Health and Social Care Bill

HC Deb 10 January 2001 vol 360 cc1125-78

Question again proposed, That the amendment be made.

6.22 pm

Sir George Young (North-West Hampshire)

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 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.

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.

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 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 (Ilford, North)

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.

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 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 (West Chelmsford)

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.

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.

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.

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 (Dartford)

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.

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 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.

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.

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 (Ceredigion)

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. 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 (Meirionnydd Nant Conwy)

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. 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. 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 (Romford)

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 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 (Southend, West)

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 (Eddisbury)

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.

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 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 (South Swindon)

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.

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 (Pudsey)

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 (Pudsey)

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 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 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 (New Forest, West)

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 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 (Sutton and Cheam)

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 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.

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 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 (Lancaster and Wyre)

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 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 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 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 (Eddisbury)

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.

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 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) 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 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 (South Swindon)

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.

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 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.

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.

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 (Isle of Wight)

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.

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.

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 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 (Brighton, Kemptown)

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 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 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 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 (Runnymede and Weybridge)

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.

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 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.

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, 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.

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 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.

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

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

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

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)

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

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

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 (Aylesbury)

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 (Colchester)

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.