House Of Commons
Friday 29 April 1988
The House met at half-past Nine o'clock
Prayers
[MR. SPEAKER in the Chair]
Orders Of The Day
Licensing (Retail Sales) Bill
As amended in the Standing Committee, considered.
Clause 1
Amendment Of Definition Of "Sale By Retail" In Licensing Act I964
I beg to move amendment No. 1, in page 1, line 8, leave out 'to any one person'.
It would be wrong to say that the Bill was subjected to protracted scrutiny on Second Reading. Indeed, this is the first occasion on which this excellent measure, which is the child of my hon. Friend the Member for Berkshire, East (Mr. MacKay), has been debated on the Floor of the House.Is my hon. Friend aware that the Committee discussed the Bill for three sittings and it was suggested in some quarters —quite wrongly, and the suggestion was rejected by you, Mr. Speaker —that we were filibustering? We considered serious amendments. We examined some of them at great length. We think that the Bill has now been fully considered.
I entirely agree with my hon. Friend. I have studied the reports of Standing Committee C with great care. My hon. Friend the Member for Grantham (Mr. Hogg) was a member of the Standing Committee, as was my hon. Friend the Member for Reigate (Mr. Gardiner), who is partly a parent of the Bill.
Our debate takes place on the 87th birthday of the Emperor of Japan and on the 46th birthday of the deputy Foreign Secretary. I know that my hon. Friends the Members for Reigate and for Mid-Worcestershire (Mr. Forth) have already been in touch with my hon. Friend the Minister of State, Foreign and Commonwealth Office, raising with her issues about double summer time which were considered by the House last evening. I do not want to be led astray down those paths, however. As well as' the two birthdays to which it is right that the House should pay tribute, we should note that our debate on the subject of drink takes place in the absence of my right hon. Friend the Father of the House. The House should not despair, however, because seated on the Treasury Bench is the Vice-Chamberlain of Her Majesty's Household —my hon. Friend the Member for Watford (Mr. Garel-Jones). He is visiting us at the start of a weekend which appears for him to have begun already. He is in his place because he has a deep interest in alcohol I have an interest in alcohol, but it is not quite the same as that of my hon. Friend the Vice-Chamberlain. I see that the hon. Member for Newham, North-West (Mr. Banks) is in his place.No, I am not.
He is not sitting beside the hon. Member for Bradford, South (Mr. Cryer). That would be quite wrong. The hon. Member for Newham, North-West was a member not of Standing Committee C but of that Committee which considered the Housing Bill. You may wonder, Mr. Speaker, why I am bringing the hon. Member for Newham, North-West into the debate —
Order. We are considering the Licensing (Retail Sales) Bill, not what went on in the Housing Bill Standing Committee, interesting though that may have been.
We need to know who is in the Chamber.
My hon. Friend the Under-Secretary of State was a member of the Standing Committee. I give way to my hon. Friend the Member for Epping Forest (Sir J. Biggs-Davison).
I do not know why my hon. Friend should wish to give way to me. I have no wish to intervene in the debate, so overcome am I by my hon. Friend's eloquence.
I do not want to be led astray, particularly with you, Madam Deputy Speaker, in the Chair.
Especially when the hon. Member is moving the amendment.
That is true. You, Madam Deputy Speaker, will have studied closely the Bill and the amendment. The amendment seeks to leave out the words, "to any one person". When I was discussing the series of amendments with some of my hon. Friends I wondered whether the words, "to any one person" were really necessary.
I dislike very much even raising a doubt about whether the draftsmanship of my hon. Friend the Member for Berkshire, East (Mr. MacKay) could in any way be defective. It is possible, although the clause was considered most carefully in Committee, that the point that I draw to the attention of the House on Report was overlooked. I say that to my hon. Friend the Member for Berkshire, East and to the Under-Secretary of State for the Home Department, who has brought with him a massive volume of paper and books that are not readily available to BackBenchers.This particular book is not so readily available to Back Benchers because I have nicked it from the Library and it was the only copy.
That book was written by my noble Friend Lord Hailsham of Saint Marylebone who has been engaged in a very erudite correspondence through The Times —with which I am in respectful agreement —with Lord Jenkins, who used to sit close to where the hon. Member for Bradford, South (Mr. Cryer) is seated, and who used to be in the same party as the hon. Member. Lord Jenkins of Hillhead has been engaged in a correspondence in The Times—I do not know whether the hon. Gentleman reads The Times —about the powers of another place. It will be interesting to see, when the Bill reaches another place, whether the amendment is rejected or withdrawn. It is quite possible that the amendment will be considered in another place.
Will my hon. Friend say whether he believes, in the light of the Under-Secretary of State's presence on the Front Bench, the amendment arises out of some conspiracy or some cock-up?
The amendment was tabled by me. It is perfectly true that none of my hon. Friends has added his or her name to the amendment. I think that it would have been in order for the Minister of State, Foreign and Commonwealth Office, my right hon. Friend the Member for Wallasey (Mrs. Chalker) to add her name to this first amendment. Madam Deputy Speaker confirms that that is so. It would not have been possible at this stage for the Minister's father to add his name since he is a member of another place.
My hon. Friend mentioned the Minister's father. Would it be appropriate for us all to congratulate him on the excellent interview that he gave on television last night in which he spoke for the British people?
Order. I doubt whether that relates to the amendment before us.
I entirely agree with the ruling that you, Madam Deputy Speaker, have given. We want to know, either from my hon. Friend the Member for Reigate (Mr. Gardiner), who had a great deal to do with the parenthood of the Bill —I hope that my hon. Friend the Member for Berkshire, East will not think it discourteous of me when I say that they were joint parents of the Bill —
There are usually joint parents.
My hon. Friend is quite wrong about that. How many letters now start off, "I am a one-parent family"?
Obviously the hon. Member for Eastbourne (Mr. Gow) is prepared to give way to anyone this morning, even to me. Although it can end up as a single-parent family, at the point of conception two parents are usually involved, unless it is a virgin birth.
As my hon. Friend —I almost referred to the hon. Member for Newham, North-West (Mr. Banks) as my hon. Friend. Indeed, we had many happy discussions about the Housing Bill. However, I should not be led astray by the hon. Gentleman.
Will my hon. Friend give way?
What do you think, Madam Deputy Speaker?
It is not for the Chair to determine whether an hon. Member must give way. The hon. Member has given away a great deal of time this morning.
9.45 am
I shall give way to my hon. Friend and if my hon. Friend the Member for Reigate should seek to intervene I shall certainly give way to him.
My hon. Friend referred to the number of one-parent families. Is he aware that more than 20 per cent. of births are illegitimate? Would he consider that as being related to the availability of alcohol?
Order. The hon. Member's interventions do not relate to the amendment.
I believe that the Bill will be improved and its comprehensibility advanced if we omit the words "to any one person" because they are superfluous. My hon. Friend the Member for Berkshire, East will acknowledge that those words are not necessary and that the clause will be made clearer if those words are omitted. I expect that to be the view of my hon. Friend the Member for Berkshire, East, and I expect that the Minister, when he advises the House, will agree that the amendment is a modest improvement to this excellent Bill.
I always hesitate to disagree with my hon. Friend the Member for Eastbourne (Mr. Gow) because for four glorious days in 1983 I served as his Parliamentary Private Secretary and I have always held him in the greatest respect.
Although I have no particular objection to the amendment, as it does not affect my Bill, I believe that when my hon. Friend the Minister addresses the House we shall find that the amendment will have consequential effects on the major licensing Acts that have been passed. Therefore, my hon. Friend the Member for Eastbourne might find it wiser to withdraw the amendment, but perhaps it would be for the convenience of the House if we were to hear from my hon. Friend the Minister about thatI have to say that I had not expected to speak so early in the debate. It occurred to me that this kind of amendment, striking at the root of parliamentary draftsmanship, about which hon. Members from both sides of the House would like to speak.
My hon. Friend the Member for Eastbourne (Mr. Gow) has raised the matter and I have been challenged, as it were, by his former Parliamentary Private Secretary. I fear that I shall not rise to that challenge in quite the way that he would have done had he continued with his speech a little longer. There is no doubt that the question that has been raised so clearly by my right hon. Friend —I am sorry, I mean my hon. Friend the Member for Eastbourne; I cannot think how such an omission has occurred —is a matter of some importance. That is because there is a nasty tendency on the part of those who draft legislation to increase the volume of words that appear in the Bill. Consequently, it is important that when a certain phrase appears in a Bill of this kind we should be in a position to justify it. Otherwise, out of an abundance of caution, we shall find the language of the Bill being multiplied, with phrase being piled upon phrase, and becoming verbose. In the end, we have to ask what it means
Precisely.
I am glad that the hon. Gentleman supports me. He will remember that on a number of occasions in Committee, when I have had the privilege of serving with him, he has tried to add phrases that have no meaning, but on this occasion I see that we are as one. Incidentally, that also applies to the hon. Member for Bradford, South (Mr. Cryer). He has given me some nasty moments, for example, on money resolutions.
That is one of life's modest consolations.
If it is one of life's modest consolations for the hon. Member for Bradford, South, I have to say that it was one of my embarrassments, but I hope that I rose to the occasion with good humour and charm. In any event, the hon. Gentleman, the hon. Member for Birmingham, Erdington (Mr. Corbett) and I, and, I think, the Vice-Chamberlain Household, Lord Tinky-pooh and various hon. Members are anxious to know —
Did I hear my hon. Friend refer in a somewhat disparaging way to a member of Her Majesty's Household? At the beginning of the debate, did I not remind my hon. Friend that today is the 87th birthday of His Majesty the Emperor of Japan? Were not the words that fell from my hon. Friend's lips anticipated earlier by the marvellous Mr. W. S. Gilbert?
That is the problem. I was reminded about the glorious birthday of the Emperor of Japan, and that put the unhappy words "Tinky-pooh" into my mind. I withdraw them, because it is disparaging to my hon. Friend the Member for Watford (Mr. Garel-Jones) and, no doubt, to the Emperor of Japan. Therefore I withdraw them on that ground as well.
Does my hon. Friend realise how closely the Bill is related to the Emperor of Japan?
Order. I believe that such references were ruled out of order earlier.
I was about to refer to the Deputy Foreign Secretary because you had ruled, Madam Deputy Speaker, that she could have added her name to the amendment. I draw that fact to the attention of my hon. Friend the Minister.
It is true that my hon. Friend the Deputy Foreign Secretary could have done just that. Had she done so, it would have been a great advantage because she occupies a much more distinguished place in the Government than I do. [HON. MEMBERS: "Hear, hear."] I do not know how to reply to the sedentary interventions behind me, Madam Deputy Speaker, and I feel sure that you would not wish me to do so. Nevertheless, had she added her name to the amendment, the House would have had the benefit of a speech from my hon. Friend the Deputy Foreign Secretary and she would have been able to bring her international experience to bear upon it.
And her intellect.
And, indeed, her intellect. We should have had both a precise analysis of the legal questions and the experience of my hon. Friend the Deputy Foreign Secretary, who would have drawn upon comparisons with Germany, France, Italy and—
Is it not the case that, had she done so, she would not have remained Deputy Foreign Secretary for very long?
I do not know about that. It is not for me to speculate on the future of my hon. Friend the Deputy Foreign Secretary, but I should have thought that the House would have been better informed—
My hon. Friend the Minister seems to be somewhat confused over titles. Understandably, but wrongly, he referred to my hon. Friend the Member for Eastbourne (Mr. Gow) as his right hon. Friend. I share his view that my hon. Friend the Member for Eastbourne should be my right hon. Friend, but he has just done a grave injustice to the Deputy Foreign Secretary by calling her his hon. Friend. He should know, as I know, that she was made a Privy Councillor about 18 months ago. No doubt he would wish to add his congratulations to her.
I most certainly wish to add my congratulations, but I think that they may be a trifle belated. I have to say that I am overcome by shame. As you know, Madam Deputy Speaker, I am not, on the whole, overcome by shame, but on this occasion I feel that the point that has been made is particularly sharp.
Is not my hon. Friend's error compounded even more by the fact that our right hon. Friend is the only other Lady, apart from the Prime Minister, who is a right hon. Member of the House?
My hon. Friend is rubbing salt into the wound. All that I can do is to grovel, and I do so in a way that I hope is much more meaningful than the way in which others grovelled in this House a few days ago. I have committed a grave sin. I can only apologise to my hon. Friends and to my right hon. Friend the Member for Castle Point (Sir B. Braine), who is not here today. I have a feeling that if I continue in this vein, Madam Deputy Speaker, I shall be in serious trouble with your good self.
On a point of order. Madam Deputy Speaker. There is no post known to the law as Deputy Foreign Secretary. May we know to whom my hon. Friend the Minister is referring?
I do not think that that has anything whatever to do with the legislation that is before us. We ought not to go down that path.
It is a tribute —
Why has my hon. Friend not paid tribute to our right hon. Friend the Father of the House, the right hon. Member for Castle Point (Sir B. Braine)? Was not mention made at the beginning of the debate to the Father of the House? Did we not say that our proceedings would be strengthened if only he were to arrive?
I am afraid that I had not noticed that my right hon. Friend the Member for Castle Point had come into the Chamber, but that is a fact upon which we should comment. Very few hon. Members know or care more than he does about legislation that relates to alcohol. I think that I speak on behalf not only of the Treasury Bench and my hon. Friends but of the hon. Members for Erdington, for Newham, North-West (Mr. Banks) and for Newcastle-under-Lyme (Mrs Golding), when I say that we very much welcome the presence of my right hon. Friend the Member for Castle Point. His presence denotes the possibility that this legislation will be examined in somewhat greater detail than might otherwise have been the case. That is inevitably good, especially on a Friday morning when we have the time to explore these matters in some detail. On behalf, therefore, of all right hon. and hon. Members who may be in the Chamber, or who are shortly to arrive, I welcome my right hon. Friend the Member for Castle Point and hope that he has a very full contribution to make to the debate.
My hon. Friend the Member for Orpington (Mr. Stanbrook) raised a point of order about the term "Deputy Foreign Secretary". He was right to do so, but it is a tribute to the reputation of my hon. Friend the Member for Eastbourne that the description that he applied should have been treated by hon. Members as a definitive description. Strictly speaking, he was not right, but, as on many occasions, he sets the tone that this Chamber is anxious to follow.My hon. Friend could be misled by the fact that the BBC constantly refers to my right hon. Friend the Member for Wallasey (Mrs. Chalker) as the Deputy Foreign Secretary. We all know that the BBC never makes a mistake.
It is perfectly true that our understanding of the facts may occasionally be perverted by the BBC, and it is undoubtedly true that—
Order. These proceedings are by no means tedious but they are quite irrelevant.
You may remember, Madam Deputy Speaker, that about 10 minutes ago I said that if I pursued my then current line I should be ruled out of order by you, but just as I was turning to the point with which I now wish to deal—the words "to any one person"—I was sidertracked by the very welcome arrival of my right hon. Friend the Member for Castle Point. Should that phrase be in the Bill? We began from the proposition that we should not include words that are surplus to the meaning of the Bill. Are those words surplus to the meaning of the Bill, and do they damage its effect?
We are getting into trouble with titles this morning. To help us make up our minds about the amendment, will my hon. Friend say whether he has consulted the parliamentary draftsmen about whether the amendment would preclude a pregnant lady from purchasing liquor?
10 am
That possibility was not in my mind when I first considered the amendment. Although it is capable, by extension, of applying to persons not present in the corporeal world, perhaps my hon. Friend is stretching the point further than I would wish. I shall discuss the matter at an appropriate moment with the parliamentary draftsmen and explore possible further refinements of the law to make the position crystal clear. I am grateful to my hon. Friend the Member for Langbaurgh (Mr. Holt) for raising that drafting point.
My hon. Friend the Member for Eastbourne looks as though he is about to leap to his feet. Does he wish to intervene?No.
We have just witnessed a unique event. I invited my hon. Friend to intervene, but he declined. I always welcome new experiences.
I revert to the interesting, if somewhat detailed, question whether the phrase, "to any one person" should appear in the Bill. There are two reasons why it should not. First, there is the question of its impact on related legislation. The House will be aware of the provisions of the Alcoholic Liquor Duties Act 1979, particularly section 4(4). The definition of "sale by retail" in the Bill follows broadly the provsions contained in section 4(4) of the 1979 legislation, where the wordsappear. My hon. Friend the Member for Eastbourne is a lawyer. I was a lawyer and hope never to be one again. We understand the importance of consistency in legislation. If I were to make one serious point—I hope to make many serious points—I would suggest that it is desirable to have the same definitions in relevant and related legislation. For that reason, I find the amendment difficult to accept."at any one time to any one person"
My hon. Friend has raised an interesting point of principle about the way in which the country is run. In view of his contribution to a recent debate, is he suggesting that when a Government have made a cock-up and legislation is on the statute book, it is inviolate for all time and cannot be amended by subsequent wiser thinking? That would suggest that a measure passed in 1982 would stand for ever. My hon. Friend the Member for Eastbourne (Mr. Gow) made a valid contribution. It is wrong to say that because words have been enshrined in legislation, or that because in the past some buffoons accepted them, we must accept them for all time.
I am a wiser person than I was two nights ago. I believe that the phrase that I used was a trifle inelegant, so I shall not repeat it. My hon. Friend the Member for Langbaurgh, however, is right. If an error was made some time ago, we are not bound by it thereafter. We are entitled to consider legislation and decide whether the error should persist I do not believe that the 1979 legislation is defective in its definition. I am, therefore, anxious to maintain consistency between relevant and related legislation.
I am sure that my hon. Friend would like to comment on whether the voters of Eastleigh, North took this amendment into consideration when yesterday they increased the Conservative majority from 228 to 511. The Labour party's vote decreased dramatically.
I suspect, although I cannot speak authoritatively, that the answer is no. I imagine that the voters of Eastleigh, North had in mind the Government's successful policies and the great leadership of my right hon. Friend the Prime Minister. Those facts are more self-evident than the true but less self-evident merits of the Bill.
The Government are neutral about the passage of the Bill. My hon. Friend the Member for Kingswood (Mr. Hayward) was right to draw to the attention of the House our remarkable victory. I think that it had more to do with the overall success of the Government and the defects of the Opposition than the merits of this important piece of legislation.And a good candidate.
And, indeed, a good candidate. As you, Madam Deputy speaker, will know, the Conservative party is extremely careful to select only good candidates. I wish that the same could be said of other parties. I am aware that I am trespassing, Madam Deputy Speaker. You need not rise, because I know that I am at fault. I apologise to you, Madam Deputy Speaker, and I would apologise to those Opposition Members who should have been selected had they been present.
My second reason why the words "to any person" should not appear in the Bill is that they do not deleteriously affect paragraphs (a), (b), (c) and (d) of clause 1, but they have a prejudicial effect on paragraph (e) because they would dilute the control encompassed in clause I. They would enable people to band together to buy quantities of alcohol, the effect of which would be that such sales would be treated as wholesales and would thus be exempt from the licensing regime. It was right that the phraseology of clause 1 should be challenged, but for the reasons that I have given I do not commend the amendment to the House.In view of what my hon. Friend the Minister has said, I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Having listened to the Minister on amendment No. 1, I shall not move amendment No. 2.
I beg to move amendment No. 3, in page 1, leave out line 12. Line 12 of clause 1 states:This Bill is a small but excellent measure and it will give added protection to children who can be misled into buying alcohol from the back of a lorry. It will be warmly welcomed by my right hon. Friend the Member for Castle Point (Sir B. Braine), the Father of the House. It will also be welcomed by my hon. Friend the Member for Watford (Mr. Garel-Jones), the Vice Chamberlain. I think that my right hon. Friend the Father of the House will agree that not every canteen or mess sells alcoholic drink. My right hon. Friend is a deputy lieutenant of his county and has also been a soldier. I have never been into a mess where alcoholic drink was not served, but, there are canteens and messes, however rare, where it is not. Indeed, I believe that that is increasingly the case. My hon. Friend the Member for Berkshire, East (Mr. MacKay) drafted clause 1 on the assumption, which I do not believe is valid, that alcohol is served in every canteen and mess."to any canteen or mess."
I assure my hon. Friend that many canteens throughout the country in many industrial premises quite rightly do not sell alcohol because it is recognised that people have to return to work having eaten in those canteens.
My hon. Friend reinforces the point I was making. I believe it to be the view of my hon. Friend the Vice-Chamberlain that it would be no bad thing if there were more canteens and messes, within and without the House, where alcohol was not served. My hon. Friend the Member for Reading, West (Mr. Durant) has many soldiers living in his constituency. Unlike the Vice-Chamberlain, he is allowed to have a drink. Indeed, in the past I have given a drink to my hon. Friend the Member for Reading, West, but I have never given an alcoholic drink to the Vice-Chamberlain. I hope that my right hon. Friend the Member for Castle Point will not think that this is an incorrect recollection on my part, but I believe that in a canteen or mess I have given a glass of sherry to my right hon. Friend. Does my right hon. Friend wish to intervene?
I am listening with intense interest to this debate. I listened to the high quality speech from my hon. Friend the Minister, which is what we expect from him, and to the contributions from my hon. Friends.
I was once the chairman of a working party—I think it was the first working party in the country—that looked into the question of alcohol in the place of work. We came to the conclusion—it was widely accepted by industry, the medical profession and the country as a whole—that alcohol and work were a mismatch. In fact, a high proportion of industrial accidents and an inordinately high incidence of absenteeism from work were caused by the imbibing of alcohol during some part of the working day. I am glad to say that, by and large, employers and trade unions agreed. I should like to pay tribute to the contribution made by the trade union movement. In fact, a distinguished member of the Trades Union Congress was a member of the working party. As a result of that, there have been considerable improvements. There is also the growing problem of young people and alcohol. Youth leaders up and down the country are urging the provision of bars and canteens where young people can take a non-alcoholic drink to refresh themselves. My hon. Friend the Member for Eastbourne is dealing with an extremely important point and I will listen to the rest of his speech with the greatest interest.I was not sure whether my right hon. Friend had caught your eye, Madam Deputy Speaker, and was making a speech or whether it was an intervention. Certainly, that brief intervention has whetted the appetite of the House and I hope that it may be possible for you to call my right hon. Friend later in the debate.
10.15 am My right hon. Friend the Member for Castle Point, with his long experience of canteens and messes as a former soldier, in his quasi-judicial role as a deputy lieutenant of his county, and as a member of the Privy Council, which, as my right hon. Friend knows, has quasi-judicial origins, has added support to the amendment. It is true that he was not able to bring himself to sign the amendment, but he has done something much more important. He has come to the House on the last Friday in April, on the very day when he could have been at the Japanese embassy signing the book on the Emperor's birthday. I do not know whether my right hon. Friend the Member for Wallasey (Mrs. Chalker) is giving a luncheon party today in order to mark her 46th birthday. All I know is that I have not been invited to that party, nor do I know whether it will take place in a canteen or a mess. I hope that my right hon. Friend's newly made constituency of Castle Point will continue to return him for many years. He is not with the Deputy Foreign Secretary, but has come to the House, whose Father he is, to support the amendment. For those reasons I hope that my hon. Friend the Member for Berkshire, East and my hon. Friend the Minister will agree with the amendment. The glittering political career of my hon. Friend the Minister may be injured if he disagrees with our right hon. Friend the Father of the House and, in view of the added weight given to this amendment, I hope that he will feel it right to acquiesce.I wonder whether my hon. Friend the Member for Eastbourne (Mr. Gow) has been putting words into the mouth of our right hon. Friend the Member for Castle Point (Sir B. Braine). I listened carefully, as I always do, to the intervention of our right hon. Friend and I was not clear whether he was supporting the amendment or simply making some extremely valid points, which have been helpful to the House, about the dangers of alcoholism at work and the detrimental effect of alcohol being drunk in the workplace. I felt that his remarks were supported widely on both sides of the House and that it was an intervention with which we all agreed.
However, with the greatest respect to my hon. Friend the Member for Eastbourne, that does not necessarily mean that our right hon. Friend was suppporting his amendment. I had hoped that it would merely be a probing amendment so that we could have the sort of enlightened debate, such as we have had already this morning, on the subject of alcohol in canteens and messes. I urge the House to reject the amendment if, after hearing from the Minister, my hon. Friend the Member for Eastbourne does not withdraw it. It would be an embarrassment to the Ministry of Defence, our hon. Friend the Parliamentary Under-Secretary of State for the Armed Forces and messes throughout the land. My hon. Friend the Member for Eastbourne is a distinguished officer in the Territorial Army and I am sure that he would be the last person to wish to cause such embarrassment. Therefore, I hope that he will withdraw the amendment.In interpreting the word "canteen", my hon. Friend the Member for Eastbourne (Mr. Gow), spoke almost entirely about military canteens. When I intervened, he referred to industrial canteens as well. Inevitably, one makes such an interpretation when it is associated with the word "mess", but there are many industrial canteens in factories and offices in the City of London, Westminster and this building. It is appropriate, as I think my right hon. Friend the Member for Castle Point (Sir B. Braine) will agree—as he did in his brief but lucid intervention—that people who are to return to work having had a meal in a canteen should not consume alcohol. It is a danger not only to themselves, especially if they work on industrial machinery, but to other workers.
The Chamber is a place of work as well. It could be argued that it is just as dangerous for Members to go into the Bars here, return in a drunken state and participate in the passage of legislation as it is for someone in a factory to drink and then operate a piece of machinery. The hon. Gentleman should be equal in his treatment.
I am not sure that you, Madam Deputy Speaker, would accept the suggestion that any right hon. or hon. Lady or Gentleman ever returns to this place in a drunken state. I hope that the hon. Member for Newham, North-West (Mr. Banks) will take the opportunity to correct that interpretation.
Will my hon. Friend give way?
I should like first to deal with the intervention of the hon. Member for Newham, North-West.
May I point out that I have not been ruled out of order by the Chair. To prevent the hon. Gentleman from trying to provoke further debate, I should like to say that I made no allegations about an individual Member. Perhaps it would satisfy the hon. Gentleman if I said that Members return here suffering from a very heavy lunch.
I thank the hon. Gentleman for clarifying the matter. I share his view that it is important that in all circumstances, whether in this place or elsewhere, but especially when safety is involved, people should be able to work to their maximum efficiency and not endanger anyone. One could reasonably presume, and hope, that my right hon. Friend the Minister of State, Foreign and Commonwealth Office—the right hon. Member for Wallasey (Mrs. Chalker) —if she is having the birthday party to which my hon. Friend the Member for Eastbourne referred, would return to work not influenced by any alcohol that she was able to acquire in a canteen, mess or club or for the purposes of her trade. No doubt my right hon. Friend will be able to convey her congratulations to the Japanese on the birthday of the Emperor of Japan. I understand that this evening the Japanese embassy will celebrate the Emperor's birthday. I am sure that my right hon. Friend the Deputy Foreign and Commonwealth Secretary will have been invited to that.
I wanted to ask my hon. Friend earlier whether he would comment on the advice given by the late Lord Attlee to a new Member of Parliament, that he should, first, specialise and, secondly, that he should keep out of the Bars.
Most ignored his advice.
I note that, as ever, the hon. Member for Newham North-West makes a sedentary intervention, observing that it was universally ignored advice. I am sure that the hon. Gentleman was not suggesting that my hon. Friend the Member for Watford (Mr. Garel-Jones) or my right hon. Friend the Member for Castle Point ignored that advice so rightly given by the great Lord Attlee. I note that the hon. Member for Newham, North-West does not wish to comment. I am sure that the advice is not universally ignored, although it may be ignored by quite a number.
I return to my original point, as you would wish me to do, Madam Deputy Speaker. I seek clarification on the amendment. Are we talking purely about canteens and messes in military establishments, about which my hon. Friend the Member for Eastbourne spoke at length, or are we speaking in general about canteens? Clarification is needed by all those responsible for running non-military canteens. I referred earlier to the by-election in Eastleigh, and my hon. Friend the Under-Secretary of State responded. There were similar results in Durham and Hammersmith which were not good news for the main Opposition party. This amendment, or previous amendments, may well have been in the voters' minds when they pondered before casting their votes yesterday.I had no intention of speaking to this amendment, until I heard my hon. Friend the Member for Eastbourne (Mr. Gow). It seemed that he lacked the sort of background knowledge that I have had, having been a boy sailor and junior sailor. Some of the messes into which we were allowed did not serve alcohol, and that was always a great regret because we never learnt at a young enough age to control the problem, and later in life we perhaps compounded it. Rather than pass the amendment, we should first decide why we all want to be Holy Joes all the time, telling people what they should and should not do, and consider the matter in relation to canteens.
Having been a director of personnel in a company with five works canteens, all of which served alcohol, I do not recall many instances when people were the worse for wear, except perhaps on their birthdays. The Emperor of Japan is no doubt celebrating his birthday today. Perhaps you are not aware, Madam Deputy Speaker, that when I was a young lad in the Navy there was a tradition that on one's birthday one was allowed to get blind, stinking drunk and was never in trouble for it. When I was a young man in the Navy, sailors were real sailors and drank rum, unlike sailors today, who are technocrats who drink lemonade. The Navy currency was that each measure was made up of a sipper, two sippers were one gulper, two gulpers were half a tot, and two halves were a whole tot. A young lad knew how many friends he did or did not have on his birthday by the number of times that he was invited to come round and have a sipper, a gulper or half a tot, or a bosum pal might even give a friend his tot. That did not make the whole British Navy any the worse. In many ways it made it better. We did not lose too many wars or battles as a consequence. Sometimes we lose sight of these important little aspects of' our life when we introduce measures such as this. It should he noted that men like to drink. They like their pint of beer. I have even known ladies who enjoyed a gin and tonic. A young couple can go to the works canteen, have a pint and a gin and tonic, and indulge in intimate conversation spread over some time, rather than have to rush clown to the car park, try to get the car out, knowing that the space will be gone when they return, and drive 30 miles to a pub. It is wise to say these things when dealing with this legislation. They enable the matter to be put in its proper perspective. It will be a sad day when we do what has been done in some places and ban all alcohol. I am afraid, though, that I might have liked to ban alcohol last Sunday when I managed finally to get into a compartment at Wembley Park after the football match and was squeezed like a sardine. Someone, who perhaps had been drinking a little too much, happened to throw up in the compartment. The problem was compounded by the fact that the Holy Joes of the GLC and London Transport had banned smoking, and I could not light up to offset the fumes from that offensive action. The more we legislate to ban things, the worse they become. I hope that my hon. Friend the Member for Eastbourne will withdraw his amendment.
I think that it will be to the benefit of the House if I proceed fairly quickly. There seems to have been a misunderstanding about the nature and scope of the words "canteen" and "mess". They are, in fact, narrowly defined in section 201 of the Licensing Act 1964, which states:
That is further defined as meaning, in effect, a military canteen. "Mess" means"'canteen', except in part X of this Act and in the expressions 'canteen licence' and 'licensed canteen', means a canteen in which the sale or supply of intoxicating liquor is carried on under the authority of the Secretary of State".
It is therefore a mistake to suppose that the word "canteen" is apt to include the ordinary canteens with which hon. Members are more familiar. It has a narrower meaning. Against that background, let me deal with the substance of the amendment. All sales of alcohol are sales by retail and are thus subject to the licensing regime unless they are exempt, and the Bill sets out the categories of transaction that should be exempt. One of those exempt categories is "canteen or mess". The amendment would mean that those who run a canteen or mess could get their supply of alcohol only from licensed wholesalers, unless they were purchasing in quantities which constituted wholesale quantities, which, in loose jargon, is purchased in bulk. That has two unfortunate consequences. First, it probably diminishes the range of suppliers who can supply to a canteen or mess. Secondly, it might persuade the secretary of a mess or canteen to order a crate of gin when a bottle would do just as well. On the basis that the amendment narrows the range of supplier and that it is at least capable of increasing insobriety, I advise the House not to accept it."an authorised mess of members of Her Majesty's naval, military or air forces".
In view of my hon. Friend's answer, I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Order, for Third Reading read.
10.32 am
I beg to move, That the Bill be now read the Third time.
I believe that the Bill that I have piloted through the House represents a significant contribution to the reduction of alcohol abuse in this country. It tackles in particular, the dreadful problem of under-age drinking. I do not believe that there is an hon. Member who has not discussed with anxious parents, teachers, social workers or other interested parties the problem of school children consuming large quantities of alcohol. By making illegal the sale of alcoholic drinks, for example, off the back of lorries, to under-age drinkers—especially at carnivals and pop festivals—the Bill makes a significant move in the direction in which the country and the House wish to proceed: we want to ensure that it is as difficult as possible for young people to consume and abuse alcohol. There has been one unfortunate aspect of the Bill's passage through the House. The House and the country have acknowledged that this is a significant Bill. Hon. Members on both sides of the House were upset, therefore, by the attitude of the hon. Member for Liverpool, Mossley Hill (Mr. Alton) and the supporters of his private Member's Bill who, earlier this year, tried to suggest that my hon. Friend the Member for Reigate (Mr. Gardiner), myself and other sponsors of this Bill, as well as hon. Members on both sides of the House who served on the Standing Committee, were in some way trying to delay the proceedings of this Bill and thus of the Bill which was introduced by the hon. Member for Mossley Hill. They tried to suggest that this Bill was irrelevant—a gross insult to everyone who is trying to tackle alcohol abuse. Then they had the impertinence and cheek to persuade their zealot supporters—the ayatollahs who parade under the banner of the Society for the Protection of Unborn Children—to write to churches and newspapers in our constituencies suggesting that we were filibustering. First, as Mr. Speaker pointed out in a ruling on the Floor of the House, that was most certainly not so, and it was an insult to the occupants of the Chair. Secondly, it was an insult to all those hon. Members who are anxious that the Bill should proceed. It should be put on record again that that disgraceful incident did no credit to the hon. Members involved. Today, we see proof of the Bill's importance. My highly respected right hon. Friend the Member for Castle Point (Sir B. Braine), who is also a strong supporter of the Bill introduced by the hon. Member for Mossley Hill—I hasten to add that he took no part in the disgraceful episode—has the House and acknowledged our work on the Bill. I hope that in future hon. Members who have been fortunate enough to draw a relatively high position in the ballot and who choose to introduce legislation that is perfectly in order, as is their right, will not be harassed as my hon. Friends and I have been harassed by outside groups aided and abetted by certain hon. Members.My hon. Friend may have clarified the point that I intended to make with his reference to our right hon. Friend the Member for Castle Point (Sir B. Braine). He used the terms "zealots" and "ayatollahs" when referring to those who supported the actions—which I regret—in support of the Bill introduced by the hon. Member for Liverpool, Mossley Hill (Mr. Alton). Perhaps he will make it clear that he was not referring to all that Bill's supporters, of whom I am one.
I am happy to make that clear. I would put my hon Friends the Members for Kingswood (Mr. Hayward) and for Hendon, South (Mr. Marshall), who I know takes a similar view on the subject, in exactly the same category. I cannot put the hon. Member for Mossley Hill and certain other hon. Members on both sides of the House, who I am not prepared to name at this stage, in the same category and I certainly cannot include in it a large number of the Bill's supporters outside the House who parade under the banner of the Society for the Protection of Unborn Children and Life, who behaved in a despicable way and have been suitably censured by the Chair.
I am delighted that the Bill is proceeding through the House. It is a significant measure. I hope that it will gain its Third Reading and proceed to the other place, that it will return unamended to us in July and that it will be on the statute book by the end of the year. I believe that it will help and do good. It is a modest but significant reform of our licensing laws.
10.38 am
As the hon. Member for Berkshire, East (Mr. MacKay) knows, the Opposition wholly support the Bill.
The hon. Gentleman does the House a favour by reminding us of the events that surrounded the start of the Bill's Committee stage. A number of us who served on the Committee were subjected to the most intense pressure by the hon. Member for Liverpool, Mossley Hill (Mr. Alton) who made the most astonishng and false accusations about us and against us—not in this place but by letter circulated all round our constituencies, and directed especially at ministers of the Church. That led to a great deal of anxiety. I have a Catholic abbey in my constituency and I like to believe that I have good and friendly relations with those who work there, although we do not always agree on the issues that we discuss. It was right and proper that, after a deal of pushing, the hon. Member for Mossley Hill wisely withdrew his accusations and caused letters to be sent to those to whom he had originally written.Does the hon. Gentleman agree that it was particularly offensive to select him for such criticism as he was appointed to the Committee in his capacity as Front Bench spokesman for the Labour party rather than as a volunteer? Does he further agree that the same applied to my position as a Minister, so it was wholly reprehensible to suggest that either of us had any choice in the matter?
I am grateful to the Minister for making that important point. It was certainly implied, if not stated, that places in the Committee were self-selected for the malevolent and improper purposes ascribed to us by the hon. Member for Mossley Hill. I am delighted that we managed to dispose of that episode, although, like the hon. Member for Berkshire, East, I greatly regret that it ever started.
The Bill is a small but none the less important measure. I suspect that there is agreement throughout the House on the immense and growing problem of alcohol abuse among young people. I do not pick on them deliberately, but one of the most alarming factors in the rise in alcohol abuse is the increase among the very young. A recent survey shows that children of 10 and 11 are regular drinkers and that there is regular heavy drinking by 13 to 15-year-olds. Anything that we can do, as the Bill does, to focus the spotlight on that problem is certainly to be welcomed. It is a pity that the press does not give the same attention to alcohol abuse as to drug abuse. The problem of drug abuse is extremely important, but a hundred times more people are affected by alcohol abuse. For reasons about which we had better not speculate, however, it is extremely difficult to get the media to take an interest in alcohol abuse. Perhaps it is felt that sustained boozing is more acceptable than sustained drug abuse. I hope that that is not so, as abuse of anything is bad for anyone. The hon. Member for Berkshire, East has done the House a service. I hope that the Bill will receive its Third Reading and have a fair wind through the other place.10.43 am
I congratulate my hon. Friend the Member for Berkshire, East (Mr. MacKay) on having secured a high place in the ballot and piloted the Bill as far as Third Reading. It is a short and in some ways modest Bill, but it is extremely important. Sometimes it falls to those who succeed in the ballot to introduce measures that will have a lasting effect for good on our society. I believe that that can truthfully be said of this Bill. It was clear from the proceedings in Committee and from my hon. Friend's speech in moving Third Reading that this is a matter about which he cares deeply.
My hon. Friend will have the satisfaction of knowing that when the Bill reaches the statute book—like him, I wish it a speedy journey through another place—and its provisions become operative, it will give protection to some of those currently exposed to exploitation by people seeking to sell alcohol to the young. My hon. Friend will be able to look back with great satisfaction at his introduction of the Bill and the skill with which he has piloted it through the House. I congratulate him again. I am sure that the Bill will be of great value to our country.10.44 am
I join my hon. Friend the Member for Eastbourne (Mr. Gow) in congratulating my hon. Friend the Member for Berkshire, East (Mr. MacKay) on his success so far with the Bill, which I am sure will be passed into law very soon. The temptation of impulse buying is a problem in a wide range of situations. By reducing the opportunities for impulse purchasing of alcohol the Bill will help the whole community
As a community, the publicans of this country are a highly responsible group in their efforts to deal with under-age drinking.Hear, hear.
I am grateful to my hon. Friend for her support. We all welcome her presence as she has played a major role in educating people into better diet and therefore better health.
The publicans of this country are highly responsible people who recognise that under-age drinking is a major social problem. They also realise that if they are found guilty of selling drink to persons under age they risk losing their licence and livelihood. I believe that we should consider further the availability of alcohol not just from the backs of lorries but in supermarkets. The availability of alcohol in supermarkets at prices with which publicans cannot compete is a major problem. I hope that when my hon. Friend the Under-Secretary of State for the Home Department replies to the debate he will deal with that point and give an assurance that the Government are examining it extremely closely. I am sure that my hon. Friend the Member for Berkshire, East will be thanked by a large number of people as a result of the Bill. As a parent of two young children, who in a few years' time may be tempted, I thank him. I am sure that he will also be thanked by many other parents and by social workers because the Bill deals with a grave social problem about which we all feel very strongly.
10.47 am
I echo the congratulations to my hon. Friend the Member for Berkshire, East (Mr. MacKay) on introducing the Bill. I hope that it will have a fair wind and progress into law as quickly as possible.
I also echo the comments of my hon. Friend the Member for Hendon, South (Mr. Marshall) about the sale of alcohol. I might perhaps disagree with the comments of the hon. Member for Birmingham, Erdington (Mr. Corbett), as I interpreted them, on the consumption of alcohol by the young. Personally, I have no objection to the consumption of alcohol by the young in a family situation, so long as they are brought up to appreciate the effect of very limited quantities. The danger of allowing young people to consume large quantities of alcohol as soon as they are 18 is that they have no previous experience of it and therefore tend to abuse it. The Bill seeks to tackle that problem by dealing with sales which do not take place in controlled circumstances. Inevitably, that is where the greatest dangers arise. At present, alcohol can be bought from the backs of lorries at carnivals, gymkhanas, and so on. It is in such circumstances that people are tempted to consume a large amount rather than to learn slowly the dangers of abuse. In so doing, they may put at risk not just their own lives but those of others. I share also the views of my hon. Friend the Member for Hendon, South about the easy availability of large quantities of alcohol in supermarkets where it is not controlled in the way that it is, for example, in the family home or in a public house or club. It is too easy for people —some of whom may be under age—to buy alcohol in large quantities by taking it off supermarket shelves to the checkout. The checkout girl herself may be under-age. It is difficult for her to refuse, to call a supervisor, or to say to the person, "I am not going to sell you this large quantity of alcohol." Like my hon. Friends and, I believe, Opposition Members, I support the Bill. I believe it will close a loophole in the law regarding the sale of alcohol and help to prevent abuse. We wish to see a realistic and sensible consumption of alcohol. We all hope that our society can progress to that. This measure will go a small way to achieving that end.10.51 am
I join hon. Members in congratulating my hon. Friend the Member for Berkshire, East (Mr. MacKay) on his energy and skill in getting the measure through, at least to its Third Reading. As he and other hon. Members have said, I have a considerable interest in the Bill, as it is substantially the same measure as I introduced in the last Session of Parliament, so I take some pride in at least a shared parentage.
The Bill has an interesting history and teaches us much about the best approach to tackling the abuse of alcohol, which does, unfortunately, occur in our society. The Bill was promoted originally by the Wine and Spirit Association of Great Britain and Northern Ireland to which I occasionally offer parliamentary advice, in consultation with the Brewers Society and the Scotch Whisky Association, with helpful and constructive advice from the Home Office. I thank my hon. Friend the Under-Secretary of State for the Home Department for the help that his Department has given with the measure, both in the last Session and in this. The Bill is an example of the trade's desire to ensure that its products are not abused by a minority of members of our community, and that those products should not be sold to those who are under age. The trade is prepared to support, and in this case initiate, legislation that will prove effective in promoting what my hon. Friend the Member for Kingswood (Mr. Hayward) called "sensible drinking". For thousands of years the moderate drinking of alcohol has played a significant part in civilised societies throughout the world. Alcohol is used for hospitality, for celebrations, in religious ceremonies and as an integral part of an enjoyable meal. There is also considerable evidence that, when taken in reasonable quantities, it improves health rather than worsening it. About 40 million people in the United Kingdom, consume alcoholic drinks of one kind or another—which is about 95 per cent. of the adult population. Almost all do so in moderation, and benefit accordingly. The United Kingdom has a relatively low per capita consumption of alcohol. It is the lowest among EEC countries. There have always been some individuals who misuse alcohol, and certain people who sell it in such a way as to encourage its misuse, but, the highest figures given official credence show that a very small minority of people who drink develop alcohol problems. The figure is a little over 1 per cent. In the United Kingdom there is extensive legislation to control the quality of alcohol and key aspects of its use. The trade bodies to which I have referred support all reasonable legislation to ensure that that is so. In a free society, responsibility for the proper use of alcohol lies ultimately with the individual, but society as a whole has a responsibility to promote its proper use. Parents, teachers and others who guide children and young people, the Government, public agencies, employers, trade unions, voluntary organisations, and sellers of alcoholic drinks should act responsibly and uphold the law. The drinks trade wishes to promote sensible drinking and to ensure that its products are not misused. The efforts of the trade are two-pronged and relate to research and education. The industry is not interested in participating in the numbers game. Anti-alcohol lobbies frequently feed the press with manipulated and misleading statistics, carefully selected to gain popular support for policies which, for example, would prevent any relaxation of licensing hours and penalise the vast majority of moderate drinkers by heavy taxation. The drinks industry should not be drawn into that kind of phoney war. Instead, its efforts should be, and are, directed at funding the necessary research to find out why some people develop a drinking problem and towards educating those who are recognised to be susceptible. The drinks industry makes grants and donations to over seven major organisations associated with research into alcohol misuse. It has also provided funds for research into various aspects of alcohol misuse to six institutions, nine universities and four hospitals. The efforts of the drinks industry to prevent abuse of alcohol follow similar lines to the Government's policy and are directed at target groups. Young people need to be educated on the strength of different drinks, on how alcohol is absorbed and eliminated from the blood stream, and on the harmful effects of excessive consumption. For this purpose, the Scotch Whisky Association, for example, has produced a booklet, "Alcohol and Man", which is available to all schools, and has also produced films and videos on the subject. There is an Alcohol Advisory Centre booklet, "A Do-It-Yourself Guide to Sensible Drinking for Young People". The Wine and Spirit Asssociation of Great Britain and Northern Ireland has produced a useful video for youth leaders. It is only by educating young people in this way, as they begin to come into contact with alcohol, that they will learn to drink sensibly and appreciate the harm of excessive drinking. The drinks industry is keen to promote research into the problem of drinking and driving. The Brewers' Association has produced a booklet for all people who drive, giving the essential facts about which every driver should be aware. The Wine and Spirit Association of Great Britain and Northern Ireland has recognised—I think ahead of the Government—that too few organisations appreciated the need to consider the relationship between alcohol and work, and to develop a coherent policy. The association has produced "Alcohol Policy Guidelines for Companies", which advises them on how to develop a rational policy by which employees with an alcohol problem can be identified and treated.What representations did my hon. Friend make to the Chancellor of the Exchequer before his last Budget, proposing that there should be much greater—[Interruption.]
Order. I remind the hon. Gentleman that we are on Third Reading. As a very experienced parliamentarian, he knows that Third Reading is concerned only with what is in the Bill.
I made representations to my right hon. Friend the Chancellor of the Exchequer before his last Budget and I am glad that he accepted most of them. However, I advise my hon. Friend that they were not directly related to this matter.
It is vital that when those in the professions involved are able to detect alcohol dependency, they are trained to identify and treat the problem. The Scotch Whisky Association gives an annual grant to the Medical Research Council to train doctors, nurses and other members of the health care professions for this purpose. The Wine and Spirit Association of Great Britain and Northern Ireland publishes a booklet, "Drinking and Alcohol—Questions and Answers". It contains information for adults on all aspects of alcohol, and sets out the beneficial and detrimental effects that it can have. Those research and education initiatives, together with this legislation, are vital in finding a solution to the problems of alcohol abuse. The answer lies, not in the manipulation of statistics, but in the recognition that while the majority of people indulge in only a harmless drink, a tiny minority abuse alcohol and must be helped. It is essential that all interested groups work with the drinks trade to find a solution to the problems, rather than indulge in an orgy of statistical manipulation. Within the framework of education and research, the drinks trade recognises its responsibility to detect any loopholes in the law, and the Bill is a case in point. It represents part of the industry's commitment to solving the problems of alcohol abuse and to promoting sensible drinking. By the Bill, the drinks industry, together with my right hon. and hon. Friends, is making a laudable initiative to prevent alcohol abuse.
11.2 am
I congratulate my hon. Friend the Member for Berkshire, East (Mr. MacKay) on introducing this modest measure. Indeed, he referred to it as a small Bill. However, the length of a Bill, no more than the length of a speech, does not denote its merits or strengths. It has been said that for speeches to be memorable they do not need to be interminable, and neither do Bills need to be overlong to be meaningful.
I wonder whether the Bill is entirely correct. None would argue with its aims, but we must not continually give the impression that drinking is wrong. I am sure that many hon. Members were sad to hear today of the death of Lord Brockway. Until very recently he could be seen having a drink with his old colleagues in the Pugin Room. He was using alcohol, not abusing it; it was a means of enjoyment. Other people who used it in that way included Mannie Shinwell and Winston Churchill. We must be careful not to inhibit all drinking. Although the Bill is good in many ways, I have one major criticism of it, and I am sorry that my hon. Friend the Member for Berkshire, East is not in the Chamber to hear it. As in many areas, Parliament has the means to do certain things, but fails to use them. Penalties for breaking the law should be so severe that no one would dream of doing so. Why do so many people abuse the litter, speeding and parking laws? It is because they know that if they are caught, they will not face too great an embarrassment. If those who sell liquor to youngsters under the legal age limit faced swingeing fines and the confiscation of their entire stock, they would soon insist on seeing a birth certificate before selling alcohol to anyone who might be under age. Such heavy penalties would, in some ways, obviate the need for some of this legislation. The Government have been namby-pamby with offenders, and that has caused many of the problems. If they increased the penalties available to the courts, more people would obey the law. We should use the Bill as a vehicle for that. I hope that the Bill reaches the statute book, but I fear that it will not prevent the timorous from saying, "Shall we or shan't we prosecute? Did they know that they had sold alcohol to someone under age?" If the retailer faced severe fines, he would take the necessary steps to ensure that the law was obeyed. My hon. Friend the Member for Kingswood (Mr. Hayward) said that the checkout girls in a supermarket could not judge whether to sell alcohol to youngsters. The law should be changed so that only someone over a given age—perhaps 40—could work at a checkout—Steady on.
That should be the law where alcohol is sold.
Such extreme age limits are not necessary. The lower age limit for selling alcohol should be set at the age limit at which people are allowed to buy alcohol. My hon. Friend's proposal would not allow me to work at a checkout—
Order. I remind hon. Members that the question of age limits does not arise under this Bill.
My hon. Friend the Member for Kingswood (Mr. Hayward), with his activities with a funny little ball, is somewhat of a Peter Pan. However, I hope that he appreciates the serious, underlying point that it is for the proprietors of supermarkets and other stores to ensure that those taking the money for alcohol are fit, proper and responsible. If the law comes down on that proprietor, he should not have the let-out of saying, "I am in the hands of my staff."
Although it is right to introduce this legislation, the Government must also consider the penalties and controls so that, ultimately, we can prevent the far too many young people who are on the streets with bottles and cans of alcoholic liquor from indulging in anti-social behaviour. The Bill will not prevent that. I know that my hon. Friend the Minister cannot be definitive when he answers, but I ask him to give a thought to how the penalties can be stiffened to ensure that people do not profit by selling alcohol to youngsters.11.7 am
I congratulate my hon. Friends the Members for Berkshire, East (Mr. MacKay) and for Reigate (Mr. Gardiner) on introducing the Bill and carrying it through its parliamentary stages.
The Bill's main purpose is to bring under the licensing regime the sale of alcohol from the backs of lorries and similar points of sale. It would, therefore, help the House if I reminded it of how the licensing regime is conducted. All sales of alcohol through retail outlets are subject to the licensing laws, the most important aspects of which are the restrictions on supplying the under age and on the hours of sale, and the various offences that relate to the manner of sale. The significant aim of the Bill is that all sales of alcohol should be treated as retail sales, and thus subject to the licensing laws, unless they fall within the scope of the exemptions set out in clause 1. Paragraphs (a), (b), (c) and (d) of clause 1(1) prescribe various exempted sales, whereas paragraph (e) deals with quantity. If the nature of the transaction is such that it falls within paragraphs (a), (b), (c) and (d) or if the quantity falls within paragraph (e), it is an exempted quantity or sale. Paragraphs (a) to (d) are probably what most people would describe as wholesale transactions—that is to say, a sale to another trader for the purpose of his trade, a sale to a registered club for the purposes of the club, a sale to a canteen or mess, or the sale to the holder of an occupational permission. Each such transaction is probably properly regarded as—I use a loose word—a wholsale transaction, to which it would not be right to apply the full rigour of the licensing laws. Paragraph (e) deals with quantity, to exclude what is defined as "wholesale quantity" from the full rigour of the licensing law. That provision is enshrined in the Bill because of the intervention of my hon. Friend the Member for Mid-Worcestershire (M r. Forth). In Committee, he was concerned about the fear that was expressed by organisations such as the Majestic wholesaling company that their activities would be caught by a prohibition which, in effect, was designed to catch back-of-lorry merchants. They felt that that was unfair, and the Committee was persuaded of that view, the Government's position being one of neutrality. My hon. Friend the Member for Mid-Worcestershire moved the amendment that is now enshrined in paragraph (e). It protects genuine wholesalers dealing in substantial quantities, provided that they trade from their ordinary business premises, as defined in the Bill. That exemption was understandable, and it won the support of the Committee. During this debate, questions have been raised about sale by and to under-age persons. I shall answer those points briefly, because I am anxious to keep within the scope of a Third Reading debate. It is important to bear in mind that the Bill is to be treated in conjunction with the Licensing Bill has nearly completed its parliamentary process. In the Licensing Bill, the Government were conscious of and tried to meet several points that have been made by hon. Members in this debate. Wholesale sales of intoxicating liquor to or by persons under 18 on wholesale premises—to use a shorthand reference, the Majestic Warehouse—are covered by the provisions in clause 17 of the Licensing Bill. In particular, it is an offence for a wholesaler thus defined to sell intoxicating liquor to a person under the age of 18. Moreover, it is an offence for a wholesaler to allow a person under 18 to make a sale of intoxicating liquor unless that sale has been specifically approved by the wholesaler or by a person over the age of 18 acting on his behalf. Some of my hon. Friends' anxieties are met by clause 17 of the Licensing Bill, which has nearly completed its parliamentary process. Another group of anxieties have been expressed by my hon. Friends. In broad terms, they relate to the sale of alcohol in supermarkets. The point was most forcibly made by my hon. Friend the Member for Kingswood (Mr. Hayward). I commend to him the provisions of clauses 16 and 18 of the Licensing Bill. Clause 16 greatly tightens the control in section 169 of the principal Act, the Licensing Act 1964. The law has been tightened up on sale to under-age persons. That provision applies to off-licences —for example, supermarkets—in precisely the same way as it applies to on-licences. I commend that clause to my hon. Friend. Clause 18 is also relevant to my hon. Friend's anxieties. That clause also provides—very much in the same terms as clause 17 does in the context of wholesale distributors—that the sale of alcohol by an under-age person should be effectively supervised and approved. By the interaction of the two pieces of legislation—that is to say, the one now before us and the one that is passing through the House —we have tried to meet the kind of anxieties that have so understandably been raised in the House and in Committee. My hon. Friends who have promoted the Bill are greatly to be congratulated. The Bill will significantly tighten the sale of alcohol. It brings into the licensing regime disorderly and ad hoc sales of alcohol. Such sales were previously outside the scope of the Licensing Act. That was undesirable, primarily because it resulted in the disorderly sale of alcohol and was in no way controlled by legislation. Of course, in turn, that led to the supply of alcohol to under-age people, or at least it provided the opportunity for that, which the House would deprecate. Having regard to those considerations, I warmly commend the Bill to the House. I hope that it will receive its Third Reading, and I congratulate my hon. Friends.Question put and agreed to.
Bill accordingly read the Third time, and passed.
Community Health Councils (Access To Information) Bill
As amended (in the Standing Committee), considered.
Clause 2
Access To Information Relating To Members Of Community Health Councils Etc
11.17 am
I beg to move amendment No. 4, in page 3, line 18, at end insert
Clause 2(1) provides:'; and(d) whether or not the member has any financial interest in the affairs of any health authority served by the council to which the member has been appointed.".'
Then there are three paragraphs (a), (b) and (c). I should like to add a fourth paragraph, (d), as set out in my amendment. This is an important amendment. We all know that those who serve on public bodies, in any shape or form, and have a financial interest in industry, or whatever, should declare any financial interest. After all, for right and proper reasons, hon. Members must declare their interests in a register."A Community Health Council shall maintain a register containing the name and address of every member of the Council and of every committee appointed by the Council whether alone or jointly with another Council and stating in the case of each member of the Council".
My hon. Friend, who is a new Member, would not wish to mislead the House. We do not have to register our interests; if asked, we do so voluntarily.
I thank my hon. Friend for that correction. Nevertheless, whether or not it is compulsory, it is right and proper that hon. Members should register their financial interests and the register should be open for public inspection.
Exactly the same principle applies to this amendment. Community health councils exist to serve local communities and to represent them and their interests. Members of a community health council are, as the name implies, drawn from the local community, which is as it should be. Otherwise, the health authorities which serve the community could become remote from the members of the community. Many members of the community know nothing about their health authority. Indeed, authorities, divided as they are into regions and districts, can appear to be far away. For example, the offices of my regional health authority, which covers my constituency of Walthamstow, are based in Paddington. None of my constituents wishing to get in touch with it would think that it was based there; they would expect it to be based locally. Indeed, the offices of my district health authority, although based a little more locally, are some considerable distance away in a place not well served by public transport. Community health councils have been set up to represent the interests of local people. They serve these vital interests. I was about to say all too frequently, but I shall amend that. Now and again local people have cause for complaint and it is right and proper that they should have a body of citizens who can put those complaints to the relevant authorities and ask for action. Clause 2 states:That is right and proper because local people must know who their representatives are. It makes life much easier for them and in many ways for the authorities, both regional and district, to be able to look at the register and see who the members of the community health council are. The clause goes on to say that the council"A Community Health Council shall maintain a register containing the name and address of every member of the Council".
It is important that those serving on the community health council should declare any financial interest they may have in the affairs of any health authority. Bearing in mind the immense sums spent these days on the National Health Service, it is important that those with a financial interest in the affairs of health authorities should have to declare it publicly through the medium of the register. The sums are of the order of £22 billion a year—"shall maintain a register … of every committee appointed by the Council".
Twenty three billion pounds a year.
The sum is £23 billion a year. That is an immense amount and all too often people and hon. Members do not realise that. It is only too easy to say £23 billion. It is only six syllables and it does not sound an enormous amount. One should think of all those noughts and remember that they are being spent not just once, but every year, and they are increasing. When such huge sums are involved it is only right and proper that local people should have a say in how the money is spent. Indeed, they will want to be assured that their representatives do not have any pecuniary interests.
I know a man whose company is busy putting up advertisements for various medical products in NHS hospitals. For example, if he wishes to advertise baby foods, where more appropriate than in the waiting room where expectant mothers are congregating? He is getting right to his target market. He is not directly taking money from the NHS; he is providing a supplement to it to ensure that when expectant mothers finally have their babies they have a good idea of what sort of products are available for feeding their babies so that, I hope, they have strong, healthy families. Obviously, with huge sums in the system, there must be opportunities for speculation. A member of a community health council will have access to all sorts of information about the goings on in his local area, in which I include districts. If he has some sort of financial interest in the affairs of the health authority, that could be greatly to his advantage. We should not put temptation in his way. That is not to say that merely because members have their names on a register, temptation will automatically be removed, but that would act as a good, strong, firm check on any action which could perhaps transgress or infringe the rules. My amendment seeks to provide that the register shall state whether the memberThat means that a member does not have to register his interest until he has been appointed. That is right. Someone may have been asked to join a community health council and it would be absurd to require him to register any financial interest before being appointed. Once he has been appointed his financial interest can be seen and taken into account. I think that I am right in saying that any hon. Member wishing to speak in a debate on a matter in which he has a financial interest, although he has declared his financial interest through the register, must state openly in the House that he has that interest. That is right. My amendment does not mean that merely because someone has put his name on the register, he should not declare his interest in the community health council's proceedings. The paragraphs all form a coherent clause 2. Paragraph (a) states that for each member the register must contain"has any financial interest in the affairs of any health authority served by the council to which the member has been appointed."
It is hoped that bodies which appoint members will know in advance or will at least ask the provisional appointee about his financial interests. It is important that the process is started from the beginning. There is no point in taking a cuckoo into the nest, and suddenly realising that he is the chairman of the regional health authority. I realise that that is not likely, but the point of the law is to be certain. Paragraph (b) states that for each member the register shall state"the name and address of the body which appointed him".
That is clear, and I have covered it in my remarks. Paragraph (c) provides that the register shall state:"whether or not he is a member of that body".
I have some difficulty in understanding what that means. It appears to be a non sequitur. The latter part of clause 2(1) provides:"in the case of a member appointed by a voluntary organisation (within the meaning of the National Health Service Act 1977), that he has been so appointed."
which meaning has to be carried to each of the paragraphs. In regard to paragraph (c), therefore, the clause reads:"and stating in the case of each member of the Council"—
Some of those words are redundant. I have to consider the meaning of clause 2 and establish whether amendment No. 4 adds to it what I hope it adds. It would ensure that all members of community health councils are there solely to represent the interests of the local community. They should be able to be single-minded in their deliberations and representations and have no possible form of financial speculation niggling away in the backs of their minds. Service for the community is what CHCs are about and I hope that it will be strengthened by the amendment."stating in the case of each member of the Council…(c) in the case of a member appointed by a voluntary organisation (within the meaning of the National Health Service Act 1977), that he has been so appointed."
11.30 am
I have listened carefully to the arguments adduced by the hon. Member for Walthamstow (Mr. Summerson) in support of his amendment. He is a personable young Member, eager to serve the House and his community. I am sure that he accepts that the only offence that I hold against him is that he replaced one of the most admirable hon. Members of this House—Eric Deakins—and will have a great deal to live up to to meet the performance and service that that former colleague brought to the House.
On first hearing, the hon. Gentleman's arguments appear reasonable. I urge the House that, on closer examination, the amendment is not at all necessary. The purpose of it appears to seek to ensure that financial impropriety by members of community health councils is prevented—an admirable aim, but it is not necessary in this case. I want to make some adverse comments on the arguments as to the advisability, as the hon. Gentleman sees it, of the amendment. In the first place, CHCs are not established to serve health authorities, as is implied in the amendment. Their function is to represent the interests of the Health Service and of the public in the districts for which they are established. Secondly, it would be difficult, to follow the argument that the hon. Gentleman advanced, to identify anybody who does not have a financial interest, in the broadest sense, in the affairs of a health authority, either as a consumer of services, or as a supplier of goods and services, or as an employee or even as a taxpayer. The third argument is whether the answer on the register as to financial interest is yes or no. This is what the hon. Gentleman wants included. It is not at all clear how that information would be used or how it would affect the status of members. The fourth point in rejection of the amendment is that community health councils are not strategic decision-taking bodies. They do not control the allocation of NHS resources as I think might be suggested in the hon. Gentleman's argument. In view of my adverse comments, I must ask the hon. Gentleman to withdraw the amendment. I hope—dare I say I suspect—that I shall receive the Minister's support for my rejection of the amendment.I congratulate the hon. Member for Warley, East (Mr. Faulds) yet again on getting his Bill this far. As I said in Committee, the Government have an interest in seeing that legislation that reaches the statute book is satisfactory. The amendments that we discussed in Committee did not cover the area of work that my hon. Friend the Member for Walthamstow (Mr. Summerson) has brought up. The amendments that we discussed then were purely technical. They did not affect the substance of the Bill.
I understand that the Bill is designed to provide greater access to the work of community health councils than is currently provided by the Public Bodies (Admission to Meetings) Act 1960, and that it strengthens the rights of members of the public to attend CHC meetings and inspect agendas, minutes and background papers, copies of which can be provided for a reasonable fee. In an eloquent and succinct presentation, my hon. Friend the Member for Walthamstow discussed the role of the membership of CHCs and rightly said that, if they are to function properly, their membership must be correct and they must be seen to be working above board. In that respect, I have much sympathy with what he said. Before I comment in detail on the amendment, perhaps I could pick up some of the points that my hon. Friend made, confirm some of them and put them in context. My hon. Friend was right about the growth in health care. It means that the efforts of watchdog bodies such as CHCs to ensure that the growth in money and staffing goes to patient care are that much more important. Expenditure on the Health Service has risen to £23·5 billion this year, mainly because of the additional money required for the pay review body agreements. They have given 15 per cent. extra to our nurses and 8 per cent. extra to our doctors. A sister's basic scale will now start at a higher level than the top rate of the previous scale. Our senior staff are about to experience some substantial increases in pay. The net result is that spending on the NHS this year is yet again the second largest element in Government spending—it is second only to social security. It has been larger than defence and education for some time, although in respect of defence there is perhaps not a consumer as there is in the NHS. The Health Service involves a substantial number of people, many of whom are perhaps not best placed to argue with the producers of the service when they need it, so the role of CHCs is important. There is also growth in the private sector. We should remind ourselves that CHCs examine the state sector, but I have no objection to their taking an interest in the private sector in so far as it impinges on health care needs in a neighbourhood. A lot more staff have come into the NHS recently. We have 60,000 more nurses—whole-time equivalents—more doctors, more physiotherapists and more occupational therapists. Indeed, we have more of just about everything, and yet many health care plans are predicated on more people entering the service. One of my worries is that that might not be quite so easy to achieve. We have previously recruited heavily among school leavers, but the number of school leavers is now dropping. That is presenting problems where the job market is active, as it is in London and my hon. Friend's constituency. It will be important for consumer watchdog bodies to be aware that we cannot simply expect to recruit large numbers of staff as we have in the past, for they simply will not exist. That is particularly true of young girls. Therefore, it follows that some patterns of care and treatment and some patterns of work in the NHS may have to change. The role of the more mature workers in the NHS will become relatively more important. The implication of that is that there will have to be more in-service training and perhaps a switch from the intensive efforts on initial training to in-service training, such as has occurred in teaching and education. I hope that our community health councils will note that changing pattern and will not expect our staff to look exactly the same in future as they have in the past. The main role of the CHCs are in representing patients' interests and seeing the patient as a consumer. Certainly there are many more patients now in whom they should take an interest. In recent years we have been looking after an in-patient load of about 6·5 million a year, taking account of the fact that some people are likely to be readmitted. As lengths of stay shorten, particularly in psychiatry, people will seek help if they have acute bouts of difficulty. That is not a bad policy; in fact it is a good policy and has been pursued for some time. Even if we take into account that there may have been some readmissions, it is certainly clear from research studies that the number of patients being looked after is far higher than it used to be. That means that the pattern of work is changing and the volume of work in some specialities is rising very fast, particularly in orthopaedics. The pattern of work between the hospital services, the community services such as the domiciliary health visitors and district nurses, and the work loads of GPs are tending to shift and the role of the community health councils has become more complex. We do not expect that health care will cost any less in future; it will continue costing us more. We do not expect that in future we will be able to manage with fewer staff. We shall continue to need to use our staff very heavily and seek ways of rendering their efforts and their skills even more productive. I expect that we shall have to look after more patients in future. Later today we are to have a short debate about the health authority in Eastbourne. On much of the south coast the proportion of people over the age of 65 has risen to a quarter of the population and is rising fast. For that reason we are obliged to look at patterns of care and service which are a particular reflection of the increased needs of our rising elderly population. That is a problem in Walthamstow, in Warley East and in Derbyshire, South, but it is a particular problem in some parts of the country where large numbers of elderly people have chosen to settle and spend what they thought would be their last few years, but have become their last decades.My hon. Friend said that the problem of the rising proportion of the population who are elderly is moving away from what one might describe as retirement resorts. That is an important matter. Whereas previously it was assumed that there were concentrations of elderly people only in such places as Bognor Regis, Littlehampton and Eastbourne, in many parts of the country well over one in five of the population are of retirement age, and in some cases more than a quarter of the population are elderly people who are concentrated not only in retirement towns but in constituencies such as mine where people have chosen not to move away from their native communities.
Will my hon. Friend note that that phenomenon occurs not only on the geriatric coast but in northern industrial towns such as my constituency where so many young people are moving away to find work elsewhere leaving behind the older population who are less mobile and create just as many problems as they do in Eastbourne?
Both my hon. Friends have made serious and important points. I must confess that I hope to do my best in the time that I hold this post to increase the proportion of elderly people in Britain. If I am successful in persuading people that by sensible modifications of their lifestyles in early and middle age they may thereby reduce the risks of preventable disease which stands at a high level in this country, it will not only be in Eastbourne where 25 per cent. of the population is over 65, it will be all over the country. In many parts of the country there is a rising number of people over 85. That offers us exciting opportunities.
Perhaps we should ask our CHCs to take that into account and ensure that at least some of their members are drawn from the older age groups so that the needs of this group are not ignored. People do not lose their wits or their citizenship when they reach retirement age and it is important that the services are responsive to their needs. 11.45 am One aspect of the improvement going on in the Health Service to which the community health councils have contributed in their watchdog role, is the fact that we have much greater life expectancy. That means that the typical patient is no longer a young person. The typical patient is an older person and a women—in other words, an old lady. In the past women have tended to be a little acquiescent in their responses to care and treatment. As the patterns of demography and patient care have shifted in the directions that I have described, the role of a watchdog body becomes more important. The National Health Service is a huge organisation which employs 1·25 million people. It employs more people than any other organisation in this country. In fact it is the third largest employer in the world. I understand that it is third only to Indian Railways and the Red army. In any large institution the producers tend to have a very large say in the pattern and development of service. lf we want to know what to do about medical services we tend to ask doctors—Order. I should be obliged if the hon. Lady would refer rather more to the community health councils, which are what the clause is really about.
I apologise. At the end of that sentence I intended to show exactly how it relates to the debate.
If we wanted to develop services in pharmacy we would ask a pharmacist, and if we wanted to develop services in nursing we would ask nurses, if we wanted to develop services in optical work we would ask opticians. In other words, there is built into any major organisation the supposition, the implication and the inevitability that when we want to change a service we should ask the producers of that service. In future, we need to ask those who use the service what they think. This is a small Bill, to which our official approach is neutral. We would not have introduced it ourselves, but we do not object to it—other work offered to us later intends to redress that balance. Just as it has been said in the past that war is too important to leave to the generals, I would say that the medical health of our people and the circumstances that we are discussing are so important that we cannot leave them only to the producers.The Minister has spoken about listening more to the users of our National Health Service. Did she see the fascinating opinion poll in The Independent yesterday which revealed that 29 per cent. of Conservative voters think that things are getting worse in the National Health Service and that 65 per cent. of the total population said the same?
The hon. Member for Birmingham, Erdington (Mr. Corbett) should address that question to the people who commissioned the poll. When another organisation which is concerned about the role of the consumer in the NHS—the National Association of Health Authorities in England and Wales—commissions its poll every May or June, it finds that 88 per cent. of people who use the Health Service say that they were satisfied or very satisfied with it. I suspect that it has a lot to do with the way one asks the question.
We hope that by developing our services and by developing an increasing responsiveness to the needs of consumers and potential consumers we may be able to get better value for money and satisfaction in some of those services. In the end, our overall objective must be better health, not just better opinion polls. The problems of ensuring the interests of the consumer in health care are not quite the same as they are for cornflakes or chocolate. Health care is not an everyday product. In this area, the producer, the doctor, the optician or the dentist, has all the knowledge on his side. The consumer is at a considerable disadvantage. He is often in no position to argue because he—or, more likely she—is frightened or unwilling to complain and may find that he does not even know how to answer questions, let alone understand them, even though he may be in a great hurry to get something done. That is why community health councils were set up in 1974. Their role has been discussed and in 1981 it was reaffirmed in health circular HC81/15. It was reaffirmed again in 1985, particularly by my hon. Friend the Member for Oxford, West and Abingdon (Mr. Patten) who confirmed that the status of community health councils would not be changed during the lifetime of that Parliament. I am glad to confirm that view. My hon. Friend the Member for Walthamstow commented at length on the membership of the community health councils. It would be helpful to remind the House that the regional health authorities appoint the community health councils, and that about 50 per cent. of the nominations come from the local authorities, although not all of them are councillors. Many of them will be people who have connections with the local council but who are not councillors. Their membership can be extremely valuable. The rest come from voluntary organisations and other interested bodies, including such august bodies as the Socialist Medical Society. Some of them make a worthwhile contribution. However, the community health council is intended to be composed of lay people. Our statutory instrument of 1985 made that absolutely clear. People are disqualified from appointment as members of a community health council if they are members of a regional health authority or of a district health authority. They cannot be members of both. They are also disqualified from appointment as a member of a community health council if they have been dismissed otherwise than by reason of redundancy from any paid employment with bodies that include a health authority, the Dental Estimates Board, the National Radiological Protection Board and an area health authority. There are strict rules about who can be a member of a community health council. We do not mind in the least if the members of a community health council are professionally qualified, but their job on the CHC is not to represent any professions. It is important that that should be so. Their job is to look after the interests of patients. There are other people on other bodies whose job it is to represent the professions. For example, on a teaching district health authority—the kind that I chaired in Birmingham from 1982—there are people who are nominated and appointed at the request of the teaching university. There is a nurse member, a consultant member and a general practitioner member. It is on the district health authority that we expect the professionals to make themselves heard, if they so wish, as representatives of their professions, not as members of the community health council. It is also important that the membership should bear in mind exactly what are and what are not their responsibilities on the CHC so that they may discharge their work well. They have wide responsibilities which we expect them to exercise. They do not have to work entirely within the National Health Service. For example, a community health council in the city of Birmingham during the time that I was health chairman decided to investigate why patients were complaining bitterly about out-patient waiting times, particularly in the maternity hospital. There were a number of good reasons for that, some of which have been put right, although the others have not. One reason was the difficulty of getting to the new maternity hospital. The CHC negotiated with the transport authority and managed to arrange that buses should run into the main hospital complex and right up to the door of the maternity hospital, so that pregnant ladies could get off the bus and walk inside. That was of considerable benefit to them. Many community health councils have also become directly involved with employment linked to consumer needs. I have seen the work being done in east London. The community health council has joined with the district health authority to employ link workers and facilitators. It felt strongly that many local people, particularly the women whose English is inadequate, were having great difficulty in understanding the medical advice that was given to them. I thought that that work was excellent. I saw what was being done in the east end, met the community health council and was very impressed. Many CHCs are signing up with us for the Look After Your Heart campaign and for conferences on particular aspects of health care in their neighbourhoods. The people in east London whom I met were organising a conference on the health needs of the ethnic minorities and helped to reawaken my interest in haemoglobinopathy, from which some members of the minority communities suffer. Partly as a result of the discussions during my visit, we were able to launch the sickle cell anaemia and thalassaemia cards a couple of weeks ago. Most important of all, the community health councils have an important statutory right, almost the right of veto. That is why it is important that their activities should be open to public scrutiny and that is why I have not resisted the Bill. It is also why my hon. Friend's amendment is unnecessary. The statutory responsibilities clearly set out what the members are expected to do. I hope that my hon. Friend will therefore understand that I cannot commit myself to supporting his amendment. The right of veto is set out clearly in the 1985 statutory instrument. If there is a major change in health care in a neighbourhood, the district health authority has to issue a consultative paper and consult the local people. That does not necessarily mean closure, but usually it involves a major closure, or a shift of service, or a transfer of service between one hospital and another. There have been occasions when CHCs have protested to me about a change that they consider to be a major change under the statutory instrument. I have shared their view and have told the district health authority that it must consult the community health council, which has the right to suggest alternatives to the proposal. Those alternatives must be considered by the district health authority. If the district health authority sticks to its original view, or to a view with which the CHC does not agree, and the regional health authority confirms what the district health authority wants but the community health council still objects, the matter must come before Ministers. That is a very important right, though not quite a veto because the responsibility remains with Ministers. However, it is the right to force consultation with Ministers. We take that right very seriously, with the result that I frequently meet members of community health councils to listen to their views on various proposed changes. There was a good example recently. I went back to the district health authority with the community health council's proposals, and I believe that we have managed to persuade the DHA that the CHC was right. That occurred in Liverpool where major changes are taking place. The city of Liverpool has 10 hospitals within a mile of the city centre, but the population is declining quite fast. Nevertheless, there are serious health problems that need to he addressed. A marvellous new £44 million hospital was built recently. The DHA now wishes to move some of the services on to that hospital site. That leaves it with the problem of what to do with the older and, very often, rather tatty facilities that it has in the city centre. One proposal involves turning Myrtle street hospital into a minor injuries day centre, thereby serving the city centre as a minor accident and emergency department. The proposal was that it should be open until 8 o'clock in the evening. The community council told me that it felt that the injuries centre, which is currently open all night, provides during the late hours an excellent, sensitive and caring service to the children of the inner city, some of whom are seriously at risk of being hurt by their parents. They drift in during the evening to seek help from the nursing and other staff, either because they are in fear of going home and being hurt or because they feel that they need sanctuary. The members of the community health council told me that they regarded the service as invaluable and that it would be tragic for it to be lost for the sake of a few thousand pounds. I listened to what they and their Members of Parliament had to say, came to the conclusion that they were right and communicated my views to the district health authority. I told the district health authority that the community health council had contacted local GPs who were willing to provide some of the services. On that basis, we were able to agree that the Myrtle street day centre should remain open much later. I left it to the community health council, local GPs, consultants and the district health authority to decide what time it should close. 12 noon Not all community health councils are good. It bothers me that some of them oppose everything as a matter of course. That is a pity, because much of what we are all trying to do is intended to improve the Health Service. We now have the largest ever capital hospital building programme and we are slowly replacing grotty buildings in Warley, Walthamstow and Derby with new ones fit to take us into the next century. I hope that community health councils—particularly in areas where the Health Service has been neglected but is now rapidly coming up to scratch—will realise that they are not Her Majesty's Opposition. Their job is to represent the interests of consumers, who may be better served by the construction of new buildings, getting rid of grotty old properties and trying to keep to budgets rather than trying to break them. Not everything in health care can be a priority, and a community health council that realises that fact is serving local people better than one that opposes everything as a matter of course. The role of community health councils does not conflict with that of district and regional health authorities or family practitioner committees, as my hon. Friend the Member for Walthamstow mentioned. I suspect that sometimes the role of community health councils becomes confused. The regional health authority is the strategic planning authority. We provide it with money for hospital and community services—the system is different in Scotland. We allocate money directly to family practitioner committees, which cover services that are not provided by hospitals, particularly those relating to independent contractors, family doctors, dentists, opticians and local pharmacists. The regional health authority allocates money and delegates responsibility to district health authorities, which run local and hospital services and community services such as district nurses and chriopodists. District health authorities also contribute to planning. District health authorities normally cover a population of 200,000, although in London the figure tends to be smaller. I am sorry that my hon. Friend the Member for Walthamstow feels that the DHA is not situated centrally in his constituency. In Derbyshire, the district health authority covers 500,000 people in an area ranging almost from Manchester down to Birmingham. There are only two district health authorities, two community health councils and a single family practitioner committee. However, I reckon that it offers a jolly good service. The fact that some of my constituents must travel 20 miles to the headquarters of the district health authority is a matter that we must accept. We envy the concentration of services in London. The amendment confuses the roles of community health councils and health authorities. It talks about serving health authorities, but a community health council is not established to serve a health authority. Its function is to represent the interests of the public. The Bill serves a purpose because it is intended to open the activities of community health councils to the public in certain significant and small ways. The amendment mentions "any financial interest". The word "any" is dangerous in legislation as the courts always interpret it in its broadest possible sense. I suspect that it would be almost impossible to identify someone who does not have any financial interest in the affairs of a health authority, partly because almost all of us are consumers of the National Health Service, partly because many of us are suppliers of goods and services—the National Health Service is the largest employer in the country and many of us have family connections with people who work for it —and partly because as taxpayers we are all interested in it. The average family, not only people who pay income tax but those who pay VAT, contributes £1,600 a year to the Health Service. The wording of the amendment suggests that the only answer to the question that it poses would be yes or no. It is not clear how the information that it seeks would he useful or what difference it would make to the status of members of community health councils. I do not know whether the amendment would result in people who have a financial interest or those who do not have a financial interest being excluded. In the light of the comments that I made earlier, my hon. Friend might accept that, as we are all taxpayers and have a financial interest in the National Health Service it would be wise to think that only people with a financial interest should be members of community health councils.I shall give an example to help my hon. Friend the Minister. My father died two years ago, in a National Health Service geriatric hospital in Inverness. The care and treatment that he received was quite outstanding. If my mother, who still lives in Inverness, were a member of a community health council and a director of a company supplying services to the regional health authority—and perhaps, therefore, to that hospital —would it not be right that she should have to declare an interest?
As a general principle, we would always expect members of public bodies to say whether some aspect of their personal or business lives might influence the opinions that they are offering. My hon. Friend is going too far, as the good lady that he mentioned would have a strong interest in ensuring that the local health service was cost-effective and efficient, that it delivered health in response to the health needs of local people and that it was available when she needed it. In that regard, other interests would be affected.
Should anybody serving on a public body such as a community health council or a district health authority have a financial interest in the outcome of a discussion—particularly if there was to be a vote—we would expect him to declare it and take guidance from the chairman about whether it was sufficiently relevant for him not to vote or be present. The community health council does not take such decisions, except with regard to its right of veto and to delay any major changes in the health authority. Its role is to take decisions about somebody else's decisions. It does not run a hospital or employ staff directly, except in very small numbers. Its main job is to make representations about the interests of consumers. I do not see any overriding need to legislate along the lines that my hon. Friend the Member for Walthamstow has suggested. Community health bodies are not strategic, decision-making bodies and do not control the allocation of National Health Service resources. Therefore, the amendment is unnecessary.I suspect that my hon. Friend the Member for Warley, East (Mr. Faulds) had a wry smile on his face when the Minister congratulated him on the Bill and made it clear that she was not opposing it. It will be within his memory, as it is within mine, because I was here on the same Friday, that a Government Whip on the Treasury Bench shouted "Object" and blocked progress. That led to my hon. Friend getting up on a point of order and venting his anger. Better one sinner who repenteth—
My hon. Friend must not go too far. I very rarely vent anger in the House. I occasionally vent disagreement.
My hon. Friend did it, so he will know what he was doing.
The Minister paints a picture of the NHS with which few members of community health councils could agree. Apparently there are no waiting lists, no closed wards, no cancelled operations, no shortage of specialist nurses, no shortage of midwives and no shortage of training opportunities. Indeed, this is heaven. I can tell the Minister, if she needs telling, that my local community health council has a much more realistic view. In the Good Hope hospital, which the Minister will know, which serves people in my constituency and in the constituency of the hon. Member for Staffordshire, South-East (Mr. Lightbown), a Government Whip, a ward was closed temporarily about 10 months ago, and remains closed. I was interested in what the Minister said about the value that the Government attach to community health councils. Presumably, as soon as the hon. Lady leaves the House, she will get in touch with the South Manchester health authority. She will probably know that the South Manchester health authority agreed, on the casting vote of the person in the chair, to close immediately geriatric and rehabilitation wards at Burton house at Withington hospital, and psychiatric beds at the same hospital. There is nothing new about that. However, it was done without proper consultation with the community health council. Because of what the Minister said and the tales that she told about Liverpool, I expect her now to get in touch with that health authority and make known her displeasure at its lack of proper consultation with the community health council. I hope that in her usual quiet and persuasive manner she will persuade the authority to undo that decision until there has been adequate time for consultation. I do not know whether the Minister wants to rise to give me that assurance, or perhaps I can take it on the nod. That is how I shall take it.The hon. Gentleman should never take my nods on the nod. We are in touch with all Manchester health authorities. In fact, I had the pleasure of meeting a small delegation led by my hon. Friend the Member for Altrincham and Sale (Sir F. Montgomery) this week, and we have been in touch with the three Manchester health authorities more recently. They have a statutory obligation not to overspend, and I have no doubt that they will also bear in mind the recent ruling in the courts that because a change may be temporary, that does not rule out any possibility of consultation.
I am grateful to the Minister for that. They have a statutory duty not to overspend, but they also have a statutory duty to consult. The recent court decision underlines that point. I have no doubt that my hon. Friend the Member for Manchester, Withington (Mr. Bradley) will be delighted when he reads the Minister's words on Tuesday.
There is an even simpler argument against the amendment of the hon. Member for Walthamstow (Mr. Summerson) than that put by my hon. Friend the Member for Warley, East and the Minister. The purpose of the Bill is to open up the proceedings of community health councils and their papers to members of the public. I would hope that that is totally unexceptionable. If that is the case, and if the hon. Member for Walthamstow has worries about the misuse of a position on a community health council by one of its appointed members, the amendment will not stop that. If somebody is looking for naked commercial advantage from the proceedings of a CHC, he, or she, under the terms of the Bill, has only to sit at the back of the room when the council is discussing an item out of which he or she may see an opportunity to make a bob or two. I find myself in the embarrassing position of agreeing with the Minister's arguments against the amendment. Also, it is not often that my hon. Friend the Member for Warley, East and I are able to agree. I hope that on that basis, the hon. Member for Walthamstow will take all the advice that has been offered in such a free and kind manner and see the wisdom of withdrawing his amendment.12.15 pm
I have listened with the greatest care to all the advice that has been flooding in for the past hour or two. As the hon. Member for Warley, East (Mr. Faulds) referred to my predecessor in Walthamstow, Eric Deakins, I hope that I shall be allowed to refer to him briefly. On the occasions when I met Eric Deakins, I always thought that he was a pleasant man. Indeed, on one occasion when we were both invited to address a large gathering of teachers who set up a howl of rage and execration as soon as I entered the hall, it was a great relief to see the friendly face of Mr. Deakins smiling at me from the platform. It is now a matter of history that the good people of Walthamstow preferred a Conservative candidate to a Labour one.
Not for long.
We shall see.
As I said, I have listened carefully to what has been said. Huge amounts of money are being spent on the Health Service. Indeed, £23·5 billion is now being spent on the NHS, which I think I am right in saying is about three times more then when we came to power in 1979. Community health councils doubtless have a great deal of influence, especially in these days of putting more services out to tender to get better value for money and to provide even more funds to be ploughed back into the NHS. Nevertheless, having listened carefully to what my hon. Friend the Minister has said, her usual charm and perspicacity have persuaded me to withdraw the amendment, and I beg to ask leave to do so.Amendment, by leave, withdrawn.
Order for Third Reading read.
12.17 pm
I beg to move, That the Bill be now read the Third time.
Now that we have at long last come to this happy stage of the Third reading, I do not want to detain my colleagues for too long from the later-in-the-day constituency engagements. The Minister has played a notable role in that. I have heard some extraordinarily lengthy pronouncements on a number of Third Readings, but I think that today's must take the biscuit. I want briefly, because of the interesting history of the Bill, to enlarge slightly on how it came about. My hon. colleague the Member for Worsley (Mr. Lewis) was responsible in the previous Parliament for introducing this Community Health Councils (Access to Information) Bill which he thought was an admirable little measure, and of course I shared that view. But the Prime Minister, towards the fourth year of that Parliament, decided that things were a bit sticky for the Government and that they had better go to the country before they got worse. She went to the country, and, unfortunately for us and the people of Britain, won the election. [Interruption.] I am glad that I have the agreement of the majority of hon. Members in the Chamber. One of the unfortunate results of that victory was that this minor Bill fell, before it got to the Lords, on the dissolution of that Parliament. Although I have been here now for many many years and have put my name forward for most of the ballots over those years, I have never once been drawn earlier than 14th. I cannot remember what I did with that effort. In the first ballot of this Parliament I drew the 19th place. It was clear that, with that number, I was unlikely to be able to introduce a major matter of personal or public interest that would ever land on the statute book. I was fortunate enough to engage in discussions with members of the Public Bill Office. Out of that sagacious exchange came the suggestion that I should support an admirable little Bill that had fallen in the previous Parliament and stood a good chance of getting on to the statute book in this Parliament. That was how my support for and introduction of the Bill came about. The Bill's purpose is explicit in the title. I need not enlarge on that too much, but perhaps for the record I should say that this legislation would require all meetings of the community health councils and their committees to be open to the public, and that is admirable. The Bill would require them to publish agendas—again, that Is admirable—and permit the public to inspect and copy reports and the background papers to those reports, and permit meetings and documents to be closed to the public only for specified genuine reasons. I am delighted that I have the broad agreement of the House and the Minister's support in introducing the Bill and furthering its advance on Third Reading. Because of the Bill's rather strange history, I should say that when I discussed the advancement of the Bill in Committee I was advised by parliamentary counsel that the earlier version had certain technical errors that should be put right. We pursued those errors in Committee and put them right. Parliamentary counsel's arguments were based on the understandable reason that the Bill applied the Local Government Act 1972, as amended by the Local Government (Access to Information) Act 1985, to comunity health councils. Legislation of this kind, which picks up bits of Bills by reference to earlier Acts, tends to be untidy, especially as the Local Government Act was not intended to cover community health councils. Minor modifications to that Act were necessary to accommodate the different nature of community health councils. The Department of the Environment, which takes the lead interest in the Local Government Acts, drew attention to some "drafting infelicities", which I think is the phrase, and parliamentary counsel suggested amendments that secured technical improvements to the Bill in Committee. They affected neither the substance nor the objectives of the Bill. As I have made clear, this is not a major piece of legislation. It is a tidying-up, good little Bill that provides public access to the proceedings of CHCs and their reports. I am sure that I shall have the Chamber's support. I very much commend the Third Reading, with the earnest hope that none of my colleagues will hold us too long in further discussion on this issue.
12.23 pm
I cannot allow the Third Reading of this important Bill to pass without uttering a few comments, starting with congratulations to the hon. Member for Warley, East (Mr. Faulds). I mentioned in Committee that when I was a child he used to frighten me. I listened to "Journey into Space"—
Now the hon. Lady and my hon. Friend have swopped places.
That is a line for the gossip columns this Sunday.
I used to clutch my father's hand while listening to that dreadful science fiction rubbish, as I now realise it to be, and there was the sainted voice of the fine actor that the hon. Member for Warley, East was once, and I suspect still is, scaring the life out of the nation's children. It was a very long time ago. On those occasions and in his sensible, intelligent remarks today he has done much better than he has when my right hon. Friend the Prime Minister has been at the Dispatch Box and he has felt obliged to use his actor's training to try to shout her down. On those occasions, he does his erstwhile profession a disservice.The Minister is being naughty because she is provoking me into further utterances which I had hoped not to have to make. I am not interested in her comments on my previous profession. I was an extremely distinguished actor and I still am. I still have those talents, but of course I do not abuse them in this Chamber. I simply use them to a limited extent.
If the hon. Lady thinks that my interventions when the Prime Minister is speaking are made simply from a wish to create a small performance, she could not be more wrong. I profoundly disagree with the Prime Minister's philosophy and thinking and consequent damage that she has done to the community of Britain.Order. Will hon. Members please return to the Bill.
The community health councils to which the Bill refers were established in 1974. They operate under current legislation—the National Health Service community health council regulations 1985, some of which I quoted earlier, and the current circulars HC81/15 and HC85/11. Their duties are to represent the interests of the public in the Health Service in their districts. They are not by themselves strategic bodies or decision-making bodies. They do not run any parts of the Health Service, although one or two have decided, commendably, to use some of their allocation of funds to employ staff in a role that helps to facilitate the relationships of patients to the Health Service, especially when there are some communication problems. I commend that, although we would not want them to expand that role to the point where they were trying to vie with the district health authority which perhaps should have been fulfilling that role in the first place.
The community health councils have certain rights. A CHC has the right to relevant information from the local district health authority and the family practitioner committee. I sometimes wish that the CHCs spent more time looking at the work to which the family practitioner committee relates. The bulk of our patients see their GP rather than have contact with the hospital. That is one of the best parts of our system. Our GP system acts as a gateway system. It is one reason why we have better health and more effective use of health care money than many other countries. The CHCs have the right of access to district health authority premises. They have asked for rights of access to private sector establishments and homes. I am minded to resist that because I want them to exercise their statutory duties as regards district health authority premises. I have noticed with interest that in some parts of the country, especially where there has been a growth in the private sector for residential care and nursing homes, the community health council has been able to obtain the co-operation of the owners of those homes. In one place—I think it is Blackpool—a consumers' guide to the homes has been drawn up stating what is available and what is not. Local people, especially in areas where there is a large proportion of elderly people, perhaps even very elderly people with elderly children trying to look after them, have found such publications extremely useful. That is a fruitful aspect of work where CHCs can make progress. As I said, the CHCs have a right to be consulted by the district health authorities on proposals for substantial developments or variations in local services, and that right extends to family practitioner committees; the CHCs must be consulted by the FPCs on proposals for substantial change. The CHCs also have the right to meet their district health authorities and family practitioner committees once a year, and the Bill refers to such meetings. That is extremely valuable. It is to be hoped that that will be the minimum, especially in areas where there is much substantial change. It was deemed wise by my predecessors to write it into legislation that the community health council has the right to an annual meeting and the right to be consulted by the local family practitioner committee about changes in the provision of general practice and pharmaceutical services. In the next couple of years, as the reforms outlined in our White Paper on the primary health care services, "Promoting Better Health", are introduced, the community health councils may well be directing rather more of their attention to the services outside hospitals, especially those provided by local doctors. I hope so; they have much that is valuable to contribute. There are 194 community health councils—rather more than the number of district health authorities, partly because since the reorganisation in 1974 it has been regarded as wise in some parts of the country, especially in London, to amalgamate some of the smaller health authorities that were losing population very quickly. We have just done that by amalgamating Brent and Paddington and North Kensington district health authorities to create the Parkside health authority. None of the boundaries of the community health councils have changed, so there are slightly more of them. In 1986-87, the community health councils spent a total of £7·2 million, which works out at about £37,000 per community health council. That has tended to increase slowly, but it has kept roughly in line with inflation. My hon. Friend the Minister of State, Home Office, who was then Under-Secretary of State for Health and Social Security gave a commitment on 29 April 1985 that we would retain community health councils for the life of this Parliament. That was reaffirmed by my right hon. Friend the Minister for Health at the annual general meeting of the Association of Community Health Councils of England and Wales on 3 July 1986. We have no proposals to change in any substantive way the work that the community health councils do, although we recognise that there my he some benefit in the minor changes proposed in the Bill. While we would not have chosen to legislate on CHCs, we feel that the Bill does no harm. Perhaps the hon. Member for Warley, East should not attribute to me quite such ecstatic support as he suggested, but the Government are neutral, and we would not seek to oppose the Bill. It has been suggested that the Bill's provisions are onerous for small bodies such as community health councils. I do not agree. Apart from anything else, the community health councils have budgets of £37,000 on average. Provided that they are well-organised, it is quite within the CHC's resources to implement the Bill's provisions. The CHCs themselves advocate openness and are bitterly critical of lack of openness elsewhere. Therefore, provided that they sincerely wish to be as open as possible with the public they serve, they will not need bureaucratic mechanisms to comply with the Bill. I had better repeat that the community health councils must comply with the provisions of the Bill within existing resources. Having said that, I await the decision of the House on Third Reading.12.33 pm
I hope that my hon. Friend the Member for Warley, East (Mr. Faulds) will take no offence if I say that modesty is not one of the traits normally associated with him. However, he is being far too modest in describing the Bill as modest. He may have noticed that his is a 90p Bill; that is the price that members of the public pay for it. The Bill with which we started the day was a 45p Bill and the one that we shall be discussing very soon, I hope, is a £1·60 Bill. My hon. Friend need not be too modest because he has pitched it about right and his Bill is clearly exceptionally good value for money.
My serious point touches on the Minister's remarks about community health councils having to carry out their-obligations under the Bill within existing resources. It relates to the provisions for councils to charge a fee for copies or extracts of various documents. If the councils decide that it is proper to make a charge for documents, I hope that they will relate that charge to the ability of the person making the inquiry to pay. The House will recall that as recently as a week ago we were debating ability to pay. It is important that we should not let unreasonable charges be an impediment to people obtaining documents to which it is proper for them to have access. Perhaps may put it this way. So far as I know, no councils charge members of the public for copies of council minutes and I should deprecate such a practice very much. I hope that, by and large, community health councils will find no need to impose any charge.Before my hon. Friend sits down, may I ask him just to back me in saying that although I cannot refer to my colleague the hon. Member for Worsley (Mr. Lewis) as the only begetter of the Bill, I think we should remember that it was originally his and that he has had assistance since then in getting his Bill, with my help, on to the statute book? I would be very grateful if my hon. Friend would just make a word of commendation.
I am grateful to my hon. Friend. It often happens that a Bill falls by the wayside for one reason or another and is then picked up by someone else. As my hon. Friend has said, that is basically what happened in this case. Perhaps one should take a more relaxed view of these matters—if it is nice to have one father, it must be even better to have two. I congratulate my hon. Friend. I hope that the House will give the Bill a Third Reading and that a general election will not stop it reaching the statute book.
Question put and agreed to.
Bill accordingly read the Third time, and passed.
Access To Medical Reports Bill
Considered in Committee.
[SIR PAUL DEAN in the Chair.]
Clause 1
Right Of Access
12.37 pm
I beg to move amendment No. 1, in page 1, line 8, at end insert
It may be for the convenience of the Committee if I explain that although I have tabled a number of amendments which appear quite substantial, many can be dealt with fairly briefly. I am pleased to say that amendment No. 1 is one of those. The purpose of the amendment is to exclude explicitly any retrospective right of access. The right of access under the Bill will thus apply only to reports prepared after the Bill becomes law. On that basis, I commend the amendment to the Committee.'and prepared after the date of commencement of this Act',
Events this morning have meant that we have perhaps slightly longer to discuss certain aspects of this important and valuable little Bill than we might otherwise have expected. I welcome this opportunity. As I was not able to be present for the Second Reading on 12 February, I begin by congratulating the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) on getting his Bill so far.
This important, small Bill is part of a general trend towards greater access to patient records, greater openness about health care, and greater awareness of the need for co-operation between practitioners and the patients whom they seek to assist. This is a feature of a noticeable change of attitude in recent years, which, broadly speaking, we welcome. The Government's overall attitude towards the Bill is one of neutrality. We would not have sought to promote it ourselves. My task throughout has been to try to ensure that the details of the legislation are effective and will achieve what the promoter seeks, without causing undue difficulties for those who have to implement them. Therefore, on that basis, the amendment is not essential, but I am sure that it will assist the passage of the Bill. The Bill seeks to change the attitude, which has been deeply held for a long time, that records belong, not to the patient, but to the doctor. That attitude has been held in the belief that general access would harm the patient. When efforts are made to put into legislation the shifts of attitude that are occurring, that should not be done retrospectively but should take us on from where we are. The Association of British Insurers has made that point strongly, as has the British Medical Association, which represents the medical profession, and I felt obliged to put that to the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) whenever I met him to discuss the details of the Bill. I am glad therefore that he has tabled the amendment. He knows that, broadly speaking, he has my support, and that of many of my hon. Friends, in everything that he is seeking to do to open up patients' access to their medical records. It is important that we have the full co-operation of all concerned. It is important that those who are calling for these changes, including employers and insurers, and, perhaps more importantly, the practitioner who writes the records and deals with the health care of a person, should not feel that records of days gone by, when the law did not exist in this form, or when attitudes were different, should be open to scrutiny. I know that part of the hon. Gentleman's objective is to improve the quality and standards of the records. He, and many Conservative Members, feel that if records are more open to scrutiny, that will result in exactly what he wants. On that basis, we do not seek to object to the Bill. Indeed, at all stages I have tried to advise him in small but important ways on how the clause might be improved. I wait to hear the will of the House on this amendment.The Minister's wise advice on the amendment meets the anxieties of some of those who are likely to be affected by it. I hope that those who will be tolerant towards the purpose of the Bill. While the amendment makes it clear that retrospection is not intended, or implied, it would be unfortunate if that rare circumstance arose where the tick of a clock marking the end of one day and the beginning of another gave one individual rights while keeping those rights away from another. I am sure that if such problems arise, there would be a sensible way around them, without sticking to the letter of the law.
Amendment agreed to.
Clause 1, as amended, ordered to stand part of the Bill.
Clause 2
Interpretation
I beg to move amendment No. 2, in page 1, line 24, after 'to' insert
I should like to respond positively to what the Minister has just said. I acknowledge that although she has many other fish to fry, albeit it in polyunsaturated oils, on her political agenda, and in spite of her difficulties in other areas, both she and her Department have taken a special interest in the Bill. That is significant, because the Bill cost only £1·60. If we encourage hon. Members to measure the value of their Bills by the price of them that will only detain the House further on Fridays, because more expensive Bills mean more clauses. I do not know that I would go all the way with that advice. Amendment No. 2 is also formal. It is one of a series of amendments. We shall deal later with amendments Nos. 7, 8 and 9, which seek to bring the Bill into line with the provisions in the Data Protection Act 1984 for access to computerised medical records. The Bill provides a definition of "medical report" that is consistent with those that have been adopted in the Data Protection (Subject Access Modification) (Health) Order 1987. The Government believe it sensible to keep the definitions consistent on all counts, insofar as they are in the public domain. That is why we have used that definition in the Bill.'the physical or mental health of'.
12.45 pm
We welcome the amendment, which clarifies the definition of "medical report". Without it, the Bill would have included, for example, character references supplied by a medical practitioner. As the hon. Gentleman said, the background to the definition lies in the Data Protection Act, a major piece of legislation promoted by the Government, when issues such as what may be included in the report were dealt with in considerable detail in Committee and on Second Reading, Report and Third Reading. It is therefore eminently sensible to make good use of that experience; it is helpful if legislation is reasonably consistent and there is the benefit of having a precise definition.
I thank the hon. Gentleman for his kind remarks when he introduced the amendment. There is a considerable background to access to medical records that goes well beyond the Bill. The hon. Gentleman will be aware of the commitment given by my right hon. and learned Friend the Member for Ribble Valley (Mr. Waddington), when he was a Home Office Minister, that patients should have far better access to their medical records. Voluntary negotiations are continuing and we are hopeful that there will be some progress. I certainly want progress on developing draft guidelines for general access to medical records, which I hope will be achieved either this summer or in the autumn. It is now a year since my right hon. Friend made his commitment. A year may be a short or a long time in politics, but it is certainly long enough for progress to be made in negotiations between intelligent people. It is in the interests of everyone, and especially the health and welfare of patients, that progress should be made. We believe that the amendment improves the Bill.Amendment agreed to.
Clause 2, as amended, ordered to stand part of the Bill.
Clause 3
Consent And Notification Of Rights
I beg to move amendment No. 3, in page 2, line 1, leave out from 'apply' to end of line 6 and insert—
'and before obtaining such consent has—(b) informed the individual in writing of the individual's right under this Act— (i) to have access to the report before it is supplied by the medical practitioner provided that the individual has contacted the practitioner and arranged to have access within the period specified in subsection (2) or subsection (3) of section (Access before supply of report) below. (ii) to have access to a report which has been supplied for a period of six months from the date on which it was supplied; and (iii) to seek the correction of information which is incorrect or misleading in accordance with section 5(2) below; and (iv) to prevent the supply of a report in accordance with section 5(3) below; and (c) invited the individual in writing to give notice in writing to the person seeking the report, when giving the consent referred to in this section, indicating whether he or she wishes to have access to a report before it is supplied.'.
With this we may discuss the following: Amendments Nos. 5 and 6,
New clause 1— Access before reply of report
New clause 2— Application to the court
As the Minister said earlier, the House is conscious of the fact that this Bill received a formal Second Reading. Although I understand that the House wishes to proceed to a later important debate, as some substantial issues arise in this group of amendments I wish to spend a few moments considering them in some detail.
The amendments are an attempt to strengthen and clarify the individual rights provided in the Bill, whose aim is to give people the new right to see the medical reports that their general practitioners, or any other doctors who have been responsible for their care, provide to an insurance company or an employer. Such reports are already supplied strictly with the consent of the person concerned, as is right and proper, but, at present, they are not available as of right to that person. The essence of the Bill is to make them available as of right. Amendment No. 3 contains several important changes that repay some consideration. It will ensure that people are more fully informed of their new rights when they are asked to consent to a medical report being obtained. At present, a person applying for an insurance policy—or for a job, for that matter—is sent a form by the insurance company or the prospective employer. Normally, that form requests permission to approach the person's doctor. Under clauses 3, 4 and 5 of the Bill as it stands, they will also have an additional right to tell them of their new right of access and any other rights that are contained in the Bill. Some of the amendments extend such rights—for example, by allowing the correction of mistakes. If the amendments are passed, the current notification provisions will be extended. I wish to be open and honest with the Committee. I have discussed the Bill with the Association of British Insurers and others. Like the Under-Secretary of State, that association has other fish to fry, but it has co-operated and tried to make the Bill as practical and workable as possible. The association was concerned, and made representations to me to the effect that the Bill contained some worrying features—for example, that there was no time limit for seeking access. It rightly suggested that, under the Bill as it stands, in certain circumstances a doctor could not know whether a patient was likely to want to see the report and, therefore, he might quite properly feel obliged to hang on to it for a considerable time before sending it out. That would involve intolerable delays. It was certainly not my intention to do that. The amendments will remedy that defect. Another problem that the association saw was that, as the Bill stands, a doctor might immediately supply a report, only to discover later that the patient expected to discuss it before it was sent. I have suggested a useful procedure, and I shall be happy to adopt it to eliminate that uncertainty and make it easier to obtain access.I may have misunderstood the basic purpose of the hon. Gentleman's Bill. Is it implicit that a report may not be sent by a doctor unless the patient agrees with it, or is it implicit that a report may not go forward unless the patient has seen it? If it is a matter of seeing the report, why can it not simply be covered by what I assume to be normal office practice? A doctor may copy the report, which he would surely do in any event for his own records.
The hon. Member for Ealing, North (Mr. Greenway) has probably slightly misunderstood the Bill. There are clear provisions. I know that the amendments are long and complicated, but amendment No. 6 substantially deals with checks and balances and with what the patient can do in terms of amending reports or preparing statements if he considers that he cannot persuade the doctor that there has been an explicit error. Indeed, the patient has three options. He may withdraw his consent to the medical practioner supplying the report. We have tried to take careful account of such matters and provide a proper balance.
I stress that in no sense are we asking for the medical practitioner to change his judgment. That would be quite improper. We are trying to give the patient a balanced right, to make sure that any inaccuracies are corrected and matters relating to judgment are at least subject to his statement, in an attempt to elucidate his point of view. I hope that that has dealt with the point, as I am anxious to win the support of the Committee.I support the general principle which the hon. Gentleman seeks to advance in this important Bill, but I wonder where this complex amendment takes us. Is it implicit in the amendment that at some point the individual may say, "I shall go elsewhere. I am not going along with this"? The insurer may say that a second opinion is required. At what point might that happen?
I am giving the right to a patient to withdraw his consent. If there is an irreconcilable dispute between the medical practitioner who is supplying the report to an insurance company or an employer and the patient— it may prejudice a job or an insurance policy—under the amendment the patient has the right to say, "I would prefer not to have this report shown to my prospective employer or insurance company. I would prefer no report to be given." Then the medical practitioner would be in breach of his ethical duty to his patient if he supplied the report.
I know that the hon. Gentleman has a keen interest in these matters. I have been through the amendment line by line with both the ABI and the BMA. That combination, together with the infallible reasoning and inspection of the Minister, gives the amendment an impeccable pedigree. If the hon. Gentleman does not take my word for it, I hope that he will accept the word of the ABI, the BMA and the Minister. If the amendments are passed, the new consent forms would ask the applicant explicitly to indicate whether he or she wanted to see the report before the doctor supplied it. That is the function of paragraph (c) in amendment No. 3. If the applicant agreed, the insurer or employer would pass that information to the doctor when contacting him for a report. The doctor would be required to give the patient up to 21 days to see the proposed report. Taken with new clause 1, amendment No. 3 would allow for that procedure which would replace the present provision in clause 4. If the Committee agrees with the amendments, it would be necessary to remove clause 4. We have attempted to clarify other matters, but I shall not go into them all because it would detain the Committee too long. However, I must refer to one or two other issues. The amendments will omit the 90-day time limit that was in the original Bill. In proposing the limit I was thinking of job applications and applications for insurance policies, and, indeed, the proposal is uncontroversial in those contexts. But, having again had the benefit of consultation with the ABI and BMA, I confess that I did not appreciate that the limit would also apply in other circumstances, for example, claims after death. Occasionally, an insurer will deal with a death from an illness which would normally have a long incubation period. When a death occurs from such a disease shortly after a policy has been taken out, there is a prima facie case for an investigation into whether there has been a fraudulent application. I understand that an insurance company may be reluctant to pay unless a doctor confirms that the illness was not known to the patient when the policy was obtained. That raises basic conflicts with the principle of medical confidentiality. There are strong feelings on the subject in the medical profession. I have tried to steer a path through the difficulties but have to report that I have not succeeded. It has become clear that any proposal I could make would raise extremely powerful objections from either the insurance industry or the BMA. The issue is far more complex than any other element in the Bill and it has been made clear that my pursuing the matter might jeopardise the Bill. I hope that the House understands that, in the circumstances, the wisest course is to drop clause 3(2). I am satisfied that clause 3(2) would change the law significantly and make it illegal in certain circumstances for an insurance company to contact a doctor after the death of an insured person. Omitting clause 3(2) will preserve the status quo and insurance companies will be able to contact a doctor, and doctors will be free, though not necessarily obliged, to reply. 1 pm Amendment No. 5 partly reflects the new time limits that I have mentioned. The hon. Member for Ealing, North tabled amendment No. 13. Clause 7 requires a doctor to keep a medical report for five years after it has been sent to the employer or insurer. A medical report is drawn up for a specific purpose. It is not a medical record. I hope that the House is not labouring under any confusion about the two. A medical report is much more finely focused. Clause 7 requires an excessive period of retention. The need is to ensure that someone who has been turned down for a job or insurance should be able to establish whether information or a misjudgment on the report was responsible. That need should arise at or shortly after the time when the application is turned down. Amendment No. 10 would reduce to six months the time for which a report should be kept.The hon. Gentleman has drawn attention to the distinction between a medical record and a medical report. In the light of his long conversations with insurers and others, can he confirm that a medical report's purpose is to establish whether an individual is basically fit and free of illness or disease? Will he confirm that it is not a detailed investigation but a general statement?
I am happy to confirm that it is not a complex in-depth medical investigation. It is, as the hon. Gentleman suggests, a statement of the applicant's fitness to undertake a job or for an insurance policy.
When the hon. Member for Ealing, North speaks to amendment No. 13, I hope that he will bear in mind the fact that a balance must be struck and that, if only for reasons of space, the time for which reports must be kept should be reduced. It is difficult to keep reports for five years. Indeed, they may have to be filed separately. It would be unnecessarily bureaucratic to require reports to be preserved for 10 years. Amendment No. 6 is fairly complicated. I have dealt with a substantial part of it in attempting to assuage the fears expressed by the hon. Member for Ealing, North in an intervention. The amendment contains the procedure for dealing with errors. If the patient sees the report before it is sent off and discovers that it is incorrect or misleading, he would be able to ask that it be amended. If the information was demonstrably wrong, the doctor would he obliged to amend it and there would be no difficulty about that. However, if the doctor did not accept that there was a mistake, he or she would not change the report but instead would invite the patient to provide a written statement setting out his or her view of the disputed matter. That statement would be included in the report that would go to the employer or insurer along with the doctor's report. I stress that a patient cannot force a doctor to change his or her professional opinion or to suppress any particular facts. If there is a difference, the solution in the Bill is that both options should be set out. However, if a patient sees a report and decides that it is wholly unacceptable he could prevent the report from being supplied. That is the effect of subsection (3) in amendment No. 6. I accept that that may jeopardise his or her prospects of securing the insurance policy or the job, but it is right that an individual should have the freedom to make such a decision. Finally, new clause 2 seeks to provide a basic mechanism for enforcement. The Bill is deficient in terms of the sanctions available to individuals under the new rights that it provides. If an individual considers that an employer, an insurer or a doctor is failing to comply with any of the Bill's requirements, he or she can apply under new clause 2 to the courts for an order to ensure compliance. That is an appropriate way to deal with the enforcement provisions. I apologise to the Committee for detaining it at some length on this group of amendments which make substantial changes to the Bill that received a formal Second Reading. Therefore, it was only fair and proper that the Committee should spend a moment or two considering some of the consequences that flow from this set of amendments. The amendments are the fruit of substantial consultation. They strengthen and clarify the Bill and I hope that they will find favour with the Committee.I greatly respect the care with which the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) has prepared the Bill and all the research and discussion that lies behind it and the amendments. I know that his interest is deep and genuine and that the Bill follows up his work in the House on other matters.
I am worried that implicit in the amendments is a right for, indeed an invitation to, a patient to disagree with the doctor and to invite him to change an opinion to which, presumably he will have given due consideration and careful thought, backed up with a medical examination. Under the amendments, the patient has the right to say to a doctor, "I do not accept what you, Mr. Professional Doctor, say about me in the important matter of my fitness to be insured in the way that I seek to be insured, or for the employment or the job that I seek. I do not agree with your medical assessment. After your seven years of medical training, all your experience in hospitals and the rest, I John Bloggs or Harry Greenway say that you are wrong." If a patient says to his doctor, "I cannot agree with you" he is telling his doctor that he is wrong. I do not say that an individual has no right to tell his doctor that he is wrong, but his opinion is based on a hunch or an idea. We have to beware of the slim knowledge that all of us who are not doctors have of medical and other related matters. We may have views about psychological matters, such as behavioural problems, a similarly expert question, but teachers with a good deal of expertise in child behaviour and child psychology might find themselves in difficulty if they challenged the careful assessment of a psychologist. I shall not seek to divide the House, but I am fundamentally opposed to the amendments. The hon. Gentleman says that an individual should be able to say that he does not accept a doctor's medical report. He may accept the good intentions of the doctor's report, but to challenge it means that he does not accept it. In those circumstances, a more satisfactory solution would be for the patient to say that he intends to seek a second opinion.The hon. Gentleman says that to challenge a medical report would not be to question the good intentions of the medical practitioner, but that is not an accurate description of what the relationship should be between a patient and his doctor. The medical report is a matter of judgment. The doctor will consult the medical records and perhaps examine the patient, after which it becomes a matter of judgment.
As it is a matter of judgment, if the patient does not share that judgment he should be able to say to his doctor that he has got it wrong. That is the purpose of the Bill. If the doctor disagrees with him, he should be able to say to the patient, "I shall put a note to that effect on your records, but I think you are wrong." I see nothing wrong with that.This is a semantic argument. The hon. Gentleman referred to a disagreement. I used the word "challenge", which is a parliamentary term and it may be too strong a word for what we hope will be a modest disagreement. If a doctor said to his patient, "You have cancer" and the patient's reply was, "I do not", that amounts to challenge. There are people who are told that they have cancer, but who, somehow, know that they do not. There can be disagreement or challenge on as big a matter as that, but that is not what we are dealing with.
We are dealing with a small disagreement or a small challenge about what a doctor says in a medical report that is necessary for insurance or employment. A patient who is dissatisfied with a report prepared by his doctor should be able to say to him, "I have nothing against you personally, but I intend to seek a second opinion." That is how it should be handled, rather than there being an argument between the doctor and the individual about the contents of the report.I should like the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) to help me with a matter that follows from the remarks of the hon. Member for Ealing, North (Mr. Greenway).
The hon. Member for Roxburgh and Berwickshire said that we are talking about medical reports that are prepared for a specific purpose at the request of an employer or insurance company. The reports will make judgments based on medical records held by a doctor, but not all those records may necessarily have been prepared and kept by that doctor. Someone may have moved and their records may have followed when that move involved a change of doctor. I do not understand why the hon. Member for Roxburgh and Berwickshire thought that it would not be necessary to keep a copy of the report. It will be compiled from records and may involve a medical examination. I should have thought that the copy would be a proper part of a patient's medical records and I cannot foresee a GP not wanting to keep a copy, as it would be part of a package of the patient's medical records. 1.15pm I should like further to ask the hon. Member for Roxburgh and Berwickshire about medical practitioners being able to decline to disclose what is in the report where he or she is of the opinion that it is likely to cause serious harm to the physical or mental health of the individual. I do not want to start a semantic argument about the difference between harm and serious harm, but amendment No. 7 worries me because the hon. Member for Roxburgh and Berwickshire wants to insert:I accept that clause 6 is a difficult part of the Bill. It argues about patient's access to reports, and in that regard it is opening another door, but it says that when a medical practitioner properly makes a judgment that door will be slammed shut. I am not sure that the amendment properly deals with that matter. We must assume that there is a reasonable relationship between the patient and GP. If either side does not like the relationship it has the right to end it. The GP can say, "On your bike" and the patient can say, "I am dissatisfied with you, so I shall find another doctor." What will happen when a doctor looks at the patient's medical records and thinks, "Blimey O'Reilly, if I put that in the report and show it to the patient it will cause serious harm"? Let us suppose that it will cause serious mental or emotional harm. What will happen? Is the GP expected to communicate the contents of the record to the patient? I suspect not, judging by amendment No. 7. When patient and GP come face to face, the patient will say, "will you please let me see a copy of the report that you propose to send to the insurance company?" The doctor will say, "No I cannot do that." The patient will ask, "Why not?" the doctor will reply, "I cannot tell you." The doctor is acting quite properly because the Bill allows disclosre to be withheld where it would be likely to cause serious harm. So the patient persists and says, "Why can't you tell me?" and the doctor says, "I just can't tell you." That leaves a great yawning chasm. It could be interpreted as mistrust at its best, and the patient may feel something akin to deep and terrifying despair and think, "My godfathers, I have a dreadful disease and will drop dead at the end of next week and that is why the GP is not telling me." Of course, that will be rare and, I hope, would occur only in extreme cases. However, it is an interesting point. The Bill is all about access and one would hope that the GP, in the difficult circumstances in which he or she reached the conclusion that to reveal a report would be likely to cause serious harm, would want a relationship with the patient that would enable him or her to indicate in some way why such action was being taken. I have to say rapidly to the hon. Member for Roxburgh and Berwickshire and the Committee that I think that I have uncovered the problem, but I do not know what the answer is."or would indicate the intentions of the practitioner in respect of the individual."
Is that not just typical of the Labour party?
I have listened to the exchanges of the past few minutes with a great deal of interest. It would probably help the Committee if I told my hon. Friend the Member for Ealing, North (Mr. Greenway) that this is a limited Bill and that much of what he was concerned about is being discussed elsewhere in the efforts we are making to try to achieve voluntary agreements between the Government and the medical profession. Perhaps I should also warn the Committee that I have been a little reluctant to commit a great deal of officials' time, particularly scarce parliamentary counsels' time, to ensuring that every "t" is crossed and every "i" is dotted. I wanted to wait to see whether the Bill made progress. Should it be the will of the Committee and the House that it should so do, I shall try before it reaches the other place, to ensure that some of the necessary tidying up is attended to. We would not wish to see a Bill go on the statute book that could cause anyone major difficulties. As I understand it—this is my response to my hon. Friend the Member for Ealing, North—the Bill covers the following possibilities. An individual seeks insurance or renewal of insurance or is involved in an existing or potential contract of employment and in order to maintain or promote that contract, the insurer or employer asks for a medical report. The requester—the employer or insurer —must under the Bill and the amendments before us notify in writing the individual concerned, who for these purposes we should call "the patient". If the patient wants to see the report, he has to say so in writing and quickly. If he does not like it, he can change it and prevent it from being sent. I am looking to the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) to see that I have got that right because it is quite complex stuff. I can well understand the concern of my hon. Friend the Member for Ealing, North, but I shall offer him a rather different anecdote, which shows why I am increasingly minded to be sympathetic to moves to open up access to medical records. Not long ago I went to the family practitioner committee in my neighbourhood. It has very good people and has recently computerised its records. It proudly punched up my cervical smear test record and said, "You have not had one for ages. You are due for one now." I said, "But you haven't got any of my cervical cancer smear test records on your computer, I had one as recently as—" and I gave the date. It punched more buttons and the computer record was a total blank. The reason for that was that it had the wrong NHS number. It had one digit wrong. I knew that and I was probably the only person in the entire country who did. It had punched in "LNUN" instead of "LNVN". That was clearly a mistake in somebody's handwriting, possibly one that had been around for a long time. It is valuable for a patient who is concerned about accuracy and about ensuring that it is his medical record that has been examined to have the right of access. If, however, he prevents the document from being sent, the insurer or the employer will know and can draw conclusions. If the patient is content or does not bother about it and the report goes to the insurer or employer and perhaps produces an adverse reaction, he will still have the right to see the document, but only within a time limit. Under the amendment, the limit will be six months, and we may debate later whether to have a longer period. It is reasonable to have a time limit. This is not a debate about general access to medical records. It is about an individual's need to know what is said about him or her in a particular document in which he or she has a strong pecuniary interest. It is not a small matter because we may be talking about the possibility of a person losing his job or about someone who is unable to get car insurance to allow him to drive. It is not a small matter to someone like me. I am an asthmatic and, in the past, have been offered insurance only at much increased rates. I regard myself as generally rather fit and I have not had an attack in a long time. I would challenge such attitudes. I can envisage circumstances in which an individual's entire life is affected by an individual report on an individual occasion which is not accurate, not full enough or about the wrong person. That can happen in families in my sort of constituency where father and son frequently have the same name.Does my hon. Friend agree that, although we are not talking about medical reports, we are talking about a medical snapshot at a given time? If we are not, what are we talking about?
That is right, but, as I am not the Bill's promoter, I am sure p that the hon. Member for Roxburgh and Berwickshire will respond. The individual is not an innocent, uninterested bystander. A potential pecuniary contract is involved. It is wise to allow a person access to a report which could substantially affect his livelihood. That is why we do not seek to oppose the Bill.
The hon. Member for Birmingham, Erdington (Mr. Corbett) referred to "serious harm", which as he knows is the wording in other legislation. From time immemorial, patient records have been regarded as belonging to the doctor. In the current state of the law there is no way that a patient can gain access to those records. The doctor has an absolute veto over them. Surely, in a world of intelligent, educated people, that cannot be right. It no longer fits in with our general view that the patient is a co-operative animal in the treatment of his condition. Every effort should be made to win his co-operation to provide him with information about his condition. The more people live long, happy and fruitful lives, even with chronic conditions such as asthma and diabetes, the more it makes sense to move in this general direction. I was interested to hear the remarks of the hon. Member for Roxburgh and Berwickshire about the co-operation of the Association of British Insurers. I am sure that it is in insurers' interest to get accurate reports. It is in the interests of all of us, since we pay the insurance rates, that insurers should not take inordinate risks that will fall on the rest of us. If this proposal becomes law, guidance will be issued. It will not be instituted by the Government, as this is not a Government Bill, but will be issued, I understand, by the medical profession through the British Medical Association. The Government stand ready to assist in drawing up guidelines. The Bill is somewhat vague. If I may offer the faintest hint of criticism of the hon. Member for Roxburgh and Berwickshire, it is that I am surprised that, after years of debating these matters, he originally put on the Table a Bill which made a number of well-meaning and well-sounding comments but did not give any power or teeth to what he intended doing. I am sure that, because of the discussions in recent weeks, some of those points will be put right. Amendment No. 3 ensures that employers and insurers will advise individuals in writing of their right to have access to a medical report, but it puts the onus on the individual to make the necessary arrangements with the medical practitioner within 21 days of notification that a report has been requested. That seems sensible. The amendment provides for access to a report within six months of its supply to the employer or the insurer. It gives the individual the right to amend or notify a report that is considered to be inaccurate or misleading and to prevent a report from being sent to an employer or an insurance company. The amendment also provides that individuals should be advised that if they wish to have access to a report they should make known in writing their desire to do so. In other words, the amendment sets out clearly the gateways through which the individual must pass. It spells out the rights that form the cornerstone of the Bill. 1.30 pm I hear what the hon. Gentleman says about the validity of consent. The amendment deletes any reference to validity of consent lasting for 90 days, as originally suggested. It is interesting to hear the views of the Association of British Insurers and the British Medical Association on this matter, and the amendment maintains the status quo. However, between now and the Bill's arrival in another place, the hon. Gentleman might like to give more thought to the matter. Although 90 days was too restrictive, a time limit of some kind might be desirable. I offer him merely the thought—it is not a recommendation —that the legislation requiring prescriptions to be offered before spectacles can be issued refers to a validity period of two years. That seems wise, as a person's health can change during that period, and beyond that period we would expect a further prescription to be called for. But if the hon. Gentleman makes progress, perhaps he will devote his time and attention to such issues. New clause 1 provides that if the individual makes no arrangements to see the report, the practitioner may pass it on. It also provides a necessary time scale by which action is to be taken. We regard amendment No. 5 as an improvement to the Bill, because it provides that people have the right of access by making an application within a time period—in this case six months. That right was lacking in the Bill as originally drafted and without it individuals would not have been able to find whether errors had been made in the original report. Amendment No. 6 provides the right to amend or modify an inaccurate or misleading report and inserts the right for an individual to withhold consent—a further deficiency in the Bill as originally drafted. The Government believe that the amendments represent a considerable improvement on the rather vague drafting that was originally placed before us and would preserve the intentions of the Bill if the House wishes it to proceed.
I crave the indulgence of the Committee. I have listened carefully to the debate, which has been both instructive and constructive. As the Minister said, some of the issues are being discussed in other places on other more substantial legislation. I am sure that the subject referred to by the hon. Member for Ealing, North (Mr. Greenway) will raise its head during our discussions, and I am sure also that both he and I will want to keep an eye on the matter. I assure him that I shall weigh very carefully his remarks as well as the Minister's helpful recommendation and her comment that the Government will assist and try to clear up some of the vaguer aspects of the Bill. In my own defence, I remind the House that we are all amateurs when it comes to parliamentary draftsmanship. We need to strike a balance between the violence that is done to the English language and the clarity of legislation; but perhaps that balance is not right in the Bill as drafted and I am happy to accept the Government's kind offer to assist us.
The hon. Member for Birmingham, Erdington (Mr. Corbett) raised some substantial issues. Matters such as the freedom of retention of documents were gone into in some detail with the BMA and other bodies. I am sure that the hon. Gentleman knows that when one is ninth or 10th in the private Member's ballot one is not really master of one's own destiny. The hon. Gentleman spent much time constructively criticising the Access to Personal Files Bill, which I introduced last year. The same applies this year, but more so. My position is even less strong than it was last year. I hope the hon. Gentleman will accept that we shall pay close attention to what he said and seek to make adjustments in the other place if the measure finds favour with the Committee. If the Committee is prepared to accept the amendments, we shall pay careful attention to all that has been said.I was most interested in what the hon. Gentleman and my hon. Friend the Minister said. Although this is a small measure, I enunciated an important principle. If the hon. Gentleman will give an assurance that he will pay attention to that principle, I shall be happy.
I give that assurance. If we had more time, I believe that I could give substantial reassurance to the hon. Gentleman. I shall seek to do so at some other time or place. I hope the Committee will feel that these important and complicated amendments, vague though they may be, have been properly discussed and will allow them to pass.
Amendment agreed to.
Clause 3, as amended, ordered to stand part of the Bill.
Clause 4 disagreed to.
Clause 5
Giving Of Access
Amendments made: No. 5, in page 2, line 12, leave out paragraph (a) and insert—
`(a) make available to the individual for inspection—(1) within the period specified in subsection (2) or subsection (3) of section (Access before supply of report) above a copy of a medical report relating to that individual which the practitioner intends to supply for employment or insurance purposes; or (ii) a copy of a medical report relating to that individual which the practitioner has supplied for employment or insurance purposes within the previous six months.'.
No. 6, in line 17, at end insert—
'(2) Where an individual notifies a medical practitioner that a medical report which the practitioner intends to supply for employment or insurance purposes contains information which in the individual's opinion is incorrect or misleading the practitioner shall:(a) if the information is incorrect or misleading, amend the report accordingly; (b) if the practitioner does not accept that the information is incorrect or misleading, invite the individual to prepare a statement in writing setting out his or her views in relation to the disputed information and the practitioner shall attach any such statement to any report relating to the individual which is supplied for employment or insurance purposes.
(3) Where an individual has had access to a report which a medical practitioner intends to supply for employment or insurance purposes the practitioner shall, notwithstanding any consent given under section 3 above, refrain from supplying the report until such time as the individual has given written consent for the report to be supplied.'.— [Mr.
Kirkwood.]
Clause 5, as amended, ordered to stand part of the Bill.
Clause 6
Exemptions
I beg to move amendment No. 7, in page 2, line 21, at end insert—
`or would indicate the intentions of the practitioner in respect of the individual'.
With this it will be convenient to discuss amendments Nos. 8 and 9.
I can deal with these amendments very briefly. They are designed to bring the Bill into line with the Data Protection Act 1984. Some Members may feel, as I do, that that Act has some way to go before it can be regarded as a model disclosure Act. The Government have stressed, however—quite properly, in my view—the need for single common standards for disclosure, particularly in the limited area of medical information. I have sought to improve on the Data Protection Act, but I accept that it would not be helpful to have two conflicting sets of complicated rules.
Amendment No. 7 adopts the basic premise found in section 1(3) of the Data Protection Act, which rules that while an opinion is disclosable an expression of intention is not. I fully accept that. Amendment No. 8 deletes a minor divergence from the standard laid down in the Data Protection Act about access to health records. Amendment No. 9 adopts the exemption on national security grounds contained in that Act and specifies identical procedures.When we considered the Bill in detail we found one or two slight difficulties. For example, information relating to national security could have been released in a way that was possibly not desirable. We drew the hon. Gentleman's attention to those deficiencies and we are pleased that he has tabled amendments Nos. 7, 8 and 9, which not only achieve consistency with the Data Protection Act, but, in one or two cases, will possibly be very much in the national interest. We are therefore glad to see the amendments and do not oppose them.
I appreciate the hon. Gentleman's comments about single common standards, but amendment No. 9 is unacceptable. With regard to the Data Protection Act, single common standards are all right only if the standards themselves are all right.
I cannot for the life of me understand why the Government wish to extract from the Data Protection Act this kind of cover for material, the release of which, it is said, would jeopardise national security. Perhaps the Minister will explain exactly where this might lead. The hon. Lady will know that a judgment was delivered yesterday, affecting a group of ex-service men and women, who, as part of their service, were forced to take part, in the sense of witnessing, in tests with nuclear weapons in Australia about 25 years ago. The result of that judgment is that they are now free to sue the Crown for what they say are diseases caused by having to undertake those duties. I can imagine a Minister of the Crown getting a piece of paper and writing, "I say that the release of that information would jeopardise national security", then handing it to a general practitioner, and saying, "That is secret, because I say that it is secret." That is what the amendment allows the general practitioner or medical practitioner to do. At least those ex-service men and women can now go to court. One hopes that the Government will see the sense of trying to deal with that matter more sensibly, but that is up to them. However, if Ministers could have taken the action that I have just described, that information may never have come out. It could have been buried, locked deep away in a doctor's file. I hope that the Minister will not try to persuade the Committee that nobody would ever do that. Unhappily, the clause could be used restrictively by Ministers. I do not doubt that they would do it with their hands on their hearts and say that they were right, but that would not make it right. I cannot for the life of me see the need for this measure in the context of medical reports. What, in a medical report, could jeopardise national security? We should remember that access to medical reports is for employment or insurance purposes. Will the fact that I occasionally suffer from corns jeopardise national security? Probably not. Let us imagine that I have a disease which at the moment is incurable, but with which I can cope because I have medication to help me. If a doctor states such facts about an individual in a medical report, in what possible circumstances would a Cabinet Minister come down the road on a great charger, waving a bit of paper, and saying, "Keep that quiet. If they found out about that in the Kremlin, all hell would be let loose."? Never mind the other arguments about the Data Protection Act 1984; we are talking about opinions and judgments formed on the basis of facts. Medical records overwhelmingly record the facts of a patient's health over the years. It is a fact that I broke my elbow at the start of the general election in 1979. I am quite clumsy. The Minister will no doubt rib me about that later. It is a fact that I started last new year by tripping over a kerbstone, which I did not see, falling against a wall and cracking a couple of ribs. That is a medical fact, which will be on my medical records. I hope that everything else on my medical records are matters of medical fact. Medical records also record treatment. One goes into the surgery complaining about belly ache or whatever, there is an examination, a bit of chat, "Take this" or "Do not take the other", one is told to stop eating this, that or the other. That treatment is recorded in the medical record. As we have said, those records are gone through for report purposes. There may or may not be an examination, but a report is drawn up. Because the circumstances outlined in amendment No. 9 relate to facts and do not deal with anything other than opinions and judgments formed on the basis of those facts, what use is that information for insurance purposes? The sort of questions asked are: "Is the applicant in reasonably good health? Yes/No. Has the applicant suffered from any major illness or disease during the past … years? Yes/No. If yes, give details." 1.45 pm I understand why the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) had to table the amendment. I hope that he will forgive me for phrasing it that way. It was not his idea. The Minister's paw prints are all over it. I am making a song and dance about it because the Home Secretary has promised us a White Paper on reforming the Official Secrets Act by the end of next month. I bet that any new Act will be as restrictive as the current Act, but more smartly written. When we object to the sort of provision contained in the amendment being part of the Official Secrets Act mark II, the Home Secretary will say, "What is all the fuss about? It is already contained in the Access to Medical Records Bill and the Data Protection Act, so I am doing nothing new. What are you worried about?" That is the danger. This amendment is taking a mighty big Exocet to impose a small provision. I cannot envisage any circumstances in which it could possibly be justified.I wish to allay the fears expressed by the hon. Member for Birmingham, Erdington (Mr. Corbett). Someone might enter a sensitive job in the security services with a serious health problem. Should that be known? There may be circumstances in which it might help the security of the state for that fact not to be made broadly known.
What?
The hon. Gentleman might express surprise, but it all depends on the circumstances. Such a health problem should certainly be known to a prospective employer. It is the use of that information from that point onwards that is in question. In certain circumstances, the security of the state could be at risk, so I support the amendment.
When it comes to firing Exocets, the hon. Member for Birmingham, Erdington (Mr. Corbett) has just shown us how it is done. I wonder how much advice he has sought from his many hon. Friends who have actively supported improved access to information, especially to medical records. Indeed, on many occasions they have been more active supporters than the Government. The hon. Gentleman's words were not really part of today's debate, but part of a quite different debate that he may seek to have through the usual channels. If he felt so strongly about the matter, I am surprised that he did not discuss it with the Bill's sponsor or make any effort to verify the status of the amendment.
The hon. Gentleman mentioned the people who yesterday were granted the right to sue the Government, but I am sure that he does not expect me to comment on that. He should remember that the Bill seeks to increase, not diminish, access to information. Perhaps he should give further thought to whether he wants to jeopardise its passage in the way that his strong words have suggested, and also to whether it would be appropriate to do that today. We asked for amendments Nos. 7, 8 and 9 to be included partly because it is wise and sensible not to have a wide diversity of legislation on similar issues. It makes sense to have legislation on similar issues. It has long been the Government's view—whichever colour the Government happens to be—that it is wise to include a provision that, where national security might be involved, there should be an exclusion. That has long been the practice. As a student I well recall spending many hours listening to the row between Mr. Wilson and the D Notice Committee. Efforts were then made of a similar kind, perhaps unnecessarily. We firmly believe that national security issues are likely to arise in relation to medical reports only on extremely rare occasions. Therefore, it is in the interests of the individuals concerned, and perhaps hon. Members, that the clause should be inserted. If the hon. Gentleman and his colleagues have such strong views on that topic—observing the Opposition Benches, it does not look as though the other 220-odd Labour Members share his views—they may take them up in debates on that topic elsewhere or at different times. It may well be that if the Bill proceeds in its passage today, they may wish to take them up in the other place. Therefore, the hon. Gentleman may like to take some proper advice about it. It is for the promoter of the Bill to decide whether the amendment should stand or be withdrawn. It is our view that it improves the Bill. We would wish to take further advice if the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) wants to withdraw it.This has been an interesting debate. All things being equal, and if I were in charge of the legislative programme of Her Majesty's Government, the wording of the clause, and particularly that of amendment No. 9, is not what I would have wanted. I assure the hon. Member for Birmingham, Erdington (Mr. Corbett) that it is the most acceptable agreement that could be reached in the time available. I hope that he will continue to discuss this important matter, but not in Committee this afternoon.
Amendment agreed to.
Amendments made: No. 8, in page 2, line 28, leave out paragraph (b).
No. 9, in line 33, leave out subsection (3) and insert—
'(3) A medical practitioner shall not disclose to an individual any part of a medical report containing information whose disclosure a Minister of the Crown has determined would jeopardise national security; and a certificate signed by a Minister of the Crown certifying that a disclosure would jeopardise national security shall be conclusive evidence of the fact.
(4) The powers conferred by subsection (3) above on a Minister of the Crown shall not be exercisable except by a Minister who is a member of the Cabinet or by the Attorney General or the Lord Advocate.
(5) This section shall not be construed as excusing a practitioner from making available to an individual so much of a medical report as may be made available without causing serious harm or indicating the practitioner's intentions as mentioned in subsection (1) above or without revealing the
information or identity mentioned in subsection (2) above or without disclosing the information mentioned in subsection (3) above.'.— [Mr. Kirkwood.]
Clause 6, as amended, ordered to stand part of the Bill.
Clause 7
Retention Of Reports
Amendments made: No. 10, in page 2, line 40, leave out `five years' and insert 'six months'.— [Mr. Kirkwood]
No. 13, in line 40, leave out 'five' and insert 'ten'.— [Mr. Greenway.]
No. 11, in line 42, leave out subsections (2) and (3). — [Mr. Kirkwood.]
Clause 7, as amended, ordered to stand part of the Bill.
Clause 8
Short Title, Commencement And Extent
I beg to move amendment No. 12, in page 3, line 9, leave out 'extends' and insert 'does not extend'.
I understand that matters such as those proposed in the Bill will be dealt with properly in Northern Ireland by making an Order in Council, hence the need for the amendment.Amendment agreed to.
Clause 8, as amended, ordered to stand part of the Bill.
New Clause 1
Access Before Supply Of Report
`(1) Where an individual has given written notice in accordance with section 3(1)(c) above to a person seeking a medical report indicating that he or she wishes to have access to a report before it is supplied by a medical practitioner the person shall not apply to a practitioner for such a report unless he or she has—
(2) Where a medical practitioner has received notification under subsection (1)(b) above the practitioner shall refrain from supplying a report for a period of twenty one days from the date on which the notification referred to in subsection (1)(a) was given unless the individual has been given access within that period.
(3) Where a medical practitioner has not received notification under subsection (1)(b) above but before supplying the report has been notified by the individual in writing that the individual wishes to have access to the report before it is supplied the practitioner shall refrain from supplying a report for a period of twenty one days from the date on which the individual gave notification unless the individual has been given access within that period.'.— [Mr. Kirkwood.]
Brought up, read the First and Second time, and added to the Bill.
New Clause 2
Application To The Court
`(1) An individual who considers that a person has failed, or who has reasonable grounds to consider that a person is likely to fail, to comply with any requirement of this Act in relation to a medical report containing information about the individual may apply to the court and the court may order the person to take such steps as are necessary to comply.
(2) The jurisdiction conferred by this section shall be exercisable by a county court or, in Scotland, by the sheriff.'. — [Mr. Kirkwood.]
Brought up, read the First and Second time, and added to the Bill.
Bill, as amended, to be reported.
Bill reported, with amendments.
Order for Third Reading read.
1.54 pm
I beg to move, That the Bill be now read the Third time.
This is an important measure and I am grateful for the forbearance shown in its early stage. It had a formal Second Reading. Today's debate has been of considerable assistance to me. This is an important advance which to some extent is the consequence of my private Member's Bill which I introduced last year. There are continuing arguments about access to medical records, as opposed to medical reports, and I have been substantially encouraged by the Minister during both the early stages and today's proceedings. The Government's attitude is always crucial to any private Member's Bill, and I have been especially fortunate in that respect. I have greatly appreciated the helpful and positive spirit in which the Minister has approached the Bill and our discussions. I extend that commendation to those to whom we are never supposed to refer—the officials in the DHSS. The BMA has supported the principle of the Bill from the outset. I am grateful to it for that, for the considerable time that a great many of its staff have devoted to helping me with the fine detail, and for their practical suggestions which have improved it. I acknowledge the contribution of the ABI, which expressed anxiety about some of the Bill's implications. I have tried to be as helpful as possible on those points and it is now satisfied that the measure is workable. The Bill has benefited as a result. As the House will recognise, the Bill comes from a fairly familiar stable—the freedom of information campaign. Finally, I wish to pay tribute to its members and their energetic and resourceful director, Mr. Maurice Frankle, who has been ever present at my side. I hope that the House will give the Bill its Third Reading. If so, I look forward to taking the opportunity in the other place of tidying it up and tabling any technical amendments that may be necessary.1.56 pm
I congratulate the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) on steering this complex and important Bill towards the statute book.
This morning I received a letter telling me that an insurance policy that I took out years ago and had forgotten about matures next week. I shall be the richer for it.The drinks are on the hon. Gentleman.
The drinks are on the Bill's promoter. It is interesting that I did not have to have a medical for that insurance policy and I have never had to have a medical for any other insurance. I have had one medical for employment purposes and that was 31 years ago, although I have had several jobs since. So I wonder how much the Bill will be applied. We are talking more about an important and valuable principle than about what will be a widespread practice.
The general principle of giving people access to medical records is in tune with the times, in the spirit of freedom to see what is written about one and people's ability to receive medical information about themselves which they could not take previously. Many people can be told that they have a fatal illness who could not have taken being told that years ago. I hope that nobody will receive such information as the result of a medical report for insurance or employment purposes. It is some years since the Inner London education authority established the principle that teachers should have the right to see reports written about them for employment purposes. Much can rightly be said about the inadiquacies of ILEA. I supported its abolition, although I have reservations about it. That principle was as important as that which is enshrined in the Bill, and was analogous to it. It gave teachers the right to see what was written about them. It helped to improve relationships between heads and teachers working with and for them and between teachers, inspectors and others concerned with the education service. As a result, children have benefited. 1 believe that people at work and those who want to insure themselves, as I have been able to do with the happy result that I have mentioned, will be helped by the Bill.2 pm
I have been critical of parts of the Bill, for reasons which the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) understands. I congratulate him on getting this far and hope that the House will give the Bill a Third Reading so that it might go to the other place and reach the statute book.
It is a shame that we have to advance at a snail's pace, step by tiny step along the road to more freedom of information. It is a pity that the Government do not yet understand the need for a proper freedom of information Act to open doors which remain locked for no good reason and to enable and encourage citizens to play a much fuller part in our democracy on the basis of much greater knowledge of what is going on. That remains an ambition. I am sure that the hon. Member for Roxburgh and Berwickshire will be with me when I say that I hope that if the Bill reaches the statute book, it will not be regarded as an end. It should be a spur to those of us on both sides of the House who want the repeal and rewriting of the Official Secrets Act and the arguments turned on their head. The present arrangements should be swept aside. There should be a presumption in favour of people knowing more about what is going on and on what basis decisions are taken by the Government and others. People should know why decisions are taken and have the information on which they are based. Such decisions have a large and often lasting effect on the lives, welfare and fortunes of every citizen in these islands. I hope that the House will allow the Bill to proceed.2.2 pm
I am not sure that I accept the criticism of the hon. Member for Birmingham, Erdington (Mr. Corbett) about the Government's view on freedom of information. He was not in Birmingham when I was involved in social services there. I felt strongly that access to social services records was important, but it was a social worker who went to court and tried to stop us. The case ended up in another place where, many years later, I was vindicated. The hon. Gentleman knows my views on these matters.
Today's progress with the Bill helps the Government in their discussions elsewhere. We are always keen for progress to be made voluntarily. Satisfactory resolution of complex issues such as those that have been raised today relies on co-operation and agreement. Such legislation is not workable without the willing consent of all concerned. The Bill has been much improved in Committee, so we do not oppose its Third Reading. We look forward to seeing what progress it makes elsewhere.Question put and agreed to.
Bill accordingly read the Third time, and passed.
Medical Examination Of Children At Risk Bill
Order for Second Reading read.
2.4 pm
I beg to move, That the Bill be now read a Second time.
My purpose in bringing forward the Bill is to attempt to introduce a simple specific measure for the protection of children while recognising the understandable rights of parents. It seeks to provide a tool for social workers and health visitors who carry the onerous responsibility of protecting children, making their work easier and more effective. It remains a challenge to us all at a time of rising prosperity and improved housing, health care and education, that there remain about 200 children a year who lose their lives at the hands of their parents or guardians, and a further 30,000 children on local authority at-risk registers. Child abuse is not a simple homogenous phenomenon. It may include physical abuse, sexual abuse, or child neglect. The debates and the outcry in our newspapers range from fury that there are not more intrusive and draconian measures to remove children from their homes, to the debate surrounding the Cleveland case, suggesting that the workers were overzealous and acted too swiftly. My measure addresses both ends of the spectrum. It is a limited measure which will ensure that a child is seen without summarily removing it from the family home. I should like to place the Bill in the context of other developments trying to tackle the scourge of child abuse. The Home Office has an important role. The recent improvements where children are able to provide evidence by means of a video link and their evidence need not necessarily be corroborated by an adult must make sense. There is no evidence to suggest that children are inherently less truthful than adults. Of course, the appalling situation in which the court appearance was at least as traumatic as the original abuse must be counteracted. There should be tougher penalties for those responsible for harming children, although that has to be seen in the context that the vast majority of abuses take place within the family and that there will be problems involving the reporting of offences if we develop an increasingly punitive atmosphere in which they are discussed. It is also important that more information about the criminal record of those who work with children should be provided. However, the investigation, the prosecution and the punishment play a small part in comparison with the importance of improving prevention. The Department of Education has taken steps to improve the training of teachers and their skills in detecting child abuse. There are plans for preparation for parenthood programmes and educational programmes encouraging children not to talk to strangers. However, the primary responsibility must lie with the DHSS. In the light of successive inquiries and concern, it has introduced a series of welcome initiatives. Since the Maria Colwell inquiry 15 years ago, there have been 35 inquiries into cases where children have lost their lives. Each inquiry has repeated the need for agencies to work together. I hope that the DHSS will bring forward its guidelines about working together. Of course, the community and the various professions involved have a part to play. Similarly, there are attempts to standardise inquiry procedures. Child abuse inquiries have often been horrifically expensive and unedifying occasions. Frequently they have been witch hunts where the professional workers, parents, friends and anyone associated have been denigrated and villified with little constructive outcome.My hon. Friend was wrong to use words such as "witch hunt". The Cleveland inquiry was in my constituency and I find that remark offensive. The inquiry sought to discover the truth. Mrs. Justice Butler-Sloss was magnificent in the chair. Such remarks are intemperate and I ask my hon. Friend to withdraw them.
My hon. Friend has made an important point. The Cleveland inquiry was very different from other inquiries into incidents where children lost their lives. By no means did I mean to imply that the leaders of the inquiry had conducted themselves in such a way. Mrs. Justice Butler-Sloss and Louis Blom-Cooper have been models in trying to combine the various interests and provide a considered report in an atmosphere of great heat. Often it is the press treatment of the individuals involved that has been particularly unedifying. All of us would hope to find a way of dealing with these appalling cases without necessarily establishing a laborious machinery for doing so. As for my hon. Friend's example of the Cleveland inquiry, my hon. Friend the Minister is to be congratulated on acting so firmly in setting up a statutory inquiry into what seems to be an idiosyncratic set of circumstances that relate to a problem that has only recently come to light.
The maintenace of national statistics is a further important development. Problems can now be analysed and assessed in their proper and considered context. In his Children and Young Persons (Amendment) Act 1986 my hon. Friend the Member for Westbury (Mr. Walters) improved the rights of parents and grandparents and made it possible for regulations to be made to cover those who are at home under a care order. In the case of both Tyra Henry and Jasmine Beckford there was a care order in place; the children were the responsibility of the local authority, yet they slipped through the net. We eagerly await action to implement the remainder of the measures that are provided for in my hon. Friend's Act. Training is fundamental. Initiatives have been taken, but I remain doubtful about the full effect of the Seebohm report, which recommends that all social workers should be generic. Special skills, training and knowledge are fundamental when dealing with cases of child abuse and child neglect. Increased resources have been made available for the personal social services, and inevitably the problems of an ever-increasing elderly population take up more and more time. There should be specially trained and skilled social workers, with supervision and clear line management guidance to deal with cases of child abuse. Training needs to be given to deal with the confusing multiplicity of orders available. A point that emerged from the Kimberley Carlile inquiry was that the power to issue a warrant is not widely recognised. I am pleased that the DHSS responded so swiftly by clarifying the section 40 warrant procedure under the 1933 Act. A comprehensive review of the legislative framework is needed, and much work has been done on that. The White Paper "The Law on Child Care and Family Services" recommends many improvements to the legislation dealing with child protection. It recognises the rights of parents and recommends that the powers of social workers should be clarified and improved. However, the White Paper does not cover adequately the need for medical assessment. A major recommendation in the White Paper is the introduction of an emergency protection order. If there are worries about a child's safety apart from the section 40 warrant the only provision is a place of safety order. That means removing the child from home. Under the emergency protection order, removal would take place when it was reasonable to believe that damage to the child's health or well-being was likely unless the child could immediately be removed from home and kept in a place of safety. It is time limited to eight days and gives greater power to the parents, but it provides for the removal of the child. The important point for the protection of children, for the respect of parental rights and for the use of the power by social workers in my Bill is that it requires the child to be seen, but it expressly does not provide the power to remove the child from the home. Recently, the Family Rights Group's solicitor, Katherine Gieve, wrote about the order. She said:The Bill gives social workers and health visitors power to ensure that a child is seen. It is extraordinary that many children who lost their lives were not seen. All sorts of excuses were given about why the child could not keep an appointment or was not available at the time of contact. The clear power in the Bill will ensure that the child is properly seen, measured, weighed and assessed. It should not be underestimated how difficult it is for a social worker to visit a family and say, "I need to see your child, and I ask you to take the child's clothes off because I must see whether the child is being neglected or injured." The social worker arrives at that home as a visitor. A medical assessment has much broader acceptability. Medical assessments are part of our day-to-day lives. Indeed, we have just had a debate about them. For the most part, child health clinics are not threatening places. Medicals before attending school and throughout a child's life are straightforward, non-provocative occasions. Some people have written to me in response to the Bill asking for all child health assessments to become a statutory requirement. They have suggested that child benefit should hinge on attendance at a child health clinic. I have not been convinced of the merits of that argument. Parents' rights are considered in the Bill. The European Court of Human Rights recently decided that any parent whose access to a child is restricted can challenge that decision. The Cleveland cases have drawn attention to the fact that the parents' position must be considered. However, not only their rights but the traumatic effect of removing a child from the home must be considered. I shall give a quotation from a letter sent by the director of the National Children's Bureau, Ronald Davie, to The Times. He said:"the Family Rights Group's experience suggests that it would be preferable to distinguish clearly the search for evidence of abuse from the need for a child to be removed from a dangerous situation. These two may run side by side, but they may not: a child should not be summarily removed from home in order to find out if there is a risk in being there."
None of us should underestimate how difficult it is to make such judgments. Under the Bill, parents have a right of appeal; it is rather like paying a parking ticket. They must either produce the child for a medical within the required time of three days or appear in the juvenile court or before a magistrate to explain their objections. The specification of a child health clinic, a medical centre or, if necessary, a hospital gives a certain amount of discretion to the person making the order, according to what is likely to be required by way of further tests. Some children may require only a weighing or sighting. For others it may be necessary to have specialist paediatric help to hand, and others may need an X-ray. It is possible to require further assessment if it is necessary. I realise that the inclusion of a health visitor and general practitioner as people who can require an order is breaking new ground. I think that the medical profession is re-evaluating its traditional code of confidentiality, and its relationship with the patient must be questioned in the light of child protection. As long ago as the Maria Colwell inquiry, the GP had a significant part to play. The GP also had a part to play in the Kimberley Carlile inquiry. It is right and proper for the medical profession to reconsider where its first duty must lie when a child's health and welfare are at risk. Similarly, an NSPCC worker is empowered to make the order, but, in my view, it would not be appropriate to include a police officer because, above all, the order will be available for children who are at risk or may be vulnerable, as opposed to a child in specific danger. A child in danger will remain the subject of emergency protection orders or a warrant. I believe that the provision of 72 hours—three days —is a balanced move. A week is too long and 24 hours is too little. It recognises that it is at the time of assessment that a crisis within a family can be precipitated. The Bill has received widespread support. The National Children's Bureau, National Children's Home, the Children's Society, the Association of Directors of Social Services and the British Association of Social Workers have all argued—I would not argue against it—that this should become part of comprehensive reforming legislation for our child care law. They agree that the gap needs to be filled. I should like to quote Jim Harding, the director of child care for the NSPCC. He was a member of the commission of inquiry in the Kimberley Carlile case. He said:"There are many circumstances when the removal from his family of a child at risk may add further crippling emotional damage to the harm already done. There is therefore a conflict of potential risk to the child. The professional judgement needed in the individual case is typically complex and made no easier by the frightening consequences for the child—psychological or physical—of getting it wrong."
I hope that the Minister will find a way to bring forward his legislation at the earliest opportunity and I hope that he will find a way to incorporate this measure, into that legislation. Whether one is concerned about excessive intrusion of workers or about their lack of action, I believe that this small, discreet and specific measure has an important part to play in respecting parents, safeguarding children and adding to the tools necessary for those charged with the responsible work of protecting the young."This Bill will afford greater protection to children without removing them from their parents. Medical examinations and assessment could help provide evidence of child abuse but more importantly could allow for a child who has been abused or neglected to be seen and offered help … The need for a Medical Examination Order was emphasised by the Commission of Inquiry … This child's tragic death might have been avoided had such an order been available to the professional agencies involved. It will offer greater protection to the thousands of children at risk of abuse and neglect in Britain today."
2.23 pm
I know that the House will join me in congratulating my hon. Friend the Member for Surrey, South-West (Mrs. Bottomley) on the manner in which she has spoken to her Bill. The House benefits from her wide experience in social work and as a juvenile court magistrate. She has applied to the preparation and presentation of the Bill the diligence and attention to detail that does her credit.
In 1985 the NSPCC celebrated its centenary. It is sad that 100 years after the society was founded it is still necessary for it to exist. I have the honour to sit on the society's central executive committee, and I therefore see at first hand something of the wide extent of its activities. There has been a good deal of publicity recently about the sexual abuse of children. However, non-sexual, ordinary physical abuse, alas, continues. The society's literature provides details of some horrific cases. The society can provide statistics for the thousands of known cases per year, but how many cases are unknown or undiscovered? A feature of the recent sexual abuse cases is that the publicity produced a number of adults who came forward to give details of their experiences as children—cases of which nothing was known at the time. The extent to which parents sometimes seek help from the society is encouraging, but there are many instances when the society is given information by neighbours who are worried about what may be going on. The society's officers make further inquiries. They call at the home and, if they are allowed access, can perhaps form a view. Possibly it is necessary just to give a little help or advice. The fears may be ill-founded. If the problem is found to be serious, the officers can go to court, obtain a place of safety order, and the child is removed, but what happens if the officers cannot see the children? What happens if they are told repeatedly that the child is ill or is staying with grandparents? The social worker and NSPCC officers are faced with a dilemma—either they apply for a place of safety order on what may be flimsy and second hand evidence, and the child is removed from the home, or they ignore the situation and hope that all is well. There is no middle course. A number of recent cases have demonstrated the clear gap in the law. The Bill seeks to fill it. Neighbours and relatives may be aware of what is happening and be anxious about whether there is child abuse, but may be hesitant to report it because they fear that the child will be taken from the home. Surely it is more likely that these cases will be reported if, as under the Bill's provisions, it will lead simply to examination of the child so that further steps can be taken or fears laid to rest. The Kimberley Carlile inquiry recommended that an assessment order, such as is provided for in the Bill, should be available so that the child can be produced for examination, but not necessarily removed from the home. If that power had existed it might well have avoided some distressing cases, such as those which were the subject of the Cleveland inquiry. I can confirm that the NSPCC warmly welcomes the Bill and the initiative of my hon. Friend the Member for Surrey, South-West in bringing it forward. The NSPCC thinks that an assessment order as provided for in the Bill would be helpful to social workers. We are awaiting the Cleveland report and expect a wide-ranging review of child care law and subsequent legislation to implement it, but that, of necessity, will take time. The Bill could be passed and the powers in it activated rapidly. I hope that the Government will feel able to give it their support. I hope, too, that I have allowed time for my right hon. Friend the Minister for Health to say that that is what he will do.2.27 pm
The answer to the last observation by my hon. Friend the Member for Chislehurst (Mr. Sims) is "just about", but "not very much". I hope that my hon. Friend the Member for Surrey, South-West (Mrs. Bottomley) will accept my apologies because I shall not have time to pay her the full tribute that I would otherwise have paid both to her assiduous pursuit of this matter and her experience in the many activities that give her her expertise.
To avoid my comments being cut off by the ruthless actions of the Chair, the clock, or whatever it may be before I have said much, I shall try to distil my message into some basic points. As my hon. Friend the Member for Surrey, South-West has acknowledged, we have put forward a range of proposals for the widespread reform of child care law because we, too accept the need for reform. As we said when I set up the Cleveland inquiry in July last year, and as we have said a number of times since, we think it right to look again at some of our proposals in the light of the outcome of that inquiry and the inquiries into the Kimberley Carlile and Tyra Henry cases in the intervening period. We do not intend to use this additional information and these additional reports as an excuse for delaying the introduction of legislation. I cannot, for reasons which the whole House understands, give any undertaking about the introduction of any particular Bill at any particular point, but it remains the Government's clear intention to get on with this as soon as possible. We considered a proposal not dissimilar to my hon. Friend's when we were preparing the White Paper. However, we thought that on balance the emergency protection order that we proposed was the right way forward. A number of people support my hon. Friend's view that the proposal or something like it, was suggested in Louis Blom-Cooper's report on one of the child abuse cases. Therefore, I can undertake that we will re-examine the arguments, in the light of my hon. Friend's Bill, today's debate and what emerges from the Cleveland inquiry report as well as the other report, before attempting to reach a final conclusion.It being half-past Two o'clock, the debate stood adjourned.
Private Members'bills
Security Services (Parliamentary Scrutiny) Bill
Not moved.
Planning Permission (Demolition Of Houses) Bill
Order for Second Reading read.
Object.
Objection taken. Second Reading what day'?
On a point of order, Mr. Deputy Speaker. I think that there may have been a mistake. I thought that I heard the Government Whip objecting. I think that he was doing so erroneously, in the belief that the Bill would slow down planning procedures. That is not the intention of the Bill.
Order. I cannot allow the hon. Gentleman to discuss his Bill now. I distinctly heard objections coming from a number of quarters. Second Reading what day?
Friday 17 June.
Second Reading deferred till Friday 17 June.
Hospital Consultants (Transfer And Revision Of Contracts) Bill
Order for Second Reading read.
Object.
Objection taken. Second Reading what day?
No day named.Health And Safety At Work (Tobacco Smoking) Bill
Order for Second Reading read.
Object.
Second Reading what day?
On behalf on the hon. Member concerned, Friday 6 May.
Second Reading deferred till Friday 6 May.
Blacklists (Access To Information) Bill
Order for Second Reading read.
Object.
Objection taken. Second Reading what day?
Friday 6 May.
Second Reading deferred till Friday 6 May.
Abortion (Treatment Of Non-Resident Women) Bill
Not moved.
Scottish Constitution (Referendum) Bill
Order for Second Reading read.
Object.
Objection taken. Second Reading what day?
On behalf of the hon. Member concerned, Friday 6 May.
Second Reading deferred till Friday 6 May.
Betting, Gaming And Lotteries (Amendment) Bill Lords
Order for Second Reading read.
Object.
Objection taken. Second Reading what day?
Friday 6 May. Second Reading deferred till Friday 6 May.
Business Of The House
Ordered,
That, at the sitting on Tuesday 3rd May, the Motion in the name of Mr. John Wakeham relating to the First Scottish Standing Committee may be proceeded with, though opposed, for one and a half hours after it has been entered upon, and if proceedings thereon have not been disposed of at that hour, any Amendments which may have been selected by Mr. Speaker may then be moved, the Question thereon shall be put forthwith, and Mr. Speaker shall then put the Main Question or the Main Question, as amended.—[Mr. Peter Lloyd.]
Coroners Bill Lords
Ordered,
That, in respect of the Coroners Bill [Lords], notices of Amendments, New Clauses and New Schedules to be moved in Committee may be accepted by the Clerks at the Table before the Bill has been read a second time.—[Mr. Peter Lloyd.]
Eastbourne General Hospital
Motion made, and Question proposed, That this House do now adjourn.— [Mr. Peter Lloyd.]
2.32 pm
I welcome the opportunity to draw the attention of the House and the Minister to the number of people on the waiting list at Eastbourne general hospital and the length of time that patients have to wait before seeing a consultant and before an operation can be performed.
This debate is part of a paradox. We all know that spending on the National Health Service this year will be £23 billion—up by more than one third compared with 1979, after allowing for inflation. We know that there are 13,000 more doctors and dentists and 65,000 more nurses working for the National Health Service than there were in 1979. We know, too, that a week ago yesterday nurses were awarded a pay increase averaging 15.3 per cent., backdated to 1 April, and funded in full by the Government—or, perhaps I should say, by the taxpayer. In Eastbourne, phase 2 of our district general hospital will be complete before the end of this year and it will be operational next year. All of that sounds and is—most impressive. In Eastbourne, however, waiting lists have been getting bigger, and waiting times longer. I will compare the figures for December 1979 with those for March 1988, giving the number of patients on the waiting list for our district general hospital without an admission date for the key specialties. For general surgery, the figures are 395 for 1979 and 491 for 1988; ear, nose and throat, 269 in 1979 and 561 in 1988; orthopaedics 518 in 1979 and 1,104 in 1988; ophthalmology, 69 in 1979 and 398 in 1988; oral surgery, 18 in 1979 and 175 in 1988; gynaecology, 363 in 1979 and 777 in 1988. Overall, the number of patients on the waiting list without an admission date has virtually doubled, from 2,006 in 1979 to 3,905 in 1988. The number of patients on the waiting list is only part of the story. As my hon. Friend the Minister knows, the length of time that they have to wait is far more important. The notional waiting time for ophthalmology increased from 25 weeks last year to 39 weeks this year, for gynaecology from 39 weeks last year to 58 weeks this year, and for ear, nose and throat operations it more than doubled from 26 weeks last year to 59 weeks this year. So the position has been getting worse. It is easy to be mesmerised by statistics. The National Health Service exists, however, not to provide figures for Ministers and others to produce, but to heal the sick and, wherever possible, to prevent our people from becoming sick. I shall give two examples of the way in which those statistics actually affect my constituents. In both cases, I have been authorised to give the details to the House. On 11 February this year, Mr. B. wrote to me as follows:On 17 February I wrote to the chairman of our district health authority. The manager of the district general hospital replied on the chairman's behalf on 25 February:"My wife is on the waiting list for a hysterectomy peration. She went to see our GP in January 1987. He made an appointment for her to see Mr. Shardlow at the district general hospital, which she eventually did on 29th June 1987. She was told there was a waiting list of up to two years. My wife is a very patient person, and has been waiting now for almost eight months. Unlike my wife, I am not patient, and resent the fact that the quality of her life is not as it should be. In desperation, I am writing to you, hoping that in some way you can suggest something more that I can do."
On I March I wrote to my right hon. Friend the Minister for Health. On 24 March, my hon. Friend the Under-Secretary of State for Health and Social Security, my hon. Friend the Member for Derbyshire, South (Mrs.Currie), who is to reply to this debate, explained that Eastbourne health authority had been allocated £155,000 from the waiting lists fund, which would mean that an extra 150 gynaecological operations, mostly hysterectomies, and 250 extra ear, nose and throat operations could be performed. I sent a copy of my hon. Friend's letter to the chairman of our district health authority, who replied three days ago, on 26 April, in the following terms:"I have discussed this with Mr. Shardlow, who is the consultant responsible for Mrs. B's care. He has confirmed that Mr. B's account of the case is accurate and that there is a wait of approximately two years for non-urgent operations."
I ask my hon. Friend to note the words,"You ask me about Mrs. Irene Barber. Regrettably, all that she says in her letter to you is correct. The earliest that it is possible to open the temporary surgical unit is the beginning of October. That unit will certainly remove a number of people from the waiting lists, but whether Mrs. Barber will be fortunate, I am unable to say, since this is a decision to be made by the consultant nearer the time. The best estimate I can give of the date on which Mrs. Barber will have her hysterectomy operation is not less than six months from now and not more than 18 months from now."
Mrs. Barber was put on the waiting list for a hysterectomy operation on 29 June 1987–10 months ago today. Even if her operation is carried out midway between the dates given to me by the chairman of the district health authority, she will have been waiting for 22 months. I advise my hon. Friend that for a woman, aged 72, to have to wait 22 months for a hysterectomy operation is unacceptable to her Member of Parliament. I hope that my hon. Friend will say that it is unacceptable to her, too. I wish to give another example to the House. Mrs. G wrote to me on 22 March:"not less than six months from now and not more than 18 months from now."
30 years younger than Mrs. B—"I am 42"—
I wrote to Mrs. G's consultant on 30 March in the following terms:"and need a hysterectomy. I have been told the waiting list for this is two years. As I am in a lot of pain, amongst other symptoms, I am absolutely appalled at this terribly long waiting list. I would ask for your help, please."
The consultant replied on 8 April:"I spoke to your patient and my constituent Mrs. G, on the telephone this afternoon. She tells me that you saw her earlier this month, and that she would have to wait for two years for her hysterectomy. Is that really so, please?"
I repeat that that letter was dated 8 April. We have the statistics that matter much, we have the patients who matter more and we have my hon. Friend the Minister who, mercifully, has the power to bring about an improvement in a situation that certainly I, and I suspect she, believe to be unacceptable. The Eastbourne health authority has an outstanding chairman and general manager. On the basis of figures that I have seen, it is one of the most efficient health authorities in the country. It is not wasting money. The problem is that this year it is receiving only 85 per cent. of the amount to which, under the Government's RAWP formula, it is entitled. The revenue cash allocation for the current year is £47·4 million—£47 million short. Mrs. Barber and Mrs. Grayling and the growing numbers on our waiting lists are a direct consequence of giving to Eastbourne only 85p in every pound that the Government say that it needs. The regional health authority is proposing that Eastbourne should receive 96 per cent. of its RAWP target in 1994—so, even then, it will not receive the amount which, according to the Government, it should receive. It needs a supplementary allocation from a supplementary waiting list fund. That would at least halt the rise in the length of time that my constituents are having to wait for operations. My hon. Friend knows that the whole of my constituency and parts of the constituencies of my hon. Friends the Member for Wealden (Sir G. Johnson Smith), for Lewes (Mr. Rathbone) and for Bexhill and Battle (Mr. Wardle) are served by the Eastbourne health authority. Each of my hon. Friends has an engagement in his constituency today. Although they cannot be here, each has authorised me to say that I speak on behalf of all four of us. Even if my hon. Friend the Minister cannot this afternoon announce any specific measures to help to resolve a problem that is becoming worse all the time, I hope that she will agree to consider very carefully the facts that have been drawn to her attention in this debate, and to which her officials will have drawn her attention since they first knew a week ago that the debate would take place. If my hon. Friend's constituents were faced with the same problems as those that face my constituents, I know that she, too, would raise the matter with the appropriate Minister. I remind her of the advice given in St. Luke's gospel:"Overall, the waiting time for the person who comes up when their name is called forward is about two years for a hysterectomy.
Today's debate is only the start. My hon. Friends and I will continue to raise these matters with the Minister of Health and with my hon. Friend until justice is done for the people of Eastbourne."Though he will not rise and give him, because he is his friend, yet because of his importunity he will rise and give him."
2.49 pm
I congratulate my hon. Friend the Member for Eastbourne (Mr. Gow) on securing the debate. Of course, I am aware of his interest in and concerns about health services in his constituency. My right hon. Friend the Minister for Health and I met my hon. Friend and the other hon. Members whom he mentioned—my hon. Friends the Members for Lewes (Mr. Rathbone), for Bexhill and Battle (Mr. Wardell), and for Wealden (Sir G. Johnson Smith)—on 10 February, and we had a most useful discussion.
Eastbourne health authority serves a population of around 180,000, but more than 25 per cent. of those people are over 65. From 1983–86, there was an increase of 10·5 per cent. in the number of people aged over 85. The overall population is also rising. Between 1981 and 1986 Eastbourne's population increased by more than 30,000. So the population is increasing and the average age is rising. We are aware of the pressures—particularly the over-85s—and have been studying them in the light of the resource allocation working party. One of the recommendations in the National Health Service management board's interim report on RAWP is that an over-85 age band be introduced into the national calculations by which we allocate resources. That will particularly benefit South-East Thames region, which covers my hon. Friend's constituency. In fact, in setting targets for districts in this current year, 1988–89, South-East Thames regional health authority incorporated the 85-plus age band in its allocation formula to the districts, and that helped districts such as Eastbourne. Our national review analysis research on the issue is complete. We are considering recommendations, and shall shortly make announcements. Partly as a response to demographic pressures, the funding of Eastbourne health authority has been substantially increased. In 1982, when the health authority was created, its cash allocation was £34|·5 million. In addition, £2·3 million was allocated for smaller capital schemes within the district. The initial money is the basis of funding and is not the whole story. Last year, 1987–88, the initial cash allocation had jumped to £41·8 million. On top of that, there was £3·2 million for smaller capital schemes. Cost improvement schemes since 1984–85 have also improved, through better efficiency, with a substantial movement of nearly £2 million within the authority to improve patient care. There has also been the sale of land and surplus property since 1982–83, which has provided the district with £4·7 million on top of that. In these ways, we expect the health authority to make itself more efficient and use the cash released for improved patient care. In 1987–88, the year just ended, adding together all the funding elements for that year, total funding stood at £46·6 million, which is clearly a substantial increase—25 per cent.—over 1982. This year's initial allocation is a further increase of 13 per cent., up to the £47·4 million that my hon. Friend mentioned. That increase is clearly much more than inflation, and it is the highest increase of all health authorities in South-East Thames region. On the capital side, since 1982, a total of almost £40 million has been allocated to Eastbourne, the major share of which is for the new district general hospital phase II, which is costing £16·6 million. There has also been refurbishment at Hellingly—I gather that the health authority has some interesting ideas about developments there—plus a new chiropody school that cost almost £1 million, and two health centres. The Forest Row health centre is costing nearly £400,000, and the Seaford health centre, which is costing £1·44 million, was opened by my noble Friend Lord Skelmersdale last year. There are considerable developments going on. That achievement is translated into more staff. From 1982–86, front line staff increased by 75 whole-time equivalents. I note with interest that there was a substantial rise in the number of general practitioners, dentists and opticians. That should have been sufficient to keep pace with demographic change and many of the increasing demands placed on them. Most of all, it means that far more patients are being treated in Eastbourne. I am sure that my hon. Friend is aware of the figures. In 1982, there were 22,500 in-patients. In 1986, the latest year for which figures are available, there were 24,800—an increase of over 10 per cent. For day cases, the increase was even larger—34 per cent. Overall, there has been a small reduction in out-patient attendances, but that is largely due to a change in obstetric attendances, which, again, is a feature of the demography of the area. But, for example, there has been a rise of over 14 per cent. in the number of gynaecological out-patient attendances. Again, to look at where things are going well, there has been a 25 per cent. increase in general surgery in-patients. Clearly, some of the consultants and staff are working harder and are enabled thereby to increase their productivity. One of the calculations that it is possible to do on this data, and which I have had done in the week since the debate was called, which shows day cases as a percentage of all in-patients and day cases, demonstrates that there is considerable variation between specialities in this district. Day case work is valuable. It tends to increase throughput faster than costs, and patients like it. In 1986 in general medicine, general surgery and opthalmology the district was among or close to the bottom 10 per cent. of districts in the entire country. Yet for trauma, orthopaedic surgery and gynaecology it was in the top 10 per cent. of districts. It may be, therefore, that some of the consultants need to share their worthwhile experiences with their colleagues. I met the district general manager, Mr. Sully, and the chairman, Mr. Platt, of the Eastbourne district health authority early this morning. They came to my office here at the House of Commons at my request. I am deeply grateful to them for giving me so much of their time today and I am satisfied that they are aware of my concerns and those of my hon. Friend. I do not feel that all the difficulties are due to funding, for, as I have indicated, increased funding has been relatively generous whereas the level of activity around the district is distinctly variable. My hon. Friend has drawn attention to the waiting lists and I told him that we share his anxiety. The picture is possibly not as black as painted. For example, the numbers on the longest list, trauma and orthopaedics, were starting to come down during 1987, partly because the district received £110,000 from the waiting list initiative last year and partly because it managed to do some 94 additional hip replacement operations in six months. Nevertheless, my hon. Friend is right that other lists remain stubbornly high and are tending to increase. This year Eastbourne's main priority is to reduce its gynaecology and ENT waiting lists. I was interested to hear what my hon. Friend said about his constituents, Mrs. Barber and Mrs. Grayling. If he would be kind enough to allow me, I shall look again at the details of those cases. He will realise that the decision when to operate is not mine but their clinicians'. That £155,000 that we have made available to district health authorities is available now and we do not expect it to be held over until October or any other arbitrary date. We expect it to be used promptly. I noticed that the health authority issued a press statement on Thursday 21 April about a committee of inquiry into services for women in the area. The committee has now reported to the health authority on problems in maternity and gynaecological services. Several recommendations have been made to the health authority which may include the appointment of an additional specialist and the realignment of clinical responsibilities between consultants. In the light of what my hon. Friend said, I am surprised that the health authority has asked its general manager to report back in July. It seems entirely right that it should acquire a sense of urgency about this matter and report back sooner. Perhaps it cannot report back in May, but I would expect it to deal with the issue at the June meeting and I should like to know if it does not. My hon. Friend should not assume that because patients have no booked date they will never be seen or will be seen only by chance. I obtained the latest figures for the quarter June to September 1987 and I established that Eastbourne health authority admitted 1,696 cases from the waiting list to the hospitals who did not have booked admission dates. The median waiting time for these cases was 10 weeks. Therefore, it is not entirely a matter of gloom. I am also told that in Eastbourne the September 1987 figures, again the latest available, show that 95 per cent. of those admitted as in-patients or day patients were admitted within 12 months, which is roughly the same as the national average. That suggests, as do some of the other figures that my hon. Friend mentioned, that a list of two years is both most unusual in this district and most unacceptable to those concerned. I think that I have made my remarks about gynaecology clear to him and the district health authority, and we expect action on that. Some of these difficulties were made much worse last year by the temporary closure of half the operating theatres for three months during the summer. They were very much in need of upgrading and redecorating. Nevertheless, I take the view that arrangements should have been made for as many patients as possible to be treated elsewhere. It is not good enough to close theatres, keep the staff on and leave patients waiting. I gather that some 300 waiting list cases were lost during that period. I have taken another close look at the figures for ophthalmology, which is one of the bad waiting lists. Although Eastbourne's throughput figures are generally good, they are only around average in gynaecology and among the lowest 20 per cent. in the country in ophthalmology. If in ophthalmology the district were to reduce the length of time that beds are left empty between patients from six days to even the regional average of three days, which is still too high, and if in the same specialism the throughput was increased from its low level of barely 75 per cent. of the national average, a lot more patients would be seen and perhaps a lot more patients would be able to see. My calculation is that between 250 and 300 more ophthalmology patients would be attended to, which would virtually clear the waiting list. I am told that they are all busy doing out-patient clinics. I have suggested to the health authority that it needs to review its links between its general practitioners, clinical assistants, out-patient clinics, in-patient work and day case work in a speciality such as ophthalmology to ensure that people are not merely seen and sent away without treatment. The district is doing other things which are helping to develop services in other important areas. To be fair to it, we should note them. An extra consultant paediatrician will shortly be appointed. Staffing levels for midwives and those who care for the elderly will be improved. Temporary out-patient clinics in, for example, rheumatology, are to be made permanent and more homes in the community for people with mental handicaps will be opened. I have indicated my concern, which I hope my hon. Friend recognises. I am giving some thought to how districts that face rapid increases in the number of very old people in their areas during the next few years should manage their affairs to avoid a build-up of waiting lists. I have therefore asked my officials to consider whether a study would be useful, perhaps building on expertise elsewhere and possibly looking at several districts on the south coast, including Eastbourne. If we decide to proceed on those lines, I hope that my hon. Friend could give such a study his full support. I put the same point to the chairman this morning. He said that the authority would co-operate enthusiastically with such a study, which would be of wide interest. Service provision in the district will be invigorated when the second phase of the district general hospital becomes operational next year. It will provide another 350 beds for elderly psychiatric patients and general medical patients, and there is to be a 120-place psychiatric day hospital. More money will therefore go to Eastbourne in the coming years to help run services from this major capital development.Question put and agreed to.
Adjourned accordingly at two minutes past Three o'clock till Tuesday 3 May, pursuant to Resolution of the House of 25 March.