson, D. (Calder Valley)

  Maude, Hon Francis

  Thompson, Patrick (Norwich N)

  Mawhinney, Dr Brian

  Thorne, Neil

  Maxwell-Hyslop, Robin

  Thornton, Malcolm

  Mayhew, Rt Hon Sir Patrick

  Thurnham, Peter

  Mellor, David

  Tracey, Richard

  Meyer, Sir Anthony

  Trippier, David

  Mills, Iain

  Trotter, Neville

  Miscampbell, Norman

  Twinn, Dr Ian

  Mitchell, Andrew (Gedling)

  Vaughan, Sir Gerard

  Mitchell, Sir David

  Waddington, Rt Hon David

  Moate, Roger

  Waldegrave, Rt Hon William

  Monro, Sir Hector

  Walden, George

  Montgomery, Sir Fergus

  Walker, Bill (T'side North)

  Morris, M (N'hampton S)

  Walker, Rt Hon P. (W'cester)

  Moss, Malcolm

  Waller, Gary

  Moynihan, Hon Colin

  Ward, John

  Neale, Gerrard

  Wardle, Charles (Bexhill)

  Nelson, Anthony

  Watts, John

  Neubert, Michael

  Wells, Bowen

  Newton, Rt Hon Tony

  Wheeler, Sir John

  Nicholls, Patrick

  Widdecombe, Ann

  Nicholson, David (Taunton)

  Wiggin, Jerry

  Nicholson, Emma (Devon West)

  Wilkinson, John

  Norris, Steve

  Wilshire, David

  Onslow, Rt Hon Cranley

  Winterton, Mrs Ann

  Page, Richard

  Winterton, Nicholas

  Paice, James

  Wolfson, Mark

  Parkinson, Rt Hon Cecil

  Wood, Timothy

  Patnick, Irvine

  Woodcock, Dr. Mike

  541

  Yeo, Tim

  Tellers for the Noes:

  Young, Sir George (Acton)

  Mr. Alastair Goodlad and Mr. Tony Durant.

  Younger, Rt Hon George

  Question accordingly negatived.
  Main Question put:—
  The House divided: Ayes 287, Noes 210.

  Division No. 124]

  [7.27 pm

  AYES

  Adley, Robert

  Dorrell, Stephen

  Alexander, Richard

  Douglas-Hamilton, Lord James

  Alison, Rt Hon Michael

  Dover, Den

  Allason, Rupert

  Dunn, Bob

  Amery, Rt Hon Julian

  Emery, Sir Peter

  Amess, David

  Evans, David (Welwyn Hatf'd)

  Amos, Alan

  Fallon, Michael

  Arbuthnot, James

  Favell, Tony

  Arnold, Jacques (Gravesham)

  Fenner, Dame Peggy

  Arnold, Tom (Hazel Grove)

  Field, Barry (Isle of Wight)

  Atkins, Robert

  Fishburn, John Dudley

  Baker, Rt Hon K. (Mole Valley)

  Forman, Nigel

  Baker, Nicholas (Dorset N)

  Forsyth, Michael (Stirling)

  Baldry, Tony

  Forth, Eric

  Banks, Robert (Harrogate)

  Fowler, Rt Hon Sir Norman

  Batiste, Spencer

  Fox, Sir Marcus

  Beaumont-Dark, Anthony

  Franks, Cecil

  Bellingham, Henry

  Freeman, Roger

  Bendall, Vivian

  French, Douglas

  Bennett, Nicholas (Pembroke)

  Gale, Roger

  Benyon, W.

  Gardiner, George

  Biffen, Rt Hon John

  Garel-Jones, Tristan

  Body, Sir Richard

  Gill, Christopher

  Bonsor, Sir Nicholas

  Gilmour, Rt Hon Sir Ian

  Boscawen, Hon Robert

  Glyn, Dr Sir Alan

  Boswell, Tim

  Goodhart, Sir Philip

  Bottomley, Mrs Virginia

  Goodson-Wickes, Dr Charles

  Bowden, A (Brighton K'pto'n)

  Gorman, Mrs Teresa

  Bowden, Gerald (Dulwich)

  Gorst, John

  Bowis, John

  Gow, Ian

  Boyson, Rt Hon Dr Sir Rhodes

  Grant, Sir Anthony (CambsSW)

  Braine, Rt Hon Sir Bernard

  Greenway, John (Ryedale)

  Brandon-Bravo, Martin

  Gregory, Conal

  Brazier, Julian

  Griffiths, Peter (Portsmouth N)

  Bright, Graham

  Grist, Ian

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

  Ground, Patrick

  Bruce, Ian (Dorset South)

  Grylls, Michael

  Buchanan-Smith, Rt Hon Alick

  Hague, William

  Buck, Sir Antony

  Hamilton, Hon Archie (Epsom)

  Budgen, Nicholas

  Hamilton, Neil (Tatton)

  Burns, Simon

  Hampson, Dr Keith

  Butler, Chris

  Hanley, Jeremy

  Butterfill, John

  Hannam, John

  Carlisle, John, (Luton N)

  Hargreaves, Ken (Hyndburn)

  Carlisle, Kenneth (Lincoln)

  Harris, David

  Carrington, Matthew

  Haselhurst, Alan

  Cash, William

  Hayhoe, Rt Hon Sir Barney

  Chalker, Rt Hon Mrs Lynda

  Hayward, Robert

  Channon, Rt Hon Paul

  Heathcoat-Amory, David

  Chapman, Sydney

  Hicks, Mrs Maureen (Wolv' NE)

  Churchill, Mr

  Hicks, Robert (Cornwall SE)

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

  Higgins, Rt Hon Terence L.

  Clark, Dr Michael (Rochford)

  Hill, James

  Clark, Sir W. (Croydon S)

  Hind, Kenneth

  Clarke, Rt Hon K. (Rushcliffe)

  Hogg, Hon Douglas (Gr'th'm)

  Conway, Derek

  Holt, Richard

  Coombs, Anthony (Wyre F'rest)

  Howell, Rt Hon David (G'dford)

  Coombs, Simon (Swindon)

  Howell, Ralph (North Norfolk)

  Cope, Rt Hon John

  Hughes, Robert G. (Harrow W)

  Couchman, James

  Hunt, David (Wirral W)

  Cran, James

  Hunt, Sir John (Ravensbourne)

  Critchley, Julian

  Hurd, Rt Hon Douglas

  Currie, Mrs Edwina

  Irvine, Michael

  Curry, David

  Irving, Sir Charles

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

  Jack, Michael

  Davis, David (Boothferry)

  Jackson, Robert

  Day, Stephen

  Janman, Tim

  Devlin, Tim

  Jessel, Toby

  542

  Johnson Smith, Sir Geoffrey

  Renton, Rt Hon Tim

  Jones, Gwilym (Cardiff N)

  Rhodes James, Robert

  Jones, Robert B (Herts W)

  Ridsdale, Sir Julian

  Jopling, Rt Hon Michael

  Rifkind, Rt Hon Malcolm

  Kellett-Bowman, Dame Elaine

  Roberts, Wyn (Conwy)

  Key, Robert

  Rossi, Sir Hugh

  King, Roger (B'ham N'thfield)

  Rost, Peter

  Kirkhope, Timothy

  Rowe, Andrew

  Knapman, Roger

  Rumbold, Mrs Angela

  Knight, Greg (Derby North)

  Sackville, Hon Tom

  Knight, Dame Jill (Edgbaston)

  Sayeed, Jonathan

  Knowles, Michael

  Scott, Rt Hon Nicholas

  Knox, David

  Shaw, Sir Michael (Scarb')

  Lang, Ian

  Shelton, Sir William

  Latham, Michael

  Shephard, Mrs G. (Norfolk SW)

  Lawrence, Ivan

  Shepherd, Colin (Hereford)

  Lee, John (Pendle)

  Sims, Roger

  Leigh, Edward (Gainsbor'gh)

  Skeet, Sir Trevor

  Lennox-Boyd, Hon Mark

  Smith, Sir Dudley (Warwick)

  Lester, Jim (Broxtowe)

  Smith, Tim (Beaconsfield)

  Lightbown, David

  Speed, Keith

  Lilley, Peter

  Speller, Tony

  Lloyd, Sir Ian (Havant)

  Spicer, Sir Jim (Dorset W)

  Lloyd, Peter (Fareham)

  Squire, Robin

  Lord, Michael

  Stanbrook, Ivor

  Luce, Rt Hon Richard

  Stanley, Rt Hon Sir John

  Lyell, Rt Hon Sir Nicholas

  Stern, Michael

  McCrindle, Robert

  Stevens, Lewis

  Macfarlane, Sir Neil

  Stewart, Allan (Eastwood)

  Maclean, David

  Stewart, Andy (Sherwood)

  McLoughlin, Patrick

  Stewart, Rt Hon Ian (Herts N)

  McNair-Wilson, Sir Michael

  Stradling Thomas, Sir John

  Madel, David

  Sumberg, David

  Malins, Humfrey

  Summerson, Hugo

  Mans, Keith

  Taylor, Ian (Esher)

  Maples, John

  Taylor, John M (Solihull)

  Marland, Paul

  Taylor, Teddy (S'end E)

  Marlow, Tony

  Tebbit, Rt Hon Norman

  Marshall, Michael (Arundel)

  Temple-Morris, Peter

  Martin, David (Portsmouth S)

  Thatcher, Rt Hon Margaret

  Maude, Hon Francis

  Thompson, D. (Calder Valley)

  Mawhinney, Dr Brian

  Thompson, Patrick (Norwich N)

  Maxwell-Hyslop, Robin

  Thorne, Neil

  Mayhew, Rt Hon Sir Patrick

  Thornton, Malcolm

  Mellor, David

  Thurnham, Peter

  Meyer, Sir Anthony

  Tracey, Richard

  Mills, Iain

  Trippier, David

  Miscampbell, Norman

  Trotter, Neville

  Mitchell, Andrew (Gedling)

  Twinn, Dr Ian

  Mitchell, Sir David

  Vaughan, Sir Gerard

  Moate, Roger

  Waddington, Rt Hon David

  Monro, Sir Hector

  Waldegrave, Rt Hon William

  Montgomery, Sir Fergus

  Walden, George

  Morris, M (N'hampton S)

  Walker, Bill (T'side North)

  Moss, Malcolm

  Walker, Rt Hon P. (W'cester)

  Moynihan, Hon Colin

  Waller, Gary

  Neale, Gerrard

  Ward, John

  Nelson, Anthony

  Wardle, Charles (Bexhill)

  Neubert, Michael

  Watts, John

  Newton, Rt Hon Tony

  Wells, Bowen

  Nicholls, Patrick

  Wheeler, Sir John

  Nicholson, David (Taunton)

  Widdecombe, Ann

  Nicholson, Emma (Devon West)

  Wiggin, Jerry

  Norris, Steve

  Wilkinson, John

  Onslow, Rt Hon Cranley

  Wilshire, David

  Page, Richard

  Winterton, Mrs Ann

  Paice, James

  Winterton, Nicholas

  Parkinson, Rt Hon Cecil

  Wolfson, Mark

  Patnick, Irvine

  Wood, Timothy

  Patten, Rt Hon Chris (Bath)

  Woodcock, Dr. Mike

  Pawsey, James

  Yeo, Tim

  Peacock, Mrs Elizabeth

  Young, Sir George (Acton)

  Porter, Barry (Wirral S)

  Younger, Rt Hon George

  Porter, David (Waveney)

  Portillo, Michael

  Tellers for the Ayes:

  Price, Sir David

  Mr. Alastair Goodlad and Mr. Tony Durant.

  Raison, Rt Hon Timothy

  Rathbone, Tim

  543

  NOES

  Abbott, Ms Diane

  Gilbert, Rt Hon Dr John

  Adams, Allen (Paisley N)

  Godman, Dr Norman A.

  Allen, Graham

  Golding, Mrs Llin

  Alton, David

  Gordon, Mildred

  Anderson, Donald

  Gould, Bryan

  Archer, Rt Hon Peter

  Graham, Thomas

  Armstrong, Hilary

  Grant, Bernie (Tottenham)

  Ashton, Joe

  Griffiths, Nigel (Edinburgh S)

  Banks, Tony (Newham NW)

  Griffiths, Win (Bridgend)

  Barnes, Harry (Derbyshire NE)

  Hardy, Peter

  Barnes, Mrs Rosie (Greenwich)

  Harman, Ms Harriet

  Barron, Kevin

  Heffer, Eric S.

  Beckett, Margaret

  Henderson, Doug

  Beggs, Roy

  Hinchliffe, David

  Beith, A. J.

  Hoey, Ms Kate (Vauxhall)

  Benn, Rt Hon Tony

  Hogg, N. (C'nauld & Kilsyth)

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

  Home Robertson, John

  Bermingham, Gerald

  Hood, Jimmy

  Blair, Tony

  Howarth, George (Knowsley N)

  Blunkett, David

  Howells, Geraint

  Boateng, Paul

  Howells, Dr. Kim (Pontypridd)

  Boyes, Roland

  Hoyle, Doug

  Bradley, Keith

  Hughes, John (Coventry NE)

  Brown, Gordon (D'mline E)

  Hughes, Robert (Aberdeen N)

  Brown, Nicholas (Newcastle E)

  Hughes, Roy (Newport E)

  Buchan, Norman

  Hughes, Sean (Knowsley S)

  Buckley, George J.

  Hughes, Simon (Southwark)

  Caborn, Richard

  Illsley, Eric

  Campbell, Menzies (Fife NE)

  Ingram, Adam

  Campbell, Ron (Blyth Valley)

  Janner, Greville

  Campbell-Savours, D. N.

  Jones, Barry (Alyn & Deeside)

  Carlile, Alex (Mont'g)

  Jones, Ieuan (Ynys Môn)

  Cartwright, John

  Jones, Martyn (Clwyd S W)

  Clark, Dr David (S Shields)

  Kennedy, Charles

  Clarke, Tom (Monklands W)

  Kilfedder, James

  Clay, Bob

  Kirkwood, Archy

  Clelland, David

  Lamond, James

  Clwyd, Mrs Ann

  Leadbitter, Ted

  Cohen, Harry

  Lestor, Joan (Eccles)

  Coleman, Donald

  Lewis, Terry

  Cook, Frank (Stockton N)

  Livingstone, Ken

  Cook, Robin (Livingston)

  Livsey, Richard

  Corbett, Robin

  Lloyd, Tony (Stretford)

  Cousins, Jim

  Lofthouse, Geoffrey

  Cox, Tom

  Loyden, Eddie

  Crowther, Stan

  McAllion, John

  Cryer, Bob

  McAvoy, Thomas

  Cummings, John

  McCartney, Ian

  Dalyell, Tam

  Macdonald, Calum A.

  Darling, Alistair

  McFall, John

  Davies, Rt Hon Denzil (Llanelli)

  McGrady, Eddie

  Davies, Ron (Caerphilly)

  McKay, Allen (Barnsley West)

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

  McKelvey, William

  Dewar, Donald

  Maclennan, Robert

  Dixon, Don

  McNamara, Kevin

  Dobson, Frank

  Madden, Max

  Doran, Frank

  Mahon, Mrs Alice

  Duffy, A. E. P.

  Marek, Dr John

  Dunnachie, Jimmy

  Marshall, Jim (Leicester S)

  Eadie, Alexander

  Martin, Michael J. (Springburn)

  Eastham, Ken

  Martlew, Eric

  Ewing, Harry (Falkirk E)

  Maxton, John

  Ewing, Mrs Margaret (Moray)

  Meacher, Michael

  Faulds, Andrew

  Meale, Alan

  Fearn, Ronald

  Michael, Alun

  Field, Frank (Birkenhead)

  Michie, Bill (Sheffield Heeley)

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

  Michie, Mrs Ray (Arg'l & Bute)

  Fisher, Mark

  Molyneaux, Rt Hon James

  Flannery, Martin

  Moonie, Dr Lewis

  Flynn, Paul

  Morgan, Rhodri

  Foot, Rt Hon Michael

  Morris, Rt Hon A. (W'shawe)

  Foster, Derek

  Mowlam, Marjorie

  Foulkes, George

  Mullin, Chris

  Fraser, John

  Murphy, Paul

  Fyfe, Maria

  Nellist, Dave

  Galloway, George

  Oakes, Rt Hon Gordon

  Garrett, John (Norwich South)

  Orme, Rt Hon Stanley

  Garrett, Ted (Wallsend)

  Owen, Rt Hon Dr David

  George, Bruce

  Patchett, Terry

  544

  Pendry, Tom

  Smith, J. P. (Vale of Glam)

  Pike, Peter L.

  Smyth, Rev Martin (Belfast S)

  Powell, Ray (Ogmore)

  Soley, Clive

  Prescott, John

  Spearing, Nigel

  Primarolo, Dawn

  Steel, Rt Hon Sir David

  Quin, Ms Joyce

  Steinberg, Gerry

  Radice, Giles

  Taylor, Mrs Ann (Dewsbury)

  Randall, Stuart

  Taylor, Rt Hon J. D. (S'ford)

  Redmond, Martin

  Thompson, Jack (Wansbeck)

  Rees, Rt Hon Merlyn

  Turner, Dennis

  Richardson, Jo

  Wallace, James

  Robertson, George

  Walley, Joan

  Robinson, Geoffrey

  Warden, Gareth (Gower)

  Rogers, Allan

  Wareing, Robert N.

  Rooker, Jeff

  Welsh, Andrew (Angus E)

  Ross, Ernie (Dundee W)

  Welsh, Michael (Doncaster N)

  Ross, William (Londonderry E)

  Wigley, Dafydd

  Rowlands, Ted

  Williams, Rt Hon Alan

  Ruddock, Joan

  Williams, Alan W. (Carm'then)

  Salmond, Alex

  Wilson, Brian

  Sedgemore, Brian

  Winnick, David

  Sheerman, Barry

  Wise, Mrs Audrey

  Sheldon, Rt Hon Robert

  Worthington, Tony

  Shore, Rt Hon Peter

  Young, David (Bolton SE)

  Sillars, Jim

  Skinner, Dennis

  Tellers for the Noes:

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

  Mr. Frank Haynes and Mr. John Battle.

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

  Question accordingly agreed to.
  Resolved,
  That the following provisions shall apply to the remaining proceedings on the Bill:—

  Report and Third Reading
  1.—(1) The remaining proceedings on consideration and Third Reading of the Bill shall be completed in two allotted days.
  (2) The proceedings on consideration shall be brought to a conclusion at midnight on the first allotted day.
  (3) The proceedings on Third Reading shall be brought to a conclusion three hours after their commencement.
  (4) Standing Order No. 80 (Business Committee) shall not apply.

  Dilatory Motions
  2. No dilatory Motion with respect to, or in the course of, proceedings on the Bill shall be made on an allotted day except by a member of the Government, and the Question on any such Motion shall be put forthwith.

  Extra time on allotted days
  3.—(1) On an allotted day, paragraph (1) of Standing Order No. 14 (Exempted business) shall apply to the proceedings on the Bill, but on the first allotted day it shall apply only for two hours after Ten o'clock.
  (2) On the first allotted day, any period during which proceedings on the Bill may be proceeded with after Ten o'clock under paragraph (7) of Standing Order No. 20 (Adjournment on specific and important matter that should have urgent consideration) shall be in addition to the said period of two hours.
  (3) If the first allotted day is one to which a Motion for the adjournment of the House under Standing Order No. 20 stands over from an earlier day, a period of time equal to the duration of the proceedings upon that Motion shall be added to the said period of two hours.

  Private business
  4. Any private business which has been set down for consideration at Seven o'clock on an allotted day shall, instead of being considered as provided by Standing Orders, be considered at the conclusion of the proceedings on the Bill on that day, and paragraph (1) of Standing Order No. 14 (Exempted business) shall apply to the private business for a period of three hours from the conclusion of the proceedings on the Bill or, if those proceedings are concluded before Ten o'clock, for a period equal to the time elapsing between Seven o'clock and the conclusion of those proceedings.

  Estimates
  5. Proceedings on the Bill or on any private business taken under paragraph 4 of this Order shall not be interrupted for

  545
  the purposes of Standing Order No. 53 (Questions on voting on estimates etc.) and if on an allotted day Mr. Speaker is directed by that Standing Order (as modified by the Order of the House [12th March]) to put questions at Ten o'clock he shall put those questions at Ten o'clock or at the conclusion of the proceedings on the private business, whichever is the later.

  Conclusion of proceedings
  6.—(1) For the purpose of bringing to a conclusion any proceedings which are to be brought to a conclusion at a time appointed by this Order and which have not previously been brought to a conclusion, Mr. Speaker shall forthwith put (so far as they are applicable and notwithstanding any Order of the House relating to the order in which the Bill is to be considered) the following Questions (but no others)—

  (a) any Question already proposed from the Chair;

  (b) any Question necessary to bring to a decision a Question so proposed (including, in the case of a new Clause or new Schedule which has been read a second time, the Question that the Clause or Schedule be added to the Bill);

  (c) the Question that such of the amendments 139 to 141, 158, 256, 275, 276 and 341 as remain to be made be made to the Bill;

  (d) the Question that the new Schedule (amendment 269) be added to the Bill;

  (e) the Question that all remaining amendments standing in the name of a member of the Government be made to the Bill;

  (f) any other Question necessary for the disposal of the business to be concluded;
  and on a Motion so made for a new Clause or a new Schedule, Mr. Speaker shall put only the Question that the Clause or Schedule be added to the Bill.

  (2) Proceedings under sub-paragraph (1) above shall not be interrupted under any Standing Order relating to the sittings of the House.
  (3) If an allotted day is one on which a Motion for the adjournment of the House under Standing Order No. 20 (Adjournment on specific and important matter that should have urgent consideration) would, apart from this Order, stand over to Seven o'clock—

  (a) that Motion shall stand over until the conclusion of any proceedings on the Bill which, under this Order, are to be brought to a conclusion at or before that time;

  (b) the bringing to a conclusion of any proceedings on the Bill which, under this Order, are to be brought to a conclusion after that time shall be postponed for a period equal to the duration of the proceedings on that Motion.

  (4) If an allotted day is one to which a Motion for the adjournment of the House under Standing Order No. 20
  546
  stands over from an earlier day, the bringing to a conclusion of any proceedings on the Bill which under this Order are to be brought to a conclusion on that day shall be postponed for a period equal to the duration of the proceedings on that Motion.

  Supplemental orders
  (7).—(1) The proceedings on any Motion made in the House by a member of the Government for varying or supplementing the provisions of this Order (including anything which might have been the subject of a report of the Business Committee) shall, if not previously concluded, be brought to a conclusion one hour after they have been commenced, and paragraph (1) of Standing Order No. 14 (Exempted business) shall apply to the proceedings.
  (2) If on an allotted day on which any proceedings on the Bill are to be brought to a conclusion at a time appointed by this Order the House is adjourned, or the sitting is suspended, before that time no notice shall be required or a Motion made at the next sitting by a member of the Government for varying or supplementing the provisions of this Order.

  Saving
  8. Nothing in this Order shall

  (a) prevent any proceedings to which the Order applies from being taken or completed earlier than is required by the Order; or

  (b) prevent any business (whether on the Bill or not) from being proceeded with on any day after the completion of all such proceedings on the Bill as are to be taken on that day.

  Recommittal
  9.—(1) References in this Order to proceeding on consideration or proceedings on Third Reading include references to proceedings at those stage, respectively, for, on or in consequence of, recommittal.
  (2) On an allotted day no debate shall be permitted on any Motion to recommit the Bill (whether as a whole or otherwise), and Mr. Speaker shall put forthwith any Question necessary to dispose of the Motion, including the Question on any amendment moved to the Question.

  Interpretation
  10. In this Order—
  "allotted day" means any day (other than a Friday) on which the Bill is put down as first Government Order of the Day, provided that a Motion for allotting time to the proceedings on the Bill to be taken on that day either has been agreed on a previous day, or is set down for consideration on that day;
  "the Bill" means the National Health Service and Community Care Bill.

Orders of the Day

  National Health Service and Community Care Bill
  As amended (in the Standing Committee), further considered.
  [Relevant documents: Eighth Report, Session 1988–89, Resourcing the National Health Service: the Government's plans for the future of the NHS (House of Commons Paper No. 214-III); Second Report, Session 1989–90, Community Care: Future funding of Private and Voluntary Residential Care (House of Commons Paper No. 257); Third Report, Session 1989–90, Community Care: Funding for local authorities (House of Commons Paper No. 277); Minutes of Evidence taken on 17th, 24th and 31st January 1990 (House of Commons Papers No. 148-i, 173-i and 194-i); and the Government's Reply to the Eighth Report of Session 1988–89 (Cm. 851).]
  Mr. Robin Cook: On a point of order, Madam Deputy Speaker. It may be for the convenience of the House if I say that, in the light of the vote, it is not our intention to move new clause 7. It might also be convenient to the House if we grouped new clauses 9 and 11 together, as they relate to competitive tendering.
  Madam Deputy Speaker (Miss Betty Boothroyd): That is most helpful and certainly acceptable to the Chair and, I am sure, the House.

  National Health Service and Community Care Bill
    New clause 6

      FAMILY HEALTH SERVICES AUTHORITIES AND HEALTH BOARDS (APPEALS FUNCTION)
      '(1) A patient who is removed by a general medical practitioner from the patient list of that practice shall have a right of appeal to the Family Health Services Authority.
      (2) On receiving an appeal under subsection (1) a Family Health Services Authority or a health board in Scotland shall determine whether:

      (a) the decision to remove the appellant was based on a breakdown of the relationship between patient and general practitioner or

      (b) the decision to remove the appellant was based on financial or other reasons.

      (3) Where the Family Services Authority determines under subsection (2) above that a breakdown of relationship with the patient was not the sole or main reason for removing the patient they shall require the general medical practitioner to restore the patient.'.—[Ms. Harman.]
      Brought up and read the First time.
      7.39 pm
      Ms. Harriet Harman: I beg to move, That the clause be read a Second time.
      The purpose of the new clause is to protect patients. Under the new business ethos imposed on the family doctor service, every patient will have a price tag on his head. For some patients, that price will be too high for their doctor and they will risk being culled from their general practitioner's list.
      The tragedy is that the new clause is necessary because there will be pressure to jettison uneconomic patients, which will be exerted in three ways. First, the pressure will come from the new GP contract imposed on the family doctor service. Secondly, pressure will come from the cash
      548
      limits on the amount of drugs that family doctors can prescribe, and, thirdly, because of cash limits on the funds of those GPs who opt to hold their own practice budgets.
      The GPs have been doing their sums, and they have discovered that, in some cases, the removal of a family that refuses immunisation for their children could make a difference of more than £3,000 to them. Doctors are also discovering that they could be better off if they removed from their lists some women who, possibly for perfectly good reasons, do not want or do not need a cervical smear. They have also discovered that they could be better off if they removed from their lists elderly and chronically ill patients who might need night visits.
      Mr. A. J. Beith: Some GPs have discovered that, if they exclude a convent from their lists, they would no longer be penalised for failing to meet cervical smear targets, which would be wholly inappropriate and unnecessary for such patients.
      Ms. Harman: The hon. Gentleman demonstrates the inflexibility of the target system.
      Doctors have done their sums, they know how things are working out and we must listen to them. Patient organisations share the fears expressed by doctors because they will be made vulnerable in a situation in which they have no rights. At the very least, the Government should accept the new clause, as it would give such vulnerable patients at least some legal protection.
      The Government are also making patients vulnerable through the cash-limited indicative drug budget. There is no doubt that that budget will be cash-limited, because the aim of that budget, as stated by the Government, is a downward pressure on spending. The Government refused to accept our amendment that would have meant no cash limits on indicative drug budgets and that no patient would be denied a necessary drug as a result of such cash limiting. For all their assurances, the Government refused to accept our amendment; therefore, their assurances are in flat contradiction of the intention behind that indicative drug budget and their refusal to accept our amendment.
      Patients who need a large number of drugs, such as those who suffer from cystic fibrosis, whose drugs can cost as much as £1,000 per month, or patients who need hormone replacement therapy or fertility treatment may find that their GPs overspend their drug budgets and thus risk having their pay docked. In such circumstances, those who use many drugs will soon turn into uneconomic patients—GPs have already expressed their fear about that. Given that the indicative drug budget is a mechanism for downward pressure on spending, it poses a threat to those whose continued presence on GP lists creates an upward pressure on spending.
      The Government are also making patients vulnerable through cash limits on fund-holding practices, as those doctors who opt to become fund-holders will have their budgets cash-limited. The Government have repeatedly denied that, but the British Medical Association believes that that is the Government's aim. The White Paper said that the accident and emergency departments of hospitals would be monitored to see whether the patients in those departments are genuine cases instead of refugees from practices where the budget is running out and the doctor has advised patients to avoid a cash limit on the budget by going to casualty in an attempt to be taken in as an accident and emergency case.

      549
      With a cash limit on drugs, hospital tests and treatments, the elderly or chronically sick patient could soon become uneconomic for the GP who is a practice budget holder. The Secretary of State and other Ministers have said that hundreds of applications have been received from GPs who want to become budget holders. The least that the Secretary of State could do would be to place the names of the relevant practices in the Library, so that patients depending on those practices will know whether their GP is planning to opt out.
      7.45 pm
      I note that the Secretary of State smiles, but why should there be anything to hide? I also want to know about the nature of the applications: are we talking about a vague expression of interest or something much firmer? We should know the details. It is not good enough for the right hon. and learned Gentleman to make assertions and then laugh when we ask for further and better particulars.
      The Secretary of State for Health (Mr. Kenneth Clarke): The hon. Lady has said that I was laughing, but my immediate thought was how she would react the moment she got the list of the particular doctors. Given her approach to the Bill from beginning to end, she would circulate the areas of the practices involved with leaflets giving her broad-brush descriptions of our proposals, as she has just done, to try to frighten the patients about that prospect. I disapprove of the approach that the hon. Lady has consistently adopted to our proposals. Those doctors who have expressed an interest in being fund holders—850 practices have done so—would deeply disapprove of the hon. Lady's campaigning style being brought to bear on their patients.
      Ms. Harman: The Secretary of State should allow the patients and the community served by those practices to judge for themselves whether they accept our fears or whether they are prepared to accept the Secretary of State's assurances. He does not want us to know the details, because he knows that we share the concerns of the patients and that he is out of touch with them.
      On previous occasions, the Secretary of State and other Ministers have asked why doctors would take the decision to be a budget holder if it was likely to be so damaging to their patients. Under the new NHS contract system, GPs will be caught between the devil and the deep blue sea. If they stay as they are, they will lose their most important clinical freedom and right to operate on behalf of their patients—exercising choice about where to go for tests and treatments. If doctors opt for a practice budget, it will be cash-limited, and that will have a chilling effect on the drugs, tests and treatment that they are able to offer their patients. It might even lead to doctors having to cull patients from their lists. Doctors are faced with an invidious choice, and those patients whose GPs become budget holders may be put at risk if they are uneconomic.
      Our new clause gives patients a right of appeal. If a patient is not struck off a list because of a breakdown in relations, the family health services authority will have the opportunity to reinstate the patient on a GP's list. We are not talking about those circumstances in which the patient and the GP have a genuine row, but where patients become
      550
      uneconomic because of the three reasons I have given. In those circumstances, there is a financial disincentive in keeping that patient on the list.
      When such cases come to light, it will be no good the Secretary of State blaming the doctors and saying that they represent the rotten apple in the barrel. It is no good the Secretary of State simply accusing us of scaremongering. There is genuine concern among patients and doctors. The new clause is backed by the Consumers Association.
      We remain fundamentally opposed to cash limits on indicative drug budgets and to cash-limited practice budgets. There is not a shred of evidence that the family doctor service is extravagant or bad value for money, yet the Government press ahead with a whole range of cash limits to try to cheapen the family doctor service.
      The next Labour Government will ensure that the family doctor service is free to put patients first and care before cash. The least the Government should do now is give patients the benefit of the doubt in situations where there is great upheaval in the family doctor service. The new clause would provide a safety net in those circumstances.
      Mr. Kenneth Clarke: If I respond briefly to the remarks of the hon. Member for Peckham (Ms. Harman), hon. Members may be able to confine their remarks later and thereby help to deal with the shortage of time.
      I have considerable respect for the hon. Lady as a political opponent, but at times I find her political style startling, even somewhat unpleasant—[HON. MEMBERS: "Oh!"] She relies on the repeated assertion, in somewhat strident terms, of alleged facts about our reforms which we have demonstrated time and again to everybody else's satisfaction—and I sometimes think to hers—are totally factually untrue.
      The hon. Lady revived yet again her usual talk about cash-limited drug budgets leading to people with serious conditions perhaps being threatened with loss of treatment. She knows that we have satisfied everybody, from the BMA onwards, that that is not the case. She used a dreadful phrase about patients being culled from doctors' lists, when we have demonstrated in all the cases that she has raised that talk about it being the consequence of the contract and so on is utter nonsense.
      The hon. Lady puts such matters forth in letters, press releases and speeches in chilling tones, regardless of the factual background to what she is talking about and with the deliberate intention of trying to whip up fears, particularly among patients, about the consequences for them of things which she says are in reports.
      When the hon. Lady cannot bring herself to make a totally untrue assertion yet again, she has started using the phrase, "Doctors have said that." The Daily Mirror is fond of that sort of statement. I am reminded of those cheapjack advertisements making ridiculous claims for some fringe product which say, "Doctors have said that," and then a startling and unsupportable proposition is made on behalf of some dubious product.
      Mr. Kenneth Hind: My right hon. and learned Friend has made it clear that the underlying impression given by some of the remarks of the hon. Member for Peckham (Ms. Harman) about doctors disposing of patients and so on is that doctors are money-grabbing and uncaring. The bottom line of such remarks must represent a deep criticism of doctors, casting

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      doubt on their dedication and veracity. Not only do I believe her to be wrong, but there is no reason to believe that doctors would behave in the way she suggests.
      Mr. Clarke: I agree with my hon. Friend. As for doctors culling patients, the hon. Lady once cited a case on the Floor of the House which I was able to identify and follow up. She knows that the doctor concerned made no claim that the removal of the patient from his list had anything to do with our review or with the White Paper. I imagine that the hon. Lady has seen the correspondence in that case.
      I looked into a similar case in Burnley. After the hon. Member for Burnley (Mr. Pike) raised the case with me, the doctor concerned persisted in allegations, although he was unable to substantiate them. In the case cited by the hon. Member for Peckham, the doctor made no attempt to claim to me that the incident that she was exploiting had anything to do with my White Paper or with the contract proposals.
      Ms. Harman: Publicity was attracted to the case to which the right hon. and learned Gentleman referred, my having raised it in the House. I am afraid that the doctor withdrew the comments that he had originally made—[Interruption.] My assistant telephoned the doctor and asked him to give his version of why the patient in question had been struck off, and he told my assistant that the woman was an uneconomic patient because of her requirement for night visits. He patiently explained to my assistant how the new deputising rules would work and how the patient would mean him being out of pocket. My assistant took a verbatim note—I asked her to take such a note, being myself legally trained—and when the matter was raised in Parliament, the doctor changed his story. That is an honest description of the position.
      Mr. Clarke: The hon. Lady now knows that he withdrew it because he could not substantiate the claims that he had made to her assistant. The hon. Lady alleged that the patient—who turned out to have had a long history of a somewhat difficult relationship with the doctor—would be more costly because she required night visits. As the hon. Lady knows, under the former arrangements, for each night visit the doctor concerned received £20·25. Under the new contract, from the beginning of next year he will receive £15 if he uses a deputising service but £45 for each visit made personally or made by a colleague from his practice or from a local group.
      In that case, the doctor did not persist in the claim because it was plainly not true. It was clear that the claim that there was some financial motive for removing the patient from the list was a fiction. From the doctor's point of view, it was probably a polite excuse to a patient whom he wished to get removed from his list because patient and doctor were not getting on well.
      If the hon. Lady wishes to persist in such matters, she must look at the consequences of the new contract, which she knows, above all else, places obligations on doctors to extend their services to their patients in many cases, for example, by offering initial check-ups, check-ups every three years, and annual contacts for the over-75s and so on. It increases the payments for patients over 65 and 75 compared with the previous position and pays doctors for services that they may choose to offer or targets that they may seek to attain.
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      We have debated the contract. It is nonsense for any doctor to seek to demonstrate that a particular patient is being removed from the list because the financial attractiveness of that patient is less than it was under the old contract. Only the Daily Mirror still pursues that campaign and only the hon. Lady seeks to give it some credibility by persisting in the matter.
      If I were to go over the whole question of cash-limited drug budgets, I would encroach on the time available to other hon. Members. It was a total invention from the word go to suggest that drug budgets would be cash-limited. We rely on the White Paper and everything that has flowed from it to disprove that. We have made it clear all along that in no circumstances would any patient ever be refused the medication or equipment that he or she used and that no doctor would be exposed to any risk of penalty for giving drugs or equipment to a patient who needed them. The hon. Member for Peckham knows that those assurances are reliable and have been accepted by everybody. She just likes, for campaigning reasons, to keep a heavy emphasis on cash-limited drug budgets. with references to other patients.
      Underlying all that is a problem which hon. Members might seriously wish to address, and that is what happens when the relationship between doctor and patient breaks down or becomes troublesome to one or the other, without necessarily there being any fault on either side. I am not talking about pharmaceutical treatment. It may be, in conversational terms, that the chemistry does not work between a doctor and patient.
      Since the NHS began, a doctor has always had an absolute right to ask a patient to withdraw from his list without giving any reason.
      Mr. D. N. Campbell-Savours: If what the right hon. and learned Gentlemen says is true, why did he not include in the Bill a simple clause saying that a general practitioner shall not do any of the things that we are suggesting a GP might be in a position to do? Had he done that, we would not be having this discussion.
      Mr. Clarke: I am not sure that it is right to take away from the doctor the right to say to a patient, "I would rather you left my list", or "I would rather your family left my list." The trouble with the new clause is that it will present the doctor with serious difficulties because it insists that a patient can go through an appeal process and get on to that doctor's list. There is no doubt that the doctor-patient relationship should, wherever possible, be based on a good relationship of confidence and trust on both sides. There may be occasions where a responsible GP has perfectly good reasons for not wanting a patient any more. It is seriously debatable whether it would be in everybody's interests to introduce such an appeal process.
      The snag is that, as every doctor knows, there has always been a small minority of doctors who, over the years, have been reluctant to take on certain patients. There is no doubt that under whichever system—it has nothing to do with my reforms or the new contract—some patients impose a much greater workload on the doctor and the practice than others.
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      If there are many chronically sick and elderly patients and patients who have intensive courses of care, there is no doubt that those patients make up the doctor's workload. Most doctors are lucky enough to have their work with

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      those patients compensated for, to some extent, by a raft of patients on the list who are never ill from one year to the next and whom they never see. The method of paying doctors has always included capitation and a combination of other factors so that the list as a whole is the basis of the GP's remuneration.
      There have always been some doctors who have been extremely reluctant to take on to their lists elderly people, the chronically sick and people who might make demands on them at night. The British Medical Association and I would describe as unscrupulous any doctor who took this policy too far. The vast majority of doctors are not like that and accept that it is largely chance that determines their workload. They accept that it is their professional duty to give the best treatment that they can to their patients, in line with their needs. Recently, a few doctors who want to shed their workload and have had difficulty trying to find a reason for shaking off a difficult patient have slipped into the habit of blaming the reforms or the new contracts. I regret that they are being encouraged in that by the hon. Member for Peckham.
      The idea that in future we should announce a formal appeal mechanism to allow patients who do not want to be removed from the doctor's list to get on to that list is debatable. In the last resort, if a patient cannot get a doctor—there are some patients who have been on every doctor's list and there is no longer a doctor left who is willing to accept them—there is a provision whereby the family practitioner committee can require a nominated doctor to take the patient on to his or her list.
      It is difficult to improve on that system. Sometimes one feels sorry for a patient who has been removed for no apparent reason, and there is nothing that one can do about it. However, I say on behalf of the Government, and personally, that I am not attracted to a full appeal mechanism whereby patients can try to force themselves back on to the list of a GP who may have perfectly good personal or professional reasons for not wanting the patient.
      I rose early in the debate because I felt that this issue should be disentangled from the Bill. To campaign and frighten elderly patients by saying that they will be "culled"—that was the word used—from their GP's list because of our proposals is distasteful, disreputable and takes campaigning against the proposals much too far.
      Several Hon. Members rose—
      Mr. Deputy Speaker (Mr. Harold Walker): Order. I remind the House that we are debating this issue under tight time constraints.
      Mr. Nigel Spearing: I am grateful to be called immediately after the Secretary of State, who constantly amazes me. I always think of him as a decent man somewhere inside a less decent man, and the decent man is sometimes trying to get out. He had a cheek to talk about unpleasantness on the part of my hon. Friend the Member for Peckham (Ms. Harman) as he has not been at all pleasant in the way in whch he has dealt with medical and ambulance matters in the past few months. I have twice attended debates in the House about the ambulance service from which the Secretary of State has been absent. I am glad that he is here today. His last contribution was more in the line of the decent right hon. and learned
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      Member for Rushcliffe (Mr. Clarke) who, I am sure, uses his best bedside manner on the patients who come to his surgery, as they come to all of us.
      I agree immediately with the right hon. and learned Gentleman that the relationship between the general practitioner and his or her patients is absolutely fundamental—just as there is, or should be, a fundamental relationship between any of us who aspire to be reasonable Members of Parliament and our constituents. The analogy is not that far from the truth. The trouble is that the Secretary of State has misunderstood the inevitable overall effect of the Bill, when enacted, on that relationship. As I understand it, he has accurately outlined the present position—any GP can ask any patient or tell the family practitioner committee that a patient will no longer be on his panel. Similarly, patients can remove themselves from doctors' lists. The reserve power that he mentioned works quite well psychologically, and doctors and the officers of the FPC keep some sort of equilibrium. Until two days ago I was unaware that that was the system.
      Why do my hon. Friends and I feel it necessary to support an amendment which adds to the system? Is it not true that the relationship between a patient and a doctor is extremely personal and crucial? In another context we use the phrases "in sickness or in health," and "for better, for worse". We all know that at some time any of us might have an interview with our GP which could have the gravest implications for us and our families. We know of friends and relatives who have gone through that.
      The Bill could potentially—I believe that it will—transform the fundamental relationship between GPs and our constituents. That means that 60,000 to 80,000 people per hon. Member—perhaps 60,000 or 70,000 of the Secretary of State's own constituents—could be affected. The conditions in which all general practitioners function will be greatly changed. Those conditions will be changed from a structure which many doctors who are middle aged and older have experienced, and in which they were brought up. The younger ones believe that the framework of their chosen profession may not be perfect but it should not be primarily a business concern, involving constant calculations about costs, time and choice of hospital, in the structure presented in the Bill and about which we have heard ad nauseam in the past few months.
      The attitude of mind that all GPs must bring to their profession could be transformed by the Bill. If that did not happen, the Government would consider the Bill a failure. Therefore, the circumstances in which doctors meet patients, organise their daily lives, work out their accounts, relate to partners in the same practice, relate to the FPC and consultants in this, that or the other type of new hospital together with other changes that will rapidly come about as a result of the Bill, will transform their attitudes.
      The attitude of the patient to the doctor will inevitably change. The Secretary of State has said,—he may be absolutely sincere in this,—that there will be no element of disincentive to dissuade doctors from taking on patients. He upbraided my hon. Friend the Member for Peckham for suggesting such a thing. However, there has been sufficient evidence in Committee, in the House and from general practitioners to show that many patients will not believe that. The Secretary of State is a politician, as we all are, and he knows that it is not a matter of what it is, but what the voters think that it is. That is real politics as we know to our cost and sometimes to our benefit. If there is

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      a scintilla of suspicion by any patient that the doctor's attitude is being influenced or even controlled by some force that is beyond the doctor's professional opinion, the relationship between them will be ruptured or at the very least it will not be so good as it is under the current system.
      Mr. Kenneth Clarke: I agree with the hon. Gentleman about that, but does he agree with me that he should discourage those members of his party who run campaigns suggesting that doctors will wish to cull elderly patients from their lists? That gives the individual elderly patient a feeling of unease. He wonders, "Will my doctor throw me off his list? Am I somehow an expense to my doctor that he does not want?" That is a fiction, but it is the kind of political campaign which causes unease to patients and damages the relationship between patient and doctor.
      Mr. Spearing: The right hon. and learned Gentleman is repeating what he said to my hon. Friend the Member for Peckham. I understand that organisations representing vulnerable people have said virtually the same thing. We do not know the details and consequences of the structure being erected because there has been little experiment or trials with it. General practitioners view that structure with considerable apprehension. On that fact alone, I suggest that my remarks are accurate.
      The right hon. and learned Gentleman's premises are fundamentally wrong because the Bill does not necessarily support what general practitioners regard as good, professional medicine and practice. If he had asked them in what way they wanted to improve the medical service, he might have come up with something better.
      Mr. Rhodri Morgan: My hon. Friend goes to the heart of the matter. The fears of doctors and patients are not thought up by my hon. Friend the Member for Peckham and the Daily Mirror in some Pied Piper of Hamlin conspiracy to mislead everyone. We can all look across the water to the United States of America where doctors no longer make house calls because they are compelled to have a commercial attitude. In this country, thank God, someone can still ask for a house call without worrying whether he will be thought to be a burdensome patient. We want to preserve that system, but doctors and patients are worried that it may be lost. That fear has not been dredged up by the Daily Mirror—it is deep in the consciousness of all who value the NHS.
      Mr. Spearing: I agree with my hon. Friend. I shall conclude with two facts which illustrate both what he has said and the case that I am making.
      A few months ago a man came to my surgery. He was ill and he was also nursing a sick wife. He was concerned because he thought that his general practitioner was not providing sufficient medication. He said that his wife was sometimes screaming with pain because painkillers were not available. I thought that he was right. I made inquiries of the City and East London family practitioner committee, which said that some sort of monitoring was taking place and that the doctor in question had been given a communication on the matter.
      The doctor's judgment may have been correct—I take it from the FPC that he is a humane and considerate doctor—but the position that I have outlined exists today under the present structure, even before the other criteria proposed by the Secretary of State are introduced.
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      My second fact, which the right hon. and learned Gentleman cannot deny, is his view—as I understand it from general practitioners—that there will be some movement between good general practitioners and less good general practitioners. I understand that a good general practitioner thinks that about 2,000 patients on a mixed list is about right, given some sort of balance. Is it not a fact—the right hon. and learned Gentleman can deny it if he so wishes—that, as with the hospital structure, he foresees that the good general practitioners will attract more patients and that the not-so-good ones will attract fewer patients?
      8.15 pm
      I understand from doctors that, once over that figure, time is taken up, pressure raised and the job becomes difficult to do. Market forces do not operate in a doctor's surgery as they do on a production line, but unless doctors have misunderstood the position, they believe that to be the assumption behind most of the legislation—which is at its worst in respect of the opting-out provisions for hospitals that we debated earlier. Time and again we have heard that the most effective and efficient unit will attract more so that unit costs will reduce and everybody will gain—even if they have to go up the motorway in an ambulance. That is the Government's philosophy. It will not work for general practitioners and it will not work for the NHS.
      The Government are undermining that tracery of human relationships on which most medicine works and they stand in danger of taking away the nerve trains within the Health Service. It is fatal for the body when the nerve trains are attacked. The Government should have ascertained more about the problems. If they continue with their proposals, the Health Service as we know it today, which has been built up over many years with the support of professional organisations, will be ruined. That will be the responsibility of the right hon. and learned Gentleman, and of his right hon. Friend the Prime Minister who lies behind that dreadful market philosophy.
      Mr. Charles Kennedy: I shall be brief. As both the Secretary of State and the hon. Member for Newham, South (Mr. Spearing) acknowledged, there is a difficult balance to be struck. Articles about general practitioners have appeared in the Daily Mirror from time to time. My concern is not the concern expressed by the right hon. and learned Gentleman about general practitioners. He has proved himself adept in and enthusiastic about doctor bashing, so it is rather ironic for him to rise to their defence like a knight in shining armour.
      If too much emphasis is placed on the suggestion that doctors will want to shift patients from their lists—I do not accuse the hon. Member for Peckham (Ms. Harman) of doing that, as the right hon. and learned Gentleman did—there will be genuine anxiety. However, my political concern is that it helps to add to the rhetoric in which the right hon. and learned Gentleman has invested so much time, not least about the contract.
      I recognise the practical problems outlined by the right hon. and learned Gentleman, but some reassurance is needed. A nod in the direction of an appeal mechanism would be at least a step forward. However, the problem lies rather deeper than that, in the practical impact of the contract. We have debated contracts with the Secretary of State both in Committee and in the House, and I repeat the

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      point that it is only logical, given the financial underpinning of the new contract, that, if there is to be an incentive for doctors to move to larger lists, many patients may find treatment inadequate. In areas such as mine, the Borders, and other rural parts, the right of appeal raises the legitimate question whether, as the list sizes of GPs grow to such an extent, the practices will be viable in terms of patient care.
      What is the equivalent right of appeal for a patient who may want to move to an adjoining practice but in an area which is sparsely populated or geographically spread? We might be talking about a practice which is 20 miles away. That would not offer people without access to transport facilities the kind of patient choice which the Secretary of State tells us he is anxious to establish through the Bill. Therefore, does the Secretary of State feel that there is a deficiency in the legislation because it does not deal properly with appeals? Although he may not be sympathetic to the right of appeal outlined in the new clause, he may feel that the principle should be enshrined in the legislation.
      Two basic points are not adequately addressed by the Bill. The first relates to the resources put into general practice. The Secretary of State outlined how GPs can benefit financially from the range of services offered, the number of voluntary calls, spot checking and so on. If we are advocating a preventative medicine approach, I do not think that enough emphasis has been placed on public campaigns and on public involvement. A golden opportunity has been missed.
      In an intervention in the speech of the hon. Member for Peckham my hon. Friend the Member for Berwick-upon-Tweed (Mr. Beith) spoke about the practical idiocy involved in the new contract when we consider the circumstances of key categories of patients. As the Secretary of State will be aware, that has given rise to much concern.
      The extreme example of cervical testing in convents has been mentioned, but there have been many examples, as I am sure the Secretary of State has seen, of single female patients having had unfortunate experiences in trying to establish virginity. We can think of the effect that that would have on the doctor-patient relationship. I hope that that will be taken into account by the Secretary of State, however dismissive he is of the clause as drafted.
      Patients should have a greater say and should be conversant with their rights. They should have an input to the range of services and options for treatment offered by their GP. If there is not to be an appeal system, I should have thought that the Secretary of State would have taken the new clause as a green light for a proper patients' charter. The hon. Member for Newbury (Sir M. McNair-Wilson) has played a distinguished role in furthering the issue in recent years, and there has been cross-party support for a charter.
      The opportunity has been missed to introduce a patients' charter, whatever the BMA might have said. The Secretary of State has accused those on the Labour Front Bench of using foul means. On a constituency basis, he must be aware that many people are concerned, because uncertainty and change always create concern among patients. Surely he recognises that much of the sting could have been taken out of the issue by the introduction of a
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      charter. Although the Secretary of State dismisses the clause as drafted, many of the issues raised by it are legitimate and highlight deficiencies in the legislation and in the contract which could have been remedied, but sadly have not been.
      Sir Michael McNair-Wilson: I cannot support the new clause, because the concept behind it is improbable. If my general practitioner did not want me on his list, I could not see myself appealing to remain on it, because the doctor-patient relationship is one of trust and confidence, and if that is damaged the object of having an appeal is unimportant.
      If I could catch the attention of the hon. Member for Peckham (Ms. Harman), I think she strayed, perhaps inadvertently, on to a subject which deserves more consideration than it has been given. I agree entirely with my right hon. and learned Friend the Secretary of State that there should be targets for things like cervical smears and immunisation. He is right to set target figures at which the maximum remuneration will be paid.
      The question that worries me was addressed in an article in The Daily Telegraph only last week by Dr. John Lockley. He put a simple case: if a doctor asked all his women patients whether they would agree to a cervical smear and 79 per cent. agreed, but the effective I per cent. said no, he would lose perhaps as much as £1,000 in remuneration because of one or two patients whom another GP might not want on his list.
      By the same token, if a GP offered immunisation to mothers of young children and if 89 per cent. agreed to immunisation but the essential 1 per cent. refused, the doctor would lose the remuneration which he might reasonably expect to get because the service had been offered. It would not be the unwillingness of the doctor to provide the service that denied him the remuneration, but the refusal of the patient to take up the service that was on offer. Therefore, it seems difficult to sustain the argument that that will not affect the attitude of doctors or will not put a strain on doctor-patient relationship unless we can find another way of satisfying the requirement of the target.
      Dr. Lockley offered a solution. He suggested that, if a lady patient refused a cervical smear, the doctor should be allowed to ask her to sign a form confirming that he had offered the service but that she did not want it. If a doctor could show that he would have crossed the target line, he should be able to obtain the maximum remuneration because in effect he was offering a service which was not taken up. I should like my right hon. and learned Friend to address that point in his reply.
      On drug budgets, I have no difficulty in supporting the concept of a GP having a cash-limited drug budget. The medical profession should be as answerable as any other on how it spends money. I declare an interest as a kidney patient and as president of a kidney charity. I am fortunate enough not only to be on dialysis but to receive a drug called erythropoetin as a dialysis patient. That drug has made all the difference to my haemoglobin level, my energy level and, indeed, to my general well-being. Any kidney dialysis patient suffering from anaemia, a very common problem with kidney failure, will want to be on EPO if possible.
      My consultant told me that he did not have enough money to afford to give all the renal patients in his ward that drug. He wondered whether I would mind asking my

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      GP whether he would prescribe the drug for me. I duly wrote to my GP with that request and my GP came to see me. He said, "Of course I'll prescribe it. I know you, and I have treated you ever since your kidneys failed." However. he told me that he was worried because he said that he was not my consultant and the drug is not licensed. He said, "I don't know its side effects, but I have been asked to prescribe it for you wondering to myself whether I am entering into a commitment which may have some unforeseen results." He questioned whether that was calling his professional judgment to account. He wondered whether he should be indemnified or whether he should ask the Department to give a ruling to clarify the position.
      8.30 pm
      If a consultant can do that with an unlicensed drug, why can another consultant not do the same? Will the GP, with his cash-limited drug budget, be able to absorb that cost which originally belonged to a hospital, but which the hospital is passing to the GP to enable the hospital to provide the drug to more people? That is an important point, although I admit that it affects only a small number of people in terms of kidney patients. However, that is an example of what might happen in future.
      Mrs. Alice Mahon: I will be very brief. When the Secretary of State said that the only people who were raising alarm were people like my hon. Friend the Member for Peckham (Ms. Harman), he was misleading the House.
      Many organisations representing ill people or people who need special services have produced for hon. Members on both sides of the House briefs expressing their fears. I want to refer to a very respected association—the Family Planning Association—which has expressed fears similar to those expressed by my hon. Friend the Member for Peckham.
      There have been many reports in the media about patients being struck off a GP's list. Three of my constituents were struck off in as many months. I am very concerned, because they belong to a particular category of people. They were all women with young children, and arguably they would all take up a lot of a GP's time.
      In its brief, which it sent to hon. Members on 21 February, the Family Planning Association states that it is
      "deeply concerned that women requiring certain treatment due to reproductive health problems could either be at risk of being dropped from their existing GP's lists or find it hard to register with another practice. These women need the security"
      of the proposals in the new clause
      "which place a legal obligation on … authorities to ensure that all people within it's registered population have access to a GP who can meet their needs."
      The Family Planning Association refers also to women who need treatment for infertility or for chronic gynaecological complaints such as endometriosis, which require expensive drugs or referrals. Many consultants and GPs consider the profitability of the patient. We cannot get away from that.
      The Family Planning Association is also concerned that women between the ages of 25 and 64 who do not want a smear test or have the test elsewhere, such as at a family planning clinic, may find themselves unwelcome because their presence on a GP's list affects the doctor's payment for carrying out the tests. That could also apply to people with HIV or full-blown AIDS, and they could experience difficulty.
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      I have referred only to a brief from the Family Planning Association because I am deeply concerned that women's health problems will be affected by the Bill. I am sure that other hon. Members could pick a dozen others which stress the same problems. That is not scaremongering: it is telling the truth. Those organisations are responsible, and the Secretary of State should take note of them.
      Mr. Michael Morris: I must declare an interest as I have been married to a general practitioner for 30 years and I am also an adviser to two pharmaceutical companies.
      I do not think that the scenario painted by the hon. Member for Peckham (Ms. Harman) is likely to happen initially. However, I emphasise "initially". If it happens, my right hon. and learned Friend the Secretary of State for Health will have to live with it because he included the provision in the contract in the first place.
      I hope that my right hon. and learned Friend the Secretary of State listened carefully to my hon. Friend the Member for Newbury (Sir M. McNair-Wilson). My hon. Friend referred to articles that appeared in the Daily Mirror. Articles also appeared in The Daily Telegraph, as my hon. Friend for Newbury (Sir M. McNair-Wilson) said, and I would be happy to pass a copy of it to my right hon. and learned Friend if he has not seen it.
      The article has a sub-heading
      "Pity the doctor who looks after a convent—or a hostel for the handicapped".
      We should also pity the GP who has a large ethnic community of women who, for religious reasons, might not want to have smears. The article is considered and understandable. There must be some provision whereby a conscientious objector should not form part of a target. I understand why my right hon. and learned Friend the Secretary of State produced a target that was not 100 per cent. because that allows for some slippage.
      However, the distribution of difficult patients is not perfect. However hard a GP tries, in some cases he will not be able to make his target. He will then have to choose. For the moment, the vast majority of GPs will accept those people, but my right hon. and learned Friend will have to address that problem when he considers the pricing and re-pricing of the contract. If not, all hell will be let loose again and that cannot be in anyone's interest.
      I made a note on my memo pad of the drug erythropoetin for kidney patients. As I understand it, there is a scandalous situation in the North West Thames regional health authority where that product is on a limited licence and consultants are being told that they can use only a certain amount of the drug on a limited number of patients. That blows apart the whole idea of drugs budgets at the hospital level.
      We are all aware of what has been happening in recent years. Hospitals have told people that the minute they leave hospital they will not get any supplies and the GP will have to provide the medicine. I hope that my right hon. and learned Friend will listen with care to the marvellous case history outlined by my hon. Friend the Member for Newbury.
      I was not a member of the Standing Committee that considered this Bill. However, I wonder why clause 18 on indicative drug budgets is still in the Bill. My right hon. and learned Friend the Secretary of State is on the record as saying that no patient will go without his or her medicine. However, he has not told us what happens if the

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      regional health authority has overspent once all the GPs have finished prescribing. He has not told us whether that money will come from supplementary provisions or from some other health service. My right hon. and learned Friend has had the pharmaceutical price regulation scheme, which has worked perfectly well. He can normally use PACT—prescribing analyses and costs—although I cannot understand why we have not had any PACT for the September to December quarter at level I. It is extraordinary that the Department of Health, its underlings and its subsidiary and ancillary organisations are falling down. That is another example where something that had been running reasonably smoothly has stopped running for some reason.
      I hope that either my right hon. and learned Friend will drop clause 18 altogether or that it will be dropped in another place. We never learn. Some interesting work has been done in the United States on formularies by some people called Moore and Newman. Research in 47 states showed that not only did the states with formularies fail to achieve savings in prescription drug expenditure but they were required to spend more on other services. Against that background, one would think that we would not introduce formularies into this country.
      The hon. Member for Peckham spoke about budget holders. I understand that there has been a statement that there will be 850 practice budget holders. The hon. Lady has a point. As sure as eggs is eggs, the names of practices that are budget holders will get out. The Health Service is not exactly the most secure service. It would be far better if practices which wish to take part in pilot schemes openly admit to doing so. The fact will get out, so they might as well say it up front.
      It is no surprise to anyone who knows anything about general practice that people are applying for practice budgets. One need only examine the attractive administrative bonuses given to everyone who applies. It is a highly profitable area. Some might phrase it differently, but either way it is not surprising.
      My hon. Friend the Member for Newbury was right when he said towards the end of his speech that the relationship between a GP and the patient is special. If, for one reason or another, it breaks down, it is right for both parties that the patient should go to another GP. The allocation system has always worked well to the benefit of both parties. To that extent, the new clause is unnecessary.
      Mr. Tom Cox: As my hon. Friend the Member for Peckham, (Ms. Harman) said, the new clause is important. The speeches of the last two Conservative Members who have spoken show the breadth of concern on the matter. The Secretary of State should start paying attention. He claimed that all the anxieties and problems raised on this issue have been built up by my hon. Friend the Member for Peckham, but that is not true. Several Opposition Members have given examples of the problems, but the Secretary of State can be in no doubt that many Conservative Members could also give examples of the same problems.
      I dealt with the case recently of an elderly constituent who rang her doctor and asked him to visit her. She was told that she was no longer on his list. She was given absolutely no reason. Even the Secretary of State can understand the great fear that that created in her and her
      562
      family who said, "Look, Mum, don't complain—don't be a nuisance". Is that the way in which our Health Service is developing? Will it develop under the conditions outlined by my hon. Friend and other hon. Members who have spoken about the costing of drugs?
      8.45 pm
      The Secretary of State says that the problems that we have described do not exist. I have sent several letters in recent weeks to the Secretary of State from medical practitioners in Wandsworth health authority expressing deep anxiety about what is happening. I received a letter yesterday dated 9 March from the chair of the South West Thames regional health authority. She says:
      "I know how difficult things are in Wandsworth. If you would like me or the officers to meet with you we will be only too happy to do so."
      That was from the chair of the regional health authority which covers Wandsworth. Does the Secretary of State believe that she would write such a letter if she were not worried about the circumstances of that health authority?
      I wish to make some specific points about the problems of my constituent. It is all very well to say that if there is a breakdown in the relationship between patient and doctor, the best thing is for the patient to find another practitioner who will take the patient on to his or her list, but how is that done? In the case of my constituent, it took a considerable time to find another doctor who would take that elderly lady on to his list. The new clause is important because no one should be removed from a list until they have been given a reason for their removal and a list of other doctors prepared to take the patient. Otherwise who is supposed to look after patients until they are put on another list?
      There should be a right of appeal. We often hear about the rights of working people, as affected by many issues, but where are patients' rights? Why are they not given the right to say that they are not happy with the attitude adopted by their GP and that they want the right to appeal? Patients need more than the right to appeal. Often we are dealing with elderly, disabled people who, sadly, do not always understand procedures. The procedures should be made clear to them and help and advice should be made available so that if they wish to appeal they have the opportunity to do so. If we are really committed to the rights of patients, the conditions outlined in the clause are essential. They should be supported not only by Opposition Members but by Conservative Members who have participated in the debate.
      Mr. Hind rose—
      Mr. Kenneth Clarke rose—
      Mr. Deputy Speaker: Order. Does the Secretary of State have the leave of the House to speak again?
      Mr. Clarke rose—
      Mr. Deputy Speaker: Order. The right hon. and learned Gentleman needs the leave of the House.
      Ms. Harman: I thank my hon. Friends who spoke in support of the new clause and the two Tory Back Benchers who made important speeches. The best way to deal with the matter would have been to have no financial disincentive for GPs to keep expensive patients on their lists. Then we should not have to worry about an appeals procedure. Because those legal safeguards are not written

      563
      into the Bill to protect people from becoming uneconomic patients, we intend to press the new clause to a Division. I hope that hon. Members who expressed reservations will either vote with us or at least abstain.
      Question put, That the clause be read a Second time:—
      The House divided: Ayes 197, Noes 264.

      Division No. 125]

      [8.47 pm

      AYES

      Abbott, Ms Diane

      Fyfe, Maria

      Adams, Allen (Paisley N)

      Galloway, George

      Allen, Graham

      Garrett, John (Norwich South)

      Alton, David

      Garrett, Ted (Wallsend)

      Anderson, Donald

      George, Bruce

      Archer, Rt Hon Peter

      Godman, Dr Norman A.

      Armstrong, Hilary

      Gordon, Mildred

      Ashton, Joe

      Gould, Bryan

      Banks, Tony (Newham NW)

      Graham, Thomas

      Barnes, Harry (Derbyshire NE)

      Griffiths, Nigel (Edinburgh S)

      Barnes, Mrs Rosie (Greenwich)

      Griffiths, Win (Bridgend)

      Barron, Kevin

      Hardy, Peter

      Battle, John

      Harman, Ms Harriet

      Beggs, Roy

      Hattersley, Rt Hon Roy

      Beith, A. J.

      Henderson, Doug

      Benn, Rt Hon Tony

      Hinchliffe, David

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

      Hoey, Ms Kate (Vauxhall)

      Bermingham, Gerald

      Hogg, N. (C'nauld & Kilsyth)

      Blair, Tony

      Home Robertson, John

      Blunkett, David

      Hood, Jimmy

      Boyes, Roland

      Howarth, George (Knowsley N)

      Bradley, Keith

      Howells, Geraint

      Brown, Gordon (D'mline E)

      Howells, Dr. Kim (Pontypridd)

      Buchan, Norman

      Hoyle, Doug

      Buckley, George J.

      Hughes, John (Coventry NE)

      Caborn, Richard

      Hughes, Robert (Aberdeen N)

      Campbell, Menzies (Fife NE)

      Hughes, Roy (Newport E)

      Campbell, Ron (Blyth Valley)

      Hughes, Sean (Knowsley S)

      Campbell-Savours, D. N.

      Illsley, Eric

      Carlile, Alex (Mont'g)

      Ingram, Adam

      Cartwright, John

      Janner, Greville

      Clark, Dr David (S Shields)

      Jones, Barry (Alyn & Deeside)

      Clarke, Tom (Monklands W)

      Jones, Ieuan (Ynys Môn)

      Clay, Bob

      Jones, Martyn (Clwyd S W)

      Clelland, David

      Kennedy, Charles

      Clwyd, Mrs Ann

      Kilfedder, James

      Cohen, Harry

      Kirkwood, Archy

      Coleman, Donald

      Lamond, James

      Cook, Robin (Livingston)

      Leadbitter, Ted

      Corbett, Robin

      Lestor, Joan (Eccles)

      Cousins, Jim

      Lewis, Terry

      Cox, Tom

      Livsey, Richard

      Crowther, Stan

      Lloyd, Tony (Stretford)

      Cryer, Bob

      Lofthouse, Geoffrey

      Cummings, John

      Loyden, Eddie

      Dalyell, Tam

      McAllion, John

      Darling, Alistair

      McAvoy, Thomas

      Davies, Rt Hon Denzil (Llanelli)

      McCartney, Ian

      Davies, Ron (Caerphilly)

      McFall, John

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

      McGrady, Eddie

      Dewar, Donald

      McKay, Allen (Barnsley West)

      Dixon, Don

      McKelvey, William

      Doran, Frank

      Maclennan, Robert

      Duffy, A. E. P.

      McNamara, Kevin

      Dunnachie, Jimmy

      Madden, Max

      Eadie, Alexander

      Mahon, Mrs Alice

      Eastham, Ken

      Marek, Dr John

      Ewing, Harry (Falkirk E)

      Marshall, Jim (Leicester S)

      Ewing, Mrs Margaret (Moray)

      Martin, Michael J. (Springburn)

      Faulds, Andrew

      Martlew, Eric

      Fearn, Ronald

      Maxton, John

      Field, Frank (Birkenhead)

      Meacher, Michael

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

      Meale, Alan

      Fisher, Mark

      Michael, Alun

      Flannery, Martin

      Michie, Bill (Sheffield Heeley)

      Foot, Rt Hon Michael

      Michie, Mrs Ray (Arg'l & Bute)

      Foster, Derek

      Molyneaux, Rt Hon James

      Foulkes, George

      Moonie, Dr Lewis

      Fraser, John

      Morgan, Rhodri

      564

      Morris, Rt Hon A. (W'shawe)

      Sillars, Jim

      Mowlam, Marjorie

      Skinner, Dennis

      Mullin, Chris

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

      Murphy, Paul

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

      Nellist, Dave

      Smith, J. P. (Vale of Glam)

      Oakes, Rt Hon Gordon

      Smyth, Rev Martin (Belfast S)

      Orme, Rt Hon Stanley

      Soley, Clive

      Paisley, Rev Ian

      Spearing, Nigel

      Patchett, Terry

      Steel, Rt Hon Sir David

      Pike, Peter L.

      Steinberg, Gerry

      Powell, Ray (Ogmore)

      Taylor, Mrs Ann (Dewsbury)

      Prescott, John

      Taylor, Matthew (Truro)

      Primarolo, Dawn

      Thompson, Jack (Wansbeck)

      Quin, Ms Joyce

      Turner, Dennis

      Radice, Giles

      Wallace, James

      Randall, Stuart

      Walley, Joan

      Redmond, Martin

      Wardell, Gareth (Gower)

      Rees, Rt Hon Merlyn

      Wareing, Robert N.

      Richardson, Jo

      Welsh, Andrew (Angus E)

      Robertson, George

      Welsh, Michael (Doncaster N)

      Robinson, Geoffrey

      Wigley, Dafydd

      Rogers, Allan

      Williams, Alan W. (Carm'then)

      Rooker, Jeff

      Wilson, Brian

      Ross, Ernie (Dundee W)

      Winnick, David

      Ross, William (Londonderry E)

      Wise, Mrs Audrey

      Rowlands, Ted

      Worthington, Tony

      Ruddock, Joan

      Young, David (Bolton SE)

      Sedgemore, Brian

      Sheerman, Barry

      Tellers for the Ayes:

      Sheldon, Rt Hon Robert

      Mr. Frank Haynes and Mrs. Llin Golding.

      Shore, Rt Hon Peter

      Short, Clare

      NOES

      Adley, Robert

      Chapman, Sydney

      Alexander, Richard

      Churchill, Mr

      Alison, Rt Hon Michael

      Clark, Dr Michael (Rochford)

      Allason, Rupert

      Clark, Sir W. (Croydon S)

      Amess, David

      Clarke, Rt Hon K. (Rushcliffe)

      Amos, Alan

      Colvin, Michael

      Arbuthnot, James

      Conway, Derek

      Arnold, Jacques (Gravesham)

      Coombs, Anthony (Wyre F'rest)

      Arnold, Tom (Hazel Grove)

      Coombs, Simon (Swindon)

      Baker, Rt Hon K. (Mole Valley)

      Cope, Rt Hon John

      Baker, Nicholas (Dorset N)

      Couchman, James

      Baldry, Tony

      Cran, James

      Banks, Robert (Harrogate)

      Currie, Mrs Edwina

      Batiste, Spencer

      Curry, David

      Bellingham, Henry

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

      Bendall, Vivian

      Davis, David (Boothferry)

      Bennett, Nicholas (Pembroke)

      Day, Stephen

      Benyon, W.

      Devlin, Tim

      Biffen, Rt Hon John

      Dorrell, Stephen

      Blaker, Rt Hon Sir Peter

      Douglas-Hamilton, Lord James

      Body, Sir Richard

      Dover, Den

      Bonsor, Sir Nicholas

      Dunn, Bob

      Boscawen, Hon Robert

      Eggar, Tim

      Boswell, Tim

      Emery, Sir Peter

      Bottom ley, Mrs Virginia

      Evans, David (Welwyn Hatf'd)

      Bowden, A (Brighton K'pto'n)

      Favell, Tony

      Bowden, Gerald (Dulwich)

      Fenner, Dame Peggy

      Bowis, John

      Field, Barry (Isle of Wight)

      Boyson, Rt Hon Dr Sir Rhodes

      Fishburn, John Dudley

      Brandon-Bravo, Martin

      Forman, Nigel

      Brazier, Julian

      Forsyth, Michael (Stirling)

      Bright, Graham

      Forth, Eric

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

      Fowler, Rt Hon Sir Norman

      Bruce, Ian (Dorset South)

      Fox, Sir Marcus

      Buchanan-Smith, Rt Hon Alick

      Franks, Cecil

      Buck, Sir Antony

      Freeman, Roger

      Budgen, Nicholas

      French, Douglas

      Burns, Simon

      Gale, Roger

      Butler, Chris

      Gardiner, George

      Butterfill, John

      Garel-Jones, Tristan

      Carlisle, John, (Luton N)

      Gill, Christopher

      Carrington, Matthew

      Glyn, Dr Sir Alan

      Carttiss, Michael

      Goodhart, Sir Philip

      Cash, William

      Goodlad, Alastair

      Chalker, Rt Hon Mrs Lynda

      Goodson-Wickes, Dr Charles

      Channon, Rt Hon Paul

      Gorman, Mrs Teresa

      565

      Gorst, John

      Miscampbell, Norman

      Gow, Ian

      Mitchell, Andrew (Gedling)

      Grant, Sir Anthony (CambsSW)

      Mitchell, Sir David

      Greenway, John (Ryedale)

      Moate, Roger

      Griffiths, Peter (Portsmouth N)

      Monro, Sir Hector

      Grist, Ian

      Montgomery, Sir Fergus

      Ground, Patrick

      Morris, M (N'hampton S)

      Grylls, Michael

      Moss, Malcolm

      Hague, William

      Moynihan, Hon Colin

      Hamilton, Hon Archie (Epsom)

      Neale, Gerrard

      Hamilton, Neil (Tatton)

      Nelson, Anthony

      Hampson, Dr Keith

      Neubert, Michael

      Hanley, Jeremy

      Newton, Rt Hon Tony

      Hannam, John

      Nicholls, Patrick

      Hargreaves, Ken (Hyndburn)

      Nicholson, David (Taunton)

      Harris, David

      Nicholson, Emma (Devon West)

      Haselhurst, Alan

      Norris, Steve

      Hayhoe, Rt Hon Sir Barney

      Onslow, Rt Hon Cranley

      Hayward, Robert

      Paice, James

      Heathcoat-Amory, David

      Parkinson, Rt Hon Cecil

      Hicks, Mrs Maureen (Wolv' NE)

      Patnick, Irvine

      Hicks, Robert (Cornwall SE)

      Pawsey, James

      Higgins, Rt Hon Terence L.

      Peacock, Mrs Elizabeth

      Hill, James

      Porter, Barry (Wirral S)

      Hind, Kenneth

      Porter, David (Waveney)

      Hogg, Hon Douglas (Gr'th'm)

      Portillo, Michael

      Holt, Richard

      Price, Sir David

      Howell, Rt Hon David (G'dford)

      Raison, Rt Hon Timothy

      Howell, Ralph (North Norfolk)

      Rathbone, Tim

      Hughes, Robert G. (Harrow W)

      Renton, Rt Hon Tim

      Hunt, David (Wirral W)

      Rhodes James, Robert

      Hunt, Sir John (Ravensbourne)

      Ridsdale, Sir Julian

      Irvine, Michael

      Rifkind, Rt Hon Malcolm

      Irving, Sir Charles

      Roberts, Wyn (Conwy)

      Jack, Michael

      Rossi, Sir Hugh

      Janman, Tim

      Rost, Peter

      Jessel, Toby

      Rowe, Andrew

      Johnson Smith, Sir Geoffrey

      Rumbold, Mrs Angela

      Jones, Gwilym (Cardiff N)

      Sackville, Hon Tom

      Jones, Robert B (Herts W)

      Sayeed, Jonathan

      Jopling, Rt Hon Michael

      Scott, Rt Hon Nicholas

      Kellett-Bowman, Dame Elaine

      Shaw, Sir Michael (Scarb')

      Key, Robert

      Shephard, Mrs G. (Norfolk SW)

      King, Roger (B'ham N'thfield)

      Shepherd, Colin (Hereford)

      Kirkhope, Timothy

      Sims, Roger

      Knapman, Roger

      Skeet, Sir Trevor

      Knight, Greg (Derby North)

      Smith, Sir Dudley (Warwick)

      Knight, Dame Jill (Edgbaston)

      Smith, Tim (Beaconsfield)

      Knowles, Michael

      Speed, Keith

      Knox, David

      Speller, Tony

      Lang, Ian

      Spicer, Sir Jim (Dorset W)

      Latham, Michael

      Stanley, Rt Hon Sir John

      Lee, John (Pendle)

      Stern, Michael

      Leigh, Edward (Gainsbor'gh)

      Stevens, Lewis

      Lennox-Boyd, Hon Mark

      Stewart, Allan (Eastwood)

      Lester, Jim (Broxtowe)

      Stewart, Andy (Sherwood)

      Lightbown, David

      Stewart, Rt Hon Ian (Herts N)

      Lilley, Peter

      Stradling Thomas, Sir John

      Lloyd, Sir Ian (Havant)

      Sumberg, David

      Lloyd, Peter (Fareham)

      Summerson, Hugo

      Lord, Michael

      Taylor, Ian (Esher)

      Luce, Rt Hon Richard

      Taylor, John M (Solihull)

      Lyell, Rt Hon Sir Nicholas

      Taylor, Teddy (S'end E)

      Macfarlane, Sir Neil

      Tebbit, Rt Hon Norman

      Maclean, David

      Temple-Morris, Peter

      McLoughlin, Patrick

      Thompson, D. (Calder Valley)

      McNair-Wilson, Sir Michael

      Thompson, Patrick (Norwich N)

      Madel, David

      Thornton, Malcolm

      Malins, Humfrey

      Thurnham, Peter

      Mans, Keith

      Tracey, Richard

      Maples, John

      Trippier, David

      Marland, Paul

      Trotter, Neville

      Marlow, Tony

      Twinn, Dr Ian

      Marshall, Michael (Arundel)

      Vaughan, Sir Gerard

      Martin, David (Portsmouth S)

      Waddington, Rt Hon David

      Mawhinney, Dr Brian

      Waldegrave, Rt Hon William

      Maxwell-Hyslop, Robin

      Walden, George

      Mellor, David

      Walker, Bill (T'side North)

      Meyer, Sir Anthony

      Waller, Gary

      Mills, Iain

      Ward, John

      566

      Wardle, Charles (Bexhill)

      Wood, Timothy

      Watts, John

      Woodcock, Dr. Mike

      Wells, Bowen

      Yeo, Tim

      Wheeler, Sir John

      Young, Sir George (Acton)

      Widdecombe, Ann

      Wilkinson, John

      Tellers for the Noes:

      Wilshire, David

      Mr. Tony Durant and Mr. Kenneth Carlisle.

      Winterton, Mrs Ann

      Question accordingly negatived.
      Mr. Deputy Speaker: We come now to new clause 8.
      Mr. Kenneth Clarke: On a point of order, Mr. Deputy Speaker. I am sure you will confirm that the hon. Member for Peckham (Ms. Harman) exercised her undoubted right in refusing me leave to speak twice. Thereby she deprived me of an opportunity to reply. May I assure my hon. Friends that I will answer their points in correspondence, and may I point out that the discourtesy to the House was that of the hon. Lady, not mine?
      Mr. Deputy Speaker: I have an apology to make to the Secretary of State. I had not realised that a right of reply is accorded to the Minister in charge of a Bill. I was quite incorrect to check him when he sought to reply. I hope that he and the House will accept my apology. I, too, can be wrong.

    New Clause 8

      JUNIOR DOCTORS' CONTRACTS
      "(1) Subject to subsections 2 and 3 below, a junior hospital doctor employed by an NHS Trust shall not be required to work or be available for work for more than 72 hours in any one working week, averaged over a one-month period.
      (2) The Secretary of State may by order reduce the working hours specified in section 1 above in stages to 60 hours
      (3) Sections 1 and 2 above shall not apply in the event of:

      (a) a state of emergency proclaimed by Her Majesty under section 1(1) of the Emergency Powers Act 1920; or

      (b) a major accident procedure or its equivalent being put into operation."—[Mr. Michael.]

      Brought up, and read the First time.
      9 pm
      Mr. Alun Michael: I beg to move, That the clause be read a Second time.
      Before dealing with the new clause, may I say that, if there was any difficulty, Mr. Deputy Speaker, we placed you in that difficulty. However, following discussions through the usual channels, it was understood that there were to be no further speeches from the Government side.
      New clause 8 addresses the problem of junior hospital doctors, particularly in relation to new NHS trusts. Our proposal is that junior hospital doctors should not be required to work more than 72 hours in any working week, averaged over a period of one month, and that the Secretary of State should have power to reduce the working hours specified, in stages, to 60 hours. It may well be felt that even those hours are excessive, but the proposition is that the scandal of junior hospital doctors' hours should be tackled in some way in this Bill. No doubt the Government will hide behind the various circulars on this topic that have been issued, but those circulars will no longer be relevant to hospitals that opt out and become NHS trusts. This provision is needed to make sure that the scandal is tackled.

      567
      The extent of the problem is obvious. There is plenty of evidence of it. The results of a recent survey carried out in Bristol show that only 14 per cent. of the junior hospital doctors who took part said that they had made no mistakes as a result of excessive hours' work; 22 per cent. said they had made four or more mistakes; 85 per cent. were aware of one or more mistakes as a result of lack of sleep. The BMA has given evidence to the effect that it believes that figures relating to hours are inadequately represented by the Department of Health. The Department and Ministers have suggested that there has been an improvement over the years. In fact, there is evidence of deterioration.
      Long hours—an average of 67 hours on call, and sometimes up to 120 hours—are causing serious concern both for doctors' health and, extremely important, for the health of patients. One junior doctor has said, "After a weekend on duty you feel as if you have just crossed the Atlantic. It is like being jet-lagged. It is not a sensible system for us or for the patient. Would you fly in a plane on a Monday morning if you knew that the pilot had been working since Friday?" Those of us who have been assiduous in attending to our duties in relation to this Bill know exactly what that junior hospital doctor meant. Indeed, this is an appropriate stage in the passage of the Bill to be considering such a scandal.
      It may be thought that our method of dealing with legislation is less than perfect, but, as I am sure hon. Members will agree, this is an even more important consideration in the case of doctors dealing with life-and-death matters in our hospitals. The Geneva convention makes it
      "a cruel and unnatural punishment to deprive a prisoner of sleep for more than 48 hours."
      There is something ludicrous and bizarre about the fact that the hours of truck drivers are half those of people who deal with our bodies and undertake delicate surgery.
      There is considerable evidence of stress on junior hospital doctors. The suicide rate is three times the national average, and the divorce rate is twice the national average. Surely those facts give cause for concern. By definition, junior doctors are mainly people of child-rearing age, and there are special difficulties for women who wish to follow this career.
      Mr. Andrew Rowe (Mid-Kent): I must confess that I have never understood these hours. Perhaps the hon. Gentleman would be kind enough to enlighten me. Why do junior hospital doctors have such difficulty in fixing their rosters? Is it because senior hospital doctors do not take their fair share of the job?
      Mr. Michael: I am sure that there is an element of that in it. This matter will not be put right until a limit on the hours worked by junior hospital doctors forces a proper regime to be arranged in hospitals. This provision needs to be made so that the administration of a hospital and senior doctors have to observe the law. The new clause allows the Secretary of State to use his good offices over a period to bring pressure to bear to make improvements on what we think is a reasonable initial limit.
      Rev. Martin Smyth: Is the hon. Gentleman aware that it is a matter not just of senior consultants not taking their share of the work but of staff
      568
      shortages in a number of hospitals? I know of one place where, instead of eight staff, there are six to work the roster.
      Mr. Michael: That does happen. I am trying to speak briefly on the new clause, so that other hon. Members can take part.
      The basic principle is that there should be a limit on the number of hours worked by junior doctors. Matters such as those introduced into the debate by the hon. Members for Mid-Kent (Mr. Rowe) and for Belfast, South (Rev. Martin Smyth) should be sorted out by hospital administrators, by doctors and by the Department in terms of observance of regulations. As I said, the circular system will not apply in relation to hospital trusts. That is why it is not enough to ask Ministers to take care of this matter by circular. Provision needs to be made in the Bill.
      Medicine is now more invasive and intensive than in the past. Nowadays, being on call is identical to being called. It is not a matter of "perhaps" being called; it is extremely likely that doctors will be called during their period on duty. The percentage of junior hospital doctors getting less than five hours sleep shows a worrying progression between 1981 and 1985—in paediatrics, from 33 per cent. to 63 per cent.; in general medicine, from 44 per cent. to 56 per cent,; and in general surgery, from 32 per cent. to 45 per cent.
      Moving from the subjective and the descriptive, there have been objective studies, including one by Orton and Gruzelier which stated:
      "the risks to patients increase when errors are made by tired doctors, who lack agility in making decisions due to a slowing in cognitive functions. The personal lives of the doctors are compromised, which may lead to psychiatric problems, drug abuse, and broken marriages. Disillusion with hospital medicine may result, and undesirable behavioural traits that permeate future practice and lifestyle may develop. These issues are becoming more pressing as demands grow owing to the exacting requirements of modern technology, as the number of malpractice suits increases, and as pressures mount to treat and discharge patients more quickly."
      The report stated:
      "In conclusion the reduction in cognitive performance combined with the adverse changes in mood show less than desirable conditions for personal wellbeing and the practice of medicine. Superimposed night duty rosters may be a stress adversely affecting the welfare of both the doctor and the patient."
      I am aware of the pressure we face to debate some extremely important issues in the short time remaining to us, but there are few things more important and more obvious than the need to reduce the excessive hours worked by junior hospital doctors. I commend the new clause, which I hope will be supported by both sides of the House.
      The extent of the problem was brought home to me by a couple who visited my surgery recently, who said that their daughter, a junior hospital doctor, was being "drained of her life" by the work that she does and the unacceptably long hours that she is required to be on duty. I stress that that was not their daughter's complaint, as she is obviously dedicated to her profession, but the comments of parents who love her and who notice the way that the pressures of the work are affecting her. That underlines the importance of safeguarding patients and the well-being of doctors, whom we do not want to see broken and leaving the profession, and whose skills are needed for many years to come. I commend the new clause to the House.
      Mrs. Rosie Barnes: The case for the new clause has been clearly and admirably made, and there is little to add to the remarks of the hon. Member for Cardiff, South and Penarth (Mr. Michael). The problem has been brought to the attention of numerous right hon. and hon. Members through statistical information and press bulletins from a variety of sources. Many right hon. and hon. Members have also received deputations, personal visits, and letters from people who are directly involved.
      When I first entered the House, I received a deputation of junior doctors who were prepared to describe off the record some of the errors, including those involving fatalities, that had been made, and clearly that situation must be redressed. There is an archaic if not Victorian element in the number of hours that junior doctors are permitted to work.
      Mr. Campbell-Savours: Is the hon. Lady saying that the junior doctors she met indicated that deaths have resulted from the number of hours they were required to work? What action did she take?
      Mrs. Barnes: The doctors who visited me gave information about the hours that they worked, and were prepared to admit—without giving specific details—that all junior doctors know of errors that had been made, some of which had resulted in fatalities. That will come as no surprise to many right hon. and hon. Members. Doctors' professional code of conduct prevents them from divulging the full details of colleagues who may have been involved in such incidents, but the fact that they occur will not come as a shock to any right hon. and hon. Member who has received information on that aspect.
      In the studies that have been drawn to our attention, lack of sleep is blamed for seriously affecting a doctor's ability to make quick and logical decisions. Right hon. and hon. Members have particular reason for knowing the truth of that statement. Although we may make life-and-death decisions one step removed, we are not presented with casualties brought in off the street, a young girl dying from an asthma attack, or someone in a critical medical condition—in all of which cases a wrong diagnosis can make all the difference. Senior registrars and junior doctors in general have to make crucial decisions, and they do make errors when overtired.
      Mr. Allan Rogers: When my daughter was a junior doctor, she recounted similar stories. They work horrendous hours of more than 100 per week, and double-back 20 to 30 hours. Those working in casualty departments are subjected to violence and other forms of stress. The hon. Lady is right to say that it is difficult to make the right clinical judgments when one is under such pressure.
      Mrs. Barnes: The facts of the situation are well known to many right hon. and hon. Members, and perhaps it is not to our credit that we have allowed the situation to continue for so long. We taken measures to ensure that airline pilots and lorry drivers, for example, are restricted in the number of hours that they work, and their rest times are prescribed. The number of consecutive hours of flying or driving that they can undertake is also strictly controlled. It seems quite wrong that we have made restrictions for those jobs but have not attended to such a vital profession.
      Mr. Campbell-Savours: Let me make a suggestion to the hon. Lady. If those junior doctors believed that they had evidence of errors and fatalities, if they had made public statements, that would have led to actions in the courts for compensation and the Government would have been bound to act by way of legislative change. On the basis of what the hon. Lady said, if the Government are not willing to move, the way to sort out the problem is for junior doctors to make that information public, as that will lead to actions in the courts for negligence against hospital authorities.
      9.15 pm
      Mrs. Barnes: Junior doctors have gone to great lengths to make such matters public. Obviously they have a professional code of conduct, but tonight's debate reflects the degree of anxiety about the matter.
      Before concluding, I should like to quote extracts from two letters. One is from a senior registrar working at the department of anaesthetics in one of my local hospitals:
      "I myself have been unable to stay awake and alert at times when working continuously through the night (often for several nights, and days, at a stretch) and you will appreciate that the life of a patient under anaesthetic depends directly on the anaesthetist's awareness.
      I have also literally fallen asleep when driving home, after a Friday morning to Monday evening weekend stint. Thankfully I was stationary in a traffic queue at the time."
      I should like to add just one more example to the conclusive evidence that has been presented to the House this evening. A letter from a constituent, after making observations about her nephew, stated:
      "It was during the week when my nephew was in greatest danger that I became aware, possibly for the first time, of the situation that Junior Doctors were trying to bring to public attention at Christmas time—namely the unbelievably long hours that they have to work on certain shifts."
      A doctor, whom I shall not name,
      "came on duty on Friday, 10th March in the morning and stayed on duty until Monday afternoon, 13th March—a total of some seventy-six hours. During this time, there were a number of emergencies on the unit (a heart-attack patient, a seriously ill post-operative patient) as well as the routine checking of my nephew's medication, the changing of his antibiotic prescription, which necessitated the most careful calculation and calibration of the various 'drips' that he was receiving and the constant monitoring of his heart, blood pressure and 'gases' because he was on a ventilator".
      Such evidence makes clear the pressures on doctors, patients and relatives observing their work, and we have overlooked it for too long.
      Mr. Michael Morris: There is a strong argument in the new market-oriented Health Service for the problem affecting junior doctors to be dealt with and the costs faced.
      The only additional point that I would make is that the foundation of the National Health Service was that it should have an equal distribution of consultants by discipline and by geographical region. If the National Health Service trust hospitals are to have different terms and conditions from other district general hospitals, resources will be skewed and we will go back to the bad old system that existed before the war, when all the best doctors, both junior and consultants, went to the better-off parts of the country and decided not to go to the inner cities or the less attractive regions.
      I shall listen carefully to what my hon. Friend the Minister says in reply to the debate on the new clause, as it seems to have a great deal of merit.
      Mr. Jim Cousins: I am happy to be associated with the Medical Practitioners Union, whose relentless campaigning on this topic has ensured that it has never been allowed to disappear from view. Since 1982, the Government have introduced a series of initiatives, and some progress has been made in getting junior doctors' rosters down to one in three, 84 hours a week. But the progress has not been so marked as the Government like to pretend or as their latest figures suggest. Some of the rosters have been put out of sight by being classified as not being onerous, although they still add up to 84 hours a week, one in three. That is sharp practice. Another technique is to introduce a one-in-three, 84 hours per week roster depending on time off in lieu, which is not then made available. The apparent improvement thus lacks foundation in reality.
      It is a matter for regret that, although the Government launched their own study in 1985, they took five years to publish the information, which confused the issue and delayed progress. I recognise that the present ministerial team has made amends and ensured that it was published, but five years is far too long.
      What should we do? It is clear that the problem cannot be solved merely by reorganising rosters. We need additional manpower resources—new posts both for junior doctors and for consultants. The 100 extra consultants' posts that the Government have announced make a small contribution, but there is a shortfall in new consultants' appointments anyway and they are offset by consultants' posts which are not in fact available.
      Studies in my region illustrate the problem clearly. A northern region special study of orthopaedics, conducted to get the rosters down to the target level of one in three, 84 hours a week—which, in all conscience, is not a wonderful target at which to aim—showed that that would require seven additional junior doctor posts and seven additional consultant posts in orthopaedics. That is in one region alone, and even that will leave a further 320 junior doctors' rosters worse than the target level and still classified as onerous. It is a scandalous situation and it must be dealt with. It can be dealt with, but only by making more junior doctors' and consultants' posts available.
      I hope that the Minister will not simply say that she does not like the idea of changing the law in this way. I hope that she will declare her hand and tell us what other positive practical initiatives she proposes in order to make more jobs available.
      Mr. Terry Davis: The Medical Practitioners Union, which is part of the union to which my hon. Friend the Member for Newcastle upon Tyne, Central (Mr. Cousins) and I belong—the Manufacturing, Science and Finance Union—has campaigned for years for something to be done about the scandal of junior hospital doctors' hours. Last year, a Bill passed by the other place put a limit on the hours worked by junior doctors, but although a similar Bill that I introduced in this House received its Second Reading, it was thwarted by the Government, who put up their Whips to object to the Bill from a sedentary position. They were not prepared to come out in the open and vote against the Bill, so they abused parliamentary procedure and sheltered behind the rules of the House to prevent this scandal coming out into the open and to avoid having to stand up and be counted in the Division Lobbies.
      572
      I congratulate my hon. Friend the Member for Cardiff, South and Penarth (Mr. Michael) on his clear, detailed and succinct summary of the scandal throughout the United Kingdom. As he said, it is not only a question of the intolerable burden placed on junior hospital doctors, many of whom are not newly qualified. The term can cover doctors well into middle age: indeed, everyone who is not a consultant is a junior hospital doctor. One may be a junior doctor not only for two, three or five years, but for many years. Doctors are having to bear an intolerable burden. We should not allow it, not only because it is against doctors' interests and because it is an unfair and impossible burden for employers to place on employees, but because it is against the interests of patients.
      The new clause is a modest attempt to deal with this problem in one part of the Health Service. I question whether self-governing trusts can strictly be called the National Health Service, but the new clause will deal with this scandal at least in them. However, as my hon. Friend the Member for Cardiff, South and Penarth will recognise, it will still allow doctors to work 72 hours a week in one continuous shift at the weekend, which is what tends to happen now. If possible, no one should go to hospital on a Sunday, because it is possible that he will receive attention from a doctor who has been working for two days or more. He may have started on Friday morning and worked through to Sunday without adequate sleep.
      The new clause is in the interests of patients. We do not have to rely on anecdote or common sense to appreciate what is happening on Sunday evenings in hospitals. We have the recent evidence of a confidential inquiry into post-operative deaths in one region of England. It showed that people were dying because of doctors' fatigue. The inquiry was carried out not by administrators or community health councils but by the surgeons themselves. They found that a significant number of unnecessary post-operative deaths were due to doctor fatigue. Of course, people also die as a result of mistakes made by physicians, and they die in other regions. We shall never know how many people have died unnecessarily in hospital as a result of doctor fatigue. We must do something about this disgraceful scandal.
      The hon. Member for Mid-Kent (Mr. Rowe) asked whether the problem was all the fault of senior doctors—the specialists and consultants. They are partly to blame. Given their central role in the NHS, they could put their house in order if they wanted to. However, they are not the only ones; administrators must take their share of the blame. It is cheaper for hospitals to work doctors for long hours than to employ more doctors. It is cheaper to employ one doctor for 80 hours than two for 40. It would not be tolerated in industry, but the overtime rate for doctors is worse than the standard rate, which is ridiculous and appalling. The problem can be solved given the will to solve it. It was stopped overnight in New Zealand, for instance, by altering the wage structure.
      The Government are not willing to spend money where it is necessary to spend it to end this scandal. The Government rely on peer group pressure and on other doctors in the profession. The royal colleges, which have existed, not for 10 or 100, but for hundreds of years, have still done nothing about this. They shelter behind the skirts of Government circulars. But self-governing trusts will not be subject to Government circulars, which is why my hon. Friend the Member for Cardiff, South and Penarth is right to concentrate first on an area which no circular will reach

      573
      —on self-governing trusts, the hospitals that will be pressurised by the Government to opt out of local health authority control.
      I commend the new clause to the House and I hope that hon. Members will support it in the Lobby.
      Mr. Patrick Cormack: Like my hon. Friend the Member for Northampton, South (Mr. Morris), I shall be interested to hear what the Minister has to say about this subject. We must recognise that there is enormous public concern about it. Many people have been deeply worried by stories of junior hospital doctors being wholly fatigued when dealing with patients, often in extremely dangerous and difficult conditions. I hope that my hon. Friend will either accept the new clause, which is modest, or say that within two years its aims will be the Government's stated objective.
      After all, most of us Members work at least 72 hours a week and we know that if we do that week after week we do not operate at peak efficiency. We should have a great deal of fellow feeling for young doctors.
      I know that my hon. Friend is an extremely diligent and hard-working Minister. I hope that from her experience she will agree that the working hours of junior doctors are wholly unacceptable and that that situation should be brought to an end as quickly as possible.
      9.30 pm
      Mrs. Virginia Bottomley: This is a serious problem which requires further action.
      I must clear up one misunderstanding. We have made it clear that NHS trusts must follow our guidance regarding junior doctors' hours—they are not outwith the scheme and the guidance. I hope that hon. Members will look at section 5·22 of "Self-Governing Hospitals: an Initial Guide", which makes that clear. Paragraph 6(2)(e) of schedule 2 gives the Secretary of State powers to direct NHS trusts to comply with the guidance.
      This is a long-standing problem which requires action on a number of fronts. The new clause suggests that junior doctors' hours should be limited to a maximum of 72 on call or on duty. Hon. Members will be aware, however, that in some specialties one can work onerous hours without being called out that often. I was talking to a psychiatrist to a gaol, who works a one in two and is called out perhaps once a fortnight. A legislative move as suggested in the new clause would mean that that individual could not fulfil his rota commitment even though he was called out perhaps once a fortnight. There are other specialties in which the duties are extremely onerous and the individual may be not only be on call or on duty, but working for unacceptably long hours. We must appreciate, however, that the problem is complex and multi-faceted.
      In the past, the royal colleges have felt that individual training posts might be put in jeopardy if they did not include sufficient contact with patients. If the royal colleges reconsider the matter, they may decide that a training post which deprives an individual of any sleep—let alone any capacity for training, education or research—cannot rightly or properly continue to be approved as such. If they can be persuaded to look again at the way in which they approve training posts, it might be an extra lever to improve matters.
      574
      There is a difference between the consultant who regards himself as the head of an entourage of juniors following in his wake and the consultant who believes that he has a part to play. After all, the rotas are essentially devised locally by the professionals involved. The consultant may contribute by providing cover himself. It is well known that we want the Health Service to have an increasing number of such medically qualified personnel. That is why an extra 2,500 consultants have been appointed—an increase of 21 per cent. since 1979. The management also has an input regarding the way in which the rotas are organised, the shifts worked or the arrangements for a split site. On some occasions a nurse can undertake some of the tasks that a junior doctor fulfils.
      I must make it clear that the blunt instrument of a legislative limit is not appropriate or helpful. I agree with hon. Members that working over-long hours not only makes people go to sleep at work—that may be all right for the hon. Member for Livingston (Mr. Cook), but it is not all right for a junior hospital doctor—is not good for the patients.
      Comment has been made about whether the relevant figures are getting better or worse. I have looked at the figures extremely carefully and they are getting better. After 1982, the numbers working the most onerous rotas fell from about 5,000 to about 3,500, and following the initiative by the Secretary of State for Social Security in 1988, there was a further fall, from about 27 per cent. working onerous rotas to 22 per cent., and we think that next September about one in eight will be working the most onerous rotas. Nevertheless, I shall not be content—no hon. Member could feel content—until all such rotas are eliminated. It is not right for junior doctors to work such onerous rotas because we want them to be fit for work.
      Mr. Campbell-Savours: Will the Minister explain why a junior pilot on an aeroplane is not allowed to work an onerous rota while a junior doctor in a hospital is? What is the distinction?
      Mrs. Bottomley: The distinction is that the junior pilot is flying—[Interruption.] When we are talking about the hours worked by junior doctors, we are talking about doctors who are not necessarily working. Junior doctors may be on call, in which case they may fall into the category that I described of a person who is on call one night in two but is called out once a fortnight. That is different from the person who is working constantly.
      Nor must we overlook the involvement of the junior doctors themselves, because the existence of long continuous rotas is an area where junior doctors can themselves play a part in rescheduling rotas, taking time off in lieu or splitting shifts.
      Mr. Terry Davis: The Minister says that a pilot is in a different position from a junior doctor because the pilot is flying. Has she never heard of co-pilots? There may need to be two pilots in the cockpit, one flying and one not flying, or one might be on call.
      Mr. Bill Walker: Will my hon. Friend accept a fact from a former professional pilot—[Interruption.] Biggles or not, I shall be happy to be called squadron leader or sir. Pilots, whether first or second pilots, when on an aircraft are flying all the time because a two-man crew requires two people to fly the plane. Pilots'

      575
      flying hours are their determining hours of work. My hon. Friend was right to say that doctors are not flying all the time, as it were, whereas pilots are.
      Mr. Michael Morris: As a former RAF pilot with a son who has recently been a junior doctor, I must tell my hon. Friend the Member for Tayside, North (Mr. Walker) that he is wrong. The vast majority of junior doctors in our district general hospitals are on call and are being called out more regularly now than they were when my wife trained as a doctor. The degree of work that they must do is increasing all the time. My hon. Friend the Member for Tayside, North is not right to talk about the first and second pilot having to be on duty the whole time. There are many occasions when the second pilot is undertaking tasks which involve him not being on the flight deck all the time.
      Mrs. Bottomley: It is clear that we are discussing a subject about which hon. Members feel strongly. The crucial element, to which I have not yet referred, is the need to achieve a balanced policy. It is not possible to legislate overnight to reduce working hours without having a mechanism to ensure that the patients are cared for. That is why the whole discussion of medical manpower must be closely tied in with the issue of junior hospital doctors' hours.
      I am pleased to report that I have now received acceptances from all the crucial partners involved in this issue to come to discuss what can be done. We must ensure that each and every element involved in the use of junior hospital doctors is committed to taking the action that is necessary. The royal colleges, the consultants, the junior doctors, the NHS in terms of the management and we at the Department of Health all have a part to play. All concerned will be coming, before Easter, to have discussions about what further action can be taken. I do not believe that a legislative limit is the right way through the problem, but I do not rule out the possibility that at some stage amending the terms and conditions of employment might be an appropriate way through, so I would not rule out that course.
      First, however, we must ensure that the progress that we are seeing is implemented. We have a commitment that the most onerous rotas will be further eliminated by next September and we must ensure that that happens. We must draw together a coherent and comprehensive strategy to bring to an end what we all agree is an unacceptable way for junior hospital doctors to work.
      Mr. Michael: It must be obvious to the Minister that her reply was as unsatisfactory to some of her hon. Friends as it was to Opposition Members. It was an extremely unsatisfactory reply which, I regret, seemed to demonstrate a commitment to do nothing. I cannot believe that hon. Members would regard the matter as safe in the Minister's hands in the light of that reply.
      As the Minister said, this is an entrenched problem. That is why it needs to be shaken free. I hope that the Government and Conservative Members will support the new clause on the basis of accepting the principle; the detail can be refined in another place. I think that all hon. Members who have spoken would agree that the principle needs to be established. It is regrettable that the Minister did not accept the principle. Therefore, I encourage my hon. Friends and Conservative Members to join us in the Lobby.
      Question put, That the clause be read a Second time :—
      The House divided: Ayes 204, Noes 266.

      Division No. 126]

      [9.41 pm

      AYES

      Abbott, Ms Diane

      Garrett, John (Norwich South)

      Adams, Allen (Paisley N)

      Garrett, Ted (Wallsend)

      Allen, Graham

      George, Bruce

      Alton, David

      Godman, Dr Norman A.

      Anderson, Donald

      Golding, Mrs Llin

      Archer, Rt Hon Peter

      Gordon, Mildred

      Armstrong, Hilary

      Gould, Bryan

      Ashton, Joe

      Graham, Thomas

      Banks, Tony (Newham NW)

      Griffiths, Nigel (Edinburgh S)

      Barnes, Harry (Derbyshire NE)

      Griffiths, Win (Bridgend)

      Barnes, Mrs Rosie (Greenwich)

      Hardy, Peter

      Barron, Kevin

      Harman, Ms Harriet

      Beckett, Margaret

      Hattersley, Rt Hon Roy

      Beggs, Roy

      Haynes, Frank

      Beith, A. J.

      Henderson, Doug

      Benn, Rt Hon Tony

      Hinchliffe, David

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

      Hoey, Ms Kate (Vauxhall)

      Bermingham, Gerald

      Hogg, N. (C'nauld & Kilsyth)

      Blair, Tony

      Home Robertson, John

      Blunkett, David

      Hood, Jimmy

      Boateng, Paul

      Howarth, George (Knowsley N)

      Boyes, Roland

      Howells, Geraint

      Bradley, Keith

      Howells, Dr. Kim (Pontypridd)

      Brown, Gordon (D'mline E)

      Hoyle, Doug

      Brown, Nicholas (Newcastle E)

      Hughes, John (Coventry NE)

      Brown, Ron (Edinburgh Leith)

      Hughes, Robert (Aberdeen N)

      Buchan, Norman

      Hughes, Roy (Newport E)

      Buckley, George J.

      Hughes, Sean (Knowsley S)

      Caborn, Richard

      Hughes, Simon (Southwark)

      Campbell, Menzies (Fife NE)

      Illsley, Eric

      Campbell-Savours, D. N.

      Ingram, Adam

      Carlile, Alex (Mont'g)

      Janner, Greville

      Cartwright, John

      Jones, Barry (Alyn & Deeside)

      Clark, Dr David (S Shields)

      Jones, Ieuan (Ynys Môn)

      Clarke, Tom (Monklands W)

      Jones, Martyn (Clwyd S W)

      Clay, Bob

      Kennedy, Charles

      Clelland, David

      Kilfedder, James

      Clwyd, Mrs Ann

      Kirkwood, Archy

      Cohen, Harry

      Lamond, James

      Coleman, Donald

      Leadbitter, Ted

      Cook, Robin (Livingston)

      Lestor, Joan (Eccles)

      Cousins, Jim

      Lewis, Terry

      Cox, Tom

      Livingstone, Ken

      Crowther, Stan

      Livsey, Richard

      Cryer, Bob

      Lloyd, Tony (Stretford)

      Cummings, John

      Lofthouse, Geoffrey

      Dalyell, Tam

      Loyden, Eddie

      Darling, Alistair

      McAllion, John

      Davies, Rt Hon Denzil (Llanelli)

      McAvoy, Thomas

      Davies, Ron (Caerphilly)

      McCartney, Ian

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

      Macdonald, Calum A.

      Dewar, Donald

      McGrady, Eddie

      Dixon, Don

      McKay, Allen (Barnsley West)

      Dobson, Frank

      McKelvey, William

      Doran, Frank

      Maclennan, Robert

      Duffy, A. E. P.

      McNamara, Kevin

      Dunnachie, Jimmy

      Madden, Max

      Eadie, Alexander

      Mahon, Mrs Alice

      Eastham, Ken

      Marek, Dr John

      Ewing, Harry (Falkirk E)

      Marshall, Jim (Leicester S)

      Ewing, Mrs Margaret (Moray)

      Martin, Michael J. (Springburn)

      Faulds, Andrew

      Martlew, Eric

      Fearn, Ronald

      Maxton, John

      Field, Frank (Birkenhead)

      Meacher, Michael

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

      Meale, Alan

      Fisher, Mark

      Michael, Alun

      Flannery, Martin

      Michie, Bill (Sheffield Heeley)

      Flynn, Paul

      Michie, Mrs Ray (Arg'l & Bute)

      Foot, Rt Hon Michael

      Molyneaux, Rt Hon James

      Foster, Derek

      Moonie, Dr Lewis

      Foulkes, George

      Morgan, Rhodri

      Fraser, John

      Morris, Rt Hon A. (W'shawe)

      Fyfe, Maria

      Mowlam, Marjorie

      Galloway, George

      Mullin, Chris

      577

      Murphy, Paul

      Skinner, Dennis

      Nellist, Dave

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

      Oakes, Rt Hon Gordon

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

      Orme, Rt Hon Stanley

      Smith, J. P. (Vale of Glam)

      Paisley, Rev Ian

      Smyth, Rev Martin (Belfast S)

      Patchett, Terry

      Soley, Clive

      Pike, Peter L.

      Spearing, Nigel

      Powell, Ray (Ogmore)

      Steel, Rt Hon Sir David

      Prescott, John

      Steinberg, Gerry

      Primarolo, Dawn

      Taylor, Mrs Ann (Dewsbury)

      Quin, Ms Joyce

      Taylor, Matthew (Truro)

      Radice, Giles

      Thompson, Jack (Wansbeck)

      Randall, Stuart

      Turner, Dennis

      Redmond, Martin

      Wallace, James

      Rees, Rt Hon Merlyn

      Walley, Joan

      Richardson, Jo

      Warden, Gareth (Gower)

      Robertson, George

      Wareing, Robert N.

      Robinson, Geoffrey

      Welsh, Andrew (Angus E)

      Rogers, Allan

      Welsh, Michael (Doncaster N)

      Rooker, Jeff

      Wigley, Dafydd

      Ross, Ernie (Dundee W)

      Williams, Alan W. (Carm'then)

      Ross, William (Londonderry E)

      Wilson, Brian

      Rowlands, Ted

      Winnick, David

      Ruddock, Joan

      Wise, Mrs Audrey

      Sedgemore, Brian

      Worthington, Tony

      Sheerman, Barry

      Young, David (Bolton SE)

      Sheldon, Rt Hon Robert

      Shore, Rt Hon Peter

      Tellers for the Ayes:

      Short, Clare

      Mr. John McFall, and Mr. John Battle.

      Sillars, Jim

      NOES

      Adley, Robert

      Clark, Dr Michael (Rochford)

      Alexander, Richard

      Clark, Sir W. (Croydon S)

      Alison, Rt Hon Michael

      Clarke, Rt Hon K. (Rushcliffe)

      Allason, Rupert

      Colvin, Michael

      Amess, David

      Conway, Derek

      Amos, Alan

      Coombs, Anthony (Wyre F'rest)

      Arbuthnot, James

      Coombs, Simon (Swindon)

      Arnold, Jacques (Gravesham)

      Cope, Rt Hon John

      Arnold, Tom (Hazel Grove)

      Couchman, James

      Atkins, Robert

      Cran, James

      Baker, Nicholas (Dorset N)

      Currie, Mrs Edwina

      Baldry, Tony

      Curry, David

      Banks, Robert (Harrogate)

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

      Batiste, Spencer

      Davis, David (Boothferry)

      Bellingham, Henry

      Day, Stephen

      Bendall, Vivian

      Devlin, Tim

      Bennett, Nicholas (Pembroke)

      Dorrell, Stephen

      Benyon, W.

      Douglas-Hamilton, Lord James

      Biffen, Rt Hon John

      Dover, Den

      Blaker, Rt Hon Sir Peter

      Dunn, Bob

      Body, Sir Richard

      Durant, Tony

      Bonsor, Sir Nicholas

      Eggar, Tim

      Boscawen, Hon Robert

      Evans, David (Welwyn Hatf'd)

      Boswell, Tim

      Fallon, Michael

      Bottomley, Mrs Virginia

      Favell, Tony

      Bowden, A (Brighton K'pto'n)

      Fenner, Dame Peggy

      Bowden, Gerald (Dulwich)

      Field, Barry (Isle of Wight)

      Bowis, John

      Fishburn, John Dudley

      Boyson, Rt Hon Dr Sir Rhodes

      Forman, Nigel

      Brandon-Bravo, Martin

      Forsyth, Michael (Stirling)

      Brazier, Julian

      Forth, Eric

      Bright, Graham

      Fowler, Rt Hon Sir Norman

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

      Fox, Sir Marcus

      Bruce, Ian (Dorset South)

      Franks, Cecil

      Buchanan-Smith, Rt Hon Alick

      Freeman, Roger

      Budgen, Nicholas

      French, Douglas

      Burns, Simon

      Gale, Roger

      Butler, Chris

      Garel-Jones, Tristan

      Butterfill, John

      Gill, Christopher

      Carlisle, John, (Luton N)

      Glyn, Dr Sir Alan

      Carlisle, Kenneth (Lincoln)

      Goodhart, Sir Philip

      Carrington, Matthew

      Goodlad, Alastair

      Carttiss, Michael

      Goodson-Wickes, Dr Charles

      Cash, William

      Gorman, Mrs Teresa

      Chalker, Rt Hon Mrs Lynda

      Gorst, John

      Channon, Rt Hon Paul

      Gow, Ian

      Chapman, Sydney

      Grant, Sir Anthony (CambsSW)

      Churchill, Mr

      Greenway, John (Ryedale)

      578

      Gregory, Conal

      Mitchell, Andrew (Gedling)

      Griffiths, Peter (Portsmouth N)

      Moate, Roger

      Grist, Ian

      Monro, Sir Hector

      Ground, Patrick

      Montgomery, Sir Fergus

      Grylls, Michael

      Moss, Malcolm

      Hague, William

      Moynihan, Hon Colin

      Hamilton, Hon Archie (Epsom)

      Neale, Gerrard

      Hamilton, Neil (Tatton)

      Nelson, Anthony

      Hampson, Dr Keith

      Neubert, Michael

      Hanley, Jeremy

      Newton, Rt Hon Tony

      Hannam, John

      Nicholls, Patrick

      Hargreaves, Ken (Hyndburn)

      Nicholson, David (Taunton)

      Harris, David

      Nicholson, Emma (Devon West)

      Haselhurst, Alan

      Norris, Steve

      Hayes, Jerry

      Onslow, Rt Hon Cranley

      Hayward, Robert

      Page, Richard

      Heathcoat-Amory, David

      Paice, James

      Hicks, Mrs Maureen (Wolv' NE)

      Parkinson, Rt Hon Cecil

      Hicks, Robert (Cornwall SE)

      Patnick, Irvine

      Higgins, Rt Hon Terence L.

      Peacock, Mrs Elizabeth

      Hill, James

      Porter, Barry (Wirral S)

      Hind, Kenneth

      Porter, David (Waveney)

      Hogg, Hon Douglas (Gr'th'm)

      Portillo, Michael

      Holt, Richard

      Price, Sir David

      Howell, Rt Hon David (G'dford)

      Raison, Rt Hon Timothy

      Howell, Ralph (North Norfolk)

      Rathbone, Tim

      Hughes, Robert G. (Harrow W)

      Renton, Rt Hon Tim

      Hunt, David (Wirral W)

      Rhodes James, Robert

      Hunt, Sir John (Ravensbourne)

      Ridsdale, Sir Julian

      Hurd, Rt Hon Douglas

      Rifkind, Rt Hon Malcolm

      Irvine, Michael

      Roberts, Wyn (Conwy)

      Irving, Sir Charles

      Rossi, Sir Hugh

      Jack, Michael

      Rost, Peter

      Jackson, Robert

      Rowe, Andrew

      Janman, Tim

      Rumbold, Mrs Angela

      Jessel, Toby

      Sackville, Hon Tom

      Johnson Smith, Sir Geoffrey

      Sayeed, Jonathan

      Jones, Gwilym (Cardiff N)

      Scott, Rt Hon Nicholas

      Jones, Robert B (Herts W)

      Shaw, Sir Michael (Scarb')

      Jopling, Rt Hon Michael

      Shephard, Mrs G. (Norfolk SW)

      Kellett-Bowman, Dame Elaine

      Shepherd, Colin (Hereford)

      Key, Robert

      Sims, Roger

      King, Roger (B'ham N'thfield)

      Skeet, Sir Trevor

      Kirkhope, Timothy

      Smith, Sir Dudley (Warwick)

      Knapman, Roger

      Smith, Tim (Beaconsfield)

      Knight, Greg (Derby North)

      Speed, Keith

      Knight, Dame Jill (Edgbaston)

      Speller, Tony

      Knowles, Michael

      Spicer, Sir Jim (Dorset W)

      Knox, David

      Stanbrook, Ivor

      Lang, Ian

      Stanley, Rt Hon Sir John

      Latham, Michael

      Stern, Michael

      Lee, John (Pendle)

      Stevens, Lewis

      Leigh, Edward (Gainsbor'gh)

      Stewart, Allan (Eastwood)

      Lennox-Boyd, Hon Mark

      Stewart, Andy (Sherwood)

      Lester, Jim (Broxtowe)

      Stewart, Rt Hon Ian (Herts N)

      Lilley, Peter

      Stokes, Sir John

      Lloyd, Sir Ian (Havant)

      Stradling Thomas, Sir John

      Lloyd, Peter (Fareham)

      Sumberg, David

      Lord, Michael

      Summerson, Hugo

      Lyell, Rt Hon Sir Nicholas

      Taylor, Ian (Esher)

      Macfarlane, Sir Neil

      Taylor, Teddy (S'end E)

      Maclean, David

      Tebbit, Rt Hon Norman

      McLoughlin, Patrick

      Temple-Morris, Peter

      McNair-Wilson, Sir Michael

      Thompson, D. (Calder Valley)

      Madel, David

      Thompson, Patrick (Norwich N)

      Malins, Humfrey

      Thornton, Malcolm

      Mans, Keith

      Thurnham, Peter

      Maples, John

      Tracey, Richard

      Marland, Paul

      Trippier, David

      Marlow, Tony

      Trotter, Neville

      Marshall, John (Hendon S)

      Twinn, Dr Ian

      Marshall, Michael (Arundel)

      Vaughan, Sir Gerard

      Martin, David (Portsmouth S)

      Waddington, Rt Hon David

      Mawhinney, Dr Brian

      Waldegrave, Rt Hon William

      Maxwell-Hyslop, Robin

      Walden, George

      Mayhew, Rt Hon Sir Patrick

      Walker, Bill (T'side North)

      Mellor, David

      Waller, Gary

      Meyer, Sir Anthony

      Ward, John

      Mills, Iain

      Wardle, Charles (Bexhill)

      Miscampbell, Norman

      Watts, John

      579

      Wells, Bowen

      Woodcock, Dr. Mike

      Wheeler, Sir John

      Yeo, Tim

      Widdecombe, Ann

      Young, Sir George (Acton)

      Wilkinson, John

      Wilshire, David

      Tellers for the Noes:

      Winterton, Mrs Ann

      Mr. David Lightbown and Mr. John M. Taylor.

      Wood, Timothy

      Question accordingly negatived.

    New clause 9

      REGISTER OF PRIVATE CONTRACTORS
      '(1) The Secretary of State shall maintain a register of private companies available to tender for contracts awarded under competitive tender by an National Health Service Trust, health authority or an health board in Scotland.
      (2) A company registered under subsection (1) above shall provide an annual return which shall state:

      (a) Any contracts held with National Health Trusts, health authorities, or Health Boards in Scotland.

      (b) Any penalties invoked under such contracts.

      (c) The total number of employees in post and annual staff turnover.

      (d) Any parliamentary consultancies awarded in the preceding six years.

      (3) Contracts to be tendered for under this Act shall only be tendered for by private companies listed on its register to be maintained under subsection (1) of this section.'.—[Mr. Campbell-Savours.]
      Brought up, and read the First time.
      Mr. Campbell-Savours: I beg to move, That the clause be read a Second time.
      Mr. Speaker: With this, I understand that it will be convenient also to take new clause 11—Contracts for competitive tendering—
      '(1) A National Health Service trust, health authority or health board in Scotland shall not award a contract for services to a private company unless it is satisfied that the cost of such a contract is less than the cost of direct provision by its own staff.
      (2) In establishing whether the cost of a private contract is less than direct provision, a National Health Service Trust, health authority or health board in Scotland shall have regard to—

      (a) any additional charge of value added tax.

      (b) any redundancy payments arising from dismissal of staff.'.

      Mr. Campbell-Savours: The objective of new clause 9 is to place a responsibility on the Secretary of State to set up a register of contractors, the effect of which would be to provide for greater glasnost in the way in which private contractors operate, wherever they may be in the United Kingdom.
      Much controversy surrounds the activities of private contractors. Privatisation is politically sensitive and, so far as the public is concerned, extremely controversial. The industrial side of the National Health Service includes catering, domestic and laundry services. When between 70 per cent. and 90 per cent. of the costs of that industry comprise wages, the only opportunity for profit taking in that industry must come from reducing wages and conditions—and in particular the wages.
      A year or two ago, the Treasury produced a report called "Using Private Enterprise in Government". That report stated:
      "most of the savings from contracting out arise because contractors offer poorer conditions of employment. Contractors in the ancillary services usually offer similar basic rates of pay ranging from 10 per cent. less to a few per cent. more in some cases, but they eliminate costly bonus schemes
      580
      and overtime working, provide little if any sick pay and avoid national insurance payments by means of more part-time working."
      The truth is that savings to generate profits in those industries in which we require a register to be set up arise because people cut labour costs and the result is discontent and a high turnover of staff.
      That is why I pursued the Under-Secretary of State for Scotland, the hon. Member for Stirling (Mr. Forsyth), in Committee. People and those Members of this House who press for contractorisation and privatisation in the NHS are pressing on Government the need to reduce the wages and salaries of people who already work in low paid areas of the NHS.
      I understand that many hon. Members have consultancies and directorships in those organisations, whether they be lobbying companies or in direct contact with contractors. I also understand that many hon. Members, and particularly their spouses who are not required to register shareholdings in the Register of Members' Interests, have holdings and are direct beneficiaries of legislation which promotes privatisation. In so far as the Bill is enabling legislation, it will ensure that many thousands more contracts will be let for services.
      Under the terms of new clause 9(a) the register would show
      "Any contracts held with National Health Trusts, health authorities, or Health Boards in Scotland."
      Members might question the need for that. The answer is to be found not in a Government document, but in a document published by the trades union privatisation unit. That document lists the authorities that have had difficulties with private contractors. It identifies the contractors and the services that they were providing.
      For example, there are well documented complaints over many months about the laundry service in the acute unit of Croydon health authority. The company involved there was Advance Laundry. South West Surrey district health authority had problems with Allied Medical Catering, which went into voluntary liquidation three months into its contract. Andmarc, another company providing domestic service in North West Surrey health authority, had its contract terminated after just 10 clays, during which it could not meet the required standard. Blue Arrow, another company providing domestic service at Parkside hospital in Macclesfield health authority, failed to meet the standards. It pulled out of the contract after just one year. Following the failure of another company, A and E Chapman, to provide adequate service at new East Surrey hospital, the contractors' performance was put under strict health authority scrutiny. Its one year contract was not subsequently renewed.
      10 pm
      Contract Clean (Southern) in North West Surrey health authority, which provided domestic service, claimed that it had under-estimated costs and quit after a year of the contract. I have pages and pages of companies in this sector employed under rules instituted by the Government, no doubt driven down the route of competitive tendering by more than obliging Members of Parliament asking parliamentary questions to elicit a response from district health authorities.
      Many companies listed in the document have either lost their tender or simply been put out by the health authority. Contract Clean (Southern), County Cleaners and

      581
      Crothall, are further examples. Crothall failed in many contract areas covering the three areas covered by the clause—catering, laundry and domestic—in every part of the United Kingdom. Its record is appalling.
      Endless Hospital Services is another such company. Exclusive is another, which I understand has representatives in the House. The list also includes Express Laundries (Blackpool), Gardner Merchant, Hall Hospital Services, Home Counties Cleaning, Hospital Hygiene Services, ICC Hospital Services, Ideal, Initial Laundry, Kneels, B. A. Lister, Mediclean, OCS, RCO, Reckitt, Royal Jersey Laundry, Spinneys, Sunlight, and Westcott. It is a roll of dishonour. People have taken on contracts who cannot run them properly or meet standards. They have either been forced to leave or booted out of the contract by the district health authority.
      Mr. Rowe: Will the hon. Gentleman give way?
      Mr. Campbell-Savours: I have no intention of giving way. The hon. Gentleman had weeks in Committee to ask questions on these matters. He did not do so.
      Mr. Nicholas Bennett: We did.
      Mr. Campbell-Savours: He concentrated on matters which were insignificant.
      Mr. Neil Hamilton: Is this a COHSE brief?
      Mr. Campbell-Savours: No. The information is available to any Member of Parliament who seeks to find out the truth. Anyone can find it. The problem is that Conservative Members sit on their backsides and refuse to address themselves to the truth. The truth is that contractorisation and privatisation in the NHS are appalling failures.
      Mr. Donald Thompson: Will the hon. Gentleman give way?
      Mr. Campbell-Savours: No.
      I want to move on to paragraph 2(b) of the new clause which deals with the registration of penalties invoked in such contracts. Why do we need to refer to penalties? Why should the register show where penalties had to be paid? The answer is simple. Many companies have been subject to penalties. They include Allied Medical Catering, in South West Surrey health authority. The company went into liquidation. The health authority also terminated the contract of Andmarc. In Kingston and Esher health authority in 1986, Advance Laundry pulled out. Blue Arrow Cleaning Group in Macclesfield health authority pulled out in 1986. Exclusive Cleaning in Bromley health authority pulled out.
      In every area of the United Kingdom, and particularly in the constituencies of Conservative Members, this policy has miserably failed. Contractors have been turfed out, and often penalised. It was Sir Whatisname Forte who three or four years ago decided to go into this business until he took a closer look and decided that he could make money from privatisation only by cutting wages. Not even Sir Charles Forte was willing to do that. Where he was unwilling to go, Conservative Members were perfectly willing to press for in this House. Clearly, they do not carry with them the same moral standards, if I may use that word. We are talking about standards.
      A Conservative Member who is willing to come to the House and advocate that a privately contracted NHS
      582
      worker earns only 1·80 an hour, which is indeed the going rate offered by many contractors, is unfit to sit at Westminster. No one in his right mind in the society of the 1990s and living in the real world can possibly advocate such wage levels, yet people do. That is why we took such strong exception to the Under-Secretary of State for Scotland, the hon. Member for Stirling. Before coming to Parliament, he spent his life pushing these appalling contracts that led to low-income families throughout the country suffering. They could not afford to go to work and earn as little money as they were earning. [Interruption.] Hon. Members can cringe—[HON. MEMBERS: "We are not cringeing."] Hon. Members can cringe. Let them stand up and defend those wage levels. They are indefensible.
      I wish to raise the question of what you referred to yesterday, Mr. Speaker, as public policy. Sponsored Members of Parliament receive no money from their sponsoring union. I receive nothing personally and I claim no expenses, not one penny. The Conservative party has successfully sown a myth in the public mind about what sponsorship means in order to be able to justify their consultancies and directorships, which are based on personal financial remuneration.
      If we are to accept the principle of public policy and if a Member who receives personal remuneration is entitled to vote, on what basis can that principle of public policy be extended to cover procedural motions, such as the guillotine motion? It is an important principle. Why should Members of Parliament be able to drive through legislation, not on its principle, but procedurally simply because they will be the financial beneficiaries? Why should they have that right?
      We had that argument some years ago in the Committee considering licensing hours. Three Conservative Members voted for a sittings motion. Weeks later, we blocked the Bill on Report on the Floor of the House as a punishment for their moving the sittings motion before the 1987 general election. Hon. Members may remember that. We believed that it was wrong that those with a direct pecuniary interest should use procedure to drive through legislation from which they could benefit directly.
      Mr. Bill Walker: Will the hon. Gentleman give way?
      Mr. Campbell-Savours: I have absolutely no intention of giving way. [HoN. MEMBERS: "Give way."] I gave way to the hon. Gentleman many times last week, and he will be getting a letter from me about it.
      It is wrong that people with a direct pecuniary interest who receive money in their back pocket should be allowed to vote. That has happened on this Bill. It is a constitutional outrage that it is happening in the House. If the general public understood the complexities of procedure, but saw it simply as, indeed, it is in practice, they would feel equally outraged. The problem is that they will not learn the truth, but they should know the truth.
      I feel strongly about the new clause, but, as many Members wish to speak, I advise my hon. Friends not to push the matter to a Division. Let us have more debate, in the hope that some Government Member will get up and defend the levels of wages paid in the industries about which I have been talking.
      Mr. Nicholas Bennett: Those of us who served for three months on the Standing Committee that dealt with the Bill enjoyed listening to the hon. Member for Workington

      583
      (Mr. Campbell-Savours) make these speeches week in and week out. He was the Robespierre playing to Madam Defarge from Halifax. We have been told that he is incorruptible, but when we examine his interests what do we find? First of all, he is a sponsored member of a Health Service union. Time and time again, he has voted against competition in the Health Service, against competitive tendering, and in favour of union monopoly power.
      Did the hon. Gentleman just once stop to think about what he was doing as a union-sponsored Member? What was his interest in voting for union monopoly power? Tonight he has impugned the honour of other hon. Members, but not once did he make such a declaration. He does not consider it wrong that he and his hon. Friends should be sponsored by unions with a vested interest in a Health Service that is not reformed, in working practices that are not changed, and in entrenched monopoly power for one union in the Health Service.
      But this applies not only to the hon. Member for Workington. The hon. Member for Halifax (Mrs. Mahon) is sponsored by the National Union of Public Employees, the hon. Member for Wakefield (Mr. Hinchliffe) is sponsored by the National Union of Public Employees, and the hon. Member for Peckham (Ms. Harman) is sponsored by the Transport and General Workers Union. One could do a long roll-call of Labour Members who, week in and week out, have spoken—
      Ms. Dawn Primarolo: On a point of order, Mr. Speaker. The hon. Member for Pembroke (Mr. Bennett) has just named several hon. Members. It is a courtesy of the House that Members who are to be named are notified. Has the hon. Gentleman notified these Members?
      Mr. Speaker: We must not get too wide of the new clause, which concerns the register of private contractors. I think that we have had enough of the other matter.
      Mr. Bennett: If the hon. Member for Workington thinks that it is important to have a register of private contractors and that the interests of Members should be looked at, we are entitled to wonder why certain Opposition Members are so keen to defend the status quo. They oppose private contractors because they have a vested interest in supporting union power.
      Mr. Bill Walker: The question that I had hoped to put to the hon. Member for Workington (Mr. Campbell-Savours) I shall put instead to my hon. Friend. Does not my hon. Friend find it interesting that the hon. Member for Workington and others appear to believe that it is quite in order for Members of this House to write articles attacking the principles, and sometimes the practices, of privatisation and to accept substantial fees for doing so and then speak in this House about the subject without declaring an interest? Is that in any way different from the activities of any Member engaging in any other activity that ought to be declared?
      Mr. Bennett: My hon. Friend is absolutely right. Indeed, he has made the point better than I could have done.
      Mr. James Couchman: My hon. Friend will remember that, early in the Committee's proceedings, we willingly and properly declared our interests. Many Government Members did so, as did many Opposition
      584
      Members, including the hon. Members for Halifax (M rs. Mahon) and Wakefield (Mr. Hinchliffe). Indeed, that is what convention dictates. Does my hon. Friend remember that three times I had to prod the hon. Member for Workington (Mr. Campbell-Savours) into making any declaration of interest at all?
      Mr. Bennett: My hon Friend is absolutely right: the hon. Gentleman did not declare those interests without being prodded into action.
      10.15 pm
      Mr. Campbell-Savours: On a point of order, Mr. Speaker. You know me and you would know that what has just been said is a tissue of lies.
      Mr. Speaker: I was not on the Standing Committee—
      Mr. Campbell-Savours: Let me finish my point of order, Mr. Speaker.
      Mr. Speaker: Order. I was not on the Standing Committee, so I have no knowledge of these matters. May I say to the whole House that this debate is not about Members' interests but about the register of private contractors.
      Mr. Campbell-Savours rose—
      Mr. Speaker: Order. The hon. Member for Workington (Mr. Campbell-Savours) mentioned this matter, and I have allowed a response. We must now return to the kernel of the debate.
      Mr. Campbell-Savours: Further to the point of order, Mr. Speaker. Will you allow me to deal with the final comment by the hon. Member for Gillingham (Mr. Couchman)? If he wishes to repeat that statement outside the House, I shall prove that I am right by suing him in the courts. Perhaps he would like to take up my offer. If he does so, I promise him a writ. All right?
      Mr. Couchman rose—
      Mr. Speaker: Order. This is developing into a much wider subject than the debate on the new clause. I do not think that a point of order can arise on this matter. The hon. Member for Workington must not allege—I should have stopped him at the time—that any hon. Member has told a lie. Perhaps he will withdraw his comment.
      Mr. Campbell-Savours: I referred to a tissue of lies, Mr. Speaker. If you find that term offensive, I will withdraw it, for you.
      Mr. Speaker: Let us return to the debate and stick closely to it.
      Mr. Bennett: The hon. Member for Workington does not like getting a taste of his own medicine. We shall bear that in mind in future debates, when he may try this on again.
      When looking at the new clause, we are entitled to ask what a lack of competitive tendering means in terms of union power. It was interesting that the hon. Member for Workington talked about companies that had lost contracts or failed to deliver. Under the old system, where contracts were carried out by in-house union members, there was no control over the service. There was no opportunity to get a new contract from someone else,

      585
      because the power was in the hands of the union—the porters and the cleaning staff in the hospital—and there was no competition for the customer, the NHS.
      The new system is much better, because it enables district health authorities and hospitals to say that, if a contractor does not provide the services required, he can be turfed out, and taken to court if in breach of contract, and the contract will be handed over to someone else. That is a much better system than the old union monopoly power system.
      The hon. Member for Workington said that he, as a member of the Confederation of Health Service Employees, receives no money. Of course, the fact that some of those members do not receive the money personally—some of them do—means that that money is used for their election expenses and other things, which the rest of us have to find out of—
      Mr. Campbell-Savours: On a point of order, Mr. Speaker.
      Mr. Bennett: The hon. Gentleman is off again.
      Mr. Campbell-Savours: I should like to clarify for the House the fact that no member of COHSE in the House of Commons receives any money personally. The hon. Member for Pembroke (Mr. Bennett) should withdraw his remark. No money is received from COHSE as either expenses or salary. The hon. Gentleman should read what he said.
      Mr. Speaker: Order. We seem to be returning to a matter that I said was not in order. Let us keep to the subject of the new clause.
      Mr. Bennett: I should like to finish my last point, Mr. Speaker. I did not say that any member of COHSE received the money direct—
      Mr. Campbell-Savours: The hon. Gentleman did.
      Mr. Bennett: I did not. Hon. Members should listen. The money that those people receive for election expenses means that they do not have to spend money out of their own pocket—taxed income—on election expenses, because they receive it from someone else. The rest of us have to pay out of our own pocket. It is an indirect remuneration. On that point, I finish my speech.
      Mr. Jeff Rooker: On a point of order, Mr. Speaker. Let us clarify the matter so there is no mistake. It is illegal for a candidate to fund his own campaign.
      Mr. Speaker: Order. I think that the hon. Member for Pembroke (Mr. Bennett) has sat down.
      Mr. Win Griffiths: When I skimmed through the Bill, I could not see a clause under which I could legitimately raise the point that I wanted to make, but new clause 9 gives me that opportunity. Although my hon. Friend the Member for Workington (Mr. Campbell-Savours) has been concerned with obnoxious current practices relating to private tendering in the Health Service, I want to raise an issue that could have important implications if the Bill is passed.
      At the Princess of Wales hospital in my constituency, a full-time consultant in the pathology department, Dr.
      586
      Joan Williams, and the chief medical laboratory scientific officer, Mr. David Else, established a private pathology company named Healthcare Diagnostics Ltd. at the science park in Bridgend. While no direct conflict of interests exists at present between their work at the hospital's pathology department and their status as shareholders and directors of a private company, obviously one will arise soon.
      The hospital's pathology department is an income-generating department, and Dr. Joan Williams especially is in a position to obtain privileged information from that department and to know of the costs of all the services offered by the hospital to individuals and to private companies who want, for example, blood tests on all their employees. A third of the fees paid go directly to the health authority. In the case of drug screening trials, 100 per cent. of the money goes into the health authority's research budget.
      I thought that might have been a one-off case of possible commercial espionage within the Health Service by full-time NHS employees. However, when I publicised the facts of that case, I discovered that at the University of Wales hospital in Cardiff, a similar situation had developed involving Dr. Keith Davies, a top-grade biochemist working for the hospital, and Dr. Stephanie Matthews, a part-time consultant.
      They established a private company, Lifecare Advanced Medical Ltd, of which they are shareholders, directors, company secretary, and company chairman. They, too, are in a position to take work from the pathology department of the hospital for which they work. In the case of drug screening trials, shortly after Lifecare was established, the hospital pathology department lost that work by some direct or indirect route—the matter is still in dispute. What is not in dispute is that Lifecare Advanced Medical Ltd was suddenly undertaking the drug screening work that had previously been the responsibility of the hospital's own pathology department.
      Dr. Keith Davies is at least partly responsible for setting the charges that are made for that work, so he is in a position to obtain work both for the Health Service laboratory by which he is employed full-time and the private laboratory of which he is chairman and a shareholder.
      I can divulge another abuse of Dr. Davies' position. He served on a panel interviewing candidates for the post of a medical laboratory scientific officer with the University of Wales hospital. The same evening, he phoned the candidate who had been offered that job and said, "Come and join us at Lifecare." That was the job that the candidate then took up. That is the kind of scandal that can arise when Health Service employees are involved in private companies competing with the income-generating departments of the Health Service.
      Not only should there be a register of private companies allowed to tender, but any such company that has an NHS employee or one of his or her close relatives as a shareholder, director, or whatever, should be disqualified from the register. Individuals who are intent on competing with the National Health Service should decide whether they want to remain employed within the NHS or to run their own private companies. I hope that the Minister who replies to the debate will denounce and reject such activities as unsuitable for NHS employees and that he will undertake to issue guidelines to prevent them from being carried out in the future.
      Mr. Rowe: The hon. Member for Bridgend (Mr. Griffiths) has described what prima facie appears to be a clear conflict of interests. If that is the case, I have no hesitation in condemning it. However, in a structure of the size and diversity of the National Health Service, at every level there will be conflicts of interest and it is essential that we are alert to them. For example, we all know that many Health Service personnel augment their salaries by working partly in the private sector. I have absolutely no doubt that that provides them with opportunities for cross-fertilisation.
      Mr. Win Griffiths: I agree with the hon. Gentleman that if Dr. Keith Davies was carrying out tests for a private pathology laboratory owned and controlled by someone else for £10 an hour or whatever, there would be no conflict of interests. However, he is the director, company chairman and a shareholder in the private company while he is responsible for getting such work into the Health Service pathology laboratory. The Minister should make it quite clear that that should not be allowed.
      Mr. Rowe: I have absolutely no brief for such a practice and I condemn it wholeheartedly if that is the case.
      I am sorry that the hon. Member for Workington (Mr. Campbell-Savours) is not in his place—I apologise, he is not in his usual place, and he does not appear to be paying attention. The privatisation publication of his union is unlikely to list the large number of contracts which have been discharged successfully, because the union is interested only in those which have failed to deliver the goods. I happen to find some consolation and comfort in the long list of contracts which have been terminated because they have not reached the standard required by the health authority because it shows that the health authorities are keeping a close eye on the quality of the contractors delivering the service. Throughout the National Health Service millions of pounds are being saved and in many cases a very much higher standard of service is being delivered by private contractors.
      There is one element, however, on which I hope that my hon. Friend the Minister will be able to reassure me. When the necessary breaking up of the trade union dominated monopoly of services to the health authorities was started, it was written into the law that health authorities had to accept the lowest tender. That was a mistake, as I know from my own experience. A constituent of mine told me that he worked for a highly ethical cleaning company with high standards which made a point of never diminishing the salaries and conditions of service of staff whom they took over. That company added immense value by a combination of training and technology, but when it tried to break into tendering for the National Health Service it found it impossible because it was unable to underbid other contractors. It tendered to break in at the point at which it was paying exactly the same salaries and conditions of service and to improve the service over the 12 months in which it had the first contract until it became apparent that it was offering good value for money, but that was not possible.
      I hope that my hon. Friend the Minister can assure me that the new system will not contain such an artificial barrier to high quality services due to some routine rule which dismisses anyone who does not offer the lowest price.
      10.30 pm
      Mr. John Maxton: I shall be brief because we are trying to keep to a timetable and I suspect that we may be running a little behind.
      The case that my hon. Friend the Member for Bridgend (Mr. Griffiths) cited is not unique. Greater Glasgow health board recently employed a person to get its laundry service into shape for privatisation—to prepare the contracts and reorganise the service in a certain area of Glasgow. Then it was discovered that that same man and his son were setting up a laundry company to bid for the contract. What did the health board do? It rightly removed the man from the job that he had been doing, but it did not fire him. Moreover, it did not stop his company from taking part in the tender process. That seems to me to be quite wrong.
      My hon. Friend the Member for Workington (Mr. Campbell-Savours) may sometimes seem abrasive and his remarks may sometimes rile people, but he is right to talk of the sleaze factor in the privatisation process, of which there is a genuine fear. The Opposition and large sections of the public feel that there is something sleazy about privatisation, and "sleazy" is the right word. The Conservative party is advancing an ideology and arguing in favour of what is supposedly a great principle—the principle of privatisation—which benefits it, its friends and supporters and, in some case, its members.
      We should remember, too, that in laundry and catering services, competition is almost non-existent. The competition is between the in-house tenderers and large multinational companies which do not compete with each other but carve up the contracts between them. There is no competition at that level; the only competition is against the in-house tenderers.
      Mr. Campbell-Savours: But in an industry in which between 70 per cent. and 90 per cent. of the costs are labour-related, surely the real competition has to do with who can secure the lowest costs. That is the real competitive position and that is why I find the whole business so utterly immoral.
      Mr. Bill Walker rose—
      Mr. Maxton: I hope that the hon. Gentleman will at least allow me to answer my hon. Friend the Member for Workington, who referred to a second sleaze factor. The first is that the large multinational companies involved are mostly contributors to the funds of the Tory party, whose election expenses they pay. A lot of nonsense is talked about Labour's election expenses, but the Conservative party spends much more money than we do and the multinationals pay their election expenses.
      Mr. Bill Walker: I thank the hon. Gentleman for giving way to me again. He is well aware of the position. Does he suggest that a company such as Fishers based in Aberfeldy in my constituency is part of a multinational company? Where does that company—one of the leading companies in its field in Scotland—figure in his calculations?
      Mr. Maxton: Of course, some small companies are involved. No one is suggesting that the multinationals have an absolute monopoly. What I suggest, though, is that 81 per cent. of catering is in the hands of two or three major companies and that they are nearly all contributors to Tory party funds. That is the first sleaze factor.

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      The only point that I want to make—[HON. MEMBERS: "Only?"] It has been a long day. I have been in the House since 8.30 yesterday morning and I must admit that it is beginning to show.
      The profits that the companies make and the savings which Ministers claim accrue—they are dubious savings—are almost entirely at the expense of some of the lowest-paid people in the country. That is what we find so disgusting. People in the Health Service who are paid just over £2 an hour, which hardly provides them with a high standard of living, are being forced to take wages of £1·60 or £1·70 an hour. If I take my wife out to dinner, we spend between the two of us what these people are expected to live on for a week. The friends of the Conservatives are lining their pockets at the expense of low-paid workers.
      The factors that I have mentioned are what make the process of privatisation sleazy and what give it a corrupt feel. It is a distasteful business, and we will continue to fight it for a long time to come.
      The Parliamentary Under-Secretary of State for Health (Mr. Roger Freeman): The hon. Member for Workington (Mr. Campbell-Savours) has continued his campaign of attacks on my hon. Friend the Member for Stirling (Mr. Forsyth). I am sure that I speak on behalf of all my hon. Friends when I say that my hon. Friend has behaved fairly, correctly, honestly and in accordance with the rules of the House.
      Mr. Brian Sedgemore: Does the Minister agree that if the hon. Member for Stirling (Mr. Forsyth) has operated in accordance with the rules of the House, there may be something wrong with the rules?
      Mr. Freeman: I repeat the support that my Government colleagues and all Conservative Members extend to my hon. Friend, and our condemnation of the wholly unjustified innuendoes and attacks made by the hon. Member for Workington.
      The hon. Members for Workington and for Glasgow, Cathcart (Mr. Maxton) fail to distinguish between privatisation and contracting. Privatisation is about the change in ownership of assets and services, but we are talking now about contracting. There is a big difference. Contracting can be about services provided within the public sector and from the private sector. The arguments advanced by the hon. Member for Cathcart do not accord well with the reason of our earlier debates. He argues that all contractors are spivs, that they all contribute to the Conservative party, and that something stinks about the whole operation. I do not believe that most hon. Members would sympathise with that argument, nor would anyone observing the debate regard it as a fair representation of what is a sensible procedure.
      We have introduced into the NHS compulsory tendering for catering, cleaning and laundry. The Labour party manifesto, I understand, commits the party to ending compulsory tendering in those three services—a process which has saved £110 million for the NHS, money that has gone back into improving patient care.
      Most of these services are labour-intensive. Both in-house groups and private companies which tender should seek to make the most efficient use of the staff to be employed. That does not mean only wage rates, but it
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      includes them because this is a free country in which we have a free economy. Other factors are numbers of staff employed, equipment and motivation. All those factors must be taken into account, and that is why some private tenders win. I must tell the House, however, that only some 20 per cent. of all contracts have been won by private sector companies outside the NHS.
      Mr. Campbell-Savours: We know why.
      Mr. Freeman: I can tell the hon. Gentleman why—because the redundancy payments that private sector companies have to pay must be borne by those companies. Although payment may be spread over the term of the contract, it presents a great impediment to those companies competing for such work.
      Mr. Couchman: Does my hon. Friend agree that the fact that direct labour has been successful in winning so many of the contracts is a measure of the old "Spanish" practices which operated before tendering? Direct labour now works much more effectively and efficiently than previously.
      Mr. Freeman: I am grateful to my hon. Friend.
      Mr. Maxton: What about VAT?
      Mr. Freeman: Where VAT makes a difference between the price tendered by a private company and an in-house bid, it is not taken into account. The hon. Gentleman will know that VAT is refunded under the Finance Act 1984. It is fair to take that into account when comparing the cost of an in-house tender with that of a private company.
      My hon. Friend the Member for Mid-Kent (Mr. Rowe) asked me specifically about contracts and quality. There is no question of NHS authorities always being obliged to accept the lowest tender. I admit frankly that other factors must be taken into account. If quality is such a factor, the authority can opt for the higher tender and it must disclose that publicly. I do not believe that we need to amend the law to deal with the position that my hon. Friend described.
      The hon. Member for Bridgend (Mr. Griffiths) raised a question which gives cause for concern. If the facts are as presented by him, we must give him the benefit of the doubt. I will study the record. Contracts for consultants and all other NHS employees should provide for the elimination of such conflicts of interest.
      Mr. Win Griffiths: The Minister should study the Official Report of 1 March, columns 464–69, where I described in great detail what is happening in those two companies. I did not want to detain the House by doing so again today—I just wanted to mention the issues involved. I am glad that the Minister's response has been positive because the potential for conflicts of interest is serious in the cases that I mentioned.
      Mr. Freeman: I am sure that the House shares the hon. Gentleman's concern. I will study the record and draw it to the attention of my hon. Friend the Minister at the Welsh Office with responsibility in that matter.
      Mr. Campbell-Savours: I wish to tell the Minister the story of a trade union official who attended a meeting between another person and me some four years ago. He was a regional official and he wept as he told me that he had felt obliged to go to the trade union representatives in a hospital in the north of England and tell them that they

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      should accept wage cuts to ensure that an in-house tender won, thus keeping out an outside contractor. Are the Government really trying to build the kind of Health Service in which trade union officials are driven into such quandaries and have to compromise decades of representing of workers' rights?
      Mr. Freeman: It is in the interests of all patients in the NHS not only in those three sectors but in others that such activities—be they cleaning, contracting or laundry activities not of a clinical nature—are tested and shown to represent the most efficient and effective combination of employees in the Health Service.
      Mr. Campbell-Savours: Garbage.
      Mr. Freeman: It is not garbage because that is how we shall ensure that we get value for the £30 billion that the taxpayer spends on the NHS.
      We have provided that contracts in the Health Service are open, non-discriminatory, properly timetabled and documented, and that Members' interests are fully and properly declared. I invite the House to resist the new clause.
      Question put and negatived.

    New Clause 12

      SMALL HOMES
      'The provisions of section 1(4) of the Registered Homes Act 1984 shall not apply for the purposes of this Act.'.—[Ms. Harman.]
      Brought up, and read the First time.
      10.45 pm
      Ms. Harman: I beg to move, That the clause be read a Second time.
      Madam Deputy Speaker (Miss Betty Boothroyd): With this it will be convenient to debate amendment No. 21, in page 42, line 18, clause 39, leave out
      'or is not required to be so registered by virtue of the home being a small home.'
      Ms. Harman: I can deal with new clauses 12 and 13 briefly because the Minister is aware of the points at issue, which were well aired in Committee. We have tabled them to give her an opportunity to announce what solutions she has to the problems with which they deal, remembering that in Committee we had considerable sympathy from Conservative Members.
      New clause 12 would extend the safeguards provided by the Registered Homes Act 1984 to elderly and disabled people who currently have no protection in their private residential care homes because those homes have fewer than four residents.
      The Government have said that they do not know how many homes escape registration and how many residents are therefore unprotected by the law because they do not know how many small homes there are. Between Committee and Report I carried out a survey among directors of social services. I asked them how many small homes they estimated there were in their social services areas, and the results of my survey are worrying.
      The directors estimate that one in five of all homes in their areas are unregistered because they are small, having fewer than four residents. That means that the safeguards provided by the 1984 Act—about quality of standards, staffing and premises and about the character of the
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      proprieters of homes—do not extend to residents in one in five such homes in Britain. I remind the House that we are talking about people who are vulnerable, elderly and dependent—otherwise they would not be in residential care.
      New clause 13 deals with the problem of people setting up registered care homes—
      Madam Deputy Speaker: Order. Is not the hon. Lady referring to amendment 213? I said at the outset that it would be convenient to take that amendment with new clause 12.
      Ms. Harman: I apologise, Madam Deputy Speaker.
      Madam Deputy Speaker: The hon. Lady need not worry. We are all a little tired.
      Ms. Harman: When I saw "213," I thought that it was a typing error and that it should have read "NC 13."
      Mr. Kenneth Clarke: No, we are dealing with new clause 12 and amendment No. 213.
      Ms. Harman: I am obliged to the Secretary of State for pointing that out, demonstrating that he is still awake.
      Amendment No. 213 deals with the problem of people who set up registered care homes but do not disclose that they have criminal convictions which render them unfit to care for elderly and dependent people. There have been numerous cases of dishonest people with criminal convictions failing to disclose those facts to the registration authority. They have been discovered only as a result of some awful scandal—after the residents in their charge have suffered.
      There is a clear loophole, but the Government have said that they will address the problem. The problems of small homes and homes being run by people with criminal convictions are related, as I shall illustrate.
      Mr. Rowe: There was a great deal of talk in Committee about the television programme, "The Granny Business." The only person against whom a criminal conviction could be sustained, as a consequences of that programme being referred to the police, eventually had all but two of her convictions overturned in the Appeal Court. However., she was found guilty of assault. It is now believed that, although she is disqualified from running a registered home, she still cares for two elderly people. That example seems to make the hon. Lady's case fully and clearly.
      Ms. Harman: I thank the hon. Gentlman for giving an example which shows that the safeguards are not working. They cannot be working if, when the registration authority ultimately finds that somebody is unfit to run a registered care home because he or she has a criminal conviction, it deregisters the home, but the person is able to carry on the business of providing residential care. Those people can do so by dropping the number of residents, still claiming income support and running a totally unsatisfactory business at the expense of elderly and dependent people.
      I can give another example, the details of which were sent to me by the Association of Directors of Social Services. Olive Waring ran a private home called Oliveen in Blackpool. She was imprisoned in January 1987 for physically abusing a resident. In 1984, Iancashire county council found her running an unregistered home for four people in Jubilee lane, Blackpool. She was fined £1,000 for running an unregistered home, after which she merely

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      reduced her number of residents to three and continued to operate. Although Lancashire county council knew about the matter, it could do nothing because the law did not allow it. Last December, Olive Waring was imprisoned on a £30,000 fraud charge involving the forgery of a will of someone who used to live in one of her homes.
      That is just one example, but the Minister knows that there are numerous others. There is no problem about dealing with the disclosure of criminal convictions. I hope that the Government will be able to accept the amendment which deals with that issue without any difficulty. It merely extends the safeguards that the Government have already extended to cover people caring for children. We are asking the Government to extend the restrictions and regulations to those who care for elderly people.
      The problem is how to deal with small homes. I readily accept that perhaps new clause 12 goes a little too far. NALGO, which organises among its membership the inspectors of private residential care homes, has helpfully made a recommendation that would also be acceptable to the Association of Directors of Social Services. It might be a way forward to give registration authorities the power to enter, inspect and take action against small homes. They are given the power when a problem is identified, but they do not have a duty to require them to register all the small homes which they know to be in their areas. Therefore, when they know that there is a problem they have the power to act, but they are not borne down with extra registration duties when they already have inadequate resources to carry out their present registration functions.
      The Bill provides the opportunity to legislate to protect thousands of people who have no protection under the present law. The Government must show not just that they have a vague aim to do something about the matter, but that they intend to act. I want to be sure that we hear from the Government, when the Minister replies, that they have plans to deal with this matter and that the Bill will not become an Act without containing legislative protection for people who are currently guaranteed no protection under the law.
      It is late, but I hope that tonight the Minister will not flannel about vague aims and intentions. We want not good words, but action.
      Mrs. Virginia Bottomley: I think that the hon. Lady has confused her papers. She was speaking to new clause 13, which is not on the selection list—
      Madam Deputy Speaker: Order. The hon. Member for Peckham (Ms. Harman) was slightly confused when she started. She was speaking to new clause 12, but became confused with amendment No. 213.
      Mrs. Bottomley: The revealing of convictions comes under new clause 13. The hon. Lady was speaking to new clause 13 when she referred to criminal records.
      Madam Deputy Speaker: Order. We are dealing with new clause 12 on small homes.
      Mr. Rowe: I agree that it is essential that the size of the home is not used as an excuse for allowing people to avoid inspection. I agree with the proposal that inspection should be carried out only where there are grounds for suspicion.
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      I want to put on record the fact that a substantial number of people look after one or two elderly people in almost ideal circumstances. They are treated as though they were living in their own homes. That is an extremely good service. I do not want the debate to be taken as some sign that anyone running a small home for one or two people is likely to be some sort of crook.
      Mr. Kennedy: The last remark of the hon. Member for Mid-Kent (Mr. Rowe) was fair, but the 1984 Act contains a significant loophole and the Bill provides an opportunity to close it.
      When the question of bringing homes with fewer than four residents under the inspectorate was raised in Committee, the Minister said:
      "That would involve the inspection unit in a great deal of work at a time when they are already embarking on their new tasks, establishing standards and working with those involved to ensure that the policies are effective. That provision would be an additional burden on small units, many of which are already effective."—[Official Report, Standing Committee E, 8 February 1990; c. 794.]
      I do not doubt the effectiveness of a large number of units in that category, but on the point about inspection and the additional bureaucratic burden I refer the Minister to a quite different matter—recent experience of the poll tax in Scotland. Small units such as those offering bed and breakfast faced considerable difficulty because of commercial rating and the new tax burden on those premises. Within the past week or so, the Scottish Office has announced that units with six or fewer beds operating for 100 or fewer days per year would be exempt. That sort of accommodation is both essential and prolific in the Scottish Highlands. The policing and the bureaucracy to make any sense of the Government's policy will be a major headache. The Government seem to believe that it can be done, although I have my doubts—I believe that they will encounter great practical difficulties.
      If the Scottish Office thinks that it can make that policy work in the Scottish Highlands, why does the Department of Health believe that a similar function could not come within the ambit of this legislation, especially as the inspectorate is already in place? Why cannot the inspectorate deal with small units catering for four or fewer people? I should be interested to learn whether the Minister stands by the case that she made in Committee—that she cannot accept the practical implications involved. There is a duty on the Department to provide the funds for additional inspectors. That seems to be the logical accompanying element which is required.
      11 pm
      Mr. Jeff Rooker: The hon. Gentleman has had the experience of the poll tax in Scotland, which we have not had in England. I want to ask him a question. One problem will be finding out where the places are. There should be an automatic exemption from poll tax, because residential care is involved. If home owners have to apply for exemption from poll tax, that should enable a local authority to find out the addresses where there are one, two or three people in residential care. The policing part would be done. How has it been dealt with in Scotland where the exemption should be the same?
      Mr. Kennedy: The hon. Gentleman makes a fair point. I will give an example to show how ludicrous the position is, without straying from the amendment into the rights and wrongs of the poll tax. I was speaking to someone who

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      provides residential care. Because of the type of people he caters for, he has to have an overnight matron in order to be registered. The matron rebuilt, with a 100 per cent. local authority grant, a house which is a dwelling place, but if she does not register for the poll tax in the private residential home the owner will not get certification because he does not have an overnight matron. As soon as she registers in the residential home, her house will count as a holiday home, even though she could never let it because she had a grant to rebuild it, and she will have to pay a double charge poll tax on it.
      One hopes that the method is sufficiently sophisticated to track down small homes, but when at local authority level one hand literally does not know what the other is doing, it does not fill us with confidence. Perhaps uncharacteristically, for one shining moment, the Minister in her reply on this occasion, unlike others, can fill us with confidence.
      Mrs. Virginia Bottomley: It is a source of disappointment to me that it is not possible within the scope of the Bill to achieve what we all wish—the registration of smaller homes. We might disagree about the type of registration. As I made clear in Committee, I would like it to be minimal, but it is essential that we have the names and addresses of small home owners. When they go through the process of applying for registration, they should complete a form where they have to reveal any previous convictions. When the list of cancelled registrations was circulated by my Department to local authorities, a local authority would be aware if somebody had previously been refused registration or had had his registration cancelled. Those would be important safeguards. None of us wants to under-estimate the valuable work done in many small homes, but we are all concerned about a gap which needs to be plugged.
      The difficulty of the new clause is that it could apply only to those for whom the local authority provides care under the terms of the Bill. We would want to find a way of bringing all small homes within the provisions of the Registered Homes Act 1984, whether their residents had been placed by the local authority or independently.
      There are many safeguards in the Bill. Under the new regime, a local authority will be placing contracts in which it can specify conditions. For example, it might stipulate that the home should be subject to inspection by the inspection unit which the local authority would have to set up at arm's length. We are making an important provision about complaints procedures; that will help to eliminate difficulties, as will the establishment of case managers. In the present regime, once an individual is placed in a residential home of any sort with income support, there is no need to follow up or monitor that individual. Under a system of case management, it will be possible to keep in closer touch with the individual to make sure that his needs are properly met.
      I hope I have made our intention clear. We hope to find a legislative opportunity to bring units with fewer than four residents under control.
      We have great confidence that under the new regime there will be far better safeguards for individuals. Indeed, we have a programme designed to try to improve the quality of residential care. We are spending £2 million on the "Caring in homes" initiative. That is a response to the Wagner report. We are seeking to improve standards across the public and private sectors.
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      I shall refer briefly to new clause 13, which was not selected but which the hon. Member for Peckham (Ms. Harman) mentioned briefly. The hon. Lady will be aware that under the Children Act 1989 arrangements are being made for those responsible for children to be checked to ascertain whether they have criminal records. There is an experimental scheme to provide access to criminal records for those involved in the operation of voluntary child care. We are having discussions to see whether that scheme can be extended further to cover those concerned with the elderly.
      I agree that smaller residential homes can make a valuable contribution in the provision of care for the elderly. They often cater for the mentally frail, the elderly and vulnerable people generally. It is important, of course, that proper and sufficient safeguards are in place. I hope that with the commitment that I have given—I am disappointed that it has not been possible to plug the loophole at this stage—the hon. Member for Peckham will not press the matter at this stage.
      Mr. David Hinchliffe: Is the Minister able to give us a legislative timescale? My hon. Friend the Member for Peckham (Ms. Harman) has produced an estimate of the number of small homes and Community Care referred last month to there being about 1,000 in east Sussex alone. That means that throughout the country there are many small homes. I accept the argument of the hon. Member for Mid-Kent (Mr. Rowe) that many of these homes are offering excellent care. I would not want to knock them. On many occasions in Committee we were talking about institutions. I believe that smaller homes often offer precisely the sort of provision that is appropriate for many people. I know from personal contact that some small homes offer excellent forms of care. Unfortunately, however, few of the people who run such homes do not have the best motives. Are we to wait for a scandal and an inquiry before we see some action? Can the Minister say when the legislation that she accepts is needed will be introduced?
      Mrs. Bottomley: I do not feel able to give the hon. Member for Wakefield (Mr. Hinchliffe) a clear timetable this evening. I hope that it will be possible before long to find a legislative opportunity to introduce an appropriate measure. I think that it will be useful to spend a little longer deciding what form of legislation we think is most appropriate for the units that we are discussing.
      I do not think that there is any difference between us on this. There is a need for some controls and I wish to work with others to find a moment at which we can tackle the problem.
      Ms. Harman: I thank the Minister for her reply. There is no difference between us on the principle, but there is a difference in our determination that something must be done and the pace at which it must proceed.
      I hope that the hon. Lady will accept that she must enter into consultation immediately with all the organisations that she said she would consult when she talked about the issue in response to a probing amendment in Committee. I understand that, so far, she has not engaged in any consultation with those organisations. I hope that she will do so at the first opportunity. The first step is to achieve consensus on registration which is appropriate, sufficient to be meaningful and worth having although less than the full registration procedure for

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      homes for more than four persons. That is the first thing that the Minister must do. Having achieved that, she must seek—we shall commit ourselves to do this—the first legislative opportunity.
      Given the amount of time that the Government spend legislating in respect of local authorities, I feel that it will not be long before we have a Bill dealing with the powers that local authorities used to have, might have in the future or might not have any longer. When that measure is before us, we can look for an opening for the new clause. Similarly, in respect of criminal records, there are always criminal justice Bills going through the House. We shall assist the Minister by looking for a legislative opportunity, but she must enter into negotiations immediately. We do not want to miss a legislative opportunity because she has not undertaken the consultation. She must be ready with the decision in principle and then look for the opportunity.

    New clause 15

      ADVISORY COMMITTEE WITH RESPECT TO STANDARDS
      '( ).—(1) The Secretary of State shall establish and maintain a committee for advising him with respect to the maintenance and improvement of the quality of goods or services provided by any health service body under an NHS contract.
      (2) The committee established and maintained under this section—

      (a) shall consist of a chairman and not more than nine other members, appointed by the Secretary of State;

      (b) shall include such representatives of the medical and nursing professions and organisations representing consumers as seem appropriate to the Secretary of State; and

      (c) shall meet at least twice a year.

      (3) It shall be the duty of the Secretary of State—

      (a) to consult the advisory committee, and

      (b) to consider any representation made to him by the advisory committee,
      on any matter pertaining to the quality of any goods or services provided by any health service body under an NHS contract.

      (4) It shall be the duty of the Advisory Committee to make recommendations to the Secretary of State with respect to measures which it considers best calculated to maintain and improve standards of goods or services provided by health service bodies.
      (5) The Secretary of State may by regulation, approve any recommendations of the advisory committee for the purpose of—

      (a) giving practical guidance to health service bodies with respect to maintaining and improving standards of goods or services supplied or received; and

      (b) promoting what appear to him to be desirable practices in the provision of goods or services under NHS contracts.

      (6) In this section "health service body" and "NHS contract" have the same meanings as in section 4 of this Act.'.—[Mr. Tom Clarke.]
      Brought up, and read the First time.
      Madam Deputy Speaker: With this it will be convenient to take the following: New Clause 16—Advisory Committee: supplementary powers—
      '( ).—(1) For the purpose of ensuring compliance with any regulation issued under subsection (Advisory Committee with respect to standards) (5) above, the chairman of the advisory committee may, at any time, cause an assessment to be made of the working practices of any hospital, establishment or other facility involved in the provision of goods or services under section 4 of this Act.
      (2) The results of any assessment carried out under subsection (1) above shall be reported to the Secretary of State by the chairman of the advisory committee.
      (3) The chairman of the advisory committee may, with the approval of the Secretary of State as to the numbers and terms and conditions of service, appoint such staff as he may determine to fulfil the duties of the advisory committee under this Act.
      (4) There shall be paid out of monies provided by Parliament the remuneration of, and any travelling or other allowances payable to the members of staff of the advisory committee in consequence of the provisions of this Act.'.
      New clause 35—Standards and inspection of community care services—
      "(1) The Secretary of State shall establish a minimum standard for community care services which every individual may expect to receive.
      (2) The Secretary of State shall ensure that there is an inspectorate that is sufficiently staffed to ensure that the minimum standards are adhered to by local authorities.
      (3) In setting minimum standards under subsection I the Secretary of State shall consult those bodies he considers are representative of those who have the experience and knowledge of the provision and need for community care services.'.
      New clause 38—Standards and inspection of community care services (Scotland)—
      "(1) The Secretary of State shall establish a minimum standard for community care services which every individual may expect to receive.
      (2) The Secretary of State shall ensure the establishment of a Social Services Inspectorate sufficiently staffed to ensure that the minimum standards are adhered to by local authorities.
      (3) In setting minimum standards under subsection 1 the Secretary of State shall consult those bodies he considers are representative of those who have the experience and knowledge of the provision and need for community care services.'.
      New Clause 45—NHS Contracts—
      (1) The acquirer of an NHS contract shall take into account not just price but a broad range of factors when considering which provider should be awarded the contract. This will include the quality of service provided taking into account both patient satisfaction and clinical effectiveness.
      (2) The acquirer shall institute a thorough and ongoing monitoring of the contract as it progresses which shall be open to public inspection.
      (3) A complaints procedure shall be instituted for both staff and patients with respect to the operation of the contract.'.
      New Clause 47—Clinical Effectiveness—
      'The Secretary of State shall in pursuit of satisfactory systems of measuring clinical effectiveness and quality of treatments:—

      (1) create an applied research agency for the NHS;

      (2) develop a clinical database to support the epidemiological research it will do;

      (3) with the data and methodoligies developed, introduce an ongoing monitoring and audit of clinical practice both to discover and disseminate best practice throughout the system.'.

      We will also consider the following amendments: No. 228, in clause 3, page 3, line 11, at end insert—
      '1A. In carrying out its primary functions including those provided under Section 4 below, a Regional, District or Special Health Authority or a Family Health Services Authority must ensure that the quality of such goods or services that it may provide, attains such standards of quality as may be determined by the Secretary of State for those particular goods and services and must publish annually a report giving details of its attainments in monitoring and improving quality standards.'.
      No. 15, in clause 4, page 4, line 36, at end insert—
      '(3) No National Health Service contract shall be valid unless it specifies the quality of service to be provided under the contract and how the quality is to be measured and monitored.'.
      No. 21, in page 4, line 36, at end add—
      '(3A) The acquirer will—

      (a) publish the terms and conditions of any contract agreed with the provider;

      (b) institute a thorough and ongoing monitoring and quality assurance programme keeping the local CHC aware of developments;

      (c) create a complaints procedure for staff and patients with respect to the contract.'.

      No. 33, in page 4, line 36, at end insert—
      '(()) The Secretary of State may by regulations, require any health service body acting as a provider to have regard to:

      (a) any relevant national codes of practice pertaining to any goods or services provided;

      (b) any specific outcome requirements established by him, both applicable generally and in relation to specific clinical conditions, or

      (c) any minimum standards of performance on any matter of concern, determined by him, in respect of any NIIS contract to which the provider is a part.'.

      No. 4, in page 4, line 42, at end insert—
      '(3A) Where any health service body proposes to enter into an arrangement which will be an NHS contract in which it will be the acquirer within the meaning of subsection (1) above, it shall publish a document setting out the standards of goods and services which are proposed to be acquired under that arrangement.
      (3B) Prior to making a decision about the standards of goods and services which are proposed to be acquired, a health service body shall seek the views of Community Health Councils within their district on the standards of goods and services, and shall also seek the views of such other persons as seem to them to have an interest in the matter or to be representative of the interest of patients in their district on the matter, and shall, in determining the standards of goods and services, take account of any views or representations received on the matter.'.
      No. 5, in page 4, line 42, at end insert—
      '(3A) The Secretary of State shall by regulations specify, for each category of services, the standards of goods and services which shall be the minimum standards for goods and services which may be specified by any health service body which is an acquirer in the terms and conditions of any arrangements which is a National Health Service contract.'.
      No. 57, in page 4, line 42, at end insert—
      '(3A) Any contract made under subsection (1) above shall provide that services supplied by NHS consultants shall he subject to the professional standards of care then in force under the regulations of the Royal College having jurisdiction for the place in which the contract is made.'.
      No. 6, in page 5, line 33, at end insert—
      '(7A) The terms and conditions of any arrangement which is an NHS contract shall include a statement of the means by which the acquirer will satisfy himself, throughout the term of the arrangement, that the standards of goods and services provided under that arrangement are sufficient to meet the standards specified in the terms and conditions of the arrangement.
      (7B) Where the terms and conditions of any arrangement which is an NHS contract include a statement referred to in subsection (7A), it shall be the duty of the provider under that arrangement to make available any facilities, information or services necessary to permit the acquirer to satisfy himself as subsection (7A) requires.'.
      No. 135, in clause 28, page 26, line 33, at end insert—
      '(2A) No National Health Service contract shall be valid unless it specifies the quality of service to be provided under the contract and how the quality is to be measured and monitored.'.
      No. 136, in page 26, line 38, at end insert—
      '(3A) The acquirer will—

      (a) publish the terms and conditions of any contract agreed with the provider;

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      (b) institute a thorough and ongoing monitoring and quality assurance programme keeping the local CHC aware of developments;

      (c) create a complaints procedure for staff and patients with respect to the contract.'.

      No. 37, in page 27, line 22, at end insert—
      '( ) Where a reference is made to the Secretary of State under subsections (4) and (5), he or the person appointed by him, shall take into account the distance a patient would otherwise have to travel when determining what is "practicable" under subsection (5).'
      No. 45, in clause 5, page 6, line 42, at end insert—
      '( ) In exercising his powers under this Section, the Secretary of State shall have particular regard to ensuring ).hat there exists a sufficient range and quality of services both in a local area and nationally to ensure that the functions of the National Health Service contained in the principal Act are carried out.'.
      Mr. Tom Clarke: I beg to move, That the clause be read a Second time.
      I shall refer to new clauses 15 and 16, and I hope that the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) will not mind if I say a few words about new clause 38. Hopefully, I shall not anticipate his speech too much.
      Hon. Members who served on the Standing Committee will recall that in Committee my hon. Friend the Member for Leicester, East (Mr. Vaz) moved a similar amendment to establish a national inspectorate under the director of patient services. In his excellent speech to the Committee he explained that he had the support of several important bodies and people, including the Royal College of Nursing. At this time in the evening I do not wish to be provocative, so I hope that the Secretary of State will not mind if I mention one last opinion poll. The RCN conducted an opinion poll among Conservative Members. It discovered that 80 per cent. of Conservative Members support the setting of national standards and 70 per cent. support the establishment of a national inspectorate to monitor health care provision. Most people would welcome those views.
      We are trying to find ways of ensuring that those views are recognised in the Bill, particularly in view of the clear support for them within the House and elsewhere. When the hon. Member for Ross, Cromarty and Skye speaks to the new clause he will probably broaden the arguments to deal with proper monitoring and inspection of community care in Scotland.
      I remind the House that earlier this evening the hon. Member for Great Yarmouth (Mr. Carttiss)—I hope that I spare his blushes—made a thoughtful and courageous speech. He said that many issues which had not been resolved in Committee were meant to be debated on the Floor of the House. They will not be reached because of the guillotine motion. The issue dealt with by the new clause is just such an item. I was glad that the hon. Gentleman made that point and I sincerely welcome what he said.
      In Committee, under pressure from my hon. Friend the Member for Leicester, East, the Under-Secretary of State for Health said:
      "The Government will reflect on how best to improve standards. We do not believe that it should be through a national inspectorate, or through a national accreditation scheme. However, there are ways to improve the service, for example by a national advisory committee. My right hon. and learned Friend the Secretary of State will reflect on and bring forward proposals for such improvement. The health advisory service advises on the quality of care provided to the mentally ill and the elderly. Its work with the mentally ill is

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      under review. It could provide a useful model for advising DHAs, and hospitals with which they have contracts, about standards of care."—[Official Report, Standing Committee E, 23 January 1990; c. 347.]
      The Committee welcomed that in so far as it went and in anticipation of something more extensive—a bigger commitment—perhaps even a new clause or amendment on Report. So far as I can see, that has not happened. I hope that when the Secretary of State replies he will appreciate that in new clauses 15 and 16 we aim to respond to what we consider to be the Government's assurance to improve standards by enshrining the advisory committee in legislation.
      11.15 pm
      When the hon. Member for Ross, Cromarty and Skye dealt in his new clause with community care, many of us felt that he was absolutely right. That is why earlier this evening, in the debate on the guillotine motion, I was particularly surprised when the hon. Member for Lancashire, West (Mr. Hind), who unfortunately is not in his seat now but, in fairness, was here for most of the evening, said that the House had discussed Scotland. That comes as no surprise. Scotland is part of the United Kingdom. Scotland is dealt with in the Bill. Community care in Scotland is important. Frankly, we have not debated the matter enough. Therefore, I am pleased that community care in Scotland and the need for proper monitoring and inspections are dealt with in this group.
      I hope that the importance of that is not lost on the House. Many people are convinced that community care in Scotland is not properly monitored. Moreover, it is difficult to do because of the present limited nature of joint planning, despite the legislative opportunities that the Secretary of State and the Under-Secretary of State for Scotland have not so far embraced or introduced.
      The new clauses would be an ideal opportunity for the Government to show their commitment to standard setting and improving quality within the NHS. New clause 15 would establish the advisory committee and give it the power to establish minimum standards of care. That is terribly important in the light of the evidence of the accident of geography, where in some areas standards are high, yet in others they are not only far too low, but entirely unacceptable for community care.
      New clause 16 gives the committee supplementary powers to assess local working conditions to ensure minimum standards. The case for that is self-evident. It is self-evident that we are attempting, particularly in the absence of real advocacy, to ensure that basic standards are met and that there is accountability and proper monitoring. We have a great deal of support for that.
      I referred earlier to the Royal College of Nursing. In its evidence to the Select Committee on Social Services, it said:
      "Therefore, in order to ensure a high quality of standards of care, the College wishes to see an independent, nationally trained inspectorate working at local level to monitor the care that is delivered by the private, the voluntary and the public sectors. This would be an independent body which would maintain quality and which is neither purchaser nor provider. Precedents for this include the HMI in education and, more recently, the directors of consumer services established in the privatised water, gas, telecommunications and electricity industries to safeguard consumer interests and uphold standards."
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      The very important point which emerges from that evidence is that we are dealing with consumers. The frail, the vulnerable, the elderly, the physically disabled, the mentally ill and the mentally handicapped are consumers. Unfortunately, because of the restrictions on our debate, we have not had many opportunities—we have had far too few—to discuss those groups in the context of community care. None the less, if there is a commitment to consumers, these new clauses give the Government an opportunity to go beyond mere words, to go beyond a mere oral assertion that they will issue circulars, and so on. We are offering them a statutory opportunity to do the minimum necessary to ensure that the standards of care that are insisted upon are proper and reasonable standards that can be monitored and for which there can be proper accountability.
      The amount of money involved is considerable. There is much talk of value for money. We are entitled to an assurance that taxpayers' money is being spent in a way that is consistent with the principle of value for money as well as with the rights of the consumer. For all those reasons, I thought that the excellent case that my hon. Friend the Member for Leicester, East and others made in Committee would have persuaded Ministers to accept some reasonable proposals.
      Unfortunately, Ministers did not at that stage accept any of our amendments. I recall only one promise from the Parliamentary Under-Secretary of State for Scotland—the hon. Member for Stirling (Mr. Forsyth). That is a matter that we shall follow closely, but it is not particularly relevant to these new clauses. Beyond that promise we were offered not just very little but nothing at all, except, as in respect of so many other matters, the promise that, by the time of the Report stage, the Government would have taken advice, would have involved themselves in consultations, and might even surprise us by saying that they agreed to our modest proposals.
      In presenting these new clauses, we are giving the Secretary of State an opportunity—not just at the 11th hour but almost at the 12th—to show just a little generosity. Generosity is something that was absent from his dealings with the Committee and the House.
      In that spirit I commend the new clauses to the House. I look forward to hearing from the Secretary of State a response that is as positive as I am sure the House would want.
      Mr. Tim Devlin: Amendment No. 57, which stands in my name, deals with two essential points—one is a general point and the other clears up an existing anomaly. Perhaps I should first declare an indirect interest in that my father is a member of the council of the Royal College of Surgeons and joint author of the "National Confidential Enquiry into Perioperative Deaths". I wish to refer to the monitoring role of the royal colleges of surgeons, anaesthetists, obstetricians, gynaecologists and others. It is right to ensure in any Bill of this kind that the services delivered to the public meet certain minimum quality criteria. That is the aim of my amendment.
      I shall be interested in the response of my right hon. and learned Friend the Secretary of State to my point about the anomalous positions of the royal colleges of England and those of Scotland. The standard maintenance role of the royal colleges of England is being upset by that of the colleges of Edinburgh and Glasgow. This is a particular difficulty. A member of the Royal College of Surgeons of

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      England who practises in Scotland is not subject to the authority of the Royal College of Surgeons of Edinburgh or Glasgow. Because he is beyond the territorial jurisdiction of the English college, he cannot be monitored from there either.
      Similarly, a small number of Scottish practitioners who practise south of the border are beyond the geographical jurisdiction of the Scottish colleges, yet when they are monitored by the English colleges they say that they are members of the Scottish college and therefore do not wish to submit to the jurisdiction of an English college.
      This is a small, but important, point. If we want a system in which there is professional peer group pressure to improve standards of health care, that pressure must be exercised through the appropriate royal college. That does not happen with those two minority groups.
      Sir George Young: The new clauses and the amendments have the same objective, but they would achieve it in different ways. Amendments. Nos. 4, 5 and 6, which stand in my name, are slightly less bureaucratic than new clause 15 in that they avoid setting up an advisory committee, but their objectives are the same—to use the new regime to drive up standards, to improve the quality of services and to increase confidence in the NHS.
      Amendment No. 4 provides the machinery for delivering those objectives—machinery which is not explicit in the Bill. It would require that, for any NHS contract, the acquiring body should consult on the standards of service to be provided under the contract. There needs to be a mechanism for ensuring in each case that the quality of service that patients can expect is understood publicly and that there is a quality yardstick by which a contractor can be assessed. Patients and the organisations which represent their interests have the right to know what they can expect from a contractor in the Health Service. The amendment provides such a mechanism. It would require that the quality standards are consulted upon and made public.
      Amendment No. 5 clarifies the regulatory responsibility of the Secretary of State in relation to standards of health care. Where resources are limited, as they always will be, there may be a temptation for a hard-pressed Health Service body to cut corners on standards. Some health authorities and budget-holding general practitioners may therefore be tempted, when entering into contracts for the provision of care, not to specify adequate standards from their contractors. The amendment would limit this temptation by giving to the Secretary of State the role of setting for each category of service minima below which the quality of health care should not fall. At the moment, the Department provides a substantial amount of material regulating the standards of provision, and the amendment simply makes that explicit.
      Amendment No. 6 deals with monitoring. The working of contracts for health care should be closely monitored to ensure that contractors meet the standards expected of them and that the terms of the contract are met. The amendment would require that the means by which monitoring and evaluation of quality of care provided under contracts should be set out in the contracts and would require contractors, by statutory duty, to co-operate with monitoring and evaluation procedures. That would help patients to feel secure, in that a system of
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      monitoring and enforcement would guarantee that high standards are maintained and ensure the full co-operation of contractors.
      The three amendments are fully consistent with the objectives in the White Paper. They simply seek to write into the Bill a procedure for guaranteeing the high quality of service that we all want to see.
      11.30 pm
      Mr. Kennedy: New clauses 35 and 38, to which the hon. Member for Monklands, West (Mr. Clarke) was kind enough to refer in his opening remarks, are partly based on the learning curve of the hon. Member for Glasgow, Cathcart (Mr. Maxton) in Committee. They refer to standards of inspection of community care services in Scotland, England and Wales, and take account of the slight differences in the role or existence of the inspectorates in each.
      Despite earlier exchanges in Committee, there remains considerable doubt that the Bill's objectives in respect of community care will be fully realised. The Secretary of State might have acknowledged in our earlier debate on the timetable motion that it is regrettable that the House cannot devote more time to important aspects of the Bill. However, I suspect that new clause 15 and other parts of the Bill will have much more of an uphill struggle when they reach the other place, and I shall be watching its progress—and, hopefully, the alterations that are made to it—very closely.
      The Bill makes welcome provision for local authorities to publish plans for community care, but there is no proper agreement on a mechanism to ensure that minimum standards are met, and therefore there is nothing positive or indicative for which inspectors can look.
      If one considers the education system, it should not be so great a problem as is feared in the minds of Ministers or civil servants at the Department of Health. The education system proves that it is possible to set minimum standards and to operate an inspectorate without necessarily imposing too much centralisation or inhibiting scope for personal initiative and development.
      One must question how community care plans will be properly assessed in the absence of minimum standards—particularly as it is more than likely under present budgetary constraints that there will be disagreements between the health authority or health board and the local authority.
      The Secretary of State repeated earlier today that heavy reliance is being placed on contract setting to ensure quality of service. The right hon. and learned Gentleman spoke of competition in the hospital sector being based on quality. The same applies to the care in the community approach. The quality control aspects of a contract, whether it concerns health or community care, are currently minimal and are unlikely to provide an adequate safeguard, at least in the short term.
      The guidance issued since the Committee stage is encouraging. The word "quality" is used in the very first sentence and recurs throughout. Ministers appear to have become more sensitive to that aspect than they were earlier. Nevertheless, there remains genuine anxiety that minimum standards will be fastened upon by the providers and contractors of care rather than serve as a starting point.

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      My final point concerns the social services inspectorate. Exchanges between the Minister for Health and me in Committee revealed that in the past few years the number of inspectors in England and Wales has doubled. That is welcome, and it will probably increase further if the Minister is successful in realising her ambition to extend the scope and the role of the inspectorate. However, such a major and fundamental change as the community care aspect of the Bill surely contains scope for a further inspectorate. In Scotland, the need for minimum standards still exist, but the establishment of a proper inspectorate is crucial.
      I am indebted to the Royal College of Nursing for its assistance with amendment No. 33. The amendment aims to give the Secretary of State a reserve power to establish a series of minimum standards of care which health care providers would have to observe. In effect, it would establish a safety net for quality in future. There is no time to go into the details of the argument behind the amendment, but perhaps in the short time available I should commend back to the Secretary of State his own words on 10 October 1989 at that marvellous occasion, the Conservative party conference. The Secretary of State referred to the two prime problems which arise if all decisions about acceptable standards are left to individual contracts: first, will the purchaser be in a strong enough position to face a monopoly provider and, secondly, will minimum standards vary significantly throughout the country from Plymouth to Inverness? In his speech at the conference, the Secretary of State listed a catalogue of inexplicable anomalies between districts and regions and concluded:
      "These failings are not fair to the patients when the treatment you receive (and the delay you experience) depends entirely on the luck of the draw. Above all, on where in the country you live and whether you have an illness which is well-treated locally or not."
      Amendment No. 33 aims to provide a permissive regulatory framework for the Secretary of State to be able to exercise the power to address precisely the problem that he highlighted on that occasion.
      Amendment No. 37 expresses the concern that hospitals, particularly in rural areas, will be in a monopoly position under contracts because they are the only providers of a service in that region. What effects will there be on people having to travel, as that clearly will be a logical component of the internal market, and on the fact that the Secretary of State will view a local monopoly in an entirely different way from patients because many patients in rural areas have to travel significant distances to receive treatment? [Interruption.] If the hon. Member for Wirral, South (Mr. Porter) finds this boring, I am sure that he can find entertainment elsewhere. Perhaps these are rough and ready arguments because those of us who served on the Committee did not pursue many of the points as we had hoped for a proper debate.
      Amendment No. 45 embodies the plea that
      "the Secretary of State shall have particular regard to ensuring that there exists a sufficient range and quality of services both in a local area and nationally to ensure that the functions of the National Health Service contained in the principal Act are carried out."
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      There is genuine anxiety about the future of the service because of the step into the unknown that the Bill represents. Even at this late stage the Secretary of State has a chance to offer some reassurance.
      Mr. Michael Morris: I am happy to associate myself with amendments Nos. 5 and 6, in the name of my hon. Friend the Member for Ealing, Acton (Sir G. Young), and I hope that they will appeal to my right hon. and learned Friend the Secretary of State. If we are not talking about medical audit, we are talking about performance review. There is a great deal of experience of performance review among professional organisations across the Atlantic and I had hoped that we might learn from that experience.
      Certain questions need to be asked. Was the operation necessary in the first place? Was it correctly undertaken? What is the rate of readmission and cross-infection? What was the cost of performing the operation, and was the patient satisfied? Certain initiatives can be taken to guard against inappropriate surgery, unnecessary blood transfusions and the unco-ordinated treatment of intensive care patients. The amendments address the question of who is to check the quality of care. Every other industry in the country has quality control, and I cannot believe that it is right that the NHS should not. That is why I support the amendments.
      Mrs. Maria Fyfe: I support the proposals of the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy). I am sure that we can all agree that it ought to be perfectly possible to set minimum standards and to have inspectorates to ensure that they are achieved. The hon. Gentleman cited the example of schools, for which we have minimum standards, and inspectors to ensure that they are met. An even more useful example, perhaps, is the example of the factory inspectorate, which ensures that the conditions in which people work are adequate.
      Similarly, we should want to ensure that a large number of criteria are satisfied in relation to the suitability of the conditions in which old people are looked after in small premises. I have been shocked by some of the cases of which I have heard in the course of my constituency work and by the conditions in which some old people have been made to live.
      There is also the question of the charge made for services. I heard of one old lady who was persuaded to leave the home in which she was living to go into a private house where her rent was doubled after two months. That old person felt vulnerable and unable to do much about her plight. The attitude seems to be that the Department of Social Services will pick up the tab, and that it does not matter if the public purse is robbed to pay people to provide the services.
      There is also a danger to old people's privacy. Some people seem to view old people as having lost all right to be treated as thinking and sentient human beings. They open their mail, listen to their telephone conversations and generally engage in a lot of unwarranted interference that would not be tolerated by someone who was capable of defending himself. But many old people are powerless unless they have a relative to stand up for them.
      What about the items that are provided for old people? In one case, for example, a person who was virtually immobile was given only a commode and felt extremely embarrassed and ill at ease. That person could no longer

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      get to the bathroom because it was so far away. It seems pretty obvious that decent toilet and washing facilities should be provided within easy reach of people who cannot move far.
      There is much detail to be worked out in seeking to achieve proper inspection, but it needs to be done if old people are not merely to be set aside and forgotten about as though they have stopped mattering as long as they have a roof over their head. If we do not set standards and establish an inspectorate to check them, local authority social workers may well feel that they simply have to put up with the standards set in their area.
      It would depend on what happened to be available. Standards could vary widely, and we could know that some of them were unacceptable but be unable to do anything about it—except to wring our hands and try to shift people around to better accommodation. But old people should not be shunted around like parcels from one place to another. They should be able to end their days in comfort, peace and security. It does not seem too much to ask that old people who cannot look after their own affairs any more should be assured of safety, security and comfort and minimal decent standards.
      I hope that the Minister will be able to accede to our request. If the Government can inspect cottages to discover whether they are liable to poll tax, they can surely inspect small homes in which old people live.
      11.45 pm
      Mr. Kenneth Clarke: I have always regarded the hon. Members for Monklands, West (Mr. Clarke) and for Ross, Cromarty and Skye (Mr. Kennedy) as among the more sincere hon. Members in the House. However, when they said that they were looking forward to continuing after midnight and how much they feared the imminent approach of the guillotine, I was less than usually convinced that they meant everything that they were saying—they do not look like men dying to go on after midnight.
      I am delighted that we have reached the new clauses dealing with quality. As speeches from hon. Members on both sides of the House have shown, there is virtual unanimity on the idea that raising the quality of care and clinical treatment in the NHS and of the care and support that can be given to those who live in the community and require better domiciliary services is at the heart of all our ambitions. Certainly, the notion of raising the quality of the NHS and of domiciliary and residential services in the community is at the heart of the Government's reforms, and of this Bill.
      Quality has been the mainstay of all our proposals, and I do not instinctively think about it along the lines of the amendments. That reveals the political division between us on method. I do not begin by thinking of great national committees and quangos to inspect everyone and ensure quality in a service that is already giant and daunting in its complexity and geographical scope. I have always thought that the idea of central Government laying down minimum standards, as suggested by the hon. Member for Ross, Cromarty and Skye, is not very useful, because there is so much variation across the country and among client groups.
      Our approach to these reforms has been to build into the organisation and the systems of the NHS and care in the community methods that will stimulate those who
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      work in the service at local level to strive to achieve the highest possible quality in response to the patients and clients whom they serve.
      Those of us who were here between 3 am and 6 am today will recall that the Government look to contracts, above all else, to raise the quality of the services provided in the NHS. At times we held what was almost a seminar this morning; at times our exchanges about exactly how we see quality being reflected and defended in the contract system were lively. The hon. Member for Newham, South (Mr. Spearing) laughs. From beginning to end, the hon. Gentleman has not quite understood the contract system in the NHS.
      In future, services will be provided locally in pursuance of an agreement between the district health authority or general practitioner and hospitals and community units. Those who want services provided for residents will stipulate what they want—not just their quantity and cost, but most importantly their quality which they can specify and how they will measure it when the service is delivered. In exchange, those who work in the units and deliver the services will sign up to a given level of quality, explain how they propose to measure it, and deliver it in exchange for the resources that they have agreed to receive.
      Every contract will stipulate the quality of service. We went over this ground in Committee when I said that I would let Committee members have the first specimen contract as quickly as possible. Those contracts vary in quantity and they have been worked out in different parts of the NHS as people with enthusiasm for the idea have got down to producing the type of contract that should be exchanged between a district health authority of a GP practice and a hospital that sets out what service is meant to be provided and what quality is to be attained.
      I want the professions, doctors and nurses to look at the contract to see what they think about it for their particular service. Many doctors and nurses may not like the way in which the quality of their service is described. In that case the royal colleges must lay down how they would like their service to be judged and describe the quality to which they aspire. In that way they will help us to produce good contracts with which they can feel content because they are being asked to deliver something sensible that they should like to achieve and by which they are content to be measured in exchange for the resources that they require.
      Fortunately, we are moving away from some of the rubbish that we have had for heaven knows how many hours. We are now coming down to the realities of what is being worked upon in 190 districts in England, Scotland and Wales as they prepare for the reforms.
      My hon. Friend the Member for Ealing, Acton (Sir G. Young) tabled amendments Nos. 4, 5 and 6, supported by my hon. Friend the Member for Northampton, South (Mr. Morris). They agree with the underlying aim to build stipulated quality into the arrangements for the work of the NHS. I do not like putting the whole thing in a straitjacket as their amendments suggest. I welcome my hon. Friends' attempts to set up, step by step, what should be done and what is required, but I do not want all the units and all the districts to grab the rulebook or the statute while saying that everything must be reduced to this, this and this. We are pursuing the underlying aims described by my hon. Friends.
      I know that I frequently describe all our reforms in terms of acute services—I always talk about hip replacements or varicose veins, things for which there are

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      waiting lists. I talk about the cold surgery about which most of our constituents are conscious. It is best to describe those services because they are the easiest to describe in terms of contract, quality, arranging the price and such. The contracts on which we must work, however, are those for more complicated services. We want an integrated service between the acute sector and community care. We must work on those contracts involving a mixture of disciplines—for example, doctors and nurses. In those circumstances, one may be talking not about the treatment of a disease, but the management of a condition such as diabetes.
      The contractual system at the heart of our reforms will contribute far more to raising the quality of the NHS than the committees and other ideas—the only ideas—produced by the Opposition.
      Sir Michael McNair-Wilson: I accept what my right hon. and learned Friend says about contracts being an obvious yardstick of the success of a particular hospital, but he is talking too clinically. Surely the real critic of the efficiency of a service is the patient. He will decide whether the contract was placed in the right hospital and whether the right service was provided. The contract can give only an indication. It cannot supply the playback from the customer that many of us want.
      Mr. Clarke: We can steer through all the formalities. We can enter into contracts and alter present structures so that everyone knows what we are talking about in terms of quantity, how soon one will receive one's first outpatient treatment, how much it will cost, the quality stipulated by the GP and how that will be measured by the DHA or whoever thereafter.
      What in the end will determine whether it is a success is the patient's judgment of how it works. So we are building in more consumer choice, making GPs more responsive to their patients and the DHAs more responsive to their GPs. The contracts will also be steered to those places where the patients feel most content, either because they particularly want to go to their local hospitals or because they are treated better there in every way, from the appointment arrangements to the follow-up after they have left hospital. That will help to determine what really goes on, will humanise the whole system and help to stimulate higher quality.
      My hon. Friend the Member for Northampton, South said that we needed a system of quality control. I could not agree more. It is surprising that of all the health care systems throughout the world, none of them measures the quality of outputs. Indeed, most health care systems never bother to measure their outputs at all. The Labour party in the House typifies what goes on in health care systems throughout the world. They are dominated by the interests of the people who work in them to such an extent that they never bother to ask what is coming out by way of service and quality.
      We are introducing a system of clinical audit, and we have the full agreement of the medical profession in doing so. When I was first at the Department of Health a few years ago, for a Minister to suggest to many in the medical profession that we would clinical audit and go in for organised quality control across the system was regarded as a blasphemous utterance. I concede that the Royal
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      College of Surgeons has done valuable pioneering work. The same is true of the Royal College of Anaesthetists, the Royal College of General Practitioners and the Royal College of Nursing. The whole medical profession has swung round, and we are allowing them to organise their own system of clinical audit which will systematically measure the quality of their output.
      But I appreciate that there are still concerns about quality in the NHS. Some of those concerns expressed last summer, when all the campaigning was going on, involved people raising fears about the quality of the service as an excuse for trying to stop anything being changed in the environments in which they worked. But that was never the position of the Royal College of Nursing, to which several hon. Members have referred.
      As I say, concerns remain. The hon. Member for Ross, Cromarty and Skye said that all I talked about now was interesting but new, and was therefore disturbing, unsettling and worrying to those who worked in the service. We must continue to reassure all concerned that we are striving to raise quality and that they have nothing to fear—either themselves or in terms of the quality of care for their patients—if they join in with us.
      Because there are still those fears, which I think are misplaced, I have invited all the medical royal colleges and the other statutory bodies to enter into talks with me about how, even at this stage of the Bill—if necessary, by statutory revision, which will have to occur in another place—we can devise new systems which will enable us to monitor and check to make sure that the higher standards of care are achieved. Those talks are going on now and I trust that they will reach a successful outcome.
      Mr. Michael: What a filibuster.
      Mr. Clarke: I am not taking lectures from the hon. Gentleman about filibusters. He conducted a filibuster about eight hours ago. Now he can listen to some serious content.
      In respect of care in the community, which is a particular concern of the hon. Member for Monklands, West, we are strengthening greatly the social services inspectorate in England.
      Mr. Tom Clarke: The Secretary of State must be aware that, although those may sound to him like fine words, they in no way match up to the promises given in Committee. If the Government are as convinced as the right hon. and learned Gentleman claims about the need for quality, let them show it by accepting what is a reasonable new clause. I hope that he will do that. But if he does not, I shall invite the House to divide on the issue.
      Mr. Clarke: I am glad to hear that. As I said at the outset, the whole basis of our reforms is aimed at raising the quality of treatment and care in the Health Service and the community services. All that the Labour party can do after hours of debate and months of deliberation is to advocate the setting up of a new Committee. The bureaucratic approach to the Health Service which dominated its policy in the past will soon be swept away. If Labour Members wish to divide on this new clause, I trust that it will be rejected as wholly inadequate to the challenges facing the National Health Service which will be more properly addressed by our reforms, when they are

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      implemented—on time—at the beginning of April 1991. That is when a better National Health Service will begin to be delivered.
      12 midnight
      Mr. Tom Clarke: That was as unsatisfactory as the rest of the Secretary of State's speech. I ask the House to divide.
      Question put, That the clause be read a Second time:—
      The House divided: Ayes 203, Noes 279.

      Division No. 127]

      [12 midnight

      AYES

      Abbott, Ms Diane

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

      Adams, Allen (Paisley N)

      Fisher, Mark

      Allen, Graham

      Flannery, Martin

      Alton, David

      Flynn, Paul

      Anderson, Donald

      Foot, Rt Hon Michael

      Archer, Rt Hon Peter

      Foster, Derek

      Armstrong, Hilary

      Fraser, John

      Ashton, Joe

      Fyfe, Maria

      Banks, Tony (Newham NW)

      Galloway, George

      Barnes, Harry (Derbyshire NE)

      Garrett, John (Norwich South)

      Barnes, Mrs Rosie (Greenwich)

      Garrett, Ted (Wallsend)

      Barron, Kevin

      George, Bruce

      Battle, John

      Gilbert, Rt Hon Dr John

      Beggs, Roy

      Godman, Dr Norman A.

      Beith, A. J.

      Gordon, Mildred

      Benn, Rt Hon Tony

      Gould, Bryan

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

      Graham, Thomas

      Bermingham, Gerald

      Grant, Bernie (Tottenham)

      Blair, Tony

      Griffiths, Nigel (Edinburgh S)

      Blunkett, David

      Griffiths, Win (Bridgend)

      Boateng, Paul

      Hardy, Peter

      Boyes, Roland

      Harman, Ms Harriet

      Bradley, Keith

      Hattersley, Rt Hon Roy

      Brown, Gordon (D'mline E)

      Henderson, Doug

      Brown, Nicholas (Newcastle E)

      Hinchliffe, David

      Brown, Ron (Edinburgh Leith)

      Hoey, Ms Kate (Vauxhall)

      Buchan, Norman

      Hogg, N. (C'nauld & Kilsyth)

      Buckley, George J.

      Home Robertson, John

      Caborn, Richard

      Hood, Jimmy

      Campbell, Menzies (Fife NE)

      Howarth, George (Knowsley N)

      Campbell, Ron (Blyth Valley)

      Howells, Geraint

      Campbell-Savours, D. N.

      Howells, Dr. Kim (Pontypridd)

      Carlile, Alex (Mont'g)

      Hoyle, Doug

      Cartwright, John

      Hughes, John (Coventry NE)

      Clark, Dr David (S Shields)

      Hughes, Robert (Aberdeen N)

      Clarke, Tom (Monklands W)

      Hughes, Roy (Newport E)

      Clay, Bob

      Hughes, Simon (Southwark)

      Clelland, David

      Illsley, Eric

      Clwyd, Mrs Ann

      Ingram, Adam

      Cohen, Harry

      Jones, Barry (Alyn & Deeside)

      Coleman, Donald

      Jones, Ieuan (Ynys Môn)

      Cook, Robin (Livingston)

      Jones, Martyn (Clwyd S W)

      Cousins, Jim

      Kennedy, Charles

      Cox, Tom

      Kilfedder, James

      Crowther, Stan

      Lamond, James

      Cryer, Bob

      Leadbitter, Ted

      Cummings, John

      Lestor, Joan (Eccles)

      Dalyell, Tam

      Lewis, Terry

      Darling, Alistair

      Livingstone, Ken

      Davies, Rt Hon Denzil (Llanelli)

      Livsey, Richard

      Davies, Ron (Caerphilly)

      Lloyd, Tony (Stretford)

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

      Lofthouse, Geoffrey

      Dixon, Don

      Loyden, Eddie

      Dobson, Frank

      McAllion, John

      Doran, Frank

      McAvoy, Thomas

      Duffy, A. E. P.

      McCartney, Ian

      Dunnachie, Jimmy

      Macdonald, Calum A.

      Eadie, Alexander

      McFall, John

      Eastham, Ken

      McKay, Allen (Barnsley West)

      Ewing, Harry (Falkirk E)

      McKelvey, William

      Ewing, Mrs Margaret (Moray)

      Maclennan, Robert

      Faulds, Andrew

      McNamara, Kevin

      Fearn, Ronald

      Madden, Max

      Field, Frank (Birkenhead)

      Maginnis, Ken

      612

      Mahon, Mrs Alice

      Salmond, Alex

      Marek, Dr John

      Sedgemore, Brian

      Marshall, Jim (Leicester S)

      Sheerman, Barry

      Martin, Michael J. (Springburn)

      Sheldon, Rt Hon Robert

      Martlew, Eric

      Shore, Rt Hon Peter

      Meacher, Michael

      Short, Clare

      Meale, Alan

      Sillars, Jim

      Michael, Alun

      Skinner, Dennis

      Michie, Bill (Sheffield Heeley)

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

      Michie, Mrs Ray (Arg'l & Bute)

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

      Moonie, Dr Lewis

      Smith, J. P. (Vale of Glam)

      Morgan, Rhodri

      Smyth, Rev Martin (Belfast S)

      Morris, Rt Hon A. (W'shawe)

      Soley, Clive

      Mowlam, Marjorie

      Spearing, Nigel

      Mullin, Chris

      Steel, Rt Hon Sir David

      Murphy, Paul

      Steinberg, Gerry

      Nellist, Dave

      Stott, Roger

      Oakes, Rt Hon Gordon

      Taylor, Mrs Ann (Dewsbury)

      Orme, Rt Hon Stanley

      Taylor, Rt Hon J. D. (S'ford)

      Owen, Rt Hon Dr David

      Taylor, Matthew (Truro)

      Paisley, Rev Ian

      Thompson, Jack (Wansbeck)

      Patchett, Terry

      Turner, Dennis

      Pendry, Tom

      Wallace, James

      Pike, Peter L.

      Walley, Joan

      Powell, Ray (Ogmore)

      Wardell, Gareth (Gower)

      Prescott, John

      Wareing, Robert N.

      Primarolo, Dawn

      Welsh, Andrew (Angus E)

      Quin, Ms Joyce

      Welsh, Michael (Doncaster N)

      Radice, Giles

      Wigley, Dafydd

      Randall, Stuart

      Williams, Rt Hon Alan

      Redmond, Martin

      Williams, Alan W. (Carm'then)

      Rees, Rt Hon Merlyn

      Winnick, David

      Richardson, Jo

      Wise, Mrs Audrey

      Robertson, George

      Worthington, Tony

      Robinson, Geoffrey

      Young, David (Bolton SE)

      Rogers, Allan

      Rooker, Jeff

      Tellers for the Ayes:

      Ross, Ernie (Dundee W)

      Mrs. Llin Golding and Mr. Frank Haynes.

      Ross, William (Londonderry E)

      Ruddock, Joan

      NOES

      Adley, Robert

      Burns, Simon

      Alexander, Richard

      Butcher, John

      Alison, Rt Hon Michael

      Butler, Chris

      Allason, Rupert

      Butterfill, John

      Amery, Rt Hon Julian

      Carlisle, John, (Luton N)

      Amess, David

      Carlisle, Kenneth (Lincoln)

      Amos, Alan

      Carrington, Matthew

      Arbuthnot, James

      Carttiss, Michael

      Arnold, Jacques (Gravesham)

      Cash, William

      Arnold, Tom (Hazel Grove)

      Chalker, Rt Hon Mrs Lynda

      Atkins, Robert

      Channon, Rt Hon Paul

      Baker, Rt Hon K. (Mole Valley)

      Chapman, Sydney

      Baker, Nicholas (Dorset N)

      Churchill, Mr

      Baldry, Tony

      Clark, Dr Michael (Rochford)

      Banks, Robert (Harrogate)

      Clark, Sir W. (Croydon S)

      Batiste, Spencer

      Clarke, Rt Hon K. (Rushcliffe)

      Bellingharn, Henry

      Colvin, Michael

      Bendall, Vivian

      Conway, Derek

      Bennett, Nicholas (Pembroke)

      Coombs, Anthony (Wyre F'rest)

      Benyon,W.

      Coombs, Simon (Swindon)

      Biffen, Rt Hon John

      Cope, Rt Hon John

      Blaker, Rt Hon Sir Peter

      Couchman, James

      Body, Sir Richard

      Cran, James

      Bonsor, Sir Nicholas

      Currie, Mrs Edwina

      Boscawen, Hon Robert

      Curry, David

      Boswell, Tim

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

      Bottomley, Mrs Virginia

      Davis, David (Boothferry)

      Bowden, A (Brighton K'pto'n)

      Day, Stephen

      Bowden, Gerald (Dulwich)

      Devlin, Tim

      Bowis, John

      Dorrell, Stephen

      Boyson, Rt Hon Dr Sir Rhodes

      Douglas-Hamilton, Lord James

      Brandon-Bravo, Martin

      Dover, Den

      Brazier, Julian

      Dunn, Bob

      Bright, Graham

      Durant, Tony

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

      Eggar, Tim

      Bruce, Ian (Dorset South)

      Emery, Sir Peter

      Buck, Sir Antony

      Evans, David (Welwyn Hatf'd)

      Budgen, Nicholas

      Favell, Tony

      613

      Fenner, Dame Peggy

      Lloyd, Peter (Fareham)

      Field, Barry (Isle of Wight)

      Lord, Michael

      Fishburn, John Dudley

      Luce, Rt Hon Richard

      Forman, Nigel

      Lyell, Rt Hon Sir Nicholas

      Forsyth, Michael (Stirling)

      Macfarlane, Sir Neil

      Forth, Eric

      MacGregor, Rt Hon John

      Fowler, Rt Hon Sir Norman

      Maclean, David

      Fox, Sir Marcus

      McLoughlin, Patrick

      Freeman, Roger

      McNair-Wilson, Sir Michael

      French, Douglas

      Madel, David

      Gale, Roger

      Malins, Humfrey

      Garel-Jones, Tristan

      Mans, Keith

      Gill, Christopher

      Maples, John

      Glyn, Dr Sir Alan

      Marland, Paul

      Goodhart, Sir Philip

      Marlow, Tony

      Goodson-Wickes, Dr Charles

      Marshall, John (Hendon S)

      Gorman, Mrs Teresa

      Marshall, Michael (Arundel)

      Gorst, John

      Martin, David (Portsmouth S)

      Gow, Ian

      Maude, Hon Francis

      Grant, Sir Anthony (CambsSW)

      Mawhinney, Dr Brian

      Greenway, John (Ryedale)

      Maxwell-Hyslop, Robin

      Gregory, Conal

      Mayhew, Rt Hon Sir Patrick

      Griffiths, Peter (Portsmouth N)

      Mellor, David

      Grist, Ian

      Meyer, Sir Anthony

      Ground, Patrick

      Mills, Iain

      Grylls, Michael

      Miscampbell, Norman

      Hague, William

      Mitchell, Andrew (Gedling)

      Hamilton, Hon Archie (Epsom)

      Mitchell, Sir David

      Hamilton, Neil (Tatton)

      Moate, Roger

      Hampson, Dr Keith

      Monro, Sir Hector

      Hanley, Jeremy

      Montgomery, Sir Fergus

      Hannam, John

      Morris, M (N'hampton S)

      Hargreaves, Ken (Hyndburn)

      Moss, Malcolm

      Harris, David

      Moynihan, Hon Colin

      Haselhurst, Alan

      Neale, Gerrard

      Hayes, Jerry

      Nelson, Anthony

      Hayhoe, Rt Hon Sir Barney

      Neubert, Michael

      Hayward, Robert

      Newton, Rt Hon Tony

      Heathcoat-Amory, David

      Nicholls, Patrick

      Hicks, Mrs Maureen (Wolv' NE)

      Nicholson, David (Taunton)

      Hicks, Robert (Cornwall SE)

      Nicholson, Emma (Devon West)

      Higgins, Rt Hon Terence L.

      Norris, Steve

      Hill, James

      Onslow, Rt Hon Cranley

      Hind, Kenneth

      Page, Richard

      Hogg, Hon Douglas (Gr'th'm)

      Paice, James

      Howard, Rt Hon Michael

      Parkinson, Rt Hon Cecil

      Howell, Rt Hon David (G'dford)

      Patnick, Irvine

      Howell, Ralph (North Norfolk)

      Patten, Rt Hon Chris (Bath)

      Hughes, Robert G. (Harrow W)

      Pawsey, James

      Hunt, David (Wirral W)

      Peacock, Mrs Elizabeth

      Hunt, Sir John (Ravensbourne)

      Porter, Barry (Wirral S)

      Hurd, Rt Hon Douglas

      Porter, David (Waveney)

      Irvine, Michael

      Portillo, Michael

      Irving, Sir Charles

      Price, Sir David

      Jack, Michael

      Raison, Rt Hon Timothy

      Jackson, Robert

      Rathbone, Tim

      Janman, Tim

      Renton, Rt Hon Tim

      Jessel, Toby

      Ridsdale, Sir Julian

      Johnson Smith, Sir Geoffrey

      Roberts, Wyn (Conwy)

      Jones, Gwilym (Cardiff N)

      Rossi, Sir Hugh

      Jones, Robert B (Herts W)

      Rost, Peter

      Jopling, Rt Hon Michael

      Rowe, Andrew

      Key, Robert

      Rumbold, Mrs Angela

      King, Roger (B'ham N'thfield)

      Sackville, Hon Tom

      Kirkhope, Timothy

      Sayeed, Jonathan

      Knapman, Roger

      Scott, Rt Hon Nicholas

      Knight, Greg (Derby North)

      Shaw, Sir Michael (Scarb')

      Knight, Dame Jill (Edgbaston)

      Shelton, Sir William

      Knowles, Michael

      Shephard, Mrs G. (Norfolk SW)

      Knox, David

      Shepherd, Colin (Hereford)

      Lang, Ian

      Sims, Roger

      Latham, Michael

      Skeet, Sir Trevor

      Lawrence, Ivan

      Smith, Sir Dudley (Warwick)

      Lee, John (Pendle)

      Smith, Tim (Beaconsfield)

      Leigh, Edward (Gainsbor'gh)

      Speller, Tony

      Lennox-Boyd, Hon Mark

      Spicer, Sir Jim (Dorset W)

      Lester, Jim (Broxtowe)

      Squire, Robin

      Lightbown, David

      Stanbrook, Ivor

      Lilley, Peter

      Stanley, Rt Hon Sir John

      Lloyd, Sir Ian (Havant)

      Stern, Michael

      614

      Stevens, Lewis

      Waldegrave, Rt Hon William

      Stewart, Allan (Eastwood)

      Walden, George

      Stewart, Andy (Sherwood)

      Walker, Bill (T'side North)

      Stewart, Rt Hon Ian (Herts N)

      Waller, Gary

      Stokes, Sir John

      Ward, John

      Stradling Thomas, Sir John

      Wardle, Charles (Bexhill)

      Sumberg, David

      Watts, John

      Summerson, Hugo

      Wells, Bowen

      Taylor, Ian (Esher)

      Wheeler, Sir John

      Taylor, John M (Solihull)

      Widdecombe, Ann

      Taylor, Teddy (S'end E)

      Wiggin, Jerry

      Tebbit, Rt Hon Norman

      Wilkinson, John

      Temple-Morris, Peter

      Wilshire, David

      Thompson, D. (Calder Valley)

      Winterton, Mrs Ann

      Thompson, Patrick (Norwich N)

      Winterton, Nicholas

      Thorne, Neil

      Wolfson, Mark

      Thornton, Malcolm

      Wood, Timothy

      Thurnham, Peter

      Woodcock, Dr. Mike

      Tracey, Richard

      Yeo, Tim

      Tredinnick, David

      Young, Sir George (Acton)

      Trippier, David

      Trotter, Neville

      Tellers for the Noes:

      Twinn, Dr Ian

      Alastair Goodlad and Michael Fallon.

      Waddington, Rt Hon David

      Question accordingly negatived.
      It being after Twelve o'clock, MADAM DEPUTY SPEAKER proceeded to put forthwith the Questions which she was directed to put at that hour, pursuant to the Order [14 March.]
      Question put, That amendments Nos. 39 to 141, 158, 256, 275, 286 and 341, remaining to be made, be made to the Bill:—
      The House divided: Ayes 276, Noes 202.

      Division No. 128]

      [12.13 am

      AYES

      Adley, Robert

      Butterfill, John

      Alexander, Richard

      Carlisle, John, (Luton N)

      Alison, Rt Hon Michael

      Carlisle, Kenneth (Lincoln)

      Allason, Rupert

      Carrington, Matthew

      Amery, Rt Hon Julian

      Carttiss, Michael

      Amess, David

      Cash, William

      Amos, Alan

      Chalker, Rt Hon Mrs Lynda

      Arbuthnot, James

      Channon, Rt Hon Paul

      Arnold, Jacques (Gravesham)

      Chapman, Sydney

      Arnold, Tom (Hazel Grove)

      Churchill, Mr

      Atkins, Robert

      Clark, Dr Michael (Rochford)

      Baker, Rt Hon K. (Mole Valley)

      Clark, Sir W. (Croydon S)

      Baker, Nicholas (Dorset N)

      Clarke, Rt Hon K. (Rushcliffe)

      Baldry, Tony

      Colvin, Michael

      Banks, Robert (Harrogate)

      Conway, Derek

      Batiste, Spencer

      Coombs, Anthony (Wyre F'rest)

      Bellingham, Henry

      Coombs, Simon (Swindon)

      Bendall, Vivian

      Cope, Rt Hon John

      Bennett, Nicholas (Pembroke)

      Couchman, James

      Benyon, W.

      Cran, James

      Biffen, Rt Hon John

      Currie, Mrs Edwina

      Blaker, Rt Hon Sir Peter

      Curry, David

      Body, Sir Richard

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

      Bonsor, Sir Nicholas

      Davis, David (Boothferry)

      Boscawen, Hon Robert

      Day, Stephen

      Boswell, Tim

      Devlin, Tim

      Bottomley, Mrs Virginia

      Dorrell, Stephen

      Bowden, A (Brighton K'pto'n)

      Douglas-Hamilton, Lord James

      Bowden, Gerald (Dulwich)

      Dover, Den

      Bowis, John

      Dunn, Bob

      Boyson, Rt Hon Dr Sir Rhodes

      Durant, Tony

      Brandon-Bravo, Martin

      Eggar, Tim

      Brazier, Julian

      Emery, Sir Peter

      Bright, Graham

      Evans, David (Welwyn Hatf'd)

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

      Fallon, Michael

      Bruce, Ian (Dorset South)

      Favell, Tony

      Buck, Sir Antony

      Fenner, Dame Peggy

      Buckley, George J.

      Field, Barry (Isle of Wight)

      Burns, Simon

      Fishburn, John Dudley

      Butcher, John

      Forman, Nigel

      Butler, Chris

      Forsyth, Michael (Stirling)

      615

      Forth, Eric

      McNair-Wilson, Sir Michael

      Fowler, Rt Hon Sir Norman

      Madel, David

      Fox, Sir Marcus

      Malins, Humfrey

      Freeman, Roger

      Mans, Keith

      French, Douglas

      Maples, John

      Gale, Roger

      Marland, Paul

      Garel-Jones, Tristan

      Marlow, Tony

      Gill, Christopher

      Marshall, John (Hendon S)

      Glyn, Dr Sir Alan

      Marshall, Michael (Arundel)

      Goodhart, Sir Philip

      Martin, David (Portsmouth S)

      Goodson-Wickes, Dr Charles

      Maude, Hon Francis

      Gorman, Mrs Teresa

      Mawhinney, Dr Brian

      Gorst, John

      Maxwell-Hyslop, Robin

      Gow, Ian

      Mayhew, Rt Hon Sir Patrick

      Grant, Sir Anthony (CambsSW)

      Mellor, David

      Greenway, John (Ryedale)

      Meyer, Sir Anthony

      Gregory, Conal

      Mills, Iain

      Griffiths, Peter (Portsmouth N)

      Miscampbell, Norman

      Grist, Ian

      Mitchell, Andrew (Gedling)

      Ground, Patrick

      Mitchell, Sir David

      Grylls, Michael

      Moate, Roger

      Hague, William

      Monro, Sir Hector

      Hamilton, Hon Archie (Epsom)

      Montgomery, Sir Fergus

      Hamilton, Neil (Tatton)

      Morris, M (N'hampton S)

      Hampson, Dr Keith

      Moss, Malcolm

      Hanley, Jeremy

      Neale, Gerrard

      Hannam, John

      Nelson, Anthony

      Hargreaves, Ken (Hyndburn)

      Neubert, Michael

      Harris, David

      Newton, Rt Hon Tony

      Haselhurst, Alan

      Nicholls, Patrick

      Hayes, Jerry

      Nicholson, David (Taunton)

      Hayward, Robert

      Nicholson, Emma (Devon West)

      Heathcoat-Amory, David

      Norris, Steve

      Hicks, Mrs Maureen (Wolv' NE)

      Onslow, Rt Hon Cranley

      Hicks, Robert (Cornwall SE)

      Page, Richard

      Higgins, Rt Hon Terence L.

      Paice, James

      Hill, James

      Parkinson, Rt Hon Cecil

      Hind, Kenneth

      Patnick, Irvine

      Hogg, Hon Douglas (Gr'th'm)

      Patten, Rt Hon Chris (Bath)

      Howard, Rt Hon Michael

      Pawsey, James

      Howell, Rt Hon David (G'dford)

      Peacock, Mrs Elizabeth

      Howell, Ralph (North Norfolk)

      Porter, Barry (Wirral S)

      Hughes, Robert G. (Harrow W)

      Porter, David (Waveney)

      Hunt, David (Wirral W)

      Portillo, Michael

      Hunt, Sir John (Ravensbourne)

      Price, Sir David

      Irvine, Michael

      Raison, Rt Hon Timothy

      Irving, Sir Charles

      Rathbone, Tim

      Jack, Michael

      Renton, Rt Hon Tim

      Jackson, Robert

      Ridsdale, Sir Julian

      Janman, Tim

      Roberts, Wyn (Conwy)

      Jessel, Toby

      Rossi, Sir Hugh

      Johnson Smith, Sir Geoffrey

      Rost, Peter

      Jones, Gwilym (Cardiff N)

      Rowe, Andrew

      Jones, Robert B (Herts W)

      Rumbold, Mrs Angela

      Jopling, Rt Hon Michael

      Sackville, Hon Tom

      Key, Robert

      Sayeed, Jonathan

      King, Roger (B'ham N'thfield)

      Scott, Rt Hon Nicholas

      Kirkhope, Timothy

      Shaw, Sir Michael (Scarb')

      Knapman, Roger

      Shelton, Sir William

      Knight, Dame Jill (Edgbaston)

      Shephard, Mrs G. (Norfolk SW)

      Knowles, Michael

      Shepherd, Colin (Hereford)

      Knox, David

      Sims, Roger

      Lang, Ian

      Skeet, Sir Trevor

      Latham, Michael

      Smith, Sir Dudley (Warwick)

      Lawrence, Ivan

      Smith, Tim (Beaconsfield)

      Lee, John (Pendle)

      Speller, Tony

      Leigh, Edward (Gainsbor'gh)

      Spicer, Sir Jim (Dorset W)

      Lennox-Boyd, Hon Mark

      Squire, Robin

      Lester, Jim (Broxtowe)

      Stanbrook, Ivor

      Lightbown, David

      Stanley, Rt Hon Sir John

      Lilley, Peter

      Stern, Michael

      Lloyd, Sir Ian (Havant)

      Stevens, Lewis

      Lloyd, Peter (Fareham)

      Stewart, Allan (Eastwood)

      Lord, Michael

      Stewart, Andy (Sherwood)

      Luce, Rt Hon Richard

      Stewart, Rt Hon Ian (Herts N)

      Lyell, Rt Hon Sir Nicholas

      Stokes, Sir John

      Macfarlane, Sir Neil

      Stradling Thomas, Sir John

      MacGregor, Rt Hon John

      Sumberg, David

      Maclean, David

      Summerson, Hugo

      McLoughlin, Patrick

      Taylor, Ian (Esher)

      616

      Taylor, John M (Solihull)

      Wardle, Charles (Bexhill)

      Taylor, Teddy (S'end E)

      Watts, John

      Tebbit, Rt Hon Norman

      Wells, Bowen

      Temple-Morris, Peter

      Wheeler, Sir John

      Thompson, D. (Calder Valley)

      Widdecombe, Ann

      Thompson, Patrick (Norwich N)

      Wiggin, Jerry

      Thorne, Neil

      Wilkinson, John

      Thornton, Malcolm

      Wilshire, David

      Thurnham, Peter

      Winterton, Mrs Ann

      Tracey, Richard

      Winterton, Nicholas

      Trippier, David

      Wolfson, Mark

      Trotter, Neville

      Wood, Timothy

      Twinn, Dr Ian

      Woodcock, Dr. Mike

      Waddington, Rt Hon David

      Yeo, Tim

      Waldegrave, Rt Hon William

      Young, Sir George (Acton)

      Walden, George

      Walker, Bill (T'side North)

      Tellers for the Ayes:

      Waller, Gary

      Mr. Alastair Goodland and Mr. Greg Knight.

      Ward, John

      NOES

      Abbott, Ms Diane

      Faulds, Andrew

      Adams, Allen (Paisley N)

      Fearn, Ronald

      Allen, Graham

      Field, Frank (Birkenhead)

      Alton, David

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

      Anderson, Donald

      Fisher, Mark

      Archer, Rt Hon Peter

      Flannery, Martin

      Armstrong, Hilary

      Flynn Paul

      Ashton, Joe

      Foot, Rt Hon Michael

      Banks, Tony (Newham NW)

      Foster, Derek

      Barnes, Harry (Derbyshire NE)

      Fraser, John

      Barnes, Mrs Rosie (Greenwich)

      Fyfe, Maria

      Barron, Kevin

      Galloway, George

      Battle, John

      Garrett, John (Norwich South)

      Beggs, Roy

      Garrett, Ted (Wallsend)

      Beith, A. J.

      George, Bruce

      Benn, Rt Hon Tony

      Gilbert, Rt Hon Dr John

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

      Godman, Dr Norman A.

      Bermingham, Gerald

      Golding, Mrs Llin

      Blair, Tony

      Gordon, Mildred

      Boateng, Paul

      Gould, Bryan

      Boyes, Roland

      Graham, Thomas

      Bradley, Keith

      Grant, Bernie (Tottenham)

      Brown, Gordon (D'mline E)

      Griffiths, Nigel (Edinburgh S)

      Brown, Nicholas (Newcastle E)

      Griffiths, Win (Bridgend)

      Brown, Ron (Edinburgh Leith)

      Hardy, Peter

      Buchan, Norman

      Harman, Ms Harriet

      Buckley, George J.

      Hattersley, Rt Hon Roy

      Caborn, Richard

      Haynes, Frank

      Campbell, Menzies (Fife NE)

      Henderson, Doug

      Campbell, Ron (Blyth Valley)

      Hinchliffe, David

      Campbell-Savours, D. N.

      Hoey, Ms Kate (Vauxhall)

      Cartwright, John

      Hogg, N. (C'nauld & Kilsyth)

      Clark, Dr David (S Shields)

      Home Robertson, John

      Clarke, Tom (Monklands W)

      Hood, Jimmy

      Clay, Bob

      Howarth, George (Knowsley N)

      Clelland, David

      Howells, Geraint

      Clwyd, Mrs Ann

      Howells, Dr. Kim (Pontypridd)

      Cohen, Harry

      Hoyle, Doug

      Coleman, Donald

      Hughes, John (Coventry NE)

      Cook, Robin (Livingston)

      Hughes, Robert (Aberdeen N)

      Cousins, Jim

      Hughes, Roy (Newport E)

      Cox, Tom

      Hughes, Simon (Southwark)

      Crowther, Stan

      Illsley, Eric

      Cryer, Bob

      Ingram, Adam

      Cummings, John

      Jones, Barry (Alyn & Deeside)

      Dalyell, Tam

      Jones, Ieuan (Ynys Môn)

      Darling, Alistair

      Jones, Martyn (Clwyd S W)

      Davies, Rt Hon Denzil (Llanelli)

      Kennedy, Charles

      Davies, Ron (Caerphilly)

      Kilfedder, James

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

      Lamond, James

      Dixon, Don

      Leadbitter, Ted

      Dobson, Frank A

      Lestor, Joan (Eccles)

      Doran, Frank

      Lewis, Terry

      Duffy, A. E. P.

      Livingstone, Ken

      Dunnachie, Jimmy

      Livsey, Richard

      Eadie, Alexander

      Lloyd, Tony (Stretford)

      Eastham, Ken

      Lofthouse, Geoffrey

      Ewing, Harry (Falkirk E)

      Loyden, Eddie

      Ewing, Mrs Margaret (Moray)

      McAllion, John

      617

      McAvoy, Thomas

      Rogers, Allan

      McCartney, Ian

      Rooker, Jeff

      Macdonald, Calum A.

      Ross, Ernie (Dundee W)

      McFall, John

      Ross, William (Londonderry E)

      McKay, Allen (Barnsley West)

      Rowlands, Ted

      McKelvey, William

      Ruddock, Joan

      Maclennan, Robert

      Salmond, Alex

      McNamara, Kevin

      Sedgemore, Brian

      Madden, Max

      Sheerman, Barry

      Maginnis, Ken

      Sheldon, Rt Hon Robert

      Mahon, Mrs Alice

      Short, Clare

      Marek, Dr John

      Sillars, Jim

      Marshall, Jim (Leicester S)

      Skinner, Dennis

      Martin, Michael J. (Springburn)

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

      Martlew, Eric

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

      Meacher, Michael

      Smith, J. P. (Vale of Glam)

      Meale, Alan

      Smyth, Rev Martin (Belfast S)

      Michael, Alun

      Soley, Clive

      Michie, Bill (Sheffield Heeley)

      Spearing, Nigel

      Michie, Mrs Ray (Arg'l & Bute)

      Steel, Rt Hon Sir David

      Moonie, Dr Lewis

      Steinberg, Gerry

      Morgan, Rhodri

      Stott, Roger

      Morris, Rt Hon A. (W'shawe)

      Taylor, Mrs Ann (Dewsbury)

      Mowlam, Marjorie

      Taylor, Rt Hon J. D. (S'ford)

      Mullin, Chris

      Taylor, Matthew (Truro)

      Murphy, Paul

      Thompson, Jack (Wansbeck)

      Nellist, Dave

      Turner, Dennis

      Orme, Rt Hon Stanley

      Walley, Joan

      Owen, Rt Hon Dr David

      Warden, Gareth (Gower)

      Paisley, Rev Ian

      Wareing, Robert N.

      Patchett, Terry

      Welsh, Andrew (Angus E)

      Pendry, Tom

      Welsh, Michael (Doncaster N)

      Pike, Peter L.

      Wigley, Dafydd

      Powell, Ray (Ogmore)

      Williams, Rt Hon Alan

      Prescott, John

      Williams, Alan W. (Carm'then)

      Primarolo, Dawn

      Winnick, David

      Quin, Ms Joyce

      Wise, Mrs Audrey

      Radice, Giles

      Worthington, Tony

      Randall, Stuart

      Young, David (Bolton SE)

      Redmond, Martin

      Rees, Rt Hon Merlyn

      Tellers for the Noes:

      Richardson, Jo

      Mr. James Wallace and Mr. Alex Carlile.

      Robertson, George

      Robinson, Geoffrey

      Question accordingly agreed to.

    Clause 5

      NHS TRUSTS
      Amendments made: No. 276, in page 6, line 25, at end insert
      'and, without prejudice to the generality of the power, and such regulations may make provision to deal with cases where the post of any officer of an NHS trust is held jointly by two or more persons or where the functions of such an officer are in any other way performed by more than one person'.—[Mr. Day.]
      No. 139, in page 6, leave out lines 43 to 48.—[Sir George Young.]

    Clause 34

      ACCOUNTS AND AUDIT OF NHS TRUSTS AND FUND-HOLDING PRACTICES
      Amendment made: No. 256, in page 39, line 29, leave out '(1)' and insert—
      '(1) The enactments specified in Schedule (Amendments relating to audit of accounts of Scottish health service bodies) to this Act shall have effect subject to the amendments set out in that Schedule, being amendments—

      (a) to extend the functions of the Commission for Local Authority Accounts in Scotland (in this section referred to as "the Commission") to cover Health Boards and other bodies established under the 1978 Act, the Mental Welfare Commission for Scotland
      618
      and State Hospital Management Committees constituted under the Mental Health (Scotland) Act 1984;

      (b) to alter the title and constitution of the Commission to reflect its wider role; and

      (c) to make provision consequential on or supplemental to the amendments referred to in paragraphs (a) and (b) above.

      (1A)'.—[Mr. Michael Forsyth.]

    Clause 43

      LOCAL AUTHORITY PLANS FOR COMMUNITY CARE SERVICES
      Amendment made: No. 341, in page 45, line 26, at end insert—
      '(1A) In carrying out any of their functions under paragraphs (a) to (c) of subsection (1) above, a local authority shall consult—

      (a) any District Health Authority the whole or any part of whose district lies within the area of the local authority;

      (b) any Family Health Services Authority the whole or any part of whose locality lies within the area of the local authority;

      (c) in so far as any proposed plan, review or modifications of a plan may affect or be affected by the provision or availability of housing and the local authority is not itself a local housing authority, within the meaning of the Housing Act 1985, every such local housing authority whose area is within the area of the local authority;

      (d) such voluntary housing agencies and other bodies as appear to the local authority to provide housing or community care services in their area; and

      (e) such other persons as the Secretary of State may direct.'.—[Sir George Young.]

    Schedule 1

      HEALTH AUTHORITIES AND FAMILY HEALTH SERVICES AUTHORITIES
      Amendment made: No. 275, in page 60, line 17, at end insert—
      '10. After paragraph 12 of that Schedule there shall be inserted the following paragraph:—
      "12A. Regulations made by virtue of this Schedule or Schedule 1 to the National Health Service and Community Care Act 1990 may make provision (including provision modifying those Schedules) to deal with cases where the post of chief officer or any other officer of an authority is held jointly by two or more persons or where the functions of such an officer are in any other way performed by more than one person.".'.—[Mr. Day.]

    Schedule 2

      NATIONAL HEALTH SERVICE TRUSTS
      Amendments made: No. 140, in page 60, line 34 leave out 'any special provision as to' and insert 'a provision to secure'.—[Sir George Young.]
      No. 141, in page 60, line 42 at end insert—
      '(1A) In a case where the order contains a provision made by virtue of sub-paragraph (1)(d) above and a person who is being considered for appointment by virtue of that provision—

      (a) is employed by the university or medical or dental school in question, and

      (b) would also, apart from this sub-paragraph, be regarded as employed by the trust,

      619
      his employment by the trust shall be disregarded in determining whether, if appointed, he will be a non-executive director of the trust.'.—[Sir George Young.]

    Schedule 4

      AMENDMENTS OF PART III OF THE LOCAL GOVERNMENT FINANCE ACT 1982
      Amendment made: No. 158, in page 69, line 33 at end insert—
      '(2) At the end of that section there shall be added the following subsection—
      "(6) Notwithstanding that the services provided by health service bodies are excluded from the scope of studies under this section, in undertaking or promoting studies under section 26(1) above relating to a health service body, the Commission may take into account the implementation by the body of—

      (a) any particular statutory provision or provisions, and

      (b) any directions or guidance given by the Secretary of State (whether pursuant to any such provision or otherwise),

      but the power conferred by this subsection shall not be construed as entitling the Commission to question the merits of the policy objectives of the Secretary of State.".'.—[Mr. Andrew Mitchell.]
      Amendment proposed: No 269—new schedule—

    'AMENDMENTS RELATING TO AUDIT OF ACCOUNTS OF SCOTTISH HEALTH SERVICE BODIES

      The Local Government (Scotland) Act 1973
      1. Part VII of the Local Government (Scotland) Act 1973 (finance) shall be amended in accordance with Paragraphs 2 to 13 below.
      2. In section 96 (accounts and audit of local authorities), in subsection (4), for the words "Commission for Local Authority Accounts" there shall be Substituted "Acccounts Commission for Scotland".
      3.—(1) Section 97 (establishment of Commission for Local Authority Accounts in Scotland) shall be amended as follows.
      (2) In subsection (1)—

      (a) for the words "Commission for Local Authority Accounts in Scotland" there shall be substituted "Accounts Commission for Scotland",

      (b) for the word "twelve" there shall be substituted "fifteen",

      (c) for the word "nine" there shall be substituted "eleven", and

      (d) after the word "authorities" there shall be inserted "and such organisations connected with the health service".

      (3) In subsection (2)—
      (a) in paragraph (a)—

      (i) after the words "accounts of" there shall be inserted "(i)", and

      (ii) after the word "authorities" there shall be inserted the following sub-paragraphs"—(ii) the bodies mentioned in section 86(1)(a) to (c) of the National Health Service (Scotland) Act 1978;

      (iii) the members of every recognised fund-holding practice;

      (iv) the Mental Welfare Commission for Scotland; and

      (v) any State Hospital Management Committee constituted under section 91 of the Mental Health (Scotland) Act 1984,";

      (b) in paragraph (c), after the word "authorities" there shall be inserted "or, as the case may be, health service bodies"; and
      (c) in paragraph (d), after the word "authorities" there shall be inserted "or health service bodies".
      (4) After subsection (2) there shall be inserted the following subsections—
      620
      "(2A) Subject to section 100(1A) of this Act, in relation to the members of a recognised fund-holding practice, any reference in this Part of this Act to their accounts is a reference only to the accounts relating to allotted sums paid to them.
      (2B) In this Part of this Act—
      "health service body" means a body referred to in subsection (2)(a)(ii) to (v) above; and
      "recognised fund-holding practice" and "allotted sure" have the same meanings as in section 87B of the National Health Service (Scotland) Act 1978."
      (5) In subsection (3), after the word "authorities" there shall he inserted "and such organisations connected with the health service"
      (6) After subsection (4) there shall be inserted the following subsections—
      "(4A) It shall be the duty of the Commission to make, any such date as the Secretary of State may determine, an offer of employment by the Commission to each person employed in the Civil Service of the State in connection with the audit of the accounts of any health service body whose name is notified to the Commission by the Secretary of State for the purposes of this subsection; and the terms of the offer must be such that they are, taken as a whole, not less favourable to the person to whom the offer is made than the terms on which he is employed on the date on which the offer is made.
      (4B) An offer made in pursuance of subsection (4A) above shall not be revocable during the period of three months beginning with the date on which it is made.
      (4C) Where a person becomes an officer of the Commission in consequence of subsection (4A) above, then, for the purposes of the Employment Protection (Consolidation) Act 1978, his period of employment in the Civil Service of the State shall count as a period of employment by the Commission and the change of employment shall not break the continuity of the period of employment.
      (4D) Where a person ceases to be employed as mentioned in subsection (4A) above—

      (a) on becoming an officer of the Commission in consequence of an offer made in pursuance of that subsection; or

      (b) having unreasonably refused such an offer,

      he shall not, on ceasing to be so employed, be treated for the purposes of any scheme under section 1 of the Superannuation Act 1972 as having been retired on redundancy."
      (7) At the end of subsection (6) there shall be added—"or a person who is, within the period of five years beginning with the relevant date, approved by the Secretary of State, acting on the recommendation of the Commission.
      (6A) In subsection (6) above, "the relevant date" means the date appointed for the coming into force of Schedule (Amendments relating to audit of accounts of Scottish health service bodies) to the National Health Service and Community Care Act 1990."
      4.—(1) Section 97A (studies for improving economy etc in services) shall be amended as follows.
      (2) At the end of subsection (2) there shall be added "and, in the case of studies relating to a health service body, shall, on request, furnish to the Comptroller and Auditor General all material relevant to the studies."
      (3) At the end of subsection (3) there shall be added "and, in the case of a health service body, the Commission shall also consult the Secretary of State and the Comptroller and Auditor General."
      5.—(1) Section 98 (expenses and accounts of Commission) shall be amended as follows.
      (2) In subsection (1)—

      621

      (a) in paragraph (b), after the word "Commission" where it first occurs there shall be inserted "relating to their functions with respect to local authorities"; and

      (b) at the end of paragraph (b) there shall be inserted the following paragraph—

      "(c) such part of the expenses of the Commission relating to their functions with respect to health service bodies as is not met by grants under paragraph (a) above shall be met by health service bodies in accordance with regulations made by the Secretary of State after consultation with such organisations connected with the health service as appear to him to be concerned."

      (3) In subsection (2), after "(b)" there shall be inserted "or (c)"
      6. In section 99 (general duties of auditors)—

      (a) after the word "authority" in both places where it occurs there shall be inserted "or health service body"; and

      (b) in paragraph (a), after the word "Act" there shall be inserted "or, in the case of a health service body, directions under section 86(3) of the National Health Service (Scotland) Act 1978".

      7.—(1) Section 100 (auditor's right of access to documents) shall be amended as follows.
      (2) In subsection (1)—

      (a) after the word "authority" where it first occurs there shall be inserted "or health service body"; and

      (b) after the word "authority" in the second place where it occurs there shall be inserted "or body".

      (3) After subsection (1) there shall be inserted the following subsection—
      4"(1A) In the case of a recognised fund-holding practice, the reference in subsection (1) above to documents includes a reference to documents relating to all the accounts and records of the members of the practice, whether or not relating to an allotted sum."
      (4) In subsection (2), after the word "authority" there shall be inserted "and health service body".
      8. In section 101 (completion of audit), after subsection (4) there shall be added the following subsection—
      "(5) Within 14 days of the completion of the audit of the accounts of a health service body the auditor shall place on any abstract of those accounts prepared by the health service body by virtue of section 86 of the National Health Service (Scotland) Act 1978 a Certificate, in such form as the Commission may direct, to the effect that he has audited the accounts in accordance with the provisions of this Part of this Act; and the auditor shall, on so certifying, forthwith send copies of the abstract of the accounts to the Commission, the Secretary of State and the health service body."
      9.—(1) Section 102 (reports to Commission by Controller of Audit) shall be amended as follows.
      (2) In subsection (1)—

      (a) after the word "authorities" there shall be inserted "and health service bodies"; and

      (b) after the word "authority" there shall be inserted "or health service body".

      (3) After subsection (4) there shall be added the following subsection—
      "(5) Without prejudice to subsection (1) above and section 104A(2) of this Act, the Controller of Audit may make a report to the Commission on any matters arising out of or in connection with the accounts of a health service body and shall send a copy of any report so made to any health service body which is named in that report and to the Secretary of State."
      10. In section 103 (action by Commission on reports by Controller of Audit), after the word "Audit" there shall be inserted "with respect to the accounts of any local authority".
      11. After section 104 there shall be inserted the following section—

      Audit of accounts of health service bodies: special provisions.
      104A.—(1) Where the auditor of the accounts of a health service body has reason to believe that the body, or any officer of the body—

      (a) has made a decision which involves the incurring of expenditure which is unlawful; or

      (b) has taken a course of action which, if pursued to its conclusion, would be unlawful and likely to cause a loss or deficiency,
      he shall forthwith make a report to the Controller of Audit.

      (2) On receipt of a report under subsection (1) above the Controller of Audit—

      (a) shall forthwith send a copy of the report to the Commission and to the Secretary of State; and

      (b) may, if he thinks fit, send to the Commission and to the Secretary of State any observations which he may have on the report.

      (3) The Commission may make a report to the Secretary of State on any matters arising out of or in connection with the accounts of a health service body."
      12. After subsection (2) of section 106 (application of sections 93 to 105 to bodies other than local authorities and to officers) there shall be added the following subsection—
      "(3) In the application of subsection (2) above to an officer of a health service body, for the words from "96" to "section 105" there shall be substituted "97 to 104A."."
      13. In Schedule 8 (provisions as to the Commission), for the words "Commission for Local Authority Accounts in Scotland" in both places where they occur there shall be substituted "Accounts Commission for Scotland".

      The National Health Service (Scotland) Act 1978
      14.—(1) Section 86 of the National Health Service (Scotland) Act 1978 (keeping and audit of accounts of certain Scottish health bodies) shall be amended as follows.
      (2) In subsections (1) and (1A), for the words "by auditors appointed by the Secretary of State" there shall be substituted "in accordance with Part VII of the Local Government (Scotland) Act 1973 by auditors appointed by the Accounts Commission for Scotland".
      (3) After subsection (1A) there shall be inserted the following subsection—
      "(1B) To the extent that regulations made by the Secretary of State so provide, the requirement in subsection (1A)(a) to have accounts audited shall not apply to the accounts for any year of a recognised fund-holding practice if those accounts are submitted to a Health Board and summarised in the Board's accounts."
      (4) Subsection (2) shall cease to have effect.'.—[Mr. Michael Forsyth.]
      Question put, That the schedule be added to the Bill:—
      The House divided: Ayes 270, Noes 56.

      Division 129]

      [12.27 pm

      AYES

      Adley, Robert

      Bendall, Vivian

      Alexander, Richard

      Bennett, Nicholas (Pembroke)

      Alison, Rt Hon Michael

      Benyon, W.

      Allason, Rupert

      Biffen, Rt Hon John

      Amess, David

      Blaker, Rt Hon Sir Peter

      Amos, Alan

      Body, Sir Richard

      Arbuthnot, James

      Bonsor, Sir Nicholas

      Arnold, Jacques (Gravesham)

      Boscawen, Hon Robert

      Arnold, Tom (Hazel Grove)

      Boswell, Tim

      Atkins, Robert

      Bottomley, Mrs Virginia

      Baker, Rt Hon K. (Mole Valley)

      Bowden, A (Brighton K'pto'n)

      Baker, Nicholas (Dorset N)

      Bowden, Gerald (Dulwich)

      Baldry, Tony

      Bowis, John

      Banks, Robert (Harrogate)

      Boyson, Rt Hon Dr Sir Rhodes

      Batiste, Spencer

      Brandon-Bravo, Martin

      Bellingham, Henry

      Brazier, Julian

      623

      Bright, Graham

      Hicks, Mrs Maureen (Wolv' NE)

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

      Hicks, Robert (Cornwall SE)

      Bruce, Ian (Dorset South)

      Higgins, Rt Hon Terence L.

      Buck, Sir Antony

      Hill, James

      Budgen, Nicholas

      Hind, Kenneth

      Burns, Simon

      Hogg, Hon Douglas (Gr'th'm)

      Butcher, John

      Howard, Rt Hon Michael

      Butler, Chris

      Howell, Rt Hon David (G'dford)

      Butterfill, John

      Howell, Ralph (North Norfolk)

      Carlisle, John, (Luton N)

      Hughes, Robert G. (Harrow W)

      Carlisle, Kenneth (Lincoln)

      Hunt, David (Wirral W)

      Carrington, Matthew

      Hunt, Sir John (Ravensbourne)

      Carttiss, Michael

      Irvine, Michael

      Cash, William

      Irving, Sir Charles

      Chalker, Rt Hon Mrs Lynda

      Jack, Michael

      Channon, Rt Hon Paul

      Jackson, Robert

      Chapman, Sydney

      Janman, Tim

      Churchill, Mr

      Jessel, Toby

      Clark, Dr Michael (Rochford)

      Johnson Smith, Sir Geoffrey

      Clark, Sir W. (Croydon S)

      Jones, Gwilym (Cardiff N)

      Clarke, Rt Hon K. (Rushcliffe)

      Jones, Robert B (Herts W)

      Colvin, Michael

      Jopling, Rt Hon Michael

      Coombs, Anthony (Wyre F'rest)

      Key, Robert

      Coombs, Simon (Swindon)

      King, Roger (B'ham N'thfield)

      Cope, Rt Hon John

      Kirkhope, Timothy

      Couchman, James

      Knapman, Roger

      Cran, James

      Knight, Greg (Derby North)

      Currie, Mrs Edwina

      Knight, Dame Jill (Edgbaston)

      Curry, David

      Knowles, Michael

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

      Knox, David

      Davis, David (Boothferry)

      Lang, Ian

      Day, Stephen

      Latham, Michael

      Devlin, Tim

      Lawrence, Ivan

      Dorrell, Stephen

      Lee, John (Pendle)

      Douglas-Hamilton, Lord James

      Leigh, Edward (Gainsbor'gh)

      Dover, Den

      Lennox-Boyd, Hon Mark

      Dunn, Bob

      Lester, Jim (Broxtowe)

      Eggar, Tim

      Lightbown, David

      Emery, Sir Peter

      Lloyd, Sir Ian (Havant)

      Evans, David (Welwyn Hatf'd)

      Lloyd, Peter (Fareham)

      Fallon, Michael

      Lord, Michael

      Favell, Tony

      Luce, Rt Hon Richard

      Fenner, Dame Peggy

      Lyell, Rt Hon Sir Nicholas

      Field, Barry (Isle of Wight)

      MacGregor, Rt Hon John

      Fishburn, John Dudley

      Maclean, David

      Forman, Nigel

      McLoughlin, Patrick

      Forsyth, Michael (Stirling)

      McNair-Wilson, Sir Michael

      Forth, Eric

      Madel, David

      Fowler, Rt Hon Sir Norman

      Malins, Humfrey

      Fox, Sir Marcus

      Mans, Keith

      Freeman, Roger

      Maples, John

      French, Douglas

      Marland, Paul

      Gale, Roger

      Marlow, Tony

      Garel-Jones, Tristan

      Marshall, John (Hendon S)

      Gill, Christopher

      Marshall, Michael (Arundel)

      Glyn, Dr Sir Alan

      Martin, David (Portsmouth S)

      Goodhart, Sir Philip

      Maude, Hon Francis

      Goodson-Wickes, Dr Charles

      Mawhinney, Dr Brian

      Gorman, Mrs Teresa

      Maxwell-Hyslop, Robin

      Gorst, John

      Mellor, David

      Gow, Ian

      Meyer, Sir Anthony

      Grant, Sir Anthony (CambsSW)

      Mills, Iain

      Greenway, John (Ryedale)

      Miscampbell, Norman

      Gregory, Conal

      Mitchell, Andrew (Gedllng)

      Griffiths, Peter (Portsmouth N)

      Mitchell, Sir David

      Grist, Ian

      Moate, Roger

      Ground, Patrick

      Monro, Sir Hector

      Grylls, Michael

      Montgomery, Sir Fergus

      Hague, William

      Morris, M (N'hampton S)

      Hamilton, Hon Archie (Epsom)

      Moss, Malcolm

      Hamilton, Neil (Tatton)

      Neale, Gerrard

      Hampson, Dr Keith

      Nelson, Anthony

      Hanley, Jeremy

      Neubert, Michael

      Hannam, John

      Newton, Rt Hon Tony

      Hargreaves, Ken (Hyndburn)

      Nicholls, Patrick

      Harris, David

      Nicholson, David (Taunton)

      Haselhurst, Alan

      Nicholson, Emma (Devon West)

      Hayes, Jerry

      Norris, Steve

      Hayward, Robert

      Onslow, Rt Hon Cranley

      Heathcoat-Amory, David

      Page, Richard

      624

      Paice, James

      Sumberg, David

      Parkinson, Rt Hon Cecil

      Summerson, Hugo

      Patnick, Irvine

      Taylor, Ian (Usher)

      Patten, Rt Hon Chris (Bath)

      Taylor, John M (Solihull)

      Pawsey, James

      Taylor, Teddy (S'end E)

      Peacock, Mrs Elizabeth

      Tebbit, Rt Hon Norman

      Porter, Barry (Wirral S)

      Temple-Morris, Peter

      Porter, David (Waveney)

      Thompson, D. (Calder Valley)

      Portillo, Michael

      Thompson, Patrick (Norwich N)

      Price, Sir David

      Thorne, Neil

      Raison, Rt Hon Timothy

      Thornton, Malcolm

      Rathbone, Tim

      Thurnham, Peter

      Renton, Rt Hon Tim

      Tracey, Richard

      Ridsdale, Sir Julian

      Trippier, David

      Roberts, Wyn (Conwy)

      Trotter, Neville

      Rossi, Sir Hugh

      Twinn, Dr Ian

      Rowe, Andrew

      Waddington, Rt Hon David

      Rumbold, Mrs Angela

      Waldegrave, Rt Hon William

      Sackville, Hon Tom

      Walden, George

      Sayeed, Jonathan

      Walker, Bill (T'side North)

      Scott, Rt Hon Nicholas

      Waller, Gary

      Shaw, Sir Michael (Scarb')

      Ward, John

      Shelton, Sir William

      Wardle, Charles (Bexhill)

      Shephard, Mrs G. (Norfolk SW)

      Watts, John

      Shepherd, Colin (Hereford)

      Wells, Bowen

      Sims, Roger

      Wheeler, Sir John

      Skeet, Sir Trevor

      Widdecombe, Ann

      Smith, Sir Dudley (Warwick)

      Wiggin, Jerry

      Smith, Tim (Beaconsfield)

      Wilkinson, John

      Speller, Tony

      Wilshire, David

      Spicer, Sir Jim (Dorset W)

      Winterton, Mrs Ann

      Squire, Robin

      Winterton, Nicholas

      Stanbrook, Ivor

      Wolfson, Mark

      Stanley, Rt Hon Sir John

      Wood, Timothy

      Stern, Michael

      Woodcock, Dr. Mike

      Stevens, Lewis

      Yeo, Tim

      Stewart, Allan (Eastwood)

      Young, Sir George (Acton)

      Stewart, Andy (Sherwood)

      Stewart, Rt Hon Ian (Herts N)

      Tellers for the Ayes:

      Stokes, Sir John

      Mr. Alastair Goodlad and Mr. Tony Durant.

      Stradling Thomas, Sir John

      NOES

      Allen, Graham

      Loyden, Eddie

      Alton, David

      McCartney, Ian

      Anderson, Donald

      Maclennan, Robert

      Ashton, Joe

      Marek, Dr John

      Barnes, Harry (Derbyshire NE)

      Marshall, Jim (Leicester S)

      Beggs, Roy

      Meale, Alan

      Beith, A. J.

      Michie, Bill (Sheffield Heeley)

      Benn, Rt Hon Tony

      Michie, Mrs Ray (Arg'l & Bute)

      Blair, Tony

      Mullin, Chris

      Campbell, Menzies (Fife NE)

      Murphy, Paul

      Carlile, Alex (Mont'g)

      Nellist, Dave

      Clay, Bob

      Redmond, Martin

      Cousins, Jim

      Richardson, Jo

      Cryer, Bob

      Ross, William (Londonderry E)

      Dalyell, Tam

      Rowlands, Ted

      Ewing, Mrs Margaret (Moray)

      Sheldon, Rt Hon Robert

      Fearn, Ronald

      Sillars, Jim

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

      Skinner, Dennis

      Garrett, John (Norwich South)

      Smyth, Rev Martin (Belfast S)

      Gould, Bryan

      Steel, Rt Hon Sir David

      Graham, Thomas

      Taylor, Mrs Ann (Dewsbury)

      Griffiths, Win (Bridgend)

      Taylor, Rt Hon J. D. (S'ford)

      Hogg, N. (C'nauld & Kilsyth)

      Taylor, Matthew (Truro)

      Howells, Geraint

      Wallace, James

      Hoyle, Doug

      Welsh, Andrew (Angus E)

      Hughes, Robert (Aberdeen N)

      Young, David (Bolton SE)

      Jones, Ieuan (Ynys Môn)

      Kennedy, Charles

      Tellers for the Noes:

      Kilfedder, James

      Alex Salmond and Dafydd Wigley.

      Livingstone, Ken

      Livsey, Richard

      Question accordingly agreed to.
      Question put, That all remaining amendments standing in the name of a member of the Government be made to the Bill:—
      The House divided: Ayes 272, Noes 187.

      Division No. 130]

      [12.39 am

      AYES

      Adley, Robert

      Forman, Nigel

      Alexander, Richard

      Forsyth, Michael (Stirling)

      Alison, Rt Hon Michael

      Forth, Eric

      Allason, Rupert

      Fowler, Rt Hon Sir Norman

      Amess, David

      Fox, Sir Marcus

      Amos, Alan

      Freeman, Roger

      Arbuthnot, James

      French, Douglas

      Arnold, Jacques (Gravesham)

      Gale, Roger

      Arnold, Tom (Hazel Grove)

      Garel-Jones, Tristan

      Atkins, Robert

      Gill, Christopher

      Baker, Rt Hon K. (Mole Valley)

      Glyn, Dr Sir Alan

      Baker, Nicholas (Dorset N)

      Goodhart, Sir Philip

      Baldry, Tony

      Goodson-Wickes, Dr Charles

      Banks, Robert (Harrogate)

      Gorman, Mrs Teresa

      Batiste, Spencer

      Gorst, John

      Bellingham, Henry

      Gow, Ian

      Bendall, Vivian

      Grant, Sir Anthony (CambsSW)

      Bennett, Nicholas (Pembroke)

      Greenway, John (Ryedale)

      Benyon, W.

      Gregory, Conal

      Biffen, Rt Hon John

      Griffiths, Peter (Portsmouth N)

      Blaker, Rt Hon Sir Peter

      Grist, Ian

      Body, Sir Richard

      Ground, Patrick

      Bonsor, Sir Nicholas

      Grylls, Michael

      Boscawen, Hon Robert

      Hague, William

      Boswell, Tim

      Hamilton, Hon Archie (Epsom)

      Bottomley, Mrs Virginia

      Hamilton, Neil (Tatton)

      Bowden, A (Brighton K'pto'n)

      Hampson, Dr Keith

      Bowden, Gerald (Dulwich)

      Hanley, Jeremy

      Bowis, John

      Hannam, John

      Boyson, Rt Hon Dr Sir Rhodes

      Hargreaves, Ken (Hyndburn)

      Brandon-Bravo, Martin

      Harris, David

      Brazier, Julian

      Haselhurst, Alan

      Bright, Graham

      Hayes, Jerry

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

      Hayward, Robert

      Bruce, Ian (Dorset South)

      Heathcoat-Amory, David

      Buck, Sir Antony

      Hicks, Mrs Maureen (Wolv' NE)

      Budgen, Nicholas

      Hicks, Robert (Cornwall SE)

      Burns, Simon

      Higgins, Rt Hon Terence L.

      Butcher, John

      Hill, James

      Butler, Chris

      Hind, Kenneth

      Butterfill, John

      Hogg, Hon Douglas (Gr'th'm)

      Carlisle, John, (Luton N)

      Hordern, Sir Peter

      Carlisle, Kenneth (Lincoln)

      Howard, Rt Hon Michael

      Carrington, Matthew

      Howell, Rt Hon David (G'dford)

      Carttiss, Michael

      Howell, Ralph (North Norfolk)

      Cash, William

      Hughes, Robert G. (Harrow W)

      Chalker, Rt Hon Mrs Lynda

      Hunt, David (Wirral W)

      Channon, Rt Hon Paul

      Hunt, Sir John (Ravensbourne)

      Chapman, Sydney

      Irvine, Michael

      Churchill, Mr

      Irving, Sir Charles

      Clark, Dr Michael (Rochford)

      Jack, Michael

      Clark, Sir W. (Croydon S)

      Jackson, Robert

      Clarke, Rt Hon K. (Rushcliffe)

      Janman, Tim

      Colvin, Michael

      Jessel, Toby

      Coombs, Anthony (Wyre F'rest)

      Johnson Smith, Sir Geoffrey

      Coombs, Simon (Swindon)

      Jones, Gwilym (Cardiff N)

      Cope, Rt Hon John

      Jones, Robert B (Herts W)

      Couchman, James

      Jopling, Rt Hon Michael

      Cran, James

      Key, Robert

      Currie, Mrs Edwina

      King, Roger (B'ham N'thfield)

      Curry, David

      Kirkhope, Timothy

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

      Knapman, Roger

      Davis, David (Boothferry)

      Knight, Greg (Derby North)

      Day, Stephen

      Knight, Dame Jill (Edgbaston)

      Devlin, Tim

      Knowles, Michael

      Dorrell, Stephen

      Knox, David

      Douglas-Hamilton, Lord James

      Lang, Ian

      Dover, Den

      Latham, Michael

      Dunn, Bob

      Lawrence, Ivan

      Eggar, Tim

      Lee, John (Pendle)

      Emery, Sir Peter

      Leigh, Edward (Gainsbor'gh)

      Evans, David (Welwyn Hatf'd)

      Lennox-Boyd, Hon Mark

      Fallon, Michael

      Lester, Jim (Broxtowe)

      Favell, Tony

      Lightbown, David

      Fenner, Dame Peggy

      Lloyd, Sir Ian (Havant)

      Field, Barry (Isle of Wight)

      Lloyd, Peter (Fareham)

      Fishbum, John Dudley

      Lord, Michael

      626

      Luce, Rt Hon Richard

      Shaw, Sir Michael (Scarb')

      Lyell, Rt Hon Sir Nicholas

      Shelton, Sir William

      MacGregor, Rt Hon John

      Shephard, Mrs G. (Norfolk SW)

      Maclean, David

      Shepherd, Colin (Hereford)

      McLoughlin, Patrick

      Sims, Roger

      McNair-Wilson, Sir Michael

      Skeet, Sir Trevor

      Madel, David

      Smith, Sir Dudley (Warwick)

      Malins, Humfrey

      Smith, Tim (Beaconsfield)

      Mans, Keith

      Speller, Tony

      Maples, John

      Spicer, Sir Jim (Dorset W)

      Marland, Paul

      Squire, Robin

      Marlow, Tony

      Stanbrook, Ivor

      Marshall, John (Hendon S)

      Stanley, Rt Hon Sir John

      Marshall, Michael (Arundel)

      Stern, Michael

      Martin, David (Portsmouth S)

      Stevens, Lewis

      Maude, Hon Francis

      Stewart, Allan (Eastwood)

      Mawhinney, Dr Brian

      Stewart, Andy (Sherwood)

      Maxwell-Hyslop, Robin

      Stewart, Rt Hon Ian (Herts N)

      Mayhew, Rt Hon Sir Patrick

      Stokes, Sir John

      Mellor, David

      Stradling Thomas, Sir John

      Meyer, Sir Anthony

      Sumberg, David

      Mills, Iain

      Summerson, Hugo

      Miscampbell, Norman

      Taylor, Ian (Esher)

      Mitchell, Andrew (Gedling)

      Taylor, John M (Solihull)

      Mitchell, Sir David

      Taylor, Teddy (S'end E)

      Moate, Roger

      Tebbit, Rt Hon Norman

      Monro, Sir Hector

      Temple-Morris, Peter

      Montgomery, Sir Fergus

      Thompson, D. (Calder Valley)

      Morris, M (N'hampton S)

      Thompson, Patrick (Norwich N)

      Moss, Malcolm

      Thorne, Neil

      Neale, Gerrard

      Thornton, Malcolm

      Nelson, Anthony

      Thurnham, Peter

      Neubert, Michael

      Tracey, Richard

      Newton, Rt Hon Tony

      Trippier, David

      Nicholls, Patrick

      Trotter, Neville

      Nicholson, David (Taunton)

      Twinn, Dr Ian

      Nicholson, Emma (Devon West)

      Waddington, Rt Hon David

      Norris, Steve

      Waldegrave, Fit Hon William

      Onslow, Rt Hon Cranley

      Walden, George

      Page, Richard

      Walker, Bill (T'side North)

      Paice, James

      Waller, Gary

      Parkinson, Rt Hon Cecil

      Ward, John

      Patnick, Irvine

      Wardle, Charles (Bexhill)

      Patten, Rt Hon Chris (Bath)

      Watts, John

      Pawsey, James

      Wells, Bowen

      Peacock, Mrs Elizabeth

      Wheeler, Sir John

      Porter, Barry (Wirral S)

      Widdecombe, Ann

      Porter, David (Waveney)

      Wiggin, Jerry

      Portillo, Michael

      Wilkinson, John

      Price, Sir David

      Wilshire, David

      Raison, Rt Hon Timothy

      Winterton, Mrs Ann

      Rathbone, Tim

      Winterton, Nicholas

      Renton, Rt Hon Tim

      Wolfson, Mark

      Ridsdale, Sir Julian

      Wood, Timothy

      Roberts, Wyn (Conwy)

      Woodcock, Dr. Mike

      Rossi, Sir Hugh

      Yeo, Tim

      Rowe, Andrew

      Young, Sir George (Acton)

      Rumbold, Mrs Angela

      Sackville, Hon Tom

      Tellers for the Ayes:

      Sayeed, Jonathan

      Mr. Alistair Goodlad and Mr. Tony Durant.

      Scott, Rt Hon Nicholas

      NOES

      Abbott, Ms Diane

      Boateng, Paul

      Adams, Allen (Paisley N)

      Boyes, Roland

      Alton, David

      Bradley, Keith

      Anderson, Donald

      Brown, Gordon (D'mline E)

      Archer, Rt Hon Peter

      Brown, Nicholas (Newcastle E)

      Armstrong, Hilary

      Buchan, Norman

      Ashton, Joe

      Buckley, George J.

      Barnes, Harry (Derbyshire NE)

      Caborn, Richard

      Barnes, Mrs Rosie (Greenwich)

      Campbell, Menzies (Fife NE)

      Barron, Kevin

      Campbell, Ron (Blyth Valley)

      Battle, John

      Campbell-Savours, D. N.

      Beggs, Roy

      Carlile, Alex (Mont'g)

      Beith, A. J.

      Cartwright, John

      Benn, Rt Hon Tony

      Clark, Dr David (S Shields)

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

      Clarke, Tom (Monklands W)

      Bermingham, Gerald

      Clay, Bob

      Blunkett, David

      Clelland, David

      627

      Clwyd, Mrs Ann

      Macdonald, Calum A.

      Cohen, Harry

      McFall, John

      Coleman, Donald

      McKelvey, William

      Cook, Robin (Livingston)

      Maclennan, Robert

      Cousins, Jim

      McNamara, Kevin

      Cox, Tom

      Madden, Max

      Crowther, Stan

      Maginnis, Ken

      Cryer, Bob

      Mahon, Mrs Alice

      Cummings, John

      Marek, Dr John

      Dalyell, Tam

      Marshall, Jim (Leicester S)

      Darling, Alistair

      Martin, Michael J. (Springburn)

      Davies, Rt Hon Denzil (Llanelli)

      Martlew, Eric

      Davies, Ron (Caerphilly)

      Meacher, Michael

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

      Meale, Alan

      Dixon, Don

      Michael, Alun

      Doran, Frank

      Michie, Bill (Sheffield Heeley)

      Duffy, A. E. P.

      Michie, Mrs Ray (Arg'l & Bute)

      Dunnachie, Jimmy

      Moonie, Dr Lewis

      Eadie, Alexander

      Morgan, Rhodri

      Eastham, Ken

      Morris, Rt Hon A. (W'shawe)

      Ewing, Harry (Falkirk E)

      Mowlam, Marjorie

      Ewing, Mrs Margaret (Moray)

      Nellist, Dave

      Faulds, Andrew

      Orme, Rt Hon Stanley

      Fearn, Ronald

      Owen, Rt Hon Dr David

      Field, Frank (Birkenhead)

      Paisley, Rev Ian

      Fisher, Mark

      Patchett, Terry

      Flannery, Martin

      Pike, Peter L.

      Flynn, Paul

      Powell, Ray (Ogmore)

      Foot, Rt Hon Michael

      Prescott, John

      Foster, Derek

      Primarolo, Dawn

      Fraser, John

      Quin, Ms Joyce

      Fyfe, Maria

      Radice, Giles

      Galloway, George

      Randall, Stuart

      Garrett, John (Norwich South)

      Rees, Rt Hon Merlyn

      Garrett, Ted (Wallsend)

      Richardson, Jo

      George, Bruce

      Robertson, George

      Gilbert, Rt Hon Dr John

      Robinson, Geoffrey

      Godman, Dr Norman A.

      Rogers, Allan

      Golding, Mrs Llin

      Rooker, Jeff

      Gordon, Mildred

      Ross, Ernie (Dundee W)

      Graham, Thomas

      Ross, William (Londonderry E)

      Grant, Bernie (Tottenham)

      Rowlands, Ted

      Griffiths, Nigel (Edinburgh S)

      Ruddock, Joan

      Hardy, Peter

      Salmond, Alex

      Harman, Ms Harriet

      Sedgemore, Brian

      Hattersley, Rt Hon Roy

      Sheerman, Barry

      Haynes, Frank

      Short, Clare

      Henderson, Doug

      Sillars, Jim

      Hinchliffe, David

      Skinner, Dennis

      Hoey, Ms Kate (Vauxhall)

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

      Hogg, N. (C'nauld & Kilsyth)

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

      Home Robertson, John

      Smith, J. P. (Vale of Glam)

      Hood, Jimmy

      Smyth, Rev Martin (Belfast S)

      Howarth, George (Knowsley N)

      Soley, Clive

      Howells, Geraint

      Spearing, Nigel

      Howells, Dr. Kim (Pontypridd)

      Steel, Rt Hon Sir David

      Hoyle, Doug

      Steinberg, Gerry

      Hughes, John (Coventry NE)

      Taylor, Rt Hon J. D. (S'ford)

      Hughes, Robert (Aberdeen N)

      Taylor, Matthew (Truro)

      Hughes, Roy (Newport E)

      Thompson, Jack (Wansbeck)

      Hughes, Simon (Southwark)

      Turner, Dennis

      Illsley, Eric

      Wallace, James

      Ingram, Adam

      Walley, Joan

      Jones, Barry (Alyn & Deeside)

      Warden, Gareth (Gower)

      Jones, Martyn (Clwyd S W)

      Wareing, Robert N.

      Kennedy, Charles

      Welsh, Andrew (Angus E)

      Kilfedder, James

      Welsh, Michael (Doncaster N)

      Lamond, James

      Wigley, Dafydd

      Leadbitter, Ted

      Williams, Rt Hon Alan

      Lestor, Joan (Eccles)

      Williams, Alan W. (Carm'then)

      Lewis, Terry

      Winnick, David

      Livsey, Richard

      Wise, Mrs Audrey

      Lloyd, Tony (Stretford)

      Worthington, Tony

      Lofthouse, Geoffrey

      Loyden, Eddie

      Tellers for the Noes:

      McAllion, John

      Mr. Tony Banks and Mr. Allen McKay.

      McAvoy, Thomas

      McCartney, Ian

      Question accordingly agreed to.

    Clause 1
      REGIONAL AND DISTRICT HEALTH AUTHORITIES
      Amendment made: No. 93, in page 2, line 7, leave out 'purposes' and insert 'coming into force.'.—[Mr. Kenneth Clarke.]
    Schedule 1

      HEALTH AUTHORITIES AND FAMILY HEALTH SERVICES AUTHORITIES
      Amendments made: No. 70, in page 58, line 15, at beginning insert
      'Except in so far as regulations otherwise provide'.
      No. 69, in page 58, line 31, at beginning insert
      'Except in so far as regulations otherwise provide'.
      No. 94, in page 59, line 5, leave out 'Practitioner' and insert 'Health'.
      No. 95, in page 59, line 6, leave out 'Practitioner' and insert 'Health'.
      No. 96, in page 59, line 11, leave out 'Practitioner' and insert 'Health'.
      No. 97, in page 59, line 23, leave out 'Practitioner' and insert 'Health'.
      No. 98, in page 59, line 46, leave out 'Practitioner' and insert 'Health'.
      No. 99, in page 60, line 6, leave out 'the principal' and insert `this'.—[Mr. Kenneth Clarke.]

    Clause 4

      NHS CONTRACTS
      Amendments made: No. 100 in page 5, line 19, at end insert—
      `(6A) A determination of a reference under subsection (3) above may contain such directions (including directions as to payment) as the Secretary of State or, as the case may be, the person appointed under subsection (5) above considers appropriate to resolve the matter in dispute; and it shall be the duty of the parties to the NHS contract in question to comply with any such directions.'.
      No. 101, in page 5, line 20, leave out 'By his determination of' and insert
      'Without prejudice to the generality of his powers on'.
      No. 102, in page 5, line 22, after 'may', insert
      'by his determination in relation to an arrangement constituting an NHS contract'.
      No. 103, in page 5, line 27, leave out from 'the' to first 'as' in line 28 and insert
      'directions included in the determination by virtue of subsection (6A) above may contain such provisions'.
      No. 104, in page 5, leave out lines 32 and 33.—[Mr. Kenneth Clarke.]

    Clause 28

      NHS CONTRACTS
      Amendments made: No. 234, in page 27, line 29, at end insert—
      `(7A) A determination of a reference under subsection (4) may contain such directions (including directions as to payment) as the Secretary of State or, as the case may be, the person appointed under subsection (6) considers appropriate to resolve the matter in dispute; and it shall be the duty of the parties to the NHS contract in question to comply with any such directions.'.
      No. 235, in page 27, line 30, leave out 'By his determination of and insert
      'Without prejudice to the generality of his powers on'.
      No. 236, in page 27, line 32, at end insert
      `by his determination in relation to an arrangement constituting an NHS contract'.
      No. 237, in page 27, line 39, leave out from `the' to second `as' line 40 and insert
      `directions included in the determination by virtue of subsection (7A) may contain such provisions'.
      No. 238, in page 27, leave out lines 46 and 47.—[Mr. Michael Forsyth.]

    Clause 5

      NHS TRUSTS
      Amendments made: No. 71, in page 6, line 5, after 'and', insert
      'subject to paragraph 5(2) of Schedule 2 to this Act'.
      No. 72, in page 6, line 22, after 'trust', insert `(including the validation of proceedings in the event of a vacancy or defect in appointment).'—[Mr. Kenneth Clarke.]

    Schedule 2

      NATIONAL HEALTH SERVICE TRUSTS
      Amendments made: No. 73, in page 61, line 8, at end insert—
      '(2) If an order makes the provision referred to in sub-paragraph (1) above, then, at any time during the period referred to in that sub-paragraph, the NHS trust shall be regarded as properly constituted (and may carry out its limited functions accordingly) notwithstanding that, at that time, all or any of the executive directors have not yet been appointed.'.
      No. 74, in page 61, line 26, leave out 'the retention or and insert
      'prohibiting or restricting the disposal of, or of any interest in'.
      No. 75, in page 61, line 42, at end insert—
      `(3) In such circumstances and at such time or times as may be prescribed, an NHS trust shall hold a public meeting at which such document as may be prescribed shall be presented.'.
      No. 105, in page 62, line 44, after 'trust' insert
      `eiher for the general or any specific purposes of the NHS trust or for all or any purposes relating to the health service'.
      No. 106, in page 62, line 45, at end insert—
      '(2) The reference in sub-paragraph (1)(c) above to specific purposes of the NHS trust includes a reference to the purposes of a specific hospital or other establishment or facility which is owned and managed by the trust.'.
      No. 107, in page 63, line 50, at end insert—

      NATIONAL HEALTH SERVICE TRUSTS

        'Making of charges
        21A. In each of sections 81 (Charges for more expensive supplies) and 82 (Charges for repairs and replacement necessitated by an act or omission of the person supplied etc.) of the principal Act, in paragraph (a)—

        (a) after the words "Secretary of State" there shall be inserted "or an NHS trust"; and

        (b) after the word "him" there shall be inserted "or, as the case may be, by the trust".'.

        No. 108, in page 64, line 7, at end insert—
        '(3) In subsection (5) for the words from "Area or District" onwards there shall be substituted "body responsible for the hospital if that body and the special trustees agree; and in this subsection the body responsible for a hospital is,—

        (a) in the case of a hospital vested in a NHS trust, that trust; and

        (b) in any other case, the District Health Authority exercising functions on behalf of the Secretary of State in respect of the hospital".

        (4) After subsection (5) of that section there shall be inserted the following subsection—
        "(5A) Where property is given in pursuance of this section on trust for any purposes of an NHS trust for which trustees have been appointed under section 11(1) of the National
        630
        Health Service and Community Care Act 1990, then, if those trustees and the NHS trust agree, the property may be held, administered and applied by those trustees instead of by the NHS trust."
        (5) In subsection (6) of that section for the words "or to special trustees" there shall be substituted "to an NHS trust or to special trustees or trustees for an NHS trust".'
        No. 274, in page 64, line 11, at end insert—
        `(2) After subsection (2A) of that section there shall be inserted—
        "(2B) in preparing its annual accounts in pursuance of subsection (2) above, an NHS trust shall comply with any directions given by the Secretary of State with the approval of the Treasury as to—

        (a) the methods and principles according to which the accounts are to be prepared; and

        (b) the mnformation to be given in the accounts.".'

        No. 109, in page 64, line 18, at end insert—
        'Use and development of consecrated land and burial grounds
        24A. Section 128 of the Town and Country Planning Act 1971 (use and development of consecrated land and burial grounds) applies to consecrated land and land comprised in a burial ground, within the meaning of that section, which an NHS trust holds for any of its purposes as if—

        (a) that land had been acquired by the trust as mentioned in subsection (1) of that section; and

        (b) the trust were a statutory undertaker, within the meaning of that Act.'

        No. 110, in page 64, line 26, leave out 'purported' and insert 'purporting'.
        No. 111, in page 65, line 3, at end add
        `and any such order may include provisions corresponding to those of section 8 of this Act'.—[Mr. Kenneth Clarke.]

    Clause 7

      SUPPLEMENTARY PROVISIONS AS TO TRANSFER OF STAFF
      Amendments made: No. 170, in page 8, line 4, leave out
      `and'.
      No. 171, in page 8, line 7, at end insert—
      `and
      (d) for the purposes of section 146 of and Schedule 13 to the Employment Protection (Consolidation) Act 1978, the number of hours normally worked, or, as the case may be, the hours for which the employee is employed in any week under either of those contracts shall be taken to be the total of the hours normally worked or. as the case may be, for which he is employed under the two contracts taken together.'.—[Mr. Kenneth Clarke.]

    Clause 11

      TRUST FUNDS AND TRUSTEES FOR NHS TRUSTS
      Amendment made: No. 112, in page 11, line 31, at end insert—
      '(7) In section 98(1) of the principal Act (accounts and audit) after paragraph (d) there shall be inserted—
      "(dd) any trustees for an NHS trust appointed in pursuance of section 11 of the National Health Service and Community Care Act 1990; and".'.—[Mr. Kenneth Clarke.]

    Schedule 3

      FINANCIAL PROVISIONS RELATING TO NHS TRUSTS
      Amendments made: No. 226, in page 65, line 25, at end insert—
      '(1A) An NHS trust may not mortgage or charge any of its assets or in any other way use any of its assets as security for a loan.'.
      No. 113, in page 66, line 18, after 'of' insert
      'or to provide and manage'.
      No. 114, in page 66, line 23, after 'or insert

      631
      'or to provide and manage'.
      No. 227, in page 66, line 45, leave out from beginning to end of line 5 on page 67 and insert—
      '7. An NHS trust may not invest any money held by it except in securities of the Government of the United Kingdom or in such other manner as the Secretary of State may with the consent of the Treasury approve.'.—[Mr. Kenneth Clarke.]

    Clause 29

      NATIONAL HEALTH SERVICE TRUSTS
      Amendments made: No. 239, in page 28, line 46, after first `and', insert
      ',subject to paragraph 5(2) of Schedule 7A,'.
      No. 240, in page 29, line 21, after `trust', insert
      `(including the validation of proceedings in the event of a vacancy or defect in appointment),'.
      No. 241, in page 30, leave out lines 1 to 9.
      No. 184, in page 31, line 26, leave out 'and'.
      No. 185, in page 31, line 31, at end insert—
      'and
      (d) for the purposes of section 146 of and Schedule 13 to the Employment Protection (Consolidation) Act 1978, the number of hours normally worked, or, as the case may be, the hours for which the employee is employed in any week under either of those contracts shall be taken to be the total of the hours normally worked or, as the case may be, for which he is employed under the two contracts taken together.'.—[Mr. Michael Forsyth.]

    Schedule 6

      SCHEDULES TO BE INSERTED AFTER SCHEDULE 7 TO THE NATIONAL HEALTH SERVICE (SCOTLAND) ACT 1978
      Amendments made: No. 243, in page 72, line 39, at end insert—
      '(1A) In a case where the order contains a provision made by virtue of sub-paragraph (1)(d) and a person who is being considered for appointment by virtue of that provision—

      (a) is employed by the university or medical or dental school in question; and

      (b) would also, apart from this sub-paragraph, be regarded as employed by the trust,
      his employment by the trust shall be disregarded in determining whether, if appointed, he will be a non-executive director of the trust.'.

      No. 244, in page 73, line 5, at end insert—
      '(2) If an order makes the provision referred to in sub-paragraph (1), then, at any time during the period referred to in that sub-paragraph, the NHS trust shall be regarded as properly constituted (and may carry out its limited functions accordingly) notwithstanding that, at that time, all or any of the executive officers have not yet been appointed.'.
      No. 245, in page 73, line 23, leave out `the retention of and insert
      `prohibiting or restricting the disposal of, or of any interest in'.
      No. 246, in page 73, line 39, at end insert—
      '(3) In such circumstances and at such time or times as may be prescribed, an NHS trust shall hold a public meeting at which such documents as may be prescribed shall be presented.'.
      No. 247, in page 74, line 39, after `trust' insert
      `for purposes relating to any service which it is their function to provide, administer, or make arrangements for, which purposes shall include any purposes relating to a hospital or other establishment or facility which is provided or managed by the trust.'.
      No. 248, in page 76, line 41, at end insert—
      632
      '(1A) An NHS trust may not grant any security over any of its assets or in any other way use any of its assets as security for a loan.'.
      No. 249, in page 78, leave out lines 7 to 16 and insert—
      '7. An NHS trust may not invest any money held by it except in securities of the Government of the United Kingdom or in such other manner as the Secretary of State may with the consent of the Treasury approve.'.—[Mr. Michael Forsyth.]

    Clause 15

      PAYMENTS TO RECOGNISED FUND-HOLDING PRACTICES
      Amendments made: No. 76, in page 16, line 1, leave out from `to' to `Authority' in line 2 and insert
      'pay to the relevant Regional Health'.
      No. 77, in page 16, line 3, leave out from 'them' to end of line and insert
      `an amount determined in accordance with the regulations as the basic cost of the drugs, medicines and listed appliances'.
      No. 78, in page 16, line 19, at end insert—
      `(7A) In the application of subsection (7) above to the members of a practice whose relevant Family Health Services Authority has a locality in Wales, for the reference in paragraph (a) of that subsection to the relevant Regional Health Authority there shall be substituted a reference to the Secretary of State.'—[Mr. Kenneth Clarke.]

    Clause 32

      FUND-HOLDING PRACTICES
      Amendments made: No. 242, in page 36, line 33, leave
      out `reimburse' and insert `pay to'.
      No. 250, in page 36, line 35, leave out from `them' to `supplied' in line 36 and insert
      `an amount determined in accordance with the regulations as the basic cost of the drugs, medicines and listed appliances'.—[Mr. Michael Forsyth.]

    Clause 18

      INDICATIVE BUDGETS FOR DOCTORS' PRACTICES
      Amendments made: No. 79, in page 18, line 7, leave out `pharmaceutical services' and insert
      `drugs, medicines and listed appliances'.
      No. 80, in page 18, line 22, leave out `pharmaceutical services' and insert
      `drugs, medicines and listed appliances'.
      No. 81, in page 18, line 23, leave out `services' and insert `items'.
      No. 82, in page 18, line 30, leave out `pharmaceutical services' and insert
      `drugs, medicines and listed appliances'.
      No. 83, in page 18, line 34, leave out `pharmaceutical services' and insert
      `drugs, medicines or listed appliances'.—[Mr. Kenneth Clarke.]

    Clause 33

      INDICATIVE BUDGETS
      Amendments made: No. 251, in page 38, line 33, leave out `pharmaceutical services' and insert
      `drugs, medicines and listed appliances'.
      No. 252, in page 39, line 3, leave out 'pharmaceutical services' and insert
      `drugs, medicines and listed appliances'.
      No. 253, in page 39, line 5, leave out `services' and insert `items'.
      No. 254, in page 39, line 13, leave out 'pharmaceutical services' and insert
      'drugs, medicines and listed appliances'.
      No. 255, in page 39, line 17, leave out 'pharmaceutical services' and insert
      `drugs, medicines and listed appliances'.—[Mr. Michael Forsyth.]

    Clause 19

      AMENDMENTS RELATING TO FUNDING OF HEALTH AUTHORITIES ETC.
      Amendment made: No. 84, in page 20, line 7, after `above', insert
      `or by virtue of section I 5(7)(a) of the National Health Service and Community Care Act 1990'.—[Mr. Kenneth Clarke.]

    Clause 20

      EXTENSION OF FUNCTIONS ETC. OF AUDIT COMMISSION TO COVER THE HEALTH SERVICE
      Amendment made: No. 85, in page 21, line 46, at end insert—
      '(8) Without prejudice to any express amendment made by this Act, on and after the day appointed for the coming into force of this subsection, any reference in any enactment (including an enactment comprised in subordinate legislation) to the Audit Commission for Local Authorities in England and Wales shall be construed as a reference to the Audit Commission for Local Authorities and the National Health Service in England and Wales.'.—[Mr. Kenneth Clarke.]

    Schedule 4

      AMENDMENTS OF PART III OF THE LOCAL GOVERNMENT FINANCE ACT 1982
      Amendments made: No. 115, in page 67, line 33, leave out from `(3C)' to 'the' and insert—
      'In subsection (3A) above "allotted sums" has'.
      No. 116, in page 68, line 21, [Schedule 4J, leave out from 'practice' to 'the' in line 23.—[Mr. Kenneth Clarke.]

    Clause 34

      ACCOUNTS AND AUDIT OF NHS TRUSTS AND FUNDHOLDING PRACTICES
      Amendments made: No. 257, in page 39, line 30, after
      `with', insert 'the following provisions of.
      No. 258, in page 39, line 39, leave out 'subsection' and insert 'subsections'.
      No. 259, in page 49, line 9, at end insert—
      '( 1B) In preparing its annual accounts in pursuance of subsection (1), and NHS trust shall comply with any directions given by the Secretary of State with the approval of the Treasury as to—

      (a) the methods and principles according to which the accounts are to be prepared; and

      (b) the information to be given in the accounts.'.

      No. 260, page 40, line 10, after `(4)' insert
      'Until the day appointed for the coming into force of subsection (1) above,'.—[Mr. Michael Forsyth.]

    Clause 21

      THE MEDICAL PRACTICES COMMITTEE
      Amendment made: No. 117, in page 22, line 13, leave out from `(4)' to 'with' in line 14 and insert
      `After consulting the Medical Practices Committee, the Secretary of State may give the Committee directions'.—[Mr. Kenneth Clarke.]

    Clause 36

      SCOTTISH MEDICAL PRACTICES COMMITTEE
      Amendment made: No. 261, in page 41, line 4, leave out from `(1A)' to 'with' in line 5 and insert
      `After consulting the Medical Practices Committee, the Secretary of State may give the Committee directions'.—[Mr. Michael Forsyth.]

    Clause 22

      DISTRIBUTION OF GENERAL MEDICAL SERVICES
      Amendment made: No. 118, in page 22, line 31, at end insert—
      '(2) At the beginning of subsection (2) of that section (the Medical Practices Committee to select the persons whose applications are to be granted) there shall be inserted "Subject to subsection (2A) below" and after that subsection there shall be inserted the following subsection—
      (2A) If, in the opinion of the Medical Practices Committee, a medical practitioner is required for a particular part of the locality of a Family Health Services Authority, then, in such circumstances as may be prescribed,—

      (a) the Authority (instead of the Committee) shall, in accordance with regulations, select the medical practitioner whose application they wish to be considered by the Committee; and

      (b) the Committee shall not consider any application from a medical practitioner who is not so selected; and

      (c) any medical practitioner who has made an application but is not so selected may appeal to the Committee on a point of law;
      and if the Committee allow an appeal under paragraph (c) above they shall remit the application to the Authority for reconsideration."

      (3) In subsection (4) of that section (applications under section 30 may be granted subject to certain conditions), after the words "subject to" there shall be inserted "(a)" and at the end of the subsection there shall be added "or
      (b) prescribed conditions limiting, by reference to hours or the sharing of work, the provision of general medical services for which the applicant will be entitled to be remunerated;
      and an order under subsection (1A) above may make provision as to the extent to which account is to be taken under the order of medical practitioners whose ability to carry out remunerated work is limited by virtue of conditions imposed under paragraph (b) above".(4) In subsection (5) of that section (appeals to the Secretary of State) for the words following "Secretary of State", in the first place where those words occur, there shall be substituted "on a point of law; and, if the Secretary of State allows such an appeal, he shall remit the application to the Medical
      Practices Committee for reconsideration".
      (5) Subsection (7) of that section (directions on a successful appeal) shall be omitted.
      (6) In subsection (8) of that section (matters to be taken into account) for the words from the beginning to "in any case" there shall be substituted "In any case where medical practitioners have to be selected from a number of applicants, the Medical Practices Committee or, where subsection (2A) above applies, the Family Health Services Authority shall".
      (7) In section 34 of the principal Act (regulations for Medical Practices Committee)—

      (a) in paragraph (b)(ii) for the words "under section 33 above" there shall be substituted "or the Medical Practices Committee under section 33 above and, where such an appeal is allowed, the reconsideration of any application"; and

      (b) at the end of the section there shall be added the following subsection—

      "(2) Regulations under this section may make provision for, and in connection with, the variation of any condition imposed under subsection (4) or subsection (5) of section 33 above.".'.—[Mr. Kenneth Clarke.]

    Clause 37

      DISTRIBUTION OF GENERAL MEDICAL SERVICES
      Amendment made: No. 262, in page 41, line 25, at end insert—
      '(2) At the beginning of subsection (2) of that section (the Medical Practices Committee to select the person whose applications are to be granted) there shall be inserted "Subject to subsection (2A)" and after that subsection there shall be inserted the following subsection—
      "(2A) If, in the opinion of the Medical Practices Committee, a medical practitioner is required for a particular part of the area of a Health Board, then, in such circumstances as may be prescribed,—

      (a) the Board shall, in accordance with regulations, select the medical practitioner whose application they wish to be considered by the Committee; and

      (b) the Committee shall not consider any application from a medical practitioner who is not so selected; and

      (c) any medical practitioner who has made an application but is not so selected may appeal to the Committee on a point of law;
      and if the Committee allow an appeal under paragraph (c) they shall remit the application to the Board for reconsideration."

      (3) In subsection (4) of that section (applications under section 20 may be granted subject to certain conditions), after the words "subject to" there shall be inserted "(a)" and at the end of the subsection there shall be added—
      "or
      (b) prescribed conditions limiting, by reference to hours or the sharing of work, the provision of general medical services for which the applicant will be entitled to be remunerated;
      and an order under subsection (1A) may make provision as to the extent to which account is to be taken under the order of medical practitioners whose ability to carry out remunerated work is limited by virtue of conditions imposed under paragraph (b)".
      (4) In subsection (5) of that section (appeals to the Secretary of State) for the words following "Secretary of State", in the first place where those words occur, there shall be substituted "on a point of law; and, if the Secretary of State allows such an appeal, he shall remit the application to the Medical Practices Committee for reconsideration".
      (5) Subsection (7) of that section (directions on a successful appeal) shall be omitted.
      (6) In subsection (8) of that section (matters to be taken into account) for the words from the beginning to "in any such case" there shall be substituted "In any case where medical practitioners have to be selected from a number of applicants, the Medical Practices Committee or, where subsection (2A) applies, the Health Board shall".
      (7) In section 24 of the 1978 Act (Regulations for Medical Practices Committee)—

      (a) in paragraph (b)(ii) for the words "un`er section 23" there shall be substituted "or the Medical Practices Commiteee under section 23 and, where such an appeal is allowed, the reconsideration of any application"; and

      (b) at the end of the section there shall be added the following subsection—

      "(2) Regulations under this section may take provision for, and in connection with the variation of any condition imposed under subsection (4) or (5) of section 23.".'.—[Mr. Michael Forsyth.]

    Clause 39

      PROVISION OF ACCOMMODATION AND WELFARE SERVICES: AGENCY ARRANGEMENTS
      Amendments made: No. 198, in page 42, line 4, leave out `21(I)(a)' and insert '21(1)'.
      No. 186, in page 42, line 7, after 'circumstances)' insert—
      '(a) in paragraph (a)'.
      No. 233, in page 42, line 8, at end add 'and
      (b) at the end of that paragraph there shall be added
      "and
      (aa) residential accommodation for expectant and nursing mothers who are in need of care and attention which is not otherwise available to them".'.
      No. 202, in page 42, line 43, at end insert—
      `(2A) at the end of subsection (2) of that section (under which the arrangements must provide for the local authority to make payments in respect of accommodation provided) there shall be added "and the local authority shall recover from each person for whom accommodation is provided under the arrangements the amount of the refund which he is liable to make in accordance with the following provisions of this section".'.—[Mr. Kenneth Clarke.]

    Clause 40

      EXCLUSION OF POWERS TO PROVIDE ACCOMMODATION IN CERTAIN CASES
      Amendments made: No. 336, page 43, line 38, after `that', insert
      `in such cases and subject to such conditions as may be prescribed.'.
      No. 337, in page 43, line 38, leave out
      `the case of and insert 'relation to'.—[Mr. Kenneth Clarke.]

    Clause 53

      EXCLUSION OF POWERS TO PROVIDE ACCOMMODATION IN CERTAIN CASES
      Amendments made: No. 338, in page 52, line 29, after `that', insert
      `in such cases and subject to such conditions as may he prescribed.'
      No. 339, in page 52, line 29, leave out 'the case or and insert `relation to'.—[Mr. Michael Forsyth.]

    Clause 41

      CHARGES FOR ACCOMMODATION PROVIDED BY LOCAL AUTHORITIES
      Amendments made: No. 214, in page 44, line 5, leave out `(2) and' and insert '(1A) to'.
      No. 215, in page 44, line 5, at end insert—
      '(1A) In subsection (1) (which relates to a person's liability to pay for accommodation) for the words from the beginning to "the accommodation" there shall be substituted "Subject to section 26 of this Act, where a person is provided with accommodation under this Part of this Act the local authority providing the accommodation shall recover from him the amount of the payment which he is liable to make".
      (1B) In subsection (2) (which requires the authority managing premises to fix the standard rate) after the word "payment" there shall be inserted "which a person is liable to make" and at the end of that subsection there shall be added the words "and that standard rate shall represent the full cost to the authority of providing that accommodation".
      (1C) In subsection (3) (which makes provision for people who are unable to pay at the standard rate)—

      (a) the words "(disregarding income support)", and

      637

      (b) the words from "Provided that" to the end of the subsection,
      shall be omitted.'.

      No. 216, in page 44, line 10, leave out 'subsection (3) or'.—[Mr. Kenneth Clarke.]

    Schedule 7

      PROVISIONS ARISING OUT OF REMOVAL OF CROWN IMMUNITIES FROM HEALTH SERVICE BODIES
      Amendment made: No. 86, in page 78, line 37, at end add
      'or a National Health Service trust established under Part I of that Act or the National Health Service (Scotland) Act 1978'.—[Mr. Michael Forsyth.]

    Clause 57

      HEALTH SERVICE BODIES: TAXATION
      Amendment made: No. 87, in page 56, line 5, at end insert—
      '(5) At the end of Schedule 3 to the Inheritance Tax Act 1984 (gifts for national purposes) there shall be added—
      "A health service body, within the meaning of section 519A of the Income and Corporation Taxes Act 1988".'.—[Mr. Kenneth Clarke.]

    Clause 60

      REGULATIONS, ORDERS AND DIRECTIONS
      Amendment made: No. 88, in page 56, line 37, at end add
      'and at the end of that section there shall be added the following subsection—
      "(5) Without prejudice to the generality of subsection (4) above, any power which may be exercised as mentioned in paragraphs (a) and (b) of that subsection may make different provision for different areas.".'.—[Mr. Kenneth Clarke.]

    Schedule 8

      MINOR AND CONSEQUENTIAL AMENDMENTS
      Amendments made: No. 89, in page 88, line 18, leave out 'At the end of and insert 'In'.
      No. 90, in page 88, line 18, at end insert
      `(enactments conferring functions assisgned to social services committee), in the entry relating to the Children Act 1989, in the second column after the words `health authorities' there shall be inserted "National Health Service trusts"; and at the end of that Schedule'.
      No. 91, in page 88, line 45, at end insert—

      MINOR AND CONSEQUENTIAL AMENDMENTS

        The Adoption Act 1976
        In section 2 of the Adoption Act 1976 (local authorities' social services) in paragraph (a) (as set out in paragraph 1 of Schedule 10 to the Children Act 1989) after the words "health authorities" there shall be inserted "National Health Service trusts".'.
        No. 119, in page 89, line 2, leave out '63 of the National Health Service Act 1977' and insert—
        '41 of the National Health Service Act 1977 (arrangements for pharmaceutical services)—

        (a) for the words "supply to persons who are in that locality" there shall be substituted "provision to persons who are in that locality of";

        (b) in paragraph (b) after the words "health authority" there shall be inserted "or an NHS trust" and the word "and" at the end of the paragraph shall be omitted; and

        (c) after paragraph (c) there shall be inserted "and

        (d) such other services as may be prescribed."

        (1A) At the end of section 43 of that Act (persons authorised to provide pharmaceutical services) there shall be added the following subsection—
        "(3) No arrangements for the provision of pharmaceutical services falling within section 41(d) above shall be made with persons other than those who are registered pharmacists or are of a prescribed description." (1B) In section 63 of that Act'.—[Mr. Kenneth Clarke.]
        No. 263, in page 90, leave out from beginning of line 37 to 'for' in line 38 and insert—
        '(5) In section 27 of that Act (arrangements for provision of pharmaceutical services)—
        (a) in subsection (1)—

        (i) for the word "supply" there shall be substituted "provision";

        (ii) in paragraph (b), after the word "Board" there shall be inserted "or by an NHS trust";

        (iii) at the end of paragraph (c) there shall be inserted—"; and

        (d) such services as may be prescribed,"; and
        (iv) for the words "services provided in accordance with the arrangements are" there shall be substituted "provision of drugs, medicines, appliances and services in accordance with the arrangements is";
        (b) in subsection (2). after the word "mentioned" in the second place where it occurs there shall be inserted ", or to whom services mentioned in subsection (1)(d) are to be provided,";
        (c) in subsections (3)(b), (c) and (d) and (4), before the word "services" in each place where it occurs there shall be inserted "pharmaceutical"; and
        (d) in subsection (4)(d)".'.
        No. 264, in page 90, line 39, at end insert—
        '(5A) In section 28(2) of that Act (persons authorised to provide pharmaceutical services)—

        (a) after the word "medicines" in the first plece where it occurs there shall be inserted "or the provision of pharmaceutical services";

        (b) after the word "undertake" there shall be inserted "(a)";

        (c) for the word "supplied" there shall be substituted "provided"; and

        (d) after the word "dispensed" there shall be inserted", and

        that all services mentioned in section 27(1)(d) provided by them under those arrangements shall be provided,".'
        No. 265, in page 91, leave out lines 43 and 44 and insert—
        '(17) in section 105 (orders, regulations and direction) of that Act—

        (a) after subsection (1) there shall be inserted the following subsection—"(1A) Subsection (1) does not apply to orders made under section 12D(1) or paragraph 23(1) of Schedule 7A.";

        (b) in subsection (4), after the words "10(3) to (5)" there shall be inserted the words " I2A(1), 12A(7), 12E(1), 12G(2),"; and

        (c) at the end of the said subsection (4) there shall be inserted the words "paragraph 22(1) of Schedule 7A and paragraph 3 of Schedule 7B".'.

        No. 266, page 91, line 45, at end insert—
        '(za) in the definition of "Health Board", for the word "board" there shall be substituted the words "Health Board";'.
        No. 267, in page 92, line 3, leave out 'and'.
        No. 268, in page 92, line 6, at end insert—
        and
        (d) after the definition of "the Research Trust" there shall be inserted—
        ""Special Health Board" means a Special Health Board constituted under section 2;".'.—[Mr. Forsyth.]
        No. 120, in page 97, line 6, at end insert—

        The Children Act 1989
        .—(1) In section 21 of the Children Act 1989 (provision of accommodation for children in police protection ect.), in subsection (3) after the words "vested in the Secretary of State" shall be inserted the words "or otherwise made available pursuant to arrangements made by a District Health Authority".
        (2) In section 24 of that Act (advice and assistance for certain children)—

        (a) at the end of subsection (2)(d)(ii) there shall be added the words "or in any accommodation provided by a National Health Service trust"; and

        (b) at the end of subsection (12)(c) there shall be added the words "or any accommodation provided by a National Health Service trust".

        (3) In section 29 of that Act (recoupment of cost of providing services etc.), at the end of paragraph (c) of subsection (8) there shall be added the words "or any other hospital made available pursuant to arrangements made by a District Health Authority".
        (4) In section 80 of that Act (inspection of children's homes etc.)—

        (a) in subsection (1)(d) after the words "health authority" there shall be inserted "or National Health Service trust"; and

        (b) in subsection (5)(e) after the words "health authority" there shall be inserted "National Health Service trust".

        (5) In section 85 of that Act (children accommodated by health authorities and local education authorities), in subsection (1) after the words "health authority" there shall be inserted "National Health Service trust".'.—[Mr. Kenneth Clarke.]

    Schedule 9

      ENACTMENTS REPEALED
      Amendments made: No. 121, in page 99, line 8, column 3, at end insert—

      'In section 41(b) the final word "and".'

      No. 123, in page 99, column 3, leave out lines 13 and 14.
      No. 122, in page 99, line 24, column 3, at end insert—

      'Section 33(7).'.

      No. 270, in page 99, line 45, column 3, at end insert—

      'Section 23(7).'.

      No. 271, in page 99, line 47, column 3, at end insert—

      'Section 86(2).'.

      No. 92, in page 100, leave out lines 19 to 24.
      No. 272, in page 101, line 10, at end insert—
      640

      '1990 c. 00.

      The National Health Service and Community Care Act 1990.

      Section 34(4).'.

      —[Mr. Kenneth Clarke.]

    Clause 62

      SHORT TITLE, COMMENCEMENT AND EXTENT
      Amendment made: No. 340, in page 57, line 11 at end insert
      'subsection (2A) of section 39,'.—[Mr. Kenneth Clarke.]

    Title
    Amendment made: No. 273, in line 5, after 'amend' insert
    'Part VII of the Local Government (Scotland) Act 1973 and'.—[Mr. Kenneth Clarke.]
    Bill to be read the Third time this day.

  PETITION

    Roads
    12.49 am
    Mr. Humfrey Malins: The petition that I wish to present has been signed by more than 4,500 of the inhabitants of Norbury and Thornton Heath in my constituency of Croydon, North-West and urges the Secretary of State for Transport not to proceed with any new carriageways or major road widenings in Norbury or Thornton Heath which would damage those communities.
    The petition is strongly supported by Norbury councillors Colin Johnston, Brian Kendall and Roy Hodges and by the local action group Norbury Against Trunk Roads, all of whose members work tirelessly on behalf of local people. Recently, the mayor of Croydon and I led a march of 2,500 Norbury people to demonstrate our united opposition to the proposals.
    The petition reads:
    Wherefore your petitioners pray that your honourable House urge the Secretary of State for Transport to recognise the great concern caused to the communities in Norbury, Thornton Heath, and in southern Streatham, by the proposals for new carriageways and widening of the A23 that are contained in the South London Assessment Study, Stage 2b. We also have concern for those proposals which similarly threaten other communities in London. We request that the Secretary recognise our concerns and that the manner of this recognition be as follows:

    1. That he should dismiss all the options in the South London Assessment Study which propose major construction of roads, or major widening of roads and proposals which will damage communities and the natural environment.

    2. That he should seek instead to promote investment in making substantial improvements in the Public Transport infrastructure.

    And your petitioners, as in duty bound, will ever pray.
    To lie upon the Table.

  McGimpsey Judgment (Irish Supreme Court)
  Motion made, and Question proposed, That this House do now adjourn.—[Mr. Goodlad.]
  12.52 am
  Mr. Ken Maginnis: I am grateful to have been allowed this early opportunity to bring to the attention of the House the Supreme Court case of McGimpsey and McGimpsey v. Ireland in which judgment was obtained on 1 March, but I am disappointed that the Government have not seen fit to require a Law Officer to respond to the debate. That is not to impugn the ability of the Parliamentary Under-Secretary of State for Northern Ireland, and I acknowledge that the Attorney-General is on the Treasury Bench, but a legal matter which impinges on the very right of the people of Northern Ireland to exist should be of such concern to our Government that they should wish to give a legal response.
  The outcome of the case to which I refer is that the Irish Republic is now deemed to have a de jure claim—an unequivocal legal claim—to Northern Ireland. It does not matter what our Government believe to be the position—and for the past four years they have encouraged us to understand that our rights as British citizens are most firmly enshrined in the Anglo-Irish Agreement—the ruling of the Irish Supreme Court is that nothing in any legislation can overrule the constitutional imperative to achieve a united Ireland.
  I wish now to outline the background to the case. When the Anglo-Irish Agreement was signed on 15 November 1985 it provoked from Michael and Christopher McGimpsey exactly the same traumatic reaction as it engendered throughout the entire Unionist community. But while they identified with and joined in Unionists' protests against the unjust imposition of the diktat, they were soon convinced that only through legal action could there be any hope of proving just how dangerous and deceitful the agreement was. Being historians who had taken a special interest in Irish affairs, they came to the conclusion that the best chance of success would be through the Irish Republic's courts.
  While a similar action against the agreement to be taken by Enoch Powell in the High Court in London would soon run into the sand because the United Kingdom does not have a written constitution, the McGimpseys' initiative was based on the fact that the Irish Republic certainly does have one. Moreover, the Irish constitution had previously been the basis of legal challenges in respect of other international agreements entered into by the Government of the day. Boland v. An Taoiseach 1974, concerning the constitutionality of the Sunningdale agreement, provided some basis for argument but it was eventually the case of Crotty v. An Taoiseach 1987 which provided the real impetus for the McGimpseys. In it, the Supreme Court had ruled that the Government of the Republic did not have the competence to implement the Single European Act without the approval of the Irish people through a referendum.
  The crux of the Crotty argument was that no aspect of foreign policy could be ceded by the Government of the Republic to another Government—or, in this case, to the
  642
  European Community. Articles 28 and 29 of the Irish constitution precluded any fettering of the power of the Government to conduct external affairs of state.
  Article 2 of the Irish constitution reads:
  "The national territory consists of the whole island of Ireland, its islands and the territorial seas."
  To mount a successful challenge the McGimpseys therefore had to prove that article 2 of the Irish constitution was intended to be a legal claim and not merely a political aspiration and, if that was so, that the Anglo-Irish Agreement restrained the Republic's Government from pursuing that legal claim in so far as it recognised the de jure right of the United Kingdom Government to govern Northern Ireland, and hence to dictate the foreign policy for that part of the island.
  The right hon. Member for Bridgwater (Mr. King), when Secretary of State for Northern Ireland, appeared to believe that article 1 of the Anglo-Irish Agreement was a de jure acknowledgement of the United Kingdom's right when he spoke about it "copper-fastening the union." But the testy reaction of the Irish Foreign Minister, Peter Barry, showed that this was not the Republic's perception. Whatever the real truth, the McGimpseys were increasingly convinced that it could be proved only by obtaining a judgment in the Supreme Court of the Irish Republic.
  Thus it was in 1987 that the two brothers put their theory to me and I agreed to help them to co-ordinate the necessary action to finance and promote their case. As the case progressed through the legal system, more and more people, including many politicians from the Republic, suggested that the premise that article 2 of the constitution was "a legal claim" would be disproved. These opinions were based on a judgment given at a time when the Criminal Law (Jurisdiction) Bill 1977 was passing through the Irish Parliament and the Irish Government had sought a Supreme Court ruling on its constitutionality.
  Then, Justice O'Higgins had been understood to say:
  "This national claim to unity exists not in the legal but in the political order".
  Perhaps that was the perception in the mind of our Government when they signed the 1985 diktat, but, as I said earlier, they should have been alerted when Barry squealed at Secretary of State King's "copper-fastening" comment. This apart, we all felt a definitive judgment was necessary and we presumed that the outcome would prove our case.
  If the McGimpseys were correct in their "legal claim" thesis, Unionist fears of being subsumed within a politically united Ireland would be justified, but at least the hated agreement which was inevitably going to trundle us there more quickly should be deemed unconstitutional and would, we reasoned, have to be abandoned.
  On the other hand, we accepted that if the "political aspiration" argument was correct there would be an end of Unionist fears, the Northern Ireland Office would be proved right and Unionists would have to come to terms with that. The atmosphere of suspicion and distrust—the Unionist siege mentality—which has pervaded our community since the Irish Republic's constitution was adopted in 1937 would change and the basis for new relationships would be created. The Unionist community approved that strategy and provided the funds necessary to mount the challenge.
  The essential features of the Dublin Supreme Court's judgment are that articles 2 and 3 of the Irish constitution

  643
  constitute a legal claim of right over the jurisdiction of Northern Ireland; that the Republic can give only de facto recognition of British sovereignty over Northern Ireland and is constitutionally prohibited from acknowledging this de jure. I trust that the Minister can assure me that he will place a copy of the judgment in the Libary so that right hon. and hon. Members can read it and judge its implications for themselves.
  On the legal claim, it is significant that the Supreme Court saw fit to overrule specifically its earlier decision in the Criminal Law (Jurisdiction) Bill judgment. It is generally felt among lawyers in the Irish Republic that that is quite a remarkable step for the court to have taken given the sensitivity of the matter. This is only the sixth occasion the Supreme Court has ever expressly departed from its earlier ruling.
  It is also interesting that, although article 3 is now taken to preclude the Republic from legislating with respect to Northern Ireland
  "pending the reintegration of the national territory", the court states that that restriction
  "in no way derogates from the claim as a legal right to the entire national territory."
  Furthermore, the express language of articles 2 and 3 constitute an
  "express denial and disclaimer to the Community of Nations"—
  that the present border—
  "is or can be accepted as conclusive of the matter"
  so as to prevent any question of estoppel arising in international law. In turn, that reinforces the "legal claim of right" interpretation of articles 2 and 3.
  The court then concluded that the recognition of Northern Ireland accorded by the Anglo-Irish Agreement was de facto only. Chief Justice Finlay states:
  "There can be no doubt but that the only reasonable interpretation of article 1 taken in conjunction with the denial of derogation from sovereignty contained in article 2(b) of the Anglo-Irish Agreement is that it constitutes a recognition of the de facto situation in Northern Ireland, but does so without abandoning the claim to the reintegration of the national territory."
  The House should note the next sentence well:
  "These are essential ingredients of the constitutional provisions in articles 2 and 3."
  They are the essential ingredients enshrined in the Anglo-Irish Agreement—that should be clear to everyone. Obviously it will be clear to the Attorney-General.
  Here is a clear and unequivocal statement that the Anglo-Irish Agreement enhances the Republic's "legal claim" by virtue of the "essential ingredients" and the "constitutional imperative" of achieving unity. It follows that no Irish Government can ever de jure recognise the existing status of Northern Ireland as part of the United Kingdom as that would be manifestly unconstitutional. So the McGimpseys won the argument that the Irish had abandoned their hard-line nationalist claim to Northern Ireland contained in articles 2 and 3, but who could have guessed that the Supreme Court would have been able, in those circumstances, to endorse the Anglo-Irish Agreement as being complementary to that point of view? The answer to that is, most of the Unionist leadership. From comments that I have heard from the Minister's colleagues, however, it appears that they wish to ignore reality.
  Let Unionists not appear to be the only people who appreciate the full significance of the judgment. Hon. Members can refer to The Times article by Dr. Conor
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  Cruise O'Brien on 10 March in which he suggested to Her Majesty's Government that they suspend the agreement. He went on to remind readers:
  "As a general principle, it may be affirmed that no government should conclude an agreement concerning a part of its territory with another government that is laying claim to that territory. A government which breaches that principle inescapably gives the impression that it is on the way towards accepting the other government's claim."
  The Irish Times on 5 March carried an article by Dr. David Gwynn Morgan, a legal expert. He made the startling but logical assertion that the consequence of the court's decision was that
  "an Irish government is simply not legally competent to reach certain kinds of compromise with the Unionist majority."
  Hence, one must ask if it is competent to make arrangements on an ongoing basis with this Government, except for the purpose of implementing the "constitutional imperative" spelt out by the Supreme Court to unify the island.
  Virtually every informed scholar and journalist who has written on the issue is agreed that our Government's credibility and integrity will be called into question if they do nothing about the fraud that has been perpetrated against them. Even The Irish News, a respectable if strictly anti-Unionist daily paper in Northern Ireland, concluded in its 12 March edition that the McGimpseys may hake lost the battle but should win the war. John Hume's biographer, writing in The Belfast Telegraph on 9 March, acknowledged the injustice of the situation.
  There is one way forward. It is for the Government of the Irish Republic to volunteer, or to allow themselves to be persuaded, to amend or revoke articles 2 and 3 of their constitution by putting the matter to a referendum. The McGimpseys and I suggested that we would be willing to go to meet the opinion-formers in the south, including political leaders, to put the case. Unfortunately, Mr. Haughey, who has consistently boasted about how generous he would be if Unionists would only come to talk with him, has responded by slamming the door in our faces. He would, he said on Tuesday, consider meeting us, but then he firmly precluded discussion about the one topic on which we need to talk.
  This House was persuaded to accept in the debate on 26 and 27 November 1985 that the Anglo-Irish Agreement would bring peace, stability and reconciliation. Who other than those of us who are close to the reality of the situation could possibly have voted against that? In less heady moments, the Government assured the House that the three tangible benefits would be the recognition, for the first time, of the de jure status of Northern Ireland within the United Kingdom until such time as the majority voted otherwise; the extradition of terrorists; and an end to megaphone diplomacy.
  The court case has made it clear that the first is not on offer. Will the Minister explain that to Unionists? Extradition is, most of us believe after Tuesday's debacle, firmly on the back burner. Let him explain that to the widow of a murdered prison officer and to the families of all the other victims. And when we hear the raucous, yet self-righteous, tones first of Peter Barry and now of Gerry Collins before every meeting of the conference threatening what will be demanded and insisted upon, how does this Government live with that indignity?
  If some in this House cannot or will not believe that the agreement is dead because it is being propped up for appearance's sake, perhaps they can at least accept that it

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  is meaningless. When I was first sent to this House in 1983, the honest to God decent people who sent me here thought that this was a place where they would get justice. Enoch Powell always insisted that this Parliament was the final arbiter, but Harold McCusker died believing otherwise. On behalf of the people of Northern Ireland, I ask the Minister to tell us who is right. Are we to continue to be sold out for political expediency or will the Government now recognise, in the light of the McGimpsey judgment, their obligation to justice and the people I represent?
  1.10 am
  Mr. Ivor Stanbrook: With the leave of my hon. Friends the Member for Fermanagh and South Tyrone (Mr. Maginnis) and the Minister, I wish to say a few words about the subject of this debate.
  The constitution of the Irish Republic suffers from all the defects of written constitutions in that it embodies national ideals, vague aspirations and noble objectives, but has to respect certain major legislation which it inherited from this country. It also comes within the common law tradition. As a result, when its Supreme Court interprets the constitution, it provides many opportunities for obscurity and tendentious interpretation to cover almost any decision that the court may see fit to take, even those which are purely politically motivated. That is the crux of the problem that we have faced in recent years in relation to the actions of the courts in the Republic.
  The McGimpsey case illustrates the ambiguity. The court treated the Single European Act as law within the terms of article 40 of the constitution. It was treated as law because the court accepted that a derogation of the sovereignty of the Irish Republic was all right because it was properly done and was, after all, a treaty. However, the Anglo-Irish Agreement, which is also supposed to be an internationally binding treaty and must be respected by all sovereign states party to it, is not law for this purpose. Why? After studying the constitution, the court concluded that provision for the Anglo-Irish Agreement came out of the section of the constitution that allowed for the mere ordering of peaceful international relations. That was the basis of authority for the Irish Government to conclude that that agreement with the United Kingdom was an international treaty, but it did not reach the status of law for the purpose of the constitution. That ambiguity is reflected in the constitution in articles 2 and 3. It is difficult to construe the meanings of those two articles, but the message is repeated in article 1 of the Anglo-Irish Agreement, which states that there will be
  "no change in the status of Northern Ireland."
  My right hon. and hon. Friends, the leaders of the Government, assigned that agreement with those very words and have paraded it as if, at last, the Irish Republic has accepted that Northern Ireland is a part of the United Kingdom. It has done nothing of the sort. The phrase that there will be
  "no change in the status of Northern Ireland"
  makes one ask, what is its status? Under Irish law, the status of Northern Ireland is that it is a part of Ireland, not the United Kingdom. Under British law its status is that it is a part of the United Kingdom. That ambiguity has never been resolved and, politically, the British Government have asked us to accept that the meaning should be that
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  attributed to it by British courts, whereas we all know that the meaning attributed to it by Irish courts, such as in this case, is quite different.
  Due to that ambiguity and the many times that we have allowed Irish courts to get away with—and forgiven them for—the errors which, according to our jurisprudence, they continually make, we have enabled them to block off all possibility in law of the extradition of terrorists from the Irish Republic. Under the most recent judgment, a finding of fact was made which will be instanced in future to show the impossibility of extraditing people to the United Kingdom because they may be beaten up when they arrive in United Kingdom jurisdiction.
  Previously there was a finding, allowed and confirmed by the courts, by the Attorney-General that in the case of Father Ryan no extradition could take place because there was no chance of his getting a fair trial. That ambiguity is at the heart of the Anglo-Irish Agreement. It is a tragic mistake that has been confirmed by the recent experience that we have had to endure.
  1.15 am
  The Parliamentary Under-Secretary of State for Northern Ireland (Dr. Brian Mawhinney): I do not have too much time to respond to this interesting debate. I congratulate the hon. Member for Fermanagh and South Tyrone (Mr. Maginnis) on obtaining such an early Adjournment debate on this important subject. I also congratulate him on his speech. He asked me to place a copy of the Supreme Court judgment in the Library, and I shall see that this is done.
  The hon. Gentleman indicated his belief that the recent judgment of the Irish Supreme Court in some sense substantially changed Northern Ireland's position and that, perhaps, Unionists had never before understood article 2 of the Irish constitution to be a legal claim on the north.
  I cannot accept that argument. I fully understand the sense of dismay felt by many, including Unionists, at the clear affirmation in the judgment that articles 2 and 3 constitute a legal claim to Northern Ireland. But Unionists have always known that the claim was legal and territorial. They did not need the Irish Supreme Court to spell it out. When the hon. Gentleman and I were growing up in the Province, Unionists were not referring to article 2 as some sort of political aspiration. If they had believed that, they would have been much less agitated. It was precisely because they believed that the article did lay legal claim to the Province that Unionists were so upset and offended—as, indeed, were others in the United Kingdom. In fact, the hon. Gentleman may remember the report from an all-party committee of the Dail, chaired by George Colley, a Fianna Fail deputy if I remember correctly, which reported in 1967 and which proposed a number of Irish constitutional amendments, including the desirability of converting articles 2 and 3 into a political aspiration using the words:
  "The Irish nation hereby proclaims its firm will"
  —and so on.
  After all, a constitutional document, almost by definition, has to be seen and understood in a legal sense. Most people accepted this. While it may come as a shock to many that this understanding should have been confirmed in such stark terms in 1990, it cannot be said to be a surprise.

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  The hon. Gentleman postulated that the judgment changed something fundamental in our relationship with the Irish Republic in general and rendered meaningless article 1 of the Anglo-Irish Agreement in particular. I shall deal with each claim in turn.
  It is not my responsibility to defend the Irish constitution. It is for Irish Ministers to consider and, if they feel it necessary, to explain this territorial claim in light of that country's signing of the Helsinki Final Act. Our two countries have differing historical perceptions and constitutional frameworks, and as we are entitled to ours, so they are to theirs. It is also for Irish Ministers to relate article 2 of their constitution to their signing of the Anglo-Irish Agreement.
  Rev. Ian Paisley rose—
  Dr. Mawhinney: I cannot give way, as I have little time left.
  That notwithstanding, both Governments value the Anglo-Irish Agreement, its aims and its modus operandi. Whatever the constitutional facts, in practice it has proved to be an important treaty.
  I cannot accept that the hon. Gentleman is seriously asking the House to believe that the Supreme Court judgment actually makes any difference in reality to the United Kingdom's unwritten constitution or Northern Ireland's safe inclusion within it. As far as we are concerned, Northern Ireland is part of the United Kingdom and is clearly so in international law. He said that it does not matter what the Government believe, but in the United Kingdom—that includes Northern Ireland—what Parliament and the Government believe is all important.
  Article I of the Anglo-Irish Agreement, which is an internationally binding treaty, is not and cannot be affected by a judgment of the Irish court. In signing the Agreement, the Irish and British Governments recognised the reality of Northern Ireland's position within the United Kingdom, whatever the different de jure positions.
  I say that because the nub of article 1 is not a definition of the status of Northern Ireland but says that that status cannot be changed save by the freely given consent of the people of the Province. Willingness to contemplate change carries with it de facto recognition of the position from
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  which change might occur. I hasten to add that the British Government's view is that there will be no majority for change in the foreseeable future. In other words, the declaration on status in the Anglo-Irish Agreement is simply aligned with reality. The reality is that the status of Northern Ireland is British.
  Lest the hon. Member thinks that I theorise, let me point out to him that we are having this debate in the House of Commons, not the Dail. It is in this forum that decisions affecting Northern Ireland are taken—as is affirmed by article 2b of the Anglo-Irish Agreement. Arid the court judgment makes no difference to that reality either. I accept that the Irish Government have not abandoned any aspiration to unity. They have accepted, however, that this aspiration can be realised only on the basis of the consent of the people of Northern Ireland. This position holds, irrespective of the Irish constitution and the Supreme Court's interpretation of it.
  Let me summarise. The people of Northern Ireland and the United Kingdom have lived with this territorial claim for over 50 years. The United Kingdom Government have never accepted it, do not accept it and have said so, as I do again tonight. We regard it as having no validity in international law. It has never had any practical effect on Northern Ireland's position as part of the United Kingdom.
  Nor do I lend credence to the view that the court judgment will serve to sustain the Provisional IRA in its campaign of violence. PIRA does not recognise the legitimacy of the Government, institutions or constitution of the Republic. It cannot therefore be argued that it will be influenced by some legal interpretation of a part of that constitution.
  I wish to make one final point. In light of what I have said, the Government believe that it would be wrong to suggest that this judgment should in any way affect prospects for political progress in Northern Ireland. As the talks offered are without precondition, Unionists may legitimately—
  The motion having been made after Ten o'clock and the debate having continued for half an hour, MADAM DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
  Adjourned at twenty-two minutes past One o'clock.