TABLE

Sitting	Proceedings	Time for conclusion of proceedings
1st	Clause 1 and Clauses 17 and 18	5 p.m.
2nd	Clause 16 and Clauses 2 to 6	—
3rd	Clause 16 and Clauses 2 to 6 (so far as not previously concluded)	10 p.m.
4th	Clauses 19 to 28	—
5th	Clauses 19 to 28 (so far as not previously concluded)	5 p.m.
6th	Clauses 14 and 15, Clauses 7 and 8, Schedule 1, Clauses 9 to 13	—
7th	Clauses 24 and 15, Clauses 7 and 8, Schedule 1, Clauses 9 to 13 (so far as not previously concluded)	10 p.m.
8th	Clauses 29 and 30, Schedule 2, Clauses 31 to 40, Schedule 3, Clause 41, Clause 69, Clauses 42 to 44	—
9th	Clauses 29 and 30, Schedule 2, Clauses 31 to 40, Schedule 3, Clause 41, Clause 60, Clauses 42 to 44 (so far as not previously concluded)	5 p.m.
10th	Clauses 45 to 58	—
11th	Clauses 45 to 58 (so far as not previously concluded)	10 p.m.
12th	Clause 59, Clauses 61 to 66, Schedules 4 and 5, new Clauses and new Schedules	—
13th	Clause 59, Clauses 61 to 66, Schedules 4 and 5, new Clauses and new Schedules (so far as not previously concluded)	5 p.m.

Health and Social Care Bill
2:30 pm

Mr John Maxton (Glasgow Cathcart, Labour)

I remind the Committee that under Sessional Orders, debate on this resolution may last for a maximum of 30 minutes.

Mr Philip Hammond (Runnymede and Weybridge, Conservative)

I welcome the Minister's remarks and I shall make a few comments about them in a moment. I look forward to serving on the Committee under your chairmanship, Mr. Maxton, and, notwithstanding the constraints that the House has placed on our deliberations, I hope that we shall have an opportunity to scrutinise the Bill adequately.

At the outset, I draw the Committee's attention to my registered interest relating to property development, which may be relevant to clause 4. My right hon. and hon. Friends will speak to amendments to that clause; I shall take no part in that debate, but it is right that the Committee is aware of my interest.

We object in principle to the timetabling of the business of the House and the way in which the Government have imposed it upon us. I do not intend to rehearse the arguments that have already been made on the Floor of the House. However, I am disappointed. I have participated in constructive Committee proceedings with the Minister and the Government Whip who are leading on the Bill. My view is that the old system worked well. We managed our business in an informal and progressive way as the Bills went through consideration in Committee. We saw how the debate evolved and which issues needed further deliberation rather than commenced from the outset with a fixed programme. Perhaps we will lose something in our scrutiny of legislation if we are unable to allow further debate on the clauses that come to be seen as important or complex.

The Minister has already indicated that there will be Government amendments. At least I believe that that was what he said. They may be minor amendments, but nearly all hon. Members will have had experience of serving on Standing Committees where the Government have tabled substantial amendments during the course of the Bill. I think of the Care Standards Act 2000, during the progress of which the Government tabled substantial amendments relating to Wales. It is impossible for a Programming Sub-Committee, when setting out a rigid timetable at the outset of the Committee's deliberations, to take into account matters that are unknown to the Committee at the start. I hope that will not happen in this case. However, sooner or later, for perfectly legitimate reasons, the Government will table substantial amendments in Committee that will restrain debate on the clauses programmed for consideration at that point.

The Minister has indicated that he hopes in the next 24 hours to publish a paper on the traffic light system, which the Committee will debate on Tuesday. That is unacceptable. The House is not sitting tomorrow. If amendments for consideration on Tuesday are to be unstarred, they have to be tabled by the rise of the House tonight and yet the Government intend to publish a document that is highly relevant to the controversial matters that we will debate on Tuesday morning.

Mr John Maxton (Glasgow Cathcart, Labour)

I should remind the hon. Gentleman that amendments can be tabled up until three o'clock tomorrow.

Mr Philip Hammond (Runnymede and Weybridge, Conservative)

I am grateful for that advice. It is good news, but it does not alter the substance of my remarks.

As tomorrow is a non-sitting day, the great majority of Members will not be in Westminster. If the Government's document is published tomorrow morning, we are unlikely to have informed responses from health service professionals and managers, in time to formulate orderly amendments by 3 pm tomorrow.

I ask the Minister whether it was impossible to publish the document before today or tomorrow. Perhaps it might be in order to ask you, Mr. Maxton, whether in the light of the unusual circumstances you will adopt a flexible attitude toward starred amendments relating to the traffic light system given that the Minister has told us that late information will be made available.

Mr. Denham indicated dissent.

Mr Philip Hammond (Runnymede and Weybridge, Conservative)

The Minister shakes his head, but I understood him to say that material new information would be published within the next 24 hours that would inform the Committee's debate on Tuesday morning. I hope that some flexibility can be shown with respect to that.

Having stated my objections in principle to the timetabling arrangements—not just the deadline for the consideration of the Bill, but the fixed milestones within that deadline—and having expressed our concerns about the ability of the Committee properly to scrutinise legislation in those circumstances, we accept that the House has resolved to proceed in such a way. The timetable allocates the limited available time in the most sensible way, attempting to ensure that there is debate on key issues that are likely to be of great concern. However, I get the impression that the Government would not be unhappy for debate on certain parts of the Bill to be curtailed, just as the Prime Minister indicated in his response to my right hon. Friend the Member for Richmond, Yorks (Mr. Hague) that he was anxious to avoid proper debate wherever possible.

The composition of the Committee, which strikes me as rather extraordinary, makes me suspicious of the Government's motives. I was under the impression that the convention was that the membership of Committees was drawn, by and large, from hon. Members who contributed on Second Reading. For the information of the Government Whip, every single hon. Member on this side of the Committee spoke on Second Reading. With the honourable exception of the Minister, and of the Government Whip, who was unable to contribute on Second Reading, only one Labour Member—I think that I am right, and someone will bounce up and correct me if I am wrong—spoke on Second Reading.

Mr Ian Stewart (Eccles, Labour)

So what?

Mr Desmond Swayne (New Forest West, Conservative)

Could it have anything to do with the fact that those hon. Members who contributed on Second Reading, bar two, spoke against clauses 14 and 15?

Mr Philip Hammond (Runnymede and Weybridge, Conservative)

My hon. Friend may have hit the nail right on the head. The hon. Member for Eccles (Mr. Stewart) said, ``So what?'' Is he, perhaps, challenging the convention that hon. Members who contribute on Second Reading should, by and large, form the Committee that considers the Bill?

Mr John Maxton (Glasgow Cathcart, Labour)

Order. I do not wish to be overzealous at this stage, but the membership of the Committee has nothing to do with the programme resolution. It might be better if the hon. Gentleman returned to that resolution and continued his remarks on another occasion.

Mr Philip Hammond (Runnymede and Weybridge, Conservative)

Thank you for your guidance, Mr. Maxton. I am not sure at which other stage it would be appropriate to make those remarks. This is a very important point, and it has a bearing on the time that the Committee will require to consider the Bill.

On Second Reading, several hon. Members displayed a very clear knowledge, sometimes backed up by personal experience, of the matters that the Committee will consider, and made worthwhile contributions. I am sure that many of those hon. Members hoped to serve on the Committee, in order to assist it in speeding up its deliberations by giving it the benefit of their considerable knowledge and expertise. What is the Government's motive in putting forward for membership of the Committee several Members who did not contribute on Second Reading, and only one Member who did? On Second Reading, in response to an intervention from my hon. Friend the Member for New Forest, West (Mr. Swayne), the Minister of State, referring to the Committee that considered the Bill that became the Health Act 1999, said:

I remember that Committee—it is seared on my memory. I remember in particular the hon. Member for Lichfield (Mr. Fabricant)—he is not present tonight, so I assume that he will not be a member of the forthcoming Committee—[Official Report, 10 January 2001; Vol. 360, c. 1187.]

The Minister clearly expected that speaking on Second Reading would be a prerequisite for being selected for membership of the Committee.

I shall move on, but I feel that I have a duty to put the matter on record on behalf of certain hon. Members who made valuable contributions to that debate. They include the hon. Members for Erith and Thamesmead (Mr. Austin), for Ilford, North (Ms Perham) and for Romford (Mrs. Gordon), who had direct personal experience to relate, but were excluded from the Committee simply for committing the sin of questioning the Government line. We now have a Committee drawn from hon. Members who did not speak on Second Reading, with one honourable exception.

Mr Simon Burns (West Chelmsford, Conservative)

I am grateful to my hon. Friend. In his list of hon. Members who have not been selected for the Committee, he failed to mention the hon. Member for Wakefield (Mr. Hinchliffe), who happens to be chairman of the Select Committee on Health and is extremely knowledgeable on such matters.

Mr Philip Hammond (Runnymede and Weybridge, Conservative)

As is usual for the hon. Member for Wakefield, with whom I do not always see precisely eye to eye, he made a valuable contribution on Second Reading. I too was disappointed that he was not to be a member of the Committee. As chairman of the Health Committee, the hon. Gentleman invariably speaks in health debates, and I am perhaps not entirely surprised that he was not asked to serve on the Committee. I am certain that some other hon. Members who spoke, who perhaps hold less illustrious positions, would have expected to be asked to serve on the Committee.

Mr Ian Stewart (Eccles, Labour)

On a point of order, Mr. Maxton. Is it appropriate for the Opposition spokesman to question the composition of the Labour side of the Committee and to make presumptions about why hon. Members were or were not able to attend Second Reading, and which hon. Members are or are not critical of the Government? Surely that is not appropriate.

Mr John Maxton (Glasgow Cathcart, Labour)

I have some sympathy with that point of order. I have already asked the hon. Member for Runnymede and Weybridge (Mr. Hammond) to consider the motion. It would be better if he now did so.

Mr Philip Hammond (Runnymede and Weybridge, Conservative)

The point has been made—new Laboured, perhaps—and I am sure that the import of the decisions will become clear as the Committee progresses in its consideration.

I do not know whether it is the perfect moment to raise the matter, but I would like formally to place on the record a point that I raised in the Programming Sub-Committee this morning. I want to preface my remark by expressing my gratitude to the Minister for his undertaking to be as helpful as possible in supplying documentation to the Opposition.

The architecture of the Bill largely functions by amending existing legislation, especially the National Health Service Act 1977. That Act has been amended more times than most people would care to remember, yet nowhere in the House is a fully up-to-date, consolidated and amended copy of it available. When we see reference to, for example, making insertions after section 97 of the 1977 Act, we cannot readily find documentary evidence of that position.

As I said, the Minister has kindly undertaken to give the Opposition as much help as possible on documentation. However, I ask you, Mr. Maxton, whether it could be suggested through the regular meetings of the Chairman's Panel that the responsibility of providing us with documentation belongs not to the Department, but to the House authorities. If hon. Members are to be able properly to consider complicated Bills that work by inserting clauses into much-amended Acts, it is essential that all hon. Members be furnished with an amended, consolidated copy of the relevant base legislation. If we are not, our work is made doubly difficult. I would be extremely grateful to you, Mr. Maxton, if you would take that plea back to the House authorities, perhaps though meetings of the Chairmen's Panel, to see whether in future we might be spared the indignity of having to cobble together photocopies of different statutes from the Library. That was the only way we could piece together the structure of the measure before us today.

Mr Desmond Swayne (New Forest West, Conservative)

We deserve an answer to a simple question before we take a decision. If the Government table substantial amendments, or if the Committee at some stage reaches agreement that some aspect of the Bill requires greater scrutiny than the programme resolution allows, will the Government be flexible in reconvening the Programming Sub-Committee to change the motion? That has already happened in the case of the Standing Committee considering the Vehicles (Crime) Bill. Will a resolution on the Floor of the House be used to change the end date, if scrutiny of the Bill reveals that that is necessary?

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

The hon. Member for Runnymede and Weybridge (Mr. Hammond) is unduly crotchety this afternoon.

I make no apology for telling the Committee that we shall attempt to provide extra information for hon. Members if necessary. When the right hon. Member for North-West Hampshire (Sir G. Young), who unfortunately is not in his place at the moment, was a housing Minister, he was, I am fairly certain, responsible for the Bill that became the Leasehold Reform, Housing and Urban Development Act 1993. That was the first Bill that I served on as an Opposition Member. During its passage, several additional briefing documents were provided, usually on the day when the Committee was to meet, to explain some of the more technical or complex aspects of the clause and the underlying calculations. I found it useful and good practice. It happens in some Committees and not in others, and I hope to do it where possible.

It is also common practice for Governments, when introducing a measure, to explain that they will be consulting on one or other detailed aspect before implementation. In the case of the performance fund, the consultation is with the NHS. I felt that members of the Committee would want to be able to study the consultation before debating the matter in Committee. We have not done the work at the last possible moment. Rather, we have produced the document at the earliest possible moment, so as not to publish a consultation document after the Committee has considered the matter. We have been endeavouring to help hon. Members, which is how I intend to deal with the Committee.

While I have promised to be as helpful as possible with the Department's resources in assisting members of the Committee, I share the view of the hon. Member for Runnymede and Weybridge that it would be helpful if another way of providing consolidated versions of legislation were available, that did not rely on Departments to put it forward. I draw that to your attention, Mr. Maxton.

I understand that the procedure, in the event of a change to the sitting hours, would be to reconvene the Programming Sub-Committee. The Government showed flexibility this morning in extending the hours initially allocated for debate, although I think that the mood of this morning's meeting was that we should be able to conclude our business within the overall time envelope and not sit as late as is suggested, certainly on Tuesdays. I hope that our intention to make good progress while allowing proper scrutiny is clear.

Question put and agreed to.

Mr John Maxton (Glasgow Cathcart, Labour)

As the programming motion to which the Committee has just agreed contains an order of consideration I shall not put the separate order of consideration motion.

Clause 1

Determination of allotments to and resource limits for Health Authorities and Primary Care Trusts

Mr Philip Hammond (Runnymede and Weybridge, Conservative)

I beg to move amendment No. 11, in page 1, line 12, leave out `amount' and insert `amounts'.

Mr John Maxton (Glasgow Cathcart, Labour)

With this it will be convenient to take the following amendments: No. 12, in page 1, line 12, leave out `a Health Authority' and insert `Health Authorities'.

No. 13, in page 1, line 16, leave out `Authority's'.

No. 14, in page 1, line 16, after `expenditure', insert `of each Authority'.

No. 6, in page 1, line 17, leave out `the' and insert `each'.

No. 7, in page 2, line 3, leave out

`an amount for a Health Authority'

and insert `amounts for Health Authorities'.

No. 15, in page 2, line 9, leave out `Authority's'.

No. 16, in page 2, line 9, after `expenditure', insert `of each Authority'.

No. 17, in page 2, line 15, leave out `amount' and insert `amounts'.

No. 18, in page 2, line 15, leave out `a Primary Care Trust' and insert `Primary Care Trusts'.

No. 20, in page 2, line 27, leave out

`an amount for a Primary Care Trust'

and insert

`amounts for Primary Care Trusts'.

Mr Philip Hammond (Runnymede and Weybridge, Conservative)

I apologise for the fact that, in our attempts to avoid accusations of technical deficiency, it has been necessary to table so many amendments so that we can have consistency throughout clause 1 and make our point.

The Minister will have the benefit of a more detailed briefing than I do, but I shall set the scene. Clauses 1, 17 and 18 seek to change the methodology for distributing the general practice medical work force in England and Wales. Perhaps I can characterise the proposed change as moving from a planned approach to the use of a financial mechanism to send the required signals. One might characterise that as a market-led approach to the distribution of the medical work force. Perhaps an eyebrow or two raised when the Government adopted the idea.

On the face of it, the idea has some attractiveness, and we share the Government's objective of improving access to general practitioner services in under-doctored areas. It is clear that there are parts of the country—not only regions, but quite small areas—that are noticeably under-doctored and suffer from poor provision of primary health care services. It is not so much the Government's intentions that are at stake and that the amendments intend to address, but the methodology that the Government have adopted to achieve them.

On Second Reading, the Secretary of State and the Minister in his winding-up speech emphasised their view that the overall effect of the Bill would be to decentralise power. A recurring theme that the Committee will hear from me—and I suspect from my right hon. and hon. Friends—is that although some of the clauses may superficially appear to devolve power and authority, a careful reading of the powers of direction and the discretion of the Secretary of State confirms the idea that the ultimate power is being focused into his hands.

That residual power—the fact that the Secretary of State may issue directions—is important. Whether or not he issues directions sends a powerful signal. It means that bodies charged with carrying out activity know that he has the power to direct how they behave and act if they do not do his bidding. We must look all the time behind the superficial structures of the Bill, and at where the real power will lie after the Bill is enacted.

Dr Peter Brand (Isle of Wight, Liberal Democrat)

I am listening to the argument with great interest. Does the hon. Gentleman agree that, if we were to abolish the commissioner-provider split, which the Bill would enable the Government to do, it would be much better to be honest and up-front about it? It would save a great deal of money and return us to a directly run national health service.

Mr Philip Hammond (Runnymede and Weybridge, Conservative)

I am not sure whether I entirely agree with the hon. Gentleman. Our concern is that power is not only being centralised but, by the nature of the Secretary of State's role, politicised. We have concentrated in the persona of the Secretary of State the ultimate power to direct all sorts of bodies and to decide how things are done, in a way in which we do not think will be helpful when trying to run an organisation that employs 1 million people. It is the largest productive enterprise in the country, producing one of our most valuable commodities and accounting for nearly 6 per cent. of this country's gross domestic product.

On Second Reading, I asked the Secretary of State whether he could think of an effective, productive enterprise on such a scale. His rather feeble attempt at a response was the Chinese army. If he believes that the Chinese army is an effective, productive enterprise, I am afraid that the national health service has bigger problems that most of us thought.

Clause 1 allows the Secretary of State to take into account in an unspecified way the historical part II expenditure of a health authority when making allocations of money to it. The explanatory notes to the Bill suggest that the purpose of the clause is to enhance fairness by balancing out part II expenditure with other health authority expenditure. Implicit in the explanatory notes is the suggestion that an authority with historically high part II spending might find its allocations of finance in other areas reduced so that more money could be allocated to areas with historically low part II spending, part II spending being essentially demand driven.

Our anxiety is that the clause does not require that the Secretary of State's power be used in that way. It states quite explicitly that

the Secretary of State may take into account

the authority's general part II expenditure

in whatever way he thinks appropriate,

and, implicitly, for whatever purpose he thinks appropriate. It is therefore not obvious that the effect of the Bill will be always to have in place a mechanism designed to transfer resources from areas that are overspending to those that are underspending.

Another anxiety is at the back of my mind. Expenditure will not in itself be a good measure of excess provision or underprovision. I hope that this does not sound like special pleading on behalf of my constituency or health authority area, but it will be readily apparent to any member of the Committee who considers the matter for a moment that some of the costs involved in meeting part II services will be considerably higher in areas where property prices, wages and salaries are higher than in other areas.

One of the part II expenditure items is the cost of providing premises for primary health services for general practice. It will of course cost more to provide primary health care premises in Guildford than in Sunderland. That is not an exhaustive argument, as I readily accept that in some areas, such as inner-city London, primary services are inadequate and premises costs are high. However, if the Secretary of State simply took the view that an area that has high spending on part II services needed to be penalised through a reduction in other areas, in order to persuade health authorities to adjust the level of provision of part II services, that would seriously and negatively affect the provision of general medical, dental and ophthalmic services in high-cost areas.

We need to be assured that the honourable purpose that ostensibly lies behind the clause will be implemented and that it will not be used as a way of redistributing funds on an unaccountable basis from areas that the Government do not favour to areas that the Government do favour. I do not want to insult hon. Members by putting it too bluntly, but I want to ensure that the clause does not become a charter for shovelling money into marginal constituencies in the run-up to a general election.

The amendments were framed to achieve that objective. They would provide a clear sign that the Secretary of State's behaviour should be consistent and applied to health authorities in general rather than one health authority in particular. The Minister may say that that is the Secretary of State's intention, but it is not what the Bill suggests. It implies that the Secretary of State would have the ability to take into account one authority's general part II expenditure in a certain way, yet in relation to another authority, he would not have to take part II expenditure into account, or he could take it into account in a different way.

In this country, we tend towards the principle that public money is allocated according to formulae. Unfortunately, that principle has been eroded by the extensive use of ring-fenced grants. Those formulae may not be perfect; they may be seriously flawed, but they have the advantage of being transparent, objective and not readily vulnerable to political manipulation. My concern is that the Bill introduces a mechanism that allows the Secretary of State to change the distribution of financial resources if he believes that something should be taken into account in another way that he thinks appropriate. If he is allowed to do that on a different basis for each health authority, a dangerous precedent will be created.

I do not suggest that the present Secretary of State would abuse his position, but a future Secretary of State in another Government would have that ability. During our proceedings, we must consider carefully the way in which power is not only accruing to the Secretary of State through the little provisions about directions and discretion, but can be used arbitrarily. I hesitate to use that word, because I know that Ministers do not behave arbitrarily, by definition. However, it would be inappropriate for the Bill to allow Ministers to treat different authorities in different ways. If the Government's agenda is genuinely one of fairness, I cannot foresee that they can object to the transparency and accountability provided through this group of amendments, when they are read together with the amendments that we will consider later today.

Dr Peter Brand (Isle of Wight, Liberal Democrat)

First, may I apologise, Mr. Maxton, for my discourtesy in leaving the Room after I have spoken? I have a previous engagement. May I also say how pleased I am that you are in the Chair?

The amendments are interesting, although I was not sure of their purpose, so I am grateful for the explanation given by the hon. Member for Runnymede and Weybridge. I would welcome a move away from rigid, but transparent formulae, because there is nothing worse than a transparent formula that is also a brick wall behind which Ministers can shelter even when the formula is patently wrong. I do not want to make a special plea but, as the representative of the only island constituency in England, I can say that there is no such thing as an island factor in any of the Government resource distribution formulae. That is clearly nonsense.

It is difficult to have a rigid formula in practice, which is where so many resource allocations have gone wrong. In the health service, services in different places are delivered in completely different ways. The amount of primary care work done in some districts is much greater than in others, so it is right to have some way of reflecting that activity. The point on premises costs is well taken. One hopes that whatever mechanism is adopted will take that into account.

My real concern is that the clauses—not the amendments—represent further cash limiting. We experienced that when prescribing budgets were rolled into primary care group budgets and now the total pot of available money will probably be capped. That is a matter of great concern on which I welcome the Minister's response.

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

I believe that I can assuage the concerns that hon. Gentlemen have raised. It may help the Committee if I follow the lead of the hon. Member for Runnymede and Weybridge and set the amendments and the clause in context, touching on how they relate to later clauses about the Medical Practices Committee.

Clause 1 allows the Secretary of State to take into account spending on non-cash limited spending on primary care services when determining health authority allocations. The amendments and the discussion have been asking us how we intend that to work in practice and what the practical effects of the change will be, so I shall address those issues before moving on to the amendments.

The underlying purpose of clause 1 is part of the Government's drive to close the health gap between the worst off and the better off in health terms. It will enable the Secretary of State to take account of all the health care resources that are available to meet the needs of a health authority's local population and to target increases in allocations accordingly. In effect, areas with fewer doctors than might be expected for the needs of their population will expect to receive higher levels of growth in their allocations.

It will be common ground in the Committee that different parts of the United Kingdom have different health needs. The formula used for determining fair shares for health authority allocations already recognises that, and the Government are already reviewing the formula to ensure that it is better focused on addressing those needs properly and fairly. At present, the formula sets fair shares only for the cash limited services. Clause 1 will allow us to extend the formula and the concept of fair shares to include some or all of the non-cash limited primary care services. It will allow the Secretary of State to take account of spending on non-cash limited primary care services when he makes the cash limited, unified budget allocations to health authorities. It will allow health authorities to take account of the distribution of spending on non-cash limited primary care services when they make cash limited allocations to primary care trusts or to set the budgets for primary care groups.

We have commissioned the Advisory Committee on Resource Allocation—ACRA—to develop the general medical services non-cash limited element of the new formula. ACRA will build on earlier work that was undertaken with the Medical Practices Committee, which developed a formula that set fair shares of unrestricted GP principles at health authority level. We have now asked ACRA to advise on whether and how that formula needs to modify to operate in cash terms for the whole GMS non-cash limited budget at health authority level and in respect of the allocations from health authority to primary care trust or group level.

The first point of reassurance for the Committee is that we intend it to be a formula based system. We have gone to the usual advisory group for advice in drawing up the formula that will back up clause 1.

When the new formula is available and is implemented, there will be a single funding formula that will set a target or fair share for each health authority and primary care trust that covers GMS non-cash limited expenditure as well as the existing unified allocations.

Mr Philip Hammond (Runnymede and Weybridge, Conservative)

The Minister is telling us that he intends to introduce a transparent formula. However, will he confirm that clause 1 does not require that and will not in future require that any formula is used and applied even-handedly to all health authorities, and that it would be possible for the Secretary of State to apply different criteria to different health authorities?

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

I was going to come to that in due course, but I shall deal with it now. The existing provisions of section 97 of the National Health Service Act 1977 referred to the Secretary of State determining allocations for individual health authorities rather than determining the amounts for health authorities globally. That is why we took the same approach in drafting the clause. I hope that the hon. Gentleman will be reassured that we have reflected the previous approach by referring to ``the health authority'' rather than to ``health authorities'', as is proposed in his amendments. To do so has always meant, as it did under the previous Government, that health authorities were not considered individually in isolation from all others, but were seen in the round. When allocations have been made under this and the previous Administration, the relative positions of all authorities were taken into account. We intend that to remain the case under the Bill.

Such a general power must be exercised in accordance with the principles of administrative law. It must be exercised rationally. It cannot be applied in an irrational way. No reasonable Secretary of State would agree with that. It follows that when non-cash limited expenditure is taken into account, the Secretary of State must carry out a proper decision-making exercise. He must consider all relevant factors and ignore all irrelevant ones. The amendments would not open the door to the type of arbitrary decision making that concerns the hon. Gentleman and which he and I would find deplorable.

Mr Philip Hammond (Runnymede and Weybridge, Conservative)

I am grateful to the Minister for his helpful comments. Is there a good correlation between the level of general part II expenditure and the number of GPs in practice? In other words, how useful will the criteria that the Secretary of State will take into account be in determining the real level of services provided to patients in a given area? I ask that question because of my worry about the differential costs in different areas.

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

I shall try to avoid to giving an extended reply to the hon. Gentleman's question. Clearly, with the non-cash limited services, the greater the number of GPs, the greater the share of non-cash limited expenditure into such areas will be. One follows the other: the pounds follow the GPs. There is not a uniform distribution of GPs, when considering need against a weighted population per head. There seems to be a potential distortion in the overall resources going into areas in relation to need, particularly because of the separation between the unified budget, which does not cover such services, and the non-cash limited part II expenditure.

The hon. Gentleman asked the reasonable question concerning how allowance is made for the different costs that apply in different parts of the country in an allocation formula such as that which we use for distributing health authority allocations. The allocations formula already reflects different costs in different parts of the country because within the allocations formula that we use is a market forces factor. The approach taken in the formula reflects those varying costs through the market forces factor. The type of extra costs that do not reflect salary per GP are taken up in the wider market forces factor, which is part of the overall allocation mechanism.

Mr Philip Hammond (Runnymede and Weybridge, Conservative)

Perhaps the Minister missed my specific point. Will examining the level of general part II expenditure health authority by health authority provide a good correlation with the number of GPs in practice in those health authorities who provide both general medical services and personal medical services?

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

There will be a correlation, but it will not be a perfect correlation because of the differences in costs. It would not be a uniform correlation from one part of the country to another. It is important to recognise that because there are variations in the numbers of GPs in different health authority areas and in different primary care trusts and care group areas, the overall impact is that when the unified budget and non-cash-limited budget are put together, different areas do not collectively receive fair shares of their allocation of resources.

Our approach is intended to ensure that we move towards fair shares of health resources in each part of the country. The reason for developing a formula for a target for fair shares that includes what are currently non cash-limited general medical services, is to enable us to do that in a rational and effective way across the whole country. Clearly, if we did not believe, on the basis of our work, that that would produce any difference in resources, it would be a huge bureaucratic exercise for no purpose. We are embarking on this exercise precisely because examination of one health authority against another shows an inequality of resources.

The new formula will produce a new target or fair share for each health authority or primary care trust, which brings together non-cash-limited expenditure together and the unified allocations. In practice, that will require a second stage. When the available resources are allocated, there will need to be a pace of change policy—as there is currently—which determines how quickly an individual health authority moves towards its target, whether it receives extra resources to move faster towards its fair share target, or whether it is experiencing a slower rate of growth in a particular year. Clearly, we will continue to approach fair shares in terms of a levelling up rather than a levelling down of resources. I do not suppose that any Committee member would think otherwise, but it is worth putting on record that we would not use the mechanism to reduce the resources available in an area that was over-doctored.

Mr Philip Hammond (Runnymede and Weybridge, Conservative)

I regret to inform the Minister that some Committee members might have dreamt something else. When the abolition of fundholding was considered under a previous Bill—which became the Health Act 1999—I recall the Minister giving a clear assurance that the Government intended to level services up to the best. However, I am sure that the Minister will acknowledge that, as a result of that abolition, the experience in many areas was that fundholding GPs had to abandon services that they were providing to their patients.

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

Overall, when primary care groups examined services and their cost-effectiveness, they found a levelling up of services across the country as a whole. I cannot say that there were no areas in which colleagues felt that local services were not cost-effective, but we have seen a levelling-up. The greatly increased resources allocated to the NHS under this Administration have helped to advance that process.

I have tried to outline the way in which the funding formula will work. The clause must be considered alongside the proposals to abolish the Medical Practices Committee and to enable health authorities to declare GP vacancies. Clause 1 will provide a health authority with the means to manage all the health care resources for its population, whether in primary or secondary care. We intend the health authority to discharge that key strategic responsibility with the local primary care trust, other members of the local health economy and local government partners. In the areas which are currently under-doctored in relation to their populations, the additional growth moneys that they will receive will enable them, for example, to disband PMS pilots, introduce further GMS local development schemes or support their existing primary care services through the provision of extended services in primary care.

Mr Philip Hammond (Runnymede and Weybridge, Conservative)

Perhaps the Minister can clarify one point. Is the cost of PMS services included in the general part II expenditure or excluded from it? How does that impact on the way in which the Secretary of State will want to take into account general part II expenditure when looking at a particular health authority?

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

As the hon. Gentleman will know, when a PMS pilot is established, funds that would have been within the global budget for GMS become part of the unified budget within a local area. There is some transfer from one pot to another. The Bill addresses the part of the non-cash-limited budget that is currently in GMS. The two sums of money—whatever is within the unified budget, whether it is spent on PMS or other services, and the GMS non-cash-limited budget—are looked at together, as one budget. Allocations are then made against that and the new fair share target.

Health authorities can also attract new doctors by declaring vacancies for GMS GPs. There is no question of taking away resources, cash-limited or non-cash-limited, from health authorities with more doctors than are expected for their population needs. However, it is likely that those authorities will receive a smaller increase in their unified budget than would otherwise be the case.

I am sure that we will touch on several other issues during debate on other amendments and clauses. I hope that I have set the scene and reassured hon. Members about the way in which the clause has been drafted, our intentions, and the practical constraints that will prevent the Secretary of State from using the legislation in a way that is not rational or fair.

Mr Philip Hammond (Runnymede and Weybridge, Conservative)

I am grateful to the Minister for putting the terminology into the historical context of legislation in respect of cash-limited expenditure. I hope that, when I read his words in Hansard, I will find a reassurance that the Secretary of State will act in a formulaic, transparent and objective way that is not subject to manipulation or variations on a case-by-case basis that could not be properly and effectively predicted by someone who was privy to the formula and the data available to the Secretary of State. We seek simply to ensure that the allocation of money to health authorities is done by means of impartial funding formulae, rather than introducing yet another element of discretion.

In view of what the Minister has said, I shall not press the amendment to a Division. We may need to raise a couple of other issues, but they will naturally fall within the scope of the debate on amendments Nos. 9 and 10. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Sir George Young (North West Hampshire, Conservative)

I beg to move amendment No. 2, in page 1, line 15, leave out

`(in whatever way he thinks appropriate)'.

It is good to see you in the Chair, Mr. Maxton. Any propensity to misbehave disappeared the moment that I knew that you would be chairing the Committee.

Amendment No. 2 is a probing amendment; this debate should follow on well from the previous debate. The amendment would remove from the Secretary of State the discretion in allocating substantial sums of money. It is interesting to compare the discretion that the Secretary of State has under this Bill with that of the 1977 Act, which we are amending. Section 97 of the 1977 Act states:

It is the Secretary of State's duty to pay...such expenditure...as the Secretary of State approves in the prescribed manner.

That wording is tighter than that in the Bill, which states:

In determining the amount to be allotted...the Secretary of State may take into account (in whatever way he thinks appropriate)—

taking us back towards Henry VIII rather than onwards to whoever the next monarch might be.

If, as the Minister said, the new system will be formula driven, fair and objective, despite the way in which the Bill is worded, I am not sure that he needs the discretion that my amendment would delete.

I shall try to put the issue in perspective. The NHS budget this year is about £44.5 billion, a very substantial sum of money, most of which is distributed to our constituencies. The revenue support grant is £21.5 billion, less than half that. Yet we monitor the distribution of the revenue support grant much more strictly than we monitor the distribution of the NHS budget.

Next week, the House will debate and vote on the distribution of the revenue support grant and we will have the opportunity to say on behalf of our constituents that the distribution is unfair and to complain about the formula. It is also quite easy to get briefing from one's local authority about the way in which the RSG formula penalises one's own constituency. Any director of finance worth his salt can produce powerful evidence that shows that the formula is unfair to one's constituency. Having been a local government Minister, I can pay tribute to the ingenuity of hon. Members and local government officers in finding ways round the formula.

The budget and the means of allocation that we are now considering are not subject to similar scrutiny although the sums are far higher. Local health authorities, which are agents of the Minister, are understandably reluctant to brief Members of Parliament about the way in which formula is unfair on any particular constituency. It is the job of every Member of Parliament to fight for the fairest share possible for his or her constituents. We are talking about a very substantial sum of money.

I have no difficulty with the principle of resource equalisation. I believe in the concept of equity in health care. I read the White Paper ``Our Healthier Nation'' that says that any sensible public health strategy must take into account resource allocation and the differential distribution of need. That goes far wider than just the NHS. It applies to housing and all the other budgets. I take the view that everyone, wherever they live, should have the right to good access to a high-quality service. It follows from that that the allocation and application of NHS resources should be related to need. There can surely be no disagreement with what I have said so far.

After the election, I arrived at my new constituency—North-West Hampshire, which was very different from the inner-city seat that I had previously represented— and I found that for every £100 of NHS resources allocated nationally, my constituents received £80. We were deemed to be 20 per cent. healthier than the rest of the country. Being a conscientious local Member of Parliament, I thought that I would run that round the course to see whether it was substantiated. It is not the case that all deprived people live in deprived areas. More than half of the most deprived individuals in the country live outside the most deprived 20 per cent. of wards. So any resource allocation that just targets the most deprived wards will miss more than half of the most deprived people in the country.

What really interested me were two documents that supported my suspicion that, sadly, my constituents were not 20 per cent. healthier than the national average. One document, ``Meeting the Challenges'', was the report of a scrutiny panel set up by the Parliamentary Under-Secretary of State for Health, the hon. Member for Birmingham, Edgbaston (Ms Stuart). The panel was appointed in April last year to examine proposals that were aimed at achieving savings of £13.5 million. It may come as a surprise to Committee members that, at a time of more resources being allocated to the NHS, the Government are looking to make savings of £13.5 million in my constituency. The panel, in its report, said it wished to emphasise its independence of Government, the health authority, trusts, primary care groups and community health councils. It said that

we are our own men and women and unanimously recorded, at our first meeting, that we would not ``rubber stamp'' any proposals.

Mr Philip Hammond (Runnymede and Weybridge, Conservative)

My right hon. Friend expresses some surprise at the fact that, given all the additional money that the Government are putting into the health service, it is necessary for his health authority to make such savings. He might be interested to know that my health authority also has to make savings of £8 million, and he might notice that his health authority and mine have something in common: they both occupy areas represented by Conservative Members of Parliament. Does he think that that is entirely coincidental?

Sir George Young (North West Hampshire, Conservative)

Very hard-working and conscientious Members of Parliament at that. I want to develop my theme and, I hope, give the Minister the opportunity to dispel the suspicion that my hon. Friend and I may share.

The report went on to state that

The National Funding Formula for Health Authorities is at the heart of the problem. This is a challenge for central Government...North and Mid Hampshire Health Authority receives 80 per cent. of the national needs assessment. Panel members felt strongly that this was too low.

I find the next remark especially interesting. The document continues:

We heard no evidence to support such a large reduction in the national needs ``norm''. What is more, we were told of both urban and rural ``pockets of deprivation'' within the Authority, where an 80 per cent. allocation was arguably inadequate...This challenge lies at the door of Government but the authority should fight for it, too.

That is one of my concerns. An independent panel appointed by a Minister found the formula unfair, and we are discussing extending that formula to the part of the health service that is not cash-limited at the moment.

``Coronary Heart Disease—an equity profile for north and mid Hampshire'', the other document that supported my view that the present formula was unfair, landed on my desk yesterday. Extracts from it show that it would be misleading to assume that because one lives in north and mid-Hampshire one is healthier than the national average. It states that

Basingstoke and Deane residents have strikingly higher death rates from coronary heart disease, not explained by deprivation,

and that

Prescribing of statins in Mid Hampshire PCG is lower than expected on the basis of need.

Mr Simon Burns (West Chelmsford, Conservative)

What is a statin?

Sir George Young (North West Hampshire, Conservative)

I was hoping that my hon. Friend would not ask me what a statin was. I imagine that it is a drug that is prescribed for coronary heart disease.

The profile goes on to state that,

for North Hampshire Primary Care Group residents, these treatments are carried out less frequently despite the higher levels of need.

As one reads on, one begins to question even more deeply the assumptions behind the formula that prosperous areas require less money.

The document continues:

The north Hampshire PCG has the highest mortality from CHD—

coronary heart disease—

but the lowest level of investment in invasive cardiac interventions.

The conclusion is that

North Hampshire PCG faces substantial costs in responding to the unmet local need and the Health Authority should recognise this in allocating resources for CHD.

Those two documents, written not by Conservative central office but by independent bodies, put a big question mark behind the extension of the provision to more of the NHS that is referred to in clause 1. I pursued the matter with the NHS, asking about the formula and the prospects for change. I received a reply from a representative of the NHS Executive for the south-east, Dr. Mike Gill, who referred to the review that the Minister mentioned. He stated:

One of the aims of the review of NHS funding is to develop a more sophisticated approach to the inclusion of measures of health inequalities in the resource allocation formula. It is possible, indeed perhaps likely, that the review will seek ways of ensuring that proper account is taken of the needs of pockets of deprivation within health authorities which have relatively good indicators of health overall.

I think that that would apply to my constituency, and that of my hon. Friend. Unhappily, Dr. Gill goes on to conclude that, whatever comes out of the review, any increases to allocations—that is, to north and mid-Hampshire—are likely to be below the national average. Before we roll out the formula to primary care, I want much more proof of its fairness to my constituents and to others.

The explanatory notes state that the measure is designed to deal with the problem of under-doctored areas. I would like to see more doctors in those areas; there is no dispute about that. However, that would not be cash-limited. That is the one bit of the budget that one can fill at the moment without going on bended knee to the Treasury.

I do not see why the Bill is relevant to meeting the needs of the under-doctored areas. If an area is under-doctored, all that must be done is to establish that it is under-doctored, and find a GP. There is no cash limit at all on meeting that particular problem. I do not follow the logic in paragraph 21 of the explanatory notes, which says that clause 1 is necessary to deal with under-doctored areas.

In my constituency, the one part of health care that is not being squeezed, and where we are not looking for £13.5 million, is primary care—the GP services work well. I was worried, as the Minister wound up the earlier debate, when he spoke of a potential distortion—I hope that I wrote his words down correctly—in the distribution of GPs. I am concerned that, having worked out the formula, he will tell me that I have too many GPs. He has already told me that my constituents spend too much on the NHS. The part of the health service that is working well in my constituency is going to come within the warm embrace of the Treasury's cash limits, and we will find that we must spend 20 per cent. less on that part as well.

At the end of his remarks, the Minister said that if there were not a redistribution of GP expenditure, then the exercise would have been pointless. Having listened to the Minister—a courteous and intelligent man—reply to the earlier debate, my concerns were exaggerated rather than allayed. He comes from the same part of the country as I do. I am happy to say that there are a large number of hon. Members representing Hampshire constituencies on the Committee, and I am sure that the needs of the county will be commented on as we progress through the Bill. However, before I am prepared to support clause 1 and the concept behind it, I need to be reassured that the problems that we face in the hospital sector will not be extended to the primary care sector. In a nutshell, those are the fears behind the amendment.

Mr Simon Burns (West Chelmsford, Conservative)

Like my right hon. Friend the Member for North-West Hampshire, I would like to probe the Government on clause 1. What I find attractive about the amendment tabled by my right hon. Friend is that it seeks to remove most of line 15. That part of the Bill worries me. It deals with the funding formula for health authorities and primary care trusts—how much money the Secretary of State, in whichever way that he thinks appropriate, will give to them. For historic reasons, that causes me tremendous worry. The explanatory notes for clause 1 state:

Clause 1 changes the way in which resources are allocated fairly—

the critical word in the explanatory notes is ``fairly''—

between Health Authorities ... by the Secretary of State and between Primary Care Trusts

by health authorities.

There was a Labour Secretary of State from 1973 to 1979, and then a Conservative one from 1979 until my right hon. Friend the Member for South-West Surrey (Mrs. Bottomley)—who I know is not the greatest of favourites with the Department of Health—took over. For 23 years, I have admired the appropriateness of the sums that Secretaries of State have allocated to health authorities for health care. In most of that period, we had the old resource allocations working party system. My constituency is, to use a gross generalisation, affluent and middle-class. It is also part of an old regional health authority area, North East Thames which links my area with the east end of London—Newham, Redbridge and other places. We found that the funding distribution was not fair at all, by any definition. The east end of London, where there were regrettable social deprivation and problems but a falling population, took, if we use the crude terminology of pounds per head, a disproportionate amount of the health care budget, at the expense of areas at the other end of the regional health authority which were affluent and middle-class.

From 1977 until about 1990, therefore, we received, although we had an expanding population, an unfair proportion of the financing for health care because the part of the regional health authority area that had genuine social problems and needed more money had a declining population. I am not saying that more money from the centre should not be put into areas with greater problems, but I criticise the fact that affluent middle-class areas are linked with areas of utter social deprivation in the east end of London. That causes distortion.

My right hon. Friend the Member for South-West Surrey abolished that system when she was Secretary of State for Health and gave us a fair deal that led to substantial annual increases in health funding to make up for the adverse impact of RAWP until that time. Sadly, however, one of the first things that the current Secretary of State for Health did, when he was Minister of State in summer 1997, was to fine-tune the formula that my right hon. Friend had put in place. That meant that it slightly—not totally: we did not go back to a pre-1990 position—but adversely affected the formula for mid-Essex so that, although we no longer had a regional health authority area, more money was channelled back into the east end of London.

I do not begrudge the east end of London more money for health care because of its social problems. However, the Government should have given that area the money without fine-tuning a formula in such a way that they took money away from an area that did not have the social problems but had been adversely affected and was finally beginning to improve its position.

The impact has been bad. I am sure that you, Mr Maxton, unlike me, spent six weeks in March and April of 1997 heralding from the rooftops the little pledge on the Prime Minister's pledge card. The Prime Minister promised—[Interruption.] There is nothing awful in that. You, Mr. Maxton, were probably proud to tell your constituents in 1997 that if a Labour Government were returned, waiting lists would be reduced. I am sure that you did it.

Mr Philip Hammond (Runnymede and Weybridge, Conservative)

My hon. Friend is talking about the pride of Labour Members, but are they not desperately trying to forget about that little pledge card?

Mr Simon Burns (West Chelmsford, Conservative)

I am extremely grateful to my hon. Friend for slightly anticipating my next point. You, Mr. Maxton, and, I imagine, everybody on the Labour Benches, spent the six weeks of the election campaign shouting from the rooftops. In fact, my Labour opponent—sadly, he was direly unsuccessful, although I hope that he will be less unsuccessful at the next election, because I am counting on him to give me a good majority—banged on a lot—[Interruption.] We are talking about the fairness of allocation of money for health care through health authorities, which is relevant. You, Mr. Maxton, would have ruled me out of order if my point was not relevant.

It took my Labour opponent six weeks—and he is obviously not a convincing individual, because he is no longer standing as a Labour candidate—but he tried to convince my constituents that if a Labour Government were elected on 1 May 1997, there would be a new Jerusalem. My constituents would be able to go to the excellent local hospital, the Broomfield, where consultants would be queueing at the door and fighting among themselves to operate on them, because there would be no waiting lists. There would be no problems in the new Jerusalem.

Sadly, and this is when we return to fairness and the formula, that has not happened in mid-Essex. At the end of a Health Committee sitting, the Minister kindly told me that my health trust was a head case. Ironically, he was right.

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

That was not the expression.

Mr Simon Burns (West Chelmsford, Conservative)

That was the expression. To be fair to the Minister, it was used in the vernacular in a friendly way. I accept the context in which it was said, and I agree with him. To be fair to the Government, there have been improvements—we have a new chief executive and a new chairman—but to paraphrase the Secretary of State, one cannot turn round an ocean liner overnight.

We will examine the fairness of the formula—the money that North Essex health authority receives from the Government and the fairness of that money—with the result of the change of the formula, and its impact on mid-Essex. On 31 March 1997, 104 people in mid-Essex were waiting 12 months or longer and 8,341 individuals were waiting between one day and 18 months for health treatment.

The Prime Minister kindly wrote to me about my problems. I say kindly, because every time I have asked him about them in the House—the only question that I have asked him, though on five occasions in two years—he seems totally oblivious to what is happening in mid-Essex. During my time in government, every time the Prime Minister had a named question on the Order Paper, every Department was expected to provide No. 10 with a briefing on particular issues in the relevant constituency on matters such as unemployment, health or education. I am slightly surprised, therefore, that the present Prime Minister does not have a clue about what is going on. I always remind him afterwards when he claims not to know.

Even the Prime Minister agrees that there have been problems with health care in my constituency because of the fairness of the distribution of the money. On 31 March, 104 people were waiting between one day and 18 months for hospital treatment. At its peak in late 1998, there were 10,000—up from 8, 341. Even today, more than 9,000 people are waiting. My constituents, having gone to Broomfield hospital, and, despite the impression given at the election, not having seen consultants queueing up to give them treatment, cannot understand why the Government's pledge to reduce waiting lists has passed them by.

Mr Philip Hammond (Runnymede and Weybridge, Conservative)

I suggest that the solution to my hon. Friend's problem, and, perhaps, the reason why the Prime Minister is not focused on the issue, lies in the following piece of information: one of the Prime Minister's constituents waiting for surgery is nine times less likely to have to wait 12 months or longer than one of mine. My hon. Friend is speaking about fairness and equity. Does he think that that is the result of the Government's attempt to bring fairness to the national health service?

Mr Simon Burns (West Chelmsford, Conservative)

My hon. Friend is absolutely right. Like me, he represents a home county constituency, and the figures that he has mentioned must be broadly similar to those for my constituency. It does not altogether help my argument—

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

Then the hon. Gentleman should not say it.

Mr Simon Burns (West Chelmsford, Conservative)

I shall say it for the sake of fairness and for a cheap laugh. During my career, I have been Parliamentary Private Secretary to Ministers at the former Department of Employment and the former Department of Education and Science. During the period of my noble Friend Baroness Thatcher's Government, I was at the Department of Employment, and I assure the Committee that no job centre was closed in Finchley. When I was at the Department of Education and Science, education in Huntingdon was looked after so that it received good treatment.

Mr David Jamieson (Government Whip (technically a Lords Commissioner, HM Treasury); Plymouth, Devonport, Labour)

Oh!

Mr Simon Burns (West Chelmsford, Conservative)

It is somewhat disingenuous for the Whip to say, ``Oh!'' I could understand it from the lobby fodder on the Labour Benches, who do not understand such things, but the Whip and the Ministers are intelligent enough to realise that the constituency of a Prime Minister is, of course, looked after, as is that of the current Prime Minister. What saddens me is that, given the increased funding of the health service under this Government—which I do not criticise in any way, as I am proud to welcome and acknowledge it—there are still areas of this country, which do not have the Prime Minister or Deputy Prime Minister as their constituency Members, and which are being bypassed in terms of the pledge given at the last general election to reduce waiting lists. My constituency has not had waiting lists below the level of March 1997 for one single day. I warn the Minister that they will not fall below the level of March 1997 by 3 May either, although if he wants to pour money into getting my constituents better health care and quicker hospital operations during the next 10 weeks, I would be happy to drop the relevant part of my election literature, because I want a good deal for my constituents.

I shall return to my concern about the clause, and the reasons why I support the amendment tabled by my right hon. Friend the Member for North-West Hampshire. Despite what the clause states, neither the Secretary of State, his predecessor nor even the predecessors of my right hon. Friend the Member for South-West Surrey have allocated appropriately under the funding formula to pass money from the Department of Health or the Treasury to health authorities in areas in the home countries such as mine, if they have been linked—it is a slightly bizarre prospect but an historic one—to areas of extreme social deprivation.

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

I shall make a few brief points. According to my recollection, the expression that I may have used about a hospital in the hon. Gentleman's constituency was not the one that he stated.

Mr Simon Burns (West Chelmsford, Conservative)

It was.

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

No, it was a different expression, though I do not intend to put it on the record this afternoon. Undoubtedly, that hospital has had problems, which are being addressed.

Mr Simon Burns (West Chelmsford, Conservative)

I apologise to the Minister. I have just remembered that he was not referring to the hospital, as that would have been unfair, and he was not being unfair to the staff and nurses who work so hard in that hospital. He was referring to the trust, which is very different. Secondly, he did not say ``head case''. He said ``basket case''.

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

The hon. Gentleman will have to rely on his memory. I was indeed referring to the trust, not the hospital.

Mr Michael Jabez Foster (Hastings and Rye, Labour)

Perhaps my hon. Friend was referring to the hon. Member for West Chelmsford, not the trust.

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

If so, I would undoubtedly have used the other expression.

Despite the acknowledged problems that I am confident are now being tackled, the North Essex health authority waiting list for September 2000 was shorter than that for March 1997.

Mr Simon Burns (West Chelmsford, Conservative)

Will the Minister give way?

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

No. I should like to make some progress.

Mr Simon Burns (West Chelmsford, Conservative)

On that point.

Mr John Maxton (Glasgow Cathcart, Labour)

Order. The Minister is not giving way.

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

Thank you, Mr. Maxton.

According to the figures for the North Essex health authority, the number of people waiting for in-patient treatment in March 1997 was—

Sitting suspended for a Division in the House.

On resuming—

Mr Philip Hammond (Runnymede and Weybridge, Conservative)

On a point of order, Mr. Maxton. When the Programming Sub-Committee met and agreed a tight schedule, consideration was not given to the possibility that our proceedings would be interrupted by Divisions. That has happened twice this afternoon, but there might have been more Divisions during the sitting. Will you advise the Committee, Mr. Maxton, what the appropriate procedure would be if, during its consideration of a group of clauses, scheduled for one sitting, it became apparent that more time was needed? Would it be appropriate for any member of the Committee to move that the Committee resolve itself into a programming sub-committee and seek to extend the sitting by half an hour to compensate?

Mr John Maxton (Glasgow Cathcart, Labour)

Order. In theory, I am told that that could happen. I would have to clear the Room and call a meeting of the Programming Sub-Committee. However, in that case there would be a new programme motion, which would be debatable for half an hour; that would not necessarily be an appropriate way of spending the half hour that we lost. I think that we should play it by ear and see what happens.

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

These are new procedures that we are all learning to work with.

The waiting list in north Essex fell from 22,612 in March 1997 to 21,254 in September 2000.

Mr Simon Burns (West Chelmsford, Conservative)

I am sure that the Minister is not being disingenuous, but I was referring to mid-Essex. His written answer, which I have just received, states that waiting lists in mid-Essex, which is part of the North Essex health authority area, are about 700 patients higher, at 9,050, than they were at the last general election.

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

I am sure that the hon. Gentleman would want to confirm that his constituents are impressively served by the North Essex health authority and that the figures that I gave him were the correct ones.

The right hon. Member for North-West Hampshire made several points. Although we accept that the formula is capable of revision, and we have initiated such a revision, we would say that there are underlying health differences that justify the formula. It is not purely based on payment per head. For example, in north and mid-Hampshire, the death rate from coronary heart disease is 582 in the 65 to 74-year-old age group per 100,000, whereas for Salford and Trafford health authority, in the area represented by my hon. Friend the Member for Eccles (Mr. Stewart), the relevant figure is 797 per 100,000. That sort of difference in mortality rates and health statistics justifies the principle of a weighted formula approach.

Mr Philip Hammond (Runnymede and Weybridge, Conservative)

The Minister is quoting mortality figures; my right hon. Friend referred to morbidity figures. Does he accept that that is quite a different issue?

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

I agree that morbidity is different from mortality, although one frequently leads to the other, in popular experience. Whichever basis one chooses, a variation between areas is usually reflected in the figures.

The formula-based transparent approach is right, because it means that, if anything different from the formula is applied, the process is transparent. That is what we discovered when we made, in addition to health authority allocations, specific allocations to health action zones.

I agree with the point that health authorities occupy large areas and, with some of the mergers that have been proposed, they will become larger. Within them, there are significant variations, so it is important to have a fair shares target at the level of the primary care group or trust to keep pace with changes. Those of us familiar with Hampshire, for example, know that there are real inequalities, with some areas in the poorest health being under-targeted and those in the best of health above target. Targeting resources to a smaller area is an important principle.

However, it is worth saying, for the record, so that there is no avoidance or doubt, that no one has suggested redistributing the existing pool of general practitioners. The number of GPs is expanding, and will do so in the future; we must ensure that an appropriate proportion of the growing number of GPs goes to the areas that are under-doctored.

The same is true for resources. In 1996-97, in north and mid-Hampshire, the resources available to the health authority were £200 million. Next year, they will be £345 million. Even allowing for inflation, that is a huge increase, which outweighs the concerns about the detail of the formula. In the case of Southampton and South West Hampshire health authority, a health authority that I share with the hon. Member for New Forest, West, the funding in 1996-97 was £212.9 million. This coming year it will be £388.5 million. In the case of West Surrey health authority, to which the hon. Member for Runnymede and Weybridge referred, the figure for 1996-97 was £254.4 million. In the coming year it will be £432.5 million. In the much discussed case of North Essex health authority—I fear that this may not be the last time over the next three weeks that I have cause to refer to these figures—the funding in 1996-97 was £335.1 million. There has been an increase of £260 million during the period of this Government, and the figure for the coming year will be £595.4 million. Those figures put into perspective the claim that any right hon. or hon. Member's constituency has been hard done by under this Government.

Would the Minister to go back to something that he said a few moments ago? He said that we are talking about a substantially increasing number of GPs, not about redistributing GPs. Each year, a significant number of GPs reach retirement age or leave the service for other reasons. Is he telling the Committee that there will not be a reduction in the number of GPs in any health authority area?

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

I would be surprised if there were a reduction in any health authority area. One can never be absolutely sure without seeing the detailed figures, population shifts and so on. Given that we are seeking to increase the number of GPs by 2,000 net over the period of the NHS plan, I hope that we will see expansion, but I think that there is a case for faster expansion in some areas of the country than others. However, I cannot give an absolute assurance, because I have not looked at every health authority and its circumstances.

The number of GPs in individual practices always varies over time: practices grow or shrink, partly because of the population base and partly for other reasons. The underlying point is that we are expanding the number of GPs. We have made it clear that we regard the figure in the NHS plan as a floor not a ceiling. If we can expand further, we will.

Mr Philip Hammond (Runnymede and Weybridge, Conservative)

The Minister will be aware that the NHS plan proposes significant improvements in access to service provided by GPs, and the Government suggest that an additional 2,000 GPs will be needed to achieve that. The British Medical Association suggests that it will need four to five times that number. Is not the logic of what the Minister is telling the Committee that the improvements in service proposed by the NHS plan will not be available to areas that the Government consider to be over-doctored or adequately doctored if he intends to target most new GPs to areas that he considers to be under-doctored?

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

I do not accept that. We believe that the number of GPs in the plan will be adequate to meet the access targets and service developments set out in the period of the plan. It is important to offer that high level of primary care access not just in some parts of the country but across the country as a whole and, in particular, in areas which, in relative terms, are under-doctored. We should always talk in relative rather than absolute terms when we talk about the development of GP practices.

Sir George Young (North West Hampshire, Conservative)

I am grateful to the Minister for addressing the issues that I raised when I initiated this debate. I have never disputed the assertion that a differential approach to resource allocation is necessary and I made it clear that areas that faced greater challenges should have more money. However, I queried whether 80 per cent. was the right figure and I quoted from a panel set up by the Minister, which found no evidence for such a wide disparity. The document from which I quoted is now in the safe hands of Hansard, so I cannot draw on it again. I am not sure that the Minister's reply dealt with the independent panel's comment that that variation of 80 per cent. could be substantiated.

I caution the Minister before he quotes what seem to be substantial figures. Each time that I hear an announcement from a Minister about substantial new resources for my local authority, health authority or police authority, I take the precaution of writing to the authorities to ask for their assessment of the announcement. I must say that their perception of the increase is not always the same as that of the Government. In this case, the Minister referred to huge increases in allocations to my health authority. I did exactly what I have just described, and the reply from the director of finance stated:

The headline figures give only the tip of the iceberg. The funding covers cost increase and improvements across the range of health spending including local and specialist hospital services, community services, GPs and prescribing costs.

The letter also stated:

The `general increase' (estimated at 4.9 per cent. for us) is intended to meet the pressure on pay, prices and the cost of implementing NICE recommendations etc. that all health systems will face.

Large increases in resources for all health authorities were announced in November, so I wrote to my health authority and asked whether that meant that they did not need to find savings of £13.5 million. The director of finance's reply stated:

As the funding announced for next year is in line with the assumptions underpinning `Meeting the Challenges'—

that is the document looking for economies—

the proposals remain valid.

In other words, the authority has been unable to change the proposals that it made earlier in the year as a result of the increased allocation. I add those words of caution because the public in my constituency are becoming suspicious of large figures broadcast by Ministers. They cannot reconcile big increases with the local situation, where the health authority is scratching around for £13.5 million in savings.

On a more positive note, the Minister was able to say that there will be no reduction in GPs, which is welcome. I do not wish to press my amendment to a Division, but I remain concerned about the application of a formula that the Minister's independent panel believes to be unfair to one section of the health service. I ask him to pause before he inflicts a formula that does not have wide support on part of the health service, primary care, that is working well. This is a Treasury-driven proposal to cash-limit that portion of the NHS budget that is not currently cash limited. The Treasury has being trying to do that for years, and it has succeeded under this Administration. I urge caution on the part of the Minister before he pushes that forward to primary care services. Nevertheless, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Mr Philip Hammond (Runnymede and Weybridge, Conservative)

I beg to move amendment No. 10, in page 1, line 21, at end insert—

`(3AB) Prior to determining amounts under subsection (3) above or varying amounts under subsection (5) below, the Secretary of State shall publish details of the matters he shall take into account in accordance with subsection (3) or subsection (5) as the case may be and the way in which he will take them into account'.

The Chairman: With this it will be convenient to take the following: Amendment No. 9, in page 2, line 12, at end insert—

`(2B) Prior to specifying an amount under subsection (1) above or varying an amount under subsection (6) below, the Secretary of State shall publish details of the matters he shall take into account in accordance with subsection (1) or subsection (6) as the case may be and the way in which he will take them into account'.

Amendment No. 19, in page 2, line 24, at end insert—

`(1B) Prior to determining amounts under subsection (1)(b) above or varying amounts under subsection (3) below, the Authority shall publish details of the matters they shall take into account in accordance with subsection (1)(b) or subsection (3) as the case may be and the way in which they will take them into account'.

Amendment No. 21, in page 2, line 38, at end add—

`(2B) Prior to specifying amounts under subsection (1) above or varying amounts under subsection (4) below, the Authority shall publish details of the matters they shall take into account in accordance with subsection (1) or subsection (4) as the case may be and the way in which they will take them into account'.

Mr Philip Hammond (Runnymede and Weybridge, Conservative)

Thank you, Mr. Maxton. We are all on a learning curve with these new arrangements, and I have no idea whether it was the Government's intention that the effect would be, in practice, to curtail debate of some clauses that are important to interested and knowledgeable bodies outside Parliament. In order that we should have an opportunity to discuss clause 17, it will be necessary for us to spend a moment only on this group of amendments.

The issues that the amendments seek to address have already been aired in the previous two debates. If the Minister is genuinely committed to a transparent process, which entails the use of formulae that can be clearly understood and applied consistently and fairly, I suggest that the amendments are necessary or, at the least, can do no harm. They simply set out a requirement that the Secretary of State will make public the matters that he takes into account when he makes his funding allocation, and the way in which he does so. That is parliamentary phraseology for publishing the formula. If the Minister's intends to make the formula public, perhaps he would be good enough to tell the Committee that he accepts the amendments.

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

We already publish details of the current health allocations

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

We already publish details of the current health allocations formula and that process is quite transparent. Everyone knows the formula and local target and the pace of change that has been achieved each year. We fully intend to continue that arrangement for the additional element in the formula proposed in the clause and when the main allocation formula is revised, I am sure that that will be the case. Unlike the right hon. Member for North-West Hampshire, I find the 99 health authorities remarkably good auditors of the process. They are quick to shout if they think that things are not fair or not working.

As drafted, the amendment would add an unnecessary bureaucratic element to what is actually a transparent process. Everyone can see every year what the Secretary of State has done and how he has done it.

Mr Philip Hammond (Runnymede and Weybridge, Conservative)

I am grateful to the Minister. It is not clear from the present wording in the Bill that there will be a formula and that it will be made public, but the Minister has effectively reassured the Committee and me that that will be the case and on that basis, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

I beg to move amendment No. 3, in page 2, line 24, at end insert—

`(1B) The Secretary of State shall in directions under subsection (1A) have regard to the need to ensure and maintain an adequate distribution throughout England and Wales of medical practitioners providing general medical services under arrangements made under section 10 or providing personal medical services under section 28C'.

Mr John Maxton (Glasgow Cathcart, Labour)

With this it will be convenient to discuss amendment No. 4, in page 2, line 38, at end add—

`(2B) The Secretary of State shall in directions under subsection (2A) have regard to the need to ensure and maintain an adequate distribution throughout England and Wales of medical practitioners providing general medical services under arrangements made under section 10 or providing personal medical services under section 28C'.

Clause 17

New clause 2—Medical Practice Advisory Body—

`.—(1) There shall be a body to be known as the Medical Practice Advisory Body.

(2) The Secretary of State may make regulations for the membership, constitution and operation of the Medical Practice Advisory Body.

(3) The function of the Medical Practice Advisory Body shall be to advise the Secretary of State on the maintenance of an adequate distribution throughout England and Wales of medical practitioners providing general medical services under section 10 of the 1977 Act or providing personal medical services under section 28C of that Act.

(4) Any advice given to the Secretary of State by the Medical Practice Advisory Body shall be published in such manner as that body determines at the time the advice is given.'.

Mr Philip Hammond (Runnymede and Weybridge, Conservative)

Amendment No. 3, along with amendment No. 4, deals with the question of how the Secretary of State will use the formula with which he is empowering himself in clause 1 in order to ensure an adequate distribution throughout England and Wales of medical practitioners. The amendment would place upon the Secretary of State a specific duty to use the powers in clause 1 in such a way that an adequate distribution was ensured.

Clause 17 abolishes the Medical Practices Committee. That raises a number of questions about how health authorities will exercise the powers that will then reside with them when vacancies for GPs arise in their areas and in relation to local versus national priorities. Health authorities will now be working with unified budgets and considering filling GP vacancies in the context of other pressures.

My hon. Friend the Member for West Chelmsford (Mr. Burns), my right hon. Friend the Member for North-West Hampshire and I all have experience of health authorities under extreme pressure—sometimes to make cash reductions in order to repay loans. There will be pressures on health authorities to resist filling medical vacancies for general practitioners in order to meet other needs.

Dr Peter Brand (Isle of Wight, Liberal Democrat)

I was not aware that the Medical Practices Committee had the power to extinguish a vacancy. I should be grateful if the hon. Gentleman could explore with the Minister whether the new arrangement will create such a power. The Medical Practices Committee has largely been about the ability to expand rather than to replace retiring partners.

Mr Philip Hammond (Runnymede and Weybridge, Conservative)

My understanding is that the financial allocation mechanism, using as it does a rather crude cash-limiting basis, will in practice constrain health authorities' ability to fill vacancies, as well as constraining their ability to expand the service. The Minister will, of course, correct me if that is a misinterpretation, but it seems that there will in effect be a single global budget, and if the health authority wishes to expand another aspect of its service, or indeed, has to meet a deficit and repay brokerage that it has already incurred within the system, it may find that it has to postpone or cancel filling vacancies.

A number of concerns have been expressed about the abolition of the Medical Practices Committee, which has existed for many years—for as long as the NHS, I believe—to provide strategic guidance in the allocation of general practitioners across England and Wales. I am worried that by abolishing the Medical Practices Committee, the Government may be shutting the stable door after the horse has bolted.

In a letter to the Secretary of State dated 17 January, the chairman of the MPC said that

incorrect and misleading information is being presented as a justification of the proposed abolition.

He drew the Secretary of State's attention to the fact that paragraph 13.10 of the national health service plan states that

there are 50 per cent. more GPs in Kingston and Richmond or Oxfordshire than there are in Barnsley or Sunderland after adjusting for the age and needs of their respective populations.

The data quoted in the NHS plan were already three years out of date when the plan was published. Last week, those assertions were repeated in the House on Second Reading. In fact, using up-to-date figures that are adjusted for patient needs and demands and taking into account the growth of personal medical services—the PMS pilots, which the MPC supports—there will be proportionately more GPs in Sunderland and Barnsley than in Kingston and Richmond or Oxfordshire.

What is the Minister trying to achieve by abolishing the MPC? The letter from the chairman of the MPC refers to

a letter from your Minister of State's office—

so it is not clear whether it was from the Minister or his ministerial colleague, The Minister of State, Department of Health, the hon. Member for Barrow and Furness (Mr. Hutton)—

dated 30 August last year, just one month after the publication of the NHS Plan, it was stated that ``...the MPC has made a valuable and important contribution over the years towards achieving equity in the distribution of doctors providing general medical services in England and Wales.'' This is a view—

shared by—

the BMA's General Practitioner's Committee and the Royal College of General Practitioners.

The number of general practitioners is finite, and it may not be true that it is no longer appropriate to retain the existing successful formula for ensuring their equitable distribution in England and Wales. Using a financial allocation formula can only create a market for a scarce commodity—GPs. Health authorities may be able to attract GPs to their under-doctored areas through enhanced financial inducements, but if only a finite number of GPs is available, that activity must occur at the expense of other areas.

New clause 2 would create a new body, the medical practice advisory body, to advise the Secretary of State—remember that he has the power to issue directions to health authorities—on action that must be taken to ensure an equitable and adequate distribution of GPs. It would also provide for that advice to be published. That would mean that there was a body—independent of the Secretary of State—considering the distribution of GPs, advising the Secretary of State about how he needs to exercise his powers under clause 1 to address any inequities or inadequacies in distribution, and publishing that information so that interested parties—the professional bodies, the public and whatever feeble watchdogs of the public interest remain after the Government have abolished the community health councils—can see what the advice is and bring the appropriate pressure to bear on the Secretary of State.

In the letter, the Minister of State clearly acknowledged the value of the MPC. There is a theme running through the Bill. The Prime Minister's office wrote to the Sedgefield community health council congratulating it on the work of community health councils and wishing it every success in the future, only five minutes before the Government announced that they were abolishing all the CHCs without consultation. In August, the Minister of State wrote to the MPC confirming its excellent work in ensuring the adequate distribution of general practitioners, only weeks before the Government announced that that was to be abolished. A letter of praise from someone in Government seems to be the kiss of death for any public service body.

As time is so short, I want to ask the Minister a couple of specific questions on abolition of the MPC. What will the Secretary of State do if an inequitable distribution of GPs develops? If there is a problem when he has published and implemented his formula, what will he do? If the Government intend to regulate the distribution of GPs via resource allocations to health authorities, what consequences will relative local efficiency or inefficiency in the use of those resources have in practice for the distribution of GPs? Will the Minister tell the Committee what transitional arrangements will be put in place? Will the MPC be expected to complete existing applications for additional or replacement GPs before it is wound up? What safeguards will be contained in the Secretary of State's directions to health authorities to ensure and maintain an adequate distribution of GPs throughout England and Wales. Perhaps most importantly, how does he intend to avoid levelling down, which would damage patient care, as GPs are siphoned away from the stronger areas to deal with the acknowledged problem of under-doctoring, but in the process damaging the infrastructure in those areas that are currently not under-doctored?

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

It may be helpful if I respond as briefly as possible to the hon. Gentleman's main points.

No one is suggesting that the Medical Practices Committee has been a failure or that it has not sought to do its job well, but there is an unequal distribution of GPs throughout the country, despite the MPC's role during the past 50 years.

Dr Peter Brand (Isle of Wight, Liberal Democrat)

Is it not a fact that the MPC has been largely ineffective because it has not had the power to direct? If the pattern described by the hon. Member for Runnymede and Weybridge were true, we would have a Cuban-type health system in which doctors could be directed where to go. Does the Minister recognise that independent practitioners will move to where jobs are created. If vacancies are not filled, patients will find themselves without GPs.

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

The MPC has had the power to say no, but it has not had the power positively to create the circumstances in which GPs would move to areas in which there were too few doctors. Enabling development of resource allocation in the way that have I described will make it easier for areas that lack doctors to attract them. The reality is that, 50 years on, we have not achieved an adequate level of general practice availability in every part of the country.

Mrs. Ro Day, chair of the Medical Practices Committee, suggested that the figures are out of date and referred to personal medical services, but the reality is that the increase in PMS doctors in Sunderland is the result of my overruling the advice that I received from the MPC not to allow PMS practices to be created in Sunderland on the scale suggested. That highlights some of the difficulties with the mechanism.

In the remaining time available, it is important to consider whether the system simply leaves the health authority, with its resource allocation, to decide what to do about GPs. The answer is no.

The decisions taken by health authorities need to be set in a wider context. Health authorities and primary care trusts are already responsible for salaried GMS GPs and the wider NHS work force, including community and hospital services, and they have a growing role in relation to PMS GPs. GPs are an essential part of that picture. Health authorities should consider GPs and the wider primary care work force in a strategic way. Determining the need for GP vacancies must form part of the health authority's local strategic planning for all its services. It must take account of the potential of the whole work force. The additional—

Dr Peter Brand (Isle of Wight, Liberal Democrat)

Will the Minister give way?

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

I should like to make some progress, but I will give way later if I can.

In the new arrangement, we are devolving responsibility for GP distribution to health authorities, but not in isolation. Health authorities must consider GP numbers as part of their whole NHS work force planning. There is a need for a framework to oversee national GP distribution.

The Government will set up a new national work force development board in April, as set out in last year's work force planning review and as reflected in the national plan. It will oversee the development of the work force of all NHS clinical staff, including GPs and their staff, at national level. The medical education standards board will keep under review the impact of training requirements on the distribution of GP trainees and principals. Through the national work force development board, we have established an integrated structure of national work force planning, which will be reflected in health improvement programmes at local level.

Performance monitoring and the management of work force numbers will be integral features of the new system. Performance management of health authorities by regional offices will be informed by the work of the national work force development board and the medical education standards board. As part of the process, regional offices will agree targets for GP growth with individual health authorities. That is the right balance. Health authorities will be given the freedom to manage the development of their local services across primary and secondary care.

Our new structures for work force planning and regional office performance management will provide the national framework and the necessary safeguards within which health authorities will take decisions about GP distribution. The hon. Gentleman asked about the safeguards in the system. I have described the way in which we intend it to work. The Government are committed to achieving the targets that we set out in the NHS plan and we want to ensure that those mechanisms allow us to achieve them.

Dr Peter Brand (Isle of Wight, Liberal Democrat)

Could the Minister tell us whether the new system will allow health authorities to extinguish vacancies when there is a retirement?

Mr John Denham (Minister of State, Department of Health; Southampton, Itchen, Labour)

The current power, as I understand it, means that a vacancy is not filled unless the health authority makes a proposal to the Medical Practices Committee, which then considers it as a vacancy. Many of its decisions are taken on the basis of information provided by the health authority. We are transferring that decision to the health authority, rather than having it taken by the Medical Practices Committee at national level.

I hope that I have helped the Committee. I also hope that, in the brief time available, I have assured the hon. Member for Runnymede and Weybridge that, although we want health authorities to exercise the responsibility of planning the development of GP numbers and primary care, we want to do so within a framework that ensures that GP expansion is properly managed throughout the country.

Mr Philip Hammond (Runnymede and Weybridge, Conservative)

What we have been engaged in over the past half hour is not proper scrutiny of the Bill. I understand that it is not possible for us to vote on clause 17. As we have not exhausted the issues, I will press amendment No. 3 to a Division.

Question put, That the amendment be made:—

The Committee divided: Ayes 6, Noes 9.