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Orders Of The Day

Volume 401: debated on Wednesday 19 March 2003

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Community Care (Delayed Discharges Etc) Bill

Lords amendments considered.

Clause 1

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

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.

    Clause 2

    Notice Of Patient's Possible Need For Community Care Services

    Lords amendment: No. 5, in page 2, line 5, after "hospital" insert "after 1st April 2004".

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

    With this it will be convenient to discuss Lords amendment No. 47 and the Government motion to disagree.

    Lords amendment No. 5 would delay for a year until April 2004 the implementation of the policy outlined in the Bill. When we announced the policy in April 2002, we were keen to implement it by April this year so that older people could benefit as quickly as possible from the improvements in services and procedures that we firmly believe the Bill will bring. They include: focus on the individual, and ensuring that people get the right care at the right time and in the right place; the introduction of incentives to invest in alternatives in the community so that older people are not trapped in hospital when they would be better treated outside; and a clear framework for partnership between health and social care locally.

    2.30 pm

    We know from the implementation team that we have established that many areas have made significant achievements since we announced the policies. The Bill has led to an unprecedented wave of activity around delayed discharge with local authority and NHS partners discussing shared problems and finding common solutions. Several areas have initiated reviews of whole systems to consider discharge processes and community service capacity so that they are well prepared for reimbursement.

    Other areas have planned staff increases or co-location to speed up assessment and improve discharge planning. The Bill can therefore be considered a success already because people know that if they do not make efforts to improve discharge procedures and put services in place, they cannot benefit from the extra funding that we are transferring from the NHS. They will have to reimburse the NHS.

    Before the Minister embarks on a spinning fantasy, will she clarify the reason for her use in Committee and now of words such as "incentives", "bonuses" and "improvements", when the Secretary of State describes the penalties under the Bill as "fines"? Indeed, that is what they are.

    Despite having been involved with the Bill for a long time, the hon. Gentleman fails to understand the principle that payment follows responsibility. His failure to understand is not my fault. When responsibility for providing services based on the individual's needs shifts from the NHS to social care, so should responsibility for payment.

    The Bill can already be considered a success and we are worried that amendment No. 5 in particular puts that at risk. One social services manager stated that in the past five years he had never witnessed so much commitment to reducing delays in the NHS and social care. That is not an isolated remark. People who attended a recent conference, which our change agents team ran, stated that, far from wrecking partnership—Conservative Members have sometimes alleged that—the pressure to improve discharge that the Bill generates led staff from the NHS and social services to discuss together, sometimes for the first time, plans to reduce delays in their local hospitals.

    There is a genuine risk that the benefits of that concentrated effort will be lost.

    I fear that the Minister risks creating a pervasive cynicism about the Bill—even more pervasive than that that has existed hitherto—unless she responds properly to the point of my hon. Friend the Member for West Chelmsford (Mr. Burns). If people incur a financial cost for doing something that they should not, or for failing to do something that they should, can the Minister think of a shorter or more accurate term for what they face than "fine"?

    A fine implies that someone is not supposed to be doing something. It is strange that the hon. Gentleman does not realise that we are considering putting right a position in which all the incentives in the system are for leasing people in hospital over a longer period because the NHS effectively pays for the needs of largely older people, responsibility for which should rest with social services departments.

    If the hon. Gentleman wants to argue for cost-shunting and shifting responsibility, he should do so. The Bill aims to put matters right.

    If the Minister will allow me, I will exercise my discretion over the language that I deploy. I would not settle for the rather down-market lexicon that she has in mind for me. If she will not use the word "fine", why does the Secretary of State continue to do that regularly?

    Perhaps the hon. Gentleman should ask the Secretary of State. My right hon, Friend and I share an understanding that at present—[Laughter.] We can laugh and banter about words, but Conservative Members should be ashamed of the underlying reason for the measure. In 1997, 6,800 people were inappropriately delayed in hospital. Our investment and reforms have reduced that number.

    I should be interested to know when that happened. There is a significant reduction in the number of delayed discharges that we inherited from the previous Government. Investment and some top-down management have brought that about. We have argued that such a system is not sustainable. We need to ensure that the system includes incentives for the considerable extra investment in local authorities to be spent on alternatives that provide that older people can get out of hospital when necessary. The Bill will achieve that. As I said earlier, to some extent it already ensures that that happens. It gives an impetus to the joint working that we need and the focus on the needs of individuals when they are ready to be discharged from hospital.

    Accepting the amendments will convey the message that the work can be put on hold for a year. The impetus that has built up will be wasted and a continued and sustained reduction in waiting times for discharge will be delayed.

    We have listened to the anxieties of the NHS, local government, the voluntary sector and responsible hon. Members about the speed of implementation and the need for time for new investment in services to bear fruit. The Government have therefore proposed delaying implementation for six months until October 2003. As Lord Morris said in another place:
    "The benefits of this Bill are urgently needed and I believe it is not too late to avoid delaying their delivery … There is still time for consensus to be reached on this Bill and those it seeks to help deserve no less."—[Official Report, House of Lords, 17 March 2003; Vol. 646, c. 19.]

    Will the Minister explain to a simple soul like me why it makes things better for the people who have to implement the measure in the real world to introduce it half way through a financial year? Is that sensible? What sort of chaos will that produce in the system?

    We would have preferred to introduce the measure in April but we listened to what people in the real world said about their worries. [HON. MEMBERS: "Lords."] Whether hon. Members in another place are the people in the real world is questionable, but we listened to people who operate in the real world and we shall ensure, through the delay in implementation, that the considerable extra investment from April 2003–04 makes the necessary impact without delaying, to the detriment of largely older people, the incentives that the Bill establishes and the action that it has prompted. Those older people will benefit from the provisions and already benefit from the reduction in delayed discharge that the prospect of action has brought about. I do not understand what can be gained from delaying implementation for a year. There is something to lose from that.

    The Minister has been telling us that the Government have been listening to real people outside this place. Will she comment on why the Government chose to ignore their own consultation results, which showed that primary care trusts, social services departments and voluntary organisations of all sorts told the Government that they wanted a delay of at least a year, and to see implementation no earlier than 1 April 2004?

    As I was explaining, we listen not only to those who provide the services, but to the people who need them. They are the older people who, in too large numbers, are being trapped in hospital when they would be better off being treated outside. We believe that the Bill will make a difference to those older people, and that is why we are keen to ensure that it is implemented as soon as possible. Of course we need to listen to the people who provide the services, but those—largely older people—who are being delayed in hospital when it would be more appropriate to treat them outside are at the heart of the Bill and of our concerns.

    If it really is the view of elderly people that the Government should proceed as she has just outlined, why has Age Concern written to every Member of Parliament totally disagreeing with her?

    Various groups have taken various positions on this, but I reiterate my view that the Bill is about ensuring that those older people who are currently not getting the deal that they deserve can get a better deal. That is why I do not believe that we have anything to gain from delaying implementation for a whole year. Indeed, as I was saying, we have something to lose. The Secretary of State announced on Second Reading, having listened to the concerns of people—particularly those in local authorities who had the responsibility of providing those alternatives in relation to community care—that, in addition to the doubling of the real rate of increase of social services funding, we would also make a transfer from the NHS to social services budgets. If implementation were delayed for a full year, councils would not receive any additional funding in 2003–04. If it were delayed for six months, and councils received £50 million for that period, they could invest that money during the first part of the year and be able to invest in the staff or services that they needed, in order to avoid reimbursement charges when the scheme is implemented.

    Will the Minister share with the House the conclusions that the Government had reached about how they would have distributed the £100 million? Would it have been targeted at those authorities that were doing least well in facilitating discharges from hospital, or those that were being the most effective? What decisions had the Government taken on that?

    Depending on the progress of the Bill, we hope to be able to issue for consultation our decisions on how that would happen. The whole point of the investment is that it should facilitate the necessities contained in the legislation. The hon. Gentleman makes an important point about one of the disadvantages of the considerable investment—in the form of the building care capacity grant—that has been distributed to local authorities during 2001–02 and 2002–03. We took the decision—rightly, I believe—to focus that investment on particular hot-spot authorities. That was characterised by some local authorities—wrongly, in my view—as rewarding failure, or rewarding those authorities that had not properly tackled the problems of delayed discharge. That bears heavily on our consideration of how—given the successful passage of the Bill—we should distribute the money that is being transferred from the NHS. That will be part of our consideration.

    I am extremely grateful to the hon. Lady for giving way. She knows the high esteem in which I hold her, but I am bound to say that she has not persuaded me, she has clearly not persuaded the House and it seems uncertain whether she has yet managed to persuade herself of this argument. How many individuals or organisations have written to her to express their opposition to the idea of an implementation date of April 2004? She said that there was a miscellany of different opinions: how many, and who?

    2.45 pm

    Nobody has written to us to oppose an implementation date of April 2004. Having said that, nobody—so far as I am aware—has written to us to oppose an implementation date of October 2003 either. People recognise that the Government have proposed a sensible delay of six months, which would maintain progress rather than stymieing it and kicking it into the long grass—as Conservative Members want to do—to the detriment of the older people who will benefit from this legislation. We must maintain the momentum, so as to build on the good progress that has been made. If we do not, the older people who are trapped in acute beds will continue to suffer.

    Conservative Members have attempted to introduce a variety of ways of wrecking this legislation, aided by their colleagues in another place. The first was to delay the implementation. The second is represented by amendment No. 47, on which I also urge my colleagues to disagree with the Lords. It is effectively a sunset clause, under which the part of the Bill that puts in place the necessary incentives would cease to have effect after five years. This is an entirely inappropriate use of a sunset clause. They are generally used only in Acts that are passed because of national emergencies or are restrictive of civil liberties. Clearly this is not such a Bill. It is, however, a Bill that the Opposition are trying to limit in every way that they can, by delaying the start and limiting its life.

    The argument for this amendment in the other place appeared to be that, because the provisions in the Bill would make a difference, it was necessary to limit their life. Certainly under this Government, the majority of Bills—in fact, all the Bills that we introduce—contain elements of policy that are new, because they are intended to bring improvement and changes. Of course, all policies should be evaluated and monitored—how else can the Government ensure that they are successful, and improve them if necessary? However, we already have reliable and well-established procedures and monitoring systems in place to monitor the impact of particular policies.

    In the unlikely event that the Bill does not work in the way that we want it to, we would want to act well before the end of five years. If, on the other hand, as I expect, it drives action on delayed discharges to the point at which hardly any charges will be changing hands at the end of the five-year period, why do we need a sunset clause? Although I suspect that the good practice around planning and assessment underpinned by the Bill would continue, with or without legislation, there would be little additional activity moving funding around. However, one would not want to repeal the Act, since the possibility of charging would remain to ensure that performance on delays did not drift again. As we have heard in the interventions that have been made today, the two amendments are clearly about wrecking and limiting the effects of the Bill. On that basis, I hope that hon. Members will disagree with the Lords.

    May I say from the outset that the Conservatives would like two separate votes on Lords amendments Nos. 5 and 47 at the appropriate time?

    However loveable the Minister might be, one has to admire her sense of humour and her nerve in trying to convince the House about certain issues today. I want to deal briefly with two of them. One is the ongoing battle over the question of fines. To her credit, the Minister has found every word in the thesaurus to try to describe the main thrust of the Bill, except the one word that describes it completely. That word is "fines". It is to the Minister's lasting annoyance that her Secretary of State—

    No, I will not.

    It is to the Minister's lasting annoyance that her Secretary of State caught her out in his statement after the Budget, when he described his own legislation as "fines". Finally, on Report, the Minister herself had the honesty to use the F-word.

    I will, although I am slightly surprised that the hon. Gentleman has spoken as he has. I, too, read Ceefax a few days ago, when he announced to the world in bold terms that because of the Government's policy on Iraq he would not support the Government—his Government—in any Divisions on any matter.

    That just goes to show that you should not believe all you read in the press. I am proud to support the Government on this, and on many other aspects of their legislative programme.

    As the hon. Gentleman may recall, we have been around the block before. Will he put himself in the position of a nursing home owner looking after a person who need not remain in the home because his or her needs have changed, who is faced with all the costs of having to care for that person? Is nor, the use of the word "fines" entirely misplaced? We are talking about a charge for services. When the hon. Gentleman next goes to a hotel, will he expect to pay, or will he complain to the proprietor that he has been fined?

    I know that there will be a reshuffle shortly because of losses on the Government Front Bench, but I must tell the hon. Gentleman that regardless of whether I believe what I read in the press, the press know what he said. I do not want to disappoint him, but I think that as a result of what he said he will not be considered by the Whip who is currently on duty, or by her colleagues, in the forthcoming reshuffle. As for his narrow point on fines, "fines" is his own Secretary of State's terminology for what the Government are doing. By all means let the hon. Gentleman be a help to the Government from the Back Benches, but let him at least be consistent with his Secretary of State.

    Let me deal briefly with a point of fact. The Minister challenged my hon. Friend the Member for Woodspring (Dr. Fox) about the number of detailed discharges, saying that when my Government left power in May 1997 the figure was just over 6,000 and that since her Government came to power the figure had always been lower and falling. I remind the Minister—for I too have the facts—that in 2001–02, four years almost to the day after this Government came to power, the figure was 6,361, and that in the second quarter it had risen to 7,065. She really must not try to confuse the House with spin that is not based on factual reality.

    Does the hon. Gentleman accept that the number of people aged 75 and over whose discharges have been delayed was 3,502 in December 2002? Is that figure not less than half the 6,985 that the Government inherited?

    On the basis of parliamentary written answers I have received from the Minister, I accept that the figures have dropped. There is no secret about that. It is, however, bogus codswallop for the Minister to claim, as she did in her speech, that the result was achieved through the success of a Bill that has not even become law—although we are now used to new Labour, new spin.

    The Lords amendments are at the nub of why my colleagues and I, along with many others, oppose this nasty piece of legislation. As I am sure you know, Madam Deputy Speaker, success has many fathers and failure is an orphan. One could list the examples, but as was pointed out by my hon. Friend the Member for Buckingham (Mr. Bercow) and my right hon. Friend the Member for North-West Hampshire (Sir George Young), in the real world in which people look after the elderly in hospital, care homes or their own homes on a daily basis there are no friends for the Bill: it is very much an orphan. Its only supporters are the Minister, her boss and her Back Benchers—with notable exceptions. The wise Chairman of the Select Committee does not support it, along with many other Labour Members.

    Those Members do not support the Bill because it is wrong in its intent to introduce a system of fines that will do incalculable damage to the tremendous progress that has been made over the past decade or so in getting the NHS and local authorities to work together in the whole area of care for the elderly and discharge from hospital. As has been said by many local authorities and by the Local Government Association—led by Sir Jeremy Beecham, a Labour councillor I believe—it will damage, perhaps destroy, those working relationships. It will also set the NHS against social services departments. There are better ways of legislating. Moreover, the proposals are unfair. As we all know—except, of course, the Minister, who is in constant denial because this is not good news for the Government—more than 60,000 care home beds have been lost over the past six years.

    The hon. Gentleman knows only too well that that figure, which he keeps parroting, is completely wrong. He knows that the Health Committee, of which he is a member, came up with a figure that, although it did not accord with the Government's figure, certainly did not accord with the Tories' 50,000 figure, which has now risen to 60,000. I respect the hon. Gentleman, who does a good job on the Committee, but he must accept that sometimes we come up with the facts rather than the fiction that he has just presented.

    I respect the hon. Gentleman too. We have a mutual admiration society. If he returns to the relevant papers, however, he will be reminded that we asked the Select Committee to look into the matter and try to find a solution. The Committee said that both figures were right: my figure and the figure of about 19,000 that the Government gave about 18 months ago. The papers go on to say, though, that the Government's figure excludes the number of beds lost in the local authority sector. If the local authority figures are added to the private sector figures, we reach the figure that I have given.

    No, because this is a timed debate and I want to make progress. Along with Lang and Buisson, an independent body, I believe that my figure is correct.

    The fines will put pressure on social services departments to bring about inappropriate and premature discharge of patients from hospitals. Already—although, interestingly, the Minister did not mention this—the rate of readmission of over-75s has increased dramatically in the last few years. Let me give the Minister the figures. There were 12,165 readmissions within seven days of discharge in the second quarter of 2001–02; the number had risen to 13,813 by the third quarter of 2002–03. That is an increase from 2.9 to 3.3 per cent. Similarly, emergency readmission rates for up to 28 days have risen from 2.9 to 4.9 per cent. By putting unfair financial penalties on the system, patients will be discharged from hospital prematurely, and will perhaps not receive the most appropriate care. As the figures suggest, the result will be unacceptable and unfair readmittance for those patients.

    3 pm

    I believe that we must seek to bring down the level of delayed discharges. Everyone in this House accepts that having people in hospital who should not be there, and at a considerably greater expense than if they were out of hospital, is an utter waste of money; where we disagree is on the solution to the problem. To bring in a simplistic policy that sets local authority against the health service and vice versa, and which can lead to inappropriate and hasty discharges from hospital, and to readmissions, is the wrong way to proceed. I hope that many Members will join me in voting for amendment No. 5, which would postpone the introduction of this legislation by a year, to 1 April 2004.

    As a sop to Back-Bench Labour MPs who were in revolt on Second Reading, the Secretary of State announced that health service money would be made available to social services to help them pay the fines that they will incur if they fail to comply with this law. However, postponing enactment of the legislation beyond the six months proposed by Lord Hunt following the introduction of this amendment would provide a year during which the money made available by the Department of Health could be invested to improve the situation, and to minimise the problems of delayed discharge. [Interruption.] The Minister nods in a negative way. Does that suggest—[Interruption.] Nodding in a negative way may be a contradiction in terms, but that is what she was doing. Is she suggesting that if this amendment were successful and the law's introduction were to be delayed by a year, the Government would not make that money available for the financial year 2003–04? If so, that differs from what the Government have been saying so far. If not—if the money will be paid out this April—it would be better to invest the money for a year in the health service, and in local authorities and social service departments, to seek to minimise the problem of delayed discharge. Then, if we have to, we could introduce the system of fines next year, after a year of investing the money to seek to minimise the problem.

    If this legislation is as wonderful as the Minister claims, there should be a sunset clause—amendment No. 45—so that it is removed from law within five years of coming into force. The Minister asked what would happen if the problem were solved before then, but the answer is very easy for the Government. All that they would have to do is to repeal the law immediately; they need not wait for the sunset clause to take effect.

    For those reasons, we should agree with the Lords. The Government may find it difficult to believe this now, but they will believe in time that the other place has in fact done them a favour by passing these amendments. In doing so, they have provided a semblance of improvement to what, in essence, is nasty legislation.

    As my hon. Friend the Minister knows, I share some of the disquiet evinced by my hon. Friend the Member for Wakefield (Mr. Hinchliffe), who chairs the Select Committee that has dealt with this Bill. In this instance, it seems somewhat less than fair to impute blame—essentially, that is what we are doing—in respect of an elderly or frail person who is kept in hospital for an unnecessarily long time because social services have not been able to create the proper care environment past their recovery.

    I shall not rehearse the arguments that I made on Second Reading, and I am grateful to the Government for listening to the concerns that have been expressed by my own local authority and by voluntary organisations throughout London. However, in a sense, a period of six months is neither fish nor fowl, nor good red herring. There are specific difficulties, of which my hon. Friend the Minister will be aware, that impact particularly on authorities such as mine, which represent inner-London boroughs. No one could argue that the borough of Camden has been lax on this issue, and I know that the Government would not attempt to do so. It is a beacon authority, and it has made extremely good use of the additional funding provided by the Government. It is assiduous in attempting to incorporate a properly constructed care package, with proper input from individuals or their carers. However, there are real difficulties in central London relating to the availability and cost of properties, and, on the most simplistic of levels, to the availability of a work force who are capable of adapting, say, an individual's private home for the necessary bathroom, shower and fitments, so that they can live within their own property. There are also grave difficulties in ensuring security of domiciliary care, when that is included in the package.

    I raise these issues—I have no doubt that the Minister is aware of them—simply to ask the Government to consider, even at this late stage, delaying the Bill's introduction. As I said on Second Reading, I know that their heart is in the right place. No one wishes to see the elderly or frail kept in hospital if an alternative location would not only probably make them infinitely happier, but ensure their future health. There are real difficulties, but there is no difficulty as far as my local authority social services are concerned in attempting to create partnerships. Indeed, they have created extremely effective partnerships not only with the national health service and the voluntary sector, but with the private sector, which they deal with in many instances, to ensure the creation of a proper care package for individuals. However, there are difficulties in ensuring that internal office systems are the same—an issue that is not exclusively the responsibility of local authorities or of the NHS.

    Solving such practical difficulties takes time, and I should point out to the Minister that it also takes money. I have my doubts about how beneficial it is to move £100 million from one aspect of the provision of care to another. However, it would be a shame if the money that the Government are investing were to be spent somewhat hastily not only because of the pressure resulting from the Bill's introduction, but because of the time pressure on the introduction of these requirements. As we know, more haste means less speed, but it also often means spending unnecessary amounts of money.

    I ask the Government to consider the points that I have made and perhaps to delay the Bill's introduction. That would address many of the anxieties experienced not only by my local authority social services department and the NHS, but, most importantly—I stress this point to the Minister—by those who care for the elderly. They are looking for a properly structured care package, and they are anxious about the time pressure resulting not only from the Bill itself, but from its introduction. If it were possible 10 extend the period before its introduction, many of my constituents would be very grateful.

    I agree with many of the points that have just been made by the hon. Member for Hampstead and Highgate (Glenda Jackson), and she probably speaks for all Members when she says that we do not want people to be stuck in hospital unnecessarily. That is absolutely the case, and we would support any measures that facilitate appropriate discharges. Our fear and our belief is that the Bill does not facilitate appropriate discharges. Some of the Minister's comments gave me the strong impression that the anxiety of the Government is not so much to secure the appropriate discharge of an elderly person as to free up a bed so as to facilitate other NHS objectives.

    It is wrong if someone is discharged prematurely. That is why we have seen a massive increase—

    In a moment, when I have finished answering the hon. Gentleman's sedentary intervention. We have seen a massive increase in emergency readmissions. Indeed, the National Audit Office, in its report on delayed discharges, identified that as a serious risk. A focus on discharges may increase the number of emergency readmissions.

    Neither the hon. Gentleman nor the Conservative Front-Bench spokesman appears to understand that the decision to discharge is a clinical decision, and nothing in the Bill will affect the clinical decision about when a patient may be safely discharged.

    The hon. Gentleman is a member of the Health Committee and took part in the evidence sessions. He will have heard the officials from the Department talk the Committee through the definition, and they made it clear that it was not just a clinical decision. They said that the decision to discharge was a multi-disciplinary one.

    When the National Audit Office published its report in February, after we had finished our initial consideration of the Bill, it included some interesting findings that we must consider when deciding whether we should retain the Lords amendments. Those findings make a strong case for delay so that matters may be properly considered.

    The first is the finding of the NAO about the accuracy of the measurement of delayed discharges. According to the report, the NHS finds it difficult 'to provide accurate and reliable figures. Indeed, a survey found that only 27 per cent. of NHS trusts provided figures based entirely on the definition issued by the Department. Some 22 per cent. of trusts used only a vague approximation of the definition and 44 per cent. did not follow the definition at all and were, therefore, supplying incorrect and unreliable data to the Department. Those are the data being used by Ministers to frame their policy and to demonstrate a reduction in the number of delayed discharges. From the work of the NAO, we know that we cannot place confidence in those figures.

    The NAO report states:
    "Continued inaccuracies in this data could affect the effective implementation of the Community Care (Delayed Discharges etc.) Bill, if it becomes law from April 2003, as the data will form the basis for calculating reimbursements payable by Councils to acute hospitals as part of the new arrangements".
    I hope that the Minister will be able to explain why she has such confidence in the figures, given the findings of the NAO.

    The other issue that I hope the Minister will consider is the Coughlan judgment and continuing NHS care. In the light of the health service ombudsman's report last month, real anxiety still exists that the guidance issued by the Department of Health in 2001 is misleading, inaccurate and does not comply with the Coughlan judgment and is, therefore, not in accordance with the law. As a consequence, people are being passed from the NHS to social services departments, where they are means-tested for their care, when they should have continued to be the responsibility of the NHS.

    I hope that the Minister will tell us more about what steps the Department will take to ensure that it issues proper guidance on delayed discharge and discharge planning to clinicians who take initial decisions about the appropriateness of discharge, so that they can make a proper assessment of any continuing health care needs. Clinicians judge not only whether the need is still acute but also whether the need is continuing. If it is, the NHS clearly has a responsibility to continue funding care whatever the patient's location after discharge. That is not clear in the present guidance or in the majority of the rules used by local health authorities to guide those who make the decisions.

    3.15 pm

    My final concern, which is picked up in the NAO report several times, relates to capacity, which has been a running theme since Second Reading. The report finds that many parts of the country—especially London and the south-east—now have occupancy rates of more than 90 per cent. in care homes. The lack of capacity means that the NHS cannot discharge patients. If the Bill were to be implemented from 1 April this year, the extra resources for social services—for which I voted—would not be available in time to bring extra capacity on stream. The issue is not only care home capacity, but home care capacity, as the NAO report confirms. There is a shortage of care home workers and new ones cannot be recruited overnight.

    For those reasons, the Liberal Democrats believe that the Lords amendments should continue to stand part of the Bill. The Lords were right and wise to say that the sun should not rise over the Bill until we have got the detailed answers to the points made by the NAO, which we have raised time and again with Ministers without receiving proper answers. I hope that the Minister will be able to reassure us, but I will encourage my colleagues to support the retention of the sunset and sunrise clauses in the Lobby this afternoon.

    When the Bill was introduced, several Labour Members wished to consider whether it would be possible to improve it fundamentally. We had grave doubts that the mechanism in the Bill was the right one to adopt in the circumstances. The only common ground we could reach on what amendment could be made is reflected in Lords amendment No. 5, so I support it as all that could be done to improve what is not good legislation. I regret having to say that, but I made my views clear on Second and Third Reading.

    The Government have taken many steps to address is a major problem in the NHS and they have done much to improve the working relationship between the NHS and social services. The Government have produced a definition of a delayed discharge—on that point, I disagree with the hon. Member for West Chelmsford (Mr. Burns), because I recall asking the previous Government about delayed discharges, but they did not even have a definition for them. It is commendable to try to establish what we mean by delayed discharge, because it is useful to know exactly what the problem is before addressing it. However, I take the point—picked up in the Health Committee's inquiry into delayed discharges—that several different approaches have been taken to the definition, which will cause problems when trying to apply a common system such as that in the Bill.

    I agreed with some of what the hon. Member for Sutton and Cheam (Mr. Burstow) said a moment ago, and with virtually everything that my hon. Friend the Member for Hampstead and Highgate (Glenda Jackson) said a little earlier. I object to the common thread that appears in debates such as this—that our problems in this country could be solved by making more institutional care available. The lack of care home capacity is mentioned time and again. It saddens me that that is repeated as though it is factually correct. In this country, the problem is that far too often we have gone down the road of providing institutional care for elderly people. We have not examined how we could take concrete steps to develop alternatives.

    To be fair to the Government, they accept that. It frustrates me that other European countries not very far away provide no care homes or nursing homes at all. People in their old age are afforded much more in the way of independence and rights than elderly people in this country are offered. It is about time that we kicked into touch the nonsensical proposition that we should have more and more institutional care for old people. It is simply untrue.

    Does my hon. Friend agree that a good example of what he describes can be found much closer to home than Denmark? The hon. Member for West Chelmsford (Mr. Burns) completely undermined his argument about care home places when he told us how successful the Government have been in introducing partnerships and in forging partnerships between health and social care services. The public, private and voluntary sectors work really well together.

    Yes. It is also about time we recognised that a reduction in the number of care home places is a success, providing that we are assured that the alternatives to that form of care are being developed. Far too often, colleagues in other parties assume that the way to make progress on these matters is to provide more and more institutional care in the private sector. I profoundly disagree with that.

    My hon. Friend the Minister said that there were 6,000 inappropriately delayed people in NHS beds. The Health Committee did some costings on the matter, which were very worrying. Money is being wasted that could be invested in treating the people in those beds who need treatment.

    However, as I and one or two others noted on Second Reading, it is worrying that so much emphasis is being given to delayed discharges. As I know from my own local hospital, inappropriate admissions are another significant problem. If we are applying one approach to delayed discharges, it would be inconsistent not to apply a similar approach to inappropriate admissions. I would be more convinced that the proposed mechanism was going to work if it was being applied in an even-handed way, and if it was proposed to establish a mechanism that would push costs back to the people who are making the inappropriate admissions in the first place. Why are they doing that? We need to find out.

    I want to refer to what the Health Committee has said in connection with the amendment. I hope that, on the many issues that we investigate, the Committee's comments are seen to be constructive and helpful. They are made on the basis of the evidence that we take, and on the basis of the cross-party consideration of matters. Committee members belong to different parties, and those that belong to the same party often have different views. Even so, we came to some clear conclusions on the matter, and I should like to refer to a couple of them now.

    At paragraph 162, the Select Committee states:
    "While there was some cautious support for the model"—
    that is, the model being adopted by the Government now—
    "the predominant reaction was that the proposals constituted a blunt instrument that, rather than improving partnership, would be likely to reinforce a negative blame culture. We are especially concerned that the underlying assumptions behind the charging proposals is that most delays in the system are the fault of social services. As we have emphasised throughout this report, the causes of delay are Complex and multi-factoral. It is far from clear that the issue can be resolved by such a crude solution."
    The Government's approach is a crude solution. The Committee also went on to say that it agreed
    "that appropriate incentives have a role to play, but we would also urge the development of positive incentives that reward good practice, rather than any precipitate and over-zealous emphasis on penalties. We recommend that any new schemes should be subject to piloting."
    I am sorry that the Government have not picked up on that point. The amendment that proposes a delay of a year is the nearest sensible suggestion to what the Health Committee proposed in the report.

    Finally, these problems come up time and again, in all sorts of bits of legislation. We have a go at them around the edges, but we never address the fundamental) problem—the organisational division between health and social services. In the previous Parliament, the Committee, which had a completely different membership, came to the key conclusion that the only real solution is to integrate our health and social care systems. That requires common budgets. The Health Committee's most important conclusion in respect of delayed discharges is that we should integrate health and social services.

    I shall say no more this afternoon. I shall go and lie down now that I have made my contribution. I hope that, at some point, the Government will adopt what is increasingly the consensual opinion among people in the voluntary sector and in pressure groups—that there is a need to examine the matter radically. Once and for all, we must end the nonsensical division between these two key areas of policy.

    It is a pleasure to follow the hon. Gentleman, who has been brave and consistent in his hostility to the Bill. I agree with what he said about the need to take an even-handed approach rather than just singling out social services for fines.

    I spent yesterday speaking and voting in favour of the Government, but my generosity is curtailed on reaching this Bill, which, as I said on Second Reading, is one of the worst Bills that I have ever seen. The Minister is pushing her luck. As it stands, the Bill comes into effect in April next year. Had there been a vote on Second Reading in the upper House, it would have been lost. There was only one speech in its support and there was nearly a vote, so the Government are lucky that it still exists.

    The Minister tells us that she has listened and that as a result she is delaying the Bill for six months, but when we propose a 12-month delay we are told that we are trying to wreck it. This is not a wrecking amendment. It is supported by Age Concern, the Local Government Association and several peers in another place who support the Minister's party, not mine. She says that the Bill is in the interests of older people, but I wonder whether she is the best advocate for their interests, given that we have received clear advice from Age Concern that it, too, would prefer the delay. The Bill remains fundamentally unpopular. The NHS Confederation, the organisation that it is proposed to assist, is resistant, as are the Local Government Association, the British Medical Association, the nurses and the voluntary organisations. The Bill is without friends.

    Is my right hon. Friend aware that in Sweden, whose position is cited in support of the Bill—the Government clearly have to go as far as Sweden to find anyone who might speak out in its favour—it took some two years to implement similar legislation, but in a much simpler system?

    My hon. Friend is right. That is why several organisations have argued for piloting. Of course, if the measure were delayed for 12 months there would be an opportunity to pilot it.

    The Minister kept talking about the real world, but in reality the only world in which the Bill has any support at all is her world of Health Ministers. If one talks to anyone else, one finds that they are fundamentally opposed to the Bill. She has produced no new arguments. The protests against the Bill are undiminished. It remains fundamentally misconceived. It puts tension where we need partnership and focuses on just one part of what should be a holistic process.

    I will not, because the Minister should in fairness be allowed two or three minutes in which to reply. I hope that the hon. Gentleman did not support the guillotine that imposed this time scale on our consideration of the Bill.

    If the Minister is well advised, she will save the House one Division, leave Lords amendment No. 5 as it is, and thank her lucky stars that the Bill was not completely demolished in another place.

    First, I shall respond to my hon. Friend the Member for Hampstead and Highgate (Glenda Jackson), who identified the pressures on community care services as an argument for a longer delay than I would be happy with—I shall come back to the reasons for that later. She is right that we need to build up alternatives to hospital. We need to ensure, as has the £300 million which has been made available over a period of 18 months in preparation for the Bill, that that process allows us to build capacity in the care homes sector and to develop domiciliary care. All our evidence is that that money is already having that effect. We also base the Bill on the fact that from April we will increase investment into social services departments by 6 per cent. in real terms and that we will introduce access and systems capacity grant of £170 million—

    No, I will not, because I am winding up. The hon. Gentleman should have stayed for the debate if he was that interested.

    The argument therefore is that we need longer in order to ensure that that money has an effect. Part of our justification for the Bill is that, in order to ensure that the extra investment is going into those community alternatives, we need to focus both on the individual and the incentives. That is what the Bill allows us to do. I repeat to hon. Members—and this was a new argument—that we now have experience from the field about the momentum that has resulted from this legislation. I hope that I will have the opportunity later of responding to some of the points that were raised by the hon. Member for Sutton and Cheam (Mr. Burstow) on continuing care.

    We have to put in place the incentives necessary to focus—

    It being three and a half hours before the moment of interruption, MADAM DEPUTY SPEAKER put the Question already proposed from the Chair, pursuant to Orders [28 June 2001 and 29 October 2002].

    The House divided: Ayes 330, Noes 205.

    Division No. 120]

    [3:30 pm

    AYES

    Adams, Irene (Paisley N)Cryer, Ann (Keighley)
    Ainger, NickCummings, John
    Alexander, DouglasCunningham, Jim (Coventry S)
    Allen, GrahamCunningham, Tony (Workington)
    Anderson, rh Donald (Swansea E)Curtis-Thomas, Mrs Claire
    Anderson, Janet (Rossendale & Darwen)Dalyell, Tam
    Davey, Valerie (Bristol W)
    Armstrong, rh Ms HilaryDavid, Wayne
    Atherton, Ms CandyDavidson, Ian
    Atkins, CharlotteDavies, rh Denzil (Llanelli)
    Austin, JohnDavies, Geraint (Croydon C)
    Bailey, AdrianDavis, rh Terry (B'ham Hodge H)
    Banks, TonyDawson, Hilton
    Barnes, HarryDean, Mrs Janet
    Beard, NigelDhanda, Parmjit
    Beckett, rh MargaretDismore, Andrew
    Begg, Miss AnneDobbin, Jim (Heywood)
    Bell, StuartDobson, rh Frank
    Benn, HilaryDonohoe, Brian H.
    Bennett, AndrewDoran, Frank
    Benton, Joe (Bootle)Dowd, Jim (Lewisham W)
    Berry, RogerDrew, David (Stroud)
    Best, HaroldDrown, Ms Julia
    Betts, CliveDunwoody, Mrs Gwyneth
    Blackman, LizEagle, Angela (Wallasey)
    Blizzard, BobEagle, Maria (L'pool Garston)
    Boateng, rh PaulEdwards, Huw
    Borrow, DavidEfford, Clive
    Bradley, rh Keith (Withington)Ellman, Mrs Louise
    Bradley, Peter (The Wrekin)Ennis, Jeff (Barnsley E)
    Bradshaw, BenEtherington, Bill
    Brennan, KevinFarrelly, Paul
    Brown, rh Nicholas (Newcastle E Wallsend)Field, rh Frank (Birkenhead)
    Fitzpatrick, Jim
    Bryant, ChrisFitzsimons, Mrs Lorna
    Buck, Ms KarenFlint, Caroline
    Burden, RichardFlynn, Paul (Newport W)
    Burgon, ColinFollett, Barbara
    Burnham, AndyFoster, rh Derek
    Byers, rh StephenFoster, Michael (Worcester)
    Cairns, DavidFoster, Michael Jabez (Hastings & Rye)
    Campbell, Alan (Tynemouth)
    Campbell, Mrs Anne (C'bridge)Foulkes, rh George
    Campbell, Ronnie (Blyth V)Francis, Dr. Hywel
    Casale, RogerGapes, Mike (Ilford S)
    Caton, MartinGardiner, Barry
    Cawsey, Ian (Brigg)George, rh Bruce (Walsall S)
    Chapman, Ben (Wirral S)Gerrard, Neil
    Chaytor, DavidGibson, Dr. Ian
    Clapham, MichaelGilroy, Linda
    Clark, Mrs Helen (Peterborough)Godsiff, Roger
    Clark, Dr. Lynda (Edinburgh Pentlands)Goggins, Paul
    Griffiths, Jane (Reading E)
    Clark, Paul (Gillingham)Griffiths, Win (Bridgend)
    Clarke, rh Charles (Norwich S)Hain, rh Peter
    Clarke, Tony (Northampton S)Hall, Mike (Weaver Vale)
    Clelland, DavidHall, Patrick (Bedford)
    Clwyd, Ann (Cynon V)Hamilton, David (Midlothian)
    Coaker, VernonHamilton, Fabian (Leeds NE)
    Coffey, Ms AnnHanson, David
    Cohen, HarryHarman, rh Ms Harriet
    Coleman, IainHarris, Tom (Glasgow Cathcart)
    Cook, Frank (Stockton N)Havard, Dai (Merthyr Tydfil & Rhymney)
    Cooper, Yvette
    Corbyn, JeremyHealey, John
    Corston, JeanHenderson, Ivan (Harwich)
    Cousins, JimHepburn, Stephen
    Cox, Tom (Tooting)Heppell, John
    Cranston, RossHeyes, David
    Crausby, DavidHill, Keith (Streatham)
    Cruddas, JonHodge, Margaret

    Hoey, Kate (Vauxhall)Marsden, Gordon (Blackpool S)
    Hood, Jimmy (Clydesdale)Marshall, Jim (Leicester S)
    Hoon, rh GeoffreyMarshall-Andrews, Robert
    Hope, Phil (Corby)Martlew, Eric
    Hopkins, KelvinMeacher, rh Michael
    Howarth, George (Knowsley N & Sefton E)Merron, Gillian
    Milburn, rh Alan
    Howells, Dr. KimMiliband, David
    Hughes, Beverley (Stretford & Urmston)Miller, Andrew
    Mitchell, Austin (Gt Grimsby)
    Hughes, Kevin (Doncaster N)Mole, Chris
    Humble, Mrs JoanMoonie, Dr. Lewis
    Hurst, Alan (Braintree)Moran, Margaret
    Hutton, rh JohnMorgan, Julie
    Iddon, Dr. BrianMorris, rh Estelle
    Illsley, EricMountford, Kali
    Jackson, Glenda (Hampstead & Highgate)Mudie, George
    Mullin, Chris
    Jackson, Helen (Hillsborough)Munn, Ms Meg
    Jamieson, DavidMurphy, Denis (Wansbeck)
    Jenkins, BrianMurphy, Jim (Eastwood)
    Johnson, Alan (Hull W)Murphy, rh Paul (Torfaen)
    Johnson, Miss Melanie (Welwyn Hatfield)Naysmith, Dr. Doug
    Norris, Dan (Wansdyke)
    Jones, Helen (Warrington N)O'Brien, Bill (Normanton)
    Jones, Jon Owen (Cardiff C)O'Hara, Edward
    Jones, Kevan (N Durham)Olner, Bill
    Jones, Martyn (Clwyd S)Organ, Diana
    Joyce, Eric (Falkirk W)Osborne, Sandra (Ayr)
    Kaufman, rh GeraldOwen, Albert
    Keeble, Ms SallyPalmer, Dr. Nick
    Keen, Alan (Feltham)Perham, Linda
    Kemp, FraserPicking, Anne
    Kilfoyle, PeterPickthall, Colin
    King, Andy (Rugby)Pike, Peter (Burnley)
    King, Ms Oona (Bethnal Green & Bow)Plaskitt, James
    Pollard, Kerry
    Knight, Jim (S Dorset)Pope, Greg (Hyndburn)
    Kumar, Dr. AshokPound, Stephen
    Ladyman, Dr. StephenPrentice, Ms Bridget (Lewisham E)
    Lammy, David
    Lawrence, Mrs JackiePrentice, Gordon (Pendle)
    Laxton, Bob (Derby N)Prescott, rh John
    Lazarowicz, MarkProsser, Gwyn
    Lepper, DavidPurchase, Ken
    Leslie, ChristopherPurnell, James
    Levitt, Tom (High Peak)Quinn, Lawrie
    Lewis, Ivan (Bury S)Rapson, Syd (Portsmouth N)
    Lewis, Terry (Worsley)Reed, Andy (Loughborough)
    Liddell, rh Mrs HelenRoche, Mrs Barbara
    Linton, MartinRooney, Terry
    Lloyd, Tony (Manchester C)Ross, Ernie (Dundee W)
    Love, AndrewRoy, Frank (Motherwell)
    Lucas, Ian (Wrexham)Ruane, Chris
    Luke, Iain (Dundee E)Ruddock, Joan
    Lyons, John (Strathkelvin)Russell, Ms Christine (City of Chester)
    McAvoy, Thomas
    McCabe, StephenRyan, Joan (Enfield N)
    McCafferty, ChrisSalter, Martin
    MacDonald, CalumSarwar, Mohammad
    McDonnell, JohnSavidge, Malcolm
    MacDougall, JohnSawford, Phil
    McFall, JohnSedgemore, Brian
    McGuire, Mrs AnneShaw, Jonathan
    McIsaac, ShonaSheridan, Jim
    McKechin, AnnShipley, Ms Debra
    Mackinlay, AndrewSimon, Siôn (B'ham Erdington)
    McNulty, TonySimpson, Alan (Nottingham S)
    MacShane, DenisSingh, Marsha
    McWalter, TonySmith, rh Andrew (Oxford E)
    Mahmood, KhalidSmith, Geraldine (Morecambe & Lunesdale)
    Mahon, Mrs Alice
    Mallaber, JudySmith, Jacqui (Redditch)
    Mandelson, rh PeterSmith, John (Glamorgan)
    Mann, John (Bassetlaw)Smith, Llew (Blaenau Gwent)
    Marris, Rob (Wolverh'ton SW)Soley, Clive

    Southworth, HelenTwigg, Stephen (Enfield)
    Spellar, rh JohnTynan, Bill (Hamilton S)
    Squire, RachelVaz, Keith (Leicester E)
    Starkey, Dr. PhyllisVis, Dr. Rudi
    Steinberg, GerryWalley, Ms Joan
    Stevenson, GeorgeWard, Claire
    Stewart, David (Inverness E & Lochaber)Wareing, Robert N.
    Watson, Tom (W Bromwich E)
    Stewart, Ian (Eccles)Watts, David
    Stinchcombe, PaulWhite, Brian
    Stoate, Dr. HowardWhitehead, Dr. Alan
    Stringer, GrahamWicks, Malcolm
    Stuart, Ms GiselaWilliams, rh Alan (Swansea W)
    Tami, Mark (Alyn)Williams, Betty (Conwy)
    Taylor, Dari (Stockton S)Wills, Michael
    Taylor, David (NW Leics)Winnick, David
    Thomas, Gareth (Clwyd W)Winterton, Ms Rosie (Doncaster C)
    Thomas, Gareth (Harrow W)
    Timms, StephenWood Mike (Betley)
    Tipping, PaddyWoodward, Shaun
    Todd, Mark (S Derbyshire)Wrignt Anthony D. (Gt Yarmouth)
    Touhig, Don (lslwyn)
    Trickett, JonWright, David (Telford)
    Truswell, PaulWright, Tony (Cannock)
    Turner, Dr. Desmond (Brighton Kemptown)Wyatt, Derek

    Tellers for the Ayes:

    Turner, Neil (Wigan)

    Mr. Ivor Caplin and

    Twigg, Derek (Halton)

    Mr. Phil Woolas

    NOES

    Ainsworth, Peter (E Surrey)Davies, Quentin (Grantham & Stamford)
    Allan, Richard
    Amess, DavidDavis, rh David (Haltemprice & Howden)
    Ancram, rh Michael
    Atkinson, David (Bour'mth E)Djanogly, Jonathan
    Atkinson, Peter (Hexham)Dodds, Nigel
    Bacon, RichardDonaldson, Jeffrey M.
    Baker, NormanDorrell, rh Stephen
    Barker, GregoryDoughty, Sue
    Baron, John (Billericay)Duncan, Alan (Rutland)
    Beggs, Roy (E Antrim)Duncan Smith, rh Iain
    Bellingham, HenryEvans, Nigel
    Bercow, JohnFabricant, Michael
    Beresford, Sir PaulFallon, Michael
    Boswell, TimField, Mark (Cities of London & Westminster)
    Bottomley, Peter (Worthing W)
    Bottomley, rh Virginia (SW Surrey)Flight, Howard
    Flook, Adrian
    Brady, GrahamForth, rh Eric
    Brake, Tom (Carshalton)Foster, Don (Bath)
    Brazier, JulianFox, Dr. Liam
    Breed, ColinGale, Roger (N Thanet)
    Brooke, Mrs Annette L.Garnier, Edward
    Browning, Mrs AngelaGeorge, Andrew (St. Ives)
    Bruce, MalcolmGibb, Nick (Bognor Regis)
    Burnett, JohnGidley, Sandra
    Burns, SimonGillan, Mrs Cheryl
    Burnside, DavidGoodman, Paul
    Burstow, PaulGray, James (N Wilts)
    Calton, Mrs PatsyGrayling, Chris
    Cameron, DavidGreen, Damian (Ashford)
    Carmichael, AlistairGreen, Matthew (Ludlow)
    Cash, WilliamGrieve, Dominic
    Chapman, Sir Sydney (Chipping Barnet)Gummer, rh John
    Hague, rh William
    Chidgey, DavidHammond, Philip
    Chope, ChristopherHancock, Mike
    Clappison, JamesHarris, Dr. Evan (Oxford W & Abingdon)
    Clarke, rh Kenneth (Rushcliffe)
    Clifton-Brown, GeoffreyHarvey, Nick
    Collins, TimHawkins, Nick
    Cormack, Sir PatrickHayes, John (S Holland)
    Cran, James (Beverley)Heald, Oliver
    Curry, rh DavidHeath, David
    Davey, Edward (Kingston)Heathcoat-Amory, rh David

    Hendry, CharlesRandall, John
    Hermon, LadyRedwood, rh John
    Hinchliffe, DavidReid, Alan (Argyll & Bute)
    Hoban, Mark (Fareham)Rendel, David
    Hogg, rh DouglasRobathan, Andrew
    Horam, John (Orpington)Robertson, Hugh (Faversham & M-Kent)
    Howard, rh Michael
    Howarth, Gerald (Aldershot)Robertson, Laurence (Tewk'b'ry)
    Hughes, Simon (Southwark N)Robinson, Mrs lris (Strangford)
    Hunter, AndrewRobinson, Peter (Belfast E)
    Jack, rh MichaelRoe, Mrs Marion
    Jackson, Robert (Wantage)Rosindell, Andrew
    Jenkin, BernardRuffley, David
    Johnson, Boris (Henley)Russell, Bob (Colchester)
    Jones, Lynne (Selly Oak)Sanders, Adrian
    Jones, Nigel (Cheltenham)Sayeed, Jonathan
    Keetch, PaulSelous, Andrew
    Kennedy, rh Charles (Ross Skye & Inverness)Shephard, rh Mrs Gillian
    Simmonds, Mark
    Key, Robert (Salisbury)Smith, Sir Robert (W Ab'd'ns & Kincardine)
    Kirkbride, Miss Julie
    Kirkwood, Sir ArchySmyth, Rev. Martin (Belfast S)
    Knight, rh Greg (E Yorkshire)Soames, Nicholas
    Laing, Mrs EleanorSpelman, Mrs Caroline
    Lait, Mrs JacquiSpicer, Sir Michael
    Lamb, NormanSpink, Bob (Castle Point)
    Lansley, AndrewSpring, Richard
    Laws, David (Yeovil)Stanley, rh Sir John
    Leigh, EdwardStreeter, Gary
    Letwin, rh OliverStunell, Andrew
    Lewis, Dr, Julian (New Forest E)Swayne, Desmond
    Liddell-Grainger, IanSwire, Hugo (E Devon)
    Lidington, DavidSyms, Robert
    Lilley, rh PeterTapsell, Sir Peter
    Loughton, TimTaylor, Ian (Esher)
    Luff, Peter (M-Worcs)Taylor, John (Solihull)
    Mackay, rh AndrewTaylor, Matthew (Truro)
    Maclean, rh DavidTaylor, Dr. Richard (Wyre F)
    Maclean, rh DavidTaylor, Sir Teddy
    McLoughlin, PatrickThomas, Simon (Ceredigion)
    Malins, HumfreyThurso, John
    Maples, JohnTredinnick, David
    Marsden, Paul (Shrewsbury and Atcham)Trend Michael
    Trimble, rh David
    Mawhinney, rh Sir BrianTurner, Andrew (Isle of Wight)
    May, Mrs TheresaTyler, Paul (N Cornwall)
    Mercer, PatrickTyrie, Andrew
    Mitchell, Andrew (Sutton Coldfield)Waterson, Nigel
    Webb, Steve (Northavon)
    Moore, MichaelWhittingdale, John
    Moss, MalcolmWiggin, Bill
    Murrison, Dr. AndrewWilkinson, John
    Norman, ArchieWilletts, David
    Oaten, Mark (Winchester)Williams, Hywel (Caernarfon)
    O'Brien, Stephen (Eddisbury)Williams, Roger (Brecon)
    Öpik, LembitWillis, Phil
    Osborne, George (Tatton)Winterton, Ann (Congleton)
    Ottaway, RichardWinterton, Sir Nicholas (Macclesfield)
    Page, Richard
    Paice, JamesYeo, Tim (S Suffolk)
    Paterson, OwenYoung, rh Sir George
    Pickles, EricYounger-Ross, Richard
    Price, Adam (E Carmarthen & Dinefwr)

    Tellers for the Noes:

    Prisk, Mark (Hertford)

    Angela Watkinson and

    Pugh, Dr. John

    Mr. Mark Francois

    Question accordingly agreed to.

    Lords amendment disagreed to.

    Lords amendment: No. 47.

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

    The House divided: Ayes 333, Noes 203.

    Division No. 121]

    [3.44 pm

    AYES

    Abbott, Ms DianeCummings, John
    Adams, Irene (Paisley N)Cunningham, Jim (Coventry S)
    Ainger, NickCunningham, Tony (Workington)
    Alexander, DouglasCurtis-Thomas, Mrs Claire
    Allen, GrahamDalyell, Tam
    Anderson, Janet (Rossendale & Darwen)Davey, Valerie (Bristol W)
    David, Wayne
    Armstrong, rh Ms HilaryDavidson, Ian
    Atherton, Ms CandyDavies, rh Denzil (Llanelli)
    Atkins, CharlotteDavies, Geraint (Croydon C)
    Bailey, AdrianDavis, rh Terry (B'ham Hodge H)
    Baird, VeraDawson, Hilton
    Banks, TonyDean, Mrs Janet
    Barnes, HarryDhanda, Parmjit
    Beard, NigelDismore, Andrew
    Beckett, rh MargaretDobbin, Jim (Heywood)
    Begg, Miss AnneDobson, rh Frank
    Bell, StuartDonohoe, Brian H.
    Benn, HilaryDoran, Frank
    Bennett, AndrewDowd, Jim (Lewisham W)
    Benton, Joe (Bootle)Drew, David (Stroud)
    Berry, RogerDrown, Ms Julia
    Best, HaroldDunwoody, Mrs Gwyneth
    Betts, CliveEagle, Angela (Wallasey)
    Blackman, LizEagle, Maria (L'pool Garston)
    Blears, Ms HazelEdwards, Huw
    Blizzard, BobEfford, Clive
    Borrow, DavidEllman, Mrs Louise
    Bradley, rh Keith (Withington)Ennis, Jeff (Barnsley E)
    Bradley, Peter (The Wrekin)Etherington, Bill
    Bradshaw, BenFarrelly, Paul
    Brennan, KevinField, rh Frank (Birkenhead)
    Brown, rh Nicholas (Newcastle E Wallsend)Fitzpatrick, Jim
    Fitzsimons, Mrs Lorna
    Bryant, ChrisFlint, Caroline
    Buck, Ms KarenFlynn, Paul (Newport W)
    Burden, RichardFollett, Barbara
    Burgon, ColinFoster, rh Derek
    Burnham, AndyFoster, Michael (Worcester)
    Byers, rh StephenFoster, Michael Jabez (Hastings & Rye)
    Cairns, David
    Campbell, Alan (Tynemouth)Foulkes, rh George
    Campbell, Mrs Anne (C'bridge)Francis, Dr. Hywel
    Campbell, Ronnie (Blyth V)Gapes, Mike (Ilford S)
    Casale, RogerGardiner, Barry
    Caton, MartinGeorge, rh Bruce (Walsall S)
    Cawsey, Ian (Brigg)Gerrard, Neil
    Chapman, Ben (Wirral S)Gibson, Dr. Ian
    Chaytor, DavidGilroy, Linda
    Clapham, MichaelGodsiff, Roger
    Clark, Mrs Helen (Peterborough)Goggins, Paul
    Clark, Dr. Lynda (Edinburgh Pentlands)Griffiths, Jane (Reading E)
    Griffiths, Nigel (Edinburgh S)
    Clark, Paul (Gillingham)Griffiths, Win (Bridgend)
    Clarke, rh Charles (Norwich S)Hain, rh Peter
    Clarke, Tony (Northampton S)Hall, Mike (Weaver Vale)
    Clelland, DavidHall, Patrick (Bedford)
    Clwyd, Ann (Cynon V)Hamilton, David (Midlothian)
    Coaker, VernonHamilton, Fabian (Leeds NE)
    Coffey, Ms AnnHanson, David
    Cohen, HarryHarman, rh Ms Harriet
    Coleman, IainHarris, Tom (Glasgow Cathcart)
    Cook, Frank (Stockton N)Havard, Dai (Merthyr Tydfil & Rhymney)
    Cooper, Yvette
    Corston, JeanHealey, John
    Cousins, JimHenderson, Ivan (Harwich)
    Cox, Tom (Tooting)Hepburn, Stephen
    Cranston, RossHeppell, John
    Crausby, DavidHewitt, rh Ms Patricia
    Cruddas, JonHeyes, David
    Cryer, Ann (Keighley)Hill, Keith (Streatham)

    Hodge, MargaretMann, John (Bassetlaw)
    Hoey, Kate (Vauxhall)Marris, Rob (Wolverh'ton SW)
    Hood, Jimmy (Clydesdale)Marsden, Gordon (Blackpool S)
    Hoon, rh GeoffreyMarshall, Jim (Leicester S)
    Hope, Phil (Corby)Marshall-Andrews, Robert
    Hopkins, KelvinMartlew, Eric
    Howarth, George (Knowsley N & Sefton E)Meacher, rh Michael
    Merron, Gillian
    Howells, Dr. KimMilburn, rh Alan
    Hughes, Beverley (Stretford & Urmston)Miliband, David
    Miller, Andrew
    Hughes, Kevin (Doncaster N)Mitchell, Austin (Gt Grimsby)
    Humble, Mrs JoanMole, Chris
    Hurst, Alan (Braintree)Moonie, Dr. Lewis
    Hutton, rh JohnMoran, Margaret
    Iddon, Dr. BrianMorgan, Julie
    Illsley, EricMorris, rh Estelle
    Jackson, Glenda (Hampstead & Highgate)Mountford, Kali
    Mudie, George
    Jackson, Helen (Hillsborough)Mullin, Chris
    Jamieson, DavidMunn, Ms Meg
    Jenkins, BrianMurphy, Denis (Wansbeck)
    Johnson, Alan (Hull W)Murphy, Jim (Eastwood)
    Johnson, Miss Melanie (Welwyn Hatfield)Murphy, rh Paul (Torfaen)
    Naysmith, Dr. Doug
    Jones, Helen (Warrington N)Norris, Dan (Wansdyke)
    Jones, Jon Owen (Cardiff C)O'Brien, Bill (Normanton)
    Jones, Kevan (N Durham)O'Hara, Edward
    Jones, Martyn (Clwyd S)Olner, Bill
    Joyce, Eric (Falkirk W)Organ, Diana
    Kaufman, rh GeraldOsborne, Sandra (Ayr)
    Keeble, Ms SallyOwen, Albert
    Keen, Alan (Feltham)Palmer, Dr. Nick
    Kemp, FraserPerham, Linda
    Kilfoyle, PeterPicking, Anne
    King, Andy (Rugby)Pickthall, Colin
    King, Ms Oona (Bethnal Graen & Bow)Pike, Peter (Burnley)
    Plaskitt, James
    Knight, Jim (S Dorset)Pollard, Kerry
    Kumar, Dr. AshokPope, Greg (Hyndburn)
    Ladyman, Dr. StephenPound, Stephen
    Lammy, DavidPrentice, Ms Bridget (Lewisham E)
    Lawrence, Mrs Jackie
    Laxton, Bob (Derby N)Prentice, Gordon (Pendle)
    Lazarowicz, MarkPrescott, rh John
    Lepper, DavidProsser, Gwyn
    Leslie, ChristopherPurchase, Ken
    Levitt, Tom (High Peak)Purnell, James
    Lewis, Ivan (Bury S)Quinn, Lawrie
    Lewis, Terry (Worsley)Rapson, Syd (Portsmouth N)
    Liddell, rh Mrs HelenReed, Andy (Loughborough)
    Linton, MartinReid, rh Dr. John (Hamilton N & Bellshill)
    Lloyd, Tony (Manchester C)
    Love, AndrewRoche, Mrs Barbara
    Lucas, Ian (Wrexham)Rooney, Terry
    Luke, Iain (Dundee E)Ross, Ernie (Dundee W)
    Lyons, John (Strathkelvin)Roy, Frank (Motherwell)
    McAvoy, ThomasRuane, Chris
    McCabe, StephenRuddock, Joan
    McCafferty, ChrisRussell, Ms Christine (City of Chester)
    McCartney, rh Ian
    MacDonald, CalumRyan, Joan (Enfield N)
    McDonnell, JohnSalter, Martin
    MacDougall, JohnSarwar, Mohammad
    McFall, JohnSavidge, Malcolm
    McGuire, Mrs AnneSawford, Phil
    McIsaac, ShonaSedgemore, Brian
    McKechin, AnnShaw, Jonathan
    Mackinlay, AndrewSheridan, Jim
    McNulty, TonyShipley, Ms Debra
    MacShane, DenisSimon, Siôn (B'ham Erdington)
    McWalter, TonySimpson, Alan (Nottingham S)
    Mahmood, KhalidSingh, Marsha
    Mahon, Mrs AliceSmith, rh Andrew (Oxford E)
    Mallaber, JudySmith, Geraldine (Morecambe & Lunesdale)
    Mandelson, rh Peter

    Smith, Jacqui (Redditch)Turner, Neil (Wigan)
    Smith, John (Glamorgan)Twigg, Derek (Halton)
    Smith, Llew (Blaenau Gwent)Twigg, Stephen (Enfield)
    Soley, CliveTynan, Bill (Hamilton S)
    Southworth, HelenVaz, Keith (Leicester E)
    Spellar, rh JohnVis, Dr. Rudi
    Squire, RachelWalley, Ms Joan
    Starkey, Dr. PhyllisWard, Claire
    Steinberg, GerryWareing, Robert N.
    Stevenson, GeorgeWatson, Tom (W Bromwich E)
    Stewart, David (Inverness E & Lochaber)Watts, David
    White, Brian
    Stewart, Ian (Eccles)Whitehead, Dr. Alan
    Stinchcombe, PaulWicks, Malcolm
    Stoate, Dr. HowardWilliams, rh Alan (Swansea W)
    Stringer, GrahamWillams, Betty (Conwy)
    Stuart Ms GiselaWills, Michael
    Tami, Mark (Alyn)Winnick, David
    Taylor, Dari (Stockton S)Winterlon, Ms Rosie (Doncaster c)
    Taylor, David (NW Leics)Wood, Mike (Batley)
    Thomas, Gareth (Clwyd W)Woodward, Shaun
    Thomas, Gareth (Harrow W)Wright Anthony D. (Gt Yarmouth)
    Timms, Stephen
    Tipping, PaddyWright, David (Telford)
    Todd, Mark (S Derbyshire)Wright, Tony (Cannock)
    Touhig, Don (Islwyn)Wyatt, Derek
    Trickett, Jon
    Truswell, Paul

    Tellers for the Ayes:

    Turner, Dr. Desmond (Brighton Kemptown)

    Mr. Ivor Caplin and

    Mr. Phil Woolas

    NOES

    Ainsworth, Peter (E Surrey)Cran, James (Beverley)
    Allan, RichardCurry, rh David
    Amess, DavidDavey, Edward (Kingston)
    Ancram, rh MichaelDavies, Quentin (Grantham & Stamford)
    Atkinson, David (Bour'mth E)
    Atkinson, Peter (Hexham)Davis, rh David (Haltemprice & Howden)
    Bacon, Richard
    Baker, NormanDjanogly, Jonathan
    Barker, GregoryDodds, Nigel
    Baron, John (Billericay)Donaldson, Jeffrey M.
    Beggs, Roy (E Antrim)Dorrell, rh Stephen
    Bellingham, HenryDoughty, Sue
    Bercow, JohnDuncan, Alan (Rutland)
    Beresford, Sir PaulDuncan Smith, rh Iain
    Blunt, CrispinEvans, Nigel
    Boswell, TimFabricant, Michael
    Bottomley, Peter (Worthing W)Fallon, Michael
    Bottomley, rh Virginia (SW Surrey)Field, Mark (Cities of London & Westminster)
    Brake, Tom (Carshalton)Flight, Howard
    Brazier, JulianFlook, Adrian
    Breed, ColinForth, rh Eric
    Brooke, Mrs Annette L.Foster Don (Bath)
    Browning, Mrs AngelaFox, Dr. Liam
    Bruce, MalcolmGale, Roger (N Thanet)
    Burnett, JohnGarnier, Edward
    Burns, SimonGeorge, Andrew (St. Ives)
    Burnside, DavidGibb, Nick (Bognor Regis)
    Burstow, PaulGidley, Sandra
    Calton, Mrs PatsyGillan, Mrs Cheryl
    Cameron, DavidGoodman, Paul
    Carmichael, AlistairGray, James (N Wilts)
    Cash, WilliamGrayling, Chris
    Chapman, Sir Sydney (Chipping Barnet)Green, Damian (Ashford)
    Green, Matthew (Ludlow)
    Chidgey, DavidGrieve, Dominic
    Chope, ChristopherGummer, rh John
    Clappison, JamesHague, rh William
    Clarke, rh Kenneth (Rushcliffe)Hammond, Philip
    Clifton-Brown, GeoffreyHancock, Mike
    Collins, TimHarris, Dr. Evan (Oxford W & Abingdon)
    Cormack, Sir Patrick

    Harvey, NickRandall, John
    Hawkins, NickRedwood, rh John
    Hayes, John (S Holland)Reid, Alan (Argyll & Bute)
    Heald, OliverRendel, David
    Heath, DavidRobathan, Andrew
    Heathcoat-Amory, rh DavidRobertson, Hugh (Faversham & M-Kent)
    Hendry, Charles
    Hermon, LadyRobertson, Laurence (Tewk'b'ry)
    Hoban, Mark (Fareham)Robinson, Mrs Iris (Strangford)
    Hogg, rh DouglasRobinson, Peter (Belfast E)
    Horam, John (Orpington)Roe, Mrs Marion
    Howard, rh MichaelRosindell, Andrew
    Howarth, Gerald (Aldershot)Ruffley, David
    Hughes, Simon (Southwark N)Russell, Bob (Colchester)
    Hunter, AndrewSanders, Adrian
    Jack, rh MichaelSayeed, Jonathan
    Jackson, Robert (Wantage)Selous, Andrew
    Jenkin, BernardShephard, rh Mrs Gillian
    Johnson, Boris (Henley)Simmonds, Mark
    Jones, Nigel (Cheltenham)Smith, Sir Robert (W Ab'd'ns & Kincardine)
    Keetch, Paul
    Kennedy, rh Charles (Ross Skye & Inverness)Smyth, Rev. Martin (Belfast S)
    Soames, Nicholas
    Key, Robert (Salisbury)Spelman, Mrs Caroline
    Kirkbride, Miss JulieSpicer, Sir Michael
    Kirkwood, Sir ArchySpink, Bob (Castle Point)
    Knight, rh Greg (E Yorkshire)Spring, Richard
    Laing, Mrs EleanorStanley, rh Sir John
    Lait, Mrs JacquiSteen, Anthony
    Lamb, NormanStreeter, Gary
    Lansley, AndrewStunell, Andrew
    Laws, David (Yeovil)Swayne, Desmond
    Leigh, EdwardSwire, Hugo (E Devon)
    Letwin, rh OliverSyms, Robert
    Lewis, Dr. Julian (New Forest E)Tapsell, Sir Peter
    Liddell-Grainger, IanTaylor, Ian (Esher)
    Lidington, DavidTaylor, John (Solihull)
    Lilley, rh PeterTaylor, Matthew (Truro)
    Loughton, TimTaylor, Dr. Richard (Wyre F)
    Luff, Peter (M-Worcs)Taylor, Sir Teddy
    Mackay, rh AndrewThomas, Simon (Ceredigion)
    Maclean, rh DavidThurso, John
    McLoughlin, PatrickTredinnick, David
    Malins, HumfreyTrend, Michael
    Maples, JohnTrimble, rh David
    Marsden, Paul (Shrewsbury & Atcham)Turner, Andrew (Isle of Wight)
    Tyler, Paul (N Cornwall)
    May, Mrs TheresaTyrie, Andrew
    Mercer, PatrickViggers, Peter
    Mitchell, Andrew (Sutton Coldfield)Waterson, Nigel
    Webb, Steve (Northavon)
    Moore, MichaelWhittingdale, John
    Moss, MalcolmWiggin, Bill
    Murrison, Dr. AndrewWilkinson, John
    Norman, ArchieWilletts, David
    Oaten, Mark (Winchester)Williams, Hywel (Caernarfon)
    O'Brien, Stephen (Eddisbury)Williams, Roger (Brecon)
    Öpik, LembitWillis, Phil
    Osborne, George (Tatton)Winterton, Ann (Congleton)
    Ottaway, RichardWinterton, Sir Nicholas (Macclesfield)
    Page, Richard
    Paice, JamesYeo, Tim (S Suffolk)
    Paterson, OwenYoung, rh Sir George
    Pickles, EricYounger-Ross, Richard
    Price, Adam (E Carmarthen & Dinefwr)

    Tellers for the Noes:

    Prisk, Mark (Hertford)

    Mr. Mark Francois and

    Pugh, Dr. John

    Angela Watkinson

    Question accordingly agreed to.

    Lords amendment disagreed to.

    Lords amendments Nos. 4, 10 to 13, 21 and 7, 8 and 39 agreed to.

    Clause 2

    Notice Of Patient's Possible Need For Community Care Services

    Lords amendment: No. 6.

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

    With this we may discuss Lords amendment No. 9.

    These amendments raise the crucial issue of involving and informing patients and carers during the notification under clause 2. I am sure that those hon. Members who have taken a close interest in the Bill as it has gone through its stages will be aware that I am referring to the notification from the hospital to social services that starts the process of assessment that identifies to a social services department that the hospital believes that an individual may need community care services so that it is safe to discharge him from hospital. It is an important new responsibility on hospitals to ensure that they improve communication with social services departments.

    The current position is that, in exercising their functions, the NHS and social services must give all proper information to a person so that he can make an informed decision about whether to accept care or services. Those are fundamental duties that stem from the fact that they are public bodies exercising public functions. However, we noted the concerns of both Houses that there is no duty for the NHS to consult the patient prior to referring him to social services.

    Government amendment No. 9, with which I hope the House will agree, will place a duty upon the NHS to consult the patient and, where appropriate, his carer before issuing a notice to the local authority of the patient's likely need for community care services on discharge under what will be section 2. That avoids wasting the time of the NHS and social services by initiating assessments that are not required, and ensures that patients are not involved in an assessment without their prior knowledge and that of their carers.

    4 pm

    The Government amendment reinforces the existing good practice that has been built through experience and emphasised in guidance for section 47 assessments, the single assessment process and the recently published discharge workbook. All those processes are built on the premise that the patient should be kept informed and will be consulted at all stages of the assessment process. Even in the context of the Bill, how could the NHS body decide whether the patient is likely to need community care services in order to be safely discharged without consulting the patient? Lords amendment No. 9 puts the matter beyond doubt by writing the requirement into primary legislation.

    The same applies to involving carers, although the requirement to consult the carer is slightly circumscribed in that the NHS body must consult the carer only if it knows who the carer is, and if it is reasonably practicable to do so. That is to avoid placing a blanket duty on the NHS body that it cannot meet without incurring further delay. The Government have concerns about amendment No. 6 because it is quite a different matter for the NHS to require consent before informing social services. That would be a new right that does not exist elsewhere in the NHS.

    Although to us, discussing the matter in the Chamber, consent may seem a simple, straightforward matter, it may not seem so when presented to older people. They may be confused and fearful, possibly having just had a fall and having come into hospital by ambulance. They may not have any experience of social services or know what an assessment entails, and may not feel able to give consent. The amendment would mean that that had to happen before social services could be involved.

    In situations where older people are not able formally to give or withhold consent, it is important that health and social care professionals can begin talking to the patient, explaining options, understanding their home situation and forming a view about what services they may need for a safe discharge. None of that could happen if the NHS could not notify social services without clear and informed consent to notification. A week or more could go by and the patient might nearly be ready for discharge before they felt ready to give a definite yes, which by that time would probably be a yes to social services providing services.

    Many people have rightly argued for faster and more timely assessment. The difficulty with amendment No. 6 is that it could work against that. The Bill does not prevent a patient from refusing to co-operate with the NHS or social services in assessment; that is their human right. But it would be deeply counterproductive to give a person the right to prevent the NHS from taking the first step to inform local authorities that, for their own well-being and safety, there may be a need for social services. Most importantly, it would do nothing to ensure that people receive the appropriate care and support when they need it and in the right setting. To add the need for consent would require extra and unnecessary bureaucracy, requiring the NHS to gain, record and pass on the record of that consent to social services.

    Is my hon. Friend aware that since the National Health Service and Community Care Act 1990 came into force, many social services and health authorities have had in place systems whereby, as soon as a person is admitted to hospital, the relevant social services authority is notified that an assessment will be needed, so that the procedures can quickly be put in place? Does my hon. Friend agree that the amendment would cause considerable difficulties for authorities that already have sound, quick procedures that operate effectively?

    As we have seen from previous debates, my hon. Friend understands the real world in this matter and she has put her finger on the difficulty. We recognise the need to ensure that patients are consulted about a notification of their needs going to social services. That seems reasonable, and the Government amendment will ensure that that happens. However, we fear that the Lords amendment could put a spoke in the wheel of the sensible arrangements to which my hon. Friend refers, and that would not achieve what all of us want to see, which is a more timely and appropriate assessment for people in hospital in order to provide them with the necessary support. As I emphasised earlier, people will still have the right not to participate in that assessment and to refuse the services, but to place individuals and organisations in a position where they have to obtain full consent before a notification could even take place would not deliver the sort of improvements that we want.

    I want to persuade the House that it should not agree with the Minister but instead should agree with Lords amendment No. 6, and I shall explain why.

    First, I welcome Lords amendment No. 9 because it provides a movement in the direction that I think hon. Members on both sides of the House wish to see, recognising the need for a process that ensures that carers and patients are consulted.

    The crux of the debate is about whether consent puts a spoke in the wheel, or whether it should be a legitimate part of the Bill. Many hon. Members, and many people outside the House, are concerned that, by not referring at all to patients' rights in terms of being consulted or being able to exercise their right to informed consent, the Bill is not patient centred. In many ways, the Bill could be described, uncharitably perhaps, as regarding patients as passive recipients of a process of care, establishing a process and set of mechanisms whereby they are merely passed from one authority to another. I do not think that that is what it should be about.

    In Lords amendment No. 6, my noble Friends in the other place sought, I think succinctly, to include in the Bill the much-needed right of carers to be consulted, which is important, not least in the light of research by Carers UK, which found, when it surveyed carers on their experiences of delayed discharge and the management of a person's discharge, that their views were taken into account less in 2002 than they had been in 1998. It is on that basis that I and my noble Friends came to the conclusion that simply relying on the hospital's discharge workbook would not be enough. It may well contain excellent practice or good practice, but we want clear law, not just guidance, to NHS and other practitioners.

    The amendment seeks to place a proactive duty on the NHS and social services to offer assessments of care to carers, not just to wait for the carer to ask. That was an important concern that we had when the Bill left this place.

    The other point that the amendment seeks to raise, which the Minister did not really address, concerns mental capacity. The Minister referred to that at least in passing by suggesting that professionals would be hamstrung if they were unable to obtain informed consent. Yet the reality is that the amendment would include in the Bill a requirement that, where a person lacks the mental capacity to give such consent, a record should be placed on the file of the steps taken to ensure the patient's best interests. That places on record within the NHS the process by which the clinicians came to a decision that it was in the person's best interest for social services to be involved and for other decisions to be made.

    As we do not have in our law a recognition of mental incapacity in respect of a person's right to advocacy or surrogate decision making in terms of health care, this is a way of encouraging the Government to consider the matter now, because it is an integral part of making the Bill effective and patient centred. That is why we make the proposal.

    To conclude, I want to touch on one other issue. I hope that, even at this late stage, the Government will be prepared to consider finding a way by which further amendments can be made to address this concern. That is what my noble Friends were seeking to achieve, and that was the opportunity that they presented. I regret that that opportunity has not been taken. There is a serious issue in relation to how we ensure that those who do not have capacity can have their wishes reflected on, acted on and properly documented, and how those who do have capacity can have a say on whether they wish social services to intervene and make an assessment of their needs. Surely that is their right, although, currently, the Bill does not reflect that. I hope that hon. Members will establish that right clearly in the Bill today, and not accept the Government's dissent from the amendment.

    I have listened to the arguments of my hon. Friend the Minister. Although I am not necessarily especially moved by the Lords amendments, I would like to mention some issues that have been raised with me by constituents in relation to health professionals and social services listening to carers, as well as the issue of mental capacity, which has been touched on.

    I know that the Government have made major moves in relation to incorporating the opinions of carers when creating a truly effective care package for an individual. I hope, however, that they will consider a problem, which, although not massive, is real for the individuals and families concerned, and which has caused difficulties in my constituency. The problem is that, on some occasions, health service professionals and, in other instances, social services suddenly get very exercised about issues of confidentiality, which seems to me to be absolutely unacceptable.

    In the case of someone who has a mental incapacity, it is very unusual in my borough of Camden for there not to be an extremely efficient, caring advocate, whether that is an official or someone who has simply taken it on themselves to become a carer for an elderly person without a family. If the issue of confidentiality is raised, however, and that involves the input of the individual carer—whether a family member or an advocate for someone with a mental incapacity—it slows the system down. Under the Bill, there can be fines— [Interruption.] I know that my hon. Friend the Minister does not like that word. None the less, financial penalties can be incurred if there is what is deemed to be a delay in the discharge. It may be that the issue of confidentiality is being exercised because people believe that that is in the best interests. Indeed, sometimes, they may erroneously believe that they will be infringing some kind of ethical, if not legal, embargo.

    I understand the Government's arguments against the Lords amendment, but I ask them to consider this issue. I am happy to furnish my hon. Friend the Minister with anecdotal evidence from my constituency, as the Government should be aware of it. As I have said, not only can the process be delayed but real difficulties can be caused for families, for the individual for whom they are caring, and, most particularly, for those who suffer from a mental incapacity, in relation to their advocate. It is not unusual, in the first instance, for attempts to be made to sideline their contribution. Importantly, too, those people who are closely engaged with an individual can offer good ideas as to what would be the best possible care package for that person.

    Although I will not vote for the Lords amendment, I hope that my hon. Friend will take on board the points that I have made, and I am happy to provide her with even more details if they can be of help.

    4.15 pm

    I shall be brief because we have much ground to cover. The basic challenge to any Opposition is the extent to which they should strive to improve a measure that is fundamentally unimprovable. However, the central objection has always been that the Bill is not patient centred. Almost everybody in the world, except Health Ministers, takes that view. It is a tribute to the sustained opposition from all quarters, not only parliamentary, that the Government have been dragged kicking and screaming towards at least nodding in the direction of patients.

    The Minister claims that the amendment would grant a new right that does not exist in the NHS. She may be right. However, the Government are taking some draconian new powers, which do not yet exist, over the NHS and social services. It is only fair that those powers, which are misconceived and bound to trigger the law of unintended consequences, are counterbalanced by stronger rights for patients.

    In an ideal world, consultation would mean an unhurried attempt to sit down with the patient, carer or both, discuss the options, ensure that the patient has all the available information, and reach a consensus. However, how can we guarantee that in the real world? The only way is to include the word "consent" in the Bill. There would thus be an absolute requirement to obtain the consent—hopefully informed—of a patient or carer before the shift to some other form of care.

    In the majority of cases, obtaining consent should not present a problem. All too often, the patient clamours to get out of hospital into more appropriate care. However, in a small minority of cases, there will be a clash of views between the patient, the family, the carers and the aims of the health professionals. Those aims will be driven by the financial penalties—incentives, as the Minister calls them, fines as everybody else, including the Secretary of State refers to them—that the Bill imposes.

    It would be churlish not to welcome the Government's deathbed conversion to the patient having some role. Until now, the patient has been regarded as a commodity, to be shunted back and forth in the system as rapidly as possible in a bizarre game of pass the parcel to ensure that whoever has the patient when the music stops pays a fine. For once, the Government are beginning to acknowledge that a patient plays a genuine role in the process.

    It is only fair to record that Age Concern has welcomed the Government's comments about consultation, guidance and so on. However, Age Concern is not alone in the view that it expressed in its latest briefing, which states:
    "Age Concern believes that it is essential that older people have the right to agree to their care package and that this requirement is explicitly spelt out on the face of the Bill."
    That does not mean setting out a requirement in regulations or guidance.

    Community care legislation has been in place for nearly 10 years. Expectations about agreement to care packages have also existed for that time. We are not discussing anything that is new or relates specifically to the issues that the Bill tackles.

    If that is a point in favour of patient consent and agreement between everyone, who am I to disagree? Of course, there should be agreement, and I said that the problem will affect only a minority of cases.

    Age Concern's briefing, reflecting the point that the hon. Member for Hampstead and Highgate (Glenda Jackson) made, continues:
    "This is especially important with this Bill which will allow information to be passed from one authority to another (NHS to local authorities)."
    The hon. Lady was right. Problems with confidentiality may slow down the process. That is not a matter for us; it is for Ministers and civil servants to tackle so that there is no extra cause of delay. Age Concern concludes:
    "We strongly urge MPs to keep this requirement on the face of the Bill."
    I think that Age Concern is absolutely right.

    The combined opposition to the Bill from within and outside Parliament has persuaded the Government to look at the rights of patients. They have not gone far enough down that road, however. They should go the whole hog and withdraw their opposition to this eminently sensible and fair Lords amendment.

    With the leave of the House, I should like to respond to the hon. Member for Eastbourne (Mr. Waterson) first. Most of his contribution was about consenting to a care package. He has, therefore, misunderstood the section of the Bill that we are discussing. The two amendments in question relate to the process whereby the NHS body, the hospital, notifies social services that someone might need community care services, thereby starting the process of assessment. We have not yet reached the question of the care package, although I hope that we shall do so when we discuss the next two groups of amendments. It would, therefore, have been better if the hon. Gentleman had saved some of his arguments for later.

    I reiterate the point that I raised earlier about amendment No. 9, which is that it ensures that, even before that notification happens, the patient and carer will need to be consulted about the fact that the assessment process has started. That is an important step forward.

    I want to seek clarity on amendment No. 9, in which paragraph (b) refers to the circumstances in which carers should be consulted if it is "reasonably practicable" to do so. Will the Minister amplify what would be meant by "reasonably" in those circumstances, so that we can help those outside who will have to live with this amendment in future?

    As I started to outline in my introduction, this provision is intended to avoid a situation in which an inability to find a carer—perhaps because a patient was not clear about who their carer was, for example, or because the carer was away or uncontactable at the relevant time—would put a brake on the ability to notify social services and start the assessment. In such circumstances, we would not want the notification of the assessment to stop.

    The point of difference between us is whether we should make it a requirement for the patient to consent to the notification of social services to start the assessment. My hon. Friend the Member for Hampstead and Highgate (Glenda Jackson) raised some important issues about capacity—as did the hon. Member for Sutton and Cheam (Mr. Burstow)—and confidentiality, which seemed to go to the heart of the need to have in place a better way for those without capacity to have determined in advance who might take these decisions on their behalf. I am pleased that the Parliamentary Secretary, Lord Chancellor's Department, my hon. Friend the Member for Doncaster, Central (Ms Winterton) is on the Front Bench today to hear these concerns. Hon. Members will be aware that the Lord Chancellor's Department is currently working on draft legislation on incapacity, and I understand that my hon. Friend has also set up a mental incapacity forum to deal with some of these issues. The Government are, therefore, considering them in detail.

    To return to the crux of the matter of obtaining consent, I would ask hon. Members to imagine the position in which we might place a hospital if, for example, someone had come in following an accident in which they had fallen over and were confused, and it was clear that they would almost certainly need community care services in order to be able to be discharged from hospital. Under amendment No. 6, the patient would have to give their informed consent before the social services could even be notified to start the process. My concern is that, for a variety of reasons, they might not be able to do that. In addition, all the bureaucracy involved in obtaining consent would, in such a case, increase the period of time between the patient being admitted and social services being informed of the possible need for care. That could reduce the time available to social services departments to plan and arrange a care package.

    Nothing changes the fact that patients need not co-operate with assessments. They can refuse the package offered to them. Nevertheless, professionals must be involved at every stage to ensure that patients understand the consequences of refusing care, rather than a box being ticked for "consent given" or "consent not given".

    While it is unlikely to add to the process of consulting patients, what is proposed in the amendment might add to both the problems involved and the time taken before health and social care professionals can start working together to assess people's needs and to ensure that the necessary services are available. I hope that Members will disagree with Lords amendment No. 6, and agree with Lords amendment No. 9.

    Question put, That this House disagrees with the Lords in the said amendment:—

    The House divided: Ayes 328, Noes 198.

    Division No. 122]

    [4:25 pm

    AYES

    Adams, Irene (Paisley N)Cooper, Yvette
    Ainger, NickCorston, Jean
    Ainsworth, Bob (Cov'try NE)Cousins, Jim
    Alexander, DouglasCox, Tom (Tooting)
    Allen, GrahamCranston, Ross
    Anderson, Janet (Rossendale & Darwen)Crausby, David
    Cruddas, Jon
    Armstrong, rh Ms HilaryCryer, Ann (Keighley)
    Atherton, Ms CandyCryer, John (Hornchurch)
    Atkins, CharlotteCummings, John
    Bailey, AdrianCunningham, Jim (Coventry S)
    Banks, TonyCunningham, Tony (Workington)
    Barnes, HarryCurtis-Thomas, Mrs Claire
    Beckett, rh MargaretDalyell, Tam
    Begg, Miss AnneDavey, Valerie (Bristol W)
    Benn, HilaryDavid, Wayne
    Bennett, AndrewDavies, rh Denzil (Llanelli)
    Benton, Joe (Bootle)Davies, Geraint (Croydon C)
    Berry, RogerDavis, rh Terry (B'ham Hodge H)
    Betts, CliveDawson, Hilton
    Blackman, LizDean, Mrs Janet
    Blears, Ms HazelDhanda, Parmjit
    Blizzard, BobDismore, Andrew
    Boateng, rh PaulDobbin, Jim (Heywood)
    Borrow, DavidDobson, rh Frank
    Bradley, rh Keith (Withington)Donohoe, Brian H.
    Bradley, Peter (The Wrekin)Doran, Frank
    Brennan, KevinDowd, Jim (Lewisham W)
    Brown, rh Gordon (Dunfermline E)Drew, David (Stroud)
    Drown, Ms Julia
    Brown, rh Nicholas (Newcastle E Wallsend)Eagle, Angela (Wallasey)
    Eagle, Maria (L'pool Garston)
    Bryant, ChrisEdwards, Huw
    Buck, Ms KarenEfford, Clive
    Burden, RichardEllman, Mrs Louise
    Burgon, ColinEnnis, Jeff (Barnsley E)
    Burnham, AndyEtherington, Bill
    Byers, rh StephenFarrelly, Paul
    Caborn, rh RichardField, rh Frank (Birkenhead)
    Cairns, DavidFitzpatrick, Jim
    Campbell, Alan (Tynemouth)Fitzsimons, Mrs Lorna
    Campbell, Mrs Anne (C'bridge)Flint, Caroline
    Campbell, Ronnie (Blyth V)Flynn, Paul (Newport W)
    Casale, RogerFollett, Barbara
    Caton, MartinFoster, rh Derek
    Cawsey, Ian (Brigg)Foster, Michael (Worcester)
    Chapman, Ben (Wirral S)Foster, Michael Jabez (Hastings & Rye)
    Chaytor, David
    Clapham, MichaelFrancis, Dr. Hywel
    Clark, Mrs Helen (Peterborough)Gapes, Mike (Ilford S)
    Clark, Dr. Lynda (Edinburgh Pentlands)Gardiner, Barry
    George, rh Bruce (Walsall S)
    Clark, Paul (Gillingham)Gerrard, Neil
    Clarke, rh Charles (Norwich S)Gibson, Dr. Ian
    Clarke, Tony (Northampton S)Gilroy, Linda
    Clelland, DavidGodsiff, Roger
    Clwyd, Ann (Cynon V)Goggins, Paul
    Coaker, VernonGriffiths, Jane (Reading E)
    Coffey, Ms AnnGriffiths, Nigel (Edinburgh S)
    Cohen, Harry Griffiths, Win (Bridgend)
    Coleman, IainHain, rh Peter
    Cook, Frank (Stockton N)Hall, Mike (Weaver Vale)

    Hall, Patrick (Bedford)McDonnell, John
    Hamilton, Fabian (Leeds NE)MacDougall, John
    Hanson, DavidMcFall, John
    Harman, rh Ms HarrietMcGuire, Mrs Anne
    Harris, Tom (Glasgow Cathcart)McIsaac, Shona
    Havard, Dai (Merthyr Tydfil & Rhymney)McKechin, Ann
    Mackinlay, Andrew
    Healey, JohnMcNulty, Tony
    Henderson, Ivan (Harwich)MacShane, Denis
    Hepburn, Stephen McWalter, Tony
    Heppell, JohnMahmood, Khalid
    Heyes, DavidMahon, Mrs Alice
    Hill, Keith (Streatham)Mallaber, Judy
    Hodge, MargaretMann, John (Bassetlaw)
    Hoey, Kate (Vauxhall)Marris, Rob (Wolverh'ton SW)
    Hope, Phil (Corby)Marsden, Gordon (Blackpool S)
    Hopkins, KelvinMarshall, Jim (Leicester S)
    Howarth, rh Alan (Newport E)Marshall-Andrews, Robert
    Howarth, George (Knowsley N & Sefton E)Martlew, Eric
    Meacher, rh Michael
    Howells, Dr. KimMerron, Gillian
    Hughes, Beverley (Stretford & Urmston)Milburn, rh Alan
    Miliband, David
    Hughes, Kevin (Doncaster N)Miller, Andrew
    Humble, Mrs JoanMitchell, Austin (Gt Grimsby)
    Hurst, Alan (Braintree)Mole, Chris
    Hutton, rh JohnMoonie, Dr. Lewis
    Iddon, Dr. BrianMoran, Margaret
    Illsley, EricMorgan, Julie
    Jackson, Glenda (Hampstead & Highgate)Mountford, Kali
    Mudie, George
    Jackson, Helen (Hillsborough)Mullin, Chris
    Jamieson, DavidMunn, Ms Meg
    Jenkins, BrianMurphy, Denis (Wansbeck)
    Johnson, Alan (Hull W)Murphy, Jim (Eastwood)
    Johnson, Miss Melanie (Welwyn Hatfield)Murphy, rh Paul (Torfaen)
    Naysmith, Dr. Doug
    Jones, Helen (Warrington N)Norris, Dan (Wansdyke)
    Jones, Jon Owen (Cardiff C)O'Brien, Bill (Normanton)
    Jones, Kevan (N Durham)O'Brien, Mike (N Warks)
    Jones, Lynne (Selly Oak)O'Hara, Edward
    Jones, Martyn (Clwyd S)Olner, Bill
    Joyce, Eric (Falkirk W)O'Neill, Martin
    Kaufman, rh GeraldOrgan, Diana
    Keeble, Ms SallyOsborne, Sandra (Ayr)
    Keen, Alan (Feltham)Owen, Albert
    Kidney, DavidPalmer, Dr. Nick
    Kilfoyle, PeterPerham, Linda
    King, Andy (Rugby)Picking, Anne
    King, Ms Oona (Bethnal Green & Bow)Pickthall, Colin
    Pike, Peter (Burnley)
    Knight, Jim (S Dorset)Plaskitt, James
    Kumar, Dr. AshokPollard, Kerry
    Ladyman, Dr. StephenPope, Greg (Hyndburn)
    Lammy, DavidPound, Stephen
    Lawrence, Mrs JackiePrentice, Ms Bridget (Lewisham E)
    Laxton, Bob (Derby N)
    Lazarowicz, MarkPrentice, Gordon (Pendle)
    Lepper, DavidProsser, Gwyn
    Leslie, ChristopherPurchase, Ken
    Levitt, Tom (High Peak)Purnell, James
    Lewis, Ivan (Bury S)Quin, rh Joyce
    Lewis, Terry (Worsley)Quinn, Lawrie
    Liddell, rh Mrs HelenRapson, Syd (Portsmouth N)
    Linton, MartinReed, Andy (Loughborough)
    Lloyd, Tony (Manchester C)Reid, rh Dr. John (Hamilton N & Bellshill)
    Love, Andrew
    Lucas, Ian (Wrexham)Roche, Mrs Barbara
    Luke, Iain (Dundee E)Rooney, Terry
    Lyons, John (Strathkelvin)Ross, Ernie (Dundee W)
    McAvoy, ThomasRoy, Frank (Motherwell)
    McCabe, StephenRuane, Chris
    McCafferty, ChrisRuddock, Joan
    McCartney, rh IanRussell, Ms Christine (City of Chester)
    McDonagh, Siobhain
    MacDonald, CalumRyan, Joan (Enfield N)

    Salter, MartinTipping, Paddy
    Sarwar, MohammadTouhig, Don (Islwyn)
    Savidge, MalcolmTrickett, Jon
    Sawford, PhilTruswell, Paul
    Sedgemore, BrianTurner, Dr. Desmond (Brighton Kemptown)
    Shaw, Jonathan
    Sheridan, JimTurner, Neil (Wigan)
    Shipley, Ms DebraTwigg, Derek (Halton)
    Simon, Siôn (B'ham Erdington)Twigg, Stephen (Enfield)
    Simpson, Alan (Nottingham S)Tynan, Bill (Hamilton S)
    Singh, MarshaVis, Dr. Rudi
    Smith, rh Andrew (Oxford E)Walley, Ms Joan
    Smith, Geraldine (Morecambe & Lunesdale)Ward, Claire
    Wareing, Robert N.
    Smith, Jacqui (Redditch)Watson, Tom (W Bromwich E)
    Smith, John (Glamorgan)Watts, David
    Smith, Llew (Blaenau Gwent)White, Brian
    Soley, CliveWhitehead, Dr. Alan
    Spellar.rh JohnWicks, Malcolm
    Squire, Rachel Williams, rh Alan (Swansea W)
    Starkey Dr. PhyllisWilliams, Betty (Conwy)
    Starkey, Dr PhyllisWills, Michael
    Steinberg, GerryWilson, Brian
    Stevenson, GeorgeWinnick, David
    Stewart, David (Inverness E & Lochaber)Winterton, Ms Rosle (Doncaster C)
    Stewart, Ian (Eccles)Wood Mike (Batley)
    Stinchcombe, PaulWoodward, Shaun
    Stoate, Dr. HowardWoolas, Phil
    Stringer, GrahamWright, Anthony D. (Gt Yarmouth)
    Stuart, Ms Gisela
    Tami, Mark (Alyn)Wright David (Telford)
    Taylor, rh Ann (DewsburY)Wright, Tony (Cannock)
    Taylor, Dari (Stockton S)Wyatt, Derek
    Taylor, David (NW Leics)
    Thomas, Gareth (Clwyd W)

    Tellers for the Ayes:

    Thomas, Gareth (Harrow W)

    Mr. Fraser Kemp and

    Timms, Stephen

    Mr. Ivor Caplin

    NOES

    Ainsworth, Peter (E Surrey)Chope, Christopher
    Allan, RichardClappison, James
    Amess, DavidClifton-Brown, Geoffrey
    Ancram, rh MichaelCollins, Tim
    Arbuthnot, rh JamesCormack, Sir Patrick
    Atkinson, David (Bour'mth E)Cran, James (Beverley)
    Atkinson, Peter (Hexham)Curry, rh David
    Bacon, RichardDavey, Edward (Kingston)
    Baker, NormanDavies, Quentin (Grantham & Stamford)
    Barker, Gregory
    Baron, John (Billericay)Davis, rh David (Haltemprice & Howden)
    Beggs, Roy (E Antrim)
    Beith, rh A. J.Djanogly, Jonathan
    Bellingham, HenryDodds, Nigel
    Bercow, JohnDorrell, rh Stephen
    Beresford, Sir PaulDoughty, Sue
    Blunt, CrispinDuncan, Alan (Rutland)
    Boswell, TimDuncan Smith, rh Iain
    Bottomley, Peter (Worthing W)Evans, Nigel
    Bottomley, rh Virginia (SW Surrey)Fabricant, Michael
    Fallon, Michael
    Brake, Tom (Carshalton)Field, Mark (Cities of London & Westminster)
    Brazier, Julian
    Breed, ColinFlight, Howard
    Browning, Mrs AngelaFlook, Adrian
    Bruce, MalcolmForth, rh Eric
    Burnett, JohnFoster, Don (Bath)
    Burns, SimonFox, Dr. Liam
    Burstow, PaulFrancois, Mark
    Calton, Mrs PatsyGale, Roger (N Thanet)
    Cameron, DavidGarnier, Edward
    Carmichael, AlistairGeorge, Andrew (St. Ives)
    Cash, WilliamGibb, Nick (Bognor Regis)
    Chapman, Sir Sydney (Chipping Barnet)Gidley, Sandra
    Gillan, Mrs Cheryl
    Chidgey, DavidGoodman, Paul

    Gray, James (N Wilts)Paterson, Owen
    Grayling, ChrisPickles, Eric
    Green, Damian (Ashford)Price, Adam (E Carmarthen & Dinefwr)
    Green, Matthew (Ludlow)
    Grieve, DominicPrisk, Mark (Hertford)
    Gummer, rh JohnPugh, Dr. John
    Hague, rh WilliamRandall, John
    Hammond, PhilipRedwood, rh John
    Hancock, MikeRendel, David
    Harris, Dr. Evan (Oxford W & Abingdon)Robathan, Andrew
    Robertson, Hugh (Faversham & M-Kent)
    Harvey, Nick
    Hawkins, NickRobertson, Laurence (Tewk'b'ry)
    Hayes, John (S Holland)Robinson, Mrs Iris (Strangford)
    Heald, OliverRobinson, Peter (Belfast E)
    Heath, DavidRoe, Mrs Marion
    Heathcoat-Amory, rh DavidRosindell, Andrew
    Hendry, CharlesRuffley, David
    Hermon, LadyRussell, Bob (Colchester)
    Hoban, Mark (Fareham)Sanders, Adrian
    Hogg, rh DouglasSayeed, Jonathan
    Horam, John (Orpington)Shephard rh Mrs Gillian
    Howard, rh MichaelSimmonds, Mark
    Howarth, Gerald (Aldershot)Smith, Sir Robert (W Ab'd'ns & Kincardine)
    Hughes, Simon (Southwark N)
    Hunter, AndrewSmyth, Rev. Martin (Belfast S)
    Jack, rh MichaelSoames, Nicholas
    Jackson, Robert (Wantage)Spelman, Mrs Caroline
    Jenkin, BernardSpicer, Sir Michael
    Johnson, Boris (Henley)Spink, Bob (Castle Point)
    Keetch, PaulSpring, Richard
    Kennedy, rh Charles (Boss Skye & Inverness)Stanley, rh Sir John
    Steen, Anthony
    Key, Robert (Salisbury)Streeter, Gary
    Kirkbride, Miss JulieStunel1, Andrew
    Kirkwood, Sir ArchySwayne, Desmond
    Knight, rh Greg (E Yorkshire)Swire, Hugo (E Dewn)
    Laing, Mrs EleanorSyms, Robert
    Lait Mrs JacquiTapsell, Sir Peter
    Lamb, NormanTaYlor, Ian (Esher)
    Lansley, AndrewTaylor, John(Solihull)
    Laws, David (Yeovil)Taylor, Matthew (Truro)
    Leigh, EdwardTaylor, Dr Richard (Wyre F)
    Letwin, rh OliverTaylor, Sir Teddy
    Thomas, Simon (Ceredigion)
    Lewis, Dr. Julian (New Forest E)Thurso, John
    Liddell-Grainger, IanTonge, Dr. Jenny
    Lidington, DavidTrimble, rh David
    Llwyd, ElfynTurner Andrew (Isle of Wight)
    Luff, Peter (M-Worcs)Tyler, Paul (N Cornwall)
    McIntosh, Miss AnneTyrie, Andrew
    Mackay, rh AndrewViggers, Peter
    Maclean, rh DavidWaterson, Nigel
    McLoughhn, PatrickWatkinson, Angela
    Maples, JohnWebb, Steve (Northavon)
    Marsden, Paul (Shrewsbury & Atcham)Whittingdale, John
    Wiggin, Bill
    May, Mrs TheresaWilkinson, John
    Mitchell, Andrew (Sutton Coldfield)Willetts, David
    Williams, Hywel (Caernarfon)
    Moore, MichaelWilliams, Roger (Brecon)
    Moss, MalcolmWillis, Phil
    Murrison, Dr. AndrewWilshire, David
    Norman, ArchieWinterton, Ann (Congleton)
    Oaten, Mark (Winchester)Winterton, Sir Nicholas (Macclesfield)
    O'Brien, Stephen (Eddisbury)Yeo, Tim (S Suffolk)
    Öpik, LembitYoung, rh Sir George
    Osborne, George (Tatton)
    Ottaway, Richard

    Tellers for the Noes:

    Page, Richard

    Mr. Alan Reid and

    Paice, James

    Richard Younger-Ross

    Question accordingly agreed to.

    Lords amendment disagreed to.

    Lords amendment No. 9 agreed to.

    Lords amendment: No. 14.

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

    With this it will be convenient to take Lords amendment No. 15 and Government motion to disagree thereto, Lords amendment No. 16 and Government motion to disagree thereto and Lords amendment No. 18 and Government motion to disagree thereto.

    Although I am proposing that we disagree with the Lords in these amendments on the important issue of informing and involving patients and carers in the performance of the social services assessment and decisions about which services are to be provided, I hope that I can give hon. Members some reassurance that the Government have gone even further than the aspirations expressed in the Lords amendments in what we propose to do.

    Amendments Nos. 14 and 15 propose that local authorities should consult patients and carers during the assessment of community care needs and obtain their consent to the care plan. Amendment No. 16 would further require the local authority to inform patients of the costs of this care.

    It is clear in clause 3(11) that this assessment and care planning process is part of the section 47 assessment process and that it is therefore one stage, or part, of the single assessment process. By singling out this assessment and care planning process from all other section 47 assessments and care planning, we would differentiate the process under this Bill from all other processes of assessment and care planning. That would include processes outside the hospital and those applying to other patients in the hospital who do not happen to be "qualifying patients" according to the terms of the Bill.

    We are very clear that there should be no difference in the type or standard of assessment to which a person is entitled, whether they are assessed in hospital or in their own home. I do not believe that that is what the amendments are designed to achieve. I would have thought that if it was necessary to reiterate these steps here—although they are set out already in statutory guidance for both section 47 assessments and the single assessment process—then it must be necessary for all assessments, not just for those in this Bill. We have always been clear that the Bill should not affect the underlying substantive law, and we would not want to agree an amendment that did just that.

    Similarly, it has always been the case that care plans prepared as a result of a section 47 assessment should be agreed by the user. That point was made earlier by my hon. Friend the Member for Sheffield, Heeley (Ms Munn). Providing information about costs of care services is covered specifically in the section 7 guidance to local authorities on the single assessment process. Furthermore, it was covered in the statutory guidance on section 47 assessment that was issued to accompany the National Health Service and Community Care Act 1990.

    With respect to assessments carried out under section 47, case law is already clear that the local authority must make reasonable efforts to provide patients with their chosen options, as long as there are no resource implications to prevent that. In reality, it would not be possible for the local authority to do that without having first consulted the patient to ascertain how he or she bout the various choices available.

    The Bill makes no difference to a patient's rights with respect to consent. Patients have an existing right not to consent to receiving the services that social services has assessed them as needing. Clearly, neither the NHS nor social services has a right to force services upon a patient who does not want to receive them.

    Of course, good practice will dictate that patients should be kept informed and that they should be consulted at all stages of the discharge process. The revised hospital discharge workbook has a chapter specifically on patient and carer involvement. We will expect both NHS and social services staff to follow it. The statutory guidance for the Bill will also make it plain that patients and their carers and family are to be kept fully informed and consulted throughout the discharge process.

    It is a slightly different case in terms of a carer's assessment, which is actually triggered by a request from the individual carer. There can therefore be no question of consent to the assessment, since it is implicit in the request for an assessment that the person involved has consented. In terms of agreeing the carer's plan, the statutory guidance is clear—the plan must focus on what the carer wants to happen, and agreement, or any differences between carer and assessor, are recorded and a copy provided to the carer. Moving away from this arrangement, as suggested in the amendment, would differentiate carers' plans from others. The amendment would make these plans less responsive to the carer's wishes than other carers' assessments carried out under section 2 of the Carers and Disabled Children Act 2000.

    However, as I suggested earlier, I understand that the first three amendments in this group are trying to strengthen the arrangements around assessment and care planning. I hope that I made it clear that, if that is needed, it should be all section 47 assessments, regardless of where or when they take place.

    Section 47(4) of the National Health Service and Community Care Act 1990 contains a power for the Secretary of State to issue directions as to the manner in which assessment is carried out. I can confirm, therefore, that we will issue a direction under this power to make it clear that the local authority, having assessed the needs of the patient, should consult the patient before deciding which services to provide. Where possible, it should gain agreement to the care plan, and provide information about the costs of that care plan.

    That direction would apply to all section 47 assessments. It would not create the divergence that these amendments would create, but I hope that it offers some reassurance to the House that these important issues are being addressed.

    Some of the issues that we are debating under this group of amendments are a re-run of those that we debated a few moments ago, so many of my previous arguments also apply. We are now talking about the care planning process, as opposed to whether consent should be passed on social services in the first place.

    4.45 pm

    I listened with interest to the Minister's comments to the effect that the amendments that were tabled by my noble Friends and other noble Lords cover only one particular stage of the assessment process, and I welcome her suggestion that the Government will issue section 7 guidance to apply these matters to all stages of the assessment process under section 47. However, if the Government are now minded to do that, would it not have been easier to table an amendment to the Bill to place it beyond doubt that it was part of the law of the land and a requirement on parties to assessment processes, whether they be NHS bodies, social services departments or any others? Although I find the measure a helpful step forward, it does not sufficiently answer my concern, or that of my noble Friends, that the provisions that we should like to be included in the Bill are not yet there. The amendments are intended to ensure that the issues of consent and mental incapacity are addressed fully and clearly in the Bill. For that reason, we particularly want to press amendments Nos. 14 and 18 to a vote so as to test the opinion of this House before the Lords considers the matter again.

    My other question relates to the section 7 guidance that is to be issued. In the other place, Lord Hunt said that it was intended that a clear guidance or direction should be issued to the national health service in respect of continuing care assessments, that it would be put in writing as part of the process and that it would have to take place before a section 2 notice could be issued. Can the Minister confirm that that is the case, and can she explain why the provision is not included in the Bill, where it would be much clearer to all of us?

    I shall certainly wish for votes on amendment Nos. 14 and 18, and I hope that the Minister can respond to my queries.

    The two issues that I should like to raise with my hon. Friend the Minister have essentially to do with consent. In my experience from my constituency, a carer will often find the health professional's definition to be simply incomprehensible. There is far too little movement in terms of the ability of health professionals to translate clinical assessments into the kind of English that most people would understand. That is particularly pertinent when the carer is also elderly.

    The other issue concerns consent. It is not unusual for an elderly person who has been in hospital to be absolutely desperate to go home and absolutely to refuse any kind of alternative. That can often place an enormous burden on their carer, who, as I said, may be of an equal age. The individual concerned may be going back to a home that is completely inappropriate to their new needs. It is therefore not unusual for the idea of a temporary convalescent home—I still call them that, although I know that the situation has changed—to be presented so that the necessary adaptations to the family home can be undertaken. However, such homes can be a long way from where people live. Often, for the best of reasons to do with consent, the individual may place a terrible burden on their carer. Indeed, it is not unusual for the carer to end up in hospital.

    I am not being quite as precise as I would like to be, but I hope that my hon. Friend the Minister has picked up what I mean. There can be a fine line. Without wanting there to be a kind of prison state, I would like, when consent is given by the social services and the NHS to what the patient wants, better explanations to be given to the individual and their carer of the possible repercussions if the only proposal that is acceptable to the individual is to go immediately from hospital to home.

    I do not wish to detain the House for long, but I wish to speak to Lords amendment No. 16, which was successfully passed in the other place. It deals with clauses 2 and 3, which are to do with the determination of need for community care services on discharge. I am sure that hon. Members would agree that that is the nuts and bolts of this legislation. As you will be aware, Mr. Deputy Speaker, clause 2, under the heading of

    "Notice of patient's possible need for community care services",
    gives the background rules, regulations and legislation. Clause 3, to which Lords amendment No. 16 refers, goes into greater detail on what has to be done during the process. The amendment seeks simply to add to the duties that the responsible authority must carry out. Clause 3(3)(a) says that the responsible authority must
    "carry out an assessment of the patient's needs with a view to identifying any community care services that need to be made available".
    Clause 3(3)(b) says that the authority must,
    "after consulting the responsible NHS body, decide which of those services … the authority will make available for the patient."
    This amendment specifies that, before making a decision under clause 3(3), the responsible authority should have certain duties to carry out to give more power and involvement to the patient and carer. There are straightforward common-sense things that I would assume that no one would disagree with—although I may be proved wrong. For example, there is the duty to
    "consult the patient and his carer, if he has one";
    the duty to
    "inform them of the cost of the proposed care plans";
    and the duty to
    "obtain the consent of the patient".
    Those duties are an important improvement to the legislation and I hope that the Minister, having had time to reflect since the amendment was passed in the other place, will come round to the logic and advantages of accepting it. If she is not prepared to accept it, I will ask, Mr. Deputy Speaker, whether I may press it to a Division. I hope that it will not come to that. Even at this late stage, I hope that common sense will prevail and that the Minister will think again.

    I have a slight feeling that hon. Members are looking a gift horse in the mouth. Most of what the hon. Member for West Chelmsford (Mr. Burns) was arguing for represented good practice that would be desirable in the assessment of the provision of services. However, if the duties that he spoke about were put into the Bill, they would apply only to assessments that came under this legislation—in other words, to assessments relating to the services necessary for people to be safely discharged from hospital.

    The argument that I obviously failed to get over in my introduction was that, if those things are important in relation to one part of a section 47 assessment, they are important in relation to all section 47 assessments. That is why I said that we would issue legally binding directions which would make it clear that the local authority, having assessed the patient's needs, should consult the patient before deciding which services to provide, gain agreement to the care plan where possible and provide information about the cost of the care plan. That would apply to all section 47 assessments and would also cover the point made by my hon. Friend the Member for Hampstead and Highgate (Glenda Jackson), who was rightly concerned about the extent to which both carers and patients could engage in and understand the assessment process and the services provided.

    The directions will make much more explicit what is expected and the process that should be undertaken.

    The Minister seems to be arguing that it would not be possible to apply those important consent and consultation changes to all aspects of the assessment process. Surely the long title of the Bill has been drafted so widely that it would allow the Government to make precisely the amendments that the Minister intends to introduce under a section 7 direction. Would not it be better to include such provisions in the Bill?

    I was talking not about section 7, but about legally binding directions. We have already argued about whether our proposals would make the procedure more flexible—I think that they would. For example, they would enable us to introduce other changes in the future; but if the provisions were in the Bill such changes would necessarily be more difficult to make, due to the times at which we can change primary legislation.

    I shall give way in a moment, but I want to deal with the point made by the hon. Member for Sutton and Cheam (Mr. Burstow) about continuing care criteria, in case I do not have the chance to do so later.

    I can confirm that we shall issue a direction requiring a continuing care assessment before the section 2 notice is issued and that regulations will require that to be confirmed in a section 2 notice. That direction will be legally binding and will have the same force as if it was a provision under the Bill, but it will be easier to change in the light of experience. It will place an important legal responsibility on the NHS to carry out continuing care assessments before the local authority is notified. I know that the hon. Gentleman has been concerned about that point.

    Will the Minister give us some clarification about Lords amendment No. 16 so that there are no mistakes or misunderstandings? Did she say that the legally binding direction for the guidance would categorically and comprehensively include all the elements of Lords amendment No. 16? Will the amendment thus be irrelevant, because the Minister is dealing with the matter under legally binding guidance? Yes or no?

    I spelt out what the guidance would cover. If the hon. Gentleman is actually pushing me on the issue of consent, I also said that the Bill makes no difference to patients' rights in respect of consent. Patients already have the right not to consent to services that social services departments have assessed them as needing. Neither the NHS nor social services departments has the right to force services on a patient who does not want them.

    Our proposals for continuing care would strengthen responsibility during the whole assessment process, before social services were even involved. I hope, therefore, that hon. Members will agree to reject the amendment.

    Question put, That this House disagrees with the Lords in the said amendment:—

    The House divided: Ayes 321, Noes 202.

    Division No. 123]

    [4.59 pm

    AYES

    Abbott, Ms DianeCampbell, Mrs Anne (C'bridge)
    Adams, Irene (Paisley N)Campbell, Ronnie (Blyth V)
    Ainger, NickCasale, Roger
    Ainsworth, Bob (Cov'try NE)Caton, Martin
    Allen, GrahamCawsey, Ian (Brigg)
    Anderson, Janet (Rossendale & Darwen)Chapman, Ben (Wirral S)
    Clapham, Michael
    Armstrong, rh Ms HilaryClark, Mrs Helen (Peterborough)
    Atherton, Ms CandyClark, Dr. Lynda (Edinburgh Pentlands)
    Bailey, Adrian
    Banks, TonyClark, Paul (Gillingham)
    Barnes, HarryClarke, rh Charles (Norwich S)
    Barron, rh KevinClarke, Tony (Northampton S)
    Begg, Miss AnneClelland, David
    Benn, HilaryClwyd, Ann (Cynon V)
    Bennett, AndrewCoaker, Vernon
    Benton, Joe (Bootle)Coffey, Ms Ann
    Berry, RogerCohen, Harry
    Best, HaroldColeman, Iain
    Betts, CliveCook, Frank (Stockton N)
    Blackman, LizCooper, Yvette
    Blears, Ms HazelCorston, Jean
    Blizzard, BobCousins, Jim
    Blunkett, rh DavidCox, Tom (Tooting)
    Boateng, rh PaulCranston, Ross
    Borrow, DavidCrausby, David
    Bradley, rh Keith (Withington)Cruddas, Jon
    Bradley, Peter (The Wrekin)Cryer, Ann (Keighley)
    Bradshaw, BenCryer, John (Hornchurch)
    Brennan, KevinCummings, John
    Brown, rh Gordon (Dunfermline E)Cunningham, Jim (Coventry S)
    Cunningham, Tony (Workington)
    Brown, rh Nicholas (Newcastle E Wallsend)Curtis-Thomas, Mrs Claire
    Dalyell, Tam
    Bryant, ChrisDarling, rh Alistair
    Buck, Ms KarenDavey, Valerie (Bristol W)
    Burden, RichardDavid, Wayne
    Burgon, ColinDavies, rh Denzil (Llanelli)
    Burnham, AndyDavies, Geraint (Croydon C)
    Byers, rh StephenDavis, rh Terry (B'ham Hodge H)
    Caborn, rh RichardDawson, Hilton
    Cairns, DavidDean, Mrs Janet
    Campbell, Alan (Tynemouth)Dhanda, Parmjit

    Dismore, AndrewJones, Lynne (Selly Oak)
    Dobbin, Jim (Heywood)Jones, Martyn (Clwyd S)
    Dobson, rh FrankJoyce, Eric (Falkirk W)
    Donohoe, Brian H.Kaufman, rh Gerald
    Doran, FrankKeeble, Ms Sally
    Doughty, SueKeen, Alan (Feltham)
    Dowd, Jim (Lewisham W)Kemp, Fraser
    Drew, David (Stroud)Kidney, David
    Drown, Ms JuliaKilfoyle, Peter
    Eagle, Angela (Wallasey)King, Andy (Rugby)
    Eagle, Maria (L'pool Garston)King, Ms Oona (Bethnal Green & Bow)
    Edwards, Huw
    Efford, CliveKnight, Jim (S Dorset)
    Ellman, Mrs LouiseKumar, Dr. Ashok
    Ennis, Jeff (Barnsley E)Ladyman, Dr. Stephen
    Etherington, BillLammy, David
    Farrelly, PaulLawrence, Mrs Jackie
    Fitzpatrick, JimLaxton, Bob (Derby N)
    Fitzsimons, Mrs LornaLazarowicz, Mark
    Flint, CarolineLepper, David
    Flynn, Paul (Newport W)Leslie, Christopher
    Follett, BarbaraLevitt, Tom (High Peak)
    Foster, rh DerekLewis, Ivan (Bury S)
    Foster, Michael (Worcester)Lewis, Terry (Worsley)
    Foster, Michael Jabez (Hastings & Rye)Lidded, rh Mrs Helen
    Linton, Martin
    Foulkes, rh GeorgeLloyd, Tony (Manchester C)
    Francis, Dr. HywelLove, Andrew
    Gapes, Mike (Ilford S)Lucas, Ian (Wrexham)
    Gardiner, BarryLuke, Iain (Dundee E)
    George, rh Bruce (Walsall S)Lyons, John (Strathkelvin)
    Gerrard, NeilMcAvoy, Thomas
    Gibson, Dr. IanMcCabe, Stephen
    Gilroy, LindaMcCafferty, Chris
    Godsiff, RogerMcCartney, rh Ian
    Goggins, PaulMcDonagh, Siobhain
    Griffiths, Jane (Reading E)MacDonald, Calum
    Griffiths, Win (Bridgend)McDonnell, John
    Hall, Mike (Weaver Vale)MacDougall, John
    Hall, Patrick (Bedford)McFall, John
    Hamilton, Fabian (Leeds NE)McGuire, Mrs Anne
    Hanson, DavidMcIsaac, Shona
    Harman, rh Ms HarrietMcKechin, Ann
    Harris, Tom (Glasgow Cathcart)Mackinlay, Andrew
    Havard, Dai (Merthyr Tydfil & Rhymney)MacShane, Denis
    McWalter, Tony
    Healey, JohnMahmood, Khalid
    Henderson, Ivan (Harwich)Mahon, Mrs Alice
    Hepburn, StephenMallaber, Judy
    Heppell, JohnMann, John (Bassetlaw)
    Heyes, DavidMarris, Rob (Wolverh'ton SW)
    Hill, Keith (Streatham)Marsden, Gordon (Blackpool S)
    Hoey, Kate (Vauxhall)Marshall, Jim (Leicester S)
    Hope, Phil (Corby)Marshall-Andrews, Robert
    Hopkins, KelvinMartlew, Eric
    Howarth, rh Alan (Newport E)Meacher, rh Michael
    Howarth, George (Knowsley N & Sefton E)Merron, Gillian
    Milburn, rh Alan
    Howells, Dr. KimMiliband, David
    Hughes, Beverley (Stretford & Urmston)Miller, Andrew
    Mole, Chris
    Hughes, Kevin (Doncaster N)Moonie, Dr. Lewis
    Humble, Mrs JoanMoran, Margaret
    Hurst, Alan (Braintree)Morgan, Julie
    Hutton, rh JohnMountford, Kali
    Iddon, Dr. BrianMudie, George
    Illsley, EricMullin, Chris
    Jackson, Glenda (Hampstead & Highgate)Munn, Ms Meg
    Murphy, Denis (Wansbeck)
    Jackson, Helen (Hillsborough)Murphy, Jim (Eastwood)
    Jamieson, DavidMurphy, rh Paul (Torfaen)
    Jenkins, BrianNaysmith, Dr. Doug
    Johnson, Miss Melanie (Welwyn Hatfield)Norris, Dan (Wansdyke)
    O'Brien, Bill (Normanton)
    Jones, Jon Owen (Cardiff C)O'Brien, Mike (N Warks)
    Jones, Kevan (N Durham)O'Hara, Edward

    Olner, BillStarkey, Dr. Phyllis
    O'Neill, MartinSteinberg Gerry
    Organ, DianaStevenson, George
    Osborne, Sandra (Ayr)Stewart, David (Inverness E & Lochaber)
    Owen, Albert
    Palmer, Dr. NickStewart, Ian (Eccles)
    Perham, LindaStinchcombe, Paul
    Picking, AnneStoate, Dr. Howard
    Pickthall, ColinStrang, rh Dr. Gavin
    Pike, Peter (Burnley)Stringer, Graham
    Plaskitt, JamesStuart, Ms Gisela
    Pollard, KerryTami, Mark (Alyn)
    Pope, Greg (Hyndburn)Taylor, rh Ann (Dewsbury)
    Pound, StephenTaylor, Dari (Stockton S)
    Prentice, Ms Bridget (Lewisham E)Taylor, David (NW Leics)
    Thomas, Gareth (Clwyd W)
    Prentice, Gordon (Pendle)Thomas, Gareth (Harrow W)
    Prescott, rh JohnTipping, Paddy
    Prosser, GwynTrickett, Jon
    Purchase, KenTruswell, Paul
    Purnell, JamesTurner, Dr. Desmond (Brighton Kemptown)
    Quin, rh Joyce
    Quinn, LawrieTurner, Neil (Wigan)
    Rapson, Syd (Portsmouth N)Twigg, Derek (Halton)
    Reed, Andy (Loughborough)Twigg, Stephen (Enfield)
    Reid, rh Dr. John (Hamilton N & Bellshill)Tynan, Bill (Hamilton S)
    Vis, Dr, Rudi
    Roche, Mrs BarbaraWalley, Ms Joan
    Rooney, TerryWard, Claire
    Ross, Ernie (Dundee W)Wareing, Robert N.
    Roy, Frank (Motherwell)Watson, Tom (W Bromwich E)
    Ruddock, JoanWatts, David
    Russell, Ms Christine (City of Chester)White, Brian
    Whitehead, Dr. Alan
    Ryan, Joan (Enfield N)Wicks, Malcolm
    Salter, MartinWilliams, rh Alan (Swansea W)
    Sarwar, MohammadWilliams, Betty (Conwy)
    Savidge, MalcolmWills, Michael
    Sawford, PhilWilson, Brian
    Sedgemore, BrianWinnick, David
    Shaw, JonathanWinterton, Ms Rosie (Doncaster C)
    Sheridan, Jim
    Shipley, Ms DebraWood, Mike (Batley)
    Simon, Siôn (B'ham Erdington)Woodward, Shaun
    Simpson, Alan (Nottingham S)Woolas, Phil
    Singh, MarshaWright, Anthony D. (Gt Yarmouth)
    Smith, rh Andrew (Oxford E)
    Smith, Geraldine (Morecambe & Lunesdale)Wright, David (Telford)
    Wright, Tony (Cannock)
    Smith, Jacqui (Redditch)Wyatt, Derek
    Smith, John (Glamorgan)
    Smith, Llew (Blaenau Gwent)

    Tellers for the Ayes:

    Soley, Clive

    Mr. Ivor Caplin and

    Squire, Rachel

    Charlotte Atkins

    NOES

    Ainsworth, Peter (E Surrey)Bottomley, rh Virginia (SW Surrey)
    Allan, Richard
    Amess, DavidBrady, Graham
    Ancram, rh MichaelBrake, Tom (Carshalton)
    Arbuthnot, rh JamesBrazier, Julian
    Atkinson, David (Bour'mth E)Breed, Colin
    Atkinson, Peter (Hexham)Brooke, Mrs Annette L.
    Bacon, RichardBrowning, Mrs Angela
    Baker, NormanBruce, Malcolm
    Barker, GregoryBurnett, John
    Baron, John (Billericay)Burns, Simon
    Beggs, Roy (E Antrim)Burnside, David
    Burstow, Paul
    Beith, rh A. J.Calton, Mrs Patsy
    Bellingham, HenryCameron, David
    Bercow, JohnCarmichael, Alistair
    Beresford, Sir PaulCash, William
    Blunt, CrispinChapman, Sir Sydney (Chipping Barnet)
    Boswell, Tim
    Bottomley, Peter (Worthing W)Chidgey, David

    Chope, ChristopherLamb, Norman
    Clappison, JamesLansley, Andrew
    Clarke, rh Kenneth (Rushcliffe)Laws, David (Yeovil)
    Clifton-Brown, GeoffreyLeigh, Edward
    Collins, TimLewis, Dr. Julian (New Forest E)
    Cormack, Sir PatrickLiddell-Grainger, Ian
    Cran, James (Beverley)Lidington, David
    Curry, rh DavidLilley, rh Peter
    Davey, Edward (Kingston)Llwyd, Elfyn
    Davies, Quentin (Grantham & Stamford)Loughton, Tim
    Luff, Peter(M-Worcs)
    Davis, rh David (Haltemprice & Howden)McIntosh, Miss Anne
    Mackay, rh Andrew
    Djanogly, JonathanMaclean, rh David
    Dodds, NigelMcLoughlin, Patrick
    Donaldson, Jeffrey M.Malins, Humfrey
    Dorrell, rh StephenMaples, John
    Duncan, Alan (Rutland)Marsden, Paul (Shrewsbury & Atcham)
    Duncan Smith, rh Iain
    Evans, NigelMates, Michael
    Fabricant, MichaelMay, Mrs Theresa
    Fallon, MichaelMercer, Patrick
    Field, Mark (Cities of London & Westminster)Mitchell, Andrew (Sutton Coldfield)
    Flight, HowardMoore, Michael
    Flook, AdrianMoss, Malcolm
    Forth, rh EricMurrison, Dr. Andrew
    Foster, Don (Bath)Norman, Archie
    Fox, Dr. LiamOaten, Mark (Winchester)
    Francois, MarkO'Brien, Stephen (Eddisbury)
    Gale, Roger (N Thanet)Osborne, George (Tatton)
    Garnier, EdwardOttaway, Richard
    George, Andrew (St. Ives)Page, Richard
    Gibb, Nick (Bognor Regis)Paice, James
    Gidley, SandraPaterson, Owen
    Gillan, Mrs CherylPickles, Eric
    Goodman, PaulPrice, Adam (E Carmarthen & Dinefwr)
    Gray, James (N Wilts)
    Grayling, ChrisPrisk, Mark (Hertford)
    Green, Damian (Ashford)Pugh, Dr. John
    Green, Matthew (Ludlow)Randall, John
    Grieve, DominicRedwood, rh John
    Gummer, rh JohnRendel, David
    Hague, rh WilliamRobathan, Andrew
    Hammond, PhilipRobertson, Hugh (Faversham & M-Kent)
    Hancock, Mike
    Harris, Dr. Evan (Oxford W & Abingdon)Robertson, Laurence (Tewk'b'ry)
    Robinson, Mrs Iris (Strangford)
    Harvey, NickRobinson, Peter (Belfast E)
    Hawkins, NickRoe, Mrs Marion
    Hayes, John (S Holland)Rosindell, Andrew
    Heald, OliverRuffley, David
    Heath, DavidRussell, Bob (Colchester)
    Heathcoat-Amory, rh DavidSanders, Adrian
    Hendry, CharlesSayeed, Jonathan
    Hermon, LadySelous, Andrew
    Hoban, Mark (Fareham)Shephard, rh Mrs Gillian
    Hogg, rh DouglasSimmonds, Mark
    Horam, John (Orpington)Smith, Sir Robert (W Ab'd'ns & Kincardine)
    Howard, rh Michael
    Howarth, Gerald (Aldershot)Smyth, Rev. Martin (Belfast S)
    Hughes, Simon (Southwark N)Soames, Nicholas
    Hunter, AndrewSpicer, Sir Michael
    Jack, rh MichaelSpink, Bob (Castle Point)
    Jackson, Robert (Wantage)Spring, Richard
    Jenkin, BernardStanley, rh Sir John
    Johnson, Boris (Henley)Steen, Anthony
    Keetch, PaulStreeter, Gary
    Kennedy, rh Charles (Ross Skye & Inverness)Stunell, Andrew
    Swayne, Desmond
    Key, Robert (Salisbury)Swire, Hugo (E Devon)
    Kirkbride, Miss JulieSyms, Robert
    Kirkwood, Sir ArchyTapsell, Sir Peter
    Knight, rh Greg (E Yorkshire)Taylor, John (Solihull)
    Laing, Mrs EleanorTaylor, Matthew (Truro)
    Lait, Mrs JacquiTaylor, Dr. Richard (Wyre F)

    Taylor, Sir TeddyWilkinson, John
    Thomas, Simon (Ceredigion)Willetts, David
    Thurso, JohnWilliams, Hywel (Caernarfon)
    Tonge, Dr. JennyWillis, Phil
    Trimble, rh DavidWilshire, David
    Turner, Andrew (Isle of Wight)Winterton, Ann (Congleton)
    Tyler, Paul (N Cornwall)Winterton, Sir Nicholas (Macclesfield)
    Tyrie, Andrew
    Viggers, PeterYeo, Tim (S Suffolk)
    Waterson, NigelYoung, rh Sir George
    Watkinson, Angela
    Webb, Steve (Northavon)

    Tellers for the Noes:

    Whittingdale, John

    Richard Younger-Ross and

    Wiggin, Bill

    Mr. Alan Reid

    Question accordingly agreed to.

    Lords amendment disagreed to.

    It being less than two hours before the moment of interruption, MR. DEPUTY SPEAKER put the remaining Questions necessary to dispose of business at that hour, pursuant to Orders [28 June 2001 and 29 October 2002].

    Lords amendment No. 15 disagreed to.

    Lords amendment: No. 16.

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

    The House divided: Ayes 321, Noes 203.

    Division No. 124]

    [5.15 pm

    AYES

    Abbott, Ms DianeCairns, David
    Adams, Irene (Paisley N)Campbell, Alan (Tynemouth)
    Ainger, NickCampbell, Mrs Anne (C'bridge)
    Ainsworth, Bob (Cov'try NE)Campbell, Ronnie (Blyth V)
    Allen, GrahamCaplin, Ivor
    Anderson, rh Donald (Swansea E)Casale, Roger
    Anderson, Janet (Rossendale & Darwen)Caton, Martin
    Cawsey, Ian (Brigg)
    Armstrong, rh Ms HilaryChapman, Ben (Wirral S)
    Atherton, Ms CandyClapham, Michael
    Atkins, CharlotteClark, Mrs Helen (Peterborough)
    Bailey, AdrianClark, Dr. Lynda (Edinburgh Pentlands)
    Baird, Vera
    Banks, TonyClark, Paul (Gillingham)
    Barnes, HarryClarke, Tony (Northampton S)
    Barron, rh KevinClelland, David
    Begg, Miss AnneClwyd, Ann (Cynon V)
    Benn, HilaryCoaker, Vernon
    Bennett, AndrewCoffey, Ms Ann
    Benton, Joe (Bootle)Cohen, Harry
    Berry, RogerColeman, Iain
    Best, HaroldCook, Frank (Stockton N)
    Betts, CliveCooper, Yvette
    Blackman, LizCorbyn, Jeremy
    Blears, Ms HazelCorston, Jean
    Blizzard, BobCousins, Jim
    Blunkett, rh DavidCox, Tom (Tooting)
    Boateng, rh PaulCranston, Ross
    Borrow, DavidCrausby, David
    Bradley, rh Keith (Withington)Cruddas, Jon
    Bradley, Peter (The Wrekin)Cryer, Ann (Keighley)
    Bradshaw, BenCryer, John (Hornchurch)
    Brennan, KevinCummings, John
    Brown, rh Nicholas (Newcastle E Wallsend)Cunningham, Jim (Coventry S)
    Cunningham, Tony (Workington)
    Bryant, ChrisCurtis-Thomas, Mrs Claire
    Buck, Ms KarenDalyell, Tam
    Burden, RichardDarling, rh Alistair
    Burgon, ColinDavey, Valerie (Bristol W)
    Burnham, AndyDavid, Wayne
    Byers, rh StephenDavies, rh Denzil (Llanelli)
    Caborn, rh RichardDavies, Geraint (Croydon C)

    Davis, rh Terry (B'ham Hodge H)Johnson, Miss Melanie (Welwyn Hatfield)
    Dawson, Hilton
    Dean, Mrs JanetJones, Jon Owen (Cardiff C)
    Dhanda, ParmjitJones, Kevan (N Durham)
    Dismore, AndrewJones, Lynne (Selly Oak)
    Dobbin, Jim (Heywood)Jones, Martyn (Clwyd S)
    Dobson, rh FrankJoyce, Eric (Falkirk W)
    Donohoe, Brian H.Kaufman, rh Gerald
    Doran, FrankKeeble, Ms Sally
    Dowd, Jim (Lewisham W)Keen, Alan (Feltham)
    Drew, David (Stroud)Kemp, Fraser
    Drown, Ms JuliaKidney, David
    Eagle, Angela (Wallasey)Kilfoyle, Peter
    Eagle, Maria (L'pool Garston)King, Andy (Rugby)
    Edwards, HuwKing, Ms Oona (Bethnal Green & Bow)
    Efford, Clive
    Ellman, Mrs LouiseKnight, Jim (S Dorset)
    Ennis, Jeff (Barnsley E)Kumar, Dr. Ashok
    Etherington, BillLadyman, Dr. Stephen
    Fitzpatrick, JimLammy, David
    Fitzsimons, Mrs LornaLawrence, Mrs Jackie
    Flint, CarolineLaxton, Bob (Derby N)
    Flynn, Paul (Newport W)Lazarowicz, Mark
    Follett, BarbaraLepper, David
    Foster, rh DerekLeslie, Christopher
    Foster, Michael (Worcester)Levitt, Tom (High Peak)
    Foster, Michael Jabez (Hastings & Rye)Lewis, Terry (Worsley)
    Liddell, rh Mrs Helen
    Foulkes, rh GeorgeLinton, Martin
    Francis, Dr. HywelLloyd, Tony (Manchester C)
    Gapes, Mike (Ilford S)Love, Andrew
    Gardiner, BarryLucas, Ian (Wrexham)
    George, rh Bruce (Walsall S)Luke, Iain (Dundee E)
    Gerrard, NeilLyons, John (Strathkelvin)
    Gibson, Dr. IanMcAvoy, Thomas
    Gilroy, LindaMcCabe, Stephen
    Godsiff, RogerMcCafferty, Chris
    Goggins, PaulMcCartney, rh Ian
    Griffiths, Jane (Reading E)McDonagh, Siobhain
    Griffiths, Win (Bridgend)MacDonald, Calum
    Hall, Mike (Weaver Vale)McDonnell, John
    Hall, Patrick (Bedford)MacDougall, John
    Hamilton, David (Midlothian)McFall, John
    Hamilton, Fabian (Leeds NE)McGuire, Mrs Anne
    Hanson, DavidMcIsaac, Shona
    Harman, rh Ms HarrietMcKechin, Ann
    Harris, Tom (Glasgow Cathcart)Mackinlay, Andrew
    Havard, Dai (Merthyr Tydfil & Rhymney)MacShane, Denis
    McWalter, Tony
    Healey, JohnMahmood, Khalid
    Henderson, Ivan (Harwich)Mahon, Mrs Alice
    Hepburn, StephenMallaber, Judy
    Heppell, JohnMandelson, rh Peter
    Heyes, DavidMann, John (Bassetlaw)
    Hill, Keith (Streatham)Marris, Rob (Wolverh'ton SW)
    Hoey, Kate (Vauxhall)Marsden, Gordon (Blackpool S)
    Hood, Jimmy (Clydesdale)Marshall, Jim (Leicester S)
    Hope, Phil (Corby)Marshall-Andrews, Robert
    Hopkins, KelvinMartlew, Eric
    Howarth, rh Alan (Newport E)Meacher, rh Michael
    Howarth, George (Knowsley N & Sefton E)Milburn, rh Alan
    Miliband, David
    Howells, Dr. KimMiller, Andrew
    Hughes, Beverley (Stretford & Urmston)Mole, Chris
    Moran, Margaret
    Hughes, Kevin (Doncasier N)Morgan, Julie
    Humble, Mrs JoanMountford, Kali
    Hurst, Alan (Braintree)Mudie, George
    Hutton, rh JohnMullin, Chris
    Iddon, Dr. BrianMunn, Ms Meg
    Illsley, EricMurphy, Denis (Wansbeck)
    Jackson, Glenda (Hampstead & Highgate)Murphy, Jim (Eastwood)
    Murphy, rh Paul (Torfaen)
    Jackson, Helen (Hillsborough)Naysmith, Dr. Doug
    Jamieson, DavidNorris, Dan (Wansdyke)
    Jenkins, BrianO'Brien, Bill (Normanton)

    O'Brien, Mike (N Warks)Soley, Clive
    O'Hara, EdwardSquire, Rachel
    Olner, BillStarkey, Dr. Phyllis
    O'Neill, MartinSteinberg, Gerry
    Organ, DianaStevenson, George
    Osborne, Sandra (Ayr)Stewart, David (Inverness E & Lochaber)
    Owen, Albert
    Palmer, Dr. NickStewart, Ian (Eccles)
    Perham, LindaStinchcornbe, Paul
    Picking, AnneStoate, Dr. Howard
    Pickthall, ColinStrang, rh Dr. Gavin
    Pike, Peter (Burnley)Stringer, Graham
    Plaskitt, JamesStuart, Ms Gisela
    Pollard, KerryTami, Mark (Alyn)
    Pope, Greg (Hyndburn)Taylor, rh Ann (Dewsbury)
    Pound, StephenTaylor, Dari (Stockton S)
    Prentice, Ms Bridget (Lewisham E)Taylor, David (NW Leics)
    Thomas, Gareth (Clwyd W)
    Prentice, Gordon (Pendle)Thomas, Gareth (Harrow W)
    Prosser, GwynTipping, Paddy
    Purchase, KenTrickett, Jon
    Purnell, JamesTruswell, Paul
    Quin, rh JoyceTurner, Dr. Desmond (Brighton Kemptown)
    Quinn, Lawrie
    Rapson, Syd (Portsmouth N)Turner, Neil (Wigan)
    Reed, Andy (Loughborough)Twigg, Derek(Halton)
    Reid, rh Dr. John (Hamilton N & Bellshill)Twigg, Stephen(Enfield)
    Tynan, Bill(Hamilton)
    Roche, Mrs BarbaraVaz, Keith (Leicester E)
    Rooney, TerryVis, Dr. Rudi
    Ross, Ernie (Dundee W)Walley, Ms Joan
    Wareing, Robert N.
    Roy, Frank (Motherwell)Watson, Tom (W Bromwich E)
    Ruddock, JoanWatts, David
    Russell, Ms Christine (City of Chester)White, Brian
    Whitehead, Dr. Alan
    Ryan, Joan (Enfield N)Wicks, Malcolm
    Salter, MartinWilliams, rh Alan (Swansea W)
    Sarwar, MohammadWilliams, Betty (Conwy)
    Savidge, MalcolmWills, Michael
    Sawford, PhilWilson Brian
    Sedgemore, BrianWinterton, Ms Rosie (Doncaster C)
    Shaw, Jonathan
    Sheridan, JimWood, Mike (Batley)
    Shipley, Ms DebraWoodward, Shaun
    Simon, Siôn (B'ham Erdington)Wright, Anthony D. (Gt Yarmouth)
    Simpson, Alan (Nottingham S)
    Singh, MarshaWright, David (Telford)
    Smith, rh Andrew (Oxford E)Wright, Tony (Cannock)
    Smith, Geraldine (Morecambe & Lunesdale)Wyatt, Derek
    Smith, Jacqui (Redditch)

    Tellers for the Ayes:

    Smith, John (Glamorgan)

    Mr. Phil Woolas and

    Smith, Llew (Blaenau Gwent)

    Gillian Merron

    NOES

    Ainsworth, Peter (E Surrey)Brady, Graham
    Allan, RichardBrake, Tom (Carshalton)
    Amess, DavidBrazier, Julian
    Arbuthnot, rh JamesBreed, Colin
    Atkinson, David (Bour'mth E)Browning, Mrs Angela
    Atkinson, Peter (Hexham)Bruce, Malcolm
    Bacon, RichardBurnett, John
    Baker, NormanBurns, Simon
    Barker, GregoryBurnside, David
    Baron, John (Billericay)Burstow, Paul
    Beggs, Roy (E Antrim)Calton, Mrs Patsy
    Beith, rh A. J.Cameron, David
    Bellingham, HenryCarmichael, Alistair
    Bercow, JohnCash, William
    Beresford, Sir PaulChapman, Sir Sydney (Chipping Barnet)
    Blunt, Crispin
    Boswell, TimChidgey, David
    Bottomley, Peter (Worthing W)Chope, Christopher
    Bottomley, rh Virginia (SW Surrey)Clappison, James
    Clarke, rh Kenneth (Rushcliffe)

    Clifton-Brown, GeoffreyLaws, David (Yeovil)
    Collins, TimLeigh, Edward
    Cormack, Sir PatrickLewis, Dr. Julian (New Forest E)
    Cran, James (Beverley)Liddell-Grainger, Ian
    Curry, rh DavidLidington, David
    Davey, Edward (Kingston)Lilley, rh Peter
    Davies, Quentin (Grantham & Stamford)Llwyd, Elfyn
    Loughton, Tim
    Davis, rh David (Haltemprice & Howden)Luff, Peter (M-Worcs)
    McIntosh, Miss Anne
    Djanogly, JonathanMackay, rh Andrew
    Donaldson, Jeffrey M.Maclean, rh David
    Dorrell, rh StephenMcLoughlin, Patrick
    Doughty, SueMalins, Humfrey
    Duncan, Alan (Rutland)Maples, John
    Duncan Smith, rh IainMarsden, Paul (Shrewsbury & Atcham)
    Evans, Nigel
    Fabricant, MichaelMates, Michael
    Fallon, MichaelMaude, rh Francis
    Field, rh Frank (Birkenhead)May, Mrs Theresa
    Field, Mark (Cities of London & Westminster)Mercer, Patrick
    Mitchell, Andrew (Sutton Coldfield)
    Flight, Howard
    Flook, AdrianMoore, Michael
    Forth, rh EricMoss, Malcolm
    Foster, Don (Bath)Murrison, Dr. Andrew
    Fox, Dr. LiamNorman, Archie
    Gale, Roger (N Thanet)Oaten, Mark (Winchester)
    Garnier, EdwardO'Brien, Stephen (Eddisbury)
    George, Andrew (St. Ives)Osborne, George(Tatton)
    Gibb, Nick (Bognor Regis)Ottaway, Richard
    Gidley, SandraPage, Richard
    Gillan, Mrs CherylPaice, James
    Goodman, PaulPaterson, Owen
    Gray, James (N Wilts)Pickles, Eric
    Grayling, ChrisPrice, Adam (E Carmarthen & Dinefwr)
    Green, Damian (Ashford)
    Green, Matthew (Ludlow)Prisk, Mark (Hertford)
    Greenway, JohnPugh, Dr. John
    Grieve, DominicRandall, John
    Gummer, rh JohnRedwood, rh John
    Hague, rh WilliamReid, Alan (Argyll & Bute)
    Hammond, PhilipRendel, David
    Hancock, MikeRobathan, Andrew
    Harris, Dr. Evan (Oxford W & Abingdon)Robertson, Hugh(Faversham & M-Kent)
    Harvey, NickRobertson, Laurence (Tewk'b'ry)
    Hawkins, NickRobinson, Mrs Iris (Strangford)
    Hayes, John (S Holland)Robinson, Peter (Belfast E)
    Heald, OliverRoe, Mrs Marion
    Heath, DavidRosindell, Andrew
    Heathcoat-Amory, rh DavidRuffley, David
    Hendry, CharlesRussell, Bob (Colchester)
    Hermon, LadySanders, Adrian
    Hoban, Mark (Fareham)Sayeed, Jonathan
    Hogg, rh DouglasSelous, Andrew
    Horam, John (Orpington)Shephard, rh Mrs Gillian
    Howard, rh MichaelSimmonds, Mark
    Howarth, Gerald (Aldershot)Smith, Sir Robert (W Ab'd'ns & Kincardine)
    Hughes, Simon (Southwark N)
    Hunter, AndrewSmyth, Rev. Martin (Belfast S)
    Jack, rh MichaelSoames, Nicholas
    Jackson, Robert (Wantage)Spicer, Sir Michael
    Jenkin, BernardSpink, Bob (Castle Point)
    Johnson, Boris (Henley)Spring, Richard
    Keetch, PaulStanley, rh Sir John
    Kennedy, rh Charles (Ross Skye & Inverness)Steen, Anthony
    Streeter, Gary
    Key, Robert (Salisbury)Stunell, Andrew
    Kirkbride, Miss JulieSwayne, Desmond
    Kirkwood, Sir ArchySwire, Hugo (E Devon)
    Knight, rh Greg (E Yorkshire)Syms, Robert
    Laing, Mrs EleanorTapsell, Sir Peter
    Lait, Mrs JacquiTaylor, John (Solihull)
    Lamb, NormanTaylor, Matthew (Truro)
    Lansley, AndrewTaylor, Dr. Richard (Wyre F)

    Taylor, Sir TeddyWilkinson, John
    Thomas, Simon (Ceredigion)Willetts, David
    Thurso, JohnWilliams, Hywel (Caernarfon)
    Tonge, Dr. JennyWillis, Phil
    Trimble, rh DavidWinterton, Ann (Congleton)
    Turner, Andrew (Isle of Wight)Winterton, Sir Nicholas(Macclesfield)
    Tyler, Paul (N Cornwall)
    Tyrie, AndrewYeo, Tim (S Suffolk)
    Viggers, PeterYoung, rh Sir George
    Waterson, NigelYounger-Ross, Richard
    Watkinson, Angela
    Webb, Steve (Northavon)

    Tellers for the Noes:

    Whittingdale, John

    Mr. David Wilshire and

    Wiggin, Bill

    Mr. Mark Francois

    Question accordingly agreed to.

    Lords amendment disagreed to.

    Lords amendment: No. 18.

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

    The House divided: Ayes 320, Noes 203.

    Division No. 125]

    [5:26 pm

    AYES

    Adams, Irene (Paisley N)Chapman, Ben (Wirral S)
    Ainger, NickChidgey, David
    Allen, GrahamClapham, Michael
    Anderson, rh Donald (Swansea E)Clark, Mrs Helen (Peterborough)
    Anderson, Janet (Rossendale & Darwen)Clark, Dr. Lynda (Edinburgh Pentlands)
    Armstrong, rh Ms HilaryClark, Paul (Gillingham)
    Atherton, Ms CandyClarke, Tony (Northampton S)
    Atkins, CharlotteClelland, David
    Bailey, AdrianClwyd, Ann (Cynon V)
    Baird, VeraCoaker, Vernon
    Banks, TonyCoffey, Ms Ann
    Barnes, HarryCohen, Harry
    Barron, rh KevinColeman, Iain
    Begg, Miss AnneCooper, Yvette
    Benn, HilaryCorbyn, Jeremy
    Bennett, AndrewCorston, Jean
    Benton, Joe (Bootle)Cousins, Jim
    Berry, RogerCox, Tom (Tooting)
    Best, HaroldCrausby, David
    Betts, CliveCruddas, Jon
    Blackman, LizCryer, Ann (Keighley)
    Blears, Ms HazelCryer, John (Hornchurch)
    Blizzard, BobCummings, John
    Blunkett, rh DavidCunningham, Jim (Coventry S)
    Boateng, rh PaulCunningham, Tony (Workington)
    Borrow, DavidCurtis-Thomas, Mrs Claire
    Bradley, rh Keith (Withington)Dalyell, Tam
    Bradley, Peter (The Wrekin)Darling, rh Alistair
    Bradshaw, BenDavey, Valerie (Bristol W)
    Brennan, KevinDavid, Wayne
    Brown, rh Nicholas (Newcastle E Wallsend)Davies, rh Denzil (Llanelli)
    Davies, Geraint (Croydon C)
    Bryant, ChrisDavis, rh Terry (B'ham Hodge H)
    Buck, Ms KarenDawson, Hilton
    Burden, RichardDean, Mrs Janet
    Burgon, ColinDhanda, Parmjit
    Burnham, AndyDismore, Andrew
    Byers, rh StephenDobbin, Jim (Heywood)
    Caborn, rh RichardDobson, rh Frank
    Cairns, DavidDonohoe, Brian H.
    Campbell, Alan (Tynemouth)Doran, Frank
    Campbell, Mrs Anne (C'bridge)Doughty, Sue
    Campbell, Ronnie (Blyth V)Dowd, Jim (Lewisham W)
    Caplin, IvorDrew, David (Stroud)
    Casale, RogerDrown, Ms Julia
    Caton, MartinEagle, Angela (Wallasey)
    Cawsey, Ian (Brigg)Eagle, Maria (L'pool Garston)

    Edwards, HuwKilfoyle, Peter
    Ellman, Mrs LouiseKing, Andy (Rugby)
    Ennis, Jeff (Barnsley E)King, Ms Oona (Bethnal Green & Bow)
    Etherington, Bill
    Fitzpatrick, JimKnight, Jim (S Dorset)
    Fitzsimons, Mrs LornaKumar, Dr. Ashok
    Flint, CarolineLadyman, Dr. Stephen
    Flynn, Paul (Newport W)Lammy, David
    Follett, BarbaraLawrence, 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, Terry (Worsley)
    Gapes, Mike (Ilford S)Liddell, rh Mrs Helen
    Gardiner, BarryLinton, Martin
    George, rh Bruce (Walsall S)Lloyd, Tony (Manchester C)
    Gerrard, NeilLove, Andrew
    Gibson, Dr. IanLucas, Ian (Wrexham)
    Gilroy, LindaLuke, Iain (Dundee E)
    Godsiff, RogerLyons, John (Strathkelvin)
    Goggins, PaulMcAvoy, Thomas
    Griffiths, Jane (Reading E)McCabe, Stephen
    Griffiths, Nigel (Edinburgh S)McCafferty, Chris
    Griffiths, Win (Bridgend)McCartney, rh Ian
    Hall, Mike (Weaver Vale)McDonagh, Siobhain
    Hall, Patrick (Bedford)MacDonald, Calum
    Hamilton, David (Midlothian)McDonnell, John
    Hamilton, Fabian (Leeds NE)MacDougall, John
    Hanson, DavidMcFall, John
    Harman, rh Ms HarrietMcGuire, Mrs Anne
    Harris, Tom (Glasgow Cathcart)McIsaac, Shona
    Havard, Dai (Merthyr Tydfil & Rhymney)McKechin, Ann
    Mackinlay, Andrew
    Healey, JohnMacShane, Denis
    Henderson, Ivan (Harwich)McWalter, Tony
    Hepburn, StephenMahmood, Khalid
    Heppell, JohnMahon, Mrs Alice
    Hewitt, rh Ms PatriciaMallaber, Judy
    Heyes, DavidMandelson, rh Peter
    Hill, Keith (Streatham)Mann, John (Bassetlaw)
    Hodge, MargaretMarris, Rob (Wolverh'ton SW)
    Hoey, Kate (Vauxhall)Marsden, Gordon (Blackpool S)
    Hood, Jimmy (Clydesdale)Marshall, Jim (Leicester S)
    Hope, Phil (Corby)Marshall-Andrews, Robert
    Hopkins, KelvinMartlew, Eric
    Howarth, rh Alan (Newport E)Milburn, rh Alan
    Howarth, George (Knowsley N & Sefton E)Miliband, David
    Miller, Andrew
    Howells, Dr. KimMole, Chris
    Hughes, Beverley (Stretford & Urmston)Moran, Margaret
    Morgan, Julie
    Hughes, Kevin (Doncaster N)Mountford, Kali
    Humble, Mrs JoanMudie, George
    Hurst, Alan (Braintree)Mullin, Chris
    Hutton, rh JohnMunn, Ms Meg
    Iddon, Dr. BrianMurphy, Denis (Wansbeck)
    Illsley, EricMurphy, Jim (Eastwood)
    Jackson, Glenda (Hampstead & Highgate)Murphy, rh Paul (Torfaen)
    Naysmith, Dr. Doug
    Jackson, Helen (Hillsborough)Norris, Dan (Wansdyke)
    Jamieson, DavidO'Brien, Bill (Normanton)
    Jenkins, BrianO'Brien, Mike (N Warks)
    Johnson, Alan (Hull W)O'Hara, Edward
    Johnson, Miss Melanie (Welwyn Hatfield)Olner, Bill
    O'Neill, Martin
    Jones, Jon Owen (Cardiff C)Organ, Diana
    Jones, Kevan (N Durham)Osborne, Sandra (Ayr)
    Jones, Lynne (Selly Oak)Owen, Albert
    Jones, Martyn (Clwyd S)Palmer, Dr. Nick
    Joyce, Eric (Falkirk W)Perham, Linda
    Kaufman, rh GeraldPicking, Anne
    Keeble, Ms SallyPickthall, Colin
    Keen, Alan (Feltham)Pike, Peter (Burnley)
    Kemp, FraserPlaskitt, James

    Pollard, KerryStewart, David (Inverness E & Lochaber)
    Pope, Greg (Hyndburn)
    Pound, StephenStewart, Ian (Eccles)
    Prentice, Ms Bridget (Lewisham E)Stinchcornbe, Paul
    Stoate, Dr. Howard
    Prentice, Gordon (Pendle)Strang, rh Dr. Gavin
    Prosser, GwynStringer, Graham
    Purchase, KenStuart, Ms Gisela
    Purnell, JamesTami, Mark (Alyn)
    Quin, rh JoyceTaylor, rh Ann (Dewsbury)
    Quinn, LawrieTaylor, Dari (Stockton S)
    Rapson, Syd (Portsmouth N)Taylor, David (NW Leics)
    Reed, Andy (Loughborough)Thomas, Gareth (Clwyd W)
    Reid, rh Dr. John (Hamilton N & Bellshill)Tipping, Paddy
    Trickett, Jon
    Robinson, Geoffrey (Coventry NW)Truswell, Paul
    Turner, Dr. Desmond (Brighton Kemptown)
    Roche, Mrs Barbara
    Rooney, TerryTurner, Neil (Wigan)
    Ross, Ernie (Dundee W)Twigg, Derek (Halton)
    Roy, Frank (Motherwell)Twigg, Stephen (Enfield)
    Ruddock, JoanTynan, Bill (Hamilton S)
    Russell, Ms Christine (City of Chester)Vaz, Keith (Leicester E)
    Vis, Dr. Rudi
    Ryan, Joan (Enfield N)Walley, Ms Joan
    Salter, MartinWareing, Robert N.
    Sarwar, MohammadWatson, Tom (W Bromwich E)
    Savidge, MalcolmWatts, David
    Savidge, MalcolmWhite, Brian
    Sawford, Phil
    Sedgemore, BrianWhitehead, Dr. Alan
    Shaw JonathanWicks, Malcolm
    Sheridan JimWilliams, rh Alan (Swansea W)
    Shipley, Ms DebraWilliams, Betty (Conwy)
    Simon, Siôn (B'ham Erdington)Wills, Michael
    Simpson, Alan (Nottingham S)Wilson, Brian
    Singh, MarshaWinterton, Ms Rosie (Doncaster C)
    Smith, rh Andrew (Oxford E)Wood Mike (Batley)
    Smith, Geraldine (Morecambe & Lunesdale)Woodward, Shaun
    Wright Anthony D. (Gt Yarmouth)
    Smith, Jacqui (Redditch)
    Smith, John (Glamorgan)Wright, David (Telford)
    Smith, Llew (Blaenau Gwent)Wright, Tony (Cannock)
    Soley, CliveWyatt, Derek
    Squire, Rachel
    Starkey, Dr. Phyllis

    Tellers for the Ayes:

    Steinberg, Gerry

    Mr. Phil Woolas and

    Stevenson, George

    Gillian Merron

    NOES

    Ainsworth, Peter (E Surrey)Burnett, John
    Allan, RichardBurns, Simon
    Arness, DavidBurnside, David
    Arbuthnot, rh JamesBurstow, Paul
    Atkinson, David (Bour'mth E)Calton, Mrs Patsy
    Atkinson, Peter (Hexham)Cameron, David
    Bacon, RichardCarmichael, Alistair
    Baker, NormanCash, William
    Barker, GregoryChapman, Sir Sydney (Chipping Barnet)
    Baron, John (Billericay)
    Beggs, Roy (E Antrim)Chope, Christopher
    Beith, rh A. J.Clappison, James
    Bellingham, HenryClarke, rh Kenneth (Rushcliffe)
    Bercow, JohnClifton-Brown, Geoffrey
    Beresford, Sir PaulCollins, Tim
    Blunt, CrispinCormack, Sir Patrick
    Boswell, TimCran, James (Beverley)
    Bottomley, Peter (Worthing W)Curry, rh David
    Bottomley, rh Virginia (SW Surrey)Davey, Edward (Kingston)
    Davies, Quentin (Grantham & Stamford)
    Brady, Graham
    Brake, Tom (Carshalton)Davis, rh David (Haltemprice & Howden)
    Brazier, Julian
    Breed, ColinDjanogly, Jonathan
    Browning, Mrs AngelaDodds, Nigel
    Bruce, MalcolmDonaldson, Jeffrey M.

    Dorrell, rh StephenMaples, John
    Duncan, Alan (Rutland)Marsden, Paul (Shrewsbury & Atcham)
    Duncan Smith, rh Iain
    Evans, NigelMates, Michael
    Fabricant, MichaelMaude, rh Francis
    Fallon, MichaelMay, Mrs Theresa
    Field, Mark (Cities of London & Westminster)Mercer, Patrick
    Mitchell, Andrew (Sutton Coldfield)
    Flight, Howard
    Flook, AdrianMoore, Michael
    Forth, rh EricMoss, Malcolm
    Foster, Don (Bath)Murrison, Dr. Andrew
    Fox, Dr. LiamNorman, Archie
    Francois, MarkOaten, Mark (Winchester)
    Gale, Roger (N Thanet)O'Brien, Stephen (Eddisbury)
    Garnier, EdwardÖpik, Lembit
    George, Andrew (St. Ives)Osborne, George (Tatton)
    Gibb, Nick (Bognor Regis)Ottaway, Richard
    Gidley, SandraPage, Richard
    Gillan, Mrs CherylPaice, James
    Goodman, PaulPaterson, Owen
    Grayling, ChrisPickles, Eric
    Green, Damian (Ashford)Price, Adam (E Carmarthen & Dinefwr)
    Green, Matthew (Ludlow)
    Greenway, JohnPrisk, Mark (Hertford)
    Grieve, DominicPugh, Dr. John
    Gummer, rh JohnRandall, John
    Hague, rh WilliamRedwood, rh John
    Hammond, PhilipRendel, David
    Hancock, MikeRobathan, Andrew
    Harris, Dr. Evan (Oxford W & Abingdon)Robertson, Hugh (Faversham & M-Kent)
    Harvey, NickRobertson, Laurence (Tewk'b'ry)
    Hawkins, NickRobinson, Mrs Iris (Strangford)
    Hayes, John (S Holland)Robinson, Peter (Belfast E)
    Heald, OliverRoe, Mrs Marion
    Heath, DavidRosindell, Andrew
    Heathcoat-Amory, rh DavidRuffley, David
    Hendry, CharlesRussell, Bob (Colchester)
    Hermon, LadySanders, Adrian
    Hoban, Mark (Fareham)Sayeed, Jonathan
    Hogg, rh DouglasSelous, Andrew
    Horam, John (Orpington)Shephard, rh Mrs Gillian
    Howard, rh MichaelSimmonds, Mark
    Howarth, Gerald (Aldershot)Smith, Sir Robert (W Ab'd'ns & Kincardine)
    Hughes, Simon (Southwark N)
    Hunter, AndrewSmyth, Rev. Martin (Belfast S)
    Jack, rh MichaelSoames, Nicholas
    Jackson, Robert (Wantage)Spelman, Mrs Caroline
    Jenkin, BernardSpicer, Sir Michael
    Johnson, Boris (Henley)Spink, Bob (Castle Point)
    Keetch, PaulSpring, Richard
    Kennedy, rh Charles (Ross Skye & Inverness)Stanley, rh Sir John
    Steen, Anthony
    Key, Robert (Salisbury)Streeter, Gary
    Kirkbride, Miss JulieStunell, Andrew
    Kirkwood, Sir ArchySwayne, Desmond
    Knight, rh Greg (E Yorkshire)Swire, Hugo (E Devon)
    Laing, Mrs EleanorSyms, Robert
    Lait, Mrs JacquiTapsell, Sir Peter
    Lamb, NormanTaylor, John (Solihull)
    Lansley, AndrewTaylor, Matthew (Truro)
    Laws, David (Yeovil)Taylor, Dr. Richard (Wyre F)
    Leigh, EdwardTaylor, Sir Teddy
    Lewis, Dr. Julian (New Forest E)Thomas, Simon (Ceredigion)
    Liddell-Grainger, IanThurso, John
    Lidington, DavidTonge, Dr. Jenny
    Lilley, rh PeterTrimble, rh David
    Llwyd, ElfynTurner, Andrew (Isle of Wight)
    Loughton, TimTyler, Paul (N Cornwall)
    Luff, Peter (M-Worcs)Tyrie, Andrew
    McIntosh, Miss AnneViggers, Peter
    Mackay, rh AndrewWaterson, Nigel
    Maclean, rh DavidWatkinson, Angela
    McLoughlin, PatrickWebb, Steve (Northavon)
    Malins, HumfreyWhittingdale, John

    Wiggin, BillWinterton, Sir Nicholas (Macclesfield)
    Wilkinson, John
    Willetts, DavidYeo, Tim (S Suffolk)
    Williams, Hywel (Caernarfon)Young, rh Sir George
    Williams, Roger (Brecon)
    Willis, Phil

    Tellers for the Noes:

    Wilshire, David

    Mr. Alan Reid and

    Winterton, Ann (Congleton)

    Richard Younger-Ross

    Question accordingly agreed to.

    Lords amendment disagreed to.

    Lords amendment: No. 23.

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

    The House divided: Ayes 322, Noes 206.

    Division No. 126]

    [5:38 pm

    AYES

    Adams, Irene (Paisley N)Clwyd, Ann (Cynon V)
    Ainger, NickCoaker, Vernon
    Allen, GrahamCoffey, Ms Ann
    Anderson, rh Donald (Swansea E)Cohen, Harry
    Armstrong, rh Ms HilaryColeman, Iain
    Atherton, Ms CandyCook, Frank (Stockton N)
    Atkins, CharlotteCooper, Yvette
    Bailey, AdrianCorbyn, Jeremy
    Baird, VeraCorston, Jean
    Banks, TonyCousins, Jim
    Barnes, HarryCox, Tom (Tooting)
    Barron, rh KevinCrausby, David
    Begg, Miss AnneCruddas, Jon
    Benn, HilaryCryer, Ann (Keighley)
    Bennett, AndrewCryer, John (Hornchurch)
    Benton, Joe (Bootle)Cummings, John
    Berry, RogerCunningham, Jim (Coventry S)
    Best, HaroldCunningham, Tony (Workington)
    Betts, CliveCurtis-Thomas, Mrs Claire
    Blackman, LizDalyell, Tam
    Blears, Ms HazelDarling, rh Alistair
    Blizzard, BobDavey, Valerie (Bristol W)
    Blunkett, rh DavidDavid, Wayne
    Borrow, DavidDavidson, Ian
    Bradley, rh Keith (Withington)Davies, rh Denzil (Llanelli)
    Bradley, Peter (The Wrekin)Davies, Geraint (Croydon C)
    Bradshaw, BenDavis, rh Terry (B'ham Hodge H)
    Brennan, KevinDean, Mrs Janet
    Brown, rh Nicholas (Newcastle E Wallsend)Dhanda, Parmjit
    Dismore, Andrew
    Bryant, ChrisDobbin, Jim (Heywood)
    Buck, Ms KarenDobson, rh Frank
    Burden, RichardDonohoe, Brian H.
    Burgon, ColinDoran, Frank
    Burnham, AndyDowd, Jim (Lewisham W)
    Byers, rh StephenDrew, David (Stroud)
    Caborn, rh RichardDrown, Ms Julia
    Cairns, DavidEagle, Angela (Wallasey)
    Campbell, Alan (Tynemouth)Eagle, Maria (L'pool Garston)
    Campbell, Mrs Anne (C'bridge)Edwards, Huw
    Campbell, Ronnie (Blyth V)Efford, Clive
    Caplin, IvorEllman, Mrs Louise
    Casale, RogerEnnis, Jeff (Barnsley E)
    Caton, MartinEtherington, Bill
    Cawsey, Ian (Brigg)Fitzpatrick, Jim
    Chapman, Ben (Wirral S)Fitzsimons, Mrs Lorna
    Clapham, MichaelFlint, Caroline
    Clark, Mrs Helen (Peterborough)Flynn, Paul (Newport W)
    Clark, Dr. Lynda (Edinburgh Pentlands)Follett, Barbara
    Foster, rh Derek
    Clark, Paul (Gillingham)Foster, Michael (Worcester)
    Clarke, rh Charles (Norwich S)Foster, Michael Jabez (Hastings & Rye)
    Clarke, Tony (Northampton S)
    Clelland, DavidFoulkes, rh George

    Francis, Dr. HywelLinton, Martin
    Gapes, Mike (Ilford S)Lloyd, Tony (Manchester C)
    Gardiner, BarryLove, Andrew
    Gerrard, NeilLucas, Ian (Wrexham)
    Gibson, Dr. IanLuke, Iain (Dundee E)
    Gilroy, LindaLyons, John (Strathkelvin)
    Godsiff, RogerMcAvoy, Thomas
    Goggins, PaulMcCabe, Stephen
    Griffiths, Jane (Reading E)McCafferty, Chris
    Griffiths, Nigel (Edinburgh S)McCartney, rh Ian
    Griffiths, Win (Bridgend)McDonagh, Siobhain
    Hall, Mike (Weaver Vale)MacDonald, Calum
    Hall, Patrick (Bedford)McDonnell, John
    Hamilton, David (Midlothian)MacDougall, John
    Hamilton, Fabian (Leeds NE)McFall, John
    Hanson, DavidMcGuire, Mrs Anne
    Harman, rh Ms HarrietMcIsaac, Shona
    Harris, Tom (Glasgow Cathcart)McKechin, Ann
    Havard, Dai (Merthyr Tydfil & Rhymney)Mackinlay, Andrew
    MacShane, Denis
    Healey, JohnMcWalter, Tony
    Henderson, Ivan (Harwich)Mahmood, Khalid
    Hepburn, StephenMahon, Mrs Alice
    Heppell, JohnMallaber, Judy
    Hewitt, rh Ms PatriciaMandelson, rh Peter
    Heyes, DavidMann John (Bassetlaw)
    Hill, Keith (Streatham)Marris, Rob (Wolverh'ton SW)
    Hodge, MargaretMarsden, Gordon (Blackpool S)
    Hoey, Kate(Vauxhall)Marshall, Jim (Leicester S)
    Hood, Jimmy (Clydesdale)Marsha-Andrews, Robert
    Hope, Phil(Corby)Martlew, Eric
    Hopkins, KelvinMilburn, rh Alan
    Howarth, rh Alan (Newport E)Miliband, David
    Howarth, George(Knowsley N & Sefton E)Miller, Andrew
    Mole, Chris
    Hughes, Beverley (Stretford & Urmston)Moran, Margaret
    Morgan, Julie
    Hughes, Kevin (Doncaster N)Mountford, Kali
    Humble, Mrs JoanMudie, George
    Hurst, Alan (Braintree)Mullin, Chris
    Hutton, rh JohnMunn, Ms Meg
    Iddon, Dr. BrianMurphy, Denis (Wansbeck)
    Illsley, EricMurphy, Jim (Eastwood)
    Jackson, Glenda (Hampstead & Highgate)Murphy, rh Paul (Torfaen)
    Naysmith, Dr. Doug
    Jackson, Helen (Hillsborough)Norris, Dan (Wansdyke)
    Jamieson, DavidO'Brien, Bill (Normanton)
    Jenkins, BrianO'Brien, Mike (N Warks)
    Johnson, Alan (Hull W)O'Hara, Edward
    Johnson, Miss Melanie(Welwyn Hatfield)Olner,Bil1
    Jones, Jon Owen (Cardiff C)O'Neill, Martin
    Jones, Kevan (N Durham)Organ, Diana
    Jones, Lynne (Selly Oak)Osborne, Sandra (Ayr)
    Jones, Martyn (Clwyd S)Owen, Albert
    Joyce, Eric (Falkirk W)Palmer, Dr. Nick
    Kaufman, rh GeraldPerham, Linda
    Keeble, Ms SallyPicking, Anne
    Keen, Alan (Feltham)Pickthall, Colin
    Kemp, FraserPike, Peter (Burnley)
    Kidney, DavidPlaskitt, James
    Kilfoyle, PeterPollard, Kerry
    King, Andy (Rugby)Pope, Greg (Hyndburn)
    King, Ms Oona (Bethnal Green & Bow)Pound, Stephen
    Prentice, Ms Bridget (Lewisham E)
    Knight, Jim (S Dorset)
    Kumar, Dr. AshokPrentice, Gordon (Pendle)
    Ladyman, Dr. StephenProsser, Gwyn
    Lammy, DavidPurchase, Ken
    Lawrence, Mrs JackiePurnell, James
    Laxton, Bob (Derby N)Quin, rh Joyce
    Lazarowicz, MarkQuinn, Lawrie
    Lepper, DavidRapson, Syd (Portsmouth N)
    Levitt, Tom (High Peak)Reed, Andy (Loughborough)
    Lewis, Terry (Worsley)Reid, rh Dr. John (Hamilton N & Bellshill)
    Liddell, rh Mrs Helen

    Robinson, Geoffrey (Coventry NW)Stuart, Ms Gisela
    Tami, Mark (Alyn)
    Roche, Mrs BarbaraTaylor, rh Ann (Dewsbury)
    Rooney, TerryTaylor, Dari (Stockton S)
    Ross, Ernie (Dundee W)Taylor, David (NW Leics)
    Roy, Frank (Motherwell)Thomas, Gareth (Clwyd W)
    Ruane, ChrisThomas, Gareth (Harrow W)
    Ruddock, JoanTipping, Paddy
    Russell, Ms Christine (City of Chester)Trickett, Jon
    Truswell, Paul
    Ryan, Joan (Enfield N)Turner, Dr Desmond (Brighton Kemptown)
    Salter, Martin
    Sarwar, MohammadTurner, Neil (Wigan)
    Savidge, MalcolmTwigg, Derek (Halton)
    Sawford, PhilTwigg, Stephen (Enfield)
    Sedgemore, BrianTynan, Bill (Hamilton S)
    Shaw, JonathanVaz, Keith (Leicester E)
    Sheridan, JimVis, Dr. Rudi
    Shipley, Ms DebraWalley, Ms Joan
    Simon, Siôn (B'ham Erdington)Wareing, Robert N.
    Simpson, Alan (Nottingham S)Watson, Tom (W Bromwich E)
    Singh, MarshaWatts, David
    Smith, rh Andrew (Oxford E)White, Brian
    Smith, rh Chris (Islington S & Finsbury)Whitehead, Dr. Alan
    Wicks, Malcolm
    Smith, Geraldine (Morecambe & Lunesdale)Williams, rh Alan (Swansea W)
    Williams, Betty (Conwy)
    Smith, Jacqui (Redditch)Wills, Michael
    Smith, John (Glamorgan)Wilson, Brian
    Smith, Llew (Blaenau Gwent)Winnick, David
    Soley, CliveWinterton, Ms Rosie (Doncaster C)
    Spellar, rh John
    Squire, RachelWood, Mike (Batley)
    Starkey, Dr. PhyllisWoodward, Shaun
    Steinberg, GerryWright, Anthony D. (Gt Yarmouth)
    Stevenson, George
    Stewart, David (Inverness E & Lochaber)Wright, David (Telford)
    Wright, Tony (Cannock)
    Stewart, Ian (Eccles)Wyatt, Derek
    Stinchcombe, Paul
    Stoate, Dr. Howard

    Tellers for the Ayes:

    Strang, rh Dr. Gavin

    Mr. Phil Woolas and

    Stringer, Graham

    Gillian Merron

    NOES

    Ainsworth, Peter (E Surrey)Cameron, David
    Allan, RichardCarmichael, Alistair
    Amess, DavidCash, William
    Arbuthnot, rh JamesChapman, Sir Sydney (Chipping Barnet)
    Atkinson, David (Bour'mth E)
    Atkinson, Peter (Hexham)Chidgey, David
    Bacon, RichardChope, Christopher
    Baker, NormanClappison, James
    Barker, GregoryClarke, rh Kenneth (Rushcliffe)
    Baron, John (Billericay)Clifton-Brown, Geoffrey
    Beggs, Roy (E Antrim)Collins, Tim
    Beith, rh A. J.Cormack, Sir Patrick
    Bellingham, HenryCran, James (Beverley)
    Bercow, JohnCurry, rh David
    Beresford, Sir PaulDavey, Edward (Kingston)
    Blunt, CrispinDavies, Quentin (Grantham & Stamford)
    Boswell, Tim
    Bottomley, Peter (Worthing W)Davis, rh David (Haltemprice & Howden)
    Bottomley, rh Virginia (SW surrey)
    Djanogly, Jonathan
    Brady, GrahamDodds, Nigel
    Brake, Tom (Carshalton)Donaldson, Jeffrey M.
    Brazier, JulianDorrell, rh Stephen
    Breed, ColinDoughty, Sue
    Browning, Mrs AngelaDuncan, Alan (Rutland)
    Bruce, MalcolmDuncan Smith, rh Iain
    Burnett, JohnEvans, Nigel
    Burns, SimonFabricant, Michael
    Burnside, DavidFallon, Michael
    Burstow, PaulField, Mark (Cities of London & Westminster)
    Calton, Mrs Patsy

    Flight, HowardMitchell, Andrew (Sutton Coldfield)
    Flook, Adrian
    Forth, rh EricMoore, Michael
    Foster, Don (Bath)Moss, Malcolm
    Fox, Dr. LiamMurrison, Dr. Andrew
    Francois, MarkNorman, Archie
    Gale, Roger (N Thanet)Oaten, Mark (Winchester)
    Garnier, EdwardO'Brien, Stephen (Eddisbury)
    George, Andrew (St. Ives)Öpik, Lembit
    Gibb, Nick (Bognor Regis)Osborne, George (Tatton)
    Gidley, SandraOttaway, Richard
    Gillan, Mrs CherylPage, Richard
    Goodman, PaulPaice, James
    Grayling, ChrisPaterson, Owen
    Green, Damian (Ashford)Pickles, Eric
    Green, Matthew (Ludlow)Price, Adam (E Carmarthen & Dinefwr)
    Greenway, John
    Grieve, DominicPrisk, Mark (Hertford)
    Gummer, rh JohnPugh, Dr. Jonn
    Hague, rh WilliamRandall, John
    Hammond, PhilipRedwood, rh John
    Hancock, MikeReid, Alan (Argyll & Bute)
    Harris, Dr. Evan (Oxford W & Abingdon)Rendel, David
    Robathan, Andrew
    Harvey NickRobertson, Hugh (Faversham & M-Kent)
    Hawkins, Nick
    Hayes, John (S Holland)Robertson, Laurence(Tewk'b'ry)
    Heald, OliverRobinson, Mrs Iris (Strangford)
    Heath, DavidRobinson, Peter (Belfast E)
    Heathcoat-Amory, rh DavidRoe, Mrs Marion
    Hendry, CharlesRosindell, Andrew
    Hermon LadyRuffley, David
    Hogg, rh DouglasRussell, Bob (Colchester)
    Horam, John (Orpington)Sanders, Adrian
    Howard, rh MichaelSelous, Andrew
    Howarth, Gerald (Aldershot)Shephard, rh Mrs Gillian
    Hughes, Simon (Southwark N)Simmonds Mark
    Hunter, AndrewSmith sir Robert (w Ab'd'ns & Kincardine)
    Jack, rh Michael
    Jackson, Robert (Wantage)Smyth, Rev. Martin (Belfast S)
    Jenkin, BernardSoames, Nicholas
    Johnson, Boris (Henley)Spelman, Mrs Caroline
    Jones, Nigel (Cheltenham)Spicer, Sir Michael
    Keetch, PaulSpink, Bob (Castle Point)
    Kennedy, rh Charles (Ross Skye & Inverness)Spring, Richard
    Stanley, rh Sir John
    Key, Robert (Salisbury)Steen Anthony
    Kirkbride, Miss JulieStreeter, Gary
    Kirkwood, Sir ArchyStunell, Andrew
    Knight, rh Greg (E Yorkshire)Swayne, Desmond
    Laing, Mrs EleanorSwire, Hugo (E Devon)
    Lait, Mrs JacquiSyms, Robert
    Lamb, NormanTapsell, Sir Peter
    Lansley, AndrewTaylor, John (Solihull)
    Laws, David (Yeovil)Taylor, Matthew (Truro)
    Leigh, EdwardTaylor, Dr. Richard (Wyre F)
    Lewis, Dr. Julian (New Forest E)Taylor, Sir Teddy
    Liddell-Grainger, IanThomas, Simon (Ceredigion)
    Lidington, DavidThurso, John
    Lilley, rh PeterTonge, Dr. Jenny
    Llwyd, ElfynTrimble, rh David
    Loughton, TimTurner, Andrew (Isle of Wight)
    Luff, Peter (M-Worcs)Tyler, Paul (N Cornwall)
    McIntosh, Miss AnneTyrie, Andrew
    Mackay, rh AndrewViggers, Peter
    Maclean, rh DavidWaterson, Nigel
    McLoughlin, PatrickWatkinson, Angela
    Malins, HumfreyWebb, Steve (Northavon)
    Maples, JohnWhittingdale, John
    Marsden, Paul (Shrewsbury & Atcham)Wiggin, Bill
    Wilkinson, John
    Mates, MichaelWilletts, David
    Maude, rh FrancisWilliams, Hywel (Caernarfon)
    May, Mrs TheresaWilliams, Roger (Brecon)
    Mercer, PatrickWillis, Phil

    Winterton, Ann (Congleton)Younger-Ross, Richard
    Winterton, Sir Nicholas (Macclesfield)

    Tellers for the Noes:

    Yeo, Tim (S Suffolk)

    Mr. David Wilshire and

    Young, rh Sir George

    Mr. Mark Hoban

    Question accordingly agreed to.

    Lords amendment disagreed to.

    Lords amendments Nos. 17, 19, 40, 42, and 44 to 46 agreed to.

    Clause 3

    Duties Arising Where A Notice Under Section 2 Is Given

    Lords amendment: No. 24.

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

    With this it will be convenient to discuss Lords amendment No. 25 and Government motion to disagree thereto.

    The amendments would impose a permanent statutory duty on inspection bodies to monitor the impact of the Bill on patients and carers, and a permanent statutory duty on the Secretary of State to report annually to Parliament. The implication seems to be that health and social care professionals will irresponsibly discharge patients with inappropriate care packages, but we do not believe that this will be the case. Of course, they will also duplicate safeguards and inspection mechanisms already in place, and will jeopardise the independence of those that are planned.

    NHS and local authorities should, of course, already monitor the quality and effectiveness of their discharge arrangements, which are subject to the normal performance management, performance assessment and monitoring and inspection arrangements. Current inspection bodies already monitor the quality of discharge arrangements and the effect on patients and carers as part of their normal inspection and monitoring activities. For example, the social services inspectorate monitors the quality of services to older people. 'This will include the achievement of national priorities and targets—including the proportion of those helped to live at home, compared with residential care—as well as local improvement plans. As part of that, it will of course look at the quality of community support following discharge from hospital. It will also question the balance between investment in services and the amount spent on reimbursement charges.

    In a similar way, when the Commission for Health Improvement reviews clinical governance arrangements within a hospital, it covers planning of patients' entire hospital stay and their discharge. That is an important part of its review methodology. Of course, where a combination of performance indicators and inspection points to particular problems in a given area, the inspection bodies and, ultimately, the Secretary of State have an escalating power to intervene, and to ensure that action is taken to improve outcomes and performance.

    As hon. Members know, we have introduced legislation to establish two new health and social care inspectorates: the Commission for Health Care Audit and Inspection and the Commission for Social Care Inspection. We have already stressed that those bodies will strengthen the accountability of those responsible for the commissioning and delivery of health and social services, and an important part of this role will be for both inspectorates to report annually to Parliament on the provision of NHS and social care. However, we have also stressed their independence from the Department, so although they will agree priorities with the Department, it would not be appropriate for detailed instructions such as those proposed in the amendments to pass from the Secretary of State to the inspectorate concerning the details and the frequency with which they need to inspect particular elements of older people's services.

    We do not believe, therefore, that it is necessary or appropriate to impose that permanent and specific statutory duty on the inspection bodies to monitor the effects of this Bill, or to impose a duty on the Secretary of State to report every year to Parliament specifically on the Bill's effect.

    I should say at the outset that I am very disappointed with the Minister's assessment of, and views on, two very valuable and important amendments for the raising and maintaining of standards. This Government have rightly—I am not criticising them—always maintained that patients, the NHS itself and the professionals who work in it should attain the highest possible standards, and that the quality of care should be of the highest level. I can assure the Minister that I do not disagree with her one iota on that important issue. As constituency MPs, we owe that to those of our constituents who may use the national health service, and to the NHS itself because of the professionals who work within it. What surprises me is that the Minister, by rejecting the amendments, does not seem to share our enthusiasm for ensuring the highest quality and standards in all areas of the NHS.

    For example, Lords amendment No. 24, notwithstanding he Minister's comments, seems eminently reasonable. It asks that
    "The Secretary of State shall specify to the bodies charged with inspection of health and social services that they should monitor, at regular intervals, the impact of this Act on patients and their carers."
    On the face of it, that seems to be a welcome added benefit to health and social care. So that the Minister fully appreciates the intention behind the specification that the Secretary of State would be expected to make, I confirm that the bodies that would be charged with the responsibility would be the Audit Commission, CHI—and its successor, if and when other legislation is introduced—and the social services inspectorate.

    The Government have been in power for six years now, during which time they have taken a perverse pleasure in examining every nook and cranny of our national life. They have not been averse to increasing bureaucracy, but when the other place makes an eminently sensible suggestion to ensure that standards are maintained, they—somewhat churlishly on this occasion—reject it, Under the Bill, the patient should be the most important: part of the equation of the provision of health care, but the pressures that will be placed on social services by the fines system will mean that the patient will be the piggy in the middle, caught between the NHS and local authority social services departments.

    My hon. Friend is making an effective case and demolishing the Minister's arguments. Is not the Minister wrong when she says that the amendments imply that some sort of wrongdoing is likely to take place? The words added by the other place refer to monitoring and to reporting back to Parliament and, in a democracy, that is eminently sensible and desirable.

    I am indebted to my right hon. Friend. Perspicacious as ever, he has anticipated a point that I was about to make. In all candour, I was surprised and shocked by that comment from the Minister, because it was unfair. Nothing in any amendment to health legislation that I have supported has ever criticised or cast doubt on the huge professionalism of the staff at all levels of the NHS. It perplexed me, listening to the Minister, and I carefully read the words again in case the other place had—uncharacteristically—slipped up. I could not see that it had, and I am sure that the Minister will wish to rectify her comments later.

    I shall try to be charitable to the Minister and suggest that she and my hon. Friend are simply and genuinely at cross-purposes. When the Minister talks about the existing inspection and audit regime, that is fine, but we are talking about a Bill that may have all sorts of unintended consequences. If those consequences are undesirable—because, in the real world, it is just possible that the Minister could be wrong about the Bill—the sooner that we identify by specific audit any national trend that suggests that, the better for all of us.

    My hon. Friend has made an important point, and he is right. We must ensure that we get the legislation right at this stage. I must say that I took umbrage at one point in my hon. Friend's intervention when he suggested—unless I misheard him—that the Minister was at cross-purposes with me because she wanted the best in this legislation. I find that difficult to reconcile in one respect. How can the Minister want the best for the Bill when she is bringing in a rather nasty system of fines on local authorities? That does not equal wanting the very best from the Bill. The Bill will do exactly the opposite of providing the very best.

    Before those helpful interventions, I was saying that the Bill will mean that patients become caught, like piggy in the middle, between the NHS and local authorities. That will happen because the Bill will pressure authorities to discharge patients to avoid a fine. I am sure that the Minister does not want patients to suffer in any way. She is talking to her silent Whip at the moment; if she were listening to me, she would be able to hear what I want to tell her in all sincerity. However, she is clearly not listening and will therefore have to read Hansard.

    The Minister says that she has heard it all before, which is odd, as I have not presented this amendment before. It has come from another place, where common sense has prevailed and caused the Government to suffer a defeat. The Opposition in this House are trying to save the Government from making another mistake in overturning the amendment.

    Before that rather cruel intervention—the Minister cannot have heard my speech before—I was saying that it is important that patients do not suffer. I am sure that the Minister agrees with that. However, the Bill could cause them to suffer as a result of the possible early discharge from hospital to residential care or to domiciliary care in their own homes. That discharge could happen because local authorities want to avoid fines. The result could be emergency readmissions, or an unacceptable level of readmissions to hospital, within a seven to 28-day time scale.

    In an earlier debate, I set out the rising incidence of emergency readmissions to hospital among people aged over 75. The statistics show that there is a problem, and I argued that it could be exacerbated by the Bill. Amendment No. 24 would help to minimise that potential problem.

    6 pm

    Similarly, in the rush to avoid a fine, patients could be discharged into inappropriate care, or into the least appropriate care. No one wants that to happen, but it may be an unfortunate consequence of the possibility that local authorities could be fined. Alternatively, patients could be discharged to their own homes without adequate support services from either the NHS or the local authority social services department. Carers could suffer because undue burdens are placed on them when patients are discharged—by local authorities wishing to avoid being fined—without the support of a proper and comprehensive care package.

    Amendment No. 24 would alleviate those potential problems. It would allow the situation to be monitored, as reports would be made to local authorities and the NHS. In that way, the problems that could arise would be minimised. For that reason, the Minister got it wrong when she criticised the amendment in her opening comments. She should think again.

    Amendment No. 25 is eminently sensible. It would straightforwardly require the Secretary of State to report annually to Parliament on the outcomes of patients affected by the provisions in the Bill. I should have thought that the Government would warmly welcome that. Certainly, in opposition, they were strong proponents of open government. We have heard the rhetoric—they have talked the talk, but they do not often walk the walk—that people should be empowered with information and knowledge. The amendment represents a classic example of that. It is justifiable that Parliament—which will, if the Government get their way, pass this unpleasant Bill—should be made aware of the outcome of the legislation that it passes. That is not an unreasonable requirement, and I should have thought that the Government, in the spirit of open government and empowering people with information, would be prepared to accept it.

    There may be an overriding reason why the Government do not want the Secretary of State to be required to report annually to Parliament on the outcomes of patients affected by the legislation. Perhaps, in their heart of hearts, they accept the arguments that my right hon. and hon. Friends and I, as well as the Liberal Democrats, have been making for many months—that the Bill is counterproductive and highly damaging, that it will destroy partnership working between the health service and local authorities, and that it will have an adverse impact on patients because it will increase pressures on the early discharge of patients, especially elderly patients over the age of 75. As is shown by the statistics that the Government have produced in recent months, those pressures have led to a rising level of emergency readmissions. In fact, it is probably the case that the Government do not oppose the principle of amendment No. 25, but fear its consequences, in that it would annually reveal to Parliament the failings of the legislation. Moreover, it would show how right the Opposition have been to oppose the Bill root and branch and how misguided Ministers and their followers on the Back Benches have been to press ahead with it in defiance of all the evidence that it is not a good piece of legislation.

    is not there another argument that the Minister might find more attractive—that is, that if the legislation works well, members of the Government would have an annual opportunity to come to this House to say so?

    My right hon. Friend makes an interesting point. He knows as well as I do that some members of the Government are not as keen on coming to this place as others. In some cases, the amendment could represent an opportunity to ensure that they are here, and it could become an annual visit, so it has that extra potential benefit.

    I hope that the Minister will, in the spirit of maintaining the highest possible standards and of open government, be minded to think again. I am not confident about that, but perhaps I can encourage her by saying that I will ask at the appropriate moment to divide the House on amendments Nos. 24 and 25.

    I support the amendments because it is appropriate to ask the various inspection agencies covering health and social care now and in future to monitor the implementation of the legislation, and, not least, because the Minister has been unable to answer several questions in the course of the debate, and by monitoring the situation closely we might begin to get some of those answers. Earlier, I referred to the National Audit Office report—and specifically to the accuracy of data that were being supplied on the numbers of people who are suffering delays in their discharge. I was a little disappointed that the Minister was unable to cast any light on Government actions in response to the NAO's findings and was unable to say whether the Government accepted the NAO's conclusion that there were difficulties that would impact on the Government's ability to implement the system of fines that the Bill would introduce. More than four out of every 10 NHS bodies that are responsible for submitting data on the numbers of people who are experiencing delays appear not to be following the Government's definitions. That is a problem.

    However, it is not only what the NAO is saying that causes concern. Not surprisingly, local authorities, in partnership with their local NHS, are trying to test how the system would work. A colleague of mine from a metropolitan authority in the midlands told me:
    "There is also a problem over definitions (there almost always has been but local work had, we thought, given … agreed definitions). A recent batch of 9 discharges from a local hospital went through a trial run to see what the results of the delayed discharge scheme would be, and the social services department thought they had agreement that only one of the discharges would count"
    for the purposes of the fine system. However, when the department went back to the NHS trust, the trust declared that nine would be counted as delayed under the legislation. That was clearly a trial exercise to see what would happen, but it bears on the issue of clarity of definition. That clarity is still not in the Bill. The NAO has raised concerns about that.

    Another issue that I hope will be contained in an annual report to Parliament, and that certainly ought to be subject to monitoring by the Commission for Health Improvement and the Commission for Social Care Inspection, is the interface between health and housing and social care. From 1 April, the supporting people programme will be rolled out across the country. Large amounts of money will be reorganised and distributed by local authorities to pay for supporting people in their own homes and in settings such as sheltered accommodation. However, I was surprised to learn recently that guidance on how the supporting people programme fits with the single assessment process—guidance that one would have thought should have been provided by now to local authorities—has not even begun to be written. The group that will do that work has not even been called together. It would therefore seem appropriate to have in the Bill a measure to enable agencies such as the Commission for Social Care Inspection to consider how the intersection between the single assessment process and the supporting people programme works.

    One cause of dispute in the Chamber and in Committee, relating to whether this Bill can be implemented effectively, can be examined. It is the shortage of specialist staff. The NAO report found that two groups in particular—social workers and therapists—are in short supply. It was not only social services departments that foresaw a problem; it was the overwhelming view of primary care trusts that such shortages would continue to hamper dealing with issues of delayed discharge.

    I have one final question for the Minister, and I feel that this amendment could allow this issue to be monitored. It concerns the dividing line between what is NHS-funded continuing long-term care and what are NHS part-funded registered nursing care contributions—also called free nursing care. I have raised a concern with the Minister and others on a number of occasions. The criteria for the highest band of registered nurse contributions are setting a threshold that requires a higher and more complex level of need than the eligibility criteria for fully funded NHS continuing care. It would be useful for that to be looked at.

    The nursing care practice guide and workbook states:
    "People with high needs for registered nursing care will have complex needs that require frequent medical, technical and/or therapeutic intervention. They will need frequent intervention and re-assessment by a registered nurse throughout a 24 hour period and their physical/mental health state will be unpredictable."
    That is the definition used to enable a nurse to determine whether someone is in the top band and will receive a contribution of £110 towards their nursing care in a nursing home.

    6.15 pm

    The case studies in the workbook are examples that help nurses to apply the guidance meaningfully. However, it is interesting to compare them with the health ombudsman's report, which deals with real cases. The workbook stated that a woman who had suffered a cerebrovascular accident—CVA—would be placed in the highest band of nursing because she had suffered
    "loss of speech and was unable to swallow; partial paralysis and poor balance and co—ordination, doubly incontinent, pressure sore and tearful and distressed. She requires peg feeding and enemas to maintain bowel function, the use of a hoist to ensure safe transfer, and monitoring of the pressure sore, teaching to improve sitting balance, review of need for anti-depressant therapy and work to maintain social interaction."
    The amendment should include provision for the inspectorate to examine such cases because the health service ombudsman found that peg feeding was a criterion for continuing NHS care in one authority but not in another. In one case, the ombudsman's report helpfully listed Mrs. N's needs. They were
    "a hoist to help with transfers, a … catheter in place to deal with her incontinence of urine and assistance with her bowel function every three to four days; changing position to maintain skin viability, help with washing and oral care, and peg feeding. She did not appear to be depressed but smiled in response to other people."
    Those cases are similar, yet in one, used as an example, the person was entitled only to a contribution of £110 towards their nursing while in the other—a real case cited in the health service ombudsman's report—the person was entitled to have all their care met and paid for by the national health service. The Department's case study guidance is issued to nurses whose job is to make those systems work and it ought to lead to the conclusion that people are entitled to continuing NHS care funding.

    Will the Minister comment on that? More important, I hope that we do not have to rely only on the health service ombudsman to resolve, on a case-by-case basis, the problem of the dividing line between free continuing NHS care and nursing contributions. The Government should take the opportunity provided by the health service ombudsman's report to clarify the situation so that we stop the injustice that is undoubtedly being done to thousands of people who are being denied their rights.

    I am extremely puzzled by the attitude of the Minister and the Government to these perfectly sensible and appropriate amendments. Lords amendment No. 24 would specify bodies that will monitor the impact of the measure at regular intervals and Lords amendment No. 25 provides for an annual report to Parliament. As my right hon. Friend the Member for East Yorkshire (Mr. Knight) pointed out, such a report might give the Government the chance to trumpet the success of the legislation. I seem to recall that the Government used to issue an annual report to trumpet their achievements, but that practice seemed to fall into disuse two or three years ago—presumably because there was not much to trumpet.

    I urge the Minister to think again about the amendment. I appreciate why she might be feeling defensive about the measure; as we have already established, the Bill does not have a friend in the world. Even some of the Government's Back Benchers, including the Chairman of the Select Committee on Health, are not willing to support it. It has caused a storm of protest throughout the country, expressed through the Local Government Association, the Association of Directors of Social Services and so on.

    The Minister seems to think that the amendment will wreak a huge sea change in the position. Indeed, her thesis, which seems to go further away from reality, is that the mere threat of the Bill has enormously improved the bed-blocking position and that it will make a vast difference and improve the lives of many hundreds of thousands of patients throughout the country. She may be right. If she is, fine, but I do not think that she is. Equally, the Opposition and various bodies may well be right, and the law of unintended consequences will kick in and set at odds with one another some of the agencies that, certainly in my constituency, are now working in much closer partnership than they ever did before.

    I pay tribute to East Sussex county council for its work in the past year or two, since it has been run by the Conservatives, who have got to grips with the issue and worked closely with the health organisations. Although there are occasional blips, the result is a steady decline in the number of beds blocked or delayed discharges.

    I concede that the truth may turn out to be somewhere between those two views. However, on any assessment, this is a brand new regime with some pretty draconian powers, and it could all go horribly wrong or, at the very least, not produce the results that the Minister wants, so I fail to understand why she does not think that monitoring its progress is a good idea. There may be some scope for discussing whether that duty should arise only in the initial stages of its implementation. I can understand the Minister's argument that that should not happen every year, for ever, if the legislation has settled down or, even more likely, the problem has gone away of its own accord.

    In the debate in the other place, Baroness Noakes said that, under the current arrangements, the bodies involved would be the Audit Commission, the Commission for Health Improvement and the social services inspectorate, and she put it extremely well. Of course we have heard that, yet again, some of those bodies are in a state of flux, and we will end up with something called the Commission for Health Care Audit and Inspection. Whatever label is attached to those bodies, if legitimate concerns are felt not just by the official Opposition or the Liberal Democrats, but by lots of people at the coalface throughout the country who deal with such problems daily, it is surely important that we should get an idea early on whether the provisions are having the effect that the Minister thinks that they should. Surely, she, more than anyone else, would wish to know whether that was the case.

    If I may give the Minister a bit of friendly advice, I do not think that she should associate herself too closely with the Bill or she may turn into another Minister who never was, like Lord Hunt who used to deal with such matters in the other place.

    The Bill's effects will need careful examination in the real world. We have heard about some of the problems. Baroness Noakes referred to some of them in the other place, and my hon. Friend the Member for West Chelmsford (Mr. Burns) has dealt with the problem of readmission, so I need not do so. It is possible that people will be discharged home without adequate support services, and there is a whole series of possible knock-on effects, simply because of this ill-thought-out, hurried Bill.

    It is worth quoting what the Right Rev. Bishop of Hereford said in the other place. He referred to what he called
    "the widespread feeling that patients are treated … as commodities."—[Official Report, House of Lords, 17 February 2003; Vol. 644, c. 975.]
    Other hon. Members and I have expressed that view in earlier debates on the Bill. That is the nub of the problem. The Opposition and many other people are worried that patients and their needs are not central to the Bill and that they will be pushed aside in the interests of what I have already called this bizarre game of pass the parcel. Let us stop using the words "fines" and "incentives". I shall say that the Bill has financial repercussions—that may make the Minister happy—if people are holding the parcel when the music stops.

    There will be some serious, hard cases in the real world, affecting our constituents, as well as those of the Minister and other hon. Members, so why on earth does not the Minister want to reassure people? Of course she takes the view that the rest of the world is out of step and that she is the only one in step, but if she is so utterly convinced of her rectitude, why not put it to the test? As my right hon. Friend the Member for East Yorkshire has already said, if there is good news to tell, let her blazon it in the House with an annual report and let it be reported on and authenticated by those audit bodies.

    I could not agree more with the comment that Baroness Noakes made in last month's debate:
    "the Bill … tends to marginalise the individuals who are at the heart of the processes."—[Official Report, House of Lords, 18 February 2003; Vol. 644, c. 1029.]
    That has been and will continue to be our fear about the Bill. We are happy and willing to be proved wrong. Surely, the way to ensure that that happens is to use one or more of the sort of bodies that are so beloved of the Government to audit progress, see whether the legislation is working and report annually to Parliament. I cannot see the Minister's problem, as by accepting the amendments—if she will only leave them alone, they are already part of the Bill—she can at a stroke prove us all wrong and prove that hers is the lonely voice that has been right all along.

    I hope that the House will support the Lords in their amendments and maintain them in the Bill.

    We have just heard three very powerful speeches explaining why the Minister is wrong on the issue with which the amendments deal but not one voice raised in support from the Labour Benches.

    The Minister's opening remarks sounded rather half-hearted and certainly showed a paucity of reason. We are disappointed by her attitude to the amendments because we had a debate yesterday in which the Opposition were prepared to take a non-partisan approach on a very important issue and say that, where we thought that the Government and the Prime Minister in particular were right, they had our support. All that we are asking her to do is listen to our arguments and reflect on what she will say in advising the House about how to treat the proposed additions to the Bill. What are we seeking to do? We are seeking to say that proposals that are moderate, modest and reasonable should remain in the Bill.

    Amendment No. 24 states:
    "The Secretary of State shall specify to the bodies charged with inspection of health and social services that they should monitor".
    The word "monitor" was put into the Bill by the other place, and it does not carry with it any of the implications to which the Minister referred in relation to a presumption of wrongdoing. The monitoring process would occur "at regular intervals". If the Minister were willing to reflect on the matter again, I would be happy to accept that regular intervals do not need to involve continual monitoring, but could entail annual monitoring or even a biannual process. Surely, however, it is right to see that best practice is being followed and that it is consistent throughout the United Kingdom.

    I cannot understand why the Minister is not willing to accept Lords amendment No. 25. As you will be well aware, Mr. Deputy Speaker, it used to be said in the days of the previous Conservative Government that there was terrible pressure on parliamentary time and that it was not possible always to accommodate debates on every single issue that hon. Members felt was important. However, there has been a change in our procedures since that time—the addition of Westminster Hall. Although the former Leader of the House, who has just resigned his position, and his predecessor both gave an undertaking to the official Opposition that Westminster Hall would not be used for introducing legislation, there is consensus in all parts of the House that it could and should be used for debates on annual reports such as the one in question. In the light of the fact that we now have that other Chamber a stone's throw away from this place, I am at a loss to understand why the Minister will not accept the amendment.

    My right hon. Friend touches on an extremely important point. He is as aware as I am that Westminster Hall is already used to debate Select Committee reports, so the precedent exists and the powerful suggestion that he is making would dovetail with what already happens in our proceedings.

    6.30 pm

    I agree wholeheartedly with my hon. Friend. An annual report does not have to be debated every year. If an annual report was good but was deemed to contain nothing exciting or worthy of criticism, then the usual channels could produce a system in which a debate did not have to occur every year. Clearly, cost is not an issue because the Minister did not mention it. I was apprehensive that she might argue that she did not want the amendments because of the cost to the Exchequer, but that does not seem to be a problem. I hope that she will think again. I say to her: be bold, be reckless and, in the light of the powerful arguments adduced in the debate, allow the amendments to stand.

    With the leave of the House, I shall respond to the debate.

    Hon. Members suggested that a monitoring and reporting system is not in place to ensure that the good outcomes produced by the Bill will be clearly monitored. However, I outlined a variety of ways—I do not intend to repeat them—in which that will be ensured. I think that the amendments are otiose and that it can be argued that they will have a detrimental effect on the inspection bodies that will be established.

    Having feigned indignation when I suggested that the amendments were proposed on the assumption that the health and social care services might not operate in the best interests of patients, the hon. Member for West Chelmsford (Mr. Burns) then gave a string of ways in which the system might indeed not operate in the best interests of patients. I reassure him that monitoring is in place to ensure that that does not happen. The NHS and social care performance indicators, introduced by the Government to ensure greater accountability of the performance of the NHS and social care services, already include delayed discharges, emergency readmissions and home care to help people live at home. We are also introducing indicators on the speed of service provision. Those will show when substantial problems arise.

    Hon. Members also asked about debating annual reports that are made to Parliament. Under the previous system—with the exception of the Commission for Health Improvement, largely inherited from the Conservative Government—annual reports were published, but not to Parliament. Under the new system, the Commission for Social Care Inspection and the Commission for Health Care Audit and Inspection will make annual reports to Parliament. We amply cover the concerns of hon. Members that both the successes and the challenges are reported to Parliament on an annual basis.

    When we debate the legislation to establish the new inspection bodies, I shall be interested to hear whether Opposition Members raise concerns about the need to ensure that they are able to make an independent determination of quality in the health service and social care service. That would be different from the approach taken by the hon. Member for West Chelmsford, who believes that we should instruct the bodies in the minutiae of their considerations.

    That is the implication of the Lords amendment. The other place claims to believe in the independence of the inspection bodies, but that claim lies rather uncomfortably with the proposals in the amendment.

    I want to spend some time responding to the points raised by the hon. Member for Sutton and Cheam (Mr. Burstow) about, among other things, his specialist subject of continuing care. On the points made by the National Audit Office about the definition of good practice, one of the important features of the Bill is that it will put in place a clear process and decision points for determining a delayed discharge and, therefore, the point at which reimbursement should kick in. I heard what the hon. Gentleman said about his colleagues on the metropolitan authority in the west midlands, but perhaps that authority would welcome a visit from the Department's implementation team to ensure that some of the concerns can be ironed out before the Bill comes into force.

    The hon. Gentleman asked about the broader definition of delayed discharge. Sir Nigel Crisp, the chief executive of the NHS, has written to those trusts that told the National Audit Office that they were not using the definition. All of them have confirmed that they are now using the correct definition.

    The hon. Gentleman also asked about continuing care and its relationship with free nursing care. When nurses undertake a determination of NHS-funded nursing care, we have made it clear that all nurses should consider eligibility under continuing NHS health care criteria as the first step in assessing people's needs for care in a care home providing nursing. Furthermore, in the guidance on NHS-funded nursing care, we have consistently maintained the distinction between NHS-funded nursing care and continuing NHS health care, making it clear that NHS-funded nursing care is part of a spectrum of care that falls short of what one would expect to see when the primary need is for health care. As I have suggested, we have made it clear that, regardless of the eventual setting in which someone is likely to be cared for, we expect the first consideration in a joint assessment of someone's need to be always the extent to which that person meets or does not meet the criteria for NHS continuing health care.

    The Minister is making some helpful clarifications. However, will she also undertake to take away the workbook that is currently used for guiding nurses in applying the tool for assessing the entitlement to free nursing care contributions? The workbook contains a case that is exactly the same as a real case considered by the ombudsman, and that must provide incorrect information and the incorrect basis for making decisions.

    I was just coming to that point. I have pointed out that the first task is to assess whether someone has a need for NHS continuing care and emphasised that we must consider that on a case-by-case basis. The fictitious case that the hon. Gentleman mentioned would be considered in the assessment of nursing care only if the continuing care criteria were not met. A consideration of that would previously have been carried out. The hon. Gentleman's points about the workbook are not justified.

    We are considering inspection and monitoring, and the hon. Gentleman asked whether we could consider the monitoring of the continuing care criteria. Although not solely in response to his concerns, we have asked CHI to consider local policies and criteria as part of a review of the older people's national service framework.

    In conclusion, I believe I have provided the reassurance that right hon. and hon. Members wanted. The amendments are unnecessary and challenge the current arrangements and the independence of the inspectorates that we want to develop. For that reason, I hope the House will disagree with the Lords.

    Question put, That this House disagrees with the Lords in the said amendment:—

    The House divided: Ayes 308, Noes 198.

    Division No. 127]

    [6:40 pm

    AYES

    Abbott, Ms DianeClark, Mrs Helen (Peterborough)
    Adams, Irene (Paisley N)Clark, Dr. Lynda (Edinburgh Pentlands)
    Ainger, Nick
    Ainsworth, Bob (Cov'try NE)Clark, Paul (Gillingham)
    Allen, GrahamClarke, rh Charles (Norwich S)
    Anderson, rh Donald (Swansea E)Clarke, Tony (Northampton S)
    Anderson, Janet (Rossendale & Darwen)Clelland, David
    Anderson, rh Donald (swansea E)Clarke, rh Charles (Norwich S)
    Anderson, Janet (Rossendale & Darwen)Clelland, David
    Clwyd, Ann (Cynon V)
    Armstrong, rh Ms HilaryCoaker, Vernon
    Atherton, Ms CandyCoffey, Ms Ann
    Atkins, CharlotteCohen, Harry
    Bailey, AdrianColeman, Iain
    Baird, VeraCook, Frank (Stockton N)
    Banks, TonyCorbyn, Jeremy
    Barnes, HarryCorston, Jean
    Barron, rh KevinCousins, Jim
    Begg, Miss AnneCox, Tom (Tooting)
    Benn, HilaryCrausby, David
    Bennett, AndrewCruddas, Jon
    Benton, Joe (Bootle)Cryer, Ann (Keighley)
    Berry, RogerCryer, John (Hornchurch)
    Betts, CliveCummings, John
    Blackman, LizCunningham, Jim (Coventry S)
    Blears, Ms HazelCunningham, Tony (Workington)
    Blizzard, BobDalyell, Tam
    Borrow, DavidDavey, Valerie (Bristol W)
    Bradley, rh Keith (Withington)Davidson, Ian
    Bradley, Peter (The Wrekin)Davies, rh Denzil (Llanelli)
    Bradshaw, BenDavies, Geraint (Croydon C)
    Brennan, KevinDavis, rh Terry (B'ham Hodge H)
    Brown, rh Nicholas (Newcastle E Wallsend)Dawson, Hilton
    Dean, Mrs Janet
    Bryant, ChrisDhanda, Parmjit
    Buck, Ms KarenDobbin, Jim (Heywood)
    Burden, RichardDobson, rh Frank
    Burgon, ColinDonohoe, Brian H.
    Burnham, AndyDoran, Frank
    Byers, rh StephenDowd, Jim (Lewisham W)
    Cairns, DavidDrew, David (Stroud)
    Campbell, Alan (Tynemouth)Drown, Ms Julia
    Campbell, Mrs Anne (C'bridge)Eagle, Angela (Wallasey)
    Campbell, Ronnie (Blyth V)Eagle, Maria (L'pool Garston)
    Caplin, IvorEdwards, Huw
    Casale, RogerEfford, Clive
    Cawsey, Ian (Brigg)Ellman, Mrs Louise
    Chapman, Ben (Wirral S)Ennis, Jeff (Barnsley E)
    Chaytor, DavidEtherington, Bill
    Clapham, MichaelField, rh Frank (Birkenhead)

    Fitzpatrick, JimLinton, Martin
    Fitzsimons, Mrs LornaLloyd, Tony (Manchester C)
    Flint, CarolineLove, Andrew
    Flynn, Paul (Newport W)Lucas, Ian (Wrexham)
    Follett, BarbaraLuke, Iain (Dundee E)
    Foster, rh DerekLyons, John (Strathkelvin)
    Foster, Michael (Worcester) McAvoy, Thomas
    Foster, Michael Jabez (Hastings & Rye)McCabe, Stephen
    McCafferty, Chris
    Foulkes, rh GeorgeMcCartney, rh Ian
    Gapes, Mike (Ilford S)McDonagh, Siobhain
    Gardiner, Barry MacDonald, Calum
    George, rh Bruce (Walsall S)MacDougall, John
    Gerrard, NeilMcFall, John
    Gibson, Dr. IanMcGuire, Mrs Anne
    Gilroy, LindaMcIsaac, Shona
    Godsiff, RogerMcKechin, Ann
    Griffiths, Jane (Reading E)McWalter Tony
    Griffiths, Win (Bridgend)Mahmood, Khalid
    Hain, rh PeterMahon, Mrs Alice
    Hall, Mike (Weaver Vale)Mallaber, Judy
    Hall, Patrick (Bedford)Mandelson, rh Peter
    Hamilton, Fabian (Leeds NE)Mann John (Bassetlaw)
    Hanson, DavidMarris Rob (Wolverh'ton SW)
    Harris, Tom (Glasgow Cathcart)Marsden, Gordon (Blackpool S)
    Harris, Tom (Glasgow Cathcart)Marshall Jim (Leicester S)
    Healey, JohnMarshall-Andrews, Robert
    Henderson, Ivan (Harwich)Martlew, Eric
    Hepburn, StephenMerron, Gillian
    Hewitt, rh Ms PatriciaMilburn, rh Alan
    Heyes, DavidMiliband, David
    Hill, Keith (Streatham)Miller, Andrew
    Hoey, Kate (Vauxhall)Mitchell, Austin (Gt Grimsby)
    Hood, Jimmy (Clydesdale)Mole, Chris
    Hope, Phil (Corby)Moran, Margaret
    Hopkins, KelvinMorgan, Julie
    Howarth, George (Knowsley N & Sefton E)Morris, rh Estelle
    Mountford, Kali
    Hughes, Beverley (Stretford & Urmston)Mudie George
    Mullin, Chris
    Hughes, Kevin (Doncaster N)Munn, Ms Meg
    Humble, Mrs JoanMurphy, Denis (Wansbeck)
    Hurst, Alan (Braintree)Murphy, Jim (Eastwood)
    Iddon, Dr. BrianMurphy, rh Paul (Torfaen)
    Illsley, EricNaysmith, Dr. Doug
    Jackson, Glenda (Hempstead & Highgate)Norris Dan (Wansdyke)
    O'Brien, Bill (Normanton)
    Jackson, Helen (Hillsborough)O'Brien, Mike (N Warks)
    Jamieson, DavidO'Hara, Edward
    Jenkins, BrianOlner, Bill
    Johnson, Alan (Hull W)O'Neill, Martin
    Jones, Jon Owen (Cardiff C)Organ, Diana
    Jones, Kevan (N Durham)Osborne, Sandra (Ayr)
    Jones, Martyn (Clwyd S)Owen, Albert
    Joyce, Eric (Falkirk W)Palmer, Dr. Nick
    Kaufman, rh GeraldPerham, Linda
    Keeble, Ms SallyPicking, Anne
    Keen, Alan (Feltham)Pickthall, Colin
    Kidney, DavidPike, Peter (Burnley)
    Kilfoyle, PeterPlaskitt, James
    King, Andy (Rugby)Pollard, Kerry
    King, Ms Oona (Bethnal Green & Bow)Pope, Greg (Hyndburn)
    Pound, Stephen
    Knight, Jim (S Dorset)Prentice, Ms Bridget (Lewisham E)
    Kumar, Dr. Ashok
    Ladyman, Dr. StephenPrentice, Gordon (Pendle)
    Lammy, DavidProsser, Gwyn
    Lawrence, Mrs JackiePurchase, Ken
    Laxton, Bob (Derby N)Purnell, James
    Lazarowicz, MarkQuin, rh Joyce
    Lepper, DavidQuinn, Lawrie
    Levitt, Tom (High Peak)Rapson, Syd (Portsmouth N)
    Lewis, Ivan (Bury S)Reed, Andy (Loughborough)
    Lewis, Terry (Worsley)Reid, rh Dr. John (Hamilton N & Bellshill)
    Liddell, rh Mrs Helen

    Robinson, Geoffrey (Coventry NW)Taylor, rh Ann (Dewsbury)
    Taylor, Dari (Stockton S)
    Roche, Mrs BarbaraTaylor, David (NW Leics)
    Rooney, TerryThomas, Gareth (Harrow W)
    Ross, Ernie (Dundee W)Timms, Stephen
    Roy, Frank (Motherwell)Tipping, Paddy
    Ruddock, JoanTodd, Mark (S Derbyshire)
    Russell, Ms Christine (City of Chester)Trickett, Jon
    Truswell, Paul
    Ryan, Joan (Enfield N)Turner, Dr. Desmond (Brighton Kemptown)
    Salter, Martin
    Sarwar, MohammadTurner, Neil (Wigan)
    Savidge, MalcolmTwigg, Derek (Halton)
    Sawford, PhilTwigg, Stephen (Enfield)
    Sedgemore, BrianTynan, Bill (Hamilton S)
    Sheridan, JimVaz, Keith (Leicester E)
    Shipley, Ms DebraVis, Dr. Rudi
    Simon, Siôn (B'ham Erdington)Walley, Ms Joan
    Simpson, Alan (Nottingham S)Wareing, Robert N.
    Singh, MarshaWatson, Tom (W Bromwich E)
    Smith, rh Andrew (Oxford E)Watts, David
    Smith, Geraldine (Morecambe & Lunesdale)White, Brian
    Whitehead, Dr. Alan
    Smith, Jacqui (Redditch)Wicks, Malcolm
    Smith, John (Glamorgan)Williams, rh Alan (Swansea W)
    Smith, Llew (Blaenau Gwent)Williams, Betty (Conwy)
    Soley, CliveWills, Michael
    Spellar, rh JohnWilson, Brian
    Squire, RachelWinnick, David
    Starkey, Dr. PhyllisWinterton, Ms Rosie (Doncaster C)
    Steinberg, GerryWood Mike (Batley)
    Stevenson, GeorgeWoodward, Shaun
    Stewart, David (Inverness E & Lochaber)Woolas Phil
    Wright, Anthony D. (Gt Yarmouth)
    Stewart, Ian (Eccles)
    Stinchcombe, PaulWright, David (Telford)
    Stoate, Dr. HowardWright, Tony (Cannock)
    Strang, rh Dr. Gavin
    Stringer, Graham

    Tellers for the Ayes:

    Stuart, Ms Gisela

    Mr. John Heppell and

    Tami, Mark (Alyn)

    Mr. Fiaser Kemp

    NOES

    Ainsworth, Peter (E Surrey)Cameron, David
    Allan, RichardCarmichael, Alistair
    Amess, DavidCash, William
    Ancram, rh MichaelChapman, Sir Sydney (Chipping Barnet)
    Arbuthnot, rh James
    Atkinson, David (Bour'mth E)Chidgey, David
    Atkinson, Peter (Hexham)Chope, Christopher
    Bacon, RichardClappison, James
    Baker, NormanClarke, rh Kenneth (Rushcliffe)
    Barker, GregoryClifton-Brown, Geoffrey
    Baron, John (Billericay)Collins, Tim
    Beggs, Roy (E Antrim)Cormack, Sir Patrick
    Beith, rh A. J.Cran, James (Beverley)
    Bellingham, HenryCurry, rh David
    Bercow, JohnDavey, Edward (Kingston)
    Beresford, Sir PaulDavies, Quentin (Grantham & Stamford)
    Blunt, Crispin
    Boswell, TimDavis, rh David (Haltemprice & Howden)
    Bottomley, Peter (Worthing W)
    Bottomley, rh Virginia (SW Surrey)Djanogly, Jonathan
    Dorrell, rh Stephen
    Brady, GrahamDoughty, Sue
    Brake, Tom (Carshalton)Duncan, Alan (Rutland)
    Brazier, JulianDuncan Smith, rh Iain
    Breed, ColinEvans, Nigel
    Browning, Mrs AngelaFabricant, Michael
    Bruce, MalcolmFallon, Michael
    Burnett, JohnField, Mark (Cities of London & Westminster)
    Burns, Simon
    Burnside, DavidFlight, Howard
    Burstow, PaulFlook, Adrian
    Calton, Mrs PatsyForth, rh Eric

    Foster, Don (Bath)Öpik, Lembit
    Fox, Dr. LiamOsborne, George (Tatton)
    Gale, Roger (N Thanet)Ottaway, Richard
    Garnier, EdwardPage, Richard
    George, Andrew (St. Ives)Paice, James
    Gibb, Nick (Bognor Regis)Paterson, Owen
    Gidley, SandraPickles, Eric
    Gillan, Mrs CherylPrice, Adam (E Carmarthen & Dinefwr)
    Goodman, Paul
    Grayling, ChrisPrisk, Mark (Hertford)
    Green, Damian (Ashford)Pugh, Dr. John
    Green, Matthew (Ludlow)Randall, John
    Greenway, JohnRedwood, rh John
    Grieve, DominicReid, Alan (Argyll & Bute)
    Gummer, rh JohnRendel, David
    Hague, rh WilliamRobathan, Andrew
    Hammond, PhilipRobertson, Hugh (Faversham & M-Kent)
    Hancock, Mike
    Harris, Dr. Evan (Oxford W & Abingdon)Robertson, Laurence (Tewk'b'ry)
    Robinson, Mrs Iris (Strangford)
    Harvey, NickRobinson, Peter (Belfast E)
    Hawkins, NickRosindell, Andrew
    Hayes, John (S Holland)Ruffley, David
    Heald, OliverRussell, Bob (Colchester)
    Heath, DavidSanders, Adrian
    Hermon, LadySayeed, Jonathan
    Hoban, Mark (Fareham)Selous, Andrew
    Holmes, PaulShephard, rh Mrs Gillian
    Horam, John (Orpington)Simmonds, Mark
    Howard, rh MichaelSmith sir Robert (W Ab'ns & Kincardine)
    Hughes, Simon (Southwark N)
    Hunter, AndrewSmyth, Rev. Martin (Belfast S)
    Jack, rh MichaelSpelman, Mrs Caroline
    Jackson, Robert (Wantage)Spicer Sir Michael
    Jenkin, BernardSpink Bob (Castle Point)
    Jones, Nigel (Cheltenham)Spring Richard
    Keetch, PaulStanley, rh Sir John
    Kennedy, rh Charles (Ross Skye & Inverness)Steen Anthony
    Streeter Gary
    Key, Robert (Salisbury)stunell, Andrew
    Kirkbride Miss JulieSwayne Desmond
    Kirkwood, Sir ArchySwire, Hugo (E Devon)
    Knight, rh Greg (E Yorkshire)Syms, Robert
    Laing Mrs EleanorTaylor, John (Solihull)
    Lait, Mrs JacquiTaylor, Matthew (Truro)
    Lamb, NormanTaylor, Dr. Richard (Wyre F)
    Lansley, AndrewTaylor, Sir Teddy
    Laws, David (Yeovil)
    Leigh, EdwardThomas, Simon (Ceredigion)
    Lewis, Dr. Julian (New Forest E)Thurso, John
    Liddell-Grainger, IanTonge, Dr. Jenny
    Lidington, DavidTredinnick, David
    Lilley rh PeterTurner, Andrew (Isle of Wight)
    Llwyd ElfynTyler, Paul (N Cornwall)
    Loughton, TimTyrie, Andrew
    Luff, Peter (M-Worcs)Viggers, Peter
    McIntosh, Miss AnneWaterson, Nigel
    Mackay, rh AndrewWatkinson, Angela
    Maclean, rh DavidWebb, Steve (Northavon)
    McLoughlin, PatrickWhittingdale, John
    Malins, HumfreyWiggin, Bill
    Maples, JohnWilkinson, John
    Marsden, Paul (Shrewsbury & Atcham)Willetts, David
    Williams, Hywel (Caernarfon)
    Mates, MichaelWilliams, Roger (Brecon)
    Maude, rh FrancisWillis, Phil
    May, Mrs TheresaWinterton, Ann (Congleton)
    Mercer, PatrickWinterton, Sir Nicholas (Macclesfield)
    Mitchell, Andrew (Sutton Coldfield)
    Yeo, Tim (S Suffolk)
    Moore, MichaelYoung, rh Sir George
    Moss, MalcolmYounger-Ross, Richard
    Murrison, Dr. Andrew
    Norman, Archie

    Tellers for the Noes:

    Oaten, Mark (Winchester)

    Mr. David Wilshire and

    O'Brien, Stephen (Eddisbury)

    Mr. Mark Francois

    Question accordingly agreed to.

    Lords amendment disagreed to.

    Lords amendment: No. 25

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

    The House divided: Ayes 318, Noes 198.

    Division No. 128]

    [6:53 pm

    AYES

    Abbott, Ms DianeCorston, Jean
    Adams, Irene (Paisley N)Cousins, Jim
    Ainger, NickCox, Tom (Tooting)
    Ainsworth, Bob (Cov'try NE)Crausby, David
    Allen, GrahamCruddas, Jon
    Anderson, rh Donald (Swansea E)Cryer, Ann (Keighley)
    Anderson, Janet (Rossendale & Darwen)Cryer, John (Hornchurch)
    Cummings, John
    Armstrong, rh Ms HilaryCunningham, Jim (Coventry S)
    Atherton, Ms CandyCunningham, Tony (Workington)
    Atkins, CharlotteCurtis-Thomas, Mrs Claire
    Bailey, AdrianDalyell, Tam
    Baird, VeraDavey, Valerie (Bristol W)
    Banks, TonyDavidson, Ian
    Barnes, HarryDavies, rh Denzil (Llanelli)
    Barron, rh KevinDavies, Geraint (Croydon C)
    Begg, Miss AnneDavis, rh Terry (B'ham Hodge H)
    Benn, HilaryDean, Mrs Janet
    Bennett, AndrewDhanda, Parmjit
    Benton, Joe (Bootle)Dobbin, Jim (Heywood)
    Berry, RogerDobson, rh Frank
    Best, HaroldDonohoe, Brian H.
    Betts, CliveDoran, Frank
    Blackman, LizDowd, Jim (Lewisham W)
    Blears, Ms HazelDrew, David (Stroud)
    Blizzard, BobDrown, Ms Julia
    Borrow, DavidEagle, Angela (Wallasey)
    Bradley, rh Keith (Withington)Eagle, Maria (L'pool Garston)
    Bradley, Peter (The Wrekin)Edwards, Huw
    Bradshaw, BenEfford, Clive
    Brennan, KevinEllman, Mrs Louise
    Brown, rh Nicholas (Newcastle E Wallsend)Ennis, Jeff (Barnsley E)
    Etherington, Bill
    Bryant, ChrisField, rh Frank (Birkenhead)
    Buck, Ms KarenFitzpatrick, Jim
    Burden, RichardFitzsimons, Mrs Lorna
    Burgon, ColinFlint, Caroline
    Burnham, AndyFlynn, Paul (Newport W)
    Byers, rh StephenFollett, Barbara
    Caborn, rh RichardFoster, rh Derek
    Cairns, DavidFoster, Michael (Worcester)
    Campbell, Alan (Tynemouth)Foster, Michael Jabez (Hastings & Rye)
    Campbell, Mrs Anne (C'bridge)
    Campbell, Ronnie (Blyth V)Foulkes, rh George
    Caplin, IvorGapes, Mike (Ilford S)
    Casale, RogerGardiner, Barry
    Cawsey, Ian (Brigg)George, rh Bruce (Walsall S)
    Chapman, Ben (Wirral S)Gerrard, Neil
    Chaytor, DavidGibson, Dr. Ian
    Clapham, MichaelGilroy, Linda
    Clark, Mrs Helen (Peterborough)Godsiff, Roger
    Clark, Dr. Lynda (Edinburgh Pentlands)Goggins, Paul
    Griffiths, Jane (Reading E)
    Clark, Paul (Gillingham)Griffiths, Nigel (Edinburgh S)
    Clarke, Tony (Northampton S)Griffiths, Win (Bridgend)
    Clelland, DavidHain, rh Peter
    Clwyd, Ann (Cynon V)Hall, Mike (Weaver Vale)
    Coaker, VernonHall, Patrick (Bedford)
    Coffey, Ms AnnHamilton, David (Midlothian)
    Cohen, HarryHamilton, Fabian (Leeds NE)
    Cook, Frank (Stockton N)Hanson, David
    Corbyn, JeremyHarris, Tom (Glasgow Cathcart)

    Havard, Dai (Merthyr Tydfil & Rhymney)Mahon, Mrs Alice
    Mallaber, Judy
    Healey, JohnMandelson, rh Peter
    Henderson, Ivan (Harwich)Mann, John (Bassetlaw)
    Hepburn, StephenMarris, Rob (Wolverh'ton SW)
    Hewitt, rh Ms PatriciaMarsden, Gordon (Blackpool S)
    Heyes, DavidMarshall, Jim (Leicester S)
    Hill, Keith (Streatham)Marshall-Andrews, Robert
    Hoey, Kate (Vauxhall)Martlew, Eric
    Hood, Jimmy (Clydesdale)Merron, Gillian
    Hope, Phil (Corby)Milburn, rh Alan
    Hopkins, KelvinMiliband, David
    Howarth, rh Alan (Newport E)Miller, Andrew
    Howarth, George (Knowsley N & Sefton E)Mitchell, Austin (Gt Grimsby)
    Mole, Chris
    Hughes, Beverley (Stretford & Urmston)Moonie, Dr. Lewis
    Moran, Margaret
    Hughes, Kevin (Doncaster N)Morgan, Julie
    Humble, Mrs JoanMorris, rh Estelle
    Hurst, Alan (Braintree)Mountford, Kali
    Hutton, rh JohnMudie, George
    Iddon, Dr. BrianMullin, Chris
    Illsley, EricMunn, Ms Meg
    Jackson, Glenda (Hampstead & Highgate)Murphy, Denis (Wansbeck)
    Murphy, Jim (Eastwood)
    Jackson, Helen (Hillsborough)Murphy, rh Paul (Torfaen)
    Jamieson, DavidNaysmith, Dr. Doug
    Jenkins, BrianNorris, Dan (Wansdyke)
    Johnson, Alan (Hull W)O'Brien, Bill (Normanton)
    Jones, Jon Owen (Cardiff C)O'Brien, Mike (N Warks)
    Jones, Kevan (N Durham)O'Hara, Edward
    Jones, Martyn (Clwyd S)Olner, Bill
    Jowell, rh TessaO'Neill, Martin
    Joyce, Eric (Falkirk W)Organ, Diana
    Kaufman, rh GeraldOsborne, Sandra (Ayr)
    Keeble, Ms SallyOwen, Albert
    Keen, Alan (Feltham)Palmer, Dr. Nick
    Kidney, DavidPerham, Linda
    Kilfoyle, PeterPicking, Anne
    King, Andy (Rugby)Pickthall, Colin
    King, Ms Oona (Bethnal Green & Bow)Pike, Peter (Burnley)
    Plaskitt, James
    Knight, Jim (S Dorset)Pollard, Kerry
    Kumar, Dr. AshokPope, Greg (Hyndburn)
    Ladyman, Dr. StephenPound, Stephen
    Lammy, DavidPrentice, Ms Bridget (Lewisham E)
    Lawrence, Mrs Jackie
    Laxton, Bob (Derby N)Prentice, Gordon (Pendle)
    Lazarowicz, MarkProsser, Gwyn
    Lepper, DavidPurchase, Ken
    Levitt, Tom (High Peak)Purnell, James
    Lewis, Ivan (Bury S)Quin, rh Joyce
    Lewis, Terry (Worsley)Quinn, Lawrie
    Liddell, rh Mrs HelenRapson, Syd (Portsmouth N)
    Linton, MartinReed, Andy (Loughborough)
    Lloyd, Tony (Manchester C)Reid, rh Dr. John (Hamilton N & Bellshill)
    Love, Andrew
    Lucas, Ian (Wrexham)Robinson, Geoffrey (Coventry NW)
    Luke, Iain (Dundee E)
    Lyons, John (Strathkelvin)Roche, Mrs Barbara
    McAvoy, ThomasRooney, Terry
    McCabe, StephenRoss, Ernie (Dundee W)
    McCafferty, ChrisRoy, Frank (Motherwell)
    McCartney, rh IanRuddock, Joan
    McDonagh, SiobhainRussell, Ms Christine (City of Chester)
    MacDonald, Calum
    McDonnell, JohnRyan, Joan (Enfield N)
    MacDougall, JohnSalter, Martin
    McFall, JohnSarwar, Mohammad
    McGuire, Mrs AnneSavidge, Malcolm
    McIsaac, ShonaSawford, Phil
    McKechin, AnnSedgemore, Brian
    Mackinlay, AndrewSheridan, Jim
    MacShane, DenisShipley, Ms Debra
    McWalter, TonySimon, Siôn (B'ham Erdington)
    Mahmood, KhalidSimpson, Alan (Nottingham S)

    Singh, MarshaTurner, Dr. Desmond (Brighton Kemptown)
    Smith, rh Andrew (Oxford E)
    Smith, Geraldine (Morecambe & Lunesdale)Turner, Neil (Wigan)
    Twigg, Derek (Halton)
    Smith, Jacqui (Redditch)Twigg, Stephen (Enfield)
    Smith, John (Glamorgan)Tynan, Bill (Hamilton S)
    Smith, Llew (Blaenau Gwent)Vaz, Keith (Leicester E)
    Soley, CliveVis, Dr. Rudi
    Spellar, rh JohnWalley, Ms Joan
    Squire, RachelWareing, Robert N.
    Starkey, Dr. PhyllisWatson, Tom (W Bromwich E)
    Steinberg, GerryWatts, David
    Stevenson, GeorgeWhite, Brian
    Stewart, David (Inverness E & Lochaber)Whitehead, Dr. Alan
    Wicks, Malcolm
    Stewart, Ian (Eccles)Williams, rh Alan (Swansea W)
    Stinchcombe, PaulWilliams, Betty (Conwy)
    Stoate, Dr. HowardWills, Michael
    Strang, rh Dr. GavinWinnick, David
    Stringer, GrahamWinterton, Ms Rosie (Doncaster C)
    Stuart, Ms Gisela
    Tami, Mark (Alyn)Wood, Mike (Batley)
    Taylor, rh Ann (Dewsbury)Woodward, Shaun
    Taylor, Dari (Stockton S)Woolas, Phil
    Taylor, David (NW Leics)Wright, Anthony D. (Gt Yarmouth)
    Thomas, Gareth (Harrow W)
    Timms, StephenWright, David (Telford)
    Tipping, PaddyWright, Tony (Cannock)
    Todd, Mark (S Derbyshire)
    Touhig, Don (Islwyn)

    Tellers for the Ayes:

    Trickett, Jon

    Mr. Fraser Kemp and

    Truswell, Paul

    Mr. John Heppell

    NOES

    Ainsworth, Peter (E Surrey)Cormack, Sir Patrick
    Allan, RichardCran, James (Beverley)
    Amess, DavidCurry, rh David
    Ancram, rh MichaelDavey, Edward (Kingston)
    Arbuthnot, rh JamesDavies, Quentin (Grantham & Stamford)
    Atkinson, David (Bour'mth E)
    Atkinson, Peter (Hexham)Davis, rh David (Haltemprice & Howden)
    Bacon, Richard
    Baker, NormanDjanogly, Jonathan
    Barker, GregoryDorrell, rh Stephen
    Baron, John (Billericay)Doughty, Sue
    Beggs, Roy (E Antrim)Duncan, Alan (Rutland)
    Beith, rh A. J.Duncan Smith, rh Iain
    Bellingham, HenryEvans, Nigel
    Beresford, Sir PaulFabricant Michael
    Blunt, CrispinFallon, Michael
    Boswell, TimField, Mark (Cities of London & Westminster)
    Bottomley, Peter (Worthing W)
    Bottomley, rh Virginia (SW Surrey)Flight, Howard
    Flook, Adrian
    Brady, GrahamForth, rh Eric
    Brake, Tom (Carshalton)Foster, Don (Bath)
    Brazier, JulianFox, Dr. Liam
    Breed, ColinGale, Roger (N Thanet)
    Browning, Mrs AngelaGarnier, Edward
    Bruce, MalcolmGeorge, Andrew (St. Ives)
    Burnett, JohnGibb, Nick (Bognor Regis)
    Burns, SimonGidley, Sandra
    Burnside, DavidGillan, Mrs Cheryl
    Burstow, PaulGoodman, Paul
    Calton, Mrs PatsyGrayling, Chris
    Cameron, DavidGreen, Damian (Ashford)
    Carmichael, AlistairGreen, Matthew (Ludlow)
    Cash, WilliamGreenway, John
    Chapman, Sir Sydney (Chipping Barnet)Grieve, Dominic
    Gummer, rh John
    Chidgey, DavidHague, rh William
    Chope, ChristopherHammond, Philip
    Clappison, JamesHancock, Mike
    Clarke, rh Kenneth (Rushcliffe)Harris, Dr. Evan (Oxford W & Abingdon)
    Clifton-Brown, Geoffrey
    Collins, TimHarvey, Nick

    Hawkins, NickPrice, Adam (E Carmarthen and Dinefwr)
    Hayes, John (S Holland)
    Heald, OliverPrisk, Mark (Hertford)
    Heath, DavidPugh, Dr. John
    Hermon, LadyRandall, John
    Hoban, Mark (Fareham)Redwood, rh John
    Hogg, rh DouglasReid, Alan (Argyll & Bute)
    Holmes, PaulRendel, David
    Horam, John (Orpington)Robathan, Andrew
    Howard, rh MichaelRobertson, Hugh (Faversham & M-kent)
    Hughes, Simon (Southwark N)
    Hunter, AndrewRobertson, Laurence (Tewk'b'ry)
    Robinson, Mrs Iris (Strangford)Jack, rh Michael
    Robinson, Peter (Belfast E)
    Jackson, Robert (Wantage)Rosindell, Andrew
    Jenkin, BernardRuffley, David
    Jones, Nigel (Cheltenham)Russell, Bob (Colchester)
    Keetch, PaulSanders Adrian
    Kennedy, rh Charles (Ross Skye & Inverness)Sayeed, Jonathan
    Selous, Andrew
    Key, Robert (Salisbury)Shephard, rh Mrs Gillian
    Kirkbride, Miss JulieSimmonds, Mark
    Kirkwood, Sir ArchySmith, Sir Robert (W Ab'd'ns & Kincardine)
    Knight, rh Greg (E Yorkshire)
    Laing, Mrs EleanorSmyth, Rev. Martin (Belfast S)
    Lait, Mrs JacquiSpelman, Mrs Caroline
    Lamb, NormanSpicer, Sir Michael
    Lansley, AndrewSpink, Bob (Castle Point)
    Laws, David (Yeovil)Spring, Richard
    Leigh, EdwardStanley, rh Sir John
    Lewis, Dr. Julian (New Forest E)Steen, Anthony
    Liddell-Grainger, IanStreeter, Gary
    Lidington, DavidStunell, Andrew
    Lilley, rh PeterSwayne, Desmond
    Llwyd ElfynSwire, Hugo (E Devon)
    Loughton, TimSyms, Robert
    Luff, Peter (M-Worcs)Taylor, John (Solihull)
    McGrady, EddieTaylor, Matthew (Truro)
    Taylor, Dr. Richard (Wyre F)
    McIntosh, Miss AnneTaylor, Sir Teddy
    Mackay, rh AndrewThomas, Simon (Ceredigion)
    Maclean, rh DavidThurso, John
    McLoughlin, PatrickTonge Dr. Jenny
    Malins, HumfreyTredinnick, David
    Maples, JohnTurner, Andrew (Isle of Wight)
    Marsden, Paul (Shrewsbury & Atcham)Tyler, Paul (N Cornwall)
    Tyrie, Andrew
    Mates, MichaelViggers, Peter
    Maude, rh FrancisWaterson, Nigel
    May, Mrs TheresaWatkinson, Angela
    Mercer, PatrickWebb, Steve (Northavon)
    Mitchell, Andrew (Sutton Coldfield)Whittingdale, John
    Wiggin, Bill
    Moore, MichaelWilkinson, John
    Willetts, David
    Moss, MalcolmWilliams, Hywel (Caernarfon)
    Murrison, Dr. AndrewWilliams, Roger (Brecon)
    Norman ArchieWinterton, Ann (Congleton)
    Oaten, Mark (Winchester)winterton, Sir Nicholas (Macclesfield)
    O'Brien, Stephen (Eddisbury)
    Öpik, LembitYeo, Tim (S Suffolk)
    Osborne, George (Tatton)Young, rh Sir George
    Ottaway, RichardYounger-Ross, Richard
    Page, Richard
    Paice, James

    Tellers for the Noes:

    Paterson, Owen

    Mr. David Wilshire and

    Pickles, Eric

    Mr. Mark Francois

    Question accordingly agreed to.

    Lords amendment disagreed to.

    It being after Seven o' clock, Mr. Speaker then proceeded to the Questions necessary to conclude proceedings, pursuant to Orders [28 June 2001 and 29 October 2002.]

    After Clause 3

    Lords amendment: No. 26.

    Motion made and Question put, That Government amendment (a) to the said amendment be made:—

    The House divided: Ayes 315, Noes 197.

    Division No. 129]

    [7:04 pm

    AYES

    Abbott, Ms DianeCorbyn, Jeremy
    Adams, Irene (Paisley N)Corston, Jean
    Ainger, NickCousins, Jim
    Ainsworth, Bob (Cov'try NE)Cox, Tom (Tooting)
    Allen, GrahamCrausby, David
    Anderson, rh Donald (Swansea E)Cruddas, Jon
    Anderson, Janet (Rossendale & Darwen)Cryer, Ann (Keighley)
    Cryer, John (Hornchurch)
    Armstrong, rh Ms HilaryCummings, John
    Atherton, Ms CandyCunningham, Jim (Coventry S)
    Atkins, CharlotteCunningham, Tony (Workington)
    Bailey, AdrianCurtis-Thomas, Mrs Claire
    Baird, VeraDavey, Valerie (Bristol W)
    Banks, TonyDavidson, Ian
    Barnes, HarryDavies, rh Denzil (Llanelli)
    Barron, rh KevinDavies, Geraint (Croydon C)
    Beckett, rh MargaretDavis, rh Terry (B'ham Hodge H)
    Begg, Miss AnneDawson, Hilton
    Benn, HilaryDean, Mrs Janet
    Bennett, AndrewDhanda, Parmjit
    Benton, Joe (Bootle)Dobbin, Jim (Heywood)
    Berry, RogerDobson, rh Frank
    Best, HaroldDonohoe, Brian H.
    Betts, CliveDoran, Frank
    Blackman, LizDowd, Jim (Lewisham W)
    Blears, Ms HazelDrew, David (Stroud)
    Blizzard, BobDrown, Ms Julia
    Borrow, DavidEagle, Angela (Wallasey)
    Bradley, rh Keith (Withington)Eagle, Maria (L'pool Garston)
    Bradley, Peter (The Wrekin)Edwards, Huw
    Bradshaw, BenEfford, Clive
    Brennan, KevinEllman, Mrs Louise
    Brown, rh Nicholas (Newcastle E Wallsend)Ennis, Jeff (Barnsley E)
    Etherington, Bill
    Bryant, ChrisField, rh Frank (Birkenhead)
    Buck, Ms KarenFitzpatrick, Jim
    Burden, RichardFitzsimons, Mrs Lorna
    Burgon, ColinFlint, Caroline
    Burnham, AndyFlynn, Paul (Newport W)
    Byers, rh StephenFollett, Barbara
    Caborn, rh RichardFoster, rh Derek
    Cairns, DavidFoster, Michael (Worcester)
    Campbell, Alan (Tynemouth)Foster, Michael Jabez (Hastings & Rye)
    Campbell, Mrs Anne (C'bridge)
    Campbell, Ronnie (Blyth V)Foulkes, rh George
    Caplin, IvorGapes, Mike (Ilford S)
    Casale, RogerGardiner, Barry
    Cawsey, Ian (Brigg)George, rh Bruce (Walsall S)
    Chapman, Ben (Wirral S)Gerrard, Neil
    Chaytor, DavidGibson, Dr. Ian
    Clapham, MichaelGilroy, Linda
    Clark, Mrs Helen (Peterborough)Goggins, Paul
    Clark, Dr. Lynda (Edinburgh Pentlands)Griffiths, Jane (Reading E)
    Griffiths, Nigel (Edinburgh S)
    Clark, Paul (Gillingham)Griffiths, Win (Bridgend)
    Clarke, Tony (Northampton S)Hain, rh Peter
    Clelland, DavidHall, Mike (Weaver Vale)
    Clwyd, Ann (Cynon V)Hall, Patrick (Bedford)
    Coaker, VernonHamilton, David (Midlothian)
    Coffey, Ms AnnHamilton, Fabian (Leeds NE)
    Cohen, HarryHanson, David
    Cook, Frank (Stockton N)Harris, Tom (Glasgow Cathcart)

    Havard, Dai (Merthyr Tydfil & Rhymney)MacShane, Denis
    McWalter, Tony
    Healey, JohnMahmood, Khalid
    Henderson, Ivan (Harwich)Mahon, Mrs Alice
    Hepburn, StephenMallaber, Judy
    Heyes, DavidMandelson, rh Peter
    Hill, Keith (Streatham)Mann, John (Bassetlaw)
    Hoey, Kate (Vauxhall)Marris, Rob (Wolverh'ton SW)
    Hood, Jimmy (Clydesdale)Marsden, Gordon (Blackpool S)
    Hope, Phil (Corby)Marshall, Jim (Leicester S)
    Hopkins, KelvinMarshall-Andrews, Robert
    Howarth, rh Alan (Newport E)Martlew, Eric
    Howarth, George (Knowsley N & Sefton E)Merron, Gillian
    Milburn, rh Alan
    Hughes, Beverley (Stretford & Urmston)Miliband, David
    Miller, Andrew
    Hughes, Kevin (Doncaster N)Mitchell, Austin (Gt Grimsby)
    Humble, Mrs JoanMole, Chris
    Hurst, Alan (Braintree)Moonie, Dr. Lewis
    Hutton, rh JohnMoran, Margaret
    Iddon, Dr. BrianMorgan, Julie
    Illsley, EricMorris, rh Estelle
    Jackson, Glenda (Hampstead & Highgate)Mountford, Kali
    Mullin, Chris
    Jackson, Helen (Hillsborough)Munn, Ms Meg
    Jamieson, DavidMurphy, Denis (Wansbeck)
    Jenkins, BrianMurphy, Jim (Eastwood)
    Johnson, Alan (Hull W)Murphy, rh Paul (Torfaen)
    Jones, Jon Owen (Cardiff C)Naysmith, Dr. Doug
    Jones, Kevan (N Durham)Norris, Dan (Wansdyke)
    Jones, Martyn (Clwyd S)O'Brien, Bill (Normanton)
    Jowell, rh TessaO'Brien, Mike (N Warks)
    Joyce, Eric (Falkirk W)O'Hara, Edward
    Kaufman, rh GeraldOlner, Bill
    Keeble, Ms SallyO'Neill, Martin
    Keen, Alan (Feltham)Organ, Diana
    Kidney, DavidOsborne, Sandra (Ayr)
    Kilfoyle, PeterOwen, Albert
    King, Andy (Rugby)Palmer, Dr. Nick
    King, Ms Oona (Bethnal Green & Bow)Perham, Linda
    Picking, Anne
    Knight, Jim (S Dorset)Pickthall, Colin
    Kumar, Dr. AshokPike, Peter (Burnley)
    Ladyman, Dr. StephenPlaskitt, James
    Lammy, DavidPollard, Kerry
    Lawrence, Mrs JackiePope, Greg (Hyndburn)
    Laxton, Bob (Derby N)Pound, Stephen
    Lazarowicz, MarkPrentice, Ms Bridget (Lewisham E)
    Lepper, David
    Levitt, Tom (High Peak)Prentice, Gordon (Pendle)
    Lewis, Ivan (Bury S)Prosser, Gwyn
    Lewis, Terry (Worsley)Purchase, Ken
    Liddell, rh Mrs HelenPurnell, James
    Linton, MartinQuin, rh Joyce
    Lloyd, Tony (Manchester C)Quinn, Lawrie
    Love, AndrewRapson, Syd (Portsmouth N)
    Lucas, Ian (Wrexham)Reed, Andy (Loughborough)
    Luke, Iain (Dundee E)Reid, rh Dr. John (Hamilton N & Bellshill)
    Lyons, John (Strathkelvin)
    McAvoy, ThomasRobinson, Geoffrey (Coventry NW)
    McCabe, Stephen
    McCafferty, ChrisRoche, Mrs Barbara
    McCartney, rh IanRooney, Terry
    McDonagh, SiobhainRoss, Ernie (Dundee W)
    MacDonald, CalumRoy, Frank (Motherwell)
    McDonnell, JohnRuddock, Joan
    MacDougall, JohnRussell, Ms Christine (City of Chester)
    McFall, John
    McGuire, Mrs AnneRyan, Joan (Enfield N)
    McIsaac, ShonaSalter, Martin
    McKechin, AnnSarwar, Mohammad
    Mackinlay, AndrewSavidge, Malcolm

    Sawford, PhilTodd, Mark (S Derbyshire)
    Sedgemore, BrianTouhig, Don (Islwyn)
    Sheridan, JimTrickett, Jon
    Shipley, Ms DebraTruswell, Paul
    Simon, Siôn (B'ham Erdington)Turner, Dr. Desmond (Brighton Kemptown)
    Simpson, Alan (Nottingham S)
    Singh, MarshaTurner, Neil (Wigan)
    Smith, rh Andrew (Oxford E)Twigg, Derek (Halton)
    Smith, Geraldine (Morecambe & Lunesdale)Twigg, Stephen (Enfield)
    Tynan, Bill (Hamilton S)
    Smith, Jacqui (Redditch)Vis, Dr. Rudi
    Smith, John (Glamorgan)Walley, Ms Joan
    Smith, Llew (Blaenau Gwent)Wareing, Robert N.
    Soley, CliveWatson, Tom (W Bromwich E)
    Spellar, rh JohnWatts, David
    Squire, Rachelwhite, Brian
    Starkey, Dr. PhyllisWhitehead, Dr. Alan
    Steinberg, Gerrywicks, Malcolm
    Stevenson, GeorgeWilliams, rh Alan (Swansea W)
    Stewart, David (Inverness E & Lochaber)Williams, Betty (Conwy)
    Wills, Michael
    Stewart, Ian (Eccles)Winnick, David
    Stinchcombe, PaulWinterton, Ms Rosie (Doncaster C)
    Stoate, Dr. Howard
    Strang, rh Dr. GavinWood, Mike (Batley)
    Stringer, GrahamWoodward, Shaun
    Woolas, Phil
    Stuart, Ms GiselaWright, Anthony D. (Gt Yarmouth)
    Tami, Mark (Alyn)
    Taylor, rh Ann (Dewsbury)Wright David (Telford)
    Taylor, Dari (Stockton S)Wright Tony (Cannock)
    Taylor, David (NW Leics)
    Thomas, Gareth (Harrow W)

    Tellers for the Ayes:

    Timms, Stephen

    Mr. Fraser Kemp and

    Tipping, Paddy

    Mr. John Heppell

    NOES

    Ainsworth, Peter (E Surrey)Chidgey, David
    Allan, RichardChope, Christopher
    Amess, DavidClappison, James
    Ancram, rh MichaelClarke, rh Kenneth (Rushcliffe)
    Arbuthnot, rh JamesClifton-Brown, Geoffrey
    Atkinson, David (Bour'mth E)Collins, Tim
    Atkinson, Peter (Hexham)Cormack, Sir Patrick
    Bacon, RichardCurry, rh David
    Baker, NormanDavey, Edward (Kingston)
    Barker, GregoryDavies, Quentin (Grantham & Stamford)
    Baron, John (Billericay)
    Beggs, Roy (E Antrim)Davis, rh David (Haltemprice & Howden)
    Beith, rh A. J.
    Bellingham, HenryDjanogly, Jonathan
    Beresford, Sir PaulDorrell, rh Stephen
    Blunt, CrispinDoughty, Sue
    Boswell, TimDuncan, Alan (Rutland)
    Bottomley, Peter (Worthing W)Duncan Smith, rh Iain
    Bottomley, rh Virginia (SW Surrey)Evans, Nigel
    Fabricant, Michael
    Brady, GrahamFallon, Michael
    Brake, Tom (Carshalton)Field, Mark (Cities of London & Westminster)
    Brazier, Julian
    Breed, ColinFlight, Howard
    Browning, Mrs AngelaFlook, Adrian
    Bruce, MalcolmForth, rh Eric
    Burnett, JohnFoster, Don (Bath)
    Burns, SimonFox, Dr. Liam
    Burnside, DavidFrancois, Mark
    Burstow, PaulGale, Roger (N Thanet)
    Calton, Mrs PatsyGarnier, Edward
    Cameron, DavidGeorge, Andrew (St. Ives)
    Carmichael, AlistairGibb, Nick (Bognor Regis)
    Cash, WilliamGidley, Sandra
    Chapman, Sir Sydney (Chipping Barnet)Gillan, Mrs Cheryl
    Goodman, Paul

    Grayling, ChrisPage, Richard
    Green, Damian (Ashford)Paice, James
    Green, Matthew (Ludlow)Paterson, Owen
    Greenway, JohnPickles, Eric
    Grieve, DominicPrice, Adam (E Carmarthen & Dinefwr)
    Gummer, rh John
    Hague, rh WilliamPrisk, Mark (Hertford)
    Hammond, PhilipPugh, Dr. John
    Hancock, MikeRandall, John
    Harris, Dr. Evan (Oxford W & Abingdon)Redwood, rh John
    Rendel, David
    Harvey, NickRobathan, Andrew
    Hawkins, NickRobertson, Hugh (Faversham & M-Kent)
    Hayes, John (S Holland)
    Heald, OliverRobertson, Laurence (Tewk'b'ry)
    Heath, DavidRobinson, Mrs Iris (Strangford)
    Hermon, LadyRobinson, Peter (Belfast E)
    Hoban, Mark (Fareham)Rosindell, Andrew
    Hogg, rh DouglasRuffley David
    Holmes, PaulRussell, Bob (Colchester)
    Horam, John (Orpington)Sanders, Adrian
    Howard, rh MichaelSayeed Jonatnan
    Hughes, Simon (Southwark N)Selous Andrew
    Hunter, AndrewShephard, rh Mrs Gillian
    Jack, rh Michaelsimmonds, Mark
    Jackson, Robert (Wantage)Smyth Rev Martin (Belfast s)
    Jenkin, Bernard
    Jones, Nigel (Cheltenham)Spelman, Mrs Caroline
    Keetch, PaulSpicer, Sir Michael
    Kennedy, rh Charles (Ross Skye & Inverness)Spink, Bob (Castle Point)
    Spring, Richard
    Key, Robert (Salisbury)Stanley, rh Sir John
    Kirkbride, Miss JulieSteen, Anthony
    Kirkwood, Sir ArchyStreeter, Gary
    Knight, rh Greg (E Yorkshire)Stunell Andrew
    Laing, Mrs EleanorSwayne, Desmond
    Lait, Mrs JacquiSwire, Hugo(E Devon)
    Lamb, NormanSyms, Robert
    Lansley, AndrewTaylor John (Solihull)
    Laws, David (Yeovil)Taylor, Matthew (Truro)
    Leigh, EdwardTaylor, Dr Richard (Wyre F)
    Lewis, Dr. Julian (New Forest E)Taylor, sir Teddy
    Liddell-Grainger, IanThomas, Simon (Ceredigion)
    Lidington, DavidThurso, John
    Lilley, rh PeterTonge, Dr. Jenny
    Llwyd, ElfynTredinnick, David
    Loughton, TimTurner, Andrew (Isle of Wight)
    Luff, Peter (M-Worcs)Tyler, Paul (N Cornwall)
    McIntosh, Miss AnneTyrie, Andrew
    Mackay, rh AndrewViggers, Peter
    Maclean, rh DavidWaterson, Nigel
    McLoughlin, PatrickWatkinson, Angela
    Malins, HumfreyWebb, Steve (Northavon)
    Maples, JohnWhittingdale, John
    Marsden, Paul (Shrewsbury & Atcham)Wiggin, Bill
    Wilkinson, John
    Mates, MichaelWilletts, David
    Maude, rh FrancisWilliams, Hywel (Caernarfon)
    May, Mrs TheresaWilliams, Roger (Brecon)
    Mercer, PatrickWillis, Phil
    Mitchell, Andrew (Sutton Coldfield)Wilshire, David
    Winterton, Ann (Congleton)
    Moore, MichaelWinterton, Sir Nicholas (Macclesfield)
    Moss, Malcolm
    Murrison, Dr. AndrewYeo, Tim (S Suffolk)
    Norman, ArchieYoung, rh Sir George
    Oaten