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Volume 175: debated on Wednesday 27 June 1990

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

6.—(1) Mr. Speaker shall put forthwith the Question on any Motion made by a Minister of the Crown for the appointment and quorum of a Committee to draw up Reasons.

(2) Such a Committee shall report before the conclusion of the sitting at which it is appointed.

7.—(1) In this paragraph "the proceedings" means proceedings on Consideration of Lords Amendments or on any further Message from the Lords on the Bill, on the appointment and quorum of a Committee to draw up Reasons and the Report of such a Committee.

(2) Paragraph (1) of Standing Order No. 14 (Exempted business) shall apply to the proceedings.

(3) No dilatory Motion with respect to, or in the course of, the proceedings shall be made except by a member of the Government, and the Question on any such Motion shall be put forthwith.

(4) If the proceedings are interrupted by a Motion for the Adjournment of the House under Standing Order No. 20 (Adjournment on specific and important matter that should have urgent consideration) a period equal to the duration of the proceedings on the Motion shall be added to the period at the end of which the proceedings are to be brought to a conclusion.

On a point of order, Mr. Speaker. I am sorry to interrupt these important proceedings, but I hope that you will understand that this is a matter directly related to your responsibilities and the rights of the House of Commons.

You will be aware, Mr. Speaker, that, following the European Community summit in Dublin yesterday, a declaration of 40 pages was issued by the Heads of Government. It anticipated that the Prime Minister would be making a statement about it tomorrow. Understandably a number of right hon. and hon. Members, including myself, have sought to obtain a copy of the document, and naturally we went first to the Library, which is always extremely helpful and forthcoming on these matters. We were given to understand that the document would not be available in the Library until tomorrow because the Foreign Office had refused to supply it, on the directions of 10 Downing street.

We made our own efforts to obtain a copy and have done so through the office of the European Communities. I understand that copies are now in the Library, because the Library told the Foreign Office that it would seek to obtain the document elsewhere if the Foreign Office did not supply it.

Clearly, if that is true, it is a deliberate attempt by the Prime Minister's office to withhold from Parliament material that would enable Members properly to interrogate the Prime Minister tomorrow. It would be wholly unacceptable if the Library, which provides a valuable service to all right hon. and hon. Members, whatever their party, were prevented from providing that service, and I should therefore be most grateful if you would look into the matter.

That is not strictly a matter for me, but if the Library is prepared to produce these documents that is certainly a matter for the Library and for me. The provision of documents of this kind is a matter for the Government. I am sure that what the right hon. Gentleman has said will have been heard by the Leader of the House.

The motion proposes eight hours of debate on the Bill. The House will share my pleasure at the fact that we can anticipate that by midnight we will have completed discussions on this most important Bill. We are approaching the stage where we are about to start on the important process of implementing the reforms that the Government sketched out some time ago in a White Paper.

Obviously, no Government introduce such a supplemental timetable motion lightly. Hon. Members will agree that it is helpful to have some limit on our debates so that they can be ordered and we can conclude our discussions at an acceptable hour.

I have attempted to discuss the timetabling through the usual channels. I will say nothing other than it is unfortunate that the hon. Member for Livingston (Mr. Cook) declined to discuss with me at all the basis on which we might proceed. That approach to parliamentary procedure shows that perhaps the hon. Gentleman expects to stay in opposition for rather longer than he publicly implies. Anyone contemplating government knows the importance of having discussions through the usual channels on matters of this kind. No doubt that follows from the way in which proceedings were conducted on Report. The House will remember that, after a comparatively peaceful and reasonable Committee stage, we suddenly had an all-night sitting on Report, with inordinately long debates on some amendments so that we covered only five amendments in nearly 18 hours.

In case anyone should argue that the Bill will not have had adequate consideration by midnight, I remind the House that in Committee the Bill received 109 hours of detailed consideration. More than 800 amendments were tabled, full discussion took place, and some amendments were made to the Bill. There was more detailed scrutiny in the other place where the Bill had eight days in Committee and four days on Report. More than 800 amendments were put before the other place and nearly 100 hours of further consideration took place there.

As a result, the Bill has quite correctly taken up an enormous amount of parliamentary time during the winter. I am told that the two Houses have given more consideration to the Bill than they did to, for example, the Water Act 1989 which we all remember was a Bill of equal political controversy. This one is even more important. In case it is argued that all that debate has led to inflexibility by the Government, I can tell the House that throughout the discussions we have responded to debate and made important amendments. I am told that in 24 policy areas substantive change has been made in response to parliamentary and other discussion.

Hon. Members may have noticed that 177 of the amendments before us are Government amendments introduced in another place. That sounds like a formidable amount of last-minute change, but it should not cause the House undue alarm because many of the amendments are drafting changes and almost without exception the others fulfil undertakings given by Ministers in response to pressure from hon. Members. Those not in response to undertakings are the result of the Government's introducing new material which received a general welcome. I do not think that they are likely to give rise to controversy. For example, we are about to consider statutory consultation on the creation of national health service trusts.

We have incorporated provisions for a procedure on community care complaints, and the most important matter that we shall discuss in the time laid down by the motion is the fact that we have paved the way for a new clinical standards advisory group. On that I reached an important agreement with the presidents of the Royal Colleges of Medicine and the Royal Colleges of Nursing and the associated statutory bodies. I think that the climate in the health service has substantially improved since we reached that agreement with the leaders of the professions not only on the detail of the reforms, but on the need to make sure that we have a new mechanism which will keep under constant scrutiny the standards of clinical care given to patients. That falls within the remit of the debate.

Those are significant improvements. We have discussed almost all of them at great length on previous occasions and we shall properly give them a final eight hours of consideration today.

I believe that eight hours will give the House ample time to consider the amendments. There is not a great deal of genuine controversy on the amendment paper, although one important matter has been trailed which we shall undoubtedly reach later this evening. There is ample time to talk about ring fencing and other matters. There is little else that anyone will want to vote on or argue about. Therefore, I hope that the timetable motion is generally acceptable to the House.

4.10 pm

In opposing the timetable motion, may I say that the Secretary of State once again has shown his ineffable imperviousness to criticisms of his measure. During his address he was unwise enough to say that the agreement on clinical standards with the heads of the royal colleges demonstrated, if I remember his words correctly, the improved attitude within the health service to his reforms. Those royal colleges are precisely the same royal colleges which, in a unique document on which they achieved joint agreement, recorded their view that

"there is no evidence that the changes overall will improve the standard of care, will improve access to care, will improve choice of care or will improve the cost-effectiveness of care."
That is the statement which the Secretary of State is desperately obliged to claim in support of the improved climate for his reforms.

The Secretary of State was good enough to make public the discussions that have taken place through the usual channels about whether there should be discussions about the timetable motion. Thereby he releases me from any obligation to maintain the confidentiality of the discussions. Therefore, I share with the House what I said to the Secretary of State's office. We refused to discuss tonight's timetable motion with the Secretary of State because throughout the Committee proceedings we discussed through the usual channels sensible arrangements for debating and timetabling the Bill. Those arrangements were in the interests of both the members of the Committee and the staff and patients of the health service who thereby secured adequate debate on the matters of importance in the Bill. The Secretary of State knows full well why I now decline to enter into any such discussions. Our discussions with him on the procedure in Committee were misrepresented by him as agreement to the principle of the Bill.

I am interested that the Secretary of State now tells the House that an enormous amount of time has been spent on considering the Bill. It was only back in March that he told the British Medical Journal that he was impressed by the smooth and rapid progress of the Bill. At that stage there was no suggestion that the Bill required guillotining. On the contrary, he cited the speed with which the House disposed of the Bill as a sign that he was winning the arguments.

The Secretary of State suggested that his motion will be helpful to the House. In this regard, as in so many others, I beg to differ with the Secretary of State. On Monday night, when the messenger brought from the House of Lords the amendments that we are to debate this afternoon, he passed along a corridor which contains a series of paintings depicting the triumph of Parliament in the civil war—the triumph of the rights of the House over arbitrary government and the triumph of the freedom of the House to decide for itself what issues it will debate and vote on. If King Charles I were capable of putting his head back on and returning to the Chamber, he would be astonished at the powers that the present Administration exercise over the Commons.

The Prime Minister and the Patronage Secretary exercise powers over this House of which King Charles could only dream. As my hon. Friends will be aware, King Charles's misfortune was that he had to deal with a Parliament of free men, not pressed by party faction, bribed by patronage from No. 10 or cowed by the threat of a row from the hon. Member for Derby, North (Mr. Knight). It was a Parliament of Members who asserted the rights of this House for the people who sent them here.

The most remarkable feature of the proceedings is not that we are invited to dispose of 24 groups of amendments in seven hours after the debate on the timetable motion, which gives us just about one vote per group of amendments. We are used to the Government treating the House with contempt. This is the same ministerial team that on Report invited the House to dispose of 100 Government amendments in a single block vote, thus giving a wholly new context to the term "block vote." It is therefore no surprise that we should be faced with such a motion.

The real surprise would be if the Opposition were to find a single Conservative Member of Parliament voting with them tonight; it would be a surprise if any Government Back Bencher were prepared to vote for the rights of the House against the Government's proposals and had the courage to defend them without the protection of the guillotine.

The hon. Member for Harlow (Mr. Hayes) is taking a close interest in the proceedings. Let me tell him about the extent to which Ministers assume that they can use him and his hon. Friends as rubber stamps. Let me outline the timetable for the rest of the week. Tomorrow the House of Lords expects to receive the results of our debate. The other place is expected to reach a conclusion tomorrow. The press has been briefed to expect Royal Assent to the Bill on Friday. Tonight the House of Commons is faced with considering 187 amendments—but, no matter, the press has been confidently told that in 48 hours the Bill will become law. That is the real reason for the timetable motion; that is why the House has to consider the amendments and reach a conclusion by midnight. It is not because the Secretary of State is afraid that he will turn into a pumpkin and be towed away by 12 white mice at midnight, nor is it because he is frightened that I might warm to my theme, get carried away by the points that I want to make and speak for another two hours during the proceedings.

The reason why the Government have to get the proceedings concluded by midnight is that they have to get the measure back to the House of Lords before it rises tonight. The reason for guillotining our proceedings on the amendments passed by their Lordships is solely to allow their Lordships to go to bed at midnight.

If the hon. Gentleman wishes to intervene, I shall be happy to allow him to do so. If he does not, I shall not give way to him.

I am amazed to hear the hon. Gentleman talk about block votes with the eloquence of Satan denouncing sin. We have debated the Bill at considerable length. There were tremendous contributions from both sides, particularly the Government side, in Committee. That is most unusual. [Interruption.] Yes, it is most unusual. It has made this measure much better than other measures that we have considered in the past. It has been properly debated and discussed. There is not a great deal to argue about. There will be a few little skirmishes on ring fencing, but the fact is that the overwhelming majority of the Bill has been accepted by Conservative Members and by the medical profession.

The hon. Gentleman did his best in Committee with a fairly weak case. However, most of the arguments were put forward by my hon. Friends. Nothing much happened on the Opposition side. Therefore, they felt so horrendously guilty about it that they had to keep us up all night to show their trade union friends that they were doing something. Now we are having this nonsensical debate. The hon. Gentleman did not consult my right hon. and learned Friend the Secretary of State for Health about the guillotine motion because he had not thought out his arguments on it. Judging by his speech, he has not even yet made up his mind.

I hope that the hon. Gentleman's intervention will at least have served the purpose of sparing the House yet another speech from the hon. Gentleman. I must, however, take up one point that he made during that stream of consciousness. Some of my hon. Friends will have noted it; it is thoroughly revealing of the difficulty that faces us in getting the Administration to believe that there are people in this country who oppose the measure. The hon. Gentleman said that the medical profession now accept the proposals.

Only today, at the British Medical Association conference, another major campaign was launched by the medical profession against the very matters that we are discussing. Does any Conservative Member ever listen to anything that is said by people outside this Chamber?

One can confidently predict that, as a result of the motion, a number of Lords amendments will not be debated. For instance, Lords amendments Nos. 111 to 114 are the third last group on the selection list. They have not a hope of being reached. They are, Mr. Speaker, among the amendments that you will almost certainly be called upon to put to the House forthwith at midnight. The House will then have to vote on those amendments, along with all the other outstanding amendments—in one single vote. We shall not only not debate them; we shall not vote upon them separately.

Lords amendments Nos. 111 to 114 provide that at least one member of a health authority shall represent the universities and teaching schools in that authority's area. The Secretary of State will be aware that the Opposition have tabled an amendment to build on that precedent and to require that one other member of the health authority should also be a member of the local authority for that district or region. It tackles one of the greatest perversities of the Bill, which purports to expand services to the community while at the same time booting off the health authorities the last remaining representatives of the very councils that provide those services in the community.

We want to hear from the Secretary of State whom he intends to put on the health authorities in their place. Will the new representatives be like the new chair of South-West regional health authority, who celebrated his recent appointment by writing to every member of the staff telling them that he has a lot to learn about what the NHS does and offering a holiday for two in Amsterdam for the best explanation in 50 words? The people whom we want to serve on health authorities are people who know more than can be said in 50 words about the business of the NHS. We want people who are committed to keeping the NHS a public service. I warn the Secretary of State that if, this autumn, he does not appoint such people to the health authorities, the Labour Government, when they come to power, will not be bound by those appointments.

Lords amendment No. 111 raises matters of controversy on the Labour Benches. But, in fairness to the Secretary of State, I remind the House that some of the measures before us tonight apparently are matters of controversy on the Treasury Bench. I was dumbfounded—almost struck dumb—by his claim that there are few items of genuine controversy before us tonight. We have before us tonight no fewer than five Government motions to disagree with Lords amendments.

The most perverse of those would strike out the ring fencing of community care required in Lords amendment No. 70. The House will certainly regard that as a matter of major controversy. I should point out, therefore, that the motion that we are invited to pass tonight prescribes that if we disagree with the Lords on that amendment and send it back to be debated tomorrow and if tomorrow the Lords decline to be persuaded by our disagreement and send it back to us, we shall have precisely one hour in which to dispose of that second message from the Lords and any other message that we may receive from them.

The Secretary of State can be forgiven for wanting to get that debate over quickly. After all, it concerns an issue on which he stands entirely alone. Sir Roy Griffiths recommended ring fencing and the Select Committee concluded unanimously in favour of ring fencing. Every voluntary organisation that has commented on it has supported ring fencing, and 97 per cent. of directors of social services have demanded ring fencing. Even the proprietors of private residential care homes are terrified that the local authorities will not have the resources that they will require if there is no ring fencing.

Yet now, at this late stage in our proceedings on the Bill, we once again find the Secretary of State standing alone, convinced that everybody but him is wrong. Such defiance of all informed opinion gives the Secretary of State a heroic stature. He stands alone upon a peak in Richmond terrace. Like stout Cortez, he probably stands in silence, too, because I can make one prediction with confidence: if the timetable motion is passed, we shall not have time to debate all five Government motions to disagree with the Lords amendments.

I am sure that it has not escaped the hon. Gentleman's attention that, when stout Cortez stood silent on that peak, he had conquered the terrain on which he stood.

I am most grateful to the hon. Gentleman for convincing the House that at least one other hon. Member has read Keats.

As I was about to say, if the motion is passed, the House will certainly not debate all five Government motions. At midnight, Back-Bench Members will be invited to vote down the relevant Lords amendments without even hearing why the Government want them to do that. After that is over, my hon. Friends and I will go on a reasons committee to approve the reasons why the House disagrees with the Lords amendments. That will probably be the first time that any hon. Member hears what those reasons are.

Does the hon. Gentleman agree that, while he is sounding indignant about constitutional impropriety, he appears to be working to ensure that we do not actually discuss the Lords amendments, because he has taken a quarter of an hour out of the allotted eight hours expostulating rage about the inadequacy of time? When the hon. Gentleman concludes his remarks, we will embark on a debate on consultation on NHS trusts, on which subject he used five and a half hours on Report, when he first got into the macho "Let's liven it up" opposition that he did not previously display. Will the hon. Gentleman please allow us to get on to the substance of the issue rather than go over old ground again?

The Secretary of State helpfully brings me to my next point. He is perfectly correct. The first amendment is a grudging concession to my two-hour speech on Report, because, at long last, it would write into the Bill a requirement that regional health authorities must consult on opt-out proposals. That is welcome as far as it goes. The problem is that, although it obliges the regions to consult, it does not oblige the Secretary of State to pay any attention to the results of those consultations. Why? It is because every ballot and every opinion poll on this matter has shown that the right hon. and learned Gentleman cannot sell the idea that patients will get a better health service if local hospitals go it alone. The Secretary of State will never persuade the people who need the health service that a more commercial health service will be a more caring health service.

The Secretary of State knows that my hon. Friends and I have tabled a modest amendment that will require him not to make an order for opt-out unless the consultation for which the Bill provides reveals substantial support for opt-out.

My hon. Friend the Member for Peckham (Ms. Harman) has a fine speech ready on the issue. She has been working on it for the three months since the Bill was considered on Report. I shall startle my hon. Friend by saying that I am willing to forgo hearing her speech. I am even willing to forgo the exquisite entertainment of hearing the Secretary of State explain how he can square an order for consultation with freedom for him not to be bound by that consultation. I shall forgo all that and offer the Secretary of State a deal. We will drop our amendment if he will drop his five motions to disagree with the Lords amendments. If he does that, we can conclude the business inside two hours flat, and we could all go off to dinner. To tempt the Secretary of State, let me say that I shall buy the beer. The right hon. and learned Gentleman cannot say, "You will vote down the five Lords amendments, and you will finish that by midnight." I note the wider irony of our proceedings. I cannot resist it.

I would probably be out of order, Mr. Speaker, if I made a speech without giving way to the hon. Gentleman.

So that the nation and the House may get the hon. Gentleman's indignation into some perspective, is he any relation to the Mr. R. Cook who represented Edinburgh, Central and voted five times on 20 July 1976 to guillotine five separate Bills?

Yes, I plead guilty to that charge. As the hon. Gentleman has raised that point—it is not a wildly original point as it has been made in every guillotine debate of this Session—I shall make three points in response. I voted for the five guillotine motions on measures that were all in the manifesto and electoral address on which I stood. We are debating a motion on a Bill of which there was not a hint in the manifesto or electoral address on which the hon. Member for Pembroke (Mr. Bennett) stood. Secondly, the 1974–79 Parliament approved 11 motions to guillotine 11 Bills, but since 1987 the Government have guillotined 12 Bills. Thirdly, if the hon. Gentleman checks, he will find that those guillotine motions did not apply to Lords amendments. There were no guillotine motions on Lords amendments until 1983, under the Administration which he purports to support.

As my hon. Friend says, a rugby score.

There is a wider irony about our proceedings tonight. The haste of our proceedings in the House this week conflicts with the collapse of the Secretary of State's timetable for his reforms in the world outside, where all his bluster cannot drown the noise of squealing brakes. When the Secretary of State produced the White Paper, we were told that by April health managers would be shopping round Britain for the best buy in, to use one of his favourite phrases, an all-singing, all-dancing internal market. Those same health managers have been firmly told that in April they must stick so closely to existing referral patterns that no one will notice that anything has changed. The problem with the Secretary of State is not that he cannot get his reforms to work by April but that the Prime Minister is terrified that he might get them to work before the next general election.

Here I come to the appropriate final thought for the debate, which puts in context the motion to curtail our democratic rights. As the Bill ends its passage through Parliament, it is even more unpopular with the public than when it began. When the Prime Minister launched on "Panorama" the review that led to the Bill, she said:
"When we are ready, we shall come forward with our proposals for consultation. Should they meet with what people want, we will then translate them into legislation."
I must have nodded off through the consultation period.

The proposals in the Bill certainly do not meet what people want. The Bill has never been opposed by fewer than four votes to one in every opinion poll. Tonight, the Secretary of State will get his motion; he will get his Bill by midnight; and he will get Royal Assent on Friday. But then his troubles start because the debate leaves this place, the one place in Britain where he can find a majority for his proposals, and goes out into the country, where it has lost in every ballot that has been held. There will be no guillotine motion to protect the right hon. and learned Gentleman, no Whips to dragoon the voters and not even the hon. Member for Pembroke to egg him on with helpful reflections from Hansard. There will be only him and us. We shall pursue him around the country. We shall treat every consultation on opt-out as though it were a by-election. We shall hang the reforms round the necks of himself and his colleagues.

It is fitting that the Bill ends its proceedings with this squalid motion because it was introduced without any democratic mandate. The electorate, who were denied an opportunity to express a view at the last general election, will take their revenge at the next general election, not just to put the right hon. and learned Gentleman into opposition but to vote for a publicly funded, publicly managed health service run by local people accountable to local communities. That is the health service we believe in, and that is the health service that we shall create after this Bill is repealed.

4.33 pm

I was surprised by the disingenuous way in which the Secretary of State introduced the motion. He said that the House will be pleased to have completed discussion on the Bill by midnight. He knows quite well that Labour Members are anything but pleased about completing discussion by midnight. We want to have full and proper discussion.

The Secretary of State was wrong when he said that there had been what he called more detailed scrutiny in the House of Lords. The point is that the guillotine motion will not allow us to discuss the House of Lords amendments fully. That is what is wrong with the motion. By refusing to allow us to discuss these important amendments properly, he is insulting members of the House of Lords and he is guilty of failing to allow this House full and proper discussion of crucial amendments.

The major issues in the Bill are about both health services and community care. I have no doubt what will be sacrificed by the guillotine. Health services are important and have the backing of pressure groups, the royal colleges and, not least, the suffering patients, but on the whole the Government neglect community care. Certainly we shall not have an adequate opportunity to discuss that aspect.

The Secretary of State is failing to ensure that the 6 million people—according to the Office of Population Censuses and Surveys—who need community care receive proper consideration in the House. There are many disabled people and many more millions of old people who live alone or are looked after by relatives who themselves may be disabled or old. They will not be given the consideration that we should give them. I hope that, within the limited confines of the debate, we shall be able to have adequate discussions about disabled and old people who need community care.

We shall probably discuss the important issue of ring fencing. I remind the Secretary of State that, on the general timetable, it is illuminating to remember the build-up to the Bill. In March 1988, Sir Roy Griffiths published his report on community care. Twenty months later, after a great deal of pressure, the Government introduced their proposals in the White Paper. Only one week later, the Minister introduced the Bill. It is outrageous to rush these matters without proper discussion. The same is happening again tonight.

This is an enabling Bill and will give local authorities the opportunity to act in certain ways to help disabled people through community care. If the provision is poor, as it will be, the Secretary of State will be able to blame local authorities rather than the Government. That is the clever twist in the Government's handling of the Bill. The Secretary of State may say, "There they go, those terrible local authorities, falling down on the job, and here am I, a concerned Secretary of State anxious to help, but I cannot control the town halls," while not giving them enough money, denuding them of resources and denying them the cash to look after disabled people and old people. That is the trick that he will play. He will not even allow us to discuss those issues tonight. That is deplorable.

I have heard a rumour—it is only a rumour—that the Government intend to overturn the Lords amendments which ensure that people who run homes for those with a mental handicap must declare criminal convictions. If it is true, it is shocking. The idea that Ministers can allow crooks, thieves and possibly sexual molesters to take charge of those homes without declaring their criminal background is outrageous.

The Government, understandably, provide care for children. They say that they regard the welfare of children as important. But what about the welfare of mentally handicapped people? Their welfare will go by the board if the Government oppose that Lords amendment. What discussions will we be able to have about that? The Secretary of State referred to all the hours that we have devoted to the Bill including all those hours in Committee, but we will not be able to deal with the Lords amendments which will deny something that is very important—[Interruption.] The Secretary of State is not listening because he is enjoying a conversation with the Minister for Health.

I am glad. I would enjoy a conversation with the Minister for Health. She is a marvellous conversationalist and wonderful to talk to. However, I listen to the debates and I would appreciate it if the Secretary of State would listen to my point about the overturning of Lords amendments.

The Lords amendments are of great value. I was referring to the Lords amendments that will deal with people who run homes for the mentally handicapped. If the people running those homes have crooked backgrounds, we should know about that. We are entitled to know. It would be wrong of the Government to hide that information from us and it would also be damaging for the mentally handicapped. I hope that the Secretary of State will think again.

I have about 5,000 other points that I should like to have made, but I will not because I am aware of your eye on the clock, Madam Deputy Speaker. The Secretary of State is anxious to get on to the subject matter. We are also anxious to do that.

The Secretary of State does his homework and he works very hard. No doubt he has read the report of the debates in another place. Although he will not agree with me, I believe that the Lords made substantial points. They won their amendments by reasoned arguments, not by wild rhetoric or banging a drum. They were seeking to provide community care for the disabled and for old people. It will be a matter of great regret if those amendments are thrown out. It would be a scandal if they were thrown out without any discussion. I ask the Secretary of State to allow us more time to discuss those amendments.

4.41 pm

I want to detain the House for a few moments with a specific practical problem that arises from the timetable motion. I hope that the House will reject the motion, for the reasons outlined by the hon. Member for Livingston (Mr. Cook). He referred to two groups of amendments that we will not reach and on which we will have no proper discussion. Those groups are amendments Nos. 111 to 115 in schedule 1 and the equivalent set for Scotland, amendments Nos. 118 to 122.

I object to the timetable motion in principle, and I will also oppose it because it is extremely important that we discuss the amendments to which I have referred as there were further developments in another place earlier this week. The substance of the Bill was changed at 1 am on Tuesday morning in the other place.

The position of universities in England and Wales and in Scotland have changed. I hoped that the Secretary of State for Wales would be able to say something about that tonight, because that was a significant change. As a result, the universities in England and Wales and those in Scotland have moved out of step with regard to the Health Service. One of the few useful things that the Bill offered was an opportunity to bring those universities back into step, because they have been out of phase on and off for the past 15 years.

We referred in Committee to the universities' position in the wider context of the relationship between the universities and the health service. The amendments in schedules 1 and 2 to which I have referred were tabled by Lady Young and accepted by the Government on Report in the Lords. I believe that there was cross-party support for the arguments in Committee. That was clear from the way in which Lady Young moved the amendments in the House of Lords and also from the way in which the Government accepted them.

According to the amendments, universities have a duty to consult about appointments. It seems to me that, if the purpose of the amendments is to secure effective joint management, that consultation must take place. If that were to happen in Scotland, appointments in England and Wales would be brought into line with the present practice.

The position between universities in England and Wales and those in Scotland has been different in the principal Acts—the National Health Service Act 1977 and the National Health Service (Scotland) Act 1978. As a result of amendment No. 134, which was accepted by the Government earlier this week in another place, there is now a statutory duty to include appointments to the Scottish health boards from universities with medical and dental schools, as happens with regional and district authorities in England and Wales. In addition, however, there is a statutory duty under schedule 1 to the 1978 Act to consult the universities in Scotland about those appointments. My amendments would tidy up that position which exists as a result of the amendment that was accepted earlier in the week.

As we have a national system of education and a national health service—I read with interest the France report, in the name of the permanent secretary at the Department of Health, which appeared last week and which is signed by the Secretary of State for Health and the Secretary of State for Education and Science—it seems sensible that we should have a proper United Kingdom basis for that uniformity. It is disappointing that this timetable motion will prevent us from discussing that point. I should appreciate any clarification from the Secretary of State about my points.

4.46 pm

In supporting the timetable motion, I must stress most strongly that this Bill has been thoroughly and rigorously scrutinised at great length already. It has spent 146 hours in this place, and 92 hours in the other place, and more than 2,000 amendments have been tabled to it. As my right hon. and learned Friend the Secretary of State has said, significant changes have been made to 24 areas of the Bill. No one can seriously claim that the Bill has been railroaded through. On the contrary, it has been thoroughly tested and significantly improved.

Yes, Conservative Members are in a hurry. We want to see the benefits of this legislation. We do not want to delay unduly. Six and a half months have passed since Second Reading, and during that time every aspect of the Bill has been rigorously and thoroughly scrutinised and debated.

I must reiterate the point made by my right hon. and learned Friend. All but five of the 182 amendments are either technical drafting changes or positive concessions made by the Government. My right hon. and learned Friend has already referred to the important clinical standards advisory group, which is an important further addition to our reforms. He also referred to the community care complaints procedures which we accepted as a result of discussions in Committee. There will also be statutory consultation on NHS trusts.

Further improvements and developments have occurred as a result of careful debate and scrutiny. There will be consultations with carers' and users' organisations on community care plans. This is the first time that the interests of carers and users have been enshrined in legislation. The Bill also removes any doubt about the ability of local authorities to provide emergency treatment, and that is in recognition of an important point made by the hon. Member for Livingston (Mr. Cook).

I hope that I do not sound churlish, but the Minister said that this is the first time that the needs of carers have been embraced in legislation. Does that represent a total dismissal of the Disabled Persons (Services, Consultation and Representation) Act 1986?

The hon. Gentleman knows very well that I take a serious and detailed interest in the 1986 Act and recognise the important contribution that it has made in this area. However, the Bill provides a new framework for care in the community for the elderly, the frail, the vulnerable, the mentally ill and the mentally handicapped. It will establish a new framework of care for the next decade and beyond. For the first time, we shall have a rational system with community care plans, opportunities for proper assessment and a complaints procedure. We shall be able to ensure that the vast resources that are already spent on care in the community are spent rationally and effectively.

All that my hon. Friend has said is undoubtedly true, but it does not necessarily preclude ring fencing.

My hon. Friend is drawing me into what will doubtless be the subject of a lengthy debate later in the evening.

It is clear, however, that local authority social services departments have more than held their own in relation to other spending departments in local government. They have increased their spending by 37 per cent. If my hon. Friend essentially distrusts local government—

That is sad.

For many years local authorities have bemoaned the fact that the Government have insufficient confidence in them. However, we have confidence that they can undertake these important new tasks. Ring fencing would not mean a single penny more of additional resources. The role of ring fencing and specific grants lies in areas which have been neglected and which need special leverage. Examples include the mental illness specific grant, and the resources that have been devoted to AIDS. My hon. Friend will note the new proposition for ring fencing the money for those with drug and alcohol problems. Those matters were referred to several times in Committee. However, ring fencing the entire resources for care in the community would seriously undermine the role of local government.

I refer my hon. Friend to the remarks made by my hon. Friend the Member for Mid-Kent (Mr. Rowe) on several occasions, when he said that ring fencing tends to lead to a reactionary, fossilised and backward-looking attitude to those provisions. We want innovation and the development of appropriate services for care in the community that will need modern needs, on the basis of careful planning and rigorous scrutiny.

There has also been further recognition of the role of universities as members of the health authorities, and protection and enhancement of medical research and education in NHS trusts. That is an important further development. I do not accept what the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) said about the necessity for precisely the same mechanism in Scotland as in the rest of the country. His amendment might lead to individuals who are not from the locality of the authority becoming members of it. However, I appreciate his point and can reassure him that, when appointments are made to the authorities, a number of considerations will be borne in mind. Association with the district or region is obviously an important consideration.

The hon. Member for Livingston made the most outrageous allegations about those who are being appointed to serve on health authorities.

I am grateful to the Minister for giving way and do not want to delay her on this point. Although, unfortunately, I do not have the specific wording to hand, I am sure that her Department has made it clear that the intention behind the Government's thinking on that matter is to use people from the locality. The Minister's response did not seem to make such a strong commitment. If that is the Government's intention, why not include it in the Bill? There is anxiety that someone from one part of the country may be appointed to serve on a board in another part of the country, without necessarily having any grasp of the educational or health implications for that area.

I refer the hon. Gentleman to the example of Salford, where there are teaching hospitals which will have a university member but where the medical school lies outside the district boundary. That is an example of a case that would be confined by the hon. Gentleman's amendment and where we could not achieve the end that we are seeking.

The issues that have already been raised will be reconsidered later today and will follow from those raised in the other place. However, I must return to the outrageous allegations made by the hon. Member for Livingston about members of health authorities. I should like to know whether the hon. Gentleman feels that he can justify them—not at this moment but perhaps in a later debate.

Greenwich health authority, for example, has—what a surprise—chosen as its representatives on the district health authority three Labour party prospective parliamentary candidates. That reveals its view of the sort of people whom it wants to put on the health authority. One individual concerned has absolutely no connection with the area—[HON. MEMBERS: "What is wrong with that?"] Opposition members ask, "What is wrong with that?" What is wrong is that it is characteristic of the Opposition, who constantly treat the health service as a party political football. Patients and those who work for the health service are heartily sickened when they see Opposition Members treating every development and improvement in the service as something about which they can make mischief and exploit for party political capital.

The hon. Member for Livingston has said that he will treat every consultation on an NHS trust proposal as a by-election, but I must advise him that Conservative Members know exactly what we are trying to achieve in modifying the membership of the health authorities. We want effective committed individuals, with a businesslike approach, who realise that when one is running a service that is the largest employer not only in this country but in the whole of western Europe, and which is worth £29 billion, party political placemen from the Opposition are not what is wanted. We want those whom we can trust to discharge their responsibilities effectively, to continue making the improvements in health care that we have seen over the past decade, and who can continue to work under the guidance of and in liaison with my right hon. and learned Friend the Secretary of State, who has secured unprecedented resources for the health service and further improvements for the care of our people.

I am grateful to the hon. Lady for drawing breath at that point. She has referred to the appointments made to the Greenwich health authority. Is she aware that one of the appointees is the leader of the Greenwich authority? He was elected to the authority and then elected leader of it. His appointment marks the sort of close relationship between the social services and the health authority that my hon. Friends and I welcome and wish happened more often in the country. However, if the Minister is taking that tack, will she explain how, in applying the criteria of businesslike, efficiency and commitment to the health service, it has just been concluded that the most appropriate chair for one of the Leeds health authorities is the chairman of the West Yorkshire Conservative Association?

We are looking for those who have the ability to discharge their responsibilities effectively and constructively. A close working relationship between the health authorities and the local authorities can frequently play an important part in health provision. It is essential that there are close working agreements, especially for the care in the community proposals. However, those appointed are appointed because of the contribution that they can make to the health service, not so that they can represent avested interest or group.

I know that hon. Members want to make headway in debating the amendments at greater length. We are in haste to implement the reforms to ensure that the British people can benefit from an improved and more rationally run health service. Our care in the community proposals set a new framework for the next decade and beyond. Carers and users will be respected and recognised. My right hon. and learned Friend has included safeguards. Community care plans will be published and consulted on locally to ensure the good will of the local community in constructing proposals for the frail and the elderly.

Under this Government, more patients are being treated and we have more doctors, nurses and resources. Fundamental to our proposals for reform is the fact that we want better management and more effective use of resources. Above all, we want the patient to be put first. I urge hon. Members to support the timetable motion.

Question put:—

The House divided: Ayes 305, Noes 200.

Division No. 267]



Adley, RobertEmery, Sir Peter
Aitken, JonathanEvans, David (Welwyn Hatf'd)
Alexander, RichardEvennett, David
Alison, Rt Hon MichaelFairbairn, Sir Nicholas
Allason, RupertFallon, Michael
Amess, DavidFavell, Tony
Arbuthnot, JamesFenner, Dame Peggy
Arnold, Jacques (Gravesham)Field, Barry (Isle of Wight)
Arnold, Sir ThomasFinsberg, Sir Geoffrey
Ashby, DavidFishburn, John Dudley
Atkins, RobertForman, Nigel
Atkinson, DavidForsyth, Michael (Stirling)
Baker, Rt Hon K. (Mole Valley)Forth, Eric
Baker, Nicholas (Dorset N)Franks, Cecil
Banks, Robert (Harrogate)Freeman, Roger
Batiste, SpencerFrench, Douglas
Bellingham, HenryGale, Roger
Bennett, Nicholas (Pembroke)Gardiner, George
Benyon, W.Garel-Jones, Tristan
Bevan, David GilroyGill, Christopher
Biffen, Rt Hon JohnGilmour, Rt Hon Sir Ian
Blackburn, Dr John G.Glyn, Dr Sir Alan
Blaker, Rt Hon Sir PeterGoodhart, Sir Philip
Body, Sir RichardGoodson-Wickes, Dr Charles
Bonsor, Sir NicholasGorman, Mrs Teresa
Boscawen, Hon RobertGorst, John
Boswell, TimGow, Ian
Bottomley, PeterGrant, Sir Anthony (CambsSW)
Bottomley, Mrs VirginiaGreenway, Harry (Ealing N)
Bowden, A (Brighton K'pto'n)Greenway, John (Ryedale)
Bowden, Gerald (Dulwich)Gregory, Conal
Bowis, JohnGriffiths, Sir Eldon (Bury St E')
Boyson, Rt Hon Dr Sir RhodesGriffiths, Peter (Portsmouth N)
Braine, Rt Hon Sir BernardGrylls, Michael
Brandon-Bravo, MartinGummer, Rt Hon John Selwyn
Brazier, JulianHague, William
Bright, GrahamHampson, Dr Keith
Brown, Michael (Brigg & Cl't's)Hannam, John
Bruce, Ian (Dorset South)Hargreaves, A. (B'ham H'll Gr')
Buchanan-Smith, Rt Hon AlickHargreaves, Ken (Hyndburn)
Buck, Sir AntonyHarris, David
Burns, SimonHaselhurst, Alan
Burt, AlistairHayes, Jerry
Butcher, JohnHayward, Robert
Butler, ChrisHeathcoat-Amory, David
Carlisle, John, (Luton N)Hicks, Mrs Maureen (Wolv' NE)
Carlisle, Kenneth (Lincoln)Hicks, Robert (Cornwall SE)
Carrington, MatthewHill, James
Carttiss, MichaelHind, Kenneth
Cash, WilliamHogg, Hon Douglas (Gr'th'm)
Chalker, Rt Hon Mrs LyndaHolt, Richard
Channon, Rt Hon PaulHordern, Sir Peter
Chapman, SydneyHoward, Rt Hon Michael
Chope, ChristopherHowarth, Alan (Strat'd-on-A)
Clark, Dr Michael (Rochford)Howarth, G. (Cannock & B'wd)
Clark, Sir W. (Croydon S)Howe, Rt Hon Sir Geoffrey
Clarke, Rt Hon K. (Rushcliffe)Howell, Rt Hon David (G'dford)
Colvin, MichaelHowell, Ralph (North Norfolk)
Conway, DerekHughes, Robert G. (Harrow W)
Coombs, Anthony (Wyre F'rest)Hunt, David (Wirral W)
Coombs, Simon (Swindon)Hunt, Sir John (Ravensbourne)
Cope, Rt Hon JohnHunter, Andrew
Cormack, PatrickHurd, Rt Hon Douglas
Cran, JamesIrvine, Michael
Critchley, JulianIrving, Sir Charles
Davies, Q. (Stamf'd & Spald'g)Jack, Michael
Davis, David (Boothferry)Janman, Tim
Day, StephenJessel, Toby
Devlin, TimJohnson Smith, Sir Geoffrey
Dickens, GeoffreyJones, Robert B (Herts W)
Dicks, TerryJopling, Rt Hon Michael
Dorrell, StephenKellett-Bowman, Dame Elaine
Douglas-Hamilton, Lord JamesKey, Robert
Dover, DenKilfedder, James
Dunn, BobKing, Roger (B'ham N'thfield)
Durant, TonyKirkhope, Timothy
Dykes, HughKnapman, Roger

Knight, Greg (Derby North)Ridsdale, Sir Julian
Knight, Dame Jill (Edgbaston)Rifkind, Rt Hon Malcolm
Knowles, MichaelRoberts, Wyn (Conwy)
Knox, DavidRoe, Mrs Marion
Lamont, Rt Hon NormanRost, Peter
Lang, IanRowe, Andrew
Latham, MichaelRumbold, Mrs Angela
Leigh, Edward (Gainsbor'gh)Ryder, Richard
Lennox-Boyd, Hon MarkSackville, Hon Tom
Lester, Jim (Broxtowe)Sainsbury, Hon Tim
Lightbown, DavidScott, Rt Hon Nicholas
Lilley, PeterShaw, David (Dover)
Lloyd, Sir Ian (Havant)Shaw, Sir Giles (Pudsey)
Lord, MichaelShaw, Sir Michael (Scarb')
Luce, Rt Hon RichardShelton, Sir William
Lyell, Rt Hon Sir NicholasShephard, Mrs G. (Norfolk SW)
McCrindle, RobertShepherd, Colin (Hereford)
Macfarlane, Sir NeilShersby, Michael
MacKay, Andrew (E Berkshire)Sims, Roger
Maclean, DavidSkeet, Sir Trevor
McLoughlin, PatrickSmith, Sir Dudley (Warwick)
McNair-Wilson, Sir MichaelSmith, Tim (Beaconsfield)
McNair-Wilson, Sir PatrickSoames, Hon Nicholas
Madel, DavidSpeed, Keith
Major, Rt Hon JohnSpeller, Tony
Malins, HumfreySpicer, Sir Jim (Dorset W)
Mans, KeithSpicer, Michael (S Worcs)
Maples, JohnSquire, Robin
Marland, PaulStanbrook, Ivor
Marlow, TonyStanley, Rt Hon Sir John
Marshall, John (Hendon S)Steen, Anthony
Marshall, Sir Michael (Arundel)Stern, Michael
Martin, David (Portsmouth S)Stevens, Lewis
Maude, Hon FrancisStewart, Allan (Eastwood)
Maxwell-Hyslop, RobinStewart, Andy (Sherwood)
Mayhew, Rt Hon Sir PatrickStewart, Rt Hon Ian (Herts N)
Mellor, DavidStokes, Sir John
Miller, Sir HalStradling Thomas, Sir John
Mills, IainSumberg, David
Miscampbell, NormanSummerson, Hugo
Mitchell, Andrew (Gedling)Tapsell, Sir Peter
Mitchell, Sir DavidTaylor, Ian (Esher)
Monro, Sir HectorTaylor, John M (Solihull)
Montgomery, Sir FergusTaylor, Teddy (S'end E)
Moore, Rt Hon JohnTebbit, Rt Hon Norman
Morris, M (N'hampton S)Temple-Morris, Peter
Morrison, Sir CharlesThompson, D. (Calder Valley)
Moss, MalcolmThompson, Patrick (Norwich N)
Moynihan, Hon ColinThornton, Malcolm
Neale, GerrardThurnham, Peter
Needham, RichardTownsend, Cyril D. (B'heath)
Nelson, AnthonyTrotter, Neville
Neubert, MichaelTwinn, Dr Ian
Newton, Rt Hon TonyVaughan, Sir Gerard
Nicholls, PatrickViggers, Peter
Nicholson, David (Taunton)Waddington, Rt Hon David
Nicholson, Emma (Devon West)Walden, George
Norris, SteveWalker, Bill (T'side North)
Onslow, Rt Hon CranleyWard, John
Oppenheim, PhillipWardle, Charles (Bexhill)
Page, RichardWarren, Kenneth
Paice, JamesWells, Bowen
Parkinson, Rt Hon CecilWheeler, Sir John
Patnick, IrvineWhitney, Ray
Patten, Rt Hon JohnWiddecombe, Ann
Pattie, Rt Hon Sir GeoffreyWiggin, Jerry
Pawsey, JamesWilshire, David
Peacock, Mrs ElizabethWinterton, Mrs Ann
Porter, Barry (Wirral S)Winterton, Nicholas
Porter, David (Waveney)Wolfson, Mark
Portillo, MichaelWoodcock, Dr. Mike
Powell, William (Corby)Yeo, Tim
Price, Sir DavidYoung, Sir George (Acton)
Raison, Rt Hon Timothy
Rathbone, Tim

Tellers for the Ayes:

Redwood, John

Mr. Alastair Goodlad and

Rhodes James, Robert

Mr. Timothy Wood.

Ridley, Rt Hon Nicholas


Allen, GrahamGriffiths, Win (Bridgend)
Alton, DavidGrocott, Bruce
Anderson, DonaldHardy, Peter
Archer, Rt Hon PeterHarman, Ms Harriet
Armstrong, HilaryHeal, Mrs Sylvia
Ashdown, Rt Hon PaddyHenderson, Doug
Ashley, Rt Hon JackHinchliffe, David
Ashton, JoeHoey, Ms Kate (Vauxhall)
Banks, Tony (Newham NW)Hogg, N. (C'nauld & Kilsyth)
Barnes, Harry (Derbyshire NE)Hood, Jimmy
Barnes, Mrs Rosie (Greenwich)Howarth, George (Knowsley N)
Barron, KevinHowell, Rt Hon D. (S'heath)
Bell, StuartHowells, Geraint
Benn, Rt Hon TonyHowells, Dr. Kim (Pontypridd)
Bennett, A. F. (D'nt'n & R'dish)Hoyle, Doug
Bidwell, SydneyHughes, John (Coventry NE)
Blair, TonyHughes, Robert (Aberdeen N)
Boateng, PaulHughes, Simon (Southwark)
Boyes, RolandIllsley, Eric
Bradley, KeithIngram, Adam
Brown, Nicholas (Newcastle E)Jones, Barry (Alyn & Deeside)
Brown, Ron (Edinburgh Leith)Jones, Ieuan (Ynys Môn)
Bruce, Malcolm (Gordon)Jones, Martyn (Clwyd S W)
Buchan, NormanKaufman, Rt Hon Gerald
Buckley, George J.Kennedy, Charles
Caborn, RichardKirkwood, Archy
Callaghan, JimLambie, David
Campbell, Ron (Blyth Valley)Lamond, James
Campbell-Savours, D. N.Leadbitter, Ted
Canavan, DennisLeighton, Ron
Clark, Dr David (S Shields)Lewis, Terry
Clarke, Tom (Monklands W)Litherland, Robert
Clay, BobLivingstone, Ken
Clwyd, Mrs AnnLloyd, Tony (Stretford)
Cohen, HarryLofthouse, Geoffrey
Coleman, DonaldLoyden, Eddie
Cook, Frank (Stockton N)McAllion, John
Cook, Robin (Livingston)McAvoy, Thomas
Corbett, RobinMacdonald, Calum A.
Cousins, JimMcKelvey, William
Cox, TomMcNamara, Kevin
Crowther, StanMadden, Max
Cryer, BobMaginnis, Ken
Cummings, JohnMahon, Mrs Alice
Cunliffe, LawrenceMarek, Dr John
Cunningham, Dr JohnMarshall, Jim (Leicester S)
Dalyell, TamMartin, Michael J. (Springburn)
Darling, AlistairMartlew, Eric
Davies, Ron (Caerphilly)Maxton, John
Davis, Terry (B'ham Hodge H'I)Meale, Alan
Dewar, DonaldMichael, Alun
Dixon, DonMichie, Bill (Sheffield Heeley)
Dobson, FrankMichie, Mrs Ray (Arg'l & Bute)
Doran, FrankMitchell, Austin (G't Grimsby)
Douglas, DickMolyneaux, Rt Hon James
Duffy, A. E. P.Moonie, Dr Lewis
Dunnachie, JimmyMorgan, Rhodri
Eastham, KenMorris, Rt Hon A. (W'shawe)
Ewing, Harry (Falkirk E)Mowlam, Marjorie
Ewing, Mrs Margaret (Moray)Mullin, Chris
Fatchett, DerekNellist, Dave
Faulds, AndrewOakes, Rt Hon Gordon
Fearn, RonaldO'Brien, William
Field, Frank (Birkenhead)O'Neill, Martin
Fields, Terry (L'pool B G'n)Orme, Rt Hon Stanley
Fisher, MarkParry, Robert
Flannery, MartinPatchett, Terry
Flynn, PaulPendry, Tom
Foot, Rt Hon MichaelPike, Peter L.
Foster, DerekPowell, Ray (Ogmore)
Foulkes, GeorgePrimarolo, Dawn
Fraser, JohnQuin, Ms Joyce
Garrett, Ted (Wallsend)Redmond, Martin
Gilbert, Rt Hon Dr JohnRees, Rt Hon Merlyn
Godman, Dr Norman A.Reid, Dr John
Golding, Mrs LlinRobertson, George
Graham, ThomasRogers, Allan
Grant, Bernie (Tottenham)Rooker, Jeff
Griffiths, Nigel (Edinburgh S)Ross, Ernie (Dundee W)

Ross, William (Londonderry E)Thompson, Jack (Wansbeck)
Rowlands, TedTrimble, David
Ruddock, JoanTurner, Dennis
Salmond, AlexVaz, Keith
Sheerman, BarryWallace, James
Sheldon, Rt Hon RobertWalley, Joan
Shore, Rt Hon PeterWareing, Robert N.
Sillars, JimWatson, Mike (Glasgow, C)
Skinner, DennisWelsh, Andrew (Angus E)
Smith, Andrew (Oxford E)Welsh, Michael (Doncaster N)
Smith, C. (Isl'ton & F'bury)Wigley, Dafydd
Smith, Rt Hon J. (Monk'ds E)Williams, Rt Hon Alan
Soley, CliveWilliams, Alan W. (Carm'then)
Spearing, NigelWilson, Brian
Steel, Rt Hon Sir DavidWinnick, David
Steinberg, GerryWise, Mrs Audrey
Stott, RogerWorthington, Tony
Strang, GavinWray, Jimmy
Straw, JackYoung, David (Bolton SE)
Taylor, Mrs Ann (Dewsbury)
Taylor, Rt Hon J. D. (S'ford)

Tellers for the Noes:

Taylor, Matthew (Truro)

Mr. Frank Haynes and

Thomas, Dr Dafydd Elis

Mr. Allen Adams.

Question accordingly agreed to.


That the Order of the House [14th March] be supplemented as follows:—