National Health Service and Community Care Bill

HL Deb 26 April 1990 vol 518 cc671-84

3.37 p.m.

The Parliamentary Under-Secretary of State, Department of Health (Baroness Hooper)

My Lords, I beg to move that the House do now again resolve itself into Committee on this Bill.

Moved, That the House do now again resolve itself into Committee. —[Baroness Hooper.]

On Question, Motion agreed to.

House in Committee accordingly.

[The CHAIRMAN OF COMMITTEES in the Chair.]

Clause 5 [NHS trusts]:

Lord Hunter of Newington moved Amendment No. 94D: Page 6, line 6, after "(1)" insert ("Subject to subsection (lA) below").

The noble Lord said: In moving Amendment No. 94D I shall speak also to Amendment No. 95D, which concern NHS trusts. I shall also make brief reference to Amendment No. 96 dealing with the hospital incentive fund proposals regarding the type of stimulus and opportunity which is proving so successful in Canada and which avoids any suggestions or dangers regarding two-tier systems.

The Government asked for volunteers to develop trusts. Out of the 70 or so applicants in 1991 they will have a trial run of 30 of the most promising. I hope that those were the words of the noble Baroness, Lady Hooper, when she spoke to us. There is a dilemma here. What criteria have the Government applied to the applicants to make that choice? Some said that these trusts were the flagship proposals of the health service Bill, but others seemed to be concerned that the trusts were divisive and would encourage two-tier systems in hospitals and other facilities.

There are situations where specialist facilities should be treated in a special way. Perhaps I may take the example of the Christie Hospital in Manchester. There is no doubt that it should be a special trust. I must confess an interest. My eldest son is a senior consultant to the hospital and keeps me informed. The service that the hospital provides is a specialist and expensive one. It meets the needs of the North West of England. The treatments require special skills in the field of radiotherapy and chemotherapy and also in the field of counselling for the very special problems that the patients have. Such is the nature of that facility that it should be special. It is also in a position to command the regard of the medical charities who know that resources expended there on staff and equipment will be well spent. In fact the hospital has a world-wide reputation. One can also see the case for specialist bums or accident units to be treated in this way.

To make a London hospital a trust seems to me most difficult and could result in the opposite effect to that intended. London medicine is in the process of change and has been since the Todd Report of 1968. Reorganisation and other changes have a long way to go. It has also suffered more than most from a decade of RAWP—Resource Allocation Working Party—reports which effectively removed considerable resources from the London teaching hospitals.

In my view, the Guy's Hospital experiment has shown that doctors must be effectively involved in the management of resources. At the same time I agree with the majority of staff and their concern about the concept of a trust.

I pose a problem that is not unusual in these days of motorway expansion. A new road is built within the territory of a country hospital which is equipped to meet the needs of the local population. It is decided that it is necessary to develop a modern accident wing to meet the needs of the hospital's new responsibilities. How is that to be done? Should it be made into a trust hospital? A much better way, which is successful in Canada, is to have a hospital contingency fund. I shall discuss that when we come to Amendment No. 96. One of the important features of such a scheme is that it is open to all in the health service to improve their lot and if they do not do well their resources are cut. Does not that proposal present a challenge to the whole of the service?

I now come to Amendment No. 95D: that the Secretary of State be required to publish his reasons for setting up trusts. Views may differ on the need to consult a community health council but the essential reasons for the approval of this proposal must become known to hospital staffs and managers alike. There is another aspect that concerns me and where I look forward to the results of the first study. The White Paper referred to an aspect that I mentioned recently—the amalgamation of district hospital authorities with family practitioner authorities. I believe that there is a need for one authority, particularly if group practices of the future develop with special diagnostic and treatment skills. That may take 20 per cent. of patients away from hospital attendance and could cut hospital waiting lists substantially. Nothing should be done to prevent such a change. Would it be more difficult, I ask the Minister, if trust hospitals were involved? They might be concerned at losing their special status and therefore resist an important and effective change which ravours the patients and is cheaper.

A group of noble Lords have made a special study of teaching hospitals, particularly medical centres, and how they should fare in this situation. I suspect they are more concerned about adequate resources for teaching and research than becoming a trust, but they must speak for themselves. Main teaching hospitals have had special treatment since the beginning of the health service, as was pointed out by Sir Christopher France in his report on knock-for-knock principles.

I believe that the proposals under Amendment No. 95 D are a minimal request in the circumstances that I have described. They would do much to reassure many of those who are similarly concerned. I beg to move.

Lord Ennals

This amendment originally appeared in the name of the noble Lord, Lord Hunter, and also that of the noble Lord, Lord Carr, who, unfortunately, cannot be here at the moment. I added my name to this amendment which is grouped with my own Amendment No. 95G which refers to consultation with community health councils.

I warmly support everything said by the noble Lord, Lord Hunter. This is the first opportunity that the Committee have had to discuss the proposals for NHS trusts. There can be no escape from the fact that there is substantial fear in each area where an NHS trust may be established that the pattern of health care delivery will be disturbed in a way that could create real problems for patients. I am not saying that it will but that at the moment that fear exists. The fear is a little like the consequence of a cuckoo in the nest; that a trust might eat up all the resources.

The concerns are several. First, there is concern that there will be increasing emphasis on the more glamorous acute services at the expense of the generality of hospital services. I have in mind, particularly, the Cinderella services; the needs of the elderly, mentally ill and mentally handicapped. The danger is that commercial pressure will shape the future of medical specialities, that a financial director will want priority given to high volume rapid turnover specialties which maximise the rate of return per bed. Specialties which treat chronic conditions at high expense with low prospect of permanent cure will be at risk for the same commercial reasons that private hospitals do not attempt to provide them.

There is a fear that there will be some loss in terms of continuity of service as between the general practitioners, the hospitals and other services in the community. That has been highlighted by the Royal College of Nursing which states that discharge planning and the continuity of care are already not the most successful features of our existing system and that self-governing hospitals could disrupt an already imperfect system by increasing the number of patients travelling outside their district of residence and dislocating the management link with the district authorities.

The problem of travelling longer distances for treatment if certain services are cut for commercial reasons is of serious concern to the public, particularly with our increasingly elderly population. There is also concern that the NHS trusts will suck in the best staff, undermining national pay agreements and conditions of service. We will be discussing that aspect in a later amendment. It is certainly envisaged that NHS trusts should be in a position to offer more lucrative contracts and inevitably that must be to the detriment of other hospitals that do not have that special privilege. It is seen by the medical profession as a danger in introducing competition on a financial basis, with self-governing hospitals as a major part of the proposed means of achieving this commercial approach.

There is the danger that a two-tier service will develop in which inevitably there will be not only winners but losers; and we must look at the losers as well as at the winners. There is a fear that national assets—units often paid for originally from private contributions—will serve the interests of the minority rather than the majority. After all, most of the great hospitals have had enormous amounts of money pumped into them by the public. We have to look at them as public assets. Somehow or other the Secretary of State will have to find current extra money to ensure that these trial run trusts really work. As we go along, there can be no satisfactory evaluation of the success of these NHS trusts if more money is put in than is available for those hospitals that are not trusts. That would not be reasonable competition. I hope that we can have an assurance from the Minister.

In any event there will be great cost involved. News is coming in daily about cuts. Yesterday there was a report concerning cuts at St. Thomas's Hospital; today there is news of cuts being planned at Westminster Hospital. One wonders whether in the history of the National Health Service this is the time to be adding all the extra costs that the trusts will demand. There is concern among many that National Health Service trusts will pave the way for privatisation. That is an issue of fundamental importance which will come up in a later amendment.

The health authorities themselves have their own fears. The National Association of Health Authorities has pointed out that the aim is to introduce a competitive approach and that that is bound to lead to a rationalisation of services. In my view rationalisation almost always means a cutting down of certain services. The association says that in a modified way that is all to the good, but taken to its ultimate extent it could seriously reduce access to some services for many patients.

Those Members of the Committee who heard the noble Lord, Lord Nugent, speak at Second Reading and subsequently know that five of the six hospitals which have been taking part in the resource management initiative to try out the market techniques have already expressed to the Secretary of State their feeling that the time is not yet ripe for moving forward. Guy's Hospital did not associate itself with the letter which was sent to the Secretary of State. The opinion given reflects that of hospitals across the country, in Newcastle-upon-Tyne, the Wirral, Huddersfield, the Pilgrim Hospital in Lincolnshire and the Royal Hampshire County Hospital, which I drove past this morning. The letter states: We believe that we should continue to direct our energy towards the successful development of resource management … rather than be diverted towards what would undoubtedly be premature consideration of self-governing status for these hospitals". As I said, only five hospitals agreed with that view. At that stage Guy's Hospital did not associate itself with that view. However, the vast majority of the staff at Guy's have indicated that they do not want to see it becoming a National Health Service trust. There is a great deal of concern. The day before yesterday we discussed evaluation, but that subject will not be raised in the course of this debate. If the noble Lord, Lord Carr, were here he would repeat what he has said time and time again concerning the timetabling of the establishment of these new trusts.

In a sense this amendment is another way of controlling and limiting the rate of change so that it can be effected after careful consideration, place by place, the Secretary of State having looked at the situation, presented his report, as suggested by the noble Lord, Lord Hunter, and consulted community health councils on the part of the community.

The question of the pace of change was emphasised by Sir Geoffrey Howe in a speech that he made yesterday. He warned a Conservative meeting in London: We can secure widespread public support for the far-sighted reforms we are bringing forward. But we will only enjoy that support over the long run if they are pursued at a pace that can be sustained politically. That does not mean discarding our basic diagnosis. But it does mean matching the style of our reforms to the mood of the electorate at large. This is one of the central challenges we face between now and the next election". I hope—and it is part of the purpose of this amendment—that there will be nothing automatic about the Secretary of State giving his approval to a group of enthusiasts within a hospital. It will not be enough to say that there is great enthusiasm which must not be dampened. What is required is that the Secretary of State should look at every aspect of the issue —what is in the best interests of the community, whether the hospital itself is ready, whether its staff are trained, whether it has the information technology at its disposal and the database to enable all this work to be done. These matters should not be light heartedly handed over to a group of directors. I hope that the Committee will be impressed by the arguments contained within these amendments.

It is especially important that the interests of the community are looked at. That is why I have my own amendment to which I have made reference. It seeks the views of the community health council and of other bodies. I hope that those other bodies will include the health authority itself. It certainly means that the Secretary of State should satisfy himself very carefully and systematically before proceeding to introduce a provision into a particular area which may have great merit but which may do great damage. He must make an assessment before he enters into that commitment. I hope that the Committee will accept the amendment.

The Parliamentary Under-Secretary of State, Department of Social Security (Lord Henley)

As the noble Lord, Lord Ennals, said, this is our second opportunity to discuss more generally National Health Service trusts. I say that it is our second opportunity because they were discussed to some extent and in some detail at Second Reading.

I begin by making one or two general points about National Health Service trusts. The Bill merely provides a framework for establishing these trusts as self-governing units within the National Heahh Service. Management freedom of NHSTs will enable them to respond more effectively to patient needs and improve the quality of services. Freedoms available to NHSTs will include the freedom to employ staff, retain surpluses, borrow money and acquire, own and dispose of assets. Most important, NHSTs will be an integral part of the National Health Service and will be accountable to the National Health Service Management Executive.

The noble Lord, Lord Hunter, feared that developments in family practitioner services could be hindered by the development and creation of NHSTs. I do not believe that these fears are justified. Like all hospitals, trusts will have to be responsive to general practitioners. They will depend on contracts for their income and will have no incentive to develop services which GPs provide themselves and which they do not wish to refer to the hospitals.

The noble Lord, Lord Ennals, referred to what has been described in the past as Cinderella services. He said that they would suffer. All types of units, including long-stay hospitals, community units, district general hospitals and teaching hospitals of all types, have expressed interest in trust status. All these bodies are eligible and the Government believe that all can benefit. I believe that the noble Lord knows well that the key is the role of the district health authority in planning comprehensive care for its resident population. All care needs should be met and there should be no danger of services for priority groups being squeezed out.

Neither do I feel that the fears of the noble Lord that trusts will poach their staff are justified. We shall be discussing these trusts in connection with later amendments. The trusts will be free to set their own pay and conditions and so respond flexibly to the local labour market. However, I do not believe that it will lead to the poaching of staff That would simply drive up their costs across the board and make them less able to win the contracts.

4 p.m.

Lord Ennals

I am most grateful to the noble Lord for giving way. If the NHS trusts are able to offer something above the going rate, will that not automatically force up the "going rate" so far as concerns other health services? That would be the end of national agreements. However, if that does not happen, surely they would automatically be pulling away staff attracted by the higher rewards which they would receive in NHS trusts?

Lord Henley

The noble Lord knows very well that in many parts of the country we already have problems with recruitment. That is true not just in the National Health Service but also in a great many other areas of employment. NHS trusts will have the flexibility to respond to that situation. It will be up to them to set their own limits. As I said, there is no incentive for them to push up their prices to such an extent that they cannot compete effectively.

I have made those general points first before dealing with the details of the amendment tabled in the name of the noble Lord. He is asking for two provisions: first, for details of the consultations required; and, secondly, for a document to be published by my right honourable friend the Secretary of State three months before he makes any order setting up a National Health Service trust.

We made it clear back in June 1989 in a document of which noble Lords will be aware entitled Self-governing Hospitals: An Initial Guide that we expect all applications for trust status to be subject to proper consultation and that we expect regional health authorities to make arrangements for such consultation. We have also indicated that such consultation will cover a wide range of interests: the local community, health authorities, community health councils, local general practitioners and, of course, the staff of any potential trust. We will expect regions to arrange for consultation to be carried out over a three-month period.

So far as concerns community health councils which are referred to in the second half of the noble Lord's principal amendment, I should make it clear that consultation on the establishment of trusts will be undertaken under the provisions of the 1985 regulations which require health authorities to consult with the relevant CHC when they are considering proposals which would represent a significant change in National Health Service services in the district. That consultation would take place at the same time as consultation with other interests. Any views expressed by the CHC would be passed to the Secretary of State so that he could consider them with the application and with the views of others consulted.

I should stress that the key to our approach is that the process of consultation should be flexible and tailored to meet the needs of the people who will be most affected by the establishment of the potential trust concerned. We do not believe that this aim would be furthered by prescribing in statute either how the consultation should be undertaken, the period of consultation, or that it should be the responsibility of the Secretary of State, rather than the region, who will be best placed to identify those groups and individuals who should be consulted.

We have made clear that the application prepared by a potential trust will be the key document on which consultation will take place. I do not believe that any benefit would flow from the Secretary of State preparing a separate document for consultation. As I said, consultation will take place on the application document prepared by the trust. The document will set out its plans in some detail covering among others matters: the benefits to patients; proposals to develop services and ensure quality; leadership and management arrangements in trusts; and personnel information and finance matters.

Lord Ennals

I am most grateful to the noble Lord for giving way a second time. He said that the basic document will be prepared by the trust. However, the trust will not have been established. Will it simply be submitted by the enthusiasts as opposed to a structure such as a trust?

Lord Henley

Perhaps I misled the noble Lord on the matter. The document will be put forward by those applying for trust status. As I said, there will then be consultation on that document. We see no need for there to be a repeat document from the Secretary of State.

As I said, the document will be wide-ranging. It would, therefore, seem strange for the Secretary of State to have to prepare a separate document setting out the reasons for establishing a trust. That would either repeat the application document or provide for consultation proposals which differ to a greater or lesser extent from the terms of the trust's applicants. That would not seem the right way to go about the process of consultation. That is why we believe that such consultation should be carried out by the regions, as I stated, on the basis of the document prepared carefully by the trust applicants.

I can assure Members of the Committee that responses to consultation from interested bodies will carry weight in the Secretary of State's decision. However, I do not believe that it would change the weight which the Secretary of State placed on the results of consultation if he was bound by a statutory duty to take account of such responses. He will take account of all relevant factors when reaching his decision and will decide upon the option which he believes will be best for National Health Service patients.

I should explain that the functions specified in the establishment orders of trusts will be based upon the services they provide, as set out in their applications for trust status. As I have already made clear, CHCs will be consulted on the applications. Therefore, the suggested amendment, Amendment No. 95G, tabled in the name of the noble Lord, Lord Ennals, would I think merely duplicate this process to no real purpose.

I hope that the information about consultation, and also my answer to the noble Lord, Lord Hunter, as regards his proposal that a document should be published by the Secretary of State, will reassure the Committee that the Government are fully committed to consultation on trust applications and that these amendments are unnecessary.

Lord McColl of Dulwich

Perhaps I may deal first with the issue which the noble Lord, Lord Ennals, frequently mentions; that is, commercialism. I should like to ask this question. Who was it who brought up the subject of the sordidness of money and cash limits? Who introduced cash limits into the hospital service in the first place? The noble Lord, Lord Ennals, will no doubt correct me if I am wrong, but I believe that it was the noble Lord himself who did so. Therefore the great emphasis on controlling the amount of money which is spent came initially—quite rightly—from him.

I should like to take Members of the Committee back to the time of one of the noble Lord's predecessors; namely, Mr. Richard Crossman. One day he found himself in the lift with a clerk to the board of governors of a famous London teaching hospital. He said to the clerk, "You are overspending and you must cut down on the amount of money being spent". The clerk responded by saying, "I have no intention of controlling the spending; I shall encourage them to go on overspending". Thus we had this difficulty of limiting or controlling the expenditure of hospitals. The noble Lord, Lord Ennals, then brought in these cash limits. However, he does not seem to me to be very enthusiastic about the matter.

Lord Ennals

I feel I must respond to the noble Lord's remarks. I admit that I introduced cash limits. If a Secretary of State has established cash limits he must then decide, if the rate of inflation is running over the estimate made at the time of the establishment of the cash limit, whether the health service ought to be protected against the higher rate. Further, if there has been a major increase in remuneration by agreement, he must also decide whether that should be covered or whether both aspects must come out of patient care. That is part of the task of the Secretary of State.

Lord McColl of Dulwich

I thank the noble Lord for that answer. However, it is also true to say that no Secretary of State has ever given enough cash to cover inflation. If inflation is estimated at 5 per cent. and it turns out to be 8 per cent. it is part of the technique of the Treasury to ensure that it remains at 5 per cent.

I wish to return to the patient and the hospital. Let us bring in a little commercialism, in which the noble Lord, Lord Ennals, may be interested. Right now, in January this year in one hospital not 40 miles from here one surgical unit managed to carry out operations at a cost of £40 per hernia equivalent. That is a unit which is a way of measuring how much surgery costs. In this same hospital another unit operated at a cost of £200—that is a five-fold difference. That is what is happening now. We have no way to control that.

We believe that the introduction of the Bill will, especially in the case of the self-governing hospital enable there to be an enormous incentive to find out why those differences occur, to iron them out and to obtain real value for money. That is what it is about.

The noble Lord, Lord Ennals, also mentioned St. Thomas's Hospital and asked why it was experiencing these cuts. He himself said repeatedly that every year more and more money is spent on the National Health Service. The costs increase every year. What then are these cuts? If he were to go out one day to do the shopping and spent five times more than he should on the food, he might find that his household had to institute cuts in the following months. Is that a true cut or part of his failure to control expenditure?

Lord Peston

Perhaps I may interrupt the noble Lord, with respect. I have some connection with St. Thomas's Hospital. Is he saying that St. Thomas's has to make these cuts because it mismanages its resources? Does he wish to place that on record at this time? I should be grateful to know what he has said because in due course I could take the opportunity to rebut it.

Lord McColl of Dulwich

I do not wish to go into details or to blame anyone. I should like to say that at a particular hospital there is a solution which answers the problem of St. Thomas's. There is apparently something called the suspense account. If one receives a bill and is not sure what to do with it, one puts it in the suspense account, which is also known as the dustbin. That is a reasonable technique so long as one keeps looking in the dustbin and paying the bills. However, if it is left for a long time one may find oneself in difficulty.

I do not wish to go into the details of particular hospitals, but I emphasise that there is not the slightest doubt that we do not have proper financial control in the hospitals of this country. We must achieve that and I believe that the Bill will go a long way towards instituting that control. It is essential.

Lord Ennals

Since this is the Committee stage perhaps I may respond to some of the points made by the noble Lord. He is not right that no government have provided additional funds because the rate of inflation is different from the one they estimated. That is not true and I am able to furnish him with the information.

I live basically on my pension. The noble Lord asked what I do about shopping. My pension is linked to the rate of inflation. I get an index link every year so that my pension has the same value as the year before. All right. The cuts now being carried out in the health service are because the rate of inflation is several points higher than estimated by the Government. Also, quite properly there have been paid increases that have not been totally covered by the department. If the department leaves the situation that way, there will be headlines such as, "Hospital to feel the axe", which appeared in a newspaper today concerning Westminster Hospital.

I see nothing in the Bill which will make it easier for health authorities to keep their accounts properly. The first point I wish to make to the noble Lord is that inevitably, if there is a system of cash limits, it must be administered. If anybody had said in the lift to Dick Grossman or to myself that he would not observe his cash limits, we would have put in commissioners. Indeed I put in commissioners at a time when it was perfectly clear that the health authority would not live within the means available to it. There has to be a discipline. I see nothing in the Bill that will increase that discipline; in fact exactly the opposite.

The point that I tried to make when I spoke at the beginning of the debate was that, if there is a National Health Service trust which is not part of the health authority, all right it may be directly responsible to the Secretary of State but not to the health authority, and that health authority will have a much more difficult job in balancing its budget and knowing what expenditure it has to cope with. It will live with a cuckoo in the nest in the middle of the district for which it is responsible.

I believe that in the present situation, with the lack of additional money to make all this possible, with the uncertainties on whether the staff are trained and whether the money and the information technology will be available, this will produce chaos. I say again that it will produce financial chaos in the National Health Service which will start on about 1st April 1991.

Lord Henley

I do not wish to increase the political nature of the debate, but it is worth correcting some points that the noble Lord made. I do so purely for the sake of the record. He implies that there have been cuts in health spending under the Government. As he knows perfectly well, there has been a growth in real terms since 1979 of 45 per cent. There has been a growth in spending per capita in real terms of 41 per cent., which brings the expenditure on the health service under this Government—indeed under all governments—to an all time high.

4.15 p.m.

Lord Hunter of Newington

I am sorry to say that the noble Lord, Lord McColl, has only confirmed my view that the situation is as I described it. In other words, it does not require a self-governing hospital to achieve his objects because a good number of years ago one hospital which I served did just that without having been made into a self-governing hospital trust.

The issue is essentially medical people being involved with managers. I do not think there would be any disagreement on that on any side of the House. Managers and medical people must work together. I am grateful to the Minister for what he has said but, with respect, a great deal of it has a familiar ring. I am still in a position where I have no idea what criteria the Government used in choosing the 30 people on trial, and whether there will be a period of consultation or examination after they have been on trial for a while. I do not know whether the Minister wishes to answer that.

Lord Henley

As I said, there will be further guidance. Perhaps I may return to the document put forward by the applicants. As I explained, that document will cover in some detail quite a range of issues, and I spelt them out: benefits to patients; proposals to develop services and to ensure quality; leadership in management arrangements and trusts; personnel information and financial matters. Having had such a wide-ranging document from the applicants for the trust, I do not think that it will be necessary for the Secretary of State to produce another document on which there would be yet further consultation. There would be consultation on the document produced by the applicants for trust status.

Lord Hunter of Newington

I still find myself confused. I feel that the matter is so critical that I must determine the views of the House on it.

4.20 p.m.

On Question, Whether the said amendment (No. 94D) shall be agreed to?

Their Lordships divided: Contents, 101; Not-Contents, 103.

DIVISION NO.1
CONTENTS
Addington, L.	Harris of Greenwich, L.
Adrian, L.	Hatch of Lusby, L.
Airedale, L.	Hayter, L.
Annan, L.	Hirshfield, L.
Ardwick, L.	Houghton of Sowerby, L.
Aylestone, L.	Howie of Troon, L.
Birk, B.	Hughes, L.
Blackstone, B.	Hunt, L.
Blease, L.	Hunter of Newington, L. [Teller.]
Bonham-Carter, L.
Bottomley, L.	Hutchinson of Lullington, L.
Bruce of Donington, L.	Hylton, L.
Callaghan of Cardiff, L.	Hylton-Foster, B.
Campbell of Eskan, L.	Ilchester, E.
Carmichael of Kelvingrove, L.	Jacques, L.
	Jay, L.
Cledwyn of Penrhos, L.	Jeger, B.
Cocks of Hartcliffe, L.	Jenkins of Putney, L.
Craigavon, V.	John-Mackie, L.
David, B.	Kilbracken, L.
Dean of Beswick, L.	Kilmarnock, L.
Diamond, L.	Leatherland, L.
Ennals, L.	Listowel, E.
Ewart-Biggs, B.	Llewelyn-Davies of Hastoe, B.
Falkland, V.
Fisher of Rednal, B.	Lloyd of Hampstead, L.
Fitt, L.	Lloyd of Kilgerran, L.
Gallacher, L.	Lloyd-George of Dwyfor, E.
Galpern, L.	Longford, E.
Graham of Edmonton, L. [Teller.]	Lovell-Davis, L.
	Macaulay of Bragar, L.
Grantchester, L.	McFarlane of Llandaff, B.
Hampton, L.	McGregor of Durris, L.

Masham of Ilton, B.	Serota, B.
Mayhew, L.	Shackleton, L.
Molloy, L.	Shaughnessy, L.
Monson, L.	Stallard, L.
Murray of Epping Forest, L.	Stedman, B.
Nicol, B.	Stoddart of Swindon, L.
Oram, L.	Swann, L.
Orr-Ewing, L.	Taylor of Blackburn, L.
Peston, L.	Thurlow, L.
Phillips, B.	Thurso, V.
Ponsonby of Shulbrede, L.	Turner of Camden, B.
Prys-Davies, L.	Underbill, L.
Rea, L.	Wallace of Coslany, L.
Robson of Kiddington, B.	Walton of Detchant, L.
Russell, E.	White, B.
Sainsbury, L.	Williams of Elvel, L.
Saltoun of Abernethy, Ly.	Winchilsea and Nottingham, E.
Scanlon, L.
Seear, B.	Winterbottom, L.
Seebohm, L.	Young of Dartington, L.

NOT-CONTENTS
Alexander of Tunis, E.	Lauderdale, E.
Annaly, L.	Layton, L.
Arran, E.	Long, V.
Balfour, E.	Luke, L.
Beaverbrook, L.	McColl of Dulwich, L.
Belhaven and Stenton, L.	Mackay of Clashfern, L.
Beloff, L.	Mancroft, L.
Belstead, L.	Marshall of Leeds, L.
Bessborough, E.	Merrivale, L.
Blatch, B.	Mersey, V.
Boyd-Carpenter, L.	Monk Bretton, L.
Brookes, L.	Mottistone, L.
Brougham and Vaux, L.	Mountevans, L.
Butterworth, L.	Mowbray and Stourton, L.
Caithness, E.	Moyne, L.
Caldecote, V.	Munster, E.
Campbell of Alloway, L.	Murton of Lindisfarne, L.
Campbell of Croy, L.	Nelson, E.
Carnegy of Lour, B.	Newall, L.
Carnock, L.	Norfolk, D.
Colwyn, L.	Nugent of Guildford, L.
Constantine of Stanmore, L.	Pender, L.
Cork and Orrery, E,	Plan of Writtle, B.
Cottesloe, L.	Quinton, L.
Cranbrook, E.	Reay, L.
Crickhowell, L.	Kenton, L.
Davidson, V. [Teller.]	Renwick, L.
Denham, L. [Teller.]	Romney, E.
Eden of Winton, L.	St. Davids, V.
Elliot of Harwood, B.	St. John of Bletso, L.
Elliott of Morpeth, L.	Sanderson of Bowden, L.
Elton, L.	Selborne, E.
Ferrers, E.	Sempill, Ly.
Fortescue, E.	Sherfield, L.
Eraser of Kilmorack, L.	Stodart of Leaston, L.
Gardner of Parkes, B.	Strathclyde, L.
Gisborough, L.	Strathcona and Mount Royal, L.
Greenway, L.
Gridley, L.	Strathmore and Kinghorne, E.
Hailsham of Saint Marylebone, L.	Swansea, L.
Havers, L.	Swinfen, L.
Hemphill, L.	Swinton, E.
Henley, L.	Teviot, L.
Hesketh, L.	Trefgame, L.
Hives, L.	Tryon, L.
Hood, V.	Ullswater, V.
Hooper, B.	Vaux of Harrowden, L.
Howe, E.	Whitelaw, V.
Iddesleigh, E.	Willoughby de Broke, L.
Killeam, L.	Wolfson, L.
Kimberley, E,	Wyatt of Weeford, L.
Knutsford, V.	Young, B.

Resolved in the negative, and amendment disagreed to accordingly.

Baroness Blatch

I beg to move that the House do now resume.

Moved accordingly, and, on Question, Motion agreed to.

House resumed.