Commons Sitting of 22 May 2002

Preamble
The House met at half-past Two o'clock
PRAYERS
[MR. SPEAKER in the Chair]

PRIVATE BUSINESS
MERSEY TUNNELS BILL (BY ORDER)
Order for Second Reading Read.
To be read a Second time on Wednesday 12 June.

Oral Answers to Questions
  The Deputy Prime Minister and First Secretary of State was asked—
  DEPUTY PRIME MINISTER

    Special Advisers
    Norman Baker: What plans he has to improve the code relating to special advisers. [55925]
    The Minister of State, Cabinet Office (Mrs. Barbara Roche): A code of conduct for special advisers was published in July 2001.
    Norman Baker: I thank the Minister for that illuminating answer. Does she accept the need to amend the code to improve the accountability of special advisers, as it is almost impossible to find out what they are doing? In particular, does she agree that there is an opportunity to allow Select Committees to interview special advisers so that we could find out officially what we know unofficially—that Lord Birt knows nothing about transport and is full of ludicrous ideas?
    Mrs. Roche: First, on behalf of the Government, may I congratulate the hon. Gentleman on his recent marriage? However, wonderful as this place is, perhaps the Chamber is not the most exciting place for a honeymoon.
    We are the first Government to publish a code of conduct for special advisers, which we did immediately after the general election. By contrast, our Conservative predecessors refused to do anything of the kind. It is for Ministers to decide who should represent them before Select Committees.

    Government Offices for the Regions
    Vernon Coaker: What priorities guide the operation of Government regional offices. [55927]
    The Minister of State, Cabinet Office (Mrs. Barbara Roche): The Government offices for the regions bring together the work of many different Departments, and we have increased their number from three to nine. Their priorities are to deliver the programmes of sponsor Departments, such as the national strategy for neighbourhood renewal and the crime reduction programme.
    Vernon Coaker: Will my hon. Friend make sure that in the delivery of the Government offices' priorities, particularly priorities such as tackling poverty and regeneration, small pockets of deprivation outside city areas get the attention that they deserve? Too often, in my Gedling constituency, although we now have sure start and some regeneration money, money pours into the city but pockets of deprivation outside the city area have missed out. Will my hon. Friend look into that to make sure that we get the support and help that we need to regenerate those communities as well?
    Mrs. Roche: I accept the points that my hon. Friend makes. It is right to concentrate on the most deprived areas, but of course regeneration needs to go much wider, which is why, as he suggested, we have programmes such as sure start, which have proved such a success. However, I shall certainly take his comments to heart and make sure that in our regeneration programmes we do not forget those other areas.
    Mr. John Wilkinson: Will the Minister bear in mind the fact—which, as a London Member, she will know—that if the Deputy Prime Minister has his way and regional assemblies are imposed on the kingdom, Londoners will primarily pay for that, because we produce more wealth than any other part of the kingdom? Will she at least eliminate one tier of interference—the Government offices for the regions?
    Mrs. Roche: I am surprised that the hon. Gentleman has mentioned the Government offices for the regions in that way, because in fact they were created by the Conservative Government that he supported. If that is yet another policy U-turn, it is good that the Chamber should hear about it first. As for regional governance, I am afraid that the hon. Gentleman is far behind the times; it was clear from the White Paper published by my right hon. Friend the Deputy Prime Minister that that would be a matter of choice for regions, and they could decide by way of referendums. We are in favour of people having a say. Would the hon. Gentleman deny them that?
    Mr. David Clelland: Will my hon. Friend expand on the role of Government offices for the regions following the election of regional assemblies? Will the assemblies, for instance, draw the bulk of their administrative staff from the existing regional office staff, as happened to some extent in Wales and Scotland?
    Mrs. Roche: Some of the staff of the Government offices will go to the new bodies, but we will still need

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    the Government offices because, as we indicated clearly in the White Paper, some central functions will not go, including certain locally delivered services such as education.

    Welsh Assembly
    Ian Lucas: If he intends to contribute to the recently announced inquiry into the powers of the National Assembly for Wales. [55931]
    The Deputy Prime Minister and First Secretary of State (Mr. John Prescott): I understand that, with the exception of Lord Richard, no appointments have yet been made to the independent commission on Assembly powers. As I understand it, the terms of reference of the inquiry have not yet been agreed, so it would be premature for me to speculate on the Government's input to the work of the commission.
    Ian Lucas: I thank my right hon. Friend for that reply. The devolution settlement in Wales is still very young, but any changes to it should be made only with the consent of the people of Wales. Does he agree that Members of Parliament should be fully involved in the inquiry that has been set up, and will he write to the First Minister to say so?
    The Deputy Prime Minister and First Secretary of State: The agreement and settlement for the Welsh Assembly and Welsh devolution was decided by the Welsh people. However, the partnership agreement signed in October 2000 between the Labour and Liberal elements of the Administration established the commitment that before the end of the Assembly's first year, an independent commission on its powers and electoral arrangements would ensure that we could operate in the best interests of the people of Wales. The commission has not been appointed and terms of reference have not been given. We must wait and see what emerges from the discussions.
    Mr. Simon Thomas: I welcome the publication of the right hon. Gentleman's White Paper on the English regions a couple of weeks ago. I think that paragraph 5.2 says that the document recognises that in England, devolution will be a process not an event. Will he use his considerable influence in such matters to ensure that whatever happens in England in terms of regional devolution, Wales, as a nation that is part of the United Kingdom, will stay one step ahead in the process of devolution?
    The Deputy Prime Minister and First Secretary of State: I think that we have made the position absolutely clear. The people of Wales settled for their Welsh Assembly and the people of Scotland settled for their Scottish Parliament. We now intend to give the English regions the opportunity to decide about English regional government. It will be their choice—and properly so— and the people will soon have that opportunity to speak.
    Llew Smith: Does the Minister not think it somewhat ironic that certain people are pushing for more powers for the Welsh Assembly, when it refuses to use the powers that it already has, such as those relating
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    to quangos? Is it not also ironic that those people have the cheek to ask for more powers for the Assembly when virtually no one in Wales is at all sympathetic to the idea?
    The Deputy Prime Minister and First Secretary of State: My hon. Friend makes a good point; there is certainly an awful lot of irony in this debate—in all parts of the United Kingdom.

    Civil Defence and Emergency Planning
    Colin Burgon: What plans he has to improve the co-ordination of civil defence and emergency planning. [55932]
    The Parliamentary Secretary, Cabinet Office (Mr. Christopher Leslie): The civil contingencies secretariat at the Cabinet Office was established last June. It provides the central focus for the Government's commitment to deal effectively with disruptive challenges, crises and emergencies. Effective multi-agency arrangements for dealing with emergencies, whatever their cause, are in place. We need to update the statutory framework and we are preparing the ground for that.
    Colin Burgon: I thank the Minister for that reply. Is he confident that local authorities in areas of high population density such as Leeds can cope with the various emergency scenarios that they may face?
    Mr. Leslie: One thing that I have learned in the course of my work on emergency planning is that the preparedness and work of local authority emergency planning officers are excellent. I should like to pay tribute to them. There is excellent co-ordination between the health services, the police and the fire authorities. I am confident that in major centres of population such as Leeds, the emergency services stand ready to cope with whatever challenges they may have to face.
    Mr. Tim Collins: The Minister will recall from our extensive debates on the Civil Defence (Grant) Bill that many local authorities throughout the land remain deeply disappointed at the level of support and guidance from central Government following the events of 11 September. Will he clarify whether the Cabinet Office has now issued definitive guidance to all local authorities about what they should do to prepare for any repetition of 11 September or anything like it? Do the Government endorse the conclusions announced in the past few days by senior members of the US Administration that further terrorist attacks may indeed be very likely? If so, will he review any guidance that he has already issued?
    Mr. Leslie: In respect of any terrorist threat, we remain on the alert and the situation is as it was after 11 September. As for discussion with local authorities, a ream of advice is available for emergency planning offices. The website at www.ukresilience.info should be sufficient to provide up-to-date information from the central news co-ordination centre about a number of different matters. I assure the hon. Gentleman that advice to postal services and a series of other agencies, including health and fire authorities, is available in the public

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    domain, as well as on the basis of the emergency planning college and the training that is done through the civil contingencies secretariat.
    Mrs. Louise Ellman: What powers would a directly elected assembly have in relation to emergency planning and civil defence?
    Mr. Leslie: The Deputy Prime Minister recently published the White Paper on regional governance, which included information on how we intend to give responsibilities to regional authorities in respect of civil contingency matters—and to strengthen the regions that do not opt for regional elected assemblies—in terms of the capacity to co-ordinate on a regional basis any mutual aid arrangements between local authorities, and other more strategic issues. I am certainly working hard to ensure that we have a strong regional dimension in emergency planning.
    Mr. Peter Viggers: Does the Minister agree that the system of making security status known in Government buildings is obscure and not widely publicised? The term ?Black Bikini", for example, does not mean much to people in security terms. Has he observed that in the United States, the Department with responsibility for homeland defence has recently produced and widely publicised a new system using five different statuses ranging from red to green? Does he think that we have something to learn from that?
    Mr. Leslie: The British are always very good at such things, and I am confident that the advice given to all public officials and civil servants in Government buildings about the level of security that applies is widely understood and readily available. I am not aware of the hon. Gentleman's "Black Bikini" example, but, having discussed with American homeland security officials some of the wider experiences in the United States, I shall certainly look much more closely at the matter.

    Civil Service
    Tony Wright: When he plans to bring forward a civil service Bill. [55933]
    The Deputy Prime Minister and First Secretary of State (Mr. John Prescott): In response to recommendations from both the Committee on Standards in Public Life and the Select Committee on Public Administration, which is chaired by my hon. Friend himself, the Government have committed themselves to civil service legislation, the timing of which will be announced in the normal way.
    Tony Wright: I thank my right hon. Friend for that answer. I suppose I am getting a little weary of asking this question, and I am sure that my right hon. Friend is getting weary of answering it, but we have to sort it out somehow. The outgoing Cabinet Secretary says that we need a Bill now, the incoming Cabinet Secretary says that he is not sure, the First Civil Service Commissioner says that we need a Bill urgently, and the Public Administration Committee says that it is going to produce
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    a Bill of its own. Can my right hon. Friend now say with some precision when he expects a consultation document to appear, and when he expects a draft Bill to follow it?
    The Deputy Prime Minister and First Secretary of State: We have made it absolutely clear that the Government's position is that we will produce a civil service Bill, which will become a civil service Act. We are in agreement with the conclusions of the Public Administration Committee on these matters. The recent comment by my hon. Friend, who is the Chairman of the Committee, that he felt that there was some doubt about that was quite wrong. We are strongly of this opinion, and we will produce that Bill. We welcome any consultation and any views that may be presented to us, and a consultation document will be produced shortly.
    Mr. A. J. Beith: The sooner the better. Does the Deputy Prime Minister recognise that not only is this measure widely sought after—and there is some consensus around it—but it is a proper response to the welcome stream of apologies and expressions of regret that have been heard from, for example, Alastair Campbell, who said that the techniques of opposition had been used in government for too long, and from the right hon. Member for Hartlepool (Mr. Mandelson), who referred to over-politicised press officers? Surely, drawing the boundary lines more clearly is what the Act would be for.
    The Deputy Prime Minister and First Secretary of State: I agree with the right hon. Gentleman about drawing the boundary lines. We have made that clear, and I think that we are the first Government to make it clear that there should be a civil service Act. We will carry out that promise.
    Brian White: Does my right hon. Friend recognise that the danger of introducing a civil service Bill at this time is that it will get bogged down in the current controversies? Will he ensure that the long-term future of the civil service, and the issues of "departmentalitis" and the division between policy and implementation, are addressed before a Bill is introduced?
    The Deputy Prime Minister and First Secretary of State: I can assure my hon. Friend that that is exactly what we intend to do. We will consult before the Bill is introduced. That is our intention; let us make no mistake, the Government are committed to bringing in a new civil service Act—with all in agreement on the matter, we hope.
    Mr. Roy Beggs: Does the Deputy Prime Minister agree that all civil servants throughout the United Kingdom should have an opportunity to develop their expertise and competency? Will he seek to include in the civil service Bill provision for such training for professional civil servants as will enable them to gain expertise that will facilitate easy transfer between the Assemblies and Parliament, and thereby afford them greater opportunity for career development?
    The Deputy Prime Minister and First Secretary of State: The hon. Gentleman is absolutely right, and the consultation document will cover many aspects of training, management and transferability between different sections.
    Kevin Brennan: I welcome the Deputy Prime Minister's reaffirmation that it is the Government's intention to publish a draft civil service Bill in the near future. Is it still current thinking that it may contain a proposal for a cap on the number of special advisers?
    The Deputy Prime Minister and First Secretary of State: The Bill will address itself to that point—but my hon. Friend must await the consultation document.
    Mr. Tim Collins: As there is genuine cross-party consensus that we should have a civil service Bill, and furthermore that one of the principles that should be enshrined in it is protection of the independence of the civil service from any allegations of undue political influence, does the Deputy Prime Minister agree that such a Bill would be a good vehicle for introducing a genuinely independent non-partisan watchdog to check that donations to the governing party have not bought any favours? Does he further agree that such a vehicle is greatly to be preferred to the toothless poodle announced by his party yesterday?
    The Deputy Prime Minister and First Secretary of State: The name of Asil Nadir comes clearly to mind. Let me tell the hon. Gentleman that we are committed to making sure that there is transparency in all political donations. We committed ourselves to that in opposition, although the previous Conservative Administration would not support such a proposal. We continue to be committed to that aim, because we believe that all contributions should be open to proper examination, and we took another step towards it yesterday when we said how our party will deal with the matter. Can the hon. Gentleman give an assurance that his party will do the same?

    World Summit
    Mr. Tam Dalyell: Pursuant to his oral answer of 24 April to the hon. Member for Harrow West (Mr. Thomas), Official Report, columns 320–21, on sustainable development, if he will make a statement on progress in preparation for the world summit. [55934]
    The Deputy Prime Minister and First Secretary of State (Mr. John Prescott): The fourth preparatory ministerial committee for the summit will take place in Indonesia from next weekend. My right hon. Friend the Secretary of State for Environment, Food and Rural Affairs will lead the United Kingdom delegation.
    Mr. Dalyell: Do Ministers preparing for the summit recognise that civil nuclear power is essential for sustainable development?
    The Deputy Prime Minister and First Secretary of State: My hon. Friend is right to point out that nuclear power is an important part of the provision of power in this country, and it will continue to be so. As the recent report by the performance and innovation unit pointed out, by 2010 about 20 per cent. of our power will be provided
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    by nuclear generation. We are now conducting serious consultations about the future of power, and particularly about the role of nuclear power, which will be covered by a White Paper to be announced at the turn of the year.
    Pete Wishart: I am sure that the Deputy Prime Minister will have seen the BBC news item last night about the perilous situation in Malawi, where the worst famine since that in Ethiopia some 20 years ago is expected. As part of his preparations for the conference in southern Africa, will he ensure that all western Governments are fully engaged in efforts to avert that crisis?
    The Deputy Prime Minister and First Secretary of State: The hon. Gentleman is absolutely right. We are involved in many matters around the world, and the world summit on sustainable development is about trying to get the same commitment to helping poorer nations and those who suffer great degradation and poverty as we gave to combating terrorism after 11 September.
    Mr. Tim Collins: I genuinely commiserate with the Deputy Prime Minister following the news that he may be suffering from diabetes. I know from my own family experience that that has no impact whatsoever on the ability to conduct an active career, and I am sure that he will able to do that. Given that the Cabinet Office has made it clear that health factors played no part in his decision not to go to Bali, will he explain why he will no longer be joining his officials there? Is it because he is a little embarrassed about the reports of the level of luxury that will be enjoyed by those who do attend?
    The Deputy Prime Minister and First Secretary of State: The hon. Gentleman is developing a reputation for asking personal questions that have no relevance whatever to the point before us. He relies heavily on a British press that is much discredited for its handling of such stories— [HON. MEMBERS: "Oh."] Hon. Members may say "Oh", but a recent European Union report points out that only 20 per cent. of the British public trust the British press, yet the figure for the rest of Europe is more than double that. That shows how press prattle tends to dominate many matters of substance, both in this place and outside it.
    As it was the Conservative Government who took the first delegation to the world summit in Rio in 1992, the hon. Gentleman should be aware of the well known fact that those negotiations are conducted by the Secretary of State for the Environment. My responsibility for such matters therefore ended at the last general election, when I moved from the Department of the Environment, Transport and the Regions, and they are now dealt with by the current Secretary of State for Environment, Food and Rural Affairs. I never intended to be part of the delegation to which the hon. Gentleman refers, or to attend Bali Hi—or Bali Low—at any point.

    Urban Poverty
    Mr. Adrian Bailey: What recent meetings he has had with organisations involved in combating urban poverty. [55935]
    The Minister of State, Cabinet Office (Mrs. Barbara Roche): My right hon. Friend the Deputy Prime Minister has recently met local organisations involved in combating urban poverty in Bradford, Doncaster and Hull. He also chairs the new deal for communities MPs' forum, which was attended by representatives of the Bristol and Salford new deal for community partnerships when it met last month.
    Mr. Bailey: Does the Minister agree that combating urban poverty involves not just improving income, but improving opportunity and the environment, and reducing crime? In my local authority of Sandwell, the new deal in the community has found employment for 150 people and secured training places for a further 600. By working with the police, it has also reduced burglaries by 50 per cent. Will the Minister apply the example of the Sandwell partnership to new deal projects in other areas of the country, and consider extending the Sandwell project to other parts of my constituency?
    Mrs. Roche: I certainly agree that in tackling poverty it is important to adopt minimum standards, or floor targets, which I describe as the social equivalent of the minimum wage. My hon. Friend is also right to say that, through the new deal for communities, some excellent work is being carried out in Sandwell by the local college and the police. I congratulate him on that work, and we will of course want to learn from such good practice.
    Mr. Derek Foster: Does my hon. Friend agree that in dealing with urban poverty, it is crucial both to create jobs and to get people to existing jobs? Has she seen the recent report that highlights the importance of the bus service in getting people to their jobs, and to college opportunities? Will she persuade the Government to pay far greater attention to providing more buses and creating a better bus service?
    Mrs. Roche: My right hon. Friend is right. We know that there is a correlation between transport, jobs and unemployment, and that is precisely why the social exclusion unit is producing a report on that very subject.

    Ministerial Code of Conduct
    Richard Ottaway: What plans he has to review the ministerial code of conduct. [55937]
    The Parliamentary Secretary, Cabinet Office (Mr. Christopher Leslie): A revised ministerial code of conduct was published last year, and it remains under review.
    Richard Ottaway: It is apparently okay for a Minister to mislead the House about the sacking of a civil servant, yet when the same Minister tells the truth about the
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    referendum on the euro, he gets into trouble. Is there not something wrong, therefore, with the ministerial code of conduct?
    Mr. Leslie: This is becoming a very tired subject. The hon. Gentleman should reread the statements that were made to the House; it is time that we moved on.
    Michael Fabricant: When he next plans to review the ministerial code with reference to parliamentary statements and other Government announcements. [55938]
    The Parliamentary Secretary, Cabinet Office (Mr. Christopher Leslie): I refer the hon. Gentleman to the reply that I gave some moments ago.
    Michael Fabricant: The Minister may think that it is time to move on, but I am not sure that the country does, so when will he answer the question? When will the ministerial code deal with those who lie to the House?
    Mr. Leslie: Jonathan Aitken, Neil Hamilton, Jeffrey Archer—I am trying to remember the names. Perhaps my mind is a little jaded by the history of Conservative Administrations. The hon. Gentleman should recognise that the ministerial code of conduct is a strong document that ensures high standards of conduct from Ministers. I am proud of it. The hon. Gentleman should read it, and the amendments that are being made to it.

  The Prime Minister was asked—
  PRIME MINISTER

    Engagements
    Mr. Bill Rammell: If he will list his official engagements for Wednesday 22 May.
    The Prime Minister (Mr. Tony Blair): This morning, I had meetings with ministerial colleagues and others. In addition to my duties in the House, I shall have further such meetings later today.
    Mr. Rammell: Does the Prime Minister share my concern at the acute shortage of affordable homes and homes for rent in London and the south-east? Will he therefore ensure that the desperate need for extra housing investment is addressed in the forthcoming spending review? Does he agree that through such extra investment and by building on the fact that we have already reversed the disastrous cuts in housing investment that took place under the Conservative Government, we will demonstrate more clearly than ever the utterly hollow sham represented by the words "caring Conservatism"?
    The Prime Minister: I am pleased to say that over the next couple of years, as a result of the additional investment, investment in housing will amount to some £4 billion, compared with about £1.6 billion when we came to office. As important as anything else has been the starter homes initiative for key workers in London, which will help about 4,500 of them. However, I entirely

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    agree with my hon. Friend that there is a great deal more to do. That is clearly an important matter in relation to the comprehensive spending review. Of course, all that investment was opposed by the Conservative Opposition.
    Mr. Iain Duncan Smith: In 1998 the Prime Minister removed the power of head teachers to exclude pupils involved in drugs. Does he now regret that policy?
    The Prime Minister: Of course head teachers have the power to exclude pupils who are causing a problem in their schools. We have tried to bear down on unnecessary exclusions, but the right of head teachers to exclude pupils is necessary.
    Mr. Duncan Smith: The Prime Minister speaks of excluding children, but in 1998 he gave appeals panels the power to overrule head teachers' decisions to exclude those involved in drug taking or dealing. Worse than that, the Prime Minister made it clear in that legislation that head teachers had to listen and respond to the directions of the Secretary of State. The present Secretary of State has said that excluding pupils for drugs offences was
    "extreme and not related to the real world".
    Will the Prime Minister tell us whether the number of school pupils taking drugs has gone up or down since then?
    The Prime Minister: We know very well that the numbers of pupils who take drugs is a serious issue in our schools, but it is nonsense to suggest that we are saying that head teachers should not have the power to exclude pupils who are taking drugs. What is more, the work that we have been doing in schools on drug education and on ensuring that those who are dealing in drugs are properly punished bears comparison with anything that the previous Government did. In fact, over the past few years, we have invested more money in drugs education in our school, whereas the previous Government cut the amount of money available.
    Mr. Duncan Smith: As ever—promises, but never the answer. Drug taking in schools has risen by nearly a third since the present Government have been in power, all because they undermined head teachers. Linked to that, assaults on teachers have risen fivefold since the Government came to power. Is it not a fact that schools are more drug-infested and more violence-ridden as a direct result of the way in which the Government have undermined the discipline of teachers and head teachers?
    The Prime Minister: That is a pathetic attempt to exploit an issue which everybody knows is a serious issue in schools. It is nonsense to suggest that we have been lenient with people assaulting teachers in schools. We have made it clear that they should be subject to the severest penalties. As for drug taking in schools, if the Government were responsible, how does the right hon. Gentleman account for the fact that when the Conservatives were in power, crime doubled and drug taking at every level increased? We have taken measures to ensure that head teachers have the power to exclude, but we are also trying to deal with the causes of drug
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    taking in our schools. Once again, the Conservative party sees a problem and, instead of trying to deal with it, simply wants to exploit it.
    Mr. Mohammad Sarwar: My right hon. Friend will be aware of the rising tensions between India and Pakistan over the disputed area of Kashmir, which are in danger of developing into a full-scale war, or even a nuclear confrontation. What steps will he and the British Government take to defuse that extremely dangerous and potentially lethal situation?
    The Prime Minister: The situation is indeed grave and serious and the dangers inherent in it cannot be stressed enough. India and Pakistan are currently confronting each other, and I urge the leadership of both countries to pause and reflect before taking action that could plunge not just their countries but the wider region into conflict, with implications for the whole world. We are in constant touch with both countries and other allies, and we will do everything that we possibly can to try to calm the tension and remove the source of conflict.
    My own view is that it is essential in the end that Pakistan should stop support for any form of terrorism in Kashmir or anywhere else in the region and, at the same time, that India should be prepared to offer a proper system of dialogue to resolve all issues between the two countries, including disputes over Kashmir. That is the only way we will resolve the issue in the long term. In the short term, I urge both countries to reflect carefully on the moves on which they may embark.
    Mr. Charles Kennedy: Without doubt, the entire House will agree with the Prime Minister's sentiments on that issue.
    On a different issue, does he agree with his former policy director, the hon. Member for South Shields (Mr. Miliband), who this week signed a parliamentary motion that puts forward his view that the five economic tests for sterling's entry into the single currency have already been met?
    The Prime Minister: I agree—of course—with the Government's policy.
    Mr. Kennedy: Then here is the ideal opportunity for the Prime Minister to clarify what the Government's policy actually is. Given the conflicting signals over the past week coming from the Treasury and No. 10, has the Prime Minister ruled out introducing legislation in the Queen's Speech this autumn to enable a single currency referendum?
    The Prime Minister: The position is entirely clear, as it always has been. We believe that if the economic tests are met and passed—that assessment has to be made before June 2003—we will put the issue to people in a referendum. That is clear, and it is different from the policy of the Conservative party, which is against the single currency for good, for ever and at any point in time,

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    and the policy of the Liberal Democrats, which is to enter the single currency even if the economic tests are not met and it is not in the economic interests—
    Mr. Kennedy indicated dissent.
    The Prime Minister: If the right hon. Gentleman denies that, he presumably agrees with me. He should adopt the Government's policy, too.
    Geraint Da vies: I am sure that the whole House will wish to join me in sending our condolences to Ken and Libby Osborne, whose son Joshua was tragically killed by their child minder, Linda Bayfield. Will the Prime Minister instigate an urgent review of the laws that protect our children from abusive child minders and nannies and, in particular, give parents the right of access to serious complaints that have been made against child minders? In the case of Ken and Libby Osborne, that would have saved their son Joshua, who would still be with us.
    The Prime Minister: I extend my sympathy to Mr. and Mrs. Osborne on the tragic death of their child. The Department for Education and Skills is looking at how the regulation of child care and child minders can be strengthened. However, no decisions have yet been taken. This case obviously illustrates the need for such a review.
    Adam Price: I know that the Prime Minister is aware of the crisis in the coal industry, including the threat to Betws colliery in my constituency. Will he tell us when the Government intend to make an announcement about an extension to the existing coal subsidy regime, which is currently set to expire on 23 July?
    The Prime Minister: As the hon. Gentleman says, we are considering that now. I should point out that I think Betws colliery has already received nearly £3 million under the operating aid scheme, and I think a further £1 million, or slightly more, is likely to be approved by the European Union shortly.
    The operating aid scheme has brought benefits to the coal industry—some £140 million has been paid out under it—but we must review it, and we are reviewing it. I cannot say exactly when the decision will be made, but it will obviously be made before the deadline that we set.
    Mr. Peter Kilfoyle: Does the Prime Minister agree with the American Government's assertion that Cuba is a terrorist state?
    The Prime Minister: I think that America is entitled to its position on Cuba, which it takes for obvious reasons. We, however, take our position.
    Nick Harvey: What assessment have the Government made of recent reports of confirmed outbreaks of foot and mouth disease in South Korea and, indeed, in southern Japan? One case was less than 20 miles from a principal World cup stadium.
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    Given that rural Britain is still reeling from the impact of foot and mouth disease last year, what steps will the Government take to ensure that the thousands of Britons travelling to the World cup, as supporters and as journalists covering not just England matches but all matches taking place in those two countries, do not inadvertently bring the virus back to the United Kingdom through British airports?
    The Prime Minister: Obviously we will consider what measures are necessary, but it is important to recognise that strict measures are already in place as a result of the foot and mouth outbreak that occurred here. While we must of course take any reasonable precaution, we must also ensure that we are not over-restrictive or unnecessarily bureaucratic.
    Ian Lucas: After Potters Bar, safety on the railways is at the forefront of all our minds. British Rail was forced to sell off its track maintenance operations in 1993. Does the Prime Minister agree that the use of sub-contracted maintenance workers since then makes it more difficult for us to create a railway that is truly safe?
    The Prime Minister: I think that the Lord Cullen recommendations give the answer. Lord Cullen recommended certain changes which are being implemented now. I know that my right hon. Friend the Secretary of State for Transport, Local Government and the Regions has also asked for work to be done by the Health and Safety Commission.
    I do not think that the use of contractors and sub-contractors always means that a lower standard of safety is adhered to, but it does mean we should ensure that the proper checks are made to establish that safety standards are being adhered to. That is, of course, the very reason for Lord Cullen's recommendations.
    Sir Michael Spicer: Why, according to the Institute for Management Development, has Britain fallen from ninth to 19th in the world competitiveness league since Labour took office?
    The Prime Minister: Actually, the country moves around that competitive league virtually from year to year.
    Unfortunately for the hon. Gentleman, the same report makes it clear that Britain will have a better growth record than any other major economy anywhere in the world. I thank him for giving me an opportunity to raise the issue of the economy. Britain now has the lowest inflation and the lowest interest rates for 40 years. Britain now has the lowest unemployment for nearly 30 years. Britain has cut long-term unemployment massively, and I pleased to say that Britain's economy is set to grow more than any comparable economy this year.
    I thank the hon. Gentleman for that question.
    Mr. Chris Bryant: The Prime Minister will know that heroin is one of the biggest problems facing former mining constituencies such as his and mine. Is he surprised, given his earlier remarks about primary school education, that Rhondda Cynon Taff county borough council, which is run by Plaid Cymru, still refuses to fund primary school education on drugs,

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    such as the project in my constituency called DARE— Drug Abuse Resistance Education? Is he worried about the fact that my constituents must wait for 12 months for projects related to crime, drugs and alcohol? Does he believe that the way to deal with the problems is not to talk about reclassifying drugs, but to start thinking about making the extra investment in health, education and anti-crime measures that the Tories pointedly failed to make?
    The Prime Minister: It is important that we take action in relation to this problem. First, we must make sure that there is proper investment in drugs treatment and in drugs education. That is what we are doing. We must also make sure that those who engage in peddling drugs are dealt with severely. That is why the changes in the criminal justice system and the Proceeds of Crime Bill, which is being opposed by the Conservatives, are just as important as drug treatment and prevention.
    Mr. Iain Duncan Smith: Will the Prime Minister tell us which Cabinet Minister is in charge of organising elections and referendums?
    The Prime Minister: The issue of elections and referendums has obviously been dealt with through the Home Office in the past. However, all decisions are Cabinet decisions. If the right hon. Gentleman wants to know anything particular, he can ask us.
    Mr. Duncan Smith: On 8 June 2001, in a Downing street press notice—issued, no doubt, by the Prime Minister—he made it clear that responsibility for referendums and elections was transferred to the newly created Department for Transport, Local Government and the Regions. Last year, therefore, the Prime Minister put the Secretary of State for Transport, Local Government and the Regions in charge of referendums. When the Transport Secretary said that legislation on the euro referendum would be announced on the day of the next Queen's Speech, was he telling the truth?
    The Prime Minister: First, the Home Office did indeed introduce the legislation on elections and referendums. Secondly, of course local elections are governed by the DTLR. As for what the Secretary of State has said, the position in relation to the euro referendum is exactly as I set it out a moment ago.
    Mr. Duncan Smith: That is clear, then. It is marvellous that when the Transport Secretary goes on failing to tell the truth, the Prime Minister runs to his defence. When it appears that there is a glimmer of truth in what the Transport Secretary says, the Prime Minister dumps on him. Perhaps the Prime Minister could now answer the question. The Transport Secretary, the man in charge of referendums who will organise the legislation, said that on the day of the next Queen's Speech there would be legislation on the euro referendum. Was he telling the truth—yes or no?
    The Prime Minister: The position in relation to the referendum is clear. If the economic tests are passed, we put the matter to the people in a referendum. What is more, those tests have to be met, or passed, or assessed
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    before June 2003. [HON. MEMBERS: "More."] Let me say this to the right hon. Gentleman: it is clear, as we said in the manifesto, that the tests have to be assessed before June 2003. If the tests are met, the issue goes to people in a referendum. The right hon. Gentleman can make whatever debating points he wants, but that is the policy. It is clear—indeed, it is a darn sight clearer than his policy.
    Hon. Members: More!
    Mr. Speaker: Order.
    Harry Cohen: The Highways Agency made public commitments to environmental improvements before its operations in the capital were transferred to Transport for London. Those commitments have not been honoured. Four years ago, after the M11 link road was built through my constituency, I was promised, in writing, £1 million for environmental improvements to Leyton and Wanstead. That promise has not been fulfilled. Will the Prime Minister look into the matter so that trust can be restored in the word of Government agencies?
    The Prime Minister: This is another case of a transferred obligation, as I gather that Transport for London is now responsible for compensation schemes. It has received about £20 million for doing so, but I will certainly look into my hon. Friend's point.
    Mr. Ian Taylor: The Prime Minister made some remarks in the past week with which I agreed. I refer to his science policy announcement on Monday, when he said that he would take further action to protect the science base and support scientists. Will the right hon. Gentleman back that up by making sure that we can in practice prevent animal rights activists from stopping legal research, and encourage trials of genetically modified crops to find out what their impact is? Does he recognise that problems of facilities and academic pay in the universities will create tensions for big research laboratories, which may well go to the United States. There is a big agenda here. Will the Prime Minister follow his good words with action?
    The Prime Minister: The work that we have done already in trying to protect companies, such as Huntingdon Life Sciences, has been important, and we need to make it quite clear that those people who want to protest should do so legitimately and lawfully. What they should not do is disrupt legitimate business and prevent research, because people may be totally opposed to GM crops, but at least we should know the facts, based on research.
    I will be making it clear tomorrow as well that, of course, we want to continue the support for science. We have already increased its funding very significantly, both in the public sector and in partnership with the Wellcome Trust, but I entirely agree with the hon. Gentleman that it is important that we carry on that work. The science base

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    is hugely important not just to the future of this country, but, in particular, to the economy and the education of our children.
    Peter Bradley: Is my right hon. Friend aware that the complaints of people who are intimidated—or who, more often than not, feel intimidated—by the collections of young people on street corners are echoed by the young people themselves, who would much rather have somewhere else to go and something else to do? Will he take the opportunity of the comprehensive spending review to invest heavily in the youth service, which has been a Cinderella service, and in facilities for young people throughout the country?
    The Prime Minister: We are doing two things: first, we are investing more money in youth services, and secondly, we are also investing in the new Connexions service which offers young people the prospect of proper career advice and development, which is vitally important for them. But my hon. Friend is right: at the same time as we bear down heavily on street crime and make sure that people who are repeat offenders are not constantly bailed, and so forth, we have to invest in programmes, such as sure start, and education, making sure that the youth services are properly funded so that young people have something to do and somewhere to go, rather than hanging about on street corners, creating mischief.
    Mr. Patrick McLoughlin: On 26 February, the Secretary of State for Transport, Local Government and the Regions said:
    "Martin Sixsmith offered his resignation, which was accepted, on 15 February."—[Official Report, 26 February 2002; Vol. 380, c. 574.]
    Was he telling the truth?
    The Prime Minister: That has been dealt with by my right hon. Friend and me. What this indicates, yet again, is the utter inability of the Conservatives to deal with any policy issue. It is fascinating—is it not?—that just once at this Prime Minister's Question Time have I been asked a serious policy question from the Conservative party— and that was from someone who does not agree with his party's leadership.
    Mr. Piara S. Khabra: In light of the reports of a college placing creationism and evolution on the same terms, does the Prime Minister agree that the national curriculum should be clarified to prevent the two being presented as scientific equivalents? Does he also agree that it is better to draw a clear line now, rather than later, to deal with the consequences of those teachers who abuse their position?
    The Prime Minister: We must be careful of exaggerating the issue of creationism in schools. I say to my hon. Friend that the national curriculum already provides certain safeguards. Of course those safeguards are kept under review, but I am hesitant myself about saying that those particular issues should be dealt with if it is the case, as I believe, that the school in question is a good school, providing a good service for its pupils.
    Mr. Paul Tyler: Does the Prime Minister agree with the former membership
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    secretary in his own constituency that the Labour party has ceased to be a democratic movement and has become a centralised mail order business?
    The Prime Minister: I do not believe that he would have said that at all. I would simply point out to the hon. Gentleman that, if he looks at some of the local election results, he will see that we saw off the Liberal Democrats in many areas of the country.
    Andrew Mackinlay: May I raise the question of Gibraltar? [HON. MEMBERS: "Yes."] Does the Prime Minister recall the prayer that says, "God grant me the courage to change the things which I can, the patience to accept those things that I cannot, and the wisdom to know the difference"? Should not that be applied in relation to the Government's policy on Gibraltar? The fact is that we cannot change Spain's position, so is it not time that we concluded those abortive and foolhardy talks and robustly defended the right of the people of Gibraltar to enjoy access throughout Europe and to promote their economy unhindered by Spain?
    Hon. Members: Hear, hear.
    The Prime Minister: Opposition Members cheer, but they should know that the Brussels process in which we are engaged began in 1984 and has been carried forward in good faith by the Government. It has been carried forward for a very simple reason: there is a dispute over Gibraltar and it has many ramifications within the European Union, for this country as well as for Spain. It is important that we try to resolve it, but we have made it clear throughout that the final say has to rest with the people of Gibraltar. We have conducted the talks in good faith and we will continue to do so.
    Sir Patrick Cormack: As the Prime Minister very sensibly expects strong support for his policy against terrorism, and as there is no commitment in the Good Friday agreement to granting an amnesty to terrorists on the run, can the right hon. Gentleman give the House an absolute assurance that he has no such intention?
    The Prime Minister: What I can say is that we will look at the issue very carefully—as we said; there is a real issue as regards people on the run who have been either charged or convicted of offences, and circumstances where those who have been convicted and served their time are now out on the prisoner release scheme. We are well aware of the sensitivities regarding that issue in Northern Ireland and we hope that we can find a way forward that meets those sensitivities but that deals with a genuine problem—an anomaly in the system.
    Paul Farrelly: Will my right hon. Friend join me in congratulating Newcastle-under-Lyme Labour borough council on its work with the Labour Government and the Labour county council in attracting thousands of new jobs to former coal mining areas in my constituency? Furthermore, does he agree that the effective partnerships that we are forging

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    show Labour making a real difference up and down the country in clearing up the wreckage left in former mining communities by the Conservatives?
    The Prime Minister: It is true that massive investment is going into the former coal mining areas. That has of course created many, many jobs; indeed, there are 1.5 million extra jobs in the economy as a whole. All that investment was opposed by the so-called new party of the vulnerable.
    Pete Wishart: As a fellow musician, the Prime Minister, I am sure, appreciates the contribution of the creative industries of the United Kingdom. He will therefore be aware that massive losses have been incurred by some of the major record companies in the UK. What are he and his Government going to do about the real issues of music piracy and copyright infringement that pose a great threat to the UK music industry?
    The Prime Minister: I do not describe myself as a musician, but in respect of record companies, we have tightened the law in this country—it has also been tightened internationally. Many of the laws against piracy have to be dealt with internationally—as we are trying to do—and although I understand the frustration experienced by the record companies, as the hon. Gentleman knows, the result of the technology that is now available makes that very difficult.
    Dr. Phyllis Starkey: In answer to an earlier question, my right hon. Friend re-emphasised the Government's commitment to increasing investment in science and engineering. In that context, does he share my disappointment that in a recent survey of 16-year-old school leavers neither scientist nor engineer figured in the top ten career choices of girls?
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    What are the Government doing to improve the attractiveness of careers in science and engineering for girls and for boys?
    The Prime Minister: My hon. Friend is right to draw attention to the fact that many young people do not see science as a good career. One of the best things that we can do is to show by what is happening in science today— in particular the extraordinary spin-offs between scientific endeavour and the commercial world—what huge opportunities there are for our young people. I hope that the investment and the priority given to science by the Government will play a part in that. If young people knew, for example, that in the Cambridge area alone there were some 60,000 high-tech, well-paid jobs as a result of co-operation between science and the academic world, we should have a lot more people going into science.
    Peter Bottomley: If the Prime Minister believes that questions in the House about whether a Minister has told the truth are not important matters for the House, may I ask that he take advice from his mentors and come back next week with a different answer?
    Moving on from that, my specific question is on Northern Ireland. Has the Prime Minister noticed that the proportion of people—[Interruption.]
    Mr. Speaker: Order. The hon. Gentleman asked one question, and that is enough.
    The Prime Minister: Of course it is important that Ministers tell the truth. I was simply saying that the issue had been dealt with comprehensively by the Secretary of State. I was saying also that it was typical of the Conservative party that it wants to personalise every issue rather than deal with policy issues, which are the real stuff of politics.

Points of Order
3.31 pm
David Burnside: On a point of order, Mr. Speaker. On 10 April I tabled a question to the Secretary of State for Northern Ireland—[Interruption.]
Mr. Speaker: Order. Will hon. Members leave the Chamber quietly?
David Burnside: Thank you, Mr. Speaker.
I asked the Secretary of State whether he would make a statement on the status of the Provisional IRA ceasefire in relation to the theft of intelligence information from special branch at Castlereagh police station. I received what I believe is called a holding answer which was "as soon as possible".
Yesterday, at Hillsborough Castle, the residence of the Secretary of State for Northern Ireland, the right hon. Gentleman briefed the Alliance party, a party that has no representation and no Members in the House. He briefed it that he believed that the IRA ceasefire continued to be in existence. I do not wish on this point of order to comment on the content of the right hon. Gentleman's statement, which obviously proves that he lives on another planet from the rest of us in Northern Ireland. However, is the briefing of the Alliance party at Hillsborough yesterday and refusing to answer my question not in contempt of the House?
Mr. Speaker: I shall examine the hon. Gentleman's point of order, and will get back to him.
Mr. Wayne David: On a point of order, Mr. Speaker. I raise an issue of grave concern to many of us. Nearly every day we see many people queuing to enter the Strangers Gallery. As that is happening, we discover
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that there is a website which has been organised by the president of Plaid Cymru, who is not a Member of this place. He states on his website that if a certain sum—£180 a year—is paid to his club, he will arrange access for members of the public—[Interruption.] I ask the authorities of the House urgently to look into the matter—[Interruption.].
Mr. Speaker: Order. Let me reply to the hon. Gentleman. I have examined the document to which he refers. I see no breach of the rules of the House. However, individual Members are responsible for the issue of their allocation of Gallery tickets, bearing in mind that the facilities of the House should not be used in connection with fund raising for a political party or for any other causes.
Mr. Simon Thomas: On a point of order, Mr. Speaker. May I draw your attention to written question No. 5, which was tabled yesterday for answer today, in the name of the hon. Member for Chorley (Mr. Hoyle)? It having been tabled yesterday, I think that it is a planted question. It refers to an application for a wind farm in my constituency. Is it not a gross discourtesy to the House to table a question that relates specifically to an application in another Member's constituency, without giving some indication to that Member of the intention to table the question?
Secondly, Mr. Speaker, does it not concern you, as it concerns me, that the BBC are now phoning me for my reaction to the answer to the question, when the answer has not yet been placed in the Library?
Mr. Speaker: The hon. Gentleman is correct. Any Member tabling a question that has regard to another Member's constituency should have the courtesy to let that Member know. As for the BBC phoning the hon. Gentleman, he should do what I do and just ignore phone calls from the BBC.

Political Parties (Funding)
3.35 pm
Mr. John Maples: I beg to move,
That leave be given to bring in a Bill to make provision about the funding of political parties.
I hope that I shall be able to generate a little cross-party consensus on this proposal, in contrast, perhaps, to the last half-hour. This subject is very high on the political agenda and the media's agenda at the moment, and a lot of different ideas are flying around.
Towards the end of the American civil war, when the union armies were taking over the south, military governors were appointed in southern towns. In one town, whoever they appointed was bought off by the local crooks—I guess we would call them the mafia nowadays. Lincoln kept sending down better and better people, but they all got bought off. The sums got higher, but they still ended up getting bought off. In the end, Lincoln sent down his childhood friend and trusted law partner, and he thought that that would sort it out. He heard nothing for about six weeks, until he received a cable saying, "Mr. President, please relieve me, they've almost reached my price."
I do not know my price—all I get offered nowadays is lunch, and it is certainly a lot higher than that—but there is a moral in this. Politics needs money, but somehow the money at least gives the appearance of corrupting the politics. That is what is getting the current Government into trouble and what has got us into trouble in the past. It is a problem of all political parties, although it tends to affect the party in government more than the party in opposition, as it is easier for the party in government to raise the money and the party in opposition does not have much to offer in return.
Big donations are the problem. People do not have trouble with smaller donations—even £5,000 or £10,000 donations—but with donations of £100,000 and £200,000. Inevitably, those donations come from wealthy people, who usually have business interests. While they may not have an immediate point to make with the Government of the day, they often have an agenda. In exchange, they probably get some sort of access, which may be accidental, because party treasurers find it much easier to raise large sums of money from a very small number of people than small sums of money from a very large number of people. They therefore tend to offer lunch or dinner with senior Ministers or even with the Prime Minister. The process is pretty unsavoury to those who participate in it, and it leads to the feeling among donors that they have access, as they have met a Cabinet Minister or the Prime Minister. When a matter arises in which they have an interest, with the best intentions in the world— and saying that it is in the national interest—they tend to pursue that access.
That creates an appearance to the public of parties being corruptible by donors. The big donations, and not even the medium-sized ones, are the problem. We must address that. We would all acknowledge that politicians have a pretty low standing at the moment, and this is one of the things that make it worse. The alternatives that have been proposed tend to focus on public funding and using taxpayer's money through the Treasury, either on a matching funding basis or in replacement of private donations and party fundraising. That has met with a lot
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of resistance from taxpayers and a huge amount of resistance from the press—I do not know whether the whole of the media are resistant to it, but the newspapers certainly seem to be enormously resistant.
We therefore need to find a compromise, middle way, third way or whatever term is fashionable—perhaps we can call it different things on opposing sides. First, we need to acknowledge that parties need to raise money. It costs money to run a political party and an election campaign, and it is in the interests of the democratic process that parties put their points of view over to the electors and that they do so using modern communications and in a way that gets their message across.
Approximately—these are very rough figures—it costs the Conservative party and the Labour party £10 million a year to run their central party organisations and about another £20 million for the general election campaign. That is an average of £15 million a year over a four-year electoral cycle. The Liberals do not spend as much money as the rest of us, but, on the basis of the figures that I have seen, their average is about £4 million a year. We must acknowledge that parties need to raise money of that order. That is why it so much easier for the party treasurers who are charged with this task to try to raise it with a small number of very large donations. If they get a few people to give half a million pounds, that goes a long way towards reaching their annual target.
I propose that there is a way through this that achieves voluntarism on the one hand and gets rid of very large donations on the other. I would create a pot of matching funding by inviting taxpayers, on their tax return forms, to tick a box. If they did not tick that box, £2 would be added to their tax bill—£2 a year, which is the equivalent of 4p a week—and paid into a matching funding pot run by the Electoral Commission. If they did not want to pay, they would tick the box and they would not pay. Of course, if everyone ticked the box and did not pay, the scheme would not work, but that would at least put the solution in the hands of the electorate.
To qualify for such matching funding, a political party would have to do two things. First, it would have to say that it would not accept any donation of more than, let us say, £5,000, although the figure might be £10,000 or £2,000. The figure should be such that no one could believe that undue influence could be bought for that sum. Therefore, political parties would have to forgo large donations on an entirely voluntary basis.
Secondly, a political party would have to raise donations of less than £5,000 from a wider group of supporters, and it would then be entitled to money out of the matching fund for up to 100 per cent, of what it had succeeded in raising privately. That would encourage parties to get lots of small donations from the many supporters that we have out there but who do not pay us much attention. That would obviate the necessity for political parties to raise perhaps half their budgets from very large donations.
My Bill is different from other proposals that have been made for taxpayer finance because the donations would not be compulsory. It would be entirely up to individuals to decide whether to donate, and they would be under no compulsion to do so. It would not be the Chancellor of the Exchequer's decision, but the electorate's decision to decide whether to pay and how much there would be in the pot.

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There are about 27 million taxpayers in the country. If 30 per cent, of them did not tick the box and gave their £2, that would raise approximately half of what the three major parties spend in the course of the electoral cycle. Matching funding would fund about half a party's current total expenditure and the balance would come from small donations. Most of those donations would be for much less than £5,000—as they are at the moment—but there would have to be more of them. Perhaps people would be more likely to donate if they felt that giving large donations would obviate the necessity for parties to seek very large donations.
There is cross-party consensus for my Bill. I am grateful to the people in my party, those on the Government side and those in the Liberal Democrats who have sponsored the Bill. I hope that my proposal will be taken into account as the debate continues, because I believe that it would achieve several purposes. There would be no more big donations, which are the problem that all parties face when they raise money. They create the problem that we have with our image with the public. It would reduce the pressure on party leaders to make themselves available for fund-raising events and perhaps, even worse, to make themselves and their Cabinet colleagues subsequently available to the people who have given money to the party. That would vastly improve our image collectively as politicians, and we all share an interest in that. Furthermore, there would be no compulsion either on the political party or on individual taxpayers to become involved. It would be an entirely voluntary scheme on both sides. I hope that the House will accept the Bill.
Question put and agreed to.
Bill ordered to be brought in by Mr. John Maples, Mr. David Curry, Mr. Peter Lilley, Mr. Archie Norman, Mr. Andrew Tyrie, Sir George Young, Donald Anderson, Andrew Mackinlay, Mr. Mike O'Brien, Ms Gisela Stuart and Mr. David Chidgey.

Political Parties (Funding)
  POLITICAL PARTIES (FUNDING)
  Mr. John Maples accordingly presented a Bill to make provision about the funding of political parties: And the same was read the First time; and ordered to be read a Second time on Friday 21 June, and to be printed [Bill 144].
Orders of the Day

  National Health Service Reform and Health Care Professions Bill (Programme) (No. 2)
  Ordered,
  That the following provisions shall apply to the National Health Service Reform and Health Care Professions Bill for the purpose of supplementing the Order of 20th November 2001:
  Consideration of Lords Amendments
  1. Proceedings on Consideration of Lords Amendments to the Bill shall (so far as not previously concluded) be brought to a conclusion four hours after their commencement.
  2. Those proceedings shall be taken in the order shown in the first column of the following Table, and each part of the proceedings shall, if not previously concluded, be brought to a conclusion at the time specified in the second column of the Table.

  Table

  Lords Amendments

  Time for conclusion of

  proceedings

  Nos. 2, 4, 1, 3, 5, 17 to 30

  One hour after the commencement

  of proceedings on Consideration

  of Lords Amendments

  Nos. 6 to 16

  Four hours after the

  commencement of those

  proceedings

  Subsequent stages
  3. The proceedings on any further Message from the Lords shall (so far as not previously concluded) be brought to a conclusion one hour after their commencement.—[Mr. McNulty.]

  National Health Service Reform and Health Care Professions Bill
  Lords amendments considered.
  Mr. Speaker: I must draw the House's attention to the fact that privilege is involved in Lords amendment No. 6, which is to be considered today. If the House agrees to this Lords amendment, I shall ensure that the appropriate entry is made in the Journal.

  National Health Service Reform and Health Care Professions Bill

    New Clause
    Lords amendment: No. 2, after clause 2, to insert the following new clause—Duty of Primary Care Trusts, NHS Trusts and Strategic Health Authorities regarding education, training and research.
    3.45 pm
    The Minister of State, Department of Health (Mr. John Hutton): I beg to move, That this House disagrees with the Lords in the said amendment.
    Mr. Speaker: With this we may discuss Lords amendment No. 4.
    Mr. Hutton: I should express right at the beginning of my remarks the fact that I fully understand the sentiments and concerns that underpin amendments Nos. 2 and 4, which were made to the Bill in another place. In particular, I am sure that we would all wish to ensure that the enormously important contribution that academic

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    medicine makes to the national health service is properly safeguarded and that its international reputation for excellence is properly secured.
    Fundamentally, the arguments in favour of the amendments are based on two assumptions, the first of which is that the existing legal framework to ensure that education, training and research is properly underpinned in the NHS is either inadequate or ineffective. I do not believe that to be the case. The necessary statutory powers already exist and help to ensure that a proper focus on education, teaching and research is maintained right across the service.
    The second assumption is that the NHS does not take the question of education, training and research seriously enough—that it is too low a priority and that creating a new legal duty in this area will improve matters.
    On the first of those two arguments, I remind the House that section 51 of the National Health Service Act 1977 places a clear duty on the Secretary of State to exercise his functions so as
    "to secure that there are made available such facilities as he considers are reasonably required by any university which has a medical or dental school, in connection with clinical teaching and with research connected with clinical medicine, or as the case may be, clinical dentistry".
    That duty is already delegated to health authorities, and once the changes under "Shifting the Balance of Power within the NHS" take effect—and once the changes under the Bill take effect later this year—it will be delegated directly to primary care trusts across the country. The duty is no less of a duty because it is delegated by the Secretary of State to PCTs. The Secretary of State and, through him, PCTs, will have a duty under the section to ensure the provision of facilities that are necessary for clinical teaching and research.
    Under paragraphs 14 and 15 of part 3 of schedule 5 A to the 1977 Act, which broadly sets out the powers and duties of PCTs, PCTs are empowered to conduct, commission or assist the conduct of research and to make officers and facilities available in connection with training by a university or any other body providing training in connection with the health service.
    Under paragraph 11 of schedule 2 to the National Health Service and Community Care Act 1990, an NHS trust may undertake and commission research and make available staff and provide facilities for research by other persons. Under paragraph 12 of schedule 2 to the 1990 Act, an NHS trust may also provide training for persons employed or likely to be employed by the trust or otherwise in the provision of services under the 1977 Act, and to make facilities and staff available in connection with training by a university or any other body providing training in connection with the health service.
    Under section 5(2)(d) of the National Health Service Act 1977, the Secretary of State has the power to conduct, or assist others to conduct, by grants or otherwise, research into matters relating to the causation, prevention, diagnosis and treatment of illness, and into any such other matters connected with any service provided under the 1977 Act, as he considers appropriate.
    In addition to those specific powers, if it appears to the Secretary of State that it is necessary under section 17 of the 1977 Act, as amended by the Bill, he has a power to
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    give directions about their exercise of any functions to strategic health authorities, PCTs and NHS trusts. The exercise of all those powers in relation to health bodies in Wales has been devolved to the National Assembly for Wales.
    Anyone with a fair mind would regard that description of legal powers and duties as a comprehensive one, which I believe provides a solid legal basis for education, training and research right across the NHS.
    The Lords amendment was made with the best of intentions—I am absolutely sure of that—but it would be superfluous to include its provisions in the Bill. As a general principle, we should not legislate unless there is a clear and obvious need to do so. An adequate legal framework is already in place and can, if necessary, be supplemented by directions from the Secretary of State to strategic health authorities, PCTs and NHS trusts about the exercise of relevant functions. There is, in short, no substantive need for the amendment, and that is why we should not accept it. There is another set of difficulties with the amendment. It is too vague to be meaningful. It does not even define education, training or research, or limit the scope of those three concepts to the health sector; nor does it offer any way of measuring whether the bodies concerned are meeting their legal obligations.
    The second argument in support of the amendments relates to the concern about whether there is sufficient focus on education, training and research in the NHS. I believe that there is. That is certainly true of resources. On research, the Department of Health has increased its research and development budget from £432 million in 1996–97 to £507 million in this financial year. In relation to education and training, the budget for multi-professional education and training—the new MPET budget—has increased from £1.7 billion in 1996–97 to £2.9 billion this year. Those are significant increases in resources. No one looking at those figures could say that the Government have not focused sufficiently on education and training issues.
    The amendments are not necessary to protect the funding for education, training or research. NHS funding for supporting research and development and for education and training is already managed centrally, as I am sure the hon. Member for West Chelmsford (Mr. Burns) recalls from his time in the Department of Health. NHS education and training funding is allocated to local NHS work force development confederations, which bring together local NHS organisations, including primary care organisations. Those in turn have the responsibility to purchase NHS-funded education and training from higher education institutions in accordance with local work force requirements, of course taking account of national priorities. NHS trusts can also use their own funds to support education and training where appropriate.
    PCTs in particular, therefore, will not be under pressure to spend that money for other purposes. We have no plans to put the funding for research into PCTs' allocations for patient care. The money for research is ring-fenced. Indeed, even the small amount of money that health authorities spend directly on commissioning public health research and development will in future be protected within a ring-fenced central research and development budget.

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    The argument is not simply about money, however. It is right that we continue to look carefully at how we can improve present arrangements. That is why we will look for an increasingly closer collaboration between universities and research-active NHS bodies to guarantee the quality of research that meets the needs of patients and of staff delivering services at the front line.
    We are already putting in place a new network of PCTs that will help to promote high standards of research governance and management across health and social care. The creation of that network by April next year is one of the targets in implementing the research governance framework for health and social care, which my Department published in March 2001. Those PCTs will have research management capacity that they will share with other PCTs around them, encouraging, I hope, a collaborative approach to research. By next April, we will also have in place around 30 new teaching PCTs, mainly in underprivileged and under-staffed areas to provide teaching, research and clinical opportunities for primary and community care professionals to support and improve the delivery of services to local populations. Teaching PCTs will work alongside local universities to provide a learning environment for their own organisation, as well as a local resource for the wider health community.
    PCTs will also have the ability and opportunity to enhance the quality of patient care by engaging patients and carers in support of teaching and research; by fostering the special opportunities available in primary care for research and for teaching students across the range of health professions; and by taking full account of teaching and research in their commissioning of local and more distant hospital and specialist services. We expect PCTs to grasp those opportunities to ensure both the long-term success of the NHS plan and the continuing contribution of the NHS to health-related research and education.
    To ensure that PCTs are fully equipped to take on their new functions, the national primary care trust development programme has been established. The programme recognises that, in addition to developing the general competencies of PCTs, more detailed work is required over a longer period on specific issues. I am pleased to be able to announce that one of those subjects will be the research, education and training issues affecting PCTs. The national primary care trust development programme will pull together a number of front-line PCTs, and other key individuals and organisations, to help to take that work forward. That will help to support PCTs in discharging their important responsibilities in that sector.
    The Government are fully committed to investment in the NHS work force. The NHS plan has made that commitment clear, and our record in office confirms the priority that we rightly attach to education, training and research. Since 1997, the number of nurses has increased by 31,520; in the year between September 2000 and September 2001, the number of qualified nurses employed in the NHS increased by 14,430, or more than 4 per cent. Since 1997, the number of qualified scientific, therapeutic and technical staff has increased by almost 14,000; in the past year alone, the number of such staff has increased by 4,290 or 4 per cent. Since 1997, the number of doctors has increased by 9,550; there are now 99,170 doctors, excluding GP retainers, in the NHS in England. In the
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    past year, the number of NHS doctors has increased by 2,850, or 3 per cent. I am glad to say that there are now 4,320 more consultants than there were in 1997.
    The House will probably be grateful if I do not continue to read through that long list of statistics, but overall they are extremely positive. They confirm that we have prioritised that necessary investment, and that it is being made. We are committed to the development of that work through an expanded programme of education, training and research. The NHS plan and the most recent Budget underline those strong commitments. The Government are also committed to a modern NHS that values and makes use of research-based evidence in developing patient services.
    Given the legal provisions that are currently available to sustain the proper focus on education, training and research, and the special arrangements that apply to the use of those resources in the NHS, I hope that the House agrees that amendment No. 2 is not necessary. Although I am sure that it is motivated by the best intentions, the circumstances in which we should and should not legislate are clear.
    Amendment No. 4 would impose a similar statutory duty on local health boards, NHS trusts in Wales and specialist commissioning bodies in Wales. The position in Wales in respect of legal powers must now take into account the devolution settlement and the Government of Wales Act 1998. The existing powers and duties of the Secretary of State, laboriously described by me this afternoon, as they apply to the NHS in Wales have been devolved to the Welsh Assembly.
    In addition, clause 6 confers on the Assembly a new general power both to establish local health boards and to determine their functions and duties. Consultation on the new structures will soon start in Wales. The problem with the amendment is that to a large extent it pre-empts that consultation exercise by establishing on the face of the Bill one of the duties of these new bodies; it is therefore inconsistent with the thrust of clause 6.
    Were we to accept the amendment, we would in effect fetter the democratically elected devolved Administration in the exercise of their powers over those policy matters. The form, functions and responsibilities of local health boards are rightly matters for the Welsh Assembly to determine through regulations. Those regulations will be subject to scrutiny through the secondary legislation procedure, which will allow full open debate by Assembly Members. That is the right way to determine the functions of the new bodies in Wales, and that is what clause 6 already provides for. Amendment No. 4 would take us in the opposite direction, and for that reason, we should not agree to it.
    Mr. Simon Burns: I listened carefully to the Minister and I appreciate his acknowledging that the amendments were tabled in all good faith. However, he went on to say that they were superfluous; I do not concur with that aspect of his analysis. As the Minister will know, concerns have been expressed in many areas by a large number of individuals both inside and outside the NHS about the terms of medical education, training and research. The amendments apply to England and Wales; they have the widest possible terms and embrace all aspects of education, training and research relevant to the NHS.

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    4 pm
    I am sure that we all agree about the importance of education, training and research, but we cannot ignore problems in respect of their delivery, which is at the heart of our disagreement with the Minister. We want to focus on the size of the problem and whether existing NHS structures allow education, training and research to thrive and prosper. No one would disagree that our final goal is to ensure that they do so, but our disagreement or, rather, our change of emphasis, concerns the way in which we maximise opportunities and ensure that delivery goes beyond mere rhetoric and lives up to expectations. The issue at stake is not simply the existence of powers in NHS legislation, but whether they are being used to their full extent to maximise benefits and opportunities, which is why the proposed new clauses use the word "duty" in their titles. Will the Minister explain again why he believes that that word is superfluous, instead of regarding it as a back-up in the armoury of delivery to ensure that we achieve the end that we all seek?
    While we all agree about the importance of education and its vital role in the NHS, it is plain to many people, particularly those involved in training and research, that those disciplines are vulnerable and threatened in the NHS. There is abundant anecdotal evidence that teaching and research resources are currently squeezed in NHS trusts. Lecture theatres are used for other purposes; there is a staffing crisis in universities; and doctors are so overwhelmed by day-to-day demands on their time, which affect their health care functions, that there is little or no time for research. It is all too tempting to sit back, secure in the comfort of the extra resources to which the Minister referred this afternoon and the possible extra resources that will emanate from last month's Budget. Citing statistics, however, will not make the problem go away; after all, part of the problem has been the squeeze on finances.
    The problem, however, is not as simple as that. It is far from clear that any extra resources will find their way into teaching and research, as the Minister hopes. The crux of the matter is whether all the bodies in the NHS with a role in teaching, research and education will deliver the enhanced service we all hope for. I have doubts, for example, about primary care trusts and their lack of expertise and experience. The Minister may say with some justification that as PCTs bed down and gain experience, that problem may be minimised. The fact is that, as we made abundantly clear in Committee, the time scale for the introduction of PCTs was rushed; there will be problems with the new bodies' lack of experience and their ability to cope with their heavy responsibilities.
    I have no doubt—and I hope that no doubts arise—that PCTs will build up experience and that the fears and concerns expressed in the initial stages of their creation will be removed. None the less, experience is a problem in the early stages, as it will be in any new organisation. The trusts have been asked in these early days to concentrate on identifying and providing acute care and other health services. However, if all their time and effort is concentrated on the delivery of health care—everyone would agree that that is their main function—problems may arise if they have to cut corners in the early stages because of those demands.
    Education, training and research are a classic issue that PCTs will always feel they can pick up on later while seeking now to minimise the other problems concerning
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    health care provision. Another problem is that the trusts' natural orientation is towards primary care. For those reasons, I do not believe that there can be certainty that PCTs will commission so as to promote and safeguard education, training and research to the extent that we would have hoped and expected them to do, especially in their early days.
    The safeguarding of those elements of the health service, on whose importance we all agree, is still not addressed by strategic health authorities. The Government have stressed the role of SHAs in terms of the performance management of PCTs that fail to achieve what the authorities believe they should achieve on education and research. I am deeply sceptical, however, about whether the introduction of such loose structures and untried processes at this stage of the reforms will solve the problem.
    Nevertheless, there is one sure way we can safeguard the three critical areas in question and put beyond any doubt the responsibility of NHS bodies for those vital elements, which are crucial if our health service is to continue to make improvements and enhancements and to deliver quality treatment. That solution is for the Minister to think again and accept the amendments introduced by another place—a place that is renowned for being not the partisan and highly political body that this House often is, but a more reflective body, which in debates about the Bill has drawn on the expertise of people who have spent a considerable proportion of their professional lives in the health service and in health and research in general. It would be unwise not to heed their wise words and reflective views and to seek to reverse a measure that was introduced into the Bill not to cause trouble but to strengthen, encourage and enhance training, research and education.
    In the light of the reasonable way in which I have tried to convince the Minister of the argument. I hope that he will understand in an equally reasonable way that as we are considering such a crucial matter it would be wise to strengthen and reinforce the message by agreeing to the amendments, instead of deciding that they are superfluous and relying on the provisions as they stood before the Bill was amended.
    Dr. Evan Harris: I speak in support of the Lords amendments and against the motions to disagree on the basis of, first, a series of problems that exist at the level of academic medicine and teaching and research; secondly, an additional problem caused by Government policy, which puts more pressure on primary care trusts not to deal with the problem; and thirdly, a question mark over whether there is any problem with introducing the amendments. The Government may suspect that they will not be effective, but I do not believe that they would do any harm.
    There are significant problems in education, training and research. There are also significant numbers of vacancies in academic medicine, and that situation is not getting any better; if anything, it is getting worse. Without the people to do the training—and, indeed, the people to train the trainers—we shall not have a work force in the future. A briefing provided by the British Medical Association tells us that the number of medical academics as a proportion of the work force has fallen from 11 to 8 per cent.

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    That fall is partly the result of an increase in the numbers of staff, but I would argue that there is an a priori reason for the proportion to stay the same, because as we recruit new staff they will initially be at a junior level, and we are still not seeing enough resources going to provide either the trainers or the trainers for the trainers. The significant problems in the recruitment of medical academics are often due to the pressures on them, and the lack of resources they feel they have in terms of time, equipment, hardware and space to do the teaching that is required.
    A further component of the need to ensure that resources are allocated to this area is the desperate need for consultant expansion. If resources were spent on education and research because of the amendment that has been made in the House of Lords, the side effects would be that a significant amount of that money would be extra funding, and that extra priority would be given to consultant expansion. I have said to the Government— and to the Minister who is speaking for them today— on many occasions since 1997 that they must safeguard consultant expansion and ensure that resources go into enabling senior-level consultant staff to do high-quality work, research and training, rather than allowing the expansion of sub-consultant and non-consultant career grade posts, which, for all their merit, are almost by definition not involved in the training of the next generation of specialists; they are almost entirely service-related posts.
    Until the Government can do something about the explosion of such posts, I will have little faith in their ability to ensure that there will be sufficient numbers of people to do important work such as the research that is led—although not exclusively carried out—by consultants, and the training that ought do be done almost entirely by fully trained specialists. Were the Government to introduce, through separate legislation, the means of controlling this explosion in sub-consultant grades and non-consultant career grades, we would be much more inclined to support the position that they are taking here and—I suppose that this is what counts for the Government in terms of the size of their majority—in another place. The Minister will accept that I have raised this issue several times; I have never had a satisfactory answer. Perhaps, with this Government, I never will.
    Dr. Andrew Murrison: Does the hon. Gentleman agree that a lot of what he is saying has to do with semantics, because what were once senior registrar grades are now, effectively, consultant grades, as we have recruited consultants who are younger and less experienced?
    Dr. Harris: I fear that I do not understand the hon. Gentleman's question, and I would hesitate to guess at what he means. The easiest thing for me to do might be to restate our position, which is that we need—and the Government have said that they wish to see—a consultant-provided service for the treatment of patients and for the education and training of the next generation of the work force, and a consultant-provided, or at least consultant-led, research service. This applies to the other health care professions as well; I am using this as an example, but I am keen not to be seen to be concentrating on this one aspect.
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    If I have misunderstood the hon. Gentleman I apologise, but what we have seen instead is an explosion of jobs being created that are not to do with education and training. They are purely service jobs, including staff grades and associate specialists or, worse, non-mainstream trust grade doctors who are there to do the service work that trusts feel under pressure to do. Their numbers have expanded enormously. The Minister has heard me say before that many of the people filling those posts have not been treated well by the health service, often on the basis of their background or race, and that there are significant issues to address in this area.
    We need to expand consultant opportunities and increase the number of people being trained for that specialist status. In the absence of a Government policy to guarantee that, this amendment, which would put a duty on the commissioners of services who provide the funding for those posts, would provide a mechanism for applying pressure for consultant expansion, although it would not be enough in itself. I hope that by setting out my position I have addressed the hon. Gentleman's point.
    4.15 pm
    The Minister said that the Government recognise the importance of research and try to base their policy on it. I question that, as I have before, because of some of the health policies that the Government are pursuing, such as giving priority to the two-week wait policy for cancer patients, which for all its merit is certainly not based on evidence of clinical outcomes. If the Government are saying that they support research so that it can inform their policies, they must "want"—to coin a phrase once used by another hon. Member—more research evidence, because I am not satisfied that that is happening.
    My main concern is the pressure on primary care trusts and budget-holders arising from the distortion of priorities caused by the welter of Government targets, which are based, at best, on sensible service provision and, at worst, on aims that have little significance for, or impact on, rational patient outcomes. We know that education and training will always suffer when the commissioners of care are faced with compulsory targets.
    If the Government withheld from setting some targets or at least adopted a more rational approach to target setting, I would be more likely to support their position that there is no need for the Bill explicitly to defend and protect less glamorous areas of the NHS. They may be less glamorous, but what is significant in this discussion is that they are not outcome-measured like many of the other initiatives that the Government have forced on primary care trusts. We have the tyranny of appraisal and the measurement of outcomes, and anything that does not have a hard outcome is deprioritised. That is why placing this duty on primary care trusts, although it is not the optimum solution, is a useful approach.

    I turn finally to ring-fencing. The Minister knows my view that ideally we would have proper devolution of funding. Local commissioners would not be hidebound by ring-fenced pots or targets but would be in a position to allocate funding as they saw fit, according to local priorities, with a recognition of services that are not affordable through explicit rationing.
    The Minister seeks to defend his position by saying that funding for research and education is ring-fenced, but at the same time he claims that the Government are

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    devolving responsibility for decision making to primary care trusts, and that is not wholly consistent. The Government must decide once and for all whether they are in favour of full devolution of spending decisions or whether they are in favour of a ring-fenced approach. We could then examine that policy in more detail.
    The time of people in education and training is not ring-fenced. They find that increasingly even their unpaid overtime is being eaten into by service requirements, some of which are reasonable and some of which are merely target chasing. It is to protect their ability to do their job and to avoid causing them to leave the NHS in disgust, which would create an even greater manpower problem, that we should agree with the Lords in their amendment and allow the duty to remain in the Bill.
    Mr. Hutton: I shall try to deal with the points raised by the hon. Members for West Chelmsford (Mr. Burns) and for Oxford, West and Abingdon (Dr. Harris). Both made thoughtful and well argued cases for the amendment, but none of their arguments confronted the issues as I see them. They did not deal with the inescapable logic that we should consider the legal basis of how these matters are currently regulated in the NHS. They also failed to deal with my remarks about our commitments and our allocation of resources. Listening to those contributions, one would think that education, training and research budgets were being cut because of service pressures elsewhere. That might well be an accurate description of past times, but it does not describe where we are today. Education, training and research projects are all growing substantially—a fact that provides the right context for the discussion that we should be having about these issues.
    The hon. Member for Oxford, West and Abingdon raised some important points, and I agree with much of what he said about non-consultant service grade doctors and so on. There is little doubt that some of the growth in those grades constituted a reaction by trusts to the problems—as they perceive them—arising from the working time directive. To find solutions, we need to address that issue and to engage with the service urgently. It is not in the long-term interests of patients, doctors or the NHS itself to trap a large number of doctors in service grades in which they will be unable to use their full potential and skills. Frankly, such posts would not seem attractive or easy to fill in any case, even if it were right to set them up.
    There is one aspect of the hon. Gentleman's argument that I find slightly difficult to understand. How would placing such a duty on primary care trusts deal with the problem? I accept that, in essence, we are talking about service issues that relate to resources. We need to look at medical, education and training issues in the round, and that is what we are doing. For example, we are considering senior house officer training, and there is a very strong case for reconsidering other grades, particularly non-consultant grade 2. Education, research and training are not—as the hon. Gentleman and the hon. Member for West Chelmsford have suggested—at the bottom of a list that prioritises issuing targets, and so on. Such issues are a priority, because fundamentally the national health service is a knowledge-based service. It is based on, and driven by, science and evidence.
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    The key to growing capacity—the biggest challenge that the NHS faces—is to invest in the NHS work force. We must train the new doctors, nurses, therapists and other grades of staff that the NHS needs for the future. We would be daft to compromise its ability to meet the NHS plan's challenging targets by taking a penny-pinching approach to education, training and research. We are simply not going to do that.
    Dr. Harris: The Minister knows I accept the argument that he has just made, and I recognise that funding is available to begin the expansion of various aspects of the health service that we all want to see. I welcome his comments on non-consultant career grades, and perhaps we can pursue that issue later. However, I should stress that I am arguing not that the amendment would resolve the problem, but that—in terms of the need for consultant expansion, rather than service grade expansion—it would offer a protection, until we can see the fruits of the Government's thinking. Such thinking is reassuring, but we need to see the fruits of it.
    Mr. Hutton: If I genuinely thought that that were so, I would take a different view, but I simply do not believe that the amendment would achieve the hon. Gentleman's aim, and it certainly would not achieve mine.
    There is also a wider context, to which the hon. Gentleman referred, that we should keep in mind. On the broadly philosophical question of the balance between earmarked funding and general allocations to NHS organisations, I hope that he recognises the fact that we are earmarking unified general allocations to NHS trusts less and less. However, education and training is a separate issue. The hon. Gentleman, his Liberal Democrat colleagues and the hon. Member for West Chelmsford have identified the importance of such investment. We can secure prioritisation in an effective way without fundamentally compromising the thrust, the spirit or the letter of our policy on devolution.
    The work force development confederations that receive the new training and education resources on behalf of the NHS are constituent organisations, consisting of local acute trusts, primary care trusts and so on. They are the organisations best placed to take such decisions. In distributing training and education resources to the confederations, identifying such resources carefully, and ensuring that they are spent on the purpose for which they were intended—a point that the hon. Member for Oxford, West and Abingdon raised in support of the amendment— we are in no way conflicting with our overall position on the devolution of power to the NHS front line.
    This is probably one of those debates in which, despite having all the arguments on my side, I will not persuade the hon. Member for West Chelmsford and the Liberal Democrats to take a different stance. They supported the amendments in the other place and I fully understand why they did so. In asking the House to disagree with the Lords amendments, I am in no way trying to downplay the importance of education, training and research. We differ about how the goal can best be achieved.
    I am absolutely sure that the Secretary of State, the Department of Health and the NHS recognise the importance of education, training and research. We have shown that commitment in the way that we have dedicated significant additional resources to challenging some of the

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    problems that we face and dealing with the capacity constraints that we inherited in the training of nurses, doctors and other therapists.
    We are getting on with that job. The best way that we can do that is to continue in the direction that we have set, and not legislate unnecessarily. We would be doing that, and ineffectively as well, if we accepted the amendments. The Government will continue to attach the highest priority to education, training and research across the national health service.
    Question put, That this House disagrees with the Lords in the said amendment:—
    The House divided: Ayes 32], Noes 193.

    Division No. 251]

    [4.26 pm

    AYES

    Ainger, Nick

    Coaker, Vernon

    Allen, Graham

    Cohen, Harry

    Anderson, Rt Hon Donald (Swansea E)

    Coleman, Iain

    Colman, Tony

    Anderson, Janet (Rossendale)

    Connarty, Michael

    Armstrong, Rt Hon Ms Hilary

    Cook, Rt Hon Robin (Livingston)

    Atkins, Charlotte

    Cooper, Yvette

    Austin, John

    Corston, Jean

    Bailey, Adrian

    Cousins, Jim

    Baird, Vera

    Cranston, Ross

    Banks, Tony

    Crausby, David

    Barnes, Harry

    Cruddas, Jon

    Barron, Kevin

    Cryer, John (Hornchurch)

    Battle, John

    Cummings, John

    Bayley, Hugh

    Cunningham, Jim (CoV'try S)

    Beard, Nigel

    Cunningham, Tony (Workington)

    Begg, Miss Anne

    Curtis-Thomas, Mrs Claire

    Benn, Hilary

    Davey, Valerie (Bristol W)

    Bennett, Andrew

    David, Wayne

    Benton, Joe

    Davidson, Ian

    Berry, Roger

    Davies, Geraint (Croydon C)

    Best, Harold

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

    Betts, Clive

    Blackman, Liz

    Dawson, Hilton

    Blair, Rt Hon Tony

    Dean, Mrs Janet

    Blears, Ms Hazel

    Denham, Rt Hon John

    Blizzard, Bob

    Dhanda, Parmjit

    Boateng, Rt Hon Paul

    Dismore, Andrew

    Bradley, Rt Hon Keith (Withington)

    Dobbin, Jim

    Brennan, Kevin

    Dobson, Rt Hon Frank

    Brown, Rt Hon Gordon (Dunfermline E)

    Donohoe, Brian H

    Dowd, Jim

    Brown, Russell (Dumfries)

    Drown, Ms Julia

    Bryant, Chris

    Dunwoody, Mrs Gwyneth

    Buck, Ms Karen

    Eagle, Angela (Wallasey)

    Burden, Richard

    Eagle, Maria (L'pool Garston)

    Burgon, Colin

    Edwards, Huw

    Caborn, Rt Hon Richard

    Efford, Clive

    Cairns, David

    Ellman, Mrs Louise

    Campbell, Alan (Tynemouth)

    Farrelly, Paul

    Campbell, Mrs Anne (C'bridge)

    Field, Rt Hon Frank (Birkenhead)

    Campbell, Ronnie (Blyth V)

    Fishier, Mark

    Caplin, Ivor

    Fitzpatrick, Jim

    Caton, Martin

    Fitzsimons, Mrs Lorna

    Cawsey, Ian

    Flint, Caroline

    Challen, Colin

    Follett, Barbara

    Chapman, Ben (Wirral S)

    Foster, Rt Hon Derek

    Clapham, Michael

    Foster, Michael (Worcester)

    Clark, Dr Lynda (Edinburgh Pentlands)

    Foster, Michael Jabez (Hastings)

    Foulkes, George

    Clarke, Rt Hon Charles (Norwich S)

    Francis, Dr Hywel

    Galloway, George

    Clarke, Rt Hon Tom (Coatbridge)

    Gapes, Mike

    Clarke, Tony (Northampton S)

    Gardiner, Barry

    Clelland, David

    George, Rt Hon Bruce (Walsall S)

    Clwyd, Ann

    Gerrard, Neil

    312

    Gilroy, Linda

    McDonagh, Siobhain

    Griffiths, Jane (Reading E)

    MacDonald, Calum

    Griffiths, Win (Bridgend)

    McDonnell, John

    Grogan, John

    MacDougall, John

    Hain, Rt Hon Peter

    McFall, John

    Hall, Patrick (Bedford)

    McGuire, Mrs Anne

    Hamilton, David (Midlothian)

    McIsaac, Shona

    Hanson, David

    McKechin, Ann

    Harris, Tom (Glasgow Cathcart)

    McKenna, Rosemary

    Henderson, Doug (Newcastle N)

    Mackinlay, Andrew

    Henderson, Ivan (Harwich)

    McNulty, Tony

    Hepburn, Stephen

    MacShane, Denis

    Heppell, John

    McWalter, Tony

    Hesford, Stephen

    McWilliam, John

    Heyes, David

    Mahmood, Khalid

    Hill, Keith

    Mahon, Mrs Alice

    Hodge, Margaret

    Mallaber, Judy

    Hood, Jimmy

    Mann, John

    Hoon, Rt Hon Geoffrey

    Marris, Rob

    Hope, Phil

    Marsden, Gordon (Blackpool S)

    Hopkins, Kelvin

    Marshall, David (Shettleston)

    Howarth, Rt Hon Alan (Newport E)

    Marshall, Jim (Leicester S)

    Howarth, George (Knowsley N)

    Marshall-Andrews, Robert

    Hoyle, Lindsay

    Martlew, Eric

    Hughes, Beverley (Stretford)

    Merron, Gillian

    Hughes, Kevin (Doncaster N)

    Milburn, Rt Hon Alan

    Humble, Mrs Joan

    Miller, Andrew

    Hutton, Rt Hon John

    Mitchell, Austin (Gt Grimsby)

    Iddon, Dr Brian

    Moffatt, Laura

    Illsley, Eric

    Mole, Chris

    Ingram, Rt Hon Adam

    Morgan, Julie

    Irranca-Davies, Huw

    Mountford, Kali

    Jackson, Glenda (Hampstead)

    Mudie, George

    Jackson, Helen (Hillsborough)

    Mullin, Chris

    Jamieson, David

    Munn, Ms Meg

    Jenkins, Brian

    Murphy, Denis (Wansbeck)

    Johnson, Alan (Hull W & Hessle)

    Murphy, Jim (Eastwood)

    Jones, Helen (Warrington N)

    Murphy, Rt Hon Paul (Torfaen)

    Jones, Jon Owen (Cardiff C)

    Naysmith, Dr Doug

    Jones, Kevan (N Durham)

    Norris, Dan

    Jones, Lynne (Selly Oak)

    O'Brien, Bill (Normanton)

    Jones, Martyn (Clwyd S)

    O'Brien, Mike (N Warks)

    Joyce, Eric

    Olner, Bill

    Kaufman, Rt Hon Gerald

    O'Neill, Martin

    Keeble, Ms Sally

    Organ, Diana

    Keen, Alan (Feltham & Heston)

    Osborne, Sandra (Ayr)

    Keen, Ann (Brentford & Isleworth)

    Palmer, Dr Nick

    Kelly, Ruth

    Pearson, Ian

    Kemp, Fraser

    Perham, Linda

    Khabra, Piara S

    Picking, Anne

    Kidney, David

    Pickthall, Colin

    Kilfoyle, Peter

    Pike, Peter

    King, Andy (Rugby & Kenilworth)

    Plaskitt, James

    King, Ms Oona (Bethnal Green)

    Pollard, Kerry

    Knight, Jim (S Dorset)

    Pope, Greg

    Kumar, Dr Ashok

    Pound, Stephen

    Lammy, David

    Prescott, Rt Hon John

    Lawrence, Mrs Jackie

    Primarolo, Dawn

    Laxton, Bob

    Prosser, Gwyn

    Lazarowicz, Mark

    Purchase, Ken

    Lepper, David

    Purnell, James

    Leslie, Christopher

    Quin, Rt Hon Joyce

    Levitt, Tom

    Quinn, Lawrie

    Lewis, Ivan (Bury S)

    Rammell, Bill

    Lewis, Terry (Worsley)

    Rapson, Syd

    Liddell, Rt Hon Mrs Helen

    Raynsford, Rt Hon Nick

    Linton, Martin

    Reed, Andy (Loughborough)

    Lloyd, Tony

    Robertson, John (Glasgow Anniesland)

    Love, Andrew

    Lucas, Ian

    Robinson, Geoffrey (Cov'try NW)

    Luke, Iain

    Roche, Mrs Barbara

    Lyons, John

    Rooney, Terry

    McAvoy, Thomas

    Ross, Ernie

    McCabe, Stephen

    Roy, Frank

    McCafferty, Chris

    Ruane, Chris

    McCartney, Rt Hon Ian

    Ruddock, Joan

    313

    Russell, Ms Christine (Chester)

    Thomas, Gareth R (Harrow W)

    Ryan, Joan

    Timms, Stephen

    Sarwar, Mohammad

    Tipping, Paddy

    Savidge, Malcolm

    Todd, Mark

    Sawford, Phil

    Touhig, Don

    Sedgemore, Brian

    Trickett, Jon

    Shaw, Jonathan

    Truswell, Paul

    Sheerman, Barry

    Turner, Dennis (Wolverh'ton SE)

    Sheridan, Jim

    Turner, Neil (Wigan)

    Shipley, Ms Debra

    Twigg, Derek (Halton)

    Simon, Siôn

    Twigg, Stephen (Enfield)

    Simpson, Alan (Nottingham S)

    Walley, Ms Joan

    Singh, Marsha

    Ward, Ms Claire

    Skinner, Dennis

    Wareing, Robert N

    Smith, Rt Hon Andrew (Oxford E)

    Watson, Tom

    Smith, Angela (Basildon)

    Watts, David

    Smith, Geraldine (Morecambe)

    White, Brian

    Smith, Jacqui (Redditch)

    Whitehead, Dr Alan

    Smith, John (Glamorgan)

    Williams, Rt Hon Alan (Swansea W)

    Smith, Llew (Blaenau Gwent)

    Southworth, Helen

    Williams, Mrs Betty (Conwy)

    Squire, Rachel

    Wills, Michael

    Starkey, Dr Phyllis

    Winnick, David

    Steinberg, Gerry

    Wood, Mike

    Stevenson, George

    Woodward, Shaun

    Stewart, David (Inverness E)

    Wray, James

    Stewart, Ian (Eccles)

    Wright, Anthony D (Gt Yarmouth)

    Stinchcombe, Paul

    Wright, David (Teltord)

    Stoate, Dr Howard

    Wright, Tony (Cannock)

    Strang, Rt Hon Dr Gavin

    Wyatt, Derek

    Sutcliffe, Gerry

    Tami, Mark

    Tellers for the Ayes:

    Taylor, David (NW Leics)

    Mr. Graham Stringer and

    Thomas, Gareth (Clwyd W)

    Mr. Phil Woolas.

    NOES

    Ainsworth, Peter (E Surrey)

    (Rushclifte)

    Allan, Richard

    Clifton-Brown, Geoffrey

    Amess, David

    Collins, Tim

    Ancram, Rt Hon Michael

    Conway, Derek

    Arbuthnot, Rt Hon James

    Cormack, Sir Patrick

    Atkinson, David (Bour'mth E)

    Cotter, Brian

    Atkinson, Peter (Hexham)

    Cran, James

    Bacon, Richard

    Curry, Rt Hon David

    Baker, Norman

    Davey, Edward (Kingston)

    Baldry, Tony

    Davies, Quentin (Grantham)

    Baron, John

    Davis, Rt Hon David (Haltemprice)

    Barrett, John

    Djanogly, Jonathan

    Beggs, Roy

    Dodds, Nigel

    Beith, Rt Hon A J

    Dorrell, Rt Hon Stephen

    Bellingham, Henry

    Doughty, Sue

    Bercow, John

    Duncan, Alan (Rutland & Melton)

    Boswell, Tim

    Duncan, Peter (Galloway)

    Bottomley, Peter (Worthing W)

    Duncan Smith, Rt Hon Iain

    Bottomley, Rt Hon Virginia

    Evans, Nigel

    Brady, Graham

    Fabricant, Michael

    Brazier, Julian

    Fallon, Michael

    Breed, Colin

    Field, Mark (Cities of London)

    Brooke, Mrs Annette L

    Flight, Howard

    Browning, Mrs Angela

    Flook, Adrian

    Bruce, Malcolm

    Forth, Rt Hon Eric

    Burnett, John

    Foster, Don (Bath)

    Burns, Simon

    Fox, Dr Liam

    Burstow, Paul

    Francois, Mark

    Butterfill, John

    Gale, Roger

    Cable, Dr Vincent

    Garnier, Edward

    Calton, Mrs Patsy

    George, Andrew (St Ives)

    Cameron, David

    Gillan, Mrs Cheryl

    Campbell, Rt Hon Menzies

    Gray, James

    (NE Fife)

    Grayling, Chris

    Carmichael, Alistair

    Green, Damian (Ashford)

    Cash, William

    Green, Matthew (Ludlow)

    Chidgey, David

    Grieve, Dominic

    Chope, Christopher

    Gummer, Rt Hon John

    Clappison, James

    Hammond, Philip

    Clarke, Rt Hon Kenneth

    Harris, Dr Evan (Oxford W)

    314

    Harvey, Nick

    Rendel, David

    Hawkins, Nick

    Robathan, Andrew

    Hayes, John

    Robertson, Laurence (Tewk'b'ry)

    Heald, Oliver

    Robinson, Peter (Belfast E)

    Hermon, Lady

    Roe, Mrs Marion

    Hoban, Mark

    Ruffley, David

    Holmes, Paul

    Russell, Bob (Colchester)

    Horam, John

    Sanders, Adrian

    Howard, Rt Hon Michael

    Sayeed, Jonathan

    Howarth, Gerald (Aldershot)

    Selous, Andrew

    Hughes, Simon (Southwark N)

    Shephard, Rt Hon Mrs Gillian

    Hunter, Andrew

    Simpson, Keith (Mid-Norfolk)

    Jack, Rt Hon Michael

    Smith, Sir Robert (WAb'd'ns)

    Jackson, Robert (Wantage)

    Smyth, Rev Martin (Belfast S)

    Jones, Nigel (Cheltenham)

    Soames, Nicholas

    Keetch, Paul

    Spelman, Mrs Caroline

    Kennedy, Rt Hon Charles

    Spicer, Sir Michael

    (Ross Skye & Inverness W)

    Spink, Bob

    Key, Robert

    Spring, Richard

    Knight, Rt Hon Greg (E Yorkshire)

    Stanley, Rt Hon Sir John

    Laing, Mrs Eleanor

    Steen, Anthony

    Lait, Mrs Jacqui

    Streeter, Gary

    Lamb, Norman

    Stunell, Andrew

    Lansley, Andrew

    Swayne, Desmond

    Laws, David

    Swire, Hugo

    Leigh, Edward

    Syms, Robert

    Letwin, Oliver

    Tapsell, Sir Peter

    Lewis, Dr Julian (New Forest E)

    Taylor, I an (Esher & Walton)

    Liddell-Grainger, Ian

    Taylor, John (Solihull)

    Lidington, David

    Taylor, Matthew (Truro)

    Llwyd, Elfyn

    Taylor, Dr Richard (Wyre F)

    Loughton, Tim

    Taylor, Sir Teddy

    Luff, Peter

    Thomas, Simon (Ceredigion)

    McIntosh, Miss Anne

    Thurso, John

    Maclean, Rt Hon David

    Tonge, Dr Jenny

    McLoughlin, Patrick

    Tredinnick, David

    Maples, John

    Trend, Michael

    Marsden, Paul (Shrewsbury)

    Turner, Andrew (Isle of Wight)

    Mates, Michael

    Tyler, Paul

    Maude, Rt Hon Francis

    Tyrie, Andrew

    Mawhinney, Rt Hon Sir Brian

    Viggers, Peter

    May, Mrs Theresa

    Walter, Robert

    Mitchell, Andrew (Sutton Coldfield)

    Waterson, Nigel

    Moore, Michael

    Watkinson, Angela

    Moss, Malcolm

    Webb, Steve

    Murrison, Dr Andrew

    Whittingdale, John

    Oaten, Mark

    Wiggin, Bill

    öpik, Lembit

    Willetts, David

    Osborne, George (Tatton)

    Williams, Hywel (Caernarfon)

    Ottaway, Richard

    Williams, Roger (Brecon)

    Page, Richard

    Willis, Phil

    Paice, James

    Winterton, Mrs Ann (Congleton)

    Paterson, Owen

    Winterton, Nicholas (Macclesfield)

    Pickles, Eric

    Yeo, Tim

    Price, Adam

    Young, Rt Hon Sir George

    Prisk, Mark

    Younger-Ross, Richard

    Pugh, Dr John

    Randall, John

    Tellers for the Noes:

    Redwood, Rt Hon John

    Mr. Charles Hendry and

    Reid, Alan (Argyll & Bute)

    Mr. David Wilshire.

    Question accordingly agreed to.
    Lords amendment disagreed to.
    Lords amendment No. 4 disagreed to.

    Clause 1

      ENGLISH HEALTH AUTHORITIES: CHANGE OF NAME
      Lords amendment: No. 1.
      Mr. Hutton: I beg to move, That this House agrees with the Lords in the said amendment.
      Madam Deputy Speaker (Sylvia Heal): With this we may discuss Lords amendment No. 3.
      Mr. Hutton: Members will recall that on Report I tried to deal with the concerns of those on both sides of the

      315
      House by tabling an amendment seeking to provide for consultation before name changes, boundary changes and mergers of strategic health authorities could take place.
      I am very grateful to Baroness Thomas of Walliswood for helpfully recommending in Committee in another place on 14 March that the Government could usefully reconsider the wording proposed for the new section 8(5) of the National Health Service Act 1977 Act contained in clause 1 of the Bill. My noble Friend Lord Hunt of Kings Heath promised at the time to look at the wording again, and I am pleased to say that on reflection we were able to bring a revised and shortened version of subsection (5) before their Lordships.
      The wording as now drafted follows the precedent set for NHS trusts in section 5(2) of the National Health Service and Community Care Act 1990, as substituted by the Health Authorities Act 1995. The term "prescribed" is defined in section 128 of the 1977 Act as meaning prescribed in regulations made by my right hon. Friend the Secretary of State.
      Let me make it clear that the previous version was not wrong. It would have achieved exactly the same in policy terms as this amendment. However, as we considered the issue further during the passage of the Bill, it became clear that what we wanted to do could be drafted more simply. We accordingly took the opportunity of making what I hope will be regarded on both sides as an improvement to the Bill. However, it does not change the substance.
      Amendment No. 3 tidies up a minor drafting error in a definition in clause 5 to make it clear that for the purposes of this section
      "a section 28C dental practitioner"
      means a dentist who performs personal dental services in the area of the primary care trust. The amendment simply ensures that the wording in clause 5 is exactly the same for medical and dental practitioners. I am afraid that the words
      "in the area of the Primary Care Trust"
      had been mistakenly omitted from the earlier draft of the Bill.
      Mr. Oliver Heald: Let me start by saying as I did on a previous occasion that it is welcome that the Minister has accepted that there should be consultation on the orders about the establishment, variation, the name or the abolition of a strategic health authority. In supporting our amendment on Report, some Labour Members, including the hon. Member for Leigh (Andy Burnham) said that it was necessary to have proper consultation.
      We had a concern, however, about the wording, if the Minister should make such regulations as provided for in the previous amendment that the Minister put forward on Report. Earl Howe, speaking for the Opposition in the other place, made that point. It is good that the Government have responded to the points that we made in Committee and on Report and have come up with what is, without doubt, a neater form of wording. I entirely agree with the Minister that amendment No. 3 is purely technical. We welcome these amendments.
      Lords amendment agreed to.
      Lords amendment No. 3 agreed to.

    Clause 14

      COMMISSION FOR HEALTH IMPROVEMENT: CONSTITUTION
      Lords amendment: No. 5.
      The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears): I beg to move, That the House agrees with the Lords in the said amendment.
      Madam Deputy Speaker: With this we may take Lords amendment No. 30.
      Ms Blears: Amendments Nos. 5 and 30 enable the Secretary of State for Health to delegate the appointment of the chair and members of the Commission for Health Improvement and the Commission for Patient and Public Involvement in Health to the NHS Appointments Commission. Indeed, we go further than this, demonstrating that we are committed to the independence of these bodies and distancing the appointments process from the Secretary of State.
      The amendments enable the Secretary of State to delegate to the NHS Appointments Commission such of his functions as may be appropriate in relation to the tenure of office, terms of appointment, dismissal, and so on, of the chair and members. The details of how such arrangements with the Appointments Commission might work in practice are subject to negotiation with Sir William Wells and his team.
      As I have said, similar arrangements have been made for the appointment of the chair and members of the Commission for Health Improvement—
      It being one hour after the commencement of proceedings on consideration of Lords Amendments, MADAM DEPUTY SPEAKER, pursuant to Order [this day], put forthwith the Question already proposed from the Chair.
      Lords amendment agreed to.
      MADAM DEPUTY SPEAKER then proceeded to put forthwith the Questions necessary for the disposal of the business to be concluded at that hour.
      Lords amendments Nos. 17 to 30 agreed to.

      New Clause
      Lords amendment: No. 6, before clause 16, to insert the following new clause—Establishment of Patients' Councils.
      4.45 pm
      Ms Blears: I beg to move, That this House disagrees with the Lords in the said amendment.
      Madam Deputy Speaker: With this it will be convenient to take Lords amendments Nos. 7 to 16 and the Government motions to disagree thereto, and Government amendments (a) to (d), (o) to (q), (e) to (1), (r), (m) and (n) in lieu.
      Ms Blears: I should like to express my sincere apologies to all hon. Members for the late tabling of some of these amendments, as that lateness may have caused hon. Members some concern. I have certainly done my best, by issuing covering memorandums and by writing directly to Opposition Members, to try to set out not just

      317
      the terms of the amendments, but their effect so as to try to minimise any awkwardness that may have been caused. The amendments have been tabled in a genuine attempt to try to engage the widest possible range of stakeholders in producing a proposal that I can put before the House this afternoon. I should like to express my genuine apologies for any difficulty that the amendments' late tabling may have caused.
      At last we are coming to the end of a rather tortuous journey to strengthen patient and public involvement in health. From the NHS plan, published in July 2000, to the Health and Social Care Act 2001, and now in the Bill, we have reached a position on patient and public involvement that is as good as it gets. I genuinely believe that we will have a robust, independent and vigorous system of public and patient involvement. I and my ministerial colleagues, as well as previous Ministers—and our officials, too—have been in discussion with many stakeholders during the last year and a half to ensure that we develop the best possible set of arrangements.
      The points made during parliamentary scrutiny and arising from the involvement of stakeholders have been extremely constructive. Although we have not agreed with all of the views expressed, it is fair to say that they have all played their part in helping to fine-tune the system. Patients councils were one of the turning points in our preparations.
      The amendments to provide for patients councils that the other place voted to include in the Bill are not welcomed by the Government, as patients councils are, in our view, flawed organisations for reasons we have rehearsed in the House and in the other place. One of the primary reasons why they are not welcome is that they would involve the introduction of 150 new bodies, adding an entirely new layer to the system of public and patient involvement.
      The other fundamental reason why we oppose introducing patients councils is that they would involve a system in which a body purports to speak on behalf of the public. That is fundamentally opposed to the whole system that we have tried to establish, which enables the public to speak for themselves. That is a key difference in the kind of facilities that we want to put in place.
      Dr. Evan Harris: I am still recovering from the last few sentences, but I want to ask the Minister whether she has worked out how many enhanced PCT patients forums her proposals will produce? Will not there be twice as many as there would be patients councils based on overview and scrutiny committee areas? Although the proposed forums will be in addition to PCT patients forums, does she accept the argument that increasing PCT patients forums is at least as bureaucratic and will result in smaller organisations than introducing a more limited number of larger, local authority patients councils, based on overview and scrutiny committees, or something of that sort?
      Ms Blears: I understand the point that the hon. Gentleman seeks to make, but I do not accept it. We propose to enhance existing organisations, whereas patients councils would introduce a whole new layer of separate organisations in the system. I am keen to ensure
      318
      that we do not recreate a hierarchy of organisations that operate with increasing exclusivity and in which people see themselves as delegates of other people. The whole thrust of the patient and public involvement mechanisms is to enable people to express their own views and for them to have support in doing so, rather than having a delegate system whereby other people purport to speak for them. Hon. Members may have difficulty with that distinction—it may be complex—but it is crucial to the new approach in the new national health service that we have a system that is not about an exclusive delegate democracy but about liberating local people so that they can speak for themselves.
      Mr. Heald: Which body will run "casualty watch"?
      Ms Blears: As I explain the full implications of the amendments, the hon. Gentleman will see that we propose—in amendment (r), I think—to introduce a new power, or rather a function—which could be a power or a duty—for the Commission for Patient and Public Involvement in Health to consider reports from patients forums and to assess emerging trends that may give rise to issues of national concern that should be taken up by patients forums generally. That would not be limited exclusively to "casualty watch". The forums might want to consider other issues that span the spectrum of their concerns; for example, they might want to undertake a review of a national service framework.
      Our proposals are stronger than those envisaged by the hon. Gentleman; they are not simply limited to "casualty watch". It might be perfectly legitimate for patients forums to look into accident and emergency waiting times. They could report to the commission to ensure that we had a national overview. They might be even more creative and look into other issues.
      Linda Perham: As regards the point made by the hon. Member for Oxford, West and Abingdon (Dr. Harris), will my hon. Friend explain why the proposals in respect of the duties of patients councils and the patients forums of the primary care trusts would not create a hierarchy of PCTs?
      Ms Blears: I am grateful to my hon. Friend for that question. She will be aware that I and my ministerial colleagues have expressed concern about the creation of a hierarchy of patients forums. I am keen to ensure that one forum is not seen as better than another. I want to try to ensure that the forums are able to attract local people of high calibre. I want patients forums for acute trusts and mental health trusts to be just as attractive as those for the PCTs. We want to ensure that the system is rooted in patients forums—that people see them as the driver in the system. There are genuine reasons for PCT patients forums to have a wider role, because PCTs do not merely provide primary care but also commission secondary services. Instead of seeing the system as a hierarchy—where one patients forum is better than another—I should prefer the PCT patients forums to be seen as having a broader remit. They should be seen not as reporting upwards in a hierarchy of organisations, but as having extended responsibilities.
      Dr. Harris: I realise that the hon. Lady wants to make progress, and I shall be welcoming her proposals for other

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      aspects of the measure, but this matter is important. One of the points that she made about patients councils is that she does not want people to feel that they are representing other people—or acting as delegates—and she wants people to feel free to speak out. I have not really understood that point. However, in order to create the super-patients forum—the PCT patients forum to which she referred—the amendments provide that at least one member of that forum should come from one of the other patients forums in the area. Does not that recreate what she considers a problem in the proposals for patients councils, although we would consider it a strength?
      Ms Blears: When I go through the amendments, I shall explain the extended membership of the PCT patients forums. That is not about people representing others—it is a way of making connections and ensuring that people can share their ideas, knowledge and experience. It may help the hon. Gentleman if I explain that I said that the system should not involve people speaking on behalf of other people because there will be complex issues on which the public will hold a range of views. I do not want one organisation to weigh up that range of views and to come down firmly on one side and to promote only that point of view. Where there is a diverse range of views on a complex health service issue in a community, we need to have mechanisms that allow all of those views to be expressed, to be ventilated and to be weighed by those who are making decisions. Firm decisions should not be set in stone at an early stage before all the relevant views have been expressed. I appreciate that these matters are complex but I do not think that it is beyond our understanding to develop new ways of working.
      We have said that much of the purpose of patients councils fits with our view of a strong and comprehensive public and patient involvement system. I think that the way forward is clear, and that is to try to ensure that the system that we have proposed builds on the strengths of patients councils but does not weaken the overall structure of embedding those powers in patients forums.
      I shall explain the effects of amendments (a) to (d), (o) to (q), (e) to (l) and (r). The overall effect of what we are doing is to give to PCT patients forums the functions that we previously envisaged for the local offices of the Commission for Patient and Public Involvement in Health. I genuinely think that that makes for a stronger local connection.
      The commission will appoint staff to support and work with every PCT forum in England. The staff of the forum will support the members of the PCT forum on a day-to-day basis. That will ensure that there is a robust process in place for the work priorities of the staff to be fully informed by the priorities of local people. There will be real accountability to those communities.
      It will be the job of the forum to promote the involvement of the local community in local decision-making processes. In particular, it will be its job to go out and find out the views of those disadvantaged and marginalised groups that traditionally have not had a say in shaping the development of health services.
      It will also be the job of the forum to promote the views of people in its area to local decision makers, and in particular to a local overview and scrutiny committee. I believe that this arrangement will root and ground the commission's staff in local neighbourhoods.
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      In addition—this is where we have picked up some of the key strengths of the patients councils concept—the staff of the PCT forums will be able both to provide and to commission independent advocacy support. During various stages of the Bill's consideration many Members have talked about incorporating the duty to represent the views of local people, and the provision of independent complaint and advocacy support would make sense. We genuinely picked up on that idea.
      It will also be the responsibility of PCT patients forums to act as a sort of one-stop shop for local people, by providing advice and information to them about how they can get involved locally, what consultations are taking place and how they can make a complaint. The forums will also be responsible locally for keeping an eye on the arrangements that other NHS bodies have in place to fulfil their duty to involve the public and to make arrangements to consult them about changes to services.
      We have amended the composition of PCT patients forums. They will now include members of local community groups that represent the views of the public on issues that affect their health. For example, if a local environmental group was concerned with a particular issue that could affect the health of local people, it would be welcome to be involved. It is important to note that we are trying to expand the remit not only of the NHS in terms of the service that clinicians and the NHS has traditionally provided, but to try to make key links with the wider determinants of health—the environment, jobs, education and safe streets. All those things significantly influence health.
      Dr. Harris: I stress that I welcome the fact that the Minister wants to include on one of these consultative bodies—which she wants to be PCT patients forums—people from other groups. However, she has just referred to them as representatives from other groups. I do not see a problem with that save that I wish they were to be democratically accountable. That is the only difference between us. However, she has talked earlier about rejecting the patients councils idea because she wants people to speak for themselves and not to feel that they are delegates of organisations. Has the hon. Lady sold the pass—I welcome it if she has—by recognising that it is reasonable for that representation to take place?
      Ms Blears: No, I have not sold the pass on this one. What I have said is that there are organisations and groups out there who will want to feed people's views into the patients forum who will then put those views forward to other people. That is a perfectly legitimate position to be in.
      By placing all these responsibilities with the PCT patients forum, we have shifted the power base of the new system for patient and public involvement to local communities. To do that, we will remove the middle layer of our original proposals: local offices of the national commission. We recognise, however, that there needs to be a way for forums to come together across an agreed area, which is a key concern raised by many Members. We have strengthened the provisions in the Bill to say that forums must work together in prescribed circumstances. Those circumstances will be set out in regulation, and I hope that that will meet the concerns of many Members about the integration.
      5 pm
      Helen Jones: I welcome what my hon. Friend is saying about the representation of community groups. Will she assure me, however, that the regulations will ensure that, in places such as Warrington, deprived areas get representation on these bodies, as well as the better-off areas? Will she assure me that there will not be a repeat of what we have seen in the Warrington PCT, on which my constituency has hardly any representatives?
      Ms Blears: My hon. Friend makes an extremely important point. She has made a significant contribution over recent weeks, expressing her concern about what has happened in her local PCT. For that reason, we propose that members of patients forums should be appointed by the Commission for Patient and Public Involvement in Health rather than by the Appointments Commission. We want to ensure not only that people respond to an advertisement but that we seek out people from communities who, traditionally, have not put themselves forward. That is easier said than done. In many cases, people will need encouragement, support, training, advice and back-up to come forward and feel that they can be part of the patients forum. That is a very different and much more proactive approach—not simply issuing an advertisement, waiting for people to apply and allowing a very self-selecting group to come forward to be part of our public involvement, but going out to deprived, marginalised, excluded communities that, traditionally, have not been part of running our services and making those decisions. My hon. Friend makes a key point about the way in which these mechanisms will operate differently in the future.
      We are also amending the provisions that apply to both primary care trust and NHS trust patients forums. We are making it explicit in the Bill that patients forums will not only have a role in monitoring and reviewing the services that a trust provides but that they will also be able to identify gaps in service provision and make reports and recommendations about those to trusts. Trusts will have to publish forum recommendations in their annual patients prospectus, together with the action that they will take as a result, further ensuring that forums have real influence.
      What was said to me, at many of the events that I attended with local people, was that all the structures in the world could be as perfect as we could make them, but unless there was real evidence that the decision makers in the health service took notice of what local people said and acted on it, they would quickly fall into disrepute, and rightly so. Therefore, making sure that a patients forum's recommendations are published in the prospectus and acted on by the trust will be a key mechanism in saying to local people, "It was worth while coming forward to get involved in your patients forum, because something has happened as a result of your activity. It was not simply a talking shop; action has been taken."
      Many local people have also said to me that, although they do not expect 100 per cent. of things to be changed, they do expect significant changes to take place.
      Mr. Burns: Was the Minister dismissing the valuable work done by community health councils by suggesting that they were just talking shops?
      Ms Blears: The hon. Gentleman knows well that, in various discussions of these matters, on Second Reading
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      and in Committee, I have put on record three, four, five or half a dozen times my tribute to many community health councils that have done an excellent job in representing people. The hon. Gentleman also knows—and many members of his party have agreed with me—that their performance has, in some cases, been patchy and inconsistent, and that people's ability to get involved has varied dramatically up and down the country. He knows fine well that the situation is more complex than he seeks to portray it, and that standards have varied dramatically.
      We have also made explicit the breadth of the powers for forums to be able to refer matters. Concerns have been expressed, but the forums will be able to refer matters not just to overview and scrutiny committees, as previous amendments to the Bill provided for, but to the commission and, indeed, to any other person or body that the forums deem appropriate. They will be able to make their representations and concerns public.
      We have transferred some of the functions envisaged for the Commission for Patient and Public Involvement in Health that would have been carried out by its local offices to the PCT patients forums. We have also strengthened the functions that the commission will carry out at a national level. On top of its job of setting and monitoring quality standards for all patients forums and providers of independent complaints advocacy, it will also be able to make recommendations to them about how they can improve their performance. The commission will have a performance management role, and that is key to ensuring consistency right across the country and high quality in the activities of complaints services and patients forums. We are dealing with the key issue of inconsistency.
      Laura Moffatt: Does my hon. Friend agree that the proposals are genuinely about going out and involving people in decision making in the NHS? As a nurse, I very much welcome the fact that people will be involved. Does she also agree that some of the opposition to the proposals is merely about maintaining a cosy and comfortable atmosphere for the NHS watchdog? Implementing the proposals will not be easy—no one ever said that it would be—but it must be worth trying to involve people who were not previously involved in the NHS.
      Ms Blears: I thank my hon. Friend for that contribution. She is right. Change and new ways of working are never easy. One of the most difficult things has been to try to get people to visualise what a new system might look like. When something exists, people can see, touch and feel it. It is hard to get people to understand something that is not yet in place. One of the problems is that people feel that the proposed system will be complex but, once the provisions are established, people will get used to working with them. They will see that that they are integrated at the right stages of the NHS. However, I do not pretend that the system will be revolutionised overnight; it is a matter of building on our proposals over the next few years.
      The right for the commission to have a performance management role will ensure that the public,, wherever they are, and the NHS can be assured of consistently high standards in the patients forums and from the providers of independent complaints and advocacy services.

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      We have listened to parliamentarians and to stakeholders and, in particular, to the Association of Community Health Councils for England and Wales and to community health councils, which were on our transition advisory board and helped us with transition to the new system. They have referred to the often-cited need for a "casualty watch" exercise. As I said earlier, rather than limiting the activities to "casualty watch" per se, the commission should have the right to undertake national reviews of patient experience data on issues that appear to it to be of national concern. That might include the waits in accident and emergency departments or a wider range of issues.
      Dr. Murrison: The Minister says that the Government have listened to interested bodies about the future of community health councils. However, I have a list of about 20 organisations that are very much against the abolition of the CHCs. The bodies that have written to voice their concerns include the Manic Depression Fellowship, Mencap, the National Association of Citizens Advice Bureaux and the National Council for Voluntary Organisations. I could go on. How much has she listened to outside organisations?
      Ms Blears: The hon. Gentleman will be aware from previous debates that all sides of the argument have prayed in aid other organisations to support their case. However, I draw his attention to the view of the Long-term Medical Conditions Alliance, which has 115 patients organisations in its membership. On 8 April, it wrote to Members of the other place when the Bill was being considered there and said:
      "The argument over Patients' Councils seemed to our members to be a political one; the proposals as currently set forth appear to be perfectly adequate".
      It consulted one of its groups that held an event in the local community and it reported that members were
      "alive with awareness about the possibilities offered by the new strategy, eager to participate, but prevented from doing so by what seem …to be esoteric arguments about detail".
      It went on to say:
      "We do not see the need for more committees, which we see as likely to lead to the strangling of genuine citizen involvement and the promotion of bureaucracy at the expense of the voice of individual users of the NHS."
      The hon. Gentleman is correct—there is a range of views on these issues—but the Long-term Medical Conditions Alliance expressed the view, on behalf of its members, that it wanted to be able to get on with the new issues at stake. We have listened, and I hope that the hon. Gentleman will accept that.
      Dr. Evan Harris: I accept the Minister's point that there are different views. However, she will be aware that in January this year the Long-term Medical Conditions Alliance welcomed the local network of the Commission for Patient and Public Involvement in Health, which she has just announced an interest in abolishing. It also welcomed the separation of advocacy services from commissioning, for which there is an argument, but from which she is announcing a retreat. She should accept that certain organisations, even those that were among her initial supporters, will not welcome her proposals.
      Ms Blears: The hon. Gentleman has been following the development of these issues closely and with great
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      interest, and he will be aware that a wide range of organisations welcomed the functions of the commission in taking a proactive role to draw in views from communities that traditionally have not been represented and in promoting the involvement of local people. Certainly, the Long-term Medical Conditions Alliance, together with a wide range of organisations, welcomes the functions of the commission. Those functions remain very much at the forefront of our proposals but will be exercised by the PCT patients forum, and thus in a way that is more connected to local communities. We are not doing away with the functions of the commission, but embedding and grounding them much more in local structures. I hope that the hon. Gentleman is reassured by that.
      James Purnell: Does the Minister agree that the real test of the system will be what patients and people who work in the NHS think of it once it is in place, which we shall not know for a while? Will she tell us the views of the Chairman of the Select Committee on Health, whom no hon. Member would accuse of being a stooge of the Government, about the reforms?
      Ms Blears: Certainly, I will. The Chairman of the Health Committee, my hon. Friend the Member for Wakefield (Mr. Hinchliffe), expressed concerns during our previous consideration of these matters. He said:
      "We are inches apart, but those inches are extremely important."—[Official Report, 15 January 2002; Vol. 378, c. 207.]
      Today, unfortunately, we are thousands of miles apart, because my hon. Friend is delayed in a long-arranged previous commitment in Russia. However, he was able to have a discussion with me before he went on his journey. I was keen to involve him in working up these new proposals, because he made some important points during previous debates.
      In a letter to me, my hon. Friend said:
      "Unfortunately, as you are aware I have a long standing commitment…I felt it might be helpful to outline my views on the amendments you are bringing forward."
      He continues:
      "You will recall that I raised specific concerns about the fragmentation of the separate Patients Forums and the inability to ensure an overview of the local health economy. I felt very strongly that a unifying structure of lay people at the level of local health economy should be written in the Bill."
      He goes on to say:
      "I therefore genuinely welcome the fact that your new amendment"
      the one that I referred to—
      "places on the face of the Bill the requirement that all Patients Forums in an area should come together regularly to share ideas, views and experiences."
      We are now providing that patients forums must, in prescribed circumstances, co-operate in jointly exercising their functions, which will give us that overview. He continues:
      "Obviously, I have not had the opportunity to consider fully the implications of your amendments, but I am satisfied that you have moved very significantly in the direction I and others felt necessary."
      I am extremely grateful to my hon. Friend for setting out those concerns, because I have been keen to try to maximise the degree of consensus that we can achieve.

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      5.15 pm
      To summarise, every NHS trust and PCT will have a patient advocacy and liaison service, ensuring that concerns are dealt with before they become a serious problem, and a patients forum, ensuring that the local public have a vehicle to express their views about matters relating to health. The forum will also monitor and review services. Every PCT patients forum will have staff to commission or provide independent support to help individuals make a complaint.
      Mr. Paul Truswell: Leeds has one community health council. Under the new structure, we will have seven patients forums, which will be responsible for undertaking the vast range of crucial functions that my hon. Friend sets out. Will they receive a commensurate increase in staff and support from the commission?
      Ms Blears: My hon. Friend is right to raise the issue of resources, which has been mentioned in all my meetings with local people. I have acknowledged and put on the record that the new system will be more expensive and will need to receive greater resources. Public consultation does not come cheap. If we are serious about involving patients, the public and the community in shaping health services, then we have to do it properly. It cannot be a superficial sham.
      There are bids for additional resources to enable us to have a rigorous, strong and independent system. I need to ensure that all the elements are properly resourced so that we do not involve patients and the public without providing the necessary back-up and support that they need to make the system work. We should be open and honest about that. Real involvement requires hard work by all organisations, including the NHS, and we need to ensure that the system works.
      Mr. Patrick Hall: Broadly speaking, the Government amendments are welcome. Will the new system allow agreement to take place at a local level to allow a PCT patients forum to act as the lead on behalf of other PCT patients forums in a geographical area, such as Bedfordshire or Leeds, which my hon. Friend the Member for Pudsey (Mr. Truswell) mentioned? That would avoid the expensive duplication which would defeat the object of the new system.
      Ms Blears: My hon. Friend has made several welcome and thoughtful contributions on such matters before, and I know that he is conscious of the detail. Many lead arrangements are in place for PCTs to commission services, so the idea of having lead organisations is already well established within the NHS. I would not want to do anything to provide a rigid blueprint framework to determine how people must operate. For patient involvement to work well, people have to agree on the system and feel as though they own it at a local level. I want the proposed regulations that will set out guidance for organisations to be flexible enough to accommodate the arrangement that my hon. Friend outlines.
      My hon. Friend is probably aware that a number of pilot patient forums exist which are beginning to test out some of the new models. One such model in Tyneside has brought together the various elements in the system. They are sharing resources because they obviously get better
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      value by bringing some activities together. However, that has to be based on local agreement. We do not want to impose a framework from the centre. What we are trying to achieve is in tune with shifting the balance of power. We will set the framework, but it is up to local people how they want to operate it. It is for them to decide how they get maximum input in driving up the standards of local health services. My hon. Friend makes an important point.
      Every PCT forum will have staff who will commission or provide independent support to help individuals make a complaint. They will work to empower the local population to express their views about health issues, and will provide the one-stop shop service by giving advice and information about public involvement, the complaints process and how people can participate.
      Dr. Murrison: Will the Minister give way?
      Ms Blears: I will just make a little progress.
      Nationally, the Commission for Patient and Public Involvement in Health will set quality standards for the work of patients forums and the independent complaints and advocacy service. It will also performance manage them in relation to those standards. The commission will submit reports to the Secretary of State on how the whole public and patient involvement system is working and advise him about it. It will make reports as it sees fit to other national bodies such as Commission for Health Improvement, the National Care Standards Commission and the National Patient Safety Agency on issues that in its opinion give rise to concern about the safety or welfare of patients, and that have not been or are not being dealt with properly. It will review patient data in patients forums' annual reports and follow that up with reports as appropriate to the Secretary of State and others.
      The overall effect of the changes that we are making today is to make the system simpler to understand, less bureaucratic and consequently more effective. As a result, it will be easier for patients and the public to navigate themselves around the system, and easier for them to get involved. We must not forget that what underpins all our patient and public involvement provisions is empowerment. All patients have the right to have their concerns addressed and to be properly supported in making complaints. All patients and all members of the public have the right to be supported in expressing their views about health issues, to be listened to and to have their views acted upon.
      That will be undermined by adopting patients councils. Councils and what goes with them would have the effect of perpetuating what we most want to change about the existing system—the idea of an organisation that only represents the interests of patients and the public, without encouraging the wider population to get involved; an organisation that consequently has to take a decision about the relative importance of the many and varied views of members of the local population; in other words, an organisation that decides for people what is in their best interests.
      I genuinely believe that local people can make those decisions, provided they are given support. The changes that we propose will, with the original provisions, create a system that is truly accessible to everyone, that is radical and far-reaching, and that will make a positive difference to the services the NHS provides and to patients' and the public's experience of the NHS.
      Mr. Burns: The purpose of the debate is to enable the Government to persuade the House to disagree with the amendments made in another place that put patients councils on the face of the Bill, in defiance of the Government's wishes. A debate on this subject without the hon. Member for Wakefield (Mr. Hinchliffe)—the father of the amendments, which were rejected by this House—being present seems rather like a production of "Hamlet" without the gravediggers. It is extraordinary that the poor man has been banished to Siberia because of the debate. I suspect that the Government Whips Office had known for some time about the hon. Gentleman's diary engagements when—conveniently, from the Government's point of view—the debate was scheduled for a day on which he was many thousands of miles away. The Minister shakes her head, but if she consults her Whips Office, she might find that there is far more truth in what I have just said than she believes.
      The Minister alluded to the long history of this subject, and we have trodden a long road to get to where we are today. The proposals emanate from a desire, expressed in the Health and Social Care Act 2001, to abolish community health councils. When that legislation was passing through Parliament, the Conservatives said that that decision was wrong and not in the interests of patients, local communities or the NHS. CHCs were clearly defined, easily understood and well recognised by local communities. They were transparent, independent and able to consider and ask the awkward questions, as both Conservative and Labour Governments discovered.
      Mr. Tom Harris: The Conservative party has been curiously reticent about revealing any details of its health policy. Can we now assume that the reinstatement of community health councils will be a centrepiece of its health policy if and when it ever gets round to telling us what it is?
      Mr. Burns: The hon. Gentleman rightly said that, in health as in other areas, we are in the middle of a review, which any Opposition party is perfectly entitled to undertake. Indeed, the hon. Gentleman's party undertook them on at least four occasions between 1979 and 1997. In due course, I shall give him my view of the abolition of CHCs and the way forward, but he must be patient.
      As I was saying, CHCs were a one-stop shop that performed a vital and valuable service for the local community in dealing with patients' problems and general health provision. They also made controversial decisions about the provision of health care, whether closing down a ward in a hospital or the hospital itself, as they had a power of veto and could formally object to the Secretary of State; Ministers could then look at decisions that CHCs considered were not in the public interest. Many people say that some CHCs did not work as well as others and that the provision of the service was patchy. If a system provides an invaluable service in principle, but has certain flaws, those flaws should be identified so that improvements can be made; we should strengthen the system, rather than destroying it altogether. The Minister was a distinguished chair of Salford CHC in the 1990s and I suspect that she was fully supportive of the role of CHCs and thought that they did a tremendous job in looking after the interests of the local community and individuals. I wonder how many of the Government
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      proposals that we are considering today are motivated by a desire to remove a thorn in their side: they do not like criticism, especially if it comes from an independent source and gains credence among members of the public. The Government motion and amendments are a mistake. Personally, I would have preferred a strengthening and improvement of the CHC system to deal with perceived weaknesses, rather than the wholesale removal and replacement of the system.
      The initial replacement was to my mind—and presumably to the Government's, as they have now backtracked dramatically—a ridiculous miasma of proposals, which included things like patient advocacy and liaison services and other bodies. The system would have been fragmented, and there was little confidence that it would be independent. To be fair to the Government, they have bowed to sustained criticism of their proposals and have taken a different direction.
      Laura Moffatt: The hon. Gentleman and his party often talk about reform and how crucial it is to the NHS. Yet, in one of the most important parts of the NHS—the watchdog organisation—they propose little or no reform. How then can the hon. Gentleman pretend that his party's view reflects that of the general public?
      5.30 pm
      Mr. Burns: I know that the hon. Lady was trying desperately in her earlier intervention to impress her Whip; of course, this is the season of the run-up to reshuffles. Unfortunately, she has not been listening. I said that my preferred choice was to pick up the weaknesses in the CHC system and legislate to improve, enhance and strengthen it to make it more effective where perceived weaknesses existed, instead of abolishing it wholesale. As the hon. Lady will notice if she reads tomorrow's Hansard, that is the view that I expressed. I am afraid that her intervention bore little relation to what I was saying.
      Let me return to the point that I was making before I ill-advisedly gave way. The Government have had to alter their position on the patients forums proposals in tabling their amendments. The battle on CHCs is over and they are not going to change their mind about them. Another place decided on the patients council option instead of seeking to restore the community health councils. As a realist, I accept that we must now move forward because of those actions. As the hon. Member for Wakefield made clear in speaking to his amendments in this place and in expressing his views in the Select Committee on Health and other arenas, the patients councils are for a number of reasons preferable to the Government's broad proposal.
      Patients councils not only offer a range of features that were present in community health councils, but represent a move forward in terms of adjusting to some of the concerns that have been expressed. I believe for a number of reasons that they are more attractive than what the Government are offering, as they are an attempt to oversee the health service from the perspective of the patients and to consider a wider spectrum of activity than would a body based solely on specific trusts.
      I accept that we will move away from some of those areas as a result of the Government's amendments, but I believe that patients councils will be able to monitor the

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      complete patient journey between trusts. They can also play an advocacy role over a sustained period. In relation to Alder Hey, patients benefited from the work of CHCs in that regard. Campaigning work such as "casualty watch" and other work that is still done by community health councils would be within the remit of patients councils, which could continue working in line with developments in the past 27 years by acting as a watchdog and advocate for patients.
      It is also important to consider that patients councils would not be working in isolation within their trusts and that there would be greater interrelation between the trusts and on the progress of patient issues. The restoration of the one-stop shop and the removal of the maze brought into the system by the patients forums are also important, as the patients councils would be more easily understood by patients and members of the public in local communities. That is a preferable way forward.
      Regardless of what the Minister says and of some of the amendments that have been tabled, the Government are proposing to introduce complex organisational bodies. In the early days, they will also be seen to be complex by patients and local communities. Whether that perception will disappear if they survive the legislation remains to be seen. With patients councils, as with CHCs, people would have a greater understanding of where they needed to go if they had individual health problems or problems with the provision of service in their area. The councils would, however, have to be properly financed.
      The Government's statistics show that the funding of CHCs costs between £20 million and £30 million. I understand from the projections relating to the Government's proposals that the funding of the patients forum system will be considerably more—given their complexity and the sheer numbers involved—than the funding required for CHCs. I listened with interest when the Minister said earlier that she was determined that the forums would be properly resourced to ensure their success. That commitment is a slightly diluted version of one that would ensure proper funding to provide the resources necessary to operate effectively. I should be grateful if the Minister would return to the question of funding and give the House an assurance on that issue.
      Mrs. Gwyneth Dunwoody: Is the hon. Gentleman suggesting that, unlike other members of his party, he would be happy to see an expansion in the amount of money available for the NHS budget and for this particular service? If so, it is a welcome conversion.
      Mr. Burns: I am grateful to the formidable hon. Lady. I will be cautious in crossing swords with her; I do not wish to make the mistake made by many of her own Ministers.
      What I meant was that, in the context of CHCs versus patients forums, it is extraordinary that, in making a commitment fully to fund the forums, the Government are prepared to spend so much extra money when we already have a system in place that works.
      Mrs. Dunwoody: More money?
      Mr. Burns: If the hon. Lady will wait, I will tell her that I do not criticise extra money for the health service.
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      What concerns me about the extra money that has been made available is that there are no systems in place to ensure that it will achieve what it is meant to achieve—the improved, enhanced provision of health care. It worries me that, if we do not have structures in the health service to ensure that we get value for money and enhanced patient care, that money will be frittered away and the patients of this country will become even more disillusioned and discontented.
      Mrs. Joan Humble: Will the hon. Gentleman give way?
      Mr. Burns: No, I will not.
      So that we do not continue to talk about money, which is slightly off the subject, I shall conclude by saying that the Government's proposals are ham-fisted, and that they will not work as the Minister suggests. The proposal for reformed and improved CHCs was the best way forward, but that is not to be. The proposals of the hon. Member for Wakefield for patients councils that were incorporated into the Bill in another place represent the better way forward. I question the motives behind the Government's proposals, because they are a way of trying to stifle any criticism and proper inquiry into problems in the health service in local communities. For that reason, I ask my right hon. and hon. Friends to join me in opposing the Government's proposals to reverse the decisions made in another place.
      Linda Perham: I speak as secretary of the all-party group on community health councils, as someone who has been a CHC member for four years, and as one of the 26 Members who voted on 15 January for the amendment on patients councils tabled by my hon. Friend the Member for Wakefield (Mr. Hinchliffe). As hon. Members know, this debate is taking place on a day when my hon. Friend has a long-standing commitment, of his choice, abroad.
      Mr. Burns: Of his choice?
      Linda Perham: Yes.
      Mr. Burns: Has the hon. Lady spoken to the Whips Office?
      Linda Perham: The hon. Gentleman may go in for conspiracy theories: indeed, everyone in this place is more willing to believe in a conspiracy than in the true version of events.
      Mr. Burns: Has the hon. Lady discussed this matter with the hon. Member for Wakefield? If not, I recommend that she does so.
      Linda Perham: I have had many discussions with my hon. Friend, and I am coming to those.
      Mr. Burns: On this matter?
      Linda Perham: I intend to continue with my speech.
      My hon. Friend's contribution on these matters will be missed by many inside and outside the House. The Minister and others have acknowledged that my hon. Friend has done more than anyone else to draw attention

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      to the shortcomings, if I may use that word, of the Government's original proposals for patient and public involvement in the health service. In consultation with the Association of Community Health Councils for England and Wales, my hon. Friend has made constructive suggestions for a way forward.
      I spoke to my hon. Friend at length on Monday night before he left the country, as well as to the Minister. As Members have heard from the Minister, my hon. Friend has written to her welcoming the amendment to include in the Bill the requirement that all patients forums in an area should come together regularly to share ideas, views and experiences. Members will recall that, in his speech on 15 January, my hon. Friend asked for
      "a unifying structure of lay people at the level of the local health economy, offering an overview of that economy".—[Official Report, 15 January 2002: Vol. 378, c. 208.]
      Because that provision was lacking in the Bill, my hon. Friend tabled and voted for an amendment, which was also supported by myself and 24 colleagues.
      I know that my hon. Friend has been grateful to the Minister for her co-operation in seeking to resolve the problems from the time when these matters were last before the House until a few days ago, but that he is not entirely happy about what is proposed today. Obviously, he would prefer the Government to support the introduction of his model for patients councils. It is almost two years since one line in chapter 10 of the NHS plan baldly stated that CHCs were to be abolished, and I have never had a satisfactory and rational explanation of why CHCs could not have been reformed and strengthened to play the central role in other reforms, most of which are warmly welcomed. [Interruption.] I am glad that Members are listening closely.
      During the passage of the Health and Social Care Bill, an earlier version of my hon. Friend's amendment on patients councils was accepted by the Government but subsequently withdrawn. As the hon. Member for West Chelmsford (Mr. Burns) said, it has taken the other place, together with a well co-ordinated and competently argued campaign by ACHCEW and a range of other stakeholders, to bring us to the point where we may finally have a resolution.
      I regret that so much time and effort has had to be expended when it has always been clear that a compromise would add value to the proposals as well as resolving the ongoing controversy. However, I recognise that the Minister has been very helpful and proactive in working on alternatives that seem capable of achieving much of what patients councils would deliver. I wish that the dialogue had started much sooner, perhaps even before her time as a Minister, but I have only praise for her tireless work in seeking a resolution of our differences, particularly in the past week or so with my hon. Friend the Member for Wakefield and latterly myself.
      There are some positives to take from this experience. It should be the good news story that we could have had earlier. The Minister and the Government are showing that they know that even though they did not get it wrong, they certainly did not get it all right. They have listened, and we have before us a compromise that I hope can lead to consensus. In this policy area, we ought to be able to reach agreement.
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      5.45 pm
      I hope that CHCs and their national association will feel better after today. Theirs has been a long and stressful road that has taken a heavy toll. Although they and some patients and members of the public are not getting exactly what they wanted, they can claim a moral victory in the light of the Government's proposal, which includes a strong, independent, community-led and integrated watchdog for PCT patients forums. However, I hope that we can come up with a more user-friendly name, such as the "community health service".
      I hope that the Minister will join me and the rest of the House in paying tribute to CHC voluntary members and staff, who have continued to serve their communities well during a time of much uncertainty and instability. I pay particular tribute to my own Redbridge CHC, of which I used to be a member. I hope that the Minister and other colleagues will also join me in congratulating the Association of Community Health Councils for England and Wales, its director, Peter Walsh, and its supporters, on conducting its campaign with such rigor and integrity. There can be no denying that the proposal before us is a great improvement on past attempts. That is due in no small part to ACHCEW's well informed and well argued briefings, and the excellent work—as has been widely acknowledged—carried out on behalf of NHS users by CHCs for almost a generation.
      I heartily welcome the genuine attempts by all concerned to secure greater public involvement in health services. This Government are rightly investing huge sums in those services, thereby reflecting our constituents' continuing commitment to the national health service.
      Dr. Evan Harris: All of us—perhaps excluding the Minister—are sick of repeatedly discussing this issue, but it is important to recognise that we have made progress, and I want to make a constructive contribution.
      We have yet to reach consensus, but if we build on the excellent speech from the hon. Member for Ilford, North (Linda Perham) we might find a starting point. The hon. Member for Wakefield (Mr. Hinchliffe) said that, although the two sides of the argument are inches apart, those inches are very important. If I might modernise his terminology—a risky procedure—perhaps they are now only centimetres apart, although the distance remains very important. Perhaps we can explore that issue.
      I thank the Government for agreeing to change the programme motion. I do not understand how such matters are dealt with, but it was appropriate to extend the original offer, thereby enabling us to explore these issues properly. It is unfortunate that we cannot discuss a sheaf of amendments line by line in a Committee; perhaps we should do so outside this Chamber, so that we can resolve some of the confusion. I am confident that we can do that, because the Minister has always been willing to discuss this issue. If the amendments give rise to specific questions, we can discuss them.
      In his usual style, the hon. Member for West Chelmsford (Mr. Burns) explained some of the reasons why the Government's entire strategy is flawed—a view with which we agree. It is not worth my repeating the points that I made on Second Reading, in Committee and on Report. My predecessor in this role, my hon. Friend the Member for North Devon (Nick Harvey), made the same points. Originally, he worked closely with the hon.

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      Member for Wakefield to try to save community health councils and the other important elements that need to be saved.
      I have never understood why the Government felt it necessary to abolish CHCs. Perhaps they did so on the basis of patchy performance, but such reasoning would threaten the roles of many Front Benchers.
      Mr. Burns: Speak for yourself.
      Dr. Harris: We should all watch out, and particularly members of the Cabinet. If patchy performance were a basis for abolition, we would have even more of a dictatorship, and even less Cabinet government.
      I do not accept that it was ever reasonable to abolish community health councils, but the Government want to change the way in which things are done and we have to meet them part of the way. I accepted on Report, a little before the hon. Member for West Chelmsford, that we must move on to consider a way of reaching agreement.
      As the Minister knows, the arithmetic is such that in the House of Lords, where the Government do not have a majority, there was a strong turnout of both main Opposition parties and Cross Benchers against the Government's proposals. Unless we can reach full agreement, I fear that that will continue. Despite the progress that we have made, I cannot say that my party will necessarily change its position. I do not believe that there is huge enthusiasm for the Government's proposals on the Labour Benches, although they are welcomed by some hon. Members, who are more than capable of speaking for themselves. There is still some way to go, but we have a useful platform.
      Mr. Tom Harris: For the purposes of clarity, it would be wise to point out that, in Committee, the Lords voted for the abolition of community health councils, with a Government majority of 27. That was not made clear by the Conservative spokesman.
      Dr. Harris: That is an intervention for the Conservative Front Bench. Some time ago, my party accepted that we should fight on for patients councils—the amendment tabled by the hon. Member for Wakefield has had our support throughout. We want to fight now for what patients councils provide; otherwise, we will just go round in circles. We cannot hold out time and again for the identical amendment in the House of Lords. I stress that unless we are satisfied on specific issues, there will continue to be opposition—it does not matter how strong; it will still be voting opposition—to the position that we have reached.
      The hon. Member for Wakefield has been described as a grave-digger. Today, in his absence, he is more like the spectre at the feast. I accept, of course, the Government's assurances that the debate was not timed to coincide with the hon. Gentleman's absence. We had a helpful contribution from the hon. Member for Ilford, North, who I know has been working with the hon. Gentleman in negotiating with the Government. There is not much value in asking whether he went of his own accord; I am sure that he did.
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      The hon. Member for Wakefield did not write to me to express his views before he left, although I know that it was a last-minute decision. The letter that he did write has not been published, and the hon. Member for Ilford, North hinted that the hon. Member for Wakefield did not agree completely with the Government's proposals. I probably share that lack of agreement.
      Linda Perham: I said that my hon. Friend the Member for Wakefield was not entirely happy, as we would clearly have preferred the patients council model. However, the Minister has read out my hon. Friend's letter, and hon. Members can judge what he means from what the Minister said.
      Dr. Harris: I accept that the Minister read from the letter. I do not suggest that she misread the hon. Gentleman's words, but I do not see why it should be a problem for the letter to be seen in its entirety and context. Although my party will make its own decision, it is useful to be informed by someone who has been involved in negotiation of the issues.
      Let us consider some of the specific issues. Many of the functions proposed in the patients council model are delivered by the series of Government amendments. I put that on the record. When we are trying to persuade the Government to change their view, it is not helpful to hector them for doing so. We welcome the Government's proposals. That is how the two Houses work well, and how pressure from the Government's side works best. Even if it does exclude the Opposition parties, such negotiations bring progress to the public forum. There are, however, a number of objectives that have not yet been delivered by the amendments. I hope that in her response, the Minister will indicate that there may be some flexibility.
      The Association of Community Health Councils for England and Wales, to which I pay tribute, has been up as late as all of us, dealing with the late amendments from the Minister. It is a remarkable feat of her office to have delivered vaguely competent amendments in such a short time, given that negotiations were still taking place on Tuesday. In a briefing sent to hon. Members on 17 May, the Association of Community Health Councils set out why it liked the patients council option. There are various criteria on which the association based its case for patients councils.
      One criterion was integration and simplification. It is not clear that that criterion has been met fully, but the abolition of the local networks of the Commission for Patient and Public Involvement in Health helps to meet some of those concerns.
      Another criterion was less bureaucracy than currently exists. I accept that there are arguments on both sides, but it is not clear that the proposed system is less bureaucratic because of the imbalances created by different types of patients forum of different sizes. The Association of Community Health Councils wanted a one-stop shop. The primary care trust patients forum provides almost all the aspects of the one-stop shop. Again, I put on record my gratitude for the progress made in the Government's amendments on that point.
      A further factor was local credibility and accountability. To a certain extent, that relies on paid staff within the organisation. The theory of local networks and

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      volunteer-run patients forums did not have that credibility, let alone the accountability. The fact that there will be staff for the PCTPFs—I agree with the hon. Member for Ilford, North that we need a better word, and as the Minister has had plenty of practice at coming up with new words I am sure that we will make progress in that respect—will provide more credibility.
      The Association of Community Health Councils argued for a powerful, independent voice for local people. I am not convinced that the forum, as the Minister envisages it, delivers that, and I still fail to understand her distinction between the patients forum and the community health council or patients council model, in terms of allowing people to speak, rather than being spoken for. I have never understood what the hon. Lady meant by that.
      What people want locally is for their view—their agreed view, if necessary—to be transmitted. The outcome is more likely to be a talking shop if people simply give their view, and no agreement is reached about the way forward by whatever body. I am sceptical about what the Minister said, particularly as she then said that there will be representatives—not people from, but representatives—of local health interest groups on the PCT patients forums. That is welcome, but it is inconsistent with her approach. I question whether it is a legitimate basis for her opposition to the patients council approach.
      Another part of the case for patients councils is the need for an overview of health issues and services. That depends on whether the area governed by the primary care trust patients forum is large enough to provide an overview; otherwise it will merely provide a bottom view of a part of it. There is a major concern that when the Government think about PCTs, they are thinking about London, and not, as the hon. Member for Bedford (Mr. Hall) said, about shire counties and the size of PCTs there.
      Bob Spink: Does the hon. Gentleman agree that under the current proposals, which lack overall integration, there would be no body to examine the impact of health issues on a local community?
      Dr. Harris: There is the oversight and scrutiny committee of local authorities, which the Government introduced, but that does not represent the patient voice directly. That is why the patients council used as its base in terms of the local health economy, to quote the phrase coined by the hon. Member for Wakefield, the oversight and scrutiny committees of local authorities. That was a much better way of tackling the problem. In shire counties, there would be a county-sized overview and scrutiny committee, and a patients council or larger patients forum, which would benefit from the economies of scale, but would have the critical mass of expertise and be able to take a proper overview.
      I shall be more specific. In Oxfordshire, there are a multitude of PCTs, so there will be four, five or six—who knows?—primary care trust patients forums with an interest in Oxfordshire, whereas at present there is one community health council that does a very good job, not just because of the people who serve on it, but because it is big enough to take an overview, with the one large acute trust in the county. It would be bizarre if there were five PCT patients forums with a wide remit and one acute
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      trust patients forum that was subservient to them. That sounds like five chiefs and one Indian. It would be top-heavy and overly bureaucratic. It would be better to have a structure based at county level, which is where the overview and scrutiny committees work. That works well in London, for example, where PCTs are larger and often coterminous with local authorities.
      The Minister should perhaps consider a scheme to allow the merging of PCT patients forums where that is supported locally. They could have a duty to consult on mergers, which would offer local people the structure that they want and would fit well with local authority scrutiny. The Minister knows that we supported the Government's proposals in the Local Government Act 2000, which provided for that function, but setting up multitudes of non-coterminous PCT patients forums is not joined-up government. If the Minister can make some concession on that important point, I might find more to commend in the amendments.
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      There are currently about 180 CHCs and some 150 overview and scrutiny committees. The functions performed by CHCs include oversight and the reporting of concerns, and they have the resources, the secretariat and the research capability to perform the necessary investigations. Placing those functions with local authority overview and scrutiny committees would maintain the critical mass necessary for effective performance. Placing those functions with 300 or so PCT patients forums will multiply bureaucracy and increase costs. The Government claim that resources will be provided, but the House has an interest in ensuring that whatever resources are finally decided—we can argue about quantum—are spent as efficiently as possible. That could be achieved most efficiently through patients councils, or larger patients forums, operating at local authority level. The area covered should certainly be bigger than the chunks of shire counties that patients forums will cover in my area and others.
      I have several detailed points to raise on the amendments, but I know that other hon. Members wish to speak. I hope that the Minister will accept interventions when she winds up the debate. I cannot at the moment support the Government's motion to disagree, but I recognise that we have made some progress. It would be wrong to fail to recognise that the provisions have improved in terms of function, but the structure is not yet right and some issues remain on resources. I hope that the Minister will express a willingness to negotiate both in the Chamber and outside on some of the specific points that I have made.
      Dr. Richard Taylor: I am amazed and delighted that some of my first impressions of the Government are beginning to be proved wrong. As we sat through the tedious hours in Committee, I felt that the Government were a juggernaut that was not for turning. Today, however, we have evidence that the Government have taken notice of many of the concerns expressed about the abolition of CHCs.
      The first concern was the loss of the one-stop shop, but that does seem to have been addressed. Just this week, I have had complaints from a man who would have had to go to at least two separate PCTs; now, he should be able

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      to go to a one-stop shop. I am also very pleased that the Minister has said that the forums will not be only talking shops, but will have opportunities to make changes.
      My second concern—the independence of patients forums—is more difficult to address. There was no doubt about the independence of CHCs, but I remain to be convinced about the independence of patients forums. The Prime Minister recently wrote that PCTS were
      "run by patients, doctors and nurses."
      They are certainly run by doctors and nurses, but I remain to be convinced that the patient input is effective. I have not been convinced by the independence or the effectiveness of some of the non-executive directors whom I have seen in action.
      The non-executive directors are appointed by the NHS Appointments Commission. Several issues were raised at a recent public meeting of the Health Committee that called into question the independence of the commission. I do not wish to cast aspersions on individuals—the problem is the system that has been set up. For example, the chief executive of the commission was the chief executive of the previous similar body and the chairman has been well steeped in the functions of the NHS as a chairman of trusts. The first act of the commission was to appoint 28 strategic health authority chairs, 26 of whom already chaired, or were non-executive directors of, trusts or health authorities and had been appointed by the Secretary of State.
      I am waiting to see what effect the appointment of patients forum members by the Commission for Patient and Public Involvement in Health will have. I am pleased to hear that it will be able to seek members from potentially disadvantaged groups, but I was puzzled to hear recently that patients forums will elect a member to sit on PCTs and the NHS Appointments Commission will have the power to vet—and, presumably, veto—those elections. I hope that the Minister will deny that.
      I was encouraged to see that the amendments would open the door to patients forum membership for people from health-related voluntary groups. That was one of the strengths of CHCs. My fear about patients councils is that they would add an extra tier, so I fully approve of strengthening an existing tier instead. On balance, I will support the Government, because they have widened and strengthened the scope and functions of PCT patients forums. However, as other hon. Members have pointed out, we need a better name for the forums. That would be a help, but their independence will be largely in the hands of their members—if they are given enough freedom.
      Tony Baldry: Like almost everyone who has spoken in this debate, I am at something of a loss to explain why CHCs have been abolished. The hon. Member for Oxford, West and Abingdon (Dr. Harris) and I have both had experience of the Oxfordshire CHC. For many years it was led by John Power, the leader of the Labour group on Oxford city council. It was a constructive and critical CHC, irrespective of which party was in office. I still do not understand why it was felt necessary to abolish CHCs.
      Mr. Heald: Does my hon. Friend think that the abolition might have had anything to do with "casualty watch", which showed how poor the situation was in accident and emergency departments?
      Tony Baldry: I genuinely do not know, but we have never been given a coherent explanation for the abolition. If I was looking for bits of the machinery of government that caused concern, CHCs—especially the Oxfordshire CHC—would not have been high on my list. As Ministers and everybody else would have hoped, Oxfordshire CHC was an effective voice for patients and the community as a whole. It was critical and constructive, and it engaged in the debate.
      The most important thing about community health councils, however, was that people could find them. We in the Westminster hothouse may sometimes forget how long it takes for our constituents to adapt to change—and the NHS has experienced an enormous amount of change recently. I suspect that if we asked people in the high streets of our constituencies "What do you know about primary care trusts?" we would find that few had caught up with the change, or would know who was involved in the trusts. Our Oxfordshire health authority has been replaced by five primary care trusts; I suspect that few of my constituents could name the trust currently covering their area.
      Stephen Hesford: Does the hon. Gentleman realise that community health councils were introduced in 1974, while PCTs have existed, broadly, since April this year? He is not really comparing like with like. My experience is the reverse of his: I found that even after nearly 30 years people did not know where their community health council was, and most of those I bumped into did not even know what community health councils were.
      Tony Baldry: Perhaps the Oxfordshire CHC was a star, but I suspect that many people in Oxfordshire knew about it. We experienced a number of dramas over the years. There were concerns about the future of hospitals such as the John Radcliffe and the Horton general hospital in my constituency. When public meetings were needed, people were content for the CHC to organise them, knowing that it was objective and independent and would not be party political or partisan. CHCs dealt in the politics of the possible, carrying out effectively the job with which Parliament had entrusted them.
      As I have said, a lot of change is taking place in the NHS and it is sometimes difficult for our constituents to keep up with it. For each primary care trust there will be a patients forum. I must tell the Minister that I do not think that my constituents, or indeed many other people, are desperately gripped by the debate about whether there should be a patients forum or a patients council. I will support those on my Front Bench because I think that the other place has made some good points, but I believe that what people out there really want is stability.
      My postbag today contained a newsletter from the primary care network, whose line was simply "Give NHS managers space, time and freedom to deliver". Inside was an article by the hon. Member for Dartford (Dr. Stoate), in which he said that PCTs must be allowed space in which to establish their own priorities.

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      People do want stability. If there is to be a patients forum for each primary care trust, people must at least know what the trusts are. As I said earlier, Oxfordshire now has five PCTs, one of which—Cherwell Vale—is based in Banbury. When it was set up, with the agreement of all, it included a chunk of Northamptonshire. The reason was simple: as Banbury is a market town, a day's cart ride has historically been involved. That is how it came to be a market town.
      For centuries, those in many villages and small towns in the constituency of my hon. Friend the Member for Daventry (Mr. Boswell) have considered Banbury to be their natural market focus. Consequently, general practices in south Northamptonshire have traditionally sent patients to Horton general hospital in my constituency. Indeed, 30 per cent. of the hospital's work comes from Northamptonshire.
      6.15 pm
      Mr. Tim Boswell: Will my hon. Friend accept a declaration of interest? I have lived in my constituency, in the far south-west of Northamptonshire, for more than 30 years. Throughout that period I have not only used Horton general as my local hospital, but used a general practice in Banbury. I have crossed the border for primary as well as secondary services.
      Tony Baldry: My hon. Friend—who has lived in, worked in and represented his constituency for many years—makes an effective point.
      The primary care trusts that the forums will represent "went live" on 1 April 2001, but only began active life on 1 April this year with the demise of the Oxfordshire health authority. They were shadowing the authority for a year. As I have said, Cherwell Vale primary care trust stretches into Northamptonshire. Members can imagine my amazement on seeing a letter from the chief executive of the Northamptonshire strategic health authority. Incidentally, if few people know which PCT represents them, I suspect that almost no one—and this goes for many Members of Parliament—understands what strategic health authorities do.
      One thing strategic health authorities clearly want to do is reorganise PCTs. On 10 April, less than a fortnight after Cherwell Vale went live, David Sissling, chief executive of the Northamptonshire strategic health authority, wrote to the chief executive of the Thames Valley health authority saying:
      "We recently discussed a possible adjustment to the boundaries of Cherwell Vale PCT and Daventry and South Northamptonshire PCTs. This would enable an alignment with the boundaries of Northamptonshire and Oxfordshire and of course the new health authorities.
      I have discussed the proposal with a"—
      listen to the next word—
      "limited number of colleagues including the Chief Executive of Daventry and South Northamptonshire PCT. On the basis of these discussions I can formally confinn our strong support for a reconfiguration."
      No one in the PCT was consulted. No patients or general practitioners were consulted. Members of Parliament were not even given the courtesy, then or since, of being told about the possible configuration of PCTs, just 10 days after they had come into being.
      Mr. David Cameron: Many of my constituents, particularly those living around Chipping
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      Norton, use Horton general. It will concern them greatly that if the hospital does not have the support of PCTs and patients in south Northamptonshire, it may not be as viable as it is today. It currently gives my constituents a very good service, often much better than that provided by the very strapped John Radcliffe hospital in Oxford.
      Tony Baldry rose—
      Mr. Deputy Speaker (Sir Alan Haselhurst): Order. Before the hon. Gentleman follows that line too far, let me say that the debate seems to be straying somewhat from the main point of the amendment.
      Tony Baldry: We are focusing on patients forums, Mr. Deputy Speaker. Important questions are who will be on those forums, and what geographical areas they will represent. People in south Northamptonshire need to know which forum to go to, and they can know that only if they know which is their PCT. As I have said, they need some stability. For instance, people living in Chipping Norton, in the constituency of my hon. Friend the Member for Witney (Mr. Cameron), need to know which PCT represents them.
      One of the most important concerns of the forums, however, will be the viability and vitality of their local general hospitals. The only logical reason for the Northamptonshire strategic health authority to want to take patients away from the Cherwell Vale PCT is that it wants to refer them to hospitals in Northamptonshire—which will undermine the viability and vitality of Horton general.
      At present, Oxfordshire has five primary care trusts; each one will, under the Government's proposals, have a patients forum. They came into being after considerable consultation between general practitioners, everyone involved in the national health service and all the stakeholders. Doubtless they had to have ministerial approval. It was agreed that there would be five of them. They have chief executives, boards and chairman—all the paraphernalia of a primary care trust. The Government are asking us to vote tonight for a patients forum for each of those PCTs.
      Similarly, as soon as the primary care trusts took up their effective duties on 1 April, the chief executive of the Thames Valley strategic health authority tried to bludgeon the five to become three. Not surprisingly, the smallest of these, the North East Oxfordshire primary care trust, based in Bicester in my constituency, is somewhat concerned. The chairmen of at least two of the primary care trusts said:
      "We 'went live' 1st April 2001, i.e. 13 months ago, and are all now engaging fully and constructively with patient groups, local agencies and health professionals, including our GPs. We are certain that to close down our 5 trusts in order to create 3 new ones will very significantly disrupt and damage the ever improving quality of provision for our patients."
      That was written by the chairmen of the North East Oxfordshire and the Cherwell Vale primary care trusts.
      It is irrelevant to my constituents whether they have patients forums or patients councils. They want stability; people working in the NHS want stability; GPs want stability. The Government have set boundaries for primary care trusts—let us keep to them, at least until 2005, for heaven's sake. At least let there be natural

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      evolution. The Government should not set up primary care trusts on 1 April 2002 and seek to change the boundaries radically, without consulting anyone, by 10 April. What kind of precedent is that for patient or consumer involvement? Ministers talk about involving the wider community. If the national health service does not even have the courtesy to involve Members of Parliament, what hope is there of involving the wider community?
      The Government will win the vote tonight because they will dragoon all their members into their Division Lobby, except for those who have been expelled to Siberia for the occasion. However, this debate is irrelevant if Ministers cannot accept and understand that, above all, the NHS needs some stability for the next two or three years so that everyone involved can understand what is happening. Simply rewriting the geographical boundaries will benefit no one. I hope that the Minister will intervene with the chief executives of the various strategic health authorities who seem to have nothing better to do than try to rewrite the boundaries of primary care trusts.
      Dr. Murrison: In an earlier intervention on the Minister, I referred to a number of organisations that objected to the abolition of community health councils. I cited a number of charities, and the Minister responded with the name of an organisation which, unlike the ones to which I had referred, could hardly be said to be a household name.
      I see from the list that someone has helpfully passed me that a number of establishment bodies have complained that to shut down CHCs would be a retrograde step. These include the British Medical Association and the General Medical Council. Interestingly, however, that view is also held by the Socialist Health Association, Health Action for Homeless People and the Co-operative party, while the Greater London Assembly has objected unanimously. There seems to be a pretty uniform view that the Government are about to make a retrograde move. It is a great shame that they have not listened.
      The hon. Member for Wyre Forest (Dr. Taylor) said that he was heartened that the Government had been listening since the Bill's Committee stage. My impression throughout the Committee stage and subsequently is that the Government have been extremely recalcitrant with regard to all the helpful suggestions that have been offered to them. That is a great shame.
      Brian McGinnis of Mencap said very tellingly that the CHC network has been a nuisance to the Government, but that that has been one of its strengths at times. He said that the new patchwork of half-baked ideas, designed for difference rather than effectiveness, lacks any real credibility.
      Mr. Truswell: For some years, I was a member of a CHC. The crocodile tears that Conservative Members are splashing about are making me smile wryly. If the Conservative party is so wedded to the idea of CHCs' independence and critical role, why did a former Conservative Government remove from CHC observers to
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      health bodies the right to participate in their proceedings? That right existed until a Conservative Government took it away. How does that square with all these crocodile tears?
      Dr. Murrison: The hon. Gentleman's knowledge of history is greater than mine. The important thing is our commitment to the general concept of community health councils.
      The CHCs offer a fairly seamless guide to people passing through the journey of the national health service. We must remember that people do not simply go to their GP and then suddenly go to hospital—it is a journey. One of our chief concerns is that the new proposals will cut across that. No longer will people have that seamless recourse to a knowledgeable and well respected body if they want to raise an issue of concern in the national health service.
      There was a wider consultation on the future of community health councils in Wales, which subsequently opted to keep its CHCs. We could learn something from that.
      I was interested to learn that Bath and District community health council, to which I pay tribute for all its hard work, cost £119,000 in the last financial year. Its chief officer thinks that patient advocacy and liaison services alone will cost about £750,000. There is a big difference. The Health Service Journal reckoned around the time of Second Reading that the new structures would come to about 10 times the current cost of community health councils. It is important to bear that in mind. Subsequent Government amendments could conceivably lead to greater costs.
      Functions are far more important than institutions, however. I was interested to see the comments of my community health council on the recent revelation that the Royal United hospital in Bath will end the year with a deficit of £17 million, and that there is evidence of fiddled waiting lists. My CHC reacted in a timely and effective manner in contributing to that debate. I am left struggling to work out how the new bodies that the Government intend to replace CHCs would cope with the crisis facing the Royal United hospital in Bath.
      I was pleased to read the agenda for the Bath and District community health council meeting of 14 May, held in Bath. It contains a raft of useful things that that body has done. It includes a review of the emergency unit and a "casualty watch" 2002, which took place earlier this week. It comments on detailed plans for the new emergency unit at the Royal United hospital and on transport into Bath for medical attention. That is a tribute to the many and varied things that my local community health council does, and its work is replicated across the country.
      One of my concerns about the proposals is the impact that they are likely to have on staff. It seems to me that there is some confusion about who staff will work for and to whom they will be accountable. If I understood the Minister correctly, she suggested that the staff of PCT patients forums would be farmed out from the CPPIH, yet ACHCEW thinks that staff will answer to the PCTs. I would be grateful to the Minister if she could clarify that because, if ACHCEW and I are confused, I suspect that the general public will be as well. I am genuinely concerned that, if the staff who participate in the new

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      bodies do not know to whom they are accountable and where they fit in the organisation, there is a real risk that they will become disheartened and dispirited.
      6.30 pm
      I am also concerned that the remit of PCT patients forums is being widened to include issues that broadly affect health. I would be the first to admit that, in general, many things impact on health and that issues such as housing, transport and so on have a very definite impact on people's lives and, indeed, health, but I would caution the Government that, by widening the remit in that way, they are perhaps diluting the forums' focus on the NHS. Of course the resources will have to be increased if the remit is widened, and the Minister has said nothing about that so far.
      The Minister talked about representatives from various interest groups that could conceivably have a view on health related issues. I am confused about that notion because she appeared to suggest that representatives would not be the way ahead in the new order of things. I disagree with her on that point, but I would be grateful to her if she could clarify it. If she is referring to representatives, who will choose them? Will they be appointed? If so, who could dismiss them?
      Mr. David Wilshire: One of the great advantages of being an Opposition Whip rather than a Government Whip is that one is not quite tied to the same vows of silence. I am conscious of the fact that I have not heard all the debate, but I do not wish to go over any ground, other than to say that I note the time is 6.32 pm and it would be fair to say that the Government willingly agreed to our request to change the guillotine arrangements so that there would be a guillotine part way through our proceedings. I should like to put on record our appreciation for that.
      A subsequent request for further time came not from Her Majesty's official Opposition but from the Liberal Democrats. [HON. MEMBERS: "Where are they?"] They wanted an extra hour. The Government offered us two hours to discuss this business, and I am sure that you will notice, Mr. Deputy Speaker, that we have indeed said all we wish to say. We have had our opportunity to disagree. We do not like what is going on, and I doubt whether we will be satisfied by the Minister's reply. However, I must make the point that the Liberal Democrats demanded an extra hour, but none of them can even bother to be here to hear the Minister's response.
      Mr. Heald: Does my hon. Friend agree that the effect of changing the guillotine arrangements in that way was that we were unable to debate three groups of amendments that would have been discussed earlier, as a result of the Liberal Democrats' activities? [Interruption.] I see that one Liberal Democrat Member is now arriving in his place.
      Mr. Wilshire: That very Member—the hon. Member for Oxford, West and Abingdon (Dr. Harris)—is the one who demanded the extra time because he had so much to say, and so many of his hon. Friends wanted to say it, but I have made my point, and I do not wish to stray into the issues that were debated when I was not present in the
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      Chamber. However, I am most grateful to the Government for agreeing to our request, and I ask the House to note what else has happened.
      Ms Blears: This has been an interesting and wide-ranging debate. It is fair to say that all hon. Members involved in it probably know far more about patient and public involvement than they could ever had anticipated when we first embarked on this journey almost two years ago, and I hope that we have all extended our knowledge and understanding during that period.
      The hon. Member for West Chelmsford (Mr. Burns) said at the outset of his contribution that the decision to abolish CHCs was wrong, and he set out why he thought that was the case. I would simply remind him that the decision to abolish CHCs was approved in the other place by a majority of 27 and that Lords amendment No. 6 deals with patients councils, and therefore we are discussing the fact that the Government disagree with that amendment. The issue of whether to retain CHCs is in fact behind us.
      The hon. Gentleman expressed a kind of nostalgia about CHCs and said that they had a power of veto over hospital closures. I need hardly remind him that that power of veto, or power of referral, has now been transferred to democratically elected local government, and I would hope that that very important step forward would command the support of the whole House. Such crucial local decisions should be taken not by non-elected bodies but by ones that are locally accountable and democratic. I am sure that overview and scrutiny committees will carry out their tasks in a very discerning and appropriate way in future. That is real progress.
      The hon. Gentleman also expressed concern about whether the new system will be able to address issues such as the terrible events that occurred at Alder Hey hospital. Hon. Members have also mentioned the dreadful trauma caused by the events at Bristol. I should like to remind the House that Professor Kennedy made the absolutely crucial point during the Bristol inquiry that patients and the public need to be on the inside of the system of patient and public involvement, not on the outside reacting to events when things have already gone wrong.
      People should be inside the system and able to shape and influence the decisions that are taken. It is crucial to this debate to say that patients councils would perpetuate the system whereby people are on the outside, observing. Patients forums are fundamentally different; they are about patients and the public being on the inside of the system and able to exercise real power and influence.
      The Conservative party is going through what the hon. Member for West Chelmsford described as a fundamental review of its policies on health and everything else. Obviously, there has been huge change in the NHS recently, which is the very reason why the system of public and patient involvement needs to change as well. If the hon. Gentleman is undertaking a review, he needs to be a little more creative and imaginative in looking to the future, not back at what has gone on for the past 27 years with CHCs. The shape of the system will be very different in future, and its values will be different as well. I urge him to keep up with the pace of change in our system.
      The hon. Gentleman raised the issue of funding. My hon. Friend the Member for Crewe and Nantwich (Mrs. Dunwoody) welcomed his commitment to extra

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      funding for the NHS. It is a great pity that the hon. Gentleman did not see fit to vote for it in the recent Budget debate. Nevertheless, I have acknowledged that more resources will be needed to ensure that the system works properly and that we do not get consultation and involvement on the cheap, so we will need to invest extra resources.
      The hon. Gentleman also raised the important issue of value for money. At long last, performance management of patient and public involvement will be part of the new system, so we will be able to find out what we get for our money. In future, the people whom we have asked to pay a little extra for the NHS—I am delighted to say that the vast majority of the community are happy to do that—will be able to see exactly where the money is spent, what they get for it and how well the system of patient and public involvement is working across the country, instead of having perhaps a bit of a hit-and-miss system.
      Dr. Evan Harris: On taxpayers' money being spent on a locally accountable health service, there is a strong argument for local democratic accountability in running the health service. Will the Minister make an announcement on the funding available to resource the model that she now proposes? Many of us think that it will cost a lot of money. If that money comes from the same announced resources, it will be spread more thinly, simply because of the multitude of organisations that she now seeks to beef up as PCT patients forums.
      Ms Blears: I have in fact put it on the record in this debate and in Committee that the system will be more expensive. I am not in a position to make an announcement about specific allocation decisions, because they will be made as we decide where it is appropriate to put the massive extra investment that Labour is making in the national health service. The announcement of those allocations will be made at the appropriate time. However, we value a robust, independent and vigorous system of patient involvement, and clearly its implementation will cost more than the existing system. That is evidence of our commitment to investment.
      Mr. Burns: Although I accept the Minister's statement that she cannot tell us about funding allocations for the bodies, has her Department made any assessment of their probable costs and, if so, can she share those figures with us?
      Ms Blears: I have already acknowledged that the proposed system will cost more. At present, CHCs receive about £23 million; we allocated an extra £10 million to fund the patient advocacy and liaison services. The staffing of the patients forums will require additional resources, but I am not in a position to go into further detail. We could make hugely ambitious proposals for public and patient involvement, but we need to be sensible when making decisions, because investment is crying out to be made in other parts of the health service. Getting the balance right will be fundamental as we go through the next few months.
      Dr. Evan Harris: I recognise that the Minister is committed to putting more resources into the new system
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      than the old one, which included PALS. I also recognise the need to ensure that the money is well spent and that there is a crying need for it actually to be spent on services. However, if she cannot give us an undertaking about money, can she give us some indication of the possible staff numbers in PCT patients forums? We know about the staffing levels of CHCs—at least in our own areas—but if there were to be only 0.7 of a person per PCT forum that would significantly obstruct us in reaching agreement with her as regards the proposed structure.
      Ms Blears: I have already said that there will be staffing both for the PCT patients forums and to facilitate the co-ordination of other patients forums. I am certainly not in a position to say whether that would be one person or one and a half, two, three or four people, but the staffing support will be adequate to enable the forums to carry out their functions. That is the key part of the equation. It would be wrong to give bodies responsibilities without the resources to discharge them. No sensible Government would ever do that.
      Mr. Tom Harris: Does my hon. Friend share my surprise that the Conservatives are demanding accurate figures for the funding of the new bodies, yet will not commit themselves to the shape of the NHS—or even to support it?
      Ms Blears: My hon. Friend goes to the heart of the matter. Our proposals are evidence of our commitment both to reform the system—this measure is a major reform—but also to the investment that makes reform work. The Opposition are unwilling to provide extra funds for the national health service as a whole. They have a reactionary approach to the whole subject. They are not looking forward—they have no creativity or imagination—and that is very disappointing indeed.
      My hon. Friend the Member for Ilford, North (Linda Perham) made an excellent contribution and I was grateful for her support for the detailed amendments that we propose. I am pleased that she feels we have made significant progress in establishing a strong, independent and community-led system of public and patient involvement. She expressed a willingness to move towards those principles—as we are trying to do; we are talking about functions rather than rigid structures to which people should conform. I am grateful to my hon. Friend for her contribution, and for the time and effort that she has put in to try to reach a position that reflects the views not only of hon. Members but of the many stakeholders in the public and patient involvement system.
      6.45 pm
      The hon. Member for Oxford, West and Abingdon (Dr. Harris) said that my hon. Friend the Member for Wakefield (Mr. Hinchliffe) and I were centimetres rather than inches apart. I am grateful for the hon. Gentleman's acknowledgement of the progress made by the amendments. He accepts that the decision to abolish CHCs has been taken both in this place and in the other place and that we should now move on to try to provide a robust system for future patient and public involvement.

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      I am sorry that before my hon. Friend the Member for Wakefield left for Russia he did not write to the hon. Gentleman, but I have noted the hon. Gentleman's concerns and the fact that my hon. Friend welcomed our amendments.
      Dr. Evan Harris: We shall make our own decision about the proposals—as will the hon. Member for Wakefield (Mr. Hinchliffe) when he reads the report of the proceedings—but as some of the amendments were not tabled before he left, he would not have fully known the Government's position. We do not know whether the entire letter was read out and we still do not know whether he thinks that more progress could be made. I am not trying to be awkward, but, in his absence, we cannot be persuaded that the concerns that we share with him have yet been met in their entirety.
      Ms Blears: I do not have the Moscow telephone number of my hon. Friend the Member for Wakefield—if I did, I would pass it to the hon. Gentleman. I assure him that my hon. Friend was aware of the principles and intentions behind all our amendments.
      The hon. Gentleman read out a briefing from ACHCEW when he expressed his concerns. I urge him to take into account the fact that there are other views. ACHCEW has provided some constructive contributions, but one of the main reasons why we want to broaden the system of patient and public involvement is to incorporate the views of a range of patients organisations, carers groups and people in the community who are not part of the existing CHC framework. In many cases, they have been denied the opportunity to get involved because once the CHC world was consulted, the health service judged that it had fulfilled its duty. I ask the hon. Gentleman not to think that the views of ACHCEW express those of all patients and the public on important and crucial issues.
      Recently, I attended an event organised by a support group for patients with bowel cancer. During the past three months, it had involved almost 1,000 people in various events; they had come together to share their experiences and to talk to clinicians about how standards could be driven up. That would not happen in a traditional, CHC framework. It is crucial that we involve people more creatively and imaginatively, so I urge the hon. Gentleman to look beyond the world of CHCs in coming to a view on the issues.
      Clive Efford: My hon. Friend referred to the involvement of local people in the formulation of health policy and decisions. Will that inform the process for choosing members of the local forums?
      Ms Blears: As I explained earlier, the members of the forums will be appointed by the Commission for Patient and Public Involvement in Health, part of whose remit will be to seek out people rather than simply waiting for them to make an application—as is sometimes the case, when we end up with a self-selected and fairly limited group. The commission will actually go out and find people who, in the past, had no say in the health service and will give them support, guidance and training to enable them to come forward. I very much hope that a much more representative group of people than ever before will be shaping decisions. Crucially, involvement will not be confined to the people in the organization—
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      they will be charged with finding out the views of the public. The members of the forum will not simply put their own view—they will have to ensure that they draw in the views of a wider section of the community.
      The hon. Member for Oxford, West and Abingdon and other Members expressed some concern about the name "primary care trust patients forums" and asked whether we could come up with something snappier. I have had my fingers slightly burned in coming up with names for organisations. I hesitate to say that we should call PCT patients forums "local voices". Perhaps we shall not go back down that path. However, I hear what is being said to me and perhaps we can consider the matter.
      The hon. Gentleman made an important point about the different configuration of different communities—urban communities, rural areas and places with small market towns, which will be different throughout the country. Therefore, there may be a need for PCT patients forums to come together so that we avoid duplication. I draw the hon. Gentleman's attention to regulations that will be made under clause 18(2). Paragraph (f) provides for regulations to be made which govern
      "the discharge of any function of a Patients' Forum by a committee of the Forum or by a joint committee appointed with another Forum".
      There is legislative provision there to meet the flexibility that not only the hon. Gentleman but my hon. Friend the Member for Bedford (Mr. Hall) wants. My hon. Friend made a similar point.
      Dr. Harris: Clearly there are not yet regulations to read. Is the hon. Lady saying that there will be regulations that will allow, for example, the five PCT patients forums in Oxfordshire to group together to form one unit in the county as a PCT patients forum, which will have the staff and carry out all the functions, or will there still have to be five duplicated and different forums, that will come together for occasional issues?
      Ms Blears: Far be it from me to take a centralist approach and to impose that on local communities. The regulations will be the subject of consultation. I am sure that the hon. Gentleman will want to make his views and those of his community known in the consultation process.
      Dr. Harris: Will the hon. Lady give way?
      Ms Blears: No. I think that I have responded adequately to the hon. Gentleman.
      The hon. Member for Wyre Forest (Dr. Taylor) welcomed the changes that the Government are putting forward. I am delighted that his faith in the political process has been slightly restored since consideration of the Bill in Committee. I can reassure him that the forums will not merely be talking shops. They will be taking action. The hon. Gentleman expressed some concern about the election of a patients forum member as a non-executive member of the trust, and whether the NHS Appointments Commission would have a power of veto over that appointment.
      The patients forum will put forward the person it wants to be on the NHS trust. That person will have to meet the criteria set by the appointments committee and will have the same status as all other members of the trust. It is vital

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      that that person is not seen as a second-class member of the trust board, and that there is parity of esteem and influence within the board to ensure that their issues are taken on board.
      There is a precedent in that at present the NHS Appointments Commission appoints a person—he or she is usually from the education sector—to trust boards, but it is the education sector that nominates that person to go forward. I hope that that reassures the hon. Gentleman. I am delighted to have his support for the Government amendments.
      The hon. Member for Banbury (Tony Baldry) expressed the view that people knew where to find community health councils. Some of my hon. Friends expressed concern about the proportion of people who knew that. Some polling was done in the past. I do not pray it in aid and say that CHCs were bad because people did not know about them. However, extremely few local people knew what CHCs did, where they were and how they could get in touch with them. Less than 10 per cent. knew that. There is not the view that CHCs are well known and representative bodies.
      The hon. Gentleman said that there had been a great deal of change in the NHS. That is exactly why the system of patient and public involvement needs to change, too, so that it can align with the changes that have taken place. He talked about dramas at the hospital in his area with which the CHC has been involved. There will be dramas about hospital configurations, but that is a tiny part of the entire system of the NHS. We are trying to get to a system that involves people who have diabetes, cancer and kidney disease, young people and children—the entire range of services.
      In the past, everything has been about a drama and a crisis as a result of a configuration. That is one important aspect. but it does not reflect the entire range of concerns that people have about how the health service works for them. I genuinely believe that our new system will draw in many more views and issues than simply the sharp point about reconfiguration.
      The hon. Gentleman raised an important issue about how decisions that change the way in which primary care trusts operate would be subject to public consultation. The general duty on the NHS, under section 11 of the Health and Social Care Act 2001, is that the trusts must consult—every part of the NHS must consult—where there will be an effect on the operational services. If it is a purely administrative matter that does not affect the way in which services are delivered, that can go ahead. Where the issue affects any of the services to be provided to the hon. Gentleman and his constituents, it needs to be the subject of proper and detailed consultation. That is a strong power in our provisions.
      The hon. Member for Westbury (Dr. Murrison) again raised the issue of the abolition of CHCs, which is unfortunately not the subject raised by the amendments. However, I welcomed his statement that functions are far more important than structures. That was real recognition. Perhaps he is keeping up a little faster than the hon. Member for West Chelmsford with a new approach. I am delighted about that.
      The hon. Member for Westbury raised some concern about staffing. There will be staff employed by the Commission for Patient and Public Involvement in Health
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      who work with PCT patients forums, supporting all of the forums in an area, commissioning and providing independent complaints and advocacy services and, crucially, promoting public involvement in the whole of the health service and those wider issues that determine health in local communities. The staff will be a key part of the system, but they will be grounded and rooted in PCT patients forums close to their communities. I can confirm that the commission will be appointing members of the patients forums.
      I believe that we have had an extremely wide-ranging debate on these issues. I like to think that after going over this ground perhaps half a dozen times, I may even have persuaded Opposition Members that the NHS is changing dramatically. Therefore, public and patient involvement needs to change too. We have recognised the fact that to get change we must have investment. We must ensure that our services improve and that we give local people the tools to get on with the job. We must give them guidance, back-up, education, training and support. We have active, articulate citizens who are able to take their rightful place in being involved in the NHS. We are proposing real and radical change. Perhaps these changes are a little too radical for Opposition Members, but we are committed to real change, real reform and massive investment, which we had the courage to vote for and take forward. I commend the amendments to the House.
      Question put, That this House disagrees with the Lords in the said amendment:—
      The House divided: Ayes 303, Noes 179.
      Question accordingly agreed to.
      Lords amendment disagreed to.
      Lords amendments Nos. 7 to 16 disagreed to.
      Government amendments (a) to (d), (o) to (q), (e) to (1), (r), (m) and (n) agreed to in lieu of Lords amendments Nos. 6 to 16.
      Committee appointed to draw up Reasons to be assigned to the Lords for disagreeing to their amendments Nos. 2 and 4: Mr. Simon Burns, Jim Fitzpatrick, Dr. Evan
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      Harris, Mr. John Hutton and Ms Claire Ward; Mr. John Hutton to be the Chairman of the Committee; Three to be the quorum of the Committee.—[Jim Fitzpatrick.]
      To withdraw immediately.
      Reasons for disagreeing to Lords amendments Nos. 2 to 4 reported and agreed to; to be communicated to the Lords.

      HOUSE OF COMMONS MEMBERS' FUND
      Ordered,
      That Mr. A. J. Beith, Mr. John Butterfill and Sylvia Heal be discharged as Managing Trustees of the House of Commons Members' Fund and Mr. Peter Lilley, Mr. Eric Martlew and Mr. John Burnett be appointed as Managing Trustees in pursuance of section 2 of the House of Commons Members' Fund Act 1939.—[Mr. Caplin.]

      PETITIONS

        RAF Lyneham
        7.13 pm
        Mr. James Gray: I have the honour to present a petition on behalf of 11,657 of my constituents. [Interruption.]
        Mr. Deputy Speaker (Sir Alan Haselhurst): Order. Will those hon. Members who are not staying please leave quickly and quietly? The hon. Gentleman will then have a better opportunity to exhibit his honour on this matter.
        Mr. Gray: Thank you, Mr. Deputy Speaker. I have the honour to present a petition on behalf of 11,657 of my constituents who are very concerned about the possibility that the base at RAF Lyneham, the home of the Hercules aircraft, may have to close as a result of current Government studies. If that were to happen, not only would it cost my constituency £75 million in local income and 750 local jobs, but it would mean that all British Air Force, Army and Navy transport fleets would be based in one place. That would be at Brize Norton rather than Lyneham.
        The petition states:
        The Petition of the Residents of Lyneham, Wootton Bassett, Caine, Chippenham, Malmesbury and of the other towns and villages of North Wiltshire.
        Declares that we are proud of the contribution which we make to the defence of the Realm by being home for 50 years to the Royal Air Force at Lyneham; that we support the activities of the Hercules fleet in every way; and that the closure of RAF Lyneham would have a devastating effect on the local economy and jobs.
        The Petitioners therefore request that the House of Commons urge the Secretary of Sate for Defence to take steps to ensure that the A400M transport plane is based at RAF Lyneham; and that even if it is not, Lyneham continues to serve as the base for the C130J Hercules.
        And the Petitioners remain, etc.
        To lie upon the Table.

        Traffic-calming Measures
        Mr. Peter Luff: It is my very sad duty to present a petition from 490 residents of North

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        Claines and members of the general public using the A38 through Fernhill Heath in Worcestershire. It is one of the great sadnesses of being a Member of Parliament that one discovers that it is often only after a fatal accident has occurred that the necessary traffic-calming measures are put in place. The petition describes one such circumstance.
        The petition implies no criticism of the Highways Agency, which is about to de-trunk the road and is at last showing sufficient urgency in its approach to the problem. However, with the imminence of de-trunking, the petitioners believe that it is all the more important that the House of Commons, the Highways Agency and the successor body, Worcestershire county council, are reminded of the importance of the issue.
        The petition states:
        The Petition of North Claines Parish Council on behalf of the residents and general public using the A38T through Fernhill Heath, Worcestershire.
        Declares that, due to traffic speed and volume and the lack of traffic calming measures, this has contributed to the tragic death of a four year old child on the A38T outside Hindlip Church of England First School.
        The Petitioner therefore requests that the House of Commons supports the recommendations of the North Claines Parish Council that Worcestershire County Council "Safer Routes to School" measures for Hindlip Church of England First School be accepted along with the following additions:—
        A further speed reduction to 20 mph outside Hindlip Church of England First School.
        The 30 mph limit extended past Hindlip Hall Drive towards Sandyway Cottages.
        A pelican crossing installed at an appropriate point as there is no "lollipop person" at Hindlip Church of England First School.
        And the Petitioner remains, etc.
        To lie upon the Table.

    Stroke Victims
    Motion made, and Question proposed, That this House do now adjourn.—[Mr. Kemp.]
    7.17 pm
    Mr. Jim Cunningham: I thank the Speaker's Office for granting me this important debate. I am grateful for this opportunity to raise the issue of the support services available to the victims of strokes.
    Let us first be clear what we are talking about. Each year more than 100,000 people in England and Wales have a first stroke. About 10,000 of them are under retirement age. There are 200 strokes each week in those under 55, and there are close to 60,000 deaths due to strokes each year.
    Stroke is the third most common cause of death in England and Wales after heart disease and cancer. It accounts for more than 8 per cent. of all deaths in men and 13 per cent. of deaths in women in England. The cost of stroke to the nation in terms of health and social care is estimated to be more than £2.3 billion. That is 5.8 per cent. of total national health service and social service expenditure. The total cost of stroke care is expected to rise in real terms by around 30 per cent. by 2023.
    Most important for the purposes of this debate, stroke is the largest single cause of severe disability in England and Wales, with 300,000 people being affected at any one time. About a third of people who have had a stroke die within a year, a third make a good recovery and a third are left with a serious disability.
    Over the last 20 years, a number of small, randomised controlled trials for stroke units have been conducted. These trials show that stroke units reduce mortality and disability compared with management in acute general medical wards. No other treatment for stroke has demonstrated such large benefits. It is imperative that all victims of stroke, no matter where they live, be treated in a stroke unit. That is just not happening at the moment.
    The Royal College of Physicians sentinel audit has shown that only 26 per cent. of patients are accessing such treatment. Even those hospitals that have a stroke unit often have insufficient beds to accommodate all their stroke patients. That means that some patients are treated in general wards just paces away from the specialist care that they need. In Coventry, we are fortunate to have a stroke unit at the Walsgrave university hospital. However, it is estimated that at least five people continue to die each day and seven require institutional care because they could not receive care in a specialised unit.
    I welcome the Government's commitment to improving the care of those affected by stroke as laid out in the national service framework for older people. I particularly welcome their commitment to stroke victims receiving treatment from specialist stroke teams in designated stroke units. The framework, which has been endorsed by the Stroke Association, provides an excellent care standard for victims of stroke. Should any of those near and dear to me suffer stroke, I would rest easier knowing that their care was based on that outlined in the document.
    The first milestone in the implementation of the framework has already passed—by last month, every general hospital should have had a plan in place to introduce a specialised stroke service. That is where my

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    concerns about the Government's approach to stroke services begin, because progress towards that milestone is not yet known. I take this opportunity to ask my hon. Friend how the Department of Health is monitoring progress in this area and what mechanisms it intends to use to ensure that the milestone is reached. It is vital that hospitals that have yet to introduce a plan are supported and, dare I say it, compelled to introduce one.
    We should welcome the publication of the national framework, but the Government must do more. I am concerned that no resources have been made available for hospitals to pump-prime stroke units or to increase the size of a unit to accommodate all patients. Obviously, the success of stroke units depends on adequate staffing of the multi-disciplinary team, ideally comprising specialist nurses, a specialist physician, a speech therapist, a dietitian, a clinical psychologist, a pharmacist and a social worker. It is essential that the Government ensure that there are sufficient numbers of therapy staff to support stroke victims in making the best possible recovery. Health care professionals need to be encouraged to specialise in those fields.
    Strokes primarily affect older people, and with an ageing population we can expect their incidence to increase in coming years. I welcome the work that the Government and the Stroke Association are doing on stroke prevention. I particularly welcome the Stroke Association's work on stroke prevention in the Afro-Caribbean population. Afro-Caribbean people are twice as likely to have a stroke as those of European origin, and are more likely to have their first stroke at an early age. Although research is under way to try to explain that, the Stroke Association is not waiting for the results, but is conducting a major campaign to raise awareness within the community. It should be congratulated on that initiative.
    It is important to recognise that investment today in adequate stroke units across the country will reap huge rewards in the future for individual patients and the public purse. There is a danger, however, that stroke is seen only as an older person's condition, especially as the stroke standard is contained within the national service framework for older people. A significant number of younger people and children suffer, and will continue to suffer, from strokes. It is vital that the needs of young people are acknowledged and that appropriate treatment and support is available to them as part of a comprehensive stroke service. The Stroke Association has raised concerns with me about the extent to which the stroke standard is being applied to the care of younger patients. How does the Minister's Department plan to ensure that young stroke victims receive specialist care?
    I reiterate the importance of this subject. We are all aware of the demographic time bomb, and if we fail to take action now, we are storing up huge problems for the future. Although I hope that the prevention programmes in place today will reduce the numbers who fall victim to stroke, realistically we must expect more and more stroke patients over the coming years. Patients of the future are entitled to expect the best possible care—that is, through being treated in a stroke unit.
    I have some questions for my hon. Friend. How is the Department of Health monitoring the progress of hospitals' plans to introduce stroke units? What is the
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    Department doing to encourage health care professionals to specialise in the field of stroke care? What plans does she have to provide assistance for existing stroke units to expand? What is the
    doing to encourage health care professionals to specialise in stroke care? What plans does she have to provide assistance for existing stroke units? Finally, how does her Department plan to ensure that young stroke victims receive specialist care? Stroke victims across the country await the Minister's response.
    7.24 pm
    Mrs. Claire Curtis-Thomas: I start by offering warm congratulations to my hon. Friend the Member for Coventry, South (Mr. Cunningham) on securing this important debate. As he said, stroke affects thousands of people in this country every year and affects some families more than others. I welcome his support for the Stroke Association, which does a great job in my community and in communities throughout the United Kingdom, not least in providing sometimes very distressed family members with vital information when they need it most, sometimes when consultants are too busy or no specific consultant is available to advise on stroke. The association is there to help people and to guide them through a very troubling time.
    Difficulties sometimes start in hospitals where patients are not placed in appropriate facilities—a stroke unit is not available and they have to go into general wards—and may continue long after the patient is discharged, sometimes into communities without appropriate facilities for people with stroke and perhaps an absence of physiotherapy services as well. In our community in the north-west, care is sporadic. I endorse the sentiments expressed by my hon. Friend and ask the Minister to reassure us about the implementation of the stroke plan, with particular reference to hospitals and stroke units.
    Some hospitals are engaging in research activity on stroke. That is welcome. A local hospital, Aintree university hospital, has such a research facility. I recently visited it, and was delighted to hear that the stroke unit had received £1 million for research. I thought that that was rather a small amount of money for one year, and asked how it had been spent over the course of the year. I was told that it had been spent over a period of six years. One million pounds over six years does not a lot of research make. There is a desperate need to do far more research, because intervention and good management can lead to a good prognosis for many people who endure a stroke.
    However, the argument is not just about money—it is far more complex than that. There is an acute shortage of appropriately qualified and motivated individuals who want to embark on work on this condition. Will the Minister touch on the initiatives that her Department is engaged in, first, to make more research funding available for people interested in stroke and in developing good outcomes for stroke victims and, secondly, to stimulate the clinical world's interest in stroke?
    I want to say a few words about educating the public on what they can do to minimise susceptibility to stroke. Far too few people understand that salt is a significant factor in stroke, as is hypertension. Although we have started to educate the public on both those factors, far more work remains to be done. Unfortunately, it is often

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    only when people have suffered a stroke that they discover that they could have taken several simple measures to reduce their risk. Will the Minister tell me what has been done to improve the information available?
    7.28 pm
    The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears): I commend my hon. Friends the Members for Coventry, South (Mr. Cunningham) and for Crosby (Mrs. Curtis-Thomas) for securing and contributing to this important debate. The management of stroke is an important aspect of health care, and I welcome the debate, not least because it gives me an opportunity clearly to explain the Government's policy and how we are helping to make progress in this crucial area.
    Stroke is an illness in which part of the brain is suddenly severely damaged or destroyed. The result is loss of function of the affected part of the brain. It usually causes weakness and paralysis of parts of the body, and in some cases, disturbance of vision and of speech. Stroke is the United Kingdom's third biggest killer and largest cause of serious disability.
    During the 1990s, death rates from stroke fell by just over a third, having been falling continuously since the 1960s. However, although the figures have been coming down for several years, in 2000 the figure still stood at 19.9 deaths per 100,000. Although the majority of strokes affect older people, they can affect people at any age, and the consequences of a stroke for a young person are especially devastating.
    My hon. Friend the Member for Coventry, South asked what was happening about strokes and young people. The standards set out in the national service framework for older people apply equally to services for young people. They are not exclusively for older people. It is the responsibility of each coronary heart disease team and primary care trust to work together to ensure that they develop services that are appropriate to younger people. Involving patients in designing those services will help to make them more accessible and responsive. The health service often puts people into categories, such as older people or younger people, and the right services are not always available. That is particularly true of adolescents, who find that the services available are often not appropriate to their needs. Involving those patients will be a key consideration.
    The Government are committed to reducing the number of disabilities and deaths that result from strokes. We are making changes and improvements in access to, and delivery of, effective care and treatment. That includes the key priorities of prevention and education about risk factors. It also relates to the care and rehabilitation services that people receive immediately following a stroke, which make a difference to the quality of life that stroke victims experience.
    On funding, substantial new investment in health and social care services was announced in the Budget. The NHS will receive an annual average increase of 7.5 per cent. above inflation over the next five years. That represents an increase of about £34 billion and is the highest sustained growth in funding that the NHS has ever received. There will be a similar increase over the next three years of 6 per cent. in real terms for social services, which are just as important to people who suffer strokes as acute medical services.
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    My hon. Friend the Member for Crosby made the important point that the problem is not just one of investment; we also have to consider the capacity of the staff who work in the system. We are acutely aware that we need to boost the number of staff who are available to treat people in the NHS. The NHS plan makes it clear that we need a huge increase in consultants across the board if we want to have a consultant-led service. The target was initially set at 7,500 extra consultants by 2004. The recent Budget announcements have allowed us to roll that target forward and we now want to recruit at least 15,000 more doctors—consultants and GPs—over the 2000 baseline by 2005.
    We are not just providing more doctors. Between September 2000 and September 2001, the number of qualified nurses employed in the NHS increased by 14,400, which is about 4.3 per cent. However, the Budget has allowed us to forecast a further increase of 35,000 more nurses by 2008. Again, we are trying to get qualified staff into the system as soon as possible.
    Therapists are particularly important for people who have suffered strokes because they help with their rehabilitation. There will be 6,500 more therapists and other health professionals working in the NHS by 2004. There will also be an extra 4,450 training places. In the past, we failed to invest in training people in the system or we cut training places. The therapists will include physiotherapists, occupational therapists and speech therapists, who are particularly important for stroke victims. Many of the stroke victims I met said that had they received speech therapy at an early stage in their treatment, their quality of life—in particular their communication with their families, friends and neighbours—would have been greatly enhanced.
    I recently met an elderly lady who had recovered from a stroke. Before her stroke, she used to get a great deal of pleasure from completing crosswords, which formed a large part of her life. Following her stroke, she lost the ability to spell, which left a big hole in her leisure time. I managed to enrol her in classes for literacy and spelling, and she is well on the way to being able to complete crosswords again. The NHS would not necessarily have thought of providing her with educational support to ensure that her skills went back to the levels at which they were before she suffered her stroke. It is important that we are more imaginative about the services and links that we provide for rehabilitation.
    We want to deliver a patient-centred service. That is a big challenge for us—nowhere more so than in services for people who have suffered strokes. We have a 10-year programme to provide extra investment and to reform the service. We need to increase capacity but we also need to look more creatively at the services that we provide. However, the extra funding will help us to deliver the national service framework for older people, on which clinical services for strokes will be centred.
    We want to ensure that patients can return as far as possible to the lifestyle that they enjoyed before their stroke. Work on the national service framework will help us to achieve that. Many of the policies that we are developing, such as helping people to give up smoking, promoting healthy eating, encouraging people to increase their physical activity and reducing the number of overweight people, especially those who have problems with obesity, will help to reduce the incidence of stroke and to tackle heart disease.

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    It is important to prevent and limit the burden that strokes impose on the people who suffer them and, crucially, their carers. A huge responsibility is put on the families and friends of those who have had a stroke. We recognise that in the White Paper "Saving Lives: Our Healthier Nation", in which we identify heart disease and stroke as priorities for positive action to improve prevention. We set a target to reduce stroke mortality by at least a further third by 2010, using 1996 as a baseline. We are trying to build on recent reductions in mortality from strokes, and we have set a challenging target to reduce that even further.
    Although we might reduce the number of people who have strokes, we must not forget that stroke victims still need a wide variety of services. Some people need acute care immediately following their stroke. Depending on the severity of the stroke, they will need a programme of rehabilitation to help them optimise their independence afterwards. Services for older people, especially stroke victims, were not always the most attractive parts of the health service and did not necessarily draw in clinicians. I am pleased to say that that is changing and we are developing good doctors, consultants, nurses and therapists who are committed to team working when helping stroke victims. I have seen evidence showing that when rehabilitation services work together, they have a huge impact on someone's quality of life in years to come. That intervention has to be at the earliest possible opportunity. If we leave problems for a long time, there is a corresponding reduction in the quality of life. Ensuring that different members of the team work together, and work quickly, is a priority.
    Clearly, stroke is a medical emergency. The majority of patients are admitted to acute medical wards from accident and emergency departments. The aim of initial treatment is to stabilise the patient and reduce the risk of fatality; to reduce the prospect of major disability; and to prevent secondary strokes, which happen far too often and affect someone's quality of life enormously. The development of stroke services—the team working—has brought about an enormous change in the care of stroke patients. There is growing evidence that dedicated care improves outcome, reduces mortality and is cost-effective. Specialisation of nursing staff is a key factor in a successful stroke unit.
    The latest development of stroke care was contained in the national service framework for older people, published in March last year. That sets specific standards and milestones, to which my hon. Friend the Member for Coventry, South referred. It establishes the development of integrated stroke services and improvements in the delivery of stroke care as a priority. I am pleased to say that the NHS priorities and planning framework for 200203 reinforces the high priority given to delivery of the milestones set in the national service framework. The health service used to have a wide range of priorities—probably far too many, in fact. Having a smaller number of priorities should enable the NHS to deliver better on the targets that we set, and stroke care is one of those high-priority targets.
    Mr. Jim Cunningham: Will my hon. Friend say more about numbers of social workers? How many specialist
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    units have been established and where are they? My hon. Friend knows that provision throughout the country is patchy.
    Ms Blears: I understand my hon. Friend's concern about the inconsistency in the way in which the units have been established. I understand that the results of monitoring will be available later this summer, so in the next couple of months we should get a clear picture of where services have been established, where they are planned but not yet up and running, and where we need to ensure that they are provided.
    I know that the way in which monitoring will be carried out in future is a particular concern. In future, strategic health authorities will monitor the performance of acute trusts and primary care trusts in delivering the national planning priorities. Therefore, there will be a performance management route through the system, so that we can see where things are happening, and, where nothing is happening, take action through investment and creation of services on the ground. In future, the levers will be at strategic health authority level, rather than in the centre at the Department of Health. That is part of our drive to ensure that while the Department does not micro-manage the service, the service is managed according to the national standards and frameworks that we set. I assure both my hon. Friends that the matter is covered in the national priorities and planning framework and that it will be performance-managed to ensure proper performance in every community.
    The aim of the stroke standard is to reduce the incidence of stroke in the population; to ensure that those who have had a stroke have prompt access to integrated stroke care; and to take action to prevent strokes, working in partnership with other agencies where that is appropriate. We are determined to ensure that people who have had a stroke have prompt access to diagnostic services; that they are treated appropriately by a specialist stroke service; and that subsequently they, with their carers, participate in a multidisciplinary programme of secondary prevention and rehabilitation.
    Recently, I visited a beacon stroke service in the south-west which is attended by people who have had a stroke and their carers, so that they can learn together about the action that they can take to maximise the extent of rehabilitation and the mobility, speech and basic skills regained by the person who has had the stroke. I met an incredibly impressive husband-and-wife team who, as a result of their involvement with the stroke service in their area, resolved to set up a self-help group in their community. The stroke service was able to help them to set up this entirely new group, which could go on to help others in the community. I was impressed by that close collaboration between people who had had strokes, their carers and their wider family. That provides a good model for us.
    The standards in the national service framework will be supported by wider action and development work on the elimination of age discrimination; the delivery of person-centred care through the single assessment process, which will apply to older people across health and social care, so that in future those involved in social care are involved in assessment as well as the NHS; the delivery of intermediate care services to promote faster recovery from illness and to prevent acute hospital admissions; and improving access to appropriate specialist

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    care in the best hospital environments. Each of those standards has a contribution to make to the care of stroke patients.
    Mr. Cunningham: Does my hon. Friend intend to speak about the Afro-Caribbean community—an issue that was drawn to my attention a couple of weeks ago? I am sure that she is aware that the Esaba Afro-Caribbean women's group in Coventry was involved in a pilot scheme during stroke week, which was last week.
    Ms Blears: I am aware that certain groups in our community are particularly susceptible to certain conditions. A challenge facing all of us—not only those involved in stroke services but everyone involved in NHS provision—is to make sure that services are accessible, responsive and appropriate to the needs of a far more diverse and varied community than before.
    The constituency group my hon. Friend mentions provides evidence of the way in which dramatic changes to services can be achieved when patients, their carers and their families are involved. The people with the best ideas for change are usually those who are at the sharp end—they know their illness better than any expert specialist, because they live with it every day. My Department is developing the expert patient programme, which covers a wide range of conditions including arthritis, diabetes and stroke. That programme will help to develop patients' skills in helping themselves and others. My hon. Friend's constituency group provides an excellent illustration of the way in which local people can influence the shape of health services in their community. I undertake to find out details of that project and to feed them into the development of policies within the Department.
    The milestones for action were set from April this year. They are being monitored now and we should have the results very soon, which will enable us to see where specialised stroke services have been established. By April next year, all hospitals will have to have established clinical audit systems that ensure delivery of the Royal College of Physicians clinical guidelines for stroke care. By April 2004, PCTs will have to have linked with local specialist stroke services to ensure that general practices can identify, manage, treat and refer through agreed protocols. In that way, we will establish services at all levels—primary care, secondary care, and rehabilitation and community care—thus providing a seamless service for people with stroke.
    Mrs. Curtis-Thomas: Recently, and to his great misfortune, a member of my staff succumbed to a second stroke, having had his first four years ago. Unfortunately, his prognosis is extremely grim. The problems he has experienced are familiar to me because this awful affliction has affected several members of my family.
    From meeting this man's family and others, I have become concerned about the fact that when stroke strikes, people who have never been in that position before have no idea what type of services they can expect. This dear man is expected to leave hospital very shortly—the hospital can do no more for him, nor can physiotherapy—and his wife feels that she has been abandoned. She
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    desperately wants to look after him at home, even though that will be extremely difficult, but she believes that social services are likely to tell her, "We're terribly sorry, but that's not an option. Your husband has to go into care because we're not prepared to fund the support that you need at home."
    What can I say to that woman? Can I say, "If you want to nurse your husband—our dear friend—at home, you can do so and you will have the support of social services", or is there a class of individual who will invariably be consigned to a nursing home—
    Mr. Deputy Speaker (Sir Alan Haselhurst): Order. The hon. Lady cannot make a second speech during an intervention.
    Mrs. Curtis-Thomas: I apologise, Mr. Deputy Speaker. I hope that my hon. Friend the Minister is able to respond to the case that I have outlined.
    Ms Blears: My hon. Friend gives a poignant illustration of the difficulties that people experience when seeking post-hospital care. The introduction through the national service framework of the single assessment process, which involves the NHS and social care, should ensure that people do not fall through the net. Closer integration and working between those two arms of the service will be key. In some circumstances, the assessment may indicate that residential care is the appropriate course of action. I have no knowledge of the personal circumstances of those involved in the case my hon. Friend describes, but in some cases residential care is appropriate. What is important is that the family, the carers and the person who has had the stroke are involved as far as possible in reaching what are extremely difficult and important decisions.
    The involvement of specialist nurses is also important, as experience of other conditions such as cancer has shown. Macmillan nurses are able to assist people with home care, and the principles that govern their activities are equally applicable to a range of different conditions. Specialist help from people who have a wide range of knowledge and previous experience can help to guide and shape the services that should be established. Certainly, stroke services are not as well developed as cancer services, which have been in place for many years, so we need to look at developing them.
    We have just embarked on a 10-year programme on the national service framework stroke standard. As it develops, I hope that fewer people will have a first or repeat stroke because there will be early identification and preventive action, and that there will be general advice and support on how to reduce risks; access to specialist stroke services, based on best evidence; better care and better outcomes to reduce death and disability from stroke; co-ordinated rehabilitation to improve people's chance of regaining independence; and support for carers.
    As I said, it is important that standards in the national service framework for older people inform services provided for younger people in an age-appropriate setting.

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    We are acutely aware that the organisation of stroke care across the country remains variable, and there is still much to do to ensure that services are consistent and that people can access them. In Coventry, there are 10 beds in a dedicated stroke unit at University Hospitals Coventry and Warwickshire NHS trust, supported by a stroke co-ordinator, a consultant leader and a professor of age-related medicine, which represents good progress.
    Approximately 1,000 patients a year are admitted to that hospital with stroke-related disease, but only 30 to 40 per cent. of them go through the dedicated unit, which has a very high occupancy rate. It is recognised that that low coverage of at-risk patients is not desirable, so more efficient use of beds is being examined. However, the stroke co-ordinator's role ensures that all patients admitted to hospital with stroke-related disease receive appropriate care, although there is more work to be done on getting people into the specialist unit. The primary care trust in the area is running an experimental national programme for stroke care called Smartcare, which aims to smooth out the early identification of stroke and the management of treatment across primary and secondary care. It tries to make those processes seamless so that people do not fall through the net. The two-year programme has already begun and we hope to learn national lessons from it.
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    I hope that my hon. Friends the Members for Coventry, South and for Crosby agree that the Government are committed to improving services for all NHS patients, including those who have had strokes. We have invested substantial extra funds in the NHS and intend to invest even more over the next five years. For people with stroke, initiatives such as the national service framework will do much to drive up standards of care. The improved standards will apply to stroke patients across the country, whatever their age.
    I am delighted that my hon. Friends have raised this issue, which is of great concern to patients and their families. As I said, we have made progress, but we have a long way to go before we can be proud of services in every part of the country. However, shining a light on something which, in the past, may have been a Cinderella service is welcome; it can do nothing but good, draw clinicians and researchers together, and help to make the service a priority. When good teamwork and specialist clinicians are involved, there is evidence that the outcomes for people who have suffered a stroke are a lot better than many of us may expect in the early days. I am therefore delighted that my hon. Friends have participated in our debate, and I hope that they accept that we are making progress on aims that we all share.
    Question put and agreed to.
    Adjourned accordingly at seven minutes to Eight o'clock.