§ "(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 (Cardiff, South and Penarth)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. MichaelI 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 (Belfast, South)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. MichaelThat 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 (Greenwich)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-SavoursIs 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. BarnesThe 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 (Rhondda)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. BarnesThe 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-SavoursLet 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.
§ Mrs. BarnesJunior 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 MorrisThere 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 (Newcastle upon Tyne, Central)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 (Birmingham, Hodge Hill)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 (Staffordshire, South)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.
§ Mrs. Virginia BottomleyThis 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-SavoursWill 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. BottomleyThe 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 DavisThe 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 (Tayside, North)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 MorrisAs 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. BottomleyIt 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. MichaelIt 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.
579| 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 |
| 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) |
| 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 |
| 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.