Commons Sitting of 10 January 2001

Preamble
The House met at half-past Two o'clock
PRAYERS
[Mr. SPEAKER in the Chair]
Oral Answers to Questions
  INTERNATIONAL DEVELOPMENT
  The Secretary of State was asked—
  INTERNATIONAL DEVELOPMENT

    Montserrat
    Mrs. Linda Gilroy: What progress has been made with respect to the country plan for Montserrat. [143195]
    The Parliamentary Under-Secretary of State for International Development (Mr. George Foulkes): The country policy plan for Montserrat has led to the development of economic activity, housing, health, education and other facilities in the north of the island for the 4,500 Montserratians now living there. All the key facilities for normal life are now in place. The volcano, however, continues to pose a threat to the south of the island.
    Mrs. Gilroy: I thank my hon. Friend for that response. He may know that one of the 40 places named after the Plymouth that I represent is—or rather, sadly, was—in Montserrat and that therefore some of my constituents tend to take a rather keen interest in its affairs. Would he therefore put a little more flesh on the bones of his answer? It sounded fairly positive, but could he give some examples of current projects?
    Mr. Foulkes: I am the right Minister to put flesh on bones. My hon. Friend rightly reminds us that nearly two thirds of the island was destroyed, including the capital of Plymouth and most of the infrastructure. I am glad to say that fuel, electricity and water supplies have been secured and enhanced; that new health, education and Government facilities have been built and existing facilities upgraded; that transport infrastructure has been improved by the building of new roads; that we have upgraded the heliport; and that we have provided a new jetty and funding for nearly 1,000 houses. That is a tremendous effort for the people of Montserrat, and rightly so.
    Mr. John Bercow: Given that Montserrat was listed as a tax haven by the Organisation for Economic Co-operation and Development, what representations on that point has the hon. Gentleman made, or alternatively what assistance does his Department envisage providing for the territory, bearing in mind that if its financial services
    1062
    sector is damaged or destroyed, the country is much more likely to be prey to the commission of serious crime, including drug trafficking?
    Mr. Foulkes: Montserrat was developing as an offshore tax haven prior to the eruption of the volcano. Since then, it has of course been difficult, if not impossible, for the Montserratians to envisage that. They are keen to develop, but we have reservations. We want to ensure secure and proper arrangements for supervision. We discussed that recently at the Consultative Council of the Overseas Territories when the Chief Ministers were here, and we shall continue to do so. We are of course aware that were any overseas territory to lose any resources as a result of the pressure that the hon. Gentleman describes, our Department would need to make available additional resources.

    Everything But Arms Initiative
    Mr. Peter Luff: What recent representations she has received from sugar-producing countries about the everything but arms initiative; and if she will make a statement. [143196]
    The Secretary of State for International Development (Clare Short): Since October 2000, the Government have received more than 1,000 representations from UK sugar interests, and just six from sugar producing countries about the European Union proposal to provide duty-free trade access to the 48 least developed countries. In reply, we have made clear the importance of improved access to the EU market for the world's poorest countries, which comprise just 0.4 per cent. of world trade. There is also a need for the UK sugar industry to be prepared to adjust to forthcoming reforms of the CAP. We have also reassured the middle-income sugar producing countries that the least developed countries are not in a position to export large amounts of sugar in the short term. Generous assistance is available from the EU and others to support adjustment to more open markets to which these countries are already committed.
    Mr. Luff: I am genuinely grateful to the Secretary of State for that answer, but is she aware of the continuing alarm in African, Caribbean and Pacific countries and the British sugar producing industry, and of the apparent considerable internal dissent in the European Commission, about the precise impact of the proposals? Exactly what impact studies are the Government conducting, what contribution is her Department making to those studies, and when will the results be published?
    Clare Short: I am aware of all the discussion and of the vested interests at work. I hope that the whole House agrees that the poorest countries in the world—in which the very poorest people live—which are currently responsible for only 0.4 per cent. of world trade, should be given better trade access so that they can grow their economies and improve the lives of their people. I know that there is worry among sugar producers in Britain and that there has been some worry in ACP countries. We have done our own analysis, and more is being conducted by the European Union. I am confident that they need not be so worried. The poorest countries do not have the

    1063
    capacity rapidly to build up their production and exports. Some of the adjustment that needs to be made is among our sugar producers and ACP countries anyway.
    Mr. Lawrie Quinn: I am sure that my right hon. Friend is aware that although many sugar beet producers in north Yorkshire, particularly in my constituency, are concerned about their future, they support the end objective. One concern that they have expressed to me in consultation is that they cannot envisage the time scale of the initiative. Is she able at this stage to spell out when it will be fully implemented?
    Clare Short: The current proposal from Pascal Lamy, the Trade Commissioner, is a three-year phase-in period, but the matter has not been finalised and longer phase-in periods have been discussed. Common agricultural policy reform must come because of the peace clause in the Uruguay round, which requires the World Trade Organisation to examine protectionism for agricultural production. The existing common agricultural policy would bankrupt an enlarged European Union, so reform is coming. Sugar producers must face up to the fact that it is unsustainable to have a guaranteed high price that is above international market prices. They need help to adjust, and I think that their friends will do that. They cannot go on under the present regime, because at some point it will collapse underneath them.
    Mr. Bowen Wells (Hertford and Stortford): How exactly will the Secretary of State fulfil her promise to the traditional producers of sugar cane and sugar beet that they will not suffer as a result of this initiative? I agree with her that the world's poorest countries deserve the trade support that the European Community is proposing, but none the less there should not be a beggar thy neighbour policy that makes countries such as Guyana, which is a highly indebted poor country and very vulnerable, more impoverished than it is, and possibly push it into the category of the most poor and least developed countries.
    Clare Short: I am surprised that the hon. Gentleman should refer to a beggar thy neighbour policy in relation to improving trade access for the very poorest people and countries in the world, given that there may anyway be an adjustment cost to middle-income Caribbean countries. This principle is extremely important, and we must all stand by the policy of enlarging trade access for the poorest countries so that their economies can grow.
    Under the Cotonou agreement, which replaced the Lomé accord, there should be duty free access for all products from least developed countries by 2005, so this change is coming. The Caribbean and its banana industry need help to adjust to the opening of trade, not reassurance that an old, dying industry will be protected when the prices of its products are massively higher than world market prices and are in breach of WTO rules and so will increasingly be challenged. The Caribbean needs help to adjust, and we are doing that, but its friends should encourage it to adjust and not to carry on thinking that it can be protected by existing arrangements.

    Poverty Reduction
    Dr. Nick Palmer: What assessment she has made of progress in focusing development aid on the reduction of poverty. [143197]
    The Secretary of State for International Development (Clare Short): We set out in our 1997 White Paper our aim to persuade the international development system to focus its efforts on achieving the international development targets. Those include halving the proportion of people living in extreme poverty by 2015, universal primary education and improved health care for all. We now have unprecedented agreement between the International Monetary Fund, the World Bank, the United Nations system, the Organisation for Economic Co-operation and Development, G7 and others that meeting the targets should be the focus of our joint efforts.
    On current trends the halving poverty target is likely to be met because of major progress in Asia, but most African countries are not yet on target. Progress in being made on health and education, but greater effort is needed. The Chancellor and I are hosting a conference in London next month to encourage all countries and development agencies to increase their efforts to ensure that today's poor children are not the parents of larger numbers living in extreme poverty in the next generation.
    Dr. Palmer: My right hon. Friend's priorities will be welcomed in all same parts of the House. Unfortunately, the European Union's priority in this area is increasingly focused on the Mediterranean and Balkan countries. The proportion of multilateral European Union aid is down to 41 per cent. for the most impoverished countries, and will probably sink further if nothing is done. Will my right hon. Friend press our European Union partners to give real priority to poverty reduction at the coming meeting on this issue in Stockholm?
    Clare Short: I agree strongly with my hon. Friend. As he knows, we are seriously concerned. It is disgraceful that, for a considerable number of years, an ever lower proportion of EU development assistance has gone to the poorest countries, the effectiveness of which leaves much to be desired. We have been working hard on the reform agenda and there are now strong commitments to reform. [Interruption.] We should not turn away from the Mediterranean and the Balkans, but middle-income countries need different forms of assistance from very poor countries. They do not need big resource transfers, but help with reforms to ensure that they run their Governments better. I agree, and I hope that the House agrees, that the EU, which has promised to reform, must do so. [Interruption.] Our aim is that 70 per cent. of its assistance should be focused on poor countries by 2006.
    Mr. Speaker: Order. I appeal to hon. Members, particularly Government Members, not to conduct private conversations. They are not appreciated.
    Mr. Nigel Jones: Will the Secretary of State join me in congratulating the people of Ghana and its new President, John Kufuor, on the successful, democratic and peaceful change of Government which they have just achieved? Is she planning any early meetings with the new Government to consider what her

    1065
    Department can do to help reduce poverty in Ghana, and does she have any view on whether Ghana might be successful if the new Government decide to apply for debt relief under the HIPC initiative?
    Clare Short: I agree very much with the hon. Gentleman. Ghana's achievement in its democratic transition is fantastically important. President Rawlings ended up changing to democracy, but came to power through a military coup. For Ghana to go through that and have a proper, peaceful and democratic election is an important achievement for the Government. I have plans to visit Ghana, probably towards the end of February. There has been economic reform in Ghana and it has done well, but it slipped a bit before the election, so we need to help it to get back on track and get its economy growing to improve the lives of its people.
    Ghana is a HIPC country and has considerable debt. The previous Government decided not to apply for debt relief. I am sad to say that it was under pressure from some donors. It will be possible for the new Government to go for debt relief, and that would help Ghana to get back on an economic reform agenda. It is for Ghana to decide. It was Ghana that decided previously not to go for such relief, but it is entitled to do so if it wishes.
    Mr. Andrew Miller: Has my right hon. Friend had any discussions with Aung San Suu Kyi on providing development aid should there be a return to democracy in Burma? Can my right hon. Friend throw any light on the story that the World Service ran early this morning that there have been discussions with the regime and Aung San Suu Kyi in that country?
    Clare Short: I have not had the pleasure of meeting Aung San Suu Kyi, but if Burma turns to democracy the world will help it. We would be delighted to do so and massive support would be available to help build a new democratic and economically successful country.
    I heard the reports, not on the World Service but on the BBC this morning. Some talks have been brokered by the United Nations and the World Bank. At this moment, I do not have enough information to be optimistic, but if we can be optimistic, if there is reform in Burma, that will bring relief to many long-suffering people—as I hope there will be.
    Mrs. Cheryl Gillan: The right hon. Lady and I agree that to make progress in reducing poverty we need, among other things, to eliminate corruption. Why then, two years after signing the OECD's convention on bribery—making it an offence to bribe officials abroad—have we still no legislation implementing it? We have had the rhetoric. Last April, in a parliamentary answer, a Minister from the Department of Trade and Industry promised legislation as soon as possible, and the Home Office has said that it is looking to bring in legislation at the earliest opportunity. But now the UK is attracting fierce international criticism. The head of the OECD's anti-corruption unit said:
    As far as we can determine there has not been an effective prosecution under existing UK laws. This wasn't good enough.
    1066
    To put it bluntly, no one is going to be as bad as the UK. We know that the Government are all spin and no delivery, but, to put it bluntly: "You made the promises, where is the legislation?"
    Clare Short: I find it astonishing that the Opposition seem to think that is was year zero when they lost the general election. We inherited advice that had been the position of the previous Government, that—[Interruption.] Perhaps the hon. Lady would listen. It was the view of the Conservative Government, and our initial advice—attention, please—that the existing UK law complied with the OECD convention. That was false, false, false, as usual. It was a bit like "Where's the trains?"—we know why they are missing. Again, it is the fault of the previous Government.
    We set up a working party which determined that the advice from the previous Government was completely wrong, as with so much else that they did. We are now committed to legislation, and it will be introduced as soon as a decent Government publish a Queen's Speech, which happily will not be a Government of whom the hon. Lady will be a member.

    Global Environment Facility
    Ms Christine Russell: What support her Department is providing to the global environment facility. [143198]
    The Parliamentary Under-Secretary of State for International Development (Mr. George Foulkes): The global environment facility was established following the UN Earth summit in Rio to provide funding to developing countries for their costs incurred in dealing with global environmental challenges. Up to now it has committed nearly $3 billion. The UK contribution to that has been £215 million. We have made it clear that we would like to have a third replenishment by 2002, to increase this facility by 50 per cent. Our Department stands willing to increase our own contribution by that amount.
    Ms Russell: I am sure that the House will agree that that is welcome news. I wonder whether the House is aware that the Red Cross now estimates that more refugees lose their homes through natural disasters than through war and famine. Will my hon. Friend and my right hon. Friend give a commitment that environmental protection and sustainable development will be factored into all their Department's work?
    Mr. Foulkes: I can give my hon. Friend that absolute assurance. She is absolutely right: the common perception is that refugees are principally fleeing conflict, but the vast majority are fleeing floods and other environmental degradation. That is why we need to put more money into the global environment facility, to stop the degradation and inhibit the flooding by replanting.
    That is why we will put in more money, which would not be possible if the policies of the Government opposite—[HON. MEMBERS: "Hear, hear."] That would not

    1067
    be possible if the policies of the Opposition—[HON. MEMBERS: "Hooray."]—became the policies of the Government, and that is why they must be rejected.
    Mr. James Gray: The Minister's Freudian slip harks back to the negotiation of the global environment facility at Rio in 1992 by my right hon. Friend the Member for Huntingdon (Mr. Major), on which I hope he will congratulate him. If the Government are as committed to environmental goals as the Minister claims, why, just yesterday, did the Environmental Audit Committee report say that they do not take the environment seriously at all?
    Mr. Foulkes: I have read that report. The Committee criticised itself more than it criticised the Government. As the green Minister for our Department, I can say that it is entirely wrong in its criticism of the Government. We are taking the environment more seriously than any previous Government. As for Freudian slips, as a psychologist I can tell the House that I am somewhat prone to them—but there is one thing that I am absolutely sure about: when the people of this country are asked to choose the next Government, they will make no slip whatever.

    Poverty Reduction
    Mr. Denis MacShane: What assessment she has made of the contribution of the International Labour Organisation to eradicating poverty in developing countries. [143199]
    The Secretary of State for International Development (Clare Short): In the past, International Labour Organisation work focused on the needs of workers in formal employment and had little relevance to the needs of the poorest. More recently, the convention on eliminating the worst forms of child labour and the commitment more actively to promote core labour standards, including action against bonded labour, discrimination and promoting the right to organise, have increased the relevance of ILO work to the needs of the poorest, so my Department has increased its collaboration with the ILO and has provided £9 million in funding since 1997.
    Mr. MacShane: I welcome that strong statement and congratulate my right hon. Friend on the encomium for the ILO on page 29 of her excellent White Paper. The ILO is an important institution, and we should play a full part in it.
    I spent a part of my life before entering Parliament working in Asia, Latin America and Africa, supporting workers in developing countries. My conclusion is that the best way to let workers earn a decent living is to allow them to participate fully in the world economy. Therefore, will my right hon. Friend continue to make the case for free trade, for eliminating trade barriers and, above all, for defeating the isolationist and protectionist attitude of the Opposition?
    Clare Short: I agree with my hon. Friend. In the words of the Director General of the International Labour Organisation, the poor of the world want the chance to have decent work, to earn a living, to bring up their children and send them to school, to get health care, to improve their lives and to be self-reliant. For that they
    1068
    need strong economies, the right of workers to organise, for their children not to be in labour and therefore not in school, and not to have bonded labour that is not properly paid. We are working with the ILO on all that. Indeed, we are negotiating a partnership agreement between my Department and the ILO to work on improving the livelihoods of the poorest. That means free trade and the poorest countries having the opportunity to export and to grow their economies.
    Mr. Dafydd Wigley: Does the right hon. Lady agree that the elimination of child labour is an essential part of the Programme of developing educational opportunities for children in developing countries? Is she satisfied that enough progress is being made to reach the targets that have been set with regard to primary education?
    Clare Short: I shall not be satisfied until every child in the world is in primary education. The research evidence is clear that the single most powerful intervention that any country can make in its development is to educate a generation of children, including the girls. Those children grow up and transform their country. They have fewer children later, so their children are much more likely to survive to go to school, to get health care and to improve family incomes. Although children have a right to education, it is also profoundly developmental to get them into school. Children who are labouring and are not in school lose out on their childhood, but damage is also being caused to the next generation. We have expanded our work in this area massively, but none of us should be content until every child in the world is getting a basic education.

    Globalisation White Paper
    Mr. Ben Chapman: What plans she has to discuss the White Paper on globalisation with developing countries. [143200]
    Mr. Andrew Mackinlay: If she will make a statement on the globalisation White Paper. [143201]
    The Secretary of State for International Development (Clare Short): The new White Paper, "Eliminating Poverty—making globalisation work for the poor", stands alongside our first White Paper that was published in 1997. It reaffirms our commitment to the elimination of poverty and the achievement of the international development targets. It sets out an agenda for managing globalisation, increased trade, investment and the new technologies in a way that could ensure that the abundance of wealth currently being generated brings benefits to the one in five of humanity who live in extreme poverty.
    The White Paper makes it clear that globalisation can be managed either to bring a massive improvement in life to the poor of the world or to lead to their growing marginalisation, leading to division, squalor, poverty, conflict and environmental degradation. The future is not pre-determined; it is a matter of will and choice. The White Paper is designed to help mobilise a stronger international effort systematically to reduce poverty.
    Mr. Chapman: May I urge my right hon. Friend to hold talks with developing countries on the issues in the

    1069
    White Paper as broadly and as quickly as possible? May I urge her also to hold talks with our Organisation for Economic Co-operation and Development partners, not least on the issue of untying aid? Does she share my view that the issues in the White Paper are so important that they merit a full debate on the Floor of the House?
    Clare Short: I thank my hon. Friend. I should love to have such a debate on the Floor of the House. These are the most important moral issues facing the world and it is important that we do better for the future stability of the world and its security and avoid growing conflict, environmental degradation and the movement of refugees. I am proud of the fact that the UK has entirely untied its aid. There is $50 billion worth of aid in the international system, but it could be twice as effective if instead of being used to promote the exports of donor countries, it were used to build capacity in developing countries to run their Governments and their economies well. That is what the UK is doing and we are doing all that we can to persuade other countries to follow our lead.
    Mr. Mackinlay: While welcoming the moneys for promoting ILO conventions to which my right hon. Friend referred in reply to my hon. Friend the Member for Rotherham (Mr. MacShane), will she bear in mind that ILO conventions are widely flouted and ignored throughout the world? What proposals does she have in terms of international discussions to ensure the enforcement of ILO core values and conventions, particularly the right of association? Will she beef up the commission proposed in the White Paper on trade-related intellectual property rights? When will that commission meet? From where will it take evidence—will it be from overseas? When will it report?
    Clare Short: I will make a statement on the commission on intellectual property as soon as I can. I do not yet have full details for my hon. Friend, but we are anxious to get it up and going to sort out how we can ensure that those rules benefit developing countries. I can certainly give him an undertaking that we shall do all we can to enforce core labour standards. Too many children in the poorest countries are in work and not in school, as we said earlier. There is still much bonded labour; people go into debt and therefore work for nothing and their children work for nothing. They need decent rights to work with a rate of return so that they can build up their future. Enforcing those standards is about justice and decency, economic self-reliance and a safer and more decent world. We are strongly committed to do all that we can to ensure that they are better enforced.

  The Prime Minister was asked—
  PRIME MINISTER

    Engagements
    Mr. Jim Cunningham: If he will list his official engagements for Wednesday 10 January.
    The Prime Minister (Mr. Tony Blair): This morning, I had meetings with ministerial colleagues and others. In addition to my duties in the House, I will have further such meetings later today.
    Mr. Cunningham: First, Mr. Speaker, I wish everyone, including you and my right hon. Friend, a happy new year. [HON. MEMBERS: "Division!"] Now we start to get serious. Is my right hon. Friend aware that Rolls-Royce Anstey proposes to export 600 jobs, including technologies, to Canada this year, and 2,000 jobs by 2003? Will my right hon. Friend use his good offices to ask Rolls-Royce to reconsider that proposal? Secondly, will he ask the company to reconsider realistically any proposals made from the work force through their representatives? Thirdly, will he re-examine the agreement, made in the early 1990s under the previous Government, regarding assistance to Rolls-Royce to export those jobs?
    The Prime Minister: I can well understand the concerns of my hon. Friend's constituents about the announcement made by Rolls-Royce. The Department of Trade and Industry is in close contact with the company. The Government are, therefore, keeping in close contact with Rolls-Royce about exactly what is planned. The company has yet to clarify the position, but I assure my hon. Friend that we will do everything that we possibly can to safeguard the jobs of people in his constituency.
    Mr. William Hague: If the tax burden is 36.9 per cent. of national income in one year and 37.3 per cent. in the next year, is it rising or is it falling?
    The Prime Minister: I am glad to say—[HON. MEMBERS: "Answer."] Those are of course the published figures—[HON. MEMBERS: "Ah!"] I am very glad to say that the difference between those figures—the first published in the Budget and the second in the pre-Budget report—is wholly a result of the increase in the number of jobs in the economy and increased earnings; and overall under this Government, the proportion of revenues to national income has risen by exactly the same amount as in the last three years of the previous Conservative Government, when the right hon. Gentleman was a Cabinet member.
    Mr. Hague: It is a new argument from the Prime Minister that an increase in the tax burden has nothing to do with the increase in taxes that has been levied by the Chancellor. To go from 36.9 per cent. to 37.3 per cent. is obviously an increase, so will he correct his statement to the House on 1 November last year? He said that
    the tax burden this year is falling.—[Official Report, 1 November 2000; Vol. 355, c. 703.]
    Will he now correct that statement?
    The Prime Minister: The right hon. Gentleman has not listened to what I have said. The pre-Budget report was, indeed, corrected, but that happened because of the extra jobs in the economy. In fact, the tax burden is lower today than it was in seven of the 10 years when Margaret Thatcher was Prime Minister. If the tax burden is to be the sole judge of the economy, I should point out that the lowest tax burden in the past 25 years was achieved in

    1071
    the final year of the previous Labour Government. I do not believe that that figure is the only judge. The reason for the change in the figures between the Budget and the pre-Budget report is that there are 1 million extra jobs in the economy.
    In our first few years, the Government took action to clear the deficit. We wanted to invest in our public services. We favour making that investment. Will the right hon. Gentleman say whether he is committed to those sums?
    Mr. Hague: When the Prime Minister is caught out, he comes out with several minutes of specious waffle, and that is what we have had today. He has reached a new low in answering questions when he cannot even say that 37 is a rise on 36. He has refused to admit that today. Yesterday, his Ministers alleged that the average family was £800 better off because of Labour's tax changes, a figure arrived at by missing out all changes in excise duties on fuel and tobacco, all the impact of dividend tax credit abolition on pension funds and all increases in council tax. If the Prime Minister thinks that the average family never drinks, does not have a mortgage and does not get married, he has been spending too much time with the Cabinet rather than the rest of the country. Given that people have paid all the extra taxation, does he expect the number of police constables to be higher at the election than it was at the 1997 election?
    The Prime Minister: Let me point out that mortgage rates under this Government are half the average under the right hon. Gentleman's Government. That saves families more than £1,000 a year. The House need not take my word for that. It is time to introduce to the House and the wider country—it may be the only introduction he ever gets—Mr. Nigel Hastilow, the Conservative prospective parliamentary candidate for Birmingham, Edgbaston. Yesterday, Mr. Hastilow said:
    For many voters and most of the media, the Conservative Party is a lost cause.
    On the economy, Mr. Hastilow—should we call him Nigel? —provided the answer to the right hon. Member for Richmond, Yorks (Mr. Hague) when he said that
    we've never had it so good … people are prospering, unemployment is falling, interest rates are low. There's nothing much to worry about.
    Mr. Hastilow provides a rather more accurate summary of the economy than does the Leader of the Opposition.
    It is correct to say that police numbers have been falling over the past three years. That is absolutely right. In the whole of the United Kingdom, they have fallen for seven years, and in London for 10. Last year, however, we invested an extra £700 million, and police numbers are rising again. We are committed to investment; the right hon. Gentleman is committed to cutting it. That is the difference between us.
    Mr. Hague: The right hon. Gentleman knows that we are not committed to cutting investment—he knows that absolutely. Once again, he is the great pretender, with no regard for the facts. The number of police constables reached an all-time record in spring 1997, when he became Prime Minister. It has fallen by 2,000 since then. The Police Superintendents Association says that the police service is moving towards crisis. The increase to
    1072
    which he has just referred has happened only because the Government are allowing police forces to recruit people who had previously been rejected, a policy that cannot be sustained for the future. Does the Prime Minister expect the number of special constables to be higher at the next election than it was at the last one?
    The Prime Minister: Let me first correct the right hon. Gentleman: the number of police officers fell for seven years. It is rubbish to say that the numbers are now rising only because of some change in the rules. They are rising because the money is there. In the same way, there are 7,000 more teachers today than there were three years ago, but we need more—through investment. There are 16,000 more nurses, but we need another 20,000— through investment.
    The difference between our two political parties is that we are committed to the investment that will provide those extra police officers, whereas the right hon. Gentleman is committed to taking it away. The shadow Chancellor has said—he repeated it yesterday—that whereas we, the Government, will increase public spending by 3.3 per cent., he will increase it by only 2 per cent. That is a £16 billion cut in spending.
    That is why, when asked today how she would fund those extra police officers, the shadow Home Secretary said that she would do so by cutting the number of press officers in the Home Office. Even better, she went on to say that she would put more people in prison and, on being asked how she would fund that, replied:
    Well, what will increase … the number of people actually in prison will be the regimes which—and the regimes will be self-financing—are applied in those prisons.
    I do not know what a self-financing prison scheme is: I can think of many ways in which the criminal element in our prisons might seek to raise money, but I do not think that we would want to encourage any of them.
    The truth is that there is now a chasm between the economic policy announced by the shadow Chancellor and that pursued by every shadow spending Minister. Is the right hon. Member for Richmond, Yorks with his shadow Chancellor, with the rest?
    Mr. Hague: We can take it from that that the Prime Minister has no idea of how many special constables there were at the last election, or how many there will be at the next election. We have set out our spending plans and shall continue—[HON. MEMBERS: "No!"] Oh yes, we have. As I told the right hon. Gentleman at the last Prime Minister's questions, if he thinks that we will fight at the election for a reduction in the police budget, he is completely crazy. That is obviously not going to be the policy of the Conservative party. Let me give him the latest figures on special constables: at the last election there were 19,800, whereas now there are 13,500—a reduction of almost one third in the number of special constables in this country.
    The Prime Minister is saying to the country: we have increased your taxes, we have taken away your police constables, we are taking away your special constables, and we are closing your police stations, but we will give you instead a CD-ROM and a summit on mobile phones to fight crime. Is it not the truth that, until the Home Secretary's early release scheme is ended, until the march of political correctness in the police force is stopped and

    1073
    until police numbers are restored, the police force cannot have the morale and effectiveness needed to fight crime in this country?
    The Prime Minister: The way to increase the number of police is to invest in the police. We are committed to that investment and the right hon. Gentleman is not. He says that I must be crazy if I think that he will not invest in the police, but I think that it is dangerous to call the Conservative party's sanity—or mine—into question in that way. Let me again quote Mr. Nigel Hastilow, who says:
    It might be thought a strange form of madness for someone to nail their colours to the Conservative mast at such a time of crisis for the party.
    So the madness is not on the Government side, but on the Conservative side.
    The simple fact is that the right hon. Gentleman has to choose. We have proposed investment plans that increase investment by 3.3 per cent. over the next three years. That is what provides the nurses, the teachers and the police—[HON. MEMBERS: "Give us the figures "] I am delighted to do so. The number of teachers has already increased by 7,000 and the number of nurses by 16,000. Over the next three to four years, the number of police will increase to a record level and it is increasing now. My point remains: the only reason we can increase those numbers is that we are putting in the money—yet the right hon. Gentleman is committed to taking it out.
    In his great campaign yesterday, the right hon. Gentleman, typically, made a huge strategic blunder. He has made the issue of the next few months the question: who believes in investment in public services? The truth is that we do and he does not.
    Mr. Hague: Is it not the truth that a Government who promised no tax increases at all and better public services all round have now produced higher taxes all round, accompanied by a crisis in the police a crisis in teacher recruitment, a permanent crisis in the national health service, and a standstill on the railways and the roads? Nothing makes it clearer that this Government is all spin and no delivery.
    The Prime Minister: I thought that we both agreed that the transport system needs more money. We are committed to putting that extra investment in the transport system, but when we announced that investment, the right hon. Gentleman called it reckless, irresponsible and unsustainable. That was only a few months ago. Now, is the right hon. Gentleman in favour of that extra investment in transport or not? We do not know.
    I should point out, perhaps for the benefit of Opposition Members, and especially the shadow Chancellor, that it is not merely that the shadow Chancellor is committed to cutting spending while all the other spending shadow Ministers are committed to increasing it. I shall name one Conservative spending commitment, and let us hope that we can find out from the Conservative, party in the next few days how it will finance it. The shadow legal affairs spokesman announced that the Conservatives would end all means testing of legal aid. That may be worth while, but it is massively expensive. How on earth will the
    1074
    Conservatives fund that? The same is true of defence, farmers, schools and hospitals—which is why the last word should rest with Mr. Nigel Hastilow. He says:
    Confusion seems to reign throughout the party.
    To win back Edgbaston, Mr. Hastilow says,
    the Tories will need to increase their support by at least five per cent compared with the last election—yet support is slipping away from the party nationally, if not locally.
    If the Conservatives own candidates are saying that about their party, I cannot wait for the country's verdict.
    Hon. Members: Hear, hear!
    Mr. Speaker: Order.
    Mr. Tony Benn: As the Prime Minister has introduced a fully elected Scottish Parliament accountable to the people, fully elected Assemblies in Wales and Northern Ireland and a fully elected Assembly in London, could I persuade him to come out in favour of a fully elected Parliament, which most countries have? Appointing people by patronage is no basis for law making. Will the Prime Minister give a single reason why we should not have a fully elected Parliament in this country?
    The Prime Minister: I will give my right hon. Friend a simple reason. In my view, the second Chamber is a revising Chamber. We do not need two Chambers competing against one another. This Chamber is the proper Chamber for democratic authority and overall control, and that is why I do not believe in a fully elected second Chamber, in which my right hon. Friend believes. As for the issue of patronage, before Opposition Members start talking about it, I am the Prime Minister who is introducing the first restrictions on prime ministerial patronage. No doubt Opposition Members are keen on that now, but it slipped their minds in 18 years of government.
    Mr. Charles Kennedy: Apart from wondering how much members of the Labour party paid that Tory candidate to say all those things—
    Mr. Paul Keetch: Two million.
    Mr. Kennedy: If they did, please could they let me into the secret?
    On the issue of police numbers, leaving aside the Dutch auction on tax that the leader of the Conservative party wants to get into for the election, has not the Prime Minister simply confirmed this afternoon that, having stuck to Conservative spending limits on police numbers for the first half of this Parliament, the bottom line is that there are 2,500 fewer police officers in this country today than when he came to power?
    The Prime Minister: I have accepted that there are fewer. There have been fewer police officers in the whole of the UK in the last seven years, and in the last 10 years in London. My point is that this can be cured only by investment, and we are now putting in that investment.

    1075
    To return to the right hon. Gentleman's first point: why did we not do this before? The answer is that until we had stabilised the economy, got the national debt under control and got borrowing down—[Interruption.] Let me remind Opposition Members that when we came to office, the country had £28 billion of borrowing and a doubled national debt, and was paying out more on interest payments on the debt than on the whole school system. I make no apology for being very tight in the first two years, difficult though that was, and for now allowing ourselves the ability to fund year-on-year increases in spending on schools, hospitals, police and transport. I believe that that was the right thing to do.
    Mr. Kennedy: The Prime Minister is the politician who, in opposition, told the country that he was going to be tough on crime and tough on the causes of crime. What has happened? The police's recorded crime figures show that crime has risen, and that cannot be divorced from the fact that there are fewer police officers out on the beat in local communities. Should not the Prime Minister get tough on failure and tough on the causes of the failure of his and the Home Office's policies?
    The Prime Minister: First, let me correct the right hon. Gentleman. Crime has fallen under this Government, not risen. That is no consolation to people who are victims of burglary, car crime or any other kind of crime, but it has fallen. Secondly, we have introduced a series of measures in relation to juvenile justice, burglary, rape, crimes of violence and other matters.
    It is important that we now carry on investing in the infrastructure of the police. We are investing not only in police numbers, but in things such as closed-circuit television and the new police communications system. The police need investment in those, and in personnel. We also need to reform the criminal justice system, and we have embarked on that programme in this parliamentary Session.
    Of course it is right that in the first few years police numbers went down, for the reasons that I have given, as they had been doing for years. That situation is now being turned around, and it can only be sustained on the basis of a strong economy, not a weak one. That is why the Liberal Democrat proposition, which is to spend unlimited sums of money without wondering where they come from, is not, in reality, a substitute for a sound economic policy.
    Mr. David Crausby: Does my right hon. Friend agree that inflation-busting fare rises by several rail companies demonstrate a commitment to profit before consumers? Is that not a testament to Tory privatisation?
    The Prime Minister: It is important to remember that we have the ability to keep those fares that are regulated low. However, my hon. Friend is right. One of the reasons for the Strategic Rail Authority is that it is important that we get greater co-ordination into our railways and make up for the botched, failed, fragmented privatisation that we inherited from the Conservatives.
    Mr. Jonathan Sayeed: The British Medical Association and the Royal College of General Practitioners have said that 10,000 more family doctors are essential if the national health service is to
    1076
    function. At present, the taxpayer is funding the training of some 1,100 medical students and the Government have proposed to train a further 900. That would leave a shortfall of some 8,000 family doctors. Will the Prime Minister say what he intends to do about that?
    The Prime Minister: First, the fact is that the number given by the hon. Gentleman relates to training places every year, so he is not correct. Secondly, since we came to office, I think that the number is 4,500 extra doctors; and the NHS plan commits us to several thousand more.
    It is time the Conservative party understood what it is trying to say, which is that we need even more investment in our public services. With the greatest respect to the hon. Gentleman, I agree with that. That is why we announced the comprehensive spending review last year. We are putting the extra money in, but the hon. Gentleman and his Front-Bench colleagues are committed to taking it back out again. Whoever may make criticisms of the numbers of nurses, teachers, doctors or police, one group of people cannot do so, and that is the group of people sitting with the hon. Gentleman.
    Mr. Tom Levitt: Given that a report published today has shown a clear link between investment in information technology in schools and educational achievement, today's announcement of an £8 million investment in computers for Derbyshire schools in the next three years is very welcome.
    Is the Prime Minister nevertheless aware that schools in Derbyshire receive considerably less funding than those in other authorities? Will he give an assurance to Derbyshire parents that his commitment to revise the standard spending assessment system and reform it to make it operate more fairly by 2003 will be delivered on time?
    The Prime Minister: The local government finance Green Paper deals with these issues, as my hon. Friend knows, and we are well aware of people's concerns. I am delighted that that extra investment is being put into technology in schools. I think that I am right in saying that nine out of 10 schools are wired up to the internet. Every school that I visit shows more investment in hardware and software in the classroom. The possibilities are enormous, provided, of course, that we make the investment. I do not think that I need repeat the points that I made earlier on that.
    Mr. James Gray: An acute teacher shortage in Wiltshire is leading to a four and a half day week in some schools and to growing class sizes in every school across my constituency. A moment ago the Prime Minister was boasting about the 7,000 new teachers across England. In that case, how does he react to the comment of Mr. David Hart of the National Association of Head Teachers, who says that teacher recruitment is in meltdown? Or does he agree with Nigel de Gruchy of the National Association of Schoolmasters/Union of Women Teachers who says that the Prime Minister is incredibly complacent about it? The

    1077
    right hon. Gentleman says that the teachers are there, and the taxpayers are paying for them, but where are the teachers?
    The Prime Minister: The hon. Gentleman just about got his soundbite out at the end of his question. To increase the number of teachers, we introduced training salaries of £6,000 for new graduates in last year's Budget and there are salaries of up to £13,000 for career switchers. The first rise in recruitment for eight years has just taken place. I have already indicated to the hon. Gentleman that there are 7,500 more teachers since we came to office. Since the beginning of this year, we have seen the largest ever increase in inquiries from people wanting to join the teaching profession. [Interruption.] Yes, of course it is right. We have 7,500 teachers—we need even more. What is the answer to that? It is to put money in to get them. The difficulty for the hon. Gentleman and his colleagues is that, whereas we are committed to putting the money in, they are committed to taking the money out.
    Mr. George Stevenson: Given the significant changes in the global economy, particularly in the United States, and the continuing problems suffered by manufacturing, as witnessed by 350 job losses in manufacturing in my constituency over Christmas, does my right hon. Friend agree that an early cut in United Kingdom interest rates would be not only prudent but desirable?
    The Prime Minister: It would be unwise of me to answer that question specifically. The interest rate decision has to be left to the Bank of England. On manufacturing industry, it is the case—partly as a result of the euro's improvement in its competitiveness with the pound—that the situation is better, but it is still very difficult for some areas of manufacturing. However, for manufacturing, as for the rest of the British economy, the worst thing would be a return to the boom and bust of the late 1980s and early 1990s. [Interruption] They want the facts—they can have them. When the Conservatives were in office, we lost 1 million manufacturing jobs, output plummeted by 7 per cent. and we had the two worst recessions since the war. Since this Government have been in office, we have had lower mortgages, more jobs and a better run economy.
    Mr. David Chidgey: Is the Prime Minister aware that the shortfall in police recruitment in Hampshire is now greater than at any time since 1995 and is set to double again this year? As a
    1078
    result, instead of getting four extra officers in my constituency of Eastleigh, we are likely to have fewer. Does the right hon. Gentleman accept that giving chief constables extra cash and the power to recruit extra officers is pretty meaningless when police pay and conditions are tied to a national scale which does not reflect the high cost of housing in my area, for example, where house prices have gone up by a quarter in the past 12 months? Will he give an undertaking to make police pay and conditions more flexible so that Hampshire can recruit the officers that it needs and, most importantly, the officers that my constituents expect?
    The Prime Minister: I understand from the Home Secretary that recently the numbers in Hampshire have started to turn the corner as a result of the additional money that has been put in. One of the biggest problems that we have recruiting public sector workers, whether nurses, teachers or police, is not simply a shortage of money to buy the individual teacher, nurse or police officer, but the cost of housing and other things faced by people in certain parts of the country. That is why we are offering increased support for housing costs, for example. We have done that in London and we are looking to see how we can do it in other areas too. However, I must return to this point: it can be done only if we are prepared to put in the money. I understand that the hon. Gentleman supports the extra investment that we are putting in, but that is a choice that the country has to make. Only if we are prepared to put in the investment will we get the police, nurses and teachers that we need.
    Dr. Brian Iddon: Last year, I visited the laboratories at the Royal Bolton hospital and saw the excellent work that the scientists do there. Without their work, the national health service would probably grind to a halt. Does my right hon. Friend agree, therefore, that the announcement of a significant pay award to that group of people will not only reverse more of the Tory damage, but will boost morale in that service and aid recruitment and retention?
    The Prime Minister: That is a perfect example of what I was saying a moment ago. We are trying to get additional sums of money to hard-pressed groups in our public services, where we need to recruit and pay properly. It will take time and it has to be done in a way that will not put at risk the strength of the economy. We now know that the Conservative party would take that money away from the very groups to which my hon. Friend refers. The difference between the two parties—[Interruption.] I am not surprised that Conservative Members are leaving. They should go and take a crash course in the economy and then come back and debate it.

Points of Order
3.31 pm
Mr. John Bercow: On a point of order, Mr. Speaker. You will be aware that the Prime Minister's final answer to my right hon. Friend the Leader of the Opposition lasted precisely one minute and 50 seconds. Given your periodic appeals for brevity on the part of right hon. and hon. Members and the fact that you are empowered to impose—[Interruption.]
Mr. Speaker: Order. Let me tell the hon. Member for Slough (Fiona Mactaggart) that this is not the first time that she has made a great deal of noise in this Chamber, but it will be the last time.
Mr. Bercow: Thank you, Mr. Speaker. Given your periodic appeals for brevity and the fact that you are empowered to impose 10, 12 or 15-minute limits on Back-Bench contributions to debates, would you consider the imposition of a one-minute limit on the Prime Minister's answers to questions, so that he does not waffle irrelevantly, to the disadvantage of the House and the country?
Mr. Speaker: I am concerned at every Question Time that Back Benchers should get an opportunity to contribute. Today, I was disappointed at the slowness of progress. I hope that my disappointment will be taken on board by the Ministers concerned and by those on the Opposition Front Bench.
Mr. Norman Baker: Further to that point of order, Mr. Speaker. Prime Minister's Question Time is an opportunity for hon. Members to raise serious issues, in particular constituency issues. Yet again today, more than half the time available has been occupied by the Leader of the Opposition, with specious questions and so-called jokes halfway through. The right hon. Gentleman finished at 3.17 pm and only six hon. Members were called from the Order Paper. Surely there is a case for asking the Leader of the Opposition to ask questions and not make semi-speeches.
Mr. Speaker: I expect short questions and short replies, which would allow Back Benchers to contribute.
Dr. Julian Lewis: Further to that point of order, Mr. Speaker. Is not part of the problem the fact that when the Prime Minister is supposed to be answering questions about his policy he launches into long rants about Opposition policy, for which he has no responsibility? Could you not exercise your discretion to prevent that from happening with the frequency that it so regrettably does?
Mr. Speaker: The one thing for which I do not have responsibility is the content of the answer or the question.

CAPITAL ALLOWANCES BILL
Ordered,
That the Capital Allowances Bill be proceeded with as a tax simplification bill; but that the Bill shall not stand referred to a second reading committee.—[Mr. Clelland.]

Orders of the Day

  Health and Social Care Bill
  Order for Second Reading read.
  Mr. Speaker: I should inform the House that I have selected the amendment in the name of the Leader of the Opposition, and that there is a 15-minute limit on Back-Bench speeches.
  3.35 pm
  The Secretary of State for Health (Mr. Alan Milburn): I beg to move, That the Bill be now read a Second time.
  When the Government came to office, our first job was to stabilise the national health service. Decades of neglect, coupled with years of failed reforms, had left the NHS with neither the investment nor the fundamental changes that it needed. [Interruption.] If the hon. Member for Mid-Worcestershire (Mr. Luff) thinks that that is so funny, perhaps he will explain why, when this Government came to office, the health authority in his area of Worcestershire had built up debts of £12 billion under the previous Conservative Government. Would he like to stand up and explain why that was? The truth is that the internal market imposed on the health service by Conservative Ministers had failed patients and disempowered staff. It created a lottery in care and failed to raise standards.
  In our first two years, the Government laid the foundation for fundamental reform in the national health service. The internal market—tough on finance but soft on quality—has now gone. In its place there is a new emphasis on raising standards. Doctors and nurses know patients' needs best, and they are now in the driving seat to shape local health services, controlling about £20 billion of NHS spending every year.
  Secondly, after decades of under-investment, we have supplied the new resources that the NHS needs. For years, the NHS budget rose by just 3 per cent. a year. In the previous Parliament, it grew by even less. In the final year of the Conservative Government, NHS spending actually fell in real terms. Cuts for the short term did lasting damage for the long term. There were cuts in the numbers of nurse training places, of beds and of GP trainees, and there were cuts in spending on buildings and on equipment.
  For 18 years, the Conservatives short-changed the national health service. Their failure to invest then is the root cause of NHS problems now.
  Mr. Peter Bottomley: Will the Secretary of State give way?
  Mr. Milburn: There are too few doctors, nurses and beds. If the hon. Gentleman has a convincing explanation, I look forward to hearing it.
  Mr. Bottomley: While the Secretary of State is talking about such matters, will he say at what stage he or his junior Ministers decided to abolish community health councils, and why they did not consult on that decision?
  Mr. Milburn: As the hon. Gentleman would expect, I shall come to the matter of community health councils.

  1081
  However, as far as consultation is concerned, I know that under the Conservative Government it tended to be merely a period of time rather than a meaningful exercise. The hon. Gentleman will recall that last year the Government embarked on the largest consultation ever undertaken in the national health service. He cannot claim not to have heard about it, as he and other Conservative Members were busy criticising it.
  We consulted the British people and NHS staff, and we received a quarter of a million responses. We assessed what action, in terms of policy and investment, needed to be taken to turn the service around. That required both new resources and new reforms.
  Mr. Graham Brady: Will the Secretary of State say how many of those quarter of a million replies called on him to abolish community health councils?
  Mr. Milburn: There were many different views as to the best way to ensure that the voice of patients could be enhanced within the national health service. If the hon. Gentleman wants me to demonstrate the range of the responses received from various organisations with regard to CHCs, I should be happy to oblige.
  For example, Marianne Rigge is the director of the College of Health, of which the hon. Member for Altrincham and Sale, West (Mr. Brady) might know. It is responsible for providing patients with information about waiting times, for example, and is an extremely reputable organisation. She said:
  The College of Health welcomes the new statutory duty for public involvement and consultation by health authorities, primary care trusts and NHS trusts. We also welcome the creation of Patient Forums as statutory bodies.
  Claire Rayner is involved with patients' associations, and she said:
  I welcome the proposals put forward by the Government which will allow patients to influence directly the services they receive.
  The NHS Confederation supported the proposals, and the Local Government Association stated:
  The proposals are an important contribution to a more patient centred and locally accountable NHS.
  [Interruption.]
  Mr. Speaker: Order. I do not expect the hon. Member for Worthing, West (Mr. Bottomley) to shout down the Secretary of State. That is just not acceptable.
  Mr. Peter Bottomley: I apologise for causing you to rise, Mr. Speaker. However, I was not trying to shout the Secretary of State down, but to encourage him to answer the specific question that he allowed me to ask. I asked when he decided to abolish community health councils, and what consultation was held on that. He was not answering that question.
  Mr. Speaker: I would not have expected the hon. Gentleman to shout encouragement to the Minister either.
  Mr. Milburn: The hon. Gentleman should know better. The fact that he did not receive the answer he wanted does not mean that it is not the right answer.
  1082
  Step by step, the Government are putting right what the Conservatives did wrong. In just five years, the NHS will grow by a third in real terms—that is the biggest growth that it has ever experienced. Capital budgets that fell by an average of more than 2 per cent. a year in the last Parliament are growing by an average of 8 per cent. a year in the current Parliament.
  Of course it takes time for resources to produce results, but after decades of neglect the NHS is moving in the right direction. Waiting lists that rose by 400,000 under the last Government have fallen by more than 130,000 under this Government. Hospital bed numbers that were cut by 40,000 under the Conservatives are now rising again with Labour.
  Mr. Roger Gale: Will the Secretary of State give way?
  Mr. Milburn: I will in a moment. I have already given way two or three times.
  Cancer and cardiac services that had been shamefully neglected are now receiving the investment that they need: they will receive an extra £450 million in the next year alone. Nurse numbers, cut in the 1990s, have risen by 16,000 under this Government.
  Mr. Gale: Given his extravagant tirade of abuse against the last Government and his equally extravagant claims for the present Government, can the Secretary of State explain why the private nursing and private residential care sectors are in almost as much despair as farmers? Can he explain why nursing homes in east Kent are closing at a rate of almost one a week? Can he explain why we have lost more than 200 beds since April? Can he explain why hospital beds are being blocked by patients who should not be there, and why operations—although he claims that the situation is improving—are being cancelled daily?
  Mr. Milburn: The hon. Gentleman asks for an explanation of what is happening in areas including his own. As he will know, it is true that some nursing homes are closing—[Interruption.] Of course that is true, and of course some residential homes are closing as well, largely because of changes in property values in the hon. Gentleman's area.
  Those nursing home closures, however—and the reduction in the number of beds—have been more than compensated for by the extra money that we have invested through our social services spending. The question for the hon. Gentleman, and for the Opposition health spokesman, the hon. Member for Woodspring (Dr. Fox), is this: if the Conservative party is so concerned about closures of care homes and bed blocking in hospitals, will it now commit itself to matching our increases in social services expenditure? That is a simple question, requiring a yes or a no.
  Mr. Stephen Day: Perhaps the Secretary of State can answer my question—that is what he is here for. He constantly tells the House of the "neglect" of the NHS that took place during the 18 years when the Tories were running it. The NHS, incidentally, was safer for longer in our hands than under Labour: the Tory party has run it for more years than Labour ever has. Does the right hon. Gentleman accept that there was a 70 per cent. real-terms

  1083
  increase in the NHS budget between the election of a Conservative Government in 1979 and the regrettable election of his party in 1997?
  Mr. Milburn: If I were the hon. Gentleman, I really would not start giving facts and figures about investment in the NHS. For nearly 20 years, the Conservatives increased NHS spending by about 3 per cent. in real terms. That was not enough to enable the NHS to keep pace with changes in technology and treatment, let alone modernise services for patients. It left the NHS in the state in which it is today. Hon. Members on both sides of the House acknowledge that there are too few beds, too few nurses and too few doctors, that not enough patients are being treated, and that there is not enough investment in cancer and cardiac equipment. Over five years, we are doubling that investment.
  If I were the hon. Gentleman, I would look at what the Conservative Government did in the last Parliament. In their last year in office they cut NHS expenditure, cut capital budgets, failed to invest, and cut the number of nurse training places. A little less bleating from the Conservatives would not come amiss.
  Today, the NHS is a service in transition. It is true that too many patients still wait too long for treatment, and it is true that more staff are still needed. There is a long way to go, but progress is taking hold. None of that happened by chance; it happened because of the choices that the Government made, and they were the right choices for Britain. We chose to get the public finances back in order to give the country economic stability after years of instability. A strong and growing economy is now providing the foundations for strong and growing public services, not just for one year—it is not a one-off—but for year after year after year of sustained investment. That is what the NHS needs, that is what the Government are delivering, and that is what the Conservatives would cut back.
  Investment on its own, however, will not deliver the goods for patients. The NHS needs sustained reform to run alongside the programme of sustained investment. The fundamentals of the NHS—its principles, fairness and the commitment of its staff—are sound, but major changes are needed if it is to meet the aspirations of the public, staff and patients for services that are faster, fairer and more convenient.
  The sustained investment that we are making provides the best ever opportunity fundamentally to redesign the health service around the needs of its patients. The NHS plan that we published last July sets out the essential reforms necessary to transform the way in which the NHS works. They address many of the underlying weaknesses that have bedevilled the NHS for decades, such as old-fashioned demarcations between staff, barriers between services, the lack of clear incentives to provide encouragement for better performance, over-centralisation of decision making and the fact that patients lack real power inside the system. The Bill addresses those fundamental problems which have for too long held back the NHS from realising its full potential.
  First and foremost, the Bill is about devolving power from the centre to the local—from the NHS executive and the Department of Health to front-line clinicians, local
  1084
  hospitals, primary care groups and, above all others, patients themselves It transfers the oversight of local primary care services. Let us not forget that in all the discussions about hospitals that inevitably take place in the House—[Interruption] There must be something happening, Mr. Speaker, because all the Opposition's bleepers have gone off at once. No doubt someone from their Front Bench I as gone too.
  The oversight of local primary care services—the primary point of contact for patients with the NHS—will be transferred from national quangos to the local health service. The House knows that in the past few years we have strengthened systems of accountability and inspection in the health service. The Bill goes further and offers more support to doctors and better protection for patients. Let me emphasise one important point: the overwhelming majority of doctors do a brilliant job for the NHS, and I believe that it is in their interests, as well as those of the patients, for the few problem doctors whom patients en counter to be dealt with fairly and quickly.
  The NHS tribunal system is responsible for deciding whether an individual GP can remain practising within the NHS when concerns have been raised about his or her performance. That system has failed. It has not acted swiftly enough to suspend GPs or remove them from NHS lists when they pose a real risk to patients. The Bill abolishes the tribunal. Its role will be devolved to local health authorities, allowing them to take urgent action when there is a local cause for concern. There will, of course, be a right of appeal to an independent body.
  Together with other measures that we are taking, such as the annual appraisal of all doctors, the Bill will provide extra safeguards for patients, including a requirement that previous convictions and judgments by regulatory bodies be reported to the local authority. The new system will be faster, fairer, more flexible and offer better protection for patients.
  Dr. Peter Brand: I welcome anything that will speed up the control of unsatisfactory doctors, in particular the idea that the disqualification or suspension of a doctor by one health authority will be valid for all other health authorities. However, I am concerned that there is no parallel provision for doctors who are approved to serve on the list of one health authority automatically to be included on the list of other health authorities. That will make life extremely difficult for locums and others.
  Mr. Milburn: The hon. Gentleman is aware that, particularly where there are GP shortages, local patients and local health services rely disproportionately on locums. The truth is that, hitherto, we have not had an appropriate structure to ensure that they are capable of providing services of the highest standards to patients. As we all know, there have been unfortunate incidents involving locum GPs.
  The vast majority of locum GPs, like the vast majority of permanent GPs, do a first-class job, but some do not. We cannot allow such people to slip through the net, which is why there are proposals to ensure that every health authority list not only includes full-time GPs who work permanently for a practice, whether single-handed or group practices, but registers for the first time locum or temporary family doctors. I believe that that will make

  1085
  a substantial difference, certainly in assuring the public that those from whom they receive care and treatment are always of the highest quality, wherever they come from and whether they be temporary or permanent.
  Dr. Brand: Perhaps I did not make my question completely clear. The issue is that a disqualification by one health authority disbars a person from working in all health authorities. An approval by one health authority surely should allow a person to be approved automatically by all other health authorities. The Bill does not make that clear.
  Mr. Milburn: If the hon. Gentleman wants to be a member of the Committee and wants to go into those issues in detail, he will have an opportunity to do so—there is an offer he cannot refuse. The Bill says that to practise in any health authority, a locum has to be on the list of one health authority. I hope that that will get the balance right in ensuring that We provide proper safeguards for patients but do not over-bureaucratise the system, and that my remarks offer him the reassurance that he wants.
  Dr. Howard Stoate: I am grateful to my right hon. Friend for giving way.[Interruption] There is a doctors' lobby going on, I am afraid, and the doctor will see the Secretary of State now.
  My right hon. Friend rightly says that certain parts of the country have to rely too heavily on locum doctors. Will he clarify the point about the Medical Practices Committee, which is able to oversee the number of GPs across the country to ensure equitable access to services for patients? If that committee is abolished as the Bill proposes, how will he ensure that there remains a good spread of GPs and that that spread will be overseen centrally to ensure that pockets of real shortage do not exist next door to pockets of relative plenty?
  Mr. Milburn: My hon. Friend speaks as more than a locum GP—he is an expert GP on those issues. On the question of the Medical Practices Committee, the Bill proposes to establish yet another quango and devolve that down to the local health services. The Medical Practices Committee is supposed to ensure an even distribution of GPs between areas, but the truth is that it has failed to do its job properly. Hon. Members have only to look to Barnsley, Sunderland and some inner-city areas to realise that those places are not over doctored, but under doctored. It is entirely right and proper that the people who should take decisions about whether they need to recruit more GPs should be these responsible for overseeing the provision of local health services, rather than some national committee that has simply failed to do the job.
  I offer my hon. Friend this reassurance: the Department of Health and the NHS executive must and will ensure that there is oversight to get the incentives in the right place, particularly through the new personal medical services contracts. That will ensure that we recruit family doctors to the areas where they are needed most.
  Mr. David Chaytor: Will the new powers for health authorities include one to monitor in detail the performance of individual doctors? I speak as one of the few Members—perhaps the only one—whose
  1086
  family was registered at one of the group practices where Dr. Shipman formerly worked, so I have a close interest in the matter. It is surprising that I am here, in view of the circumstances. At a very early stage in the Shipman case, there was well-documented local evidence of malpractice, which was not picked up and not formally fed into the system. Will the health authorities' new powers change that?
  Mr. Milburn: I think that they will do so. As my hon. Friend knows, there is a raft of measures to strengthen the safeguards that he seeks. Some of those measures are contained in the Bill and require new legislative powers, although others can be introduced under existing powers.
  The most important of the measures that we are taking, apart from the establishment of the Commission for Health Improvement and the new National Clinical Assessment Authority, is the introduction of a requirement for all doctors, whether family or hospital doctors, to undergo annual appraisal. Many people would expect similar arrangements to exist in other industries and other parts of the public sector. Although such measures can be controversial, the provision enjoys a great deal of support not only among patients and patients' organisations, but in the medical profession. There is now a recognition that things cannot continue as they have done.
  We must be careful with the assumption that there is a raft of doctors who go around killing their patients, as that is not the case. We must be clear about Harold Shipman and his crime. He was a cold, calculating and evil killer who manipulated the system and abused trust in the most callous way imaginable. The Bill deals with poor performance and with spotting problems early on. That is what we must deal with.
  I remind my hon. Friend the Member for Bury, North (Mr. Chaytor) of what happens every time the cases in question arise. There is a recurring pattern. Everybody knows that there is a problem, except, of course, the patients themselves. It is gossiped about by managers and clinicians in the local health service, but nobody does a damn thing about it. That is what we must change. Such change is difficult, controversial and will not always enjoy support, but I say to my hon. Friend that it is the right thing to do. Things must change and move on. In my three and a half years in the Department of Health, I have found that a big sea change has also occurred in the medical profession, which now recognises that these matters must be hammered out jointly between it, the Government and patients' organisations. That process is in the interests of the profession and of patients, and the Bill is a big step forward in that respect.
  The Bill contains other measures that will improve services for patients. Not least among them is the formation of local care trusts. The Bill gives local health and social services the power to form new care trusts, bringing their services together under one organisation to provide more seamless care for patients. In the overwhelming majority of cases, care trusts will be formed as a result of agreed local decisions between health and social services. In the rare case in which either service is failing patients, however, the Bill provides powers to compulsorily form a care trust.
  As hon. Members from all parties know, the truth is that local services, which often serve markedly similar populations, have different levels of performance. Some

  1087
  are good, a few are bad and all could be better. That lottery in care is not good enough. It was made worse by the fragmentation associated with the internal market, but no one should believe that a return to old-style, centralised command and control can deliver for the NHS in the 21st century. The NHS is too large and too complex an organisation to be micro-managed from Whitehall. What is needed instead is a combination of clear national standards so that patients know that they can expect a quality service, regardless of where they live. Local responsibility should determine how best to meet those standards.
  Rev. Martin Smyth: I appreciate the Secretary of State's remarks, but does he accept that there is some concern about the division that may still remain between health care and social care, and about the definition of nursing care? Will guidance be provided to ensure that the trust will pay for health care? I should also like to check another point now, to avoid intervening later. I take it that clause 60, which deals with prescribing rights, brings Northern Ireland into line with the rest of the United Kingdom, especially in respect of nurse prescribing.
  Mr. Milburn: Yes, it does, and I hope that that is welcome. The provision will extend the right to prescribe to nurses and other health professionals such as pharmacists. That will make for better and faster services for patients and will reduce pressure on the family doctor service.
  The hon. Gentleman's first point concerned health care, social care and funding. I shall deal in a moment with the royal commission's recommendations and with the part of the Bill in question. When we have hammered out agreement on the definition of free nursing care, we will expect that, if the go ahead is given to free nursing care for the individual patient, it will be funded by the local health service.
  What is needed today in the NHS is a combination of clear national standards with responsibility for local delivery. For exceptional circumstances, where services persistently fail, the Bill proposes new powers to replace failing management teams and to bring in new leadership. The more that standards rise and modernisation takes hold, the more that devolution can take place. The concept of earned autonomy, which was outlined in the NHS plan, has gained widespread support within the NHS. The Bill seeks to enshrine it through a new performance fund, which will rise to £500 million a year. The best performers will be free to spend those extra resources without strings attached; others will have to earn the right to that flexibility.
  The views of patients will, for the first time in the NHS, help to determine the cash that local services receive. That seems to me to be right. The relationship between the patient and the service must fundamentally change. For too long, patients have been too much talked at and not enough listened to. When they have had an immediate problem with a service, they have not always been able to have it addressed quickly. The complaints system is discredited; few rights of redress have been available. The patient's voice does not sufficiently influence the provision of services. Local communities and local
  1088
  democracy are poorly represented in NHS decision-making structures. The culture is more of the last century than of this century: that must now be reformed.
  Giving patients new powers is one of the keys to unlocking patient-centred services. The Bill will strengthen the way in which we involve patients in the NHS. It will give patients more say than ever over how their health service works for them—but that, too, requires fundamental reform.
  I know that there are concerns in the House about some of the proposals, most notably about the abolition of community health councils. We listened very carefully to the arguments that were put to us and took action when drafting the Bill to respond, most notably by strengthening still further the independence of the new structures that we propose.
  The first major change to make local health services more accountable to the local communities that they serve involves giving new powers of scrutiny over the local NHS to those elected by the local community—to the local council. On democratic grounds, I believe that that is right. Health authorities will have a duty to consult local authorities on proposed major changes to service development. Scrutiny committees in the local authority—formed on an all-party basis—will be able to refer contested proposals to the new independent national reconfiguration panel if they think that the plans are not in the interests of local people.
  Mr. Hilton Dawson: I welcome the renewed role of local government in scrutinising vital health services. Will my right hon. Friend assure me that, where a shire council and a district council have different functions, both will be involved in scrutiny at district level, which is crucial?
  Mr. Milburn: There are two points on that issue. First, the lead will probably be with the social services authority. In some cases, that will be in the old so-called district councils, as in my area of Darlington, which has a unitary council, and in others it will be in county councils. We will ensure the involvement of district councils.
  Secondly, we will work very closely with the Local Government Association to ensure that appropriate guidance is given to local health services and authorities. Council boundaries form a patchwork quilt— some local health services cross many local authority boundaries—so we shall have to ensure co-ordination. I believe that that can be addressed through guidance.
  Mr. David Hinchliffe: On democratising the health service and the relationship between it and social services—I support my right hon. Friend's desire to achieve that—why not simply shift the health authority function to local government and deal with the job lot in one go?
  Mr. Milburn: My hon. Friend has been extremely consistent on this point, and I have been extremely consistent in resisting it down the years. I do not believe that that is what the national health service needs. It has had years of structural and organisational upheaval. Of course we need to change the structures when that is appropriate, but our emphasis now is not just on the

  1089
  structures but on incentives and on breaking down barriers between services and staff. That is precisely what the NHS needs.
  I do not believe that the best way forward is for the NHS to have a local government takeover. Incidentally, I do not believe that the best way forward for local government and social services is to have a national health service takeover. When services work together on the ground—the new care trust will provide a model for that—partnership among organisations is enhanced and the service to patients is enhanced and more seamless.
  I am sure that, like me, my hon. Friend meets the most vulnerable people in his constituency surgery who find the current system byzantine. It must change, and it must be made easier. We must have more seamless services, better co-ordinated planning and more consistent assessment of people's health and social care needs. That is precisely what our proposed reforms will do, including the care trusts.
  Mr. John Bercow: Will the right hon. Gentleman give way?
  Mr. Milburn: I shall give way to the hon. Gentleman, and then I shall make some progress.
  Mr. Bercow: On 31 October last year, an early-day motion was tabled that rightly celebrated the work of the community health councils. Does the Secretary of State recall the letter that shortly thereafter was sent by the Prime Minister's agent, Mr. John Burton, which said "Tony agrees with every word of the motion. Tony would certainly like to add his congratulations to the work of the community health councils over the past 25 years, and he wishes them every success in the future"? Had the Prime Minister at that stage already decided to scrap those community health councils, or did he stumble on that stupidity only at a later stage?
  Mr. Milburn: I was looking for a reasoned argument from the hon. Gentleman, but more fool me. I am not privy to the Prime Minister's correspondence, but of course many community health councils have done a good job—some have and some have not. We should not be conservative about this issue. We should consider what is needed from the patients' point of view. No organisation has a God-given right to exist. Governments do not have a God-given right to exist. Community health councils do not have a God-given right to exist. MPs do not have a God-given right to exist.
  If the hon. Gentleman looks at the problem from the patients' point of view, what do they need? If they are in a hospital or in a primary care setting and they have a problem—heaven knows, people encounter problems in the national health service—they need somewhere to go to get it nipped in the bud before it becomes serious or it engenders a serious complaint. They need a complaints system that is accessible, open and independent. If they have a serious complaint, they need help through the complaints system. They also need a form of inspection and accountability so that they are able to assess how well the local health service is performing. We are putting all those measures in place.
  Mr. Simon Burns: Will the right hon. Gentleman give way?
  Mr. Milburn: I shall make progress, but I shall give way to the hon. Gentleman in a second.
  1090
  The Bill establishes entirely new, independent and statutory patient bodies in every part of the country. Every NHS trust and every primary care trust will have a patients forum made up of individual patients and representatives from patients' groups and voluntary organisations. Patients forums will not be managed by the trust, they will not be funded by the trust and they will not be answerable to the trust. The Bill makes it clear that it is the other way round. NHS trusts will have to answer to the patients forums.
  The forums will be wholly independent. Unlike CHCs, which are partly appointed by the Department of Health, members of each new statutory patients forum will be appointed independently by the new independent NHS appointments commission. Furthermore, every patients forum will have the power to appoint a non-executive director to the trust board. For the first time, patients will elect a patient to the governing bodies of local health services as of right. For the first time, too, a patients' organisation, the forum, will be able to monitor, review and inspect all aspects of local health services from the patients' perspective. It will be able to visit and inspect every place in which patients are treated—hospitals, nursing homes, private health care, and, for the first time, all primary care settings.
  Mr. Clive Efford: I am grateful to my right hon. Friend for his reference to the involvement of the voluntary sector because, in my experience as a former member of a CHC, it provides enormous expertise and insight into the way in which the NHS operates, which has allowed it to be an effective patients' advocate. How will patients be selected for the patients forums? At the moment, they appear to be self-selecting. How patients become part of the forums is a bit of a mystery to me.
  Mr. Milburn: There will be two points of entry to the patients forums, but only one organisation responsible for the appointments, which will not be me, other Ministers or the Department of Health but the completely independent appointments commission. I hope that that deals with the concerns that are being expressed about independence.
  As we all know from our constituencies, extremely good local patient and voluntary organisations do a brilliant job, whether they be the local branches of the Alzheimer's Disease Society or the Multiple Sclerosis Society. It is right and proper that we should give such organisations the opportunity better to influence local health services. Therefore, they will be represented, as of right, on the patients forums.
  The second group of people who will be represented is simple and straightforward—the patients who have previously used the health service. That is reasonable. We all use local health services, but the people who really count are the patients themselves, so it is right and proper that they should have an opportunity to put themselves forward to the independent appointments commission, which will make a decision and try to achieve the right balance between different interest groups, genders, races and so on to ensure that every primary care trust and NHS trust has an organisation that it can be legitimately said is standing up for and properly representing the needs of patients.
  Mr. Burns: If the forums and patient advocacy liaison services will be so independent and reflective of the

  1091
  wishes of local people, can the right hon. Gentleman reassure the Parliamentary Secretary, Lord Chancellor's Department, the hon. Member for Wyre Forest (Mr. Lock), that they will have more effect and influence than community health councils and other local people on the changes to Kidderminster hospital, which are so deeply unpopular?
  Mr. Milburn: I thought that the hon. Gentleman intended to make a serious point. I am happy to have a serious debate about some of these issues. He will know, having dealt with such matters as a Minister in the Department of Health, that local service changes are always under way in the NHS, and rightly so. Some are more controversial than others. At the moment, a contested local service change will land on my desk, and, ultimately, Ministers have some responsibility for ensuring that the right decisions are made. In future, an independent reconfiguration panel, comprising clinicians, managers and patients, will assess whether a decision is in the best interests of the local NHS and patients. That will be a much more coherent way to make decisions and it will help to take some of the silly party politics out of such issues.
  Dr. Brand: I welcome the greater independence that is now being proposed for patients forums. Although patients are important, are not people important before they become patients, and communities too? Are we not at risk of handing over an important function to a special interest group? Is the Minister not designing a scheme for a national illness service, rather than a national health service? Are not we likely to lose the public health input, which is so important and was available through community health councils, and especially through their local authority membership?
  Mr. Milburn: I thought that the Liberal party was committed to the idea of democratising the national health service. Does the hon. Gentleman oppose the idea that we should transfer the extremely important function of monitoring on behalf of the local community how well the local health service is performing from an unelected body—the community health council—to an elected body that, in the end, has to face the crucial test, doing what we do every few years, which is to stand for election? That seems to me to be precisely the right thing to do.
  The patients forum will also oversee the work of the patient advocacy and liaison services, which will provide an entirely new tier of service in the NHS: someone to sort out problems within hospital or community services on the spot, be they poor communication, worries about cleanliness or discharge arrangements.
  PALS will be placed in every trust to have the knowledge and clout to sort out problems for patients before they escalate into serious complaints. To safeguard against their "capture" by NHS trusts or primary care trusts, the independent patients forum will be able to recommend that a patient advocacy service be taken out of the trust and be run independently from it.
  The fourth element of the new system will be an effective complaints procedure. The existing complaints system is being reviewed and I want the new system to be much more independent than the old. It is likely, for
  1092
  example, that when necessary it will be fully independent of the NHS body being complained about, unlike in the current system. In addition, there will now be an independent advocacy service commissioned in each area to support complainants. Some have suggested that there would be particular advantages if the services were provided by a local authority. There is merit in that argument, and we will be very happy to consider it further in Committee.
  To ensure that there is a strong voice for patients nationally as well as locally, we are working with voluntary and patient groups, including the College of Health and the Long Term Medical Conditions Alliance, to explore how best to form a national patients' organisation to act as an independent umbrella body for NHS patients. The feasibility work is being funded by my Department, and I expect that when it is completed in March the Department will in turn provide the funding needed to establish and run the new national patients' organisation.
  Ms Debra Shipley: As the long title of the Bill says that it is intended
  to make provision in relation to the supply or other processing of patient information
  will my right hon. Friend consider favourably a small amendment to allow my constituent Marian Jordan to register her late husband's name on her son Daniel's birth certificate? As the law stands, birth information—and therefore medical history—is inaccurate by omission. I might add that such a commitment was given by my hon. Friend the Minister for Public Health in August.
  Mr. Milburn: We have agreed the policy, I am told—so it must be right. I know that my hon. Friend the Minister for Public Health has agreed the policy, and I will be happy to chase it up. Clearly, if we can make progress on it, we should do so.
  Helen Jones: Will my right hon. Friend clarify the role of the independent appointments commission? I am concerned that large parts of constituencies such as mine remain under-represented throughout the health service. Will the commission actively seek applications from unrepresented groups and areas rather than simply appointing from among those who put themselves forward?
  Mr. Milburn: That is obviously the right thing to do. Before 1997, women and people from black and ethnic minority backgrounds were under-represented on trust and health authority boards. We changed that precisely because Ministers operated to a clear set of guidelines that increased the ethnic and gender mix on those boards. We can give precisely the same guidance to the independent appointments commission.
  It is important to recognise that, for too long, decision making in the national health service has been behind closed doors and that all too often it has resembled a secret society rather than a public service. We have to open it up to all sections of society because the national health service does not serve just one part of the community; it serves the whole community and we must have a means of decision making that properly reflects all interest groups.

  1093
  The changes proposed in the Bill respond to many of the concerns expressed about the abolition of community health councils. The Standing Committee will allow further detailed consideration, but I believe profoundly that the reforms will give more power to patients in the health service and more independent scrutiny than ever before.
  Mr. Paul Burstow: Will the Minister give way?
  Mr. Milburn: I must move on. I have been speaking for about 40 minutes and I now want to refer to the royal commission.
  The steps that we are taking to make the funding of long-term care fairer are also important. From October this year, with the consent of Parliament, nursing care will be free at the point of use and fully funded by the NHS. Residents in nursing homes will, in future, be treated in the same way as people who are being cared for at home, with NHS services and equipment being provided according to need, not ability to pay. This is indeed an historic step. It is long overdue. It will make a huge difference to thousands of older people.
  By 2004, we will be spending an extra £1.4 billion on those reforms and on new services for older people. New intermediate care services, for example, will promote independence and allow more older people to stay at home for longer, in many cases avoiding altogether the need for them to enter residential care
  We could, of course, have chosen to spend the money instead—as I think the Liberal Democrats suggest—on implementing the royal commission's recommendation that all personal care, as well as nursing care, should he free. I believe that this would not have improved front-line services in any way, shape or form—[Interruption.] The hon. Member for Sutton and Cheam (Mr. Burstow) is nodding. Perhaps he should look again at the Liberal Democrat amendment, which, thankfully, has not been selected.
  Not one more older person would have received any extra care or support to remain independent for as long as possible. Nor would it have benefited the least well-off, as seven out of 10 people in residential care already get all or some of their personal care costs paid for. Instead, it would have locked in place the existing range of often inadequate services that have been the frequent subject of criticism from many older people.
  I know that these are hard choices, but in future our priority must surely be to develop a wider range of services that will meet the health and social care needs of our society much more effectively than in the past. That is what the NHS plan does and what this Bill supports.
  Mr. Hinchliffe: I welcome the steps that the Government have taken to go part of the way towards what was recommended by the royal commission. My concern relates to how we distinguish between personal care and nursing care in a practical sense. For example, if in a care or nursing home a care assistant, supervised by a qualified nurse, bathes an elderly resident, is that social care or nursing care?
  Mr. Milburn: It would depend on the assessment—
  Mr. Burstow: Ah!
  Mr. Milburn: I had managed to get only four words out. If the hon. Gentleman would allow me 40 words,
  1094
  I would provide an explanation. It would depend on the assessment of the case. First, the royal commission accepted the premise that we could differentiate between nursing care and personal care. Secondly, we are going further than the royal commission recommended, not least in spending more money on this package of measures. We are also going for a wider definition of free nursing care. As my hon. Friend is aware, we have had discussions with the Alzheimer's Disease Society, with our colleagues in Scotland and with the Royal College of Nursing to come up with a definition of free nursing care that provides some consistency, but which also must afford some flexibility.
  Each patient has different and individual needs. We need flexibility to ensure that the needs of the individual are taken fully into account, consistent with the national framework that we are trying to hammer out with voluntary organisations, patient organisations and clinical organisations.
  Mr. Burstow: I am grateful to the Secretary of State for giving way. Will he confirm that the definition in the Bill means that it is not an assessment of the need for nursing care but who provides it that will determine whether such care is free? If a dressing is changed by a care assistant, that must be paid for; if it is changed by a nurse, it is not.
  Mr. Milburn: No, that is not the position. A proper assessment will be made by the nurse. Who can make the assessment for free nursing, other than the nurse? My hon. Friend the Minister of State is not going to do it; I am not going to do it; officials and bureaucrats are not going to do it—nurses are going to do it. If I know nurses, they will make an assessment based on the health needs of the patient. That is precisely what we shall have. Where a nurse makes an assessment, it will be properly funded by the local health service. I gave that commitment before the Select Committee on Health and I give it before the House.
  I read with some amazement the Opposition's reasoned amendment and its reference to free nursing care as a "modest" change. That change that will benefit 35,000 people. It will save them on average £5,000 a year. It is a change so modest that it was resisted year after year by the Conservatives when they were in government.
  The truth about today's Conservative party is that it has neither the inclination nor the conviction to support such changes in the NHS. The Conservatives do not have a credible programme either for reform of health and social care services or for investment in health and social care services. Instead, they have a programme of cuts to damage public services.
  Mr. Burns: Rubbish.
  Mr. Milburn: The hon. Gentleman says that is rubbish. The Conservatives' programme would repeat the decades of damage to social services that they inflicted during the 1980s and the 1990s.
  Mr. Burns: Rubbish.
  Mr. Milburn: I have questioned the hon. Member for Woodspring on this matter before and he has refused to

  1095
  answer. I shall give him another opportunity to answer. In a moment or two, when he speaks, will he give a clear commitment to match our spending on social services? If he does not—if he cannot—his crocodile tears on bed blocking and care homes will be clear to the whole House.
  Health and social services—as the Bill makes clear—go hand in hand; we cannot have one without the other. Any failure to match our increases in social services spending will bring more bed blocking in hospital, less rehabilitation in the community and more old people once again paying the price for the Conservatives' failure to invest.
  The Bill is about investment in and reform of health and social services—after decades of under-investment and failed reforms in those services. Just as the first post-war Labour Government in the last century created the NHS, so the first Labour Government in this new century are now busy rebuilding it. Just as the Conservatives opposed the creation of the NHS then, so they oppose its modernisation now.
  Today, with this Bill, we make progress on free nursing care, progress on patient power, progress on primary care and progress on patient protection. We make progress on implementing the NHS plan—not just to save the NHS from its enemies, but to secure it for a whole new generation.
  The Labour party stands firmly on the side of the NHS. We are on the side of its principles and on the side of its staff. In our heads and in our hearts, we know that care based on need and not on the ability to pay is the right way forward for Britain. Today, with this Bill, we modernise the NHS so that it can improve the health of our nation—all of our nation—across the whole nation. I commend the Bill to the House.
  4.24 pm
  Dr. Liam Fox: I beg to move, To leave out from "That" to the end of the Question, and to add instead thereof:
  "this House declines to give a Second Reading to the Health and Social Care Bill because, although it contains some welcome provisions including the modest changes relating to nursing care, it increases still further the powers of the Secretary of State, reinforces the central bureaucracy and entrenches the micro-management by Whitehall of the National Health Service which so demoralizes NHS staff, is likely to worsen problems of recruitment and retention of medical and nursing staff and, by abolishing Community Health Councils, removes the only effective and independent voice which local communities have in health care."
  I begin by making a personal apology to the House. No Member would purposely mislead the House, but I did so inadvertently at Question Time yesterday and I want to correct the record. Yesterday, I said that the number of patients waiting for appointments—the waiting list for the waiting list—had gone up by 55,000 under the Labour Government. I should have corrected that, because the number has gone up by 188,000 under the Government—[HON. MEMBERS: "Ah!"] I do not want the record to underestimate the amount of misery caused to patients by the Government.
  That is the background to the current debate. The Secretary of State said that the Government came to office to stabilise the NHS. In fact, more people are waiting than were waiting previously and clinical priorities have been
  1096
  distorted through the waiting list initiative. Last week, a consultant from a major London hospital told me that he had been told to stop carrying out so many hip replacements and start completing more minor procedures that would bring down the waiting list more quickly. That is ethically unacceptable.
  There is greater public dissatisfaction with the lack of cleanliness in our wards. There has been an increased number of hospital-acquired infections and consequent unnecessary deaths. There are failures in public health policy—in tuberculosis—and there is an unacceptably and dangerously low level of immunisation against common illnesses such as measles. The Government say that they are proud of "The NHS Plan", but it took them six months to bring it to the House of Commons to have it debated. It is part smokescreen, and only part reform.
  Dr. Stoate rose—
  Dr. Fox: I shall give way to the hon. Gentleman, but must warn him that I shall do so only once, so he had better make use of it.
  Dr. Stoate: I am, grateful. The hon. Gentleman talked of clinical priorities. Does he believe that the fast-tracking of suspected cancer patients, who can now see a consultant within two weeks, is a distortion of clinical priorities?
  Dr. Fox: It is obviously right to treat the sickest patients first. Quite wrong, however, are the examples of which we have heard from up and down the country of patients whose cancer surgery has been postponed because more minor cases are being treated. That is an unacceptable ethical distortion, and it happens up and down the country regularly.
  The Bill is aspirational, if undeliverable in many ways, but it is, fundamentally, the wrong approach to the problems. Despite what the Secretary of State has said, the Bill is not a decentralising, but a centralising Bill. It is all about micromanagement of the NHS from Whitehall. It is impossible to run an organisation that employs almost 1 million people from behind a single Minister's desk. The more micromanagement that we attempt, the poorer morale becomes for those at the front line in the national health service.
  The Bill perpetuates the myth of a one-size-fits-all structure for health care. There is no single blueprint. Forcing primary care groups to become primary care trusts, and then forging them into being care trusts implies that some magical Whitehall blueprint can work in all parts of the country. It will not. We must allow systems to develop that are fit for the purpose required in their locality. We need to move from a managed health care system to a regulated one. We need an outcome-based system with investment directed accordingly.
  We need less power in the hands of the Secretary of State. We need depoliticisation with an independent appointments body established in legislation. We need more decisions to be made by doctors, not taken by hospital managers on the orders of Ministers. We need authority to match responsibility for the nurses on our wards, and a return to what we might call matron's values of discipline and cleanliness. We need an expansion of the private sector, with incentives to create more capacity.

  1097
  We need to maximise the use of the voluntary sector, and patient choice and competition between providers must be recognised as good, not something to be deprecated.
  In considering the effectiveness of the Bill, we must return to first principles. We need to examine the functions of the NHS and whether the Bill will improve them. The first function of the NHS is as a funding mechanism for the provision of health care free at the point of use. By any measure, the NHS must be regarded as, at the least, a highly qualified success in that area. Costs are controlled, it is relatively efficient and there is no wealth barrier to access. Funding is relatively even across the country; we could all name areas in which it is slightly higher or lower, but it is relatively even.
  The Government, to their credit, have shown commitment to funding the NHS. United Kingdom spending on health fell behind what was then the common market average in 1963, so that during almost my entire life—and certainly my life as a working doctor—our spending had been historically behind that of continental Europe. The simple truth is that we only get what we pay for, irrespective of whether funding comes via taxation or insurance. I do not believe that there is any benefit in shifting the funding basis of the NHS to insurance.
  The second function of the NHS is that of the delivery of health care, which is where the NHS falls down. Its delivery is poor. Our outcomes are unacceptable. The chance of surviving stomach cancer in the United Kingdom for five years is only about a quarter of the chance in Germany and the chance of surviving lung cancer for five years in the United Kingdom is half of the chance in Germany. Life expectancy in this country—the world's fourth biggest economy—is 19th in the world, similar to that in Turkey.
  There is widespread public dissatisfaction with the delivery of health care under the NHS. That is why, since the Government came to power, 450,000 uninsured people have paid directly for procedures to be carried out privately. I have no problem with that if they can afford it and it is their choice. Choice is a good thing; in addition, the burden on the NHS is off-loaded, which is welcome. However, people should not have to pay with their life savings for life-saving surgery. Until we tackle the deficits in NHS delivery, the problem will remain, but I do not believe that the measures described by the Secretary of State will necessarily improve matters.
  Mrs. Linda Gilroy: I am following with great interest the theme that the hon. Gentleman is beginning to set out, especially the part about insurance. Does he agree with the following remark made by the right hon. Member for Maidstone and The Weald (Miss Widdecombe)? She said:
  If someone wants to pay to see their GP, they should be encouraged to do so ‖ The problem with the NHS is that we do not charge for much of what we do.
  Dr. Fox: It is not our policy—nor, under my stewardship, will it ever be—to charge for access to general practice, for the very reasons that I have mentioned of access to care and barriers of wealth. I hope that that is perfectly clear.
  In the delivery of our health care system, we need to use private capital. We need to develop the private health care sector to supplement delivery, whether that provision
  1098
  is funded via the NHS or from another source, such as private personal insurance or company-based insurance. The Government have made some progress in that respect, and it is only reasonable that we should welcome that. Under the Government's concordat, primary care trusts are allowed to buy health care for patients directly from outside private sources and are, therefore, able to bypass NHS provision entirely. I welcome that freedom for doctors and patients.
  Mr. Milburn indicated dissent.
  Dr. Fox: The Secretary of State shakes his head—is he saying that that is not so? It is the case in the concordat. I know that he has spoken to Labour Back Benchers about NHS doctors buying NHS treatment in the private sector for NHS patients, but they can, in fact, buy treatment entirely outside the NHS. I think that that is a good thing and that the element of competition is to be welcomed.
  Mr. Bercow: My hon. Friend's attitude to private health care has always been thoroughly sensible. Does he recall the interview given to the Health Service Journal by the Chairman of the Select Committee on Health, the hon. Member for Wakefield (Mr. Hinchliffe), in which, by contrast, the hon. Gentleman had the temerity to abuse all professionals working in the independent health care sector, likening them to illegitimate children? Was that not a disgraceful insult, both to people working in the private health care sector and to illegitimate children? Does it not provide evidence of the profoundly ideological, dogma-ridden, backward-looking, socialist approach of the Labour party?
  Dr. Fox: Sometimes, I wish that my hon. Friend would speak his mind a little more clearly. He describes the experience of many Labour Members who have to endure a permanent "Groundhog Day" whereby they wake up in the morning natural socialists, but have to go to bed born-again Blairites. The Bill is full of parallels. However, I am sure that the hon. Member for Wakefield (Mr. Hinchliffe) will prove more than capable of paraphrasing his previous comments when he speaks in the debate, as no doubt he will.
  Mr. Hinchliffe: That intervention has appeared in almost every health debate of the past two years and it is getting rather boring. I think that the hon. Member for Buckingham (Mr. Bercow) is aware of the context in which I made certain remarks in respect of the private health care sector. I did so after a sitting of the Health Committee in which a man described how, in a private hospital, he had had to lay out his wife's body because of the lack of care in that hospital. I admit to having been extremely angry and to using possibly intemperate language, but if the hon. Gentleman had sat through what the Committee sat through, he would have shared our shock and concern.
  Dr. Fox: I do not wish to intrude on a private dispute between two colleagues. However, it is always wrong to extrapolate a general situation from individual cases. I am sure that the hon. Gentleman would wish to retract his comments if they were disparaging about all the dedicated professionals who work in the private sector.

  1099
  I welcome Government developments in two other areas. They have taken up the private finance initiative, which was developed under the previous Government, and advanced it. We have seen a great deal of capital investment as a result. Clause 4 in part I makes provision for the Government to use private investment to improve the premises for primary care. It would be hypocritical and wrong of the Opposition not to welcome Government proposals when we would like those provisions to be advanced.
  There is widespread agreement on other areas of the Bill. There are some measures about which we would like to see more detail and some with which we disagree. I shall begin with the good news for the Secretary of State about those parts of the Bill with which we agree. I draw particular attention to the widening of the franchise for prescribing. Again, the pilot for that was started by my right hon. Friend the Member for South-West Surrey (Mrs. Bottomley), when she was Secretary of State for Health. Certainly, with the restrictions on manpower and the length of training for those who work in health care, there is a need to use all health care personnel at the ceiling of their training and ability. I therefore welcome the extension of the right to prescribe to the nursing profession and pharmacists. Indeed, some of the Government's ideas which we would like to explore in Committee very much echo our own ideas on prescription-first medicines and allowing pharmacists to re-prescribe, once the initial prescription has been given by a doctor.
  Most hon. Members will understand my own experience as an asthmatic, unable to get an inhaler on a Saturday morning when I was running my constituency surgery. I phoned my doctor and got the receptionist, who was probably a sad loss to the SS—[Interruption.] She happens to be a good friend of mine. I was not allowed to see my GP that morning, and was told that I could not get an inhaler for my asthma. When I asked why not, I was told that I had to go and see the doctor. When I said that I was a doctor, the receptionist said that that did not matter. I said that I had run out of inhalers and could become dangerously asthmatic over the weekend. However, I was told that I still could not have an inhaler. I said that I can write prescriptions for other people, but I was told that I still could not have an inhaler. I said that I was a member of the Royal College of General Practitioners, but I was told that I still could not have an inhaler.
  That is nonsense. Simply taking out common prescriptions, such as those for asthma, would stop about 30 million repeat prescriptions going across doctors' desks. That is a sensible policy and if the Government intend to take that forward, expand it and create a new category of medicine in prescription-first medicines—or whatever they want to call it—they will have the Opposition's support. That common-sense measure is long overdue because we have greatly over-regulated prescribing in this country. We could give a good deal more discretion to other professionals.
  The Government see potential in personal medical services. I believe that the days of the Red Book in medicine are numbered. There is a limit to how long we can continue with general medical services. We need to move to a quality agenda, and PMS allows us to do that.
  1100
  However, we need to avoid excessive centralisation and control. We need a duty to consult on changes to PMS in the Bill, in the same way as we have a duty to consult on GMS. I hope that the Secretary of State will give us that assurance. Perhaps the Minister of State, the hon. Member for Southampton, Itchen (Mr. Denham), will provide it when he winds up.
  Likewise, we welcome the proposal on supplementary lists for locums, part-timers and other employees. The hon. Member for Dartford has already mentioned locums, and the proposal is essential to protecting patients. We could all give examples of horror stories—either anecdotally or from our own experience—of what is happening in locum services throughout the country and what has happened in individual cases in the past. I therefore welcome the proposal.
  I also welcome the concept of the need to reward excellence. The Bill includes a proposal to increase funding for those who excel in health care, which makes a great deal of sense. However, how does that fit with the Government's education plans, in which they say that giving money to the se who are failing, rather than those who are succeeding, is the best way forward? We look forward to the Minister describing the thinking behind that proposal in Committee.
  I welcome the Government's decision to make all nursing care free, and we shall match that. Workability has been mentioned, and there are problems with defining exactly what matters will fall within which category. There is also a danger of creating perverse incentives. Nurses on the ground carrying out the kind of decision making that the Secretary of State described could be forced to claim that some services that might otherwise objectively be deemed social care were nursing care, to qualify for payment. Great care will have to be taken in Committee to ensure that that does not happen.
  Mr. Dawson: It is good to hear the hon. Gentleman welcoming so much of the Government's work to put right the mess that pus party left behind. Given that he is accepting so much of what is on offer today, will he move on from the medical model and give the House an assurance for which he was asked earlier? In the highly unlikely—in fact, amazingly unlikely—event of his ever being in a position to do anything about it, will he give an assurance that a future Conservative Government would fund the social services element of these matters to the same extent as this Government?
  Dr. Fox: I should like to give the hon. Gentleman a lesson in verbal efficiency. I can confirm that our funding proposals relate not only to the NHS budget, but to the Department of Health's budget, which we see increasing from £45.285 mill ion in 2000–01 to the full £59.011 million in 2003–04 including the personal social services funding via the Department of Health and the funding for the Food Standards Agency.
  The Secretary of State talked about the balance between local and central Government. I would caution him that he should go back and look at the Red Book figures on funding. They show that the balance between local and central Government in the funding for personal social services changes quite markedly in that period. The Department's funding rises from £713 million to £2,247 million in a period in which the standard spending

  1101
  assessment funding only goes up from £8,693 million to £9,962 million. In the interests of clarity, that means that the balance of power between local and central Government falls dramatically towards centralised Government. This is a centralising measure; it is in the Red Book, and those in Labour local authorities might be alarmed at the consequences.
  The Parliamentary Under-Secretary of State for Health (Yvette Cooper): Has the hon Gentleman cleared his remarks about matching the Department of Health funding with the shadow Chief Secretary to the Treasury, who said on "Newsnight" that his party was committed only to matching the funding for hospitals?
  Dr. Fox: Of course I have cleared them. I have given as clear a statement of policy as I can possibly give. When we give the Labour party a clear statement of our policy, we are immediately told that that is not what we really mean, and that we must mean something else. The hon. Lady should have used up her credit on interventions in a more constructive way.
  Mr. Edward Leigh: Will my hon. Friend give way?
  Dr. Fox: Of course.
  Madam Deputy Speaker (Mrs. Sylvia Heal): Mr. Christopher Chope.
  Mr. Leigh: No, I am Edward Leigh, Madam Deputy Speaker. I am sorry—I have only been here for 18 years.
  Despite what my hon. Friend says, will he make it absolutely clear that many people believe that we cannot take the debate forward simply by both sides trying to up the ante in terms of matching funds? Many Conservative Members believe that, if we are to deliver a quality health service, we have to increase private sector involvement while keeping the principle of health care being free at the point of demand. We should, for example, increase private sector involvement in capital projects, and we must make that clear.
  Dr. Fox: I do not see the matter as a choice between the two systems. There is a case For improving the functioning and the funding of the NHS as well as encouraging the private sector and ensuring that the services are available to a wider range of citizens in our society. By operating the two systems together, as most European countries do, we might achieve the health outcomes, survival rates and cure rates enjoyed in those countries. It has perhaps been our failure not least in the Conservative party, to make the case for the growth of both the private sector and the NHS, and that has meant that we have not been able to make the progress with outcomes in this country that we might otherwise have made over recent years.
  We require more detail on parts of the Bill. The first relates to the abolition of the Medical Practices Committee. I hope that the Secretary of State will accept that the MPC works quite well at present. It controls the number of doctors in each area to a reasonable degree. This is a hugely centralising proposal once again. Moving away from capitation as the sole basis for remuneration is
  1102
  inevitable—that is the way that medicine is going. We should open the way for quality to be more matched by income. However, if we are to abolish the MPC, we should have an independent review mechanism, not just the view of an omnipotent Secretary of State. I do not mean that as a compliment in case the right hon. Gentleman interprets it as such.
  In this place we have a boundary review commission to ensure an even match between representatives and the electorate. It would be reasonable to expect, within a certain time frame, a review of how the abolition of the MPC is working in terms of how many patients there are to each doctor across the country. That would be a sensible safeguard to include in the Bill.
  I have reservations about confidentiality. We need to protect patient privacy, give clear guidelines to doctors about disclosure and keep the flow of information going for such things as the cancer registry. The provisions are too loosely drawn and leave too much discretion for the Secretary of State. The British Medical Association is worried about the potential conflict between the ethical position of doctors and the law if doctors are forced to disclose information that they believe would be disadvantageous to their patients. We need to tighten up those provisions in Committee.
  The approach to the declaration of gifts for doctors is too bureaucratic. Obviously, we need to control excessive gifts to the medical profession, and we require transparency. We will put down amendments in Committee that will liken the treatment of doctors with that of Ministers. I fail to see why Ministers who make the policy for doctors should be allowed to keep gifts to a higher value than they allow for the doctors. It will be interesting to hear the Minister talk about that in Committee.
  On the proposed traffic light scheme, rewarding excellence is fine, but the success or failure of this policy will depend on what is currently ill defined—the so-called initial amount of the settlement. It will depend on whether the criteria set are reasonable and whether the targets are fair and attainable. Again, this is a hugely centralising measure—it requires transparency in a way that we cannot currently envisage and the concept of earned autonomy. In other words, doctors will be given some freedom to do what they want only if it is earned under the conditions set down by the Secretary of State. "Earned autonomy" is indeed an Orwellian phrase.
  We also have practical worries, as do many medical groups, about the practicalities of recruitment and retention for hospitals which are graded as "red light". How will they go about attracting staff? Will that not make it more difficult for them to recruit and retain staff?
  We also require a properly independent body for national health service appointments. The Bill goes in the opposite direction—it gives the Secretary of State more power over recruitment; it allows him to fire those who work in the NHS and replace them with those he chooses. We need an independent body—one that is specifically independent of the Secretary of State—if we are to stop political gerrymandering.
  The area of the Bill on which we disagree most profoundly with the Government is the abolition of community health councils. Three things are perfectly clear: there was no consultation on the abolition of CHCs, there was no consultation on the decision since the

  1103
  abolition, and none of the dialogue on patient empowerment has dealt with the abolition of CHCs. The decision was made in advance and no consultation took place.
  I reiterate what my hon. Friend the Member for Buckingham (Mr. Bercow) said. The Prime Minister's agent said that the right hon. Gentleman agrees with the motion praising CHCs, congratulates them on the work that they have done and wishes them every success in the future. To be wished every success in the future by this Prime Minister means looking for one's P45. I would be quaking if I were the Secretary of State, come the reshuffle. It is absolute nonsense and profoundly dishonest to claim that there has been any consultation on the abolition of the CHCs.
  There is a strong case for reform. We had a very good debate in Westminster Hall in which there was strong agreement on both sides of the House on the need for better standardisation and resourcing. However, we are being asked to accept that, effectively, any body that is under the auspices of the trust and that feels strong enough will be able to criticise it, or that any body in local government will be independent enough to do so. That will be made all the more difficult as Labour has been appointing local government people to health board trusts.
  In other words, the Government are asking us to accept that Labour party cronies in local government will be capable of criticising Labour party cronies who have been appointed to the health boards. That is nonsense. As Dame Rennie Fritchie pointed out in her damning indictment of the Government's handling of the position, between 1997 and 1999, 284 Labour councillors were appointed to NHS trust positions, compared with 23 Conservatives and 36 Liberal Democrats. These are the bodies that the Government tell us will be independent of party and able to act independently on behalf of patients. They must think that the public were born yesterday.
  We will fight to retain the CHCs. If the Government do not give ground on this, I warn the Secretary of State that we will fight to defeat them in another place, even if it means the loss of the Bill in its entirety.
  Mr. Bercow: My hon. Friend will recall that the Prime Minister was all over the shop at Prime Minister's Question Time when he replied to a question from my hon. Friend the Member for Eddisbury (Mr. O'Brien) on that very subject. Does my hon. Friend recall that the Prime Minister—wriggling out of the situation as best he could—subsequently wrote on 20 November to my hon. Friend, saying that the community health councils were to be abolished subject to legislation? He went on to say that that better described the consultation to which he alluded at Question Time. Is that the nearest we get to an admission of error and an apology from the Prime Minister?
  Dr. Fox: That is the closest that we get with this Prime Minister to any definition that remotely resembles the truth as the rest of the country would understand it. I am sure that my hon. Friend the Member for Eddisbury (Mr. O'Brien) will contribute to the debate and perhaps he will expand on that matter. It does not surprise me, however, because I believe that the Prime Minister would
  1104
  say anything to get through Prime Minister's questions irrespective of the trouble stored up for later. To cope with the questions from the Leader of the Opposition on beds in the community, he started to count beds in people's homes simply to make more. In effect, he conjured up 30 million extra NHS beds overnight. I no longer believe anything that he may say.
  The Government have shown that they are committed to the increased funding for the NHS. I made it clear that we would match that funding, both for the NHS and, in the wider Department of Health budget, for personal social services. I hope that that has been absolutely clear.
  In presenting the Bill, the Government have shown no grasp of the wider picture: how to maximise capacity, decentralising properly the model of health care, deal effectively with an ageing population, prepare for using new medical technologies to their best advantage, and maximise the use of the private and voluntary sectors. They talk about decentralising, but the Bill would bring far more power to the centre. It places too much trust in bureaucrats and too little in health professionals. It gives too much emphasis to management from the centre and too little to patient choice. They may be well intentioned, but they have failed to grasp the real problems of the health service. This is, par excellence, a missed opportunity.
  4.58 pm
  Mr. David Hinchliffe: This is a wide-ranging Bill containing a huge number of different elements that would implement significant and important parts of the national health service plan. It contains many positive measures, but also some that need to be given further thought, as hon. Members on both sides of the House have argued in interventions. I particularly welcome the continued efforts to encourage joint working between the NHS and social services, building on the important provisions in the Health Act 1999, which I also strongly welcomed.
  To reiterate what I said in an intervention on my right hon. Friend the Secretary of State, I have long had a personal preference, as he made clear, for placing the health authority function in local government—where it was, to some extent, until the Conservative party removed it way back in 1974. In a number of ways, reverting to that arrangement would deal with certain key matters of concern that arise in the Bill.
  For example, we could tackle the false division between health and social care. That fundamental problem has faced both major parties for many years. In my view, it would also unite the public health function. I am speaking in advance of any conclusions that the Select Committee on Health may reach with regard to public health, but I have long believed that it is more sensible to locate the public health function in local government than in health authorities, where it is separated from the central drivers of public health, such as the housing function.
  Returning to the arrangement that obtained before 1974 would also democratise health and make possible democratic scrutiny at local level. I know that my right hon. Friend the Secretary of State firmly rejects that idea, and we differ over the point, but I will continue to argue for what I consider to be a sensible course of action. I hope that I may yet succeed in convincing my right hon. Friend. However, even if the Government are not going

  1105
  to move in the direction that I prefer, the proposal for care trusts is a welcome step forward. The policy will address some of the problems at local level, and I will support it strongly.
  I am worried about a number of elements in parts I and IV of the Bill, and I hope that the Government will consider them further. Of particular concern are the proposals in clauses 7 to 14, regarding scrutiny and complaints. It is not often that I agree with the hon. Member for Woodspring (Dr. Fox), but I feel that there has not been adequate public consultation and discussion in respect of some of those proposals. Although the NHS plan contains some important and positive proposals, I get the distinct impression that the proposals regarding CHCs and scrutiny were something of an afterthought.
  I am also concerned because the Bill introduces proposals regarding the wider issue of complaints before the project team in the Department of Health has completed its evaluation of complaints procedures. Clearly, the measures in the Bill—which will probably go into Standing Committee next week—have a bearing on the complaints procedures. The Government have put the cart before the horse, and it would be more sensible to await the departmental team's report before examining complaints procedures.
  My right hon. Friend the Secretary of State knows that less than two years ago, the Health Committee considered in detail the handling of adverse incidents in the health service. We met hundreds of patients for whom things had gone wrong, and we were impressed by the extent of the suffering that health service incompetence had caused them. For example, some people had lost family members—although that was rare. The difficulties that people faced were made far worse when they tried to obtain some explanation or redress by making a complaint.
  Members of the Health Committee met people who had been treated by Richard Neale, Christopher Ingolby and Rodney Ledward. They had been at the sharp end of some pretty difficult treatments, and I want to pass on some of the key messages that those people communicated to us about what scrutiny and complaints procedures should do, and how the Bill should go about changing those procedures.
  Any complaints procedure must be independent, and must be seen to be so. The current system is not independent, as Ministers know. The procedure must be simple to understand, so that people have access to it and will know where they must go when they have a difficulty with a particular service. It also needs to be transparent and comprehensive. It must cover primary, secondary and tertiary care, and care in the community—all the areas in which treatment may have been given.
  I appreciate that further thought has probably been given to some of the proposals in the Bill, but I am worried that the proposed system will not be independent, as it should be. The patient advocacy and liaison services will be trust-based and non-statutory. They will clearly be regarded as part of the health trusts, whether or not they are in fact.
  In addition, as the Bill stands, the independent advocacy proposals will be commissioned by the health authority. I accept the remarks that were made earlier, but all hon. Members will have experience of complaints
  1106
  directed at us that also relate, directly or indirectly, to the policies and practices of the complainant's health authority. I have received complaints against a trust for difficulties that have been blamed directly on the health authority. It is wrong to suggest that the Bill's proposals for independent advocacy should be commissioned by a health authority that may be the subject of a complaint.
  I accept that the Government are giving the matter further attention, and considering the possibility of advocacy relating to scrutiny of local government. That is a welcome step. I met the Minister of State earlier this week, and we had a very happy discussion. I appreciate the fact that he has listened to some of my concerns.
  Dr. Brand: Does the hon. Gentleman agree that many complaints are appropriately dealt with internally, either within primary care or within the hospital trust sector? Patient advocacy and liaison services can be very helpful in the reaching of an agreed conclusion, but sometimes patients and carers will not be satisfied with an internal arrangement. In those instances we require a separate system, not run by a trust tribunal—or, indeed, serviced by PALs.
  Mr. Hinchliffe: I entirely agree. The hon. Gentleman sat through the same evidence as I did, and the message was loud and clear. The patients whom we saw wanted complete independence and fairness, and I do not think that the proposed system offers the independence and fairness that I would like to think the Government want.
  I feel that what is being proposed is somewhat clumsy and confusing. If I were a patient with no knowledge of the structure of the health service, rather than a Member of Parliament involved in health policy, I would like to know who did what in the complaints process. The Bill specifies a range of agencies and other bodies that I, as a patient, might or might not need to consult: the trust, the district health authority, PALS, the independent local advisory forums, the patients forum, the scrutiny committee, the National Clinical Assessment Authority, the ombudsman, and various professional regulatory organisations. People are baffled by the complexity of what is on offer now, and I think that we are making the system even more complex. I hope that it will be simplified in Committee, so that it makes sense to patients.
  I also feel that what is proposed would fragment the scrutiny and complaints function. The patients forums and PALS will relate to just one element in the service—a trust. As I have said, many complaints that I—and, I am sure, other Members—have dealt with relate to more than one element. They may relate to primary care, secondary or tertiary care, and community care. It must be possible to look at the whole process, rather than focusing on only one aspect. I hope that that too will be considered in Committee.
  I hold no particular brief for community health councils. I became a member of a CHC in 1974, and served as its vice-chair. I worked for many years on that CHC, which I considered to be a good one. I know, however, that the effectiveness of CHCs varies. 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

  1107
  authorities. They have not stood up to be counted on occasions when patients' views should have been expressed loudly and clearly at local level.
  Nevertheless, I am not convinced that the new system will be better. Indeed, it may be worse. I am sorry to say that, because I welcome much of what the Government have done on health, and warmly commend Ministers for introducing so many positive measures, especially with regard to the relationship between health and social care. I feel, however, that further consideration is needed.
  Shortly before Christmas I wrote to the Secretary of State suggesting a possible compromise. My suggestion, which may or may not have been helpful, was that we beef up the membership and powers of CHCs. I suggested that their powers should be extended to cover complaints in the context of primary care, and that—as the Health Committee proposed—they should have an advocacy function. If the Secretary of State wants a link with local authorities, he could easily increase the proportion of local authority appointees on local CHCs. That proportion is currently one third; the Secretary of State could make it a majority. Many Labour Members—they will not speak today, and they are not among the "usual suspects"—are deeply worried about what is being proposed. I hope that I have made my point constructively, and that the Government will consider the issue in Committee.
  I genuinely welcome the Government's attempts in part IV to rectify the long-term care shambles that the Conservatives left them. I was amused yesterday to see the Leader of the Opposition launch his "Where has all the money gone?" campaign. It made me think about the amount of money that was sunk into private institutional care between 1981 and 1993, when community care changes came into effect. Some £10 billion was thrown at gross over-provision of private institutional care, when people were crying out for investment to support them in their homes. Tory MPs bleat about empty private care homes, but that is utter hypocrisy. They are empty because we provided too many beds, and the Government—thank goodness—are ensuring that people do not end up in institutional care.
  We are supporting people in the community. That is a positive step, and the Government can be satisfied with that achievement. I think that we should look to Denmark, where housing-with-care schemes have replaced institutional care. The Government are right to emphasise in the Bill the need to restore and support older people's independence. I strongly welcome the new investment in community care.
  I also welcome the proposal for free nursing care, but I regret the failure fully to implement the royal commission's proposal. We have not completely addressed that issue, and a difficult situation will develop. The royal commission's definition of personal care offered a sensible answer to the social nursing care issue that has dogged successive Governments for many years. The Government can develop assessment processes and local protocols until the cows come home, but I do not think that it will ever be possible to draw a clear boundary between personal care and nursing care. The previous Secretary of State admitted that, and I would I have to agree.
  1108
  Today I received a letter about personal care and nursing care from a nursing home in West Yorkshire. Mr. Andrew Makin wrote about the
  specious and probably resource-led division between these two ideas … it is an entirely artificial and unnecessary construct … there is no such thing as a distinction between nursing and personal care in a care setting.
  All care is directed at the well being of the client in an holistic sense, which by all modern accepted definitions is a nurse's role. Nursing looks at all the facets of a person's care and does not draw theoretical divisions between different aspects of it.
  I entirely agree with him. He has summed up the problem. If the Bill is not amended, I believe that there will be huge disputes about where the line is drawn locally. I have looked in the Bill for procedures to resolve disputes, but I cannot see them, and problems will arise.
  To conclude, I want to reinforce the fact that the Bill contains many positive proposals. I hope that other matters will be addressed in Committee. The Government have shown their willingness to listen to concerns, and I hope that they will continue to listen and amend the Bill in Committee, so that it makes more sense on Report.
  5.13 pm
  Mr. Nick Harvey: The Bill gives effect to many provisions in the NHS plan, which was published in July last year. We welcomed the plan because it made a valuable contribution to the renaissance of the NHS, and we appreciated the investment that the Government pledged. However, we had reservations about specific aspects of it. Similarly, although we welcome some of the Bill's provisions, we have reservations.
  At the outset, however, let me restate for the record the Liberal Democrats' absolute commitment to the founding principles of the NHS. We believe that it should be comprehensive, free at the point of delivery and paid for by general taxation. We do not think that it should be supported by induced contributions from people who have to pay for themselves, either directly or through insurance contributions.
  We have significant reservations about three aspects of the Bill. First, it provides for free nursing care, but does not take up the royal commission's recommendation for free personal care. Secondly, although we welcome the fact that it creates care trusts that bring together social care and primary and community health care, we have some misgivings about how that will be achieved. Thirdly, we are concerned about the abolition of the community health councils—and, more specifically, about the manner in which their functions will be distributed.
  However, we agree with many of the provisions in the Bill and believe that they will make a valuable contribution to the continuing progress and development of the NHS. We welcome the commitment to ensuring that more funding gets through. I disagree with the comments of the hon. Member for Woodspring (Dr. Fox) about the so-called traffic light system—one of the mechanisms by which additional funds are provided. The Government's approach does not seem entirely unreasonable, although I have some reservations about specific aspects. Their proposal is far more sensible than any equivalent idea that has been considered in the past.
  Rewarding areas that have done especially well with extra funds will increase existing inequalities. Conversely, rewarding areas that have done badly gives an incentive

  1109
  for everybody to try to achieve a red light. As I understand it, the strength of the proposed system is that the funds will go through come what may, but more strings will be attached to what must be done with them in "red light" areas.
  My specific misgiving is that the Government seem to want to predetermine the proportion of trusts, primary trusts and authorities that fall into each category. That approach does not seem ideal. Surely it would be better to work on the basis of merit. The obvious ideal is that everybody should have green light status, so I am not sure that preconceived notions about the proportion for each status will create the incentives that we seek. Nevertheless, the idea is worth working on.
  The Liberal Democrats also welcome the provisions for greater use of nationally agreed terms and conditions for NHS staff. One of the especially adverse aspects of the internal market was local trusts' arrangement of their own contracts. I hope that the Bill will ensure the rolling back and ending of those arrangements. I make a particular plea for practice nurses, who are not—in a manner of speaking—currently part of the NHS. but are employed directly by general practitioners. It would be useful if they, too, could be incorporated into a national framework.
  We welcome the opportunity that the Bill provides for modernising GP contracts, on which I agreed with the general tone of the hon. Member for Woodspring. I hope that compulsion will not be necessary, but an overhaul is undoubtedly needed. I hope that the Bill provides a framework for ensuring that that happens in a constructive way.
  The Opposition's reasoned amendment refers to the new powers of the Secretary of State to intervene. I confess that I was mildly astonished to discover that he did not already have such powers. If he does not, and is to be given new powers to make interventions from the centre, they must be exercised with great care. I hope that the trigger point for the powers will be the discovery, through one of the various checks introduced by the Bill, that a hospital, trust or primary trust has been failing and requires such intervention. I am slightly worried that the Secretary of State seems able to make such interventions almost on a whim. Perhaps that matter can be probed in further detail later during the Bill's passage.
  As for health service resources in areas with too few GPs, I understand that the Medical Practices Committee may be seen to have had its day, but I thought that the Secretary of State was rather too harsh about it. Although it has not by any means delivered a perfectly even distribution throughout the country, I am sure that things are a great deal better than they would have been without it. If the new arrangements are to be based on a market in which health authorities bid in accordance with the resources available to them, there is a serious risk of mayhem. I hope that we will hear about the mechanisms for performing the functions now exercised by the Medical Practices Committee. We welcome the extensions of prescribing rights, and pharmaceutical pilots. The requirement for GPs to declare gifts, on a similar basis to that which applies to other doctors, is right even if it will discomfit some pharmaceutical companies.
  As the Bill progresses, we shall need to define in rather more detail proposals for scrutiny and assessment of doctors. We have welcomed much of what the Government
  1110
  have done to date to address the issue of patient safety, especially in the wake of the tragic circumstances surrounding the Shipman case. In addition to further modernisation of the General Medical Council and the creation of the Commission for Health Improvement, the Government have proposed the creation of the National Clinical Assessment Authority. The Bill proposes that the role, authority and responsibility of health authorities should be extended, particularly with regard to the list system. Clearly, interaction between the various bodies will be crucial if they are not to duplicate each other's work—and, which is perhaps more important, if practitioners are not to fall between the remits of those bodies. We shall certainly want to probe the matter further as the Bill progresses.
  The hon. Member for Wakefield (Mr. Hinchliffe) spoke persuasively and convincingly about personal care. The Bill leaves many unanswered questions, and many opportunities have been lost to improve welfare and rights, particularly those of older, disabled and mentally infirm people. Above all, it means that hundreds of thousands of older people will have to pay for the essential help that they need in their daily lives to dress, take meals and bathe.
  The Government's proposals to distinguish personal and nursing care are likely to be almost impossible to administer in practice. No one chooses to leave home, abandon independent living and seek long-term care in a residential setting. That choice is imposed on people by necessity, and it is unfair and iniquitous for the state to penalise people for it.
  Mr. Dawson: I follow the hon. Gentleman's remarks, but I am slightly disturbed about where they seem to be leading. Is he seriously saying that entering residential care cannot be a positive choice for an older person?
  Mr. Harvey: Of course it can, but it should—and, I hope, usually would—be the last choice. There should be a commitment to fulfil the adage of Florence Nightingale, who said originally that everybody's hospital should be their home. I would have thought that there is a commitment across the political spectrum to provide help in a person's home where at all possible.
  That was why I was mystified by the Secretary of State's saying that our policy of implementing in full the recommendations of the royal commission somehow ran contrary to, and was in conflict with, the Government's proposals to expand intermediate care. I remind the House that the royal commission recommended that all personal care should be provided free, whether in a domiciliary context or a residential home. I would have thought that provision of both services was essential, and that the overriding objective in all cases should be to preserve independent living.
  The hon. Member for Wakefield has already alluded to some of the anomalies that will arise. He rightly pointed out some of the difficulties that will occur in practice. It seems impossible that we will reach a definition of nursing care when we are told by the Secretary of State that neither he nor the Minister of State, the hon. Member for Barrow and Furness (Mr. Hutton), will hand one down, but that it will be determined by nurses on the ground. That will be impossible to administer. There does not seem to have been any rational debate about what

  1111
  constitutes nursing care. I am also very sceptical that such care will be provided within the Government's estimate of £420 million over three years. That seems most improbable; I think that the bottom-line cost of providing free nursing care will be considerably more than that.
  Dr. Brand: Is there not a risk that nurses will have a closed budget for this service, and will be asked to become gatekeepers and rationers of services?
  Mr. Harvey: I am sure that that will happen, and we will have the same spectre as we have now, but on a wider scale. Social services directors warn us that as the financial year goes on and budgets get thinner, their funds run out and it is not possible to give the care that should be given. That leads to a fairly crude system of rationing. That is why the measure will prove difficult in practice.
  The proposal leaves some aspects of health care to be paid for, when in other settings it is free.
  Mr. Philip Hammond: Given that the hon. Gentleman is inside the big tent, can he help me to clear up some confusion? The Secretary of State spoke earlier of nursing care in nursing homes being provided by NHS nurses with NHS equipment. Is it the hon. Gentleman's understanding that NHS nurses will be put into private nursing homes, or will the NHS fund the nurses that are already there? That is an important distinction. The Secretary of State said "providing" rather than "financing".
  Mr. Harvey: It has not been my understanding that the nurses in question will have to be NHS nurses, but I confess that it is a long time since I have been in any sort of tent, so I could not really say. No doubt the Minister will make the point clear at the end of the debate if he sees fit to do so.
  We are concerned that some aspects of health care will be paid for in one context, but not in another—whether that be physiotherapy, incontinence pads, which the NHS does not currently supply to nursing homes, or the practice of GPs charging for call-outs to residential and nursing homes and those costs being passed on to residents. The Government's desire to maintain this wholly artificial, wrong and illogical division between the two categories of patient is inconsistent with the provision in the Bill to bring together primary and community health care and social care. As they are bringing those organisations together in one, they have the opportunity to get rid of the artificial divisions and distinctions once and for all. If we entrench this completely artificial division in legislation, the opportunity will be missed.
  We are concerned that older people and others will no longer be able to establish under what legislation services are being provided, and thus whether their care should be free, as an NHS service, or charged as a social service. The Bill provides the opportunity to clarify that once and for all. It is entirely reasonable that people are expected to make their own financial provision for their accommodation, the roof over their head, the food they eat, heating and so on, but it is wrong that people who are suffering from chronic long-term conditions will have to pay for their personal care, whereas others with acute
  1112
  conditions will enjoy a different degree of financial support and will have the services they receive paid for under the Bill. It would surely be right for the same treatment, often given in the same establishment and by the same staff, always to be provided free. This is a missed opportunity to iron out some of those anomalies at a time when the organisations are changing.
  The care trusts are welcome. The Liberal Democrats have long campaigned for and supported the bringing together of health and social care. The formation of primary care trusts provides a context in which to do that which is different from any that we have considered in the past. If they are to be brought together into the care trusts, we have some reservations, especially about accountability. The role that local government could play should be considered further, and smoked out.
  I agree with the hon. Member for Wakefield that it would be more logical for public health to be vested in the hands of local authorities rather than health authorities, because so much of the public health agenda is influenced by issues outside the health service, such as housing, transport, job opportunities and a variety of other social issues. To some extent, the Government acknowledge that by having local authorities play the part that they do in health improvement programmes. In the Bill they propose to take that role further by giving local authorities a significant role in scrutiny of primary care trusts—and also, presumably, the wider care trusts, when they come in—and NHS trusts. It would be logical to take that a little further by using local authorities as a mechanism to hold all those bodies more democratically to account.
  In future, all trust boards will be more independent, in the sense that their composition will be handled by the new commission, and I welcome that. The Secretary of State is right to have relinquished that power. I listened with some amazement to the hon. Member for Woodspring talk about the number of Labour councillors who have apparently been appointed to the trust boards. Perish the thought that the previous Conservative Government would have stuffed the boards full of their appointees. Those people were independent business men, not Conservative councillors; they had taken the precaution of losing their seats first, so they were ex-Conservative councillors.
  It is no good knocking the matter around on a party political basis. Nothing happening now is any different from what went on under the previous Government. That is why the Secretary of State is right to have put things on an independent basis, and it is right that he should have relinquished that power in order to do so. [Interruption.] I am sorry that the Tories do not like what I am saying, but they should look in the mirror and see what happened under their Government.
  Mrs. Virginia Bottomley rose—
  Mr. Harvey: I give way to the right hon. Lady, who I think was one of the leading culprits.
  Mrs. Bottomley: I hope that the hon. Gentleman will withdraw that comment when he considers the evidence. I was responsible for the appointments of Baroness Hayman, Baroness Dean and Dame Rennie Fritchie, quite apart from Julia Neuberger and Baroness Thomas. Dame Rennie Fritchie was a leading health service regional

  1113
  chairman under the previous Government. If the situation then was as the hon. Gentleman describes, it is surprising that she should have written quite such a critical report. Will the hon. Gentleman investigate for himself the truth of his statements?
  Mr. Harvey: I shall be more than happy to do what the right hon. Lady suggests and look at the evidence. If by any chance I find that what I have said is incorrect I shall certainly withdraw it, but I sincerely doubt whether that will be the case. We all have recollections of such matters. I well remember, in my constituency, how each time one particular Conservative councillor lost his seat on a further tier of local government, he was rewarded with another place on some quango or other—including the local health care trust.
  The final issue to which I shall refer is the abolition of the CHCs. I recognise the successful role that CHCs have played in many communities in the past 25 years, but it is important not to have too starry-eyed an idea about how successful they were across the board They were good in some areas and not so good in others Everyone to whom I have spoken in the CHC movement in the past few months has recognised that there was a need for major reform of the whole function.
  We must be wary of throwing the baby out with the bath water, but the Government have tabled some proposals and we must address those and consider what merits they have and how they might be improved. The Government's proposals have improved somewhat since the original blueprint put forward last summer.
  To consider the individual components for a moment, the patient forums were originally to have been supported and staffed by employees of the trusts that they were supposed to be monitoring. We now learn that they will be set up on a completely independent footing, and that must be a significant improvement. However, the Secretary of State was wrong to dismiss quite so firmly the point made by my hon. Friend the Member for Isle of Wight (Dr. Brand).
  If the forum is to consist of representatives of patient groups with particular concerns about particular conditions, and a cross-section of patients who have used the service in the preceding year, it will not really represent the wider community and those who have not recently been health service users. The CHCs have made that point in recent representations. It is right that those who have recently used the service should be represented, but there should be a slightly wider focus and remit.
  Most CHC chief officers to whom I have spoken have been candid about the fact that the handling of complaints has been one of the weakest areas of CHCs' performance. They have not felt that they have had adequate funds for the task, and it has often been the poor relation when they have had to prioritise.
  Having heard the Secretary of State's speech, I am still not entirely clear about what the new system is to be. The patient advocates are within the hospitals and the trusts; as my hon. Friend the Member for Isle of Wight said, they sort out the problems that are appropriate for sorting out within the organisation. However, I understand that if a patient still has a fundamental complaint, there will then be an independent complaints procedure.
  I understand that the Secretary of State is awaiting the report that he commissioned, and perhaps he will say more about that presently. He suggested in his speech that
  1114
  it might be possible for local authorities to provide the service, area by area. The criticism of the Government's plans to replace the CHCs that has rung truest with me is that the component parts that they want to introduce, although each has a certain logic, do not really hang together.
  If the scrutiny role is to go to local government, why not also give it the responsibility for commissioning the independent complaints procedure, area by area, and for funding, staffing and supporting the patients forum? Then at least the three essential component parts would be together. Local government could fulfil the scrutiny role on the basis of the information gathered from the patients forum. That could begin to solve some of the problems of fragmentation that form the strongest case against the Government's proposals.
  We are talking about local government ceding its traditional role in managing social services to what is essentially a health service body—the care trust. Giving local government a good deal of responsibility for defining what provision there ought to be in a community, and for monitoring what goes on, would therefore be a significant way of remedying what might otherwise be deficiencies in democracy and accountability in those trusts.
  We welcome many of the proposals, but we have some major reservations.
  Mr. John Burnett: My hon. Friend talks about local government having a greater say in such matters, and refers to public health issues. He will be aware that a survey by the Department of the Environment, Transport and the Regions and West Devon borough council of the incidence of radon in properties on Dartmoor with private water supplies was published yesterday. Does he agree that that should precipitate immediate research on the problem?
  Mr. Harvey: I am aware of that, because the issue affects my constituency, too. If local government had responsibility for public health, and had the wherewithal to undertake the necessary research, it would be able to make a valuable impact on public health issues at community level. That is another example of why it would be better to give it a greater role.
  In conclusion, the Bill contains many measures with which we agree, and others about which we have major reservations. We do not feel able to support its Second Reading today, but doubtless it will proceed to Standing Committee, where Liberal Democrats will do what we can to amend the Bill along the lines that I have suggested.
  5.40 pm
  Mr. John Austin: First, I apologise to the hon. Member for Woodspring (Dr. Fox) for missing the opening couple of sentences of his speech as I was in the Lobby voting.
  Like my hon. Friend the Member for Wakefield (Mr. Hinchliffe), I greatly welcome many of the measures in the Bill, which addresses some of the inequities in health service provision, emphasises primary care and addresses the crucial issue of the joint working of social services and health authorities.
  In relation to the primary care trusts, I recognise that the changes in the allocation of cash-limited and non-cash-limited funds to health authorities and PCTs

  1115
  could in time help to tackle the unequal distribution of GPs across the country. The Government are right to redress the situation in under-doctored areas and improve GP services in some of the most needy and deprived areas. However, if they are to succeed, guarantees are needed to ensure that additional funding is spent on primary care services and not diverted into secondary care. I hope that, in his reply to the debate, my hon. Friend the Minister can give such guarantees.
  While I fully understand and support the Government's intentions to drive up standards in the NHS, I have some reservations about how the green, amber and red traffic light system will work. I have similar reservations about the way in which Ofsted has labelled some schools as failing and the impact that that has had on morale and the recruitment and retention of staff. To label an organisation as failing can have adverse effects. I am much more in favour of using carrots rather than sticks. Although I can see how the green and amber traffic lights would work, I have some reservations about the red ones.
  In his speech to the Royal College of Nursing in May last year, my right hon. Friend the Secretary of State described his vision of the NHS as:
  A health service of all the talents.
  He described a service which liberates nurses, not limits them, and said that an NHS that was patient-centred must be nurse-centred too. He outlined Labour's plans to put nurses at the centre of the modernisation of the NHS, stating:
  nursing values are health service values. Caring. Compassionate. Professional. Dedicated. The needs of the patient at the core of all we do.
  I share that view, as I am sure my hon. Friends do, but we must also value other professions working in the health service and ensure that their role and contribution is not overlooked or taken for granted. That means recognising their value and reflecting it in their pay and conditions and their role in policy making.
  A health service of all the talents will require the involvement of all relevant staff, not just in service delivery but in planning and policy formulation and in management. It means involving all the relevant professions on working groups, taskforces and committees.
  I deal now with the staff terms and conditions elements in the Bill. I welcome the new powers to be given to the Secretary of State to make regulations about the terms and conditions of staff. Most staff in the NHS are employed according to nationally agreed terms and conditions, most professional staff coming within the terms of the pay review body. The Secretary of State and the Minister will know of my concerns about staff who are outside the pay review body, such as medical laboratory scientific officers whose pay has fallen way behind that of nurses and other professions allied to medicine that are within the purview of the pay review body. They will recall my early-day motion 68, which was supported by right hon. and hon. Members on both sides of the House.
  I wish to be one of the first to join my hon. Friend the Member for Bolton, South-East (Dr. Iddon) in welcoming the Secretary of State's recognition of a long-standing problem that was ignored for so long by the previous Administration and yesterday's announcement of substantial pay increases to some of the lowest-paid
  1116
  professionals who provide an essential diagnostic and preventive service as well as playing a key role in treatment.
  I want to mention briefly some of the positive changes in the NHS that have occurred under the Secretary of State and his predecessor, my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson), especially with regard to the nursing profession. My right hon. Friend the Secretary of State has recognised that, in the past, a nurse had narrow career options, and that in order to advance the only paths were to enter nurse education and the realms of management.
  There is no problem with those choices: we need able nurses in management and we should welcome the increasing number of nurses who make it as chief executives in the NHS. Equally, nurse education needs some of the best nurses to ensure that the next generation of nurses is adequately skilled. It has, however, been frustrating for good clinical practitioners who want to remain with their patients. Since the Halsbury report of 1974, the profession has sought genuine opportunities for a clinical career grade—a desire wholly ignored by previous Governments, but which the Labour Government have taken on board, providing nurses and the nursing profession with a real chance to break new ground in building solid options for a clinical career.
  One group of nurses mentioned earlier—practice nurses employed by individual GPs—are not technically part of the NHS, although they clearly work in and for the health service. Their terms and conditions should be brought within the remit of the NHS.
  Dr. Brand: Does the hon. Gentleman agree that those practice nurses should not lose out by being brought into the framework of the NHS? In my experience, practice nurses have much better and more flexible employment opportunities than some of the nurses employed directly by the NHS.
  Mr. Austin: That is so and it is all to the good. However, in many cases practice nurses are at a disadvantage compared with their colleagues.
  The issue of practice nurses is a key part of the Bill. Yesterday, my hon Friend the Member for Wythenshawe and Sale, East (Mr. Goggins) described an excellent example of the role that practice nurses are playing in his area. There are examples of initiatives of nurse-led practices under the Government's innovative personal medical services pilots where a nurse is actually responsible for managing the practice and employing a salaried GP—leading to a better service for patients and freeing up time for the GP to see those patients who need to consult a doctor. Why cannot those nurses legally be principals in their own right?
  I welcome what the Government have done in the Bill to extend nurse prescribing. I was among the first to criticise Opposition Members, but I pay tribute to Baroness Cumberlege who pioneered the concept of nurse prescribing. None the less, it was the Labour Government and my right hon. Friend the Secretary of State who developed and extended that concept.
  I welcome the PMS initiative. I am pleased that all the schemes submitted by Bexley in the recent wave have been approved. However, I have written to the Secretary of State about some anxieties that were expressed as to

  1117
  whether sufficient growth funds to support the additional salaried GPs and nurse practitioner posts will be available. I await his reply with interest.
  The Minister of State, my hon. Friend the Member for Southampton, Itchen (Mr. Denham) will be aware that I first joined the CHC in the area where I lived in 1974 as a local government nominee, having been elected to the local council in three successive elections. At the time, I worked in a neighbouring borough for a local voluntary organisation and registered charity. Some years later, when my term of office on the CHC in the area where I lived expired, I was appointed to the CHC in the area where I worked, having been chosen in an election process involving all the local voluntary organisations with an interest in health—including Mencap, MIND, the Multiple Sclerosis Society and the Association of Disabled People—as well as general interest groups, such as residents and tenants associations and ethnic minority organisations.
  In speaking of CHCs, the Under-Secretary, my hon. Friend the Member for Birmingham, Edgbaston (Ms Stuart), has referred to a democratic deficit in the NHS. In reality, until now CHCs have been the most democratic and accountable part of the NHS; they are not directly elected—although some of their members are appointed from local authorities—but are an innovative experiment in representative democracy. That experiment has worked and it has worked in the interest of patients.
  Some people have pointed out that not all CHCs worked well. I could say the same thing about hon. Members. I venture to suggest that my appointment, first as a democratically elected local councillor nominated by the local council, and subsequently as the choice of a consortium of voluntary and community organisations serving the community, made me a more democratic choice and more accountable to the community that I served than any of the health authority and trust board members appointed under the patronage of the Secretary of State.
  We need no lessons in democracy and accountability from Opposition Members. With my colleague, my hon. Friend the Member for Eltham (Mr. Efford), I also served for a period on my local health authority. He chaired the social services committee, and I was one of his predecessors. The right hon. and learned Member for Rushcliffe (Mr. Clarke) removed all local authority and elected representation from health authority boards, and the right hon. Member for South-West Surrey (Mrs. Bottomley) was the Minister of State at that time. My hon. Friend and I were replaced on the health authority by a computer salesman and a double glazing salesman, after which the health authority got into some dodgy financial deals, some of which I suspect to have been not exactly lawful. That left the authority with a substantial financial loss.
  I also served for two years as chair of the Association of Community Health Councils for England and Wales. It will not surprise anyone, therefore, that I have grave reservations about the proposals to abolish CHCs, notwithstanding the assurances that I received from the Minister of State, my hon. Friend the Member for Southampton, Itchen, this morning. I believe that the Secretary of State went further in his statement this afternoon.
  Mr. Hammond: The hon. Gentleman has referred to two clearly identifiable individuals, and may have put the
  1118
  suggestion into some minds that those people were guilty of some impropriety. Would he confirm, for the record, that that was not his intention?
  Mr. Austin: I did not intend that implication as far as those two individuals were concerned, but I stand by my assertion that the financial scams in which the health authority became involved were unlawful. They certainly led to financial losses.
  I am aware that the proposal to abolish CHCs followed consultation on the national plan. I welcome both the consultation and the plan, but it was general consultation—there has been no specific consultation on the proposal to abolish CHCs or on their replacement. CHCs had some weaknesses, and some of the Bill's proposals address that. The Welsh Assembly has decided to consult widely on patient advocacy and support, including the future remit of CHCs. It is likely that local health councils will continue in Scotland. The Welsh Assembly may, of course, reach conclusions different from those arrived at in England—that is what devolution is all about. However, England should be entitled to the same consultation as Wales, and I urge the Secretary of State to adopt a similar procedure in England.
  Time does not permit me to go into detail on the roles of patient advocacy and liaison services and patients forums, but I welcome additional resources for advocacy and dealing with complaints.
  The CHCs were not resourced for or charged with the responsibilities of dealing with complaints, but that is what they have done, effectively, in most cases. CHCs have proved themselves capable of organising, servicing and supporting patient forums. As they have been so successful, I would apply the adage, "If it ain't broke, don't fix it."
  There are faults in CHCs, and remedies are needed, but where they have failed—or, perhaps, not been as successful as they might have been—it has generally been because they have lacked resources or statutory powers. They are tried and tested and, above all, they are trusted by patients as champions of the users of the NHS. Will my hon. Friend the Minister consider keeping CHCs, placing PALS within them, and giving them the responsibility for servicing, supporting and co-ordinating the work of patients forums?
  I served for 24 years as a local councillor, so I welcome the scrutiny role being given to local government. Local authorities have a duty to care for the general well-being of their areas. Although Greenwich borough council was neither a health nor an education authority, when I was leader it set up health and education advisory committees. We thought it right that the local authority and its elected representatives should scrutinise providers. I welcome the new scrutiny role, but do not see it as a substitute for the scrutiny of the CHCs.
  Under the Bill, the power to veto, or refer to the Secretary of State or an independent body, closures or major changes in services will transfer from CHCs to the scrutiny committee of the local authority. The Minister may say that that addresses the democratic deficit. Increasingly, however, patterns of service and service delivery are determined jointly by health authorities and local authorities. A local authority is much less likely to comment adversely on service provision that it has been responsible for planning or delivering. The joint working

  1119
  of NHS and local authorities and the creation of care trusts, which I welcome, strengthen—not weaken—the case for monitoring by an independent body such as the CHC.
  I echo the points made by my hon. Friend the Member for Lancaster and Wyre (Mr. Dawson) about areas that have two tiers of local authorities. District councils have a vital role to play—
  Madam Deputy Speaker: Order. Time is up.
  5.55 pm
  Mrs. Virginia Bottomley: I appreciate the opportunity to speak on Second Reading. Aspects of the Bill are undoubtedly constructive and positive and will help to build better health care and greater confidence. Other aspects are more doubtful and will need careful scrutiny in Committee. Further elements are, frankly, wrong-headed, and I hope that the Government—although they are not given to listening—will think again.
  I shall comment on the Government's style of stewardship of the national health service and the gap between their perceptions from the political bunker, advised by political appointments made by the Department of Health and No. 10 Downing street, and the reality experienced by people who use or work in the health service. One of the advantages of being a Back Bencher, and one associated with health care in many manifestations over many years, is that one has the time to listen and to learn what really concerns people.
  I shall start with the positive points, and I am grateful to the hon. Member for Erith and Thamesmead (Mr. Austin) for paying credit to Baroness Cumberlege. If ever there were a champion of the cause of nursing and nurse prescribing, it is my noble Friend. I am pleased to see such an extension of nurse prescribing in the Bill.
  Like my hon. Friend the Member for Woodspring (Dr. Fox), I am pleased by the Bill's more constructive attitude towards the relationship with the independent sector. At last, that provides recognition that pragmatism rather than political dogma is taking a higher priority. The Government have spoken in a paltry manner about and to the independent sector. They have had an obsession with the ownership of the means of production in health care, which is quite unlike their attitude in other parts of the public sector. Even now, they harbour some reactionary prejudices in that regard.
  The fact is that the independent sector delivers much excellent care. I have not used it, I hasten to say, but if we are to meet people's rising expectations of health and social care, we shall have to use the independent sector. There must be more scope to allow people to put their hands into their own pockets to purchase services and treatments that the NHS is not, despite its justice and integrity, able to provide. For the Government to say anything else is unhelpful and irresponsible.
  Let me turn now to matters that I hope will receive further scrutiny in Committee. There are real questions about confidentiality of patient information. I am concerned about comments made by the British Medical Association. In the running of cancer registers, issues arise about patient information being made available and the degree to which that might be extended to other areas.
  1120
  The confidentiality of patient information in the NHS is a fundamental principle. With that in mind, I mean to draw to the House's attention a matter that I regard as being extremely serious. In my constituency, there is a patient who is a chronic schizophrenic. I have had contact with him for 12 years, and he suffers great distress and, frankly, poor service. He is being treated with anti-psychotic drugs, but he believes that his condition is influenced by satellites. Whatever the House's view on that, I felt that, as his Member of Parliament and after repeated and urgent entreaties, it was right that I drew the matter to the attention of the Prime Minister.
  I leave it to the House to imagine my horror when, on 28 December, I was contacted by Mr. Guy Adams of The Daily Telegraph who told me that he had received a tip-off from No. 10 that I was wasting time, raising questions about UFOs. I regard that as the most shocking breach of patient and constituent confidentiality. It is all the more extraordinary that, having raised with the Prime Minister questions about the growing inequity in health services in this country since his stewardship began, and having written to the right hon. Gentleman after a Prime Minister's Question Time last summer, I should receive, five months later an inadequate reply from a parliamentary secretary.
  The correspondence I received from No. 10 consists of a photocopied letter from a correspondence secretary. That paints an extraordinary picture of the priorities of the Prime Minister and his office and their view of the courtesy due to Members of Parliament, and it insults one of my constituents who suffers a long-term and chronic condition. I should not have dreamed of raising his case in the House—even now I hope that it will not come to his attention—had not someone in No. 10 brought it to the attention of The Daily Telegraph. I have spoken to the parliamentary commissioner and written to Sir Richard Wilson, but I thought that as the Minister takes an interest in mental health policy, he might like to investigate the matter further himself.
  The Standing Committee will have to give further consideration to other aspects the Bill, such as the clauses relating to the royal commission on long-term care. I have no Front-Bench responsibilities and can offer my views as one who has been a Minister and considered the issue. Bedlam is already breaking out about the different proposals for England and Scotland for the funding of long-term care. In my view, Christine Hancock is right to say that the proposals are unworkable. The greatest injustice we could do to elderly people would be to imply or pretend that their long-term care was to be funded; that would be to mislead them when, in fact, the service available to them was to be inaccessible or entirely lacking.
  The Government should try to disregard the political timetable that always occupies first place in their thoughts—which is not surprising, given that from the word go the Prime Minister has made it clear that his only thought as Prime Minister is re-election, not public service. On this issue, the right step for the Government may be not to please the interest groups, but to take the braver decision that it is not affordable to please the interest groups. It might be more responsible fully to achieve the priorities that they have set than to open up a new wish list of policies, initiatives and constructs.

  1121
  I say that because the gap between the Government's rhetoric and the reality on the ground appears to be growing all the time. People working in the health service in my area say that they feel beleaguered, oppressed, undermined and tyrannised. I live in a red-light district— an area in which the care available to my constituents has been deteriorating. I have raised the issue repeatedly with Ministers.
  Although in the localities of the Secretary of State for Health and the Prime Minister only one person in 66 waits more than a year for treatment, my hon. Friend the Member for Runnymede and Weybridge (Mr. Hammond) will confirm that in West Surrey one person in eight waits more than a year for in-patient treatment. That is not an adequate service in this day and age. Ministers dismiss the issue and talk about long-standing financial difficulties. I acknowledge that such difficulties exist, but I have constituents living on social security in West Surrey who have to wait more than a year for treatment at eight times the rate of the constituents of the Prime Minister and the Secretary of State. If Ministers care about the lottery of funding and the health care lottery, they cannot continue to be so indifferent to the problems in West Surrey.
  Ministers have taken steps to make themselves even less accessible to Members of Parliament and those who represent localities. The new body, the national reconfiguration panel, is presumably another attempt by Ministers to wash their hands of the problems with which they do not want to become involved. I have described how impossible it is to gain the attention of the Prime Minister: even though he does not hesitate to launch the NHS plan, he has no interest in hearing, about reality from Members of Parliament—even those who have been in the House as long as he has.
  In their centralising, authoritarian manner, the Government are removing regional chairmen. In my judgment, regional chairmen have performed a valuable role. They are not part of the management line on which the Government repeatedly turn the screw, and they do not belong to the tribes of nurses, doctors and professions allied to medicine. They have a degree of independence and Ministers are well advised to listen to them, but their post is to be abolished.
  That abolition takes place alongside another about which the House is almost unanimously concerned—that of community health councils. For the past year, my local health authority has survived in crisis. Despite a deteriorating service, ministerial pressure has forced the health authority to say that it will close most of the community hospitals. It is community health councils which, with distinction, responsibility and rigour, have argued the case and developed a rational consensus on a more sensible way forward.
  Will Hutton, not known as a great Conservative thinker, has said:
  the National Plan paid lip service to the idea that accountability had to be improved and decision-making delegated. Health Secretary Alan Milburn has proved the great centraliser.
  That issue causes me great concern. Devolution to NHS trusts—much misportrayed by the Labour party, which we in our business have to accept—allowed genuine delegation to those people who were most involved and closest to patients. Now, trust chief executives and regional directors up through the line have less room for manoeuvre and less freedom to speak. That greatly
  1122
  worries those who work in the service. I say that because, having been forced to develop the extremely unappetising proposals I have described, the chief executive of my local health authority, who is an honourable and sincere person, is now leaving the health service, and the chief executive of the community trust most involved has left the service on sabbatical. If the Government's bullying of people in the service results in the loss of talented individuals, it will be a great shame for the NHS.
  Another aspect of the culture over which the Secretary of State presides, and of which there has been no mention, is Nigel Crisp, the new chief executive. Conservatives believe that politicians do not own the NHS but act as stewards. The Government should show more respect and concern for those working in the service. I am worried about reports from the medical profession that the Government are fuelling doctor hostility and suspicion. Doctors live under great pressure and face very high expectations from patients and the public. The degree to which they are subjected to unfair pressure and intimidation from the current team of Health Ministers should cause us all alarm and concern. I am sure that Government Members are aware that the reports are widespread.
  There are growing expectations of health care, and the Bill includes sensible measures. However, I hope that in Committee the Government will think again and temper their rhetoric with the reality and delivery of care as it affects all our constituents from day to day.
  6.10 pm
  Mr. Patrick Hall: I welcome the wide-ranging reforms promised in the Bill as they advance the prospect outlined in the NHS plan of a health service in which the patient is to be the most important person and in which NHS institutions are open and accountable, better to serve the patient and the wider community.
  That is a truly radical approach, requiring nothing less than the transformation of the service. Until now, for more than 50 years, the NHS has done a good, worthy and cost-effective job for the people of Britain. However, those people have had to fit in with the NHS, rather than the other way round. That has been the dominant culture, and still is. That unacceptable state of affairs has gone on for too long and needs to change. In my view, it represents a poor appreciation of the concept of public service. I am delighted that the Government understand that and are prepared to take on ambitious reform.
  Given my role as chair of the all-party parliamentary group on community health councils, I should like to concentrate on part I of the Bill, which deals with the abolition of CHCs and the establishment of structures for patient empowerment and greater public accountability. Reference has already been made, in this debate and earlier, to the manner in which the planned abolition of CHCs was announced last summer. That could and should have been handled much better.
  There is one overriding reason for that: if the new proposals that replace CHCs are to work, it is essential to harness the skills, experience, knowledge and good will of as many as possible of the 700 staff and 5,000 volunteers who work for CHCs in England. I know that the Government are engaged in the process of talking to those people, and they now recognise that point. Making the system work is the overwhelming will of the majority of people in this country.

  1123
  As I said in the Adjournment debate on the future of CHCs on 28 November, a key question is whether the proposals for the new system of patient empowerment and community involvement provide the necessary mechanism to make things work and, more important, whether they do so better than CHCs. That question was behind early-day motion 1103, which was tabled in my name last October and was re-tabled as early-day motion 109 in the current Session. The hope was, having laid down the gauntlet last July, that the Government would work with others to fill the many gaps in their outline proposals. I welcome Ministers' willingness to engage in that process. They and their officials have worked hard with many people from CHCs, patients groups, voluntary organisations, research institutions and others to address those matters, and continue to do so. As a result, a fuller, clearer and more reassuring picture is in the making, but it is still far from complete.
  That is the difficulty that we face. Today, we are debating the general principles of a Bill that deals with only part of the new structures. It includes, for the first time, a statutory duty on health authorities and trusts to consult on changes in service delivery, which is extremely good. It abolishes CHCs and sets up patients forums for every NHS and primary care trust. It places scrutiny of local NHS plans and the ability to refer contested proposals to the Secretary of State in the hands of local council scrutiny committees.
  The only truly new body in the Government's proposals to appear in the Bill is the patients forum. Other bodies are not mentioned directly. I do not see how we can debate those matters effectively and answer the question that I have just posed unless we discuss patient advocacy and liaison services, independent local advisory forums and how the existing Commission for Health Improvement is to play a part.
  In addition to the five bodies that I have just mentioned, Ministers have talked about health authorities commissioning citizens advice bureaux or other bodies— we have heard today that they could include local authorities, which is an interesting and welcome move— to perform the key role of offering independent advocacy services to handle patients' complaints. That is a welcome recognition of the fact that PALS are not suited to that task. However, that means that there will be another organisation, making a total of six, only two of which are included in the Bill and only one of which—the patients forum—is genuinely new. Several matters relating to the membership and powers of patients forums will be dealt with by regulation, so we might not get the detail until the Bill has completed its parliamentary stages.
  In considering those aspects of the Bill, there is a strong need for a clear vision of the bigger picture. I do not mean that every detail should be included in the Bill and, of course, there should be flexibility. However, there is surely a need to demonstrate some detail, such as national standards for training, resourcing and sharing good practice. If that is not done, we could end up with a system that displays the patchiness of performance that has been cited, rightly, as a key weakness of CHCs.
  I therefore urge the Under-Secretary to respond to our debate by addressing the need for sufficient detail, to enable us to scrutinise the whole picture, not just what is
  1124
  in the Bill. We must tease out the details of issues involving PALS, independent local advisory forums and the Commission for Health Improvement, and how everything fits together. We must consider how those are to be resourced, supported and integrated, both locally and nationally, to provide a coherent, workable and joined-up system. To do that, it would be helpful if draft regulations and guidance were made available when the Bill is considered in Committee. Will my hon. Friend the Minister give me an assurance that that will be done?
  It is proposed that one patients forum will be set up for every trust, charged with a duty to monitor, review and inspect the provision of health services from the patient's perspective. It is a relief to have heard today that the forums will be funded by health authorities, not the trust to which they are attached. That gives them every chance to be independent, which they need to be. There is a radical proposal in the requirement for the forums to elect a representative to serve as a non-executive director on the trust's board. However, would there be a conflict of interest? To whom would the extra new non-executive director be accountable? Would it be the patients forum or the trust's board? After all, a trust's board is a corporate body that expects collective responsibilities and confidentialities to be respected. Would that compromise the independence of the forum?
  Mrs. Caroline Spelman: I know that there is a time constraint, but does the hon. Gentleman accept that there might be a conflict of interest if the patient has a complaint against the health authority that is funding the forum?
  Mr. Hall: That needs to be worked out. The money has to come from somewhere, and it has to come from the public sector. After all, CHCs are funded through regional health authorities, and it is sometimes possible to trace policy back to the regions. Such issues should be examined thoroughly in Committee so that we can see the full picture. That is a perfectly fair point, although it is preferable to remove the patients forum from the direct management and financial responsibility of the trust to which it is attached. I hope that the hon. Lady agrees with that. I am not saying that a healthy tension between a non-executive director from the patients forum and the board on which he or she sat would not work. However, the status of that non-executive director needs to be clarified.
  The proposal for local council overview and scrutiny committees is one of the best in the Bill. It is a welcome initiative that will confer a new and important role on local government. However, that role will only be as good as the information and advice that councillors receive. Councillors will need to be well informed to engage constructively in debate about the local health scene, and to decide whether to refer proposed service changes with which they do not agree to the Secretary of State. They will need easy access to independent, reliable sources of information as well as to the official views of the health authorities and trusts, which brings us back to the point about the integration of new structures.
  What will happen in parts of the country such as Bedfordshire with two tiers of local government? What will happen to a trust covering a wide geographical area? For example, the Bedfordshire and Hertfordshire

  1125
  ambulance trust covers two county councils, one unitary district and 13 ordinary district councils. How is that trust to be held to account?
  There is a great deal at stake in these matters. The transformation and modernisation of the NHS is an ambitious and desirable goal. I wish it well, and I would like to assist in that process. However, there remains much more to be done before the system that replaces community health councils can be seen to be credible and capable of bringing about the improvements for the patient and the community for which most of us are looking.

  DEFERRED DIVISION
  Mr. Deputy Speaker (Mr. Michael Lord): Order. I now have to announce the result of a Division deferred from a previous day.
  On the motion "Electoral Commission", the Ayes were 486, the Noes 4, so the motion was agreed to.
  [The Division Lists are published at the end of today's debates.]

  Health and Social Care Bill
  Question again proposed, That the amendment be made.
  6.22 pm
  Sir George Young: The hon. Member for Bedford (Mr. Hall) made a good point when he said that we need to look at the whole picture and that we should not be too constrained by the elements that appear in the Bill. I hope that the Government will put some of the missing pieces of the jigsaw puzzle on the table in Committee so that we can begin to assemble the bigger picture.
  Before I turn to the two sections of the Bill that I want to talk about, may I ask the Minister to say a little more about the prospects of this important Bill reaching the statute book? The Government have made some controversial changes to our procedure with the objective of injecting some certainty into the legislative programme. I therefore think that this is a reasonable request to make.
  We know the immediate plans for the Bill, because they are in the motion that we shall debate later. However, the Bill is already in a queue behind other Bills that have already had Second Readings. It is behind another Bill that has little relevance to most of our constituents. The House, those who run the health service and those who will benefit from the changes in clause 48 would like to know whether the Bill—which is quite long and controversial—now has a realistic prospect of completing all its stages by, say, the end of March.
  I mention in passing the proposals on CHCs. I attended the meeting chaired by the hon. Member for Bedford. I also listened to the excellent speech by my hon. Friend the Member for Eddisbury (Mr. O'Brien) in Westminster Hall in November. I have been in touch with the Basingstoke and North Hampshire CHC and the Winchester and Central Hampslure CHC—both quality organisations. I do not oppose reform of the CHCs; nor does my own CHC. It is quite sanguine about the prospects for change, although somewhat bruised by the
  1126
  process that is bringing it about. However, it is by no means clear that the Government's formula is the right one, the best one or the most cost-effective one, so I hope that there will be some flexibility on this question.
  My CHC wanted a resource or organisation that brought together the four or five strands into which the CHCs are to be split. It was worried about the loss of cohesion and co-ordination, and about the shortage of volunteers in the new structure. It was also doubtful about getting the new structure up and running by April 2001.
  I want to discuss clause I and clauses 45 to 47. Clause I looks innocuous but represents an important victory for the Treasury, which has long wanted to cash-limit the whole NHS budget and remove the safety valve that exists for services that are demand-led and therefore not cash-limited. The explanatory notes, perhaps wisely, do not explain the policy quite so bluntly as I have just done. They use more emollient words, such as
  to extend the concept of fair shares.
  However, it is important to understand what is going on. At present, hospital and community services are cash-limited and, as a result, there are waiting lists. The services provided by GPs are not cash-limited and, by and large, there are no waiting lists for primary care.
  Clause 1 does not directly cash-limit those demand-led services, but it enables the Secretary of State to reduce funds for the cash-limited services in the same area if he thinks that too much is being spent on primary care. That is clearly aimed at exerting downward pressure on primary care in those areas in which he thinks there is overspending, even though that might represent very good value for money and reduce demand on other parts of the NHS.
  There are a number of difficulties with that proposal. GPs are the gatekeepers to the NHS and the Government are in the process, quite rightly, of driving up the standards provided by GPs, in terms of minimum waiting times and so on. Bringing this key part of the NHS within the warm embrace of the Treasury's cash limits is a bold strategy for the Government to adopt when they have ambitions—which I share—for driving up the standards of care. Crucially, it means that someone will have to work out in which part of the country GPs are overspending, and that will mean a formula.
  I must warn the House about the impact of formulae, because they can lead to problems. In north and mid-Hampshire, the formula for the cash-limited services requires us to be 20 per cent. healthier than average. In other words, for every £100 spent on the NHS nationally, £80 is spent locally. As a result, while the Secretary of State was launching the NHS plan—with all its promises of extra funds, real benefits for NHS patients, less waiting and faster and more convenient care—my health authority was consulting on a different document called "Meeting the Challenges".
  "Meeting the Challenges" takes £13.5 million out of what it calls the local health economy. Andover hospital is pencilled in for savings of £200,000, when it needs substantial extra investment. Locally, we are not promised a better health service. The task is described as making
  the health services in North and Mid-Hampshire both modern and affordable.
  My health authority is not unique.

  1127
  It is certainly not the case that we are doing well at the moment. I visited the Labour party website and tapped in my postcode to see what was happening to the health service in my constituency—a facility that it offers. This is what I found.
  There are 4,386 people on out-patient waiting lists locally, compared with 1,212 people in March 1998 (the first year that figures were collected).
  Ministers and other hon. Members may say that resources should be fairly allocated, and that areas with higher mortality and morbidity should receive more money. I have no difficulty with that, but the current formula is nonsense. The Secretary of State appointed an independent scrutiny panel to review "Meeting the Challenges", which said:
  The National Funding Formula for Health Authorities is at the heart of the problem. This is a challenge for central Government.
  It is a challenge to which they are not responding, as the formula is not going to be changed in the near future.
  The independent panel also made the following comments about Ministers, and I shall read them out to complement what my right hon. Friend the Member for South-West Surrey (Mrs. Bottomley) has said. This might help the Government to understand why the public are reluctant to believe what Ministers tell them. I repeat that this panel was chosen by the Secretary of State. It stated:
  We find a contradiction between the aspirations of central Government and the reality for the local health economy.
  It went on:
  We regret seeing cuts, albeit with limited improvements in efficiencies when, nationally, the country seems awash with health spending.
  Finally, and damningly, the panel said:
  The panel deplores the scale of political interference in seeking a solution to the Authority's financial problems.
  That is why my constituents take any message from Ministers with a little pinch of salt. The Minister's document—the NHS plan—is not the relevant one. In my constituency the relevant document is "Meeting the Challenges".
  Ministers might say that increased funding was announced in November, which it was. After the Secretary of State wrote to all right hon. and hon. Members on 14 November telling us about next year's funding allocations, I asked my health authority whether that meant that extra services could be planned or some of the cuts abandoned. The answer was no. It had anticipated the allocation, and it made no difference.
  I return to clause 1. The formula that, in the words of the Secretary of State's independent panel, is at the heart of the problem is to be extended. The one area that everyone agrees is working well is primary care. It is certainly working well in my constituency. We have good health centres, high-quality general practitioners and support staff, low staff turnover and a high level of satisfaction. The squeeze on the hospital sector in my constituency might be extended to the primary care sector if, under clause 1, we apply the formula to primary care. It might also mean that downward pressure on primary care spending is exerted elsewhere in the country. With the experience of north-west Hampshire in mind, I urge the House to treat clause 1 with the utmost care.
  1128
  The second set of clauses that I want to touch on are, I believe, the most radical in the Bill. Clauses 45 to 47 deal with the establishment of care trusts, implementing chapter 7 of the NHS plan. I understand and support the case for joined-up government generally, in particular at the interface between the NHS and social services. The patient is not interested in bureaucratic boundaries—he or she wants a seamless service. We began to break down these barriers with joint funding and the present Government are continuing the process.
  The Government should answer a few questions raised by this initiative. Have they put the clauses in a broader context and asked what they mean for local government? Some 85 per cent. of the education budget goes straight to schools. I have no difficulty with that. The next largest service is social services, for which these proposals have dramatic implications. They cover not just services for the elderly—the care trusts could take over responsibility for those with learning difficulties, for mental health and for the physically disabled. If no further changes are made to education and this reform for social services is introduced, a large question mark will hang over local government, particularly the county councils. Has there been some joined-up thinking on this aspect with the Department of the Environment, Transport and the Regions?
  Related to that question is one about the democratic deficit. Social services are delivered locally, are partly funded locally and are accountable locally. Transferring social services to a care trust, which is a creature of central Government, is a step towards centralisation rather than decentralisation. With specific grants, the social services inspectorate and the right to intervene and take over social services departments, Ministers are taking over from councillors responsibility for social services. This is a further step down a centralising road, and it makes the democratic deficit worse.
  Issues of accountability have been raised by other right hon. and hon. Members. The way in which the care trust works involves the social services department handing over its budget to the care trust. How are councillors to be accountable for the spending and, indeed, the discharge of their statutory responsibilities if control rests with the trust on which they have but a small voice?
  I am sure that the Minister will say that the proposals are welcomed by some directors of social services, and I will tell him why. The directors have looked over the fence and seen that the grass is greener. They have compared the increase in resources for the NHS with the much more modest increases in revenue support grant for the counties.
  Local government is under pressure to deliver the Government's first priority—education. Social services are having a tough time. Some 75 per cent. of social service departments, according to the Association of Directors of Social Services, are struggling to cope. Directors see the possibility of solving the problems that confront them with inadequate resources by transferring the problems to the NHS, which has a bigger budget. If the difficulties with community care are primarily those of resources, is it right to tackle them by making a structural change quite soon after the changes in 1993?
  I think that funding is at the heart of the problem. Beds were blocked in my constituency not because we did not have a care trust but because the Government had not allocated enough money to social services. The

  1129
  Government recognised not just that it was a problem but that they were responsible for resolving it. In December, Hampshire county council received £2.1 million to enable it to purchase and provide additional care for people returning home or moving to residential or nursing home care.
  Sir Jeremy Beecham says about local authorities:
  Yet the reality for many councils is still one of having to make very difficult choices between cuts in services and double figure council tax rises.
  Of course local authorities are attracted by the prospect of nudging the problem next door to the NHS.
  I have two final points about care trusts. The NHS and social services have different cultures—one is free at the point of use, the other is not. More important, the NHS copes by having waiting lists. That is the cushion, the safety valve, the way that it survives. However, social services are not allowed waiting lists—the Gloucester, Sefton and Macgregor judgments put paid to that. An individual is entitled to an assessment; if the assessment shows that he or she is entitled to services, they must be provided. A care trust seeking to provide a joint service would have to merge and manage the two different cultures within a fixed budget.
  Secondly, under a care trust, a cottage hospital that provides post-operative care or convalescent treatment could be redesignated as a nursing home, exposing patients to charges. That cannot happen at the moment—people know where they stand. However, this issue worries organisations such as Age Concern.
  There is much else in the Bill that I would like to talk about, and much that I welcome, but time does not permit. I hope that I may have an opportunity to develop some of my other concerns in Committee.
  6.36 pm
  Ms Linda Perham: I welcome the Bill, which implements a number of the proposals in the NHS plan, on which I spoke at the end of June and again in the Queen's Speech debate in December. I support the Government's continuing commitment to reforming and modernising our cherished NHS. However, along with many other right hon. and hon. Members of all parties, I have concerns about the Government's proposals to change the system of patient representation in the NHS, including the proposed abolition of community health councils.
  I was a member of Redbridge CHC during the 1980s. My hon. Friend the Member for Romford (Mrs. Gordon) represented the neighbouring CHC of Barking, Havering and Brentwood, as it then was. Together, we took on the might of the obstetricians and gynaecologists at the local hospitals in fighting for improvements in health treatment for women and children in our areas. I believe that my CHC performed an effective scrutiny role for NHS services, challenging the health authority, flagging up important issues and dealing with patients' complaints.
  CHCs undoubtedly need reinvigoration: they need their powers enhancing and extending to cover primary health care, in respect of which there is a considerable deficit. I regret that the Government, in their commendable efforts to improve patient representation in relation to complaints and the scrutiny of services, have decided to abolish rather than reform CHCs. I have had strong representations about the issue, not only from Redbridge CHC but from a number of local and national organisations and from individuals.
  1130
  The patients forums are the only new bodies in the Bill, and there are anxieties that the patient advocacy and liaison services, while being immediately accessible to patients, may lack the independence from the trusts that the CHCs enjoy. Will they provide a true advocacy service, as it appears that they may need to steer people towards independent advocacy services? They may be useful when complaints can be quickly resolved, but what about the more serious issues that will take longer to tackle?
  I was pleased to hear the Secretary of State say that the independent advocacy services may include local authorities. However, there needs to be a way of monitoring the standards of service provided by such bodies. I look forward to hearing how the services will work in practice on behalf of patients and how they will be integrated and monitored to provide the highest standards for all NHS patients—in particular, those who are seeking a resolution of their complaints. I am confident that, whatever we come up with, the Government will provide a proper service for patients, particularly to deal with their complaints.
  As secretary of the all-party group on ageing and older people, I welcome a number of the measures included in the Bill, perhaps with the exception of the ominously numbered clause 28. I wonder why it is deemed necessary to state that the president of the Family Health Services Appeal Authority
  may not continue to hold office after he reaches the age of 70.
  Where is the justification for that ageism? Many hon. Members will know of my commitment to fighting ageism. I wonder why there is a tendency to impose an age limit instead of focusing on someone's ability to do the work.
  Parts III and IV of the Bill contain provisions that should be widely supported, including—in spite of what the right hon. Member for North-West Hampshire (Sir G. Young) said—the care trusts. I hope that they will provide a workable partnership between local authorities and health authorities to integrate services, in particular for older people, who use 40 per cent. of NHS resources and who often suffer from the consequences of a lack of co-ordination between the services.
  As my right hon. Friend the Secretary of State said, clause 48 will free 35,000 people in nursing homes from having to pay for nursing care. However, the all-party group and others are concerned that 125,000 people will still have to pay for personal care. As hon. Members know, the Sutherland report recommended that nursing and personal care should be free. Often, it is difficult to separate and define those two activities, as my hon. Friend the Member for Wakefield (Mr. Hinchliffe) said, both in an intervention on my right hon. Friend and in his speech.
  I welcome the £1.4 billion extra that is to be spent on health and social services for older people. I also welcome the provisions of clauses 52 and 54. Clause 52 will enable the Secretary of State to specify in regulations that local authorities, when determining whether care and attention are otherwise available, should ignore certain capital. At present, authorities may refuse to support someone who has capital of more than £16,000.
  I also welcome the proposals in clause 54 for local authorities to enter into deferred payment agreements so that older people do not necessarily have to sell their

  1131
  homes to pay fees. According to the NHS plan, that would help about 5,000 people. I have received representations from constituents on that issue.
  Clause 26 contains new arrangements for the suspension and removal of practitioners from relevant lists on grounds of inefficiency, fraud or unsuitability, which my right hon. Friend the Secretary of State covered in some detail in his opening statement. I am pleased about that provision because it is another step towards protecting patients.
  I well remember the Government's swift action last year when they amended the Medical Act 1983 to increase from 10 months to five years the length of time before doctors who had been removed from the medical register could apply for reinstatement; that followed on from my ten-minute Bill, which arose out of a case involving a doctor in my constituency. I thank my hon. Friend the Minister of State, the hon. Member for Southampton, Itchen (Mr. Denham), who is to reply to the debate, for his help in progressing that matter.
  I hope that the Bill will result in the enactment of radical changes in the ways in which health and local authorities co-operate and work together, in particular in providing for older people. I also hope that the Government will listen to our concerns and respond positively as the Bill progresses through Parliament.
  6.44 pm
  Mr. Simon Burns: The Bill is like a curate's egg—good in parts and infinitely bad in others. It would be fair to say that I, like many other hon. Members in the Chamber, warmly welcome the provisions on free nursing care, which are long overdue, but I am concerned—as are hon. Members on both sides of the House—about the proposals to abolish community health councils. That is not simply a question of the total lack of proper consultation or working with CHCs on which the Government have embarked. I am fearful that the patients forums and patient advocacy and liaison services with which the Government wish to replace the councils simply will not work and, more important, will not be seen to be working. Regardless of whether the trust or the health authority is to finance the replacements, local people will not have the confidence to believe that they are independent bodies working on behalf of local individuals, as, by and large, the CHCs, in spite of some failings, have been perceived to do. The CHCs have been the independent representative body for the local community over the whole range of health care provision.
  No one is going to say that the present CHC structure is 100 per cent. ideal. However, on balance, I believe it to be the best system. There are problems with the system—for example, with the Mid Essex CHC in my area. Owing to severe financial problems 15 months ago, the Mid Essex Hospital Services NHS trust proposed to close three wards in my area with a loss of 84 beds. Not unnaturally, the local community was in uproar. The CHC was consulted. Local people violently opposed the closure and did not believe that it would achieve the savings for which the trust was aiming, although it would adversely affect patient care. Trade unionists, professionals working in the health service in mid-Essex, Conservative and Labour Members of Parliament and even the local authorities opposed the proposal.
  1132
  As the decision was so wrong and unjust, we were desperate for the CHC to use its powers to oppose the proposals. It could have asked the Secretary of State and the Department of Health—an independent body in so far as one can have one, as the Department and Ministers are totally detached from the running of the health service in mid-Essex—to consider the issues and arguments against the closure so that what we believed to be the right decision could be reached, which was to prevent closure of the wards.
  What happened? At the preliminary meeting, the CHC was as appalled as everyone else. However, when it came to the crunch meeting and the decision had to be taken to appeal to the Secretary of State, the CHC ducked the issue and formally refused to oppose the closure of the three wards. That was in November 1998. The CHC thought that it had a deal with the trust to stagger the closures. Within three months, it was clear that closing the three wards would not save the money envisaged and that waiting and out-patient lists were escalating to such a level that closure was not feasible. The trust had a new chairman and chief executive. Fortunately, because of the pressures put on the CHC by the local community, it reconsidered its decision three months later and appealed formally to the Secretary of State. Immediately, the trust changed its mind and announced that it would reopen the wards.
  For three months, that CHC failed to represent the views of the people of mid-Essex. That is an illustration of the fact that CHCs do not always get it right. However, for many years the Mid Essex CHC has done tremendous work representing individuals with complaints about the health service, and has fought for improvements in health care. There are arguments on both sides, but that is not a reason to get rid of CHCs which, by and large, have done a good job.
  I question whether as many locally elected councillors should be members of CHCs, regardless of their political party. If we were to keep CHCs, I would structure their composition to include more independent individuals of no known political persuasion, rather than appointing so many local authority representatives, be they from the Conservative, Labour or Liberal Democrat parties, Plaid Cymru or whatever. That would give less of a partisan, political flavour to those bodies.
  The CHC system contains some flaws, but it is preferable to what is proposed in the Bill. Certainly, CHCs are more respected by the people whom they serve. Like my hon. Friend the Member for Woodspring (Dr. Fox), I hope that the Government will think again about the proposals when the Bill is scrutinised in detail in Committee, on the Floor of the House and in another place. It is clear that the Bill faces much opposition from Back-Bench Labour Members. I hope that they will stand up and be counted, and fight for CHCs.
  The question of long-term care was discussed as part of the Queen's Speech debate a few weeks ago. I said then that the Government's proposals fudged the issue, and that not all the recommendations of the royal commission had been adopted. The result was a short-term fix that did not go to the heart of the problem.
  Serious difficulties remain with regard to free nursing care. As I said earlier, I warmly welcome the proposals in that regard but, as other hon. Members have rioted, there will be a problem when it comes to distinguishing nursing care from personal care and services.

  1133
  I put that to the Minister of State, the hon. Member for Barrow and Furness (Mr. Hutton), in the debate on the Queen's Speech. He said that he agreed that anecdotal evidence suggested that, in times of tight health service budgets, people were assessed as needing residential rather than nursing care. The reason for that is that residential care is cheaper, and places less of a strain on social service or NHS budgets. Although I am sure that the Government's intentions are good, I fear that problems could arise when it comes to defining nursing care and personal care and services when money is tight. That problem will not be easy to resolve.
  The hon. Member for Bedford (Mr. Hall) mentioned that much of the Bill is a skeleton structure and that Ministers will have great regulatory powers to flesh it out. The proposals on long-term care are no exception. Clause 52 provides that the disregard limit—presently determined on a sliding scale between £10,000 and £16,000—will be increased, but we do not know by how much. Any increase in that limit will benefit many people.
  Similarly, people will not be required to sell their houses during their first three months residence in a home. That will also help, but I wonder whether the period is too short. When people first go into a nursing or residential home, they are often confused and distressed. Will three months be long enough for them to settle and stabilise in their new surroundings before they are required to consider something as serious, and with such long-term consequences, as selling a house or making other arrangements, such as those outlined elsewhere in the Bill?
  If they had won the 1997 general election, the Conservatives were committed to introducing a voluntary insurance scheme. That scheme would have allowed people to bypass the means test by as large an amount as they wished, so protecting their homes or assets. It would have offered a sensible way forward, aid would have been preferable to tinkering with the disregard amounts.
  Regardless of what happens to the Bill in Committee, the rules on the disregards for homes need to be reconsidered. I offer the example of a husband and wife who live in their own home. Under the present rules, if one of them has to go into residential care, the other may remain in the family home, which does not have to be sold. That is eminently reasonable, but society and the structures of caring have changed since the rules were drawn up.
  Briefings from citizens advice bureaux show that, increasingly, children live in the family home to act as carers for an aged parent. Under the present rules, those children are not allowed to stay in the home if the person whom they are looking after has to go into care. The same applies to other relatives or long-term permanent carers who are not related to the person being cared for. Arrangements whereby people could lose their homes because they are not married to the individual who is going into a home seem to belong to a bygone, antiquated age. I urge the Government to consider that matter further in Committee, as I believe it badly needs to be tackled.
  Problems have arisen or grown more acute over the past 20 years because people are living longer and because, with the state's encouragement, they want to stay in their own homes. They highlight the financial difficulties of long-term care with which our parents' generation was not burdened, as the National Assistance Act 1948 covered that.
  1134
  The Government have gone some way to addressing the problem with regard to nursing care, although I have highlighted the difficulties that remain. However, they should have been bolder and done more to help the even larger proportion of the population who will end their lives in residential rather than nursing care. The Bill will not make that problem go away. The House will have to return to it, and I suspect that it will have to do so in the not-so-distant future.
  6.58 pm
  Dr. Howard Stoate: I welcome the Bill, which sets out an enormous improvement in the national health service. It goes a long way towards making the contents of the NHS plan a reality. Hon. Members have presented reasoned arguments about why they are not happy with some elements of the Bill, and why they would like the Government to look further at some others.
  I share some of those concerns, especially when it comes to long-term care of the elderly and to the replacement of community health councils. Those are legitimate questions, but is extraordinary how Conservative Members pontificate about these matters and berate Ministers for their plans to make nursing care free. What did the previous Conservative Government do over 18 years? They did not make any nursing care free.
  Moreover, Conservative Members seem to believe that proposals to establish a three-month disregard period, during which people will not have to sell their houses, somehow sell people short. Yet we had years and years of a Conservative Government who did nothing at all to prevent people from having to sell their homes to pay for residential care.
  I am happy to listen to reasoned arguments, but I will not take lessons from Opposition Members who did nothing for so long.
  Dr. Brand: I agree entirely with what the hon. Gentleman has just said. However, does he not think that the problem goes further? Did not the Conservative Government effectively privatise all long-term care? Previously, it was supplied through the national health service.
  Dr. Stoate: The hon. Gentleman makes a valid point. Many homes are closing because the financial arrangements have not worked out, and because they have not met the standards demanded of them by the present Government; but it is important to bear in mind the care provided in the community for people who no longer need to go into long-term residential care homes.
  I believe that, as one who still carries out a certain amount of general practice in the NHS, I am well placed to recognise the many problems faced by the NHS over a number of years. I have first-hand experience, and I understand the difficulties that have been faced by both patients and staff. This evening, however, I want to concentrate on patients, because they are what this is all about. We must focus all our plans for changes in the NHS on ensuring that they are given a better deal. Any measure that improves their lot—anything that makes the service more accessible to them, and makes that service better—must constitute a step forward, as I am sure all Members will agree.

  1135
  I want to talk not just about what is in the Bill, but about other changes that I would like the Government to consider. There are currently five pinch points, certainly from the point of view of patients. As I have said, I intend to concentrate on processes and outcomes as they affect patients, rather than on structures. Patients do not necessarily want to know who is providing care; they want to know that the care will be provided when they need it, at the standard that they require.
  The first of my five pinch points concerns access to primary care. The second concerns arrangements for managing patients in accident and emergency departments. The third concerns elective surgery. The fourth concerns what is to be done about delayed discharges in hospitals dealing with acute cases. The fifth concerns the need to maximise the skills of the many different types of health specialist in the NHS, which I consider are under-used at present.
  So far the Government have made good progress in regard to access to primary care, through NHS Direct, the extension of GP co-operatives, out-of-hours centres and walk-in centres, increased use of nursing practitioners and practice nurses in GPs' surgeries, and their commitment to reducing the time for which people must wait to see their GPs and nurses to 48 hours and 24 hours respectively by 2004. Those are important steps towards improving access to primary care, but I think that we could go still further. We could do more to ensure that there are more GPs, that practice premises are better resourced and that more attention is paid to how patients can have access to services out of hours. Securing appointments with GPs often presents a barrier to patients, especially in certain parts of the country. They are often forced to use other services that may not be appropriate.
  That brings me to the subject of accident and emergency departments. Many people who use their services do so inappropriately. By definition, accident and emergency services should be dealing with accidents and emergencies, but many people whom I see in my local accident and emergency department, where I spend a lot of time, have not used its services appropriately. The department is being clogged up by people who could have consulted a pharmacist or GP, or telephoned NHS Direct. We must tackle the reasons for that, and the question of what happens to people when they go to accident and emergency departments.
  Currently, those who go to such departments will have nurse triage. They will be categorised according to whether their problems are acute and constitute an emergency, or are more routine, and they will wait to be dealt with for a time that accords with that. The system causes huge dissatisfaction not just among patients but among accident and emergency staff, who feel overburdened and overstressed by the sheer number of patients.
  Moreover, accident and emergency doctors have not always had the most appropriate training. They are often junior doctors, who have trained in, say, surgery or orthopaedics but are not general practitioners, and do not necessarily possess the required skills and years of experience. The Government should consider arrangements enabling more GPs to be stationed in accident and emergency departments at busy times of the year, and busy times of
  1136
  the week. Such arrangements have been piloted in some parts of the country, very successfully. Ministers should encourage further projects of that kind, so that more accident and emergency departments have GPs with the necessary skills and experience—and, sometimes, the necessary forcefulness—to ensure that patients are moved through the system much more quickly. I think that that would benefit everyone.
  Then there is the issue of elective surgery. One of the most difficult experiences for any patient is to be teed up for an operation, only for it to be cancelled at the last minute because the bed has to be used for an emergency. Everyone understands that the NHS must deal with emergencies, but that is not much consolation to someone who has had to rearrange child care and family life. That person may have spent the past week preparing psychologically for what may constitute a major life event, only to have his or her hopes dashed. When someone is told, "I am sorry but the bed has gone; come back next week", that is not acceptable.
  The Government should consider setting up dedicated elective-surgery units whose beds are not subject to emergency pressures. Those beds would be guaranteed—a cast-iron guarantee—for elective work. Providing such arrangements in general hospitals would ensure not only that all ancillary emergency services were on hand, but that patients were given the paramount attention that they needed. In the event of an emergency, the patient could still be dealt with in an acute hospital in the usual way.
  Doctors and nurses could spend six months or a year in elective units as part of their training—as part of surgical rotations, perhaps. There could be dedicated units. Patients could be guaranteed beds, and it would be almost inconceivable that anyone else could use those beds. Patients would really know where they were.
  Then there is the problem of delayed discharges. My local hospital in Dartford currently experiences between 40 and 50 on a given day, and I am sure that the same obtains throughout the country. The hospital has only 400 beds. If 40 are filled with people who have completed their treatment and are ready to be discharged, but cannot be discharged for a number of reasons, 10 per cent. of the hospital's capacity has been taken up. The problem is, of course, much greater for a hospital that is dealing with acute emergencies, GP admissions and elective surgery.
  When the Secretary of State visited my constituency recently to open the new district hospital, he added his weight to the call for a step-down community unit in the constituency of my hon. Friend the Member for Gravesham (Mr. Pond), which would allow 24 patients to move into a nurse led unit with much lower levels of medical cover. That would be entirely appropriate. It would be much cheaper and cost-effective, and would allow the expensive acute hospital to provide the high-tech care that is needed. The acute hospital would be able to use all its 400 beds, not just 350. By that means the Government could speed progress through the system, and give patients a far better deal.
  We need to maximise the skills of all who work in the NHS. I chair the all-party group on pharmacy, and I meet many groups representing pharmacists. I meet community pharmacists; I talk to pharmacists at length. It seems to me that pharmacists can and want to do far more than they do currently, and I think that if they were able to do so it would be of enormous benefit to both the NHS and patients.

  1137
  I welcome the part of the Bill that deals with the extension of prescribing. I am glad that pharmacists will be able to prescribe drugs—that they will be able to issue not just repeat prescriptions but de novo prescriptions in the case of certain classes of drug. Where that has been tried in pilot studies involving, for example, emergency contraception, it has proved very popular and workable. It has greatly satisfied patients, who have been given much-needed access to drugs. I hope that, as the Bill progresses, we shall be given more details.
  The Bill contains proposals for the remote provision of medicines through the internet, by mail order or through a delivery service to patients' homes. That, too, is a good idea. For all sorts of reasons, some patients have difficulty in getting a prescription, taking it to the pharmacy and collecting their drugs, which may cause considerable hardship. Again, I hope we shall have more details as the Bill progresses.
  There is no doubt that community pharmacy contractors welcome the opportunity to broaden the range of services that they provide. They have called for such opportunities for some time. However, they have an over-arching concern. At present, community pharmacy is probably the most accessible part of the NHS. There are pharmacies all over the country, in most high streets and in all but the most remote parts of the country—in cities, towns and villages, and areas where people work.
  Community pharmacists are more accessible than the majority of health professionals. Community pharmacies are normally open six days a week, sometimes seven. They are open for long hours. People do not need an appointment; they can just drop in and talk to pharmacists, who provide expert advice on medicines, medicine management, compliance issues and a range of other health-related matters. They sell "p" medicines, which are available only from pharmacies, dispense drugs and ensure that people understand how to take them. That extraordinary accessibility and flexibility is the cornerstone of what pharmacies have managed to achieve. Pharmacists welcome that advance and patients also find it useful.
  I am slightly concerned about clause 31, which allows for the suspension of control of entry regulations to facilitate the provision of new services. Pharmacists have explained that suspending control of entry and establishing new premises from which pharmaceutical services, including existing services, are provided, might have a serious impact on existing pharmacy services and pharmacies in the area.
  I want the Standing Committee to consider whether it would be reasonable to include a provision that allows health authorities to take account of the effects of the arrangements on existing pharmaceutical supply services. Rather than simply suspending the list and allowing new contractors to establish services, which might be in direct competition with existing contractors and might, therefore, have a destabilising effect, we should allow the authorities to take careful account of the effect of the new arrangements. We do not want to damage the fragile but essential network of community pharmacies. I would hate a brand new arrangement to be implemented that appears, on the face of it, to be a good idea, but which destabilises existing contractors and worsens the service for patients. I would be extremely happy for that to be flagged up, and perhaps the Minister will be able to comment on it.
  1138
  Men have had a bad deal from health services over many years. They suffer from far more illnesses, die much younger and contract more cancer and heart disease than women. However, they are very bad at accessing services. We do not understand why that is the case. Women have been extremely successful at improving and accessing their services. Men lag a long way behind. The Government should consider what they can do to understand why men get a bad deal, are more ill and do not access services. We need to find out what we can do to ensure that they are included in the health improvements that are needed so that the health service is fit for the 21st century.
  7.12 pm
  Mr. Simon Thomas: I am afraid that I cannot give the Bill such a warm welcome. It is decent enough in parts, but it is not quite good enough for my party, which is why we have tabled a reasoned amendment. Our main complaint is that it does not fully address the recommendations of the royal commission on long-term care for the elderly. In particular, it makes no allowance for the full recommendations to be applied in Wales if the National Assembly for Wales wanted to do that.
  Much of the Bill is progressive so far as Wales is concerned. For example, we are exempt from the requirement to abolish community health councils, which have been discussed in detail this evening. That aspect of the Bill is, therefore, less injurious to the people of Wales. The social care proposals are also progressive. However, there is concern in Wales that the full impact of the royal commission's recommendations will not be felt. That is a gaping flaw.
  Hon. Members will have noticed that most of the detail relates to English needs and England's national plan. There is no national plan for Wales. The national plan that was trumpeted and launched by the Prime Minister and advanced by the Secretary of State is a plan for England only. The Bill will implement the needs of England in the context of the national plan. I accept that parts of the national plan do affect Wales—long-term care of the elderly being the obvious example. However, the Bill needs tweaking so that it can fully respond to the needs and opinions of Wales and the consultation that is taking place there.
  There are two issues of concern—health and social care. Last year, the National Assembly encountered difficulties when it tried to extend the provision of free prescriptions and free eye tests in Wales by introducing a wider range of categories for free prescriptions. It would have been useful if the Government had taken those problems into account, and the Bill does not address them. We should reconsider how we can give the National Assembly greater power to determine the provision of prescriptions in Wales.
  I am pleased that the hon. Member for Erith and Thamesmead (Mr. Austin), who is no longer in the Chamber, was also careful to explain that the requirement to abolish CHCs does not apply to Wales. An enabling clause allows the National Assembly to decide whether it wishes to abolish them. At least 3 million people in England and Wales are taking part in a fairly in-depth consultation exercise on the future of CHCs in Wales. I have not been alerted to any serious problems with them. Some hon.

  1139
  Members have talked of problems in parts of England, but those problems are not apparent in Wales, perhaps because CHCs there are small, close to communities and, on the whole, located in unitary authorities. That relationship has given them strength in Wales.
  I hope that the National Assembly will decide to retain CHCs. Perhaps the Minister will comment on the enabling provisions in clause 15. Bearing in mind that we are consulting in Wales, the National Assembly might decide that, although it wants to retain CHCs, it would like to reconfigure and enhance them, perhaps to take account of the valid points that the Secretary of State made about independence and the role of an advocate for patients, which might not be fully developed in CHCs. I wonder whether the clause is strong enough to allow the National Assembly not only to decide whether to keep or abolish CHCs, but to reform them and give them a wider role. That is what the majority of people in Wales want, and it would be a good example for the people of England.
  Private medicine has been mentioned. A recent problem in my health authority, Dyfed Powys, has brought to light a practice that should be outlawed. Tenby cottage hospital, a small hospital with only 14 beds, is threatened with closure. One reason given for closing it is that beds can be found within the private care sector locally—but that is not what the public-private partnership is about. I think that that is an alarming prospect for the NHS in Wales. I have no problem with using private beds to meet NHS needs, but I do not want NHS hospitals closed and NHS money used for private beds in the locality. That is a poor way to develop the health service in Wales.
  On social care, my party welcomes in principle the establishment of care trusts, although the details need to be worked out. Plaid Cymru, the Party of Wales, went into the 1997 general election with a policy of establishing elected health and social care authorities. The creation of care trusts shows that the Government are willing to dip the tip of a toe into the water. There should be benefits in bringing together social services and health services. In rural areas such as my constituency and that of my hon. Friend the Member for Meirionnydd Nant Conwy (Mr. Llwyd), services are stretched and people who are dependent on social services and health services are often visited by several different people who cater for different needs. There must be a way to put that care into one package, but we need to address the funding, so care trusts are a useful way forward.
  However, the question of democratic accountability is involved—it was succinctly put by the right hon. Member for North-West Hampshire (Sir G. Young)—and that is why I would prefer local authorities to be responsible for health. I have some sympathy with the remarks made on that subject by the hon. Member for Wakefield (Mr. Hinchliffe).
  The Bill's central failure is in not implementing fully the proposal on free nursing and personal care made by the royal commission on long-term care for the elderly.
  Mr. Elfyn Llwyd: My hon. Friend, like me, will have been lobbied by Methodist Homes for the Aged, which is concerned that
  proposals in the Bill will discriminate against older people who qualify for personal care but not nursing care.
  1140
  Does he agree with that view?
  Mr. Thomas: That puts in a nutshell the difficulties that will be stored up by this policy, and Ceredigion Age Concern has lobbied me locally along similar lines.
  A curious position could arise. The National Assembly for Wales has legislative powers in this respect, although it has not used them. The Assembly could introduce in Wales provision different from that in England. For example, it could adopt some of the royal commission's recommendations—on benefit, for example—and could also vary the proposed means test disregards for three months, although it could not fully introduce the recommendation on personal care. Therefore, there is no difference of principle over the idea of arrangements being different in Wales and England. The situation in Scotland is already different, and I understand that the Scottish Executive are considering introducing personal care provision, albeit wrapped up in a different care package.
  The cost of introducing the royal commission recommendations in full in Wales would be between £40 million and £60 million, which is a considerable sum, and the Secretary of State rejected it as reasonable expenditure in England. That is fine for England, if that is what the national plan for England says and such expenditure is not a priority for England. All well and good. However, why cannot provision be made to enable the Assembly to introduce the recommendations in full in Wales if it so wishes?
  The Assembly may consider the cost and say, "No, we have other priorities as well." None the less, for the long-term future, and to set the right relationship between the House and the Assembly, and between the health service in England and in Wales, we should consider whether we could give those enabling powers to the Assembly. It decides priorities for the health service in Wales, which on heart surgery, cancer and adolescent mental health are different from those in England.
  The royal commission recommendations for the long-term care of the elderly could also be implemented differently in Wales. The Assembly does not yet have the power fully to introduce the recommendation on personal care, but it can already vary elements of social care, and we should consider that. Surely there is no stumbling block on principle here, because there is already variation.
  In response to an intervention, the Secretary of State said that the NHS had suffered too much restructuring in recent years. There is a lot of sympathy for that view, but when I consider the NHS in Wales and the plethora of bureaucracy that is still in place, I despair. We have GP fundholding, local health groups, NHS trusts and authorities. Now we are to have care trusts. We are dealing with a situation created, to a greater or lesser extent, by previous Conservative Governments. No wonder the poor patient needs a community health council to understand these issues. Members of Parliament often have difficulty understanding who is responsible for what, and who has made the decision that means that Mrs. Jones will not have her operation in the morning, and the Bill has missed an opportunity to get to the heart of the problem and sort out some of the mess in the NHS.
  We need democratically accountable, non-competing multi-purpose health and social care authorities. Care trusts are a good step forward, but not the full answer.

  1141
  The Government do not want to take too bold a step at this stage in the electoral process. As with so much else, the new Labour Government have taken the Tory edifice, tinkered with it and put on new cladding, but they have left the deep-rooted problems in place.
  There was a misguided introduction of competition into the NHS many years ago under another Government. That competition is still present; it does not work because it is neither one thing nor the other, and the health service is neither fish nor fowl. Until we eradicate that competition, the health service in Wales will remain a long way from the original socialist vision.
  7.25 pm
  Mrs. Eileen Gordon: I cannot resist commenting on the contribution of the right hon. Member for South-West Surrey (Mrs. Bottomley), and I am sorry that she is not in her place now. I sympathise with her constituents and their health care concerns, but I am confident that the money that the Government are investing in the NHS will feed through and improve the situation. I would almost have felt sorry for her if I had not spent years as a member of a local community health council, leading a campaign to save the accident and emergency unit at Oldchurch hospital in Romford.
  With the support of the CHC, I wrote, lobbied, demonstrated and collected signatures. All appeals fell on deaf ears—the right hon. Lady's ears, as it happened, as she was Secretary of State for Health in the Tory Government. I am proud that a Labour Government have saved that service and given the go-ahead for a £148 million new hospital at Oldchurch, which is progressing very well.
  I, too, welcome many of the Bill's provisions, because we are making progress in modernising the NHS. I also welcome the Government's investment in and commitment to the NHS. The strength of the national plan, on which the Bill is based, is largely due to a great deal of consultation. However, therein lies the weakness of the proposals on patient representation: there was no consultation—at least not with the CHCs—which is why changes are already being made. The first that CHCs knew about the proposal to get rid of them was when the national plan landed on their desks. Imagine how those people, most of whom work tirelessly to represent patients' interests, felt. It was seen fit to involve CHCs in the consultations on all parts of the plan except their own future.
  I was a member of Barking and Havering CHC for many years as a local authority nominee and as a co-opted member, and I hope that that has given me some insight into the way in which CHCs work. I have been critical of CHCs, and no one would deny that they need reform—I often complained about the lack of reform when I was a member—but most of the problems were caused by lack of resources and support, the work load put on volunteers, and the limitations on the remit of CHCs, such as not having the right to inspect primary care facilities.
  The best of the CHCs carry out the roles of advocacy, scrutiny and inspection extremely well. Those with high street shop fronts have a high profile, and the fact that they make a nuisance of themselves with trusts and health authorities when things go wrong is a sign of success. Therefore, I have a real problem with the proposals. The roles of advocacy, scrutiny and inspection are
  1142
  fundamentally linked, and are better dealt with by one body as a one-stop shop for service users. They should not, as is proposed, be fragmented.
  I have read all the papers and, like most MPs, have received representations from many groups, but I still think that the suggested new structure, although it has to be put in place in just over a year, is far too complex, and that there is little obvious connection between the parts. Currently, if a problem is identified, it can be dealt with at all levels by one body—the CHC. Patient advocacy can take place and an unannounced visit may be made, but I am not sure who, under the Bill, will have the power to make such visits, which can be valuable.
  A CHC is based in one office, so all the people involved can talk to each other. If a problem is identified as having wider implications, the National Association of Community Health Councils in England and Wales—NACHCEW—can take up the concerns on a national scale. For example, Casualty Watch has been useful in identifying problems in accident and emergency departments.
  My preferred option for reform of the CHCs would have been to keep their current structure, widen their remit, improve their staff levels, build on their expertise and increase their resources so that they can do the job properly. Instead, we are faced with fairly vague proposals that have not been thought through. For instance, I find it hard to come to terms with the fact that half of the patient forum members will be chosen at random from people who write to trusts and health authorities. I am sorry, but that seems too haphazard to be of any value. Members of Parliament probably write more letters to health trusts and authorities than anybody else. Does that increase our chances of being picked at random? As my son Peter would say, "What's that all about?" I could make a selection of constituents at random from the letters that I receive each year. They might turn out to be an interesting group of people, but I am not sure whether they would necessarily represent all my constituents.
  As for patient advocacy and liaison services, I am not confident that PALS staff sitting in a hospital reception area and paid for by the trust can be truly independent. I am not clear about what networking will occur between PALS in hospitals and those in primary care trusts. The arrangement seems to contradict the holistic approach that we are now advocating for patient care. I do not oppose the involvement of local government in scrutiny; more of that is needed. I am, however, concerned about how independent local government will be, especially as it, too, commissions services. I am especially concerned about that in connection with care trusts, although their creation is a policy with which I agree. I worry that patients will be bounced between the new bodies, and that their complaints and concerns will be lost in the bureaucracy. Rather than empowering patients, we could be silencing them.
  I shall support Second Reading, as the Bill contains many good measures. I shall, however, consider the legislation carefully when it returns to the House from Standing Committee. If patients are to be at the heart of health care—as they should be—we must get the Bill right. I believe that establishing an enhanced CHC structure, with one body dealing with the whole range of patients' interests, would be far preferable to splitting up the services. I hope that the Committee will review and rethink the proposals.
  7.33 pm
  Mr. David Amess: Oh dear, oh dear, oh dear. Yet again, we are considering deeply flawed legislation, introduced by a deeply flawed Government. At a time when the national health service has been brought to its knees by this rotten Government, it is amazing that the Secretary of State has treated the House with such utter disdain.
  When this was a proper debating Chamber and Members came here to scrutinise legislation, a Secretary of State would not have introduced a Bill with 66 clauses and five schedules by participating in a brief knockabout session and then clearing off with the public relations people to get the right spin in the media. In the past, the Secretary of State would have taken time to speak about the clauses. He would have realised that he had huge problems among his Back Benchers in terms of their opposition to the abolition of community health councils, and would at least have tried to persuade them to accept the policy. That is not, however, the Government's style. They find coming to the Chamber an absolute bore—fancy having to have any proposals considered.
  God help those hapless individuals who will serve on the Standing Committee that considers the Bill. The Committee will be the first on such a Bill to which I shall not offer my services. I have found serving on such Committees to be a deeply depressing experience and their proceedings to be a shambles. Ministers would come to them without understanding the legislation for which they were trying to argue, and civil servants would be scratching their heads and the whole thing would turn out to be a fiasco.
  Of course, the current proceedings are also a fiasco. We all know that the Government will cut and run and have an early general election. I understand that there will be a programme motion and all the rest of it, but unless they ensure that the House of Lords is completely silent, there will be no results. Yet again, this rotten Government are trying to hoodwink the general public into believing that they will do something with the health service that they have brought to its knees. Instead, we are merely going through the motions yet again. The Chamber no longer talks to anyone other than itself. It has come to resemble a glorified lounge where hon. Members sit and chat with one another and where nothing counts.
  For instance, the fiasco of deferred votes has been introduced because some hon. Members cannot even be bothered to stay here late at night. If the Secretary of State seriously wants to do something about the health service, he could at least have done the House the courtesy of explaining in detail what the Bill is about. Earlier, he answered one of my hon. Friends by praying in aid three or four people who thought that the abolition of CHCs was a good idea. One of those people was an out-and-out Labour supporter. I cannot remember who the others were, but I do not think that their remarks impressed anyone.
  Mr. Stephen O'Brien: As I recall, the Secretary of State prayed in aid comments made in support of reform of CHCs' functions. I do not recall any quotation in support of their abolition. His remarks were interestingly selective.
  Mr. Amess: I entirely accept my hon. Friend's correction.
  1144
  It is a pity that the Government and Health Ministers do not spend more time walking around our hospitals and finding out what is going on. I would like to challenge the Health team to visit Southend hospital. How did it find out how it was affected by the Bill? One week after the start of the summer recess, the Government decided to shame it, which destroyed morale in the local health service. Ministers should speak to people who work in the health service and find out whether they think that all the provisions will do them any good. Instead of being named and shamed because it did not reach the Government's ridiculous targets, Southend hospital needed more experienced staff and more incentives to keep its current staff. Instead, those in charge had a disgraceful attitude and brought in a time and motion person who delivered nothing at all, but brought morale to its knees.
  The Government then commissioned a report on the health service from the Virgin group. The report stated:
  Within the service there is the impression of "management by cascading paper", of ideas and instructions being passed down from above. The dead hand of bureaucracy seems to stifle imagination and flair and obscure responsibility.
  The Government treat their workers disgracefully. We have lost 12,000 nurses and there are 20,000 vacancies. They are obsessed with the Prime Minister's waiting lists. Every hon. Member knows that the cut in in-patient waiting lists was achieved by postponing complex surgical procedures. The out-patient list of people who wait more than 13 weeks for treatment after seeing their general practitioner has risen by 188,000 under the Government. Waiting lists have risen by 55,000, and 79 of the 99 health authorities in England and Wales have more patients waiting for treatment now than were doing so at the last election.
  I recognise, however, that the Government will not listen to anything that the hon. Member for Southend, West has to say about the matter. If they did so, they would probably join their fellow partners in crime—those in the Liberal party—and take a long walk off Southend pier. I hope, however, that they will take notice of the excellent analytical briefings on the Bill that every hon. Member has received. If the Minister reads them, he will find that what the experts have to say is not reassuring.
  It is Labour's style now that it is in government to dismiss the British Medical Association, the Royal College of Nursing and community health councils because they do not suit its agenda. The Government are at least consistent on one front: when things occasionally go right for them they take the credit, but when things go wrong it is all the fault of the previous Conservative Government. [HON. MEMBERS: "Too right."] I note what Labour Members are saying, but the manifesto that they peddled to the British people at the previous election did not say, "Vote Labour. We'll fiddle about for four years because it will be so difficult to put things right in that time." It told the British people, "Vote Labour and the national health service will be saved." As a result of the treachery of this rotten Labour Government, it will take a Conservative Government to save the NHS.
  The Minister may not take my advice about Southend pier, but I hope that he will listen to, for instance, the

  1145
  advice of Age Concern on long-term care of the elderly. It says that the Bill in its present form is littered with
  unanswered questions and lost opportunities to improve the welfare and rights of older, disabled and mentally infirm people. Above all, it will mean that hundreds of thousands of older people will have to pay for the essential help they need to live their daily lives, including dressing, meals and bathing.
  The Minister of State, Department of Health (Mr. John Denham): Will the hon. Gentleman enlighten the House on whether his party is promising free social care?
  Mr. Amess: If the Minister gives me a chance, I will come to that.
  Ms Julia Drown: Will the hon. Gentleman also point out that Age Concern welcomes moves to improve local accountability in the health service, welcomes the new statutory duty on health bodies to consult on and involve local people in planning, and welcomes proposals to improve the provision of general dental services? Those are just three of many welcomes throughout its briefing.
  Mr. Amess: The hon. Lady will be pleased to know that I have the Age Concern briefing in front of me and have highlighted comments in it, but I am in injury time and have an awful lot to get off my chest in the remaining six minutes of my speech.
  Never mind Age Concern's briefing—perhaps the Library briefing will please the Minister. It quotes Gordon Lishman, director general of Age Concern England, as saying:
  The Government is continuing to dodge the issue of principle—that personal as well as nursing care should be free.
  He goes on to say much more.
  The Government are obviously not interested in Age Concern, but perhaps they will listen to the BMA and reflect on the implications of clause 17—if Ministers understand it. According to Dr. John Chisholm:
  Patients with equal clinical needs must have equal access to high quality GP services, so the BMA shares the Government's aim for there to be an equitable distribution of family doctors. Inequalities have been drastically reduced over the past 52 years as a direct result of the operation and influence of the Medical Practices Committee.
  Clearly, the BMA thinks that it will be a disaster to abolish the MPC.
  The Department of Health must have been having its Christmas party when it came up with the ridiculous traffic light system. Health authorities, NHS trusts and primary care trusts are to be categorised red, amber or green. The system is complete nonsense. The Royal College of Nursing supports measures to improve standards in the NHS, but remains concerned about the system of judging such bodies and allocating resources accordingly. The briefing states that in particular the RCN does not believe it is right for the proportions of NHS bodies to be categorised as "green", "yellow" and "red". Its briefing goes on to destroy the argument for such categorisation. The next few clauses after clause 17 cover care trusts, with which my right hon. Friend the Member for North-West Hampshire (Sir G. Young) dealt.
  Labour, which is obsessed with joined-up government, plans to unite the NHS and social services. Does it really think that the general public will be taken in by such a claim before an election? It is an absolute fiasco.
  1146
  Finally, there is the proposal with which even this Government are a little uncomfortable: the proposal to abolish community health councils. When Labour was in opposition, it loved CHCs and was always quoting their work. Since the CHCs have been critical of this rotten Labour Government, however, the Government have thought, "We'll abolish them; we mustn't have any insubordination in the ranks. We've managed to silence the House of Commons and now those well-intentioned"—this is the Government being patronising—"individuals on CHCs must be silenced too." The way in which the Government are not prepared to be scrutinised is a disgrace.
  Mr. Paul Truswell: Will the hon. Gentleman give way?
  Mr. Amess: I am sorry, but I have only one minute left.
  The attack on my right hon. Friend the Member for South-West Surrey (Mrs. Bottomley) and the way in which my right hon. Friend the Member for North-West Hampshire was heard were an absolute disgrace. Those former Ministers spoke a great deal of sense.
  Yet again, this rotten Labour Government are letting down the country and the people of Southend, West, and once again particularly undermining the wonderful staff in our national health service.
  7.47 pm
  Mr. Paul Truswell: I would like to be able to say that it is a pleasure to follow the Vaudeville rant of the hon. Member for Southend, West (Mr. Amess), but I am afraid that I cannot.
  As many hon. Members have said, the Bill has much to recommend it, but it is often in the nature of Government Back Benchers to be churlish and to dwell on elements that they question rather than those with which they wholeheartedly agree. Before I do that, I want to answer one question that has been festooning posters the length and breadth of the country—where has the money gone? I know where a great deal of the money has gone in Leeds: it has gone on refurbishing accident and emergency units at St. James' hospital and Leeds general infirmary; on boosting the funding of Leeds health authority by 40 per cent. in the next financial year; and in helping to fill the huge chasms in the service created by the previous Government.
  Mr. Hammond: What is the current out-patient waiting time for orthopaedic consultations at St. James' hospital, Leeds?
  Mr. Truswell: It is far longer than it should be; that is an admission. Every Leeds Member of Parliament has been pursuing that issue and will continue to do so. They were pursuing it just as vigorously under the previous Government, who created much of the problem.
  Rather than be deflected by that intervention, I shall mention the fact that, at long last, the neglected Wharfedale general hospital, which serves my community, is to rebuilt. Plans to do so have been kick-started by this Government. That hospital was left to rot by the previous Government. We have seen the earmarking of £45 million to rebuild our mental health services in Leeds; that is long overdue. Their

  1147
  state was largely down to the previous Conservative Government. So much for the question, "Where has the money gone?"
  I should like to raise one or two concerns to which other hon. Members have referred. The first is on performance funding. We appear to have a system of performance funding at the moment, which, to some extent, penalises Leeds.
  I make a plea that target setting should be sufficiently reasonable and sophisticated to recognise the difference between various health districts and health trusts. Leeds is a centre of excellence and, as such, patients are often referred to its hospitals because other trusts believe that Leeds possesses the expertise to deal much more effectively with cases that they can. I am talking not just about tertiary referrals, but about an increasing number of secondary referrals within districts. That being the case, the capacity in Leeds to manage its waiting lists is diminished because of this skew in the case mix, which perversely enhances the case mix of those authorities that make the referrals.
  I welcome the recognition in the NHS plan of the importance of advocacy services, which complement existing services in such places as Leeds where they are provided by the voluntary sector. I urge Ministers to ensure that the advocacy provided is the most effective, so that advocates represent the interests of patients in a truly professional way and as they would represent their own personal interests. I am not sure how that role fits in with PALS as a welcoming face at a hospital reception, important though that is for customer care. Advocates—whether through PALS or the independent advocacy system—must not only be independent of the NHS, but must be seen by patients to be so.
  I am delighted by my right hon. Friend the Secretary of State's announcement that he and his colleagues are considering the possibility of local authorities providing advocacy services. In the 1980s, as a then local authority member I was closely involved in establishing a local authority advocacy scheme—I think that it was the first in the country. It was based on the pioneering work of one of the London CHCs. I remember just how much opposition we had from the health service. The medical profession found it threatening, and health professionals felt that the term "advocacy" was adversarial and felt threatened by what they saw as an intrusion. They tried to reduce our advocates to interpreters for minority ethnic groups or people who would reiterate the professional message.
  We finished up having to change the name of the service to the patients advisory service. The rose by another name still smelled as sweet, and it was advocacy pure and simple. If a change of name was necessary to get the system into the health service, we were prepared to make that compromise. That is why it is important for an advocacy service to be truly independent; otherwise it will be moulded and influenced by the inherent—some may say paranoid—mistrust of the concept of advocacy in some areas of the NHS.
  Advocates provide support to individuals and to their families. They can play an equally important role in aggregating individual experiences into a much broader picture of what is happening on the ground in the NHS
  1148
  and feeding that into the process of lobbying for change. I am not certain how that can be done within the arrangements promulgated in the NHS plan and in the Bill. Like many other hon. Members, especially Labour Members, I would like answers to those questions—if not immediately, then during the passage of the Bill.
  CHCs play a major role in supporting patients through the labyrinth that is the complaints process. They often employ specialist complaints officers. I continue to work closely with my local CHC, which provides my constituents with experience and expertise that, I admit, I could not provide. Some Members may be sufficiently well versed in the complaints procedure, but I am not one of them. The role that the CHCs play is crucial.
  It is essential that PALS, or the independent advocacy service if that is to be separate, are able to provide such experience and expertise, and to assist patients in following through their complaints from the beginning of the informal exchanges with the trust and service providers right through to the more formal and heavy end of the complaints process if necessary.
  That is the nub of my concern about the new proposals. We run the risk of losing a valuable element of the CHC experience: that is, the co-ordination and cross-fertilisation of services to which many colleagues have referred. None of the services provided by the CHCs or the bodies intended to replace them should operate in isolation. Inspection, monitoring, commenting on service changes, advocacy, complaints and support for nominees to health bodies should inform and complement each other, rather than be fragmented across a range of different bodies, as my hon. Friend the Member for Romford (Mrs. Gordon) said.
  I do not subscribe to the view that what the Government Front-Bench health team are suggesting will prevent criticism from being voiced within the NHS; the reverse is the case. Many different groups and bodies will be set up, so the Government are increasing the number of platforms for criticism. I would be surprised if the people who serve on those various bodies did not use them in that way.
  I should declare an interest as a former member of a CHC for two years. I became a member when the previous Government ejected local authority nominees from health bodies The Tories frequently talk about cronyism, but their practice can only be described as toadyism. People with no aptitude for the job were appointed—their only qualification was that they owned a Conservative party card and pursued an unswerving devotion to the Conservative cause.
  I attended my first meeting as a CHC observer. The chair of that authority happened to be the chair of the Yorkshire regional Conservative association—so I am not talking about a run-of-the-mill Tory.
  Mr. Bercow: A serious heavyweight.
  Mr. Truswell: That is right—someone who carried the grand order of the blue rinse, probably with bar.
  Mr. Desmond Swayne: He would not have called himself the "chair".
  Mr. Truswell: She.
  Mr. Deputy Speaker: Order. We cannot have interventions across the Chamber from a sedentary position.
  Mr. Truswell: She made it clear that I would not be allowed to participate. Conservative Members seem to have forgotten the fact that your Government took away from CHC observers to health authorities the right to speak. You ought to reflect on that. If these bodies are so great that you have now found renewed support for them, why did you do that?
  Mr. Deputy Speaker: Order. The hon. Gentleman must use correct parliamentary language.
  Mr. Truswell: I am sorry, Mr. Deputy Speaker. I got carried away by the argument. I apologise. My comments were directed not at you, but at Conservative Members.
  The right hon. Member for South-West Surrey (Mrs. Bottomley) made an interesting contribution. She talked about the handful of Labour party members whom she appointed to health bodies, but not about the several hundred Labour party members whom she and her colleagues removed from those bodies.
  My argument is not that of someone intent on the preservation of CHCs in their existing form. My former membership of a CHC and my affection for them does not make me blind to their shortcomings. I do not see CHCs as a classic car that should be preserved at all costs. Throughout the country, they have grown and developed differently, depending on the local circumstances and the quality of the staff and of their members. The strength of many CHCs is their ability to co-ordinate roles and services. My right hon. Friend's proposal has clear merit, but that is devalued by a potential lack of co-ordination.
  I welcome the scrutiny role being given to local authorities. In the 1980s and early 1990s, many local authorities set up health committees to discharge that function, so there is a precedent for that. Scrutiny is crucial, but, as others have said, it cannot take place in isolation from other mechanisms for patient representation.
  I welcome the fact that patients forums will be given the same status as CHCs in monitoring and inspecting services. PALS also recognise the valuable role that advocacy can play. I should like to hear a little more about the independent local advisory forums before passing any comment on them.
  By my calculation, the Bill will result in the setting up of nine new bodies under the NHS plan in Leeds. They include the independent local advisory forum, PALS and seven patient forums. In Leeds there will be a patient forum for the acute hospital trust, the Community and Mental Health Services Teaching NHS trust and the five primary care trusts when the primary care groups make the transformation to PCTs. How will they be serviced to ensure that they operate with maximum effectiveness? Who will advise and brief them and support their nominees to various trusts? Those nominees will have a key role to play, just as CHC nominees to various health bodies do at the moment, but they will not be able to
  1150
  discharge that function effectively without the sort of support that I know is provided by CHC staff in Leeds and elsewhere.
  If that support is to be made available to so many bodies, I fear that there will be a duplication several times over of that which currently exists within the CHCs. If the support is not made available to those members and nominees, it will undermine their effectiveness. At the moment, in the best CHCs the whole is greater than the sum of the parts, but I am not convinced that that can be said about the new structures that have been proposed.
  In conclusion, it would be a pity if, having dismantled the existing vehicle and enhanced so many of its components, we do not reassemble it in a way that provides the most coherent means for conveying patient interests throughout the system. I can understand that Ministers wish to avoid a "should they go or should they stay" debate about CHCs. However, I firmly believe that the issues involved are far too important to pick up after the introduction of the new structures and must be dealt with from the outset. I urge my right hon. Friend and his colleagues to ensure that that is the case.
  8.2 pm
  Mr. Paul Burstow: I apologise for not having been in the Chamber for the entirety of the speeches of one or two hon. Members, but I did listen to the hon. Member for Pudsey (Mr. Truswell) and I want to say a little more about his comments on CHCs and the role of the new patients forums and their possible proliferation.
  My hon. Friend the Member for North Devon (Mr. Harvey) made the worthwhile proposal that the patients forums be allied to the new overview and scrutiny function, and said that having a patients forum to cover a local authority area would be a much more efficient and effective way of allowing the patient's voice to be heard.
  The Bill shatters the patients watchdog role of the CHCs, leaving a confused and compromised arrangement in its wake. The replacement for CHCs is to be a combination of patients forums, local authority overview and scrutiny committees, independent local advisory forums and patient advocacy and liaison services. The Bill abolishes CHCs without making it clear how the new arrangements will fit together. We are told that such matters will be dealt with through regulations and will therefore be subject to the tender mercies of unamendable regulations, which will be debated in Committee, not in the House.
  For example, rules governing patients forums access rights over premises owned or controlled by trusts within which they operate will be left to regulations. There should be a clear statutory power of access with no prior permission being required for the forums to be able to discharge their functions properly.
  Patients must have access to free, reliable and impartial advice and advocacy when they make a complaint. Liberal Democrats feel strongly that that important issue should be developed, and we welcome the Government's comments on developing advocacy services. However, we shall want to see the details of how they will work in practice.
  As things stand, the new arrangements fail to achieve what the Government say they will achieve. Patient advocacy and liaison services are not advocates but are

  1151
  employed by the trusts and are not even independent. As a result, PALS will be seen as the trust's poodles, not the patient's advocate. PALS' role, despite their title, is not patient advocacy. It is more about provider advocacy; about putting a customer-care gloss on the NHS rather than delivering what patients want—a genuine partner and advocate of any complaints that they might make during their experience of the NHS. Instead, we shall have meeting and greeting, signposting and information provision and trouble-shooting. All that is customer care.
  Mr. Dawson: How do the hon. Gentleman's comments fit with the intention in the NHS plan to shape the future NHS around patients?
  Mr. Burstow: I shall develop that point later. The Government say that if patients forums believe that PALS are not working in the best interests of patients, they can recommend that they become independent. Why have such a device in place? Why not simply make them independent in the first place?
  The same flaws that can be laid at the door of PALS also apply to patients forums. How easy will it be in practice for forum members, individually or collectively, to spotlight service failures, and how will they maintain the distance and independence from the trust in which they are taking a close interest, especially as we now learn that they will be on the board itself? Being on the board places a legal duty on members to act in the best interests of the trust. How can they do that when they are meant to be acting in the best interests of the patients forum and the patients whom it seeks to represent?
  Reform of the NHS complaints system is needed, but not necessarily the current package. Public confidence requires that the reforms are firmly grounded in the outcomes of full, frank and detailed consultation that seeks the views of those with experience of the current system.
  The health ombudsman is an example of someone with experience of the existing system, but the health ombudsman was not consulted. Why not? Could it be that Ministers feared that the ombudsman might say something that would be unhelpful to this package of measures? Without such consultation, how can anyone have confidence in the new arrangements? The new system will be so full of loopholes that the concerns will go unreported and bad practice will go unidentified and even unchallenged.
  We welcome the news tonight that an attempt is being made to put together a national overview body, but it is essential that we have a strategic overview, nationally, regionally and across the local health economy, drawing all matters together rather than fragmenting them, which is what the Bill appears to do.
  To succeed, care trusts must be genuine partnerships between the NHS and local government. Both parent agencies should share responsibility for a jointly accountable body. The local link and the accountability of local councils should not be lost or diluted when it comes to services for older people and the wider services that the new care trusts could be providing. I hope that, in Committee, we shall have time to explore in more detail the checks and balances to be put in place to ensure that care trusts do not simply medicalise social care.
  1152
  Help the Aged, in its brief for today's debate, rightly says how important it is that there is a genuine balance between medical, nursing and social care. That is a concern that was echoed by the Local Government Association, which rightly seeks assurances that community based services will not find themselves submerged in an organisation that focuses on treatment and ill health.
  The key is cultural change, not organisational change. It is not about patient-centred care but about people-centred care and the need to consider the whole person, his medical and social needs. That is what a care trust could and should do and I hope that that addresses the earlier intervention of the hon. Member for Lancaster and Wyre (Mr. Dawson).
  The Bill leaves open the possibility that NHS services provided through a care trust could be charged for. For example, an Alzheimer's or dementia sufferer receives a service free in an NHS facility but could suddenly find himself in a private or local authority facility paying for the same respite service. The Bill must ensure that care trusts do not allow new charging policy anomalies to emerge and thwart all the good intentions.
  On the grounds of equity, fairness and practicality, I believe that the proposals regarding free nursing care are the meanest in the Bill. The Government's free nursing care plans are fatally flawed and take no account of the unsustainable squeeze on care home fees over the past few years or the accelerating rate of care home closures.
  The Bill is trying to get free nursing care on the cheap and will force more care homes to go out of business, deepening the existing crisis. In written answers, Ministers have admitted that the three-year £420 million estimated cost of the nursing care package is little more than a back-of-a-fag-packet calculation. No effort has been made to measure the true cost of free nursing care and no assessment has been made of the level of need.
  The figures used in the Government's calculations come from market analysts Laing and Buisson. The Government's figures are derived by taking average residential homes fees from average nursing home fees, giving a difference of £100 a week. Those same analysts warn, however, that fee levels are unsustainably low, and the figures that the Government have relied on date back to 1999.
  The proposed definition of nursing care will leave care home residents unclear about what they will have to pay for. The management and delivery of care involves a variety of nursing and care staff. Who performs what task can vary depending on a person's state of health. The bureaucracy involved in recording billable care will be formidable and costly. Who will foot the bill—the individual, the care home manager or the NHS?
  Vulnerable old and disabled people will have to pay for care that should be free, such as dressing ulcers, changing a catheter or skin care. If such tasks are delegated to a care assistant, they will have a price tag attached, but they will be free if performed by a nurse. A definition of nursing care based on who performs the task, rather than on what the task is, is plain wrong.
  The Secretary of State said that there will be constant assessment of the individual's nursing requirements. There will certainly need to be, because a person's needs are not set in stone and may change from day to day. To say that an initial assessment will set the basis on which

  1153
  a person will be charged is impractical and unfair and will create new anomalies. The Government have not fully thought through the proposal.
  Where are the extra nurses to do all these assessments to come from? We know that the Government want 20,000 extra nurses in the NHS and that the Royal College of Nursing says that over the next four years there is a nursing gap of 57,000. That is before one even talks about extra nurses in the private sector to make the proposals stand up. How can we make the system work in practice?
  We believe that the Government should implement the royal commission's recommendation for free personal care on the basis of an assessment of need. In Scotland, the First Minister has signalled a rethink of policy, and the Scottish Parliament's Health and Community Care Committee was unanimous in endorsing the recommendation. The Committee took its decision not only on the basis of equity and fairness but because the evidence convinced it that it would lead to better service delivery and would add value. Adopting the royal commission's proposals in full would underpin many of the Government's developments on care trusts and pooled budgets, not undermine them. Unlike the Government's proposals, it would be fair to all, and not just the few.
  The Bill tears up by the roots the independent system that CHCs represent and substitutes a confusing army of bodies that lack the teeth or the authority to act independently on behalf of patients. It also fails the test of fairness and equity in respect of long-term care. People with dementia and many other chronic conditions will be forced to pay for personal care such as help with washing and bathing that hospital patients get free.
  Before the last general election, the Prime Minister said that he did not want to live in a country where people were forced to sell their homes to pay for their care. The Bill means that that promise has been broken. The debt collector will still come a-calling on some of the most frail and elderly people in the country. That is why the Bill should not receive a Second Reading.
  8.15 pm
  Mr. Hilton Dawson: As we are discussing a health Bill, it occurs to me that the life style here is incredibly unhealthy, what with spending the night in one's office and five hours on the Benches. I was wondering where the pain in my neck was coming from, but then I realised that it was from listening to absurdities about the Conservative party riding to the rescue of community health councils.
  Quite a few colleagues have come out as former members of CHCs. I used to be a very junior and inexperienced member of Lancaster CHC. At no point during my eight years in that body did the local Conservative Member of Parliament talk to me about health issues, and I certainly did not see her at any of the meetings or demonstrations that we organised. I was not conscious of her support for us as we tried to fight off the rundown of vital health service resources in Lancaster, the disastrous introduction of market orientation, the removal of local representatives from any positions of influence and the barring of the CHC from doing its job effectively.
  We should acknowledge that this is a good and important Bill. It is another example of the Government making public-private partnerships work, with the new investment in family doctor premises. The emphasis on
  1154
  bringing together health and social services in a coherent way has been welcomed by almost everyone who has spoken on the issue. We need greater incentives in the NHS to support the best-performing hospital and community trusts, and there should be more intervention.
  We have not had full acknowledgment of the major step forward that the Bill takes to provide free nursing care in nursing homes, benefiting about 35,000 of the most needy and vulnerable people in the country. In May 1997, my constituency embodied some of the worst features of both urban and rural deprivation, and I am extremely pleased to see the new measures to attract GPs to under-doctored and deprived rural areas. The Government are trying to bring fair funding to the NHS. In the two rural health authority areas in my constituency, that can only be for the good. There is no doubt that many people in rural communities lost out badly in the past. I also welcome the new GP's contract.
  The great thing about the Bill and the NHS plan is embodied in the quote that I offered the hon. Member for Sutton and Cheam (Mr. Burstow) a few minutes ago:
  The NHS will shape its services around the needs and preferences of individual patients—
  I agree that it should probably refer to people—
  their families and their carers.
  That quote is from the core principles of the NHS plan.
  We heard a lot of nonsense from the hon. Member for Southend, West (Mr. Amess) about who did not agree with that plan, but there has been clear acknowledgement of its importance. Almost every reputable health-based organisation has signed up to the fundamental principles of the new future of the NHS.
  The following quote is also significant to me:
  This patient-centred thing is good. It makes you do things differently.
  That is what a doctor said to me when I visited the Royal Lancaster infirmary in my constituency. Incidentally, on the same day my right hon. Friend the Secretary of State announced an extra £800,000 for intensive care services at that excellent hospital.
  We are getting the major investment that the health service has needed for many years. There is to be an increase of one third in real terms in NHS funding in the next five years, but we also need the radicalism to transform an institution—albeit a beloved one—that has become ossified because it has been underfunded and neglected. We need to change its structures, its systems, its strategies, its policies, its practice and all its myriad ways of getting on with the job to meet the needs and preferences of individual patients, their families and their carers. The tremendous radicalism of that change of emphasis, that fundamental transformation in the way in which we want the national health service to work has been overlooked throughout this debate.
  Mr. Hammond: The hon. Gentleman seems to have moved slightly off the point. I should be grateful if he would clarify whether he supports the Government's proposal to abolish CHCs in England, or whether he opposes it. In my winding-up speech, I shall want to do a

  1155
  tally of hon. Members who have spoken on each side of that argument and the hon. Gentleman's position is a little ambiguous.
  Mr. Dawson: The hon. Gentleman should possess his soul in patience. I shall come to that in due course.
  Mr. Bercow: We cannot wait.
  Mr. Dawson: Good.
  The Government are embarking on a radical agenda that promises to put behind us the medical model of the NHS, which sees patients as collections of symptoms rather than unique individual human beings. The new measures will bring the NHS into the modern world. One of my constituents, a GP, told me:
  So often people come to surgery telling me all about their condition because they've researched it off the internet.
  The new plan is so radical that some of the NHS's best friends do not appreciate what is being undertaken. That is understandable because CHCs in particular had to fight for the principles of the NHS against the policies of the Conservative Government. As they had to defend vital services from the cuts imposed by the previous Administration and try to protect and preserve local quality services that were under threat for so long, many of my constituents who are involved in CHCs remain in a very defensive mode. That certainly applies to some of the dedicated, experienced people who fought the depredations of the Conservatives for so long. However, we cannot hold up CHCs as paragons of perfect performance within the NHS because, no matter how experienced, qualified, able and articulate people were, they were shouting from the sidelines and their efforts made very little difference against the will of the previous Government, who were trying to run down the NHS.
  We need far more effective ways of involving patients in the future of the NHS. It is the statutory duty of all elements of the NHS to consult people and it is now important to wrap the service around the fundamental principle of patients' needs.
  Mr. Bercow: I am grateful to the hon. Gentleman for giving way because a cloud of ambiguity continues to overhang his view of the future of community health councils. Does he now regret signing the motion commending the work of community health councils on 13 December?
  Mr. Dawson: I do not regret that for an instant. I thought that I had made it perfectly clear that I think that community health councils have done a remarkable job. Since I signed that motion, the Government's vision of the future of patient involvement and patient empowerment—[Interruption.] Opposition Members may scoff, but it has been obvious from what we have heard during the past few painful hours that they have no vision for the future of the NHS and have given it little thought. As usual, they are jumping on one nonsensical bandwagon that years of their failure to support CHCs cannot possibly justify.
  The new care trusts provide an opportunity to bring the civilising values of social work to the health service. As someone who cannot bear petty squabbles about
  1156
  organisational boundaries, special pleading about who does what, jobsworths, bureaucrats, pedants and bores, I look forward to the new discipline of community trusts looking at what is in patients' best interests, what works, how we can do better and a fundamental raising of standards, bringing parties together, joining up policies and making things work better.
  I am delighted at the end of preserved rights. There can be no more grievous misnomer than preserved rights for the penury inflicted on very old people whose money has all gone and whose income support has failed to keep up with the changes. Such people have been left in an extremely vulnerable position.
  The Government need to listen to the words of my hon. Friend the Member for Wakefield (Mr. Hinchliffe), especially on free personal care; he made an excellent speech. I have previously pointed out that residential care for older people is extremely important; we need high standards in the quality of such care. It must be seen as a positive choice for older people. We shall not achieve the quality and consistency that we need if personal care has to be paid for while nursing care is free. There is an inconsistency and illogicality in that position and I urge the Government to reconsider the matter.
  A considerable amount of money is involved. If we are ever unfortunate enough to suffer again under a Conservative Government, that money plainly would not be in the system. However, the money could be invested to improve the quality of care offered, to ensure that boundaries are broken down and that the logic of the partnership approach is allowed to operate.
  The Bill is visionary. The Government are visionary on the NHS and so much else—
  Mr. Deputy Speaker (Sir Alan Haselhurst): Order. The hon. Gentleman has had his time.
  8.30 pm
  Mr. Stephen O'Brien: In some respects I am glad to follow the hon. Member for Lancaster and Wyre (Mr. Dawson)—not least because my mother was a theatre sister at Lancaster infirmary, which gives me some insight into the workings of the NHS from the point of view of one generation. Furthermore, I am married to a nurse, which gives me an insight into the present workings of the NHS.
  NHS patients in south, west and mid-Cheshire, in the area encompassed by my Eddisbury constituency, have been well served by the Cheshire Central community health council and the Chester and Ellesmere Port CHC on the relatively few occasions when patient care has gone wrong, or has appeared to do so. In the 16 months since I had the privilege to be elected to the House, I have come to know of the excellent, fair and, above all, independent work of the CHCs—not least from the many constituents who have ensured that I have been informed about it.
  I hasten to add that that is no argument for preserving CHCs in aspic: it is common ground between us that they need to be developed, expanded and supported, as many hon. Members have pointed out, including the hon. Member for Salford (Ms Blears) during a Westminster Hall debate; I think the word that the hon. Lady used was "evolving". However, as far as I have been able to determine, there has been no Back-Bench agreement about scrapping the CHCs.

  1157
  The Government's NHS plan exercise, in which they received a derisory number of responses to their rushed pretence at consultation—a hallmark of the Labour Government and a matter to which I shall return— included no reference to the possibility of scrapping CHCs, let alone a proposal to do so. When the Government announced on the internet the abolition of CHCs—at paragraph 10.27 of the NHS plan—there was consternation and despair, not only naturally enough, among the CHCs' employed staff and volunteers, but among patients, trusts, doctors and nurses. That was certainly true in my area.
  In the light of the early-day motions that have been tabled during the past few years in support of CHCs—we have just heard about one of them—and knowing, from his agent's letter, of the Prime Minister's views, I challenged the right hon. Gentleman to drop his plans to scrap community health councils. He said that he was
  aware that there is bitter opposition, which is why the proposals are being consulted on … 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.]
  Given the events of the preceding months, that gave rise to immediate and real hope among CHCs, patients and NHS staff.
  The House can imagine my surprise when, on the following Monday, I received a letter from the Prime Minister, extraordinarily addressing me as "Dear Stephen", in which he wrote:
  Following your question in the House regarding the abolition of Community Health Councils, I thought it would be helpful if I clarified the nature of the consultation on which we are currently engaged … Our proposals mean that Community Health Councils are to be abolished, subject to legislation.
  He then rabbited on with the usual guff for a few more pages, concluding:
  This better describes the consultation I alluded to in my answer during Prime Minister's Question time.
  On which occasion—15 November or 20 November—was the Prime Minister telling the truth? That same week, we were informed—
  Mr. Deputy Speaker: Order. I think that the hon. Gentleman could choose his words more felicitously. It is not the practice of the House to make such implications—let alone directly to accuse a right hon. or hon. Member of misleading the House.
  Mr. O'Brien: Thank you for your guidance, Mr. Deputy Speaker. I did not intend to imply anything other than a need to find out on which of the statements I could rely.
  Mr. Deputy Speaker: Order. In that case, the hon. Gentleman might do the House a service by correcting his words or apologising suitably for them.
  Mr. O'Brien: In that case, Mr. Deputy Speaker, I shall rephrase my point. On which of the Prime Minister's points of view could I place most reliance?
  Later in the same week, the chairman of the Association of London Health Councils telephoned No. 10 to find out whether it was true that there would be an opportunity for further consultation. She was told by the press office that
  1158
  the Prime Minister had made a slip of the tongue and that community health councils would be abolished. My hon. Friend the Member for Worthing, West (Mr. Bottomley) asked the Secretary of State for the precise date on which the Prime Minister and Secretary of State decided to abolish CHCs. An answer to that question would give us the opportunity to assess whether there was in fact any prior consultation.
  We should consider the effect of these events—the Secretary of State should certainly consider it—on the employees and volunteers at CHCs. While we are dealing with crass shortcomings in due democratic processes, let me quote two letters from the chief officers of my local CHCs, written last November and December—five to six months after the bombshell was dropped in "The NHS Plan" that CHCs would be scrapped. Mr. Ryall-Harvey, chief officer of Chester and Ellesmere Port CHC wrote to the hon. Member for Ellesmere Port and Neston (Mr. Miller), who copied the letter to me. Mr. Ryall-Harvey wrote:
  I should remind you that the jobs of all CHC staff were put at risk following the announcement of the abolition of CHCs over the internet and without prior consultation on 27th July. It is now mid-November and the Secretary of State is refusing to discuss the legitimate concerns of CHC staff with either their Unions or in individual correspondence. He has refused to make an announcement on TUPE transfers or on clearing house arrangements. These are not the actions that one would expect of the NHS as a responsible employer and they do not sit well with Mr. Milburn's recent speech on improving the working lives of people who work in the NHS.
  I find it difficult to understand the motivation for this behaviour and it simply adds credence to Dr. Liam Fox … I am extremely concerned about the effect this situation is having on my staff and colleagues. I feel that whatever the experience individual politicians have been of their local Community Health Councils, they should recognise that CHC staff … many with long service … deserve to be treated decently.
  Mr. Dawson: Given the major initiative embodied in the Bill and other aspects of the Government's approach to the health service, the hon. Gentleman should surely tell his constituent that there will be tremendous opportunities for CHC workers and volunteers in the new NHS.
  Mr. O'Brien: I shall not use my short time to answer that question. This is a matter for the employers, particularly the Secretary of State.
  On 22 December—just before Christmas—the chief officer of Cheshire Central CHC wrote:
  The NHS in the regions has been ordered to undertake rapid consultation on the Plan. We went to a meeting on 12 December when we were "reliably" told by the NHS Executive that the second reading of the Health and Social Care Bill would be in February. Yesterday, the day before the Christmas break was to start, we were informed it will be on 10 January. This makes the rushed consultation exercise an absolute farce. The government has again got its timing just right to achieve maximum gloom for CHC staff.
  The Minister should take this opportunity to do the right thing and provide answers to those concerns. I was pleased to secure a one and a half hour Adjournment debate in Westminster Hall on 28 November, which was attended by many right hon. and hon. Members from the Labour Benches who seemed not to support the Government. I believe that their support was absent for good reason. The same has been the case today, although the hon. Member for Lancaster and Wyre (Mr. Dawson)

  1159
  was entirely opaque about whether he thought CHCs should continue. Labour Members wish to welcome the plan, but are ashamed of their Government.
  Mr. Dawson: I am sorry to have been opaque. I do not think that CHCs should continue. The vision set out in the Bill and other documents provides a far better way in which to empower and involve patients in the future of the NHS. I hope that that is clear.
  Mr. O'Brien: I am grateful for that clarification, which is better than the hon. Gentleman achieved in his speech. Government Back Benchers in general are ashamed of this aspect of the proposed NHS plan—
  Mr. Swayne: That is why they signed the early-day motion.
  Mr. O'Brien: As my hon. Friend says, many signed the early-day motion.
  The Government showed breathtaking arrogance in their assertion that consultation had taken place prior to the decision to scrap CHCs. That was a sorry and sad spectacle of shameless window dressing. They should now drop their plans to scrap CHCs and should instead resource and improve them, as my party is committed to doing, as my hon. Friend the shadow Secretary of State made plain. We should support CHCs by providing resources and giving them confidence in their job, which involves dealing with vulnerable members of our society. That is because, when things have gone wrong, NHS patients need to be able to trust the independence of those who will take up their case for them, and the last thing that they are likely to trust is a creature of the very body that they are trying to hold to account.
  I fear that the Government thought at one point of sidling away from scrapping CHCs but were scared of looking as though they were caving in to outcry, either from Her Majesty's official Opposition, or from their own Back Benchers. For what it is worth, I should like to offer Ministers a deal: if the Government now execute a U-turn and do not exterminate CHCs, I for one shall refrain from calling it a U-turn. CHCs and NHS patients truly believed that, at Prime Minister's questions on 15 November, the Prime Minister had his hand on the steering wheel ready to make that U-turn. However, it is clear that the Secretary of State for Health and his civil servants had grabbed the wheel by 20 November.
  I fervently hope that CHCs will be retained. If so, their future quality will rest primarily on their independence and effectiveness in ensuring that NHS patients' interests have the opportunity to be taken through the maze that the NHS naturally represents to most people. One of the most valuable services performed by CHCs, as Members of Parliament on both sides of the House have said, is that they are a friend in need who knows how to map a route through the maze. I do not believe that the plethora of proposed new bodies will simplify the system or enhance confidence, or that they can command the trust of patients at their most vulnerable. That is especially true of the elderly, who fear that they will need to use the NHS fairly regularly and do not want to gain a reputation for complaining. The new bodies are hardly likely to alleviate
  1160
  those fears. CHCs have generally done a tremendous job in recent times, especially in ensuring that there is a degree of trust.
  I am conscious that it is unlikely that Ministers will be swayed by a member of the Opposition, as that reflects their approach to Parliament, but it might be helpful to my case to cite the views of people who live in the catchment area of the CHCs serving my constituency. Mrs. Cynthia Taylor writes:
  I am sorry to hear of the proposed demise of the CHC. I feel that the proposed five agencies will not be in the patients' interest … The council needs to be independent, not involving the trust in any way. The CHC was helpful to me in my complaint against
  the local hospital. She adds that
  the CHC did a pretty good job. The proposed new council sounds like just another quango to me.
  Mrs. Taylor says that "Healthwatch"—a local health magazine—
  reflects the view of ordinary folks
  that CHCs should continue, and she ends by asking, "or don't we matter?" Denise Pritchard of Tarporley writes:
  The multiplicity of Ministers in the present government should, I feel, have in each of their offices a large notice—"If it ain't broke don't fix it". They seem unable to resist the temptation to change things and the changes they make are of doubtful value and usually cost more!
  I have a number of letters, but there is not enough time to read them all out. Supportive comments for the retention of CHCs have been made by the Law Society and the British Medical Association, although, interestingly, Dr. Ian Bogle was a signatory to the NHS plan. Age Concern, despite an earlier reference to it, says:
  Many older people and their relatives have received support from Community Health Councils …, which they value for their independent perspective.
  I urge Ministers to consider the enormous amount of evidence from those with past experience and all those who are concerned about the quality of the NHS and patient care. CHCs should not scrapped, but supported, developed and given the resources to do the fine job which we know they can do.
  8.45 pm
  Ms Julia Drown: In an intervention on the hon. Member for Southend, West (Mr. Amess), I quoted support for the measure in a briefing from Help the Aged. However, I inadvertently referred to that briefing as being from Age Concern. I apologise, but I saw the same briefing in the hands of the hon. Member for Southend, West, so my point remains valid.
  I welcome the Bill, which comes from a Government committed to improving the NHS, increasing investment in it, and improving its quality. I see that in my South Swindon constituency, where a new hospital is being built, and where we have an NHS walk-in clinic, access to NHS Direct, a refurbished accident and emergency service, a new mobile breast cancer screening service and additional ear, nose and throat facilities and cataract services. That is all happening on the ground in my constituency. By contrast, the Opposition divided up the NHS, made one hospital compete against another and failed to fund the health service. Their management of the NHS led to an increase of 400,000 people on waiting lists from 1979 to 1997.

  1161
  In looking at the Bill, I should like to start with the issue of long-term care. The House should note that the royal commission did not produce a unanimous report. There was a significant minority report, which made recommendations similar to those in the Government's proposals. The commission addressed difficult issues, and the Select Committee on Health dealt with the same difficulties when it considered long-term care. I share the Government's view and that of the minority report on the need to distinguish between personal and nursing care: that was a persuasive viewpoint. How ever, I would be the first to welcome personal care being free, if money for that could be found. However, I accept that a balance must be struck.
  On one hand, we all know about the concern in our constituencies that those who go into residential nursing care are sad to leave their own homes, and feel additional sadness when their finances disappear to pay for care. They are disappointed that they have less inheritance to pass on to the next generation than they had planned. On the other, we all see nursing and residential care homes in our constituencies which, with more funding, could provide better care. We see how the quality of life for residents could be greatly improved by the provision of more therapists, more staff, who should be better paid, and more staff training.
  All Governments have to think about the funds that they have and must strike a balance between those two concerns. The majority report of the commission on long-term care argued for more support for individuals' personal finances, saying that all personal and nursing care should be paid for. However, the minority report called for more of a balance in provision, which the Government have been correct in striking. Individuals' finances have been supported, and free nursing care will help 35,000 people. The three-month disregard will help families financially, and will allow our constituents to keep more of the funds that they have earned in their lifetime.
  It is right to balance that financial help with improving quality of life. It is not only about improving the quality of life for those in nursing and residential homes, but about supporting the quality of life for people at home. I want to see an expanded home help service and go back to the days when one could get individual help, such as a home help service to help with cleaning around the house. Such help is not provided by most local authorities, but it is good preventive care and would pay for itself in the long run. To get those finances, have that good preventive care and get more aid more quickly to our constituents, we must look to the Government to strike those balances. I therefore support the Government's decision to create a balance between supporting people's personal finances and the care that we give our constituents.
  I also welcome some of the Bill's specific proposals. Clause 53 allows residents to pay a top-up towards more expensive accommodation. There must be good quality nursing and residential care for everyone, but I also welcome the freedom that this measure will give to my constituents to buy into more expensive homes, just as younger people can choose to spend their money on more expensive houses or services. I know that my constituents will welcome that.
  I have a concern—which has also been raised by the citizens advice bureaux—relating to disregarding the value of people's homes. Local authorities currently have
  1162
  the power to disregard the value of a property when other family members live there. That is an important disregard. A person's moving into a residential or nursing home should not make another family homeless.
  The CABs have made a sensible suggestion, which I hope the Government will consider. It is that there should be mandatory property disregards, and that they should be extended to all cases in which the property continues to be occupied by a relative, a same-sex partner or a carer who received or met the conditions for invalid care allowance during the 12-month period before the resident entered residential care.
  I particularly welcome the ability to provide health and social services care in an integrated way. This will be welcomed throughout the country. I am sure that most hon. Members have come across instances in which one of their constituents needed care but was faced with the health service and social services arguing about who should provide it. The more we can push people to work together, allow people to work together, and establish pooled budgets, the better we shall be able to achieve what our constituents want: a good quality service. Many people do not understand the distinction between health and social services. The more we can create a seamless service, the better the care we shall be able to provide for our constituents.
  I also welcome the setting up of the local investment finance trust, providing up to £1 billion of investment so that GP practices can be improved. I should like to bid, right now, on behalf of a number of practices in my constituency that have been waiting for some time for development funds such as these, so that they can update their premises and give their patients the care that they want to give.
  Pharmacists in my constituency will welcome the proposals for expanding their role. They have frequently talked to me about the greater help that they could provide to GPs and to the wider NHS. The Bill allows some of those developments to take place. It is absolutely right that we should extend prescribing rights to pharmacists and other health professionals, and I am glad that we have support across the House for that measure, which is most welcome.
  The Bill also allows for prescriptions by e-mail. Some of my constituents have asked me why we cannot use new technology to make things easier for them. The proposal is all part of creating a flexible and modernised NHS for this new century.
  The powers to extend NHS dentistry will also be widely welcomed. I am delighted that this Government have restored NHS dentistry to Swindon, where none was available to adults under the Tories. The more that that can be made available across the country, the better.
  I am also pleased that the Government will look at patient involvement. That is important. There are undoubtedly good proposals on patient involvement in the Bill, and they will have a positive impact on health. NHS care should not be something that is done to people; it should be a partnership between an individual and the clinicians and, ultimately, patients should take charge of their treatment. Taking charge in that way has a positive mental and physical impact on many illnesses. Better physical and mental outcomes will result if patients are seen to be the centrepiece of their care and their care plan.

  1163
  I welcome all the new developments, particularly the involvement of local authorities. In the history of consultation, local authorities have been better at genuinely consulting than the NHS has been. The NHS has traditionally been very good at making announcements to the local population, then going on and doing exactly what it said it was going to do. Local authorities, however, have a history of listening and changing as they go through a consultation process.
  Mr. Bercow: I was somewhat provoked by the hon. Lady's elliptical reference to patient involvement. Will she tell the House whether, pursuant to her signature of the early-day motion on community health councils—we are keeping a tally of those involved—she continues to support those councils, or whether she now supports the PALS that are to be employed by the trusts that they are somehow expected to scrutinise?
  Ms Drown: I was just about to explain my position. Perhaps the hon. Gentleman could wait a little longer.
  It is important to have more patient involvement, but there should be independent support for people making complaints in the NHS. People should receive help from the trusts so that their complaint can be dealt with straight away. The Select Committee on Health found that the earlier a complaint is dealt with, the more likely it is to be dealt with constructively.
  In that sense, these proposals are an improvement. However, why not allow more of the proposed structures to be linked to the Commission for Health Improvement? Including independent people in the process could lead to better logging of complaints across the country. Patterns might be created across the country in a way that cannot happen at present under community health councils. The movement of locums across the country could be logged and complaints picked up more easily. I hope that the Government will consider that.
  There are three points on patients forums on which I would like clarification. The first is the right to inspect in all settings. That will impose on all members of those forums a need for patient confidentiality. I hope that Ministers can reassure us about that.
  Clause 12 refers to the annual reports to be produced by patients forums. They do not have to be the type of mammoth, glossy exercises, of questionable benefit, that are produced by many trusts across the country. One page of A4 paper will do, if it gets across the key points. That will enable patients forums to concentrate on their important work.
  Age Concern has reported how elderly people find it hard to have their complaints about the NHS listened to. The views of women and children are also often not heard. One reason why women are still sometimes invisible in our society is the sexism in our language and in the wider society. Sexist language reinforces the male dominance that we still see. The explanatory notes to the Bill refer to "manpower" when "staffing" could be used, and the Bill provides that forums should be chaired by a chairman. People tend to think of men when they hear "chairman", so I would encourage the use of "chair" or another alternative.
  1164
  I urge Ministers and right hon. and hon. Members on both sides of the House not to be too prescriptive or bureaucratic in the way that we develop the NHS. We are, quite rightly, being asked for more details about the Bill. Organisations are also pushing for matters such as membership of patients forums to be subject to primary legislation rather than regulation and for the Bill to state the system of accountability to be exercised by local authorities over their own scrutiny committees.
  We do not want over-regulation in the NHS. It has a tendency to bury itself in paperwork and it needs the freedom to allow pilot schemes to start, to create flexibility and to see what works for various areas. Of course we need to regulate for safety, but apart from that we should limit regulation to allow NHS and social services staff to get on with caring for people, as they do so well—staff on the front line and behind the scenes too. The more regulations and paperwork that exist, the more we limit their flexibility. I am glad that the Government support managers all the way down the line—or perhaps that should be up the line—to patients so as to limit regulations and allow people the freedom to get on with caring for patients.
  The Bill contains powers to extend the direct payment scheme. That is welcome in terms of giving people more control over their care. However, direct payments can lead to extra bureaucracy and there can be dangers when the care plan breaks down, for example. We must ensure that there is a choice and that it is monitored carefully.
  Clause 59 is entitled "Control of patient information". Again, I hope that we can avoid the mistake made by the Tories, which was to create too many regulations to protect patient confidentiality when NHS staff should be trusted. They recognise the need for confidentiality. We need to ensure that information flows throughout the NHS, which will help to support research and patient care. That is important too.
  I have dealt with parts of the Bill in detail. It is a good measure and I welcome it. It will be a leap forward for patient care—I should say people care, as much of it is social care and we must think of people as individuals, rather than patients My constituents will welcome the Bill. I apologise to you, Mr. Deputy Speaker, and to both sides of the House, as I cannot be here for the replies, but I will read them with great interest. I am pleased to be here, however, to support this Second Reading.
  9 pm
  Dr. Peter Brand: I shall not talk about community health councils or long-term care—not because those are not important parts of the Bill, but because that ground has been covered well in the debate, in particular by my hon. Friends the Members for North Devon (Mr. Harvey) and for Sutton and Cheam (Mr. Burstow).
  A number of the issues in the Bill concern me as matters of detail, but they are best explored in Committee. I shall highlight the more philosophical issues that underpin some of the hints that the Government are giving us as they unroll their plans for the national health service.
  I was intrigued to see the parts of the Bill that deal with setting up pilots, which are to be administered by the Secretary of State. I was bemused by the traffic light system, which would empower the right hon. Gentleman to reward positively or negatively the performance outcomes not of health authorities but of trusts.

  1165
  I wonder about the Government's avowed intent, because when they came to power they made it clear that they wanted to retain the commissioner-provider split. The Bill, as we will explore further in Committee, will result in direct management of NHS provider units by the imposition of particular standards, not through the commissioning bodies—health authorities—but directly through the trusts. If that is to happen, let us be open and honest about it. Let us say that the great experiment— the tension between commissioning and providing—is no longer relevant if we are not to have a managed market.
  I was a big critic of the unmanaged market unleashed by the previous Government's reforms, but the managed market was working in the interests of patients. It made trusts sit up and tailor some of their activities to the communities that they serve, rather than to what suited them best.
  In the Bill we see an extension of what we have seen with the special initiatives of which the Government are so fond, and the projects for bidding for extra funds, in which the delivery units are directly influenced. Once one influences, one controls what happens on the ground. That is worth exploring, and I should be grateful if the Minister could say in his reply where the Government intend to go in the long term.
  I recognise that the health service evolves; it has never stood still. I think that this is the fourth or fifth reorganisation during the 30 years that I have worked in the service.
  Mr. Swayne: It is what will happen on the ground that concerns me. Will the hon. Gentleman consider the case in which constituents may already be unfortunate in the service that they are receiving from a trust, then the trust gets the red light and is therefore punished by the Secretary of State in some way? Are they likely to get an improved service as a result, or is it more likely that there will be an even worse service?
  Dr. Brand: The hon. Gentleman makes a valid point, and it needs to be examined in Committee. The wording in the Bill is unfortunate. It seems to imply that funding will go only to trusts that meet performance targets, whereas the Secretary of State has said that funds would be made available to other trusts, but with strings attached. That implies that a management team will emerge from Richmond house to sort things out. I wonder whether that would not be better done through health authorities, as they should be more aware of what is required in their localities.
  Before I move to my next question, I have to declare an interest. I qualified as a doctor in 1971, and have worked for the national health service for 27 years as a general practitioner, largely on the Isle of Wight. I have enjoyed being an independent contractor tremendously, and I still do a little work on a part-time basis. I shall have to see what happens later this year, but I have greatly enjoyed my calling.
  In previous NHS reorganisations, GPs were often asked how they would meet certain objectives, and what they were going to try to achieve. The usual answer was that GPs wanted to continue to provide a good service to patients and to be responsive to their needs, while remaining able to employ the team of people who are so vital in primary care—and to pay the mortgage. That is a small ambition, but it is amazing how inventive GPs have had to be to achieve it in the face of reorganisations.
  1166
  Two proposals in the Bill ring a small alarm bell with me. The first is the plan to scrap GPs 24-hour responsibility for their patients. I know that many of my colleagues will not be displeased by that proposal, but I may belong to the last generation of family doctors who felt that they were responsible for the total care of their communities and the individuals within them.
  The proposals to allow organisations to take over some of that responsibility are much to be welcomed, but the doctors with whom patients are registered should retain a responsibility for the quality of care that an outside organisation delivers.
  Mr. Denham: The Bill does not remove GPs 24-hour responsibility for patients. In practice, many GPs look to an out-of-hours provider, and the Bill clarifies the way in which a GP can delegate that responsibility to an accredited provider. That is an important distinction. We can discuss it further in Committee, but I want to clarify that very important point this evening.
  Dr. Brand: I accept that distinction, but GPs will still be contracting out a responsibility. Before, we contracted out a service and retained responsibility for it. There is a difference.
  My other misgiving concerns the extension of the private finance initiative into primary care. It is clearly good for GPs to have access to funding. That allows them to improve their capital stock and give a better service to patients. However, I am concerned that we will end up with a uniform pattern of one-stop shops. They might be completely suitable for cities and more densely populated areas, but it would be difficult to sustain them, and their responsiveness to patients, in more rural areas. In addition, whoever contracts with the private sector to provide the premises will also have control over who works there.
  I have been very privileged. I have been answerable to my patients, the General Medical Council and God. I do not think that the Secretary of State came into it very much. One could continue to provide a service as long as one had a patient base. The introduction of clinical governance is absolutely right, as is the need to look at outcomes and to take account of all the other matters that are so important. I agree that things have changed; I may have started my career in feudal mode, but things have moved along considerably. A GP relies on team work, and patients are part of that team.
  I am worried about the possible creation of a blueprint that might be too prescriptive, dictating to primary care teams not only what service they deliver, but how it is delivered. We are already seeing evidence of that in primary care groups and trusts. I suspect that I am being old-fogeyish, but I think we have done extremely well out of the dedication and initiative shown by private independent contractors. I hope that we can retain that arrangement, because I do not think that a more bureaucratic organisation will create what the hon. Member for Bedford (Mr. Hall) described as a national health service according with patients' needs.
  We must have balance. It is entirely right for us to be responsive to patients' needs, but pure consumerism in health care would be very expensive. It could not be afforded, even given the Government's more relaxed attitude to funding. Patients' demand for access is almost

  1167
  infinite. It is not unusual for a doctor to be called out in the middle of the night because a shower is not working, or because someone needs a plumber. It should be possible to say no occasionally. I am sorry to say that my practice recently had to introduce an all-appointments system, because the work load could not be managed in any other way, unless people were made to wait for a very long time. We no longer deal with requests for prescriptions on the telephone, because we do not have enough staff to deal with that work load either.
  I welcome some of the initiatives on prescribing. It is entirely right to enable other members of a clinical team to take responsibility for their areas of expertise. I would be foolish not to countersign prescriptions written by my practice nurse or the district nurse, but it is demeaning and stupid that I should have to do so. On the other hand, I would be very worried if there were a free-for-all allowing me to sign prescriptions for my own medication, or—this aspect was raised by the hon. Member for Woodspring (Dr. Fox)—to obtain my asthma inhalers ad lib over the counter. If that were possible, someone might be given too much of the wrong medication, which would not be in that person's interest.
  A balance must be struck. Consumerism in the NHS may be good, in the sense that we must be responsive to people, but allowing patients to dictate what happens in the NHS would not be a positive development, because it might not benefit the wider community. That is why I made my point about the naming of the patients forum, and the over-dominance of direct NHS users in it. The health service should do more than just treat people who are sick. It should be there to maintain health, to promote health and to take account of the broader aspects of the community that it serves. I hope that we shall have an opportunity to explore some of those issues in Committee.
  9.13 pm
  Dr. Desmond Turner: I give the Bill a hearty welcome, principally because I think it constitutes a genuine attempt to deal with a number of serious problems left by the last Government.
  As always when I listen to the right hon. Member for South-West Surrey (Mrs. Bottomley), who was Secretary of State for Health in that last Government, I could not help but be amused. She spoke as though she had left us a garden of Eden, but we saw it quite differently. The Bill, as I have said, addresses problems left by her and other Conservative Secretaries of State.
  Mr. Hammond: Will the hon. Gentleman give way?
  Dr. Turner: I have hardly started.
  Although I very much welcome the Bill, there are three proposals that I cannot agree to and I want some definite answers on them.
  Clause 6, which has not been mentioned, relates to terms and conditions. The national health plan makes a reasonable commitment to provide better and fairer rewards for NHS staff. The Minister knows that for some time we have been drawing to the Government's attention the plight of grotesquely underpaid members of staff. We have been particularly concerned about medical laboratory scientists who, until today, entered the service
  1168
  as graduates on a starting salary of less than £8,000 a year, which is half what a graduate nurse receives. Unsurprisingly, it is difficult to recruit and retain medical laboratory scientists. In a service that is increasingly dependent on sophisticated diagnostic skills, those people are essential.
  I am happy—as is my union, the Manufacturing Science and Finance Union, which represents those people—about the double-figures, inflation-busting pay increases. That is great, but there is still an enormous gap. Those workers are poorly paid by the standards of comparable professions. However, that is a good start and we are grateful for it, but it has not solved the problem.
  How will the provisions in clause 6 help to address such issues in future? Are the Government going to do something about the decoupling that the previous Government undertook many years ago when they removed many groups of NHS workers from the remit of the pay review body?
  Mr. Denham: The purpose of clause 6 is to enable us to ensure that the outcome of the "Agenda for Change" negotiations, which are taking place with trade unions, will apply to all health service employers. We do not have the power to do that under existing legislation. My hon. Friend will be aware that "Agenda for Change" deals with the issue of membership of the pay review body. However, trade unions in general welcome clause 6 because it will mean that the national framework for pay and conditions, which was destroyed by the previous Government, will be available for NHS employees. The Government and the unions have sought the reintroduction of that framework.
  Dr. Turner: I am grateful to my hon. Friend for answering my question. It means that I can move on to another point—[Interruption.] One out of three ain't bad.
  As for the democratic deficit, I believe that the Opposition are keeping a score. It is possible to add another name to the people who are happy to see the CHCs abolished. I, too, speak as a former member of a CHC. Although it is true that many of them have done good work, the one that I served on did not. I got off it as quickly as I could because it was a totally ineffective knitting circle. It was not helped by the fact that it had virtually no statutory powers, because they had been eroded. It was a bit of a dead letter. I feel that there is tremendous merit in returning local authorities to a scrutiny and accountability role in respect of the national health service. A council scrutiny committee will punch with greater weight and do much more incisive work, so the development should be welcomed.
  I am also happy with patient advocacy services, which are an absolute necessity as the current NHS complaints system is woefully inadequate. Currently, it is almost voluntary for a health authority or trust to respond to complaints. It does not have to grant a hearing unless it feels like doing so. That is wrong. If a complainant is unsatisfied, he or she should be entitled, as of right, to a full hearing at some form of independent tribunal. When we hear the detail of the proposals, I hope that we will be assured that such a structure will be introduced. I shall not join the chorus of defence for CHCs. It is interesting that such support should come from the Opposition, who were happy when the CHCs could not do much about

  1169
  the awful state into which they—the Opposition—were getting the national health service. Some false pleading is going on, and I think that it can be discounted.
  I am much more concerned about long-term care. Although I welcome the proposal for free nursing care, I, too, think that it should extend to personal care. I do not accept the Ministers' view that there is a clear and simple division between personal care and nursing care. For example, it is extremely difficult to make that distinction in respect of Alzheimer's sufferers. Indeed, the Secretary of State undermined the principle by saying that he would extend the coverage of nursing care. In what manner and by how much? Clearly, there will be opportunities for arguments, bureaucratic mistakes and vast amounts of assessment and reassessment, and hard cases could be thrown up. The proposal throws into question the financial imperative.
  It is clear that the Government have a problem—or, at any rate, a perceived problem—with fully implementing the Sutherland proposals and with instituting free personal care because of the cost involved. The Sutherland report shows that the difference between the extra cost of providing free personal care and of providing only nursing care would be 30 per cent. by the year 2050. All such calculations and predictions are fraught with danger. The range of possibilities means that it is difficult to be precise. The fact that the Government's proposal on nursing care extends more widely than the matters considered by the Sutherland commission when it made its calculations suggests that the difference in cost between nursing care and personal care may be less than the commission envisaged. Obviously, the cost is substantial; nobody would deny that. Meeting the cost of nursing care alone is a substantial and welcome commitment. However, I beg the secretary of State to reconsider the personal care issue.
  It is probably possible to encompass personal care in reasonable spending predictions and to deliver it. That would have the great merits of simplicity and fairness. It would save an enormous amount of administration in determining what is and what is not personal and nursing care. Anything that involves intimate body contact would be covered. The definition would be much simpler to operate and therefore much less likely to create hard cases. That is my instinctive view, having spent years as a councillor helping to run social services as a politician, but it is also a professional view.
  I tend to talk mostly to directors of social services and it is their view as individuals that such distinctions are not easy and are fraught with difficulty. I am told that the Government should not be totally satisfied with the response of the Association of Directors of Social Services, which appears to acquiesce to the Government's proposals, because a poll of directors of social services across the country would reveal a majority very much in favour of making personal care free. I think that that is the only fair thing to do. The proposal on personal care is the greatest flaw in an otherwise fine Bill. It needs a lot more careful thought. Providing free personal care is achievable, and, if we managed to do so, we would leave a reasonably proud inheritance to the nation.
  I believe that the Scottish Parliament is to do just that. It thinks that it is possible to institute to free personal care without having to resort to increased taxation, and proposes to do so. I therefore again ask the Secretary of State to look very long and hard at that question once
  1170
  more, because he has got that part of the Bill wrong. I do not ask him to judge the matter solely on the fact that many other hon. Members have latched on to the issue. There is good evidence to sustain the virtue of making personal care free. Then, we would all be able to subscribe to the situation.
  The rest of the proposals for dealing with the mess of community care are very welcome, although it will obviously be vital to know exactly how far the capital limits for disregard will be raised and other details of the financial regulations that will follow.
  Despite those three areas of concern—the first of which the Minister has answered to my satisfaction—I warmly applaud the Bill, although I hope that the Secretary of State will think very hard about personal care.
  9.29 pm
  Mr. Philip Hammond: I draw the House's attention to my registered interests in respect of property, which are relevant to the context of clause 4, about which I have nothing to say this evening.
  The Bill delivers the primary legislative changes that are required for the implementation of the national health service plan and the Government's response to the royal commission on long-term care of the elderly. The plan was presented to the House of Commons on 27 July last year. Perhaps surprisingly, given the apparent importance of the plan to the Government's strategy, this is the first opportunity that Parliament has had to debate it.
  We have now waited six months to debate the 10-year plan to save the NHS, which was brought to us after three years in office by the party that was elected claiming that there were only 24 hours in which to save the NHS. It is hardly surprising that we read about the cynical interpretation of the plan by people such as the member of the British Medical Association's general practice committee who was quoted in the press as saying:
  The NHS Plan exists to help re-elect the Government, not to save the NHS.
  No one denies that the plan contains some fine aspirations. Who could disagree with supporting and valuing staff, improving clinical outcomes, shaping services around patients, reducing waiting times and improving access? No one could disagree with those and many other worthy objectives outlined in the plan, but the idea that the way to make progress is to write down a 10-year central plan imposing a blueprint on this vast organisation from Bournemouth to Burnley, to be implemented and managed from Whitehall, suggests to me the thinking of Gosplan rather than a modern, democratic political party.
  Our judgment and the judgment of the people of this country on the Government's management of our health service will be based on the state of the real NHS. The gap between the real NHS that people have to deal with every day of their lives and the virtual NHS that we increasingly hear about from Ministers at the Dispatch Box is widening as their ambitions expand. Dr. Hamish Meldrum, a BMA leader, said that
  the plan promises the earth, but will not deliver.
  It has ratcheted up patient expectations beyond the capacity of the available resources to meet them. I am afraid that the Secretary of State must take direct responsibility for that escalation of public expectations.

  1171
  In those circumstances, it is perhaps no wonder that 84 per cent. of GPs surveyed in one of the GP publications described the NHS plan as "ill-resourced" and a "political tool". In a market research survey, 63 per cent. of the public believed that the plan was designed as a vote catcher and not a general commitment to reform.
  In the Government's fantasy NHS, there is to be an end to automatic efficiency savings. In the real world, we read today that £1 billion must be slashed from catering and cleaning bills, while a third of our hospitals are officially described as filthy. In the Secretary of State's fantasy NHS,
  no one will be denied the drugs that they need.—[Official Report, 30 June 1998; Vol. 315, c. 143.]
  That is a direct quote from the Secretary of State. In the real world, as every Member of the House knows or ought to know, British patients are denied an ever-expanding range of efficient drugs that are available in other developed countries.
  In the Government's fantasy NHS, the Prime Minister apparently thinks that providing an hour a day of domiciliary care in a person's own home is the equivalent of creating an NHS bed, whereas in the real national health service the number of nursing and care home beds in many areas of the country is contracting at an alarming rate. I have no idea what the hon. Member for Wakefield (Mr. Hinchliffe) was going on about when he said that Conservative Members had been bleating about empty care homes. We have been bleating about the absence of any available care beds in many parts of the country.
  I can give an example of the plan's detachment from reality. It establishes targets for GP services, such as a 48-hour guaranteed appointment, which we welcome, and it offers an extra 2,000 GPs by 2004 to achieve that target. However, when the Government were challenged by the entire medical profession with the evidence that it will take four or five times that number of GPs to deliver the plan, Ministers honestly admitted that the 2,000 figure had been included because that was the number they believed could be achieved. They did not remove those objectives from the plan, which they know cannot be delivered with the resources available. Apparently, the outbreak of honesty does not stretch that far in an election year.
  The most important point to note is that, running through the NHS plan, through the Bill and through most of the Government's health legislation to date is a slightly sinister, unspoken but quite consistent theme of the desire, the need, for total control of the NHS—of every detail of every aspect of the service. Some of my colleagues might be inclined to be a little less charitable than me, but I have no doubt that the Secretary of State genuinely believes that taking more power to direct and micro-manage every aspect of the service for himself is the best, perhaps the only, way to improve the NHS. That is his instinct; it is in his blood, his upbringing. But history, experience and observation of the world, as well as a growing weight of informed commentary, are against him. We should not be squeamish.
  The Secretary of State is running Britain's largest productive enterprise, the NHS, accounting for nearly 6 per cent. of the nation's GDP—a virtual monopoly producer of an important commodity, health care. To think that an organisation on this scale, operating in
  1172
  diverse conditions across England, can best be improved by centralising rather than by decentralising power, betrays a disappointing lack of ability to think outside the box.
  The key to prosperity or even survival of an organisation on the scale of the NHS must be devolution, flexibility and diversity of response, but on the evidence of the Bill the Secretary of State still hankers after absolute power to micro-manage the empire. [Interruption.] There seems to be some dissent on the Government Benches. Let us look at the Bill. Remember, it is ultimate power that counts because that is the real power and the Secretary of State knows that very well.
  The Bill contains clauses giving the Secretary of State the power to dictate the terms and conditions on which individual employees are hired and fired by every NHS body in the country. There are clauses to give him the power to dismiss boards or to hand over their functions to private contractors. There are clauses to force unwilling elected local authorities to surrender their responsibilities to unelected and as yet unproven care trusts. There are clauses that say that the Secretary of State can give or take money from any trust or primary care trust, bypassing health authorities and existing allocation mechanisms and their transparency and accountability. There are clauses that will allow him to grade NHS bodies through his traffic light scheme and dictate which of them have earned their autonomy by faithfully adhering to the line from Whitehall.
  That degree of hands-on control or micro-management is not only dangerous but is bound to fail in an organisation of the size and complexity of the NHS. If the Secretary of State can point to a single successful productive enterprise on this scale anywhere in the western world, organised on a centralised basis, I would be pleased to hear about it because I have not been able to discover one.
  Mr. Milburn: The Chinese army.
  Mr. Hammond: I should not have thought that that was a very effective example for the right hon. Gentleman's cause.
  Under the regime that the right hon. Gentleman has in mind, it will be increasingly difficult to detect what is going on in the NHS because he also intends to silence potential critics of this brave new world by abolishing the only independent voice of patients and communities in the health service—the CHCs.
  In today's debate, with two exceptions—I acknowledge that the hon. Member for Lancaster and Wyre (Mr. Dawson) clearly set himself apart from this view—every speaker from every part of the House disagreed with the Government's intention. [Interruption.] I said that there were two exceptions. [Interruption.] If I had to go into battle with only two people behind me I would not have chosen the hon Members for Lancaster and Wyre and for Brighton, Kemptown (Dr. Turner). No hon. Member has suggested that CHCs are perfect. They themselves recognise the scope for reform and improvement, but the Government's ham-fisted attempt to replace independent CHCs with employees of the bodies to be monitored and committees of party politically controlled local authorities in the name of improved scrutiny is clearly incredible.

  1173
  We all know that many patients are already extremely wary of making complaints against doctors or hospitals. My hon. Friend the Member for Eddisbury (Mr. O'Brien) alluded to that point. How much more so will they be when the person handling the complaint is a direct employee of the hospital in question? Who can really believe that controversial service reconfigurations, as part of a Government strategy, will be reviewed objectively by party politically controlled councils?
  Nowhere in the Government's plans is even a pretence of replacing the whistleblowing role of community health councils. All Members of Parliament receive Casualty Watch reports from councils. Who will count the people lying unattended on trolleys for hours, correlate the results and circulate them to Members of Parliament so that we can hold Ministers to account? The answer of course is no one. It is no part of the Government's plan to be held to account. We see that in their treatment of Parliament, in their manipulation of the news agenda, in the Department of Health's arbitrary discontinuation of the publication of the chief medical officer's report after 100 years and in the proposal in the Bill to abolish CHCs arbitrarily without any consultation.
  Care trusts may well be a good way of delivering services—the Opposition have an open mind on them—but before the model has been tested or any proper evaluation has been made, the Government are instinctively reaching for powers of compulsion to impose them. Their response to the royal commission on long-term care of the elderly, albeit 18 months late, is welcome as far as it goes. It will provide some relief to some elderly people in long-term care, but it will fall far short of the promise—implied, at least, by the Prime Minister—to end the forced consumption of capital to pay for care. It will present real practical difficulties and create the perverse incentives to which hon. Members of all parties have alluded.
  The loan scheme, while it has merit, may conceal but does not alter the fact that the prudent, thrifty elderly person who has saved all his or her life will still have to consume capital to pay for long-term care.
  The Bill fails entirely to provide anything for those who are struggling to meet care bills, or to help people such as myself—the future generations of the elderly—to prepare themselves to meet the costs of their care without the trauma of consuming the capital in the family home.
  My hon. Friend the Member for Woodspring (Dr. Fox) said that we are minded broadly to support the Government's proposals on local pharmaceutical services, as long as they are properly trialled and evaluated, although I was quite taken by the point made by the hon. Member for Dartford (Dr. Stoate). We will want to consider the issues carefully in Committee, should the Bill reach that stage.
  Despite the fine aspirations of parts of the plan and the fact that some parts of the Bill are worthy, and despite the welcome for the measures, albeit limited, on long-term care costs, I will ask my colleagues to support our reasoned amendment. The Bill's underlying theme of centralising power to the Secretary of State and increasing the micro-management of the NHS from Whitehall is one that we oppose both in principle and for practical reasons.
  We oppose the Bill because it will do nothing to end the appalling distortion of clinical priorities that is an inevitable result of centralised political management of,
  1174
  and resource allocation to, the NHS. Indeed, it will have the reverse effect, because of the damage that it will do to NHS staff morale through the divisive traffic light system and the huge new powers of intervention for the Secretary of State but, above all, because of the shamelessness, brazen even by his standards, with which the Secretary of State has sought to snuff out the watchdogs and whistleblowers who are the only effective independent voice for patients and communities in our national health service.
  That is unacceptable to Conservative Members, and from the tone of the debate today it is clearly unacceptable to most Government Members as well. The Bill is another missed opportunity to begin the process of genuine decentralisation and depoliticisation of the national health service that could yet ensure its survival and prosperity in the future.
  9.45 pm
  Mr. Denham: What is striking about tonight's debate is the extent to which the Government have won the argument about the future of the national health service. Although there is a debate about community health councils, which I shall turn to in a moment, and long-term care costs, no right hon. or hon. Member on either side of the Chamber has challenged the core vision that the Government have set out in the NHS plan for the future of the national health service.
  There has, of course, been silence from the Conservative party on their real agenda, which includes health insurance. Tonight there has been silence about the notorious list of hips, knees, cataracts and hernias in respect of which people would need private medical insurance, and there has been no fundamental challenge to the Government's vision.
  The hon. Member for Woodspring (Dr. Fox) once said that his ambition was to be the least active Secretary of State for Health ever, or words to that effect. That is certainly his approach to the job of Opposition spokesman. Tonight he said not a word about what the Opposition would do. There were no ideas, no proposals and no policies. The hon. Gentleman is indeed Doctor Dolittle.
  Let us consider a few of the issues that have come up tonight. There have been protests from the hon. Member for Southend, West (Mr. Amess) and from the Opposition Front-Bench spokesmen about the idea of any system that enables us to identify parts of the health service that are failing to provide an adequate service to patients and about our willingness to say that we want to raise standards in those trusts. The hon. Member for Southend, West complained about his local trust being so identified and, as he put it, time and motion men being sent in. He will know that in August, Southend had one of the worst out-patient performances in the country in terms of long waiting times. As a result of the support given by the national patients action team, working with the hard-working staff of the trust, waiting times have decreased by 25 per cent. in a couple of months and have reduced further since. So there are measures to enable us to work with trusts that are not performing to the highest standards to produce improvements.
  The Conservatives have made it clear tonight that they do not wish to do anything to tackle poor performance or low standards. They are wrong about that and they are letting patients down.
  Mr. Amess: I cannot believe that the Minister of State is coming out with more claptrap. Will he tell the House, as a result of his time and motion man coming in, how many extra staff he sent to Southend hospital? I can tell him the answer now: absolutely none. He should be ashamed of what he has just said, as it is a further attack on the hard-working women and men of Southend hospital.
  Mr. Denham: The point is that it did not take extra staff to bring about such a significant improvement in out-patient performance; it took support and the co-operation of the management and the organisation of the trust. The issue was never that the trust staff were not working hard enough. It was that the system was not sufficiently well organised and that something needed to be done.
  I now turn to the most important issues that were raised tonight, starting with patient representation. For more than 50 years, the NHS has to far too great an extent made patients fit around the way in which the NHS is organised, to the frustration of patients and staff alike. We cannot modernise the NHS unless we put patients at the centre of everything that it does, organising services around their needs. We cannot do that unless patients themselves have a powerful voice. We have already done a lot. Most of the new primary care groups have patients forums or other systems for patient participation.
  We have undertaken and published, for the first time ever, nationwide patient surveys. Last year's national plan was drawn up after the biggest consultation exercise in the history of the national health service.
  This Bill goes much further. In our first health measure, we gave trusts a duty of quality—clinical governance. In this Bill, for the first time, every NHS trust and primary care trust will have a statutory duty to consult with and involve patients. Over and beyond that, the Bill underpins new structures to protect patients.
  In the consultation on the NHS plan, we were told by patients time and again that, when they needed a problem sorted out, no one was there to do it. They did not know where to go to complain; they did not receive sufficient support in doing so. That is what patients told us.
  We had to make a choice: to look at the system from scratch and design a system based on what patients said they wanted; or to try to tinker with what currently existed—but that is what the NHS has done too often. It has too often responded to a problem by saying, "Let's be radical, let's be bold and change everything, but at the end of the day, let's back off because we do not want to change what we already have." We did not do that; it would have been a mistake. We needed to take a fresh look at what patients said they needed.
  First and foremost, patients want somebody to sort out a problem when it arises—poor communication; concerns about cleanliness; help with food and drink and going to the toilet; worries about discharge arrangements. They want to tackle the problem not by means of a complaint after the event, but when it actually happens. That is what the patient advocacy and liaison services will do. They are part of each trust, because they are needed in order to sort out problems when they first arise. The service is not a replacement for CHCs, as hon. Members have suggested. CHCs have never exercised such a role; it is a new element of patient representation.
  1176
  Although that is important, however, patients want more. They want to know that they have a real voice. That is why each trust will have an independent, statutory patients forum—legally separate, financially independent and with real power. Forums will have the power—if they choose—to undertake exactly the type of campaigning activities undertaken by CHCs. If patients forums want to set up a casualty watch, they can do so. There is no question of that not happening under the new system.
  Forums will have power to monitor the work of the PALS. Although we believe that the advocacy and liaison services should be part of the trust, if the patients forum is dissatisfied with the work of a particular service, it will be able to recommend that that service is taken out of the trust and run independently. There is a safeguard against the service being captured by the trust.
  Forums will have the power to produce an annual report and to sign off the patients prospectus for each trust. They will have power to engage directly with the management of trusts in a way that no patient or representative organisation has previously been able to do. They will have power to elect a non-executive director of the trust itself. They will have power to go wherever NHS patients go—including the voluntary and private sector.
  We recognise that even with advocacy and liaison services dealing with day-to-day problems and even with patients' forums, sometimes things will still go wrong. As hon. Members on both sides of the House have pointed out, when things go wrong people want to know that there will be an effective complaints system, and that they will have an independent guide through the system. The existing system is under review and we shall receive the report soon. However, it is fair to say that we expect changes to the complaints system itself to make it more, rather than, less independent.
  We want patients to have an independent guide—an independent advocate—through the complaints system. That will not be PALS, because, as hon. Members have observed, it is part of the trust itself; the service cannot play that role in the complaints system. An independent advocacy service will be commissioned for patients in each area. The Government think that that should be commissioned by the health authority, but it could be done from a range of local organisations. In the run-up to and during the debate several people have suggested that it should not be the health authority—that is not seen as being sufficiently independent—and that perhaps the services should routinely be commissioned from the local authority. We want to consider those ideas in detail in Committee so as to determine their potential.
  We are keeping a considerably open mind as to the detail of the commissioning of that independent advocacy system, but the principle of such a system for the complaints service is unquestioned.
  Mr. Austin: Will my hon. Friend give way?
  Mr. Denham: No, I must make progress.
  There is broad acceptance that overall scrutiny of the local NHS should be led by democratically elected councils and their scrutiny committees. My hon. Friend the Member for Wakefield (Mr. Hinchliffe), who chairs the Health Committee, has suggested putting more councillors on CHCs, but I think that a point of principle is at stake: the ultimate right of scrutiny should lie with a

  1177
  democratically elected body, not an appointed one. My hon. Friend wishes to capture some of the expertise that has existed on CHCs, and local authorities can do so when they appoint members to the scrutiny committees.
  The issue of a national patients forum has been raised. As my right hon. Friend the Secretary of State announced earlier, we have accepted a proposal from the patients forums and other organisations to fund a project to consider the best way to strengthen the patient's voice nationally.
  Having dealt with community health councils and patients forums, I turn to free nursing care. Under the current system, nursing care is provided free for anyone ill in hospital or at home, but those who are ill in nursing homes must pay for it, subject to a means test. That has long been wrong and unfair, and the Bill tackles the problem head on. In future, nursing care will be free in every setting.
  Much of tonight's debate has centred on whether we should go further. The House should recognise that we are taking an historic step. The previous Administration did not take such a step during their 18 years in office. Indeed, in the previous Parliament, that Government's solitary proposal was to force more people to buy private long-term care insurance. As always when the choice is between extending the NHS and relying on private insurance, they relied on private insurance. Free nursing is a major step forward. We have gone further than the royal commission in defining nursing care, which is another good step forward.
  The Liberal Democrats say that we should simply spend the extra £1 billion required for free social care. The simple truth is that spending £1 billion on free social care would not improve the quality of care for a single elderly person. Care provision needs improving, and we shall invest £900 million a year above current provision on improving intermediate care and related services, helping more elderly people to return to their homes, and supporting them more effectively in their homes. Indeed, it will help to prevent them from having to go into hospital in the first place.
  The hon. Member for Woodspring made an important point, saying, in sharp contradistinction to what has been said by the hon. Member for West Dorset (Mr. Letwin)—the shadow Chief Secretary to the Treasury—that he would guarantee to match our spending proposals across the whole Department of Health budget, including social services. As the hon. Gentleman knows, social service spending comes primarily not from the Department of Health but from the Department of the Environment, Transport and the Regions. Under our proposals, less than £2.3 billion of personal social services will come through the Department of Health in 2003–04, and nearly £10 billion from the standard spending assessment.
  We must ask whether the hon. Gentleman's spending guarantee covers the £10 billion-worth of social services funding provided through the SSA. Is the answer yes or no? If the hon. Gentleman does not rise to answer, we must rightly assume that the Conservatives have given no guarantee on social services spending. The cuts that they wish to bring about in every constituency will include cuts in spending on social services. The hon. Gentleman does not answer, so we have it confirmed by his inactivity that there is no guarantee that the Conservatives will match our spending on social services, and that his words about care for the elderly are nothing but not air.
  1178
  Question put, That the amendment be made:—
  The House divided: Ayes 128, Noes 352.

  Division No. 45]

  [9.59 pm

  AYES

  Ainsworth, Peter (E Surrey)

  King, Rt Hon Tom (Bridgwater)

  Amess, David

  Kirkbride, Miss Julie

  Arbuthnot, Rt Hon James

  Laing, Mrs Eleanor

  Atkinson, David (Bour'mth E)

  Lait, Mrs Jacqui

  Atkinson, Peter (Hexham)

  Lansley, Andrew

  Baldry, Tony

  Leigh, Edward

  Beggs, Roy

  Letwin, Oliver

  Bercow, John

  Lewis, Dr Julian (New Forest E)

  Blunt, Crispin

  Lidington, David

  Body, Sir Richard

  Lilley, Rt Hon Peter

  Boswell, Tim

  Lloyd, Rt Hon Sir Peter (Fareham)

  Bottomley, Peter (Worthing W)

  Loughton, Tim

  Bottomley, Rt Hon Mrs Virginia

  Lyell, Rt Hon Sir Nicholas

  Brady, Graham

  MacGregor, Rt Hon John

  Brazier, Julian

  McIntosh, Miss Anne

  Brooke, Rt Hon Peter

  MacKay, Rt Hon Andrew

  Browning, Mrs Angela

  Maclean, Rt Hon David

  Bruce, Ian (S Dorset)

  McLoughlin, Patrick

  Burns, Simon

  Malins, Humfrey

  Butterfill, John

  Maples, John

  Cash, William

  May, Mrs Theresa

  Chapman, Sir Sydney (Chipping Barnet)

  Moss, Malcolm

  Nicholls, Patrick

  Chope, Christopher

  Norman, Archie

  Clappison, James

  O'Brien, Stephen (Eddisbury)

  Clifton-Brown, Geoffrey

  Ottaway, Richard

  Collins, Tim

  Page, Richard

  Cormack, Sir Patrick

  Paice, James

  Pickles, Eric

  Cran, James

  Portillo, Rt Hon Michael

  Davies, Quentin (Grantham)

  Prior, David

  Davis, Rt Hon David (Haltemprice)

  Randall, John

  Dorrell, Rt Hon Stephen

  Redwood, Rt Hon John

  Duncan, Alan

  Robathan, Andrew

  Emery, Rt Hon Sir Peter

  Robertson, Laurence (Tewk'b'ry)

  Evans, Nigel

  Roe, Mrs Marion (Broxbourne)

  Fallon, Michael

  Rowe, Andrew (Faversham)

  Flight, Howard

  Ruffley, David

  Forth, Rt Hon Eric

  St Aubyn, Nick

  Fox, Dr Liam

  Sayeed, Jonathan

  Fraser, Christopher

  Simpson, Keith (Mid-Norfolk)

  Gale, Roger

  Smyth, Rev Martin (Belfast S)

  Garnier, Edward

  Spelman, Mrs Caroline

  Gibb, Nick

  Spicer, Sir Michael

  Gillan, Mrs Cheryl

  Spring, Richard

  Gorman, Mrs Teresa

  Stanley, Rt Hon Sir John

  Gray, James

  Streeter, Gary

  Green, Damian

  Swayne, Desmond

  Greenway, John

  Syms, Robert

  Grieve, Dominic

  Tapsell, Sir Peter

  Gummer, Rt Hon John

  Taylor, Ian (Esher & Walton)

  Hamilton, Rt Hon Sir Archie

  Taylor, John M (Solihull)

  Hammond, Philip

  Taylor, Sir Teddy

  Hawkins, Nick

  Thompson, William

  Hayes, John

  Tredinnick, David

  Heald, Oliver

  Tyrie, Andrew

  Horam, John

  Viggers, Peter

  Howard, Rt Hon Michael

  Waterson, Nigel

  Howarth, Gerald (Aldershot)

  Wells, Bowen

  Jack, Rt Hon Michael

  Whitney, Sir Raymond

  Jackson, Robert (Wantage)

  Whittingdale, John

  Jenkin, Bernard

  Widdecombe, Rt Hon Miss Ann

  Key, Robert

  Wilkinson, John

  1179

  Willetts, David

  Tellers for the Ayes:

  Wilshire, David

  Yeo, Tim

  Mr. Peter Luff and

  Young, Rt Hon George

  Mr. Stephen Day.

  NOES

  Abbott, Ms Diane

  Coffey, Ms Ann

  Ainsworth, Robert (Cov'try NE)

  Cohen, Harry

  Alexander, Douglas

  Coleman, Iain

  Allan, Richard

  Colman, Tony

  Allen, Graham

  Connarty, Michael

  Anderson, Rt Hon Donald (Swansea E)

  Cooper, Yvette

  Corbett, Robin

  Anderson, Janet (Rossendale)

  Corbyn, Jeremy

  Armstrong, Rt Hon Ms Hilary

  Cotter, Brian

  Ashton, Joe

  Cousins, Jim

  Atkins, Charlotte

  Cox, Tom

  Austin, John

  Cranston, Ross

  Bailey, Adrian

  Crausby, David

  Baker, Norman

  Cryer, John (Hornchurch)

  Banks, Tony

  Cummings, John

  Barnes, Harry

  Cunningham, Rt Hon Dr Jack (Copeland)

  Barron, Kevin

  Battle, John

  Cunningham, Jim (Cov'try S)

  Bayley, Hugh

  Darling, Rt Hon Alistair

  Beard, Nigel

  Darvill, Keith

  Begg, Miss Anne

  Davey, Edward (Kingston)

  Bell, Stuart (Middlesbrough)

  Davidson, Ian

  Benn, Hilary (Leeds C)

  Davis, Rt Hon Terry (B'ham Hodge H)

  Benn, Rt Hon Tony (Chesterfield)

  Bennett, Andrew F

  Dawson, Hilton

  Bermingham, Gerald

  Denham, John

  Berry, Roger

  Dismore, Andrew

  Best, Harold

  Dobbin, Jim

  Blears, Ms Hazel

  Dobson, Rt Hon Frank

  Blizzard, Bob

  Donohoe, Brian H

  Blunkett, Rt Hon David

  Doran, Frank

  Boateng, Rt Hon Paul

  Dowd, Jim

  Bradley, Keith (Withington)

  Dunwoody, Mrs Gwyneth

  Bradley, Peter (The Wrekin)

  Eagle, Angela (Wallasey)

  Brand, Dr Peter

  Eagle, Maria (L'pool Garston)

  Brinton, Mrs Helen

  Edwards, Huw

  Brown, Rt Hon Nick (Newcastle E)

  Ellman, Mrs Louise

  Brown, Russell (Dumfries)

  Ennis, Jeff

  Browne, Desmond

  Etherington, Bill

  Bruce, Malcolm (Gordon)

  Fearn, Ronnie

  Buck, Ms Karen

  Field, Rt Hon Frank

  Burden, Richard

  Fisher, Mark

  Burgon, Colin

  Fitzpatrick, Jim

  Burstow, Paul

  Flint, Caroline

  Butler, Mrs Christine

  Flynn, Paul

  Campbell, Alan (Tynemouth)

  Foster, Rt Hon Derek

  Campbell, Rt Hon Menzies (NE Fife)

  Foster, Don (Bath)

  Foster, Michael Jabez (Hastings)

  Campbell, Ronnie (Blyth V)

  Foster, Michael J (Worcester)

  Campbell-Savours, Dale

  Galbraith, Sam

  Cann, Jamie

  Galloway, George

  Caplin, Ivor

  Gapes, Mike

  Casale, Roger

  Gardiner, Barry

  Caton, Martin

  George, Andrew (St Ives)

  Cawsey, Ian

  George, Rt Hon Bruce (Walsall S)

  Chapman, Ben (Wirral S)

  Gerrard, Neil

  Chaytor, David

  Gilroy, Mrs Linda

  Chidgey, David

  Godsiff, Roger

  Clapham, Michael

  Goggins, Paul

  Clark, Rt Hon Dr David (S Shields)

  Golding, Mrs Llin

  Clark, Dr Lynda (Edinburgh Pentlands)

  Gordon, Mrs Eileen

  Griffiths, Jane (Reading E)

  Clark, Paul (Gillingham)

  Griffiths, Nigel (Edinburgh S)

  Clarke, Charles (Norwich S)

  Griffiths, Win (Bridgend)

  Clarke, Eric (Midlothian)

  Grocott, Bruce

  Clarke, Rt Hon Tom (Coatbridge)

  Grogan, John

  Clarke, Tony (Northampton S)

  Hall, Mike (Weaver Vale)

  Clelland, David

  Hall, Patrick (Bedford)

  Clwyd, Ann

  Hamilton, Fabian (Leeds NE)

  Coaker, Vernon

  Hancock, Mike

  1180

  Hanson, David

  Maclennan, Rt Hon Robert

  Harman, Rt Hon Ms Harriet

  McNamara, Kevin

  Harris, Dr Evan

  MacShane, Denis

  Harvey, Nick

  Mactaggart, Fiona

  Healey, John

  McWalter, Tony

  Heath, David (Somerton & Frome)

  McWilliam, John

  Henderson, Doug (Newcastle N)

  Mallaber, Judy

  Henderson, Ivan (Harwich)

  Marsden, Gordon (Blackpool S)

  Hendrick, Mark

  Marshall, David (Shettleston)

  Hepburn, Stephen

  Marshall, Jim (Leicester S)

  Heppell, John

  Marshall-Andrews, Robert

  Hesford, Stephen

  Martlew, Eric

  Hill, Keith

  Maxton, John

  Hoey, Kate

  Meacher, Rt Hon Michael

  Hope, Phil

  Meale, Alan

  Hopkins, Kelvin

  Merron, Gillian

  Howarth, Rt Hon Alan (Newport E)

  Michael, Rt Hon Alun

  Howells, Dr Kim

  Michie, Bill (Shef'ld Heeley)

  Hoyle, Lindsay

  Michie, Mrs Ray (Argyll & Bute)

  Hughes, Ms Beverley (Stretford)

  Milburn, Rt Hon Alan

  Hughes, Kevin (Doncaster N)

  Miller, Andrew

  Hughes, Simon (Southwark N)

  Mitchell, Austin

  Humble, Mrs Joan

  Moffatt, Laura

  Hurst, Alan

  Moonie, Dr Lewis

  Hutton, John

  Moore, Michael

  Iddon, Dr Brian

  Morgan, Ms Julie (Cardiff N)

  Illsley, Eric

  Morley, Elliot

  Jackson, Ms Glenda (Hampstead)

  Morris, Rt Hon Sir John (Aberavon)

  Jackson, Helen (Hillsborough)

  Jenkins, Brian

  Mudie, George

  Johnson, Alan (Hull W & Hessle)

  Murphy, Rt Hon Paul (Torfaen)

  Jones, Helen (Warrington N)

  Naysmith, Dr Doug

  Jones, Ms Jenny (Wolverh'ton SW)

  Norris, Dan

  O'Brien, Bill (Normanton)

  Jones, Jon Owen (Cardiff C)

  O'Brien, Mike (N Warks)

  Jones, Dr Lynne (Selly Oak)

  O'Hara, Eddie

  Jones, Martyn (Clwyd S)

  O'Neill, Martin

  Jones, Nigel (Cheltenham)

  Öpik, Lembit

  Joyce, Eric

  Organ, Mrs Diana

  Kaufman, Rt Hon Gerald

  Pearson, Ian

  Keeble, Ms Sally

  Perham, Ms Linda

  Keen, Alan (Feltham & Heston)

  Pickthall, Colin

  Keen, Ann (Brentford & Isleworth)

  Pike, Peter L

  Keetch, Paul

  Plaskitt, James

  Kemp, Fraser

  Pond, Chris

  Kennedy, Jane (Wavertree)

  Pope, Greg

  Khabra, Piara S

  Pound, Stephen

  Kidney, David

  Prentice, Ms Bridget (Lewisham E)

  Kilfoyle, Peter

  Prentice, Gordon (Pendle)

  King, Ms Oona (Bethnal Green)

  Prosser, Gwyn

  Kingham, Ms Tess

  Quin, Rt Hon Ms Joyce

  Kirkwood, Archy

  Quinn, Lawrie

  Ladyman, Dr Stephen

  Radice, Rt Hon Giles

  Lawrence, Mrs Jackie

  Rammell, Bill

  Laxton, Bob

  Rapson, Syd

  Lepper, David

  Raynsford, Nick

  Leslie, Christopher

  Reed, Andrew (Loughborough)

  Levitt, Tom

  Reid, Rt Hon Dr John (Hamilton N)

  Lewis, Ivan (Bury S)

  Rendel, David

  Lewis, Terry (Worsley)

  Robertson, John (Glasgow Anniesland)

  Liddell, Rt Hon Mrs Helen

  Linton, Martin

  Robinson, Geoffrey (Cov'try NW)

  Livsey, Richard

  Roche, Mrs Barbara

  Lloyd, Tony (Manchester C)

  Rogers, Allan

  Llwyd, Elfyn

  Rooker, Rt Hon Jeff

  Lock, David

  Rooney, Terry

  McAvoy, Thomas

  Ross, Ernie (Dundee W)

  McCabe, Steve

  Rowlands, Ted

  McCartney, Rt Hon Ian (Makerfield)

  Ruane, Chris

  Russell, Bob (Colchester)

  McDonagh, Siobhain

  Russell, Ms Christine (Chester)

  Macdonald, Calum

  Salter, Martin

  McDonnell, John

  Sanders, Adrian

  McFall, John

  Sarwar, Mohammad

  McIsaac, Shona

  Savidge, Malcolm

  Mackinlay, Andrew

  Sawford, Phil

  1181

  Sedgemore, Brian

  Tipping, Paddy

  Shaw, Jonathan

  Todd, Mark

  Sheldon, Rt Hon Robert

  Touhig, Don

  Shipley, Ms Debra

  Trickett, Jon

  Simpson, Alan (Nottingham S)

  Truswell, Paul

  Singh, Marsha

  Turner, Dr Desmond (Kemptown)

  Skinner, Dennis

  Turner, Dr George (NW Norfolk)

  Smith, Rt Hon Andrew (Oxford E)

  Turner, Neil (Wigan)

  Smith, Angela (Basildon)

  Twigg, Derek (Halton)

  Smith, Rt Hon Chris (Islington S)

  Tyler, Paul

  Smith, Miss Geraldine (Morecambe & Lunesdale)

  Tynan, Bill

  Vaz, Keith

  Smith, Jacqui (Redditch)

  Vis, Dr Rudi

  Smith, Llew (Blaenau Gwent)

  Walley, Ms Joan

  Smith, Sir Robert (W Ab'd'ns)

  Ward, Ms Claire

  Soley, Clive

  Wareing, Robert N

  Southworth, Ms Helen

  Watts, David

  Spellar, John

  White, Brian

  Starkey, Dr Phyllis

  Whitehead, Dr Alan

  Steinberg, Gerry

  Wicks, Malcolm

  Stevenson, George

  Williams, Rt Hon Alan (Swansea W)

  Stewart, David (Inverness E)

  Stewart, Ian (Eccles)

  Williams, Alan W (E Carmarthen)

  Stoate, Dr Howard

  Williams, Mrs Betty (Conwy)

  Strang, Rt Hon Dr Gavin

  Willis, Phil

  Stringer, Graham

  Winnick, David

  Stuart, Ms Gisela

  Winterton, Ms Rosie (Doncaster C)

  Stunell, Andrew

  Wood, Mike

  Sutcliffe, Gerry

  Woodward, Shaun

  Taylor, Rt Hon Mrs Ann (Dewsbury)

  Worthinigton, Tony

  Wray, James

  Taylor, Ms Dari (Stockton S)

  Wright, Anthony D (Gt Yarmouth)

  Taylor, David (NW Leics)

  Wright, Tony (Cannock)

  Taylor, Matthew (Truro)

  Wyatt, Derek

  Temple-Morris, Peter

  Thomas, Gareth (Clwyd W)

  Tellers for the Noes:

  Thomas, Gareth R (Harrow W)

  Mr. David Jamieson and

  Thomas, Simon (Ceredigion)

  Mr. Clive Betts.

  Question accordingly negatived.
  Main Question put forthwith, pursuant to Standing Order No. 62 (Amendment on Second or Third Reading):—
  The House divided: Ayes 320, Noes 44.

  Division No. 46]

  [10.15 pm

  AYES

  Abbott, Ms Diane

  Blizzard, Bob

  Ainsworth, Robert (Cov'try NE)

  Blunkett, Rt Hon David

  Alexander, Douglas

  Boateng, Rt Hon Paul

  Allen, Graham

  Bradley, Keith (Withington)

  Anderson, Rt Hon Donald (Swansea E)

  Brinton, Mrs Helen

  Brown, Rt Hon Nick (Newcastle E)

  Anderson, Janet (Rossendale)

  Brown, Russell (Dumfries)

  Armstrong, Rt Hon Ms Hilary

  Browne, Desmond

  Ashton, Joe

  Buck, Ms Karen

  Atkins, Charlotte

  Burden, Richard

  Austin, John

  Burgon, Colin

  Bailey, Adrian

  Butler, Mrs Christine

  Banks, Tony

  Campbell, Alan (Tynemouth)

  Barnes, Harry

  Campbell, Ronnie (Blyth V)

  Barron, Kevin

  Campbell-Savours, Dale

  Battle, John

  Cann, Jamie

  Bayley, Hugh

  Caplin, Ivor

  Beard, Nigel

  Casale, Roger

  Begg, Miss Anne

  Caton, Martin

  Bell, Stuart (Middlesbrough)

  Cawsey, Ian

  Benn, Hilary (Leeds C)

  Chapman, Ben (Wirral S)

  Benn, Rt Hon Tony (Chesterfield)

  Chaytor, David

  Bennett, Andrew F

  Clapham, Michael

  Bermingham, Gerald

  Clark, Rt Hon Dr David (S Shields)

  Berry, Roger

  Clark, Dr Lynda (Edinburgh Pentlands)

  Best, Harold

  Blears, Ms Hazel

  Clark, Paul (Gillingham)

  1182

  Clarke, Charles (Norwich S)

  Henderson, Ivan (Harwich)

  Clarke, Eric (Midlothian)

  Hendrick, Mark

  Clarke, Rt Hon Tom (Coatbridge)

  Hepburn, Stephen

  Clarke, Tony (Northampton S)

  Heppell, John

  Clelland, David

  Hesford, Stephen

  Clwyd, Ann

  Hill, Keith

  Coaker, Vernon

  Hoey, Kate

  Coffey, Ms Ann

  Hope, Phil

  Cohen, Harry

  Hopkins, Kelvin

  Coleman, Iain

  Howarth, Rt Hon Alan (Newport E)

  Colman, Tony

  Howells, Dr Kim

  Connarty, Michael

  Hoyle, Lindsay

  Cooper, Yvette

  Hughes, Ms Beverley (Stretford)

  Corbett, Robin

  Hughes, Kevin (Doncaster N)

  Corbyn, Jeremy

  Hughes, Simon (Southwark N)

  Cousins, Jim

  Humble, Mrs Joan

  Cox, Tom

  Hurst, Alan

  Cranston, Ross

  Hutton, John

  Crausby, David

  Iddon, Dr Brian

  Cryer, John (Hornchurch)

  Illsley, Eric

  Cummings, John

  Jackson, Ms Glenda (Hampstead)

  Cunningham, Rt Hon Dr Jack (Copeland)

  Jackson, Helen (Hillsborough)

  Jenkins, Brian

  Cunningham, Jim (Cov'try S)

  Johnson, Alan (Hull W & Hessle)

  Darling, Rt Hon Alistair

  Jones, Helen (Warrington N)

  Darvill, Keith

  Jones, Ms Jenny (Wolverh'ton SW)

  Davidson, Ian

  Davis, Rt Hon Terry (B'ham Hodge H)

  Jones, Jon Owen (Cardiff C)

  Jones, Dr Lynne (Selly Oak)

  Dawson, Hilton

  Jones, Martyn (Clwyd S)

  Denham, John

  Joyce, Eric

  Dismore, Andrew

  Kaufman, Rt Hon Gerald

  Dobbin, Jim

  Keeble, Ms Sally

  Dobson, Rt Hon Frank

  Keen, Alan (Feltham & Heston)

  Donohoe, Brian H

  Keen, Ann (Brentford & Isleworth)

  Doran, Frank

  Kemp, Fraser

  Dowd, Jim

  Kennedy, Jane (Wavertree)

  Dunwoody, Mrs Gwyneth

  Khabra, Piara S

  Eagle, Angela (Wallasey)

  Kidney, David

  Eagle, Maria (L'pool Garston)

  Kilfoyle, Peter

  Edwards, Huw

  King, Ms Oona (Bethnal Green)

  Ellman, Mrs Louise

  Kingham, Ms Tess

  Ennis, Jeff

  Ladyman, Dr Stephen

  Etherington, Bill

  Lawrence, Mrs Jackie

  Field, Rt Hon Frank

  Laxton, Bob

  Fisher, Mark

  Lepper, David

  Fitzpatrick, Jim

  Leslie, Christopher

  Flint, Caroline

  Levitt, Tom

  Flynn, Paul

  Lewis, Ivan (Bury S)

  Foster, Rt Hon Derek

  Lewis, Terry (Worsley)

  Foster, Michael Jabez (Hastings)

  Liddell, Rt Hon Mrs Helen

  Foster, Michael J (Worcester)

  Linton, Martin

  Galbraith, Sam

  Lloyd, Tony (Manchester C)

  Galloway, George

  Lock, David

  Gapes, Mike

  Love, Andrew

  Gardiner, Barry

  McAvoy, Thomas

  George, Rt Hon Bruce (Walsall S)

  McCabe, Steve

  Gerrard, Neil

  McCartney, Rt Hon Ian (Makerfield)

  Gibson, Dr Ian

  Gilroy, Mrs Linda

  McDonagh, Siobhain

  Godsiff, Roger

  Macdonald, Calum

  Goggins, Paul

  McDonnell, John

  Golding, Mrs Llin

  McFall, John

  Gordon, Mrs Eileen

  McIsaac, Shona

  Griffiths, Jane (Reading E)

  Mackinlay, Andrew

  Griffiths, Nigel (Edinburgh S)

  McNamara, Kevin

  Griffiths, Win (Bridgend)

  McNulty, Tony

  Grocott, Bruce

  MacShane, Denis

  Grogan, John

  Mactaggart, Fiona

  Hall, Mike (Weaver Vale)

  McWalter, Tony

  Hall, Patrick (Bedford)

  McWilliam, John

  Hamilton, Fabian (Leeds NE)

  Mallaber, Judy

  Hanson, David

  Marsden, Gordon (Blackpool S)

  Harman, Rt Hon Ms Harriet

  Marshall, David (Shettleston)

  Healey, John

  Marshall, Jim (Leicester S)

  Henderson, Doug (Newcastle N)

  Marshall-Andrews, Robert

  1183

  Martlew, Eric

  Singh, Marsha

  Maxton, John

  Skinner, Dennis

  Meacher, Rt Hon Michael

  Smith, Rt Hon Andrew (Oxford E)

  Meale, Alan

  Smith, Angela (Basildon)

  Merron, Gillian

  Smith, Rt Hon Chris (Islington S)

  Michael, Rt Hon Alun

  Smith, Miss Geraldine (Morecambe & Lunesdale)

  Michie, Bill (Shef'ld Heeley)

  Milburn, Rt Hon Alan

  Smith, Jacqui (Redditch)

  Miller, Andrew

  Smith, Llew (Blaenau Gwent)

  Mitchell, Austin

  Soley, Clive

  Moffatt, Laura

  Southworth, Ms Helen

  Moonie, Dr Lewis

  Spellar, John

  Morgan, Ms Julie (Cardiff N)

  Starkey, Dr Phyllis

  Morley, Elliot

  Steinberg, Gerry

  Morris, Rt Hon Sir John (Aberavon)

  Stevenson, George

  Stewart, David (Inverness E)

  Mudie, George

  Stewart, Ian (Eccles)

  Murphy, Rt Hon Paul (Torfaen)

  Stoate, Dr Howard

  Naysmith, Dr Doug

  Strang, Rt Hon Dr Gavin

  Norris, Dan

  Stringer, Graham

  O'Brien, Bill (Normanton)

  Stuart, Ms Gisela

  O'Brien, Mike (N Warks)

  Sutcliffe, Gerry

  O'Hara, Eddie

  Taylor, Rt Hon Mrs Ann (Dewsbury)

  O'Neill, Martin

  Organ, Mrs Diana

  Taylor, Ms Dari (Stockton S)

  Pearson, Ian

  Taylor, David (NW Leics)

  Perham, Ms Linda

  Temple-Morris, Peter

  Pickthall, Colin

  Thomas, Gareth (Clwyd W)

  Pike, Peter L

  Thomas, Gareth R (Harrow W)

  Plaskitt, James

  Tipping, Paddy

  Pond, Chris

  Todd, Mark

  Pope, Greg

  Touhig, Don

  Pound, Stephen

  Trickett, Jon

  Prentice, Ms Bridget (Lewisham E)

  Truswell, Paul

  Prentice, Gordon (Pendle)

  Turner, Dr Desmond (Kemptown)

  Prosser, Gwyn

  Turner, Dr George (NW Norfolk)

  Turner, Neil (Wigan)

  Quin, Rt Hon Ms Joyce

  Twigg, Derek (Halton)

  Quinn, Lawrie

  Tynan, Bill

  Radice, Rt Hon Giles

  Vaz, Keith

  Rammell, Bill

  Vis, Dr Rudi

  Rapson, Syd

  Walley, Ms Joan

  Raynsford, Nick

  Ward, Ms Claire

  Reed, Andrew (Loughborough)

  Wareing, Robert N

  Reid, Rt Hon Dr John (Hamilton N)

  Watts, David

  Robertson, John (Glasgow Anniesland)

  White, Brian

  Whitehead, Dr Alan

  Robinson, Geoffrey (Cov'try NW)

  Wicks, Malcolm

  Roche, Mrs Barbara

  Williams, Rt Hon Alan (Swansea W)

  Rogers, Allan

  Rooker, Rt Hon Jeff

  Williams, Alan W (E Carmarthen)

  Rooney, Terry

  Williams, Mrs Betty (Conwy)

  Ross, Ernie (Dundee W)

  Winnick, David

  Rowlands, Ted

  Winterton, Ms Rosie (Doncaster C)

  Ruane, Chris

  Wood, Mike

  Russell, Ms Christine (Chester)

  Woodward, Shaun

  Salter, Martin

  Worthington, Tony

  Sarwar, Mohammad

  Wray, James

  Savidge, Malcolm

  Wright, Anthony D (Gt Yarmouth)

  Sawford, Phil

  Wright, Tony (Cannock)

  Sedgemore, Brian

  Wyatt, Derek

  Shaw, Jonathan

  Sheldon, Rt Hon Robert

  Tellers for the Ayes:

  Shipley, Ms Debra

  Mr. David Jamieson and

  Simpson, Alan (Nottingham S)

  Mr. Clive Betts.

  NOES

  Allan, Richard

  Cotter, Brian

  Baker, Norman

  Davey, Edward (Kingston)

  Beggs, Roy

  Fearn, Ronnie

  Brand, Dr Peter

  Forth, Rt Hon Eric

  Bruce, Malcolm (Gordon)

  Foster, Don (Bath)

  Burstow, Paul

  George, Andrew (St Ives)

  Campbell, Rt Hon Menzies (NE Fife)

  Gummer, Rt Hon John

  Hancock, Mike

  Chidgey, David

  Harris, Dr Evan

  1184

  Harvey, Nick

  Redwood, Rt Hon John

  Heath, David (Somerton & Frome)

  Rendel, David

  Howarth, Gerald (Aldershot)

  Russell, Bob (Colchester)

  Jones, Nigel (Cheltenham)

  Sanders, Adrian

  Keetch, Paul

  Smith, Sir Robert (W Ab'd'ns)

  Kennedy, Rt Hon Charles (Ross Skye & Inverness W)

  Smyth, Rev Martin (Belfast S)

  Stunell, Andrew

  Kirkwood, Archy

  Taylor, Matthew (Truro)

  Leigh, Edward

  Thomas, Simon (Ceredigion)

  Livsey, Richard

  Thompson, William

  Llwyd, Elfyn

  Tyler, Paul

  Maclean, Rt Hon David

  Willis, Phil

  Maclennan, Rt Hon Robert

  Michie, Mrs Ray (Argyll & Bute)

  Tellers for the Noes:

  Moore, Michael

  Mr. David Wilshire and

  Öpik, Lembit

  Mr. Christopher Chope.

  Question accordingly agreed to.
  Bill read a Second time.
  Mr. David Lidington: On a point of order, Mr. Speaker, of which I have given you notice. It concerns a written question to the Home Secretary, tabled yesterday by the hon. Member for Corby (Mr. Hope), which appears on today's Order Paper. The hon. Gentleman asked the Home Secretary to make a statement on the Government's policy on volunteering.
  This afternoon I asked the Library whether it had—as would normally happen—received a copy of the Government's response to the hon. Gentleman's question. It had not. I asked it to make inquiries of the parliamentary clerk at the Home Office. I have since been informed by Library staff that they were told by the Home Office that the Home Secretary had decided not to release an answer to the question today and that, instead, an answer would be supplied to the Library tomorrow morning, as soon as possible after the Chancellor of the Exchequer had made a press statement about the policy in question.
  I have subsequently discovered not only that the Chancellor plans to make a press announcement tomorrow, ahead of any announcement to Members, but that he has already t given interviews to the broadcasting media, and has arranged to publish an article on the subject in at least one newspaper tomorrow.
  My purpose, Mr. Speaker, is to request you to investigate and consider what steps you can take, not just to secure an apology from the Ministers responsible for what appears to be—even by this Government's standards—a disgraceful abuse of our normal procedures, but to ensure that in future Ministers do their duty not just to Members but, through us, to the people who elect us and send us here to represent them, by giving information to Parliament before it is supplied via spin doctors and the media.
  Mr. Speaker: I am obliged to the hon. Gentleman for giving me notice of his point of order. I will investigate the matter.
  Mr. Bob Russell: Further to that point of order, Mr. Speaker. Will you also inquire into whether any other Ministers are involved in tomorrow's press launch, or whatever it is—in particular, Lord Falconer?
  Mr. Speaker: I will investigate the hon. Gentleman's point of order.

  Health and Social Care Bill (Programme)
  10.33 pm
  Mr. Denham: I beg to move,
  That the following provisions shall apply to the Health and Social Care Bill:

  Health and Social Care Bill (Programme)

    Standing Committee
    1. The Bill shall be committed to a Standing Committee.

    2. Proceedings in the Standing Committee shall (so far as not previously concluded) be brought to a conclusion on Thursday 8th February 2001.

    This is an important Bill, as was recognised by Members on both sides of the House who spoke on Second Reading. We had a good debate.
    The motion proposes that the Committee stage concludes on 8 February. We think that that gives us enough time to debate a Bill of this size, especially as many of its provisions are discreet and manageable.
    The Bill delivers the policy commitments of the NHS plan, which was published in July and which is familiar to all.
    Mr. John Redwood: Will the Minister apologise to his right hon. and hon. Friends for the way in which they have been misled over the idea that, under these new procedures, everyone would go home at 10 pm? Does he understand that trying to gerrymander and to force measures through the House in such a despicable way will cause more trouble, more grief and more debate? Would it not be better to go back to doing things by agreement?
    Mr. Denham: We are well aware that views on how to ensure logical, sensible and orderly handling of business in the House vary. Not all Members share my opinion that proper programming and timetabling legislation will enhance effective scrutiny. Many of us have, over the years, spent time in Committee experiencing filibusters and debates on timetable motions that last for weeks on end, involving seemingly endless late night debates. I would rather ensure that we can make good progress in Committee, and scrutinise the Bill properly. We will want to make sure that there is sufficient time to debate the key areas of interest properly.
    Mr. Swayne: On those key areas of interest, will the Minister give way?
    Mr. Denham: Yes, why not.
    Mr. Swayne: When the Minister chose the end date in the motion, did he know that all but two speakers from the Labour Back Benches would express reservation or outright opposition to his proposals for community health councils? On that basis, is he absolutely sure that there will be sufficient time in Committee to accommodate the concerns of Labour Members?
    Mr. Denham: Yes, indeed. I am confident that there will be time to give particular consideration to the issues that were raised tonight: the scrutiny arrangements for the NHS, including community health councils; the
    1186
    arrangements for dealing with poorly performing doctors; care trusts; the new arrangements for pharmacy; and free nursing care, which 44 Members voted against—their constituents will be interested in that. Those key issues were flagged up, and I am confident that they can be dealt with in some detail and that proper scrutiny will be given to all the other measures.
    Mr. Bercow: In addition helpfully to providing the House with an end date for consideration, will the Minister tell us how many hours he envisages being allocated for debate in Committee to cover the 66 clauses and five schedules?
    Mr. Denham: Well, that is of course a matter for the Committee. As I understand the proceedings, the Programming Sub-Committee will, subject to the motion being passed, begin consideration on Thursday next week. That will enable us—in Committee and, if it is desired, through the usual channels—to ensure that the proper time is allocated. In particular, and I accept the point entirely, the great bulk of time should be devoted to the more contentious proposals, especially those that Opposition and Labour Members want to scrutinise closely. Whether the Conservatives want to use the usual channels constructively is beyond my control—I understand that they are open for discussion—but, if not, those matters will have to be discussed in the Programming Sub-Committee.
    We listened carefully to the opinions expressed tonight and we understand the importance of the views of both sides of the House. That is a key advantage of timetabling, and we want to ensure that the Opposition can use the time allocated by the House to concentrate on the priority areas for scrutiny. The suggested end date of 8 February will provide enough time in Committee, starting with consideration next week. The Programming Sub-Committee will consider the detailed timetable, the frequency of sittings and so on in the usual way.
    Sir Peter Emery rose—
    Mr. Bercow rose—
    Mr. Denham: I was about to finish, but I give way to the right hon. Member for East Devon (Sir P. Emery).
    Sir Peter Emery: I have listened with care to all that has been said. Does not the Minister agree that, before the Programming Sub-Committee meets, it would be right and proper for the Opposition to make it clear to the Government what time they believe would be necessary to consider the Bill and that all sections should be covered during that time scale?
    Mr. Denham: Absolutely. That is the purpose of the discussions through the usual channels. We have invited that input, and I understand that meetings have taken place through the usual channels. However, we have received less information than we would have liked or that the Opposition might have found helpful. My point to the right hon. Gentleman—
    Mr. Swayne rose—
    Mr. Denham: I have not finished my answer yet.

    1187
    What the right hon. Gentleman says is perfectly sensible, but whether his Front Benchers want to take advantage of the arrangements in the new procedures is beyond our control.
    Mr. Swayne: I thank the Minister for giving way a second time. Can he tell us, on the basis of his experience, how much time the Health Act 1999, which he steered through, took in Committee?
    Mr. Denham: I remember that Committee—it is seared on my memory. I remember in particular the hon. Member for Lichfield (Mr. Fabricant)—he is not present tonight, so I assume that he will not be a member of the forthcoming Committee—and the hon. Member for Southend, West (Mr. Amess), who told us tonight that he would not be a member of that Committee, as well as a number of others, speaking to the timetable motion for sitting after sitting after sitting, totally pointlessly and aimlessly. That was my experience. [Interruption.] Well, the behaviour must have been in order because the Chairman allowed it to continue. However, in my opinion, it was aimless, if not out of order.
    Committee time under different Administrations has often not been used for scrutinising Bills efficiently and effectively. The Health and Social Care Bill covers many issues that are very important for patients. I hope that the Conservative party will use Committee time constructively to scrutinise the Bill effectively. However, we cannot control that; it is in the hands of the Conservative party.
    I commend the motion to the House.
    10.40 pm
    Dr. Fox: I oppose the motion on grounds of principle and of practice. In this Parliament, we have witnessed the rise of an already powerful Executive to new heights. It is the height of arrogance for the Minister to say that, in his view as the Minister who piloted the Health Act 1999 through its Committee stage, the time was not used effectively. Ministers are there to answer questions, to be subjected to scrutiny by the Opposition and—before the Government came to office—by Back-Bench Government Members. It is up to the House to decide whether the time is used effectively, and up to the Committee Chairman to determine whether contributions are in order or relevant. It is not up to the Minister, who seems to want to determine the process as well the measure.
    As a former Whip, I believe that we are witnessing a terrible rise in the power of the Whips Office. That is unhealthy for democracy in the House. Doubtless I shall get a black mark from my hon. Friend the Member for Cheadle (Mr. Day), who is the Whip on duty, for saying that. However, dangerous trends are currently developing in the House. They may have existed for some time, but they are now being exacerbated to an unacceptable extent. Nowadays, the House of Commons is simply Downing street in Parliament, and we have little say in the running of our country.
    Mr. John Gummer: I ask my hon. Friend not to be so critical of the Whips Office. Much more serious is the fact that a Minister claims in the
    1188
    House that the opinions of other hon. Members are not important. All Ministers believe that Opposition Members—and, indeed, hon. Members from their party, too—who disagree with them are taking up time that would be better spent in another way. I admit that after 16 years as a Minister. I too believed that. It was extremely good for me that the House of Commons reminded me that we are in a democracy, and that hon. Members should be there to hold Ministers to account. The procedure that the motion proposes is designed to stop Ministers from ever being held to account.
    Dr. Fox: I agree with my right hon. Friend, except on one small point. He may be right to say that, in time, Ministers come to regard the views of other hon. Members as unimportant. The difference with this Government is that they believe that the House is unimportant. That is why we are treated with such contempt.
    Mr. Bercow: My hon. Friend, with his beady eye and good ear, will have noted the absurdity of the Minister's claim that there was adequate time for considering the Bill while simultaneously failing to specify—because he does not yet know—how many hours would be available. Does my hon. Friend agree that it would be risible and unsatisfactory if the Health and Social Care Bill suffered the fate of the Vehicles (Crime) Bill, which requires us to consider 45 clauses, and a potential 100 amendments, over 23 hours in 10 sittings by 23 January? Does my hon. Friend agree that, on the strength of our experience of the Vehicles (Crime) Bill, it is important that the Programming Sub-Committee, which considers the total amount of time and the order of consideration, should meet in public, not in private, as the Government have decreed?
    Dr. Fox: My hon. Friend makes a helpful suggestion. I would go further; I am sure that wiser and more experienced heads than ours, with the benefit of experience and hindsight, would agree that the quality of legislation is directly proportional to the time that we take to consider it. Some of the Bills that have been rushed through the House in recent years have turned into the legislation that has subsequently required the most change. When the Government force Bills through the House at such a pace, they cannot be considered properly by hon. Members and by outside bodies that wish to comment on them in order to guarantee legislation of the highest possible quality. There will be more flawed legislation from this Parliament than from any in living memory.
    We need to ensure time to consider the drafting of the Bill and any changes that the Government may want to make. That is the same point as the argument about quality of legislation. I have been in this House only since 1992, but I can remember many Bills which, following considerable scrutiny over some time, the Government decided were fundamentally flawed and had to amend considerably. By such undue haste, with which they are also treating every other Bill, the Government are denying themselves the chance to look again at the Health and Social Care Bill.
    Mr. Redwood: Has my hon. Friend noticed that the Government selected the deadline for the limited scrutiny of the measure before they had been able to hear the views

    1189
    of the House on Second Reading? During that debate, many colleagues made some very powerful points, which will either prompt substantial amendment of the Bill, requiring time for consideration, or prolong difficult discussions in Committee. How can they possibly have chosen the right deadline when they did not know the power and range of the arguments?
    Dr. Fox: I hesitate to say to my right hon. Friend that the Government are not interested in the views of the House. They did not care what hon. Members were going to say. Only two Labour Back Benchers supported the Bill on Second Reading; the Government got it through with the usual Lobby fodder and Whips' poodles whom we are used to seeing. The subject and quality of the debate did not matter. It would not have mattered if the Government had introduced fundamental changes; they would have determined the timetable in any case. It is ironic that it took them six months even to arrange a debate in the House on the national plan that the Bill introduces, yet we are to complete the passage of the legislation in an obscenely short period.
    I seriously remind the Minister that, as a result of arguments during the legislative process, the Government have often had to table amendments to their legislation late in the day. With such a very short timetable, they are denying themselves the opportunity to do that, and that can only lead to poorer legislation.
    Mr. Edward Leigh: Turning a Government can take a bit of time. I have sat through all three debates on programme motions this week. On the first day, the Minister for Housing and Planning said nothing; he just moved the motion formally. On the second day, the Under-Secretary of State for Defence spoke for about 45 or 50 seconds. Today, the Minister graced the House with a speech of three or four minutes. I think that the penny is beginning to drop. Very slowly, the Government are realising that such matters are important and special, and that we need a reasonable debate. Perhaps what we have done over the past three days is important and is having an effect on the Government.
    Dr. Fox: I would love to think that my hon. Friend was right, and that even this Government would have second thoughts—but, hand on heart, I must say that the Government are so completely arrogant and contemptuous of the democratic process that they will almost certainly force through whatever they want, whenever they want, irrespective of any argument, however valid or from whatever quarter.
    This is a long Bill. It has 67 pages, 66 clauses and five schedules. It is a complex Bill; it introduces many detailed reforms. It is very centralising legislation which has profound implications for the way in which our health service is run and the process of government is developed. It confers a range of new powers on the Secretary of State, and it is important that we ensure that those powers will be exercised by the Executive reasonably and responsibly, with proper safeguards, transparency and accountability to the elected Parliament of this country.
    The Bill will increase Whitehall's influence still further, yet it is Whitehall's influence and the influence of the Executive that are at the root of the problem that we are discussing on this motion. It will not only affect
    1190
    the 1 million or so employees of the national health service, as it varies their terms and conditions and gives further powers to the Secretary of State, but will influence the millions of users of the NHS.
    Many outside bodies have already written to hon. Members to give their views, to express their worries, and sometimes to give their support to parts of the Bill. The Bill will inevitably evolve, as changes to one part will affect another part. Those outside groups are not being given a chance to see how the Bill develops. Instead, the Government are telling them that only their views at the outset are valid, and anything after that is irrelevant. That is grossly insulting to the many groups that take a close interest in health matters, to many of our constituents who have written to us on this subject, and to the many interest groups that come to see us, and that inform the all-party committees that take a close interest in the workings of health policy.
    On Second Reading, many of the Government's own supporters accused them of undue haste, especially in their proposals to abolish community health councils. They said that the Government's plans had been evolving since they were first published. That tells me that the Government have not finished their thought process, yet we are not to be given time to accommodate any changes in approach to any areas of the Bill.
    It is extraordinary that the Government believe that when they publish a Bill it is the apogee of wisdom, and nothing can possibly better what is set down in print—if anything did, it would be given scant consideration. The Minister said that everyone knew about these issues. That is one of the most ridiculous things that I have heard a Minister say in a long time. If everyone knew about the issues, we would not have to debate them in the House of Commons, and we would not have piles of paper from outside bodies advising us on the experience of interested and expert groups in the different areas of policy.
    I imagine that all hon. Members have had briefings from the Consumers Association. Notwithstanding its initial support for clause 26, it says:
    However, we would like clarification on whether or not information on disqualified doctors is automatically referred to the Family Health Services Appeals Authority … or is it only when a health care worker appeals against their disqualification that the FHSAA is notified? This is particularly relevant to locums as due to the transitory nature of this work they frequently move between Health Authorities. It is important that if one Health Authority removes a GP or locum from the list that other Health Authorities are informed.
    If everyone knew already about these issues, the Consumers Association would not be asking that question.
    On pharmaceutical pilots, the association says:
    there is a need for more information about how these pilots will operate and about the measures that will be put in place to safeguard the interests of patients and the public. For example, what will be the exact status of the pharmaceutical pilots—if they are not NHS bodies will they be governed by the Care Standards Act?
    If everything was a clear as the Minister says, those questions would not be asked.
    The association goes on to say:
    We also require clarification about patients' right to redress should they have problems with services provided by these pilots. It is our view that these pilots should be part of the NHS and patients should have access to the full range of rights provided by the NHS.
    If the association knew about those matters, and if the proposals were so simple, why would it bother to write to every Member of Parliament to ask us to raise these

    1191
    matters with Ministers through the proper scrutiny procedures and to have them clarified, so that the rights of patients could be protected? It is complete nonsense for the Minister to dismiss, as he did in his short speech, the interests of those groups by saying. "They should know all about it already, because we know about it. We are bringing forward the Bill. We don't need time." That is deeply insulting.
    Such problems occur in many other parts of the Bill. On Second Reading, I said that we agreed with many of the provisions in principle—but we require proper information before we can decide whether to give our support to the Bill in Committee clause by clause. That is not an unreasonable position for any Opposition to take.
    On the expansion of prescribing rights, we said that there was a need to use all personnel at the ceiling of their ability, but that there were a number of things that we did not know. We wanted to know what the balance would be between doctors, practice nurses, other nurses and pharmacists after the expansion of prescribing. We wanted to know if any deregulation measures would be brought forward for categories of medicines. Those details are vital to the workability of ideas which are basically sound.
    Who carries liability for prescribing? If I write a prescription for an hon. Member, as I do regularly for hon. Members on both sides—I do not do Prozac or Viagra—I carry my own liability. Who will carry liability for nurses who write prescriptions? Who will carry liability when pharmacists prescribe? Those are deeply important matters, which require much debate.
    When we explore the clauses in detail in Committee, I am sure that the outside bodies that will be affected will want to speak to the Opposition and the Government, and, being far more expert in these matter than we are, they will want to consider all the implications as they see them. They will be denied that secondary input because of the short time scale.
    On Second Reading, we talked about the potential for personal medical services. We welcome the development of personal medical services. We said that GMS had had its day and would gradually disappear; there is no difference between the two sides of the House there. However, it all comes down to the detail. What will a quality agenda mean? How much control will be exercised from the centre? How much autonomy will doctors have?
    The British Medical Association and the Royal College of General Practitioners will have strong views on such topics, and they will want to tell us what they believe are the implications of any ministerial answers given in Committee. We shall have so little time that the chances are that by the time that they get back to us with their views on any potential flaws, we will be unable to change anything. That is a real tragedy, which could be avoided.
    When I was a Government Whip, the Opposition were given adequate time when it was felt that they had a reasonable case. It is far better to carry forward legislation in the House with as much co-operation as possible, yet the Government are intent on using their big parliamentary majority to batter the House into submission, to treat us with contempt and not to give us the chance to scrutinise properly what is being proposed, which is part of our duties as elective representatives.
    1192
    Another reason for our need for time is the Government's plan to force its model for change on the NHS. I do not have a problem with the progression of primary care groups to primary care trusts, or the establishment of care trusts. As my hon. Friend the Member for Runnymede and Weybridge (Mr. Hammond) said on Second Reading, we have an open mind on the substantive issue, but we have a problem with our ability to trust the Government on the subject.
    During consideration of a previous Bill in Committee, the Minister of State said that doctors would not be forced from a primary care group into a primary care trust against their will. But at the very first test case in Southend, the majority of doctors voted against moving to a primary care trust, yet were forced to by the Government. It is hard for us to trust the word of Ministers when we have seen that word broken so quickly in the past. We want time to scrutinise such cases and to look back at precedents to see when Ministers have said one thing in Committee and done something different in practice. That is crucial to our willingness to grant them any powers of discretion in any of the many areas dealt with in the Bill.
    We want to consider the implications for supplementary lists. We want to consider the Government's plans to reward excellence. We want to explore with Ministers how their proposal fits with the programmes of other Departments, not least the Department for Education and Employment's approach to failing schools, as compared with how the Government intend to deal with failing hospitals. To consider such matters properly will require quite a lot of time. Members of the Select Committee on Health may not have been members of the Committees that considered the other Bills involved, and we shall want to talk to other groups that we have not yet consulted. All those things take time.
    Having spent so much time in Opposition, the Minister and his colleagues should know better than anyone else that there is a huge difference in the amount of information that one can assimilate with the help of a full civil service and what the Opposition are capable of assimilating. It is doubly unfair to the Opposition to have their timetable curtailed to this extent. The Government have all the information at their fingertips and the Opposition always have to run to keep up, even on a Bill with a generous timetable, not to mention one that has been so ridiculously concertinaed.
    We will want to explore new issues in Committee that we did not raise on Second Reading. For example, we want to see how the Government's proposals for the NCAA fit in with their wider plans for GMC reform, and to consider validation and other associated issues.
    We will want to consider whether the Government might look favourably on time limits for disciplinary cases at the GMC, not least because of the manpower considerations of having a large—and ever increasing, it seems—number of doctors under investigation and unable to work. It would be much better if doctors could practise in the national health service. We will want to know Ministers' views on those matters. We could not touch on them on Second Reading, because we would have been out of order.
    We will want to explore Ministers' ideas about an independent appointments body. We found it absolutely amazing that the Minister could claim that this was a decentralising Bill giving away his powers, when it is

    1193
    exactly the opposite. We wanted a truly independent body for national health service appointments, free from the influence of the Secretary of State, so that we could avoid the possibility of any party appointing people to the NHS because of the loyalty that they might bring to their political masters rather than the experience that they might bring to the running of the health service.
    Mr. Denham: The Opposition had the opportunity to indicate, through the usual channels, how long they wanted to debate the Bill, and they did not do so. They could have tabled an amendment to the programme motion, and they did not do so. I am at a loss to understand how the hon. Gentleman can complain about a lack of time, when he has not at any stage said how long he would like to debate the Bill.
    Dr. Fox: There is the rub. The Minister cannot understand that we object on a point of principle. We do not want automatically timetabled Bills. If our argument is that the Government cannot know what will come up in Committee and how much time will be needed, how could the Opposition possibly know in advance how much time would be appropriate? We need to get into Committee and then decide, on the evidence before us and the representations that we receive, how much time is required for proper scrutiny of the legislation. That is our duty towards our constituents, to ensure that Bills are of a proper quality and not fundamentally flawed or pushed through with undue haste by an arrogant and contemptuous Government.
    11.4 pm
    Mr. Tony Baldry: For as long as all of us can remember, the House has worked on two conventions: that the Government are entitled to get their business through—none of us would challenge that—and, just as important, that the Opposition are entitled to challenge the Government's proposals. The only mechanism that the Opposition has to do that is time.
    Most Conservative Members have served in Committee as Ministers or Back Benchers and we know that the Minister of the day is put up to bat and is challenged by way of amendments. In the past, Government Back Benchers were enjoined to be quiet because Ministers needed to respond to the challenges put up by way of amendment by Opposition Back Benchers and Front-Bench spokesmen. This device is a complete mockery of that system. If an amendment on the Order Paper is inconvenient to Ministers—for example, if Ministers find amendments in relation to community health councils which they would rather not address—they will have every incentive to put up their own Back Benchers simply to wallpaper over time. So in future, Government Back Benchers will make long-winded speeches in Standing Committees, filibustering to fill the time to ensure that Ministers are not obliged to address difficult points and answer difficult questions. It is particularly pertinent in respect of this very technical Bill, which has 66 clauses and five schedules.
    The Secretary of State made a perfectly competent Second Reading speech, which was in broad terms, as one would expect. He did not deal with any of the detail of the Bill or any of the new organisations; nor did he explain why community health councils are being abolished or what they have done wrong. He did not deal
    1194
    with the new health authorities, organisations and statutory bodies. Those are all perfectly proper issues on which the Opposition could challenge the Government by way of amendment. I am prepared to lay money on it that, on every inconvenient amendment, the Government Whips will say to their Back Benchers, "Please speak on previous amendments to squeeze out the Opposition amendments that are inconvenient." So not only is the time allocated to these Bills ridiculously short—the idea that we can deal with a Bill of 66 clauses and five schedules by 8 February is frankly absurd—but the time allocated to Opposition Members will be substantially reduced. That is a perversion.
    I have been fortunate enough to have been in the House for 18 years and I hope to be here for a few more. Many of us will have sat on both sides of the House during our time here. This place can work only if the Opposition respect the fact that, at the end of the day, the Government are entitled to get their business through—I do not think that any Opposition Member challenges that—and the Government recognise that the Opposition are entitled to challenge their proposals. If the Government of the day do not give the Opposition sufficient opportunity to challenge their proposals in detail by amendments, the system becomes a perversion and that results in far poorer legislation and public policy. The Government, the country and public policy are far weaker for that.
    11.8 pm
    Sir Peter Emery: I have listened with great interest to my hon. Friend the Member for Banbury (Mr. Baldry), who speaks with considerable experience. I have been in the House twice as long as he has and a factor in the whole of that time has been the major criticism that Governments introduce guillotines to cut Bills in half so that massive parts of them are never discussed in Committee. The Opposition never have the chance of doing what my hon. Friend says and challenging the Government on particular questions. In the past, we were stopped by the old-fashioned guillotine structure. This motion attempts to make public what my hon. Friend and I knew as Ministers.
    When I started in Committee, the Whips Office, which used to be at the end of the Corridor, knew exactly what day they would demand that a Bill was out of Committee. That was something between the Whips and the Minister. If, in fact, we were nowhere near the date when it should have left Committee, there was a guillotine and parts of the Bill were never even discussed.
    The motion is at least an attempt—I am not certain whether it will work—to ensure that the whole House is told about the date, which the Government know. The Committee is told that, in order to debate all parts of the Bill, it can decide the amount of time and the way in which that time will be orchestrated in Committee. That is the concept of a Programming Sub-Committee of the Committee. The matter will thus not be decided by the Whips in a guillotine motion, but settled by the people who should debate it and who should know what it is about.
    It is important—this is the crux of the matter—that the Opposition's demand for time should be accepted by the Government in order that that can be delivered. If the Government refuse that, we have every right to object.

    1195
    Whatever the Programming Sub-Committee decides should be recorded, as would occur in a Standing Committee, so that everyone can know what went on.
    Mr. David Winnick: Will the right hon. Gentleman give way?
    Sir Peter Emery: May I finish my speech? There is very little time for the debate.
    We need to ensure that the Government behave as the Modernisation Committee expected them to do. If that can be achieved, there is an advantage for the Opposition because we shall be able to programme matters during Committee. The comments of my hon. Friend the Member for Banbury will apply just as much whether we have a Programming Sub-Committee or whether we return to the previous situation when the Government spoke up to stop amendments being introduced. There is nothing new in that and I am not positive that we shall have got rid of that system.
    The proposal would achieve at least two results, however. It would ensure that every part of a Bill is considered and that the Government give the necessary time for that in Committee. If that is the case, there will be an improvement in the procedures of the House.
    11.13 pm
    Mr. John Gummer: I very much agree with my right hon. Friend the Member for East Devon (Sir P. Emery). However, our experience is not as has been described. Our experience is that the Committees that consider such matters have not listened to the Opposition. The reason is clear: under the old system, the Opposition had some power. They could refuse the time that the Government wanted—they could use the time—but that is no longer true.
    The Opposition have no power. They depend entirely on the Government's willingness to behave in the civilised way to which my right hon. Friend referred. Some members of the Government want to be civilised, but the actions of their Whip during this debate do not suggest much civilisation—the hon. Member for Plymouth, Devonport (Mr. Jamieson) has giggled throughout the whole debate. He has not actually listened to any of the comments that have been made, so I do not believe that there is much willingness to listen.
    If the Government were willing to say that they were prepared to provide as much time as is necessary for the Opposition to propose their various views between now and that date, we should have a timetable motion. However, we do not have a timetable motion; we have a guillotine. The one thing we know is the end date. The Government are perfectly able to say that we will hold one meeting every week and that it will last an hour. We have to rely on them all down the line to allow the time needed.
    Many Conservative Members would be happy with a system that enabled these matters to be debated in a civilised manner. That cannot be so unless the Government show a willingness to give all the time necessary and to listen to the arguments advanced. If the Government are able to use their Back Benchers to block
    1196
    discussion of particular amendments or if they prove unwilling to provide the necessary time, we must always oppose guillotine motions.
    Mr. Paul Tyler: If the new system, of which the right hon. Member for East Devon (Sir P. Emery) is, as much as anyone, the godfather, is to work, we must be given some assurance that when Conservative Front Benchers agree to a programme motion, the undertaking will be held to right across the House, even by the mavericks on the Conservative Back Benches.
    Mr. Gummer: There is no question of an undertaking being given. The motion is a timetable motion—a guillotine—tabled on the basis that there is no alternative. No one asked Conservative Front Benchers whether they wanted an agreement. I shall vote against the proposal because I am not Prepared to support Bills that are guillotined unless there are changes to the system.
    The Bill, in fact, is supported, not opposed, by our Front Benchers. In such circumstances, in a civilised society, agreement would be reached between the two sides, but that has not happened. The Government have produced an end date and told the Opposition that that is it. That is not agreement [Interruption.] The Minister can say what he likes, but there can be no agreement when he has not told our spokesmen how many hours of debate he will allow. Until he is prepared to do so, and until he agrees to allow us every hour that our Front Benchers want, no agreement can he reached.
    I am not prepared to agree to a guillotine motion—either as a Back Bencher or, perhaps, as a maverick—until those who seek good legislation are given enough time to achieve it and to represent their constituents.
    Question put:—
    The House divided: Ayes 324, Noes 118.

    Division No. 47]

    [11.18 pm

    AYES

    Abbott, Ms Diane

    Blizzard, Bob

    Ainsworth, Robert (Cov'try NE)

    Boateng, Rt Hon Paul

    Alexander, Douglas

    Bradley, Keith (Withington)

    Allan, Richard

    Bradley, Peter (The Wrekin)

    Allen, Graham

    Brand, Dr Peter

    Anderson, Rt Hon Donald (Swansea E)

    Brinton, Mrs Helen

    Brown, Rt Hon Nick (Newcastle E)

    Anderson, Janet (Rossendale)

    Brown, Russell (Dumfries)

    Armstrong, Rt Hon Ms Hilary

    Browne, Desmond

    Ashton, Joe

    Bruce, Malcolm (Gordon)

    Atkins, Charlotte

    Buck, Ms Karen

    Austin, John

    Burden, Richard

    Bailey, Adrian

    Burgon, Colin

    Banks, Tony

    Burstow, Paul

    Barnes, Harry

    Butler, Mrs Christine

    Barron, Kevin

    Campbell, Alan (Tynemouth)

    Battle, John

    Campbell, Rt Hon Menzies (NE Fife)

    Bayley, Hugh

    Beard, Nigel

    Campbell-Savours, Dale

    Begg, Miss Anne

    Cann, Jamie

    Benn, Hilary (Leeds C)

    Caplin, Ivor

    Benn, Rt Hon Tony (Chesterfield)

    Casale, Roger

    Bennett, Andrew F

    Caton, Martin

    Bermingham, Gerald

    Cawsey, Ian

    Berry, Roger

    Chapman, Ben (Wirral S)

    Best, Harold

    Chaytor, David

    Betts, Clive

    Chidgey, David

    Blears, Ms Hazel

    Clapham, Michael

    1197

    Clark, Rt Hon Dr David (S Shields)

    Hanson, David

    Clark, Dr Lynda (Edinburgh Pentlands)

    Harris, Dr Evan

    Harvey, Nick

    Clark, Paul (Gillingham)

    Healey,.John

    Clarke, Charles (Norwich S)

    Heath, David (Somerton & Frome)

    Clarke, Eric (Midlothian)

    Henderson, Doug (Newcastle N)

    Clarke,Rt Hon Tom (Coatbridge)

    Henderson, Ivan (Harwich)

    Clarke, Tony (Northampton S)

    Hendrick, Mark

    Clelland, David

    Hepburn, Stephen

    Clwyd, Ann

    Heppell, John

    Coaker, Vernon

    Hesford, Stephen

    Cohen, Harry

    Hill, Keith

    Coleman, Iain

    Hoey, Kate

    Colman, Tony

    Hope, Phil

    Connarty, Michael

    Hopkins, Kelvin

    Corbett, Robin

    Howarth, Rt Hon Alan (Newport E)

    Corbyn, Jeremy

    Howells, Dr Kim

    Cotter, Brian

    Hoyle, Lindsay

    Cousins, Jim

    Hughes, Ms Beverley (Stretford)

    Cox, Tom

    Hughes, Kevin (Doncaster N)

    Cranston, Ross

    Hughes, Simon (Southwark N)

    Crausby, David

    Humble, Mrs Joan

    Cryer, John (Hornchurch)

    Hurst, Alan

    Cummings, John

    Hutton, John

    Cunningham, Rt Hon Dr Jack (Copeland)

    Iddon, Dr Brian

    Illsley, Eric

    Cunningham, Jim (Cov'try S)

    Jackson, Helen (Hillsborough)

    Darvill, Keith

    Jamieson, David

    Davey, Edward (Kingston)

    Jenkins, Brian

    Davidson, Ian

    Johnson, Alan (Hull W & Hessle)

    Davis, Rt Hon Terry (B'ham Hodge H)

    Jones, Helen (Warrington N)

    Jones, Jon Owen (Cardiff C)

    Dawson, Hilton

    Jones, Dr Lynne (Selly Oak)

    Denham, John

    Jones, Martyn (Clwyd S)

    Dismore, Andrew

    Jones, Nigel (Cheltenham)

    Dobbin, Jim

    Joyce, Eric

    Dobson, Rt Hon Frank

    Kaufman, Rt Hon Gerald

    Donohoe, Brian H

    Keeble, Ms Sally

    Doran, Frank

    Keen, Alan (Feltham & Heston)

    Dowd, Jim

    Keen, Ann (Brentford & Isleworth)

    Eagle, Angela (Wallasey)

    Keetch, Paul

    Eagle, Maria (L'pool Garston)

    Kemp, Fraser

    Edwards, Huw

    Kennedy, Jane (Wavertree)

    Ellman, Mrs Louise

    Khabra, Piara S

    Ennis, Jeff

    Kidney, David

    Etherington, Bill

    Kilfoyle, Peter

    Fearn, Ronnie

    King, Ms Oona (Bethnal Green)

    Field, Rt Hon Frank

    Kirkwood, Archy

    Fisher, Mark

    Ladyman, Dr Stephen

    Fitzpatrick, Jim

    Lawrence, Mrs Jackie

    Flint, Caroline

    Laxton, Bob

    Flynn, Paul

    Lepper, David

    Foster, Rt Hon Derek

    Levitt, Tom

    Foster, Don (Bath)

    Lewis, Ivan (Bury S)

    Foster, Michael Jabez (Hastings)

    Lewis, Terry (Worsley)

    Foster, Michael J (Worcester)

    Liddell, Rt Hon Mrs Helen

    Galloway, George

    Linton, Martin

    Gapes, Mike

    Lloyd, Tony (Manchester C)

    Gardiner, Barry

    Lock, David

    George, Andrew (St Ives)

    Love, Andrew

    George, Rt Hon Bruce (Walsall S)

    McAvoy, Thomas

    Gerrard, Neil

    McCabe, Steve

    Gibson, Dr Ian

    McCartney, Rt Hon Ian (Makerfield)

    Gilroy, Mrs Linda

    Godsiff, Roger

    McDonagh, Siobhain

    Goggins, Paul

    Macdonald, Calum

    Golding, Mrs Llin

    McDonnell, John

    Gordon, Mrs Eileen

    McFall, John

    Griffiths, Jane (Reading E)

    McIsaac, Shona

    Griffiths, Nigel (Edinburgh S)

    Mackinlay, Andrew

    Griffiths, Win (Bridgend)

    Maclennan, Rt Hon Robert

    Grocott, Bruce

    McNamara, Kevin

    Grogan, John

    McNulty, Tony

    Hall, Patrick (Bedford)

    MacShane, Denis

    Hamilton, Fabian (Leeds NE)

    Mactaggart, Fiona

    Hancock, Mike

    McWalter, Tony

    1198

    McWilliam, John

    Shipley, Ms Debra

    Mallaber, Judy

    Simpson, Alan (Nottingham S)

    Marsden, Gordon (Blackpool S)

    Singh, Marsha

    Marshall, David (Shettleston)

    Skinner, Dennis

    Marshall, Jim (Leicester S)

    Smith, Rt Hon Andrew (Oxford E)

    Marshall-Andrews, Robert

    Smith, Miss Geraldine (Morecambe & Lunesdale)

    Martlew, Eric

    Maxton, John

    Smith, Jacqui (Redditch)

    Meacher, Rt Hon Michael

    Smith, Llew (Blaenau Gwent)

    Meale, Alan

    Soley, Clive

    Merron, Gillian

    Southworth, Ms Helen

    Michael, Rt Hon Alun

    Spellar, John

    Michie, Bill (Shef'ld Heeley)

    Starkey, Dr Phyllis

    Michie, Mrs Ray (Argyll & Bute)

    Steinberg, Gerry

    Milburn, Rt Hon Alan

    Stevenson, George

    Miller, Andrew

    Stewart, David (Inverness E)

    Moffatt, Laura

    Stewart, Ian (Eccles)

    Moonie, Dr Lewis

    Stoate, Dr Howard

    Moore, Michael

    Strang, Rt Hon Dr Gavin

    Morgan, Ms Julie (Cardiff N)

    Stringer, Graham

    Morley, Elliot

    Stuart, Ms Gisela

    Murphy, Rt Hon Paul (Torfaen)

    Stunell, Andrew

    Naysmith, Dr Doug

    Sutcliffe, Gerry

    Norris, Dan

    Taylor, Rt Hon Mrs Ann (Dewsbury)

    O'Brien, Mike (N Warks)

    O'Hara, Eddie

    Taylor, Ms Dari (Stockton S)

    O'Neill, Martin

    Taylor, David (NW Leics)

    Öpik, Lembit

    Taylor, Matthew (Truro)

    Organ, Mrs Diana

    Temple-Morris, Peter

    Pearson, Ian

    Thomas, Gareth (Clwyd W)

    Perham, Ms Linda

    Thomas, Gareth R (Harrow W)

    Pickthall, Colin

    Tipping, Paddy

    Pike, Peter L

    Todd, Mark

    Plaskitt, James

    Trickett, Jon

    Pond, Chris

    Truswell, Paul

    Pope, Greg

    Turner, Dr Desmond (Kemptown)

    Pound, Stephen

    Turner, Dr George (NW Norfolk)

    Prentice, Ms Bridget (Lewisham E)

    Turner, Neil (Wigan)

    Prentice, Gordon (Pendle)

    Twigg, Derek (Halton)

    Prosser, Gwyn

    Tyler, Paul

    Quin, Rt Hon Ms Joyce

    Tynan, Bill

    Quinn, Lawrie

    Vis, Dr Rudi

    Rammell, Bill

    Walley, Ms Joan

    Rapson, Syd

    Ward, Ms Claire

    Raynsford, Nick

    Wareing, Robert N

    Reed, Andrew (Loughborough)

    Watts, David

    Reid, Rt Hon Dr John (Hamilton N)

    White, Brian

    Rendel, David

    Whitehead, Dr Alan

    Robertson, John (Glasgow Anniesland)

    Williams, Rt Hon Alan (Swansea W)

    Roche, Mrs Barbara

    Williams, Alan W (E Carmarthen)

    Rooker, Rt Hon Jeff

    Williams, Mrs Betty (Conwy)

    Rooney, Terry

    Willis, Phil

    Ross, Ernie (Dundee W)

    Winnick, David

    Rowlands, Ted

    Winterton, Ms Rosie (Doncaster C)

    Ruane, Chris

    Wood, Mike

    Russell, Bob (Colchester)

    Woodward, Shaun

    Russell, Ms Christine (Chester)

    Worthington, Tony

    Salter, Martin

    Wray, James

    Sanders, Adrian

    Wright, Anthony D (Gt Yarmouth)

    Sarwar, Mohammad

    Wyatt, Derek

    Savidge, Malcolm

    Sawford, Phil

    Tellers for the Ayes:

    Sedgemore, Brian

    Mr. Mike Hall and

    Shaw, Jonathan

    Mr. Don Touhig.

    NOES

    Ainsworth, Peter (E Surrey)

    Body, Sir Richard

    Amess, David

    Boswell, Tim

    Arbuthnot, Rt Hon James

    Bottomley, Peter (Worthing W)

    Atkinson, David (Bour'mth E)

    Bottomley, Rt Hon Mrs Virginia

    Atkinson, Peter (Hexham)

    Brady, Graham

    Baldry, Tony

    Brazier, Julian

    Beggs, Roy

    Browning, Mrs Angela

    Bercow, John

    Bruce, Ian (S Dorset)

    Blunt, Crispin

    Burns, Simon

    1199

    Butterfill, John

    McIntosh, Miss Anne

    Cash, William

    Maclean, Rt Hon David

    Chapman, Sir Sydney (Chipping Barnet)

    McLoughlin, Patrick

    Malins, Humfrey

    Chope, Christopher

    Maples, John

    Clappison, James

    May, Mrs Theresa

    Collins, Tim

    Moss, Malcolm

    Cormack, Sir Patrick

    Nicholls, Patrick

    Cran, James

    O'Brien, Stephen (Eddisbury)

    Davies, Quentin (Grantham)

    Ottaway, Richard

    Davis, Rt Hon David (Haltemprice)

    Page, Richard

    Day, Stephen

    Paice, James

    Dorrell, Rt Hon Stephen

    Pickles, Eric

    Duncan, Alan

    Portillo, Rt Hon Michael

    Evans, Nigel

    Prior, David

    Flight, Howard

    Randall, John

    Forth, Rt Hon Eric

    Redwood, Rt Hon John

    Fox, Dr Liam

    Robathan, Andrew

    Fraser, Christopher

    Robertson, Laurence (Tewk'b'ry)

    Gale, Roger

    Roe, Mrs Marion (Broxbourne)

    Garnier, Edward

    Ruffley, David

    Gibb, Nick

    St Aubyn, Nick

    Gillan, Mrs Cheryl

    Sayeed, Jonathan

    Gray, James

    Simpson, Keith (Mid-Norfolk)

    Green, Damian

    Smyth, Rev Martin (Belfast S)

    Greenway, John

    Spelman, Mrs Caroline

    Grieve, Dominic

    Spicer, Sir Michael

    Spring, Richard

    Gummer, Rt Hon John

    Stanley, Rt Hon Sir John

    Hamilton, Rt Hon Sir Archie

    Swayne, Desmond

    Hammond, Philip

    Syms, Robert

    Hawkins, Nick

    Tapsell, Sir Peter

    Hayes, John

    Taylor, Ian (Esher & Walton)

    Heald, Oliver

    Taylor, John M (Solihull)

    Horam, John

    Taylor, Sir Teddy

    Howard, Rt Hon Michael

    Thomas, Simon (Ceredigion)

    Howarth, Gerald (Aldershot)

    Thompson, William

    Jack, Rt Hon Michael

    Tredinnick, David

    Jackson, Robert (Wantage)

    Tyrie, Andrew

    Jenkin, Bernard

    Waterson, Nigel

    Key, Robert

    Wells, Bowen

    King, Rt Hon Tom (Bridgwater)

    Whitney, Sir Raymond

    Lait, Mrs Jacqui

    Whittingdale, John

    Leigh, Edward

    Widdecombe, Rt Hon Miss Ann

    Letwin, Oliver

    Wilkinson, John

    Lewis, Dr Julian (New Forest E)

    Willetts, David

    Lidington, David

    Wilshire, David

    Lilley, Rt Hon Peter

    Yeo, Tim

    Lloyd, Rt Hon Sir Peter (Fareham)

    Young, Rt Hon Sir George

    Liwyd, Elfyn

    Loughton, Tim

    Tellers for the Noes:

    Lyell, Rt Hon Sir Nicholas

    Mr. Peter Luff and

    MacGregor, Rt Hon John

    Mr. Geoffrey Clifton-Brown.

    Question accordingy agreed to.

  HEALTH AND SOCIAL CARE BILL [MONEY]
  Queen's recommendation having been signified—
  Motion made, and Question put forthwith, pursuant to Standing Order No. 52(1)(a),
  That, for the purposes of any Act resulting from the Health and Social Care Bill, it is expedient to authorise—

  (1) the payment out of money provided by Parliament of—

  (a) any expenditure incurred by the Secretary of State in
  consequence of the Act; and

  (b) any increase attributable to the Act in the sums payable out of money so provided by virtue of any other Act; and

  (2) the payment into the Consolidated Fund of sums received by the Secretary of State by virtue of the Act.—[Mr. McNulty.]

  The House divided: Ayes 293, Noes 43.

  Division No. 48]

  [11.32 pm

  AYES

  Abbott, Ms Diane

  Cunningham, Rt Hon Dr Jack (Copeland)

  Ainsworth, Robert (Cov'try NE)

  Alexander, Douglas

  Cunningham, Jim (Cov'try S)

  Allen, Graham

  Darvill, Keith

  Anderson, Rt Hon Donald (Swansea E)

  Davidson, Ian

  Davis, Rt Hon Terry (B'ham Hodge H)

  Anderson, Janet (Rossendale)

  Armstrong, Rt Hon Ms Hilary

  Dawson, Hilton

  Ashton, Joe

  Denham, John

  Atkins, Charlotte

  Dismore, Andrew

  Austin, John

  Dobbin, Jim

  Bailey, Adrian

  Dobson, Rt Hon Frank

  Banks, Tony

  Donohoe, Brian H

  Barnes, Harry

  Doran, Frank

  Barron, Kevin

  Dowd, Jim

  Battle, John

  Eagle, Angela (Wallasey)

  Bayley, Hugh

  Eagle, Maria (L'pool Garston)

  Beard, Nigel

  Edwards, Huw

  Begg, Miss Anne

  Ellman, Mrs Louise

  Benn, Hilary (Leeds C)

  Ennis, Jeff

  Benn, Rt Hon Tony (Chesterfield)

  Etherington, Bill

  Bennett, Andrew F

  Field, Rt Hon Frank

  Bermingham, Gerald

  Fisher, Mark

  Berry, Roger

  Fitzpatrick, Jim

  Best, Harold

  Flint, Caroline

  Betts, Clive

  Flynn, Paul

  Blears, Ms Hazel

  Foster, Rt Hon Derek

  Blizzard, Bob

  Foster, Michael J (Worcester)

  Boateng, Rt Hon Paul

  Galloway, George

  Bradley, Keith (Withington)

  Gapes, Mike

  Bradley, Peter (The Wrekin)

  Gardiner, Barry

  Brinton, Mrs Helen

  George, Rt Hon Bruce (Walsall S)

  Brown, Rt Hon Nick (Newcastle E)

  Gerrard, Neil

  Brown, Russell (Dumfries)

  Gibson, Dr Ian

  Browne, Desmond

  Gilroy, Mrs Linda

  Buck, Ms Karen

  Godsiff, Roger

  Burden, Richard

  Goggins, Paul

  Burgon, Colin

  Golding, Mrs Llin

  Butler, Mrs Christine

  Gordon, Mrs Eileen

  Campbell, Alan (Tynemonth)

  Griffiths, Jane (Reading E)

  Campbell-Savours, Dale

  Griffiths, Nigel (Edinburgh S)

  Cann, Jamie

  Griffiths, Win (Bridgend)

  Caplin, Ivor

  Grocott, Bruce

  Casale, Roger

  Grogan, John

  Hall, Mike (Weaver Vale)

  Caton, Martin

  Hall, Patrick (Bedford)

  Cawsey, Ian

  Hamilton, Fabian (Leeds NE)

  Chapman, Ben (Wirral S)

  Hanson, David

  Chaytor, David

  Healey, John

  Clapham, Michael

  Henderson, Doug (Newcastle N)

  Clark, Rt Hon Dr David (S Shields)

  Henderson, Ivan (Harwich)

  Clark, Dr Lynda (Edinburgh Pentlands)

  Hendrick, Mark

  Hepburn, Stephen

  Clark, Paul (Gillingham)

  Heppell, John

  Clarke, Charles (Norwich S)

  Hesford, Stephen

  Clarke, Eric (Midlothian)

  Hill, Keith

  Clarke, Rt Hon Tom (Coatbridge)

  Hoey, Kate

  Clarke, Tony (Northampton S)

  Hope, Phil

  Clelland, David

  Hopkins, Kelvin

  Clwyd, Ann

  Howarth, Rt Hon Alan (Newport E)

  Coaker, Vernon

  Howells, Dr Kim

  Cohen, Harry

  Hoyle, Lindsay

  Coleman, Iain

  Hughes, Ms Beveriey (Stretford)

  Colman, Tony

  Humble, Mrs Joan

  Connarty, Michael

  Hurst, Alan

  Corbett, Robin

  Hutton, John

  Corbyn, Jeremy

  Iddon, Dr Brian

  Cousins, Jim

  Illsley, Eric

  Cox, Tom

  Jackson, Helen (Hillsborough)

  Cranston, Ross

  Jamieson, David

  Crausby, David

  Jenkins, Brian

  Cryer, John (Hornchurch)

  Johnson, Alan (Hull W & Hessle)

  Cummings, John

  Jones, Helen (Warrinqton N)

  1201

  Jones, Jon Owen (Cardiff C)

  Prentice, Ms Bridget (Lewisham E)

  Jones, Dr Lynne (Selly Oak)

  Prentice, Gordon (Pendle)

  Jones, Martyn (Clwyd S)

  Prosser, Gwyn

  Joyce, Eric

  Quin, Rt Hon Ms Joyce

  Kaufman, Rt Hon Gerald

  Quinn, Lawrie

  Keeble, Ms Sally

  Rammel, Bill

  Keen, Alan (Feltham & Heston)

  Rapson, Syd

  Keen, Ann (Brentford & Isleworth)

  Raynsford, Nick

  Kemp, Fraser

  Reed, Andrew (Loughbotough)

  Kennedy, Jane (Wavertree)

  Reid, Rt Hon Dr John (Hamilton N)

  Khabra, Piara S

  Robertson, John (Glasgow Anniesland)

  Kidney, David

  Kilfoyle, Peter

  Roche, Mrs Barbara

  King, Ms Oona (Bethnal Green)

  Rooker, Rt Hon Jeff

  Ladyman, Dr Stephen

  Rooney, Terry

  Lawrence, Mrs Jackie

  Ross, Ernie (Dundee W)

  Laxton, Bob

  Rowlands, Ted

  Lepper, David

  Ruane, Chris

  Levitt, Tom

  Russell, Ms Christine (Chester)

  Lewis, Ivan (Bury S)

  Sarwar, Mohammad

  Lewis, Terry (Worsley)

  Savidge, Malcolm

  Liddell, Rt Hon Mrs Helen

  Sawford, Phil

  Linton, Martin

  Sedgemore, Brian

  Lloyd, Tony (Manchester C)

  Shaw, Jonathan

  Llwyd, Elfyn

  Shipley, Ms Debra

  Lock, David

  Simpson, Alan (Nottingham S)

  Love, Andrew

  Singh, Marsha

  McAvoy, Thomas

  Skinner, Dennis

  McCabe, Steve

  Smith, Rt Hon Andrew (Oxford E)

  McCartney, Rt Hon Ian (Makerfield)

  Smith, Miss Geraldine (Morecambe & Lunesdale)

  McDonagh, Siobhain

  Smith, Jacqui (Redditch)

  Macdonald, Calum

  Smith, Llew (Blaenau Gwent)

  McDonnell, John

  Soley, Clive

  McFall, John

  Southworth, Ms Helen

  McIsaac, Shona

  Spellar, John

  Mackinlay, Andrew

  Starkey, Dr Phyllis

  McNamara, Kevin

  Steinberg, Gerry

  McNulty, Tony

  Stevenson, George

  MacShane, Denis

  Stewart, David (Inverness E)

  Mactaggart, Fiona

  Stewart, Ian (Eccles)

  McWalter, Tony

  Stoate, Dr Howard

  McWilliam, John

  Strang, Rt Hon Dr Gavin

  Mallaber, Judy

  Stringer, Graham

  Marsden, Gordon (Blackpool S)

  Stuart, Ms Gisela

  Marshall, David (Shettleston)

  Sutcliffe, Gerry

  Marshall, Jim (Leicester S)

  Taylor, Rt Hon Mrs Ann (Dewsbury)

  Marshall-Andrews, Robert

  Martlew, Eric

  Taylor, Ms Dari (Stockton S)

  Maxton, John

  Taylor, David (NW Leics)

  Meacher, Rt Hon Michael

  Temple-Morris, Peter

  Meale, Alan

  Thomas, Gareth (Clwyd W)

  Merron, Gillian

  Thomas, Gareth R (Harrow W)

  Michael, Rt Hon Alun

  Thomas, Simon (Ceredigion)

  Michie, Bill (Shef'ld Heeley)

  Tipping, Paddy

  Milburn, Rt Hon Alan

  Todd, Mark

  Miller, Andrew

  Trickett, Jon

  Moffatt, Laura

  Truswell, Paul

  Moonie, Dr Lewis

  Turner, Dr Desmond (Kemptown)

  Morgan, Ms Julie (Cardiff N)

  Turner, Dr George (NW Norfolk)

  Morley, Elliot

  Turner, Neil (Wigan)

  Murphy, Rt Hon Paul (Torfaen)

  Twigg, Derek (Halton)

  Naysmith, Dr Doug

  Tynan, Bill

  Norris, Dan

  Vis, Dr Rudi

  O'Brien, Mike (N Warks)

  Walley, Ms Joan

  O'Hara, Eddie

  Ward, Ms, Claire

  O'Neill, Martin

  Wareing, Robert N

  Organ, Mrs Diana

  Watts, David

  Pearson, Ian

  White, Brian

  Perham, Ms Linda

  Whitehead, Dr Alan

  Pickthall, Colin

  Williams, Alan W (E Carmarthen)

  Pike, Peter L

  Williams, Mrs Betty (Conwy)

  Plaskitt, James

  Winnick, David

  Pond, Chris

  Winterton, Ms Rosie (Doncaster C)

  Pope, Greg

  Wood, Mike

  Pound, Stephen

  Woodward, Shaun

  1202

  Worthington, Tony

  Tellers for the Ayes:

  Wray, James

  Mr. Kevin Hughes and

  Wright, Anthony D (Gt Yarmouth)

  Wyatt, Derek

  Mr. Don Touhig.

  NOES

  Allan, Richard

  Heath, David (Somerton & Frome)

  Beggs, Roy

  Howarth, Gerald (Aldershot)

  Body, Sir Richard

  Hughes, Simon (Southwark N)

  Brand, Dr Peter

  Jones, Nigel (Cheltenham)

  Bruce, Malcolm (Gordon)

  Keetch, Paul

  Burstow, Paul

  Kirkwood, Archy

  Butterfill, John

  Leigh, Edward

  Campbell, Rt Hon Menzies (NE Fife)

  McIntosh, Miss Anne

  Michie, Mrs Ray (Argyll & Bute)

  Chidgey, David

  Moore, Michael

  Chope, Christopher

  Öpik, Lembit

  Cotter, Brian

  Redwood, Rt Hon John

  Davey, Edward (Kingston)

  Rendel, David

  Davis, Rt Hon David (Haltemprice)

  Russell, Bob (Colchester)

  Emery, Rt Hon Sir Peter

  Smith, Sir Robert (W Ab'd'ns)

  Fearn, Ronnie

  Taylor, Matthew (Truro)

  Forth, Rt Hon Eric

  Tyler, Paul

  Foster, Don (Bath)

  Wilkinson, John

  George, Andrew (St Ives)

  Willis, Phil

  Gummer, Rt Hon John

  Wilshire, David

  Hancock, Mike

  Harris, Dr Evan

  Tellers for the Noes:

  Harvey, Nick

  Mr. Andrew Stunell and

  Hayes, John

  Mr. Adrian Sanders.

  Question accordingly agreed to.

  SITTINGS IN WESTMINSTER HALL
  Motion made,
  That, following the Order [20th November 2000], Mr. Nicholas Winterton, Mr. John McWilliam, Mr. Barry Jones and Frank Cook be appointed to act as additional Deputy Speakers at sittings in Westminster Hall during this Session.—[Mr. McNulty.]
  Hon. Members: Object.

  SELECT COMMITTEES (JOINT MEETINGS)
  Motion made,
  That, for the current Session of Parliament, Standing Order No. 152 (Select committees related to government departments) be amended as follows:

  Line 37, before the word 'European' insert the words 'Environmental Audit Committee or with the'.

  Line 46, before the word 'European' insert the words 'Environmental Audit Committee or with the'.

  Line 48, at the end insert the words:—

  '(4A) notwithstanding paragraphs (2) and (4) above, where more than two committees or sub-committees appointed under this order meet concurrently in accordance with paragraph (4)(e) above, the quorum of each such committee or sub-committee shall be two.'—[Mr. McNulty.]
  Hon. Members: Object.

  BUSINESS OF THE HOUSE
  Motion made,
  That Private Members' Bills shall have precedence over Government business on 2nd and 9th February, 9th, 16th, 23rd and 30th March, 6th and 27th April, 11th and 18th May, 8th and 15th June and 20th July.—[Mr. McNulty.]
  Hon. Members: Object.

  HUMAN RIGHTS (JOINT COMMITTEE)
  Motion made,
  That—
  the Lords Message [12th July 2000] communicating a Resolution relating to Human Rights (Joint Committee), be now considered;
  this House concurs with the Lords in the said Resolution; and the following Standing Order be made:
  (1) There shall be a Select Committee, to consist of six Members, to join with the Committee appointed by the Lords as the Joint Committee on Human Rights.
  (2) The Committee shall consider—

  (a) matters relating to human rights in the United Kingdom (but excluding consideration of individual cases);

  (b) proposals for remedial orders, draft remedial orders and remedial orders made under Section 10 of and laid under Schedule 2 to the Human Rights Act 1998; and

  (c) in respect of draft remedial orders and remedial orders, whether the special attention of the House should be drawn to them on any of the grounds specified in Standing Order No. 151 (Statutory Instruments (Joint Committee));

  (3) The Committee shall report to the House—

  (a) in relation to any document containing proposals laid before the House under paragraph 3 of the said Schedule 2, its recommendation whether a draft order in the same terms as the proposals should be laid before the House; or

  (b) in relation to any draft order laid under paragraph 2 of the said Schedule 2, its recommendation whether the draft Order should be approved;

  and the Committee may report to the House on any matter arising from its consideration of the said proposals or draft orders.
  (4) The Committee shall report to the House in respect of any original order laid under paragraph 4 of the said Schedule 2, its recommendation whether—

  (a) the order should be approved in the form in which it was originally laid before Parliament; or

  (b) that the order should be replaced by a new order modifying the provisions of the original order; or

  (c) that the order should not be approved,

  and the Committee may report to the House on any matter arising from its consideration of the said order or any replacement order.
  (5) The quorum of the committee shall be three.
  (6) Unless the House otherwise orders, each Member nominated to the committee shall continue to be a member of it for the remainder of the Parliament.
  (7) The committee shall have power—

  (a) to send for persons, papers and records, to sit notwithstanding any adjournment of the House, to adjourn from place to place within the United Kingdom, to adjourn to institutions of the Council of Europe outside the United Kingdom no more than four times in any calendar year, and to report from time to time; and

  (b) to appoint specialist advisers either to supply information which is not readily available or to elucidate matters of complexity within the committee's order of reference.—[Mr. McNulty.]

  Hon. Members: Object.

  Flood Plains (Vale of York)
  Motion made, and Question proposed, That this House do now adjourn.—[Mr. McNulty.]
  11.45 pm
  Miss Anne McIntosh: I am delighted to have secured this Adjournment debate on planning guidance for developments on the flood plain in the Vale of York. The topic is very important to my constituents. The background to the debate is the recent flooding, but the debate is very timely as we await the much delayed consultation document PPG25, which deals with planning policy guidance for developments on flood plains.
  I am pleased that this debate is not being held at such a late hour as was the case yesterday, and it is always a pleasure to appear opposite the Under-Secretary.
  The recent maps of the flood plain published by the Environment Agency show that, at a conservative guesstimate, a very large proportion—between about 30 and 35 per cent.—of the Vale of York appears to be on the flood plain. I believe that the presumption should be against development on what is considered to be a functional flood plain.
  The Government appear to be in conflict with their own targets for development of brownfield sites that are functional or potentially functional flood plains. Respect for the status of flood plains and the flooding that could happen on them should overrule Government targets for building on flood plains.
  Paragraph 14 on page l3 of the consultation document PPG25 states:
  The primary responsibility for safeguarding land and other property against natural hazards such as flooding remains with the owner. There is no statutory duty on the Government to protect land or property against flooding … Operating authorities have permissive powers to carry out flood defence works in the public interest.
  That raises some important questions. How can a property owner protect land from acts of God such as floods caused by unprecedented weather that persists over several days, when the impact of that natural hazard is compounded by the actions of public authorities? The Environment Agency is looking closely at the impact on the flooding of the newly developed and recently opened park-and-ride scheme at Rawcliffe.
  The floods caused 170 homes in Rawcliffe to be flooded and their occupants to be evacuated in the first week of last November. The park-and-ride scheme was deeply unpopular among residents, who resented it. The glossy, flashy consultation exercise cost many thousands of pounds, but not one resident of Rawcliffe received a leaflet about the scheme, or was consulted about it. People there could not believe their misfortune when the outcome of the consultation was to move the scheme, which had been so successful at Clifton Moor business park, to a greenbelt site at Rawcliffe. Injury has been added to insult: many of the families evacuated from the 170 homes have no realistic chance of returning for two or three months yet.
  The park-and-ride scheme may have compounded the effects of the flood. Rumours that City of York council officials are to be feted, welcomed and congratulated in Downing street are especially inappropriate and insulting to residents of Rawcliffe, as the evacuees have no homes to go to.

  1205
  Evidence given to the Select Committee on the Environment, Transport and Regional Affairs showed that car parks and other developments can compound flood conditions. Tarmac allows water to accumulate until it is released in one big and dangerous whoosh.
  In addition, farmers have suffered especially badly as a result of the floods. A strong feeling exists among the farming community that vast areas of farm land were flooded to save towns and cities. Many people would argue that that was inevitable, but farmers have incurred heavy financial losses as a result.
  A constructive way in which farmers could be invited to help would be to relax existing Treasury rules. With the farmers' agreement, designated farm land could be recognised as a potential flood plain area, through the creation of new riparian wetlands. Farmers could be reimbursed through a Government-funded voluntary scheme.
  Such a strategy could benefit farm planning by identifying areas prone to flooding, and estimating the relevant periodicity of floods. It could benefit farm incomes by providing adequate compensation, for the public good, in connection with flood storage. It could benefit flood protection by providing less intrusive flood defences. It could also benefit biodiversity and water resources. I hope that the Minister will pass on my plea, and my suggestion that not just farmers but the local community could benefit.
  The strategy might work in, for example, the Ings, north of York, where farm land has been allowed to be flooded in order to avoid flooding in houses within the inner ring road. I hope that the Parliamentary Secretary to the Ministry of Agriculture, Fisheries and Food—who has responsibility for matters connected with flooding—will respond to that.
  The strategy would have other potential benefits. It could secure incomes from riverside land in an increasingly unstable climate. It could reduce the speed at which water runs off agricultural land, thus reducing river speeds. It could create water calming zones, which allow rivers to widen gradually and reduce the impact of flooding. It could help to replenish the nation's groundwater reserves by allowing greater interaction between river systems and groundwater. It could create natural barriers that would enhance soil retention and improve river water quality, while increasing the area of wildlife habitats.
  Let me also draw the Minister's attention to the serious loss to local businesses in the Vale of York—in, for example, Thirsk and Boroughbridge. In many instances premises and stock were severely damaged, and sales were seriously affected. The pursuant rail disruption, on top of the impact of the floods, has hampered the local economy further. Longer-term detrimental effects are feared: lower visitor numbers, fewer overseas student admissions to York university and lower inward investment. Job losses are also feared. The repercussions for local businesses are far wider than the immediate physical damage to their properties in the aftermath of the floods.
  In their planning policy guidance on development and flood risk, the Government absolve themselves of any statutory responsibility to make good losses to businesses, farmers or home owners. I fear that they may find the electorate unforgiving in this regard.
  1206
  In its conclusions, the Select Committee recommended that only very exceptional development should be allowed in the functional flood plain. It also said that flood-proof construction techniques should be encouraged, and that sustainable drainage systems should be adopted.
  I heard today that tomorrow morning, at York race course, the Environment Agency's regional office for Yorkshire and the Humber will announce, together with the flood defence committee, a 63 per cent. increase on this year's flood levy for 2001–02. By any standards that is a massive increase—an increase of £10.7 million—and it will inevitably be passed on in an increase of at least 1 per cent. in council tax payments.
  In connection with this debate, the Association of British Insurers wrote to me:
  The development and implementation of appropriate planning policies, together with targeted action on flood defences, will be an integral part of insurers' decisions on future premiums and the availability of cover."
  In its submission to the Select Committee's report on development and flood risk, the ABI wrote:
  ABI members have been concerned for many years about the threat of coastal and inland flooding. A particular issue is the control of development in the flood plain. The Government target of 3 million new homes by 2016, together with increased weather volatility and severity coupled with climate change will increase significantly the nation's exposure to flood risk. Such development will need to be controlled effectively to avoid potential insurance availability and affordability problems going forward.
  In revising PPG25, we have an opportunity to block further developments on functional flood plains, to make Environment Agency advice obligatory on planners and developers alike and to streamline the archaic and arcane procedures involved in flood protection. Why do such diverse operating authorities as the Environment Agency, the Internal Drainage Board, local authorities and other bodies have the power to make or maintain works for the drainage of land? Bodies such as the Environment Agency must give warnings of imminent flooding while others, such as the drainage boards, need not.
  Key features are envisaged for PPG25. For example, the susceptibility of land to flooding is a material consideration for planning purposes and the Environment Agency has the lead role in providing strategic advice on flood issues. Many of us—members of the Select Committee and others—hope that following such advice will be made mandatory so that planners and developers can no longer ignore it. Policies in development plans should outline the consideration that will be given to flood issues, recognising the uncertainties inherent in predicting such events. Planning decisions should apply the precautionary principle to flood risk, avoiding such risk where possible and managing it elsewhere.
  Developers should contribute to the cost of flood defences required because of development. In particular, I hope that that aspect of PPG25, should it be included in the Government's final document, will be used if it can be proved that the park-and-ride scheme at Rawcliffe led to serious flooding there on the first weekend in November. We hope that PPG25 will determine that planning policies and decisions need to be applied on a whole-catchment basis and should not be restricted to flood plains.
  I repeat that where the Government's targets for brownfield sites and what appears to be a functional flood plain coincide, the purposes of the flood plain should have

  1207
  priority over meeting housing requirements for brownfield sites. There should also be a clearer allowance made in urban areas protected by flood defences for locally agreed solutions that take into account the alternative locations for development, the risk of flooding, the scope for design solutions to mitigate risk and other local considerations. The recent flood was one flood too many.
  Mr. John Hayes: Is my hon. Friend aware that the Agriculture Committee considered the matter in considerable detail three years ago? Long before the current round of floods, it recommended to the Government many of the measures that she is pertinently highlighting. Although the Government have had a long time to deal with the matter, they do not seem to have addressed the issues that were raised, so she is rightly raising them again now.
  Miss McIntosh: I am grateful to my hon. Friend for making that point. I said at the outset how regrettable the delay has been. Even more regrettable is the suggestion, made not necessarily in Government quarters but in some of the media, that intensive farming practices have compounded the flooding. I want to go on record as saying that that is simply not the case. Farming practices in the past five years have not changed to the extent of having such a dramatic effect.
  The Government must act now after such a long delay to prevent future occurrences on the scale that we have witnessed recently.
  12 midnight
  The Parliamentary Under-Secretary of State for the Environment, Transport and the Regions (Ms Beverley Hughes): I congratulate the hon. Member for Vale of York (Miss McIntosh) on securing the debate. She has a deserved reputation for being assiduous in pursuing constituency interests. I know that she has worked hard locally to help people who have suffered because of the floods. She has demonstrated her considerable knowledge, which she may have acquired rapidly as a result of the crisis caused by flooding.
  The debate is timely given the continuing concern with flooding, in the hon. Lady's constituency and nationally. The issues that she has raised reflect the concerns that were expressed in the second report of the Select Committee on the Environment, Transport and Regional Affairs, which was published just before Christmas, and to which the hon. Lady contributed.
  As the hon. Lady said, much anxiety has been expressed recently that flooding has been exacerbated by development on flood plains, as well as by the increased run-off from other development. Not only does that place additional house owners at risk because their homes are located in the flood plain: it increases the risk to the large number of properties that were already there. Consequently, as the hon. Lady said, there have been calls for a ban on development on flood plains. Indeed, she sought a moratorium on building new homes on flood plains such as the Vale of York until an estimate could be made of the damage incurred during the recent floods.
  I digress slightly, but we should remember that there is a significant historical legacy of development on flood plains. Many developments, including the City of York,
  1208
  originated in Roman times. Rivers were a means of transport as well as sources of water and power. They needed to be crossed by land transport. It is therefore not surprising that settlements grew up on flood plains, especially at river crossings where there was flat ground that was easy to build on. Such settlements have expanded over the centuries, and about 10 per cent. of the English population now live in areas that are at risk from flooding. The social and economic case for locating close to rivers and river crossings is still strong. We should bear that in mind. Other issues should be balanced with some of the valid points that the hon. Lady made.
  Planning guidance is the main subject of the debate. The Government recognise that the risk of flooding is an important consideration when deciding where to build houses and undertake other development. The land use planning system takes full account of that through policies in development plans and in decisions on applications for planning permission. Current planning guidance, which the previous Government introduced in circular 30/92, advises local authorities to use their planning powers to discourage inappropriate development in flood risk areas and to restrict development that would increase the risk of flooding. However, new planning policy guidance note 25, which we are preparing, will considerably toughen the approach to development in flood risk areas.
  Following the Easter floods of 1998 and the sixth report of the Select Committee on Agriculture, the Government decided to review the existing guidance to ascertain whether it needed strengthening. Little did we know that even worse floods were on the way. In April 2000, we issued a new draft PPG25, to which the hon. Lady referred, as a consultation document. The responses were being analysed and taken on board in revising the draft when the rains commenced last autumn.
  My right hon. Friend the Deputy Prime Minister described the rain and flooding as a "wake-up call". It further emphasised the need to strengthen planning guidance on development and flood risk to avoid increasing the risks to people and property owing to flooding. We needed to learn the lessons of the worst floods since 1947. I agree with the hon. Lady that all of us, including central and local government, now need to give the matter higher priority relative to other considerations. That view was shared by the Environment, Transport and Regional Affairs Committee in its brief inquiry into the subject. As I said, its second report was published in December, and we shall be responding to it.
  Let me get down to the substance of the debate: planning policy guidance and surrounding issues. It is no secret that, as a result of events since we started to review the guidance, we are toughening it up even further. We hope to consult on the revised text later this month, with a view to publication in the spring. The new guidance will be much more robust in discouraging inappropriate development on flood plains. It will specifically state that built development is generally inappropriate in undeveloped and undefended flood plains which still function to transfer and store excess water during times of flood. Only development that specifically requires a waterside location or is essential infrastructure should take place on such functional flood plains. I hope that that is a response to one of the hon. Lady's points which she mentioned several times.

  1209
  We recognise, however, that in some areas, including some parts of the Vale of York—and, indeed, in parts of eastern England in particular—there is no alternative location for development. We cannot bring further social and economic development across large areas to a complete halt. In such cases, the first essential will be to ensure that new development is as safe as it could and should be.
  It must be recognised that it is not possible to defend absolutely against flooding. Flood defences can only reduce the risk; they cannot eliminate it. However, developers will be required to fund both the construction and future maintenance of flood defences that may be necessary to protect such development. We will also be setting target standards, which must be met for defences to protect new houses.
  Alongside the search sequences that have become a hallmark of other PPGs, we will be introducing an explicit sequential test for those seeking to identify sites for housing and other development. That will be based on quantified categories of risk, specified by the Environment Agency, for both river and coastal flooding and types of development. Local authorities will be required to review their development plans in relation to that sequential test as part of the reviews of land suitable for housing that we have already required them to undertake under PPG3. The two requirements will be brought together.
  It will be important that those proposing sites for development—whether it be the local authority in preparing local plans or developers when preparing planning applications—should carry out an appropriate flood-risk assessment. In doing so, they should consult the Environment Agency and other operating authorities. They must carry out such investigations as are necessary to determine the precise risks to the proposed development and its likely effects on flood risk. They must then demonstrate the efficacy of any mitigation measures that are to be incorporated as a result of that risk assessment in the development.
  I should now like to address how we should look at levels of risk. If the hon. Lady accepts that we cannot eliminate risk completely, she should agree that how we consider and define levels of risk is crucial to the approach. There is a continuum from no risk to high risk, so the first choice for development in the sequential approach should be areas of no risk, followed by areas of low risk. The latter are defined—I took sometime to get my head round this; I hope the hon. Lady does not ask me to repeat it in this debate—by an annual probability of flooding of between 1 per cent. and 0.1 per cent. There is a precise definition of how those percentages are arrived at. It basically relates to the probability of somebody suffering flooding once a year; a calculation produces that 1 per cent.
  In areas of high risk—those with an annual probability of flooding of 1 per cent. or above—the suitability of development will depend on whether the land is already developed and defended against an appropriate level of flooding and whether such development will add to flood risk downstream. Those will be the two tests.
  Areas that are already extensively developed may be suitable for further residential, commercial and industrial uses subject to essential conditions. There must be
  1210
  adequate flood defences, buildings must be designed to resist flooding should defences be overtopped and there must be suitable warning and evacuation procedures.
  Miss McIntosh: I am pleased to hear from the Minister that the Government are minded to have a sequential league table, but how does it compare with the previous measure of a one in 100 year risk or a one in 200 year risk?
  Ms Hughes: The level of risk to which I referred and the probability are not new ways of assessing risk. They are a standard, and they relate to different time scales, other than the annual time scales. The 1 per cent. risk equates to the probability that flooding will occur four times during the length of an average mortgage, which is 30 years, or an evens chance within the human lifespan. They are not new figures: that is an already established standard.
  Areas at high risk of flooding that are currently undeveloped will not generally be suitable under the sequential test for residential, commercial and industrial uses unless a particular location is essential: for instance, for navigation, for water-based recreational uses or for essential transport and infrastructure necessary for the population.
  Areas at the highest risk from flooding, such as low-lying land behind defences, where failure could lead to rapid inundation by fast-flowing water, may be suitable for recreation, sport and conservation uses provided adequate warning and evacuation procedures are in place, and possibly for essential transport and utilities infrastructure. Residential uses should only be permitted in wholly exceptional circumstances, when no alternative is possible, and should be subject to fully suitable mitigation design and warning and evacuation procedures.
  Even in areas at no risk from river or coastal flooding, excessive rainfall can flood low-lying areas and cause flooding as a result of surface flow, particularly from paved areas. The hon. Lady mentioned excessive run-off from developed areas that can cause significant problems downstream, such as the park-and-ride scheme. We shall also be requiring developers and local planning authorities to assess the effects of development on flood risk throughout the river catchment. Guidance on catchment flood management plans based on assessment of catchment flood is currently being prepared under the Ministry of Agriculture, Fisheries and Food and Environment Agency research programme. That will provide a large-scale framework for integrated management of risks associated with high flood flows in a sustainable manner. I understand that parts of the Vale of York will be among the first areas to be examined under that research programme.
  The hon. Lady mentioned the importance of design, which is critical. We must also consider the potential effects of climate change, and research on that is taking place. I shall refer to the relevant Minister the points that she made about farmers.
  I do not accept the hon. Lady's contention that the Government have absolved themselves of responsibility. I feel very strongly about our approach, which I accept is not yet completely in the public domain because we have

  1211
  not yet fully produced PPG25 for her and others to peruse. That will show that, in so far as Governments can act, we have taken this issue seriously; we have responded to the plight of the people affected; and we will require a much more robust approach in response to these issues in the future.
  Question put and agreed to.
  Adjourned accordingly at fourteen minutes past Twelve midnight.

  Deferred Divisions

    ELECTORAL COMMISSION
    That an Humble Address be presented to Her Majesty, praying that Her Majesty will appoint as Electoral Commissioners:

    (1) Pamela Joan Gordon for the period of four years;

    (2) Sir Neil William David McIntosh KBE for the period of four years;

    (3) Johnathon Glyn Mathias for the period of five years;

    (4) Sukhminder Karamjit Singh CBE for the period of five years;

    (5) James Samuel Younger for the period of six years; and

    (6) Graham John Zellick for the period of five years;

    and that Her Majesty will appoint James Samuel Younger to be the chairman of the Electoral Commission for the period of six years.
    The House divided: Ayes 486, Noes 4.

    Division No. 44]

    AYES

    Ainsworth, Peter (E Surrey)

    Brown, Rt Hon Nick (Newcastle E)

    Ainsworth, Robert (Cov'try NE)

    Brown, Russell (Dumfries)

    Alexander, Douglas

    Browne, Desmond

    Allan, Richard

    Browning, Mrs Angela

    Allen, Graham

    Bruce, Ian (S Dorset)

    Amess, David

    Bruce, Malcolm (Gordon)

    Ancram, Rt Hon Michael

    Buck, Ms Karen

    Anderson, Rt Hon Donald (Swansea E)

    Burgon, Colin

    Burnett, John

    Anderson, Janet (Rossendale)

    Burns, Simon

    Armstrong, Rt Hon Ms Hilary

    Burstow, Paul

    Ashton, Joe

    Butterfill, John

    Atherton, Ms Candy

    Cable, Dr Vincent

    Atkins, Charlotte

    Campbell, Alan (Tynemouth)

    Atkinson, David (Bour'mth E)

    Campbell, Mrs Anne (C'bridge)

    Atkinson, Peter (Hexham)

    Campbell, Rt Hon Menzies (NE Fife)

    Austin, John

    Bailey, Adrian

    Campbell, Ronnie (Blyth V)

    Baker, Norman

    Campbell-Savours, Dale

    Baldly, Tony

    Caplin, Ivor

    Banks, Tony

    Casale, Roger

    Barnes, Harry

    Caton, Martin

    Barron, Kevin

    Chapman, Ben (Wirral S)

    Battle, John

    Chapman, Sir Sydney (Chipping Barnet)

    Bayley, Hugh

    Beard, Nigel

    Chidgey, David

    Begg, Miss Anne

    Chope, Christopher

    Beggs, Roy

    Clapham, Michael

    Bell, Stuart (Middlesbrough)

    Clappison, James

    Benn, Hilary (Leeds C)

    Clark, Rt Hon Dr David (S Shields)

    Benn, Rt Hon Tony (Chesterfield)

    Clark, Dr Lynda (Edinburgh Pentlands)

    Bennett, Andrew F

    Bercow, John

    Clark, Dr Michael (Rayleigh)

    Bermingham, Gerald

    Clarke, Charles (Norwich S)

    Berry, Roger

    Clarke, Eric (Midlothian)

    Best, Harold

    Clarke, Rt Hon Tom (Coatbridge)

    Betts, Clive

    Clarke, Tony (Northampton S)

    Blair, Rt Hon Tony

    Clelland, David

    Blears, Ms Hazel

    Clifton-Brown, Geoffrey

    Blizzard, Bob

    Clwyd, Ann

    Blunt, Crispin

    Coaker, Vernon

    Boateng, Rt Hon Paul

    Coffey, Ms Ann

    Boswell, Tim

    Coleman, Iain

    Bottomley, Peter (Worthing W)

    Collins, Tim

    Bottomley, Rt Hon Mrs Virginia

    Colman, Tony

    Bradley, Keith (Withington)

    Connarty, Michael

    Bradley, Peter (The Wrekin)

    Cooper, Yvette

    Brady, Graham

    Corbett, Robin

    Brake, Tom

    Cormack, Sir Patrick

    Brand, Dr Peter

    Corston, Jean

    Brazier, Julian

    Cox, Tom

    Brinton, Mrs Helen

    Cran, James

    Brooke, Rt Hon Peter

    Cranston, Ross

    1213

    Crausby, David

    Griffiths, Nigel (Edinburgh S)

    Cryer, Mrs Ann (Keighley)

    Griffiths, Win (Bridgend)

    Cryer, John (Hornchurch)

    Grocott, Bruce

    Cummings, John

    Gummer, Rt Hon John

    Cunningham, Rt Hon Dr Jack (Copeland)

    Hague, Rt Hon William

    Hall, Mike (Weaver Vale)

    Cunningham, Jim (Cov'try S)

    Hall, Patrick (Bedford)

    Curry, Rt Hon David

    Hamilton, Rt Hon Sir Archie

    Curtis-Thomas, Mrs Claire

    Hamilton, Fabian (Leeds NE)

    Dalyell, Tam

    Hammond, Philip

    Darling, Rt Hon Alistair

    Hancock, Mike

    Darvill, Keith

    Hanson, David

    Davey, Edward (Kingston)

    Harman, Rt Hon Ms Harriet

    Davidson, Ian

    Harris, Dr Evan

    Davies, Geraint (Croydon C)

    Harvey, Nick

    Davies, Quentin (Grantham)

    Hawkins, Nick

    Davis, Rt Hon David (Haltemprice)

    Hayes, John

    Davis, Rt Hon Terry (B'ham Hodge H)

    Heald, Oliver

    Healey, John

    Dawson, Hilton

    Heath, David (Somerton & Frome)

    Day, Stephen

    Henderson, Doug (Newcastle N)

    Denham, John

    Henderson, Ivan (Harwich)

    Dismore, Andrew

    Hendrick, Mark

    Dobbin, Jim

    Hepburn, Stephen

    Dobson, Rt Hon Frank

    Heppell, John

    Donaldson, Jeffrey

    Hesford, Stephen

    Donohoe, Brian H

    Hill, Keith

    Doran, Frank

    Hinchliffe, David

    Dowd, Jim

    Hoey, Kate

    Drown, Ms Julia

    Hope, Phil

    Duncan, Alan

    Hopkins, Kelvin

    Eagle, Angela (Wallasey)

    Horam, John

    Eagle, Maria (L'pool Garston)

    Howarth, Rt Hon Alan (Newport E)

    Edwards, Huw

    Howells, Dr Kim

    Efford, Clive

    Hoyle, Lindsay

    Ellman, Mrs Louise

    Hughes, Ms Beverley (Stretford)

    Ennis, Jeff

    Hughes, Kevin (Doncaster N)

    Etherington, Bill

    Hughes, Simon (Southwark N)

    Evans, Nigel

    Humble, Mrs Joan

    Fallon, Michael

    Hutton, John

    Fearn, Ronnie

    Iddon, Dr Brian

    Field, Rt Hon Frank

    Illsley, Eric

    Fitzpatrick, Jim

    Ingram, Rt Hon Adam

    Flight, Howard

    Jackson, Ms Glenda (Hampstead)

    Flint, Caroline

    Jackson, Helen (Hillsborough)

    Flynn, Paul

    Jamieson, David

    Follett, Barbara

    Jenkin, Bemard

    Foster, Rt Hon Derek

    Jenkins, Brian

    Foster, Don (Bath)

    Johnson, Alan (Hull W & Hessle)

    Foster, Michael Jabez (Hastings)

    Johnson, Miss Melanie (Welwyn Hatfield)

    Foster, Michael J (Worcester)

    Foulkes, George

    Johnson, Smith, Rt Hon Sir Geoffrey

    Fowler, Rt Hon Sir Norman

    Fox, Dr Liam

    Jones, Rt Hon Barry (Alyn)

    Fraser, Christopher

    Jones, Helen (Warrington N)

    Gale, Roger

    Jones, Ieuan Wyn (Ynys Môn)

    Galloway, George

    Jones, Ms Jenny (Wolverh'ton SW)

    Gapes, Mike

    Gardiner, Barry

    Jones, Jon Owen (Cardiff C)

    Garnier, Edward

    Jones, Martyn (Clwyd S)

    George, Andrew (St Ives)

    Jones, Nigel (Cheltenham)

    Gerrard, Neil

    Joyce, Eric

    Gibb, Nick

    Kaufman, Rt Hon Gerald

    Gibson, Dr Ian

    Keeble, Ms Sally

    Gidley, Sandra

    Keen, Alan (Feltham & Heston)

    Gillan, Mrs Cheryl

    Keen, Ann (Brentford & Isleworth)

    Gilroy, Mrs Linda

    Keetch, Paul

    Godsiff, Roger

    Kelly, Ms Ruth

    Goggins, Paul

    Kemp, Fraser

    Golding, Mrs Llin

    Kennedy, Rt Hon Charles (Ross Skye & Inverness W)

    Gordon, Mrs Eileen

    Gray, James

    Kennedy, Jane (Wavertree)

    Green, Damian

    Key, Robert

    Greenway, John

    Khabra, Piara S

    Grieve, Dominic

    Kidney, David

    Griffiths, Jane (Reading E)

    Kilfoyle, Peter

    1214

    King, Andy (Rugby & Kenilworth)

    Morley, Elliot

    King, Ms Oona (Bethnal Green)

    Morris, Rt Hon Ms Estelle (B'ham Yardley)

    King, Rt Hon Tom (Bridgwater)

    Kingham, Ms Tess

    Morris, Rt Hon Sir John (Aberavon)

    Kirkbride, Miss Julie

    Ladyman, Dr Stephen

    Moss, Malcolm

    Laing, Mrs Eleanor

    Mountford, Kali

    Lait, Mrs Jacqui

    Mudie, George

    Lansley, Andrew

    Murphy, Denis (Wansbeck)

    Lawrence, Mrs Jackie

    Murphy, Jim (Eastwood)

    Laxton, Bob

    Murphy, Rt Hon Paul (Torfaen)

    Leigh, Edward

    Norman, Archie

    Lepper, David

    Norris, Dan

    Leslie, Christopher

    Oaten, Mark

    Letwin, Oliver

    O'Brien, Bill (Normanton)

    Levitt, Tom

    O'Brien, Mike (N Warks)

    O'Brien, Stephen (Eddisbury)

    Lewis, Ivan (Bury S)

    O'Hara, Eddie

    Lewis, Dr Julian (New Forest E)

    O'Neill Martin

    Lewis, Terry (Worsley)

    Öpik, Lembit

    Liddell, Rt Hon Mrs Helen

    Organ, Mrs Diana

    Lidington, David

    Ottaway, Richard

    Livsey, Richard

    Page, Richard

    Lloyd, Rt Hon Sir Peter (Fareham)

    Pearson, Ian

    Lloyd, Tony (Manchester C)

    Perham, Ms Linda

    Llwyd, Elfyn

    Pickles, Eric

    Lock, David

    Pickthall, Colin

    Loughton, Tim

    Pike, Peter L

    Love, Andrew

    Plaskitt, James

    Luff, Peter

    Pond, Chris

    McAvoy, Thomas

    Pope, Greg

    McCabe, Steve

    Portillo, Rt Hon Michael

    McCartney, Rt Hon Ian (Makerfield)

    Pound, Stephen

    Prentice, Ms Bridget (Lewisham E)

    McDonagh, Siobhain

    Prentice, Gordon (Pendle)

    Macdonald, Calum

    Primarolo, Dawn

    McDonnell, John

    Prior, David

    McFall, John

    Prosser, Gwyn

    MacGregor, Rt Hon John

    Purchase, Ken

    McGuire, Mrs Anne

    Quin, Rt Hon Ms Joyce

    McIntosh, Miss Anne

    Quinn, Lawrie

    McIsaac, Shona

    Radice, Rt Hon Giles

    MacKay, Rt Hon Andrew

    Rammell, Bill

    Mackinlay, Andrew

    Randall, John

    Maclean, Rt Hon David

    Rapson, Syd

    Maclennan, Rt Hon Robert

    Raynsford, Nick

    McLoughlin, Patrick

    Redwood, Rt Hon John

    McNamara, Kevin

    Reed, Andrew (Loughborough)

    McNulty, Tony

    Reid, Rt Hon Dr John (Hamilton N)

    MacShane, Denis

    Rendel, David

    Mactaggart, Fiona

    Robathan, Andrew

    McWalter, Tony

    Robertson, John (Glasgow Anniesland)

    McWilliam, John

    Madel, Sir David

    Robertson, Laurence (Tewk'b'ry)

    Mallaber, Judy

    Roe, Mrs Marion (Broxbourne)

    Marsden, Gordon (Blackpool S)

    Rogers, Allan

    Marshall, David (Shettleston)

    Rooker, Rt Hon Jeff

    Marshall, Jim (Leicester S)

    Rooney, Terry

    Marshall-Andrews, Robert

    Ros, Ernie (Dundee W)

    Martlew, Eric

    Rowe, Andrew (Faversham)

    Maxton, John

    Roy, Frank

    Ruane, Chris

    May, Mrs Theresa

    Ruffley, David

    Meacher, Rt Hon Michael

    Russell, Bob (Colchester)

    Meale, Alan

    Russell, Ms Christine (Chester)

    Merron, Gillian

    Ryan, Ms Joan

    Michael, Rt Hon Alun

    St Aubyn, Nick

    Michie, Bill (Shef'ld Heeley)

    Salter, Martin

    Michie, Mrs Ray (Argyll & Bute)

    Sanders, Adrian

    Milburn, Rt Hon Alan

    Sarwar, Mohammad

    Miller, Andrew

    Savidge, Malcolm

    Mitchell, Austin

    Sawford, Phil

    Moffatt, Laura

    Sayeed, Jonathan

    Moonie, Dr Lewis

    Sedgemore, Brian

    Moore, Michael

    Short, Rt Hon Clare

    Morgan, Ms Julie (Cardiff N)

    Simpson, Alan (Nottingham S)

    1215

    Simpson, Keith (Mid-Norfolk)

    Streeter, Gary

    Singh, Marsha

    Stringer, Graham

    Smith, Rt Hon Andrew (Oxford E)

    Stuart, Ms Gisela

    Smith, Angela (Basildon)

    Stunell, Andrew

    Smith, Rt Hon Chris (Islington S)

    Sutcliffe, Gerry

    Smith, Miss Geraldine (Morecambe & Lunesdale)

    Swayne, Desmond

    Syms, Robert

    Smith, Jacqui (Redditch)

    Tapsell, Sir Peter

    Smith, John (Glamorgan)

    Taylor, Rt Hon Mrs Ann (Dewsbury)

    Smith, Llew (Blaenau Gwent)

    Smith, Sir Robert (W Ab'd'ns)

    Taylor, Ms Dari (Stockton S)

    Smyth, Rev Martin (Belfast S)

    Taylor, David (NW Leics)

    Soames, Nicholas

    Taylor, Ian (Esher & Walton)

    Soley, Clive

    Taylor, John M (Solihull)

    Southworth, Ms Helen

    Taylor, Matthew (Truro)

    Spellar, John

    Temple-Morris, Peter

    Spelman, Mrs Caroline

    Thomas, Gareth (Clwyd W)

    Spring, Richard

    Thomas, Gareth R (Harrow W)

    Squire, Ms Rachel

    Thomas, Simon (Ceredigion)

    Stanley, Rt Hon Sir John

    Tipping, Paddy

    Starkey, Dr Phyllis

    Todd, Mark

    Steen, Anthony

    Touhig, Don

    Steinberg, Gerry

    Tredinnick, David

    Stevenson, George

    Trickett, Jon

    Stewart, David (Inverness E)

    Turner, Dennis (Wolverh'ton SE)

    Stoate, Dr Howard

    Turner, Dr George (NW Norfolk)

    Strang, Rt Hon Dr Gavin

    Turner, Neil (Wigan)

    Straw, Rt Hon Jack

    Twigg, Derek (Halton)

    1216

    Tyler, Paul

    Widdecombe, Rt Hon Miss Ann

    Tynan, Bill

    Wigley, Rt Hon Dafydd

    Tyrie, Andrew

    Wilkinson, John

    Vaz, Keith

    Willetts, David

    Viggers, Peter

    Williams, Alan W (E Carmarthen)

    Vis, Dr Rudi

    Williams, Mrs Betty (Conwy)

    Walley, Ms Joan

    Wills, Michael

    Walter, Robert

    Wilshire, David

    Ward, Ms Claire

    Wilson, Brian

    Wareing, Robert N

    Winterton, Ms Rosie (Doncaster C)

    Wood, Mike

    Waterson, Nigel

    Woodward, Shaun

    Watts, David

    Worthington, Tony

    Webb, Steve

    Wray, James

    Welsh, Andrew

    Wright, Anthony D (Gt Yarmouth)

    White, Brian

    Wright, Tony (Cannock)

    Whitehead, Dr Alan

    Wyatt, Derek

    Whitney, Sir Raymond

    Yeo, Tim

    Whittingdale, John

    Young, Rt Hon Sir George

    Wicks, Malcolm

    NOES

    Body, Sir Richard

    Ross, William (E Lond'y)

    Forth, Rt Hon Eric

    Wells, Bowen

    Question accordingly agreed to.