HC Deb 15 June 1999 vol 333 cc223-34

"The Special Health Authority known as the National Institute for Clinical Excellence shall make its appraisals of different treatments and clinical interventions on the basis of clinical efficacy or relative cost-effectiveness compared with alternative treatments or clinical interventions for the same symptoms, but not on the basis of their affordability in relation to the funds available to the National Health Service."—[Dr. Harris.]

Brought up, and read the First time.

Question proposed, [14 June], That the clause be read a Second time.

7.46 pm

Question again proposed.

Mr. Deputy Speaker (Mr. Michael J. Martin)

I remind the House that with this we are discussing new clause 14—National Institute for Clinical Excellence (duties and consultation with public)

'.—(1) The Special Health Authority known as the National Institute for Clinical Excellence (the "Authority") shall meet in public.

(2) The Authority shall publish annually a report on its activities during the preceding calendar year which the Secretary of State shall lay before Parliament.

(3) The Secretary of State shall establish a public consultative committee in relation to the Authority, which shall have the duty of advising the Authority on the public's view on the priority to be accorded to different treatments and clinical interventions within the NHS.

(4) The constitution and membership of the committee mentioned in subsection (3) shall be such as the Secretary of State may determine in Regulations.'.

New clause 16—Protection of doctors' clinical freedom to prescribe appropriate drugs'.—The Secretary of State shall not exercise his powers to include a drug in schedule 11 to the National Health Service (General Medical Services) Regulations 1992 (as subsequently amended) in such a way as to restrict the circumstances in which the drug may be prescribed by reference to the different underlying causes of the symptoms for whose treatment it is clinically effective.'.

New clause 17—Cost or affordability not to be criteria for restricting prescribing of drugs.'.—In issuing guidance on prescribing, or in exercising his powers to include a drug in schedule 10 (drugs and other substances not to be prescribed for supply under pharmaceutical services) or schedule 11 (drugs to be prescribed under pharmaceutical services only in certain circumstances) to the National Health Service (General Medical Services) Regulations 1992 (as subsequently amended), the Secretary of State shall not base his decision on the criterion of either the cost or the affordability of the drug in question.'.

Mr. John Bercow (Buckingham)

The House will be delighted to learn that last night I was bringing my remarks, which had necessarily to be brief, to a conclusion when an untimely interruption to our business took place. I am happy to round up my remarks now.

We are concerned about the National Institute for Clinical Excellence and the new clauses relating thereto. I have made the point before, and I underline it now, that there is interest in, but considerable concern about, the future direction of the national institute. It is for the Minister of State to assuage our concerns.

Will NICE be genuinely independent, given the framework agreement—to use the Minister's term—within which it will have to operate? Will it be possible for the national institute, when it is up and running, to exercise its own judgment without interference, public or private, from Health Ministers or Department officials acting on their behalf?

Will the Minister assure us that the national institute's assessments of treatments for conditions will take into account not only clinical cost-effectiveness but other costs that should properly form part of the equation? Will it be able to consider, make a judgment on, and draw up recommendations based on the social costs of opting for, or of failing to provide, one treatment or another? Those are crucial judgments at the heart of the new clauses.

Yesterday evening, in the absence of any significant contribution to the debate from Labour Members, it was left to Conservative Members to represent their constituents' interests and to scrutinise the Executive. We had a little assistance from Liberal Democrat Members, and it would be churlish to deny that. The Minister of State had a relatively easy time as he listened to us. This evening, we need to hear from him. What are his answers to our questions? What form will the body take? Can he produce the evidence? Is he capable of assuaging the legitimate concerns of the official Opposition, of the Liberal Democrats, and much more important, of millions of people throughout the country who are waiting to find out what sort of creature NICE is? We have made our case, and await a response.

The Minister of State, Department of Health (Mr. John Denham)

We had a lengthy debate on the new clauses last night and important issues have been raised, although some of those were fully explored in Committee. I shall try to deal with some of the issues that were raised in last night's debate.

The casual observer of the debate might think that the Bill is about the establishment of the National Institute for Clinical Excellence, which has been established in the proper way as a special health authority. Given the way in which the Bill intermeshes with other reforms that the Government are carrying through, it is understandable that hon. Members have sought to debate NICE and its relationship to other health reforms.

As we have made clear on numerous occasions, NICE will play a key role in modernising the NHS and driving up standards within it. The intention is that the national institute will issue authoritative guidance to health professionals, and help to ensure the faster and more uniform uptake of clinically effective and cost-effective treatments. New clause 14 tabled by the Liberal Democrats deals with a number of separate issues. Subsection (1) would require NICE to hold its meetings in public. It is entirely right that there should be openness and transparency in the workings of NICE. During the debate on the establishment of NICE we made a commitment to extend the Public Bodies (Access to Meetings) Act 1960 to incorporate the National Institute for Clinical Excellence. We are doing that. We are currently preparing a statutory instrument to ensure that NICE will be subject to the 1960 Act. In practice, that means that meetings will generally be open to the public, but allows them to be excluded where publicity would be prejudicial to the public interest by reason of the confidential nature of the business or for other special reason.

Mr. Simon Hughes (Southwark, North and Bermondsey)

I am grateful to the Minister for his helpful remarks. On the qualification point, which I understand, can he give us an assurance that if there are to be times when NICE will meet in secret for the reasons that he has given, a record of the meeting and its conclusions will be available to the public at a later stage? I understand that occasionally a meeting may need to be held in secret.

Mr. Denham

I am sure that normal procedures with regard to publication of records of meetings of public bodies would apply. I imagine—the matter is probably worthy of further examination—that if the information would be of great commercial importance to the companies whose products were being appraised, great care should be taken by me this evening not to give the impression that the position of those companies would be lightly undermined. I am sure that normal procedures for public bodies would otherwise apply.

Subsection (2) of new clause 14 would require NICE to publish an annual report, and would require the Secretary of State to lay the report before Parliament. It has also long been the Government's intention that NICE should publish an annual report, and that, as is common practice, the report should be made available to Parliament. We do not need primary legislation to do that. It will be achieved through directions issued by the Secretary of State.

The national institute is a special health authority established in secondary legislation under the National Health Service Act 1977 and, accordingly, directions are the appropriate way forward. Subsections (3) and (4) confuse the role of NICE and the guidance that it will issue with the way in which priorities are set in the NHS. That goes to the heart of part of the debate last night.

By developing a consistent body of guidance on the clinical effectiveness and cost-effectiveness of different treatments and procedures, NICE will play an important role in tackling unjustified variations in access to treatment and it will provide valuable information on which clinicians, the Government and others in the NHS will make their decisions. NICE will, we believe, help to ensure that the most clinically effective and cost-effective treatments are widely available, without the delays that have accompanied the introduction of effective treatments in the past. However, we do not intend that NICE should become a substitute for the decisions that clinicians and others must take. That was the point raised by the hon. Member for Buckingham (Mr. Bercow).

Ministers are accountable for setting overall priorities for the NHS and, on occasion, for setting specific priorities—for example, the priority that we attach to the coronary heart disease national service framework. We have also given a particular priority to smoking cessation. Ministers are and must remain accountable for those decisions. On the example of smoking, as we discussed in Committee, there is a substantial body of work on the clinical and cost-effectiveness of smoking cessation. As it happens, that guidance predates NICE, but is the sort of guidance that might be issued by NICE in the future. I believe that it is right that we should establish NICE to make such information available. I also believe that it is right that in such a case it is the Government who set the priorities.

However, not all such decisions are taken by Government. Clinicians must also take important decisions about the treatments that are best for their patients and, in so doing, they want information about clinical and cost-effectiveness. NICE will provide that information, but NICE has no power to determine what decision is taken in each individual case. If a drug or treatment were ruled out on the NHS, that could be done only by the Government, and therefore by Ministers, as is the case at present.

The Liberal Democrats seem to want to transfer both the general responsibility of Government and the specific individual decisions of clinicians to NICE. That is what I understand to be the role of the patients forum that the Liberal Democrats want to establish. That is not the role that we intend NICE to play. I do not believe that it is the role NICE should play, whether it is advised by a committee of patients or not.

Of course, patients and their representatives have an important role in shaping the way in which NICE approaches its task. That is reflected in the way that patients are represented on the partners council. Through the council patients will help to ensure that the guidance that NICE issues is as good as it can be, and that NICE produces its guidance in a form that all groups can best understand. We want the information to be accessible to patients as well as to clinicians, and they will help to ensure that the voice of patients and other important stakeholders will be heard at the heart of the national institute.

Mr. Bercow

The hon. Gentleman said a moment ago that only the Government would be in a position—ultimately, I presume he means—to rule out the provision of treatments. Assuming that in some circumstances the national institute might judge that a particular treatment was not cost-effective and should not therefore be provided, is the hon. Gentleman referring to a situation in which NICE has one view and the Government have another? If so, is NICE obliged to accept some form of collective responsibility, or is it entitled to make it clear that although it defers to the Government, it disagrees with the Government's decision?

Mr. Denham

The point that I was making is straightforward. Perhaps I can best deal with it by turning to new clause 4, which covers it. As I said in Committee, NICE will operate within a framework agreement set by the Secretary of State.

We are committed to ensuring that that framework, and any other guidance from the Secretary of State, is open and transparent. It will be clear where the Government have given guidance, if they did so. We made it clear in the appraisal document, "Faster Access to Modern Treatment", that there may be circumstances in which NICE concludes that a particular procedure should not generally be available on the NHS, because of its lack of clinical or cost-effectiveness or because alternative procedures are simply and clearly more effective.

We would expect health authorities, primary care groups and primary care trusts, NHS trusts and clinicians to take full account of such guidance, but it is important to make it clear that NICE will have no power to reach and impose a decision on what is or is not available. If, having read NICE guidance, Ministers concluded that it should be enforced by regulation, it must remain the responsibility of Ministers to take such a decision and be accountable for it.

Mr. Philip Hammond (Runnymede and Weybridge)

The Minister has several times used the phrase "cost-effectiveness". Can he elaborate on what he means by that? When he asks NICE to consider various treatments for the same symptom or disorder, it is clear how he will measure the cost-effectiveness, but how will he measure the cost-effectiveness of a treatment for cancer against the cost-effectiveness of a hip replacement?

8 pm

Mr. Denham

The point is that it will be for NICE to make the judgments and to explain how it has reached the judgments that it will provide on particular treatments or interventions. If it compares different approaches to treating a particular condition, it must also explain how it has assessed those approaches, one against the other, and reached its conclusions. That is the role that we will look to the national institute to play in making the appraisals that we have asked it to make. Professor Michael Rawlins, the widely respected chairman of the national institute, will play a role in developing the methodologies that will enable that to be done effectively, which is one reason why we want substantial expertise to be available to the national institute.

Mr. Bercow

That was a nice try, but I am afraid that it will not suffice. The Minister has provided an excellent answer to a question that I did not ask, but, unfortunately, he has not provided an answer to the question I asked. If he does not mind, I will choose the questions and I should be very grateful if he would provide the answers. The situation to which I am referring is one in which NICE concludes that it believes that a treatment should be provided, but the Government decide otherwise. If the Government insist on getting their own way, will NICE be at liberty publicly to declare its disagreement with the Government's decision? That is my question.

Mr. Denham

It is absolutely our intention that the appraisals carried out by NICE will be public appraisals. If the national institute produces an appraisal suggesting that a particular drug should be used in particular circumstances and the Government of the day decide that that drug should not be used, that decision will be there for people to see. They will be able to compare the published appraisal of the national institute with the decision taken by Ministers. I hope that I can make some progress, because some other important issues were raised. I turn to new clauses 16 and 17.

Dr. Evan Harris (Oxford, West and Abingdon)

I thank the Minister for giving way and, to save time on my reply, may I press him on the nub of new clause 4? I should like to hear from him the following words: NICE will not be asked to take into account overall cost or affordability in its calculations and appraisals and will stick strictly—as the hon. Gentleman has already said, although he has not yet limited it to this—to clinical effectiveness and relative cost-effectiveness.

Mr. Denham

I risk repeating what I said several times over in Committee. Some months ago, we published a document on the appraisal techniques to be used by the national institute. We received a wide range of responses, some of which said that NICE must take into account almost every penny of NHS resources and apply a particular procedure to that. Others took the position that NICE should take no account even of cost-effectiveness, let alone wider NHS resources. I said in Committee that we were considering the responses to the consultation and we will decide in due course what factors we will ask NICE to take into account. I have made an important promise this evening, and have repeated what I said in Committee. The key point is that the framework that we establish for NICE and any guidance that is issued to it will be open and transparent. I am repeating a commitment made in Committee.

Mr. Hammond


Mr. Denham

I am somewhat in the hands of the hon. Gentleman, but I had assumed that the House would want to discuss more than one issue this evening. I shall give way to him once more and then perhaps I can make progress.

Mr. Hammond

I thank the Minister for giving way. Will he acknowledge that the question that he has ducked is extremely important? We cannot consider how NICE will operate in practice until we know the answer to it. If NICE will simply consider on a comparative basis the cost of providing a given outcome in a given situation, that will be beneficial—no one would disagree with that—but if it is to be asked to look at different outcomes to different situations and weigh them against each other, that will clearly be a rationing mechanism, which is what Conservative Members have suspected all along. We must know the answer.

Mr. Denham

The hon. Gentleman persists in missing the fundamental point, which is that NICE will provide the guidance sought by clinicians and others in the health service about how they take decisions. They will wish to know, and they will know, on what basis the national institute has reached those decisions and they will be able to take that into account in responding to the guidance. I shall move on—

Mr. Simon Hughes

Will the Minister give way on that point?

Mr. Denham

No, I will resist the hon. Gentleman. The hon. Member for Oxford, West and Abingdon (Dr. Harris) spoke for over an hour last night. [Interruption.] I may have been present for part of that discussion, and I think that it would be fairer to respond to the points that the hon. Member for Oxford, West and Abingdon has already made and with which I have not yet had a chance to deal.

I turn to new clauses 16 and 17, which would restrict the Secretary of State's freedom to take decisions about which medicines should be prescribable by general practitioners under the NHS. The Liberal Democrats are in a somewhat confusing situation: they are seeking to establish a patients forum to determine what drugs should be available on the NHS and, at the same time, they are tabling new clauses which would remove from any Government the ability to take decisions about which medicines should be prescribable.

Schedule 11 to the National Health Service (General Medical Services) Regulations 1992 lists drugs that can be prescribed under the NHS only in certain circumstances. For example, clobazam can be prescribed only for the treatment of epilepsy, not as a sedative or tranquilliser, but there are good reasons for that. Clobazam offers clinical benefit in treating epilepsy, yet it is a far more expensive sedative or tranquilliser than similar drugs which have the same properties. At current prices, a packet of 30 clobazam tablets costs about £10, but a similar-sized packet of diazepam costs no more than a few pence. It would be ridiculous, I suggest, to countenance the use of clobazam as a sedative when other, equally effective treatments are available much more cheaply. The new clause would make it impossible for a Government to continue to use that provision.

That schedule, subject to parliamentary acceptance of the necessary regulations, will be used to restrict the prescribing of treatments for impotence from 1 July. In this instance, it is proposed that treatment will be available to categories of men with specified underlying organic causes of impotence.

New clause 17 strikes at the heart of the Government's ability to influence or control the costs of prescribing and would constrain even the Secretary of State's ability to issue guidance. He could not say to doctors, for example, "Think about the cost of this medicine when you are considering prescribing it." He could not even point out that an equally effective medicine was available at lower cost. That would be plainly absurd. It would also constrain his ability to make regulations that would either prevent GPs from prescribing things on the NHS or restrict the circumstances in which they should do so. New clause 17 would undermine the purposes of schedules 10 and 11 to the GMS regulations. The majority of the products in those schedules appear as a result of advice from two committees: the Advisory Committee on NHS Drugs and the Advisory Committee on Borderline Substances.

I hope that I have covered the core issues if not the detailed issues that have been raised. We were invited yesterday to agree that the NHS rations; I do not agree with that. We were also invited to agree that rationing is defined as sharing out in fixed quantities; that is precisely what the NHS does not do. We do not each have a fixed quantity of NHS resources. What we use and what we gain from the NHS varies according to our own life histories and ill-health. That is precisely the reason why we reject language that is used only by those who seek to undermine the NHS and put a private health service in its place.

Dr. Harris

I am afraid that that reply varied from disappointing to very disappointing. The Minister is usually correct in his facts, but during a debate, mainly on Liberal Democrat new clauses and amendments, lasting nearly six hours, I spoke for 45 minutes and took eight interventions—a greater number than he was able to take in his reply. I regret that he would not take the intervention of my hon. Friend the Member for Southwark, North and Bermondsey (Mr. Hughes), our Front-Bench spokesman, which he has been good enough to do in the past.

On new clause 4, it is clear that the Government are hiding their answer behind a consultation process. I believe that primary legislation—this may be our only opportunity to discuss this issue on that basis during the current Parliament—should take precedence over consultation. It will not do for the Government to try to hide their position behind a consultation process in which, according to the Minister himself—I think that he understood this point—there would be extremes of view. People, certainly including clinicians and patients' organisations, are desperate to know whether the Government are minded to allow guidance to come from a professional body on the basis of affordability or of overall costs. As the Government have not allowed us a separate debate, this is our best opportunity to find that out.

The Government say that it is for them to regulate on the basis of guidance from the institute—guidance which will bind neither them nor individual clinicians. We fear, however, that this Government or other Governments may say, "We must look at the guidance from the professionals. We would be foolish to ignore it." We are keen to ensure that a professional body—or, at least, a body that is informed by experts and by professional advice—is not forced by the Government to consider matters that should be solely the Government's remit, and that the Government are not allowed to hide behind such arrangements.

Mr. Simon Hughes

About a year ago, when the Government asked the health service pay review bodies what they wanted to do, the Government set a precedent by telling the pay review bodies that they must take account of cost before recommending the level of salaries. That is a bad precedent, but it look as if the Government will go down the same road in relation to advice on rationing.

Dr. Harris

My hon. Friend is absolutely right. Because the Government will not rule out that option, professionals and friends of the health service must look at the Government's form—and, as far as the NHS is concerned, the Government have previously sought to run away from their responsibilities for the fact that the service is desperately short of funds.

The Minister refused to answer another question, which was asked badly by the hon. Member for Buckingham (Mr. Bercow) but which I shall put in a different way. If the National Institute for Clinical Excellence has to look at just the effectiveness and cost-effectiveness of drugs and treatments, will it be able to criticise Government policy—such as the Government's obsession with waiting lists—on the ground that it is an ineffective and non-cost-effective use of resources? I shall be interested to see whether the Minister can tell us now that the institute will be free to criticise Government policy and priorities. His decision to remain seated suggests that the institute will not be free to do that, which is a great pity. New clause 14 sought to bring the institute into the public domain. We are pleased with the Minister's response to subsection (1), but both the Government and the Conservative Opposition failed to understand that subsection (3) was intended to ensure that the patient's voice was heard in decisions about which treatments the institute would consider, rather than in decisions about whether the Government should engage in rationing. It is unfortunate that neither party decided to consider that. I am also concerned about the Government's response to new clause 16.

Mr. Hammond

Will the hon. Gentleman give way?

Dr. Harris

No. I want to finish my speech, and the hon. Gentleman has had plenty of time in which to speak.

Effectively, the Government are saying that new clause 16 would stop them from restricting the use of drugs as treatment for certain conditions when other treatment would be equally effective, both clinically and in terms of cost. Perhaps the new clause should have been drafted in those precise terms, but I am sure that the Government would have rejected it in any event. In the Minister's example, it was clear that the decision to restrict use of an anti-epileptic drug was based on its effectiveness, and relative cost-effectiveness, in certain conditions, rather than being based—as with the restrictions on the use of Viagra—on the original cause of the condition. That is highly discriminatory. In a similar manner, the Government wriggled out of the implications of new clause 17 by claiming that cost was the same as cost-effectiveness. Of course it is right for the Minister to be able to offer guidance on the use of a drug on the basis of cost-effectiveness, but the new clause refers to cost and affordability, so the Minister's answer does not wash. On the basis of all that, we shall press the motion to a Division.

Question put, That the clause be read a Second time:—

The House divided: Ayes 34, Noes 322.

Division No. 206] [8.15 pm
Allan, Richard Livsey, Richard
Beith, Rt Hon A J Llwyd, Elfyn
Brake, Tom Maclennan, Rt Hon Robert
Bruce, Malcolm (Gordon) Moore, Michael
Burnett, John Morgan, Alasdair (Galloway)
Burstow, Paul Öpik, Lembit
Cable, Dr Vincent Rendel, David
Chidgey, David Ross, William (E Lond'y)
Cotter, Brian Russell, Bob (Colchester)
Davey, Edward (Kingston) Sanders, Adrian
Feam, Ronnie Smyth, Rev Martin (Belfast S)
Forsythe, Clifford Stunell, Andrew
Foster, Don (Bath) Tonge, Dr Jenny
Hancock, Mike Webb, Steve
Harris, Dr Evan Willis, Phil
Harvey, Nick
Hughes, Simon (Southward N) Tellers for the Ayes: Mr. Mark Oaten and Sir Robert Smith.
Keetch, Paul
Kirkwood, Archy
Abbott, Ms Diane Anderson, Janet (Rossendale)
Ainger, Nick Ashton, Joe
Ainsworth, Robert (Cov'try NE) Atherton, Ms Candy
Alexander, Douglas Atkins, Charlotte
Anderson, Donald (Swansea E) Barnes, Harry
Barron, Kevin Dobson, Rt Hon Frank
Battle, John Donohoe, Brian H
Beard, Nigel Doran, Frank
Beckett, Rt Hon Mrs Margaret Dowd, Jim
Begg, Miss Anne Drew, David
Bell, Martin (Tatton) Drown, Ms Julia
Bell, Stuart (Middlesbrough) Dunwoody, Mrs Gwyneth
Benn, Hilary (Leeds C) Eagle, Angela (Wallasey)
Benn, Rt Hon Tony (Chesterfield) Eagle, Maria (L'pool Garston)
Bennett, Andrew F Edwards, Huw
Bermingham, Gerald Efford, Clive
Berry, Roger Ellman, Mrs Louise
Best, Harold Ennis, Jeff
Betts, Clive Fisher, Mark
Blackman, Liz Fitzpatrick, Jim
Blears, Ms Hazel Fitzsimons, Loma
Blizzard, Bob Flint, Caroline
Blunkett, Rt Hon David Follett, Barbara
Borrow, David Foster, Rt Hon Derek
Bradley, Keith (Withington) Foster, Michael Jabez (Hastings)
Bradley, Peter (The Wrekin) Foster, Michael J (Worcester)
Bradshaw, Ben Foulkes, George
Brinton, Mrs Helen Galloway, George
Brown, Russell (Dumfries) Gapes, Mike
Browne, Desmond Gardiner, Barry
Buck, Ms Karen George, Bruce (Walsall S)
Burden, Richard Gerrard, Neil
Burgon, Colin Gibson, Dr Ian
Butler, Mrs Christine Gilroy, Mrs Linda
Caborn, Rt Hon Richard Godsiff, Roger
Campbell, Alan (Tynemouth) Goggins, Paul
Campbell, Mrs Anne (C'bridge) Golding, Mrs Llin
Campbell, Ronnie (Blyth V) Gordon, Mrs Eileen
Campbell—Savours, Dale Giffiths, Jane (Reading E)
Cann, Jamie Griffiths, Nigel (Edinburgh S)
Caton, Martin Griffiths, Win (Bridgend)
Cawsey, Ian Grocott, Bruce
Chapman, Ben (Wirral S) Gunnell, John
Chaytor, David Hain, Peter
Clapham, Michael Hall, Mike (Weaver Vale)
Clark, Dr Lynda (Edinburgh Pentlands) Hall, Patrick (Bedford)
Hamilton, Fabian (Leeds NE)
Clark, Paul (Gillingham) Hanson, David
Clarke, Charles (Norwich S) Heal, Mrs Sylvia
Clarke, Eric (Midlothian) Healey, John
Clarke, Rt Hon Tom (Coatbridge) Henderson, Doug (Newcastle N)
Clarke, Tony (Northampton S) Henderson, Ivan (Harwich)
Clelland, David Hepburn, Stephen
Clwyd, Ann Heppell, John
Coaker, Vernon Hesford, Stephen
Coffey, Ms Ann Hewitt, Ms Patricia
Cohen, Harry Hill, Keith
Coleman, Iain Hinchliffe, David
Colman, Tony Hodge, Ms Margaret
Connarty, Michael Hoey, Kate
Corbett, Robin Hood, Jimmy
Corbyn, Jeremy Hoon, Geoffrey
Corston, Ms Jean Hope, Phil
Cousins, Jim Hopkins, Kelvin
Cranston, Ross Howarth, Alan (Newport E)
Crausby, David Howarth, George (Knowsley N)
Cryer, John (Hornchurch) Howells, Dr Kim
Cummings, John Hoyle, Lindsay
Curtis—Thomas, Mrs Claire Hughes, Ms Beverley (Stretford)
Dalyell, Tam Hughes, Kevin (Doncaster N)
Darling, Rt Hon Alistair Humble, Mrs Joan
Darvill, Keith Hurst, Alan
Davey, Valerie (Bristol W) Hutton, John
Davidson, Ian Iddon, Dr Brian
Davies, Rt Hon Denzil (Llanelli) Ingram, Rt Hon Adam
Davies, Geraint (Croydon C) Jackson, Ms Glenda (Hampstead)
Dawson, Hilton Jackson, Helen (Hillsborough)
Dean, Mrs Janet Jenkins, Brian
Denham, John Johnson, Alan (Hull W & Hessle)
Dismore, Andrew Johnson, Miss Melanie (Welwyn Hatfield)
Dobbin, Jim
Jones, Barry (Alyn & Deeside) Pond, Chris
Jones, Mrs Fiona (Newark) Pope, Greg
Jones, Helen (Warrington N) Pound, Stephen
Jones, Jon Owen (Cardiff C) Prentice, Ms Bridget (Lewisham E)
Jones, Dr Lynne (Selty Oak) Prentice, Gordon (Pendle)
Kaufman, Rt Hon Gerald Primarolo, Dawn
Keeble, Ms Sally Prosser, Gwyn
Keen, Alan (Feltham & Heston) Purchase, Ken
Keen, Ann (Brentford & Isleworth) Quinn, Lawrie
Kelly, Ms Ruth Radice, Giles
Kennedy, Jane (Wavertree) Rammell, Bill
Khabra, Piara S Reed, Andrew (Loughborough)
Kidney, David Reid, Rt Hon Dr John (Hamilton N)
King, Andy (Rugby & Kenilworth) Robertson, Rt Hon George (Hamilton S)
King, Ms Oona (Bethnal Green)
Kumar, Dr Ashok Roche, Mrs Barbara
Ladyman, Dr Stephen Rooney, Terry
Lawrence, Ms Jackie Ross, Ernie (Dundee W)
Laxton, Bob Rowlands, Ted
Lepper, David Roy, Frank
Leslie, Christopher Ruane, Chris
Levitt, Tom Ruddock, Joan
Lewis, Ivan (Bury S) Russell, Ms Christine (Chester)
Lewis, Terry (Worsley) Ryan, Ms Joan
Liddell, Rt Hon Mrs Helen Sarwar, Mohammad
Linton, Martin Savidge, Malcolm
Livingstone, Ken Sawford, Phil
Lloyd, Tony (Manchester C) Sedgemore, Brian
Lock, David Shaw, Jonathan
McAvoy, Thomas Sheerman, Barry
McCabe, Steve Sheldon, Rt Hon Robert
McCartney, Rt Hon Ian (Makerfield) Simpson, Alan (Nottingham S)
Skinner, Dennis
Macdonald, Calum Smith, Rt Hon Andrew (Oxford E)
McDonnell, John Smith, Angela (Basildon)
McFall, John Smith, Rt Hon Chris (Islington S)
McGuire, Mrs Anne Smith, Jacqui (Redditch)
McIsaac, Shona Smith, John (Glamorgan)
Mackinlay, Andrew Smith, Llew (Blaenau Gwent)
McNulty, Tony Snape, Peter
Mactaggart, Fiona Soley, Clive
Mallaber, Judy Southworth, Ms Helen
Marsden, Paul (Shrewsbury) Squire, Ms Rachel
Marshall, David (Shettleston) Steinberg, Gerry
Marshall—Andrews, Robert Stevenson, George
Martlew, Eric Stewart, David (Inverness E)
Maxton, John Stinchcombe, Paul
Meale, Alan Stoate, Dr Howard
Merron, Gillian Stott, Roger
Michie, Bill (Shef'ld Heeley) Strang, Rt Hon Dr Gavin
Milburn, Rt Hon Alan Straw, Rt Hon Jack
Miller, Andrew Stringer, Graham
Moffatt, Laura Stuart, Ms Gisela
Moonie, Dr Lewis Sutcliffe, Gerry
Moran, Ms Margaret Taylor, Rt Hon Mrs Ann (Dewsbury)
Morgan, Ms Julie (Cardiff N)
Morley, Elliot Thomas, Gareth (Clwyd W)
Morris, Ms Estelle (B'ham Yardley) Thomas, Gareth R (Harrow W)
Morris, Rt Hon John (Aberavon) Timms, Stephen
Mountford, Kali Tipping, Paddy
Mudie, George Touhig, Don
Mullin, Chris Trickett, Jon
Murphy, Denis (Wansbeck) Truswell, Paul
Murphy, Jim (Eastwood) Turner, Dennis (Wolverh'ton SE)
Murphy, Rt Hon Paul (Torfaen) Turner, Dr Desmond (Kemptown)
Naysmith, Dr Doug Turner, Dr George (NW Norfolk)
Norris, Dan Twigg, Derek (Halton)
O'Brien, Mike (N Warks) Twigg, Stephen (Enfield)
Olner, Bill Vaz, Keith
O'Neill, Martin Walley, Ms Joan
Osborne, Ms Sandra Ward, Ms Claire
Pearson, Ian Wareing, Robert N
Pendry, Tom Watts, David
Pickthall, Colin White, Brian
Pike, Peter L Whitehead, Dr Alan
Plaskitt, James Wicks, Malcolm
Williams, Rt Hon Alan (Swansea W) Woolas, Phil
Worthington, Tony
Williams, Alan W (E Carmarthen) Wright, Anthony D (Gt Yarmouth)
Williams, Mrs Betty (Conwy) Wright, Dr Tony (Cannock)
Wills, Michael Wyatt, Derek
Winnick, David
Winterton, Ms Rosie (Doncaster C) Tellers for the Noes: Mr. David Jamieson and Mr. Graham Allen.
Wise, Audrey
Wood, Mike

Question accordingly negatived.

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