COMMUNITY HEALTH COUNCILS: SCHEME FOR REFORM

HC Deb 14 February 2001 vol 363 cc381-412

".—(1) The Secretary of State shall lay before Parliament within 12 months of the date of coming into force of this section regulations setting out a scheme for the reform of Community Health Councils in England.

(2) The scheme set out by the Secretary of State in regulations under subsection (1) above shall extend t3 all parts of the health service (including the provision of Part [I services under the 1977 Act).

(3) The Secretary of State may make regulations providing for access by members of a Community Health Council to premises from which services under Part II of the 1077 Act are provided.

(4) The scheme set out by the Secretary of State in regulations under subsection (1) shall provide for the proper representation of the population in the area served by a Community Health Council on that Council.

(5) Regulations under subsection (1) may not be made unless a draft of the statutory instrument containing the regulations has been laid before, and approved by a resolution of, each House of Parliament.'.—[Dr. Fox.]

Brought up, and read the First time.

7.30 pm

Dr. Fox

I beg to move, That the clause be read a Second time.

Mr. Deputy Speaker

With this it will be convenient to discuss the following: New clause 7—Community Health Councils: additional functions—

".—(1) The Secretary of State shall make regulations providing in relation to Community Health Councils ("Councils") in England for—

1. (a) the delivery by Councils of support and advocacy services to patients and others with complaints about health services;
2. (b) Councils to advise and make recommendations to the relevant overview and scrutiny committee, health authority and trust about matters arising from complaints;
3. (c) reports on the operation of the complaints support service to be compiled by Councils and provided to the Secretary of State to the relevant overview and scrutiny committee, health authority, trust, and other appropriate organisations;
4. (d) annual reports to be published by Councils detailing the arrangements maintained in that year for obtaining the views of patients;
5. (e) the establishment of sub-committees of each Council to be known as Patients' Forums, for each NHS and primary care trust in the district of the Council, made up of representatives of the Council, and co-opted representatives of the local authority overview and scrutiny committee, patients, carers and the wider community, with duties to—
1. (i) monitor and review the operation of services provided by, or under arrangements made by, the trust to which it relates;
2. (ii) obtain the views of patients, carers and the wider community about those services and report on those views to the Council and the trust;
3. (iii) provide advice and make reports and recommendations about matters relating to those services to the Council, the relevant Health Authority, and the trust to which it relates,
4. (iv) make available to patients, carers and the wider community advice and information about those services;
5. (v) in the case of primary care services carry out the functions as may be prescribed by regulations made by the Secretary of State;
6. (vi) carry out such other functions as may be prescribed by regulations made by the Secretary of State;
6. (f) the appointment of representatives from the Patients' Forum as non-executive directors to the board of the trust to which the Forum relates;
7. (g) for functions of Patients' Forums to be performed under joint arrangements between Councils, where such arrangements are appropriate to meet the needs of their communities;
8. (h) the extension of Councils' rights of inspection to all premises from which services as defined in subsection (3) are provided and;
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9. (i) matters of concern which Councils may refer to the National Institute for Clinical Excellence, the Commission for Health Improvement, the Audit Commission and the Secretary of State.

(2) References in subsection (1) to "services" are references to—

1. (a) services provided as part of the health service (within the meaning of the 1977 Act) in England;
2. (b) services provided in England in pursuance of arrangements under regulations under section 31 of the Health Act 1999; and
3. (c) services provided elsewhere in pursuance of such arrangements with a local authority in England.

(3) In subsection (2)—

1. (a) "relevant overview and scrutiny committee", means the committee of the council or councils whose district corresponds, or is included within, the community represented by the Council.
2. (b) "relevant Health Authority" in subsection (1)(e) in relation to a Patients' Forum for a Primary Care Trust, means the Health Authority whose area is, or includes, the area for which the trust is established.

(4) Before making regulations under this section the Secretary of State shall consult with Councils and such patients' and carers' organisations as he shall consider appropriate.'.

New clause 8—Community Health Councils in Wales—

'. The National Assembly for Wales may, by order, in relation to Community Health Councils in Wales, make provision corresponding to the provision which the Secretary of State must, by regulations, make in relation to Community Health Councils in England under section (Community Health Councils: additional functions).'.

New clause 9—Patients' Councils—

'.—(1) The Secretary of State shall by regulations provide for the establishment of bodies to be known as Patients' Councils (referred to in this section as "Councils") the members of which are to be appointed in each case by two or more Patients' Forums.

(2) The regulations shall provide for determining—

1. (a) the Patients' Forums by which the members of a Council are to be appointed, and
2. (b) the area in relation to which the functions of a Council are exercisable.

(3) The functions of a Council are—

1. (a) to facilitate the co-ordination by member Forums of their activities;
2. (b) to make reports to health authorities, local authorities and their committees and to the Secretary of State in accordance with the regulations;
3. (c) to carry out such arrangements as may be made with the Council under section 19A of the 1977 Act (independent advocacy services);
4. (d) such other functions as the regulations may prescribe.

(4) The "member Forums" of a Council are the Patients' Forums by which its members are for the time being appointed.'.

New clause 10—Independent advocacy services—

'. After section 19 of the 1977 Act there shall be inserted—

"Independent advocacy services

19A.—(1) It is the duty of the Secretary of State to arrange, to such extent as he considers necessary to meet all reasonable requirements, for the provision of independent advocacy services.

(2) "Independent advocacy services" are services providing assistance (by way of representation or otherwise) to individuals making or intending to make—

1. (a) a complaint under a procedure operated by a health service body or independent provider,
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2. (b) a complaint to the Health Service Commissioner for England or the Health Service Commissioner for Wales,
3. (c) a complaint of a prescribed description which relates to the provision of services as part of the health service and
1. (i) is made under a procedure of a prescribed description. Or
2. (ii) gives rise, or may give rise, to proceedings of a prescribed description.

(3) In subsection (2)— health' service body" means a body which, under section 2(1) or (2) of the Health Service Commissioners Act 1993, is subject to investigation by the Health Service Commissioner for England or the Health Service Commissioner for Wales; independent provider" means a person who, under section 2B(1) or (2) of that Act, is subject to such investigation.

(4) The Secretary of State may make such other arrangements as he thinks fit for the provision of assistance to individuals in connection with complaints relating to the provision of services as part of the health service.

(5) In making arrangements under this section the Secretary of State must have regard to the principle that the provision of services under the arrangements should, so far as practicable, be independent of toy person who is the subject of a relevant complaint or is involved in investigating or adjudicating on such a complaint.

(6) Before making arrangements under this section in respect of complaints relating to the provision of any services. the Secretary of State shall consult—

1. (a) any relevant Patients' Council, and
2. (b) such other persons as he considers appropriate.

(7) A Patients' Council is, for the purposes of subsection (6)(a), a relevant Council if the services concerned are ones to which functions of a member Forum of the Council relate.

(8) The Secretary of State may make payments to any person in pursuance of arrangements under this section.".'.

Amendment No. 2, in page 9, line 6, leave out clause 11.

Government amendments Nos. 144 to 150.

Amendment No. 3, in page 10, line 18, leave out clause 12.

Amendment No. 4, in page 10, line 30, leave out clause 13.

Amendment No. 5, in page 10, line 38, leave out clause 14.

Amendment No. 24, in clause 14, page 10, line 39, at end insert "and Patients" Councils ("Councils").".

Government amendment No. 151.

Amendment No. 25, in clause 14, in page 11, line 24, at end insert— '() Subsection (2) applies in relation to a Council as it applies in relation to its member Forums.'.

Amendment No. 26, in clause 14, in page 11, line 36, at end insert— '() The regulations must include provision as to the use by member Forums of a Council, and by the Council, of shared facilities and staff.'.

Amendment No. 6, in page 12, line 7, leave out clause 15.

Amendment No. 19, in page 12, line 34, leave out clause 16.

Government amendment No. 159.

Dr. Fox

This is likely to be the most controversial of the debates today. The strength of feeling aroused must have come as a shock to the Government; it must have come as a lesson to them that, although they may be able to muzzle criticism inside the How e, it is much more difficult for them to do so in the real 'world. We look forward to whatever climbdown from the proposals the Minister of State is going to make.

Under the Government's proposals, the current functions of community health councils will be divided up into patient advocacy and liaison services, patients forums and local authority scrutiny committees. During the debates in Standing Committee, the Government did nothing to dispel our fear that the replacement of CHCs with a fragmented system will mean that there will no longer be an overall body that can span many care providers to oversee the whole of a patient's experience. The example was used of a patient who, in a single episode of illness, had a problem with his GP, a problem with the ambulance service and a problem with the acute trust. Under the new system, to whom would such a patient complain about each of those bodies? Will the patient find the new system more difficult or easier than the current one?

Similarly, the separation of scrutiny and complaints procedures undermines the work of CHCs in understanding the broader patterns of health provision. The Government have tried to argue that bringing scrutiny closer to trusts will mean that there will be speedier action. However, the loss of an independent perspective may result in no action at all. Attempts to solve those problems will necessitate further quangos. The new clauses proposed by the hon. Member for Wakefield (Mr. Hinchliffe) would create even more confusion. The Government are creating a system in which patients will have to shop around for their rights.

I am sorry that no apology was offered in Committee for the way in which CHCs have been treated by the Government during the progress of this matter. The Government have still to apologise for the lack of consultation that has left their employees in the dark as to the future. In the House, the Prime Minister famously claimed to have consulted the CHCs, but they denied it and the right hon. Gentleman was forced to backtrack. As Richard Gordon QC told the Association of Community Health Councils for England and Wales: in my opinion, the consultation process Dyer the new NHS plan was…legally flawed. That is a severe indictment of Ministers. What was the ministerial response? In a letter, the Under-Secretary, the hon. Member for Birmingham, Edgbaston (Ms Stuart), who is not in the Chamber at present, replied: We do not accept that the Association of Community Health Councils for England and Wales or CHCs had any legitimate expectation to be consulted in relation to the proposals that CHCs should be abolished in primary legislation to be introduced in parliament in due course. So, the association was felt not to have "any legitimate expectation"—yet the Prime Minister went to great lengths to point out how extensively the Government were consulting over the proposal. The Minister let the cat out of the bag: the Government never believed that there was any legitimate expectation that CHCs would be consulted. That is the definitive version of the Government's policy.

Mr. Fabricant

My hon. Friend says that the Government saw no reason to expect the CHCs to wish to consult. I suspect that he will not be surprised to learn that I received a letter from the South East Staffordshire community health council that states the Government has consistently refused to consult on this issue, and has still not produced substantive detail on our proposed replacements, even at Committee Stage.

In a short intervention, I might just go on to say—

Mr. Deputy Speaker

Order. I think perhaps the hon. Gentleman might not go on to say anything.

Dr. Fox

My hon. Friend the Member for Lichfield (Mr. Fabricant) is right—the House will not be shocked to learn that I am not surprised at the information that he imparts.

In Committee, the Government also failed to answer some of the questions on funding in respect of CHCs. Will the Minister tell us whether the Government continue to reject the claims of the association that, by 2004–05, the new bodies that are to replace CHCs will cost £114 million, compared with the current CHC budget of £23 million? If the Government reject those sums, will the Minister tell us how they expect hospitals to fund the additional bodies?

On Second Reading and in Committee, the Government argued that the presence of patient advocacy and liaison services in hospitals will lend more immediacy to the complaints of patients. However, to steer patients towards the complaints system where necessary is greatly different from the proactive advocacy role currently played by CHCs. Independence will undoubtedly be lost, not gained—to the detriment of patient care.

The Government have also tried to argue that patients forums will be able to remove PALS from the control of trusts. That just might prevent a gross distortion of the system, but it would do nothing to stop PALS employees from feeling beholden to trusts; they might take decisions different from those that they would have taken had they enjoyed full independence.

The Government have failed to explain how conflicts of interest on the part of councillors scrutinising care trusts will be dealt with. Such conflicts will arise when councillors are increasingly called on to scrutinise services for whose funding and provision their authority has joint responsibility. They will thus not be independent of the services that they scrutinise. Many such councillors will be of the same political persuasion as the non-executive directors, and even chairmen, of the local trusts. We do not need to go back over the ground about appointments to trusts under the Labour Government-of which Dame Rennie Fritchie gave such a damning indictment. An alternative scenario might pertain, in which such councillors were of a different political colour. What we would then see would not be cronyism but the use of the situation as a political football, in a way that does not occur at present. That cannot be to the advantage of patients.

The Government have been unable to confirm that the lone member of the patients forum appointed to a hospital trust board will be selected by the relevant patients forum.

Perhaps the Minister can offer us that assurance tonight. In a Labour party briefing, the Government have also tried to portray patients forums as mini-CHCs. This is the line that goes out: "Don't worry about it because the patients forums are really mini-CHCs". If that is so, why are the Government abolishing CHCs? That makes no sense whatever.

In Committee, the Minister of State said: It is our expectation, however, that patients forums will undertake specific or general monitoring activity. That is important as an allegation has been made—and repeated this morning—that the aim of the exercise has been to remove from the system of scrutiny in the NHS any organisation or body that could play that role. That is not the case. Patients forums will be able to carry out that role, as CHCs have in the past."—[Official Report, Standing Committee E, 30 January 2001; c. 235.] If all that the Minister said in Committee is true, why do the Government want to abolish CHCs, which are currently performing those tasks, in many cases—as the Minister pointed out—excellently?

Ministers have conspicuously avoided public discussion of these issues. The Association of Community Health Councils for England and Wales held a seminar on 4 December last year, but the Minister who was to respond wrote in advance that she would be unable to answer questions about the Government's proposals to abolish CHCs. In other words, the Minister with responsibility for the abolition of CHCs tells a conference of CHCs that she is unable to answer questions on that very issue.

The Department of Health arranged a meeting in Fulham on a day when the Standing Committee was discussing many of those issues. A junior Minister took the place of the Secretary of State, but there was no sign of the promised guidelines. That is not surprising, given the confusing signals coming from the Government.

As we noted in Committee, the Prime Minister's agent wrote to his local CHC in Durham to say that, on the anniversary, Tony would certainly like to add his congratulations to the work the CHCs have done over the last 25 years and wishes them every success in the future. The Prime Minister's implementation of the concept of "every success" is the success we wish for the Government in the coming general election. A short time after that letter, the Government announced the abolition of CHCs. Indeed, on 4 December, the South Durham and Weardale CHC, which covers the Prime Minister's constituency, wrote: We are concerned that the Government have announced the intention to abolish CHCs as a cynical attempt to silence any negative publicity…What better way to deflect attention away from any shortcomings than by silencing the only independent monitor that the public has for the NHS. Interestingly, neither the Labour-dominated Scottish Executive nor the Labour-dominated Welsh Assembly has made any plans to abolish CHCs. What have patients in England done to deserve such special silencing treatment from the Government?

Mr. Peter Bottomley (Worthing, West)

My hon. Friend has quoted the Prime Minister's agent wishing CHCs well in the future and cited the Prime Minister saying on the Floor of the House that there had been consultation on their abolition. Has any Minister from Department of Health acknowledged on the Floor of the House that there has been no consultation? If no Minister has yet done so, will the Secretary of State do so now?

Dr. Fox

I very much look forward to Ministers being open about the fact that there was absolutely no consultation on the abolition of CHCs, either before it was announced in the national plan or subsequently. They have consulted only on what should replace CHCs. To suggest that proper consultation on abolition has taken place is to define the concept in a way that the rest of us would not understand from reading an English dictionary. That shows that the Government's interpretation of consultation is very far removed from that which anyone else would regard as meaningful.

Under new clause 10, tabled by the hon. Member for Wakefield, CHCs would not be retained, and we simply cannot accept the complex mechanism that he proposes as an alternative. What has been suggested in that new clause constitutes a tool for limiting the damage that the Government's proposals would cause, rather than an attempt to stop the damage being done in the first place. I am sorry that the hon. Gentleman has departed from his position, which involved a robust defence of CHCs; he is now trying to ameliorate the damage. That is a case of crusader turned collaborator, and it does the hon. Gentleman no justice.

Mr. Fabricant

Will my hon. Friend give way?

Dr. Fox

I will not. I hope my hon. Friend will forgive me.

We make a strong case in new clause 2 for reforming CHCs to make them more effective. For example, there could be more standardisation of CHC work, reform of the appointments systems and better resourcing. No one can deny that CHCs have done good work-for example, in the Harold Shipman and Rodney Ledward cases, in preparing and publishing "Casualty Watch" and in highlighting the many instances of poor performance in our hospitals. It should never be forgotten that CHCs represent the entire public, not just patients in the NHS. There is a growing feeling among politicians, CHCs and patient and medical bodies that Ministers are making up all the new systems as they go along. No doubt, they will make up a new version on the hoof during the debate.

Some CHCs do work well, and we all accept that. Ministers have said that some are excellent, and we also all accept that. Our logic suggests that we should bring the standard of the poorest up to the standard of the best. The Government's logic suggests that everyone should be judged by the standard of the poorest—then let them be abolished. I should love to see them try to apply that Mandelson test to Ministers.

The Opposition will accept nothing less than reform and retention of CHCs. If we are defeated on new clause 2 tonight, we shall carry the fight to the other place. The Government are running out of time as they come to a general election. We look forward to carrying into the general election our proposal to maintain and reform CHCs, whereas th,3 Government want to abolish organisations run by many people who have not only done sterling public service in the past and helped many patients, but who support their own party. Government Back Benchers should be warned that if they vote to abolish CHCs, they will inflict deep hurt on many people who may well have been willing to help them in the forthcoming general election. Given that the Government have treated CHCs with contempt by failing to consult, and given that they are now treating them with disdain, Labour Members may not receive that help in the future.

Mr. Paul Burstow (Sutton and Cheam)

The Liberal Democrats want to make it clear that we stand on a ticket of reforming CHCs, not of abolishing them. I want to outline our views on the amendments that my hon. Friends and I have tabled. I want to make it clear that if a Division takes place on new clause 2, we will join the official Opposition in the Lobby to advocate the case for retaining CHCs and building on what is good about them, not throwing out the baby with the bath water as is proposed at the moment. We belive that an effective watchdog is needed, so we must look at the good practice that exists in CHCs, which Ministers acknowledged in Committee.

7.45 pm

The new arrangements will fragment the watchdog rule. They will shatter the complaints handling system and inspection and overview. They will scatter those matters around to a range of new bodies. The new system—which is being gradually revealed, piece by piece—is more centred on the interests and needs of care providers than on those of the patients who receive that care. The reality is that people's experience of the NHS is gained not on a piecemeal basis of what individual trusts provide, but on the care pathway that they take through the NHS, which includes visits to their GPs and the services provided by community NHS trusts and acute trusts. To end up with a system in which different patient, forums deal with different aspects of patients experience misses the point of trying to create a patient-centred NHS. That is what the Government say in their NHS plan they want to do, but the new system will not deliver it in practice.

As the hon. Member for Woodspring (Dr. Fox) has said, the new arrangements will leave community interests out in the cold. We are specifically sealing with patients experience of the services provided, so it is essential that we do not lose the wider view of the interests of the local community being served by the local health care economy, the NHS and other care providers. The powers and other aspects of the proposals show. time and again, the confusion between customer care and advocacy on behalf of patients and the community and the effective oversight and scrutiny of the NHS.

Mr. Gordon Marsden (Blackpool, South)

I think we would all applaud what the hon. Gentleman says about the needs of the community, but does he not accept that the role of the proposed patient advocacy and liaison service is an entirely new one, especially for patients in hospital, which is not currently addressed by CHCs?

Mr. Burstow

The hon. Gentleman is right to say that the role of PALS is entirely new, but it is a customer-care role, not a customer advocacy role. Indeed, the Bill contains no specific proposals about setting up independent advocacy services. New clause 10, tabled by the hon. Member for Wakefield (Mr. Hinchliffe), tries to deal with that, and the hon. Gentleman has our support in that respect because proposals that establish genuine, independent advocacy services for patients are needed.

Dr. Fox

Does the hon. Gentleman accept that even if we accepted that PALS were good in itself, there would be nothing to stop that being introduced alongside CHCs, as an additional measure rather than as a substitute?

Mr. Burstow

I entirely agree. The proposals on PALS should be viewed completely outwith those on patient advocacy and the ability to scrutinise how the NHS works on behalf of local community and patients. PALS are separate matter, but the proposals, although useful, are more about customer service than about anything else. Although PALS are a good idea, we do not view them as part of the watchdog role that we need to retain and develop. Many outside the House, including many of those who lobbied hon. Members today, view PALS as poodles rather than effective watchdogs.

Dr. Brand

Does my hon. Friend agree that the real value of PALS is to encourage the internal resolution of complaints in trusts and that they will be very useful vehicles for doing just that, but that they cannot be a substitute for supporting people who have genuine problems with the care provided by trusts and who have lost faith in them?

Mr. Burstow

My hon. Friend is absolutely right. It is worth stating that the Government still have to produce the details of the complaints procedures. They are designing the systems to operate a new complaints procedure before we have seen them. They are putting the cart before the horse.

The overview role, which is to pass to local authorities, will be handicapped if we do not have the benefit of the insight provided by inspection and individual complaints. The independent local advisory forums that health authorities will set up are neither independent nor particularly local—and, not least, they lack statutory backing. As a result, they will be the creatures of the Secretary of State. I hope that they will be independent, but they will be very much at the beck and call of individual Secretaries of State in terms of the directions that will be used to set them up.

The Government have so far failed to make the case for abolition. The CHCs, as they stand, are underpowered and under-resourced. As has been said in this debate and in Committee, their performance is variable across the country. However, surely we should raise the standards of the poorest performers to match those of the best. We should examine what is good in the system and build on that instead of casting the whole system aside. The Government's reasons do not sustain the case for abolition; they are reasons for reform and for properly resourcing CHCs, not for getting rid of them.

If we are unable to persuade the Government tonight of the merits of new clauses 7 and 8, my colleagues will not accept the case for abolition when the Bill is considered in the other place. They will not vote for abolition and will want the Government to embrace the case for reform before they accept any attempt to take the Bill through the Lords. To that extent, we welcome the fact that Members in both Opposition parties support that approach.

The Government have failed to make their case. In Committee, several Labour Members told us that CHCs had not fulfilled their role as the bodies that deal with complaints in the NHS. Unfortunately, that is a bit of misconception. Although CHCs undertake complaints on behalf of complainants and help them navigate their way through the complaints system, there is no statutory duty on them to do such work. Despite the fact that no funds had been specifically earmarked for that purpose, CHCs saw a gap, recognised a need and undertook that responsibility and it is only because of that that they carry out the role at all. That is another reason for considering how we can ensure that they are properly equipped. We should pay tribute to the work that CHCs have carried out, for example, in the Alder Hey case. The work that they did in supporting parents should not be neglected when we consider the case for keeping them.

Our new clauses 7 and 8 show how CHCs could be reformed to become the delivery mechanisms for the proposals set out in the NHS plan. The new clauses address the need for independence and co-ordination. They are about stitching together the pieces in the NHS plan and in the scheme for consultation and the empowerment of patients. Quite rightly, they would extend the remit to primary care and they would locate the independent advocacy services in the new reformed CHCs. They would establish patients forums as sub-committees of CHCs and allow co-ordination, sharing and the following of patients care pathways to take place more effectively. They would also require the Secretary of State to consult on the detail.

I do not believe that the Government have demonstrated that their proposals, as they currently stand in their various pieces, will enhance the patients voice. New clause 9, which was tabled by the hon. Member for Wakefield, will not do that, either. It does not go far enough. Although I understand the intentions behind it, it fails to deal with the fragmentation of the proposals in the Bill and in the NHS plan. It would add an extra tier without being clear as to what that tier would do for the management of patient advocacy.

The Government have overlooked the wider community, but one of the questions that has been asked tonight and in Committee is how much their proposals will cost. When the Bill was in Committee, I tabled a written question to ascertain from the Government how much the proposals would cost and I received a reply from a Minister telling me that it would not be appropriate to provide that information because we were not at the right stage of the Bill's passage through the House. Does that mean that there can be no scrutiny of the Government's proposals for the abolition of CHCs and their replacement, or does it mean that scrutiny must occur once the Bill has become an Act and the details have been worked out in regulations? What on earth does it mean when a Minister tells the House in a written answer that it is inappropriate to provide the costings that should be the basis of examination, scrutiny and debate in this place?

The proposals in the Bill were unmodified in Committee and I suspect will remain unmodified after the Report stage. The arrangements are nothing more than a dog's breakfast. We need a decent watchdog on behalf of patients and the wider community, and unless we get that, we will not accept this part of the Bill.

Mr. David Hinchliffe (Wakefield)

I wish to speak to the new clauses that stand in my name and in those of my hon. Friends.

I have listened with interest to the two previous contributions, and he hon. Member for Woodspring (Dr. Fox) appears to think that I have performed a U-turn. He must have been absent when I spoke on Second Reading. I said that I had been a member of a CHC for 10 years and served as its vice-chair, but added: I hold no particular brief for community health councils…Some are excellent, but some have not done the job required of them, and the voice of patients has not been heard. Such CHCs have been the poodles of local trusts and health authorities. They have not stood up to be counted on occasions when patients' views should have been expressed loudly and clearly at local level."—[Official Report, 10 January 2001; Vol. 360, c. 1106.] That comment was not reflected in what the hon. Member for Woodspring said about my personal position.

On Second Reading, I said—and I repeat it tonight—that the provisions in the Bill, as it stands, do not offer a better alternative to tie C'HC system, and I tabled my new clauses in the hope that we could improve the Bill in a constructive fashion.

Mr. Fabricant

The hon. Gentleman has suggested that there is nothing in the Bill that would make CHCs better. Does he agree with me and other Opposition Members, including those in the Liberal Democrat party, that the Bill will make the position worse?

Mr. Hinchliffe

There are positive aspects in the Bill that I wish to mention, but I think that we can improve it. I hope that by the end of the debate we shall have a new structure that will represent patients' interests in a more effective way.

As I argued a moment ago—and as I argued on Second Reading—the effectiveness of CHCs varies considerably. Every hon. Member knows that. Some are excellent, but some are anonymous and some are invisible. I picked up that point when the Select Committee on Health conducted a major inquiry into adverse incidents and considered some serious problems. I asked several patients who had been affected—in some instances they had lost relatives—and some of them had never even heard of the local CM. We must address that point.

In other areas—the Alder Hey case is a positive example—CHCs have played an important role and there is a different picture We need to get consistency, and I hope that my new clauses will introduce a degree of consistency.

Dr. Fox

The hon. Gentleman has said, as the Minister has said before, that some CHCs are excellent—so is not the logic to bring the standards of the poorest up to the standards of the best, if necessary by plugging the gaps that the hon. Gentleman mentioned by introducing services such as patients advocacy and liaison services? Would that not be better than going down the route of abolition, and introducing other bodies to ameliorate the damage, as is suggested in his new clauses 9 and 10?

Mr. Hinchliffe

I hope that the new system will build on the excellence of some CHCs. That is precisely what I want to see the new clauses achieve. [Interruption.] If Conservative Members listen, I shall explain what the new clauses mean.

On Second Reading, I made the point that, arising from the work that the Health Committee did on the scrutiny of complaints in our adverse incidents inquiry, we picked up directly from patients the clear principle that they wanted to be included in any changed system. I mentioned the details on Second Reading, and I shall not repeat them now. However, the two key area; that patients were concerned about were independence and having a comprehensive system.

My concern about the Bill echoes one or two of the points that have been made in the two previous speeches. The PALS—patient advocacy and liaison services—system is, indeed, trust based. It focuses on the work of a single trust, be that a hospital or i primary care trust. Therefore it is neither independent nor comprehensive. However, I have no problem with a system that offers an effective customer services department in my local hospital or my local primary care trust where I, as a patient, can go to resolve issues face to face with the trust. As I understand it, that is the purpose of PALS, so I am happy for that system, as proposed in the Bill, to remain.

The concern that I raised on Second Reading about patient advocates was that the Bill was not explicit about the location of the advocacy function. We were initially advised that that function might be commissioned by health authorities. I was worried about that because I have dealt with complaints that relate to health authorities. It struck me as wrong that any system that purports to be independent could be funded by a party to a complaint, that is involved in the problem. It was suggested that we might locate advocates within the remit of the local authority scrutiny panels, but those panels will be scrutinising the work of the new care trusts.

8 pm

Dr. Brand

The hon. Gentleman knows that I have much respect for his views. Is he riot surprised that we are being asked to decide on the Bill tonight, before we know of the outcome of the Government's review of the complaints system? Perhaps he has greater knowledge of what is in the minds of Ministers, put is he not alarmed that we are being invited to adopt a framework without knowing what it has to deliver?

Mr. Hinchliffe

If the hon. Gentleman reads my speech on Second Reading, he will see mat I referred to that matter. However, the principles that we can establish tonight will relate to the review's conclusions.

The Bill also provides for the patients forums. I am concerned that the new arrangements will focus primarily on one aspect of the system and will not enable a complaint or problem to be considered comprehensively. We all know that the patient's pathway through health care often starts in primary can, and moves on to secondary and tertiary care before going back into the community. The system needs to reflect the need to look across the board at the comprehensive issues that affect patients when they have a complaint.

I want to thank a number of people who have been involved in many discussions with me and others in the past few days and during the Committee's proceedings. The Clerk was extremely helpful, because he attempted to pick up on some of our concerns. I am also grateful to the Association of Community Health Councils for England and Wales and, in particular, Donna Covey. The hon. Member for Woodspring said that I had sold out on CHCs, but I was with Donna Covey immediately before I tabled my new clauses and amendments on Monday, and she did not give me that impression—nor do representatives from my local CHC, who have been here today. They recognise that we are proposing a positive way forward, on which we can build.

Dr. Stoate

My hon. Friend knows that I support what he is trying to do. I met my CHC earlier today and its members, too, were happy with the new clauses and amendments. They believe that they will strengthen the position of CHCs rather than make it worse. I urge the Minister to accept my hon. Friend's new clauses and amendments.

Mr. Hinchliffe

I am grateful for my hon. Friend's support. The new clauses and amendments have drawn a wide range of support from Labour Members, and have also received positive comments from the Opposition. I am proud to have got both my hon. Friend the Member for Houghton and Washington, East (Mr. Kemp) and my right hon. Friend the Member for Chesterfield (Mr. Benn) to support the same new clause. That is quite an achievement—I think I have discovered the third way.

I pay tribute to my right hon. Friends the Minister of State and the Secretary of State for the work that they have done on this issue in the past few weeks and today. They have taken the concerns that we have expressed seriously, and listened to them.

Let me explain my proposals, because Conservative Members obviously do not understand them. I am suggesting that the PALS system should remain. The customer services role is valid and reasonable. It will be genuinely helpful in resolving many—possibly most—of the issues that affect patients in local hospitals and local primary care trusts. I have also included patients forums in new clause 9, because it is logical for them to be closely involved in considering the detail of individual trusts at a local level.

The hon. Member for Sutton and Cheam (Mr. Burstow) said that I would introduce an extra tier. I am probably more intimate with the detail of his new clause than he is—he knows the background to that, and I do not wish to embarrass him. There would be no extra tier. Instead, my proposed arrangements would occupy the same tier as the CHC would represent in his new clause on the retention of CHCs. I want patients councils to be established as umbrella bodies that will collectively draw together the individual patients forums to address the issue that worries me—the lack of a comprehensive overview of the work of the trusts. That function will create a better system.

I am proposing to establish a common secretariat to service the individual forums and the patients councils. The councils functions would not be dissimilar to those discharged by CHCs. However, the significant change, which reflects the Select Committee's views on advocacy, is that they would, in most instances, host the independent advocacy services set out in new clause 10. The hon. Member for Sutton and Cheam is wrong to say that CHCs already have that advocacy function, because many do not. A major weakness of the health service, which the Committee has noticed several times, is the lack of advocacy services.

In my dialogue with the Government, I have recognised that basing advocacy services within every patients council may not be the most appropriate arrangement. There are geographic differences in the areas to be covered. I believe that patients councils should be consulted by the Secretary of State, in accordance with new clause 10, about where the advocacy function should be placed.

Mr. Simon Thomas (Ceredigion)

I thank the hon. Gentleman for explaining his proposals so carefully. Will he elucidate a little further on how they will affect CHCs in Wales? Wales is covered by new clause 10, but CHCs are to be retained in Wales—[HON. MEMBERS: "You support that."] Indeed, I do, but surely it would be better for the Government to go back to the drawing board, forget about their current proposals and return to the House with fresh suggestions.

Mr. Hinchliffe

I support devolution and believe that if the Welsh wish to retain CHCs they should have that right. I look forward to a time when there is devolution in Yorkshire, and I no longer have to mix with some of the people that I meet here.

Dr. Lynne Jones (Birmingham, Selly Oak)

Representatives from my local CHC told me today that they were concerned about how representatives on patients forums and patients councils might be appointed. Does my hon. Friend agree that great care will need to be taken to ensure that representatives are genuinely independent? That might be easier with trusts that have an on-going relationship with patients—such as mental health trusts—than acute trusts, where patients are often involved with the hospital only for a short time.

Mr. Hinchliffe

My hon. Friend will understand that I have not proposed to amend the Bill as it relates to the new NHS Appointments Commission, which was established after the publication of Rennie Fritchie's report. I accept that the issue needs to be considered carefully, and I make no bones about the fact that I am proposing a framework that needs to be examined in more detail.

New clause 10 is especially important. The Select Committee noticed—

Mr. Mark Todd (South Derbyshire)

Will my hon. Friend give way?

Mr. Hinchliffe

No, I am sorry but I must conclude; I have given way several times.

The Select Committee picked up on patients concerns that when something has gone badly wrong in the NHS—fortunately, that does not happen very often—the experience has been worsened by the inability to get an appropriate response, help in complaining, and someone to rectify the damage. I hope that the advocacy services as proposed in new clause 10 would help to deal with that.

My proposals wilt improve the system proposed in the Bill. Patients councils will be independent and comprehensive. They will bring together the various patients forums. They will cover primary care. Community health councils do not co that, which is a huge weakness. I am surprised that those who are defending the status QUO do not recognise that. Moving to the idea of patients councils reflects the work that they will do better than does the term "community health council".

In my constituency—as in the constituencies of some of my hon. Friends, perhaps—there is a community health trust. I would bet that 99 per cent. of my constituents have not the least idea about the difference between the community health council and the trust. I hope that the name "patients council", which will reflect so much of the positive contributions of the CHCs, will have an impact.

Dr. Fox

Will the hon. Gentleman give way?

Mr. Hinchliffe

No.

I accept that the new clause and the amendments should be reconsidered in another place. However, I hope that we have a framework on which we can build. We must consider continuity between any change and the new system. I genuinely hope that some of those who have served so well on CHCs will make a major contribution within the new system. My proposals offer a framework for improving patient representation. I hope that the Government will accept them. If not, I intend to put the issue to the vote.

Mr. John Wilkinson (Ruislip-Northwood)

The debate characterises all that is worst about the Government, and particularly their management of the national health service. Earlier, we had the disgraceful spectacle of the Prime Minister refusing to admit how many people had written to him in support of his proposals to abolish community health councils. He did not have the courage or the candour to recognise that it was only a handful of people, or none. We know that there have been numerous representations in favour of the retention of CHCs. They have been articulate and well argued. I have received no representations in favour of the proposal to abolish them, as announced in the NHS White Paper.

That was typical of the Government. There was a fanfare of political trumpets in favour of the proposals in the White Paper for increased resources for cardiac care and thoracic medicine, for example. However, in the small print it was seen that the CHCs were to be abolished. People realised that yet again they had been conned. They were unimpressed and, as a consequence, opposition to the proposals to abolish CHCs grew to the point where Parliament was lobbied by many people this afternoon. I am talking of individuals who have given many years of service, dedication and professional expertise to helping to resolve patients' complaints and representing the interests of their local communities through the health service.

The hon. Member for Sutton and Cheam (Mr. Burstow) was right to stress the importance of the representational role of local communities, which CHCs fulfil. It is the arrogant and soviet-style management of the NHS which is so abhorrent to n any of our electors. There is the feeling that decisions are taken on high in Whitehall that have no relationship to the situation in particular community areas. CHCs fulfil a crucial lightning-conductor role in trying to dissipate the feeling of impotence, fury and frustration within many local communities against decisions that they believe to be entirely wrongheaded and against their interests.

Mr. Hilton Dawson (Lancaster and Wyre)

Will the hon. Gentleman give way?

Mr. Wilkinson

No, I will not. I w ill amplify my point.

In the part of Middlesex that I represent, proposals have been imposed by the Government to move one of the best burns and plastic surgery units in the country from its present location at Mount Vernon hospital. To its credit, the CHC provided the impartial chairmanship of consultation meetings. It answered the questions and it sought to resolve the difficulties. Above all, it provided a mechanism, as it has for the proposed closure of Harefield hospital, for objections to be lodged with the Secretary of State, upon which he will have to make a decision. The crucial function of official objection is one which needs to be maintained. It gives the public at least some hope that they have an opportunity of redress against wrongheaded public policy.

8.15 pm

The hon. Member for Wakefield (Mr. Hinchliffe) gave me the impression, with all his bluster, that he had been bought off politically. New clauses 9 and 10 may be verbose but they are not clear. Patients councils, which he is advocating, seem to offer a bureaucracy which gullible people might believe to be a genuine alternative to an effective system provided by CHCs, in which the public already have great confidence.

Mr. Hinchliffe

Will the hon. Gentleman explain the difference between what I have proposed and existing CHCs that have sub-committees? The only difference, as I see it, is independent advocacy and the title.

Mr. Wilkinson

I leave that judgment to the Secretary of State. If he and his Department are impressed with the proposals of the hon. Gentleman and his numerous friends who have similarly been bought off, the right hon. Gentleman will show himself to be more amenable to rational argument than he has in most of his direction of the NHS. I shall applaud the event. I am sure that some Labour Members will, too. However, I do not believe that it will happen, any more than I believe that I shall see pigs airborne tonight.

We have heard about local government being a forum within which complaints can be addressed. Usually, local people fail to regard local authorities as impartial. Instead, they regard them as party political institutions. Local government is not genuinely objective. The joint responsibility that it has with the NHS in the social services sector gives it a vested interest that CHCs do not possess.

We have heard, too, about the patient advocacy service. If patients are to have confidence and feel that their complaints are properly addressed, NHS hospitals need a clear line of command. There should be one chief executive, to whom complaints shot Id be addressed. He should address them properly, answer them and meet any failings in the service with the necessary changes, and, if necessary, alterations of style and method of service. However, this does not happen.

All too many hospitals have a shared boss. In the part of London that I represent, one section of Mount Vernon, a major hospital, has, in essence, a head who is the boss of three other hospitals. How will that give confidence to patients? How does it give staff the authority to know to whom they should refer? It is a recipe for chaos. That is why even a patients advocacy service in a hospital is not the right mechanism. One wants a clear line of command, and the man or woman in charge at the top to take full responsibility for everything that goes on in the institution.

Mr. John Hayes (South Holland and The Deepings)

Does not the difference between existing practice and that advocated by Government Members as a replacement centre on the fact that the existing system is well tried and tested, well understood by many people and involves many good people who are already giving service? If it is working, why change it? If it ain't broke, why fix it? Is that not the difference between what my hon. Friend is proposing and what was proposed by Government Members?

Mr. Wilkinson

As so often, my hon. Friend is right, and he makes his point succinctly and clearly. I suspect that there is a malign motive: CHCs, by and large, do their job so well that they show up the deficiencies of the NHS and reflect the foolishness of many public policy decisions taken by the Government.

Mr. Dawson

rose—

Mr. Wilkinson

I shall now give way to the hon. Member for Lancaster and Wyre (Mr. Dawson); I accept that I ought to have given way to him earlier.

Mr. Dawson

Does the hon. Gentleman accept that CHCs are not powerful enough? They often end up making their point by shouting from the sidelines. Does he further accept that putting a representative from a patients forum on the board of every trust undermines all the pejorative remarks that he has made about the new system of representation?

Mr. Wilkinson

The hon. Gentleman makes an extremely wise point, with which I have considerable sympathy. If he studied new clause 2, he would see that we propose that there should be 12 months from the enactment of the Bill for the Secretary of State to consider appropriate reform of CHCs. The Secretary of State would have time to get it right. The Government bounced abolition of CHCs on an unwitting public, with no consultation or prior notice.

Under subsection 4 of the new clause, the Secretary of State would be bound to provide for the proper representation of the population". It is therefore essential that he appoints individuals with qualifications, impartiality and commitment to public service, which are all attributes that would give confidence to local communities and those whom they would represent. Last but not least, Parliament itself would have to consider whether proposed reform was wise. We would have to judge it, with debate on a statutory instrument giving effect to the proposed reform.

To conclude, the hon. Member for Lancaster and Wyre suggested that the CHCs were not powerful enough. As I said, I am sympathetic to that view. However, the problem also lies with Whitehall and Secretaries of State who believe that they know best. The official objections lodged against proposed changes to the NHS—such as the closure of Harefield hospital, to which my local CHC, along with Brent and Harrow, have lodged official objections-should be taken seriously by the Secretary of State and acted upon through modifications of policy and changes to bring public policy into line with the wishes of local communities. Because the Government seek to impose their will, Soviet—style, on local communities, there is frustration and a feeling of impotence, which can be best addressed by the retention of CHCs and their intelligent reform, as proposed by new clause 2 and the Opposition's related amendments.

Dr. Stoate

We have now had CHCs for about 25 years. Listening to Opposition Members, one would think that everything in the garden was rosy and that there was no cause for concern whatever. Even on the admission of Opposition Members who have spoken, the service provided by CHCs is at best patchy. There are some excellent ones: the CHC serving Dartford and Gravesham is a good one, and I have an excellent relationship with it. I have been a doctor for a long time and, time and again, I hear of cases in which CHCs have failed patients or been unable to help them in the required way. I shall give some examples.

CHCs have no role in primary care. Opposition Members talk about CHCs as if they were wonderful. However, although the Tories were in power for 18 years, they never addressed the fact that CHCs have no role at all in primary care. My practice is immune to CHC interference, which is illogical. If everything was so wonderful, why is performance so patchy, why do CHCs have no role in primary care and why are they unable to investigate when primary care services fail or when premises are substandard and patients consequently get a bad deal? That is an illogical situation.

There is no consistent advocacy role across the country. Some CHCs, including my own, provide an advocacy service. Others, however, do not. There is no requirement for them to do so, so patients in some parts of the country have no access to advocacy. If CHCs were uniformly wonderful, surely that sort of thing would be provided by all CHCs? Given that the Opposition were in power so long and did not address those issues, one wonders what was their understanding of what was going on in the community and the health service.

Mr. Burstow

Does the hon. Gentleman accept that he is making a case for reform to drive up standards to the best standard? Has he considered new clause 7, which my hon. Friends and I tabled, which specifically extends the role of CHCs to cover primary care and deal with advocacy?

Dr. Stoate

The hon. Gentleman makes valid points, and I agree with some of them. However, the bottom line is that doing nothing is not an option. For far too long, CHCs have provided a complacent service in some parts of the country, which has not worked. We need radical reform; how that reform is carried out is a subject for debate, and which proposals we accept are a legitimate concern for the House.

Making the advocacy service uniform across the country is the right way forward. Patient advocacy and liaison services, which will provide a point of contact in every hospital, are the right way forward. If wards are dirty or showers are not working, there will be somebody on site who can call the management to account then and there. Recently, the House heard how the mortuary in Bedford hospital had rusty hinges on its doors. PALS could pick up and sort out that kind of thing, avoiding some of the tragedies that have occurred. We have to have that radical reform.

It is equally important that we make sure that patients feel as if they are at the center of the NHS. Although it is important that patients get a good deal, it is also important that they feel they are getting a good deal. In too many parts of the country, they do not feel that. The Government's proposals on patients forums go a long way towards dealing with that. However, there is clearly a problem.

Some patients and some people in the community feel that patients forums might be too close to the health authority, the trust or the local authority. The umbrella organisation—the patients council—suggested by my hon. Friend the Member for Wakefield (Mr. Hinchliffe) is surely the way forward. That could give a sense of overriding impartiality and independence, and would encompass all the reforms under one umbrella.

When I discussed the idea with members of my CHC earlier today, they were reassured by the proposal and think that it would go a long way towards addressing their legitimate concerns. I do not want to belittle CHCs. They have done a marvellous job, they are a well-intentioned group and they include some excellent people, but the service is not uniform. For far too long, patients have been sold short because they have not received the uniform, guaranteed level of service that they have a right to expect in the 21st century.

Opposition Members tell us that everything in the garden is rosy, when clearly it is not. They failed to address the problems for 18 years. [Interruption.] I do not mean the Liberal Democrats; I am referring to the previous Government. I believe that the Liberal Democrats have honourable intentions on the matter and I do not dismiss what they say. I do not believe that they have the right ideas, but I do not belittle what they do.

Mr. Gordon Marsden

Does my hon. Friend agree that it is the height of hypocrisy for the Conservatives to complain about postcode rationing, as they do so often in their rhetoric, when they are prepared to continue the system of community health councils which leads to that?

Dr. Stoate

My hon. Friend makes an excellent point. Effectively, there is postcode rationing through CHCs. There are excellent ones in some parts of the country, and others that are unacceptably poor. My hon. Friend the Member for Wakefield and I are asking the Government to consider how we could get the best of all worlds— a truly uniform service under the umbrella of patients councils, which will ensure that patients get a good deal, wherever they live.

Mr. Fabricant

I have been listening to the hon. Gentleman's rant, but he clearly has not read new clause 2. The Opposition recognise that everything in the garden is not rosy, despite what the hon. Gentleman says. That is why we propose in new clause 2 that there should be reform. He proposes throwing the baby out with the bath water.

Dr. Stoate

The hon. Gentleman I as not been listening. That is precisely what I suggest we should not do. His party was in government for 18 years, and has finally come round to the idea that there ought to be reform. That is laughable. The Conservatives had a long time in which to do something, yet they did nothing. We are proposing radical reform and, more important, reform that brings benefits to patients, uniformity of service, an advocacy role and the guaranteed impartiality of the umbrella suggested by my hon. Friend the Member for Wakefield, which I hope Ministers will accept.

8.30 pm

Mr. Stephen O'Brien (Eddisbury)

Let us start at the beginning and not lose sight of tow the issue arose; perhaps then it would be proper to ask about the motivation behind the Government's summary decision to scrap community health councils.

There was a consultation exercise on the NHS, which was not well responded to. It is nimoured—we do not have the findings—that the few respondents who referred to CHCs generally did not know much about them. Let us consider why that might be. Although they were not originally expected to deal with complaints, CHCs have grown to be the body in which patients have confidence and which they trust to deal with their complaints, because CHCs are seen to be independent.

One of the reasons for the success of CHCs is that patients, who are often vulnerable at this stage, or their relatives, have been able to engage with them in trust, because CHCs have tended not to trumpet what they do. With their knowledge, expertise and volunteer spirit, CHCs have sought to resolve problems, and only when a resolution was not possible, after exhaustive efforts, were formal procedures initiated to take a complaint forward and ensure that it was properly resolved in accordance with the patient's rights.

It is not right to think that because CHCs are not generally known, they should be abolished. Surely a Government using the rhetoric—but not the substance—of meritocracy would look at the worth of CHCs, not seek to abolish them because they were not known.

I was more hopeful about what the Chairman of the Select Committee, the hon. Member for Wakefield (Mr. Hinchliffe), would say, and I eagerly awaited his comments. I found his speech disappointing and not as dispassionate as I had hoped. It brought to mind Churchill's remark when he was told that there was a new hon. Member in the House called Mr. Bossom. He said, "Oh dear, poor man. Neither one thing, nor the other." That was very much my reaction to the speech of the Chairman of the Health Committee. It is not possible to argue for independence and at the same time to trumpet the potential benefits of structures whose purpose is to expose the difficulties of the very institutions of which they are part.

Mr. Hinchliffe

The hon. Gentleman is arguing that the existing structure of CHCs is independent. Does he understand the current make-up of CHCs, particularly the fact that one third of their members are members of local authorities? How would they monitor independently the work of future care trusts?

Mr. O'Brien

I hope that the hon. Gentleman would be surprised if I were not aware of the make-up of CHCs, as I have made a study of the subject. The members currently nominated by local authorities are in balance with the other interested parties on CHCs. One of the difficulties with the Government's proposals is that that balance would shift towards much more political involvement at local authority level. That is an important point to recognise, even if the Chairman of the Health Committee believes that the Government are proposing something different. Like him, I have had discussions with the Association of Community Health Councils for England and Wales. It was keen to support new clauses 9 and 10, but that support was expressed before the association had seen new clause 2. Today I had a meeting with CHC representatives who were specific about the fact that they regard new clause 2 as the better option and that they would prefer it to win through on Report.

The decision to abolish CHCs appeared shortly before the summer recess, tucked away in page 95 of the Government's NHS plan, in paragraph 10.35. It was a decision, not a proposal for consultation, and it had been made without any prior consultation. The staff of Chester and Ellesmere Port CHC and of Cheshire Central CHC came to see me almost immediately. They learned through the internet of the threat to their jobs and to what they realised were regarded as voluntary organisations. That is no way for any Government to handle the morale and expertise of people who have given dedicated service and who, above all, have demonstrated that they are in it not out of careerism, but to ensure that patients get the best out of the NHS. It was a ghastly shame on the workings of the Government that they informed CHC staff through the internet that their jobs were under threat.

Of course, the decision caused massive consternation. No prior consultation had taken place. I have had regular contact with my local CHCs, which are generally acknowledged to be excellent. However, I know that strong feelings have built up not only within them, as would have been expected—the decision has also been hugely controversial among patients and NHS staff who have found CHCs to be a worthwhile and important aspect of the broad delivery of health care services.

I raised the matter in Prime Minister's questions on 15 November last year. I asked the Prime Minister whether he was aware that his proposals to scrap community health councils were bitterly opposed. He answered: I am aware that there is bitter opposition, which is why the proposals are being consulted on. He went on to say: It is precisely because we want to consult that we have issued the health plan. We will report back to the House in due course on the consultation."—[Official Report, 15 November 2000; Vol. 356, c. 937.] Surprise, surprise—I received a letter on the following Monday. It began with the words "Dear Stephen", which, surprisingly, appeared in the Prime Minister's handwriting. In the letter, the Prime Minister states: I thought it would be helpful if I clarified the nature of the consultation on which we are currently engaged"— in relation to the abolition of CHCs. He goes on to state: Our proposals mean that Community Health Councils are to be abolished". The letter continues for a further two pages, without adding anything of substance, but the Prime Minister concludes: This better describes the consultation I alluded to in my answer during Prime Minister's Question time. It is important to put those matters on record.

The letter, which the Prime Minister's office placed in the Library, showed that despite all the claims about prior consultation, even the Prime Minister was caught out and had to correct the direct answer that he gave to me during Question Time.

I cannot tell the House how many calls, e-mails, faxes, letters and other representations I received from CHCs and others who were concerned about the issue in the days between the Prime Minister's answer on the Floor of the House and the day I received his letter. They were delighted to see that there was a chink of light after all and that CHCs might not be abolished. However, we found a few days later, when I received the letter, that that assurance had been cynically removed. I sought to question the Secretary of State for Health the following day—21 November—but he said that he would not give an answer. In my view, that was an outrage and a gross abuse of parliamentary accountability.

I was then fortunate enough to secure a debate on the matter in Westminster Hall. The debate had an unusually high attendance, but it was notable because it was well attended not only by Opposition Members, but by Labour Members. One displayed a touch of "careerismitis" during the debate, but none spoke in favour of the Government's decision—I wish that I could say "proposals", but I cannot. We were presented with a summary decision at the end of July last year.

Second Reading and a Committee stage have occurred to no avail, despite the strength of feeling that was expressed on the subject. It is fair to put it on record that, in terms of consultation and process, the proceedings constitute a travesty and a sham. The Government should be deeply ashamed of that. They owe an apology to the hard-working staff in CHCs across the country and to the volunteers and nominees from local authorities.

Mr. Hayes

Does my hon. Friend acknowledge that the sham continued this afternoon at Prime Minister's Question Time? Although the Prime Minister knew that we were considering the Bill later, he pretended at the Dispatch Box that consultation on the abolition of CHCs, not the new arrangements, was continuing. The sham went on. We heard weasel words from the Prime Minister, and weasel words from Dr. Stoate and other Labour Members.

Mr. Deputy Speaker (Sir Alan Haselhurst)>

Order. The hon. Gentleman does not help the debate by using those terms, and he did not observe the forms of the House in the way in which he referred to another hon. Member.

Mr. O'Brien

I noted the Prime Minister's answer, to which my hon. Friend the Member for South Holland and The Deepings (Mr Hayes) referred quite properly. The Prime Minister attempted to paint a picture of genuine consultation. It was claimed that consultation, as it is defined in English, would take place and that people could make representations, which would be taken into account when a decision was made. We know that such consultation has not occurred. The Government have already made their decision on the abolition of CHCs. The process has been a sham. The fact that we have reached that point reflects shame on the House

My constituency of Eddisbury is in south-west Cheshire, and it is important to note that in Cheshire, where genuinely good CHCs exist, local Labour Members of Parliament have been challenged in the press to state whether they support abolishing them. Notwithstanding a hiccup from the hon. Member for City of Chester (Ms Russell), who pulled back from issuing a specific press release, nothing has been heard. No attempt has been made to justify the Government's actions.

Representatives of CHCs who came to see us today are rightly proud of their service to local patients. They are proud not only of their knowledge and independence but of their lack of careerism. The Association of Community Health Councils for England and Wales has rightly asked whether patients at e better served by lapdogs or watchdogs. The association has earned a reputation for being a watchdog.

Trust and confidence are vital. The Government have the audacity to make a distinction in Wales. As it is a properly derogated matter, it has been decided to maintain CHCs in Wales. Why should England be different? We should all question CHCs' abolition in England.

The replacements could be more costly, more complicated and less trusted by vulnerable patients who need them. Ministers have said nothing to justify abolishing CHCs, to efface the shame of their lack of prior consultation or to show that they have listened. They have had the brass neck to resist all representations, logic and the need to retain trust and confidence. Let us hope against hope that, for once, this arrogant Government will stick their brass neck out far enough to accept that they have misjudged the matter, climb down with grace and support new clause 2.

8.45 pm

Mr. Denham

A patient-centred NHS is central to the vision that we set out in the NHS plan. Lip service has been paid for years to the idea of a patient-centred NHS, without bringing about any real change. As the NHS plan acknowledges, services are all too often not organised around the needs and lives of patients, and when things go wrong patients find inadequate safeguards and little help available to them.

During the consultation on the NHS plan, patients across the country complained that no one listened to them, that there was no one there when they needed help, and that there was no one to turn to for advice. Patients organisations stressed, throughout the consultation, that patients need to have real influence in every part of the NHS. That is why, during our consultations on the NHS plan, we decided that there was a case for real change. The NHS plan set out radical proposals to strengthen the voice of patients in the NHS. It also sought to address the lack of democratic scrutiny at local level by involving local government elected councillors. The Bill introduces the legislative change to deliver the plan.

I want to make it clear that the starting point for the proposals was not—and still is not—the abolition of community health councils. We have designed a new system based on the need to increase and improve patient representation in the NHS. The functions of CHCs will be taken forward by new more powerful or more appropriate organisations. It is for that reason, and no other, that the plan proposed the abolition of CHCs. Some CHCs have undoubtedly done good work, given their limited structure and remit. However, that has too of ten depended on the undoubted merits of the individuals involved, rather than on the structures in which they were working. The case for radical reform has been made, and it is a case that cannot be answered with piecemeal changes.

Dr. Fox

Will the Minister answer a question that has often been asked during this debate? Was there any consultation with the CHCs about their potential abolition before the national plan was introduced?

Mr. Denham

Prior to the national plan, there was consultation with everybody who had an interest in the NHS. That included CHCs and patients. We introduced the plan in response to what patients said about what had happened to them, and about what they thought was available to them when things went wrong.

In the debate over the past few months, there have been three distinct voices. First, we heart the complacent and conservative voice of those who will not recognise the scale of the changes that need to be made if we are really going to put the patient's voice at the heart of the NHS. Those are the ones who advised us co tinker with this or that problem.

Secondly, we heard the voice of those who have suddenly discovered an interest in patents' rights that was never evident before. They are happy to jump on a bandwagon to make the Government look temporarily uncomfortable, without making a real commitment.

Thirdly, and more importantly, we have heard the constructive voice of those who have considered the Government's proposals, and asked whether the proposals are right and how they could be in 'proved. This debate has involved many people inside and outside the House, and I welcome the contributions that my hon. Friends have made tonight. We should listen to that third voice.

Mr. John Austin (Erith and Thamesmead)

I do not know whether my right hon. Friend received any Valentine cards today. I received one from some residents in Bexley, asking me to support their request for independent monitoring and independent advocacy in the national health service. Does my rid ht hon. Friend agree that the amendments tabled by my hon. Friend the Member for Wakefield (Mr. Hinchliffe) would give a guarantee of such provisions?

Mr. Denham

I shall come to those amendments in just a moment. The issues that my hon. Friend mentions are very important.

I shall set out briefly what we shall put in place. There will be a patient advocacy and liaison service in every trust and primary care trust. Patients want someone to sort out their problems when things first go wrong, before they need to make a formal complaint. PALS are not a replacement for CHCs because that is a role that CHCs have never played. PALS will be a powerful part of each trust, but patients forums will have the power to ensure that PALS remain influential and effective.

There will be a patients forum for each trust, monitoring its work, inspecting premises, electing a non-executive director and reporting on the quality of patient services of each trust. The patients forums will also have the power to take action if PALS fail to provide an effective service. They will have independently appointed members, representative of individual patients, patients groups and carers organisations. Establishing a patients forum for every trust and PCT is key, because that will bring the voice of the patients to bear on the individual building blocks of the NHS—that is, on each chief executive, each medical director, each nursing director, each clinical governance lead.

We have also recognised the importance of co-operation by patients forums in each local area. One of our findings from consultation and debate was the need to institutionalise such co-operation. As a result of amendments, the Bill already supports the idea of joint committees between patients forums to enable that to happen. We have already made it clear that forums in each area should share administrative and professional support, so that expertise can be located in one place.

The amendments tabled by my hon. Friend the Member for Wakefield (Mr. Hinchliffe) take those issues a step further. I shall say more about that shortly, but first I want to say something about another issue, which was in the NHS plan and has been stressed throughout the consultation. We need an independent advocacy service for patients in every part of the country, because however good the system is in each trust things will go wrong and will not be sorted out, and someone will not then be able to rely on a part of the NHS to take them through the complaints procedure and ensure that they are looked after.

We are talking about a service that has never existed uniformly in the NHS. Some community health councils have provided it, but others have not. As we have made clear, we will ensure that independent advocacy services exist in every part of the country. That represents a major step forward in patient rights in the NHS, but my hon. Friend the Member for Wakefield seeks to go further by enshrining it in the Bill.

The NHS has long lacked any democratic scrutiny at local level. The Bill provides for overview committees to scrutinise the service locally, and to scrutinise joint work between the NHS and local authorities, in exactly the same way as the work of local authorities is scrutinised.

I want to leave time for the hon. Member for Woodspring (Dr. Fox), so I shall be brief. During consultation, organisations stressed the need for a national body representing patients' interests—a body that could represent patients, while also supporting those whom we want to volunteer to serve on patients forums. We are already working on a study, instigated by patients organisations, on the best way to set up such a body.

From the outset, we have stressed our wish to ensure that the experience and expertise of CHC members and staff can be retained in the NHS. We expect local health communities to help CHC staff to find new employment. As I think my speech should make clear, in future there will be more rather than fewer opportunities to work in patient empowerment and scrutiny in and around the NHS than there are at present, backed up by our commitment of an additional £10 million of investment—a sum that builds on the funds already available for CHCs.

What we have already done has greatly strengthened the voice of patients in the NHS. The Opposition amendments tie us to a system that, however hard people have worked, is not right for the modern NHS. My hon. Friend the Member for Wakefield has raised an important point. We have already said—indeed, we have said it in the Bill—that patients forums should work together; my hon. Friend says we should go further and legislate for a patients council capable of facilitating the co-ordination of the work of patients forums as well as other functions.

I think that the case has been made very clearly that there are people whose problems begin in primary care, continue in the ambulance trust and end up in the hospital trust, perhaps then returning to primary care in a long stay context. We need co-ordination across the system. My hon. Friend is, I think, right to want the Bill to include provision for a patients forum.

I have said that we will provide a common secretariat to support patients in each area. Amendment No. 26 would enshrine that responsibility in the Bill and extend it to providing support for the patients councils. That would ensure that the new organisations had a coherent structure at local level.

Although we have made this commitment from the outset, a case has been made that it would be a big step forward to include—for the first time in the 50 or more years since the NHS was founded—the provision of independent advocacy in NHS legislation. New clause 10 will do just that. It also places a responsibility on the Secretary of State to consult with interested bodies, but particularly with patients councils, on the best location of those services.

Nevertheless, although we accept the amendments in this group tabled by my hon. Friend the Member for Wakefield (Mr. Hinchliffe), which will enable us to create a better structure, much of the necessary action is not purely legislative. We must have clear signposting to the new advocacy services. Additionally, the telephone number, like that for NHS Direct, should be the same in every part of the country so that people are routed to the service.

I have again set out our proposals and stated very clearly how we have already responded to the issues raised in consultation. I have also dealt with and accepted the new clauses and amendments tabled by my hon. Friend the Member for Wakefield. I know that the hon. Member for Woodspring would now like to reply to the debate.

Dr. Fox

I am so grateful for the crumbs that the Minister has seen fit to leave the Opposition to reply to the debate.

Very many questions remain completely unanswered. Despite repeatedly asking the Minister, we still do not know how much the new system will cost. We still do not really know what will happen to CHC staff and to CHC medical records. CHCs keep a huge amount of confidential information. Will that be returned to patients doctors or go to hospital trusts? What about cases in which patients have complained about those very hospitals or trusts? who owns the information and where will it go?

The Government's approach of abolition is illogical. As the Minister and some Labour Members said, some CHCs are excellent. An argument made repeatedly today by Opposition Members is that we have to bring the standards of the poorest up to those of the best. If it is possible for CHCs in some parts of the country to be excellent and to provide the standards and services that many hon. Members and very many members of the public claim they offer, that should be an argument for reform.

On Second Reading. the hon. Member for Wakefield (Mr. Hinchliffe) said—he quoted it himself today—that the abolition of CHCs and scrutiny were an "afterthought" in the Government's plan. I am sure that most hon. Members agree that if his new clauses are accepted, that would diminish the damage that would be done by the Government's original proposals. However, I am sorry that he did not throw his considerable weight in the House behind new clause 2 and fight for proper reform of CHCs.

The hon. Member for Sutton and Cheam (Mr. Burstow) said that the provision is just an extra tier on top of the Government's proposals, and I have much sympathy with that comment. It certainly means more complexity and a more labyrinthine structure. I wonder about the whole concept of a single point of access. As was mentioned in the debate, what about a patient who, in a single episode of illness, has several complaints about different bodies? Where is his or her single point of entry to the system? I am not sure that the new clauses tabled by the hon. Member for Wakefield identify that point.

My hon. Friend the Member for Ruislip-Northwood (Mr. Wilkinson) described local examples of CHCs working well and the need for reform. My hon. Friend the Member for Eddisbury (Mr. O'Brien) started the ball rolling with his expos" of the Prime Minister's cynical use of the term "consultation". He gave the House a very good example of ht w the culture of this Government operates.

It is sad that the Labour Back Benchers who spoke at length on Second Reading about their opposition to the principle of abolishing CHCs have been absent from this debate. Notably missing have been those Labour Members who haw been going around Westminster telling us privately how much they hate the Government's proposals. We did no hear much from them in the debate.

It has been a genuinely sorry tale. There has been a refusal to apologise for claiming consultation when there was none, and a refusal to be properly accountable to those who are most involved—the CHCs. Despite knowing that he was going to change the system at the end of this debate, the Prime Minister refused to give a straight answer to straight questions at Prime Minister's questions today. The Minister could not even give us a straight answer to the straightest question of all—was there consultation with the CHCs before their abolition was announced in the national plan? If they were thirsty, they could not ask for water.

New clause 2 does not tie us to a failed system; the only thing it ties anyone to is reform. The new clause would bring the standard of the poorest up to that of the best. We did not want CHCs to be abolished. We will continue to fight to thwart the Government's plans beyond this House in the other place, so that these proposals go into the general election—

It being Nine o'clock, MR. DEPLIT Y SPEAKER proceeded to put the Question already proposed from the Chair, pursuant to Order [this day].

The House divided: Ayes 163, Noes 301.

Division No. 123]	[9 pm
AYES
Ainsworth, Peter (E Surrey)	Greenway, John
Allan, Richard	Grieve, Dominic
Amess, David	Gummer, Rt Hon John
Arbuthnot, Rt Hon James	Hague, Rt Hon William
Ashdown, Rt Hon Paddy	Hamilton, Rt Hon Sir Archie
Atkinson, Peter (Hexham)	Hammond, Philip
Baldry, Tony	Hancock, Mike
Ballard, Jackie	Hayes, John
Beggs, Roy	Heald, Oliver
Beith, Rt Hon A J	Heath, David (Somerton & Frome)
Bell, Martin (Tatton)	Heathcoat-Amory, Rt Hon David
Bercow, John	Hogg, Rt Hon Douglas
Beresford, Sir Paul	Horam, John
Blunt, Crispin	Howard, Rt Hon Michael
Body, Sir Richard	Howarth Gerald (Aldershot)
Boswell, Tim	Hughes, Simon (Southwark N)
Bottomley, Peter (Worthing W)	Hunter, Andrew
Bottomley, Rt Hon Mrs Virginia	Jackson Robert (Wantage)
Brady, Graham	Jenkin, Bernard
Brake, Tom	Johnson Smith, Rt Hon Sir Geoffrey
Brand, Dr Peter
Brazier, Julian	Keetch, Paul
Breed, Colin	Key, Robert
Brooke, Rt Hon Peter	Kirkbride, Miss Julie
Browning, Mrs Angela	Kirkwood, Archy
Bruce, Malcolm (Gordon)	Laing, Mrs Eleanor
Burnett, John	Lait, Mrs Jacqui
Burns, Simon	Lansley, Andrew
Burstow, Paul	Leigh, Edward
Butterfill, John	Letwin, Oliver
Cash, William	Lewis, Dr Julian (New Forest E)
Chapman, Sir Sydney (Chipping Barnet)	Lidington, David
	Livsey, Richard
Chope, Christopher	Lloyd, Rt Hon Sir Peter (Fareham)
Clark, Dr Michael (Rayleigh)	Loughton, Tim
Collins, Tim	Lyell, Rt Hon Sir Nicholas
Cormack, Sir Patrick	McCrea, Dr William
Cotter, Brian	McIntosh, Miss Anne
Cran, James	MacKay Rt Hon Andrew
Curry, Rt Hon David	Maclean Rt Hon David
Davey, Edward (Kingston)	McLoughlin, Patrick
Davies, Quentin (Grantham)	Malins, Humfrey
Davis, Rt Hon David (Haltemprice)	Mates, Michael
Day, Stephen	Michie, Mrs Ray (Argyll & Bute)
Duncan, Alan	Moore, Michael
Emery, Rt Hon Sir Peter	Moss, Malcolm
Evans, Nigel	Nicholls, Patrick
Fabricant, Michael	Norman. Archie
Fallon, Michael	Oaten, Mark
Flight, Howard	O'Brien, Stephen (Eddisbury)
Forth, Rt Hon Eric	Öpik, Lembit
Fowler, Rt Hon Sir Norman	Ottaway Richard
Fox, Dr Liam	Page, Richard
Gale, Roger	Pickles, Eric
Garnier, Edward	Portillo, Rt Hon Michael
George, Andrew (St Ives)	Prior, David
Gibb, Nick	Randall, John
Gidley, Sandra	Redwood, Rt Hon John
Gill, Christopher	Rendel, David
Gillan, Mrs Cheryl	Robertson, Laurence (Tewk'b'ry)
Gorman, Mrs Teresa	Roe, Mrs Marion (Broxbourne)
Gray, James	Russell, Bob (Colchester)

St Aubyn, Nick	Townend, John
Sanders, Adrian	Tredinnick, David
Sayeed, Jonathan	Trend, Michael
Shephard, Rt Hon Mrs Gillian	Tyler, Paul
Shepherd, Richard	Viggers, Peter
Simpson, Keith (Mid-Norfolk)	Walter, Robert
Smith, Sir Robert (W Ab'd'ns)	Waterson, Nigel
Smyth, Rev Martin (Belfast S)	Webb, Steve
Spelman, Mrs Caroline	Whitney, Sir Raymond
Spring Richard	Whittingdale, John
Stanley, Rt Hon Sir John	Widdecombe, Rt Hon Miss Ann
Steen Anthony	Wilkinson, John
Streeter, Gary	Willetts, David
Swayne, Desmond	Willis, David
	Willshire, David
Syms, Robert	Winterton, Mrs Ann (Congleton)
Taylor, Ian (Esher & Walton)	Winterton, Nicholas (Macclesfield)
Taylor, Rt Hon John D (Strangford)	Yeo, Tim
Taylor, John M (Solihull)	Young, Rt Hon Sir George
Taylor, Matthew (Truro)
Taylor, Sir Teddy	Tellers for the Ayes:
Thomas, Simon (Ceredigion)	Mr. Peter Luff and
Tonge, Dr Jenny	Mr. Geoffrey Clifton-Brown.

NOES
Adams, Mrs Irene (Paisley N)	Clarke, Charles (Norwich S)
Ainger, Nick	Clarke, Eric (Midlothian)
Ainsworth, Robert (Cov'try NE)	Clarke, Rt Hon Tom (Coatbridge)
Allen, Graham	Clarke, Tony (Northampton S)
Anderson, Rt Hon Donald (Swansea E)	Clelland, David
	Coaker, Vernon
Anderson, Janet (Rossendale)	Coffey, Ms Ann
Armstrong, Rt Hon Ms Hilary	Cohen, Harry
Ashton, Joe	Coleman, Iain
Atkins, Charlotte	Colman, Tony
Austin, John	Connarty, Michael
Bailey, Adrian	Cooper, Yvette
Banks, Tony	Corbett, Robin
Barnes, Harry	Corbyn, Jeremy
Barron, Kevin	Cousins, Jim
Battle, John	Cox, Tom
Bayley, Hugh	Cranston, Ross
Beard, Nigel	Crausby, David
Beckett, Rt Hon Mrs Margaret	Cryer, John (Hornchurch)
Begg, Miss Anne	Cummings, John
Bell, Stuart (Middlesbrough)	Darling, Rt Hon Alistair
Benn, Hilary (Leeds C)	Darvill, Keith
Benn, Rt Hon Tony (Chesterfield)	Davey, Valerie (Bristol W)
Bennett, Andrew F	Davidson, Ian
Benton, Joe	Davies, Rt Hon Denzil (Llanelli)
Bermingham, Gerald	Davies, Geraint (Croydon C)
Berry, Roger	Davis, Rt Hon Terry (B'ham Hodge H)
Best, Harold
Betts, Clive	Dawson, Hilton
Blears, Ms Hazel	Denham, Rt Hon John
Blizzard, Bob	Dismore, Andrew
Borrow, David	Dobbin, Jim
Bradshaw, Ben	Dobson, Rt Hon Frank
Brinton, Mrs Helen	Donohoe, Brian H
Brown, Russell (Dumfries)	Doran, Frank
Browne, Desmond	Dowd, Jim
Buck, Ms Karen	Drew, David
Burden, Richard	Dunwoody, Mrs Gwyneth
Burgon, Colin	Eagle, Angela (Wallasey)
Byers, Rt Hon Stephen	Eagle, Maria (L'pool Garston)
Campbell, Mrs Anne (C'bridge)	Edwards, Huw
Campbell, Ronnie (Blyth V)	Efford, Clive
Campbell-Savours, Dale	Ellman, Mrs Louise
Cann, Jamie	Ennis, Jeff
Caplin, Ivor	Etherington, Bill
Cawsey, Ian	Fisher, Mark
Chapman, Ben (Wirral S)	Fitzpatrick, Jim
Chaytor, David	Fitzsimons, Mrs Lorna
Clapham, Michael	Flint, Caroline
Clark, Rt Hon Dr David (S Shields)	Flynn, Paul
Clark, Paul (Gillingham)	Foster, Rt Hon Derek

Foulkes, George	McDonagh, Siobhain
George, Rt Hon Bruce (Walsall S)	Macdonald, Calum
Gerrard, Neil	McDonnell, John
Gibson, Dr Ian	McIsaac, Shona
Gilroy, Mrs Linda	Mackinlay, Andrew
Goggins, Paul	McNamara, Kevin
Golding, Mrs Llin	McNulty, Tony
Griffiths, Jane (Reading E)	Mactaggart, Fiona
Griffiths, Nigel (Edinburgh S)	McWalter, Tony
Griffiths, Win (Bridgend)	McWilliam, John
Grocott, Bruce	Mahon, Mrs Alice
Grogan, John	Mallaber, Judy
Gunnell, John	Mandelson, Rt Hon Peter
Hall, Mike (Weaver Vale)	Marsden, Gordon (Blackpool S)
Hamilton, Fabian (Leeds NE)	Marsden, Paul (Shrewsbury)
Hanson, David	Marshall, David (Shettleston)
Harman, Rt Hon Ms Harriet	Marshall, Jim (Leicester S)
Healey, John	Martlew, Eric
Henderson, Doug (Newcastle N)	Meacher, Rt Hon Michael
Henderson, Ivan (Harwich)	Meale, Alan
Hendrick, Mark	Merron, Gillian
Hepburn, Stephen	Michael, Rt Hon Alun
Heppell, John	Michie, Bill (Shefld Heeley)
Hesford, Stephen	Milburn, Rt Hon Alan
Hewitt, Ms Patricia	Miller, Andrew
Hinchliffe, David	Mitchell, Austin
Hodge, Ms Margaret	Moffatt, Laura
Hope, Phil	Morgan, Ms Julie (Cardiff N)
Hopkins, Kelvin	Morris, Rt Hon Ms Estelle (B'ham Yardley)
Howarth, George (Knowsley N)
Howells, Dr Kim	Morris, Rt Hon Sir John (Aberavon)
Hoyle, Lindsay
Hughes, Ms Beverley (Stretford)	Mullin, Chris
Hughes, Kevin (Doncaster N)	Murphy, Denis (Wansbeck)
Humble, Mrs Joan	Murphy, Rt Hon Paul (Torfaen)
Hutton, John	Naysmith, Dr Doug
Iddon, Dr Brian	Norris, Dan
Illsley, Eric	O'Brien, Bill (Normanton)
Jackson, Helen (Hillsborough)	O'Hara, Eddie
Jamieson, David	Olner, Bill
Jenkins, Brian	O'Neill, Martin
Johnson, Alan (Hull W & Hessle)	Organ, Mrs Diana
Jones, Mrs Fiona (Newark)	Pickthall, Colin
Jones, Helen (Warrington N)	Pike, Peter L
Jones, Ms Jenny (Wolverh'ton SW)	Pond, Chris
	Pope, Greg
Jones, Jon Owen (Cardiff C)	Pound, Stephen
Jones, Dr Lynne (Selly Oak)	Powell, Sir Raymond
Jones, Martyn (Clwyd S)	Prentice, Ms Bridget (Lewisham E)
Jowell, Rt Hon Ms Tessa	Prentice, Gordon (Pendle)
Joyce, Eric	Primarolo, Dawn
Kaufman, Rt Hon Gerald	Prosser, Gwyn
Keeble, Ms Sally	Purchase, Ken
Keen, Alan (Feltham & Heston)	Quin, Rt Hon Ms Joyce
Keen, Ann (Brentford & Isleworth)	Quinn, Lawrie
Kemp, Fraser	Rammell, Bill
Kidney, David	Raynsford, Nick
Kilfoyle, Peter	Reed, Andrew (Loughborough)
King, Andy (Rugby & Kenilworth)	Robertson, John (Glasgow Anniesland)
Kumar, Dr Ashok
Ladyman, Dr Stephen	Robinson, Geoffrey (Cov'try NW)
Lammy, David	Rogers, Allan
Lawrence, Mrs Jackie	Rooker, Rt Hon Jeff
Laxton, Bob	Rooney, Terry
Lepper, David	Ross, Ernie (Dundee W)
Leslie, Christopher	Rowlands, Ted
Levitt, Tom	Ruane, Chris
Lewis, Ivan (Bury S)	Ruddock, Joan
Liddell, Rt Hon Mrs Helen	Russell, Ms Christine (Chester)
Linton, Martin	Ryan, Ms Joan
Lock, David	Salter, Martin
Love, Andrew	Sarwar, Mohammad
McAvoy, Thomas	Savidge, Malcolm
McCabe, Steve	Sawford, Phil
McCartney, Rt Hon Ian (Makerfield)	Sedgemore, Brian
	Sheldon, Rt Hon Robert

Shipley, Ms Debra	Trickett, Jon
Singh, Marsha	Turner, Dennis (Wolverh'ton SE)
Skinner, Dennis	Turner, Dr Desmond (Kemptown)
Smith, Rt Hon Andrew (Oxford E)	Turner, Dr George (NW Norfolk)
Smith, Miss Geraldine (Morcambe & Lunesdale)	Turner, Neil (Wigan)
	Twigg, Derek (Halton)
Smith, Jacqui (Redditch)	Twigg, Stephen (Enfield)
Smith, John (Glamorgan)	Vis, Dr Rudi
Soley, Clive	Walley, Ms Joan
Southworth, Ms Helen	Ward, Ms Claire
Spellar, John	Wareing, Robert N
Squire, Ms Rachel	Watts, David
Starkey, Dr Phyllis	White, Brian
Steinberg, Gerry	Whitehead, Dr Alan
Stewart, Ian (Eccles)	Wicks, Malcolm
Stinchcombe, Paul	Williams, Rt Hon Alan (Swansea W)
Stoate, Dr Howard	Williams, Alan W (E Carmarthen)
Strang, Rt Hon Dr Gavin	Williams, Mrs Betty (Conwy)
Stringer, Graham	Wills, Michael
Stuart, Ms Gisela	Winnick, David
Sutcliffe, Gerry	Winterton, Ms Rosie (Doncaster C)
Taylor, Rt Hon Mrs Ann (Dewsbury)	Woodward, Shaun
	Woolas, Phil
Taylor, Ms Dari (Stockton S)	Wray, James
Taylor, David (NW Leics)	Wright, Anthony D (Gt Yarmouth)
Temple-Morris, Peter	Wright, Tony (Cannock)
Thomas, Gareth R (Harrow W)
Timms, Stephen	Tellers for the Noes:
Tipping, Paddy	Mr. Don Touhig and
Todd, Mark	Mr. Ian Pearson.

Question accordingly negatived.

Mr. Deputy Speaker

With the leave of the House, I shall put together new clauses 9 and 10.