There shall be established a Quality Control Commission for the Health Service in Scotland. Its members including the chairman shall be appointed by the Secretary of State following consultation with Health Boards, local authorities, the CBI in Scotland, the Scottish Trade Union Congress and such other bodies as he considers appropriate. Its responsibilities will include:—
It may be convenient for the House if I tell the hon. Member for Moray (Mrs. Ewing) that I am happy to accept amendment (a).
Following the controversy over new clause 1, and knowing the generosity of the Under-Secretary of State for Scotland, the hon. Member for Stirling (Mr. Forsyth), and the uncontroversial nature of new clause 2, I am certain that we shall not have such a vote again and that the Minister will be happy to accept the new clause. That will save the House and the Government considerable inconvenience.
The Minister has shown in the past 10 days that he is happy to establish new quangos in Scotland. He set up the new National Health Service management executive under Mr. Cruickshank last week, and earlier today he established new special health boards in Scotland. As he is merrily setting up quangos all over the place in Scotland, I feel certain that he will set up one more, as proposed in the new clause.
The hon. Gentleman is wrong to describe the NHS management executive as a quango. It is a management executive within the Scottish Home and Health Department, being part of that Department. It is not a quango. The previous new clause did not set up a body, as the hon. Gentleman suggests; it gave the Secretary of State power to set up such bodies.
As usual, the Minister is splitting hairs. I accept that the earlier new clause gave the Secretary of State power to establish special health boards, but I understand that in a written answer this afternoon he made it clear that he intends to use that power to establish a special health board in Scotland for the purpose of carrying out health education. Whatever one may call it, it will be a quango. It may require the laying of an order under the negative procedure to bring it into being, but he intends to do that.
If the new management executive is to be appointed by the Scottish Home and Health Department from its employees, it will be a Civil Service body and not a quango. But he does not propose that course. He intends to bring in people from outside to be on it. In other words, the Minister is splitting hairs by contradicting me. In any event, I am sorry that he took so seriously what was intended to be a mild joke. Perhaps at this hour he has lost what little sense of humour he has.
The new clause is important, although perhaps not in its detail and technicality, because in the past 10 years we have experienced dramatic changes in the NHS in Scotland and in the demands made on it. Some of those demands have been outwith the control of the Government, such as the demographic changes throughout the nation which have resulted in fewer births at one end of the scale and many more elderly people at the other. Those changes have put strains on the NHS.
The dreadful new disease of AIDS is already causing problems in the Lothian health board area and will undoubtedly cause increasing problems to all the health boards in Scotland. Dramatic technological breakthroughs have given hope to many, but they are expensive both in terms of the operations involved, such as transplants, and the long-term costs in caring for the individuals who undergo such treatment.
In addition, there are the changes over which the Government have control. Particularly worrying to us are the changes that the Government have already initiated and those that will occur as a result of the Bill. We have had ever-increasing rises in prescription, dental and optical charges, with charges now for the testing of eyes and for limited dental treatment. In addition to changes affecting drugs on prescription lists, we have suffered the harsh and hasty imposition of the share formula in Scotland, with cuts in spending in the two largest health board areas, Glasgow and Lothian.
We have had the introduction of general managers and the privatisation of many NHS services, all of which have caused patients and health boards great problems. Now we face the opting out of hospitals, fund-holding general practices, the internal market, indicative budgets and the need to ensure that the community care provisions in the Bill are properly implemented. At the same time, the Government are actively encouraging private medicine in Scotland, a concept that is foreign to the Scottish medical scene and is blurring the line between the public and private sectors.
Health boards, emboldened by the Minister's support, are seeking to extend privatisation well beyond the ancillary services: into radiography, laboratories, pharmacies, medical records and even kidney dialysis—and, of course, care for the elderly. Given such enormous developments and changes, it is essential that the quality of services should be monitored, and that quick and effective action should be taken to deal with any problems.
The Government constantly claim that all the changes in the Bill are designed to give patients a better and more responsive service. As a Glasgow Member, I find it hard to see how cutting funds for the Greater Glasgow health board year in, year out can improve services in a city with the unenviable reputation of having the worst urban health record in western Europe.
It is for the Government to prove their claims to the Scottish public. They are always giving statistics to show that they are spending more on the Health Service, that Glasgow and Lothian are the best-funded health authorities in Britain, and that more is spent per head on health in Scotland than anywhere else in Britain. I am sure that the Minister will give us the same statistics tonight that he has given us throughout his career as Health Minister. The problem is that no one in Scotland believes him: patients, doctors, nurses and other Health Service workers all think that the service has worsened since the Government came to power, and that the changes in the Bill—and the privatisation of services—will only make matters worse.
The new clause would establish a quality control commission for the Health Service in Scotland. I have given way to the popular Government norm of Government appointment, although I believe that it should be a matter for consultation with certain bodies. The commission will be empowered to establish certain defined qualities for each service, and to ensure that they are observed. Above all, if a service is privatised or put out to competitive tender, the commission will be able to monitor quality and ensure that it is improved if necessary. If the service fails to meet the previous standards—or the standards laid down by the commission—the commission will have the power to instruct the health board to end the contract and introduce in-house staff.
The Health Service in Scotland is no longer an integrated whole, and once the Bill goes through it will be even less so. It will not be possible to plan for the different components to work together informally to ensure that help is provided in the areas that they cover. Hospital cleaners and caterers—and, perhaps, radiographers, laboratory assistants, technicians and even those who work the dialysis machines—will no longer be responsible to, and the responsibility of, the management of their hospitals. Instead, they will be responsible to, and the responsibility of, other managers who may not even reside in the United Kingdom, let alone Scotland. International companies will be running many of the privatised concerns. Such people cannot be seen as part and parcel of a Health Service team that is running a hospital in the way that they have been in the past.
If the Bill is enacted, we shall have opt-out hospitals and fund-holding practices. The Health Service will work on a contract basis. The opt-out hospitals will still be funded by the NHS and related to it by commercial contracts, but they will not be part and parcel of an integrated Health Service. Their facilities will be available to the Health Service but they will be separate from it and will operate quite differently from the rest of the Health Service.
Even within the Health Service there will be the constant aim to seek contracts between different parts of the Health Service. The relationships will all exist on a separate commercial basis, not integrated and planned in the way that they have been in the past. Therefore, there must be some organisation such as that suggested in the new clause to ensure that the quality of the Health Service is maintained.
We oppose most of the Government's changes to the Health Service and we would like to reverse them. But while those changes are being made, it is essential that we try to maintain quality.
I am following the hon. Gentleman"s argument closely, and I support the general thrust of Ins case, but why does he include the CBI in Scotland and the Scottish Trades Union Congress, neither of which organisation I object to, but no health care professionals on the quality control commission? Is that deliberate, and, if so, why?
There are Health Service unions with the necessary expertise within the STUC. The new clause refers to other bodies that the Secretary of State considers appropriate, and that would include the health professionals about whom the hon. Gentleman is talking. I am sure that he has read the new clause sufficiently carefully to see that even though it may not be spelled out.
If the Government genuinely believe in their past reforms and those that they now seek to establish, and if they genuinely believe that those are in the interests of patients in Scotland, they will happily concede at least the principle of the new clause, even if they find fault with its wording. If they do not, the people of Scotland will rightly say that the purpose of the privatisation that has taken place and the other reforms in the Bill is not for the good of the patient or to improve the quality of service but, first, to give profits to large numbers of the Minister's friends and, secondly, to shift the Health Service in Scotland, as in the rest of the United Kingdom, towards a commercial Health Service which will eventually lead to the privatisation of the NHS and to a much greater use of private medicine by most of the population.
If we consider the privatisation of services in Scotland, we are entitled to be sceptical about its so-called advantages. Unlike England, the Scottish health boards were reluctant to go down the road of competitive tendering. In 1983, the then Minister for Health put out a circular asking health boards
to test the cost-effectiveness of their domestic, catering and laundry services by seeking tenders for these services from outside contractors and comparing them with the cost of in-house services.
It also asks boards in appropriate cases to let contracts to private firms.
Because the circular asked the health boards to do that, most—nearly all—simply said no. They did not want to have anything to do with privatisation. Even the Greater Glasgow health board unanimously voted against putting any of its services out to contract at that time. I have never managed to find out how she voted, but one of the then board members was Lady Goold, the wife of the then chairman of the Conservative party in Scotland. Apparently she was opposed to privatisation.
The boards conducted a series of negotiations with trade unions and came to agreements about improving—in inverted commas—the services that were being provided and seeking greater efficiency within the Health Service. However, along came the general election of 1987, the Minister with responsibility for health, John MacKay, lost his seat, and the Prime Minister and the Secretary of State had the difficult job of choosing a Minister of Health from the hon. Member for Tayside, North (Mr. Walker) and the hon. Member for Stirling (Mr. Forsyth). They decided that the hon. Member for Stirling, with all his ideological faults, would be a better Minister than the hon. Member for Tayside, North.
Just for once I can say with an absolutely clear conscience that I agree with both the Prime Minister and the hon. Gentleman. Whatever the faults of the hon. Member for Stirling, and however difficult the choice might have been, I think that the Prime Minister made the right choice.
I do not intend to raise the matters raised by my hon. Friend the Member for Workington (Mr. Campbell-Savours), but not only is the hon. Member for Stirling an ideologue but he makes no bones about the fact that, prior to becoming a Minister, he had commercial interests in this issue. He has given them up, and I accept that absolutely, but the fact is that his previous business experience and his ideology lead him to believe in the privatisation of the Health Service, particularly of those services that can be put out to contract. As soon as he came to office, there was a drive towards the privatisation of the Health Service in Scotland.
The Minister organised a seminar on 2 October 1987 which was attended by health board general managers and chairmen, representatives of contractors and Scottish Home and Health Department officials. There the two parties were brought together and told, "Come on, we want to see privatisation." The boards' membership had changes, general managers, such as Laurence Peterken in Glasgow, had been appointed who were almost as comitted to privatisation as the hon. Member for Stirling, and the drive was on.
In December 1987, the Minister sent out a letter to general managers stating:
As you know, the Minister is very concerned that so little competitive tendering for support services has been undertaken in Scotland,
and wants things to move faster. It continued:
Competitive tendering for support services must be pursued with greater vigour.
The hon. Gentleman always says that it is a matter of competitive tendering, and that includes in-house tendering. That is right, but in the letter he did not say that that was where the health boards had to look first and that they should take greater account of the in-service tenders—far from it.
The letter stated that boards were directed to seek to co-operate with private contractors and specifically asked to explore options informally before tenders were invited, show a willingness to consider more flexible forms of contract, avoid over-complex tender documentation, provide adequate time for contractors to prepare bids and produce monitoring arrangements without being excessively burdensome to the contractor. The Government wanted to find the easy way of doing the job and ensure that it was made as easy as possible for those outside contractors. That is how we went down the road towards the privatisation of services in Scotland.
Since then there has been the contracting out of a fair number of services, but it is still early days to judge all of them. I accept that a few have been awarded to in-house tenders. However, even then it means a reduction in the service provided. To obtain that in-house contract often means cutting the number of people employed and a reduction in wages and overtime. Those employees often have to work shorter hours with considerably less pay. Although the work is better done by in-house teams than outside contractors, because fewer people are doing the work for less money it is less well done than in the past.
It is not simply a matter of whether a floor is cleaned properly or whether the auxiliary services that provide the tea do the job adequately; it is a question whether they are still part of the team. Once services have been contracted out, even to an in-house team, the bond between the workers in the hospital is broken, and that causes problems.
I am listening carefully to the hon. Gentleman's fascinating remarks about competitive tendering. He does less than justice to the in-house work forces in the Health Service in Scotland, which have won three quarters of the contracts. Is he saying that standards are falling? Is he criticising the standards that were set out in the contract—which do not show a diminution of standards? Is he criticising the in-house teams for a failure to perform to the standards to which they committed themselves when they won the contract?
That is the divide between us—the Minister believes that nothing can be done other than on a commercial contract. He cannot understand that people co-operate and work together as part of a team in the Health Service. He believes that everything is about cash and contracts.
The hon. Gentleman is most courteous to give way, unlike some of his colleagues—[Interruption.] The hon. Gentleman is always courteous. I have listened carefully, but I find great difficulty in relating his remarks to occurrences during the winter of discontent, when all those people with their team spirit did everything that they could to destroy the working of our hospitals. They set out to destroy the Labour Government.
I shall be rude, not courteous. The only mental quality that I have ever found in the hon. Gentleman is that he is much like an elephant—he has an extremely long memory. All professionals in hospitals, from the doctors downwards, believe that they should operate as a team. Contracting out, whether or not in-house, breaks that bond. If people work for lower wages and with poorer conditions of service, their loyalty to the hospital and to the team is considerably less. They are bound to deliver a service at a certain price. They cannot exceed it.
I know that the hon. Gentleman has spent some time in hospital following an accident. He must agree about the psychological impact of a friendly ward orderly. He is an untrained worker whose job is to sweep up or to pour cups of tea for patients and nurses. He feels that he is part of a team. Because of his loyalty, his impact on the psychology of patients is enormous. I have seen it in operation. When we privatise and bring in the commercial element, we break the loyalty, and the position gets worse.
The Minister is right; three quarters of the contracts have been won by in-house teams. The health boards have seen what happened in England and Wales when contracts were given to private companies. They have seen the effect and they want nothing to do with them. Many of them have tried desperately to find a way to in-house contracts.
Even with in-house contracts, it is not as easy as the Minister suggests. The general manager may force further cuts. We had the example less than a couple of years ago of the catering staff in the Royal Hospital for Sick Children and the Queen Mother maternity hospital in Glasgow. There was no bid from a private company. The in-house contract cut the cost. The in-house team cut and cut again, and closed certain things. At the end of the day it was told that the contract would not be accepted until there was a further cut in the cost, although that was the only bid. We are talking not about mass catering for a factory but about the complex diets of sick, young children.
We have seen the impact south of the border when private companies have won contracts. Health boards in Scotland are judging accordingly. Health authorities in England and Wales have had to cancel contracts. Already in Glasgow at the Victoria infirmary the cleansing company has been fined more than £3,000 for failing to carry out its contract properly. The general manager of the company said that he should not have to pay the fine because he thought that he was carrying out the contract properly.
After the company had been fined, the health board gave the contract for portering in five hospitals in Glasgow to the same company. The board did not take account of the incompetence already shown in cleansing at the Victoria infirmary. Having seen that the private company was interested only in the profit that it could make, the board gave it further contracts. A friend of mine who works in the Western infirmary in Glasgow said recently that he saw a new porter from the privatised company waking up a patient to find out where the X-ray department was. That is the portering that hospitals are now experiencing.
With low wages there is a high turnover of staff in privatised companies. I shall repeat a story which I told in Committee of two porters in a lift in the Western infirmary. One said to the other, "Why on earth are you working here for these abysmal wages?" The other said, "Because I am more likely to get another job if I have this one than if I am trying to get a job from the unemployed register." The chances were that he would not be long in that hospital, that he would never learn the job adequately and that he would never have great loyalty to the health board or the hospital.
Certainly in Glasgow and in Ayrshire and Arran health boards there will be an extension of privatisation. I am talking not about ancillary services but about core services which are essential to the medical needs of patients. The Greater Glasgow health board is considering putting out to private tender the laboratory services and the testing of samples. Companies will come in and take over those services. They will also take over the pharmacies and the control of drugs in a health board area. That seems to be a recipe for high costs as only one drug company will take the contract. Companies might also take over medical records. I agree that in the Greater Glasgow health board area there is a need to improve the handling of medical records. If someone's medical records are at the Southern general and that person has an accident and is taken to the Western infirmary, it cannot be right that the medical records at Southern general are not available. However, to put medical records, with all their confidential information, into the hands of private companies which are operating solely for profit is totally wrong.
Radiography and X-rays are also to be put out to tender. The Ayrshire and Arran board is considering putting dialysis out to private tender. The care of the elderly is also subject to private tender and many of my hon. Friends will refer to that in greater detail. However, there will be a great deal of privatisation and there will be great changes with the opting out of hospitals.
The Opposition would prefer the Health Service to remain a service based on caring for patients and one that provided the health care that we believe should be provided. We are intent on delivering that kind of Health Service. We do not believe in making the Health Service a commercial operation, although the Minister obviously does. If the Minister insists on following that path, we insist that the care should be monitored in Scotland, and the clause would provide that monitoring.
I listened to the hon. Member for Glasgow, Cathcart (Mr. Maxton) with great interest. He gave us a broad brush account of the Health Service in Scotland, but did not give us much information about what his proposed monitoring commission would do. When we set out the structure of the Health Service in Scotland under the National Health Service (Scotland) Act 1972 we adopted a one-tier system that became the envy of the United Kingdom because England and Wales adopted the two-tier system. It would be a great pity if we added another layer of bureaucracy to a system which, in general, is working very well. With the assistance of the hon. Member for Aberdeen, North (Mr. Hughes), the Standing Committee on the 1972 Act included in the legislation the health councils and the Parliamentary Commissioner for Administration. Those are two good checks on failure within the area health boards. It is unnecessary, given those two checks, to have the additional bureaucratic monitoring system suggested by the hon. Member for Cathcart.
Mr. Robert Hughes:
Is the hon. Gentleman aware that the number of local health councils has been reduced drastically and they have to cover much wider areas? Therefore, the checks and balances to which he referred so flatteringly have been cut severely and that cannot be good for patient accountability.
The hon. Member for Kilmarnock and Loudoun (Mr. McKelvey) may groan away. I have been speaking for only two minutes. The hon. Member for Cathcart spoke for about 40 minutes. It would be a bit rough for me to have to make my speech in two minutes.
The hon. Member for Aberdeen, North made an important point about the health councils. Their duties are laid down specifically in the 1972 Act and they were to monitor the work of the area health boards. I am afraid that many councils seem to have undertaken operations that are far more extensive and far beyond the scope of what they were originally set up to do and, because of that, they have lost a lot of the influence and power they should have had, as laid down by that Act.
The hon. Member for Cathcart was quiet about costs. Inevitably, it would be expensive if the plans set out in the new clause were to be fulfilled. A fairly effective scientific back-up would be needed to monitor all the schemes that the hon. Gentleman feels are worthy of investigation.
The new clause is a major criticism of the area health boards. Of course, they do not run as effectively as everyone would wish, but, by and large—I can speak mainly of the Dumfries and Galloway health board in my area—they run effectively. As the constituency Member, I deal with that board and, indirectly, with Glasgow, to which several patients from Dumfries have to travel. As my hon. Friend the Minister knows—and will know again tomorrow when he receives another letter—I have some criticisms of the working of the Glasgow board and the staff under its jurisdiction. However, by and large, I should be happy to leave the decision about the quality of the Health Service in Dumfries and Galloway to the area health board itself. After all, that is why its members are appointed. Their prime duty is to ensure that there is an effective Health Service and that the administrative and medical staff provide the highly efficient Health Service to which the constituents of Dumfries and Galloway are entitled.
The Minister knows that I have never been the world's greatest enthusiast for the privatisation of individual aspects of the Health Service or of self-governing hospitals. I very much doubt whether the Dumfries and Galloway royal infirmary will ever become self-governing, but I accept that the procedures for competitive tendering have had an important impact on the Health Service. I have always welcomed the fact that in Dumfries and Galloway the in-house bids have won on each occasion and I have supported the health board to that end. My goodness, many hundreds of thousands of pounds have been saved, which have gone directly to patient care, which is the prime objective of the policy of my hon. Friend the Minister.
The poll that was held in the Health Service last year showed that patients were satisfied with the quality of medical care under the health board. All the proposals in the new clause should be carried out effectively by the health boards themselves. We do not need another monitoring body, which would inevitably cost a great deal of money, without any guarantee that it would show up faults of which the health board was not already aware and for which remedies were not already in place.
The hon. Member for Cathcart rightly praised the Health Service for the team spirit that it engenders. That is right. The medical, domestic and administrative staff must all work together with the common objective of providing the very finest Health Service possible for the patients in the area. From my experience, I believe that that is exactly what happens.
I believe that, because we have the structure provided under the 1972 Act, it would be unfortunate to bring in another layer of management, or—some would say—of interference, when the work is being carried out effectively at present. There are enough checks and there is good administration and effective management. Because of that and because my hon. Friend the Minister channelled additional resources well above inflation into the Health Service this year and last year, we have been able to increase extensively the number of hospital buildings and other facilities during his period of office.
I have listened carefully to the hon. Gentleman's argument. He is skirting round the crucial aspect of the change introduced in the Bill. He and I know that in our areas the area health boards provide a perfectly acceptable service. The new clause has been introduced because the new competitive element introduced into a rural area will make quality much more difficult to attain. What representations has he had from his health professionals about whether the new competitive, free market approach in the Bill will affect the local health service?
The hon. Gentleman is putting into my argument something that I did not argue. I have had extensive consultations and, like all hon. Members, a large mail bag in the past 12 months. Many people were full of foreboding that the Health Service would be a shambles. Here we are 12 months later and the Health Service is rather better than it was 12 months ago. In 12 months' time it will be better still and 12 months after that better still again. Opposition Members are full of forebodings that misrepresent what my hon. Friend the Minister and my right hon. Friend the Secretary of State are doing to make the NHS better.
I accept that, as the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) said, we have good area health boards and good general hospitals. But that does not mean that that is the case throughout the country. Certainly it is not the case throughout the United Kingdom. I hear stories about hospitals in urban areas where a great deal needs to be done. [Interruption.] Does the hon. Gentleman wish to intervene?
The hon. Gentleman is champing away. He will have plenty of time to speak. I am speaking against the new clause which will make it much more complicated and more expensive to provide a high-quality Health Service. I do not want the change suggested by the new clause. It will not add to the effectiveness and efficiency of the area health boards.
No. In the new clause, the hon. Gentleman is creating a completely new structure to monitor what is happening not only now but in the future. That is completely unnecessary. If the area health board is not doing its job, will it need to be monitored by another extraneous body such as the TUC?
If we had a Select Committee on Scottish Affairs to monitor the activities of the health boards, perhaps the new clause and others would not be necessary. My hon. Friend the Member for Glasgow, Cathcart (Mr. Maxton) is correct. The new clause has been tabled to compete with the Government's clause. They want to introduce a new health board which has an overseeing role and will be given extensive powers by the Government. If we do not need the overseeing group, we do not need the new health board. It would probably solve the problem if some Conservative Back-Bench Members would get off their backsides and serve on a Select Committee on Scottish Affairs which could consider such affairs.
The hon. Gentleman could have spent a few hours in Standing Committee to help balance things up. I will not rise to his challenge about the Select Committee. He knows as well as I that all the Select Committee's reports over the umpteen years produced singularly few results, particularly the report on the NHS. [HON. MEMBERS: "Why"?] I do not want to be diverted from the issue before us. New clause 2 is wholly unnecessary, wholly bureaucratic and highly critical of the management of the area health boards, and I am not prepared to accept it.
My final point relates to renal dialysis units and the Minister will know what I am about to say. I think that Dumfries and Galloway will have these units soon. They must be spread much more evenly geographically. It is intolerable for some of my constituents—I accept that they are few in number—to have to travel to Edinburgh or Glasgow weekly and sometimes more frequently for renal dialysis, especially when we consider the cost and discomfort of trailing up and down the A74 to Glasgow or over the Beef Tub to Edinburgh. Even if we could come to an agreement with Carlisle, I should prefer to see a renal unit in Dumfries to serve those west of us through to Stranraer. I have received optimistic notes from the area health board that one will be established, with luck, this year. I should be grateful if my hon. Friend the Minister could add some ministerial pressure.
The new clause is unnecessary and I hope that the Government will oppose it.
I wish to speak to amendment (a). I am extremely grateful to the hon. Member for Glasgow, Cathcart (Mr. Maxton) for his courteous acceptance of the amendment, which I suspect he gathers would tighten the proposals in the new clause.
My colleagues and I believe that it is essential to have a quality control commission to monitor standards in the Health Service. We shall support the proposed new clause, but we wish to see included within it a statutory right to have an annual review because we are in no doubt that the Bill represents a fundamental push towards private medicine in Scotland. It also moves towards the integration of the private sector with the NHS and the creation of a two-tier system. Additionally, there appears to be a secondary objective in the Minister's intentions, which is to break existing powers within the NHS—organisations such as the British Medical Association, the trade unions, the royal colleges, the health boards and, in England and Wales, the regional health authorities.
The hon. Member for Tayside, North (Mr. Walker) seems consistently to object to the use of the phrase "opting out" and prefers "self-governing". It would be more interesting if he would use self-government for Scotland, not just for schools, hospitals and bus companies, for which he is prepared to push firmly.
I am perfectly prepared to agree that if more than 50 per cent. of Scots elected more than 50 per cent. of Scottish Members for a party that wanted independence, we would find it difficult to prevent that. The Scottish National party must get that share of the vote before its members can talk to the House about that.
I am interested to note that the hon. Gentleman referred to 50 per cent. of Scottish voters. It seems he also wishes to change the normal majority rule which has been accepted as a mandate for changing a Government. I will leave him to think that over, and no doubt colleagues in other parties will wish to discuss in detail with him propositions for proportional representation.
Returning to the issue of opting out, the Bill offers the possibility of a fragmented Health Service in Scotland. in which planned development will be impossible. If money follows patients, one hospital's gain is potentially somewhere else's loss. We seem to be moving towards a competitive, devil-take-the-hindmost attitude with hospitals and doctors touting for patients, as they do in Germany.
I shall give hon. Members some idea of what happens in Germany, because it is one of the most realistic comparisons that we can make. No doubt the Minister will point out that there are no waiting lists and no shortages, and that they do not run campaigns for scanners in the German health service. They spend more and they get more than the NHS—more pacemakers, more bypass operations, more investigations and more drugs. It is a competitive system, and therefore, according to the free-market thinkers on the Conservative Benches, it should provide value for money.
Payment is by item of service in Germany. There is competition between the various health insurance companies—which are non-profit making—and between the different health care providers, such as general practitioners, specialists and hospitals. There is competition not only between hospitals and between specialists, but between hospital and specialist, and specialist and GP. As a result, the different layers of the service compete rather than co-operate. They are trying to outbid each other and to hang on to the source of finance—the patient—for as long as possible rather than co-operating to ensure the most appropriate treatment.
Communication between hospitals, specialists and GPs is dreadful because each hoards its own information and that leads to expensive, wasteful and sometimes dangerous duplication of investigations, and in some cases to over-treatment. It is a tremendous temptation to pander to the perceived wishes of patients—to give them what they want so that they do not go elsewhere. Doctors hesitate to give unwanted advice in case the patient finds a more agreeable doctor.
The system is wide open to abuse. Health insurance companies, which are also in competition, try to reduce the costs of the system. They have imposed contracts on hospitals and limits on some specialist investigations and have alienated themselves from both doctors and patients.
Within the flashy new hospitals in German towns and cities, and the expensively equipped doctors' surgeries, the atmosphere is unhappy and disillusioned. Patients distrust doctors, suspecting that the commercial interests of doctors and insurance companies are influencing clinical decisions. The doctor is not candid with the patient, doctors and hospitals distrust each other, and everyone distrusts the insurance companies. All are entangled in a vast web of regulations, restrictions and demands. An enormous bureaucracy is required to keep track of the patients as they move about the country, change companies, and change doctors. It also has to cope with changing contracts with hospitals, and with different restrictions, and to try to ensure that there is no fraud.
If that is the kind of health service——
I am trying to exemplify the kind of system that I believe will require monitoring if the legislation becomes law. I am trying to point out the sort of problems that exist elsewhere, why we need a quality monitoring commission as proposed in new clause 2, and why it must undertake annual work. We are being pushed towards the type of health service which the free-market thinkers want, without consultation with those people who are most directly involved.
I have referred to some research undertaken by practitioners in Scotland, by people who are directly involved with the Health Service and who have spent considerable time studying examples elsewhere. My party believes that there should be a comprehensive Health Service which is freely available to all at time of need. We do not seek a two-tier system in Scotland, which would be contrary to the egalitarian ethic which is so important to Scottish life.
The Government are not taking seriously the request that their proposals should be monitored. The hon. Member for Aberdeen, North (Mr. Hughes) has already referred to the fact that the number of health councils is to be reduced. The local health council in Moray will probably be abolished; it will be subsumed within a Grampian health council. Moray is a separate administrative unit of the Grampian health board. A local health council is therefore needed. If local health councils are to be abolished, it is important that there should be a national body to monitor the changes and their impact on the delivery of health care to the people of Scotland.
New clause 2 is worthy of support. No doubt the Minister will reject it. He prefers his own appointees and his own health boards. An organisation such as this, which would be representative of corporate organisations in Scotland and of Scottish public opinion, ought to be enshrined in legislation. I hope that hon. Members will support new clause 2 and amendment (a), which proposes an annual review.
The hon. Member for Moray (Mrs. Ewing) has wandered down an avenue that I do not propose to enter. She has compared the Health Service in Scotland with the service that is provided in Germany. I agree with my hon. Friend the Member for Dumfries (Sir H. Monro) that the Health Service throughout much of Scotland is splendid. I can speak with authority only about Tayside, where the service is probably second to none anywhere on this planet. That is quite a statement to make.
The hon. Member for Glasgow, Cathcart (Mr. Maxton) drew attention to the fact that I spent a long time in hospital. Yes, I did, following an accident. However, he has probably forgotten that not long ago I spent some time in a hospital in Dundee, at the same time as the hon. Member for Dundee, West (Mr. Ross). We were in the same ward. He would probably confirm that the quality of service that we received, not because we were Members of Parliament but because we were ill and required attention, was splendid. That does not mean that we do not wish to improve the Health Service. As new techniques, skills and operations become available we want them to be available in our area.
I believe that the hon. Gentleman was in hospital in Dundee in the late 1970s and early 1980s before all the Government's reforms. He has described it as a wonderful service. Why on earth, therefore, has he constantly supported the Government's reforms?
I was in a hospital where there were no disputes. That is important when one remembers the period in question. The staff at Stracathro hospital were absolutely splendid and superb. They were not involved in any of the disputes that were taking place elsewhere. I make no issue out of the absence of dispute. I was also in hospital two and a half years ago—not too long ago, by anybody's standards.
The hon. Member for Cathcart repeated in his speech what we heard so often in Committee—his views on competitive tendering, privatised services and in-house tendering. However, the new clause talks about
(a) establishing the standards that shall be met by
Health Boards in carrying out its functions.
I imagine that all health boards, in carrying out their functions, have to deal with a huge element of what could
be described as clinical activity, yet the hon. Gentleman, in nearly 40 minutes' chat, did not mention clinical standards once. In those very narrow specialist areas, who will monitor standards? The hon. Gentleman and I both know that it is health boards that have the people to do so. As my hon. Friend the Member for Dumfries said, the appointment of people throughout Scotland for that purpose would amount to the creation of an unnecessary tier of bureaucracy.
The hon. Gentleman did not really intend that clinical standards should be covered—at least that is the impression that his observations conveyed to me. Thus, it seems, this new clause, with an amendment in the name of the hon. Member for Moray, is designed to deal with privatisation, competitive tendering and in-house tendering. If that is what the hon. Gentleman intended he should have made his new clause much more specific and much clearer. In fact, the new clause covers every area of activity with which health boards deal. It says that the commission's responsibilities will include
where any services have been put out to competitive tendering, ensuring that the standards of that service are maintained".
I accept that, but
carrying out investigations from time to time to ensure that such standards are being met
is another matter. Those are the words of paragraph (b)
Paragraph (a) says that the commission's responsibilities will include
establishing the standards that shall be met by Health Boards in carrying out its functions"——[Interruption.] The point I am making, which Opposition Members find frivolous, is that, according to the way in which the hon. Gentleman has drafted and presented his new clause, this body would monitor every single activity of all health boards throughout Scotland. The cost of meeting the statutory requirements laid down here would be horrendous. If the hon. Gentleman is minded to tell me that that is not what is intended, let me make it clear that it is what the new clause spells out. Paragraph (d) says that the commission's responsibilities will include
where such services are not maintained, to instruct the Health Board to take such action as they consider necessary".
The hon. Gentleman mentioned pharmacy. It is astonishing to suggest that pharmacists, of all professionals, are unable to do inside hospitals the work that they do in their shops. Indeed, most pharmacy is privatised. Is it suggested that the pharmacy service that we in Scotland enjoy through chemists' shops is not up to standard? That is what the hon. Gentleman is suggesting.
The hon. Gentleman went on to other areas of medical activity, such as X-rays and dialysis. In my view, this new clause typifies the hon. Gentlman's prejudice against anything to do with privatisation or competitive tendering. We saw that in Committee, and it comes through every time.
The hon. Gentleman's idea is that we cannot have an inspectorate to investigate standards. There is no question of every hospital or every element of the Health Service being investigated annually or at some other interval. As with schools, factories and a range of other places in which there are inspectors, it is a question of attempting to ensure that standards are met. I realise that the Government do not like such arrangements. The hon. Gentleman may not like them, but they are there. Why should not arrangements that exist in many other areas apply to the Health Service, too?
Labour Members are not constantly showing their prejudices. The Government not only show their prejudices but impose them against the wishes of the majority of the people in the United Kingdom. They put those prejudices into legislation.
I drew attention to the all-embracing, expensive proposals in the new clause because the hon. Gentleman accepted without hesitation the amendment tabled by the hon. Member for Moray which requires this review to be carried out annually. Having accepted the amendment, the hon. Gentleman must accept that he was trying to put into law the requirement to carry out an annual review at all levels in every sector of the Health Service. He now says, "We want to qualify that. We want a system of monitoring on an ad hoc basis." That is exactly what the health boards do now, so we do not need this nonsense.
If the hon. Member for Cathcart says that we all want a Health Service that operates as effectively and efficiently as humanly possible, none of us will argue with him. A statutory requirement to set up a body to police annually every sector of activity of the Health Service in Scotland would be a recipe for printing money, which would have to come from the taxpayer. The taxpayer would much rather the money were spent on new hospitals and on other such provisions. That is exactly what the Government have done, unlike any Government whom the hon. Gentleman would like to see in power.
One must be judged by what one does. The damage sustained to the Health Service under the previous Labour Administration is our only measure of what would be likely to happen in the future. We would end up with an expensive bureaucracy. The money would be better spent on health care. That reasoning lies behind the Government's thinking and that is why I hope that my hon. Friend the Minister will throw out the new clause.
Mr. Robert Hughes:
I am grateful for the opportunity to take part in this debate, which takes place against: a background of changes in the Health Service in the past and those that are about to occur. The hon. Member for Dumfries (Sir H. Monro) said that the Health Service was better than it was 12 months ago and that the dire forecasts of the damage that would be caused by the Government's changes have not been fulfilled. Of course, they have not, because the changes have not taken place. Opting out of self-governing hospitals and general practitioner budgeting have not yet occurred.
Before the current health boards, there were regional health boards and, below them, special hospital boards dealing with children, the mentally ill and other areas. There were different levels of involvement by people in the lay administration of the Health Service. We were worried that under the new health boards far fewer people would be involved in that lay administration. The argument for many of the changes was that the system was too disparate, clumsy and bureaucratic, that too many people were involved, and that there was no proper administration.
I do not pretend that the old system was perfect. I can give ample examples of specialist hospital boards not carrying out their functions effectively. I do not argue that we should return to that system. Many took the view that there has to be lay accountability and the involvement of ordinary people who were not medical specialists, but who had a great interest in the Health Service and were willing to ensure that the different functions in patient care were carried out. There was a strong feeling that that link with the public was being weakened, so the local health councils were brought into being.
People's experience of local health councils varies from area to area. No area in Scotland could say that everything was lovely and that there was a perfect relationship between the local health council and the area health board. Equally, no area in Scotland could say that its local health council was a complete disaster. I shall not be thanked for this by people who have done a great deal of work in local health councils, but I must say that my judgment is that they have not been as effective as they should have been in monitoring patient care and the way in which the health boards have carried out their responsibilities. They have not been particularly effective in discussing with health boards changes and plans for the future. However, it is a retrograde step to cut down the numbers.
As I am sure that the Minister will remind us, after an independent investigation, the proposition was that all local health councils should disappear. It is worth putting on record our appreciation of my hon. Friend the Member for Strathkelvin and Bearsden (Mr. Galbraith) and of the Minister. I know that my hon. Friend the Member for Strathkelvin and Bearsden went to see him to tell him that it was a mistake to do away with all local health councils. We now have a compromise, which is better than nothing, although I have had a letter today from my local health council saying that it is very disturbed that there will be one local health council for the whole of the Grampian region and that there will be insufficient representation for matters to be covered properly.
The hon. Gentleman is being very fair. Will he make his own position clear? The position of the hon. Member for Strathkelvin and Bearsden (Mr. Galbraith), as the Front-Bench spokesman, was that he favoured moving towards having one health council for each health board area, with the possible exception of areas such as the Highlands. The general principle was to move towards one health council per area. I had the impression that the hon. Gentleman did not support that.
In the absence of my hon. Friend the Member for Strathkelvin and Bearsden, I must say that if his position is that there should be, generally speaking, one local health authority or its equivalent to cover the whole health board area, except in remote areas, I respectfully disagree. However, there is no dishonour in that and it is no reflection on my hon. Friend, who, as we know, is unable to be with us in the debate. I am expressing a personal judgment. I am unhappy about the proposition to have only one local health council per health board. Whether we have two is a matter of judgment, so these matters must be considered in terms of individual areas.
I do not want to be diverted down this path for too long, although it is relevant to the debate on the quality control commission but there is a great difference between the city of Aberdeen, which is fairly densely populated and has highly sophisticated facilities at the hospitals, and the constituency of Moray, where the facilities could not be expected to mirror what happens in the inner cities. However, because of the differences of population and psyche between city dwellers and those who live in rural areas, we should have local health councils covering different areas, a different geographical spread and a different range of interests. I hope that, as the matter has arisen sharply in this debate, the Minister will reconsider the matter and where we go from here.
A quality control commission is necessary. The Mental Welfare Commission is already in existence. It oversees the welfare of patients in mental hospitals. The people who have served on that body over the decades have done a splendid job. On the few occasions when I have found it necessary to raise cases with that body, my inquiry has been dealt with fully and I have always been satisfied with the result. It is a comfort to have that commission in place so that complaints about the way in which patients have been treated can be followed up. I understand that the commission does not deal with clinical matters, so that one cannot refer to it complaints about the clinical treatment of patients.
We are moving to the time when patient care will be dealt with at one stage removed from the direct control of area health boards. That will particularly be the case with private nursing care, especially of geriatrics, which normally would have been done as a matter of course by the NHS. That type of activity will gradually be done more and more by private industry.
I wish to relate the details of a case, but I will not give the name of the private nursing home because the circumstances involved have been taken care of and I would not want to malign the present management of the home. A blind constituent raised with me problems concerning the care of the residents and the conditions at and services provided by the nursing home. The health board was aware of the case because complaints had been made directly to the board. The matter was taken up with the owners, who changed the management, and conditions have improved.
In addition, my blind constituent believed strongly that the lack of care of her husband led to his premature death. I raised that serious allegation with the health board and received a letter in reply at the beginning of December saying that an investigating officer would visit my constituent and discuss the issue. I appreciate that grave matters of that sort take time to be investigated. I was not surprised when two months went by and I received no further correspondence. At the beginning of March, when going through my files, I thought it was time I gently prodded to see what was happening.
I wrote in mild terms saying that I had been told at the beginning of December that the issue was being investigated, that I had heard nothing further and that I would like a progress report. I was astonished to receive a letter today, signed pp, for and on behalf of someone else, by somebody in an area unit—not by the chairman or secretary of the board, not by a chief medical officer and not by the area health board manager—saying in four or five lines, in effect, "We can confirm that an investigating officer saw your constituent who, following discussions, is now satisfied. Yours sincerely."
That is not acceptable to me. The health board should at least have had the decency and courtesy to let me know that the matter had been dealt with. I will willingly let the Minister have the letter, which I have not quoted. I am more than pleased that my constituent is satisfied, but the issue seems to have been dealt with in a ham-fisted way. A serious allegation was raised by a Member of Parliament, who did not receive a proper explanation or even a courteous reply.
If the hon. Gentleman will let me have the correspondence, I will investigate the matter. I confirm that when Members of Parliament write to health boards, I would expect them to receive a reply from the chairman or general manager of the board explaining the position. It is difficult for me, without knowing the circumstances of the case, to respond, but I apologise to the hon. Gentleman and will follow up the matter if he will give me the necessary correspondence.
I thank the Minister. I have not yet dictated my reply; I was about to fire it off on my word processor, but then I realised that if I did that I would burn out the works, so I decided to wait until tomorrow and dictate it to my secretary. I shall be sending a letter to the chairman of Grampian health board, anyway.
During my investigations and my discussions with the board, I established that, although it has a responsibility to license private institutions and to monitor their general operation, it has absolutely no responsibility for health care in such institutions. The responsibility for health care clearly rests with individual GPs. Although they will of course do their best, we all know what a GP's life is like. Even when a patient is living at home, he or she—from now on I shall just say "he", because at this time of night I shall not remember to say "he or she" each time; I hope that the hon. Member for Moray (Mrs. Ewing) will not take it amiss—does not have time to look at his list and say, "I have not seen Mrs. Smith for a couple of months. I had better see how she is getting on." He has not time to visit private health-care establishments to check on the quality of care; it is up to the management to call in the doctor if it is thought necessary. I feel that there must be a closer check, whether through a quality control commission or through some other machinery.
The control of clinicians and clinical judgment is an issue with which we have wrestled for as long as we have had health legislation. Who controls the medical profession? By and large, it controls itself. I served for some time on the General Medical Council, as a lay member, and I am bound to say that its specialists do an extremely good job. My one quarrel with them is that they always seemed to deal with allegations of negligence less severely than with allegations of sexual misconduct. The GMC being an open forum, the press turned up in droves if there was an allegation of sexual misconduct; they filled the GMC press gallery. If the question was whether a doctor had gone out to visit a child at night, however, they were not so interested. I am not saying that the medical profession was uninterested in such cases, but it seemed to me that it was harder on allegations of sexual misconduct than on those of possible clinical misjudgment. Clinical misjudgment is dealt with, in one way or another, by the medical profession. Lay people find it difficult to deal with. There is a gap at present, which my hon. Friends and I have sought to fill in debates on various health Bills.
Let me cite another case from my constituency. Again I shall not name names, although the Minister will recognise the case from correspondence that he has received from me. My constituent suffered from obesity. She underwent a form of surgery whose medical description I can never pronounce. Essentially, it means that the stomach is closed up for a period, leading to a loss of appetite and consequent weight loss; the operation is then reversed and the patient should be able to function normally. In this case, however, the woman was extremely ill and could not keep food down. When she went to see the doctor and other hospial staff, they all said, "It is psychosomatic. Nothing has gone wrong with the operation; you should see a psychiatrist." That did not help her—indeed, the hospital did not provide a proper psychiatric counsellor. I am advised that that operation should not be done without pre-operative and postoperative psychological counselling so that people know what to expect. All the papers in the case confirm that.
My constituent went through sheer hell. Her weight went down to between 5½ and 6 stones. Luckily, she discovered by accident that the surgeon who had done the operation had moved to another hospital in the Grampian area, so she was able to go to see him. As soon as he heard her symptoms, he said that there was something very wrong. She was examined and it was discovered that the operation has not been done properly. Fortunately—or unfortunately—my constituent is now back to her previous gross weight. However, she went through a difficult period.
Such an investigation can go down only two roads. First, there is the pure investigation within the Health Service. If a patient is dissatisfied with that investigation, the only alternative is to take an action in court for negligence, and that is about the most difficult thing that can be done. First, an independent assessor is appointed. He is a doctor, and I make no complaint about that.
The doctor decided that my constituent was badly advised psychologically, that the operation was done wrongly, and that she should have been examined more carefully when the problem developed. But he still came to the conclusion that there had been no negligence. That very statement immediately cuts out the possibility of an action in court because in such a case the legal aid board in Scotland will not provide legal aid. A particular case sets out the test, but basically it says that there must be a reasonable chance of the action succeeding. As long as an independent medical assessor says that there is no negligence, there is no legal aid, and the case stops.
In that position, all that I could do was to write to the Minister and ask him to set up an independent inquiry because the same operation had gone wrong in other cases in other parts of Scotland. I do not criticise the Minister. He replied courteously and pointed out that this was a highly speculative operation which should be done only as a last resort with the greatest of care and preparation. But he would not set up an independent inquiry.
A patient who is dissatisfied with the Health Service and the in-house medical report and wants the matter to be looked at again has no means of doing so. There is no commission and the Minister will not have an inquiry. What on earth can happen next? This is only one example of dissatisfaction. There are many other examples.
The hon. Gentleman will know that the Health Service Commissioner investigates all areas other than clinical judgments. I accept that he cannot comment on that aspect. I spent some years as a member of the Select Committee on the Parliamentary Commissioner for Administration and aspects of the case described by the hon. Gentleman seem similar to cases that have come before the Health Service Commissioner, have gone to the Select Committee and have been dealt with in a way with which the hon. Gentleman would be pleased. That is a course that the hon. Gentleman should consider because, if nothing else, the Health Service Commissioner will look at the handling of the administrative aspects of the case and if there has been any maladministration it could well form a ground on which his constituent could decide whether to take action.
I appreciate that the hon. Gentleman is intending to be helpful. I shall certainly look again at the case papers. However, this matter should not go to the Health Service Commission for Scotland because it is outwith its remit. I certainly would not want to give a constituent hope. I do not believe that one should simply palm off a constituent by saying that one is going to send on his complaint to a certain place, and so get rid of the problem. I shall see whether there is a possibility of sending it.
I am sure that all hon. Members could quote other examples involving clinical care, as I could. We should look at this matter. The new clause states that one of the commission's responsibilities would be
To investigate complaints from patients in regard to the Health Service, and take such action as seems appropriate.
That would cover the possibility of looking at clinical judgment. I would be prepared to allow the medical profession to take part in such an exercise, act as monitor and referee and give guidance.
However, there is a big gap at present. The gap between the perception of patients about how their complaints are examined and the reality of what happens is likely to get wider because the privatisation of the Health Service is moving apace, to the extent that before legislation is passed health boards are examining services which they want to put out to tender.
It is grossly wrong for Grampian health board to be looking at the possibility of a new 60-bed unit which is being built and should be open already. It is to be open temporarily to tide the health board over while it deals with a clinical problem. The full clinical care, from beginning to end, in that unit is to be put out to private tender. Apparently, the board is to consider an in-house offer. I do not know how there can be an in-house offer when there are no consultant psychiatrists, consultant geriatricians, nurses or managers in place, so I do not know how there can be the possibility of an in-house team when there is no in-house team to put in a tender.
My hon. Friend the Member for Aberdeen, South (Mr. Doran) and I went to see the chairman of the Grampian health board, Mr. Kyle. I expected the chief administrative medical officer to be there, not the unit manager. I found that offensive. It was clear that the discussion was driven by the unit manager. Even more impertinent was the fact that one functionary, a paid employee of the health board, not a board member—I could take it from a board member—had the temerity to criticise my hon. Friend and me in public for daring to question the health board decisions before they had been taken. In other words, Members of Parliament are supposed to wait until decisions are taken by bureaucrats, or even the board, and are then brought into consultation. That is quite unacceptable, and that has been made plain to the health boards.
Entire hospitals, as full separate units, will be handed over to private enterprise, with no mechanism for checking what goes on. If the new unit goes over entirely to a private company, who will be responsible for the medical treatment and conduct within the new unit? Will it be a parallel position to that of the private nursing homes that I mentioned earlier? They are licensed by the boards, which have overall responsibility to ensure that they are run reasonably well, but the patients' clinical care will not be the health boards' responsibility.
The Minister must address himself to that issue. If the whole exercise, from consultants to nurses, is done by a private company, who will have ultimate responsibility for the health of the patients and ensuring that their clinical treatment is met absolutely? I would prefer it if none of the new clause was necessary, although there are gaps here and there that should be closed, even within the Health Service, as a matter of public administration. We must look at this issue clearly. A quality control commission would be worthwhile.
Although my hon. Friend the Member for Glasgow, Cathcart (Mr. Maxton) may not have every dot and comma right, the concept is worth pursuing because the Health Service is important. I shall go even as far as to say that, although I do not like large numbers of them, there is a place for business men on the area health boards.
However, the best way to achieve a public Health Service in the best tradition of looking after patients must involve the public in the widest sense. That involvement is shrinking each year and the Health Service is becoming more specialist, both in clinical and managerial areas, which is bad for the development of health care. A quality control commission would go a long way towards mitigating the effects of present practice until such time as we could restore the NHS to the full public ownership, full public participation and full public provision that the people want.
I am aware of the late hour, but I have waited for some time to be called to speak and I hope that my tired and weary hon. Friends will bear with me. They will be even more weary by the time I finish.
A quality control commission for the National Health Service in Scotland would be invaluable, especially as its members would be appointed after consultation with a wide spread of Scottish opinion. It would play a vital role in establishing the standards to be met by health boards. My constituency would provide such a commission with just the circumstances in which to set standards to be met by the health board. The conduct of Greater Glasgow health board in its secret negotiations with Takare plc, involving the privatisation of care for the elderly, has been nothing less than disgraceful.
The necessity for a local geriatric hospital has been recognised by health boards for a number of years. It is intolerable that residents of Cambuslang and Rutherglen should have to go to Cleland hospital for geriatric services. There is considerable difficulty and expense for visiting relatives. A more convenient location would ease the problem, with the added bonus for both patients and relatives of additional visits because they would be easier to undertake. It is a reflection on Greater Glasgow health board that that indisputable need was not made a priority.
I am aware that the health board had, and still has, difficulties with capital and revenue funding, but the need in Cambuslang and Rutherglen is longstanding and should have been dealt with. I am sure that a quality control commission would ask the health board why, if it was committed to providing care for the elderly in Cambuslang and Rutherglen, it initiated discussions with Takare plc.
I wish to quote from an extract from the Greater Glasgow health board report of its annual meeting with the south east local health council on Thursday 1 May 1986. Mr. Macquaker, the then chairman of the board,
revealed that the Final Cost Limit, £7,845,500 had been approved by the Scottish Home and Health Department.
However, the report suggested that there might be a problem because of the revenue consequence of £1,208,445. Therefore, in May 1986 permission was given for the hospital and the capital costs were made available. Yet the board is proposing to take on the revenue costs of 180 beds with Takare plc, with a charge of at least £230 per week, and the signs are that the figure will be considerably higher. That amounts to more than £2 million of revenue at just that one location. Although the board said four years ago that it could not afford £1·2 million, it is giving over £2 million to Takare.
The behaviour of the board should be scrutinised carefully. I am a strong supporter of a quality control commission which would subject the board to a statutory examination of its activities. In its own documents about the proposed privatisation of elderly care at Rutherglen, the board stated that there should be consultation with the local regional council. Yet no attempt was made to consult the regional council, as the major provider of other aspects of care for the elderly, about Takare. That goes against the board's own policy and is an indication——
I want to be clear about this. Is the hon. Gentleman saying, as the constituency Member for Rutherglen, that he is opposed to a new facility being provided for elderly people in his constituency at no capital cost to Greater Glasgow health board and at less revenue cost than it would cost the board to provide those facilities, even if it was prepared to make the capital available? Is that what the hon. Gentleman is saying?
As the constituency Member, supported by every community organisation in Cambuslang and Rutherglen, and by all elected Members with the exception of the Liberals, I can tell the Minister that the whole community wants the health board to fulfil its commitment to provide a National Health Service hospital, based in Rutherglen and covering the catchment areas of Cambuslang and Rutherglen.
The Minister talked about finance. I shall deal with the financial aspects of the proposed deal with Takare. It is a bad financial deal for the public, according to information from the chairman of Takare. There are two aspects to my opposition. The whole community wants a National Health Service hospital; in addition, we maintain that this is a bad financial deal for the public.
There is ample scope for a quality control commission to ensure that, when services are put out to competitive tender, the standard of service is maintained. There is a complication. If a quality control commission was supervising the arrangements that might come into being through Takare, it would have to check whether the competitive tendering that resulted in Takare being awarded the contract was legal. No other company was involved. Where was the great principle of competitive tendering about which we hear so repetitively from the Minister? We are told that in the interests of the patient there should be competitive tendering. Not one other company was invited to be involved in the negotiations. The whole thing stinks.
My hon. Friend and the House will realise that Greater Glasgow health board is not within my constituency; nevertheless, I am an interested Member. I was appalled at the attitude of the board when we went to see it about the privatisation of the laboratory system. I have not seen anything like it unless we go back 30 years in industrial relations. The board was prepared to ride roughshod over the concerns of Members of Parliament and others. My hon. Friend is right. The one thing that might have brought the board into line was a body such as is proposed in the new clause. I have never seen such a Victorian attitude displayed by any authority for the past 30 years.
I entirely endorse what my hon. Friend said about the attitude of Greater Glasgow health board. In his intervention the Minister sounded like a parrot mouthing the words of Mr. Peterken. However, perhaps Mr. Peterken is the parrot repeating the Minister's words. I accept that the health board's attitude is disgraceful.
Paragraph (d) of new clause 2 allows the commission
to instruct the Health Board to take such action as they consider necessary
if such services are not maintained. That brings me to the standards of care operated by Takare that would come under the authority of a quality control commission.
I welcome and endorse the principle of moving frail and elderly people who do not need constant medical care out of hospitals. However, I have considerable doubts about what conditions will apply. In what condition would a resident have to be in order to be admitted to a Takare development? Home care environment is referred to in the Takare documentation, but that can mean different things to different people. I have visited Takare establishments at Preston, Chorley and Oldham. The matrons at those establishments confirmed that on average 75 per cent. of the residents were stroke patients and 75 per cent. were also incontinent.
Such conditions did not square with the board's statements about sheltered housing being suitable for the kind of resident in the Takare establishments. The board described the Takare model as nursing care—that might be a back-handed compliment to Takare. However, the care that I witnessed in Takare units goes far beyond what can be regarded as nursing care.
The type of patient that would be established at a Takare development at Rutherglen must be clarified. From what the matrons told me and from what I saw, there seems to be some confusion about that. There should be no confusion about the care of the elderly. We are here because of those people and they should be elevated to the highest position in society.
I visited the Takare developments as a lay person. I reported back that, as a lay person, I made no criticism of the homes provided by Takare. However, I made it clear that I reserved my position on the application of medical and professional criteria.
I managed to get hold of a report of the Forth Valley health board. I think it came in a plain brown envelope. The health board sent a team of professionals to assess the Takare facilities. The report stated that commodes were kept in residents' and patients' rooms and that there were no en-suite toilet facilities. It stated that, as far as possible, the Forth Valley health board's nursing home inspection team was trying to discourage such practices in nursing homes.
The report states that bathing and toilet areas were rather remote from the main day rooms and were lacking in privacy. It stated that there were no showers and only relatively few assisted baths. It made the professional criticism that there was no structured attempt to introduce health promotion measures in the area. The report confirmed something that I recalled. It stated that there seemed to be a higher number of wheelchairs in use than expected. I recall my quandary as I pondered what kind of resident would benefit from such accommodation.
The report also referred to a strong smell of urine in several, but not all, of the units. The team could not ascertain the cause of the smell specifically. It stated that it may have been due to inadequate nurse-patient ratios. I mentioned that in my submission to the consultation process. The staff worked shifts and a professional view would have to be taken of the system to ensure that that care was the best for the elderly people.
The Forth Valley health board stated that there was no attempt at primary nursing or employing a key worker. As a result, most of the nursing care was task-oriented according to professional criteria, and medical records were poorly designed. It stated that there was no organised database, either current or historical, for the residents. However, the really amazing thing comes in the next sentence, which states:
It is therefore recommended that the Board pursue more detailed discussions with Takare to determine and explore the viability of future joint ventures.
The logic of that escapes me.
I come now to one more sign of the highly political direction that is given to the boards by the Minister. Under para (e) of the new clause, the quality control commission would be well placed to investigate complaints from patients and to take action on them. I am sure that the quality control commission could play a major role in carrying out such investigations to ensure that the standards that have been established are being met by the health boards.
I am also sure that financial criteria would be a key element because we all want value for money, but let us have a close look at this financial involvement. I met an official of the board in September, who roughly outlined the financial arrangements round which the discussions with Takare had centred. When I went down to Takare, I met Mr. Keith Bradshaw, its chairman. Hon. Members might be interested to know that Takare's motto is, "Who cares wins". The House can make what it likes of that.
I spent about eight or nine hours talking to Mr. Bradshaw and his company. He was a lot more forthcoming with information than the board had been. He told me that at that point the discussions with the board had centred round the price of £375,000 for the land. When I pointed out that the district valuer would have to set the price of the land, Mr. Bradshaw said, "I know that, but that is the price round which all the discussions have centred." I asked how he could work out the deal if he did not know the price that he would be paying. He then told me that if the district valuer valued the land at more than £375,000, Greater Glasgow health board would finance the borrowing costs of the capital that would be required to make up the difference.
The Minister said that this is a good financial deal for the public, but the board is financing the purchase of its own land by a private company. That is what Mr. Keith Bradshaw said to me. I have it on record at two public meetings that were held in Cambuslang and Rutherglen when Mr. Cleary of the health board was present. I challenged the board to refute what I had said, but as no refutation was made, I hope that no one will suggest that what I am saying about my discussions with Mr. Bradshaw is untrue.
I shall give the House an example of where the quality control commission could crack down on financial standards. For every £100,000 over the discussion price of £375,000 that Takare would have to pay, the board would allow Takare to load £18,000 per year on to the total cost of the beds in the unit. The health board official told me that, in his opinion as an experienced person, the land might be sold for between £850,000 and £870,000. That is £500,000 more than the discussion price of £375,000. If the board allowed Takare to load £18,000 on to the total cost per unit for each £100,000 over the discussion price, and as £875,000 is £500,000 over the discussion price, we must multiply £18,000 per year by five, which means that £90,000 per year would be loaded on to the price of the beds for ever. Is that a good financial deal for the public? I do not think so.
That land was owned by the royal borough of Rutherglen. It was public land. The former town council sold it only on the basis that the site would be used for an NHS facility for the people of Cambuslang and Rutherglen. I do not accept that that is a good financial deal and nor do the people of Cambuslang and Rutherglen.
We also need the commission to oversee incestuous relationships such as are envisaged in that deal. The board would be the licensing authority for one of its main providers of service for the care of the elderly. Is that right and proper?
If that is good business for the boards, there is also another complication. The boards have stated clearly that if this private company ran into financial trouble and had to close the week after it opened, the board would simply buy the hospital back under the contract at the going market price. If the board has the money to buy back the hospital from Takare at the market price, why not use the capital to build an NHS hospital in the first place? It is clear to me that the board is politically desperate to go ahead with the deal.
The people of Cambuslang and Rutherglen, and, indeed, the whole of south Glasgow, are affected not only by the Bill but by serious proposals relating to services at Victoria infirmary. They are causing a great deal of worry in our area. It is wrong that people should be worried about health.
Every time that I go to a meeting with Greater Glasgow health board, I leave feeling that I have been through 15 rounds with a political opponent. That was echoed by my hon. Friend the Member for Kilmarnock and Loudoun (Mr. McKelvey). The boards are supposed to represent, reflect and work for the good of the public. Nobody should leave a meeting with one of them feeling that way. I would make the same criticism if Conservative Members left a meeting with their Labour health board feeling that they had gone through 15 rounds. That would also be wrong. It has happened more than once with Greater Glasgow health board. But a new day is dawning and each opinion poll that is published makes that clear.
In its haste to push the deal through, the board has run into a few problems with the trading conditions for the sale of the land. There is no doubt that in the absence of a quality control commission, the Minister can do practically whatever he wants. Under his political direction, his political puppets on health boards throughout Scotland and certainly in Glasgow are jumping to his tune.
A quality control commission would have asked Greater Glasgow health board several questions. Why was no company other than Takare involved? Why was a ridiculous price for the land set at £350,000 in negotiations with Takare? Why should the board finance the purchase of its own land? Why was no account taken of the responses to the consultation process, which were overwhelmingly against the proposal?
I shall make one more point and then I shall give way. I am sure that the hon. Gentleman will appreciate the point that I am about to make. The only people who welcomed the proposal in the whole of Cambuslang and Rutherglen were not the local Conservative association, but, lo and behold, the local Liberal association. It saw the chance to obtain a bit of kudos, but its welcome backfired. It will pay the price at the regional elections in May.
I shall certainly consider that suggestion. I shall consult on it. I assure the Minister that the battle is not over. There is a long way to go yet.
The quality commission would also ask why the board was willing to subsidise a private company to purchase its own land. If it is willing to buy the development back if the company collapses, why not use that money to build a hospital?
I am sure that a quality control commission would do a job for the vulnerable and elderly in my constituency by ensuring the highest standards of care for a generation which deserves them.
I apologise for intervening again. I intervened earlier but the hon. Gentleman did not answer my question directly. I want to be clear about what he wants me to do. Does he argue that the Takare proposal, which will provide a facility for the elderly in his constituency, should not go ahead? Does he want that facility to be provided? Will he answer yes or no?
As an English Member, I apologise to my Scottish colleagues for intervening in the debate. I have listened with interest. Yesterday I received an anonymous letter from a representative of private care owners in my area asking me to look into an allegation that a company called Takare was about to get a contract from Wigan health authority, without tendering, to remove mentally ill patients from Billinge hospital in my constituency. I have been asked to investigate why the health authority is involved with a company in relation to such important services without it tendering or consulting. I had no knowledge of the company until this evening when my hon. Friend said that it was alive and well in the Greater Glasgow health board area. It may have some considerable friends at court. Perhaps we can consult about the matter later this morning.
Is my hon. Friend aware that at the beginning of his speech the Minister asked whether my hon. Friend was in favour of this facility at no cost to public funds, but after my hon. Friend had given the cost to public funds the Minister dropped that part of his question? It is significant that the Minister changed his question.
That was noticeable and I am grateful to my hon. Friend for pointing it out. The Minister is blackmailing Cambuslang and Rutherglen in exchange for future facilities. We know the type of facility on offer. There is no guarantee about what type of service there will be or for how long it would be there. We know the NHS in Cambuslang and Rutherglen. Those are the standards and the hospitals that we want. I serve notice on the Minister that the battle is not over.
Without in any way endorsing the details of the new clause, I broadly support its intention, which is to insert in the Bill some measure of concern about the future quality of our NHS in Scotland. I am wholly in sympathy with that objective.
Inevitably, each hon. Member who has participated has spoken about the effect on the quality of the service in his or her area and I shall be no different. It is well known that in the Borders we have the good fortune to have a new district general hospital of which we are proud, although it came 10 years after the date when it was first supposed to be completed. As it is the general view in our area that we have a good NHS, there is great concern that the Government have unnecessarily upset the morale, structure and funding of that service.
Although many representations have been made to the Minister since the Government issued the original consultative paper, his reaction has always been that people do not understand our proposals, give them time, it is all part of a propaganda campaign by the British Medical Association and if only they will study our proposals, listen to our speeches and consult, they will agree. All I can say is that at the end of the process, having listened to all the speeches and having had a visit from the new business chief executive of the NHS in Scotland, those who work in the service are as worried as they were at the beginning.
It is no good the Minister shaking his head. On Sunday afternoon my hon. Friend the Member for Roxburgh and Berwickshire (Mr. Kirkwood) and I were summoned to a meeting by a representative collection of NHS consultants, administrators, GPs and nursing staff. Their overriding message was that they were deeply concerned that the Bill would lead to the fragmentation of an otherwise wholly accepted, well integrated NHS. It is no good the Minister shaking his head. I was at the meeting and he was not.
I take the point that the right hon. Gentleman has made about what happened at his meeting, but he said that there was as much concern now as there was at the beginning. That cannot be true, because even the BMA has withdrawn the allegation that it made that patients would not be able to get the drugs that they required because of the proposals. To date I have had 28 expressions of interest from doctors who wish to become budget holders. A number of hospitals—[HON. MEMBERS: "How many? Name them."] Four hospitals have shown an interest in self-governing status. The right hon. Gentleman is wrong to suggest that there is the same concern now as there was at the beginning.
I was telling the Minister about the mood of medical opinion in the Borders area. I am talking not about public opinion generally, but about the experience in the Borders, where there is a good Health Service, which we wish to retain as it is.
The Minister says that practices have applied for budgetary status and that hospitals have applied for opting-out, but I challenge him to say whether any of them is in the Borders. I am pretty certain that they are not. Silence speaks more loudly on this occasion.
The hon. Gentleman may have flown over my constituency in Concorde, but I trust that he will allow me not to give way for the moment. I have only just started and I want to spell out some of the anxieties of people in the Borders, since the Minister doubts me. He will have a chance to reply to the debate.
First, all hon. Members who represent Scottish constituencies know that there is no question but that there has always been a different ethos in the National Health Service in Scotland from that south of the border. General practitioners in my area find that as people come from the south, either for employment or to retire, they ask to go on to a private practice list. The GPs look at them and say, "What on earth are you talking about? We don't do private practice". They say that generally in that part of Scotland everyone is treated the same. Those people may have come from a part of England where it is different, but we do not do that in Scotland. Gradually people realise that they can get decent health care without getting involved with private medicine. The medical profession expects that to continue in Scotland. The Bill is driving a coach and horses through that principle.
GPs point out that the Government have allowed a 5 per cent. increase in the cost of supplies and services in the current year, but that inflation in those areas is about 8 per cent. Therefore, there is a cut in the health board budget. The board has not been fully compensated for the funding of pay awards and for the regrading exercise, which has been a long, tedious and time-consuming exercise.
The result is that for the coming year the local area health board is £500,000 short of its budget. It has had to look around for savings to meet that shortfall. The first thing that it is proposing to do—it will cause an almighty row—is to renege on the undertakings which it gave about reopening the cottage hospitals at Selkirk and at Galashiels. That will cause a public outcry. It is no good the Minister saying that there are no cuts in the Health Service, because people can see with their own eyes that there is a difference between the service that the public expects and what it will get because of the shortfall in funding.
When the chief executive met much the same group that I met—or at any rate some of the consultants—he was asked about the future of the gastroenterology service in the Borders. Could he guarantee that it would continue? He said that the service could go if it proved non-competitive. What does that mean? As far as we can make out, it means that if a particular specialty, at present provided as part of a comprehensive Health Service in the Borders region, does not pay its way in accounting terms because there are not enough patients, that specialty might be closed and the patients transferred to Edinburgh. From an accountants' point of view, sitting in St. Andrew's house, that might make sense.
That brings me back to the whole question of the quality of the Health Service. What about patients who have to make a journey of 50 or 60 miles to hospital to be treated? What about their relatives? What about the quality of the service that they have come to expect? It cannot be an accounting exercise; it cannot be thought of just in terms of pounds, shillings and pence, as the Government propose.
Last year the orthopaedic service in the Borders general hospital was estimated to cost £30,000. The outturn was £69,000—more than double. These were mainly hip and knee joint operations. The increase in the demand for such operations has been colossal throughout the last decade or so. Ten years ago hip operations were rare; it was pioneering work. The elderly now expect such an operation to be provided. It is regarded as a facility. As the outturn was £69,000, the health board, due to its straitened budget, said to the hospital, "Next year you must budget for £48,000." If that is not a cut, what is?
In the Government's plans for the Health Service great stress is laid—probably inevitably; I do not quarrel about it—on computerisation. The vaccination programme in the Borders has been computerised. However, general practitioners have been told that the programme must be stopped for nine months because the cost of the vaccine cannot be afforded. What sense does it make to set up a sophisticated programme and then to say that it cannot be used because the vaccine cannot be afforded?
A consultant told me that she had paid out of her own pocket the £100 that was necessary to buy a nebuliser for an elderly patient who could thus be allowed to go home, thereby releasing a badly needed hospital bed in an elderly patient unit. No money was available for that small item of equipment.
These are not fictitious pieces of propaganda, dreamt up by a central organisation; they are complaints by people who are operating the service in the way that the public expect it to be operated. No general practitioner in the Borders wants to move to a system under which he has to limit his practice budget. At the end of a long meeting last Sunday it was said that that was not what any of them had gone into medicine for.
If the Government were to ask people whether they would he prepared to pay more for the Health Service, the answer would be yes. The Government believe that, because expenditure on the National Health Service has inevitably increased, and will inevitably increase, no matter which party is in power, it must be cut, and that more and more of that expenditure should be borne by the private sector. The Government are changing the National Health Service into a national health business. That is not what is wanted.
If we cannot impede the Bill's progress, at least we should insist that some sort of external quality control commission should be added to the new system so that it can assess what facilities the National Health Service is failing to provide. That is what people want to know. The Government ought to remember that this is a service, not a private enterprise profit-making organisation. If they did, they would get back on the right tracks.
I detect some unrest among hon. Members. It is not something for which I apologise. The fact that the debate has continued into the early hours of the morning reflects the concern of Scottish Members of Parliament—particularly on this side of the House—about the direction in which the National Health Service is moving and has moved in Scotland, particularly since the hon. Member for Stirling (Mr. Forsyth) became Minister with responsibility for health in the Scottish Office.
Over the past two or three years, one of the saddest features of the Health Service in Scotland has been the way in which, by and large, we have moved from a consensus approach to confrontation. The one thing that is absolutely certain is that this is doing the Health Service, those who work in it and in particular those who use it, no good at all.
The right hon. Member for Tweeddale, Ettrick and Lauderdale (Sir D. Steel) referred to the Borders district general hospital. I was accompanied by the right hon. Gentleman when, as Health Minister, I went to purchase the cricket ground on which that hospital now stands. We had tremendous problems not only with the purchase of the land but with a certain Professor Trevor-Roper, about whom I still have nightmares.
Yes, he is now in another place. I remember well all the restrictions that he placed on the building of the Borders district general hospital.
I mention that only as a means of getting back to a point made by the hon. Member for Tayside, North (Mr. Walker)—the hospital building programme. It is the only point on which I shall take the hon. Gentleman up. It is the very nature of politics that progammes started under one Government are continued and completed by a succeeding Government. [Laughter.] The hon. Member for Tayside, North is laughing. I hope that he will contain himself for a moment.
During the period of office of the 1974–79 Labour Government Monklands district general hospital and Inverclyde royal hospital were opened. North Ayrshire district general hospital could have been opened, but because of a serious defect in the ventilation system of the operating theatres we refused to accept it from the contractors. The biochemistry unit at Glasgow royal infirmary was opened during that period, and the foundations for the major reconstruction at Stirling royal infirmary were laid. The massive expansion at Raigmore hospital at Inverness was begun during the period of the 1974–79 Labour Government. A host of projects that had been started by the hon. Member for Dumfries (Sir H. Monro) were picked up first by my hon. Friend the Member for Aberdeen, North (Mr. Hughes), then by the late Frank McElhone, and then by me. Likewise, projects that had been started by me were picked up by Sir Russell Fairgrieve. The projects that were announced by the hon. Member for Stirling last week will not be opened officially by him; the official opening will be carried out by my hon. Friend the Member for Strathkelvin and Bearsden (Mr. Galbraith). That is in the nature of hospital building.
I hope that the hon. Gentleman did not get the impression that I was suggesting that there had been no programmes during the period of the Labour Government. That would have been nonsense. I was making the point that the Labour Government, at the behest of the IMF, had to make savage cuts in their capital spending programme. If the hon. Gentleman is saying that that did not happen, he is contradicting the record.
The hon. Gentleman was not in the House at that time. Let me tell him that at no time—even when the Labour Government went to the IMF—was any Scottish hospital or health centre that was under construction restricted or delayed. If the hon. Gentleman examines the record he will find that my comments are absolutely accurate. The Minister mentions Health Service expenditure from time to time. Sometimes politicians distort the record—I suppose that I am as good at it as anyone else—but if Government Ministers check the record they will find that throughout very difficult times during the period of the Labour Government there was constant growth of 1 per cent. in real terms. All this talk about Health Service spending being cut is rubbish.
But that is not what the new clause is about. I can sense that you are becoming a bit concerned, Madam Deputy Speaker. I am astonished that the Minister seems to be poised to resist the new clause. I wish that this measure were not necessary. The hon. Member for Dumfries has been here throughout the debate, so I do not complain because he is not here at the moment. If he were in the Chamber, he would confirm what happened when he reorganised the Health Service. Three wings—the hospital board wing; the preventive medicine side, which was run not by the Health Service but by the education authorities; and the family practitioner wing—were brought together into a co-ordinated Health Service. That was done by agreement on the Floor of the House, with little whipping on the legislation. The treatment of health care in Scotland occurred through the ages.
The Minister announced last week the setting up of a body above the health boards in order, he said, to impose the Government's policy on them. If that is the purpose of that body, it must be counterbalanced. That would be done by the very body which the new clause would set up. There must be a counterbalance for patients. If one body acts on the Minister's behalf and imposes Government policies where sometimes they would be resisted by health boards, there must be a consumer voice. It would be in the quality control commission that is suggested in the new clause, as amended by the amendment tabled by the hon. Member for Moray (Mrs. Ewing).
I have listened with great interest to hon. Members who have waxed eloquent about the standard of health care in their constituencies. I cannot do the same, but that is not a criticism of the doctors, consultants, nurses or anybody else who works in Falkirk royal infirmary. The problem is the net result of the constant transfer of facilities and services from Falkirk royal infirmary to sustain Stirling royal infirmary in the Minister's constituency. [Laughter.] The Minister laughs, but let us see how he laughs off my next remarks.
The ear, nose and throat department was transferred from Falkirk royal infirmary to sustain Stirling royal infirmary. My constituents have to travel many miles from their villages to see their children who are having their tonsils removed or to see their old folk when they are having eye operations. That must be measured in terms of quality control. The quality of health care that my constituents have to put up with must be measured against the inconvenience and trouble to which they have been put because the department has been moved 15 miles along the road to Stirling royal infirmary.
Hospitals are accredited for training purposes by the royal colleges. Stirling royal infirmary is not recognised as a training hospital for consultant anaesthetists because it does not carry out the range of anaesthetic work necessary for people to qualify. The Forth Valley health board is trying to correct the problem, not by getting more patients into Stirling royal infirmary—which could be done—but by transferring work from Falkirk royal infirmary to provide the necessary range at Stirling royal infirmary. Before we know what is going on, facilities will be transferred to Falkirk and our hospital will be downgraded.
My hon. Friend the Member for Falkirk, West (Mr. Canavan) has to tolerate such problems. They should be measured by a quality control commission. Such a commission would be able to prove that we could get more patients into Stirling royal infirmary. I have an interest in that hospital, too, and I have a high regard for it. I had close contacts with it during my 13 years as a Member of Parliament representing a constituency that includes Stirling.
The hon. Member for Dumfries referred to a survey that the Minister commissioned about a year ago, yet the Minister has referred to that survey only once. It covered a host of experience of patients in our hospitals. It covered what they thought of meals, of visiting hours and of the facilities available. One aspect of that survey—the number of patients being referred to hospitals outside their health board area—was very interesting. In each of the health board areas in Scotland, the average was 3 per cent. to 5 per cent. That can be accounted for easily by the need to refer to the specialist centres. No one would argue that we should have such specialist centres in every health board area, but in the Forth Valley health board area the figure was 17 per cent.
The Minister knows better than I do that general practitioners in the landward area, which is the western part of the Forth Valley health board's area—in the Minister's constituency—are referring patients to Edinburgh and Glasgow for general examinations which should be carried out at Stirling royal infirmary. Any treatment arising from those general examinations should also be performed at Stirling royal infirmary. We are talking about measuring quality of service to patients, and about the quality of health care that should be provided to the community. We must take into account whether such health care is there at all. For many years in Falkirk, we have enjoyed such health care provided expertly by good people at Falkirk and District royal infirmary.
I tell the Minister, in the kindest possible way, that we are in no mood to give up that care lightly. The Forth Valley health board's option appraisal is still to be published and the Minister has, in many ways, pre-empted that option appraisal by references to facilities at Stirling royal infirmary, which we shall not debate tonight, but will keep for another time. However, if there is any suggestion that Falkirk and District royal infirmary should be downgraded and that more services should be transferred, thus reducing the service to our people, the Minister will have a fight on his hands.
I found the speech of my hon. Friend the Member for Glasgow, Rutherglen (Mr. McAvoy) very disturbing. I cannot for the life of me think how a self-respecting Minister of any political party could go within 10 miles of a deal such as the one my hon. Friend explained to the House tonight. Even without this debate and even without the new clause on which to base it, my hon. Friend's speech could have stood on its own. He raised a very serious issue. The hon. Member for Tayside, North talks about the Public Accounts Committee examining the matter far better than it would have been examined by the Select Committee on Scottish Affairs. The issue that my hon. Friend the Member for Rutherglen raised is so serious—I do not say this lightly and I am not given to calling for public inquiries—as to require the closest public examination.
Quality control is about the availability of a service. If a service is not available or if it is taken away, we would examine that closely. That is why I shall support my hon. Friends in the Lobby tonight.
We have had a long debate and it may be for the convenience of the House if I intervene now.
The hon. Member for Glasgow, Cathcart (Mr. Maxton) some hours ago made a number of points when moving the new clause. I echo the remarks of the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood). I too was puzzled by the organisations that the hon. Member for Cathcart suggested should be consulted about the membership of the proposed body. He did not mention the Royal College of Nursing, the British Medical Association and other professional bodies. That was surprising, given his concern about the Health Service. It was revealing about his real intentions.
I will not respond to all the points that the hon. Member for Cathcart made about competitive tendering, which he insisted on calling privatisation, despite the fact that he acknowledged that three quarters of the contracts had been awarded in-house. I noted his comments about standards. If he was critical of standards, they cannot have been the standards of specification in the contracts. He must have been referring to the execution of the contracts, and I took that to be an attack on the performance of the in-house teams.
The hon. Gentleman said that fines were being levied in respect of some contracts. Given that the whole process of competitive tendering is about defining the level of service required, ensuring that that service is subsequently delivered and implementing the procedures for fining private contractors where they fall below standard, I should have thought that that met the requirements that the hon. Gentleman was putting forward in the new clause for the proper policing of standards in the NHS.
It is not possible to impose fines and take sanctions where contracts are held in-house, which is in by far the majority of cases, but in the light of the hon. Gentleman's remarks I will look again at the procedures that are in place for policing the standards of performance of in-house contracts and the activities of the boards in seeing that that which was promised when the contract was awarded is delivered.
I found it remarkable that in the history that the hon. Member for Cathcart gave of the process by which competitive tendering was embarked on in Scotland at no point did he say that nearly £60 million had been released as additional resources for health boards.
I answered a parliamentary question—it is available in the Library—which set out all the additional services that the boards had bought with the savings resulting from that process. Simply saying "Nobody believes it" is not a way of substituting for the facts.
My hon. Friend the Member for Dumfries (Sir H. Monro), in an excellent contribution—one of the few which addressed the issue in the new clause—highlighted the fact that the new clause would result in substantial additional costs for the NHS, money that would be diverted from patient care. It could be financed only at the expense of less progress being made on reducing waiting lists and not extending the range and quality of treatment available to patients.
As my hon. Friend pointed out, the whole point of the White Paper proposals and the Bill is to try to bring about a separation between the role of health boards as purchasers and as providers. The role of ensuring the highest standards of quality and policing the quality of service is that of the health boards. The idea that we should set up a new organisation to take over the role of health boards is extraordinary, a point that was also made by my hon. Friend the Member for Tayside, North (Mr. Walker).
As my hon. Friend the Member for Dumfries said, the NHS today in Scotland is better than it was a year ago, and I agree with him that in a year from now it will be better still, particularly as a result of this measure becoming law.
The hon. Member for Roxburgh and Berwickshire, in an intriguing split with his right hon. Friend the Member for Tweeddale, Ettrick and Lauderdale (Sir D. Steel), informed us that his constituency in the Borders had an excellent health board and nothing to complain about. In fact, he interrupted to say, "If it ain't broke, don't fix it." Apologies for the grammar, but I agree with the hon. Gentleman. He is right: the Borders has a brand-new hospital and an excellent Health Service. Nevertheless, his right hon. Friend subsequently listed a series of complaints.
My hon. Friend the Member for Dumfries rightly spoke of the importance of dialysis being available within easy travelling distance of patients, while at the same time acknowledging the difficulties of providing such facilities in rural areas. I am happy to assure my hon. Friend that we are keen for progress to be made in that regard. Unlike Opposition Members, we feel that, if it is possible to provide them more cheaply by involving the private sector, it should be done: we have no ideological baggage to prevent us from acting in the interests of patients. The hon. Member for Glasgow, Rutherglen (Mr. McAvoy) smiles. [Interruption.] I will deal with his allegations in a moment, but let me ask him for the third time whether he is asking me to prevent Takare from providing that facility in his constituency.
Let me repeat for the third time what I said. I, as Member of Parliament, and the whole community of Cambuslang and Rutherglen do not want the deal, because of the lack of principle and because of the financial details. Will the Minister confirm, for the first time tonight, what I have said about the financial details of the proposed deal with Takare or will he take this opportunity to tell us the details, in the interests of truth?
What I will say is that the Greater Glasgow health board's proposals were examined in detail by my officials, who believe that they represent value for money. They required the approval of the Treasury, which—after examining them in detail—is also satisfied that they represent value for money. The hon. Gentleman has made a series of allegations which I shall certainly pursue, but I take if from what he has said that he does not wish to see the Takare facility in his constituency.
The hon Member for Moray (Mrs. Ewing) made a number of points, but she was particularly worried about a reduction in the number of local health councils. The Bill provides for the provision of more than one health council where it is considered necessary, and when the Grampian health board's proposals are presented we shall bear her views in mind.
The hon. Member for Aberdeen, North (Mr. Hughes), who made the same point about health councils, very fairly explained the divergence of view between him and the hon. Member for Strathkelvin and Bearsden (Mr. Galbraith). He mentioned the work of the Mental Welfare Commission. May I add that we also have the Scottish Hospital Advisory Service, the Health Service Commissioner and a number of other agencies, all of which would provide for the functions proposed in the new clause.
The right hon. Member for Tweeddale, Ettrick and Lauderdale spoke of the difficulties with his orthopaedic service. I am not familiar with the budget, but it may have been inflated by the waiting list initiative which has resulted in a considerable reduction. In the Borders, with a new hospital, the waiting list is more or less at base level.
The right hon. Gentleman's example of the nebuliser is precisely the kind of thing that the reforms are designed to change. He explained the frustration of doctors who found that for the sake of £100 they could not get a patient out of hospital. That is ridiculous. The principles of money following the patient and the devolution of management responsibility at hospital level are designed to cut precisely the kind of red tape about which the right hon. Gentleman was complaining.
The hon. Member for Falkirk, East (Mr. Ewing) said that one Government may commission a hospital but the credit for it will be taken by the Government in power when it is built. This Government have presided over the biggest capital investment programme in the history of the Health Service. The Labour Government cut the hospital building programme. In reply to my hon. Friend the Member for Tayside, North, the hon. Gentleman said that no project that was being built was delayed. What he did not mention was all the projects which were not started and which were delayed because of the Labour Government's incompetence.
If the hon. Gentleman has found a way of cutting the hospital building programme and maintaining its progress, I would be interested to hear about it because it would be useful not only for me but for other Ministers with responsibility for health.
The hon. Member for Falkirk, East made a serious point about the facilities at Falkirk and Stirling. I assure him that it is central to the aims of our White Paper and to the Bill that health boards should fulfil their function to ensure that services are available to communities which reflect their needs. That is what they have to make a judgment on. I agree that basic essential services should be available to patients within reasonable travelling distance. I am well aware of the distances that people have to travel to Stirling royal infirmary and to Falkirk. Therefore, the hon. Gentleman would do well to see what emerges from the health board before jumping to conclusions.
For those reasons, I suggest that the hon. Member for Cathcart should withdraw his new clause.
I certainly have no intention of detaining the House for any longer than I can help. However, the Minister's speech deserves some response.
If the thrust of the new clause is, as I understand it, to try to establish some new standards of quality control in the Health Service, it must be of some interest to the House to know exactly what the response has been to the Bill's proposals from general practitioners who have expressed an interest in the GP budget-holding facility. More importantly, and more immediately, it is important to know a bit more about the details of the hospitals which have expressed an interest—that is all that they can do at present—in the Bill's provisions.
If there were sensible guarantees about the quality of the service that could be provided under the Bill's terms, more hospitals in particular, as well as general practitioners, would be expressing an interest in the proposals for opting out or moving towards self-governing status. It is important for the rest of the debate to know a bit more about the types of hospital which have been expressing an interest in the Bill's provisions so that we can judge whether the new clause is necessary.
The competitive and free-market thrust of the Bill, certainly where it relates to rural areas, requires a cast-iron guarantee of quality assurance if the Bill is to be put on the statute book. If the Minister is not prepared to accept the new clause, he and the Government should be prepared to accept new clause 16. The suggestions it contains have come from the Royal College of Nursing, which set out alternative proposals for advisory boards. In principle, they would achieve the same end as new clause 2 and reflect the interests of health professionals a bit better than that new clause 2 and, in principle, I support them.
The Government are determined to proceed with this new internal market procedure and moving towards more commercial interests being introduced into the National Health Service. I listened carefully to the speech of the hon. Member for Dumfries (Sir H. Monro) and he certainly did not convince me that the health care provision in Dumfries and the Borders requires a new competitive system. If the Health Service in the Borders area is divided into a system of providers, with National Health Service trusts and opted-out hospitals on one side and health board acquirals, the basis of contracts and the edifice of bureaucracy which that would spawn would not he worth a candle. The improvements, if any, that would be effected would not be worth having. That is true of competitive tendering. The costs involved for a board the size of the Borders health board for doing the specifications for the contracts do not measure up to the savings that can be made.
Therefore, the Minister is unjustified in saying that there is a difference of opinion between my right hon. Friend the Member for Tweeddale, Ettrick and Lauderdale (Sir D. Steel) and me. We both say that the system in place for administering health care in the Borders is perfectly adequate and needs just a little extra money, not a vast amount, to make the present system work that much more smoothly. If the Minister insists on inflicting this new edifice of a free market on rural areas, he risks losing good will, prejudicing staff morale and losing the integration and co-operation between health professionals—and all for the ideological purpose of installing and instituting a free market system.
A system of quality control will be necessary in rural areas if the Bill is passed. For the reasons mentioned by the hon. Member for Dumfries, the only way to avoid the need for the new clause would be to remove the provision in the Bill. The Minister would have the co-operation and agreement of the health professionals in the Borders if he stepped back from full implementation of the Bill and instead introduced a system of pilot studies, on a selective basis over a period, so that we could assess the results. The new clause would not then be necessary. However, if the Minister insists on sticking to the whole system proposed in the Bill, it is essential, especially in rural areas, that there be some system to guarantee quality control.
If the Minister is not prepared to accept the new clause, he should say, first, which hospitals have directly expressed interest in self-governing status, and, secondly, whether he will accept new clause 15 or new clause 16.
|Division No. 115]||[2.11 am|
|Alexander, Richard||Bowis, John|
|Alison, Rt Hon Michael||Brazier, Julian|
|Allason, Rupert||Bright, Graham|
|Amess, David||Brooke, Rt Hon Peter|
|Amos, Alan||Brown, Michael (Brigg & Cl't's)|
|Arbuthnot, James||Bruce, Ian (Dorset South)|
|Arnold, Jacques (Gravesham)||Budgen, Nicholas|
|Arnold, Tom (Hazel Grove)||Burns, Simon|
|Baker, Nicholas (Dorset N)||Butcher, John|
|Baldry, Tony||Butler, Chris|
|Batiste, Spencer||Butterfill, John|
|Bellingham, Henry||Carlisle, Kenneth (Lincoln)|
|Bendall, Vivian||Carrington, Matthew|
|Bennett, Nicholas (Pembroke)||Carttiss, Michael|
|Blaker, Rt Hon Sir Peter||Cash, William|
|Bonsor, Sir Nicholas||Chalker, Rt Hon Mrs Lynda|
|Boscawen, Hon Robert||Channon, Rt Hon Paul|
|Boswell, Tim||Chapman, Sydney|
|Bottomley, Peter||Clarke, Rt Hon K. (Rushcliffe)|
|Bottomley, Mrs Virginia||Colvin, Michael|
|Bowden, A (Brighton K'pto'n)||Conway, Derek|
|Bowden, Gerald (Dulwich)||Coombs, Anthony (Wyre F'rest)|
|Coombs, Simon (Swindon)||Lord, Michael|
|Cope, Rt Hon John||Luce, Rt Hon Richard|
|Couchman, James||MacKay, Andrew (E Berkshire)|
|Cran, James||Maclean, David|
|Currie, Mrs Edwina||McLoughlin, Patrick|
|Curry, David||Malins, Humfrey|
|Davies, Q. (Stamf'd & Spald'g)||Mans, Keith|
|Davis, David (Boothferry)||Maples, John|
|Day, Stephen||Marland, Paul|
|Devlin, Tim||Marshall, Michael (Arundel)|
|Dorrell, Stephen||Martin, David (Portsmouth S)|
|Douglas-Hamilton, Lord James||Maude, Hon Francis|
|Dover, Den||Mayhew, Rt Hon Sir Patrick|
|Dunn, Bob||Mellor, David|
|Emery, Sir Peter||Meyer, Sir Anthony|
|Evans, David (Welwyn Hatf'd)||Mills, Iain|
|Evennett, David||Mitchell, Andrew (Gedling)|
|Fallon, Michael||Mitchell, Sir David|
|Fenner, Dame Peggy||Moate, Roger|
|Fishburn, John Dudley||Monro, Sir Hector|
|Forman, Nigel||Moss, Malcolm|
|Forsyth, Michael (Stirling)||Neale, Gerrard|
|Forth, Eric||Nelson, Anthony|
|Franks, Cecil||Neubert, Michael|
|Freeman, Roger||Nicholls, Patrick|
|French, Douglas||Nicholson, David (Taunton)|
|Gale, Roger||Nicholson, Emma (Devon West)|
|Gardiner, George||Onslow, Rt Hon Cranley|
|Garel-Jones, Tristan||Oppenheim, Phillip|
|Gill, Christopher||Paice, James|
|Glyn, Dr Sir Alan||Patnick, Irvine|
|Goodhart, Sir Philip||Patten, Rt Hon Chris (Bath)|
|Goodlad, Alastair||Patten, Rt Hon John|
|Goodson-Wickes, Dr Charles||Pawsey, James|
|Gorst, John||Peacock, Mrs Elizabeth|
|Gow, Ian||Porter, David (Waveney)|
|Greenway, John (Ryedale)||Price, Sir David|
|Gregory, Conal||Raison, Rt Hon Timothy|
|Grist, Ian||Rathbone, Tim|
|Ground, Patrick||Redwood, John|
|Hague, William||Renton, Rt Hon Tim|
|Hamilton, Neil (Tatton)||Roe, Mrs Marion|
|Hampson, Dr Keith||Rossi, Sir Hugh|
|Hanley, Jeremy||Rowe, Andrew|
|Hannam, John||Rumbold, Mrs Angela|
|Hargreaves, A. (B'ham H'll Gr')||Ryder, Richard|
|Harris, David||Sackville, Hon Tom|
|Haselhurst, Alan||Sayeed, Jonathan|
|Hawkins, Christopher||Shaw, Sir Giles (Pudsey)|
|Hayes, Jerry||Shaw, Sir Michael (Scarb')|
|Hayward, Robert||Shephard, Mrs G. (Norfolk SW)|
|Heathcoat-Amory, David||Shepherd, Colin (Hereford)|
|Hicks, Mrs Maureen (Wolv' NE)||Shersby, Michael|
|Hicks, Robert (Cornwall SE)||Sims, Roger|
|Higgins, Rt Hon Terence L.||Smith, Sir Dudley (Warwick)|
|Hind, Kenneth||Smith, Tim (Beaconsfield)|
|Holt, Richard||Speller, Tony|
|Howarth, Alan (Strat'd-on-A)||Spicer, Sir Jim (Dorset W)|
|Hughes, Robert G. (Harrow W)||Squire, Robin|
|Hunt, Sir John (Ravensbourne)||Stanbrook, Ivor|
|Irvine, Michael||Stanley, Rt Hon Sir John|
|Jack, Michael||Stevens, Lewis|
|Jackson, Robert||Stewart, Andy (Sherwood)|
|Janman, Tim||Stradling Thomas, Sir John|
|Jessel, Toby||Summerson, Hugo|
|Johnson Smith, Sir Geoffrey||Tapsell, Sir Peter|
|Jones, Gwilym (Cardiff N)||Taylor, Ian (Esher)|
|Jones, Robert B (Herts W)||Taylor, John M (Solihull)|
|Key, Robert||Taylor, Teddy (S'end E)|
|King, Roger (B'ham N'thfield)||Thompson, D. (Calder Valley)|
|Kirkhope, Timothy||Thompson, Patrick (Norwich N)|
|Knapman, Roger||Thorne, Neil|
|Knight, Greg (Derby North)||Thornton, Malcolm|
|Knight, Dame Jill (Edgbaston)||Thurnham, Peter|
|Lang, Ian||Townsend, Cyril D. (B'heath)|
|Lawrence, Ivan||Tredinnick, David|
|Lee, John (Pendle)||Trippier, David|
|Leigh, Edward (Gainsbor'gh)||Trotter, Neville|
|Lennox-Boyd, Hon Mark||Twinn, Dr Ian|
|Lloyd, Peter (Fareham)||Walker, Bill (T'side North)|
|Waller, Gary||Wolfson, Mark|
|Ward, John||Wood, Timothy|
|Wardle, Charles (Bexhill)||Yeo, Tim|
|Watts, John||Young, Sir George (Acton)|
|Wells, Bowen||Younger, Rt Hon George|
|Wheeler, Sir John|
|Widdecombe, Ann||Tellers for the Ayes:|
|Wilshire, David||Mr. Tony Durant and Mr. David Lightbown.|
|Winterton, Mrs Ann|
|Abbott, Ms Diane||Kennedy, Charles|
|Alton, David||Kilfedder, James|
|Barnes, Harry (Derbyshire NE)||Kirkwood, Archy|
|Battle, John||Livsey, Richard|
|Bennett, A. F. (D'nt'n & R'dish)||Lloyd, Tony (Strettord)|
|Bradley, Keith||McAvoy, Thomas|
|Bruce, Malcolm (Gordon)||McCartney, Ian|
|Buckley, George J.||McKay, Allen (Barnsley West)|
|Campbell-Savours, D. N.||McKelvey, William|
|Carlile, Alex (Mont'g)||McLeish, Henry|
|Clarke, Tom (Monklands W)||Madden, Max|
|Clelland, David||Mahon, Mrs Alice|
|Cook, Robin (Livingston)||Martin, Michael J. (Springburn)|
|Cousins, Jim||Maxton, John|
|Cryer, Bob||Meale, Alan|
|Dalyell, Tam||Michael, Alun|
|Davies, Ron (Caerphilly)||Michie, Bill (Sheffield Heeley)|
|Davis, Terry (B'ham Hodge H'l)||Michie, Mrs Ray (Arg'l & Bute)|
|Dewar, Donald||Morgan, Rhodri|
|Dixon, Don||Murphy, Paul|
|Eadie, Alexander||Nellist, Dave|
|Evans, John (St Helens N)||Patchett, Terry|
|Ewing, Harry (Falkirk E)||Pike, Peter L|
|Ewing, Mrs Margaret (Moray)||Powell, Ray (Ogmore)|
|Flynn, Paul||Primarolo, Dawn|
|Foster, Derek||Redmond, Martin|
|Foulkes, George||Ross, Ernie (Dundee W)|
|Fyfe, Maria||Rowlands, Ted|
|Godman, Dr Norman A.||Spearing, Nigel|
|Graham, Thomas||Steel, Rt Hon Sir David|
|Griffiths, Win (Bridgend)||Turner, Dennis|
|Hardy, Peter||Wallace, James|
|Harman, Ms Harriet||Wareing, Robert N.|
|Haynes, Frank||Watson, Mike (Glasgow, C)|
|Hinchliffe, David||Welsh, Andrew (Angus E)|
|Home Robertson, John||Welsh, Michael (Doncaster N)|
|Hood, Jimmy||Williams, Rt Hon Alan|
|Howarth, George (Knowsley N)||Wilson, Brian|
|Howells, Dr. Kim (Pontypridd)||Winnick, David|
|Hoyle, Doug||Wise, Mrs Audrey|
|Hughes, Robert (Aberdeen N)|
|Hughes, Simon (Southwark)||Tellers for the Noes:|
|Ingram, Adam||Mrs. Llin Golding and Mr. Jimmy Dunnachie.|
|Jones, Barry (Alyn & Deeside)|
|Jones, Ieuan (Ynys Môn)|
|Division No. 116]||[2.23 am|
|Abbott, Ms Diane||Dalyell, Tam|
|Alton, David||Davies, Ron (Caerphilly)|
|Barnes, Harry (Derbyshire NE)||Davis, Terry (B'ham Hodge H'l)|
|Battle, John||Dewar, Donald|
|Bennett, A. F. (D'nt'n & R'dish)||Dixon, Don|
|Bradley, Keith||Eadie, Alexander|
|Bruce, Malcolm (Gordon)||Evans, John (St Helens N)|
|Buckley, George J.||Ewing, Harry (Falkirk E)|
|Campbell-Savours, D. N.||Ewing, Mrs Margaret (Moray)|
|Carlile, Alex (Mont'g)||Flynn, Paul|
|Clarke, Tom (Monklands W)||Foster, Derek|
|Clelland, David||Foulkes, George|
|Cook, Robin (Livingston)||Fyfe, Maria|
|Cousins, Jim||Godman, Dr Norman A.|
|Cryer, Bob||Golding, Mrs Llin|
|Graham, Thomas||Michie, Bill (Sheffield Heeley)|
|Griffiths, Win (Bridgend)||Michie, Mrs Ray (Arg'l & Bute)|
|Hardy, Peter||Morgan, Rhodri|
|Harman, Ms Harriet||Murphy, Paul|
|Hinchliffe, David||Nellist, Dave|
|Home Robertson, John||Patchett, Terry|
|Hood, Jimmy||Pike, Peter L.|
|Howarth, George (Knowsley N)||Powell, Ray (Ogmore)|
|Howells, Dr. Kim (Pontypridd)||Primarolo, Dawn|
|Hoyle, Doug||Redmond, Martin|
|Hughes, Robert (Aberdeen N)||Ross, Ernie (Dundee W)|
|Hughes, Simon (Southwark)||Rowlands, Ted|
|Ingram, Adam||Short, Clare|
|Jones, Barry (Alyn & Deeside)||Skinner, Dennis|
|Jones, leuan (Ynys Môn)||Spearing, Nigel|
|Kennedy, Charles||Steel, Rt Hon Sir David|
|Kilfedder, James||Turner, Dennis|
|Kirkwood, Archy||Wallace, James|
|Livsey, Richard||Wareing, Robert N.|
|Lloyd, Tony (Stretford)||Watson, Mike (Glasgow, C)|
|McAvoy, Thomas||Welsh, Andrew (Angus E)|
|McCartney, Ian||Welsh, Michael (Doncaster N)|
|McKay, Allen (Barnsley West)||Williams, Rt Hon Alan|
|McKelvey, William||Wilson, Brian|
|McLeish, Henry||Winnick, David|
|Madden, Max||Wise, Mrs Audrey|
|Mahon, Mrs Alice|
|Martin, Michael J. (Springburn)||Tellers for the Ayes:|
|Maxton, John||Mr. Frank Haynes and Mr. Jimmy Dunnachie.|
|Alexander, Richard||Currie, Mrs Edwina|
|Alison, Rt Hon Michael||Davies, Q. (Stamf'd & Spald'g)|
|Allason, Rupert||Davis, David (Boothferry)|
|Amess, David||Day, Stephen|
|Amos, Alan||Devlin, Tim|
|Arbuthnot, James||Dorrell, Stephen|
|Arnold, Jacques (Gravesham)||Douglas-Hamilton, Lord James|
|Arnold, Tom (Hazel Grove)||Dover, Den|
|Baldry, Tony||Dunn, Bob|
|Batiste, Spencer||Emery, Sir Peter|
|Bellingham, Henry||Evans, David (Welwyn Hatf'd)|
|Bendall, Vivian||Evennett, David|
|Bennett, Nicholas(Pembroke)||Fallon, Michael|
|Blaker, Rt Hon Sir Peter||Fenner, Dame Peggy|
|Bonsor, Sir Nicholas||Fishburn, John Dudley|
|Boscawen, Hon Robert||Forman, Nigel|
|Boswell, Tim||Forsyth, Michael (Stirling)|
|Bottomley, Peter||Forth, Eric|
|Bottomley, Mrs Virginia||Franks, Cecil|
|Bowden, A (Brighton K'pto'n)||Freeman, Roger|
|Bowden, Gerald (Dulwich)||French, Douglas|
|Bowis, John||Gale, Roger|
|Brazier, Julian||Gardiner, George|
|Bright, Graham||Garel-Jones, Tristan|
|Brooke, Rt Hon Peter||Gill, Christopher|
|Brown, Michael (Brigg & Cl't's)||Glyn, Dr Sir Alan|
|Bruce, Ian (Dorset South)||Goodhart, Sir Philip|
|Budgen, Nicholas||Goodlad, Alastair|
|Burns, Simon||Goodson-Wickes, Dr Charles|
|Butcher, John||Gorst, John|
|Butler, Chris||Gow, Ian|
|Butterfill, John||Greenway, John (Ryedale)|
|Carlisle, Kenneth (Lincoln)||Gregory, Conal|
|Carrington, Matthew||Grist, Ian|
|Carttiss, Michael||Ground, Patrick|
|Cash, William||Hague, William|
|Chalker, Rt Hon Mrs Lynda||Hamilton, Neil (Tatton)|
|Channon, Rt Hon Paul||Hampson, Dr Keith|
|Chapman, Sydney||Hanley, Jeremy|
|Clarke, Rt Hon K. (Rushcliffe)||Hannam, John|
|Colvin, Michael||Hargreaves, A. (B'ham H'll Gr')|
|Conway, Derek||Harris, David|
|Coombs, Anthony (Wyre F'rest)||Haselhurst, Alan|
|Coombs, Simon (Swindon)||Hawkins, Christopher|
|Cope, Rt Hon John||Hayes, Jerry|
|Couchman, James||Hayward, Robert|
|Cran, James||Heathcoat-Amory, David|
|Hicks, Mrs Maureen (Wolv' NE)||Price, Sir David|
|Hicks, Robert (Cornwall SE)||Raison, Rt Hon Timothy|
|Higgins, Rt Hon Terence L.||Rathbone, Tim|
|Hind, Kenneth||Redwood, John|
|Holt, Richard||Renton, Rt Hon Tim|
|Howarth, Alan (Strat'd-on-A)||Rossi, Sir Hugh|
|Hughes, Robert G. (Harrow W)||Rowe, Andrew|
|Hunt, Sir John (Ravensbourne)||Rumbold, Mrs Angela|
|Irvine, Michael||Ryder, Richard|
|Jack, Michael||Sackville, Hon Tom|
|Janman, Tim||Sayeed, Jonathan|
|Jessel, Toby||Shaw, Sir Giles (Pudsey)|
|Johnson Smith, Sir Geoffrey||Shaw, Sir Michael (Scarb')|
|Jones, Gwilym (Cardiff N)||Shephard, Mrs G. (Norfolk SW)|
|Jones, Robert B (Herts W)||Shepherd, Colin (Hereford)|
|Key, Robert||Shersby, Michael|
|King, Roger (B'ham N'thfield)||Sims, Roger|
|Kirkhope, Timothy||Smith, Sir Dudley (Warwick)|
|Knapman, Roger||Smith, Tim (Beaconsfield)|
|Knight, Greg (Derby North)||Speller, Tony|
|Knight, Dame Jill (Edgbaston)||Spicer, Sir Jim (Dorset W)|
|Lang, Ian||Squire, Robin|
|Lawrence, Ivan||Stanbrook, Ivor|
|Lee, John (Pendle)||Stanley, Rt Hon Sir John|
|Leigh, Edward (Gainsbor'gh)||Stevens, Lewis|
|Lennox-Boyd, Hon Mark||Stewart, Andy (Sherwood)|
|Lightbown, David||Stradling Thomas, Sir John|
|Lloyd, Peter (Fareham)||Summerson, Hugo|
|Lord, Michael||Tapsell, Sir Peter|
|Luce, Rt Hon Richard||Taylor, Ian (Esher)|
|Lyell, Rt Hon Sir Nicholas||Taylor, John M (Solihull)|
|MacKay, Andrew (E Berkshire)||Taylor, Teddy (S'end E)|
|Maclean, David||Thompson, D. (Calder Valley)|
|McLoughlin, Patrick||Thompson, Patrick (Norwich N)|
|Malins, Humfrey||Thorne, Neil|
|Mans, Keith||Thornton, Malcolm|
|Maples, John||Thurnham, Peter|
|Marland, Paul||Townsend, Cyril D. (B'heath)|
|Marshall, Michael (Arundel)||Tredinnick, David|
|Martin, David (Portsmouth S)||Trippier, David|
|Mayhew, Rt Hon Sir Patrick||Trotter, Neville|
|Mellor, David||Twinn, Dr Ian|
|Meyer, Sir Anthony||Walker, Bill (T'side North)|
|Mills, Iain||Waller, Gary|
|Mitchell, Andrew (Gedling)||Ward, John|
|Mitchell, Sir David||Wardle, Charles (Bexhill)|
|Moate, Roger||Watts, John|
|Monro, Sir Hector||Wells, Bowen|
|Moss, Malcolm||Wheeler, Sir John|
|Neale, Gerrard||Widdecombe, Ann|
|Nelson, Anthony||Wilshire, David|
|Neubert, Michael||Winterton, Mrs Ann|
|Nicholls, Patrick||Winterton, Nicholas|
|Nicholson, David (Taunton)||Wolfson, Mark|
|Nicholson, Emma (Devon West)||Wood, Timothy|
|Onslow, Rt Hon Cranley||Yeo, Tim|
|Oppenheim, Phillip||Young, Sir George (Acton)|
|Paice, James||Younger, Rt Hon George|
|Patten, Rt Hon John||Tellers for the Noes:|
|Pawsey, James||Mr, Tony Durant and Mr. Nicholas Baker.|
|Peacock, Mrs Elizabeth|
|Porter, David (Waveney)|