(4) The Secretary of State shall—
and shall then publish a draft of a statement or of amendments to a statement.
- (a) consult such persons as he considers appropriate and, in determining who to consult, he shall take advice from the Commission; and
- (b) request the Commission to give him advice as to the likely impact of the proposed statement or the proposed amendment on—
- (i) the aggregate supply of the service provided by establishments or agencies of the type concerned in England and Wales; and
- (ii) the cost of supplying such services in accordance with the statement of minimum standards;
(5) The Secretary of State shall lay before both Houses of Parliament a draft of any proposed statement of national minimum standards or amendments to a statement together with copies of representations received in respect of the consultation under subsection (4)(a) and the advice received from the Commission under subsection (4)(b).
Amendment No. 39, in page 14, line 35, at end insert—
'(m) make provision in the case of an establishment providing cosmetic surgery as to—
Government amendment No. 61.
Amendment No. 2, in clause 23, page 15, line 3, leave out Clause 23.
New clause 4 and amendment No. 2, which is a paving amendment for it, would remove clause 23 from the Bill and substitute it with new clause 4. The new clause would do broadly the same things as clause 23, but with some important differences.
For the benefit of hon. Members who did not serve on the Standing Committee, I shall briefly explain what clause 23 does. It gives the Minister the power to
prepare and publish statements of national minimum standards applicable to establishments or agencies
and to keep the statements of standards under review. The statements will not be subject to any parliamentary scrutiny; they will be prepared by the Minister and published after the consultation that he considers appropriate.
Once the standards are published, they will "be taken into account"—that is a rather indefinite phrase—in making certain decisions and in any proceedings taken under the Bill. It also seems likely that the statements will be referred to in regulations made under other parts of the Bill. Therefore, the regulations that refer to the standards or incorporate them may be subject to scrutiny in the House, but the statements themselves will not be.
Of course, the Minister will consult with whoever he considers to be appropriate before he publishes the statement of minimum standards. However, I remind the House that people's businesses and livelihoods may be at stake and they may be driven out of business if they do not comply with the statement that the Minister has issued. For it to become effective, all he has to do is publish it; there will be no parliamentary scrutiny whatever.
New clause 4 and the paving amendment seek to do two things. First, the new clause would change the process of bringing into force a statement of minimum standards. It would place a clear obligation on the Secretary of State to prepare statements of minimum standards; he would not merely be allowed to publish them. The statements are a vital part of the structure that the Government are creating and the Secretary of State should have a clear obligation to prepare them.
Secondly, new clause 4 lays down a procedure for consultation outside Parliament and for a process of interaction with the commission, along the lines suggested by my right hon. Friend the Member for Bromley and Chislehurst (Mr. Forth) in the previous debate. That process would require the Secretary of State to require from the commission an analysis of the likely effect of the statements of minimum standards so that he can make a proper appraisal of their probable impact on the supply of services and the cost of providing them. Finally, it provides for proper parliamentary scrutiny of the draft statement of minimum standards before it comes into force.
Will my hon. Friend clarify proposed subsection (4)(b)(ii), which is a crucial part of the new clause and refers to
the cost of supplying such services…?
Does that mean the cost of supplying the service to the business providing it or does it mean the cost of supplying the service to the individual who is benefiting from it? Or does it mean both?
The two are obviously related, but the provision is intended to relate to the cost to the business supplying the service. Proposed subsection (4)(b) seeks to ensure that, when formulating a draft statement of minimum standards which is to be laid before Parliament, the Secretary of State has advice from the commission about the likely effect of such a statement on the aggregate supply of services in England and Wales and the likely cost of supplying them.
My hon. Friend spoke about the connection between the cost to the business of supplying a service and the cost to the person enjoying it. Of course, he could go further and discuss the cost to the public purse because, in the majority of cases, the service will ultimately be paid for from the public purse. There is, therefore, a direct read-across from implications for costs on the businesses providing such services to implications for the public purse.
Did I understand my hon. Friend correctly when he suggested that, in the absence of new clause 4, regulations will become effective on publication? Is my hon. Friend telling the House that, under the Bill, there is no required minimum period of consultation for draft regulations, and no required gap between the consultative process and the required date of implementation?
As I understand it, the Secretary of State will consult such persons as he considers appropriate before publishing statements. However, those statements will become effective on publication. I am sure that the Minister will correct me if I have misunderstood that aspect of the working of clause 23.
May I go back to the point I was making about what the new clause seeks to do? First, it deals with the process of bringing such a statement into force and, secondly, it makes it clear in proposed subsection (7) that someone who does not comply with the statement of national minimum standards will not be registered. Clause 23 states:
The standards shall be taken into account
in making decisions, in any proceedings for making orders and
in any proceedings for an offence under regulations.
That seems to be rather vague for a matter as important as national minimum standards. If a national minimum standard is to mean anything, it should mean that someone who does not comply with it cannot come to the table. New clause 4 would therefore provide that someone who does not comply with the standard cannot be registered.
Of course, we accept that many standards are going to be made—indeed, some have already been made in draft. The Under-Secretary of State for Education and Employment, the hon. Member for Barking (Ms Hodge), has already circulated draft minimum standards on child minding. It would, therefore, be wrong to lead the House into thinking that statements of minimum standards published under clause 23 or, indeed, our new clause would relate only to care homes. However, everyone present will understand why I will focus on the statements of minimum standards for care homes, as there cannot be a Member who has not received correspondence from owners, operators and residents of care homes in their constituencies expressing concern about the potential impact of the national standards that the Government have circulated for consultation in the draft consultation document "Fit for the Future?".
We accept the need for minimum standards, which are a central feature of the Bill and the structure that the Government are putting in place. However, standards must not simply be aspirations: they must be deliverable, and the question of cost must be addressed. We have repeatedly asked the Government whether they accept that higher quality equals high cost and that that cost must be paid for. Do they recognise that the great majority of those in nursing and care homes are paid for by the state and the public purse? Therefore, as I have asked the Minister many times, does the state accept the implications for public spending and is it ready to meet them?
Throughout the industry, the concern is not that the Government want to raise standards—indeed, people would be delighted to operate to higher standards. The industry is concerned that the Government want to raise standards without paying the costs incurred, which will have a disastrous consequence. In the vast majority of cases, local authorities are the purchasers of this type of care. If they are not funded to meet the higher costs that these aspirations will impose, higher quality for the lucky ones will, inevitably, mean that no funding is available for others. Regrettably, the Government have consistently refused to address that point, and have not told the House or the Standing Committee whether they accept that there will be substantial costs and whether they are prepared to meet them in the case of those whose funding is met from the public purse. If the Government can reassure providers about that, many concerns will, at least, be diminished and, in some cases, will melt away completely.
We cannot look at the matter in a vacuum. The new higher standards in "Fit for the Future?" are being introduced against a background of tight finances for providers in the care home and nursing home market. They are dealing with the consequences of the national minimum wage—which has an impact in some areas, but not in others—the working time directive and other elements of the Government's social and employment legislation that have involved significant costs. They work in an environment in which, to a great extent, they face cost inflation of the type faced by the NHS, which is significantly higher than general inflation in the economy. In particular, wage and pay increases for NHS personnel, however welcome, have an inevitable consequence for competing employers in the private sector who provide services to publicly funded residents in nursing and care homes.
For many years, in many, if not most, parts of the country, providers of such care have faced below-inflation fee increases from local authorities that, with the best will in the world, cannot be more generous because their finances are too squeezed.
Has my hon. Friend considered the possible financial implications for local authority providers of residential care? There is much evidence that local authorities that still have residential homes do not receive in their Government grant the financial resources that will be necessary to upgrade the quality and structure of their premises to meet any minimum standards that the Secretary of State may set under the Bill.
My hon. Friend is absolutely right to point out the difficulty in which local authorities find themselves. Local authority accommodation is some of the least compliant of any accommodation, and the Government's recognition of that is the main factor behind their intention to bring it into the regulated system. They want to create a level playing field and to ensure that the quality of that accommodation is improved. I say to my hon. Friend, however, that local authorities' ability to improve their accommodation, particularly through capital works, will depend ultimately on the Government making funding available or authorising local authorities to finance the necessary works in unconventional ways.
Many private care home operators, particularly the smaller players in the market, do not have the luxury of being able to anticipate capital grants from central Government. As I shall show in a moment, they have found that the capital markets are closed to them because of the uncertainty created about the potential standards for nursing and care homes.
I do not know whether, in Committee, my hon. Friend received any assurances from the Minister that the Government would ensure that those who provide standards higher than the minimum—which, in looking after people, would be a natural way to get business—would not be financially penalised. It should not be possible for someone to say to them, "Although you are giving value for money in your provision, the minimum standards mean that you can provide the services for less," because that would force providers down to the minimum standard.
My hon. Friend has made an important point. One introduces minimum standards with the best of intentions, but if the contracting price is set at the minimum standard level, one compels anyone who wants to participate in the market to reduce their standards to the minimum. As I said in Committee, I fear that that is inevitable unless the Government introduce a method to incentivise the provision of care over and above the minimum standards. I shall not digress further because that is another debate.
New clause 4 would require the Secretary of State not only to undertake the usual consultations, but to use his powers to require the commission to evaluate the likely impact on aggregate supply and cost. That is to ensure that decisions are properly informed and that the full impact of proposed national minimum standards is properly taken into account. The new clause provides for that information to be made available to Parliament. That would mean that a quasi-independent body would be required to review the cost and supply implications of any proposed standards or changes to standards. It would not be right to characterise the commission as a fully independent body because it is required to act on directions in writing from the Secretary of State. The new clause would therefore introduce objectivity into the debate about new or changed standards.
I shall contrast that with what the Government have achieved with their draft standards for residential care homes. As many hon. Members will know, the Government commissioned a report, which they have put out for consultation. I believe that it contains some 280 recommendations, some of which are not controversial and will not have significant cost implications. Others, however, are highly controversial, and many of my hon. Friends will know from their postbags that the standards relating to staffing ratios and room sizes, in particular, have alarmed providers.
There is no doubt that the standards set in the draft document—10 sq m for rooms in existing accommodation and rooms of 12 sq m for wheelchair users and in newly built accommodation—would drive some providers out of business. I refer to particular individual providers whose accommodation is of a certain type and, perhaps, incapable of being easily converted. Other standards would have a more general impact across all providers in the sector; for example, recommendations for staffing ratios would have the straightforward effect of increasing costs for providers of all sizes.
My hon. Friend's grasp of the detail is positively Powellite, and I want to probe him on subsections (5) and (6) of the new clause, which properly require that a draft of the proposed national minimum standards should be subject to approval through a resolution of each House of Parliament. My hon. Friend will understand that I am troubled because it is not entirely clear from either subsection that the resolution of approval will require a debate.
My hon. Friend raises an important point. Subsection (6) says that the national minimum standards will not have effect until they are approved by a resolution of each House of Parliament. I understand that that is what we know as the affirmative procedure.
All homes will come under a standard regime. As my hon. Friend implies, some of the proposals in the draft minimum standards document will be more onerous for small providers than for large providers. If, for example, there were a requirement to have a member of staff in a management position who was supernumerary to the established staffing ratio, that would clearly be a more damaging blow to a very small home than to a large home provided by a large corporate provider.
I shall give the House some measure of the impact that "Fit for the Future?" would have on provision in this country if it were implemented in full. I do not want to mislead the House: the Minister has made it clear that the document will not be implemented in full. On this issue, he can be characterised as a man on a bicycle pedalling very fast backwards, but unfortunately we do not know where he will have got to when he stops pedalling, so uncertainty still hangs over the marketplace.
Let me illustrate the scale of the problem. The Department of Health has estimated that 20 to 23 per cent. of independent sector residential homes, 12 per cent. of independent sector nursing homes and 55 per cent. of local authority residential homes would not meet the draft space and amenity standards; and that 53 per cent. or more of nursing homes would not meet the draft staffing standards. Even those alarming figures ignore the impact of economics, considering only the possibility of meeting the standards by reducing the number of places and, thus, income; in the real world, in many cases, reducing the number of places would drive the home out of business.
Regional and local variations are even more striking. In the Southampton area, more than 50 per cent. of capacity in the residential market will be non-compliant. In Hampshire, a survey has shown that, overall, 71 per cent. of nursing homes and 68 per cent. of registered care homes would be non-viable. The position is worse in Portsmouth, where 88 per cent. of registered care homes and 65 per cent. of nursing homes claim that they would be non-viable if the draft standards were imposed in full. In the constituency of the other Minister of State, Department of Health, the hon. Member for Southampton, lichen (Mr. Denham), 82 per cent. of registered care homes and 85 per cent. of nursing homes would be non-viable. In Blackpool, a staggering 91 per cent. of care home provision would be non-compliant with the 10 sq m standard; and I am told that in Blackburn that figure is an astonishing 100 per cent. of provision.
The problem is serious and, unsurprisingly in view of the figures I have just read out, it has provoked—in a masterly understatement—a reaction in the market; actually, it has produced something nearer to panic. Lenders have withdrawn; many potential sellers of homes have found that they are unable to sell their property because the buyer cannot know whether it will be compliant with a standard as yet undetermined and unpublished; potential new entrants are being denied access to capital, because no one knows what the final standards will be; and the presence of distressed sellers unable to sell causes a downward spiral in values. The overall result is chaos and blight in the market.
New premises have to be larger to comply with the regulations, and someone selling a business will, in effect, lose his registration. Will a new business taking over the same premises with a new registration come under the regulations for new premises, or those for old premises?
That brings me back to my description of the Minister as a cyclist furiously peddling backwards. The concern that my hon. Friend expresses was circulating widely in the marketplace until very recently. However, the Minister recently wrote to me specifically confirming that transfer of ownership will not constitute a trigger event that would cause a change of status requiring the larger room size standard.
To be fair, as I always try to be, the Minister has been doing his best to stem the tide of speculation that has been rising for the past year and causing considerable harm; he has been engaged in a damage-limitation exercise, drip feeding pieces of information as and when possible, in an attempt to dampen expectations of the final standards. However, the fact remains that he has been unable to make a definitive announcement of either the standards in the key areas that are the source of disruption in the marketplace, or, most critical of all, the time scale for compliance. To be frank, those are the only two pieces of information that will calm the market.
The story becomes worse, degenerating into Whitehall farce. At the beginning of the Standing Committee's consideration of the Bill, the Minister said that he should be able to
share with the Committee some of the detailed thinking—[Official Report, Standing Committee G, 6 June 2000; c. 29.]
on the standards by the time that Committee reached consideration of the relevant part of the Bill. At that time, it was common knowledge that negotiations were being held with providers of residential and nursing accommodation about the detail of the most contentious remaining issue: room size. As the Committee made progress, hon. Members were delighted to be invited to the Department of Health, there to partake of the largesse of Her Majesty's Government and to look at a little display showing what the different room size options meant in practice: helpful plastic cut-outs had been laid on the floor and some plans prepared by NHS Estates were hung on the wall.
That lunch set alarm bells ringing in the minds of some, because the plans clearly showed that the area of the room occupied by the sweep of the door as it opens—that arc—was to be excluded from the calculation of usable space, as were any en-suite bathroom facilities. I questioned the Minister in the Committee that same afternoon; he replied that it had always been intended that only usable space would be measured. I and people outside took that as confirmation that the area swept by the opening door and the en-suite bathroom would be excluded.
I am happy to say that the Minister has since made matters clear in correspondence, which I have faxed on to everyone I thought might be interested. He has stated that it is not now the Government's intention to exclude the door-opening area and en-suite bathroom facilities when calculating usable space. I am delighted to hear that; otherwise, we would have faced the absurdity of care home owners who two years ago had spent large sums installing en-suite bathroom facilities—as one owner that I met had—being forced to take them out to comply with the minimum standard. That would have been bureaucracy gone mad, especially as surveys consistently show that the facility most valued by residents in care homes is an en-suite bathroom.
I am somewhat reassured by the letter my hon. Friend has apparently received from the Minister, but does he not agree that it is only right that such an assurance should have been forthcoming, given that, otherwise, the Minister would have been implying that en-suite bathrooms did not constitute usable space, which would have been bizarre, even by the standards of the current Government?
My hon. Friend is right. My point is that the process followed by the Government, if it were intended to introduce workable standards in an orderly fashion without damaging the market, has failed. Instead, that process has resulted first, in the breakdown of the negotiations that the Minister expected, wrongly, would reach enough of a conclusion to enable him to make an announcement to the Standing Committee; and secondly, in a lack of clarity about issues such as whether or not en-suite bathrooms and door-sweep areas are to be included. I am merely speculating, but, as the Minister makes announcement after announcement in an attempt to reassure the market, it strikes me that, in his efforts to make the arrangements workable, the Minister is having, time and again, to overrule civil servants who have led him seriously astray and left him with a system that would be unworkable and unaffordable.
We still have no definitive answer to clarify the mystery of what the minimum acceptable room size will be. Similarly, we do not have a time scale for compliance in existing properties. We are still in a mess. I do not pretend that the new clause will solve all the problems. Clearly this is a matter of process rather than one of legislation. However, I believe that the new clause would lead to cleaner, better, more informed and more transparent processes for arriving at national minimum standards. It would ensure that the Minister had all the relevant information. To put it bluntly, he would be able to see the size of the bomb crater that he would create in his own backyard before he published the draft standard. There would then never be a danger of disrupting a market by allowing rumour and speculation to get a hold.
Critically, the new clause will provide for proper parliamentary scrutiny of these most important parts of the regulatory system. I suspect that my hon. Friends will agree strongly with me that it is outrageous that a key element of the Bill, which could destroy people's businesses and livelihoods, should lie outside and beyond the scrutiny of Parliament.
I hope that the Minister will be able to give us some reassurance. Perhaps he will be able to tell us when he will make a definitive announcement, and what the time scale will be for compliance with the definitive room size that he determines. Of course, he will tell us that he is still in the process of consultation, and we have no objection to that. Indeed, it is valuable. However, we know that the Department can act when it has to. It managed to consult 12 million people in its so-called national health service survey in a fortnight. Apparently, it cannot talk to those responsible for about 17,000 care homes in much less than a year so as to get them on board and understand their responses to the consultation process. Meanwhile, individual owners of care homes and residents—those who live in fear of what will happen to their homes, many of them having gone into them expecting to live out the remainder of their lives there—are suffering from blight. Repairs are not getting done, and extension plans are being put on hold. The system has degenerated into chaos.
It is easy, tempting and convenient for government to express national minimum standards for care homes in terms of what is easily measurable—for example, the size of a room, the number of staff, the number of choices on a menu and the number of square metres available per resident in the day room. I have serious doubts about that, which I know are shared by other hon. Members on both sides of the House. Are we measuring what matters or what is easily measurable? What matters to those who are being cared for is the quality of care being delivered. The danger of introducing prescriptive national minimum standards is the elimination of choice and diversity.
It seems self-evident that if there is a given income—usually provided by a local authority—for housing a resident, it can be spent in several ways. For example, a larger bedroom may be provided, but there may be smaller areas of communal accommodation. Smaller rooms might be provided for both purposes, but there may be a vastly superior menu. There might be smaller rooms but a much higher staffing ratio, or much better qualified staff. There should be choices because different residents will have different needs. Someone who has limited ambulatory capability—in other words, someone who cannot walk about—will not have much use for elaborate day-room facilities. Someone who is active and sprightly may have little need for a large bedroom. It seems self-evident that there should be no one set of prescriptions to govern all the accommodation in the marketplace. That would have the effect of eliminating choice still further.
The new clause would improve on clause 23. It would ensure that future proposals for new national minimum standards were better informed. It should help to avoid shambles such as those created by the circulation of "Fit for the Future?" Crucially, it would allow for proper parliamentary scrutiny of these vital national minimum standards, which have a huge impact on individuals and on the public policy agenda.
I am listening carefully to what the hon. Gentleman is saying, and he is setting out his case clearly. Will he confirm what I think I heard him say? Is he saying that there should not be a national room-size standard for residential or nursing care homes?
I questioned whether there should be rigid criteria which reduce choice and—[Interruption.] The record will show what I said. I shall clarify what is in my mind and what concerns me. The Minister knows of my concerns because he has heard me express them before. I believe that different people have different needs and different wants. We are talking about people, not statistics. There needs to be enough flexibility in the system to cater for people's diverse needs and wants.
In an ideal system, we could have 12 sq m rooms for everybody, and payments high enough to allow care homes to provide additional services. However, if resources are constrained so that we are forced into choices, surely it is better not to lay down certain criteria and state that they will apply to all care homes, but to lay down some variable geometry. That might be sensible. Some care homes might provide better bedroom accommodation and fewer communal facilities. Others might provide better communal facilities and less bedroom space. One category of home will appeal to one category of resident and another type will appeal to a different category.
I understand what the hon. Gentleman is saying about the need for discretion in terms of a possible national minimum room-size standard. I shall take up his argument when I respond. However, does he think that there should be a national minimum room-size standard, perhaps subject to discretion?
The Minister knows very well that minimum standards are required by local authorities, and that they vary from area to area. I can see advantages in having national minimum standards—but we must regard them as the minimum. As I said in response to an intervention from my hon. Friend the Member for South Dorset (Mr. Bruce), if we introduce minimum standards we run the danger of their becoming the normal standards.
If we introduce minimum standards at a level low enough to allow, within the resource envelope available, some discretion to provide above-minimum standards in other areas, we must always avoid the minimum standard becoming the norm. Some sort of variable geometry, which recognises the reality of a trade-off and takes into account the fact that different residents will have different needs and wants, is the way forward.
I wish to clarify the hon. Gentleman's exposition. He is saying that there is a clear link between quality and costs, and that standards may need to be lower to accommodate the current financial envelope. Which is his preference? Is he saying that we should increase resources to enable a higher standard to be achieved, or that we should lower the standard?
The hon. Gentleman misquotes me. I was saying that if we want room for discretion—and if we want diversity there must be room for discretion—the minimum standards will have to be set at a level which leaves some resource in the hands of the provider, so that he can add to that minimum provision in one area or another. If the minimum standard in each area where a minimum standard is set—room size, staffing ratio, meals—is at a level which, together, consumes all the resource available to the provider, there is no possibility of diversity and variation between providers, and the consequence of that is no choice for those entering residential care.
Amendment No. 38 seeks to leave out from the powers to make regulations a reference to imposing
requirements as to the financial position of an establishment or agency.
The Bill seeks to level the playing field between public and private sector providers. It is unlikely that anyone will lay down requirements as to the financial position of a county council or unitary authority before it is allowed to operate or register a care home. Therefore, the provision allowing the Minister to set regulations regarding requirements as to financial position can only be taken to be addressed to private sector providers, and to open up again a distinction between private and public sector providers, which the Government have sought to close.
I am not sure what the criteria will be. The Minister knows that a considerable number of care and nursing homes operate in receivership. That, I am afraid, is the nature of the pressures in the marketplace. The Minister assured me in a letter that the provision that we seek to omit, which concerns requirements as to financial position, would not be used to disallow the registration of an operator merely because it was operating in receivership.
One's financial position cannot get much worse than operating in receivership, so I am not sure quite what the Minister has in mind. However, the provision will act as a barrier to entry. It will stifle new entrants to the sector if they are required to show a financial robustness which, typically, start-up businesses may not have. That would be a massive own goal for the Minister because competition among providers is essential to him in ensuring good quality and sensibly priced provision.
We also run up against the problem of who will make decisions about adequacy of financial position. By and large, the people doing the inspecting, registering and regulating will be people who know about the care and accommodation of frail elderly people, not accountants, and that is a major problem.
Amendment No. 39 will not get the attention that it deserves, but it is important, as it would enable the Minister to make regulations to
make provision in the case of an establishment providing cosmetic surgery
the nature of statements that may be made with regard to the services provided; and…the titles that may be used to describe persons carrying on, managing or employed at such an establishment.
The first problem arises because there are many well-documented examples of misleading claims being made for cosmetic surgery and premises providing cosmetic surgery. The second provision is there because there is hard evidence that in some cases, people have been seen by, and indeed treated by, people who describe themselves as consultants, but who are sales consultants,
not medical consultants. Whether or not the Minister is prepared to accept the amendment, he will share the worry about the fact that that is going on. Those are areas of concern, and the amendment is simply intended to highlight them.
I add my support to the important new clause moved by my hon. Friend the Member for Runnymede and Weybridge (Mr. Hammond). However, I warn my hon. Friend that I have a grave reservation about part of it.
As my hon. Friend said, minimum standards are a fundamental part of the Bill and of its impact not only on care home owners in the private sector but on local authorities that still own and control residential homes.
As I said in an intervention on my hon. Friend, there is grave concern among many local authorities, not least Essex county council, about the bills that they will have to pay to upgrade their homes to a decent standard. For a variety of reasons, over the years some authorities have fallen behind in renovations and improvements, to the point where the cost of complying with any minimum standard issued by the Department of Health would be excessively high—and that is before we even come on to the issue of the quality of care. The quality of care could be, and in many cases will be, infinitely better than the quality of the buildings in which people may live.
Therefore, I am concerned about who will finance local authorities' need to improve their homes. As I have said, Essex county council has a real problem. It already spends significantly above its standard spending assessment on social services. As the Minister will know, there is no relaxation or abatement in the demands that are being put on social service budgets by the needs of the populations that they and local authorities have to meet. To have to find on top of that a significant amount of money to enhance their residential homes stock will be an onerous burden.
Has the Minister made any provision for helping local authorities through central Government grants to take that into account? Many hon. Members whose local authorities are concerned about that would be grateful if the Minister could deal with it when he replies.
Given the financial constraints that local authorities face, does my hon. Friend agree that those authorities would welcome from the Minister tonight a clear idea of the timetable within which they will be expected to achieve the minimum standards that he favours? Does my hon. Friend also agree that it is incumbent on the House in taking forward the Bill properly to distinguish between desirable standards and those that are essential to human safety?
I am grateful to my hon. Friend for raising two crucial points. I hope that the Minister listened carefully to my hon. Friend's point about the timetable that the Government expect local authorities to use to bring the physical structure of their residential homes up to the standards required. With regard to the quality of care, there is probably no problem in the vast majority of residential homes.
My hon. Friend's second point is critical. It would be desperately perverse if residential homes were penalised because they were way above the minimum standard. By definition, the service that they provided would be too good according to the criteria of the bureaucracy entailed in establishing any minimum standard. I hope that the Minister will bear that in mind. It would be terrible if care home owners were penalised because they had enhanced and improved, or were seeking to enhance and improve, the quality of their service way above the minimum standard
I agree with my hon. Friend, but does he agree that the unintended effect of minimum standards could well be that local authorities get out of residential provision entirely, and such provision then becomes a private sector monopoly?
That is a logical conclusion to draw from the situation facing several local authorities. Particularly in the case of Essex, unless the Government are exceptionally generous in providing ring-fenced additional money to help authorities deal with their residential home stock, local authorities will have to sell those homes into the private sector. If they do not, the homes will not reach the minimum standards that the Government plan to establish. Presumably, they would then have to be closed down, and that would be intolerable.
I do not entirely agree with the conclusion of my hon. Friend the Member for Beckenham (Mrs. Lait) that it would necessarily be a bad thing for local authority owned residential homes to move into the private sector. There is a great deal to be said for that, particularly in view of the problems that the public sector has faced for many years because the financial resources have not been made available to it by central Government to allow it to keep pace with the standards and quality of private homes.
I echo the comments of my hon. Friend the Member for Runnymede and Weybridge about minimum standards. When Governments start laying down minimum standards, there is a danger that an attitude of mind develops, and that what began as a minimum becomes set in stone. The troubles multiply as people try to enforce the minimum standards. If they have got it wrong in any way, tremendous problems can result for the care home owners providing residential care and nursing care to our citizens.
Similarly, as my hon. Friend pointed out, there is considerable uncertainty about what the standards will be and how much parliamentary scrutiny the process of establishing them will receive. I assume that the Government intend the standards to be a movable feast as changes are needed in the light of experience and developments in the provision of residential care and nursing care for members of the community.
There is one aspect of my hon. Friend's new clause about which I have serious concerns. I do not criticise my hon. Friend lightly, because he does not deserve criticism, but part of his new clause suffers from what may tactfully be described as careless or ambiguous drafting. I refer to subsection (4)(b)(ii).
Under subsection (4), the Secretary of State shall
consult such persons as he considers appropriate
request the Commission to give him advice as to the likely impact of the proposed statement or the proposed amendment
on, according to subsection (4)(b)(ii),
the cost of supplying such services in accordance with the statement of minimum standards.
As I suggested to my hon. Friend in an intervention, the reference to the cost of supplying services could mean one of two things, or possibly both. It could mean the cost to the supplier of the service—the owner of the care home—or it could mean the cost to the person using the service.
I do not want to engage my hon. Friend in a detailed grammatical debate, but I feel obliged to defend myself. It seems to me that the cost of supplying a service can be incurred only by the supplier. The cost of purchasing a service will be incurred by the purchaser.
I thank my hon. Friend. His knowledge of the construction of the English language is probably superior to mine. I do not want to continue to argue with him, and I accept his clarification, but that has implications for the person to whom the service is supplied. There should be a sub-paragraph (iii) referring to the cost to the user of the service supplied in accordance with the minimum standards.
I have good reason for considering that to be important. The sheer horror of the situation will become apparent only next Tuesday. I expect that the Minister saw or had drawn to his attention the main story on the Channel 4 news last night. I do not know how many of my hon. Friends saw it. The subject, which has a serious impact on many hundreds of thousands of elderly people and their families, was the leak of what the comprehensive spending review to be published next Tuesday will say about long-term care, its cost and how that will be met.
As the Minister will remember, although he was not at the Department of Health at the time, the former Secretary of State, when announcing the royal commission, said that it must complete its work swiftly. The original timetable set was 12 months from its inception in the summer of 1997. Because of the sense of urgency and the rhetoric, we expected the Secretary of State to consider the recommendations and make an announcement to the country fairly swiftly.
The 12-month period would have ended in July or August 1998. It is now July 2000 and we have not heard a single word from the Department of Health about how it is to move forward. I understand from the Channel 4 report last night—this will have a direct bearing on new sub-paragraph (iii), which I urge my hon. Friend to include in new clause 4—that the state is to pick up the bill for nursing care in nursing homes. The Government would be absolutely right to make such a decision. The difference between what the health service should provide and what the individual should pay for has become increasingly blurred as the National Assistance Act 1948 has become more and more irrelevant to society's changing needs over the past 52 years. If that is what the Government intend to do, it is a step in the right direction.
The powerful case that my hon. Friend is developing seems to be an argument in favour of new clause 4. The Minister may be reluctant to accept subsection (4)(b)(ii) because the only advice that the Secretary of State will wish to take will be that of the Chancellor, who will tell him what he can and cannot spend. The Secretary of State has no interest in independent, possibly awkward, advice.
My hon. Friend makes an extremely pertinent point in his correct analysis of the thinking in the Department of Health. He identifies the straitjacket within which Health Ministers must operate. They have received different moneys from the Chancellor for hospital and medical care, and I imagine that the Chancellor thinks that enough is enough.
As Channel 4 said last night, pensioners will now be hit with a double whammy—the miserly 75p a week increase in pensions this April and the announcement—
Order. These matters are worth mentioning given that some people live on fixed incomes or are in long-term care, but the hon. Gentleman must not make a meal of them.
I am grateful for your guidance, Mr. Deputy Speaker. In conclusion on that point, then, I feel that the new clause should include a subsection (4)(b)(iii). The Government will apparently announce on Tuesday that they will not fund long-term care. They may raise the £16,000 threshold, but will still expect families to sell their homes to pay for long-term care. That takes us to the need for an analysis by the commission or by those whom the Secretary of State consults of the costs of the minimum standards to the users of the services. Those costs must include the costs to families or individuals for living in a residential or nursing home.
We shall not know until Tuesday whether Channel 4 was accurate, but if it was, there is even more need for a change to new clause 4. It is, of course, too late to amend the new clause tonight. I shall support my hon. Friend the Member for Runnymede and Weybridge if he wishes to pursue his new clause, but, without being unduly unfair to him, repeat that it is a pity that my additional proposal is not in the new clause.
I support the new clause, which provides a basis for exploring the Government's attitude towards national minimum standards and the process by which we have reached our present point. The Bill is primarily a vehicle for a series of regulation-making powers, giving the Minister powers to redefine and rewrite large chunks of the Bill. It also gives the power to introduce minimum standards in a range of differing care settings, and we must be clear what the role of the House will be, not only in passing the Bill, but for the future when standards are introduced.
The Standing Committee explored in some detail an issue that we must revisit—the need for a clear and transparent process that gives the House and the other place an opportunity to debate both the statutory instruments that give effect to national minimum standards and those standards themselves. As we know from "Fit for the Future?", the standards will contain an awful lot of detail, and many devils lie in the details, which has raised much concern outside the House.
The debate about national minimum standards is at least in part motivated by understandable anxieties among care home owners, and all Members will have had representations from them. It is important to record, however, that minimum standards exist for the safety and security of the consumers of the service, and act as a guarantee for them. That should be our starting point in constructing any minimum standards. I entirely accept that legitimate concerns exist about minimum room size, staffing ratios and so on. We must address those questions, but other standards—identified in "Fit for the Future?"—are welcome and should be implemented at the earliest opportunity.
The debate about minimum standards will of necessity be better informed if we consider what has happened to date rather than talking only in the abstract about future domiciliary care, day care or any other type of care. It is crucial to bear in mind that a key element underlying minimum standards must be the principle of maintaining the independence and dignity of people in care. We must consider how to provide choice and how to ensure as much control as possible for the individual. "Fit for the Future?" covers such issues as social activities and other measures of quality that ought to be covered by minimum standards. I do not see room size as an adequate proxy for quality.
That said, we must recognise that standards change over time and cannot be absolute. My generation may expect something different in a care home from what a future generation will expect. Perhaps there are differences in what those living in care homes expect. Those differences should be borne in mind. Equally, on choice, someone living in a care home may have chosen a particular location because it is a listed building with unique features. That may be the very reason why that person has chosen that home, and we should not lose sight of that fact as we implement standards. It would be wrong to drive out of business a home in which people are receiving the quality of care and life that they want just for the sake of complying with a minimum room size standard.
The regulatory impact assessment attached to "Fit for the Future?" said that 7,000 additional nurses would be required to give effect to the national minimum standards. We know all too well from questions and debates that the Government are struggling to recruit and train enough nurses to fill the 17,000 vacancies in the national health service. To suggest that we can find another 7,000 beggars belief. As we consider "Fit for the Future?" and the emerging national minimum standards, we should be given clear timetables showing when consultation will end and when ministerial deliberations will be concluded. That would provide the maximum possible clarity on the minimum standards, which the industry—home care, day care or care homes—wants.
I agree with the thrust of what the hon. Gentleman says, but may I focus his attention on Government amendment No. 61? Given that clause 22, which will be amended under that amendment, contains no fewer than 10 subsection and 34 paragraphs, what precisely is the merit of, or the need for, Government amendment No. 61?
That is an interesting point. When the Minister responds, we may discover that the Government are attempting to respond constructively to concerns that were expressed in Committee by the hon. Member for Runnymede and Weybridge (Mr. Hammond). The hon. Member for Buckingham (Mr. Bercow) may have to wait to listen to the Minister's gracious comments on those matters.
In Committee, several hon. Members expressed concerns about the impact that standards would have on the supply of places in care homes, but the availability of domiciliary care is also important. The Government need to accept that there is a crisis of confidence in the care homes sector. How many homes are closing in any given week may be a matter of dispute, but I have heard that one a week, possibly more, are closing. They may be closing for the perfectly legitimate reason that they do not provide a good standard of care. Such homes should be closed, but many others are closing because they cannot provide a decent rate of return on the investment that they have made in their businesses.
Fees have not kept pace with costs. That key problem predates the Bill and national minimum standards, but the uncertainty about those standards has added fuel to it. As the hon. Member for West Chelmsford (Mr. Burns) has said, local authorities are under financial pressure on the provision of social care and the increasing demands that are placed on them. As a result, they must be ruthless in exercising their role in purchasing care places. They are undoubtedly holding down fees as much as they can. There have been some increases, but they have not been adequate in many cases.
The link between quality and the cost of meeting the standards is not straightforward. The equation is more complicated than that, but there is a link. If the standards are driven up—I would entirely applaud and support that—it must be recognised that, at some point, that will have a bearing on the fees that need to be charged and the incomes that need to be provided. We shall expect care assistants and others involved in domiciliary care and care homes to receive more training to meet the new national minimum standards and to ensure that adequate numbers of staff are registered with the commission.
All too often, better trained staff look for better paid jobs. Care assistants in care homes are not paid decent salaries. They can get better pay stocking the shelves at the local supermarket. If we do not recognise that problem, we shall store up problems for ourselves. There will be a flight from the sector as a result of improving the qualifications of its staff because they can get better jobs in other aspects of social care, where their skills are more fairly rewarded.
The hon. Member for West Chelmsford, who is no longer in his place, rightly expressed concern about the link between improvements in standards and the potential increase in costs to the consumers—those who live in care homes. He linked that to reports of yet other leak about what the Government have in mind for long-term care and the relative distribution of the consequent costs between the state and the individual. We shall have to wait for the White Paper, rather than the comprehensive spending review, to find out whether the leak is true.
If "Channel 4 News" is to be believed, I hope that the Government, even at this late stage, will give further thought to what the Prime Minister said before the general election. He said that he did not want to live in a country where old people had to sell their homes to pay for their care. The many hundreds of thousands of people who thought that the Government would take serious action on that feel betrayed and let down by the Government in that respect.
We shall have to wait until next week to find out whether the comprehensive spending review will provide a true idea of exactly what sums will be allocated to such matters. Time will tell, but I fear that we might have to wait until the White Paper is published, I hope, at the end of the month.
If the hon. Member for Runnymede and Weybridge decides to press the motion to a Division, we shall support him. New clause 4 proposes an entirely right and proper structure in which the Government should discharge their responsibility to produce minimum standards. The House should have a clear role in scrutinising those standards. Its role should involve much more than approving a statutory instrument under the negative procedure. The affirmative procedure should be used, so that we can consider not only the regulations, but the details behind them. I hope that the Minister will be able to respond positively.
I do not want to fall out with my hon. Friend the Member for West Chelmsford (Mr. Burns), but I congratulate my hon. Friend the Member for Runnymede and Weybridge (Mr. Hammond) on his skilful drafting of new clause 4. I found his arguments entirely convincing and hope that the Minister will accept new clause 4.
The Minister will know from our deliberations in Committee, that I feel very strongly about such matters. There are a huge number of residential and nursing homes in Southend. That should be no surprise because it is well known that Southend is the finest seaside resort in the country and elderly people are flocking to the town because the movement of the Thames estuary is extremely good for people's breathing. That is why our residential and nursing homes are so popular, especially those in Southend, West. I regularly visit those homes and I am in constant contact with the people there.
The Minister takes a different view, but of course Conservative Members support national minimum standards. That is well understood, but he is saying "Trust the Government." I, for one, do not trust the Government. I am very concerned about those standards. As the Minister knows only too well, this is not about the curtains, the en suite facilities or similar matters, but about the love and care that many elderly people in those homes are given by the home owners. I baulk at using the expression "running their business", but it is not good enough for the Government to expect the owners of those homes to do whatever the Government want without proper and due consultation.
I take my hat off to the Minister; he was kind enough to invite the Committee to 79 Whitehall to look at the different rules and regulations on which he was consulting. However, I ask him to consider new clause 4 carefully because it would be a tremendous fillip to all our residential home owners if it were accepted. He knows only too well that the Independent Healthcare Association, Leonard Cheshire, the National Care Homes Association, Help the Aged, William Laing and others have all been somewhat concerned about the overall tenor of the minimum standards.
Perhaps the Minister will tell us that he has managed to placate those concerns in the past few days, but the magazine, "Caring Times" carried out a survey to discover the effects of "Fit for the Future?". That survey should be of concern to the Minister because more than 50 per cent. of respondents said that they could be obliged to close due to bankruptcy.
We all know from our constituencies that the national health service is in crisis. My goodness, I experienced that myself at St. Thomas's accident and emergency unit in the wee hours of the morning on Monday, learning at first hand how the NHS is in great difficulty. Many of our constituencies are experiencing bed blocking. We have 56 people in hospital at the moment—
Of course, Mr. Deputy Speaker.
A residential home proprietor in the north-east said of minimum standards:
Basically, this is another idea developed by those who do not know and never ask.
A nursing home proprietor in Scotland said:
We are negotiating a loan to improve our facilities and have been experiencing difficulties with lenders directly due to the possible implication of these proposals. We are now having to alter plans and hope this will satisfy lenders. This will increase our loan and without an adequate increase in fees, budgets will be very tight. These are onerous standards, financially wasteful and will threaten small establishments.
That is why we need the Minister's reassurance that there will be due and proper consultation. For that reason, I am an enthusiast for new clause 4. The Scottish proprietor continued:
The larger homes can easily absorb costs. Is this the future—the large pies controlling the care sector?
That is another concern.
I do not want to cause controversy in Southend, West, but when I go round residential nursing homes and see chintzy curtains and plush facilities, I am not taken in for a minute. I am concerned about the quality of care. I have first-hand experience because next door to me is an excellent residential nursing home called Cherry Croft, and I pay tribute to the loving care and nursing that it gives to many of my constituents. However, I also have first-hand experience of another nursing home outside the area that I represent, although I shall not go public on that as I am trying to deal with the matter tactfully at the moment. One would think that the home is the cat's whiskers, but I happen to know that the care and attention that it provides are somewhat disappointing to say the least and there have been unfortunate outcomes.
Recently, I had the privilege of visiting a small home with only eight beds in my constituency. It is struggling, and it told its Member of Parliament that it is struggling because it is concerned about minimum standards. It is looking for certainty, as it wants to plan for the long term. The people there love their residents, but they think that, unless there is the certainty that new clause 4 would provide, the home may have to close, adding to the 50 per cent. of homes that believe that they will have to close.
A residential home owner in the midlands said:
We've just spent a fortune upgrading to existing standards. If new standards are introduced, we would have to close. Residents would lose their homes, staff would lose their jobs and we would be devastated.
That is happening right this minute in the midlands. Linda Nazarko, the director of the Registered Nursing Homes Association, said:
Standards must be meaningful, and concentrate on quality, not merely on physical standards… The RNH is 100 per cent. committed to quality care but have been saying for some time that it is unjustifiable to raise physical standards any further in a climate of decreasing resources.
That is a different argument, but we should not completely reject the points that she has made.
A residential home proprietor in the south-west said:
We comply with all the current regulations. I have difficulty comprehending how an increase in bedroom size can have that great an effect on the care and wellbeing of our residents. The vast majority spend no waking time in them whatsoever. We employ more care staff per week than the basic requirement, our staff are comprehensively trained and care is of the highest standard. These standards would bankrupt us. Eighteen residents would be homeless. Twenty-four staff, many of them breadwinners, would be unemployed.
Another residential home proprietor in the south-west said:
In our experience, most of our residents have used the bedroom only for sleeping in at night and a few for a nap after lunch.
Recently, I attended a reception at which home owners gathered to debate the national minimum standards and I say to my hon. Friend the Member for Runnymede and Weybridge that I found them overwhelmingly enthusiastic about the proposals in new clause 4.
I have received a letter from the Norfolk Residential Care Homes Association, which is very concerned about minimum standards. It says:
We are seeing Home closures in Norfolk which result in residents being transferred up to 20 miles away
and that is
a problem for relatives and friends for…maintaining contact
with their loved ones. I have also been contacted by the Brighton and Hove National Care Homes Association. It, too, is very concerned and I am advised that 17 of every 20 care homes for old people in Brighton and Hove—85 per cent.—will close as a result of the minimum standards. The councillor dealing with this matter said that the Conservatives were scaremongering and that the closure rate would be only 30 per cent. That is no comfort to the good people of Brighton and Hove.
I ask the Minister to consider carefully the arguments made by my hon. Friend the Member for Runnymede and Weybridge. I support minimum standards—they are desperately important to the living standards and living conditions of elderly people—but where is the measure for the love, care and devotion that many home owners give to residents? An overwhelming number of residents have no relatives and might have lived in a home for 10, 15 or 20 years. They may not have en suite bedrooms or rooms that meet the standard that the Minister has in mind, but none of that is important to them. They do not regard home owners as wicked capitalists. In fact, morning, noon and night, they put their hands in their pockets to make sure that standards for residents are decent and they also celebrate residents' birthdays and provide all sorts of entertainment. None of that is recognised in the minimum standards.
I know that the Minister has the best intentions, as he showed in Committee, but we need to be convinced that the minimum standards are in the best interests of residents. I hope that he will reconsider new clause 4.
I am sure that the motives behind "Fit for the Future?" were right, but it has caused great concern, mainly because it does not necessarily address the issue of fit for the purpose. I have been struck by the complaints. Small care home owners are concerned about rigidity—the bricks, mortar and buildings—and are relaxed about the excellent quality standards for care and staffing. Conversely, the larger providers—those quoted on the stock market which run large granny factories—were relaxed about the bricks and mortar, but extremely concerned about meeting the staffing levels and qualifications. There is no doubt that care is more to do with staff than with buildings.
It is right that the Government should set minimum standards for staffing and training, which are vital. We should commend the Minister for his efforts in that area. However, minimum structural standards for care homes could be best addressed through ministerial guidelines to the commissioning agents. Different homes suit different people. That is not only because different personalities are happier in different settings, but because their physical, emotional and social needs may be different.
It would be sad if a fixed ratio were imposed on the double occupancy of bedrooms, as opposed to single occupancy. Even in a place such as the Isle of Wight, there are cultural differences. In one part of the island, it is the norm to share. In other parts, everyone wants an en suite room and not to talk to anyone else. We must accept that that is part of giving residents choice.
The issue of communal facilities has been mentioned. In nursing homes dealing mainly with post-operative conditions, people spend a great deal of time in their bedrooms. They do not want to go out, mix or sit in a dining room. They want to rest in peace and quiet and then go home. If that is the business that the establishment is in, it seems unreasonable that it should be required by regulations to have facilities that it does not use.
In Committee, I supported the imposition of statutory standards by affirmative resolution, but these should be backed by ministerial guidelines which, in time, may show where statutory standards may go in the fullness of time. That will help health authorities and local authorities in their commissioning role. There is a need for standards to rise even in places such as the Isle of Wight, where we have done well at the expense of some less effective and less successful home owners. One must accept that we are dealing with a part of the business sector, and that businesses should compete. With that goes grief from time to time.
There is no doubt that what is happening to the sector is unreasonable. One of my slight criticisms of new clause 4, which is well drafted, is that it does not give a time scale for consultation. Consultation is vital. The Government consultation on "Fit for the Future?" was announced in October last year and it took until a week after Christmas before I could get copies to the people affected by it. It was difficult to get responses in within the deadline and, when people put in their responses, nothing happened. In the meantime, we have had a long period of uncertainty, which is having a detrimental effect on investment in raising standards and on those who were about to retire, but cannot at the moment.
We have rehearsed the arguments and we have heard indications of comfort, but no real comfort from the Minister. I hope that he will go further than he did in Committee.
First, I wish to explain to the hon. Member for Buckingham (Mr. Bercow) why amendment. No. 61 has been tabled. The amendment will place an obligation on the Government to consult the people and bodies whom they think appropriate before making any regulations under clause 22 and before making any significant amendments to regulations made under clause 22. In tabling the amendment we are responding to concerns raised by the hon. Member for Runnymede and Weybridge (Mr. Hammond), who raised the issue in Committee. I assured him then, and I confirm today, that it was always the Government's clear intention to consult on all the regulations made under this clause. However, I am happy to table this amendment to put the matter beyond any reasonable doubt.
I hope that the hon. Member for Runnymede and Weybridge will be pleased to see that we have actually gone further than his amendment would have required, in that we have included a requirement to consult on any substantial changes to regulations that have already been made under this clause. I hope that that will be welcomed by the hon. Gentleman and his colleagues.
We have had a wide-ranging debate about some other issues, particularly new clause 4. This is a familiar theme to those Members who take an interest in national minimum required standards. The hon. Member for Southend, West (Mr. Amess) spoke with his usual passion—if not accuracy—about the subject. The hon. Member for West Chelmsford (Mr. Burns) spoke with substantial knowledge, gained from his time as a Health Minister. I thought that his contribution was important and useful.
The hon. Member for West Chelmsford explained the difficulties that he had experienced in his own county, Essex. It is my own county, too; I lived there for many years.
It might explain a few things, but I do not think that we should go there today.
The hon. Member for West Chelmsford was explaining some of the problems that small care home owners in Essex were experiencing primarily with the room size standard. He will be aware that the problem in Essex perfectly illustrates the need for the changes in the Bill and the new laws that we are proposing. Essex county council has had a 10 sq m standard since 1991, and the council gave care home owners 10 years to comply with the standard. The hon. Member for Southend, West was moaning about the standard, but it was introduced nearly 10 years ago in his constituency and that of his hon. Friend the Member for West Chelmsford. To be fair to both hon. Members, I must say that I have no information about the extent to which the standard has been implemented by the county council and, in particular, the social services department. It may be possible for us to correspond about that.
The hon. Gentleman was concerned about the fact that the county council had never applied the standard to its own homes. In the Bill, we are creating a level playing field between the public and private sectors. I should have thought that the hon. Gentleman and his hon. Friends would at least welcome that advance.
I will in a minute. Conservative Members have taken nearly an hour and three quarters; I have spoken for four minutes.
An important point has been made today—all who have spoken made it effectively. We have tried to make it too; certainly, I made it repeatedly in response to the concerns expressed by the hon. Member for Runnymede and Weybridge in Committee. We absolutely must get the emphasis right. The quality of care must be measured accurately, and that cannot always be done with a tape measure.
Not all hon. Members—although, to be fair, the hon. Member for Isle of Wight (Dr. Brand) probably came closest to it—have sufficiently stressed the importance of room sizes as a measurement of quality. We should ask ourselves whether, if we were going into a care home, we would want to be in a small room, or in a reasonably sized room. The hon. Member for Southend, West said that some care home owners were saying, "These people do not spend much time in their bedrooms." We should bear in mind, however, that in a typical residential or nursing home the bedroom is probably the only private space for residents.
The care home owner may believe that a resident is not spending much time in the bedroom. That is an observation. It must be recognised, however, that for many people the size of the room is an important issue. I am certain that, whatever hon. Members on either side of the House may say, it would be important for us if the time arrived for us to be in care homes.
The Minister asks whether any of us would want to be in a small room. Viewing the question in isolation, everyone would probably prefer the idea of a larger room; but we cannot consider such questions in isolation. If limited resources are available, choices must be made. That, I think, is the point that some of my hon. Friends have been trying to make.
Obviously, the hon. Gentleman is right. The whole process of government and decision making in this place is about making choices. I will not pretend that we do not have difficult choices to make in setting national minimum required statements; of course we do. It would be naive to imagine that we could sail through it without having to make difficult judgments. What planet does the hon. Gentleman live on?
Of course these are difficult issues. That is why the process is taking time—that is a matter of record; it is taking time to make the right decisions, but we are determined to get them right.
A couple of minutes ago, the Minister referred to room sizes, in the plural. In the light of his earlier challenge to my hon. Friend the Member for Runnymede and Weybridge (Mr. Hammond), will he confirm that he is irrevocably committed to a single national minimum room size?
I do not know where the hon. Gentleman has been for the past 12 months or so, but he has obviously not been following this debate.
The hon. Gentleman may have been following it closely, but if he has I am surprised that he should ask such a question.
I am pleased to learn that.
We have always made it clear that we want to establish proper national minimum requirement standards, and those standards will include room sizes. My grammar may be wrong. I have been picked up on that a few times before in this place and I am sorry if I confused the hon. Gentleman, who is obviously punctilious in his use of grammar. If it is easier for him to come to terms with "room size", that is what I am talking about.
If the hon. Gentleman is as familiar with "Fit for the Future?" as he says, he will know that we are talking about the separate room-size requirement in relation to nursing homes, as opposed to residential care homes. We have postulated the possibility of a different room size for residents who are permanently in wheelchairs, for instance. I am afraid that the suggestion that we ever discussed just one figure makes me less convinced than I otherwise would have been that the hon. Gentleman was paying as close attention as he would have us believe.
Let me now deal with amendment No. 39. We consider it important for prospective patients to receive clear and accurate information about the treatment and services that are proposed. The Bill already contains scope for that in clause 22. The power that we already have, enabling regulations and standards to be produced in relation to patients information requirements, is more flexible than the power in the amendment.
The Government's response to the fifth report of the Select Committee on Health on the regulation on independent health care, produced in 1999, was that the powers in the Control of Misleading Advertisements Regulations 1988 were sufficient to control advertising. That, of course, is a matter for the Advertising Standards Authority and the trading standards departments of local authorities.
The amendment also deals with the question of the medical titles that people might use in cosmetic surgery clinics. As the hon. Member for Runnymede and Weybridge will know—he conducts his research carefully—section 49 of the Medical Act 1983 already makes it an offence for any person to pretend to be, or use the title of, a physician, Doctor of Medicine, surgeon, general practitioner or Licentiate of Medicine—I must say that in my travels across the country I have never come across anyone who has described himself as that. I think we have the right balance: there is already enough legislation to prevent such problems, and section 49 of the 1983 Act triggers liability for criminal sanctions.
Amendment No. 38 concerns the financial position of establishments and agencies. I cannot accept the amendment, which would remove a key power to ensure the protection of vulnerable people who depend on regulated care services. The purpose of this express power is simply to ensure that the establishment or agency is and remains financially viable. Would-be providers must be able to demonstrate that they have the means to run their businesses properly. Establishments or agencies providing care must be financially sound; otherwise, service users who depend on them will be put at risk.
The hon. Member for Isle of Wight rightly said that the focus of all this work should be on the consumers—those who live in residential homes. That is what the provision is about. It will, I hope, prevent unreasonable and unnecessary movements between care homes.
The principle was recognised in recent case law relating to fitness under the Registered Homes Act 1984, and therefore already forms part of the existing regulatory arrangements. In that case, the registration authority proposed to refuse registration on the ground of a lack of financial viability. The case was referred to the High Court for judicial review. As the hon. Gentleman knows, the care home owners challenged the decision. The court upheld the registration authority's view. The judgment confirmed that the consideration of the way in which it was intended to carry on the home must include the means available to provide the facilities and services.
The hon. Gentleman spoke of intrusiveness, but I think that most sensible people will see the power as simply a demonstration of common sense. Of course we need the provision in the Bill, and I would not advise my right hon. and hon. Friends to remove it.
I accept that our proposals may require commercially sensitive information to be made available to the commission, and I fully appreciate some of the concerns raised by the hon. Gentleman. However, as I told him in Committee, such information will be confidential, and the commission will have to observe high standards of security in respect of it. Not to allow the commission to be able to satisfy itself about these matters would make it harder, not easier, for it to do its job properly. That should be our yardstick.
Could the Minister clear up a point of confusion on a slightly different subject? Close care sheltered housing, quite rightly, will be regulated. However, on 14 June, in a debate on sheltered housing in Westminster Hall, the Under-Secretary of State for the Environment, Transport and the Regions, the hon. Member for Sunderland, South (Mr. Mullin), said:
The Care Standards Bill…will introduce the regulation and inspection of all types of home care provision, including that provided in sheltered accommodation.—[Official Report, Westminster Hall, 14 June 2000; Vol. 351, c. 270WH.]
Does that refer to all sheltered housing, or just close care sheltered housing?
If the hon. Lady will forgive me, I should like to look at that reference myself and confirm—[Interruption.] She is waving it at me. I cannot actually read it from here, but I am sure that we will have a chat about it in the Lobby in a minute. We tabled amendments to the Bill to make it clear what type of care homes we wanted to regulate. We do not intend to extend the category of homes currently being inspected and regulated by inspection units. We have tabled amendments to put that beyond reasonable doubt.
The difficulty is, as the hon. Lady will be aware—she has much experience in the matter—that none of those categories of sheltered housing is legally defined anywhere. Therefore, we have made clear in the Bill which care homes we think the new powers should relate to. We have tried to reassure care providers that the Bill will not widen or broaden the scope of registration. I hope that that clears up the point for the hon. Lady.
There has been substantial discussion on new clause 4 and amendment No. 2. They have led to a long discussion tonight, and the same subject led to extensive discussions in Standing Committee. New clause 4 goes to the nub of the Bill—how we intend the new regulatory system to work in practice, and the impact that it may have on the viability of some the establishments and agencies to be regulated. When debating these matters it is important that we maintain our primary focus on the benefits of the Bill's changes for the people—children, young adults and older people—who use the services that we intend to regulate.
Those people are at the heart of our regulatory reforms. It is important to know how vulnerable they are to shoddy, negligent and, in some cases, abusive care. We know that there are some operators who should not be in the business of providing care, whose performance damages the reputation of decent providers and has led to the destruction of public confidence in some areas. Our intention with the Bill is to establish a proper regulatory system that promotes good quality care services and supports those many providers—the vast majority, in fact—whom the public can rightly trust. Therefore, I want to argue against the amendment tabled by the hon. Member for Runnymede and Weybridge, both in substance and in practice. It should not be part of the Bill.
The regulations will, as it were, form the bones on which the minimum standards will be the flesh. The current system works similarly, but the main difference is that under the present arrangements there are no national standards; there are only local standards. We want a level playing field between different providers. The independent sector has been calling for national standards for a long time—a point that was never acknowledged by Opposition Members during the debate. That is what we intend to deliver, but consistency must be balanced with discretion.
In Committee, much of the debate on standards centred on "Fit for the Future?", the draft standards for care homes for older people. Through consultation, we established that nine of the 11 topic areas were widely supported. Standards cover fundamental aspects of quality of care for residents. They introduce principles of dignity, privacy and choice, and demand that residents are treated with respect by properly trained, competent and trustworthy staff. Two controversial areas—room sizes and staffing—have provoked concerted opposition from some sectors of home owners, especially owners of smaller homes, and opposition from owners in certain parts of the country rather than others. The wide variation in standards is in itself an argument for more consistency nationally.
I want to say something about resources in a minute. Labour Members still have to be persuaded that the hon. Gentleman and his friends are the right people to hand out any lectures about the level of public funding and public support for some of these important social services. His party, I understand, has something of a widening gap, or black hole, in its public sector finance policies after some of the recent announcements and U-turns by his right hon. and hon. Friends.
Of course, the hon. Gentleman will be aware—again, because of his interest in the subject—that the Government are making record resources available to finance social services. The present comprehensive spending review provided nearly £3 billion-worth of additional expenditure during this period. There will be more to come. He will have to wait for those announcements, like everyone else, but the general financial situation is a positive one for local authorities and social services, with record resources going into those sectors.
I was referring to two controversial areas that have caused legitimate concern. On staffing, I have already stated our intention to base trained nurse staffing levels on assessment of need rather than fixed ratios. That should be of considerable help to many small nursing home providers.
On room sizes, it is important to state that 10 sq m is a reasonable norm, long established and widely observed. However, to balance consistency with discretion and to try to respond to some of the concerns that many hon. Members have expressed, I am considering criteria within which some flexibility can be exercised on that standard, to allow rooms smaller than 10 sq m to remain in use. I hope shortly to be in a position to provide the House, especially hon. Members who have an interest in the matter, with a fuller explanation of what the minimum required standards will specify. However, let me make it clear that there is no intention to prevent good quality homes from continuing to operate. We want to preserve the stability of provision for residents.
Turning to the specific provisions of the amendment, the commission will have access to important information about the state of the care sector and will be able to advise the Secretary of State accordingly, but I personally do not believe that it is the commission's role to advise on standards in terms of their effect generally, or on the costs of their implementation. I believe strongly that that responsibility rests squarely with the Government. That is ultimately where it should remain.
The issue of consulting on standards was well aired in Committee. We have given clear undertakings to consult on standards and on regulations, and the latter will be laid clearly before Parliament. Draft standards will also be made available to hon. Members for consultation.
In Standing Committee last week, I extended to the hon. Member for Runnymede and Weybridge, who speaks for the Opposition on these matters, an opportunity to participate in some of the consultations on the Children (Leaving Care) Bill. I am more than happy to extend such an invitation in relation to the national minimum required standards to all the right hon. and hon. Members who speak for their parties on social services issues.
It is self-evident that no establishment or agency will be registered unless it complies with the standards, and of course the regulations; otherwise there is no point in having them. That is one other reason why the hon. Gentleman's amendment adds nothing of value or substance.
I have tried to address some of the concerns that have been raised in the debate. I do not want to go into all the nooks and crannies of the hon. Gentleman's description of proceedings in Standing Committee, but I do not think that he gave a completely accurate description of the exchange that we had on those issues.
The hon. Gentleman referred in particular to a letter that I had written him, which he said indicated that we were not going to include en suite bathrooms in the standard. There was not, and is not, any such letter. The letter dated 6 July that he mentioned referred to the door-sweep implications. I have in front of me a copy of the letter that I signed dated 6 July—I remember it clearly—and it does not refer to en suite bathrooms. My recollection is that we had an exchange on the subject in Committee. Although I do not remember the exact wording that we used, I certainly did not write to the hon. Gentleman as he has implied.
This has been a full debate. I have tried to share with the House a very important piece of information—although I am not sure that the hon. Member for Buckingham was even paying attention when I told him that we were providing for discretion on the 10 sq m standard. Perhaps he acknowledged that discretion; certainly some other Opposition Members did. Nevertheless, I hope that that discretion will send a reassuring signal for decent, good quality care home providers—whom we have no intention whatever of hounding out of the business. We need them, and we rely on them. We also want to encourage them to invest in their businesses so that they can be successful.
Does my hon. Friend accept that what he has just said is tremendously good news for providers of good-quality residential care who want to remain in business and give excellent care, particularly for older people but also for people with all types of disabilities and difficulties? Do those comments not show that the Government are listening and taking on board the views of people throughout the sector?
I am pretty well bound to agree with my hon. Friend on all those points, and I am glad that he feels that way.
We are trying not only to respond to the concerns quite reasonably expressed by the industry, but to meet the legitimate needs of our constituents. It is important that their voices are heard and their interests considered in addressing all the issues. That is the balance that the Government are trying to strike, and I strongly urge my right hon. and hon. Friends to reject this group of amendments, except Government amendment No. 61.
This has been a useful and wide-ranging debate. I am certainly glad that the Minister said that he himself had found it useful.
When I said that I had received a letter from the Minister about door-sweeps and en suite bathrooms, I was working from memory. I do not have the letter with me, and I apologise to him if I misquoted it. However, I am rather more alarmed than I was if he has not ruled out the inclusion of en suite bathrooms, as that once again raises the prospect of home owners who have installed them having to rip them out to meet a future standard.
I am grateful to the hon. Gentleman for giving way on this important point. We are certainly looking to find ways of incorporating en suite bathrooms in the room size standard that we intend to develop.
I take that to mean that the Minister has not written to me to say that he is excluding en suite bathrooms, but that that is what he plans to do.
I was disappointed that the Minister could not accept our amendments Nos. 38 and 39. He read out a great list of titles that could not be used under the Medical Act 1983. However, I did not hear him read out the title "consultant", which is the one causing particular concern. On amendment No. 39, the Minister said that financial viability was an essential attribute for a care home or an establishment, but he did not explain how it would be possible for an establishment in receivership to meet that criterion.
The debate has focused mainly on new clause 4—or rather, it has focused primarily on the standards that will be promulgated, rather than on the new clause itself. The Minister has told us that he is now investigating ways of offering us a flexible response that will allow homes with rooms smaller than 10 sq m to remain in operation. I am grateful to him for sharing that information with the House. He also said that he hoped to be able to give us more detail soon. We shall, of course, wait with bated breath.
New clause 4 itself is about the methodology for preparing and approving the statements of minimum standards, rather than the detail of the standards themselves. It is clear from this debate that our new clause 4 is an improvement on clause 23, which it would replace, and that it would allow proper parliamentary scrutiny of this very important sphere of legislation. I commend the new clause to my right. hon. and hon. Friends.
|Division No. 265]||[9.3 pm|
|Ainsworth, Peter (E Surrey)||Gorrie, Donald|
|Allan, Richard||Gray, James|
|Amess, David||Green, Damian|
|Arbuthnot, Rt Hon James||Greenway, John|
|Ashdown, Rt Hon Paddy||Grieve, Dominic|
|Atkinson, David (Bour'mth E)||Hamilton, Rt Hon Sir Archie|
|Atkinson, Peter (Hexham)||Hammond, Philip|
|Baker, Norman||Hancock, Mike|
|Baldry, Tony||Hawkins, Nick|
|Ballard, Jackie||Hayes, John|
|Beggs, Roy||Heald, Oliver|
|Beith, Rt Hon A J||Heath, David (Somerton & Frome)|
|Bell, Martin (Tatton)||Heathcoat-Amory, Rt Hon David|
|Bercow, John||Hogg, Rt Hon Douglas|
|Beresford, Sir Paul||Horam, John|
|Blunt, Crispin||Howard, Rt Hon Michael|
|Body, Sir Richard||Howarth, Gerald (Aldershot)|
|Boswell, Tim||Jack, Rt Hon Michael|
|Bottomley, Peter (Worthing W)||Jackson, Robert (Wantage)|
|Bottomley, Rt Hon Mrs Virginia||Jenkin, Bernard|
|Brady, Graham||Key, Robert|
|Brake, Tom||Laing, Mrs Eleanor|
|Brand, Dr Peter||Lait, Mrs Jacqui|
|Brazier, Julian||Lansley, Andrew|
|Browning, Mrs Angela||Leigh, Edward|
|Bruce, Ian (S Dorset)||Letwin, Oliver|
|Bruce, Malcolm (Gordon)||Lidington, David|
|Burnett, John||Lilley, Rt Hon Peter|
|Burns, Simon||Livsey, Richard|
|Burstow, Paul||Lloyd, Rt Hon Sir Peter (Fareham)|
|Butterfill, John||Llwyd, Elfyn|
|Campbell, Rt Hon Menzies (NE Fife)||Loughton, Tim|
|Lyell, Rt Hon Sir Nicholas|
|Chapman, Sir Sydney (Chipping Barnet)||McIntosh, Miss Anne|
|Maclean, Rt Hon David|
|Chope, Christopher||Maclennan, Rt Hon Robert|
|Clappison, James||McLoughlin, Patrick|
|Clark, Dr Michael (Rayleigh)||Major, Rt Hon John|
|Clifton-Brown, Geoffrey||Malins, Humfrey|
|Collins, Tim||Maples, John|
|Cotter, Brian||Maude, Rt Hon Francis|
|Cran, James||Mawhinney, Rt Hon Sir Brian|
|Davey, Edward (Kingston)||May, Mrs Theresa|
|Davies, Quentin (Grantham)||Michie, Mrs Ray (Argyll & Bute)|
|Davis, Rt Hon David (Haltemprice)||Moore, Michael|
|Day, Stephen||Moss, Malcolm|
|Dorrell, Rt Hon Stephen||Nicholls, Patrick|
|Duncan Smith, Iain||O'Brien, Stephen (Eddisbury)|
|Evans, Nigel||Öpik, Lembit|
|Faber, David||Ottaway, Richard|
|Fabricant, Michael||Paice, James|
|Flight, Howard||Paterson, Owen|
|Forth, Rt Hon Eric||Pickles, Eric|
|Foster, Don (Bath)||Prior, David|
|Fowler, Rt Hon Sir Norman||Randall, John|
|Fox, Dr Liam||Redwood, Rt Hon John|
|Fraser, Christopher||Rendel, David|
|Garnier, Edward||Robathan, Andrew|
|George, Andrew (St Ives)||Robertson, Laurence|
|Gibb, Nick||Roe, Mrs Marion (Broxbourne)|
|Gidley, Sandra||Rowe, Andrew (Faversham)|
|Gill, Christopher||Ruffley, David|
|Gorman, Mrs Teresa||Sanders, Adrian|
|Shephard, Rt Hon Mrs Gillian||Viggers, Peter|
|Shepherd, Richard||Walter, Robert|
|Smith, Sir Robert (W Ab'd'ns)||Waterson, Nigel|
|Spelman, Mrs Caroline||Webb, Steve|
|Spicer, Sir Michael||Wells, Bowen|
|Spring, Richard||Whitney, Sir Raymond|
|Stanley, Rt Hon Sir John||Whittingdale, John|
|Streeter, Gary||Widdecombe, Rt Hon Miss Ann|
|Swayne, Desmond||Wilkinson, John|
|Syms, Robert||Willetts, David|
|Tapsell, Sir Peter||Wills, Phil|
|Taylor, John M (Solihull)||Wilshire, David|
|Taylor, Matthew (Truro)||Winterton, Mrs Ann (Congleton)|
|Taylor, Sir Teddy||Winterton, Nicholas (Macclesfield)|
|Thomas, Simon (Ceredigion)||Yeo, Tim|
|Townend, John||Young, Rt Hon Sir George|
|Trend, Michael||Tellers for the Ayes:|
|Tyrie, Andrew||Mr. Keith Simpson and|
|Mr. Peter Luff.|
|Adams, Mrs Irene (Paisley N)||Clarke, Eric (Midlothian)|
|Ainger, Nick||Clarke, Rt Hon Tom (Coatbridge)|
|Ainsworth, Robert (Cov'try NE)||Clwyd, Ann|
|Alexander, Douglas||Coaker, Vernon|
|Allen, Graham||Coffey, Ms Ann|
|Anderson, Donald (Swansea E)||Coleman, Iain|
|Anderson, Janet (Rossendale)||Colman, Tony|
|Armstrong, Rt Hon Ms Hilary||Connarty, Michael|
|Ashton, Joe||Cook, Frank (Stockton N)|
|Atherton, Ms Candy||Cooper, Yvette|
|Atkins, Charlotte||Corbett, Robin|
|Austin, John||Corston, Jean|
|Banks, Tony||Cousins, Jim|
|Barnes, Harry||Cox, Tom|
|Barron, Kevin||Cranston, Ross|
|Bayley, Hugh||Crausby, David|
|Beckett, Rt Hon Mrs Margaret||Cryer, Mrs Ann (Keighley)|
|Begg, Miss Anne||Cryer, John (Hornchurch)|
|Bell, Stuart (Middlesbrough)||Cunningham, Rt Hon Dr Jack (Copeland)|
|Benn, Hilary (Leeds C)|
|Bennett, Andrew F||Cunningham, Jim (Cov'try S)|
|Berry, Roger||Curtis-Thomas, Mrs Claire|
|Best, Harold||Dalyell, Tam|
|Betts, Clive||Darvill, Keith|
|Blackman, Liz||Davey, Valerie (Bristol W)|
|Blears, Ms Hazel||Davidson, Ian|
|Blizzard, Bob||Davies, Rt Hon Denzil (Llanelli)|
|Borrow, David||Davis, Rt Hon Terry (B'ham Hodge H)|
|Bradley, Keith (Withington)|
|Bradley, Peter (The Wrekin)||Dawson, Hilton|
|Bradshaw, Ben||Dean, Mrs Janet|
|Brinton, Mrs Helen||Denham, John|
|Brown, Russell (Dumfries)||Dobbin, Jim|
|Browne, Desmond||Dobson, Rt Hon Frank|
|Buck, Ms Karen||Donohoe, Brian H|
|Burden, Richard||Doran, Frank|
|Butler, Mrs Christine||Dowd, Jim|
|Caborn, Rt Hon Richard||Drew, David|
|Campbell, Mrs Anne (C'bridge)||Eagle, Angela (Wallasey)|
|Campbell, Ronnie (Blyth V)||Eagle, Maria (L'pool Garston)|
|Campbell-Savours, Dale||Edwards, Huw|
|Cann, Jamie||Efford, Clive|
|Caplin, Ivor||Ennis, Jeff|
|Casale, Roger||Etherington, Bill|
|Caton, Martin||Field, Rt Hon Frank|
|Cawsey, Ian||Flynn, Paul|
|Chapman, Ben (Wirral S)||Follett, Barbara|
|Chisholm, Malcolm||Foster, Rt Hon Derek|
|Clapham, Michael||Foster, Michael Jabez (Hastings)|
|Clark, Rt Hon Dr David (S Shields)||Foster, Michael J (Worcester)|
|Clark, Dr Lynda (Edinburgh Pentlands)||Foulkes, George|
|George, Bruce (Walsall S)|
|Clark, Paul (Gillingham)||Gerrard, Neil|
|Clarke, Charles (Norwich S)||Gilroy, Mrs Linda|
|Godsiff, Roger||Mactaggart, Fiona|
|Goggins, Paul||McWalter, Tony|
|Golding, Mrs Llin||Mallaber, Judy|
|Gordon, Mrs Eileen||Marsden, Gordon (Blackpool S)|
|Griffiths, Jane (Reading E)||Marsden, Paul (Shrewsbury)|
|Griffiths, Nigel (Edinburgh S)||Marshall, David (Shettleston)|
|Griffiths, Win (Bridgend)||Marshall-Andrews, Robert|
|Grocott, Bruce||Martlew, Eric|
|Gunnell, John||Meacher, Rt Hon Michael|
|Hall, Mike (Weaver Vale)||Meale, Alan|
|Hall, Patrick (Bedford)||Merron, Gillian|
|Hamilton, Fabian (Leeds NE)||Michael, Rt Hon Alun|
|Hanson, David||Michie, Bill (Shef'ld Heeley)|
|Harman, Rt Hon Ms Harriet||Milburn, Rt Hon Alan|
|Heal, Mrs Sylvia||Miller, Andrew|
|Healey, John||Moffatt, Laura|
|Hepburn, Stephen||Moonie, Dr Lewis|
|Heppell, John||Moran, Ms Margaret|
|Hesford, Stephen||Morgan, Ms Julie (Cardiff N)|
|Hewitt, Ms Patricia||Morgan, Rhodri (Cardiff W)|
|Hill, Keith||Morley, Elliot|
|Hodge, Ms Margaret||Morris, Rt Hon Ms Estelle (B'ham Yardley)|
|Hoon, Rt Hon Geoffrey||Mountford, Kali|
|Hopkins, Kelvin||Mowlam, Rt Hon Marjorie|
|Hoyle, Lindsay||Mudie, George|
|Hughes, Ms Beverley (Stretford)||Mullin, Chris|
|Hughes, Kevin (Doncaster N)||Murphy, Denis (Wansbeck)|
|Hurst, Alan||Murphy, Jim (Eastwood)|
|Hutton, John||Murphy, Rt Hon Paul (Torfaen)|
|Jackson, Helen (Hillsborough)||Norris, Dan|
|Jamieson, David||O'Brien, Bill (Normanton)|
|Jenkins, Brian||O'Hara, Eddie|
|Johnson, Alan (Hull W & Hessle)||Olner, Bill|
|Johnson, Miss Melanie (Welwyn Hatfield)||O'Neill, Martin|
|Osborne, Ms Sandra|
|Jones, Rt Hon Barry (Alyn)||Pearson, Ian|
|Jones, Ms Jenny (Wolverh'ton SW)||Pendry, Tom|
|Perham, Ms Linda|
|Jones, Jon Owen (Cardiff C)||Pickthall, Colin|
|Jones, Dr Lynne (Selly Oak)||Pike, Peter L|
|Keeble, Ms Sally||Plaskitt, James|
|Keen, Alan (Feltham & Heston)||Pollard, Kerry|
|Keen, Ann (Brentford & Isleworth)||Pond, Chris|
|Kemp, Fraser||Powell, Sir Raymond|
|Kennedy, Jane (Wavertree)||Prentice, Gordon (Pendle)|
|Khabra, Piara S||Prescott, Rt Hon John|
|Kidney, David||Prosser, Gwyn|
|Kilfoyle, Peter||Purchase, Ken|
|King, Andy (Rugby & Kenilworth)||Quinn, Lawrie|
|Kumar, Dr Ashok||Rapson, Syd|
|Ladyman, Dr Stephen||Raynsford, Nick|
|Lammy, David||Reid, Rt Hon Dr John (Hamilton N)|
|Lawrence, Mrs Jackie||Rogers, Allan|
|Laxton, Bob||Rooker, Rt Hon Jeff|
|Lepper, David||Rooney, Terry|
|Leslie, Christopher||Ross, Ernie (Dundee W)|
|Levitt, Tom||Rowlands, Ted|
|Lewis, Ivan (Bury S)||Roy, Frank|
|Lewis, Terry (Worsley)||Ruane, Chris|
|Liddell, Rt Hon Mrs Helen||Ruddock, Joan|
|Linton, Martin||Russell, Ms Christine (Chester)|
|Lloyd, Tony (Manchester C)||Salter, Martin|
|Lock, David||Sarwar, Mohammad|
|Love, Andrew||Sawford, Phil|
|McAvoy, Thomas||Sedgemore, Brian|
|McCafferty, Ms Chris||Shaw, Jonathan|
|Macdonald, Calum||Sheerman, Barry|
|McDonnell, John||Sheldon, Rt Hon Robert|
|McFall, John||Shipley, Ms Debra|
|McGuire, Mrs Anne||Short, Rt Hon Clare|
|McIsaac, Shona||Simpson, Alan (Nottingham S)|
|McKenna, Mrs Rosemary||Skinner, Dennis|
|Mackinlay, Andrew||Smith, Angela (Basildon)|
|McNamara, Kevin||Smith, Miss Geraldine (Morecambe & Lunesdale)|
|Smith, Jacqui (Redditch)||Turner, Neil (Wigan)|
|Smith, John (Glamorgan)||Twigg, Derek (Halton)|
|Smith, Llew (Blaenau Gwent)||Twigg, Stephen (Enfield)|
|Soley, Clive||Tynan, Bill|
|Southworth, Ms Helen||Vis, Dr Rudi|
|Spellar, John||Ward, Ms Claire|
|Squire, Ms Rachel||Wareing, Robert N|
|Steinberg, Gerry||Watts, David|
|Stewart, Ian (Eccles)||White, Brian|
|Stinchcombe, Paul||Wicks, Malcolm|
|Stoate, Dr Howard||Williams, Rt Hon Alan (Swansea W)|
|Stuart, Ms Gisela|
|Sutcliffe, Gerry||Williams, Alan W (E Carmarthen)|
|Taylor, Rt Hon Mrs Ann (Dewsbury)||Winnick, David|
|Winterton, Ms Rosie (Doncaster C)|
|Taylor, Ms Dari (Stockton S)||Woodward, Shaun|
|Taylor, David (NW Leics)||Woolas, Phil|
|Temple-Morris, Peter||Worthington, Tony|
|Thomas, Gareth (Clwyd W)||Wray, James|
|Timms, Stephen||Wright, Anthony D (Gt Yarmouth)|
|Touhig, Don||Wright, Tony (Cannock)|
|Trickett, Jon||Wyatt, Derek|
|Turner, Dennis (Wolverh'ton SE)||Tellers for the Noes:|
|Turner, Dr Desmond (Kemptown)||Mr. Greg Pope and|
|Turner, Dr George (NW Norfolk)||Mr. Tony McNulty.|