§ 10 pm
§ Mr. Robin Cook (Livingston)I beg to move,
That an humble Address be presented to Her Majesty, praying that the Family Health Services Authorities (Membership and Procedure) Regulations 1990 (S.I., 1990, No. 1330) dated 2nd July 1990, a copy of which was laid before this House on 5th July, be annulled.I understand that it will be convenient to discuss also the second motion,
That an humble Address be presented to Her Majesty, praying that the Regional and District Health Authorities (Membership and Procedure) Regulations 1990 (S.I., 1990, No. 1331), dated 2nd July 1990, a copy of which was laid before this House on 5th July, be annulled.To save time, I propose to confine my remarks to the regulations relating to regional and district health authorities. For the convenience of the House, I state that we intend to divide the House on those regulations at the end of the debate.The debate's shortness is not a measure of its importance. The regulations provide for the creation of health authorities across England and Wales and give those countries health authorities explicitly modelled on the board of directors. Each health authority is to have five executive directors and five non-executive directors. There is no room within that small scope for representatives of the local authorities. At the very time when every progressive writer on health policy is urging us to break down the barriers between the health service and the social services, the Government have chosen to break the link between social service authorities and health authorities.
There is no prospect of community care ever succeeding if the local authorities which provide the community services are kept outside the doors while the health authorities decide which patients to put into the communities. In addition, no room has been found within those health authorities for the representatives of the people who work for them.
For the first time, so far as I am aware, the regulations write into law the offensive principle that, if one is a paid employee of a trade union, one will be debarred from that civic office. The full flavour of the regulations is contained in regulation 13, on which it is worth dwelling. Regulation 13(a) provides that one is disqualified for appointment if one has within the preceding five years been convicted; sub-paragraph (b) provides that a person is disqualified if he or she has been bankrupt; sub-paragraph (c) provides that someone is disqualified if he or she has been dismissed; and sub-paragraph (h) provides that someone is disqualified if he or she holds any paid appointment or office with a trade union. Convicts, bankrupts and trade unionists are clearly an unsavoury bunch.
Such institutionalised discrimination is thoroughly repugnant. People who work for trade unions are entitled to the same chance as anyone else of serving their communities on their local health authority. They should not be penalised because they work for an organisation of which the Government disapprove. Even more worrying is the fact that there is precious little room on the health authorities for the representatives of the people who use the hospitals.
This debate is not a theoretical one about how the regulations might work in the abstract. Characteristically, the Government did not wait until after the debate before going ahead with the appointments. They have already 1162 appointed people to almost every place on both regional and district health authorities. If the prayers are carried this evening, the Parliamentary Under-Secretary of State will tomorrow be in the embarrassing position of signing a thousand letters to appointees explaining what has happened.
I have the evidence of the people whom the Government want to run the authorities and I should like to share some of that evidence with the House. The most remarkable feature of those who have been appointed to the new health authorities is that they come from a dramatically narrow occupational base. I have completed a survey of 700 new members of these health authorities. There are exceptions to the rule. There are occasional areas in which it would appear that progressive chairs of district health authorities have succeeded in retaining a balance on health authorities, but the overwhelming majority of health authorities look more like local chambers of commerce than a public service.
The single largest professional group among non-executive members are company directors. Of the 700 whom we have surveyed, no fewer than 400 have a commercial background as industrialists, business men, accountants and lawyers.
§ Mr. David Ashby (Leicestershire, North-West)Not enough.
§ Mr. CookIn fairness to the Secretary of State, I must defend him against that claim by saying that, after a decade of decline in Britain's manufacturing base, he is to be congratulated on finding so many industrialists with whom to stuff the health authorities. I thank the right hon. and learned Gentleman for his honesty. He has given a clear signal to the House and to the nation that he intends the NHS to be run as just another commercial business. The notion that he frequently puts about—that the health authorities will be the voice of the consumer—is singularly droll, given the evidence of the people who have been appointed to the health authorities.
This clutch of businessmen have spent their entire working lives on the opposite side of the fence from the consumers. It is not even obvious that they are consumers of the very health services that they are now appointed to run. There are some interesting conflicts of interest which would have bothered a previous Government, whether Labour or Conservative. East Hertfordshire health authority now contains a marketing manager of Glaxo, a retired manager of International Computers Limited and a director of Blue Arrow. All three of those companies are major contractors to the NHS. Why is it all wrong that paid employees of staff unions should be on the health authorities, because there would be a conflict of interest, but all right for paid employees of suppliers to the NHS to serve on the same boards?
I concede that there may be a case for having a representative of the local business community on the local health authority—
§ Mr. CookI would not go so far as to suggest that they should command a clear majority of places, but I would concede a case for having a representative of the local business community.
1163 A remarkable feature of the appointments is that many of them are not even local business men. In Hull, none of the non-executive members lives in Hull. In Leicester, none of the non-executive members lives in the city of Leicester. In Lancaster, four out of the five non-executive members do not live in Lancashire. In Greenwich, the local authority representatives have been replaced by a double glazing executive from Bromley and a computer executive from Chislehurst—[Interruption.] If the Secretary of State is interested in speaking in the debate, I am sure that he will succeed in catching the Chair's eye at the appropriate time. He seems to have overlooked the fact that it is not customary in this House to make one's speech while another hon. Member is on his feet.
This House insists—Conservative Members have themselves insisted in recent legislation—that all members of local authorities must live in the area covered by those local authorities. Why should it be so different for the health authorities that the Government appoint?
There are of course a few stragglers surviving from the local councils, not because they are dominated by those councils but because they have been picked by the Secretary of State—or, if he wishes to be pedantic, picked by those whom he has picked on the regional health authorities. I hope that Conservative Members will forgive me for reminding them that, despite the wonderful illusions of presentation, Conservative councillors are currently a minority on local authorities throughout Britain. However, one would not know that from the councillors selected for appointment to the health authorities, which contain a healthy majority of Conservatives. Indeed, three fifths of all councillors appointed to the health authorities are Conservatives. In addition to those councillors, we have counted five chairs of Conservative constituency associations and one vice-chair of the Bow group.
At the very time when eastern Europe is booting out the party nomenclatura, the Secretary of State is busy filling health authorities with new Conservative nomenclatura. In some cases, the appointments are almost designed to promote conflict with the local authority. In Shropshire, the Conservatives are in opposition, and the chair of the social services authority is Labour. Of the five non-executive members appointed to the Shropshire health authority, three are councillors and all three are Conservative. Such appointments are an abuse of patronage—an abuse all the more serious because the posts are no longer filled out of a sense of duty: they are now paid posts, with part-time salaries of £5,000 for 20 days' work. Ministers cannot treat that patronage as a private pork barrel for friends of the Conservative party.
I wish to make it clear that the next Labour Government will not regard itself as bound by those appointments. [Interruption.] If the Secretary of State cares to listen, rather than lecture as I know is his preference in all circumstances, he may hear what the Labour party's position is. In the short term, we will replace many of the appointments with people who represent the local community, live in the local community and use the national health service.
In the longer term, we will scrap those health authorities, restore the representatives of local authorities and rebuild the partnership between the health authorities 1164 and the social services authorities. We will drop the ban on people who work for those who work for the health authorities. We will create health authorities that will be there to serve the local communities, not to serve a Secretary of State in Whitehall, and who are therefore accountable to their local communities and not to a Secretary of State.
The Labour party would bury the regulations with the short shrift that befits such an abuse of central power.
§ Mr. Michael Morris (Northampton, South)I want to contrast the two statutory instruments.
I do not share the concern of the hon. Member for Livingston (Mr. Cook) about the employment of business people and business techniques in the running of the health service; for a long time some of those disciplines should have been there and used, and the employment of some of those people is therefore entirely appropriate. However, I do share his feeling that there should not be appointees—especially on the district health authorities or the family health services authorities—who are not local. It seems entirely wrong for us to appoint such people to those authorities, although I do not share his view in relation to a regional health authority. I reserve judgment on the operations of the regional health authorities: I want to see how they settle down, and whether they perform better than their predecessors.
I welcome the changes that have been made to the district health authorities, which are generally welcomed in my constituency by those who take an interest in the health service—apart from those who lost their seats. I shall contrast that with what is happening in the family health service authorities in my constituency and in the other area that I know well, which is where I live in Bedfordshire. Things are not going well on the ground in either of those areas. It appears that the chairmen do not know their areas very well. Why have I still not been briefed about the identity of "Mr. Mustard" in the family health services authority in my county? I wrote asking about that three weeks ago and it seems strange that I have not yet been told. Perhaps no one in Northampton has heard of him, but I am sure that he is an accomplished gentleman in the field of business. We wish him well in his assignment.
The original briefing on family health services authorities stated:
The previous statutory framework for sub-committees within which FPCs worked has been largely removed.That may be so, but the family health services authorities are now appointing hosts of associate members. What on earth is the difference between sub-committees, which on the whole were reasonably effective, certainly in my constituency, and this host of associate members? The matter seems to be getting out of hand and I hope that my right hon. and learned Friend the Secretary of State will take to task any family health services authority that appoints many associate members.I hope that the war between the Department of Health and the medical profession is over. Our health service cannot be run without the good will of the medical profession, especially at family health service level. One of the problems is representation on the FHSAs. We must listen to medical professionals who are prepared to give time and energy and who know their areas exceedingly well. They are not listened to at the moment but I hope that in future they will be.
§ Mr. David Hinchliffe (Wakefield)First, I should like to raise a couple of technical points. The National Association for Mental Health, MIND, is concerned about the implications of recent changes. It has made it clear to me that it is worried about the accountability of the new-style DHA members and the decisions taken about detained patients under the Mental Health Act 1984. I should like the Minister to comment on that. MIND says that the new regulations will remove the link that health authority members must have with the Mental Health Act Commission. MIND sees that as a retrograde step because it reduces the accountability which is healthy in relation to psychiatric patients who may be compulsorily detained by regulation.
MIND says tha the new regulations meean that the new-style health authorities and hospital trusts are not required to have health authority or trust members represented on the committee that decides on issues about detained patients. I am sure that the Minister is aware of the seriousness of that, especially for patients who have had their liberty removed by the exercise of the legal provisions of the Mental Health Act. MIND says that there is no doubt accountability by the Mental Health Act Commission to the DHA or the trust. Even at this late stage, I hope that the Government will consider that technical point.
I should like to restate the concern expressed in Committee by Opposition Members about the way in which the regulations will completely remove the formal links between local authorities and district health authorities on the issue of joint planning for community care. That is strange at a time when we see good examples in many parts of the country of local authorities and health authorities working together on community care. We are trying to refoirm community care and many Opposition Members support some aspects of the legislation on community care. However, the arrangements now before the House will destroy the formal liaison that exists.
I shall now refer to democracy in the national health service. I am proud to have spent all my life in a society that has enjoyed the tremendous achievement of the Labour Government of the 1940s. The NHS is supported by the vast majority of the electorate. From the word go, however, one of the major failures of the NHS has been the lack of any real democratic accountability to the patients, its users. Under this and previous Conservative Governments, there have been moves away from the limited accountability that existed in the organisation prior to 1974. The reorganisation in 1974 moved accountability further away from the patients; the 1983 changes added to that problem, and the 1990 changes remove any element of local accountability in the NHS.
I am a supporter of community health councils: indeed, I am a former vice-chairman. However, if they posed any challenge or threat to Government policies and were a bulwark of defence of the NHS, I am sure that the Government would have abolished them in recent legislation. I shall continue to support CHCs, but their powers were emasculated some considerable time ago.
I want to be parochial and deal with the problems of Wakefield and question the sort of people who have been appointed to the new health authority. I speak as someone who served on a health authority for a number of years and, as I said, on a community health council. I take a 1166 close interest in health issues in my constituency. It has always struck me as strange that since the Wakefield district health authority came into existence, it has never appointed a chairperson who has lived within the area. Is there a problem with Wakefield? Are our people unsuitable to be chairpersons of health authorities? Why cannot someone who lives in the area be appointed? The chair of a health authority is an important job. What is so wrong with my constituents that they are not suitable for and do not have the ability to hold the chair of the local health authority?
It is interesting that, including the chair, one third of the non-executive members live outside the area served by the health authority. That is not an academic point; it is important. If someone is in the position to make important decisions about the treatment of patients in the NHS, occasionally it might be useful for that person to be a patient and to sample the facilities available. I recently attended a clinic with a member of my family and I was appalled to see the number of people crammed into it. Large numbers of elderly people were standing because no chairs were available.
I am not attacking the consultants or the nursing staff, who do their level best to ease the problems, but there is something radically wrong with a management that fails to provide chairs for people in their 70s, 80s and 90s while they are waiting for treatment. Sometimes they have to wait two or three hours before receiving basic treatment. I should like those who are making the decisions to sample the facilities, because they would then realise what people have to tolerate. I suspect that a number of those who serve on the health authority in Wakefield would never go anywhere near the NHS.
Another issue, which was a problem with the previous structure of health authorities and will be an even bigger problem now, is when such very busy people, with all their commercial and business interests, will find the opportunity to visit hospital wards and clinics, as they should, to see what is happening at the grassroots level. I do not suggest, nor do I need to suggest, any political bias in the appointments in Wakefield, but half the non-executive members who live in the area live in one electoral ward. I am sure that it is a coincidence, but it is the only ward in the entire Wakefield district to elect Conservative councillors. People who know the area will appreciate that Sandal is not representative of the Wakefield district, but it is very well represented on the new health authority.
One third of the people of Wakefield live on council estates. Would it be unreasonable to expect at least one member of the health authority to live on a council estate and therefore have some insight into the problems of the working class?
We should have health authorities that are composed entirely of people who live in the areas that they serve and who actually use health service facilities that are, or are not, available, as the case may be. The membership of the authorities should genuinely reflect the aspirations, needs and views of the local community. Why should not they include a few working-class mums who have experience of sitting in a clinic for two or three hours, waiting for treatment? Such people would properly be able to express the views and real concerns of the service users.
Why should there not also be direct democratic accountability? Why shy away from health authority elections? I would go further even than my own party and 1167 suggest that we should go from door to door, telling people that they should vote for a particular health authority candidate. We would also be able to learn what the public want, in the way that we do when canvassing in local or general elections.
My plea, more to the next Labour Government and to my right hon. and hon. Friends on the Front Bench than to the present Tory Government, is that we should move towards direct elections, for I am sure that they would be welcomed by the vast majority of our constituents.
§ Dame Elaine Kellett-Bowman (Lancaster)In Lancaster we are lucky in the calibre of our district health authority, whose members include people of wide experience who know the area well. They are led by our exceedingly able existing district chairman, who has piloted huge improvements and innovations so that our local health service is at or near the top of any list of criteria or league table that one cares to use.
I am a great believer in encouraging the state of marriage, and I feel sure that the Government share my views. I am therefore puzzled by the regulations, because, while the Government have removed the advantage of unmarried couples living together in respect of mortgages, and the advantage of unmarried couples living together for social security purposes, they have reinstated in the regulations the disadvantage for a married couple living together in respect of the declaration of interest.
I refer to regulation 13(6) of SI 1330, and to the words
the interest of one of a married couple living togetherand to regulation 20(5) in SI 1331, which refers to the situationin the case of married persons living together.Why should they be at a disadvantage? I should like an answer.
§ Mrs. Alice Mahon (Halifax)In Committee stage on the National Health Service and Community Care Bill, my hon. Friend the Member for Newcastle upon Tyne, Central (Mr. Cousins) referred to the new district health authorities as a system of management that Queen Victoria would have recognised when she surveyed the crowned heads of Europe, and he was absolutely right. Everything leads back to the Secretary of State, and my hon. Friend the Member for Livingston (Mr. Cook) was also correct when he said that the new set-up is centralisation in an extreme form.
In the case of Calderdale district health authority, off go the two council representatives, who happen to be elected Labour councillors, and the trade union representative, and on come the business men, with only one exception. We have the same chair as before in Alan Templeton, an ex-director of the Halifax Insurance Company. During his chairmanship, he has presided over every cut that the Government have proposed, even using his casting vote to get rid of the NHS's own laundry service, a decision which was followed by a few disastrous years.
The newly appointed vice-chair, Barry George, was vice-chair of the previous district health authority. From 1168 the positions that he takes, he is obviously a Thatcherite. Until recently, he was employed as an architect. A new member of the authority, Clifford Fee, is a long-time Tory party member. He is a former chair of Halifax Conservative Association and recently retired from the family business. His new post should pay about £250 per meeting, which is a nice little earner for a recently retired business man. We have Dr. Hughes, who was previously a board member and is a fairly reactionary, right-wing medic. When I was a member of the district health authority, he only came alive when there were cuts to be made. He always voted for them.
Another new member of the board is a solicitor, and not someone whom I have heard had any interest in or knowledge of the national health service until his recent election to the board, which has already met and voted through a round of cuts which will lead to the loss of 99 beds. I imagine that the solicitor is a Government supporter because he voted for the cuts without any previous experience, as far as anyone can tell, of the national health service.
The one saving grace is that a woman, Jackie Stark, has been elected to the board. She was the only person to vote against the cuts, and she has spent most of her life working for the voluntary sector. Apart from that one exception, we have middle-aged men with business backgrounds who will slavishly follow any cuts that the Secretary of State suggests.
Today I learned that the latest infant mortality rates in Calderdale were shocking. In Calderdale the rate is 12.6 per cent., in Yorkshire and Humberside it is 9.1 per cent., and in the rest of England and Wales it is 8.4 per cent. The perinatal statistics—deaths in first week or stillbirths—were 12.9 per cent. in Calderdale, 8.5 per cent. in Yorkshire and 8.3 per cent. for England and Wales as a whole. Given those statistics, I must ask myself what on earth this Tory-appointed group of people were doing voting for cuts in beds and cuts in maternity services.
I know that the Secretary of State and his Ministers have received representations from a group of people in Calderdale about planning permission for a 40-bed private home for people with learning difficulties. I mentioned the issue when I was on the Committee on the National Health Service and Community Care Bill. That plan is totally at odds with the district health authority's philosophy of care for such people. The group making representations came out of hospital recently and are speaking up on behalf of their friends in Stansfield View, who are totally opposed to the home.
I think that there is a hidden agenda and that Stansfield View will be emptied while 40 people with learning and physical difficulties are still waiting to come out. If planning permission is given—it seems that it will be—they will end up in a totally unsuitable home, situated between a canal and a river, on a rat-infested industrial site. The business men appointed by the Secretary of State will happily go ahead with that, but it bodes ill for the people of Calderdale.
I am disgusted at the deliberate way in which the Government have put their friends into lucrative part-time jobs. I hope that the rest of the country and the people of Calderdale realise that those whom the Secretary of State has placed on the board will earn about £250 an hour and they will make all the wrong decisions.
§ Mr. David Evennett (Erith and Crayford)I support the regulations, and do not share the concerns that have been expressed by Opposition Members this evening.
Change for change's sake is never a good idea, but change to improve the system should be supported. Following the hon. Member for Halifax (Mrs. Mahon) is always an experience, but her view of democracy in the health service is totally wrong. Democratic control over the NHS is represented by Parliament and by the Secretary of State. That has always been the case and it always will be. We are the guardians of the national health service.
The Opposition spokesman, the hon. Member for Livingston (Mr. Cook), is living in the past. He and the hon. Member for Halifax seem to want to see their old friends, the Labour councillors and the trade union members, restored to the health authority—people who were not elected but nominated on a political basis. By means of the regulations, the Government intend to introduce better management and more management experience into the national health service.
§ Mrs. MahonWill the hon. Gentleman give way?
§ Mr. EvennettNo. The hon. Lady has had her opportunity to speak. It is high time that she listened to some common sense.
If the management of the national health service is to be improved, new people with management and business skills must be persuaded to offer their services. The NHS is a much valued and much loved national institution. However, we hear much criticism of the NHS in our constituency surgeries. The criticism that is most generally voiced, in both general and specific terms, relates to the local management of the NHS.
Unfortunately, there have been many examples of poor management. Although more money has been poured into the NHS, so that more patients can be treated, the criticism that is expressed—it is a valid criticism in certain areas—is that there has not been more effective and efficient utilisation of resources in the interests of patients. We need good management at all levels in the NHS to ensure that patient services are, and continue to be, first class.
How can good management be achieved? Local councillors were not elected to the district health authorities; they were appointed. Why should local authorities appoint health authority representatives? Of course there must be liaison between local authority social services and the NHS, but we need better management. Therefore, if we can appoint people who are better qualified to serve NHS management at local level, we should do so.
§ Mr. Geoffrey Lofthouse (Pontefract and Castleford)Will the hon. Gentleman give way?
§ Mr. EvennettYes, I shall give way to the hon. Gentleman.
§ Mr. LofthouseIf we accept that better management is required and that better management should be provided by people with experience of management in manufacturing industry, why is it necessary to go miles away from local health authority areas to pick such people? Does it mean that no suitable people can be found in the area?
§ Mr. EvennettThe point is that we want the best people, wherever they may come from, so that they can provide expertise for the management of the NHS.
In conclusion—
§ Mr. Bob Cryer (Bradford, South)Will the hon. Gentleman give way?
§ Mr. EvennettNo, I shall not give way. The hon. Gentleman never listens. If he did so, he might learn something. We have had too many sedentary interventions from him over many years.
We want to improve the NHS. We have put more money into it, and more patients have been treated. What we need now is a better management structure in the interests of patients.
§ Mr. Charles Kennedy (Ross, Cromarty and Skye)I echo the concern expressed during the passage of the Bill, both on the Floor of the House and in Committee, and also tonight about regulations of this nature that are the consequence of the Bill having been passed.
The hon. Member for Livingston (Mr. Cook) referred to the number of business men who have been appointed. We should not be surprised about that. The thrust of the reforms is to put the NHS on a more business-cum-private footing. From the Government's point of view, therefore, it is entirely consistent that business men should be put in charge of the NHS. As has been acknowledged, however, certainly on this side of the House and to a certain extent by Conservative Members, the sad thing is that all too often the business men and others who have been appointed have no direct local contacts. That is inappropriate when we are talking about the management of the NHS.
Why is it, one wonders, that people have so often been moved in from other parts of the country to serve on district health authorities? I suspect that the reason is partly that, in some parts of the country, the political complexion is such that it may not be as easy as the Secretary of State would wish to find people of both his and his Government's cast of mind to serve on the authorities. Therefore, people have to be shipped in from elsewhere.
There is a more practical reason. If someone lives in a local community and is facing pressures and having to take difficult decisions—if he is the subject of letters in local newspapers, of people phoning him at home and of people making their concerns known to him when he is shopping—that is something of a strain. It is much easier to take cold-blooded decisions resulting in cuts, closures and a diminution of the health service when someone does not have to face the people whom his decisions will adversely affect. That is one of the reasons why the thinking of the Secretary of State in making these appointments is so clear.
§ Mr. CryerIs there a possible third reason—that if, as is unlikely, the Tories are re-elected, they have in place, free from any local accountability, a remote character ready to take the next step of privatising the national health service?
§ Mr. KennedyI would be straying a bit wide of the regulations if I answered that, but given the motives and the means that this legislation have given rise to, one 1171 cannot, being as generous as possible to the Government, dismiss the possibility of such a change following under a future Tory Administration. That should be said loud and clear; I welcome the hon. Gentleman's intervention.
It is regrettable that, in addition to the other examples that have been given of the trade unions and local authorities, the Government resisted an amendment moved in Committee—their track record on these appointments confirms how useful that amendment would have been—to improve the comparatively meagre number of nurses who have been appointed. At the time of the original Griffiths management report and the recommendations that flowed from it, the Government were reluctant to concede a central role in the management of the health service to the nursing profession. They conceded it in due course, which was welcome.
Further down the line of management, that absence of guaranteed or direct nursing input has been replicated in the appointments that have been made. The Secretary of State was given lists of nominees by the regions from which to choose non-executive members. Nurses appeared on those lists, and some of the executive members are nurses, but the regions of Wessex, Yorkshire, South West Thames and North West Thames have no nursing representatives on the new bodies.
That is not good for the health service, especially when the thrust is towards a business or management-orientated health service to deal with such items as throughput, which, as any nurse could advise those bodies, is not a mark of success. If people are discharged from the hospital sector into the community before they have recovered, their chances of recovery may be damaged and another statistic may be added to the admissions column a few weeks later. Throughput is not a categoric or sufficiently illuminating indication of success in the health service. Nobody would be better advised to tell a health authority that than a nurse, but all too often nurses have not been appointed.
The classic example of a lack of local knowledge occurred recently. We all know the very tragic circumstances that gave rise to the by-election campaign in Eastbourne. The Conservative candidate is known to us as the former Member for Glanford and Scunthorpe. He was recently adopted, and at this stage his knowledge of Eastbourne is not full and detailed. That was borne out by his statement during the campaign pointing to the success of one of the local hospitals. A photograph of that hospital was subsequently produced which showed it to be a pile of rubble.
That highlights the dangers of having people who do not have sufficient local knowledge expounding the virtues of the health service in a given locality. It was a classic example which considerably embarrassed the local campaign and, I suspect, the Conservative party nationally.
§ Mr. Rhodri Morgan (Cardiff, West)It was a successful demolition.
§ Mr. KennedyAs the hon. Gentleman says, it was a successful demolition. It remains to be seen whether a phoenix will rise from the ashes. One lives in some doubt about that.
1172 The new system is unrepresentative and undemocratic. It will put more and more power in the hands of central Government at the expense of local communities. For that reason, we shall be joining the Labour party in opposing the regulations.
§ Sir Michael McNair-Wilson (Newbury)I welcome the revision of the membership of the regional and district health authorities, and of the family health services, as much as anything because the previous membership of those bodies, even if drawn from a wider catchment, were remarkably out of touch with the areas and the populations that they claimed to represent. How rarely do I remember any of those authorities holding a public meeting in my constituency to explain the problems they were up against. The whole question of public accountability by those bodies has not left much of a mark on me.
One of the weaknesses of these authorities always seemed to lie in the fact that, apart from the officers, most of the members were not sure what job they were meant to perform or whom they represented. In those terms, to have a more businesslike approach or, as my right hon. and learned Friend the Secretary of State said, to make a more effective decision-making team seems to make good sense and to be wholly welcome.
However, business efficiency and effective decision-making, although important—no one would dispute that every health authority requires that expertise—may be too narrow an approach. Nobody disputes the need for the NHS to be able to draw on business acumen and, as the internal market develops, that ability will become ever more important. However, what requirement is there for the new, non-executive officers to be NHS patients? That question has already been asked by the Opposition.
I believe that the members should be not only directors but consumers of the authorities if they are to have a valuable input into the discussions of those authorities. The regulations seem to have the single drawback that they lay too little stress on the voice of the consumer or on how the new bodies are to be accountable to the communities they serve. They are appointed for four years, but not by local people. Is their sole remit business efficiency? if so, what proposals are there for giving the voice of the patient some way of being heard?
Community health councils have also been mentioned. I suggest that, up to a certain point, they can fulfil the job of being the consumer's voice. However, if we want them to succeed as the consumer's voice in the newly shaped national health service, surely one of the non-executive members should be the chairman of the local CHC or there should be room for co-opted members on the new bodies. After all, if we are concerned with business acumen, and with restructuring and reshaping the national health service to give it a more businesslike approach to its massive task and to the huge funds it handles, we should follow big business down the road of having either a customer relations director or a customer relations manager among those who are non-executive, co-opted members.
In welcoming the changes, I believe that there is still a gap in what has been proposed. We should give the patient's voice rather more time to be heard than seems to be possible with these proposals.
§ Mr. Ian McCartney (Makerfield)I promise you, Mr. Deputy Speaker, that I shall take only a couple of minutes. I saw you raise your eyebrows when I rose, and I know that a number of hon. Members wish to participate. I am glad that you can take a joke.
I am probably one of the few hon. Members who knows the wrath of the Secretary of State. In his earlier office of Minister for Health, he sacked me from my local family practitioner committee. Conservative Members will probably say, "That is the only good decision that he has made at the Department of Health." I was sacked purely and simply because I had been put on the committee by the local authority and was asking pertinent but awkward questions about the administration of the committee. The right hon. and learned Gentleman could not find a local authority member with whom to replace me because there were no elected Conservative representatives in our area at the time. He left the position vacant rather than making a fresh appointment from among the local authorities.
The Secretary of State has a long history of attempting to remove from authorities people with political views that he does not like, including some of the most efficient and hard-working people in the national health service, who have been withdrawn from service over the years.
The present regulations represent the final nail in the coffin of public accountability and public and local representation in the national health service. My authority, which looks after 340,000 people, has the following criteria: one must not live or work in Wigan, and if one is a member of the local authority or a community group that has comments to pass about the running of the health authority one will be excluded. Amazingly, when the present chairman of the health authority was appointed he said that he knew nothing about the running of the authority but that he was a quick learner.
Since then, Mr. Hague has, indeed, learnt quickly. He has learnt about hospital closures because he is constantly closing hospitals. He has learnt about privatisation through his wholesale closure of hospitals and as he has privatised care for the elderly and the mentally ill. He knows something about contracts. At almost every health authority meeting, when the first item on the agenda is reached, the "public interest" is invoked, a resolution is passed and the public are thrown out. The authority then proceeds to talk about contracts for companies such as Takare. In privacy, the authority may change the whole system of contracts so that Takare is the only company that can apply for and obtain contracts. In private, the authority consistently acts against the public interest.
A Mr. Robertson, the retired chief executive of Robertson's jam, is to be appointed to the family health services authority. At least the health service in Wigan can look forward to jam tomorrow. Mr. Robertson is somewhat coy when it comes to whether he lives in the borough. The press statement sent to local Members of Parliament says that he lives somewhere in Cheshire. The members of the health service authority representing the professions also live anywhere but Wigan—in Cheshire, in Lancashire, in Bolton and in other parts of Greater Manchester but not in the local community.
I should have no personal objection to the Conservatives even controlling the health services authority if they lived in the borough and if they used, and were accountable for, its services. But that is plainly not the case. The Government are a centralising Government who are taking for themselves complete political control of 1174 the health service by means of appointees who do not live in or care for the local community and who do not care for the national health service. Many of those appointed have been appointed for one reason—their sole objective during their two or four-year term is to privatise as much of the health service as they can, preferably before the next general election. That is why I welcome the statement by my hon. Friend the Member for Livingston (Mr. Cook), that at the earliest possible opportunity Messrs. Robertson and Hague et al will be sacked and replaced by people who live and work in the community and who have a commitment to the national health service.
§ Mr. Frank Haynes (Ashfield)I am a bit surprised that the Secretary of State for Health has left the Chamber. He should be ashamed of himself. He should be here listening to what we are saying because the Opposition totally disagree with his proposals. Indeed, one or two observations have also been made by Conservative Members—[Interruption.] Ah, the Secretary of State must have heard me because he has just returned to the Chamber.
We know what is going on. We know what the Secretary of State is doing. He frittered around with transport before he came to social services and I remember well what happened. The Secretary of State has made a mess since he took over his flaming job. He is now moving towards more closures for the national health.
The Secretary of State need not frown because I shall put him in the picture. He is coming to my constituency on Saturday for "Europe Week" and he will stand on a platform with the Conservative candidate for the next general election. [Interruption.] That is not a big joke. It is a serious matter. I warn the Secretary of State that he is going to get an earbashing on Saturday.
The Secretary of State obviously has some influence on cuts and the way in which a local health authority should spend its money. The Secretary of State knows where the King's Mill hospital is because he lives just down the road in Rushcliffe. I do not know what his constituents think about him there, nor do I know what people think of him in the city of Nottingham after what the Secretary of State has done there.
The Secretary of State must be aware of the finances that have been made available for Central Nottinghamshire district health authority. He has appointed people to carry out his dirty work. That is what it is all about. There will be no come-back. They sit around the table and tell the manager what she has to do—and the manager is a lady in Central Nottinghamshire. That wonderful lady has done a first-class job since she was appointed, but she will not be able to do the job that she should be doing because the Secretary of State has appointed all those bosses from all over the damn place and has sacked the real link with the community.
The Secretary of State talks about community care and he gets the Prime Minister to say the same things. They say that they care about the facilities that are provided in the community. At the Victoria hospital in Mansfield there are a number of bungalows provided for the mentally handicapped. They were built so that the parents of mentally handicapped children could have some respite. The children could move into the bungalows to allow the parents some freedom, a change and a rest. Two of those 1175 bungalows are to be closed, yet the Government talk about caring for the community. They could not care less. One of my colleagues made a good point earlier: every step that the Secretary of State has taken with regard to the NHS has been a step towards privatisation.
§ Mr. Kenneth ClarkeI am sure that the hon. Member for Ashfield (Mr. Haynes) will agree that I cannot leave it to my hon. Friend the Under-Secretary of State for Health to answer all that.
I am glad that I shall be meeting the hon. Gentleman in the Asda carpark at Sutton in Ashfield on Saturday. The hon. Gentleman's predecessor used to campaign with me for Europe and I hope that the hon. Gentleman will join me on Saturday. I hope that he has heard that the Labour party has undergone a conversion and the party's policy is now also in favour of "Europe Week". I look forward to visiting King's Mill again. I know it extremely well.
§ Mr. HaynesOn a point of order, Mr. Deputy Speaker.
§ Mr. ClarkeNo, after the hon. Gentleman has heard me out on King's Mill.
§ Mr. HaynesOn a point of order, Mr. Deputy Speaker. In my contribution I have not mentioned Europe—[Interruption.] Wait a minute—except for "Europe Week." That is all. That is what the Secretary of State is coming to. That is all I have said about Europe.
§ Mr. Deputy Speaker (Mr. Harold Walker)Order. I very much—
§ Mr. ClarkeThe last time I visited King's Mill hospital was to open a major extension that the Government had financed. I look forward to the expansion of services in Central Nottinghamshire health authority. To which of the new appointments to Central Nottinghamshire health authority does the hon. Gentleman really object? He is a fair man. He is not as partisan as he likes to make out on the Floor of the House. He knows perfectly well that we have appointed people who are interested in a better health service in central Ashfield. Would he please not lark about trying to claim that he seriously objects—[Interruption.] The hon. Member for Livingston (Mr. Cook) has to go in for jobbery because he needs votes to be elected to the national executive. The hon. Member for Ashfield (Mr. Haynes)—I nearly said my hon. Friend the Member for Ashfield—knows perfectly well that he does not really object to any of the people whom I have appointed to Central Nottinghamshire district health authority.
§ Mr. HaynesHe has got a bloody neck. He really has got a neck to make a comment of that sort.
§ Mr. Deputy SpeakerOrder. That sort of coarse language is uncharacteristic of the hon. Gentleman.
§ Mr. HaynesI withdraw it, but I still mean it. I have not been laughing. The Secretary of State is still laughing—he has been laughing throughout the debate. He thinks that this a damn joke. This is a serious matter. We are all complaining about the rundown of the national health service in our own areas, and now the Secretary of State has appointed bosses who jump to attention when he says so. He is pouring money into their pockets. No doubt they 1176 will get an increase pretty soon—[Interruption.] A part-time job with a damn good salary to go along with it, but to do his dirty work.
The reason why ward closures are taking place is that people are frightened of overspending by the end of the financial year. The reason why people are overspending is that this Secretary of State has cut services in the Central Nottinghamshire district. That is having a serious effect on the Ashfield constituency. I wanted to get up and say it, and I have said it.
§ 11.2 pm
§ Ms. Joan Walley (Stoke-on-Trent, North)I shall be very brief, as time is passing by all too quickly in this important debate. My points are about North Staffordshire district health authority. We do not want business men who have no knowledge of the local area or of local services wheeled in to deal with the management of the national health service. My hon. Friends have made it quite clear that there is a hidden agenda—that the changes are taking us one step nearer to the privatisation of the national health service.
Nurses who have been recruited in north Staffordshire and nurses on Project 2000 ask me whether I realise that they are afraid that there will be no jobs by the time they finish their training. What do business men know about decisions that are made behind the scenes by the Government? It is absolutely impossible to train the number of nurses who are needed.
A further point to which I object very strongly is that, having reduced the numbers on the district health authority, we now have to wheel in ex-members of the district health authority to deal with nurse regradings. They are paid in the region of £40 a day. Why cannot some concern be introduced? Why could we not have had people who are prepared to do that work, have knowledge, put in the time and visit all the different facilities in the area?
The community health council in north Staffordshire has made it clear that it thinks that it is totally out of order that it can no longer as of right sit on the district health authority. That is entirely wrong. We have heard so much about the interests of consumers, or patients, but there are moves afoot for the health authority to meet behind closed doors and for business men to run the NHS.
In north Staffordshire, a health profile report has been commissioned by the Stoke-on-Trent city council. It has identified huge amounts of ill health within Stoke-on-Trent. How can key decisions on health be made if there is no link between those who have been democratically elected? How are we to deal with the great problems posed by ill health under such undemocratic arrangements? I do not want the NHS to be run on entirely commercial lines.
§ 11.5 pm
§ The Parliamentary Under-Secretary of State for Health (Mr. Stephen Dorrell)Although no one would realise it after listening to the contributions of Opposition Members, the regulations are designed to demonstrate the Government's commitment to improving the delivery of the national health service and to ensure that the health care that the British people enjoy from the NHS will continue to improve. The regulations are part of the programme which gives effect to the Government's commitment to more effective management within the NHS. That is understood by my hon. Friends the 1177 Members for Erith and Crayford (Mr. Evennett) and for Newbury (Sir M. McNair-Wilson), and I thank them for their support.
The NHS is a vast organisation—it is the largest employer in Europe. It is not a business, and we do not pretend that it is. It is, however, a huge organisation, and it can and should benefit from more business-like management, more effective management and by securing the best use of the resources that are devoted to it by the taxpayer on behalf of the patient. That is the purpose to which the motions are directed.
§ Mr. LofthouseIf that expertise is required, why is it that a member of the Pontefract health authority is the managing director of the Rockware glass group—his factory is on the border of my constituency and an adjoining one and he lives in Rotherham—and another is a doctor's wife who lives in Wetherby, which is 20 miles away? I do not have the full list of the members at my disposal. Is there not a doctor's wife or a business man within the Pontefract health authority who has the expertise to do the job?
§ Mr. DorrellThe hon. Gentleman is advancing an argument which was introduced on several occasions by one or two of his hon. Friends. If the purpose of the health authority is to secure the good management of health resources within its area, why does he consider it vital that every member of it should have what he deems to be the right postcode? That would not seem to be the critical factor when someone is nominated to serve on the health authority.
I must tell Opposition Members who feel so strongly about postcodes that their view is not shared by the majority of those who are involved daily with the management of the NHS. I have heard less adverse comment about the commitment to a more effective, slimmer and more efficient health service than about all the other principles that come within the NHS reforms. It is hardly a secret that the reforms have generated a degree of interest and controversy. Even the hon. Member for Livingston (Mr. Cook) could not make a leak out of that.
Within the national health service, this set of proposals is almost entirely uncontroversial. It is only Opposition Members, who are so consumed by the conviction that every decision in the NHS management should be regarded as political, who see this as a controversial initiative.
The hon. Member for Livingston has not answered in his mind the fundamental question—what a health authority is there for: is it a political forum or a management organisation? Is it there to hold an interesting debate about the quality of health care and the ideas of its members about health care in a particular area, or is it an organisation charged with the effective use of health service resources in a particular locality to produce the best health care it can for the patients who live there? I have no doubt what the answer is, but the hon. Gentleman does not seem to have sorted it out in his mind.
Let us consider the charges that he levied against the regulations this evening. He said that there was no representation as of right on the health authorities for the local authority of the district. That is correct, but there is no representation on the health authorities for anyone else 1178 either. They are not there as representational organisations—that is not their function, but the function of the community health council within the context of the health service.
When we are asked to whom the health service is accountable, the answer, as my hon. Friend the Member for Erith and Crayford correctly said, is that, since the day of its inception, the health service has been accountable to Health Ministers, not local bureaucracies, in whatever form they have existed during the history of the service.
§ Mr. MorganThat is splitting hairs.
§ Mr. DorrellTo talk of parliamentary accountability is not splitting hairs; it is an important matter.
§ Mr. MorganWhen the Minister describes the health authorities as management organisations, he surely forgets that health authority members also acted a s lay representatives when anybody was appointed to a senior position in a hospital. They were also asked to take particular care of one hospital and acted as lay representatives on grading appeals for nurses. Surely, if they are management organisations, numbers on them are suddenly reduced from 20 plus to five and the position is not thought through, we are then confronted with the problem of what to do with functions other than those of the business whizz kid management organisations, that the previous health authority members carried out.
Was there ever better evidence of a Government proposal that had not been thought through than this evidence that they are going back to the ex-members of health authorities that they have just sacked and asking them to do for money what they previously did for nothing when sitting on grading appeals for nurses?
§ Mr. DorrellNever have I heard better evidence of the tail wagging the dog. Are the authorities there in order to provide a quarry for people to perform those important, valuable functions, or are they there as a group of people whose job it is to manage the health service within a locality? I have already made clear my answer to that question.
§ Mr. CookI shall carry the Under-Secretary back to the comment that he made a moment ago—that it is not his intention that the health authorities should be representative. I would certainly agree that the Government have achieved that objective through the appointments. But he made the case that the job of representation is a task for the community health councils. If he is to rely on them to inject a note of representation into decision making in the health service, will he now issue an instruction to all those health authorities which, since August, have withdrawn observer status from the community health council at their meetings and simultaneously refused to send members of the new authorities along to community health council meetings?
§ Mr. DorrellCertainly not because the purpose of representational organisations such as CHCs is to have sufficient roots in the community to be aware at all times of the community's needs and represent those to the health authority. Through the local Member of Parliament or whatever organisations they wish to approach, they should ensure that their views about the health authority's policies are known and understood. That is the legitimate function 1179 of the CHC. It is not part of its function to second-guess and become involved in the management process. The two functions are separate and should be seen as such.
The second point made by the hon. Member for Livingston was not dissimilar from the one that he made in his intervention a moment ago. He took us to task for debarring from membership of health authorities paid officials of unions whose members are employees of the health authority in question. The straightforward reason for that is that it clarifies whose task is that of representation—whether it be CHCs representing patients, or paid union officials representing employees—and whose that of management. The two tasks are separate and can be better discharged if they are understood by all parties to be separate.
Thirdly, the hon. Gentleman said that members of the health authorities were overwhelmingly business men. His mathematics was interesting. He quoted the percentage of business men as 52, a figure that included laywers. As a lapsed business man, I am bound to say that I do not regard lawyers as business men.
We make no apology for having sought to introduce to the structure of the health authorities people with experience of managing large organisations. We believe that that will provide more efficient management of our public health service.
Once the hon. Gentleman had got those three weak arguments off his chest, he degenerated into wild accusations about political bias. That was when he showed himself in his true colours. He left behind the measured tones of his initial arguments and began accusing us of all sorts of political malpractice—including the introduction to this country of the principles of nomenclatura. He showed that he understood those principles so well that he intends to apply them in reverse in the unlikely event of a Labour Government being elected.
My hon. Friend the Member for Northampton, South (Mr. Morris) asked why the associate membership—in the context of FHSAs—should continue to contribute to the work of the authority in addition to the slimmed down authority itself. I believe that that is a more efficient way to proceed than past methods. The narrow, smaller group will have the responsibility for evolving the policy of the authority in the area, but that does not stop its members calling on the wider group of associate members to discharge some of the less central functions of the authority.
That has always been explicit in the model that we have advanced for health authorities' discharge of their functions. To some extent, it also answers the point made earlier by the hon. Member for Cardiff, West (Mr. Morgan)—
§ Mr. Michael MorrisIf the associate members are to discharge such a valuable function, am I to understand that they are not to be paid? Are they supposed to do the work on a voluntary basis?
§ Mr. DorrellThey will continue to do the work on the same basis as before. The smaller group will be paid for the additional responsibilities of full membership of an authority.
The hon. Member for Wakefield (Mr. Hinchliffe) said that he was proud of the NHS, and had always regarded 1180 himself as a lifelong supporter of its principles and the way in which it had been introduced; he then said that he felt that our proposals represented inadequate democratic accountability in the running of the service. He has not reconciled himself to the fact that those two statements are fundamentally contradictory.
The NHS that was introduced in 1947 was a national service, accountable to Parliament, whose democratic accountability was—through Ministers—to the House of Commons. It is not, and never has been, a system of different local health services accountable to a local elected body. If the hon. Gentleman can persuade his hon. Friends that that is what Labour policy should be, I shall watch with interest—and I shall be very pleased to argue against it, because I do not believe that it represents either an efficient way in which to use resources or a just way in which to provide health care. But the hon. Gentleman cannot claim to be a supporter of a national health service and then, in his next breath, argue for the disintegration of the NHS into a series of locally democratically accountable health services.
§ Mr. HinchliffeWill the Minister give way?
§ Mr. DorrellI will give way once more, but I cannot engage in a debate on every point.
§ Mr. HinchliffeThroughout its history, the NHS has involved local people—either councillors or members of hospital management committees—who live among people who use the service, and who use it themselves. My objection to the structure set up by the Government is that there is no accountability to local people; the Government's model involves people who do not live in the area concerned, and who have nothing to do with activities such as visiting hospitals and clinics and seeing the problems that face the NHS daily—nothing to do with participation. The Minister has not responded to that point.
§ Mr. DorrellSeveral Opposition Members have convinced themselves that the health authorities are being staffed with people who—almost to a man—have no connection with the area in which they work. That is a travesty of the truth. Certainly we have not insisted on what I call the postcode test; but the vast majority live either in or very close to the health authority districts in which they will serve, and all will quickly develop a deeper knowledge of the authorities in their areas than any previous generation of health authority members.
My hon. Friend the Member for Lancaster (Dame E. Kellett-Bowman) raised an interesting point about whether we were discriminating against married couples. If we had listed every conceivable relationship that could lead to a conflict of interests which should properly be declared, these measures would be enormously lengthy. There is a specific requirement for the interest of the spouse of a health authority member to be regarded in the same way as the interest of the member himself, or herself. Beyond that, however, it depends on the understanding, or desire to act properly, of each member of the health authority, whom we expect to declare any commercial activity that might give him or her an interest. The provision to which my hon. Friend referred is not intended to give carte blanche to anyone whose relationship falls outside that test not to consider whether he has an interest that he should declare.
1181 The hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) asked whether nurses should be represented on health authorities. He should remember that, under the reforms to be introduced in April, health authorities will be the bodies purchasing health care on behalf of a resident population. The Government continue to think it important that there should be a medical input into the management of units within the NHS: that is, that the management of hospitals—whether they are trusts or directly managed units—should involve such input. It is not obvious to me, however, that it is essential to have a "nurse input" into what is basically a contracting organisation.
My hon. Friend the Member for Newbury asked whether there should be a stronger voice for the patient in the form of a customer relations director. My hon. Friend does not seem to place as much emphasis as I do on the fact that the health authority itself is customer/patient-centred. After April, the whole purpose of a health authority will be to look at the health needs of everyone in a defined geographical area and to devote all its efforts to trying to secure the best possible health care for the resident population for which it is responsible. The idea of a customer relations director in an organisation that is totally directed to that purpose is somewhat otiose.
§ Sir Michael McNair-WilsonMany organisations that do nothing but serve the customer for commercial purposes think that it is best to have a customer relations manager. Why should the health authorities be different? If they did not have to take it upon themselves to assume that they know what the customer wants and that they are always right, they would listen to what the customer says.
§ Mr. DorrellThe difference lies in the phrase "for commercial purposes". A commercial organisation serves the customer, but also has to serve shareholders. That is not the case with a health authority, whose sole task is to use public money to secure the best quality health care for its resident population.
The House heard an interesting discussion between the hon. Member for Makerfield (Mr. McCartney), the hon. Member for Ashfield (Mr. Haynes) and the absent hon. Member for Bradford, South (Mr. Cryer). They convinced themselves that the Government had embarked upon a programme of privatisation of the national health service. None of the hon. Gentlemen explained why, if that was the case, we did not take the opportunity in our White Paper on the future of the NHS to explain such a policy and the reasons for it.
§ Mr. McCartneyWill the Minister give way?
§ Mr. DorrellI have given way a great deal.
§ Mr. McCartneyOn a point of order, Mr. Deputy Speaker. Surely the Minister should not be allowed to attack hon. Members and then to refuse to allow interventions. Let us have a free debate.
§ Mr. Deputy SpeakerOrder. Mr. Dorrell.
§ Mr. DorrellThose three hon. Members satisfied themselves, although I think no other hon. Member, that there was a paper tiger lurking in the bushes—the privatisation of the NHS. They then had a heroic battle in which no doubt they convinced themselves that they were the victors. It was not instructive for any of us.
1182 The regulations represent a major improvement in the way in which the health service is run and everyone who works in the service knows that. The argument about the future of the service is not just about the level of spending. It is also about how best we can provide for the efficient management of the NHS in order to ensure that that money buys the best possible health care for the patient. The Opposition have not taken a single step into that part of the argument. We have heard no proposals from them about how they would ensure maximum improvement and efficiency in the service. The Government proposals will improve efficiency, and I commend them to the House.
§ Mr. Robin CookI beg to ask leave to withdraw the motion.
§ Motion, by leave, withdrawn.
§
Motion made, and Question put,
That an humble Address be presented to Her Majesty, praying that the Regional and District Health Authorities (Membership and Procedure) Regulations 1990 (S.I., 1990, No. 1331), dated 2nd July 1990, a copy of which was laid before this House on 5th July, be annulled.—[Mr. Robin Cook.]
§ The House divided: Ayes 94, Noes 158.
1184| Division No. 319] | [11.29 pm |
| AYES | |
| Abbott, Ms Diane | McAvoy, Thomas |
| Allen, Graham | McCartney, Ian |
| Barnes, Harry (Derbyshire NE) | McFall, John |
| Barnes, Mrs Rosie (Greenwich) | McKay, Allen (Barnsley West) |
| Barron, Kevin | McKelvey, William |
| Bennett, A. F. (D'nt'n & R'dish) | Maclennan, Robert |
| Blunkett, David | Mahon, Mrs Alice |
| Boateng, Paul | Marshall, David (Shettleston) |
| Callaghan, Jim | Marshall, Jim (Leicester S) |
| Campbell, Menzies (Fife NE) | Maxton, John |
| Campbell, Ron (Blyth Valley) | Meale, Alan |
| Campbell-Savours, D. N. | Michael, Alun |
| Canavan, Dennis | Michie, Bill (Sheffield Heeley) |
| Clarke, Tom (Monklands W) | Moonie, Dr Lewis |
| Clay, Bob | Morgan, Rhodri |
| Cohen, Harry | Morley, Elliot |
| Coleman, Donald | Murphy, Paul |
| Cook, Robin (Livingston) | Nellist, Dave |
| Cousins, Jim | O'Brien, William |
| Crowther, Stan | Orme, Rt Hon Stanley |
| Cryer, Bob | Patchett, Terry |
| Cummings, John | Pike, Peter L. |
| Cunliffe, Lawrence | Powell, Ray (Ogmore) |
| Dalyell, Tam | Primarolo, Dawn |
| Darling, Alistair | Robertson, George |
| Dewar, Donald | Ross, Ernie (Dundee W) |
| Dixon, Don | Salmond, Alex |
| Dunnachie, Jimmy | Skinner, Dennis |
| Ewing, Harry (Falkirk E) | Smith, C. (Isl'ton & F'bury) |
| Ewing, Mrs Margaret (Moray) | Steinberg, Gerry |
| Flynn, Paul | Strang, Gavin |
| Foster, Derek | Thomas, Dr Dafydd Elis |
| Fyfe, Maria | Turner, Dennis |
| George, Bruce | Vaz, Keith |
| Griffiths, Win (Bridgend) | Wallace, James |
| Harman, Ms Harriet | Walley, Joan |
| Heal, Mrs Sylvia | Wardell, Gareth (Gower) |
| Hinchliffe, David | Wareing, Robert N. |
| Home Robertson, John | Watson, Mike (Glasgow, C) |
| Hughes, John (Coventry NE) | Welsh, Andrew (Angus E) |
| Hughes, Robert (Aberdeen N) | Williams, Alan W. (Carm'then) |
| Illsley, Eric | Wilson, Brian |
| Ingram, Adam | Winnick, David |
| Jones, Barry (Alyn & Deeside) | Wise, Mrs Audrey |
| Jones, Ieuan (Ynys Môn) | Young, David (Bolton SE) |
| Kennedy, Charles | |
| Leadbitter, Ted | Tellers for the Ayes: |
| Lofthouse, Geoffrey | Mr. Ken Eastham and |
| McAllion, John | Mr. Frank Haynes. |
| NOES | |
| Adley, Robert | Hordern, Sir Peter |
| Alison, Rt Hon Michael | Howarth, G. (Cannock & B'wd) |
| Amess, David | Howell, Ralph (North Norfolk) |
| Arbuthnot, James | Hughes, Robert G. (Harrow W) |
| Arnold, Jacques (Gravesham) | Hunt, Sir John (Ravensbourne) |
| Arnold, Sir Thomas | Hunter, Andrew |
| Ashby, David | Jack, Michael |
| Aspinwall, Jack | Janman, Tim |
| Atkins, Robert | Johnson Smith, Sir Geoffrey |
| Baker, Nicholas (Dorset N) | Jones, Gwilym (Cardiff N) |
| Batiste, Spencer | Jones, Robert B (Herts W) |
| Bellingham, Henry | Jopling, Rt Hon Michael |
| Bennett, Nicholas (Pembroke) | Kellett-Bowman, Dame Elaine |
| Bevan, David Gilroy | King, Roger (B'ham N'thfield) |
| Biffen, Rt Hon John | King, Rt Hon Tom (Bridgwater) |
| Boscawen, Hon Robert | Kirkhope, Timothy |
| Boswell, Tim | Knapman, Roger |
| Bottomley, Peter | Knight, Greg (Derby North) |
| Bottomley, Mrs Virginia | Knight, Dame Jill (Edgbaston) |
| Bowis, John | Lang, Ian |
| Brazier, Julian | Latham, Michael |
| Bruce, Ian (Dorset South) | Lawrence, Ivan |
| Budgen, Nicholas | Lee, John (Pendle) |
| Burns, Simon | Lightbown, David |
| Burt, Alistair | Lord, Michael |
| Butler, Chris | Macfarlane, Sir Neil |
| Carrington, Matthew | MacKay, Andrew (E Berkshire) |
| Carttiss, Michael | McNair-Wilson, Sir Michael |
| Chapman, Sydney | McNair-Wilson, Sir Patrick |
| Chope, Christopher | Malins, Humfrey |
| Clark, Sir W. (Croydon S) | Mans, Keith |
| Clarke, Rt Hon K. (Rushcliffe) | Maples, John |
| Conway, Derek | Martin, David (Portsmouth S) |
| Coombs, Anthony (Wyre F'rest) | Mellor, David |
| Coombs, Simon (Swindon) | Meyer, Sir Anthony |
| Cormack, Patrick | Miller, Sir Hal |
| Currie, Mrs Edwina | Mills, Iain |
| Davies, Q. (Stamf'd & Spald'g) | Mitchell, Sir David |
| Davis, David (Boothferry) | Monro, Sir Hector |
| Day, Stephen | Morris, M (N'hampton S) |
| Devlin, Tim | Morrison, Sir Charles |
| Dicks, Terry | Moss, Malcolm |
| Dorrell, Stephen | Neale, Gerrard |
| Douglas-Hamilton, Lord James | Neubert, Michael |
| Dover, Den | Newton, Rt Hon Tony |
| Dunn, Bob | Nicholson, David (Taunton) |
| Evennett, David | Norris, Steve |
| Fairbairn, Sir Nicholas | Onslow, Rt Hon Cranley |
| Fenner, Dame Peggy | Paice, James |
| Fishburn, John Dudley | Pawsey, James |
| Forsyth, Michael (Stirling) | Porter, David (Waveney) |
| Forth, Eric | Price, Sir David |
| Fox, Sir Marcus | Renton, Rt Hon Tim |
| Franks, Cecil | Ridsdale, Sir Julian |
| Freeman, Roger | Shaw, David (Dover) |
| French, Douglas | Shephard, Mrs G. (Norfolk SW) |
| Fry, Peter | Skeet, Sir Trevor |
| Gardiner, George | Taylor, Ian (Esher) |
| Glyn, Dr Sir Alan | Taylor, John M (Solihull) |
| Goodhart, Sir Philip | Thompson, D. (Calder Valley) |
| Goodlad, Alastair | Thompson, Patrick (Norwich N) |
| Goodson-Wickes, Dr Charles | Thornton, Malcolm |
| Greenway, Harry (Ealing N) | Thurnham, Peter |
| Greenway, John (Ryedale) | Tracey, Richard |
| Gregory, Conal | Tredinnick, David |
| Griffiths, Peter (Portsmouth N) | Trotter, Neville |
| Grylls, Michael | Twinn, Dr Ian |
| Hamilton, Hon Archie (Epsom) | Waddington, Rt Hon David |
| Hamilton, Neil (Tatton) | Walden, George |
| Hanley, Jeremy | Walker, Bill (T'side North) |
| Hannam, John | Ward, John |
| Hargreaves, A. (B'ham H'll Gr') | Watts, John |
| Hargreaves, Ken (Hyndburn) | Wheeler, Sir John |
| Harris, David | Widdecombe, Ann |
| Hawkins, Christopher | Wilkinson, John |
| Hayward, Robert | Winterton, Mrs Ann |
| Hill, James | Winterton, Nicholas |
| Hind, Kenneth | Wood, Timothy |
| Yeo, Tim | Tellers for the Noes: |
| Young, Sir George (Acton) | Mr. Irvine Patnick and |
| Mr. Tom Sackville. |
§ Question accordingly negatived.