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Meaning Of "Nhs Body" And "Qualifying Hospital Patient"

Volume 401: debated on Wednesday 19 March 2003

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Lords amendment: No. 1.

1.26 pm

I beg to move, That this House agrees with the Lords in the said amendment.

With this we may discuss Lords amendment No. 2 and the Government motion to disagree thereto and Lords amendment No. 3.

In welcoming the Bill back from the other place, I take this opportunity to express my appreciation of the work of my noble Friend Lord Hunt in taking the Bill through the Lords. He was a good and able colleague, who will be missed by me and by many people who are interested in this sector.

Lords amendments Nos. 1 and 3 are technical amendments, which are necessary to provide clarification that the Bill does not apply to any person who is ordinarily resident outside England and Wales. They do not affect the substance of the Bill in any way, but simply serve to avoid any misunderstanding in the future about the patients to whom the Bill is intended to apply. I therefore hope that hon. Members will join me in supporting them.

We disagree with the Lords in their amendment No. 2. The amendment would specifically exclude patients with a mental health condition from the Bill's provisions. The intention of the Bill is that payment responsibility should rest with the body that has responsibility for providing for the needs of a patient, to ensure that the patient receives the right care, in the right place and at the right time. It would establish a system of incentives to ensure the appropriate delivery of care.

The Government's intention is to use the regulations to exclude mental health care from the scope of the Bill, and later to extend the provisions of the Bill to other types of care where there are delays. We have chosen to take a pragmatic approach, as we do not want to overload local partnerships with preparing for implementation across the system.

It is not justified, however, to prevent the possibility of those provisions being extended to cover mental health. Indeed, the Joint Committee on Human Rights was concerned that the provisions of the Bill should not exclude patients with mental health problems, as that could be seen as discrimination because the nature of the patient's condition was mental rather than physical. However, we will make the decision to extend the scope of the Bill after a full and proper examination of the needs of mental health patients and of incentives in the mental health sector as a whole.

The Department has received representations from many mental health professionals who are concerned that their patients should be included in these provisions as soon as possible, to benefit from the more timely provision of services that should result. For example, an e-mail from a consultant psychiatrist for older people puts it clearly:
"Many of my patients are waiting months for placement in appropriate long term care; waiting on an acute ward with acutely ill, depressed or confused patients is very detrimental to their health. They are just as disadvantaged as any other older patient which this Bill seeks to benefit".
I recognise that concern. Surely patients with mental health problems deserve the opportunity to ensure, as the Bill will for other patients, that they receive that care when they need it.

1.30 pm

If the Bill is successful—I am confident that it will be—in continuing to reduce patient waits for community care services so that patients can be safely discharged from hospital, I cannot understand how excluding mental health patients from the system can be justified. The right course of action is to monitor the effect of reimbursement on the acute sector and then, if appropriate, make a decision to include the mental health sector in the light of evidence. If we were to exclude that sector now, we would fail to recognise the very important benefits that the Bill could bring, and that could be discriminatory; so I hope that my colleagues and other hon. Members will disagree with the Lords in the said amendment.

I wish to speak to Lords amendment No. 2. I hope that my right hon. and hon. Friends and others will not share the Government's view that they should disagree with the other place in that amendment, because its purpose is to exclude mental health patients from these provisions. Notwithstanding what the Minister has just said, we believe that there is a separate problem with mental health patients, as opposed to acute patients, partly because of the historic situation in the national health service until about a decade ago.

I believe that—this is becoming a bit of a cliché—mental health was a Cinderella service until about a decade ago, regardless of which Government were in power. If a Government—again, regardless of their political complexion—needed to make savings or had financial constraints on health spending for other reasons, it was too easy to sweep a range of services under the carpet, and mental health services suffered most. In addition, there was—sadly, there still is—a problem with the general attitude of this country's population.

Some people think that there is something odd or unacceptable about mental health problems, so people suffering from such problems do not receive the same consideration and concern from friends and even family as other patients. That prejudice has continued despite, to be fair, the efforts of this Government and those of John Major's Government to reduce the stigma attached to mental illness and to bolster the health service provision for those with mental illness with genuine increases in funding and focusing attention on improving and enhancing mental health care. There is still, however, a fundamental difference—whether it is right or wrong is another matter—between mental health patients and acute patients, and the Bill should reflect that fact of life, whether one likes it or not.

Of course, over-extended stays in psychiatric wards are a problem. For example, a recent survey in acute psychiatric wards, conducted by the Sainsbury Centre for Mental Health, concluded that hospital care was non-therapeutic, but there are times when hospital admissions cannot be avoided. For example, when patients are so ill that they are incapable of looking after themselves, hospitals provide the only appropriate care for them. However, mental health care is in many ways very different from acute care, so different approaches are needed.

Given those unique mental health considerations, if legal duties are imposed under the Bill to compel one part of the sector, in effect, to penalise the others, that could put at risk especially vulnerable patients suffering from mental health problems. In addition, there is a shortage of capacity in hospitals, other supported accommodation, rehabilitation services and 24-hour staffed beds in inner cities. As a result, to require local authorities to provide care quickly in those circumstances is unrealistic and unfair, and it could be dangerous in certain conditions.

Instead of trying to introduce some, frankly spurious, distinctions between mental health and other aspects of the health service, will the hon. Gentleman direct his remarks to the question of the right patients? Do not people with mental health problems have exactly the same right as anyone else to live in the community and receive provision there?

I find the hon. Gentleman's intervention slightly contradictory and complex, but I agree with the last part of what he says. No one wants people to be kept in hospital when they do not need to be there, and all of us want each patient to receive the most appropriate care—whether, in the case of the elderly, in their own homes with a domiciliary care package, or in residential care homes. We would agree on that. With respect to the hon. Gentleman, particularly given some of his statements in recent days, I resent his use of the word "spurious" because the argument is not spurious, and I hope that the hon. Member for Wakefield (Mr. Hinchliffe), who is the Chairman of the Select Committee on Health, will back me up.

It is not exactly a secret that I am not the Bill's biggest fan, but I am trying to understand how Lords amendment No. 2 would work in practice, and I have not been assisted so far by the contribution of the hon. Gentleman who speaks from the Opposition Front Bench. What is meant by the phrase "a person receiving mental health services"? That seems to be such a wide-ranging definition, and it could include huge numbers of people who are on antidepressants from a general practitioner. Is the hon. Gentleman specifically focusing on individuals in psychiatric beds in acute hospitals? Is that the purpose of his argument?

I am grateful to the hon. Gentleman for that intervention. I apologise if I am being obscure in certain areas, but, yes, the fundamental basis of my argument is that I believe—this is the intention of Lords amendment No. 2—that those people who are, in effect, defined as receiving treatment in hospital psychiatric beds should be exempt from the Bill. The bottom line is that I do not want the pressure that the Bill will put on hospital discharges to be put on those patients because of the nature of their illness and treatment, and the Bill should recognise the difference between mental health treatment and acute treatment. I know what the hon. Gentleman said, but it is interesting that the Minister in the other place, the late Lord Hunt—

The Whip is absolutely right. Lord Hunt is not dead, but he is politically dead to such an extent that the Deputy Prime Minister did not recognise that he was a human being or that he had been a member of the Administration, despite the fact that he had been for almost six years. He is politically dead, so the word "late" was probably justified in that context.

My confusion about the hon. Gentleman's proposal arises because he talks in a broad and categorical way about patients who are in beds in psychiatric hospitals, but even that does not bring the definition down to a level that I find comprehensible. People who suffer from mental illnesses may need a bed in a secure psychiatric hospital for a comparatively short time, but others will need such a bed for much longer. There are as many variations among the extreme episodes endured by people who suffer from mental illnesses as there are in any other field of medicine. The proposal is simply not clear.

The hon. Lady is entitled to her view. Her point that the time spent in a hospital bed by an individual suffering from mental health or acute health problems will vary depending on individual circumstances is right. The point that I am trying to make is that the situation is different for mental health, and we do not want to impede the treatment and future appropriate care of individuals suffering from mental health by putting them under the umbrella of the Bill and placing additional pressures on them.

I shall not, because I want to make progress.

The answer is to exclude mental health patients from the Bill in the same way as other groups of people will be excluded from its ambit, although the Government have the power to include them if they are so minded. Excluding mental health patients is the right way to proceed because of the nature of mental illness and its historic position in the NHS until about a decade ago. The group could be included in the future, but it should not be included at the moment. That is why I hope that the House will agree with the Lords amendment and disagree with the Government's motion.

I shall simply respond to the hon. Gentleman's comments. I listened carefully as he supported the Lords amendment, but his arguments do not seem to relate to its wording. His comments were very specific. He clearly implied that he was focusing on the circumstances of individuals who are in acute psychiatric beds and—to use his words—suffering from mental health. We all have mental health, although we do not necessarily suffer from it. The phrase is "suffering from mental illness".

The amendment is more wide ranging than the specific matter on which the hon. Gentleman focused. Despite my personal opposition to the Bill, I cannot understand how the Government could honestly accept the amendment, because it is badly drafted and so wide ranging that it could cover any number of individuals, which I do not believe is the hon. Gentleman's intention.

1.45 pm

Other Lords amendments would improve the Bill, although I am not necessarily convinced that they would be a positive step toward addressing delayed discharges. Indeed, the Government might concede that on occasions. The hon. Gentleman's arguments are extremely thin and the Government could not genuinely accept such a wide-ranging amendment.

I shall be much more generous to the h on. Member for West Chelmsford (Mr. Burns) than my esteemed and hon. Friend the Member for Wakefield (Mr. Hinchliffe), because the hon. Gentleman made a good attempt at proposing something that is basically unacceptable. I do not believe that his remarks showed a total commitment to the amendment.

The Lords amendment is appalling and should be dismissed out of hand. We should question what the other place was doing when it was tabled. It would be quite wrong specifically to exclude mental health services from the range of services that will be included—before very long, I hope—in the provisions of this first-class Bill. I recently visited Ridge Lea hospital, which is my local hospital in Lancaster, and I met people who had been living on the locked Lonsdale ward for many years. The patients and the people who care for them expressed enormous concerns about the difficulties entailed in assisting patients to move on to appropriate community services. Difficulties are encountered when liaising with social security services. It is extraordinarily difficult to ensure that the patients have appropriate places to live in the community and that appropriate support services are available.

Some of those people lived in locked circumstances with restricted liberty. It is outrageous, and a matter of enormous worry, that people live in such circumstances for longer than their acute mental health needs require. If appropriate provisions were available in the community, they could move there with their liberties assured. That is a fundamental human rights issue. I have no doubt that the Bill is not a universal panacea. We need considerable investment in, and new legislation for, mental health services. However, the provisions will be an enormous help for such people by ensuring that agencies are made well aware of the need to work closely together to ensure that services are available.

I am slightly disappointed that mental health will not be one of the services to which the provisions will apply immediately. I urge hon. Members to reject the amendment, but I also urge my hon. Friend the Minister to assure me that the Government will move quickly to ensure that mental health services are included.

I also have concerns about the amendment. The Opposition say that mental illness services are a Cinderella service and that they are anxious that they are improved. I am perfectly prepared to accept that that is an honourable and justifiable position to take. The Government have done much to bring services for mentally ill patients out of the shadows and into the light, but I am sure that they would not want anyone to believe that the services are in full sunshine as yet. However, great improvements have been made.

I am sure that, with the best will in the world, the Opposition want to ensure that mentally ill people receive treatment but, as my hon. Friend the Member for Lancaster and Wyre (Mr. Dawson) pointed out, their amendment would lead to seemingly permanent incarceration behind locked doors. Such a provision would act as an active deterrent to improving mental health services for everyone.

I have some questions for my hon. Friend the Minister. I have concerns about the definition of services that will be provided only to someone who is normally—if that is the correct word—resident in England and Wales. My concerns stem from a case in my constituency in which the mother of a family in my constituency was resident in Northern Ireland. She visited the family in my constituency, but was taken ill. She received excellent treatment from the national health service, but the family then decided that, because she lived alone in Northern Ireland, she should come to live with them. Does the provision mean that my constituents' mother will be excluded from a proper care package that is put in place by my local authority? What does "resident" mean in that context?

When my constituents raised this case, I was concerned because people from all over the world reside in my constituency. They have the right to live in this country and they have lived here for a considerable time. They pay their taxes and are not a drain on the state. If one of their elderly relatives should visit and the same situation were replicated, would that mean that the citizens of the United Kingdom whose parents come from a country other than England or Wales would not receive proper care or would not be able to patch into the national health services that are open to the rest of the United Kingdom's citizens? Will my hon. Friend clarify the position?

I wish to support amendment No. 2, and I shall argue that it deserves particular consideration.

I accept the Minister's argument that no one in the House wishes to stigmatise mental health patients or to treat them as a completely separate group. However, we are considering an imperfect Bill that deals with particularly vulnerable groups of people, such as mental health patients, who, on occasions, are not able to articulate their own needs. Therefore, particular care should be taken when they are discharged from hospital.

I hope that the amendment will remain in the Bill. Mentally ill people and other vulnerable groups should not be among the patients for whom a charge is made.

Surely the point about the process is that the patient is deemed able to be discharged at the appropriate time. Therefore, the decision that it is right for the patient to move on to more appropriate care is taken by the health care professionals who are charged with taking care of the patient's mental health. By agreeing to the amendment, we would be going against the advice of the professionals who have that responsibility.

I thank the hon. Lady for that intervention. I am interested to hear that she perceives this to be a very much one-sided decision process. The reason Opposition Members are concerned about the Bill and its references to vulnerable patients is that it will speed up the process by which particularly vulnerable people are removed to the exclusion of assistance from other carers and expert advocates.

Does the hon. Lady agree that the flaw in the logic of the intervention of the hon. Member for Sheffield, Heeley (Ms Munn) is that, at the moment, the Government have exempted other groups from the Bill even though they may bring those groups within the Bill's ambit at a later stage?

A further flaw results from the fact that, as the Minister said, the Government have taken a pragmatic approach to mental health patients. For the time being anyway, they have exempted them. If the charge of stigmatisation applies, it applies to that pragmatic approach.

I am concerned that because of the different procedures for mental health and acute discharges and because of the differences in working across health and social services, the onward journey of services users will not be facilitated by the Bill. Under the draft regulations, the local authority would not be made liable if the patient was waiting for an NHS or another community service, such as psychiatric or mental health care provision, after the care assessment, but found that service unavailable because of the lack of social care provision. The Minister and the Government cannot have it all ways. If it is now right to exempt mental health patients, it must be right at a later date unless we can be absolutely sure that all the necessary provision is available.

My worry is that these debates increasingly tend to consider segments of care. We put people into compartments, and that is where they remain. I intervened on the hon. Member for West Chelmsford (Mr. Burns) because I believe the Lords amendment to be flawed. For example, an elderly patient could be initially admitted to a psychiatric bed before being put into an elderly care bed in an acute hospital as they get ready for discharge. Is that person a mental health patient or not?

As my hon. Friend suggests, Alzheimer's and a whole range of conditions lead to people being moved from an acute psychiatric environment in a general hospital to a psychogeriatric situation or to an acute ward. At what stage is someone a mental health patient? It is inconceivable that anyone could genuinely operate the Bill if it contained this amendment.

I thank the hon. Gentleman for that point, but the Minister has accepted that there is a problem. She has decided that there will be an exemption for mental health services and I presume that she, like the rest of us, has read the relevant section of the amendment. The arguments that have been made could be given credibility, but it would not take much more precision for the amendment to make it clear in line 10 of clause 1 that those receiving mental health services are those

"accommodated at—
  • (a) a health service hospital; or
  • (b) an independent hospital in pursuance of arrangements made by an NHS body".
  • The definitions already exist, and it would not need much further clarification to specify which group of particularly vulnerable patients would be affected. Again, I would add other groups of vulnerable patients—those who are not able to articulate their needs and who would require additional support in the arrangements for their discharge.

    2 pm

    The Government's national services framework for mental health identifies the lack of capacity in community mental health services, not inefficiencies in social services departments, as the key cause of delayed discharges for psychiatric patients. That will not disappear just because the Bill causes fines to be levied. There will be a tendency to rush assessments of psychiatric patients' fitness for discharge, which entails a complex package of considerations. Patients must be assessed in terms of whether they will self-harm, whether they are a risk to others, and whether they will have appropriate accommodation. It is rare that that can be worked through in a three-day period, even if all the various services are in place.

    There is no provision in the Bill for specialist advocates and for carers to take part in the discharge planning process. There is a risk that pressure to reduce prolonged hospital admissions will concentrate resources on the acute sector at the expense of community care provision. Hard-pressed councils will tend to divert resources into services that avoid penalties, instead of the longer-term preventive work that would reduce the need for acute admissions. There is a further danger that patients discharged earlier than they should be will be given inappropriate medication to control symptoms, rather than a range of therapeutic interventions, because of inappropriate accommodation and a lack of essential support services.

    There is a basic flaw in the Government's argument that they need to make interim provision now, but are not prepared to write that into the Bill for the longer term for particularly vulnerable groups of patients.

    I shall contribute briefly, as some of the related issues will arise more naturally later in the Bill's consideration today. There were two major errors in the approach adopted by Members on the Government Benches. One was a gross caricature of what their lordships we re trying to achieve by the amendment. The other was the notion that the Bill would be of unalloyed benefit to the average patient. It is precisely because the Bill still is not patient centred that the issue arises.

    The most powerful argument to be deployed in favour of the exclusion, as the hon. Member for Cheadle (Mrs. Calton) said, is the extent to which the concerns of patients and their carers are taken into account. Perhaps it is a matter of first thoughts are best, which is clearly the Government's view at present. At an earlier stage of the Bill's progress, we had some very good briefing from organisations such as the Alzheimer's Society about patients suffering from dementia and more specifically Alzheimer's, and so on. Surely patients with mental health problems, particularly severe mental health problems, will be the most vulnerable category.

    Even if there are proper arrangements for the discharge of such patients and proper consultation—we shall deal with that in more detail later—will they be able to express a view, let alone an informed view? Will the views of their carers be taken into account on their behalf? For that central reason, the official Opposition have always opposed the Bill. There are many reasons for opposing it—not least, the fact that it will not work—but the most human reason for opposing it is that it ignores the needs and wishes of individual patients. That is true in spades in respect of those with mental health problems. That is the overwhelming argument for the amendment.

    I shall not dwell on the point as we have a great deal of progress to make. I commend my hon. Friend the Member for West Chelmsford (Mr. Burns), who was right to argue that we should support the Lords amendment.

    I shall begin by responding to the question from my hon. Friend the Member for Hampstead and Highgate (Glenda Jackson) with respect to amendments Nos. 1 and 3 and the case that she described. Obviously, I do not know the details of the case, but the principle of defining ordinary residence is intended to make it clear which authorities are responsible for the necessary community care provision. The case does not have to come within the ambit of the Bill for social services to have that responsibility. Anybody who establishes ordinary residence will be within the provisions of the Bill. That is established on the facts of the case, and can sometimes be established virtually immediately. Although that is not very clear, the answer probably is that it depends. There would not be an automatic bar against somebody who had come from abroad.

    The main point of contention was Lords amendment No. 2. Let us be clear what the Lords are proposing. It is not that there might be particular issues that make the way in which we respond to patients with mental health problems different from the way in which we respond to other patients in acute care. It is that in perpetuity we should exclude from any benefits that might come from the Bill those people with mental health problems.

    I agree with the hon. Member for West Chelmsford (Mr. Burns) that during the 1980s and 1990s our mental health services were underfunded and poor.

    I am saddened that the Minister is taking that tack. Given of the importance of the issue of mental health, I deliberately tried not to make my comments party political. I said, and it is a recognised fact, that over the past decade, under the last Conservative Government and under this Government, there has been a greater concentration of attention on mental health and inputting of resources for it. It saddens me if the Minister is trying to make political points, saying that the Conservatives did nothing and the present Government have done everything.

    The hon. Gentleman can stand or fall on the record of the Government of which he was a member. The first national service framework introduced by the Labour Government tackled the issue of mental health services, in particular linking considerable new investment to attempts to find new ways of addressing some of the problems identified by the hon. Member for Cheadle (Mrs. Calton) in relation to capacity, and to ensuring that services are available in the community to address the needs of people with mental health problems who would be better cared for in the community.

    With the development of assertive outreach teams, crisis resolution teams and early intervention teams, we see that they have an impact on the number of people who need to be admitted or to stay for longer periods in inpatient provision. It is right that we need to expand capacity and reform the way in which we offer mental health services, to make sure that provision in the community is available. Despite improved investment—£40 million worth of capital over this year and last year—and guidance leading to improved acute inpatient mental health services, there are people for whom inpatient mental health care is not appropriate and who do not want it.

    I find it hard to understand why the Lords and the Opposition, in their support for the amendment, believe that we should for ever exclude mental health patients from the benefits of the legislation. Although I was shocked to hear that my hon. Friend the Member for Wakefield (Mr. Hinchliffe) is not the biggest fan of the Bill in the House, both he and my hon. Friend the Member for Lancaster and Wyre (Mr. Dawson), who, as a fan of the Bill, pressed me to bring mental health within the ambit of the Bill more quickly, recognise the illogicality of for ever putting mental health outside the legislation.

    The hon. Member for West Chelmsford also made the point that those with mental health problems have suffered in the past from stigma, which has affected services. I agree, but I fail to see how ensuring that it would never be possible for those with mental health problems to come within the Bill's ambit helps to tackle that stigma. It does not.

    I do not dispute that different circumstances will apply to people with mental health problems. Of course they will, which is why we have taken the decision that the first group that we should address through the legislation are those in acute hospital care. Different considerations will apply to how we bring in those with mental health problems. As I suggested earlier, we will decide whether to extend the Bill's scope after a full and proper examination of the needs of mental health patients and the incentives in the mental health sector.

    For example, we would want to consider whether, as happens in Sweden, the level of reimbursement or the minimum compliance period should be altered to reflect any additional difficulties that might arise when assessing mental health patients or putting services in place. We would want to recognise that quite often—for example, housing services are important to those with mental health problems.

    It is not beyond the wit of the House to ensure that we would be able to recognise those specific circumstances in the future and to design the system to take those on board, and to ensure that those with mental health problems have the opportunity, when it is successful, to benefit from the Bill.

    Lord's amendment No. 2 would ensure that that was never possible and I hope that, on that basis, hon. Members will disagree with it.

    Lords amendment agreed to.

    Lords amendment: No. 2.

    Motion made, and Question put, That this House disagrees with the Lords in the said amendment.— [Jacqui Smith.]

    The House divided: Ayes 320, Noes 178.

    Division No. 119]

    [2:12 pm

    AYES

    Abbott, Ms DianeBest, Harold
    Adams, Irene (Paisley N)Betts, Clive
    Ainger, NickBlackman, Liz
    Alexander, DouglasBlizzard, Bob
    Allen, GrahamBorrow, David
    Anderson, rh Donald (Swansea E)Bradley, rh Keith (Withington)
    Anderson, Janet (Rossendale & Darwen)Bradley, Peter (The Wrekin)
    Bradshaw, Ben
    Armstrong, rh Ms HilaryBrennan, Kevin
    Atherton, Ms CandyBrown, Russell (Dumfries)
    Austin, JohnBryant, Chris
    Bailey, AdrianBuck, Ms Karen
    Baird, VeraBurden, Richard
    Barnes, HarryBurgon, Colin
    Beckett, rh MargaretBurnham, Andy
    Begg, Miss AnneByers, rh Stephen
    Benn, HilaryCaborn, rh Richard
    Bennett, AndrewCairns, David
    Benton, Joe (Bootle)Campbell, Alan (Tynemouth)
    Berry, RogerCampbell, Mrs Anne (C'bridge)

    Campbell, Ronnie (Blyth V)Gerrard, Neil
    Casale, RogerGilroy, Linda
    Caton, MartinGodsiff, Roger
    Cawsey, Ian (Brigg)Goggins, Paul
    Chapman, Ben (Wirral S)Griffiths, Jane (Reading E)
    Chaytor, DavidGriffiths, Nigel (Edinburgh S)
    Clapham, MichaelGriffiths, Win (Bridgend)
    Clark, Mrs Helen (Peterborough)Hain, rh Peter
    Clark, Dr. Lynda (Edinburgh Pentlands)Hall, Mike (Weaver Vale)
    Hall, Patrick (Bedford)
    Clark, Paul (Gillingham)Hamilton, David (Midlothian)
    Clarke, Tony (Northampton S)Hamilton, Fabian (Leeds NE)
    Clelland, DavidHanson, David
    Clwyd, Ann (Cynon V)Harris, Tom (Glasgow Cathcart)
    Coaker, VernonHavard, Dai (Merthyr Tydfil & Rhymney)
    Coffey, Ms Ann
    Cohen, HarryHenderson, Ivan (Harwich)
    Coleman, IainHepburn, Stephen
    Colman, TonyHeppell, John
    Cook, Frank (Stockton N)Hewitt, rh Ms Patricia
    Cook, rh Robin (Livingston)Heyes, David
    Corbyn, JeremyHill, Keith (Streatham)
    Corston, JeanHinchliffe, David
    Cousins, JimHoey, Kate (Vauxhall)
    Cox, Tom (Tooting)Hood, Jimmy (Clydesdale)
    Cranston, RossHoon, rh Geoffrey
    Crausby, DavidHope, Phil (Corby)
    Cruddas, JonHopkins, Kelvin
    Cryer, Ann (Keighley)Howarth, George (Knowsley N & Sefton E)
    Cryer, John (Hornchurch)
    Cummings, JohnHowells, Dr. Kim
    Cunningham, Jim (Coventry S)Hughes, Beverley (Stretford & Urmston)
    Cunningham, Tony (Workington)
    Curtis-Thomas, Mrs ClaireHughes, Kevin (Doncaster N)
    Dalyell, TamHumble, Mrs Joan
    Davey, Valerie (Bristol W)Hurst, Alan (Braintree)
    David, WayneHutton, rh John
    Davidson, IanIddon, Dr. Brian
    Davies, rh Denzil (Llanelli)Illsley, Eric
    Davies, Geraint (Croydon C)Jackson, Glenda (Hampstead & Highgate)
    Davis, rh Terry (B'ham Hodge H)
    Dawson, HiltonJackson, Helen (Hillsborough)
    Dean, Mrs JanetJamieson, David
    Dhanda, ParmjitJenkins, Brian
    Dismore, AndrewJohnson, Alan (Hull W)
    Dobbin, Jim (Heywood)Johnson, Miss Melanie (Welwyn Hatfield)
    Dobson, rh Frank
    Donohoe, Brian H.Jones, Helen (Warrington N)
    Doran, FrankJones, Jon Owen (Cardiff C)
    Dowd, Jim (Lewisham W)Jones, Kevan (N Durham)
    Drew, David (Stroud)Jones, Lynne (Selly Oak)
    Drown, Ms JuliaJones, Martyn (Clwyd S)
    Dunwoody, Mrs GwynethJoyce, Eric (Falkirk W)
    Eagle, Angela (Wallasey)Kaufman, rh Gerald
    Eagle, Maria (L'pool Garston)Keeble, Ms Sally
    Edwards, HuwKeen, Alan (Feltham)
    Ellord, CliveKemp, Fraser
    Ellman, Mrs LouiseKidney, David
    Ennis, Jeff (Barnsley E)Kilfoyle, Peter
    Etherington, BillKing, Andy (Rugby)
    Farrelly, PaulKing, Ms Oona (Bethnal Green & Bow)
    Field, rh Frank (Birkenhead)
    Fisher, MarkKnight, Jim (S Dorset)
    Fitzpatrick, JimKumar, Dr. Ashok
    Fitzsimons, Mrs LornaLadyman, Dr. Stephen
    Flint, CarolineLammy, David
    Flynn, Paul (Newport W)Lawrence, Mrs Jackie
    Foster, rh DerekLaxton, Bob (Derby N)
    Foster, Michael (Worcester)Lazarowicz, Mark
    Foster, Michael Jabez (Hastings & Rye)Lepper, David
    Leslie, Christopher
    Foulkes, rh GeorgeLevitt, Tom (High Peak)
    Francis, Dr. HywelLewis, Ivan (Bury S)
    Gapes, Mike (Ilford S)Lewis, Terry (Worsley)
    Gardiner, BarryLiddell, rh Mrs Helen
    George, rh Bruce (Walsall S)Linton, Martin

    Love, AndrewSalter, Martin
    Lucas, Ian (Wrexham)Sarwar, Mohammad
    Luke, Iain (Dundee E)Savidge, Malcolm
    Lyons, John (Strathkelvin)Sawford, Phil
    McAvoy, ThomasSedgemore, Brian
    McCabe, StephenShaw, Jonathan
    McCafferty, ChrisSheridan, Jim
    MacDonald, CalumShipley, Ms Debra
    McDonnell, JohnSimon, Siôn (B'ham Erdington)
    MacDougall, JohnSimpson, Alan (Nottingham S)
    McFall, JohnSingh, Marsha
    McGuire, Mrs AnneSmith, Geraldine (Morecambe & Lunesdale)
    McIsaac, Shona
    McKechin, AnnSmith, Jacqui (Redditch)
    McKenna, RosemarySmith, John (Glamorgan)
    Mackinlay, AndrewSmith, Llew (Blaenau Gwent)
    McNulty, TonySoley, Clive
    MacShane, DenisSouthworth, Helen
    McWalter, TonySquire, Rachel
    Mahon, Mrs AliceSteinberg, Gerry
    Mallaber, JudyStevenson, George
    Mandelson, rh PeterStewart, David (Inverness E & Lochaber)
    Mann, John (Bassetlaw)
    Marris, Rob (Wolverh'ton SW)Stewart, Ian (Eccles)
    Marsden, Gordon (Blackpool S)Stinchcombe, Paul
    Marshall, Jim (Leicester S)Stringer, Graham
    Martlew, EricStuart, Ms Gisela
    Merron, GillianTami, Mark (Alyn)
    Milburn, rh AlanTaylor, Dari (Stockton S)
    Miliband, DavidTaylor, David (NW Leics)
    Miller, AndrewThomas, Gareth (Clwyd W)
    Moffatt, LauraThomas, Gareth (Harrow W)
    Mole, ChrisTimms, Stephen
    Moran, MargaretTipping, Paddy
    Morgan, JulieTodd, Mark (S Derbyshire)
    Morris, rh EstelleTouhig, Don (Islwyn)
    Mountford, KaliTrickett, Jon
    Mudie, GeorgeTruswell, Paul
    Mullin, ChrisTurner, Dr. Desmond (Brighton Kemptown)
    Munn, Ms Meg
    Murphy, Denis (Wansbeck)Turner, Neil (Wigan)
    Murphy, Jim (Eastwood)Twigg, Derek (Halton)
    Naysmith, Dr. DougTwigg, Stephen (Enfield)
    Norris, Dan (Wansdyke)
    0 Brien, Mike (N Warks)Tynan, Bill (Hamilton S)
    Organ, DianaVaz, Keith (Leicester E)
    Osborne, Sandra (Ayr)Vis, Dr. Rudi
    Owen, AlbertWalley, Ms Joan
    Palmer, Dr. NickWard, Claire
    Perham, LindaWareing, Robert N.
    Picking, Anne
    Pickthall, ColinWatson, Tom (W Bromwich E)
    Pike, Peter (Burnley)Watts, David
    Plaskitt, JamesWhite, Brian
    Pollard, KerryWhitehead, Dr. Alan
    Pope, Greg (Hyndburn)Wicks, Malcolm
    Pound, Stephen
    Prentice, Ms Bridget (Lewisham E)Williams, rh Alan (Swansea W)
    Williams, Betty (Conwy)
    Prentice, Gordon (Pendle)Wills, Michael
    Prosser, GwynWinnick, David
    Purchase, KenWinterton, Ms Rosie (Doncaster C)
    Purnell, James
    Quinn, LawrieWood, Mike (Batley)
    Rapson, Syd (Portsmouth N)Woodward, Shaun
    Reed, Andy (Loughborough)Woolas, Phil
    Reid, rh Dr. John (Hamilton N & Bellshill)Worthington, Tony
    Wright, Anthony D. (Gt Yarmouth)
    Roche, Mrs Barbara
    Rooney, TerryWright, David (Telford)
    Ross, Ernie (Dundee W)Wright, Tony (Cannock)
    Roy, Frank (Motherwell)Wyatt, Derek
    Ruane, Chris
    Ruddock, Joan

    Tellers for the Ayes:

    Russell, Ms Christine (City of Chester)

    Charlotte Atkins and

    Joan Ryan

    NOES

    Ainsworth, Peter (E Surrey)Hancock, Mike
    Amess, DavidHarris, Dr. Evan (Oxford W & Abingdon)
    Atkinson, David (Bour'mth E)
    Atkinson, Peter (Hexham)Hawkins, Nick
    Bacon, RichardHayes, John (S Holland)
    Baker, NormanHeald, Oliver
    Barker, GregoryHeath, David
    Baron, John (Billericay)Heathcoat-Amory, rh David
    Beggs, Roy (E Antrim)Hermon, Lady
    Bellingham, HenryHoban, Mark (Fareham)
    Bercow, JohnHogg, rh Douglas
    Beresford, Sir PaulHoram, John (Orpington)
    Blunt, CrispinHowarth, Gerald (Aldershot)
    Boswell, TimHughes, Simon (Southwark N)
    Bottomley, Peter (Worthing W)Jack, rh Michael
    Bottomley, rh Virginia (SW Surrey)Jenkin, Bernard
    Johnson, Boris (Henley)
    Brady, GrahamKennedy, rh Charles (Ross Skye & Inverness)
    Brake, Tom (Carshalton)
    Brazier, JulianKey, Robert (Salisbury)
    Breed, ColinKirkbride, Miss Julie
    Brooke, Mrs Annette LKirkwood, Sir Archy
    Browning, Mrs AngelaKnight, rh Greg (E Yorkshire)
    Bruce, MalcolmLaing, Mrs Eleanor
    Burnett, JohnLait, Mrs Jacqui
    Burns, SimonLamb, Norman
    Burnside, DavidLaws, David (Yeovil)
    Burstow, PaulLewis, Dr. Julian (New Forest E)
    Calton, Mrs PatsyLiddell-Grainger, Ian
    Cameron, DavidLidington, David
    Carmichael, AlistairLilley, rh Peter
    Cash, WilliamLlwyd, Elfyn
    Chapman, Sir Sydney (Chipping Barnet)Loughton, Tim
    Luff, Peter (M-Worcs)
    Chidgey, DavidMcIntosh, Miss Anne
    Chope, ChristopherMackay, rh Andrew
    Clappison, JamesMaclean, rh David
    Clifton-Brown, GeoffreyMcLoughlin, Patrick
    Cormack, Sir PatrickMalins, Humfrey
    Cran, James (Beverley)Maples, John
    Curry, rh DavidMarsden, Paul (Shrewsbury & Atcham)
    Davies, Quentin (Grantham & Stamford)
    Mawhinney, rh Sir Brian
    Davis, rh David (Haltemprice & Howden)May, Mrs Theresa
    Mercer, Patrick
    Djanogly, JonathanMitchell, Andrew (Sutton Coldfield)
    Donaldson, Jeffrey M.
    Dorrell, rh StephenMoore, Michael
    Doughty, SueMurrison, Dr. Andrew
    Duncan Smith, rh IainOaten, Mark (Winchester)
    Evans, NigelO'Brien, Stephen (Eddisbury)
    Fabricant, MichaelÖpik, Lembit
    Fallon, MichaelOsborne, George (Tatton)
    Field, Mark (Cities of London & Westminster)Ottaway, Richard
    Page, Richard
    Flight, HowardPaice, James
    Flook, AdrianPaterson, Owen
    Forth, rh EricPickles, Eric
    Fox, Dr. LiamPrice, Adam (E Carmarthen & Dinefwr)
    Francois, Mark
    Gale, Roger (N Thanet)Prisk, Mark (Hertford)
    Garnier, EdwardPugh, Dr. John
    George, Andrew (St. Ives)Randall, John
    Gibb, Nick (Bognor Regis)Redwood, rh John
    Gillan, Mrs CherylReid, Alan (Argyll & Bute)
    Goodman, PaulRobathan, Andrew
    Gray, James (N Wilts)Robertson, Laurence (Tewk'b'ry)
    Grayling, ChrisRobinson, Mrs Iris (Strangford)
    Green, Damian (Ashford)Robinson, Peter (Belfast E)
    Green, Matthew (Ludlow)Roe, Mrs Marion
    Grieve, DominicRosindell, Andrew
    Gummer, rh JohnRuffley, David
    Hague, rh WilliamRussell, Bob (Colchester)
    Hammond, PhilipSanders, Adrian

    Sayeed, JonathanTrimble, rh David
    Selous, AndrewTurner, Andrew (Isle of Wight)
    Shephard, rh Mrs GillianTyler, Paul (N Cornwall)
    Simmonds, MarkTyrie, Andrew
    Smith, Sir Robert (W Ab'd'ns & Kincardine)Viggers, Peter
    Waterson, Nigel
    Smyth, Rev. Martin (Belfast S)Watkinson, Angela
    Spelman, Mrs CarolineWebb, Steve (Northavon)
    Spicer, Sir MichaelWiggin, Bill
    Spink, Bob (Castle Point)Wilkinson, John
    Stanley, rh Sir JohnWilletts, David
    Steen, AnthonyWilliams, Roger (Brecon)
    Streeter, GaryWillis, Phil
    Stunell, AndrewWinterton, Ann (Congleton)
    Swayne, DesmondWinterton, Sir Nicholas (Macclesfield)
    Taylor, Ian (Esher)
    Taylor, John (Solihull)Yeo, Tim (S Suffolk)
    Taylor, Matthew (Truro)Young, rh Sir George
    Taylor, Dr. Richard (Wyre F)Younger-Ross, Richard
    Taylor, Sir Teddy
    Thomas, Simon (Ceredigion)

    Tellers for the Noes:

    Tonge, Dr. Jenny

    Mr. Robert Syms and

    Tredinnick, David

    Hugh Robertson

    Question accordingly agreed to.

    Lords amendment disagreed to.

    Lords amendment No. 3 agreed to.