§ Amendments made: No. 319, in page 152, line 14, at end insert
|'Children Act 1989 (c. 41)||Section 14G.'.|
|No. 300, in page 153, line 30, leave out from beginning to end of line 28 on page 157 and insert—|
|Reference||Extent of repeal or revocation|
|National Health Service (Amendment) Act 1949 (c.93)||The whole Act.|
|Parliamentary Commissioner Act 1967 (c.13)||In Schedule 3, in paragraph 8(1), "the Dental Practice Board or".|
|Health Services and Public Health Act 1968 (c.46)||In section 59(2A), "section 28C of the 1977 Act,".|
|In section 63(2)(ba), "section 28C of the 1977 Act or".|
|House of Commons Disqualification Act 1975 (c.24)||In Schedule 1, in Part 3, the entry relating to the Chairman or Vice-Chairman of the Dental Practice Board or member of that Board appointed at an annual salary.|
|Race Relations Act 1976 (c.74)||In Schedule 1A, in Part 2, the entry relating to the Dental Practice Board.|
|Patents Act 1977 (c.37)||In section 56(4)(a)(ii), "section 28C of the 1977 Act,".|
|National Health Service Act 1977 (c.49)||In section 3(3), "medical, dental,".|
|In section 18A(3)(a), "general medical, general dental,".|
|In section 26(2)(a) and (4)(a), "general medical services, general dental services".|
|Section 28C(3) and (7).|
|In section 28D(2), the
definitions of "qualifying
dental practitioner" and
|In section 28E—
in subsection (2), paragraph
(b) and the words following
subsection (3)(f), (g) and (j);
subsections (5) to (8).
|Sections 28F to 28H.|
|Sections 29 to 37.|
|Section 43ZA(3)(a) and (b).|
|In section 43C(3), in the
definition of "Part II services"
the words "general medical
services, general dental
|In section 43D—
in subsection (1), "general
medical services, general dental
subsection (10)(a) and (b).
|In section 44—
subsections (ZA1) to (B1);
|In section 45—
subsection (1ZA)(b) and the
in subsection (1A),
"Strategic Health Authority";
in subsection (3), "general
medical services, general dental
Section 49F(1)(a) and (c).
|In section 49H(1)(a), "or a
|In section 52, "general medical
services, general dental services,".
|Section 56(a) and (b).|
|In section 72(5)(a), ", dental
|In section 78—
in the side-note, "dental or";
subsections (1A) and (2).
|In section 98—
subsection (1)(e) and the
in subsection (4), in
paragraph (a), the words from
", other than" to the end, and
|Section 99(1)(f) and the
|Section 100(1)(e) and the
|Section 102(1)(a)(iii) and (iv)
and (2)(b) and (c).
|In section 103(1)(a), "or in
accordance with section 28C
|In section 126(4), the words
from "regulations made under
section 32" to "or to"
In section 128(1)—
|the definitions of "dental
corporation", "medical list",
"personal dental services" and
"personal medical services";
in the definition of "terms of
service", the words "general
medical services, general dental
|In Schedule 1—
in the title, "and their
education in dental health";
in paragraph 1(a), "or
dental" and "or for education
in dental health".
|In Schedule 12—
in the heading preceding
paragraph 2, "dental or";
in paragraph 2, sub-
paragraphs (3) to (7) and, in
sub-paragraph (8), the words
from "and, in the case of" to
paragraph 3 and the
paragraphs 6 and 7.
|In Schedule 12A—
paragraph 1(2)(d) and the
paragraph 2(2)(c) and the preceding "or";
paragraph 4(2)(b) and the
paragraph 5(2)(b) and the
paragraph 6A(2)(d) and the
paragraph 6B(2)(c) and the
|National Health Service
(Scotland) Act 1978 (c.29)
|Health Services Act 1980 (c.53)|
|In Schedule 5, paragraphs 2(3)and 4.|
|Health and Social Services and
Social Security Adjudications
Act 1983 (c.41) Section 14(1).
|In Schedule 6, paragraph 2.|
|Medical Act 1983 (c.54) In
section 11(4), in the definition
of "medical practice"—
in paragraph (a), "Part II of
the National Health Service
in paragraph (b), "section
28C of the 1977 Act,".
|In Schedule 5, paragraph 16(a).|
|Dentists Act 1984 (c.24) In
section 40(2)(ab), "section 28C
of the National Health Service
Act 1977 or".
|In Schedule 5, paragraph 8.|
|Health and Social Security Act
1984 (c.48) In Schedule 3,
|Income and Corporation Taxes
Act 1988 (c.1) Section
and Patents Act 1988 (c.48) Section
|Health and Medicines Act
1988 (c.49) In section 2(1)(a)—
in sub-paragraph (i), "Part II
of the National Health Service
|Act 1977 or";
in sub-paragraph (ii),
"section 28C of the 1977 Act
|In section 8(1)—
in paragraph (a), "section 29
of the National Health Service
Act 1977 or";
in paragraph (b), "section 36
of the National Health Service
Act 1977 or".
|In section 12(1)—
"The Dental Estimates
Board shall be renamed as "the
Dental Practice Board" and";
in paragraph (a), "for any
reference to the Dental
Estimates Board there were
substituted a reference to the
Dental Practice Board and";
in paragraph (b), "the
Dental Estimates Board or"
and "the Dental Practice
|Section 12(2) and (3)(a).|
|In section 17—
in subsection (1), "29, 36";
subsection (2)(b) and the
|In Schedule 2, paragraphs 4 to
6, 7(1) and (2) and 8(2) and (3).
|National Health Service and
(c.19) In section 4(2)(g), "the
Dental Practice Board or".
|Sections 23 and 24.|
|Access to Health Records Act 1990 (c.23) In section 7—
in subsection (2), the words
from "(other" to "section
|In section 11, the definition of
|Trade Union and Labour
1992 (c.52) In section 279(a),
"28C, 29, 35".
|Health Service Commissioners
Act 1993 (c.46) Section 2(1)(f).
|In section 6(5), "29, 36".|
|Health Authorities Act 1995
(c.17) In Schedule 1,
paragraphs 18 to 26.
Performance) Act 1995 (c.51)
In the Schedule, paragraph 28.
|Employment Rights Act 1996
(c.18) In section 43K(1)(c)(i),
|National Health Service
(Primary Care) Act 1997 (c.46)
|Section 40(1) and (3).|
|In Schedule 2, paragraphs 6, 8
to 12, 16 to 19, 24, 25, 71 to 73,
80 and 81.
|Health Act 1999 (c.8) Section|
|Section 9(2) and (3).|
|In section 10(1)—
in the section 43A inserted
into the National Health
Service Act 1977, in subsection
(1), "general medical services,
general dental services,";
in the section 43B so
inserted, in subsection (6), the
words from "Subject to" to
|Section 39(2) and (3).|
|In section 61(2), the words
from ", or Part 1" to "1997,".
|In Schedule 3, paragraph 11(3).|
|In Schedule 4—
in paragraph 2, "section
29(4) of the 1977 Act and";
paragraphs 17 and 88.
|National Assembly for Wales
(Transfer of Functions) Order
1999 (S.I.1999/672) In
Schedule 1, in the entry for
1977, paragraphs (c) and (e).
|Freedom of Information Act
2000 (c.36) In Schedule 1, in
in paragraph 44, "general
medical services, general dental
|Health and Social Care Act
2001 (c.15) Section 15.
|Sections 17 and 18.|
|Section 20(2) to (4).|
|Section 22 Section 23(2) and (3).|
|In section 41(1)—
in paragraph (a), "(provision
of personal medical or dental
paragraph (b) and the
|In Schedule 5, paragraphs 5(4)
to (7), 11(2) and (3) and 12(2).
|National Health Service
Reform and Health Care
Professions Act 2002 (c.17)
|Section 5(2), (3) and (6)
In section 17(1)(g), the words
from "or under" to "that Act".
|In Schedule 1, paragraph 17.|
|In Schedule 2, paragraphs 3 to 10 and 72.|
|In Schedule 3, paragraphs 2 to 6, 10 and 15 to 17.|
|In Schedule 8, paragraph 2.|
§ Note The repeals in this Part of this Schedule to the following enactments extend to England and Wales only—
- (a) the National Health Service (Amendment) Act 1949 (c.93);
- (b) the Access to Health Records Act 1990 (c.23);
- (c) the National Health Service (Primary Care) Act 1997 (c.46) and enactments amending that Act.'.
§ Order for Third Reading read.-[Queen's Consent, on behalf of the Crown, and Prince of Wales's consent, on behalf of the Duchy of Cornwall, signified.]1082
§ Motion made, and Question proposed, That the Bill be now read the Third time.—[Dr. John Reid.]
§ 8.6 pm
§ The Secretary of State for Health (Dr. John Reid)
As several speakers have said, there is never sufficient time to examine and debate a subject as important as this, but today's has been a long debate that is the culmination of previous long discussions.
§ Mr. McLoughlin
The Secretary of State said that there can never be sufficient time to deal with this subject, but the other place will not have a time restraint put on it. Does the right hon. Gentleman not find it rather odd that the elected House is timetabled, yet the unelected House can speak on the Bill for as long as it likes?
§ Dr. Reid
Of course the other House is constrained by its own conventions. I do not know whether the hon. Gentleman was making a threat; I suspect that he was. If so, I remind him that this House—specifically the majority of this House who form the Government—has a mandate from the people of this country, especially when it comes to decentralising power and modernising the national health service.
§ Dr. Stoate
Does my right hon. Friend agree that the real issue surrounding the Bill is that people deserve a modern health service that is accountable to the people and gives them more flexibility, more control over local services and more choice? That is what this Government are trying to do. The Opposition are trying to get rid of the health service and privatise it, while we want to modernise it and bring it into the 21st century to provide the level of care that people deserve.
§ Dr. Reid
Even though I am well used to the articulacy of my hon. Friends, I am sometimes astounded by just how articulate and on the mark their comments can be. I could not have put it better myself.
1083 I begin by paying a courteous tribute to my predecessor, my right hon. Friend the Member for Darlington (Mr. Milburn) for all his work, and to my Ministers, especially the Minister of State, my right hon. Friend the Member for Barrow and Furness (Mr. Hutton), who has performed so admirably today. I say with total modesty that he has carried the weight of the Bill. He is a great asset to me, my team and the Government.
The Government have a proud record of investing in and developing the national health service. That is not only because politically it is a child of the movement, but because morally it has long been at the centre of our values that no one in this country should be deprived, through lack of finance or station in life. of health care when needed, free at the point of need. Such a national health service, through collective provision, is increasingly not only a moral but a circumstantial imperative. As our health becomes more predictable through advances in genetics—they may not become definitive for some considerable time but they must be taken into account—the NHS becomes more, not less relevant. That is especially true when the health service is compared with private health insurance. Any health insurance actuary who is doing his job will give the minimum coverage to those who need it most. Actuaries are paid to do that. [Interruption.]
Mr. Deputy Speaker
Order. The Chair frowns on electronic devices in the Chamber. I wish hon. Members would ensure that they were turned off before they came into the Chamber.
§ Dr. Reid
I was explaining why the NHS is so important to us and why we are intent on ensuring that it will be as effective and well supported in future as it has been in the past.
We introduced the Bill because the same strong belief in the values that drove the architects of the NHS endure to persuade me, the Government and, I hope, all other Labour Members to support the measure.
§ Dr. Reid
The hon. Gentleman may point to differences in the Labour party, and I would be the last to deny them, but they are as nothing compared with the yawning chasm between all Labour Members and the hon. Gentleman over the real dividing line: our insistence that everyone in this country has health care when it is needed, free at the point of need. I shall refer to that later.
The Bill and the changes in it are intended to ensure that the NHS survives and thrives for future generations as it has done for the past six decades—three or four generations. We intend it to serve our children and grandchildren as it served our parents and grandparents: as a national health service free at the point of need, without regard to background or station in life.
Our challenge, the response to which is enshrined in the Bill, is to ensure that the same values that underpinned the NHS remain in a service that fulfils the rising expectations and ambitions of current and succeeding generations. The Labour party, which forms 1084 the Government, can claim to have been a central dynamo over the past century in ensuring that the influence as well as the affluence of working people in this country increased with each generation. We rejoice that one of the effects is that their expectations and ambitions increase with every generation. Our job is not only to provide a socially just system of Government and public service but to develop that system and service for each generation.
It is the job of those of us who believe in the NHS to ensure that people's desired choice and increased expectations can be fulfilled in the NHS. Otherwise, we will do the NHS a great disservice. As people in this country become better off, they will make choices, fulfil their ambitions and have their expectations met. They will do that because, as their expectations rise, increasing financial affluence allows them to make choices. It is our job to ensure that we develop a national health service in which expectations can be met rather than forcing those who wish to fulfil their ambitions to go outside the NHS.
§ Mr. Graham Allen (Nottingham, North)
Will my right hon. Friend consider that a key factor in providing such a health service and such choices might be a period of stability, not least for him and his new, welcome Front-Bench team, thus allowing people a year or possibly two in which the many changes that have been introduced in recent years can bed in, and letting staff and patients use the NHS in the way he outlined?
§ Dr. Reid
I have discussed the matter with my hon. Friend. We do not agree about everything but I take the sense of his point. However, I cannot say to any organisation—my party, Parliament or the services that serve the people of this country—that it can exist in a world that does not change. As one old philosopher said, the only constant is change. I cannot promise that the NHS will be isolated from the necessity to change. I take my hon. Friend's point that sudden lurches and changes in direction, pulling back and stopping and starting are most debilitating for a service that wants to use the increased capacity that we are providing to the best effect. I was therefore pleased to tell the NHS Confederation last week that, although in a sense the big challenge is that change occurs, the good news is that the direction of change will not shift. In partnership, we want to work out how we can increase the momentum of that change, but I take my hon. Friend's point that we do not want yet another road map, road sign and direction for everyone.
It is important to recognise that, whatever our differences over introducing change, they are minuscule compared with the big debate about the essential nature of the health care system that future generations will inherit. Not everyone wants us to succeed in the task of modernisation because not everyone shares the values on which the NHS is based. Those values are under attack from the Opposition who want to introduce finance into the relationship between doctor and patient. The Conservative party is capable of reducing the highest moral values to the cash nexus. It has a genius for that, despite the fact that we know from experience how that affects the human condition. For example, the United States has a health system that the 1085 Opposition greatly admire, and no less than 40 per cent. of all personal bankruptcies are attributable to people's inability to find the money to pay for their health care.
§ Dr. Fox
I hope I can save the Secretary of State time by stopping him peddling the myth that Conservative Members are attracted by the American system. We have gone out of our way to say that we are not attracted by it. But we are very attracted by the social insurance systems of other European countries. Why do the Chancellor and the Secretary of State insist, Don Quixote-like, on chasing monsters that they have imagined?
§ Dr. Reid
That is an interesting intervention. I believed that the hon. Gentleman was pledged to a system of patient passports, as he calls them—vouchers that are equal to approximately 60 per cent. of the cost of an NHS operation. That would be given to individuals at the same time as the Conservatives would cut—
§ Dr. Reid
The hon. Gentleman mentions Finland and the Netherlands. I like the British NHS. It has served us well. The idea of eager little Tory Front-Bench spokesmen scuttling around Finland doing a little fishing and trying to pick up an NHS that is better than ours is mind-boggling. However, the Opposition plough ahead with a plan that would mean that patients, including pensioners, have to pay up to £4,000 or £6,000 for a hip operation and £1,000 to £2,000 for a cataract operation. That is their PPP—poor pensioners paying for Tory health policy.
§ Dr. Fox
Our politics have reached a sad state when, rather than defending his own Bill, a Minister goes off at a tangent and starts referring to utterly untrue allegations about what the Opposition have said. What we have said is perfectly clear: we have said that patients will be entitled to free care in the NHS in their own or any other hospitals when that is what they want. Only if they themselves decide to go outside the NHS will they get some of their own tax back to help them—and that is something they are denied by the present Government.
Mr. Deputy Speaker
Order. Be fore the Secretary of State responds, I should point out that Third Reading debates are designed for debate of the content of Bills. Perhaps hon. Members on both sides of the House could now do just that.
§ Dr. Evan Harris
One part of the Bill reconfirms the existence of dental charges. Let me ask a serious question. I accept that the Secretary of State is genuinely concerned about lack of wealth being a barrier to access. Has he reflected on a report by the National Association of Citizens Advice Bureaux which shows that charges for health care can deter people from seeking treatment? It seems that about 750,000 people in England and Wales do not obtain their prescriptions because of the cost involved. Does the Secretary of State propose to do something about that problem of access, based on lack of funds? [Interruption.]
§ Dr. Reid
My hon. Friend the Minister of State says that £450 million is currently being spent on subsidising prescriptions. We introduced free eye tests for pensioners as well, of course. We have done a number of things, but we are always trying to do more for pensioners.
A Liberal Democrat laughs. We introduced a guaranteed minimum pension. We introduced a fuel allowance. Three years ago, we introduced—[interruption.]
Mr. Deputy Speaker
I understand the Secretary of State's dilemma, but I should be grateful if he did not follow these red herrings.
§ Dr. Reid
The hon. Gentleman suggests that I talk about the Bill and not about the values and principles behind it. Let me explain this to him. When we bring a Bill to the House, we do not pluck it out of the air; we do not kneel down and adore it because it has been there for 30 years. It is based on a set of principles and a set of values. The hon. Gentleman may consider the words "values" and "principles" entirely alien to his political philosophy, but they are quite important to us. If I share them with the House and he agrees with the principle, no doubt he will find himself in the same Lobby as us.
The hon. Gentleman will recognise the first principle: that the dividing line between those who support the national health service and those who oppose it lies in the belief that health care should be provided equally to those who need it, free at the point of need. That principle has been approved by the British people for 60 years, and has been supported by them ever since. I understand that changes such as the introduction of foundation trusts are often controversial, and that we must continue the discussions to carry people with us on 1087 such radical proposals. I would point out, however, that the new Commission for Healthcare Audit and Inspection will be able to audit and inspect all hospitals—not just foundation trusts and not only other hospitals, but all hospitals in the public and the private sectors. NHS foundation trusts will operate totally within that principle.
§ Dr. Reid
I want to make some progress. The hon. Gentleman has spent the last 10 minutes shouting "Get on to the Bill"; now he interrupts me when I am doing that.
Our Bill proposes, in effect, a new form of local public ownership, guaranteeing equally high-quality service to patients that is free at the point of need. It has never surprised me that when we introduce such novel forms of local public ownership we encounter resistance from the Conservatives: that is entirely in keeping with their beliefs. They oppose anything that smacks of communal or public ownership. Whatever differences we have, however, I accept that my own colleagues find that difficult. I will not hide my disappointment that some of them felt the need to join the Conservatives in the Lobbies tonight, but I hope we can continue to talk it through. Because this is a new and radical form of public ownership, there will be problems that we shall have to work out; but I genuinely believe that this is one way in which we can ensure that we revitalise the NHS in a way that is in keeping with its principles, and at the same time allow local decision-making—which is possible and, indeed, necessary—to meet the different needs and expectations of 60 million of our fellow countrymen.
§ Mr. Weir
It is interesting that the Secretary of State should make that point, because that was not why we voted. It was because of the Barnett consequentials, as he should know.
The Secretary of State has said a lot about foundation hospitals. Although I do not agree with it, I understand why someone might want foundation hospitals in both Scotland and England, but can the Secretary of State explain why some Scottish Labour Members seem to favour foundation hospitals in England but not back in Scotland? Is that not an inconsistency?
§ Dr. Reid
I am sure that those who voted tonight—and some Scots voted against the Bill, including the hon. Gentleman and his colleagues and some on our side, as well as Scottish Liberals, although others voted for it—hold the same views whether they vote here or voice their opinions in Scotland.
Of course we believe in devolution in this House. Part of the deal, which we as a Labour Government put before the people and brought to the House, was the simple proposition that all Members are equal in terms 1088 of voting rights and of their opportunities to hold office. Not only is that right in principle; to go in the direction in which the hon. Gentleman wishes to go would bring chaos. There would have to be different voting regulations, and opportunities for ministerial office would have to be different for the Scots, the Welsh and those in Northern Ireland. [Interruption.] The hon. Gentleman says, "Yes". That is three categories. Then there are London Members, because we devolved the executive control of transport. Then there is the north-west of England and the north-east, if they opt for regional government. We would end up with eight classes of MPs. That is a recipe for chaos. We have never accepted that.
§ Mr. Salmond
As the Secretary of State should be aware, there are huge implications for funding in Scotland if foundation hospitals, via the Barnett formula, go ahead in England; however, he has not answered the point made by my hon. Friend the Member for Angus (Mr. Weir). How can Scottish Labour Members be in favour of foundation hospitals in England, given that the Labour party policy in Scotland is against them? How can Labour Members in Scotland simultaneously hold the positions of being in favour of them south of the border and against them north of the border?
§ Dr. Reid
The answer is the same as the one that I gave earlier. What the hon. Gentleman is saying is not true—there is a thing called devolution. The Labour party is slightly bigger than the hon. Gentleman's own party. We draw our members from a much wider base, whereas his party is confined to one country—as, incidentally, is the Tory party. Indeed, if the Tories are not careful, they will be overtaken by the SNP. For those of us who belong to a party that is truly represented throughout Britain—
§ Dr. Reid
I am afraid that I genuinely cannot. I have already taken a longtime, and I want to get to some of the meat. We believe in devolution. We believe that there is no one-size-fits-all solution for Britain, and nor is there a one-size-fits-all solution for the national health service. That is why we are decentralising power.
The second principle is that the value of the national health service is defined around patients, not around the needs of providers. Yes, I have the greatest respect for politicians—for those who provide the decisions, the policy and the money—for those who work in the national health service, for those who lay the bricks and build the buildings, for those who make the tea, and, indeed, for those who make the surgical incisions. But ultimately, this is not about the providers; it is about the patient, and the patient must be the arbiter of everything that we do and the benchmark of our success. Again, 1089 that leads to striking difficult balances and making difficult choices, but Labour Members have never been frightened to do that.
§ Mr. Allen
The whole foundation hospitals episode has been bruising for everybody on the Labour Benches, regardless of which side of the argument they are on. Many of us remember my right hon. Friend's pugnacity as Leader of the House and as chairman of the Labour party, but some of us also remember the skill that he brought to bear in Northern Ireland and in the former Department for the Environment, Transport and the Regions. Will he make every effort to ensure that those who have made honest representations on this issue are still part of the family of people whom he will consult and maintain very close links with as we rebuild the health service?
§ Dr. Reid
The answer to that is yes, yes and yes again, because I genuinely believe that the commitment on the Labour Benches to the values of the national health service is such that it overcomes, and should overcome, any differences in terms of exactly how we get that system operating and how we enshrine those values.
The third point is that the Bill enshrines true security and equity for our people. That was built in as one of the objectives of the early health system, but to be truthful, it has never been delivered in the light of the sheer uniformity of production of service. The truth is that choice, in terms of meeting the ambitions of our people through the decades, will remain theoretical rather than real unless sufficient capacity is injected into the NHS itself. I am not one of those who think that this is a question of choosing between increasing capacity and increasing choice; the truth is that both are necessary. If we do not increase capacity, we cannot give the patients themselves true choice; and if we do not give them true choice, we will not maximise the focus, direction and use of the extra capacity that we are putting into the health service—a point that also relates to the question of fairness
As has been pointed out, we have listened to the various concerns that have been expressed about the Bill. For instance, we have introduced measures to cap the amount of private work that an NHS foundation trust can do, introduced local accountability and ensured common application of the terms and conditions agreed under "Agenda for Change". So in the teeth of opposition from the Conservatives, we have tried to listen, but above all we have tried to make real progress for the national health service. I believe that NHS foundation trusts will help us to take a further great stride forward for patients. And when we do so—when we make decisions about the systems, processes and structures through which we are trying to enshrine our values—Labour Members will never forget, I hope, that the choice is now clear.
The real dividing lines are opening up on this great issue of health care. After six decades of post-war consensus, there is now a breach in that consensus. The 1090 choice, which is enshrined in this Bill, is between reforming the NHS or breaking it up; between mending it or ending it; between massive investment or savage cuts; between modernisation or privatisation; and between increased spending or increased charging. It is a choice between our promise to provide the systems to run alongside the training of doctors and nurses, the building of skills in hospitals and the provision of teachers and skills, thereby building on the Bill itself; or the Tory pledge card, of which the hon. Member for Woodspring (Dr. Fox) is the architect and proud parent. That pledge card outlines their aims: to cut public spending, to sack nurses and doctors, to axe hospitals and to transfer money away from the NHS and into private care.
When I consider that choice—between a Labour party that believes in health care free at the point of need, and a Tory party that now apparently believes that when someone is ill, the health service should take their money before taking their temperature and feel their wallet before feeling their pulse—all I can say is, "Roll on the general election." Meanwhile, I commend the Bill to the House.
§ Dr. Fox
To end with an utterly fatuous analysis of the difference between the parties and to create demons that do not exist, thereby frightening the sick and vulnerable, is unworthy even of a Secretary of State thrown into the job unwittingly in a botched reshuffle by a Prime Minister who had the poor sense to put in charge of health care in England someone who does not have to take responsibility for any of his actions in respect of his own constituents in Scotland. I am also saddened that the Secretary of State made his debut on this subject tonight by barely mentioning the Bill at any point in his speech. Instead, he gave us a lecture about some strange and bizarre version of history and his party philosophy. He preferred that to facing his Back-Bench colleagues head on in the difficult debate on foundation hospitals. If the Secretary of State does not have the courage to do so, the Opposition cannot be held to account for it, but it is a great pity.
We should remind the Secretary of State of a couple of things. When it comes to the post-war consensus on the national health service, which he says has been maintained up to this point by all Governments, it is worth pointing out that in the post-war period since the NHS was created, it has been maintained for 35 years by a Conservative Government and for only 17 by a Labour Government. I would have thought that that speaks for itself.
The Secretary of State spoke rather patronisingly—and the Minister of State insultingly earlier—to his own Back Benchers, accusing them of going into the Lobby with the Tories tonight. I had better point out that it was a Labour amendment, not one of our amendments, on which the Conservatives chose to go into the Lobby with his hon. Friends. The Secretary of State needs to learn not to insult his own side as often as he seems intent on doing.
One could not have gleaned it from listening to the Secretary of State, but there are three main elements in the Bill—foundation hospitals, the CHAI and its reform to provide a new system of inspection, and of course the 1091 GP contract, which is essential to changes in primary care, though it was not mentioned once in the Secretary of State's Third Reading speech on his own Bill. That speaks volumes about the Government's approach to primary care.
§ Dr. Fox
The Secretary of State needs a little lesson, because the GP contract is primary care. I know that he is not au fait with the terminology of his new job yet, but most of us regard general practice as one of the essential parts of primary care. Perhaps the Secretary of State should ask the Minister of State for some advice on the language of the NHS in England.
Mr. Deputy Speaker
Order. All I insist on is that we do not have two Front-Bench Members on their feet at the same time.
§ Dr. Fox
No, we are not accepting plea bargaining tonight.
We need to assess the basic elements one by one. On foundation hospitals, we do not have a problem with the concept. Indeed, we are keen on the model of foundation hospitals in other countries—Sweden, for example. Swedish hospitals have freedom to borrow according to their own plans and in terms of their own investment needs; they have freedom from political interference in setting targets and freedom to set their own pay and conditions. The Secretary of State described us as scuttling around Europe, as if we in Britain had nothing to learn from other countries in Europe, many of which provide better health care than we do in the United Kingdom. If we examine countries such as Germany, we find that they have far better quality care than is received by poorer groups in the United Kingdom. We have much to learn from the social insurance model in other parts of Europe.
We could have argued today that we were in favour of the move closer to the internal market and the potential proto-legislation that Labour has introduced, because such are the secondary powers in the Bill that an incoming Conservative Government could move much faster towards the sort of model that we would like to see, without having to introduce primary legislation. However, we laid out the reasons why we were unhappy with the Bill as regards foundation hospitals, and why we supported the relevant amendment earlier. I shall elaborate on those reasons.
§ Mr. Jon Owen Jones
On the subject of the lessons learned from Europe, is the hon. Gentleman familiar 1092 with the processes, currently going through European courts and our courts, that will determine the rights of European Union citizens to access health services in any other European state? Those will have profound implications for the development of the health service. Does the Tory party agree that British citizens should have the right to access services in any other EU state?
§ Dr. Fox
I know that to answer that question would be to stray on to the issue of European legislation, and therefore you might not approve, Mr. Deputy Speaker. However, if we are to have such rights, they should be genuinely reciprocal. For example, British patients in France should be treated as French patients would be treated in this country—in other words, free at the point of use. At the moment, British patients go to France but have to pay, but the French can come to Britain and be treated free. We should have genuine reciprocal rights, not the loaded dice that we have at present.
§ Dr. Fox
No, I am not going to be tempted further on Europe. We need to make progress on discussing the Bill, because we have only an hour to do so, courtesy of the Government's timetable.
What do we see when we compare the freedoms of foundation hospitals in other countries with what we will have here? Here, we see borrowing curtailed by the Treasury. In fact, it is worse than that, because any borrowing will be curtailed within a single envelope. Any foundation hospital that is able to access more money will do so at the expense of other hospitals. That is a recipe for what Labour Members have called a two-tier system. The whole point of being able to borrow outside Government limits is to be able to raise expenditure without affecting the resources available to others in the publicly funded sector. However, the Government fail to understand that. The freedoms will be rolled out for only a few hospitals, rather than as a programme for all of them, and that is a recipe for maximum instability in the system.
On the issue of the regulator, the Minister of State told us that the Government had taken increasing measures throughout the passage of the Bill to guarantee the independence of the regulator. What sort of independence is it when the regulator will be hired by the Secretary of State, fired by the Secretary of State, has his rates of pay set by the Secretary of State, and cannot give agreement to a foundation hospital unless it has first been agreed by the Secretary of State?
We did not receive sufficient explanation of several areas of the Bill in the debates earlier today. We asked, frequently, about pay and conditions. What freedoms will foundation hospitals have to alter pay and conditions that other hospitals will not have? If foundation hospitals will not have those freedoms, what is the point of the exercise? If they will have those freedoms, they need to be defined at the outset. How will those freedoms impact on the Chancellor's regional pay 1093 strategy and on the Prime Minister's pledge to uprate above inflation? How will all those factors affect the pay rates of foundation hospitals?
§ Mr. Allen
On freedoms and the ability of hospitals to set their own parameters, I assume that the hon. Gentleman refers also to the freedom of individuals to be charged £5,000 for a hip replacement or £9,000 for a heart bypass under the Conservatives' passport scheme. He mentioned looking to Scandinavia, including Finland, but is that giving another meaning to the phrase "finish the NHS"?
§ Mr. Lansley
My hon. Friend was talking about the role of the independent regulator. We only really understood in Standing Committee that the regulator is going to have to exercise his functions in a way that is consistent with the performance of the duties of the Secretary of State under the 1977 Act. As the Minister admitted in Committee, that means that the Secretary of State will be able to issue guidance to the independent regulator on the exercise of all his functions.
§ Dr. Fox
I imagine that this is plumb in line with the previous Secretary of State's well known way of running the health service along the lines of earned autonomy, which meant, "You can do whatever you want, as long as it's what I want". This is the same doctrine, and it is now being extended to the independent regulator, who could not possibly be regarded as independent in any normal sense.
§ Dr. Fox
I am certainly not going to give way to the hon. Gentleman, who is wasting his time as much as he is wasting mine. I can tell him things, but I cannot understand them for him.
One of the most contentious areas of our debate today, and throughout the passage of the Bill, has been the question of governance.
Mr. Deputy Speaker
That is not a point of order for the Chair, and I have to say that there comes a point at which attempts to intervene simply interrupt the debate in a quite irrational way.
§ Dr. Fox
Yes, Mr. Deputy Speaker, especially from someone who has taken no part in the passage of the Bill up to this point.
1094 It is interesting that the question of governance caused the most trouble on the Government's Back Benches. We got no answer to many of our questions on this issue. What is the logic of having an electoral system for the providers, but not for the commissioners, of care? Several Labour Back Benchers asked today how this provision would impact on their constituencies. People will have no ability to change the basis on which services are configured, because that configuration will be dependent on the allocation of resources. To establish electoral formats for the providers will therefore make no difference whatever.
The Secretary of State says that this is all about public ownership, but I always thought that the national health service was in public ownership, so why we have to redo it is quite beyond me. What are the great constituencies going to be? In relation to the regional and national hospitals, we are still waiting for an answer on who the voters are going to be, what the constituencies are going to be, and what the cost is going to be. Not once have Ministers denied our indicative figure of up to £250,000 per trust per year, simply to run the system. The Government say that they are decentralising and cutting red tape and bureaucracy, but they are creating a whole new tier of bureaucracy and red tape, in which hospital managers will be more concerned with running elections than with running hospitals. This is a disaster in the making.
The Secretary of State talked about what the Government were doing on capping private health care. That was one of the most profoundly dishonest parts of the passage of the Bill, because the Government have changed the provisions in the Bill on capping private income from "must" to "may". They state that the power is to be exercisedwith a view to securing that … proportion of the total income",but they have done nothing finally to cap it.
On CHAI, we have argued since the first Government Bill when they came to office in 1997 that there should be a single regulator across all parts of health care, regulating on the basis of the patient's experience and not according to who the provider is. The Government have belatedly caught up with us on this issue, and we welcome that.
Part of the Bill that has changed since Second Reading is the section relating to the GP contract, and this makes a profound difference to the Bill as a whole. I should perhaps declare an interest as a member of the Royal College of General Practitioners. Following substantial negotiations between the BMA and the NHS Confederation, and the overwhelming vote—an absolute majority—by GPs that this is what they want, it is clear that this is the model of health care that we will take forward. It is unfortunate that we did not have more time to discuss these matters in the House of Commons, but we shall certainly have plenty of time to consider them in detail in the House of Lords.
The Prime Minister said that the Bill was of historic importance. It is historic—it is an historic waste of opportunity. The Government will have to come back and remedy it, because it is deeply flawed and was made up as they went along. It therefore gets the worst of both worlds—it has the worst possible financial framework, and that fault is augmented by Whitehall control. It truly is a wasted opportunity that the Government will live to regret.
1095 8.50 pm
§ Kate Hoey (Vauxhall)
I am pleased to have caught your eye, Mr. Deputy Speaker. I spent eight hours in the Chamber on Second Reading and all of today without being able to express my views, despite having two trusts with three stars in my constituency. I would like to put on record my reasons for opposing the setting-up of foundation trusts and not backing Third Reading, despite the fact that I support certain aspects of the Bill.
I am disappointed that the Secretary of State did not choose to answer some of the many serious criticisms made by many hon. Members about foundation hospitals. I would like to remind the House that, according to the Secretary of State, the fundamental reason for establishing foundation hospitals is to improve the care of patients. Since Second Reading, I have spent a lot of time talking to my hospitals, local people and the PCT, and have yet to meet anyone who can come up with a single reason as to why a foundation hospital trust will achieve concrete improvements to patient services. It is important that we look at all the proposals in the Bill that could have been carried out simply by amending existing measures. We talk about democratisation of governance, and want local authorities to get involved, but that could have been done by amendment.
Trying to achieve a supposed democracy by involving local people will be a nightmare, and will cost far too much. I cannot justify the spending of thousands of pounds by hospitals in my constituency. Kings College hospital and Guy's and St. Thomas's hospitals will all compete for the same membership, with the exception of people who go for treatment at national centres at St. Thomas's and Guy's, not to mention the huge numbers of MPs who are always popping over to St. Thomas's. Presumably they will all be able to pay their money and become members of trusts. I cannot justify the spending of that money to establish an electoral process that will stand up to legal scrutiny—it is just nonsense.
No one in my constituency accepts the need for that kind of artificial democracy, as the hospitals already offer patients forums. St. Thomas's, in particular, reaches out to people in the area with pensioners forums—pensioners go to the hospital to discuss their needs, such as home helps and many other things. There is no need for this supposed democracy, which will not make the slightest difference, because the money is held by the PCTs, which are undemocratic. The whole thing is therefore nonsense.
Hospitals will supposedly be able to borrow more than they can at the moment, but they will have to pay it back. I am worried about what will happen if they run into difficulties. At the moment, if they decide to sell an asset, they have to offer it first to other hospitals and keep it within the NHS but, under the new arrangements, as soon as they get into trouble there will be asset stripping. I shall be brief, as other hon. Members wish to speak. I am all in favour of taking power away from Whitehall and giving it to local hospitals, but we do not need to create foundation hospitals to do so. All the problems that hospitals experience with bureaucracy and paper-chasing could be solved, as my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) said, by the Secretary of State simply saying that things are not going be done that way. This is a complete distraction 1096 and diversion, and it comes just as hospitals are beginning to see the benefits of the money that the Government have put in. It takes a long time for the benefits to come through but that is beginning to happen. However, we are completely diverting everyone in the trusts and setting them to work on establishing foundation hospitals.
Officials from the Department of Health are on the telephone and sending e-mails almost every day to the trusts, asking what people there think that they should do about foundation hospitals. The Department cannot answer a single question about the practicalities of how the system will work. Resources will be taken away from those in our health service and hospitals who should be working to improve matters for patients. The proposal is a diversion and a distraction. It was not in the manifesto, and I feel no compunction whatsoever about opposing my Government today.
§ Dr. Evan Harris
Second Reading was held some time ago and was kicked off by the right hon. Member for Darlington (Mr. Milburn). It is appropriate to pay tribute to his work on the Bill, flawed though the proposals are. There is no doubt that he was a very able Minister and Secretary of State. It is unfortunate that personal circumstances should have prevented him from seeing the Bill through to this stage.
I wish the new Secretary of State well. I recognise that, despite the qualifications held by me and the hon. Member for Woodspring (Dr. Fox), he is the only proper doctor among the three of us. I tell that to my constituents on a regular basis. However, when questions are raised on specific policies, I hope that he will resist the temptation that his predecessor could not always resist—that is, to impugn the motives of others and to launch half-hearted and supposedly humorous personal attacks on those who do not agree with him.
Liberal Democrat Members, and even sometimes Conservative Members, ask reasonable questions that deserve to be answered, on Second or Third Reading. It is unfortunate when every question about the Government's policy draws as a response an attack on the policies of Opposition parties. That may be tempting but, if there is a time and place for such a response, it must come after questions about Government policy have been addressed.
The Secretary of State said several times that he is committed to an NHS that is universal and comprehensive, free at the point of delivery and in which treatment is based on clinical need, not the ability to pay. I do not doubt his sincerity about wanting to support an NHS like that, as that is the NHS that I support. However, I recognise that the NHS that we have at the moment—even before it is subject to the policies of any other party—is not universal or comprehensive.
We have to accept that rationing exists in the NHS, and recognise that the best thing that we can do is hope to limit rationing by putting in the necessary resources. I voted for the Government to do that. They have done it—belatedly, but they have done it. In addition, we must make sure that what rationing there is is made explicit. In that way, people will know the consequences of voting for tax cuts and for cutting resources for the NHS.
I do not doubt that the Secretary of State wants the NHS to be free at the point of delivery. However, he must recognise that it is not always free at the point of delivery. 1097 In dental care, for example, 84 per cent. of people, even including those of pensionable age, are not exempt from contributing to NHS dental charges, which can amount to as much as 80 per cent. of a maximum of £366. Also, hundreds of thousands of people, even those with chronic diseases, are prevented from getting their prescriptions because of prescription charging. For them, the NHS is not free at the point of delivery. The Government should have greater aspirations even than those contained in the Bill, as they would see it, to establish an NHS that is truly free at the point of delivery.
The Secretary of State would also argue that treatment should be based on clinical need and not the ability to pay. I hope that he recognises that the amount of NHS capacity reserved for paying patients means that, at a time when capacity is limited, there are thousands of people whose clinical need is greater than that of those in the pay beds. However, those NHS beds are occupied by people who have jumped the queue because they can pay. As the Select Committee said, the Government should do something about pay beds.
The Bill has five parts. One part, which has received less attention than it deserves, contains the proposals for the quality inspection regime—the Commission for Healthcare Audit and Inspection, and its sister body covering social care inspection. The Bill is a disaster for the independence of both bodies, which will become the Government's creatures, charged by the Government to implement Government policy. The Bill even contains a clause that states that the commission "shall have regard" to Government policy. The target regime and the so-called standards regime will clearly be seen to be political. The Commission for Healthcare Audit and Inspection will be far less independent even than the Commission for Health Improvement. I do not think that the NHS will have confidence in it.
Another part of the Bill deals with the recovery of charges from employers where they are liable. Even that has had to be postponed because the Department for Work and Pensions requires a review of its impact on small businesses.
The GP contract may be good for GPs; I do not blame them for voting for it. At best, however, it will mean no change for patients and, at worst, it will be worse for them. The contract provides neither more GPs nor more GP time; it merely allows GPs to opt out of providing holistic care on a one-stop-shop basis.
My hon. Friend the Member for Cheadle (Mrs. Calton), to whom I pay tribute, has drawn attention to the great deficiencies in the welfare food scheme. Many of the provisions should not and will not survive the Bill's passage through the House of Lords.
The Government majority of only 35 on the foundation hospitals proposals shows that their policy is wounded as the Bill limps to the Lords. The policy is unloved by staff; the unions and professional staff oppose it. It is unloved by patient groups; they know that the priority should not be to set hospital against hospital. We oppose it. Many of the Government's Back Benchers oppose it, including at least six former Ministers. The policy is loved only by the Tories, but not so much that they could not vote against it. The House of Lords should put the policy out of its misery so that 1098 the NHS can concentrate on providing the freedoms required to empower commissioners and to put patients' needs first. We should have an inspectorate free from political control.
For all those reasons, we shall oppose Third Reading and we urge hon. Members on both sides of the House to join us in so doing.
§ Dr. Stoate
I realise that time is short but as I am the only practising GP in the House, I feel qualified to make one or two points that may, I hope, help hon. Members.
My constituents believe passionately in the NHS. They believe in a service free at the point of use and available to all, regardless of their circumstances. The only alternative to a national health service is some sort of privatised service, based on social insurance or a private insurance scheme, neither of which would cut much ice with people in this country.
People tell me that one of the current problems is that the service is too often geared to the needs of the providers and not enough to the needs of the users. They want more choice, more flexibility and more say in how their services are run.
There has been a huge, long debate on foundation hospitals, but it boils down to a simple concept, which is not rocket science and does not involve destroying the health service or huge upheaval. The proposals would do two things: first, they would give more democracy to the health service by setting up boards of governors whereby local people can have an important say in the way that the health service is run.
§ Dr. Stoate
I am very short of time.
People on the board of governors can say how the hospital is run. People would also have the opportunity to decide for themselves how services are provided, dependent on local needs, priorities and circumstances. Surely, that is the way to go. It is merely opening up the health service, to provide more flexibility, more choice and more democracy.
It is difficult to understand what all the fuss is about. The proposals are a way of improving the health service to deliver the health care that we need in the next century. The NHS is 60 years old, and it is ripe for modernisation. We need a service that is more responsive to users and less geared to the needs of providers.
I realise that there is little time to develop the debate, but those points are important. The new GP contract will also be of huge benefit to patients because it will allow GPs to provide a much more responsive service and to meet as many needs as possible in a health service of which we should all be proud. I hope to be part of it as it develops.
§ Mr. Lansley
As the Bill goes off to another place, I urge those in that place to reform it so that primary care trusts and commissioning are at the heart of local ownership, that if there is to be an independent regulator, he should—
1099 It being eight hours after the commencement of proceedings on the programme motion, MR. DEPUTY SPEAKER, pursuant to Order [this day], put forthwith the question already proposed from the Chair.
§ Question put, That the Bill be now read the Third time:—
§ The House divided: Ayes 306, Noes 57.1101
|Division No. 284]||[9.04 pm|
|Adams, Irene (Paisley N)||Cranston, Ross|
|Ainger, Nick||Crausby, David|
|Ainsworth, Bob(Cov'try NE)||Cruddas, Jon|
|Alexander, Douglas||Cummings, John|
|Allen, Graham||Cunningham, rh Dr. Jack|
|Anderson, Janet (Rossendale&||(Copeland)|
|Darwen)||Cunningham, Jim (Coventry S)|
|Armstrong, rh Ms Hilary||Cunningham, Tony (Workington)|
|Bailey, Adrian||Darling, rh Alistair|
|Banks, Tony||Davey, Valerie (Bristol W)|
|Barren, rh Kevin||David, Wayne|
|Beard, Nigel||Davidson, Ian|
|Beckett, rh Margaret||Davies, rh Denzil (Llanelli)|
|Begg, Miss Anne||Davies, Geraint (Croydon C)|
|Benn, Hilary||Dawson, Hilton|
|Bennett, Andrew||Denham, rh John|
|Benton, Joe (Bootle)||Donohoe, Brian H.|
|Belts, Clive||Doran, Frank|
|Blackman, Liz||Dowd, Jim (Lewisham W)|
|Blears, Ms Hazel||Eagle, Maria (L'pool Garston)|
|Blizzard, Bob||Edwards, Huw|
|Blunkett, rh David||Ennis, Jeff (Barnsley E)|
|Boateng, rh Paul||Farrelly, Paul|
|Bradley, rh Keith (Withington)||Field, rh Frank (Birkenhead)|
|Bradley, Peter (The Wrekin)||Fitzpatrick, Jim|
|Bradshaw, Ben||Fitzsimons, Mrs Lorna|
|Brennan, Kevin||Flint, Caroline|
|Brown, rh Gordon (Dunfermline||Flynn, Paul (Newport W)|
|Brown, Russell (Dumfries)||Foster, rh Derek|
|Browne, Desmond||Foster, Michael (Worcester)|
|Bryant, Chris||Foster, Michael Jabez (Hastings|
|Buck, Ms Karen||&Rye)|
|Burden, Richard||Foulkes, rh George|
|Burgon, Colin||Francis, Dr. Hywel|
|Burnham, Andy||Gapes, Mike (llford S)|
|Caborn, rh Richard||Gardiner, Barry|
|Cairns, David||Gerrard, Neil|
|Campbell, Alan (Tynemouth)||Gilroy, Linda|
|Campbell, Mrs Anne (C'bridge)||Godsiff, Roger|
|Campbell, Ronnie (Blyth V)||Goggins, Paul|
|Caplin, Ivor||Griffiths, Jane (Reading E)|
|Casale, Roger||Griffiths, Nigel (Edinburgh S)|
|Caton, Martin||Grogan, John|
|Cawsey, Ian (Brigg)||Hain, rh Peter|
|Challen, Colin||Hall, Mike (Weaver Vale)|
|Chapman, Ben (Wirral S)||Hall, Patrick (Bedford)|
|Chaytor, David||Hanson, David|
|Clark, Mrs Helen (Peterborough)||Harman, rh Ms Harriet|
|Clark, Dr. Lynda (Edinburgh||Harris, Tom (Glasgow Cathcart)|
|Clarke, rh Charles (Norwich S)||Henderson, Ivan (Harwich)|
|Clarke, rh Tom (Coatbridge &||Hendrick, Mark|
|Clwyd, Ann (Cynon V)||Heppell, John|
|Coaker, Vernon||Hermon, Lady|
|Coffey, Ms Ann||Hesford, Stephen|
|Cohen, Harry||Hill, Keith (Streatham)|
|Colman, Tony||Hodge, Margaret|
|Cook, rh Robin (Livingston)||Hood, Jimmy (Clydesdale)|
|Cooper, Yvette||Hoon, rh Geoffrey|
|Corston, Jean||Hope, Phil (Corby)|
|Cousins, Jim||Howarth, rh Alan (Newport E)|
|Howarth, George (Knowsley N &||Michael, rh Alun|
|Sefton E)||Milburn, rh Alan|
|Howells, Dr. Kim||Miliband, David|
|Hoyle, Lindsay||Miller, Andrew|
|Hughes, Beverley (Stretford &||Moffatt, Laura|
|Hughes, Kevin (Doncaster N)||Moonie, Dr. Lewis|
|Hurst, Alan (Braintree)||Moran, Margaret|
|Hutton, rh John||Morley, Elliot|
|Iddon, Dr. Brian||Morris, rh Estelle|
|Ingram, rh Adam||Mountford, Kali|
|Irranca-Davies, Huw||Mullin, Chris|
|Jackson, Helen (Hillsborough)||Munn, Ms Meg|
|Jamieson, David||Murphy, Denis (Wansbeck)|
|Johnson, Alan (Hull W)||Murphy, Jim (Eastwood)|
|Johnson, Miss Melanie (Welwyn||Murphy, rh Paul (Torfaen)|
|Hatfield)||Naysmith, Dr. Doug|
|Jones, Jon Owen (Cardiff C)||Norris, Dan (Wansdyke)|
|Jones, Martyn (Clwyd S)||O'Brien, Bill (Normanton)|
|Jowell, rh Tessa||O'Brien, Mike (N Warks)|
|Joyce, Eric (Falkirk W)||O'Hara, Edward|
|Kaufman, rh Gerald||O'Neill, Martin|
|Keeble, Ms Sally||Osborne, Sandra (Ayr)|
|Keen, Alan (Feltham)||Palmer, Dr. Nick|
|Keen, Ann (Brentford)||Pearson, Ian|
|Kemp, Fraser||Perham, Linda|
|Kennedy, Jane (Wavertree)||Pickthall, Colin|
|Khabra, Piara S.||Pike, Peter (Burnley)|
|Kidney, David||Plaskitt, James|
|King, Andy (Rugby)||Pollard, Kerry|
|King, Ms Oona (Bethnal Green &||Pond, Chris (Gravesham)|
|Knight, Jim (S Dorset)||Prentice, Ms Bridget (Lewisham|
|Kumar, Dr. Ashok||E)|
|Ladyman, Dr. Stephen||Prescott, rh John|
|Lammy, David||Primarolo, rh Dawn|
|Lawrence, Mrs Jackie||Prosser, Gwyn|
|Laxton, Bob (Derby N)||Purchase, Ken|
|Lazarowicz, Mark||Purnell, James|
|Lepper, David||Quinn, Lawrie|
|Leslie, Christopher||Rammell, Bill|
|Levitt, Tom (High Peak)||Rapson, Syd (Portsmouth N)|
|Lewis, Ivan (Bury S)||Raynsford, rh Nick|
|Liddell, rh Mrs Helen||Reed, Andy (Loughborough)|
|Linton, Martin||Reid, rh Dr. John (Hamilton N &|
|Lucas, Ian (Wrexham)||Robertson, John (Glasgow|
|McCabe, Stephen||Robinson, Geoffrey (Coventry|
|McCartney, rh Ian||NW)|
|McDonagh, Siobhain||Roche, Mrs Barbara|
|MacDonald, Calum||Rooney, Terry|
|MacDougall, John||Roy, Frank (Motherwell)|
|McFall, John||Ruane, Chris|
|McGuire, Mrs Anne||Ruddock, Joan|
|McKechin, Ann||Russell, Ms Christine (City of|
|McNamara, Kevin||Ryan, Joan (Enfield N)|
|McNulty, Tony||Salter, Martin|
|MacShane, Denis||Sarwar, Mohammad|
|Mactaggart, Fiona||Sawford, Phil|
|McWalter, Tony||Shaw, Jonathan|
|McWilliam, John||Sheerman, Barry|
|Mahmood, Khalid||Sheridan, Jim|
|Mallaber, Judy||Simon, Siôn (B' ham Erdington)|
|Mandelson, rh Peter||Singh, Marsha|
|Mann, John (Bassetlaw)||Skinner, Dennis|
|Marris, Rob (Wolverh'ton SW)||Smith, rh Andrew (Oxford E)|
|Marsden, Gordon (Blackpool S)||Smith, Angela (Basildon)|
|Marshall, David (Glasgow||Smith, rh Chris (Islington S &|
|Marshall, Jim Leicester S)||Smith, Jacqui (Redditch)|
|Martlew, Eric||Smith, John (Glamorgan)|
|Meacher, rh Michael||Soley, Clive|
|Meale, Alan (Mansfield)||Southworth, Helen|
|Merron, Gillian||Spellar, rh John|
|Starkey, Dr. Phyllis||Ward, Claire|
|Steinberg, Gerry||Watson, Tom (W Bromwich E)|
|Stewart, Ian (Eccles)||Watts, David|
|Stinchcombe, Paul||White, Brian|
|Stoate, Dr. Howard||Whitehead, Dr. Alan|
|Strang, rh Dr. Gavin||Wicks, Malcolm|
|Stringer, Graham||Williams, rh Alan (Swansea W)|
|Sutcliffe, Gerry||Williams, Betty (Conwy)|
|Tami, Mark (Alyn)||Wilson, Brian|
|Taylor, rh Ann (Dewsbury)||WinnicK, David|
|Taylor, Dari (Stockton S)||Winterton, Ms Rosie (Doncaster|
|Taylor, David (NW Leics)||C)|
|Thomas, Gareth (Clwyd W)||Woodward, Shaun|
|Thomas, Gareth (Harrow W)||Woolas, Phil|
|Timms, Stephen||Worthington, Tony|
|Todd, Mark (S Derbyshire)||Wray, James (Glasgow|
|Touhig, Don (lslwyn)||Bailleston)|
|Trickett, Jon||Wright, Anthony D. (Gt|
|Turner, Dennis (Wolverh'ton SE)||Yarmouth)|
|Turner, Neil (Wigan)||Wright, David (Telford)|
|Twigg, Derek (Halton)||Wright, Tony (Cannock)|
|Twigg, Stephen (Enfield)||Wyatt, Derek|
|Tynan, Bill (Hamilton S)||Tellers for the Ayes:|
|Vaz, Keith (Leicester E)||Charlotte Atkins and|
|Vis, Dr. Rudi||Paul Clark|
|Allan, Richard||Oaten, Mark (Winchester)|
|Beith, rh A. J.||Öpik, Lembit|
|Breed, Colin||Paisley, Rev. Ian|
|Brooke, Mrs Annette L.||Price, Adam (E Carmarthen &|
|Burnside, David||Pugh, Dr. John|
|Burstow, Paul||Reid, Alan (Argyll & Bute)|
|Cable, Dr. Vincent||Rendel, David|
|Calton, Mrs Patsy||Robertson, Angus (Moray)|
|Campbell, Gregory (E Lond'y)||Robinson, Mrs Iris (Strangford)|
|Cotter, Brian||Robinson, Peter (Belfast E)|
|Davey, Edward (Kingston)||Russell, Bob (Colchester)|
|Dodds, Nigel||Salmond, Alex|
|Donaldson, Jeffrey M.||Sanders, Adrian|
|Doughty, Sue||Smyth, Rev. Martin (Belfast S)|
|Ewing, Annabelle||Stunell Andrew|
|Foster, Don (Bath)||Taylor, David M(NW Leics)|
|George, Andrew (St. Ives)||Taylor, Dr. Richard (Wyre F)|
|Gidley, Sandra||Thomas, Simon (Ceredigion)|
|Green, Matthew (Ludlow)||Thurso, John|
|Harris, Dr. Evan (Oxford W &||Tonge, Dr. Jenny|
|Abingdon)||Tyler, Paul (N Cornwall)|
|Harvey, Nick||Webb, Steve (Northavon)|
|Hughes, Simon (Southwark N)||Weir, Michael|
|Keetch, Paul||Williams, Hywel (Caernarfon)|
|Kirkwood, Sir Archy||Williams, Roger (Brecon)|
|Lamb, Norman||Willis, Phil|
|Laws, David (Yeovil)||Younger-Ross, Richard|
|Marsden, Paul (Shrewsbury &||Tellers for the Noes:|
|Atcham)||Tom Brake and|
|Moore, Michael||Sir Robert Smith|
§ Question accordingly agreed to.
§ Bill read the Third time, and passed.