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Limits On Reimbursement Of Expenses

Volume 131: debated on Thursday 14 April 1988

The text on this page has been created from Hansard archive content, it may contain typographical errors.

I beg to move amendment No. 85, in page 16, line 25, leave out clause 13.

With this, we will take the following amendments: No, 77, in page 16, line 36, at end insert—

'( ) It shall be the duty of a Family Practitioner Committee to report to the Secretary of State any instance when. it considers that the amount allotted under subsection (97)(1)(b)(ii) above is insufficient for the purposes prescribed, and to make known to the public in its locality the content of such report'.
No. 78, in page 17, line 2, at end insert—
'( ) It shall be the duty of a Health Board to report to the Secretary of State any instance when it considers that the amount allotted under subsection (85)(2)(a) above is insufficient for the purposes prescribed, and to make known to the public in its locality the content of such report'.
No. 79, in page 17, line 7, at end insert—
'(5) Each Family Practitioner Committee and each Health Board shall have the duty to satisfy itself, after consulting such bodies as appears to it to represent the interests of the public in its locality within the National Health Service, that the payments made pursuant to this section are available without discrimination in all parts of its locality and to all practitioners in contract with it and covered by any such allotment'.

In view of the time, I intend to be brief. I was not a member of the Standing Committee which considered the Bill but I have read the debate in Committee on clause 13. Many of the details were well aired in the debate. However, it is right at this stage that hon. Members who did not have the opportunity to participate in that debate should search further to find out whether the Government have advanced their thinking on these issues.

I want to refer to statements by the Parliamentary Under-Secretary of State. She referred to doctors who
"were worried that the new system has not been explained sufficiently to allay their fears. This is partly because some of the details…are still to be worked out."
I wonder whether the Government have worked out further details. She also said:
"My first and most important reassurance is that we firmly anticipate spending a great deal more on the services than currently."—[Official Report, Standing Committee A, 23 February 1988; c. 870.]
Can a specific figure be offered by the Government now, particularly in view of the fact that later in that debate the Parliamentary Under-Secretary said that she was hoping that funds would be raised from the implementation of clauses 8 and 10? We have had a concession from the Minister for Health that there will be a reduction of £7 million to £8 million as a result of his statement. Will that affect in any way the money which comes in?

The Parliamentary Under-Secretary of State also indicated that it was not the Government's expectation that the clause would come into effect immediately. It seems strange to include in the Bill a clause which is not to be implemented until negotiations are complete. Surely we must be given a final date which will be applied to the negotiations.

We put our general practitioners in the front line of medicine. We turn to them in times of crisis and indeed of health. How can we expect them to expand and improve primary care and preventive medicine, yet put cash limitations on their ability to do so? If we expect our GPs to take a pro-active role, we must take account of their financial needs. It is wrong to place cash limits on GPs in the clause, rather than look at the service and the needs of patients.

It is clear that general practitioners have been very cost-effective in their application of the funding available to them. I will quote from a letter that I received from Grampian local medical committee, because that is my local medical authority. The committee is deeply concerned about the implications of the clause. The letter says:
"We would emphasise that such cash-limiting is not necessary, as the service we provide is widely recognised as being extraordinarily cost-effective—the cost of the availability and services of the General Practitioner being around £28 per patient per year, which includes all the expenses of running a practice."
For a Government who talk of cost-effectiveness, I do not think that I could find a better example of a cost-effective service than that provided in Grampian at a cost of £28 per patient per year.

Because of other financial pressures being exercised on the National Health Service, and presssure on the Grampian health board budget, several practices, mainly in health centres, are already withdrawing treatment room nurse provision. Arrangements are being negotiated so that the GPs will meet part of the cost, the whole cost previously having been borne by the health board. Against that sort of background, I ask the Government to withdraw the clause until we have sorted things out and know in our own minds exactly what to do. They should give our general practitioners the vote of confidence that they so obviously deserve.

I am anxious not to protract the proceedings, but I am sure that I am not the only hon. Member who has had letters from GPs within his constituency. They are concerned that the effect of the clause will be to restrict the extent to which patients consult them. I am sure that that is not intended, and it would be helpful if the Minister could give appropriate assurances when replying to the debate. Indeed, perhaps at some stage what is known as a "Dear Doctor" letter can be sent clarifying the situation so that these misunderstandings can be removed.

In my constituency, people are very fortunate in the high quality and standards offered to them by the general practitioner service throughout Angus. I have had the opportunity to visit practices in Montrose, and I was very impressed by their use of technology, and modernisation assisting in patient care, to ensure an efficient and caring service.

My purpose in speaking is to draw to the Government's attention the views of such working general practitioners. These practical and qualified men and women are concerned about the Government's proposals. I shall be using their words, and I hope that the Minister will respond to them.

The substance of clause 13 implies a concept of cash limiting the funding of primary care services, and it is that to which these general practitioners are opposed. Montrose practices are typical of those in Angus, and elsewhere in Scotland, in that forward-looking practices are extending their functions in preventive medicine to include cervical and other screening procedures and the care of the sick at home in the community. In national terms these services are cost effective because they relieve hospitals of additional burdens. If cash limits are imposed on primary care, such initiatives will be abandoned. My doctors believe that it will revert to a "national sickness" service.

The unique contractual relationship within the NHS means that general practitioners have a direct incentive to extend and improve services, retaining, in their own interests, the need to be very cost effective. There is an entrepreneurial attitude in Montrose, which its GPs believe should be supported by the Government rather than be hamstrung by cash limiting.

General practice in the United Kingdom is experiencing a renaissance of technological development, an extension of function and an improvement in services for patients. Notwithstanding that, the cost to the state is lower than in any other country in the Western developed world. The profession is willing and has the capacity to do much more in primary care, but that attitude will be to no avail if cash limits are imposed.

The doctors in another Montrose practice state:
"Primary care is cost-effective at present, with patients entitled to open access to Primary Health Care services, with no limits on the number of consultations."
Despite that open-endedness, the primary health care system is cost effective, making this unlimited access available at the cost of about £28 per patient per year in total for expenses and paying for the general practitioner. Those doctors believe that cash limiting is an attempt to bring the hospital cuts into the sphere of general practice, and there will be cuts if the clause is passed.

Hospital cuts have led to longer waiting lists which have increased the work load on GPs; for example, because patients require attention for pain relief and drugs while waiting for admission. Earlier discharge from hospital means that GPs treat more people with drugs which otherwise would have been provided from hospital, thus adding to the work load and costs of general practice.

Rationing primary health care is not a desirable option and any attempt at rationing in this sphere would impose limitations on patient access to primary health care. My doctors believe that cash limits are not necessary. In general, practice costs are largely reimbursed on the basis of national average cost levels and GPs control their costs tightly to maintain their practice income. This in turn ensures that average cost levels are maintained in future years. Therefore, doctors have a personal incentive in controlling costs, resulting in national saving.

The Government want GPs to develop their service to patients, but to do that they must have sufficient quality staff. Doctors state that it is obvious from their surgeries that ancillary staff offer great benefits to patients, for example, in easing the arrangements between patients and hospitals, ambulances, social work departments, the DHSS, employers, the district nurse and the health visitor, and by making available in the surgery treatments which would normally mean a patient having to travel to hospital. The benefits cover the whole spectrum of staff, from practising nurses to administrators, secretaries and receptionists. The direct reimbursement scheme pays only part of those salaries and GPs shoulder the remainder, so they have a powerful incentive to be cost effective.

The doctors of Montrose have attractive premises in the town, but they state that with cash limitations even planned projects will now be made more doubtful, let alone new projects. Limitations on the existing cost-rent scheme threaten them, but further cash limiting would torpedo them altogether.
"This direct reimbursement scheme also has powerful incentives to cost-effective development, for although the scheme yields a return on capital invested in practice premises, the GP still has to put up the capital and bear the burden of increased running costs of new or improved premises."
Those are the words of working GPs who deal not only with the theory, but with the practice, of medicine. The Government's proposals will threaten directly their work and efficiency. I support my hon. Friend in opposing clause 13 and I hope that the Minister will listen and respond to the genuine voice of the medical profession.

I support amendment No. 85. We do not believe that the case for imposing cash limits has been made by the Government. There is no evidence that across the country GPs plan to be unreasonable in their demands to take advantage of what the Government clearly see as a potential loophole in the Bill. On the contrary, GPs will be reasonable and will not employ more staff than they need to look after their patients. However, it is certain that the Government will not concede this point. Accordingly, amendments Nos. 77 and 78 place a duty on a general practitioner committee or a health board to make a public report to the relevant Secretary of State if they believe that their allocation for these purposes is insufficient.

The amendment assumes that family practitioner committees will be responsible. If they need to report they will reflect the inadequacy of Government provision. Any responsible Government would welcome such a report and take action to remedy the unsatisfactory state of affairs. We cannot see any justification for the Government refusing to accept the amendment.

Amendment No. 79 places a duty upon FPCs to ensure that, if a limited sum is available, it is distributed in a non-discriminatory manner. It would be entirely inappropriate if an FPC benefited part of its area at the expense of other parts. The amendment also strengthens the hands of FPCs in their planning functions. It will help FPCs to strengthen services in deprived parts of their areas. The fact that they can plead that statutory duty is likely to overcome the resistance that they might encounter. That can only benefit the service. In other words, FPCs can become more active in aiding the development of services. It will no longer be sufficient for FPCs simply to react to events. I hope that the amendments, like some of my others, are not too clever for the Minister.

9.30 pm

I rise briefly to support amendment No. 85. There is universal opposition to cash-limiting the family doctor service. Representations have been made to Members of Parliament, including no doubt to members of the Government, from worried general practitioners around the country. I challenge the Government to name one single independent reputable organisation that supports the cash-limiting of GP services. I am talking about anybody the Under-Secretary of State can mention who supports clause 13, not about people who have made statements of general support for the White Paper. Nobody supports clause 13 and its cash limits.

General practitioners are absolutely right to be fearful. It is clear that the Government now intend to wield the axe over GP services in exactly the same way as they have chopped hospital services.

I hope that the Government will not insult our intelligence tonight by saying that they are introducing cash limits so that they can spend more than they currently spend. We were not born yesterday. It is unbelievable to think that in introducing a clause entitled,
"Limits on reimbursement of expenses"
the Government are introducing the clause to enable them to spend more. It is nonsense to say that a cash limit will improve and develop services. A cash limit is there simply to limit cash. It will stifle the development of services.

GP services do need developing. We want to see the benefits of new technology harnessed for the benefit of patients. New technology in communication and in diagnostic equipment should be available to GPs. We want to see GPs work as part of an enhanced team with nurses, health visitors, midwives, chiropodists, physiotherapists and other health professionals. We want to see GPs' premises improved so that they provide pleasant waiting and treatment areas with easy access for parents with small children and for disabled people. We want to see GPs develop their work on screening and prevention and provide, at local level, diabetic clinics, ante-natal services and counselling on diet and smoking. There is no chance of those developments taking place if, instead of saying to family doctors, "Let us discuss how we can improve services", the Government say, "Go away and cut costs."

It is not as if at any time in Committee the Government pointed out that there has been an inefficient use of resources. Family practitioner committees are already obliged to, and do, take into account value for money. If anything, we would criticise them for having erred on the side of caution and for not pressing hard enough or fast enough to develop and improve GP services. It is clear that the Government intend to squeeze GP services. They want to use the dissatisfaction that that creates in patients as an excuse to bring in commercial, American-style health maintenance organisations. That would be a catastrophic mistake.

The family doctor service is not perfect, but it is a good base and provides a good framework on which to build. The problem is that the Government do not want universal public provision of primary care services. This is the first step on the road to undermining those services.

The Parliamentary Under-Secretary has been kind enough to inform me that she issued a press release earlier today, announcing an initiative on practice nurse training. I welcome the fact that the Government are taking this initiative but I feel that it is not a serious measure because of the sum of money and the number of nurses involved. The training initiative has, we are told in the press statement, attracted only £150,000 of Government money. That addition to nurse training must be looked at against a background of a cut of £40 million in nurse training provision between 1979 and today. The figure of £40 million comes from a parliamentary answer from the Minister. We are told that the training initiative is to cover 500 nurses; but that must be looked at against a background of a cut in the intake of student and pupil nurses of 12,550 between 1979 and now. That figure again comes from a parliamentary answer from the Minister.

I hope that the Parliamentary Under-Secretary will acknowledge that, although the Government now say that they are promoting practice nurse training, this is a very measly start from a Government with a shameful record on nurse training. I hear the Parliamentary Under-Secretary muttering that I do not understand the figures. I understand only too well that what the Government have done, in practice, in nurse training is cut programmes to ribbons. Yet they are trying to give themselves a bit of a public relations puff by announcing £150,000 to cover 500 nurses. The wool will not be pulled over our eyes in that respect.

The system for paying general practitioners is, like that of the other family practitioner professions, based on the cost-plus principle which was established at the inception of the National Health Service. That is, the payments that they receive are intended to cover expenses and to provide on top a net income for every GP. Based on the return to the Inland Revenue, expenses incurred in providing general medical services are paid back to the profession in full. That is, if the tax man accepts it as a legitimate expense, we accept it.

Some of these expenses are paid back to the individual GP, and that is known as direct reimbursement. The remainder is reimbursed on an average basis through standard rate fees and allowances—that is, indirectly reimbursed—and general practitioners' net income is also delivered through fees and allowances. I am sure that the hon. Member for Southport (Mr. Fearn), who was an assistant bank manager, has understood all that.

Clause 13 will enable directly reimbursed expenses to be subject to a cash limit, but expenses not directly reimbursed in full will nonetheless be reimbursed indirectly through fees and allowances.

The total spend on family practitioner services in Britain is over £5,000 million, and by 1990–91 we hope to have increased it by some £600 million. I cannot tell the hon. Member for Moray (Mrs. Ewing) exactly how much will come under clause 13 because at least part of it will be the subject of discussions with the profession, but that is the sort of sum of money that we are talking about; and the directly reimbursed element of that sum amounts to £455 million in 1987–88. These are Great Britain figures.

Our proposals, as set out in the White Paper, would involve cash-limiting barely half of that. In other words, the proposals would cover less than 5 per cent. of the total spend on these important family practitioner services, and over 95 per cent. would continue to be run in exactly the same way as they are now.

Our intent, as was recognised in Committee, is to give family practitioner committees and health boards a chunk of money to help them concentrate premises improvement funds where they are most needed, particularly, for example, in the inner cities, and we also want them to help doctors everywhere to improve their practice teams, with a far wider range of staff than is currently possible. We are very concerned to improve the practice team. I share that view with the hon. Member for Angus, East (Mr. Welsh).

As the hon. Lady the Member for Peckham (Ms. Harman) said, I was very glad to announce earlier today that we are making an extra £150,000 available immediately to increase sharply the number of training opportunities for practice nurses. The detailed arrangements are a matter for discussion with the profession, but I expect to see rapid action as the money is available now. We hope that £50,000 will be used to create distance learning materials, including videos, which will help practice nurses all over the country, particularly those in rural areas such as the constituences of the hon. Member for Moray and Angus, East and my own, the sort of nurses in rural areas who cannot always get to meetings or training courses.

In addition, the bulk of the money will be used, I hope, to pay the course fee. If the hon. Lady the Member for Peckham wants to understand the figures and the amounts, perhaps she would like to listen to this. I hope that the bulk of the money will be used to pay the course fee for practice nurse training courses. Indeed, we expect more such courses to be set up as a result of that money. We foresee 500 nurses being able to take advantage of the extra money this year. If those courses are satisfactory, we hope to do the same next year. After that, clause 12, which has gone through all its stages without comment, will come into operation and will enable those fees to be paid.

The difference between that money and the money about which the hon. Member for Peckham was speaking is that it is used simply to pay course fees. The money about which the hon. Lady was speaking includes salaries.

I have told the officials concerned that I am particularly keen to improve training for practice nurses to take cervical smears, and I hope that the hon. Member for Peckham will at least say thank you for that.

We have been asked why we should not continue with the current set-up. The present ancillary staff scheme was introduced in the mid-1960s. Some 20 years on 24,000 family doctors in Great Britain are employing over 36,000 practice staff. Of that figuree, 16,000 are receptionists and 11,000 are secretaries, but the number of practice nurses is only 3,000. In Scotland, 3,000 family doctors have only 170 practice nurses for a population of 5 million, which is completely unsatisfactory.

We consider the present system to be far too restrictive because it does not encourage the recruitment of other health professionals such as chiropodists, counsellors and physiotherapists, and it prevents the payment of people such as doctors' wives, which I regard as iniquitous. We shall change that.

With regard to practice premises, we feel that the present system is unsatisfactory. Many examples of bad surgery premises were given in Committee. That system is used at present simply because there is a strong incentive for the doctor to do nothing, which answers the question of the hon. Member for Angus, East.

The present system is old-fashioned because it does not link spending with health needs and we shall do something about that in the near future. We think that cash limits will be useful as they will concentrate minds and enable priorities to be sorted out. I therefore reject the amendments.

If the Minister was seeking to reassure me, she has singularly failed to do so. I believe that there are various principles at stake in the amendment.

The Minister spoke of cash-limiting the total amount given. That would be detrimental to general practices throughout the United Kingdom. A principle is involved, because if half of the total amount is to be cash limited, as time goes on the amount cash limited will increase more and more.

I refer the Minister to what the British Medical Association said about clause 13. It said:
"Indeed it carries the potential to threaten patients' equality of access to services in the future."
Nothing that the Minister said showed that she will guarantee equality of access or protect the rights of general practitioners. Therefore, I feel that I have no option but to press the amendment to a vote.

Question put, That the amendment be made:—

The House divided: Ayes 182, Noes 304.

Division No. 260]

[9.42 pm

AYES

Abbott, Ms DianeFisher, Mark
Adams, Allen (Paisley N)Flannery, Martin
Allen, GrahamFlynn, Paul
Archer, Rt Hon PeterFoot, Rt Hon Michael
Armstrong, HilaryFoster, Derek
Ashdown, PaddyFraser, John
Ashley, Rt Hon JackFyfe, Maria
Banks, Tony (Newham NW)Galbraith, Sam
Barron, KevinGalloway, George
Battle, JohnGarrett, John (Norwich South)
Beckett, MargaretGeorge, Bruce
Benn, Rt Hon TonyGodman, Dr Norman A.
Bennett, A. F. (D'nt'n & R'dish)Golding, Mrs Llin
Bermingham, GeraldGraham, Thomas
Bidwell, SydneyGrant, Bernie (Tottenham)
Blair, TonyGriffiths, Nigel (Edinburgh S)
Boyes, RolandGriffiths, Win (Bridgend)
Bradley, KeithGrocott, Bruce
Bray, Dr JeremyHardy, Peter
Brown, Gordon (D'mline E)Harman, Ms Harriet
Brown, Nicholas (Newcastle E)Haynes, Frank
Brown, Ron (Edinburgh Leith)Heffer, Eric S.
Bruce, Malcolm (Gordon)Henderson, Doug
Buchan, NormanHinchliffe, David
Buckley, George J.Hogg, N. (C'nauld & Kilsyth)
Caborn, RichardHome Robertson, John
Campbell, Menzies (Fife NE)Hood, Jimmy
Campbell-Savours, D. N.Howarth, George (Knowsley N)
Canavan, DennisHowell, Rt Hon D. (S'heath)
Clarke, Tom (Monklands W)Howells, Geraint
Clay, BobHoyle, Doug
Clelland, DavidHughes, John (Coventry NE)
Clwyd, Mrs AnnHughes, Robert (Aberdeen N)
Cohen, HarryHughes, Simon (Southwark)
Cook, Frank (Stockton N)Illsley, Eric
Cook, Robin (Livingston)John, Brynmor
Corbett, RobinJones, Barry (Alyn & Deeside)
Corbyn, JeremyJones, Ieuan (Ynys Môn)
Cox, TomJones, Martyn (Clwyd S W)
Cummings, JohnKennedy, Charles
Dalyell, TamKilfedder, James
Darling, AlistairLeadbitter, Ted
Davies, Rt Hon Denzil (Llanelli)Leighton, Ron
Davies, Ron (Caerphilly)Lewis, Terry
Davis, Terry (B'ham Hodge H'I)Litherland, Robert
Dewar, DonaldLivsey, Richard
Dixon, DonLloyd, Tony (Stretford)
Doran, FrankLofthouse, Geoffrey
Duffy, A. E. P.Loyden, Eddie
Dunnachie, JimmyMcAllion, John
Dunwoody, Hon Mrs GwynethMcAvoy, Thomas
Eadie, AlexanderMcCusker, Harold
Eastham, KenMcFall, John
Ewing, Mrs Margaret (Moray)McKay, Allen (Barnsley West)
Fatchett, DerekMcKelvey, William
Fearn, RonaldMcLeish, Henry
Field, Frank (Birkenhead)McNamara, Kevin
Fields, Terry (L'pool B G'n)McTaggart, Bob

Madden, MaxRobertson, George
Mahon, Mrs AliceRobinson, Geoffrey
Marek, Dr JohnRogers, Allan
Marshall, David (Shettleston)Rooker, Jeff
Marshall, Jim (Leicester S)Ross, Ernie (Dundee W)
Martin, Michael J. (Springburn)Rowlands, Ted
Martlew, EricRuddock, Joan
Meacher, MichaelSedgemore, Brian
Michie, Bill (Sheffield Heeley)Sheerman, Barry
Millan, Rt Hon BruceSheldon, Rt Hon Robert
Mitchell, Austin (G't Grimsby)Shore, Rt Hon Peter
Molyneaux, Rt Hon JamesShort, Clare
Moonie, Dr LewisSkinner, Dennis
Morgan, RhodriSmith, Andrew (Oxford E)
Morley, ElliottSmith, C. (Isl'ton & F'bury)
Morris, Rt Hon J. (Aberavon)Soley, Clive
Mowlam, MarjorieSpearing, Nigel
Mullin, ChrisSteinberg, Gerry
Murphy, PaulStott, Roger
Oakes, Rt Hon GordonTaylor, Matthew (Truro)
O'Brien, WilliamTurner, Dennis
O'Neill, MartinVaz, Keith
Parry, RobertWall, Pat
Patchett, TerryWalley, Joan
Pendry, TomWardell, Gareth (Gower)
Pike, Peter L.Wareing, Robert N.
Powell, Ray (Ogmore)Williams, Rt Hon Alan
Prescott, JohnWilliams, Alan W. (Carm'then)
Quin, Ms JoyceWinnick, David
Radice, GilesWorthington, Tony
Randall, StuartYoung, David (Bolton SE)
Rees, Rt Hon Merlyn
Reid, Dr JohnTellers for the Ayes:
Richardson, JoMr. Andrew Welsh and
Roberts, Allan (Bootle)Mr. Archy Kirkwood.

NOES

Adley, RobertCarlisle, John, (Luton N)
Aitken, JonathanCarlisle, Kenneth (Lincoln)
Alexander, RichardCarrington, Matthew
Alison, Rt Hon MichaelCarttiss, Michael
Allason, RupertCash, William
Amery, Rt Hon JulianChalker, Rt Hon Mrs Lynda
Amess, DavidChapman, Sydney
Amos, AlanChope, Christopher
Arbuthnot, JamesChurchill, Mr
Ashby, DavidClark, Dr Michael (Rochford)
Aspinwall, JackClark, Sir W. (Croydon S)
Atkinson, DavidClarke, Rt Hon K. (Rushcliffe)
Baker, Rt Hon K. (Mole Valley)Colvin, Michael
Baker, Nicholas (Dorset N)Conway, Derek
Baldry, TonyCoombs, Anthony (Wyre F'rest)
Banks, Robert (Harrogate)Coombs, Simon (Swindon)
Batiste, SpencerCope, John
Bellingham, HenryCormack, Patrick
Bennett, Nicholas (Pembroke)Couchman, James
Biggs-Davison, Sir JohnCran, James
Blackburn, Dr John G.Currie, Mrs Edwina
Blaker, Rt Hon Sir PeterCurry, David
Body, Sir RichardDavies, Q. (Stamf'd & Spald'g)
Bonsor, Sir NicholasDavis, David (Boothferry)
Boswell, TimDay, Stephen
Bottomley, PeterDevlin, Tim
Bowden, A (Brighton K'pto'n)Dickens, Geoffrey
Bowden, Gerald (Dulwich)Dorrell, Stephen
Bowls, JohnDouglas-Hamilton, Lord James
Boyson, Rt Hon Dr Sir RhodesDover, Den
Braine, Rt Hon Sir BernardDunn, Bob
Brandon-Bravo, MartinDurant, Tony
Brazier, JulianEggar, Tim
Bright, GrahamEmery, Sir Peter
Brittan, Rt Hon LeonEvans, David (Welwyn Hatf'd)
Brooke, Rt Hon PeterEvennett, David
Brown, Michael (Brigg & Cl't's)Fallon, Michael
Bruce, Ian (Dorset South)Farr, Sir John
Buck, Sir AntonyFavell, Tony
Burns, SimonFookes, Miss Janet
Burt, AlistairForman, Nigel
Butcher, JohnForsyth, Michael (Stirling)
Butler, ChrisForth, Eric

Fowler, Rt Hon NormanLloyd, Peter (Fareham)
Fox, Sir MarcusLord, Michael
Franks, CecilLyell, Sir Nicholas
Freeman, RogerMcCrindle, Robert
Fry, PeterMacfarlane, Sir Neil
Gale, RogerMacGregor, Rt Hon John
Gill, ChristopherMacKay, Andrew (E Berkshire)
Glyn, Dr AlanMaclean, David
Goodhart, Sir PhilipMcLoughlin, Patrick
Goodlad, AlastairMcNair-Wilson, M. (Newbury)
Goodson-Wickes, Dr CharlesMcNair-Wilson, P. (New Forest)
Gorman, Mrs TeresaMadel, David
Gorst, JohnMajor, Rt Hon John
Gow, IanMalins, Humfrey
Gower, Sir RaymondMans, Keith
Grant, Sir Anthony (CambsSW)Maples, John
Greenway, Harry (Ealing N)Marlow, Tony
Greenway, John (Ryedale)Marshall, John (Hendon S)
Griffiths, Sir Eldon (Bury St E')Martin, David (Portsmouth S)
Griffiths, Peter (Portsmouth N)Mates, Michael
Grist, IanMaude, Hon Francis
Ground, PatrickMawhinney, Dr Brian
Grylls, MichaelMayhew, Rt Hon Sir Patrick
Gummer, Rt Hon John SelwynMellor, David
Hamilton, Hon Archie (Epsom)Meyer, Sir Anthony
Hamilton, Neil (Tatton)Miller, Hal
Hampson, Dr KeithMills, Iain
Hanley, JeremyMitchell, Andrew (Gedling)
Hargreaves, A. (B'ham H'll Gr')Moate, Roger
Hargreaves, Ken (Hyndburn)Monro, Sir Hector
Harris, DavidMoore, Rt Hon John
Hawkins, ChristopherMorris, M (N'hampton S)
Hayes, JerryMorrison, Hon Sir Charles
Hayhoe, Rt Hon Sir BarneyMorrison, Hon P (Chester)
Hayward, RobertMoss, Malcolm
Heathcoat-Amory, DavidMoynihan, Hon Colin
Heddle, JohnNeale, Gerrard
Heseltine, Rt Hon MichaelNeedham, Richard
Hicks, Robert (Cornwall SE)Nelson, Anthony
Higgins, Rt Hon Terence L.Neubert, Michael
Hind, KennethNewton, Rt Hon Tony
Hogg, Hon Douglas (Gr'th'm)Nicholls, Patrick
Holt, RichardNicholson, David (Taunton)
Hordern, Sir PeterNicholson, Emma (Devon West)
Howard, MichaelOnslow, Rt Hon Cranley
Howarth, Alan (Strat'd-on-A)Oppenheim, Phillip
Howarth, G. (Cannock & B'wd)Page, Richard
Howell, Rt Hon David (G'dford)Paice, James
Howell, Ralph (North Norfolk)Parkinson, Rt Hon Cecil
Hughes, Robert G. (Harrow W)Patnick, Irvine
Hunt, David (Wirral W)Patten, Chris (Bath)
Hunt, John (Ravensbourne)Patten, John (Oxford W)
Irvine, MichaelPattie, Rt Hon Sir Geoffrey
Irving, CharlesPawsey, James
Jack, MichaelPeacock, Mrs Elizabeth
Jackson, RobertPorter, David (Waveney)
Janman, TimPortillo, Michael
Jessel, TobyPowell, William (Corby)
Johnson Smith, Sir GeoffreyPrice, Sir David
Jones, Gwilym (Cardiff N)Raffan, Keith
Jones, Robert B (Herts W)Raison, Rt Hon Timothy
Kellett-Bowman, Dame ElaineRedwood, John
Key, RobertRenton, Tim
King, Roger (B'ham N'thfield)Rhodes James, Robert
Kirkhope, TimothyRiddick, Graham
Knapman, RogerRifkind, Rt Hon Malcolm
Knight, Greg (Derby North)Roberts, Wyn (Conwy)
Knight, Dame Jill (Edgbaston)Roe, Mrs Marion
Knowles, MichaelRossi, Sir Hugh
Knox, DavidRost, Peter
Lamont, Rt Hon NormanRowe, Andrew
Lang, IanRumbold, Mrs Angela
Latham, MichaelRyder, Richard
Lawrence, IvanSackville, Hon Tom
Lee, John (Pendle)Sainsbury, Hon Tim
Lennox-Boyd, Hon MarkSayeed, Jonathan
Lester, Jim (Broxtowe)Scott, Nicholas
Lightbown, DavidShaw, David (Dover)
Lilley, PeterShaw, Sir Giles (Pudsey)
Lloyd, Sir Ian (Havant)Shaw, Sir Michael (Scarb')

Shephard, Mrs G. (Norfolk SW)Tredinnick, David
Shepherd, Richard (Aldridge)Trippier, David
Sims, RogerTrotter, Neville
Skeet, Sir TrevorTwinn, Dr Ian
Smith, Sir Dudley (Warwick)Vaughan, Sir Gerard
Smith, Tim (Beaconsfield)Viggers, Peter
Soames, Hon NicholasWaddington, Rt Hon David
Spicer, Sir Jim (Dorset W)Wakeham, Rt Hon John
Spicer, Michael (S Worcs)Waldegrave, Hon William
Squire, RobinWalden, George
Stanbrook, IvorWalker, Bill (T'side North)
Stanley, Rt Hon JohnWalker, Rt Hon P. (W'cester)
Stern, MichaelWaller, Gary
Stevens, LewisWalters, Dennis
Stewart, Allan (Eastwood)Ward, John
Stewart, Ian (Hertfordshire N)Wardle, Charles (Bexhill)
Stokes, JohnWells, Bowen
Sumberg, DavidWheeler, John
Summerson, HugoWhitney, Ray
Tapsell, Sir PeterWiddecombe, Ann
Taylor, Ian (Esher)Wiggin, Jerry
Taylor, John M (Solihull)Wilshire, David
Taylor, Teddy (S'end E)Wolfson, Mark
Tebbit, Rt Hon NormanWood, Timothy
Temple-Morris, PeterWoodcock, Mike
Thompson, D. (Calder Valley)Young, Sir George (Acton)
Thompson, Patrick (Norwich N)Younger, Rt Hon George
Thornton, Malcolm
Thurnham, PeterTellers for the Noes:
Townsend, Cyril D. (B'heath)Mr. Robert Boscawen and
Tracey, RichardMr. Tristan Garel-Jones.

Question accordingly negatived.