§ 9.—(1) It shall be the duty of the Secretary of State to lay before both Houses of Parliament an annual report on the activities of the regional offices of the National Health Service Management Executive in respect of the discharge of all duties and functions transferred to those offices from Regional Health Authorities with effect from 1st April 1996.
§ (2) In this section, 'regional office' means any office of the National Health Service for the time being designated by the Secretary of State to have responsibility for the "oversight of the finances and activities of National Health Service purchasing authorities and trusts on a regional basis.'.—[Mrs. Beckett.]
§ Brought up, and read the First time.3.56 pm
§ Madam Speaker
With this, it will be convenient to discuss new clause 2—Duty of Secretary of State to publish accounts relating to projected expenditure savings—'The Secretary of State shall, no later than 1st April 1997, lay before the House of Commons a statement of accounts giving—
- (a) the level of expenditure on National Health Service administration in the financial year ending on 31st March 1996, excluding any expenditure attributable to the costs of implementing this Act,
- (b) the estimated outturn of expenditure on National Health Service administration for the financial year ending on 31st March 1997, and
- (c) an explanation of the factors to which any differences between the figures provided under paragraphs (a) and (b) above are attributed.'.
§ Mrs. Beckett
New clauses 1 and 2 go to the heart of the Government's purpose, or what we believe to be their purpose, in enacting the Bill, although new clause 2 relates principally to the financial consequences of the Bill. New clause 1 creates a mechanism by which Parliament can be informed of the outcome of the legislation, and can monitor its effects in practice as opposed to in claimed intent.
If the Government's real intention is what they claim—to remove unnecessary bureaucracy, to increase efficiency and create savings—the new clause will present them with no problems whatever. It creates an opportunity for the Government to parade their achievements. If, on the other hand, the Government's real intention is not what they claim but what we fear—to prevent public and parliamentary scrutiny of an operation which is to be carried out for the purposes of sheer dogma without regard for its potential and considerable practical difficulties and which might seriously inhibit the future 166 smooth running of the national health service—new clause 1, calling as it does for an annual report to Parliament, will be the last thing they want.
Although the logic of new clause 1 is impeccable and its case irresistible, if the Government's primary purpose in moving the Bill was to draw a cloak of secrecy across the operation of the NHS, new clause 1—with its adherence to the principle of accountability to Parliament and to the public—strikes at that purpose itself. The logic of and the case for the new clause are irresistible, because the Bill is not just half-baked, it is not baked at all.
In 1991, as part of the Government's so-called reforms, regional health authorities were given greater powers because it was judged that a strategic authority at regional level was required. On Second Reading, we highlighted some of the major responsibilities of the existing regional authorities, and our wish to explore in Committee how they would be addressed in future. We have had the Committee, but—in all too many cases—we have not had the answers. It is bad enough that, as usual, the Government have left so much to later regulation. But not only is there no detail as to what those regulations might contain, it seems all too often that the decisions have not even been made. Issue after issue is "to be decided" or is "being discussed", including the key issues of how future doctors and nurses will he trained and by whom they will be employed.
A Government who embark on such a major structural change without working out how its consequences will be dealt with are a Government of crass irresponsibility. Incidentally, it casts an interesting light on the demands of Conservative Members for details of policies which the Labour party might pursue after the next election that this Bill is on its way to the statute book without the details having been worked out.
Two matters are crystal clear: first, the Bill will allow infinitely greater secrecy and concealment in hospitals and trusts; and, secondly, it will ensure that all roads lead back to the Secretary of State. At present, regional directors of public health have a duty to produce an annual public report on health care in their region. Historically, the role of practitioners of public health medicine as potential whistle blowers for public safety is one of the glories of British medicine and British public service. At regional level, they will become civil servants, bound by the Official Secrets Act 1911, their duty not to the public but to the Secretary of State.
The only remotely independent voice in the new structure that the Bill creates is that of the community health councils. Their chief executives—full-time salaried public servants—are presently employed by regional health authorities. We asked what will become of them and whether they, too, would become not public servants in the employment of regional offices but civil servants whose duty is to the Secretary of State. No answer came.
At present, regional health authorities collect statistics at regional level and, as public servants, make much of that information public if requested. The only information that we can currently get about matters such as hospital closures comes from those regional health authorities. The Department of Health does not know about such matters and does not want to know. It tells us that, in future, regional offices will collect only the statistics that the Department wants for its own purposes in administering the system. On precedent, that would presumably not include information about hospital closures, the closure of 167 accident and emergency departments or other such decisions, which impinge directly on the pattern of available health care across a region and which are certainly of public interest, whether the Department wants to know them or not.
Apart from the information that the regional health authorities will no longer collect, any requests for information, for example from Members of Parliament, will in future be referred to individual authorities or trusts. So there will not be the same responsibility for the flow of information to the public or their representatives for the use of public money.
The mechanism in new clause 1 would allow Parliament to explore how those and other functions of existing regional health authorities are being carried out under the new structure or, if they are not being carried out, to consider the effects of the change. Vital responsibilities of the present regional health authorities are to stay at regional office level, including oversight of the cancer screening programme and maintenance of cancer registers—at least until what the Minister called "other arrangements" can be made, whatever that may mean. National confidential inquiries may still be handled at that level. Existing ethnic health units will be "centralised" in the NHS, whatever that may mean for their future and role.
When we inquired about the training and education of clinical staff, we were told that it was "to be decided", although later the Minister of State said that it might remain "at regional level", as will the training of some junior doctors. However, the arrangements for such training and how they can take account of the role of universities and the dual academic-clinical role of postgraduate deans is, again, far from clear—if it has been decided at all.
That group of issues is vital to the future of Britain's health care. The training of doctors, nurses and other health service staff, such as physiotherapists, and the holding of employment contracts for junior doctors impinge directly on whether the terms of their employment facilitate or even permit their continuing education.
On all those matters, practitioners and their representatives express deep concern. They are alarmed at the prospect that those matters might be decided, in practice if not in theory, at the level of the individual trust, whose purpose, laid on it by the Government, is to secure its own future as a profitable health business, competing with other such businesses—not to co-operate in a general endeavour of training and employment, from which it can derive, as an individual trust, only partial benefit.
We recognise that the Government have spoken of the possibility of consortiums, variously of trusts or authorities, but the fact that they continued to discuss in Committee an issue of such relevance and importance as the holding of junior doctors' contracts, highlights the recklessness of the endeavour behind the Bill and the irresponsibility with which those fundamental decisions have been approached.
There remain severe doubts, including among health professionals, whether the new authorities that the Bill creates in place of regions will have the expertise to plan and co-ordinate the existing activities of those regional health authorities.
168 All that shows that, whether at regional office level or away from that level, there is a continuing and important role to be played by those charged with carrying out duties that are currently the responsibility of regional health authorities. Parliament must have the chance to scrutinise the effects of the legislation, not only by discussing regulations when they are proposed, but by exploring, year by year, the cumulative practical changes to which the Bill will give effect.
It is useless to pretend that, under the new structure, even our present access to information will be maintained. Members of Parliament and other people with queries about the running of the health service will be referred to the individual authority or institution. Those are institutions in which staff at every level have gagging clauses in their contracts and local—no doubt soon performance-related—pay, to encourage them to remember where their loyalties are supposed to lie: not, as Mr. Roy Lilley recently remarked, to the patient, but to the organisation.
The position that appears likely to exist after the passage of the Bill reminds me strongly of the famous quote from Henry IV Part I, in which Glendower says that he cancall spirits from the vasty deep",only for Hotspur to reply,
Will the information come from the authorities or trusts when Members of Parliament or other people call for it?
- "Why, so can I, or so can any man,
- But will they come when you do call for them?"
A classic example from proceedings in Committee illustrates why we doubt that the answer might come when we call for it; it is a classic example of the way in which that process works now, even before the Bill reaches the statute book.
My hon. Friend the Member for Stockport (Ms Coffey) told the Committee that she had been so impertinent as to ask the chief executive of her local trust exactly how the trust had spent £215,000 of taxpayer's money on the costs of setting up that trust. That was a small part of the £120 million or so devoted to that purpose throughout Britain, but a substantial sum of taxpayer's money none the less. When she spoke in Committee—and, as far as I am aware, to this day—the chief executive had declined to reply, thinking it, presumably, none of her business how he chooses to spend what the previous Prime Minister used to call "our money".
What advice did my hon. Friend the Member for Stockport receive from the Parliamentary Under-Secretary of State, the hon. Member for Bolton, West (Mr. Sackville), that staunch tribune of the people, the defender of the public purse? He advised her towork to improve her relationship with the chief executive of her local trust"—[Official Report, Standing Committee A, 26 January 1995; c. 54.]—in the hope, presumably, that if she did so he might condescend to answer her letter and her queries on behalf of her constituents.
No doubt Ministers will dispute whether the further concealment of the truth about the national health service is part of the purpose of the Bill. They cannot dispute, because they themselves acknowledge it, that the effect of the Bill will be the removal of information now in the public domain. New clause 1 would go some way to redressing the balance; I therefore commend it to the House.
§ The Minister for Health (Mr. Gerald Malone)
I am pleased to be able to respond to what has been a short debate on an important matter. It is obvious that those of my colleagues who were sitting, hanging on my every word in Committee, have been entirely convinced by the debates that we had on that occasion.
The right hon. Member for Derby, South (Mrs. Beckett) talked about the "cloak of secrecy" which will be introduced with the passage of the Bill. I reiterate what I said in Committee: nothing could be further from the truth, and I welcome this opportunity to set out how the arrangements will work.
The regional offices will be an integral part of the NHS executive and, therefore, part of the reporting arrangements which are already in place for the Department of Health through the departmental annual report. That is not simply a report which is issued to the public; it is a Command Paper which is laid before Parliament and is available to the public. It describes in detail the Department's activities and expenditure across all its responsibilities. The right hon. Lady said that information would be concealed, but the opposite is the case. The Department remains accountable to the House through its annual report and I cannot think of any stronger accountability than that.
The right hon. Lady also said rather curiously, in an antithetical way, that all roads lead back to the Secretary of State under the new structure. They do, but the right hon. Lady cannot have it both ways. She argues one day that the national health service structure is not accountable either to the Secretary of State or to Parliament because the Government have fragmented it and sent it off in all sorts of directions, ending up in institutions which act on their own initiative and are accountable to no one. We sometimes hear that speech on a Monday afternoon, only to hear the right hon. Lady say on a Tuesday—as she has today—that all roads in the health service lead back to the Secretary of State.
Ultimately, all roads lead back not just to the Secretary of State but to the House, to whom Ministers are accountable. During that part of the Committee proceedings which I was fit and well enough to attend, I was at pains to emphasise the fact that that responsibility is extremely important and is taken very seriously.
Further information about NHS executive activities is made public through a wide range of publications, such as the NHS annual report. Further reports are planned, including a series of quarterly reviews which will start in May this year, an NHS quarterly magazine which will replace "NHS News" from June 1995 and, as the right hon. Lady knows, a range of statistical bulletins and issues-based newsletters concerning the performance of the service.
It is entirely wrong for the right hon. Lady to suggest that a "cloak of secrecy" surrounds the NHS. I think that there is more like a blizzard of information which is published directly either for the purposes of the House or for those who are keen to research those matters in their or the public interest, as well as for the general public. That approach is right and proper and it will continue under the new structure.
§ Mrs. Beckett
In making his remarks, I think that the Minister should address who controls the information that 170 is supplied. He says, quite correctly, that a blizzard of information is coming from the Department; but if one is so unwise as to request information which is not couched in precisely the form in which the Secretary of State chooses to release it, that information is not forthcoming.
I do not think that anyone—except perhaps a Minister in this Government—could defend the fact that the Department of Health does not, for example, collect statistics about the current number of hospitals, how many accident and emergency units are threatened with closure, or what the pattern of provision of such health care should be across the nation. That is exactly the kind of information that is collected by regional offices because, as regional health authorities, they have a separate duty to the public. All that information will now be controlled by the Secretary of State, and precedent suggests that she does not tell anyone anything that does not suit her purposes.
§ Mr. Malone
The right hon. Lady is entirely wrong about that issue. Information must be collected for statutory purposes—for example, to fulfil the requirements of the Public Accounts Committee and the Audit Commission and to report to the House through the departmental annual report. I regret that the right hon. Lady and her hon. Friends sometimes table questions in a way that does not allow me to answer them, simply because information is not available in the form requested. There are occasions when we puzzle over the questions, and only after conversations with the right hon. Lady's researchers are we able to guess at the purpose of a question.
§ Mr. Malone
We do what we can to answer and to be as full and frank as possible on every occasion. In that spirit, I give way to the hon. Gentleman.
§ Mr. Brown
The whole House has obviously caught the Minister in a good mood and that is to be welcomed. If he is saying, as he has on countless occasions, that information is not held centrally and, therefore, the questions that we table seeking factual information are not properly worded, perhaps he will assist the whole House by telling us in plain English how we could table a question to find out how many hospitals there currently are, how many his Department has closed and how many his Department plans to close.
§ Mr. Malone
To answer the hon. Gentleman's last point first, we do not keep statistics on hypothetical questions. The other points that he raises relate to matters of definition—for example, what one defines as a hospital. There are many institutions that he may define as a hospital, that perhaps a member of the public might not define as a hospital, where information is held. The Government would never mislead the hon. Gentleman in any way by giving him any information that could not be precisely defined.
While I have the opportunity to engage the hon. Gentleman's attention on this point, I hope that he will recollect that when questions are tabled, perhaps some regard could be had for the public expense incurred in answering them. I say that not about questions that seek 171 genuine information but about those that repeat what has been asked, sometimes a week previously, by his hon. Friends, and answered.
I should also mention questions which are clearly trawling exercises for the purpose of basic research and on which published information is readily available. On one occasion, 155 questions were tabled in one day, at huge public expense and involving huge consumption of management time. I hope that we can use the debate to achieve a modus operandi so that public cash is not wasted on consuming health resources, which could otherwise be spent on patient care, by littering the Order Paper with what is essentially unnecessary.
§ Ms Ann Coffey (Stockport)
Is the Minister saying that, in future, he will not be able to answer questions about hospital closures because his Department no longer has a definition of a hospital? If so, that will be an interesting debate.
§ Mr. Malone
I shall be guided by better information than the hon. Lady suggests. Certainly that would not apply to matters which are ultimately the Department's responsibility and in which regional offices are involved, especially where such matters are referred directly to Ministers. Of course we shall continue to answer questions on those matters.
§ Mr. Malone
Before I move on, I shall give way to the hon. Gentleman, as I am in an extremely good mood this afternoon.
§ Mr. Hughes
I am grateful to the Minister for giving way and even more grateful for his good mood. How does he define a hospital? It is interesting that the definition of a hospital is no longer what it used to be. I would be grateful if the Minister would say what he means by a hospital, so that not only Opposition Members but everybody else can be clear about just what it is.
§ Mr. Malone
The hon. Gentleman's uncertainty underlines my point that it may not be sensible to try to hit on a precise definition.
Opposition Members have often said—the right hon. Member for Derby, South repeated it this afternoon—that the move from regional health authorities to NHS executive regional offices, which will be part of the service, will mean a loss of openness. The right hon. Lady asked specifically what would happen to reports from directors of public health. As I believe I said in Committee, regional directors of public health will not publish reports, for the simple reason that the function that they currently exercise will be devolved nearer the population, to health authorities. They will continue to make reports, but in the context of the health authorities. I hope that I have finally got the point across to the right hon. Lady.
I hope to persuade the right hon. Lady that, as directors' reports will be made at health authority level, they will be far more relevant to smaller population groups. That is important when we are trying to identify and address health needs on an authority-by-authority basis. In any event, regional offices are not the bodies that need to be independent, as the right hon. Lady suggested. They will not make the decisions that will affect local people directly—the new health authorities will make those 172 decisions. They will be independent in the same way as regional health authorities and, in addition—under the codes of conduct and accountability issued in April 1994, which we discussed a good deal in Committee—will be expected to produce and publish annual reports.
The regional offices will have a monitoring role. They will contribute to the development of central policies for the NHS, influencing the policy-making process by offering advice to Ministers. It is entirely appropriate for such tasks—including any that involve the collation of reports from health authority public health directors—to be performed by civil servants, who will be part of the process that requires direct accountability to Ministers.
As for centralisation, as a result of the 1990 reforms responsibility has already been successfully devolved from regional health authorities to a level that is closer to patients. The Bill will devolve it still further by moving vital functions, such as non-medical work force planning and many public health functions, down from RHAs to the new health authorities.
The right hon. Member for Derby, South said that the reforms had not been thought through. In Committee, we did not discuss which functions would reside where after the enactment of the Bill. I shall not detain the House by repeating the lengthy statement of functions that I made in Committee, but I draw it to the right hon. Lady's attention. It seemed, if not to satisfy the Committee, certainly to silence it—which, at the time, I may have interpreted as something rather different.
The right hon. Lady referred specifically to training and employment contracts. The Committee dealt with that in some detail, but for the sake of certainty I shall reiterate the position. The education contracts of registrars and senior registrars will be held at regional level by postgraduate deans; in Committee it was widely conceded that that was by far the most important aspect of the contracts, and the main source of concern.
Future arrangements for the holding of contracts are still under discussion, but, as I said in Committee, that is more a technical matter. The fundamental issues were what would happen to education and who would guarantee that doctors could move around the system to secure proper training. I welcome this opportunity to tell the whole House that postgraduate deans will have that responsibility.
I simply do not accept the premise from which the right hon. Lady starts—that this addition to the Bill is necessary. It is not true that less information is available on the service than before. Under the new national health service, far more information is available than ever before. Trusts are accountable to their patients and must publish annual reports. Across the country, more information exists about the performance of the health service in terms of waiting lists and of the quality of institutions that deliver health care, and it is much more widely available than in the past. Much of the debate that we have in the House and elsewhere about how the health service is performing involves information that is used by Opposition right hon. and hon. Members. In years past, under the old NHS, the lack of information would not have allowed such a debate to take place.
The combination of annual reports, accounts and league tables—vital information that tells us how public money is accounted for, and how it is translated into patient care—is accessible not only to hon. Members but to a wider public. The new clause is not necessary. The service 173 will ultimately remain accountable in a proper way to the House. Perhaps, although I fear that this is a forlorn hope, the right hon. Lady will seek to withdraw the motion.
§ Ms Coffey
The new clause seeks to make information available. I note the Minister's comment that he thinks that information is already freely available. He mentioned that the information will be available in the annual accounts of trusts, but I understand that the trusts' annual reports will be late this year. I have no clear idea of when my local trust's annual report, which will make all this information available to me, will be published.
In Committee, I raised the issue of the £215,000 that has been spent by my health care trust on set-up costs. I have failed to obtain information from the trust's chief executive on how that money was spent. That is clearly symptomatic of the problem that Members of Parliament have in obtaining information from trusts. In a letter to me, the chairperson of the local acute services trust, said:As far as accountability is concerned I am directly accountable to the Minister who is of course accountable to Parliament for the trust's action".Why is it then that, when I write to the Minister about some aspect of my local trust, he refers me back to the trust? Somehow, this wonderful circle of accountability does not go the circle.
The £215,000 is public money, and was given to the trust for set-up costs. I have consistently asked the simple question: can the chief executive tell me how that £215,000 was spent? He has refused to tell me. He has referred me to the annual report. That seems illogical: if the information will be available in the annual report, why cannot the information be available to me now?
§ Mr. Malone
I ran through an analysis of start-up costs in Committee. I cannot give the hon. Lady a breakdown of the figures precisely in relation to her own hospital, but I will be delighted to consider that matter and to give her whatever information is available. I will write to her on that point.
I have no idea where she gets the suggestion that reports will be published late—that is news to me. When those reports are published, more information will be available, for example, on management costs. That is an important step forward, which she would doubtless welcome, because Opposition Members question the service about the proportion of funding that is being spent on those costs. I hope that that underpins the serious intention of the Government to disclose, wherever possible, as much information as possible, so that the true performance of trusts will be publicly visible beyond the service itself.
§ Ms Coffey
I was told that the annual accounts were to be late in a letter from one of the Ministers in reply to my letter asking why the information about the £215,000 was not being given to me. He referred me to the annual report, and said that it would be late. I should be happy to show the Minister the letter.
I welcome the fact that the Minister intends to give me a breakdown of the £215,000 set-up costs. I should be happy if the Minister would tell the chief executive of my 174 local health care trust that the information should be made available to Members of Parliament. That would be a great step forward. I am sure that the chief executive believes that, by not giving me the information, he is in some way carrying out the Government's wishes. Clearly that is not right, and he must be made aware of that, as must all chief executives of trusts.
The main issue I wish to raise with the Minister deals with the monitoring of the programme to discharge mentally handicapped people into the local community once the regional health authorities have been abolished. As the Minister is aware, the programme has been going on for several years and involves closing down institutions such as Cranage or Offerton house in my constituency, which for years nursed mentally handicapped people in an institutional setting.
Over the years, that programme has been the subject of some financial dispute and argument between local authorities, district health authorities and regional health authorities. The arguments involved the money for those patients—it has been referred to in the past as dowries—as well as arrangements for financing the entire programme, including complicated deals about the notional value of regional health authority land and the selling off of that land.
The programme is almost complete: effectively, the regional health authority programme has transferred to the health authorities, and people with mental handicaps are living in houses in the community. Financially, they are living as normal people, entitled to housing benefit and other benefits. Care is being provided by the health authorities and, in my locality, staff employed by the health care trust go in on a daily basis to care for those people.
The patients are highly dependent; some of them have been living in institutions for many years. Therefore, transferring to the community can be difficult. The care they need must be of the highest quality, because, however much we talk about them living as normal people, their needs make them special. They are a risk to themselves: unfortunately, in Stockport recently a mentally handicapped person died in one of those homes.
The care provided is paid for by the local health care trust, which also employs the staff. As far as I can see, this has nothing to do with the Stockport health commission, and there is no commissioning role in buying the care. It is provided through the money from the regional health authority, and has ended up with the health care trust.
I can see several problems with this. If the Government felt able to accept the new clause, I believe that some of the inherent difficulties and conflicts might be resolved. A local health care trust should not be responsible for employing staff and providing care, because the cost of that care and the staff come out of the same budget.
I was quite concerned to see an advert in my local paper, which asked for staff and said that experience with mentally handicapped people was desirable but not necessary. A cynical thought passed through my head—of course, it costs less to employ unqualified people than qualified people. The ratio of unqualified to qualified people in Stockport is on a balance with the unqualified people who are employed part-time on a bank staff basis, where at the beginning of the week they are sent here, 175 there and everywhere, depending on where the need is. That, obviously, is cheaper than employing full-time or fully trained staff.
There is an inherent conflict, because if there is pressure on the budget—and there was last year—what better way of saving money is there than by employing less qualified staff on a lower rate of pay? That is not right, because mentally handicapped people who come into those homes have care plans, and the same authority that supplies and employs the staff monitors that care plan.
That cannot be right. There seems to be no independent inspection. There are no targets laid down by the Government about the quality of care. The homes are not subject to inspection, because they are not considered to be residential homes. The health and safety regulations do not apply. The homes are, in fact, operated as mini-institutions.
I am concerned about the quality of life for people in those mini-institutions. I have always supported the ideology behind community care—that institutions are not homes for people, and that it is better for people to be in a home and for care to be put into that home—but surely quality must be addressed. If mentally handicapped people in those homes are not provided with day care or stimulus outside the home, and if day care simply means providing them with Sky Television 24 hours a day. I am concerned about the quality of care, because that is not what community care is supposed to be about.
Who assesses whether the quality of care for those people is better than that in the hospital in which they were previously resident? Community care is supposed to be about improving the quality of people's lives. Where, and by whom, is that judgment made? I am concerned, because of the abolition of the regional health authorities, and the duties of the new regional offices not being clear by any means, about how the programme is being monitored across the country. Monitored it must be, and properly inspected. Mentally handicapped people need protection. They cannot speak for themselves. There must be some independent inspection of their needs and the quality of their lives.
I am not sure how the Minister will address that question and what input the regional offices will have. If there is a commissioning body—a health commission—and a provider unit, as in the trusts, in a sense there is some inspection by the health commission, because it purchases care and can demand to see the quality of that care.
But if the provision and purchasing of the care happens within the same organization—for example, the trust—which appears to be the case in the care of mentally handicapped people, I suggest to the Minister that will stack up problems for the future. There must be some way in which to provide some independent inspection, whether that means, when the regional health offices go, placing that role back into the health commission and giving it the responsibility of commissioning care for mentally handicapped people. Perhaps that is a way round it. I am sure that it is not the only issue that needs to be dealt with, but it is in my thoughts, as this is happening in my constituency. No doubt other hon. Members could think of a number of other issues to be raised in this context.
The problem is that it is not clear what the regional offices will be monitoring, and what their responsibilities will be. At one level, this important Bill may seem uncontroversial, but I suspect that it will have far-reaching consequences for the delivery of health care. It therefore 176 seems especially regrettable that it does not contain sufficient clarity. As we have discovered, we sometimes pass legislation without paying sufficient attention to its consequences.
The new clause offers a safety net by ensuring that proper monitoring takes place and that appropriate information is available to the public. The Government claim to be in favour of access to information, so I do not understand why they do not support the new clause and ensure that information is open to the public.
§ Mr. Martin Redmond (Don Valley)
I apologise to the Minister of State for having missed the beginning of his speech, but I was upstairs at a meeting of the Carers National Association, listening to the trials and tribulations experienced by its members because of Government policies.
My remarks all relate to accountability, or the lack of it. There is going to be no accountability in the national health service. The regional health authorities are to be kicked into obscurity, and their replacements will mean an absence of accountability. Brian Edwards, who used to be the secretary of Trent Regional health authority, has moved up into the money markets, and we have heard a great deal recently about people who have done extremely well.
Let us consider the appointment of the chairman of the trust in Doncaster and of the people who sit on the board. It is remarkable that those people do not represent a cross-section of the community; it seems that only people from a certain clique are wanted. The Minister and the Secretary of State must take responsibility for such appointments. For there to be accountability, the people who sit on trusts should be under no obligation to the Conservative party. Due consideration should be given to the secretaries and chairmen of the community health care councils sitting, as of right, on trust boards.
In the old days of the area health authorities, the press were invited to attend meetings, and the only matters from which they were excluded were those that required patient confidentiality. That is the only way to be open and above board, and avoid the sort of scandals about which we have recently heard so much. I am all for reform and progress, but making progress means going forward, not back to Victorian days.
I have been to hospital in the past couple of years, and have been fortunate enough to receive excellent treatment from nurses and doctors. Indeed, were it not for their skills, I should not be here now. I have much to be grateful for, and I am sad to see the health service, which I love, being dismantled because of the Conservative party's political dogma.
The Doncaster health authority used to spend about 3.5 per cent. of its budget on administration costs. I suspect that, were the Minister to do a similar calculation of the trusts' administration costs, he would find that the figure was more like 8 per cent. I am guessing, but it is an educated guess. In any event, it means that a tremendous percentage of available funds is not being spent on patient care.
I believe that there is more accountability and openness among the Freemasons than in the health service. [HON. MEMBERS: "How do you know?"] I live in the real 177 world of the doctors and nurses. I hear the Minister, the Secretary of State and Conservative Members expound the benefits of the new arrangements and talk about money in "real terms", but I lie in bed at night adding up the hours that junior doctors spend on the wards, and they are unacceptable.
The general waste and handouts to get rid of bad appointees as chairmen of authorities all adds to the lack of accountability. Conservative Members should go out into the real world and talk to nurses and doctors, not the lackeys appointed by the Secretary of State. Patients praise the dedication of the nurses but condemn the money wasted on administration. Accountability is important, and the Conservatives need to understand what is really going on.
§ Mrs. Bridget Prentice (Lewisham, East)
Once again, I stress the need for a strategic health authority for London but the Bill as drafted does not allow for the accountability that Londoners need in terms of their health care.
My remarks are intended as an act of kindness. In London, as elsewhere, the Government are singularly unpopular and have wholly misunderstood what people in London want. We are giving them the opportunity to rectify that. I hope that the Minister will accept the new clause as a measure of good will and take it as an opportunity for the Government to join us in seeking to provide a strategic health authority for London. It would be a popular decision among Londoners and would go some way to meeting London's health care needs. The chances are that my words will fall on deaf ears yet again, but I live in hope that one day even the Government might listen to Londoners.
Yesterday, I listened carefully to the Secretary of State's speech on the health crisis in London. She talked at length about what was happening in London as a whole. I should have thought that even her comments made it clear that there is a need for strategic thinking when planning health care and health provision across London. It is not just that the capital city needs strategic planning—it does fundamentally. Strategic planning is important because the needs within London as a whole and within inner London in particular are so much greater than they are elsewhere.
The Government often like to divide London from the rest of the country on the ground that London is over-resourced compared with the rest of the country. A number of the reports that have come out in the past year or two—certainly since the Secretary of State began her reforms in London—show that the Tomlinson report, on which the Secretary of State has based her slashing of services in London, was flawed because it was based on a great deal of misinformation, inaccurate statistics and unfounded dogma.
Not only Professor Jarman but others have shown that the acute bed need in London is great, that waiting lists are now rising rapidly and that the health needs in London are significant compared with those elsewhere. London obviously has the highest level of homelessness in the country. I use the word "obviously" because people are attracted to the capital city, which is one reason why homelessness is so bad in the capital. There is also more pressure on housing to rent in London than there is elsewhere. Young people in particular have no 178 opportunity to get decent housing. Every medical expert tells us that homelessness has an effect on people's health. The level of homelessness is one way in which London is unique compared with the rest of the country.
As a number of my hon. Friends have mentioned in other debates, London has the highest level of people who are HIV positive or who have Aids-related diseases which require specialist care in hospitals, in people's homes and in community care facilities. Such specialisation is costly, but it is necessary and we must do all that we can to ensure that whatever the resources available for people who are HIV positive or who have AIDS, they are made available to people when they need them.
The capital also has the highest level of drug dependency in the country. This is a specialist area and we need to consider how to get resources to people as quickly as possible so that we can help them to survive. The amount of poor housing in London, the extent of homelessness and a series of other factors mean that other debilitating diseases are more prevalent in the capital city than elsewhere.
The comments of the Secretary of State suggest that a strategic health authority for our capital city is vital. It is extremely sad that the Government have ruled against any possibility of such an authority being set up. Instead of setting up that strategic authority, as they could have done under the Bill, they have removed the present level of accountability, small though it is, to the regional offices. That will not reflect the needs of people in London.
The Bill will have an especially dire effect on two areas. The Secretary of State has talked a great deal about care for the elderly and she appears to be terribly proud of her community care policy. In my experience and in the experience of many colleagues on both sides of the House, care in the community is simply not working in London.
When elderly people are discharged from hospital and sent back to their homes, often with only an elderly, frail relative to care for them, there is little back-up and little thought is given to the resources and resource management that are needed to ensure that people can recover properly from whatever illness put them in hospital in the first place. Some people have to go back to hospital for a second or third time and others, sadly, do not survive the experience at all. Unless we have a strategic overview of what happens in our hospitals in London and of what happens when people are discharged from hospital into their local community, we shall not serve the people of London well.
I now turn to mental health. My hon. Friend the Member for Stockport (Ms Coffey) mentioned mental health and spoke about the needs in her area. London has a greater need for mental health services than elsewhere. There are examples, right across the capital city, of people being discharged from institutions into the community without any resources to back them up. There have been a number of tragic instances.
A few weeks ago, a woman, who was not a constituent, came to my surgery. A relatively young person with a mental illness, who had been discharged into the community, attacked her when she had three children under five with her. Although she was not badly injured, it was a frightening experience and one that neither she nor anyone else would want to have. She recognises, as 179 the rest of us do, that the reason why such incidents happen is that there is no proper resourcing of community care in the city.
People should be discharged from institutions only if the Government are prepared to put resources into the local community to enable care to be given properly. Some time ago, there was the tragic affair of the Clunis report, with which the Guy's and Lewisham health trust had to deal. There have been many other cases which hon. Members can cite.
There is growing concern in the capital city that although people who have mental illnesses and those who are drug dependent or have some other specialist problems are more prevalent in London than elsewhere, they are not being properly looked after. The hospitals are totally under-resourced and we need to find a strategic way in which they can be resourced. Just before Christmas, there were examples of people with mental illness being shipped 50, 60 or 70 miles away because there were no beds in London in which they could be cared for.
The Government seem to be committed to ignoring what Londoners want. The new clause would enable the health service in London to become more accountable. That would go some way towards alleviating many of the fears of people in London about the state of the health service here.
I now touch on another aspect of accountability which I raised in Committee and which still concerns me because I do not believe that the Government have recognised the seriousness of the situation. I refer to the universities having a place on the health authorities. At present, they have a place on the existing health authorities as of right under a statutory provision. Under the Bill, that statutory place will be removed.
That will be a tragedy not just for the universities, which are well aware of the problems that will arise, but for the new health authorities. They will not have the direct expertise of the medical practitioners and the academics in the universities who know about their teaching methods and about their teaching programmes, and who can influence and support the health authorities to ensure that they dovetail their programmes of work with that of the universities.
Listening to the Secretary of State yesterday, I found it rather strange that she spoke eloquently about the centres of excellence and about the importance of our educational and academic training for doctors, in London in particular. The Secretary of State said:I am also strongly committed to our international position and centres of excellence.She said later in the debate, when talking about the importance of education and research:Those are fundamental to the reputation of London as a world leader in medical teaching and research."—[Official Report. 20 February 1995; Vol. 255, c. 37–41.]In that case, it strikes me that we ought to acknowledge teaching and research by ensuring that those academics are involved in the process of decision making in the hospital service.
§ Mr. Malone
I would not like the hon. Lady to give the House the impression that this matter has been disregarded and was not discussed in Committee. Of course it was and I pointed out in Committee that, if a medical school is in the area of the health authority, there 180 would be a medical school representative, a university representative, on the board. I made that absolutely clear. However, like every other board position of that sort, it will be prescribed in regulation. Perhaps the hon. Lady's debate is over whether those positions should be in regulation or in the Bill. She is giving the impression that there may not be representation at all. It is certainly the Government's intention—I gave an undertaking to that effect in Committee—that there will be such representation.
§ Mrs. Prentice
I am grateful to the Minister for making that clear. I was not clear about that in Committee. Although, as the Minister would expect, I disagree with him over the provision being prescribed in regulation; it should be in the Bill, but one step at a time is perhaps as much as we can hope to take with this Government.
I believe such representation to be important. I have a special interest in training in general and, in this context, in medical training in particular. The fact that it will be purely under regulation and not a statutory requirement evokes fear for two practical reasons. First, when hospitals are being rationalized—closed, to those of us who understand the term—it is very important that universities are centrally involved in decision making because the costs involved of moving staff and medical students from one hospital to another can be enormous, as some hospitals elsewhere in the country have found.
Secondly, universities fear, and justifiably so, that the Department for Education, which presently funds the moving of the medical training and therefore funds part of the health service, will say that it will not fund such future moves. Yet we must feel confident that universities are aware right from the start were such funding to cease, so that they can participate in the process and be party to events.
As I said, the costs of changes can be enormous. It cost £15 million in Oxford, £20 million in Glasgow and Edinburgh—
§ Mr. Deputy Speaker (Mr. Michael Morris)
Order, I was hoping that the hon. Lady was coming to the end of that part of her speech. Frankly, the new clause does not apply to matters concerning the Department for Education.
§ 5 pm
§ Mrs. Prentice
I am trying to establish the fact that the Department for Education funds part of the health service through the university medical schools, which is why accountability is so important. University medical schools need to be able to speak directly to the Department of Health about what is happening—
§ Mr. Deputy Speaker
Order. I was listening to the hon. Lady and I was well aware of the point that she was making. It is perfectly proper to make an aside, but she is developing the argument. I hope that she will now desist from that and return to the main thrust of her speech.
§ Mrs. Prentice
I am grateful, Mr. Deputy Speaker, and I shall move on, because the Minister has responded, to some extent, to my point.
I hope that, in responding to the debate, the Minister will remember that that aspect of accountability is centrally important if we are to ensure that those centres of excellence, which the Secretary of State discussed 181 yesterday, remain. I hope that there is accountability in medical education, and especially as an hon. Member who represents a London constituency which suffers great deprivation and has large demands, I hope that we consider again the need for a strategic authority in London to provide the accountability in their health service that Londoners want.
§ Mr. John Gunnell (Morley and Leeds, South)
The two new clauses are excellent, and I urge the Minister to look at them carefully and to consider accepting them. They would strengthen the health service and provide the Department of Health with a much better defence against the proposed reforms than they have been able to put up against the reforms which have already been implemented.
The new clauses are strongly linked and deal specifically with accountability, as most hon. Members who have spoken said. Accountability is very important. We recognise that there is an automatic lessening of accountability in moving from an authority that has some external features to a regional office of government. We recognise that that implies a loss of accountability, and we must establish how that accountability will be made good in the arrangements under the new plan.
Financial accountability is also very important. Projected expenditure savings have been made. However, my interpretation of the answer given by the Under-Secretary of State, the hon. Member for Bolton, West (Mr. Sackville), on the day of the Committee's last sitting, was incorrect. When I looked back at what he said, I realised that he had been consistent in suggesting that he had projected savings of £150 million which applied to the whole country. However, it is fair to say that the Under-Secretary of State for Wales, the hon. Member for Clwyd, North-West (Mr. Richards), purloined £60 million of that overall amount for Wales, which left £90 million for England.
§ The Parliamentary Under-Secretary of State for Wales (Mr. Rod Richards)
§ Mr. Gunnell
It was said in Committee, and I urge the Under-Secretary to look at the relevant proceedings of the Committee sitting. We are talking about global figures, to which I shall return.
Nevertheless, it is important to note that if savings are projected and Ministers have any confidence in them at all, they will obviously welcome not only the duty to publish accounts but the opportunity to publish them, to demonstrate how right they were in their projections. If they do not publish accounts and are not able to accept new clause 2, it suggests that they are not so confident about their projected figures. I shall return to that point.
The annual report is an extremely valuable feature of the Bill. In response to questions which several hon. Members and I asked in Committee, the Minister said that he intended to make clear at some point where every responsibility of the present regional health authorities would lie in future. He indicated that they could all be dealt with and that all current responsibilities of regional health authorities would go somewhere to a specific responsibility—to a health authority or the regional offices which are being set up or to an even higher responsibility. It is important that that indication is 182 followed up—not merely by a statement from Ministers but by putting it into effect, so that the annual report clearly demonstrates how each function, if it has been necessary, is carried out.
As my hon. Friend the Member for Lewisham, East (Mrs. Prentice) said, we are dealing with the removal of a strategic tier. Many of us believe that strategic matters are best handled by an authority that takes an overall perspective of the issues as they affect the region. A regional perspective is therefore important in several respects.
Hon. Members have already referred to mental health. We must ensure that strategic facilities are available. The region plays an important role in that regard at the moment. I was a member of the health authority that contemplated the eventual closure of High Royds, a mental institution on the outskirts of Leeds. That institution is interesting as it sits on a large plot of land which, if suitable planning permission were given, would be extremely valuable. The institution was important to the region from a resource point of view. It was the region's job to allocate resources on a strategic basis throughout Yorkshire; therefore, the enormous accumulation of resources at Menston was an important potential asset, the use of which would have been determined strategically on a regional basis.
I come from the Yorkshire region. Even though the Under-Secretary of State for Health, the hon. Member for Bolton, West—who is not in the Chamber at the moment—has described me as a foreigner—
§ Mr. Gunnell
Yes, but one understands that, in Yorkshire, the definition of a foreigner is very precise. Under the Yorkshire county cricket club's former rules, I would certainly he regarded as a foreigner. Indeed, my hon. Friend the Member for Wolverhampton, South-East (Mr. Turner) would also he regarded as a foreigner.
§ Mr. Gunnell
No, such accusations have not been levelled at me. I would have to wait a long time and have a more august position than I have at present in order for it to be worth while to make such suggestions.
From Yorkshire's point of view, the division of the large sum of money to which I have referred, and how it is allocated, is very important. Would it be allocated to mental illness, because mental illness requires huge resources? If we abolished the region and there were a great deal of income from a land sale, could we be sure that that money would be used in the area from which it came or, in the absence of regional authorities, would it go into a national pot?
From the allocation of resources we know how much can be done within the health service. The allocation of resources is currently a regional function. How will resources be allocated in the health service in future? Will they be allocated through the national health service executive? Will regional policy board members argue for resources for their regions in an executive that considers all the resources and distributes them on a national basis? If savings are made in a particular region, will those resources be allocated within that region'?
183 Ministers must have already decided what will happen. They must know how they intend to distribute resources. In the absence of regional health authorities, how will resources be distributed? That point could be covered in an annual report which states how that function of the region is determined. Only if we know how the resources will be allocated can we be sure that they will be distributed with roughly the same results as now.
I know that you take an interest in such matters, Mr. Deputy Speaker, because I recall the reception that you gave downstairs. You are obviously concerned about the care of those who suffer mental handicap or mental illness. Yesterday, I launched a report by the Matthew Trust which showed how the trust funded, with very small amounts of money, care for people who were mentally ill and had suffered some other hardship.
The trust was concerned with very small amounts of money, but it was clear that a section of people had somehow fallen through the net of our social welfare system. One might say that it is the health authority's job to ensure that those individuals do not fall through the net. However, one might also say that there is a responsibility at every level to ensure that the safety net that we believe exists—hon. Members on both sides of the House believe that it exists in the welfare state—is made seamless so that fewer casualties fall through it.
Many of the people whom I learned of yesterday suffered from mental illness. Many of them had other handicaps—for example, they had been victims of crime. Those people were falling through the net and they clearly needed help. We must ensure that our strategy is right. If the strategy used to be determined in part at regional level, how will it operate in future?
Regions currently carry out many functions in respect of which we would like a report. When there are local disputes, the arbitration procedures are provided by the region. As we said in Committee, with regard to "The Health of the Nation", regions were given a specific function. Who will carry out that specific task of setting a health promotion strategy in future? Will there be a regional health promotion strategy or will it simply be a strategy set out by the Secretary of State here in the House?
There are clearly regional factors at play if we consider disease across the nation. I believe that there should be regional health promotion. What will happen in that respect? Although I did not attend yesterday's debate on health care in London, I am pleased to hear that the Secretary of State was concerned about centres of excellence. I wrote about the destruction of such centres of excellence and received a letter from the Minister for Health this week. I believe that we can learn lessons from the United States about the preservation of centres of excellence.
The regions have responsibility for research and development. Where has that responsibility gone or where is it going? What about a region's responsibility for registration? Responsibility for fundholders and their registration is going to the district health authorities. We have already discussed that, so it is not quite at issue now; if, however, there were an annual report, it could have been made plain that that responsibility had been transferred.
184 The responsibility for the appointment of community health council chairs currently rests with the region. Who will have that responsibility in future? The appointment of the chairs of community health councils and of those connected with the councils is very important, especially to local communities. When we come to talk about other health service appointments, we will have the benefit of a paper produced by the Secretary of State only this month which says that responsibility lies specifically with individual regional policy board members. We do not know whether responsibility for appointments to community health councils will also lie with regional policy board members.
A number of questions need to be answered. I would expect that an annual report would be able to say not just what was suggested by the Minister in Committee but where responsibility was exercised and who was exercising it. We need to know what will happen to those people who are working in the regional authority for the north and Yorkshire. We are told that there will be 135 people working initially in Harrogate, with some working in Durham and others elsewhere.
No doubt, some people will be transferred to the civil service. We need to know where those people are and what tasks they will carry out. We also need to know what tasks will be given to those people who have been transferred elsewhere. What will be done at Durham when the building is built? What will be done at Quarry house? Which matters will be dealt with in Whitehall for which the region is currently responsible?
In addition, we need to know about savings. My experience of savings brought about by abolition goes back to my time as leader of West Yorkshire metropolitan county council, when it was abolished. I was told that the abolition of my county, and five other metropolitan counties, would save £50 million. That does not sound much when it is compared with the £150 million that the Government claim will be saved by this change. It was claimed that the saving was one of the motivating factors for removing democracy and abolishing those authorities.
A study carried out three years after the abolition of those councils stated that, although it was not possible to say that the abolition had cost a great deal of money, it was certainly not possible to say that it had saved money. The report, produced by the university of Birmingham, suggested that the change had been financially neutral. I want there to be agreement that the forecasts that the Ministers make will be quantified. We must know where they think the savings will come from, as it is not enough to project a global figure of £150 million.
I can understand that there will be fewer appointments to health boards following the merging of authorities, and therefore I can see where some specific savings will be quantified. I do not believe that those savings will come anything near £150 million, and Ministers must state from where the other savings will come. New clause 2 says that a statement of accounts must be produced before 1 April 1997. that might be a significant month for the Government. They will not be able to last here any longer than that without public approval, but I believe that the public will approve the presence of the Conservative party on the Opposition Benches.
We know that health service reforms are a costly business. It is now a year and a half since the controller of the Audit Commission said that whether the NHS got value for money from its was a "very legitimate question". 185 I asked whether the Audit Commission had been allowed to look at the savings projected in the Bill, because that might have thrown an interesting light on the issue. That question was not answered, so I suspect that the Audit Commission has not been brought into the matter.
It would be helpful to look at some aspects of management in the NHS. We know that the management of the introduction of the reforms has already cost the best part of £1 billion. Have we had value for money for that amount? I doubt whether many patients would think that we have; I am quite sure that they would have preferred much less to be spent on management changes and much more spent on patient care.
We are talking about the future, and the Bill will bring about changes in the future. We are told the Bill will save £150 million. Hon. Members should ask for that to be demonstrated after the event so that, even if the changes are not justified in any other way, the Government can show that they have produced the forecast savings.
The examples which I have been able to raise do not fill me with confidence. I understand the Minister's reluctance to put the new team working for Yorkshire and Humberside in Quarry house. We are told that Quarry house, which is near the centre of Leeds, is not in the middle of the region. I accept that. Harrogate may be a bit better, but that is not the centre of gravity of the region either. That, no doubt, is the argument for going to Durham; but the costs of going there must be regarded in the light of the fact that there is space in the £55 million Quarry house building in Leeds and there is also a building in Harrogate which, for the particular reasons we gave in Committee, will not get the best price in the market at the moment.
§ Mr. Nicholas Brown
The situation is even worse than my hon. Friend outlines. There is, of course, a fourth building—the northern regional headquarters at Walkergate in Newcastle. Instead of having one headquarters per region, the Government—in their great push for efficiency and savings—are giving us four.
§ Mr. Gunnell
I thank my hon. Friend for that comment. It was remiss of me to have had such a Yorkshire-biased point of view. I ignored the building in Newcastle. [Interruption.] The Speaker admonished Members for going from one constituency to another. I was wondering whether the sacred turf of the Hawthorns in West Bromwich was in her patch, because hon. Members go there from time to time.
The questions about the costs of change and why there must be an increase in expenditure for a new building in Durham have been unanswered. Thanks to my hon. Friend the Member for Newcastle upon Tyne, East (Mr. Brown), I can say that there are three buildings which are being neglected while a new one is built. That is the antithesis of the suggestions which Ministers usually come up with. There is a strong case to ask Ministers to accept new clause 2, and to be prepared to publish the financial results of their activity.
§ Mr. Kevin Hughes
I have the feeling that I have been here before. The two new clauses are about accountability, and we explored the Bill's lack of accountability in Committee. We talked about democracy, openness, 186 accountability and consultation but we have not yet had a proper answer from the Minister of State on any of those issues. That does not surprise me, given his response when asked to define a hospital. If he cannot define what he means by a hospital, how on earth can we expect him to give us straight answers about democracy, openness, accountability and consultation? Is it really too much to ask a Minister what the Bill means and what the Government mean by accountability, openness and democracy?
The two new clauses are basically no different from what we have discussed in the past. My hon. Friend the Member for Don Valley (Mr. Redmond) referred to the secret service that operates in Doncaster. He and I share the same regional health authority and trusts, so we can both speak with experience about the lack of openness in our area. Other colleagues have a similar experience in their areas. We have the Doncaster Health Care trust; the district health authority, which is being merged with the family health service authority, piloting what the Bill is about; and the Doncaster Royal and Montagu Hospital trust. Of the three, the Doncaster Royal and Montagu Hospital trust—[Interruption.]
The Minister might like to listen to what I am about to say because Opposition Members do not often sing the praises of a trust. Of the three, the Doncaster Royal and Montagu trust is the most open and accountable, and invites local Members of Parliament to talk about what it is doing and proposes to do. That is significantly different from the other trust and certainly different from the district health authority.
New clause 1 seeks to have a report laid before the House. It says:It shall be the duty of the Secretary of State to lay before both Houses of Parliament an annual report on the activities of the regional offices of the National Health Service Management Executive".Those reports must be a valuable feature. What possible harm could they do? Do not we need to know what is happening in our health service? Do not we need to know about the overview of the new regional bodies? Let us not forget that people employed in those bodies will be civil servants. Will the Minister come to the Dispatch Box and justify why we should not have such a report? I see no reason whatever.
The Minister said earlier that hon. Members table too many parliamentary questions and waste public funds. If we had those reports and could find out what was happening, hon. Members might not need to table so many parliamentary questions. Who knows, the reports may even contain a definition of a hospital. If the Ministers do not know, somebody in the national health service executive may know what constitutes a hospital. I might table a parliamentary question later today asking the Minister to define a hospital, because he did not answer that question in the Chamber this afternoon. I find it incredible.
Let us not forget that the new bodies, which will be made up of civil servants, will still have a strategic role to play in overviewing their regions. It is important that we have that overview and a report on what is happening. Without a report, how will we know what those people are doing? Although they will report back to the Secretary of State, if a report is not laid before Parliament, we shall not know what is happening in our regions.
Apart from the Secretary of State, who will monitor the new regional bodies? Will they monitor themselves? A lot of self-monitoring seems to go on in the health service. After all, to be appointed to one of those bodies, it takes 187 just a nudge and a wink. My hon. Friend the Member for Don Valley mentioned the Freemasons and he may not have been too far from the truth, because the new trust boards and the district health authorities are like secret societies. No one seems to know how people are appointed to them. A nudge and a wink, a word here or there, and suddenly someone with no experience whatever in the health service is appointed. So long as they are a friend of a friend—they might happen to be a friend of the Tory party or a friend or relative of a Tory Member—they are appointed. We have been round that circle before.
New clause 2 is about accountability for expenditure in the health service. Again, I see no good reason why we should not have such accountability and why we cannot be told how taxpayers' money is being spent. How on earth are we to scrutinise whether taxpayers are getting value for money? Is the health service to be left to monitor itself?
My hon. Friend the Member for Morley and Leeds, South (Mr. Gunnell) discussed the £150 million—or is it £60 million?—of savings that the Bill will make. Nobody seems to know whether savings of £150 million, £60 million or somewhere in between will be made. One reason why the Minister does not want us to have the financial report proposed in new clause 2 is because he does not want us to see that somebody somewhere—perhaps him—got the figure wrong along the way. If we have that report we may discover the truth, which I suspect is that savings of neither £150 million nor even £60 million will be made.
It is hard to keep a straight face when the Government say that they will save money when they have been responsible for increasing spending on administration in the health service to figures as long as telephone numbers. It is unbelievable how spending on administration has risen.
The two new clauses are about accountability and openness. We have been round that circle many times and will undoubtedly be round it again because we never get straight answers and Ministers seek to avoid the issue. In my opinion, the Government do not want openness, they do not want democracy and they certainly do not want accountability.
Let me tell the Minister that people such as those whom I represent want openness, accountability and democracy in the health service; they want to know how their money is spent. The two new clauses will give the power to their Members of Parliament to obtain the answer to that question for them.
§ Mr. Nicholas Brown
Rather perceptively, my notes are headed "NCI", which I assume must stand for "No Conservative in sight". The British public are entitled to draw the pretty obvious conclusion from the fact that not a single member of the Conservative party has come here today to take part in an important debate to defend the Minister's point of view, except for the Minister himself.
I acknowledge that the Minister is here. He is ever present—apart from during the opening stages of the Bill, when he was unable to take part, and was helpfully described by the Parliamentary Under-Secretary of State, the hon. Member for Bolton, West (Mr. Sackville) as being ill-tempered and plague-ridden. It is not a description that I recognise of the Minister but, in fairness, his hon. Friend obviously knows him better.
188 The Minister no doubt hopes to cut an heroic figure among his parliamentary colleagues, standing alone at the Dispatch Box, holding back the forces of socialism, but the only nationalisation that is being undertaken here today has been undertaken by him, as he nationalises the functions of the regional health authorities by taking them in-house, under the direct control of the state, centralised under his direct personal control, inasmuch as the Secretary of State will allow him to exercise such control.
Our amendments are modest. They merely seek to hold the Minister accountable for his actions. Specifically, our new clause 2 seeks to hold the Minister accountable for the public money that he spends. That appears to me to be a perfectly reasonable proposition to put before the House. It has not originated in the ranks of the parliamentary Labour party alone. As my hon. Friend the Member for Morley and Leeds, South (Mr. Gunnell) rightly said: it is a perfectly sensible suggestion of the Audit Commission.
If the Government claim value for money, they have at least a duty to prove the point. Our new clause 2 would require them to do exactly that, no later than April 1997. We might not have felt it necessary to bring new clause 2 before the House had the Minister been more candid in Committee. Not only did he not appear to know the answers to the questions about the amount that he was spending, the amount that he was saving and the ultimate cost or saving to the taxpayer, but he offered us a moving feast of different figures.
In the first week—I accept that it was not the Minister's fault but that of the Under-Secretary, the hon. Member for Bolton, West—we were told that the savings would be £150 million, but the Committee was treated to that figure without any context. No doubt we were all supposed to be overawed by it and to think that it represented good value for money. We then discovered that the figure for savings in Wales was to be £3 million. My hon. Friend the Member for Cardiff, West (Mr. Morgan) calculated that, if one took the figure for Wales and applied a population factor to obtain an equivalent figure for England, one would obtain a figure of £50 million.
The Minister then told us that the true figure that the Government anticipated for eventual savings for England was £60 million. Therefore, more money was to be saved from England, per head of the population, than was to be saved in Wales.
The Minister knew enough about the figures to treat us to that information, but he was unable to tell us how the figures were calculated. He may have made them up, which is always a possibility, I suppose, or perhaps he had no intention of being candid with the Committee—he wished to keep the information to himself. I hesitate to suggest that his reasoning might have been that the information was commercially confidential, but nowadays, given the direction in which the national health service is going, frankly, one never knows. The Minister has not shared the information with the Committee. Labour Members believe that he should be required to share it with the House.
The Minister boasts about a saving. On Second Reading, the Bill was accompanied by a money resolution. That money resolution was permissive; its purpose was not to facilitate the saving of money but to facilitate the spending of money, so the Minister is effectively saying to the House that he will need to spend money on implementing the legislation.
189 No doubt the Minister's argument is that he spends money now to save it later. That is a perfectly reasonable argument to make; we simply require him to justify it, and we are entitled, as is the country, to draw our own conclusions from the fact that the Minister cannot justify it, or at least has not done so so far.
If the Minister is unwilling to justify that argument, are we not entitled to draw some conclusions from the fact that he wishes that information to remain secret? Whatever it is, it is not good conduct; it is not good public administration; it is not parliamentary accountability. Indeed, the Minister is not even able to outline which functions will remain at the regional level, which will be devolved to local level and what the costs will be. If savings are to be made, I think that we are entitled to assume that some functions will be performed less well, perhaps not even performed at all. What functions? So far, the Minister has not said.
The case for new clause 2 appears to be well made in terms of parliamentary accountability and the good management of public finances alone. There is, however, an even stronger case to explore further—as we seek to do in new clause 1—the strength of the arguments that lie behind the Minister's nationalisation of the functions of regional health authorities.
The purpose of our new clause is to place on the Secretary of State a duty to lay before Parliament an annual report on the activities of the regional offices of the national health service executive in respect of the duties that will be transferred to them from the abolished regional health authorities. We are simply saying that the Secretary of State should be accountable to Parliament.
If the Government think that they are justified in proceeding in the way they suggest, let them explain their actions to the House. That appears to me to be a perfectly reasonable stance for any publicly elected representative to take. I am surprised that the Minister does not embrace the opportunity to boast about his achievements, instead of running away from the opportunity. That fills me with doubts and uncertainties about his true motivations.
Worries have been expressed by my hon. Friends. There are anxieties that the regional offices of the national health service executive will not have the resources or the expertise required to exercise effectively a range of functions—a subject that we explored in Committee, but which it is right to explore again with the Minister, as we received no satisfactory answers. Our fears are more deeply felt because, although staffing levels for those regions are to be similar, the size of the regions are not to be similar.
My hon. Friend the Member for Morley and Leeds, South cited the specific case of the North and Yorkshire region, as the Minister likes to think of two regions that have been added together. The Minister speaks to the House about efficiency savings. Those efficiency savings will not be found easily in the headquarters building.
As my hon. Friend the Member for Morley and Leeds, South said, there is spare space in Quarry house in Leeds. The region has as an objective the sale of the existing headquarters at Harrogate. There is also an existing headquarters building at Walkergate in Newcastle, and, as 190 if three headquarters were not enough for one region, the region intends to build a fourth new building in Durham city to add to its property holdings. I think that people would like the regional health authority to add to the primary and secondary health care it provides, not to its steadily burgeoning portfolio of office buildings.
We believe that the strategic regional overview of providing and purchasing decisions made by health authorities, GP fundholders and NHS trusts will be carried out in a thin and an episodic manner. My hon. Friend the Member for Lewisham, East (Mrs. Prentice) raised concerns about services which may not be purchased enthusiastically as priority services in the Government's new marketplace, but which are nevertheless important. My hon. Friend referred to HIV/AIDS and drug dependency units, and my hon. Friend the Member for Morley and Leeds, South made a similar point about mental health care. Those important areas may be downgraded rather than given the attention that they rightly deserve in the Government's new structure.
Although the argument stands true across the country, as we debated yesterday, I believe that there is a special and specific case for a region-wide overview of health care services in London. That case is extraordinarily well made, and the structures we will be invited to put in place later today will do absolutely nothing to help achieve it—although the Government seem to acknowledge the case for regional structures, albeit nationalised ones, elsewhere in the country.
Our proposed new clause requires the Minister to report to the House about the outcome of the structural reorganisation. We want to know about the savings, the safety nets and the important functions that are perhaps not being monitored and carried out as well as they should be. I think that it is perfectly reasonable for Members of Parliament from London to draw certain conclusions about a structure which is perfectly all right for regional planning areas but which is not all right for the nation's capital. The Minister's report—if there were to be one—would provide hon. Members with useful evidence for any case that they may wish to make.
There is a separate issue about training, including the co-ordination and strategic planning of nurses' training. In any market with a purchaser-provider split, it is often difficult to see what driving force will require the purchasing—that is the language that we must use these days—of nurses' training. The Royal College of Nursing has expressed some concerns. It believes that the ever-increasing demand for trained nurses will not be met, and it has pointed out that, since 1987, the number of training places for nurses in the national health service has been cut by 33 per cent. If that trend is being driven not by planning but by the marketplace, it is likely to continue.
Similar fears have been expressed about the operation of cancer registries and the organisation of cancer screening programmes. That important regional function will be nationalised by the Minister and carried out directly by his Department. It will be supervised by him personally, but I am not sure how reassuring that will be for those who expect the programme to be provided by a regional health authority with clinical decision-making and health care priorities—not driven by the political imperatives which drive Ministers.
191 My hon. Friend the Member for Stockport (Ms Coffey) drew attention to very important regional level public health initiatives. Where will they figure in the Government's marketplace? The Minister is effectively nationalising the people in charge, as the Bill transfers regional directors of public health from the employment of the NHS to the civil service. Regional directors will be not officials with a duty of responsibility to the general public but civil servants with a duty of responsibility to the Minister which, as we have discovered time and again in this place, is quite a different matter.
The British Medical Association has written to all hon. Members who served on the Committee expressing its concern that the resulting restrictions will curb the necessary freedom of public health officials to speak out, even if it is inconvenient to the Government. It is very difficult for civil servants to do that, because it constitutes a breach of the Official Secrets Act. I suspect that the Minister would be the first to invoke such legislation if it were in his interests to do so.
That is the sort of behaviour that one would expect of a former vice-chairman of the Conservative party. I see that the Minister is flinching; I thought that he would take it as a compliment, but he obviously considers it an insult to be accused of being an official of the Conservative party.
§ Mr. Brown
I am reminded by the hon. Member for Altrincham and Sale, who graces us with his presence, that the Minister was a deputy chairman of the Conservative party. The hon. Gentleman is clearly taking a close interest in health care provision, and I will move on to facilities for the elderly later. The hon. Gentleman has told me that he has reached the age of retirement, and I for one will miss him very much, because he is my pair. I think that the laws of supply and demand may work against me in the next Parliament, so I will miss him more than he thinks.
Before turning to those important considerations, I raise again the question of the siting of junior doctors' contracts. As the Minister would be the fast to acknowledge, junior doctors are the cornerstone of secondary health care. The Committee spent some time trying to explore with the Minister where the contracts of junior doctors would be located—would they be held by individual trust hospitals or by a consortia of trust hospitals, or would they be nationalised along with other regional functions and held by the state?
It was clear to me at the beginning of the Committee process that the Minister did not know the answer to that question. By the end of the process, he had told us that the contracts would be held at a regional level for the time being, and that the situation would be considered further. The BMA was concerned that, if the contracts were held at trust level, the necessary rotation of junior doctors would be affected, and training might not be completed.
It was clear to Committee members that the Government toyed with the idea of having a consortia of hospital trusts—a consortia of providers—hold the contracts. From the Government's point of view, it is perfectly rational to consider that proposal. Junior doctors are providers of health care, and it fits with the Government's purchaser-provider philosophy that the contracts should be held by the provider. When the 192 Government wish to sell off the hospitals to the private sector, the doctors and their contracts will go with them. Having the state hold the contracts at a regional level cuts across the market-based philosophy which is behind the rest of the Government's health care reforms.
The Government may be retreating from the original structures that constituted their great vision in the mid-1980s when they embarked on this stupidity. That is one possible explanation for their change in approach. We require the Secretary of State to come back to Parliament with a report which sets out whether the restructuring has succeeded. That is the key proposition in new clause 1.
My hon. Friends have raised correctly—although I accept that it is tangential to the main thrust of the argument—the question of involving universities and medical schools in planning decisions. Moneys are transferred from the Department of Education to the Department of Health. The Bill removes the statutory position which was enacted only recently.
The National Health Service and Community Care Act 1990 enabled universities and medical schools to participate in planning and decision-making at regional level. It is perfectly right that we should seek from the Government an explanation as to how the new interface is to work and to require, as we do in new clause 1, the Government to report to Parliament about the effectiveness of the new arrangements.
My hon. Friend the Member for Lewisham, East raised the separate issue of membership of health authorities and the Minister repeated the assurance which I understood him to have given in Committee: that, if a medical school or a dental school was involved, the appropriate person would be considered for membership of the health authority.
The Minister told us something about the structures of the health authorities and the nature of the people who are to serve upon them, but from my point of view and that of other members of the Committee, that was not enough. He did not tell us about the rest of the composition of the health authority.
Which other professionals are to be involved and how are the laity to he chosen? Who are they to he? Perhaps Conservative Members are absent from the debate because they are encouraging their friends and relatives and people of equal virtue to fill in their application forms to apply for the new lay posts. Perhaps they have a head start on the rest of the nation, and are trying to get in before the Nolan committee reports. Who knows? I would accept any explanation that the Minister was willing to give the House—perhaps "accept" is putting it too strongly: I would at least listen to it charitably.
In any event, new clause 1 would require the Minister to report to Parliament on how the structures were working and to defend his decisions when they turned out to be perhaps politically motivated or even sordid.
The Committee was worried about the co-ordination of vocational training for general practitioners—again that is not easily purchased in the marketplace—and who would undertake responsibility for GP fundholders. We did riot think it right that that function should he handed over to health authorities. That could not he done easily, as health authorities are responsible for the non-fundholders, and in the Secretary of State's new quasi-market, fundholders 193 and health authorities are supposed to be competing purchasers, no longer co-operating but fighting over patients—presumably the ones who are not ill, as they are the ones who are worth having in the new marketplace.
Finally, the question has been raised and not satisfactorily answered as to how on earth hon. Members are to get parliamentary questions answered. The Minister already says that information is not held centrally, and hints that it is available somewhere. We have welters of answers saying exactly that. He suggests that we are not getting answers because we are not framing the questions properly.
In the spirit of all-party co-operation, I sought from the Minister advice as to how to phrase questions. The example I cited was, how should I phrase a question to discover how many hospitals there were in the country—hospitals for which he is directly responsible to the House? I asked the Minister how many hospitals there are, how many had closed and how many he is planning to close. He said that planning to close a hospital was a hypothetical question. One assumes that there is still some planning in the Department of Health, and that not everything has been thrown to the market.
§ Mr. Kevin Hughes
Perhaps, when he is tabling questions, my hon. Friend ought to go back to basics and ask the question, what is a hospital? [Interruption.] If he starts from there and he gets an answer to that question, he may be able to progress to other questions to which he would like answers.
§ Mr. Brown
My right hon. Friend the Member for Derby, South (Mrs. Beckett) advises me that the answer to such a question would probably be that the information is not held centrally. The perfectly reasonable information that I was trying to extract from the Minister was: how many hospitals are there in Britain, how many have closed, and how many is he planning to close?
Perhaps, in a certain sense, planning is hypothetical, but Ministers have shared their plans with the House before in a candid way and in a spirit of openness and willingness to discuss, perhaps even learn and to listen to suggestions from others. In my experience, however, whenever the Minister suggests closing a hospital, the local halls fill up with citizens who are worried that their hospital will be taken away and most people are against it, which seems more rational that the Minister might expect.
Not only is he unwilling to share information with us about which hospitals he is planning to close: he goes further in trying to conceal information by saying, as my hon. Friend for Doncaster, North (Mr. Hughes) has just pointed out, that he cannot answer the question, "What is a hospital?" That is Jesuitical in the extreme.
The Minister gave us no definition of a hospital. The Minister of State is supposed to hold an important office in the national health service, and he does not know what a hospital is. If the Minister does not know what a hospital is, how much confidence can we have in the rest of his legislation? Surely the Minister's lack of knowledge on a pretty fundamental and elementary point cannot reassure my hon. Friends or, indeed, Conservative Members.
How reassured is the hon. Member for Altrincham and Sale (Sir F. Montgomery) that the Minister of State does not know what a hospital is? I have heard the hon. Gentleman 194 speak eloquently about hospitals in his constituency. The hon. Gentleman has never had any difficulty in defining what he wanted kept open and wanted the Department to support rather than do down. The same is true of many Conservative Members. Surely they should join us in the Lobby tonight and support our proposition, which at least holds the Minister of State to account, and might even in future require him to explain what a hospital is.
§ Mr. Malone
We had an admission from the hon. Member for Doncaster, North (Mr. Hughes) that we had run round the same course many times before during the debate. That was two hours ago. He said that we had already run round the course 47 times. Let me say to the hon. Member for Newcastle upon Tyne, East (Mr. Brown) that we gave up running round it and started to ramble across it at will during the past 30 minutes or so.
I shall concentrate on new clause 2, which I did not deal with in my opening remarks, as it was not touched on by the right hon. Member for Derby, South (Mr. Beckett). If Opposition Members were looking for proof that the savings from the Bill will actually be delivered, I am sorry to tell them from a reading of their amendment they will not get it from that.
The amendment seeks to compare spending in 1995–96 and 1996–97. As I made clear in Committee, the savings will be made over a slightly longer time scale into 1997–98. We made all the figures perfectly clear in Committee, but I shall return to them for the purpose of absolute clarity during my short wind-up speech.
Savings are already being made from slimming down regional health authorities in preparation for the transition to regional offices. For example, RHA core staffing has already fallen from nearly 7,900 in July 1992 to about 2,600 in March 1994. Savings are also being made from the integration of the work of DHAs and FHSAs, and in total we expect savings approaching £60 million to be made in 1995–96. There is no great mystery about what will happen thereafter. By 1997–98, when the new structure is fully implemented, the savings will rise to nearly £150 million net per year.
Opposition Members asked how those savings are to be broken down. More than £100 million-worth of the total saving results from the abolition of RHAs and the consequent reduction and overlap of work between the central Department and the regions. The remainder is due to the replacement of DHAs and FHSAs with health authorities. As for savings in departmental running costs, savings secured from the elimination of functions that currenty overlap between regional health authorities and the NHS executive will also contribute to the saving of some £50 million in the running costs of the Department of Health to be made by 1997–98.
The hon. Member for Morley and Leeds, South (Mr. Gunnell) raised a point that was also raised in Committee, asking whether savings would stay in the region concerned. In the case of certain savings, the answer is yes. All RHA spending, except the amount to be transferred to the Department of Health administration vote for the running costs of the regional offices, will have been devolved to the districts in the region, and will form part of their baselines before decisions are made about allocations to health authorities for 1996–97.
195 That relates to the direct part of the spending; as I said in Committee, any other savings that accrue will be available for general health needs. They will be spent on patients, and will be allocated in the normal way.
New clause 2 is intended to ensure that savings are delivered. The annual departmental report—which, as I said earlier, is a Command Paper and is laid before Parliament—describes in detail the Department's expenditure and activities, including all its responsibilities and all major developments during the previous year. In future, it will also include the effects of the abolition of RHAs. It will be possible to quantify savings, and the House will have an opportunity to consider them in detail.
The hon. Member for Don Valley (Mr. Redmond) apologised for not having been present at the beginning of the debate; no doubt, if he ever returns to the Chamber, he will apologise again for not having been present at the end.
The hon. Gentleman referred to his own experience of the health service, and described it as extremely good. Let me point out that it is no use Opposition Members always saying that the health service in general is useless—as they do in the House—and then, when narrating their own experiences, saying that it is good. I hope that their experience of the service is coloured by what happens to them when they have to use it.
The hon. Member for Lewisham, East (Mrs. Prentice) made a point about London planning. Health care in London—which was debated at length yesterday—is currently changing: the existence of the London implementation group, which was created to serve a time-limited purpose, is drawing to its conclusion. The hon. Lady feared that there might not be enough drive to ensure proper provision and a proper strategy for London's health care, but I assure her that there will.
I should point out to the hon. Lady that the organisational structure of London's health service is now much simpler than it was; its former complexity led to the establishment of the implementation group. The four regional health authorities have become two, and, as part of the move to the new, streamlined regional structure, they now incorporate the work of the former outposts.
All but one or two providers of health care will be trusts by 1 April, including most of the former special health authorities. The health authorities have been brought together to form commissioning agencies, responsible for assessing needs and ensuring that the right balance of services is available in both hospital and community in each area. We also expect a considerable increase in the number of GP fundholders in inner London, with an extension of the 14 per cent. of the population who are already covered to some 24 per cent. by 1 April.
The role of the London implementation group is now largely completed, except in the case of primary health care: the primary care support force and the primary care 196 forum will remain. There is, indeed, a proper London perspective on health matters, and a much simpler structure which will enable that perspective to be implemented.
§ Mr. Malone
The hon. Gentleman has not participated so far, and I was on the point of finishing the speech.
§ Mr. Malone
As the hon. Gentleman points out, he did not participate in the Committee stage, either.
§ Mr. Malone
I shall not go into that, but we missed the presence of the hon. Gentleman's party. I understand that its members were not very excited about making an appearance.
§ Mr. Hughes
On a point of order, Mr. Deputy Speaker. [Interruption.] It is a genuine point of order for the Chair. Is it correct for the Minister to assert that members of my party were not represented in the Standing Committee, given that we were not nominated?
§ Mr. Malone
I am obliged to you, Mr. Deputy Speaker. My understanding is that, if members of the hon. Gentleman's party had wished to secure a place on the Committee, they would have been entitled to do so; but they did not take advantage of that entitlement. No doubt the hon. Gentleman can complain to those who manage his party's business affairs, but it is a bit late for him to raise the matter on Report.
§ Mr. Deputy Speaker
Order. I have already made it clear that this has nothing to do with either the Chair or the debate.
§ Mr. Malone
You are quite right, Mr. Deputy Speaker. I shall speak to the hon. Gentleman privately after the debate, so that he is certain about the position.
I think that we have made it clear that there will be sufficient means of examining the savings generated by the reforms. The information will be available in the normal departmental report, which will be discussed in Parliament. Both new clauses are unnecessary, and if the Opposition choose to press them to a vote, I shall ask the House to reject them.
§ Mr. Deputy Speaker
Order. I think that the Minister has already sat down. Unless the hon. Lady wishes to make a speech—
§ Mr. Deputy Speaker
Order. The hon. Lady must resume her seat. She may make another speech if she 197 wishes to do so, but the Minister has finished his speech, and she therefore cannot intervene. Perhaps she will wait until a bit later.
§ Mr. Deputy Speaker
Order. Did I hear a no? Has the hon. Lady the leave of the House? [HON. MEMBERS: "Yes."] I think she has.
§ Mr. Deputy Speaker
Order. I must be addressed as "Mr. Deputy Speaker", or referred to as the Chair.
§ Ms Coffey
My apologies, Mr. Deputy Speaker.
In my earlier speech, I asked some specific questions. I asked, for instance, who would inspect and monitor the community programme for the mentally handicapped. That is a serious issue, and I am deeply disappointed that the Minister did not refer to it: given that the RHAs are to be abolished, it is very pertinent.
§ Question put, That the clause be read a Second time:—
§ The House divided: Ayes 242, Noes 283.201
|Division No. 80]||[6.17 pm|
|Abbott, Ms Diane||Cann, Jamie|
|Adams, Mrs Irene||Chidgey, David|
|Ainger, Nick||Chisholm, Malcolm|
|Allen, Graham||Church, Judith|
|Alton, David||Clapham, Michael|
|Armstrong, Hilary||Clarke, Eric (Midlothian)|
|Ashton, Joe||Clarke, Tom (Monklands W)|
|Austin-Walker, John||Clelland, David|
|Banks, Tony (Newham NW)||Clwyd, Mrs Ann|
|Barnes, Harry||Coffey, Ann|
|Barron, Kevin||Connarty, Michael|
|Battle, John||Corbett, Robin|
|Bayley, Hugh||Cousins, Jim|
|Beckett, Rt Hon Margaret||Cox, Tom|
|Beith, Rt Hon A J||Cummings, John|
|Bell, Stuart||Cunliffe, Lawrence|
|Benn, Rt Hon Tony||Cunningham, Jim (Covy SE)|
|Bennett, Andrew F||Cunningham, Rt Hon Dr John|
|Berry, Roger||Darling, Alistair|
|Betts, Clive||Davidson, Ian|
|Blair, Rt Hon Tony||Davies, Bryan (Oldham C'tral)|
|Blunkett, David||Davies, Rt Hon Denzil (Llanelli)|
|Boateng, Paul||Davies, Ron (Caerphilly)|
|Bradley, Keith||Davis, Terry (B'ham, H'dge H'l)|
|Bray, Dr Jeremy||Denham, John|
|Brown, Gordon (Dunfermline E)||Dewar, Donald|
|Brown, N (N'c'tle upon Tyne E)||Dixon, Don|
|Bruce, Malcolm (Gordon)||Dobson, Frank|
|Burden, Richard||Donohoe, Brian H|
|Byers, Stephen||Dowd, Jim|
|Cabom, Richard||Dunnachie, Jimmy|
|Callaghan, Jim||Eagle, Ms Angela|
|Campbell, Mrs Anne (C'bridge)||Eastham, Ken|
|Campbell, Ronnie (Blyth V)||Enright, Derek|
|Campbell-Savours, D N||Etherington, Bill|
|Canavan, Dennis||Evans, John (St Helens N)|
|Fatchett, Derek||Marshall, Jim (Leicester, S)|
|Field, Frank (Birkenhead)||Martin, Michael J (Springburn)|
|Fisher, Mark||Maxton, John|
|Flynn, Paul||Meacher, Michael|
|Foster, Rt Hon Derek||Michael, Alun|
|Foulkes, George||Michie, Bill (Sheffield Heeley)|
|Fraser, John||Michie, Mrs Ray (Argyll & Bute)|
|Fyfe, Maria||Milburn, Alan|
|Galbraith, Sam||Miller, Andrew|
|Galloway, George||Mitchell, Austin (Gt Grimsby)|
|Gapes, Mike||Moonie, Dr Lewis|
|Gilbert, Rt Hon Dr John||Morgan, Rhodri|
|Godman, Dr Norman A||Morley, Elliot|
|Golding, Mrs Llin||Morris, Rt Hon Alfred (Wy'nshawe)|
|Graham, Thomas||Morris, Estelle (B'ham Yardley)|
|Grant Bernie (Tottenham)||Morris, Rt Hon John (Aberavon)|
|Griffiths, Nigel (Edinburgh S)||Mowlam, Marjorie|
|Griffiths, Win (Bridgend)||Mudie, George|
|Grocott, Bruce||Mullin, Chris|
|Gunnell John||Murphy, Paul|
|Hain, Peter||Oakes, Rt Hon Gordon|
|Hall, Mike||O'Brien, Mike (N W'kshire)|
|Hanson, David||O'Brien, William (Normanton)|
|Harvey, Nick||O'Hara, Edward|
|Henderson, Doug||Olner, Bill|
|Heppell, John||O'Neill, Martin|
|Hill, Keith (Streatham)||Orme, Rt Hon Stanley|
|Hinchlirffe, David||Parry, Robert|
|Hoey, Kate||Patchett, Terry|
|Hogg, Norman (Cumbernauld)||Pearson, Ian|
|Home Robertson, John||Pendry, Tom|
|Hood, Jimmy||Pickthall, Colin|
|Hoon, Geoffrey||Pike, Peter L|
|Howarth, George (Knowsley North)||Pope, Greg|
|Hughes, Kevin (Doncaster N)||Powell, Ray (Ogmore)|
|Hughes, Robert (Aberdeen N)||Prentice, Bridget (Lew'm E)|
|Hughes, Roy (Newport E)||Prentice, Gordon (Pendle)|
|Hughes, Simon (Southwark)||Primarolo, Dawn|
|Hutton, John||Purchase, Ken|
|Illsley, Eric||Raynsford, Nick|
|Jackson, Glenda (H'stead)||Redmond, Martin|
|Jackson, Helen (Shef'ld, H)||Reid, Dr John|
|Jamieson, David||Rendel, David|
|Jones, Ieuan Wyn (Ynys Mon)||Robertson, George (Hamilton)|
|Jones, Jon Owen (Cardiff C)||Robinson, Geoffrey (Co'try NW)|
|Jones, Lynne (B'ham S O)||Roche, Mrs Barbara|
|Jones, Martyn (Clwyd, SW)||Rogers, Allan|
|Jones, Nigel (Cheltenham)||Rooker, Jeff|
|Jewell, Tessa||Rooney, Terry|
|Keen, Alan||Ross, Ernie (Dundee W)|
|Kennedy, Jane (Lpool Brdgn)||Rowlands, Ted|
|Kilfoyle, Peter||Ruddock, Joan|
|Lewis, Terry||Salmond, Alex|
|Liddell, Mrs Helen||Sedgemore, Brian|
|Litherland, Robert||Sheerman, Barry|
|Livingstone, Ken||Shore, Rt Hon Peter|
|Lloyd, Tony (Stretford)||Short, Clare|
|Llwyd, Elfyn||Skinner, Dennis|
|Loyden, Eddie||Smith, Andrew (Oxford E)|
|Lynne, Ms Liz||Smith, Chris (Isl'ton S & F'sbury)|
|McAllion, John||Smith, Llew (Blaenau Gwent)|
|McAvoy, Thomas||Soley, Clive|
|McCartney, Ian||Spearing, Nigel|
|Macdonald, Calum||Spellar, John|
|McFall, John||Steinberg, Gerry|
|McKelvey, William||Stevenson, George|
|Mackinlay, Andrew||Stott, Roger|
|McMaster, Gordon||Strang, Dr. Gavin|
|McNamara, Kevin||Straw, Jack|
|MacShane, Denis||Sutcliffe, Gerry|
|McWilliam, John||Taylor, Mrs Ann (Dewsbury)|
|Madden, Max||Taylor, Matthew (Truro)|
|Maddock, Diana||Timms, Stephen|
|Mahon, Alice||Tipping, Paddy|
|Marek, Dr John||Touhig, Don|
|Marshall, David (Shettleston)||Trimble, David|
|Turner, Dennis||Williams, Alan W (Carmarthen)|
|Vaz, Keith||Wilson, Brian|
|Walker, Rt Hon Sir Harold||Wise, Audrey|
|Walley, Joan||Worthington, Tony|
|Wardell, Gareth (Gower)||Wray, Jimmy|
|Wareing, Robert N||Wright Dr Tony|
|Wicks, Malcolm||Tellers for the Ayes:|
|Wigley, Dafydd||Mr. Peter Mandelson and Mr. Joe Benton.|
|Williams, Rt Hon Alan (Sw'n W)|
|Ainsworth, Peter (East Surrey)||Day, Stephen|
|Aitken, Rt Hon Jonathan||Deva, Nirj Joseph|
|Alexander, Richard||Devlin, Tim|
|Alison, Rt Hon Michael (Selby)||Dicks, Terry|
|Allason, Rupert (Torbay)||Douglas-Hamilton, Lord James|
|Amess, David||Dover, Den|
|Arbuthnot, James||Duncan, Alan|
|Arnold, Jacques (Gravesham)||Duncan Smith, Iain|
|Ashby, David||Dunn, Bob|
|Atkins, Robert||Durant, Sir Anthony|
|Atkinson, David (Bour'mouth E)||Dykes, Hugh|
|Atkinson, Peter (Hexham)||Eggar, Rt Hon Tim|
|Baker, Nicholas (North Dorset)||Elletson, Harold|
|BakJry, Tony||Evans, David (Welwyn Hatfield)|
|Bates, Michael||Evans, Jonathan (Brecon)|
|Batiste, Spencer||Evans, Nigel (Ribble Valley)|
|Bellingham, Henry||Evans, Roger (Monmouth)|
|Bendall, Vivian||Evennett, David|
|Beresford, Sir Paul||Faber, David|
|Biffen, Rt Hon John||Fabricant, Michael|
|Body, Sir Richard||Field, Barry (Isle of Wight)|
|Bonsor, Sir Nicholas||Fishburn, Dudley|
|Booth, Hartley||Forman, Nigel|
|Boswell, Tim||Forsyth, Rt Hon Michael (Stirling)|
|Bottomley, Peter (Eltham)||Forth, Eric|
|Bottomley, Rt Hon Virginia||Fox, Dr Liam (Woodspring)|
|Bowden, Sir Andrew||Fox, Sir Marcus (Shipley)|
|Bowis, John||Freeman, Rt Hon Roger|
|Boyson, Rt Hon Sir Rhodes||French, Douglas|
|Brandreth, Gyles||Fry, Sir Peter|
|Brazier, Julian||Gale, Roger|
|Bright, Sir Graham||Gallie, Phil|
|Brooke, Rt Hon Peter||Gardiner, Sir George|
|Brown, M (Brigg & Cl'thorpes)||Garnier, Edward|
|Browning, Mrs Angela||Gill, Christopher|
|Bruce, Ian (Dorset)||Gillan, Cheryl|
|Burns, Simon||Goodlad, Rt Hon Alastair|
|Burt, Alistair||Goodson-Wickes, Dr Charles|
|Butcher, John||Gorman, Mrs Teresa|
|Butler, Peter||Gorst, Sir John|
|Butterfill, John||Grant Sir A (SW Cambs)|
|Carlisle, John (Luton North)||Greenway, Harry (Ealing N)|
|Carlisle, Sir Kenneth (Lincoln)||Greenway, John (Ryedale)|
|Carrington, Matthew||Griffiths, Peter (Portsmouth, N)|
|Carttiss, Michael||Grylls, Sir Michael|
|Cash, William||Gummer, Rt Hon John Selwyn|
|Channon, Rt Hon Paul||Hague, William|
|Chapman, Sydney||Hamilton, Neil (Tatton)|
|Clappison, James||Hampson, Dr Keith|
|Clark, Dr Michael (Rochford)||Hanley, Rt Hon Jeremy|
|Clarke, Rt Hon Kennelh (Ru'clif)||Hannam, Sir John|
|Clifton-Brown, Geoffrey||Harris, David|
|Colvin, Michael||Haselhurst, Alan|
|Congdon, David||Hawkins, Nick|
|Conway, Derek||Hawksley, Warren|
|Coombs, Anthony (Wyre For'st)||Hayes, Jerry|
|Coombs, Simon (Swindon)||Heald, Oliver|
|Cope, Rt Hon Sir John||Heath, Rt Hon Sir Edward|
|Couchman, James||Heathcoat-Amory, David|
|Cran, James||Hendry, Charles|
|Currie, Mrs Edwina (S D'by'ire)||Hicks, Robert|
|Curry, David (Skipton & Ripon)||Higgins, Rt Hon Sir Terence|
|Davies, Quentin (Stamford)||Hill, James (Southampton Test)|
|Hogg, Rt Hon Douglas (G'tham)||Pawsey, James|
|Horam, John||Peacock, Mrs Elizabeth|
|Howard, Rt Hon Michael||Pickles, Eric|
|Howarth, Alan (Strat'rd-on-A)||Porter, Barry (Wirral S)|
|Howel, Rt Hon David (G'dford)||Porter, David (Waveney)|
|Howell, Sir Ralph (N Norfolk)||Portillo, Rt Hon Michael|
|Hughes, Robert G. (Harrow West)||Powell, William (Corby)|
|Hunt, Sir John (Ravensbourne)||Redwood, Rt Hon John|
|Hunter, Andrew||Renton, Rt Hon Tim|
|Hurd, Rt Hon Douglas||Richards, Rod|
|Jack, Michael||Riddick, Graham|
|Jackson, Robert (Wantage)||Rifkind, Rt Hon Malcolm|
|Jenkin, Bernard||Robathan, Andrew|
|Jessel, Toby||Robertson, Raymond (Ab'd'n S)|
|Jones, Gwilym (Cardiff N)||Robinson, Mark (Somerton)|
|Jones, Robert B (W Hertfdshr)||Roe, Mrs Marion (Broxbourne)|
|Kellett-Bowman, Dame Elaine||Rowe, Andrew (Mid Kent)|
|Key, Robert||Rumbold, Rt Hon Dame Angela|
|King, Rt Hon Tom||Ryder, Rt Hon Richard|
|Kirkhope, Timothy||Sackville, Tom|
|Knapman, Roger||Sainsbury, Rt Hon Sir Timothy|
|Knight, Mrs Angela (Erewash)||Scott, Rt Hon Sir Nicholas|
|Knight, Greg (Derby N)||Shaw, David (Dover)|
|Knight, Dame Jill (Bir'm E'st'n)||Shaw, Sir Giles (Pudsey)|
|Knox, Sir David||Shephard, Rt Hon Gillian|
|Kynoch, George (Kincardine)||Shepherd, Colin (Hereford)|
|Lait, Mrs Jacqui||Shepherd, Richard (Aldridge)|
|Lang, Rt Hon Ian||Shersby, Michael|
|Lawrence, Sir Ivan||Skeet, Sir Trevor|
|Legg, Barry||Smith, Tim (Beaconsfield)|
|Leigh, Edward||Soames, Nicholas|
|Lennox-Boyd, Sir Mark||Speed, Sir Keith|
|Lester, Jim (Broxtowe)||Spicer, Sir James (W Dorset)|
|Lidington, David||Spicer, Michael (S Worcs)|
|Lightbown, David||Spink, Dr Robert|
|Lilley, Rt Hon Peter||Spring, Richard|
|Lloyd, Rt Hon Sir Peter (Fareham)||Sproat, Iain|
|Lord, Michael||Squire, Robin (Homchurch)|
|Luff, Peter||Stanley, Rt Hon Sir John|
|Lyell, Rt Hon Sir Nicholas||Steen, Anthony|
|MacGregor, Rt Hon John||Stern, Michael|
|MacKay, Andrew||Stewart, Allan|
|McLoughlin, Patrick||Streeter, Gary|
|McNair-Wilson, Sir Patrick||Sumberg, David|
|Madel, Sir David||Sweeney, Walter|
|Maitland, Lady Olga||Sykes, John|
|Malone, Gerald||Tapsell, Sir Peter|
|Mans, Keith||Taylor, Ian (Esher)|
|Marland, Paul||Taylor, John M (Solihull)|
|Marlow, Tony||Temple-Morris, Peter|
|Marshall, John (Hendon S)||Thomason, Roy|
|Marshall, Sir Michael (Arundel)||Thompson, Sir Donald (C'er V)|
|Martin, David (Portsmouth S)||Thompson, Patrick (Norwich N)|
|Mates, Michael||Thornton, Sir Malcolm|
|Mawhinney, Rt Hon Dr Brian||Thurnham, Peter|
|Merchant Piers||Townsend, Cyril D (Bexl'yh'th)|
|Mills, Iain||Tracey, Richard|
|Mitchell, Andrew (Gedling)||Tredinnick, David|
|Mitchell, Sir David (NW Hants)||Trend, Michael|
|Moate, Sir Roger||Trotter, Neville|
|Monro, Sir Hector||Twinn, Dr Ian|
|Montgomery, Sir Fergus||Vaughan, Sir Gerard|
|Nelson, Anthony||Walden, George|
|Neubert, Sir Michael||Walker, A Cecil (Belfast N)|
|Newton, Rt Hon Tony||Walker, Bill (N Taysrde)|
|Nicholls, Patrick||Waller, Gary|
|Nicholson, David (Taunton)||Wardle, Charles (Bexhill)|
|Nicholson, Emma (Devon West)||Waterson, Nigel|
|Norris, Steve||Watts, John|
|Onslow, Rt Hon Sir Cranley||Whitney, Ray|
|Oppenheim, Phillip||Whittingdale, John|
|Ottaway, Richard||Widdecombe, Ann|
|Page, Richard||Wiggin, Sir Jerry|
|Paice, James||Wilkinson, John|
|Patnick, Sir Irvine||Wilshire, David|
|Patten, Rt Hon John||Winterton, Mrs Ann (Congleton)|
|Winterton, Nicholas (Macc'fld)||Young, Rt Hon Sir George|
|Wolfson, Mark||Tellers for the Noes:|
|Wood, Timothy||Mr. Bowen Wells and Mr. David Willetts.|
§ Question accordingly negatived.