Commons Chamber

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House Of Commons

Friday 31 January 1992

The House met at half-past Nine o'clock

Prayers

[MR. SPEAKER in the Chair]

Petition

Mifegyne

9.34 am

I wish to present a petition, which reads as follows:

To the Honourable the Commons of Great Britain, Northern Ireland in Parliament assembled. The humble petition of the Ealing Chapter of Full Gospel Business Men's Fellowship International.

The petition is in the name of John K. Winget, of 25 Conway crescent, Perivale, Greenford, Middlesex, and others. It

Showeth

That we the undersigned wish to note with regret that the Abortion Pill Mifegyne (known as "RU486") has been granted a product licence. We believe that drugs and medicines should be used only to save life. We deplore the fact that this drug causes the death of unborn human beings, and we express our grave concern that it will damage women physically and psychologically.

I support and associate myself strongly with the petitioners.

The petition ends:

Wherefore your petitioners pray that your honourable House, which is committed to upholding respect for human life and protection of the weak and vulnerable, will do everything possible to prevent the distribution and use of Mifegyne (known as RU486) and any other drugs which, like it, are produced with the deliberate intention of destroying innocent human life. And your Petitioners, as in duty bound will ever pray, etc.

To lie upon the Table.

Orders Of The Day

Medicinal Products: Prescription By Nurses Etc Bill

Order for Second Reading read.

9.36 am

I beg to move, That the Bill he now read a Second time.

I imagine that I am not the first hon. Member to be faced with a dilemma on learning, with a mixture of pleasure and trepidation, that he has won a high place in the ballot for private Members' Bills. Should one propose a controversial measure that is likely to attract publicity but will have little chance of ultimate success; or should one introduce a modest Bill with some value, unlikely to make front-page headlines but with a reasonable prospect of reaching the statute book? It was obvious to me that, given that little of the parliamentary Session remained, I should choose the latter course, and I had little difficulty in deciding to introduce a Bill to allow a nurse prescribing.

We are all familiar with the respective roles of doctors and nurses. Doctors diagnose complaints and propose treatment, usually involving drugs. They may see the patient from time to time thereafter, but the responsibility for supervision of the patient and the administration of treatment lies with the nurse, who will see the patient far more frequently. That applies particularly when the patient is being treated at home—in the community—rather than in hospital.

Clearly, in some circumstances, when a nurse sees the need for drugs and dressings to be applied, it would be an advantage for her—or possibly him—to be able to issue a prescription without having to trouble the doctor, who will certainly have full confidence in the nurse. The case is particularly strong when the patient needs perfectly straightforward medication or dressings which can be bought over the counter but to which the patient will be entitled free of charge if he has a prescription.

It is not difficult to imagine the frustration that is experienced by a district nurse who makes a regular visit to a patient and finds that that patient needs further supplies of a medicinal product or dressings. The nurse will have to return to the surgery, interrupt the doctor to get a prescription signed, and then go back to the patient to hand over the prescription.

The concept of nurse prescribing is not new. In 1986, the then DHSS commissioned a review chaired by Mrs. Julia Cumberlege on community nursing. Its report was entitled "Neighbourhood Nursing—a Focus for Care". I apologise to the House for the length of the quotation that I am about to give, but it is very much at the core of the issue that we are discussing. Under the heading "Power to Prescribe", the report said:

"We found district nurses waste time in requesting prescriptions from general practitioners for such things as dressings, ointments and medical sprays—those for leg ulcers, for example. In addition, many nurses have become very skilled in managing pain relief programmes for terminally ill patients. We believe therefore that community nurses who work with terminally ill patients should be permitted to use their professional judgment on matters such as the timing and dosage of drugs prescribed for pain relief. We recommend that the DHSS should agree a limited list of items and simple agents which may be prescribed by nurses as part of a nursing care programme, and issue guidelines to enable nurses to control drug dosage in well-defined circumstances. Detailed medical protocols should be drawn up with general practitioners which encourage community nurses within strictly agreed limits to vary the timing and dosage and use of alternative pain relief agents for patients who have been diagnosed by general practitioners as terminally ill and in pain. This may require nurses carrying on their own small supply of drugs, as midwives do now."

Its views were supported by a 1987 report of the Social Services Select Committee. Based on the evidence that it received, it recommended that

"the Government introduce legislation to permit nurses with appropriate training limited powers to prescribe and in defined circumstances to modify dosage."

In the same year, the Government's primary care White Paper said that representatives of the professions would be consulted. Paragraph 7.13 said:

"The Government also sees merit in giving nurses more freedom to prescribe a limited range of items (such as dressings, ointments or medical sprays) and to exercise their professional judgment in relation to the timing and dosage of drugs prescribed by doctors for pain relief. To some extent this development is already taking place. The Government will consult the Professional Standing Advisory Committees about the professional and ethical issues of prescribing by nurses with a view to producing appropriate guidance."

The Government then set up the advisory group on nurse prescribing under Dr. June Crown. Its terms of reference were to make recommendations on the circumstances in which nurses might prescribe, the categories of items to be covered and methods of prescribing them, the circumstances in which nurses might vary the timing and doses of drugs prescribed by doctors, the implications for nurse training and the resource implications.

The advisory's group's report was published on 20 December 1989. It comprises a detailed analysis of what might be involved in the proposal. I quote simply from some of its core recommendations, one of which was that

"suitably qualified nurses working in the community … should be able, in clearly defined circumstances, to prescribe from a limited list of items and to adjust the timing and dosage of medicines within a set protocol."

It suggested that

"Nurses with a district nurse or health visitor qualification (including those employed as paediatric community nurses, practice nurses or private nurses …) having had the additional necessary training: should be empowered to prescribe items necessary for the care of patients with those conditions for which the nurse takes independent clinical responsibility; should be able to supply certain categories of patients with items within a group protocol and adjust the timing and dosage of medicines within a patient-specific protocol."

My hon. Friend the Minister indicated general acceptance of the report's recommendations and that work and consultation on it would proceed.

Almost a year ago to the day, my hon. Friend the Member for Kensington (Mr. Fishburn) introduced his Nurse Prescribing Bill under the ten-minute rule. Shortly afterwards, the Minister announced that a cost-benefit analysis was being commissioned. That did not happen until April, when Touche Ross was asked to assess the cost and benefits of nurse prescribing. No doubt my hon. Friend's Bill was talked out because that analysis had only just been put in hand.

It seemed to me that this was an admirable measure for the Government to introduce, particularly in a short parliamentary Session. I suggested that course to my right hon. Friend the Secretary of State and was encouraged by his comments at the Royal College of Nursing congress in May and at the Conservative party conference at Blackpool in October, when he expressed his general support for the concept.

I was rather surprised, therefore, that such a measure was not included in the Queen's Speech. I know that the Royal College of Nursing and other professional bodies were disappointed by that omission. When I drew third place in the ballot for private Members' Bills, my choice of Bill seemed obvious.

Fortunately, my success coincided with the publication of the Touche Ross report—a formidable document which gives a most detailed analysis of the costs and benefits. I do not think that I would endear myself to the House if I went into them. There are obvious difficulties in making precise assessments of costs and savings when one is faced with a range of variables such as to what extent giving nurses the right to prescribe will lead to more prescriptions. It is difficult to translate savings in time and greater convenience into cash terms. Perhaps I could quote from part of the conclusions at paragraph 5.4:

"We conclude that the nominal value of time saved and the gross costs of nurse prescribing are relatively close before allowance is made for benefits not evaluated in this study, namely"—

these seem very important benefits—

"faster treatment, at times, for patients, benefits from additional items prescribed and increased job satisfaction for nurses."

The publication of the Touche Ross report appeared to remove the only remaining ground on which the Government might prefer to defer action. Once I had persuaded the Department of Health that I was anxious to proceed with the Bill, it offered complete co-operation. I should like to take this opportunity to offer my thanks to my hon. Friend the Minister for Health and her officials for their help in introducing the Bill, to the Royal College of Nursing for its persistent and effective campaigning, briefing and help in publicising the Bill, and to my hon. Friend the Member for Kensington for blazing the parliamentary trail. I am happy that he is a sponsor of the Bill, and I hope that he will speak later in the debate.

The Bill is brief and simply amends existing legislation. Clause 1 brings nurses, midwives and health visitors into the category of "appropriate practitioners" for prescribing purposes and gives the Minister the power to specify, by regulation, categories of nurses who may prescribe and the qualifications and training that they would need. Clause 2 makes it legal for dispensers to dispense prescriptions written by such authorised nurses. Clauses 3 and 4 merely make similar provision for Scotland and Northern Ireland.

I emphasise the fact that if the Bill becomes law there is no question of nurses in general immediately being able to prescribe. The Minister would have the power, which she does not have at present, to make regulations to turn the principle of nurse prescribing into practice. Of course, the cynic might think that that means that once the Bill has been passed nothing more needs to be done. I assure the House that that is not so.

Discussions have been taking place for some time about the formulary covering the range of drugs which nurses would be allowed to prescribe, although that is likely to be relatively small because the majority of items that nurses will want and need to prescribe are those which can be purchased over the counter, and various forms of dressings. Discussions are also in hand about the training and the qualifications needed, and work is being done to set up the appropriate training courses.

The report to which I referred suggested that people with district nurse and health visitor qualifications should be authorised to prescribe. If that happens, it will apply to about 28,000 district nurses and health visitors who are serving the community. Their ability to prescribe will clearly save time, avoid troubling doctors, save patients' and carers' time and will generally be more convenient. The measure will be especially beneficial to the elderly, to the disabled being cared for at home, to diabetics and to the terminally ill. The Bill has been welcomed on an individual and an organisational basis by nurses, by general practitioners and by patient organisations.

As I have said, it is merely an enabling measure. Once it reaches the statute book it would be up to the Secretary of State—not to me—to take further steps because lie will have the regulation-making powers. I need hardly say that I shall be keeping an eagle eye on my hon. Friend the Minister, although I suspect that by then it may be her successor, as she is destined for higher things. However, I shall be pressing the occupant of that office for action if it proves necessary to do so.

I know that nurses in particular are anxious to see the intentions of the Bill translated into action. I hope that the Minister will be able to tell us more about the preparatory work in hand and give some idea of the timetable that she envisages for the Bill's implementation, when the regulations are likely to be laid, when training will start and when the first batch of authorised nurses will be able to exercise their right to prescribe.

I understand that the likelihood is that initially only nurses with district nurse and health visitor qualifications are likely to be involved. I should mention the fact that I have received representations from practice nurses suggesting that they should also be included. If they have the qualifications to which I referred they would in any event be included in, as it were, the first batch of qualifiers, but perhaps the Minister will confirm that some thought could be given in due course to extending the authorisation to practice nurses. I want to make it clear—and perhaps the Minister will confirm this—that there is no quest ion of extending prescribing rights to hospital nurses in general. That is clearly not necessary, because doctors are invariably on site.

Of course, there will be costs involved in the implementation of the Bill and perhaps the Minister will say how she envisages that they will be met. I presume that her Department will meet the training costs, but as to the costs incurred in the prescribing operation, where nurses are attached to a fund-holding practice I imagine that those costs will be charged against the practice's budget, and I hope that that will be taken into account when the budgets are fixed. Otherwise it would seem appropriate that the costs should be met either by the health authority or—more likely—by the local family health service authority.

This is a simple Bill which will benefit many of our fellow citizens. It will ease the burden on hard-pressed general practitioners, will facilitate the work of the unsung heroines of our communities—the district nurses and health visitors—and will improve the treatment of their patients, among whom any of us might find himself numbered in the fullness of time.

I mentioned the fact that the Bill started with the report of a body chaired by Mrs. Julia Cumberlege. The House will be aware that she is now Baroness Cumberlege, and I am happy that she is standing by, ready to sponsor the Bill should it find its way—as I hope that it will—to another place. Therefore, I hope that the Bill will receive the House's support and that its progress will be facilitated so that it may pass into my noble Friend's hands in another place and reach the statute book before it is overtaken by events.

9.56 am

I congratulate the hon. Member for Chislehurst (Mr. Sims) on choosing this subject for his private Member's Bill. He said that he had faced a dilemma about whether to choose a Bill that would make the headlines or one that would be passed. I am sure that the 7 million or so patients who will benefit from nurses being able to prescribe will be grateful that he has chosen a Bill which will certainly be passed and will certainly—once it has reached the statute book and is implemented—have practical benefits for that many patients.

The Bill will also help district nurses and health visitors. They do not want to waste their time going backwards and forwards to the general practitioner's surgery. The hon. Gentleman rightly said that it is a waste of the doctor's time for him to turn his attention to something that has already been decided by someone else and merely to rubberstamp it. Such a situation also undermines the role of district nurses and health visitors if they have to go through that procedure when they know that they should be able to take the responsibility. The Bill has the confidence of GPs and will suit patients.

The hon. Member for Chislehurst can be certain that the Bill has the Opposition's support. It is important but not controversial. Everyone agrees that it makes sense and that it is a long-overdue reform. I do not want to concentrate on procedural matters, but, as the hon. Gentleman said, it is curious that the Bill has not been introduced by the Government, especially as the Nurses, Midwives and Health Visitors Bill has just completed its Committee stage. It would have made sense for the Government to include this measure in that Bill so that it could be dealt with at the same time. Having publicly committed themselves to extending legislation to protect residents in small private residential care homes, the Government left it to a Back-Bench Member to bring in a Bill, and they have done the same thing again. Having said that this is not the procedure by which such a measure should reach the statute book, I welcome the Bill because it will result in a long-overdue reform.

I wish to raise three issues that are part of the backdrop to the Bill. The first is training, which the hon. Gentleman mentioned. The second is retaining those district nurses and health visitors who, as a result of the Bill, will be better trained, more skilled and more useful. We need to keep them within the national health service work force and to make better use of their additional skills. The third is the question of nurse prescribing in community care.

I am simply flagging those issues; I do not want to go into them in great detail. The Bill has the support of the Government and both sides of the House. It is uncontroversial. I should be sorry if the debate on the Bill were to be unnecessarily prolonged and so prevented the House from debating the Civil Rights (Disabled Persons) Bill that hon. Members are waiting to discuss.

The issue of training was partly dealt with in the Nurses, Midwives and Health Visitors Bill. The training of nurses to prescribe will be vital if the service is to be as widely available as we want it to be and if it is genuinely to benefit patients. However, there are problems with post-basic education. Training for nurse prescribing is likely to be at post-basic level. Although there is usually an incentive to safeguard funding for pre-registration education to maintain the supply of nurses coming into the NHS, the incentives for post-basic education are less secure.

The Royal College of Nursing has expressed its particular concern that trust employers might offer a poor deal to nurses who want to undertake training courses. The RCN suggests that nurses in trusts who want to undertake post-basic training are being required to transfer to fixed-term training contracts, with no guarantee of employment on completion of training. We do not want any disincentives in the system that would prevent people doing post-basic training and becoming nurse prescribers. Can the Minister assure us that training for nurse prescribing will be provided and that it will be accessible to those nurses who need it? I wish briefly to deal with two other issues, but we shall explore them further in Committee. We need to retain trained staff. Prescribing will be carried out by specially trained and experienced nurses, yet trained nurses are leaving the NHS at the rate of 80,000 a year—a quarter of all nurses. That is bad enough for nurses with the basic qualification, but it will be an absolute waste of training and experience if we do not retain within the NHS those who are qualified to be nurse prescribers.

So far, the Government have made a large number of verbal commitments to creating the terms and conditions of employment that would enable women to stay in the work force and not give up when they have families. However, at district health authority and hospital level there have not been the practical measures needed to achieve that. That is why the figures for nurses leaving the NHS remain so bad.

It all comes down to practical implementation of flexible working hours and job sharing, so that women working in the nursing profession do not have to follow male patterns of employment, where eventually they find that combining family responsibility with work is simply too difficult, and they leave. That point applies to nurses at the basic level, but it is even more important when they become a more valuable resource after their post-basic education has given them the ability to prescribe.

Community care is also an issue. Nurse prescribing should be an important component of care for those who have long-term continuing needs, but are living in the community. I want community care to be properly implemented and funded, with nurses prescribing as a part of their work in the care of people living at home.

Nurse prescribing will happen, and I hope that it does so promptly. I hope that the Minister gives the assurances about timing asked for by the hon. Member for Chislehurst. The Bill will work better if it is implemented properly, if there is access to training for all who want it, if there are flexible patterns of employment to enable nurses to stay in the work force following post-basic training and if community care—where they will be doing their work—is implemented and fully funded. I hope that the Minister will also assure us on those points.

Once again, I congratulate the hon. Member for Chislehurst on choosing this subject for his Bill. He will not hit the headlines, but he will receive the gratitude of patients and nurses. We welcome the Bill.

10.5 am

Like the hon. Member for Peckham (Ms. Harman), I congratulate my hon. Friend the Member for Chislehurst (Mr. Sims) on his good fortune in winning a high place in the ballot. I am delighted that he has chosen to introduce a Bill on nurse prescribing and I am honoured to be associated with it as one of its sponsors.

As my hon. Friend said, the Bill deals primarily with the delivery of health care in the community. As presently envisaged, it has little relevance to medical practice in hospitals. However, I wish to put down a marker that, as the provisions of the Bill succeed in care in the community—for health visitors and community nurses—I hope that the possibility of its being extended to certain aspects of hospital work will be considered. Both I and my hon. Friend have received representations from the Southampton eye hospital, suggesting that there might be a case for extending the provisions of the Bill to ophthalmic casualty.

I shall not develop that point today, because it is not immediately relevant; I am simply putting down a marker that, as the Bill's provisions succeed in the community, we should not exclude an extension into other areas. As the Bill is drafted, such an extension would be possible at a subsequent stage through the Minister of the day introducing the necessary order.

My hon. Friend quoted from the Cumberlege report in support of his proposition that there should be a limited extension of prescribing from doctors to nurses. The report of my hon. and noble Friend Lady Cumberlege has clearly impressed my hon. Friend. It equally impressed those who served on the old Select Committee on Social Services. Paragraph 61 of the Select Committee report succinctly encapsulates all the arguments for the immediate move proposed by my hon. Friend. It states:

"The CNR team, and many witnesses believe that nurses should have freedom to prescribe a limited range of items, such as dressings, ointment and medical sprays".

I pause here to point out that items such as dressings are available on prescription. Hon. Members can buy them over the counter in a chemist's shop. It continues:

"and that they should be able to use their professional judgment on matters such as the timing and dosage of drugs prescribed by doctors for pain relief."

Pain relief is greatly important to many people. Our experience of people in that condition is that they are not in a steady state so, rightly, the prescription must be altered almost day by day according to the pain of the patient. It continues:

"Both suggestions have merit; to some extent they reflect developments which are already happening, for example in the care of the terminally ill where many nurses have special expertise. It is obviously wasteful nonsense for a district nurse needing a new dressing for a patient to have to return to the surgery, tell the doctor what is needed, possibly even draft the prescription for him, get the prescription dispensed by a pharmacist and then make a second visit to the patient to apply the dressing."

Those last few words describe the present position. I am sure that all would agree that it is nonsense and that there must be a simpler way. My hon. Friend's Bill would provide that simpler way. Our report continued:

"We recommend that the Government introduce legislation to permit nurses with appropriate training limited powers to prescribe and in defined circumstances to modify dosage."

I hope that my hon. Friend the Minister will forgive me if I say that the Treasury, as always, seems to have made rather heavy weather of this matter. What are the extra costs of nurse prescribing? The truth is that nobody knows—and in so far as there will be an extra cost, that cost shows an unfulfilled need.

That is the story of the resource implications of care in the community. One factor after another shows unfulfilled needs. As we become more successful in delivering health care in the community, we discover things that we should have been doing in the past but have not done. Now that those things are identified, we do them and—surprise, surprise—it costs more. I ask the Treasury to be relaxed about that.

Does my hon. Friend agree that in practice, costs may be reduced? Nurse prescribing will save the waste of time that he has described when district nurses have to go backwards and forwards to doctors, and will allow them to give their time to more beneficial activities, rather than wasting petrol on such journeys.

My hon. Friend has made an excellent point, succinctly put, which has not yet been fully recognised by the Treasury.

The Touche Ross report had to be completed in a considerable hurry, for reasons that we understand. Let us not attach too much weight to it, because the overall response rate from the 18 district health authorities surveyed was 15 per cent. of district nurses and 23 per cent. of health visitors. That sort of return is even lower than those used by political pollsters.

All that we know is that nurse prescribing will cost a bit more in medication. The extra costs will be those for the extra prescriptions generated; we cannot say more than that. It is not possible to put a figure on the costs. However, I am delighted that the Government are giving my hon. Friend a money resolution—that is all very proper—but I beg the House not to be too concerned about what the figure is. Let us recognise that there is a figure and settle for that.

I warn the House—I am afraid that I have been an awful bore in continually pointing this out—that, as we extend the concept of health care out into the community, we shall find more and more unsatisfied demands that have not previously been recognised. I hope that in so far as we are achieving a consensus on care in the community, there is a general recognition that it will cost more and use more resources.

I shall say nothing more about the financial side. The Touche Ross report had one or two nice things to say about the advantages of nurse prescribing. Under the heading, "Other Benefits"—uncosted—it said:

"The further benefits from Nurse Prescribing are the benefits to patients of faster access to some prescription items and the benefits they will derive from additional items prescribed for them by District Nurses and Health Visitors."

That sentence encapsulates one of the obvious advantages that will accrue from the Bill.

I am sure that both sides of the House will welcome my hon. Friend's Bill. In modern jargon, it is a patient-friendly Bill, and as such, it will appeal to both sides of the House.

10.13 am

I congratulate the hon. Member for Chislehurst (Mr. Sims) on deciding to promote the Bill. It is important, because, as the hon. Member said, there have been earlier opportunities for such legislation—the Government could have chosen to include a measure in their order of business, and a private Member once introduced a Bill, but unfortunately did not have enough time to secure its progress. I believe that the Bill will make headline news, because millions of people will benefit from it and they will see the advantages to them. So, although the hon. Member for Chislehurst feels that he may not achieve headlines in the newspapers, I feel that he will.

The hon. Gentleman has the opportunity of warning us all not to speak for too long, because another important measure, concerning the civil rights of disabled people, is to come before the House today. I hope that we shall be able to ensure that both these important measures make progress.

In principle, the Liberal Democrats support the Bill because it puts patients first; it brings their needs and concerns to the fore. It is so important that the person nearest to the patient should have the right to prescribe that I am sure the measure will receive all-party support.

We are told that there are 28,000 qualified district nurses and health visitors. With so many people who may eventually receive the training to prescribe, we can imagine the advantages that patients will derive from that training and delivery.

Such a measure has taken a long time to appear. I wonder why. The Government have had opportunities, but have not taken them. Nevertheless, the Bill will form an important part of the full delivery of their policy of care in the community. We shall not see real care in the community without nurses being able to prescribe drugs at the point at which they are needed.

We have an aging population and a growing number of residential care homes in the private, voluntary and statutory sectors. It is important that the health visitors and nurses who go to those homes can meet the needs that they find there. If we support care in the community we must realise that nurse prescribing is part of that and will help to make it work. That is why I was especially pleased to hear that the Government are prepared to allocate the necessary funds. If they did not, the costs would fall elsewhere—or the job would not be done.

Elderly people and chronically sick people in residential and nursing homes will not be the only ones to benefit. People in the community will benefit, too. I know from my work with homeless families that such people invariably need help late at night, in the early hours of the morning or at weekends, when it is especially difficult to find a general practitioner who will respond quickly to a call to see someone who has arrived on the doorstep—in my case that means the doorstep of the YMCAs for which I worked.

I accept what the hon. Gentleman says about the homeless, but does he agree that we should not be in danger of slighting the work of many general practitioners in inner cities where there are many transient homeless people? To give those GPs credit, working with family health authorities they have developed specialisations in dealing with the needs of transient people.

I agree that some of the work of GPs is outstanding in such areas, but they are greatly overburdened and have considerable calls on their time. Those of us who have worked with homeless families have found that many hours can pass between the telephone call and the arrival of a general practitioner. In recent years that situation has grown worse. Many of our GPs now have technology in their surgeries whereby calls are transferred to other doctors in the area. One tends not to know the GP who turns up, whereas one always knows the local health visitors and community nurses. I accept the hon. Gentleman's point, but he should also consider what I have said.

Terminally ill patients would also benefit. Not long ago I had the opportunity to visit St. Wilfrids hospice in Eastbourne, where wonderful work is done. That is true of hospices in every constituency. The hospice movement is wonderful, caring for people in their last weeks, days and hours. In those circumstances prescribing can relieve an enormous amount of pain, but it needs to be done very quickly. The Bill will help enormously there, and the people in Eastbourne certainly support that aspect of it.

In rural areas, the time taken by the GP to travel or the time taken by a family friend to go to the surgery to obtain a prescription can be considerable. Through the Bill, we seek to achieve the relief of pain for patients at the earliest opportunity. The Bill will be especially appreciated in rural areas.

I warmly commend the Bill and 1 congratulate the hon. Member for Chislehurst on introducing it. It has all-party support, so I hope that hon. Members will have the opportunity of saying a few words on it and of making progress on the Civil Rights (Disabled Persons) Bill. I commend the Bill to the House.

10.20 am

It is a pleasant and unusual experience to speak in a health debate in which we are united. Not even the hon. Member for Peckham (Ms. Harman) has said a word against the Bill, which is supported not only by the Government, but by the British Medical Association, the Royal College of Nursing, general practitioners, phamacists and many charities. I join in congratulating my hon. Friends the Members for Chislehurst (Mr. Sims) and for Kensington (Mr. Fishburn), who set the ball rolling, on their collective good judgment and common sense in introducing such legislation.

We should also congratulate Christine Hancock, the general secretary of the Royal College of Nursing. Even my hon. Friend the Minister must accept that Christine Hancock has always criticised the Government constructively. She, with her members, has shown much support for reforms such as the NHS trusts and GP fund holding. I also congratulate the chief nursing officer, Dame Anne Poole, who, sadly, will be retiring in a few weeks' time. All involved in health would wish to express thanks for what she has done for the Department of Health and for nursing. We shall all miss her and we send every good wish for the future to her successor.

My hon. Friend the Member for Eastleigh (Sir D. Price), who will, sadly, be leaving the House in a few weeks' time, made a masterly speech in which he summed up the position perfectly. I am not sure how one persuades the Treasury to be relaxed about anything, but the fact that the Government have tabled a money resolution is encouraging.

My hon. Friend the Member for Wanstead and Woodford (Mr. Arbuthnot) made an especially good point about the time that is wasted at present. From briefings that I have seen, it seems that 1.2 million hours of nursing time are lost. As the hon. Member for Eastbourne (Mr. Bellotti) said, there will be benefits for the terminally ill and for the elderly.

Although it is unfashionable in this debate, I will say a word on behalf of the Treasury. My hon. Friend the Member for Harlow (Mr. Hayes) will have noticed that, although the Touche Ross report accepts the principle that the Bill would help to save a great deal of time by reducing the hours that nurses, especially district nurses, spend travelling backwards and forwards, the monetary savings would be almost insignificant. Inevitably and rightly, the nurses, who are full-time employees, would use the time in other ways, to the great benefit of patients.

My hon. Friend is right; he speaks with his usual sagacity. He is an accountant, but I do not hold that against him.

I believe that my hon. Friend the Member for Bristol, North-West (Mr. Stern) is wrong. Health authorities will be able to make choices. As we shall save nurses' time, we can either give the nurses more productive work to do or reduce the number of nurses and spend the money saved on other health care procedures or drugs. The options would be wider and I do not think that the Treasury should be quite so restrictive.

I do not want to sound too much like a Liberal Democrat, especially before a general election, but I must say that I agree with my hon. Friends the Members for Wanstead and Woodford and for Bristol, North-West (Mr. Stern) at the same time. We shall utilise nurses' time and there will be savings, although there is a row over how great the savings will be.

The Government and the whole House accept the crucial role that nurses play in the health care team. It is significant that, since 1979, the three aims of Trevor Clay, the then general secretary of the Royal College of Nursing, have been achieved. First, he wanted an independent review body system for pay, and we have that. Secondly, he wanted the modernisation of the nurses' career structure, and we have that. Thirdly, he wanted a modern training system, which nurses will receive under Project 2000. The hon. member for Peckham mentioned Project 2000, and I will say a few words on it. Project 2000 gives more weight to the process of learning and less to sharing the work load in hospital wards. That has been welcomed by nurses. Trainees will have student status and 62 per cent. of colleges in England have now converted to the system. Some £109 million has been spent in the past three financial years, and another–98 million has been allocated for 1992–93.

The trouble with nurse training, as the Government and the Royal College of Nursing accept, is that the training and education programmes have a high degree of rostered service which is not conducive to the learning process. All that will be changed. The education changes should go a long way towards providing a future nursing work force who are better equipped to meet the complex demands of modern health care, and who will have more interesting and satisfying careers. For the first time, nurses will have a broadly based education which emphasises health promotion as well as the care of the sick. It will enable them to work either in hospitals or in the community without the need for extensive further training. I agree wholeheartedly with my hon. Friend the Member for Eastleigh. When the regulations are introduced, we should look again at the hospital sector. I suspect that nurses are very much like sergeants and sergeant-majors in the Army. They tend to hold the hands—I do not mean that literally—of young doctors in training and they know far more about diagnosis and about prescription than do many of the young men and women who have just entered the medical profession. Nurses should have an even more professional role in prescribing in hospitals, and 1 hope that my hon. Friend the Minister will consider that point carefully.

There will be a better alignment of the practical and theoretical components of nurse training so that the practical component, which will not diminish significantly, will reflect the theoretical stage reached. There will also be an opportunity to rationalise the confused pattern of post-basic training, thus eliminating duplication and overlap. Provided that we can encourage as many nurses as possible to come in, the end result should be more flexible and adaptable practitioners who can respond to changes in the provision of service. I hope that the whole House recognises that.

I am sure that nurses will take into account the fact that their pay has increased substantially—I know that some would say not substantially enough—by 48 per cent. in real terms since 1978–79. Since that time the number of nurses has increased by 69,000, despite the difficulties in recruitment, which are being overcome. I am sure that my hon. Friend the Minister accepts that this Government are very pro nurses. We have embraced the majority of sensible suggestions proposed by the Royal College of Nursing.

My hon. Friend has rightly drawn attention to the Government's record in improving nurses' pay. Would it be introducing an unduly controversial note to point out that, under the Labour Government, from 1974 to 1979 nurses" pay was cut by 3 per cent. in real terms?

I wholeheartedly disagree with my hon. Friend. Nurses' pay was not cut by 3 per cent. in real terms. In the five years to 1979, the Labour Government cut nurses' pay by 21 per cent. in real terms—even if the overall figure was 3 per cent. Nurses should be aware of that. I do not want to introduce a party political note, given the unified stance that we have achieved on the Bill, but I had hoped that the hon. Member for Peckham would say that what she said last year and the year before about indicative budgets was totally wrong. I remember all the scare stories—how the elderly, sick and vulnerable would not get their drugs from the doctors. That has not happened at all.

Will the hon. Gentleman give way?

I shall give way to the hon. Lady so that she can set the record straight and so that we can have a full televised apology.

I came to the House this morning warmly to welcome the Bill introduced by the hon. Member for Chislehurst (Mr. Sims), which has all-party support. I hope that, in addition to securing the Bill's passage through the House today, we shall proceed to debate the Civil Rights (Disabled Persons) Bill—a measure which profoundly affects many of our constituents. I shall not be rising to party political provocation and I am confident that the Minister will not either, so I suggest that the hon. Member for Harlow (Mr. Hayes) addresses himself to the Bill and does not try unsuccessfully to waylay and mislead the House so that we cannot proceed to the next item of important business. Shame on him!

I apologise profusely for giving in to temptations of the flesh. The hon. Lady referred to the next Bill on the list which I wholeheartedly support—as, I suspect, do the majority of hon. Members present. That will be debated at another time.

I ask the Minister to consider the question of head lice—not a pleasant topic for a Friday morning. At the moment, we are in difficulty because parents do not like to think that their children have head lice, but they do have head lice. The presence of head lice does not mean that a child is dirty: they are often to be found on very clean children. Head lice are a taboo subject in many areas.

As a result of a change in the regulations, district health authorities cannot supply schools with the prescribed shampoo. My hon. Friend the Minister will no doubt point out that one can still get the shampoo free, but parents will still have to go to the chemist and ask for it, or go to their GP. They will find that extremely embarrassing because everyone knows what the shampoo is for.

I have received a number of letters on the subject. I do not expect my hon. Friend the Minister to comment today, but would ask her to re-examine the regulations and consider carefully allowing district authorities to prescribe to schools the shampoo that is needed to eradicate head lice. There is quite a lot of feeling on the subject.

Another matter relating to drugs on which I do not expect an immediate response from my hon. Friend the Minister is generic prescribing.

:My hon. Friend has suggested quite an extension of the idea of nurse prescribing for individual patients—nurse prescribing for entire schools. I should have thought that that would be better handled by a doctor, if by anyone.

I honestly do not care who handles it as long as it is handled in such a way as to spare many of my constituents the embarrassment of asking for head lice shampoo publicly—a matter on which they feel very strongly. This may not be a subject which ought to be considered on the present Bill, but I ask my hon. Friend to think carefully about it.

I shall refer briefly to the great potential savings from generics on GP prescription. About£50 million could be saved if GPs were given the opportunity to tick a little box on their prescription forms, with the consent of the patient, to indicate that, when the drug was dispensed, its generic equivalent could be given. I understand that the matter has been carefully researched and that £50 million-plus could be saved and ploughed back into the health service.

I warmly welcome the Bill. I wholeheartedly congratulate my hon. Friend the Member for Chislehurst and ask that the Bill be put on the statute book as soon as possible—taking into account the general election. I hope that both Houses will be wholeheartedly committed to rushing it through, because it is needed.

10.35 am

I do not intend to detain the House. I congratulate my hon. Friend the Member for Chislehurst (Mr. Sims) on his excellent Bill. It is a commonsense measure. There is no reason why nurses, with all their practice and training, should not be permitted to prescribe to some limited extent. As we have heard, the measure is supported by the Royal College of Nursing, and I look forward to the time when nurses can, indeed, prescribe. It will help them; it will help patients; and it will help to take a little of the burden from doctors.

I want to make a plea for the continuing expansion of the categories of people who can prescribe and suggest that we draw pharmacists into that widening network. Increasingly, people go to the pharmacist when they have some minor problem and pharmacists are becoming the centre of attention for those who do not want to bother their doctors with petty complaints. At the moment, people have to go to the doctor's surgery to get a prescription. Then they have to take it to the pharmacist to get whatever medicine has been prescribed.

There is a bit of a problem, however, and the process can be obstructed if someone living on his own is so ill that he cannot get to his doctor. What can he do? He can ring up the doctor and say, "I am ill." The doctor may know something about his condition and may agree to let him have a prescription. If he is too ill to go to get the prescription, he has to ring friends or relatives to ask them to collect it for him from the doctor, to go to the pharmacist and to bring him the medicine.

I suggest that pharmacists have a valuable role to play. There may be a pharmacist just down the road from where the patient lives and if there were a little more co-operation, perhaps sick people who could not collect medicines themselves could have them delivered to their doorsteps.

The Bill will be of particular value in rural areas where there is rather a waste of petrol as cars rush back and forth. Nurses visiting patients have to return to the doctor's surgery for a prescription, then get the medicine and take it back to the patient. Nurses who visit patients regularly may know their needs better than the doctor does. If the nurses can say what the patient needs and prescribe that item, it will be much better for the patient.

I was sorry to hear the hon. Member for Peckham (Ms. Harman) bringing in a note of complaint. She said that the Bill could have been tacked on to the Nurses, Midwives and Health Visitors Bill. I have a copy of that Bill and it is clear that there is no way that the present measure could have been tacked onto it. My hon. Friend the Member for Chislehurst has introduced a welcome measure, which has the wholehearted support of the Government and of hon. Members on both sides of the House. We look forward to its becoming law.

10.38 am

It is no coincidence that my hon. Friend the Member for Chislehurst (Mr. Sims) should have introduced the Bill. He is a wise man who has long been interested in all aspects of the medical services, and was a sponsor of the idential Bill which I introduced in the previous Session. I am pleased to be a sponsor of the present Bill and to assist in my hon. Friend's far more successful attempt. I think that I can say that I support every word of the Bill, because it is almost word-for-word the Bill that I introduced last year.

My hon. Friend the Minister for Health, who is present in the Chamber today, is the very same charming Minister who killed the Bill then. Indeed, my hon. Friend the Member for Chipping Barnet (Mr. Chapman) from the Whips Office, although less charming, is from the same Whips Office that used the mechanics necessary to ensure that the Bill did not proceed. I recall being ticked off for writing a letter toThe Times which advocated nurse prescribing and which pushed the Government in that direction. All that is now water under the bridge. I am delighted that we are all on the same side and that the Medicinal Products: Prescription by Nurses etc. Bill will make it to the statute book.

If primary legislation is to have distinction and life—and so much does not—it must be rested upon an idea or principle. This short Bill has a principle attached to it—the principle of liberalisation. That principle is the belief that the more responsibility we give to people, the more welcome it will be. Indeed, these new responsibilities are welcomed by the nurses. The more we can peel back layers of the onion skin of bureaucracy—in this case the bureaucracy of health care—the better society will be. That principle gives the Bill life.

That principle first caught the attention of Mr. Samuel Brittan, the economics writer for the Financial Times. He, perhaps more than anyone, even in this place, has pursued the concept of liberalisation over the past decade. He wrote a column in the Financial Timeslast year supporting the prescribing Bill and it was no conincidence that he entitled the column:

"A Modest Blow for Freedom."

That, of course, is just what the Bill is. It is modest and it is certainly a blow for freedom. It will free up the system.

Sam Brittan got to the core of what is interesting about the Bill when he wrote:

"The main thrust of economic liberalism is to remove unnecessary restrictions and barriers; and there is no reason for health to be exempt . . . Liberalism is concerned with putting the onus of proof on those who want to restrict.
There are many cases in which there are genuine costs of deregulation to be weighed up against the benefits. Here is a rare case where there seem only benefits."

I wholly agree. That is why the Bill should make progress. Although my hon. Friend the Member for Chislehurst has spelt out clearly that the Bill will allow 25,000 community nurses—those with the highest training—to write prescriptions against a limited formula agreed in advance by the British Medical Association and the Government, we should push this a little further. We must consider the ideas put forward by my hon. Friend the Member for Eastleigh (Sir D. Price). In time, some hospitals may seek to have this liberalising measure applied in their wards.

There is an interesting precedent here in that midwives can alter the amount of painkillers, without recourse to a doctor's permission, in hospital, during childbirth. They have done that for years with tremendous skill and without anyone taking any notice or believing that that was a new measure. In time, I hope that we will look to an expansion of the measure to hospital nurses so that they can write their own prescriptions.

With regard to expanding the measure to hospital nurses, will my hon. Friend consider a point made by my hon. Friend the Member for Chislehurst (Mr. Sims) who said that the proposal would not be necessary in hospitals because of the constant presence of doctors in hospitals? The Bill deals with an area where nurse prescribing is necesssary.

The point is that if it is not necessary, it will not happen. If it is necessary or desired, in a liberal society, it should happen. My hon. Friend the Member for Eastleigh made that point.

The hon. Member for Eastbourne (Mr. Bellotti) referred to the advantages of the Bill in a rural setting where community nurses have to travel great distances. I believe that the Bill will be equally welcomed in an urban setting like my constituency of Kensington. Picking one's way through the urban jungle can be every bit as time-consuming for a community nurse as travelling over the rustic downs of Sussex.

A community nurse in an urban setting experiences an enormous waste of time. She may finally arrive to see a bed-ridden patient in a tower block only to find that a bandage, lotion or painkiller is required, but she must return to base, to her GP's office, to get a prescription. That could easily take an hour or even the better part of an afternoon. That is extremely frustrating for the nurse and worrying for the patient.

I want to question my hon. Friend the Minister on a point which will be important as the legislation makes progress. Will practice nurses be able to prescribe? As I understand it, if a practice nurse has the qualifications of a district or community nurse, she will be able to prescribe. The thrust of this Government, through GP fund holding and the reforms of the past few years, has been to allow family health practitioners to have within their boundaries a range of health provision that brings care as close as possible to the patient.

GPs across the country have increasingly recruited practice nurses and the Government have rightly supported that. It would be a great shame if, as the Bill makes progress, it was not made clear that practice nurses could, particularly if a GP so wished, write prescriptions.

I have four children under the age of 10. When I am not in the House, I spend most of my time in the doctor's surgery. One of my children has mild asthma. Not unnaturally, we visit the practice nurse every two months. My child blows into the blower and sucks from the sucker and, once every six months or so, the nurse says, "You're coming on fine. That's great, but you have run out of the lozenge which has to go into the machine." When I say, "Right, I'll take some away now", she says, "Ah, I can't give you more because I cannot write a prescription". The doctor is busy next door—probably seeing one of my other children—so he cannot write the prescription right away. Therefore, I have to go away and come back the next day. That is the kind of inefficiency that the Bill can break through. Does my hon. Friend the Minister envisage that practice nurses will be able to write prescriptions if their GPs so wish? Will the Bill or the subsequent regulations that the Department will bring into effect allow that or will we have to agree amendments in Committee?

Everything in this country takes time. As my hon. Friend the Member for Chislehurst is aware, this modest measure has taken a long time. The first report from Baroness Cumberlege appeared in 1986. Considering the most rapid progress that the Bill might make, it is proposed that the regulations will be in place by the autumn of 1993. With a little slippage, we are talking about 10 years between the birth of an idea and its practice.

However, that is the birth of this idea only in Britain. We must not forget that we are not reinventing the wheel. Nurse prescribing is practised widely in other countries that abhor bureaucracy and practise economic liberalism and which believe in having no layers of the onion skin between the patient and the doctor or nurse. Nurses prescribe in Canada and in most of the states in America. I hope that we will not set out on another study in the years ahead, but will act on this Bill with all speed and dispatch.

10.49 am

I am grateful to you, Mr. Deputy Speaker, for calling me to speak on this important measure. I join all hon. Members in congratulating my hon. Friend the Member for Chislehurst (Mr. Sims) on bringing forward this welcome measure. We know that this will be a truncated parliamentary Session. Therefore, the difficulties facing any private Member's Bill are even greater than usual. The Government's support for the measure is welcome. Indeed, the support of the Opposition, despite their somewhat reduced numbers today, is also welcome. We need all that support, and support in another place, to give the measure even the slightest chance of success in a shortened time scale. I am sure that all hon. Members wish it well.

At the outset, I stress that the points that 1 wish to make in no way detract from my support for what will be a welcome measure not only in rural areas, which are one of the wellsprings for it, but in heavily urbanised areas such as the one that I represent. I wish to draw attention to a couple of aspects of the proposed restricted list of drugs and the formulary which the Bill will set up under regulations. I congratulate my hon. Friend on drafting, or allowing the Bill to be drafted, to permit much of the detail of the Bill to be dealt with by regulation rather than being in the context of the Bill itself. There is a considerable history of successful regulation by the Department of Health. The idea of a limited prescribing list began in the teeth of considerable opposition to the Department of Health, and it has proved to be far more successful than the medical profession and Her Majesty's Opposition thought at the time. Because of the rapid change in the work demanded of nurses within the community, there will be a need for equal flexibility within the Department of Health in respect of the powers given to nurses under the Bill.

My hon. Friend is entirely right, albeit that most of us normally deprecate legislation that effectively hands over substantial additional powers to Departments rather than them being within the review of the House. My hon. Friend is entirely right to pass that power to the Department and effectively take it from Parliament.

A regulated list of drugs or preparations under the control of the Department finds support in some rather surprising quarters. The Department's work in preparation for the Bill parallels work that has been done in the pharmaceutical world over many years, in particular leading up to the campaign which started a few years ago for pharmacists to be able to sell and advise on certain drugs without a prescription. I hope that the passage of the Bill will not damage that campaign by pharmacists to be able to use their professional knowledge and expertise to a greater extent and that the movement toward non-prescription will not be damaged by the movement towards greater freedom of prescription.

That work has received support from some surprising sources. I remember a pamphlet from the Institute of Economic Affairs some years ago—not a body to which one would normally look in such matters—which argued strongly for greater freedom for pharmacists to be able to sell without prescription. I hope that my hon. Friend the Minister will reassure me that the movement toward greater freedom of non-prescription will not be harmed by the Bills.

The Bill refers to appropriate training for nurses in the use of the restricted list. It is worth dwelling on that for a moment. What may be appropriate training for a district nurse in a rural area may not be appropriate for a health visitor dealing with an area of urban stress. The demands on their time and their abilities to prescribe are likely to be totally different. I hope that, when considering the training schemes that will be set up under the Bill, my hon. Friend will give appropriate weight to the flexibility that will be needed to ensure that nurses are trained for the many tasks that will become necessary under the Bill. I suspect that that suggestion would lead to an unacceptably wide and demanding training course. Alternatively, I hope that my hon. Friend will look at some form of modular training so that a nurse who wishes to take on prescribing rights in, say, an urban area will be able to receive specific training in, for example, dealing with the homeless and areas containing a large number of people with tranquilliser dependency, such as occurs in at least one area of my constituency. Those demands will be totally different from those on a nurse who is training for the right to prescribe in some rural areas or, indeed, urban areas which do not suffer the same social stress.

I now refer to the signature of prescriptions which will be permitted under the Bill. I ask my hon. Friend the Minister how that will relate back to doctors, health authorities or other bodies responsible for a certain aspect of patient care with which the nurse will be dealing when the prescription is generated. In that connection, I draw my hon. Friend's attention to an organisation which, so far, has not been mentioned. My hon. Friend will know it well. I refer to the Prescription Pricing Authority, a body which is centered on Newcastle upon Tyne. One's first acquaintance with it would indicate that it is a great contributor to the welfare of the warehousing business in Newcastle upon Tyne, because it stores and sorts, under a system called PACT—prescription analysis and cost—every prescription that is ever written. That body does much unsung technical work to a very high level of professional expertise. Any family health services authority which wishes to inquire into the prescribing habits of a doctor or a practice will be able to go to the Prescription Pricing Authority and obtain from it, with appropriate safeguards, all prescriptions issued by that doctor or practice over a certain period. I do not have to tell the House the extent of the work that is necessary to provide that service.

At the moment, the Prescription Pricing Authority will work to a certain doctor, so the sorting mechanism at the PPA is determined by the need to sort by doctor or, frequently, by type of preparation. I wonder how the PPA will have to adapt its work. A district nurse or a nurse on the official list will sometimes work with a certain doctor or health authority. There may be other circumstances in which the ultimate responsibility for a validity of a prescription will not be relevant to a certain general practitioner. I hope that my hon. Friend the Minister can reassure the House that, under the Bill, the standards of control and the "findability" of prescriptions will be no less than those for prescriptions currently issued by a registered general practitioner.

Recommendation 5 of the Crown report refers to the type of work of nurses for whom prescribing could become useful. The recommendation states:

"In addition to nurses with a district nurse or health visitor qualification, certain community nursing staff who have successfully completed appropriate specialist education, training and assessment should be able within a patient specific protocol".

I emphasise the phrase "patient-specific" as it is underlined in the recommendation—

"to adjust the timing and dosage of medicines which are prescribed by medical practitioners."

That is an important recommendation.

The recommendation continues:

"At present we propose that community psychiatric nurses, community mental handicap nurses, specialist nurses for terminally ill patients and diabetic liaison nurses should be given this authority."

I entirely agree with that recommendation. It shows a breadth of understanding of the specialist work of the nursing profession which is highly commendable. However, one aspect of nursing is not covered by the recommendation. I refer to the case of qualified nurses who, under the general training provisions of the Bill, qualify for prescribing, but have chosen a career path that has led them to become matrons in nursing homes, especially for the elderly in the private sector. I have come across cases in my constituency where such matrons who in every way qualify to issue a prescription under the Bill are debarred and may continue to be debarred from issuing a prescription to a patient under their care because those matrons have no direct relationship with the general practitioner who has responsibility for the elderly patient in the nursing home.

The case of an elderly person living in my constituency who was urgently admitted to a nursing home on the other side of Bristol has recently been drawn to my attention. That patient's GP practised in my constituency and was, therefore, unable to provide an immediate service to the patient. Shortly after the patient was admitted to the nursing home, and before there was time to transfer the patient to the care of a GP close to it, the patient needed a prescription. However, the matron was forced to say to that patient's children that she was sorry but was unable to help other than to arrange for the patient's admission to hospital so that an urgent prescription could be given. It would be helpful if matrons of nursing homes could, as of right under the Bill and subject to proper training, be given the same powers of prescription as will be given to other groups of nurses.

Clause 2 of the Bill rightly extends the duty of family health services authorities in England and Wales to cover the prescription duties. I should declare an indirect interest as my wife chairs such an authority. I assume that, under the Bill, when any nurse is acting for or working with a GP to issue a prescription, any complaint of an offence on the issue or non-issue of a prescription will be related to the nurse and the doctor by the family health service authority. I should like my hon. Friend the Minister to clarify that assumption. One assumes that a disciplinary hearing, which at present can be brought only against a doctor, could in future be brought against a nurse.

However, how will a family health services authority carry out a similar duty if there is a complaint about prescription by a nurse when he or she is acting for a health authority, for a home run by the social services or a privately run home that provides services to the social services authority? How will the family health service authority conduct a disciplinary hearing when the case does not relate to a practitioner who is registered with that authority? That may seem a technical point, but disciplinary hearings cause much anguish both to the practitioner and the patient. It is worth while to reassure all health service users and all nurses that there will be adequate mechanisms for coping with what I am sure will be very few disciplinary or complaints hearings.

There have been a number of comments in the debate on the Treasury's attitude to the proposals. Unlike my hon. Friend the Member for Eastleigh (Sir D. Price), I do not regret that the Treasury has not adopted an open-handed attitude as, by their very nature, Treasuries are debarred from so doing. I congratulate the Treasury on making available, through the money resolution and the Government's support for the Bill, the not insubstantial sum of money that it will cost to implement the legislation. Many apparently equally deserving proposals that would have cost less than the estimated cost of the Bill have been put to the Government and, regretfully, the Treasury has had to refuse. Treasury Ministers deserve praise, not grudging acceptance, for the fact that they are prepared to make available the necessary money.

The notes attached to the Bill make it clear that the sums involved will fall on the budget of the family health service, which generally seems entirely appropriate. But I hope that we may be assured that, when the regulations are drafted under the Bill, the budget of the family health service will not be unnecessarily put upon from either health authority budgets or social service budgets. That could happen as services are provided under the Bill that would otherwise have been paid for by health authority or social service budgets. I speak as an accountant and foresee a difficult accounting problem that should be addressed early. Inevitably, even given the greatly expanded funding that the Government have made available to the health service generally, there is still—rightly—considerable pressure of competition on all aspects of budgeting for resources in the health service. So the Minister should account in advance for some of the issues that will occur between budgets as a result of the Bill.

I underline some of the points made in the Touche Ross report about the likely costs of the measure. My hon. Friend the Member for Eastleigh pointed out that much of it was guesswork, which means that the report must sometimes, inevitably, put figures to guesswork. Even so, those figures are based on the best analysis available. They take into account all the known factors, so that, although we must accept them with caution, it would be unwise to discount the figures. Although we recognise—I appreciate that my hon. Friend the Member for Wanstead and Woodford (Mr. Arbuthnot) takes issue with me on this—that there will be considerable savings in time resulting from nurses not having to travel backwards and forwards to get prescriptions filled out and redeliver them to patients, that degree of time saving, though welcome, will manifest itself not in cost savings but in the more efficient use of nursing time and, one hopes, in less delay in patients receiving the drugs that they need.

My hon. Friend is making the case for the inevitability of the extra time being made available by the Bill to district nurses being taken up by extra work by those nurses. Is that acceptable? We shall have many options to consider when the measure becomes law, including a reduction in the number of district nurses and the channelling of the resources so saved into other areas of health care. It would be unwise to reject those options at this stage of the Bill.

I accept that, and my hon. Friend is underlining in many respects the strength of the Bill in that it draws together the support of hon. Members who look at the issue from the standpoint of the greater service that will become available, for example, in some of the most stressful inner-city areas such as that which I represent. That advantage will apply right across the spectrum, through to the services that other hon. Members expect to receive in more rural or less stressful urban areas. I do not anticipate there being any reduction, as a result of the Bill, in the numbers or costs of the services in the area that I represent. But I expect a higher level of service and, I hope, slightly less stress on the providers of that service.

I welcome the Bill because it is about supporting the nursing profession and giving its members more facilities and greater ability to do their job. In that way, we shall not only assist the members of the nursing profession in a difficult and dangerous part of their work, but give them additional responsibilitiess which add to their problems.

I think of one area in my constituency, the walk-up flats in Lawrence Weston. I was recently taken round the area and during my visit, which lasted a day, saw some of the cases and problems that people face on a day-to-day basis. The Bill will not reduce the physical danger in which nurses sometimes find themselves, but it will help them to provide a better service in areas of high stress. It will also help them to plan their day better, so enabling them se their time more effectively, for the benefit of their patients.

While we have been in office, there has been an unprecedented increase of about 68,000 in the number of active nurses in the profession. I welcome a measure which, I hope, will not decrease those numbers but will strengthen the hand of the profession in dealing with its problems.

11.15 am

I congratulate my hon. Friend the Member for Chislehurst (Mr. Sims) on coming high in the ballot and on choosing a subject that is close to the hearts of us all. We are all subject to the vagaries of health, and he has made it possible, by introducing the Bill, to improve the care that is available to the public at large and to make it more effective and efficient at the point of service.

I echo what was said by my hon. Friend the Member for Harlow (Mr. Hayes) in congratulating Christine Hancock on all the work that she has done in helping to bring the Bill forward. Before moving to her present position, she was the general manager of the Waltham Forest health authority, which covers my constituency. She may have been the first such general manager to occupy her present position, and her work has been extremely valuable.

In May last year my hon. Friend the Member for Kensington (Mr. Fishburn) introduced a Bill under the ten-minute rule which was discussed on the Floor of the House on a Friday morning. It was unusual for such a Bill to come so close to achieving legislative effect. He managed it in a way that is almost unique to him, for he has introduced many ideas that have been taken up only after he thought of them. In that respect he is an admirable successor to his predecessor, our late-lamented colleague, Sir Brandon Rhys Williams. So not for the first time has my hon. Friend the Member for Kensington brought forward fresh ideas that have helped not only his constituents but the country as a whole.

Several reservations were registered to the Bill that my hon. Friend introduced last May, some of which I raise again in the hope that they will be answered. I spoke briefly when that Bill was debated on 3 May 1991, and at that time the Minister did not have an opportunity to deal with some of the issues that I raised.

It is crucial that nurses who are given power to prescribe have proper training, and obviously the power to prescribe should be limited to those who have had that training. It is essential for that not simply to involve going through various courses, but for those who go through them to prove that they have an understanding of, and achievement in, what was contained in the courses. Merely to have been sent on a course should not be sufficient proof that a nurse has grasped all the principles involved in this important and delicate matter of prescribing. Training is crucial. I suspect that it should be limited to a relatively small number of nurses, at least at the beginning.

The important question that needs to be addressed is precisely what nurses should be allowed to prescribe. My hon. Friend the Member for Eastleigh (Sir D. Price), in his excellent speech, read out a paragraph from the report of the Social Services Select Committee in which it was said:

"many witnesses believe that nurses should have freedom to prescribe a limited range of items, such as dressings, ointments and medical sprays, and that they should be able to use their professional judgment on matters such as the timing and dosage of drugs prescribed by doctors for pain relief."

If that report is accepted, the implication is that the Bill should cover only dressings, ointment and medical sprays, and the amount and timings of drugs already prescribed by a doctor.

I am not sure whether the Bill would allow nurses to prescribe new drugs. If it has that effect, we must consider it extremely carefully in the light of the negotiations and discussions since my hon. Friend the Member for Kensington introduced his Bill. That innovation would present dangers and problems. What would happen if a patient were prescribed two drugs that interacted with each other? I raised that problem in my few remarks on 3 May.

Frequently patients do not tell their doctor or nurse what they are taking. Therefore, a nurse could prescribe one drug which would react with another to provide a dangerous effect in the patient. We must guard against that. Doctors are well able to guard against that by reason of their training. If the Bill becomes law, as I sincerely hope it will, nurses, too, should be trained to deal with that. That probably applies even to an increase in dosage, to which the Select Committee report refers.

The next question raised during this morning's debate is precisely where nurses should be able to prescribe. There has been a difference of opinion on that. My hon. Friend the Member for Chislehurst said that health visitors and district nurses who travel a lot in the country should be able to prescribe. They do not want to have to go back to the doctor for a prescription for something about which they may know more than the doctor, then travel to a chemist and back to the patient. All the time that that procedure takes up would be saved.

If the circumstances are expanded to include nurses in hospitals writing prescriptions, altogether different questions arise. My hon. Friend the Member for Chislehurst said that it was not necessary for nurses in hospitals to prescribe because doctors are on hand and, with all their training, should be available to make the necessary prescriptions. He told us that that circumstance was, therefore, not covered by the Bill. I questioned my hon. Friend the Member for Kensington, who suggested that that circumstance should be covered in the Bill on the ground that if it was necessary for nurses in hospital to prescribe, as circumstances might suggest that it would be, the law should allow them to do so.

My hon. Friend is an eloquent proponent of liberalisation of all sorts, but we must be exceptionally careful with the prescription of drugs. Although they can bring great benefits, they can also cause great tragedies. We must be careful about the extent to which we liberalise our drugs regime.

My hon. Friend the Member for Bristol, North-West (Mr. Stern) gave an example to show why it was necessary to consider at least the possibility of some hospital prescribing. He referred to the matron of a nursing home or some similar establishment and related how someone could not obtain a prescription from a doctor as there was no local link with a doctor. That tipped the balance in my mind between the views of my hon. Friend the Member for Chislehurst and the views of my hon. Friend the Member for Kensington. We should consider whether an amendment should perhaps be made in Committee.

This century matrons have acquired a respect. They were noticed only when they began to disappear as a result of some health reforms some time ago. I am delighted to say that matrons are now coming back, partly because of our health reforms. They are increasing our respect for the health service. Those who would prefer a doctor to a matron to give a prescription would often be considered to be rather odd.

I entirely agree with my hon. Friend about matrons. He called for an amendment to the Bill, but he may well find on reading the Bill that the extension to which he referred could be dealt with by regulations under the Bill as it stands.

I have read the Bill, and it deals with amendments to other legislation which one then must follow through and follow through and follow through. It is complicated to work out precisely the effects of

"after the words 'exemption conferred' there shall be inserted the words 'or modification made'".

I am grateful to hear from my hon. Friend that that could be done by regulation. If that is so, I hope that my hon Friend the Member for Kensington will consider it.

The Bill will create for the first time—I am open to correction on this—two different forms of prescription: those produced by nurses, district nurses or health visitors, and those produced by doctors. An essential aspect of the Bill is that chemists must be able to tell at a glance which prescriptions are being presented to them. They must be able to ensure that nurses' prescriptions are limited to the drugs or appliances that are permitted by the regulations introduced under this legislation.

I am not sure how it is proposed that those prescriptions should be differentiated. Perhaps they should be on two different coloured prescription pads so that chemists may know that a white prescription comes from a doctor and a green prescription from a nurse. In that case a green prescripton would not permit a chemist to give over the counter to a nurse drugs that only a doctor can prescribe. That, of itself, would mean that not only nurses but chemists would need training as a result of the Bill. That is to be welcomed. Contrary to the belief of my hon. Friend the Member for Bristol, North-West, I believe that the Bill may well produce financial savings as well as savings in time and effort. The training of chemists in that respect could easily be absorbed within the money resolution.

The Bill will save district nurses and health visitors time and journeys now wasted on going to the doctor, writing out the prescription for the doctor, persuading the doctor to sign it, going to the chemist, and taking the appliance, or whatever, to the patient. But doctors, who are very highly paid, will also experience a saving: they will no longer have to spend time dealing with prescriptions for patients about whom they propbably do not know very much.

My hon. Friend the Member for Bristol, North-West feels confident that the savings in time would be absorbed immediately by the extra work done by district nurses and, probably, by doctors. I disagree. One of the benefits of the health reforms that we have introduced is the fact that health authorities are being literally forced to be sensible about priorities, and to allocate resources accordingly. If they find that district nurses or health visitors have more time available as a result of the Bill, health authorities will have not only the ability but a positive duty to consider whether to reallocate the resources that have been saved —to hip replacement operations, for instance. In the constituency of my hon. Friend the Member for Bristol, North-West, those resources might be used to increase the amount of productive work done by district nurses.

An artificial disagreement is being created. I agree that the Bill would allow resources to be reallocated, but I was trying not to give the impression that it would result in a net cost saving; it would merely result in an increased provision of service.

On that note of harmony, I shall move on to another point. The hon. Member for Peckham (Ms. Harman) said that trained nurses were leaving the national health service at a rate of 80,000 a year. I am not sure whether that statistic is correct, but I understand that there are now 69,000 more nurses and midwives than there were when the present Government took office. That may be a result of a pay increase of nearly 50 per cent. in real terms.

Nevertheless, the retention of nurses is essential. One advantage of the Bill is the increase in job satisfaction that it would give nurses. At present, a district nurse is forced to say to a patient, "I am sorry, but I cannot provide you with this ointment. It is silly, but I will have to go to a doctor who knows nothing about your case and get him to sign something that he probably will not read. I will then have to take the prescription to a chemist—who probably will not be able to read it—and bring the ointment back to you."

Not only is that process a waste of time; it humiliates the nurse or health visitor, and makes her feel that her job is menial—which it certainly is not, and which it should never be considered to be. The Bill would give that nurse or health visitor the responsibility that—in practice—she already exercises: she would be seen to have that responsibility. I believe that such an increase in job satisfaction would contribute greatly to the retention of district nurses and health visitors. Their job is already rewarding, but the Bill would make it more rewarding.

That valuable increase in the responsibility of district nurses and health visitors would also involve a valuable decrease in the burdens borne by doctors. I do not know whether the retention of doctors has been a problem, but, if so, the Bill might help to solve it.

Still more can be done to improve job security for nurses. We can increase the provision of training, not just in regard to prescriptions but in regard to other matters.

Order. I very much hope that the hon. Gentleman is not using a Second Reading debate to make a general speech about the nursing profession, and that he will adhere more closely to the terms of the Bill.

I was going to say that I hoped that the Bill could be used to increase nurses' job satisfaction. Training is an essential aspect, and one reason for it is that increase in job satisfaction. I hope that the Bill will be used almost as a platform to give nurses the status of highly qualified medical practitioners—not quite on the same level as doctors, but more respected than they are now.

I do not wish to detract from the importance of what the hon. Gentleman is saying, or from the value of the Bill, but I was interested by his remarks about giving people a better quality of life and more job satisfaction. The next Bill on the Order Paper—the Civil Rights (Disabled Persons) Bill—is also very important, and many of us hope that we shall reach it today.

I am aware of that, and I shall end my speech shortly.

It is pointless to restrict the prescribing of medicines, ointments and appliances to doctors, given that the number of prescriptions with which they must deal makes it inevitable that they will sign forms without giving them proper attention, and without exercising the required clinical judgment. The same applies to Ministers: if they have to sign about 100 letters each day, they will inevitably sign some without reading them.

In many cases, nurses might well be better at prescribing than doctors. A district nurse with 25 years' experience would have much more knowledge of individual patients' needs and circumstances than a newly qualified doctor who did not have the same opportunity to get out and about.

I welcome the Bill. I am glad that both the Government and the Opposition support it, and I wish it every success.

11.37 am

Although I am sure that we all appreciate the importance of reaching the Civil Rights (Disabled Persons) Bill, I have no doubt that every hon. Member also appreciates the importance of this Bill, small though it is. It gives us the opportunity to comment both on the use of nursing resources generally and on the implications of the Bill for our constituents.

I apologise to my hon. Friend the Member for Chislehurst (Mr. Sims) for entering the Chamber towards the end of his speech; I was inadvertently delayed. As I came in he was saying, in effect, that the Bill need not be extended to cover hospital nurses, because doctors were normally in attendance. Would that that were the case.

I welcome the Bill. Like many others, I have long believed that the medical skills of our experienced nurses are an underused resource. The more that we can utilise their skills, the better it will be for patient care. The Bill is a small step in the right direction. It inches forward when perhaps we could have taken a giant step for mankind, but I hope that it will be used to go further, perhaps within the regulations that might follow.

I hope that we shall not lose the momentum to develop further the use of skilled and experienced nurses for services where the patient is not getting that speedy and rapid service that he or she desires, There is a long way to go. I do not go as far as my hon. Friend the Member for Kensington (Mr. Fishburn), who wished to apply Mr. Samuel Brittan's rules of economic liberalism to prescribing. I accept some of his economic prescriptions, but not his medical prescriptions.

I accept, too, that we must be careful of simplistic solutions. As my hon. Friend the Member for Wanstead and Woodford (Mr. Arbuthnot) said clearly and concisely, not only benefits but risks will be conferred by easier prescribing.

One understands why the medical profession moves carefully and slowly, but it can go too slowly and I suggest that it has done so. Although the Bill is welcome, the Cumberlege report was published in 1986 and it will be a long time before the benefits of the Bill are conferred on midwives, community nurses and patients. I hope that the medical profession will try to speed up the process whereby we extend the use of nursing skills into other areas.

I am sorry if I missed the more detailed explanation that my hon. Friend the Member for Chislehurst gave of why it is not necessary to extend prescribing rights to hospital nurses. Perhaps we shall hear more from my hon. Friend the Minister about that.

I feel strongly about the Bill because in my constituency—I am sure that this experience is shared in other constituencies—the services of smaller hospitals have been progressively cut. Services have been concentrated on general district hospitals. The acute services and other facilities of smaller hospitals and, indeed, of medium-sized hospitals have been cut. Those cuts have been made under every Government in the past 25 years. To a large extent, it has been a question not of resources but of changing medical practice. In areas such as the Isle of Sheppey—this is echoed elsewhere in the United Kingdom—acute local hospital services are now denied to local people, who must travel further afield for urgent medical attention.

A welcome new trend is the greater emphasis on primary care hospitals, community hospitals or GP hospitals, whichever is the preferred term. Some of the primary care hospitals will be substantial. None the less, we cannot expect them to be manned constantly by consultants, trainee doctors or GPs, who might be on call. Many emergencies and minor matters will have to be treated at a district general hospital many miles away.

It is extraordinary that a highly trained but relatively inexperienced paramedic ambulance driver may take a patient to hospital, but a senior nurse at that hospital with 20 or 30 years' experience cannnot use the same equipment to the same degree as the paramedic. That does not make sense.

There is a new senior grade of nurses—nurse practitioners. I am unaware of the extent to which they are being encouraged to practise. My impression is that their use is not widespread, but it would be a tremendous step forward if nurse practitioners, with the ability to prescribe and use the emergency equipment, were encouraged to practise in smaller primary care hospitals. All nurse practitioners should certainly also practise in the larger new health centres operated by general practitioners.

That seems such common sense that I suspect that it would receive widespread support, as long as it was done within the proper disciplines and standards that we expect of the health service. But it all seems to be taking so long—and time that we do not have—when the speed of change in the hospital service is so great and when facilities are being closed rapidly to meet the increasing demands of modern technology and science. We should be moving quickly to release the tremendous resources and skills of those nurses.

Are there any impediments to developing the nurse practitioner facility in the hospitals that I am talking about? Close to my heart is Sheppey general hospital, which has lost many acute services. It will soon be redeveloped as a fully fledged substantial community hospital. The same applies to Sittingbourne hospital. It would mean much to my constituents if nurse practitioners were able to use their skills and resources in a 24-hour minor casualty service. If the problem is extending Prescribing powers—I think that it might be—would the Bill allow the extension of prescribing powers to nurse practitioners? Or is the problem money? If many nurses are promoted to higher grades to carry out those services, is there a problem of relativity within the nursing profession and, if so, could it be resolved by extra resources? If that is so, it is an issue which we must tackle.

I return to what I said at the beginning. The real problem is that in many hospitals doctors are not on hand at all times and must be called in, which takes time. For that reason, casualties are often directed to other hospitals many miles away. That is an unsatisfactory situation which could be solved by the philosophy contained in the Bill.

I have said how far I should like the Bill to go and why it is important, but I regret that it has taken us so long to get this far. However, I welcome the Bill for what ii says explicitly and I congratulate my hon. Friend the Member for Chislehurst on introducing a measure which will help the elderly and chronically disabled people in my constituency and elsewhere. It will help people in rural areas—such areas are a large part of my constituency—and it will encourage nurses and give them greater job satisfaction. Many of them undoubtedly have great skills which should be better used. The Bill will save their time because they will no longer have to go to the surgery to get a prescription signed. It is in general a good measure which should be warmly welcomed. I wish it a speedy passage, but I hope that we shall use it as a foundation stone on which to build more extensive involvement for senior and experienced nurses in the delivery of good patient care.

11.51 am

Like my hon. Friend the Member for Faversham (Mr. Moate), I shall be brief because I appreciate the importance of moving on to the next Bill. I join him in congratulating my hon. Friend the Member for Chislehurst (Mr. Sims) on the introduction of this important measure. It is right that it should be properly debated, especially when one bears in mind the fact that the three categories of health service workers mentioned in the Bill perform a very important task.

I pay tribute to the work of nurses, midwives and health visitors. I have had a great deal of contact with them during my 23 years as a teacher, during one or two spells in hospital and during my constant hospital visits o my sick constituents which I and all my hon. Friends and all hon. Gentleman make.

It must be said that nurses, midwives and health visitors already undertake virtually the duties set out in this valuable Bill. They cannot do so by law, but they have a good knowledge of the drugs that patients need. They are in constant contact with patients

at least in hospitals—and are well aware of any changes in a person's health. Like most doctors, they know what medicines are needed in a particular situation. In my experience of hospitals, I found that nurse would tell patients that they needed this, that or the other and that they would write the prescription. They could not sign it but they could produce it.

It seems absurd that such health workers do not have the written and delegated legal authority to sign prescriptions when they have the knowledge to suggest a prescription. They also have the detailed knowledge that only a nurse can have—in many cases, more so than the doctor—of the way in which a patient reacts in the short and in the long term to a particular medicine. Such workers are in an almost unique position to suggest sudden changes in medication and it would be right and proper if they had the authority to authorise such changes.

Hospitals are well geared to handle nurses' prescriptions just as they are geared to handle doctors' prescriptions. After all, there is a pharmacy in most hospitals and nurses' prescriptions could be used or cashing in—so to speak—in such pharmacies as well as anyone else's. Therefore, the health service is well geared to responding to the measures set out in the Bill should it be enacted.

What about midwives? Surely they, more than almost any other category of health service official, operate on their own. When my three children were born I was present on each occasion. We did not see much of any doctors; the midwife was the figure—the health service representative—with whom my wife and I continued to deal afterwards. She must have had a unique knowledge of the health or otherwise of our children and must have been in a position to suggest and authorise any medication required. Happily, none was required in our case, but we all know that, sadly, in many instances midwives have to suggest to doctors particular medication for mothers and babies if doctors are unable to get to them. It is ridiculous that midwives do not have the final authority.

My hon. Friend will be aware of the fact that under separate legislation midwives today have limited powers of prescribing.

I am aware that they have limited powers of prescribing. They always have had such powers, but why should they be limited? My grandmother was a midwife and as children we used to walk around with her and she would point to some enormous man or woman and say that he or she was one of her babies. She would then give a detailed explanation of the parent of that child and the medication needed. She could do a great deal even all those years ago, but midwives still do not have the full powers for which we are arguing.

Health visitors also have limited powers. I should not want anyone in this country or anyone else in the world to have unlimited powers, because that is unhealthy. However, health visitors should have fuller powers than they have at present. I have had much contact with health visitors in schools and the work that they do with mothers and children. There are not many parents who do not have more than one child and a child's school attendance is often affected by the health or otherwise of a younger child, especially when the parents have to go out to work. In those circumstances, the younger child is often visited by the health visitor who will advise parents on how to handle the particular case. It does not make sense for health visitors not to have the full authority to dispense prescriptions.

From every point of view, the Bill has a great deal to offer. It will resolve a problem that should have been dealt with long ago, perhaps even when the health service first came into being but certainly shortly afterwards. For nurses, midwives and health visitors not to have the authority and powers set out in the Bill is, in a sense, a slap in the face for them. It is a denial of their professionalism and their contribution and of the fact that their contribution could save the valuable time of doctors and sometimes of consultants and others. I strongly support the Bill.

12 noon

I shall be very brief because I am conscious that hon. Members are waiting to debate the Civil Rights (Disabled Persons) Bill. I congratulate my hon. Friend the Member for Chislehurst (Mr. Sims), first, on winning his place in the ballot, and, secondly, on what I think will be viewed as an excellent choice of subject for health care, especially by the patients. I declare an interest in the medical field, as listed in the Register of Members' Interests.

This is an excellent Bill, which is long overdue. The fact that nurses cannot prescribe does not keep up with today's world and the level of education that nurses have reached. That fact militates against patients because doctors and others who prescribe are overloaded. It also decreases the efficiency of nurses.

I agree with my hon. Friend the Member for Faversham (Mr. Moate) that the Bill should be seen as the thin end of the wedge for future legislation.

My constituency is a rural area. In addition to the City of Winchester, we have the towns of Alton, Bishop's Waltham and Arlesford, but there are also some 74 villages. The Bill will be given a special welcome in rural areas because it will greatly increase the efficiency of nurses and midwives. It will also increase the efficiency of doctors, because a load will be taken off them. The Bill will also increase the morale of doctors, midwives and nurses. It will greatly benefit patients in the NHS, especially those in rural areas where the inefficiency and inconvenience of travelling backwards and forwards to surgeries are so manifest.

I wish the Bill all success on its passage through the House.

12.1 pm

Many hon. Members have made clear in the debate their strong commitment to the introduction of nurse prescribing. I warmly congratulate my hon. Friend the Member for Chislehurst (Mr. Sims) as well as my hon. Friend the Member for Kensington (Mr. Fishburn), who has played such an important part in these matters. It is perhaps fitting that my hon. Friend the Member for Wanstead and Woodford (Mr. Arbuthnot) paid a tribute to the predecessor of my hon. Friend the Member for Kensington, Sir Brandon Rhys Williams, whose wife is chairman of the family health services authority in that area, and she does a magnificent job.

My hon. Friend the Member for Chislehurst paid tribute to the work of our noble Friend Baroness Cumberlege. He hopes that she will steer the Bill through another place. Her work for community nurses is second to none. That work, which she is now able to carry forward as chairman of a regional health authority, ensures that right at the heart, in the leadership of the NHS, there is someone with special knowledge and authority in this area.

I wish to remind the House of the context of the debate, both the development of the service and the status of nurses, into which nurse prescribing fits. It is a step of great significance, which I believe will mean that the status of nurses, which is so fundamental to the health service, is reinforced and enhanced.

Our commitment to the health service is based on our determination to improve services for patients—nothing more, nothing less. That is why in the health reforms outlined in the patients charter we have spelt out our commitment to patients, especially the commitment to have a named nurse so that patients know to whom they should turn in times of difficulty, whether that be a midwife, a nurse or a health visitor. We are already seeing remarkable results. The maximum use of those who work in the service is fundamental to our being able to deliver further and improved patient care.

I am grateful to those hon. Members who have seen the Bill in the context of our introduction of care in the community. It is essential that those community nurses make a maximum contribution to enhancing the care of patients once they have left hospital. We know about the improvements in hospital care for the elderly—the 43 per cent. rise in geriatric consultants and the 84 per cent. rise in the number of elderly patients treated. However, patients are increasingly treated in the community and the support of community nurses is important.

I appreciate the comments of my hon. Friend the Member for Harlow (Mr. Hayes), who spelt out the three long-standing aims of the Royal College of Nursing, all of which have been achieved. He referred to the work of Trevor Clay, and then paid tribute to his successor, Christine Hancock. I thank my hon. Friend for his warm remarks about Dame Anne Poole, who, as chief nursing officer, has made an important contribution and has ensured that the interersts of nurses, midwives and health visitors are kept in the forefront of our considerations.

One of the first decisions of my right hon. Friend the Secretary of State was to appoint the chief nursing officer to the policy board so that, as we considered reforms and changes, we had her advice at the centre of our considerations.

Nurses have achieved an independent pay review body. As hon. Members have made clear, their pay has risen by 48 per cent. in real terms, ahead of inflation, since 1979. Pay is important, but so is training. Again, I thank hon. Members for their reference to Project 2000. Some£207 million has been put into that new form of nurses' training, to provide the qualified nurses that we need for the next century. We need those dedicated professionals, and we must get a better balance between classroom skills and hands-on care.

We have provided a better career structure under the new clinical grading structure introduced in 1988. Nurses now have better opportunities than ever before if they remain in clinical practice. Last year, we introduced a new senior nurse structure, which provides greater flexiblity and access to performance-related pay. Just this week the Nurses, Midwives and Health Visitors Bill completed its Committee stage. It will strengthen the professional self-regulation of nursing. Again, we worked closely with the professions to ensure that we have the mechanisms in place that can best enable self-regulation and the control of training. Those are very important steps. The hon. Member for Peckham (Ms. Harman) was wrong to suggest that nurse prescribing could have been appended to that important and significant Bill.

I must mention the work of the nursing development units and nursing audit. In a number of areas there is a practical commitment to recognising and enhancing the role of nurses. Nurse prescribing fits well into that background. It will be a significant and worthwhile improvement in the services for patients. They will be able to get their medicines and dressings more quickly, and so have speedier treatments. Nurses will have greater responsibilities as professionals in their own right. The Bill builds on our determination to ensure that nurses achieve their rightful status in the health service.

One of the important issues in nurse prescribing is the number of nurses who work for general practitioners. I congratulate my hon. Friend the Minister on the fact that in 1979 there were only 990 nurses in general practice, whereas in October 1990 there were 7,700 full-time equivalents—making 13,520 nurses in general practice. Is not that a remarkable achievement, which underlines the case for the Bill?

My hon. Friend is right in his figures. I am grateful for his comment. The role of the practice nurse is important. Primary health care has been transformed beyond recognition. More general practitioners are using computers. The whole area of general practice is developing. The practice nurse plays a vital role in that. If my hon. Friend will bear with me, I shall explain how we envisage the increasing involvement of practice nurses.

It is important to go into the details, even if only briefly, because it is a significant and important step. A number of comments during the debate show that there is some misunderstanding about precisely how the new arrangements will work.

We have long supported the principle of nurse prescribing. In 1986, the Cumberlege report on community nursing recommended:

"The DHSS should agree a limited list of items and simple agents which may be prescribed by nurses as part of a nursing care programme, and issue guidelines to enable nurses to control drug dosage in well-defined circumstances."

The Government accepted that recommendation in principle and, through our standing medical nursing and midwifery and pharmaceutical advisory committees, set up the advisory group on nurse prescribing to advise us

"how arrangements for the supply of drugs, dressings, appliances and chemical reagents to patients as part of their nursing care in the community might be improved by enabling such items to be prescribed by a nurse, taking into account where necessary current practice and likely developments in other areas of nursing practice."

The recommendations of the advisory group included a considerable number that required further work. One of the key aspects was the economic implications. Now that we have completed that further work, we are in a position to support nurse prescribing in practice as well as in principle.

I share the feelings of many hon. Members who wish that we had been able to make speedier progress. However, it is important to ensure that we have examined all the aspects—costings, cost-effectiveness, the mechanisms of how the prescriptions will be organised and referred back, and how the other professional groups have responded.

One of the reasons why we have received such warm and wide support for the measure is that we have been able to take the time to consult effectively and to take people with us. The advisory group report recommended that certain groups of nurses working in the community should be authorised to prescribe from a limited list of products and to supply medicines or vary their timing and dosage, within agreed protocols.

My hon. Friend's Bill provides the primary legislation to enable prescribing aspects of the recommendations to be implemented. Those are the aspects of most interest to community nurses, GPs, pharmacists and—most important—patients and their carers. I should also mention—this has been raised in the debate—that at the same time we are taking forward the recommendations concerning supply and changing timing and dosage. That aspect does not require primary legislation; it is a question of agreed protocols.

In its recommendations about prescribing, the report considered that nurses working in the community who had a district nurse or health visitor qualification should be permitted to prescribe the items that they needed for the nursing care of their patients. That is the basis on which we have worked in preparing the secondary legislation needed to turn my hon. Friend's Bill into a reality.

My hon. Friends the Members for Eastleigh (Sir D. Price) and for Faversham (Mr. Moate) and others have said that they support the idea with regard to community nurses and asked, "What about hospital nurses?" The advisory group reported in the context of community nurses, but the Bill would establish a framework whereby the concept could be extended to hospital nurses.

I was interested in what my hon. Friend the Member for Eastleigh said about people working in ophthalmic casualty. Before we took that further step, however, careful consideration and consultation would be required.

I am interested to hear my hon. Friend say that. Is she suggesting that such a consultation process might be put in hand or that she would view favourably the beginnings of such consultation—the start of a process of extending the provisions to cover hospital nurses?

At this stage our view is that we welcome the Bill and would like to see it translated into practice, but we do not envisage community nurses being able to prescribe until October 1991 Then there is further work to be done in considering what other items may be made available and how other groups may be incorporated. Special consideration should always be given to the role of groups such as community psychiatric nurses and others, and to the items that they may be able to prescribe.

A move such as that envisaged by my hon. Friend the Member for Faversham is therefore a considerable way off. We must be sure that we have established the right framework for the first group before opening our minds to the question whether others might have an important part to play.

My hon. Friend made a point—perhaps I should deal with it now rather than later—about the changing role of the health service and the development of community hospitals. He spoke of the combination of acute high-tech medicine in district general hospitals, alongside more effective and sophisticated comprehensive care in the community. The point was well made and we certainly wish the role of the nurse, whether in the hospital or in the community, to be developed and maximised.

As I have said, we want appropriate nurses to be able to prescribe the items that they need for the nursing care of their patients. There will be a formulary of items that they may prescribe which represents the items that nurses in the community with district nurse and health visitor qualifications might need for the care of their patients, and which it would be appropriate for them to prescribe. Some hon. Members may have envisaged that nurses will be able to prescribe a far wider range of items than is proposed.

The Joint Formulary Committee, which produces the British national formulary and the dental practitioners' formulary has set up a sub-committee to produce a nurse prescribers' formulary. Medical, nursing and pharmaceutical interests are represented on the sub-committee, which has already met twice, and plans to complete its work in the summer. We are very grateful for its urgent help.

Hon. Members who are interested in the types of product that nurses will be allowed to prescribe should refer to the illustrative formulary in the advisory group report. Items include laxatives, stoma care products, pain killers such as aspirin and paracetamol, skin preparations, and a wide range of appliances and dressings. Most items can be bought over the counter by patients. The illustrative formulary lists a number of prescription-only medicines: Nystatin, for oral fungal infection; Clotrimazole, an antifungal preparation; Iodosorb, a medicated dressing; and Varidase, a desloughing agent. We anticipate that the final nurse prescribers' formulary will cover the same range of items, or similar items.

Other aspects have been raised by hon. Members—about the full implications of the Bill, about the nurses who will be able to prescribe and about their qualifications.

The advisory group gave very careful consideration to which groups of community nurses it would be appropriate to allow to prescribe and recommended that, at least initially, prescribing should be limited to those holding a district nurse or health visitor qualification. Secondary legislation under the proposed Act will, therefore, limit prescribing to appropriately qualified district nurses and health visitors working in the community. Before such nurses may prescribe, they will, of course, need training in nurse prescribing. In future, nurse prescribing will be integrated in district nurse and health visitor training courses, but at present we are working urgently and closely with the UKCC and the national boards to produce a nurse prescribing training module for those currently employed.

Many hon. Members will know a great deal about the work of the UKCC and the national boards, as we have spent some hours in Committee discussing their work. Hon. Members will be pleased to know that extra money has been made available for the training module. We have provided funds in 1992–93 for setting up the courses and providing training materials. We have also provided funds for 1993–94 and 1994–95 for running the training modules at the various centres around the country that run district nurse and health visitor courses. In England, taking account of practice nurses with district nurse or health visitor qualifications there are about 25,000 potential nurse prescribers. Some of those will leave or retire before implementation, and they will usually be replaced by nurses who have received nurse prescribing training as part of their initial training, so we anticipate that about 23,000 would-be nurse prescribers will attend the special course between April 1993 and April 1995.

The UKCC has advised us about standards, kind, content and length of courses. The national boards are now organising further discussions with course tutors. I know that my hon. Friends will want to be satisfied about the courses, because we are taking a new step and it is important to consider all the aspects.

The courses will cover, of course, the items on the nurse prescribers' formulary—drug interactions, reporting adverse reactions, communication with other professionals, good practice in prescribing, budgetary accountability and monitoring and all the other relevant issues. The courses will need to meet the criteria set by the UKCC and to be approved by the national boards.

At the end of the courses, potential nurse prescribers will be assessed and only if they reach the required standard of knowledge will they be allowed to prescribe. Nurses who have satisfactorily completed the training module will have their details submitted by the national boards to the UKCC which will be able to identify them as nurse prescribers on the UKCC register. Eligibility to prescribe can then be checked by bona fide inquirers with the UKCC at any time. It has been important to ensure that we consider all those angles to ensure also that, as we start the new move, it is carefully monitored and properly prepared for.

Budgetary accountability and monitoring were mentioned, scarcely surprisingly, fairly thoroughly by my hon. Friend the Member for Bristol, North-West (Mr. Stern), as well as by a number of other hon. Members. My hon. Friend has expert knowledge in these questions and a close awareness of the working of the family health services authorities. I made it clear that one of the areas that would-be nurse prescribers would need to address was budget accountability. We plan that the cost of nurses' prescribing, specifically the net ingredient cost of the items that they prescribe and the pharmacist fees, will be met in the family health services budget.

It is not appropriate to meet the costs from the hospital and community health services budget because, on the whole, nurse prescribers will be prescribing for general practitioners' patients and if the community nurses were not prescribing for them, the general practitioners would be doing so.

If nurse prescribers are practice nurses—that is, employed by GPs— we envisage their prescribing costs being linked to their GPs' indicative or actual prescribing budgets. If nurse prescribers are health authority employed, we envisage each provider unit being responsible for prescribing costs. More work is needed in that area before final decisions can be made. Through the Prescription Pricing Authority, GPs and community nurse managers will be able to monitor the patterns of their nurses' prescribing.

My hon. Friend the Member for Wanstead and Woodford raised the question whether there would be a differentiation between GP and nurse prescriptions. We intend that nurse prescriptions will be a different colour from GP prescriptions. I am sure that my hon. Friend is aware that pharmacists already manage to distinguish between GPs' and dentists' prescriptions, so there will be no difficulty in identifying a nurses' prescription. Apart from the different colour, the prescription will haw the nurse prescriber's name on it.

My hon. Friend the Member for Bristol, North-West also raised the question of the Prescription Pricing Authority and its work. The PPA, which does not always get the tribute it deserves, is a remarkably efficient and effective body. It will be able to identify the nurse prescribing undertaken by a particular group of nurses attached to GPs or by nurses prescribing in the community. It intends to identify the amount spent on nurse prescribing, not by individual nurses, but only according to a nurse's unit of employment.

Mention has been made of the Touche Ross report. I am the first to acknowledge that these questions are complex.

Would not it be beneficial to have the prescribing practices of individual nurses identifiable, if purely from a budgetary standpoint?

That is a matter to which we have given careful consideration. My hon. Friend's point would introduce an extra layer of complexity. We are talking to health authorities and especially to those in the family health services about the further steps that we need to take in monitoring the prescribing practices of, particularly, community nurses. Our judgment is that the most helpful way to take the matter forward is to be able to identify the nurse prescribing undertaken according to the GP practice in which the nurse is employed or according to her employment in the community. We can, no doubt, consider that aspect further as we finalise details.

According to the Touche Ross report, apart from the one-off cost of implementation, nurse prescribing, as my hon. Friend the Member for Chislehurst said, will cost the Exchequer£15 million a year in England. Most of the extra costs—£11·65 million—are estimated to come from the cost of additional items prescribed. In addition, there are the cost of pharmacists' dispensing fees, costs at the PPA for pricing nurses' prescriptions and monitoring them, the cost of providing copies of the nurses' formulary, the drug tariff and prescription pads, and various other administrative costs.

Against those costs, we must consider the considerable benefits available from introducing nurse prescribing. There will be concrete benefits in terms of community nurses and GPs being able to save time. Nurses will no longer have to make trips to the surgery to get prescriptions signed, as several hon. Members eloquently described. GPs will no longer have to sign those prescriptions. Those time savings are considerable in total, although none of us believes that those time savings have the significance that the benefit of the measure would have in improved service for patients and for the convenience of those who are in the community.

There will be improvement in terms of the satisfaction of community nurses who will know that they can take full responsibility for the nursing care that they provide. It is ludicrous that district nurses with years of experience must bother GPs to get them to sign prescriptions for the nursing care of patients. I am very pleased that, through the Bill, we can recognise the skills and competence of community nurses.

The safety of patients will not be compromised. I have already outlined the special training that will take place. I mentioned the nurse prescribers' formulary which will mostly contain medicines and appliances that patients can buy over the counter. We also fully recognise the importance of good communications between nurse and doctor to ensure good-quality care for patients and to maintain patient safety. We shall issue further guidance before implementing nurse prescribing on the handling of adverse reactions and on the maintenance of patient records.

My hon. Friend the Member for Chislehurst rightly asked about implementation. Having reached this stage, he, like my hon. Friend the Member for Kensington and many others who have championed the cause so excellently, wants to ensure that we achieve our implementation date of October 1993. We are working to a good timetable. We shall begin work on the regulations as soon as the Bill becomes an Act. There should be no problem in preparing the regulations in accordance with that time scale.

There is more to be done. There is the secondary legislation under the Medicines Act 1968 and under the National Health Service Act 1977 to specify the types of nurses, the training and the circumstances. We are already consulting all interested parties before we can make the statutory instrument under the Medicines Act.

Clearly, the question of legal liability is important. Nurses are professionally personally accountable for their actions. In terms of legal liability for actions carried out in the course of their duties, their employers take vicarious responsibility, so that health authorities will be responsible for the prescribing activities of health-authority employed nurses and general practitioners will be responsible for their practice nurses' prescribing. My hon. Friend the Member for Bristol, North-West referred in particular to the family health services authorities and their service committee hearing proceedings. It will be the GP who is subject to such proceedings because it is the GP who is answerable, but all nurses are subject to the control of the UKCC, so in cases of professional misconduct, whether involving a practice nurse or a nurse in the community, should there be difficulties, proceedings could be taken by the UKCC.

Hon. Members have made it clear that they take a close interest in the role of pharmacists. My hon. Friends the Members for Wanstead and Woodford and for Walthamstow (Mr. Summerson) will know that we are already working on the wider role of community pharmacists. I can advise my hon. Friend the Member for Harlow (Mr. Hayes)—without whose contributions a debate on health matters would be almost empty—that recent information was sent to community pharmacists on the vital question of head lice, which he brought to the attention of the House. I hope that that reassures him on that front.

We are also working to consider those items that could more appropriately be provided over the counter. Obviously safety is the key criterion in deciding whether an item should be prescription-only or whether it should be available over the counter. The Secretary of State acts on the advice of the independent Committee on the Safety of Medicines and the Medicines Commission in reaching such a decision. I am grateful to my hon. Friends for their comments.

I want to comment briefly on the importance of retention and recruitment and the role of nurses in the service generally, to which the hon. Member for Peckham referred. We were the first Government Department to sign up to Opportunity 2000. We were congratulated only the other day by Lady Howe on our work towards ensuring that we continue to enjoy the excellent retention rates that we have now established. I can report to the House that the average length of stay for any nurse in the service is now 14 years as against the seven that it was some years ago.

We have explicitly stated our goals under Opportunity 2000. We in the health service have given ourselves eight goals that we shall achieve before 1994, and two of them particularly relate to nurses. First, we should not allow the number of midwives, nurses and health visitors leaving the profession to increase. We are proud of the position that we have reached and we want to maintain it. Secondly, those returning after a career break or maternity leave should be able to return to their job at the same grade as they were in when they left it.

We want job-splitting and job-sharing to be the norm in the service. It is up to employers to explain why women should not job-share rather than for individuals to seek to negotiate the arrangement. We are well in the forefront of developments, seeking to ensure that the NHS is not only the largest employer of women in Britain but the most enlightened. We know that it is our ability to use our staff to the full and to ensure that we have flexible employment patterns that will enable us to achieve the health goals to which we are all strongly committed.

My hon. Friend the Member for Ealing, North (Mr. Greenway) mentioned midwives. The Bill has the support of many midwives, some of whom are with us today. My hon. Friend the Member for Eastleigh drew attention to the special role of midwives since 1902. They already have satisfactory arrangements for obtaining the drugs that they are allowed to supply and administer, but it is important that the Bill's provisions should include them, as we may need to extend to them the ability to prescribe, which they do not have at present. I hope that, as we make good headway on the Bill, we shall be able to extend and develop its provisions through secondary legislation.

We all welcome my hon. Friend's determination to ensure that all the necessary measures are in place. We all believe that the role of nurses is fundamental to the health service. We wish the Bill extremely well and congratulate my hon. Friend. I hope that, on the many important points of detail, I have been able to satisfy my hon. Friend and the House of the rigour, care and commitment surrounding this most important measure.

12.34 pm

With the leave of the House, may I first apologise for not being present when my hon. Friend the Minister began her speech. I had to leave the Chamber for a few minutes to meet a group of district nurses who wanted to tell me how very much they support the Bill and to express their anxiety that it should pass through all its stages before the end of this Parliament.

I thank my hon. Friend the Minister for her remarks about the Bill and for her support for it. I thank also hon. Members on both sides of the House for their kind remarks about me and, in particular, for their support for the Bill. That augurs well, and I hope that the Bill will now make rapid progress and that the district nurses who came to see me, and who do such a wonderful job, will not be disappointed.

Question put and agreed to.

Bill read a Second time, and committed to a Standing Committee, pursuant to Standing Order No. 61 ( Committal of Bills).

Civil Rights (Disabled Persons) Bill

Order, for Second Reading read.

12.35 pm

11 beg to move, That the Bill be now read a Second time.

The Bill's wholly legitimate purpose is to meet the undoubted moral right of disabled people to full citizenship and social equality. The Bill aims to confer long-awaited civil rights and freedoms on millions of people with physical, mental and sensory disabilities. As all hon. and right hon. Members know from their postbags, the outcome of this debate is anxiously awaited not only by our disabled constituents, but by all their organisations and by everyone who works with and among them. I myself have had a huge correspondence in support of the Bill. Let me quote briefly from just two letters.

First, Peter Large of the Disablement Income Group, whose distinguished work for disabled people is well known to this House, describes the Bill as

"the essential foundation on which campaigns of education and persuasion can be mounted and true good will, as opposed to 'do-gooding', can be enabled to flourish."

He says as well:

"In the absence of such legislation people with disabilities will never be enabled fully to enjoy their rightful place in society."

Peter Large is uniquely well placed to make these comments, as his letter reminds us. It says:

"The Committee on Restrictions Against Disabled People, which you set up as the then Minister in 1979 and I had the honour to Chair, reported in 1982 the need for legislation to combat unreasonable discrimination. We have thus already waited 10 years for this legislation, losing 10 years hoping that education and persuasion and the voluntary application of goodwill would eventually transform disabled people's lives. We now know they will not. We were right to believe that campaigns to educate and persuade are too costly and ineffective in the absence of a legislative foundation of acceptable behaviour."

Secondly, I want to quote from a letter of support from Sir John Wilson, chairman of The Impact Foundation, than whom very few people in any country can have given more distinguished service to blind people. A blind person himself, Sir John writes most hearteningly:

"Good luck for your Private Member's Bill on Anti-Discrimination next Friday. We will all be rooting for you!"

Today is not the first time this House has been asked to implement the report of the official inquiry I appointed Peter Large to chair in 1979. Nor is this the only time that disabled people whose daily experience is of unequal treatment and unjustified discrimination have looked to Parliament to set right the deep sense of injustice they feel.

The House may recall the ten-minute Bill of my right hon. Friend the Member for Stoke-on-Trent South (Mr. Ashley), and the two debates which took place on similar measures in 1983. I myself was present and spoke in those debates and well remember the bitter disappointment felt by supporters of the earlier Bills when their paths were blocked by what was seen then as Government antipathy.

Many years have elapsed since then, but, in my view, more than simply time has passed. I detect a very different climate both in this House and beyond for today's debate on my Bill. Far from time's passage weakening the case for this Bill, the argument is stronger now than ever before for extending our anti-discrimination legislation into this field. The social changes the Bill seeks are urgently necessary, widely supported and fully justified, but will not come about without a change in the law.

The recent change of climate was well exemplifed by the right hon. Member for Chelsea (Mr. Scott) on the BBC Radio 4 programme "You and Yours" on 21 January. He summarised his current attitude to giving disabled people a legal remedy against unjustified discrimination as "benevolently neutral". Not very long ago the Government's attitude was widely seen as "malevolently hostile" by the organisations that represent disabled people. Naturally I welcome the change of climate, just as I rejoice in the fact that my Bill's co-sponsors are from all parties in this House. They demonstrate that increasingly now the argument is seen not so much as a clash between right and left, but as one between right and wrong.

Twenty-one years ago, when my Chronically Sick and Disabled Persons Bill was passed, itself in part an anti-discrimination measure, the first of its kind in any country, Britain led the world in disability legislation. Today we lag behind. Other countries at first copied and have now overtaken us. Many have legislated to end unfair discrimination against disabled people, not least the United States. President Bush set the tone for the 1990s when he signed the Americans with Disabilities Act of 1990 and told the American business community:

"You have in your hands the key to the success of this Act, for you can unlock a splendid resource of untapped human potential that, when freed, will enrich us all … Let the shameful wall of exclusion finally come tumbling down."

There was not much benevolent neutrality about that statement. It was an act of political leadership that is widely admired by disabled people across the world. They look to this House today to give the same kind of leadership. Our commitment is shown to be doubly needed by a recent survey by the British Council of Organisations of Disabled People. It found that 6 per cent. of British employers were unwilling to employ any disabled person "under any circumstances" at a time when employable disabled people are six times more likely than non-disabled people to be turned down for a job.

That is not only outrageous, but a challenge to this House, which legislated nearly 50 years ago to require firms with 20 or more employees to give 3 per cent. of jobs to disabled people. We must not duck that challenge today.

Unless words have lost their meaning, when the Minister says he is "benevolently neutral" towards my Bill he must mean that, with me, he would most strongly deprecate any attempt to frustrate a Second Reading today. He especially will know that any such attempt would provoke intense exasperation and indeed fury among disabled people and their organisations.

The case for the Bill has two sides—it has a moral one, which begs the question, "What sort of society do we want to create?" And it has a pragmatic one, namely "What do we have to do to make that society?"

I shall deal with the moral arguments briefly, since no one has yet attempted seriously to contradict them. Let me recall some deservedly famous words of Martin Luther King when he dismissed the case for relying only on education and persuasion to end racial prejudice:

"Morality cannot be legislated, but behavioiur can be regulated. Judicial decrees may not change the heart, but they can restrain the heartless."

It is an affront to civilised values, in a country claiming to respect human rights, for citizens with a present or past disability to suffer prejudice, exclusion and both demeaning and unjustified treatment for no other reason than their disability. It is shameful that to the restrictions their disability imposes is added the gratuitous extra handicap that attidudinal and physical barriers create. Let no one in this House imagine that such discrimination is a thing of the past.

Who can justify, to quote one of the many examples given by Lord Snowdon, in a fine speech in another place, the shameful treatment of a young policewoman, injured, ironically, while displaying conspicuous bravery in the course of her duties, who was turned away from a charity event because, and only because, she was in a wheelchair.

What about the conduct of taxi drivers who refuse to carry blind people, as now happens every day, if they have guide dogs? Or the practice of employers who never shortlist any job applicant who discloses a disability? Research by the Spastics Society in 1986 and 1990 found that non-disabled candidates were 1–5 times more likely to be offered a job interview than a disabled candidate.

Again, what about the conduct of an employer who imposes unnecessary conditions for a job, such as possessing a driving licence, which adversely affects disabled people more than non-disabled people? Or the case of a successful candidate for a senior civilian post with a police authority who, because of her disability, but with no justification on grounds of special risk, was refused entry to its pension scheme?

If anyone still doubts that hurtful discrimination exists, they need look no further than the Government Benches for a clear endorsement of what I am describing. In this House on 28 March last year, the right hon. Member for Chelsea said that he had,

"no doubt that some employers' recruitment practices discriminate unfairly against people with disabilities."

—[Official Report, 28 March 1991; Vol. 188, c. 1148.] Later last year, the Secretary of State for Health told a Conferation of British Industry conference on employment and mental health that:

"People who suffer mental illness can find themselves discriminated against. Ancient prejudices are still to be found in the 20th century workplace."

Only last week, again in his Radio 4 interview, the right hon. Member for Chelsea said:

"There exists too much prejudice against disabled people in this country—indeed in most countries in the world—and that leads to unjustified discrimination."

I could go on, but need not do so in view of the wide cross-party agreement now about the unfairness which disabled people meet in Britain today.

There is, however, another element to the unfair discrimination which disabled people experience. It is not confined simply to where their disability is irrelevant, but extends to where it is chosen as the reason to justify different treatment. Too often people find that, because of their disability, society expects them to shoulder an unequal and unfair burden compared with someone without it. Far from having equal access to potential employment, public services, transport, housing and recreational facilities, disabled people are often doubly handicapped by total lack of access.

This is not to say that expensive and sophisticated means are always required to accommodate their needs, since frequently any necessary changes will be straightforward and insignificant in terms both of cost and inconvenience. When I talk to people whose daily lives are restricted in this way, who find their desire for self-determination and independent living needlessly denied, it is not hard to see why they regard society's refusal to remove barriers as unjustified discrimination, more especially where equal access can be accomplished at reasonable expense. Nor is it hard to imagine why people with disabilities now demand the means legally to enforce their right to access and freedom from segregation and exclusion.

As well as arguments on principle, there are pragmatic reasons why we should be legislating for change. In a democratic society, law must inevitably be one of the means for creating the sort of community we want to see and it has a major part to play here as in other policy areas.

Hon. Members have claimed before, and may do so again today, that legal recourse is not needed, that education and exhortation will suffice. Just two days ago, employers were invited by the Prime Minister, when he launched the employers agenda on disability, to change outmoded ways of treating disabled job-seekers or employees which are discriminatory, although the agenda itself apparently made no mention even of the word "discrimination".

While I would not claim that this or any other Bill can be a panacea that alone will change practices and make society more accessible, I am sure that it will do more to aid the process of education and persuasion than anything else that has happened so far. Education is often neither a cheap option nor an effective one, and attempts to persuade which are not founded in fundamental rights set by the law will, in my view, end in failure.

I need only remind the House of the single and simple issue of compulsory seat belt use. It was claimed year after year that public education would suffice. But after more than£7 million had been spent on advertising a message that drivers still declined to hear, Ministers had to concede that legislation was needed even to make drivers change behaviour that endangered their own lives. To succeed, any educational process requires a sound and rational base. This was one of the reasons for legislating on sex and race discrimination, and the point applies with the same force now to disability. Law which highlights the incidence of inequality faced by disabled people in our society, and ensures that its worst signs are removed, offers such a base.

I think that is why the Employment Select Committee, in its report on employment and disability of December 1990, called on the Government to examine the case for equal opportunities law in the field of employment. It took the view, quite rightly, that no amount of voluntary codes of good practice, or public relations exercises like the lamentable "Two Ticks" scheme, would be sufficient to make many employers recognise the need for justified change to which they were resistant.

There are practical social gains that will result from this Bill for people other than its direct beneficiaries. The greater integration of disabled people into the mainstream of our national life—as workers, consumers or taxpayers—will add to the wealth by reducing their dependence on benefits and increasing the economic contribution that they can make. This is no academic point.

As the Americans with Disabilities Bill was passing through Congress, it was the realisation of this effect which secured the support of the telecommunications industry for the major changes proposed. The companies in question saw that making their systems more accessible would produce new subscribers.

I referred earlier to the climate for this debate having changed. The 1990s opened with renewed and increasing interest from many quarters in the creation of more and better rights for the individual citizen. That was partly stimulated by what other countries had achieved in terms of citizens' rights.

Sceptics who once argued that legislation like this could not be drafted or, when introduced, would fail, now have to reckon with the fact that America is not by any means the only country to have law that deals with unjustified discrimination against disabled people. Moreover, if it is argued that America's new law will not be fully operational for many years, at least the clock has started ticking there; and the sooner we make a start here, the sooner we shall have social justice for our disabled people.

In any case, the Minister's public comments on the United States legislation, on the BBC and elsewhere, have mistakenly ignored the fact that there was already state law in 46 states, much of it going back years, not to mention the Federal Rehabilitation Act 1973 and the changes which gave a personal right to enforce this in 1978.

The European Commission is interesting itself in this issue. For example, a recent draft directive is concentrating the minds of EC Transport Ministers on the need for domestic laws to redress the discrimination experienced by disabled people and workers on public transport systems as they travel to and from work. To my mind, the tide has long since turned on those who argue that law has no part to play in achieving justice for disabled people and, as many disability organisations now say, the question that we in the United Kingdom face is not whether we shall come to realise this but whether we shall be the last country to do so.

I must now very briefly explain the effects of the more important provisions of the Bill, which applies throughout the United Kingdom. The prohibition of discrimination is achieved by defining in general terms and more specifically the circumstances in which unequal treatment experienced by disabled people will in future be unlawful. It establishes the means by which this will be judged where there is a dispute and creates a disablement commission, modelled on the existing commissions on sex and race, which is intended to contribute to the Bill's effective enforcement. By virtue of its definition on disability, the Bill confers rights also on those treated unfairly because of a past recovered disability or one which is reputed to impair them—for example, a recovered mental patient—whatever may be its actual effect. The rights created by the Bill are not extended to all persons who have a disability, but only to those who are "qualified" as defined by the Bill. This distinction is important since the Bill recognises that some decisions to treat persons differently are fair and proper. Someone with a disability may be unable, for example, to meet an essential requirement for undertaking a job or obtaining a service. The Bill's aim is to limit the occasions when unequal treatment may lawfully occur only to these situations. In relation to employment, a person will be "qualified" when able to perform the essential functions of the job, taking account of any adaptations or alterations to the employer's workplace or organisation which it would be reasonable to introduce. The same approach is taken in relation to the provision of goods and services. A disabled person is qualified under the Bill if able to meet the essential eligibility requirements for receiving them, bearing in mind reasonable changes which could be made to accommodate the effects of their disability. In addition to possible modifications to an organisation or to its physical facilities, the provision of assistance, such as by interpreters, will fall within the scope of reasonable changes which may be envisaged.

The Bill's general definition of discrimination is a familiar one in this field of law. It encompasses not only less favourable treatment of a person with a disability, but also the imposition of apparently neutral conditions or requirements which have a disproportionate and adverse effect for disabled people and which is unfair. Given that the Bill creates duties to ensure reasonable access to employment and to services, a failure or refusal to comply with a duty may be described as a third type of discrimination formulated in the Bill.

In the part dealing with employment, very detailed clauses describe the coverage of the new protections and give particular examples of what will constitute unequal treatment in the workplace. Of course the Bill recognises, as we all must, that deciding to treat a person differently is sometimes going to be justified. To help determine what changes it will be reasonable to require an employer to make so as to accommodate a person's disability, the Bill provides for five factors to be considered, relating to the cost of the adaptations and the nature, scale and financial resources of the employer's concern. This is an important feature of the Bill. Extra costs needed to ensure compliance with its provisions should not be allowed to jeopardise the financial viability of businesses affected. I am confident that the Bill as drafted cannot have this effect.

A similar approach is taken in regard to the provision of goods and services. A general duty to ensure freedom from discrimination and the right to all reasonable access is applied to the provision of public services. Twelve types of service are listed, ranging from public buildings and spaces, through housing, education and transport to the provision of trade or professional services. The new obligations will not require any change that is technically impracticable or unsafe and, again, the test of what is reasonable will be determined by what is achievable without "undue hardship" being caused to the person or body needing to change. To allow time for the planning and introduction of modifications and adaptations, the Secretary of State is given powers to grant specific exemptions from compliance for up to five years to those who will be affected by the new requirements.

As the Bill makes new rights and obligations, their effective enforcement must be provided for. It achieves this in two ways. First, it confirms the right of the individual citizen, aggrieved by discrimination, to bring a civil claim in his or her local court seeking compensation and/or a mandatory order. Secondly, the disablement commission it creates is invested with powers and duties to enable it both to conciliate, where there is a complaint of discrimination, and to take enforcement action if this is necessary.

Hon. Members may recall that one of the objections voiced in the past to legislating in this field is the complexity and difficulty of the laws that would be needed in order to do the job. The Civil Rights (Disabled Persons) Bill leaves little scope for that particular argument to resurface. I believe that all the essential rights and duties are fully and effectively described. I have to acknowledge that any draft Bill will be far from perfect. Improvements may be suggested today or at some later date, and I and my co-sponsors of all parties will be glad to receive comments on the Bill. We shall look constructively at any and all amendments that may be proposed.

The Bill is widely supported in the House and by people of all parties, and of none, throughout the country. In particular, it is supported by all the organisations that represent disabled people. For all their help in the work of preparing the Bill, I most warmly thank Peter Mitchell, Ian Bynoe, Pat Healy and others who, while they cannot be named, provided skills of parliamentary draftsmanship as good as any available to the Minister. I speak with some experience of bringing Government legislation to the House.

The Spastics Society recently published a most striking photograph of two baby girls, with the caption:

"One of them has cerebral palsy, the other will grow up with full human rights."

That is what my Bill is all about, and I commend it to the House.

1.2 pm

It is a privilege to follow the right hon. Member for Manchester, Wythenshawe (Mr. Morris), who is widely respected for his work in the area of disability. Twenty-two years ago he pioneered the present effective disability legislation, and he has always worked unceasingly in the House on behalf of the disabled. Indeed, his work is recognised not only in this country and in both Houses of Parliament, but in the English speaking world and—as he is too modest to mention—by Commonwealth Governments. He is a pioneer in his area and we salute him for his work.

My intention is to get the Bill on to the statute book, and that can be best achieved by saying as little as possible, as quickly as possible. The Bill has 13 clauses and one schedule, and the right hon. Gentleman dealt with it ably and explicity; there is no time to make any sensible comments, so we shall do that in Committee. I welcome the Bill and, in particular, I welcome the provision for a disablement commission.

I wish to draw the attention of the House to one real need, which I learned about in January this year from the borough of Oadby and Wigston, which is in my constituency. It relates to carers and the council tax. The borough is worried because, although it supports the concept of some form of exemption for carers in the community from the council tax, it feels that the contribution that carers make to the community is measurable in cash terms—that it is possible to assess the savings that are made in hospital and nursing home fees, for instance—although the carers themselves probably take on their responsibilities without regard for such implications.

It is felt that such people should receive some small recompense for their efforts. According to the latest information available to the borough, council tax discounts will be available to certain categories of occupier. Many other councils are equally concerned about this. The discount is expected to be 25 per cent., with a maximum of two persons per household, but the council intends to make representations—which I hope will be noted in the appropriate quarters—to the effect that carers should themselves attract a discount. I agree.

Let me give some examples. A man suffering from Alzheimer's disease is currently exempt from community charge; he is cared for at home by his wife. The latest information suggests that the council tax on their home will be subject to a 25 per cent. discount, as one of only two adults residing at the property was exempt from community charge. The new proposals would increase the discount to 50 per cent.—25 per cent. for each person, carer and previously exempt chargepayer.

A second example—one known to me personally—is the case of a severely physically disabled man who is not exempt from community charge. He is cared for at home by his daughter. Under the current plan, the council tax on their property will attract a 25 per cent. discount, as one of only two adults present in the household is a carer.

Oadby and Wigston council feels that the criteria for discount eligibility should not be restrictive. If they have to be at all restrictive, they should certainly not be as restrictive as those governing who receives the carer premium in benefit cases. We feel that the qualifications are ridiculously strict and unfair. In benefit cases, it is deemed that the carer should be in receipt of invalid care allowance—or would be, but for another benefit that he is already receiving. It is felt that such a criterion would be unduly restrictive for discount purposes, especially as a carer would have to be of working age to qualify for the allowance.

A suggested criterion is the fact that a person needs to spend a good deal of time looking after someone who receives attendance or mobility allowance. I hope that, having given the matter some thought, my right hon. Friend will agree that a more human interpretation of the existing regulations is necessary, for the problems affecting carers are widespread.

I congratulate the right hon. Member for Wythenshawe on introducing the Bill. I respect him for what he has struggled to achieve. Every time that he pushes the door open, he finds that further doors are closed on him. All hon. Members wish him every success.

1.9 pm

The Bill is the sixth attempt to place anti-discrimination legislation on the statute book since the report of the Committee on Restrictions Against Disabled People—CORAD—10 years ago. I hope that it will be more successful than previous ones, because disabled people are desperate and determined to have legislation. It is a long time since Harold Macmillan coined the phrase, "Now we can appreciate the wind of change", but there is now a wind of change among disabled people in Britain. They are determined to have legislation, and the sooner that is accepted and recognised by the Government the better.

My right hon. Friend the Member for Manchester, Wythenshawe (Mr. Morris) used the phase "benevolent neutrality". I hope that we shall hear no nonsense about benevolent neutrality, because it is a euphemism for sitting smiling on the fence when we want active support and participation.

I was delighted that the hon. Member for Harborough (Sir J. Farr) paid tribute to my right hon. Friend the Member for Wythenshawe. This is a splendid Bill, on which my right hon. Friend has done much work. It is finely drawn, and he made a comprehensive and eloquent speech. I have heard none better and it deserves the support of both sides of the House.

I hope that there will not be any bickering about the main thrust of the Bill. I echo my right hon. Friend's compliments to Peter Mitchell, Pat Healy and others who helped with its drafting. His fine speech deserves the warm support of both sides of the House and the active support of the Minister.

The essence of the Bill is the creation of new legislative rights rather than charity and patronage. I see no sense in insisting on disabled people pleading for rights that are taken for granted by able-bodied people. The crux of the problem of disablement is not medical but relationships with other people. That is why statutory rights are crucial; without them, disabled people, especially severely disabled people, are disadvantaged.

My right hon. Friend the Member for Wythenshawe clearly said that the Bill provides the nuts and bolts of legislation to protect disabled people. But it does far more than that: it encapsulates in legislation the ideals, aspirations and visions of disabled people throughout the ages. They have not been articulated. We must accept those visions, because they are what disabled people want in their everyday lives.

The Bill helps to provide equal opportunity for disabled people. It gives them a chance to do what they want, rather than what other people think they want. It gives them a chance to do things their way, rather than the way in which other people think they should do them. It gives them a chance to express their individuality, rather than be patronised. It gives them a chance of fulfilling their potential. That is its noble aim. It is in tune with the march of times— its time has come. When it reaches the statute book—under this Government or, more probably, under the incoming Labour Government—disabled people will have full rights of citizenship enshrined in law. They will be able to take their place in society without discrimination and with the same rights as everyone else.

1.14 pm

As always, it is a great pleasure to follow the right hon. Member for Stoke-on-Trent, South (Mr. Ashley) and to hear him support the measure. In passing, I thought that I heard an additional clause being added to the Bill—the rehabilitation of Harold Macmillan through his "winds of change" speech. Perhaps we could encourage that idea among the Opposition.

I join my hon. Friend the Member for Harborough (Sir J. Farr) in congratulating the right hon. Member for Manchester, Wythenshawe (Mr. Morris) on his good fortune in coming high enough in the ballot to be able to introduce the measure and on his wisdom in selecting it to be debated in the House and then, I hope, in detail in Committee and in another place.

It is not too long—in fact, it is a week—since we discussed another private Member's Bill. That involved traffic calming and one of its aims was to try to reduce the number of people who suffer disabilities as a result of road accidents. About that time there was a lobby in Westminster Hall of people supporting this Bill, many of whom had suffered from the uncalmed traffic of our inner-city streets. Therefore, on recent Fridays we have been considering a seamless robe of legislation. I shall not mention the National Lottery Bill, but that might even be connected.

About 18 months ago I had the good fortune to have a Friday to myself and I chose to debate the subject of people with disabilities. On that occasion the right hon. Member for Wythenshawe was kind enough to support me and to point out that it was the first time in, I think, 10 years that a Back Bencher had initiated such a debate. Many of the right hon. Gentleman's proposals in this Bill flow from the points that I and other hon. Members made during that debate. That is why I have come especially today to support his measure.

I accept that there will be difficulties with the wording of the measure and I fear that there will probably be lengthy though positive and forward-looking discussions in Committee to decide how the Bill can be worded in a practical way to help people with disabilities.

I am especially pleased that my right hon. Friend the Minister for Social Security and Disabled People is with us, as he was on the previous occasion. He, the right hon. Member for Wythenshawe and the right hon. Member for Stoke-on-Trent, South, who is the chairman of the all-party committee, have a national and international reputation for supporting people with disabilities. The debate crosses party boundaries and the Floor of the House, as happens when we welcome the measures that my right hon. Friend has been able to introduce and those which the right hon. Member for Wythenshawe has sought and is seeking to introduce.

I mention another international figure whose reputation has perhaps suffered recently, not least in some recent films. I am talking of President Kennedy and of his great inaugural speech—"Ask not what we can do for them". There is something of that sentiment in this measure. However, it is not a question of what we can do for people with disabilities but of what they can do for themselves if we remove some of the obstacles to progress and achievement. That was the theme of my debate and I believe that it is the theme of the Bill.

We represent people of all abilities and disabilities. Above all, we represent those who are less able to come here to represent themselves. Therefore, it is right that we should do what we can for them on occasions such as this.

No doubt there will be considerable debate on the wording, and discussion about how one can legislate against discrimination. It is not an easy question to answer, and I know that the right hon. Gentleman would not pretend that it is. I believe that he seeks to establish in some sort of legislative framework the concept that, all other things being equal, people who have a disability should not be obstructed and prevented from having the same opportunities as other people—whether at a place of work, in a place of entertainment, in their homes, or while using transport.

That is a difficult concept to embody in law. I have no doubt that my right hon. Friend the Minister for Social Security and Disabled People will have some thoughts on the subject. We do not seek to do anything absurd. We do not seek to legislate so that people with visual difficulties drive buses, nor to put people whose disabilities would make the handling of certain types of machinery dangerous to themselves or to others into inappropriate situations. We are simply trying to find a form of legal jargon whereby, other things being equal, people with disabilities do not face the obstacle of discrimination.

Those of us who represent inner cities probably see a great many of the obstacles that are placed in the path of people with disabilities. On one of my "Can I help you?" visits in my constituency, I vividly remember finding, quite by chance, a lady in a wheelchair living in the upper of two one-up-one-down flats. Because of her condition she was especially heavy, and because the staircase was so narrow it was difficult for anyone to help her to get downstairs, so most of her life was spent upstairs in a wheelchair, totally dependent on other people bringing in groceries, and providing any sort of company. Having discovered her by chance, I was able to help to resolve the problem, but too many such people in inner cities are in inadequate accommodation. Even if they can get to the front door, it is often not wide enough for a wheelchair, or there is a step down instead of a ramp.

Many people need a little help just to get up in the morning—perhaps because their fingers cannot cope with zips, or they cannot put on their shoes and socks. They need the support of society to enable them to get up, to go out, and to achieve.

I hope that more progress will be made in assessing the needs of people with disabilities, especially physical disabilities. So often in the past—or rather, in comparatively recent years—there have been long delays in the adaptation of someone's house, or the decision on the need for a particular type of wheelchair, while therapists are called in and assessments are passed through social services. People may have to go some distance to the place where wheelchairs are tried out. That can cost money and can make life difficult.

I know that we shall have the opportunity to discuss this another day, but there is also the question whether we can increasingly provide, as of right, powered rather than manual wheelchairs, instead of having to rely on charitable organisations and others to provide them. Progress on all those matters would help. We can begin to look at the needs, and hence the rights.

As one walks about, one becomes aware of people's right not to be obstructed in the street. There may be a problem with the legal standing of the parking space outside someone's home—all too often, such spaces are advisory and not legally binding, so that disabled people cannot park outside their homes. Obstructions may be caused by thoughtless, rather than malicious, people parking their vehicles on pavements. Visually handicapped people may trip over such obstacles—or, indeed, over pavement furniture. People may, without realising it, park across pavement ramps, so that people in wheelchairs who have been out shopping cannot get back on to the pavement in order to get back into their homes. There may be a problem of people parking on bus stops so that the buses cannot park flush to the pavements for people to get on to them.

We may need to encourage the right to more types of public transport, especially buses. In the previous debate, I referred to Omni buses—which was reported as omnibuses, which was not what I had in mind. Such buses kneel down so that wheelchairs can get on board. Such services could be improved and I hope that the Bill will help in that. I hope that the Bill will also help with the rights to a reliable service from taxicard users. There are also the rights for dial-a-ride users to have a bigger say in the service provided by that organisation.

The Bill rightly concentrates on employment and then on the provision of services. The definition of

"a qualified person with a disability"

in both parts of the Bill is good and worthy of consideration.

The right hon. Member for Wythenshawe talked about quotas. I have previously advocated the stricter enforcement of quotas. Since then, I have talked to more people who have said, "Be careful. Don't forget that an awful lot of people with a disability do not want to be labelled as such and may not come forward to claim their place in the queue for the quotas." Quotas may not be the whole answer, although I am sure that they are part of it.

Access to employment in every sense is important, whether it is the availability of the job or the availability of the entrance to the building where the job is. The Bill should help with that. The Bill will also help with promotion. There are too many places, including civil service Departments, in which if one has a particular type of disability, one cannot work above a certain floor because of, for example, fire regulations. The regulations should not be changed in terms of public safety, but the opportunities should be changed so that people who are promoted do not have to work above such a floor. It is a straightforward question of attitude rejigging.

Training is clearly important and we need to work with the training and enterprise council system to ensure that adequate training comes through. Above all, we need to educate the public and employers to have the patience to enable someone with a particular disability, such as a learning difficulty, to get into a job and then to establish him or herself there. All too often, patience runs out and then the job runs out for the individual.

The Bill also refers to education. One of the great desires of my life is that people should have the opportunity for education to continue throughout their lives, from the nursery through to adult education for the retired. I want more such education and I want to ensure that people with disabilities can also benefit from increasing opportunities. It is not merely a matter of the child's access to the school or of the special school for the special need. It is also a matter of thinking about the parents who want to come to support the child in school. Parents may have a disability and all too often they are excluded from coming to support their children.

I refer, merely in headings, for the need to provide opportunities in the arts. There is also the question of people with mental illness coming into the community. My hon. Friend the Member for Harborough rightly referred to carers. The rights of people with disabilities are connected to the provisions for the carers who help them. All that is important.

The Bill will go further to assist people with disabilities. Above all, it will help to educate the able-bodied and the able-minded to look after the interests to a greater extent of the people who need our help as desperately as those whom the Bill is intended to support.

1.28 pm

I too am very glad to support the Bill and to congratulate the right hon. Member for Manchester, Wythenshawe (Mr. Morris) on his good fortune in coming high in the ballot and on introducing such a worthwhile Bill. As the right hon. Member for Stoke-on-Trent, South (Mr. Ashley) mentioned, there have been several attempts over a number of years to get such legislation on to the statute book. My goodness, the time is ripe. I hope that the Minister will be more forthcoming and more positive than he has been on some television programmes recently in commenting on the Bill.

Of course we could nit-pick and find forms of words in the Bill that may require improvement, but the question is whether we are behind the principle. That principle is one that has already been enshrined in statute in respect of racial and sex discrimination. I have not heard the Minister or his colleagues advocating that we should do away with that legislation so presumably—despite the difficulties experienced in passing it—the right hon. Gentleman accepts that it has been worth while and that it is doing a good job. The same must surely be the case with the present Bill.

If there is such a thing as discrimination against disabled people—I do not think that the Minister would dissent from the assertion that there is—and if there is a problem, on what possible basis can we shy away from enacting legislation parallel to that passed to deal with racial and sex discrimination? None of us pretends that passing legislation is a panacea, but at least legislation lays down ground rules, sets standards and reminds people what a civilised society expects of them. That should be as true of disability as it is of the other issues.

All of us are aware of examples of discrimination against disabled people. The recent publication "Disabled People in Britain and Discrimination—A Case for Anti-Discrimination Legislation", funded and supported by the Joseph Rowntree Foundation, underlines the needs. Despite legislation to encourage integrated schools, in 1989 the number of children in special schools was only marginally down on the 1977 figure—from 1.41 per cent. to 1.35 per cent. That means that relatively little progress has been made.

The work also showed that disabled people are three times more likely to be out of work and unemployed for longer periods than non-disabled people—and that is according to figures published by the Government themselves. When disabled people do find jobs, they are usually more poorly paid. Some 63 per cent. of disabled people earn less than £200 a week, compared with 35 per cent. of non-disabled people. We have heard examples today of how the benefits system itself is working against disabled people. Moreover, although we have more than 4 million people with disabilities and motor-related impairments, only some 80,000 houses have been adapted and made accessible to disabled people.

In all those areas, there are examples of discrimination. Some may not be deliberate. Some may be accidents, arising from the fact that people simply have not thought at the right time. But some—in the world of employment —may arise from a positive prejudice out of which people have not been educated. The passage of the Bill would up the argument and make employers think twice before ruling out disabled people purely on the basis of prejudice.

Last week, a good example of the existence of day-to-day discrimination came to my attention. We had a launch meeting of the excellent work undertaken by Mencap in its study of the leisure needs of profoundly and multiply disabled people. I was fortunate enough to chair that launch, and we heard speakers such as Lord Rix whom we welcome to the other place and congratulate on his role in the work for disabled people.

Three young profoundly deaf disabled people came down from Manchester for the launch. They had intended to travel down together on the train. Unfortunately, however, British Rail could accommodate only one of the wheelchairs and had facilities for only one at a time so they had to travel on three separate trains. We hear much about the Government's proposed citizens charter. But all the citizens charters in the world, and everything that we say here, will not get that sort of thing put right. We need more than that, and that is why we need the Bill.

I urge the Minister to respond positively. I urge him to say that whatever difficulties may arise with the wording, they can be dealt with in Committee and in another place. If parts of the Bill need to be redrafted, let us consider that positively and not use it as a reason for not making progress. If a general election is called before the Bill reaches the statute book and if the Minister's Government are returned, I urge him to say that they will be predisposed to finding a way to ensure that the Bill reaches the statute book.

Pious hopes for good practice are not enough. It behoves us to pass legislation in this area of discrimination, as in other areas. This Bill is the opportunity and I urge the House not to let that opportunity pass.

1.34 pm

I congratulate the right hon. Member for Manchester, Wythenshawe (Mr. Morris) on introducing the Bill. I am here to support the Bill today because there is a Scottish Bill on the Order Paper later. I do not apologise for that; it is my principal reason for not being in Scotland on a Friday.

I was reminded by people who were visiting Parliament to lobby on behalf of the disabled that I had spent some time in a wheelchair. I had forgotten about that because one tends to forget past difficulties. I had the misfortune to hit the ground rather hard in one of Her Majesty's flying machines. I spent some months in hospital and many months in a wheelchair as a result.

Being a Member of this place is one of the few jobs in which there is no discrimination against disability. The only requirement is to become elected. I fought the election at which I was elected to this place from a wheelchair and I became aware of the problems facing people who must go around in wheelchairs. It was most vividly demonstrated at the count when one must mount the platform at the local town hall to hear the announcement. There were no facilities to allow someone in a wheelchair to mount the platform. I had go get out of my wheelchair against the advice of the RAF doctors who had been looking after me. They had made it clear that I should not do that. However, I had to get out of my wheelchair to be in place for the count. As the count was successful, I was happy to do that. That experience clearly showed me that there are problems.

Prior to becoming a Member of Parliament I was a chief executive of a stores group. We had a definite and positive policy of employing disabled people. As everyone is aware, there is legislation requiring employers to employ a percentage of disabled people.

We had a positive policy which was largely of my initiation. However, we rarely achieved the required numbers for different reasons. We were unable to offer the kind of jobs that disabled people could do. Also, many disabled people do not wish to be registered as such. We employed people whom we knew would qualify as registered disabled which would have helped our figures and statistics. However, those people did not wish to be registered as such.

As I have said, I am in favour of the Bill. I recognise that, as with all Bills, Government and draftsmen will always tell us what is wrong with them. Having introduced several private Members' Bills of my own, I understand the difficulties. However, that does not change the principle. As an enlightened humane society, we should be considering ways of removing obstacles.

I remind the House that I was still confined to a wheelchair on the day that I arrived in the House. I understand the problems that that can present. I was back in hospital for many months after the election. When I was finally released and came to this place, I had to carry around a metal support. That presented problems as well.

The Bill brings to mind the fact that most of the House is completely inaccessible to someone in a wheelchair. It is virtually impossible for me to employ a secretary, for example, who is in a wheelchair because of all the stairs in the House and the absence of wheelchair-available lifts. We should start by putting our own house in order.

My hon. Friend has saved me from making the very point to which I was leading. We should set an example, but we frequently do not, and that has been demonstrated by the way in which we employed our secretaries and various other people. One must know whether one can get a wheelchair into a lift in this building. One had to carry out considerable research to find out which lifts to use. My wife was the expert, I am pleased to say—she found out for me. There is a great need for people to be made aware of the problems.

I am a great believer in lobbying. Our democracy would fail to function if people did not lobby. However, one must be very careful when one lobbies. The other day, I was desperately trying to give television and radio performances—I think that that is the best way to describe them; others might say "appearances"—on problems relating to Scottish constitutional matters. As I was charging in and out of the building, as we all must do from time to time, I found to my horror that my way was barred by a row of wheelchairs. People were determined that I would not get in. I asked, "Don't you realise that I'm on your side and that I can be of good to you only if I am in there?" Anyone who lobbies must not assume that all Members of Parliament are necessarily hostile to their views. Also, they must recognise that Members of Parliament can express their views only if they are actually in Parliament. That was an example of mistaken lobbying, and I hope that that has been drawn to their attention.

It is always difficult to find legislative words to put into practice what is positive discrimination. There is always the possibility of discriminating against others, but that should not inhibit one from attempting to legislate. I congratulate the right hon. Member for Wythenshawe and the right hon. Member for Stoke-on-Trent, South (Mr. Ashley) on their distinguished record in the House and elsewhere in supporting the cause of the disabled.

1.42 pm

I congratulate the right hon. Member for Manchester, Wythenshawe (Mr. Morris) on choosing this subject for his Bill. It is important and long overdue. At the heart of trying to get rid of discrimination in society lies the desire of the majority of us, if not all hon. Members, to achieve equal opportunity for every member of society. I shall limit my comments to two or three minutes, because we need to come to a conclusion on the discussion.

It is shame on the Government that they have not seen fit to implement sections 1, 2 and 3 of the Disabled Persons (Services, Consultation and Representation) Act 1986, which would have given representation and opportunities for advocacy to all disabled people. It is to the shame and discredit of the Government that they have not taken a firmer line with companies and local authorities that have gone no way toward the quota of 3 per cent. employment of disabled people. It is also to the shame and discredit of the Government that, in their own training programmes —for example, employment training and youth training —in the past three years we have seen successive reductions in the number of people with disabilities enjoying participation. If they doubt that-they appear to doubt it—they should look at the answers to my questions on that subject last year.

The Bill will bring about the reversal of all that the Government have sought to do, because the Government have not implemented help for disabled people for many years. They have not given the problem the priority that they should have given it.

The Bill is not just about access to buildings, although that is important. It is about access to participation in our society. It involves equal access to pensions, health care, entertainments and the whole range of services and activities which people without disability enjoy. The Bill is not just about parking vehicles; it is about full participation.

There was reference earlier to the council tax. I regret that the Government have not done more for disabled people and their carers. Government support was lacking when they had the opportunity to press the House to help those with disabilities and their carers.

The Bill is about rights; it is not about concessions or what we do for other people. It is about how we enable all people to participate fully in our society. That aim is demonstrated in the make-up of the disablement commission referred to at the back of the Bill. It is proposed that at least three quarters of the people who serve on that commission should have a disability. Only those people with a disability understand what it is like. The right hon. Member for Wythenshawe has shown that he fully understands what society needs to help disabled people play their full part.

I have not spoken for long and I hope that other hon. Members will follow that pattern to ensure that the Bill makes progress today. It is long overdue.

1.45 pm

I shall make my intervention now, but I do not seek to bring the debate to a close as I know that other hon. Members wish to contribute. I have listened to the six right hon. and hon. Members who have spoken today.

To my hon. Friend the Member for Harborough (Sir J. Farr) I say that the Local Government Finance Bill is before the House, and representatives of the Royal Association for Disability and Rehabilitation have made representations to the Department of the Environment, which is currently considering them. We shall look forward to what emerges from that.

My hon. Friend the Member for Battersea (Mr. Bowis) will understand that the assessment of the needs of disabled people and the provisions for community care from April 1993 will depend very much on individual assessments of the needs of disabled and elderly people and the production of packages of care to meet those needs.

I listened to the right hon. Member for Stoke-on-Trent, South (Mr Ashley), the hon. Members for Caernarfon (Mr. Wigley), for Eastbourne (Mr. Bellotti) and my hon. Friend the Member for Tayside, North (Mr. Walker) and heard the strength of feeling on the subject. I congratulate the right hon. Member for Manchester, Wythenshawe (Mr. Morris) on finding a slot to enable us to discuss the Bill today. There has been all-party support for the Bill in today's discussions and sponsorship of the Bill crosses party lines. The House has a long and splendid tradition of cross-party interest in disabled people are meeting their needs. The all-party disablement group plays a notable part in keeping up pressure on whoever holds my post. I pay tribute to the right hon. Member for Stoke-on-Trent, South, my hon. Friend the Member for Exeter (Mr. Hannam) and the staff of the all-party group for the dedicated assiduity with which they pursue the promotion of the interests of disabled people in our society. It is four and a half years since I returned from Ireland to take up my present responsibilities and it has been an immense privilege to be able to spend so much of my time and effort on behalf of disabled people. I believe that we have made progress.

There is much common ground between the parties in the House. We all know that there is still too much unjustified discrimination against disabled people. We know that that is wrong and often has a cruel impact on the quality of life of disabled people. It is also remarkably stupid, because the wealth of ability and talent that disabled people have to offer—a variety of enterprise in society—is significant, and it is a waste of those talents if they suffer unjustifiable discrimination.

I hope that I carry the whole House with me when I say that we need to reduce, if we cannot totally eliminate, such unfair discrimination, that we wish to develop approaches in society to raise awareness and educate employers and others about meeting the needs of disabled people so that we can avoid the prejudice that leads to discrimination against disabled people, and that we want disabled people to achieve the independence and integration in the whole of society that they demand and enable them to assert control over their own lives.

I have been particularly impressed by the gathering pace during the time I have had my present responsibilities and the determination of disabled people to control their own lives and no longer just quietly to accept what they are told is good for them. They are anxious to say, "This is what we want. It is your duty to give it to us." Our final aim—again, I believe that I carry the whole House with me—must be to enable those who can and wish to work to do so.

The past few years have seen considerable and fundamental improvements in the situation facing disabled people. I do not deny that a great deal remains to be done. I have noticed attitudes towards disabled people changing, as well as changes in the attitude of disabled people towards their situation. Disabled people do not just want sympathy. They do not want to be patronised or to be looked-after people or people who are told what is good for them. Nor, if my postbag is anything to go by, do they believe that any solution that is worth having to their problems will be like waving a magic wand so that all those problems are solved at once.

Nor is there by any means unanimity in the disabled community, let alone among others in society, that legislation is necessarily the right way at this time to carry that work forward. That, in essence, is the point on which the House must decide today—whether to opt for the legislative route now or, at least for a while longer, continue with the other approach, without ruling out legislation if the alternative is shown to be inadequate.

As I say, I have listened to the strength of argument in the debate and will continue to listen to further contributions. I remain unrepentantly and benevolently neutral in my attitude and, if the right hon. Member for Stoke-on-Trent South calls that sitting on the fence, then in essence it probably is, for there are arguments both ways.

I am influenced, too, to some extent by the fact of the prospective life left to this Parliament. I shall come shortly to some of the deficiencies in the drafting of the Bill. I appreciate that a good long Committee stage might sort out some of those difficulties, but somehow I doubt whether we shall have an opportunity to do that, though that is not within my control.

It will have been useful to have had this considerable in-depth discussion of the issues. I appreciate that it will come as a disappointment to many, inside and outside the House, to hear that I cannot go further today. I respect people such as Peter Large, John Wilson, Lord Rix and Lord Snowdon, all good friends of mine, who have been pressing on me the case for this legislation. I have no doubt that I may also be upsetting a young four-legged lady named Quella, who I understand may also be present during the debate.

I hope that in reaching a decision, the House will be prepared to bear in mind a number of factors outside those put forward by the right hon. Member for Wythenshawe and others in the debate. I congratulate the right hon. Gentleman, Peter Mitchell and others who have worked on the Bill. I recognise that any faults it has might be suitable for amendment in Committee, but I put two points now to the right hon. Gentleman, because, if I am right in my assessment of the situation, this will not be the last time that the House discusses these matters.

First, I am surprised that the county court is envisaged as the appropriate forum for employment matters. I should have thought that such work would be more useful for an industrial tribunal to undertake, rather than a county court. Even if we involved a court, I am not sure that the county court would be the right place. The powers of the High Court to grant remedies are more powerful than those of county courts. I hope that that matter can be taken into account.

As the right hon. Gentleman knows, I took a close interest in both the race relations and sex discrimination legislation when they went through the House. It strikes me that in his Bill the requirement on an alleged discriminator to show that a requirement is reasonable is a less stringent test than that which exists in the sex and race discrimination legislation, where it must be shown to be justifiable. The right hon. Gentleman will be well aware that recent case law shows a strict interpretation of that justifiable requirement.

May I emphasise that we are open to all suggestions for improving the Bill? The essential point is that disabled people should have legal recourse if they are unfairly or unjustifiably discriminated against. It is that principle which is important.

I understand that. If we eventually decide to follow the legislative route, I am anxious not to create a bean feast for lawyers or a legal nightmare—the two are probably one and the same—but to ensure that the legislation is clear and easily understood.

It is often thought that Britain compares unfavourably with other European Community member states, countries across the Atlantic and elsewhere in its treatment of disabled people. In recent months I have visited France more than once and Germany. I am impressed by some steps taken there, but, generally, I have the impression that they are envious of many of our provisions for disabled people, not least for them to live independently. Although we can learn lessons from Scandinavian countries, Germany, France and, no doubt, the United States to improve our provision, I am certainly not convinced that we are lagging behind them in terms of general provision for disabled people.

Last November when I addressed the first meeting of Council of Europe Ministers for Disabled People and listened to the speeches in Paris, it was clear that our European partners were envious of much of our provision. Sweden, although not an EC country, is often mentioned in this regard. It is interesting that even before the change of Government, Sweden had chosen not antidiscrimination legislation, but to tackle the problems as we have been trying to do: by identifying particular problems facing disabled people and finding the resources to overcome them. For example, Sweden talks about the accessibility of transport to disabled people. The approach there is to provide special transport, not to integrate them into the provision of transport across the board.

It is acknowledged that it is early days for the Americans with Disability Act. The President made a proud declaration when he signed the Bill. I well understand that and I do not underestimate the importance of declaratory legislation in changing attitudes. Certainly I have that factor in mind in considering an approach to this Bill and, no doubt, subsequent initiatives in this area. The employment provisions of that legislation do not come into effect until July. Another reason for postponing a decision today is to see how those provisions work in the United States before coming to a clear conclusion about them. What is clear is that the federal Government of the United States are putting no federal resources towards implementing their Act. America has a much more litigious society than Britain, so perhaps the federal Government will take other action to ensure that the Act is implemented in due course.

The right hon. Gentleman said that we were behind a number of other countries in our anti-discriminatory legislation. I accept that we have not introduced legislation similar to that in several other countries, but I do not believe that we are behind in our overall provision for disabled people. We have a good record on what I would call—although not in any derogatory sense—piecemeal legislation for disabled people in our society. The most recent improvement in the building regulations has been a big step in ensuring that people with wheelchairs or sensory impairments have access to public buildings. We have also introduced legislation dealing with transport, community care, education and social security benefits, and we have greatly encouraged employers to move forward in this important area.

As the Government take action in those separate areas, they combine to raise awareness in the community about the issues of disability. There will be a particular opportunity to do that in the coming weeks when we launch the two new disability benefits—the disability living allowance and the disability working allowance. The widespread advertising campaigns in the press, on television and through the BBC select system will inevitably raise awareness of the needs of disabled people, not just among the disabled community, but in society in general. That will be a tremendous impetus to our progress in meeting the needs of the disabled.

I do not want to spend a great deal of time talking about the two new benefits, but those concerned with disability issues have welcomed a number of their features—not least the move away from medical examination to self-assessment. The widespread promotion of the new benefits and the introduction of the benefits inquiry line, and so on, have also been welcomed. The two new benefits are in addition to the steady incremental progress that has been made over the past 10 years in meeting the needs of disabled people through the benefits system.

Other initiatives, such as the national provision of a telephone exchange for the deaf, have made significant improvements for the deaf and the hard of hearing in the community. On employment, there are training and special schemes, such as sheltered employment and sheltered placements, which also make a significant contribution towards enabling disabled people to get into employment. The new disability symbol, which was adopted by the Department of Employment in 1990, and is now increasingly used by employers as a sign of their commitment to meeting the employment needs of disabled people, is another step in the right direction.

I mentioned building regulations, which currently apply to commercial and public buildings. I am delighted to note that my colleagues in the Department of Employment have announced their intention to consider the accessibility of domestic buildings. In my view—and it is a personal, not a Government, view at the moment—we should ensure that all new houses are built so that they are properly accessible to disabled people. That would be a minimal cost compared with the cost of adaptation at some later stage.

We have a long way to go with transport—buses, trains and tubes. However, anyone who considers the matter fairly and with an open mind will recognise that we are making substantial progress. Taxis in London are becoming more accessible—4,000 are wheelchair acces-sible—and another 60 local authorities are following London's lead in insisting that all new taxis are wheelchair accessible.

It is easy to understate our progress in a number of different areas People may complain that we have progressed on a piecemeal basis rather than waving a magic wand and imagining that everything would be all right when certain legislation reached the statute book—

I am surprised at the line that the Minister is taking. Why cannot such progress be an addition to, rather than a substitute for, the granting of new legislative rights for disabled people?

I tried to explain that earlier, when I mentioned the doubts that are felt. There is a lack of unanimity within the disabled community, as well as outside. I was struck by the latest initiative launched the other night by the Employers Forum on Disability, in the presence of the Prime Minister. A number of employers start out with the utmost good will, firmly committed to employing disabled people, but the forum seemed to feel —employers representing more than I million people were present—that legislating was not the best way in which to encourage their employment. I do not wish to rule out legislation, but I feel that, for the time being, it is best simply to continue to encourage, educate and increase awareness.

My right hon. Friend mentioned taxis. Many taxi drivers live in my constituency, and they consider the cost of the new taxis—over £20,000—prohibitive. A couple of days ago, a newspaper report suggested that the new taxis might no longer be required. Does my right hon. Friend share my concern about the matter?

I am responsible for disabled people rather than taxi drivers. I was delighted to learn that, in London and 60 other areas, all new taxis must be wheelchair-accessible, and that London Regional Transport is considering the introduction of "low-level entry" buses. I did not know that taxi drivers were worried, but I put the interests of disabled people first, and I am very pleased with the progress that has been made.

Further progress is in sight: attitudes are changing. The other night, the employers' forum presented a 10-point plan. I shall not go into the details, but I urge hon. Members to read the agenda carefully. It could give a substantial boost to the employment of disabled people.

Companies that sign up for the plan will commit themselves to making the employment of disabled people an integral part of all their equal opportunities policies and practices. The agenda mentions the need to target recruiting staff, and to ensure that they are aware of the potential of disabled people and can bring that knowledge to bear on the selection process. Companies must see that, once employed, disabled people are not simply forgotten, but are considered for promotion; they must ensure that those who become disabled when already working for a company are not dismissed, but are given the proper training and rehabilitation to enable them to return to work. Companies must recognise and respond to disabled people—not just as employees, but as customers, suppliers, shareholders and members of the community as a whole.

The Bill is an important step in the right direction. The House, rightly, is giving careful consideration to its principles within the limited time that is available. I hope that it will help to view the Bill in the context of some of what I have said today. There is no difference of opinion in the House about the ends that we seek: the integration of disabled people, their independence and their participation in a range of activities, including employment, the securing of proper housing, recreation and sport. Above all, we want them to have control over their own lives.

Where we differ is whether we should proceed with the Bill or give the voluntary approach a further chance to prove that it can work. It is a fine balance, but I just favour the second approach. We want to encourage education and to raise awareness. I understand that some will be disappointed about that. In the longer term, I do not rule out a return to the legislative approach if the approach that I am commending to the House does not work.

Finally, may I say with all possible passion that disabled people are not a race apart from the rest of society. They are of us and we are of them, and we owe them a duty to ensure that unfair discrimination is reduced and eventually, we hope, eliminated. Our common humanity, whether we are able or disabled, should transcend the differences between us.

I say to people who are still blinkered to the potential contribution of disabled people to our society, "Recognise and utilise that potential on behalf of your enterprises, whatever they may be."

I should prefer to achieve the ends of the Bill by such awareness, enlightenment and what I call enlightened self-interest. If that is not possible, no doubt a future Parliament will wish to return to the matter again.

2.10 pm

Labour Members believe that the voluntary approach has been tried and found wanting. We believe that the time has come for legislation. We warmly welcome the Bill and I congratulate my right hon. Friend the Member for Manchester, Wythenshawe (Mr. Morris) and the sponsors of the Bill on its introduction.

The "benevolent neutrality" of the Government amounts to the kiss of death. The Minister's speech has been the kiss of Caiaphas. It is not good enough to say that the Bill is welcome and at the same time indicate, by everything that is said and done in the Chamber, an intention to talk it out.

I shall be brief so that we can hear the speeches of my hon. Friends the Members for Paisley, South (Mr. McMaster) and for Langbaurgh (Dr. Kumar), who, in their short time in the House, have championed the cause of disabled people here and in their constituencies.

It is right to support a Bill that enables and empowers those who suffer from disabilities. We believe—I am happy to give the weight of the Opposition Front Bench to the proposition—that those who suffer from disability and who experience handicap have an enormous contribution to make to the wealth and welfare of our country. We want to see the Bill on the statute book because it will break some of the chains that inhibit them from doing so—chains which are not of their making but which all too often result from our—able-bodied people's—attitudes and lack of experience of disability or handicap.

As my right hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley) said, we have a responsibility to recognise that the winds of change are blowing through this country. It is important to ensure that we open the House to that call for change. Disabled people have found that the voluntary approach is not working. All the disabled people who came to the House to lobby us told us that enough is enough and that they want us to act now. Labour will act. We expect the Government to give the Bill a fair wind. If they do not, we shall do so when we take office after the next election.

2.13 pm

I rise briefly to congratulate the right hon. Member for Manchester, Wythenshawe (Mr. Morris) on introducing the Bill. It is a good measure to bring before the House. I believe that it should be explored in Committee, where its disadvantages can be put more forcefully by the Government.

I am president of the Winchester group for the disabled. Not long ago, we had an awareness day when we had a fleet of wheelchairs and a circuit around Winchester. Any member of the public could sit in a wheelchair half way around the circuit and then change over and push. That exercise brought vividly to people's attention the fact that major physical obstacles still exist in terms of mobility even around a city as small as Winchester.

Clearly, there is a lot to be done. Much has been done but there is still much to do. The big question is whether we should legislate. On balance I agree with my right hon. Friend the Minister for Social Security and Disabled People. There is a great danger that legislation will create a discrimination which does not exist now—people may be more unwilling to take on invalided people.

In a village in a former part of my constituency—before the boundaries were changed—a firm employed a staff comprising 50 per cent. disabled people. Of course, it was run on a voluntary basis or, at least, its top management was. It ran into the problem of being a one-product company and during the big retrenchments of 1980, it very nearly went out of business because of an over concentration upon the subject of disablement. I have to thank the Government and especially the Ministry of Defence for keeping it in business.

If we were to legislate we could create risks which would work against the employment interests of disabled and severely disabled people. I believe that the Government have got it right, but I shall vote for the Bill to reach its Committee stage so that it can be examined further.

2.15 pm

I have come prepared with much to say because I feel passionately about the issue of disability. However, I am beginning to get suspicious about what is happening. The Bill is about the dignity of disabled people—"dignity" is the most important word. If what I suspect is happening is in fact happening, it is not very dignified. I shall not waste the House's time.

That we should get the Bill to its next stage is far more important than anything that I have to say, but I tell Conservative hon. Members that if this Bill is important, this should be its day. If this is not its day, its day will come.

2.16 pm

I understand some of the comments that have been made about the need for legislation, but, like the Minister and my hon. Friend the Member for Winchester (Mr. Browne), I do not share the view that it is needed at this stage. Comments have been made about changes in legislation but also about changes in attitude.

I first came to the House in 1983 and soon afterwards I raised the question of lift operators in the House. I received a very condescending letter which said that the House had to continue to employ lift operators because it had to employ a reasonable number of disabled people. That letter displayed the attitude of people in this House—that such jobs were acceptable for disabled people. I do not and did not take that view. I almost went through the roof at that reaction.

Several hon. Members have commented on the accessibility of the House. Just over a year ago, I sponsored an HTV function for a telethon for severely handicapped people. The difficulties that we faced in getting individuals into and around the House were enormous, but we received the co-operation of all the staff. Every group—security staff, police, the Clerks, administrators and the cafeteria staff—went out of their way to provide us with assistance. However, having said that, I do not believe that we have made anywhere near as much progress as we should have in changing the attitudes within the House itself.

My hon. Friend the Member for Tayside, North (Mr. Walker) said that when he first came to the House he was in a wheelchair. I do not know whether other hon. Members—

indicated assent.

I see that a number of hon. Members are noding and saying that some previously had wheelchairs. The general facilities for wheelchairs, blind people and so on in this building are appalling. An example has been set by the hon. Member for Sheffield, Brightside (Mr. Blunkett), the right hon. Member for Stoke-on-Trent, South (Mr. Ashley) and others, including the right hon. Member for Manchester, Wythenshawe (Mr. Morris), who has shown great determination over the years, and great authority on this issue. Such people have been able to push the barriers backwards.

May I cite the sort of difficulties—

I know that the hon. Gentleman is knowledgeable on the subject. Will he ensure speedy progress for the Bill, and not talk it out?

I have already clearly given my views on the Bill, as has my right hon. Friend the Minister—[Interruption.] I intend to make my comments in terms of my own personal experiences—

Is the hon. Gentleman talking the Bill out?

I am not going to talk it out; I am going to make my views known.

Comments have also been made by my right hon. Friend the Minister and others about the general views of people outside the House, to which I should respond. Several hon. Members have said that dramatic progress has been made with regard to people's attitudes. That is true, but I still despair of the public when I see how they fill parking bays and block access to parking spaces clearly designated as reserved for the disabled.

In my constituency the parking bays reserved for the disabled, behind the shops, are regularly filled by cars without the appropriate parking sticker. Downstairs from the Chamber, in Strangers Court, how many of the cars do not have a disabled person's parking sticker? How many supermarket parking bays are filled by cars without those stickers? Those are examples of people's attitudes. My hon. Friend the Member for Battersea (Mr. Bowis) spoke of the parking problems in his constituency, whereby access for disabled people is blocked. People are thoughtless beyond belief at times.

The Bill deals primarily with employment, but covers other areas too. As a former personnel manager, I spent a long time trying to get people to accept not only the disabled, but women and people from the ethnic minorities. I am only too conscious of the changes now taking place in people's attitudes. Many hon. Members have referred to the efforts of the Prime Minister and others to change attitudes over employment. I believe that those efforts are working. The Government regulations on Department of Employment schemes and the like make it clear that there is a requirement to acknowledge that people with disabilities face problems, and that they should be catered for in the schemes.

Although the hon. Gentleman has to make his case, is he aware that the Bill is necessary for hundreds of thousands of disabled people in Britain? The Opposition want a guarantee that he will finish his speech well before half-past two, so that the Bill will have a proper passage in the last entrails of the Government. I hope that the hon. Gentleman will not talk it out. If he does, hundreds of thousands of disabled people will suffer as a result of his intransigence.

The hon. Member for Bolsover (Mr. Skinner) has just come into the Chamber, after a debate —[Interruption.] The hon. Member for Bolsover and several of his hon. Friends have just walked into the Chamber. [Interruption.] The hon. Member for Bolsover has not been present at any point in the debate.

He is a better attender than the hon. Gentleman is.

Am I to be allowed to make my comments, Mr. Deputy Speaker? The hon. Member for Bolsover was not present at the start of the debate at 12.33 pm.

I am here now.

The hon. Gentleman was not present to hear the comments of the right hon. Member for Wythenshawe. He has not been present at any earlier point in the debate. He now complains that I should take the opportunity to comment on a speech in which I have a keen interest. He has continued to talk during my comments and I do not intend to give way to him. I have made clear my view in relation to the need for legislation. On a number of occasions, in the Chamber and in Committee, I have made my position clear. If the hon. Member for Bolsover does not know now, he should read the record.

The hon. Member for Bolsover should be aware that seven years ago this month, I was diagnosed as having multiple sclerosis. I am, therefore, more conscious than most hon. Members of the problems faced by disabled people. It is on the basis of that experience that I have come to the conclusion that legislation would not be appropriate at this stage. I said that earlier and I repeat it for the benefit of the hon. Member for Bolsover, who has just walked in.

Legislation is not required at this stage and I believe that not only because of my own personal experience, but because of my experience as an employer. Reference has been made to the quota system and to the green card. The green card system has not worked over decades. Exemptions have been sought and employers have found ways round it, disregarded it and abused it. It was well-intentioned legislation. I now look for a change in attitude in society as a whole which should be achieved and should continue to be pressed for without legislation. In terms of the changes, for example, in relation to transport—

The hon. Gentleman does not accept the Bill. Will he at least sit down and give it a chance to go to Committee?

The Minister's comments in relation to the willingness of hon. Members of all parties to continue to press for changes in terms of improved employment, access in transport and benefit provision show the appropriate avenue to pursue. There are substantial deficiencies and difficulties associated with the Bill. It is important that we debate these issues on the Floor of the House, but, as my right hon. Friend has said, there are difficulties associated with the timing. We should recognise the position in relation to the election. My right hon. Friend's comments are right. We can consider the position and change it in terms of process and pressure. There is no need at this stage to introduce legislation.

The right hon. Member for Wythenshawe said that substantial limits and difficulties were faced in defining disability.

Tory discrimination.

That is not—

I beg to move, That the Question be now put.

I must inform the hon. Gentleman that I cannot accept his request. Mr. Hayward.

rose—

Sit down.

During my speech, I have accepted interventions, both sedentary and from hon. Members on their feet—in particular, from the right hon. Members for Wythenshawe and for Stoke-on-Trent, South and from the hon. Member for Bolsover. [HON. MEMBERS: "Shame; sit down."] I have tried to make a series of comments—[HON. MEMBERS: "Sit down."] I have tried—

It being half-past Two o'clock, the debate stood adjourned.

Debate to be resumed on Friday 21 February.

On a point of order, Mr. Deputy Speaker. May I seek your guidance? Does it not detract from the reputation of the House, and is it not demeaning of this House, for us to be refused the opportunity even to make a decision in principle about this important matter, when all hon. Members present, but one, have made it quite clear that they are prepared to allow the Bill to proceed to Committee? Is it not utterly disgraceful?

On a point of order, Mr. Deputy Speaker.

Order. Let me deal with one point at a time. The right hon. Member for Manchester, Wythenshawe (Mr. Morris) has made comments, which he is perfectly entitled to do, but he has not raised a point of order for the occupant of the Chair. It is the job of the occupant of the Chair at 2.30 pm on a Friday—and on other occasions—if the debate is still proceeding, to ask what day it is to be resumed. That is the normal procedure and it is the procedure that has been followed today.

Further to the point of order, Mr. Deputy Speaker. Given that the right hon. Member for Manchester, Wythenshawe (Mr. Morris) won a place in the ballot and was privileged to have his Bill discussed in the House, does not it seem ridiculous that the Bill can be talked out and prevented from entering Committee? Surely, any such action should be taken in Committee or on Report, and the Bill should be allowed a further airing.

On a point of order, Mr. Deputy Speaker. You heard the hon. Member for Kingswood (Mr. Hayward) say in response to my hon. Friend the Member for Langbaurgh (Dr. Kumar), that he would not talk the Bill out. That was a solemn undertaking given to this House of Commons on this day. You have seen the hon. Member for Kingswood break his word, act dishonourably and destroy the Bill. Does not that require some statement from the Chair?

I remind the House that we are following the normal procedures of the House, and that it is my duty, as the occupant of the Chair, to ensure that they are carried out.

Further to the point of order, Mr. Deputy Speaker. The Minister has misled the House. He said clearly that his attitude to the Bill was one of benevolent neutrality, yet the Government have organised the torpedoing of a Bill that is vital to disabled people. That is shocking and disgraceful, and the Minister should apologise to the House.

Further to the point of order, Mr. Deputy Speaker. It was quite clear—unless there was a conspiracy by the Conservative Whips—that only one hon. Member sought to delay the passage of the Bill, and that hon. Gentleman said he did not want to talk the Bill out. In those circumstances, did you not have discretion to put the Question? If you did not, and if those on the Government Front Bench knew that, is not it patently clear that, throughout the morning, there has been organised filibustering to enable the Bill to be talked out and the Conservative party to go into the election as the party which wants to perpetuate discrimination against disabled people? The people of these islands understand that.

Order. I remind the House that we cannot continue the debate now. However, I will take points of order so long as they are genuine points of order.

On a point of order, Mr. Deputy Speaker. Some quite unjustified slurs have been made about my hon. Friend the Member for Kingswood (Mr. Hayward). My hon. Friend said that he intended not to talk the Bill out, but to make his points. He was prevented from doing that by constant barracking and interruptions from Opposition Members. The longest speech in the debate was made by the right hon. Member for Manchester, Wythenshawe (Mr. Morris). His speech was longer than that of my right hon. Friend the Minister for Social Security and Disabled People. It was also longer than the speech made by my hon. Friend the Member for Chislehurst (Mr. Sims) when he moved his Medicinal Products: Prescription by Nurses etc. Bill. Any suggestion that the Civil Rights (Disabled Persons) Bill has been talked out by Conservative Members is political posturing and nonsense.

Further to that point of order, Mr. Deputy Speaker. You will recall that the Opposition spokesman, my hon. Friend the Member for Brent, South (Mr. Boateng) spoke for a couple of minutes. The Minister spoke for about 25 minutes. Other Opposition Members spoke for only a minute or so to allow the Bill to make progress. The Liberal Democrat representative stood up, supported the Bill, and sat down. It should have crossed your mind, Mr. Deputy Speaker, when the request for a closure was made, that you knew that the view of the House in general was that the Bill should be given its Second Reading. It is clear that Tory Members have talked the Bill out. It has been said over the years that the Tory party is the party of organised hypocrisy and it has proved that again today by attacking disabled people around Britain. However, the electorate will have the final say.

Further to that point of order. Mr. Deputy Speaker. How can Conservative Members be protected from such unwarranted charges? I promised people in wheelchairs that I would speak in the debate today and that I would support the Bill. I did just that and I find it offensive when people who did not attend the debate make such charges.

Further to that point of order, Mr. Deputy Speaker. I shortened my speech although I had much to say. I cut my speech to a minute or less to ensure the swift passage of the Bill.

In the earlier debate on the Medicinal Products: Prescription by Nurses etc. Bill I intervened in the speech of the hon. Member for Wanstead and Woodford (Mr. Arbuthnot) and asked whether he would be brief so that we could reach the Civil Rights (Disabled Persons) Bill and I received that assurance. What has happened is a disgrace to the House and to the 6.5 million disabled people, their carers and families. I can tell everyone who participated in that disgraceful behaviour that I would rather live with a disability than with their consciences.

Further to that point of order, Mr. Deputy Speaker. The hon. Member for Kingswood (Mr. Hayward) said that he would not talk the Bill out. It has been said that some Opposition Members were not present for the whole debate. I have sat through the whole debate. I listened to the hon. Member for Kingswood and I sacrificed my speech so that the Bill could make progress. No one can deny that I sat through the whole debate. I am shocked. Six and half million people have watched the conduct of this Tory Government. The Government's days are numbered.

Further to that point of order, Mr. Deputy Speaker. Will you consult the Procedure Committee because I and, I am sure, other hon. Members came to the House especially to vote for the Bill which I believe should go into Committee? There should be a 10-minute limit on speeches in private Member's time.

Further to that point of order, Mr. Deputy Speaker. I think that you have been placed in an invidious position this afternoon. It is not just the past two hours which have been a problem. The fact is that the previous debate was timetabled by Tory Whips to finish precisely at 12.35 pm, leaving you with only one hour and 55 minutes for the next debate. Would you do what I have just done and look at the list of speakers for the two debates? You will find that in the first debate of four hours, there were 14 speakers. In the second debate on disabled people's civil rights, in one hour and 55 minutes there were 12 speakers.

Surely, Mr. Deputy Speaker, the traditions of debate mean that you have to decide whether to accept a closure motion if there has been sufficient debate. Traditionally, that has been a minimum of two hours. However, the second debate had almost the same number of speakers as the first debate. You would be well within your rights in the Chair to reconsider your decision, and, on the basis of the second debate having had an adequate number of speakers on both sides, now to accept the motion put by my right hon. Friend the Member for Manchester, Wythenshawe (Mr. Morris) and, on behalf of my constituents and 6 million disabled people at least allow this worthy Bill to be considered in Committee.

I have allowed a good run on points of order because I realise that there are strong feelings on this matter on both sides of the House. However, I can only repeat that it is the job of the Chair to carry out the Standing Orders and the procedures of the House as they are at present. That has been done. If hon. Members feel that the procedure should be changed, of course they are perfectly free to put their points to the Select Committee on Procedure, which would be prepared to consider them.

rose—

Order. We must make progress.

Private Members' Bills

Sexual Offences (Amendment) Bill

Order for Second Reading read.

Object.

Second Reading what day?

No day named.

Sea Fisheries (Wildlife Conservation) Bill

Order for Second Reading read.

Object.

Second Reading deferred till Friday 7 February.

Protection Of Pension Funds And Investments Bill

Order for Second Reading read.

Not moved.

Representation Of The People (Amendment) Bill

Order for Second Reading read.

Not moved.

National Health Service (Supply Of Medical Equipment) Bill

Order for Second Reading read.

Object.

Second Reading what day?

With the permission of the hon. Member in charge of the Bill, Friday 7 February.

Corporate Safety And Environmental Information Bill

Order for Second Reading read.

Object.

Second Reading what day?

With the permission of the hon. Member in charge of the Bill, Friday 7 February.

Education (School Premises) Bill

Order for Second Reading read.

Object.

Second Reading what day?

With the permission of the hon. Member in charge of the Bill, Friday 7 February.

Armed Forces (Liability For Injury) Bill

Order for Second Reading read.

Object.

Licensing (Amendment) (Scotland) Bill

Not amended (in the Standing Committee), considered. Read the Third time, and passed.

Tourism (Overseas Promotion) (Wales) Bill

Not amended (in the Standing Committee) considered. Read the Third time, and passed.

Social Security (Mortgage Interest Payments) Bill

Motion made,

That, in respect of the Social Security (Mortgage Interest Payments) Bill, notices of Amendments, new Clauses and new Schedules to be moved in Committee may be accepted by the Clerks at the Table before the Bill has been read a second time. — [Mr. David Davis.]

Object.

Social Security (Mortgage Interest Payments) Bill

Motion made,

That, if the Social Security (Mortgage Interest Payments) Bill be committed to a Committee of the whole House, further proceedings on the Bill shall stand postponed and that as soon as any proceedings on any Resolution come to by the House on Social Security (Mortgage Interest Payments) Bill [Money] have been concluded, this House will immediately resolve itself into a Committee on the Bill. — [Mr. David Davis.]

Object.

Business Of The House

Motion made,

That, at the sitting on Tuesday 4th February, notwithstanding the provisions of Standing Order No. 14 (Exempted business), Mr. Speaker shall put the Questions necessary to dispose of proceedings on the Motions in the name of Mr. Secretary Heseltine relating to Local Government Finance not later than Ten o'clock; and those Questions may be decided after the expiry of the time for opposed business.— [Mr. David Davis.]

Object.

Business Of The House

Motion made,

That, at the sitting on Tuesday 4th February, the Motions in the name of Mr. Francis Maude relating to Supplementary Estimates 1991–92 and Estimates 1992–93 (Vote on Account) may be proceeded with, though opposed, until half-past Eleven o'clock or for one and a half hours after the first of them has been entered upon, whichever is the later, at which time Mr. Speaker shall put the Questions necessary to dispose of them.— [Mr. David Davis.]

Object.

Business Of The House

Motion made,

That, at the sitting on Wednesday 5th February, notwithstanding the provisions of Standing Order No. 14 (Exempted business), the Motions in the name of Mr. Secretary Hunt relating to Local Government Finance (Wales) may be proceeded with, though opposed, until half-past Eleven o'clock or the end of a period of one and a half hours after the first of them has been entered upon, whichever is the later, at which time Mr. Speaker shall put the Questions necessary to dispose of them; and those Questions may be decided after the expiry of the time for opposed business. — [Mr. David Davis.]

Object.

Mod Personnel (Injury Compensation)

Motion made, and Question proposed, That this House do now adjourn. — [Mr. David Davis.]

2.43 pm

May I thank you, Mr. Deputy Speaker, for selecting this debate?

Ours is a warrior nation and, because of that, the men and women of our armed forces hold a very special place in our hearts—at least in times of war. Sadly, however, in times of peace we are sometimes apt, as in Kipling's famous poem, "Tommy", to take them for granted. Because we truly are a warrior nation, right hon. and hon. Members—probably all of us—yearly on the vigil of Remembrance Sunday, echo those time-honoured words, "We will remember them." It is true that we will remember them. But what about those who are not killed—at least not quite? I refer to those who suffer horrific wounds, but who are saved from death by the miracle of modern science, good luck and their own outstanding mental fortitude. Many of them live on, but they are severely disabled. Do we truly remember them? I think that the honest answer is yes officially, but do we remember them well enough? I believe that we do not.

Regardless of political party, the people of our country feel that the Government should take more, much more, care of injured service personnel. In relation to the armed forces the Government should, above all, be seen as the very model of a good employer. I believe that the armed services are good employers. The Royal Navy, since the time of Nelson, has been ahead of most navies in the world, if not all. The same applies to the Army since the time of Wellington.

However, when an injured service man falls into political hands, I do not believe that we look so good. Too often, there are long and undue delays in receiving compensation and a woeful lack of information is given to the injured and their families. There is an apparent unwillingness to honour moral and financial obligations. On 8 December 1986, the Secretary of State for Defence said:

"members of the Armed Forces, by their very nature of their profession, undertake tasks which ordinary members of the public do not." —[Official Report, 8 December 1986; Vol. 107, c. 85.]

I believe that that is a correct and telling statement which should be writ large on the walls of the offices of my right hon. Friends the Minister of State for the Armed Forces and the Chancellor of the Exchequer.

On 8 December 1986, the Secretary of State went on to invite the repeal of section 10 of the Crown Proceedings Act 1947. His lead was followed by my hon. Friend the Member for Davyhulme (Mr. Churchill), who introduced the Crown Proceedings (Armed Forces) Act 1987. It was an excellent Bill and I supported it. It allowed armed services personnel, for the first time, to be able to sue the Crown for negligence. However, with the passage of time, certain glaring loopholes have appeared in the Act. I mean no criticism, because the loopholes were not foreseen at the time. The Act was well intentioned and the loopholes have since appeared.

First, the Ministry of Defence was allowed to withhold documents on the ground of secrecy. I believe that that privilege has been abused on a number of occasions. Secondly, it abolished the flexibility previously given to the Secretary of State to make ex-gratia payments. I believe that that flexibility is a vital element of the humane treatment of those injured personnel of the armed forces, especially as, rightly, the Act could not be used retrospectively. I also believe that the Act has left the onus of proof to fall always on the injured service person. That is a heavy onus which could be lifted in some obvious severe cases. If one imagines having both legs blown off and one's body lacerated and, in order to obtain full compensation, being forced to take on the might of the Ministry of Defence in a law suit it soon becomes obvious that such loopholes should be plugged.

In Committee, the then Under-Secretary, for whom I have the highest personal respect, set out the three Government principles for settling cases. He stated that the Government wished to settle out of court in the interests of the plaintiff. He continued:

"we are not seeking to set up legal barriers by employing a raft of lawyers to deter genuine plaintiffs …we shall proceed diligently and quickly to reach settlements. We shall not seek to protract cases." —[Official Report, Standing Committee C, 18 March 1987; c. 22.]

He also mentioned the most interesting fact that the civil service estimate of the financial cost of the Act was £13 million a year after 10 years. It is now five years since the Act came into force and the total cost of claims is only £1 million a year. Yet the still deformed bodies of some of our injured service men are living examples of the injustice of under-compensation. The figures speak for themselves and confirm that there is under-compensation. I come to the case of the three injured Grenadiers, Lance-Corporal John Ray and Guardsmen Adrian Hicks and Shaun Povey of the Grenadier Guards. I do so not to rehash the case—because I believe that there has been a just settlement—but because it is so well-known. Sadly, however, in its settlement, it is still a rare exception. It is also illustrative of the problems.

In the summer of 1989, those three Grenadiers were ordered to prepare a trench on the Batus firing range in Canada. While digging, one of them struck a buried unexploded anti-tank shell fired some years before but then concealed in the ground. The shell exploded, blowing both legs off each of the three Grenadiers. The explosion injured their bodies so badly that despite prompt and efficient casualty evacuation action, it took the best of medical science about two years to nurse them back to sufficient health even to be invalided out of the armed forces.

A board of inquiry was convened. While it concluded that none of the Grenadiers was to blame, it was not even required to investigate either why the blind shell was in an area used for trench digging or whether all safety precautions and briefings had been carried out effectively. Despite that, the House was assured, incredibly, that no blame was attributable. Perhaps that was legal advice, and I do not blame the Minister personally. That is illustrative of the problems that such injured people face —the need to get the facts through and have them heard openly, rather than everything happening behind closed doors.

About 18 months later, when the first Grenadier, Adrian Hicks, was invalided from the Army, the Government appeared to dig in their heels at the very thought of paying compensation, or at any rate compensation anything near the levels paid in civilian life. When Hicks was discharged on 30 December 1990, he was not paid anything other than his unemployment and sickness benefit from the DSS until 15 May 1991, and then only after a ballyhoo had been created by that fine gentleman who fights many such cases, Colonel Terence Otway.

Here were three men cut down in the prime of their youth by devastating injuries. They were mentally drained after a two-year ordeal in hospital and of course extremely depressed, at their immobility. They had no personal real wealth. Yet the mighty Ministry of Defence challenged those mutilated men to prove negligence. Worse still, the same Ministry withheld the full findings of the board of inquiry, even though those findings were vital to the proving of their case. It provided only an abridged version which left out the crucial and damning details.

Where was the spirit of the Government assurances that had been given to the Standing Committee on 18 March 1987? It was ignored and the Government fought those injured men to the very last trench. Fortunately, those Grenadiers were lucky. They were members of a strong and family-like regiment which not only gave them invalid motor cars but provided funds for their lawyers. As hon. Members are aware, pressure was brought in the House, by the media, and in the end the Prime Minister intervened and a just settlement was achieved.

Those Grenadiers were lucky, but a parliamentary answer given in another place on 14 October 1991, showed that many others had not been so lucky. Indeed, on that date there were still unsettled over 1,000 claims, 56 of them stretching back to 1987, five years previously.

I appreciate that there can be legitimate causes for delay. For example, there is need to prove negligence and there must be time for gravely injured men or women to have their physical conditions stabilised so that an assessment can be made of the degree of disability. But why are there so many, and such long, delays? Let us not overlook the trauma and anguish that is caused by such delay.

To help alleviate the situation and reduce the delays, I introduced the Armed Forces (Liability for Injury) Bill, which would have reversed the onus of proof for negligence for compensation for armed service personnel who received severe injuries in the course of their duties—

Order. I remind the hon. Gentleman that it is not in order on the Adjournment to discuss legislation. I am sure that he can use his ingenuity to make his points without referring to legislation.

I respect that remark, Mr. Deputy Speaker. My right hon. Friend the Minister knows the contents and purposes of the Bill. All I ask is, why does his Ministry continue to try to kill the Bill? Only five minutes ago, an effort was made to stop its progress through the House. It is iniquitous that this sort of Bill is not at least allowed to reach its Committee stage. Why is it not allowed a passage? Why is not the Ministry of Defence pushing the Bill forward to ensure fair treatment for the injured?

Order. Perhaps I can help the hon. Gentleman. He may refer to changes that he would like to see. So long as he avoids referring to a Bill he will remain in order.

Thank you, Mr. Deputy Speaker. I respect your ruling on that.

I turn now to the provision of information by the Ministry of Defence. The first example is the case of the injured Grenadiers. Why was it not possible to produce the full board of inquiry report into an accident in Canada several years previously? The reason was because the report was restricted. Who made it restricted? The major in charge of the board of inquiry. It is easy for any Minister or senior officer to have that restricted qualification lifted. Why was it not lifted? Why was only a precis given to the guardsmen and their solicitors when the full inquiry showed—I have seen it illicitly—a story with interesting information that would have been important to them in proving their case, but was not given in the precis?

The second case relates to Mark Booth, a parachutist in the Fifth Airborne division. He was gravely injured in a mysterious convoy accident. There have been endless delays and the Ministry has provided the minimum of information. Why? How can it be seen as a good employer? I simply do not understand.

Then we have the case of Conrad Cole, Richard Gillespie and Lee Thompson of the Royal Fusiliers and others who were injured in friendly fire accidents in the Gulf. I fully understand that there are problems finding out exactly what happened. Other nations may be involved, there may be diplomatic problems and so on. But why do we refuse to give information and cause anguish and trauma to the injured men and their parents? Surely some of that information could be given up front rather than always having to be fought for, creating such a bad impression.

I have tabled many questions, particularly on the Grenadier case. Some answers came back. I do not know whether they can be called answers—perhaps I should say, replies. They were not only unhelpful, but almost downright rude. I asked for a list of the claims outstanding under the 1987 Act showing the names, the disability claimed and the date of accident. I did not think that that could be too hard for the Ministry. The answer was:

"No. To do so would be a breach of medical confidentiality." —[Official Report, 21 January 1992; Vol. 202, c. 190.]

Could the Ministry not ask the men concerned whether they minded their names being put on such a list? I doctored the question and tabled a further request, this time just for the names and date of accident. I was told:

"To list the information requested would breach confidentiality and be in contravention of the Data Protection Act." —[Official Report, 27 January 1992; Vol. 202, c. 453.]

If that is true, the Data Protection Act 1988 needs amending urgently.

Other questions relate to the board of inquiry report. I asked whether in convening the board of inquiry report into the Grenadiers at Batus range any requirement was made for it to investigate why the blind round remained in an area used for digging outside the impact area of the live firing ranges. The answer was:

"The convening order directed the board of inquiry to consider all the circumstances that contributed to the accident. —[Official Report, 25 June 1991; Vol. 193, c. 465.]

I have seen that board and my view is that it was not asked and certainly did not make any real investigation into why that round was there in the first place. That was bad.

In the interests of time, I shall skip other examples. Why is the Minister of Defence so intent on secrecy in this area? I do not blame my right hon. Friend personally for that. I can understand that if there was an accident on board a nuclear submarine, there would be a real security risk—but not on a live firing range in Canada, an assault course in some Aldershot depot, or a convoy in Cyprus, or wherever. Why does such a great load of secrecy have to swamp every request for information by the injured men, their legal representatives and their families?

Why cannot the Ministry of Defence understand that by not being open, it increases the anguish for the injured men, their parents and their mates? Over time, that anguish turns into trauma. It also lessens the men's chances of bringing a successful suit against the MOD. That, by itself, must be grossly unfair. It makes the MOD appear so very callous and uncaring, and not at all the good employer that we want it to be. That is to the detriment of the Government in general and to morale in the armed forces in particular.

I have spoken about the flexibility that was eroded in the 1987 Act. It did away with the Secretary of State's ability to make ex-gratia payments to those deserving cases that occurred before the Act came into force. I agree that Acts should not be retrospective; I have always voted against retrospective legislation. However, I wish to cite two cases. Martin Ketterick, a Royal Marine, was on an exercise when a rope on which he was hanging while climbing a cliff face was cut by mistake. I accept that it was a genuine accident. The non-commissioned officer responsible was disciplined, so there must be some element of negligence by the MOD as the employer. Why has not that man been given compensation? He is almost a walking vegetable, yet he lies there without compensation simply because his accident occurred before the 1987 Act came into force. Why are not the Government generous enough to make an ex-gratia payment? Why could not such a system, by amending legislation, be built into the Act?

The second case is that of Andy Konalyk, a parachutist who was training on an assault course. It was pouring with rain and he had mud all over his boots. He was 30 ft in the air, he jumped across a 6 ft gap and one of his feet missed the girder on the other side. He slipped and smashed 30 ft to the ground. Six other people were injured on the very same day on the same assault course, so there must be an element of negligence. That man is severely disabled, so why is he not compensated as he would be in civilian life?

There is a clear, moral obligation to give compensation. Where is the heart in the Ministry of Defence—the same heart that it asks for and inspires in its employees, the members of the armed forces? Why are the Government so laggardly in calling for an urgent amendment to the 1987 Act to make good the gaps?

There is a need for the flexibility to award ex-gratia payments to be given back to the Secretary of State. There should be an obligation on the MOD to provide all relevant documents, especially the board of inquiry report, to the people bringing suit or their legal representatives.

If secrecy is involved, could not the MOD think of some way in which the information could be provided just to the lawyers under the Official Secrets Act? Why is no one pressing for that? While the provision of information is denied, there is an obvious and grotesque injustice.

I have highlighted delay, the lack of information and the lack of flexibility in the giving of ex-gratia payments. I want now to talk about resettlement—the vital transition of a badly injured member of the armed forces from their care.

Order. I am sorry to interrupt the hon. Gentleman, but time is moving on. I am sure that he wishes to be fair to the Minister and give him an opportunity to reply.

I do, Mr. Deputy Speaker.

At this vital time of transition, the badly injured person moves from the care of the armed forces into local authority care. Such people are often severely injured and they should be prepared early for that transition, not in the last two weeks before they are finally invalided out of the armed forces. My right hon. Friend the Minister was an officer in the Coldstream Guards. He knows that officers in the Foot Guards must visit people in hospital every week. That is not universal practice, however. Surely it should be insisted on that men are visited in hospital, even if they are in a civilian hospital. Sometimes the Ministry does not know where a man is, because he is still in a civilian hospital.

Will the Minister also consider the possibility of ensuring that the Ministry liaises with the local authority concerned, the local office of the Department of Social Security, the Soldiers, Sailors and Airmens Families Association and the Royal British Legion, especially the latter. Peter Godley is outstanding when it comes to helping people with claims, but surely the MOD should be obliged to ensure that such liaison takes place.

The MOD suggested today that men take out insurance. The package is advantageous, although I do not think that it has many advantages over normal holiday packages.

On the whole, insurance is sold rather than bought. I am amazed that the MOD should imagine that 18-year-olds—physically fit and full of idealism—will start thinking at a depot, "I am going to insure myself against accidents." It is unreasonable to expect that.

I believe that it should be a condition of employment for every member of the armed forces to take out insurance. The payments should be deducted from their pay. If the MOD considers that too severe, it could—like an ordinary employer—subscribe to the cost. The insurance should be organised on a bulk basis; if it were arranged for the armed forces as a whole, the rate would probably be considerably reduced.

If the Government do not want that, why do they not insure themselves? They would then be more able to give generously in the event of accidents.

The United States has a veterans' department, which does an excellent job. I sometimes feel ashamed when I see how American veterans are treated—especially the injured —compared to the way in which ours are treated. Will the Minister consider introducing a similar organisation here?

I have left my right hon. Friend very little time, and I do not expect him to give detailed answers now, but I hope that he will be prepared to put his replies in the Library. Will he consider amending the 1987 Act to allow ex-gratia payments and to require the MOD to produce relevant documents?

Will he also agree to lay down enhanced regulations for resettlement on this vital matter of transition, requiring in particular liaison between the MOD and the organisations that I have mentioned? Will he require the MOD to publish status reports, on a three-monthly basis on cases that have not been settled?

Finally, will he examine in depth the whole question of compulsory insurance and the establishment of a veterans' department?

I thank my right hon. Friend for coming here today, and I apologise for leaving him so little time to answer.

3.3 pm

My hon. Friend the Member for Winchester (Mr. Browne) has raised an important subject concerning the position of Ministry of Defence personnel—both service and civilian—who are killed or injured in the course of their duties. I am grateful for being given the opportunity to explain the position on some of the issues arising out of this matter. It is, however, a complex subject and, as it concerns the whole question of legal liability and the relationship between employers and employees as it is dealt with under the law, I am sure that the House will readily understand some of the background to the subject. However, it may be helpful if I give a short account of the way in which the present legal position on injured personnel has developed.

My hon. Friend mentioned the Crown Proceedings Act 1947, which enabled servants of the Crown to take proceedings against the Crown in the same way that any other employee could proceed against his employer. However, section 10 of the Act prevented the Crown or a member of the armed forces from being sued for damages for injury or death of an on-duty service man due to some negligent act or omission by the service. The House will recall that the law was changed in a Bill presented by my hon. Friend the Member for Davyhulme (Mr. Churchill) and section 10 was repealed in 1987. While this removed the prohibition on members of the armed forces suing other members, or the Crown, it did not alter the law of evidence or the substantive law of tortious liability.

The Ministry therefore has a legal liability to pay compensation to service personnel where negligence can be established by the Ministry or someone acting on its behalf. The effect of the repeal of section 10 was to put service personnel in the same position as the Ministry's civilian employees—or, indeed, any other civilian worker—as regards the right to seek compensation for injuries received in the course of their work.

There has been much debate and a number of proposals have been made on proposals to change the basis of legal liability. They seek to remove some of the perceived disadvantages, particularly for service personnel, in claiming compensation from a Department of State such as the Ministry of Defence. One proposal was to extend the legal rights and remedies of service men to place them in a far more favourable position than Ministry of Defence civilians or any other group of civilian employees, by imposing an absolute liability on the Ministry in removing the requirement for service personnel to prove negligence when taking civil actions for damages against the Crown.

Although no one is more aware than I am of the worth and value to this country of our service personnel, and the risks to which they are exposed, the proposal to change the law in this way cannot be right. It is a fundamental principle of our system of civil law that for one person to seek compensation from another, that person must show that a wrong, causing him damage, has been done to him by the other party. In the sphere of employer's liability, it is not a principle of the law that an employee may claim compensation from his employer whenever he suffers an injury at work, regardless of whether the injury was attributable to an act of negligence and however much he has contributed to his own misfortune. That applies whether claims are settled in or out of court directly between the parties involved. The proposal would he contrary to current legal principles on personal injury and employer's liability under the law of tort and it would have ramifications far beyond the narrow scope of the proposal itself.

That does not mean that Ministry of Defence personnel, service or civilian, are left without any financial benefits if they are injured in the course of their duties. Indeed, the arrangements under service and civilian pension schemes compare very well with best employer practice. Any service man who is obliged to leave the service because of an attributable injury is eligible for pension and disability awards from the Ministry of Defence and the Department of Social Security, which administers the war pension scheme. Those awards are either lump-sum payments or pension payments with an additional lump sum. They are tax free, index linked to cover inflation, related to the degree of disability and reassessed if there is a deterioration in the individual's condition.

Those awards are made automatically, on a no-fault basis, if a service man is invalided as a result of his injuries. He is not required to prove negligence or make any legal claim for damages, with all the risks attendant on that process. Similarly, in the event that a married service man dies as a result of injuries attributable to service, enhanced benefits are paid under the Ministry's pension scheme to his widow and any eligible children. They are also able to benefit under the Department of Social Security war pension scheme. Civilian employees of the Ministry of Defence are eligible for benefits under the civil service pension scheme where injury or illness results in premature retirement, and may receive an enhanced pension for loss of earnings capacity where this is attributable to their employment.

The motion having been made after half-past Two o'clock, and the debate having continued for half an hour, MR. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at thirteen minutes past Three o'clock.

Volume 202: debated on Friday 31 January 1992

House Of Commons

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