Health and Personal Social Services (Northern Ireland)

HC Deb 14 February 1994 vol 237 cc700-22 6.14 pm

The Parliamentary Under-Secretary of State for Northern Ireland (Mr. Tim Smith)

I beg to move, That the draft Health and Personal Social Services (Northern Ireland) Order 1993, which was laid before this House on 9th December, be approved. My noble Friend Baroness Denton, who has responsibility for health and personal social services in Northern Ireland, introduced the order in another place on 31 January and it is my pleasure to introduce it to the House this evening.

The purpose of the draft order is to enable health and social services trusts in Northern Ireland to carry out certain statutory functions which, at the moment, are the legal responsibility of the health and social services boards. The order is a local solution to a local problem. Hon. Members who were present at the Northern Ireland Committee debate on 20 January may recall that some of the issues involved were mentioned on that occasion.

It may be helpful to the House if I comment briefly on the background to the order and the present organisation of the services in the province. Both those points are important if one is to have an understanding of the need for the legislation.

In Northern Ireland, health and personal social services were integrated into one structure in 1973. We have therefore had an integrated service for more than 20 years. During that period, the services have been provided by four health and social services boards. That integrated system has served Northern Ireland well through 20 turbulent years and the people of the Province are—quite justifiably—proud of that unique service. The draft order seeks to preserve that integration and to enable services to continue more or less in their present form. It is needed only to remedy a weakness in the existing law and not because the present services are deficient in any way.

The Government's reforms for health and social services provided for the separation of the purchase and provision of services. The Health and Personal Services (Northern Ireland) Order 1991 redefined the role of the four boards as being responsible, primarily, for assessing the needs of their populations and commissioning services to meet those needs. The order provided for units to be established as health and social services trusts—fully independent of board management, but wholly in the statutory sector.

However, although the 1991 order enabled trusts to be established and allowed boards to contract with them for services, it did not permit trusts to carry out certain functions associated with those services, except for mental health functions, for which specific provision was made. Those functions flow from a range of existing legislation, such as the Children and Young Persons Act 1968 and the Adoption Order 1987. Some are sensitive powers, involving the restriction of civil liberties—the taking of a child into care, for example. That legislative weakness prevents some units, such as those providing personal social services, from becoming fully operational as trusts. The order is concerned with putting that right.

In bringing forward the order, we have aimed to provide a legal framework for the discharge of functions by trusts which ensures clarity about where responsibility lies and secures full accountability for the work undertaken by trusts. Within that framework, the order enables boards, with the approval of the Department of Health and Social Services in Northern Ireland, to delegate certain statutory functions, which will be specified by the Department, to health and social services trusts. The functions involved were set out in the explanatory document published last summer, along with the proposal for legislation. A copy of the draft regulations dealing with them were placed in the Library when the order was laid on 9 December.

The order allows trusts to carry out those functions and makes provision for schemes to be agreed between trusts and boards on the way in which the functions are to be carried out.

Since the proposal for legislation was published last June, many people have voiced concern about its effect on services, particularly in relation to the protection of children. Some have expressed doubts about the accountability of trusts within the new arrangements. Questions about fragmentation and inequality of provision have also been raised.

My noble Friend Baroness Denton and her predecessor Lord Arran considered very carefully the concerns raised and devoted much time and effort to explaining the issues to people. It is fair to say that many of the concerns stemmed from a misunderstanding about the role of trusts and about the new role of the boards to which I have already referred. Perhaps I can clarify these points for the House.

Health and social services trusts are state bodies established firmly within the health and personal social services in Northern Ireland. They are fully accountable for all that they do and they are closely monitored by the Department and by the boards. They are not independent companies and are bound by the same guidance as governs the operation of boards at present.

For their part, the boards—freed from any involvement in the day-to-day management of the services—can concentrate on improving the health and social well-being of their populations through the contracts they agree with trusts and setting the agenda for them in terms of quality of service, standards of care and equity of provision.

The Government accept that people have anxieties and concerns. They are genuinely held, but they have not been ignored. Regardless of which side of the debate one is on, we have one thing in common: concern for the welfare of children and other vulnerable groups in our society.

Rev. Ian Paisley (Antrim, North)

Will the Minister discuss the financial implications of the proposal? The matter has been raised in the Lords and it has also been raised by many people in Northern Ireland. According to the figures that we have been given about the 12 trusts, the chairmen of the trusts will receive £15,000 a year and each of the five board members will receive £5,000 a year. We have been told that that amounts to between £1 million and £2 million which will be required to finance the procedure. Would not that money be better used to keep the present structure, which has provided such a good service to the people of Northern Ireland?

Mr. Smith

I agree that the present structure has provided an excellent service to the people of Northern Ireland. However, there is always room for improvement. The right way to achieve that is by making a clear distinction between purchaser and provider. Of course, the members of those boards and the chairmen will be remunerated, but the costs will not be substantial when one considers the huge scope for securing improvements in value for money and better service delivery to patients. The figures quoted by the hon. Member for Antrim, North (Rev. Ian Paisley) must be placed in the context of total health spending in the Province.

Mr. Eddie McGrady (South Down)

Surely the point made by the hon. Member for Antrim, North should be pursued on the basis that the 12 new quangos are in addition to the existing personnel who will be retained in the various boards dealing with personal and social services? There must be an enormous increase in the establishment costs appertaining to this exercise.

Mr. Smith

I was not seeking to suggest that there was not an increase in costs. I accepted the figures given by the hon. Member for Antrim, North. However, I said that I thought that that cost was fully justified in securing better value for money and better quality of service for patients and other users of the social services. I strongly believe that to be true, just as it is true in the rest of the United Kingdom with regard to the Government's national health service reforms.

Before the interventions, I said that the thing that we have in common is our concern for the welfare of children and other vulnerable groups in our society. For that reason, the trusts and boards concerned have been working very hard to establish procedures that will ensure that those who are entrusted with the discharge of statutory responsibilities at local level will be clear about their role and fully accountable for all that they do.

Baroness Denton has, for her part, met representatives from the British Association of Social Workers to hear at first hand their concerns. She has visited units which are preparing for trust status and she has talked to people who are directly involved in providing services and who are preparing the ground. From the conversations that my noble Friend has had with managers and professionals alike, and on the evidence that she has seen, there can be no doubt that the schemes being developed between boards and trusts will address clearly and comprehensively the key issues that have been raised. Under the terms of the draft order, they will have to be approved by the Department of Health and Social Services.

I shall refer briefly to two other important issues which, although not technically part of the legislation, are intended to underpin it. Trusts which will be providing personal social services will need to have access to expert advice and guidance in providing those services and carrying out the functions that I have mentioned. To ensure that they have that, we are making it a legal requirement for any trust providing those services to appoint a qualified social worker as an executive director. At the same time, we will make it mandatory for each health and social services board to appoint a director of social services if they have not done so already. Guidance on the roles and responsibilities of both posts will be issued.

Those changes taken together represent a significant strengthening of the structures involved in the delivery of personal social services in Northern Ireland. Chief executives of trusts have gone to great pains to build in safeguards for existing social work structures, both organisationally and professionally within trusts.

Rev. Ian Paisley

The Minister has just informed us about the appointment of a full-time, qualified social worker and a director of social services. How much will that add to the present bill?

Mr. Smith

I cannot give the hon. Gentleman a figure, but I should have thought that he would welcome the fact that we are to appoint professionals as executive directors. That directly meets the concern that the management should incorporate at least one person with direct knowledge and a qualification as a social worker.

Mr. Andrew Mackinlay (Thurrock)

What consultation has the Minister initiated, and what observations has he received, in respect of the trade unions which represent the employees in the area of social work about which we are concerned?

Mr. Smith

I mentioned that my noble Friend Baroness Denton had met representatives of the British Association of Social Workers—

Mr. Mackinlay

That is not a trade union.

Mr. Smith

Well, my noble Friend met association representatives. I will let the hon. Gentleman know later whether she met trade union representatives. However, since her appointment, my noble Friend has gone out of her way to meet those who are principally concerned about the implications and consequences of the order.

The order contains three other changes to Northern Ireland health and social services legislation. First, it amends existing law on the audit of health and social services bodies. The law in that area is no more than adequate at present and the order is designed to modernise and strengthen it. Secondly, the order amends the law on the registration of pharmaceutical chemists by requiring people seeking registration to satisfy prescribed conditions as to character, health and other matters. That will bring Northern Ireland legislation into line with that in other countries. Finally, the order repeals an existing provision in relation to the employment of nurses which is no longer needed because of changes in the way in which nurses are recruited and trained.

The proposals are about ensuring that our services in the area are structured and organised in a way that maximises their capacity to respond to the needs of people quickly and effectively while at the same time safeguarding the interests of the public and those vulnerable people in our society who need the protection of the state. I commend the order of the House.

6.29 pm

Mr. William O'Brien (Normanton)

The Parliamentary Under-Secretary of State referred to the Northern Ireland Committee's debate of 20 January. I should like to refer to some of the points that were made by the Minister of State on that occasion. We have been told that the people of Northern Ireland are proud of the existing system. If that is the case, why do the Government want to change it? If the people of Northern Ireland are satisfied with their system, what is the need for this order? I put it to the Under-Secretary and to the House that the intention of the legislation is not to improve health and social services but to fulfil the political dogma of the Conservative party, which is intent on dismantling the national health service.

The Under-Secretary of State referred to a debate that had been held in another place. Hon. Members will know that on that occasion an amendment calling on the Government to withdraw the legislation was defeated only very narrowly. It cannot be right to plough on relentlessly against such opposition from the upper House and against the opposition that will be expressed tonight by Labour and Northern Ireland Members. This order is premature. It should not be before the House, and we shall oppose its substance and the principles that underlie it. I hope that Ministers, rather than driving hon. Members into the Lobbies, will wake up to common sense and withdraw the order.

This legislation, which delegates statutory responsibilities to further private quangos, should not have been introduced in advance of legislation affecting the care of children. The first piece of legislation mentioned in schedule 2 is the Children and Young Persons Act (Northern Ireland) 1968. It is totally unfair and unreasonable that this order should be introduced before the House has had a chance to debate the forthcoming amendment to the legislation on children. We want to know how Parliament will be able to influence the scrutiny of child care in Nothern Ireland. That information will not be forthcoming in advance of the amending legislation to which I have just referred. The order that we are debating now ought to be withdrawn if the Government believe that people should have a say in matters of serious significance to Northern Ireland.

These trusts, to whose creation the Minister of State referred during the meeting of the Northern Ireland Committee on 20 January, will do nothing to improve health care in Northern Ireland. The Minister said: The creation of social services trusts is of particular significance. The management freedoms which come with trust status are designed to devolve decision-making to those responsible for delivering services, offering them the opportunity to be imaginative and responsive to local needs.—[Official Report, Northern Ireland Committee, 20 January 1994; c. 4.] On 19 April 1993—less than 12 months ago—I asked the Secretary of State for Northern Ireland what Department will make the necessary assessments under the community care reforms for people applying for residential arid nursing home care in Northern Ireland? The reply was as follows: Health and social services boards, through their units of management, are responsible for carrying out an assessment of need for any individual who lives within their area who requires community care services, including residential care and nursing home accommodation."—[Official Report, 19 April 1993; Vol. 223, c. 18] Are we to take it from what the Parliamentary Under-Secretary of State has said tonight that that answer will no longer apply and that assessments will now be made by those administering the trusts? In other words, will what we were told 10 months ago be changed by this order? Is this what the Government call forward planning and forward thinking?

Rev. Ian Paisley

Does the hon. Gentleman agree that a right that public representatives enjoy under the current law—the right to question a course of action—is to be removed? Does he agree that the distancing of public representatives from the boards that is taking place already will be increased, thus reducing opportunities to question and to call to account?

Mr. O'Brien

The hon. Gentleman is perfectly correct. The democracy that is necessary in the administration of Northern Ireland's health and personal social services is being further diminished. Local communities will have their input into the question of quality of service reduced further.

The foreword to a document published last year by the Eastern health and social services board says: The future role of the Eastern Health and Social Services Board is to purchase services to meet the health and social care needs of its resident population within the boundaries of Government policy. Chief among these must be the needs of the population illustrated, as far as possible, by objective information, the views of the people themselves, the views of general practitioners and others. Professional advice, particularly from those in the caring professions, must also continue to influence the decisions of the Board in the purchase of health and social services care. In other words, we are witnessing a reduction in the management of the services. Through this order, the people of Northern Ireland are being offered less time spent on patient care and—much worse—pressure on a service that is already under pressure. The Eastern health and social services board has declared its future role as being the provision of services in line with Government policy. This order will reduce the role of the health and social services boards and will result in lessened health and community care services for the people of Northern Ireland.

There will be no difference in the lines of responsibility. The health and social services boards are currently responsible to the Minister and the Department. The new trusts, too, will be responsible to the Minister and the Department. Indeed, the Minister of State told the Northern Ireland Committee: The vast majority of functions to which the hon. Gentleman referred are already carried out by the board staff at local level. The only difference is that the staff carrying them out in future will, in many cases, work for trusts instead of boards, but they will essentially be the same people carrying out the same jobs."—[Official Report, Northern Ireland Committee, 20 January 1994; c. 32.] If the same people will be performing the same jobs and be responsible to the same Minister and boards, why is the order needed? It will only add to the expense of managing Northern Ireland's health and personal social services.

The trusts will be fully accountable to the Department for the discharge of delegated functions, but what will happen with training? At present, the requirement for personal social services training through a working partnership with employers and education institutions provides positive training at all levels. Since 1990, qualifying and post-qualifying social work training throughout the United Kingdom has been delivered through partnerships between employers and teaching institutions. In Northern Ireland, such partnerships currently operate at area health and social services board level, not unit trust level. The Minister should address that point in considering the provision of qualified people. Will trusts be responsible in future?

The people of Northern Ireland do not want the changes that the order will bring. Will the Minister confirm that 95 per cent. of those asked for their opinion of the order opposed it? The order will extend the Tory obsession with privatising and commercialising health and social services care. The Government are using the language of the market place to sell ill health and rationalise the sick. That philosophy underpins the order.

Mr. William Ross (Londonderry, East)

If 95 per cent. of people canvassed were against the order, it would be revealing to know who accounted for the 5 per cent. in favour.

Mr. O'Brien

I assume that they were Government supporters, as is usually the case. Ninety-five people out of every 100 canvassed totally opposed the order. I hope that the Minister will take note of the wishes of the people of Northern Ireland.

The Government seem intent on creating more managerial posts and bureaucracy, rather than more hospital beds. Nothing better illustrates that than the creation of 12 management units providing personal social services. The order will bring Northern Ireland in line with some of the sweeping changes already made in other parts of the United Kingdom.

Mr. Tim Smith

I have been reading the Labour party document "Health 2000". Does not Labour now accept the purchaser-provider split?

Mr. O'Brien

The proposals contained in that document are significantly different from those in the order. We argue for more local input into the future provision of social services. The order will deny local input in health and personal social services care in Northern Ireland. If the Minister accepts our proposals, he should withdraw the order.

The Minister would be the first to agree that there is a vast difference between the regions. In other parts of Britain, social care for the elderly and mentally ill and children involves considerable local input through local authorities. If the Minister has read "Health 2000", he will know that we intend to continue with that approach. In England, locally elected representatives have a say in care provision which directly affects the quality of life of the elderly, children and the mentally ill.

Funding is equally important. It is abundantly clear that in the English regions local authorities are underfunded in the provision of community care. Although it may be the Minister's intention to allow individuals who want to do so to live independently or semi-independently, his promises will be empty if back-up resources are not available to provide the services that the elderly and mentally ill require. Caring for such people in the familiar surroundings of their own homes costs money. If the Government intend to offer wider choice and genuine opportunities to the weaker members of Northern Ireland society, they must be prepared to underpin their stated intentions with adequate resources.

In extending choice, will the new community care trusts in Northern Ireland be instructed, as English local authorities are at present, that a fixed proportion of their funding for the care of the elderly must be directed at providing private care? If so, will the Minister explain how the top-up payments required of close relatives will be obtained? Can the Minister give an assurance that families caring for an elderly parent or other relative who enters a private nursing home will not be turned out of their homes so that the houses can be sold to provide the top-up money required for private nursing care for those whose mental or physical disposition requires it? That is an important matter which the Minister should address. Many people are concerned about the demand for top-up payments for families who live in private sector homes.

In extending the new choice, to which the Minister referred, will he give some indication of how the elderly will be looked after with regard to the financial provisionsin private nursing homes? Will he also give some indication that those who work in the voluntary sector in Northern Ireland, many of whom have a sound record of developing new and important welfare initiatives, will be allowed to continue providing those initiatives? Will they be encouraged to develop those initiatives and innovations in community care into the next century? Will voluntary workers be given the same incentive to do their work under the trusts as they have under the health boards? I make that point specifically because the National Health Service and Community Care Act 1990 has no equivalent in Northern Ireland.

Therefore, I return to the issue of accountability. The Minister, Baroness Denton, recently stated in another place: Accountability is to boards, to the Department and then to me. In other words, accountability is restricted by Government influences. Baroness Denton also said: There is a line to the social work person on the board of the trust; a dotted professional line, and added: If something should go wrong, the trust … will be fully accountable and responsible."—[Official Report, House of Lords, 31 January 1994; Vol. 551, c. 1152] Some red lights are flashing and the Minister should explain what Baroness Denton meant.

We should again consider what the Minister said in the Northern Ireland Committee. He said: The trusts will be fully accountable to the boards and, ultimately, to the Department for the discharge of delegated functions,"—[Official Report, Northern Ireland Committee, 20 January 1994; c. 32.] There is some conflict between the views expressed in Committee and in another place. Therefore, the Minister should clear up some of the misunderstandings that have developed because of the debates on this order. I am afraid that those vague attempts at reassurance do nothing to make the position concerning accountability and ultimate responsibility any clearer.

Will the Minister tell the House who will finally be responsible for the taking of children into care? Who carries the professional responsibilities? Will it lie with the health and social services board or the trust board? Will it ultimately lie with the director of the board or the executive director of the relevant trust? Is the Minister ultimately accountable for the taking of children into care? As I pointed out, we ought to have debated the children's order before the order before us was presented to the House. Since we are seeking to amend the children's order, the Minister should answer those significant questions.

I remind the Minister that the patients and citizens charters, which were launched in a blaze of publicity and have all but fizzled out, emphasised the rights of people to personal services and related needs. How will the citizens charters apply in Northern Ireland? Will the Government make it compulsory for the new trust boards to employ approved social workers to care for the mentally sick and for people with disabilities? Will it be mandatory for the trust boards to employ qualified people in accordance with current legislation or will it be another sacrifice of the standards of so-called safety and efficiency? Will deregulation involving the provision of health and community care apply in Northern Ireland, reducing the quality of service?

There is a genuine and, in our view, justified concern in Northern Ireland about the future provision of personal social services and health care. Since the Conservatives came to power in 1979, one in five hospitals have closed and since 1981, one in three beds in hospitals have been lost. Those figures speak for themselves, but even worse is the £500,000—I am being a little generous to the Minister compared with the figure given by the hon. Member for Antrim, North (Rev. Ian Paisley) earlier—which will be required in order to pay the additional appointed chairman and non-executive members of the trust. That clearly shows that it is not the provision of beds and hospitals or of social workers that is the priority of the Government, but ensuring that bureaucracy in Northern Ireland is built higher and higher.

Salaried Government placemen, instead of treatment for the sick of Northern Ireland seem to be the order of the Minister's presentation. The order does nothing to redress that situation and the national health service has never faced a greater threat than it does today. I urge the House to reject the order, but I also appeal to the Minister to withdraw it before we enter the Lobbies in the light of the points I have made in my short address.

6.56 pm

Sir James Kilfedder (North Down)

I listened to the hon. Member for Normanton (Mr. O'Brien) with great care. He spoke with sympathy and great knowledge of the needs of the people of Northern Ireland. I shall not repeat what he said because I could not do so with the same eloquence.

I intend to vote against the order for a number of reasons, but, because of the lack of time, I cannot list them all. However, all the reasons are valid and they are all important to the people that I represent. The order will be opposed by every representative of Northern Ireland. In view of such unanimity across the political divide in the Province, and in view of the considerable time that the Government spend urging the Northern Ireland politicians to co-operate, they should reward such united opposition to the order by putting it to one side. I join the hon. Member for Normanton in appealing to the Minister to withdraw the order as a gesture of good will to the Ulster people and to the united front presented by Ulster politicians.

According to press reports, the Secretary of State is about to launch—or, perhaps, has launched—another political initiative that entails the creation of a Northern Ireland assembly with power. The ideal time and the proper place for the discussion of the order before us is in such an assembly. In fact, the assembly, when established, will have to examine the health and social services provision in Northern Ireland and may wish to alter radically the present system.

I shall also vote against the draft order because it epitomises the lack of full democracy in the Province. Unlike other parts of the United Kingdom, we are denied the fundamental right to table amendments and to have a proper debate on Second Reading, in Committee, at Report and on Third Reading. Our debate is limited to 90 minutes, which means that I shall have to cut my speech short to allow other hon. Members from Northern Ireland to take part.

In addition, I shall vote against the order not only because I want it to be rejected, but as a protest—the only form of protest that is available to me, as a believer in parliamentary democracy—against the undermining of health and social services provision in my constituency.

I have often made speeches in the House condemning Eastern health board's imposition of major cuts on Ulster hospital in Dundonald, Ards hospital and Bangor hospital. Bangor hospital serves at least 75,000 people, and the population is increasing each year as a result of new housing developments. Bangor should have a fully functioning hospital with acute facilities, a gynaecology ward and a casualty department. Having applied pressure, I was promised that services would be improved, but that promise has not yet been fulfilled. In the name of the people of Bangor and surrounding areas, I again demand the restoration of a fully equipped community hospital.

The order will lead to the creation of 12 trust boards for social services. There is no need for those boards, for reasons already catalogued by the hon. Member for Normanton. They will be costly manifestations of the bureaucracy that now dominates Northern Ireland. The Minister has admitted that the chairman and non-executive members will receive what I consider to be substantial salaries for the number of hours that will be put in—money that is desperately needed for the elderly, the young, the mentally handicapped and others who require community care.

Who allocates these lucrative posts to chairmen of trusts? Over the past year or two, we have seen examples in Northern Ireland—

Rev. Ian Paisley

Such as Albert Reynolds.

Sir James Kilfedder

A more immediate example is the appointment of the chairmen of the tourist board and the electricity company. Those and other appointments were made before privatisation by the Secretary of State or one of his Ministers.

Rev. Ian Paisley

It is patronage.

Sir James Kilfedder

It is patronage on a large scale.

Rev. Ian Paisley

As I am sure the hon. Gentleman is well aware, under the legislation that brought in the iniquitous Anglo-Irish Agreement, the Dublin Government have the right to put forward names for all those posts. It is clear to anyone who examines those names that the current political representation in the House of Commons is not replicated on quangos. The official Unionists are not represented; nor are the popular Unionists, members of my own party or, indeed, members of the SDLP. Those who stand for the Conservative party or the Alliance party and are defeated, however, get on to all the boards.

Sir James Kilfedder

My hon. Friend has stated the position very frankly.

Each chairman is to receive between £15,000 and £20,000 a year. The Public Accounts Committee has expressed anxiety about the manner in which they have been appointed, and about their management of the trusts' affairs.

The Minister said that the present health and social services system had the backing of the people of Northern Ireland, but adduced no evidence to support his claim. I challenge that claim: who supports the order? Which political party in Northern Ireland supports it; which organisation in Northern Ireland supports it; which indivdual supports it? Perhaps the Minister will also tell us whether the Conservative party in Northern Ireland supports it. There is widespread discontent about the present system. The new trusts, and the appointment of chairmen and non-executive members, have added to that grave concern. The system will largely remove the element of accountability to elected representatives of the people.

The people of Bangor have demonstrated conclusively that they want to retain both the Banks residental home for the elderly and Enler house, in Dundonald. Under the new system of trusts, however, the people of Bangor—people who believe in democracy—can be treated with contempt. Where is the democracy that this Parliament epitomises? I ask the Minister to take the order away from the House, and keep it away.

7.5 pm

Mr. William Ross (Londonderry, East)

Two or three speakers have already said pretty much the same; no doubt we shall hear much more of the same before the debate is over.

The order breaks new ground in that, for the first time, trusts are taking responsibility for social services work. We are deeply concerned about that, and feel that it deserves much closer examination than it will receive in an hour and a half. In the other place, Lady Denton said that this was a local solution to a local problem; today, the Minister used the same words. That attracted my attention to the report of the debate in the other place, and I noted that the Minister read out whole slabs of what had been said there. He might at least have made some effort to update his material, in the light of experience.

Neither Lady Denton nor our Minister told us how the "local problem" to which they referred had been created. That might have been enlightening. Both said that the present system had served Northern Ireland very well for 20 years. In that case, why is change now needed? Has the present system been found to be deficient in some respect? Neither Minister suggested that it had, so we must assume that changes in health and social services provision created the "local problem" and that the Government had to make changes as a result.

The people of Northern Ireland have not asked for those changes. They are well aware that democratic input into every aspect of administration in the province has been diminishing steadily for many years. The order will move democratic control from one arm's length to two or three arm's lengths—a serious development that does not sit well with the Government's declared commitment to democracy. This is part of a process that has been going on for far too long, and should have been reversed long ago.

The mere fact that the Government are putting more and more buffers between the people and the delivery of service in itself creates a climate of suspicion, and makes people chary of accepting the Government's view that this scheme will secure public confidence. That is pie in the sky: in reality, the Government are not very widely trusted in Northern Ireland, where people feel that they are being used as guinea pigs in preparation for what will happen elsewhere in the United Kingdom.

The House will recall that when the Government introduced the community charge—to give it its proper title rather than its more popular description—the rest of the United Kingdom was used as a guinea pig. They did not get around to introducing the community charge in Northern Ireland as it disappeared before it got that far—thank God that we had the wit to object to it on various grounds. We were right to object and we have been right about many things relating to Northern Ireland. We now say that this is not the right time for the order—in fact, it may never be the right time.

We want answers to a number of questions. What is to be the legal status of the trusts? It is not spelled out as clearly as it should be. If the Government are to embark on this confidence-building exercise, such issues should be spelt out. Are the trusts to be agents of the Government or of the boards? For whom are they acting? How is the perforance of their duties to be monitored?

In one respect, the Minister went some way to clearing up an issue that was troubling me. He said that social workers would be introduced at trust level. Surely they will be doing a job that is already being done by someone else, so who will lose their jobs? If no one is to lose his job, why do we need the new folk? The Government should have done a great deal of thinking before the order got this far, but it seems that that was not the case.

The order will affect very vulnerable groups. One has only to read schedule 2 to see who will be affected. Schedule 2 states that the order will repeal various provisions of, among others the Children and Young Persons Act (Northern Ireland) 1968, the Health and Personal Social Services (Northern Ireland) Order 1972, the Nurses, Midwives and Health Visitors Act 1979, the Mental Health (Northern Ireland) Order 1986, the Adoption (Northern Ireland) Order 1987 and the Disabled Persons (Northern Ireland) Act 1989. These Acts and orders deal with some of the most vulnerable groups in society.

I do not think that this is the way to proceed. Baroness Denton made it perfectly clear in another place that the functions that will be transferred to the trusts flowed from the legislation that I have cited. When people on the ground realise what is happening, their distrust of the Government's intentions will be greatly increased.

Article 92B deals with the improvement of the economy, services and so on. It states: The Department may appoint auditors to undertake comparative or other studies to promote economy, efficiency and effectiveness in the provision of services. The first issue to be studied is the question of how effective, efficient and economical the present services are so that we shall at least have something with which to compare the new body when it is, unfortunately, established.

It is clear that the Government are intent on introducing the order and will whip their cannon fodder through the Lobbies this evening. Their cannon fodder comprises hon. Members who have not heard the debate and who know nothing about it. If they did, successive Governments would probably have suffered more defeats. When dealing with vulnerable groups, economics is surely not our prime concern—or is it? If we think only of economics, those who have been disadvantaged for whatever reason will suffer grievously. Such folk should not be treated as mere chattels. We are not talking about the efficiency of the provision of goods or groceries; we are considering the services that are to be provided for vulnerable people.

Social services provision in Northern Ireland has been integrated and has worked well for 20 years but is now being deliberately fragmented. I see no good reason for that. If the order is passed, as I fear it will be, we need a truly independent and highly critical element—a bit of sand—to be introduced into the works. We need to ask the nasty questions which far too many people are willing to brush under the carpet.

The Government have set up shadow trusts and have proceeded as if the opinion of the House did not matter, because they know that they can win the necessary majority. They have also appointed the shadow staff. I wonder whether they are already being paid—I assume that they are. We are aware of the cost of the salaries alone, but that is not the only expenditure that will arise. A new bureaucracy is being created which must duplicate the existing system. If it does not, people in post will have to get the sack, no doubt with very large redundancy payments which are not mentioned in the order.

Article 6 deals with chemists. Why is the article included? Is this merely a convenient vehicle? What is the purpose of article 6? Why are these changes being made? The Minister should say a word about them.

My final comments relate to the need for proper ministerial accountability to the House or to the elected representatives of the people of Northern Ireland. The legislation highlights yet again the need for proper legislative processes in the House. Despite his chattering, the Minister knows perfectly well that if the order had to be dealt with in Committee, and if it were amendable, and if the Government had to answer probing questions and provide for Northern Ireland the information that they are required to give on legislation for other parts of the United Kingdom, the Government would have more explaining to do than could possibly be extracted from them in a one-and-a-half-hour debate.

Today's proceedings also highlight the need for a Select Committee on Northern Ireland—

Mr. Raymond S.Robertson (Aberdeen, South)

indicated assent.

Mr. Ross

I am glad to see the hon. Gentleman nodding.

The Government will no doubt have the support of the Labour party. If members of the Social Democratic and labour party catch your eye, Mr. Deputy Speaker, they will also complain that they are unable to ask probing questions to find out what is happening. I advise the Labour party and the SDLP not to throw away this opportunity but to join those of us who oppose the order. Of course, a Bill would have been most welcome, but that is an idea to be pursued at some other time.

7.17 pm

Rev. Ian Paisley (Antrim, North)

There are some issues to which we are all anxious to hear the Minister's reply. Those of us who have read the record of the proceedings in another place discovered that pertinent questions were asked and reference was made to a debate in the Northern Ireland Committee. It was reported that there was a consensus among the political parties about the issues that were causing grave concern to the people of Northern Ireland.

Will the Minister tell the House who responded when the draft order was published and what was their response? If 95 per cent. of the responses were against the order, should not that have been a warning bell to cease pressing ahead with it, or is the consultation process a charade and a farce?

The Minister has recently been appointed and we wish him well in his task. He may not believe this now, but when he has been in his job for longer and when he has listened to the people of Northern Ireland, he will find that many of them, including members of his party, have grave concerns about meaningless consultation. People may marshal their facts and lobby a Minister, who will listen but not heed anything they say because the decision has already been made. When Government Departments continue to behave in that manner, it causes grave resentment and bitterness in the hearts of people.

Why have a consultation period and ask people to make representations if, when 95 per cent. of people say no to a proposal, the Government say yes? The Minister's party preaches to us that it would be wonderful if we could only get the elected representatives of the people of Northern Ireland to show unity. What is the Government response when Northern Ireland Members, whose opinions are diverse on many matters and between whom an unbridgeable and wide gulf exists on others, come together and agree on a proposal? They use their majority in the House to thumb their nose at the unanimous opinion of Ulster representatives and proceed with business. That is not the way to develop good relations in Northern Ireland and to give people confidence in the democratic process.

Accountability concerns all hon. Members and it has been mentioned in every speech tonight. The Minister's noble Friend spoke on the proposal in another place and I trust that he wii interpret what she meant, because I do not know what she meant. She said: Accountability is to boards, to the department and then to me. That position does not change. There is another line in the structure. What did she mean by that? Does the line of accountability run from the boards to the Department and then to her? If so, why did she mention another line in the structure? Why did she not say that the line of accountability ran from the trusts, the boards, the Department and then to her? She left out trusts, but she described another line: There is a line to the social work person on the board of the trust; a dotted professional line, which is of benefit in this case."—[Official Report, House of Lords, 31 January 1994; Vol. 551, c. 1152.] What has that to do with accountability? Will the trust be accountable in the same way as the boards, the Department and the Minister? We want that question answered tonight.

Hon. Members are aware that the taking of children into care is a serious matter. We have received phone calls from distracted parents saying that they have had domestic trouble and that their children have been "lifted", and that no one will now talk to them. Will we be able to discuss such matters with anyone? Has the line of accountability moved so far that there will be no way of bridging the gulf?

Dr. Joe Hendron (Belfast, West)

Does the hon. Gentleman agree that it seems crazy and foolish for the House to be discussing this order today when on Thursday we shall discuss the proposal for a Children (Northern Ireland) Order? Many activities of the proposed trusts will be to do with the care of children. As we have not sorted out the proposals on the care of children, why should the order be passed tonight?

Rev. Ian Paisley

I agree with the hon. Gentleman. It would have been better to put the horse before the cart. The best way of achieving that would be to withdraw the order, allow us to debate the other order and then return to this matter. I do not know what the Government were up to when they decided to debate the order today. Perhaps they decided that, as the House would be dealing with orders all day, they could throw in another for discussion by Northern Ireland Members, who would be present to discuss the order on the airport.

They may have done it for convenience, but it is not convenient to those hon. Members who work in difficult circumstances that are unknown to Ministers and who are the only elected representatives in contact with the Government. We have councils in Northern Ireland, but they have relatively little power. We are the elected representatives and we have to carry out all the duties that councillors on this side of the water carry out. We have to do everything and the Minister should help the public's representatives to stand up for their constituents and to bring their constituents' complaints to them as part of the process of accountability.

The Minister's noble Friend said that a trust was a "statutory body". Would the Government define that? Do the inverted commas around those words mean they are not really statutory bodies or that they have a higher breeding? Perhaps the Minister will explain the standing of these organisations.

Seven of the units will work in areas that have no acute hospital services and only five will work in areas that have acute hospital services. We do not know for how long those five areas will have acute hospital services. We have heard a cry from Bangor loud and clear tonight. I could raise a cry from the North Antrim hills and from the Lame area, which has been brought to the House's attention by the area's representative and myself on numerous occasions. We can all cry about what has happened to our hospital services. Will the Minister tell us what accountability we can expect?

The Minister in the other place continued: The draft order seeks to preserve this integration and to enable services to continue more or less in their present form."—[Official Report, House of Lords, 31 January 1994; Vol. 551, c. 1125.] I do not understand that, because this is indeed a real change that demands the appointment of a chairman, executive members, a director and a social service worker. As the hon. Member for Londonderry, East (Mr. Ross) said, there will inevitably be redundancies. Where will they begin and where will they end? We cannot establish the new structure without redundancies. The integrated system that we have at present is perfectly good and I do not see why we have to inject into it a new arrangement altogether.

Those are some of the questions to which the order gives rise. I have been able to refer to very few of the issues because our time is limited and I join my hon. Friend the Member for North Down (Sir J. Kilfedder) in saying that matters as serious as this, which have a bearing on the family and the civil liberty of the subject, should be discussed in a debate on a proper Bill, which can be amended. We cannot amend this order; we can only vote against it. That is not the way in which business should be conducted.

The Minister would do well to heed my advice tonight. He would then be lauded by the people who thought it worth while to make representations to him about their objections to the order, and by the people of Northern Ireland and their representatives in this House, all of whom are saying, "Take this order back. Let us have a debate on the important order that is to be considered by the Northern Ireland Committee and come back to this order when we have dealt with that." That, more than anything else that the Government could do at the moment, would inspire hope and confidence in democratic principles. This is a personal matter—it has to do with persons, children, families and welfare. Let the Minister be a man tonight. Let him stand up and say, "Yes, I will consider the order further and withdraw it in the meantime."

7.31 pm

Dr. Joe Hendron (Belfast, West)

As someone who has spent the past 30 years in primary health care in the constituency of Belfast, West, let me first pay tribute to those involved in community care not only in that territory but throughout Northern Ireland. The past 20 years have been very difficult for all of them—especially for social workers who have to implement much of the legislation. I pay tribute to social workers, community and psychiatric nurses, medical practitioners and ordinary community workers on the ground who are not necessarily professionals.

The order has been introduced becasue the legislation introduced in 1991 was inadequate. We know about the trusts that we already have and about the trouble in relation to various hospitals, although that is not relevant tonight.

Like other hon. Members, I have studied the speech of the Minister responsible for health in the other place. On 31 January, Baroness Denton said: Since the proposal for legislation was published last June many people have voiced anxieties about its effect on services, particularly in relation to those for children. Children are the most important subject that we are discussing tonight.

Baroness Denton continued: Some have expressed doubts about the accountability of trusts within the new arrangements. Questions about fragmentation and inequality of provision have been raised. My noble friend and predecessor and, more recently, I have considered very carefully the anxieties raised and have devoted much time and effort to listening and then explaining the issues. I have devoted a fair amount of time to reading Baroness Denton's speech to establish exactly what she proposes.

The Minister's speech continued: I think it is fair to say that many of the anxieties expressed stemmed from a misunderstanding of the role of trusts, and perhaps t can clarify that point. Health and social services trusts are state bodies, established firmly within the health and personal social services in Northern Ireland … They are not independent companies and are bound by the same guidance and directions that govern the operation of health and social services boards at present. Like my noble predecessor, I recognise that people have anxieties". That is true: all the people of Northern Ireland and all the professionals have great anxieties about the proposals. I appreciate their concerns. They are genuinely held, but they have not been ignored. Regardless of which side of the debate we are on, we have one interest in common—the welfare of children and other vulnerable groups in our society. For that reason, the shadow trusts and boards concerned have been working very hard"— here are the key words— to establish procedures which will ensure that those who are entrusted with the discharge of statutory responsibilities at local level will be clear about their role and fully accountable for all that they do."—[Official Report, House of Lords, 31 January 1994; Vol. 551, c, 1125–26.] Baroness Denton used the words "establish procedures", but I am certainly not aware of any procedures that have been established. Earlier today I attended a meeting of the Eastern health and social services board to discuss the order. The hon. Members for Mid-Ulster (Rev. William McCrea), for Belfast, South (Rev. Martyn Smyth) and the representative of the Alliance party were also there, as were representatives of the social work and legal professions and of Queen's university.

As the hon. Member for Antrim, North (Rev. Ian Paisley) said earlier, the cart is being put before the horse. Some of the most important legislative proposals are contained in the Children (Northern Ireland) Order, which we are to discuss on Thursday. Not all the aspects of that proposal have been worked out. We shall have to address a great many questions to do with children in need and in care, sexual or physical abuse, and children who are in some way involved with paramilitary people. All those matters will have to be dealt with under the Children (Northern Ireland) Order, yet the trusts dealt with in the order before the House tonight will have to implement those provisions.

Baroness Denton and Baroness Faithfull both referred to accountability. Where is the accountability? We all know that, if a child tragically dies, everyone asks, "Where is the social worker? When did he or she last call?" Who should those on the ground speak to and seek guidance from? Is it the trusts? I am well aware that there will be a qualified social worker on the trusts. We must also consider the accountability of the trusts to the four boards and of the four boards to the management executive or the Department and eventually the Minister.

Rev. Martin Smyth (Belfast, South)

We are told that procedures have been put in place. Does the hon. Gentleman agree that there is great concern that, although a social worker is to serve on the directorate, there is no clear line management right down to grass roots level?

Dr. Hendron

I thank the hon. Gentleman for that remark. There is no line management. I am not criticising the excellent professionals involved in shadow trusts because they themselves have not been given guidance. The boards do not seem to know where they are. As regards the Children (Northern Ireland) Order, anyone who has time to attend the Committee on Thursday—which I understand will sit for at least four hours—may glean some understanding of how complicated the problem is.

Another aspect relevant to the debate tonight and even more relevant to that on Thursday is the role of the police. Northern Ireland has many problems, similar to those in Britain but exacerbated by violence and by the fact that we have so many one-parent families. Children go before the courts, and the police are often involved. If we are to develop a comprehensive strategy for children and young poeple, we must involve the police. How on earth will we bring together the police force right across the north of Ireland, the 12 new trusts and four boards?

What we really need is a comprehensive system for dealing with child care. I sincerely believe—I have studied the order carefully—that it is a grave mistake on the part of Government to move it this evening. I do not want to repeat what other hon. Members have said, but I pay tribute to the British Association of Social Workers, Health Care in Northern Ireland, Barnardo's and various other bodies which have briefed us for some time. I ask the Minister to withdraw the order.

7.39 pm

Mr. Tim Smith

Much of the debate has focused on trusts. To some extent, we have had a rerun of the debate that took place in 1991 on the original order. There is a misunderstanding about the scope of the order. It is not unimportant, but it is relatively narrow. There was a misunderstanding by quite a number of those who responded during consultation who were inclined to criticise the concept of the trusts.

The concept of trusts in Northern Ireland was accepted when the House approved the 1991 order. That order provides for a clear distinction between the purchaser and provider and for the delegation of services from boards to trusts. What it does not do is provide for delegation of all functions of boards to trusts—only for some of them. I explained that mental health functions were transferred, but many other functions were not. I think that that was because at the time we were largely focusing on hospital trusts and not on the possibility of integrated trusts—combined health and personal social services trusts.

Frankly, it will simply not be possible for the trusts to operate most efficiently if those functions are not transferred to them. I am sorry that there has been a misunderstanding about that point. There has not been a deliberate attempt at obfuscation. The matter is relatively straightforward if the principle on which the 1991 order is based is accepted.

Dr. Hendron

The Minister could resolve many of our problems if he explained in simple language. If there is non-delivery of a service within the ambit of the order, who is responsible? Will it be the trust, the board, the Department or the Minister, all four, or any of them?

Mr. Smith

I can deal with that because a number of hon. Members raised the question of accountability. It is important. The position is no different in England and Wales, where we have trusts. The trusts are responsible for the delivery of the service and they are accountable, but there is a clear line of accountability from the trusts—[HON. MEMBERS: "To whom?"' The chief executive. I would normally expect, if I had a complaint about the operation of a health service trust in my constituency, to write initially to the chief executive. If I was not satisfied with the reply, I would take it to a higher level. The higher level goes from the trust to the board, to the Department and, finally, to the Minister in charge of the health service. That seems to be straightforward.

Rev. Martin Smyth

This is an important point. As I understand it, health trusts are to provide the service and the health authorities purchase the service. In Northern Ireland, the community trusts will be responsible not only for providing services but for purchasing the service. There is a dichotomy. It is bureaucratic logic going astray to extend it to community trusts.

Mr. Smith

The whole point of the order is to achieve a total split between purchaser and provider. That is why we are proposing in it to transfer certain functions from boards to trusts. We shall achieve a total transfer only if we accept the order, otherwise we shall be left with something of a halfway house which will not enable the trusts that are due to come into operation on 1 April to operate satisfactorily. I am sorry that it has been so difficult to explain all this, but I suspect that it is based on the fact that some people have a misconception about what trusts are really about. They are statutory public bodies. There is no question of them having any other constitutional status. They will be fully accountable for their actions and will be fully accountable to the boards, the Department and the Minister. It is vital that we should make the change in the order. I commend it to the House.

It being one and a half hours after the commencement of proceedings on the motion, MR. DEPUTY SPEAKER proceeded to put forthwith the Question necessary to dispose of them, pursuant to order [11 February].

The House divided: Ayes 296, Noes 266.

Division 122]	[7.44 pm
AYES
Ainsworth, Peter (East Surrey)	Currie, Mrs Edwina (S D'by'ire)
Aitken, Jonathan	Curry, David (Skipton & Ripon)
Alexander, Richard	Davies, Quentin (Stamford)
Alison, Rt Hon Michael (Selby)	Davis, David (Boothferry)
Allason, Rupert (Torbay)	Day, Stephen
Ancram, Michael	Deva, Nirj Joseph
Arbuthnot, James	Dickens, Geoffrey
Arnold, Jacques (Gravesham)	Dicks, Terry
Arnold, Sir Thomas (Hazel Grv)	Dorrell, Stephen
Ashby, David	Douglas-Hamilton, Lord James
Aspinwall, Jack	Dover, Den
Atkins, Robert	Duncan, Alan
Atkinson, David (Bour'mouth E)	Duncan-Smith, Iain
Atkinson, Peter (Hexham)	Dunn, Bob
Baker, Rt Hon K. (Mole Valley)	Durant, Sir Anthony
Baker, Nicholas (Dorset North)	Dykes, Hugh
Baldry, Tony	Eggar, Tim
Banks, Matthew (Southport)	Elletson, Harold
Banks, Robert (Harrogate)	Emery, Rt Hon Sir Peter
Bates, Michael	Evans, David (Welwyn Hatfield)
Batiste, Spencer	Evans, Jonathan (Brecon)
Bellingham, Henry	Evans, Roger (Monmouth)
Bendall, Vivian	Evennett, David
Beresford, Sir Paul	Faber, David
Biffen, Rt Hon John	Fabricant, Michael
Blackburn, Dr John G.	Fenner, Dame Peggy
Bonsor, Sir Nicholas	Field, Barry (Isle of Wight)
Booth, Hartley	Fishburn, Dudley
Boswell, Tim	Forman, Nigel
Bottomley, Peter (Eltham)	Forsyth, Michael (Stirling)
Bottomley, Rt Hon Virginia	Forth, Eric
Bowden, Andrew	Fox, Dr Liam (Woodspring)
Bowis, John	Fox, Sir Marcus (Shipley)
Boyson, Rt Hon Sir Rhodes	Freeman, Rt Hon Roger
Brandreth, Gyles	French, Douglas
Brazier, Julian	Gale, Roger
Bright, Graham	Gallie, Phil
Browning, Mrs. Angela	Gardiner, Sir George
Bruce, Ian (S Dorset)	Garel-Jones, Rt Hon Tristan
Burns, Simon	Gamier, Edward
Burt, Alistair	Gill, Christopher
Butler, Peter	Gillan, Cheryl
Butterfill, John	Goodlad, Rt Hon Alastair
Carlisle, John (Luton North)	Goodson-Wickes, Dr Charles
Carlisle, Kenneth (Lincoln)	Gorman, Mrs Teresa
Carrington, Matthew	Gorst, John
Carttiss, Michael	Grant, Sir A. (Cambs SW)
Cash, William	Greenway, Harry (Ealing N)
Channon, Rt Hon Paul	Greenway, John (Ryedale)
Churchill, Mr	Griffiths, Peter (Portsmouth, N)
Clappison, James	Grylls, Sir Michael
Clark, Dr Michael (Rochford)	Gummer, Rt Hon John Selwyn
Clarke, Rt Hon Kenneth (Ruclif)	Hague, William
Clifton-Brown, Geoffrey	Hamilton, Rt Hon Sir Archie
Colvin, Michael	Hamilton, Neil (Tatton)
Congdon, David	Hampson, Dr Keith
Conway, Derek	Hanley, Jeremy
Coombs, Anthony (Wyre For'st)	Hannam, Sir John
Coombs, Simon (Swindon)	Hargreaves, Andrew
Cope, Rt Hon Sir John	Harris, David
Cormack, Patrick	Haselhurst, Alan
Couchman, James	Hawkins, Nick
Cran, James	Hawksley, Warren

Hayes, Jerry	Oppenheim, Phillip
Heald, Oliver	Ottaway, Richard
Heathcoat-Amory, David	Page, Richard
Hendry, Charles	Paice, James
Heseltine, Rt Hon Michael	Patnick, Irvine
Hicks, Robert	Pattie, Rt Hon Sir Geoffrey
Higgins, Rt Hon Sir Terence L.	Pawsey, James
Hill, James (Southampton Test)	Peacock, Mrs Elizabeth
Hogg, Rt Hon Douglas (G'tham)	Pickles, Eric
Horam, John	Porter, Barry (Wirral S)
Hordem, Rt Hon Sir Peter	Porter, David (Waveney)
Howard, Rt Hon Michael	Portillo, Rt Hon Michael
Howarth, Alan (Strat'rd-on-A)	Rathbone, Tim
Howell, Rt Hon David (G'dford)	Redwood, Rt Hon John
Howell, Sir Ralph (N Norfolk)	Renton, Rt Hon Tim
Hughes Robert G. (Harrow W)	Richards, Rod
Hunt, Rt Hon David (Wirral W)	Riddick, Graham
Hunt, Sir John (Ravensboume)	Robathan, Andrew
Hunter, Andrew	Roberts, Rt Hon Sir Wyn
Jack, Michael	Robertson, Raymond (Ab'd'n S)
Jackson, Robert (Wantage)	Robinson, Mark (Somerton)
Jenkin, Bernard	Roe, Mrs Marion (Broxboume)
Jessel, Toby	Rowe, Andrew (Mid Kent)
Johnson Smith, Sir Geoffrey	Rumbold, Rt Hon Dame Angela
Jones, Gwilym (Cardiff N)	Ryder, Rt Hon Richard
Jones, Robert B. (W Hertfdshr)	Sackville, Tom
Jopling, Rt Hon Michael	Sainsbury, Rt Hon Tim
Kellett-Bowman, Dame Elaine	Scott, Rt Hon Nicholas
Key, Robert	Shaw, David (Dover)
King, Rt Hon Tom	Shaw, Sir Giles (Pudsey)
Kirkhope, Timothy	Shephard, Rt Hon Gillian
Knapman, Roger	Shepherd, Colin (Hereford)
Knight, Mrs Angela (Erewash)	Shepherd, Richard (Aldridge)
Knight, Greg (Derby N)	Shersby, Michael
Knight, Dame Jill (Bir'm E'st'n)	Sims, Roger
Knox, Sir David	Smith, Sir Dudley (Warwick)
Kynoch, George (Kincardine)	Smith, Tim (Beaconsfield)
Lait, Mrs Jacqui	Soames, Nicholas
Lamont, Rt Hon Norman	Speed, Sir Keith
Lang, Rt Hon Ian	Spicer, Sir James (W Dorset)
Lawrence, Sir Ivan	Spicer, Michael (S Worcs)
Legg, Barry	Spink, Dr Robert
Leigh, Edward	Spring, Richard
Lennox-Boyd, Mark	Sproat, Iain
Lester, Jim (Broxtowe)	Squire, Robin (Hornchurch)
Lidington, David	Stanley, Rt Hon Sir John
Lightbown, David	Steen, Anthony
Lilley, Rt Hon Peter	Stephen, Michael
Lloyd, Rt Hon Peter (Fareham)	Stern, Michael
Lord, Michael	Stewart, Allan
Luff, Peter	Streeter, Gary
Lyell, Rt Hon Sir Nicholas	Sumberg, David
MacGregor, Rt Hon John	Sweeney, Walter
MacKay, Andrew	Sykes, John
Maclean, David	Tapsell, Sir Peter
McNair-Wilson, Sir Patrick	Taylor, Ian (Esher)
Madel, Sir David	Taylor, John M. (Solihull)
Maitland, Lady Olga	Taylor, Sir Teddy (Southend, E)
Malone, Gerald	Temple-Morris, Peter
Mans, Keith	Thomason, Roy
Marland, Paul	Thompson, Sir Donald (C'er V)
Marlow, Tony	Thompson, Patrick (Norwich N)
Marshall, John (Hendon S)	Thornton, Sir Malcolm
Martin, David (Portsmouth S)	Thumham, Peter
Mates, Michael	Townend, John (Bridlington)
Mawhinney, Rt Hon Dr Brian	Townsend, Cyril D. (Bexl'yh'th)
Merchant, Piers	Tracey, Richard
Mills, Iain	Trend, Michael
Mitchell, Andrew (Gedling)	Twinn, Dr Ian
Moate, Sir Roger	Vaughan, Sir Gerard
Moss, Malcolm	Viggers, Peter
Needham, Richard	Waldegrave, Rt Hon William
Nelson, Anthony	Walden, George
Neubert, Sir Michael	Walker, Bill (N Tayside)
Newton, Rt Hon Tony	Waller, Gary
Nicholls, Patrick	Ward, John
Nicholson, David (Taunton)	Wardle, Charles (Bexhill)
Nicholson, Emma (Devon West)	Waterson, Nigel
Norris, Steve	Watts, John
Onslow, Rt Hon Sir Cranley	Wells, Bowen

Whitney, Ray	Wolfson, Mark
Whittingdale, John	Wood, Timothy
Widdecombe, Ann	Yeo, Tim
Wiggin, Sir Jerry
Wilkinson, John	Tellers for the Ayes:
Willetts, David	Mr. Sydney Chapman and Mr. Michael Brown.
Wilshire, David

NOES
Abbott, Ms Diane	Dunwoody, Mrs Gwyneth
Adams, Mrs Irene	Eagle, Ms Angela
Ainger, Nick	Eastham, Ken
Ainsworth, Robert (Cov'try NE)	Enright, Derek
Allen, Graham	Etherington, Bill
Anderson, Donald (Swansea E)	Evans, John (St Helens N)
Anderson, Ms Janet (Ros'dale)	Ewing, Mrs Margaret
Armstrong, Hilary	Fatchett, Derek
Banks, Tony (Newham NW)	Faulds, Andrew
Barnes, Harry	Field, Frank (Birkenhead)
Barron, Kevin	Fisher, Mark
Battle, John	Flynn, Paul
Beith, Rt Hon A. J.	Forsythe, Clifford (Antrim S)
Bell, Stuart	Foster, Rt Hon Derek
Benn, Rt Hon Tony	Foulkes, George
Bennett, Andrew F.	Fraser, John
Benton, Joe	Fyfe, Maria
Bermingham, Gerald	Galbraith, Sam
Berry, Dr. Roger	Galloway, George
Betts, Clive	Gapes, Mike
Blair, Tony	Garrett, John
Boateng, Paul	George, Bruce
Boyes, Roland	Gerrard, Neil
Bradley, Keith	Gilbert, Rt Hon Dr John
Bray, Dr Jeremy	Godman, Dr Norman A.
Brown, Gordon (Dunfermline E)	Godsiff, Roger
Brown, N. (N'c'tle upon Tyne E)	Golding, Mrs Llin
Burden, Richard	Gordon, Mildred
Byers, Stephen	Graham, Thomas
Caborn, Richard	Grant, Bernie (Tottenham)
Callaghan, Jim	Griffiths, Win (Bridgend)
Campbell, Mrs Anne (C'bridge)	Grocott, Bruce
Campbell, Menzies (Fife NE)	Gunnell, John
Campbell, Ronnie (Blyth V)	Hain, Peter
Campbell-Savours, D. N.	Hall, Mike
Canavan, Dennis	Hanson, David
Cann, Jamie	Hardy, Peter
Carlile, Alexander (Montgomry)	Hattersley, Rt Hon Roy
Chisholm, Malcolm	Henderson, Doug
Clapham, Michael	Hendron, Dr Joe
Clark, Dr David (South Shields)	Heppell, John
Clarke, Eric (Midlothian)	Hill, Keith (Streatham)
Clarke, Tom (Monklands W)	Hinchliffe, David
Clelland, David	Hogg, Norman (Cumbernauld)
Clwyd, Mrs Ann	Home Robertson, John
Coffey, Ann	Hood, Jimmy
Connarty, Michael	Hoon, Geoffrey
Cook, Frank (Stockton N)	Howarth, George (Knowsley N)
Cook, Robin (Livingston)	Howells, Dr. Kim (Pontypridd)
Corbett, Robin	Hoyle, Doug
Corbyn, Jeremy	Hughes, Kevin (Doncaster N)
Corston, Ms Jean	Hughes, Robert (Aberdeen N)
Cousins, Jim	Hughes, Simon (Southward)
Cox, Tom	Hutton, John
Cryer, Bob	Illsley, Eric
Cummings, John	Ingram, Adam
Cunliffe, Lawrence	Jackson, Glenda (H'stead)
Cunningham, Jim (Covy SE)	Jackson, Helen (Shet'ld, H)
Dafis, Cynog	Jamieson, David
Dalyell, Tarn	Janner, Greville
Darling, Alistair	Jones, Barry (Alyn and D'side)
Davidson, Ian	Jones, leuan Wyn (Ynys Môn)
Davies, Bryan (Oldham C'tral)	Jones, Lynne (B'ham S O)
Davies, Rt Hon Denzil (Llanelli)	Jones, Martyn (Clwyd, SW)
Davies, Ron (Caerphilly)	Jowell, Tessa
Davis, Terry (B'ham, H'dge H'l)	Kaufman, Rt Hon Gerald
Dewar, Donald	Keen, Alan
Dixon, Don	Kennedy, Jane (Lpool Brdgn)
Donohoe, Brian H.	Khabra, Piara S.
Dowd, Jim	Kilfedder, Sir James
Dunnachie, Jimmy	Kilfoyle, Peter

Kinnock, Rt Hon Neil (Islwyn)	Pope, Greg
Kirkwood, Archy	Powell, Ray (Ogmore)
Leighton, Ron	Prentice, Ms Bridget (Lew'm E)
Lestor, Joan (Eccles)	Prentice, Gordon (Pendle)
Lewis, Terry	Prescott, John
Litherland, Robert	Primarolo, Dawn
Livingstone, Ken	Purchase, Ken
Lloyd, Tony (Stretford)	Quin, Ms Joyce
Llwyd, Elfyn	Radice, Giles
Loyden, Eddie	Randall, Stuart
Lynne, Ms Liz	Raynsford, Nick
McAllion, John	Redmond, Martin
McAvoy, Thomas	Reid, Dr John
McCartney, Ian	Rendel, David
McCrea, Rev William	Robertson, George (Hamilton)
Macdonald, Calum	Robinson, Geoffrey (Co'try NW)
McFall, John	Robinson, Peter (Belfast E)
McGrady, Eddie	Roche, Mrs. Barbara
McKelvey, William	Rogers, Allan
Mackinlay, Andrew	Rooker, Jeff
McLeish, Henry	Rooney, Terry
McMaster, Gordon	Ross, Ernie (Dundee W)
McNamara, Kevin	Ross, William (E Londonderry)
McWilliam, John	Rowlands, Ted
Madden, Max	Sedgemore, Brian
Maddock, Mrs Diana	Shearman, Barry
Maginnis, Ken	Shore, Rt Hon Peter
Mahon, Alice	Short, Clare
Mandelson, Peter	Simpson, Alan
Marek, Dr John	Skinner, Dennis
Marshall, David (Shettleston)	Smith, Andrew (Oxford E)
Marshall, Jim (Leicester, S)	Smith, C. (Isl'ton S & F'sbury)
Martin, Michael J. (Springbum)	Smith, Llew (Blaenau Gwent)
Martlew, Eric	Smyth, Rev Martin (Belfast S)
Maxton, John	Snape, Peter
Meacher, Michael	Soley, Clive
Meale, Alan	Spearing, Nigel
Michael, Alun	Spellar, John
Michie, Bill (Sheffield Heeley)	Squire, Rachel (Dunfermline W)
Milburn, Alan	Steinberg, Gerry
Miller, Andrew	Stevenson, George
Mitchell, Austin (Gt Grimsby)	Stott, Roger
Molyneaux, Rt Hon James	Strang, Dr. Gavin
Moonie, Dr Lewis	Taylor, Matthew (Truro)
Morgan, Rhodri	Trimble, David
Morley, Elliot	Vaz, Keith
Morris, Rt Hon A. (Wy'nshawe)	Walker, A. Cecil (Belfast N)
Morris, Estelle (B'ham Yardley)	Wardell, Gareth (Gower)
Mudie, George	Wareing, Robert N
Mullin, Chris	Watson, Mike
Murphy, Paul	Welsh, Andrew
Oakes, Rt Hon Gordon	Wicks, Malcolm
O'Brien, Michael (N W'kshire)	Wigley, Dafydd
O'Brien, William (Normanton)	Williams, Rt Hon Alan (Sw'n W)
O'Hara, Edward	Wilson, Brian
Olner, William	Winnick, David
O'Neill, Martin	Worthington, Tony
Orme, Rt Hon Stanley	Wray, Jimmy
Paisley, Rev Ian	Wright, Dr Tony
Parry, Robert	Young, David (Bolton SE)
Patchett, Terry
Pendry, Tom	Tellers for the Noes:
Pickthall, Colin	Mr. Jack Thompson and Mr. Dennis Turner.
Pike, Peter L.

Question accordingly agreed to.

Resolved, That the draft Health and Personal Social Services (Northern Ireland) Order 1993, which was laid before this House on 9th December, be approved.